1ST smester

Question 1

explain Five classical methods of direct patient examination

Answer 1

1. patient’s interview,
2. inspection,
3. palpation,
4. percussion,
5. auscultation

Question 2

explain DF of , Symptom,Syndrome,Diagnosis

Answer 2

• Symptom is a separate sign
  of the disease.
• Syndrome is a combination of symptoms, combined with a common pathogenesis (the mechanism of development)
• Diagnosis is a short medical conclusion about the nature of the disease and the patient’s condition

Question 3

what is the structure of medical case report

Answer 3

1- I. The patient identification data (ID).
2- II. Medical history
3- III. Physical examination
4-IV. Scheme of investigation
5-V. Investigation data
6-VI. Сlinical diagnosis
7- VII. Treatment

Question 4

explain the II. Chief complaint for the systemes

Answer 4

–—* The chief complaint (CC) :complaints refer to important symptoms of the disease, most typical for that disease, which shows to some extent the localization of the process.
— Respiratory
* Cough (dry, wet, paroxysmal)
* Sputum (mucous, purulent ,rusty)
* Hemoptysis
* Chest pain
* Breathlessness (dyspnea)
* Suffocation
–. Cardiovascular
* Pain in the region of
the heart
* Breathlessness
* Heart rhythm
disturbances
* Edema
* Headache
—Alimentary
* Appetite disorders
* Swallowing disorders
* Heartburn
* Eructation
* Nausea, vomiting
* Abdominal pains
* Diarrhea
* Constipation
–Urinary
* Fever
* Painful urination
* Pain in loin region
* Red urine
* Edema
* Altered urine volume

Question 5

explain the body Constitution

Answer 5

1- Normosthenic type : is characterized by correct habitus with proportional parts of body, well-developed somatic musculature, correct chest shape with costal angle approaching straight angle
2-Asthenic type :
 predominant body development in length,
 muscles are weakly developed,
 shoulders are sloping,
 long neck,

3-Hypersthenic type:
 predominant body development in width;
 medium height or lower,
 enhanced nutrition,
 muscles are well-developed.
 shoulders are wide, neck is short.
 the abdomen is enlarged in volume.
 the chest in is wide,

Question 6

Types of impairment of consciousness.

Answer 6

– Three grades of consciousness disturbance are distinguished :
1. Torpor : is a state of stunning out of which the patient may be taken out for a short time by speaking to him. The patient is poorly oriented in the surrounding situation, answers the questions slowly and late

2-Sopor (sleep) : is more pronounced consciousness disturbance. The patient does not react to surrounding people, although sensitivity, including pain sensitivity, is preserved, reacts to examination.

3-Coma :

Question 7

Coma and the reasons for their occurrence.

Answer 7

–consciousness and response to external stimuli (pain, etc.) are completely absent.
1-Complete muscle relaxation and loss of reflexes are observed.
2-Regulation of vital functions (breathing, circulation) are damaged, but saved.
3-Thus, in coma there is a complete unconsciousness, loss of sensitivity and movements.
—occurance :
1-alcoholic coma
2-hypoglycaemic coma
3-diabetic (hyperglycaemic) coma
4-hepatic coma

Question 8

Facial expression in various diseases.

Answer 8

-they are several types :
1-Facies mitralis : (face of a patient with mitral valve stenosis)
2-Acromegaly :The increased growth hormone of acromegaly produces enlargement of both bone and soft tissues. of the head
3-Facies nephritica : (face of a patient with renal diseases) pain, puffy, with upper and lower eyelids edema,
4-Facies leonine : (face of patient with leprosy)
5-Facies Corvisari : is characteristic for patients with pronounced cardiac insufficiency..
6-Facies micsedemica : face of a patient with thyroid gland hypofunction (myxedema).
7-Facies Basedovica : (face of a patient with thyrotoxicosis): anxious, exasperated or frightened face expression is marked,
8-hirsutism facies : Face of a female patient with hirsutism developed due to excessive testosterone in the organism

Question 9

Types of temperature curves.

Answer 9

— In a healthy human being body temperature
fluctuates in a narrow range: from 36,0°C to 37,0°C.

