Respiratory diseases.

1. What are the functions of the respiratory system?

The major function of the respiratory system is gas exchange. Oxygen diffuses out of the lungs and into the
blood, while carbon dioxide diffuses in the opposite direction, out of the blood and into the lungs. Also the
process of gas exchange regulates the acid-base balance of the body - the component of homeostasis.
The respiratory system also helps maintain body temperature and eliminate excess water from the body.
The movement of gas through the larynx, pharynx, and mouth allows humans to speak.

2. What is bronchitis? What types of it do you know? Speak on its causes, clinical pattern, treatment
and complications.
Bronchitis is an acute inflammation of the air passages within the lungs. It occurs when the trachea and
the large and small bronchi became inflamed because of infection or irritation. Bronchitis occurs most
often during the cold and flu season, usually coupled with an upper respiratory infection. It also occurs
when a person inhales irritating fumes of dust, chemical solvent
and smoke. Doctor diagnoses bronchitis on a basic symptoms and a physical examination. Methods of
diagnostics: blood test, X-ray, oxygen saturation measurement, pulmonary function test.
Acute bronchitis most commonly occurs after an upper respiratory infection such as the common cold or a
sinus infection. The affected person may have symptoms such as fever with chills, muscle aches, nasal
congestion, and sore throat. The cough may be dry or may produce phlegm, which can last for 2 weeks.
Wheezing may occur because of the muscular tightness and inflammation of the airways. Chronic
bronchitis is characterized by the presence of a productive cough that lasts for three months at least two
years. Chronic bronchitis occurs when person inhales dust, chemicals while working. Symptoms may
include wheezing, dyspnoea. The cough is often worse after awakening and the sputum produced may have
a yellow or green color.
Treatment: First of all, antipyretics such as aspirin, tylenol will help with fever and muscle aches.
Drinking a lot of fluids is also important. A cool mist vaporizer can help decrease bronchial irritation. An
over-the-counter cough suppressant may be helpful. Bronchodilator inhalers will help open airways and
decrease wheezing. For natural treatment we can use honey, lemon, ginger, bay leaf. If the doctor suspects
a bacterial infection, antibiotics will be prescribed for 4-5 days. And different immunomodulators
should be given too. In some cases patients may have complications such as pneumonia, recurrent
respiratory infections, emphysema, right-sided heart failure, pulmonary hypertension.

3.What is pneumonia? What are the causes and symptoms of pneumonia? Speak on its treatment and
complications.
It’s an inflammation of lung tissue.
The infection causes the air sacs of the lung, where oxygen passes into the blood, to become clogged with
pus and other secretions, so that the supply of oxygen to the blood is reduced.
Causes: Pneumonia is divided into viral and bacterial form. An infection leading to pneumonia can be due
to a variety of agents, including fungi, protozoa, bacteria or viruses.
The resulting symptoms include shortness of breath, fever, chills, and persistent cough that brings up
phlegm discolored by pus and sometimes by blood and chest pain. +chest pain, sweating, wheezing.
Treatment: Viral pneumonia does not respond to antibiotic treatment (anti-viral drugs), but antibiotics
may be given if there is a bacterial infection. Other treatments given for all cases of pneumonia include
medications to ease a cough and reduce pain. Patient may be hospitalized to get an oxygen therapy.
Nonsteroidal anti-inflamatory drugs – redce pain and fever. Cough suppressants, mucolytic drugs – to
thin sputum and ease cough.
The complications are pleural effusion, empyema, abscess, pulmonary oedema.

3. What is TB? What is its cause? What types of it do you know? What are the symptoms and
possible complications of TB? Speak about treatment.
Pulmonary tuberculosis is a contagious bacterial infection caused by Mycobacterium tuberculosis.
TB can develop after inhaling droplets sprayed into the air from a cough or sneeze by someone infected
with bacteria.
It can occur in 2 forms: dormant disease and active form.
Symptoms: The primary stage doesn’t have symptoms. After the developing the TB, symptoms may
include minor cough, mild fever, fatigue, unintentional weight loss, coughing up blood, phlegm-producing
cough. Additional symptoms are wheezing, excessive sweating especially at night, chest pain, breathing
difficulty, clubbing of fingers, unusual breath sounds.
Treatment is typically lasts 6 months with anti antitubercular drugs (Izonaizid, Rifamin). Hospitalization
may be indicated to prevent the spread of the disease to others until the contagious period has been
resolved.
Complications: drug resistance to particular TB strains, Relapse of the disease.
Cardiovascular disease.
5.What are the functions of the cardiovascular system?
Cardiovascular system is represented by a system of vessels that convey blood to and from tissues
throughout the body, bringing nutrients and oxygen and removing wastes and carbon dioxide; protect the
body from infection and blood loss., help the body maintain a constant body temperature
(‘thermoregulation’), help maintain fluid balance within the body.

6. What is ischemic heart disease? What types of it do you know? What factors may cause it? What are
the symptoms and possible complications? Treatment.
Ischemic heart disease is a disease characterized by ischemia (reduced blood supply) of the heart
muscle.
There two types of IHD: stable (symptoms appear on exertion and can be managed by the patient, can be
easily treated by drugs) and unstable (symptoms appear at unpredictable level of exertion and are poorly
managed by the patient; cannot be so easily treated by drugs).
Symptoms of stable IHD include angina (chest pain) and decreased exercise tolerance.
Symptoms of unstable IHD include chest pain at the rest or rapidly worsening angina + shortness of breath,
arrhythmia, weakness, anxiety, nausea and vomiting, heart palpitations, swelling in the legs and feet and
abdomen, difficulty sleeping, and sometimes lethal-death.
The main causes of IHD are
•hypercholesterolemia •high blood pressure •atherosclerosis•thrombosis•embolism •heart/renal failure
Its risk increases with age, smoking, diabetes, hypertension, male sex and genetic predisposition.
The main complications of IHD include cardiac insufficiency, myocardial infarction, myocarditis, heart
attack, acute coronary syndrome, heart failure.
Treatment:
1.Changing of lifestyle: includes healthy diet, smoking cessation, control of cholesterol level, etc
2.With medications: includes aspirin (to prevent blood clotting), beta-blockers (to reduce arrhythmia),
statins (to reduce level of LDL), nitroglycerin (to dilate coronary arteries), coatings (to decrease cholesterol
level), anticoagulants (to prevent blood clotting), diuretics (to reduce the excess fluid).
3.Surgical treatment: percutaneous coronary angioplasty, coronary artery bypass surgery.

7. What is acute myocardial infarction? Describe its pathogenesis.

Acute myocardial infarction commonly known as a heart attack, is an interruption of blood supply of
the heart muscle due the blockage of coronary artery after rupture of a vulnerable atherosclerotic plaque.
Also a heart attack can be caused by a spasm of coronary artery, pneumonia, heart failure, chronic kidney
disease etc.
The heart muscle doesn’t receive oxygen from the blood and it can not be able to pump the blood very
well. This can cause a chest, jaw, neck or back pain, shortness of breath, and sometimes death.
The heart attack happens when blood flow apart of the heart muscle is blocked. It is harmful because the
heart muscle is no longer getting oxygen from the blood. Most heart attacks are caused by a blood clot in
one of the coronary arteries. Occasionally a heart attack can be caused by a spasm of coronary artery - the
blood vessels that supply oxygenated blood to the heart muscle. The artery's lining becomes
hardened,stiffened and swollen with all sorts of gunge-including calcium deposits, fatty deposits, and
abnormal inflammatory cells - to form a plague that protrude into the channel of an artery and the blood
flow to the muscle is decreased. The heart may not be able to pump the blood very well. This can cause a
chest, jaw, neck or back pain, shortness of breath.

