“aie alt Lela ee , ay SE ALOMAR HS CURRIN 22 AA SIE PLATO a Sig arta) SED LUST SES TL 203s OHS 01-2028) iets aed aS a PRLTOE MEDAL SUBLETS Seo Tay Toews orien oTe seas ano as 2 IMTERRIOA UOS USED AS ERENCE aL, SHES ERS SEIS REPRESEN "To THE aT I Rw cs RNS OED FOR TORONTO | Cos TE NO PERL EINE HOR SUES ASR, ‘1 CURELUMREEMED BY CLASS TOPPERS ADU OF SPEC RTECHAPTER 2 eee PATHOLOGY © H. pylori - cause of around 90% of duodenal ulcers & 70% of gastric ulcers 9 NSAIDs 2 common cause Zollinger Ellison syndrome © Cigarette smoking Alcoholism Corticosteroids Pathogenesis ‘© H-pylori infection causes pangastitis or predominantly antral gastritis by Cag-A toxin > increased gastrin produetion from G cells > increased acid production fom parictal cells (parictal cell hyperplasia) > increased acid load causes ulcer in duodenum, H-pylori protect itself from acidic environment of stomach by urease enzyme © Zollinger-Ellison syndrome > uncontrolled release of gastrin > massive acid production 9 NSAIDs & Cigarette smoking > impairs mucosal blood flow and healing, ‘© Corticosteroids -> decrease prostaglandin synthesis > impair healing lorphology © Gross > Solitary, round to oval, Punched out lesion © Microscopic > Necrosis & Inflammatory cells Type Clinical Features ‘Most common site Gastric weet Epigastrie pain, Nausea, Vomiting + Pain become worse on taking food | Lesser curvature Duodenal ulcer] Epigastric pain, Nausea, Vomiting + Pain got relief on taking food First part of duodenum Usually person awake from sleep during night Cause Features Pathogenesis Non-bloody | Staphylococcus aureus | Incubation period is very short because of preformed | Enterotoxin > G protein > YeAMP in enterocytes > diarrhea toxins Vibrio cholera __| Rice water stool Outpouring of fluid & Bacillus cereus | Due to reheated rice electrolytes from enterocytes Rota virus ‘Very common cause im children therefore vaccination | into lumen of git > watery is recommended for less than 2 years children diarrhea E.coli Traveler's diarrhea Bloody Shigella Bloody diarshea (Bacillary dysentery) Direct invasion of git mucosa diathea | Entamoeba Histolytica | Bloody diarrhea (Amoebie dysentery) E.coli Tiemolytic uremic syndrome’ | Bloody diarzhea | Via Shiga toxin “Hlemolytic uremic syndrome = Flemolysis Anemia) + Thromocytopenia = ART DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [18]Cai oe 1. A33 years old male who is smoker and has been on NSAIDs for many months, He develops epigastric pain for a couple of weeks and also spitted out blood for two to three times. Endoscopy shows a sharp punched out defect in gastric antral mucosa. What is the diagnosis? A. Gastrie uleer ©. Gastrie carcinoma B, Duodenal uleer D.GERD 2. What is the most common site for gastric uleer? A. Greater curvature . Pylorus B, Lesser curvature D, Cardia 3. A 32 years old female presents with burning / aching epigastric pain 2-3 hours after meal, ‘or milk. He also sometimes feels nausea, bloating & Blenching, What is most likely diagnosis? relieved by taking some food A. Gastrie uleer C. Gastrie carcinoma B, Duodenal uleer D.GERD 44, Most common cause of peptic uleer ‘A. NSAIDs . Alcoholism B.H. pylori D. Corticosteroids ‘S.A very common eause of watery diarrhea in infants: ‘A. Rota virus . Shigella B.E. coli D, Salmonella (6. Which organism causes rapid diarrhea because of preformed toxins? A. Rota virus . Shigella BLE. coli D, Staphylococcus 17. What is the pathogenesis of Bacillary dysentery? ‘A. By reducing c-AMP in enterocytes . Release of endotoxins B, Direct invasion of git mucosa D, Release of exotoxins 8. Which of the following is NOT a causative agent for a peptic ulcer? A. NSAIDs . Physiological Stress B.HL. pyloti D. Augmentin ‘9, A man just after landing on airport collapses. Hs colleague told that he had severe rice watery stool. What isthe causative agent? A. Rota virus . Shigella BE. coli D, Vibrio cholera 10, Three friends afler eating street food 4 hours back, present with complaint of diarrhea, vomiting & abdominal pain, What may be the cause of this food poisoning? A, Salmonella . Shigella B. Staphylococcus D. E.coli 11, Which of the following bacteria is most commonly associated with traveler's diarrhea? AVE, coli C) Shigella B) Salmonella D) Vibrio cholerae 12, What is the primary mechanism of pathogenesis of Vibrio cholerae in causing diarthea? ‘A. Inflammation and tissue damage C. Adherence and colonization B, Toxin production and secretion D, Invasion and intracellular multiplication 13, Which of the following bacteria produces a toxin that increases cAMP levels in intestinal cells, leading to diarrhea? A. Vibrio cholerae . Salmonella B, Entamoeba histolytica D. Shigella ANSWER KEY TA 2B zB 4B SA 6D 7B SD xD TOA TEA TB TRACHAPTER 2 rc) hs PHARMACOLOGY DO GANTEDIARRHEALDRUGSS Drug Mechanism Use against Side effects ‘Opioids (most effective) Reduce motility by acting on mu | Non-specific diarthea Mild abdominal cramp parece ‘opioid receptor in enteric nervous Costipation © Diphenoxylate atropine | SS" CNS toxicity with © Codeine diphenoxylate atropine Kaolin + Pectin ‘Absorbs bacterial toxins & Auld Dianthea due to diverticular disease Little adverse effect Bismuth subsalicyetate Form protective coating on ulcerated mucosa & absorbs toxins Traveler diarrhea Black stools Oatreotide ‘Somatostatin analogue that reduces motility ~ secretions Dinca duc to carcinoid & VIP tumors Fiypo/Hiypergiyeemia ‘Nate: No need to do Pharmacokinetic DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [20]CHAPTER 2 Eee 1. Which ofthe following anti-diartheal drugs works by decreasing the motility ofthe intestines? A) Loperamide ©) Kaolin B) Bismuth subsatieylate D) Metronidazole 2. Which anti-diartheal drug has antibacterial properties and is used to treat traveler's diarthea? ‘A) Loperamide © Kaolin B) Bismuth subsalieylate D) Octreotide A) Inhibition of intestinal secretion ©) Inhibition of bacterial growth B) Reduction of intestinal motility D) Absorption of toxins 4. Which of the following is a common adverse effect ofloperamide? ‘A) Black tongue ©) Abdominal pain B) Diarthea 1D) CNS toxicity |S. Which of the following anti-diarrheal drugs is a mu-opioid receptor agonist? A) Loperamide ©) Kaolin B) Bismuth subsalicylate D) Diphenoxylate (6. Which anti-diartneal drug is a non-opioid receptor agonist that reduces intestinal sceretion and motility? == A) Loperamide C) Bismuth subsalicylate B) Octreotide D) Kaolin 7. Which of the following is a common adverse effect of bismuth subsalicylate? A) Black tongue ©) Constipation B) Black stools D) Diarrhea ‘A. Aluminum hydroxide C. Loperamide B. Diphenonylate D. Maghesium hydroxide (9. The most effective anidiameal drugs ame A. Opioids C. Octreotide B, Metronidazole (lagyt) . Ondansetron 