1-Continued fever (febris continua): long-term body
temperature increase with diurnal fluctuations not
exceeding 1°C.
2-Remittent fever (febris remittens): long term body temperature increase with diurnal fluctuations exceeding 1°C.
3-Intermittent fever (febris intermittens): high fever changed by normal body temperature (below 37°С) for 1-2 days and then rising again up to 38-40°С.
4-Hectic fever (febris hectica): sufficient temperature increase up to 39-41°С (more often by the evening) changed by normal temperature within 24 hours. Increase of temperature is accompanied by pronounced chill, and its increase - by emaciating sweating

Question 10

Examination of the skin and visible mucous membranes.

Answer 10

—-1-color:
-there are 5 types we can distinguished while we examine the patient :
1- Paleness = -anemias - peripheral circulation pathology:
2-Redness = 2-1peripheral vessels dilation: fever 2-2erythrocytosis, polycythemia
3-Cyanosis (bluish) = :
3-1Central cyanosis – diffuse, warm: develops in result of insufficient blood oxygenation in the lungs in various respiratory organs diseases
3-2. Peripheral cyanosis (acrocyanosis), cold : appears in case of slowing down of peripheral
circulation, in venous congestion in patients with cardiac insufficiency.
3-3. Limited, local cyanosis :develops in result of peripheral veins congestion due to their compression with tumor,
4-Jaundice ; three kinds of jaundice are distinguished = :
1. parenchymal (in hepatic parenchyma lesion);
2. mechanical (in obturation of common bile duct with a concernment or its compression with a tumor);
3. hemolytic (in enhanced hemolysis of erythrocytes)
5-Bronze (brown) = Bronze (brown) skin color is usually seen in adrenal insufficiency.

—-2- humidity (moisture) :

–they are several types :
1-Moderate (normal)
2-Excessive (sweating) – diabetes mellitus (especially when blood sugar is low)
3- Dry (dryness) -renal failure, skin diseases
4-Peeling - , «uremic powder»
—-3-elasticity (turgor):

1-Decrease in elasticity of skin - patients of old age, dehydration (vomiting, diarrhea).
2-Increase in turgor and tension of skin - liquid delay.

Question 11

Classification of skin rashes.

Answer 11

-1–Hemorrhagic
1-petechiae,
2-ecchymosis,
3- purpura
-2–Non-hemorrhagic:
1-erythema (including erythema nodosum),

Question 12

Condition of subcutaneous fat.

Answer 12

1-development (moderate, weak, excessive),
2-largest deposition sites,
3-presence of edema,
4-thickness of the fat fold at the lower angle of the scapula and on the abdomen at the level of the navel
——(obesity) ; Primary (exogenous constitutional, or alimentary-metabolic) obesity based on energetic imbalance (absolute or relative increase of energy income with food or decrease of its waste due to hypodinamia)
–the opposite of the obesity is the chexcia

Question 13

Complaints of patients with respiratory diseases and their pathogenesis.

Answer 13

there is 2 type
– Main :
1.Cough
2.Sputum
3.Breathlessness
4.Chest pain
5.Haemoptysis
6.Wheeze
–Nonspecific-
Fever, Chills, Sweating, Weakness,
decreeing working ability.

Question 14

Pathological forms of the chest.

Answer 14

1-Emphysematous or barrel
 pronounced swelling or flattening in the
supraclavicular area
 horizontal ribs and intercostal spaces increase
 rib angle greater than 90º
 an increase in the cross and especially anteroposterior
chest size
2-Paralytic
 Thorax is flattened from front to back
 anteroposterior size is about ½ the size of the frontal
 Retraction of supra- and subclavian spaces
 Expressed wide intercostal spaces
 Pterygopalatine spaced blades
 Epigastric angle is less than 90 °
3-Rachitic (keeled) thorax :(compressed from sides, sternum sharply protruding - chicken breast)
4-Funnel chest and chest cobbler : (changing the shape of the sternum, the lower part of the impression or oblong recess at the upper and middle part of the sternum - navicular thorax)

Question 15

Elasticity and resistance of the chest.

Answer 15

— Resistance of the chest opposite the property of elasticity; which caused by :
1. emphysema of the lungs,
2. ossification of ribs in the elderly,
3. fluid in the pleural cavity,
4. tumors of the pleura

Question 16

Percussion sounds over the human body. Percussion methods. General rules of percussion.

