Internal Medicine Flashcards
pyrosis
heartburn
lansoprazole
- a proton pump inhibitor
- decreases the amount of acid produced in the stomach.
- used to treat and prevent stomach and intestinal ulcers, erosive esophagitis (damage to the esophagus from stomach acid), and other conditions involving excessive stomach acid such as Zollinger-Ellison syndrome.
define
Zollinger-Ellison syndrome
-(Z-E syndrome) is a disease in which tumors cause the stomach to produce too much acid, resulting in peptic ulcers.
-Symptoms: abdominal pain and diarrhea.
Cause
Zollinger–Ellison syndrome (Z-E syndrome)
- caused by a gastrinoma, a neuroendocrine tumor that secretes a hormone called gastrin.
-Too much gastrin in the blood (hypergastrinemia) results in the overproduction of gastric acid by parietal cells in the stomach.
-Gastrinomas most commonly arise in the duodenum, pancreas or stomach
In 75% of cases Zollinger–Ellison syndrome occurs sporadically, while in 25% of cases it occurs as part of an* autosomal dominant syndrome called multiple endocrine neoplasia type 1 (MEN 1).*
Ciprofloxacin
- is a broad-spectrum antibiotic ( fluoroquinolone antibiotic used to treat a number of bacterial infections) such as:
uncomplicated urinary tract infections (UTIs)
including infections of bones and joints, endocarditis, gastroenteritis, malignant otitis externa, respiratory tract infections, cellulitis, urinary tract infections, prostatitis, anthrax, and chancroid.
Clostridium difficile (C. diff)
Check if you have a C. diff infection
Common symptoms of a C. diff infection include:
diarrhoea
a high temperature
loss of appetite
feeling sick
a stomach ache
Pseudomembranous colitis is caused by
- pathological proliferation of Clostridium difficile strains, most often after antibiotic treatment, usually:** clindamycin, penicillin, cephalosporins, fluoroquinolones**.
- The main symptoms are diarrhea and abdominal pain.
- is a type of bacteria that can cause diarrhoea. -It often affects people who have been taking antibiotics.
- It can usually be treated with a different type of antibiotic.
A 68-year-old patient for several weeks has complained of abdominal cramps, watery diarrhoea with the bowel movements 4-8 daily and bloating. Since then she has lost 4 kg. Periodically she has suffered from lumbar backache and takes diclofenac together with PPI as a gastroprotection. Routine laboratory tests were within normal limits. Ileocolonoscopy did not show any abnormalities. Biopsies taken during colonoscopy from the right half of the colon revealed lymphocyte and plasmocyte infiltration in lamina propria of the colon mucosa. The most probable diagnosis of the patient’s complaints is:
Discussion:
Spastic abdominal pain + watery diarrhea + weight loss + no changes in imaging and labolatory tests => This constellation of symptoms clearly suggests suspicion of microscopic colitis. The results of the hist-pat examination of an intestinal fragment, which is typical for microscopic colitis, are given in the question and on its basis the disease is diagnosed.
Microscopic colitis :
symptoms:
watery diarrhea
spastic abdominal pain
bloating
weight loss (about 4-6 kg)
The appearance of the colon in endoscopic examination is rather normal. The results of laboratory tests and radiological tests of the small and large intestine are normal.
Diagnosis: determined on the basis of the hist-pat examination (thickening of the collagen layer at the base of epithelial cells or increased number of intraepithelial lymphocytes )
Treatment : budesonide - a drug of choice
Diclofenac, sold under the brand name
- Voltaren,*
- is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammatory diseases such as gout and dysmenorrhea
Factors associated with faster progression of CKD
proteinuria
hyperlipidemia
hypertension
hyperglycemia
anemia
cigarettes
metabolic acidosis
low birth weight
ethnic groups: African American, Latino Americans, Asians
low socioeconomic status
old age
define
Chronic kidney disease:
definition : persistent> 3 months structural or functional kidney abnormalities
general symptoms : Clinical presentation
Chronic Kidney Disease
weakness, fatigue, loss of appetite
cardiovascular symptoms : Clinical presentation
Chronic Kidney Disease
hypervolemia , hypertension, left ventricular hypertrophy, heart failure, uremic pericarditis
electrolyte disorders: Clinical presentation
Chronic Kidney Disease
metabolic acidosis , hypo- or hypercalcemia, hyperphosphatemia , hyperkalemia , vitamin D deficiency
neurological symptoms: Clinical presentation
Chronic Kidney disease
impaired concentration, headache, drowsiness or insomnia, apathy or irritability, convulsions and coma, RLS, absent deep tendon reflexes, muscle weakness, tremor, muscle cramps
endocrine disorders : Clinical presentation
Chronic Kidney disease
menstrual disorders, infertility, sexual dysfunction, secondary or tertiary hyperparathyroidism, renal osteodystrophy
gastrointestinal symptoms: Clinical presentation
Chronic Kidney disease
gastritis, peptic ulcer disease, nausea and vomiting, paralytic ileus, acute pancreatitis
hematological symptoms: Clinical presentation
Chronic Kidney disease
weak immune system, prolonged bleeding from wounds
Respiratory symptoms: Clinical presentation
Chronic kidney disease
respiratory symptoms : uremic pleuritis, pulmonary congestion and edema (so-called uremic lung in advanced chronic renal failure)
The diastolic murmur is typical for
aortic regurgitation
The systolic murmur is typical for
mitral regurgitation, VSD- (ventricular septal defect), ASD-(Atrial septal defect) and aortic stenosis
symptoms
Aortic valve regurgitation:
Symptoms:
chronic regurgitation for many years stays asymptomatic
high pulse pressure
collapsing pulse
diastolic murmur
Austin Flint murmur
Supporting tests:
Aortic valve regurgitation
ECG: left ventricular hypertrophy, P mitrale, arrhythmias
Chest X-ray: enlargement of the left ventricle, ascending aorta and aortic arch dilation
Doppler echocardiography: regurgitation wave
During physical examination, the auscultation revealed a diastolic murmur, best audible on the left parasternal line, radiating to Erb’s point and exaggerating while sitting and leaning forward. Which cardiac defect should be suspected?
Aortic valve regurgitation
Constipation, feeling cold and fatigue are typical symptoms of _______ a side effect of what ?
hypothyroidism (one of the side effects of lithium)
SA of
Lithium:
use: control of bipolar disorder
increases the secretion of serotonin => antidepressive effect
weakens the effect of dopamine => antimanic effect
inhibits the effects of ADH => polyuria and polydipsia
inhibits the secretion of thyroid hormones => hypothyroidism
other side effects:
diarrhea, vomiting, dehydration
ataxia, tremor, increased muscle tone, muscle cramps, speech disorders, confusion, drowsiness, nystagmus
3 letters XYZ…(PSM)
Pacemakers are labelled with an international letter code:
The first letter - paced chamber:
A - Atrial pacing
V - Ventricular Pacing
D - Dual-chamber (atrial and ventricular) pacing
The second letter - sensing chamber:
A - Atrium
V - Ventricle
D - Dual (atrium and ventricle)*
The third letter - the type of pacemaker response to sensing: (mode of pacing)
I - Inhibition of pacing function
T - Triggering of pacing function
D - Dual response
A 62-year-old patient was admitted to the hospital complaining of parasternal pain lasting for approx. 1 hour. ECG revealed negative T waves in leads II, III and aVF. The patient’s condition could be assessed with the use of the following grading scale:
Discussion: The patient above should be suspected of having ACS (acute coronary syndrome), as they present the symptoms accompanying ACS, i.e.
chest pain lasting for an hour
characteristic for NSTEMI ECG picture (ST depression and inverted T wave).
To assess the symptoms of this patient, use the CCS scale, which is the scale grading angina pectoris based on its severity. Usually, in these patients, pain is classified to class III and IV CCS
EHRA
( European Heart Rhythm Association ) score is a classification system for the extent of atrial fibrillation
NYHA
( New York Heart Association) classification provides a simple way of classifying the extent of heart failure.
definition
Superior vena cava syndrome:
a group of symptoms caused by obstruction of superior vena cava that impedes the blood flow from upper body half towards the heart
causes: cancerous
Superior vena cava syndrome
cancer:
lung cancer (most common)
lymphoma
metastasis
mediastinal tumors (thymoma, thyroid cancer, germ-cell tumors)
non-cancerous: causes
Superior vena cava syndrome
thoracic aortic aneurysm
mediastinitis
vena cava thrombosis
the most important symptoms:
swelling and bruising of the face and neck
conjunctival injection
upper limb edema
pain and dizziness
dyspnoea
venous distention in the neck
PSA (Prostate Specific Antigen) is an enzyme produced only by the
- prostate gland. Its concentration increases with age, but when it exceeds 10 ng/ml, we should start a diagnosis towards prostate cancer, which includes interview, physical examination, transrectal ultrasound and obtaining specimens for histopathological examination.
- Attention! Elevated levels of PSA do not indicate cancer, and normal levels does not ensure that prostate cancer is absent.
Indications for PSA testing:
-age >50 years
-symptoms of prostate enlargement (difficulty urinating)
-hematuria
-pain in the groin and abdomen
-Elevated PSA score - ESMO (European Society for Medical Oncology) guidelines:
1) a single PSA score above the upper limit should not result in a referral to a prostate biopsy; this should be confirmed in a re-evaluation of PSA;
2) in the case of another result exceeding the norm, pelvic MRI should be performed (answer D);
3) postate biopsy is performed under local anesthesia controlled by transrectal ultrasound (transrectal ultrasonography - TRUS), and it is recommended to administer antibiotic treatment during this procedure; at least 10-12 specimens should be obtained
If a prostate cancer is suspected on the basis of elevated PSA (…), a transrectal biopsy of the prostate should be performed under ultrasound guidance.
define
myelotoxic
- destructive to bone marrow.
- myelosuppressive.
- arising from diseased bone marrow.
Fever in a patient with breast cancer who recently received a subsequent course of adjuvant postoperative chemotherapy:
Discussion :
Because chemotherapy is myelotoxic, there is a decrease in the number of neutrophils causing the susceptibility to infection.
If fever occurs in a chemotherapy patient, you should start a neutropenic fever diagnostic procedure.
After its diagnosis, the risk of complications and death should be assessed, broad-spectrum antibiotic administered and material for microbiological tests should be collected.
All other therapeutic procedures (including administration of antifungal medications or G-CSF) should be performed only after the indications specified in the relevant guidelines have been fulfilled.
Neutropenic fever:
definition (two criteria must be met):
- oral temperature ≥38.3°C in single measurement or ≥38°C persisting for ≥1 h
- neutrophil count <500/μl or predicted decrease to <500/μl in 48h
-chemotherapy is very myelotoxic , therefore neutropenia is the most common hematological complication during anticancer treatment
–procedure:
-risk assessment of complications and death
-blood drawn for microbiological test
-empiric antibiotic therapy with a broad-spectrum antibiotic
depending on the indications!: → not in every case
-addition of an antifungal medication
-additional imaging testing
-G-CSF administration
-obtaining material for further microbiological tests
-change of antibiotic to another one
Chemothrapy is very ________ and it causes a decrease in ______ . If fever occurs in Pt… you should start what procedure?
Because chemotherapy is myelotoxic, there is a decrease in the number of neutrophils causing the susceptibility to infection. If fever occurs in a chemotherapy patient, you should start a neutropenic fever diagnostic procedure
neutropenia is the most common hematological complication during what type of treatment ?
chemotherapy is very myelotoxic , therefore neutropenia is the most common hematological complication during anticancer treatment
definition :
Tumor lysis syndrome:
-a group of metabolic disorders resulting from the rapid breakdown of neoplastic cells, most often due to chemotherapy
-typical for tumors characterized by high proliferative activity, e.g.* leukemias, lymphomas*
-rapid breakdown of neoplastic cells results in the release of intracellular metabolites, **potassium, purines and phosphates **
Tumor lysis syndrome: leukemias, lymphomas
symptoms and metabolic disorders:
AKI
arrhythmias
tetany
hyperuricemia
hyperphosphatemia
hyperkalemia
hypocalcemia
Tumor lysis syndrome: leukemias, lymphomas
treatment:
allopurinol
fluids
loop diuretic
definition :
CEA (Carcinoembryonic antigen):
-a glycoprotein produced in the prenatal development period, which production is almost completely inhibited after birth.
-CEA production may be resumed, e.g. at the time of genes activation (which normally should be inactive) due to cancer mutation
CEA (Carcinoembryonic antigen):
Causes of increased CEA level:
slight increase in CEA level:
hepatitis and cirrhosis
chronic pancreatitis
peptic ulcer disease
ulcerative colitis
pneumonia
pregnancy
CEA (Carcinoembryonic antigen):
Causes of increased CEA level:
colorectal cancer:
-for this tumor, the increase in CEA is the most typical
advanced disease = high concentration of CEA
CEA (Carcinoembryonic antigen):
tumors that rarely cause CEA increase
gastric cancer
pancreatic cancer
bladder cancer
lung cancer
gynecologic cancers
prostate cancer
breast cancer
cancer recurrence or distant metastasis
Renal sympathetic denervation is a method used in the treatment of
_A 82-year-old woman has been cured with amlodipine 5 mg daily and ramipril 5 mg per day. She feels well and she has no comorbidities. If the blood pressure in repeated measurements are above 160/85 mmHg, the physician should:
If treatment with 2 low-dose drugs is not effective, then:
increase the doses of drugs used so far
add third low-dose drugs
resistant hypertension, i.e. in which desired blood pressure is not achieved with the use of 3 antihypertensive drugs from various groups (including diuretic) in appropriate doses and for the appropriate time
The main groups of antihypertensive drugs:
Antihypertensive pharmacotherapy:
- thiazide/thiazide-like diuretics
- β-blockers
- Calcium channel blockers
- ACE inhibitors
- angiotensin II receptor blockers
Antihypertensive pharmacotherapy:
Rules of pharmacotherapy:
If treatment with one low-dose drug has not led to control of the blood pressure:
- add a second drug (preferred)
- change the drug to another one
- increase the dose of the drug used so far
Antihypertensive pharmacotherapy:
Rules of pharmacotherapy:
If treatment with 2 low-dose drugs is not effective, then:
increase the doses of drugs used so far
add third low-dose drug
amlodipine 5 mg daily
(Calcium Channel Blocker)
Usual Adult Dose for:
Hypertension
Angina Pectoris
Coronary Artery Disease
-with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Amlodipine belongs to a class of drugs known as calcium channel blockers.
-It works by relaxing blood vessels so blood can flow more easily
-used to prevent certain types of chest pain (angina).
-It may help to increase your ability to exercise and decrease the frequency of angina attacks. It should not be used to treat attacks of chest pain when they occur.
-Use other medications (such as sublingual nitroglycerin) to relieve attacks of chest pain as directed by your doctor.
NOte: ends in april-opril
Examples of ACE inhibitors include:
Angiotensin-converting enzyme (ACE)
Benazepril (Lotensin)
Captopril
Enalapril (Vasotec)
Fosinopril
Lisinopril (Prinivil, Zestril)
Moexipril
Perindopril
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril
Angiotensin-converting enzyme (ACE)
ACE inhibitors
-inhibit the activity of angiotensin-converting enzyme, an important component of the renin–angiotensin system which converts angiotensin I to angiotensin II and hydrolyses bradykinin.
-Therefore, ACE inhibitors decrease the formation of angiotensin II, a vasoconstrictor, and increase the level of bradykinin, a peptide vasodilator.
-This combination is synergistic in lowering blood pressure.
In the treatment of hypertension in pregnancy- what drugas are absolutely contraindicated, because they cause ____, _____, and _____.
and are diuretics acceptable?
In the treatment of hypertension in pregnancy ACE inhibitors (eg enalapril , captopril, perindopril) and ARBs (eg losartan, valsartan) are absolutely contraindicated, because they cause oligohydramnios, kidney damage and skull hypoplasia.
Diuretics should also be avoided.
name 6
Pharmacological treatment of hypertension in pregnancy:
Methyldopa (first line drug)
beta-blockers: labetalol, metoprolol
calcium channel blockers: nifedipine
alpha1-blockers: prazosin
dihydralazine
magnesium sulfate
ends in : “sartan”
Angiotensin receptor blockers (ARBs)
- also known as angiotensin II receptor antagonists, are used to treat high blood pressure and heart failure.
- They are also used for chronic kidney disease and prescribed following a heart attack.
- They include* irbesartan, valsartan, losartan and candesartan*.
What are the 4 sensory ganglion?
-The sensory ganglions are located on:
*the trigeminal nerve: trigeminal ganglion of Gasser
*the facial nerve: geniculate ganglion
*the acoustic nerve: spiral and vestibular ganglions
*the glossopharyngeal nerve: superior (Ehrenritter1) and inferior (Andersch2) ganglions
*the vagus nerve: superior (jugular) and inferior (plexiform) ganglions.
discussion
serum sodium of 132 mmol/l has been found
Discussion:
Hyponatremia should be diagnosed in the patient.
The most important clinical indicator determining the indications for the treatment of hyponatremia are clinical symptoms.
As there are no symptoms, this is probably a mild chronic hyponatremia, which is not dangerous at 132 mmol/l.
Recommending a healthy and balanced diet is the most appropriate management .
Sodium concentration at these values can also be corrected by limiting water intake.
definition /Classification
Hyponatremia :
definition : serum sodium concentration <135 mmol/l
classification:
due to Na + concentration:
-mild - 130-134 mmol/l
-moderate - 125-129 mmol/l
-severe <125 mmol/l
due to the time of development:
-acute - lasts <48 h
-chronic hyponatremia - lasts ≥48 h
treatment:
Hyponatremia :
treatment:
symptomatic hyponatremia (with cerebral edema) => immediate treatment:
-NaCl (Saline) solutions: usually 0,9% and 3%
-target sodium concentration during the pharmacological treatment is 130 mmol/l
hyponatremia without symptoms:
-finding the cause
-Slowly increasing the sodium concentration to 130 mmol/l
-if > 125-130 mmol / l => limitation of water intake
polyuria
frequent urination
polidypsia
excessive thirst
typical symptoms of hyperglycemia
(increased thirst, polyuria, weakness)
define/characterized by
Aplastic anemia
- significantly reduced bone marrow ability to produce blood cells characterized by:
pancytopenia in complete blood count
hypocellular bone marrow
lack of neoplastic disease
Signs and symptoms
Pancytopenia
-Signs and symptoms include fatigue, weakness, dizziness, trouble breathing, fast heartbeat, fever, pale skin, purple or red spots on the skin, rash, easy bruising, and abnormal bleeding
The mechanism of pancytopenia involves
either haemopoiesis itself, decreasing blood cell productions in number (aplastic anemia), haemopoietic stem cells are displaced by malignant cells (Leukemia, lymphoma, MDS) or they are being pooled (sequestrated) (spleen)/destroyed (immune) outside bone marrow.
