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Oral exam Poslední úprava: Maxová Hana, doc. MUDr., Ph.D. (31.08.2021)
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MOODLE:https://dl1.cuni.cz/course/view.php?id=6503
DAMJANOV, Ivan. Pathophysiology. Philadelphia: Saunders Elsevier, c2009. ISBN 978-1-4160-0229-1. HALL, John E. Guyton and Hall textbook of medical physiology. 13th edition. Philadelphia, PA: Elsevier, [2016]. ISBN 978-1-4557-7005-2. KAUFMAN, Christian E. a Patrick A. MCKEE. Essentials of pathophysiology. Boston: Little, Brown and company, 1996. Essentials of basic science. ISBN 0-316-48405-9. MCPHEE, Stephen J. a Gary D. HAMMER. Pathophysiology of disease: an introduction to clinical medicine. 6th ed. New York: McGraw-Hill Medical, c2010. ISBN 978-0-07-163850-0 SCHMIDT, Robert F., Florian LANG a Gerhard THEWS. Physiologie des Menschen mit Pathophysiologie. 29. vollständig neu bearb und aktualisierte Aufl. Heidelberg: Springer, 2005. Springer-Lehrbuch. ISBN 3-540-21882-3. SILBERNAGL, Stefan a Florian LANG. Color atlas of pathophysiology: Stefan Silbernagl, Florian Lang. 3rd edition. Stuttgart: Thieme, [2016]. Basic sciences. ISBN 978-3-13-116553-4.
Poslední úprava: Maxová Hana, doc. MUDr., Ph.D. (31.08.2021)
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EXAM QUESTIONS FROM PATHOPHYSIOLOGY
GENERAL Health, illness, death Disorders of temperature control Edema Concrements, colic Icterus Acidosis Alkalosis Hyperhydration Dehydration Disorders of K+ and Cl- metabolism, relation to AB balance Disorders of Ca, P metabolism Classification of hypoxias Intoxication AB balance testing
BLOOD Anemic syndrome Anemias caused by erytrocytes loss Anemias caused by impaired hematopoesis Hyperviscosity Disorders of hemostasis DIC Hematologic testing
CIRCULATION Pathophysiology of arteries Pathophysiology of cappilaries and veins Primary arterial hypertension Secondary hypertension Hypovolemic shocks, compensatory mechanisms Distributive shocks Acute heart failure Chronic heart failure Disorders of coronary circulation, clinical forms of ischemic heart disease Acute myocardial infarction Hemodynamics of valvular defects Hemodynamics of congenital heart defects Disturbances of impulse conduction in the heart and cardias arrhythmias, including ECG findings Testing of cardiovascular system Characteristics of pathological ECG recordings
KIDNEY Disturbances of renal blood flow Disorders of glomerular filtration Disorders of tubular transport Nephrotic and nephritic syndrome Acute renal failure Chronic renal failure Disorders of urinary tract Dialysis: principles and effect Testing of renal function
RESPIRATION Changed compliance of lung and respiratory system Changed airway resistance Pneumothorax Defense lung reflexes Control of breathing in respiratory diseases Disturbances of alveolar ventilation, respiratory insufficiency Hypobaria, hyperbaria Artificial ventilation, oxygenotherapy Inequalities of ventilation-perfusion ratio Diffusion impairment, lung edema Pulmonary embolism Pulmonary hypertension Bronchial asthma Obstructive pulmonary diseases, especially COPD Restrictive pulmonary diseases Lung function tests
ENDOCRINOLOGY Disturbances of hormonal regulations Disorders of adenohypophysis Cushing’s syndrome Addison’s disease, disorders of mineralocorticoids Disorders of adrenal medulla, stress Hyperfunction of thyroid gland Hypofunction of thyroid gland Disorders of sex hormones in ontogenesis Diabetes mellitus, classification and acute complications Chronic complications of diabetes mellitus Examination of endocrine glands
GIT, METABOLISM Obesity Metabolic syndrome, gout Primary hyponutrition Malabsorption syndrome Consequences of vitamin deficiency, hypervitaminosis Disorders of oesophagus and stomach Vomiting, diarrhea Constipation, ileus Pancreatitis Liver failure Portal hypertension and ascites Examination of function of liver and pancreas