Answer 16

–Types of percussion notes ( sounds ) :
1-Resonant note
2-Dull
3-Stony dull (flat)
4-Hyporesonant
5-Hyperresonant
6-Tympanic
–methods : 2 fingers
–Rules:
* percussion - quiet
* from clear to dull percussion note
* the finger-pleximeter parallel to the border of the organ
* the border is marked by the edge of the pleximeter directed toward the zone of the more resonant sound
* percussion carried out at the ribs and intercostal space

Question 17

Name the conditions for the appearance of hyperresonance, tympanic and dull percussion sounds.

Answer 17

1-hyperresonant sound or boxed sound :
reduce the elecitic properties and increased air lungs = emphysema of lungs
2-tympainc sound :
cavity of the lung filled with air = penumothorax and lung abussce in 2nd stage
3-dull sound :
absence of air in share of segment = hydrothorax and tumor

Question 18

The height of apex of the lungs in front and behind, the reasons for its changes

Answer 18

-Upper border of the lungs in front:
1-The height of the top of the front light is normally located at 3-4 cm above the level of the clavicle
-Upper border of the lungs in back :
1-The height of the top of the back light is normally located at the level of VII cervical vertebra, 3-4 cm lateral to the spinous process of the vertebra
—–Meaning of changes in the upper boundaries of the lungs :
- Increasing the size of the lungs apex and Kroenig’s area, the displacement of the upper bounds upwards and the expansion of the Kroenig’s area:
- lung emphysema
-Decrease apex or downward displacement of upper
boundaries, narrowing of Kroenig’s area:
- pneumosclerosis
- pneumonia

Question 19

Basic complaints of CVS

Answer 19

–Pain: - coronarogenic (ischaemic) – angina pectoris
–non-coronarogenic - cardialgia
*Interruptions in the work of the heart and palpitation
*Shortness of breath (dyspnea), suffocation
*Edema
*Coughing, hemoptysis
*Headache
*Dizziness, flickering flies before the eyes
*Syncope

Question 20

explain the Skin covers in CVS Dieases

Answer 20

1-Colors of skin
- coffee with milk
- pale
- acrocyanosis
Skin rashes and formations :
1-xanthoma 2-trophic changes 3-acrocyanosis

Question 21

explain the Shift of apex beat

Answer 21

1-Left shift:
§ On the left side (3-4 см)
§ Dilation and hypertrophy of LV
§ Dilation of RV
§ Fluid or air in right pleural cavity
2-Right shift:
§ Lying on the right side (1-1,5 см)
§ Pleuro-pericardial commissures
3-Disapperas :
§Left-sided hydrothorax
§Hydropericardium
4-Negative: (constrictive pericarditis)

Question 22

explain the Cardiac (right ventricular) beat

Answer 22

*Location in the III -
4th intercostal space to the left of the sternum extends to the epigastric region
*Mechanism - reduction of enlarged right ventricle

Question 23

explain the Epigastric pulsation

Answer 23

*Elevation and lowering of the anterior abdominal wall in the epigastric region, synchronous to the contractions of the heart
*Mechanism:
- pulsation of the heart (right ventricle)
- pulsation of the abdominal aorta
- pulsation of enlarged liver

Question 24

explain the Arterial pulse and its Properties

Answer 24

-DF- Pulse is the rhythmical vibration of the arterial walls caused by contractions of the heart, blood discharge into the arterial system, and changes in pressure in this system during systole and diastole
-Properties :
-* Rhythm: regular/irregular
* Pulse rate:
- normal (60-90 per min)
- bradicardia (<60 per min)
- tachycardia (>90 per min)

Question 25

what is the Heart auscultation points

Answer 25

1 point of auscultation - in the area of apical impulse (MV)
2 point of auscultation - in the II intercostal space to the right of the sternum (AV)
3 point of auscultation - in the II intercostal space to the left of the sternum (PAV)
4 point of auscultation - at the base of the xiphoid process (TV)
5 point of auscultation - III-IV intercostal space to the left of the sternum (AV, MV)

