Task Full Topics

Task 1
Patient A., 6 years old, was hospitalized in the clinic on the 2nd day of the disease
with complaints of a runny nose, dry cough, sore throat, decreased appetite, and an
increase in body temperature to 38°C for 2 days.
Objectively: lethargic, temperature 37.8°С, the mucous membrane of the pharynx
and the back wall of the pharynx is brightly hyperemic, loose. Auscultatively hard
breathing in the lungs.
Highlight the main syndromes.
A. Catarrhal and intoxication syndromes.

B. Intoxication syndrome.
C. Catarrhal syndrome.
D. Pain syndrome.
E. Hyperthermic syndrome.
Task 2
The 8-year-old boy Y. was admitted to the infectious department with complaints
of an increase in body temperature to subfebrile numbers , decreased appetite, nasal
congestion, significant nasal discharge, and an infrequent wet cough.
Objectively: the general condition of the child is not impaired. Body temperature
is 37.4°C. There is a significant amount of mucus in the nasal passages. The mucous
membrane of the pharynx and the back wall of the pharynx is hyperemic.
Auscultatively hard breathing in the lungs.
The child is suspected of having an acute respiratory viral infection.
What additional research methods should be prescribed to confirm the diagnosis?
A. Clinical blood analysis.

B. Bacteriological analysis of a swab from the nasopharynx.
C. Virus isolation from nasopharyngeal lavage.
D. Bacterioscopic analysis of a swab from the nasopharynx.
E. Detection of viral inclusions by the method of luminescence microscopy.
Task 3
A 3-year-old child, who was treated during the day for SARS in a hospital, had a
body temperature of 39.7°C, a headache, and tonic convulsions.
Name the excitation of which brain structure is characterized by tonic
convulsions.
And Kory.
In subcortical structures.
With Cerebellum.
D Spinal cord.
E of the medulla oblongata.
Task 4
The patient is 2 years old. The disease began acutely with a runny nose, dry
cough, and an increase in body temperature to 38.6ºС. On the second day of the
illness, the child's condition worsened: the child was lethargic, the body temperature
rose to 39.9ºС, convulsions appeared.
Which of the drugs are not used for convulsive syndrome?
And Seduksen.
In Droperidol.
C Aminazine.
D Pentamin.
E Sodium oxybutyrate.
Answers to the tasks:

Task 1: A.
Task 2: E.
Task 3: V.
Task 4: D.
Task 1
A three-and-a-half-year-old girl became acutely ill this morning: her body

temperature rose to 38.2°C, she was bothered by a dry, rough cough, and a hoarse
voice. Symptomatic therapy was prescribed. In the evening, the cough intensified,
became "barking". On examination, the girl's condition is severe, her skin is pale,
perioral cyanosis. Nasal congestion, breathing with the participation of the auxiliary
muscles of the chest. BH - 38 in 1 min., "barking" cough. Auscultation - hard
breathing in the lungs.
1 Formulate a preliminary diagnosis.

A. SARS, laryngotracheitis.
B. SARS, nasopharyngitis
C. SARS, stenotic laryngotracheitis, compensated.
D. SARS, stenotic laryngotracheitis, subcompensated.
E. SARS, laryngitis.
2 Name the criteria for the decompensated degree of stenosis:
A. Shortness of breath during physical exertion.

B. Tachycardia, loss of pulse wave during inhalation.
C. Significant retraction of pliable areas of the chest.
D. Persistent cyanosis of the lips, acrocyanosis.
E. Lowered body temperature.
3 Tactics of the doctor:
A The child must be hospitalized in the intensive care unit.

B The child can be treated at home, prescribed symptomatic therapy.
C The child can be treated at home, antiviral therapy can be prescribed.
D The child must be hospitalized in the ENT department.
E The child must be hospitalized in the infectious department.
4 Name the indications for prescribing antibiotics for stenotic laryngotracheitis:

A Accompanying catarrhal syndrome.
B Compensated and subcompensated degree of stenosis .
C Decompensated degree of stenosis.
D With croup of diphtheria etiology.
E Not assigned.
Correct answers: 1- D , 2- B , C , D , 3- E , 4 - C, D. _
Task 2
A 2-year-old girl fell ill the previous evening, when the body temperature first
rose to 38°C, catarrhal symptoms appeared (hyperemia of the oropharynx and
conjunctiva, runny nose). Then (at night) the temperature rose to 40.1 °C. The skin
has become pale, the distal parts of the hands and feet are cold to the touch. The
parents gave the child paracetamol, but the temperature did not decrease. An
emergency medical doctor was called.
1. 1 Your likely clinical diagnosis.

2. 2 Name the syndrome that determines the severity of the disease.
3. 3 Make an algorithm for intensive therapy of this syndrome.
Correct answers:
1. SARS.
2. Hyperthermic syndrome ("white" hyperthermia, Ombredann syndrome).
3. Algorithm of intensive therapy:
 Physical methods of cooling are contraindicated, you can only rub the child's
skin with 40-50% alcohol until it becomes slightly red.
 To prevent chills - neurovegetative blockade: droperidol at a dose of 0.12 mg/kg
(no more than 1 ml) or pipolfen at 0.1-0.25 mg/kg (no more than 1 ml), it is possible
in combination with seduxen (0, 2 - 0.3 mg/kg).
 Trental in a dose of 2.5 - 5.0 mg/kg per day for 2 - 3 administrations or
Complamin (0.5 ml for 1 year of life).
 Antipyretics: paracetamol (10 - 20 mg/kg) orally, analgin in a single dose of 10 -
15 mg/kg (0.1 ml/year of life) intramuscularly or intravenously in combination with
antispasmodics (papaverine, no-shpa, etc.) .
Task 3
The next day, the same patient's body temperature rose again to 40.2°C, and she
suddenly developed a generalized tonic -clonic seizure that lasted for about 3
minutes . During the transportation of the child to the hospital, the convulsions
recurred and continued already in the reception department. Objectively:
consciousness is depressed to the point of sopor, the skin is pale, with a marble
pattern on the legs, acrocyanosis. Heart sounds are muffled, HR 162 per minute.
Breathing is vesicular, BH 80 per minute. The abdomen is soft, painless on palpation.
The liver and spleen are not enlarged.
1. Make a diagnosis.
2. Make an algorithm of emergency measures.
1. Diagnosis : SARS , febrile convulsions.

2. Algorithm of urgent measures:
1. 1 Oxygen therapy (30 - 50% O 2 ) continuously through a nasal catheter , a

mask, under a tent.
2. 2 Anticonvulsant therapy: seduxen ot 0.5 to 1.0 mg/kg, can be repeated after 15-
20 minutes; HOMK 75 – 100 mg/kg. When seizures are preserved , barbiturates
(thiopental, hexenal) are prescribed at a dose of 5-10 mg/kg intramuscularly or
intravenously slowly (in 5 minutes) or phenobarbital and ifenyl at a dose of 3-5
mg/kg orally through a tube.
3. 3 In severe cases, with the development of a convulsive status, possible
anesthesia is incubated with fluoroethane . In extremely severe cases, myo -
relaxants and atropine are administered, the trachea is incubated , and
mechanical ventilation is used (in the intensive care unit).
4. 4 Neurovegetative blockade: droperidol (0.12-0.25 mg/kg, but not more than 1
ml) or pipolfen (0.1-0.15 mg/kg, not more than 1 ml), or diphenhydramine (0.25
mg/kg ) intramuscularly.
5. 5 Antipyretic drugs - analgin (5-10 mg/kg) intramuscularly , physical cooling:
cold to the head and large vessels, rubbing the skin with 30-50% alcohol,
wrapping it in a wet diaper until it dries, etc.
6. 6 After elimination of the convulsive status, diacarb 5-10 mg/kg once a day for
2-3 days or Lasix at a dose of 0.5-1.0 mg/kg once, prednisone (2-3 mg/kg) or
dexazone ( 0.5 mg/kg) once or repeatedly during the day.
7. 7 In the presence of meningeal symptoms with therapeutic and diagnostic
purposes, a lumbar puncture is indicated, but not necessarily during a convulsive
attack.
8. 8 Etiotropic therapy: when clarifying the diagnosis, Ig for intravenous
administration (50 - 400 mg/kg) or antiviral drugs.
9. 9 Drugs that improve peripheral blood circulation - trental, eufilin with nicotinic
acid or complamin intravenously.
10. 10 Moderate detoxification therapy in the volume of 30 - 50 ml/kg per day
with control of diuresis and administration of rheopolyglucin to improve the
rheological properties of blood.
Task 4
A 6-year-old child was admitted to the clinic 18 hours after the onset of the
disease. She became acutely ill, when her body temperature rose to 39.90 C , she
developed a dry cough, runny nose, sore throat, clonic-tonic convulsions, and lost
consciousness. The child was taken to the clinic by ambulance.
Objectively: the condition is serious, conscious, body temperature 39.5C 0 . The
skin is pale. The mucous membrane of the pharynx is bright red, the back wall of the
pharynx is loose, granular. Auscultatively hard breathing in the lungs. Tones of the
heart of reduced volume, rhythmic. Pulse - 110 per minute, rhythmic. The abdomen is
soft, painless on palpation. The liver and spleen are not palpable. Urination and
defecation are not disturbed.
Blood analysis: er.-3.7x10 12 /l, hemoglobin 120 g/l, leukocytes - 4.1x10 9 /l, e-2%,
p- 4%, c-20%, l-66%, m- 8%, ESR-4 mm/h.
1. 1 Emergency therapy for convulsive syndrome.

2. 2 Your previous diagnosis.
3. 3 Evaluate the clinical blood count.
Correct answers:
1 At the pre-hospital stage:
- relanium 2 ml intramuscularly (0.1 ml/kg, but not more than 2 ml per
administration) or
lytic mixture (aminazine 1 ml - 2.5%, diphenhydramine 1 ml - 1.0%, novocaine 4
ml - 0.5%) 0.1 ml of the mixture per 1 kg of body weight (2 ml).
In the hospital:
- detoxification therapy;
- relanium 2 ml or sodium oxybutyrate 50-100 mg/kg (5-10 ml);
- osmodiuretics: mannitol 1-2 g/kg of weight;
- eufilin 1 ml - 2.4% per year of life;
- furosemide 2-3 mg/kg;
With signs of cerebral edema, prednisolone 3-5 mg/kg of weight.
2 SARS, nasopharyngitis. Hyperthermic and convulsive syndrome.

