《儿科学》课程教学资源（授课教案）16 Measles

重庆医科大学儿科学教案感染性疾病一麻疹教师：赵瑞秋授课题目TEACHINGTOPICMeasles第几次课TIMES2nd教学方法METHODSClass teaching教学对象OBJECTIVESeven years students in Grade 2007, 2006学时:TIME120minutes授课目的PURPOSEStudy the measles.Knows thepathogen, epidemiology,pathophysiology, clinical manifestations, diagnosis, treatment andprevention of measles.本课重点EMPHASISclinicalmanifestationsHow to make the diagnose and differential diagnosis of measles本课难点DIFFICULTIESThe nature and reasons of epidemical changes of measles inpre-immunization era and post- immunization era.Complications of measles深化与拓宽1) Emphasis the epidemiology situation of the worldThe developments2)Thee reason of cases under 6 months old and cases of teenageand adult increase.3) Emphasis on the prevention英语要求All in EnglishMGC: multinucleated giant cellEnglishrequirementsSSPE:Subacute sclerosing panencephaltis实践性教学安排Clinically, combined with the patients to learn the manifestationsClinical studyand diagnosis; To distinguish measles with other exanthemadiseases.教材TEXTBOOKUSEDYang Xiqiang Chief Editor,《PEDIATRICS》 6th Edition, People'sHealth Publication,2003及参考资料 REFERENCES1.胡亚美，江载芳：诸福棠实用儿科学.第7版.北京：人民卫生出版社,20022.RichardEBeman,RobertMKlieman,HalBJenon,Nelsontextbook of pediatrics,17th edition,Peking University MedicaPress.教具TEACHINGAIDSPPT教具PPT教学程序Procedures详细见讲稿主要内容及安排（教学内容详细安排、教学方法的运用、师生活动设计、及时间分Details see the contents and配)arrangement

重庆医科大学儿科学教案 感染性疾病－麻疹 教师：赵瑞秋 授课题目TEACHING TOPIC Measles 第几次课 TIMES 2nd 教学方法 METHODS Class teaching 教学对象 OBJECTIVE Seven years students in Grade 2007, 2006 学时: TIME 120 minutes 授课目的 PURPOSE Study the measles. Knows the pathogen, epidemiology, pathophysiology, clinical manifestations, diagnosis, treatment and prevention of measles. 本课重点 EMPHASIS clinical manifestations How to make the diagnose and differential diagnosis of measles 本课难点 DIFFICULTIES The nature and reasons of epidemical changes of measles in pre-immunization era and post- immunization era. Complications of measles 深化与拓宽 The developments 1) Emphasis the epidemiology situation of the world 2) The reason of cases under 6 months old and cases of teenage and adult increase. 3) Emphasis on the prevention 英语要求 English requirements All in English MGC: multinucleated giant cell SSPE: Subacute sclerosing panencephalitis 实践性教学安排 Clinical study Clinically, combined with the patients to learn the manifestations and diagnosis; To distinguish measles with other exanthema diseases. 教材 TEXT BOOK USED Yang Xiqiang Chief Editor，《PEDIATRICS》6th Edition，People’s Health Publication，2003 及参考资料 REFERENCES 1. 胡亚美,江载芳. 诸福棠实用儿科学.第 7 版.北京:人民卫生出版 社,2002 2. Richard E Behrman, Robert M Kliegman, Hal B Jenson, Nelson textbook of pediatrics, 17th edition, Peking University Medical Press. 教具 TEACHING AIDS PPT 教具 PPT 教学程序 Procedures （教学内容详细安排、教学方法的运用、师生活动设计、及时间分 配） 详细见讲稿主要内容及安排 Details see the contents and arrangement