10, Somatostatin analogue used to treat diarrhea related to VIP syndrome; ‘A Opioids C. Octreotide B, Metronidazole (Flagyl) ‘D, Ondansetron ANSWER KEY TA [2B ema SA sie dC Ci ‘DR. ABDUL MANAN, DR. ARYBAAD AHMAD & DR. GHULAM DASTGEER 21]CHAPTER 2 we, BEHAVIOURAL SCIENCES A. Fating Patterns T Ballemia Nervosa Its an eating disorder marked by binge eating Le. out of control eating, followed By purging, such as vomiting, taking laxative, and/or excessive activity to prevent the individual from gaining weight. Z Anorexia Nervosa | Anorexia nervosa (AN) is an eating disorder defined as an abnormally Tow body weight associated with intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness, B. Addictive patterns T. Drug dependance | A psychic and physical state resulting from interaction between a Hiving organism anda drug, characterized by behavioral and other responses that always include a compulsion to take the drug on continuous and periodic basis in order to experience its psychic effects and sometimes to avoid the discomfort of its absence 2 Drug Abuse The use oF legal drugs or the use of prescription or over-the-counter drugs Tor purposes other than those for which they are meant to be used, oF in excessive amounts Cees Operant Conditioning Reinforcement Punishment (Increase (Decrease behavior) Behavior) coe (Add noxious (Remove (Add appetative stimulus Negative Saal eeepc: following correct behavior) following following behavior} behavior) Active Avoidance (Behavior avoids noxious stimulus) Escape (Remove noxious stimulus following correct behavior) Operant Conditioning> Leaming new behaviors or changes in behaviors occur on the basis of the environmental conditions or responses to it Shaping It involves rewarding closer and closer approximations of the wanted behavior until the correct behavior is achieved. Modeling> It is a type of observational learning, That is what occurs when a student talks, walks, dress and behave in a manner similar to that of an inspiring teacher. DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [22]CHAPTER 2 Extinction It is a process in which conditioned response decreases when conditioned stimulus is never again paired with the unconditioned stimulus CE ee ee ig Patterns ‘+ Encourage individuals to keep a food diary to identify triggers for unhealthy eating and apply reinforcement techniques to modify behavior. ‘+ Gradually introduce healthier food options and reinforce their consumption through positive feedback and rewards. Addictive Patterns ‘© Implement gradual exposure and desens behaviors. ‘+ Provide support networks and resources for individuals seeking 0 overcome addictive patterns, utilizing principles of reinforcement and modeling to promote success, ation techniques to reduce cravings and reliance on addictive substances or Eee) ‘The HBM suggests that an individual's belief in a personal threat of a health problem, combined with their belie in the effectiveness of ‘8 particular action, will influence their likelihood of taking that action to prevent or treat the health problem Modifying Factors, Individual Beliefs. Action Pere saceptbity |_|” Perceived toandsewy[ >] _ test ie af dsesie Gender enicty |_|] Paci Individual Pesonaty Land behaviors Socioeconomies facial { Knowledge barirs ce scion Perce ssficagy Lets take an example of peptic ulcer Perceived Susceptibility | Patients with a family history of peptic ulcer disease may perceive themselves as susceptible to developing peptic wleer. Perceived Severity Understanding the potential consequences of untreated peptic uleer ean Relp patients recognize the severity of the condition Perceived Benefits Patients may be more likely 1 adhere lifestyle modifications (eg., dietary changes) and medications (e.g, proton pump inhibitors) if they believe these interventions will effectively manage their symptoms and prevent complications Perceived Barriers Tdentifying barriers to adherence, such as the cost or side effeels of medications, can help healtheare providers address these concerns and provide alternative strategies DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [23]CHAPTER 2 RELAPSE ‘CONTEMPLATION fall back nto ‘aware problem eee Se UPWARD SPIRAL lam from each relapse MAINTENANCE PREPARATION ‘ofeenaviour “Motivational Interviewing (MI is a goal-oriented, patient-centered approach to elicit and strengthen an individual's motivation It focuses on exploring and resolving ambivalence, rather than imposing advice or guidance. Key principles of MI 1, Express empathy and understanding Develop a non-judgmental and supportive atmosphere Explore and identify the individual's motivations and goals, Elicit and strengthen the individual's commitment to change Roll with resistance, rather than opposing it Support self-efficacy and confidence Ask + Ask for permission to discuss body weight + Explore readiness for change Assess Assess BMI, waist circumference, and obesity tage + Explore drivers end complications of excess weight ‘Aaviee ‘Advise the patient about the health risks of obesity, the benefits of modest weight loss (Le, 5-10 percent), the need for long-term strategy and treatment options. Agree > Agree on realistic weight-loss expectations, targets, behavioral changes, and specific detalls of the teeatment plan, ‘Arrange/Assist | Assist in identifying and addressing bares; provide resources, assist in finding and consulting with appropriate providers: arrange regular follow-up. Coenen Medically Unexplained Symptoms (MUS) refer to physical symptoms that cannot be attributed toa specific medical condition or disease, despite thorough medical evaluation and testing, (Characteristics of MUS: 1 Persistent and distressing symptoms 2. No clear medical explanation or diagnosis DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [24]CHAPTER 2 3. Notmal test results and physical examination 4. Significant impairment in daily functioning 5, Often accompanied by anxiety, depression, or other mental health concerns Examples of MUS: 1. Chronic pain (eg, fibromyalgia) Fatigue (e.g, chronic fatigue syndrome) Gastrointestinal issues (cg, itvitable bowel syndrome) ‘Neurological symptoms (c.g., headaches, numbness, or tingling) Respiratory symptoms (c.g., chronic cough or shortness of breath) uuishing MUS from other conditions: Differentiate from Factitious disorder where symptoms are intentionally produced or feigned physical symptoms 2 3 4 5. Differentiate from somatic symptom disorder, where symptoms are exaggerated or feigned for attention or secondary gain. Distinguish from psychological disorders, such as anxiety or depression, which may present with physical symptoms. ‘Consider cultural and social factors that may influence symptom presentation and interpretation