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Пульмонология, гематология (англ,рус)

b. Liquefaction of thick sputum may be pro­moted by inhaling warm mists and, in some cases, mucolytic agents such as acetylcysteine or 5% sodium bicarbonate given by aerosol may also be helpful.

 3. Control of respiratory infection-Exposure to respiratory infections should be minimized and the patient should be vaccinated against influenza and pneumococcal pneumonia. Antibiotic therapy is indi­cated for acute exacerbations (ie, increased production of purulent sputum, hemoptysis, etc). Long-term or prophylactic antibiotic therapy is controversial, since it has not been conclusively shown to be of  lasting benefit. Therefore, it seems rational to treat acute exacerbations in order to control infection but mini­mize  the  emergence of resistant strains. Because the bacteria most commonly involved are H inftuenzae and S pneumoniae, the drug most commonly employed is ampicillin, 250-500 mg orally every 6 hours for 5 days. Alternative therapies for the penicillin-allergic patient are erythromycin, given in the same dosage schedule as ampicillin, or trimethoprim-sulfamethoxazole, 2 double-strength tablets twice a day for 5 days.

    B. Surgical Treatment: Surgical treatment is most often .employed when hemoptysis with bron-chiectasis is recurrent and severe. Despite antibiotic therapy, localized bronchiectasis (eg, in a lower lobe or segment) with progressive uncontrolled infection and sputum production may be an indication for surgical removal of the affected segments.

Other Considerations

Bronchiectasis is also associated with mucoviscidosis. It is thought to be secondary to the thick viscid secretions that  cannot be cleared by normal cough mechanisms and that  lead to stasis of. sputum and chronic infection. This disorder, usually associated with sinusitis, may be accompanied by other manifes­tations of mucoviscidosis. Its most common organisms are S aureus or Pseudomonas aeruginosa.

Bronchiectasis is also associated with certain ab­normalities of cellular ciliary function, the most common  of which is Kartagener's syndrome, a combina­tion of sinusitis, situs in versus, and bronchiectasis. Patients with this disorder show immotile cilia second­ary to ultrastructural abnormalities, stasis of sputum, failure to clear secretions, and chronic pulmonary infection that results in bronchiectasis.           

Antibiotic treatment of mucoviscidosis and Kartagener's syndrome must be guided by sensitivity studies of organisms cultured from sputum.

Prepared by Orlovsky A. V., assistant, D.Ph.,

                    Murenets N. A., postgraduate

 

 

 

 

 

Methodological Instruction to Lesson № 7.

 

Anemia.

Hours: 5.

Working place: classroom, hospital wards.

 

Questions.

 

1. To give definition of the term “Anemias”

2. Physiology of erythropoiesis and iron metabolism in organism.

3. Classifications of anemias.  

4. Etiology and pathogenesis of IDA.

5. Clinic of IDA.

6. The laboratory diagnostic of IDA.

7. Diagnostic criteria of IDA.

8. Treatment of IDA.

9. Preparations of iron. Their dozes and circuits of use.

10. What is indication for iron transfusion.

11. Preventive maintenance of IDA.

12. To give definition of the term “B12 and folate deficiency anemias”

13. Etiology and pathogenesis of B12 and folate deficiency anemias.

14. Clinic of B12 and folate deficiency anemias.

15. Change of nervous system at these anemias.

16. The laboratory and instrumental diagnostic at these anemias.

17.  Diagnostic criteria of B12 and folate deficiency anemias.

18. Treatment of B12 and folate deficiency anemias.

19. Features of treatment at changes of nervous system.

20. Criterion efficiency of treatment of B12 and folate deficiency anemias.

21. Preventive maintenance of B12 and folate deficiency anemias.

22. Clinic, Diagnostic and Treatment of megaloblastic anemias.

23. Concept of haemolytic and aplastic anemias

24. Etiology and pathogenesis of haemolytic anemias.

25. Classifications of inherent and acquired of haemolytic anemias.

26. Clinic of Thalassemias, Favism, hereditary spherocytosis (Minkowsky-Chauffard’s disease).

27. Clinic of acquired of haemolytic anemias.

28. The laboratory diagnostic of haemolytic anemias.

29. Clinic and Diagnostic of Hemoglobinopathies: Paroxysmal nocturnal hemoglobinuria, Sickle cell anemia.

30. Treatment of haemolytic anemias and their preventive maintenance.

31. Etiology and pathogenesis of aplastic anemias

32. Clinic and complications of aplastic anemias.

33. The laboratory diagnostic of aplastic anemias.

34. Diagnostic criteria of haemolytic and aplastic anemias.

35. Differential diagnostics of haemolytic and aplastic anemias.

36.Treatment of aplastic anemias and their preventive maintenance.

37.The indications to transplantation of bone marrow.

 

Examples of tests

 

1.      Name daily requirement of vitamin B 12:

a.       1 – 3 μkg

b.      2 – 7 μkg

c.       15 – 20 μkg

d.      30 – 50 μkg

2.      Where the normal physiology absorption of vitamin B 12 may occur?

a.       in the stomach

b.      in the duodenum

c.       in the jejunem

d.      in the terminal ileum

3.      Name daily requirement of folate:

a.       100 μkg

b.      300 μkg

c.       500 μkg

d.      700 μkg

4.      Name systems that may disturb in patients with vitamin B 12 deficiency anaemia:

a.       hematopoietic system

b.      respiratory system

c.       nervous system

 

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