Family Practice Examination & Board Review, Second Edition (McGraw-Hill Specialty Board Review) |go|

НазваниеFamily Practice Examination & Board Review, Second Edition (McGraw-Hill Specialty Board Review) |go|
Дата публикации11.07.2013
Размер5.51 Mb.
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intravascular volume _

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extravascular volume | //// |

intracellular volume | //// |

gingival hemorrhage_

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Ασθενης με αιμορραγια απο τα ουλα και πετεχειες στα κατω ακρα – ποια εξεταση ενδυκνειται κατα κυριο λογο :

  • Χρονος προνθρομβινης και inr

  • Χρονος μερικης θρομβοπλαστινης

  • Ηπατικα ενζυμα

  • Ουρια και κρεατινινη ορου

  • Γενικη αιματος

"gingival hemorrhage Petechiae" |google|

Το πρωτο που πρεπει να σκεφθουμε ειναι θρομβοκυτταροπενια

 human leukocyte antigens_

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Αιμορραγικες κενωσεις

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Σε ποια απο τις παρακατω κατασταστασεις παρατηρουνται ~ :

  • Αμοιβαδικη δυσεντερια

  • Εντερικη λοιμωξη απο σιγκελλα

  • Φλεγμονωδης νοσος του εντερου

  • Ισχαιμικη κολιτιδα

  • Ολα τα παραπανω ???????

Risk factors for colonic ischemia |go|

Shigella dysenteriae / Clinical Findings |go|

After an incubation period of 1 to 4 days, symptoms begin with fever and abdominal cramps, followed by diarrhea, which may be watery at first but later contains blood and mucus. The disease varies from mild to severe depending on two major factors: the species of Shigella and the age of the patient, with young children and elderly people being the most severely affected. Shigella dysenteriae, which causes the most severe disease, is usually seen in the United States only in travelers returning from abroad. Shigella sonnei, which causes mild disease, is isolated from approximately 75% of all individuals with shigellosis in the United States. The diarrhea frequently resolves in 2 or 3 days; in severe cases, antibiotics can shorten the course. Serum agglutinins appear after recovery but are not protective because the organism does not enter the blood. The role of intestinal IgA in protection is uncertain.

^ Mesenteric ischemia / Symptoms and Signs |go|

Patients with colonic ischemia usually present with abrupt onset of crampy left lower quadrant abdominal pain, and mild to moderate rectal bleeding or bloody diarrhea within the first 24 hours. Over 90% of patients are older than 60 years. Cardiovascular disease is common, and frequent precipitating factors include hypotension, cardiovascular surgery (coronary artery bypass grafting, aortic aneurism repair), dialysis, and dehydration. Physical examination reveals mild to moderate abdominal tenderness over the affected bowel, most often left-sided.

In contrast to patients with AMI, those with colonic ischemia do not usually appear acutely ill. Bleeding is usually mild, and patients rarely require blood transfusion. Peritoneal signs, if present, would suggest perforation or peritonitis. Ischemic colitis is usually a singular event, and only 5% of patients develop a recurrence.

The diagnosis is usually established on the basis of clinical history, physical examination, and endoscopic or radiologic studies. Although most patients who develop colonic ischemia are elderly, the condition can also occur in younger patients. For patients who are younger than age 50, several precipitants of colonic ischemia should be considered (see Table 6–2). In young women, the triad of smoking, use of oral contraceptives, and carriage of the factor V Leiden mutation may be associated with increased risk of colonic ischemia. Recent reports indicate that giving penicillin derivatives to patients who harbor Klebsiella oxytoca may precipitate hemorrhagic colitis.

Intestinal Amebiasis |go|

The most common type of amebic infection is asymptomatic cyst passage. Even in highly endemic areas, most patients harbor ^ E. dispar.

Symptomatic amebic colitis develops 2–6 weeks after the ingestion of infectious cysts. A gradual onset of lower abdominal pain and mild diarrhea is followed by malaise, weight loss, and diffuse lower abdominal or back pain. Cecal involvement may mimic acute appendicitis. Patients with full-blown dysentery may pass 10–12 stools per day. The stools contain little fecal material and consist mainly of blood and mucus. In contrast to those with bacterial diarrhea, fewer than 40% of patients with amebic dysentery are febrile. Virtually all patients have heme-positive stools.