The main causes of myocardial infarction include: atherosclerosis of coronary artery, aneurism,
rupture of aorta, hyper or hypotension, bacterial infection, anemia, stenosis.
The risk factors are: previous cardiovascular disease, older age, tobacco smoking, high blood levels of
lipids and low level of high density lipoproteins, diabetes, high blood pressure, obesity, chronic
kidney disease, heart failure, living in polluted areas.
Diagnosis: ECG, echocardiography, blood tests.
8. What are patients complains during the attack? Treatment.
During the attack the most common patient’s complaint is chest pain which is described as a sensation of
tightness, pressure or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower
jaw, neck, right arm, back and epigastrium (where it may mimic heartburn). Patient may also complain of
dyspnoea (shortness of breath), diaphoresis (an excessive form of sweating), weakness, light-headedness,
(nausea, vomiting and palpitations).
The treatment for myocardial infarction includes 3 steps: The aim of treatment is to save as much
myocardium as possible.
1. First aid of myocardial infarction includes: oxygen, painkillers, aspirin, and nitroglycerin. Depending on
clinical picture further treatment may include: Oxygen, ACE-inhibitors, Beta-blockers to reduce heart
rate, aspirin or heparin to prevent blood clotting, morphine or other painkillers to relieve pain,
nitroglycerin to dilate coronary arteries, statins to reduce level of LDL.
2. Hospital treatment (depends on symptoms/causes) - medical treatment and surgical intervention.
3. Changing a lifestyle.

9. What is hypertension? Its types, causes, symptoms, treatment, complications.

Hypertension is a chronic medical condition in which the blood pressure in the arteries is constantly
elevated.
Hypertension is classified either primary (essential) hypertension or secondary hypertension.
Primary hypertension (95% cases) has no obvious causes.
Pathophysiology of primary hypertension is associated with the narrowing of artery lumina.
Secondary hypertension (5% cases) is caused by other conditions that affect kidneys (renal disease),
arteries, heart or endocrine system.
There are also malignant hypertension, which is extremely high blood pressure that develops rapidly and
causes some type of organ damage.
The exact causes of high blood pressure are not known, but several things may play a role, including:
unhealthy diets, physical inactivity, consumption of tobacco/alcohol/salt/fats, being overweight (obesity),
However there have been also identified such risk factors as: genetics, age, sex, race and stress.
Hypertension is called a “silent killer” because it may have no warning signs or symptoms. But when
symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision
changes and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion and
muscle tremors.
Treatment consists of the prevention, first of all, and then can be pharmaceutical or non-pharmaceutical,
depending on the risk and symptoms.
Non-pharmaceutical treatment includes healthy lifestyle, cessation of smoking, reduced consumption of
fats, salt, alcohol, regular exercising.
Pharmaceutical treatment includes drugs which reduce blood pressure (hypotensive drugs): ACE-
inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers.
Spasmolytics and diuretic drugs can be prescribed separately or in the combination with hypotensive drugs.
Imidazoline receptor agonists are used to control blood pressure by activating parasympathetic nervous
systems.
Complications of the hypertension are: stroke, myocardial infarction, heat failure and kidney failure. It
also may include end-organ damage.

10. What is atherosclerosis? Speak on its causes and pathogenesis. Clinical pattern, prevention,
treatment. What can it lead to?
Atherosclerosis is a condition in which an artery wall thickens as a result of build-up of fatty materials
such as cholesterol. It is a chronic inflammatory response in the walls of arteries, mainly due to the
accumulation of macrophage white blood cells and promoted by low-density lipoproteins without adequate
removal of fats by high-density lipoproteins.
The way of developing:
 LDL oxidized by free radicals;
 Oxidized LDL comes in contact with an artery wall and damages it;
 the body’s immune system sends specialized white blood cells to absorb the oxidized LDL forming
foam cells;
  White blood cells are not able to process the oxidized-LDL and rupture depositing a great amount
of oxidized cholesterol into the artery wall;
 the cholesterol plaque causes the muscle cells to enlarge and form a hard fibrous cover;
 this cover causes a narrowing of the artery, reduces blood flow and increases blood pressure.

At the higher risk of atherosclerosis are people, who has obesity, diabetes, high blood pressure, congenital
stenosis, genetic predisposition and who is smoking, drinking alcohol and eating fatty food.
Atherosclerosis has different treatment and prevention according to its type. Atherosclerosis in the ocular
arteries
has symptoms such as poor-eye-sight, which can lead to blindness. Atherosclerosis in arteries of
extremities can cause fever, sweating, pains, cold extremities, which can lead to gangrene. Atherosclerosis
in arteries of the brain can cause mental difficulties and lead to stroke or necrosis of the brain's tissues.
Atherosclerosis in arteries of kidneys can cause intoxication, anuria, oliguria, fatigue, sugaruria, pains in
the back, fever, general malaise, mental difficulties, which can lead to kidney failure or renal coma.
Treatment is divided into two types: pharmaceutical and non-pharmaceutical. The last one includes life
style changes, diet, cessation of smoking, regular exercises. Pharmaceutical includes thrombolitic therapy,
aspirin, vitamins, bypass surgery and angioplasty.
Complications: hypertension, myocardial infarction, IHD, Stroke, Necrosis of organs.
Gastrointestinal diseases.
11. Describe the process of digestion. What are the main functions of the digestive system in general?
The digestive system has three main functions: breaking down large food molecules into smaller
molecules, absorbing molecules and vitamins into the body, which go to the body sells and removing
wastes from the body.
The first step of digestion begins in the mouth. The saliva helps moisten food particles and begins the
breakdown of carbohydrates. The food is chewed to form a bolus and is forced to the pharynx by the
tongue. The oesophagus is a straight, muscular tube connecting the pharynx to the stomach. The stomach
is a c-shaped organ lying in the upper left part of abdomen. The muscle layer churns food and breaks into a
chyme. The gastric glands secrete gastric juice, which contains hydrochloric acid, mucus, pepsinogen.
Pepsinogen converts to pepsin in the presence of Hydrochloric acid and breaks large proteins into small
reffered to as peptides. Some absorption occurs in stomach such as water, glucose, ions and alcohol.The
small intestine is divided into three parts: duodenum, jejunum, ileum. Pancreas secretes enzymes, which
go to the pancreatic duct, which opens into duodenum. Bile, which breaks down large fat molecules into
smaller can be easily digested by lipase enzymes (enters the duodenum through the bile duct). The surface
of intestine contains villi, which can absorbed molecules. The large intestine consists of caecum,
ascending colon, transverse colon, descending colon, sigmoid colon and rectum. The function is to
reabsorb water, ions and vitamins. It stores the materials not digested by the body and forms the faeces,
which consists of water, inorganic salts, bacteria and undigested food.

12. What is gastritis? What are its causes and symptoms? What increases the risk of getting gastritis?
Gastritis is an inflammation of the lining of the stomach. There are two types of gastritis: acute and
chronic. Weaknesses or injury to the mucus-lined barrier that protects your stomach wall allows your
digestive juices to damage and inflame your stomach lining. A number of diseases and conditions can
increase your risk of gastritis, including Crohn's disease and sarcoidosis, a condition in which collections of
inflammatory cells grow in the body. Acute gastritis involves sudden, severe inflammation. Chronic
gastritis involves long-term inflammation that can last for years if it’s left untreated.
Acute gastritis has causes such as excessive alcohol consumption; prolonged use of non-steroidal anti-
inflammatory drugs; surgery; traumatic injury; burns and severe infections, non-healthy diet, smoking.
Chronic gastritis can be caused by untreated acute, irregular diet, stress, the infection with bacteria
primarily H. Pylori; chronic bile reflux; stress; autoimmune disorders.Weaknesses in the mucus-lined
barrier that protects your stomach wall allow digestive juices to damage and inflame the stomach lining. A
number of diseases and conditions can increase your risk of gastritis.
Gastritis may have no symptoms. But the most common symptom is upper central abdominal pain which
can be dull, vague, burning, gnawing or sharp. Indigestion, Belching, Abdominal bloating, Feeling full
after a few bites of food, Loss of appetite, Nausea, Vomiting (vomit mass can be clear green or yellow,
blood-streaked or completely with blood), Pernicious anaemia. Pernicious anemia is a condition in which
the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12. Vitamin
B12 is a nutrient found in some foods. The body needs this nutrient to make healthy red blood cells and to
keep its nervous system working properly. People who have pernicious anemia can't absorb enough
vitamin B12 from food. This is because they lack intrinsic (in-TRIN-sik) factor, a protein made in the
stomach. A lack of this protein leads to vitamin B12 deficiency.
The risk of having gastritis increases with preferring hot, spicy, oiled, salty, fast food, using drugs,
alcohol, smoking.

