Kolaeva Notesfsdff
Kolaeva Notesfsdff
Kolaeva Notesfsdff
Hepatitis
1) Preicteric
a. Flu like
b. Dyspeptic
c. Asthenic
2) Protein enzyme dissociation
a. Hepatitis (must know)
3) Criteria of severity (laboratory criteria)
a. Main prothrombin index
i. <50 hemorrhagic syndrome
ii. NORMAL= 80-100
b. AST/ALT (Beritsane test)
i. >1 severe
ii. <1 moderate/ mild
1. GOLGI APPARATUS (mitochondria organelles) AST
2. ALT cell membrane
c. Bilirubin enzyme dissociation
i. Bilirubin increase
ii. Enzyme decrease ( due to enzyme that is used to dissociate bilirubin)
d. Sedimentation test
i. Albumin: globulin decrease (progress to cirrhosis)
1. Protein acute phase
2. Severe case of parenteral hepatitis 1.6-2.4
e. Solimovine test
Cholera
- Stool characteristics
o Cloudy, white fluid that is odourless, rice water like
HYPERSECRETORY mechanism
No inflammation
- Vomiting
o Vomiting (WITHOUT nausea due to regurgitation)
Destruction of epithelial cells
- Absence of INTOXICATION syndrome
o No invasion (LPS not destroyed_
o No presence of constipation and no temperature
- What is algit
o Cold cholera (happened after fever)
- What are the drugs for ORS (I and II severity)
o ORS
o Rehydrone
o Oralit
o Citroglucosalane
- Crystalloid (III and IV)
o Disalt
o Threesalt
o Quartersalt
o Chosalt
o Acesalt
- What is the difference between crystalloid and ORS?
o Crystalloids have no glucose
o ORS is only for patient without vomiting
- Criteria of adequate rehydration therapy
o 7 steps
Hemodynamics stabilisation
Restoration of peripheral pulse and BP normalisation
Restoration of normal body temperature after hypothermia
Restoration of active diuresis
30-40 min after beginning of rehydration therapy
Cessation of volume
Disappearance of muscle cramps
Restoration of natural skin colour and turgidity
- What vaccines are present for cholera
o Killed
Dukoral
o Live
Orachal and mutachol
- Contraindication drugs
o Colloids
It will absorb ion in patients with diarrhea will worsen
Rheopolyglucin
Hemodezerin (hemodez)
o Epinephrine
Blood clotting
o Codeine/ caffeine
Spasm
Acute renal failure may develop
o Hydrochloride
Give antibiotic 3-5 days to stop enterotoxin and stop diarrhea
- Enterosorbents
o Bismuth salts
o Enterogel
o Active urogel
Rehydration therapy
- 2 phases
o Rehydrate
Must do before 4 hours
o Maintenance
Until diarrhoea stops
- There will the special poses done by the patient (gladiator pose )
Botulism
A) Prodromal symptoms
a. Gastroenteritic variant
i. Nausea/ vomiting/ diarrhoea
1. Leads to constipation and dry mouth
b. Ocular variant
i. Blurred vision (in a fog_
1. Acute farsightedness
c. Acute respiratory failure
i. Air shortage and pain in thorax
B) General intoxication symptoms
a. Headaches
b. Dizziness
c. Muscular weakness
d. Insomnia
C) Paralytic period
a. Symmetrical impairment (descending)
Treatment
1) Hospitalisation
2) Induce vomiting and gastric lavage
a. Others need to refer to notes
i. Specifics
1. Serotherapy
2. Serum trivalent botulism antitoxin
a. Type A: 10000:4
b. Type B: 5000:4
c. Type E: 10000: 4
i. Give 3-4 days
d. Must give fraction ( leptospirosis)
Food poisoning
Salmonellosis
Classification
1) GI form
a. Gastritis
b. Gastro
c. Gastroenterocolitis
2) General typhoid like and septic form
3) Intestinal
a. Carrier state
i. Acute
ii. Chronic
iii. Transient
What is an exanthema?
