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3. S. .-Ifecri\'l!:a)s. maniacal:-hipomania- maniasimpla- maniacolcric-confuzi\'a- maniasupraacuta(fmiamaniacala)
b)s.ucprcsiv:- uepresiasimpla- depresiastuporoasa- depresiaanxioasa- dcprcsiadeliranta
etiologic: - organica- simptomatica(reactiva)- inyolutie- endogena- psihogcna
4.S. Catatonic-akinezie
"---'- shIporcatatonic
- agitaticcatatonica P.s.:Aparefi-ecwlltfllschizoFenie
5.S.Haillcinatorii,,>idelirante:- s. CharlesBonnet(halueinatiivizualelabatraniO.K.)- halucinoze(alcoolica,Wemicke)- paranoia(deliI'sistematizat)- delirnesistematizat:- sehizofrenie
- senilitate- aterosclerozacerebrala- epilepsie- intoxicatiieronice
- automatism- mental- senzitiv- motor
' '6.S.Hipocondriace
formeclinice - asteniea- obsesiva- depresiva- paranoica
Ex.: S. Munchausen(falsaimbolnavire)- anamnezafalsa
- Icziunisauinfeqiiautoprovocatc
P.s.:Ideehipocondrl"adif obsesie
7. Tlliburaridecon~.tiinta:a.dclirl.ll(extremdegray,eelacut)b. s. oneroidee.amentia
d. staricrcpusel.llarc
8.S. Korsakov(psihozaaeuta+polinevrita:frccvcntalaalcoolici)
9.Demenla(vcziGeriatria)- presenila- Alzheimer- vaseulara- mixta
- tral.lmatica- epilcptica
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10.PlillOpatii:forme- excitabilc(cxpIozive)- instabilc- astcnice- psihastenicc- istcrice
- timopatica(cuforie,deprcsie)-+psihozamaniaeo-deprcsiva!- paranoid- sexuala
II. Psiha:::ele:
- reactive(de~oc)- nevrozele -neurasteniforme
-obsesivo-fobica-mixte- isteriea-schizofi-cniea- delirurisistematizateeroniee:
- endogene
- parafrenia- paranOIa '-/
BIO. APARATUL LOCOMOTOR
1.Bali asaase:
a.osteopatiimetaboliee:- ostcoporoza- osteomalacia- osteitadcformantaPaget- osteitafibroasageneralizata
b. tumoriosoase:
- eartilaginoase:eondrom,eondroblastom,condrosareom
- osoasc:osteom,osteoblastom,osteosarcom ,-- tesutconjunctiv:mixom,fibrom,histiocitom,fibrosarcom- maduvaosoasa:sareomEwing,plasmoeitom,limfoamemaligne- vase:hemangiom,limfangiom- musculatura:lciomiosarcom- grasime:lipom,liposareom
e.boliinflamatorii:osteomie1ita '--/
2.Bali articlilare:a. inflamatorii:
- eolagcnoze:poliartritareumatoida,B. Beehterew,artritapsoriazica- artritadinmorbusCrohn,colitaulceroasa- sdr.Reiter- infectii: - artritcseptice
- artritereactive- reumatismularticularacut-artritadinyersinioze- artritaLyme(borelioza)- tuberculoza
b.boli imunologice- lupusulcritcmatosdiscminat-pscudolupus- sclcrodcrmia
- sdr.Sharp- sdr.Sjogren
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c. artralgii~iartritcin altebolidcsistem:- colitaulceroasa,b.Crohn,b.Whiplc,- sarcoidoza,B. Bclwct
3.Bo/i degenerafi\"f!- artroze- spondilartroze,osteocondroze
4.Artropatii:a.boli metabolice:gutitdiabet,hiperlipcmii,hcmocromatoza,b.Wilson,al11iloidoza,etc.b. boli ndocrine:hipotiroidie,hiperparatiroidic,sdr.Cushingc. boli hcmatologiee:hemofilii,anemiaeueelulein secera,leueemii,plasl11oeitol11d. boli neurologice:neuropatii,tabes,siringomielic
'-0 /
5. Reu17Iafis17Iulpar/ilor 17Ioi:
-tendopatii- periartropatii- fibromialgii- panieulitis- enthcsopatii:epicondilita(laterala,mediala) P.s.: Cl?a17Iaiji-ecventa- a cotului
6.B. 17Iusculare:
- polil11iozite- dermatomiozite- miozitefocalein eolagcnoze- miozite- miopatii:
- vasculiteimune: - periarteritanodoasa- arteritacueelulcgigante- vaseulitaalergic-granulomatoasa- granulomatozaWegener- purpuraHennoeh-Sehoenlein
- cndocrine:hipotiroidic,insufieientasuprarenala- toxiee- medicamentoase
- traumatisme:- injeetite- rupturi- intinderi- contuzii- zdrobiri(erush-syndrom)
' /
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VI. FORMULAREA DIAGNOSTICULUI
EtapclcformuIariidiagnosticului:1. Clinic proYizoriu(anal11ncza+cxamcnobicctiv)2. Etiologic'"3. Patogenetic(cx.Infcctios,il11un,toxic,l11ccanic,traumatic,idiopatic,etc.)4. Histologic (undee posibil ~iutil ; ex: biopsiegastrica,hepatica,ganglionara,intcstinala,
pulmonara,osoasa,l11cdulara,renala,cutanata,ctc.)5. Evolutiv: formabenigna-l11aligna/ acuta-cronica/ recidivanta,persistcnta/ stabiIa-instabila6. Funcfional =graduldereducercafunctieiorganuluiafectat
a) l\larile insuficiente:I. Respiratorie(pll/mollara):
a. latenta(hipoxel11ie+hipercapnienUl11ailaefortprinmecanismdehipoventilatiealveolara+tulburaridedifuziune)
b. manifesta(hipoxemie+hipercapnieIn repausprin mecanismde tulburarea distributiei,hipoventilatiealveolara,tulburaridcdifuziune,scurtcircuitarterio-venos)
P.S.: Pcntrupractician:tulburariventilatoriiobstructive/ restrictive;difercntiereposibilaprinspirometrie(Obstructive- CV normala~iindiceleTiffeneauscazut;Restrictive- ambiiindici scazuti)
'---/
2.Cardiaca:D, S,globala/ cOl11pensata-decompensata/ acuta(ex:astmcardiac,EPA) / eronica
3.Hepatica:a.compensataparcnchil11atos(sdr.excreto-biliar,sdr. hepatocitoliticAuzepy-Boivin,sd.
