Clinical

Question 1

3 basic fluid compartment disorders?

Answer 1

1. Dehydration ® thirst + ­ serum sodium concentration
   * Replenish whole body water
2. ECF volume depletion ® interpretive physical exam, vascular dynamics
   * Treat primary cause and replenish ECF
3. ECF volume excess ® weight gain, oedema, ascites, pulmonary oedema
   * Treat primary cause and reduce ECF volume

Question 2

4 anatomical compartment of body?

Answer 2

1. Fat (20%): fat is not adipose tissue
2. Body cell mass (50%): 50% depletion is death

BMI = weight (kg) / height² (m)

1. ECG (20%)
2. Structural tissues (10%)

Question 3

Bioenergetic principles?

Answer 3

• At every moment, we generate heat from the fuel we consume
• The Atwater factors are used to calculate of the amount of food energy (calories) in food (direct calorimetry)
  
  • 1 g triglyceride provides 9 kcal
  • 1 g ethanol provides 7 kcal

  • 1 g carbohydrate provides 4 kcal
  • 1 g protein provides 4 kcal
• Indirect calorymetry calculates how much oxygen is needed to produce X amount of heat

Question 4

Determinants of energy expenditure?

Answer 4

1. The rate of fuel oxidation while a person is quietly lying at rest and simply “staying alive.” This is called resting energy expenditure (REE) or basal metabolic rate (BMR)
2. The small amount of heat released during the metabolic processing of food. This is the thermic effect of food.
3. Energy expended for activities above basal, such as moving around and carrying out external work.

Question 5

What is the teeth nomemclature?

Answer 5

Question 6

Oesophagus problems

Answer 6

• Most of difficulties swallowing (dysphagia) are due to reflux
• The second most common cause is the failure of the craco-pharangeus muscle to relax
• Diffuse oesophageal spams can mimic angina
• Apple core deformity is often malignant

Question 7

Abdominal pain approach

Answer 7

1. History
2. Colicky
3. Localized
4. Diffuse
5. Physical exam: tenderness, mass
6. Laboratory tests: liver, kidney, infections

Question 8

Abdominal differential diagnosis

Answer 8

• Small bowel obstruction cause by adhesions from previous surgery (most common cause), hernias, crohn’s disease, neoplasms, foreign bodies, intussusception, volvulus, superior mesenteric artery syndrome, ischemia
• Liver cancer
• Bile duct tumour (apple core)
• Gall stone (presents with jaundice and pain)
• Obstructive bile duct because of pancreatic tumour
• Diverticulitis (thumb printing sign on CT, old people)

Question 9

Advantages of Virtual colonoscopy?

Answer 9

• Less expensive
• No significant risk of radiation
• Almost 0 risk of perforation
• Done with CT scan with advanced software and AI
• Is equally accurate as optical colonoscopy for polyps 8 mm or larger

Question 10

Diagnosis criterias for diabetes?

Answer 10

1. FPG ≥7.0 mmol/L: fasting = no caloric intake for at least 8 hours
2. A1C ≥6.5% (in adults): using a standardized, validated assay in the absence of factors that affect the accuracy of the A1C and not for suspected type 1 diabetes
3. 2hPG in a 75 g OGTT ≥11.1 mmol/L (not ideal)
4. Random PG ≥11.1 mmol/L

Question 11

Vascular complications of DM?

Answer 11

• Atherosclerosis
• MI
• Gangrene

Question 12

Renal (nephropathy) complications of DM?

Answer 12

ALBUMIN IN THE URINE IS THE WAY TO KNOW

• Glomerular lesions: intercapillary glomerulosclerosis or Kimmelstiel-Wilson disease
• Renal vascular lesions (arteriolosclerosis)
• Pyelonephritis: prone to UTI, can lead to necrosis

Question 13

Ocular (4^th leading cause of blindness) complications of DM?

Answer 13

• Cataracts
• Glaucoma
• Retinopathy (background: capillary BM thickening and arteriolar hyalinization OR proliferative: Neovasculization as a result of ischemi)

Question 14

Neuronal complications of DM?

Answer 14

• 80% of patients have peripheral neuropathy after 15 years

Question 15

Acute complications of DM?

Answer 15

• Infections
• Type 1: diabetic ketoacidosis and hypoglycaemia (skip a meal)
• Type 2: hyperosmolar nonketotic coma