Crier cone ere 1. Paychological distress Psychosocial factors such as stress, anxioly, depression, and Wauma are commonly associated with MUS, 2, Cognitive factors Cognitive processes, including aitention, perception, memory, and interpretation of bodily sensations, play a significant role in the experience and manifestation of MUS. 3. Personality Traits Certain personality traits, such as neuroticism or alexithymia (difficulty in identifying and expressing emotions), have been linked to MUS. Social & environmental factors | Social and environmental factors, including adverse life events, interpersonal conflicts, socioeconomic status, and cultura influences, can contribute to the onset and exacerbation of MUS, 3 liness Belicfs and behaviors | Beliefs about ilness and healih-seeking behaviors can influence the experience and persistence of MUS, Factors such as illness attribution (e.g., believing symptoms are duc to a serious medical condition), illness behavior (e.g, frequent medical consultations), and illness perceptions (eg., perceived control over symptoms) can impact the course and management of MUS, 6. Biopsychosocial Model The biopsychosocial model provides a comprehensive framework for understanding MUS by ‘considering the interplay between biological, psychological, and social factors. 03. Management plan according to ‘You have already studied Biopsychosocial model in first block, 1. Biological "Avoid excessive investigations and medications Give symptomatic management for symptoms (diarrhea, nausea/vomiting, and pain) Give Antidepressants (SSRI) and Anti-psychoties (ifrequired) 2, Psychological | Counseling, CBT 3. Social Family support, educate family members regarding patient's condition CEE eke ACL) Cognitive Behavioral Therapy (CBT) plays a vital role in managing Medically Unexplained Symptoms (MUS) by addressing ‘maladaptive thought pattems, promoting coping strategies, enhancing self-efficacy, and reducing symptom severity. Ithelps individuals challenge distorted beliefs about thet symptoms, develop effective coping sil, and improve overall well-being. CBT isan evidence- based approach that empowers individuals to manage MUS by targeting both psychological and bshavioral factor. DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [25]CHAPTER 2 Minerals Effect of deficiency In mental development A, Vitamins BI Reduced levels of brain GABA, glutamate and aspartate Bz Tmpaired performance on psychomotor tests, neuromotor coordination and personality changes BS Loss of memory, nervousness, easy distractibility and schizophrenia BG Depression, inability, loss of memory, mability to concentrate, peripheral neuritis Biz Loss of memory, disorientation and emotional instability BO (Folie Acid) _ | Memory loss, forgetfulness, depression, initability, inroversion, lack of confidence c Reduced score for 1Q, memory, abstract thinking and nonverbal intelligence, altered behavior E Poor memory and attention span B. Minerals Todine Poor somatic and central nervous system growth, sluggishness, Inactivity, lethargy, poor concentration Tron Tistlessness, apathy, lack of vigor and enthusiasm, lower scores on motor development and cognitive tests and poor school grades Less myclinization and altered neurotransmitter function, Zine Lethargy, decreased visual memory, impaired cognitive development, and neuropsychalogical problems Selenium Depression, Tow mood, Tow energy level, anxiely and stress Chloride Poor memory and mental functioning DHA Short memory span, hostility, leaning disability, dyslexia, attention deficit disorder DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [26]1. Ahmad is trying to quit smoking cigarettes, Whenever he successfully goes @ day without smoking, he treats himself to a movie night ‘with his favorite snacks. What principle of learning is Ahmad utilizing? ‘a, Negative reinforcement ¢, Active avoidance », Positive reinforcement 4. Modeling 2A patient of diabetes increased his time spend in exercise in order to reduce the number of insulin injections. The increased exercising ‘behavior is most likely result of 1 Negative reinforcement , Punishment », Positive reinforcement 4d, Modeling 3. Sarah is trying to overcome her addiction to online shopping. She decides to replace her shopping habit with reading and spending time outdoors. Which principle of learning is Sarah uti a. Negative reinforcement . Extinetion ». Positive reinforcement d. Modeling 4A father scolds his son when he eats junk food. The son eventually stops eating junk food, This is an example of. ‘a. Negative reinforeement c Rann b, Positive reinforcement Sat hi re ape Jw UGE GOGAT Ae a =e GU AEG WMA TH isan example of, a. Negative reinforcement . Punishment ». Positive reinforcement 4. Modeling 66. Ayesha wants to encourage her children to eat more fruits and vegetables. She decides to offer them a small reward whenever they finish their servings of fruits and vegetables. Which principle of learning is Ayesha applying? ‘a. Negative reinforcement , Punishment », Positive reinforcement 4d. Modeling 7. Aleona wants to break her habit of eating sweets late at night. She decides to remove all sugary snacks ffom her kitchen cabinets, ‘What principle of learning is Aleena applying? ‘a, Negative reinforcement, , Punishment >. Positive reinforcement 4. Extinetion 8. Which nutrient deficiency during pregnancy is associated with an increased risk of neural tube defects in the developing fetus? ‘Vitamin C . Vitamin D », Folie acid 4. Iron 9. A child presents with poor growth, delayed motor development, and impaired language skills. Which nutrient deficiency is most likely to be the cause? a. Vitamin A c. Vitamin D >, Vitamin BS tron 10, What is the primary goal of motivational interviewing in the management of obese and diabetic patients? 2) To force patients into immediate behavior change «) To provide strict dietary and exercise guidelines ») To explore and resolve ambivalence towards change 4) To shame patients into adopting healthier habits 11. Which of the following is a key principle of motivational interviewing? 2) Providing unsolicited advice ©) Rolling with resistance ») Using confrontation to evoke change 4d) Assuming that the patient is ready to change 12, Which ofthe following statements best describes the spirit of motivational interviewing? 