Methodical instructions
to practical classes on propedeutic for 3-year students
of medical faculty.
Thematic module 2 Anatomo-physiology perculiaries ,methods of investigation and semiotics of the diseases in children.
Lesson 6 (practical – 6 hours)
Theme. Methods of clinical investigation respiratory organs in children. Semiotics of the disorders(cough,dispnoe) and main respiratory organs diseases in children. The respiratory distress and failure syndromes, main clinical symptoms .
Aim: To know how to evaluate a condition of a breathing system in children on the basis of knowledge of anatomy-physiological features, to show syndromes of a lesion of a respiratory organs. To know how to conduct indispensable measures on childreursery with illnesses of a respiratory organs, to afford the indispensable help at pressing condition, compliance with a pathology of a respiratory organs.
Profesional motivation of students: The system of respiratory organs from the moment of birth of the child has the features of operation, which one predetermine nature of a symptomatology of lesions. With growth (increase) of the child the morphological constitution of the breathing system will be improved not only, but also the functional capabilities increase. A pathology of respiratory organs one with widespread, that is why demands legible knowledge of microsymptoms of the lesion to begin treatments in time.
1. Students’ independent study program:
Baseline of knowledge and practical skills:
1. To collect anamnesis. (care of the patients in pediatrics, propedeutic therapy).
2. To evaluate correctly clinical symptoms and results of laboratory and instrumental examinations (physiology, biochemistry).
3. To formulate a diagnosis on the basis of information of anamnesis, results of clinical, laboratory and instrumental methods of diagnostics and prescribe treatment (propedeutic therapy, pharmacology).
Methodology of Practical Class – from 09.00 till 12.00
Theme 1. (list of theoretical questions)
1. Basic stages of embryogenesis of breathing organs.
2. Mechanism of the first inhalatioew-born.
3.To learn to conduct the inspection of organs of the respiratory system at the children of different age (review, palpation, percussion, auscultation)
4.What is a rales.
5.what is a quantity of breath rate in different age group.
6.what is a percussion picture in a case of pneumonia,bronchitis.
2. Examples of test tasks and situational tasks
1.Clear percussion sound is characteristic for:
A. Healthy children.
B. Newborns.
C. 6 month children.
D. 5 years children.
E. Adults.
2Puerile respiration is auscultated in children in the age:
A. Only before 6 months
B. Only before one year
C. from 1 months till 5 years
D. before 3 years
E. from 5 years
3At what age respiratory movements are abdominal or diaphragmatic?
A. Under 15 years
B. at 1-2 years
C. Under 6-7 years
D. Under 12-13 years
E. Under 1st months
4What lobes are the right lungs divided into?
A. Upper and lower (superior and inferior)
B. Front and back (anterior and posterior)
C. Upper, middle and lower (superior, middle and inferior)
D. Upper (superior) and middle
E. Front, middle and back (anterior, middle and posterior)
5What is dyspnea?
A. The increase of the respiratory rate
B. The distress during breathing
C. The decrease of the respiratory rate
D. The cessation of breathing
E. The increase of the respiratory depth
6The chest falls on inspiration and rises on expiration. What type of respiration is it?
A. Kussmaul’s respiration
B. Paradoxical respiration
C. Normal respiration
D. Biot’s respiration
E. Cheyne-Stokes respiration
Situation task
1.A 3-month-old infant who is suffering from acute segmental pneumonia reveals dyspnea [respiration rate — 80 per minute], paradoxical breathing, tachicardia, total cyanosis. Respiration-pulse ratio is 1\2. The heart size is normal. What are these signs indicative of?
A. Respiratory failure of III degree
B. Congenital heart disease
C. Respiratory failure of I degree
D. Respiratory failure of II degree
E. Myocarditis
2.A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show respiratoty disorders\ sound prolonged expiration, additional muscles taking part in breathing, crepitation rales on the background of the rough breath sounds. Assesment according to Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method can determine pneumopathy’s type in the child?
A. Chest X-ray
B. Immunologic investigation
C. Blood gases
D. Proteinogram
E. Blood test
3.A doctor found in a patient crepitatio indux. What is it suggest about?
A. Bronchial asthma attack
B. Acute bronchitis
C. Chronic bronchitis
D. Initial stage of croupous pneumonia
E. Final stage of croupous pneumonia
4.A doctor found in a patient crepitatio redux. What is it suggest about?
A. Bronchial asthma attack
B. Acute bronchitis
C. Chronic bronchitis
D. Initial stage of croupous pneumonia
E. Final stage of croupous pneumonia
Theme 1. Methods of clinical investigation respiratory organs in children
Task 1. To collect anamnesis in children and their relatives examine the patient with respiratory system, to establish the provisional diagnosis and to prove the clinical diagnosis .To examine the state of respiratory system according the usage of age proper models of communication:
Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years)
1.Friendly facial expression and smile.
2.Gentle tone of speech.
3.Greeting and introducing.
4. By means of game playing find a contact with a child.
5. Tactful and calm conversation with the parents of sick child.
6. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).
7. Conversation accomplishment.
Complaints and anamnesis taking in school-age children
1.Friendly facial expression and smile.
2.Gentle tone of speech.