hepatopriv,sd.vascular,inflamatiemezenchimala)b.dccompensataparenchimatos(micilesemnepanalacomahepatica);varianta-encefalopatia
portalac.decompensatavascular(hipertensiunep0l1ala:presinusoidalasaupostsinusoidala)
4.Rella/a1. Globala:
i. Acutaii. Croniea
I. compensatadeplin50%b. creatinina< 1,5mg/dl
2. compensata:a. nefronifunctionali50- 25%b. creatinina1,5- 2,5mg/dlEtape: 1-retentiecompensatorie(tranzitorie,deefort)
Mecanismecompensatorii: poliuriehipostenurica2-retentieazotatafixa
Mecanisme compensatorii: poliuric isostcnurica,retentieazotatafixa(uree60- 80mg/dl)
3. decompensata:a. ncfronifunctionali25- 10%b. creatinina2,5- 6mg/dlc. uree>80mg/dl
"-./
nieturie,
'f.Tat maifrccvcntnumaiprczumativdatorita:a, costurilorridicatcpcntrustabilircaagcntuluietiologiclprclevarc,culturi,dctcnninarcarczistcnlci)b, utilizarcain practicacurcntaa statisticii.cxpcricnlcipcrsonalc~iclicicnlci krapici "a vcuglc"
56
d. pseudonormaluricisostcnuriea---+oliguric4. tem1inalii(uremic)
a. ncfronifunctionali< 10%(supravictuircposibilapanala IOu)b. ereatinina6- 14mg/dlc. tulburareaprogresivaatuturorhomcostaziilor---+comauremica
'---'
2. partiala:i. glomemlara:
I. afectareafunctieidefiltrarea. 1cziuniorganicc(insuficientarcnalacronica)b. hIlburarihemodinamice(insufieientarenalafunetionaUi,
azotemicextrarenala)2. afeetareapenneabilitatiimembraneiglomemlare(membranafiltranta)
fatademacromolecule( sd.nefrotic)ii. hlbulara:
I. afectareaglobalaatuturorfunetiilortubulare=insuficientarenaliiacuta2. alterareadisociataafunctiilortubulare(unasaumaimulte)
a. leziunieongenitale(enzimatice)b. leziuniinflamatorii a.nefritaeepierdeNa,K, Mg, Ca,
b.acidozarenalahiperc1oremicaleziunivasculare(pseudodiabetulrenal)intoxicatiiexogene(metalegrele)tulbudirialemecanismelordecontrolal fuctiilortubulare
b) Alte insuficienteI. pancreatica: exocrina/ endocrina2.medulara: partiala(mono- bicitopenidi)/ globala(pancitopenie)3. intestinala: maldigestie/ malabsorbtie4. cndocrina,saliyara,musculara,vasculara,sudoralii,etc.
7. Diagnosticfinal: - fonnulatnumaidepractician-dupatrimitereabolnavuluilaspeciali~tisauinspital
\ >
P.s.: I. Practicianulimpingediagnosticulpana la limita cuno~tintelor~i dotarii sale, infunctie~idetimpuldisponibil.Diagnosticulfinaleste,ca fonnulare,foartepolimorf,ill functiedc considerentepractice,experientac1inica,cuno~tinte1e~i dotareamedicului,stadiul dedezvoltarea medicinei(Ex. non-Q-waveinfarctsepoatediagnostieanumaigratieprogresclorcardiologieimodeme~ibiochimiei- dozareatroponine1or)
2. Odatalimpezitdiagnosticul,sepoatefonnulaprognozapacientului: quoadvitam,quoadfunctioncm,quoadlaborem.
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VII. CONSEMNAREA TERAPIEI ~IEVOLUTIEI
Succesulterapcutic+ preciziadg.+ eomportare+ service=succesul+ earteadevizitaamcdicului
1. Plall detratamellt- vezimostra:
'---',
2. Pa$apoarte:
- sanatatc
- lipide- cumariniee(detaliu)
-TA- diabet- vClccillari [
Detc.
3. Evolu(ia(mostra)
"""""".,.. ..
