Information sources.

А) Basic:

1. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 215-273

B) Additional:

1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. М.:Медицина, 1985. - С.101-129.

2. Пропедевтика детских болезней / под ред. А.А.Баранова. М.: Медицина, 1998. - С.158-182.

Program of self-preparation to the theme:

1. To study Theoretical questions (see List of information sources)

2. To pay attention to the anatomic and physiologic features of organs of breathing in children.

3. To be able to question parents and sick child

4. To define anamnesis of life, anamnesis of illness, basic complaints of children with pathology of organs of breathing

5. To pay attention on the feature of inspection, palpation, percussion and auscultation of children depending on age

6. To pay attention to the general symptoms of defeat of organs of breathing

7. To learn basic pathological syndromes.

8. To know semiotics of basic diseases of respiratory (innate stridor, acute stenotis laryngitis, bronchitis, pneumonia, bronchial asthma, pleurisy

Semantic module 7. Cardiovascular system in children

Concrete aims:

• To collect anamnesis at a patient with diseases of the cardiovascular system.

• To conduct the objective examination of the cardiovascular system taking into account the age features of child .

• To interpret got findings.

• To analyze the basic syndromes of defeat of the cardiovascular system in children.

• To appoint the complex of laboratory-instrumental methods of examination at the diseases of the cardiovascular system in children.

Theme 7: Anatomic and physiologic features of cardiovascular system in children.

Theme 8: Method of examination of cardiovascular system in children.

Theme of practical training: Method of inspection, palpation, percussion and auscultation of the cardiovascular system in children. Basic signs of defeat of cardiovascular system in children (cyanosis, bradycardia, tachycardia and other).

Place: an educational room in the cardiologic department.

Professional orientation of students: Growth of cardiovascular pathology of child's age, especially congenital defects of heart is marked in recent years. The cardiovascular system of child has the row of morphological and functional features, which are necessary to take into account. Knowledge of pathological syndromes in cardiology is very important in work of doctor for the beginning of treatment in time.

Base level of knowledge and abilities:

№	Discipline	To know
1. 2. 3. 4.	Anatomy Normal physiology Histology Pathological physiology	Development of the cardiovascular system in intrauterine period. Anatomic structure of the cardiovascular system. Knowledge of principles of blood circulation in fetus and newborn Functioning of greater and lesser circulations Histological features of structure of myocardium in different age period of childhood. Basic compensating and adaptation mechanisms of the cardiovascular system.

Plan of conducting of practical training:

№	Elements of practical training	Time (minutes)
1. 2. 3. 4. 5. 6.	Verification of presents. Test control for estimation of initial level of knowledge and its analysis. Demonstration and explanation by the teacher of method of clinical examination of patient with pathology of the cardiovascular system. Independent work of students with patients. A teacher with students is the makes round of the patients. During the clinical round a teacher conducts the final control of eventual level of knowledge. Results and final estimation of knowledge and abilities of students and task to independent preparation to a next training.	5 min. 15 min. 30 min. 50 min. 50 min. 10 min. Total: 160 min.

List of theoretical questions:

5. Anatomic and physiologic features of the cardiovascular system in children of a different age and their clinical value.

6. Method of clinical examination of patient with pathology of the cardiovascular system:

а). inquire

b). features of inspection: position in a bed, color of skin and visible mucus, cyanosis, edema, pulsation and swelling of large cervical vessels, presence of cardiac hump and cardiac thrust;

c). palpation of pulse and its description;

d). palpation and description of apex beat;

e). presence of “cat’s purring”;

f). features of percussion, determination of borders of relative and absolute dullness of heart;

g). features of auscultation: points and order of auscultation of the heart, description of tones, the presence of murmur and its description;

h). determination of arterial pressure, age norms;

i).conduction of functional tests: the Stange-Gench’s test, orthostatic, the Shalkov’s test.

5. Additional methods of examination of cardiovascular system: electrocardiography, phonocardiography, sonocardiography. Features of ECG and PCG in children of early age.

Method of conducting of practical training:

1. After verification of presents and announcement of theme of training with pointing on its actuality a teacher conducts the writing test control of knowledge.