Pancytopenia usually requires a ___ ___ ____in order to distinguish among different causes.
**bone marrow biopsy **
Anemia: hemoglobin < 13.5 g/dL (male) or < 12 g/dL (female).
leukopenia: total white cell count < 4.0 x 109/L.
Decrease in all types of white blood cells (revealed by doing a differential count).
thrombocytopenia: platelet count < 150×109/L.
Pancytopenia
a medical condition in which there is significant reduction in the number of almost all blood cells (red blood cells, white blood cells, platelets, monocytes, lymphocytes, etc.).
If only two parameters from the complete blood count are low, the term bicytopenia can be used. The diagnostic approach is the same as for pancytopenia.
Anemia of chronic diseases
- an anemia resulting from a decrease in RBC production in bone marrow, increased production of proinflammatory cytokines and hepcidin, which inhibit erythropoiesis.
- the second most common anemia after iron-deficiency anemia
its frequency increases with age
causes:
Anemia of chronic diseases
causes:
infection
malignant tumors
autoimmune diseases
diagnosis
Anemia of chronic diseases
diagnosis:
MCV: normal or low
ferritin: normal or high
TIBC: low
transferrin saturation: normal or low
iron:
in serum: normal or low
in the bone marrow: presentv
Hemolytic anemia is characterized by
-an elevated reticulocyte level, which is a compensatory response of the bone marrow to red blood cells deficit.
-Haptoglobin is also a very important parameter in the diagnosis of hemolytic anemia (a protein that, when binded with free hemoglobin, protects the kidneys from hemoglobins toxic effects).
-Due to the excessive use of haptoglobin in hemolytic anemies, its level will decrease.
important parameter in the diagnosis of hemolytic anemia
Haptoglobin
Haptoglobin
(a protein that, when binded with free hemoglobin, protects the kidneys from hemoglobins toxic effects).
-important parameter in the diagnosis of hemolytic anemia
Hemolytic anemia is
-Hemolytic anemia is a group of diseases in which premature degradation of erythrocytes occurs.
-Hemolysis may occur intravascularly or extravascularly (in the spleen and/or liver).
Hemolytic anemia diagnosis:
normocytic and normochromic anemia
increased LDH activity
reduced (or not determined) concentration of haptoglobin
increased unconjugated bilirubin concentration in serum
increased excretion of urobilinogen
hemoglobinuria and dark urine
-reticulocytosis :
normal values:
a) 5-15 ‰ (0.5-1.5%) of the number of RBCs
b) 20,000 - 100,000 / μl
define
Pancytopenia
- deficiency of all blood morphotic components:
red blood cells
leukocytes
platelets
examples of conditions
Pancytopenia
It is determined on the basis of the
- It is determined on the basis of the peripheral blood count
Examples of conditions where pancytopenia is diagnosed:
myelodysplastic syndrome
aplastic anemia
focal neurologic deficit is
a problem with nerve, spinal cord, or brain function
It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits
What are the top 5 most common neurological disorders?
Alzheimer’s,
Parkinson’s disease,
epilepsy,
migraines,
multiple sclerosis,
stroke.
Define -symptoms
Stroke
- a sudden onset of focal or global neurologic deficit, caused exclusively by vascular causes associated with cerebral blood flow, lasting more than 24 hours. A stroke can also be diagnosed if:
-symptoms last <24 h but cerebral ischemia is found in brain imaging
-symptoms resolved after thrombolytic therapy
-the patient died on the first day after the onset of symptoms
-if the focal neurological symptoms resolved spontaneously within 24 h and no cerebral
-ischemia is detected in brain imaging, a transient ischemic attack (TIA) should be diagnosed
Stroke classification:
ischemic stroke (~ 80%)
hemorrhagic stroke:
intracerebral hemorrhage (~ 15%)
subarachnoid hemorrhage (~ 5%)
venous stroke (<1%)
General stroke treatment:
supporting basic life functions
blood pressure managment - reduce blood pressure if:
1) ischemic stroke:
a) systolic pressure > 220 mm Hg or diastolic> 120 mm Hg
b) if the patient is to receive thrombolytic therapy, the blood pressure must not exceed 185/110 mm Hg
2) in intracerebral hemorrhage - > 180/105 mm Hg
-compensation of electrolyte disorders
-blood sugar level control
-lowering body temperature if it exceeds 37.5°C
-evacuation of the hematoma to be considered if cerebellar hemorrhage occurs, it is not recommended in the case of intracerebral hemorrhage
-treatment of increased ICP (intracranial pressure):
a) elevating head of bed 20–30°
b) hyperventilation
c) pharmacological treatment: 20% mannitol, 3% NaCl, thiopental
d) surgical treatment - if other methods are ineffective and there is a risk of brain hernia
-diazepam (not prophylactically) in the case of epileptic seizure
prevention of complications such as:
-cerebral vasospasm
-UTI
-thrombosis
-respiratory tract infections
-bedsores
-contractures
-malnutrition
Treatment of bacterial meningitis:
- Collect CSF (if there are no contraindications for lumbar puncture)
- Start empiric antibiotic therapy with a broad-spectrum antibiotic
- Empiric treatment should be verified after obtaining the culture result
- Attention! If a bacterial meningitis is suspected, the antibiotic should be implemented as soon as possible after collecting cerebrospinal fluid (preferably up to 3 hours).
cause
Acute glomerulonephritis (AGN):
most common cause: group B beta-hemolytic streptococci
develops about 1-2 weeks after throat infection or 2-6 weeks after skin infection
Addis’s triad:
swelling
hypertension
hematuria and red blood cells casts
most often resolves spontaneously
Kidney biopsy, if after 6 months there is no recovery or progression of kidney failure
Oliguria
is defined as having only 100 mL to 400 mL (3.3 to 13.5 oz) of urine per day
anuria
(the most extreme of all of these) is defined as urine production of zero to 100 mL (0 to 3.3 oz) per day.
The most important statins side effects:
muscle damage (myopathy) (0.5% patients)
elevated liver enzymes (0.5-2% of patients)
Reduced vital capacity leads to a suspicion of the
restrictive lung disease
reduced FEV1 leads to a suspicion of
obstructive lung disease
Definitive diagnosis of restrictive lung disease requires
- requires TLC measurement (preferably body plethysmography).
- Plethysmography is a good addition to spirometry because spirometry cannot measure all parameters
Spirometry parameters:
-Tidal volume (TV) - the volume of air moved into or out of the lungs during quiet breathing
-Inspiratory reserve volume (IRV) - the maximal volume that can be inhaled from the end-inspiratory level
-Expiratory reserve volume (ERV) - the maximal volume of air that can be exhaled from the end-expiratory position
-Inspiratory capacity (IC) - the sum of IRV and TV
-Vital capacity (VC) - the sum of TV, ERV and IRV
Plethysmography parameters:
-Functional residual capacity (FRC) - the volume of air present in the lungs at the end of passive expiration
-Residual volume (RV) - tthe volume of air remaining in the lungs after a maximal exhalation
-Total lung capacity (TLC) - the sum of VC and RV (or FRC and IC)
Forced expiratory volume (FEV)
-refers to the volume of air that an individual can exhale during a forced breath in t seconds.
-It is usually representation as FEV, followed by a subscript that indicates the number of seconds of the measurement’s duration.
Forced vital capacity (FVC)
is the total amount of air exhaled during the FEV test.
What is the normal FEV1?
The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65).
Inter Alia (in-tur-aye-lee-ah)
is the Latin term often used in a formal context such as medical and legal literature to mean “among other things.
Renal stones are formed within the kidneys, and this is called
nephrolithiasis
Urolithiasis is a condition that occurs when
these stones exit the renal pelvis and move into the remainder of the urinary collecting system, which includes the ureters, bladder, and urethra.
allopurinol
Antigout agents, Antihyperuricemic agents
-intravenous powder for injection (500 mg), oral tablet (100 mg; 200 mg; 300 mg)
Allopurinol belongs to a class of medications called xanthine oxidase inhibitors. It works by reducing the production of uric acid in the body. High levels of uric acid may cause gout attacks or kidney stones.
Allopurinol is used to treat gout (a type of arthritis in which uric acid, a naturally occurring substance in the body, builds up in the joints and causes sudden attacks of redness, swelling, pain, and heat in one or more joints). Allopurinol is used to prevent gout attacks, not to treat them once they occur.
Treatments
Gout
Allopurinol
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Allopurinol
Generic name: allopurinol (oral/injection) [ AL-oh-PURE-i-nol ]
Brand names: Zyloprim, Lopurin, Aloprim
Dosage forms: intravenous powder for injection (500 mg), oral tablet (100 mg; 200 mg; 300 mg)
Drug classes: Antigout agents, Antihyperuricemic agents
Medically reviewed by Sanjai Sinha, MD. Last updated on Apr 4, 2023.
Uses
Warnings
Before taking
Side effects
Interactions
Dosage
What is allopurinol?
Allopurinol belongs to a class of medications called xanthine oxidase inhibitors. It works by reducing the production of uric acid in the body. High levels of uric acid may cause gout attacks or kidney stones.
Allopurinol is used to treat gout (a type of arthritis in which uric acid, a naturally occurring substance in the body, builds up in the joints and causes sudden attacks of redness, swelling, pain, and heat in one or more joints). Allopurinol is used to prevent gout attacks, not to treat them once they occur.
Allopurinol is also used to treat high levels of uric acid that builds up in the blood as tumors break down in people with certain types of cancer who are being treated with chemotherapy medications. It is also used to treat kidney stones that have come back in people who have high levels of uric acid in their urine.
The octreotide (somatostatin analogue) may be used in
-some cases of intestinal obstruction,
-but it is NOT ALWAYS used in malignant bowel obstruction.
provide example
not every malignant tumor has its TNM classification
e.g.:
e.g. Hodgkin’s lymphoma does not have it
provide example
not every malignant tumor has its TNM classification
e.g.:
e.g. Hodgkin’s lymphoma does not have it
Stands for
(DSM-5)
Diagnostic and Statistical Manual of Mental Disorders
Fifth Edition
What are the 5 levels of DSM?
The Multiaxial System
Axis I – Clinical Syndromes.
Axis II – Personality Disorders and Mental Retardation.
Axis III – General Medical Conditions.
Axis IV – Psychosocial and Environmental Problems.
Axis V – Global Assessment of Functioning
What is TNM in cancer classification?
-system to describe the amount and spread of cancer in a patient’s body, using TNM
- T : describes the size of the tumor and any spread of cancer into nearby tissue
(category describes the original (primary) tumor)
- N: describes spread of cancer to nearby lymph nodes
- M: describes metastasis (spread of cancer to other parts of the body
TNM staging system: letter codes
Tumor -
- the size of the primary tumor:
Tx - primary tumor cannot be assessed
T0 - no evidence for the existence of a primary tumor
Tis - cancer in situ
T1 , T2 , T3 , T4 - successive stages of development of the primary tumor
TNM staging system
Lymph Nodes -
- metastases in the lymph nodes:
Nx - cannot be assessed
N0 - lymph nodes without metastases
N1 , N2 , N3 , N4 - metastases to the lymph nodes spreading to more distant
TNM staging system
Metastases -
- distant metastases (organs):
Mx - cannot be assessed
M0 - no distant metastases
M1 - distant metastases are present
The mortality from malignant neoplasms -
ranked from the most common in **Women **
Lung
Breast
Colon
Ovary
Pancreas
The body of the womb
Stomach
Cervix uteri
Brain
Right
The mortality from malignant neoplasms - ranked from the most common in Man
Lung
Prostate
Colon
Stomach
Urinary bladder
Pancreas
Right
Kidney
Brain
Larynx
The incidence of malignant tumours - ranked from the most common in Women
Breast
Lung
The body of the womb
Colon
Ovary
Thyroid gland
Cervix uteri
Right
Kidney
Pancreas
The incidence of malignant tumours - ranked from the most common in Men
Prostate
Lung
Colon
Urinary bladder
Right
Stomach
Kidney
Pancreas
Melanoma
Larynx
The bronchoscopy is a better diagnostic method for
centrally located lesions (we do not perform it only in the diagnosis of peripheral changes
- material collected during bronchoscopy may be sent to both* histological* and cytological examination
Modifiable risk factors related to faster progression of CKD according to Szczeklik’s textbook of internal medicine:
proteinuria
hypertension
hyperglycemia
hyperlipidemia
anemia
smoking tobacco
non-respiratory acidosis
Szczeklik does not directly mention obesity or excess animal protein, but in the KDIGO guidelines we can read:
“Obesity is a risk factor for the development and progression of CKD independent of hypertension and diabetes. In the early stages of CKD, obesity accelerates the decline in GFR. It is therefore essential to maintain a healthy body weight.”
“Excessive dietary protein intake induces glomerular hyperfiltration and accelerates the progression of CKD, while avoiding excessive protein intake reduces intra-glomerular pressure and slows the progression of CKD.”
A high level of proteinuria suggests the diagnosis of
nephrotic syndrome
not the nephritic syndrome.
sequile
The nephritic syndrome:
hypertension
reduced volume of urine output
moderate edema
abnormalities in the urinalysis: low level of proteinuria ≤3.5 g / d,
hematuria,
active urine sediment (dysmorphic erythrocytes and red blood cell casts)
Pathomechanism of metabolic acidosis in CKD
It usually appears in patients when GFR decreases to the value of 20–30 ml / min / 1.73 m
insufficient production of bicarbonate,
disturbed secretion of protons from non-volatile acids,
impairment of renal bicarbonate reabsorption.
loss of bases: through the kidneys and digestive tract (diarrhea, fistulas)
Risk factors for metabolic acidosis in CKD:
hyperkalemia,
drugs:
ACE-I,
AT1,
ARB.
Sodium bicarbonate is an alkalising drug that we use to treat
metabolic acidosis.
Types - Definition
Microscopic colitis:
Types: collagenous and lymphocytic
definition: diseases of unknown etiology with the presence of characteristic microscopic lesions without macroscopic changes in the intestine
symptoms - Laboratory
Microscopic colitis:
Symptoms : watery diarrhea, abdominal cramps, bloating, weight loss
Laboratory, radiological and endoscopic inrestinal tests are normal
diagnosisbased on histological image
Microscopic colitis:
diagnosis based on histological image:
- collagenous inflammation: thickening of the collagen layer within epithelial cells
- lymphocytic inflammation: increased number of intraepithelial lymphocytes
- treatment:
Microscopic colitis:
- treatment: glucocorticoids orally, mesalazine, bismuth subsalicylate, cholestyramine, antidiarrheal medications
differentiatial diagnosis
Microscopic colitis:
differentiatial diagnosis: irritable bowel syndrome, lactose intolerance, abuse of laxatives, amyloidosis, tumors, disorders of enterohepatic circulation of bile acids
symptpms - diagnostic test
Microcytic anemia, age> 50, blood in stool -
- these may be symptoms of colorectal cancer. Keep in mind that this cancer may not show any other symptoms at first.
- Despite the fact that the cause may be different, colonoscopy is definitely an appropriate diagnostic test for such a patient.
- Test: Colonoscopy
define-
Plasma cell myeloma (multiple myeloma, MM):
- definition : neoplastic disease with proliferation and accumulation of monoclonal plasmocytes that produce monoclonal Igs or monoclonal immunoglobulin light chains alone - M protein
- average age of patients: 70 years
- Multiple myeloma is diagnosed when we find organ damage (at least 1 CRAB SLiM criterion) that cannot be explained by another disease or disorder.
symptoms
Plasma cell myeloma (multiple myeloma, MM):
symptoms:
weakness and weight loss
bone pain as the most common symptom - in the lumbar segment of the spine, pelvis, ribs,
radiculopathy, paresis, paralysis of the limbs
fecal and urinary incontinence
polyneuropathy
anemia and its symptoms
hypercalcemia and its symptoms
symptoms of kidney failure
hyperviscosity syndrome
kidney amyloidosis caused by immunoglobulin chains
Treatment:
Treatment:
Plasma cell myeloma (multiple myeloma, MM):
chemotherapy
treatment of kidney disease
bisphosphonates
analgesic treatment
treatment of hypercalcemia
treatment of hyperviscosity syndrome
additional symptoms
lupus nephritis
(chronic glomerulonephritis, rapidly progressive glomerulonephritis, acute renal failure, progressive reduction of GFR, nephrotic syndrome, interstitial nephritis, distal renal tubular acidosis, hyperkalemia)
Alport syndrome:
- hereditary nephropathy, most commonly inherited in an X-linked pattern
- there is a disorder of the synthesis of α- type IV collagen (1) chains , which causes damage to the glomerular basement membrane
- the full-blown form occurs in men, women are asymptomatic carriers or the course of their disease is much more mild (2)
- there is hematuria and proteinuria (in men since birth) (3)
the majority of male patients aged 16-30 have end-stage renal failure - accompanying symptoms: sensory hearing impairment, ocular symptoms
- treatment: relieving the symptoms of nephrotic syndrome, inhibiting chronic kidney disease progression, reducing proteinuria with ACEIs (5) ,
indicationas-
Indications for the treatment of asymptomatic bacteriuria:
prophylactic administanistration of ?
in pregnant women
in men before planned transurethral resection of the prostate
in people before urologic procedures, during which urinary tract bleeding may occur
asymptomatic bacteriuria:
prophylactic administanistration of
- Prophylactic administration of trimethoprim / sulfamethoxazole at a dose of 160/800 mg once daily is recommended in all transplant recipients [AI].