:i * debaza: -D, T, Polio :i:: * altele: -hepA, B, -meningWi :::: -febd tifoida ~gripa :::: -pneumococ -encefalitacapuse i::: -febragalbena ::
I: -profilaxiamalariei(resorchina,lariam) :1 ~;':::::::::::::: :::::::: ::::::::::::::::::::::::'.::::::::::::::: :::::,,: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :'.: \ /
.........................................................................................................................................................................................................................................................:, '
:i Data: ~~~: . Clinic: - TA, AV, Greutate ::,: - simptome,semne(in evolutie)
. Paraclinic: ::
. Plan(flcareaurmatoareiconsultafiiEx.05.08.01: 1-EKG
2-Laborator:VSH,hemograma ::. Dateimportante:operatii,divort,pensionare,deces,etc :i. Tratament:modificari(demedicamente,posologie,durataterapiei,etc.)::
.'
, ~ : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : :: : : : :: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : :: : :: ::: : :: :: ::: : ::: :::: ::: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : :: : " :: : : : : : : : : : : : :: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : :'.:
58
Numele pacielltului:I
Data:
Medicamellt Jl1omelltuladmillistrarii
dim. PrallZla /11aill tea ill timpul dupaseara
culcare meseimesel masa
1.Nifedipillcp.10mg. 1 1 1 - *2.Furosemidcpo40mg. 1 - - I - *I
.'-.,./
"'--"
-,' ~- ,,~._.
VIII. TRUSA DE URGE'NTA. -...-
* Redih11conditionareapreparatuluiromanesc** Nucxistaprodusrol11anescsimilar.Mentionamunuldinprodusc1csimilareomologatcinRomania
59
-
Subs tauta...
Preparat PreparatJ.Fiole Fiolaj* .Chimica- Obs. German Romallesc**
Respirator Dexametazon 40mg/lml IV DexametazonSuperprednolTeofilin -pHneutru 250mg/5ml IV Solosin Miofilin
Anti- Dicloflogont 75mg/2ml 1m Alvoran DiclofenacReumatice Triamcinolon 40mg/Imi 1m Triamhexal -
Digestiv Butilscopolamina 20mgllml 1m Ratiupharm ScobutilMetoclopramid 10mg/2mI 1mIV Paspertin MetoclopramidDimenhydrat IOOmg/2ml IV VomexA Xalinat*
Analgetice Metamizol IOOOmg/2mlunIV Novalgin AigocalminTramadol IOOmg/2ml 1mIV Tramadol Tramadol
Dihidergotamin- 20mg/lOmi 1m Dihidergota- Cornhidralmigrena mIll
AntialergiceDimentiden 62mg/5mI IV Fenistil -
Mg Glutamat10% Ig/10ml unIV Mg Verla GluconolactatdeCa.si Mg.
Ca Gluconat10% 1gll Oml 1mIV Ca Gluconat Ca Gluco:qatAdrenalina 1%" Img/lml IV Adrenalina AdrenalinaMetilprenisolon 1000mg/5mlIV Urbason Solu-Medrol*
NeurologicePrednisolon-infiltr.40mgllml 1m Prednihexal Depo-Medrol*Meaverin-infiltr. 25mg/5ml 1m Meaverin -
Lidocaina-infiltr. 1OOmgllOml 1m Xyloneurat XilinaDiuretice Furosemid 40mg/2ml 1mIV Furosemid FurosemidAntihipoTA Micoillinhidroclorid5mg/2ml llTIIV Gutron Gutron*Psihofanna Diazepam IOmg/2ml llTIIV Diazepam Diazepam
Prometazin 50mg/2ml UTI Atosil RomerganSulpirid 10mg/3ml 1m Dogmatil Dogmatil*Fluspirilen-antidepr. 2mg/lml 1m IMAP -
Vasodilat. Pentoxifilin 100mg/5ml 1mIV Pentoxifilin PentoxifilinAntisludge Acid acetilsalicilic 500mg/5ml 1mIV Aspisol -Antitromb. Fraxipann 0,3ml-2850UIsc Fraxiparin Fraxiparin*
Clexane 0,4ml-24mg sc Clexane Clexane*
II. Altel1ledical1l.Paracetamo1
Nitroglicerina~Metamizol
Meroc1opramidMicodrinhidroc1O1idButilscopolaminaVerapamilPrometazinaNifedipinSalbutamolLoperamidPiracetam
Tic1opidnClopidogrelGlucoza40%
i 500-1000 meT, b0,,5m
III. Creme,
IX CONCLUZII
ConditiineeGsareuneiaetivitatieoreete~irentabilepentruMG/MF
1. Legislatiesanitara111oderna~irealista.
2. Case de asigurari sigure,armonizatereciproc,corectefatade ambii pat"teneri:bolnav-medic.
3. Fondareaunei band a medicilor ~i farmaci~tiIor- crediteaccesibilefiediruimedic,eudobanzi
v/",\
0
XI~ AN.EXE
1- Examenulcomprimatalbolnavului- fataventraHi
2- Examenulcomprimatalbolnavului- fatadorsaHi
3- Locurielectivepentruinfiltratii("triggerpuncte"miofasciale)
4- Tumormarkeri(markedtumorali)
5- Infectiicurente- terapiadeelectie(drugof choice)
6- Icterul- mecanismefiziopatologice
7- FiziopatologiahipertensiuniipOl"tale
8- EtapelecoaguEirii(teoria"cascadei")
9- Alcoolul- factorderiscIn practicacurenta
10- PoligonulWillis
62
Ancxa 1-Examcnul"col11primat"al bolnavului- fatavcntrala
EXAMENUL "COt\lPRIMA TnFATA VENTRALA
GANGLIONI (5)CERVICALI----------------
BOLNAVULIN ~EZUT(pcmargincacanapelci)
TIROIDA (3). .
