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Which two pathological phenomena characterize the morphology of the left heart chamber in mitral insuficiency.
Hypertrophy of Left Ventricle, Dilation of Left Atrium, Left Atrial Stretch causing Atrial Fibrillation, left CHF symptoms (increased ejection fraction)
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So called corrigan pulse (?water-hammer? pulse) is characteristic for...
Aortic regurgitation (bounding and forceful)
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Which proportion (in percentage) of myocardial wall must be destroyed by necrosis to develop a cardiogenic shock?
40%
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What is the most specific laboratory test used to confirm the myocardial necrosis?
Troponins (peak 1st qnd stqy high), (CK-MB for reinfarctions)
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Which valve could we expect to be affected in most cases by infective endocarditis in IV Drug users?
Tricuspid
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What dose of furosemide do you choose for treatment of acute heart failure in diuretic naive patient?
20-40mg
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List at least three causes for development of mitral insufficiency.
Mitral valve prolapse, rheumatic fever, endocarditis, infarction with rupture of papillary muscles, LV distension
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List at least three basic symptoms of hypoglycemia.
Sweating, Palpitations, Presyncope, trembling, anxiety, hunger, loss of consciousness
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Intoxication with morphine and its derivatives can be treated with...
Gastric lavage + charcoal // repeated IV naloxone antidote if coma or respiratory depression
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Antidote indication in benzodiazepines or morphine derivates poisoning is based on...
loss of conciousness (coma) or respiratory depression
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What is the leading sign in a patient with acromegaly?
Acral enlargement of body parts (hands, feet, skull, tongue, jaw, lips, nose), organomegaly
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What does the term ?ischemic kidney disease? mean?
Decreased GFR caused by renal ischemia due to atherosclerosis or obstruction in renal vessels
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Define the common therapeutic dose of intravenous hydrocortisone administred during an acute situation. In which acute situation this treatment should be applied?
During Addison crisis (during stress like infection, surgery, trauma) ? 100mg IV every 6 hours for first day, then 50mg every 6 hours on second day + fludrocortisone
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What is a usual hydrocortison dose (range) used for substitution in a patient suffering from Addison?s disease?
25-30 mg/day (2/3 in morning and 1/3 in afternoon) can go up to 400mg in physical or mental stress
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What means bmi?
Body Mass Index = kg/m^2
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What is definition of obesity (using bmi value)?
30-35
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What is the upper limit of normal body weight expressed by bmi?
25
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What is the definition of oliguria?
Decreased diuresis to 50-500 ml/24 h (under 50 ml/day is anuria)
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At what size of a lymph node do we consider lymphadenectomy?
> 2.5 cm (depending on location)
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What acute disease could imitate ?a new case? of crohn?s disease?
Appendicitis
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What parameters (and what arbitrary value of them) signalize that the patient with acute gastrointenstinal bleeding is hemodynamically unstable?
BP < 90/60 mmHg, HR > 100 bmp, collapse state
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What is the definition of nosocomial pneumonia?
Pneumonia acquired 48 hours after hospital admission
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Define the possible sources of nosocomial infection. List at least two possible causes.
Mechanical ventilation, humidifiers, staff, air conditioning
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What is the most common pathogen causing nosocomial pneumonia?
Gram negative organisms (Pseudomonas aeruginosa), staph aureus
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List at least 2 groups of antibiotics used for the empirical treatment of nosocomial pneumonia.
3rd generation cephalosporin (ceftazidime) + Carbepenems + piperacillin/tazobactam
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In patient suffering from obstruction of iliac arteries where is claudicatory pain localized?
Thighs + buttocks
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Which two pathophysiological disturbances participate in development of type 2 diabetes mellitus?
Insulin resistance, decreased secretion later
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List at least three acquired hypercoagulable states?
Hormonal contraceptives, tumors, pregnancy, immobilization state, antiphospholipid syndromes, nephrotic syndrome, IBD, obesity
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Which two groups of medication significantly improve the prognosis of patients with congestive heart failure?
Beta Blockers (metaprolol), ACE inhibitors (enalapril)/ ARB
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The first used test (except of resting ECG) in differential diagnosis of chest pain in non-emergent patient should be:
Exercise stress test
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How many patients (in percentage) have an asymptomatic course of myocardial infarction (silent ischemia)?
20-30%
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What is the laboratory marker of the congestive heart failure?
BNP (brain natriuretic peptide)
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List the two most common causes of development of aortic stenosis nowadays.
Atherosclerosis with calcium deposition in older age, bicuspid valve accelerated issue
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In which leads do we observe changes on ECG record in patient with inferior myocardial infarction?
II, III, aVF
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What is the basic need for full-value proteins for a healthy person?
1.0 g/kg/24h
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What is the first aid for a patient who is unconscious due to hypoglycemia?
IV 50% Dextrose 50ml (D50)
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Which medication is used as a basic treatment for a patient with newly diagnosed type 2 diabetes mellitus?
Metformin (+ lifestyle changes)
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What kind of pain does the patient with ischemic pain in lower limbs in rest describe?
Burning like pain in arch or distal part of foot when lying down (off feet) that goes away when feet are engaged again
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List at least three inborn hypercoagulable states?
Factor V Leiden mutation, Prothrombin mutation, Antithrombin III deficiency, Protein C deficiency, Protein S deficiency
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Which pharmacological group do we use in treatment of chronic portal hypertension?
Beta blockers (nadolol, propranolol)
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What is the crucial difference between ERCP and MRCP?
Endoscopic Retrograde Cholangio Pancreatography (ERCP ? invasive cannulation of papule) vs Magnetic Resonance Cholangio Pancreatography (MRCP ? noninvasive)
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What is a usual hydrocortison dose (range) used for substitution in a patient suffering from Addison?s disease?
25-30 mg/day (2/3 in morning and 1/3 in afternoon) can go up to 400mg in physical or mental stress
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What are clinical signs of hyperaldosteronism?
Decreased excretion of sodium in urine (hypernatremia + hypertension + heart failure in chronic cases) and increased excretion of potassium in urine (hypokalemia, constipation, muscle weaknes)
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What does sentinel lymph node mean?
First lymph node draining a tumor, primary site of metastasis
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What factors contribute very often to lithogenesis? List at least two of them.
Dehydration, cholesterol excess in diet, hemolysis causing increased bilirubin, inflammation, changes in urinary pH from infection with ammonia forming bacteria
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What is the definition of polyuria?
Increased diuresis over 2.5 L/24h
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What is the definition of ?community acquired? pneumonia?
Pneumonia caught in normal environment, outside hospital
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List at least 2 groups of antibiotics used for the empirical treatment of community acquired pneumonia.
Macrolides (azithro / clarithromycin), beta lactams (amoxiclav, cefuroxime)
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What antidotes are used after ingestion of ethylene glycol and methanol?
Ethanol, fomepizole, hemodialysis
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