NERVOUS SYSTEM Upper motor neuron disorders (spastic paralysis) Lower motor neuron disorders (flacid paralysis) Spinal shock Disorders of neuromuscular junction and muscles Disorders of somatosensoric sensation, pain Disorders of basal ganglia Cerebellar disorders Schizofrenia, mood disorders Syndrome of dementia Disorders of cerebral blood flow Intracranial hypertension and hypotension Brain edema, disorders of brain blood barier Sleep disorders and disorders of consciousness Epilepsy and epileptic seizures Examination method in neurology Poslední úprava: Maxová Hana, doc. MUDr., Ph.D. (31.08.2021)
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SYLABUS OF PATHOLOGICAL PHYSIOLOGY
GENERAL Health, illness, death – definition, symptom/syndrome/disease, stages of a disease, extrinsic and intrinsic causes of diseases, clinical and biological death, signs of brain death Disorders of temperature control – fever, hyperthermia and its consequences, hypothermia and reaction of the body Edema – Starling forces, generalized (heart failure, hypoproteinemia) versus localized (inflammatory, venostatic, lymphostatic) Concrements, colic - concrement formation (types, saturation of fluid, AB balance), characteristics of different types of colic and their propagation, other consequences of concrements Icterus – causes (prehepatal, hepatal, posthepatal), diagnostics, complication Acidosis – metabolic, respiratory, causes, compensation, consequences (influence on ICF) Alkalosis - metabolic, respiratory, causes, compensation, consequences (influence on ICF) Hyperhydration – iso/hyper/hypo-osmolar, causes, consequences (lung and brain edema) Dehydration – iso/hyper/hypo-osmolar, causes, consequences (blood viscosity, hypovolemic shock) Disorders of K+ and Cl- metabolism, relation to AB balance – causes, ICF/ECF, resting membrane potential, arrhythmias, sceletal muscles Disorders of Ca, P metabolism - parathyroid glands, relation between Ca and P, parathormon, vitamin D, calcitonin, causes and consequences (tetany, calcifiation) Classification of hypoxias – hypoxic, ischemic, anemic, histotoxic, diffusion distance Intoxication – CO, kyanids, nitrates, organophosphates, botulism, alcohol, methanol, paracetamol, amanitin, faloidin, salicyláty, digitalis, atropin AB balance testing – pH, respiratory (CO2) and metabolic component (BE, HCO3-), AG, Cl-corr, principals of blood sampling and measurement
BLOOD Anemic syndrome – symptoms (paleness, fatigue, dyspnea), compensatory mechanisms Anemias caused by erytrocytes loss - chronic posthemorrhagic (causes – GIT, urogenital system), hemolytic (causes), lack of iron, chronic disease anemia (hypersplenism, renal insufficience, liver, tumors) Anemias caused by impaired hematopoesis – bone marrow disorders, erytropoetin, Fe, B12 Hyperviscosity – causes (polyglobulia, CML, paraprotein), symptoms (CNS, heart, cyanosis, thrombosis/bleeding) Disorders of hemostasis – conditions related to hypercoagulation or bleeding diathesis, innate and acquired disorders DIC – causes, pathogenesis and consequences Hematologic testing - complete blood count, morfologic classification of anemia, percentages of the types of WBCs, erythrocyte sedimentation rate, tests of hemostasis (Quick, aPTT)
CIRCULATION Pathophysiology of arteries – narrowing and obstruction, aneurysms, atherosclerosis (pathogenesis, symptoms) Pathophysiology of cappilaries and veins – edemas, specific features of venous flow, thrombosis (deep venous thrombosis, thrombophlebitis), chronic venous insufficiency, varixes, embolism Primary arterial hypertension – mechanisms of BP regulation, BP values, decreased compliance of large arteries, causes (CO, kidneys, sympaticus, endothelium), consequences, principals of therapy Secondary hypertension – renal (parenchyma, renovascular), endocrine (types), hypertension during pregnancy Hypovolemic shocks, compensatory mechanisms – types, stages of shocks, compensatory mechanisms and circulation failure causes, organ consequences, principles