2) Coercing patients into compliance with medical advice «) Ignoring patient autonomy and preferences >) Collaboration and partnership between the patient and 4) Using seare tactics to motivate behavior change healtheare provider 13, Usman presents with chronic fatigue and frequent headaches, but medical tests show no abnormalities. What term best describes his symptoms? ‘2. Migraine . Chronic illness ». Iron deficiency anemia 4. Medically unexplained symptoms 14, Fatima experiences recurrent abdominal pain and gastrointestinal discomfort. She recently went through a divorce and has been {feeling stressed. Which psychosocial factor might be contributing to her symptoms? a. Anxiety €. Peptic uleer disease . Depression . Panic disorder 15, According to the Transtheoretical Model (ITM) of behavior change, which stage involves the individual being unaware or under- aware of the need for change? 1, Preparation, «, Precontemplation , Contemplation d. Action‘a. The belief in one's ability to change a behavior ©. The acknowledgment of needing to change a behavior >, The readiness to change a behavior 4d. The action of changing. behavior ANSWER KEY LB ZA ze ae xD 6B 7D eB oD TB i. 12.5 13D aA 15.6 16. 2. In active avoidance, a patient adopts a behavior to avoid noxious stimuls. In this seneri, patient adopts exercise to decress insulin injection, Active avoidance isa type of Negative reinforcement 3. Extinction involves reducing the frequency ofa behavior by removing the reinforcement that previously followed i. In this case, Sarah is trying to overcome her addiction to online shopping by replacing it with reading and spending time outdoors, which removes the reinforcement (online shopping) associated with her previous behaviorCHAPTER 2 Cty ig COMMUNITY MEDICINE Polio Vaccination ofa child Hepatitis A ‘Vactine & Tmmmoglobalins Cholera ary prevention ‘+ Health promotion by health education, sanitary and personal hygiene ‘+ Specific protection by immunization Secondary prevention + Early diagnosis ‘© Prompt treatment with © Oral rehydration rehydration therapy for mild diarrhea © _IIV fluids for severe diarrhea Typhoid Thiee lines of Control 1, Control of reservoir Case ~ early diagnosis, notification, isolation, treatment, disinfection 2. Control of Sanitation by health education, food hygiene and improved sanitation 3._ Immunization Food Poisoning | Food sanitation by Health education, Personal hygiene, Sanitary improvement, Food inspection, and Food handling techniques Thorough cooking Milk pasteurization & Hookworm infestation “Amoebiasis ‘> Health promotion by health education, good hygiene, sanitary improvement (avoid food/water contamination) ‘+ _Isolation and treatment of infected people Asearis| ‘+ Health promotion by health education, good hygiene, sanitary improvement (proper disposal of feaces i.e Prevent faecal contamination of soil) & Wearing shoes because they transmit through soil 01. Breastfeeding, Weaning & Childhood Advice Breastfeeding | » Breastfeeding should be staried soon after delivery # There should not be any pre-lacteal feeding e.g. honey, water, and ghuti ‘+ No pacifier (rubber’plastic nipple) should be introduced + Breast-feeding should be on demand © The interval may be 1-4 hours Breast milk should be the only food in the first 4-6 months of child. Weaning | Definition of weaning? [Derived (fom the ancient word “Accustom”— means getting familiar] “it is a gradual process during which child gets accustomed familiar to food other than breast milk”. DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [29]CHAPTER 2 ‘Need of Weaning: © That's why after ‘© Ashe child grows, his /her caloric requirement also increases ‘© So, breastfeeding alone cannot meet all the caloric requirements of the baby after 4-5 months of the baby and also for preventing Infections (diarrhea) and Malnutrition (Kwashiorkor & Marasmus) ‘4 months up to 2 years, weaning is necessary for the optimal growth & development For the Purpose of weaning, the Following Foods can be used: Cow’s Milk, Cereals, Bananas, Soft coaked rice, Dalia, Juice, and Yogurt Childhood Maintain hygiene Irbelong to poor soci Breastfeed the Child properly Proper weaning of the child — Use cereals, banana, daliya, Juice and yogurt Proper distribution of food among the family members, Immunization ofthe child should be complete For any bacterial / Parasitic infection, Consult the doctor & get appropriate treatment Environmental sanitation should be good jocconomic status, use fimily planning measures to reduce the size of family Cates a) Name the likely condition and gives its risk Marasmus Causes/Risk factors factors. “Main Etiological Factors ‘Nutritional Imbalance / Deficiency Bacterial / Parasitic Infection ‘Non-Fulfilment of calorie requirements ‘Deprivation of Child From Breast feeding Contributory Etiological Factors rroncous weaning by the Ignorant Mother Early weaning due to 2" pregnancy Poor environmental sanitation Wrong distribution of food among family members ) What measures should be taken to overcome this problem in children? Level of Prevention Thterventions & Measures Primary Health Promotion| Specific Protection Health Education — Creation of Public awareness & Nutrition education Provision of adequate Food supplements to pregnant & Lactating ‘mothers Promotion of Breast feeding Development of Low-cost Weaning Foods Family Planning Prophylactic Supplementation of Fortified Foods Immunization of the child against major communicable diseases Balanced diet Secondary Early Diagnosis & Prompt Treatment Periodic Surveillance Development of Programs for early Rehydration of dehydrated children ‘Deworming of heavily infested children Early diagnosis of any Lag in growth DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [30]CHAPTER 2 Balanced diet A diet that contains variety of foods in such quanities and proportions that need for energy, amino acids, vitamins, minerals, fats, carbohydrates, and other nutrients is adequately met for maintaining health, vitality and general well-being. Dietary Factor ‘Goal age Of total energy Total Fat 15-30% Saturated & Unsaturated fats > Saturated fats > <10% of total encrgy intake, ‘© Unsaturated ils should substitute for the remaining fat requirements Carbohydrates 35-15% Note: Excessive consumption of refined carbohydrates should be avoided Free sugars, =1% Proteins 10-15% Cholesterol = 300 mg/day. Sodium chloride (salt) = Sylday Fruits & Vegetables 700 giday / greater Dietary Fiber Upto dOgiday OR more for adults = _ Sources Rich in Fats & Alcohol should be Avoided ¢ Junk Food e.g, Colas, Ketchups & other food that have zero calories should be reduced Geet ceed Itis a visual display of child's physical growth and development. Features 1, On X-axis child's age in months, and on Y-axis weight in kg is mentioned. 