/*\
title: $:/.tb/modules/startup/hide-sidebar.js
type: application/javascript
module-type: startup
created: 20151010151732122
creator: Tobias Beer
modified: 20151010151750739
Hides the sidebar on startup when the config tiddler [[$:/config/hide-sidebar-on-startup]] contains "yes"
\*/
(function(){
/*jslint node: true, browser: true */
/*global $tw: false */
"use strict";
// Export name and synchronous status
exports.name = "hide-sidebar-on-startup";
exports.platforms = ["browser"];
exports.after = ["startup"];
exports.synchronous = true;
exports.startup = function() {
var conf = $tw.wiki.getTiddler("$:/config/HideSidebarOnStartup"),
value = (conf ? conf.getFieldString("text") : "").toLowerCase(),
state = value == "yes" ? "no" : "yes";
$tw.wiki.setText("$:/state/sidebar", "text", undefined, state);
};
})();
[is[tiddler]!is[tiddler]]
{
"tiddlers": {
"$:/Acknowledgements": {
"title": "$:/Acknowledgements",
"text": "TiddlyWiki incorporates code from these fine OpenSource projects:\n\n* [[The Stanford Javascript Crypto Library|http://bitwiseshiftleft.github.io/sjcl/]]\n* [[The Jasmine JavaScript Test Framework|http://pivotal.github.io/jasmine/]]\n* [[Normalize.css by Nicolas Gallagher|http://necolas.github.io/normalize.css/]]\n\nAnd media from these projects:\n\n* World flag icons from [[Wikipedia|http://commons.wikimedia.org/wiki/Category:SVG_flags_by_country]]\n"
},
"$:/core/copyright.txt": {
"title": "$:/core/copyright.txt",
"type": "text/plain",
"text": "TiddlyWiki created by Jeremy Ruston, (jeremy [at] jermolene [dot] com)\n\nCopyright (c) 2004-2007, Jeremy Ruston\nCopyright (c) 2007-2020, UnaMesa Association\nAll rights reserved.\n\nRedistribution and use in source and binary forms, with or without\nmodification, are permitted provided that the following conditions are met:\n\n* Redistributions of source code must retain the above copyright notice, this\n list of conditions and the following disclaimer.\n\n* Redistributions in binary form must reproduce the above copyright notice,\n this list of conditions and the following disclaimer in the documentation\n and/or other materials provided with the distribution.\n\n* Neither the name of the copyright holder nor the names of its\n contributors may be used to endorse or promote products derived from\n this software without specific prior written permission.\n\nTHIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS 'AS IS'\nAND ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE\nIMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARE\nDISCLAIMED. IN NO EVENT SHALL THE COPYRIGHT HOLDER OR CONTRIBUTORS BE LIABLE\nFOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL\nDAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR\nSERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER\nCAUSED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY,\nOR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE\nOF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE."
},
"$:/core/icon": {
"title": "$:/core/icon",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" viewBox=\"0 0 128 128\"><path d=\"M64 0l54.56 32v64L64 128 9.44 96V32L64 0zm21.127 95.408c-3.578-.103-5.15-.094-6.974-3.152l-1.42.042c-1.653-.075-.964-.04-2.067-.097-1.844-.07-1.548-1.86-1.873-2.8-.52-3.202.687-6.43.65-9.632-.014-1.14-1.593-5.17-2.157-6.61-1.768.34-3.546.406-5.34.497-4.134-.01-8.24-.527-12.317-1.183-.8 3.35-3.16 8.036-1.21 11.44 2.37 3.52 4.03 4.495 6.61 4.707 2.572.212 3.16 3.18 2.53 4.242-.55.73-1.52.864-2.346 1.04l-1.65.08c-1.296-.046-2.455-.404-3.61-.955-1.93-1.097-3.925-3.383-5.406-5.024.345.658.55 1.938.24 2.53-.878 1.27-4.665 1.26-6.4.47-1.97-.89-6.73-7.162-7.468-11.86 1.96-3.78 4.812-7.07 6.255-11.186-3.146-2.05-4.83-5.384-4.61-9.16l.08-.44c-3.097.59-1.49.37-4.82.628-10.608-.032-19.935-7.37-14.68-18.774.34-.673.664-1.287 1.243-.994.466.237.4 1.18.166 2.227-3.005 13.627 11.67 13.732 20.69 11.21.89-.25 2.67-1.936 3.905-2.495 2.016-.91 4.205-1.282 6.376-1.55 5.4-.63 11.893 2.276 15.19 2.37 3.3.096 7.99-.805 10.87-.615 2.09.098 4.143.483 6.16 1.03 1.306-6.49 1.4-11.27 4.492-12.38 1.814.293 3.213 2.818 4.25 4.167 2.112-.086 4.12.46 6.115 1.066 3.61-.522 6.642-2.593 9.833-4.203-3.234 2.69-3.673 7.075-3.303 11.127.138 2.103-.444 4.386-1.164 6.54-1.348 3.507-3.95 7.204-6.97 7.014-1.14-.036-1.805-.695-2.653-1.4-.164 1.427-.81 2.7-1.434 3.96-1.44 2.797-5.203 4.03-8.687 7.016-3.484 2.985 1.114 13.65 2.23 15.594 1.114 1.94 4.226 2.652 3.02 4.406-.37.58-.936.785-1.54 1.01l-.82.11zm-40.097-8.85l.553.14c.694-.27 2.09.15 2.83.353-1.363-1.31-3.417-3.24-4.897-4.46-.485-1.47-.278-2.96-.174-4.46l.02-.123c-.582 1.205-1.322 2.376-1.72 3.645-.465 1.71 2.07 3.557 3.052 4.615l.336.3z\" fill-rule=\"evenodd\"/></svg>"
},
"$:/core/images/add-comment": {
"title": "$:/core/images/add-comment",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-add-comment tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M56 56H36a8 8 0 100 16h20v20a8 8 0 1016 0V72h20a8 8 0 100-16H72V36a8 8 0 10-16 0v20zm-12.595 58.362c-6.683 7.659-20.297 12.903-36.006 12.903-2.196 0-4.35-.102-6.451-.3 9.652-3.836 17.356-12.24 21.01-22.874C8.516 94.28 0 79.734 0 63.5 0 33.953 28.206 10 63 10s63 23.953 63 53.5S97.794 117 63 117c-6.841 0-13.428-.926-19.595-2.638z\"/></svg>"
},
"$:/core/images/advanced-search-button": {
"title": "$:/core/images/advanced-search-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-advanced-search-button tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M74.565 87.985A47.776 47.776 0 0148 96C21.49 96 0 74.51 0 48S21.49 0 48 0s48 21.49 48 48c0 9.854-2.97 19.015-8.062 26.636l34.347 34.347a9.443 9.443 0 010 13.36 9.446 9.446 0 01-13.36 0l-34.36-34.358zM48 80c17.673 0 32-14.327 32-32 0-17.673-14.327-32-32-32-17.673 0-32 14.327-32 32 0 17.673 14.327 32 32 32z\"/><circle cx=\"48\" cy=\"48\" r=\"8\"/><circle cx=\"28\" cy=\"48\" r=\"8\"/><circle cx=\"68\" cy=\"48\" r=\"8\"/></g></svg>"
},
"$:/core/images/auto-height": {
"title": "$:/core/images/auto-height",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-auto-height tc-image-button\" viewBox=\"0 0 128 128\"><path d=\"M67.987 114.356l-.029-14.477a4 4 0 00-2.067-3.494l-15.966-8.813-1.933 7.502H79.9c4.222 0 5.564-5.693 1.786-7.58L49.797 71.572 48.01 79.15h31.982c4.217 0 5.564-5.682 1.795-7.575L49.805 55.517l-1.795 7.575h31.982c4.212 0 5.563-5.67 1.805-7.57l-16.034-8.105 2.195 3.57V35.614l9.214 9.213a4 4 0 105.656-5.656l-16-16a4 4 0 00-5.656 0l-16 16a4 4 0 105.656 5.656l9.13-9.13v15.288a4 4 0 002.195 3.57l16.035 8.106 1.804-7.57H48.01c-4.217 0-5.564 5.682-1.795 7.574l31.982 16.059 1.795-7.575H48.01c-4.222 0-5.564 5.693-1.787 7.579l31.89 15.923 1.787-7.578H47.992c-4.133 0-5.552 5.504-1.933 7.501l15.966 8.813-2.067-3.494.029 14.436-9.159-9.158a4 4 0 00-5.656 5.656l16 16a4 4 0 005.656 0l16-16a4 4 0 10-5.656-5.656l-9.185 9.184zM16 20h96a4 4 0 100-8H16a4 4 0 100 8z\"/></svg>"
},
"$:/core/images/blank": {
"title": "$:/core/images/blank",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-blank tc-image-button\" viewBox=\"0 0 128 128\"/>"
},
"$:/core/images/bold": {
"title": "$:/core/images/bold",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-bold tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M41.146 51.81V21.87h26.353c2.51 0 4.93.21 7.26.628 2.33.418 4.392 1.165 6.185 2.24 1.793 1.076 3.227 2.57 4.302 4.482 1.076 1.913 1.614 4.363 1.614 7.35 0 5.379-1.613 9.263-4.84 11.653-3.227 2.39-7.35 3.586-12.37 3.586H41.146zM13 0v128h62.028a65.45 65.45 0 0016.762-2.151c5.438-1.434 10.278-3.645 14.52-6.633 4.244-2.988 7.62-6.842 10.13-11.563 2.51-4.721 3.764-10.308 3.764-16.762 0-8.008-1.942-14.85-5.826-20.527-3.884-5.677-9.77-9.65-17.658-11.921 5.737-2.75 10.069-6.275 12.997-10.577 2.928-4.303 4.392-9.681 4.392-16.135 0-5.976-.986-10.995-2.958-15.059-1.972-4.063-4.75-7.32-8.336-9.77-3.585-2.45-7.888-4.213-12.907-5.289C84.888.538 79.33 0 73.235 0H13zm28.146 106.129V70.992H71.8c6.095 0 10.995 1.404 14.7 4.212 3.705 2.81 5.558 7.5 5.558 14.073 0 3.347-.568 6.096-1.703 8.247-1.136 2.151-2.66 3.854-4.572 5.11-1.912 1.254-4.123 2.15-6.633 2.688-2.51.538-5.139.807-7.888.807H41.146z\"/></svg>"
},
"$:/core/images/cancel-button": {
"title": "$:/core/images/cancel-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-cancel-button tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M64 76.314l-16.97 16.97a7.999 7.999 0 01-11.314 0c-3.118-3.118-3.124-8.19 0-11.313L52.686 65l-16.97-16.97a7.999 7.999 0 010-11.314c3.118-3.118 8.19-3.124 11.313 0L64 53.686l16.97-16.97a7.999 7.999 0 0111.314 0c3.118 3.118 3.124 8.19 0 11.313L75.314 65l16.97 16.97a7.999 7.999 0 010 11.314c-3.118 3.118-8.19 3.124-11.313 0L64 76.314zM64 129c35.346 0 64-28.654 64-64 0-35.346-28.654-64-64-64C28.654 1 0 29.654 0 65c0 35.346 28.654 64 64 64zm0-16c26.51 0 48-21.49 48-48S90.51 17 64 17 16 38.49 16 65s21.49 48 48 48z\"/></svg>"
},
"$:/core/images/chevron-down": {
"title": "$:/core/images/chevron-down",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-chevron-down tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M64.053 85.456a7.889 7.889 0 01-5.6-2.316L2.473 27.16a7.92 7.92 0 010-11.196c3.086-3.085 8.105-3.092 11.196 0L64.05 66.344l50.382-50.382a7.92 7.92 0 0111.195 0c3.085 3.086 3.092 8.105 0 11.196l-55.98 55.98a7.892 7.892 0 01-5.595 2.317z\"/><path d=\"M64.053 124.069a7.889 7.889 0 01-5.6-2.316l-55.98-55.98a7.92 7.92 0 010-11.196c3.086-3.085 8.105-3.092 11.196 0l50.382 50.382 50.382-50.382a7.92 7.92 0 0111.195 0c3.085 3.086 3.092 8.104 0 11.196l-55.98 55.98a7.892 7.892 0 01-5.595 2.316z\"/></g></svg>"
},
"$:/core/images/chevron-left": {
"title": "$:/core/images/chevron-left",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-chevron-left tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M47.544 64.053c0-2.027.77-4.054 2.316-5.6l55.98-55.98a7.92 7.92 0 0111.196 0c3.085 3.086 3.092 8.105 0 11.196L66.656 64.05l50.382 50.382a7.92 7.92 0 010 11.195c-3.086 3.085-8.105 3.092-11.196 0l-55.98-55.98a7.892 7.892 0 01-2.317-5.595z\"/><path d=\"M8.931 64.053c0-2.027.77-4.054 2.316-5.6l55.98-55.98a7.92 7.92 0 0111.196 0c3.085 3.086 3.092 8.105 0 11.196L28.041 64.05l50.382 50.382a7.92 7.92 0 010 11.195c-3.086 3.085-8.104 3.092-11.196 0l-55.98-55.98a7.892 7.892 0 01-2.316-5.595z\"/></g></svg>"
},
"$:/core/images/chevron-right": {
"title": "$:/core/images/chevron-right",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-chevron-right tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M83.456 63.947c0 2.027-.77 4.054-2.316 5.6l-55.98 55.98a7.92 7.92 0 01-11.196 0c-3.085-3.086-3.092-8.105 0-11.196L64.344 63.95 13.963 13.567a7.92 7.92 0 010-11.195c3.086-3.085 8.105-3.092 11.196 0l55.98 55.98a7.892 7.892 0 012.317 5.595z\"/><path d=\"M122.069 63.947c0 2.027-.77 4.054-2.316 5.6l-55.98 55.98a7.92 7.92 0 01-11.196 0c-3.085-3.086-3.092-8.105 0-11.196l50.382-50.382-50.382-50.382a7.92 7.92 0 010-11.195c3.086-3.085 8.104-3.092 11.196 0l55.98 55.98a7.892 7.892 0 012.316 5.595z\"/></g></svg>"
},
"$:/core/images/chevron-up": {
"title": "$:/core/images/chevron-up",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-chevron-up tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M63.947 44.544c2.027 0 4.054.77 5.6 2.316l55.98 55.98a7.92 7.92 0 010 11.196c-3.086 3.085-8.105 3.092-11.196 0L63.95 63.656l-50.382 50.382a7.92 7.92 0 01-11.195 0c-3.085-3.086-3.092-8.105 0-11.196l55.98-55.98a7.892 7.892 0 015.595-2.317z\"/><path d=\"M63.947 5.931c2.027 0 4.054.77 5.6 2.316l55.98 55.98a7.92 7.92 0 010 11.196c-3.086 3.085-8.105 3.092-11.196 0L63.95 25.041 13.567 75.423a7.92 7.92 0 01-11.195 0c-3.085-3.086-3.092-8.104 0-11.196l55.98-55.98a7.892 7.892 0 015.595-2.316z\"/></g></svg>"
},
"$:/core/images/clone-button": {
"title": "$:/core/images/clone-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-clone-button tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M32.265 96v24.002A7.996 7.996 0 0040.263 128h79.74a7.996 7.996 0 007.997-7.998v-79.74a7.996 7.996 0 00-7.998-7.997H96V48h12.859a2.99 2.99 0 012.994 2.994v57.865a2.99 2.99 0 01-2.994 2.994H50.994A2.99 2.99 0 0148 108.859V96H32.265z\"/><path d=\"M40 56h-7.993C27.588 56 24 52.418 24 48c0-4.41 3.585-8 8.007-8H40v-7.993C40 27.588 43.582 24 48 24c4.41 0 8 3.585 8 8.007V40h7.993C68.412 40 72 43.582 72 48c0 4.41-3.585 8-8.007 8H56v7.993C56 68.412 52.418 72 48 72c-4.41 0-8-3.585-8-8.007V56zM8 0C3.58 0 0 3.588 0 8v80c0 4.419 3.588 8 8 8h80c4.419 0 8-3.588 8-8V8c0-4.419-3.588-8-8-8H8zM19 16A2.997 2.997 0 0016 19.001v57.998A2.997 2.997 0 0019.001 80h57.998A2.997 2.997 0 0080 76.999V19.001A2.997 2.997 0 0076.999 16H19.001z\"/></g></svg>"
},
"$:/core/images/close-all-button": {
"title": "$:/core/images/close-all-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-close-all-button tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><path d=\"M28 111.314l-14.144 14.143a8 8 0 01-11.313-11.313L16.686 100 2.543 85.856a8 8 0 0111.313-11.313L28 88.686l14.144-14.143a8 8 0 0111.313 11.313L39.314 100l14.143 14.144a8 8 0 01-11.313 11.313L28 111.314zM28 39.314L13.856 53.457A8 8 0 012.543 42.144L16.686 28 2.543 13.856A8 8 0 0113.856 2.543L28 16.686 42.144 2.543a8 8 0 0111.313 11.313L39.314 28l14.143 14.144a8 8 0 01-11.313 11.313L28 39.314zM100 39.314L85.856 53.457a8 8 0 01-11.313-11.313L88.686 28 74.543 13.856A8 8 0 0185.856 2.543L100 16.686l14.144-14.143a8 8 0 0111.313 11.313L111.314 28l14.143 14.144a8 8 0 01-11.313 11.313L100 39.314zM100 111.314l-14.144 14.143a8 8 0 01-11.313-11.313L88.686 100 74.543 85.856a8 8 0 0111.313-11.313L100 88.686l14.144-14.143a8 8 0 0111.313 11.313L111.314 100l14.143 14.144a8 8 0 01-11.313 11.313L100 111.314z\"/></g></svg>"
},
"$:/core/images/close-button": {
"title": "$:/core/images/close-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-close-button tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M65.086 75.41l-50.113 50.113c-3.121 3.121-8.192 3.126-11.316.002-3.118-3.118-3.123-8.19.002-11.316l50.114-50.114L3.659 13.982C.538 10.86.533 5.79 3.657 2.666c3.118-3.118 8.19-3.123 11.316.002l50.113 50.114L115.2 2.668c3.121-3.121 8.192-3.126 11.316-.002 3.118 3.118 3.123 8.19-.002 11.316L76.4 64.095l50.114 50.114c3.121 3.121 3.126 8.192.002 11.316-3.118 3.118-8.19 3.123-11.316-.002L65.086 75.409z\"/></svg>"
},
"$:/core/images/close-others-button": {
"title": "$:/core/images/close-others-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-close-others-button tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M64 128c35.346 0 64-28.654 64-64 0-35.346-28.654-64-64-64C28.654 0 0 28.654 0 64c0 35.346 28.654 64 64 64zm0-16c26.51 0 48-21.49 48-48S90.51 16 64 16 16 37.49 16 64s21.49 48 48 48zm0-16c17.673 0 32-14.327 32-32 0-17.673-14.327-32-32-32-17.673 0-32 14.327-32 32 0 17.673 14.327 32 32 32zm0-16c8.837 0 16-7.163 16-16s-7.163-16-16-16-16 7.163-16 16 7.163 16 16 16z\"/></svg>"
},
"$:/core/images/copy-clipboard": {
"title": "$:/core/images/copy-clipboard",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-copy-clipboard tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><rect width=\"33\" height=\"8\" x=\"40\" y=\"40\" rx=\"4\"/><rect width=\"17\" height=\"8\" x=\"40\" y=\"82\" rx=\"4\"/><rect width=\"17\" height=\"8\" x=\"40\" y=\"54\" rx=\"4\"/><rect width=\"33\" height=\"8\" x=\"40\" y=\"96\" rx=\"4\"/><rect width=\"12\" height=\"8\" x=\"40\" y=\"68\" rx=\"4\"/><path d=\"M40 16H24c-4.419 0-8 3.59-8 8a8.031 8.031 0 000 .01v95.98a8.03 8.03 0 000 .01c0 4.41 3.581 8 8 8h80a7.975 7.975 0 005.652-2.34 7.958 7.958 0 002.348-5.652v-16.016c0-4.414-3.582-7.992-8-7.992-4.41 0-8 3.578-8 7.992V112H32V32h64v8.008C96 44.422 99.582 48 104 48c4.41 0 8-3.578 8-7.992V23.992a7.963 7.963 0 00-2.343-5.651A7.995 7.995 0 00104.001 16H88c0-4.41-3.585-8-8.007-8H48.007C43.588 8 40 11.582 40 16zm4-1.004A4.001 4.001 0 0148 11h32c2.21 0 4 1.797 4 3.996v4.008A4.001 4.001 0 0180 23H48c-2.21 0-4-1.797-4-3.996v-4.008z\"/><rect width=\"66\" height=\"16\" x=\"62\" y=\"64\" rx=\"8\"/><path d=\"M84.657 82.343l-16-16v11.314l16-16a8 8 0 10-11.314-11.314l-16 16a8 8 0 000 11.314l16 16a8 8 0 1011.314-11.314z\"/></g></svg>"
},
"$:/core/images/delete-button": {
"title": "$:/core/images/delete-button",
"tags": "$:/tags/Image",
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"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-tip tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M64 128.242c35.346 0 64-28.654 64-64 0-35.346-28.654-64-64-64-35.346 0-64 28.654-64 64 0 35.346 28.654 64 64 64zm11.936-36.789c-.624 4.129-5.73 7.349-11.936 7.349-6.206 0-11.312-3.22-11.936-7.349C54.33 94.05 58.824 95.82 64 95.82c5.175 0 9.67-1.769 11.936-4.366zm0 4.492c-.624 4.13-5.73 7.349-11.936 7.349-6.206 0-11.312-3.22-11.936-7.349 2.266 2.597 6.76 4.366 11.936 4.366 5.175 0 9.67-1.769 11.936-4.366zm0 4.456c-.624 4.129-5.73 7.349-11.936 7.349-6.206 0-11.312-3.22-11.936-7.349 2.266 2.597 6.76 4.366 11.936 4.366 5.175 0 9.67-1.769 11.936-4.366zm0 4.492c-.624 4.13-5.73 7.349-11.936 7.349-6.206 0-11.312-3.22-11.936-7.349 2.266 2.597 6.76 4.366 11.936 4.366 5.175 0 9.67-1.769 11.936-4.366zM64.3 24.242c11.618 0 23.699 7.82 23.699 24.2S75.92 71.754 75.92 83.576c0 5.873-5.868 9.26-11.92 9.26s-12.027-3.006-12.027-9.26C51.973 71.147 40 65.47 40 48.442s12.683-24.2 24.301-24.2z\"/></svg>"
},
"$:/core/images/transcludify": {
"title": "$:/core/images/transcludify",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-transcludify-button tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M0 59.482c.591 0 1.36-.089 2.306-.266a10.417 10.417 0 002.75-.932 6.762 6.762 0 002.306-1.907c.651-.828.976-1.863.976-3.104V35.709c0-2.01.414-3.74 1.242-5.19.828-1.448 1.833-2.66 3.016-3.636s2.425-1.7 3.726-2.173c1.3-.473 2.424-.71 3.37-.71h8.073v7.451h-4.88c-1.241 0-2.232.207-2.97.621-.74.414-1.302.932-1.686 1.552a4.909 4.909 0 00-.71 1.996c-.089.71-.133 1.39-.133 2.04v16.677c0 1.715-.325 3.134-.976 4.258-.65 1.123-1.434 2.025-2.35 2.705-.917.68-1.863 1.168-2.839 1.464-.976.296-1.818.473-2.528.532v.178c.71.059 1.552.207 2.528.443.976.237 1.922.68 2.839 1.33.916.651 1.7 1.583 2.35 2.795.65 1.212.976 2.853.976 4.923v16.144c0 .65.044 1.33.133 2.04.089.71.325 1.375.71 1.996.384.621.946 1.139 1.685 1.553.74.414 1.73.62 2.972.62h4.879v7.452h-8.073c-.946 0-2.07-.237-3.37-.71-1.301-.473-2.543-1.197-3.726-2.173-1.183-.976-2.188-2.188-3.016-3.637-.828-1.449-1.242-3.179-1.242-5.19V74.119c0-1.42-.325-2.572-.976-3.46-.65-.886-1.419-1.581-2.306-2.084a8.868 8.868 0 00-2.75-1.02C1.36 67.377.591 67.288 0 67.288v-7.806zm24.66 0c.591 0 1.36-.089 2.306-.266a10.417 10.417 0 002.75-.932 6.762 6.762 0 002.306-1.907c.65-.828.976-1.863.976-3.104V35.709c0-2.01.414-3.74 1.242-5.19.828-1.448 1.833-2.66 3.016-3.636s2.425-1.7 3.726-2.173c1.3-.473 2.424-.71 3.37-.71h8.073v7.451h-4.88c-1.241 0-2.232.207-2.97.621-.74.414-1.302.932-1.686 1.552a4.909 4.909 0 00-.71 1.996c-.089.71-.133 1.39-.133 2.04v16.677c0 1.715-.325 3.134-.976 4.258-.65 1.123-1.434 2.025-2.35 2.705-.917.68-1.863 1.168-2.839 1.464-.976.296-1.818.473-2.528.532v.178c.71.059 1.552.207 2.528.443.976.237 1.922.68 2.839 1.33.916.651 1.7 1.583 2.35 2.795.65 1.212.976 2.853.976 4.923v16.144c0 .65.044 1.33.133 2.04.089.71.325 1.375.71 1.996.384.621.946 1.139 1.685 1.553.74.414 1.73.62 2.972.62h4.879v7.452h-8.073c-.946 0-2.07-.237-3.37-.71-1.301-.473-2.543-1.197-3.726-2.173-1.183-.976-2.188-2.188-3.016-3.637-.828-1.449-1.242-3.179-1.242-5.19V74.119c0-1.42-.325-2.572-.976-3.46-.65-.886-1.419-1.581-2.306-2.084a8.868 8.868 0 00-2.75-1.02c-.946-.177-1.715-.266-2.306-.266v-7.806zm43.965-3.538L80.6 52.041l2.306 7.097-12.063 3.903 7.628 10.378-6.12 4.435-7.63-10.467-7.45 10.201-5.943-4.524 7.628-10.023-12.152-4.17 2.306-7.096 12.064 4.17V43.347h7.451v12.596zm34.425 11.344c-.65 0-1.449.089-2.395.266-.946.177-1.863.488-2.75.931a6.356 6.356 0 00-2.262 1.908c-.62.828-.931 1.862-.931 3.104v17.564c0 2.01-.414 3.74-1.242 5.189-.828 1.449-1.833 2.661-3.016 3.637s-2.425 1.7-3.726 2.173c-1.3.473-2.424.71-3.37.71h-8.073v-7.451h4.88c1.241 0 2.232-.207 2.97-.621.74-.414 1.302-.932 1.686-1.553a4.9 4.9 0 00.71-1.995c.089-.71.133-1.39.133-2.04V72.432c0-1.715.325-3.134.976-4.258.65-1.124 1.434-2.01 2.35-2.661.917-.65 1.863-1.124 2.839-1.42.976-.295 1.818-.502 2.528-.62v-.178c-.71-.059-1.552-.207-2.528-.443-.976-.237-1.922-.68-2.839-1.33-.916-.651-1.7-1.583-2.35-2.795-.65-1.212-.976-2.853-.976-4.923V37.66c0-.651-.044-1.331-.133-2.04a4.909 4.909 0 00-.71-1.997c-.384-.62-.946-1.138-1.685-1.552-.74-.414-1.73-.62-2.972-.62h-4.879V24h8.073c.946 0 2.07.237 3.37.71 1.301.473 2.543 1.197 3.726 2.173 1.183.976 2.188 2.188 3.016 3.637.828 1.449 1.242 3.178 1.242 5.189v16.943c0 1.419.31 2.572.931 3.46a6.897 6.897 0 002.262 2.084 8.868 8.868 0 002.75 1.02c.946.177 1.745.266 2.395.266v7.806zm24.66 0c-.65 0-1.449.089-2.395.266-.946.177-1.863.488-2.75.931a6.356 6.356 0 00-2.262 1.908c-.62.828-.931 1.862-.931 3.104v17.564c0 2.01-.414 3.74-1.242 5.189-.828 1.449-1.833 2.661-3.016 3.637s-2.425 1.7-3.726 2.173c-1.3.473-2.424.71-3.37.71h-8.073v-7.451h4.88c1.241 0 2.232-.207 2.97-.621.74-.414 1.302-.932 1.686-1.553a4.9 4.9 0 00.71-1.995c.089-.71.133-1.39.133-2.04V72.432c0-1.715.325-3.134.976-4.258.65-1.124 1.434-2.01 2.35-2.661.917-.65 1.863-1.124 2.839-1.42.976-.295 1.818-.502 2.528-.62v-.178c-.71-.059-1.552-.207-2.528-.443-.976-.237-1.922-.68-2.839-1.33-.916-.651-1.7-1.583-2.35-2.795-.65-1.212-.976-2.853-.976-4.923V37.66c0-.651-.044-1.331-.133-2.04a4.909 4.909 0 00-.71-1.997c-.384-.62-.946-1.138-1.685-1.552-.74-.414-1.73-.62-2.972-.62h-4.879V24h8.073c.946 0 2.07.237 3.37.71 1.301.473 2.543 1.197 3.726 2.173 1.183.976 2.188 2.188 3.016 3.637.828 1.449 1.242 3.178 1.242 5.189v16.943c0 1.419.31 2.572.931 3.46a6.897 6.897 0 002.262 2.084 8.868 8.868 0 002.75 1.02c.946.177 1.745.266 2.395.266v7.806z\"/></svg>"
},
"$:/core/images/twitter": {
"title": "$:/core/images/twitter",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-twitter tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M41.626 115.803A73.376 73.376 0 012 104.235c2.022.238 4.08.36 6.166.36 12.111 0 23.258-4.117 32.105-11.023-11.312-.208-20.859-7.653-24.148-17.883a25.98 25.98 0 0011.674-.441C15.971 72.881 7.061 62.474 7.061 49.997c0-.108 0-.216.002-.323a25.824 25.824 0 0011.709 3.22c-6.936-4.617-11.5-12.5-11.5-21.433 0-4.719 1.274-9.142 3.5-12.945 12.75 15.579 31.797 25.83 53.281 26.904-.44-1.884-.67-3.85-.67-5.868 0-14.22 11.575-25.75 25.852-25.75a25.865 25.865 0 0118.869 8.132 51.892 51.892 0 0016.415-6.248c-1.93 6.012-6.029 11.059-11.366 14.246A51.844 51.844 0 00128 25.878a52.428 52.428 0 01-12.9 13.33c.05 1.104.075 2.214.075 3.33 0 34.028-26 73.265-73.549 73.265\"/></svg>"
},
"$:/core/images/underline": {
"title": "$:/core/images/underline",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-underline tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M7 117.421h114.248V128H7v-10.579zm97.871-18.525V0h-16.26v55.856c0 4.463-.605 8.576-1.816 12.338-1.212 3.762-3.03 7.046-5.452 9.851-2.423 2.806-5.452 4.974-9.086 6.504-3.635 1.53-7.939 2.296-12.912 2.296-6.25 0-11.159-1.786-14.73-5.356-3.57-3.571-5.356-8.417-5.356-14.538V0H23v65.038c0 5.356.542 10.234 1.626 14.633 1.084 4.4 2.965 8.194 5.643 11.382 2.678 3.188 6.185 5.643 10.52 7.365 4.337 1.721 9.756 2.582 16.26 2.582 7.27 0 13.582-1.435 18.938-4.304 5.356-2.87 9.755-7.365 13.199-13.486h.382v15.686h15.303z\"/></svg>"
},
"$:/core/images/unfold-all-button": {
"title": "$:/core/images/unfold-all-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-unfold-all tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><rect width=\"128\" height=\"16\" rx=\"8\"/><rect width=\"128\" height=\"16\" y=\"64\" rx=\"8\"/><path d=\"M63.945 60.624c-2.05 0-4.101-.78-5.666-2.345L35.662 35.662c-3.125-3.125-3.13-8.195-.005-11.319 3.118-3.118 8.192-3.122 11.319.005L63.94 41.314l16.966-16.966c3.124-3.124 8.194-3.129 11.318-.005 3.118 3.118 3.122 8.192-.005 11.319L69.603 58.279a7.986 7.986 0 01-5.663 2.346zM64.004 124.565c-2.05 0-4.102-.78-5.666-2.345L35.721 99.603c-3.125-3.125-3.13-8.195-.005-11.319 3.118-3.118 8.191-3.122 11.318.005L64 105.255l16.966-16.966c3.124-3.124 8.194-3.129 11.318-.005 3.118 3.118 3.122 8.192-.005 11.319L69.662 122.22a7.986 7.986 0 01-5.663 2.346z\"/></g></svg>"
},
"$:/core/images/unfold-button": {
"title": "$:/core/images/unfold-button",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-unfold tc-image-button\" viewBox=\"0 0 128 128\"><g fill-rule=\"evenodd\"><rect width=\"128\" height=\"16\" rx=\"8\"/><path d=\"M63.945 63.624c-2.05 0-4.101-.78-5.666-2.345L35.662 38.662c-3.125-3.125-3.13-8.195-.005-11.319 3.118-3.118 8.192-3.122 11.319.005L63.94 44.314l16.966-16.966c3.124-3.124 8.194-3.129 11.318-.005 3.118 3.118 3.122 8.192-.005 11.319L69.603 61.279a7.986 7.986 0 01-5.663 2.346zM64.004 105.682c-2.05.001-4.102-.78-5.666-2.344L35.721 80.721c-3.125-3.125-3.13-8.195-.005-11.319 3.118-3.118 8.191-3.122 11.318.005L64 86.373l16.966-16.966c3.124-3.125 8.194-3.13 11.318-.005 3.118 3.118 3.122 8.192-.005 11.319l-22.617 22.617a7.986 7.986 0 01-5.663 2.346z\"/></g></svg>"
},
"$:/core/images/unlocked-padlock": {
"title": "$:/core/images/unlocked-padlock",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-unlocked-padlock tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M48.627 64H105v32.01C105 113.674 90.674 128 73.001 128H56C38.318 128 24 113.677 24 96.01V64h6.136c-10.455-12.651-27.364-35.788-4.3-55.142 24.636-20.672 45.835 4.353 55.777 16.201 9.943 11.85-2.676 22.437-12.457 9.892-9.78-12.545-21.167-24.146-33.207-14.043-12.041 10.104-1.757 22.36 8.813 34.958 2.467 2.94 3.641 5.732 3.865 8.134zm19.105 28.364A8.503 8.503 0 0064.5 76a8.5 8.5 0 00-3.498 16.25l-5.095 22.77H72.8l-5.07-22.656z\"/></svg>"
},
"$:/core/images/up-arrow": {
"title": "$:/core/images/up-arrow",
"created": "20150316000544368",
"modified": "20150316000831867",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-up-arrow tc-image-button\" viewBox=\"0 0 128 128\"><path d=\"M63.892.281c2.027 0 4.054.77 5.6 2.316l55.98 55.98a7.92 7.92 0 010 11.196c-3.086 3.085-8.104 3.092-11.196 0L63.894 19.393 13.513 69.774a7.92 7.92 0 01-11.196 0c-3.085-3.086-3.092-8.105 0-11.196l55.98-55.98A7.892 7.892 0 0163.893.28z\"/></svg>"
},
"$:/core/images/video": {
"title": "$:/core/images/video",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-video tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M64 12c-34.91 0-55.273 2.917-58.182 5.833C2.91 20.75 0 41.167 0 64.5c0 23.333 2.91 43.75 5.818 46.667C8.728 114.083 29.091 117 64 117c34.91 0 55.273-2.917 58.182-5.833C125.09 108.25 128 87.833 128 64.5c0-23.333-2.91-43.75-5.818-46.667C119.272 14.917 98.909 12 64 12zm-9.084 32.618c-3.813-2.542-6.905-.879-6.905 3.698v31.368c0 4.585 3.099 6.235 6.905 3.698l22.168-14.779c3.813-2.542 3.806-6.669 0-9.206L54.916 44.618z\"/></svg>"
},
"$:/core/images/warning": {
"title": "$:/core/images/warning",
"tags": "$:/tags/Image",
"text": "<svg width=\"22pt\" height=\"22pt\" class=\"tc-image-warning tc-image-button\" viewBox=\"0 0 128 128\"><path fill-rule=\"evenodd\" d=\"M57.072 11c3.079-5.333 10.777-5.333 13.856 0l55.426 96c3.079 5.333-.77 12-6.928 12H8.574c-6.158 0-10.007-6.667-6.928-12l55.426-96zM64 37c-4.418 0-8 3.582-8 7.994v28.012C56 77.421 59.59 81 64 81c4.418 0 8-3.582 8-7.994V44.994C72 40.579 68.41 37 64 37zm0 67a8 8 0 100-16 8 8 0 000 16z\"/></svg>"
},
"$:/language/Buttons/AdvancedSearch/Caption": {
"title": "$:/language/Buttons/AdvancedSearch/Caption",
"text": "advanced search"
},
"$:/language/Buttons/AdvancedSearch/Hint": {
"title": "$:/language/Buttons/AdvancedSearch/Hint",
"text": "Advanced search"
},
"$:/language/Buttons/Cancel/Caption": {
"title": "$:/language/Buttons/Cancel/Caption",
"text": "cancel"
},
"$:/language/Buttons/Cancel/Hint": {
"title": "$:/language/Buttons/Cancel/Hint",
"text": "Discard changes to this tiddler"
},
"$:/language/Buttons/Clone/Caption": {
"title": "$:/language/Buttons/Clone/Caption",
"text": "clone"
},
"$:/language/Buttons/Clone/Hint": {
"title": "$:/language/Buttons/Clone/Hint",
"text": "Clone this tiddler"
},
"$:/language/Buttons/Close/Caption": {
"title": "$:/language/Buttons/Close/Caption",
"text": "close"
},
"$:/language/Buttons/Close/Hint": {
"title": "$:/language/Buttons/Close/Hint",
"text": "Close this tiddler"
},
"$:/language/Buttons/CloseAll/Caption": {
"title": "$:/language/Buttons/CloseAll/Caption",
"text": "close all"
},
"$:/language/Buttons/CloseAll/Hint": {
"title": "$:/language/Buttons/CloseAll/Hint",
"text": "Close all tiddlers"
},
"$:/language/Buttons/CloseOthers/Caption": {
"title": "$:/language/Buttons/CloseOthers/Caption",
"text": "close others"
},
"$:/language/Buttons/CloseOthers/Hint": {
"title": "$:/language/Buttons/CloseOthers/Hint",
"text": "Close other tiddlers"
},
"$:/language/Buttons/ControlPanel/Caption": {
"title": "$:/language/Buttons/ControlPanel/Caption",
"text": "control panel"
},
"$:/language/Buttons/ControlPanel/Hint": {
"title": "$:/language/Buttons/ControlPanel/Hint",
"text": "Open control panel"
},
"$:/language/Buttons/CopyToClipboard/Caption": {
"title": "$:/language/Buttons/CopyToClipboard/Caption",
"text": "copy to clipboard"
},
"$:/language/Buttons/CopyToClipboard/Hint": {
"title": "$:/language/Buttons/CopyToClipboard/Hint",
"text": "Copy this text to the clipboard"
},
"$:/language/Buttons/Delete/Caption": {
"title": "$:/language/Buttons/Delete/Caption",
"text": "delete"
},
"$:/language/Buttons/Delete/Hint": {
"title": "$:/language/Buttons/Delete/Hint",
"text": "Delete this tiddler"
},
"$:/language/Buttons/Edit/Caption": {
"title": "$:/language/Buttons/Edit/Caption",
"text": "edit"
},
"$:/language/Buttons/Edit/Hint": {
"title": "$:/language/Buttons/Edit/Hint",
"text": "Edit this tiddler"
},
"$:/language/Buttons/Encryption/Caption": {
"title": "$:/language/Buttons/Encryption/Caption",
"text": "encryption"
},
"$:/language/Buttons/Encryption/Hint": {
"title": "$:/language/Buttons/Encryption/Hint",
"text": "Set or clear a password for saving this wiki"
},
"$:/language/Buttons/Encryption/ClearPassword/Caption": {
"title": "$:/language/Buttons/Encryption/ClearPassword/Caption",
"text": "clear password"
},
"$:/language/Buttons/Encryption/ClearPassword/Hint": {
"title": "$:/language/Buttons/Encryption/ClearPassword/Hint",
"text": "Clear the password and save this wiki without encryption"
},
"$:/language/Buttons/Encryption/SetPassword/Caption": {
"title": "$:/language/Buttons/Encryption/SetPassword/Caption",
"text": "set password"
},
"$:/language/Buttons/Encryption/SetPassword/Hint": {
"title": "$:/language/Buttons/Encryption/SetPassword/Hint",
"text": "Set a password for saving this wiki with encryption"
},
"$:/language/Buttons/ExportPage/Caption": {
"title": "$:/language/Buttons/ExportPage/Caption",
"text": "export all"
},
"$:/language/Buttons/ExportPage/Hint": {
"title": "$:/language/Buttons/ExportPage/Hint",
"text": "Export all tiddlers"
},
"$:/language/Buttons/ExportTiddler/Caption": {
"title": "$:/language/Buttons/ExportTiddler/Caption",
"text": "export tiddler"
},
"$:/language/Buttons/ExportTiddler/Hint": {
"title": "$:/language/Buttons/ExportTiddler/Hint",
"text": "Export tiddler"
},
"$:/language/Buttons/ExportTiddlers/Caption": {
"title": "$:/language/Buttons/ExportTiddlers/Caption",
"text": "export tiddlers"
},
"$:/language/Buttons/ExportTiddlers/Hint": {
"title": "$:/language/Buttons/ExportTiddlers/Hint",
"text": "Export tiddlers"
},
"$:/language/Buttons/SidebarSearch/Hint": {
"title": "$:/language/Buttons/SidebarSearch/Hint",
"text": "Select the sidebar search field"
},
"$:/language/Buttons/Fold/Caption": {
"title": "$:/language/Buttons/Fold/Caption",
"text": "fold tiddler"
},
"$:/language/Buttons/Fold/Hint": {
"title": "$:/language/Buttons/Fold/Hint",
"text": "Fold the body of this tiddler"
},
"$:/language/Buttons/Fold/FoldBar/Caption": {
"title": "$:/language/Buttons/Fold/FoldBar/Caption",
"text": "fold-bar"
},
"$:/language/Buttons/Fold/FoldBar/Hint": {
"title": "$:/language/Buttons/Fold/FoldBar/Hint",
"text": "Optional bars to fold and unfold tiddlers"
},
"$:/language/Buttons/Unfold/Caption": {
"title": "$:/language/Buttons/Unfold/Caption",
"text": "unfold tiddler"
},
"$:/language/Buttons/Unfold/Hint": {
"title": "$:/language/Buttons/Unfold/Hint",
"text": "Unfold the body of this tiddler"
},
"$:/language/Buttons/FoldOthers/Caption": {
"title": "$:/language/Buttons/FoldOthers/Caption",
"text": "fold other tiddlers"
},
"$:/language/Buttons/FoldOthers/Hint": {
"title": "$:/language/Buttons/FoldOthers/Hint",
"text": "Fold the bodies of other opened tiddlers"
},
"$:/language/Buttons/FoldAll/Caption": {
"title": "$:/language/Buttons/FoldAll/Caption",
"text": "fold all tiddlers"
},
"$:/language/Buttons/FoldAll/Hint": {
"title": "$:/language/Buttons/FoldAll/Hint",
"text": "Fold the bodies of all opened tiddlers"
},
"$:/language/Buttons/UnfoldAll/Caption": {
"title": "$:/language/Buttons/UnfoldAll/Caption",
"text": "unfold all tiddlers"
},
"$:/language/Buttons/UnfoldAll/Hint": {
"title": "$:/language/Buttons/UnfoldAll/Hint",
"text": "Unfold the bodies of all opened tiddlers"
},
"$:/language/Buttons/FullScreen/Caption": {
"title": "$:/language/Buttons/FullScreen/Caption",
"text": "full-screen"
},
"$:/language/Buttons/FullScreen/Hint": {
"title": "$:/language/Buttons/FullScreen/Hint",
"text": "Enter or leave full-screen mode"
},
"$:/language/Buttons/Help/Caption": {
"title": "$:/language/Buttons/Help/Caption",
"text": "help"
},
"$:/language/Buttons/Help/Hint": {
"title": "$:/language/Buttons/Help/Hint",
"text": "Show help panel"
},
"$:/language/Buttons/Import/Caption": {
"title": "$:/language/Buttons/Import/Caption",
"text": "import"
},
"$:/language/Buttons/Import/Hint": {
"title": "$:/language/Buttons/Import/Hint",
"text": "Import many types of file including text, image, TiddlyWiki or JSON"
},
"$:/language/Buttons/Info/Caption": {
"title": "$:/language/Buttons/Info/Caption",
"text": "info"
},
"$:/language/Buttons/Info/Hint": {
"title": "$:/language/Buttons/Info/Hint",
"text": "Show information for this tiddler"
},
"$:/language/Buttons/Home/Caption": {
"title": "$:/language/Buttons/Home/Caption",
"text": "home"
},
"$:/language/Buttons/Home/Hint": {
"title": "$:/language/Buttons/Home/Hint",
"text": "Open the default tiddlers"
},
"$:/language/Buttons/Language/Caption": {
"title": "$:/language/Buttons/Language/Caption",
"text": "language"
},
"$:/language/Buttons/Language/Hint": {
"title": "$:/language/Buttons/Language/Hint",
"text": "Choose the user interface language"
},
"$:/language/Buttons/Manager/Caption": {
"title": "$:/language/Buttons/Manager/Caption",
"text": "tiddler manager"
},
"$:/language/Buttons/Manager/Hint": {
"title": "$:/language/Buttons/Manager/Hint",
"text": "Open tiddler manager"
},
"$:/language/Buttons/More/Caption": {
"title": "$:/language/Buttons/More/Caption",
"text": "more"
},
"$:/language/Buttons/More/Hint": {
"title": "$:/language/Buttons/More/Hint",
"text": "More actions"
},
"$:/language/Buttons/NewHere/Caption": {
"title": "$:/language/Buttons/NewHere/Caption",
"text": "new here"
},
"$:/language/Buttons/NewHere/Hint": {
"title": "$:/language/Buttons/NewHere/Hint",
"text": "Create a new tiddler tagged with this one"
},
"$:/language/Buttons/NewJournal/Caption": {
"title": "$:/language/Buttons/NewJournal/Caption",
"text": "new journal"
},
"$:/language/Buttons/NewJournal/Hint": {
"title": "$:/language/Buttons/NewJournal/Hint",
"text": "Create a new journal tiddler"
},
"$:/language/Buttons/NewJournalHere/Caption": {
"title": "$:/language/Buttons/NewJournalHere/Caption",
"text": "new journal here"
},
"$:/language/Buttons/NewJournalHere/Hint": {
"title": "$:/language/Buttons/NewJournalHere/Hint",
"text": "Create a new journal tiddler tagged with this one"
},
"$:/language/Buttons/NewImage/Caption": {
"title": "$:/language/Buttons/NewImage/Caption",
"text": "new image"
},
"$:/language/Buttons/NewImage/Hint": {
"title": "$:/language/Buttons/NewImage/Hint",
"text": "Create a new image tiddler"
},
"$:/language/Buttons/NewMarkdown/Caption": {
"title": "$:/language/Buttons/NewMarkdown/Caption",
"text": "new Markdown tiddler"
},
"$:/language/Buttons/NewMarkdown/Hint": {
"title": "$:/language/Buttons/NewMarkdown/Hint",
"text": "Create a new Markdown tiddler"
},
"$:/language/Buttons/NewTiddler/Caption": {
"title": "$:/language/Buttons/NewTiddler/Caption",
"text": "new tiddler"
},
"$:/language/Buttons/NewTiddler/Hint": {
"title": "$:/language/Buttons/NewTiddler/Hint",
"text": "Create a new tiddler"
},
"$:/language/Buttons/OpenWindow/Caption": {
"title": "$:/language/Buttons/OpenWindow/Caption",
"text": "open in new window"
},
"$:/language/Buttons/OpenWindow/Hint": {
"title": "$:/language/Buttons/OpenWindow/Hint",
"text": "Open tiddler in new window"
},
"$:/language/Buttons/Palette/Caption": {
"title": "$:/language/Buttons/Palette/Caption",
"text": "palette"
},
"$:/language/Buttons/Palette/Hint": {
"title": "$:/language/Buttons/Palette/Hint",
"text": "Choose the colour palette"
},
"$:/language/Buttons/Permalink/Caption": {
"title": "$:/language/Buttons/Permalink/Caption",
"text": "permalink"
},
"$:/language/Buttons/Permalink/Hint": {
"title": "$:/language/Buttons/Permalink/Hint",
"text": "Set browser address bar to a direct link to this tiddler"
},
"$:/language/Buttons/Permaview/Caption": {
"title": "$:/language/Buttons/Permaview/Caption",
"text": "permaview"
},
"$:/language/Buttons/Permaview/Hint": {
"title": "$:/language/Buttons/Permaview/Hint",
"text": "Set browser address bar to a direct link to all the tiddlers in this story"
},
"$:/language/Buttons/Print/Caption": {
"title": "$:/language/Buttons/Print/Caption",
"text": "print page"
},
"$:/language/Buttons/Print/Hint": {
"title": "$:/language/Buttons/Print/Hint",
"text": "Print the current page"
},
"$:/language/Buttons/Refresh/Caption": {
"title": "$:/language/Buttons/Refresh/Caption",
"text": "refresh"
},
"$:/language/Buttons/Refresh/Hint": {
"title": "$:/language/Buttons/Refresh/Hint",
"text": "Perform a full refresh of the wiki"
},
"$:/language/Buttons/Save/Caption": {
"title": "$:/language/Buttons/Save/Caption",
"text": "ok"
},
"$:/language/Buttons/Save/Hint": {
"title": "$:/language/Buttons/Save/Hint",
"text": "Confirm changes to this tiddler"
},
"$:/language/Buttons/SaveWiki/Caption": {
"title": "$:/language/Buttons/SaveWiki/Caption",
"text": "save changes"
},
"$:/language/Buttons/SaveWiki/Hint": {
"title": "$:/language/Buttons/SaveWiki/Hint",
"text": "Save changes"
},
"$:/language/Buttons/StoryView/Caption": {
"title": "$:/language/Buttons/StoryView/Caption",
"text": "storyview"
},
"$:/language/Buttons/StoryView/Hint": {
"title": "$:/language/Buttons/StoryView/Hint",
"text": "Choose the story visualisation"
},
"$:/language/Buttons/HideSideBar/Caption": {
"title": "$:/language/Buttons/HideSideBar/Caption",
"text": "hide sidebar"
},
"$:/language/Buttons/HideSideBar/Hint": {
"title": "$:/language/Buttons/HideSideBar/Hint",
"text": "Hide sidebar"
},
"$:/language/Buttons/ShowSideBar/Caption": {
"title": "$:/language/Buttons/ShowSideBar/Caption",
"text": "show sidebar"
},
"$:/language/Buttons/ShowSideBar/Hint": {
"title": "$:/language/Buttons/ShowSideBar/Hint",
"text": "Show sidebar"
},
"$:/language/Buttons/TagManager/Caption": {
"title": "$:/language/Buttons/TagManager/Caption",
"text": "tag manager"
},
"$:/language/Buttons/TagManager/Hint": {
"title": "$:/language/Buttons/TagManager/Hint",
"text": "Open tag manager"
},
"$:/language/Buttons/Timestamp/Caption": {
"title": "$:/language/Buttons/Timestamp/Caption",
"text": "timestamps"
},
"$:/language/Buttons/Timestamp/Hint": {
"title": "$:/language/Buttons/Timestamp/Hint",
"text": "Choose whether modifications update timestamps"
},
"$:/language/Buttons/Timestamp/On/Caption": {
"title": "$:/language/Buttons/Timestamp/On/Caption",
"text": "timestamps are on"
},
"$:/language/Buttons/Timestamp/On/Hint": {
"title": "$:/language/Buttons/Timestamp/On/Hint",
"text": "Update timestamps when tiddlers are modified"
},
"$:/language/Buttons/Timestamp/Off/Caption": {
"title": "$:/language/Buttons/Timestamp/Off/Caption",
"text": "timestamps are off"
},
"$:/language/Buttons/Timestamp/Off/Hint": {
"title": "$:/language/Buttons/Timestamp/Off/Hint",
"text": "Don't update timestamps when tiddlers are modified"
},
"$:/language/Buttons/Theme/Caption": {
"title": "$:/language/Buttons/Theme/Caption",
"text": "theme"
},
"$:/language/Buttons/Theme/Hint": {
"title": "$:/language/Buttons/Theme/Hint",
"text": "Choose the display theme"
},
"$:/language/Buttons/Bold/Caption": {
"title": "$:/language/Buttons/Bold/Caption",
"text": "bold"
},
"$:/language/Buttons/Bold/Hint": {
"title": "$:/language/Buttons/Bold/Hint",
"text": "Apply bold formatting to selection"
},
"$:/language/Buttons/Clear/Caption": {
"title": "$:/language/Buttons/Clear/Caption",
"text": "clear"
},
"$:/language/Buttons/Clear/Hint": {
"title": "$:/language/Buttons/Clear/Hint",
"text": "Clear image to solid colour"
},
"$:/language/Buttons/EditorHeight/Caption": {
"title": "$:/language/Buttons/EditorHeight/Caption",
"text": "editor height"
},
"$:/language/Buttons/EditorHeight/Caption/Auto": {
"title": "$:/language/Buttons/EditorHeight/Caption/Auto",
"text": "Automatically adjust height to fit content"
},
"$:/language/Buttons/EditorHeight/Caption/Fixed": {
"title": "$:/language/Buttons/EditorHeight/Caption/Fixed",
"text": "Fixed height:"
},
"$:/language/Buttons/EditorHeight/Hint": {
"title": "$:/language/Buttons/EditorHeight/Hint",
"text": "Choose the height of the text editor"
},
"$:/language/Buttons/Excise/Caption": {
"title": "$:/language/Buttons/Excise/Caption",
"text": "excise"
},
"$:/language/Buttons/Excise/Caption/Excise": {
"title": "$:/language/Buttons/Excise/Caption/Excise",
"text": "Perform excision"
},
"$:/language/Buttons/Excise/Caption/MacroName": {
"title": "$:/language/Buttons/Excise/Caption/MacroName",
"text": "Macro name:"
},
"$:/language/Buttons/Excise/Caption/NewTitle": {
"title": "$:/language/Buttons/Excise/Caption/NewTitle",
"text": "Title of new tiddler:"
},
"$:/language/Buttons/Excise/Caption/Replace": {
"title": "$:/language/Buttons/Excise/Caption/Replace",
"text": "Replace excised text with:"
},
"$:/language/Buttons/Excise/Caption/Replace/Macro": {
"title": "$:/language/Buttons/Excise/Caption/Replace/Macro",
"text": "macro"
},
"$:/language/Buttons/Excise/Caption/Replace/Link": {
"title": "$:/language/Buttons/Excise/Caption/Replace/Link",
"text": "link"
},
"$:/language/Buttons/Excise/Caption/Replace/Transclusion": {
"title": "$:/language/Buttons/Excise/Caption/Replace/Transclusion",
"text": "transclusion"
},
"$:/language/Buttons/Excise/Caption/Tag": {
"title": "$:/language/Buttons/Excise/Caption/Tag",
"text": "Tag new tiddler with the title of this tiddler"
},
"$:/language/Buttons/Excise/Caption/TiddlerExists": {
"title": "$:/language/Buttons/Excise/Caption/TiddlerExists",
"text": "Warning: tiddler already exists"
},
"$:/language/Buttons/Excise/Hint": {
"title": "$:/language/Buttons/Excise/Hint",
"text": "Excise the selected text into a new tiddler"
},
"$:/language/Buttons/Heading1/Caption": {
"title": "$:/language/Buttons/Heading1/Caption",
"text": "heading 1"
},
"$:/language/Buttons/Heading1/Hint": {
"title": "$:/language/Buttons/Heading1/Hint",
"text": "Apply heading level 1 formatting to lines containing selection"
},
"$:/language/Buttons/Heading2/Caption": {
"title": "$:/language/Buttons/Heading2/Caption",
"text": "heading 2"
},
"$:/language/Buttons/Heading2/Hint": {
"title": "$:/language/Buttons/Heading2/Hint",
"text": "Apply heading level 2 formatting to lines containing selection"
},
"$:/language/Buttons/Heading3/Caption": {
"title": "$:/language/Buttons/Heading3/Caption",
"text": "heading 3"
},
"$:/language/Buttons/Heading3/Hint": {
"title": "$:/language/Buttons/Heading3/Hint",
"text": "Apply heading level 3 formatting to lines containing selection"
},
"$:/language/Buttons/Heading4/Caption": {
"title": "$:/language/Buttons/Heading4/Caption",
"text": "heading 4"
},
"$:/language/Buttons/Heading4/Hint": {
"title": "$:/language/Buttons/Heading4/Hint",
"text": "Apply heading level 4 formatting to lines containing selection"
},
"$:/language/Buttons/Heading5/Caption": {
"title": "$:/language/Buttons/Heading5/Caption",
"text": "heading 5"
},
"$:/language/Buttons/Heading5/Hint": {
"title": "$:/language/Buttons/Heading5/Hint",
"text": "Apply heading level 5 formatting to lines containing selection"
},
"$:/language/Buttons/Heading6/Caption": {
"title": "$:/language/Buttons/Heading6/Caption",
"text": "heading 6"
},
"$:/language/Buttons/Heading6/Hint": {
"title": "$:/language/Buttons/Heading6/Hint",
"text": "Apply heading level 6 formatting to lines containing selection"
},
"$:/language/Buttons/Italic/Caption": {
"title": "$:/language/Buttons/Italic/Caption",
"text": "italic"
},
"$:/language/Buttons/Italic/Hint": {
"title": "$:/language/Buttons/Italic/Hint",
"text": "Apply italic formatting to selection"
},
"$:/language/Buttons/LineWidth/Caption": {
"title": "$:/language/Buttons/LineWidth/Caption",
"text": "line width"
},
"$:/language/Buttons/LineWidth/Hint": {
"title": "$:/language/Buttons/LineWidth/Hint",
"text": "Set line width for painting"
},
"$:/language/Buttons/Link/Caption": {
"title": "$:/language/Buttons/Link/Caption",
"text": "link"
},
"$:/language/Buttons/Link/Hint": {
"title": "$:/language/Buttons/Link/Hint",
"text": "Create wikitext link"
},
"$:/language/Buttons/Linkify/Caption": {
"title": "$:/language/Buttons/Linkify/Caption",
"text": "wikilink"
},
"$:/language/Buttons/Linkify/Hint": {
"title": "$:/language/Buttons/Linkify/Hint",
"text": "Wrap selection in square brackets"
},
"$:/language/Buttons/ListBullet/Caption": {
"title": "$:/language/Buttons/ListBullet/Caption",
"text": "bulleted list"
},
"$:/language/Buttons/ListBullet/Hint": {
"title": "$:/language/Buttons/ListBullet/Hint",
"text": "Apply bulleted list formatting to lines containing selection"
},
"$:/language/Buttons/ListNumber/Caption": {
"title": "$:/language/Buttons/ListNumber/Caption",
"text": "numbered list"
},
"$:/language/Buttons/ListNumber/Hint": {
"title": "$:/language/Buttons/ListNumber/Hint",
"text": "Apply numbered list formatting to lines containing selection"
},
"$:/language/Buttons/MonoBlock/Caption": {
"title": "$:/language/Buttons/MonoBlock/Caption",
"text": "monospaced block"
},
"$:/language/Buttons/MonoBlock/Hint": {
"title": "$:/language/Buttons/MonoBlock/Hint",
"text": "Apply monospaced block formatting to lines containing selection"
},
"$:/language/Buttons/MonoLine/Caption": {
"title": "$:/language/Buttons/MonoLine/Caption",
"text": "monospaced"
},
"$:/language/Buttons/MonoLine/Hint": {
"title": "$:/language/Buttons/MonoLine/Hint",
"text": "Apply monospaced character formatting to selection"
},
"$:/language/Buttons/Opacity/Caption": {
"title": "$:/language/Buttons/Opacity/Caption",
"text": "opacity"
},
"$:/language/Buttons/Opacity/Hint": {
"title": "$:/language/Buttons/Opacity/Hint",
"text": "Set painting opacity"
},
"$:/language/Buttons/Paint/Caption": {
"title": "$:/language/Buttons/Paint/Caption",
"text": "paint colour"
},
"$:/language/Buttons/Paint/Hint": {
"title": "$:/language/Buttons/Paint/Hint",
"text": "Set painting colour"
},
"$:/language/Buttons/Picture/Caption": {
"title": "$:/language/Buttons/Picture/Caption",
"text": "picture"
},
"$:/language/Buttons/Picture/Hint": {
"title": "$:/language/Buttons/Picture/Hint",
"text": "Insert picture"
},
"$:/language/Buttons/Preview/Caption": {
"title": "$:/language/Buttons/Preview/Caption",
"text": "preview"
},
"$:/language/Buttons/Preview/Hint": {
"title": "$:/language/Buttons/Preview/Hint",
"text": "Show preview pane"
},
"$:/language/Buttons/PreviewType/Caption": {
"title": "$:/language/Buttons/PreviewType/Caption",
"text": "preview type"
},
"$:/language/Buttons/PreviewType/Hint": {
"title": "$:/language/Buttons/PreviewType/Hint",
"text": "Choose preview type"
},
"$:/language/Buttons/Quote/Caption": {
"title": "$:/language/Buttons/Quote/Caption",
"text": "quote"
},
"$:/language/Buttons/Quote/Hint": {
"title": "$:/language/Buttons/Quote/Hint",
"text": "Apply quoted text formatting to lines containing selection"
},
"$:/language/Buttons/RotateLeft/Caption": {
"title": "$:/language/Buttons/RotateLeft/Caption",
"text": "rotate left"
},
"$:/language/Buttons/RotateLeft/Hint": {
"title": "$:/language/Buttons/RotateLeft/Hint",
"text": "Rotate image left by 90 degrees"
},
"$:/language/Buttons/Size/Caption": {
"title": "$:/language/Buttons/Size/Caption",
"text": "image size"
},
"$:/language/Buttons/Size/Caption/Height": {
"title": "$:/language/Buttons/Size/Caption/Height",
"text": "Height:"
},
"$:/language/Buttons/Size/Caption/Resize": {
"title": "$:/language/Buttons/Size/Caption/Resize",
"text": "Resize image"
},
"$:/language/Buttons/Size/Caption/Width": {
"title": "$:/language/Buttons/Size/Caption/Width",
"text": "Width:"
},
"$:/language/Buttons/Size/Hint": {
"title": "$:/language/Buttons/Size/Hint",
"text": "Set image size"
},
"$:/language/Buttons/Stamp/Caption": {
"title": "$:/language/Buttons/Stamp/Caption",
"text": "stamp"
},
"$:/language/Buttons/Stamp/Caption/New": {
"title": "$:/language/Buttons/Stamp/Caption/New",
"text": "Add your own"
},
"$:/language/Buttons/Stamp/Hint": {
"title": "$:/language/Buttons/Stamp/Hint",
"text": "Insert a preconfigured snippet of text"
},
"$:/language/Buttons/Stamp/New/Title": {
"title": "$:/language/Buttons/Stamp/New/Title",
"text": "Name as shown in menu"
},
"$:/language/Buttons/Stamp/New/Text": {
"title": "$:/language/Buttons/Stamp/New/Text",
"text": "Text of snippet. (Remember to add a descriptive title in the caption field)."