Question 26

explain the Murmur disease

Answer 26

–A heart murmur is a sound made by turbulent blood flow
within the heart.
–Causes
* Folding valve flaps - stenosis
* Incomplete closure of the valve opening - insufficiency
* The presence of anomalous holes in the heart:
- atrial septal defect;
- ventricular septal defect

Question 27

explain the Distension pain

Answer 27

associated with hypomotor
dyskinesia of smooth
muscles and hollow organ
distension
dull pains, non-intense,
without clear localization
сauses: flatulence,
hyposecretory syndrome

Question 28

explain the Vascular pain

Answer 28

associated with a violation of the blood supply to the
abdominal cavity, as a result of this, ischemia and
necrosis develop sudden onset, very intense,
progressive,
сauses: mesenteric thrombosis, embolism, ischemic
disease of the digestive system

Question 29

explain the Peritoneal pain

Answer 29

based on tension of the capsule or visceral sheet of
the peritoneum
peritoneal pain occurs gradually or suddenly (with
perforation), increases, intense, accompanied by
tension of the abdominal wall, a symptom of irritation
of the peritoneum, vomiting and fever
сauses: peritonitis due to inflammation of the organs
(appendicitis, acute cholecystitis, acute pancreatitis)
and perforation of the stomach and intestines

Question 30

explain the Dyspepsia in gastric and intestinalis

Answer 30

–1. Gastric:
* accompanied by pain in the
epigastric region;
* heartburn;
* vomiting;
* change in appetite
* belching;
* nausea;
2. Intestinal:
* accompanied by pain in
different parts of the
abdomen (in the projection
of the small and large
intestine;
* flatulence;
* diarrhea;
* сonstipation;
* tenesmus -painful impulse to
defecate

Question 31

explain Admixture of blood in the feces

Answer 31

-1-bright scarlet blood from the anus in the form of drops or trickles is a
characteristic sign of»_space
hemorrhoidal bleeding;
-2-scarlet blood on the surface of the feces - a symptom of lesions of the»_space; sigmoid and rectum;
-3-dark red brown blood, evenly mixed with feces, is characteristic of
pathological processes localized in the initial section of the large intestine;
-4-black mushy stools (melena) - a sign of massive bleeding from the esophagus, stomach or small intestine.

Question 32

Peripheral signs of long-term liver
damage

Answer 32

 Spider veins
 Drumsticks
 Palmar erythema
 Scratches
 Hemorrhagic diathesis –petechial eruption
and hemorrhage into the skin (ecchymosis)

Question 33

explain the Jaundice

Answer 33

–Jaundice staining of the skin and / or
sclera indicates hyperbilirubinemia
↑ bilirubin > 35 мкмоль/л
–Types of jaundice :
1. Hemolytic (suprahepatic or prehepatic) -
high blood levels of unconjugated (indirect) bilirubin
2. Hepatic cell (parenchymal) - increased blood
levels of both indirect and direct bilirubin.
3. Mechanical (subhepatic or post-hepatic,
obstructive) - high blood levels of conjugated
(direct) bilirubin

Question 34

explain the Dark urine (bilirubinuria)

Answer 34

–Dark urine (bilirubinuria) :Appears with an increase in direct
bilirubin in the urine - hepatic and
posthepatic jaundice

Question 35

explain the Decolorized feces (acholia)

Answer 35

– its Changing the color of feces resulting from the
absence or substantial reduction of stercobilin.

Question 36

explain the Pain in the right hypochondrium

Answer 36

-Pain in the right hypochondrium : May be due to:
-distension of Glisson’s capsule
-liver abscess
-spastic contractions of muscles of the gall
bladder and large bile ducts

Question 37

Causes of spleen enlargement
(splenomegaly)

Answer 37

acute and chronic infectious diseases
(typhus, viral hepatitis, sepsis, malaria,
etc.),
in liver cirrhosis,
thrombosis or compression of the splenic
vein,
diseases of the hemopoietic system
(hemolytic anemia, thrombocytopenic
purpura, acute and chronic leucosis).
deposition of amyloid

Question 38

What is bilirubin , ?

