Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic 9. The Basic Symptoms and Syndromes in Dry Pleurisy and Pleural Effusion. Syndrome of Respiratory Failure in the Pathology of Broncho-Pulmonary System.

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: The reasons of the development of inflammation of the pleura. Ways of occurrence and circulation of intrapleural fluid both in norm and pathologies. Complaints of a patient in dry pleurisy and pleural effusion, differences of the results of physical examination (palpation, percussion, auscultation of the lungs). Syndromes of accumulation of fluid and air in the pleural cavity. Opportunities of instrumental diagnostics. Pleural puncture: pleural fluid examination. Differences between exudates and transudates due to the results of physical and laboratory examination. The basic clinical syndromes and stages of the syndrome of respiratory failure in lung diseases.

Pleurisy

Most diseases of the pleura (pleurisy included) are secondary to disease of the lung. Pleurisy usually develops as a reaction of the pleura to pathological changes in the adjacent organs, in the lungs in the first instance, and less frequently as a symptom of a systemic disease. Serous pleurisy often arises as an allergic reaction. Purulent pleurisy is often a complication of bronchopneumonia: inflammation may extend onto the pleura, or an inflammatory focus may turn into an abscess, which opens into the pleural cavity. Inflammation of the pleura is always attended by markedly increased permeability of the wall of the affected capillaries of the pulmonary pleura.

In the presence of purulent processes in the lungs or adjacent organs (pericarditis, perioesophagitis, etc.), purulent pleurisy often develops abruptly. The affection of the pleura in tumours, which in most cases are metastatic (less frequently primary), decreases its absorptive function to promote accumulation of pleural effusion (haemorrhagic effusion in most cases).