3 In the clinical blood analysis - leukopenia, lymphocytosis.
Task 5
Boy M., 1 year 4 months, was brought to the hospital by an ambulance with
complaints of increased body temperature, hoarseness of voice, frequent "barking"
cough, shortness of breath. He became acutely ill at night, when an attack of rough
coughing appeared in the middle of his sleep. Two hours later, an increase in body
temperature to 38 0 C was detected, shortness of breath increased, and the child was
taken to the hospital.
On examination, the condition is severe. Body temperature 38.8 0 C. The skin is
pale, clean, significant periorbital and perioral cyanosis. Hyperemia in the throat. The
voice is hoarse, the cough is rough, "barking". Breathing is whistling, heard at a
distance, auxiliary muscles are involved in the act of breathing, significant retraction
of the jugular fossa. ChD - 60 per 1 min. Percussively over the lungs, the difference
of the percussion lung sound is not determined. Auscultatively conducting dry rales
on both sides against the background of evenly weakened breathing. Heart tones of
reduced volume. Heart rate - 140 per minute.
1. 1 Make a diagnosis.
2. 2 Why do such attacks develop more often at night?
3. 3 What are the rules of hospitalization for this disease?
Correct answers:
1. 1 SARS, stenotic laryngotracheitis, subcompensated.

2. 2 In the horizontal position, drainage worsens, swelling of the subfolding space
increases, mucus is not coughed up, and this, in turn, leads to reflex
laryngospasm. Great importance is also attached to the increased influence of
the vagus nerve at night.
3. 3 Hospitalization to the infectious department. Isolation of patients in boxes or
semi-boxes, in extreme cases in small wards.
Task 6
In a 12-year-old boy, during an epidemic outbreak in the city, the disease began
very acutely: the body temperature rose to 39.8°C, significant signs of intoxication
appeared, intense headache, chills, pain in the eyes when moving, aching pains in the
joints, bones. The face is hyperemic, injection of vessels of the sclera and
conjunctiva, granularity and moderate hyperemia of the pharynx . There is no rash.
Answer the questions:
1. 1 What is the most likely disease in the child?

2. 2 Is there specific prevention of this disease?
3. 3 Principles of child treatment.
Correct answers:
1. 1 Flu.
2. 2 Yes, in the pre-epidemic period.
3. 3 Antiviral therapy (Arbidol, Rimantadine, Oseltamivir), symptomatic therapy.
Task 7
1. A two-and-a-half-year-old child had a sharp rise in body temperature to 38.8°C,

moderate weakness, decreased appetite, serous-mucous discharge from the nose,
injection of scleral and conjunctival vessels , and later right-sided conjunctivitis.
Objectively - moderate hyperemia of the pharynx, back wall of the pharynx,
hyperplasia of the tonsils, enlargement of submandibular and cervical lymph
nodes. A DNA virus was isolated from nasopharyngeal washings. Answer the
questions:
2. 1 What is the most likely disease in the child?
3. 2 What anti-epidemic measures are carried out for this disease?
4. 3 What forms of this disease do you know?
Correct answers:
1. 1 Adenovirus infection.
2. 2 Isolation of the patient, ventilation of the room, wet cleaning, mask mode, UV
radiation.
3. 3 Catarrh of the upper respiratory tract, nasopharyngo-conjunctival fever,
conjunctivitis, membranous conjunctivitis, keratoconjunctivitis, pneumonia,
mesadenitis, diarrhea.
Task 1
A 3-year-old girl had fever, difficulty of nasal breathing, enlarged cervical lymph
nodes. Ampicillin was prescribed by a physician. Fever up to 38,3oC, lacunar
tonsillitis, maculopapular rash on the skin, enlarged liver and spleen had occured on
the 3rd day of illness. Blood count contained leucocytosis, limphomonocytosis,
atypical mononuclear cells – 20 %. What is your diagnosis?
A. Infectious mononucleosis
B. Rubella
C. Measles
D. Scarlet fever
E. Adenoviral infection
Task 2
A boy, 7 years, has infectious mononucleosis. During the last 2 weeks he has the
increases body temperature to 38,5°C, headache, poor appetite. Objective
examination revealed edema of the face, considerably enlarged neck lymph nodes,
liver, spleen, purulent tonsillitis. Indicate the disease severity:
A. Subcompensated
B. Moderate
C. Mild
D. Compensated
E. Severe
Task 3
A 10-year-old boy had complained of malaise, sore throat, difficulty of nasal
breathing, fever up to 39?C on the 4th day of illness. Now he has pallor of the skin,
edema of his upper eyelids, enlarged postcervical lymphnodes. Mucous membrane of
oropharynx is hyperemic, tonsils are enlarged, covered by membranes, which are
separated easily. Liver and spleen are enlarged. What is your preliminary diagnosis?
B. Adenoviral infection
C. Tonsillar diphtheria
D. Scarlet fever
E. Lymphogranulomatosis
Task 4
A 2 year-old boy has been hospitalized with measles-like rash, tonsillitis,
lymphoadenopathy, difficulty of nasal breathing and hepatosplenomegaly. What is
your preliminary diagnosis?
A. Rubella
B. Scarlet fever
C. Measels
D. Adenoviral infection
E. Infectious mononusleosis
Task 5
In 14-years old annual child high temperature during 3rd weeks, somnolence. At
the review considerably megascopic neck lymphonoduses megascopic tonsils with
stratifications, spleen + 2sm. At suspicion on mononucleosis, that does not answer
diagnosis:
A. Vesicular exanthema
B. In the leukocytic formula of blood lymphocytes of make 60 %, from them 10
% are atypical
C. Enanthema and petechias on the mucus of oral cavity
D. Positive titer of the heterophil antibodies to the red corpuscles of ram
Task 6
A boy 6,5 years old is ill for three days: subfebrile temperature, catarrhal changes
in the pharynx, insignificant increase of neck lymph nodes. After the reception of
amoxicillin on a trunk, extremities has appeared red maculous-papulous exanthema,
forming large erythema which rises above the level of skin, in the blood analysis:
leucopenia, lymphocytosis, and 10 % of atypical mononuclears.
What infectious disease does it follow to differentiate?
A. Medicinal allergy: hives
B. Measles
C. Rubella
D. URT infections
E. Pseudotuberculosis
Task 7
A boy, 15 years old, is treated in the hospital with infectious mononucleosis. A
doctor diagnosed concomitant bacterial infection. Which from antibiotics is
impossible to use for treatment in this case?
A. Penicillin
B. Roxythromycin
C. Amikacin
D. Ampicillin
E. Cefazolin
Task 8
A 12-year-old boy has been ill for 5 days. Patients complain of malaise, fatigue,
acute fever, headache, sore throat, nausea, abdominal pain. The temperature is up to
38,1°C. The physical examination findings are generalized lymphadenopathy,
splenomegaly and tonsils are enlarged.
What is your preliminary diagnosis?
B. Adenoviral infection
C. Tonsillar diphtheria
D. Scarlet fever
E. Lymphogranulomatosis
Task 9
A 7-year-old boy has been ill for 6 days. He complains of headache, fever. The
temperature is up to 38 °C. The classic physical examination findings are enlargement
of anterior and posterior cervical nodes, splenomegaly to 2-3 cm below the costal
margin, palatal petechiae at the junction of the hard and soft palate are seen. What is
your preliminary diagnosis?
A. Rubella
B. Varicella
C. Measels
D. Serum sickness
E. Infectious mononusleosis
Task 10
To the boy, 9 years old, was diagnosed the infectious mononucleosis. Anamnesis
of the disease: acute beginning from the fever, toxic syndrome, sore throat, snoring;
increase of toxic signs; lymph nodes enlargement; addition of rashes, time of its
appear, previous amoxicillin (ampicillin) treatment. Indicate what cases are typical for
this disease.
A. Epidemics
B. Sporadic
C. Sporadic only in cold time of year
D. Epidemics in cold time of year
E. Epidemics in hot time of year
Answers to tasks:
1. Task 1: A.
2. Task 2: B.
3. Task 3: A.
4. Task 4: E.
5. Task 5: A.
6. Task 6: B.
7. Task 7: D.
8. Task 8: A.
9. Task 9: E.
10. Task 10: B.
Task 1
A 13-years-old boy became ill acutely, body temperature is 38,4°С, tonsillitis,

increase of neck lymphatic nodes, splenomegalia and moderate hepatomegalia. CBC:
leucocytes 16х109/l, mononucleares – 50 %.
Give answers for questions:
1. 1. What is the most credible disease?
2. 2. What is the etiology of this disease?
3. 3. What treatment will you prescribe?
Right answers to task 1
1. 1. Infectious mononucleosis.
2. 2. Virus of Epstein-Barr from family of herpesviruses.
3. 3. Symptomatic.
1. Task 2
2. A boy 10 years old, became ill 2 days ago, when he began to complain about the
stuffiness in nose, difficulty of the nasal breathing without the signs of cold,
head-ache, weakness, enhanced perspiration, pharyngalgia. Objectively: status
of patient is medium-heavy. Body temperature is 38,70С. At palpation
submandibular, postotic, neck and cervical lymphatic nodes are not soldered
between each other and surrounding fabrics, symmetricaly expanded. At
examination the mucous membrane of pharynx is hyperemic, the edema of
amygdales and the back wall of gullet is present. On the amygdales there is a
white patch which is easily taken off. In a blood test: leucocytes 15х109/l,
erythrocytes 3х1012/l, eosinophiles – 3 %, stab neutrophiles – 2 %, segmented
neutrophiles – 15 %, lymphocytes – 45 %, monocytes – 15 %, mononucleares –
20 %, ESR – 18 mm/h.
3. 1. Formulate a provisional diagnosis.
4. 2 What additional methods of research must be conducted?
5. 3 What complications can be at this disease?
Right answers to the task 2
1. 1.Infectious mononucleosis, moderate severity, typical form.

