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Training target: using diagnostic algorithms, be able to diagnose angina and its complications (paratonsillitis, paratonsillar abscess), determine the clinical form of the disease and prescribe adequate treatment; be able to conduct dispensary observation.

Assignment for independent study of the topic. Using a textbook, guidelines and lecture material to acquire the necessary basic knowledge, learn the following sections for practical training:

1. etiology, pathogenesis and symptomatology of tonsillitis;

2. clinical and diagnostic criteria for the recognition of tonsillitis and other infectious diseases that occur with lesions of the tonsils;

3. The principles of etiotropic and pathogenetic therapy of patients with angina;

4. dispensary observation of the military personnel who have had a sore throat.

Test your knowledge by answering the following questions:

- the concept of the term "tonsillitis" and "tonsillitis";

- The main clinical syndromes that determine the diagnosis of tonsillitis;

- What are the other infectious and non-infectious diseases in which "tonsillar" syndrome may be observed;

- clinical differences between streptococcal angina and angina of Simanovsky - Plaut - Vincent, diphtheria of the pharynx, infectious mononucleosis;

- clinical signs of paratonsillitis and paratonsillar abscess;

- the place of treatment for patients with angina;

- etiotropic treatment regimens for patients with various forms of angina;

- antibiotics, which in order of preference can be used for treatment; indications, methods and doses of their use;

- means of pathogenetic treatment, which must be included in the complex therapy of tonsillitis patients;

- the requirements of a military medical examination for recovered from tonsillitis from among the flight personnel.

The solution of situational clinical problems N 9,10,11,12,20.

Materials for self-training for a practical lesson on the stages of diagnosis and treatment. In order to clarify the indicative basis of actions during the examination of patients with tonsillitis, analyze the following algorithms, schemes, and tables located in accordance with a phased diagnostic treatment search.

Sore throat diagnostic algorithm

Note: a typical mistake is diagnosing a sore throat only on the basis of subjective symptoms of the disease.

Questions for self-control:

- causative agents of angina;

- pathogens causing unilateral necrotic inflammation of the palatine tonsil;

- the nature of inflammation in tonsillitis;

- hemogram changes characteristic of tonsillitis and tonsillitis of Simanovsky - Plaut - Vincent.

Differential diagnostic signs of streptococcal tonsillitis, pharyngeal diphtheria, infectious mononucleosis and Simanovsky sore throat - Plaut - Vincent

The algorithm for determining the clinical form of angina

Recognition algorithm for paratonsillitis and paratonsillar abscess (tonsillitis complications)

Questions for self-control:

- other, in addition to the listed, possible complications of tonsillitis;

- laboratory and instrumental diagnostic methods that facilitate the recognition of these complications.

Algorithm for etiotropic therapy of tonsillitis patients

(uncomplicated and complicated forms)

Questions for self-control:

- optimal doses of the mentioned antibiotics;

- Methods for determining body allergies to penicillin.

Emergency response sequence

with anaphylactic shock arising after the introduction of penicillin

- the mechanism of the positive effects of each drug mentioned in the emergency care scheme for patients with anaphylactic shock.

Algorithm for determining the degree of recovery of people who have had a sore throat

Note: a typical mistake at this stage of the examination is the diagnosis or exclusion of metatonsillar diseases only on the basis of subjective data.

Questions for self-control:

- the timing of the control studies (blood, urine and ECG) in convalescents after angina;

- conditions and means of treating patients with complications after angina;

- therapies for myocarditis (rheumatic heart disease), glomerulonephritis (pyelonephritis);

- the requirements of the military medical commission (medical flight commission), determining the decision on the labor activity of military personnel who have had a sore throat; conditions allowing the doctor of the aviation unit to allow flight personnel from among the lifting personnel who have had tonsillitis;

- the contents of the dispensary observation of military personnel in cases of angina recurrent.

Tasks for self-monitoring in the clinical assessment of laboratory and other studies.

Evaluate a blood test (day 3 of the disease) of patients with angina: hemoglobin 147 g / l, erythrocytes 4.8x1012 / l, white blood cells 11.2 x 109 / l, neutrophils 76%, eosinophils 0%, basophils 1%, lymphocytes 17%, monocytes - 6%; ESR - 18 mm / h.

Evaluate the urinalysis of the same patient:

Evaluate the results of studies conducted in patients with tonsillitis: ECG indicators - sinus tachycardia, pulse 86 beats per minute, PQ - 0.20 ", QRS - 0.12"; study of acute phase reactions - CRP - presence of precipitate +++, sialic acid - 310 units.

Evaluate the results of a bacteriological study of a smear of mucus from the surface of the tonsils, performed on the 2nd day of illness in a patient with tonsillitis: multiple colonies were found.
pyogenes, single colonies of St. aureus.

Evaluate the results of bacterioscopy of a smear of the contents of an ulcer on the mucous membrane of the patient’s palatine tonsil on the 4th day of the disease (Romanovsky-Giemsa stain): genital sticks and spirils were found.

