1 – EDEMA: anziano con edemi declivi e nicturia cronici, puerpera con edema e dolore di gamba, giovane maschio con edema a mantellina, giovane donna diabetica con edema perioculare. Fisiopatologia: legge di Sterling e suo ruolo nei vari distretti e nelle varie patologie. Patologie: SCC, cirrosi epatica, sindrome nefrosica, LNH, angioedema ereditario, ipercortisolemia, TVP, trombofilia. Test: ECG, ecocolordoppler cuore, ecografia addominale, BNP, GGT, sierologia HCV e HBV, D-dimero, ATIII, PS, omocisteina, anti-fosfolipidi, Doppler venoso, TC torace, PET, dosaggio C1q, cortisolemia, cortilosuria, albuminemia, albuminuria, ritentivi renali, TSH-R, FT3, FT4. Terapie: ACE inibitori, sartanici, beta-bloccanti, diuertici, CRT, anticoagulanti orali e parenterali, CIT e terapie biologiche dei linfomi, levotiroxina, diuretici dell’ansa. Aspetti metodologici: test di Bayes e correlati.
2 – EMORRAGIA: triatleta con petecchie diffuse agli arti inferiori, ragazza con metrorragia cronica, anziano con astenia e melena. Patologie: ITP, emofilia congenita, porpora di Schonlein-Henoch, leucemia acuta, vWD, deficit vitamina K, CRC, malattia peptica, angiodiplasie. Test: PT, aPTT, fattori della coagulazione, esame morfologico e citofluorimetrico dei leucociti, endoscopie del tratto gastroenterico. Terapie: igev, TPO-mimetici, anti-fibrinolitici.
3 – FEBBRE: anziano diabetico con febbre, disuria e linfocitosi assoluta; signora con febbricola cronica e artro-mialgie ondulanti; diabetica obesa con febbre alta e tosse in corso pandemia COVID19. Patologie: urosepsi, scompenso glicidico, LLC, fibromialgia, infezione da TB, sindromi paraneoplastiche, infezione COVID19. Terapia: bilancio pH e idro-elettrolitico, inibitori di BTK e Moab anti CD20.
4 – RIDUZIONE DEL SENSORIO: anziano con sincope minzionale, sopore progressivo con febbricola in diabetica, agitazione e coma in anziano non diabetico. Patologie: sincope situazionale/vagale, comizialità, BAV, SSS, ictus cerebri, meningite, intossicazione da CO, lesioni intracraniche, coma diabetico, coma uremico. Test: elettrocardiograma, emogasanalisi, analisi chimico-fisica del liquor.
5 – DOLORE: dolore toracico acuto in fumatrice ipertesa, dolori articolari e addominale cronici in giovane donna, dolore addominale acuto post-prandiale contestuale a dolori ossei cronici, dolore neuropatico ingravescente in diabetica vegetariana. Patologie: SCA, pericardite, TEP, dissecazione aortica, AR, febbre mediterranea familiare, celiachia, pancreatite, colecistite, IBD, metastasi ossee, neuropatia periferica diabetica, neuropatia periferica da malattie rare. Test: curva enzimatica, FR, ANA, ENA, calprotectina fecale. Terapie: difosfonati, amitriptilina, anti-TNF, PTCA primaria, trattamento del diabete mellito tipo 2.
6 – DISPNEA: dispnea ingravescente con tachipnea in tabagista obeso, dispnea acuta post-traumatica, dispnea da sforzo cronica. Patologie: BPCO, polmonite comunitaria, EPA, infezione da COVID19, neoplasia polmonare, emopericardio, ipertensione polmonare. Test: EGA arterioso, D-dimero, Rx torace. Terapie: trattamento antibatterico empirico della CAP, C-PAP.
7 – ITTERO: donna giovane con ittero subacuto, nausea e astenia; etilista con ittero cronico e ipercromia cutanea. Patologie: epatopatia cronica, epatocarcinoma, emocromatosi, talassemia major, anemia emolitica autoimmune, ostruzioni vie biliari, m di Gilbert, sferocitosi ereditaria. Test: elettroforesi emoglobina, ferritina, test genetici per emocrmomatosi, test di Coombs diretto, transaminasi, bilirubina frazionata, sierologia HCV e HBV. Terapie: salasso, steroidi, rituximab.