- The optimal treatment time is not clearly defined, in most centers the drug is used for 6-12 months after the transplant
Different types of endoscopy procedures
Arthroscopy
- examine the joints
Different types of endoscopy procedures
Bronchoscopy
- to examine the lungs
Colonoscopy
- to examine the colon
Cystoscopy
- to examine the bladder
Enteroscopy
- to examine the small intestine
Hysteroscopy
- to examine the inside of the uterus
Laparoscopy
- to examine the abdominal and pelvic area
Laryngoscopy
- to examine the larynx
Mediastinoscopy
- to examine the mediastinum, which is the area in between the lungs
Sigmoidoscopy
- to examine the sigmoid colon and rectum, which is the lower part of the large intestine
Thoracoscopy / Pleuroscopy
- to examine the chest wall and area between the lungs
Upper gastrointestinal endoscopy/Gastroscopy
- to examine the oesophagus and upper intestinal tract
Ureteroscopy
- to examine the ureter
Eisenmenger syndrome
- is a pulmonary vascular disease secondary to left-to-right shunt within the heart or between the arteries and increased pulmonary blood flow, leading to high, irreversible pulmonary hypertension.
theophylline → this drug:v
- stimulates the respiratory and vasomotor centers of the medulla oblongata
- relaxes the smooth muscles of the bronchi and blood vessels (dilates the arterial vessels of the brain, heart, kidneys, lungs and skin as well as the veins)
- increases renal blood flow, acting weakly as a diuretic
- slightly lowers blood pressure
- in high doses, it has a positive ino- and chronotropic effect on the heart (i.e. it increases the strength and frequency of heart contractions)
- increases the contractility of the diaphragm, which facilitates breathing in patients with chronic obstructive pulmonary disease
name 11
Medications are a common cause of secondary hypertension , including:
sympathomimetics (also in the form of nasal drops)
corticosteroids
erythropoietin
cyclosporine
tacrolimus
MAO inhibitors
NSAIDs
licorice preparations
carbenoxolone
oral contraceptives
testosterone and its derivatives
definition :
Tumor lysis syndrome:
- life-threatening metabolic disorder syndrome due to the breakdown of cancer cells and the release of many substances into the bloodstream in large quantities
- it most often appears in the first days of chemotherapy
- most often in the course of treatment of rapidly dividing tumors, highly sensitive to chemotherapeutic agents
- massive cell breakdown leads to the release of large amounts of potassium, purines and phosphates
Tumor lysis syndrome:
symptoms and metabolic disorders:
AKI (uric acid and calcium phosphate crystal precipitation)
arrhythmias - hyperkalemia
hypocalcemia - tetany
hyperuricemia
hyperphosphatemia
hyperkalemia
Tumor lysis syndrome:
treatment:
allopurinol
fluids
loop diuretic + hydration (forced diuresis)
Symptoms of CKD
- General symptoms:
weakness
hypothermia
no appetite
decreased immunity
weakness
hypothermia
no appetite
decreased immunity
Symptoms of CKD
- Skin symptoms:
pallor, dry skin
earthy brown skin color
prolonged bleeding from wounds and a tendency to bruise
pruritus (in advanced CKD)
“uremic frost” (precipitation of urea on the skin)
Symptoms of CKD
- Disorders in the circulatory system:
arterial hypertension - most often it is arterial hypertension
left ventricular hypertrophy
heart failure
arrhythmias
accelerated atherosclerosis, vascular calcification
uremic pericarditis.
Symptoms of CKD
- Disorders in the respiratory system:
acidic breath
uremic pleurisy
congestion and pulmonary edema
Symptoms of CKD
- Disorders in the Digestive System:
gastroenteritis
peptic ulcer of the stomach or duodenum
gastrointestinal bleeding
uremic odor from the mouth
nausea and vomiting
acute pancreatitis.
Symptoms of CKD
- Disorders of the nervous system and muscles (occur in advanced CKD):
impaired concentration and memory,
headache
excessive sleepiness or insomnia
behavioral problems (e.g. apathy or irritability)
convulsions and coma
restless legs syndrome, muscle weakness
loss of deep tendon reflexes
Symptoms of CKD
- Reproductive system dysfunction - result of hypogonadotrophic hypogonadism:
menstrual disorders
sterility
Sexual dysfunction (decreased sex drive, impotence).
Symptoms of CKD
- Hematological Disorders:
renal anemia - the result of a lack of erythropoietin
hemorrhagic diathesisPeripheral cyanosis is visible only on the skin of distal parts of the body, such as fingertips or earlobes. It disappears when the skin is pressed . The skin on which it occurs is usually cold. This is a symptom of excessive deoxygenation of hemoglobin in peripheral tissues
Symptoms of CKD
- CKD-related mineral and bone disorder syndrome:
abnormalities in the metabolism of calcium (hypo- or hypercalcemia) and phosphorus (hyperphosphatemia)
deficiency of active vitamin D and disorders of PTH secretion (secondary or tertiary hyperparathyroidism)
Antihypertensive drug therapy:
The main groups of antihypertensive drugs:
- thiazide/thiazide-like diuretics
- β-blockers
- calcium channel blockers
- ACE inhibitors
- angiotensin receptor blockers
Division of hyponatremia by Na+ concentration:
1) mild – 130–134 mmol/l
2) moderate – 125–129 mmol/l
3) severe <125 mmol/L.
Edema and shortness of breath indicate a large presence of fluid in the extravascular space due to intravascular fluid displacement.
This is characteristic of, for example, heart failure, which we can suspect in this patient.
So the patient is?
Requires ?
overhydrated but has little fluid circulating in the vessels.
Low vascular fluid → Vasopressin release → Less diuresis → Overhydration and dilution hyponatremia.
**intravenous administration of furosemide **- this is the correct answer, the diuretic furosemide will cause the fluid to pass from the extravascular space (pleural cavity) to the intravascular space and eliminate overhydration in this patient.
Epidural hematoma:
- accumulation of blood between the skull bones and the dura mater as a result of head trauma, most often associated with damage to the middle meningeal artery
Epidural Hematoma
- symptoms:
- loss of consciousness, “clear pause” after which the patient loses consciousness again, headache, disturbance of consciousness, contralateral hemiparesis and pupil dilation on the side of the hematoma
Subdural hematoma:
- accumulation of blood between the dura and the arachnoid mater, associated with damage to the pontine veins
Subdural hematoma
- symptoms:
may be similar to those of an epidural hematoma, but usually less severe and worsening more slowly
Ketoacidosis is an
- acute syndrome of metabolic disorders resulting from insulin deficiency .
- It may be, as in the case of the patient described in the question, the first manifestation of type 1 diabetes.
- Due to insulin deficiency in the body, there is increased gluconeogenesis and lipolysis, which results in the formation of ketone bodies characteristic of acidosis .
- Diagnosis of ketoacidosis is based on laboratory tests
Symptoms of ketoacidosis include:
increased thirst
polyuria
dry mouth
disturbances of consciousness
dizziness
loss of consciousness
Ketoacidosis
In laboratory tests, the following are observed:
hyperglycemia
blood glucose > 250 mg/dl
- mild to moderate ketoacidosis
blood glucose > 400 mg/dL
- severe ketoacidosis
In laboratory tests, the following are observed:
metabolic acidosis
- arterial blood pH 7.25-7.30
mild acidosis - Arterial blood pH 7.00-7.24
moderate acidosis - Arterial blood pH <7.00
severe acidosis
Ketoacidosis
serum bicarbonate concentration of:
- 15-18 mmol/L
in mild acidosis
-10-15 mmol/L
in moderate acidity
- <10 mmol/L
in severe acidosis - the presence of ketone bodies in the urine and/or serum
- an anion gap value of 10 mol/l
The diagnosis of myocardial infarction and its location is based on the presence of characteristic ECG changes in ≥2 adjacent leads:
- V1-V4
- anterior wall of the left ventricle, interventricular septum, apex of the heart
The diagnosis of myocardial infarction and its location is based on the presence of characteristic ECG changes in ≥2 adjacent leads
- I, aVL, V5-V6
- lateral wall of the left ventricle, apex of the heart
The diagnosis of myocardial infarction and its location is based on the presence of characteristic ECG changes in ≥2 adjacent leads
-II, III, aVF
- inferior wall of the left ventricle
The diagnosis of myocardial infarction and its location is based on the presence of characteristic ECG changes in ≥2 adjacent leads
- V1-V3
- V7-V9
- (high R waves)
- (typical ST segment elevation and Q waves) - left ventricular posterior wall
The diagnosis of myocardial infarction and its location is based on the presence of characteristic ECG changes in ≥2 adjacent leads
- Vr3-Vr4 (ST elevation ≥0.05mV)
- right ventricle
name 8
Clinical symptoms of hypokalemia:
weakness
constipation
muscle cramps and paralysis
muscle weakness
arrhythmias
hypotension
polyuria
increased thirst
Zollinger-Ellison syndrome includes:
- gastrin-secreting tumor (gastrinoma)
- persistent peptic ulcers secondary to hypergastrinemia
- the syndrome often coexists with multiple endocrine tumors type 1 (MEN1)
Zollinger-Ellison syndrome
the syndrome often coexists with multiple endocrine tumors type 1 (MEN1)
MEN1 → components
MEN1 → components
- Primary hyperparathyroidism
- Neuroendocrine neoplasms of the pancreas and gastrointestinal tract, bronchi and thymus gland (including gastrinomas )
- Pituitary tumors
- Other tumors of the endocrine glands
Clinical picture of Zollinger-Ellison syndrome
- refractory ulcer disease
- diarrhea
- sometimes fatty
- heartburn
- weight loss
Lungs - Typical symptoms of lung cancer are
- visible at an earlier stage of the disease and include cough (a frequent change in the nature of coughing in smokers), progressive weakness, shortness of breath, chest pain, recurrent pneumonia, and compression symptoms and lymphadenopathy.
- Anemia is one of the paraneoplastic symptoms associated with lung cancer, and may also occur in this type of cancer. However, anemia is one of the late symptoms of lung cancer. Diagnosis of lung cancer would also be suggested by information about the patient’s nicotinism, which is the most common cause of this cancer.
prostate -
cancer has characteristic symptoms associated with
- prostate cancer has characteristic symptoms associated with prostate enlargement, which causes difficulties in urination.
- Depending on the advancement of this cancer, it can cause nocturia, pollakiuria or a complete blockage in urination. It is a slow-moving cancer.
thyroid - the symptoms of thyroid cancer are
- thyroid - the symptoms of thyroid cancer are not characteristic of benign thyroid tumors. Slow growth of the nodule, enlargement of the neck circumference are typical.
- The characteristic symptom of thyroid cancer is hoarseness resulting from infiltration of the recurrent laryngeal nerve by the tumor.
- A sudden enlargement of the neck circumference and the patient’s shortness of breath may suggest undifferentiated thyroid cancer!
bladder - bladder cancer is a cancer associated with
- bladder - bladder cancer is a cancer associated with nicotinism and most often causes hematuria (often massive), pollakiuria, urinary urgency or urinary retention.
- Like most cancers, it can cause anemia in an advanced stage, but the patient will also present the above-described symptoms that will allow for the initial diagnosis of this disease entity.
In people with an average risk of developing the disease:
colorectal cancer is screened!
- From the age of 50 (women and men)
- Fecal occult blood test every 2 years.
- Colonoscopy or sigmoidoscopy every 10 years.
most common causes of anemia in the elderly?
most common cause of iron deficiency anemia is blood loss as a result of gastrointestinal bleeding
name: Cancer of R and L half, lower rectum
Typical symptoms depend on the location of the cancer in the colon:
The symptoms of sarcoidosis are as follows:v
- shortness of breath , cough, chest pain,
- 40% of patients suffer from joint pain ; knee, ankle and elbow joints are most commonly involved
- 30% of patients; enlarged lymph nodes (mobile and painless) - most often these are cervical, axillary and inguinal lymph nodes
- 20% of patients -hepatomegaly
- 20% of patients -skin changes -: erythema nodosum, lupus frostbite
- Heart arythmia
- symptoms of eye involvement - most often uveitis, conjunctivitis and lacrimal gland inflammation
- cranial nerve involvement
Hyperkalaemia is a condition in which
the serum potassium concentration is too high, i.e. >5.5 mmol/l.
Hyperkalemia can be treated with :
Salbutamol
Furosemide
Sodium bicarbonate
Calcium chloride
glucose with insulin
Hyperkalemia can be treated with :
Salbutamol
- this drug works quickly, but its effect is temporary. It moves potassium into the cells.
Hyperkalemia can be treated with :
Furosemide
- it is a drug from the group of diuretics. Its action causes the leaching of many components from the serum, including potassium.
- The decrease in potassium is not immediate and occurs only several hours after taking the drug.
- In order to equalize the fluid balance, a simultaneous infusion of 0.9% NaCl should be used.
Hyperkalemia can be treated with :
Sodium bicarbonate
- the action of this drug consists in displacing sodium ions from the cells, which promotes the influx of potassium ions to their place.
- Currently, indications for their use are smaller due to numerous side effects.
Hyperkalemia can be treated with :
Calcium chloride
- is the drug of choice in patients with detected ECG changes (after administration, the patient must be constantly monitored by the ECG).
- It should be noted that calcium ions do not lower potassium levels, but only protect the myocardium against its negative effects and reduce the risk of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT).
- An absolute contraindication to the administration of calcium chloride is treatment of the patient with digitalis glycosides.
Hyperkalemia can be treated with :
glucose with insulin
- has a similar effect as salbutamol, i.e. it causes the shift of potassium into the cells.
define
polycystic kidney disease
There are 2 forms of this disease:
- it is a genetic disease inherited in a single gene.
There are 2 forms of this disease:
ADPKD - autosomal dominant form, usually manifests itself in adolescence. It is manifested by numerous cysts in both kidneys, which is usually manifested by hypertension, pain in the lumbar region and hematuria. It leads to kidney failure. Aneurysms of other organs may also occur in its course!
**ARPKD **- recessive form. It manifests itself already in infants and is characterized by a more violent course.
Alport’s syndrome
- it is a monogenic genetic disorder leading to disturbances in the synthesis of type IV collagen.
It may present as sex-linked Alport syndrome (85%) or be inherited in an autosomal manner.
All men develop end-stage renal disease over time and 15% of women.
Symptoms of Alport syndrome include:
hematuria
proteinuria
hearing impairment
eye symptoms
von Hippel-Lindau syndrome:
Patients have an increased predisposition to:
- is a syndrome of increased genetic predisposition to cancer inherited in an autosomal dominant manner .
- The disease is caused by germline mutations of the VHL gene .
Patients have an increased predisposition to:
CNS hemangioma
retinal hemangioblastomas
clear cell renal cell carcinoma
phaeochromocytomas of the adrenal glands
neuroendocrine tumors
tumors of the endolymphatic sac
In the course of RA, the following changes are most common in laboratory tests:
- ESR >30 mm after 1 h
- increased fibrinogen levels
- increased CRP level
- normocytic and hypochromic anemia
- slight leukocytosis with normal percentages
- thrombocytopenia (in a very active form of the disease) or thrombocytopenia (as a drug complication)
- increased plasma levels of α1 and α2 globulins
- rheumatoid factor (RF) in the IgM class - 3/4 of patients
- CPP (for RA sensitivity >50%, specificity 98%)
note: aCPP - antibodies against citrullinated peptides
ANA antibodies
- are antinuclear antibodies occurring in many autoimmune diseases, however, their presence does not determine the diagnosis of RA, moreover, they are not included in the eligibility criteria
Seronegative spondyloarthropathies are
- arthritis involving the joints of the spine and perivertebral tissues, peripheral joints, entheses, and inflammatory changes in many other systems and organs.
name the differences
We distinguish the axial form of spondyloarthritis and peripheral form
- the axial form of spondyloarthritis, in which spinal symptoms predominate
- the peripheral form, manifested mainly by arthritis (usually asymmetric) of the lower limbs, as well as sacroiliac joints and inflammation of the tendons and fingers.
Spondyloarthritis includes:
- ankylosing spondylitis
- psoriatic arthritis
- reactive arthritis
- juvenile spondyloarthritis
- arthritis in the course of inflammatory bowel disease
- SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)
- arthritis associated with acute anterior uveitis
undifferentiated spondyloarthritis
Treatments that increase the tone of the vagus nerve :
- Valsalva maneuver - an attempt to force a forced exhalation with the epiglottis closed. The modified Vlasalva test consists in adding, at the end of the maneuver, assuming the supine position by the patient with raised lower limbs
- inducing vomiting
- immersion of the face in cold water
- carotid sinus massage
Supraventricular tachycardia (SVT)
Antiarrhythmic drugs - depending on the type of SVT:
Adenosine
Beta blocker
Ca-blocker ( Verapamil, Diltiazem )
Amiodarone
Ivabradine acts only on the
sinus node and has no effect on conduction time in the atria, atrioventricular node or ventricles.
The most common causes of acute pancreatitis include the following clinical situations (acronym I GET SMASHED, i.e. I got drunk):
- I diopathic – idiopathic acute pancreatitis
- gallstones - gallstones - EXCLUDED
- ethanol – ethanol - EXCLUDED
- trauma - injury
- steroids - steroids - EXCLUDED
- mumps – mumps and other viral diseases (e.g. hepatitis)
- a utoimmune, Ascaris – autoimmune diseases, ascarid infection
- s corpion - scorpion venom
- hyperlipidemia ( hypertriglyceridemia ), hypercalcaemia , hypothermia - hyperlipidemia (hypertriglyceridemia), hypercalcaemia, hypothermia
- e RCP – endoscopic retrograde cholangiopancreatography (ERCP)
- drugs - drugs - EXCLUDED
Calprotectin is ?
and
is a very sensitive and specific marker of?
- Calprotectin is acute phase protein.
- Calprotectin is a very sensitive and specific marker of inflammation.
- In healthy people, this protein is present in trace amounts.
- Its concentration also increases in:
colorectal cancers
active rheumatic diseases
acute pancreatitis
cirrhosis
pneumonia
after considerable effort
while taking non-steroidal anti-inflammatory drugs.
deep vein thrombosis →
- deep vein thrombosis → advanced lung cancer (other cancers too) are characterized by local infiltration, which causes infiltration of vessels and damage to their walls, which significantly increases the chances of thrombus formation.
- Deep vein thrombosis usually presents as pain and swelling in the affected limb.
pain
edema
association with advanced lung cancer
peripheral arterial disease →
- a condition caused by atherosclerosis that can lead to symptoms of intermittent claudication (muscle discomfort in the lower limbs that is reproduced each time by exercise and relieved by rest).
pain
edema
association with advanced lung cancer
gout →
- rheumatic disease causing precipitation of uric acid in the joints, causing pain and swelling of a given joint (mostly metatarsophalangeal I).
pain
edema
association with advanced lung cancer
congestive heart failure
→ right heart failure may lead to edema of the lower limbs, however, they are usually painless.
pain
edema
association with advanced lung cancer
hypoalbuminemia
→ is a condition that means a reduced concentration of albumin in the blood, which reduces the oncotic pressure of the plasma and causes edema.
pain
edema
association with advanced lung cancer
Hepatic encephalopathy is a
- group of disorders of the central nervous system that occur in the course of severe, chronic liver diseases.
The symptoms occurring in this syndrome (Hepatic encephalopathy) are most likely the cause of the action of endogenous substances such as:
ammonia
mercaptans
short- and medium-chain fatty acids, phenols
the presence of false neurotransmitters
excessive activation of the GABA-ergic system.
Encephalopathy is divided into:
- **overt ** (referred to in the question) → there are behavioral, intellectual, mood and personality disorders. It can be episodic (as a result of some trigger) or permanent.
- **latent **→ minimal CNS dysfunction detected by psychometric tests.