2. There isa reference curve on growth chart for comparison (upper curve for boys and lower curve for gitls) 3. Periodic weighting is plotted on chart and a curve is obtained which indicates child health ‘On growth chart space is given for 1. Identification and registration of child Immunization status of child 2 3. Immunization of mother against tetanus 4, Birth date and weight 5. Child health record 6. ORS preparation method is written in Urdu, soit is easier to understand by people Uses of Growth Chart 1. Growth monitoring of child 2, Diagnostic too! for mortality, morbidity and health status 3. Planning and policy making by grading malnutrition 4, Mother can be educated regarding care of her child 5. Ithelps the health worker to determine type of intervention needed 6. It provides a good method to evaluate the effectiveness of corrective measures 7. Growth chart also gives information like Birth date and weight, Immunization of child, Immunization of mother is done or not, Child health record Pitfalls of Growth Chart 1, _Intead of promotive approach to nutitional problems it focus on Curative approach. It focuses on wrong age (0-5 years) instead of most important age group (0-3 years) {In it nutritional status rather than growth is emphasized It lacks feedback It has false expectations. DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [31]CHAPTER 2 ‘a) What is the most likely diagnosis? Rickels due to Vitamin D deficiency 'b) Give appropriate measures for the prevention and control of this health problem in the community. Level of Prevention Interventions & Measures Primary Health Promotion| ‘+ Health Education ~ Educating the Parents to expose their children regularly to sunshine ‘+ Provision of adequate nutrition / Foods that are good source of Vitamin D especially during early years of growth & development — e,g., Milk, Butter, Fish oil & Eges ‘+ Daily Vit D requirement in is 200 IU Specific Protection '* Periodic dosing (Prophylaxis) of young children with Vitamin D ‘* _ Vitamin D Fortification of the foods eg. Milk. Secondary ‘Early Diagnosis & Prompt Treatment + With orally supplemented Vitamin D supplements Measures of prevention of Vitamin A deficiency 1, Health promotion by ‘© Nuttitional education -> consumption of vitamin A-rich foods such as liver, eges, dairy products, and colorful fruits and vegetables) ‘© Supplementation programs > targeting high-risk groups like pregnant women and children in regions with known deficiency ©. Promotion of breastfeeding to ensure infants receive adequate vitamin A. 2. Specific protection ‘Fortification of staple foods with vitamin A, such as fortified milk and cooking oils ‘© Implementation of public health interventions such as vitamin A supplementation campaigns and nutrition education programs 3. Early detection and treatment of conditions that impair vitamin A absorption or utilization DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [32]CHAPTER 2 7 2 3 5 Hy * 2 8 = 3 8 2.208 40g b.30g 450g 2. Which of the following is recommended daily requirement of Vitamin D2 2. 1001U «©. 3001U ». 20010 4. 4001U 1. Weight for age Height for age ». Weight for height 4. All ofhe above 1. Face mask «©. Avoiding raw milk b. Vaccination 4, Safe water & proper hysgiene 2. Contaminated water «. Ingesting contaminated food ». Skin contact with contaminated soil 4d, Direct contact with an infected person ‘a. Contaminated food and water «. Vector-borne (mosquitoes) b, Direct contact with an infected person 4. Airborne ‘a. To track weight gain only ©. To assess overall growth and development ». To monitor heightlength only 4. To diagnose specific health conditions 4. Children under 5 years «. Elderly individuals », Pregnant women 4. Adolescents 1.3 months . 12 months ». 6 months 424 months ‘a. Vitamin supplementation », Nutrition education . Immunizations 4. Exclusive breastfeeding and appropriate complementary feeding ANSWER KEY Le ry ZA ae ay GA Te A oe ToD DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [33]CHAPTER 2 ig Cake kc nd Poor Appetite Chronic Tlinesses Physical and Mental Health Issues (Mobility limitations, depression, dementia, and cognitive decline can impact the ability to shop for groceries, prepare meals, and cat independently.) Social Isolation (it may reduce motivation to cook and eat nutritious meals.) Financial Constraints Polypharmacy (Taking multiple medications can interfere with nutrient absorption and cause side effects like nausea, vomiting, cor loss of appetite.) Functional Decline (Difficulty swallowing (dysphagia) or chewing due to oral health problems can affect food intake.) (Ear ocak ear ca) 1 2 3 4 s. 6 ‘Nutritional Assessment Dietary Counseling ‘Oral Health Care (Address dental problems and provide assistance with denture care to improve chewing ability and food intake.) Meal Assistance (Offer assistance with meal preparation, grocery shopping, and feeding if nceded.) ‘Nutritional Supplements Multidisciplinary Approach (Involve a multidisciplinary team including dietitians physicians, nurses, occupational therapists, ‘and social workers to address medical, functional, and psychosocial factors contributing to malnutrition.) Social Support Monitor and Evaluate nutritional status and dietary intake, and adjust the management plan as needed to achieve and maintain ‘optimal nutritional status. ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [34]CHAPTER 2 ar rrtae PATHOLOGY ‘Type of Renal Calculi_| Incidence Pathogenesis Calcium Oxalate and 70% | Idiopathic hypercalciuria 7 Hypercalciuria | Hypercalcemia 7 Hyperoxaluria > Phosphate Stones Increased urinary calcium and Oxalate constituents ~> Precipitation into Radio-opaque calcium Stones. Magnesium Ammonium | 5-10% | Infections by Urea-spliting bacteria (Proteus) > Convert urea to ammonia > Alkaline Phosphate urine > Precipitation of Magnesium ammonium phosphate salts > These form largest (Struvite / Triple Stones) stones called staghom calculi occupying large portions of the renal pelvis Urie Acid Stones 510% | Hyperuricemia (Gout Patients OR leukemias) > Tendency to excrete urine of pH below 5.5 > Predispose to Radiolucent Uric acid stones, because uric acid is insoluble in acidie urine. Cystine Stones 1-2% | Genetic defects im the renal reabsorption of amino acids (Cystine) > Cystinuria + Tow urinary pH > Formation of Cystine stones, Causes © Benign prostate hyperplasia fone in ureter ot bladder Morphology ‘© Enlarged kidney due to dilation of renal pelvis & calyces Etiology. \esncvoannnu ean ‘Ascending Inston by Sopemt 0 Escherichia coli (Most Common) Eee A © Proteus — . © Klebsiella © Enterobacter. Hematogenous Spread © Staphylococcus rer E.coli os Clinical Features © Increased urinary frequency Yet Fever = © Whes in urine & Nitrite positive © IF there is costovertebral angle pain slong with these features then itis known — as Pyelonephritis Solonization of the distal urethra and introitus (in the female) by coliform bacteria eee © From the urethra to the bladder, organisms gain entrance during urethral meinen catheterization OR other instrumentation Et Urinary tract