The contents and Arrangements讲稿主要内容及安排meanstimeMeaslesmin1st 40minsPPT1208[INTRODUCTION]General introductionof lectureShowthecase-fatalityIt is an acuterespiratory disease caused by Measles virusHistory of measlerate in the.Askquestionstomake surethat students areactively involvedpastandGeneral introduction(main characteristic) of measlesemphases it isalsohighfever,cough,coryza,conjunctivitis and exanthemaaworldwideSpecificsigns ofmeasles areKoplik'sspots and hyperpigmentationShow some maps of measles coverage of world and some outbreaks in recenttdisease.Using figureyearsSituation ofin patient measles cases in our hospital from 1964.to present thedetailed dataof inpatientsinourhospital[ETIOLOGY]4Using pictureA picture of virus particle under E.Mto present theA picture of Schema graph of measles virusetiology.Emphasis onCharacteristics of measles virus as a pathogenthe only oneClassificationserotypeofthis virus·Serotype.Location·Characterization[EPIDEMIOLOGY]Infectioussources: Measles patients arethe only sourceofinfectionEmphasis onPatients have infectiousnessfrom the late of incubation period to the 5th day after.the theoreticalthe rash eruption.basis ofclinical?Ifcomplicationshappen, theinfectivestage will prolongtothethday affertherash eruption,isolationperiod

The contents and Arrangements 讲稿主要内容及安排 Measles means time min 1 st 40mins PPT 120 [INTRODUCTION] 8 General introduction of lecture ⚫ It is an acute respiratory disease caused by Measles virus. ⚫ History of measles ⚫ Ask questions to make sure that students are actively involved. ⚫ General introduction(main characteristic) of measles high fever, cough, coryza, conjunctivitis and exanthema. Specific signs of measles are Koplik’s spots and hyperpigmentation ⚫ Show some maps of measles coverage of world and some outbreaks in recent years. ⚫ Situation of in patient measles cases in our hospital from 1964. Show the case-fatality rate in the past and emphases it is also a worldwide disease. Using figure to present the detailed data of inpatients in our hospital. [ETIOLOGY] 4 A picture of virus particle under E.M A picture of Schema graph of measles virus Characteristics of measles virus as a pathogen ⚫ Classification. ⚫ Serotype ⚫ Location ⚫ Characterization Using picture to present the etiology. Emphasis on the only one serotype of this virus [EPIDEMIOLOGY] 16 Infectious sources: Measles patients are the only source of infection. ⚫ Patients have infectiousness from the late of incubation period to the 5th day after the rash eruption. ⚫ If complications happen, the infective stage will prolong to the 10th day after the rash eruption. Emphasis on the theoretical basis of clinical isolation period. 4

Emphasis onRoutesoftransmissioMain routes of transmissionunusual routes of transmissiorQuestion:Unusualroutes oftransmisiononly stand aIitte chance.why?Population susceptibility:Question:anyone without infection or inoculation is susceptibleThe incidencebabiesofunder6monthsislower. Why?The nature and reasons of epidemical changes of measles in pre-immunization era andUsing figurepost-immunization erashowtheThe reason of the infant cases underdifferencesof teenageomonthbeforeadult increased after the use of vaccine.andafter vaccine.[PATHOPHYSIOLOGY]5infects the epithelium at the very beginning-regional lymph nodes toUsingtoreplicate-primaryviemiamononuclearphagocyticsystemtoreplicatepicturegreatlysecond viremiainvading target organsvirus iseliminated finallyshowthewholeprocess.PATHOLOGY)5The most marked pathologic change ofmeasles is theformation of multinucleated giantUsingseveralcellpicturestoshow·theformativeprocessofMGCthe·the importance for the measles early diagnosisformativeprocessofMGC.A SHORT SUMMARYI2nd 40minsICLINICAL MANIFESTATIONS)Importance ofclinical manifestations of measles General look offour stages of measles2etailedlnicarosoypcalmae inubatiosgandrdromasaLearn about.There are 4 stages in the whole process ofmeasles.symptoms in10The incubation stage lasts 10 to 14 days in average. Symptoms appear aboutprodromal

⚫ Routes of transmission: Main routes of transmission unusual routes of transmission Emphasis on respiratory transmission. Question: Unusual routes of transmission only stand a little chance. why? 4 Population susceptibility: anyone without infection or inoculation is susceptible Question: The incidence of babies under 6 months is lower. Why? 2 The nature and reasons of epidemical changes of measles in pre-immunization era and post- immunization era. ⚫ The reason of the infant cases under 6 months increased and the cases of teenage or adult increased after the use of vaccine. Using figure to show the difference before and after vaccine. 6 [PATHOPHYSIOLOGY] 5 infects the epithelium at the very beginning→regional lymph nodes to replicate→primary viremia→mononuclear phagocytic system to replicate greatly→second viremia→invading target organs→virus is eliminated finally Using a picture to show the whole process. [PATHOLOGY] 5 The most marked pathologic change of measles is the formation of multinucleated giant cell. ⚫ the formative process of MGC ⚫ the importance for the measles early diagnosis Using several pictures to show the formative process of MGC. [A SHORT SUMMARY] 2 2 nd 40mins [CLINICAL MANIFESTATIONS] Importance of clinical manifestations of measles General look of four stages of measles. 2 Detailed clinical process of typical measles; incubation stage and prodromal stage. ⚫ There are 4 stages in the whole process of measles. ⚫ The incubation stage lasts 10 to 14 days in average. Symptoms appear about Learn about symptoms in prodromal 10