13. How to diagnose and treat gastritis? What does the therapy depend on?
Methods of diagnostics gastritis are: gastroscopy, various blood tests that include blood test cell count,
blood test for presence of H. pylori, liver, kidney, gallbladder or pancreas functions, stool sample, х-ray,
checking for blood in the stool, stomach biopsy, test for gastritis and other conditions.
Treatment is prescribed individually depending on the causes and clinical picture. If gastritis caused by
NSAIDs or other drugs, avoiding those drugs may be enough to relieve your symptoms. Gastritis as a result
of H. pylori is routinely treated with antibiotics that kill the bacteria. Therapy depend on the types of
gastritis (acute or chronic) Treatment of chronic gastritis can be divided into two types according to the
pathology: hypoacidic and hyperacidic. Treatment for gastritis with high acidity may also include:
• Antacids (cimetidine, ranitidine, famotidine) neutralize stomach acid and provide fast pain relief. [
Some antacids may cause diarrhea or constipation]
• Medications that reduce the amount of acid your stomach produces include: famotidine (Pepcid)
[By lowering the amount of acid that’s released into your digestive tract, these medications relieve the pain
of gastritis and allow your stomach lining to heal.]
• Probiotics have been shown to help replenish digestive flora and heal gastric ulcers. However,
there’s no evidence that they have any impact on acid secretion. There are currently no guidelines
supporting the use of probiotics in ulcer management.
• Proton pump inhibitors (omeprazole, lansoprazole, rabeprozole, esomeprozole) block the
producing enzyme that plays a major role in hydrochloric acid and pepsin secretion, and the also inhibit
H. pylori activity [However, long-term use of these medications, especially at high doses, can lead to an
increased risk of spine, hip, and wrist fractures. It can also lead to increased risk of renal failure,
dementia, and nutrient deficiencies.]
• Cytoprotective agents (sucralfate, misoprostol, bismuth) are designed to help protect the
tissues that line the stomach and small intestine.
Treatment for gastritis with low acidity may also include
• Acid supplement, pepsin and gastric enzymes to improve the process of digestion.
• Mineral water is prescribed to stimulate acid secretion.
• Vitamin B12 injections are given to the patients with pernicious anaemia.
• Avoiding hot or spicy food.

14. What is the stomach cancer? How does it spread in the body?
Stomach cancer, also called gastric cancer, is a malignant tumor arising from the lining of the stomach.
Stomach cancers are classified according to the type of tissue where they originate. The most common type
of stomach cancer is adenocarcinoma, which starts in the glandular tissue of the stomach and accounts for
90% to 95% of all stomach cancers. Other forms of stomach cancer include lymphomas, which involve the
lymphatic system and sarcomas, which involve the connective tissue (such as stroma).
Adenocarcinoma usually begins in cells, the building blocks that make up tissues. Tissues make up the
organs of the body. Normally, cells grow and divide to form new cells when the body needs them. As cells
grow old, they die, and new cells take their place. Sometimes this process goes wrong. New cells form
when the body doesn’t need them, and old and damaged cells don’t die as they should. The build-up of
extra cells often forms a mass of tissue called a growth or tumor.
Stomach cancer usually begins in the cells in the inner layer of the stomach. Over the time, the cancer
may invade more deeply into the stomach wall. A stomach tumor can grow through the gastric outer layer
into nearby organs, such as the liver, pancreas, oesophagus or intestine.
Stomach cancer can spread by breaking away from the original tumor. They enter blood vessels or
lymph vessels which branch all the tissues of the body. The cancer cells may found in lymph nodes near
the stomach. The cancer cells may attach to other tissues and grow to form new tumors that may damage
those tissues. The spread of cancer is called metastasis.
15. Speak on the stages of stomach cancer development. What symptoms may develop during cancer
progressing? How is the stomach cancer treated? What is the role of nutrition for cancer patients?
There are 5 stages of stomach cancer:
• At the 0 stage the tumor is found only in the inner layer of the mucosa of the stomach.
• At the 1 stage the tumor has invaded only the submucosa. Cancer cells may be found in up to 6
lymph nodes. Or in another case, the tumor has invaded the muscle layer or subserosa and cancer cells have
not spread to lymph nodes.
• At the 2 stage the tumor has invaded only the submucosa. Cancer cells have spread to 7-15 lymph
nodes. Or in another case, the tumor has invaded the muscle layer or subserosa and cancer cells have
spread to 1-6 lymph nodes.Or the tumor has penetrated the outer layer of the stomach and cancer cells have
not spread to lymph nodes.
• At the 3 stage the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7-
15 lymph nodes. Or in another case, the tumor has penetrated the outer layer. Cancer cells have spread to 1-
15 lymph nodes. Or the tumor has invaded nearby organs such as the liver, colon or spleen. Cancer cells
have not spread to lymph nodes.
• At the 4 stage cancer cells have spread to more than 15 lymph nodes. Or in another case, the tumor
has invaded nearby organs and at least 1 lymph node. Or cancer cells have spread to distant organs.
• Symptoms; Early stomach cancer often does not cause symptoms. Early signs are nonspecific and
often go unnoticed. As the cancer develops, the most common symptoms are: discomfort or pain in the
stomach area; difficulties in swallowing; nausea and vomiting; weight loss; feeling of fullness or bloating
after a small meal; vomiting blood or having blood in the
• stool, fatigue, headaches,hematemesis or melena.
• Late stage gastric cancer - Palpable tumor in epigastric region,
• Treatment of the stomach cancer depends on the size, location of tumor, the stage and general
health. It is divided on stages:
• surgery - removing the whole tumor stomach or the part that has cancer;
• chemotherapy - using drugs to kill cancer cells;
• radiation therapy - using high energy rays to kill cancer cells;
• nutrition - the patient needs the right amount of calories, protein, vitamins, and minerals to maintain
his strength to heal. He may need to take daily supplements of vitamin D, B12, calcium and iron
• Proper nutrition provides patients with the ability to recover between cancer treatments, and as a
result, improve their quality of life .Nutrition is a process in which food is taken in and used by the body
for growth, to keep the body healthy, and to replace tissue. Good nutrition is important for good health.
Eating the right kinds of foods before, during, and after cancer treatment can help the patient feel better and
stay stronger. Nutrition therapy is used to help cancer patients keep a healthy body weight, maintain
strength, keep body tissue healthy, and decrease side effects both during and after treatment.

16. How is the stomach cancer treated? What is the role of nutrition for cancer patients?
Treatment of the stomach cancer depends on the size, location of tumor, the stage and general health. It is
divided on stages:
• surgery - removing the whole tumor stomach or the part that has cancer;
• chemotherapy - using drugs to kill cancer cells;
• radiation therapy - using high energy rays to kill cancer cells;
• nutrition - the patient needs the right amount of calories, protein, vitamins, and minerals to maintain
his strength to heal. He may need to take daily supplements of vitamin D, B12, calcium and iron
Proper nutrition provides patients with the ability to recover between cancer treatments, and as a result,
improve their quality of life .Nutrition is a process in which food is taken in and used by the body for
growth, to keep the body healthy, and to replace tissue. Good nutrition is important for good health. Eating
the right kinds of foods before, during, and after cancer treatment can help the patient feel better and stay
stronger. Nutrition therapy is used to help cancer patients keep a healthy body weight, maintain strength,
keep body tissue healthy, and decrease side effects both during and after treatment.