obstruction and stasis of urine, ‘Enarnactr © Vesicoureteral Reflux ~ May occur due to Incompetence of the vesicoureteral valve allows bacteria to ascend the ureter into the renal pelvis, ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [35]CHAPTER 2 ‘© Inirarenal Reflux - Vesicoureteral reflux also affords a mechanism to propel infected bladder urine up to the renal pelvis and ‘deep into the renal parenchyma through open ducts atthe tips ofthe papillae (Intrarenal Reflux) Risk Factors ‘© Diabetes © Intrumentation © Vesicouretral reflex © Stone > Obstruction like Benign prostate hyperplasia reatment Antibioties Nephrotic Syndrome Nephritic Syndrome © Massive proteinuria (© 3.5 g pet day) © Hyposlbuminemia © Edema Hyperlipidemia and Lipiduria + BPs either normal or decreased + Hypertension © Hematuria © Edema © Azotemia Mild proteinuria ‘AKI means rapid decrease in kidney function (GFR) that leads to azotemia (increased serum creatinine & blood urea nitrogen) Type ‘Causes “Management Prerenal | Reduced renal blood flow due to hypovolemia Garthea, | + Fluidreplacement therapy vomiting, burn ete) + Find & treat cause Renal Toxis medicine, Rhabdomyolyis See reeeed ere Post-renal__| Obstruction (stone ec) + Dialysis & Kidney transplant ‘Note: This a opie of inal year medicine. You can Teave Wis ope DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [36]CHAPTER 2 7 Pie es ‘A. Pyclonephritis C. Chronic kidney disease B. AKI D, Hydronephrosis ‘A, Pyelonephritis cur B. AKI D. Hydronephrosis 3. Amount of protein loss in Nephrotic Syndrome? A235 gperday C.> 300mg per day B< 35 gperday 1D. < 300 mg per day 4A child presents with fat in urine. His blood pressure is normal, What is the diagnosis? ‘A. Nephrotic syndrome ©. Nephritic syndrome BUTI D. AKI 5. Most common causative agent of Acute Pyetonephritis? ALE. coli . Klebsiella B, Proteus D, Staphylococcus ‘A, Uric acid stone C. NEB, Mg & POs B, Cysteine stone D, Calcium oxalate AUT . Nephrote syndrome B. AKI D, Pyelonephritis 8. NOT a feature of Nephrotic syndrome? ‘A. Hypertension . Hypogammaglobulinemia B,Lipiduria D. Proteinuria 9. What is the primary cause of hydronephrosis? ‘A. Obstruction of the urinary tract . Inflammation of the Bladder B. Infection of the kidneys D, Tumor in the renal pelvis 10, What isthe characteristic radiologic finding in hydronephrosis? A. Dilatation ofthe renal pelvis and calyces . Caleifcation ofthe renal parenchyma BB. Enlargement ofthe kidney D. Non-visualization ofthe kidney ANSWER KEY TA Ze _[RA ZA [SA [6C 7B TA A TO 10. Enlargment of Kidney can be seen in other diseases ike renal hyperplasia duc to occlusion of blood vessel but kidney calargement ‘due to dilatation of renal pelvis & calyces is specific for Hydronephrosis, ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER 37]CHAPTER 2 RENAL PHARMACOLOGY Drugs that moxiy sal excretion —————— PCT TAL DcT cot Osmotic ditties | i (mann Loop Ke spating ures lutein (trosemide) || gpirnolacion) carbone antyerase inns Thiaides (acotazsiamide) _(yrochiorehiazide) Site of action Mechanism Uses averse effect PCT Block HCO absorption | © Glaucoma © Metabolic acidosis inhibitors © Mountain sickness. | Sedation © Acctazolamide © Edema with alkalosis | 0 Paraesthesia Toop direties Thick Ascending | Inhibit Na7K72CT © Palmonary edema © Metabolic © Furosemide limb of loop of | transporter Heart failure hypokalemic © Bthacynicaciae | Memle Car excretion © HIN alkalosis © Hypercalcemia ci) Thindide diuretics _ | DCT TnbibtNaTCT tansporier | © HTN © Metabolic © Chlorthalidone Ca" excretion © Hyperealciuria with pean © Diabetes insipidus © serum glucose, lipids, uri acid KT sparing drugs | Collecting duct __| Inhibit aldosterone receptor | o Hypokalemi Hyperkalemia Spironolactone UK excretion (iyperaldosteronism) | 5 Gynecomastia © Eplerenone (pironolactone 0 Amiloride ao) ‘Osmotie diuretics | PCT ‘Osmotically reiains water | © Solute overload in Hyponatremia © Mamitol Descending fim | in tubule by reducing rhabdomyolysis, followed by ofloop of Henle | Feabsorption hemolysis, tumor lysis bypematremia| Collecting duct | Reduce 1OP in glaucoma syndrome, brain edema | » Headache © Glaucoma ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [38]Eee ee) 1. Which of the following diuretics would be most useful in the acute treatment of a comatose patient with traumatic brain injury and cerebral edema? ‘A. Acetazolamide C. Furosemide B. Amiloride D. Mannitol 2. Which ofthe following is an important effect of chronic therapy with loop diuretics? ‘A, Decreased urinary excretion of ealeium . Elevation of pulmonary vascular pressure B, Elevation of blood pressure D, Metabolic alkalosis 43. A $0-year-old man has a history of frequent episodes of renal colic with calcium-containing renal stones. A careful workup indicates that he has a defect in proximal tubular calcium reabsorption, which results in high concentrations of calcium salts in the tubular urine, ‘The most useful diuretic agent in the treatment of recurrent calcium stones is ‘A, Chlorthalidone C, Mannitol B. Ethacrynic acid D. Spironolactone 4. A graduate student is planning to make a high-altitude climb in South America while on vacation. He will not have time to acclimate slowly to altitude, A drug that is useful in preventing high-altitude sickness is ‘A, Acetazolamide ©. Furosemide B, Amiloride D. Ethacrynic acid ‘5. A 60-year-old patient complains of paresthesias and occasional nausea associated with one of the drugs she hhave hyperchloremic metabolic acidosis. She is probably taking is taking. She is found to A, Acetazolamide for glaucoma CC. Furosemide for severe hypertension and hear failure BB. Amiloride for edema associated with aldosteronism . Mannitol for cerebral edema ‘6. Furosemide inhibits water reabsorption at which part of the renal anatomy? A. Collecting duct . Thick ascending loop B. Thin descending loop D. Thick ascending loop 7. Which side effect is associated with spironolactone? A. Alkalosis Hyperkalemia B. Hirsutism . Hypercalcemia 8. Anew diuretic is being studied in human volunteers. Compared with placebo, the new drug increases urine volume, increases urinary, Cade, increases plasma pH, and decreases serum K+. If this new drug has a similar mechanism of action to an established diuretic, it probably A, blocks the NaCI cotransporter in the DCT . inhibits carbonic anhydrase in the PCT B, blocks aldosterone receptors in the CT D. inhibits the Nat/K+/2CI- cotransporter in the TAL 9, Chronic use of which diuretics may cause gout? ‘A, Loop diuretics C. Carbonic anhydrase B. Thiazide diureties D. Osmotic diureties 10. A diuretic that ean be used in treatment of gout: ‘A. Ethacrynic acid . Thiazide diuretic B, Furosemide D, Carbonic anhydrase ANSWER KEY. TD [2D RASA