8 – PRURITO: giovane donna con reazioni anafilattoidi ricorrenti a stimoli eterogenei, anziano con prurito acquagenico cronico. Patologie: mastocitosi, PV, MAS, scabbia, colostasi. Test: triptasi, IgE, JAK2V617F. Terapie: anti-istaminici, inteferone-alpha, midostaurina
1 - OEDEMA: elderly with chronic declivous oedema and nocturia, puerpera with edema and leg pain, young male with cape edema, young diabetic woman with periocular edema. Pathophysiology: Sterling's law and its role in the various districts and various pathologies. Diseases: SCC, liver cirrhosis, nephrotic syndrome, NHL, hereditary angioedema, hypercortisolemia, DVT, thrombophilia. Test: ECG, heart echocolordoppler, abdominal ultrasound, BNP, GGT, HCV and HBV serology, D-dimer, ATIII, PS, homocysteine, anti-phospholipids, venous Doppler, chest CT, PET, C1q assay, cortisolemia, cortylosuria, albuminemia, albuminuria, renal retentives, TSH-R, FT3, FT4. Therapies: ACE inhibitors, sartanics, beta-blockers, diuretics, CRTs, oral and parenteral anticoagulants, CIT and biological therapies for lymphomas, levothyroxine, loop diuretics. Methodological aspects: Bayes and related tests.
2 - HEMORRAGIA: triathlete with petechiae spread to the lower limbs, girl with chronic metrorrhagia, elderly with asthenia and melena. Diseases: ITP, congenital haemophilia, Schonlein-Henoch purpura, acute leukemia, vWD, vitamin K deficiency, CRC, peptic disease, angiodysplasias. Tests: PT, aPTT, coagulation factors, morphological and flow cytometric examination of leukocytes, endoscopy of the gastrointestinal tract. Therapies: igev, TPO-mimetics, anti-fibrinolytics.
3 - FEVER: diabetic elderly with fever, dysuria and absolute lymphocytosis; lady with chronic low-grade fever and undulating arthro-myalgia; Obese diabetic with high fever and cough in ongoing COVID19 pandemic. Disorders: Urosepsis, glucose decompensation, CLL, fibromyalgia, TB infection, paraneoplastic syndromes, COVID19 infection. Therapy: pH and hydro-electrolyte balance, BTK inhibitors and Moab anti CD20.
4 - SENSORY REDUCTION: elderly with urinary syncope, progressive drowsiness with low-grade fever in diabetic, agitation and coma in non-diabetic elderly. Pathologies: situational / vagal syncope, seizure, BAV, SSS, stroke, meningitis, CO poisoning, intracranial lesions, diabetic coma, uremic coma. Test: electrocardiogram, blood gas analysis, chemical-physical analysis of the CSF.
5 - PAIN: acute chest pain in hypertensive smoker, chronic joint and abdominal pain in young woman, acute postprandial abdominal pain contextual to chronic bone pain, worsening neuropathic pain in vegetarian diabetic. Diseases: SCA, pericarditis, TEP, aortic dissection, RA, familial Mediterranean fever, celiac disease, pancreatitis, cholecystitis, IBD, bone metastases, diabetic peripheral neuropathy, peripheral neuropathy from rare diseases. Test: enzymatic curve, FR, ANA, ENA, fecal calprotectin. Therapies: diphosphonates, amitriptyline, anti-TNF, primary PTCA, treatment of type 2 diabetes mellitus. 6 - Dyspnea: worsening dyspnea with tachypnea in obese smokers, acute post-traumatic dyspnea, chronic exertional dyspnea. Diseases: COPD, community-acquired pneumonia, EPA, COVID19 infection, pulmonary neoplasm, haemopericardium, pulmonary hypertension. Test: arterial EGA, D-dimer, chest x-ray. Therapies: empirical antibacterial treatment of CAP, C-PAP.
7 - Jaundice: young woman with subacute jaundice, nausea and asthenia; alcoholic with chronic jaundice and skin hyperchromia. Diseases: chronic liver disease, hepatocellular carcinoma, hemochromatosis, thalassemia major, autoimmune haemolytic anemia, biliary tract obstruction, Gilbert's disease, hereditary spherocytosis. Tests: Hemoglobin electrophoresis, ferritin, genetic tests for hemochromomatosis, direct Coombs test, transaminases, fractionated bilirubin, HCV and HBV serology. Therapies: bloodletting, steroids, rituximab.
8 - ITCH: young woman with recurrent anaphylactoid reactions to heterogeneous stimuli, elderly with chronic aquagenic itching. Pathologies: mastocytosis, PV, MAS, scabies, colostasis. Test: tryptase, IgE, JAK2V617F. Therapies: anti-histamines, inteferon-alpha, midostaurin
Seguici: