If no (20)__________ develop and patients feel good they are allowed out of the bed after the 7th day of the (21)__________. They may be (22)__________ from the hospital on the 12—14th days.

The principal (23)__________ are acute nephritis, adenitis, otitis media, pericarditis, endocarditis, etc.

Scarlet fever patients should be (24)__________ and stay in bed. Careful (25)__________ of the patient's things is important. Antibiotics are prescribed.

(3)

Exercise 1.

Guess the diagnosis and prove your choice:

A senior student is taking his exam in infectious diseases.

PROFESSOR: Well, my young colleague, what eruptive diseases have you heard about?

STUDENT: Chicken-pox, scarlet-fever, measles, small-pox and many others.

PROFESSOR (pointing to the examination card): Let’s talk about this one. What kind of the disease is it?

STUDENT: It is one of the most communicable and widespread diseases. And it is characterized by myasthenia, oral mucosal dryness, difficulty in swallowing. The appetite is absent and the patient is usually thirsty. The mucous membrane is hyperemic. The period of eruption is characterized by Belski-Koplick-Fylatov macules. The patient must be taken to a ward for contagious patients.

PROFESSOR: How can you differentiate it from chicken-pox, scarlet-fever and other eruptive diseases?

STUDENT: The diagnosis can be made on the basis of the characteristic sign – the rash, which at first appears on the mucous membrane of the mouth and looks like tiny spots of white colour and produces burning pain in the mouth.

PROFESSOR: Can there be any epidemic outbreaks of the infectious disease? And how is it transmitted?

STUDENT: The possibility of epidemics is rather high. The disease is spread by direct contact, by infected droplets from the nose and throat. It is spread by means of sneezed or coughed droplets into the air, so any unimmunized person can easily catch the disease. The transmission by a third person or any contaminated object is unlikely to occur, although possible.

PROFESSOR: Is it a dangerous disease? What do you think about it?

STUDENT: I know that it is a very dangerous disease because of its numerous and severe complications. It is universal in its distributions and no age is immune. Thus the newly born ones may be attacked and those adults who have escaped the disease in childhood may contract it. The infection during the first trimester of pregnancy may increase the rate of spontaneous abortions and congenital malformations.

PROFESSOR: What are the most common sequelae?

STUDENT: The most frequent and dangerous complications may be found in the respiratory tract (especially pneumonia), laryngitis and bronchitis may run a severe course. Affections of the digestive tract (stomatitis, for example) are very common. In addition to the respiratory and digestive tracts the mucous membranes of other organs may also be affected during the course of the disease (conjunctivitis, otitis may be observed).

PROFESSOR: Well, I see you are quite well informed on the subject. By the way, one more question about the prognosis.

STUDENT: The prognosis depends on the age and condition of the sick child (I mean weak and premature born ones) and on complications which may follow it. But I’m sure that proper treatment and good nursing may prevent possible complications in nearly every case. The incidence of the infection is recommended to be declined dramatically by a wide use of corresponding vaccination.

PROFESSOR: That’s quite right. You know the theory well enough. I hope I can give you an excellent mark. And now go to the ward 7 and give your practical recommendations to the mother of one sick child about the treatment and nursing. She is eager to speak to you.

STUDENT: Thank you, professor. Good bye.

Exercise 2.

Play the part of a doctor. Ask the patient where he/she could have been exposed to:

Exercise 3.

Fill in the gaps in the text using the following words:

have viruses always young bed from complications who day agents administered children media pneumonia shortness of good severe occur meningitis involves the pericarditis or lungs

P__________(1) is a specific acute disease which i__________(2) an entire lung o__________(3) a part of a lung. Sometimes both lungs are involved. It may o__________(4) at any time of year, but it is frequent in the months from December until May. The chief predisposing factors are: weather, draughts, loss of sleep and contact with patients w__________(5) have infections. Various v__________(6) and staphylococci may cause it.

The main symptoms are chill, fever, general weakness, sweating and persistent dry cough which can't be relieved by common measures. The child usually has poor appetite, disturbed sleep. Sometimes children have local chest pains or stomachache. Y__________(7) infants suffer f__________(8) s__________(9) of breath. In s__________(10) cases patients may h__________(11) expectoration of bloody sputum. The disease sets in abruptly. There may be a preceding upper respiratory infection with a cough, if the disease remains uncomplicated it lasts from 7 to 14 days.