- Rash on skin
What is an enanthema
- Rash on mucosa
Serological examination
Brucellosis
1) Diagnostics
a. Skin test (allergen)
i. Brucellin
2) Why is there polymorphism? Why is it called the monkey of diseases?
a. It has antigen mimicry and mimics human tissue ( for brucellosis and yersinosis)
Shigellosis
1) Clinical variants
a. Colitis
b. Gastroenterocolitis
c. Gastroenteritis
2) Diagnostics
a. Colonoscopy (DDX other diseases only)
i. Can cause further complication
3) Colitic variant
a. Large amount of stool
b. Increase in number of defecation
c. Decrease volume of stool (mucus, blood, pus)
d. Pain in lower abdomen (LLQ)
i. Spasm of sigmoid colon
e. False needs
f. Tenesmus
i. Pain during defecation around anus
4) Components of shiga toxin
a. Cytotoxin
b. Neurotoxin
c. Enterotoxin
d. Hemolysin
5) What plexi are present at the small intestine
a. Auerbach
b. Meissner
i. (gastroenterocolitic dehydration due to neurotoxin)
1. Causes distal spastic tenesmus
6) Colitic variant does not have dehydration
a. Urethritis
b. Conjunctivitis
c. Arthritis
i. Where else can u see reiters?
1. Salmonellosis
2. Yersiniosis (secondary focal form)
3. Post shigellosis
4. Chlamydia
Probiotics
- Treat dysbiosis
o Coribacterin
o Lectobacterin
o Bificol
o Linex
Typhoid fever
- In macrophages of skin
- Regional lymph nodes
- Bone marrow
- Erysipelas
o Treat relapse with lincomycin
0.6> 3 times/d for 7 days
- Typhoid fever
- Yersiniosis
- Plethora abdominalis
o All the blood enters the abdomen
o When there is internal haemorrhage ( cold patch)
Do not press
Can cause perforation (need surgery)
1) Constipation peristalsis
2) Initial maybe diarrhea
3) Severe melena
Clinical picture
a) Incubation period
a. 5-7 days
b. Subfebrile temperature
c. Increase in intoxication syndrome
d. Relative bradycardia
i. Pulse does not correlate to temperature ( temperature is 40 degrees bu
pulse is normal)
ii. If it is absolute
1. Increase in temperature will increase in pulse
e. Typhoid tongue
i. Back of tongue is brown
ii. Dry
iii. Teeth sign on tongue
iv. Incomplete closure of teeth
v. Edematous
vi. Thick
b) Padalka symptom
a. Percussion of RIF (painful)
i. Mesenteric lymphadenitis sign
ii. Can be seen in salmonella generalised form (typhoid fever like), yersiniosis,
tularemia
c) Rovsing sign
a. Palpate L iliac fossa, pain is seen on the R iliac fossa
d) Sternberg sign
e) Mark federna sign
a. From umbilicus go 90 degree 2-4 cm downwards
b. Palpation indicates pain
1) GT perforation
2) GI haemorrhage
3) Infection, intoxication shock (1st)
4) Myocarditis
5) Psychotic states
Treatment
Yersiniosis
Clinical classes
Local GI form:
- Acute appendicitis
- Gastroenterocolitis
- Terminal ileitis
- Mesenteric lymphadenitis
- Hyperplasia of epithelium
1) Red rash
2) Catarrhal angina (tonsillitis and can cause sore throat)
3) Desquamation of skin of extremities
4) Intoxication syndrome
5) Diarrhoea
6) Abdominal pain
7) Ileitis
8) Appendicitis
If it is caused by virus:
- Leukopenia
- Lymphomonocytosis
- Neutropenia ( shift to left)
- Eosinophilia
SEM 2
ERYSIPELAS
What are the chronic streptococci foci?
