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

53

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

54

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)

' /

55

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.

57

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

'~