SA [6D eSCHAPTER 2 BEHAVIORAL SCIENCES 01. Behavioral & Cognitive abnormalities caused by renal function 1. Dementia In the context of renal dysfunction, dementia refers toa decline in cognitive function that interferes with daily activities, Patients with advanced chronic kidney disease (CKD) or end-stage renal disease (ESRD) may experience cognitive impairment due to the accumulation of uremic toxins in the blood, electrolyte imbalances, and cerebrovascular complications. ‘Symptoms of dementia in renal dysfunction may include memory loss, difficulty concentrating, confusion, and disorientation 2. Uremic encephalopathy Uremic encephalopathy is a neurological condition characterized by brain dysfunction secondary to kidney failure and the ‘accumulation of uremic taxins in the bloodstream, It can manifest as a wide range of neurological symptoms, including cognitive impairment, altered mental status, seizures, and ‘Uremic encephalopathy can significantly impact a patient's cognitive function and overall quality of life 3. Delusion Delusions are false beliefs that aro firmly held despite evidence to the contrary. In patients with renal dysfunction, delusions may arise as a result of cognitive impairment, electrolyte imbalances, or the effects of uremic toxins on the brain. Delusions can contribute o confusion, agitation, and behavioral disturbances in patients with renal dysfunction, posing risks to their safety and well-being. 4. Muscle paralysis ‘Muscle paralysis refers tothe loss of muscle function or movement. In the context of renal dysfunction, muscle paralysis may occur due to electrolyte imbalances, particularly hyperkalemia (high potassium levels), which can disrupt neuromuscular function and lead to weakness or paralysis. Severe hyperkalemia can result in life-threatening complications such as cardiac arrhythmias and respiratory failure. Eee ee Patients with renal dysfunction may experience impaired decision-making, reduced functional independence, and increased reliance on caregivers, impacting their quality of life and social interactions Additionally, the financial burden of managing renal dysfunction, including the costs of medical care and supportive services, can strain healthcare systems and social support networks. Addressing the societal impact of renal dysfunction requires comprehensive strategies to improve access to healthcare, support services, and public awareness of the challenges faced by patients with kidney disease and their families. DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [40]CHAPTER 2 a) Parkinson's disease «) Uremic encephalopathy ') Alzheimer's disease 4) Mubtiple sclerosis 2. In patients with advanced chronic kidney disease (CKD), cognitive impairment may result fom: a) Decreased blood pressure «) Elevated levels of vitamin D ') Accumulation of uremic toxins 4) Excessive potassium intake a) lectrolyte imbalances €) Low blood sugar levels >) Excessive fluid intake 4) High levels of ion in the blood a) Hypokalemia «) Hypocalcemia ') Hyperkalemia @) Hypematremia 5. The societal impact of renal dysfunction includes: a) Increased risk of osteoporosis «) Financial burden on baltheare systems +) Higher rates of lung cancer 4) Improved access to medical care ANSWER KEY Le 2B 2B sc | I ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER (41)CHAPTER 2 COMMUNITY MEDICINE GET niicei eee eed Itrefers to an individual's overall well-being and satisfaction with various aspects of ther life, including physical health, mental health, social relationships, and environment, In disease and treatment settings, the significance of quality of life cannot be overstated, as it directly influences a person’s experience of illness, their response to treatment, and their overall health outcomes. Here's how quality of life is significant in these contexts: 1, Treatment Decision-Making 2, Treatment Adherence 3. Outcome Assessment 4, Patient-Centered Care 5. Long-Term Survivorship 6, Research and Policy Cee ‘Clasification Examples T. Morality indicators Grade death vate, Life expectancy, Infant morality rate, under 5 Child mortally ate Maternal mortality rate 2, Morbidity indicators Incidence, prevalence, Case fatality rato, Admission & Discharge rates, Notification rate Disability ates Suvillian’s index, HALE, DALY, Disability fee life expectanc 4, Nutrition status indicators | Anthropometric measures, Prevalence of Low birth babies 5. Health care delivery Doctor patient ratio, Docor-Nurse ratio, Population bed rato, Patent-trained birth attendant indicators ratio 6. Usilzation rates Tfants immunized under EPI schedule, Ve population using amily planning sonics, Bod ccupaney rate 7 indicators of social & Suicide, Homicide, Road walfic accidents, Smoking, FuveniTe delinquency mental health #. Environmental indicators —| Air polltion, radiation, noise, solid waste 9- Health policy indicators | Allocation of adequate resoutces, proportion of GDP for health resources 10, Socioeconomic indicators | Per capite GNF, Unemployment, Dependency ratio, Literacy rats, family size [tc Indicators of quality of fife infant mortal, Life expectancy at | year of age, Literacy geet 10) Crude death rate (CDI Life expectancy (Average no. of years that will be lived by those borne alive in the population if eurrent age-specific mortality rates persist. Example In Pakistan, according to 2021 data, life expectancy of men & women are 67 & 69 respectively) Infant mortality rate ~ 22/ Sth tnntshitiren es then yer N68" 4999) Total no. tive Births a year Under child mortality rate ~ N22? Sette or entaren eran year ap0 inayeer 5 1999) Total naaf children under years of age bv 8 year Maternal mortality rate = —822/#th af women n pregnancy thd re MAIEET_ 5 199,999) Now new eases in a given period of time Incidence = Population at risk during that time —% 1000) Noof al (old &new)eases a given period of tine Prevalene x 100) ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [42]CHAPTER 2 otal nowt deaths due to particular disease Total woof eases due to same disease Case fatality ratio represents killing power of a disease; CFR’ x 100) Suvilian’s index: I is calculated by subtracting probable duration of disability from life expectancy HALE: Health adjusted life expectancy is based on life expectancy at birth, it is no. of years a new born is expected to live in full health DALY: Daily adjusted life year is quantitative measure of overall disease burden (no. of life years lost due to premature death + no, of ‘years lived with disabailty) Average bed occupancy, Bed oceupaney Fate = Frage ea avalablity x 100) ‘Quality-Adjusted Life Year (QALY) © QALY measures the quality and quantity of life lived by individuals affected by a health condition or intervention, = QALYs