The treatment consists chiefly of b__________(12) rest. The most important a__________(13) are fresh air, g__________(14) nursing and nutritious food that t__________(15) child likes. The disease responds very well to specific medication with appropriate antibiotics (penicillin). Before the era of antibiotics sulfanilamides were used. Mustard plasters are a__________(16) a__________(17), sometimes cups as well. Diathermy of the l__________(18) gives very good results. The child should be given vitamins C, A and others from the very first d__________(19) o__________(20) the disease.

A variety of complications may occur. Sometimes empyema develops after the seventh day of the disease. Otitis m__________(21) and mastoiditis are usually found in c__________(22). Other c__________(23) are: p__________(24), endocarditis and m__________(25).

An important factor in the prophylaxis of pneumonia is fighting such infectious diseases as influenza, measles and whooping cough, all of which are often complicated by pneumonia.

(4)

Exercise 1.

Guess the diagnosis and prove your choice:

The mother of a sick child, a young doctor (intern) and a nurse.

DOCTOR: How do you do. I am your ward doctor. How is the child?

MOTHER: How do you do, doctor. You know, he started to feel worse. The cough and cold in the head became aggravated, the eyes got purulent. I have heard that it may be followed by severe complications. What measures should be taken to prevent them?

DOCTOR: First of all, proper treatment and good nursing may prevent possible complications. Nurse, will you come here, please. Place the patient’s bed so that the day light should not fall on his face, but the room must not be darkened because sun rays kill bacteria. As I see, the character of the eruptions is erythemoto-papular. There is some noticeable consolidation of the skin.

NURSE: May I air the room?

DOCTOR: Yes, the patient’s room must be aired. It’s quite stuffy in the ward. Have it aired not less than three times every 24 hours. Only cleaning with water is permissible. Wash the floor adding a disinfectant. Don’t allow any draughts.

NURSE: Certainly, doctor. I’ll do everything you have just told me.

DOCTOR (addressing to the mother): Try to keep your child’s mouth clean. He should rinse his mouth as often as possible. The nurse will give you a spittoon.

MOTHER: But unfortunately he cannot do it.

DOCTOR: Try to give him to drink some boiled water instead of rinsing after meals.

MOTHER: May I bathe him?

DOCTOR: He may be bathed as usual, but the temperature of the water is to be 36-37ºC. Several times a day you should wash the patient’s face and hands with water of room temperature and soap using a sponge or a gauze tampon. And don’t forget to wash out his eyes with a disinfective solution. Don’t allow him to rub his eyes. Remind him to wash his hands before eating.

MOTHER: But he has a poor appetite, he refuses from meals.

DOCTOR: Give him soft diet in small amounts 5-6 times a day. The patient may be given boiled meat, chicken soup, fruit juice, thick soup, rubbed gruel and steamed cutlets. Otherwise we’ll start feeding the patient artificially via a tube.

MOTHER: And what about the remedies?

DOCTOR: The nurse will bring you anti-viral drugs and disinfecting solutions. I suppose the prognosis will be favourable. I ask you to carry out all my recommendations.

MOTHER: I also hope proper conditions and good nursing will aid his recovery. Thank you.

Exercise 2.

Play the part of a doctor. Ask the patient and fill in the signs and symptoms blank:

Exercise 3.

Fill in the gaps:

Influenza is an (1)__________ infectious disease. It is caused by a filterable (2)__________. The disease (3)__________ very rapidly and affects the adult population and children. The (4)__________ period is 1-3 days. The (5)__________ is sudden with a chill, high temperature, bad (6)__________, pain in the eyes, back, joints and (7)__________. There is also a dry (8)_________. There may be sore (9)__________, sneezing and cold in the head.

The diagnosis is not difficult during an (10)__________. With the (11)__________ of symptoms the patient must be put in bed. He should stay there until the temperature is normal for at least 3 days. The disease may have numerous and dangerous (12)__________, such as: otitis media, bronchitis, pneumonia and so on. In a (13)__________ case the recovery is the rule. But during (14)__________ death may occur.

As to treatment it (15)__________ on severity of the disease. Proper nursing, hygiene and (16)__________ are very important. The patient's room must be constantly (17)__________. In warm weather the patient may be kept (18)__________ or in the room with windows wide open all day. Patients should always be (19)__________ plenty of fluid to (20)__________. Such (21)__________ as "antigrippin" (a combined anti-influenza (22)__________), different anti-viral (23)__________ (such as arbidol, remantadin) are used. Herbal and (24)__________ remedies can greatly relieve the patient’s (25)__________.