of therapy Distributive shocks – septic, anaphylactic, neurogenic, causes of vasodilation (NO), principles of therapy Acute heart failure – factor influencing CO, left/right side failure, causes, cardiogenic shock, central venous pressure, symptoms, diagnostics (EF, CVP), principles of therapy Chronic heart failure – classification of heart failure, causes, compensatory mechanisms (Frank-Starling´s law), molecular mechanisms, principles of therapy Disorders of coronary circulation, clinical forms of ischemic heart disease – determinants of myocardial oxygen supply, coronary bed flow, causes, acute coronary syndrome and chronic forms of IHD Acute myocardial infarction – causes, consequences of coronary flow arrest, symptoms, principles of diagnostics (ECG, laboratory findings) and therapy, life threatening complications of MI Hemodynamics of valvular defects – causes of valvular defects, volume and pressure overload, consequences (heart failure, pulmonary hypertension) Hemodynamics of congenital heart defects – without shunt (coarctation), with shunt (septal defects, PDA, Fallot´s tetralogy), factors influencing hemodynamics Disturbances of impulse conduction in the heart and cardias arrhythmias, including ECG findings – causes (disturbances of AP conduction - blocks, ectopic AP generation, reentry), consequences, principles of therapy Testing of cardiovascular system – BP, ECG, echocardiography, Holter monitoring, myocardial perfussion scintigraphy, ergometry (ischemia, anaerobic treshold) Characteristics of pathological ECG recordings - myocardial hypertrophy, ischemic changes, ions imbalance - K+ and Ca2+
KIDNEY Disturbances of renal blood flow – causes of decreased and increased renal blood flow, consequences, autoregulation and its changes Disorders of glomerular filtration – quantitative and qualitative Disorders of tubular transport – innate and acquired, symptoms and consequences(ability to concentrate, ions imbalace, AB balance) Nephrotic and nephritic syndrome – patogenetic mechanisms and symptoms, consequences, principles of therapy Acute renal failure – causes (prerenal, renal, postrenal), phases (oliguric, polyuric), consequences (disturbances of ECF, ions, AB balance, uremia) Chronic renal failure - causes, consequences, compensatory mechanisms, chronic cardiorenal and renocardial syndrome, hepatorenal syndrome Disorders of urinary tract – incontinence, urine retention, vesikoureteral reflux, urolithiasis Dialysis: principles and effect – hemodialysis and peritoneal dialysis, principles, indications, advantages and disadvantages Testing of renal function – urinalysis (casts, protein, hematuriy, glucose), GFR and eGFR, fractional excretion, ability to concentrate, urodynamic tests
RESPIRATION Changed compliance of lung and respiratory system - causes, consequences – components of lung compliance (elasticity, surface tension), static and dynamic measurement, work of breathing, atelectasis Changed airway resistance – factors affected airway resistance, extrathoracic and intrathoracic (air trapping, equal pressure point), consequencesof increased airway resistance (work of breathing, V/Q) Pneumothorax – causes, classification, consequences (tension type), mechanism of reabsorption, therapy Defense lung reflexes – sneezing, protective apnoea, cough (causes, complications) Control of breathing in respiratory diseases - ventilatory response to hypoxia and hypercapnia – central and peripheral receptors, izoventilatory response, changed respiratory regulation in chronic hypercapnia, pathologic respiratory patterns (Cheyne-Stokes´, Biot´s, Kussmaul´s) Disturbances of alveolar ventilation, respiratory insufficiency – hypo- and hyperventilation, causes, consequences - respiratory insufficiency (partial/global, latentn/manifest), AB dysbalance, tetany, dyspnea Hypobaria, hyperbaria – adaptation to life in high mountains, high altitude sickness, pulmonary and brain edema, chronic high altitude sickness, nitrogen