2. Analysis of the executed tests and consideration of errors.

3. In the ward of department a teacher demonstrates the method of clinical examination of patient with pathology of the cardiovascular system.

4. A teacher distributes patients for independent work of students, assigns.

5. Students independently work with children: collect anamnesis, inspect them. Protocol of inspection of patient is designed with estimation of the state of the cardiovascular system and ground of pathological syndrome.

6. Teacher conducts the analysis of patients with the analysis of ground of pathological clinical syndrome. Signing of protocols.

7. During the clinical round teacher conducts the final control of knowledge of students on this theme with the use of situation clinical tasks.

8. Teacher works out resume of training, gives estimation of knowledge and abilities of students. Assigns for independent preparation to a next training.

Forms and methods of self-control.

Test tasks

1. in what age the intensive increasing and differentiation of myocardium is marked?

1. to 1 year

2. in the first 2 years of life*

3. in 5 years

4. 6-10 years

5. in the first 6 months

2. When does arterial channel anatomically close?

1. for 6 months

2. for 1 year

3. for 3 years

4. for 2 months*

5. for 6 years

3. What frequency of pulse in healthy new-born child?

1. 120 /min.

2. 80 /min.

3. 100 /min.

4. 140 /min.*

5. 60 /min.

4. Point of auscultation of mitral valve of heart:

1. at the lower edge of breastbone

2. in 2nd intercostals left side

3. in a 2nd intercostals right side

4. at the apex of heart*

5. in a 4th intercostals left side

5. What auscultative changes does characterize the opened arterial channel?

1. rough systolic murmur in 3-4 intercostals on the left

2. systolodyastolic murmur of "machine" in 2 intercostals on the left*

3. rough dyastolic murmur in 2 intercostals on the left

4. systolic murmur in a 2 intercostals on the right

5. systolic murmur in 2 intercostals on the left

Etalons of answers

1. B

2. D

3. D

4. D

5. B

Situation tasks:

Task №1.

13 years old boy has complaints on frequent headache, nasal bleedings. At the objective examination a doctor has defined arterial pressure – 130/85 mm Hg. What index of blood pressure in norm?

Task №2.

At palpation of pulse in 5 years old child a doctor defined following its descriptions: synchronous, frequency – 108 for a minute, satisfactory filling and tension, on inhalation a pulse is accelerated, on exhalation – is slowed. How to consider the changes of pulse at a child?

.

Task №3.

To the cardiologic department 8 years boy with complaints about the fatigue ability, weakness was admitted with the purpose of examination. At inspection: skin is pale, pulse of the weak filling, 72 for a minute, АP – 80/60 mm Hg. At palpation of region of heart a doctor paid attention on cat’s purring above one and second intercostals on the right of breastbone, which coincides with an apex beat. What pathological symptoms were exposed by a doctor at the examination of child? What pathology of the cardiovascular system such symptoms characteristic for?

Standard of answer:

1. Systolic АP = 90 + 2·13 = 116 mm Hg

Dyastolic АP = 60 + 13 = 73 mm Hg

2. Frequency of pulse in 5 years child is in norm The changes of pulse rhythm can be considered as respiratory arrhythmia, that in this age is the physiologic phenomenon

3. During the examination doctor exposed the following pathological symptoms: pallor of skin, bradycardia, weak filling of pulse, decrease of АP, systolic cat’s purring above aorta. This set of symptoms is characteristic for aortal stenosis.

Hardwares and material providing of training:

1. Tables:

1. “Frequency of pulse in children of different age”

2. “Borders of relative and absolute dullness of heart in children”

2) Set of test tasks of entrance control (10 examples).

3) Set of situation clinical tasks (10 examples).

4) Methodical developments:

1. “Anatomic and physiologic features of the cardiovascular system in children”

2. “Calculation of norms of arterial pressure in children. Indexes of arterial pressure in children of different age”.

3. “Method of examination of the cardiovascular system”

4. “Points and order of auscultation of heart”

5. “Properties of pulse, change of pulse at pathology”