3.Greeting and introducing.
4. Tactful and calm conversation with sick child and his/her parents.
5. Explanation of the further steps to a child and his/her parents (hospitalization, some methods of examination, etc.).
6. Conversation accomplishment.
Physical examination (palpation of lymphatic nodes, auscultation of the lungs,) should be performed with the usage of age proper models of communication:
Physical methods of examination of toddlers and preschoolers
1.Friendly facial expression and smile.
2.Gentle tone of speech.
3.Greeting and introducing.
4. Explain to the parents what examination should be performed and obtain their informed consent.
5. Find a contact with a child, try to gain his/her confidence.
6. Prepare for examination (clean and warm hands, warm phonendoscope, etc.).
7. Examination.
8. Explaining the results of examination to child’s parents.
9. Conversation accomplishment.
Physical methods of examination of school-age children
1.Friendly facial expression and smile.
2.Gentle tone of speech.
3.Greeting and introducing.
4. Explain to a child and his/her parents what examinations should be performed and obtain their informed consent.
5. Find a contact with the child, try to gain his/her confidence.
6. Prepare youself for examination (clean and warm hands, warm phonendoscope, use the screen if necessary, etc.).
7. Examination.
8. Explaining the results of examination to child’s parents.
9. Conversation accomplishment Methods of clinical investigation respiratory organs in children.
Theme 2. Semiotics of the disorders (cough , dispnoe) and main respiratory organs diseases in children
Work 2
To select main syndromes at children with the defeat of the respiratory system.
Theme 3The respiratory distress and failure syndromes, main clinical symptoms .
Work 3
To discover and estimate the displays of respiratory insufficiency in the children of different age- groups.
Work 4
To organize the proper care of children with the different defeats of respiratory organs.
Work 5 First aid at stenotic laryngitis.
5. A procedure of implementation of practical work: 9.00-12.00 a.m.
6. Seminar discussion of theoretical questions and practical work: 12.30-14.00 p. m.
7. Self activity is checked up by solving situational tasks from every theme and by answers to the tests of “Step” type, structural questions and others. (14.15 p.m. – 15.00 p.m. for the students who didn’t pass moodle)
Students must know:
1Anatomic features of the respiratory system at the children of different age.
Functional features of the respiratory system at the children of different age.
2. Methods of objective inspection of the respiratory system at the children of different age (review, palpation, percussion , auscultation).
Additional methods of research of the respiratory system and their interpretation (laboratory and instrumental: x-ray examination, bronchoscopy and bronchography, tomographyт, spirography, functional tests, analyses of bronchial maintenance).
3. Semiotics of defeat of the respiratory system at children.
4. Syndrome of respiratory insufficiency, its degrees. Syndrome of respiratory disorders.
Students should be able to:
1. To collect anamnesis and to select information which testify to the defeat of the respiratory system of child?
2. To conduct ?the objective inspection of the respiratory system at the children of different age.
To estimate the results ?of objective inspection of the respiratory system taking into account age-old features.
To select the main syndromes of defeat of the respiratory system.
To conduct the estimation of results of functional tests laboratory and instrumental researches of the respiratory system at children.
3. To give urgent help to the child with the displays of respiratory insufficiency at the different pathos’s.
Literature:
1.2 Lecture
1.3 Lecture2
2. Nykytyuk S.O.,Balatska N.I.Manual of propaedeutic pediatrics Ukrmedkniga 2005 -218 p
3. Brennemann J. A contribution to our knowledge of the etiology and nature of hard curds in infants’ stools. Am. J. Dis. Child. 1911;1:341-359
4. Brennemann J. The care of infants. J. Am. Med. Assoc. 1912;59:542–543, 623–624, 720–721, 797–798
5. de Roos V. M., Katan M. B. Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 1998. Am. J. Clin. Nutr. 2000;71:405-411
6. Elwood P. C., Newton D., Eakins J. D., Brown D. A. Absorption of iron from bread. Am. J. Clin. Nutr. 1968;21:1162-1169
7. Epps R. P., Jolley M. P. Unsupervised early feeding of solids to infants. Med. Ann. D. C. 1963;32:493-495
8.Executive Board American Academy of Pediatrics: Committee on Nutrition, Scope and Functions. Pediatrics 1956;18:159
9. Fomon S. J. Nutrition of Normal Infants 1993 W. B. Saunders St. Louis, MO.
10. Fomon S. J., Filer L. J., Jr, Anderson T. A., Ziegler E. E. Recommendations for feeding normal infants. Pediatrics 1979;63:52-59
11. KapitanT.V. Propaedeutics of children’s diseases [Textbook for students of higher medical educations]; Fourth edition, updated &translated in English. – Vinnitsa: The State cartographical Factory, 2012. – 808 p
12. Manual of propaedeutic pediatrics Nykytuyk s Balatskan Galiash N TSMU Ukrmedkniga 2005,467p
The methodical instructions were drawn up by associated professor Nykytyuk S.O., Ph. D.
Methodical instruction was discussed and adopted at the Pediatrics # 2 Department sitting
17 of June, 2011. Minute № 18
Methodical instruction was adopted and reviewed at the Department sitting
26 of June, 2013. Minute №16
