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

2. Method of clinical neurological examination of child:

а). history

б). general estimation of behavior of child

• ability to react on surroundings

• reaction of child on examination

• state of consciousness, mood

• attention, memory

• speech of child, its disorders

• motive skills, accordance of age

в) Inspection

• position in a bed

• co-ordination of motions and step

• inspection of head, face, trunk, extremities

• presence of tremor, forced positions of extremities

г) tests on co-ordination of motions

д) exposure of pathological reflexes

е) examination of function of cranial nerves, superficial and tendon reflexes

3) Semiotics of pathology of central and peripheral nervous system in children at

• serous and purulent meningitis

• encephalitis

• hydrocephaly

• cerebral palsy

4) Rules of conducting of lumbal punction in children of a different age, knowledge of normal indexes of liquor and their changes at pathology.

5) Features of care of sick children with the defeat of the nervous system.

Method of conducting of practical training:

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

Analysis of the executed tests and consideration of errors.

In the ward of department a teacher demonstrates the method of clinical neurological examination of child. Laboratory information like a result of spinal punction is estimated.

A teacher distributes and assigns children for independent work.

5) Students design protocol of examination of patient with estimation of the state of the nervous system and substantiate pathological syndrome of defeat of the nervous system.

6) A teacher with the students carries out the round of patients, makes analysis and signs protocols.

7) A teacher works out the results of training, gives estimation of knowledge and abilities of students, assigns tasks for independent preparation to a next training.

Forms and methods of self-control:

Tests

1. Mass of cerebrum relatively to mass of body makes in new-born:

1. 2,5%

2. 5%

3. 10%*

4. 15%

5. 20%

2. The end of myelinization of cerebrum takes place:

1. in 1-2 years

2. in 2-3 years

3. in 3-5 years*

4. in 1 month

5. in 6 months

3. The feature of liquor in new-born:

1. Increasing level of protein, insignificant lymphocytosis*

2. Negative reaction by Pundy, presence of erythrocytes

3. Ksantochromia, absence of protein

4. Decrease of amount of protein, increase of amount of sugar

5. Positive reaction by Pundy, neutrophylia

4. A spinal cord in new-born ending at the level:

1. L 1-2

2. L 2-3*

3. L 3-4

4. Т 11-12

5. Т 12-L 1

5. What from the transitive symptoms is not pathological for the children of early age?

1. Kerning’s symptom*

2. Brudzinsky’s upper symptom

3. Brudzinsky’s medium symptom

4. Brudzinsky’s lower symptom

5. Lesage’s symptom

Situation tasks

Task №1.

5 years old boy has complaints on headache frequent vomits without previous nausea fever, pain of eyeballs. Position of child is forced, on a side with the head and feet attracted to the stomach head is neglected backwards. What syndrome takes a place?

Answer: meningeal syndrome

Task № 2.

Mother of 6 months old child has history of urgent, with stimulation, delivery. Estimation of newborn Apgar’s scale was 6/7 points. At inspection of child the delay of psychomotor development takes place, the volume of head is increases on 2 cm. Information of sonography expose the signs of internal hydrocephaly. What syndrome takes a place?

Answer: hydrocephaly

Task № 3.

At the examination of new-born child a doctor paid attention to absence of motions in left upper extremity. Muscular tone and tendon reflexes are sharply reduced. About what syndrome is it possible to think in this case?

Answer: syndrome of peripheral paralysis

Hardware and material maintenance of training.

1. Tables: “ Age features of psychomotor development of child”, “Central and vegetative nervous system of child” „Age features of liquor in children”

2. Laboratory analyses of liquor.

3. Set of test tasks of initial control

Sources of information:

А) Basic:

3. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 112-156

B) Additional:

1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. Санкт-Петербург: ФОЛИАНТ, 2001.-С. 135-223,130-136.

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

Program of self-preparation of students to the theme:

1. To learn basic and additional information sources.

2. To be able to conduct the examination of neurological status of children.

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

Semantic module 5. Skin, hypodermic fat tissue and skeletal system in children

Concrete aims:

• To conduct objective examination of skin, hypodermic fat

• To collect anamnesis, conduct the objective examination of the skeletal system in children.