},
"$:/language/Buttons/Strikethrough/Caption": {
"title": "$:/language/Buttons/Strikethrough/Caption",
"text": "strikethrough"
},
"$:/language/Buttons/Strikethrough/Hint": {
"title": "$:/language/Buttons/Strikethrough/Hint",
"text": "Apply strikethrough formatting to selection"
},
"$:/language/Buttons/Subscript/Caption": {
"title": "$:/language/Buttons/Subscript/Caption",
"text": "subscript"
},
"$:/language/Buttons/Subscript/Hint": {
"title": "$:/language/Buttons/Subscript/Hint",
"text": "Apply subscript formatting to selection"
},
"$:/language/Buttons/Superscript/Caption": {
"title": "$:/language/Buttons/Superscript/Caption",
"text": "superscript"
},
"$:/language/Buttons/Superscript/Hint": {
"title": "$:/language/Buttons/Superscript/Hint",
"text": "Apply superscript formatting to selection"
},
"$:/language/Buttons/ToggleSidebar/Hint": {
"title": "$:/language/Buttons/ToggleSidebar/Hint",
"text": "Toggle the sidebar visibility"
},
"$:/language/Buttons/Transcludify/Caption": {
"title": "$:/language/Buttons/Transcludify/Caption",
"text": "transclusion"
},
"$:/language/Buttons/Transcludify/Hint": {
"title": "$:/language/Buttons/Transcludify/Hint",
"text": "Wrap selection in curly brackets"
},
"$:/language/Buttons/Underline/Caption": {
"title": "$:/language/Buttons/Underline/Caption",
"text": "underline"
},
"$:/language/Buttons/Underline/Hint": {
"title": "$:/language/Buttons/Underline/Hint",
"text": "Apply underline formatting to selection"
},
"$:/language/ControlPanel/Advanced/Caption": {
"title": "$:/language/ControlPanel/Advanced/Caption",
"text": "Advanced"
},
"$:/language/ControlPanel/Advanced/Hint": {
"title": "$:/language/ControlPanel/Advanced/Hint",
"text": "Internal information about this TiddlyWiki"
},
"$:/language/ControlPanel/Appearance/Caption": {
"title": "$:/language/ControlPanel/Appearance/Caption",
"text": "Appearance"
},
"$:/language/ControlPanel/Appearance/Hint": {
"title": "$:/language/ControlPanel/Appearance/Hint",
"text": "Ways to customise the appearance of your TiddlyWiki."
},
"$:/language/ControlPanel/Basics/AnimDuration/Prompt": {
"title": "$:/language/ControlPanel/Basics/AnimDuration/Prompt",
"text": "Animation duration"
},
"$:/language/ControlPanel/Basics/AutoFocus/Prompt": {
"title": "$:/language/ControlPanel/Basics/AutoFocus/Prompt",
"text": "Default focus field for new tiddlers"
},
"$:/language/ControlPanel/Basics/Caption": {
"title": "$:/language/ControlPanel/Basics/Caption",
"text": "Basics"
},
"$:/language/ControlPanel/Basics/DefaultTiddlers/BottomHint": {
"title": "$:/language/ControlPanel/Basics/DefaultTiddlers/BottomHint",
"text": "Use [[double square brackets]] for titles with spaces. Or you can choose to <$button set=\"$:/DefaultTiddlers\" setTo=\"[list[$:/StoryList]]\">retain story ordering</$button>"
},
"$:/language/ControlPanel/Basics/DefaultTiddlers/Prompt": {
"title": "$:/language/ControlPanel/Basics/DefaultTiddlers/Prompt",
"text": "Default tiddlers"
},
"$:/language/ControlPanel/Basics/DefaultTiddlers/TopHint": {
"title": "$:/language/ControlPanel/Basics/DefaultTiddlers/TopHint",
"text": "Choose which tiddlers are displayed at startup"
},
"$:/language/ControlPanel/Basics/Language/Prompt": {
"title": "$:/language/ControlPanel/Basics/Language/Prompt",
"text": "Hello! Current language:"
},
"$:/language/ControlPanel/Basics/NewJournal/Title/Prompt": {
"title": "$:/language/ControlPanel/Basics/NewJournal/Title/Prompt",
"text": "Title of new journal tiddlers"
},
"$:/language/ControlPanel/Basics/NewJournal/Text/Prompt": {
"title": "$:/language/ControlPanel/Basics/NewJournal/Text/Prompt",
"text": "Text for new journal tiddlers"
},
"$:/language/ControlPanel/Basics/NewJournal/Tags/Prompt": {
"title": "$:/language/ControlPanel/Basics/NewJournal/Tags/Prompt",
"text": "Tags for new journal tiddlers"
},
"$:/language/ControlPanel/Basics/NewTiddler/Title/Prompt": {
"title": "$:/language/ControlPanel/Basics/NewTiddler/Title/Prompt",
"text": "Title of new tiddlers"
},
"$:/language/ControlPanel/Basics/NewTiddler/Tags/Prompt": {
"title": "$:/language/ControlPanel/Basics/NewTiddler/Tags/Prompt",
"text": "Tags for new tiddlers"
},
"$:/language/ControlPanel/Basics/OverriddenShadowTiddlers/Prompt": {
"title": "$:/language/ControlPanel/Basics/OverriddenShadowTiddlers/Prompt",
"text": "Number of overridden shadow tiddlers"
},
"$:/language/ControlPanel/Basics/ShadowTiddlers/Prompt": {
"title": "$:/language/ControlPanel/Basics/ShadowTiddlers/Prompt",
"text": "Number of shadow tiddlers"
},
"$:/language/ControlPanel/Basics/Subtitle/Prompt": {
"title": "$:/language/ControlPanel/Basics/Subtitle/Prompt",
"text": "Subtitle"
},
"$:/language/ControlPanel/Basics/SystemTiddlers/Prompt": {
"title": "$:/language/ControlPanel/Basics/SystemTiddlers/Prompt",
"text": "Number of system tiddlers"
},
"$:/language/ControlPanel/Basics/Tags/Prompt": {
"title": "$:/language/ControlPanel/Basics/Tags/Prompt",
"text": "Number of tags"
},
"$:/language/ControlPanel/Basics/Tiddlers/Prompt": {
"title": "$:/language/ControlPanel/Basics/Tiddlers/Prompt",
"text": "Number of tiddlers"
},
"$:/language/ControlPanel/Basics/Title/Prompt": {
"title": "$:/language/ControlPanel/Basics/Title/Prompt",
"text": "Title of this ~TiddlyWiki"
},
"$:/language/ControlPanel/Basics/Username/Prompt": {
"title": "$:/language/ControlPanel/Basics/Username/Prompt",
"text": "Username for signing edits"
},
"$:/language/ControlPanel/Basics/Version/Prompt": {
"title": "$:/language/ControlPanel/Basics/Version/Prompt",
"text": "~TiddlyWiki version"
},
"$:/language/ControlPanel/EditorTypes/Caption": {
"title": "$:/language/ControlPanel/EditorTypes/Caption",
"text": "Editor Types"
},
"$:/language/ControlPanel/EditorTypes/Editor/Caption": {
"title": "$:/language/ControlPanel/EditorTypes/Editor/Caption",
"text": "Editor"
},
"$:/language/ControlPanel/EditorTypes/Hint": {
"title": "$:/language/ControlPanel/EditorTypes/Hint",
"text": "These tiddlers determine which editor is used to edit specific tiddler types."
},
"$:/language/ControlPanel/EditorTypes/Type/Caption": {
"title": "$:/language/ControlPanel/EditorTypes/Type/Caption",
"text": "Type"
},
"$:/language/ControlPanel/Info/Caption": {
"title": "$:/language/ControlPanel/Info/Caption",
"text": "Info"
},
"$:/language/ControlPanel/Info/Hint": {
"title": "$:/language/ControlPanel/Info/Hint",
"text": "Information about this TiddlyWiki"
},
"$:/language/ControlPanel/KeyboardShortcuts/Add/Prompt": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Add/Prompt",
"text": "Type shortcut here"
},
"$:/language/ControlPanel/KeyboardShortcuts/Add/Caption": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Add/Caption",
"text": "add shortcut"
},
"$:/language/ControlPanel/KeyboardShortcuts/Caption": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Caption",
"text": "Keyboard Shortcuts"
},
"$:/language/ControlPanel/KeyboardShortcuts/Hint": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Hint",
"text": "Manage keyboard shortcut assignments"
},
"$:/language/ControlPanel/KeyboardShortcuts/NoShortcuts/Caption": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/NoShortcuts/Caption",
"text": "No keyboard shortcuts assigned"
},
"$:/language/ControlPanel/KeyboardShortcuts/Remove/Hint": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Remove/Hint",
"text": "remove keyboard shortcut"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/All": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/All",
"text": "All platforms"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/Mac": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/Mac",
"text": "Macintosh platform only"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/NonMac": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/NonMac",
"text": "Non-Macintosh platforms only"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/Linux": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/Linux",
"text": "Linux platform only"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/NonLinux": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/NonLinux",
"text": "Non-Linux platforms only"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/Windows": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/Windows",
"text": "Windows platform only"
},
"$:/language/ControlPanel/KeyboardShortcuts/Platform/NonWindows": {
"title": "$:/language/ControlPanel/KeyboardShortcuts/Platform/NonWindows",
"text": "Non-Windows platforms only"
},
"$:/language/ControlPanel/LoadedModules/Caption": {
"title": "$:/language/ControlPanel/LoadedModules/Caption",
"text": "Loaded Modules"
},
"$:/language/ControlPanel/LoadedModules/Hint": {
"title": "$:/language/ControlPanel/LoadedModules/Hint",
"text": "These are the currently loaded tiddler modules linked to their source tiddlers. Any italicised modules lack a source tiddler, typically because they were setup during the boot process."
},
"$:/language/ControlPanel/Palette/Caption": {
"title": "$:/language/ControlPanel/Palette/Caption",
"text": "Palette"
},
"$:/language/ControlPanel/Palette/Editor/Clone/Caption": {
"title": "$:/language/ControlPanel/Palette/Editor/Clone/Caption",
"text": "clone"
},
"$:/language/ControlPanel/Palette/Editor/Clone/Prompt": {
"title": "$:/language/ControlPanel/Palette/Editor/Clone/Prompt",
"text": "It is recommended that you clone this shadow palette before editing it"
},
"$:/language/ControlPanel/Palette/Editor/Delete/Hint": {
"title": "$:/language/ControlPanel/Palette/Editor/Delete/Hint",
"text": "delete this entry from the current palette"
},
"$:/language/ControlPanel/Palette/Editor/Names/External/Show": {
"title": "$:/language/ControlPanel/Palette/Editor/Names/External/Show",
"text": "Show color names that are not part of the current palette"
},
"$:/language/ControlPanel/Palette/Editor/Prompt/Modified": {
"title": "$:/language/ControlPanel/Palette/Editor/Prompt/Modified",
"text": "This shadow palette has been modified"
},
"$:/language/ControlPanel/Palette/Editor/Prompt": {
"title": "$:/language/ControlPanel/Palette/Editor/Prompt",
"text": "Editing"
},
"$:/language/ControlPanel/Palette/Editor/Reset/Caption": {
"title": "$:/language/ControlPanel/Palette/Editor/Reset/Caption",
"text": "reset"
},
"$:/language/ControlPanel/Palette/HideEditor/Caption": {
"title": "$:/language/ControlPanel/Palette/HideEditor/Caption",
"text": "hide editor"
},
"$:/language/ControlPanel/Palette/Prompt": {
"title": "$:/language/ControlPanel/Palette/Prompt",
"text": "Current palette:"
},
"$:/language/ControlPanel/Palette/ShowEditor/Caption": {
"title": "$:/language/ControlPanel/Palette/ShowEditor/Caption",
"text": "show editor"
},
"$:/language/ControlPanel/Parsing/Caption": {
"title": "$:/language/ControlPanel/Parsing/Caption",
"text": "Parsing"
},
"$:/language/ControlPanel/Parsing/Hint": {
"title": "$:/language/ControlPanel/Parsing/Hint",
"text": "Here you can globally disable/enable wiki parser rules. For changes to take effect, save and reload your wiki. Disabling certain parser rules can prevent <$text text=\"TiddlyWiki\"/> from functioning correctly. Use [[safe mode|https://tiddlywiki.com/#SafeMode]] to restore normal operation."
},
"$:/language/ControlPanel/Parsing/Block/Caption": {
"title": "$:/language/ControlPanel/Parsing/Block/Caption",
"text": "Block Parse Rules"
},
"$:/language/ControlPanel/Parsing/Inline/Caption": {
"title": "$:/language/ControlPanel/Parsing/Inline/Caption",
"text": "Inline Parse Rules"
},
"$:/language/ControlPanel/Parsing/Pragma/Caption": {
"title": "$:/language/ControlPanel/Parsing/Pragma/Caption",
"text": "Pragma Parse Rules"
},
"$:/language/ControlPanel/Plugins/Add/Caption": {
"title": "$:/language/ControlPanel/Plugins/Add/Caption",
"text": "Get more plugins"
},
"$:/language/ControlPanel/Plugins/Add/Hint": {
"title": "$:/language/ControlPanel/Plugins/Add/Hint",
"text": "Install plugins from the official library"
},
"$:/language/ControlPanel/Plugins/AlreadyInstalled/Hint": {
"title": "$:/language/ControlPanel/Plugins/AlreadyInstalled/Hint",
"text": "This plugin is already installed at version <$text text=<<installedVersion>>/>"
},
"$:/language/ControlPanel/Plugins/AlsoRequires": {
"title": "$:/language/ControlPanel/Plugins/AlsoRequires",
"text": "Also requires:"
},
"$:/language/ControlPanel/Plugins/Caption": {
"title": "$:/language/ControlPanel/Plugins/Caption",
"text": "Plugins"
},
"$:/language/ControlPanel/Plugins/Disable/Caption": {
"title": "$:/language/ControlPanel/Plugins/Disable/Caption",
"text": "disable"
},
"$:/language/ControlPanel/Plugins/Disable/Hint": {
"title": "$:/language/ControlPanel/Plugins/Disable/Hint",
"text": "Disable this plugin when reloading page"
},
"$:/language/ControlPanel/Plugins/Disabled/Status": {
"title": "$:/language/ControlPanel/Plugins/Disabled/Status",
"text": "(disabled)"
},
"$:/language/ControlPanel/Plugins/Downgrade/Caption": {
"title": "$:/language/ControlPanel/Plugins/Downgrade/Caption",
"text": "downgrade"
},
"$:/language/ControlPanel/Plugins/Empty/Hint": {
"title": "$:/language/ControlPanel/Plugins/Empty/Hint",
"text": "None"
},
"$:/language/ControlPanel/Plugins/Enable/Caption": {
"title": "$:/language/ControlPanel/Plugins/Enable/Caption",
"text": "enable"
},
"$:/language/ControlPanel/Plugins/Enable/Hint": {
"title": "$:/language/ControlPanel/Plugins/Enable/Hint",
"text": "Enable this plugin when reloading page"
},
"$:/language/ControlPanel/Plugins/Install/Caption": {
"title": "$:/language/ControlPanel/Plugins/Install/Caption",
"text": "install"
},
"$:/language/ControlPanel/Plugins/Installed/Hint": {
"title": "$:/language/ControlPanel/Plugins/Installed/Hint",
"text": "Currently installed plugins:"
},
"$:/language/ControlPanel/Plugins/Languages/Caption": {
"title": "$:/language/ControlPanel/Plugins/Languages/Caption",
"text": "Languages"
},
"$:/language/ControlPanel/Plugins/Languages/Hint": {
"title": "$:/language/ControlPanel/Plugins/Languages/Hint",
"text": "Language pack plugins"
},
"$:/language/ControlPanel/Plugins/NoInfoFound/Hint": {
"title": "$:/language/ControlPanel/Plugins/NoInfoFound/Hint",
"text": "No ''\"<$text text=<<currentTab>>/>\"'' found"
},
"$:/language/ControlPanel/Plugins/NotInstalled/Hint": {
"title": "$:/language/ControlPanel/Plugins/NotInstalled/Hint",
"text": "This plugin is not currently installed"
},
"$:/language/ControlPanel/Plugins/OpenPluginLibrary": {
"title": "$:/language/ControlPanel/Plugins/OpenPluginLibrary",
"text": "open plugin library"
},
"$:/language/ControlPanel/Plugins/ClosePluginLibrary": {
"title": "$:/language/ControlPanel/Plugins/ClosePluginLibrary",
"text": "close plugin library"
},
"$:/language/ControlPanel/Plugins/PluginWillRequireReload": {
"title": "$:/language/ControlPanel/Plugins/PluginWillRequireReload",
"text": "(requires reload)"
},
"$:/language/ControlPanel/Plugins/Plugins/Caption": {
"title": "$:/language/ControlPanel/Plugins/Plugins/Caption",
"text": "Plugins"
},
"$:/language/ControlPanel/Plugins/Plugins/Hint": {
"title": "$:/language/ControlPanel/Plugins/Plugins/Hint",
"text": "Plugins"
},
"$:/language/ControlPanel/Plugins/Reinstall/Caption": {
"title": "$:/language/ControlPanel/Plugins/Reinstall/Caption",
"text": "reinstall"
},
"$:/language/ControlPanel/Plugins/Themes/Caption": {
"title": "$:/language/ControlPanel/Plugins/Themes/Caption",
"text": "Themes"
},
"$:/language/ControlPanel/Plugins/Themes/Hint": {
"title": "$:/language/ControlPanel/Plugins/Themes/Hint",
"text": "Theme plugins"
},
"$:/language/ControlPanel/Plugins/Update/Caption": {
"title": "$:/language/ControlPanel/Plugins/Update/Caption",
"text": "update"
},
"$:/language/ControlPanel/Plugins/Updates/Caption": {
"title": "$:/language/ControlPanel/Plugins/Updates/Caption",
"text": "Updates"
},
"$:/language/ControlPanel/Plugins/Updates/Hint": {
"title": "$:/language/ControlPanel/Plugins/Updates/Hint",
"text": "Available updates to installed plugins"
},
"$:/language/ControlPanel/Plugins/Updates/UpdateAll/Caption": {
"title": "$:/language/ControlPanel/Plugins/Updates/UpdateAll/Caption",
"text": "Update <<update-count>> plugins"
},
"$:/language/ControlPanel/Plugins/SubPluginPrompt": {
"title": "$:/language/ControlPanel/Plugins/SubPluginPrompt",
"text": "With <<count>> sub-plugins available"
},
"$:/language/ControlPanel/Saving/Caption": {
"title": "$:/language/ControlPanel/Saving/Caption",
"text": "Saving"
},
"$:/language/ControlPanel/Saving/DownloadSaver/AutoSave/Description": {
"title": "$:/language/ControlPanel/Saving/DownloadSaver/AutoSave/Description",
"text": "Permit automatic saving for the download saver"
},
"$:/language/ControlPanel/Saving/DownloadSaver/AutoSave/Hint": {
"title": "$:/language/ControlPanel/Saving/DownloadSaver/AutoSave/Hint",
"text": "Enable Autosave for Download Saver"
},
"$:/language/ControlPanel/Saving/DownloadSaver/Caption": {
"title": "$:/language/ControlPanel/Saving/DownloadSaver/Caption",
"text": "Download Saver"
},
"$:/language/ControlPanel/Saving/DownloadSaver/Hint": {
"title": "$:/language/ControlPanel/Saving/DownloadSaver/Hint",
"text": "These settings apply to the HTML5-compatible download saver"
},
"$:/language/ControlPanel/Saving/General/Caption": {
"title": "$:/language/ControlPanel/Saving/General/Caption",
"text": "General"
},
"$:/language/ControlPanel/Saving/General/Hint": {
"title": "$:/language/ControlPanel/Saving/General/Hint",
"text": "These settings apply to all the loaded savers"
},
"$:/language/ControlPanel/Saving/Hint": {
"title": "$:/language/ControlPanel/Saving/Hint",
"text": "Settings used for saving the entire TiddlyWiki as a single file via a saver module"
},
"$:/language/ControlPanel/Saving/GitService/Branch": {
"title": "$:/language/ControlPanel/Saving/GitService/Branch",
"text": "Target branch for saving"
},
"$:/language/ControlPanel/Saving/GitService/CommitMessage": {
"title": "$:/language/ControlPanel/Saving/GitService/CommitMessage",
"text": "Saved by TiddlyWiki"
},
"$:/language/ControlPanel/Saving/GitService/Description": {
"title": "$:/language/ControlPanel/Saving/GitService/Description",
"text": "These settings are only used when saving to <<service-name>>"
},
"$:/language/ControlPanel/Saving/GitService/Filename": {
"title": "$:/language/ControlPanel/Saving/GitService/Filename",
"text": "Filename of target file (e.g. `index.html`)"
},
"$:/language/ControlPanel/Saving/GitService/Path": {
"title": "$:/language/ControlPanel/Saving/GitService/Path",
"text": "Path to target file (e.g. `/wiki/`)"
},
"$:/language/ControlPanel/Saving/GitService/Repo": {
"title": "$:/language/ControlPanel/Saving/GitService/Repo",
"text": "Target repository (e.g. `Jermolene/TiddlyWiki5`)"
},
"$:/language/ControlPanel/Saving/GitService/ServerURL": {
"title": "$:/language/ControlPanel/Saving/GitService/ServerURL",
"text": "Server API URL"
},
"$:/language/ControlPanel/Saving/GitService/UserName": {
"title": "$:/language/ControlPanel/Saving/GitService/UserName",
"text": "Username"
},
"$:/language/ControlPanel/Saving/GitService/GitHub/Caption": {
"title": "$:/language/ControlPanel/Saving/GitService/GitHub/Caption",
"text": "~GitHub Saver"
},
"$:/language/ControlPanel/Saving/GitService/GitHub/Password": {
"title": "$:/language/ControlPanel/Saving/GitService/GitHub/Password",
"text": "Password, OAUTH token, or personal access token (see [[GitHub help page|https://help.github.com/en/articles/creating-a-personal-access-token-for-the-command-line]] for details)"
},
"$:/language/ControlPanel/Saving/GitService/GitLab/Caption": {
"title": "$:/language/ControlPanel/Saving/GitService/GitLab/Caption",
"text": "~GitLab Saver"
},
"$:/language/ControlPanel/Saving/GitService/GitLab/Password": {
"title": "$:/language/ControlPanel/Saving/GitService/GitLab/Password",
"text": "Personal access token for API (see [[GitLab help page|https://docs.gitlab.com/ee/user/profile/personal_access_tokens.html]] for details)"
},
"$:/language/ControlPanel/Saving/GitService/Gitea/Caption": {
"title": "$:/language/ControlPanel/Saving/GitService/Gitea/Caption",
"text": "Gitea Saver"
},
"$:/language/ControlPanel/Saving/GitService/Gitea/Password": {
"title": "$:/language/ControlPanel/Saving/GitService/Gitea/Password",
"text": "Personal access token for API (via Gitea’s web interface: `Settings | Applications | Generate New Token`)"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Advanced/Heading": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Advanced/Heading",
"text": "Advanced Settings"
},
"$:/language/ControlPanel/Saving/TiddlySpot/BackupDir": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/BackupDir",
"text": "Backup Directory"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Backups": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Backups",
"text": "Backups"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Caption": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Caption",
"text": "~TiddlySpot Saver"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Description": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Description",
"text": "These settings are only used when saving to http://tiddlyspot.com or a compatible remote server"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Filename": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Filename",
"text": "Upload Filename"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Heading": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Heading",
"text": "~TiddlySpot"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Hint": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Hint",
"text": "//The server URL defaults to `http://<wikiname>.tiddlyspot.com/store.cgi` and can be changed to use a custom server address, e.g. `http://example.com/store.php`.//"
},
"$:/language/ControlPanel/Saving/TiddlySpot/Password": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/Password",
"text": "Password"
},
"$:/language/ControlPanel/Saving/TiddlySpot/ServerURL": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/ServerURL",
"text": "Server URL"
},
"$:/language/ControlPanel/Saving/TiddlySpot/UploadDir": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/UploadDir",
"text": "Upload Directory"
},
"$:/language/ControlPanel/Saving/TiddlySpot/UserName": {
"title": "$:/language/ControlPanel/Saving/TiddlySpot/UserName",
"text": "Wiki Name"
},
"$:/language/ControlPanel/Settings/AutoSave/Caption": {
"title": "$:/language/ControlPanel/Settings/AutoSave/Caption",
"text": "Autosave"
},
"$:/language/ControlPanel/Settings/AutoSave/Disabled/Description": {
"title": "$:/language/ControlPanel/Settings/AutoSave/Disabled/Description",
"text": "Do not save changes automatically"
},
"$:/language/ControlPanel/Settings/AutoSave/Enabled/Description": {
"title": "$:/language/ControlPanel/Settings/AutoSave/Enabled/Description",
"text": "Save changes automatically"
},
"$:/language/ControlPanel/Settings/AutoSave/Hint": {
"title": "$:/language/ControlPanel/Settings/AutoSave/Hint",
"text": "Attempt to automatically save changes during editing when using a supporting saver"
},
"$:/language/ControlPanel/Settings/CamelCase/Caption": {
"title": "$:/language/ControlPanel/Settings/CamelCase/Caption",
"text": "Camel Case Wiki Links"
},
"$:/language/ControlPanel/Settings/CamelCase/Hint": {
"title": "$:/language/ControlPanel/Settings/CamelCase/Hint",
"text": "You can globally disable automatic linking of ~CamelCase phrases. Requires reload to take effect"
},
"$:/language/ControlPanel/Settings/CamelCase/Description": {
"title": "$:/language/ControlPanel/Settings/CamelCase/Description",
"text": "Enable automatic ~CamelCase linking"
},
"$:/language/ControlPanel/Settings/Caption": {
"title": "$:/language/ControlPanel/Settings/Caption",
"text": "Settings"
},
"$:/language/ControlPanel/Settings/EditorToolbar/Caption": {
"title": "$:/language/ControlPanel/Settings/EditorToolbar/Caption",
"text": "Editor Toolbar"
},
"$:/language/ControlPanel/Settings/EditorToolbar/Hint": {
"title": "$:/language/ControlPanel/Settings/EditorToolbar/Hint",
"text": "Enable or disable the editor toolbar:"
},
"$:/language/ControlPanel/Settings/EditorToolbar/Description": {
"title": "$:/language/ControlPanel/Settings/EditorToolbar/Description",
"text": "Show editor toolbar"
},
"$:/language/ControlPanel/Settings/InfoPanelMode/Caption": {
"title": "$:/language/ControlPanel/Settings/InfoPanelMode/Caption",
"text": "Tiddler Info Panel Mode"
},
"$:/language/ControlPanel/Settings/InfoPanelMode/Hint": {
"title": "$:/language/ControlPanel/Settings/InfoPanelMode/Hint",
"text": "Control when the tiddler info panel closes:"
},
"$:/language/ControlPanel/Settings/InfoPanelMode/Popup/Description": {
"title": "$:/language/ControlPanel/Settings/InfoPanelMode/Popup/Description",
"text": "Tiddler info panel closes automatically"
},
"$:/language/ControlPanel/Settings/InfoPanelMode/Sticky/Description": {
"title": "$:/language/ControlPanel/Settings/InfoPanelMode/Sticky/Description",
"text": "Tiddler info panel stays open until explicitly closed"
},
"$:/language/ControlPanel/Settings/Hint": {
"title": "$:/language/ControlPanel/Settings/Hint",
"text": "These settings let you customise the behaviour of TiddlyWiki."
},
"$:/language/ControlPanel/Settings/NavigationAddressBar/Caption": {
"title": "$:/language/ControlPanel/Settings/NavigationAddressBar/Caption",
"text": "Navigation Address Bar"
},
"$:/language/ControlPanel/Settings/NavigationAddressBar/Hint": {
"title": "$:/language/ControlPanel/Settings/NavigationAddressBar/Hint",
"text": "Behaviour of the browser address bar when navigating to a tiddler:"
},
"$:/language/ControlPanel/Settings/NavigationAddressBar/No/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationAddressBar/No/Description",
"text": "Do not update the address bar"
},
"$:/language/ControlPanel/Settings/NavigationAddressBar/Permalink/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationAddressBar/Permalink/Description",
"text": "Include the target tiddler"
},
"$:/language/ControlPanel/Settings/NavigationAddressBar/Permaview/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationAddressBar/Permaview/Description",
"text": "Include the target tiddler and the current story sequence"
},
"$:/language/ControlPanel/Settings/NavigationHistory/Caption": {
"title": "$:/language/ControlPanel/Settings/NavigationHistory/Caption",
"text": "Navigation History"
},
"$:/language/ControlPanel/Settings/NavigationHistory/Hint": {
"title": "$:/language/ControlPanel/Settings/NavigationHistory/Hint",
"text": "Update browser history when navigating to a tiddler:"
},
"$:/language/ControlPanel/Settings/NavigationHistory/No/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationHistory/No/Description",
"text": "Do not update history"
},
"$:/language/ControlPanel/Settings/NavigationHistory/Yes/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationHistory/Yes/Description",
"text": "Update history"
},
"$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/Caption": {
"title": "$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/Caption",
"text": "Permalink/permaview Mode"
},
"$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/Hint": {
"title": "$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/Hint",
"text": "Choose how permalink/permaview is handled:"
},
"$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/CopyToClipboard/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/CopyToClipboard/Description",
"text": "Copy permalink/permaview URL to clipboard"
},
"$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/UpdateAddressBar/Description": {
"title": "$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/UpdateAddressBar/Description",
"text": "Update address bar with permalink/permaview URL"
},
"$:/language/ControlPanel/Settings/PerformanceInstrumentation/Caption": {
"title": "$:/language/ControlPanel/Settings/PerformanceInstrumentation/Caption",
"text": "Performance Instrumentation"
},
"$:/language/ControlPanel/Settings/PerformanceInstrumentation/Hint": {
"title": "$:/language/ControlPanel/Settings/PerformanceInstrumentation/Hint",
"text": "Displays performance statistics in the browser developer console. Requires reload to take effect"
},
"$:/language/ControlPanel/Settings/PerformanceInstrumentation/Description": {
"title": "$:/language/ControlPanel/Settings/PerformanceInstrumentation/Description",
"text": "Enable performance instrumentation"
},
"$:/language/ControlPanel/Settings/ToolbarButtonStyle/Caption": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtonStyle/Caption",
"text": "Toolbar Button Style"
},
"$:/language/ControlPanel/Settings/ToolbarButtonStyle/Hint": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtonStyle/Hint",
"text": "Choose the style for toolbar buttons:"
},
"$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Borderless": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Borderless",
"text": "Borderless"
},
"$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Boxed": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Boxed",
"text": "Boxed"
},
"$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Rounded": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Rounded",
"text": "Rounded"
},
"$:/language/ControlPanel/Settings/ToolbarButtons/Caption": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtons/Caption",
"text": "Toolbar Buttons"
},
"$:/language/ControlPanel/Settings/ToolbarButtons/Hint": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtons/Hint",
"text": "Default toolbar button appearance:"
},
"$:/language/ControlPanel/Settings/ToolbarButtons/Icons/Description": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtons/Icons/Description",
"text": "Include icon"
},
"$:/language/ControlPanel/Settings/ToolbarButtons/Text/Description": {
"title": "$:/language/ControlPanel/Settings/ToolbarButtons/Text/Description",
"text": "Include text"
},
"$:/language/ControlPanel/Settings/DefaultSidebarTab/Caption": {
"title": "$:/language/ControlPanel/Settings/DefaultSidebarTab/Caption",
"text": "Default Sidebar Tab"
},
"$:/language/ControlPanel/Settings/DefaultSidebarTab/Hint": {
"title": "$:/language/ControlPanel/Settings/DefaultSidebarTab/Hint",
"text": "Specify which sidebar tab is displayed by default"
},
"$:/language/ControlPanel/Settings/DefaultMoreSidebarTab/Caption": {
"title": "$:/language/ControlPanel/Settings/DefaultMoreSidebarTab/Caption",
"text": "Default More Sidebar Tab"
},
"$:/language/ControlPanel/Settings/DefaultMoreSidebarTab/Hint": {
"title": "$:/language/ControlPanel/Settings/DefaultMoreSidebarTab/Hint",
"text": "Specify which More sidebar tab is displayed by default"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/Caption": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/Caption",
"text": "Tiddler Opening Behaviour"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/InsideRiver/Hint": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/InsideRiver/Hint",
"text": "Navigation from //within// the story river"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/OutsideRiver/Hint": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/OutsideRiver/Hint",
"text": "Navigation from //outside// the story river"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAbove": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAbove",
"text": "Open above the current tiddler"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/OpenBelow": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/OpenBelow",
"text": "Open below the current tiddler"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAtTop": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAtTop",
"text": "Open at the top of the story river"
},
"$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAtBottom": {
"title": "$:/language/ControlPanel/Settings/LinkToBehaviour/OpenAtBottom",
"text": "Open at the bottom of the story river"
},
"$:/language/ControlPanel/Settings/TitleLinks/Caption": {
"title": "$:/language/ControlPanel/Settings/TitleLinks/Caption",
"text": "Tiddler Titles"
},
"$:/language/ControlPanel/Settings/TitleLinks/Hint": {
"title": "$:/language/ControlPanel/Settings/TitleLinks/Hint",
"text": "Optionally display tiddler titles as links"
},
"$:/language/ControlPanel/Settings/TitleLinks/No/Description": {
"title": "$:/language/ControlPanel/Settings/TitleLinks/No/Description",
"text": "Do not display tiddler titles as links"
},
"$:/language/ControlPanel/Settings/TitleLinks/Yes/Description": {
"title": "$:/language/ControlPanel/Settings/TitleLinks/Yes/Description",
"text": "Display tiddler titles as links"
},
"$:/language/ControlPanel/Settings/MissingLinks/Caption": {
"title": "$:/language/ControlPanel/Settings/MissingLinks/Caption",
"text": "Wiki Links"
},
"$:/language/ControlPanel/Settings/MissingLinks/Hint": {
"title": "$:/language/ControlPanel/Settings/MissingLinks/Hint",
"text": "Choose whether to link to tiddlers that do not exist yet"
},
"$:/language/ControlPanel/Settings/MissingLinks/Description": {
"title": "$:/language/ControlPanel/Settings/MissingLinks/Description",
"text": "Enable links to missing tiddlers"
},
"$:/language/ControlPanel/StoryView/Caption": {
"title": "$:/language/ControlPanel/StoryView/Caption",
"text": "Story View"
},
"$:/language/ControlPanel/StoryView/Prompt": {
"title": "$:/language/ControlPanel/StoryView/Prompt",
"text": "Current view:"
},
"$:/language/ControlPanel/Stylesheets/Caption": {
"title": "$:/language/ControlPanel/Stylesheets/Caption",
"text": "Stylesheets"
},
"$:/language/ControlPanel/Stylesheets/Expand/Caption": {
"title": "$:/language/ControlPanel/Stylesheets/Expand/Caption",
"text": "Expand All"
},
"$:/language/ControlPanel/Stylesheets/Hint": {
"title": "$:/language/ControlPanel/Stylesheets/Hint",
"text": "This is the rendered CSS of the current stylesheet tiddlers tagged with <<tag \"$:/tags/Stylesheet\">>"
},
"$:/language/ControlPanel/Stylesheets/Restore/Caption": {
"title": "$:/language/ControlPanel/Stylesheets/Restore/Caption",
"text": "Restore"
},
"$:/language/ControlPanel/Theme/Caption": {
"title": "$:/language/ControlPanel/Theme/Caption",
"text": "Theme"
},
"$:/language/ControlPanel/Theme/Prompt": {
"title": "$:/language/ControlPanel/Theme/Prompt",
"text": "Current theme:"
},
"$:/language/ControlPanel/TiddlerFields/Caption": {
"title": "$:/language/ControlPanel/TiddlerFields/Caption",
"text": "Tiddler Fields"
},
"$:/language/ControlPanel/TiddlerFields/Hint": {
"title": "$:/language/ControlPanel/TiddlerFields/Hint",
"text": "This is the full set of TiddlerFields in use in this wiki (including system tiddlers but excluding shadow tiddlers)."
},
"$:/language/ControlPanel/Toolbars/Caption": {
"title": "$:/language/ControlPanel/Toolbars/Caption",
"text": "Toolbars"
},
"$:/language/ControlPanel/Toolbars/EditToolbar/Caption": {
"title": "$:/language/ControlPanel/Toolbars/EditToolbar/Caption",
"text": "Edit Toolbar"
},
"$:/language/ControlPanel/Toolbars/EditToolbar/Hint": {
"title": "$:/language/ControlPanel/Toolbars/EditToolbar/Hint",
"text": "Choose which buttons are displayed for tiddlers in edit mode. Drag and drop to change the ordering"
},
"$:/language/ControlPanel/Toolbars/Hint": {
"title": "$:/language/ControlPanel/Toolbars/Hint",
"text": "Select which toolbar buttons are displayed"
},
"$:/language/ControlPanel/Toolbars/PageControls/Caption": {
"title": "$:/language/ControlPanel/Toolbars/PageControls/Caption",
"text": "Page Toolbar"
},
"$:/language/ControlPanel/Toolbars/PageControls/Hint": {
"title": "$:/language/ControlPanel/Toolbars/PageControls/Hint",
"text": "Choose which buttons are displayed on the main page toolbar. Drag and drop to change the ordering"
},
"$:/language/ControlPanel/Toolbars/EditorToolbar/Caption": {
"title": "$:/language/ControlPanel/Toolbars/EditorToolbar/Caption",
"text": "Editor Toolbar"
},
"$:/language/ControlPanel/Toolbars/EditorToolbar/Hint": {
"title": "$:/language/ControlPanel/Toolbars/EditorToolbar/Hint",
"text": "Choose which buttons are displayed in the editor toolbar. Note that some buttons will only appear when editing tiddlers of a certain type. Drag and drop to change the ordering"
},
"$:/language/ControlPanel/Toolbars/ViewToolbar/Caption": {
"title": "$:/language/ControlPanel/Toolbars/ViewToolbar/Caption",
"text": "View Toolbar"
},
"$:/language/ControlPanel/Toolbars/ViewToolbar/Hint": {
"title": "$:/language/ControlPanel/Toolbars/ViewToolbar/Hint",
"text": "Choose which buttons are displayed for tiddlers in view mode. Drag and drop to change the ordering"
},
"$:/language/ControlPanel/Tools/Download/Full/Caption": {
"title": "$:/language/ControlPanel/Tools/Download/Full/Caption",
"text": "Download full wiki"
},
"$:/language/Date/DaySuffix/1": {
"title": "$:/language/Date/DaySuffix/1",
"text": "st"
},
"$:/language/Date/DaySuffix/2": {
"title": "$:/language/Date/DaySuffix/2",
"text": "nd"
},
"$:/language/Date/DaySuffix/3": {
"title": "$:/language/Date/DaySuffix/3",
"text": "rd"
},
"$:/language/Date/DaySuffix/4": {
"title": "$:/language/Date/DaySuffix/4",
"text": "th"
},
"$:/language/Date/DaySuffix/5": {
"title": "$:/language/Date/DaySuffix/5",
"text": "th"
},
"$:/language/Date/DaySuffix/6": {
"title": "$:/language/Date/DaySuffix/6",
"text": "th"
},
"$:/language/Date/DaySuffix/7": {
"title": "$:/language/Date/DaySuffix/7",
"text": "th"
},
"$:/language/Date/DaySuffix/8": {
"title": "$:/language/Date/DaySuffix/8",
"text": "th"
},
"$:/language/Date/DaySuffix/9": {
"title": "$:/language/Date/DaySuffix/9",
"text": "th"
},
"$:/language/Date/DaySuffix/10": {
"title": "$:/language/Date/DaySuffix/10",
"text": "th"
},
"$:/language/Date/DaySuffix/11": {
"title": "$:/language/Date/DaySuffix/11",
"text": "th"
},
"$:/language/Date/DaySuffix/12": {
"title": "$:/language/Date/DaySuffix/12",
"text": "th"
},
"$:/language/Date/DaySuffix/13": {
"title": "$:/language/Date/DaySuffix/13",
"text": "th"
},
"$:/language/Date/DaySuffix/14": {
"title": "$:/language/Date/DaySuffix/14",
"text": "th"
},
"$:/language/Date/DaySuffix/15": {
"title": "$:/language/Date/DaySuffix/15",
"text": "th"
},
"$:/language/Date/DaySuffix/16": {
"title": "$:/language/Date/DaySuffix/16",
"text": "th"
},
"$:/language/Date/DaySuffix/17": {
"title": "$:/language/Date/DaySuffix/17",
"text": "th"
},
"$:/language/Date/DaySuffix/18": {
"title": "$:/language/Date/DaySuffix/18",
"text": "th"
},
"$:/language/Date/DaySuffix/19": {
"title": "$:/language/Date/DaySuffix/19",
"text": "th"
},
"$:/language/Date/DaySuffix/20": {
"title": "$:/language/Date/DaySuffix/20",
"text": "th"
},
"$:/language/Date/DaySuffix/21": {
"title": "$:/language/Date/DaySuffix/21",
"text": "st"
},
"$:/language/Date/DaySuffix/22": {
"title": "$:/language/Date/DaySuffix/22",
"text": "nd"
},
"$:/language/Date/DaySuffix/23": {
"title": "$:/language/Date/DaySuffix/23",
"text": "rd"
},
"$:/language/Date/DaySuffix/24": {
"title": "$:/language/Date/DaySuffix/24",
"text": "th"
},
"$:/language/Date/DaySuffix/25": {
"title": "$:/language/Date/DaySuffix/25",
"text": "th"
},
"$:/language/Date/DaySuffix/26": {
"title": "$:/language/Date/DaySuffix/26",
"text": "th"
},
"$:/language/Date/DaySuffix/27": {
"title": "$:/language/Date/DaySuffix/27",
"text": "th"
},
"$:/language/Date/DaySuffix/28": {
"title": "$:/language/Date/DaySuffix/28",
"text": "th"
},
"$:/language/Date/DaySuffix/29": {
"title": "$:/language/Date/DaySuffix/29",
"text": "th"
},
"$:/language/Date/DaySuffix/30": {
"title": "$:/language/Date/DaySuffix/30",
"text": "th"
},
"$:/language/Date/DaySuffix/31": {
"title": "$:/language/Date/DaySuffix/31",
"text": "st"
},
"$:/language/Date/Long/Day/0": {
"title": "$:/language/Date/Long/Day/0",
"text": "Sunday"
},
"$:/language/Date/Long/Day/1": {
"title": "$:/language/Date/Long/Day/1",
"text": "Monday"
},
"$:/language/Date/Long/Day/2": {
"title": "$:/language/Date/Long/Day/2",
"text": "Tuesday"
},
"$:/language/Date/Long/Day/3": {
"title": "$:/language/Date/Long/Day/3",
"text": "Wednesday"
},
"$:/language/Date/Long/Day/4": {
"title": "$:/language/Date/Long/Day/4",
"text": "Thursday"
},
"$:/language/Date/Long/Day/5": {
"title": "$:/language/Date/Long/Day/5",
"text": "Friday"
},
"$:/language/Date/Long/Day/6": {
"title": "$:/language/Date/Long/Day/6",
"text": "Saturday"
},
"$:/language/Date/Long/Month/1": {
"title": "$:/language/Date/Long/Month/1",
"text": "January"
},
"$:/language/Date/Long/Month/2": {
"title": "$:/language/Date/Long/Month/2",
"text": "February"
},
"$:/language/Date/Long/Month/3": {
"title": "$:/language/Date/Long/Month/3",
"text": "March"
},
"$:/language/Date/Long/Month/4": {
"title": "$:/language/Date/Long/Month/4",
"text": "April"
},
"$:/language/Date/Long/Month/5": {
"title": "$:/language/Date/Long/Month/5",
"text": "May"
},
"$:/language/Date/Long/Month/6": {
"title": "$:/language/Date/Long/Month/6",
"text": "June"
},
"$:/language/Date/Long/Month/7": {
"title": "$:/language/Date/Long/Month/7",
"text": "July"
},
"$:/language/Date/Long/Month/8": {
"title": "$:/language/Date/Long/Month/8",
"text": "August"
},
"$:/language/Date/Long/Month/9": {
"title": "$:/language/Date/Long/Month/9",
"text": "September"
},
"$:/language/Date/Long/Month/10": {
"title": "$:/language/Date/Long/Month/10",
"text": "October"
},
"$:/language/Date/Long/Month/11": {
"title": "$:/language/Date/Long/Month/11",
"text": "November"
},
"$:/language/Date/Long/Month/12": {
"title": "$:/language/Date/Long/Month/12",
"text": "December"
},
"$:/language/Date/Period/am": {
"title": "$:/language/Date/Period/am",
"text": "am"
},
"$:/language/Date/Period/pm": {
"title": "$:/language/Date/Period/pm",
"text": "pm"
},
"$:/language/Date/Short/Day/0": {
"title": "$:/language/Date/Short/Day/0",
"text": "Sun"
},
"$:/language/Date/Short/Day/1": {
"title": "$:/language/Date/Short/Day/1",
"text": "Mon"
},
"$:/language/Date/Short/Day/2": {
"title": "$:/language/Date/Short/Day/2",
"text": "Tue"
},
"$:/language/Date/Short/Day/3": {
"title": "$:/language/Date/Short/Day/3",
"text": "Wed"
},
"$:/language/Date/Short/Day/4": {
"title": "$:/language/Date/Short/Day/4",
"text": "Thu"
},
"$:/language/Date/Short/Day/5": {
"title": "$:/language/Date/Short/Day/5",
"text": "Fri"
},
"$:/language/Date/Short/Day/6": {
"title": "$:/language/Date/Short/Day/6",
"text": "Sat"
},
"$:/language/Date/Short/Month/1": {
"title": "$:/language/Date/Short/Month/1",
"text": "Jan"
},
"$:/language/Date/Short/Month/2": {
"title": "$:/language/Date/Short/Month/2",
"text": "Feb"
},
"$:/language/Date/Short/Month/3": {
"title": "$:/language/Date/Short/Month/3",
"text": "Mar"
},
"$:/language/Date/Short/Month/4": {
"title": "$:/language/Date/Short/Month/4",
"text": "Apr"
},
"$:/language/Date/Short/Month/5": {
"title": "$:/language/Date/Short/Month/5",
"text": "May"
},
"$:/language/Date/Short/Month/6": {
"title": "$:/language/Date/Short/Month/6",
"text": "Jun"
},
"$:/language/Date/Short/Month/7": {
"title": "$:/language/Date/Short/Month/7",
"text": "Jul"
},
"$:/language/Date/Short/Month/8": {
"title": "$:/language/Date/Short/Month/8",
"text": "Aug"
},
"$:/language/Date/Short/Month/9": {
"title": "$:/language/Date/Short/Month/9",
"text": "Sep"
},
"$:/language/Date/Short/Month/10": {
"title": "$:/language/Date/Short/Month/10",
"text": "Oct"
},
"$:/language/Date/Short/Month/11": {
"title": "$:/language/Date/Short/Month/11",
"text": "Nov"
},
"$:/language/Date/Short/Month/12": {
"title": "$:/language/Date/Short/Month/12",
"text": "Dec"
},
"$:/language/RelativeDate/Future/Days": {
"title": "$:/language/RelativeDate/Future/Days",
"text": "<<period>> days from now"
},
"$:/language/RelativeDate/Future/Hours": {
"title": "$:/language/RelativeDate/Future/Hours",
"text": "<<period>> hours from now"
},
"$:/language/RelativeDate/Future/Minutes": {
"title": "$:/language/RelativeDate/Future/Minutes",
"text": "<<period>> minutes from now"
},
"$:/language/RelativeDate/Future/Months": {
"title": "$:/language/RelativeDate/Future/Months",
"text": "<<period>> months from now"
},
"$:/language/RelativeDate/Future/Second": {
"title": "$:/language/RelativeDate/Future/Second",
"text": "1 second from now"
},
"$:/language/RelativeDate/Future/Seconds": {
"title": "$:/language/RelativeDate/Future/Seconds",
"text": "<<period>> seconds from now"
},
"$:/language/RelativeDate/Future/Years": {
"title": "$:/language/RelativeDate/Future/Years",
"text": "<<period>> years from now"
},
"$:/language/RelativeDate/Past/Days": {
"title": "$:/language/RelativeDate/Past/Days",
"text": "<<period>> days ago"
},
"$:/language/RelativeDate/Past/Hours": {
"title": "$:/language/RelativeDate/Past/Hours",
"text": "<<period>> hours ago"
},
"$:/language/RelativeDate/Past/Minutes": {
"title": "$:/language/RelativeDate/Past/Minutes",
"text": "<<period>> minutes ago"
},
"$:/language/RelativeDate/Past/Months": {
"title": "$:/language/RelativeDate/Past/Months",
"text": "<<period>> months ago"
},
"$:/language/RelativeDate/Past/Second": {
"title": "$:/language/RelativeDate/Past/Second",
"text": "1 second ago"
},
"$:/language/RelativeDate/Past/Seconds": {
"title": "$:/language/RelativeDate/Past/Seconds",
"text": "<<period>> seconds ago"
},
"$:/language/RelativeDate/Past/Years": {
"title": "$:/language/RelativeDate/Past/Years",
"text": "<<period>> years ago"
},
"$:/language/Docs/ModuleTypes/allfilteroperator": {
"title": "$:/language/Docs/ModuleTypes/allfilteroperator",
"text": "A sub-operator for the ''all'' filter operator."
},
"$:/language/Docs/ModuleTypes/animation": {
"title": "$:/language/Docs/ModuleTypes/animation",
"text": "Animations that may be used with the RevealWidget."
},
"$:/language/Docs/ModuleTypes/authenticator": {
"title": "$:/language/Docs/ModuleTypes/authenticator",
"text": "Defines how requests are authenticated by the built-in HTTP server."
},
"$:/language/Docs/ModuleTypes/bitmapeditoroperation": {
"title": "$:/language/Docs/ModuleTypes/bitmapeditoroperation",
"text": "A bitmap editor toolbar operation."
},
"$:/language/Docs/ModuleTypes/command": {
"title": "$:/language/Docs/ModuleTypes/command",
"text": "Commands that can be executed under Node.js."
},
"$:/language/Docs/ModuleTypes/config": {
"title": "$:/language/Docs/ModuleTypes/config",
"text": "Data to be inserted into `$tw.config`."
},
"$:/language/Docs/ModuleTypes/filteroperator": {
"title": "$:/language/Docs/ModuleTypes/filteroperator",
"text": "Individual filter operator methods."
},
"$:/language/Docs/ModuleTypes/global": {
"title": "$:/language/Docs/ModuleTypes/global",
"text": "Global data to be inserted into `$tw`."
},
"$:/language/Docs/ModuleTypes/info": {
"title": "$:/language/Docs/ModuleTypes/info",
"text": "Publishes system information via the [[$:/temp/info-plugin]] pseudo-plugin."
},
"$:/language/Docs/ModuleTypes/isfilteroperator": {
"title": "$:/language/Docs/ModuleTypes/isfilteroperator",
"text": "Operands for the ''is'' filter operator."
},
"$:/language/Docs/ModuleTypes/library": {
"title": "$:/language/Docs/ModuleTypes/library",
"text": "Generic module type for general purpose JavaScript modules."
},
"$:/language/Docs/ModuleTypes/macro": {
"title": "$:/language/Docs/ModuleTypes/macro",
"text": "JavaScript macro definitions."
},
"$:/language/Docs/ModuleTypes/parser": {
"title": "$:/language/Docs/ModuleTypes/parser",
"text": "Parsers for different content types."
},
"$:/language/Docs/ModuleTypes/route": {
"title": "$:/language/Docs/ModuleTypes/route",
"text": "Defines how individual URL patterns are handled by the built-in HTTP server."
},
"$:/language/Docs/ModuleTypes/saver": {
"title": "$:/language/Docs/ModuleTypes/saver",
"text": "Savers handle different methods for saving files from the browser."
},
"$:/language/Docs/ModuleTypes/startup": {
"title": "$:/language/Docs/ModuleTypes/startup",
"text": "Startup functions."
},
"$:/language/Docs/ModuleTypes/storyview": {
"title": "$:/language/Docs/ModuleTypes/storyview",
"text": "Story views customise the animation and behaviour of list widgets."
},
"$:/language/Docs/ModuleTypes/texteditoroperation": {
"title": "$:/language/Docs/ModuleTypes/texteditoroperation",
"text": "A text editor toolbar operation."
},
"$:/language/Docs/ModuleTypes/tiddlerdeserializer": {
"title": "$:/language/Docs/ModuleTypes/tiddlerdeserializer",
"text": "Converts different content types into tiddlers."
},
"$:/language/Docs/ModuleTypes/tiddlerfield": {
"title": "$:/language/Docs/ModuleTypes/tiddlerfield",
"text": "Defines the behaviour of an individual tiddler field."
},
"$:/language/Docs/ModuleTypes/tiddlermethod": {
"title": "$:/language/Docs/ModuleTypes/tiddlermethod",
"text": "Adds methods to the `$tw.Tiddler` prototype."
},
"$:/language/Docs/ModuleTypes/upgrader": {
"title": "$:/language/Docs/ModuleTypes/upgrader",
"text": "Applies upgrade processing to tiddlers during an upgrade/import."
},
"$:/language/Docs/ModuleTypes/utils": {
"title": "$:/language/Docs/ModuleTypes/utils",
"text": "Adds methods to `$tw.utils`."
},
"$:/language/Docs/ModuleTypes/utils-node": {
"title": "$:/language/Docs/ModuleTypes/utils-node",
"text": "Adds Node.js-specific methods to `$tw.utils`."
},
"$:/language/Docs/ModuleTypes/widget": {
"title": "$:/language/Docs/ModuleTypes/widget",
"text": "Widgets encapsulate DOM rendering and refreshing."
},
"$:/language/Docs/ModuleTypes/wikimethod": {
"title": "$:/language/Docs/ModuleTypes/wikimethod",
"text": "Adds methods to `$tw.Wiki`."
},
"$:/language/Docs/ModuleTypes/wikirule": {
"title": "$:/language/Docs/ModuleTypes/wikirule",
"text": "Individual parser rules for the main WikiText parser."