~~~5!TJ!2~(~l---------------BOLNAV CULCAT
OCHII (I)GURA (2)
PLAMANI (2)
CORD (3)
PULS (I)GANGLIONI
AXILARI (4) .---Sj;LTI\i~-(4): ~---------------
FICA T(2)VEZICA (3)BILIARA
RINICHII (5)PALPAREPERCUTIEGENERALA (1)GANGLIONIINGHINALI (6) .~ ~ ~ ~---------------
VI
IDEM
. VIIc::>
, )
REFLEX(I)ROTULIAN
. VIII IDEM
~
REFLEX (2)ACHILIAN
yPALPARE A.TIBIALA POST,PEDIOASA (3)
64
An exa.2~{Exam'enuh;cQnttir:im1fi1!aJ:;b{jI:Iiav.uluiJ...,.'r.~fd'&rs{lla~..".~_..,
- t EXAMENUr:"COJ\1PRIMAT"FATA DORSALA
IIII
~ ! =III1IIIIIIII11I1IIII
1---------IIIIIIII
! jI1IIIIIIIIIII
~ J_-------IIIIIIIIII
'-./
\,_/
IIIIIIII
:nIIIIIII
t----- IIIII
:mIIIIIIIIIII
T----IIIIIIIII
: IVIIIIIIIIIIII
t----III
:VIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
GANGLIONI
OCCIPIT ALI(1)rFAFA (1)
PLAMA.NI (3)
LOll (4)RENALE
COLOANA (5)CERVICAL.\.TORACALALOMBARASACRATA
'I~
65
BOLNA VULIN ~EZUT
----------------
IDEM
----------------
IDEM\.
----------------
IDEM
Anexa3- Locurileidealepe,ntrui!1fi1tratii(:~trit!2er~U~~!e!:_.!!lio_fasciale)~;~'c. "'"'" "."- ,.,,=. ... ,., .,-
TERAP/A NEURAL4 - CELE 36DE PUNCTE M/OF ASC/ALE
~
\.
"'-.J
1. M.Temporalis
2.M. Masseter3.M. Semispinaliscapitis4.M. Spleniuscapitis5.M. Stemocleidomastoideus6.M. Trapezius7.M. Deltoideus8.M. Subscapularis9.M. Pectoralismajor
10.M Pectoralisminor11.M. Serratiusanterior12."M.Bicepsbrahii13.JM.Supinator14.M. Extensorcarpiradialis15.M. Tibialisanterior
16.M. Extensordigitorumlonguspedis17.M. Rectuscapitisposteriormajor18.M. Levatorscapulae
66
",,--~,
'"._~"-., .-""- -~.-> " m "
---~--~---~--'-"-""---RECOMANDAT A DE cSOC!E!ATEAGERM-AiNA"DE ANESTEZIEC"'" """ '"".. --.","-" .~-,--,,--
~
)" '
"~
\.
19.M. Iliocostalisparscervicis20.M. Supraspinatus21.M. Infraspinatus22.M. Teresmajor23.M. Iliocostalisthoracis24.M. Longissimusthoracis25.M. Iliocostalislumborum26.M. Glutaeusmedius27.M. Piriformis
,~.jj
28.M. Trohantermajor29.M. Ischiocrural
30.M. Extensordigitorum31.M. Bicepsfemoris32.M. Gastrocnemius33.M. Soleus34.M. Rectusabdominis35.M. Transversusabdominis36.Pesanserinus
67
Anexa .:J- Markeritumorali
68
~
\.
..!
AlteiOrgan
I Tiphistopatologic Prima alegere A 2- a alegere alternative
SanI
CA 15.3+CEA CA 549 MCA , MSACA 15.3+TPS BCM
- celulemici NSE +CEAPlaman -noncelulemici SCC +CEA CYFRA 21.1
- adeno,etc ICEA ACTR, TPAPiele
ISCC TPS, CEA
Tiroida- folicular Tireoglobulina CEA
- medular(celule"C") Calcitonina NSE CEA ,Esofaf!.
I Iscc CEA ..JIStomac ICA 72.4+CA 19-9 CEA ICA-5o
PancreasCA 19-9 CA 125 CA-50
TPS CEAFicat I-adenocarcinom jAFP CA 19-9 CEA
Cai biliareCA 19-9 CEA CA 125
CA 72.4
C I t 1-adenocarcinomCA 19-9+CEA TPS CA50
0on,rec I CA 74 MCA-epitelial CA 125+CA 72.4 ICA 19-9 ICEA, MCA
Ovar CA 125+TPS CA 15.3-mucmos CA 19-9 CA 72.4 CEA-cerVIX SCC +CEA TPS MCA
Uter -endometru CEA +CA 125 CA 15.3 CA 72.4+MCA
Vulva,vaginl SCC +CEA IVezica
I
TPA CEA TPSurznara CYFRA 21.1Prostata
IPAP +PSA TPS
-semmom see RCG NSETesticul -non-semmom AFP +RCG
-cono-carcmom RCG +AFP
PlasmocitomIParaproteine
BlmacroglobulinaBENCE-JONESTimidin-kinaza
FeritinaLeucemie,Lim/om B2macroglobulina
J Neopterina"Melanom
IMelanina TPA
Tip
Hormoni
AntigeneoncoletaIe
"-../
En:::ime
"-../
ProteineTlill1or-asociate
Prescurt.