(5)

Exercise 1.

Guess the diagnosis and prove your choice:

PATIENT: May I come in, doctor? How do you do.

DOCTOR: Come in, please. How do you do. Please, come over here. What are your complaints?

PATIENT: I am awfully sick, doctor. I have chills, fever and I suffer from cold in the head and coughing. I am a subject to constant headaches. And I feel so limp all the time.

DOCTOR: Your face shows signs of tiredness. Let me check your temperature and examine you. Is it hard to swallow?

PATIENT: Yes, I feel constant pain in my throat. What’s wrong with me, doctor?

DOCTOR (examining the patient): You have a very sore throat and all the signs of a viral illness. This disease must be nipped in the bud. How long has it been since you began to feel ill?

PATIENT: I’ve got a cold this week. At first I had only general malaise, weakness and a bad headache. I couldn’t get to sleep well, actually I’m overcome by lack of sleep. And I had no appetite, I could hardly eat anything.

DOCTOR: Did you suffer from pain in the muscles and joints?

PATIENT: Yes, I had aches of every description. I felt pain in my eyes, back and joints…

DOCTOR: Well, I see. I’ll give you a sick-leave. Follow a strict bed regime. Remain in bed until the temperature is normal, for at least 3 days. Take the medicine, which I’ll administer you, regularly. You see, proper diet, hygiene and bed rest are very important for recovery.

PATIENT: And how should the medicines be taken?

DOCTOR: Take the drugs according to the prescription and on an empty stomach. And I hope that these drops will give you instant relief.

PATIENT: How long shall I have to take it?

DOCTOR: For 5 days. These remedies won’t do you any harm. In 3 days I’ll come to see you. I suppose you’ll be well soon. And next time I hope to see a marked improvement of your condition.

PATIENT: Thank you very much, doctor. Good bye.

DOCTOR: Good bye.

Exercise 2.

Look through the checklist below. Explain the main signs and symptoms of the patient:

Exercise 3.

Fill in the gaps in the text using the following words:

is first the contract careful characteristic means and incubation acute it by temperature day no clothing period desquamation of patients throat things of remains pulse

Scarlet fever is an acute contagious disease characterized by high temperature, rapid p__________(1), a punctate eruption followed by desquamation, inflammation of the throat. I__________(2) is caused b__________(3) Hemolitic Streptococcus.

The disease may be transmitted either by various objects — c__________(4), toys, books and food-stuffs, infected by the patient or by m__________(5) of droplet infection (during coughing, sneezing or talking).

All children are susceptible, particularly frequently between 18 months and 10 years of age. Adults also c__________(6) this illness, but they have only sore throat without the eruption c__________(7) o__________(8) scarlet fever.

The i__________(9) period of the disease lasts on an average 4—7 days; sometimes it only takes a few hours.

The onset of the disease is sudden. There i__________(10) generally a very sore t__________(11), a sharp rise of t__________(12) to 39—40°C, nausea, vomiting, headache a__________(13) often chills. The lymphatic nodes of the neck are enlarged. The child is restless and sleeps badly.

Within a few hours, but more often at the end o__________(14) the f__________(15) or in the beginning of the second day a diffuse red rash appears on the neck, chest and back, spreading to t__________(16) arms and legs. The area around the mouth r__________(17) free from rash. The rash lasts one or three days and then fades away. After the disappearance of the rash the p__________(18) of d__________(19) begins. Desquamation continues 10—14 days.

If n__________(20) complications develop and p__________(21) feel good they are allowed out of the bed after the 7th d__________(22) of the disease. They may be discharged from the hospital on the 12—14th days.

The principal complications are a__________(23) nephritis, adenitis, otitis media, pericarditis, endocarditis, etc.

Scarlet fever patients should be isolated and stay in bed. C__________(24) disinfection of the patient's t__________(25) is important. Antibiotics are prescribed.

(6)

Exercise 1.

Guess the diagnosis and prove your choice:

YOUNG DOCTOR: I’d like you to examine my patient. Can you?

EXPERIENCED DOCTOR: Yes, of course. What’s the trouble?

YOUNG DOCTOR: I suspect the diagnosis but I’m not sure. His mother treated him from common cold during the first 10 days, as he had only slight temperature, the onset of the disease was mild. He had quite a severe cough. But then his coughing became persistent and paroxysmal. The attacks occurred suddenly and were frequently followed by vomiting, the child coughed up a small amount of sputum. The attacks were accompanied by elevation of temperature and profuse sweating. The cough became more severe and frequent at night.