},
"$:/language/Docs/PaletteColours/alert-background": {
"title": "$:/language/Docs/PaletteColours/alert-background",
"text": "Alert background"
},
"$:/language/Docs/PaletteColours/alert-border": {
"title": "$:/language/Docs/PaletteColours/alert-border",
"text": "Alert border"
},
"$:/language/Docs/PaletteColours/alert-highlight": {
"title": "$:/language/Docs/PaletteColours/alert-highlight",
"text": "Alert highlight"
},
"$:/language/Docs/PaletteColours/alert-muted-foreground": {
"title": "$:/language/Docs/PaletteColours/alert-muted-foreground",
"text": "Alert muted foreground"
},
"$:/language/Docs/PaletteColours/background": {
"title": "$:/language/Docs/PaletteColours/background",
"text": "General background"
},
"$:/language/Docs/PaletteColours/blockquote-bar": {
"title": "$:/language/Docs/PaletteColours/blockquote-bar",
"text": "Blockquote bar"
},
"$:/language/Docs/PaletteColours/button-background": {
"title": "$:/language/Docs/PaletteColours/button-background",
"text": "Default button background"
},
"$:/language/Docs/PaletteColours/button-border": {
"title": "$:/language/Docs/PaletteColours/button-border",
"text": "Default button border"
},
"$:/language/Docs/PaletteColours/button-foreground": {
"title": "$:/language/Docs/PaletteColours/button-foreground",
"text": "Default button foreground"
},
"$:/language/Docs/PaletteColours/dirty-indicator": {
"title": "$:/language/Docs/PaletteColours/dirty-indicator",
"text": "Unsaved changes indicator"
},
"$:/language/Docs/PaletteColours/code-background": {
"title": "$:/language/Docs/PaletteColours/code-background",
"text": "Code background"
},
"$:/language/Docs/PaletteColours/code-border": {
"title": "$:/language/Docs/PaletteColours/code-border",
"text": "Code border"
},
"$:/language/Docs/PaletteColours/code-foreground": {
"title": "$:/language/Docs/PaletteColours/code-foreground",
"text": "Code foreground"
},
"$:/language/Docs/PaletteColours/download-background": {
"title": "$:/language/Docs/PaletteColours/download-background",
"text": "Download button background"
},
"$:/language/Docs/PaletteColours/download-foreground": {
"title": "$:/language/Docs/PaletteColours/download-foreground",
"text": "Download button foreground"
},
"$:/language/Docs/PaletteColours/dragger-background": {
"title": "$:/language/Docs/PaletteColours/dragger-background",
"text": "Dragger background"
},
"$:/language/Docs/PaletteColours/dragger-foreground": {
"title": "$:/language/Docs/PaletteColours/dragger-foreground",
"text": "Dragger foreground"
},
"$:/language/Docs/PaletteColours/dropdown-background": {
"title": "$:/language/Docs/PaletteColours/dropdown-background",
"text": "Dropdown background"
},
"$:/language/Docs/PaletteColours/dropdown-border": {
"title": "$:/language/Docs/PaletteColours/dropdown-border",
"text": "Dropdown border"
},
"$:/language/Docs/PaletteColours/dropdown-tab-background-selected": {
"title": "$:/language/Docs/PaletteColours/dropdown-tab-background-selected",
"text": "Dropdown tab background for selected tabs"
},
"$:/language/Docs/PaletteColours/dropdown-tab-background": {
"title": "$:/language/Docs/PaletteColours/dropdown-tab-background",
"text": "Dropdown tab background"
},
"$:/language/Docs/PaletteColours/dropzone-background": {
"title": "$:/language/Docs/PaletteColours/dropzone-background",
"text": "Dropzone background"
},
"$:/language/Docs/PaletteColours/external-link-background-hover": {
"title": "$:/language/Docs/PaletteColours/external-link-background-hover",
"text": "External link background hover"
},
"$:/language/Docs/PaletteColours/external-link-background-visited": {
"title": "$:/language/Docs/PaletteColours/external-link-background-visited",
"text": "External link background visited"
},
"$:/language/Docs/PaletteColours/external-link-background": {
"title": "$:/language/Docs/PaletteColours/external-link-background",
"text": "External link background"
},
"$:/language/Docs/PaletteColours/external-link-foreground-hover": {
"title": "$:/language/Docs/PaletteColours/external-link-foreground-hover",
"text": "External link foreground hover"
},
"$:/language/Docs/PaletteColours/external-link-foreground-visited": {
"title": "$:/language/Docs/PaletteColours/external-link-foreground-visited",
"text": "External link foreground visited"
},
"$:/language/Docs/PaletteColours/external-link-foreground": {
"title": "$:/language/Docs/PaletteColours/external-link-foreground",
"text": "External link foreground"
},
"$:/language/Docs/PaletteColours/foreground": {
"title": "$:/language/Docs/PaletteColours/foreground",
"text": "General foreground"
},
"$:/language/Docs/PaletteColours/menubar-background": {
"title": "$:/language/Docs/PaletteColours/menubar-background",
"text": "Menu bar background"
},
"$:/language/Docs/PaletteColours/menubar-foreground": {
"title": "$:/language/Docs/PaletteColours/menubar-foreground",
"text": "Menu bar foreground"
},
"$:/language/Docs/PaletteColours/message-background": {
"title": "$:/language/Docs/PaletteColours/message-background",
"text": "Message box background"
},
"$:/language/Docs/PaletteColours/message-border": {
"title": "$:/language/Docs/PaletteColours/message-border",
"text": "Message box border"
},
"$:/language/Docs/PaletteColours/message-foreground": {
"title": "$:/language/Docs/PaletteColours/message-foreground",
"text": "Message box foreground"
},
"$:/language/Docs/PaletteColours/modal-backdrop": {
"title": "$:/language/Docs/PaletteColours/modal-backdrop",
"text": "Modal backdrop"
},
"$:/language/Docs/PaletteColours/modal-background": {
"title": "$:/language/Docs/PaletteColours/modal-background",
"text": "Modal background"
},
"$:/language/Docs/PaletteColours/modal-border": {
"title": "$:/language/Docs/PaletteColours/modal-border",
"text": "Modal border"
},
"$:/language/Docs/PaletteColours/modal-footer-background": {
"title": "$:/language/Docs/PaletteColours/modal-footer-background",
"text": "Modal footer background"
},
"$:/language/Docs/PaletteColours/modal-footer-border": {
"title": "$:/language/Docs/PaletteColours/modal-footer-border",
"text": "Modal footer border"
},
"$:/language/Docs/PaletteColours/modal-header-border": {
"title": "$:/language/Docs/PaletteColours/modal-header-border",
"text": "Modal header border"
},
"$:/language/Docs/PaletteColours/muted-foreground": {
"title": "$:/language/Docs/PaletteColours/muted-foreground",
"text": "General muted foreground"
},
"$:/language/Docs/PaletteColours/notification-background": {
"title": "$:/language/Docs/PaletteColours/notification-background",
"text": "Notification background"
},
"$:/language/Docs/PaletteColours/notification-border": {
"title": "$:/language/Docs/PaletteColours/notification-border",
"text": "Notification border"
},
"$:/language/Docs/PaletteColours/page-background": {
"title": "$:/language/Docs/PaletteColours/page-background",
"text": "Page background"
},
"$:/language/Docs/PaletteColours/pre-background": {
"title": "$:/language/Docs/PaletteColours/pre-background",
"text": "Preformatted code background"
},
"$:/language/Docs/PaletteColours/pre-border": {
"title": "$:/language/Docs/PaletteColours/pre-border",
"text": "Preformatted code border"
},
"$:/language/Docs/PaletteColours/primary": {
"title": "$:/language/Docs/PaletteColours/primary",
"text": "General primary"
},
"$:/language/Docs/PaletteColours/select-tag-background": {
"title": "$:/language/Docs/PaletteColours/select-tag-background",
"text": "`<select>` element background"
},
"$:/language/Docs/PaletteColours/select-tag-foreground": {
"title": "$:/language/Docs/PaletteColours/select-tag-foreground",
"text": "`<select>` element text"
},
"$:/language/Docs/PaletteColours/sidebar-button-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-button-foreground",
"text": "Sidebar button foreground"
},
"$:/language/Docs/PaletteColours/sidebar-controls-foreground-hover": {
"title": "$:/language/Docs/PaletteColours/sidebar-controls-foreground-hover",
"text": "Sidebar controls foreground hover"
},
"$:/language/Docs/PaletteColours/sidebar-controls-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-controls-foreground",
"text": "Sidebar controls foreground"
},
"$:/language/Docs/PaletteColours/sidebar-foreground-shadow": {
"title": "$:/language/Docs/PaletteColours/sidebar-foreground-shadow",
"text": "Sidebar foreground shadow"
},
"$:/language/Docs/PaletteColours/sidebar-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-foreground",
"text": "Sidebar foreground"
},
"$:/language/Docs/PaletteColours/sidebar-muted-foreground-hover": {
"title": "$:/language/Docs/PaletteColours/sidebar-muted-foreground-hover",
"text": "Sidebar muted foreground hover"
},
"$:/language/Docs/PaletteColours/sidebar-muted-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-muted-foreground",
"text": "Sidebar muted foreground"
},
"$:/language/Docs/PaletteColours/sidebar-tab-background-selected": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-background-selected",
"text": "Sidebar tab background for selected tabs"
},
"$:/language/Docs/PaletteColours/sidebar-tab-background": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-background",
"text": "Sidebar tab background"
},
"$:/language/Docs/PaletteColours/sidebar-tab-border-selected": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-border-selected",
"text": "Sidebar tab border for selected tabs"
},
"$:/language/Docs/PaletteColours/sidebar-tab-border": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-border",
"text": "Sidebar tab border"
},
"$:/language/Docs/PaletteColours/sidebar-tab-divider": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-divider",
"text": "Sidebar tab divider"
},
"$:/language/Docs/PaletteColours/sidebar-tab-foreground-selected": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-foreground-selected",
"text": "Sidebar tab foreground for selected tabs"
},
"$:/language/Docs/PaletteColours/sidebar-tab-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-tab-foreground",
"text": "Sidebar tab foreground"
},
"$:/language/Docs/PaletteColours/sidebar-tiddler-link-foreground-hover": {
"title": "$:/language/Docs/PaletteColours/sidebar-tiddler-link-foreground-hover",
"text": "Sidebar tiddler link foreground hover"
},
"$:/language/Docs/PaletteColours/sidebar-tiddler-link-foreground": {
"title": "$:/language/Docs/PaletteColours/sidebar-tiddler-link-foreground",
"text": "Sidebar tiddler link foreground"
},
"$:/language/Docs/PaletteColours/site-title-foreground": {
"title": "$:/language/Docs/PaletteColours/site-title-foreground",
"text": "Site title foreground"
},
"$:/language/Docs/PaletteColours/static-alert-foreground": {
"title": "$:/language/Docs/PaletteColours/static-alert-foreground",
"text": "Static alert foreground"
},
"$:/language/Docs/PaletteColours/tab-background-selected": {
"title": "$:/language/Docs/PaletteColours/tab-background-selected",
"text": "Tab background for selected tabs"
},
"$:/language/Docs/PaletteColours/tab-background": {
"title": "$:/language/Docs/PaletteColours/tab-background",
"text": "Tab background"
},
"$:/language/Docs/PaletteColours/tab-border-selected": {
"title": "$:/language/Docs/PaletteColours/tab-border-selected",
"text": "Tab border for selected tabs"
},
"$:/language/Docs/PaletteColours/tab-border": {
"title": "$:/language/Docs/PaletteColours/tab-border",
"text": "Tab border"
},
"$:/language/Docs/PaletteColours/tab-divider": {
"title": "$:/language/Docs/PaletteColours/tab-divider",
"text": "Tab divider"
},
"$:/language/Docs/PaletteColours/tab-foreground-selected": {
"title": "$:/language/Docs/PaletteColours/tab-foreground-selected",
"text": "Tab foreground for selected tabs"
},
"$:/language/Docs/PaletteColours/tab-foreground": {
"title": "$:/language/Docs/PaletteColours/tab-foreground",
"text": "Tab foreground"
},
"$:/language/Docs/PaletteColours/table-border": {
"title": "$:/language/Docs/PaletteColours/table-border",
"text": "Table border"
},
"$:/language/Docs/PaletteColours/table-footer-background": {
"title": "$:/language/Docs/PaletteColours/table-footer-background",
"text": "Table footer background"
},
"$:/language/Docs/PaletteColours/table-header-background": {
"title": "$:/language/Docs/PaletteColours/table-header-background",
"text": "Table header background"
},
"$:/language/Docs/PaletteColours/tag-background": {
"title": "$:/language/Docs/PaletteColours/tag-background",
"text": "Tag background"
},
"$:/language/Docs/PaletteColours/tag-foreground": {
"title": "$:/language/Docs/PaletteColours/tag-foreground",
"text": "Tag foreground"
},
"$:/language/Docs/PaletteColours/tiddler-background": {
"title": "$:/language/Docs/PaletteColours/tiddler-background",
"text": "Tiddler background"
},
"$:/language/Docs/PaletteColours/tiddler-border": {
"title": "$:/language/Docs/PaletteColours/tiddler-border",
"text": "Tiddler border"
},
"$:/language/Docs/PaletteColours/tiddler-controls-foreground-hover": {
"title": "$:/language/Docs/PaletteColours/tiddler-controls-foreground-hover",
"text": "Tiddler controls foreground hover"
},
"$:/language/Docs/PaletteColours/tiddler-controls-foreground-selected": {
"title": "$:/language/Docs/PaletteColours/tiddler-controls-foreground-selected",
"text": "Tiddler controls foreground for selected controls"
},
"$:/language/Docs/PaletteColours/tiddler-controls-foreground": {
"title": "$:/language/Docs/PaletteColours/tiddler-controls-foreground",
"text": "Tiddler controls foreground"
},
"$:/language/Docs/PaletteColours/tiddler-editor-background": {
"title": "$:/language/Docs/PaletteColours/tiddler-editor-background",
"text": "Tiddler editor background"
},
"$:/language/Docs/PaletteColours/tiddler-editor-border-image": {
"title": "$:/language/Docs/PaletteColours/tiddler-editor-border-image",
"text": "Tiddler editor border image"
},
"$:/language/Docs/PaletteColours/tiddler-editor-border": {
"title": "$:/language/Docs/PaletteColours/tiddler-editor-border",
"text": "Tiddler editor border"
},
"$:/language/Docs/PaletteColours/tiddler-editor-fields-even": {
"title": "$:/language/Docs/PaletteColours/tiddler-editor-fields-even",
"text": "Tiddler editor background for even fields"
},
"$:/language/Docs/PaletteColours/tiddler-editor-fields-odd": {
"title": "$:/language/Docs/PaletteColours/tiddler-editor-fields-odd",
"text": "Tiddler editor background for odd fields"
},
"$:/language/Docs/PaletteColours/tiddler-info-background": {
"title": "$:/language/Docs/PaletteColours/tiddler-info-background",
"text": "Tiddler info panel background"
},
"$:/language/Docs/PaletteColours/tiddler-info-border": {
"title": "$:/language/Docs/PaletteColours/tiddler-info-border",
"text": "Tiddler info panel border"
},
"$:/language/Docs/PaletteColours/tiddler-info-tab-background": {
"title": "$:/language/Docs/PaletteColours/tiddler-info-tab-background",
"text": "Tiddler info panel tab background"
},
"$:/language/Docs/PaletteColours/tiddler-link-background": {
"title": "$:/language/Docs/PaletteColours/tiddler-link-background",
"text": "Tiddler link background"
},
"$:/language/Docs/PaletteColours/tiddler-link-foreground": {
"title": "$:/language/Docs/PaletteColours/tiddler-link-foreground",
"text": "Tiddler link foreground"
},
"$:/language/Docs/PaletteColours/tiddler-subtitle-foreground": {
"title": "$:/language/Docs/PaletteColours/tiddler-subtitle-foreground",
"text": "Tiddler subtitle foreground"
},
"$:/language/Docs/PaletteColours/tiddler-title-foreground": {
"title": "$:/language/Docs/PaletteColours/tiddler-title-foreground",
"text": "Tiddler title foreground"
},
"$:/language/Docs/PaletteColours/toolbar-new-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-new-button",
"text": "Toolbar 'new tiddler' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-options-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-options-button",
"text": "Toolbar 'options' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-save-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-save-button",
"text": "Toolbar 'save' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-info-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-info-button",
"text": "Toolbar 'info' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-edit-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-edit-button",
"text": "Toolbar 'edit' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-close-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-close-button",
"text": "Toolbar 'close' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-delete-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-delete-button",
"text": "Toolbar 'delete' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-cancel-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-cancel-button",
"text": "Toolbar 'cancel' button foreground"
},
"$:/language/Docs/PaletteColours/toolbar-done-button": {
"title": "$:/language/Docs/PaletteColours/toolbar-done-button",
"text": "Toolbar 'done' button foreground"
},
"$:/language/Docs/PaletteColours/untagged-background": {
"title": "$:/language/Docs/PaletteColours/untagged-background",
"text": "Untagged pill background"
},
"$:/language/Docs/PaletteColours/very-muted-foreground": {
"title": "$:/language/Docs/PaletteColours/very-muted-foreground",
"text": "Very muted foreground"
},
"$:/language/EditTemplate/Body/External/Hint": {
"title": "$:/language/EditTemplate/Body/External/Hint",
"text": "This tiddler shows content stored outside of the main TiddlyWiki file. You can edit the tags and fields but cannot directly edit the content itself"
},
"$:/language/EditTemplate/Body/Placeholder": {
"title": "$:/language/EditTemplate/Body/Placeholder",
"text": "Type the text for this tiddler"
},
"$:/language/EditTemplate/Body/Preview/Type/Output": {
"title": "$:/language/EditTemplate/Body/Preview/Type/Output",
"text": "output"
},
"$:/language/EditTemplate/Field/Remove/Caption": {
"title": "$:/language/EditTemplate/Field/Remove/Caption",
"text": "remove field"
},
"$:/language/EditTemplate/Field/Remove/Hint": {
"title": "$:/language/EditTemplate/Field/Remove/Hint",
"text": "Remove field"
},
"$:/language/EditTemplate/Field/Dropdown/Caption": {
"title": "$:/language/EditTemplate/Field/Dropdown/Caption",
"text": "field list"
},
"$:/language/EditTemplate/Field/Dropdown/Hint": {
"title": "$:/language/EditTemplate/Field/Dropdown/Hint",
"text": "Show field list"
},
"$:/language/EditTemplate/Fields/Add/Button": {
"title": "$:/language/EditTemplate/Fields/Add/Button",
"text": "add"
},
"$:/language/EditTemplate/Fields/Add/Button/Hint": {
"title": "$:/language/EditTemplate/Fields/Add/Button/Hint",
"text": "Add the new field to the tiddler"
},
"$:/language/EditTemplate/Fields/Add/Name/Placeholder": {
"title": "$:/language/EditTemplate/Fields/Add/Name/Placeholder",
"text": "field name"
},
"$:/language/EditTemplate/Fields/Add/Prompt": {
"title": "$:/language/EditTemplate/Fields/Add/Prompt",
"text": "Add a new field:"
},
"$:/language/EditTemplate/Fields/Add/Value/Placeholder": {
"title": "$:/language/EditTemplate/Fields/Add/Value/Placeholder",
"text": "field value"
},
"$:/language/EditTemplate/Fields/Add/Dropdown/System": {
"title": "$:/language/EditTemplate/Fields/Add/Dropdown/System",
"text": "System fields"
},
"$:/language/EditTemplate/Fields/Add/Dropdown/User": {
"title": "$:/language/EditTemplate/Fields/Add/Dropdown/User",
"text": "User fields"
},
"$:/language/EditTemplate/Shadow/Warning": {
"title": "$:/language/EditTemplate/Shadow/Warning",
"text": "This is a shadow tiddler. Any changes you make will override the default version from the plugin <<pluginLink>>"
},
"$:/language/EditTemplate/Shadow/OverriddenWarning": {
"title": "$:/language/EditTemplate/Shadow/OverriddenWarning",
"text": "This is a modified shadow tiddler. You can revert to the default version in the plugin <<pluginLink>> by deleting this tiddler"
},
"$:/language/EditTemplate/Tags/Add/Button": {
"title": "$:/language/EditTemplate/Tags/Add/Button",
"text": "add"
},
"$:/language/EditTemplate/Tags/Add/Button/Hint": {
"title": "$:/language/EditTemplate/Tags/Add/Button/Hint",
"text": "add tag"
},
"$:/language/EditTemplate/Tags/Add/Placeholder": {
"title": "$:/language/EditTemplate/Tags/Add/Placeholder",
"text": "tag name"
},
"$:/language/EditTemplate/Tags/Dropdown/Caption": {
"title": "$:/language/EditTemplate/Tags/Dropdown/Caption",
"text": "tag list"
},
"$:/language/EditTemplate/Tags/Dropdown/Hint": {
"title": "$:/language/EditTemplate/Tags/Dropdown/Hint",
"text": "Show tag list"
},
"$:/language/EditTemplate/Title/BadCharacterWarning": {
"title": "$:/language/EditTemplate/Title/BadCharacterWarning",
"text": "Warning: avoid using any of the characters <<bad-chars>> in tiddler titles"
},
"$:/language/EditTemplate/Title/Exists/Prompt": {
"title": "$:/language/EditTemplate/Title/Exists/Prompt",
"text": "Target tiddler already exists"
},
"$:/language/EditTemplate/Title/Relink/Prompt": {
"title": "$:/language/EditTemplate/Title/Relink/Prompt",
"text": "Update ''<$text text=<<fromTitle>>/>'' to ''<$text text=<<toTitle>>/>'' in the //tags// and //list// fields of other tiddlers"
},
"$:/language/EditTemplate/Title/References/Prompt": {
"title": "$:/language/EditTemplate/Title/References/Prompt",
"text": "The following references to this tiddler will not be automatically updated:"
},
"$:/language/EditTemplate/Type/Dropdown/Caption": {
"title": "$:/language/EditTemplate/Type/Dropdown/Caption",
"text": "content type list"
},
"$:/language/EditTemplate/Type/Dropdown/Hint": {
"title": "$:/language/EditTemplate/Type/Dropdown/Hint",
"text": "Show content type list"
},
"$:/language/EditTemplate/Type/Delete/Caption": {
"title": "$:/language/EditTemplate/Type/Delete/Caption",
"text": "delete content type"
},
"$:/language/EditTemplate/Type/Delete/Hint": {
"title": "$:/language/EditTemplate/Type/Delete/Hint",
"text": "Delete content type"
},
"$:/language/EditTemplate/Type/Placeholder": {
"title": "$:/language/EditTemplate/Type/Placeholder",
"text": "content type"
},
"$:/language/EditTemplate/Type/Prompt": {
"title": "$:/language/EditTemplate/Type/Prompt",
"text": "Type:"
},
"$:/language/Exporters/StaticRiver": {
"title": "$:/language/Exporters/StaticRiver",
"text": "Static HTML"
},
"$:/language/Exporters/JsonFile": {
"title": "$:/language/Exporters/JsonFile",
"text": "JSON file"
},
"$:/language/Exporters/CsvFile": {
"title": "$:/language/Exporters/CsvFile",
"text": "CSV file"
},
"$:/language/Exporters/TidFile": {
"title": "$:/language/Exporters/TidFile",
"text": "\".tid\" file"
},
"$:/language/Docs/Fields/_canonical_uri": {
"title": "$:/language/Docs/Fields/_canonical_uri",
"text": "The full URI of an external image tiddler"
},
"$:/language/Docs/Fields/bag": {
"title": "$:/language/Docs/Fields/bag",
"text": "The name of the bag from which a tiddler came"
},
"$:/language/Docs/Fields/caption": {
"title": "$:/language/Docs/Fields/caption",
"text": "The text to be displayed on a tab or button"
},
"$:/language/Docs/Fields/color": {
"title": "$:/language/Docs/Fields/color",
"text": "The CSS color value associated with a tiddler"
},
"$:/language/Docs/Fields/component": {
"title": "$:/language/Docs/Fields/component",
"text": "The name of the component responsible for an [[alert tiddler|AlertMechanism]]"
},
"$:/language/Docs/Fields/current-tiddler": {
"title": "$:/language/Docs/Fields/current-tiddler",
"text": "Used to cache the top tiddler in a [[history list|HistoryMechanism]]"
},
"$:/language/Docs/Fields/created": {
"title": "$:/language/Docs/Fields/created",
"text": "The date a tiddler was created"
},
"$:/language/Docs/Fields/creator": {
"title": "$:/language/Docs/Fields/creator",
"text": "The name of the person who created a tiddler"
},
"$:/language/Docs/Fields/dependents": {
"title": "$:/language/Docs/Fields/dependents",
"text": "For a plugin, lists the dependent plugin titles"
},
"$:/language/Docs/Fields/description": {
"title": "$:/language/Docs/Fields/description",
"text": "The descriptive text for a plugin, or a modal dialogue"
},
"$:/language/Docs/Fields/draft.of": {
"title": "$:/language/Docs/Fields/draft.of",
"text": "For draft tiddlers, contains the title of the tiddler of which this is a draft"
},
"$:/language/Docs/Fields/draft.title": {
"title": "$:/language/Docs/Fields/draft.title",
"text": "For draft tiddlers, contains the proposed new title of the tiddler"
},
"$:/language/Docs/Fields/footer": {
"title": "$:/language/Docs/Fields/footer",
"text": "The footer text for a wizard"
},
"$:/language/Docs/Fields/hide-body": {
"title": "$:/language/Docs/Fields/hide-body",
"text": "The view template will hide bodies of tiddlers if set to: ''yes''"
},
"$:/language/Docs/Fields/icon": {
"title": "$:/language/Docs/Fields/icon",
"text": "The title of the tiddler containing the icon associated with a tiddler"
},
"$:/language/Docs/Fields/library": {
"title": "$:/language/Docs/Fields/library",
"text": "Indicates that a tiddler should be saved as a JavaScript library if set to: ''yes''"
},
"$:/language/Docs/Fields/list": {
"title": "$:/language/Docs/Fields/list",
"text": "An ordered list of tiddler titles associated with a tiddler"
},
"$:/language/Docs/Fields/list-before": {
"title": "$:/language/Docs/Fields/list-before",
"text": "If set, the title of a tiddler before which this tiddler should be added to the ordered list of tiddler titles, or at the start of the list if this field is present but empty"
},
"$:/language/Docs/Fields/list-after": {
"title": "$:/language/Docs/Fields/list-after",
"text": "If set, the title of the tiddler after which this tiddler should be added to the ordered list of tiddler titles, or at the end of the list if this field is present but empty"
},
"$:/language/Docs/Fields/modified": {
"title": "$:/language/Docs/Fields/modified",
"text": "The date and time at which a tiddler was last modified"
},
"$:/language/Docs/Fields/modifier": {
"title": "$:/language/Docs/Fields/modifier",
"text": "The tiddler title associated with the person who last modified a tiddler"
},
"$:/language/Docs/Fields/name": {
"title": "$:/language/Docs/Fields/name",
"text": "The human readable name associated with a plugin tiddler"
},
"$:/language/Docs/Fields/plugin-priority": {
"title": "$:/language/Docs/Fields/plugin-priority",
"text": "A numerical value indicating the priority of a plugin tiddler"
},
"$:/language/Docs/Fields/plugin-type": {
"title": "$:/language/Docs/Fields/plugin-type",
"text": "The type of plugin in a plugin tiddler"
},
"$:/language/Docs/Fields/revision": {
"title": "$:/language/Docs/Fields/revision",
"text": "The revision of the tiddler held at the server"
},
"$:/language/Docs/Fields/released": {
"title": "$:/language/Docs/Fields/released",
"text": "Date of a TiddlyWiki release"
},
"$:/language/Docs/Fields/source": {
"title": "$:/language/Docs/Fields/source",
"text": "The source URL associated with a tiddler"
},
"$:/language/Docs/Fields/subtitle": {
"title": "$:/language/Docs/Fields/subtitle",
"text": "The subtitle text for a wizard"
},
"$:/language/Docs/Fields/tags": {
"title": "$:/language/Docs/Fields/tags",
"text": "A list of tags associated with a tiddler"
},
"$:/language/Docs/Fields/text": {
"title": "$:/language/Docs/Fields/text",
"text": "The body text of a tiddler"
},
"$:/language/Docs/Fields/throttle.refresh": {
"title": "$:/language/Docs/Fields/throttle.refresh",
"text": "If present, throttles refreshes of this tiddler"
},
"$:/language/Docs/Fields/title": {
"title": "$:/language/Docs/Fields/title",
"text": "The unique name of a tiddler"
},
"$:/language/Docs/Fields/toc-link": {
"title": "$:/language/Docs/Fields/toc-link",
"text": "Suppresses the tiddler's link in a Table of Contents tree if set to: ''no''"
},
"$:/language/Docs/Fields/type": {
"title": "$:/language/Docs/Fields/type",
"text": "The content type of a tiddler"
},
"$:/language/Docs/Fields/version": {
"title": "$:/language/Docs/Fields/version",
"text": "Version information for a plugin"
},
"$:/language/Docs/Fields/_is_skinny": {
"title": "$:/language/Docs/Fields/_is_skinny",
"text": "If present, indicates that the tiddler text field must be loaded from the server"
},
"$:/language/Filters/AllTiddlers": {
"title": "$:/language/Filters/AllTiddlers",
"text": "All tiddlers except system tiddlers"
},
"$:/language/Filters/RecentSystemTiddlers": {
"title": "$:/language/Filters/RecentSystemTiddlers",
"text": "Recently modified tiddlers, including system tiddlers"
},
"$:/language/Filters/RecentTiddlers": {
"title": "$:/language/Filters/RecentTiddlers",
"text": "Recently modified tiddlers"
},
"$:/language/Filters/AllTags": {
"title": "$:/language/Filters/AllTags",
"text": "All tags except system tags"
},
"$:/language/Filters/Missing": {
"title": "$:/language/Filters/Missing",
"text": "Missing tiddlers"
},
"$:/language/Filters/Drafts": {
"title": "$:/language/Filters/Drafts",
"text": "Draft tiddlers"
},
"$:/language/Filters/Orphans": {
"title": "$:/language/Filters/Orphans",
"text": "Orphan tiddlers"
},
"$:/language/Filters/SystemTiddlers": {
"title": "$:/language/Filters/SystemTiddlers",
"text": "System tiddlers"
},
"$:/language/Filters/ShadowTiddlers": {
"title": "$:/language/Filters/ShadowTiddlers",
"text": "Shadow tiddlers"
},
"$:/language/Filters/OverriddenShadowTiddlers": {
"title": "$:/language/Filters/OverriddenShadowTiddlers",
"text": "Overridden shadow tiddlers"
},
"$:/language/Filters/SessionTiddlers": {
"title": "$:/language/Filters/SessionTiddlers",
"text": "Tiddlers modified since the wiki was loaded"
},
"$:/language/Filters/SystemTags": {
"title": "$:/language/Filters/SystemTags",
"text": "System tags"
},
"$:/language/Filters/StoryList": {
"title": "$:/language/Filters/StoryList",
"text": "Tiddlers in the story river, excluding <$text text=\"$:/AdvancedSearch\"/>"
},
"$:/language/Filters/TypedTiddlers": {
"title": "$:/language/Filters/TypedTiddlers",
"text": "Non wiki-text tiddlers"
},
"GettingStarted": {
"title": "GettingStarted",
"text": "\\define lingo-base() $:/language/ControlPanel/Basics/\nWelcome to ~TiddlyWiki and the ~TiddlyWiki community\n\nBefore you start storing important information in ~TiddlyWiki it is vital to make sure that you can reliably save changes. See https://tiddlywiki.com/#GettingStarted for details\n\n!! Set up this ~TiddlyWiki\n\n<div class=\"tc-control-panel\">\n\n|<$link to=\"$:/SiteTitle\"><<lingo Title/Prompt>></$link> |<$edit-text tiddler=\"$:/SiteTitle\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/SiteSubtitle\"><<lingo Subtitle/Prompt>></$link> |<$edit-text tiddler=\"$:/SiteSubtitle\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/DefaultTiddlers\"><<lingo DefaultTiddlers/Prompt>></$link> |<<lingo DefaultTiddlers/TopHint>><br> <$edit tag=\"textarea\" tiddler=\"$:/DefaultTiddlers\"/><br>//<<lingo DefaultTiddlers/BottomHint>>// |\n</div>\n\nSee the [[control panel|$:/ControlPanel]] for more options.\n"
},
"$:/language/Help/build": {
"title": "$:/language/Help/build",
"description": "Automatically run configured commands",
"text": "Build the specified build targets for the current wiki. If no build targets are specified then all available targets will be built.\n\n```\n--build <target> [<target> ...]\n```\n\nBuild targets are defined in the `tiddlywiki.info` file of a wiki folder.\n\n"
},
"$:/language/Help/clearpassword": {
"title": "$:/language/Help/clearpassword",
"description": "Clear a password for subsequent crypto operations",
"text": "Clear the password for subsequent crypto operations\n\n```\n--clearpassword\n```\n"
},
"$:/language/Help/default": {
"title": "$:/language/Help/default",
"text": "\\define commandTitle()\n$:/language/Help/$(command)$\n\\end\n```\nusage: tiddlywiki [<wikifolder>] [--<command> [<args>...]...]\n```\n\nAvailable commands:\n\n<ul>\n<$list filter=\"[commands[]sort[title]]\" variable=\"command\">\n<li><$link to=<<commandTitle>>><$macrocall $name=\"command\" $type=\"text/plain\" $output=\"text/plain\"/></$link>: <$transclude tiddler=<<commandTitle>> field=\"description\"/></li>\n</$list>\n</ul>\n\nTo get detailed help on a command:\n\n```\ntiddlywiki --help <command>\n```\n"
},
"$:/language/Help/deletetiddlers": {
"title": "$:/language/Help/deletetiddlers",
"description": "Deletes a group of tiddlers",
"text": "<<.from-version \"5.1.20\">> Deletes a group of tiddlers identified by a filter.\n\n```\n--deletetiddlers <filter>\n```\n"
},
"$:/language/Help/editions": {
"title": "$:/language/Help/editions",
"description": "Lists the available editions of TiddlyWiki",
"text": "Lists the names and descriptions of the available editions. You can create a new wiki of a specified edition with the `--init` command.\n\n```\n--editions\n```\n"
},
"$:/language/Help/fetch": {
"title": "$:/language/Help/fetch",
"description": "Fetch tiddlers from wiki by URL",
"text": "Fetch one or more files over HTTP/HTTPS, and import the tiddlers matching a filter, optionally transforming the incoming titles.\n\n```\n--fetch file <url> <import-filter> <transform-filter>\n--fetch files <url-filter> <import-filter> <transform-filter>\n--fetch raw-file <url> <transform-filter>\n--fetch raw-files <url-filter> <transform-filter>\n```\n\nThe \"file\" and \"files\" variants fetch the specified files and attempt to import the tiddlers within them (the same processing as if the files were dragged into the browser window). The \"raw-file\" and \"raw-files\" variants fetch the specified files and then store the raw file data in tiddlers, without applying the import logic.\n\nWith the \"file\" and \"raw-file\" variants only a single file is fetched and the first parameter is the URL of the file to read.\n\nWith the \"files\" and \"raw-files\" variants, multiple files are fetched and the first parameter is a filter yielding a list of URLs of the files to read. For example, given a set of tiddlers tagged \"remote-server\" that have a field \"url\" the filter `[tag[remote-server]get[url]]` will retrieve all the available URLs.\n\nFor the \"file\" and \"files\" variants, the `<import-filter>` parameter specifies a filter determining which tiddlers are imported. It defaults to `[all[tiddlers]]` if not provided.\n\nFor all variants, the `<transform-filter>` parameter specifies an optional filter that transforms the titles of the imported tiddlers. For example, `[addprefix[$:/myimports/]]` would add the prefix `$:/myimports/` to each title.\n\nPreceding the `--fetch` command with `--verbose` will output progress information during the import.\n\nNote that TiddlyWiki will not fetch an older version of an already loaded plugin.\n\nThe following example retrieves all the non-system tiddlers from https://tiddlywiki.com and saves them to a JSON file:\n\n```\ntiddlywiki --verbose --fetch file \"https://tiddlywiki.com/\" \"[!is[system]]\" \"\" --rendertiddler \"$:/core/templates/exporters/JsonFile\" output.json text/plain \"\" exportFilter \"[!is[system]]\"\n```\n\nThe following example retrieves the \"favicon\" file from tiddlywiki.com and saves it in a file called \"output.ico\". Note that the intermediate tiddler \"Icon Tiddler\" is quoted in the \"--fetch\" command because it is being used as a transformation filter to replace the default title, while there are no quotes for the \"--savetiddler\" command because it is being used directly as a title.\n\n```\ntiddlywiki --verbose --fetch raw-file \"https://tiddlywiki.com/favicon.ico\" \"[[Icon Tiddler]]\" --savetiddler \"Icon Tiddler\" output.ico\n```\n\n"
},
"$:/language/Help/help": {
"title": "$:/language/Help/help",
"description": "Display help for TiddlyWiki commands",
"text": "Displays help text for a command:\n\n```\n--help [<command>]\n```\n\nIf the command name is omitted then a list of available commands is displayed.\n"
},
"$:/language/Help/import": {
"title": "$:/language/Help/import",
"description": "Import tiddlers from a file",
"text": "Import tiddlers from TiddlyWiki (`.html`), `.tiddler`, `.tid`, `.json` or other local files. The deserializer must be explicitly specified, unlike the `load` command which infers the deserializer from the file extension.\n\n```\n--import <filepath> <deserializer> [<title>] [<encoding>]\n```\n\nThe deserializers in the core include:\n\n* application/javascript\n* application/json\n* application/x-tiddler\n* application/x-tiddler-html-div\n* application/x-tiddlers\n* text/html\n* text/plain\n\nThe title of the imported tiddler defaults to the filename.\n\nThe encoding defaults to \"utf8\", but can be \"base64\" for importing binary files.\n\nNote that TiddlyWiki will not import an older version of an already loaded plugin.\n"
},
"$:/language/Help/init": {
"title": "$:/language/Help/init",
"description": "Initialise a new wiki folder",
"text": "Initialise an empty [[WikiFolder|WikiFolders]] with a copy of the specified edition.\n\n```\n--init <edition> [<edition> ...]\n```\n\nFor example:\n\n```\ntiddlywiki ./MyWikiFolder --init empty\n```\n\nNote:\n\n* The wiki folder directory will be created if necessary\n* The \"edition\" defaults to ''empty''\n* The init command will fail if the wiki folder is not empty\n* The init command removes any `includeWikis` definitions in the edition's `tiddlywiki.info` file\n* When multiple editions are specified, editions initialised later will overwrite any files shared with earlier editions (so, the final `tiddlywiki.info` file will be copied from the last edition)\n* `--editions` returns a list of available editions\n"
},
"$:/language/Help/listen": {
"title": "$:/language/Help/listen",
"description": "Provides an HTTP server interface to TiddlyWiki",
"text": "Serves a wiki over HTTP.\n\nThe listen command uses NamedCommandParameters:\n\n```\n--listen [<name>=<value>]...\n```\n\nAll parameters are optional with safe defaults, and can be specified in any order. The recognised parameters are:\n\n* ''host'' - optional hostname to serve from (defaults to \"127.0.0.1\" aka \"localhost\")\n* ''path-prefix'' - optional prefix for paths\n* ''port'' - port number on which to listen; non-numeric values are interpreted as a system environment variable from which the port number is extracted (defaults to \"8080\")\n* ''credentials'' - pathname of credentials CSV file (relative to wiki folder)\n* ''anon-username'' - the username for signing edits for anonymous users\n* ''username'' - optional username for basic authentication\n* ''password'' - optional password for basic authentication\n* ''authenticated-user-header'' - optional name of header to be used for trusted authentication\n* ''readers'' - comma separated list of principals allowed to read from this wiki\n* ''writers'' - comma separated list of principals allowed to write to this wiki\n* ''csrf-disable'' - set to \"yes\" to disable CSRF checks (defaults to \"no\")\n* ''root-tiddler'' - the tiddler to serve at the root (defaults to \"$:/core/save/all\")\n* ''root-render-type'' - the content type to which the root tiddler should be rendered (defaults to \"text/plain\")\n* ''root-serve-type'' - the content type with which the root tiddler should be served (defaults to \"text/html\")\n* ''tls-cert'' - pathname of TLS certificate file (relative to wiki folder)\n* ''tls-key'' - pathname of TLS key file (relative to wiki folder)\n* ''debug-level'' - optional debug level; set to \"debug\" to view request details (defaults to \"none\")\n* ''gzip'' - set to \"yes\" to enable gzip compression for some http endpoints (defaults to \"no\")\n\nFor information on opening up your instance to the entire local network, and possible security concerns, see the WebServer tiddler at TiddlyWiki.com.\n\n"
},
"$:/language/Help/load": {
"title": "$:/language/Help/load",
"description": "Load tiddlers from a file",
"text": "Load tiddlers from TiddlyWiki (`.html`), `.tiddler`, `.tid`, `.json` or other local files. The processing applied to incoming files is determined by the file extension. Use the alternative `import` command if you need to specify the deserializer and encoding explicitly.\n\n```\n--load <filepath> [noerror]\n--load <dirpath> [noerror]\n```\n\nBy default, the load command raises an error if no tiddlers are found. The error can be suppressed by providing the optional \"noerror\" parameter.\n\nTo load tiddlers from an encrypted TiddlyWiki file you should first specify the password with the PasswordCommand. For example:\n\n```\ntiddlywiki ./MyWiki --password pa55w0rd --load my_encrypted_wiki.html\n```\n\nNote that TiddlyWiki will not load an older version of an already loaded plugin.\n"
},
"$:/language/Help/makelibrary": {
"title": "$:/language/Help/makelibrary",
"description": "Construct library plugin required by upgrade process",
"text": "Constructs the `$:/UpgradeLibrary` tiddler for the upgrade process.\n\nThe upgrade library is formatted as an ordinary plugin tiddler with the plugin type `library`. It contains a copy of each of the plugins, themes and language packs available within the TiddlyWiki5 repository.\n\nThis command is intended for internal use; it is only relevant to users constructing a custom upgrade procedure.\n\n```\n--makelibrary <title>\n```\n\nThe title argument defaults to `$:/UpgradeLibrary`.\n"
},
"$:/language/Help/notfound": {
"title": "$:/language/Help/notfound",
"text": "No such help item"
},
"$:/language/Help/output": {
"title": "$:/language/Help/output",
"description": "Set the base output directory for subsequent commands",
"text": "Sets the base output directory for subsequent commands. The default output directory is the `output` subdirectory of the edition directory.\n\n```\n--output <pathname>\n```\n\nIf the specified pathname is relative then it is resolved relative to the current working directory. For example `--output .` sets the output directory to the current working directory.\n\n"
},
"$:/language/Help/password": {
"title": "$:/language/Help/password",
"description": "Set a password for subsequent crypto operations",
"text": "Set a password for subsequent crypto operations\n\n```\n--password <password>\n```\n\n''Note'': This should not be used for serving TiddlyWiki with password protection. Instead, see the password option under the [[ServerCommand]].\n"
},
"$:/language/Help/render": {
"title": "$:/language/Help/render",
"description": "Renders individual tiddlers to files",
"text": "Render individual tiddlers identified by a filter and save the results to the specified files.\n\nOptionally, the title of a template tiddler can be specified. In this case, instead of directly rendering each tiddler, the template tiddler is rendered with the \"currentTiddler\" variable set to the title of the tiddler that is being rendered.\n\nA name and value for an additional variable may optionally also be specified.\n\n```\n--render <tiddler-filter> [<filename-filter>] [<render-type>] [<template>] [<name>] [<value>]\n```\n\n* ''tiddler-filter'': A filter identifying the tiddler(s) to be rendered\n* ''filename-filter'': Optional filter transforming tiddler titles into pathnames. If omitted, defaults to `[is[tiddler]addsuffix[.html]]`, which uses the unchanged tiddler title as the filename\n* ''render-type'': Optional render type: `text/html` (the default) returns the full HTML text and `text/plain` just returns the text content (ie it ignores HTML tags and other unprintable material)\n* ''template'': Optional template through which each tiddler is rendered\n* ''name'': Name of optional variable\n* ''value'': Value of optional variable\n\nBy default, the filename is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nNotes:\n\n* The output directory is not cleared of any existing files\n* Any missing directories in the path to the filename are automatically created.\n* When referring to a tiddler with spaces in its title, take care to use both the quotes required by your shell and also TiddlyWiki's double square brackets : `--render \"[[Motovun Jack.jpg]]\"`\n* The filename filter is evaluated with the selected items being set to the title of the tiddler currently being rendered, allowing the title to be used as the basis for computing the filename. For example `[encodeuricomponent[]addprefix[static/]]` applies URI encoding to each title, and then adds the prefix `static/`\n* The `--render` command is a more flexible replacement for both the `--rendertiddler` and `--rendertiddlers` commands, which are deprecated\n\nExamples:\n\n* `--render \"[!is[system]]\" \"[encodeuricomponent[]addprefix[tiddlers/]addsuffix[.html]]\"` -- renders all non-system tiddlers as files in the subdirectory \"tiddlers\" with URL-encoded titles and the extension HTML\n\n"
},
"$:/language/Help/rendertiddler": {
"title": "$:/language/Help/rendertiddler",
"description": "Render an individual tiddler as a specified ContentType",
"text": "(Note: The `--rendertiddler` command is deprecated in favour of the new, more flexible `--render` command)\n\nRender an individual tiddler as a specified ContentType, defaulting to `text/html` and save it to the specified filename.\n\nOptionally the title of a template tiddler can be specified, in which case the template tiddler is rendered with the \"currentTiddler\" variable set to the tiddler that is being rendered (the first parameter value).\n\nA name and value for an additional variable may optionally also be specified.\n\n```\n--rendertiddler <title> <filename> [<type>] [<template>] [<name>] [<value>]\n```\n\nBy default, the filename is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nAny missing directories in the path to the filename are automatically created.\n\nFor example, the following command saves all tiddlers matching the filter `[tag[done]]` to a JSON file titled `output.json` by employing the core template `$:/core/templates/exporters/JsonFile`.\n\n```\n--rendertiddler \"$:/core/templates/exporters/JsonFile\" output.json text/plain \"\" exportFilter \"[tag[done]]\"\n```\n"
},
"$:/language/Help/rendertiddlers": {
"title": "$:/language/Help/rendertiddlers",
"description": "Render tiddlers matching a filter to a specified ContentType",
"text": "(Note: The `--rendertiddlers` command is deprecated in favour of the new, more flexible `--render` command)\n\nRender a set of tiddlers matching a filter to separate files of a specified ContentType (defaults to `text/html`) and extension (defaults to `.html`).\n\n```\n--rendertiddlers <filter> <template> <pathname> [<type>] [<extension>] [\"noclean\"]\n```\n\nFor example:\n\n```\n--rendertiddlers [!is[system]] $:/core/templates/static.tiddler.html ./static text/plain\n```\n\nBy default, the pathname is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nAny files in the target directory are deleted unless the ''noclean'' flag is specified. The target directory is recursively created if it is missing.\n"
},
"$:/language/Help/save": {
"title": "$:/language/Help/save",
"description": "Saves individual raw tiddlers to files",
"text": "Saves individual tiddlers identified by a filter in their raw text or binary format to the specified files.\n\n```\n--save <tiddler-filter> <filename-filter>\n```\n\n* ''tiddler-filter'': A filter identifying the tiddler(s) to be saved\n* ''filename-filter'': Optional filter transforming tiddler titles into pathnames. If omitted, defaults to `[is[tiddler]]`, which uses the unchanged tiddler title as the filename\n\nBy default, the filename is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nNotes:\n\n* The output directory is not cleared of any existing files\n* Any missing directories in the path to the filename are automatically created.\n* When saving a tiddler with spaces in its title, take care to use both the quotes required by your shell and also TiddlyWiki's double square brackets : `--save \"[[Motovun Jack.jpg]]\"`\n* The filename filter is evaluated with the selected items being set to the title of the tiddler currently being saved, allowing the title to be used as the basis for computing the filename. For example `[encodeuricomponent[]addprefix[static/]]` applies URI encoding to each title, and then adds the prefix `static/`\n* The `--save` command is a more flexible replacement for both the `--savetiddler` and `--savetiddlers` commands, which are deprecated\n\nExamples:\n\n* `--save \"[!is[system]is[image]]\" \"[encodeuricomponent[]addprefix[tiddlers/]]\"` -- saves all non-system image tiddlers as files in the subdirectory \"tiddlers\" with URL-encoded titles\n"
},
"$:/language/Help/savetiddler": {
"title": "$:/language/Help/savetiddler",
"description": "Saves a raw tiddler to a file",
"text": "(Note: The `--savetiddler` command is deprecated in favour of the new, more flexible `--save` command)\n\nSaves an individual tiddler in its raw text or binary format to the specified filename.\n\n```\n--savetiddler <title> <filename>\n```\n\nBy default, the filename is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nAny missing directories in the path to the filename are automatically created.\n"
},
"$:/language/Help/savetiddlers": {
"title": "$:/language/Help/savetiddlers",
"description": "Saves a group of raw tiddlers to a directory",
"text": "(Note: The `--savetiddlers` command is deprecated in favour of the new, more flexible `--save` command)\n\nSaves a group of tiddlers in their raw text or binary format to the specified directory.\n\n```\n--savetiddlers <filter> <pathname> [\"noclean\"]\n```\n\nBy default, the pathname is resolved relative to the `output` subdirectory of the edition directory. The `--output` command can be used to direct output to a different directory.\n\nThe output directory is cleared of existing files before saving the specified files. The deletion can be disabled by specifying the ''noclean'' flag.\n\nAny missing directories in the pathname are automatically created.\n"
},
"$:/language/Help/savewikifolder": {
"title": "$:/language/Help/savewikifolder",
"description": "Saves a wiki to a new wiki folder",
"text": "<<.from-version \"5.1.20\">> Saves the current wiki as a wiki folder, including tiddlers, plugins and configuration:\n\n```\n--savewikifolder <wikifolderpath> [<filter>]\n```\n\n* The target wiki folder must be empty or non-existent\n* The filter specifies which tiddlers should be included. It is optional, defaulting to `[all[tiddlers]]`\n* Plugins from the official plugin library are replaced with references to those plugins in the `tiddlywiki.info` file\n* Custom plugins are unpacked into their own folder\n\nA common usage is to convert a TiddlyWiki HTML file into a wiki folder:\n\n```\ntiddlywiki --load ./mywiki.html --savewikifolder ./mywikifolder\n```\n"
},
"$:/language/Help/server": {
"title": "$:/language/Help/server",
"description": "Provides an HTTP server interface to TiddlyWiki (deprecated in favour of the new listen command)",
"text": "Legacy command to serve a wiki over HTTP.\n\n```\n--server <port> <root-tiddler> <root-render-type> <root-serve-type> <username> <password> <host> <path-prefix> <debug-level>\n```\n\nThe parameters are:\n\n* ''port'' - port number on which to listen; non-numeric values are interpreted as a system environment variable from which the port number is extracted (defaults to \"8080\")\n* ''root-tiddler'' - the tiddler to serve at the root (defaults to \"$:/core/save/all\")\n* ''root-render-type'' - the content type to which the root tiddler should be rendered (defaults to \"text/plain\")\n* ''root-serve-type'' - the content type with which the root tiddler should be served (defaults to \"text/html\")\n* ''username'' - the default username for signing edits\n* ''password'' - optional password for basic authentication\n* ''host'' - optional hostname to serve from (defaults to \"127.0.0.1\" aka \"localhost\")\n* ''path-prefix'' - optional prefix for paths\n* ''debug-level'' - optional debug level; set to \"debug\" to view request details (defaults to \"none\")\n\nIf the password parameter is specified then the browser will prompt the user for the username and password. Note that the password is transmitted in plain text so this implementation should only be used on a trusted network or over HTTPS.\n\nFor example:\n\n```\n--server 8080 $:/core/save/all text/plain text/html MyUserName passw0rd\n```\n\nThe username and password can be specified as empty strings if you need to set the hostname or pathprefix and don't want to require a password.\n\n\n```\n--server 8080 $:/core/save/all text/plain text/html \"\" \"\" 192.168.0.245\n```\n\nUsing an address like this exposes your system to the local network. For information on opening up your instance to the entire local network, and possible security concerns, see the WebServer tiddler at TiddlyWiki.com.\n\nTo run multiple TiddlyWiki servers at the same time you'll need to put each one on a different port. It can be useful to use an environment variable to pass the port number to the Node.js process. This example references an environment variable called \"MY_PORT_NUMBER\":\n\n```\n--server MY_PORT_NUMBER $:/core/save/all text/plain text/html MyUserName passw0rd\n```\n"
},
"$:/language/Help/setfield": {
"title": "$:/language/Help/setfield",
"description": "Prepares external tiddlers for use",
"text": "//Note that this command is experimental and may change or be replaced before being finalised//\n\nSets the specified field of a group of tiddlers to the result of wikifying a template tiddler with the `currentTiddler` variable set to the tiddler.\n\n```\n--setfield <filter> <fieldname> <templatetitle> <rendertype>\n```\n\nThe parameters are:\n\n* ''filter'' - filter identifying the tiddlers to be affected\n* ''fieldname'' - the field to modify (defaults to \"text\")\n* ''templatetitle'' - the tiddler to wikify into the specified field. If blank or missing then the specified field is deleted\n* ''rendertype'' - the text type to render (defaults to \"text/plain\"; \"text/html\" can be used to include HTML tags)\n"
},
"$:/language/Help/unpackplugin": {
"title": "$:/language/Help/unpackplugin",
"description": "Unpack the payload tiddlers from a plugin",
"text": "Extract the payload tiddlers from a plugin, creating them as ordinary tiddlers:\n\n```\n--unpackplugin <title>\n```\n"
},
"$:/language/Help/verbose": {
"title": "$:/language/Help/verbose",
"description": "Triggers verbose output mode",
"text": "Triggers verbose output, useful for debugging\n\n```\n--verbose\n```\n"
},
"$:/language/Help/version": {
"title": "$:/language/Help/version",
"description": "Displays the version number of TiddlyWiki",
"text": "Displays the version number of TiddlyWiki.\n\n```\n--version\n```\n"
},
"$:/language/Import/Imported/Hint": {
"title": "$:/language/Import/Imported/Hint",
"text": "The following tiddlers were imported:"
},
"$:/language/Import/Listing/Cancel/Caption": {
"title": "$:/language/Import/Listing/Cancel/Caption",
"text": "Cancel"
},
"$:/language/Import/Listing/Hint": {
"title": "$:/language/Import/Listing/Hint",
"text": "These tiddlers are ready to import:"
},
"$:/language/Import/Listing/Import/Caption": {
"title": "$:/language/Import/Listing/Import/Caption",
"text": "Import"
},
"$:/language/Import/Listing/Select/Caption": {
"title": "$:/language/Import/Listing/Select/Caption",
"text": "Select"
},
"$:/language/Import/Listing/Status/Caption": {
"title": "$:/language/Import/Listing/Status/Caption",
"text": "Status"
},
"$:/language/Import/Listing/Title/Caption": {
"title": "$:/language/Import/Listing/Title/Caption",
"text": "Title"
},
"$:/language/Import/Listing/Preview": {
"title": "$:/language/Import/Listing/Preview",
"text": "Preview:"
},
"$:/language/Import/Listing/Preview/Text": {
"title": "$:/language/Import/Listing/Preview/Text",
"text": "Text"
},
"$:/language/Import/Listing/Preview/TextRaw": {
"title": "$:/language/Import/Listing/Preview/TextRaw",
"text": "Text (Raw)"
},
"$:/language/Import/Listing/Preview/Fields": {
"title": "$:/language/Import/Listing/Preview/Fields",
"text": "Fields"
},
"$:/language/Import/Listing/Preview/Diff": {
"title": "$:/language/Import/Listing/Preview/Diff",
"text": "Diff"
},
"$:/language/Import/Listing/Preview/DiffFields": {
"title": "$:/language/Import/Listing/Preview/DiffFields",
"text": "Diff (Fields)"
},
"$:/language/Import/Upgrader/Plugins/Suppressed/Incompatible": {
"title": "$:/language/Import/Upgrader/Plugins/Suppressed/Incompatible",
"text": "Blocked incompatible or obsolete plugin"
},
"$:/language/Import/Upgrader/Plugins/Suppressed/Version": {
"title": "$:/language/Import/Upgrader/Plugins/Suppressed/Version",
"text": "Blocked plugin (due to incoming <<incoming>> being older than existing <<existing>>)"
},
"$:/language/Import/Upgrader/Plugins/Upgraded": {
"title": "$:/language/Import/Upgrader/Plugins/Upgraded",
"text": "Upgraded plugin from <<incoming>> to <<upgraded>>"
},
"$:/language/Import/Upgrader/State/Suppressed": {
"title": "$:/language/Import/Upgrader/State/Suppressed",
"text": "Blocked temporary state tiddler"
},
"$:/language/Import/Upgrader/System/Suppressed": {
"title": "$:/language/Import/Upgrader/System/Suppressed",
"text": "Blocked system tiddler"
},
"$:/language/Import/Upgrader/System/Warning": {
"title": "$:/language/Import/Upgrader/System/Warning",
"text": "Core module tiddler"
},
"$:/language/Import/Upgrader/System/Alert": {
"title": "$:/language/Import/Upgrader/System/Alert",
"text": "You are about to import a tiddler that will overwrite a core module tiddler. This is not recommended as it may make the system unstable"
},
"$:/language/Import/Upgrader/ThemeTweaks/Created": {
"title": "$:/language/Import/Upgrader/ThemeTweaks/Created",
"text": "Migrated theme tweak from <$text text=<<from>>/>"
},
"$:/language/AboveStory/ClassicPlugin/Warning": {
"title": "$:/language/AboveStory/ClassicPlugin/Warning",
"text": "It looks like you are trying to load a plugin designed for ~TiddlyWiki Classic. Please note that [[these plugins do not work with TiddlyWiki version 5.x.x|https://tiddlywiki.com/#TiddlyWikiClassic]]. ~TiddlyWiki Classic plugins detected:"
},
"$:/language/BinaryWarning/Prompt": {
"title": "$:/language/BinaryWarning/Prompt",
"text": "This tiddler contains binary data"
},
"$:/language/ClassicWarning/Hint": {
"title": "$:/language/ClassicWarning/Hint",
"text": "This tiddler is written in TiddlyWiki Classic wiki text format, which is not fully compatible with TiddlyWiki version 5. See https://tiddlywiki.com/static/Upgrading.html for more details."
},
"$:/language/ClassicWarning/Upgrade/Caption": {
"title": "$:/language/ClassicWarning/Upgrade/Caption",
"text": "upgrade"
},
"$:/language/CloseAll/Button": {
"title": "$:/language/CloseAll/Button",
"text": "close all"
},
"$:/language/ColourPicker/Recent": {
"title": "$:/language/ColourPicker/Recent",
"text": "Recent:"
},
"$:/language/ConfirmCancelTiddler": {
"title": "$:/language/ConfirmCancelTiddler",
"text": "Do you wish to discard changes to the tiddler \"<$text text=<<title>>/>\"?"
},
"$:/language/ConfirmDeleteTiddler": {
"title": "$:/language/ConfirmDeleteTiddler",
"text": "Do you wish to delete the tiddler \"<$text text=<<title>>/>\"?"
},
"$:/language/ConfirmOverwriteTiddler": {
"title": "$:/language/ConfirmOverwriteTiddler",
"text": "Do you wish to overwrite the tiddler \"<$text text=<<title>>/>\"?"
},
"$:/language/ConfirmEditShadowTiddler": {
"title": "$:/language/ConfirmEditShadowTiddler",
"text": "You are about to edit a ShadowTiddler. Any changes will override the default system making future upgrades non-trivial. Are you sure you want to edit \"<$text text=<<title>>/>\"?"