• To appoint the complex of additional methods of examination for finding out of the state of the skeletal system in children.

• To interpret got findings taking into account anatomic and physiologic features of child.

• To conduct syndrome diagnostics of children with pathology of skin and skeletal system.

Theme 2. Anatomical and physiological features, methods of examination, semiotics of skin, hypodermic fat tissue in children.

Theme 3. Anatomical and physiological features, methods of examination, semiotics of the skeletal system in children.

Theme of practical training: Methods of examination of skin and hypodermic fat in children. Semiotics of violations of skin and hypodermic fat. Methods of examination of skeletal system. Semiotics of violations of skeletal system.

Place: an educational room in the somatic department.

Professional orientation of students:

A skin is important organ which acts considerable part in life and health of child. It has close physiology communication with activity of separate organs and organism on the whole. The condition of skin is an original screen which represents the pathological changes in an organism. The careful examination and adequate estimation of the state of skin is matters in diagnostic of disease in children.

Pathology of organs of the skeletal system occupies one of leading positions in the structure of morbidity of children, especially of early age children. The skeletal system in children has the row of morphological and functional features, without taking into account which examination results and put clinical diagnosis cannot be correctly appraised.

Base level of knowledge and abilities:

№	Discipline	To know
1 2 3 4	Anatomy Normal physiology Histology Pathological physiology	Anatomical structure of skin and its appendages. Anatomical structure of different parts of the skeletal system in children: skull, spinal column, extremities, muscles. Physiological features of skin and hypodermic fat: 1.Basic functions of skin, features of resorbtion, protective function and other 2.Blood supply of skin and hypodermic fat 3.Physiology of skin appendages Physiology of the skeletal system in children: 1. Physiological bases of muscular activity 2. Physiological features of the bone system 3. Blood supply of the bone system in children of early age Histological features of lymph nodes, skin and hypodermic fat in different age periods of childhood and in different areas of body of child. Histological features of structure of the skeletal system in children in different age period of childhood Basic mechanisms of development of morphological elements of skin (primary and secondary). 1. Basic mechanisms of development of violation of bone tissue 2. Mechanisms of violations of the muscular system in children

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 of skin, subcutaneous tissue and skeletal system in children. Distributing of patients for independent work of students. Registration of protocols of examination of patient with estimation of the state of skin, hypodermic fat and skeletal system in children. Round of children, which students worked with, analysis of patients. Signing of protocols. Initial control of knowledge, solving of clinical situation tasks. Results of training and final estimation of knowledge and abilities of students and task to independent preparation to a next training.	15 min. 30 min. 45 min. 40 min. 20 min. 10 min. Total: 160 min.

List of theoretical questions:

1. Anatomic and physiologic features of skin, subcutaneous tissue in children of a different age and their clinical value.

2. Method of clinical examination of patient with pathology of skin, subcutaneous tissue:

а) inquire;

b) features of examination:

• Color of skin;

• presence of primary and secondary elements, their kind, size, localization and others like that;

• development of superficial vessels;

• inspection of visible mucus;

• distribution of subcutaneous fat;

• edemas;

c) features of palpation:

• elasticity;

• turgor of tissue;

• temperature;

• pain sensitiveness;

• dryness or wetness;

• estimation of umbilical wound (in new-born);

• thickness of skin fold;

• estimation of the state of capillaries;

• edemas;

• estimation of rash

• groups of lymph nodes (size, amount, plainness, consistency, mobility, integration with surrounding tissue).

3) Semiotics of violations of skin, subcutaneous fat:

а) primary morphological elements (inflammatory, uninflammatory character, with cavity, without cavity);

b) secondary morphological elements;

c) violations from the side of appendages of skin (hair, nails);

d) hypotrphy, paratrophy;

e) edemas;

f) skleredema, sklerema;.

4). Anatomic and physiologic features of the skeletal system in the children of a different age and their clinical value.

5). Method of clinical examination of patient with pathology of the skeletal system:

1. inquire;

2. features of inspection: estimation of proportion of separate parts of body, inspection of skull, trunk, upper and lower extremities (estimation of their sizes, form, presents of deformations), estimation of the state of teeth, feature of bite, inspection of configuration of joints, the volume of mobility of joints, physical activity of child, development of muscles, volume of active moving activity.