EXPERIENCED DOCTOR: I’ll go and examine the boy. What box is he in?

YOUNG DOCTOR: Number twelve.

EXPERIENCED DOCTOR: In the patient there is oral mucosal dryness. His face is reddened and the sclera are injected. Mastication and swallowing are difficult. Did you administer X-ray examination and blood test?

YOUNG DOCTOR: Yes, of course.

EXPERIENCED DOCTOR: And what were the results of the analyses?

YOUNG DOCTOR: Leucocytes and lymphocytes were discovered in the blood. Erythrocyte sedimentation rate is twice normal. Clotting time is normal. There were some changes in the urine and bacteria specific for this disease were isolated from the sputum.

EXPERIENCED DOCTOR: Well, what treatment have you prescribed?

YOUNG DOCTOR: As the attacks of this infection are less frequent and weaker and complications occur much more rarely in the fresh air, I recommended to keep the patient in the open air as often as possible, follow bed regime, take soft diet, vitamins and isolate from other children.

EXPERIENCED DOCTOR: You don’t say anything about the drugs…

YOUNG DOCTOR: Of course. I administered antibiotics and modern cough-suppressing remedies.

EXPERIENCED DOCTOR: OK. I hope the outcome will be favourable.

YOUNG DOCTOR: Thank you, colleague.

Exercise 2.

Make a dialogue between a nurse and a doctor according to the given information:

Exercise 3.

Fill in the gaps:

Chicken-pox is a very (1)__________ disease of children. The disease occurs in (2)__________, especially in children under the age of ten years. Children of the first four years of life are the most (3)__________. There is an incubation period of 14-21 days, most (4)__________ 17 days.

The first symptoms are the following: a (5)__________ fever and sometimes pains in the (6)__________ and legs. Almost at the same time (within twenty four hours) a characteristic eruption (7)__________ on different parts of the body. It is found very frequently on the (8)__________ (the hairy part of the head).

The eruption consists of red (9)__________ quickly progressing to papules and vesicles. Soon they become (10)__________. The brownish crusts dry up and fall off in two - three (11)__________. The child remains infectious until the scabs (12)__________.

The number of vesicles is very (13)__________. In a (14)__________ case there may only be eight or ten of the vesicles, but sometimes in (15)__________ cases their number may amount to six or seven hundred.

In the vast (16)__________ of cases there is no difficulty in making a diagnosis, but a doctor must learn how to (17)__________ it from other skin disorders especially from (18)__________.

Chicken-pox is one of the mildest of (19)__________ infectious diseases of children. Children (20)__________ feverish for 2-3 days, while new vesicles still (21)__________ and after that feel well. The (22)__________ is usually complete. (23)__________ are rare. Encephalitis may occur in uncommonly severe cases.

In the majority of cases no other treatment beyond isolation is required. The child should be kept in bed during the (24)__________ stage and as long as there is any fever. The lesions should be treated with a (25)__________ solution.

(7)

Exercise 1.

Guess the diagnosis and prove your choice:

DOCTOR A: Morning!

DOCTOR B: Morning!

DOCTOR A: I’ve just examined a new patient. She has been brought to the Emergency Room by ambulance with the diagnosis of some respiratory disorder a few hours before.

DOCTOR B: You see, I take a special interest in this case and want to know as much as possible about the patient. Well, what is your opinion? What could you reveal at the examination?

DOCTOR A: Oh, she is 20 years old. You know, she is rather pretty, has some troubles with her sleep and appetite. She suffers from difficulty in breathing which is rapid with 30-40 respirations per minute., dry persistent cough, particularly during nights and sweating. The pharynx is practically free from pathology. The temperature curve is constant. Fever had an irregular course and the temperature changes were caused by the appearance of the new foci of inflammation in the pulmonary tissue.

DOCTOR B: What else did she complain of?

DOCTOR A: She complained of a troublesome arching pain in the chest and periodical expectoration of bloody and purulent sputum. Dullness in the left lung, numerous rales and crepitation were revealed. I’m afraid her both lungs are involved in the infectious process. I directed her to make immediate X-ray examination.

DOCTOR B: I see… Is her past history available? Does the patient have any alarming symptoms?