},
"$:/language/Count": {
"title": "$:/language/Count",
"text": "count"
},
"$:/language/DefaultNewTiddlerTitle": {
"title": "$:/language/DefaultNewTiddlerTitle",
"text": "New Tiddler"
},
"$:/language/Diffs/CountMessage": {
"title": "$:/language/Diffs/CountMessage",
"text": "<<diff-count>> differences"
},
"$:/language/DropMessage": {
"title": "$:/language/DropMessage",
"text": "Drop here (or use the 'Escape' key to cancel)"
},
"$:/language/Encryption/Cancel": {
"title": "$:/language/Encryption/Cancel",
"text": "Cancel"
},
"$:/language/Encryption/ConfirmClearPassword": {
"title": "$:/language/Encryption/ConfirmClearPassword",
"text": "Do you wish to clear the password? This will remove the encryption applied when saving this wiki"
},
"$:/language/Encryption/PromptSetPassword": {
"title": "$:/language/Encryption/PromptSetPassword",
"text": "Set a new password for this TiddlyWiki"
},
"$:/language/Encryption/Username": {
"title": "$:/language/Encryption/Username",
"text": "Username"
},
"$:/language/Encryption/Password": {
"title": "$:/language/Encryption/Password",
"text": "Password"
},
"$:/language/Encryption/RepeatPassword": {
"title": "$:/language/Encryption/RepeatPassword",
"text": "Repeat password"
},
"$:/language/Encryption/PasswordNoMatch": {
"title": "$:/language/Encryption/PasswordNoMatch",
"text": "Passwords do not match"
},
"$:/language/Encryption/SetPassword": {
"title": "$:/language/Encryption/SetPassword",
"text": "Set password"
},
"$:/language/Error/Caption": {
"title": "$:/language/Error/Caption",
"text": "Error"
},
"$:/language/Error/EditConflict": {
"title": "$:/language/Error/EditConflict",
"text": "File changed on server"
},
"$:/language/Error/Filter": {
"title": "$:/language/Error/Filter",
"text": "Filter error"
},
"$:/language/Error/FilterSyntax": {
"title": "$:/language/Error/FilterSyntax",
"text": "Syntax error in filter expression"
},
"$:/language/Error/IsFilterOperator": {
"title": "$:/language/Error/IsFilterOperator",
"text": "Filter Error: Unknown operand for the 'is' filter operator"
},
"$:/language/Error/LoadingPluginLibrary": {
"title": "$:/language/Error/LoadingPluginLibrary",
"text": "Error loading plugin library"
},
"$:/language/Error/NetworkErrorAlert": {
"title": "$:/language/Error/NetworkErrorAlert",
"text": "`<h2>''Network Error''</h2>It looks like the connection to the server has been lost. This may indicate a problem with your network connection. Please attempt to restore network connectivity before continuing.<br><br>''Any unsaved changes will be automatically synchronised when connectivity is restored''.`"
},
"$:/language/Error/RecursiveTransclusion": {
"title": "$:/language/Error/RecursiveTransclusion",
"text": "Recursive transclusion error in transclude widget"
},
"$:/language/Error/RetrievingSkinny": {
"title": "$:/language/Error/RetrievingSkinny",
"text": "Error retrieving skinny tiddler list"
},
"$:/language/Error/SavingToTWEdit": {
"title": "$:/language/Error/SavingToTWEdit",
"text": "Error saving to TWEdit"
},
"$:/language/Error/WhileSaving": {
"title": "$:/language/Error/WhileSaving",
"text": "Error while saving"
},
"$:/language/Error/XMLHttpRequest": {
"title": "$:/language/Error/XMLHttpRequest",
"text": "XMLHttpRequest error code"
},
"$:/language/InternalJavaScriptError/Title": {
"title": "$:/language/InternalJavaScriptError/Title",
"text": "Internal JavaScript Error"
},
"$:/language/InternalJavaScriptError/Hint": {
"title": "$:/language/InternalJavaScriptError/Hint",
"text": "Well, this is embarrassing. It is recommended that you restart TiddlyWiki by refreshing your browser"
},
"$:/language/InvalidFieldName": {
"title": "$:/language/InvalidFieldName",
"text": "Illegal characters in field name \"<$text text=<<fieldName>>/>\". Fields can only contain lowercase letters, digits and the characters underscore (`_`), hyphen (`-`) and period (`.`)"
},
"$:/language/LazyLoadingWarning": {
"title": "$:/language/LazyLoadingWarning",
"text": "<p>Trying to load external content from ''<$text text={{!!_canonical_uri}}/>''</p><p>If this message doesn't disappear, either the tiddler content type doesn't match the type of the external content, or you may be using a browser that doesn't support external content for wikis loaded as standalone files. See https://tiddlywiki.com/#ExternalText</p>"
},
"$:/language/LoginToTiddlySpace": {
"title": "$:/language/LoginToTiddlySpace",
"text": "Login to TiddlySpace"
},
"$:/language/Manager/Controls/FilterByTag/None": {
"title": "$:/language/Manager/Controls/FilterByTag/None",
"text": "(none)"
},
"$:/language/Manager/Controls/FilterByTag/Prompt": {
"title": "$:/language/Manager/Controls/FilterByTag/Prompt",
"text": "Filter by tag:"
},
"$:/language/Manager/Controls/Order/Prompt": {
"title": "$:/language/Manager/Controls/Order/Prompt",
"text": "Reverse order"
},
"$:/language/Manager/Controls/Search/Placeholder": {
"title": "$:/language/Manager/Controls/Search/Placeholder",
"text": "Search"
},
"$:/language/Manager/Controls/Search/Prompt": {
"title": "$:/language/Manager/Controls/Search/Prompt",
"text": "Search:"
},
"$:/language/Manager/Controls/Show/Option/Tags": {
"title": "$:/language/Manager/Controls/Show/Option/Tags",
"text": "tags"
},
"$:/language/Manager/Controls/Show/Option/Tiddlers": {
"title": "$:/language/Manager/Controls/Show/Option/Tiddlers",
"text": "tiddlers"
},
"$:/language/Manager/Controls/Show/Prompt": {
"title": "$:/language/Manager/Controls/Show/Prompt",
"text": "Show:"
},
"$:/language/Manager/Controls/Sort/Prompt": {
"title": "$:/language/Manager/Controls/Sort/Prompt",
"text": "Sort by:"
},
"$:/language/Manager/Item/Colour": {
"title": "$:/language/Manager/Item/Colour",
"text": "Colour"
},
"$:/language/Manager/Item/Fields": {
"title": "$:/language/Manager/Item/Fields",
"text": "Fields"
},
"$:/language/Manager/Item/Icon/None": {
"title": "$:/language/Manager/Item/Icon/None",
"text": "(none)"
},
"$:/language/Manager/Item/Icon": {
"title": "$:/language/Manager/Item/Icon",
"text": "Icon"
},
"$:/language/Manager/Item/RawText": {
"title": "$:/language/Manager/Item/RawText",
"text": "Raw text"
},
"$:/language/Manager/Item/Tags": {
"title": "$:/language/Manager/Item/Tags",
"text": "Tags"
},
"$:/language/Manager/Item/Tools": {
"title": "$:/language/Manager/Item/Tools",
"text": "Tools"
},
"$:/language/Manager/Item/WikifiedText": {
"title": "$:/language/Manager/Item/WikifiedText",
"text": "Wikified text"
},
"$:/language/MissingTiddler/Hint": {
"title": "$:/language/MissingTiddler/Hint",
"text": "Missing tiddler \"<$text text=<<currentTiddler>>/>\" -- click {{||$:/core/ui/Buttons/edit}} to create"
},
"$:/language/No": {
"title": "$:/language/No",
"text": "No"
},
"$:/language/OfficialPluginLibrary": {
"title": "$:/language/OfficialPluginLibrary",
"text": "Official ~TiddlyWiki Plugin Library"
},
"$:/language/OfficialPluginLibrary/Hint": {
"title": "$:/language/OfficialPluginLibrary/Hint",
"text": "The official ~TiddlyWiki plugin library at tiddlywiki.com. Plugins, themes and language packs are maintained by the core team."
},
"$:/language/PluginReloadWarning": {
"title": "$:/language/PluginReloadWarning",
"text": "Please save {{$:/core/ui/Buttons/save-wiki}} and reload {{$:/core/ui/Buttons/refresh}} to allow changes to ~JavaScript plugins to take effect"
},
"$:/language/RecentChanges/DateFormat": {
"title": "$:/language/RecentChanges/DateFormat",
"text": "DDth MMM YYYY"
},
"$:/language/SystemTiddler/Tooltip": {
"title": "$:/language/SystemTiddler/Tooltip",
"text": "This is a system tiddler"
},
"$:/language/SystemTiddlers/Include/Prompt": {
"title": "$:/language/SystemTiddlers/Include/Prompt",
"text": "Include system tiddlers"
},
"$:/language/TagManager/Colour/Heading": {
"title": "$:/language/TagManager/Colour/Heading",
"text": "Colour"
},
"$:/language/TagManager/Count/Heading": {
"title": "$:/language/TagManager/Count/Heading",
"text": "Count"
},
"$:/language/TagManager/Icon/Heading": {
"title": "$:/language/TagManager/Icon/Heading",
"text": "Icon"
},
"$:/language/TagManager/Icons/None": {
"title": "$:/language/TagManager/Icons/None",
"text": "None"
},
"$:/language/TagManager/Info/Heading": {
"title": "$:/language/TagManager/Info/Heading",
"text": "Info"
},
"$:/language/TagManager/Tag/Heading": {
"title": "$:/language/TagManager/Tag/Heading",
"text": "Tag"
},
"$:/language/Tiddler/DateFormat": {
"title": "$:/language/Tiddler/DateFormat",
"text": "DDth MMM YYYY at hh12:0mmam"
},
"$:/language/UnsavedChangesWarning": {
"title": "$:/language/UnsavedChangesWarning",
"text": "You have unsaved changes in TiddlyWiki"
},
"$:/language/Yes": {
"title": "$:/language/Yes",
"text": "Yes"
},
"$:/language/Modals/Download": {
"title": "$:/language/Modals/Download",
"subtitle": "Download changes",
"footer": "<$button message=\"tm-close-tiddler\">Close</$button>",
"help": "https://tiddlywiki.com/static/DownloadingChanges.html",
"text": "Your browser only supports manual saving.\n\nTo save your modified wiki, right click on the download link below and select \"Download file\" or \"Save file\", and then choose the folder and filename.\n\n//You can marginally speed things up by clicking the link with the control key (Windows) or the options/alt key (Mac OS X). You will not be prompted for the folder or filename, but your browser is likely to give it an unrecognisable name -- you may need to rename the file to include an `.html` extension before you can do anything useful with it.//\n\nOn smartphones that do not allow files to be downloaded you can instead bookmark the link, and then sync your bookmarks to a desktop computer from where the wiki can be saved normally.\n"
},
"$:/language/Modals/SaveInstructions": {
"title": "$:/language/Modals/SaveInstructions",
"subtitle": "Save your work",
"footer": "<$button message=\"tm-close-tiddler\">Close</$button>",
"help": "https://tiddlywiki.com/static/SavingChanges.html",
"text": "Your changes to this wiki need to be saved as a ~TiddlyWiki HTML file.\n\n!!! Desktop browsers\n\n# Select ''Save As'' from the ''File'' menu\n# Choose a filename and location\n#* Some browsers also require you to explicitly specify the file saving format as ''Webpage, HTML only'' or similar\n# Close this tab\n\n!!! Smartphone browsers\n\n# Create a bookmark to this page\n#* If you've got iCloud or Google Sync set up then the bookmark will automatically sync to your desktop where you can open it and save it as above\n# Close this tab\n\n//If you open the bookmark again in Mobile Safari you will see this message again. If you want to go ahead and use the file, just click the ''close'' button below//\n"
},
"$:/config/NewJournal/Title": {
"title": "$:/config/NewJournal/Title",
"text": "DDth MMM YYYY"
},
"$:/config/NewJournal/Text": {
"title": "$:/config/NewJournal/Text",
"text": ""
},
"$:/config/NewJournal/Tags": {
"title": "$:/config/NewJournal/Tags",
"tags": "Journal"
},
"$:/language/Notifications/Save/Done": {
"title": "$:/language/Notifications/Save/Done",
"text": "Saved wiki"
},
"$:/language/Notifications/Save/Starting": {
"title": "$:/language/Notifications/Save/Starting",
"text": "Starting to save wiki"
},
"$:/language/Notifications/CopiedToClipboard/Succeeded": {
"title": "$:/language/Notifications/CopiedToClipboard/Succeeded",
"text": "Copied to clipboard!"
},
"$:/language/Notifications/CopiedToClipboard/Failed": {
"title": "$:/language/Notifications/CopiedToClipboard/Failed",
"text": "Failed to copy to clipboard!"
},
"$:/language/Search/DefaultResults/Caption": {
"title": "$:/language/Search/DefaultResults/Caption",
"text": "List"
},
"$:/language/Search/Filter/Caption": {
"title": "$:/language/Search/Filter/Caption",
"text": "Filter"
},
"$:/language/Search/Filter/Hint": {
"title": "$:/language/Search/Filter/Hint",
"text": "Search via a [[filter expression|https://tiddlywiki.com/static/Filters.html]]"
},
"$:/language/Search/Filter/Matches": {
"title": "$:/language/Search/Filter/Matches",
"text": "//<small><<resultCount>> matches</small>//"
},
"$:/language/Search/Matches": {
"title": "$:/language/Search/Matches",
"text": "//<small><<resultCount>> matches</small>//"
},
"$:/language/Search/Matches/All": {
"title": "$:/language/Search/Matches/All",
"text": "All matches:"
},
"$:/language/Search/Matches/Title": {
"title": "$:/language/Search/Matches/Title",
"text": "Title matches:"
},
"$:/language/Search/Search": {
"title": "$:/language/Search/Search",
"text": "Search"
},
"$:/language/Search/Search/TooShort": {
"title": "$:/language/Search/Search/TooShort",
"text": "Search text too short"
},
"$:/language/Search/Shadows/Caption": {
"title": "$:/language/Search/Shadows/Caption",
"text": "Shadows"
},
"$:/language/Search/Shadows/Hint": {
"title": "$:/language/Search/Shadows/Hint",
"text": "Search for shadow tiddlers"
},
"$:/language/Search/Shadows/Matches": {
"title": "$:/language/Search/Shadows/Matches",
"text": "//<small><<resultCount>> matches</small>//"
},
"$:/language/Search/Standard/Caption": {
"title": "$:/language/Search/Standard/Caption",
"text": "Standard"
},
"$:/language/Search/Standard/Hint": {
"title": "$:/language/Search/Standard/Hint",
"text": "Search for standard tiddlers"
},
"$:/language/Search/Standard/Matches": {
"title": "$:/language/Search/Standard/Matches",
"text": "//<small><<resultCount>> matches</small>//"
},
"$:/language/Search/System/Caption": {
"title": "$:/language/Search/System/Caption",
"text": "System"
},
"$:/language/Search/System/Hint": {
"title": "$:/language/Search/System/Hint",
"text": "Search for system tiddlers"
},
"$:/language/Search/System/Matches": {
"title": "$:/language/Search/System/Matches",
"text": "//<small><<resultCount>> matches</small>//"
},
"$:/language/SideBar/All/Caption": {
"title": "$:/language/SideBar/All/Caption",
"text": "All"
},
"$:/language/SideBar/Contents/Caption": {
"title": "$:/language/SideBar/Contents/Caption",
"text": "Contents"
},
"$:/language/SideBar/Drafts/Caption": {
"title": "$:/language/SideBar/Drafts/Caption",
"text": "Drafts"
},
"$:/language/SideBar/Explorer/Caption": {
"title": "$:/language/SideBar/Explorer/Caption",
"text": "Explorer"
},
"$:/language/SideBar/Missing/Caption": {
"title": "$:/language/SideBar/Missing/Caption",
"text": "Missing"
},
"$:/language/SideBar/More/Caption": {
"title": "$:/language/SideBar/More/Caption",
"text": "More"
},
"$:/language/SideBar/Open/Caption": {
"title": "$:/language/SideBar/Open/Caption",
"text": "Open"
},
"$:/language/SideBar/Orphans/Caption": {
"title": "$:/language/SideBar/Orphans/Caption",
"text": "Orphans"
},
"$:/language/SideBar/Recent/Caption": {
"title": "$:/language/SideBar/Recent/Caption",
"text": "Recent"
},
"$:/language/SideBar/Shadows/Caption": {
"title": "$:/language/SideBar/Shadows/Caption",
"text": "Shadows"
},
"$:/language/SideBar/System/Caption": {
"title": "$:/language/SideBar/System/Caption",
"text": "System"
},
"$:/language/SideBar/Tags/Caption": {
"title": "$:/language/SideBar/Tags/Caption",
"text": "Tags"
},
"$:/language/SideBar/Tags/Untagged/Caption": {
"title": "$:/language/SideBar/Tags/Untagged/Caption",
"text": "untagged"
},
"$:/language/SideBar/Tools/Caption": {
"title": "$:/language/SideBar/Tools/Caption",
"text": "Tools"
},
"$:/language/SideBar/Types/Caption": {
"title": "$:/language/SideBar/Types/Caption",
"text": "Types"
},
"$:/SiteSubtitle": {
"title": "$:/SiteSubtitle",
"text": "a non-linear personal web notebook"
},
"$:/SiteTitle": {
"title": "$:/SiteTitle",
"text": "My ~TiddlyWiki"
},
"$:/language/Snippets/ListByTag": {
"title": "$:/language/Snippets/ListByTag",
"tags": "$:/tags/TextEditor/Snippet",
"caption": "List of tiddlers by tag",
"text": "<<list-links \"[tag[task]sort[title]]\">>\n"
},
"$:/language/Snippets/MacroDefinition": {
"title": "$:/language/Snippets/MacroDefinition",
"tags": "$:/tags/TextEditor/Snippet",
"caption": "Macro definition",
"text": "\\define macroName(param1:\"default value\",param2)\nText of the macro\n\\end\n"
},
"$:/language/Snippets/Table4x3": {
"title": "$:/language/Snippets/Table4x3",
"tags": "$:/tags/TextEditor/Snippet",
"caption": "Table with 4 columns by 3 rows",
"text": "|! |!Alpha |!Beta |!Gamma |!Delta |\n|!One | | | | |\n|!Two | | | | |\n|!Three | | | | |\n"
},
"$:/language/Snippets/TableOfContents": {
"title": "$:/language/Snippets/TableOfContents",
"tags": "$:/tags/TextEditor/Snippet",
"caption": "Table of Contents",
"text": "<div class=\"tc-table-of-contents\">\n\n<<toc-selective-expandable 'TableOfContents'>>\n\n</div>"
},
"$:/language/ThemeTweaks/ThemeTweaks": {
"title": "$:/language/ThemeTweaks/ThemeTweaks",
"text": "Theme Tweaks"
},
"$:/language/ThemeTweaks/ThemeTweaks/Hint": {
"title": "$:/language/ThemeTweaks/ThemeTweaks/Hint",
"text": "You can tweak certain aspects of the ''Vanilla'' theme."
},
"$:/language/ThemeTweaks/Options": {
"title": "$:/language/ThemeTweaks/Options",
"text": "Options"
},
"$:/language/ThemeTweaks/Options/SidebarLayout": {
"title": "$:/language/ThemeTweaks/Options/SidebarLayout",
"text": "Sidebar layout"
},
"$:/language/ThemeTweaks/Options/SidebarLayout/Fixed-Fluid": {
"title": "$:/language/ThemeTweaks/Options/SidebarLayout/Fixed-Fluid",
"text": "Fixed story, fluid sidebar"
},
"$:/language/ThemeTweaks/Options/SidebarLayout/Fluid-Fixed": {
"title": "$:/language/ThemeTweaks/Options/SidebarLayout/Fluid-Fixed",
"text": "Fluid story, fixed sidebar"
},
"$:/language/ThemeTweaks/Options/StickyTitles": {
"title": "$:/language/ThemeTweaks/Options/StickyTitles",
"text": "Sticky titles"
},
"$:/language/ThemeTweaks/Options/StickyTitles/Hint": {
"title": "$:/language/ThemeTweaks/Options/StickyTitles/Hint",
"text": "Causes tiddler titles to \"stick\" to the top of the browser window"
},
"$:/language/ThemeTweaks/Options/CodeWrapping": {
"title": "$:/language/ThemeTweaks/Options/CodeWrapping",
"text": "Wrap long lines in code blocks"
},
"$:/language/ThemeTweaks/Settings": {
"title": "$:/language/ThemeTweaks/Settings",
"text": "Settings"
},
"$:/language/ThemeTweaks/Settings/FontFamily": {
"title": "$:/language/ThemeTweaks/Settings/FontFamily",
"text": "Font family"
},
"$:/language/ThemeTweaks/Settings/CodeFontFamily": {
"title": "$:/language/ThemeTweaks/Settings/CodeFontFamily",
"text": "Code font family"
},
"$:/language/ThemeTweaks/Settings/EditorFontFamily": {
"title": "$:/language/ThemeTweaks/Settings/EditorFontFamily",
"text": "Editor font family"
},
"$:/language/ThemeTweaks/Settings/BackgroundImage": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImage",
"text": "Page background image"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageAttachment": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageAttachment",
"text": "Page background image attachment"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageAttachment/Scroll": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageAttachment/Scroll",
"text": "Scroll with tiddlers"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageAttachment/Fixed": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageAttachment/Fixed",
"text": "Fixed to window"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageSize": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageSize",
"text": "Page background image size"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageSize/Auto": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageSize/Auto",
"text": "Auto"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageSize/Cover": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageSize/Cover",
"text": "Cover"
},
"$:/language/ThemeTweaks/Settings/BackgroundImageSize/Contain": {
"title": "$:/language/ThemeTweaks/Settings/BackgroundImageSize/Contain",
"text": "Contain"
},
"$:/language/ThemeTweaks/Metrics": {
"title": "$:/language/ThemeTweaks/Metrics",
"text": "Sizes"
},
"$:/language/ThemeTweaks/Metrics/FontSize": {
"title": "$:/language/ThemeTweaks/Metrics/FontSize",
"text": "Font size"
},
"$:/language/ThemeTweaks/Metrics/LineHeight": {
"title": "$:/language/ThemeTweaks/Metrics/LineHeight",
"text": "Line height"
},
"$:/language/ThemeTweaks/Metrics/BodyFontSize": {
"title": "$:/language/ThemeTweaks/Metrics/BodyFontSize",
"text": "Font size for tiddler body"
},
"$:/language/ThemeTweaks/Metrics/BodyLineHeight": {
"title": "$:/language/ThemeTweaks/Metrics/BodyLineHeight",
"text": "Line height for tiddler body"
},
"$:/language/ThemeTweaks/Metrics/StoryLeft": {
"title": "$:/language/ThemeTweaks/Metrics/StoryLeft",
"text": "Story left position"
},
"$:/language/ThemeTweaks/Metrics/StoryLeft/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/StoryLeft/Hint",
"text": "how far the left margin of the story river<br>(tiddler area) is from the left of the page"
},
"$:/language/ThemeTweaks/Metrics/StoryTop": {
"title": "$:/language/ThemeTweaks/Metrics/StoryTop",
"text": "Story top position"
},
"$:/language/ThemeTweaks/Metrics/StoryTop/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/StoryTop/Hint",
"text": "how far the top margin of the story river<br>is from the top of the page"
},
"$:/language/ThemeTweaks/Metrics/StoryRight": {
"title": "$:/language/ThemeTweaks/Metrics/StoryRight",
"text": "Story right"
},
"$:/language/ThemeTweaks/Metrics/StoryRight/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/StoryRight/Hint",
"text": "how far the left margin of the sidebar <br>is from the left of the page"
},
"$:/language/ThemeTweaks/Metrics/StoryWidth": {
"title": "$:/language/ThemeTweaks/Metrics/StoryWidth",
"text": "Story width"
},
"$:/language/ThemeTweaks/Metrics/StoryWidth/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/StoryWidth/Hint",
"text": "the overall width of the story river"
},
"$:/language/ThemeTweaks/Metrics/TiddlerWidth": {
"title": "$:/language/ThemeTweaks/Metrics/TiddlerWidth",
"text": "Tiddler width"
},
"$:/language/ThemeTweaks/Metrics/TiddlerWidth/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/TiddlerWidth/Hint",
"text": "within the story river"
},
"$:/language/ThemeTweaks/Metrics/SidebarBreakpoint": {
"title": "$:/language/ThemeTweaks/Metrics/SidebarBreakpoint",
"text": "Sidebar breakpoint"
},
"$:/language/ThemeTweaks/Metrics/SidebarBreakpoint/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/SidebarBreakpoint/Hint",
"text": "the minimum page width at which the story<br>river and sidebar will appear side by side"
},
"$:/language/ThemeTweaks/Metrics/SidebarWidth": {
"title": "$:/language/ThemeTweaks/Metrics/SidebarWidth",
"text": "Sidebar width"
},
"$:/language/ThemeTweaks/Metrics/SidebarWidth/Hint": {
"title": "$:/language/ThemeTweaks/Metrics/SidebarWidth/Hint",
"text": "the width of the sidebar in fluid-fixed layout"
},
"$:/language/TiddlerInfo/Advanced/Caption": {
"title": "$:/language/TiddlerInfo/Advanced/Caption",
"text": "Advanced"
},
"$:/language/TiddlerInfo/Advanced/PluginInfo/Empty/Hint": {
"title": "$:/language/TiddlerInfo/Advanced/PluginInfo/Empty/Hint",
"text": "none"
},
"$:/language/TiddlerInfo/Advanced/PluginInfo/Heading": {
"title": "$:/language/TiddlerInfo/Advanced/PluginInfo/Heading",
"text": "Plugin Details"
},
"$:/language/TiddlerInfo/Advanced/PluginInfo/Hint": {
"title": "$:/language/TiddlerInfo/Advanced/PluginInfo/Hint",
"text": "This plugin contains the following shadow tiddlers:"
},
"$:/language/TiddlerInfo/Advanced/ShadowInfo/Heading": {
"title": "$:/language/TiddlerInfo/Advanced/ShadowInfo/Heading",
"text": "Shadow Status"
},
"$:/language/TiddlerInfo/Advanced/ShadowInfo/NotShadow/Hint": {
"title": "$:/language/TiddlerInfo/Advanced/ShadowInfo/NotShadow/Hint",
"text": "The tiddler <$link to=<<infoTiddler>>><$text text=<<infoTiddler>>/></$link> is not a shadow tiddler"
},
"$:/language/TiddlerInfo/Advanced/ShadowInfo/Shadow/Hint": {
"title": "$:/language/TiddlerInfo/Advanced/ShadowInfo/Shadow/Hint",
"text": "The tiddler <$link to=<<infoTiddler>>><$text text=<<infoTiddler>>/></$link> is a shadow tiddler"
},
"$:/language/TiddlerInfo/Advanced/ShadowInfo/Shadow/Source": {
"title": "$:/language/TiddlerInfo/Advanced/ShadowInfo/Shadow/Source",
"text": "It is defined in the plugin <$link to=<<pluginTiddler>>><$text text=<<pluginTiddler>>/></$link>"
},
"$:/language/TiddlerInfo/Advanced/ShadowInfo/OverriddenShadow/Hint": {
"title": "$:/language/TiddlerInfo/Advanced/ShadowInfo/OverriddenShadow/Hint",
"text": "It is overridden by an ordinary tiddler"
},
"$:/language/TiddlerInfo/Fields/Caption": {
"title": "$:/language/TiddlerInfo/Fields/Caption",
"text": "Fields"
},
"$:/language/TiddlerInfo/List/Caption": {
"title": "$:/language/TiddlerInfo/List/Caption",
"text": "List"
},
"$:/language/TiddlerInfo/List/Empty": {
"title": "$:/language/TiddlerInfo/List/Empty",
"text": "This tiddler does not have a list"
},
"$:/language/TiddlerInfo/Listed/Caption": {
"title": "$:/language/TiddlerInfo/Listed/Caption",
"text": "Listed"
},
"$:/language/TiddlerInfo/Listed/Empty": {
"title": "$:/language/TiddlerInfo/Listed/Empty",
"text": "This tiddler is not listed by any others"
},
"$:/language/TiddlerInfo/References/Caption": {
"title": "$:/language/TiddlerInfo/References/Caption",
"text": "References"
},
"$:/language/TiddlerInfo/References/Empty": {
"title": "$:/language/TiddlerInfo/References/Empty",
"text": "No tiddlers link to this one"
},
"$:/language/TiddlerInfo/Tagging/Caption": {
"title": "$:/language/TiddlerInfo/Tagging/Caption",
"text": "Tagging"
},
"$:/language/TiddlerInfo/Tagging/Empty": {
"title": "$:/language/TiddlerInfo/Tagging/Empty",
"text": "No tiddlers are tagged with this one"
},
"$:/language/TiddlerInfo/Tools/Caption": {
"title": "$:/language/TiddlerInfo/Tools/Caption",
"text": "Tools"
},
"$:/language/Docs/Types/application/javascript": {
"title": "$:/language/Docs/Types/application/javascript",
"description": "JavaScript code",
"name": "application/javascript",
"group": "Developer",
"group-sort": "2"
},
"$:/language/Docs/Types/application/json": {
"title": "$:/language/Docs/Types/application/json",
"description": "JSON data",
"name": "application/json",
"group": "Developer",
"group-sort": "2"
},
"$:/language/Docs/Types/application/x-tiddler-dictionary": {
"title": "$:/language/Docs/Types/application/x-tiddler-dictionary",
"description": "Data dictionary",
"name": "application/x-tiddler-dictionary",
"group": "Developer",
"group-sort": "2"
},
"$:/language/Docs/Types/image/gif": {
"title": "$:/language/Docs/Types/image/gif",
"description": "GIF image",
"name": "image/gif",
"group": "Image",
"group-sort": "1"
},
"$:/language/Docs/Types/image/jpeg": {
"title": "$:/language/Docs/Types/image/jpeg",
"description": "JPEG image",
"name": "image/jpeg",
"group": "Image",
"group-sort": "1"
},
"$:/language/Docs/Types/image/png": {
"title": "$:/language/Docs/Types/image/png",
"description": "PNG image",
"name": "image/png",
"group": "Image",
"group-sort": "1"
},
"$:/language/Docs/Types/image/svg+xml": {
"title": "$:/language/Docs/Types/image/svg+xml",
"description": "Structured Vector Graphics image",
"name": "image/svg+xml",
"group": "Image",
"group-sort": "1"
},
"$:/language/Docs/Types/image/x-icon": {
"title": "$:/language/Docs/Types/image/x-icon",
"description": "ICO format icon file",
"name": "image/x-icon",
"group": "Image",
"group-sort": "1"
},
"$:/language/Docs/Types/text/css": {
"title": "$:/language/Docs/Types/text/css",
"description": "Static stylesheet",
"name": "text/css",
"group": "Developer",
"group-sort": "2"
},
"$:/language/Docs/Types/text/html": {
"title": "$:/language/Docs/Types/text/html",
"description": "HTML markup",
"name": "text/html",
"group": "Text",
"group-sort": "0"
},
"$:/language/Docs/Types/text/plain": {
"title": "$:/language/Docs/Types/text/plain",
"description": "Plain text",
"name": "text/plain",
"group": "Text",
"group-sort": "0"
},
"$:/language/Docs/Types/text/vnd.tiddlywiki": {
"title": "$:/language/Docs/Types/text/vnd.tiddlywiki",
"description": "TiddlyWiki 5",
"name": "text/vnd.tiddlywiki",
"group": "Text",
"group-sort": "0"
},
"$:/language/Docs/Types/text/x-tiddlywiki": {
"title": "$:/language/Docs/Types/text/x-tiddlywiki",
"description": "TiddlyWiki Classic",
"name": "text/x-tiddlywiki",
"group": "Text",
"group-sort": "0"
},
"$:/languages/en-GB/icon": {
"title": "$:/languages/en-GB/icon",
"type": "image/svg+xml",
"text": "<svg xmlns=\"http://www.w3.org/2000/svg\" viewBox=\"0 0 60 30\" width=\"1200\" height=\"600\">\n<clipPath id=\"t\">\n\t<path d=\"M30,15 h30 v15 z v15 h-30 z h-30 v-15 z v-15 h30 z\"/>\n</clipPath>\n<path d=\"M0,0 v30 h60 v-30 z\" fill=\"#00247d\"/>\n<path d=\"M0,0 L60,30 M60,0 L0,30\" stroke=\"#fff\" stroke-width=\"6\"/>\n<path d=\"M0,0 L60,30 M60,0 L0,30\" clip-path=\"url(#t)\" stroke=\"#cf142b\" stroke-width=\"4\"/>\n<path d=\"M30,0 v30 M0,15 h60\" stroke=\"#fff\" stroke-width=\"10\"/>\n<path d=\"M30,0 v30 M0,15 h60\" stroke=\"#cf142b\" stroke-width=\"6\"/>\n</svg>\n"
},
"$:/languages/en-GB": {
"title": "$:/languages/en-GB",
"name": "en-GB",
"description": "English (British)",
"author": "JeremyRuston",
"core-version": ">=5.0.0\"",
"text": "Stub pseudo-plugin for the default language"
},
"$:/core/modules/commander.js": {
"title": "$:/core/modules/commander.js",
"text": "/*\\\ntitle: $:/core/modules/commander.js\ntype: application/javascript\nmodule-type: global\n\nThe $tw.Commander class is a command interpreter\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nParse a sequence of commands\n\tcommandTokens: an array of command string tokens\n\twiki: reference to the wiki store object\n\tstreams: {output:, error:}, each of which has a write(string) method\n\tcallback: a callback invoked as callback(err) where err is null if there was no error\n*/\nvar Commander = function(commandTokens,callback,wiki,streams) {\n\tvar path = require(\"path\");\n\tthis.commandTokens = commandTokens;\n\tthis.nextToken = 0;\n\tthis.callback = callback;\n\tthis.wiki = wiki;\n\tthis.streams = streams;\n\tthis.outputPath = path.resolve($tw.boot.wikiPath,$tw.config.wikiOutputSubDir);\n};\n\n/*\nLog a string if verbose flag is set\n*/\nCommander.prototype.log = function(str) {\n\tif(this.verbose) {\n\t\tthis.streams.output.write(str + \"\\n\");\n\t}\n};\n\n/*\nWrite a string if verbose flag is set\n*/\nCommander.prototype.write = function(str) {\n\tif(this.verbose) {\n\t\tthis.streams.output.write(str);\n\t}\n};\n\n/*\nAdd a string of tokens to the command queue\n*/\nCommander.prototype.addCommandTokens = function(commandTokens) {\n\tvar params = commandTokens.slice(0);\n\tparams.unshift(0);\n\tparams.unshift(this.nextToken);\n\tArray.prototype.splice.apply(this.commandTokens,params);\n};\n\n/*\nExecute the sequence of commands and invoke a callback on completion\n*/\nCommander.prototype.execute = function() {\n\tthis.executeNextCommand();\n};\n\n/*\nExecute the next command in the sequence\n*/\nCommander.prototype.executeNextCommand = function() {\n\tvar self = this;\n\t// Invoke the callback if there are no more commands\n\tif(this.nextToken >= this.commandTokens.length) {\n\t\tthis.callback(null);\n\t} else {\n\t\t// Get and check the command token\n\t\tvar commandName = this.commandTokens[this.nextToken++];\n\t\tif(commandName.substr(0,2) !== \"--\") {\n\t\t\tthis.callback(\"Missing command: \" + commandName);\n\t\t} else {\n\t\t\tcommandName = commandName.substr(2); // Trim off the --\n\t\t\t// Accumulate the parameters to the command\n\t\t\tvar params = [];\n\t\t\twhile(this.nextToken < this.commandTokens.length && \n\t\t\t\tthis.commandTokens[this.nextToken].substr(0,2) !== \"--\") {\n\t\t\t\tparams.push(this.commandTokens[this.nextToken++]);\n\t\t\t}\n\t\t\t// Get the command info\n\t\t\tvar command = $tw.commands[commandName],\n\t\t\t\tc,err;\n\t\t\tif(!command) {\n\t\t\t\tthis.callback(\"Unknown command: \" + commandName);\n\t\t\t} else {\n\t\t\t\tif(this.verbose) {\n\t\t\t\t\tthis.streams.output.write(\"Executing command: \" + commandName + \" \" + params.join(\" \") + \"\\n\");\n\t\t\t\t}\n\t\t\t\t// Parse named parameters if required\n\t\t\t\tif(command.info.namedParameterMode) {\n\t\t\t\t\tparams = this.extractNamedParameters(params,command.info.mandatoryParameters);\n\t\t\t\t\tif(typeof params === \"string\") {\n\t\t\t\t\t\treturn this.callback(params);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\tif(command.info.synchronous) {\n\t\t\t\t\t// Synchronous command\n\t\t\t\t\tc = new command.Command(params,this);\n\t\t\t\t\terr = c.execute();\n\t\t\t\t\tif(err) {\n\t\t\t\t\t\tthis.callback(err);\n\t\t\t\t\t} else {\n\t\t\t\t\t\tthis.executeNextCommand();\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\t// Asynchronous command\n\t\t\t\t\tc = new command.Command(params,this,function(err) {\n\t\t\t\t\t\tif(err) {\n\t\t\t\t\t\t\tself.callback(err);\n\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\tself.executeNextCommand();\n\t\t\t\t\t\t}\n\t\t\t\t\t});\n\t\t\t\t\terr = c.execute();\n\t\t\t\t\tif(err) {\n\t\t\t\t\t\tthis.callback(err);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t}\n};\n\n/*\nGiven an array of parameter strings `params` in name:value format, and an array of mandatory parameter names in `mandatoryParameters`, returns a hashmap of values or a string if error\n*/\nCommander.prototype.extractNamedParameters = function(params,mandatoryParameters) {\n\tmandatoryParameters = mandatoryParameters || [];\n\tvar errors = [],\n\t\tparamsByName = Object.create(null);\n\t// Extract the parameters\n\t$tw.utils.each(params,function(param) {\n\t\tvar index = param.indexOf(\"=\");\n\t\tif(index < 1) {\n\t\t\terrors.push(\"malformed named parameter: '\" + param + \"'\");\n\t\t}\n\t\tparamsByName[param.slice(0,index)] = $tw.utils.trim(param.slice(index+1));\n\t});\n\t// Check the mandatory parameters are present\n\t$tw.utils.each(mandatoryParameters,function(mandatoryParameter) {\n\t\tif(!$tw.utils.hop(paramsByName,mandatoryParameter)) {\n\t\t\terrors.push(\"missing mandatory parameter: '\" + mandatoryParameter + \"'\");\n\t\t}\n\t});\n\t// Return any errors\n\tif(errors.length > 0) {\n\t\treturn errors.join(\" and\\n\");\n\t} else {\n\t\treturn paramsByName;\t\t\n\t}\n};\n\nCommander.initCommands = function(moduleType) {\n\tmoduleType = moduleType || \"command\";\n\t$tw.commands = {};\n\t$tw.modules.forEachModuleOfType(moduleType,function(title,module) {\n\t\tvar c = $tw.commands[module.info.name] = {};\n\t\t// Add the methods defined by the module\n\t\tfor(var f in module) {\n\t\t\tif($tw.utils.hop(module,f)) {\n\t\t\t\tc[f] = module[f];\n\t\t\t}\n\t\t}\n\t});\n};\n\nexports.Commander = Commander;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/commands/build.js": {
"title": "$:/core/modules/commands/build.js",
"text": "/*\\\ntitle: $:/core/modules/commands/build.js\ntype: application/javascript\nmodule-type: command\n\nCommand to build a build target\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"build\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\t// Get the build targets defined in the wiki\n\tvar buildTargets = $tw.boot.wikiInfo.build;\n\tif(!buildTargets) {\n\t\treturn \"No build targets defined\";\n\t}\n\t// Loop through each of the specified targets\n\tvar targets;\n\tif(this.params.length > 0) {\n\t\ttargets = this.params;\n\t} else {\n\t\ttargets = Object.keys(buildTargets);\n\t}\n\tfor(var targetIndex=0; targetIndex<targets.length; targetIndex++) {\n\t\tvar target = targets[targetIndex],\n\t\t\tcommands = buildTargets[target];\n\t\tif(!commands) {\n\t\t\treturn \"Build target '\" + target + \"' not found\";\n\t\t}\n\t\t// Add the commands to the queue\n\t\tthis.commander.addCommandTokens(commands);\n\t}\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/clearpassword.js": {
"title": "$:/core/modules/commands/clearpassword.js",
"text": "/*\\\ntitle: $:/core/modules/commands/clearpassword.js\ntype: application/javascript\nmodule-type: command\n\nClear password for crypto operations\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"clearpassword\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\t$tw.crypto.setPassword(null);\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/deletetiddlers.js": {
"title": "$:/core/modules/commands/deletetiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/commands/deletetiddlers.js\ntype: application/javascript\nmodule-type: command\n\nCommand to delete tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"deletetiddlers\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing filter\";\n\t}\n\tvar self = this,\n\t\twiki = this.commander.wiki,\n\t\tfilter = this.params[0],\n\t\ttiddlers = wiki.filterTiddlers(filter);\n\t$tw.utils.each(tiddlers,function(title) {\n\t\twiki.deleteTiddler(title);\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/editions.js": {
"title": "$:/core/modules/commands/editions.js",
"text": "/*\\\ntitle: $:/core/modules/commands/editions.js\ntype: application/javascript\nmodule-type: command\n\nCommand to list the available editions\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"editions\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\tvar self = this;\n\t// Output the list\n\tthis.commander.streams.output.write(\"Available editions:\\n\\n\");\n\tvar editionInfo = $tw.utils.getEditionInfo();\n\t$tw.utils.each(editionInfo,function(info,name) {\n\t\tself.commander.streams.output.write(\" \" + name + \": \" + info.description + \"\\n\");\n\t});\n\tthis.commander.streams.output.write(\"\\n\");\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/fetch.js": {
"title": "$:/core/modules/commands/fetch.js",
"text": "/*\\\ntitle: $:/core/modules/commands/fetch.js\ntype: application/javascript\nmodule-type: command\n\nCommands to fetch external tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"fetch\",\n\tsynchronous: false\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 2) {\n\t\treturn \"Missing subcommand and url\";\n\t}\n\tswitch(this.params[0]) {\n\t\tcase \"raw-file\":\n\t\t\treturn this.fetchFiles({\n\t\t\t\traw: true,\n\t\t\t\turl: this.params[1],\n\t\t\t\ttransformFilter: this.params[2] || \"\",\n\t\t\t\tcallback: this.callback\n\t\t\t});\n\t\t\tbreak;\n\t\tcase \"file\":\n\t\t\treturn this.fetchFiles({\n\t\t\t\turl: this.params[1],\n\t\t\t\timportFilter: this.params[2],\n\t\t\t\ttransformFilter: this.params[3] || \"\",\n\t\t\t\tcallback: this.callback\n\t\t\t});\n\t\t\tbreak;\n\t\tcase \"raw-files\":\n\t\t\treturn this.fetchFiles({\n\t\t\t\traw: true,\n\t\t\t\turlFilter: this.params[1],\n\t\t\t\ttransformFilter: this.params[2] || \"\",\n\t\t\t\tcallback: this.callback\n\t\t\t});\n\t\t\tbreak;\n\t\tcase \"files\":\n\t\t\treturn this.fetchFiles({\n\t\t\t\turlFilter: this.params[1],\n\t\t\t\timportFilter: this.params[2],\n\t\t\t\ttransformFilter: this.params[3] || \"\",\n\t\t\t\tcallback: this.callback\n\t\t\t});\n\t\t\tbreak;\n\t}\n\treturn null;\n};\n\nCommand.prototype.fetchFiles = function(options) {\n\tvar self = this;\n\t// Get the list of URLs\n\tvar urls;\n\tif(options.url) {\n\t\turls = [options.url]\n\t} else if(options.urlFilter) {\n\t\turls = $tw.wiki.filterTiddlers(options.urlFilter);\n\t} else {\n\t\treturn \"Missing URL\";\n\t}\n\t// Process each URL in turn\n\tvar next = 0;\n\tvar getNextFile = function(err) {\n\t\tif(err) {\n\t\t\treturn options.callback(err);\n\t\t}\n\t\tif(next < urls.length) {\n\t\t\tself.fetchFile(urls[next++],options,getNextFile);\n\t\t} else {\n\t\t\toptions.callback(null);\n\t\t}\n\t};\n\tgetNextFile(null);\n\t// Success\n\treturn null;\n};\n\nCommand.prototype.fetchFile = function(url,options,callback,redirectCount) {\n\tif(redirectCount > 10) {\n\t\treturn callback(\"Error too many redirects retrieving \" + url);\n\t}\n\tvar self = this,\n\t\tlib = url.substr(0,8) === \"https://\" ? require(\"https\") : require(\"http\");\n\tlib.get(url).on(\"response\",function(response) {\n\t var type = (response.headers[\"content-type\"] || \"\").split(\";\")[0],\n\t \tdata = [];\n\t self.commander.write(\"Reading \" + url + \": \");\n\t response.on(\"data\",function(chunk) {\n\t data.push(chunk);\n\t self.commander.write(\".\");\n\t });\n\t response.on(\"end\",function() {\n\t self.commander.write(\"\\n\");\n\t if(response.statusCode === 200) {\n\t\t self.processBody(Buffer.concat(data),type,options,url);\n\t\t callback(null);\n\t } else {\n\t \tif(response.statusCode === 302 || response.statusCode === 303 || response.statusCode === 307) {\n\t \t\treturn self.fetchFile(response.headers.location,options,callback,redirectCount + 1);\n\t \t} else {\n\t\t \treturn callback(\"Error \" + response.statusCode + \" retrieving \" + url)\t \t\t\n\t \t}\n\t }\n\t \t});\n\t \tresponse.on(\"error\",function(e) {\n\t\t\tconsole.log(\"Error on GET request: \" + e);\n\t\t\tcallback(e);\n\t \t});\n\t});\n\treturn null;\n};\n\nCommand.prototype.processBody = function(body,type,options,url) {\n\tvar self = this;\n\t// Collect the tiddlers in a wiki\n\tvar incomingWiki = new $tw.Wiki();\n\tif(options.raw) {\n\t\tvar typeInfo = type ? $tw.config.contentTypeInfo[type] : null,\n\t\t\tencoding = typeInfo ? typeInfo.encoding : \"utf8\";\n\t\tincomingWiki.addTiddler(new $tw.Tiddler({\n\t\t\ttitle: url,\n\t\t\ttype: type,\n\t\t\ttext: body.toString(encoding)\n\t\t}));\n\t} else {\n\t\t// Deserialise the file to extract the tiddlers\n\t\tvar tiddlers = this.commander.wiki.deserializeTiddlers(type || \"text/html\",body.toString(\"utf8\"),{});\n\t\t$tw.utils.each(tiddlers,function(tiddler) {\n\t\t\tincomingWiki.addTiddler(new $tw.Tiddler(tiddler));\n\t\t});\n\t}\n\t// Filter the tiddlers to select the ones we want\n\tvar filteredTitles = incomingWiki.filterTiddlers(options.importFilter || \"[all[tiddlers]]\");\n\t// Import the selected tiddlers\n\tvar count = 0;\n\tincomingWiki.each(function(tiddler,title) {\n\t\tif(filteredTitles.indexOf(title) !== -1) {\n\t\t\tvar newTiddler;\n\t\t\tif(options.transformFilter) {\n\t\t\t\tvar transformedTitle = (incomingWiki.filterTiddlers(options.transformFilter,null,self.commander.wiki.makeTiddlerIterator([title])) || [\"\"])[0];\n\t\t\t\tif(transformedTitle) {\n\t\t\t\t\tself.commander.log(\"Importing \" + title + \" as \" + transformedTitle)\n\t\t\t\t\tnewTiddler = new $tw.Tiddler(tiddler,{title: transformedTitle});\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\tself.commander.log(\"Importing \" + title)\n\t\t\t\tnewTiddler = tiddler;\n\t\t\t}\n\t\t\tself.commander.wiki.importTiddler(newTiddler);\n\t\t\tcount++;\n\t\t}\n\t});\n\tself.commander.log(\"Imported \" + count + \" tiddlers\")\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/help.js": {
"title": "$:/core/modules/commands/help.js",
"text": "/*\\\ntitle: $:/core/modules/commands/help.js\ntype: application/javascript\nmodule-type: command\n\nHelp command\n\n\\*/\n(function(){\n\n/*jshint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"help\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\tvar subhelp = this.params[0] || \"default\",\n\t\thelpBase = \"$:/language/Help/\",\n\t\ttext;\n\tif(!this.commander.wiki.getTiddler(helpBase + subhelp)) {\n\t\tsubhelp = \"notfound\";\n\t}\n\t// Wikify the help as formatted text (ie block elements generate newlines)\n\ttext = this.commander.wiki.renderTiddler(\"text/plain-formatted\",helpBase + subhelp);\n\t// Remove any leading linebreaks\n\ttext = text.replace(/^(\\r?\\n)*/g,\"\");\n\tthis.commander.streams.output.write(text);\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/import.js": {
"title": "$:/core/modules/commands/import.js",
"text": "/*\\\ntitle: $:/core/modules/commands/import.js\ntype: application/javascript\nmodule-type: command\n\nCommand to import tiddlers from a file\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"import\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\");\n\tif(this.params.length < 2) {\n\t\treturn \"Missing parameters\";\n\t}\n\tvar filename = self.params[0],\n\t\tdeserializer = self.params[1],\n\t\ttitle = self.params[2] || filename,\n\t\tencoding = self.params[3] || \"utf8\",\n\t\ttext = fs.readFileSync(filename,encoding),\n\t\ttiddlers = this.commander.wiki.deserializeTiddlers(null,text,{title: title},{deserializer: deserializer});\n\t$tw.utils.each(tiddlers,function(tiddler) {\n\t\tself.commander.wiki.importTiddler(new $tw.Tiddler(tiddler));\n\t});\n\tthis.commander.log(tiddlers.length + \" tiddler(s) imported\");\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/init.js": {
"title": "$:/core/modules/commands/init.js",
"text": "/*\\\ntitle: $:/core/modules/commands/init.js\ntype: application/javascript\nmodule-type: command\n\nCommand to initialise an empty wiki folder\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"init\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\tvar fs = require(\"fs\"),\n\t\tpath = require(\"path\");\n\t// Check that we don't already have a valid wiki folder\n\tif($tw.boot.wikiTiddlersPath || ($tw.utils.isDirectory($tw.boot.wikiPath) && !$tw.utils.isDirectoryEmpty($tw.boot.wikiPath))) {\n\t\treturn \"Wiki folder is not empty\";\n\t}\n\t// Loop through each of the specified editions\n\tvar editions = this.params.length > 0 ? this.params : [\"empty\"];\n\tfor(var editionIndex=0; editionIndex<editions.length; editionIndex++) {\n\t\tvar editionName = editions[editionIndex];\n\t\t// Check the edition exists\n\t\tvar editionPath = $tw.findLibraryItem(editionName,$tw.getLibraryItemSearchPaths($tw.config.editionsPath,$tw.config.editionsEnvVar));\n\t\tif(!$tw.utils.isDirectory(editionPath)) {\n\t\t\treturn \"Edition '\" + editionName + \"' not found\";\n\t\t}\n\t\t// Copy the edition content\n\t\tvar err = $tw.utils.copyDirectory(editionPath,$tw.boot.wikiPath);\n\t\tif(!err) {\n\t\t\tthis.commander.streams.output.write(\"Copied edition '\" + editionName + \"' to \" + $tw.boot.wikiPath + \"\\n\");\n\t\t} else {\n\t\t\treturn err;\n\t\t}\n\t}\n\t// Tweak the tiddlywiki.info to remove any included wikis\n\tvar packagePath = $tw.boot.wikiPath + \"/tiddlywiki.info\",\n\t\tpackageJson = JSON.parse(fs.readFileSync(packagePath));\n\tdelete packageJson.includeWikis;\n\tfs.writeFileSync(packagePath,JSON.stringify(packageJson,null,$tw.config.preferences.jsonSpaces));\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/listen.js": {
"title": "$:/core/modules/commands/listen.js",
"text": "/*\\\ntitle: $:/core/modules/commands/listen.js\ntype: application/javascript\nmodule-type: command\n\nListen for HTTP requests and serve tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Server = require(\"$:/core/modules/server/server.js\").Server;\n\nexports.info = {\n\tname: \"listen\",\n\tsynchronous: true,\n\tnamedParameterMode: true,\n\tmandatoryParameters: [],\n};\n\nvar Command = function(params,commander,callback) {\n\tvar self = this;\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tvar self = this;\n\tif(!$tw.boot.wikiTiddlersPath) {\n\t\t$tw.utils.warning(\"Warning: Wiki folder '\" + $tw.boot.wikiPath + \"' does not exist or is missing a tiddlywiki.info file\");\n\t}\n\t// Set up server\n\tthis.server = new Server({\n\t\twiki: this.commander.wiki,\n\t\tvariables: self.params\n\t});\n\tvar nodeServer = this.server.listen();\n\t$tw.hooks.invokeHook(\"th-server-command-post-start\",this.server,nodeServer,\"tiddlywiki\");\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/load.js": {
"title": "$:/core/modules/commands/load.js",
"text": "/*\\\ntitle: $:/core/modules/commands/load.js\ntype: application/javascript\nmodule-type: command\n\nCommand to load tiddlers from a file or directory\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"load\",\n\tsynchronous: false\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\");\n\tif(this.params.length < 1) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar tiddlers = $tw.loadTiddlersFromPath(self.params[0]),\n\t\tcount = 0;\n\t$tw.utils.each(tiddlers,function(tiddlerInfo) {\n\t\t$tw.utils.each(tiddlerInfo.tiddlers,function(tiddler) {\n\t\t\tself.commander.wiki.importTiddler(new $tw.Tiddler(tiddler));\n\t\t\tcount++;\n\t\t});\n\t});\n\tif(!count && self.params[1] !== \"noerror\") {\n\t\tself.callback(\"No tiddlers found in file \\\"\" + self.params[0] + \"\\\"\");\n\t} else {\n\t\tself.callback(null);\n\t}\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/makelibrary.js": {
"title": "$:/core/modules/commands/makelibrary.js",
"text": "/*\\\ntitle: $:/core/modules/commands/makelibrary.js\ntype: application/javascript\nmodule-type: command\n\nCommand to pack all of the plugins in the library into a plugin tiddler of type \"library\"\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"makelibrary\",\n\tsynchronous: true\n};\n\nvar UPGRADE_LIBRARY_TITLE = \"$:/UpgradeLibrary\";\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tvar wiki = this.commander.wiki,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\tupgradeLibraryTitle = this.params[0] || UPGRADE_LIBRARY_TITLE,\n\t\ttiddlers = {};\n\t// Collect up the library plugins\n\tvar collectPlugins = function(folder) {\n\t\t\tvar pluginFolders = fs.readdirSync(folder);\n\t\t\tfor(var p=0; p<pluginFolders.length; p++) {\n\t\t\t\tif(!$tw.boot.excludeRegExp.test(pluginFolders[p])) {\n\t\t\t\t\tpluginFields = $tw.loadPluginFolder(path.resolve(folder,\"./\" + pluginFolders[p]));\n\t\t\t\t\tif(pluginFields && pluginFields.title) {\n\t\t\t\t\t\ttiddlers[pluginFields.title] = pluginFields;\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t},\n\t\tcollectPublisherPlugins = function(folder) {\n\t\t\tvar publisherFolders = fs.readdirSync(folder);\n\t\t\tfor(var t=0; t<publisherFolders.length; t++) {\n\t\t\t\tif(!$tw.boot.excludeRegExp.test(publisherFolders[t])) {\n\t\t\t\t\tcollectPlugins(path.resolve(folder,\"./\" + publisherFolders[t]));\n\t\t\t\t}\n\t\t\t}\n\t\t};\n\t$tw.utils.each($tw.getLibraryItemSearchPaths($tw.config.pluginsPath,$tw.config.pluginsEnvVar),collectPublisherPlugins);\n\t$tw.utils.each($tw.getLibraryItemSearchPaths($tw.config.themesPath,$tw.config.themesEnvVar),collectPublisherPlugins);\n\t$tw.utils.each($tw.getLibraryItemSearchPaths($tw.config.languagesPath,$tw.config.languagesEnvVar),collectPlugins);\n\t// Save the upgrade library tiddler\n\tvar pluginFields = {\n\t\ttitle: upgradeLibraryTitle,\n\t\ttype: \"application/json\",\n\t\t\"plugin-type\": \"library\",\n\t\t\"text\": JSON.stringify({tiddlers: tiddlers})\n\t};\n\twiki.addTiddler(new $tw.Tiddler(pluginFields));\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/output.js": {
"title": "$:/core/modules/commands/output.js",
"text": "/*\\\ntitle: $:/core/modules/commands/output.js\ntype: application/javascript\nmodule-type: command\n\nCommand to set the default output location (defaults to current working directory)\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"output\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tvar fs = require(\"fs\"),\n\t\tpath = require(\"path\");\n\tif(this.params.length < 1) {\n\t\treturn \"Missing output path\";\n\t}\n\tthis.commander.outputPath = path.resolve(process.cwd(),this.params[0]);\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/password.js": {
"title": "$:/core/modules/commands/password.js",
"text": "/*\\\ntitle: $:/core/modules/commands/password.js\ntype: application/javascript\nmodule-type: command\n\nSave password for crypto operations\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"password\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing password\";\n\t}\n\t$tw.crypto.setPassword(this.params[0]);\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/render.js": {
"title": "$:/core/modules/commands/render.js",
"text": "/*\\\ntitle: $:/core/modules/commands/render.js\ntype: application/javascript\nmodule-type: command\n\nRender individual tiddlers and save the results to the specified files\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.info = {\n\tname: \"render\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing tiddler filter\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\twiki = this.commander.wiki,\n\t\ttiddlerFilter = this.params[0],\n\t\tfilenameFilter = this.params[1] || \"[is[tiddler]addsuffix[.html]]\",\n\t\ttype = this.params[2] || \"text/html\",\n\t\ttemplate = this.params[3],\n\t\tvarName = this.params[4],\n\t\tvarValue = this.params[5],\n\t\ttiddlers = wiki.filterTiddlers(tiddlerFilter);\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar parser = wiki.parseTiddler(template || title),\n\t\t\tvariables = {currentTiddler: title};\n\t\tif(varName) {\n\t\t\tvariables[varName] = varValue || \"\";\n\t\t}\n\t\tvar widgetNode = wiki.makeWidget(parser,{variables: variables}),\n\t\t\tcontainer = $tw.fakeDocument.createElement(\"div\");\n\t\twidgetNode.render(container,null);\n\t\tvar text = type === \"text/html\" ? container.innerHTML : container.textContent,\n\t\t\tfilepath = path.resolve(self.commander.outputPath,wiki.filterTiddlers(filenameFilter,$tw.rootWidget,wiki.makeTiddlerIterator([title]))[0]);\n\t\tif(self.commander.verbose) {\n\t\t\tconsole.log(\"Rendering \\\"\" + title + \"\\\" to \\\"\" + filepath + \"\\\"\");\n\t\t}\n\t\t$tw.utils.createFileDirectories(filepath);\n\t\tfs.writeFileSync(filepath,text,\"utf8\");\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/rendertiddler.js": {
"title": "$:/core/modules/commands/rendertiddler.js",
"text": "/*\\\ntitle: $:/core/modules/commands/rendertiddler.js\ntype: application/javascript\nmodule-type: command\n\nCommand to render a tiddler and save it to a file\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"rendertiddler\",\n\tsynchronous: false\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 2) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\ttitle = this.params[0],\n\t\tfilename = path.resolve(this.commander.outputPath,this.params[1]),\n\t\ttype = this.params[2] || \"text/html\",\n\t\ttemplate = this.params[3],\n\t\tname = this.params[4],\n\t\tvalue = this.params[5],\n\t\tvariables = {};\n\t$tw.utils.createFileDirectories(filename);\n\tif(template) {\n\t\tvariables.currentTiddler = title;\n\t\ttitle = template;\n\t}\n\tif(name && value) {\n\t\tvariables[name] = value;\n\t}\n\tfs.writeFile(filename,this.commander.wiki.renderTiddler(type,title,{variables: variables}),\"utf8\",function(err) {\n\t\tself.callback(err);\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/rendertiddlers.js": {
"title": "$:/core/modules/commands/rendertiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/commands/rendertiddlers.js\ntype: application/javascript\nmodule-type: command\n\nCommand to render several tiddlers to a folder of files\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.info = {\n\tname: \"rendertiddlers\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 2) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\twiki = this.commander.wiki,\n\t\tfilter = this.params[0],\n\t\ttemplate = this.params[1],\n\t\toutputPath = this.commander.outputPath,\n\t\tpathname = path.resolve(outputPath,this.params[2]),\t\t\n\t\ttype = this.params[3] || \"text/html\",\n\t\textension = this.params[4] || \".html\",\n\t\tdeleteDirectory = (this.params[5] || \"\").toLowerCase() !== \"noclean\",\n\t\ttiddlers = wiki.filterTiddlers(filter);\n\tif(deleteDirectory) {\n\t\t$tw.utils.deleteDirectory(pathname);\n\t}\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar parser = wiki.parseTiddler(template),\n\t\t\twidgetNode = wiki.makeWidget(parser,{variables: {currentTiddler: title}}),\n\t\t\tcontainer = $tw.fakeDocument.createElement(\"div\");\n\t\twidgetNode.render(container,null);\n\t\tvar text = type === \"text/html\" ? container.innerHTML : container.textContent,\n\t\t\texportPath = null;\n\t\tif($tw.utils.hop($tw.macros,\"tv-get-export-path\")) {\n\t\t\tvar macroPath = $tw.macros[\"tv-get-export-path\"].run.apply(self,[title]);\n\t\t\tif(macroPath) {\n\t\t\t\texportPath = path.resolve(outputPath,macroPath + extension);\n\t\t\t}\n\t\t}\n\t\tvar finalPath = exportPath || path.resolve(pathname,encodeURIComponent(title) + extension);\n\t\t$tw.utils.createFileDirectories(finalPath);\n\t\tfs.writeFileSync(finalPath,text,\"utf8\");\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/save.js": {
"title": "$:/core/modules/commands/save.js",
"text": "/*\\\ntitle: $:/core/modules/commands/save.js\ntype: application/javascript\nmodule-type: command\n\nSaves individual tiddlers in their raw text or binary format to the specified files\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"save\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing filename filter\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\twiki = this.commander.wiki,\n\t\ttiddlerFilter = this.params[0],\n\t\tfilenameFilter = this.params[1] || \"[is[tiddler]]\",\n\t\ttiddlers = wiki.filterTiddlers(tiddlerFilter);\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar tiddler = self.commander.wiki.getTiddler(title),\n\t\t\ttype = tiddler.fields.type || \"text/vnd.tiddlywiki\",\n\t\t\tcontentTypeInfo = $tw.config.contentTypeInfo[type] || {encoding: \"utf8\"},\n\t\t\tfilepath = path.resolve(self.commander.outputPath,wiki.filterTiddlers(filenameFilter,$tw.rootWidget,wiki.makeTiddlerIterator([title]))[0]);\n\t\tif(self.commander.verbose) {\n\t\t\tconsole.log(\"Saving \\\"\" + title + \"\\\" to \\\"\" + filepath + \"\\\"\");\n\t\t}\n\t\t$tw.utils.createFileDirectories(filepath);\n\t\tfs.writeFileSync(filepath,tiddler.fields.text,contentTypeInfo.encoding);\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/savelibrarytiddlers.js": {