Inflammatory Bowel Disease |go|

IBD is usually diagnosed in older children or teenagers, and commonly the first presentation involves severe acute abdominal pain. In one large series, 95% of children <10 years old with Crohn disease presented initially with abdominal pain.40 Often, the pain is described as colicky and is associated with diarrhea, which may be bloody. Abdominal pain is not the sole presenting symptom, and IBD is associated with fever, weight loss, fatigue, and blood per rectum.
Clinical Findings

The patient typically complains of abdominal cramps and intermittent bloody diarrhea. A history of previous episodes may be given, and a long history of colitis may be present. Weight loss, fever, and anemia may be present. Cramps may develop gradually or suddenly. Abdominal examination will vary with etiology and severity of disease. Infectious causes (e.g., Shigella sp., Clostridium difficile, Campylobacter sp., Entamoeba histolytica) should be systematically ruled out.

mucous membrane_

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Pem 17/3/2011

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cardiovascular mortality

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Associations of total osteocalcin with all-cause and cardiovascular mortality in older men. The Health In Men Study | go|

Δεξια κολικη καμπη

hepatic flexure

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Αριστερη κολικη καμπη

splenic flexure

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subcutaneous nodule_

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Notes |go|

Περισσεια νατριου και υδατος δεν παρατηρειται σε :

  • Καρδιακη ανεπαρκεια

  • Νεφρωσικο

  • Συνδρομο απροσφορης εκκρισης αντιδιουρητικης

  • Οξεια σπειραματονεφριτιδα

  • Νεφρογενη αποιο διαβητη ???? [ περισσεια υδατος και ↓υδωρ ]

"Excess sodium and water " |google|
The edema states: | go|

sodium and water retention

Υπερνατριαιμια με φυσιολογικο συνολικο νατριο του οργανισμου παρατηρειται σε ολα εκτος απο :

  • Ασθενης με πυρετο και εφιδρωσεις

  • Ασθενεις με αποιο διαβτη

  • Ουραιμικοι με υπερβολικη μετακινηση υγρων στη διαρκεια της αιμοκαθαρσης / ή περιτοναικης καθαρσης

  • Ασθενεις με υπερβολικη ληψη υγρων ?????????

υπερκατατμητα πολυμορφοπυρηνα ?????????

| go| go|FPN++go|ddb|Wikipedia|def1|def2|e – medicine|
ankylosing spondylitis_

| go| go|FPN++go|ddb|Wikipedia|def1|def2|e – medicine|

Στην ~ :

  • Χαμηλη οσφυαλγια και δυσκαμψια ειναι συχνα τα πρωτα ευρηματα

  • Περιφερικη αρθριτιδα στην εξελιξη της νοσου δεν ειναι σπανια

  • Η συχνοτερη εξωσκελετικη βλαβη ειναι η οξεια προσθια ραγοειδιτιδα [ οξεια ιριδιτιδα και ιριδοκυκλιτιδα ]

  • Ολα τα παραπανω

  • Κανενα απο τα παραπανω


exudates and transudates_

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Συχνα αιτια διιδρωματος ειναι τα παρακατω εκτος απο :

  • Κιρρωση

  • Νεφρωσσικο

  • Καρδιακη ανεπαρκεια

  • Πνευμονικη εμβολη

  • Ολα τα παραπανω

inappropriate adh syndrome_

| go| go|FPN++go|ddb|Wikipedia|def1|def2|e – medicine|
legionella pneumophila_

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|best practice|

Χαρακτηριστικα τη ςλοιμωξης απο ~ ειναι τα ακολουθα εκτος απο :

  • Πενιχρη αποχρεμψη

  • Υπονατριαιμια

  • Διανοητικη συγχυση

  • Ανιχνευη του αντιγονου στα ουρα

  • Σπληνομεγαλια ?????

Ποιο απο τα παρακατω δεν ανευρισκεται συχνα στην νοσο των λεγεωναριων :

  • Τρανσαμινασαιμια

  • Διαρροια

  • Μειωμενο νατριο ορου

  • Πυρετος

  • Αυξημενο νατριο ορου

Look for hyponatremia, since syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has been associated with this disease. |e – medicine |

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Ασθενης με κιρρωση ηπατος παρουσιαζειμεγαλη αυξηση της αλφα φετοπρωτεινης – αυτο ειναι πιθανο να οφειλεται σε :

  • Εξαρση της νοσου

  • Αναπτυξη λοιμωξης

  • Ηπατικες μεταστασεις απο καρκινο του παχεος

  • Συνδρομο budd – chiari

  • Αναπτυξη ηπατοκυτταρικου καρκινου

Συσχετίζονται με :

  • Ηπατοκυτταρικο καρκινωμα

  • Αξιολογηση αμνιακου υγρου

  • Χρωματοσωμικες ανωμαλιες

  • Νεοπλασιες των γεννητικων κυτταρων

  • Προγεννητικη διαγνωση

  • Προγεννητικη φροντιδα

The use of ~ in Prenatal Diagnosis

Currently the most common use for applied genetics in obstetrics and gynecology is in prenatal counseling, screening, and diagnosis. Prenatal diagnosis first came into use in 1977 with the discovery of the significance of serum -fetoprotein (AFP).
The United Kingdom Collaboration Study found that elevated AFP in maternal serum drawn between 16 and 18 weeks of gestation correlated with an increased incidence of neural tube defects (NTDs). Since that time, much research effort has been aimed at perfecting the technique. We now can screen not only for NTDs but also for trisomy 21 and trisomy 18. In addition, cystic fibrosis, sickle cell disease, and Huntington's disease, as well as many inborn errors of metabolism and other genetic disorders, can now be identified prenatally.
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