DOCTOR A: The filling in the patient’s personal card is rather careful. Well, in the childhood she had chicken-pox and measles. And last month she had suffered from common cold and acute bronchitis of a moderate form. The blood analysis revealed leucocytosis in the range of 12,000-15,000 per cubic mm of blood and an accelerated erythrocyte sedimentation rate.

DOCTOR B: What therapy was she prescribed by her district doctor?

DOCTOR A: He considered the disease being of an unknown etiology. And she was treated with anti-influenza remedies.

DOCTOR B: Were the results quite favourable?

DOCTOR A: There was a slight improvement for some period of time, but then a change for the worse took place. Her condition assumed a grave character. The urine contained a small amount of protein and erythrocytes. The pulse rate was accelerated and the arterial pressure was reduced.

DOCTOR B: How are you going to treat her?

DOCTOR A: As no abundant liquid amount has been found in the pleural cavity I’ll administer her a diathermy of the lungs and antibiotics. It is also necessary to check the air volume emission from the fistula on respiration and coughing.

DOCTOR B: Let me examine her once more.

DOCTOR A: O.K.

Exercise 2.

Play the part of a doctor. Investigate the contacts of the patient Kevin Green:

Exercise 3.

Fill in the gaps in the text using the following words:

difficult is patient's dry condition the Such temperature the the outdoors nursing he rule different antigrippin symptoms patient epidemics warm disease the windows disease homeopathic

Influenza is an acute infectious d__________(1). It is caused by a filtrable virus. The disease spreads very rapidly and affects the adult population and children. The incubation period is 1-3 days. The onset is sudden with a chill, high temperature, bad headache, pain in t__________(2) eyes, back, joints and muscles. There is also a d__________(3) cough. There may be sore throat, sneezing and cold in the head.

The diagnosis is not d__________(4) during an epidemic. With the onset of s__________(5) the patient must be put in bed. H__________(6) should stay there until the t__________(7) i__________(8) normal for at least 3 days. T__________(9) disease may have numerous and dangerous complications, such as: otitis media, bronchitis, pneumonia and so on. In a mild case the recovery is the r__________(10). But during e__________(11) death may occur.

As to treatment it depends on severity of t__________(12) d__________(13). Proper n__________(14), hygiene and diet are very important. The patient's room must be constantly aired. In w__________(15) weather the p__________(16) may be kept o__________(17) or in t__________(18) room with w__________(19) wide open all day Patients should always be given plenty of fluid to drink. S__________(20) medication as "a__________(21)" (a combined anti-influenza medicine), d__________(22) anti-viral drugs (such as arbidol, remantadin) are used. Herbal and h__________(23) remedies can greatly relieve the p__________(24) c__________(25).

(8)

Exercise 1.

Guess the diagnosis and prove your choice:

Medical students with the attending doctor.

DOCTOR: Here you can see another sick child. He is 5. He complains of a slight headache of unknown etiology and pains of different intensity in the throat, suffers from nausea. He is restless and sleeps badly. The patient’s body weight has been considerably reducing.

FIRST STUDENT: I see. He has chills. Let’s take his temperature. Oh, a sharp rise of temperature, it’s 39ºC. It’s obviously a febrile period of the infectious disease.

SECOND STUDENT: His pulse rate is rapid, and his lymphatic nodes are enlarged. Catarrh of the upper respiratory tract is clearly marked.

THIRD STUDENT: May I examine his throat?... It is red, there is an inflammation of the throat. Oral mucosal dryness, difficulty in swallowing and strawberry tongue are characteristic.

FIRST STUDENT: Look, his body is covered with eruption.

SECOND STUDENT: The rash is red, diffuse and punctate. It looks like red goose-flesh.

THIRD STUDENT: It is on the neck, chest, back, arms and legs.

FIRST STUDENT: But we can notice pale nasolabial triangle.

DOCTOR: Can you diagnose the disease? I’m sure you can. And how long will the eruption last?

FIRST STUDENT: 1-3 days and then it fades away.

DOCTOR: And what is the eruption followed by?

SECOND STUDENT: It is followed by skin peeling which can be of macroscaling and laminar scaling character.

DOCTOR: And who knows the way of its transmission?

THIRD STUDENT: It may be spread by both direct and indirect contacts. Direct contact means the penetration of causative microorganisms from a sick infected or feverish person and indirect one is the transmission through contaminated objects.

DOCTOR: Well, OK. Let’s go and examine another patient.

Exercise 2.