3. Features of palpation:

• estimation of development of muscles, muscular force, tone of muscles, turgor of soft tissue, state of separate muscles;

• - palpation of bones of the skull, presence of fontanels, measuring of their sizes, palpation of thorax (form, direction of ribs, expressed of intercostals intervals, epigastral corner), spine (exposure of declination of its axis in different departments), extremities;

• measuring of sizes of big fontanel: from one side of rhombus to other its side (that between the parallel sides of rhombus);

• palpation of joints ( increase to the temperature, painful, edema, active and passive mobility).

6). Semiotics of violation of the skeletal system in children:

1. rickets;

2. semiotics of microcephaly and macrocephaly;

3. scoliosis

4. bone deformations

5. arthritis;

6. innate defeats of the bone system in children

7. Main syndromes at the defeat of the bone system

• pain

• joint

• hyperplasia of bone tissue

• osteomalatia

• osteoporosis

7. Main syndromes at the defeat of the muscular system in children:

• muscular hypertonic

• muscular hypotonic

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 independent work.

2. Students in the wards of department conduct the method of clinical examination of patient with pathology of skin, subcutaneous fat and skeletal system.

3. Students design protocol of examination of patient with estimation of the state of skin and skeletal system and substantiate pathological syndromes

A teacher with the students carries out the round of patients, makes analysis and signs protocols.

4. A teacher works out the results of training, gives estimation of knowledge and abilities of students, assigns tasks for independent preparation to a next

Forms and methods of self-control

Tests and situation tasks for the control:

1. What morphological element of skin does not belong to the secondary?

   1. scale

   2. fissure

   3. ecchymomas

   4. pigmentations

   5. ulcer

2. What function of skin is developed in children worse, than in adults?

1. Protective

2. Respiratory

3. Resorbtion

4. Metabolic

5. Sensor

3. At the inspection of mouth cavity of child a doctor exposed 8 chisels. To what age does this formula answer?

1. 8 months

2. 10 months

3. 12 months

4. 16 months

5. 20 months

4. In what age replacement of baby teeth on permanent one begins?

1. from 3-4 year of life

2. from 4-5 year of life

3. from 5-6 year of life

4. from 6-7 year of life

5. from 7-8 year of life

5. In what age does hypertone of lower extremities disappear in healthy children?

1. 2-3 months

2. 1-2 months

3. 6-8 months

4. 3-4 months

5. 5-6 months

Standards of answers:

1. С

2. A

3. С

4. С

5. D

Clinical situation tasks of final control.

1. 3 months old child was born from a 1st pregnancy with the weight 3200 g. From the first month he is on the artificial feeding by the cow’s milk. From 1,5 months a greasy yellow crust on parietal part of head appeared in child, in 3 months erythematic rush and shelling on cheeks appeared.

What pathology of skin is observed in a child?

2. 4 months child was born in term with weight 3200 g. Receives mixed feeding. During first 3 months added in weight 1200 g. Now child has weight 5100 g. Thickness of hypodermic fat on the stomach 0,5 cm., turgor of soft tissue reduced.

What pathology is observed in a child?

3. 7 days old premature child was born in 36 weeks with weight of body of 2100 g. At inspection doctor exposed the local condensation and edema of hypodermic fat on buttocks and thighs, a skin is not taking in a pleat, pale, cold, at pressure by finger is deepening.

What pathology you can think in this case about?

Standards of answers:

Task 1.

A child has ecssudative-catarrhal (allergic) diathesis.

Task 2.

A child has hypotrophy. For clarification of degree of hypotrophy it’s necessary to define the deficit of weight of body in %. Proper weight of body = 3200 + 800∙4 = 6400. Deficit of weight of the body 6400 - 5100 = 1300: 6400 100% = 20,8%, that answers the ІІ degree of hypotrophy. About hypotrophy thinning of hypodermic fat on a stomach and of decreased turgor of soft tissue testifies also.

Task 3.

Sckleredema is in this child.

Hardwares and material providing of training: