1. Urticaria syndrome

REASONS: one form of allergic reactions

SYMPTOMS:

• sudden appearance and disappearance of blisters on the skin, accompanied by skin itching

• sometimes, individual blisters merge (giant urticaria)

• when rash of blisters on the mucous membranes occurs: cough, stridor breathing, diarrhea, abdominal pain, arthralgia

• often accompanied by headache, fever, a feeling of general malaise.

Pic 8.1 Urticaria

2. Quincke's angioedema

REASONS: one form of an allergic reaction

SYMPTOMS:

- develops sharply, sometimes after a few seconds from the onset of the action of the allergen in the form of a passing edema of the skin of the subcutaneous tissue and mucous membranes

- localized more often on the face (lips, cheeks, around the eyes)

- dangerous swelling of the larynx (asphyxia), mucous membranes of the gastrointestinal tract (picture of an acute abdomen)

- sizes are different, but rarely larger than the human palm

- Duration from several minutes to hours.

Pic 8.2 Quincke's edema

3. Anaphylactic shock

REASONS: the most severe form of allergic reaction of immediate type

SYMPTOMS:

1. forms:

• extremely difficult (development speed - seconds, minutes)

• heavy (minutes)

• moderate (minutes, hours) (cardiac, cerebral, asthmatic, abdominal moderate) 2. phases: erectile and torpid (secrete only moderate in shock)

3. first signs:

• dizziness, headache,

• a sense of fear, anxiety,

-cold sweat,

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• shortness of breath

• chest tightness, fever,

• coughing fit

• abdominal pain, diarrhea,

• vomiting

• cramps

4. may be accompanied by other signs of anaphylaxis: - urticaria,

- Quincke's edema, - bronchospasm,

- dermatitis

4. blood pressure, anuria progressively decreases, the picture of shock itself develops.

4. Joint syndrome

REASONS: inflammatory and degenerative diseases of the joints, synoviomas, arthropathy in

metabolic disorders.

SYMPTOMS:

1. pain

2. swelling (configuration)

3. deformation

4. increase in local temperature

5. restriction of movement in the joint

6. local hyperemia or other color changes. Features:

1. Feature of pain in inflammatory joint diseases:

inflammatory rhythm of pain - pain intensifies in the second half of the night and in the morning, accompanied by morning stiffness, possibly improving as a result of movement in the joints.

2. Feature of pain in degenerative joint diseases (deforming osteoarthritis):

the mechanical rhythm of pain - a clear connection with physical activity, pain intensifies in the evening after a hard day, in the first half of the night, unloading the joints gives relief.

Starting difficulties, pain when moving in the joints, passing through a short time (several minutes) - indicate the development of secondary synovitis with degenerative lesions of the joints.

Pic 8.3 Deforming arthrosis-arthritis (Heberden Nodules)

Pic 8.4 Rheumatoid arthritis (walrus fins)

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8.1 TEST TASKS

(Choose one or more correct answers)

1. The inflammatory nature of joint pain indicates

1) joint deformation, joint crunch

2) swelling of the joint, flushing of the skin

2. Signs characteristic of arthrosis

1. mechanical pain, crunch in the joint

2. increased skin temperature over the joints, swelling of the joints

3. In rheumatoid arthritis, joints are most affected.

1) ulnar

2) vertebrates

3) proximal interphalangeal and joints of the hands

4) knee

3. Heberden's nodules is

1. manifestation of deforming osteoarthrosis

2. the phenomenon accompanying rheumatoid arthritis

3. the manifestation of a special reaction of the body with bronchitis and bronchiectasis

5. Laboratory indicators inherent in osteoarthritis

1) anemia

2) leukocytosis

3) leukopenia

4) normal blood counts

5) thrombocytopenia

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8.2. Clinical tasks for the section allergies, rheumatology

TASK № 1

Patient D., 26 years old, was taken to the emergency department of the BSMP in an unconscious state. Forty minutes ago, in the clinic, the patient was injected with penicillin (500,000 units) intramuscularly, 15 minutes after this, the patient felt a sharp weakness, lost consciousness.

Objectively: the skin is pale, hyperhidrosis. Respiration is frequent, shallow, BH - 23 per minute, heart sounds are muffled, tachycardia, heart rate - 110 per minute, filamentous pulse, blood pressure - 60/40 mm RT. Art.

Additional research methods:

General blood analysis. Er.- 4.2 x 1012, Hb-130 g / l, color index - 1.0, White blood cells -9.3 x 109, E -18, P - 3, S.- 50, L - 23, M - 6 , ESR - 18 mm / h.

General urine analysis. Yellow color. The reaction is acidic, Ud. density is 1023. Transparency is incomplete. Protein - no. Epit. cells - one. Lake - 0 - 1-3 in p / sp, Er. 1 - 0 in p / sp Blood glucose - 5.3 mmol / L.

Questions.

1. Highlight clinical syndromes.

2. Formulate a preliminary diagnosis.

3. Provide emergency care.

TASK № 2

The ambulance arrived on call to a patient of 18 years old, the patient is in a soporous state. From a survey of relatives it was established that a wasp bitten a girl 40 minutes ago. Objectively: a serious condition, severe swelling of the face and neck, the skin is hyperemic, tense, shiny. The breath is noisy, stridorous. The pulse is filiform, palpated only on the carotid arteries, 98 per minute, blood pressure - 40/0 mm Hg The abdomen is painful on palpation. Questions.

1. Highlight clinical syndromes.

2. Formulate a preliminary diagnosis

3. Provide emergency care.