(in text)
HCG
AFP
CEA
PAP
NSE
LDH
PSA
CA-125
CA 19-9
CD25
DenumiFe
Gonadotrofinacorionicaumana
Calcitonma
Catecolamine
alfafetoproteina
Antigencarcinoembrionar
fosfatazaacida
prostatica
I Conditiii
I necanceroaseBoalatrofoblastica(mola
"
Sacinahidatiforma)Carcinommcdulartiroidian
Feocromocitom ,CarcinomhcpatocelulariCiroza
---~-- I
Tumorigonadalecu JHepatitacelulegenninalc
\j IPancreatitaAdenocarcinomcolon, IH t'
t~. I epa 1a
pancreas,plaman,san, I-B--
I~--;~~ fl.
oaam am.mtcst.oyar I .
!fumat
IProstatita ..iHipertrofiebenignadeIprostata
Tip decancer
.-.
-.
Cancerprostatic
,CarcinompulmonarcuCe1ulemici
----------
NeuroblastomLimfom IHepatit! ~~-
!Anemiehemoliticac.I!Etc!ProstatitaI
IHipertrofiebenignadeiprostataI!InfeqiiIGamapatiimonoclonaleiMenstruatie
IPeritonitarsa~
Cancercolon !pancreatita--~~~-~--- I -~---,Cancerpancreas I~ ;; ~ ColitaulcerativaCanccrsan I
i BoalaHodgkin I
:Li~f~m aI~apl~~ticcu-r
-~--------
!cclulcman
lacticdehidrogenazaSarcomEwing
Cancerprostatic
i . ,Mielomi 132macroglobulma!
.CancerovarianLimfoamc
enolazaneuronal-
specifica
antigenspecificprostatic
----
---
ILeuccmiacuccluleI
~~Qa..s~____--iLimfomllcuccmiacuiceluicT adultc
--~ ]ii
69
Anexa5- Infcctii cUl-cntercspiratOl-ii- terapiadeelectie( "dnI1!of choice")
Diagnostic
BnH1~itaAcuta
Bronsitacroniciiexacerbareacuta -GrJ
Idem.Gr.II
Idem.Gr.III
Pneumonie-u~oara-medie-pacient>65deam.-laraboliasociate.
PneumonicIdcm.cuboliasociate.
Pneumonie-formagravapacient>65deani-cu boliasociate.
PneumonieSepsis.Socseptic.Inmax.24deorc.Necesitatratamentlareanunare.Otitamedieac.
Sinuzitaac.
Sinuzitiicr.
Amigdalitiiac.
Age"tbacteriaII
! Primar:Virala;Suprainf.:S.pncumoniae11.intluenzacM. catarrhalisMycoplasmcChlamydii
S.pncumoniae1-1.inlluenzae
S. pncul11oniaeH. intlucnzaeM. catarrhalisStaphylococcusK. pneul11oniaeH. influcnzaeP. acruginosaK. pneumoniaeE. coli
S.pnumoniacEntcrobacterii
S.pnumoniaeM. pl1ul11oniaeC. pneumoniaeH. inl1ucl1zaeBaciliGram(-)S. pneumol1iacH. intluenzaeBacili Gram(-)S.aureus
S.pneumoniaeH. intluenzaeEntcrobacteriiLegiol1ella
S. pneumoniaeH. intlucl1zacEntcrobactcriiLcgionellaA.nacrobi
S. pneumol1iacH. inllucnzae
Streptococcusgr.AStaphylococcusS. pneumol1iacII. inl1ucnzac1\1:catarrhalis
StaphylococcusStaphylococcusS. pncumoniacII. inllucnzac1\1.catarrhalis
Anaerobi(dcntogcn)
Streptococcus~hcmoJiticHacmophilusinl1ucnzac
BLI - inhibitoridc~-lactamaza
Terapie--MacrolidCefalosporineGr.2Aminopeniciline=BLI(Doxycyclin)(FluorochinoloneGr.3)
CcfalosporineGr.2Aminopcniciline=BLIMacrolideFluorochinoloneGr.3CefalosporineGr.2Aminopeniciline:::BLIFluorochinoloneGr.3-4CefalosporineGr.3a(APAT)
CefalosporineGr.3aJbAcylaminopeniciIliniBLIFluorchinoloneGr.2-3Carbapenem
CefalosporineGr.2Aminopeniciline:::BLIMacrolideFluorochinoloneGr.3-4(Doxiciclina)Cefalosporil1eGr.2A.minopeniciline:::BLIFluorochinoloneGr.3-4
CefalosporineGr.3a+MacrolidAcylaminopenicillinIBLI+MacroJidFluorochinololleGr.3FluorochinoloneGr.2+ClindamicinCarbapenem:tMacrolidAcylaminopenicillinIBLI+MacrolidCarbapenem+MacrolidCephal.Gr.3a+Macrolid:tClilldamicinFluorochillololleGr.3FluorochinoloneGr.2-3+ClindamicillCefalosporineGr.2Aminopenicilinei:BLIMacrolideFluorchinoloneGr.3CefalosporilleGr.2Aminopel1icilinei:BLIMacrolideFluorochinoloneGr.3
FClloximctilpenicilinaCcfalosporincGr.2Aminopenicilinei:BLIMacrolid
70
Doza/Zile
-
5-7oral c
5-7(10)posibiIoral
Bron~iectaziiasociate10-14 '-.J
7-10
posibil oral
7-10posibiloral
7-10
7-10'-/
5-10
aprox.5
aprox.5
10
Anexa6- Icterul- Mecanismefiziopatolotdce~-
aI
I 1.: SUPRAPRODUCPFI DE BILIRUBINAI 1.HEMOLITICIIi 2.ITULBURAREA:TRANSPORTUITI BILIRUBINEI ir-.;
: HEPATOCITIIII13.iTULBURAREA
: CONJUGARII ~I BILIRUBINEI INI MICROSOMIIIIII14.ITULBURAREA1EXCRETIEI: BILIRUBINEI LAI POLUL BILIARIIIIII15.I STAzAI INTRAHEP A TICA
I (COLEST AZA)III
CAI BILIAREI
ITNTRAHFPATIrF I
CANAL IHEPATI~\ /DR..STG.\ V / :CAI IBILIARE., 6. ~FXTRA- ISTAZA--~PAT1CE I EXTRAHEP A TICA
: (COLOSTAZA)II
SINUSOID HEPATIC
POLULVASCULAR
~
..
