1. Tables:

1. “Primary morphological elements of skin”;

2. ”Secondary morphological elements of skin”.

3. „Terms of appearance of points of ossification in children”.

2). Methodical developments:

1. “Method of examination of skin, subcutaneous fat tissue and skeletal system”

2. „Care of children with pathology of skin, subcutaneous fat tissue and bone system”.

Sources of information:

А) Basic:

1. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 159-195

B) Additional:

1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней. М: Медицина, 1985.- С. 71-83, 101-129.

Program of self-preparation of students to the theme:

1. To study basic and additional information sources according to the theme of training.

2. To be able to conduct the method of examination of skin, subcutaneous fat tissue, skeletal system”

3. To be able to take a care of children with the pathology of skin, subcutaneous fat tissue and skeletal system”

4. To pay attention and learn the basic pathological syndromes of defeats of skin, subcutaneous fat tissue, skeletal system”

Semantic module 6. Respiratory system in children

Concrete aims:

• To collect anamnesis at a patient with the disease of organs of breathing.

• To conduct the objective examination of respiratory system taking into account the age features of children .

• To interpret got findings.

Theme 4. Anatomic and physiologic features of respiratory system in children .

Theme 5. Method of examination of respiratory system in children.

Theme of practical training: Method of clinical examination of respiratory system in children.

Place: an educational room in the pulmonologic department.

Professional orientation of students: Growth of respiratory pathology of child's age, especially chronic and allergic diseases is marked in recent years. The respiratory system of child has the row of morphological and functional features which doctor should take into account while make physical examination. In work of pediatrician knowledge of semiotics of the respiratory system is necessary.

Base level of knowledge and abilities:

№	Discipline	To know
1. 2. 3. 4.	Anatomy Normal physiology Histology Pathological physiology	Development of the respiratory system of child in intrauterine period. Anatomic structure of the respiratory system. Knowledge of principles of breathing of new-born and children of a different age. Functioning of the respiratory system. Histological features of structure of pulmonary tissue in different age periods of childhood. Basic compensating and adaptation mechanisms of the respiratory system.

Plan of conducting of training

1. 2. 3. 4. 5. 6.

Initial control and its analysis. Demonstration and explanation of method of clinical examination of patient with pathology of respiratory system. Distributing of patients for independent work of students Independent work of students with healthy and sick children. Round of children, which students worked with. Demonstration by the students of method of examination of the respiratory system. Control of eventual level of knowledge. Results, tasks for independent preparation to a next training.

15 min. 30 min. 5 min. 50min. 45 min. 15 min. Total: 160 min.

List of theoretical questions:

1. Anatomic and physiologic features of organs of breathing in children.

2. Method of clinical examination of patient with pathology of respiratory system

1. questioning;

2. features of inspection: cyanosis, laboring of nasal breath, participation of auxiliary respiratory musculature, form and symmetry of thorax;

3. breathing description: character, depth, rhythm; frequency of breathing;

4. features of palpation: sickness and elasticity of thorax, vocal tremor;

5. features of percussion: topographical and comparative;

6. features of auscultation: determination of character of breathing, moist and dry rales, crepitation and pleural rub;

7. determination of bronchophony (vocal resonance).

3. Semiotics of defeats of organs of breathing:

1. cyanosis;

2. types of cough;

3. types of shortness of breath;

2) Pathological syndromes:

1. bronchoobstructive

2. consolidation of pulmonary tissue

3. respiratory falure

2). Syndromes of basic diseases of respiratory system:

1. innate stridor;

2. acute stenotic laryngitis;

3. bronchitis;

4. pneumonia;

5. bronchial asthma;

6. pleurisy

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 initial control of knowledge.

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

3. In the ward of department a teacher demonstrates and explains the method of clinical examination of patient with pathology of organs of breathing.

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

№	Task		Pointing of teacher to the students		Note
1.	To collect anamnesis in patient with pathology of respiratory system		Algorithm of collection of anamnesis 1. Anamnesis of disease: beginning of disease; first clinical symptoms; whether treatment was conducted, by what preparations? dynamics of disease complaints of patient in present moment 2. Anamnesis of life: current of pregnancy in mother; current of delivery; state of health of child in neonatal period and during breast age morbidity of the child; presence of allergic reactions; heredity of patient
					It is necessary to put a question, that are up to respiratory system
					.
	.
					It is necessary to expose
					risk factors of disease of respiratory system.
				. Algorithm of practical work of student
2.		To conduct objective examination of respiratory system			To conduct examination of patient with account of age features of children
				1) External inspection of patient: а) cyanosis; б) laboring nasal breath; в) form and symmetry of thorax; г) participation of auxiliary respiratory musculature; д) determination of type of shortness of breath. 2) Inspection of pharynx, description of tonsils. 3) Frequency of breathing. 4) Palpation of thorax: а) sickness; б) elasticity of thorax; в) determination vocal traemor. 5) Topographical percussion of lungs: determination of upper and lower borders. 6) Comparative percussion: determination of character of percutory sound, its symmetry 7) Auscultation of lungs: а) determination of character of breathing; б) rales and their description (localization, amount, kind, communication with the phase of breathing); в) crepitation; г) pleural rub; д) determination of bronchophony.
		.
					.
					'
3.		To make the conclusion about the state of respiratory system.		Algorithm of practical work of student. To define the pathological changes (symptoms) in a state of respiratory system.	To give estimation exposed changes with account of age features.

5) After conducting of examination of the respiratory system by the students teacher conducts the control (students demonstrate methodic)

6. A teacher works out the final 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 which from intrauterine periods production of surfactant takes a place

1. in an embryonic

2. in embryofetal

3. in a germinal

4. in early fetal

5. in late fetal*

2. Frequency of breathing of 1 year child makes:

1. 50-60 / min.

2. 40-50 / min.

3. 30-35 / min. *

4. 20-25 / min.

5. 18-20 / min.

3. Breathing frequency in 5 years old child makes:

1. 16

2. 20*

3. 30

4. 40

5. 60

4. The purpose of comparative percussion is:

1. determination of border of internal organs

2. determination of size of internal organs

3. determination of form of internal organs

4. determination of pathological changes in organs*

5. determination of sickness of internal organs

5. The lower edge of lungs on the right midclavicular line in children will be disposed at level:

1. III ribs

2. IV ribs

3. V ribs

4. VI ребра*

5. VII ribs

Standards of answers:

1. E

2. C

3. B

4. D

5. D

Clinical situation tasks

Task №1.

During the clinical examination of child the exposed following changes from the side of thorax: it is short that wide, ribs are located horizontally, excursion of thorax is limited. Name the form of thorax. Is it possible to count such form normal? If no, for what diseases characteristic such changes of thorax?

Task №2.

During the clinical examination of child the exposed following changes from the side of thorax: diminishment of all sizes, atrophy of respiratory muscles, sharp inclination of ribs down, acute epigastral angle, lag of shoulder-blades. Name the form of thorax? Is it possible to count such form normal? If no, for what diseases characteristic such changes of thorax?

Task №3.

During conducting of comparative percussion in a child is heard the loud percutory sound with a tympanic tint on the type of bandbox. The percutory sound is identically above the symmetric areas of thorax. What reasons of origin of bandbox percutory sound? What diseases is a bandbox sound characteristic for?

Standard of answers:

1. Such form of thorax is named “barrel”. Such form of thorax is pathological. These changes characteristic for the diseases of the respiratory system, for example, bronchial asthma, obstructive bronchitis, emphysema of lungs

2. Such form of thorax is named “paralytic”. Such form of thorax is pathological. These changes are characteristic for the chronic respiratory diseases

3. Bandbox percutory sound appears in children, when elasticity of pulmonary tissue diminishes and its airing raises. Bandbox sound is characteristic for emphysema of lungs, bronchial asthma and obstructive bronchitis.

Hardwares and material providing of training.

1) Tables:

1. "Borders of lungs in children"

2. "Breathing frequency in children of a different age"

3. "Projection of parts of lungs on a thorax".

2. Set of test tasks of initial control (10 copies).

3. Methodical developments:

1. "Value of anatomic features of respiratory organs in children in pathogenesis of respiratory insufficiency".

2. "Methods of examination of respiratory system".