17. What liver diseases do you know? What symptoms are typical of them?
The liver is the largest gland in the body and one of the most important accessory organs of the digestive
system. There are a lot of diseases that can affect on the liver. They include cirrhosis, alcohol abuse;
hepatitis A, B, C, D, E; non-alcoholic fatty liver disease; hemochromatosis; biliary diseases.
The symptoms may include jaundice, a lack or loss of appetite, weight loss, fatigue, bloating, weakness,
itching, yellowing of the whites of the eyes, nausea and vomiting, low-grade fever.

18. What is hepatitis and its types? Compare different types of viral hepatitis (causes, way of
transmission, duration incubation period).
Condition defined by the inflammation of the liver parenchyma. Hepatitis can be infectious and non-
infectious.
Non-infectious hepatitis can be caused by toxic drugs, toxins or diseases of immune system (a condition
where the immune system attacks and destroys liver cells as foreign bodies).

Infectious hepatitis is caused by viruses A, B, C, D, E (viral) and bacteria (bacterial) and parasites.

Hepatitis A is acquired by consuming materials contaminated with faecal matter of an individual who
already has disease. It is usually communicated as a result of poor hygiene or through personal contact. The
virus is able to survive at normal room temperature for hours on a hard surface. The incubation period for
hepatitis A lasts about 2-6 weeks. Most patients recover within a few months.

Hepatitis B is spread through infected body fluids like blood, semen, saliva, suppurating sores, breast
milk. It doesn’t spread by simple physical contact. The incubation period lasts from 1 to 6 months. After
recovering the infected person will be immune to any later reinfection with this particular virus. Some
individuals may fully recover and have no symptoms and yet remain a capable of infecting others through
sexual contact, shared hypodermic needles, food or drinks.

Hepatitis C has no symptoms. Most people become chronically infected. People with strong immune
system may recover without treatment. Those with chronic hepatitis C who are not treated or cured may
live normal lives but they remain carriers of the disease and can infect other people. Some patients with
hepatitis C develop complications like cirrhosis, liver failure or liver cancer.
Incubation period lasts 2weeks-six months.

Hepatitis D attacks only individuals with hepatitis B. A person may get 2 forms at the same time. It is
transmitted through the same routs as hepatitis B. Hepatitis D can be suspected when the condition of
someone with hepatitis B suddenly becomes worse. It can be diagnosed with tests that reveal hepatitis D
antibodies in the blood.

Hepatitis E (waterborne disease) is similar to hepatitis A and is transmitted contaminated water supplies.
Incubation period lasts about 2 or 6 weeks. Most people with hepatitis E recover from it on their own
within a few months. This type of hepatitis is spread in Certain African countries and in Asia.

19. What symptoms are typical of hepatitis? When is it considered chronic? How is it possible to treat
different types of hepatitis?
1) Symptoms: fatigue, mild upper abdomen discomfort, loss of appetite, nausea, vomiting , low- grade
fever, jaundiced skin colouring, yellowing of the whites of the eyes, dark urine. If chronic hepatitis
becomes more severe, people may experience additional symptoms, including: abdominal swelling, weight
loss, muscle weakness.
2) Chronic hepatitis is type of hepatitis at which symptoms last more than a few months. The types of
hepatitis, was can be chronic, are hepatitis B, C, D, E or autoimmune chronic hepatitis.
3) In patients with acute viral hepatitis, the initial treatment consists of relieving the symptoms of
nausea, vomiting, and abdominal pain.
Only those medications that are considered necessary should be administered since the impaired liver is not
able to eliminate drugs normally. Moreover, sedatives and "tranquilizers" are avoided because they may
accentuate the effects of liver failure on the brain and cause lethargy and coma. The patient must avoid
drinking alcohol, since alcohol is toxic to the liver.
It is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. Patients with
severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids.
Treatment of chronic viral hepatitis include
• Antiviral drugs avoiding further liver damage from alcohol or NSADs (Tylenol).
• A well-balanced diet
• Regular exercises
• Cessation of smoking
• Avoiding salty food if there is a tendency to accumulate fluids
Corticosteroids are used to suppress the immune system are the main treatment of autoimmune chronic
hepatitis. These drugs usually decrease symptoms, reduce liver inflammation and prolong survival.

20. What is cirrhosis, its types and causes, symptoms and complication.
Is a consequence of chronic liver disease characterized by replacement of liver tissue (parenchyma) by
fibrosis, scar tissue and regenerative nodules leading to loss of liver function.
The types of cirrhosis are:
• Alcohol-induced cirrhosis – usually occurs after many years of heavy drinking.
• Cryptogenic cirrhosis – is a term used to describe cirrhosis of unknown origin.
• Primary biliary cirrhosis – occurs due to inflammation of the small bile duct inside the liver, leading
to eventual scarring and obstruction.
Haemochromatosis –is a disease in which excessive amounts of iron accumulate in the liver. Causes of
cirrhosis include: Alcohol abuse, fatty liver disease, hepatitis B and C, wilson diseas, biliary diseases,
cryptogenic cirrhosis, primary hemochromatosis.
Symptoms of early cirrhosis include loss of appetite, weakness, fatigue, nausea, hematemesis (vomiting of
blood) constipation or diarrhea, weight loss, the appearance spider-like blood vessels on the skin (small
angiomas), enlarged liver.
Symptoms of advanced cirrhosis include jaundice, hard liver, Medusa head, ascites, enlargement of breast
or gynaecomastioa (in men), intense itching, reddening of palms, pain in the right quadrant of abdomen.
Complications of cirrhosis include Hepatic encephalopathy, Immune system dysfunction leading to
infection, Hepatocellular carcinoma, Hepatorenal syndrome, Portal hypertension, Hepatopulmonary
syndrome, Ascites, Portopulmonary hypertension, Oesophageal varices, Portal hypertensive gastropathy.
HIV. AIDS.
21. What are the components and functions of the immune system? What two main types of
immunity do you know?
The immune system is surveillance mechanism that protect the human from microorganisms and cancer
cells.
Immunological responses serve three functions:
1) defence against invasion by microorganisms;
2) maintenance of a stable internal environment or homeostasis within the body;
3) surveillance for or recognition of abnormal cell types and their destruction.
The lymphatic system consist of lymphatic vessels, lymph fluid, lymph nodes, and lymphocytes. The
lymphatic vessels pass through the lymph nodes, which are accumulations of lymphocytes and
macrophages, held together by a fibrous connective tissue capsule.

The immune system has two major types: humoral immunity and cell-mediated immunity.
Humoural immunity is the aspect of immunity that is mediated by macromolecules found in extracellular
fluids such as secreted antibodies, complement proteins, and certain antimicrobial peptides. Humoral
immunity is named so because it involves substances found in the humors, or body fluids.
Cell-mediated immunity is an immune response that does not involve antibodies. Rather, cell-mediated
immunity is the activation of phagocytes, antigen-specific cytotoxic T-lymphocytes, and the release of
various cytokines in response to an antigen.

22. What the HIV infections? Speak on two main strains of HIV. What does HIV affect in the
human body?
HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making
a person more vulnerable to other infections and diseases.
There two main strains of HIV: HIV-1 and HIV-2.
HIV-1 is the most common type of human immunodeficiency virus. It attacks the body's immune system.
The virus destroys CD4 cells. These cells help our body fight infections. HIV-1 is more common in the
Western Hemisphere, Europe, Asia, and most of Africa. The relatively uncommon HIV-2 virus is
concentrated in West Africa but has been seen in other countries with links to West Africa. It is less
infectious and progresses more slowly than HIV-1, resulting in fewer deaths. However, without treatment,
most people living with HIV-2 will eventually progress to AIDS and die from the disease.
HIV can kill cells in the immune system. This can make it difficult for the body to fight serious infections.
These opportunistic infections may become life-threatening because they can damage the immune system
when it's already weak.