narcosis, decompression sickness Artificial ventilation, oxygenotherapy – volume or pressure controled, assist-control mode, PEEP, high frequency oscillatory ventilation, ways of oxygen administration, hyperbaric, side effects Inequalities of ventilation-perfusion ratio – physiologic non-uniformity, hypoxic pulmonary vasoconstriction, causes of unequal ventilation and perfusion, consequences (venous adózní příměs, alveolární mrtvý prostor) Diffusion impairment, lung edema – diffusion path prolongation, decrease of diffusion area, transfer factor, interstitial and alveolar lung edema, its causes and consequences Pulmonary embolism – causes, consequences according degree of embolism (acute, chronic), diagnostics, principles of therapy Pulmonary hypertension – causes of increased pulmonary resistance, types (precapilar, postcapilar, hyperkinetic), impact on vascular morphology, principles of therapy Bronchial asthma – changed mechanics of breathing, paroxysmal obstruction (air trapping, equal pressure point), causes (bronchial hyperreactivity), eosinophilic inflammation, consequences (hypoxemia, cor pulmonale, status astmaticus), principles of therapy Obstructive pulmonary diseases, especially COPD – changed mechanics of breathing, pathogenesis of emphysema and bronchitis, clinical forms (pink puffers, blue bloaters), principles of therapy Restrictive pulmonary diseases – pulmonary fibrosis, pneumonia, RDS, ARDS – causes nad consequences of restriction (mechancs of breathing, pulmonary hypertension), patophysiology of ARDS a RDS Lung function tests - spirometry, bronchoconstriction and bronchodilation tests, blood gases, transfer factor, expired nitric oxide
ENDOCRINOLOGY Disturbances of hormonal regulations – hypothalamic-pituitary axis (primary, secondary and tertiary disorders), feedback loop, causes of hypo- and hyperfunction Disorders of adenohypophysis – regulatory hormones, growth hormone, prolactin, panhypopituitarism Cushing’s syndrome – causes (ACTH dependent, independent, iatrogenic), consequences of increased glucocorticoid levels (obesity, muscle atrophy, diabetes, hypertension, immunosuppression, striae, osteoporosis, CNS) Addison’s disease, disorders of mineralocorticoids – causes and consequences of increased mineralocorticoid levels, hypocorticalism, Addisonian crisis Disorders of adrenal medulla, stress – causes and consequences of increased catecholamines levels (vazoconstriction, organ perfusion), stress reaction, pheochromocytoma Hyperfunction of thyroid gland – causes and consequences of increased thyroid hormone levels, Graves-Basedow´s disease, thyreotoxic crisis Hypofunction of thyroid gland – causes (acquired, congenital) and consequences of decreased thyroid hormone levels, Hashimoto’s thyroiditis, myxedematous coma Disorders of sex hormones in ontogenesis – sex determination and development (types – chromosomal, gonadal, genital, hormonal), (pseudo)hermaphroditisim, (pseudo)pubertas praecox Diabetes mellitus, classification and acute complications – types, prediabetes, insulin deficiency x resistance, symptoms of DM, coma hypoglycemic, ketoacidotic and hyperosmolar (principles of therapy) Chronic complications of diabetes mellitus – macrovascular, microvascular – nephropathy, retinopathy, neuropathy, diabetic foot syndrome, principles of therapy of DM Examination of endocrine glands – adrenal glands (24 hour measurement, dexamethasone suppression test, ACTH production), thyroid gland (TSH/T3/T4, antibodies), DM – glycemia, oGTT, C-peptide, glycated hemoglobin