2. 2. Paul-Bunel-Davidson, Hoff-Bauer, Tomchik, Lovrik-Volner tests (reactions
of heteroagglutination) and specific serum tests for antibodies to the Epstein-
Barr virus (more frequently the antibodies of classes M or G to the viral capside
antigen are detected).
3. 3 Haematological: autoimmune hemolytic anaemia, thrombocytopenic purple,
rupture of spleen. Complications applying to the nervous system: bulbar
encephalitises. Suppurative complications: pneumonia, paratonsilitises, otitides,
sinuitises. Acute hepatic insufficiency.
Task 1
A boy, 5 years old is ill with acute disease: body temperature rose to 38,9ºC, headache, vomited twice,
sneezing, runny nose. After 3 days, the body temperature decreased to 37,1ºC but the pain in the left lower
extremity and staggering gait appeared.
Objective: The child’s state was moderate severity. Child was sluggish. Catarrhal phenomenon was marked
(hyperemia of the posterior wall of the pharynx). The breathing was exagerrated. Tones of heart were clear and
rhythmical. The abdomen was soft and painless. The liver and spleen were not enlarged. Movement of the left foot
is restricted and is raising in the supine position is unable to stand alone. Muscle tone decreased. The tendon
reflexes (knee and Achilles) on his left leg were reduced. The used serological diagnostic methods helpedto reveal
the increase of antibody titer in the paired serums to polio by 5 times.
Where are often localized changes at this disease?
A In ganglion cells of the posterior horns of the spinal cord.
B In ganglion cells of the anterior horns of the spinal cord.
C In ganglion cells of the brain.
D In large pyramidal cells of the cerebral cortex.
E In large pyramidal cells of the pyramidal tract.
Task 2
Disease of the child of 1 year 7 months old, was manifested by increasing of temperature to 39ºC, general
weakness, and decreasing of appetite. After 2 days on the background of temperature, there was weakness in the
legs, staggering gait, and limitation of movement of the left hand. From the history of life it is known that the child
is from the first pregnancy, first birth from twins. Pregnancy and the families of the mother were normal; the child
was on mixed feeding. Vaccinations were by age. The physical and neuro-psychological development are normal
for his age. The second child was at that time in the hospital with enterovirus infection – epidemic myalgia.
Objective: the state of moderate severity. Child is sluggish, slowed. Catarrhal phenomena is not expressed. The
breathing is exagerrated. The tones of heart are clean, rhythmical. The abdomen was soft and painless. The liver
and spleen were not enlarged. The movements of the left hand are limited. Muscle tone is sharply reduced. Tendon
reflexes are reduced on the left hand, Achilles reflex and knee reflex – on both legs, lower abdominal reflex and
cremaster’s reflex. The symptoms of tension are negative. The titer of antibodies to the polio virus in the dynamics
is without growth. On the background of prolonged therapy, positive dynamics of symptomswere recorded. On the
15th day of illness child walked without support. The muscles tone of the lower extremities was good, tendon
reflexes are present.However, the movements of his left hand remained limited, baby could not hold toys in hand.
After 1 month of onset of the disease the baby held toys with left hand and rested her, the range of motion was not.
The pain in hand was absent. Tonus and tendon reflexes were reduced. Moderate malnutrition of deltoid muscle
and muscles of shoulder was observed. Full recovery occurred within 6 weeks of onset.
What is characterized by peripheral paralysis?
A. Increasing of muscle tonus and tendon reflexes and decreasing or absence of cutaneous reflexes.
B. Advent hyperkinesia, decrease of cutaneous reflexes.
C. When improving of muscle tonus, decreasing of tendon-periosteal reflexes, muscle atrophy, changes in
electroexcitation of nerves and muscles in the unaltered skin reflexes.
D. Increasing of muscle tonus, decreasing of tendon-periosteal reflexes, muscle hypertrophy, changes in
electroexcitation of nerves and muscles in the unaltered skin reflexes.
E. Reduction or loss of muscle tonus, tendon-periosteal reflexes, muscle atrophy, changes in electroexcitation of
nerves and muscles in the unaltered skin reflexes.
Task 3
A boy, 3 years old, acute illness, body temperature rose to 38,6°C, marked by recurrent vomiting,
headache, dizziness, muscle weakness. On the 3rd day, parents noticed that the right eyelids could not close,
during a conversation – distorted face. Body temperature decreased to 37,1ºC, but painappeared in the left lower
extremity and staggering gait. Objective: the state of child was of moderate severity. Child was sluggish. Catarrhal
phenomenon was marked (hyperemia of the posterior wall of the pharynx). The breathing was exaggerated. Tones
of heart were clear, rhythmical. The abdomen was soft and painless. The liver and spleen were not enlarged. When
face is viewed, right eyelids could not close, during a conversation – distorted face. Movement of the left foot is
unable and restricted when raising it in the supine position. Decreasing of muscle tonus is noted. The tendon
reflexes (knee and Achilles) on his left leg are reduced. The increase in antibody titer in the paired serums at 5
times was revealed in child using serological diagnostic methods. Preventive vaccination has not been received.
When is vaccination and revaccination against poliomyelitis for children done according to the order?
A. It can be madeat 3 months and carried out once. Revaccination is carried out at 3 years, 6 years and 14 years
(once at every stated age).
B. It can be made at 1 month and is done three times at intervals of 30 days. Revaccination is carried out at 18
months, 3 years, 6 years and 14 years (once).
C. It can be done at 3 months and is done three times with intervals of 30 days. Revaccination is carried out at 18
months, 3 years, 6 years and 14 years (once).
D. It starts at 12 months and is done three times at intervals of 30 days. Revaccination is carried out at 3 years, 6
years and 14 years (once).
E. It begins at 3 months and is done three times at intervals of 30 days. Revaccination is not performed.
Task 4
A 9-month-old baby has spinal form of poliomyelitis.

What group of viruses are the causative agents of this disease?
A. Arboviruses.
B. Rotaviruses.
C. Reoviruses.
D. Picornaviruses.
E.Togaviruses.
Task 5
An 18-month-old non-vaccinated baby was hospitalized due to flabby paralysis of the left leg. There is loss
of muscle tonus, absence of active movement and tendon reflexes. Cutaneous sensitivity is present.
Where is the CNS lesion localized?
A. Anterior horns of the spinal cord.
B. Posterior horns of the spinal cord.
C. Cerebellum.
D. Precentral gyrus of the brain.
Task 6
A child is 2 years old. The disease started sharply with the rise of temperature up to 38,8°C, vomiting,
headache, flaccidity, pain in the abdomen and softening of stool. In 3 days weakness in the left leg, hypotonia,
hyporeflexia, hypodynamia at the same place appeared and the skin on the left leg was pale and cold.
What is the main route of transmission of this disease?
A. Respiratory.
B. Fecal-oral.
C. Respiratory and fecal-oral.
D. Respiratory and contact.
E. Fecal-oral and parenteral.
Answers to tasks:
Task 1: B.
Task 2: E.
Task 3: C.
Task 4: D.
Task 5: A.
Task 6: B.
Task 1
A child, 2 years 9 months. He was hospitalized to infectious department on the 5th day of disease with
complaints of fever up to 38,1°C, pronounced weakness, rednessof the throat, running nose, lack of active
movement in the legs, inability to stand, walk, headache, irritability. He was acutelyill, fever – 38,7°C, running
nose, redness of the throat, severe weakness, hypersensitivity. On examination: skin was pale, lower limbs were
cold, throat congestion, hypersensitivity, positive symptoms of tension, he was sitting in a "tripod"pose.He had
passive movements of the feet, all types of sensitivity has been saved. He had vesicular breathing in the lungs.
Breathing rate was 26 per min. Heart sounds were weakened, heart rate was 115 per min. The abdomen was soft,
there were painful bowel movements. Defecation was once a day and feces were undigested and mushy.
1 What is your preliminary diagnosis?

A. Poliomyelitis.
B.Myasthenia.
C. ARVI, nasopharyngitis.
D. Enterovirus infection herpanhina.
E. Meningitis.
2 What is the etiological factor of the disease?

A. Virus of the herpes family, I type.
B. Virus of the herpes family, II type.
C. Virus from the family Picornaviridae.
D. Virus from the family Paramyxoviridae.
E. Virus from the family Orthomyxoviridae.
3 What material should be collectedfrom people suspected with poliomyelitis?
A. Liquor.
B. Serum.
C. Swabs from the nasopharynx.
D. Faeces.
E. All answers are correct.
4 How long should the patient be isolated?

A. On the 5th day after the disease.
B. 14 days of the disease.
C. 18 days of the disease.
D. On the 21 days from the date of disease.
E. Isolation of the patient is required.
The correct answers are: 1-A, 2-B, 3-D, 4-D.
Task 2
A boy is 5 years old. He is acutelyill, body temperature rise to 39,6°C, marked by recurrent vomiting,
dizziness and muscular weakness. On the 3rd day, parents marked that eyelids could not close, during a
conversation – distorted face. He did not receive preventive vaccination.
1 What is the first disease you think of?

A. Poliomyelitis, pontinus form.
B. Neuritis of the facial nerve.
C. Encephalitis.
D. Meningitis.
E. Surround process in the brain.
2 In the study of cerebrospinal fluid after 14 days of onset of poliomyelitis it was detected:
A. Neutrophilic pleocytosis, proteinorahia, cell-protein dissociation.
B. Significant lymphocytic pleocytosis, reducing of protein in the cerebrospinal fluid, hyperglucosorahia.
C. Mild lymphocytic pleocytosis, proteinorahia, protein-cell dissociation, hyperglucosorahia.
D. Neutrophilic pleocytosis, reducing of protein in cerebrospinal fluid, hyperglucosorahia.
E. CSF – age norms.
3 Nonparalytic forms of poliomyelitis include:

A. Spinal.
B. Pontinus.
C. Bulbar.
D. Meningeal, innaparant, abortive.
E. Residual.
4 What term of quarantine should be set for children who have been in contact with a patient with poliomyelitis?
A. 5 days.
B. 14 days.
C. 20 days.
D. 35 days.
E. 60 days.
The correct answers are: 1-A, 2-B, 3-D and 4-B.
Task 3
Aboy, 7 years old, became ill 3 days ago: body temperature was 39,6°C, repeated vomiting, headache,
weakness. On the 3rd day he couldn't close right eye, his face has appeared asymmetry during the speech. The boy
wasn't vaccinated.
1. What disease is suspected?

2. What must his family doctor do?
1. Poliomyelitis, typical pontinus form, paralytic period, severe stage.

2. The boy must be hospitalized into infectious hospital, where he must be isolated for 40 days; inform
sanitary-epidemiologic structures; observation of contacts.
Task 4
A healthy boy, 5 months old, was brought to ambulatory clinic to perform plannedvaccination.
1. What vaccine against poliomyelitis would he receive, when next dose of booster vaccination must be
given?
2. What specific complication may occur?
1. Oral poliomyelitis vaccine, in 18 months.

2. Vaccinal poliomyelitis.
Task 5
A girl of 2 years became ill acutely from raising of temperature to 38.3 °C, catarrhal phenomena. During three
days, cough and cold were present. Then a temperature decreased, but a child could notstand on feet. A doctor
reveals limitation of movements, lowering of muscular tone in lower extremities. Sensitiveness is normal.
What is the name of preliminary diagnosis?
A. Osteomyelitis.
B. Enterovirus infection.
C. Poliomyelitis.
D. Rotavirus infection.
E. Flu.
The correct answer is C.

Task 6
A child of 2,5 years, not vaccinated is ill for 4 days. The disease had begun from hyperthermiato 38,5°C,
weakness, mild catarrhal phenomena and liquid emptying. On a 5th day a temperature wasnormal, however much
pains appeared in the muscles of feet and acute limitation of movements, lowering of tendon reflexes.
What is the name of preliminary diagnosis?

A. Acute intestinal infection.
B. Acute encephalitis.
C. URT infection.
D. Osteomyelitis.
E. Poliomyelitis.
The correct answer is E.
Task 7
In a child of 4 years about 3 days there was fever and catarrhal signs. On the 4th day temperature was normal, but
the boy began to pull his left leg. A doctor suspected poliomyelitis.
What form of disease is the most probable?