"title": "$:/core/modules/commands/savelibrarytiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/commands/savelibrarytiddlers.js\ntype: application/javascript\nmodule-type: command\n\nCommand to save the subtiddlers of a bundle tiddler as a series of JSON files\n\n--savelibrarytiddlers <tiddler> <pathname> <skinnylisting>\n\nThe tiddler identifies the bundle tiddler that contains the subtiddlers.\n\nThe pathname specifies the pathname to the folder in which the JSON files should be saved. The filename is the URL encoded title of the subtiddler.\n\nThe skinnylisting specifies the title of the tiddler to which a JSON catalogue of the subtiddlers will be saved. The JSON file contains the same data as the bundle tiddler but with the `text` field removed.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"savelibrarytiddlers\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 2) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\tcontainerTitle = this.params[0],\n\t\tfilter = this.params[1],\n\t\tbasepath = this.params[2],\n\t\tskinnyListTitle = this.params[3];\n\t// Get the container tiddler as data\n\tvar containerData = self.commander.wiki.getTiddlerDataCached(containerTitle,undefined);\n\tif(!containerData) {\n\t\treturn \"'\" + containerTitle + \"' is not a tiddler bundle\";\n\t}\n\t// Filter the list of plugins\n\tvar pluginList = [];\n\t$tw.utils.each(containerData.tiddlers,function(tiddler,title) {\n\t\tpluginList.push(title);\n\t});\n\tvar filteredPluginList;\n\tif(filter) {\n\t\tfilteredPluginList = self.commander.wiki.filterTiddlers(filter,null,self.commander.wiki.makeTiddlerIterator(pluginList));\n\t} else {\n\t\tfilteredPluginList = pluginList;\n\t}\n\t// Iterate through the plugins\n\tvar skinnyList = [];\n\t$tw.utils.each(filteredPluginList,function(title) {\n\t\tvar tiddler = containerData.tiddlers[title];\n\t\t// Save each JSON file and collect the skinny data\n\t\tvar pathname = path.resolve(self.commander.outputPath,basepath + encodeURIComponent(title) + \".json\");\n\t\t$tw.utils.createFileDirectories(pathname);\n\t\tfs.writeFileSync(pathname,JSON.stringify(tiddler),\"utf8\");\n\t\t// Collect the skinny list data\n\t\tvar pluginTiddlers = JSON.parse(tiddler.text),\n\t\t\treadmeContent = (pluginTiddlers.tiddlers[title + \"/readme\"] || {}).text,\n\t\t\tdoesRequireReload = !!$tw.wiki.doesPluginInfoRequireReload(pluginTiddlers),\n\t\t\ticonTiddler = pluginTiddlers.tiddlers[title + \"/icon\"] || {},\n\t\t\ticonType = iconTiddler.type,\n\t\t\ticonText = iconTiddler.text,\n\t\t\ticonContent;\n\t\tif(iconType && iconText) {\n\t\t\ticonContent = $tw.utils.makeDataUri(iconText,iconType);\n\t\t}\n\t\tskinnyList.push($tw.utils.extend({},tiddler,{\n\t\t\ttext: undefined,\n\t\t\treadme: readmeContent,\n\t\t\t\"requires-reload\": doesRequireReload ? \"yes\" : \"no\",\n\t\t\ticon: iconContent\n\t\t}));\n\t});\n\t// Save the catalogue tiddler\n\tif(skinnyListTitle) {\n\t\tself.commander.wiki.setTiddlerData(skinnyListTitle,skinnyList);\n\t}\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/savetiddler.js": {
"title": "$:/core/modules/commands/savetiddler.js",
"text": "/*\\\ntitle: $:/core/modules/commands/savetiddler.js\ntype: application/javascript\nmodule-type: command\n\nCommand to save the content of a tiddler to a file\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"savetiddler\",\n\tsynchronous: false\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 2) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\ttitle = this.params[0],\n\t\tfilename = path.resolve(this.commander.outputPath,this.params[1]),\n\t\ttiddler = this.commander.wiki.getTiddler(title);\n\tif(tiddler) {\n\t\tvar type = tiddler.fields.type || \"text/vnd.tiddlywiki\",\n\t\t\tcontentTypeInfo = $tw.config.contentTypeInfo[type] || {encoding: \"utf8\"};\n\t\t$tw.utils.createFileDirectories(filename);\n\t\tfs.writeFile(filename,tiddler.fields.text,contentTypeInfo.encoding,function(err) {\n\t\t\tself.callback(err);\n\t\t});\n\t} else {\n\t\treturn \"Missing tiddler: \" + title;\n\t}\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/savetiddlers.js": {
"title": "$:/core/modules/commands/savetiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/commands/savetiddlers.js\ntype: application/javascript\nmodule-type: command\n\nCommand to save several tiddlers to a folder of files\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.info = {\n\tname: \"savetiddlers\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing filename\";\n\t}\n\tvar self = this,\n\t\tfs = require(\"fs\"),\n\t\tpath = require(\"path\"),\n\t\twiki = this.commander.wiki,\n\t\tfilter = this.params[0],\n\t\tpathname = path.resolve(this.commander.outputPath,this.params[1]),\n\t\tdeleteDirectory = (this.params[2] || \"\").toLowerCase() !== \"noclean\",\n\t\ttiddlers = wiki.filterTiddlers(filter);\n\tif(deleteDirectory) {\n\t\t$tw.utils.deleteDirectory(pathname);\n\t}\n\t$tw.utils.createDirectory(pathname);\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar tiddler = self.commander.wiki.getTiddler(title),\n\t\t\ttype = tiddler.fields.type || \"text/vnd.tiddlywiki\",\n\t\t\tcontentTypeInfo = $tw.config.contentTypeInfo[type] || {encoding: \"utf8\"},\n\t\t\tfilename = path.resolve(pathname,encodeURIComponent(title));\n\t\tfs.writeFileSync(filename,tiddler.fields.text,contentTypeInfo.encoding);\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/savewikifolder.js": {
"title": "$:/core/modules/commands/savewikifolder.js",
"text": "/*\\\ntitle: $:/core/modules/commands/savewikifolder.js\ntype: application/javascript\nmodule-type: command\n\nCommand to save the current wiki as a wiki folder\n\n--savewikifolder <wikifolderpath> [<filter>]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"savewikifolder\",\n\tsynchronous: true\n};\n\nvar fs,path;\nif($tw.node) {\n\tfs = require(\"fs\");\n\tpath = require(\"path\");\n}\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing wiki folder path\";\n\t}\n\tvar wikifoldermaker = new WikiFolderMaker(this.params[0],this.params[1],this.commander);\n\treturn wikifoldermaker.save();\n};\n\nfunction WikiFolderMaker(wikiFolderPath,wikiFilter,commander) {\n\tthis.wikiFolderPath = wikiFolderPath;\n\tthis.wikiFilter = wikiFilter || \"[all[tiddlers]]\";\n\tthis.commander = commander;\n\tthis.wiki = commander.wiki;\n\tthis.savedPaths = []; // So that we can detect filename clashes\n}\n\nWikiFolderMaker.prototype.log = function(str) {\n\tif(this.commander.verbose) {\n\t\tconsole.log(str);\n\t}\n};\n\nWikiFolderMaker.prototype.tiddlersToIgnore = [\n\t\"$:/boot/boot.css\",\n\t\"$:/boot/boot.js\",\n\t\"$:/boot/bootprefix.js\",\n\t\"$:/core\",\n\t\"$:/library/sjcl.js\",\n\t\"$:/temp/info-plugin\"\n];\n\n/*\nReturns null if successful, or an error string if there was an error\n*/\nWikiFolderMaker.prototype.save = function() {\n\tvar self = this;\n\t// Check that the output directory doesn't exist\n\tif(fs.existsSync(this.wikiFolderPath) && !$tw.utils.isDirectoryEmpty(this.wikiFolderPath)) {\n\t\treturn \"The unpackwiki command requires that the output wiki folder be empty\";\n\t}\n\t// Get the tiddlers from the source wiki\n\tvar tiddlerTitles = this.wiki.filterTiddlers(this.wikiFilter);\n\t// Initialise a new tiddlwiki.info file\n\tvar newWikiInfo = {};\n\t// Process each incoming tiddler in turn\n\t$tw.utils.each(tiddlerTitles,function(title) {\n\t\tvar tiddler = self.wiki.getTiddler(title);\n\t\tif(tiddler) {\n\t\t\tif(self.tiddlersToIgnore.indexOf(title) !== -1) {\n\t\t\t\t// Ignore the core plugin and the ephemeral info plugin\n\t\t\t\tself.log(\"Ignoring tiddler: \" + title);\n\t\t\t} else {\n\t\t\t\tvar type = tiddler.fields.type,\n\t\t\t\t\tpluginType = tiddler.fields[\"plugin-type\"];\n\t\t\t\tif(type === \"application/json\" && pluginType) {\n\t\t\t\t\t// Plugin tiddler\n\t\t\t\t\tvar libraryDetails = self.findPluginInLibrary(title);\n\t\t\t\t\tif(libraryDetails) {\n\t\t\t\t\t\t// A plugin from the core library\n\t\t\t\t\t\tself.log(\"Adding built-in plugin: \" + libraryDetails.name);\n\t\t\t\t\t\tnewWikiInfo[libraryDetails.type] = newWikiInfo[libraryDetails.type] || [];\n\t\t\t\t\t\t$tw.utils.pushTop(newWikiInfo[libraryDetails.type],libraryDetails.name);\n\t\t\t\t\t} else {\n\t\t\t\t\t\t// A custom plugin\n\t\t\t\t\t\tself.log(\"Processing custom plugin: \" + title);\n\t\t\t\t\t\tself.saveCustomPlugin(tiddler);\n\t\t\t\t\t}\t\t\t\t\n\t\t\t\t} else {\n\t\t\t\t\t// Ordinary tiddler\n\t\t\t\t\tself.saveTiddler(\"tiddlers\",tiddler);\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n\t// Save the tiddlywiki.info file\n\tthis.saveJSONFile(\"tiddlywiki.info\",newWikiInfo);\n\tself.log(\"Writing tiddlywiki.info: \" + JSON.stringify(newWikiInfo,null,$tw.config.preferences.jsonSpaces));\n\treturn null;\n};\n\n/*\nTest whether the specified tiddler is a plugin in the plugin library\n*/\nWikiFolderMaker.prototype.findPluginInLibrary = function(title) {\n\tvar parts = title.split(\"/\"),\n\t\tpluginPath, type, name;\n\tif(parts[0] === \"$:\") {\n\t\tif(parts[1] === \"languages\" && parts.length === 3) {\n\t\t\tpluginPath = \"languages\" + path.sep + parts[2];\n\t\t\ttype = parts[1];\n\t\t\tname = parts[2];\n\t\t} else if(parts[1] === \"plugins\" || parts[1] === \"themes\" && parts.length === 4) {\n\t\t\tpluginPath = parts[1] + path.sep + parts[2] + path.sep + parts[3];\n\t\t\ttype = parts[1];\n\t\t\tname = parts[2] + \"/\" + parts[3];\n\t\t}\n\t}\n\tif(pluginPath && type && name) {\n\t\tpluginPath = path.resolve($tw.boot.bootPath,\"..\",pluginPath);\n\t\tif(fs.existsSync(pluginPath)) {\n\t\t\treturn {\n\t\t\t\tpluginPath: pluginPath,\n\t\t\t\ttype: type,\n\t\t\t\tname: name\n\t\t\t};\n\t\t}\n\t}\n\treturn false;\n};\n\nWikiFolderMaker.prototype.saveCustomPlugin = function(pluginTiddler) {\n\tvar self = this,\n\t\tpluginTitle = pluginTiddler.fields.title,\n\t\ttitleParts = pluginTitle.split(\"/\"),\n\t\tdirectory = $tw.utils.generateTiddlerFilepath(titleParts[titleParts.length - 1],{\n\t\t\tdirectory: path.resolve(this.wikiFolderPath,pluginTiddler.fields[\"plugin-type\"] + \"s\")\n\t\t}),\n\t\tpluginInfo = pluginTiddler.getFieldStrings({exclude: [\"text\",\"type\"]});\n\tthis.saveJSONFile(directory + path.sep + \"plugin.info\",pluginInfo);\n\tself.log(\"Writing \" + directory + path.sep + \"plugin.info: \" + JSON.stringify(pluginInfo,null,$tw.config.preferences.jsonSpaces));\n\tvar pluginTiddlers = JSON.parse(pluginTiddler.fields.text).tiddlers; // A hashmap of tiddlers in the plugin\n\t$tw.utils.each(pluginTiddlers,function(tiddler) {\n\t\tself.saveTiddler(directory,new $tw.Tiddler(tiddler));\n\t});\n};\n\nWikiFolderMaker.prototype.saveTiddler = function(directory,tiddler) {\n\tvar fileInfo = $tw.utils.generateTiddlerFileInfo(tiddler,{\n\t\tdirectory: path.resolve(this.wikiFolderPath,directory),\n\t\twiki: this.wiki\n\t});\n\t$tw.utils.saveTiddlerToFileSync(tiddler,fileInfo);\n};\n\nWikiFolderMaker.prototype.saveJSONFile = function(filename,json) {\n\tthis.saveTextFile(filename,JSON.stringify(json,null,$tw.config.preferences.jsonSpaces));\n};\n\nWikiFolderMaker.prototype.saveTextFile = function(filename,data) {\n\tthis.saveFile(filename,\"utf8\",data);\n};\n\nWikiFolderMaker.prototype.saveFile = function(filename,encoding,data) {\n\tvar filepath = path.resolve(this.wikiFolderPath,filename);\n\t$tw.utils.createFileDirectories(filepath);\n\tfs.writeFileSync(filepath,data,encoding);\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/server.js": {
"title": "$:/core/modules/commands/server.js",
"text": "/*\\\ntitle: $:/core/modules/commands/server.js\ntype: application/javascript\nmodule-type: command\n\nDeprecated legacy command for serving tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Server = require(\"$:/core/modules/server/server.js\").Server;\n\nexports.info = {\n\tname: \"server\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tvar self = this;\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(!$tw.boot.wikiTiddlersPath) {\n\t\t$tw.utils.warning(\"Warning: Wiki folder '\" + $tw.boot.wikiPath + \"' does not exist or is missing a tiddlywiki.info file\");\n\t}\n\t// Set up server\n\tthis.server = new Server({\n\t\twiki: this.commander.wiki,\n\t\tvariables: {\n\t\t\tport: this.params[0],\n\t\t\thost: this.params[6],\n\t\t\t\"root-tiddler\": this.params[1],\n\t\t\t\"root-render-type\": this.params[2],\n\t\t\t\"root-serve-type\": this.params[3],\n\t\t\tusername: this.params[4],\n\t\t\tpassword: this.params[5],\n\t\t\t\"path-prefix\": this.params[7],\n\t\t\t\"debug-level\": this.params[8]\n\t\t}\n\t});\n\tvar nodeServer = this.server.listen();\n\t$tw.hooks.invokeHook(\"th-server-command-post-start\",this.server,nodeServer,\"tiddlywiki\");\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/setfield.js": {
"title": "$:/core/modules/commands/setfield.js",
"text": "/*\\\ntitle: $:/core/modules/commands/setfield.js\ntype: application/javascript\nmodule-type: command\n\nCommand to modify selected tiddlers to set a field to the text of a template tiddler that has been wikified with the selected tiddler as the current tiddler.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.info = {\n\tname: \"setfield\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 4) {\n\t\treturn \"Missing parameters\";\n\t}\n\tvar self = this,\n\t\twiki = this.commander.wiki,\n\t\tfilter = this.params[0],\n\t\tfieldname = this.params[1] || \"text\",\n\t\ttemplatetitle = this.params[2],\n\t\trendertype = this.params[3] || \"text/plain\",\n\t\ttiddlers = wiki.filterTiddlers(filter);\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar parser = wiki.parseTiddler(templatetitle),\n\t\t\tnewFields = {},\n\t\t\ttiddler = wiki.getTiddler(title);\n\t\tif(parser) {\n\t\t\tvar widgetNode = wiki.makeWidget(parser,{variables: {currentTiddler: title}});\n\t\t\tvar container = $tw.fakeDocument.createElement(\"div\");\n\t\t\twidgetNode.render(container,null);\n\t\t\tnewFields[fieldname] = rendertype === \"text/html\" ? container.innerHTML : container.textContent;\n\t\t} else {\n\t\t\tnewFields[fieldname] = undefined;\n\t\t}\n\t\twiki.addTiddler(new $tw.Tiddler(tiddler,newFields));\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/unpackplugin.js": {
"title": "$:/core/modules/commands/unpackplugin.js",
"text": "/*\\\ntitle: $:/core/modules/commands/unpackplugin.js\ntype: application/javascript\nmodule-type: command\n\nCommand to extract the shadow tiddlers from within a plugin\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"unpackplugin\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander,callback) {\n\tthis.params = params;\n\tthis.commander = commander;\n\tthis.callback = callback;\n};\n\nCommand.prototype.execute = function() {\n\tif(this.params.length < 1) {\n\t\treturn \"Missing plugin name\";\n\t}\n\tvar self = this,\n\t\ttitle = this.params[0],\n\t\tpluginData = this.commander.wiki.getTiddlerDataCached(title);\n\tif(!pluginData) {\n\t\treturn \"Plugin '\" + title + \"' not found\";\n\t}\n\t$tw.utils.each(pluginData.tiddlers,function(tiddler) {\n\t\tself.commander.wiki.addTiddler(new $tw.Tiddler(tiddler));\n\t});\n\treturn null;\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/verbose.js": {
"title": "$:/core/modules/commands/verbose.js",
"text": "/*\\\ntitle: $:/core/modules/commands/verbose.js\ntype: application/javascript\nmodule-type: command\n\nVerbose command\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"verbose\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\tthis.commander.verbose = true;\n\t// Output the boot message log\n\tthis.commander.streams.output.write(\"Boot log:\\n \" + $tw.boot.logMessages.join(\"\\n \") + \"\\n\");\n\treturn null; // No error\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/commands/version.js": {
"title": "$:/core/modules/commands/version.js",
"text": "/*\\\ntitle: $:/core/modules/commands/version.js\ntype: application/javascript\nmodule-type: command\n\nVersion command\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.info = {\n\tname: \"version\",\n\tsynchronous: true\n};\n\nvar Command = function(params,commander) {\n\tthis.params = params;\n\tthis.commander = commander;\n};\n\nCommand.prototype.execute = function() {\n\tthis.commander.streams.output.write($tw.version + \"\\n\");\n\treturn null; // No error\n};\n\nexports.Command = Command;\n\n})();\n",
"type": "application/javascript",
"module-type": "command"
},
"$:/core/modules/config.js": {
"title": "$:/core/modules/config.js",
"text": "/*\\\ntitle: $:/core/modules/config.js\ntype: application/javascript\nmodule-type: config\n\nCore configuration constants\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.preferences = {};\n\nexports.preferences.notificationDuration = 3 * 1000;\nexports.preferences.jsonSpaces = 4;\n\nexports.textPrimitives = {\n\tupperLetter: \"[A-Z\\u00c0-\\u00d6\\u00d8-\\u00de\\u0150\\u0170]\",\n\tlowerLetter: \"[a-z\\u00df-\\u00f6\\u00f8-\\u00ff\\u0151\\u0171]\",\n\tanyLetter: \"[A-Za-z0-9\\u00c0-\\u00d6\\u00d8-\\u00de\\u00df-\\u00f6\\u00f8-\\u00ff\\u0150\\u0170\\u0151\\u0171]\",\n\tblockPrefixLetters:\t\"[A-Za-z0-9-_\\u00c0-\\u00d6\\u00d8-\\u00de\\u00df-\\u00f6\\u00f8-\\u00ff\\u0150\\u0170\\u0151\\u0171]\"\n};\n\nexports.textPrimitives.unWikiLink = \"~\";\nexports.textPrimitives.wikiLink = exports.textPrimitives.upperLetter + \"+\" +\n\texports.textPrimitives.lowerLetter + \"+\" +\n\texports.textPrimitives.upperLetter +\n\texports.textPrimitives.anyLetter + \"*\";\n\nexports.htmlEntities = {quot:34, amp:38, apos:39, lt:60, gt:62, nbsp:160, iexcl:161, cent:162, pound:163, curren:164, yen:165, brvbar:166, sect:167, uml:168, copy:169, ordf:170, laquo:171, not:172, shy:173, reg:174, macr:175, deg:176, plusmn:177, sup2:178, sup3:179, acute:180, micro:181, para:182, middot:183, cedil:184, sup1:185, ordm:186, raquo:187, frac14:188, frac12:189, frac34:190, iquest:191, Agrave:192, Aacute:193, Acirc:194, Atilde:195, Auml:196, Aring:197, AElig:198, Ccedil:199, Egrave:200, Eacute:201, Ecirc:202, Euml:203, Igrave:204, Iacute:205, Icirc:206, Iuml:207, ETH:208, Ntilde:209, Ograve:210, Oacute:211, Ocirc:212, Otilde:213, Ouml:214, times:215, Oslash:216, Ugrave:217, Uacute:218, Ucirc:219, Uuml:220, Yacute:221, THORN:222, szlig:223, agrave:224, aacute:225, acirc:226, atilde:227, auml:228, aring:229, aelig:230, ccedil:231, egrave:232, eacute:233, ecirc:234, euml:235, igrave:236, iacute:237, icirc:238, iuml:239, eth:240, ntilde:241, ograve:242, oacute:243, ocirc:244, otilde:245, ouml:246, divide:247, oslash:248, ugrave:249, uacute:250, ucirc:251, uuml:252, yacute:253, thorn:254, yuml:255, OElig:338, oelig:339, Scaron:352, scaron:353, Yuml:376, fnof:402, circ:710, tilde:732, Alpha:913, Beta:914, Gamma:915, Delta:916, Epsilon:917, Zeta:918, Eta:919, Theta:920, Iota:921, Kappa:922, Lambda:923, Mu:924, Nu:925, Xi:926, Omicron:927, Pi:928, Rho:929, Sigma:931, Tau:932, Upsilon:933, Phi:934, Chi:935, Psi:936, Omega:937, alpha:945, beta:946, gamma:947, delta:948, epsilon:949, zeta:950, eta:951, theta:952, iota:953, kappa:954, lambda:955, mu:956, nu:957, xi:958, omicron:959, pi:960, rho:961, sigmaf:962, sigma:963, tau:964, upsilon:965, phi:966, chi:967, psi:968, omega:969, thetasym:977, upsih:978, piv:982, ensp:8194, emsp:8195, thinsp:8201, zwnj:8204, zwj:8205, lrm:8206, rlm:8207, ndash:8211, mdash:8212, lsquo:8216, rsquo:8217, sbquo:8218, ldquo:8220, rdquo:8221, bdquo:8222, dagger:8224, Dagger:8225, bull:8226, hellip:8230, permil:8240, prime:8242, Prime:8243, lsaquo:8249, rsaquo:8250, oline:8254, frasl:8260, euro:8364, image:8465, weierp:8472, real:8476, trade:8482, alefsym:8501, larr:8592, uarr:8593, rarr:8594, darr:8595, harr:8596, crarr:8629, lArr:8656, uArr:8657, rArr:8658, dArr:8659, hArr:8660, forall:8704, part:8706, exist:8707, empty:8709, nabla:8711, isin:8712, notin:8713, ni:8715, prod:8719, sum:8721, minus:8722, lowast:8727, radic:8730, prop:8733, infin:8734, ang:8736, and:8743, or:8744, cap:8745, cup:8746, int:8747, there4:8756, sim:8764, cong:8773, asymp:8776, ne:8800, equiv:8801, le:8804, ge:8805, sub:8834, sup:8835, nsub:8836, sube:8838, supe:8839, oplus:8853, otimes:8855, perp:8869, sdot:8901, lceil:8968, rceil:8969, lfloor:8970, rfloor:8971, lang:9001, rang:9002, loz:9674, spades:9824, clubs:9827, hearts:9829, diams:9830 };\n\nexports.htmlVoidElements = \"area,base,br,col,command,embed,hr,img,input,keygen,link,meta,param,source,track,wbr\".split(\",\");\n\nexports.htmlBlockElements = \"address,article,aside,audio,blockquote,canvas,dd,div,dl,fieldset,figcaption,figure,footer,form,h1,h2,h3,h4,h5,h6,header,hgroup,hr,li,noscript,ol,output,p,pre,section,table,tfoot,ul,video\".split(\",\");\n\nexports.htmlUnsafeElements = \"script\".split(\",\");\n\n})();\n",
"type": "application/javascript",
"module-type": "config"
},
"$:/core/modules/deserializers.js": {
"title": "$:/core/modules/deserializers.js",
"text": "/*\\\ntitle: $:/core/modules/deserializers.js\ntype: application/javascript\nmodule-type: tiddlerdeserializer\n\nFunctions to deserialise tiddlers from a block of text\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nUtility function to parse an old-style tiddler DIV in a *.tid file. It looks like this:\n\n<div title=\"Title\" creator=\"JoeBloggs\" modifier=\"JoeBloggs\" created=\"201102111106\" modified=\"201102111310\" tags=\"myTag [[my long tag]]\">\n<pre>The text of the tiddler (without the expected HTML encoding).\n</pre>\n</div>\n\nNote that the field attributes are HTML encoded, but that the body of the <PRE> tag is not encoded.\n\nWhen these tiddler DIVs are encountered within a TiddlyWiki HTML file then the body is encoded in the usual way.\n*/\nvar parseTiddlerDiv = function(text /* [,fields] */) {\n\t// Slot together the default results\n\tvar result = {};\n\tif(arguments.length > 1) {\n\t\tfor(var f=1; f<arguments.length; f++) {\n\t\t\tvar fields = arguments[f];\n\t\t\tfor(var t in fields) {\n\t\t\t\tresult[t] = fields[t];\t\t\n\t\t\t}\n\t\t}\n\t}\n\t// Parse the DIV body\n\tvar startRegExp = /^\\s*<div\\s+([^>]*)>(\\s*<pre>)?/gi,\n\t\tendRegExp,\n\t\tmatch = startRegExp.exec(text);\n\tif(match) {\n\t\t// Old-style DIVs don't have the <pre> tag\n\t\tif(match[2]) {\n\t\t\tendRegExp = /<\\/pre>\\s*<\\/div>\\s*$/gi;\n\t\t} else {\n\t\t\tendRegExp = /<\\/div>\\s*$/gi;\n\t\t}\n\t\tvar endMatch = endRegExp.exec(text);\n\t\tif(endMatch) {\n\t\t\t// Extract the text\n\t\t\tresult.text = text.substring(match.index + match[0].length,endMatch.index);\n\t\t\t// Process the attributes\n\t\t\tvar attrRegExp = /\\s*([^=\\s]+)\\s*=\\s*(?:\"([^\"]*)\"|'([^']*)')/gi,\n\t\t\t\tattrMatch;\n\t\t\tdo {\n\t\t\t\tattrMatch = attrRegExp.exec(match[1]);\n\t\t\t\tif(attrMatch) {\n\t\t\t\t\tvar name = attrMatch[1];\n\t\t\t\t\tvar value = attrMatch[2] !== undefined ? attrMatch[2] : attrMatch[3];\n\t\t\t\t\tresult[name] = value;\n\t\t\t\t}\n\t\t\t} while(attrMatch);\n\t\t\treturn result;\n\t\t}\n\t}\n\treturn undefined;\n};\n\nexports[\"application/x-tiddler-html-div\"] = function(text,fields) {\n\treturn [parseTiddlerDiv(text,fields)];\n};\n\nexports[\"application/json\"] = function(text,fields) {\n\tvar incoming,\n\t\tresults = [];\n\ttry {\n\t\tincoming = JSON.parse(text);\n\t} catch(e) {\n\t\tincoming = [{\n\t\t\ttitle: \"JSON error: \" + e,\n\t\t\ttext: \"\"\n\t\t}]\n\t}\n\tif(!$tw.utils.isArray(incoming)) {\n\t\tincoming = [incoming];\n\t}\n\tfor(var t=0; t<incoming.length; t++) {\n\t\tvar incomingFields = incoming[t],\n\t\t\tfields = {};\n\t\tfor(var f in incomingFields) {\n\t\t\tif(typeof incomingFields[f] === \"string\") {\n\t\t\t\tfields[f] = incomingFields[f];\n\t\t\t}\n\t\t}\n\t\tresults.push(fields);\n\t}\n\treturn results;\n};\n\n/*\nParse an HTML file into tiddlers. There are three possibilities:\n# A TiddlyWiki classic HTML file containing `text/x-tiddlywiki` tiddlers\n# A TiddlyWiki5 HTML file containing `text/vnd.tiddlywiki` tiddlers\n# An ordinary HTML file\n*/\nexports[\"text/html\"] = function(text,fields) {\n\t// Check if we've got a store area\n\tvar storeAreaMarkerRegExp = /<div id=[\"']?storeArea['\"]?( style=[\"']?display:none;[\"']?)?>/gi,\n\t\tmatch = storeAreaMarkerRegExp.exec(text);\n\tif(match) {\n\t\t// If so, it's either a classic TiddlyWiki file or an unencrypted TW5 file\n\t\t// First read the normal tiddlers\n\t\tvar results = deserializeTiddlyWikiFile(text,storeAreaMarkerRegExp.lastIndex,!!match[1],fields);\n\t\t// Then any system tiddlers\n\t\tvar systemAreaMarkerRegExp = /<div id=[\"']?systemArea['\"]?( style=[\"']?display:none;[\"']?)?>/gi,\n\t\t\tsysMatch = systemAreaMarkerRegExp.exec(text);\n\t\tif(sysMatch) {\n\t\t\tresults.push.apply(results,deserializeTiddlyWikiFile(text,systemAreaMarkerRegExp.lastIndex,!!sysMatch[1],fields));\n\t\t}\n\t\treturn results;\n\t} else {\n\t\t// Check whether we've got an encrypted file\n\t\tvar encryptedStoreArea = $tw.utils.extractEncryptedStoreArea(text);\n\t\tif(encryptedStoreArea) {\n\t\t\t// If so, attempt to decrypt it using the current password\n\t\t\treturn $tw.utils.decryptStoreArea(encryptedStoreArea);\n\t\t} else {\n\t\t\t// It's not a TiddlyWiki so we'll return the entire HTML file as a tiddler\n\t\t\treturn deserializeHtmlFile(text,fields);\n\t\t}\n\t}\n};\n\nfunction deserializeHtmlFile(text,fields) {\n\tvar result = {};\n\t$tw.utils.each(fields,function(value,name) {\n\t\tresult[name] = value;\n\t});\n\tresult.text = text;\n\tresult.type = \"text/html\";\n\treturn [result];\n}\n\nfunction deserializeTiddlyWikiFile(text,storeAreaEnd,isTiddlyWiki5,fields) {\n\tvar results = [],\n\t\tendOfDivRegExp = /(<\\/div>\\s*)/gi,\n\t\tstartPos = storeAreaEnd,\n\t\tdefaultType = isTiddlyWiki5 ? undefined : \"text/x-tiddlywiki\";\n\tendOfDivRegExp.lastIndex = startPos;\n\tvar match = endOfDivRegExp.exec(text);\n\twhile(match) {\n\t\tvar endPos = endOfDivRegExp.lastIndex,\n\t\t\ttiddlerFields = parseTiddlerDiv(text.substring(startPos,endPos),fields,{type: defaultType});\n\t\tif(!tiddlerFields) {\n\t\t\tbreak;\n\t\t}\n\t\t$tw.utils.each(tiddlerFields,function(value,name) {\n\t\t\tif(typeof value === \"string\") {\n\t\t\t\ttiddlerFields[name] = $tw.utils.htmlDecode(value);\n\t\t\t}\n\t\t});\n\t\tif(tiddlerFields.text !== null) {\n\t\t\tresults.push(tiddlerFields);\n\t\t}\n\t\tstartPos = endPos;\n\t\tmatch = endOfDivRegExp.exec(text);\n\t}\n\treturn results;\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "tiddlerdeserializer"
},
"$:/core/modules/editor/engines/framed.js": {
"title": "$:/core/modules/editor/engines/framed.js",
"text": "/*\\\ntitle: $:/core/modules/editor/engines/framed.js\ntype: application/javascript\nmodule-type: library\n\nText editor engine based on a simple input or textarea within an iframe. This is done so that the selection is preserved even when clicking away from the textarea\n\n\\*/\n(function(){\n\n/*jslint node: true,browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar HEIGHT_VALUE_TITLE = \"$:/config/TextEditor/EditorHeight/Height\";\n\nfunction FramedEngine(options) {\n\t// Save our options\n\toptions = options || {};\n\tthis.widget = options.widget;\n\tthis.value = options.value;\n\tthis.parentNode = options.parentNode;\n\tthis.nextSibling = options.nextSibling;\n\t// Create our hidden dummy text area for reading styles\n\tthis.dummyTextArea = this.widget.document.createElement(\"textarea\");\n\tif(this.widget.editClass) {\n\t\tthis.dummyTextArea.className = this.widget.editClass;\n\t}\n\tthis.dummyTextArea.setAttribute(\"hidden\",\"true\");\n\tthis.parentNode.insertBefore(this.dummyTextArea,this.nextSibling);\n\tthis.widget.domNodes.push(this.dummyTextArea);\n\t// Create the iframe\n\tthis.iframeNode = this.widget.document.createElement(\"iframe\");\n\tthis.parentNode.insertBefore(this.iframeNode,this.nextSibling);\n\tthis.iframeDoc = this.iframeNode.contentWindow.document;\n\t// (Firefox requires us to put some empty content in the iframe)\n\tthis.iframeDoc.open();\n\tthis.iframeDoc.write(\"\");\n\tthis.iframeDoc.close();\n\t// Style the iframe\n\tthis.iframeNode.className = this.dummyTextArea.className;\n\tthis.iframeNode.style.border = \"none\";\n\tthis.iframeNode.style.padding = \"0\";\n\tthis.iframeNode.style.resize = \"none\";\n\tthis.iframeNode.style[\"background-color\"] = this.widget.wiki.extractTiddlerDataItem(this.widget.wiki.getTiddlerText(\"$:/palette\"),\"tiddler-editor-background\");\n\tthis.iframeDoc.body.style.margin = \"0\";\n\tthis.iframeDoc.body.style.padding = \"0\";\n\tthis.widget.domNodes.push(this.iframeNode);\n\t// Construct the textarea or input node\n\tvar tag = this.widget.editTag;\n\tif($tw.config.htmlUnsafeElements.indexOf(tag) !== -1) {\n\t\ttag = \"input\";\n\t}\n\tthis.domNode = this.iframeDoc.createElement(tag);\n\t// Set the text\n\tif(this.widget.editTag === \"textarea\") {\n\t\tthis.domNode.appendChild(this.iframeDoc.createTextNode(this.value));\n\t} else {\n\t\tthis.domNode.value = this.value;\n\t}\n\t// Set the attributes\n\tif(this.widget.editType) {\n\t\tthis.domNode.setAttribute(\"type\",this.widget.editType);\n\t}\n\tif(this.widget.editPlaceholder) {\n\t\tthis.domNode.setAttribute(\"placeholder\",this.widget.editPlaceholder);\n\t}\n\tif(this.widget.editSize) {\n\t\tthis.domNode.setAttribute(\"size\",this.widget.editSize);\n\t}\n\tif(this.widget.editRows) {\n\t\tthis.domNode.setAttribute(\"rows\",this.widget.editRows);\n\t}\n\tif(this.widget.editTabIndex) {\n\t\tthis.iframeNode.setAttribute(\"tabindex\",this.widget.editTabIndex);\n\t}\n\t// Copy the styles from the dummy textarea\n\tthis.copyStyles();\n\t// Add event listeners\n\t$tw.utils.addEventListeners(this.domNode,[\n\t\t{name: \"click\",handlerObject: this,handlerMethod: \"handleClickEvent\"},\n\t\t{name: \"input\",handlerObject: this,handlerMethod: \"handleInputEvent\"},\n\t\t{name: \"keydown\",handlerObject: this.widget,handlerMethod: \"handleKeydownEvent\"}\n\t]);\n\t// Insert the element into the DOM\n\tthis.iframeDoc.body.appendChild(this.domNode);\n}\n\n/*\nCopy styles from the dummy text area to the textarea in the iframe\n*/\nFramedEngine.prototype.copyStyles = function() {\n\t// Copy all styles\n\t$tw.utils.copyStyles(this.dummyTextArea,this.domNode);\n\t// Override the ones that should not be set the same as the dummy textarea\n\tthis.domNode.style.display = \"block\";\n\tthis.domNode.style.width = \"100%\";\n\tthis.domNode.style.margin = \"0\";\n\tthis.domNode.style[\"background-color\"] = this.widget.wiki.extractTiddlerDataItem(this.widget.wiki.getTiddlerText(\"$:/palette\"),\"tiddler-editor-background\");\n\t// In Chrome setting -webkit-text-fill-color overrides the placeholder text colour\n\tthis.domNode.style[\"-webkit-text-fill-color\"] = \"currentcolor\";\n};\n\n/*\nSet the text of the engine if it doesn't currently have focus\n*/\nFramedEngine.prototype.setText = function(text,type) {\n\tif(!this.domNode.isTiddlyWikiFakeDom) {\n\t\tif(this.domNode.ownerDocument.activeElement !== this.domNode) {\n\t\t\tthis.domNode.value = text;\n\t\t}\n\t\t// Fix the height if needed\n\t\tthis.fixHeight();\n\t}\n};\n\n/*\nGet the text of the engine\n*/\nFramedEngine.prototype.getText = function() {\n\treturn this.domNode.value;\n};\n\n/*\nFix the height of textarea to fit content\n*/\nFramedEngine.prototype.fixHeight = function() {\n\t// Make sure styles are updated\n\tthis.copyStyles();\n\t// Adjust height\n\tif(this.widget.editTag === \"textarea\") {\n\t\tif(this.widget.editAutoHeight) {\n\t\t\tif(this.domNode && !this.domNode.isTiddlyWikiFakeDom) {\n\t\t\t\tvar newHeight = $tw.utils.resizeTextAreaToFit(this.domNode,this.widget.editMinHeight);\n\t\t\t\tthis.iframeNode.style.height = (newHeight + 14) + \"px\"; // +14 for the border on the textarea\n\t\t\t}\n\t\t} else {\n\t\t\tvar fixedHeight = parseInt(this.widget.wiki.getTiddlerText(HEIGHT_VALUE_TITLE,\"400px\"),10);\n\t\t\tfixedHeight = Math.max(fixedHeight,20);\n\t\t\tthis.domNode.style.height = fixedHeight + \"px\";\n\t\t\tthis.iframeNode.style.height = (fixedHeight + 14) + \"px\";\n\t\t}\n\t}\n};\n\n/*\nFocus the engine node\n*/\nFramedEngine.prototype.focus = function() {\n\tif(this.domNode.focus && this.domNode.select) {\n\t\tthis.domNode.focus();\n\t\tthis.domNode.select();\n\t}\n};\n\n/*\nHandle a click\n*/\nFramedEngine.prototype.handleClickEvent = function(event) {\n\tthis.fixHeight();\n\treturn true;\n};\n\n/*\nHandle a dom \"input\" event which occurs when the text has changed\n*/\nFramedEngine.prototype.handleInputEvent = function(event) {\n\tthis.widget.saveChanges(this.getText());\n\tthis.fixHeight();\n\treturn true;\n};\n\n/*\nCreate a blank structure representing a text operation\n*/\nFramedEngine.prototype.createTextOperation = function() {\n\tvar operation = {\n\t\ttext: this.domNode.value,\n\t\tselStart: this.domNode.selectionStart,\n\t\tselEnd: this.domNode.selectionEnd,\n\t\tcutStart: null,\n\t\tcutEnd: null,\n\t\treplacement: null,\n\t\tnewSelStart: null,\n\t\tnewSelEnd: null\n\t};\n\toperation.selection = operation.text.substring(operation.selStart,operation.selEnd);\n\treturn operation;\n};\n\n/*\nExecute a text operation\n*/\nFramedEngine.prototype.executeTextOperation = function(operation) {\n\t// Perform the required changes to the text area and the underlying tiddler\n\tvar newText = operation.text;\n\tif(operation.replacement !== null) {\n\t\tnewText = operation.text.substring(0,operation.cutStart) + operation.replacement + operation.text.substring(operation.cutEnd);\n\t\t// Attempt to use a execCommand to modify the value of the control\n\t\tif(this.iframeDoc.queryCommandSupported(\"insertText\") && this.iframeDoc.queryCommandSupported(\"delete\") && !$tw.browser.isFirefox) {\n\t\t\tthis.domNode.focus();\n\t\t\tthis.domNode.setSelectionRange(operation.cutStart,operation.cutEnd);\n\t\t\tif(operation.replacement === \"\") {\n\t\t\t\tthis.iframeDoc.execCommand(\"delete\",false,\"\");\n\t\t\t} else {\n\t\t\t\tthis.iframeDoc.execCommand(\"insertText\",false,operation.replacement);\n\t\t\t}\n\t\t} else {\n\t\t\tthis.domNode.value = newText;\n\t\t}\n\t\tthis.domNode.focus();\n\t\tthis.domNode.setSelectionRange(operation.newSelStart,operation.newSelEnd);\n\t}\n\tthis.domNode.focus();\n\treturn newText;\n};\n\nexports.FramedEngine = FramedEngine;\n\n})();\n",
"type": "application/javascript",
"module-type": "library"
},
"$:/core/modules/editor/engines/simple.js": {
"title": "$:/core/modules/editor/engines/simple.js",
"text": "/*\\\ntitle: $:/core/modules/editor/engines/simple.js\ntype: application/javascript\nmodule-type: library\n\nText editor engine based on a simple input or textarea tag\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar HEIGHT_VALUE_TITLE = \"$:/config/TextEditor/EditorHeight/Height\";\n\nfunction SimpleEngine(options) {\n\t// Save our options\n\toptions = options || {};\n\tthis.widget = options.widget;\n\tthis.value = options.value;\n\tthis.parentNode = options.parentNode;\n\tthis.nextSibling = options.nextSibling;\n\t// Construct the textarea or input node\n\tvar tag = this.widget.editTag;\n\tif($tw.config.htmlUnsafeElements.indexOf(tag) !== -1) {\n\t\ttag = \"input\";\n\t}\n\tthis.domNode = this.widget.document.createElement(tag);\n\t// Set the text\n\tif(this.widget.editTag === \"textarea\") {\n\t\tthis.domNode.appendChild(this.widget.document.createTextNode(this.value));\n\t} else {\n\t\tthis.domNode.value = this.value;\n\t}\n\t// Set the attributes\n\tif(this.widget.editType) {\n\t\tthis.domNode.setAttribute(\"type\",this.widget.editType);\n\t}\n\tif(this.widget.editPlaceholder) {\n\t\tthis.domNode.setAttribute(\"placeholder\",this.widget.editPlaceholder);\n\t}\n\tif(this.widget.editSize) {\n\t\tthis.domNode.setAttribute(\"size\",this.widget.editSize);\n\t}\n\tif(this.widget.editRows) {\n\t\tthis.domNode.setAttribute(\"rows\",this.widget.editRows);\n\t}\n\tif(this.widget.editClass) {\n\t\tthis.domNode.className = this.widget.editClass;\n\t}\n\tif(this.widget.editTabIndex) {\n\t\tthis.domNode.setAttribute(\"tabindex\",this.widget.editTabIndex);\n\t}\n\t// Add an input event handler\n\t$tw.utils.addEventListeners(this.domNode,[\n\t\t{name: \"focus\", handlerObject: this, handlerMethod: \"handleFocusEvent\"},\n\t\t{name: \"input\", handlerObject: this, handlerMethod: \"handleInputEvent\"}\n\t]);\n\t// Insert the element into the DOM\n\tthis.parentNode.insertBefore(this.domNode,this.nextSibling);\n\tthis.widget.domNodes.push(this.domNode);\n}\n\n/*\nSet the text of the engine if it doesn't currently have focus\n*/\nSimpleEngine.prototype.setText = function(text,type) {\n\tif(!this.domNode.isTiddlyWikiFakeDom) {\n\t\tif(this.domNode.ownerDocument.activeElement !== this.domNode || text === \"\") {\n\t\t\tthis.domNode.value = text;\n\t\t}\n\t\t// Fix the height if needed\n\t\tthis.fixHeight();\n\t}\n};\n\n/*\nGet the text of the engine\n*/\nSimpleEngine.prototype.getText = function() {\n\treturn this.domNode.value;\n};\n\n/*\nFix the height of textarea to fit content\n*/\nSimpleEngine.prototype.fixHeight = function() {\n\tif(this.widget.editTag === \"textarea\") {\n\t\tif(this.widget.editAutoHeight) {\n\t\t\tif(this.domNode && !this.domNode.isTiddlyWikiFakeDom) {\n\t\t\t\t$tw.utils.resizeTextAreaToFit(this.domNode,this.widget.editMinHeight);\n\t\t\t}\n\t\t} else {\n\t\t\tvar fixedHeight = parseInt(this.widget.wiki.getTiddlerText(HEIGHT_VALUE_TITLE,\"400px\"),10);\n\t\t\tfixedHeight = Math.max(fixedHeight,20);\n\t\t\tthis.domNode.style.height = fixedHeight + \"px\";\n\t\t}\n\t}\n};\n\n/*\nFocus the engine node\n*/\nSimpleEngine.prototype.focus = function() {\n\tif(this.domNode.focus && this.domNode.select) {\n\t\tthis.domNode.focus();\n\t\tthis.domNode.select();\n\t}\n};\n\n/*\nHandle a dom \"input\" event which occurs when the text has changed\n*/\nSimpleEngine.prototype.handleInputEvent = function(event) {\n\tthis.widget.saveChanges(this.getText());\n\tthis.fixHeight();\n\treturn true;\n};\n\n/*\nHandle a dom \"focus\" event\n*/\nSimpleEngine.prototype.handleFocusEvent = function(event) {\n\tif(this.widget.editFocusPopup) {\n\t\t$tw.popup.triggerPopup({\n\t\t\tdomNode: this.domNode,\n\t\t\ttitle: this.widget.editFocusPopup,\n\t\t\twiki: this.widget.wiki,\n\t\t\tforce: true\n\t\t});\n\t}\n\treturn true;\n};\n\n/*\nCreate a blank structure representing a text operation\n*/\nSimpleEngine.prototype.createTextOperation = function() {\n\treturn null;\n};\n\n/*\nExecute a text operation\n*/\nSimpleEngine.prototype.executeTextOperation = function(operation) {\n};\n\nexports.SimpleEngine = SimpleEngine;\n\n})();\n",
"type": "application/javascript",
"module-type": "library"
},
"$:/core/modules/editor/factory.js": {
"title": "$:/core/modules/editor/factory.js",
"text": "/*\\\ntitle: $:/core/modules/editor/factory.js\ntype: application/javascript\nmodule-type: library\n\nFactory for constructing text editor widgets with specified engines for the toolbar and non-toolbar cases\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar DEFAULT_MIN_TEXT_AREA_HEIGHT = \"100px\"; // Minimum height of textareas in pixels\n\n// Configuration tiddlers\nvar HEIGHT_MODE_TITLE = \"$:/config/TextEditor/EditorHeight/Mode\";\nvar ENABLE_TOOLBAR_TITLE = \"$:/config/TextEditor/EnableToolbar\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nfunction editTextWidgetFactory(toolbarEngine,nonToolbarEngine) {\n\n\tvar EditTextWidget = function(parseTreeNode,options) {\n\t\t// Initialise the editor operations if they've not been done already\n\t\tif(!this.editorOperations) {\n\t\t\tEditTextWidget.prototype.editorOperations = {};\n\t\t\t$tw.modules.applyMethods(\"texteditoroperation\",this.editorOperations);\n\t\t}\n\t\tthis.initialise(parseTreeNode,options);\n\t};\n\n\t/*\n\tInherit from the base widget class\n\t*/\n\tEditTextWidget.prototype = new Widget();\n\n\t/*\n\tRender this widget into the DOM\n\t*/\n\tEditTextWidget.prototype.render = function(parent,nextSibling) {\n\t\t// Save the parent dom node\n\t\tthis.parentDomNode = parent;\n\t\t// Compute our attributes\n\t\tthis.computeAttributes();\n\t\t// Execute our logic\n\t\tthis.execute();\n\t\t// Create the wrapper for the toolbar and render its content\n\t\tif(this.editShowToolbar) {\n\t\t\tthis.toolbarNode = this.document.createElement(\"div\");\n\t\t\tthis.toolbarNode.className = \"tc-editor-toolbar\";\n\t\t\tparent.insertBefore(this.toolbarNode,nextSibling);\n\t\t\tthis.renderChildren(this.toolbarNode,null);\n\t\t\tthis.domNodes.push(this.toolbarNode);\n\t\t}\n\t\t// Create our element\n\t\tvar editInfo = this.getEditInfo(),\n\t\t\tEngine = this.editShowToolbar ? toolbarEngine : nonToolbarEngine;\n\t\tthis.engine = new Engine({\n\t\t\t\twidget: this,\n\t\t\t\tvalue: editInfo.value,\n\t\t\t\ttype: editInfo.type,\n\t\t\t\tparentNode: parent,\n\t\t\t\tnextSibling: nextSibling\n\t\t\t});\n\t\t// Call the postRender hook\n\t\tif(this.postRender) {\n\t\t\tthis.postRender();\n\t\t}\n\t\t// Fix height\n\t\tthis.engine.fixHeight();\n\t\t// Focus if required\n\t\tif(this.editFocus === \"true\" || this.editFocus === \"yes\") {\n\t\t\tthis.engine.focus();\n\t\t}\n\t\t// Add widget message listeners\n\t\tthis.addEventListeners([\n\t\t\t{type: \"tm-edit-text-operation\", handler: \"handleEditTextOperationMessage\"}\n\t\t]);\n\t};\n\n\t/*\n\tGet the tiddler being edited and current value\n\t*/\n\tEditTextWidget.prototype.getEditInfo = function() {\n\t\t// Get the edit value\n\t\tvar self = this,\n\t\t\tvalue,\n\t\t\ttype = \"text/plain\",\n\t\t\tupdate;\n\t\tif(this.editIndex) {\n\t\t\tvalue = this.wiki.extractTiddlerDataItem(this.editTitle,this.editIndex,this.editDefault);\n\t\t\tupdate = function(value) {\n\t\t\t\tvar data = self.wiki.getTiddlerData(self.editTitle,{});\n\t\t\t\tif(data[self.editIndex] !== value) {\n\t\t\t\t\tdata[self.editIndex] = value;\n\t\t\t\t\tself.wiki.setTiddlerData(self.editTitle,data);\n\t\t\t\t}\n\t\t\t};\n\t\t} else {\n\t\t\t// Get the current tiddler and the field name\n\t\t\tvar tiddler = this.wiki.getTiddler(this.editTitle);\n\t\t\tif(tiddler) {\n\t\t\t\t// If we've got a tiddler, the value to display is the field string value\n\t\t\t\tvalue = tiddler.getFieldString(this.editField);\n\t\t\t\tif(this.editField === \"text\") {\n\t\t\t\t\ttype = tiddler.fields.type || \"text/vnd.tiddlywiki\";\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\t// Otherwise, we need to construct a default value for the editor\n\t\t\t\tswitch(this.editField) {\n\t\t\t\t\tcase \"text\":\n\t\t\t\t\t\tvalue = \"Type the text for the tiddler '\" + this.editTitle + \"'\";\n\t\t\t\t\t\ttype = \"text/vnd.tiddlywiki\";\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tcase \"title\":\n\t\t\t\t\t\tvalue = this.editTitle;\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tdefault:\n\t\t\t\t\t\tvalue = \"\";\n\t\t\t\t\t\tbreak;\n\t\t\t\t}\n\t\t\t\tif(this.editDefault !== undefined) {\n\t\t\t\t\tvalue = this.editDefault;\n\t\t\t\t}\n\t\t\t}\n\t\t\tupdate = function(value) {\n\t\t\t\tvar tiddler = self.wiki.getTiddler(self.editTitle),\n\t\t\t\t\tupdateFields = {\n\t\t\t\t\t\ttitle: self.editTitle\n\t\t\t\t\t};\n\t\t\t\tupdateFields[self.editField] = value;\n\t\t\t\tself.wiki.addTiddler(new $tw.Tiddler(self.wiki.getCreationFields(),tiddler,updateFields,self.wiki.getModificationFields()));\n\t\t\t};\n\t\t}\n\t\tif(this.editType) {\n\t\t\ttype = this.editType;\n\t\t}\n\t\treturn {value: value || \"\", type: type, update: update};\n\t};\n\n\t/*\n\tHandle an edit text operation message from the toolbar\n\t*/\n\tEditTextWidget.prototype.handleEditTextOperationMessage = function(event) {\n\t\t// Prepare information about the operation\n\t\tvar operation = this.engine.createTextOperation();\n\t\t// Invoke the handler for the selected operation\n\t\tvar handler = this.editorOperations[event.param];\n\t\tif(handler) {\n\t\t\thandler.call(this,event,operation);\n\t\t}\n\t\t// Execute the operation via the engine\n\t\tvar newText = this.engine.executeTextOperation(operation);\n\t\t// Fix the tiddler height and save changes\n\t\tthis.engine.fixHeight();\n\t\tthis.saveChanges(newText);\n\t};\n\n\t/*\n\tCompute the internal state of the widget\n\t*/\n\tEditTextWidget.prototype.execute = function() {\n\t\t// Get our parameters\n\t\tthis.editTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\t\tthis.editField = this.getAttribute(\"field\",\"text\");\n\t\tthis.editIndex = this.getAttribute(\"index\");\n\t\tthis.editDefault = this.getAttribute(\"default\");\n\t\tthis.editClass = this.getAttribute(\"class\");\n\t\tthis.editPlaceholder = this.getAttribute(\"placeholder\");\n\t\tthis.editSize = this.getAttribute(\"size\");\n\t\tthis.editRows = this.getAttribute(\"rows\");\n\t\tthis.editAutoHeight = this.wiki.getTiddlerText(HEIGHT_MODE_TITLE,\"auto\");\n\t\tthis.editAutoHeight = this.getAttribute(\"autoHeight\",this.editAutoHeight === \"auto\" ? \"yes\" : \"no\") === \"yes\";\n\t\tthis.editMinHeight = this.getAttribute(\"minHeight\",DEFAULT_MIN_TEXT_AREA_HEIGHT);\n\t\tthis.editFocusPopup = this.getAttribute(\"focusPopup\");\n\t\tthis.editFocus = this.getAttribute(\"focus\");\n\t\tthis.editTabIndex = this.getAttribute(\"tabindex\");\n\t\t// Get the default editor element tag and type\n\t\tvar tag,type;\n\t\tif(this.editField === \"text\") {\n\t\t\ttag = \"textarea\";\n\t\t} else {\n\t\t\ttag = \"input\";\n\t\t\tvar fieldModule = $tw.Tiddler.fieldModules[this.editField];\n\t\t\tif(fieldModule && fieldModule.editTag) {\n\t\t\t\ttag = fieldModule.editTag;\n\t\t\t}\n\t\t\tif(fieldModule && fieldModule.editType) {\n\t\t\t\ttype = fieldModule.editType;\n\t\t\t}\n\t\t\ttype = type || \"text\";\n\t\t}\n\t\t// Get the rest of our parameters\n\t\tthis.editTag = this.getAttribute(\"tag\",tag) || \"input\";\n\t\tthis.editType = this.getAttribute(\"type\",type);\n\t\t// Make the child widgets\n\t\tthis.makeChildWidgets();\n\t\t// Determine whether to show the toolbar\n\t\tthis.editShowToolbar = this.wiki.getTiddlerText(ENABLE_TOOLBAR_TITLE,\"yes\");\n\t\tthis.editShowToolbar = (this.editShowToolbar === \"yes\") && !!(this.children && this.children.length > 0) && (!this.document.isTiddlyWikiFakeDom);\n\t};\n\n\t/*\n\tSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n\t*/\n\tEditTextWidget.prototype.refresh = function(changedTiddlers) {\n\t\tvar changedAttributes = this.computeAttributes();\n\t\t// Completely rerender if any of our attributes have changed\n\t\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes[\"default\"] || changedAttributes[\"class\"] || changedAttributes.placeholder || changedAttributes.size || changedAttributes.autoHeight || changedAttributes.minHeight || changedAttributes.focusPopup || changedAttributes.rows || changedAttributes.tabindex || changedTiddlers[HEIGHT_MODE_TITLE] || changedTiddlers[ENABLE_TOOLBAR_TITLE]) {\n\t\t\tthis.refreshSelf();\n\t\t\treturn true;\n\t\t} else if(changedTiddlers[this.editTitle]) {\n\t\t\tvar editInfo = this.getEditInfo();\n\t\t\tthis.updateEditor(editInfo.value,editInfo.type);\n\t\t}\n\t\tthis.engine.fixHeight();\n\t\tif(this.editShowToolbar) {\n\t\t\treturn this.refreshChildren(changedTiddlers);\n\t\t} else {\n\t\t\treturn false;\n\t\t}\n\t};\n\n\t/*\n\tUpdate the editor with new text. This method is separate from updateEditorDomNode()\n\tso that subclasses can override updateEditor() and still use updateEditorDomNode()\n\t*/\n\tEditTextWidget.prototype.updateEditor = function(text,type) {\n\t\tthis.updateEditorDomNode(text,type);\n\t};\n\n\t/*\n\tUpdate the editor dom node with new text\n\t*/\n\tEditTextWidget.prototype.updateEditorDomNode = function(text,type) {\n\t\tthis.engine.setText(text,type);\n\t};\n\n\t/*\n\tSave changes back to the tiddler store\n\t*/\n\tEditTextWidget.prototype.saveChanges = function(text) {\n\t\tvar editInfo = this.getEditInfo();\n\t\tif(text !== editInfo.value) {\n\t\t\teditInfo.update(text);\n\t\t}\n\t};\n\n\t/*\n\tHandle a dom \"keydown\" event, which we'll bubble up to our container for the keyboard widgets benefit\n\t*/\n\tEditTextWidget.prototype.handleKeydownEvent = function(event) {\n\t\t// Check for a keyboard shortcut\n\t\tif(this.toolbarNode) {\n\t\t\tvar shortcutElements = this.toolbarNode.querySelectorAll(\"[data-tw-keyboard-shortcut]\");\n\t\t\tfor(var index=0; index<shortcutElements.length; index++) {\n\t\t\t\tvar el = shortcutElements[index],\n\t\t\t\t\tshortcutData = el.getAttribute(\"data-tw-keyboard-shortcut\"),\n\t\t\t\t\tkeyInfoArray = $tw.keyboardManager.parseKeyDescriptors(shortcutData,{\n\t\t\t\t\t\twiki: this.wiki\n\t\t\t\t\t});\n\t\t\t\tif($tw.keyboardManager.checkKeyDescriptors(event,keyInfoArray)) {\n\t\t\t\t\tvar clickEvent = this.document.createEvent(\"Events\");\n\t\t\t\t clickEvent.initEvent(\"click\",true,false);\n\t\t\t\t el.dispatchEvent(clickEvent);\n\t\t\t\t\tevent.preventDefault();\n\t\t\t\t\tevent.stopPropagation();\n\t\t\t\t\treturn true;\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t\t// Propogate the event to the container\n\t\tif(this.propogateKeydownEvent(event)) {\n\t\t\t// Ignore the keydown if it was already handled\n\t\t\tevent.preventDefault();\n\t\t\tevent.stopPropagation();\n\t\t\treturn true;\n\t\t}\n\t\t// Otherwise, process the keydown normally\n\t\treturn false;\n\t};\n\n\t/*\n\tPropogate keydown events to our container for the keyboard widgets benefit\n\t*/\n\tEditTextWidget.prototype.propogateKeydownEvent = function(event) {\n\t\tvar newEvent = this.document.createEventObject ? this.document.createEventObject() : this.document.createEvent(\"Events\");\n\t\tif(newEvent.initEvent) {\n\t\t\tnewEvent.initEvent(\"keydown\", true, true);\n\t\t}\n\t\tnewEvent.keyCode = event.keyCode;\n\t\tnewEvent.which = event.which;\n\t\tnewEvent.metaKey = event.metaKey;\n\t\tnewEvent.ctrlKey = event.ctrlKey;\n\t\tnewEvent.altKey = event.altKey;\n\t\tnewEvent.shiftKey = event.shiftKey;\n\t\treturn !this.parentDomNode.dispatchEvent(newEvent);\n\t};\n\n\treturn EditTextWidget;\n\n}\n\nexports.editTextWidgetFactory = editTextWidgetFactory;\n\n})();\n",
"type": "application/javascript",
"module-type": "library"
},
"$:/core/modules/editor/operations/bitmap/clear.js": {
"title": "$:/core/modules/editor/operations/bitmap/clear.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/bitmap/clear.js\ntype: application/javascript\nmodule-type: bitmapeditoroperation\n\nBitmap editor operation to clear the image\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"clear\"] = function(event) {\n\tvar ctx = this.canvasDomNode.getContext(\"2d\");\n\tctx.globalAlpha = 1;\n\tctx.fillStyle = event.paramObject.colour || \"white\";\n\tctx.fillRect(0,0,this.canvasDomNode.width,this.canvasDomNode.height);\n\t// Save changes\n\tthis.strokeEnd();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "bitmapeditoroperation"
},
"$:/core/modules/editor/operations/bitmap/resize.js": {
"title": "$:/core/modules/editor/operations/bitmap/resize.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/bitmap/resize.js\ntype: application/javascript\nmodule-type: bitmapeditoroperation\n\nBitmap editor operation to resize the image\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"resize\"] = function(event) {\n\t// Get the new width\n\tvar newWidth = parseInt(event.paramObject.width || this.canvasDomNode.width,10),\n\t\tnewHeight = parseInt(event.paramObject.height || this.canvasDomNode.height,10);\n\t// Update if necessary\n\tif(newWidth > 0 && newHeight > 0 && !(newWidth === this.currCanvas.width && newHeight === this.currCanvas.height)) {\n\t\tthis.changeCanvasSize(newWidth,newHeight);\n\t}\n\t// Update the input controls\n\tthis.refreshToolbar();\n\t// Save the image into the tiddler\n\tthis.saveChanges();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "bitmapeditoroperation"
},
"$:/core/modules/editor/operations/bitmap/rotate-left.js": {
"title": "$:/core/modules/editor/operations/bitmap/rotate-left.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/bitmap/rotate-left.js\ntype: application/javascript\nmodule-type: bitmapeditoroperation\n\nBitmap editor operation to rotate the image left by 90 degrees\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"rotate-left\"] = function(event) {\n\t// Rotate the canvas left by 90 degrees\n\tthis.rotateCanvasLeft();\n\t// Update the input controls\n\tthis.refreshToolbar();\n\t// Save the image into the tiddler\n\tthis.saveChanges();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "bitmapeditoroperation"
},
"$:/core/modules/editor/operations/text/excise.js": {
"title": "$:/core/modules/editor/operations/text/excise.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/excise.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to excise the selection to a new tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"excise\"] = function(event,operation) {\n\tvar editTiddler = this.wiki.getTiddler(this.editTitle),\n\t\teditTiddlerTitle = this.editTitle;\n\tif(editTiddler && editTiddler.fields[\"draft.of\"]) {\n\t\teditTiddlerTitle = editTiddler.fields[\"draft.of\"];\n\t}\n\tvar excisionTitle = event.paramObject.title || this.wiki.generateNewTitle(\"New Excision\");\n\tthis.wiki.addTiddler(new $tw.Tiddler(\n\t\tthis.wiki.getCreationFields(),\n\t\tthis.wiki.getModificationFields(),\n\t\t{\n\t\t\ttitle: excisionTitle,\n\t\t\ttext: operation.selection,\n\t\t\ttags: event.paramObject.tagnew === \"yes\" ? [editTiddlerTitle] : []\n\t\t}\n\t));\n\toperation.replacement = excisionTitle;\n\tswitch(event.paramObject.type || \"transclude\") {\n\t\tcase \"transclude\":\n\t\t\toperation.replacement = \"{{\" + operation.replacement+ \"}}\";\n\t\t\tbreak;\n\t\tcase \"link\":\n\t\t\toperation.replacement = \"[[\" + operation.replacement+ \"]]\";\n\t\t\tbreak;\n\t\tcase \"macro\":\n\t\t\toperation.replacement = \"<<\" + (event.paramObject.macro || \"translink\") + \" \\\"\\\"\\\"\" + operation.replacement + \"\\\"\\\"\\\">>\";\n\t\t\tbreak;\n\t}\n\toperation.cutStart = operation.selStart;\n\toperation.cutEnd = operation.selEnd;\n\toperation.newSelStart = operation.selStart;\n\toperation.newSelEnd = operation.selStart + operation.replacement.length;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/make-link.js": {
"title": "$:/core/modules/editor/operations/text/make-link.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/make-link.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to make a link\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"make-link\"] = function(event,operation) {\n\tif(operation.selection) {\n\t\toperation.replacement = \"[[\" + operation.selection + \"|\" + event.paramObject.text + \"]]\";\n\t\toperation.cutStart = operation.selStart;\n\t\toperation.cutEnd = operation.selEnd;\n\t} else {\n\t\toperation.replacement = \"[[\" + event.paramObject.text + \"]]\";\n\t\toperation.cutStart = operation.selStart;\n\t\toperation.cutEnd = operation.selEnd;\n\t}\n\toperation.newSelStart = operation.selStart + operation.replacement.length;\n\toperation.newSelEnd = operation.newSelStart;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/prefix-lines.js": {
"title": "$:/core/modules/editor/operations/text/prefix-lines.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/prefix-lines.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to add a prefix to the selected lines\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"prefix-lines\"] = function(event,operation) {\n\tvar targetCount = parseInt(event.paramObject.count + \"\",10);\n\t// Cut just past the preceding line break, or the start of the text\n\toperation.cutStart = $tw.utils.findPrecedingLineBreak(operation.text,operation.selStart);\n\t// Cut to just past the following line break, or to the end of the text\n\toperation.cutEnd = $tw.utils.findFollowingLineBreak(operation.text,operation.selEnd);\n\t// Compose the required prefix\n\tvar prefix = $tw.utils.repeat(event.paramObject.character,targetCount);\n\t// Process each line\n\tvar lines = operation.text.substring(operation.cutStart,operation.cutEnd).split(/\\r?\\n/mg);\n\t$tw.utils.each(lines,function(line,index) {\n\t\t// Remove and count any existing prefix characters\n\t\tvar count = 0;\n\t\twhile(line.charAt(0) === event.paramObject.character) {\n\t\t\tline = line.substring(1);\n\t\t\tcount++;\n\t\t}\n\t\t// Remove any whitespace\n\t\twhile(line.charAt(0) === \" \") {\n\t\t\tline = line.substring(1);\n\t\t}\n\t\t// We're done if we removed the exact required prefix, otherwise add it\n\t\tif(count !== targetCount) {\n\t\t\t// Apply the prefix\n\t\t\tline = prefix + \" \" + line;\n\t\t}\n\t\t// Save the modified line\n\t\tlines[index] = line;\n\t});\n\t// Stitch the replacement text together and set the selection\n\toperation.replacement = lines.join(\"\\n\");\n\tif(lines.length === 1) {\n\t\toperation.newSelStart = operation.cutStart + operation.replacement.length;\n\t\toperation.newSelEnd = operation.newSelStart;\n\t} else {\n\t\toperation.newSelStart = operation.cutStart;\n\t\toperation.newSelEnd = operation.newSelStart + operation.replacement.length;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/replace-all.js": {