Treatment of overt episodic encephalopathy focuses on
- stopping exposure to the trigger, which is done by abstaining from food intake
- and sometimes mechanical bowel cleansing or flumazenil is also required if benzodiazepine-induced encephalopathy is suspected.
In both forms (episodic and overt encephalopathy) we use drugs:
- laxative → lactulose
- rifaximin → is not absorbed from the intestine and may inhibit the growth of bacteria causing deamination of urea, thus limiting the production of ammonia and other substances believed to play a role in the development of hepatic encephalopathy.
- ornithine aspariginate → it is an amino acid that enhances the removal of ammonia from the body by increasing the synthesis of urea in the urea cycle in the liver.
Spondyaloarthropathies are a group of inflammatory diseases affecting the?
Name characeristic feature of these diseases:
- joints of the spine .
- A characteristic feature of these diseases is the frequent presence of the** HLA B27 antigen **and the absence of the rheumatologic factor RF.
Spondyloarthropathies are divided into:
axial form - symptoms mainly concern the spine.
peripheral form - symptoms mainly affect other joints (lower limbs, sacroiliac).
Mnemonic
The CHA2DS2-VASc is a scale used in?
- scale used in patients with atrial fibrillation to assess the risk of ischemic stroke in patients with atrial fibrillation .
- The name of the scale correlates with the risk factors and the score it gives.
C - congestive heart failure
H - hypertension
A - age ≥ 75
D - diabetes
S - stroke x2
V - vascular disease
A - age 65-74
Sc - sex category
Recommendations management of community-acquired respiratory infections
In mild cases
an antibiotic effective against Streptococcus pneumoniae should be used:
- amoxicillin 3 x 1 g orally or 4 x 1 g ampicillin intravenously,
- In young adults with a mild course, without concomitant diseases, it is possible to use a macrolide in the first line,
The duration of treatment for uncomplicated community-acquired pneumonia of mild to moderate severity should be approximately 7 days or approximately 3 days after clinical stabilization.
Recommendations management of community-acquired respiratory infections
In a moderate course an antibiotic effective against Streptococcus pneumoniae should be used:
amoxicillin with clavulanic acid
The duration of treatment for uncomplicated community-acquired pneumonia of mild to moderate severity should be approximately 7 days or approximately 3 days after clinical stabilization.
Recommendations management of community-acquired respiratory infections
In severe course an antibiotic effective against Streptococcus pneumoniae should be used:
ceftriaxone or cefotaxime in combination with a macrolide
definition :
Chronic Kidney Disease:
> 3 months of renal structural or functional abnormalities
clinical picture -
Chronic Kidney Disease:
general symptoms :
weakness, fatigue, loss of appetite
Chronic Kidney Disease:
cardiovascular symptoms :
hypervolemia , hypertension, left ventricular hypertrophy, heart failure, uremic pericarditis
metabolic acidosis , hypo- or hypercalcemia, hyperphosphatemia , hyperkalemia , vitamin D deficiency
Chronic Kidney Disease:
neurological symptoms :
impaired concentration,
headache, drowsiness or insomnia,
apathy or irritability,
convulsions and coma,
RLS, loss of deep reflexes,
muscle weakness,
tremors, muscle spasms
Chronic Kidney Disease:
hormonal disorders :
menstrual disorders, infertility, sexual dysfunction, secondary or tertiary hyperparathyroidism, renal osteodystrophy
```
~~~
Chronic Kidney Disease:
gastrointestinal symptoms :
gastroenteritis, peptic ulcer of the stomach or duodenum, nausea and vomiting, paralytic ileus, acute pancreatitis
Chronic Kidney Disease:
haematological symptoms:
reduced resistance to infection, prolonged bleeding from wounds
Chronic Kidney Disease:
respiratory symptoms :
uremic pleurisy, pulmonary congestion and edema (so-called uremic lung in advanced CKD)
hypertension in pregnancy:
1st line:
methyldopa
name 6
diagnosis of acute pyelonephritis- is supported by the following clinical and laboratory symptoms:
fever with chills
nausea
stomach pain
significantly increased CRP values
leukocytosis
leukocyturia
Nephritic syndrome:
- hypertension
- a decrease in the volume of urine excreted
- moderate swelling
- abnormalities in the general urine test: slight proteinuria ≤3.5 g/d , hematuria, active urine sediment (leached and dysmorphic erythrocytes, erythrocyte casts)
The first-line treatment for uncomplicated UTI is:
- Furazidine 100mg 4x1 for 3-5 days
- Co-trimoxazole 960mg 2x1 for 3 days
- Trimethoprim 100mg 2x1 for 3-5 days
- Fosfomycin 3.0 g once
first-line treatment for uncomplicated UTI
If E. Coli resistance to co-trimoxazole is above 20%, fluoroquinolone should be used instead of co-trimoxazole and trimethoprim.
In this situation (not empirically) we use:
name 3 dose/usage
- Ciprofloxacin 250mg 2x1 for 3 days
- Norfloxacin 400mg 2x1 for 3 days
- Ofloxacin 200mg 2x1 for 3 days
The following drugs can trigger a gout attack:
- Thiazide diuretics , e.g. hydrochlorothiazide; and thiazide-like drugs , e.g. * indapamide *
- Loop diuretics
- Cyclosporine
- Acetylsalicylic acid
- In addition to drugs, alcohol, foods containing a large amount of purines, strenuous exercise, surgery, and infection also contribute to triggering a gout attack.
Management in a gout attack:
- Colchicine 1 mg after, then 0.5 mg after an hour
- NSAIDs in maximum therapeutic doses
- Corticosteroids in a dose equivalent to 30-35 mg of prednisolone
reduce the risk of a gout attack
Losartan, calcium channel blockers, statins and fenofibrate
name 4
Coagulogram norms:
FRI - 12-16 p
APTT - 28-30 sec
fibrinogen - 180-350 mg/dl
D-dimers - up to 500 ng/ml
Hypercalcaemic crisis is a
- sudden, immediately life-threatening condition caused by a high concentration of total calcium in the blood serum.
- Its occurrence is strictly dependent on disturbances in calcium and phosphate homeostasis regulated by parathyroid hormone (PTH), vitamin D3 (cholecalciferol) and calcitonin.
- As a result of the increase in calcium concentration, the patient first presents symptoms of hypercalcemic syndrome and then hypercalcemic crisis.
Pancytopenia
- deficiency of all morphotic components of the blood:
red blood cells
leukocytes
platelets
Pancytopenia
It is diagnosed by
peripheral blood count
Examples of conditions in which pancytopenia is diagnosed:
myelodysplastic syndrome
aplastic anemia
characteristic set of symptoms accompanying aortic dissection :
- Uncontrolled hypertension
- Chest pain radiating to the lumbar (or interscapular) region
- No pain relief after nitrate administration
- Typically, in the course of this disease, we can also find a pulse deficit in one of the limbs
remember the places of auscultation of specific valves:
- Left 2nd intercostal space → pulmonary valve
- Right 2nd intercostal space → aortic valve
- Heart apex → mitral valve
Knowing where to auscultate, we have to choose the type of murmur:
diastolic murmur →
systolic murmur →
diastolic murmur → aortic regurgitation
systolic murmur → aortic stenosis
complete: what is damaged, ? occurs
As a result of dissection of the ascending aorta……
As a result of dissection of the ascending aorta, the valve annulus is damaged and acute regurgitation of this valve occurs → Right 2nd intercostal space – diastolic murmur
match the corresponding disease entities with the remaining murmurs:
A. Left 2nd intercostal space – diastolic murmur
B. Left 2nd intercostal space – systolic murmur
C. 2nd right intercostal space – diastolic murmur →
D. 2nd right intercostal space – systolic murmur
E. apex of the heart – systolic murmur
A. Left 2nd intercostal space – diastolic murmur → pulmonary regurgitation (Graham-Steell murmur)
B. Left 2nd intercostal space – systolic murmur → pulmonary valve stenosis
C. 2nd right intercostal space – diastolic murmur → aortic dissection
D. 2nd right intercostal space – systolic murmur → aortic stenosis
E. apex of the heart – systolic murmur → mitral regurgitation
d-d= dissection (aortic)-> diastolic murmur
Systolic murmurs are caused by
stenosis of the aortic and pulmonary valves as well as mitral and tricuspid regurgitation.
Diastolic murmurs are the result of
aortic and pulmonary regurgitation or stenosis of the atrioventricular valves
a crescendo-decrescendo systolic murmur
(rising and falling) radiating to the neck audible in the 2nd MMA on the right side of the sternum = AORTAL VALVE STENOSIS
” BCC”
Cancer screening tests performed in Poland:
breast cancer
cervical cancer
colorectal cancer
spirometry will measure:
- tidal volume (TV) - the volume of air inhaled or exhaled during quiet breathing
- inspiratory reserve volume (IRV) - the volume of air by which a quiet inspiration can be deepened
- reserve expiratory volume (ERV) - the volume of air that can be expelled from the lungs after a quiet exhalation
- inspiratory capacity (IC) – sum of TV and IRV
- vital capacity (VC) – sum of TV, ERV and IRV
Plethysmography will measure:
- functional residual capacity (FRC) - the volume of air remaining in the lungs after quiet exhalation during quiet breathing
- residual volume (RV) - the volume of air remaining in the lungs after maximal exhalation
- total lung capacity (TLC) – sum of VC and RV (or FRC and IC)
tidal volume (TV)
- the volume of air inhaled or exhaled during quiet breathing
inspiratory reserve volume (IRV)
- the volume of air by which a quiet inspiration can be deepened
reserve expiratory volume (ERV)
- the volume of air that can be expelled from the lungs after a quiet exhalation
inspiratory capacity (IC)
– sum of TV and IRV
vital capacity (VC)
– sum of TV, ERV and IRV
functional residual capacity (FRC)
- the volume of air remaining in the lungs after quiet exhalation during quiet breathing
residual volume (RV)
- the volume of air remaining in the lungs after maximal exhalation
total lung capacity (TLC)
– sum of VC and RV (or FRC and IC)
List the specific disease corresponding with antibody
ACPA
- Rheumatoid Arthritis
- antibodies against citrullinated peptide highly specific (98%) , although they occur only in half of patients and are also predictors of rapid joint destruction
List the specific disease corresponding with antibody
anti-dsDNA, anti-Sm, APLA
- Systemic lupus erythematosus
List the specific disease corresponding with antibody
SS-A (anti-Ro)
- Dry syndrome, systemic lupus erythematosus,
List the specific disease corresponding with antibody
SS-B (anti-La)
- Dry syndrome, systemic lupus erythematosus
List the specific disease corresponding with antibody
Scl-70
- Systemic sclerosis (generalized form)
List the specific disease corresponding with antibody
ACA
- Systemic sclerosis (limited form)
List the specific disease corresponding with antibody
anti-Mi-2
anti-Mi-2 - Dermatomyositis
List the specific disease corresponding with antibody
anti-Jo-1
- Polymyositis
List the specific disease corresponding with antibody
RF
- rheumatoid factor in the IgM class in 3/4 patients, the titre of this antibody positively correlates with the rate of joint destruction
- all of the above diseases can be rheumatoid factor positive except for dermatomyositis and polymyositis
The T-score standard is:
correct->
→ +1.0 to –1.0
The T-score
osteopenia
→ -1.0 to -2.5
The T-score
osteoporosis →
less than -2.5
The T-score
If the patient has a T-score of –2.8 →
osteoporosis
The standard concentration of Ca2+ is:
2.75 mmol/L> normocalcemia <2.25 mmol/L
concentration of Ca2+
hypercalcemia→
> 2.75 mmol/L (>11 mg/dL)
concentration of Ca2+
hypocalcemia→
<2.25 mmol/L (<9 mg/dL)
patient has a Ca2+ concentration of 13 mg/dL or >2.75 mmol/L → Patient has
severe hypercalcemia
The action of PTH causes:
- release of calcium from bones → decrease in T-score
- increase in ionized calcium in the blood → hypercalcemia
name 2
scales used to assess the clinical probability of pulmonary embolism in a patient
- The Wells scale
- modified Geneva
EHRA scale is used to
classify symptoms associated with atrial fibrillation.
PESI scale evaluates
the prognosis in pulmonary embolism
TIMI scale is a scale used to assess
the flow through the coronary arteries , consisting in visual assessment of the flow during the coronary angiography.
The acronym CRAB stands for
multiple myeloma syndrome.
C - (Calcium) elevated serum calcium levels,
R - (Renal) renal failure,
A - anemia,
B - (bone lesions) osteolytic defects in the bones.
What is the most common acquired valvular disease in adults
Calcific aortic stenosis
The second most common acquired valvular disease in adults
mitral regurgitation
Calcific aortic stenosis
Symptoms:
for a long time the disease is asymptomatic
angina pain
palpitations
dizziness
pre-syncope states
fainting
exertional and resting shortness of breath
hypercalcemia with high PTH concentration (PTH-dependent)
- primary hyperparathyroidism
- team MEN1, MEN2A, MEN4
- calcium receptor inactivating mutations
- PTH secretion by tumors
- congenital or acquired deficiency of FGF-23
hypercalcaemia with low PTH concentration (PTH-independent)
- cancers
- ntoxication with vitamin D or its metabolites
- production of 1,25(OH)2D3 by granulomas (sarcoidosis) or lymphomas
- vitamin A poisoning
- hyperthyroidism
- taking thiazide diuretics or theophylline
- milk-alkali syndrome (abuse of calcium-containing antacids or excessive consumption of dairy products)
- prolonged immobilization (mobilization of calcium from the bones)
- adynamic bone disease in patients on dialysis with chronic kidney failure (impaired deposition of calcium in the bones)
In the treatment of hypertension, 2 or 3 antihypertensive drugs are usually used, rarely more. Preferred connections:
- thiazide/thiazide-like diuretic +
- thiazide/thiazide-like diuretic +
- thiazide/thiazide-like diuretic +
- calcium channel blocker +
- calcium channel blocker +
- thiazide/thiazide-like diuretic + ACEI
- thiazide/thiazide-like diuretic + ARB
- thiazide/thiazide-like diuretic + calcium channel blocker
- calcium channel blocker + ACEI
- calcium channel blocker + ** ARB**
In the treatment of hypertension 2 or 3 antihypertensive drugs are used
The most rational treatment with 3 drugs includes:
- drugs acting on the RAA system:
(ACEI or ARB) + calcium channel blocker + thiazide/thiazide-like diuretic
e.g. 3
ACEIs
enalapril
captopril
perindopril
ARBs
losartan
valsartan
In the treatment of hypertension in pregnant women, what drugs are absolutely contraindicated ?
because they cause?
- ACEIs (e.g. enalapril, captopril, perindopril )
- ARBs (e.g. losartan, valsartan)
- oligohydramnios, kidney damage, and skull hypoplasia. Diuretics should also be avoided.
Pharmacotherapy of hypertension in pregnancy:
- Methyldopa (first-line drug)
- beta-blockers: labetalol, metoprolol
- calcium channel blockers: nifedipine
- alpha1-blockers: prazosin
- dihydralazine
- magnesium sulfate
Antibodies corresponding to diseases
Name the disease to the corresponding Antibody
Bronchitis is
acute respiratory infection diagnosed after pneumonia has been excluded.
Etiology of bronchitis in adults:
- most often viruses (influenza A and B viruses, parainfluenza, RSV, coronaviruses, adenoviruses, rhinoviruses)
- bacteria in < 10% of patients
Bronchitis
Clinical symptoms :
cough
expectoration of mucous or purulent secretions
fever and muscle pain
temporary bronchial hyperreactivity (cough may persist for several weeks after illness)
Bronchitis
Treatment:
symptomatic
- antipyretics
- antitussives for dry cough
- expectorants for productive cough
- Inhaled ß2 agonist for symptoms of obstruction
causal
- oseltamivir for bronchitis during an influenza epidemic, within the first 48 hours from the onset of symptoms
- antibiotic therapy only in the case of whooping cough - macrolides -
define and name
HLA-B27 is a characteristic genetic marker of a group of diseases, the so-called
** seronegative spondyloarthritis** , i.e. arthritis with involvement of the spine, which we include
- ankylosing spondylitis (AS)
- psoriatic arthritis
- reactive arthritis
- arthritis in the course of inflammatory bowel disease
- juvenile spondyloarthritis
- SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)
- arthritis associated with acute anterior uveitis
- undifferentiated spondyloarthritis
IgA nephropathy is most often manifested by
- asymptomatic hematuria (or hematuria) and slight proteinuria (usually <0.5 g/d).
- As a rule, irregularities are detected accidentally during periodic examinations.
In 10-15% of cases, IgA nephropathy takes the classic form , which is manifested by
recurrent hematuria accompanied by upper respiratory tract infection
Other manifestations of IgA nephropathy include:
- nephrotic syndrome and nephritic syndrome with rapidly progressive deterioration of renal function (rapidly progressive SCN - extracapillary proliferation of SCN → >50% of glomeruli with the presence of crescents).
(Secondary) focal segmental glomerulosclerosis (FSGS) develops
- Focal segmental glomerulosclerosis (FSGS) is a common cause of proteinuria and nephrotic syndrome leading to end stage renal disease (ESRD).
- There are two types of FSGS, primary (idiopathic) and secondary forms.
- Secondary FSGS shows less severe clinical features compared to those of the primary one.
- secondary FSGS has an important clinical significance because a variety of renal diseases progress to ESRD thorough the form of secondary FSGS.
- The defining feature of FSGS is proteinuria.
(FSGS)
Secondary focal segmental glomerulosclerosis (FSGS) develops as a result of damage to the glomeruli by factors such as:
- Hyperfiltration
- reflux nephropathy
- malignant hypertension
- reduced amount of active renal parenchyma
- significant obesity (increased pressure in the capillaries of the glomeruli leads to their enlargement, distension, stretching and damage to the podocytes with exposure of the basement membrane, the consequences are adhesions and increased fibrosis)
- sickle cell anemia
name the toxins
Secondary focal segmental glomerulosclerosis (FSGS) develops as a result of damage to the glomeruli by factors such as
- toxins
- heroin nephropathy
- pamidronate
- interferon
- calcineurin inhibitors
- sirolimus
name infections
Secondary focal segmental glomerulosclerosis (FSGS) develops as a result of damage to the glomeruli by factors such as:
- Infections
HIV
parvovirus B19
CMV
EBV
Hydrate the patient intravenously:
elective →
→ 0.9% NaCl solution 1–1.5 ml/kg/h IV for 3–6 h before the test and 6–12 h after the test;
Hydrate the patient intravenously:
urgent→
→ 0.9% NaCl solution 3 ml/kg/h iv for 2 h before the test
and
continue infusion 1–1.5 ml/kg/h iv for 6–12 h after the test.