A. Bulbar.
B. Abortive.
C. Pontinus.
D. Spinal.
E. Meningeal.
The correct answer is D.

Task 1
The boy of 10 years old has chronic hepatitis Bvirus infection with the maximal activity. Which of the
listed tests most precisely characterizes the degree of cytolysis?
A. Crude protein.
B. Takara-Ara's test.
C. Prothrombin.
D. Transaminases.
E. Veltmam's test.
Task 2
A 10-year-old child is sick with chronic viral hepatitis B with a noticeable activity of the disease. Bilirubin
total – 70 µmol/L, direct – 26 µmol/L, indirect 44 µmol/L, AST – 6.2 mmol/L, ALT – 4.8 mmol/L. What
mechanism underlies the transaminase level increase of this patient?
A. Intrahepatic cholestasis.
B. Hypersplenism.
C. Failure of the synthetic function of the liver.
D. Cytolysis of hepatocytes.
E. Failure of bilirubin conjugation.
Task 3
The child of six months old has icterus with greenish shadesince the birth. The manifestations of
hemorrhagic diathesis and dermal itch are observed. What is the most likely pathology this child may have?
A. Gilbert syndrome.
B. Dubin-Johnson syndrome.
C. Biliary atresia.
D. Crigler-Najjar syndrome.
E. Erythroblastosis.
Task 4
The skin a 3 day-old child has turned yellow. The child was born with weight of 3.200 kg and length of the
body ‒ 52 sm. Active. There is puerile respiration above lungs. Breathing rate – 36 per 1 minute, heartbeat sounds
are rhythmic. The heart rate – 130 beats per minute, Belly is soft. The liver is + 2 cm, lien is not palpable. Feces ‒
in the form of meconium. What is the most likely diagnosis?
A. Hemorrhagic disease of a newborn.
B. Sepsis of newborns.
C. Physiological icterus.
D. Atresia of the bile passages.
C. Minkowski-Chauffard disease.
Task 5
Which virus does hepatitis A virus belong to?
A.Hepadnaviruses.
B.Mixoviruses.
C.Retroviruses.
D.Abroviruses.
E.Enteroviruses.
Correct answers to the tasks

Task 1: D.
Task 2: D.
Task 3: C.
Task 4: C.
Task 5: E.
Task 1
Patient A., 9 years old, hospitalized on the 7th day of illness with complaints on the icteritiousness of skin and
scleras, dark urine, single vomiting, bad appetite, temperature of 38оС during 2 days.
Objectively: languid; temperature is 36,8оС; skin and scleras are icteric; heart tones are muffled, 68 in 1 minute;the
edge to be progected on 3 sm., sensible to palpation, and softly-elastic; spleen is not determined by palpation; urine is
dark and feces are acholic.
1. Specify leading syndromes.
2. Formulate a provisional diagnosis.
3. What basic laboratory researches must be conducted?
Correct answers to the Task 1
1. Icteric and dyspeptic syndromes, hepatomegalia.

2. Viral hepatitis type A, icteric form, medium-heavy.
3. CBA, uranalysis on bilious pigments and urobilin, biochemical analysis of blood (bilirubin and its fractions,
activity of ALAT, ASAT), determination of markers of hepatitis.
Task 2
Elena K., 6 years old, became acutely ill: fever increased to 38.2оС, vomiting twice, and abdominal pain. Over
the next two days abdominal pain intensified and vomiting repeated up to 3 times a day. The child refuses to eat,
body temperature is 38.5оС. Three days later, during hospitalization, the condition is moderate, the temperature is
38.5оС, the skin is pale, on the hands and feet – a spotty-papular rash, the tongue is gray-coated, in the oropharynx –
moderate hyperemia. Heart tones –of weakened volume, heart rate – 90 per minute.
There are palpation abdominal pain in the right iliac region and around the navel, there are symptoms of irritation of
the peritoneum. The liver is not enlarged. Urination is light. Emptying 3 times a day, watery, without pathological
impurities. It is known that the child attends a kindergarten, where 6 cases of similar diseases have been registeredin
the last 5 days and, in the pantries ,have been found mice. Clinical blood tests shout : Hemoglobin – 125 g/L; RBC –
4.4x109/L; MCH – 0,9; WBC – 16,2x109/L; EO – 1%; STAB – 8% ; NEUT– 66%; LYM – 22%; MON – 3%; PLT –
230x109/L; ESR – 16 mm/hour.
1. Your clinical diagnosis.
2. What laboratory tests should be assigned to confirm the diagnosis?
3. Assign treatment.
4. Plan outbreaks during an epidemic.
5. Interpret the results of the clinical blood test.

1. Viral hepatitis A, jaundice, moderate.
2. Clinical blood test, urine analysis for bile pigments and urobilin, biochemical blood test (bilirubin and its fractions,
thymol sample values, ALT activity, AST), determination of hepatitis markers (HA antigen in feces, bile, anti-HAV-
IgM in blood).
3. Basic therapy, which includes regimen, diet, consumption of a large amount of fluid. In all forms of acute viral
hepatitis (AVH) patients should adhere to bed rest until "urinary crisis" – restoration of color of urine. Drug therapy
is used mainly in severe forms of the disease (detoxification therapy oral and intravenous, lactulose preparations, in
the presence of cholestasis –preparation ofursodeoxycholic acid or ademetionine.
4. In the case of nursing facilities, in the event of illness contact children will be supervised for 35 days after the last
patient has been isolated. All contact children are examined daily for sclera, oropharyngeal mucosa, skin, liver size,
urine, and feces color). Every 2 weeks (before the end of quarantine) patients in the HA center are advised to take a
laboratory study to identify atypical forms of HA (ALT activity and anti-HAV-IgM).
New children can be admitted to the group if there is information about previously transferred HA or subject
to prior introduction of immunoglobulin.
For the prevention of the disease to children under 1 year, unvaccinated children of all ages, members of their
families, staff of nurseries in which there is an outbreak of the disease, pregnant women who were in contact with the
patient, a single intramuscular injection of immunoglobulin at a dose of 0,02 mL/kg within the first 2 weeks of
contact is prescribed.It is necessary to conduct current and final disinfections.
The effectiveness of disease prevention depends, first and foremost, on providing the population with clean
drinking water and for household needs, creating modern sewage systems, and improving personal hygiene.
5. A child has acute hepatitis A. Explanation: results <0.8 are negative, 0.8–1.2 – doubtful, and ≥ 1,2– positive.
Positive IgM result: acute period of hepatitis A disease; recently transferred hepatitis A (up to 6–9 months). Positive
IgG result: Hepatitis A in the past.
Task 3
Patient A., 9 years old, was admitted to the clinic on the 7th day of the disease onset with complaints of skin
and sclerajaundice, dark urine, single vomiting, decreased appetite, fever up to 38оС for 2 days.
Objectively: flaccid; temperature 36,8оС; skin and sclera are jaundiced; heart rate of weakened volume, 68 per
minute, the liver projects from below the ribs on 3 cm, sensitive on palpation, soft-elastic, the spleen is not palpable.
Urine is dark. Feces are is acholic. In the blood test: IgM to HAV (anti-HAV IgM) by ELISA – 1.9, IgG to HAV
(anti-HAV IgG) by ELISA – 0.7.
1. Make a preliminary diagnosis.
2. What basic laboratory tests should be done to confirm the diagnosis?
3. Principles of treatment of this child.
4. Plan non-specific preventative measures aganst this disease in others.
5. Interpret blood test results.
Right answers to the Task 3
1. Viral hepatitis E.
2. The main method of specific laboratory diagnosis is the detection of viral particles in feces by immunoelectron
microscopy (in the last week of the incubation period and up to 12 days from the onset of the disease), as well as
specific antibodies in serum by ELISA throughout the acute period.
3. Basic therapy, which includes regimen, diet, consumption of a large amount of fluid. Drug therapy is used mainly
in severe forms of the disease.
4. At the population level, the risk of transmission of HEV can be reduced through the following measures:
maintaining high standards of public water supply and establishing proper systems for the disposal of human feces.
At the individual level, the risk of infection can be reduced as follows: compliance with hygiene rules; abstinence
from drinking water and ice of doubtful purity.
5. The child has acute hepatitis E. Explanation: results <0.8 are negative, 0.8–1.2 –doubtful, ≥ 1.2 –positive.
Positive IgM: acute period of Hepatitis E disease, or recently had hepatitis E (up to 6–9 months).
Positive IgG: Hepatitis E is a case of the past.
Task 4
A 12-years-old girl was in Uzbekistan with her relativesin the summer. A few days after she was backs her
body temperature increased, and she felt worse; afterwards, there were signs of jaundice, anemia, and brick-red urine.
In the blood test: IgM to HEV (anti-HEV IgM) by ELISA – 1.9, IgG to HEV (anti-HEV IgG) by ELISA –
0.7.
1. What is your previous diagnosis?
2. What current methods are used for laboratory diagnosis of this disease?
3. Principles of treatment of this child.
4 Plan non-specific preventative measures against this disease in others.
5. Interpret blood test results.
1. Viral hepatitis B, a typical jaundice, severe. Complications – hepatodystrophy.

2. Determination of hepatitis B surface antigen – HBsAg. The presence of HBsAg indicates acute or chronic
hepatitis; the carrier of the virus. Rapid diagnostic tests (which may be with a family doctor or pharmacy) or blood
donation in the laboratory are used to detect antibodies. Additional examinations, in particular: determination of
HBeAg, anti HBcIgM, anti-HBeIgM, HBV DNA, hepatitis delta virus.
3. Basic therapy: strict bed rest; diet with exclusion of animal proteins, other proteinsrestriction of up to 40% per day;
catheterization of the central veins and intravenous detoxification therapy at the rate of 50–60 mL / kg per day under
the control of diuresis, hematocrit number (Ringer's solution, Ringer's lactate, isotonic sodium chloride solution,
sodium hydrogen carbonate 2.4% depending on indicators of CO);5 mg / kg per day in equal doses after 6 hr for 3–7
days; plasmapheresis; aldosterone antagonists in combination with nonhepatotoxicsaluretics (furosemide) under
central venous pressure control, diuresis, CBS; proteolysis accomplished by protease inhibitors; daily enema with the
subsequent introduction of enterosorbents for 7–10 days; in case of bacterial complications – pneumonia,
pyelonephritis, cholangitis, sepsis – antibiotics.
4. Hepatitis B vaccination is done exclusively intramuscularly. Immunization from vaccination takes place in three
stages. On the recommendation of WHO, all newborns should receive hepatitis B vaccinations as soon as possible so
that the first dose is given within 24 hours of birth. The second dose is given at 2 months, and the third dose – at six
months of age.
5. A biochemical analysis of the blood shows an increase inindirectbilirubin fraction of the total bilirubin, a mild
increase in ALT level, a significant decrease of prothrombin time, a decreasedsulemic test, indicating the presence of
hepatitis, or hepatic dystrophy.
Task 5
The child, 5 years old, is treated because of hepatitis A. The intensity of jaundice, pain and dyspeptic
syndrome are moderate. The liver edge progects from the costal arc 4 cm – compact and painful. In biochemical
blood test: total bilirubin is 126.34 mcmol/L, direct bilirubin– 98.30, indirect bilirubin– 28.04, AST–1.72, ALT–2.06.
1. Put clinical diagnosis.
2. Child visits kindergarten.
3. What prophylaxis should be performed there?
1. Hepatitis A, typical jaundice form, moderate severity.

2. Quarantine for 35 days.
3. Everyday examination, thermometry, inspections of stool and urine color.
Task 1
A 10-year-old boyafter visiting his grandmother was hospitalized with complaints of fever up to 39 °С,
moderate sore throat at the time of swallowing, loss of appetite, feeling broken, severe headache.
At examination: The skin is pale. The palatine tonsils are enlarged due to their edema, the mucous
membrane is hyperemic, mostly with cyanotic tint, the surface of the tonsils is covered with a whitish-gray bloom
with a smooth surface tightly soldered to the adjacent tissue. The plaque is not removed by a spatula, at the
separation of the film the surface beneath it bleeds, and the removed film is not rubbed between the spatulas,
retains its shape in water. Submaxillary lymph nodes enlarged, edema of subcutaneous fat extends to the middle of
the neck. Despite the treatment, after 2 weeks the boy developed carditis.
In clinical blood test: RBC ‒ 3,5x10 12/l; Hb ‒ 120 g/l; WBC ‒ 16x10 9/l, e‒5%, st‒5%, seg – 67%, lymp –
20%, m – 3%, ESR‒ 20 mm/hour. General practicedoctordiagnosed with diphtheria.
The leading chain of pathogenesis in diphtheria is:
A. Toxemia.
B. Bacteriemia.
C. Homeostasis disorders.
D. Sensitization.
Task 2
A 5-month-old girl hospitalized in infectious ward with complaints of "barking" cough, hoarseness,
subfebrile body temperature. She is ill 3d day. The general condition gradually worsens. On examination the skin
is pale with perioral, feather-cyanosis, shortness of breath (appeared on the day of hospitalization; in auscultation -
hard breathing of the lungs, tachycardia). The doctor is suspected of having diphtheria.To confirm the diagnosis of
diphtheria it is necessary to carry out:
A. Bacteriological sowing of feces.
B. Bacteriological blood culture.
C. Bacteriological urine culture.
D. RPGA with diphtheria diagnosticum.
E. Bacteriological sowings of nasal mucus.
Task 3
A child 8 years complains of poor health, a rise in body temperature to 38,5°C, moderate sore throat when
swallowed for the last three days. Objectively: enlargement of the maxillary lymph nodes on both sides,
examination of the oropharynx - hyperemia with cyanotic tinge, swelling of the tongue and mucous membranes of
the tonsils and palatine brackets, on the surface of the tonsils - shiny, whitish grey. After removing the coarse
fibrinous film, the surface of the tonsils slightly bleeds. Bacterioscopy of oropharyngeal secretions revealed
pairwise, gram-positive microorganisms with mace-like thickening at the ends.
The child is diagnosed with localized diphtheria of the tonsils, a filmy form of moderate severity.
As a result of the transferred diphtheria is formed:
A. Persistent antimicrobial immunity.
B. Persistent antitoxic immunity.
C. Group antimicrobial immunity.
D. Persistent type-specific antimicrobial immunity.
Answers to tasks:
Task 1: A.
Task 2: D.
Task 3: B.
Task 1
The boy 10 years after visiting his grandmother had moderate sore throat, feeling broken, severe headache. On
the third day, the body temperature is 38.2‒38.9 °C. The skin is pale. Review of the pharynx - hyperemia with
cyanotic tinge, swelling of the tongue and mucous membrane of the pharynx, on the tonsils gray-white coarse
fibrinous film, which is difficult to remove. Submaxillary lymph nodes enlarged, edema of subcutaneous fat
extends to the middle of the neck. Bacterioscopy of swallow throat smear - large, straight, slightly curved
polymorphic rod-shaped bacteria. Metachromatic grains of locust are localized at the poles of cells, giving the
cells a characteristic "mace" shape. Grains are colored with methylene blue by Neisser. On the micropreparations
are located singly, or, due to features of cell division, are arranged in the form of the Latin letter V.
Despite the treatment after 2 weeks, the baby developed carditis.
1. What is the most likely disease in a child?
2. Which means a confirmed case of the disease
3. Who is to be hospitalized for this disease?
4. At what age do vaccinations begin against this disease?
5. Interpret the results of bacterioscopy of the oropharyngeal smear.
Correct answers to task 1

1. Toxic diphtheria of the tonsils.
2. A confirmed case of diphtheria is found in all patients with sore throats, laryngeal stenosis, etc., in which a
toxigenic strain of diphtheria rod is isolated.
3. All patients should be admitted to the hospital, depending on the severity, to the boxed or intensive care unit
of the infectious hospital.
4.In 2 months.
5. Infection with Corynebacterium diphtheriae.
Task 2
The child is 6 years old, ill the second day. Complaints of fever to 40 °C, headache, weakness, vomiting,
swallowing pain. The condition is heavy. On examination - subcutaneous fat of the neck swelled to the middle.
Above the surface of the edema, the skin is unchanged, when the fossa is depressed, the skin does not remain, the
edema has the character of jelly. On the tonsils, palatine, tongue dense, white-gray patches, removed heavily, and
after removal the surface bleeds. The mucous membrane is swollen, hyperemic with cyanotic tint. When
conducting a clinical blood test the following results were obtained: Hb‒120 g/l; RBC‒4,2x 109/l; MCH‒0,9;
WBC‒ 16,4x109/l; e ‒1%; stab ‒7%; neutr‒69%; lym‒21%; mon ‒2%; PLT‒218x109/l; ESR‒24 mm/hour.
1. Establish a previous diagnosis / emergency.
2. Identify treatment tactics and list groups of medications.
3. Name the agents in each group.
4. Specify the dosage and frequency of administration.
Correct answers to task 2:

1. Common diphtheria of the tonsils, toxic form I.
2. All patients should be admitted to the hospital, depending on the severity, to the boxed or intensive care unit
of the infectious hospital. Etiotropic therapy, antibacterial therapy.
3.Etiotropic therapy (anti-diphtheria serum (ADS), antibacterial therapy (macrolides, penicillins,
cephalosporins).
4.Etiotropic therapy - administration of anti-diphtheria serum (ADS), dose and frequency of administration
depend on the severity and clinical form of diphtheria. After a diagnosis of diphtheria, or a suspected suspicion,
ADS is administered within the first two hours after hospitalization. ADS is not given to children who have been
diagnosed with diphtheria after day 7 and have no symptoms of intoxication and lining on the tonsils. ADS is
entered only after intradermal testing. In mild diphtheria, the entire dose of ADS is administered once
intramuscularly and ranges from 20 000 to 40 000 IU. In severe diphtheria, the course dose of ADS is 90 000‒120
000 IU‒150 000 IU. The first dose should be 2/3 of the course. 3/4 of the course dose is administered per day of
hospitalization. In very severe forms of the disease is indicated intravenous drip serum.
Antibacterial therapy: in mild forms: macrolides in the middle - azithromycin 10 mg/kg, with moderate and
severe ‒parenteral amoxicillin 50‒90 mg/kg/day, ceftriaxone or cefotaxime 100 mg/kg/day. The course of
antibacterial therapy is 10-14 days.
5. Clinical blood tests show signs of inflammatory bacterial etiology (leukocytosis, left-shift neutrophilosis,
accelerated ESR).
Task 3
The child is 4 years ill within 3 days. The disease has a slow start: fever subfebrile, coughing "barking", and
then became silent, the voice aphonic, breathing noisy with the involvement of compliant places of the chest.
Cyanosis of the nasal-labial triangle appeared. Dry rales are heard in the lungs. Heart tones rhythmic, muted, 122
beats in 1 minute The child is vaccinated in violation of the vaccination schedule. When determining the level of
antibodies to diphtheria toxoid IgG − the result is 0.01 IU/ml.
1. Identify treatment tactics and list groups of drugs.
4. Interpret the clinical blood test.
Correct Answers to task 3

1. Localized laryngeal diphtheria (diphtheria cereals), a stenotic subcompensated stage.
2. Hospitalization, specific therapy (anti-diphtheria serum), antibacterial therapy, detoxification therapy.
3‒4. All patients should be admitted to the intensive care unit of the hospital. Specific therapy: administration
of anti-diphtheria serum in the first hours after hospitalization after intradermal testing at a dose of 80 000‒120
000 IU. The first dose should be 2/3 of the course. 3/4 of the course dose is administered on the day of
hospitalization. The interval for the introduction of PDS is 12 hours if the entire dose of serum was administered
intramuscularly and 8 hours if the PDS was administered intravenously. Antibacterial therapy − parenterally semi-
synthetic antibiotics of penicillin (amoxicillin 50–90 mg/kg/day and cephalosporin series (cefazolin, cefuroxime at
a dose of 30–100 mg/kg/day 3–4 administration) Duration of antibacterial therapy 10 days. therapy is carried out
with glucose-saline and colloidal solutions, taking into account daily needs and pathological losses.
5. The result is questionable, close to negative, indicating insufficient immunity after vaccinations due to
vaccination calendar disorders. (Antibodies to diphtheria toxoid IgG: <0.01 ‒ negative; 0.01‒0.099‒doubtful;>
0.1‒positive).
Task 1
A 1-year-old baby has whooping cough. In one of cough paroxysms the child becomes cyanosis and its
breathing disappears. Point the cause of breathing disappearance.
A. Impaired gas exchange secondary to pneumonia.
B. Embolism and ventilation perfusion mismatch.
C. Right to left shunt in congenital heart disease.
D. Arteriovenous malformation.
E. Inhibition of respiratory center.
Task 2
A 6-year-old girl complains of paroxysmal cough with whoops. There is edematous face, hemorrhages in
the sclera, shallow ulcer on the frenulum of the tongue. Auscultation reveals dry rales. Examination of the
oropharynx leads to cough paroxysms. What is the main route of transmission of this disease?
A. Contact domestic.
B. All answers are right.
C. Aerial-droplet route.
D. Transmissible.
E. Parenteral.
Task 3
A 3-year-old boy was ill 2 weeks ago. The disease began from dry cough, which increased gradually.
Paroxysmal cough appeared and whoops occurred. In paroxysm the patient's face is read, the cervical wins are
engorged. There are hemorrhages in the sclera. Leukocytes level is 16xl09/l, lymphocytes-72 %, ESR-4 mm/h.
Your preliminary diagnosis is whooping cough. How we can explain appearance of cough reflex on whooping-
cough?
A. Toxins effect on respiratory center and neurons, which provide for cough reflex.
B. The exciter's tropism to epithelium of upper airways.
C. Allergenic action of whooping-cough microbe.
D. Bacteremia.
E. Autoimmune mechanism.
Task 4
A 2 -year- old girl has been ill for 2 weeks. Now she has paroxysmal cough with whoop and vomiting,
hemorrhages in her sclera, shallow ulcer on the frenulum of the tongue. Auscultation reveals dry rales. Point to
medication for prophylaxis of this disease: Your preliminary diagnosis is whooping cough.
For the blood test in the typical course of the whooping-cough not characteristic is:
A. Normal ESR.
B. Lymphocytosis.
C. Neutrophilic left shift.
D. Monocytosis.
E. Leukocytosis.
Task 5
Child 3 years old, sick for 2 weeks, coughing within 8 days, the temperature was subfebrile. Then the
coughing attacks of the character got to facial flushing, reprises, a discharge of a viscous, glassy phlegm up to 15
times a day. Hemorrhages in the sclera of both eyes, bridle language are sore. In the lungs there are severe
breathing. The introduction of what drug can prevent this disease?
A. DTP vaccine.
B. Immunoglobulin.
C. Antibiotic.
D. Sulfanilamide.
E. Bacteriophage.
Answers to tasks:
Task 1: E.
Task 2: C.
Task 3: A.
Task 4: C.
Task 5: A.
Task 1
The child is 3 months old, sick for 8 days. The disease started with a cough, body temperature 36.5 оС. After 5
days from the beginning of the disease was examined by a doctor - diagnosis of ARVI. The cough intensified at
night. The prescribed treatment is not effective. From the anamnesis it is known that the child's father coughs for a
month.
On 10-11 day the cough of the child became palpable up to 15 times a day, with the face blushing, the tongue
during coughing was put forward, cyanosis of the nasolabial triangle was noted. The child took a forced position.
There was a tear. After the onset of cough, viscous sputum escaped. In one of these attacks, the baby turned blue,
stopped breathing. In the lungs hard breathing, no wheezing. Heart tones rhythmic, tachycardia. In clinical blood
test: Hemoglobin – 115 g/l; RBC – 4,0x109/l; MCH – 0.9; WBC – 19.2x109/l; EO – 1 %; STAB – 2 %; NEUT –
22 %; LYM – 72 %; MON – 3 %; PLT – 230x109/l; ESR – 2 mm/hour.
The patient has a brother of 6 years who attends kindergarten. Vaccinated, revaccinated. The neighbors have a
baby for five months.
1. Make the patient a clinical diagnosis.
2. What additional research methods are needed to confirm the diagnosis? 2 Name the criteria for a confirmed
whooping cough diagnosis as recommended by WHO and the CDC.
3. Assign a patient with etiotropic treatment.
4. What anti-epidemic measures should be taken?
1. Cough, typical severe form, period of spasmodic cough, apnea.

2. Clinical blood test, bacteriological examination (method of cough plates or smear from the back of the
pharynx), serological examination (PHT, AR in dynamics or IgA. IgM to B. pertussis in the blood), PCR.
According to the WHO and CDC recommendations, the cough is considered to be confirmed, provided the typical
clinical picture and positive PCR results or contact with the cough patient (who has a laboratory confirmed case)
are confirmed. The diagnosis of whooping cough is established in the presence of cough of any duration with a
positive bacteriological culture of B. pertussis. Serological methods can detect IgA and IgM class antibodies to B.
pertussis in the blood.
3. For etiotropic purposes, it is possible to prescribe macrolites as an example of azithromycin 10 mg/kg (50 mg
of this child) orally for 5 days or cephalosporins of the third generation – ceftriaxone 100 mg/kg intravenously for
7–14 days.
4. A sick boy is isolated for 30 days from the onset of the disease. The brother of a sick child should be
observed for 14 days. Neighborhood infants should be injected with human immunoglobulin 1.5 ml and monitored
for 14 days (during the incubation period).
5. In clinical blood tests, leukocytosis, ESR-reduced lymphocytosis, may indicate the presence of a baby's
pertussis.
Task 2
A 3-year-old child complains of a gradually coughing cough. On day 12 objectively: temperature 37.1 ºС, skin
pale. Oropharyngeal mucosa - pale pink. On the bridle of the tongue a small ulcer. Cough attacks of up to 20 per
day are noted, characterized by a series of coughing jolts followed by wheezing, the attack ends with the discharge
of vitreous sputum. In the lungs tight breathing, dry wheezing, sometimes wet. On a radiograph: horizontal
position of edges, increase of transparency of lungs, expansion of a root drawing. In the blood: WBC – 23x109/l,
EO – 1 %, STAB – 3 %, NEUT – 23 %, LYM –70 %, MON –3 %, ESR – 2 mm/hour. During one of the cough
attacks, the baby stopped breathing
1. Establish a previous diagnosis/emergency.
4. Specify the dosage and frequency of antibacterial agents used.
1. A whooping cough is a typical severe form, complicated by apnea.

2. In the case of respiratory arrest (apnea), the airway is restored as quickly as possible. The nose and mouth of
the patient should be relieved of mucus and vomiting. Normal breathing is restored by rhythmic pressure on the
chest and respirators. At frequent and prolonged apnea the child should be transferred to the intensive care unit, in
the most severe cases - to artificial respiration.
Further measures are taken to prevent new attacks of cough: etiotropic (antibacterial drugs) and pathogenetic
(oxygen therapy, antitussive drugs, neuroleptics, glucocorticosteroids) therapy.
3. Antibacterials (amoxicillin). Oxygen therapy, bronchodilators (salbutamol). Non-narcotic antitussive agents:
glaucine hydrochloride (glauvent), broncholitin, oxeladine (tusuprex, paxeladine), synecode (butamirate).
Neuroleptics (chlorpromazine - aminazine). Glucocorticosteroids (hydrocortisone).
4. Antibacterials (amoxicillin 25 to 90 mg/kg/day). Oxygen therapy, Non-narcotic cough supplements for
children under 6 years are contraindicated.
In children of the first year of life (in the presence of frequent apnea) preference is given to a titrated solution of
chlorpromazine, prepared at the rate of 1 ml of 2.5 % chlorpromazine per 3 ml of 0.25 % solution of novocaine.
The dose is calculated by chlorpromazine. In addition to chlorpromazine, diazepam at a dose of 0.3 mg/kg body
weight is used once a day to reduce cough attacks.
It is proved that the frequency and duration of apnea attacks with whooping cough reduces the introduction of
glucocorticoid hormones, especially hydrocortisone at a dose of 5–7 mg/kg body weight for 3–5 days. The dose of
hormones is gradually reduced, as a rapid reduction of it can lead to the resumption of apnea and increased attacks
of cough.
5. In clinical blood tests – leukocytosis, lymphocytosis and reduction of ESR, which makes it possible to
suspect a baby's whooping cough.
Task 3
The boy at the age of 3 years became ill gradually. From the first days of the disease, the mother of the child
complained of dry and frequent cough. Then the cough acquired a striking nature, each cough attack lasted up to
10 minutes and consisted of a series of short coughing thrusts, interrupted by a convulsive deep breath. They were
up to 6–8 during a single cough attack. The vomiting attack ended. One of the cough attacks led to apnea.
When conducting a clinical blood test, the following results were obtained: Hb – 125 g/l; RBC – 4.4x109/l;
MCH – 0.9; WBC – 19.2x109/l; EO – 1 %; STAB – 2 %, NEUT – 22 %; LYM – 72 %; MON – 3 %; PLT –
230x109/l; ESR – 2 mm/hour.
1. Establish a previous diagnosis / emergency.
1. Pertussis, typical severe form, spasmodic period, complicated course. Apnea.

2. Artificial respiration (in manual mode). Antibacterials, neuroleptics, antitussive drugs.
3. Antibacterials (amoxicillin, ceftriaxone, cefotaxime, neuroleptics (chlorpromazine), cough suppressants
(butyromate dehydrogencitrate).
4. Antibacterials (amoxicillin 50–90 mg/kg/day 3 times, ceftriaxone 100 mg/kg/day 2 times, cefotaxime 100
mg/kg/day 2 times); neuroleptics (aminazine at a dose of 1–2.5 mg/kg/day for 2–3 doses before daytime and
nighttime sleep; antitussive drugs in children for the first 6 years are contraindicated.
5. In clinical blood tests – leukocytosis, lymphocytosis and reduction of ESR, which makes it possible to
suspect a baby's whooping cough.
Task 1
1. A girl, 6 years old complains of sore throat, fever 39.2 °C, rashes on the skin. She is ill for 2 days. Rashes have appeared today.
During examination of the patient pharyngeal and tonsilar erythema, purulent tonsilar exudates, enlargement of anterior cervical lymph
nodes, erythema of the soft palate were found. Rashes as red tiny papules on the trunk and extremities, intensified in skin folds, the face is
flushing with circumoral pallor.
1. Name diagnosis.
2. Account a dose of penicillin G for this patient.

1. Scarlet fever.
2. 100000 IU x 22 kg=2,200,000 IU per day.
2,200,000:4=550,000 IU four times daily.
Task 2
A mother has addressed to physician with the girl, 5 years old. The mother complains of raised temperature in child and multiple
vomiting. The disease has begun suddenly. During examination: dry lips, sclera injection, hyperemia of the pharynx, the tongue is
covered by white "coat", small point-like rash on neck, upper part of the trunk, in skin folds. The pulse is small, heart tones are muffled.
1. What form of the scarlet fever has this child?
2. What clinical signs will prove this diagnosis?