"title": "$:/core/modules/editor/operations/text/replace-all.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/replace-all.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to replace the entire text\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"replace-all\"] = function(event,operation) {\n\toperation.cutStart = 0;\n\toperation.cutEnd = operation.text.length;\n\toperation.replacement = event.paramObject.text;\n\toperation.newSelStart = 0;\n\toperation.newSelEnd = operation.replacement.length;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/replace-selection.js": {
"title": "$:/core/modules/editor/operations/text/replace-selection.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/replace-selection.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to replace the selection\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"replace-selection\"] = function(event,operation) {\n\toperation.replacement = event.paramObject.text;\n\toperation.cutStart = operation.selStart;\n\toperation.cutEnd = operation.selEnd;\n\toperation.newSelStart = operation.selStart;\n\toperation.newSelEnd = operation.selStart + operation.replacement.length;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/save-selection.js": {
"title": "$:/core/modules/editor/operations/text/save-selection.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/save-selection.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to save the current selection in a specified tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"save-selection\"] = function(event,operation) {\n\tvar tiddler = event.paramObject.tiddler,\n\t\tfield = event.paramObject.field || \"text\";\n\tif(tiddler && field) {\n\t\tthis.wiki.setText(tiddler,field,null,operation.text.substring(operation.selStart,operation.selEnd));\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/wrap-lines.js": {
"title": "$:/core/modules/editor/operations/text/wrap-lines.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/wrap-lines.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to wrap the selected lines with a prefix and suffix\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"wrap-lines\"] = function(event,operation) {\n\t// Cut just past the preceding line break, or the start of the text\n\toperation.cutStart = $tw.utils.findPrecedingLineBreak(operation.text,operation.selStart);\n\t// Cut to just past the following line break, or to the end of the text\n\toperation.cutEnd = $tw.utils.findFollowingLineBreak(operation.text,operation.selEnd);\n\t// Add the prefix and suffix\n\toperation.replacement = event.paramObject.prefix + \"\\n\" +\n\t\t\t\toperation.text.substring(operation.cutStart,operation.cutEnd) + \"\\n\" +\n\t\t\t\tevent.paramObject.suffix + \"\\n\";\n\toperation.newSelStart = operation.cutStart + event.paramObject.prefix.length + 1;\n\toperation.newSelEnd = operation.newSelStart + (operation.cutEnd - operation.cutStart);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/editor/operations/text/wrap-selection.js": {
"title": "$:/core/modules/editor/operations/text/wrap-selection.js",
"text": "/*\\\ntitle: $:/core/modules/editor/operations/text/wrap-selection.js\ntype: application/javascript\nmodule-type: texteditoroperation\n\nText editor operation to wrap the selection with the specified prefix and suffix\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports[\"wrap-selection\"] = function(event,operation) {\n\tif(operation.selStart === operation.selEnd) {\n\t\t// No selection; check if we're within the prefix/suffix\n\t\tif(operation.text.substring(operation.selStart - event.paramObject.prefix.length,operation.selStart + event.paramObject.suffix.length) === event.paramObject.prefix + event.paramObject.suffix) {\n\t\t\t// Remove the prefix and suffix\n\t\t\toperation.cutStart = operation.selStart - event.paramObject.prefix.length;\n\t\t\toperation.cutEnd = operation.selEnd + event.paramObject.suffix.length;\n\t\t\toperation.replacement = \"\";\n\t\t\toperation.newSelStart = operation.cutStart;\n\t\t\toperation.newSelEnd = operation.newSelStart;\n\t\t} else {\n\t\t\t// Wrap the cursor instead\n\t\t\toperation.cutStart = operation.selStart;\n\t\t\toperation.cutEnd = operation.selEnd;\n\t\t\toperation.replacement = event.paramObject.prefix + event.paramObject.suffix;\n\t\t\toperation.newSelStart = operation.selStart + event.paramObject.prefix.length;\n\t\t\toperation.newSelEnd = operation.newSelStart;\n\t\t}\n\t} else if(operation.text.substring(operation.selStart,operation.selStart + event.paramObject.prefix.length) === event.paramObject.prefix && operation.text.substring(operation.selEnd - event.paramObject.suffix.length,operation.selEnd) === event.paramObject.suffix) {\n\t\t// Prefix and suffix are already present, so remove them\n\t\toperation.cutStart = operation.selStart;\n\t\toperation.cutEnd = operation.selEnd;\n\t\toperation.replacement = operation.selection.substring(event.paramObject.prefix.length,operation.selection.length - event.paramObject.suffix.length);\n\t\toperation.newSelStart = operation.selStart;\n\t\toperation.newSelEnd = operation.selStart + operation.replacement.length;\n\t} else {\n\t\t// Add the prefix and suffix\n\t\toperation.cutStart = operation.selStart;\n\t\toperation.cutEnd = operation.selEnd;\n\t\toperation.replacement = event.paramObject.prefix + operation.selection + event.paramObject.suffix;\n\t\toperation.newSelStart = operation.selStart;\n\t\toperation.newSelEnd = operation.selStart + operation.replacement.length;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "texteditoroperation"
},
"$:/core/modules/filters/addprefix.js": {
"title": "$:/core/modules/filters/addprefix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/addprefix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for adding a prefix to each title in the list. This is\nespecially useful in contexts where only a filter expression is allowed\nand macro substitution isn't available.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.addprefix = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(operator.operand + title);\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/addsuffix.js": {
"title": "$:/core/modules/filters/addsuffix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/addsuffix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for adding a suffix to each title in the list. This is\nespecially useful in contexts where only a filter expression is allowed\nand macro substitution isn't available.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.addsuffix = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title + operator.operand);\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/after.js": {
"title": "$:/core/modules/filters/after.js",
"text": "/*\\\ntitle: $:/core/modules/filters/after.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the tiddler from the current list that is after the tiddler named in the operand.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.after = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\tvar index = results.indexOf(operator.operand);\n\tif(index === -1 || index > (results.length - 2)) {\n\t\treturn [];\n\t} else {\n\t\treturn [results[index + 1]];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/all/current.js": {
"title": "$:/core/modules/filters/all/current.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/current.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[current]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.current = function(source,prefix,options) {\n\tvar currTiddlerTitle = options.widget && options.widget.getVariable(\"currentTiddler\");\n\tif(currTiddlerTitle) {\n\t\treturn [currTiddlerTitle];\n\t} else {\n\t\treturn [];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all/missing.js": {
"title": "$:/core/modules/filters/all/missing.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/missing.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[missing]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.missing = function(source,prefix,options) {\n\treturn options.wiki.getMissingTitles();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all/orphans.js": {
"title": "$:/core/modules/filters/all/orphans.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/orphans.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[orphans]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.orphans = function(source,prefix,options) {\n\treturn options.wiki.getOrphanTitles();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all/shadows.js": {
"title": "$:/core/modules/filters/all/shadows.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/shadows.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[shadows]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.shadows = function(source,prefix,options) {\n\treturn options.wiki.allShadowTitles();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all/tags.js": {
"title": "$:/core/modules/filters/all/tags.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/tags.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[tags]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tags = function(source,prefix,options) {\n\treturn Object.keys(options.wiki.getTagMap());\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all/tiddlers.js": {
"title": "$:/core/modules/filters/all/tiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all/tiddlers.js\ntype: application/javascript\nmodule-type: allfilteroperator\n\nFilter function for [all[tiddlers]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tiddlers = function(source,prefix,options) {\n\treturn options.wiki.allTitles();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "allfilteroperator"
},
"$:/core/modules/filters/all.js": {
"title": "$:/core/modules/filters/all.js",
"text": "/*\\\ntitle: $:/core/modules/filters/all.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for selecting tiddlers\n\n[all[shadows+tiddlers]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar allFilterOperators;\n\nfunction getAllFilterOperators() {\n\tif(!allFilterOperators) {\n\t\tallFilterOperators = {};\n\t\t$tw.modules.applyMethods(\"allfilteroperator\",allFilterOperators);\n\t}\n\treturn allFilterOperators;\n}\n\n/*\nExport our filter function\n*/\nexports.all = function(source,operator,options) {\n\t// Get our suboperators\n\tvar allFilterOperators = getAllFilterOperators();\n\t// Cycle through the suboperators accumulating their results\n\tvar results = [],\n\t\tsubops = operator.operand.split(\"+\");\n\t// Check for common optimisations\n\tif(subops.length === 1 && subops[0] === \"\") {\n\t\treturn source;\n\t} else if(subops.length === 1 && subops[0] === \"tiddlers\") {\n\t\treturn options.wiki.each;\n\t} else if(subops.length === 1 && subops[0] === \"shadows\") {\n\t\treturn options.wiki.eachShadow;\n\t} else if(subops.length === 2 && subops[0] === \"tiddlers\" && subops[1] === \"shadows\") {\n\t\treturn options.wiki.eachTiddlerPlusShadows;\n\t} else if(subops.length === 2 && subops[0] === \"shadows\" && subops[1] === \"tiddlers\") {\n\t\treturn options.wiki.eachShadowPlusTiddlers;\n\t}\n\t// Do it the hard way\n\tfor(var t=0; t<subops.length; t++) {\n\t\tvar subop = allFilterOperators[subops[t]];\n\t\tif(subop) {\n\t\t\t$tw.utils.pushTop(results,subop(source,operator.prefix,options));\n\t\t}\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/backlinks.js": {
"title": "$:/core/modules/filters/backlinks.js",
"text": "/*\\\ntitle: $:/core/modules/filters/backlinks.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning all the backlinks from a tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.backlinks = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\t$tw.utils.pushTop(results,options.wiki.getTiddlerBacklinks(title));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/before.js": {
"title": "$:/core/modules/filters/before.js",
"text": "/*\\\ntitle: $:/core/modules/filters/before.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the tiddler from the current list that is before the tiddler named in the operand.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.before = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\tvar index = results.indexOf(operator.operand);\n\tif(index <= 0) {\n\t\treturn [];\n\t} else {\n\t\treturn [results[index - 1]];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/commands.js": {
"title": "$:/core/modules/filters/commands.js",
"text": "/*\\\ntitle: $:/core/modules/filters/commands.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the commands available in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.commands = function(source,operator,options) {\n\tvar results = [];\n\t$tw.utils.each($tw.commands,function(commandInfo,name) {\n\t\tresults.push(name);\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/compare.js": {
"title": "$:/core/modules/filters/compare.js",
"text": "/*\\\ntitle: $:/core/modules/filters/compare.js\ntype: application/javascript\nmodule-type: filteroperator\n\nGeneral purpose comparison operator\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.compare = function(source,operator,options) {\n\tvar suffixes = operator.suffixes || [],\n\t\ttype = (suffixes[0] || [])[0],\n\t\tmode = (suffixes[1] || [])[0],\n\t\ttypeFn = types[type] || types.number,\n\t\tmodeFn = modes[mode] || modes.eq,\n\t\tinvert = operator.prefix === \"!\",\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tif(modeFn(typeFn(title,operator.operand)) !== invert) {\n\t\t\tresults.push(title);\n\t\t}\n\t});\n\treturn results;\n};\n\nvar types = {\n\t\"number\": function(a,b) {\n\t\treturn compare($tw.utils.parseNumber(a),$tw.utils.parseNumber(b));\n\t},\n\t\"integer\": function(a,b) {\n\t\treturn compare($tw.utils.parseInt(a),$tw.utils.parseInt(b));\n\t},\n\t\"string\": function(a,b) {\n\t\treturn compare(\"\" + a,\"\" +b);\n\t},\n\t\"date\": function(a,b) {\n\t\tvar dateA = $tw.utils.parseDate(a),\n\t\t\tdateB = $tw.utils.parseDate(b);\n\t\tif(!isFinite(dateA)) {\n\t\t\tdateA = new Date(0);\n\t\t}\n\t\tif(!isFinite(dateB)) {\n\t\t\tdateB = new Date(0);\n\t\t}\n\t\treturn compare(dateA,dateB);\n\t},\n\t\"version\": function(a,b) {\n\t\treturn $tw.utils.compareVersions(a,b);\n\t}\n};\n\nfunction compare(a,b) {\n\tif(a > b) {\n\t\treturn +1;\n\t} else if(a < b) {\n\t\treturn -1;\n\t} else {\n\t\treturn 0;\n\t}\n};\n\nvar modes = {\n\t\"eq\": function(value) {return value === 0;},\n\t\"ne\": function(value) {return value !== 0;},\n\t\"gteq\": function(value) {return value >= 0;},\n\t\"gt\": function(value) {return value > 0;},\n\t\"lteq\": function(value) {return value <= 0;},\n\t\"lt\": function(value) {return value < 0;}\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/contains.js": {
"title": "$:/core/modules/filters/contains.js",
"text": "/*\\\ntitle: $:/core/modules/filters/contains.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for finding values in array fields\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.contains = function(source,operator,options) {\n\tvar results = [],\n\t\tfieldname = (operator.suffix || \"list\").toLowerCase();\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler) {\n\t\t\t\tvar list = tiddler.getFieldList(fieldname);\n\t\t\t\tif(list.indexOf(operator.operand) === -1) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler) {\n\t\t\t\tvar list = tiddler.getFieldList(fieldname);\n\t\t\t\tif(list.indexOf(operator.operand) !== -1) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/count.js": {
"title": "$:/core/modules/filters/count.js",
"text": "/*\\\ntitle: $:/core/modules/filters/count.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the number of entries in the current list.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.count = function(source,operator,options) {\n\tvar count = 0;\n\tsource(function(tiddler,title) {\n\t\tcount++;\n\t});\n\treturn [count + \"\"];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/days.js": {
"title": "$:/core/modules/filters/days.js",
"text": "/*\\\ntitle: $:/core/modules/filters/days.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that selects tiddlers with a specified date field within a specified date interval.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.days = function(source,operator,options) {\n\tvar results = [],\n\t\tfieldName = operator.suffix || \"modified\",\n\t\tdayInterval = (parseInt(operator.operand,10)||0),\n\t\tdayIntervalSign = $tw.utils.sign(dayInterval),\n\t\ttargetTimeStamp = (new Date()).setHours(0,0,0,0) + 1000*60*60*24*dayInterval,\n\t\tisWithinDays = function(dateField) {\n\t\t\tvar sign = $tw.utils.sign(targetTimeStamp - (new Date(dateField)).setHours(0,0,0,0));\n\t\t\treturn sign === 0 || sign === dayIntervalSign;\n\t\t};\n\n\tif(operator.prefix === \"!\") {\n\t\ttargetTimeStamp = targetTimeStamp - 1000*60*60*24*dayIntervalSign;\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler && tiddler.fields[fieldName]) {\n\t\t\t\tif(!isWithinDays($tw.utils.parseDate(tiddler.fields[fieldName]))) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler && tiddler.fields[fieldName]) {\n\t\t\t\tif(isWithinDays($tw.utils.parseDate(tiddler.fields[fieldName]))) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/each.js": {
"title": "$:/core/modules/filters/each.js",
"text": "/*\\\ntitle: $:/core/modules/filters/each.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that selects one tiddler for each unique value of the specified field.\nWith suffix \"list\", selects all tiddlers that are values in a specified list field.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.each = function(source,operator,options) {\n\tvar results =[] ,\n\tvalue,values = {},\n\tfield = operator.operand || \"title\";\n\tif(operator.suffix === \"value\" && field === \"title\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!$tw.utils.hop(values,title)) {\n\t\t\t\tvalues[title] = true;\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else if(operator.suffix !== \"list-item\") {\n\t\tif(field === \"title\") {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler && !$tw.utils.hop(values,title)) {\n\t\t\t\t\tvalues[title] = true;\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler) {\n\t\t\t\t\tvalue = tiddler.getFieldString(field);\n\t\t\t\t\tif(!$tw.utils.hop(values,value)) {\n\t\t\t\t\t\tvalues[value] = true;\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler) {\n\t\t\t\t$tw.utils.each(\n\t\t\t\t\toptions.wiki.getTiddlerList(title,field),\n\t\t\t\t\tfunction(value) {\n\t\t\t\t\t\tif(!$tw.utils.hop(values,value)) {\n\t\t\t\t\t\t\tvalues[value] = true;\n\t\t\t\t\t\t\tresults.push(value);\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/eachday.js": {
"title": "$:/core/modules/filters/eachday.js",
"text": "/*\\\ntitle: $:/core/modules/filters/eachday.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that selects one tiddler for each unique day covered by the specified date field\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.eachday = function(source,operator,options) {\n\tvar results = [],\n\t\tvalues = [],\n\t\tfieldName = operator.operand || \"modified\";\n\t// Function to convert a date/time to a date integer\n\tvar toDate = function(value) {\n\t\tvalue = (new Date(value)).setHours(0,0,0,0);\n\t\treturn value+0;\n\t};\n\tsource(function(tiddler,title) {\n\t\tif(tiddler && tiddler.fields[fieldName]) {\n\t\t\tvar value = toDate($tw.utils.parseDate(tiddler.fields[fieldName]));\n\t\t\tif(values.indexOf(value) === -1) {\n\t\t\t\tvalues.push(value);\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/editiondescription.js": {
"title": "$:/core/modules/filters/editiondescription.js",
"text": "/*\\\ntitle: $:/core/modules/filters/editiondescription.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the descriptions of the specified edition names\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.editiondescription = function(source,operator,options) {\n\tvar results = [],\n\t\teditionInfo = $tw.utils.getEditionInfo();\n\tif(editionInfo) {\n\t\tsource(function(tiddler,title) {\n\t\t\tif($tw.utils.hop(editionInfo,title)) {\n\t\t\t\tresults.push(editionInfo[title].description || \"\");\t\t\t\t\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/editions.js": {
"title": "$:/core/modules/filters/editions.js",
"text": "/*\\\ntitle: $:/core/modules/filters/editions.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the available editions in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.editions = function(source,operator,options) {\n\tvar results = [],\n\t\teditionInfo = $tw.utils.getEditionInfo();\n\tif(editionInfo) {\n\t\t$tw.utils.each(editionInfo,function(info,name) {\n\t\t\tresults.push(name);\n\t\t});\n\t}\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/else.js": {
"title": "$:/core/modules/filters/else.js",
"text": "/*\\\ntitle: $:/core/modules/filters/else.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for replacing an empty input list with a constant, passing a non-empty input list straight through\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.else = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\tif(results.length === 0) {\n\t\treturn [operator.operand];\n\t} else {\n\t\treturn results;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/decodeuricomponent.js": {
"title": "$:/core/modules/filters/decodeuricomponent.js",
"text": "/*\\\ntitle: $:/core/modules/filters/decodeuricomponent.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for applying decodeURIComponent() to each item.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter functions\n*/\n\nexports.decodeuricomponent = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar value = title;\n\t\ttry {\n\t\t\tvalue = decodeURIComponent(title);\n\t\t} catch(e) {\n\t\t}\n\t\tresults.push(value);\n\t});\n\treturn results;\n};\n\nexports.encodeuricomponent = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(encodeURIComponent(title));\n\t});\n\treturn results;\n};\n\nexports.decodeuri = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar value = title;\n\t\ttry {\n\t\t\tvalue = decodeURI(title);\n\t\t} catch(e) {\n\t\t}\n\t\tresults.push(value);\n\t});\n\treturn results;\n};\n\nexports.encodeuri = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(encodeURI(title));\n\t});\n\treturn results;\n};\n\nexports.decodehtml = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push($tw.utils.htmlDecode(title));\n\t});\n\treturn results;\n};\n\nexports.encodehtml = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push($tw.utils.htmlEncode(title));\n\t});\n\treturn results;\n};\n\nexports.stringify = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push($tw.utils.stringify(title));\n\t});\n\treturn results;\n};\n\nexports.jsonstringify = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push($tw.utils.jsonStringify(title));\n\t});\n\treturn results;\n};\n\nexports.escaperegexp = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push($tw.utils.escapeRegExp(title));\n\t});\n\treturn results;\n};\n\nexports.escapecss = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\t// escape any character with a special meaning in CSS using CSS.escape()\n\t\tresults.push(CSS.escape(title));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/enlist.js": {
"title": "$:/core/modules/filters/enlist.js",
"text": "/*\\\ntitle: $:/core/modules/filters/enlist.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning its operand parsed as a list\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.enlist = function(source,operator,options) {\n\tvar allowDuplicates = false;\n\tswitch(operator.suffix) {\n\t\tcase \"raw\":\n\t\t\tallowDuplicates = true;\n\t\t\tbreak;\n\t\tcase \"dedupe\":\n\t\t\tallowDuplicates = false;\n\t\t\tbreak;\n\t}\n\tvar list = $tw.utils.parseStringArray(operator.operand,allowDuplicates);\n\tif(operator.prefix === \"!\") {\n\t\tvar results = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tif(list.indexOf(title) === -1) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t\treturn results;\n\t} else {\n\t\treturn list;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/field.js": {
"title": "$:/core/modules/filters/field.js",
"text": "/*\\\ntitle: $:/core/modules/filters/field.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for comparing fields for equality\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.field = function(source,operator,options) {\n\tvar results = [],indexedResults,\n\t\tfieldname = (operator.suffix || operator.operator || \"title\").toLowerCase();\n\tif(operator.prefix === \"!\") {\n\t\tif(operator.regexp) {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler) {\n\t\t\t\t\tvar text = tiddler.getFieldString(fieldname);\n\t\t\t\t\tif(text !== null && !operator.regexp.exec(text)) {\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler) {\n\t\t\t\t\tvar text = tiddler.getFieldString(fieldname);\n\t\t\t\t\tif(text !== null && text !== operator.operand) {\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t} else {\n\t\tif(operator.regexp) {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler) {\n\t\t\t\t\tvar text = tiddler.getFieldString(fieldname);\n\t\t\t\t\tif(text !== null && !!operator.regexp.exec(text)) {\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tif(source.byField && operator.operand) {\n\t\t\t\tindexedResults = source.byField(fieldname,operator.operand);\n\t\t\t\tif(indexedResults) {\n\t\t\t\t\treturn indexedResults\n\t\t\t\t}\n\t\t\t}\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler) {\n\t\t\t\t\tvar text = tiddler.getFieldString(fieldname);\n\t\t\t\t\tif(text !== null && text === operator.operand) {\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/fields.js": {
"title": "$:/core/modules/filters/fields.js",
"text": "/*\\\ntitle: $:/core/modules/filters/fields.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the fields on the selected tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.fields = function(source,operator,options) {\n\tvar results = [],\n\t\tfieldName,\n\t\tsuffixes = (operator.suffixes || [])[0] || [],\n\t\toperand = $tw.utils.parseStringArray(operator.operand);\n\t\n\tsource(function(tiddler,title) {\n\t\tif(tiddler) {\n\t\t\tif(suffixes.indexOf(\"include\") !== -1) {\n\t\t\t\tfor(fieldName in tiddler.fields) {\n\t\t\t\t\t(operand.indexOf(fieldName) !== -1) ? $tw.utils.pushTop(results,fieldName) : \"\";\n\t\t\t\t}\n\t\t\t} else if (suffixes.indexOf(\"exclude\") !== -1) {\n\t\t\t\tfor(fieldName in tiddler.fields) {\n\t\t\t\t\t(operand.indexOf(fieldName) !== -1) ? \"\" : $tw.utils.pushTop(results,fieldName);\n\t\t\t\t}\n\t\t\t} // else if\n\t\t\telse {\n\t\t\t\tfor(fieldName in tiddler.fields) {\n\t\t\t\t\t$tw.utils.pushTop(results,fieldName);\n\t\t\t\t}\n\t\t\t} // else\n\t\t} // if (tiddler)\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/get.js": {
"title": "$:/core/modules/filters/get.js",
"text": "/*\\\ntitle: $:/core/modules/filters/get.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for replacing tiddler titles by the value of the field specified in the operand.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.get = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tif(tiddler) {\n\t\t\tvar value = tiddler.getFieldString(operator.operand);\n\t\t\tif(value) {\n\t\t\t\tresults.push(value);\n\t\t\t}\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/getindex.js": {
"title": "$:/core/modules/filters/getindex.js",
"text": "/*\\\ntitle: $:/core/modules/filters/getindex.js\ntype: application/javascript\nmodule-type: filteroperator\n\nreturns the value at a given index of datatiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.getindex = function(source,operator,options) {\n\tvar data,title,results = [];\n\tif(operator.operand){\n\t\tsource(function(tiddler,title) {\n\t\t\ttitle = tiddler ? tiddler.fields.title : title;\n\t\t\tdata = options.wiki.extractTiddlerDataItem(tiddler,operator.operand);\n\t\t\tif(data) {\n\t\t\t\tresults.push(data);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/getvariable.js": {
"title": "$:/core/modules/filters/getvariable.js",
"text": "/*\\\ntitle: $:/core/modules/filters/getvariable.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for replacing input values by the value of the variable with the same name, or blank if the variable is missing\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.getvariable = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(options.widget.getVariable(title) || \"\");\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/has.js": {
"title": "$:/core/modules/filters/has.js",
"text": "/*\\\ntitle: $:/core/modules/filters/has.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking if a tiddler has the specified field or index\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.has = function(source,operator,options) {\n\tvar results = [],\n\t\tinvert = operator.prefix === \"!\";\n\n\tif(operator.suffix === \"field\") {\n\t\tif(invert) {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(!tiddler || (tiddler && (!$tw.utils.hop(tiddler.fields,operator.operand)))) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler && $tw.utils.hop(tiddler.fields,operator.operand)) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t}\n\telse if(operator.suffix === \"index\") {\n\t\tif(invert) {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(!tiddler || (tiddler && (!$tw.utils.hop($tw.wiki.getTiddlerDataCached(tiddler,Object.create(null)),operator.operand)))) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler && $tw.utils.hop($tw.wiki.getTiddlerDataCached(tiddler,Object.create(null)),operator.operand)) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t}\n\telse {\n\t\tif(invert) {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(!tiddler || !$tw.utils.hop(tiddler.fields,operator.operand) || (tiddler.fields[operator.operand] === \"\")) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddler && $tw.utils.hop(tiddler.fields,operator.operand) && !(tiddler.fields[operator.operand] === \"\" || tiddler.fields[operator.operand].length === 0)) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\t\t\t\t\n\t\t}\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/haschanged.js": {
"title": "$:/core/modules/filters/haschanged.js",
"text": "/*\\\ntitle: $:/core/modules/filters/haschanged.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returns tiddlers from the list that have a non-zero changecount.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.haschanged = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.getChangeCount(title) === 0) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.getChangeCount(title) > 0) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/indexes.js": {
"title": "$:/core/modules/filters/indexes.js",
"text": "/*\\\ntitle: $:/core/modules/filters/indexes.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the indexes of a data tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.indexes = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar data = options.wiki.getTiddlerDataCached(title);\n\t\tif(data) {\n\t\t\t$tw.utils.pushTop(results,Object.keys(data));\n\t\t}\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/insertbefore.js": {
"title": "$:/core/modules/filters/insertbefore.js",
"text": "/*\\\ntitle: $:/core/modules/filters/insertbefore.js\ntype: application/javascript\nmodule-type: filteroperator\n\nInsert an item before another item in a list\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nOrder a list\n*/\nexports.insertbefore = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\tvar target = options.widget && options.widget.getVariable(operator.suffix || \"currentTiddler\");\n\tif(target !== operator.operand) {\n\t\t// Remove the entry from the list if it is present\n\t\tvar pos = results.indexOf(operator.operand);\n\t\tif(pos !== -1) {\n\t\t\tresults.splice(pos,1);\n\t\t}\n\t\t// Insert the entry before the target marker\n\t\tpos = results.indexOf(target);\n\t\tif(pos !== -1) {\n\t\t\tresults.splice(pos,0,operator.operand);\n\t\t} else {\n\t\t\tresults.push(operator.operand);\n\t\t}\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/is/binary.js": {
"title": "$:/core/modules/filters/is/binary.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/binary.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[binary]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.binary = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.isBinaryTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.isBinaryTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/blank.js": {
"title": "$:/core/modules/filters/is/blank.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/blank.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[blank]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.blank = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!title) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/current.js": {
"title": "$:/core/modules/filters/is/current.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/current.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[current]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.current = function(source,prefix,options) {\n\tvar results = [],\n\t\tcurrTiddlerTitle = options.widget && options.widget.getVariable(\"currentTiddler\");\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title !== currTiddlerTitle) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title === currTiddlerTitle) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/image.js": {
"title": "$:/core/modules/filters/is/image.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/image.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[image]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.image = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.isImageTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.isImageTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/missing.js": {
"title": "$:/core/modules/filters/is/missing.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/missing.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[missing]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.missing = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.tiddlerExists(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.tiddlerExists(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/orphan.js": {
"title": "$:/core/modules/filters/is/orphan.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/orphan.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[orphan]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.orphan = function(source,prefix,options) {\n\tvar results = [],\n\t\torphanTitles = options.wiki.getOrphanTitles();\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(orphanTitles.indexOf(title) === -1) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(orphanTitles.indexOf(title) !== -1) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/shadow.js": {
"title": "$:/core/modules/filters/is/shadow.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/shadow.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[shadow]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.shadow = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.isShadowTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.isShadowTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/system.js": {
"title": "$:/core/modules/filters/is/system.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/system.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[system]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.system = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.isSystemTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.isSystemTiddler(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/tag.js": {
"title": "$:/core/modules/filters/is/tag.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/tag.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[tag]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tag = function(source,prefix,options) {\n\tvar results = [],\n\t\ttagMap = options.wiki.getTagMap();\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!$tw.utils.hop(tagMap,title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif($tw.utils.hop(tagMap,title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/tiddler.js": {
"title": "$:/core/modules/filters/is/tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/tiddler.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[tiddler]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tiddler = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!options.wiki.tiddlerExists(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(options.wiki.tiddlerExists(title)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is/variable.js": {
"title": "$:/core/modules/filters/is/variable.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is/variable.js\ntype: application/javascript\nmodule-type: isfilteroperator\n\nFilter function for [is[variable]]\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.variable = function(source,prefix,options) {\n\tvar results = [];\n\tif(prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!(title in options.widget.variables)) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title in options.widget.variables) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "isfilteroperator"
},
"$:/core/modules/filters/is.js": {
"title": "$:/core/modules/filters/is.js",
"text": "/*\\\ntitle: $:/core/modules/filters/is.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking tiddler properties\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar isFilterOperators;\n\nfunction getIsFilterOperators() {\n\tif(!isFilterOperators) {\n\t\tisFilterOperators = {};\n\t\t$tw.modules.applyMethods(\"isfilteroperator\",isFilterOperators);\n\t}\n\treturn isFilterOperators;\n}\n\n/*\nExport our filter function\n*/\nexports.is = function(source,operator,options) {\n\t// Dispatch to the correct isfilteroperator\n\tvar isFilterOperators = getIsFilterOperators();\n\tif(operator.operand) {\n\t\tvar isFilterOperator = isFilterOperators[operator.operand];\n\t\tif(isFilterOperator) {\n\t\t\treturn isFilterOperator(source,operator.prefix,options);\n\t\t} else {\n\t\t\treturn [$tw.language.getString(\"Error/IsFilterOperator\")];\n\t\t}\n\t} else {\n\t\t// Return all tiddlers if the operand is missing\n\t\tvar results = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tresults.push(title);\n\t\t});\n\t\treturn results;\n\t}\n};\n\n})();",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/limit.js": {
"title": "$:/core/modules/filters/limit.js",
"text": "/*\\\ntitle: $:/core/modules/filters/limit.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for chopping the results to a specified maximum number of entries\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.limit = function(source,operator,options) {\n\tvar results = [];\n\t// Convert to an array\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\t// Slice the array if necessary\n\tvar limit = Math.min(results.length,parseInt(operator.operand,10));\n\tif(operator.prefix === \"!\") {\n\t\tresults = results.slice(-limit);\n\t} else {\n\t\tresults = results.slice(0,limit);\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/links.js": {
"title": "$:/core/modules/filters/links.js",
"text": "/*\\\ntitle: $:/core/modules/filters/links.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning all the links from a tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.links = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\t$tw.utils.pushTop(results,options.wiki.getTiddlerLinks(title));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/list.js": {
"title": "$:/core/modules/filters/list.js",
"text": "/*\\\ntitle: $:/core/modules/filters/list.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the tiddlers whose title is listed in the operand tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.list = function(source,operator,options) {\n\tvar results = [],\n\t\ttr = $tw.utils.parseTextReference(operator.operand),\n\t\tcurrTiddlerTitle = options.widget && options.widget.getVariable(\"currentTiddler\"),\n\t\tlist = options.wiki.getTiddlerList(tr.title || currTiddlerTitle,tr.field,tr.index);\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(list.indexOf(title) === -1) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tresults = list;\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/listed.js": {
"title": "$:/core/modules/filters/listed.js",
"text": "/*\\\ntitle: $:/core/modules/filters/listed.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning all tiddlers that have the selected tiddlers in a list\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.listed = function(source,operator,options) {\n\tvar field = operator.operand || \"list\",\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\t$tw.utils.pushTop(results,options.wiki.findListingsOfTiddler(title,field));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/listops.js": {
"title": "$:/core/modules/filters/listops.js",
"text": "/*\\\ntitle: $:/core/modules/filters/listops.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operators for manipulating the current selection list\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nOrder a list\n*/\nexports.order = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.operand.toLowerCase() === \"reverse\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tresults.unshift(title);\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tresults.push(title);\n\t\t});\n\t}\n\treturn results;\n};\n\n/*\nReverse list\n*/\nexports.reverse = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.unshift(title);\n\t});\n\treturn results;\n};\n\n/*\nFirst entry/entries in list\n*/\nexports.first = function(source,operator,options) {\n\tvar count = $tw.utils.getInt(operator.operand,1),\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results.slice(0,count);\n};\n\n/*\nLast entry/entries in list\n*/\nexports.last = function(source,operator,options) {\n\tvar count = $tw.utils.getInt(operator.operand,1),\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results.slice(-count);\n};\n\n/*\nAll but the first entry/entries of the list\n*/\nexports.rest = function(source,operator,options) {\n\tvar count = $tw.utils.getInt(operator.operand,1),\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results.slice(count);\n};\nexports.butfirst = exports.rest;\nexports.bf = exports.rest;\n\n/*\nAll but the last entry/entries of the list\n*/\nexports.butlast = function(source,operator,options) {\n\tvar count = $tw.utils.getInt(operator.operand,1),\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results.slice(0,-count);\n};\nexports.bl = exports.butlast;\n\n/*\nThe nth member of the list\n*/\nexports.nth = function(source,operator,options) {\n\tvar count = $tw.utils.getInt(operator.operand,1),\n\t\tresults = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results.slice(count - 1,count);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/lookup.js": {
"title": "$:/core/modules/filters/lookup.js",
"text": "/*\\\ntitle: $:/core/modules/filters/lookup.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that looks up values via a title prefix\n\n[lookup:<field>[<prefix>]]\n\nPrepends the prefix to the selected items and returns the specified field value\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.lookup = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(options.wiki.getTiddlerText(operator.operand + title) || options.wiki.getTiddlerText(operator.operand + operator.suffix));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/match.js": {
"title": "$:/core/modules/filters/match.js",
"text": "/*\\\ntitle: $:/core/modules/filters/match.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking if a title matches a string\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.match = function(source,operator,options) {\n\tvar results = [],\n\t\tsuffixes = (operator.suffixes || [])[0] || [];\n\tif(suffixes.indexOf(\"caseinsensitive\") !== -1) {\n\t\tif(operator.prefix === \"!\") {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(title.toLowerCase() !== (operator.operand || \"\").toLowerCase()) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(title.toLowerCase() === (operator.operand || \"\").toLowerCase()) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t} else {\n\t\tif(operator.prefix === \"!\") {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(title !== operator.operand) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(title === operator.operand) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/math.js": {
"title": "$:/core/modules/filters/math.js",
"text": "/*\\\ntitle: $:/core/modules/filters/math.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operators for math. Unary/binary operators work on each item in turn, and return a new item list.\n\nSum/product/maxall/minall operate on the entire list, returning a single item.\n\nNote that strings are converted to numbers automatically. Trailing non-digits are ignored.\n\n* \"\" converts to 0\n* \"12kk\" converts to 12\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.negate = makeNumericBinaryOperator(\n\tfunction(a) {return -a}\n);\n\nexports.abs = makeNumericBinaryOperator(\n\tfunction(a) {return Math.abs(a)}\n);\n\nexports.ceil = makeNumericBinaryOperator(\n\tfunction(a) {return Math.ceil(a)}\n);\n\nexports.floor = makeNumericBinaryOperator(\n\tfunction(a) {return Math.floor(a)}\n);\n\nexports.round = makeNumericBinaryOperator(\n\tfunction(a) {return Math.round(a)}\n);\n\nexports.trunc = makeNumericBinaryOperator(\n\tfunction(a) {return Math.trunc(a)}\n);\n\nexports.untrunc = makeNumericBinaryOperator(\n\tfunction(a) {return Math.ceil(Math.abs(a)) * Math.sign(a)}\n);\n\nexports.sign = makeNumericBinaryOperator(\n\tfunction(a) {return Math.sign(a)}\n);\n\nexports.add = makeNumericBinaryOperator(\n\tfunction(a,b) {return a + b;}\n);\n\nexports.subtract = makeNumericBinaryOperator(\n\tfunction(a,b) {return a - b;}\n);\n\nexports.multiply = makeNumericBinaryOperator(\n\tfunction(a,b) {return a * b;}\n);\n\nexports.divide = makeNumericBinaryOperator(\n\tfunction(a,b) {return a / b;}\n);\n\nexports.remainder = makeNumericBinaryOperator(\n\tfunction(a,b) {return a % b;}\n);\n\nexports.max = makeNumericBinaryOperator(\n\tfunction(a,b) {return Math.max(a,b);}\n);\n\nexports.min = makeNumericBinaryOperator(\n\tfunction(a,b) {return Math.min(a,b);}\n);\n\nexports.fixed = makeNumericBinaryOperator(\n\tfunction(a,b) {return Number.prototype.toFixed.call(a,Math.min(Math.max(b,0),100));}\n);\n\nexports.precision = makeNumericBinaryOperator(\n\tfunction(a,b) {return Number.prototype.toPrecision.call(a,Math.min(Math.max(b,1),100));}\n);\n\nexports.exponential = makeNumericBinaryOperator(\n\tfunction(a,b) {return Number.prototype.toExponential.call(a,Math.min(Math.max(b,0),100));}\n);\n\nexports.sum = makeNumericReducingOperator(\n\tfunction(accumulator,value) {return accumulator + value},\n\t0 // Initial value\n);\n\nexports.product = makeNumericReducingOperator(\n\tfunction(accumulator,value) {return accumulator * value},\n\t1 // Initial value\n);\n\nexports.maxall = makeNumericReducingOperator(\n\tfunction(accumulator,value) {return Math.max(accumulator,value)},\n\t-Infinity // Initial value\n);\n\nexports.minall = makeNumericReducingOperator(\n\tfunction(accumulator,value) {return Math.min(accumulator,value)},\n\tInfinity // Initial value\n);\n\nfunction makeNumericBinaryOperator(fnCalc) {\n\treturn function(source,operator,options) {\n\t\tvar result = [],\n\t\t\tnumOperand = $tw.utils.parseNumber(operator.operand);\n\t\tsource(function(tiddler,title) {\n\t\t\tresult.push($tw.utils.stringifyNumber(fnCalc($tw.utils.parseNumber(title),numOperand)));\n\t\t});\n\t\treturn result;\n\t};\n}\n\nfunction makeNumericReducingOperator(fnCalc,initialValue) {\n\tinitialValue = initialValue || 0;\n\treturn function(source,operator,options) {\n\t\tvar result = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tresult.push(title);\n\t\t});\n\t\treturn [$tw.utils.stringifyNumber(result.reduce(function(accumulator,currentValue) {\n\t\t\treturn fnCalc(accumulator,$tw.utils.parseNumber(currentValue));\n\t\t},initialValue))];\n\t};\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/minlength.js": {
"title": "$:/core/modules/filters/minlength.js",
"text": "/*\\\ntitle: $:/core/modules/filters/minlength.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for filtering out titles that don't meet the minimum length in the operand\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.minlength = function(source,operator,options) {\n\tvar results = [],\n\t\tminLength = parseInt(operator.operand || \"\",10) || 0;\n\tsource(function(tiddler,title) {\n\t\tif(title.length >= minLength) {\n\t\t\tresults.push(title);\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/modules.js": {
"title": "$:/core/modules/filters/modules.js",
"text": "/*\\\ntitle: $:/core/modules/filters/modules.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the titles of the modules of a given type in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.modules = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\t$tw.utils.each($tw.modules.types[title],function(moduleInfo,moduleName) {\n\t\t\tresults.push(moduleName);\n\t\t});\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/moduletypes.js": {
"title": "$:/core/modules/filters/moduletypes.js",
"text": "/*\\\ntitle: $:/core/modules/filters/moduletypes.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the module types in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.moduletypes = function(source,operator,options) {\n\tvar results = [];\n\t$tw.utils.each($tw.modules.types,function(moduleInfo,type) {\n\t\tresults.push(type);\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/next.js": {
"title": "$:/core/modules/filters/next.js",
"text": "/*\\\ntitle: $:/core/modules/filters/next.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the tiddler whose title occurs next in the list supplied in the operand tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.next = function(source,operator,options) {\n\tvar results = [],\n\t\tlist = options.wiki.getTiddlerList(operator.operand);\n\tsource(function(tiddler,title) {\n\t\tvar match = list.indexOf(title);\n\t\t// increment match and then test if result is in range\n\t\tmatch++;\n\t\tif(match > 0 && match < list.length) {\n\t\t\tresults.push(list[match]);\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/plugintiddlers.js": {
"title": "$:/core/modules/filters/plugintiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/filters/plugintiddlers.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the titles of the shadow tiddlers within a plugin\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.plugintiddlers = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar pluginInfo = options.wiki.getPluginInfo(title) || options.wiki.getTiddlerDataCached(title,{tiddlers:[]});\n\t\tif(pluginInfo && pluginInfo.tiddlers) {\n\t\t\t$tw.utils.each(pluginInfo.tiddlers,function(fields,title) {\n\t\t\t\tresults.push(title);\n\t\t\t});\n\t\t}\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/prefix.js": {
"title": "$:/core/modules/filters/prefix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/prefix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking if a title starts with a prefix\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.prefix = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title.substr(0,operator.operand.length) !== operator.operand) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title.substr(0,operator.operand.length) === operator.operand) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/previous.js": {
"title": "$:/core/modules/filters/previous.js",
"text": "/*\\\ntitle: $:/core/modules/filters/previous.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning the tiddler whose title occurs immediately prior in the list supplied in the operand tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.previous = function(source,operator,options) {\n\tvar results = [],\n\t\tlist = options.wiki.getTiddlerList(operator.operand);\n\tsource(function(tiddler,title) {\n\t\tvar match = list.indexOf(title);\n\t\t// increment match and then test if result is in range\n\t\tmatch--;\n\t\tif(match >= 0) {\n\t\t\tresults.push(list[match]);\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/range.js": {
"title": "$:/core/modules/filters/range.js",
"text": "/*\\\ntitle: $:/core/modules/filters/range.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for generating a numeric range.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.range = function(source,operator,options) {\n\tvar results = [];\n\t// Split the operand into numbers delimited by these symbols\n\tvar parts = operator.operand.split(/[,:;]/g),\n\t\tbeg, end, inc, i, fixed = 0;\n\tfor (i=0; i<parts.length; i++) {\n\t\t// Validate real number\n\t\tif(!/^\\s*[+-]?((\\d+(\\.\\d*)?)|(\\.\\d+))\\s*$/.test(parts[i])) {\n\t\t\treturn [\"range: bad number \\\"\" + parts[i] + \"\\\"\"];\n\t\t}\n\t\t// Count digits; the most precise number determines decimal places in output.\n\t\tvar frac = /\\.\\d+/.exec(parts[i]);\n\t\tif(frac) {\n\t\t\tfixed = Math.max(fixed,frac[0].length-1);\n\t\t}\n\t\tparts[i] = parseFloat(parts[i]);\n\t}\n\tswitch(parts.length) {\n\t\tcase 1:\n\t\t\tend = parts[0];\n\t\t\tif (end >= 1) {\n\t\t\t\tbeg = 1;\n\t\t\t}\n\t\t\telse if (end <= -1) {\n\t\t\t\tbeg = -1;\n\t\t\t}\n\t\t\telse {\n\t\t\t\treturn [];\n\t\t\t}\n\t\t\tinc = 1;\n\t\t\tbreak;\n\t\tcase 2:\n\t\t\tbeg = parts[0];\n\t\t\tend = parts[1];\n\t\t\tinc = 1;\n\t\t\tbreak;\n\t\tcase 3:\n\t\t\tbeg = parts[0];\n\t\t\tend = parts[1];\n\t\t\tinc = Math.abs(parts[2]);\n\t\t\tbreak;\n\t}\n\tif(inc === 0) {\n\t\treturn [\"range: increment 0 causes infinite loop\"];\n\t}\n\t// May need to count backwards\n\tvar direction = ((end < beg) ? -1 : 1);\n\tinc *= direction;\n\t// Estimate number of resulting elements\n\tif((end - beg) / inc > 10000) {\n\t\treturn [\"range: too many steps (over 10K)\"];\n\t}\n\t// Avoid rounding error on last step\n\tend += direction * 0.5 * Math.pow(0.1,fixed);\n\tvar safety = 10010;\n\t// Enumerate the range\n\tif (end<beg) {\n\t\tfor(i=beg; i>end; i+=inc) {\n\t\t\tresults.push(i.toFixed(fixed));\n\t\t\tif(--safety<0) {\n\t\t\t\tbreak;\n\t\t\t}\n\t\t}\n\t} else {\n\t\tfor(i=beg; i<end; i+=inc) {\n\t\t\tresults.push(i.toFixed(fixed));\n\t\t\tif(--safety<0) {\n\t\t\t\tbreak;\n\t\t\t}\n\t\t}\n\t}\n\tif(safety<0) {\n\t\treturn [\"range: unexpectedly large output\"];\n\t}\n\t// Reverse?\n\tif(operator.prefix === \"!\") {\n\t\tresults.reverse();\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/regexp.js": {
"title": "$:/core/modules/filters/regexp.js",
"text": "/*\\\ntitle: $:/core/modules/filters/regexp.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for regexp matching\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.regexp = function(source,operator,options) {\n\tvar results = [],\n\t\tfieldname = (operator.suffix || \"title\").toLowerCase(),\n\t\tregexpString, regexp, flags = \"\", match,\n\t\tgetFieldString = function(tiddler,title) {\n\t\t\tif(tiddler) {\n\t\t\t\treturn tiddler.getFieldString(fieldname);\n\t\t\t} else if(fieldname === \"title\") {\n\t\t\t\treturn title;\n\t\t\t} else {\n\t\t\t\treturn null;\n\t\t\t}\n\t\t};\n\t// Process flags and construct regexp\n\tregexpString = operator.operand;\n\tmatch = /^\\(\\?([gim]+)\\)/.exec(regexpString);\n\tif(match) {\n\t\tflags = match[1];\n\t\tregexpString = regexpString.substr(match[0].length);\n\t} else {\n\t\tmatch = /\\(\\?([gim]+)\\)$/.exec(regexpString);\n\t\tif(match) {\n\t\t\tflags = match[1];\n\t\t\tregexpString = regexpString.substr(0,regexpString.length - match[0].length);\n\t\t}\n\t}\n\ttry {\n\t\tregexp = new RegExp(regexpString,flags);\n\t} catch(e) {\n\t\treturn [\"\" + e];\n\t}\n\t// Process the incoming tiddlers\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tvar text = getFieldString(tiddler,title);\n\t\t\tif(text !== null) {\n\t\t\t\tif(!regexp.exec(text)) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tvar text = getFieldString(tiddler,title);\n\t\t\tif(text !== null) {\n\t\t\t\tif(!!regexp.exec(text)) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/removeprefix.js": {