Acidosis in poisoning
Acidosis with high lactate levels
metformin
Carbon monoxide
iron
sodium valproate
cyanides
shock
Acidosis in poisoning
Acidosis with normal lactate levels
salicylates
methanol
paraldehyde
ethylene glycol
ketoacidosis
kidney damage
severe diarrhea
macroangiopathies
The macrovascular (macroangiopathic) complications of diabetes include:
- ischemic heart disease
- stroke
- lower limb ischemia with intermittent
- claudication
- hypertension
Microangiopathies
The microvascular (microangiopathic) complications of diabetes include:
- eye complications:
- diabetic retinopathy
- cranial nerve palsy (most often III, IV and VI)
- refractive errors
- cataract
- secondary hemorrhagic glaucoma
- diabetic kidney disease
- diabetic neuropathy
- including neuropathic diabetic foot
Conditions associated with the presence of antinuclear antibodies include:
- Connective tissue diseases:
- systemic lupus erythematosus (SLE 95-100%),
- systemic sclerosis (80-95%),
- mixed connective tissue disease (95-100%),
- drug-induced lupus (95-100%),
- antiphospholipid syndrome (40-50%),
- polymyositis and dermatomyositis and - - overlapping syndromes (40-80%),
- Sjögren’s syndrome (48-96%),
- rheumatoid arthritis,
- juvenile idiopathic arthritis,
- Raynaud’s phenomenon,
Conditions associated with the presence of antinuclear antibodies include:
- Infections:
tuberculosis,
viral hepatitis,
syphilis,
parasitic diseases,
Conditions associated with the presence of antinuclear antibodies include:
- Cancers:
breast cancer,
prostate cancer,
leukemia,
Hodgkin lymphoma,
Conditions associated with the presence of antinuclear antibodies include:
- Autoimmune diseases:
- primary cholangitis,
- Addison’s disease
- Hashimoto’s disease
- immune thrombocytopenic purpura,
- autoimmune hemolytic anemia,
- type 1 diabetes,
Conditions associated with the presence of antinuclear antibodies include:
- Skin diseases:
psoriasis,
lichen planus,
Nephrotic syndrome is a
- clinical condition characterized by a 24-hour urinary protein loss of >3.5g/1.73 m2 and hypoalbuminemia, lipiduria, hyperlipidemia and edema.
- In nephrotic syndrome, unlike nephritic syndrome, we do not observe hypertension.
renoscintigraphy
- will allow for the assessment of renal vessels, morphological assessment of the kidneys, their function and the presence of an obstruction in the outflow of urine
theophylline → this drug:
- stimulates the respiratory and vasomotor centers of the medulla oblongata
relaxes the smooth muscles of the bronchi and blood vessels (dilates the arterial vessels of the brain, heart, kidneys, lungs and skin as well as the veins) - increases renal blood flow, acting weakly as a diuretic
- slightly lowers blood pressure
in high doses, it has a positive ino- and chronotropic effect on the heart (i.e. it increases the strength and frequency of heart contractions) - increases the contractility of the diaphragm, which facilitates breathing in patients with chronic obstructive pulmonary disease
Medications are a common cause of secondary hypertension , including:
- sympathomimetics (also in the form of nasal drops)
- corticosteroids
- erythropoietin
- cyclosporine
- tacrolimus
- MAO inhibitors
- NSAIDs
- licorice preparations
- carbenoxolone
- oral contraceptives
- testosterone and its derivatives
Theophylline is a
- drug derived from methylxanthine (a purine derivative) and has smooth muscle relaxant, bronchial dilation, diuretic, cardiac and central nervous system (CNS) stimulant activities
- It also reduces the airway responsiveness to histamine, adenosine, methacholine, and allergens
Eptifibatide is an
- antiplatelet drug from the group of GP IIb/IIIa receptor inhibitors (alongside tirofiban and abciximab)
name old and new generation
Oral anticoagulants:
- old generation (AVK):
warfarin, acenocoumarol - next generation (NOAC):
dabigatran - direct thrombin inhibitor,
rivaroxaban,
apixaban - factor Xa inhibitors
Still’s disease is a
- systemic form of juvenile idiopathic arthritis with fever, rash, lymphadenopathy, splenomegaly, and serositis and multi-organ inflammation.
- A very characteristic feature is a very high concentration of ferritin in the serum (>3000 ng/ml indicates Still’s disease, an increase correlates with the activity of the disease).
Gliclazide is a drug from the group of
- sulfonylureas.
- it works by stimulating the pancreatic beta cells to secrete more insulin by binding to the SUR1 receptor.
- These are hypoglycaemic drugs, so their use is associated with the risk of hypoglycemia.
- They can also cause weight gain.
Treatment with gliclazide should be started with
- the lowest dose
- should be increased every 1-2 weeks depending on the patient’s blood glucose levels.
- The starting dose of **gliclazide MR is 30 mg/day. **
Treatment with gliclazide
Treatment with gliclazideIn patients with impaired consciousness
- in patients with impaired consciousness , a 20% glucose solution should be administered intravenously (even 80-100 ml), followed by an intravenous infusion of 10% glucose until the patient regains consciousness.
- Alternatively, with difficult intravenous access, glucagon can be administered im or sc .
- ** but ATTENTION!** it can only be administered to patients treated with insulin!
- In patients taking oral medications, glucagon may temporarily stimulate the pancreas to produce insulin!
The** 15/15 rule** is used in mild or moderate hypoglycaemia, which occurs in patients treated with insulin using an insulin pump - it consists in the supply of 15 g of glucose and glycemic control after 15 minutes.
Provide values in mmol/L
Hyponatremia can be divided according to Na+ concentration into:
Mild
Moderate
Severe
Mild - 130-134 mmol/l
Moderate - 125-129 mmol/l
Severe < 125 mmol/l
patient with severe hyponatremia , additionally with gradually developing symptoms of cerebral edema (disturbance of consciousness).
In this case, the strategy for treatment is as follows:
- Give the patient 150 ml of 3% NaCl solution over 20 minutes
- Then use NaCl solution to gradually increase natremia by 5 mmol/L over 24 hours
-* Administration of 3% NaCl solution should be discontinued in the following situations:* - After achieving the target sodium level (above 130 mmol/l) - continue to supplement its deficiency by limiting water intake and eating a diet with normal amounts of protein and sodium.
- Withdrawal of neurological symptoms.
Increase in natremia by 10 mmol/L from baseline.
If a 3% NaCl solution is not available, you can use
- a 10% solution and dilute it with a 5% glucose solution (e.g. 30 ml of 10% NaCl mixed with 70 ml of 5% glucose solution, which gives 100 ml of 3% NaCl)
ATTENTION! Too rapid correction of hyponatremia in patients with chronic disorders of sodium concentration in the blood with the current natremia <120mmol/l may result in ?
- may result in the development of osmotic demyelinating syndrome .
- In such cases, the rate of natremia equalization should not exceed** 10 mmol/l/24h .**
International normalized ratio (INR) is
- the preferred test of choice for patients taking vitamin K antagonists (VKA).
- It can also be used to assess the risk of bleeding or the coagulation status of the patients.
International normalized ratio (INR)
- The INR is derived from prothrombin time (PT) which is calculated as
- a ratio of the patient’s PT to a control PT standardized for the potency of the thromboplastin reagent developed by the World Health Organization (WHO) using the following formula:
INR = Patient PT ÷ Control PT
INR :norm?
INR (norma INR: 0.85-1.15)
APTT
- this is the parameter that we determine in the case of administration of UFH, i.e. unfractionated heparin.
- 26–40 s norm .
- This time may be extended in the case of many diseases, the most important of which are hemophilia and von Willebrand disease.
Clotting time
- The blood coagulation time is the time elapsing from the moment of blood extravasation to the moment of its clotting in a glass tube, which reflects the activation time of the coagulation system under artificial conditions.
- The normal clotting time is 7-9 minutes.
Bleeding time
- Bleeding time is the time elapsing from a skin injury to the cessation of bleeding.
- It is usually 4-8 minutes.
Platelet count
- Platelets: key role in the clotting process
- The norm is 150,000-400,000/microlitre.
Risk factors for chronic pancreatitis include (acronym TIGAR-O )
T - toxic-metabolic - alcohol , tobacco, hypercalcemia ( hyperparathyroidism ), hyperlipidemia, chronic renal failure, drugs (phenacetin), toxins,
I - idiopathic,
G - genetic - mutation of the cationic trypsinogen gene , CFTR gene, serine protease inhibitor gene, alpha1-antitrypsin deficiency,
A - autoimmune - IgG4 dependent disease,
R - recurrent - recurrent and severe acute pancreatitis,
O - obstructive - obstructive - bifid pancreas, functional disorders of the sphincter of Oddi, obstruction of the pancreatic duct.
Azathioprine is a risk factor for
acute pancreatitis
not chronic pancreatitis
Pancytopenia is a
- medical condition in which there is significant reduction in the number of almost all blood cells (red blood cells, white blood cells, platelets, monocytes, lymphocytes, etc.).
Pancytopenia
Causes:
- Iatrogenic causes of pancytopenia include chemotherapy for malignancies if the drug or drugs used cause bone marrow suppression.
- Rarely, drugs (antibiotics, blood pressure medication, heart medication) can cause pancytopenia.
- For example, the antibiotic chloramphenicol can cause pancytopenia in some individuals
TREATMENT OF THE ACUTE PHASE OF PULMONARY EMBOLISM:
- anti-symptomatic
fluid therapy for hypotension
mechanical ventilation
oxygen therapy
TREATMENT OF THE ACUTE PHASE OF PULMONARY EMBOLISM:
2. anticoagulant treatment:
unfractionated heparin
low molecular weight heparin
fondaparinux (Xa inhibitor)
TREATMENT OF THE ACUTE PHASE OF PULMONARY EMBOLISM:
1. recombinant plasminogen activators (thrombolysis)
alteplase
urokinase
streptokinase
TREATMENT OF THE ACUTE PHASE OF PULMONARY EMBOLISM:
vitamin K antagonists
- after completion of thrombolytic therapy, during heparin use, after stabilization of the patient’s condition
TREATMENT OF THE ACUTE PHASE OF PULMONARY EMBOLISM:
implantation of an inferior vena cava filter
- if there are absolute contraindications to anticoagulant treatment
Osteomalacia is
- a metabolic bone disease involving decalcification or insufficient deposition of calcium salts in the bone tissue.
- This leads to the bending of the bones under the influence of loads and to permanent bone deformations .
-The reasons for this state of affairs are:
- Deficiency of active metabolites of vitamin D3 - the most common cause, long-term deficiency causes the development of secondary hyperparathyroidism with hypophosphatemia
- Phosphate deficiency
- Calcium deficiency
- The equivalent of osteomalacia in children is
rickets.
Osteomalacia
Diagnosis is based on the presence of clinical symptoms and changes in laboratory exponents. The clinical picture is dominated by diffuse bone pain and their sensitivity to pressure along with muscle fatigue . In the further stages of the disease, bone deformation can be observed, especially the long bones of the lower limbs.
-In laboratory tests, attention is paid to:
- low or normal levels of calcium in the blood
- low phosphate concentration
- low concentration of 25-OH-D
- increased ALP activity in the blood serum
- increased levels of PTH
- decreased urinary calcium excretion
The patient is treated for hypertension with two antihypertensive drugs (amlodipine and indapamide) with good results - her blood pressure values reach the target values. However, he has disturbing symptoms - persistent constipation and muscle weakness.
These are the symptoms of
hypokalemia.
Clinical symptoms of hypokalemia:
weakness
constipation
muscle cramps and paralysis
muscle weakness
arrhythmias
hypotension
polyuria
increased thirst
indapamide- belongs to thiazide-like diuretics which can cause hypokalemia .
During therapy, it is recommended to monitor the concentration of?
** potassium**
if necessary, its supplementation.
Zollinger-Ellison syndrome includes:
- gastrin-secreting tumor (gastrinoma)
- persistent peptic ulcers secondary to hypergastrinemia
- the syndrome often coexists with multiple endocrine tumors type 1 (MEN1)
MEN1 → components
- Primary hyperparathyroidism
- Neuroendocrine neoplasms of the pancreas and gastrointestinal tract, bronchi and thymus gland (including gastrinomas )
- Pituitary tumors
- Other tumors of the endocrine glands
Clinical picture of Zollinger-Ellison syndrome
- refractory ulcer disease
- diarrhea, sometimes fatty
- heartburn
- weight loss.
Chronic Kidney Disease:
definition :
abnormalities of kidney structure or function persisting for >3 months
in Chronic Kidney Disease:
Clinical picture
general symptoms :
weakness, fatigue, loss of appetite
in Chronic Kidney Disease:
clinical picture -
cardiovascular symptoms
hypervolemia , hypertension,
left ventricular hypertrophy,
heart failure, uremic pericarditis
in Chronic Kidney Disease:
ionic disorders:
metabolic acidosis ,
hypo- or hypercalcemia, hyperphosphatemia ,
hyperkalemia ,
vitamin D deficiency
in Chronic Kidney Disease
neurological symptoms :
impaired concentration, headache, drowsiness or insomnia,
apathy or irritability,
convulsions and coma,
RLS,
loss of deep reflexes,
muscle weakness,
tremors,
muscle spasms
in Chronic Kidney Disease
hormonal disorders :
menstrual disorders,
infertility,
sexual dysfunction,
secondary or tertiary hyperparathyroidism,
renal osteodystrophy
In Chronic Kidney Disease:
gastrointestinal symptoms :
gastroenteritis,
peptic ulcer of the stomach or duodenum,
nausea and vomiting,
paralytic ileus,
acute pancreatitis
In Chronic Kidney Disease:
hematological symptoms:
reduced resistance to infections,
prolonged bleeding from wounds
In Chronic Kidney Disease:
respiratory symptoms :
uremic pleurisy,
pulmonary congestion and edema (so-called uremic lung in advanced CRF)
Eosinophilic esophagitis is
- a chronic immune-mediated inflammatory disease of the esophagus. – The formation of this disease is induced by food and inhalant allergens .
- Most patients have coexistence of atopic diseases, e.g.* asthma , allergic rhinitis, atopic dermatitis, food allergies*.
Eosinophilic esophagitis
It is characterized by
- the appearance of symptoms of esophageal dysfunction and inflammatory infiltration of the esophageal wall (mainly eosinophils) in the histological picture.
- These changes lead to fibrosis and esophageal motility disorders.
Eosinophilic esophagitis
The clinical picture may vary and change with age:
- CHILDREN: difficulty in feeding, refusal to eat, inhibition of weight gain and growth,
- ADULTS: dysphagia , long chewing time, drinking plenty of liquids with food, avoiding products causing problems with swallowing, retrosternal pain , reflux symptoms.
Eosinophilic esophagitis
Material for histological examination is most often taken from the
- distal and proximal part of the esophagus.
- Eosinophils are found in the epithelium and other layers of the esophagus.
Eosinophilic esophagitis
Treatment:
- Elimination diet,
- IPP
- Topical corticosteroids (nebulized budesonide and pressurized fluticasone - both used after)
- Endoscopic treatment: esophageal dilation.
Do not use GKS systemically!
Eosinophilic esophagitis
The diagnosis is made on the basis of SYMPTOMS of esophageal dysfunction, the presence of
- the presence of ≥15 eosinophils in the BIOPTATAS, persistence of changes despite the use of PPI’s
Eosinophilic esophagitis
Diagnostics:
- laboratory tests show an increased concentration of IgE and eosinophilia,
- in the endoscopic examination visible circular folds, rings of the mucous membrane, longitudinal furrows, papules, white coatings, hyperemia and swelling of the mucous membrane,
- histological examination - presence of eosinophils.
** acute pyelonephritis **
supported by the following clinical and laboratory symptoms:
fever with chills
nausea
stomach pain
significantly increased CRP values
leukocytosis
leukocyturia
Pyelonephritis
- is inflammation of the kidney, typically due to a bacterial infection.
- Symptoms most often include fever and flank tenderness.
- Other symptoms may include nausea, burning with urination, and frequent urination.
- Complications may include pus around the kidney, sepsis, or kidney failure.
Acute pyelonephritis
- is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney.
- The kidney parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils).
- Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, the glomerulus and vessels are normal.
- Gross pathology often reveals pathognomonic radiations of bleeding and suppuration through the renal pelvis to the renal cortex.
Drugs used in a gout attack:
- Colchicine - 1 mg orally, another 0.5 mg after an hour. If the attack persists, another 0.5 mg may be given after 12 hours.
- NSAIDs - orally in the maximum recommended doses. Avoid taking acetylsalicylic acid as it increases the concentration of uric acid in the blood!
- *GKS * - orally at a dose equivalent to 30-35 mg of prednisolone, use for 3-5 days. GCS is administered mainly to patients with contraindications to colchicine and NSAIDs. They can also be given intravenously .
- Canakinumab - administered to patients with > 3 attacks per year for whom the use of all the above drug groups is contraindicated.
Allopurinol
is used in the treatment of
- chronic gout, it reduces the concentration of uric acid in the blood.
- It should not be started before the gout attack has completely subsided, because allopurinol alone at the beginning of use may trigger / intensify such an attack .
- If a gout attack occurs in a patient using allopurinol, therapy should be continued and one of the above-mentioned drugs should be added.
- In such a situation, the dose of allopurinol should not be increased.
Transmissible spongiform encephalopathies (TSEs) also known as
- prion diseases,
- are a group of progressive, incurable, and fatal conditions that are associated with prions and affect the brain and nervous system of many animals, including humans, cattle, and sheep.
- According to widespread hypothesis, they are transmitted by prions, though some other data suggest an involvement of a Spiroplasma infection.
- Mental and physical abilities deteriorate and many tiny holes appear in the cortex causing it to appear like a sponge when brain tissue obtained at autopsy is examined under a microscope.
Transmissible spongiform encephalopathies
TSEs of humans include
- Creutzfeldt–Jakob disease,
- Gerstmann–Sträussler–Scheinker syndrome,
- fatal familial insomnia,
- kuru,
- as well as the recently discovered variably protease-sensitive prionopathy and familial spongiform encephalopathy.
Creutzfeldt–Jakob disease (CJD),
also known as
- subacute spongiform encephalopathy or neurocognitive disorder due to* prion disease*, is an invariably fatal degenerative brain disorder.
- Early symptoms include memory problems, behavioral changes, poor coordination, and visual disturbances.
- Later symptoms include dementia, involuntary movements, blindness, weakness, and coma.
- About 70% of people die within a year of diagnosis.
- The name Creutzfeldt–Jakob disease was introduced by Walther Spielmeyer in 1922, after the German neurologists Hans Gerhard Creutzfeldt and Alfons Maria Jakob.
A prion
- is a misfolded protein that can transmit its misfoldedness to normal variants of the same protein and trigger cellular death.
