Immunity. As a rule, one attack of whooping cough is followed by (24)__________ immunity. Second attacks of pertussis are rare.

Prophylaxis. Children should be immunized at the age of 5-6 months with a pertussis - diphtheria (25)__________.

B LEVEL

GUESS THE DIAGNOSIS:

(1)

PATIENT: May I see Doctor Bloggs?

CLERK: Doctor Bloggs is busy. I’m really sorry. But you can visit Doctor Murrey.

PATIENT: Where does he see his patients?

CLERK: Room 28. Second floor to the right.

PATIENT: Thank you.

(Some minutes later)

PATIENT: Are you all waiting for Doctor Murrey?

SECOND PATIENT: No, only two of us.

PATIENT: Is Doctor Murrey a good specialist?

SECOND PATIENT: Oh, yes, he’s quite an experienced doctor. Oh, it’s my turn now. Excuse me.

(A few minutes later)

PATIENT: Good morning, doctor.

DOCTOR: Morning. What’s wrong with you?

PATIENT: I’m sick, doctor. I have some skin troubles.

DOCTOR: Do you have any unpleasant feelings? Did the rash appear after taking some drugs or particular kinds of food?

PATIENT: Some papules appeared suddenly on different parts of the body and then they began to look like vesicles.

DOCTOR: Really? Let me examine you immediately. Take your clothes off and stand up….It doesn’t look like any allergic dermatosis…. Oh, I see. You have one of the most contagious diseases of childhood. Adults may also be susceptible to it.

PATIENT: Is it so serious, doctor?

DOCTOR: Don’t worry. The treatment is very simple. Possible complications are rare. But I must take some preventive measures. I will take you to our isolation-room. You may dress now and I’ll write you a sick-leave.

PATIENT: OK, doctor.

(2)

PATIENT: Good morning, doctor.

DOCTOR: Good morning. Take a seat, please. What’s bothering you?

PATIENT: I am not well, doctor. I sneeze and cough.

DOCTOR: Do you feel any pain?

PATIENT: Yes, I have severe headache and pain in the throat.

DOCTOR: Did you take your temperature?

PATIENT: Yes, it was 37,8ºC.

DOCTOR: Let me examine you… Oh, your pulse is rapid. The respiration is accelerated. Open your mouth, please, say ah…ah…ah.

PATIENT: It’s hard to swallow.

DOCTOR: I see… Your throat is inflamed. And now strip to the waist. I’m going to listen to your heart and lungs…

PATIENT: I have pains in the muscles and joints as well. Anything serious, doctor?

DOCTOR: No, don’t worry. Nothing very serious, but you’d better stay in bed for some days.… I’ll prescribe you some antiviral remedies and cough mixture.

PATIENT: How many times a day shall I take them?

DOCTOR: 1 tablet 3 times a day before meals.

PATIENT: Should I follow a diet?

DOCTOR: Nothing special, but a lot of warm drinking would be useful.

PATIENT: How long must I remain in bed?

DOCTOR: For about 3-4 days. Follow all the prescriptions, otherwise you will have some dangerous complications… You are to come to my consulting room on Monday. I’ll direct you to make analyses of blood and urine to make sure in your recovery.

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

DOCTOR: Good bye.

(3)

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.

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, known as Filatov-Koplick spots.

PROFESSOR: And how is it transmitted?

STUDENT: The disease is spread by direct contact, by infected droplets from the nose and throat, sneezed or coughed into the air.

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 complications.

PROFESSOR: What are the most common ones?

STUDENT: The most frequent and dangerous complications may occur 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 it (conjunctivitis, otitis may be observed).

PROFESSOR: Well, I see you are very well informed on the subject. By the way, one more question about the prognosis. So what is the prognosis?

STUDENT: The prognosis depends on the age and condition of the sick child (I mean weak ones) and on complications which may follow it. But I’m sure proper treatment and good nursing may prevent complications.

PROFESSOR: That’s quite right. You know the theory very well. I put you 5. And now go to the ward 7 and give your practical recommendations to the mother of the child ill with this disease about the treatment and nursing. She is eager to speak to you.

STUDENT: Thank you, professor. Good bye.

(4)

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

DOCTOR: How do you do. How is the child?

MOTHER: How do you do, doctor. He feels worse. The cough and cold in the head became aggravated, the eyes got purulent. I have heard that this disease 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. 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.

NURSE: May I air the room?

DOCTOR: Yes, the patient’s room must be aired and cleaned with a wet duster.

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.

MOTHER: But he cannot do it.

DOCTOR: Give him to drink 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. 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.

MOTHER: And what about remedies?

DOCTOR: The nurse will bring you anti-viral drugs and disinfecting solutions. I suppose the prognosis will be favourable.

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

(5)

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

DOCTOR: How do you do. What are your complaints?

PATIENT: I have chills, fever and I suffer from cold in the head and coughing.

DOCTOR: Let me check your temperature and examine you. Is it hard to swallow?

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

DOCTOR (examining his throat): You have a very sore throat and all the signs of a viral illness. How long have you been ill?

PATIENT: I’ve got a cold this week. At first I had only general malaise, weakness and a bad headache. I didn’t sleep well and had no appetite.

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

PATIENT: Yes, 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 medicine be taken?

DOCTOR: Take the drug according to the prescription.

PATIENT: How long shall I have to take it?

DOCTOR: For 5 days. This remedy won’t do you any harm. In 3 days I’ll come to see you. I hope, you’ll be well soon.

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

DOCTOR: Good bye.

(6)

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 and cough, the onset of the disease was mild. 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.

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

YOUNG DOCTOR: Number 12.

EXPERIENCED DOCTOR: Did you administer X-ray examination?

YOUNG DOCTOR: Yes, of course.

EXPERIENCED DOCTOR: And what were the results of analyses?

YOUNG DOCTOR: Leucocytes and lymphocytes were discovered in the blood. 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 haven’t told anything about the drugs…

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

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

YOUNG DOCTOR: Thank you, colleague.

(7)

DOCTOR A: Morning!

DOCTOR B: Morning!

DOCTOR A: I’ve just examined a new patient. She has been admitted with the diagnosis of some respiratory disorder.

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’s your impression? 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 dry persistent cough, particularly during nights, difficulty in breathing and accompanied with profuse sweating.

DOCTOR B: What else did she complain of?

DOCTOR A: She complained of pain in the chest and expectoration of bloody sputum. I’m afraid her both lungs are involved in the infectious process. I directed her to make X-ray examination.

DOCTOR B: I see… Is her past history available?

DOCTOR A: Well, in her childhood she had chicken-pox and measles. And last month she had suffered from common cold and acute bronchitis.

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

DOCTOR A: She was treated with anti-influenza remedies.

DOCTOR B: And with what result?

DOCTOR A: There was a slight improvement for some time, but then she felt worse.

DOCTOR B: How are you going to treat her?

DOCTOR A: I’ll administer her a diathermy of the lungs and antibiotics.

DOCTOR B: Let me examine her once more.

DOCTOR A: O.K.

(8)

Medical students with the attending doctor.

DOCTOR: Here you see another sick child. He is 5. He complains of headache and pain in the throat, suffers from nausea. He is restless and sleeps badly.

FIRST STUDENT: I see. He has chills. Let’s take his temperature. Oh, a sharp rise of temperature, it’s 39ºC.

SECOND STUDENT: His pulse is rapid, and his lymphatic nodes are enlarged.

THIRD STUDENT: May I examine his throat?... It is red, there is an inflammation of the throat.

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

SECOND STUDENT: The rash is red, diffuse and punctate.

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

FIRST STUDENT: But the area around his nose and mouth is free from rash.

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 desquamation.

DOCTOR: And who knows the way of its transmission?

THIRD STUDENT: It may be spread by both contacts – direct and indirect ones.

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

(9)

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

PATIENT: I feel pain and discomfort in my chest and sometimes experience stomachaches.

DOCTOR: Have you consulted the district doctor?

PATIENT: Yes, he made the diagnosis of a respiratory infection.

DOCTOR: What drugs did you take before the admission?

PATIENT: I was administered some remedies, but I didn’t take them regularly.

DOCTOR: Well, that is the cause of your prolonged illness. Now I’ll examine you… 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. Let me examine your heart and lungs. Breathe… Stop breathing. 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. Take the drugs I’m going to prescribe you regularly and don’t worry. Good bye.

