第三章第六節(jié)流行性乙型腦炎（The third and sixth section is epidemic encephalitis B）.doc

1、第三章第六節(jié)流行性乙型腦炎（The third and sixth section is epidemic encephalitis B）Documents from the network, I collected, finishing, and if there are omissions, errors, but also please correct me!The sixth section is epidemic encephalitis BFirst, the main points of learningFirst clinical manifestationThe main i

2、nfectious diseases of the central nervous system are high fever, unconsciousness, convulsions and respiratory failure, and the pathological findings and positive signs of meningeal irritation are found in the physical examinationTwo epidemiological characteristicsZoonotic natural infectious diseases

3、: pigs (especially young pigs) are the most important infectious sources of this disease. They are transmitted by mosquito bites: three Culex pipiens pallens is the main vectorStrictly seasonal: popular in summer and AutumnChildren are common: mostly children under 10 years of ageThree diagnostic po

4、intsThe epidemiological data of seasonal (Xia Qiuji), children under the age of 10.The main symptoms and signs of acute, fever, headache, vomiting, unconsciousness, convulsions, respiratory failure, pathological reflex and positive meningeal irritation signOur experiments to examine the cell count a

5、nd neutrophils were increased, the change of serous fluidSerological examination can help diagnoseFour differential diagnosisThis disease should cause poisoning and dysentery, other viral encephalitis, tuberculous meningitis and purulent meningitis identificationFive treatment pointsThere is no spec

6、ific antiviral drugMainly to take symptomatic measures and careThree major critical symptoms, such as high fever, convulsions and respiratory failure, were treatedTwo, review questionsFill in the blanks1. families of the genus Japanese encephalitis viruses2. encephalitis B is a natural epidemic dise

7、aseThe main source of infection is.Spread by way ofThe main medium of communication isMaintenance of immunity after infection3., the prevention of Japanese encephalitis is based on the comprehensive preventive measuresTwo choice questions1. A1 questionThe identification for meningitis and encephalit

8、is is the most significant:A. at the onset season, B. is obviously meningeal irritationC. high fever, headache, vomiting, coma D. skin petechiaThe peripheral leukocytes of E. increased significantly, and the percentage of neutrophils increasedThe treatment of JE convulsions, the following is wrong?A

9、. brain edema is mainly treated by mannitol dehydrationB. hyperthermia is mainly based on physical coolingC. brain parenchymal lesions are caused by the first choice of barbiturateD. blocked respiratory secretions, mainly sputum suction and oxygen deliveryRespiratory stimulants may be used in E. pat

10、ients with central respiratory failureThe typical clinical manifestations of JE, the following is wrong?A. acute onset B. fever is high, the longer the more severe the disease duration of fever.C. on the first day of the course can be delirious D. for the central respiratory failure2 weeks after the

11、 onset of E., new neurologic manifestations can still be presentThe main cause of death is the b:A. sustained convulsions, B. respiratory failure, C. circulatory failureD. cerebral edema, cerebral hernia, E., disturbance of consciousnessAbout the Japanese encephalitis, which of the following is true

12、?A. often has family aggregation, B. is more common in China in 510 monthsC. tic is accompanied by conscious disturbance, and D. virus isolation is the most common diagnostic methodE. should be treated with antiviral therapy at an early stage6 on the clinical manifestations of Japanese encephalitis,

13、 which one is wrong?A. the longer the consciousness barrier, the worse the conditionB. often has intracranial pressure elevation, and check the signs of meningeal irritationSome C. patients suffer from tic and disturbance of consciousnessThe course of D. early skin visible petechiaeE. may have cereb

14、ral hernia manifestation in severe casesWhich one of the following, cerebrospinal fluid examination results do not meet Japanese encephalitis?A. pressure increased, B. appearance colorless transparent or slightly muddyC.The WBC count was 50500 * 106/L D. chloride normalE. sugar decreased significant

15、lyWhich of the following, a performance with central respiratory failure?A. is obviously difficult to breathe, B. breathing first and then slowly, but the rhythm of breathing is regularC. chest breathing or abdominal breathing diminished and D. respiratory rhythm was irregular and unevenE. cyanosis2

16、. A2 questionA male, 12 years old, high fever and headache for 2 days, half insane hospital on July 11th, medical T40.5 CP110 / minR28 / minComaNo abnormalities were found in the heart and lungs, only in the lower hepatic rib and in the spleen, and negative in the Kernig and S signPeripheral blood,

17、WBC20 * 109/L, positiveN92%The most probable clinical diagnosis of this case is:A. B. septicemia of tuberculous meningitis C. epidemic cerebrospinal meningitisD. epidemic encephalitis B, E. malariaThe male, 20 years old, the field to spike studentsHigh fever for 3 days, convulsions, consciousness di