Write prescriptions for benzylpenicillin, erythromycin, oxacillin, ciprofloxacin, tsifran.
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  1. Differential diagnosis of angina Comparative signs of various forms of angina

  2. Angina
    Angina is a common acute infectious disease in which local acute inflammation affects the lymphadenoid tissue of various tonsils of the pharynx. In the vast majority of cases, tonsillitis is tonsillitis, other tonsils are involved in the inflammatory process much less frequently. Therefore, in medical practice it is customary to mean the tonsillitis under the term “tonsillitis"
  3. Angina
    Acute inflammation of the tonsils and pharyngeal mucosa. the term "acute tonsillitis" narrows the concept of "tonsillitis" and we do not recommend it. IN AND. Voyachek emphasized that it is necessary to pay particular attention to the defeat of the entire pharynx with angina. According to clinical data and pharyngoscopic picture, sore throats are divided into catarrhal, follicular, lacunar, ulcerative-membranous and necrotic.
  4. Sore throats
    The clinical picture of Sore throat is infectious - diseases with the most pronounced local inflammatory process in the area of ​​lymphoid tissue of the pharynx. Palatine tonsils are more often affected. Overcooling and other unfavorable factors leading to weakening of the body contribute to the disease. With catarrhal sore throat, the patient has malaise, fever, chills, headache
  5. Complications of tonsillitis
    C onclusion of General and Complicated ana ng. The most severe and formidable are common complications, since they cause persistent damage to vital organs and systems of the body. Among them in the first place (in frequency, but not in severity) rheumatism with its attacks and lesions of the heart and joints, often no less serious complications of tonsillitis in the kidneys,
  6. Angina
    Since tonsillitis is an acute inflammation of the tonsils, see the article ALMOND
  7. Angina (acute tonsillitis)
    Angina - a common acute infectious and allergic inflammation of the tonsils, often palatine, other tonsils are involved in the inflammatory process much less often. Forms of tonsillitis differ in etiology, mechanisms of disease development and clinical course. Among the various microbial pathogens of tonsillitis, which include cocci, rods, viruses, spirochetes, mushrooms, Klebsiella, in the first place
  8. Classification of angina. Treatment principles
    Classification of angina I. According to B.S. Preobrazhensky. It is based on pharyngoscopic signs, supplemented by data obtained in a laboratory study, sometimes with information of an etiological or pathogenetic nature. The following forms of angina are distinguished: catarrhal; follicular; III - lacuna; IV - fibrinous; V - herpetic; VI - phlegmonous
  9. Laryngeal tonsillitis
    Laryngeal tonsillitis (angina laryngis) is an acute inflammation of the lymphadenoid tissue of the larynx (in the area of ​​the scooped palatine folds, the intercarpal space, in the morgan ventricles, in the pear-shaped sinuses and individual follicles). As an independent disease, it is rare, it can occur as a result of hypothermia, after the flu, with TjfeBMe larynx by a foreign body, etc. K l
  10. differential diagnosis of angina
    Differential diagnosis of angina should be carried out with diseases that occur with tonsillitis syndrome: a) localized forms of diphtheria (islet and membranous) - differ from angina by the gradual onset of the disease, specific manifestations of general intoxication in the form of pale skin, moderate adynamia and lethargy ( chills, body aches, muscle and joint pains, characteristic
  11. Angina with leukemia
    Various forms of leukemia are characterized by a progressive systemic disease of the hematopoietic tissue, in which foci of pathological hematopoiesis are formed in various organs, which eject immature leukocytes into the peripheral blood. The disease is considered as neoplasia of the hematopoietic tissue, in which damage to the tissues of the pharynx can occur. With acute leukemia, tonsillitis is one of
  12. Prevention of tonsillitis and chronic tonsillitis
    Prevention of chronic tonsillitis is largely a prophylaxis of tonsillitis and is carried out in two aspects - individual and social. Individual prevention consists in strengthening the body, increasing its resistance to infectious influences and adverse environmental conditions, especially to cold. Very often, angina develops after local or
  13. Sore throats. Etiology, symptoms, prevention, care for sick children
    Angina is an acute infectious disease with a primary lesion of the tonsils. Etiology. The causative agents of infection are staphylococci, streptococci, stable in the external environment. Predisposing factors: local and general hypothermia; decreased immunity. Possible routes of transmission: airborne; contact. There are forms of angina: catarrhal, follicular,
  14. Laryngeal tonsillitis. Etiopathogenesis, clinic, treatment
    Laryngeal tonsillitis is an acute inflammation of the lymphadenoid tissue of the larynx (in the area of ​​scooped-epiglottis folds, the intercarpal space, in the pear-shaped sinuses and individual follicles). Etiopathogenesis. The disease can occur as a result of hypothermia, after the flu, with a trauma to the larynx by a foreign body, etc. Clinic. The patient is worried about pain when swallowing, pain when
  15. differential diagnosis of pharyngeal diphtheria (infectious mononucleosis, tonsillitis)
    For angina, the following differences are characteristic: acute onset (with chills, aches in the body and joints) of the disease, intoxication (severe general weakness, headache, agitation), as well as the purulent nature of tonsillitis. 2. For infectious mononucleosis, the following differences are characteristic: polyadenitis, hepatolienal syndrome, membranous with crumbling, and not a dense coating on tonsils tonsils,
  16. Acute tonsillitis (tonsillitis). U-03.
    {foto6} Treatment outcome: Clinical criteria for improving the patient's condition: 1. Normalization of temperature. 2. Normalization of laboratory parameters. 3. Improving the clinical symptoms of the disease (pain, difficulty swallowing, purulent discharge from
  17. Scarlet fever
    Scarlet fever is an infectious disease characterized by a small point rash. Scarlet fever begins acutely, with fever and sore throat. After about a day, a rash appears, and the whole body of the patient turns bright red. See the articles Fever, Sore Throat, SKIN (PROBLEMS) and SKIN RED, with the addition that a person feels intense anger caused by some kind of unexpected
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