"title": "$:/core/modules/filters/removeprefix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/removeprefix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for removing a prefix from each title in the list. Titles that do not start with the prefix are removed.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.removeprefix = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tif(title.substr(0,operator.operand.length) === operator.operand) {\n\t\t\tresults.push(title.substr(operator.operand.length));\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/removesuffix.js": {
"title": "$:/core/modules/filters/removesuffix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/removesuffix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for removing a suffix from each title in the list. Titles that do not end with the suffix are removed.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.removesuffix = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tif(title && title.substr(-operator.operand.length) === operator.operand) {\n\t\t\tresults.push(title.substr(0,title.length - operator.operand.length));\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/sameday.js": {
"title": "$:/core/modules/filters/sameday.js",
"text": "/*\\\ntitle: $:/core/modules/filters/sameday.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that selects tiddlers with a modified date field on the same day as the provided value.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.sameday = function(source,operator,options) {\n\tvar results = [],\n\t\tfieldName = operator.suffix || \"modified\",\n\t\ttargetDate = (new Date($tw.utils.parseDate(operator.operand))).setHours(0,0,0,0);\n\t// Function to convert a date/time to a date integer\n\tsource(function(tiddler,title) {\n\t\tif(tiddler) {\n\t\t\tif(tiddler.getFieldDay(fieldName) === targetDate) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/search.js": {
"title": "$:/core/modules/filters/search.js",
"text": "/*\\\ntitle: $:/core/modules/filters/search.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for searching for the text in the operand tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.search = function(source,operator,options) {\n\tvar invert = operator.prefix === \"!\";\n\tif(operator.suffixes) {\n\t\tvar hasFlag = function(flag) {\n\t\t\t\treturn (operator.suffixes[1] || []).indexOf(flag) !== -1;\n\t\t\t},\n\t\t\texcludeFields = false,\n\t\t\tfieldList = operator.suffixes[0] || [],\n\t\t\tfirstField = fieldList[0] || \"\", \n\t\t\tfirstChar = firstField.charAt(0),\n\t\t\tfields;\n\t\tif(firstChar === \"-\") {\n\t\t\tfields = [firstField.slice(1)].concat(fieldList.slice(1));\n\t\t\texcludeFields = true;\n\t\t} else if(fieldList[0] === \"*\"){\n\t\t\tfields = [];\n\t\t\texcludeFields = true;\n\t\t} else {\n\t\t\tfields = fieldList.slice(0);\n\t\t}\n\t\treturn options.wiki.search(operator.operand,{\n\t\t\tsource: source,\n\t\t\tinvert: invert,\n\t\t\tfield: fields,\n\t\t\texcludeField: excludeFields,\n\t\t\tcaseSensitive: hasFlag(\"casesensitive\"),\n\t\t\tliteral: hasFlag(\"literal\"),\n\t\t\twhitespace: hasFlag(\"whitespace\"),\n\t\t\tanchored: hasFlag(\"anchored\"),\n\t\t\tregexp: hasFlag(\"regexp\"),\n\t\t\twords: hasFlag(\"words\")\n\t\t});\n\t} else {\n\t\treturn options.wiki.search(operator.operand,{\n\t\t\tsource: source,\n\t\t\tinvert: invert\n\t\t});\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/shadowsource.js": {
"title": "$:/core/modules/filters/shadowsource.js",
"text": "/*\\\ntitle: $:/core/modules/filters/shadowsource.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the source plugins for shadow tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.shadowsource = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar source = options.wiki.getShadowSource(title);\n\t\tif(source) {\n\t\t\t$tw.utils.pushTop(results,source);\n\t\t}\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/sort.js": {
"title": "$:/core/modules/filters/sort.js",
"text": "/*\\\ntitle: $:/core/modules/filters/sort.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for sorting\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.sort = function(source,operator,options) {\n\tvar results = prepare_results(source);\n\toptions.wiki.sortTiddlers(results,operator.operand || \"title\",operator.prefix === \"!\",false,false);\n\treturn results;\n};\n\nexports.nsort = function(source,operator,options) {\n\tvar results = prepare_results(source);\n\toptions.wiki.sortTiddlers(results,operator.operand || \"title\",operator.prefix === \"!\",false,true);\n\treturn results;\n};\n\nexports.sortan = function(source, operator, options) {\n\tvar results = prepare_results(source);\n\toptions.wiki.sortTiddlers(results, operator.operand || \"title\", operator.prefix === \"!\",false,false,true);\n\treturn results;\n};\n\nexports.sortcs = function(source,operator,options) {\n\tvar results = prepare_results(source);\n\toptions.wiki.sortTiddlers(results,operator.operand || \"title\",operator.prefix === \"!\",true,false);\n\treturn results;\n};\n\nexports.nsortcs = function(source,operator,options) {\n\tvar results = prepare_results(source);\n\toptions.wiki.sortTiddlers(results,operator.operand || \"title\",operator.prefix === \"!\",true,true);\n\treturn results;\n};\n\nvar prepare_results = function (source) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(title);\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/splitbefore.js": {
"title": "$:/core/modules/filters/splitbefore.js",
"text": "/*\\\ntitle: $:/core/modules/filters/splitbefore.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator that splits each result on the first occurance of the specified separator and returns the unique values.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.splitbefore = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar parts = title.split(operator.operand);\n\t\tif(parts.length === 1) {\n\t\t\t$tw.utils.pushTop(results,parts[0]);\n\t\t} else {\n\t\t\t$tw.utils.pushTop(results,parts[0] + operator.operand);\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/storyviews.js": {
"title": "$:/core/modules/filters/storyviews.js",
"text": "/*\\\ntitle: $:/core/modules/filters/storyviews.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the story views in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.storyviews = function(source,operator,options) {\n\tvar results = [],\n\t\tstoryviews = {};\n\t$tw.modules.applyMethods(\"storyview\",storyviews);\n\t$tw.utils.each(storyviews,function(info,name) {\n\t\tresults.push(name);\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/strings.js": {
"title": "$:/core/modules/filters/strings.js",
"text": "/*\\\ntitle: $:/core/modules/filters/strings.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operators for strings. Unary/binary operators work on each item in turn, and return a new item list.\n\nSum/product/maxall/minall operate on the entire list, returning a single item.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.length = makeStringBinaryOperator(\n\tfunction(a) {return [\"\" + (\"\" + a).length];}\n);\n\nexports.uppercase = makeStringBinaryOperator(\n\tfunction(a) {return [(\"\" + a).toUpperCase()];}\n);\n\nexports.lowercase = makeStringBinaryOperator(\n\tfunction(a) {return [(\"\" + a).toLowerCase()];}\n);\n\nexports.sentencecase = makeStringBinaryOperator(\n\tfunction(a) {return [$tw.utils.toSentenceCase(a)];}\n);\n\nexports.titlecase = makeStringBinaryOperator(\n\tfunction(a) {return [$tw.utils.toTitleCase(a)];}\n);\n\nexports.trim = makeStringBinaryOperator(\n\tfunction(a) {return [$tw.utils.trim(a)];}\n);\n\nexports.split = makeStringBinaryOperator(\n\tfunction(a,b) {return (\"\" + a).split(b);}\n);\n\nexports.join = makeStringReducingOperator(\n\tfunction(accumulator,value,operand) {\n\t\tif(accumulator === null) {\n\t\t\treturn value;\n\t\t} else {\n\t\t\treturn accumulator + operand + value;\n\t\t}\n\t},null\n);\n\nfunction makeStringBinaryOperator(fnCalc) {\n\treturn function(source,operator,options) {\n\t\tvar result = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tArray.prototype.push.apply(result,fnCalc(title,operator.operand || \"\"));\n\t\t});\n\t\treturn result;\n\t};\n}\n\nfunction makeStringReducingOperator(fnCalc,initialValue) {\n\treturn function(source,operator,options) {\n\t\tvar result = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tresult.push(title);\n\t\t});\n\t\treturn [result.reduce(function(accumulator,currentValue) {\n\t\t\treturn fnCalc(accumulator,currentValue,operator.operand || \"\");\n\t\t},initialValue) || \"\"];\n\t};\n}\n\nexports.splitregexp = function(source,operator,options) {\n\tvar result = [],\n\t\tsuffix = operator.suffix || \"\",\n\t\tflags = (suffix.indexOf(\"m\") !== -1 ? \"m\" : \"\") + (suffix.indexOf(\"i\") !== -1 ? \"i\" : \"\"),\n\t\tregExp;\n\ttry {\n\t\tregExp = new RegExp(operator.operand || \"\",flags);\t\t\n\t} catch(ex) {\n\t\treturn [\"RegExp error: \" + ex];\n\t}\n\tsource(function(tiddler,title) {\n\t\tArray.prototype.push.apply(result,title.split(regExp));\n\t});\t\t\n\treturn result;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/subfilter.js": {
"title": "$:/core/modules/filters/subfilter.js",
"text": "/*\\\ntitle: $:/core/modules/filters/subfilter.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning its operand evaluated as a filter\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.subfilter = function(source,operator,options) {\n\tvar list = options.wiki.filterTiddlers(operator.operand,options.widget,source);\n\tif(operator.prefix === \"!\") {\n\t\tvar results = [];\n\t\tsource(function(tiddler,title) {\n\t\t\tif(list.indexOf(title) === -1) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t\treturn results;\n\t} else {\n\t\treturn list;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/subtiddlerfields.js": {
"title": "$:/core/modules/filters/subtiddlerfields.js",
"text": "/*\\\ntitle: $:/core/modules/filters/subtiddlerfields.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the fields on the selected subtiddlers of the plugin named in the operand\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.subtiddlerfields = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tvar subtiddler = options.wiki.getSubTiddler(operator.operand,title);\n\t\tif(subtiddler) {\n\t\t\tfor(var fieldName in subtiddler.fields) {\n\t\t\t\t$tw.utils.pushTop(results,fieldName);\n\t\t\t}\n\t\t}\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/suffix.js": {
"title": "$:/core/modules/filters/suffix.js",
"text": "/*\\\ntitle: $:/core/modules/filters/suffix.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking if a title ends with a suffix\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.suffix = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title.substr(-operator.operand.length) !== operator.operand) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(title.substr(-operator.operand.length) === operator.operand) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/tag.js": {
"title": "$:/core/modules/filters/tag.js",
"text": "/*\\\ntitle: $:/core/modules/filters/tag.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for checking for the presence of a tag\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tag = function(source,operator,options) {\n\tvar results = [],indexedResults;\n\tif((operator.suffix || \"\").toLowerCase() === \"strict\" && !operator.operand) {\n\t\t// New semantics:\n\t\t// Always return copy of input if operator.operand is missing\n\t\tsource(function(tiddler,title) {\n\t\t\tresults.push(title);\n\t\t});\n\t} else {\n\t\t// Old semantics:\n\t\tvar tiddlers;\n\t\tif(operator.prefix === \"!\") {\n\t\t\t// Returns a copy of the input if operator.operand is missing\n\t\t\ttiddlers = options.wiki.getTiddlersWithTag(operator.operand);\n\t\t\tsource(function(tiddler,title) {\n\t\t\t\tif(tiddlers.indexOf(title) === -1) {\n\t\t\t\t\tresults.push(title);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\t// Returns empty results if operator.operand is missing\n\t\t\tif(source.byTag) {\n\t\t\t\tindexedResults = source.byTag(operator.operand);\n\t\t\t\tif(indexedResults) {\n\t\t\t\t\treturn indexedResults;\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\ttiddlers = options.wiki.getTiddlersWithTag(operator.operand);\n\t\t\t\tsource(function(tiddler,title) {\n\t\t\t\t\tif(tiddlers.indexOf(title) !== -1) {\n\t\t\t\t\t\tresults.push(title);\n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t\tresults = options.wiki.sortByList(results,operator.operand);\n\t\t\t}\n\t\t}\t\t\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/tagging.js": {
"title": "$:/core/modules/filters/tagging.js",
"text": "/*\\\ntitle: $:/core/modules/filters/tagging.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning all tiddlers that are tagged with the selected tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tagging = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\t$tw.utils.pushTop(results,options.wiki.getTiddlersWithTag(title));\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/tags.js": {
"title": "$:/core/modules/filters/tags.js",
"text": "/*\\\ntitle: $:/core/modules/filters/tags.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning all the tags of the selected tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.tags = function(source,operator,options) {\n\tvar tags = {};\n\tsource(function(tiddler,title) {\n\t\tvar t, length;\n\t\tif(tiddler && tiddler.fields.tags) {\n\t\t\tfor(t=0, length=tiddler.fields.tags.length; t<length; t++) {\n\t\t\t\ttags[tiddler.fields.tags[t]] = true;\n\t\t\t}\n\t\t}\n\t});\n\treturn Object.keys(tags);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/then.js": {
"title": "$:/core/modules/filters/then.js",
"text": "/*\\\ntitle: $:/core/modules/filters/then.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for replacing any titles with a constant\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.then = function(source,operator,options) {\n\tvar results = [];\n\tsource(function(tiddler,title) {\n\t\tresults.push(operator.operand);\n\t});\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/title.js": {
"title": "$:/core/modules/filters/title.js",
"text": "/*\\\ntitle: $:/core/modules/filters/title.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for comparing title fields for equality\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.title = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler && tiddler.fields.title !== operator.operand) {\n\t\t\t\tresults.push(title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tresults.push(operator.operand);\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/untagged.js": {
"title": "$:/core/modules/filters/untagged.js",
"text": "/*\\\ntitle: $:/core/modules/filters/untagged.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator returning all the selected tiddlers that are untagged\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.untagged = function(source,operator,options) {\n\tvar results = [];\n\tif(operator.prefix === \"!\") {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(tiddler && $tw.utils.isArray(tiddler.fields.tags) && tiddler.fields.tags.length > 0) {\n\t\t\t\t$tw.utils.pushTop(results,title);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tsource(function(tiddler,title) {\n\t\t\tif(!tiddler || !tiddler.hasField(\"tags\") || ($tw.utils.isArray(tiddler.fields.tags) && tiddler.fields.tags.length === 0)) {\n\t\t\t\t$tw.utils.pushTop(results,title);\n\t\t\t}\n\t\t});\n\t}\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/variables.js": {
"title": "$:/core/modules/filters/variables.js",
"text": "/*\\\ntitle: $:/core/modules/filters/variables.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the active variables\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.variables = function(source,operator,options) {\n\tvar names = [];\n\tfor(var variable in options.widget.variables) {\n\t\tnames.push(variable);\n\t}\n\treturn names.sort();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/wikiparserrules.js": {
"title": "$:/core/modules/filters/wikiparserrules.js",
"text": "/*\\\ntitle: $:/core/modules/filters/wikiparserrules.js\ntype: application/javascript\nmodule-type: filteroperator\n\nFilter operator for returning the names of the wiki parser rules in this wiki\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nExport our filter function\n*/\nexports.wikiparserrules = function(source,operator,options) {\n\tvar results = [],\n\t\toperand = operator.operand;\n\t$tw.utils.each($tw.modules.types.wikirule,function(mod) {\n\t\tvar exp = mod.exports;\n\t\tif(!operand || exp.types[operand]) {\n\t\t\tresults.push(exp.name);\n\t\t}\n\t});\n\tresults.sort();\n\treturn results;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters/x-listops.js": {
"title": "$:/core/modules/filters/x-listops.js",
"text": "/*\\\ntitle: $:/core/modules/filters/x-listops.js\ntype: application/javascript\nmodule-type: filteroperator\n\nExtended filter operators to manipulate the current list.\n\n\\*/\n(function () {\n\n /*jslint node: true, browser: true */\n /*global $tw: false */\n \"use strict\";\n\n /*\n Fetch titles from the current list\n */\n var prepare_results = function (source) {\n var results = [];\n source(function (tiddler, title) {\n results.push(title);\n });\n return results;\n };\n\n /*\n Moves a number of items from the tail of the current list before the item named in the operand\n */\n exports.putbefore = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand),\n count = $tw.utils.getInt(operator.suffix,1);\n return (index === -1) ?\n results.slice(0, -1) :\n results.slice(0, index).concat(results.slice(-count)).concat(results.slice(index, -count));\n };\n\n /*\n Moves a number of items from the tail of the current list after the item named in the operand\n */\n exports.putafter = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand),\n count = $tw.utils.getInt(operator.suffix,1);\n return (index === -1) ?\n results.slice(0, -1) :\n results.slice(0, index + 1).concat(results.slice(-count)).concat(results.slice(index + 1, -count));\n };\n\n /*\n Replaces the item named in the operand with a number of items from the tail of the current list\n */\n exports.replace = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand),\n count = $tw.utils.getInt(operator.suffix,1);\n return (index === -1) ?\n results.slice(0, -count) :\n results.slice(0, index).concat(results.slice(-count)).concat(results.slice(index + 1, -count));\n };\n\n /*\n Moves a number of items from the tail of the current list to the head of the list\n */\n exports.putfirst = function (source, operator) {\n var results = prepare_results(source),\n count = $tw.utils.getInt(operator.suffix,1);\n return results.slice(-count).concat(results.slice(0, -count));\n };\n\n /*\n Moves a number of items from the head of the current list to the tail of the list\n */\n exports.putlast = function (source, operator) {\n var results = prepare_results(source),\n count = $tw.utils.getInt(operator.suffix,1);\n return results.slice(count).concat(results.slice(0, count));\n };\n\n /*\n Moves the item named in the operand a number of places forward or backward in the list\n */\n exports.move = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand),\n count = $tw.utils.getInt(operator.suffix,1),\n marker = results.splice(index, 1),\n offset = (index + count) > 0 ? index + count : 0;\n return results.slice(0, offset).concat(marker).concat(results.slice(offset));\n };\n\n /*\n Returns the items from the current list that are after the item named in the operand\n */\n exports.allafter = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand);\n return (index === -1) ? [] :\n (operator.suffix) ? results.slice(index) :\n results.slice(index + 1);\n };\n\n /*\n Returns the items from the current list that are before the item named in the operand\n */\n exports.allbefore = function (source, operator) {\n var results = prepare_results(source),\n index = results.indexOf(operator.operand);\n return (index === -1) ? [] :\n (operator.suffix) ? results.slice(0, index + 1) :\n results.slice(0, index);\n };\n\n /*\n Appends the items listed in the operand array to the tail of the current list\n */\n exports.append = function (source, operator) {\n var append = $tw.utils.parseStringArray(operator.operand, \"true\"),\n results = prepare_results(source),\n count = parseInt(operator.suffix) || append.length;\n return (append.length === 0) ? results :\n (operator.prefix) ? results.concat(append.slice(-count)) :\n results.concat(append.slice(0, count));\n };\n\n /*\n Prepends the items listed in the operand array to the head of the current list\n */\n exports.prepend = function (source, operator) {\n var prepend = $tw.utils.parseStringArray(operator.operand, \"true\"),\n results = prepare_results(source),\n count = $tw.utils.getInt(operator.suffix,prepend.length);\n return (prepend.length === 0) ? results :\n (operator.prefix) ? prepend.slice(-count).concat(results) :\n prepend.slice(0, count).concat(results);\n };\n\n /*\n Returns all items from the current list except the items listed in the operand array\n */\n exports.remove = function (source, operator) {\n var array = $tw.utils.parseStringArray(operator.operand, \"true\"),\n results = prepare_results(source),\n count = parseInt(operator.suffix) || array.length,\n p,\n len,\n index;\n len = array.length - 1;\n for (p = 0; p < count; ++p) {\n if (operator.prefix) {\n index = results.indexOf(array[len - p]);\n } else {\n index = results.indexOf(array[p]);\n }\n if (index !== -1) {\n results.splice(index, 1);\n }\n }\n return results;\n };\n\n /*\n Returns all items from the current list sorted in the order of the items in the operand array\n */\n exports.sortby = function (source, operator) {\n var results = prepare_results(source);\n if (!results || results.length < 2) {\n return results;\n }\n var lookup = $tw.utils.parseStringArray(operator.operand, \"true\");\n results.sort(function (a, b) {\n return lookup.indexOf(a) - lookup.indexOf(b);\n });\n return results;\n };\n\n /*\n Removes all duplicate items from the current list\n */\n exports.unique = function (source, operator) {\n var results = prepare_results(source);\n var set = results.reduce(function (a, b) {\n if (a.indexOf(b) < 0) {\n a.push(b);\n }\n return a;\n }, []);\n return set;\n };\n})();\n",
"type": "application/javascript",
"module-type": "filteroperator"
},
"$:/core/modules/filters.js": {
"title": "$:/core/modules/filters.js",
"text": "/*\\\ntitle: $:/core/modules/filters.js\ntype: application/javascript\nmodule-type: wikimethod\n\nAdds tiddler filtering methods to the $tw.Wiki object.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nParses an operation (i.e. a run) within a filter string\n\toperators: Array of array of operator nodes into which results should be inserted\n\tfilterString: filter string\n\tp: start position within the string\nReturns the new start position, after the parsed operation\n*/\nfunction parseFilterOperation(operators,filterString,p) {\n\tvar nextBracketPos, operator;\n\t// Skip the starting square bracket\n\tif(filterString.charAt(p++) !== \"[\") {\n\t\tthrow \"Missing [ in filter expression\";\n\t}\n\t// Process each operator in turn\n\tdo {\n\t\toperator = {};\n\t\t// Check for an operator prefix\n\t\tif(filterString.charAt(p) === \"!\") {\n\t\t\toperator.prefix = filterString.charAt(p++);\n\t\t}\n\t\t// Get the operator name\n\t\tnextBracketPos = filterString.substring(p).search(/[\\[\\{<\\/]/);\n\t\tif(nextBracketPos === -1) {\n\t\t\tthrow \"Missing [ in filter expression\";\n\t\t}\n\t\tnextBracketPos += p;\n\t\tvar bracket = filterString.charAt(nextBracketPos);\n\t\toperator.operator = filterString.substring(p,nextBracketPos);\n\t\t// Any suffix?\n\t\tvar colon = operator.operator.indexOf(':');\n\t\tif(colon > -1) {\n\t\t\t// The raw suffix for older filters\n\t\t\toperator.suffix = operator.operator.substring(colon + 1);\n\t\t\toperator.operator = operator.operator.substring(0,colon) || \"field\";\n\t\t\t// The processed suffix for newer filters\n\t\t\toperator.suffixes = [];\n\t\t\t$tw.utils.each(operator.suffix.split(\":\"),function(subsuffix) {\n\t\t\t\toperator.suffixes.push([]);\n\t\t\t\t$tw.utils.each(subsuffix.split(\",\"),function(entry) {\n\t\t\t\t\tentry = $tw.utils.trim(entry);\n\t\t\t\t\tif(entry) {\n\t\t\t\t\t\toperator.suffixes[operator.suffixes.length - 1].push(entry); \n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t});\n\t\t}\n\t\t// Empty operator means: title\n\t\telse if(operator.operator === \"\") {\n\t\t\toperator.operator = \"title\";\n\t\t}\n\n\t\tp = nextBracketPos + 1;\n\t\tswitch (bracket) {\n\t\t\tcase \"{\": // Curly brackets\n\t\t\t\toperator.indirect = true;\n\t\t\t\tnextBracketPos = filterString.indexOf(\"}\",p);\n\t\t\t\tbreak;\n\t\t\tcase \"[\": // Square brackets\n\t\t\t\tnextBracketPos = filterString.indexOf(\"]\",p);\n\t\t\t\tbreak;\n\t\t\tcase \"<\": // Angle brackets\n\t\t\t\toperator.variable = true;\n\t\t\t\tnextBracketPos = filterString.indexOf(\">\",p);\n\t\t\t\tbreak;\n\t\t\tcase \"/\": // regexp brackets\n\t\t\t\tvar rex = /^((?:[^\\\\\\/]*|\\\\.)*)\\/(?:\\(([mygi]+)\\))?/g,\n\t\t\t\t\trexMatch = rex.exec(filterString.substring(p));\n\t\t\t\tif(rexMatch) {\n\t\t\t\t\toperator.regexp = new RegExp(rexMatch[1], rexMatch[2]);\n// DEPRECATION WARNING\nconsole.log(\"WARNING: Filter\",operator.operator,\"has a deprecated regexp operand\",operator.regexp);\n\t\t\t\t\tnextBracketPos = p + rex.lastIndex - 1;\n\t\t\t\t}\n\t\t\t\telse {\n\t\t\t\t\tthrow \"Unterminated regular expression in filter expression\";\n\t\t\t\t}\n\t\t\t\tbreak;\n\t\t}\n\n\t\tif(nextBracketPos === -1) {\n\t\t\tthrow \"Missing closing bracket in filter expression\";\n\t\t}\n\t\tif(!operator.regexp) {\n\t\t\toperator.operand = filterString.substring(p,nextBracketPos);\n\t\t}\n\t\tp = nextBracketPos + 1;\n\n\t\t// Push this operator\n\t\toperators.push(operator);\n\t} while(filterString.charAt(p) !== \"]\");\n\t// Skip the ending square bracket\n\tif(filterString.charAt(p++) !== \"]\") {\n\t\tthrow \"Missing ] in filter expression\";\n\t}\n\t// Return the parsing position\n\treturn p;\n}\n\n/*\nParse a filter string\n*/\nexports.parseFilter = function(filterString) {\n\tfilterString = filterString || \"\";\n\tvar results = [], // Array of arrays of operator nodes {operator:,operand:}\n\t\tp = 0, // Current position in the filter string\n\t\tmatch;\n\tvar whitespaceRegExp = /(\\s+)/mg,\n\t\toperandRegExp = /((?:\\+|\\-|~|=)?)(?:(\\[)|(?:\"([^\"]*)\")|(?:'([^']*)')|([^\\s\\[\\]]+))/mg;\n\twhile(p < filterString.length) {\n\t\t// Skip any whitespace\n\t\twhitespaceRegExp.lastIndex = p;\n\t\tmatch = whitespaceRegExp.exec(filterString);\n\t\tif(match && match.index === p) {\n\t\t\tp = p + match[0].length;\n\t\t}\n\t\t// Match the start of the operation\n\t\tif(p < filterString.length) {\n\t\t\toperandRegExp.lastIndex = p;\n\t\t\tmatch = operandRegExp.exec(filterString);\n\t\t\tif(!match || match.index !== p) {\n\t\t\t\tthrow $tw.language.getString(\"Error/FilterSyntax\");\n\t\t\t}\n\t\t\tvar operation = {\n\t\t\t\tprefix: \"\",\n\t\t\t\toperators: []\n\t\t\t};\n\t\t\tif(match[1]) {\n\t\t\t\toperation.prefix = match[1];\n\t\t\t\tp++;\n\t\t\t}\n\t\t\tif(match[2]) { // Opening square bracket\n\t\t\t\tp = parseFilterOperation(operation.operators,filterString,p);\n\t\t\t} else {\n\t\t\t\tp = match.index + match[0].length;\n\t\t\t}\n\t\t\tif(match[3] || match[4] || match[5]) { // Double quoted string, single quoted string or unquoted title\n\t\t\t\toperation.operators.push(\n\t\t\t\t\t{operator: \"title\", operand: match[3] || match[4] || match[5]}\n\t\t\t\t);\n\t\t\t}\n\t\t\tresults.push(operation);\n\t\t}\n\t}\n\treturn results;\n};\n\nexports.getFilterOperators = function() {\n\tif(!this.filterOperators) {\n\t\t$tw.Wiki.prototype.filterOperators = {};\n\t\t$tw.modules.applyMethods(\"filteroperator\",this.filterOperators);\n\t}\n\treturn this.filterOperators;\n};\n\nexports.filterTiddlers = function(filterString,widget,source) {\n\tvar fn = this.compileFilter(filterString);\n\treturn fn.call(this,source,widget);\n};\n\n/*\nCompile a filter into a function with the signature fn(source,widget) where:\nsource: an iterator function for the source tiddlers, called source(iterator), where iterator is called as iterator(tiddler,title)\nwidget: an optional widget node for retrieving the current tiddler etc.\n*/\nexports.compileFilter = function(filterString) {\n\tvar filterParseTree;\n\ttry {\n\t\tfilterParseTree = this.parseFilter(filterString);\n\t} catch(e) {\n\t\treturn function(source,widget) {\n\t\t\treturn [$tw.language.getString(\"Error/Filter\") + \": \" + e];\n\t\t};\n\t}\n\t// Get the hashmap of filter operator functions\n\tvar filterOperators = this.getFilterOperators();\n\t// Assemble array of functions, one for each operation\n\tvar operationFunctions = [];\n\t// Step through the operations\n\tvar self = this;\n\t$tw.utils.each(filterParseTree,function(operation) {\n\t\t// Create a function for the chain of operators in the operation\n\t\tvar operationSubFunction = function(source,widget) {\n\t\t\tvar accumulator = source,\n\t\t\t\tresults = [],\n\t\t\t\tcurrTiddlerTitle = widget && widget.getVariable(\"currentTiddler\");\n\t\t\t$tw.utils.each(operation.operators,function(operator) {\n\t\t\t\tvar operand = operator.operand,\n\t\t\t\t\toperatorFunction;\n\t\t\t\tif(!operator.operator) {\n\t\t\t\t\toperatorFunction = filterOperators.title;\n\t\t\t\t} else if(!filterOperators[operator.operator]) {\n\t\t\t\t\toperatorFunction = filterOperators.field;\n\t\t\t\t} else {\n\t\t\t\t\toperatorFunction = filterOperators[operator.operator];\n\t\t\t\t}\n\t\t\t\tif(operator.indirect) {\n\t\t\t\t\toperand = self.getTextReference(operator.operand,\"\",currTiddlerTitle);\n\t\t\t\t}\n\t\t\t\tif(operator.variable) {\n\t\t\t\t\toperand = widget.getVariable(operator.operand,{defaultValue: \"\"});\n\t\t\t\t}\n\t\t\t\t// Invoke the appropriate filteroperator module\n\t\t\t\tresults = operatorFunction(accumulator,{\n\t\t\t\t\t\t\toperator: operator.operator,\n\t\t\t\t\t\t\toperand: operand,\n\t\t\t\t\t\t\tprefix: operator.prefix,\n\t\t\t\t\t\t\tsuffix: operator.suffix,\n\t\t\t\t\t\t\tsuffixes: operator.suffixes,\n\t\t\t\t\t\t\tregexp: operator.regexp\n\t\t\t\t\t\t},{\n\t\t\t\t\t\t\twiki: self,\n\t\t\t\t\t\t\twidget: widget\n\t\t\t\t\t\t});\n\t\t\t\tif($tw.utils.isArray(results)) {\n\t\t\t\t\taccumulator = self.makeTiddlerIterator(results);\n\t\t\t\t} else {\n\t\t\t\t\taccumulator = results;\n\t\t\t\t}\n\t\t\t});\n\t\t\tif($tw.utils.isArray(results)) {\n\t\t\t\treturn results;\n\t\t\t} else {\n\t\t\t\tvar resultArray = [];\n\t\t\t\tresults(function(tiddler,title) {\n\t\t\t\t\tresultArray.push(title);\n\t\t\t\t});\n\t\t\t\treturn resultArray;\n\t\t\t}\n\t\t};\n\t\t// Wrap the operator functions in a wrapper function that depends on the prefix\n\t\toperationFunctions.push((function() {\n\t\t\tswitch(operation.prefix || \"\") {\n\t\t\t\tcase \"\": // No prefix means that the operation is unioned into the result\n\t\t\t\t\treturn function(results,source,widget) {\n\t\t\t\t\t\t$tw.utils.pushTop(results,operationSubFunction(source,widget));\n\t\t\t\t\t};\n\t\t\t\tcase \"=\": // The results of the operation are pushed into the result without deduplication\n\t\t\t\t\treturn function(results,source,widget) {\n\t\t\t\t\t\tArray.prototype.push.apply(results,operationSubFunction(source,widget));\n\t\t\t\t\t};\n\t\t\t\tcase \"-\": // The results of this operation are removed from the main result\n\t\t\t\t\treturn function(results,source,widget) {\n\t\t\t\t\t\t$tw.utils.removeArrayEntries(results,operationSubFunction(source,widget));\n\t\t\t\t\t};\n\t\t\t\tcase \"+\": // This operation is applied to the main results so far\n\t\t\t\t\treturn function(results,source,widget) {\n\t\t\t\t\t\t// This replaces all the elements of the array, but keeps the actual array so that references to it are preserved\n\t\t\t\t\t\tsource = self.makeTiddlerIterator(results);\n\t\t\t\t\t\tresults.splice(0,results.length);\n\t\t\t\t\t\t$tw.utils.pushTop(results,operationSubFunction(source,widget));\n\t\t\t\t\t};\n\t\t\t\tcase \"~\": // This operation is unioned into the result only if the main result so far is empty\n\t\t\t\t\treturn function(results,source,widget) {\n\t\t\t\t\t\tif(results.length === 0) {\n\t\t\t\t\t\t\t// Main result so far is empty\n\t\t\t\t\t\t\t$tw.utils.pushTop(results,operationSubFunction(source,widget));\n\t\t\t\t\t\t}\n\t\t\t\t\t};\n\t\t\t}\n\t\t})());\n\t});\n\t// Return a function that applies the operations to a source iterator of tiddler titles\n\treturn $tw.perf.measure(\"filter: \" + filterString,function filterFunction(source,widget) {\n\t\tif(!source) {\n\t\t\tsource = self.each;\n\t\t} else if(typeof source === \"object\") { // Array or hashmap\n\t\t\tsource = self.makeTiddlerIterator(source);\n\t\t}\n\t\tvar results = [];\n\t\t$tw.utils.each(operationFunctions,function(operationFunction) {\n\t\t\toperationFunction(results,source,widget);\n\t\t});\n\t\treturn results;\n\t});\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikimethod"
},
"$:/core/modules/indexers/backlinks-indexer.js": {
"title": "$:/core/modules/indexers/backlinks-indexer.js",
"text": "/*\\\ntitle: $:/core/modules/indexers/backlinks-indexer.js\ntype: application/javascript\nmodule-type: indexer\n\nIndexes the tiddlers' backlinks\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global modules: false */\n\"use strict\";\n\n\nfunction BacklinksIndexer(wiki) {\n\tthis.wiki = wiki;\n}\n\nBacklinksIndexer.prototype.init = function() {\n\tthis.index = null;\n}\n\nBacklinksIndexer.prototype.rebuild = function() {\n\tthis.index = null;\n}\n\nBacklinksIndexer.prototype._getLinks = function(tiddler) {\n\tvar parser = this.wiki.parseText(tiddler.fields.type, tiddler.fields.text, {});\n\tif(parser) {\n\t\treturn this.wiki.extractLinks(parser.tree);\n\t}\n\treturn [];\n}\n\nBacklinksIndexer.prototype.update = function(updateDescriptor) {\n\tif(!this.index) {\n\t\treturn;\n\t}\n\tvar newLinks = [],\n\t oldLinks = [],\n\t self = this;\n\tif(updateDescriptor.old.exists) {\n\t\toldLinks = this._getLinks(updateDescriptor.old.tiddler);\n\t}\n\tif(updateDescriptor.new.exists) {\n\t\tnewLinks = this._getLinks(updateDescriptor.new.tiddler);\n\t}\n\n\t$tw.utils.each(oldLinks,function(link) {\n\t\tif(self.index[link]) {\n\t\t\tdelete self.index[link][updateDescriptor.old.tiddler.fields.title];\n\t\t}\n\t});\n\t$tw.utils.each(newLinks,function(link) {\n\t\tif(!self.index[link]) {\n\t\t\tself.index[link] = Object.create(null);\n\t\t}\n\t\tself.index[link][updateDescriptor.new.tiddler.fields.title] = true;\n\t});\n}\n\nBacklinksIndexer.prototype.lookup = function(title) {\n\tif(!this.index) {\n\t\tthis.index = Object.create(null);\n\t\tvar self = this;\n\t\tthis.wiki.forEachTiddler(function(title,tiddler) {\n\t\t\tvar links = self._getLinks(tiddler);\n\t\t\t$tw.utils.each(links, function(link) {\n\t\t\t\tif(!self.index[link]) {\n\t\t\t\t\tself.index[link] = Object.create(null);\n\t\t\t\t}\n\t\t\t\tself.index[link][title] = true;\n\t\t\t});\n\t\t});\n\t}\n\tif(this.index[title]) {\n\t\treturn Object.keys(this.index[title]);\n\t} else {\n\t\treturn [];\n\t}\n}\n\nexports.BacklinksIndexer = BacklinksIndexer;\n\n})();\n",
"type": "application/javascript",
"module-type": "indexer"
},
"$:/core/modules/indexers/field-indexer.js": {
"title": "$:/core/modules/indexers/field-indexer.js",
"text": "/*\\\ntitle: $:/core/modules/indexers/field-indexer.js\ntype: application/javascript\nmodule-type: indexer\n\nIndexes the tiddlers with each field value\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global modules: false */\n\"use strict\";\n\nvar DEFAULT_MAXIMUM_INDEXED_VALUE_LENGTH = 128;\n\nfunction FieldIndexer(wiki) {\n\tthis.wiki = wiki;\n}\n\nFieldIndexer.prototype.init = function() {\n\tthis.index = null;\n\tthis.maxIndexedValueLength = DEFAULT_MAXIMUM_INDEXED_VALUE_LENGTH;\n\tthis.addIndexMethods();\n}\n\n// Provided for testing\nFieldIndexer.prototype.setMaxIndexedValueLength = function(length) {\n\tthis.index = null;\n\tthis.maxIndexedValueLength = length;\n};\n\nFieldIndexer.prototype.addIndexMethods = function() {\n\tvar self = this;\n\tthis.wiki.each.byField = function(name,value) {\n\t\tvar titles = self.wiki.allTitles(),\n\t\t\tlookup = self.lookup(name,value);\n\t\treturn lookup && lookup.filter(function(title) {\n\t\t\treturn titles.indexOf(title) !== -1;\n\t\t});\n\t};\n\tthis.wiki.eachShadow.byField = function(name,value) {\n\t\tvar titles = self.wiki.allShadowTitles(),\n\t\t\tlookup = self.lookup(name,value);\n\t\treturn lookup && lookup.filter(function(title) {\n\t\t\treturn titles.indexOf(title) !== -1;\n\t\t});\n\t};\n\tthis.wiki.eachTiddlerPlusShadows.byField = function(name,value) {\n\t\tvar lookup = self.lookup(name,value);\n\t\treturn lookup ? lookup.slice(0) : null;\n\t};\n\tthis.wiki.eachShadowPlusTiddlers.byField = function(name,value) {\n\t\tvar lookup = self.lookup(name,value);\n\t\treturn lookup ? lookup.slice(0) : null;\n\t};\n};\n\n/*\nTear down and then rebuild the index as if all tiddlers have changed\n*/\nFieldIndexer.prototype.rebuild = function() {\n\t// Invalidate the index so that it will be rebuilt when it is next used\n\tthis.index = null;\n};\n\n/*\nBuild the index for a particular field\n*/\nFieldIndexer.prototype.buildIndexForField = function(name) {\n\tvar self = this;\n\t// Hashmap by field name of hashmap by field value of array of tiddler titles\n\tthis.index = this.index || Object.create(null);\n\tthis.index[name] = Object.create(null);\n\tvar baseIndex = this.index[name];\n\t// Update the index for each tiddler\n\tthis.wiki.eachTiddlerPlusShadows(function(tiddler,title) {\n\t\tif(name in tiddler.fields) {\n\t\t\tvar value = tiddler.getFieldString(name);\n\t\t\t// Skip any values above the maximum length\n\t\t\tif(value.length < self.maxIndexedValueLength) {\n\t\t\t\tbaseIndex[value] = baseIndex[value] || [];\n\t\t\t\tbaseIndex[value].push(title);\n\t\t\t}\n\t\t}\n\t});\n};\n\n/*\nUpdate the index in the light of a tiddler value changing; note that the title must be identical. (Renames are handled as a separate delete and create)\nupdateDescriptor: {old: {tiddler: <tiddler>, shadow: <boolean>, exists: <boolean>},new: {tiddler: <tiddler>, shadow: <boolean>, exists: <boolean>}}\n*/\nFieldIndexer.prototype.update = function(updateDescriptor) {\n\tvar self = this;\n\t// Don't do anything if the index hasn't been built yet\n\tif(this.index === null) {\n\t\treturn;\n\t}\n\t// Remove the old tiddler from the index\n\tif(updateDescriptor.old.tiddler) {\n\t\t$tw.utils.each(this.index,function(indexEntry,name) {\n\t\t\tif(name in updateDescriptor.old.tiddler.fields) {\n\t\t\t\tvar value = updateDescriptor.old.tiddler.getFieldString(name),\n\t\t\t\t\ttiddlerList = indexEntry[value];\n\t\t\t\tif(tiddlerList) {\n\t\t\t\t\tvar index = tiddlerList.indexOf(updateDescriptor.old.tiddler.fields.title);\n\t\t\t\t\tif(index !== -1) {\n\t\t\t\t\t\ttiddlerList.splice(index,1);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n\t// Add the new tiddler to the index\n\tif(updateDescriptor[\"new\"].tiddler) {\n\t\t$tw.utils.each(this.index,function(indexEntry,name) {\n\t\t\tif(name in updateDescriptor[\"new\"].tiddler.fields) {\n\t\t\t\tvar value = updateDescriptor[\"new\"].tiddler.getFieldString(name);\n\t\t\t\tif(value.length < self.maxIndexedValueLength) {\n\t\t\t\t\tindexEntry[value] = indexEntry[value] || [];\n\t\t\t\t\tindexEntry[value].push(updateDescriptor[\"new\"].tiddler.fields.title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\t\t\n\t}\n};\n\n// Lookup the given field returning a list of tiddler titles\nFieldIndexer.prototype.lookup = function(name,value) {\n\t// Fail the lookup if the value is too long\n\tif(value.length >= this.maxIndexedValueLength) {\n\t\treturn null;\n\t}\n\t// Update the index if it has yet to be built\n\tif(this.index === null || !this.index[name]) {\n\t\tthis.buildIndexForField(name);\n\t}\n\treturn this.index[name][value] || [];\n};\n\nexports.FieldIndexer = FieldIndexer;\n\n})();\n",
"type": "application/javascript",
"module-type": "indexer"
},
"$:/core/modules/indexers/tag-indexer.js": {
"title": "$:/core/modules/indexers/tag-indexer.js",
"text": "/*\\\ntitle: $:/core/modules/indexers/tag-indexer.js\ntype: application/javascript\nmodule-type: indexer\n\nIndexes the tiddlers with each tag\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global modules: false */\n\"use strict\";\n\nfunction TagIndexer(wiki) {\n\tthis.wiki = wiki;\n}\n\nTagIndexer.prototype.init = function() {\n\tthis.subIndexers = [\n\t\tnew TagSubIndexer(this,\"each\"),\n\t\tnew TagSubIndexer(this,\"eachShadow\"),\n\t\tnew TagSubIndexer(this,\"eachTiddlerPlusShadows\"),\n\t\tnew TagSubIndexer(this,\"eachShadowPlusTiddlers\")\n\t];\n\t$tw.utils.each(this.subIndexers,function(subIndexer) {\n\t\tsubIndexer.addIndexMethod();\n\t});\n};\n\nTagIndexer.prototype.rebuild = function() {\n\t$tw.utils.each(this.subIndexers,function(subIndexer) {\n\t\tsubIndexer.rebuild();\n\t});\n};\n\nTagIndexer.prototype.update = function(updateDescriptor) {\n\t$tw.utils.each(this.subIndexers,function(subIndexer) {\n\t\tsubIndexer.update(updateDescriptor);\n\t});\n};\n\nfunction TagSubIndexer(indexer,iteratorMethod) {\n\tthis.indexer = indexer;\n\tthis.iteratorMethod = iteratorMethod;\n\tthis.index = null; // Hashmap of tag title to {isSorted: bool, titles: [array]} or null if not yet initialised\n}\n\nTagSubIndexer.prototype.addIndexMethod = function() {\n\tvar self = this;\n\tthis.indexer.wiki[this.iteratorMethod].byTag = function(tag) {\n\t\treturn self.lookup(tag).slice(0);\n\t};\n};\n\nTagSubIndexer.prototype.rebuild = function() {\n\tvar self = this;\n\t// Hashmap by tag of array of {isSorted:, titles:[]}\n\tthis.index = Object.create(null);\n\t// Add all the tags\n\tthis.indexer.wiki[this.iteratorMethod](function(tiddler,title) {\n\t\t$tw.utils.each(tiddler.fields.tags,function(tag) {\n\t\t\tif(!self.index[tag]) {\n\t\t\t\tself.index[tag] = {isSorted: false, titles: [title]};\n\t\t\t} else {\n\t\t\t\tself.index[tag].titles.push(title);\n\t\t\t}\n\t\t});\t\t\n\t});\n};\n\nTagSubIndexer.prototype.update = function(updateDescriptor) {\n\tthis.index = null;\n};\n\nTagSubIndexer.prototype.lookup = function(tag) {\n\t// Update the index if it has yet to be built\n\tif(this.index === null) {\n\t\tthis.rebuild();\n\t}\n\tvar indexRecord = this.index[tag];\n\tif(indexRecord) {\n\t\tif(!indexRecord.isSorted) {\n\t\t\tif(this.indexer.wiki.sortByList) {\n\t\t\t\tindexRecord.titles = this.indexer.wiki.sortByList(indexRecord.titles,tag);\n\t\t\t}\t\t\t\n\t\t\tindexRecord.isSorted = true;\n\t\t}\n\t\treturn indexRecord.titles;\n\t} else {\n\t\treturn [];\n\t}\n};\n\n\nexports.TagIndexer = TagIndexer;\n\n})();\n",
"type": "application/javascript",
"module-type": "indexer"
},
"$:/core/modules/info/platform.js": {
"title": "$:/core/modules/info/platform.js",
"text": "/*\\\ntitle: $:/core/modules/info/platform.js\ntype: application/javascript\nmodule-type: info\n\nInitialise basic platform $:/info/ tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.getInfoTiddlerFields = function() {\n\tvar mapBoolean = function(value) {return value ? \"yes\" : \"no\";},\n\t\tinfoTiddlerFields = [];\n\t// Basics\n\tinfoTiddlerFields.push({title: \"$:/info/browser\", text: mapBoolean(!!$tw.browser)});\n\tinfoTiddlerFields.push({title: \"$:/info/node\", text: mapBoolean(!!$tw.node)});\n\tif($tw.browser) {\n\t\t// Document location\n\t\tvar setLocationProperty = function(name,value) {\n\t\t\t\tinfoTiddlerFields.push({title: \"$:/info/url/\" + name, text: value});\t\t\t\n\t\t\t},\n\t\t\tlocation = document.location;\n\t\tsetLocationProperty(\"full\", (location.toString()).split(\"#\")[0]);\n\t\tsetLocationProperty(\"host\", location.host);\n\t\tsetLocationProperty(\"hostname\", location.hostname);\n\t\tsetLocationProperty(\"protocol\", location.protocol);\n\t\tsetLocationProperty(\"port\", location.port);\n\t\tsetLocationProperty(\"pathname\", location.pathname);\n\t\tsetLocationProperty(\"search\", location.search);\n\t\tsetLocationProperty(\"origin\", location.origin);\n\t\t// Screen size\n\t\tinfoTiddlerFields.push({title: \"$:/info/browser/screen/width\", text: window.screen.width.toString()});\n\t\tinfoTiddlerFields.push({title: \"$:/info/browser/screen/height\", text: window.screen.height.toString()});\n\t\t// Language\n\t\tinfoTiddlerFields.push({title: \"$:/info/browser/language\", text: navigator.language || \"\"});\n\t}\n\treturn infoTiddlerFields;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "info"
},
"$:/core/modules/keyboard.js": {
"title": "$:/core/modules/keyboard.js",
"text": "/*\\\ntitle: $:/core/modules/keyboard.js\ntype: application/javascript\nmodule-type: global\n\nKeyboard handling utilities\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar namedKeys = {\n\t\"cancel\": 3,\n\t\"help\": 6,\n\t\"backspace\": 8,\n\t\"tab\": 9,\n\t\"clear\": 12,\n\t\"return\": 13,\n\t\"enter\": 13,\n\t\"pause\": 19,\n\t\"escape\": 27,\n\t\"space\": 32,\n\t\"page_up\": 33,\n\t\"page_down\": 34,\n\t\"end\": 35,\n\t\"home\": 36,\n\t\"left\": 37,\n\t\"up\": 38,\n\t\"right\": 39,\n\t\"down\": 40,\n\t\"printscreen\": 44,\n\t\"insert\": 45,\n\t\"delete\": 46,\n\t\"0\": 48,\n\t\"1\": 49,\n\t\"2\": 50,\n\t\"3\": 51,\n\t\"4\": 52,\n\t\"5\": 53,\n\t\"6\": 54,\n\t\"7\": 55,\n\t\"8\": 56,\n\t\"9\": 57,\n\t\"firefoxsemicolon\": 59,\n\t\"firefoxequals\": 61,\n\t\"a\": 65,\n\t\"b\": 66,\n\t\"c\": 67,\n\t\"d\": 68,\n\t\"e\": 69,\n\t\"f\": 70,\n\t\"g\": 71,\n\t\"h\": 72,\n\t\"i\": 73,\n\t\"j\": 74,\n\t\"k\": 75,\n\t\"l\": 76,\n\t\"m\": 77,\n\t\"n\": 78,\n\t\"o\": 79,\n\t\"p\": 80,\n\t\"q\": 81,\n\t\"r\": 82,\n\t\"s\": 83,\n\t\"t\": 84,\n\t\"u\": 85,\n\t\"v\": 86,\n\t\"w\": 87,\n\t\"x\": 88,\n\t\"y\": 89,\n\t\"z\": 90,\n\t\"numpad0\": 96,\n\t\"numpad1\": 97,\n\t\"numpad2\": 98,\n\t\"numpad3\": 99,\n\t\"numpad4\": 100,\n\t\"numpad5\": 101,\n\t\"numpad6\": 102,\n\t\"numpad7\": 103,\n\t\"numpad8\": 104,\n\t\"numpad9\": 105,\n\t\"multiply\": 106,\n\t\"add\": 107,\n\t\"separator\": 108,\n\t\"subtract\": 109,\n\t\"decimal\": 110,\n\t\"divide\": 111,\n\t\"f1\": 112,\n\t\"f2\": 113,\n\t\"f3\": 114,\n\t\"f4\": 115,\n\t\"f5\": 116,\n\t\"f6\": 117,\n\t\"f7\": 118,\n\t\"f8\": 119,\n\t\"f9\": 120,\n\t\"f10\": 121,\n\t\"f11\": 122,\n\t\"f12\": 123,\n\t\"f13\": 124,\n\t\"f14\": 125,\n\t\"f15\": 126,\n\t\"f16\": 127,\n\t\"f17\": 128,\n\t\"f18\": 129,\n\t\"f19\": 130,\n\t\"f20\": 131,\n\t\"f21\": 132,\n\t\"f22\": 133,\n\t\"f23\": 134,\n\t\"f24\": 135,\n\t\"firefoxminus\": 173,\n\t\"semicolon\": 186,\n\t\"equals\": 187,\n\t\"comma\": 188,\n\t\"dash\": 189,\n\t\"period\": 190,\n\t\"slash\": 191,\n\t\"backquote\": 192,\n\t\"openbracket\": 219,\n\t\"backslash\": 220,\n\t\"closebracket\": 221,\n\t\"quote\": 222\n};\n\nfunction KeyboardManager(options) {\n\tvar self = this;\n\toptions = options || \"\";\n\t// Save the named key hashmap\n\tthis.namedKeys = namedKeys;\n\t// Create a reverse mapping of code to keyname\n\tthis.keyNames = [];\n\t$tw.utils.each(namedKeys,function(keyCode,name) {\n\t\tself.keyNames[keyCode] = name.substr(0,1).toUpperCase() + name.substr(1);\n\t});\n\t// Save the platform-specific name of the \"meta\" key\n\tthis.metaKeyName = $tw.platform.isMac ? \"cmd-\" : \"win-\";\n\tthis.shortcutKeysList = [], // Stores the shortcut-key descriptors\n\tthis.shortcutActionList = [], // Stores the corresponding action strings\n\tthis.shortcutParsedList = []; // Stores the parsed key descriptors\n\tthis.lookupNames = [\"shortcuts\"];\n\tthis.lookupNames.push($tw.platform.isMac ? \"shortcuts-mac\" : \"shortcuts-not-mac\")\n\tthis.lookupNames.push($tw.platform.isWindows ? \"shortcuts-windows\" : \"shortcuts-not-windows\");\n\tthis.lookupNames.push($tw.platform.isLinux ? \"shortcuts-linux\" : \"shortcuts-not-linux\");\n\tthis.updateShortcutLists(this.getShortcutTiddlerList());\n\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\tself.handleShortcutChanges(changes);\n\t});\n}\n\n/*\nReturn an array of keycodes for the modifier keys ctrl, shift, alt, meta\n*/\nKeyboardManager.prototype.getModifierKeys = function() {\n\treturn [\n\t\t16, // Shift\n\t\t17, // Ctrl\n\t\t18, // Alt\n\t\t20, // CAPS LOCK\n\t\t91, // Meta (left)\n\t\t93, // Meta (right)\n\t\t224 // Meta (Firefox)\n\t]\n};\n\n/*\nParses a key descriptor into the structure:\n{\n\tkeyCode: numeric keycode\n\tshiftKey: boolean\n\taltKey: boolean\n\tctrlKey: boolean\n\tmetaKey: boolean\n}\nKey descriptors have the following format:\n\tctrl+enter\n\tctrl+shift+alt+A\n*/\nKeyboardManager.prototype.parseKeyDescriptor = function(keyDescriptor) {\n\tvar components = keyDescriptor.split(/\\+|\\-/),\n\t\tinfo = {\n\t\t\tkeyCode: 0,\n\t\t\tshiftKey: false,\n\t\t\taltKey: false,\n\t\t\tctrlKey: false,\n\t\t\tmetaKey: false\n\t\t};\n\tfor(var t=0; t<components.length; t++) {\n\t\tvar s = components[t].toLowerCase(),\n\t\t\tc = s.charCodeAt(0);\n\t\t// Look for modifier keys\n\t\tif(s === \"ctrl\") {\n\t\t\tinfo.ctrlKey = true;\n\t\t} else if(s === \"shift\") {\n\t\t\tinfo.shiftKey = true;\n\t\t} else if(s === \"alt\") {\n\t\t\tinfo.altKey = true;\n\t\t} else if(s === \"meta\" || s === \"cmd\" || s === \"win\") {\n\t\t\tinfo.metaKey = true;\n\t\t}\n\t\t// Replace named keys with their code\n\t\tif(this.namedKeys[s]) {\n\t\t\tinfo.keyCode = this.namedKeys[s];\n\t\t}\n\t}\n\tif(info.keyCode) {\n\t\treturn info;\n\t} else {\n\t\treturn null;\n\t}\n};\n\n/*\nParse a list of key descriptors into an array of keyInfo objects. The key descriptors can be passed as an array of strings or a space separated string\n*/\nKeyboardManager.prototype.parseKeyDescriptors = function(keyDescriptors,options) {\n\tvar self = this;\n\toptions = options || {};\n\toptions.stack = options.stack || [];\n\tvar wiki = options.wiki || $tw.wiki;\n\tif(typeof keyDescriptors === \"string\" && keyDescriptors === \"\") {\n\t\treturn [];\n\t}\n\tif(!$tw.utils.isArray(keyDescriptors)) {\n\t\tkeyDescriptors = keyDescriptors.split(\" \");\n\t}\n\tvar result = [];\n\t$tw.utils.each(keyDescriptors,function(keyDescriptor) {\n\t\t// Look for a named shortcut\n\t\tif(keyDescriptor.substr(0,2) === \"((\" && keyDescriptor.substr(-2,2) === \"))\") {\n\t\t\tif(options.stack.indexOf(keyDescriptor) === -1) {\n\t\t\t\toptions.stack.push(keyDescriptor);\n\t\t\t\tvar name = keyDescriptor.substring(2,keyDescriptor.length - 2),\n\t\t\t\t\tlookupName = function(configName) {\n\t\t\t\t\t\tvar keyDescriptors = wiki.getTiddlerText(\"$:/config/\" + configName + \"/\" + name);\n\t\t\t\t\t\tif(keyDescriptors) {\n\t\t\t\t\t\t\tresult.push.apply(result,self.parseKeyDescriptors(keyDescriptors,options));\n\t\t\t\t\t\t}\n\t\t\t\t\t};\n\t\t\t\t$tw.utils.each(self.lookupNames,function(platformDescriptor) {\n\t\t\t\t\tlookupName(platformDescriptor);\n\t\t\t\t});\n\t\t\t}\n\t\t} else {\n\t\t\tresult.push(self.parseKeyDescriptor(keyDescriptor));\n\t\t}\n\t});\n\treturn result;\n};\n\nKeyboardManager.prototype.getPrintableShortcuts = function(keyInfoArray) {\n\tvar self = this,\n\t\tresult = [];\n\t$tw.utils.each(keyInfoArray,function(keyInfo) {\n\t\tif(keyInfo) {\n\t\t\tresult.push((keyInfo.ctrlKey ? \"ctrl-\" : \"\") + \n\t\t\t\t (keyInfo.shiftKey ? \"shift-\" : \"\") + \n\t\t\t\t (keyInfo.altKey ? \"alt-\" : \"\") + \n\t\t\t\t (keyInfo.metaKey ? self.metaKeyName : \"\") + \n\t\t\t\t (self.keyNames[keyInfo.keyCode]));\n\t\t}\n\t});\n\treturn result;\n}\n\nKeyboardManager.prototype.checkKeyDescriptor = function(event,keyInfo) {\n\treturn keyInfo &&\n\t\t\tevent.keyCode === keyInfo.keyCode && \n\t\t\tevent.shiftKey === keyInfo.shiftKey && \n\t\t\tevent.altKey === keyInfo.altKey && \n\t\t\tevent.ctrlKey === keyInfo.ctrlKey && \n\t\t\tevent.metaKey === keyInfo.metaKey;\n};\n\nKeyboardManager.prototype.checkKeyDescriptors = function(event,keyInfoArray) {\n\tfor(var t=0; t<keyInfoArray.length; t++) {\n\t\tif(this.checkKeyDescriptor(event,keyInfoArray[t])) {\n\t\t\treturn true;\n\t\t}\n\t}\n\treturn false;\n};\n\nKeyboardManager.prototype.getShortcutTiddlerList = function() {\n\treturn $tw.wiki.getTiddlersWithTag(\"$:/tags/KeyboardShortcut\");\n};\n\nKeyboardManager.prototype.updateShortcutLists = function(tiddlerList) {\n\tthis.shortcutTiddlers = tiddlerList;\n\tfor(var i=0; i<tiddlerList.length; i++) {\n\t\tvar title = tiddlerList[i],\n\t\t\ttiddlerFields = $tw.wiki.getTiddler(title).fields;\n\t\tthis.shortcutKeysList[i] = tiddlerFields.key !== undefined ? tiddlerFields.key : undefined;\n\t\tthis.shortcutActionList[i] = tiddlerFields.text;\n\t\tthis.shortcutParsedList[i] = this.shortcutKeysList[i] !== undefined ? this.parseKeyDescriptors(this.shortcutKeysList[i]) : undefined;\n\t}\n};\n\nKeyboardManager.prototype.handleKeydownEvent = function(event) {\n\tvar key, action;\n\tfor(var i=0; i<this.shortcutTiddlers.length; i++) {\n\t\tif(this.shortcutParsedList[i] !== undefined && this.checkKeyDescriptors(event,this.shortcutParsedList[i])) {\n\t\t\tkey = this.shortcutParsedList[i];\n\t\t\taction = this.shortcutActionList[i];\n\t\t}\n\t}\n\tif(key !== undefined) {\n\t\tevent.preventDefault();\n\t\tevent.stopPropagation();\n\t\t$tw.rootWidget.invokeActionString(action,$tw.rootWidget);\n\t\treturn true;\n\t}\n\treturn false;\n};\n\nKeyboardManager.prototype.detectNewShortcuts = function(changedTiddlers) {\n\tvar shortcutConfigTiddlers = [],\n\t\thandled = false;\n\t$tw.utils.each(this.lookupNames,function(platformDescriptor) {\n\t\tvar descriptorString = \"$:/config/\" + platformDescriptor + \"/\";\n\t\tObject.keys(changedTiddlers).forEach(function(configTiddler) {\n\t\t\tvar configString = configTiddler.substr(0, configTiddler.lastIndexOf(\"/\") + 1);\n\t\t\tif(configString === descriptorString) {\n\t\t\t\tshortcutConfigTiddlers.push(configTiddler);\n\t\t\t\thandled = true;\n\t\t\t}\n\t\t});\n\t});\n\tif(handled) {\n\t\treturn $tw.utils.hopArray(changedTiddlers,shortcutConfigTiddlers);\n\t} else {\n\t\treturn false;\n\t}\n};\n\nKeyboardManager.prototype.handleShortcutChanges = function(changedTiddlers) {\n\tvar newList = this.getShortcutTiddlerList();\n\tvar hasChanged = $tw.utils.hopArray(changedTiddlers,this.shortcutTiddlers) ? true :\n\t\t($tw.utils.hopArray(changedTiddlers,newList) ? true :\n\t\t(this.detectNewShortcuts(changedTiddlers))\n\t);\n\t// Re-cache shortcuts if something changed\n\tif(hasChanged) {\n\t\tthis.updateShortcutLists(newList);\n\t}\n};\n\nexports.KeyboardManager = KeyboardManager;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/language.js": {
"title": "$:/core/modules/language.js",
"text": "/*\\\ntitle: $:/core/modules/language.js\ntype: application/javascript\nmodule-type: global\n\nThe $tw.Language() manages translateable strings\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nCreate an instance of the language manager. Options include:\nwiki: wiki from which to retrieve translation tiddlers\n*/\nfunction Language(options) {\n\toptions = options || \"\";\n\tthis.wiki = options.wiki || $tw.wiki;\n}\n\n/*\nReturn a wikified translateable string. The title is automatically prefixed with \"$:/language/\"\nOptions include:\nvariables: optional hashmap of variables to supply to the language wikification\n*/\nLanguage.prototype.getString = function(title,options) {\n\toptions = options || {};\n\ttitle = \"$:/language/\" + title;\n\treturn this.wiki.renderTiddler(\"text/plain\",title,{variables: options.variables});\n};\n\n/*\nReturn a raw, unwikified translateable string. The title is automatically prefixed with \"$:/language/\"\n*/\nLanguage.prototype.getRawString = function(title) {\n\ttitle = \"$:/language/\" + title;\n\treturn this.wiki.getTiddlerText(title);\n};\n\nexports.Language = Language;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/macros/changecount.js": {
"title": "$:/core/modules/macros/changecount.js",
"text": "/*\\\ntitle: $:/core/modules/macros/changecount.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to return the changecount for the current tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"changecount\";\n\nexports.params = [];\n\n/*\nRun the macro\n*/\nexports.run = function() {\n\treturn this.wiki.getChangeCount(this.getVariable(\"currentTiddler\")) + \"\";\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/contrastcolour.js": {
"title": "$:/core/modules/macros/contrastcolour.js",
