A subjective choice of medical cases by a family practitioner - DONE Flashcards
Pneumonia - etiology:
Typical symptoms associated with pneumonia are: cough, chest pain, fever and difficulty in breathing but sometimes a patient can have uncommon symptoms, like weight loss and night sweats (e.g tuberculosos), abdominal pain, diarrhea (e.g Legionella)
Pneumonia - etiology:
The most frequent reason in eldery people is bacterial infection comparing to viral.
Pneumonia - etiology:
The most popular is Streptococcus pneumoniae, rarely Mycoplasma pneumoniae, Chlamydiophila pneumoniae, Legionella pneumophila
Cervical cancer - world?
The second most common malignancy in women worldwide
Cervical cancer - who gets affected:
Cervical cancers usually affect women of middle age or older, but it may be diagnosed in any reproductive-aged woman
Cervical cancer - Symptoms:
- There might be hardly any symptoms
- The first symptom is abnormal vaginal bleeding, usually postcoital
- Vaginal discomfort, malodorous discharge, and dysuria
Cervical cancer - risk factors:
- sex at a young age
- multiple sexual partners
- promiscuous male partners
- history of sexually transmitted diseases
- weakened immune system
- smoking
- HPV (human papillomavirus infection) occurs in a high percentage of sexually active women.
Most of these infections clear spontaneously within months to a few years, and only a small proportion progress to cancer - The high-risk types are HPV 16 and 18
- Less common, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 should also be considered carcinogenic
Cervical cancer - diagnosis:
- If cervical cancer is the suggested diagnosis Bethesda System test should be performed.
- The patient should be referred to a gynecologist for colposcopy, direct biopsies, and endocervical curettage.
- After the diagnosis is established, a complete blood cell count and serum chemistry for renal and hepatic functions should be ordered to look for abnormalities from possible metastatic disease
Cervical cancer - prevention:
- vaccination (HPV vaccines: eg. Silgard, Cervarix)
- Regular cervix screening tests
Grave’s disease - symptoms:
- warm, moist, fine skin, sweating, vitiligo, alopecia, pretibial myxedema
- tremors, proximal muscle weakness
- palpitations, dyspnea, increased bowel motility
- tearing, photophobia, eye pain, protruding eye, diplopia, visual loss
- polyuria, polydipsia, easy bruising
- heat intolerance, weight loss despite increase or similar appetite, worsening diabetes control
- irregular menstrual periods, decreased menstrual volume, gynecomastia, impotence
- restlessness, anxiety, irritability, insomnia
Grave’s disease - diagnosis:
- Serum thyroid-stymulating hormone (TSH) is the best laboratory test
- Serum thyroxine (T4), thyroid autoantibodies
Grave’s disease - treatment:
- Propylthiouracil
- Methimazole
- Carbimazole
- radioacttive iodine therapy
- surgical thyroidectomy
Hypothyroidism - symptoms:
- fatigue, loss of energy
- weight gain
- cold intolerance
- dry skin, hair loss
- sleepiness
- depression,emotional lability
- constipation
- menstrual disturbances, impaired fertility
- hypercholesterolaemia
- oedema
- change in the voice
- slow pulse
- rarely myxedema coma
Hypothyroidism - diagnosis:
- Blood test reveals TSH ↑
- Subclinical hypothyroidism is defined as normal serum free T4 levels with slightly high serum TSH concentration
Hypothyroidism - treatment:
- oral thyroxine replacement therapy for life
- rapid T4 replacement may precipitate myocardial infarction - the starting dose in the eldery is 25-50μg per day
Brain tumours - symptoms:
- headache
- memory loss and decreased alertness
- emotional changes, and behavioral disturbances
- visual problems
- convulsions
- raised intracranial pressure leads to papilledema, decreased mentation and to brain herniation
Depression - symptoms:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day
- Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Medical etiologies of depression include the following:
- Cerebrovascular disease
- Coronary artery disease
- Chronic lung disease
- Cancer
- Endocrine disorders - hypothyroidism, hyperthyroidism, Addison disease, Cushing disease, hypogonadism
- Chronic pain
- Macular degeneration
- Sleep disorders - sleep apnea
- Infectious disease - neurosyphilis, HIV, Creutzfeldt-Jakob disease
Osteoporosis – risk factors:
- Age, sex
- Low body weight
- Family history of osteoporosis, particularly maternal history of fractures
- Reproductive factors, especially regarding early menopause and estrogen replacement therapy
- Medications (lithium, heparin, corticosteroids, thyroid suplementation)
Lifestyle factors associated with decreased bone density:
- Smoking
- Alcohol consumption
- Low levels of physical activity
- Strenuous exercise (such as occurs in marathon runners) that results in amenorrhea
Hepatitis C Virus (HCV):
Some patients infected with HCV have chronic liver disease, which can progress to cirrhosis and hepatocellular carcinoma
Hepatitis C Virus (HCV) - symptoms:
Most patients with chronic hepatitis C are asymptomatic or may have nonspecific symptoms such as fatigue or malaise in the absence of hepatic synthetic dysfunction
Hepatitis - symptoms:
- Gynecomastia
- Paraumbilical hernia
- Ascites
- Caput medusae
- Hepatosplenomegaly
- Abdominal bruit
- Small testes
- Ankle edema
- Scant body hair
- Other clues - petechia, and tattoos
Adverse drug reaction:
- hepatitis and cholestatic jaundice can develop after taking amoxycylin with clavulanic acid
- onset of signs/symptoms of hepatic dysfunction may occur during or several weeks after therapy has been discontinued
- The patient who has had documented hepatotoxicity related to this combination antibiotic should be well informed about the adverse drug reaction, and any future use should be prohibited.
- ADR should be reported