Answer 38

–Bilirubin: is the product formed by the breakdown of red blood cells in the body. Red blood cells are continuously undergoing hemolysis ( or a breaking down) process, because their average life- span is about 120 days. As the red blood cells disintegrate, the hemoglobin is degraded or broken into globin- which is the protein part, iron (which is conserved for later use), and heme
-The heme initially breaks apart into biliverdin, a green pigment which is rapidly reduced to bilirubin, an orange-yellow pigment. This is called the unconjugated or indirect bilirubin. The bilirubin is then transported to the liver where it reacts with a solubilizing sugar called glucuronic acid. Here in the liver, the unconjugated or indirect bilirubin is converted to a more soluble form of bilirubin which is called the conjugated or direct bilirubin. This Direct bilirubin is excreted into the bile, which goes through the gall bladder into the intestines where the bilirubin is changed into a variety of pigments. The most important ones are stercobilin, which is excreted in the faeces, and urobilinogen, which is excreted as a normal component of the urine.
—Types of bilirubin :
There are two types of bilirubin in the blood…

1-Unconjugated (indirect) bilirubin is insoluble in water. This is the bilirubin before it reaches the liver.(pre hepatic )
2-Conjugated (direct) bilirubin has been converted to soluble bilirubin in the liver. It then goes into the bile to be stored in the gall bladder or sent to the intestines.( post hepatic )
-Note- Routine blood tests for total bilirubin measure both unconjugated and conjugated bilirubin.
–Normal Values of bilirubin:
1-Indirect Bilirubin > 0.00- 0.80 mg/dL
2-Direct Bilirubin > 0.01- 0.30 mg/dL
3-Total Bilirubin > 0.2- 1.2 mg/dL

Question 39

What is Jaundice and hyperbiliruimia

Answer 39

-Jaundice: is the result of the accumulation of bilirubin in the blood, it is also called hyperbilirubinemia. Jaundice clinically manifests asthe yellowing of the skin and mucosa in the body, as well as itching (pruritus).
–Signs and symptoms of Jaundice :
pale-colored stools
dark-colored urine
skin itching
nauseaandvomiting
rectal bleeding
diarrhea
feverandchills
weakness
weight loss
–Types of Jaundice :
There are three types of jaundice, depending on what’saffecting the movement of bilirubin out of the body.They are:
1-pre-hepaticcauses
2-hepatic (liver) causes
3-post-hepatic causes
——
1-pre-hepaticcauses of Jaundice ( unconjegated bilirubin ) :
-Jaundice caused during the pre-hepatic phase is due to the excessive destruction (hemolysis) of red blood cells from various conditions. This rapid increase in bilirubin levels in the bloodstream overwhelms the liver’s capability to properly metabolize the bilirubin, and consequently the levels of unconjugated bilirubin increase. Conditions which can lead to an increase in the hemolysis of red blood cells include:
Malaria,
Sickle cell disease,
Hereditary spherocytosis,
Thalassemia,
—–
2-hepatic (liver) causes of Jaundice ( congregated and unconjugated bilirubin )
-Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Conditions with a hepatic cause of jaundice include:
Acute or chronichepatitis(commonly viral [Hepatitis A, B, C, D, E] or alcohol related),
Cirrhosis(caused by various conditions),
Drugs or other toxins,
Crigler-Najjar syndrome,
—–
3-post-hepatic causes of Jaundice ( Conjugated (direct)
bilirubin )
-Jaundice from a post-hepatic cause arises from a disruption (or an obstruction) in the normal drainage and excretion of the now conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Conditions that can cause post-hepatic jaundice include
Gallstones
Cancer(pancreatic cancer, gallbladder cancer andbile duct cancer),
Strictures of the bile ducts,
Cholangitis,
Pancreatitis, and Parasites (for example, liver flukes).