D ~
~
f-
---,w.,,--
1":Ir,
Anexa 7- Fiziomltoloci~hipertensiuniiportale
.
SPATIC1JINTER-LOBULARHERN"
VENA CAVAlNFERIOARA 'w",-,,)\ I(~ I .
~~"'"'.i~~ - ;;' BwePO8TH.p.mcVENESUPRAHEPATICE,-",-"" ""L/;::' ",,' >,
'}">"/-:;:::;; . "
Ancxa8-Cascadacoa2"ularii
SISTEMULINTRINSEC
SISTEMULEXTRINSEC
XII -.XIIa (HAGEMAN)I
EXTRACTTISULAR -;
XI -.XIaI
IX-.IXa~~
"-../
TIMPUL PARTIAL XDE
TROMBOPLASTINAPTT
XTESTULQUICK
Xa
1V, PIC J-a-
Il .. IIa
Protrombina+.TrombinaFibrinogen~ Fibrina
.' /
ETAPELE COAGULARII
Ancxa9 - Alcoolul cafactorderiscinj!racticacurcota
Con/il1utll/ill a/coo/a/prillcipa/e/ortipuri debiiuturia/coo/ice
/""1
Grupe/e de risc /a COI1S1t11111/de a/cool:
74
N. Cantitatea Tipll/balltllrii %A/coo/ Gralllealcool1. 1litru Bere 5% 402. 0,7litri Vin Cca.11% 603. 0,7litri $ampanic Cca.12% 654. 0,7litri Lichior Cca.30% 1705. 20gral11C Bauturispirtoasc Cca.35% 56. 20 .gral11C Bauturispirtoase Cca.40% 6,2
RisCli/ F emei Biirba!iillic 20gral11c/zi 30grame/zi
ltl{ifocill 20-50gral11c/zi 30-70grame/ziJlare Peste50gral11c/ziPeste70gral11e/zi
Gravide Max.Gral11c/sapt.
Anexa 10- PoligQ.nuLWilIis
"'-../
"-../
1, arteracarotidaintema2. arteraoftalmica3. arteracerebralaanterioara
4. chiasmaoptica5. arteraSilviana(cerebralamedic)6. artcracoroidianaanterioara
7. artcracomunicantaposterioara8. artcraccrebralaposterioara9. artcraccrcbeloasaantero-superioara
10.arteracerebeloasaantero-inferioara11.arteraprotuberantialaparamediana12.tnmchiulbazilar13.arteravertebrala
14.artcracerebeloasapostero-infcrioara
15.arteraspinalaantcrioara16.artcraspinalaposterioara17.artcracomunicantaanterioara
75
Illdexu!llume!or proprii prezellte ill text:
Adams-Stockes,31Addison,41,50Alzheimer,50,53Arnold,23Arthus,48Asmann,43Auzcpy-Boivin,56Avvclis44Baastrup,40Babinski- Frolich,45Babinsky,17Baker,29Bane,17Banet,34Basedow,14,41Bcchterew,16,20,30,31,40Bechtcrcw-Strumpell-Piene
Marie,40Belwet,55Bence- Jones, 68Betz,17Biernler,47Bloomberg,9, 10Bohler,17Bouchard,16,26Bouillaud-Sokolski,16Bom'eret,31Bracard,19Broca,45Bruzinsky,18BuddChiari,37Burger,29CasselaRiedel,20Cassidy-Seholte,27CHARLES BELL, 18CharlesBonnet,53Chauffard,10Cheyne-Stokes,6, 14Claude-Bernard-Horner,24,
31
Cloque-Rosenmuller,13,28Combur,20Conn,32,41Coombs-Gell,49CourYoisier,38CriglerNajar,36Crohn,16,28,33,35,54Cushing,13,32,41,45OA COSTA, 17Oamoiseau,14DeSCle,16
Oejcrine-Landouzy,26Diesse,70Oi George,-+9Dragstcadt,35DubinJohnson,36Dufour.43Duplay.25DupuYITcn,12,17,27Edinburgh,51Eisenmenger,29Ellis, 38EppstcinBan, 47ERB, 26Ewing,26,29,54Fallot,33Fredcrikson,46Friedlender,25Friedler.31FrugonL33,37,38Gallavardin,32Gasser.18Gerota.40
Gilbert- Hannot,36Giordano,11Glanzmann,48Glisson,10Goodpasture,38,50Gordon,17Gowers,19Grawitz,15,39Grohn,1OGuillain- Bance,45Guyon,11,27Hagemann,73Halstead,26Hannot,36Hashimoto,25,41Heberden,16,27Heinz,46Hcnoch-Schonlein,38,48,50HiperglobulincmicaWaldenst
rom,47Hodgkin,13,25,26,48,72Homans,15Horton,24Huchard,]5Huntington,44Jackson,41Jandressik,18Keyscrsdmitt,5Kernig, 18
Kimmelsticl-Willson,39Kissclbach,24Koch,42Konig ,10Konjctzny,17Korsakov,53Kussmaul,8,10,14,15Kwostck,12,17Labbe,10Lacnncc,36Lanz, 10Lanzmann,10Lapinsky-Iavorsky,10Lasegue,19Lauda,10Layden-Moebius,28Leriche,34Leriche-Ortner,38LEVINE, 6Lown-Genong-Levine,32Lohlein,38Lutembacher,33Lyme,16,54Mallet-Guy,38Mallory - Weiss,34Malmross-Hedval,43Marchiafava- Micheli,30,47McBurney,10Meckel,34,35Mendel,10Meulengracht,24,36Miculicz, 25Mirizzi,38Mobitz,22Montezuma,42Moschowitz,48Munchausen,53Murphy,10Oddi,38Oppenheim,17Osgood-Schlatter,29Osler,32,48Oudar-Jean, 16Paget,54Paget-Schrottcr,15,26Pancoast-Tobias,25Panzerherz,31Parcival- Pott.43Parkinson,!7,25,44,49Patrick,18PeanBilroth,35