Play the part of a doctor. Ask the patient and give your recommendations according to the information given in the signs and symptoms blank:

Exercise 3.

Fill in the gaps:

Pneumonia is a (1)__________ acute disease which involves an (2)__________ lung or a part of a lung. Sometimes both lungs are (3)__________. It may (4)__________ at any time of year, but it is frequent in the months from December until May. The chief (5)__________ factors are: weather, draughts, loss of sleep and (6)__________ with patients who have infections. Various viruses and staphylococci may cause it.

The main symptoms are chill, fever, general (7)__________, sweating and (8)__________ dry cough which can't be relieved by common measures. The child usually has poor appetite, disturbed sleep. Sometimes children have (9)__________ chest pains or stomachache. Young infants suffer from shortness of (10)__________. In severe cases patients may have (11)__________ of bloody sputum. The disease sets in abruptly. There may be a (12)__________ upper respiratory infection with a cough. If the disease remains uncomplicated it lasts from 7 to 14 days.

The treatment consists chiefly of (13)__________ rest. The most important agents are fresh air, good nursing and (14)__________ food that the child likes. The disease (15)__________ very well to specific medication with (16)__________ antibiotics (penicillin). Before the era of antibiotics sulfanilamides were used. (17)__________ plasters are always administered, sometimes cups as well. (18)__________ of the lungs gives very good results. The child should be given (19)__________ C, A and others from the very first day of the disease.

A variety of (20)__________ may occur. Sometimes (21)__________ develops after the seventh day of the disease. Otitis (22)__________ and mastoiditis are usually (23)__________ in children. Other complications are: pericarditis, endocarditis and meningitis.

An important factor in the (24)__________ of pneumonia is fighting such infectious diseases as influenza, measles and whooping cough, all of which are often complicated by (25)__________.

(9)

Exercise 1.

Guess the diagnosis and prove your choice:

DOCTOR: How do you do. Take this seat, please. I’m Doctor White. What’s the trouble?

PATIENT: I feel something scratchy in the throat, pain and discomfort in my chest and sometimes experience attacks of stomachache.

DOCTOR: What do you attribute these phenomena to? Have you consulted the district doctor?

PATIENT: Yes, on the basis of this clinical data and symptoms he made the diagnosis of a respiratory infection.

DOCTOR: Were you treated for your illness? What drugs did you take before the admission?

PATIENT: I was administered some remedies, but I didn’t take them regularly as I had some unusual reaction to them.

DOCTOR: Well, that is the cause of your prolonged illness. Now I’ll examine you with a stethoscope… Nurse, help the patient to take off her things, please. Stretch your hand out. Good. I’m going to check your blood pressure. Let me put this blood pressure machine cuff around your arm. Relax, please. Good.

PATIENT: Is it high?

DOCTOR: A little bit elevated. That’s because the disease is in its active phase. Let me examine your heart and lungs. Breathe… Stop breathing. Diastolic murmur is not of high amplitude. Overstrain began to have its natural effect upon all the systems of the body. Can you describe the character of your pain?

PATIENT: It’s dull and aching. What do you think, doc?

DOCTOR: You see, I suppose I can make the exact diagnosis and say for certain after laboratory tests and X-ray examination. Here is your blank analysis form. Take the drugs I’ll prescribe you and don’t worry. Good-bye.

PATIENT: Good-bye.

Exercise 2.

Study the blood analyses results. Identify which of these results are outside the normal range and describe each of them. These words might be useful for you:

Low high abnormal reduced raised elevated

The following information on the blood norm might be useful for you:

WBC x 10^9/L	3.9- 10.0	Measures the amount of white blood cells. These immune cells form in the bone marrow to help fight infection. High levels may indicate infection. Low levels may result from treatment or disease.
Hb g/dl	13.2 – 16.9	Hemoglobin is a protein used by red blood cells to distribute oxygen to other tissues and cells in the body. Low levels indicate anemia.
Hct	38.5 – 49.0%	Percent of your blood that is occupied by red blood cells. Good indicator of anemia.
MCVfl	80 – 97	Measures the size of red blood cells. Larger or smaller than normal red blood cells may indicate anemia.
Platelets x 10^9/L	140.0-390.0	Platelets are cells produced by the bone marrow to help your blood clot in order to stop bleeding from injury. Decreased platelet count is called thrombocytopenia.
ESR mm	Male 2-10 Female 2-15	The ESR is increased by any cause or focus of inflammation. The ESR is increased in pregnancy or rheumatoid arthritis, and decreased in polycythemia, sickle cell anemia, hereditary spherocytosis, and congestive heart failure. The basal ESR is slightly higher in females.
Neutro	38%-80% of the WBC	Most common granulocyte (55-70% of all leukocytes are neutrophils) Attracted to sites of injury and infection. Percentage is often increased during a bacterial infection. A low number (neutropenia) increases risk of bacterial infection. Multiplying the percentage of neutrophils by the total number of white blood cells will give the "absolute" number of these types of cells.
Lymph	15%- 40%	Include T-cells, B-cells, and natural killer (NK) cells. Viral infections may increase their number.
MONO	0.0 - 13.0	Monocytes are a type of phagocyte. These mature into macrophages, important germ eating cells. A low number can put you at a higher risk of getting sick from an infection, particularly those caused by bacteria.
EOSINO	0.0 - 8.0	A type of phagocyte that produces the anti-inflammatory protein histamine. A high number indicates allergies or parasitic infections.
BASO	0.0 - 2.0	Control inflammation and damage of tissues in the body.

Exercise 3.

Fill in the gaps in the text using the following words:

now an vaccine progressing and aired after nasopharynx of cessation epidemiologic the incubation present sometimes number of to of by common an is manifestation these

Whooping cough is a c__________(1) acute infection o__________(2) childhood, highly contagious. It is caused by the Bordutellia Pertussis. The illness is characterized by a catarrhal period of nonspecific respiratory symptoms p__________(3) to the stage of paroxysmal cough, accompanied by the typical inspiratory whoop and vomiting. It may be complicated by potentially serious involvement of the respiratory tract a__________(4) the central nervous system.

E__________(5) Factors. The disease may strike at any time of the year. Although no age is exempt from pertussis, most people have the disease in early life. Transmission is likely to occur b__________(6) direct contact with an infected person (coughing, sneezing, talking). The disease is communicable from its very first days to four weeks a__________(7) onset of typical paroxysms.

Clinical Manifestaions. The i__________(8) period is about 7 days, seldom shorter — from 2 to 4 days, or longer — up to 21 days.

The clinical course of whooping cough is divided into 3 stages — catarrhal, paroxysmal and convalescent. The catarrhal stage lasts for about 1 or 2 weeks. It begins with the symptoms of an upper respiratory infection or common cold. The child may appear listless and irritable. S__________(9) the only m__________(10) is a dry hacking cough. After about a week the cough, instead of improving, gradually becomes more severe and it begins t__________(11) occur in paroxysms. The paroxysmal stage lasts, as a rule, 4 to 6 weeks. The cough n__________(12) comes in explosive bursts. A series of 5 to 10 short, rapid coughs are given on one expiration, followed by a sudden inspiration, associated with a characteristic sound or whoop. During the attack the child's face becomes red or cyanotic, the eyes bulge, the tongue protrudes. Vomiting frequently follows the attack. In severe cases young unimmunized infants may stop breathing during a__________(13) attack (apnea).The attacks occur more frequently at night and in a stuffy room than in one well aired or out of doors.

The convalescent stage is marked by c__________(14) of whooping and vomiting. Little by little the n__________(15) and severity of paroxysms decrease.

Diagnosis. The clinical diagnosis is made by t__________(16) paroxysmal nature of the cough, the red or cyanotic appearance of the child during an attack and associated vomiting. During the catarrhal stage it is usually impossible to differentiate pertussis on clinical grounds from the common cold, bronchitis or acute respiratory disease. At this time Bordutellia Pertussis can be isolated from the n__________(17). The white blood test may also help the diagnosis. High white blood counts with a predominance of lymphocytes are characteristic of whooping cough.

Treatment. There is no specific drug to stop the attacks. Modern cough suppressing remedies may be administered in severe cases.

Whooping cough can be effectively treated with antibiotics. The sooner one of t__________(18) antibiotics is used, the better the results. The course of antibiotics treatment averages 8-12 days. Rest in bed is indicated as long as fever is p__________(19). The room should be well a__________(20). It is important to maintain proper nutrition. The diet must be adequate, rich in vitamins, especially vitamin C. The patient should be separated from other people.

Complications. The commonest and usually the most severe complication i__________(21) pneumonia. Stop of breathing during a__________(22) attack is very dangerous in young children. Otitis media, atelectasis may often occur.