- Prions cause prion diseases known as transmissible spongiform encephalopathies (TSEs) that are transmissible, fatal neurodegenerative diseases in humans and animals.
- The proteins may misfold sporadically, due to genetic mutations, or by exposure to an already misfolded protein.
- The consequent abnormal three-dimensional structure confers on them the ability to cause misfolding of other proteins.
The primary symptom of RA is arthritis
arthritis is usually symmetrical
typically the inflammation begins with inflammation of the?
-small joints of the hands and feet:
wrist joints
proximal interphalangeal joints
metacarpophalangeal
metatarsophalangeal
The primary symptom of RA is arthritis
arthritis is usually symmetrical
typically the inflammation begins with inflammation of the small joints of the hands and feet, then the larger joints become inflamed
brachial
elbows
knee
hip
Coagulogram norms:
PT -
APTT -
fibrinogen -
D-dimers -
- PT (prothrombin time) - 12-16 p
- APTT (activated partial thromboplastin time) - 28-30 sec
- fibrinogen - 180-350 mg/dL
- D-dimers - up to <500 ng/ml or 0-0.50 milligrams per liter (mg/L) of blood
The parathyroid glands secrete parathyroid hormone (PTH), which increases the concentration of calcium in the blood serum
- Low calcium levels (hypocalcemia) manifest as:
- paresthesias
-
Tetany attacks - painful cramps, tremors and numbness in the hands, forearms and face.
-* Latent tetany *- symptoms of tetany are invisible, but can be revealed by performing appropriate activities:
- Chvostek’s sign: spasm of the facial muscles after a hammer blow to the facial nerve
- Trousseau’s sign “obstetrician’s hand” after pressing the arm for 3 min with a sphygmomanometer cuff inflated to 20 mm Hg above systolic pressure
- inducing a seizure by increased ventilation (hyperventilation)
define- mame 7 symptoms
hypercalcemia
- it is a set of symptoms of various etiologies resulting from elevated serum calcium levels >2.75 mmol/l.
- Typically patients suffer from:
- kidney problems :
- polyuria, hypercalciuria, calcinosis and kidney stones - digestive tract:
- loss of appetite, nausea, vomiting, constipation - stomach or duodenal ulcer, pancreatitis, biliary tract stones
- cardiovascular:
- arterial hypertension, tachycardia, arrhythmia, hypersensitivity to digitalis glycosides - neuromuscular symptoms:
- weakened muscle strength, weakened tendon reflexes, temporary paralysis of facial muscles - cerebral symptoms:
- headache, depression, disorientation, drowsiness, coma - dehydration
Hypouricemia
- is the concentration of uric acid in the blood serum below 2 mg% (119 µmol/l), i.e. an abnormally low concentration.
- This level of uric acid occurs in about 0.5% of healthy people and is normal for them.
The causes of hypouricemia include:
- treatment with allopurinol
- congenital xanthine oxidase deficiency
- pregnancy
- SIADH
- acromegaly
- tubulopathies (uric acid escapes through the kidneys)
-mtaking uricosuric drugs (salicylates, corticosteroids, probenecid)
EHRA scale
is used to classify symptoms associated with atrial fibrillation.
PESI scale
evaluates the prognosis in pulmonary embolism
TIMI scale
- is a scale used to assess the flow through the coronary arteries , consisting in visual assessment of the flow during the coronary angiography.
additionally name condition
The acronym CRAB stands for
multiple myeloma syndrome.
C - (Calcium) elevated serum calcium levels,
R - (Renal) kidney failure,
A - anemia,
B - (bone lesions) osteolytic defects in the bones.
The ARR (aldosterone-renin index) test is the most reliable screening test for
primary hyperaldosteronism
define
primary hyperaldosteronism-also known as?
- (Conn’s syndrome) - this is the correct answer.
- Primary hyperaldosteronism results from uncontrolled secretion of aldosterone beyond the control of the RAA system.
- High levels of aldosterone have an inhibitory effect on the secretion of renin, therefore the ARR index increases as the level of aldosterone increases and the level of renin decreases.
Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in pregnancy as, even briefly administered in the third trimester, they can cause
- fatal renal failure in the fetus.
- Human and animal reports indicate that ACE inhibitors administered to pregnant women cause:
- oligohydramnios, microcephaly,
- fetal developmental delay,
- premature birth, renal failure,
- fetal malformation, shortened limbs,
- cardiovascular disorders
- pulmonary hypoplasia.
Primary acute glomerulonephritis is a disease of the glomeruli associated with the presence of
- immune complexes after infection with group A β-haemolytic streptococci
- Group A β-hemolytic streptococci secrete streptolysin , which is their virulence factor.
- For diagnostic purposes, the antistreptolysin test , or ASO, is used , answer C.
- This test determines the presence of an antibody against streptococcal surface antigens - streptolysin O in the serum.
The normal length of the kidney in a healthy person is ?
- about 9.5-12 cm.
- A patient’s 6 cm kidney may indicate chronic kidney disease, therefore dialysis may be necessary on a chronic basis .
Tumor lysis syndrome:
definition :
- life-threatening metabolic disorder syndrome due to the breakdown of cancer cells and the release of many substances into the bloodstream in large quantities
- it most often appears in the first days of chemotherapy
- most often in the course of treatment of rapidly dividing tumors, highly sensitive to chemotherapeutic agents
massive cell breakdown leads to the release of large amounts of potassium, purines and phosphates
Tumor lysis syndrome:
treatment:
allopurinol
fluids
loop diuretic + hydration (forced diuresis)
Tumor lysis syndrome: cause
symptoms and metabolic disorders:
- AKI (uric acid and calcium phosphate crystal precipitation)
- arrhythmias - hyperkalemia
- hypocalcemia - tetany
- hyperuricemia
- hyperphosphatemia
- hyperkalemia
Some rheumatic diseases with skin manifestations:
- lupus (SLE)
- dermatomyositis (DM)
- systemic scleroderma (SSc)
- Sjogren’s syndrome
- RA
- psoriatic arthritis
- juvenile arthritis
- recurrent cartilage inflammation
- IgA-associated vasculitis
- eosinophilic granulomatosis with
- polyangiitis
CEA ( carcinoembryonic antigen):
definition :
- a glycoprotein produced in the womb and almost completely inhibited after birth.
- CEA production can be resumed, e.g. when genes are activated (which should be physiologically inactive) due to a cancer mutation
CEA ( carcinoembryonic antigen):
Causes of increased CEA levels:
slight increase in CEA levels:
- hepatitis and cirrhosis
- chronic pancreatitis
- gastric and duodenal ulcers
- ulcerative colitis
- pneumonia
- pregnancy
- colorectal cancer:
a. for this tumor, an increase in CEA is most characteristic
b. advanced disease = high CEA concentration
cause and diagnosis
Primary hyperparathyroidism is caused by
- excessive secretion of parathyroid hormone due to a defect in parathyroid cells that are insensitive to the suppressive effects of hypercalcemia.
- The most common cause of the development of primary hyperparathyroidism is a** solitary parathyroid adenoma **.
- This diagnosis is also supported by the fact that primary hyperparathyroidism usually develops around the sixth decade of life.
The TNM staging of tumors applies to _____
it is not applicable to cancer of the ____ system and ____ cancer
- solid tumors
- hematopoietic system and lymphoproliferative cancer .
Typical treatment of patients with the so-called Acute tumor lysis includes:
- In expanded TLS you should:
a) transfuse fluids and force diuresis with a loop diuretic (e.g. furosemide 40-80 mg iv), so that it is >3l/24h,
b) use allopurinol (max. 500 mg/m2/d).
- In the event of acute renal failure (oliguria or anuria), hemodialysis is necessary (it effectively removes uric acid). Alkalinization of urine is not recommended because it may cause the precipitation of calcium phosphate crystals in patients with hyperphosphatemia.
- If severe hyperuricemia persists (>15 mg/dl), rasburicase (recombinant urate oxidase) may be used, usually at a dose of 0.2 mg/kg/d.
pH - 7.30 - decreased pH indicates?
pCO2 - 55 mmHg - an increased pCO2 level suggests that the acidosis is?
HCO3 - 24 mmol/l - non-increased bicarbonate content in the blood with a reduced pH? indicates that the acidosis
The above parameters paint a picture of?
- acidosis
- respiratory in nature
- has not been compensated
- decompensated respiratory acidosis .
Transudative fluid, characterized by low protein content and low lactate dehydrogenase (LDH) activity, may accumulate in the pleural cavity as a result of:
- Heart failure
- Liver cirrhosis
stands for
CHA2DS2VASc scale:
HLA-B27 is a sensitive genetic marker for
- ankylosing spondylitis
- It is useful in predicting the risk of the disease, recognizing its early stage, and may also herald its severe course.
ACEI and ARB have a ________ significantly reduce ________ and should be preferred in the treatment of ___________, especially in the case of ______ or _____ 30–300 mg/24 h.
- nephroprotective effect
- proteinuria
- hypertension
- proteinuria or albuminuria 30–300 mg/24 h.
Which drug used to treat hypertension is most likely responsible for causing the gout attack in this patient?
Indapamide
In patients with hyperuricemia ( while taking indapamide ), the frequency of gout attacks may increase.
High proteinuria is defined as ____ ____ , which in an adult means a daily protein loss ____g - it is characteristic of ______ _______.
- nephrotic proteinuria
- daily protein loss of over 3.5 g
- it is characteristic of nephrotic syndrome .
Nephrotic syndrome (NS) is a clinical condition characterized by
- daily urinary protein loss >3.5 g/1.73 m2
- hypoalbuminemia
- lipiduria
- hyperlipidemia
- edema
Myelodysplastic syndromes (MDS) are malignant diseases of the
- hematopoietic system that are characterized by peripheral blood cytopenias,
- dysplasia in one or more hematopoietic lines,
- ineffective hematopoiesis ,
- repetitive genetic changes
- and frequent transformation into acute myeloid leukemias (AML).
Multiple myeloma - it is indicated by the presence of
CRAB symptoms (hypercalcemia, renal failure, anemia, bone damage)
The most common infections in patients with liver cirrhosis are
- spontaneous bacterial peritonitis
- sepsis
- urinary tract infections
- pneumonia
Diagnostics – Location of infarction on ECG
anterior wall
V1–V4
Diagnostics – Location of infarction on ECG
side wall and apex
Diagnostics – Location of infarction on ECG
presence of typical chest pain and persistent ST segment elevation at the J point of ≥ 0.1 mV in the leads: lower wall of the left ventricle
II , III , aVF
Diagnostics – Location of infarction on ECG
right ventricular wall
Vr3 , Vr4
α-fetoprotein (AFP) - is of secondary importance in the diagnosis of the nature of?
focal lesions found in the liver ( concentration >200 ng/ml is specific for HCC , but may reach values >1000 ng/ml, which, according to some authors, indicates multifocal HCC and infiltration portal vein).
(HCC) hepatocellular carcinoma.
AFP is also a tumor marker for?
**nonseminomatous germ cell tumors **
name 6
AFP is also a tumor marker for nonseminomatous germ cell tumors .
Its increased concentration may be observed in:
cancers:
stomach,
bile ducts,
pancreas,
liver cirrhosis,
viral hepatitis,
pregnancy.
Gout - during an attack, synovial fluid shows
- inflammatory features, phagocytosed sodium urate crystals are present , which constitute the basis for immediate diagnosis of the disease.
For a patient with CKD , GFR < 30 ml/min/1.73 m² and hyperkalemia > 5.0 mmol/l, safe antihypertensive drugs are:
loop diuretic
calcium channel antagonist
name 7
typical presentation of Still’s disease :
- fever ,
- pain in knee and wrist joints,
- maculopapular rash on the trunk and thighs, most often without itching,
- recurrent (relapses may be frequent) or chronic (symptoms persist continuously for a year)
- enlargement of the liver and spleen
- increased ferritin concentration - has a high diagnostic value because Still’s disease is the most common cause of such a significant (often > 3000 ug/l) increase in ferritin concentration in adults,
- increased serum aminotransferase activity .
name 8
Symptoms which suggest the diagnosis of
subacute thyroiditis:
- typical age and gender - the highest incidence occurs in young women ;
- painful swelling of the thyroid gland;
- pain radiating to the ears, angle of the jaw and upper chest;
- fever ;
- history of a recent respiratory infection - subacute thyroiditis is an inflammation of probably viral etiology;
- decreased TSH - indicates that the patient is in the phase of the disease involving hyperthyroidism, which results from the destruction of the glandular parenchyma and the release of HT;
- temporary hyperthyroidism is responsible for:
a. systolic hypertension,
b. tachycardia ; - the lack of redness of the skin around the neck is a feature that distinguishes subacute inflammation from acute inflammation.
6
Symptoms suggesting diagnosis of acute pyelonephritis
- high fever ,
- occurrence of chills ,
- stomach pain ,
- vomiting ,
- increased CRP and WBC - inflammation,
- leukocyturia .
________should not be used as the only drug when starting the treatment of fresh deep vein thrombosis of the lower limb, because its anticoagulant effect appears only after_______ days
- Warfarin
- 3-5 days .
**Warfarin should not be used as the only drug when starting the treatment of fresh deep vein thrombosis of the lower limb, because its anticoagulant effect appears only after 3-5 days .
However, in this case it is possible to use warfarin together with
LMWH/UFH/fondaparinux , with subsequent discontinuation of the second drug when INR ≥ 2 for ≥ 2 consecutive days.**
Diagnostic criteria according to Healey:
The criteria for diagnosing polymyalgia rheumatica
- pain lasting for ≥1 month, affecting ≥2 of the following areas: neck, shoulders, pelvic girdle
- morning stiffness for more than 1 hour
- rapid response to prednisone (≤20 mg/d)
- exclusion of other diseases with similar symptoms
- age over 50
- ESR above 40 mm/h.
Primary hyperthyroidism is accompanied by
- a decrease in TSH concentration with an increase in the concentration of free thyroid hormones .
Primary hyperthyroidism = ↓TSH + ↑fT4
In AL amyloidosis, glomerulopathy manifests itself as
- nephrotic syndrome,
- renal failure with relatively large kidney sizes, but arterial hypertension usually does not occur
Name condition/symptoms
What is indicated by the presence CRAB symptoms, name symptoms
- Multiple myeloma
hypercalcemia,
renal failure,
anemia,
bone damage
Hypotonic hyponatremia with hypervolemia may be the result of
“dilution” (heart failure, cirrhosis with ascites, nephrotic edema) or impaired free water excretion ( acute and chronic renal failure ).
Alport syndrome is
- is a genetic disorder affecting around 1 in 5,000-10,000 children,characterized by glomerulonephritis, end-stage kidney disease, and hearing loss.
- syndrome can also affect the eyes, though the changes do not usually affect vision, except when changes to the lens occur in later life.
- Blood in urine is universal.
- Proteinuria is a feature as kidney disease progresses
- It occurs due to an abnormality of a gene that codes for type 4 collagen and usually presents in patients with hematuria, edema, and hypertension
Alport syndrome is caused by mutations in
- COL4A3, COL4A4, and COL4A5, three of six human genes involved in basement membrane (type IV) collagen biosynthesis.
- Mutations in any of these genes prevent the proper production or assembly of the specialised type IV collagen ‘345’ network which is an important structural component of basement membranes in the kidney, inner ear, and eye
Aortic stenosis is characterized by
- a rough, coarse, systolic ejection murmur radiating to the neck, usually ending before the second sound,
- best heard at the sternal edge in the second-third right intercostal space and the fourth left intercostal space;
- the loudness of the murmur does not reflect the degree of stenosis ;
- a loud murmur may occur in a small stenosis;
- the murmur may radiate to the apex of the heart and be louder there than at the base of the heart (Gallavardin’s phenomenon), suggesting mitral valve regurgitation.
Guaiac Tests (gFOBT)
- Qualitative tests that use the peroxidase activity of heme to oxidize guaiac acid by H2O2 to produce a colored product.
- They detect blood (hemoglobin) indirectly, so there is a risk of a false positive result in the case of consuming food or preparations containing compounds with similar activity:
= (e.g. iron preparations , meat, some vegetables [horseradish, radish, green vegetables]), as well as a false negative result in the presence of substances that are also oxidized (e.g. vitamin C). - For this reason, dietary and drug restrictions are necessary for 3 days preceding the examination.
- The determinations should be made in samples from 3 consecutive bowel movements.
Features of the murmur resulting from aortic valve regurgitation :
- holodiastolic (diastolic) decrescendo murmur , - usually loudest at the left sternal border ;
radiation to the Erb point ;
a) factors that increase the loudness of the murmur:
sitting position with a forward lean ,
- sudden crouching,
- isometric exercise (handshake),
- phenylephrine;
b) factors that reduce the loudness of the
- murmur:
- amyl nitrate,
- Valsalva maneuver (phase II).
Cystine urolithiasis
Cystine stone disease is caused by
- a genetic defect in the reabsorption of amino acids (cystine, ornithine, arginine, lysine)
Acute Myeloid Leukemia
which line of malignant cells is dominant :
lymphoblastic - characterized by a large predominance of lymphocytes;
myeloblastic - characterized by a predominance of neutrophils, eosinophils, basophils or monocytes (MO 82.95 G/L) .
Morphology can suggest the nature of the growth process
Acute Myeloid Leukemia
define parameters of acute & chronic
**acute ** - parameters regarding erythrocytes and platelets are reduced (RBC 3.82 T/L, HGB 10.8 g/dL, PLT 48 G/L)
chronic - parameters regarding erythrocytes and platelets usually remain normal.
Flosins:
promote-reduce-improve-inhibit what ?
- they promote weight loss (in the initial period of treatment) and lower blood pressure,
- reduce cardiovascular risk, including the risk of death from cardiovascular causes (empagliflozin),
- improve heart performance and reduce the risk of heart failure progression,
- inhibit the progression of kidney failure in the course of diabetes . v
Metofrmin is one of the basic drugs used in the treatment of-
- type 2 diabetes , the mechanism of antihyperglycemic action:
- inhibition of hepatic glucose production, intensification of anaerobic glucose metabolism, stimulation of peripheral insulin action (increased insulin sensitivity probably due to activation of the GLUT4 glucose transporter), inhibition of intestinal glucose absorption (rather than therapeutic doses)
Causes of secondary focal segmental glomerulosclerosis:
leading to hyperfiltration
- reflux nephropathy,
- malignant hypertension,
- reduced amount of active renal parenchyma,
- significant obesity ,
- sickle cell anemia,
toxic factors
- heroin nephropathy,
- pamidronate,
- less frequently: interferon (α, β or γ), calcineurin inhibitors, sirolimus,
HIV infection , less often other viruses (parvovirus B19, CMV, EBV).
