Information sources.

А) Basic:

1. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 568-618

B) Additional:

1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. -М: Медицина. 1985. - C.221-238.

2. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. С.-Петербург, 2001. - C. 538-583.

Program of self-preparation of students to the theme:

1. To learn basic and additional information sources to the theme.

2. To be able to conduct the method of examination of nephrological patient.

3. To be able to take a care of children with pathology of the urinary system.

4. To write essay on the themes:

а) "Description of pain syndrome, in dependence under level of defeat of the urinary system"

б) "Features of proteinuria, hematuria at different diseases of the urinary system"

в) "Changes at the laboratory and instrumental examinations of nephrological patients".

Semantic module 10. Endocrine system in children.

Concrete aims:

• To conduct the subjective and objective examination of organs of the endocrine system taking into account the features of methodic in children.

• To appoint the necessary complex of diagnostic measures at a patient with pathology of the endocrine system for clarification of pathological changes.

• To interpret findings of result of examination of child on the basis of knowledge of anatomic and physiokogic features.

• To form a complex syndrome diagnosis.

Theme 13. Anatomic and physiologic features of organs of the endocrine system, examination method, semiotics of defeats.

Theme of practical training: Method of examination of endocrine glands. Semiotics of syndromes of hyper- and hypofunction of separate endocrine glands and diseases of the endocrine system in children.

Place: an educational room in the somatic department.

Professional orientation of students: Growth of endocrine pathology of child's age is marked in recent years, especially defeats of thyroid. The endocrine system of child has the row of morphological and functional features, without taking into account which examination results and put clinical diagnosis cannot be correctly evaluated. In work of doctor knowledge of symptoms of defeat of the endocrine system is necessary during examination the child and diagnostic of disease. These actions are especially important for timely beginning of treatment.

Base level of knowledge and abilities:

№	Discipline	To know
1. 2. 3. 4.	Anatomy Normal physiology Histology Pathological physiology	Development of the endocrine system in the intrauterine period and in different periods of childhood. Description of hormones of endocrine glands. Knowledge of principles of action of hormones on process of metabolism. Histological features of structure of thyroid gland and pancreas. Basic principles of adjusting of products of hormones.

Plan of conducting of training.

№	Elements of practical training	Time (minutes)
1. 2. 3. 4. 5. 6.	Test control with the purpose of estimation of initial level of knowledge and its analysis. Demonstration of method of clinical examination with estimation of the state of the endocrine system in children. Distributing of patients for IWS. Independent work of students with the patients. Registration of protocols of examination of patient with estimation of the state of the endocrine system and ground of clinical syndrome. Round of children, which students worked with, analysis of patients. Signing of protocols. Final control of knowledge, solving of clinical situation tasks. Results of training and final estimation of knowledge and abilities of students and task for independent preparation to a next training. List of literature.	15 min. 30 min. 45min. 40 min. 20 min. 10 min. Total: 160 min.

List of theoretical questions:

1. Anatomic and physiologic features of endocrine system in children of a different age and their clinical value.

2. Method of clinical examination of patient with pathology of the endocrine system:

а). questioning;

b). features of examination: general inspection with estimation of physical development, proportion of body building, state of skin, inspection of face, inspection of neck, inspection of thorax, inspection of genitals;

c). palpation of pulse and its description;

d). palpation of thyroid gland;

e). estimation of sexual development: in girls- axillary pilosis, pilosis of pubis, development of mammary glands, character of menstrual function; in boys – pilosis of face, axillaries, pubis; forming of the Adam's apple, age changes of voice;

f). determination of arterial pressure, age norms;

3. Semiotics of defeats of the endocrine system:

a).hypo and hyperfuntion of adrenal glands;

b). hypo and hyperfuntion of thyroid;

c). hypo and hyperfuntion of pancreas

d). syndrome of violation of physical development;

e). hypo and hyperfuntion of sexual glands.

Method of conducting of practical training:

1. Students answer in writing on the tests of entrance control of base knowledge. Then is distributed for implementation of practical work with patients.

2. Students in the wards of department conduct the method of clinical examination of patient with pathology of the endocrine system.

3. Then teacher conduct round of patients together wit the students.

Students design protocol of inspection of patient with estimation of the state of the endocrine system. A teacher conducts the analysis of patients with the analysis of substantiation pathological clinical syndrome. Signing of protocols.

4. A teacher conducts the final control of knowledge and practical skills of students on this theme with the use of situation clinical tasks.

5. A teacher works out the 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

Tests:

1. What hormone determines the level of metabolism in an organism?

1. adrenocorticotropin

2. thyiroxin

3. oxitocin

4. luteinizing hormone

5. prolactinum

2. What hormone determines growth and differentiation of child’s organism on the first year of life?

1. adrenocorticotropin

2. thyiroxin

3. oxitocin

4. luteinizing hormone

5. prolactinum

3. What hormone is produced the ß-cells of pancreas?

1. glucagon

2. Insulin

3. somatostatin

4. thyroxin

5. somatotropin

4. Level of sugar in the blood of healthy children on empty stomach:

1. 6,6-8,5 mmol/l

2. 7,4- 10,2 mmol/l

3. 3,3-5,5 mmol/l

4. 10,0-15,8 mmol/l

5. 2,1-3,4 mmol/l

5. The antagonist of insulin is:

1. glucagon

2. parathormone

3. somatostatin

4. thyroxin

5. somatotropin

Standards of answers:

1. B

2. B

3. B

4. C

5. A

Situation tasks

Task 1.

Doctor-endocrinologist has established to 12 years old boy diagnosis diabetes mellitus. What are the main symptoms of this disease?

Task 2.

After birth in a child were marked the following symptoms: jaundice, increase size of abdomen, weak sucking reflex, heavy nasal breathing, somnolence, lower position of umbilicus, low timbre of voice. What endocrine pathology doctor can suspect?

Task 3.

14 years girl came to the doctor with complaints on rising irritability, emotional lability, tremor of hands, loss of mass of body. What pathological syndrome you can suspect?