'--./
',--/
~PetIy,~9 .-Phanenstie]l,I I
Plaut-'v'iJlcent.-~~lPIumm~t~J1'!~rn{bltPoupart,16,28Pouteau-Co]]cs,27Printzmetal,32Quervain,25,40Quineke,13,14,25Raynaud,16,27,29Reclus,29Redeker,43Reiter,16,28,54Riedel,25,41Roger,33Rokinsky,34Rokitansky,36Romberg,17Rontgen,34Rossolimo,17Rotor,36Rouveret,32
Rowsig,10Rumpe]]Lccd,48Rustizki-Kahler,31,47Saboureau,~OSantorini,38Scarpa,28Schaffer,17Sehatzki,34SchOber,11Sehmorl,31SchwartzBartter,41Seldinger,28Sharp,16,55Simon,43Sjogren,16.50,55Tietze,8,30Tiffeneau,56Traubc,9Trousseau,12Valleix,8, 19,30Vaquez,47Vasileseu,17
Vater,38Vclpeaux,8, 18,15,25VIRCHOW, 13,25WaalcrRose,18Weber,44Wegener,16,38,55Weiss,12,17Wenekcbaeh,32Werlhof,48Wemer- Morrison,34,39Wemieke,45,53Westergrecn,20Whip1e,55Willebrand-Jurgens,48Willis, 18Wilson,46,55Winiwarter-Buerger,28Wirsung,38Wolff- Parkinson-White,32Wright,26Zenker,34Zollinger-Ellison,34
Prillcipaleleabrevierifolositein text:
a.ae.Ac.art.eea.
- artera- aeut
- anticorpi- articu1atie- CIrca
~'cr. - cromcD, S -dreapta,stangaDd -diagnosticdiferentialDg -diagnosticP.s. - PostscriptumCV -capacitatevitalaEPA -edcmpulmonaracutex. - cxempluHLG - hcmoleucograma
77
inflam.- inflamatiem. - morbus(boala...)M. - mu~chimb. - membru
M,p - (secretie)mucoasa,purulentaN -normaln.N.R.org.pet.sdr.sup.tulb.
- nerv- notaredactiei- organ- punct- sindrom- supenor- tulburari
Cuprins detaliat
Planul.expunerii... ... ... ... ... ... """""""'" 1
PreambuL .3
I. ANAMNEZA - Priviresintetidi(Foaiadeobservatie) 5
II. EXAMENUL OBIECTIV AL BOLNAVULUI... """"""""""""""" 7
A .FOR.MACURENTA (Foaiadeobservalie) 7
A 1.DATE GENERALE.. ...... ........................... ....... ......... ...... ..... ....... .. ....7
A2. CAPUL... .. ... .... .. . .. . 7
A3. G.~TUL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..8
A4. TORACELE 8
AS. CORDUL... ... ...9
A6 ABDOMENUL.. . . """""""""""""""""""""'" 9
A7.RECTUL- ORGANELE GENITALE MASCULINE ll
A8.COLOANA VERTEBRALA 11
A9. EXTREMIT AII... .. .. ......... .... .......... ..... . ..12
A.I0 SISTEM NERVOS (PRIVIRE ORIENT ATIV A) ..12
B.FORA1A"COlvlPRIlvfATA" "... 12
C.DETALIIPENTRUANUMITEORGANESAVREGIVNITOPOGRAFICE 13
C1.DATE GENERALE .13
C2.CAPUL. .......... ... ...................... ......... .......... ....... ....... .............. ..........13
C3. GATUL ...... .14
C4. TORACELE 14
C5. CORDUL 15
C6 ABDOMENUL .15
C7.RECTUL - ORGANELE GENII ALE MASCULINE .15
C8. COLOANA VERTEBRALA.. 16
C9. EXTREMIT A II. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . .16
C.l0 SISTEM NERVOS (PRIVIRE ORIENTATIV A) ... ... 17
III. LABORATORUL iN PRACTICA CURENTA """ """"" ..20
A. SCREENING-VL PRACTICIANVLVI 20
A l. Examcncdc rutinadccfcctuatin propriulcabinct.......... .... .... ........... .. .. .. .. ..20
A2.Scrccning-ulpracticianului .20
B. E)(TENSIASCREENING-VLVI (ill cazurispeciale) ..20
'-./'
"-../
C. CONCEVTRATIA SERICApentrumedicamenteuzuafeellmaretoxicitatefa
suprado::(?i. ... ... ... ... .. .... 2I
IV TEAM-ul SPECIALI~TILOR """"""""""""""""""""" ..22
V INDREPT AR DIAGNOSTIC PENTRU MEDICUL PRACTICIAN (Medicina intema,
n1cdicinagencrala)............. .................................... 23
A. iNDREPTAR DIAGNOSTIC TOPOGRAFIC... ..23
AI. CAPUL... .. ... ... ... .... ... ..... ... ... .. ... .24