AKI is diagnosed based on:
- rapid increase in blood creatinine concentration , i.e. by >26.5 µ mol/1 (0.3 mg/dl) within 48 h
or - by >50% of the baseline value in the last 7 days, or
decreased urine volume <0.5 ml/kg body weight. for >6 consecutive hours.
Call For Nurse** P**lease Today
The first-line drugs used to treat uncomplicated cystitis include:
“CFNPT”
- nitrofurantoin (furazidine in Poland),
- co-trimoxazole,
- trimethoprim,
- fosfamycin,
- pivmecillinam (unavailable in Poland).
“prostaglandin F2α “
true statement regarding the treatment of asthma during pregnancy and breastfeeding
- prostaglandin F2α may cause bronchospasm and should be used with extreme caution
Exacerbation of symptoms during pregnancy may be caused by, among others:
- increased concentration of prostaglandin PGF2α (contraction of bronchial and uterine smooth muscles) in the last weeks of pregnancy and during delivery. 15-methyl-PGF 2α should not be used to induce uterine contractions (danger of causing bronchospasm).
Osteogenesis imperfecta is:
- A group of diseases whose common feature is spontaneous* bone fragility and blue discoloration of the sclera* .
- Most cases are inherited in an autosomal dominant manner. >90% of patients have a mutation in one of the genes encoding type I collagen.
insulin tumor
- a characteristic symptom of insulinoma is the appearance of hypoglycemia symptoms and their disappearance after the administration of carbohydrates .
- High levels of insulin (>36 pmol/l) and C-peptide (>200 pmol/l) are among the criteria for diagnosing insulin tumor .
name 6 inculde dosing
The first-line drugs used in the empirical treatment of uncomplicated urinary tract infections in non-pregnant women
First-line drugs:
- nitrofurantoin 100 mg 2 times a day for 3–5 days (another nitrofuran derivative is available in Poland
- furazidine 100 mg 4 times a day; do not use in patients with eGFR <60 ml/min/1.73 m2),
- cotrimoxazole 960 mg twice daily for 3 days,
- trimethoprim 100 mg twice daily for 3–5 days,
- fosfomycin 3.0 g once,
- pivmecillinam 400 mg twice daily for 3–7 days.
Causes of hyperuricemia:
- primary gout,
- increased consumption of purine-rich foods,
- acute and chronic renal failure,
- metabolic syndrome,
- treatment with diuretics,
- Hypothyroidism,
- carbon monoxide or lead poisoning,
- tissue breakdown (e.g. post-chemotherapy tumor lysis syndrome)
define
Hyperuricaemia or hyperuricemi
- abnormally high level of uric acid in the blood.
- In the pH conditions of body fluid, uric acid exists largely as urate, the ion form.
- Serum uric acid concentrations greater than 6 mg/dL for females, 7 mg/dL for men, and 5.5 mg/dL for youth (under 18 years old) are defined as hyperuricemia.
- The amount of urate in the body depends on the balance between the amount of purines eaten in food, the amount of urate synthesised within the body (e.g., through cell turnover), and the amount of urate that is excreted in urine or through the gastrointestinal tract
(provide appropriate acronym)
Multiple myeloma - it is indicated by the presence of what symptoms
CRAB symptoms (hypercalcemia, renal failure, anemia, bone damage).
Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of
- autoantibodies, mainly of the IgG type, against antigens in the cytoplasm of neutrophils (the most common type of white blood cell) and monocytes.
- They are detected as a blood test in a number of autoimmune disorders, but are particularly associated with systemic vasculitis, so called ANCA-associated vasculitides (AAV)
The Austin Flint murmur is
- a diastolic rattle due to relative stenosis of the mitral valve , caused by the* elevation of the anterior leaflet of the mitral valve* by the flow of refluxing blood
- a rumbling diastolic murmur best heard at the apex of the heart that is associated with severe aortic regurgitation and is usually heard best in the fifth intercostal space at the midclavicular line.
Guaiac Tests (gFOBT)
- Qualitative tests that use the peroxidase activity of heme to oxidize guaiac acid by H2O2 to produce a colored product.
- They detect blood (hemoglobin) indirectly, so there is a risk of a false positive result in the case of consuming food or preparations containing compounds with similar activity (e.g. iron preparations , meat, some vegetables [horseradish, radish, green vegetables]), as well as a false negative result in the presence of substances that are also oxidized (e.g. vitamin C).
- For this reason, dietary and drug (iron tablets) restrictions are necessary for 3 days preceding the examination.
- The determinations should be made in samples from 3 consecutive bowel movements.
Renal amyloidosis
Symptoms and treatment
- In AL amyloidosis (primary),
glomerulopathy manifests itself as nephrotic syndrome , renal failure , and albuminuria.
-Treatment: chemotherapy, auto-HCT.
- In AA amyloidosis (secondary),
the first symptom of glomerular damage is proteinuria and renal failure.
-Treatment: directed at the underlying disease.
Rheumatoid arthritis
Pharmacological treatment
Rheumatoid arthritis
Treatment – Pharmacological – Other drugs
In the further stages of RA treatment, targeted or biological _________ are used .
- In the further stages of RA treatment, targeted or biological DMARDs are used .
- Targeted drugs (tofacitinib, baricitinib) belong to the group of Janus kinase inhibitors,
which inhibit the activation of inflammatory cells at the receptor level. - Biological drugs block pro-inflammatory cytoki- nes involved in the pathogenesis of R.A or act through a different mechanism.
- These are mostly recombinant antibodies directed against specific inflammatory receptors or proteins.
Biological treatment is extremely expensive, therefore patients who meet the inclusion criteria for such treatment
receive drugs as part of drug programs.
name 5 (LMCCC)
The term “atypical microorganisms (bacteria)” includes:
Legionella pneumophila
Mycoplasma pneumoniae,
Chlamydophila pneumoniae,
Chlamydophila psittaci,
Coxiella burnetii,
Pneumonia
Community-acquired pneumonia – X-ray
Pneumococci -
solid infiltration occupying a segment or lobe , air bronchogram visible.
Pneumonia
Community-acquired pneumonia – X-ray
Staphylococci -
- multifocal lesions with a tendency to disintegrate with the formation of numerous
abscesses and thin-walled cysts (may be accompanied by spontaneous pneumothorax).
* * **
Drugs used in RA are divided into two main groups:
1) NSAIDs - examples of NSAIDs used in rheumatology:
2) DMARDs (disease-modifying drugs) can slow down the development of inflammatory changes and cause long-term remission . These are basic drugs in the treatment of RA. Their action is related to alleviating the symptoms of inflammation and preventing the progression of the disease in the joints .
Drugs used in RA are divided into two main groups:
DMARD is divided into :
- synthetic (sDMCh)
- biological (bDMChs)
CDNII
NSAIDs - examples of NSAIDs used in rheumatology:
celecoxib,
diclofenac,
naproxen,
ibuprofen,
indometacyna,
biological (bDMChs)
original (boLMCh)
T-cell co-stimulation inhibitor:
abatacept,
biological (bDMChs)
original (boLMCh)
inhibitory TNF:
adalimumab,
pegylated certolizumab,
etanercept,
golimumab,
inflixymab,
biological (bDMChs)
original (boLMCh)
monoclonal antibody directed against B lymphocytes:
rituximab,
biological (bDMChs)
original (boLMCh)
monoclonal antibody that blocks the IL-6 receptor:
tocilizumab,
biological (bDMChs)
original (boLMCh)
inhibitor interleukiny 1 (IL-1):
anakinra,
Sometimes glucocorticoids are also used to treat RA - this occurs in the following cases:
- in initial treatment as an adjunct to DMARDs;
- as intra-articular injections , when the disease (or its exacerbation) affects only one or several joints.
Thrombotic microangiopathies are
a group of disorders characterized by:
- microangiopathic hemolytic anemia,
- thrombocytopenia
- microthrombi leading to ischemic tissue injury
Thrombotic Microangiopathy (TMA)
How is it diagnosed?
- Extremely low platelet count with otherwise normal clotting factors.
- Mild to moderately low red blood cell count.
- Abnormal kidney functioned (measured with a lab test called creatinine)
Thrombotic Microangiopathy
Diseases that cause TMA
- Thrombotic Thrombocytopenic Purpura TTP
- Hemolytic Uremic Syndrome HUS
- Atypical TTP/HUS Atypical TTP/HUS
- Malignant Hypertension —
- Disseminated Intravascular Coagulation DIC
- Syndrome of Hemolysis, Elevated Liver
- Enzymes, and Low Platelets HELLP
- Scleroderma Renal Crisis SRC
Thrombotic microangiopathy (TMA) is a pathology that results in
- thrombosis in capillaries and arterioles, due to an endothelial injury
- It may be seen in association with thrombocytopenia, anemia, purpura and kidney failure.
- The clinical presentation of TMA, although dependent on the type, typically includes:
- fever, microangiopathic hemolytic anemia (see schistocytes in a blood smear), kidney failure, thrombocytopenia and neurological manifestations.
- Generally, renal complications are particularly predominant with Shiga-toxin-associated hemolytic uremic syndrome (STx-HUS) and atypical HUS, whereas neurologic complications are more likely with TTP.
- Individuals with milder forms of TTP may have recurrent symptomatic episodes, including seizures and vision loss
Nephrotic syndrome (NS) is
- a clinical condition characterized by 24-hour urinary protein loss >3.5 g/1.73 m2 and hypoalbuminemia, lipiduria, hyperlipidemia and edema.
Nephritic syndrome
- is characterized by the occurrence of hypertension, decreased urine output, and edema, usually moderate.
- General urinalysis shows proteinuria <3.5 g/day and so-called active urine sediment (red blood cells leached and dysmorphic, red blood cell and granular casts).
X-linked adrenoleukodystrophy
- X-linked adrenoleukodystrophy - the most common peroxisomal disease, occurring 1:20,000.
- Caused by mutations in the gene responsible for the import of very long chain fatty acids (VLCFA) into peroxisomes.
- The effect is damage to the adrenal glands, brain and myelin.
- Very high concentrations of VLCFA are found in the blood .
- The disease has 3 forms
X-linked adrenoleukodystrophy
The disease has 3 forms:
- childhood cerebral form - affects boys aged 4-12 years ; symptoms include difficulties in school learning , behavioral disorders , developmental regression, ataxia and adrenal insufficiency;
- adrenomyeloneuropathy - occurs in boys and much less frequently in girls, slowly progressive spastic paralysis and disorders of the sensory spinal cord;
- Addison’s disease - may be the only symptom of the disorder.
Cystic fibrosis is a congenital dysfunction of the chloride channel. A decrease in the secretion of chloride and an increase in the absorption of sodium into the cells are observed, which leads to ionic disorders and dehydration of the secretion of the exocrine glands. It is therefore true that in children with cystic fibrosis more often than in healthy ones:
1) bronchiectasis may occur;
2) cholestasis and gallstones may occur;
3) sinusitis and nasal polyps may occur;
4) a deficiency of pancreatic enzymes is observed, with fully preserved endocrine pancreatic function (including insulin secretion).
Cystic fibrosis is
- a congenital dysfunction of the chloride channel.
- A decrease in the secretion of chloride and an increase in the absorption of sodium into the cells are observed, which leads to ionic disorders and dehydration of the secretion of the exocrine glands.
The patient experienced symptoms of hypoglycemia. A low blood glucose level was detected in a measurement taken at the time of the symptoms, and the symptoms resolved after the hypoglycemia was corrected. The concentration of insulin and C-peptide in the blood was elevated. Indicate the cause:
insulinoma
sulfonylureas
The following drugs are used in H. pylori eradication treatment (in appropriate regimens):
IPP;
bismuth;
tetracycline;
metronidazole ;
clarithromycin ;
amoxicillin ;
levofloxacin .
insulinoma -
- a characteristic symptom of insulinoma is the appearance of hypoglycemia symptoms and their disappearance after the administration of carbohydrates .
- High concentration of insulin (>36 pmol/l) and C-peptide (>200 pmol/l) are among the criteria for the diagnosis of insulinoma .
sulfonylureas
– cause increased secretion of insulin by the pancreas, their side effect may be hypoglycemia - Increased release of endogenous insulin is associated with increased concentration of C-peptide .
The clinical picture suggests a diagnosis of cystic fibrosis:
newborns:
- diagnosis made during a screening test;
meconium ileus
The clinical picture suggests a diagnosis of cystic fibrosis
babies:
- prolonged neonatal jaundice;
- growth retardation ;
- recurrent respiratory infections ;
- malabsorption, fatty stools ;
The main features of the WAGR syndrome are:
W - Wilms tumor - Wilms tumor
A - A niridia - congenital absence of the iris
G - Genitourinary malformation - congenital defects of the urinary tract
R - Mental Retardation - mental retardation
(TMA)
thrombotic microangiopathy
- are clinical syndromes defined by the presence of hemolytic anemia (destruction of red blood cells), low platelets, and organ damage due to the formation of microscopic blood clots in capillaries and small arteries.
Clinical symptoms
nephrotic syndrome in the course of glomerulonephritis
- weakness and nocturia may indicate renal failure, while edema directs the diagnosis towards nephrotic syndrome , the most common cause of which (apart from diabetic nephropathy) are primary glomerulopathies - glomerulonephritis ( mainly FSGS and membranous glomerulonephritis).
Nephrotic syndrome
Causes in adults
- primary glomerulopathies , occurring in 80% of patients with NS .
- In the remaining 20% the cause is secondary glomerulopathies.
MOST COMMON PRIMARY CAUSES
Nephrotic syndrome
1) Membranous CG.
2) Focal segmental glomerulosclerosis ( FSGS ).
3) Submicroscopic GN.
In children, the most common cause is submicroscopic GN .
Hepatopulmonary syndrome
is a lung disease caused by pulmonary vasodilation resulting from cirrhosis
Hepatopulmonary syndrome leads to
- intrapulmonary arteriovenous shunting
and impaired ventilation-perfusion ratio (perfusion > ventilation).
Hepatopulmonary syndrome
Characteristic symptoms include:
– platypnea – increased shortness of breath when standing or sitting and reduced when lying down,
– orthodeoxia – decrease in blood oxygenation when standing or sitting.
Diagnostics- Interviw
Rickets
Vitamin D-dependent rickets - Vitamin D deficiency rickets -
- use of recommended supplementation ,
- diet (fat content in the diet),
- the child’s lifestyle (spending time outdoors),
- comorbidities (liver, kidneys, gastrointestinal tract),
- medications used.**
Physical examination
Rickets
Vitamin D-dependent rickets - Vitamin D deficiency rickets -
- looking for symptoms of rickets.
3) Laboratory tests:
Rickets
Vitamin D-dependent rickets - Vitamin D deficiency rickets - Diagnostics
3) Laboratory tests:
- low calcium concentrations - at the lower limit of normal or reduced,
- ↓ phosphates - excessive phosphaturia due to increased PTH,
- ↑ ALP - increased bone turnover,
- ↑ PTH - secondary hyperparathyroidism,
- ↓ 25-OH-D - diagnosis of vitamin D deficiency.
4) Radiological examinations
Rickets
Vitamin D-dependent rickets - Vitamin D deficiency rickets - Diagnostics
4) Radiological examinations – changes best visible on X-rays of the wrist or knee:
- changes in the metaphyses – thickening of the growth cartilage, blurring of the line separating the metaphyses from the growth cartilage,
cup-shaped dilatation of the metaphyses, - osteopenia ,
- thinning of the cortical layer of long bones,
- pseudofractures – present in rare cases of advanced rickets.
Symptoms of osteomalacia caused by vitamin D deficiency include
- high serum calcium concentration.
- reduced urinary calcium excretion (Long-term hypocalcaemia in the course of osteomalacia caused by vitamin D deficiency causes stimulation of PTH secretion and thus secondary hyperparathyroidism. This results in increased calcium reabsorption in the renal tubules and, as a result, reduced calcium excretion in urine)
- increased serum PTH concentration (Vitamin D deficiency results in a decrease in serum calcium concentration , which secondarily increases the secretion of PTH by the parathyroid glands)
- increased ALP activity in serum (Calcium deficiency leads to increased parathyroid hormone levels and increased bone resorption , while increased bone turnover is associated with increased ALP bone fraction activity)
Intracranial hematomas
Symptoms of Brain Stem Compression
1) Bradycardia and increase in blood pressure .
2) Slowing and shallowing of breathing.
3) Dilated pupil on the side of the hematoma.
4) Deviation of the eyeballs which “look at the hematoma”.
5) Hemiparesis on the side opposite to the hematoma.
Such symptoms are an indication for urgent neurosurgical intervention -
beginning of INSUMPTION!
Intracranial hematomas
Symptoms of increased intracranial pressure
1) Headache.
2) Nausea, vomiting.
3) Congestive changes in the fundus of the eye.
4) Drowsiness.
5) Speech, vision and behavioral disorders.
Intracranial hematomas
Clinical course of hematomas - three types
1) Short-term loss of consciousness → clearing period (intervallum lucidum) →
increased intracranial pressure → repeated loss of consciousness
(the course most characteristic of an epidural hematoma).
2) Symptoms of hematoma appear after some time, and immediately after the injury.
head does not result in loss of consciousness.
3) Persistent disturbances of consciousness worsen, and other disturbances join
symptoms of brain compression (severe injuries with contusion of the brain/brain stem).
CT scan of the head should be performed in every patient with post-traumatic disorders of consciousness!
4) Furosemide, if previous treatment is insufficient. -(If the effectiveness of the treatment is insufficient, furosemide is administered. The next step is to drain the cerebrospinal fluid from the brain ventricles. Finally, barbiturates are administered (barbiturate coma) and deeper hyperventilation is used (to pCO2 < 30 mmHg).
5) Oxygen therapy.
6) Maintaining systolic blood pressure between 110-120 mmHg. - (Blood pressure should be maintained between 110 and 120 mmHg. Too high pressure may increase bleeding and increase intracranial pressure, while too low pressure does not provide sufficient cerebral flow with increasing intracranial tightness.)
Intracranial hematomas
Conservative treatment
1) Place the patient on their back with their head elevated 30-45°. - Positioning the patient with the head elevated by 30-45° facilitates the outflow of venous blood and reduces the capacity of the vascular bed.
2) Applying ice packs to the forehead area.- Ice packs on the forehead area cause vasoconstriction and reduced metabolism of nervous tissue.
3) Drug therapy options (depending on many factors, only some options are selected):
- 20% mannitol solution,
- hypertonic NaCl solutions ,
- sedatives, painkillers.
Intracranial hematomas
Conservative treatment
Drug therapy options
- 20% mannitol solution,
mannitol in a dose of 0.25g to 1g/kg body weight is an effective method of reducing intracranial hypertension.