GIT, METABOLISM Obesity – primary and secondary, types of obesity and adipose tissue (endocrine function), consequences and risks of obesity Metabolic syndrome, gout – diagnostic criteria and other disorders in metabolic syndrome, inzulin resistance, hyperuricemia – causes and clinical manifestations Primary hyponutrition – kwashiorkor, marasmus, simple and stress starvation, cachexia, disorders of food intake (anorexia, bulimia), consequences of malnutrition Malabsorption syndrome – primary (coeliac disease, selective malapsorption) and secondary, consequences of malabsorption Consequences of vitamin deficiency, hypervitaminosis – vitamin A (retina, keratinization), D (Ca/P metabolism), E, K (blood clotting), B1 (beri-beri), folic acid and B12 (anemia, CNS), C (scurvy) Disorders of oesophagus and stomach – motility disorders, GERD, early and late dumping syndrome, pathogenesis of ulcers, functional consequences of gastritis Vomiting, diarrhea – causes (pathogenesis), consequences (changes in hydration, ions, AB balance), complications Constipation, ileus – causes (pathogenesis), consequences (changes in hydration), types of ileus and life threatening complications Pancreatitis – acute and chronic, pathogenesis, diagnostics, consequences and complications (shock, DIC, ARDS), principles of therapy Liver failure – acute and chronic, causes, diagnostics and consequences (encephalopathy, coagulopathy, hepotorenal and hepatopulmonary syndrome) Portal hypertension and ascites – pathogenesis, portocaval shunts, splenomegaly, hypoalbuminemia, hyperaldosteronism, complications Examination of function of liver and pancreas – liver tests, albumin, INR, ammonia, amylase, lipase
NERVOUS SYSTEM Upper motor neuron disorders (spastic paralysis) – causes (corticospinal tract lesions, motoric cortex, decortication and decerebration), paresis/plegia, spasticity, abnormal reflexes (Babinski) Lower motor neuron disorders (flacid paralysis) – causes (radikulopathies, neuropathies), paresis/plegia, atrophy, hyporeflexia, fasciculations and fibrilations Spinal shock – pseudoflacid plegia, phases of development, organ consequences (urinary bladder), neurogenic shock, autonomic dysreflexia Disorders of neuromuscular junction and muscles – motor unit, toxins, myastenia, Lambert-Eaton, muscular dystrophies, myotony, endocrine myopathies Disorders of somatosensoric sensation, pain – dissociation of sensation, spinal syndromes - anterolateral and medial lemniscal system, types of pain, mechanisms of nociception, principles of pain therapy Disorders of basal ganglia – pathways (direct and indirect) and mediators of BG, hypokinetic-hypertonic syndrome (parkinsonism), hyperkinetic-hypotonic syndrome (chorea, athetosis, hemibalism) Cerebellar disorders – paleocerebellar (ataxia, titubation) and neocerebellar syndrome (dyssynergia, dysmetria, adiadochokinesis) Schizofrenia, mood disorders – neurotransmiters, positive (hallucinations, delusions) and negative signs, unipolar and bipolar disorder, anxiety Syndrome of dementia - cognitiv functions, degenerative, vascular, Alzheimer´s disease, frontotemporal dementia, Lewyho bodies dementia Disorders of cerebral blood flow – flow regulation, global disorders and strokes, ischemic (TIA, RIND) and hemorhagic strokes, hypoxic-ischemic encephalopathy), excitotoxicity, penumbra, consequences (motor functions, aphasia etc.), princples of therapy Intracranial hypertension and hypotension – Monro-Kellie doctrine, causes, symptoms (trias), consequences (herniations), princples of therapy Brain edema, disorders of brain blood barier– types (vasogenic, cytotoxic, osmotic, interstitial), brain blood barier - permeability, ontogenetic development(newborns) Sleep disorders and disorders of consciousness – disorders of REM and nonREM phases (insomnia, narcolepsy, somnambulism, sleep paralysis, pavor nocturnus, sleep apnoa), causes of disorders of conciousness (ARAS), quantitative and qualitative disorders (GCS) Epilepsy and epileptic seizures – causes (neurotransmiters, paroxysmal depolarization shift), focal (with elementar or complete symptomatology), generalized (with motoric or without motoric symptoms), status epilepticus Examination method in neurology – EMG, EEG, polysomnography, monosynaptic reflex
Poslední úprava: Maxová Hana, doc. MUDr., Ph.D. (31.08.2021)
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