10-14days afer a person is infected with measles virus.stage.Prodromal stage is from the appearance of the first symptom to the appearance ofEmphasis onrash. It lasts 3 days to 5 days.Koplic spotsSymptoms in prodromal stage:Cough, Coryza and Conjunctivitis,Koplic spots andother symptoms.busingpictures.Detailed clinical procesofypicalmeaslesExanthem stageUsingExanthem stage:lasts 3-5days.Rash is themainmanifestation of this stagepicturetoIt is maculopapular rash.What maculopapular rash looks like?the order of rash eruption :behind the earalong the hairline-face-neckchesthepresent10backabdomen-limbshand and feet-palm and sole.characteristicsOther symptomsand sequenceof rash.Detailed clinical process of typical measles in convalescent stageEmphasis ontheThis stage lasts 3-5 days as wellDuring this stage, all symptoms relieve gradually. Patients get bter.diagnosis ofSpecific signs branny desquamation and brownish discoloration.brannyThey aresignificant forretrospectivediagnosidesquamationand brownishdiscoloration2Summary of rashTherash appears after 3~4 days of onset of feveThe rash is maculopapulard the ears. Within3~5 days, it spreads from the headrtsoringdowntothefullbodygraduallf appears.With fading,brannydesquamation andbrownish discoloration occurUsing a chart4Summaryoftypicalclinicalfeaturesto present theThe whole process can be divided into 3 stagescharacteristicsEach stage has its own characteristicsof each stageClinicalfeatures ofatypcamease?mildmeasles6measles in adults·severe measles3rd40minsICOMIPLICATIONS]Know about16

10-14days after a person is infected with measles virus. ⚫ Prodromal stage is from the appearance of the first symptom to the appearance of rash. It lasts 3 days to 5 days. ⚫ Symptoms in prodromal stage: Cough, Coryza and Conjunctivitis, Koplic spots and other symptoms. stage. Emphasis on Koplic spots by using pictures. Detailed clinical process of typical measles Exanthem stage: ⚫ Exanthem stage: lasts 3-5 days.Rash is the main manifestation of this stage. ⚫ It is maculopapular rash. What maculopapular rash looks like? ⚫ the order of rash eruption :behind the ear→along the hairline→face→neck→chest →back→abdomen→limbs→hand and feet→palm and sole. ⚫ Other symptoms Using a picture to present the characteristics and sequence of rash. 10 Detailed clinical process of typical measles in convalescent stage: ⚫ This stage lasts 3-5 days as well. ⚫ During this stage, all symptoms relieve gradually. Patients get better. ⚫ Specific signs branny desquamation and brownish discoloration. ⚫ They are significant for retrospective diagnosis. Emphasis on the importance of retrospective diagnosis of branny desquamation and brownish discoloration 6 Summary of rash ⚫ The rash appears after 3~4 days of onset of fever ⚫ The rash is maculopapular. ⚫ It starts on the skin behind the ears. Within 3~5 days, it spreads from the head down to the full body gradually. ⚫ It fades in the same order it appears. With fading, branny desquamation and brownish discoloration occur. 2 Summary of typical clinical features: ⚫ The whole process can be divided into 3 stages ⚫ Each stage has its own characteristics: Using a chart to present the characteristics of each stage. 4 Clinical features of atypical measles: ⚫ mild measles ⚫ measles in adults ⚫ severe measles 6 3 rd 40mins [COMPLICATIONS] Know about 16

