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:
definition : 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
Antibodies corresponding to diseases
Name the disease to the corresponding Antibody
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.
stands for
CHA2DS2VASc scale:
Rheumatoid arthritis
Pharmacological treatment
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.
Diseases of the large intestine- C. Diff
Pseudomembranous colitis – Treatment
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Pseudomembranous colitis – Treatment
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