18、sorders, 1 days admission, physical examination, T40R30 / minNeck resistance, Kernig, S sign positiveElevated positive muscle tone of the limbs and peripheral blood WBC20 * 109/LN92%Urinary protein (+)Which of the following is the most important to make a definite diagnosis?:A. blood culture, B. JE

19、specific antibody test, C. cerebrospinal fluid examinationD. virus isolation, E. epidemic hemorrhagic fever, antibody test3. B questionA.: fever, headache, drowsiness, skin bleedingB. fever, convulsions, coma, shockC. fever, headache, tenderness of gastrocnemius muscle, superficial lymph node enlarg

20、ementD. fever, coma, convulsionsE. has a slow onset of fever, headache, and meningeal irritationJapanese encephalitis is the most common type of encephalitisThe most common is the epidemicThe most common dysentery is poisoningThe most common form of tuberculous meningitis isThe A. of antibiotic trea

21、tmentB. antiviral therapyC. is symptomatic treatment for high fever, convulsions and respiratory failureD. antitoxin therapyE. fluid replacement therapyEncephalitis B is commonly used in treatmentThe treatment is commonly used in the treatment of epidemic cerebrospinal meningitisThe most important t

22、reatment for cholera isDiphtheria is the most important treatmentThree questions1. to discuss the clinical manifestation of the typical epidemic encephalitis B2. to discuss the diagnosis of Japanese encephalitis3. to discuss the treatment of epidemic encephalitis BFour medical record analysisMale, 7

23、 years old, with high fever, 3 with convulsions and unconsciousness, admitted to hospital on August 10th, 1 days, T40.3 degree centigradeBP 150/90mmHgP107 / minR32 / minNo skin rash on the whole of the bodyBoth sides of the pupil are unequal, the left 3mm, the right 4mm, light reflex, neck suspiciou

24、s resistance, double lungs can smell and phlegm sound, liver and spleen are not palpableKernig S sign is positiveBilateral Babinski sign (+), peripheral blood WBC20.5 * 109/LN86Diagnosis and its basis, further examination and treatment measures are discussedThree, reference answers and analysisFill

25、in the blanks1. flavivirusFlavivirus2. zoonotic diseasespigmosquito bitesCulex Culex threeMore durable3. mosquito controlMosquitoVaccinationTwo choice questions1. A question1 DCQuestion analysis: the main question of the principle of encephalitis B treatmentDiazepam is the first depressantEBThe CAna

26、lysis of questions: comprehensive assessment of JE knowledgeJapanese encephalitis due to latent infection is rare, highly sporadic, so there is little family aggregation; Chinas subtropical zone, found in the 7-9 month of Japanese encephalitis virus isolation; the positive rate is low, can not be us

27、ed as the most common clinical diagnosis method; clinical diagnosis method of the most commonly used should be the serum specific antibody detection of Japanese encephalitisAt present, there is still no specific antiviral treatment, so the treatment of Japanese encephalitis is still symptomatic trea

28、tmentWill DItem analysis: the typical Japanese encephalitis patients, no skin petechiaeAccording to clinical skin petechiae, help the physician of Japanese encephalitis and meningitis differential diagnosis7 EItem analysis: the features of cerebrospinal fluid with encephalitis and other viral enceph

29、alitis, cerebrospinal fluid showed serous changes, specific performance: the pressure is normal or slightly high, the appearance is colorless transparent or slightly turbid, white blood cell count in 50 500 * 106/L, the individual also can be as high as 1000 * 106/L, chloride normal. Normal or high

30、glucoseWhether the sugar content in cerebrospinal fluid is lower or not is very helpful for the differential diagnosis of encephalitis B with purulent meningitis, tuberculous meningitis, fungal meningitis and so on8 DAnalysis of the questions: the key difference between central respiratory failure a

31、nd peripheral respiratory failure is that the central respiratory rhythm is irregular and uneven, and the peripheral respiratory rhythm is regularCyanosis, dyspnea is a common manifestation of respiratory failure, can be found in the central and peripheral respiratory failure patients2. A2 question1

32、 DExamination questions: the content of the examination, diagnosis and differential diagnosisThe first consideration is: according to the JE patients are children belonging to multiple age for JE high season; the rapid onset, short course of disease; the central nervous system, brain damage is the m

33、ain clinical manifestations were fever, disturbance of consciousness and early; physical examination showed positive pathologic reflex; the laboratory. The increase of white blood cellMeningitis is also more common in children, may have fever, headache and leukocytosis, but the disturbance of consci