manifestationoneu2. subacute sclerosing panencephalitis(SSPE)& encephalitiss of each3. aryngitiscomplication.4. exacerbation oftuberculosis5. malnutrition and vitamin A deficiency[LAB STUDIES)Bloodroutineshow0multinucleated giantcellsTesting ofspecific IgMin serum.Measles virus isolation[DIAGNOSIS]EmphasisorThe diagnosis of measles can be made from three aspects.There#epidemiologic data, clinical data and laboratory datThe diagnosis is usually made from the characteristic clinical picture in typicalthemeasles patients laboratory confirmation is unnecessaryE[DIFFERENTIALDIAGNOSIS]8ullatiooysymm,relationferandrash,howdistingushwhPictures tomeasleRoseola infantum: etiology, symptoms, relation of fever and rash, how to distinguishshowwith measlesdifferences ofEoruonoymmrlatnrandrahowdisguRubella.with measlesBrief[PREVENTION]introduction.control of infectious sources, cut off the route of transmision and protect thesusceptible.passive immunization: susceptible contacts, immune globulin and dosesEmphasis onactive immunization: Efficacy and scheduleactiveContraindication:Pregnant women,Children with primary immunodeficiency,Childrenimmunization.with untreated tuberculosis, Children with AIDS,Children with cancer,et alTREATMENT!2There is no curefor measles, there are steps that can make the disease more tolerableEmphasis onthebmimportance[结课]2回顾课堂内容，说明重点要求掌握的内容

1. pneumonia 2. subacute sclerosing panencephalitis(SSPE) & encephalitis 3. laryngitis 4. exacerbation of tuberculosis 5. malnutrition and vitamin A deficiency manifestation s of each complication. [LAB STUDIES] ⚫ Blood routine shows ⚫ multinucleated giant cells ⚫ Testing of specific IgM in serum ⚫ Measles virus isolation 2 [DIAGNOSIS] ⚫ The diagnosis of measles can be made from three aspects. There are epidemiologic data, clinical data and laboratory data. ⚫ The diagnosis is usually made from the characteristic clinical picture in typical measles patients, laboratory confirmation is unnecessary. Emphasis on the diagnosis is usually made from the characteristic clinical picture 4 [DIFFERENTIAL DIAGNOSIS] 8 Rubella : etiology, symptoms, relation of fever and rash, how to distinguish with measles Pictures to show differences of Rubella. Roseola infantum: etiology, symptoms, relation of fever and rash, how to distinguish with measles Enterovirus infection: etiology, symptoms, relation of fever and rash, how to distinguish with measles [PREVENTION] control of infectious sources, cut off the route of transmission and protect the susceptible. Brief introduction. 6 ⚫ passive immunization: susceptible contacts, immune globulin and doses ⚫ active immunization: Efficacy and schedule Contraindication: Pregnant women, Children with primary immunodeficiency,Children with untreated tuberculosis, Children with AIDS, Children with cancer,et al Emphasis on active immunization. [TREATMENT] 2 There is no cure for measles, there are steps that can make the disease more tolerable. ⚫ Emphasis on the bm importance [结课] 2 回顾课堂内容，说明重点要求掌握的内容

布置见习的内容和要求Review QA :What is the pathogen of measles?What is the infectionource? How is measles virustransmitted?Who is the susceptibletomeasles?How many times does a person suffer frommeasles in his lifetime?al clinical manifestations of measles? What are the complications of measles?What are the typicalHow to diagnose measles?How to treat it?Can it be preventable? What kind of method to take'总结及补充修正授课年级备注总结及修正补充内容2007级1）参考 Nelson textbook of pediatrics, 17th edition ;2）补充2007-2010年我院住院麻疹病例数以增加对麻疹最新流行状态的了解；3）学习规范的相关专业英语

布置见习的内容和要求 Review QA： ⚫ What is the pathogen of measles? ⚫ What is the infection source? How is measles virus transmitted? ⚫ Who is the susceptible to measles? ⚫ How many times does a person suffer from measles in his lifetime? ⚫ What are the typical clinical manifestations of measles? What are the complications of measles? ⚫ How to diagnose measles? ⚫ How to treat it? ⚫ Can it be preventable? What kind of method to take? 总结及补充修正 授课年级 总结及修正补充内容 备注 2007 级 1） 参考 Nelson textbook of pediatrics, 17th edition； 2） 补充2007-2010年我院住院麻疹病例数以增加对麻疹最 新流行状态的了解； 3） 学习规范的相关专业英语