1. The severe toxic form.
2. Multiple vomiting. The pulse is small, heart tones are muffled.
Task 1
A 6-year-old child has complains of: rashes on the skin that appear today. Body temperature is 37.3 °C,
pallor-pink maculopapular eruption on the normal skin on the extensor surfaces, is separated from each other,
enlargement of occipital lymph nodes. Rubella is supposed. Virus of Rubella belongs to:
A. Paramyxovirus.
B. Arbovirus.
C. Togavirus.
D. Calicivirus.
E. Picornavirus.
Task 2
A 5-year-old child has been ill for 2 days. Physical examination: enlargement of occipital lymph nodes. It
has pallor-pink maculopapular skin rash on the extensor surfaces extremities, back, buttocks, hips. The elements
areseparated. Somewhere there is diffuse hyperemia in the pharynx. Enanthema is observed on the hard palate.
The child is not vaccinated. Rubella is supposed. Mechanism of transmission is:
A. Hemocontact.
B. Air-droplet.
C. Alimentary.
D. Droplet.
E. Contact.
Task 3
A child, aged 6, has been ill for 3 days, suffers from enlargement of occipital and hilar lymph nodes which
are painful on palpation. The temperature is 37.8 °C. There is separated maculopapular rash on the extensor
surfaces extremities, back, buttocks, hips.Enanthema is observed on the hard palate. What is the most probable
preliminary diagnosis?
A. Measles.
B. Adenovirus infection.
C. Rubella.
D. Scarlet fever.
E. Enterovirus exanthema.
Task 4
A 5-year-old child, not vaccinated, 2 weeks ago contacted with a patient with Rubella. Today his
temperature rose to subfebrile. Indicate other signs of Rubella in prodromal period.
A. Moderate intoxication and catarrhal signs, enanthema, increase of posterior cervical and occipital lymph
nodes.
B. Moderate intoxication and catarrhal sings, rashes on a skin.
C. Expressed catarrhal signs, intoxication, enanthema, Koplick’s spots.
D. Moderate catarrhal signs, enanthema, rashes on a skin.
E. Expressed intoxication, difficulty of the nasal breathing, increase of anterior and posterior cervical
lymph nodes.
Task 5
A 5-year-old girl has temperature increased to 37.5 °C. 17 days ago she contacted with a patient with
Rubella. What changes on oral mucosa will be present in this child?
A. Enanthema on a soft palate, the Koplick’s spots.
B. Hyperemia of the external opening of the parotid salivary gland’s channel.
C. Catarrhal tonsillitis, graininess of back pharyngeal wall.
D. Maculousenanthema on a hard palate, herpangina.
E. Maculousenanthema on a soft palate, hyperemia of the throat.
Task 6
To the child with the purpose of innate Rubella confirmation virology research is performed. What
environments and liquids should be admitted?
A. Blood, saliva, cerebral-spinal fluid.
B. Blood, saliva, urine, sweat.
C. Blood, cerebral-spinal fluid, urine.
D. Blood, nasopharyngeal mucus, excrements, urine.
E. Urine, excrements, saliva, sweat.
Task 7
A 5-year-old child has temperature 37.5°С and mild toxic syndrome. Rhinitis, pharyngitis, catarrhal
tonsillitisare observed. Skin is without pathology.Increase of posterior cervical, occipital lymph nodes. Rubella is
supposed. What period of the disease does the child have?
A. Incubation.
B. Prodromal
C. Rash-period.
D. Residual.
Task 8
A 4-year-old boy has been ill for 4 days. The temperature isup to 37.7°C. There is enanthema on the
mucosa of the hard palate. Enlargement of occipital and hilar lymph nodes which are painful on
palpation.Rubellais infectious:
A. Till the 5th day from the beginning of the rash.
B. In prodromalperiod.
C. On last days of incubation.
D. In rash period.
Task 9
There is a case of rubella in the middle group in the kinder-garden. Fourchildren have not had this disease
before and are non-vaccinated. Children are healthy, do not have contraindications to prophylaxis. What would
you prefer to use for prophylaxis of rubella for those children?
A. Ventilation.
B. Anti-rubella vaccination.
C. Introduction of gamma globulin.
D. Wet cleaning.
E. Home regime.
Task 10
A 3-year-old girl is not vaccinated against rubella. Shewas in touch with a child with period of exanthema
of rubella and took immunoglobulin. She can fall ill within:
A. 2 days.
B. 11 days.
C. 14 days.
D. 21 days.
E. 28 days.
Answers to the tasks:
Task 1: C.
Task 2: D.
Task 3: C.
Task 4: A.
Task 5: E.
Task 6: D.
Task 7: B.
Task 8: A.
Task 9: B.
Task 10: D.
Task 1
A baby was born on the 8 th month of gestation. It had microcephalia, cataract, cardiac defects. On the 2 nd
month of the pregnancy its mother had low-grade fever, enlarged lymph nodes, and pale red small macular rash on
her face, trunk and extremities. These signs disappeared after 3 days without residual occurrence.
1 Make the preliminary diagnosis.
2. Where should the patient be treated?
3. Make the plan of examination of the patient.
4. How to prevent from this disease?
1. Innate Rubella.
2. Hospitalization in special medical institutions.
3. Determination of RNA of the virus in blood, urine, saliva, feces, cerebrospinal fluid.Serologic
examination for IgM to rubella virus.
4. Seronegative women should be vaccinated at least 3 months before pregnancy.
Task 2
A 5-year-old child has low-grade fever, enanthema, enlarged post-auricular cervical and suboccipital
lymph nodes, palered small macular rash, which localizes mainly on the extensor surface of the extremities, back
and buttocks.
1. The prospective clinical diagnosis.
2. What is this disease should we think of (the differential diagnosis)?
3. Administer a necessary scope of examination of the patient for confirmation of the diagnosis.
4. The plan of treatment of the patient.
Right answers to the task 2
1. Rubella.
2. Measles, Scarlet fever, Pseudotuberculosis.
3. Examination: blood count, ELISA, serologic examination of blood for IgM to rubella virus.
4. Diet, bed regime. Disintoxication therapy, antipyretic drugs.
Task 3
The two years old child has fevers up to 37.2 °С and rash on skin. Objectively: general condition is
satisfactory. There is macular rash of pink color on skin of back and extension surface of extremities. Mucous
tunic of palatine arches is moderate hyperemic and has fine macular rash. There are insignificant mucous
discharge from a nose and enlargement of occipital lymph nodes. Give answers to questions:
1. What is the most credible disease?

2. What specific prophylaxis is conducted at this disease?
3. Principles of treatment of this disease.
1. Rubella.
2. Rubella virus vaccine.
3. Symptomatic therapy.
Task 1
A 4-year-old child on the 5th day of illness complains of cough, rash on the skin. The temperature is 38,2°C,
face is puffy; photophobia, conjunctivitis are observed. There is a bright maculopapular rash on the face, neck,
upper half of the thorax. The pharynx is hyperemic. There are serous and purulent discharges from nose, dry rales
in the lungs. Measles is supposed. Virus of measles belongs to:
A. Paramyxovirus.
B. Arbovirus.
C. Togavirus.
D. Calicivirus.
E. Picornavirus.
Task 2
A 9-year-old child has been ill for 5 days. Physical examination: conscious, inert. Catarrhal conjunctivitis,
scleritisare observed. It has bright-red papulous middle-spotted skin rash on the face and behind ears. The
elements merge. Somewhere there is diffuse hyperemia in the pharynx. Enanthema is observed on the soft palate.
The child is not vaccinated. Measles is supposed. The most probable entry of infection for measles virus is:
A. Injury of skin.
B. Eye conjunctiva.
C. Lungs.
D. Intestines.
E. Tonsils.
Task 3
A child, aged 4, has been ill for 5 days, suffers from cough, skin rash, facial swelling, photosensitivity,
conjunctivitis. The temperature is 38,2°C.There is bright maculopapular rash with areas of merging on the face,
neck, and upper part of the chest. The throat is hyperemic. Seropurulent nasal discharges are observed. There are
dry crackles in lungs. What is the most probable preliminary diagnosis?
A. Measles.
B. Adenovirus infection.
C. Rubella.
D. Scarlet fever.
E. Enterovirus exanthema.
Task 4
A 7-year-old child complains oftemperature– 37,7 °С, dry cough.Nasal breathing is disturbed. On the 4 th day
the temperature is 39,5 °С.There are maculopapular rashbehind the ears, on the face, and neck; some elements are
confluent. Pharynx is hyperemic.There are whitish spots on the buccal mucosa; conjunctivitis. Measles is
supposed. For measles is not typical:
A. Acute beginning.
B. Considerable catarrhal features.
C. Fever.
D. Exanthema and enanthema.
E. Hepatolineal syndrome.
Task 5
A 5-year-old childhas got acutely sick; Т – 38°С, barking cough, sharp pain in eyes. On the 4th day of the
disease: Т – 40°С, apathy, somnolence, barking cough, light fear. There is bright-red maculopapular rash on the
face, neck, and upper parts of the trunk, confluent, on the pale skin. There are enanthema and little white spots on
the buccal mucosa. The resonant breath is observed in the lungs. Child is not vaccinated, goes to kindergarten,
where there are other 5 non-vaccinated children. Measles is supposed. Name possible form of measles course:
A. Slow infection.
B. Undulating.
C. Protracted.
D. Recurrent.
E. Chronic.
Task 6
A 4-year-old child has been ill for 5 days. It complains of cough, rash appeared 2 days ago. The temperature is
38,2°С. It has pale and edematic face, conjunctivitis, rhinitis; maculopapular rash behind the ears, on the neck, and
on the upper part of thorax is observed. Pharynx is hyperemic. There are dry rhonchi in the lungs. Measles is
supposed. The reason of rash at measles is concerned with:
A. Blood velocity.
B. Degree of viremia.
C. Structure of the skin cover.
D. Different tissue sensitivity to viruses.
Task 7
A 4-year-old child has fever. The temperature is 37,8°С. Dry cough, conjunctivitis, rhinitis are observed. Face
is hyperemic, skin is without pathology. Pharynx is hyperemic. There are enanthema and little white spots (1х1
mm) on the buccal mucosa, surrounded by hyperemic area, do not detach. Measles is supposed. What period of the
disease does the child have?
A. Incubation.
B. Prodromal
C. Rash-period.
D. Pigmentation.
E. Residual.
Task 8
A 5-year-old boy has been ill for 5 days. The disease had abrupt onset with fever. The temperature is up to
38,1°C. Cough, conjunctivitis, and edema of eyelids are observed. Maculopapular rash appeared on his face, neck
and behind ears on the 5th day of the disease. On the next day the rash spread to his trunk. Measles is supposed.
Name the main reason of the skin pigmentation in sick at measles:
A. Melanin deposits in the rash elements.
B. Hemosiderin deposits as a result of hemorrhage.
C. Formation of the productive inflammation focuses.
D. Accumulation of the lymphocytic and histocytic cells in rash elements.
Task 9
A 7-year-old boy has been ill for 2 days. He complains of cough, coryza, headache, fever. The temperature is
up to 38°C. There is conjunctival hyperemia, epiphora, enanthema on the mucosa of the soft and in the part of the
hard palate, whitish papulae looking like poppy-seed, surrounded by a narrow band of hyperemia opposite the
molar teeth. Measles is infectious:
A. Till 5th day from the beginning of the rash.
B. In catarrhal period.
C. On last days of incubation.
D. In rash period.
Task 10
There is a case of measles in the middle group in the kinder-garden. Three children have not had this disease
before and are non-vaccinated. Children are healthy; do not have contraindications for prophylaxis. What would
you prefer to use for prophylaxis of measles for those children?
A. Ventilation.
B. Anti-measles vaccination.
C. Introduction of gamma globulin.
D. Wet cleaning.
E. Home regime.
Task 11
A 2-year-old boy is not vaccinated against measles. He was in touch with a child with catarrhal period of
measles and took immunoglobulin. He can fall ill within :
A. 2 days.
B. 11 days.
C. 14 days.
D. 21 days.
E. 28 days.
Answers to tasks:
Task 1: A.
Task 2: B.
Task 3: A.
Task 4: E.
Task 5: A.
Task 6: C.
Task 7: B.
Task 8: B.
Task 9: A.
Task 10: B.
Task 11: D.
Task 1
A child of 3,5 years old attends a kindergarten. Within 3 days rise in the temperature to 38,0–39,0°C was
marked, he became restless, there was a dry cough, eyes and eyelids reddened, lacrimation and photophobia were
marked. On the 3rd day his mother noticed fine whitish points like semolina in size on the child's gums. The
mother presented these complaints to the local physician.
Objectively: the child is languid, the eyelids are hyperemic, conjunctivas are hyperemic and edematous.
Integuments are pale, clean, there is no rash. The pharynx is brightly hyperemic, the mucosa is friable, there is
spotty enanthema on the palate. There is a coating in the form of fine whitish points of semolina in size on the
mucous membrane of the cheeks and gums which do not merge and can't be removed with the spatulas. Breath is
hard above the lungs, there are single conducting dry rales. Activity of the heart is rhythmical. Other pathology is
not revealed.
1.Make the preliminary diagnosis, prove it.