PATIENT: Good bye.

(10)

The child aged 4 is in his bed. Some medical students with the attending doctor are around him.

DOCTOR: The child suffers from vomiting and complains of pain in the back and legs.

FIRST STUDENT: Does he have a high temperature?

DOCTOR: He has a slight fever.

SECOND STUDENT: How old is he?

DOCTOR: 4 years old.

THIRD STUDENT: I see some eruption on his body.

FIRST STUDENT: It is particularly marked on the hairy part of the head.

SECOND STUDENT: I see some red macula and papules with vesicles in the centre.

THIRD STUDENT: But on the other side of the head there are brownish crusts.

DOCTOR: How many vesicles do you see?

FIRST STUDENT: Oh, it’s difficult to count, some hundred ones.

DOCTOR: I suppose you can diagnose the disease. During the course of the disease the body and the scalp may be covered with macula, papules, vesicles and crusts at the same time.

FIRST STUDENT: Sorry, and what’s the number of vesicles?

DOCTOR: The amount of vesicles is variable. It depends on severity of the disease. Who knows anything about this?

SECOND STUDENT: I know. In a slight case there may be only 8-10 vesicles, but sometimes in severe cases their number may reach up to six-seven hundred.

DOCTOR: Right you are. And in the majority of cases it is not difficult to diagnose the disease, but it is necessary to differentiate it from other skin eruptive disorders.

(11)

MOTHER: Doctor, help my baby, please!

DOCTOR: What’s wrong with him?

MOTHER: When I came home I found my little boy crying. I couldn’t stop him. I understood at once that something was wrong with him.

DOCTOR: Why did you think so?

MOTHER: He was very restless and irritable. He coughed severely and during it he had vomiting, his face was red and even cyanotic, his eyes bulged and his tongue protruded.

DOCTOR: Did he have any troubles before that?

MOTHER: Yes, he had been unhealthy for about 10 days. He coughed and sneezed. It looked like a common cold. He catches colds quite often, you know. I gave him anti-cold drugs, warm drinking, applied warm applications to the chest. It always helped him before. But instead of improving, in this case the cough accompanied by vomiting became more severe.

DOCTOR: I see. Don’t worry. I’ll examine your son at once………. I suppose he is ill with some infectious bacterial disease. It always begins with the symptoms of an upper respiratory infection or common cold and only analyses of blood and sputum may confirm the diagnosis.

MOTHER: Doctor, is the disease curable?

DOCTOR: Oh, yes, it is! It can be efficiently treated with antibiotics. Modern cough suppressing drugs will relieve the attacks of paroxysmal hacking cough.

MOTHER: Oh, doc, I hope everything will be OK.

(12)

PATIENT: How do you do, doctor.

DOCTOR: How do you do. Take your seat, please. What do complain of?

PATIENT: I have a sore throat, bad headache, vomiting and I feel very hot, doctor.

DOCTOR: Did you take your temperature?

PATIENT: This morning it was 38ºC.

DOCTOR: When did you feel the onset of the disease?

PATIENT: It was 3 days ago.

DOCTOR: I see you are quite ill. Why didn’t you seek for medical help as soon as your malaise began?

PATIENT: I thought it was a common cold and I took some tablets of aspirin. But this morning I felt some difficulty in swallowing. I became anxious and went to the polyclinic. Well, what do you think, doc?

DOCTOR: I must examine you. At first, I’ll do a physical examination. Well, open your mouth. Stick out your tongue, please. Your throat is red… Now let me check your neck… Enlarged lymphatic nodes… Let me feel your pulse… accelerated pulse…

PATIENT: Is it dangerous?

DOCTOR: All the vital signs: temperature, pulse rate, respiration, vomiting, enlarged lymphatic nodes, inflamed throat make me suppose it’s some eruptive infection.

PATIENT: Oh, doctor, but I have not got any eruptions.

DOCTOR: You see, adults may have only sore throat without the rash characteristic of this illness. We must have some laboratory tests done and then we’ll decide how to treat you.

PATIENT: Oh, thank you, doctor. I hope to recover soon.