34、ousness is light, physical examination to meningeal irritation as the main performance, no pathological reflexThe incidence of meningitis and season in the winter seasonBAnalysis of the questions: the differential diagnosis and experimental examination of Japanese encephalitisAccording to the patien

35、ts for the incidence of young people; the acute onset, short course of disease; the central nervous system, brain damage is the main clinical manifestations were fever, disturbance of consciousness and convulsions; the physical examination showed meningeal irritation and pathological reflex, the lab

36、oratory to see the white blood cells increased, we should first consider the clinical diagnosis of Japanese encephalitis theTo make the diagnosis clear, the most important clinical examination is the detection of encephalitis B antibodyBlood culture, cerebrospinal fluid examination and virus isolati

37、on are necessary, but they are not the most important diagnostic methods for this disease3. B questionThe D A B E 4 3 2Analysis of the questions: This is the content of the differential diagnosis of epidemic encephalitis BThis disease should cause poisoning and dysentery, other viral encephalitis, t

38、uberculous meningitis and purulent meningitis identificationThis is the main distinguishing point of every diseaseThe C A E D 4 3 2Examination question analysis: This is examines the epidemic encephalitis B and so on illness treatment principle contentUnderstand and master different diseases from th

39、e subject, the main principles of treatment are differentAlthough encephalitis B and cholera are caused by different types of pathogens, they are mainly symptomatic treatmentMeningitis is a disease caused by the bacterium to antimicrobial therapy.Diphtheria is caused by toxins and is mainly treated

40、with antitoxinThree questions1., the answer to the main points of Japanese encephalitis can be divided into three phases:At the beginning of 1 to 3 days.Acute onset of fever, headache, nausea and vomiting, lethargy, etcNeck hardThe very period of 4 to 10 daysIt mainly includes: (1) high fever;The hi

41、gher the heating, the thermal process of the longer, the more severe the disease; the disorder of consciousnessThere may be drowsiness, delirium, coma, disorientation, etc.; convulsions or convulsionsIt may be local convulsions or limb clonic or general tetanic tic in hand, foot and face, all accomp

42、anied by unconsciousness; respiratory failureMainly central respiratory failure, characterized by irregular and uneven respiratory rhythm, and sometimes peripheral respiratory failureWhen serious, can appear the expression of cerebral hernia; the symptom of nerve system and body signSuch as patholog

43、ical reflex and meningeal irritation signThe recovery period can be recovery symptoms,If the illness 6 months later, still leave some mental symptoms, known as sequelaeThe diagnosis of encephalitis B 2. answer points should be carried out according to the clinical manifestations and laboratory exami

44、nation of epidemiology, three aspects: according to the onset of summer and autumn, with data of 10 children under the age of such as epidemiology; the clinical manifestations as fever, headache, vomiting, unconsciousness, convulsions, pathological reflex and positive meningeal stimulation; experime

45、nt check: see the number of white blood cells and neutrophils were increased, CSF was aseptic meningitis can make a clinical diagnosisSerological examination, JE positive IgM antibody can help diagnose3. the key point of treatment of patients with encephalitis is to deal with high fever, convulsions

46、 and respiratory failure and other critical symptomsThe general treatment of isolation, support treatment, pay attention to water and electrolyte balanceCare of critical cases is also importantIf the symptomatic treatment for high fever, convulsions, respiratory failure and symptomatic treatmentThe

47、high fever, with physical cooling such as ice, alcohol sponge bathDrug cooling auxiliary, such as an intranasal febrile convulsion in Nei Ching, who can subhibernation therapy; the seizures or convulsions should be symptomatic treatment of different methods are used for high fever, hypoxia, cerebral

48、 edema, brain inflammation and other various reasons; the respiratory failure to maintain airway patency, such as cerebral edema should be dehydrated, with central respiratory failure the available respiratory stimulant, can also use vasodilators, to improve microcirculation, relieve cerebral edema,

49、 but mechanical ventilation when necessaryThe treatment of recovery and sequelae of functional training can be used, including physical therapy, acupuncture, massage, massage and other methodsFour medical record analysisMain reason: this case is diagnosed as epidemic encephalitis BThe diagnosis was

50、based on the children for JE multiple age; the onset of summer and autumn; the rapid onset, short course of disease; the central nervous system, brain damage is the main clinical manifestations were fever, disturbance of consciousness and convulsions; the physical examination showed positive patholo

51、gic reflex, the laboratory to see the white blood cells increasedFurther examination: serological examination: the detection of Japanese encephalitis antibody, paired sera positive diagnosis; II: cerebrospinal fluid examination is helpful to the diagnosis and differential diagnosis of disease, meningitis, tuberculous meningoencephalit