- During treatment, care should be taken to ensure that systolic pressure does not fall below 90 mm Hg;
- Mannitol should not be used prior to intracranial pressure monitoring in patients with evidence of intussusception or with deteriorating neurological status (unless caused by extracranial factors).
- Hypertonic NaCl solutions are increasingly used as an alternative to mannitol. However, the lack of studies comparing different hyperosmolar solutions does not allow for the formulation of detailed guidelines for their use.
Indications for use:
Conservative treatment
Drug therapy options
- 20% mannitol solution,
- reduction of intracranial pressure ,
cerebral edema . - To achieve maximum effect, mannitol is administered intravenously at a dose of 0.25 g/kg body weight, no more often than every 6–8 hours.
Contraindications to use:
active intracranial bleeding except bleeding during craniotomy.
an ideal test as a first step in diagnosing lung cancer.
- Chest X-ray
- The examination should be performed in all patients with suspected lung cancer; always in PA and lateral projections. In most cases, it allows to reveal pathological changes, assess their initial extent and plan further diagnostic procedures.
- Typical radiological symptoms of lung cancer:
a) tumor in the lung parenchyma
b) atelectasis associated with narrowing of the airways
c) enlargement of the hilar or mediastinal lymph nodes
d) fluid in the pleural cavity
e) elevation of the diaphragm as a result of its paralysis
f) changes indicating direct infiltration or metastases in the bones.
A normal chest X-ray does not exclude the presence of cancer, especially in the case of small tumors located near the mediastinum
Pharmacology: common-uncommon
Amlodipine
Calcium Channel Blockers (Vascular) - Adverse Effects
Common - headaches (especially at the beginning of treatment), swelling (including ankle swelling), feeling of tiredness, drowsiness, nausea, abdominal pain, sudden reddening of the face with a feeling of heat, palpitations, dizziness.
Uncommon: insomnia, mood disorders (including anxiety)
An adverse effect of thiazide diuretics ( indapamide ) may be
- hypokalemia .
- This is one of the more common causes of decreased serum potassium levels.
otassium deficiency may impair, among other things, the function of the cardiac, skeletal and smooth muscles.
In the case of the patient, we do not observe symptoms from the cardiac muscle, but impairment of skeletal muscles manifests itself as a sense of weakness and decreased strength , while impairment of smooth muscle function may include, among others, constipation and even paralytic ileus - the following should be recommended: determination of K+ concentration
Electrolyte disturbances
Potassium - Hypokalemia - Clinical picture
1) Myocardial muscle dysfunction :
– CARDIAC ARRHYTHM DISORDERS .
2) Smooth muscle dysfunction :
– PARALYTIC INTESTINAL OBSTRUCTION ,
– URINARY RETENTION .
- Skeletal muscle dysfunction :
- RHABDOMIOLYSIS ,
- REDUCTION OF MUSCLE STRENGTH ,
- lower limb cramps.
The disease develops suddenly, most often within 1-2 weeks after a streptococcal sore throat or 2-6 weeks after the appearance of skin lesions of streptococcal etiology. The basic clinical symptoms of OCZN consist of the so-called Addis triad :
- glomerulonephritis-
1) edema (85%)
2) hypertension (60-80%)
3) changes in urine (hematuria and erythrocyte casts).
Proteinuria in 80% of adult patients is of subnephrotic nature , therefore the edema is small, located mainly under the eyes, rarely generalized.
Erythrocyte casts - contain
- unchanged erythrocytes or their fragments; such casts may indicate glomerulonephritis.
Active urine sediment;
Also contains;
– high-cellular urine sediment characteristic of glomerulopathy.
Contains:
dysmorphic and leached erythrocytes (>80%), acanthocytes (<5%),
granular and erythrocytic casts .
Glomerulonephritis
Acute post-infectious GN - Diagnosis
1) Proteinuria and active urine sediment .
2) A characteristic finding is a decrease in the concentration of the C3 complement component
with an increased titer of the antistreptolysin test ( ASO ).
3) Due to the self-limiting course of the disease and the characteristic clinical picture,
renal biopsy is rarely performed (it is indicated only if there is no recovery within 6 weeks) .
Antistreptolysin test (ASO)
– a diagnostic serological test that examines the titer of specific antibodies directed against streptolysin O, a protein produced by group A streptococcus.
- An increased ASO indicates a past streptococcal infection.
Indicate treatment: first case of mild pseudomembranous colitis:
First illness - a form that does not meet the criteria for severe or fulminant:
- 1st choice treatment :
fidaxomicin 200 mg twice daily or vancomycin 125 mg four times daily for 10 days (if the availability of fidaxomicin is limited, before deciding on the choice of drug, the risk of relapse should be assessed and this drug should be used only in patients at high risk) - alternative treatment:
metronidazole 500 mg 3 times a day for 10 days only if fidaxomycin and vancomycin are unavailable; avoid repeating or prolonging treatment with metronidazole.
Vancomycin Practice Note:
- The contents of one 500 mg vial should be dissolved in 10 ml of water, and the contents of one 1000 mg vial should be dissolved in 20 ml of water.
- Single doses (eg 2.5 ml = 125 mg vancomycin) can be taken and given to the patient to drink after a small dilution or administered through a gastric tube.
- A taste enhancer, eg commonly used syrups, can be added to the prepared solution before administration.
Diseases of the large intestine- C. Diff
Pseudomembranous colitis – Treatment
Przebieg Lagodny
Diseases of the large intestine- C. Diff
Pseudomembranous colitis – Treatment
Przebieg Ciezki
Diseases of the large intestine- C. Diff
Pseudomembranous colitis – Treatment
Przebieg Pioronujacy
Pharmacological
Arterial hypertension
Treatment –
1) loop diuretics ( torasemide ),
2) steroidal MRA ( spironolactone , eplerenone ),
3) centrally acting drugs ( methyldopa, clonidine ),
4) alpha-blockers ( doxazosin , tamsulosin ),
5) vasodilators ( hydralazine ),
Pharmacological
Arterial hypertension
Treatment
The basic two-drug combinations used when starting treatment are:
1) ACE-I + thiazide/thiazide-like diuretic,
2) sartan + thiazide diuretic (no combination with thiazide-like diuretic),
3) ACE-I + calcium antagonist,
4) sartan + calcium antagonist.
Pharmacological Treatment
Arterial hypertension-
Antihypertensive treatment algorithm – Patients <65 years
The basic triple drug combinations used are:
1) ACE-I + thiazide-like diuretic + calcium antagonist,
2) ARB + thiazide diuretic + calcium antagonist.
These two connections are represented by only one SPC:
1) perindopril + indapamide + amlodipine,
2) valsartan + hydrochlorothiazide + amlodipine.
uncomplicated cystitis
patient is not pregnant and the infection is uncomplicated….in the case of the bladder : First-line drugs:
First-line drugs:
- nitrofurantoin 100 mg 2 × daily for 3–5 days (another nitrofuran derivative is available in Poland
– furazidine 100 mg 4 × daily; do not use in patients with eGFR <60 ml/min/1.73 m2),
- cotrimoxazole 960 mg 2 × daily for 3 days,
- trimethoprim 100 mg 2 × daily for 3–5 days,
- fosfomycin 3.0 g once,
- pivmecillinam 400 mg 2 × daily for 3–7 days
uncomplicated acute pyelonephritis .
patient is not pregnant and the infection is uncomplicated….in the case of kidneys :
The first-line drug in empirical treatment is
- ciprofloxacin 500 mg 2 times a day
- or
- levofloxacin 500 mg once a day for 7–10 days
example and MOA
Taking medications such as …… may trigger a gout attack:
for example
- including thiazide
- loop diuretics,
- cyclosporine,
- acetylsalicylic acid
Increased excretion of hydrogen ions (i.e. acidification of urine) reduces urinary excretion of uric acid, and the resulting hyperuricemia sometimes leads to gout attacks.
treatment of hyperlipidemia:
2 drugs
statin or fenofibrate
drugs that reduce the risk of gout attack.. in the treatment of hypertension should be considered - name 2
- losartan
- calcium channel blocker
First-line drugs used in the treatment of uncomplicated cystitis include:
- nitrofurantoin (in Poland a derivative of nitrofuran – furazidine),
- cotrimoxazole,
- trimethoprim,
- fosfamycin,
- pivmecillinam.
Types of autonomic neuropathy:
name
- cardiovascular system - manifested by resting tachycardia, orthostatic hypotension, fainting, loss of heart rate variability,
- digestive tract - manifested by dysphagia, feeling of fullness in the abdomen, constipation,
- genitourinary system - manifested by, among others, erectile dysfunction, vaginal dryness and decreased libido, retention of urine in the bladder,
- visual organ - manifestations include, among others, impaired pupil reaction to light, reduced pupil size, resistance to mydriatic drugs,
- vasomotor - manifests itself, among others, by a feeling of cold feet, orthostatic edema,
- other symptoms - disorders of sweating, taste and internal secretion.
Pulmonary vasoreactivity testing used to diagnose pulmonary hypertension can be performed with the following medications
- nitric oxide (inhalation);
- epoprostenol ( iv );
- adenosine ( iv );
- iloprost (inhalation).
- Pulmonary vascular reactivity can be imagined as the ability of these vessels to dilate after the use of certain substances .
- Nitric oxide inhalation, which lasts 5 minutes, is most often used. As a result of its use, in some patients it is possible to observe a significant decrease in the mean pressure in the pulmonary artery
Note: Patients <70 years of age are candidates for high-dose chemotherapy (HDCT) supported by transplantation of autologous peripheral blood hematopoietic stem cells (auto-PBSCT) (…) Induction treatment begins with three- or four-drug protocols containing a proteasome inhibitor ( bortezomib or carfilzomib), dexamethasone , an immunomodulatory drug (lenalidomide [off-label indication] or thalidomide) or cyclophosphamide , and optionally an anti-CD38 monoclonal antibody (daratumumab or isatuximab).
Most commonly used regimens for the treatment of multiple myeloma:
treatment protocol for multiple myeloma in a patient preparing for autologous stem cell transplantation:
- VTD ( bortezomib , thalidomide, dexamethasone,
- VCD ( bortezomib , cyclophosphamide, dexamethasone),
- VRD ( bortezomib , lenalidomide, dexamethasone),
- KRD (carfilzomib, lenalidomide, dexamethasone),
- Dara-VTD (daratumumab + VTD),
- Dara-VRD (daratumumab + VRD).
Adding daratumumab to VTD (Dara-VTD regimen available in Poland under the drug program) improves treatment efficacy and prolongs progression-free survival (PFS).
Patients <70 years of age are candidates for high-dose chemotherapy (HDCT) supported by transplantation of autologous peripheral blood hematopoietic stem cells (auto-PBSCT) (…) Induction treatment begins with three- or four-drug protocols containing a proteasome inhibitor ( bortezomib or carfilzomib), dexamethasone , an immunomodulatory drug (lenalidomide [off-label indication] or thalidomide) or cyclophosphamide , and optionally an anti-CD38 monoclonal antibody (daratumumab or isatuximab).
Pituitary adenomas derived from ____ ____ secrete excessive _________(_ _), causing acromegaly. In hormonal diagnostics, it is essential to demonstrate:
- somatotropic cells
- excessive growth hormone (GH), causing acromegaly.
- In hormonal diagnostics, it is essential to demonstrate:
increased IGF-1 concentration ,
lack of inhibition of GH secretion in a 75 g oral glucose tolerance test (OGTT).
Excessive secretion of growth hormone leads to increased synthesis of somatomedins in the liver and peripheral tissues, mainly somatomedin C, called insulin-like growth factor- 1 ( IGF-1).
IGF-1 stimulates cell division in target tissues, resulting in the growth of soft tissue and bones.
name-define
The disease develops suddenly, most often within 1-2 weeks after a streptococcal sore throat or 2-6 weeks after the appearance of skin lesions of streptococcal etiology. The basic clinical symptoms of OCZN consist of the so-called Addis triad :
glomerulonephritis.
1) edema (85%)
2) hypertension (60-80%)
3) changes in urine (hematuria and erythrocyte casts).
Proteinuria in 80% of adult patients is of subnephrotic nature , therefore the edema is small, located mainly under the eyes, rarely generalized.
Erythrocyte casts - contain unchanged erythrocytes or their fragments; such casts may indicate glomerulonephritis.
Hyperkalemia treatment regimen based on
- remove the cause of hyperkalemia
- limit potassium intake
- monitor (EKG, vital signs)
- when there are electrocardiographic signs of hyperkalemia or cardiac arrhythmias –> calcium gluconolactobionate or calcium chloride
- glucose solution + insulin (insulin will shift potassium into cells. Temporary shift can be achieved with β2-mimetic, e.g. salbutamol)
- when acidosis - NaHCO3 solution
- treatment to remove excess potassium from the body:
-loop diuretic in patients with preserved diuresis (e.g. furosemide with simultaneous administration of physiological saline - this will ensure increased glomerular filtration)
-exchanger that binds potassium in the digestive tract (polystyrene sulfonate)
-a laxative if there is a possibility of the presence of fecal masses containing a large amount of potassium
-when other methods have failed - new drugs patiromer and sodium zirconium cyclosilicate (these are substances that bind potassium) - when potassium >6.5 mmol/l –> hemodialysis
uncomplicated cystitis and uncomplicated acute pyelonephritis .
in the case of the bladder :
First-line drugs:
- nitrofurantoin 100 mg 2 × daily for 3–5 days (another nitrofuran derivative is available in Poland
– furazidine 100 mg 4 × daily; do not use in patients with eGFR <60 ml/min/1.73 m2),
- cotrimoxazole 960 mg 2 × daily for 3 days,
- trimethoprim 100 mg 2 × daily for 3–5 days,
- fosfomycin 3.0 g once, pivmecillinam 400 mg 2 × daily for 3–7 days.
uncomplicated cystitis and uncomplicated acute pyelonephritis
in the case of kidneys :
The first-line drug in empirical treatment:
- ciprofloxacin 500 mg 2 times a day
- or
- levofloxacin 500 mg once a day for 7–10 days.
primary hyperparathyroidism is characterized by:
hypercalcaemia,
hypercalciuria,
increased parthhormone levels.
primary hyperparathyroidism is often accompanied by:
- bone pain - resulting from increased osteolysis,
- kidney stones - the effect of increased excretion of calcium and phosphates in the urine.
Hyperparathyroidism – Primary hyperparathyroidism – Diagnosis
Laboratory tests:
– HYPERcalcemia ,
– increased concentration of parathyroid hormone ,
– HYPOphosphatemia ,
– HYPERphosphaturia ,
– HYPERcalciuria,
– increased values of bone turnover markers.
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
1) Transvaginal ultrasound .
2) Ca-125 .
3) HE4 marker .
4) RMI index .
5) ROMA test .
The screening test for diabetic kidney disease is:
- determination of the albumin/creatinine ratio in a urine sample.
Screening tests for CKD should be performed once a year; in type 1 diabetes, after 5 years from diagnosis, and in type 2 diabetes - from the moment of diagnosis. They include measurement of the albumin/creatinine ratio in a random (preferably first morning) urine sample and determination of serum creatinine concentration - on this basis, the glomerular filtration rate (GFR) is determined.
Due to its important role in prevention and treatment, all patients with ovarian cancer should
- undergo genetic consultation
and testing for mutations in the BRCA1/2 gene .
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
1) Transvaginal ultrasound – features suggestive of cancer:
– large diameter of the tumor,
– multilocular tumor ,
– partitions between chambers,
– growths in the lumen of the tumor,
– solid foci ,
– bilateral tumors,
– coexistence of free fluid in the peritoneal cavity.
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
2) Ca125:
– in 85% of patients with ovarian cancer >35 U/ml (only in 50% in FIGO stage I),
– also increased in endometriosis , uterine fibroids , liver cirrhosis ,
PID , endometrial, breast, lung and pancreatic cancer , during menstruation and pregnancy ,
– is not useful as an independent screening test
and its routine determination is not recommended; however, it is used during:
– monitoring the effectiveness of treatment ,
– monitoring recurrence .
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
3) HE4 marker ( human epididymis protein 4 ):
– norm up to 120–150 pmol/l,
– overexpression in ovarian malignancies: Increased HE4 concentration also occurs in:
lung cancer,
pancreatic cancer,
breast cancer,
transitional cell carcinoma,
renal failure.
– the level depends on the histological type , not on the stage of advancement
(the highest in serous, endometrial and clear cell carcinoma).
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
4) RMI ( Risk of Malignancy Index ):
RMI = ultrasound index × menopausal status × Ca125.
Gynecological oncology
Ovarian tumors – Ovarian cancer – Diagnosis
5) ROMA algorithm =
HE4 , Ca125 , menopausal status .
Gynec Onco - Ovarian tumors – Ovarian cancer – Surgical treatment
The goal of primary surgical treatment is to:
– confirmation of the diagnosis of ovarian cancer,
– determination of the stage of advancement,
– complete, or optimal cytoreduction of the tumor.
The scope of the surgical procedure and adjuvant therapy depend mainly on the clinical advancement.
The most important prognostic factor is macroscopic complete excision of lesions .
Disqualified patients receive neoadjuvant chemotherapy and
then undergo another evaluation qualifying for surgery –
the so- called delayed cytoreductive surgery .
Gyn oncology
Ovarian tumors – Ovarian cancer – Surgical treatment
Surgical treatment of a tumor macroscopically limited to the reproductive organ
(inspection of the abdominal cavity excluded lesions outside the pelvis):
– collection of fluid and washings for cytological examination (before starting surgical procedures),
– bilateral removal of the salpingo-oophores,
– total hysterectomy,
– resection of the greater omentum,
– collection of smears,
– random collection of peritoneal samples,
– pelvic and aortic lymph node dissection,
– removal of the appendix, obligatory
in the case of mucous histology
Gyn oncology
Ovarian tumors – Ovarian cancer – Chemotherapy
In FIGO IA and IB G1 stages, adjuvant (postoperative) chemotherapy is not used .
In other patients – adjuvant chemotherapy : 6 cycles of paclitaxel and platinum derivatives . In patients with FIGO III stage cancer, optimally operated, intraperitoneal chemotherapy
is considered
(it prolongs the relapse-free period and overall survival, but increases the risk of severe complications:
paralytic ileus, fever, pain and infections).
In targeted therapy of ovarian cancer, bevacizumab
and PARP inhibitors ( olaparib , niraparib ) are used .
a characteristic symptom of insulinoma is the appearance of
- hypoglycemia symptoms and their disappearance after the administration of carbohydrates .
- High concentration of insulin (>36 pmol/l) and C-peptide (>200 pmol/l) are one of the criteria for the diagnosis of insulinoma .
sulfonylureas – cause
- increased secretion of insulin by the pancreas, their side effect may be hypoglycemia .
- Increased release of endogenous insulin is associated with increased concentration of C-peptide .