allow for comparisons of the effectiveness and cost-effectiveness of different healthcare interventions by considering not only their impact on survival but also their impact on patients’ quality of life. + QALYs are commonly used in economic evaluations of healthcare interventions to inform resource allocation decisions and prioritize interventions that maximize health gains. ‘DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [43]CHAPTER 2 a) Life expectancy ©) Disability-Adjusted Life Year (DALY) +) Quality-Adjusted Life Year (QALY) 4) Healthy life expectancy 2. QALYs are used primary for 4) Assessing the burden of disease ©) Estimating life expectancy 'b) Comparing healthcare interventions 4) Measuring disability-adjusted life years a) Socioeconomic status ©) Quality of life by Healtheare access 4) Lifestyle behaviors a) Life expectancy ©) DALY b) QALY 4) Disability-adjusted life expectancy |S. DALYs provide a comprehensive assessment of the burden of disease by considering: 8) Only years of life lost due to premature death ©) Both mortality and morbidity ») Only years lived with disability 4) Only quality of life adjustments a) Life Expectancy 9) DALY ») Notification Rate 4) Bed tum-over ratio 1) Based on moxtality rates and population data €) Based on quality of life and disability rates ») Based on disease prevalence and incidence 4) Based on healtheare expenditure and utilization a) DALY measures burden of disease, while QALY measures quality of life ) DALY measures life expectancy, while QALY measures mortality rate ©) DALY measures quality of life, while QALY measures burden of disease 4) DALY measures mortality rate, while QALY measures life expectancy 2) To measure life expectancy ) To measure quality of ie 'b) To measure the burden of disease d) To measure mortality rate ANSWER KEY (rep as se ae se [ 6A [ 7A [8A] 98 1 DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [44]Peery Primary Prevention Primary prevention focuses on preventing the occurrence of urinary system disorders before they develop. This i + Promotion of good hygiene practices to prevent UTIs, such as proper genital hygiene and staying hydrated, + Encouraging lifestyle modifications like maintaining a healthy die, regular exercise, and avoiding tobacco use to reduce the risk of, kidney diseases and urinary tract cancers. ‘+ Immunization against certain infections like hepatitis B, which can lead to kidney damage in some cases. Judes: Secondary Prevention Secondary prevention aims to detect and treat urinary system disorders in theit early stages to prevent progression and complications. This involves: Routine screening tests such as urinalysis and blood tests to detect early signs of kidney discases or urinary tract infections, # Imaging studies like ultrasound or CT scans to assess kidney function and identify structural abnormalities. + Barly treatment of urinary tract infections with appropriate antibiaties to prevent complications like kidney damage or sepsis, ‘Tertiary Prevention ‘Tertiary prevention focuses on managing and reducing the impact of established urinary system disorders to prevent further ‘complications and improve quality of life. This includes: * Medication management and lifestyle modifications to control symptoms and stow the progression of chronie kidney disease. ‘© Renal replacement therapies Such as dialysis or kidney transplantation for end-stage renal disease. © Rehabilitation programs to help patients cope with urinary incontinence or other urinary system disorders and regain function, Urinary incontinence refers to the involuntary leakage of urine, which can range from occasional driboling to complete loss of bladder ‘control. It can significantly impact an individual's quality of life and may arise due to various underlying factors, including weakened pelvic floor muscles, nerve damage, or bladder abnormalities. Management includes; Lifestyle modifications Pelvic floor muscle exercises to strengthen the muscles that control urination. Bladder training techniques to gradually increase the interval between urination. © Weight management, as excess weight can contribute to urinary incontinence. + Avoiding bladder irritants such as caffeine, alcohol, and acidic foods. Scheduled toileting routines to promote regular voiding. Medications © Anticholinergic medications to relax the bladder muscles and reduce urgency. Surgical interventions ‘Sling procedures to support the urethra and prevent stress incontinence. + Bladder neck suspension surgeries to provide additional support to the bladder neck and urethra, = Artificial urinary sphincter implantation for severe cases of stress incontinence or after prostate surgery. Features ‘Stress incontinence Urge incontinence ‘Symptoms | Leak with activities which increase intra- | When urge to void occurs, patient leaks before abdominal pressure reaching tooilet Sign | Urine leakage exactly coincides with | Spontaneous Teak which persists after activity activities finishedCHAPTER 2 4) Increased urinary frequency €) Blood in the urine Painful urination @ Delayed urination 2) Stress incontinence €) Overflow incontinence Urge incontinence 4) Functional incontinence a) Anticholinergic medications «) Pelvic floor muscle exercises 'b) Bladder training 6 Surgical intervention 4. Which population group is most commonly affected by urge urinary incontinence? a) Adolescents ¢) Middle-aged adults +b) Older adults 4) Chitdren Soe ST TEE a Increasing caffeine intak €) Maintaining a healthy weight ») Avoiding regular exercise @ Drinking large amounts of alcohol 6. Which ofthe following is an example of primary prevention in urinary system health? a) Routine screening for kidney diseases ¢) Immunization against hepatitis B +) Farly treatment of urinary tract infections 4) Medication management for chronic kidney disease 7. What is the focus of secondary prevention in urinary system disorders? a) Preventing the occurrence of urinary tract infections ) Managing symptoms of end-stage renal disease ») Detecting and treating disorders in ther early stages 4) Providing rehabilitation programs for urinary incontinence a) Promotion of good hygiene practices «) Rehabilitation programs for urinary incontinence ¥) Routine screening for kidney function 4) Immunization against urinary tract infections a) To detect and treat disorders in their early stages ») To prevent the occurrence of urinary system disorders 6) To manage and reduce the impact of established disorders 4) To provide rehabilitation programs for urinary incontinence a) Primary prevention ¢) Tertiary prevention ) Secondary prevention <4) Quaternary prevention AMSWER KEY Ta Za Ze T ab T Se fe Tb Re I ob I 10.5 DR. ABDUL MANAN, DR. AAYBAAD AHMAD & DR. GHULAM DASTGEER [46]