A2.GATUL .25
"-J
A3. MEMBRUL SUPERIOR .26
A4. MEMBRUL INFERIOR ..27
AS. TORACELE... ... ... """"""""""""""""""""""""" .30
A6. ABDOMENUL ... ...33
A7 APARATUL UROGENITAL.. """"""'" 38
A8. REGIUNEA LOMBOSACRATA.. 39
B. iNDREPTAR DIAGNOSTIC PENTRU ALTE GRUPE DE BOLl (medicillii
in ternii) .. . .... ........ ...... .41
BI.BOLI ENDOCRINE ... ...41
B2.BOLI INFECTIOASE ... 42
B3. BOLI NEUROLOGICE... ... ... " ... . .. . .. ... ... ... ... . .. .. ..:..43
B4. BO LI MET ABOLICE. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...45
' /
B5.BOLI DE SANGE~IDECOAGULARE 46
B6.BOLI IMUNOLOGICE~IALERGICE 49
B7GERIATRIE ...50
B8.INTOXICATIlLE ACUTE ..51
B9.BOLI PSIHICE- MARILE SINDROAME... ... """""'" ... '" 52
BIO.APARATUL LOCOMOTOR ...54
VI. FORMULAREA DIAGNOSTICULUI 56
VII. CONSEMNAREA TERAPIEI ~IEVOLUTIEI ...58
VIII. TRUSA DE URGENTA .59
IX. CON CLUZII. . .61
X ANEXE ...62
Anexa1- Examenul"comprimat"albolnavului- fataventrala ...64
Ancxa2- Examenul"comprimat"albolnavului- fatadorsala ...65
Ancxa3 - Locurilcidcalcpcntruinfiltratii("triggerpunctc"miofasciale) .. .66-67
Anexa4 - Markeritumorali ... 68
Anexa5- Infcctiicurenterespiratorii- tcrapicdecIectie("drugof choice")... ... ....70
79
Anexa6 - IetemI - Mccanisme fiziopatoIogice... ... ... ... """ 71
Anexa7 - Fiziopatologiahipcrtensiuniiportale ,.. ...72
Anexa8 - Caseadacoagularii 73
Anexa9- AlcooluleefactordcriseInpraetieaeurenta.... .. .. ... '" .. .."""" 74
Anexa10- PoligonulWillis 75
IndexulnUl11clorpropriiprezenteIntext .. ...."'" ....... ....""'" "" .. """'" . ......76
Prineipalelc abrcvieri folositc In text ... ... . .. ... ... .. .... ... .. .. .. . .. ... . . .. .. ... ...77
Cuprins detaliat... ... ... ...... ......... ......... ..... ... .... ... ... .. . .. .. .. ... ... .... ... .. .. .... . ... .. .. .. ... .. .. ....78
CUITieulun1Vitae .81
" /'
,,_/
80
M.D.,Ph.D.FLORIN MATRESCU
Curriculum Vitae
~ Nascutin anul1940in comunaGurbane~ti(l1fov),fiu al preotuluiortodoxPetruMatrescu~ialMarieiMatrescu
'",---"
>- Absolva in 1957Liceul "Gh. $incai" diil Bucure~tica~efdepromotie
~ 1957-1963- UrmeazacursurileFacultatiideMedicinaGeneraladinBucure~tipe care0 absolvaca~efdepromotie
~ 1964-1967- Medicmedicinadefamiliein comunaCocora,judolalomita.
>- 1967-1970- Doctoratcu frecventa(prin concurs)in medicinainternalaspitalele "Carol Davila" ~i "Fundeni" din Bucure~ti,concomitentcuspecializareain medicinainterna.
>- 1970-1980- Asistentuniversitarin medicinainternala ClinicaMedicalaaSpitaluluiBnincovenesc(panain 1978)~iin SpitalulMunicipalBucure~ti(1978-1980).
' "~ Autora41dearticolemedicale~iautorprincipalal monografiei"Tahicardiile. . "
paroxlstIce.
>-Parase~tetarain 1980~iobtineazilul politic definitiv~iapoi cetateniainRepublicaFederalaGermania.
>- 1981-1984- Stagiulpostuniversitarin medicinainterna in "Niedewenigern"(Hattingen)R.F.G.
>-Din 1984~i panain prezentmedic practiciande Medicina GeneralainGermania.
81
Este 0 deosebitabucurie sa constatca un colegperformantin
Romaniaajungeun profesionistdistinsin Germania.Dupa0 activitate
de 37 de ani, daruiestecolegilordin fara de origineexperientaviefii
profesionale ~i modelul daruirii desavar~itepentru cauza celor
suferinzi.
Prezentul curs ofera dovada folosirii cu generozitate a
"talantului" primit.. Pentru noi, beneficiarii,esteun gest de mare
bunavoinfa~idaruire, iar pentrugenerafiileurmatoare-un modelde
munca,lupta~ialtruism.
Dr.Mircealorga
'~