23. What are the ways of HIV transmission?

People can get or transmit HIV only through specific activities, such as through sex or injection drug use.
HIV can be transmitted only in certain body fluids from a person who has HIV. These fluids are blood,
semen, pre-seminal fluids, rectal fluids, vaginal fluids, and breast milk. HIV transmission is only possible if
these fluids come in contact with a mucous membrane or damaged tissue or are directly injected into the
bloodstream (from a needle or syringe).

24. What does the term “opportunistic disease” mean? Name and speak on some of them.
Opportunistic disease is a disease that occurs more often in people with weakened immune system.
(weakened because of AIDS, various forms of cancer or other causes)

AIDS patients may have the following opportunistic diseases:

– Kaposi’s sarcoma – that is a type of skin cancer;
- Thrush – is a fungal infection caused by the Candida albicans;
- Pneumocystic pneumonia – is a fungal infection of the lungs caused by Pneumocystis carinii;
- Tuberculosis;
- Gastrointestinal infection;
- Cytomegalovirus – which affects the retina and causes blindness;
- Cervical cancer etc.

25. Describe the course and possible treatment options of the disease.
Various drugs have been developed to fight the HIV infection. They are:
- AZT (zidovudine) – the olest one.
- DDI (didanosine).

These drugs try to disrupt key chemical reactions in HIV’s metabolic cycle, including those controlling its
reproduction. But the virus mutates rapidly, and the drugs lose their effectiveness.
Recently, there are new antiviral drugs that are used to fight against AIDS.
They are protease inhibitor, entry inhibitor, reverse transcriptase inhibitor, and integrase inhibitor.
Protease inhibitors itself prevent the virus from being able to break down proteins in the host cells and can
reduce viral loads to undetectable levels, and this can give opportunity to paitient to live normal live by
converting AIDS from a fatal disease to a chronic condition.
Patient must continue to take these drugs indefinitely.
These classes of drugs prevent creation, assembly, and spread of new viruses.
But there are some kind of unpleasant side effectd such as losing of effectiveness after an prolong perion
of time.
Treatment for AIDS consists of treatment for HIV infection and treatment for opportunistic infections. It
includes medications specific for each type of infection.

26. How to reduce the risk of being infected with AIDS?

To prevent the HIV infection:
- needles should be safely disposed and shouldn’t be shared;
- blood for transfusion should be tested before use;
- people should practice safe sex;
- use condoms every time you have sex;
- limit your number of sexual partners;
- and a pregnant woman with AIDS should take zidovudine to reduce the chances of passing HIV to
the foetus.
Allergy.
27. What is allergy? What are the most common allergens? What are the ways of their penetrating into
body?
 It is an abnormal reaction of the immune system which is characterized by hypersensitivity of an
organism to a previously encountered usually harmless substance.
The most common allergens are dust, pollen, mould, animal dander, drugs, food (such as milk, fish,
wheat, eggs, fruit, vegetables, peanuts, walnuts, almonds, hazelnuts etc.), insect venom, poison ivy, heat
and cold.
These allergens can penetrate into our body through: the air (when we inhale it), skin contact and
gastrointestinal tract.

28. When does an allergic reaction occur? What is the role of IgE in the allergic reaction? Describe the
symptoms of different types of allergic reactions.
It occurs when the body encounters some particle or substance. The specific antibodies produced in all
allergic reactions are known as Immunoglobulin E (IgE). These antibodies trigger the release of histamine
when exposed to an allergen.
Symptoms vary depending on the type of allergen and location:
An inhaled allergen (such as dust, pollen or mould) can cause: sinus congestion, runny nose, watery,
itchy or red eyes, wheezing, sneezing, impaired breathing and asthma.
A contacting allergen (such as animal dander) can cause: itching, rash (or atopic dermatitis, eczema),
hives (or urticaria), itchy bumps and swelling.
Food or drugs may cause: abdominal pain, indigestion, swelling, hives, and inability to breath.
Food allergy shouldn’t be confused with food intolerance, which involves only digestive symptoms.

29. How to determine the cause of allergy? What is the treatment for different types of allergy?
Methods of diagnostics:
 Taking anamnesis
 Skin test – the small amounts of suspected allergen are placed on the skin of the upper arm or back.
The skin is scratched to allow entry of the allergen is injected. Swelling and redness at the test site
are considered a positive result. Several allergens are usually tested at the same time.
 The Radioallergosorbent Test measures the amounts of specific IgE antibodies in the blood stream.
The results are not immediately available.
 Blood test which may show the high level of eosinophils.
Treatment:
 If a food allergy is suspected, one food for a time is eliminated from the diet and then added back to
determine if it is triggering the allergic reaction.
 Antihistamines are the drugs most often used to control symptoms of allergic reactions.
 Symptomatic treatment may be applied. Vasoconstrictors (nasal drops) are used to relieve nasal
congestion. Ocular drops are used against red and watery eyes. Topical ointments with
corticosteroids relieve itching.
 A shot of epinephrine is given in the case of severe allergic reactions.
 Corticosteroids are injected to stop severe allergic reactions such as hives, Quincke’s oedema,
anaphylactic shock.
 Allergy shots or immunotherapy can be administered to eliminate the allergy entirely. In
immunotherapy, a small amount of an allergen is injected in order to stimulate the body to produce
an antibody to neutralize it. This, in turn, blocks the IgE antibodies from reacting with the allergen
and provoking the allergic response.
30. What is anaphylactic shock? Name the first aid measures in case of anaphylactic shock.
Anaphylactic shock is a severe life-threatening allergic reaction. It can be triggered by allergens, such as
insect venom, drugs or food. Shock occurs when the allergic reaction triggers the blood vessels to dilate,
causing circulatory failure and a drastic drop in blood pressure. In the case of anaphylaxis – epinephrine
should be given.
Endocrine system. Diabetes.
31. What are the functions of the endocrine system? - ES
ЕS - the system of glands such as hypothalamus, pituitary, thyroid and other. The endocrine system is
responsible for regulating a range of bodily functions through the release of hormones, that are secreted by
the glands into the bloodstream.
The main functions of the endocrine system are productive and regulative. Endocrine glands produce
different hormones, which help to regulate the functions of other body organs. Іn general the endocrine
system is in charge of body processes that happens slowly like cell growth and other.
Also, the hormones help control mood, growth and development, the way our organs work, sexual function
and reproduction, metabolism, heart rate, blood pressure, appetite, sleeping and waking cycles, body
temperature and other.