- Tonsillitis
- Nephritis
- Arthritis
- Paroxysm
What is erythematous
- Lymphostasis
o Lymphatic edema
- Fibredema
o Secondary elephantiasis
Frequency of course
1) Primary
2) Repeated
a. Arise in 2 years other localisation of process
3) Relapsing
a. Due to L forms
b. Present not less than 3 relapses a year
- Typhoid fever
- Erysipelas
o Relapse treat with lincomycin
0.6g> 3 times a day for 7 days
- Yersiniosis
- Meningococcal disease
Location of L forms
1) Macrophage of skin
2) Regional lymph nodes
3) Bone marrow
Convalescence
- Suprastin
Physiotherapy
- Bicillin 5
- Extensilin
- Rhertarpin
Erysipelas season
- Hyperpyrexia
- Dyspepsia
- Nausea without vomiting
Influenza
Meningococcal infection
1) Meningococcemia
a. From blood
2) Granuloma tularemia and rickettsia
3) All neurologic symptoms (like dysphagia, dysarthria, strabismus)
a. All are under botulism
4) Glucocorticoid
a. For severe infectious toxic shock
b. Stabilise hemodynamics
c. Membrane stabilisation
5) Prophylaxis of brain edema
a. Diuretics
i. Furosemide
b. Lasix
6) Why is meningococcal infection causing a decrease in glucose level?
a. Meningococcal bacteria loves glucose
7) Why do we administer higher dose of antibiotics (penicillin in meningitis)
a. As compared to erysipelas
i. Need of the drug to penetrate BBB
8) What other diseases can we use penicillin
a. Erysipelas
b. Meningococcal infection
9) What are the complications of the disease?
a. Brain edema
b. Meningeal liquor ( from CSF)?
c. Infectious toxic shock
10) If meningitis start what is the drug of immediate use?
a. Ceftriaxone regardless of aetiology
11) If there are hemorrhages what do u use?
a. Chloramphenicol (bacteriostatic)
12) If there are no symptoms
a. Use penicillin with ceftriaxone and detoxification
i. Prevention of ITS
b. Pneumococcal meningitis resistance to penicillin is up to 20
13) What is meningitis
a. There are signs of headache/ vomiting without nausea and meningeal syndromes
with liquor changes
i. Liquor changes ( milky white)
14) What is the difference between meningism(pre meningitis) and meningitis
Meningism Meningitis
a. Increase in ICP b. Meningeal syndromes
c. No meningeal syndromes d. Change in liquor colour
RHABDOMYOLYSIS
Therapy
- Desredka
o Give fractionally
o Same as in botulism antitoxin
Malaria
Bradysporozoites
- In liver tissue
Malaria malariae
- Small dose
Paroxysm
HIV
1) HIV is more dangerous or Hep?
a. HEP ( only need a small infectious dose)
2) Damage of HIV is to?
a. Neuroglia
b. Myocytes
c. CD4+ and T lymphocytes
i. Normal CD4 + is 500-1800/1900)
3) Kaposi’s sarcoma
a. For young <60 yo
4) 2 methods of diagnosis
a. ELISA
i. Screening
b. Immunoblots
i. For antibody detection and confirmation
ii. Elisa can be wrong
1. Esp in pregnant women
5) Remember 3 groups of treatment
6) Infectious mononucleosis
a. Fever
b. Lymphadenopathy
c. Pharyngitis
d. Rash
e. Lymphomonocytosis (viral infection)
f. Stomatitis
g. Temperature is febrile
h. Angina
i. Polylymphadenopathy
j. Hepatolienal syndrome
i. More common in EBV than CMV ( infectious mononucleosis)
Plague
Y. pt 8 serovars
Incubation 5d
Inx
- Biological mice
- Hemogram
o Leucocytosis
o Neutrophils shift to left
Tularemia
Abdominal form
- Mesenteric lymphadenitis
o Padalka sign
o Mark fedena sign
o Sternberg sign
- Pathogenesis is not asked but need to remember doses
INX
- Hemogram
o Leukopenia
o Lymphomonocytosis
Plague Tularemia
More sputum bloody and frothy Less sputum (interstitial pneumonia dry cough)
Neurotoxicosis No neurotoxicosis
Periadenitis and adenitis Only adenitis
BP with collapse Low BP no collapse
Embryocardia Relative bradycardia