Question 40

Main complaints of kidney dieses

Answer 40

1-Pain
2- Urinary Disorders
3-Discoloration of urine
4-Edema
5-Headache, dizziness, palpitations, pain in the region of the heart (increase in blood pressure)
6-Fever
7-Urea smell from the mouth
8- Itchy skin
9-Nausea
10-Vomiting
11- Hemorrhages on the skin
12-Decreased vision

Question 41

explain the Urolithiasis disease Pain

Answer 41

(local spasm of the smooth muscles of the ureter, with obstruction of the ureter with a stone - stretching of the
renal pelvis with urine)
- acute paroxysmal pain (renal colic)
- pain intense, unbearable
- localization - in the lower back or along the ureter, radiating to the inguinal region, to the genitals

Question 42

explain the Polyonephritis pain

Answer 42

inflammation of the mucous membrane of the renal
pelvis, impaired passage of urine and distension of the
renal pelvis)
- intense pain
- localization in the lumbar region,
- the intensity gradually increases, then weakens

Question 43

explain the Glomerulonephritis Pain

Answer 43

(parenchymal kidney disease - inflammatory
swelling of the kidney tissue, gradual distension of
the renal capsule)
- pain is not intense, dull, aching
- constant, long
- pain symmetrical, bilateral

Question 44

explain Kidney infarction pain

Answer 44

(rapid and significant distension of the renal capsule)
- intense pain,
- begins acutely, long

Question 45

what is the Provoking factors of pain and , Factors that relieves pain
( kidny diease )

Answer 45

–Provoking factors
1-Hypothermia
2-Fast walk
3-Running
4-Lifting weights
5-Act of urination
–Factors that relieves pain
1-Horizontal position (this improves blood flow to the kidneys)
2-Forced position (bringing the legs to the stomach while
lying on the side - paranephritis)
3-Taking antispasmodic drugs
4- Applying a heating pad to the pain site

Question 46

explain the Polyuria , Oliguria , Anuria , Nocturia , Ishuria , Stranguria , Pollakiuria, oligakiuria

Answer 46

–Polyuria (> 2000 mL/day voided) may be caused by
1-renal origin - with damage to the renal tubules; in
the recovery stage of acute renal failure
2-extrarenal origin - with abundant fluid intake,
diabetes mellitus and diabetes insipidus, at low
ambient temperatures, with a decrease in edema
after taking diuretics.
-Oliguria : decrease in daily urine (<500 ml / day) duo to :
1-physiological oliguria (not less than 800 ml per day) -
limited drinking regimen, increased sweating, physical
activity
2-profuse diarrhea, uncontrollable vomiting, fluid
retention in patients with heart failure, burn disease
(shock stage), shock (of any etiology)
3-impaired renal function (glomerulonephritis, uremia,
etc.)
-Anuria : –a sharp decrease (<50 ml per day) or complete cessation of urine excretion
* Secretory anuria: marked disorder of
glomerular filtration (shock, acute blood loss
-Nocturia :voiding during the night duo to :
1-various kidney diseases,
2-prostatic hypertrophy,
3- heart failure
-Ishuria : Excretory anuria (ishuria):
impaired separation of urine with preserved renal function
-Stranguria - soreness during urinating (a
sign of inflammation of the bladder and / or
urethra)- painful urination
Pain appears at the end of urination (with
maximum bladder contraction) with (cystitis-bladder )
Pain appears at the beginning and during
urination with (urethritis)
–Norma: urination frequency - 4-7 times per day
Pollakiuria - frequent urination (intake of large amounts of
fluid, inflammation of the urinary tract, severe prostate
adenoma)
Oligaciuria is a rare urination (limited fluid intake, the
formation and strengthening of edema of any origin due to
fluid retention in the body; significant extrarenal fluid loss -
intense sweating, indomitable vomiting, diarrhea; oliguria
with glomerulonephritis, uremia)

Question 47

explain the Discoloration of urine

Answer 47

-urine of red-brown color or red (admixture of
blood) - with glomerulonephritis, urolithiasis, kidney tumor;
–pale yellow (almost colorless) - with polyuria;
–clouded - from admixture of leukocytes, mucus, blood.
–Hematuria (blood in the urine) :
—–Painless
-cancer of the urinary tract
-glomerunephritis
- prostatic disease
-polycystic disease ( ovum syndrome long period ) ,
- hydronephrosis ( stretch of one of the kidneys or both
—-Painful
-ureteral calculi ( stones in the ureteral )
-bladder infections or lithiasis.
–

Answer 48

• Pain in the suprapubic region - observed in diseases of the bladder ( Cystitis )
• Pain during urination, burning sensation in the
  urethra occurs with inflammation of the urethraitits.