32. Speak on the glands that make up the endocrine system and hormones they produce? Name some
hormonal disorders.
The major glands, which make up the human endocrine system, are:
1. The hypothalamus is located in the lower central part of the brain and regulates the pituitary gland.
Hypothalamus produces releasing and inhibiting hormones, which regulate anterior pituitary. Also it
produces antidiuretic hormone, that regulates body water balance, and oxytocin, that triggers uterine
contractions during labour.
2. The pituitary gland is located on the base of the brain and is called the “master gland”, because it
controls other glands. It is divided into anterior and posterior lobes.
The pituitary gland produces hormones, that control other glands; These hormones are: growth hormone
(which stimulates protein synthesis and causes growth), follicle-stimulating hormone (that stimulates
development and maturation of a follicle in a woman’s ovary), luteinizing hormone (that causes ovulation
and the formation of corpus luteum), prolactin (which activates milk production in breastfeeding women),
thyroid-stimulating hormone and corticotropin (which stimulate production of thyroid and adrenal
hormones).
3. Pineal gland is located in the middle part of the brain and is responsible for our wake-sleep cycle.
Pineal gland produces melatonin that regulates the wake-sleep cycle and skin pigmentation.
4. Adrenal glands are located on the top of each kidney and is divided into adrenal cortex and adrenal
medulla;
Adrenal cortex produces corticosteroids, which regulate salt and water balance, and metabolism. Adrenal
medulla produces adrenalin and noradrenalin, which regulate the body’s response to stress, increase blood
pressure, heartbeat, respiration and sweating.
5. Thyroid and parathyroid glands are located in the anterior part of the neck/
Thyroid gland produces calcitonin, thyroxine and triiodothyronine, which regulate calcium balance and
metabolism. Parathyroid glands produce parathyroid hormone that also regulates calcium balance.
6. Gonads, that produce androgens in men and estrogens in women.
Male gonads (testes) produce testosterone, and female gonads (ovaries) produce estrogen. These hormones
regulate body changes associated with sexual development. Ovaries also produce progesterone that
regulates menstrual cycle and pregnancy.
7. Endocrine part of the pancreas, that is responsible for carbohydrate metabolism.
Pancreas produces insulin and glucagon, which regulate carbohydrate metabolism.
Excessive or insufficient amount of different hormones may result in hormonal disorders, such as:
- Cushing’s syndrome, which is excessive amount of glucocorticoid hormones due to tumour in the
pituitary gland;
- Addison’s disease, that is deficiency of adrenal hormones, caused by autoimmune reaction or cancer;
- Virilization, which is the development of exaggerated masculine characteristics due to excessive
production of androgens;
- Hypoglycaemia, that is abnormally low level of glucose;
- Galactorrhoea, which is characterized by production of breast milk in men or women, who aren’t
breastfeeding;
- Precocious puberty, that is excessive production of gonadotropins leading to body changes at an
abnormally young age;
- Seasonal affective disorder, which is excessive production of melatonin, especially during winter.

33. What types of diabetes mellitus do you know? What are the causes, symptoms and treatment of both
types of diabetes mellitus?
Diabetes mellitus is a disorder that is characterized by abnormally high level of glucose in the blood.
There are two types of diabetes mellitus: type I diabetes mellitus (or insulin-dependent diabetes), and type
II diabetes mellitus (or non-insulin-dependent diabetes).
Type I diabetes mellitus occurs when the body’s immune system mistakenly attacks beta cells in the
pancreas that make insulin. Genetic and environmental elements, such as viruses, may play a role. As a
result most of insulin-producing cells are destroyed, and a patient must regularly inject insulin to survive.
Symptoms:
  excessive hunger;
 excessive thirst;
 blurred vision;
 fatique;
 frequent urination;
 weight loss in a short period of time
Treatment:
 insulin;
 metformin (helps lower sugar in the blood by reducing sugar production in the liver)
 healthy diet and exercise;
 frequent blood sugar monitoring;
 carbohydrate counting.
Type II diabetes mellitus occurs when the pancreas continues to produce insulin, but the body develops
resistance to its effects. There may be a genetic predisposition to developing type 2 diabetes.
Symptoms:
 constant hunger;
 a lack of energy;
 fatigue;
 weight loss;
 excessive thirst;
 frequent urination;
 dry mouth;
 itchy skin;
 blurry vision.
If blood glucose levels have been high for a long time, the symptoms can include:
 foot pain;
 feelings of numbness in your extremities, or neuropathy;
 slow-healing cuts or sores;
 yeast infections.
Treatment:
 control weight and keep heart healthy;
 eat at regular intervals;
 low-carbohydrate diet;
 regular exercise;
 oral hypoglycaemic drugs.

34. What are the complications of diabetes mellitus?

The complications of diabetes mellitus include:
 Blood vessels – poor circulation causes wounds to heal poorly and can lead to heart disease, stroke,
gangrene of the feet and hands, impotence and infections.
 Eyes – decreased vision and, ultimately, blindness.
 Kidneys – poor kidney function; kidney failure.
 Nerves – sudden or gradual weakness of a leg; reduced sensations, tingling, pain in the hands and
feet; chronic damage to nerves.
 Autonomic nervous system – swings in blood pressure; swallowing difficulties, altered
gastrointestinal function.
 Skin – sores, deep infections (diabetic ulcers); poor healing.
 Blood – increased susceptibility to infection.
 Connective tissue – carpal tunnel syndrome; Dupuytren's contracture.

35. What are the risk factors for developing diabetes? How is it possible to prevent it?
Causes of type 1 diabetes are unknown so it is hard to detect risk factors.
But mostly people with genetic predisposition are in risk factors.
Risk factors for type II diabetes mellitus include:
 obesity,
  inactivity,
 genetic predisposition, age 45 years or older,
 high blood pressure and high cholesterol level.
There is no preventive measure for type 1 diabetes
But to prevent complications you should keep your blood sugar levels as close to normal level as
possible and getting regular checkups.
Prevention of diabetes type 2 includes weight control and physical activity, eating healthy, getting
regular physical activity, keeping your blood pressure and cholesterol at the levels your doctor sets, Take
medicines as prescribed by your doctor, even if you feel good and getting regular checkups too.

36. What is diabetes insipidus? Speak on it.

Diabetes insipidus is a condition characterized by excessive thirst and excretion of large amounts of
severely dilute urine.
Diabetes insipidus occurs when the body can't properly balance the body's fluid levels. When the fluid
regulation system is working properly, kidneys help maintain this balance. The kidneys remove fluids
from the bloodstream. This fluid waste is temporarily stored in the bladder as urine, until person urinates.
The body can also rid itself of excess fluids through sweating, breathing or diarrhea. If someone have
diabetes insipidus, the body can't properly balance fluid levels.
There are 2 major types of DI: central and nephrogenic.
Central DI results from damage to the pituitary gland, which disrupts the normal storage and release of
ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries,
neurosurgery, or genetic disorders
Nephrogenic DI results when the kidneys are unable to respond to ADH. The kidneys' ability to respond
to ADH can be impaired by drugs like lithium, by chronic disorders including polycystic kidney disease,
kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of
nephrogenic diabetes insipidus is never discovered.
Normally, ADH increases the water reabsorption in the collecting ducts of the nephrons and regulate the
water content of the body. In the absence of ADH (central DI), and when the kidneys are resistant to ADH
(nephrogenic DI), the water cannot be reabsorbed. Instead, it is increasingly excreted by the kidneys, which
produce a high volume of diluted urine.
Symptoms
Patients with DI present with polyuria, (urinary output is more than 3 L per day and may reach up to 20 L
per day), hypo-osmolar urine (the urinary osmolality < 300 mOsm/kg) and polydipsia, nocturia.
The other symptoms are lethargy, thirst, weakness, irritability, confusion, convulsions and even coma.
Methods of diagnostics
A doctor must determine which type of diabetes insipidus is involved before proper treatment can begin.
Diagnosis is based on a series of tests, including urine test and a fluid deprivation test.
In some patients, a magnetic resonance imaging (MRI) of the brain may be necessary as well.
Treatment
To treat central DI that results from any kind of damage to the hypothalamus or pituitary, a synthetic
hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking
desmopressin, a person should drink fluids only when thirsty and not at other times.
A person with nephrogenic (DI) may be given antidiuretics or NSAIDs. Again, with this combination of
drugs, one should drink fluids only when thirsty and not at other times.
Complications
Dehydration which may lead to death
Prevention
The disease cannot be prevented. However, the complications which develop in its course can be
avoided by means of adopting the right therapeutic regimen, including appropriate dose modification for
the desmopressin. The prompt treatment of the head trauma and the space occupying lesion of the CNS
also helps in preventing the development of this condition.