2. Where should the patient be treated?
In a day the child had rash on the face, behind the ears in the form of fine pink spots which became larger
within a day, they merged here and there against the background of continuous catarrhal signs. The face became
swollen. Next day rash extended to the trunk and then to the extremities. Elements of rash are brightly pink, of
irregular shape, confluent here and there, large, of 0,5 cm, protrude above the skin surface. The skin between the
rash elements is of usual color.
3. Will the initial diagnosis change? If yes, how will it be formulated?

4. Make the plan of examination of the patient.
5. Makethe plan of treatment.
5. Measles, catarrhal period, a typical course. For the catarrhal period: high temperature, catarrhal signs, dry
cough, conjunctivitis, lacrimation, photophobia, Filatov–Koplik's spots.
6. As there are no complications the child may be treated at home.
7. Measles, typical, of moderate severity, a period of eruption.
8. Blood count, general analysis of urine, roentgenography of the chest, serologic examination for IgM to measles
virus.
9. Diet, bed regimen, hygiene of the face, oral cavity, skin. Antipyretic drugs, polyvitamins, expectorant mixtures.
Task 2
A child of 1,5 years old has been ill for 3 days: temperature– 38,5°C, rough “barking” cough, rhinitis,
conjunctivitis, photophobia, fine spotty enanthema on the palate, fine white spots on the mucous membrane of the
cheeks.
1. The prospective clinical diagnosis.
2. What is this disease?(The differential diagnosis).
Today on the 4th day of the disease the condition worsened, the temperature rose up to 39,5°C, at the height
of fever there was an attack of short-term spasms and expressed dyspnea. There was rash on the face. Parents
called an ambulance.
Objectively: temperature 39,8°C, the child is languid, lethargic. He had frequent rough cough. The pharynx
is brightly hyperemic, there are fine white spots on either side of the mucous membrane of the cheeks. Plentiful
pink spotty-papulous rash is seen on the face, behind the ears and on the neck, the elements of rash merge. The
eyelids are swollen, there is conjunctivitis. Respiration is 60/min. The nose wings are strained, there is intercostal
retraction. Percussion above the lungs on the right reveals shortening of percussion sound in the lower part. On
auscultation breath is sharply weakened in the lower part on the right. Heart sounds are a little bit muffled, there is
tachycardia. Other pathology is not revealed.
3. Make the detailed clinical diagnosis.

4. Administer a necessary scope of examination of the patient for confirmation of the diagnosis.
5. The plan of treatment of the patient.
5. Measles, catarrhal period.

6. Flu, parainfluenza, adenoviral infection.
7. Measles, typical form, a period of eruption, severe degree, right-sided pneumonia
8. Examination: blood count, common urine analysis, roentgenography of the chest, serologic examination of
blood for IgM to measles virus.
9. Diet, bed regimen. Antibacterial therapy, disintoxication therapy, antipyretic drugs.
Task 3
In a child of 4 years old, who visits kindergarten, the body temperature rose to 39°С, cough, cold,
conjunctivitis appeared. The temperature remained high for three days, the catarrhalphenomenon grew. On the 4th
day of illness at examination conjunctivitis, blepharospasmwere revealed. There isa spotted-papular rash on the
skinof face, behind the ears, spots of Belskiy–Filatov–Koplik are also present.
1. Formulate the clinical diagnosis.

2. What examinations must be appointed?
3. Prescribe treatment and work out a plan of antiepidemic measures in kindergarten?
1. Measles, medium-heavy type form.

2. Blood test, urine, direct hemagglutination test with a morbillous antigen, determinationof antibodies of class M
by the method of immune-enzyme analysis.
3. Symptomatic therapy: 20 %sulfacetamide solution for eyes, mixture against a cough,desensitizing therapy,
vitamins.
Children, who didn’t have measles, on condition of one time contact canvisit kindergartensthe first 7 days,
and then they are quarantined till 17 thdays, and those, who got an immunoprotein,– to the 21thdays. In the pesthole
prophylactic examination and thermometry, regularventilation of apartment is conducted every day. The contact
children who were not vaccinatedbefore, because of contra-indications, are urgently vaccinated against measles.
Task 4
The mother of a boy, 3 years old, appealed to the doctor after four days from thebeginning of disease with
complaints about rise in temperature to 40°С, dry cough, cold,redness of eyes. One day ago a spotted-papular rash
appeared on the unchanged background ofskin behind ears and on the face. Later a rash spread to the neck, skin of
shoulder girdle. In thecommon analysis of blood –leucocytes 2,5·10 /l. It is known from anamnesis, that a boy 10
9
days ago was in contact with a patient which after arash on the skin had pigmentation.
Give answers to questions:

2. What specific prophylaxis is conducted at this disease?
3. Principles of treatment of this disease.
Right answers to task4
1. Measles.
2. Measles virus vaccine.
3. Symptomatic therapy.
Task 5
On the 11th day after a contact with an ill person, the girl’s body temperature rose to39,7°С, a cold, redness
of eyes, photophobia, hoarse voice, dry cough appeared; after 4–5 daysfrom the beginning of disease stage-by-
stage a spotted-popular rash appeared on the unchangedbackground of skin behind ears and on the face, later – on
the neck and trunk, then on the lowerextremities. The disease was complicated by pneumonia. Give answers to
questions:

2. What pathognomonic changes on the mucous membrane of the mouth are characteristic for thisdisease in the
catarrhal period?
3. Describe changes on the mucous membrane of the mouth cavity of a child, presented on the picture.
1. Measles.
2. Spots of Belskiy–Filatov–Koplik on thehyperemic mucous membrane of the mouth cavityopposite a cheek-
tooth, later – morbillousanathema in the pharynx and whitish scurf on gums.
3. Morbillousenanthema (loosening of mucous membrane of the mouth cavity, point hemorrhageon the palate).
Task 6
On the 10 day after a contact with an ill person, a girl’s body temperature rose to 40°С, adry cough, cold,
th
redness of eyes appeared. After four days from the beginning of diseasestage-by-stage spotted-papular rash
appeared on the unchanged background of skin behindears and on the face, later – on the neck and trunk, then on
the extremities. After a rash during1,5 weeks there was pigmentation, and then a branny desquamation.Give
answers to questions:
2. How long does quarantine last for children, who were in contact with a patient?
3. Describe changes on the skin of a child on the 2nd day of the rash.
1. Measles.
2. A quarantine lasts from 9 to 17 days of contact; if the globulin was used – to 21 days.
3. Spotted-papular rash on the unchanged background of skin of face and trunk.

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Task 1

A. Catarrhal and intoxication syndromes.

A. Clinical blood analysis.

Answers to the tasks:

A three-and-a-half-year-old girl became acutely ill this morning: her body

1 Formulate a preliminary diagnosis.

A. Shortness of breath during physical exertion.

3 Tactics of the doctor:

A The child must be hospitalized in the intensive care unit.

4 Name the indications for prescribing antibiotics for stenotic laryngotracheitis:

1. 1 Your likely clinical diagnosis.

1. Diagnosis : SARS , febrile convulsions.

1. 1 Oxygen therapy (30 - 50% O 2 ) continuously through a nasal catheter , a

1. 1 Emergency therapy for convulsive syndrome.

2 SARS, nasopharyngitis. Hyperthermic and convulsive syndrome.

1. 1 SARS, stenotic laryngotracheitis, subcompensated.

1. 1 What is the most likely disease in the child?

1. A two-and-a-half-year-old child had a sharp rise in body temperature to 38.8°C,

A 13-years-old boy became ill acutely, body temperature is 38,4°С, tonsillitis,

1. 1.Infectious mononucleosis, moderate severity, typical form.

A 9-month-old baby has spinal form of poliomyelitis.

1 What is your preliminary diagnosis?

2 What is the etiological factor of the disease?

4 How long should the patient be isolated?

1 What is the first disease you think of?

3 Nonparalytic forms of poliomyelitis include:

The correct answers are: 1-A, 2-B, 3-D and 4-B.

1. What disease is suspected?

1. Poliomyelitis, typical pontinus form, paralytic period, severe stage.

1. Oral poliomyelitis vaccine, in 18 months.

The correct answer is C.

What is the name of preliminary diagnosis?

The correct answer is E.

What form of disease is the most probable?

The correct answer is D.

Correct answers to the tasks

Correct answers to the Task 1

1. Icteric and dyspeptic syndromes, hepatomegalia.

Correct answers to the Task 2

Right answers to the Task 3

Correct answers to the Task 4

1. Viral hepatitis B, a typical jaundice, severe. Complications – hepatodystrophy.

Correct answers to the Task 5

1. Hepatitis A, typical jaundice form, moderate severity.

Correct answers to task 1

Correct answers to task 2:

Correct Answers to task 3

Right answers to task 1

1. Cough, typical severe form, period of spasmodic cough, apnea.

Right answers to task 2

1. A whooping cough is a typical severe form, complicated by apnea.

1. Pertussis, typical severe form, spasmodic period, complicated course. Apnea.

Right answers to task 1

Right answers to task 2

Right answers to task 1

Right answers to the task 2

1. What is the most credible disease?

1.Make the preliminary diagnosis, prove it.

3. Will the initial diagnosis change? If yes, how will it be formulated?

Right answers to task 1

3. Make the detailed clinical diagnosis.

Right answers to task 2