A subjective choice of medical cases by a family practitioner - DONE

Question 1

Pneumonia - etiology:

Answer 1

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)

Question 2

Pneumonia - etiology:

Answer 2

The most frequent reason in eldery people is bacterial infection comparing to viral.

Question 3

Pneumonia - etiology:

Answer 3

The most popular is Streptococcus pneumoniae, rarely Mycoplasma pneumoniae, Chlamydiophila pneumoniae, Legionella pneumophila

Question 4

Cervical cancer - world?

Answer 4

The second most common malignancy in women worldwide

Question 5

Cervical cancer - who gets affected:

Answer 5

Cervical cancers usually affect women of middle age or older, but it may be diagnosed in any reproductive-aged woman

Question 6

Cervical cancer - Symptoms:

Answer 6

• There might be hardly any symptoms
• The first symptom is abnormal vaginal bleeding, usually postcoital
• Vaginal discomfort, malodorous discharge, and dysuria

Question 7

Cervical cancer - risk factors:

Answer 7

• 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

Question 8

Cervical cancer - diagnosis:

Answer 8

• 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

Question 9

Cervical cancer - prevention:

Answer 9

• vaccination (HPV vaccines: eg. Silgard, Cervarix)

- Regular cervix screening tests

Question 10

Grave’s disease - symptoms:

Answer 10

• 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

Question 11

Grave’s disease - diagnosis:

Answer 11

• Serum thyroid-stymulating hormone (TSH) is the best laboratory test
• Serum thyroxine (T4), thyroid autoantibodies

Question 12

Grave’s disease - treatment:

Answer 12

• Propylthiouracil
• Methimazole
• Carbimazole
• radioacttive iodine therapy
• surgical thyroidectomy

Question 13

Hypothyroidism - symptoms:

Answer 13

• 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

Question 14

Hypothyroidism - diagnosis:

Answer 14

• Blood test reveals TSH ↑

- Subclinical hypothyroidism is defined as normal serum free T4 levels with slightly high serum TSH concentration

Question 15

Hypothyroidism - treatment:

Answer 15

• oral thyroxine replacement therapy for life

- rapid T4 replacement may precipitate myocardial infarction - the starting dose in the eldery is 25-50μg per day

Question 16

Brain tumours - symptoms:

Answer 16

• 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

Question 17

Depression - symptoms:

Answer 17

• 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

Question 18

Medical etiologies of depression include the following:

Answer 18

• 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

Question 19

Osteoporosis – risk factors:

Answer 19

• 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)

Question 20

Lifestyle factors associated with decreased bone density:

Answer 20

• Smoking
• Alcohol consumption
• Low levels of physical activity
• Strenuous exercise (such as occurs in marathon runners) that results in amenorrhea

Question 21

Hepatitis C Virus (HCV):

Answer 21

Some patients infected with HCV have chronic liver disease, which can progress to cirrhosis and hepatocellular carcinoma

Question 22

Hepatitis C Virus (HCV) - symptoms:

Answer 22

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

Question 23

Hepatitis - symptoms:

Answer 23

• Gynecomastia
• Paraumbilical hernia
  
  • Ascites
  • Caput medusae
  • Hepatosplenomegaly
  • Abdominal bruit
  • Small testes
• Ankle edema
• Scant body hair
• Other clues - petechia, and tattoos

Question 24

Adverse drug reaction:

Answer 24

• 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