Nervous system diseases

37. What are the functions of the nervous system? How is the nervous system classified?
The nervous system is a complex collection of nerves and specialized cells known as neurons that
transmit signals between different parts of the body. It is essentially the body's electrical wiring. The
nervous system is the most complex and highly organized body system. It receives information from the
sensory organs via nerves, transmits the information through the spinal cord, and processes it in the brain.
The nervous system directs our body’s reactions to the world and also controls most of our internal
functions, everything from muscle movement and blood vessel dilation to the learning of anatomy and
physiology facts.
Structurally, the nervous system has two components: the central nervous system and the peripheral
nervous system. According to the National Institutes of Health, the central nervous system is made up
of the brain, spinal cord and nerves. The peripheral nervous system consists of sensory neurons, ganglia
(clusters of neurons) and nerves that connect to one another and to the central nervous system.
Functionally, the nervous system has two main subdivisions: the somatic, or voluntary, component; and
the autonomic, or involuntary, component. The autonomic nervous system regulates certain body
processes, such as blood pressure and the rate of breathing, that work without conscious effort. The somatic
system consists of nerves that connect the brain and spinal cord with muscles and sensory receptors in the
skin.
The function of the nervous system is to send signals from one cell to others, or from one part of the
body to others. Your nervous system uses specialized cells called neurons to send signals, or messages, all
over your body. These electrical signals travel between your brain, skin, organs, glands and muscles. Also
It provides higher mental functions, such as thinking, memory, behavior, speech, mood, and also controls
our reflexes.
The messages help you move your limbs and feel sensations, such as pain. Your eyes, ears, tongue, nose
and the nerves all over your body take in information about your environment. Then nerves carry that data
to and from your brain.
Together with the endocrine system, the nervous system is responsible for regulating and maintaining
homeostasis. Through its receptors, the nervous system keeps us in touch with our environment, both
external and internal.
So in general functions of the NS:
 Sensory
 Integrative (learning, thinking, studying)
 Motor

38. What brain diseases do you know? Define them.

Despite being protected by the thick bones of the skull, suspended in cerebrospinal fluid, and isolated
from the bloodstream by the blood-brain barrier, the human brain is susceptible to many types of damage
and disease. The most common forms of physical damage are closed head injuries such as a blow to the
head, a stroke, or poisoning by a wide variety of chemicals that can act as neurotoxins. Infection of the
brain is rare because of the barriers that protect it, but is very serious when it occurs. The human brain is
also susceptible to degenerative disorders, such as Parkinson's disease, multiple sclerosis, and Alzheimer's
discase. A number of psychiatric conditions, such as schizophrenia and depression, are widely thought to
be caused at least partially by brain dysfunctions, although the nature of such brain anomalies is not well
understood.
Also another brain disorders are:
 Alzheimer's Disease. AD begins deep in the brain where healthy neurons begin to work less
efficiently and eventually die.
 Dementias. Dementia is a syndrome that involves memory loss and decline in intellectual
functioning that is severe enough to interfere with an individual’s ability to perform routine tasks.
Dementia is a decline in cognitive function resulting from death of nerve cells in the brain. The
most common form of dementia is Alzheimer’s disease.
 Brain Cancer. Brain tumors - abnormal tissue growth inside the brain
 Epilepsy and Other Seizure Disorders.
 Mental Disorders. Illnesses or medical conditions that develop in or affect the brain. These
medical conditions disrupt a person’s thinking, feeling, mood, daily functioning and ability to relate
to others.
 Parkinson's and Other Movement Disorders. Parkinson’s disease is characterized by slow
degeneration of the central brain areas, causing problems with movement and coordination. It is a
brain disorder that leads to shaking (tremors) and difficulty with walking.
  Stroke and Transient Ischemic Attack (TIA). A stroke happens when blood flow to a part of the
brain is interrupted because a blood vessel in the brain is blocked or bursts open. Stroke – that is an
interruption of blood supply of the brain
 Multiple sclerosis is a disorder in which myelin sheath (cover) is damaged.
 Cerebral edema – swelling of the brain tissue.
 Hydrocephalus – an abnormally increased amount of cerebrospinal fluid inside the skull.
 Meningitis – is an inflammation of the brain caused by infection.

A number of psychiatric conditions, such as schizophrenia and depression, are caused by brain
dysfunction, although the nature of such disorders is not well understood.

39. What is stroke? What are the types of brain stroke?

It is the acute interruption of the blood supply to the brain which may result in death of the brain cells.
Usually occurs when one of the arteries is blocked because of narrowing of the small arteries within the
brain or the hardening of the arteries that lead to the brain(atherosclerosis). Sometimes may be as a result
of embolism, in which a clot travelled from the heart to brain.
There are two chief types of strokes:
 Ischemic stroke
 Hemorrhagic stroke.
ISCHEMIC STROKE is the result of a blocked artery due to blood clot that blocks the flow of blood and
oxygen to the brain.. This is the most common type of stroke and it is the cause of 90% of all strokes. This
type of stroke can occur in 2 ways:
Thrombotic stroke - This occurs when the blood clot (thrombus) forms in an artery that supplies blood to
your brain due to a blood vessel that is already narrow. The clot deprives a part of the brain of oxygen and
blood causing the cells of that part of the brain to die.
Embolic stroke -This is also called cerebral embolism and it occurs when a blood clot or other debris
breaks off (embolus) from a blood vessel away from your brain and travels through your bloodstream to
lodge in narrower brain arteries.
HEMORRHAGIC STROKE - occurs when a blood vessel in a part of the brain becomes weak and leaks
or ruptures, causing blood to leak into the brain (Hemorrhage). Hypertension (high blood pressure) and
aneurysms (weak spots in blood vessels) are the most common causes of brain hemorrhages. It may also be
caused by the rupture of a defective blood vessel. There are two types of hemorrhagic stroke.
Intracerebral hemorrhage and Subarachnoid hemorrhage

40.What are the main causes of stroke?

There are two main causes of stroke:
 blocked artery (ischemic stroke)
 leaking of a blood vessel (hemorrhagic stroke).

The main cause of haemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain
and make them more likely to split or rupture.

The ischemic stroke is formed because of narrowing of the artery by a plaques (athetosclerosis) and some
things may speed up process of their forming:
These include:
 smoking
 high blood pressure (hypertension)
 obesity
 high cholesterol levels
 diabetes
 excessive alcohol intake

41. What are the risk main causes of stroke?

Risk factors for having stroke, which can’t be controlled by an individual, are age, gender and genetics.
Other risk factors can be controlled.
They include: high blood pressure, high cholesterol level, diabetes, obesity, smoking, physical inactivity
and stress.

42. What do the symptoms and treatment of the brain stroke depend on? What are they?
Symptoms of stroke depend upon what area of the brain has stopped working due to loss of its blood
supply. Often, the patient may present with multiple symptoms including the following:
 consciousness or confusion
 Acute onset of weakness or paralysis of half or part of the body
 Numbness of one half or part of the body
 Partial vision loss
 Double vision
 Difficulty speaking or understanding speech
 Difficulty with balance and vertigo
The symptoms of ischemic and hemorrhagic stroke may be the same, but patients with hemorrhagic
stroke may also complain more of headache and vomiting.

Treatment of a brain stroke depends on its type.

Ischemic stroke may be treated by medication to break up the clot causing the stroke.
 Tissue plasminogen activator is usually prescribed.
 Anticoagulants are prescribed to prevent the development of blood clots.
 Statins may be prescribed to reduce the level of cholesterol in blood.
 Surgery may be necessary to remove the inner wall of the carotid artery (carotid endarterectomy).
 Unlike the ischemic stroke, the treatment for hemorrhagic stroke doesn’t involve anticoagulants.
Thinning the blood would increase the amount of blood being lost in the brain. In case of
hemorrhagic stroke emergency surgery may be necessary to repair damaged arteries or reduce the
pressure of the blood on the brain.
 The patient may be given medication to help the brain’s blood flow return to normal.
 As soon as patient is no longer acutely ill he or she must follow the rehabilitation therapy in order
to regain his or her functional abilities.

43. What are the complications of the brain stroke? What do they depend on?
The complications of the brain stroke depend on the location of blood interruption. Some things happen
as a direct result of injury to the brain due to stroke. Others are because of a change in your abilities.
The most common complications of stroke are:
 Brain edema — swelling of the brain after a stroke.
 Pneumonia — causes breathing problems, a complication of many major illnesses.
 Common swallowing problems after stroke can sometimes result in things ‘going down the wrong
pipe’, leading to aspiration pneumonia.
 Urinary tract infection and/or bladder control.
 Seizures — abnormal electrical activity in the brain causing convulsions.
 Clinical depression — a treatable illness that often occurs with stroke and causes unwanted
emotional and physical reactions to changes and losses.
 Bedsores — pressure ulcers that result from decreased ability to move and pressure on areas of the
body because of immobility.
 Limb contractures — shortened muscles in an arm or leg from reduced range of motion or lack of
exercise.
 Shoulder pain — stems from lack of support of an arm due to weakness or paralysis. This usually
is caused when the affected arm hangs resulting in pulling of the arm on the shoulder.
 Deep venous thrombosis — blood clots form in veins of the legs because of immobility from
stroke.

44. What therapy does rehabilitation of the patient after the stroke include?
Stroke rehabilitation is a complicated program that helps you recover from the effects of this disease and
to low your risk of having another one.
Rehabilitation depends on the complications, which occur after the stroke. It includes:
 Speech therapy helps people who have problems producing or understanding speech.
  Physical therapy uses exercises to help you relearn movement and coordination skills you may
have lost because of the stroke.
 Occupational therapy focuses on improving daily activities, such as eating, drinking, dressing,
bathing, reading, and writing.
Therapy and medicine may help with depression or other mental health conditions following a stroke.
Support from family and friends can also help relieve fear and anxiety following a stroke. Let your loved
ones know how you feel and what they can do to help you.

Renal diseases
45. Speak on the anatomy and physiology of the urinary system.
The "urinary system" may also be called the "renal system" of "genitourinary system" because this group of
interconnected body parts process a liquid substance called urine via special organs called the kidneys.
 The urinary system's function is to filter blood and create urine as a waste by-product. The organs
of the urinary system include the kidneys, renal pelvis, ureters, bladder and urethra.
The kidney and urinary systems help the body to eliminate liquid waste called urea, and to keep chemicals,
such as potassium and sodium, and water in balance. Urea is produced when foods containing protein, such
as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to
the kidneys, where it is removed along with water and other wastes in the form of urine.
 Other important functions of the kidneys include blood pressure regulation and the production of
erythropoietin, which controls red blood cell production in the bone marrow. Kidneys also regulate
the acid-base balance and conserve fluids.
 Two kidneys. This pair of purplish-brown organs is located below the ribs toward the middle of
the back. Their function is to:
o Remove waste products and drugs from the body
o Balance the body's fluids
o Release hormones to regulate blood pressure
o Control production of red blood cells
The kidneys remove urea from the blood through tiny filtering units called nephrons.
 Two ureters. These narrow tubes carry urine from the kidneys to the bladder. Muscles in the ureter
walls continually tighten and relax forcing urine downward, away from the kidneys.
 Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in place by
ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and
expand to store urine, and contract and flatten to empty urine through the urethra.
 Urethra. This tube allows urine to pass outside the body. The brain signals the bladder muscles to
tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter
muscles to relax to let urine exit the bladder through the urethra.
Functions of the kidneys: regulation of blood volume, blood pressure, the pH of the blood and the
ionic composition of blood; production of red blood cells; synthesis of vitamin D; excretion of waste
products and foreign substances.
Functions of the ureters: transportation of urine from the renal pelvis of the kidney to the bladder;
prevention of the urine back-flow when pressure in the bladder is high during urination.
Functions of the bladder: storing urine prior to its elimination from the body; expelling urine into the
urethra by a process called micturition (also known as urination).
Functions of the urethra: serving as the passageway through which urine is discharged from the body
and in males the urethra also serves as the duct through which semen is ejaculated.

46. What are the main types of kidney diseases? Speak on them.
The main types of kidney diseases are hereditary, congenital and acquired.
Hereditary disorders include polycystic kidney disease, Alport’s syndrome, hereditary nephritis, primary
hyperoxaluria and cystinuria.
Congenital diseases usually include malformations of genitourinary tract, which can progress to chronic
kidney failure.
Acquired kidney diseases involve many disorders, such as glomerulonephritis, pyelonephritis, kidney
stones, nephrotic syndrome etc.

Also there are two types of kidney failure: acute and chronic.
Acute kidney failure may occur due to trauma to the kidney or decreased blood flow in the area. It can also
occur due to a blockage, such as a kidney stone, or very high blood pressure.

Chronic kidney disease is a condition that it occurs over a long period of time. Damage to the kidneys
occurs gradually and can eventually lead to kidney failure.

47. Speak on the kidney stones: the causes, symptoms, ways of treatment.
Kidney stones refer to acquired kidney disorders.
they can develop anywhere along your urinary tract, which consists of these parts:
 kidneys
 ureters
 bladder
 urethra
They are accumulations of material like calcium oxalate, calcium phosphate or uric acid, which form in the
urinary tract.
Kidney stones are one of the most painful medical conditions.
Causes of kidney stones may include changes in balance of water, salts and minerals, which lead to
dehydration; lack of plain water. Also kidney stones can be triggered by gout, hypercalciuria or dietary
factors.
Symptoms include:
 blood in the urine (red, pink, or brown urine)
 vomiting
 nausea
 discolored or foul-smelling urine
 chills
 fever
 frequent need to urinate
 urinating small amounts of urine
In the case of a small kidney stone, you may not have any pain or symptoms as the stone passes through
your urinary tract.

Treatment is according to the type of stone. Often includes alphablockers (to relax the wall of the ureter),
shock wave therapy, ureteroscopy, normal water consumption and healthy diet.
+ NSAIDs to relieve pain.
Pain relief may require narcotic medications.
Other medications include:
 allopurinol (Zyloprim) for uric acid stones
 thiazide diuretics to prevent calcium stones from forming
 sodium bicarbonate or sodium citrate to make the urine less acidic
 phosphorus solutions to prevent calcium stones from forming
 ibuprofen (Advil) for pain
 acetaminophen (Tylenol) for pain
 naproxen sodium (Aleve) for pain

A surgeon removes the stones through a small incision in your back. A person may need this
procedure when:
 the stone causes obstruction and infection or is damaging the kidneys
 the stone has grown too large to pass
 pain can’t be managed

48. What is pyelonephritis? What are the symptoms, causes and treatment of pyelonephritis and
complications?
Pyelonephritis is an inflammation of renal pelvis. It is more common in adult women.
The infection usually starts in the lower urinary tract as a urinary tract infection (UTI). Bacteria enter the
body through the urethra and begin to multiply and spread up to the bladder.
From there, the bacteria travel through the ureters to the kidneys.
Symptoms usually appear within two days of infection. Common symptoms include:
 fever
 pain in the abdomen, back, side, or groin
 painful or burning urination
 cloudy urine
 pus or blood in the urine
 fishy-smelling urine

Treatment includes antibiotics, and depends on the type of bacteria. If the type cannot be identified, a
broad-spectrum antibiotic will be used.
If the patient doesn’t respond to antibiotics, surgery may be required to remove any obstructions or to
correct any structural problems in the kidneys.
In cases of severe infection, a nephrectomy may be necessary. In this procedure, a surgeon removes part
of the kidney.

Complicatioons: Untreated pyelonephritis may lead to bacteraemia, hypertension, and permanent kidney
damage, acute kidney failure, acute nephritic syndrome, hypertension, chronic urinary tract infection.