"text": "/*\\\ntitle: $:/core/modules/macros/contrastcolour.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to choose which of two colours has the highest contrast with a base colour\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"contrastcolour\";\n\nexports.params = [\n\t{name: \"target\"},\n\t{name: \"fallbackTarget\"},\n\t{name: \"colourA\"},\n\t{name: \"colourB\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(target,fallbackTarget,colourA,colourB) {\n\tvar rgbTarget = $tw.utils.parseCSSColor(target) || $tw.utils.parseCSSColor(fallbackTarget);\n\tif(!rgbTarget) {\n\t\treturn colourA;\n\t}\n\tvar rgbColourA = $tw.utils.parseCSSColor(colourA),\n\t\trgbColourB = $tw.utils.parseCSSColor(colourB);\n\tif(rgbColourA && !rgbColourB) {\n\t\treturn rgbColourA;\n\t}\n\tif(rgbColourB && !rgbColourA) {\n\t\treturn rgbColourB;\n\t}\n\tif(!rgbColourA && !rgbColourB) {\n\t\t// If neither colour is readable, return a crude inverse of the target\n\t\treturn [255 - rgbTarget[0],255 - rgbTarget[1],255 - rgbTarget[2],rgbTarget[3]];\n\t}\n\t// Colour brightness formula derived from http://www.w3.org/WAI/ER/WD-AERT/#color-contrast\n\tvar brightnessTarget = rgbTarget[0] * 0.299 + rgbTarget[1] * 0.587 + rgbTarget[2] * 0.114,\n\t\tbrightnessA = rgbColourA[0] * 0.299 + rgbColourA[1] * 0.587 + rgbColourA[2] * 0.114,\n\t\tbrightnessB = rgbColourB[0] * 0.299 + rgbColourB[1] * 0.587 + rgbColourB[2] * 0.114;\n\treturn Math.abs(brightnessTarget - brightnessA) > Math.abs(brightnessTarget - brightnessB) ? colourA : colourB;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/csvtiddlers.js": {
"title": "$:/core/modules/macros/csvtiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/macros/csvtiddlers.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to output tiddlers matching a filter to CSV\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"csvtiddlers\";\n\nexports.params = [\n\t{name: \"filter\"},\n\t{name: \"format\"},\n];\n\n/*\nRun the macro\n*/\nexports.run = function(filter,format) {\n\tvar self = this,\n\t\ttiddlers = this.wiki.filterTiddlers(filter),\n\t\ttiddler,\n\t\tfields = [],\n\t\tt,f;\n\t// Collect all the fields\n\tfor(t=0;t<tiddlers.length; t++) {\n\t\ttiddler = this.wiki.getTiddler(tiddlers[t]);\n\t\tfor(f in tiddler.fields) {\n\t\t\tif(fields.indexOf(f) === -1) {\n\t\t\t\tfields.push(f);\n\t\t\t}\n\t\t}\n\t}\n\t// Sort the fields and bring the standard ones to the front\n\tfields.sort();\n\t\"title text modified modifier created creator\".split(\" \").reverse().forEach(function(value,index) {\n\t\tvar p = fields.indexOf(value);\n\t\tif(p !== -1) {\n\t\t\tfields.splice(p,1);\n\t\t\tfields.unshift(value)\n\t\t}\n\t});\n\t// Output the column headings\n\tvar output = [], row = [];\n\tfields.forEach(function(value) {\n\t\trow.push(quoteAndEscape(value))\n\t});\n\toutput.push(row.join(\",\"));\n\t// Output each tiddler\n\tfor(var t=0;t<tiddlers.length; t++) {\n\t\trow = [];\n\t\ttiddler = this.wiki.getTiddler(tiddlers[t]);\n\t\t\tfor(f=0; f<fields.length; f++) {\n\t\t\t\trow.push(quoteAndEscape(tiddler ? tiddler.getFieldString(fields[f]) || \"\" : \"\"));\n\t\t\t}\n\t\toutput.push(row.join(\",\"));\n\t}\n\treturn output.join(\"\\n\");\n};\n\nfunction quoteAndEscape(value) {\n\treturn \"\\\"\" + value.replace(/\"/mg,\"\\\"\\\"\") + \"\\\"\";\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/displayshortcuts.js": {
"title": "$:/core/modules/macros/displayshortcuts.js",
"text": "/*\\\ntitle: $:/core/modules/macros/displayshortcuts.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to display a list of keyboard shortcuts in human readable form. Notably, it resolves named shortcuts like `((bold))` to the underlying keystrokes.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"displayshortcuts\";\n\nexports.params = [\n\t{name: \"shortcuts\"},\n\t{name: \"prefix\"},\n\t{name: \"separator\"},\n\t{name: \"suffix\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(shortcuts,prefix,separator,suffix) {\n\tvar shortcutArray = $tw.keyboardManager.getPrintableShortcuts($tw.keyboardManager.parseKeyDescriptors(shortcuts,{\n\t\twiki: this.wiki\n\t}));\n\tif(shortcutArray.length > 0) {\n\t\tshortcutArray.sort(function(a,b) {\n\t\t return a.toLowerCase().localeCompare(b.toLowerCase());\n\t\t})\n\t\treturn prefix + shortcutArray.join(separator) + suffix;\n\t} else {\n\t\treturn \"\";\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/jsontiddler.js": {
"title": "$:/core/modules/macros/jsontiddler.js",
"text": "/*\\\ntitle: $:/core/modules/macros/jsontiddler.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to output a single tiddler to JSON\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"jsontiddler\";\n\nexports.params = [\n\t{name: \"title\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(title) {\n\ttitle = title || this.getVariable(\"currentTiddler\");\n\tvar tiddler = !!title && this.wiki.getTiddler(title),\n\t\tfields = new Object();\n\tif(tiddler) {\n\t\tfor(var field in tiddler.fields) {\n\t\t\tfields[field] = tiddler.getFieldString(field);\n\t\t}\n\t}\n\treturn JSON.stringify(fields,null,$tw.config.preferences.jsonSpaces);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/jsontiddlers.js": {
"title": "$:/core/modules/macros/jsontiddlers.js",
"text": "/*\\\ntitle: $:/core/modules/macros/jsontiddlers.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to output tiddlers matching a filter to JSON\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"jsontiddlers\";\n\nexports.params = [\n\t{name: \"filter\"},\n\t{name: \"spaces\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(filter,spaces) {\n\treturn this.wiki.getTiddlersAsJson(filter,$tw.utils.parseInt(spaces));\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/makedatauri.js": {
"title": "$:/core/modules/macros/makedatauri.js",
"text": "/*\\\ntitle: $:/core/modules/macros/makedatauri.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to convert a string of text to a data URI\n\n<<makedatauri text:\"Text to be converted\" type:\"text/vnd.tiddlywiki\">>\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"makedatauri\";\n\nexports.params = [\n\t{name: \"text\"},\n\t{name: \"type\"},\n\t{name: \"_canonical_uri\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(text,type,_canonical_uri) {\n\treturn $tw.utils.makeDataUri(text,type,_canonical_uri);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/now.js": {
"title": "$:/core/modules/macros/now.js",
"text": "/*\\\ntitle: $:/core/modules/macros/now.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to return a formatted version of the current time\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"now\";\n\nexports.params = [\n\t{name: \"format\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(format) {\n\treturn $tw.utils.formatDateString(new Date(),format || \"0hh:0mm, DDth MMM YYYY\");\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/qualify.js": {
"title": "$:/core/modules/macros/qualify.js",
"text": "/*\\\ntitle: $:/core/modules/macros/qualify.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to qualify a state tiddler title according\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"qualify\";\n\nexports.params = [\n\t{name: \"title\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(title) {\n\treturn title + \"-\" + this.getStateQualifier();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/resolvepath.js": {
"title": "$:/core/modules/macros/resolvepath.js",
"text": "/*\\\ntitle: $:/core/modules/macros/resolvepath.js\ntype: application/javascript\nmodule-type: macro\n\nResolves a relative path for an absolute rootpath.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"resolvepath\";\n\nexports.params = [\n\t{name: \"source\"},\n\t{name: \"root\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(source, root) {\n\treturn $tw.utils.resolvePath(source, root);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/unusedtitle.js": {
"title": "$:/core/modules/macros/unusedtitle.js",
"text": "/*\\\ntitle: $:/core/modules/macros/unusedtitle.js\ntype: application/javascript\nmodule-type: macro\nMacro to return a new title that is unused in the wiki. It can be given a name as a base.\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"unusedtitle\";\n\nexports.params = [\n\t{name: \"baseName\"},\n\t{name: \"options\"}\n];\n\n/*\nRun the macro\n*/\nexports.run = function(baseName, options) {\n\tif(!baseName) {\n\t\tbaseName = $tw.language.getString(\"DefaultNewTiddlerTitle\");\n\t}\n\treturn this.wiki.generateNewTitle(baseName, options);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/macros/version.js": {
"title": "$:/core/modules/macros/version.js",
"text": "/*\\\ntitle: $:/core/modules/macros/version.js\ntype: application/javascript\nmodule-type: macro\n\nMacro to return the TiddlyWiki core version number\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInformation about this macro\n*/\n\nexports.name = \"version\";\n\nexports.params = [];\n\n/*\nRun the macro\n*/\nexports.run = function() {\n\treturn $tw.version;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "macro"
},
"$:/core/modules/parsers/audioparser.js": {
"title": "$:/core/modules/parsers/audioparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/audioparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe audio parser parses an audio tiddler into an embeddable HTML element\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar AudioParser = function(type,text,options) {\n\tvar element = {\n\t\t\ttype: \"element\",\n\t\t\ttag: \"audio\",\n\t\t\tattributes: {\n\t\t\t\tcontrols: {type: \"string\", value: \"controls\"},\n\t\t\t\tstyle: {type: \"string\", value: \"width: 100%; object-fit: contain\"}\n\t\t\t}\n\t\t},\n\t\tsrc;\n\tif(options._canonical_uri) {\n\t\telement.attributes.src = {type: \"string\", value: options._canonical_uri};\n\t} else if(text) {\n\t\telement.attributes.src = {type: \"string\", value: \"data:\" + type + \";base64,\" + text};\n\t}\n\tthis.tree = [element];\n};\n\nexports[\"audio/ogg\"] = AudioParser;\nexports[\"audio/mpeg\"] = AudioParser;\nexports[\"audio/mp3\"] = AudioParser;\nexports[\"audio/mp4\"] = AudioParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/binaryparser.js": {
"title": "$:/core/modules/parsers/binaryparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/binaryparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe binary parser parses a binary tiddler into a warning message and download link\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar BINARY_WARNING_MESSAGE = \"$:/core/ui/BinaryWarning\";\nvar EXPORT_BUTTON_IMAGE = \"$:/core/images/export-button\";\n\nvar BinaryParser = function(type,text,options) {\n\t// Transclude the binary data tiddler warning message\n\tvar warn = {\n\t\ttype: \"element\",\n\t\ttag: \"p\",\n\t\tchildren: [{\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: BINARY_WARNING_MESSAGE}\n\t\t\t}\n\t\t}]\n\t};\n\t// Create download link based on binary tiddler title\n\tvar link = {\n\t\ttype: \"element\",\n\t\ttag: \"a\",\n\t\tattributes: {\n\t\t\ttitle: {type: \"indirect\", textReference: \"!!title\"},\n\t\t\tdownload: {type: \"indirect\", textReference: \"!!title\"}\n\t\t},\n\t\tchildren: [{\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: EXPORT_BUTTON_IMAGE}\n\t\t\t}\n\t\t}]\n\t};\n\t// Set the link href to external or internal data URI\n\tif(options._canonical_uri) {\n\t\tlink.attributes.href = {\n\t\t\ttype: \"string\", \n\t\t\tvalue: options._canonical_uri\n\t\t};\n\t} else if(text) {\n\t\tlink.attributes.href = {\n\t\t\ttype: \"string\", \n\t\t\tvalue: \"data:\" + type + \";base64,\" + text\n\t\t};\n\t}\n\t// Combine warning message and download link in a div\n\tvar element = {\n\t\ttype: \"element\",\n\t\ttag: \"div\",\n\t\tattributes: {\n\t\t\tclass: {type: \"string\", value: \"tc-binary-warning\"}\n\t\t},\n\t\tchildren: [warn, link]\n\t}\n\tthis.tree = [element];\n};\n\nexports[\"application/octet-stream\"] = BinaryParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/csvparser.js": {
"title": "$:/core/modules/parsers/csvparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/csvparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe CSV text parser processes CSV files into a table wrapped in a scrollable widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar CsvParser = function(type,text,options) {\n\t// Table framework\n\tthis.tree = [{\n\t\t\"type\": \"scrollable\", \"children\": [{\n\t\t\t\"type\": \"element\", \"tag\": \"table\", \"children\": [{\n\t\t\t\t\"type\": \"element\", \"tag\": \"tbody\", \"children\": []\n\t\t\t}], \"attributes\": {\n\t\t\t\t\"class\": {\"type\": \"string\", \"value\": \"tc-csv-table\"}\n\t\t\t}\n\t\t}]\n\t}];\n\t// Split the text into lines\n\tvar lines = text.split(/\\r?\\n/mg),\n\t\ttag = \"th\";\n\tfor(var line=0; line<lines.length; line++) {\n\t\tvar lineText = lines[line];\n\t\tif(lineText) {\n\t\t\tvar row = {\n\t\t\t\t\t\"type\": \"element\", \"tag\": \"tr\", \"children\": []\n\t\t\t\t};\n\t\t\tvar columns = lineText.split(\",\");\n\t\t\tfor(var column=0; column<columns.length; column++) {\n\t\t\t\trow.children.push({\n\t\t\t\t\t\t\"type\": \"element\", \"tag\": tag, \"children\": [{\n\t\t\t\t\t\t\t\"type\": \"text\",\n\t\t\t\t\t\t\t\"text\": columns[column]\n\t\t\t\t\t\t}]\n\t\t\t\t\t});\n\t\t\t}\n\t\t\ttag = \"td\";\n\t\t\tthis.tree[0].children[0].children[0].children.push(row);\n\t\t}\n\t}\n};\n\nexports[\"text/csv\"] = CsvParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/htmlparser.js": {
"title": "$:/core/modules/parsers/htmlparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/htmlparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe HTML parser displays text as raw HTML\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar HtmlParser = function(type,text,options) {\n\tvar src;\n\tif(options._canonical_uri) {\n\t\tsrc = options._canonical_uri;\n\t} else if(text) {\n\t\tsrc = \"data:text/html;charset=utf-8,\" + encodeURIComponent(text);\n\t}\n\tthis.tree = [{\n\t\ttype: \"element\",\n\t\ttag: \"iframe\",\n\t\tattributes: {\n\t\t\tsrc: {type: \"string\", value: src},\n\t\t\tsandbox: {type: \"string\", value: \"\"}\n\t\t}\n\t}];\n};\n\nexports[\"text/html\"] = HtmlParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/imageparser.js": {
"title": "$:/core/modules/parsers/imageparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/imageparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe image parser parses an image into an embeddable HTML element\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar ImageParser = function(type,text,options) {\n\tvar element = {\n\t\t\ttype: \"element\",\n\t\t\ttag: \"img\",\n\t\t\tattributes: {}\n\t\t};\n\tif(options._canonical_uri) {\n\t\telement.attributes.src = {type: \"string\", value: options._canonical_uri};\n\t} else if(text) {\n\t\tif(type === \"image/svg+xml\" || type === \".svg\") {\n\t\t\telement.attributes.src = {type: \"string\", value: \"data:image/svg+xml,\" + encodeURIComponent(text)};\n\t\t} else {\n\t\t\telement.attributes.src = {type: \"string\", value: \"data:\" + type + \";base64,\" + text};\n\t\t}\n\t}\n\tthis.tree = [element];\n};\n\nexports[\"image/svg+xml\"] = ImageParser;\nexports[\"image/jpg\"] = ImageParser;\nexports[\"image/jpeg\"] = ImageParser;\nexports[\"image/png\"] = ImageParser;\nexports[\"image/gif\"] = ImageParser;\nexports[\"image/webp\"] = ImageParser;\nexports[\"image/heic\"] = ImageParser;\nexports[\"image/heif\"] = ImageParser;\nexports[\"image/x-icon\"] = ImageParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/utils/parseutils.js": {
"title": "$:/core/modules/utils/parseutils.js",
"text": "/*\\\ntitle: $:/core/modules/utils/parseutils.js\ntype: application/javascript\nmodule-type: utils\n\nUtility functions concerned with parsing text into tokens.\n\nMost functions have the following pattern:\n\n* The parameters are:\n** `source`: the source string being parsed\n** `pos`: the current parse position within the string\n** Any further parameters are used to identify the token that is being parsed\n* The return value is:\n** null if the token was not found at the specified position\n** an object representing the token with the following standard fields:\n*** `type`: string indicating the type of the token\n*** `start`: start position of the token in the source string\n*** `end`: end position of the token in the source string\n*** Any further fields required to describe the token\n\nThe exception is `skipWhiteSpace`, which just returns the position after the whitespace.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nLook for a whitespace token. Returns null if not found, otherwise returns {type: \"whitespace\", start:, end:,}\n*/\nexports.parseWhiteSpace = function(source,pos) {\n\tvar p = pos,c;\n\twhile(true) {\n\t\tc = source.charAt(p);\n\t\tif((c === \" \") || (c === \"\\f\") || (c === \"\\n\") || (c === \"\\r\") || (c === \"\\t\") || (c === \"\\v\") || (c === \"\\u00a0\")) { // Ignores some obscure unicode spaces\n\t\t\tp++;\n\t\t} else {\n\t\t\tbreak;\n\t\t}\n\t}\n\tif(p === pos) {\n\t\treturn null;\n\t} else {\n\t\treturn {\n\t\t\ttype: \"whitespace\",\n\t\t\tstart: pos,\n\t\t\tend: p\n\t\t}\n\t}\n};\n\n/*\nConvenience wrapper for parseWhiteSpace. Returns the position after the whitespace\n*/\nexports.skipWhiteSpace = function(source,pos) {\n\tvar c;\n\twhile(true) {\n\t\tc = source.charAt(pos);\n\t\tif((c === \" \") || (c === \"\\f\") || (c === \"\\n\") || (c === \"\\r\") || (c === \"\\t\") || (c === \"\\v\") || (c === \"\\u00a0\")) { // Ignores some obscure unicode spaces\n\t\t\tpos++;\n\t\t} else {\n\t\t\treturn pos;\n\t\t}\n\t}\n};\n\n/*\nLook for a given string token. Returns null if not found, otherwise returns {type: \"token\", value:, start:, end:,}\n*/\nexports.parseTokenString = function(source,pos,token) {\n\tvar match = source.indexOf(token,pos) === pos;\n\tif(match) {\n\t\treturn {\n\t\t\ttype: \"token\",\n\t\t\tvalue: token,\n\t\t\tstart: pos,\n\t\t\tend: pos + token.length\n\t\t};\n\t}\n\treturn null;\n};\n\n/*\nLook for a token matching a regex. Returns null if not found, otherwise returns {type: \"regexp\", match:, start:, end:,}\n*/\nexports.parseTokenRegExp = function(source,pos,reToken) {\n\tvar node = {\n\t\ttype: \"regexp\",\n\t\tstart: pos\n\t};\n\treToken.lastIndex = pos;\n\tnode.match = reToken.exec(source);\n\tif(node.match && node.match.index === pos) {\n\t\tnode.end = pos + node.match[0].length;\n\t\treturn node;\n\t} else {\n\t\treturn null;\n\t}\n};\n\n/*\nLook for a string literal. Returns null if not found, otherwise returns {type: \"string\", value:, start:, end:,}\n*/\nexports.parseStringLiteral = function(source,pos) {\n\tvar node = {\n\t\ttype: \"string\",\n\t\tstart: pos\n\t};\n\tvar reString = /(?:\"\"\"([\\s\\S]*?)\"\"\"|\"([^\"]*)\")|(?:'([^']*)')/g;\n\treString.lastIndex = pos;\n\tvar match = reString.exec(source);\n\tif(match && match.index === pos) {\n\t\tnode.value = match[1] !== undefined ? match[1] :(\n\t\t\tmatch[2] !== undefined ? match[2] : match[3] \n\t\t\t\t\t);\n\t\tnode.end = pos + match[0].length;\n\t\treturn node;\n\t} else {\n\t\treturn null;\n\t}\n};\n\n/*\nLook for a macro invocation parameter. Returns null if not found, or {type: \"macro-parameter\", name:, value:, start:, end:}\n*/\nexports.parseMacroParameter = function(source,pos) {\n\tvar node = {\n\t\ttype: \"macro-parameter\",\n\t\tstart: pos\n\t};\n\t// Define our regexp\n\tvar reMacroParameter = /(?:([A-Za-z0-9\\-_]+)\\s*:)?(?:\\s*(?:\"\"\"([\\s\\S]*?)\"\"\"|\"([^\"]*)\"|'([^']*)'|\\[\\[([^\\]]*)\\]\\]|([^\\s>\"'=]+)))/g;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for the parameter\n\tvar token = $tw.utils.parseTokenRegExp(source,pos,reMacroParameter);\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Get the parameter details\n\tnode.value = token.match[2] !== undefined ? token.match[2] : (\n\t\t\t\t\ttoken.match[3] !== undefined ? token.match[3] : (\n\t\t\t\t\t\ttoken.match[4] !== undefined ? token.match[4] : (\n\t\t\t\t\t\t\ttoken.match[5] !== undefined ? token.match[5] : (\n\t\t\t\t\t\t\t\ttoken.match[6] !== undefined ? token.match[6] : (\n\t\t\t\t\t\t\t\t\t\"\"\n\t\t\t\t\t\t\t\t)\n\t\t\t\t\t\t\t)\n\t\t\t\t\t\t)\n\t\t\t\t\t)\n\t\t\t\t);\n\tif(token.match[1]) {\n\t\tnode.name = token.match[1];\n\t}\n\t// Update the end position\n\tnode.end = pos;\n\treturn node;\n};\n\n/*\nLook for a macro invocation. Returns null if not found, or {type: \"macrocall\", name:, parameters:, start:, end:}\n*/\nexports.parseMacroInvocation = function(source,pos) {\n\tvar node = {\n\t\ttype: \"macrocall\",\n\t\tstart: pos,\n\t\tparams: []\n\t};\n\t// Define our regexps\n\tvar reMacroName = /([^\\s>\"'=]+)/g;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for a double less than sign\n\tvar token = $tw.utils.parseTokenString(source,pos,\"<<\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Get the macro name\n\tvar name = $tw.utils.parseTokenRegExp(source,pos,reMacroName);\n\tif(!name) {\n\t\treturn null;\n\t}\n\tnode.name = name.match[1];\n\tpos = name.end;\n\t// Process parameters\n\tvar parameter = $tw.utils.parseMacroParameter(source,pos);\n\twhile(parameter) {\n\t\tnode.params.push(parameter);\n\t\tpos = parameter.end;\n\t\t// Get the next parameter\n\t\tparameter = $tw.utils.parseMacroParameter(source,pos);\n\t}\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for a double greater than sign\n\ttoken = $tw.utils.parseTokenString(source,pos,\">>\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Update the end position\n\tnode.end = pos;\n\treturn node;\n};\n\n/*\nLook for an HTML attribute definition. Returns null if not found, otherwise returns {type: \"attribute\", name:, valueType: \"string|indirect|macro\", value:, start:, end:,}\n*/\nexports.parseAttribute = function(source,pos) {\n\tvar node = {\n\t\tstart: pos\n\t};\n\t// Define our regexps\n\tvar reAttributeName = /([^\\/\\s>\"'=]+)/g,\n\t\treUnquotedAttribute = /([^\\/\\s<>\"'=]+)/g,\n\t\treFilteredValue = /\\{\\{\\{(.+?)\\}\\}\\}/g,\n\t\treIndirectValue = /\\{\\{([^\\}]+)\\}\\}/g;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Get the attribute name\n\tvar name = $tw.utils.parseTokenRegExp(source,pos,reAttributeName);\n\tif(!name) {\n\t\treturn null;\n\t}\n\tnode.name = name.match[1];\n\tpos = name.end;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for an equals sign\n\tvar token = $tw.utils.parseTokenString(source,pos,\"=\");\n\tif(token) {\n\t\tpos = token.end;\n\t\t// Skip whitespace\n\t\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t\t// Look for a string literal\n\t\tvar stringLiteral = $tw.utils.parseStringLiteral(source,pos);\n\t\tif(stringLiteral) {\n\t\t\tpos = stringLiteral.end;\n\t\t\tnode.type = \"string\";\n\t\t\tnode.value = stringLiteral.value;\n\t\t} else {\n\t\t\t// Look for a filtered value\n\t\t\tvar filteredValue = $tw.utils.parseTokenRegExp(source,pos,reFilteredValue);\n\t\t\tif(filteredValue) {\n\t\t\t\tpos = filteredValue.end;\n\t\t\t\tnode.type = \"filtered\";\n\t\t\t\tnode.filter = filteredValue.match[1];\n\t\t\t} else {\n\t\t\t\t// Look for an indirect value\n\t\t\t\tvar indirectValue = $tw.utils.parseTokenRegExp(source,pos,reIndirectValue);\n\t\t\t\tif(indirectValue) {\n\t\t\t\t\tpos = indirectValue.end;\n\t\t\t\t\tnode.type = \"indirect\";\n\t\t\t\t\tnode.textReference = indirectValue.match[1];\n\t\t\t\t} else {\n\t\t\t\t\t// Look for a unquoted value\n\t\t\t\t\tvar unquotedValue = $tw.utils.parseTokenRegExp(source,pos,reUnquotedAttribute);\n\t\t\t\t\tif(unquotedValue) {\n\t\t\t\t\t\tpos = unquotedValue.end;\n\t\t\t\t\t\tnode.type = \"string\";\n\t\t\t\t\t\tnode.value = unquotedValue.match[1];\n\t\t\t\t\t} else {\n\t\t\t\t\t\t// Look for a macro invocation value\n\t\t\t\t\t\tvar macroInvocation = $tw.utils.parseMacroInvocation(source,pos);\n\t\t\t\t\t\tif(macroInvocation) {\n\t\t\t\t\t\t\tpos = macroInvocation.end;\n\t\t\t\t\t\t\tnode.type = \"macro\";\n\t\t\t\t\t\t\tnode.value = macroInvocation;\n\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\tnode.type = \"string\";\n\t\t\t\t\t\t\tnode.value = \"true\";\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t} else {\n\t\tnode.type = \"string\";\n\t\tnode.value = \"true\";\n\t}\n\t// Update the end position\n\tnode.end = pos;\n\treturn node;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/parsers/pdfparser.js": {
"title": "$:/core/modules/parsers/pdfparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/pdfparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe PDF parser embeds a PDF viewer\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar ImageParser = function(type,text,options) {\n\tvar element = {\n\t\t\ttype: \"element\",\n\t\t\ttag: \"embed\",\n\t\t\tattributes: {}\n\t\t},\n\t\tsrc;\n\tif(options._canonical_uri) {\n\t\telement.attributes.src = {type: \"string\", value: options._canonical_uri};\n\t} else if(text) {\n\t\telement.attributes.src = {type: \"string\", value: \"data:application/pdf;base64,\" + text};\n\t}\n\tthis.tree = [element];\n};\n\nexports[\"application/pdf\"] = ImageParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/textparser.js": {
"title": "$:/core/modules/parsers/textparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/textparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe plain text parser processes blocks of source text into a degenerate parse tree consisting of a single text node\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar TextParser = function(type,text,options) {\n\tthis.tree = [{\n\t\ttype: \"codeblock\",\n\t\tattributes: {\n\t\t\tcode: {type: \"string\", value: text},\n\t\t\tlanguage: {type: \"string\", value: type}\n\t\t}\n\t}];\n};\n\nexports[\"text/plain\"] = TextParser;\nexports[\"text/x-tiddlywiki\"] = TextParser;\nexports[\"application/javascript\"] = TextParser;\nexports[\"application/json\"] = TextParser;\nexports[\"text/css\"] = TextParser;\nexports[\"application/x-tiddler-dictionary\"] = TextParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/videoparser.js": {
"title": "$:/core/modules/parsers/videoparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/videoparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe video parser parses a video tiddler into an embeddable HTML element\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar VideoParser = function(type,text,options) {\n\tvar element = {\n\t\t\ttype: \"element\",\n\t\t\ttag: \"video\",\n\t\t\tattributes: {\n\t\t\t\tcontrols: {type: \"string\", value: \"controls\"},\n\t\t\t\tstyle: {type: \"string\", value: \"width: 100%; object-fit: contain\"}\n\t\t\t}\n\t\t},\n\t\tsrc;\n\tif(options._canonical_uri) {\n\t\telement.attributes.src = {type: \"string\", value: options._canonical_uri};\n\t} else if(text) {\n\t\telement.attributes.src = {type: \"string\", value: \"data:\" + type + \";base64,\" + text};\n\t}\n\tthis.tree = [element];\n};\n\nexports[\"video/ogg\"] = VideoParser;\nexports[\"video/webm\"] = VideoParser;\nexports[\"video/mp4\"] = VideoParser;\nexports[\"video/quicktime\"] = VideoParser;\n\n})();\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/wikiparser/rules/codeblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/codeblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/codeblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for code blocks. For example:\n\n```\n\t```\n\tThis text will not be //wikified//\n\t```\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"codeblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match and get language if defined\n\tthis.matchRegExp = /```([\\w-]*)\\r?\\n/mg;\n};\n\nexports.parse = function() {\n\tvar reEnd = /(\\r?\\n```$)/mg;\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Look for the end of the block\n\treEnd.lastIndex = this.parser.pos;\n\tvar match = reEnd.exec(this.parser.source),\n\t\ttext;\n\t// Process the block\n\tif(match) {\n\t\ttext = this.parser.source.substring(this.parser.pos,match.index);\n\t\tthis.parser.pos = match.index + match[0].length;\n\t} else {\n\t\ttext = this.parser.source.substr(this.parser.pos);\n\t\tthis.parser.pos = this.parser.sourceLength;\n\t}\n\t// Return the $codeblock widget\n\treturn [{\n\t\t\ttype: \"codeblock\",\n\t\t\tattributes: {\n\t\t\t\t\tcode: {type: \"string\", value: text},\n\t\t\t\t\tlanguage: {type: \"string\", value: this.match[1]}\n\t\t\t}\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/codeinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/codeinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/codeinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for code runs. For example:\n\n```\n\tThis is a `code run`.\n\tThis is another ``code run``\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"codeinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /(``?)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\tvar reEnd = new RegExp(this.match[1], \"mg\");\n\t// Look for the end marker\n\treEnd.lastIndex = this.parser.pos;\n\tvar match = reEnd.exec(this.parser.source),\n\t\ttext;\n\t// Process the text\n\tif(match) {\n\t\ttext = this.parser.source.substring(this.parser.pos,match.index);\n\t\tthis.parser.pos = match.index + match[0].length;\n\t} else {\n\t\ttext = this.parser.source.substr(this.parser.pos);\n\t\tthis.parser.pos = this.parser.sourceLength;\n\t}\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"code\",\n\t\tchildren: [{\n\t\t\ttype: \"text\",\n\t\t\ttext: text\n\t\t}]\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/commentblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/commentblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/commentblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for HTML comments. For example:\n\n```\n<!-- This is a comment -->\n```\n\nNote that the syntax for comments is simplified to an opening \"<!--\" sequence and a closing \"-->\" sequence -- HTML itself implements a more complex format (see http://ostermiller.org/findhtmlcomment.html)\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"commentblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\tthis.matchRegExp = /<!--/mg;\n\tthis.endMatchRegExp = /-->/mg;\n};\n\nexports.findNextMatch = function(startPos) {\n\tthis.matchRegExp.lastIndex = startPos;\n\tthis.match = this.matchRegExp.exec(this.parser.source);\n\tif(this.match) {\n\t\tthis.endMatchRegExp.lastIndex = startPos + this.match[0].length;\n\t\tthis.endMatch = this.endMatchRegExp.exec(this.parser.source);\n\t\tif(this.endMatch) {\n\t\t\treturn this.match.index;\n\t\t}\n\t}\n\treturn undefined;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.endMatchRegExp.lastIndex;\n\t// Don't return any elements\n\treturn [];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/commentinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/commentinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/commentinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for HTML comments. For example:\n\n```\n<!-- This is a comment -->\n```\n\nNote that the syntax for comments is simplified to an opening \"<!--\" sequence and a closing \"-->\" sequence -- HTML itself implements a more complex format (see http://ostermiller.org/findhtmlcomment.html)\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"commentinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\tthis.matchRegExp = /<!--/mg;\n\tthis.endMatchRegExp = /-->/mg;\n};\n\nexports.findNextMatch = function(startPos) {\n\tthis.matchRegExp.lastIndex = startPos;\n\tthis.match = this.matchRegExp.exec(this.parser.source);\n\tif(this.match) {\n\t\tthis.endMatchRegExp.lastIndex = startPos + this.match[0].length;\n\t\tthis.endMatch = this.endMatchRegExp.exec(this.parser.source);\n\t\tif(this.endMatch) {\n\t\t\treturn this.match.index;\n\t\t}\n\t}\n\treturn undefined;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.endMatchRegExp.lastIndex;\n\t// Don't return any elements\n\treturn [];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/dash.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/dash.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/dash.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for dashes. For example:\n\n```\nThis is an en-dash: --\n\nThis is an em-dash: ---\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"dash\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /-{2,3}(?!-)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\tvar dash = this.match[0].length === 2 ? \"–\" : \"—\";\n\treturn [{\n\t\ttype: \"entity\",\n\t\tentity: dash\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/bold.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/bold.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/bold.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - bold. For example:\n\n```\n\tThis is ''bold'' text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except bold \n\\rules only bold \n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"bold\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /''/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/''/mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"strong\",\n\t\tchildren: tree\n\t}];\n};\n\n})();",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/italic.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/italic.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/italic.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - italic. For example:\n\n```\n\tThis is //italic// text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except italic\n\\rules only italic\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"italic\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\/\\//mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/\\/\\//mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"em\",\n\t\tchildren: tree\n\t}];\n};\n\n})();",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/strikethrough.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/strikethrough.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/strikethrough.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - strikethrough. For example:\n\n```\n\tThis is ~~strikethrough~~ text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except strikethrough \n\\rules only strikethrough \n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"strikethrough\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /~~/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/~~/mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"strike\",\n\t\tchildren: tree\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/subscript.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/subscript.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/subscript.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - subscript. For example:\n\n```\n\tThis is ,,subscript,, text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except subscript \n\\rules only subscript \n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"subscript\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /,,/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/,,/mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"sub\",\n\t\tchildren: tree\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/superscript.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/superscript.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/superscript.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - superscript. For example:\n\n```\n\tThis is ^^superscript^^ text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except superscript \n\\rules only superscript \n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"superscript\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\^\\^/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/\\^\\^/mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"sup\",\n\t\tchildren: tree\n\t}];\n};\n\n})();",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/emphasis/underscore.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/emphasis/underscore.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/emphasis/underscore.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for emphasis - underscore. For example:\n\n```\n\tThis is __underscore__ text\n```\n\nThis wikiparser can be modified using the rules eg:\n\n```\n\\rules except underscore \n\\rules only underscore\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"underscore\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /__/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\n\t// Parse the run including the terminator\n\tvar tree = this.parser.parseInlineRun(/__/mg,{eatTerminator: true});\n\n\t// Return the classed span\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"u\",\n\t\tchildren: tree\n\t}];\n};\n\n})();",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/entity.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/entity.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/entity.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for HTML entities. For example:\n\n```\n\tThis is a copyright symbol: ©\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"entity\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /(&#?[a-zA-Z0-9]{2,8};)/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Get all the details of the match\n\tvar entityString = this.match[1];\n\t// Move past the macro call\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Return the entity\n\treturn [{type: \"entity\", entity: this.match[0]}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/extlink.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/extlink.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/extlink.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for external links. For example:\n\n```\nAn external link: https://www.tiddlywiki.com/\n\nA suppressed external link: ~http://www.tiddlyspace.com/\n```\n\nExternal links can be suppressed by preceding them with `~`.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"extlink\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /~?(?:file|http|https|mailto|ftp|irc|news|data|skype):[^\\s<>{}\\[\\]`|\"\\\\^]+(?:\\/|\\b)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Create the link unless it is suppressed\n\tif(this.match[0].substr(0,1) === \"~\") {\n\t\treturn [{type: \"text\", text: this.match[0].substr(1)}];\n\t} else {\n\t\treturn [{\n\t\t\ttype: \"element\",\n\t\t\ttag: \"a\",\n\t\t\tattributes: {\n\t\t\t\thref: {type: \"string\", value: this.match[0]},\n\t\t\t\t\"class\": {type: \"string\", value: \"tc-tiddlylink-external\"},\n\t\t\t\ttarget: {type: \"string\", value: \"_blank\"},\n\t\t\t\trel: {type: \"string\", value: \"noopener noreferrer\"}\n\t\t\t},\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\", text: this.match[0]\n\t\t\t}]\n\t\t}];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/filteredtranscludeblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/filteredtranscludeblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/filteredtranscludeblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for block-level filtered transclusion. For example:\n\n```\n{{{ [tag[docs]] }}}\n{{{ [tag[docs]] |tooltip}}}\n{{{ [tag[docs]] ||TemplateTitle}}}\n{{{ [tag[docs]] |tooltip||TemplateTitle}}}\n{{{ [tag[docs]] }}width:40;height:50;}.class.class\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"filteredtranscludeblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\{\\{\\{([^\\|]+?)(?:\\|([^\\|\\{\\}]+))?(?:\\|\\|([^\\|\\{\\}]+))?\\}\\}([^\\}]*)\\}(?:\\.(\\S+))?(?:\\r?\\n|$)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Get the match details\n\tvar filter = this.match[1],\n\t\ttooltip = this.match[2],\n\t\ttemplate = $tw.utils.trim(this.match[3]),\n\t\tstyle = this.match[4],\n\t\tclasses = this.match[5];\n\t// Return the list widget\n\tvar node = {\n\t\ttype: \"list\",\n\t\tattributes: {\n\t\t\tfilter: {type: \"string\", value: filter}\n\t\t},\n\t\tisBlock: true\n\t};\n\tif(tooltip) {\n\t\tnode.attributes.tooltip = {type: \"string\", value: tooltip};\n\t}\n\tif(template) {\n\t\tnode.attributes.template = {type: \"string\", value: template};\n\t}\n\tif(style) {\n\t\tnode.attributes.style = {type: \"string\", value: style};\n\t}\n\tif(classes) {\n\t\tnode.attributes.itemClass = {type: \"string\", value: classes.split(\".\").join(\" \")};\n\t}\n\treturn [node];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/filteredtranscludeinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/filteredtranscludeinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/filteredtranscludeinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for inline filtered transclusion. For example:\n\n```\n{{{ [tag[docs]] }}}\n{{{ [tag[docs]] |tooltip}}}\n{{{ [tag[docs]] ||TemplateTitle}}}\n{{{ [tag[docs]] |tooltip||TemplateTitle}}}\n{{{ [tag[docs]] }}width:40;height:50;}.class.class\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"filteredtranscludeinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\{\\{\\{([^\\|]+?)(?:\\|([^\\|\\{\\}]+))?(?:\\|\\|([^\\|\\{\\}]+))?\\}\\}([^\\}]*)\\}(?:\\.(\\S+))?/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Get the match details\n\tvar filter = this.match[1],\n\t\ttooltip = this.match[2],\n\t\ttemplate = $tw.utils.trim(this.match[3]),\n\t\tstyle = this.match[4],\n\t\tclasses = this.match[5];\n\t// Return the list widget\n\tvar node = {\n\t\ttype: \"list\",\n\t\tattributes: {\n\t\t\tfilter: {type: \"string\", value: filter}\n\t\t}\n\t};\n\tif(tooltip) {\n\t\tnode.attributes.tooltip = {type: \"string\", value: tooltip};\n\t}\n\tif(template) {\n\t\tnode.attributes.template = {type: \"string\", value: template};\n\t}\n\tif(style) {\n\t\tnode.attributes.style = {type: \"string\", value: style};\n\t}\n\tif(classes) {\n\t\tnode.attributes.itemClass = {type: \"string\", value: classes.split(\".\").join(\" \")};\n\t}\n\treturn [node];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/hardlinebreaks.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/hardlinebreaks.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/hardlinebreaks.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for marking areas with hard line breaks. For example:\n\n```\n\"\"\"\nThis is some text\nThat is set like\nIt is a Poem\nWhen it is\nClearly\nNot\n\"\"\"\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"hardlinebreaks\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\"\"\"(?:\\r?\\n)?/mg;\n};\n\nexports.parse = function() {\n\tvar reEnd = /(\"\"\")|(\\r?\\n)/mg,\n\t\ttree = [],\n\t\tmatch;\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\tdo {\n\t\t// Parse the run up to the terminator\n\t\ttree.push.apply(tree,this.parser.parseInlineRun(reEnd,{eatTerminator: false}));\n\t\t// Redo the terminator match\n\t\treEnd.lastIndex = this.parser.pos;\n\t\tmatch = reEnd.exec(this.parser.source);\n\t\tif(match) {\n\t\t\tthis.parser.pos = reEnd.lastIndex;\n\t\t\t// Add a line break if the terminator was a line break\n\t\t\tif(match[2]) {\n\t\t\t\ttree.push({type: \"element\", tag: \"br\"});\n\t\t\t}\n\t\t}\n\t} while(match && !match[1]);\n\t// Return the nodes\n\treturn tree;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/heading.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/heading.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/heading.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for headings\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"heading\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /(!{1,6})/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Get all the details of the match\n\tvar headingLevel = this.match[1].length;\n\t// Move past the !s\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse any classes, whitespace and then the heading itself\n\tvar classes = this.parser.parseClasses();\n\tthis.parser.skipWhitespace({treatNewlinesAsNonWhitespace: true});\n\tvar tree = this.parser.parseInlineRun(/(\\r?\\n)/mg);\n\t// Return the heading\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"h\" + headingLevel, \n\t\tattributes: {\n\t\t\t\"class\": {type: \"string\", value: classes.join(\" \")}\n\t\t},\n\t\tchildren: tree\n\t}];\n};\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/horizrule.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/horizrule.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/horizrule.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for rules. For example:\n\n```\n---\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"horizrule\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /-{3,}\\r?(?:\\n|$)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\treturn [{type: \"element\", tag: \"hr\"}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/html.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/html.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/html.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki rule for HTML elements and widgets. For example:\n\n{{{\n<aside>\nThis is an HTML5 aside element\n</aside>\n\n<$slider target=\"MyTiddler\">\nThis is a widget invocation\n</$slider>\n\n}}}\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"html\";\nexports.types = {inline: true, block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n};\n\nexports.findNextMatch = function(startPos) {\n\t// Find the next tag\n\tthis.nextTag = this.findNextTag(this.parser.source,startPos,{\n\t\trequireLineBreak: this.is.block\n\t});\n\treturn this.nextTag ? this.nextTag.start : undefined;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Retrieve the most recent match so that recursive calls don't overwrite it\n\tvar tag = this.nextTag;\n\tthis.nextTag = null;\n\t// Advance the parser position to past the tag\n\tthis.parser.pos = tag.end;\n\t// Check for an immediately following double linebreak\n\tvar hasLineBreak = !tag.isSelfClosing && !!$tw.utils.parseTokenRegExp(this.parser.source,this.parser.pos,/([^\\S\\n\\r]*\\r?\\n(?:[^\\S\\n\\r]*\\r?\\n|$))/g);\n\t// Set whether we're in block mode\n\ttag.isBlock = this.is.block || hasLineBreak;\n\t// Parse the body if we need to\n\tif(!tag.isSelfClosing && $tw.config.htmlVoidElements.indexOf(tag.tag) === -1) {\n\t\t\tvar reEndString = \"</\" + $tw.utils.escapeRegExp(tag.tag) + \">\",\n\t\t\t\treEnd = new RegExp(\"(\" + reEndString + \")\",\"mg\");\n\t\tif(hasLineBreak) {\n\t\t\ttag.children = this.parser.parseBlocks(reEndString);\n\t\t} else {\n\t\t\ttag.children = this.parser.parseInlineRun(reEnd);\n\t\t}\n\t\treEnd.lastIndex = this.parser.pos;\n\t\tvar endMatch = reEnd.exec(this.parser.source);\n\t\tif(endMatch && endMatch.index === this.parser.pos) {\n\t\t\tthis.parser.pos = endMatch.index + endMatch[0].length;\n\t\t}\n\t}\n\t// Return the tag\n\treturn [tag];\n};\n\n/*\nLook for an HTML tag. Returns null if not found, otherwise returns {type: \"element\", name:, attributes: [], isSelfClosing:, start:, end:,}\n*/\nexports.parseTag = function(source,pos,options) {\n\toptions = options || {};\n\tvar token,\n\t\tnode = {\n\t\t\ttype: \"element\",\n\t\t\tstart: pos,\n\t\t\tattributes: {}\n\t\t};\n\t// Define our regexps\n\tvar reTagName = /([a-zA-Z0-9\\-\\$]+)/g;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for a less than sign\n\ttoken = $tw.utils.parseTokenString(source,pos,\"<\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Get the tag name\n\ttoken = $tw.utils.parseTokenRegExp(source,pos,reTagName);\n\tif(!token) {\n\t\treturn null;\n\t}\n\tnode.tag = token.match[1];\n\tif(node.tag.slice(1).indexOf(\"$\") !== -1) {\n\t\treturn null;\n\t}\n\tif(node.tag.charAt(0) === \"$\") {\n\t\tnode.type = node.tag.substr(1);\n\t}\n\tpos = token.end;\n\t// Check that the tag is terminated by a space, / or >\n\tif(!$tw.utils.parseWhiteSpace(source,pos) && !(source.charAt(pos) === \"/\") && !(source.charAt(pos) === \">\") ) {\n\t\treturn null;\n\t}\n\t// Process attributes\n\tvar attribute = $tw.utils.parseAttribute(source,pos);\n\twhile(attribute) {\n\t\tnode.attributes[attribute.name] = attribute;\n\t\tpos = attribute.end;\n\t\t// Get the next attribute\n\t\tattribute = $tw.utils.parseAttribute(source,pos);\n\t}\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for a closing slash\n\ttoken = $tw.utils.parseTokenString(source,pos,\"/\");\n\tif(token) {\n\t\tpos = token.end;\n\t\tnode.isSelfClosing = true;\n\t}\n\t// Look for a greater than sign\n\ttoken = $tw.utils.parseTokenString(source,pos,\">\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Check for a required line break\n\tif(options.requireLineBreak) {\n\t\ttoken = $tw.utils.parseTokenRegExp(source,pos,/([^\\S\\n\\r]*\\r?\\n(?:[^\\S\\n\\r]*\\r?\\n|$))/g);\n\t\tif(!token) {\n\t\t\treturn null;\n\t\t}\n\t}\n\t// Update the end position\n\tnode.end = pos;\n\treturn node;\n};\n\nexports.findNextTag = function(source,pos,options) {\n\t// A regexp for finding candidate HTML tags\n\tvar reLookahead = /<([a-zA-Z\\-\\$]+)/g;\n\t// Find the next candidate\n\treLookahead.lastIndex = pos;\n\tvar match = reLookahead.exec(source);\n\twhile(match) {\n\t\t// Try to parse the candidate as a tag\n\t\tvar tag = this.parseTag(source,match.index,options);\n\t\t// Return success\n\t\tif(tag && this.isLegalTag(tag)) {\n\t\t\treturn tag;\n\t\t}\n\t\t// Look for the next match\n\t\treLookahead.lastIndex = match.index + 1;\n\t\tmatch = reLookahead.exec(source);\n\t}\n\t// Failed\n\treturn null;\n};\n\nexports.isLegalTag = function(tag) {\n\t// Widgets are always OK\n\tif(tag.type !== \"element\") {\n\t\treturn true;\n\t// If it's an HTML tag that starts with a dash then it's not legal\n\t} else if(tag.tag.charAt(0) === \"-\") {\n\t\treturn false;\n\t} else {\n\t\t// Otherwise it's OK\n\t\treturn true;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/image.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/image.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/image.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for embedding images. For example:\n\n```\n[img[https://tiddlywiki.com/fractalveg.jpg]]\n[img width=23 height=24 [https://tiddlywiki.com/fractalveg.jpg]]\n[img width={{!!width}} height={{!!height}} [https://tiddlywiki.com/fractalveg.jpg]]\n[img[Description of image|https://tiddlywiki.com/fractalveg.jpg]]\n[img[TiddlerTitle]]\n[img[Description of image|TiddlerTitle]]\n```\n\nGenerates the `<$image>` widget.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"image\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n};\n\nexports.findNextMatch = function(startPos) {\n\t// Find the next tag\n\tthis.nextImage = this.findNextImage(this.parser.source,startPos);\n\treturn this.nextImage ? this.nextImage.start : undefined;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.nextImage.end;\n\tvar node = {\n\t\ttype: \"image\",\n\t\tattributes: this.nextImage.attributes\n\t};\n\treturn [node];\n};\n\n/*\nFind the next image from the current position\n*/\nexports.findNextImage = function(source,pos) {\n\t// A regexp for finding candidate HTML tags\n\tvar reLookahead = /(\\[img)/g;\n\t// Find the next candidate\n\treLookahead.lastIndex = pos;\n\tvar match = reLookahead.exec(source);\n\twhile(match) {\n\t\t// Try to parse the candidate as a tag\n\t\tvar tag = this.parseImage(source,match.index);\n\t\t// Return success\n\t\tif(tag) {\n\t\t\treturn tag;\n\t\t}\n\t\t// Look for the next match\n\t\treLookahead.lastIndex = match.index + 1;\n\t\tmatch = reLookahead.exec(source);\n\t}\n\t// Failed\n\treturn null;\n};\n\n/*\nLook for an image at the specified position. Returns null if not found, otherwise returns {type: \"image\", attributes: [], isSelfClosing:, start:, end:,}\n*/\nexports.parseImage = function(source,pos) {\n\tvar token,\n\t\tnode = {\n\t\t\ttype: \"image\",\n\t\t\tstart: pos,\n\t\t\tattributes: {}\n\t\t};\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for the `[img`\n\ttoken = $tw.utils.parseTokenString(source,pos,\"[img\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Process attributes\n\tif(source.charAt(pos) !== \"[\") {\n\t\tvar attribute = $tw.utils.parseAttribute(source,pos);\n\t\twhile(attribute) {\n\t\t\tnode.attributes[attribute.name] = attribute;\n\t\t\tpos = attribute.end;\n\t\t\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t\t\tif(source.charAt(pos) !== \"[\") {\n\t\t\t\t// Get the next attribute\n\t\t\t\tattribute = $tw.utils.parseAttribute(source,pos);\n\t\t\t} else {\n\t\t\t\tattribute = null;\n\t\t\t}\n\t\t}\n\t}\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for the `[` after the attributes\n\ttoken = $tw.utils.parseTokenString(source,pos,\"[\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Get the source up to the terminating `]]`\n\ttoken = $tw.utils.parseTokenRegExp(source,pos,/(?:([^|\\]]*?)\\|)?([^\\]]+?)\\]\\]/g);\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\tif(token.match[1]) {\n\t\tnode.attributes.tooltip = {type: \"string\", value: token.match[1].trim()};\n\t}\n\tnode.attributes.source = {type: \"string\", value: (token.match[2] || \"\").trim()};\n\t// Update the end position\n\tnode.end = pos;\n\treturn node;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/import.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/import.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/import.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki pragma rule for importing variable definitions\n\n```\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"import\";\nexports.types = {pragma: true};\n\n/*\nInstantiate parse rule\n*/\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /^\\\\import[^\\S\\n]/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\tvar self = this;\n\t// Move past the pragma invocation\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse the filter terminated by a line break\n\tvar reMatch = /(.*)(\\r?\\n)|$/mg;\n\treMatch.lastIndex = this.parser.pos;\n\tvar match = reMatch.exec(this.parser.source);\n\tthis.parser.pos = reMatch.lastIndex;\n\t// Parse tree nodes to return\n\treturn [{\n\t\ttype: \"importvariables\",\n\t\tattributes: {\n\t\t\tfilter: {type: \"string\", value: match[1]}\n\t\t},\n\t\tchildren: []\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/list.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/list.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/list.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for lists. For example:\n\n```\n* This is an unordered list\n* It has two items\n\n# This is a numbered list\n## With a subitem\n# And a third item\n\n; This is a term that is being defined\n: This is the definition of that term\n```\n\nNote that lists can be nested arbitrarily:\n\n```\n#** One\n#* Two\n#** Three\n#**** Four\n#**# Five\n#**## Six\n## Seven\n### Eight\n## Nine\n```\n\nA CSS class can be applied to a list item as follows:\n\n```\n* List item one\n*.active List item two has the class `active`\n* List item three\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"list\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /([\\*#;:>]+)/mg;\n};\n\nvar listTypes = {\n\t\"*\": {listTag: \"ul\", itemTag: \"li\"},\n\t\"#\": {listTag: \"ol\", itemTag: \"li\"},\n\t\";\": {listTag: \"dl\", itemTag: \"dt\"},\n\t\":\": {listTag: \"dl\", itemTag: \"dd\"},\n\t\">\": {listTag: \"blockquote\", itemTag: \"div\"}\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Array of parse tree nodes for the previous row of the list\n\tvar listStack = [];\n\t// Cycle through the items in the list\n\twhile(true) {\n\t\t// Match the list marker\n\t\tvar reMatch = /([\\*#;:>]+)/mg;\n\t\treMatch.lastIndex = this.parser.pos;\n\t\tvar match = reMatch.exec(this.parser.source);\n\t\tif(!match || match.index !== this.parser.pos) {\n\t\t\tbreak;\n\t\t}\n\t\t// Check whether the list type of the top level matches\n\t\tvar listInfo = listTypes[match[0].charAt(0)];\n\t\tif(listStack.length > 0 && listStack[0].tag !== listInfo.listTag) {\n\t\t\tbreak;\n\t\t}\n\t\t// Move past the list marker\n\t\tthis.parser.pos = match.index + match[0].length;\n\t\t// Walk through the list markers for the current row\n\t\tfor(var t=0; t<match[0].length; t++) {\n\t\t\tlistInfo = listTypes[match[0].charAt(t)];\n\t\t\t// Remove any stacked up element if we can't re-use it because the list type doesn't match\n\t\t\tif(listStack.length > t && listStack[t].tag !== listInfo.listTag) {\n\t\t\t\tlistStack.splice(t,listStack.length - t);\n\t\t\t}\n\t\t\t// Construct the list element or reuse the previous one at this level\n\t\t\tif(listStack.length <= t) {\n\t\t\t\tvar listElement = {type: \"element\", tag: listInfo.listTag, children: [\n\t\t\t\t\t{type: \"element\", tag: listInfo.itemTag, children: []}\n\t\t\t\t]};\n\t\t\t\t// Link this list element into the last child item of the parent list item\n\t\t\t\tif(t) {\n\t\t\t\t\tvar prevListItem = listStack[t-1].children[listStack[t-1].children.length-1];\n\t\t\t\t\tprevListItem.children.push(listElement);\n\t\t\t\t}\n\t\t\t\t// Save this element in the stack\n\t\t\t\tlistStack[t] = listElement;\n\t\t\t} else if(t === (match[0].length - 1)) {\n\t\t\t\tlistStack[t].children.push({type: \"element\", tag: listInfo.itemTag, children: []});\n\t\t\t}\n\t\t}\n\t\tif(listStack.length > match[0].length) {\n\t\t\tlistStack.splice(match[0].length,listStack.length - match[0].length);\n\t\t}\n\t\t// Process the body of the list item into the last list item\n\t\tvar lastListChildren = listStack[listStack.length-1].children,\n\t\t\tlastListItem = lastListChildren[lastListChildren.length-1],\n\t\t\tclasses = this.parser.parseClasses();\n\t\tthis.parser.skipWhitespace({treatNewlinesAsNonWhitespace: true});\n\t\tvar tree = this.parser.parseInlineRun(/(\\r?\\n)/mg);\n\t\tlastListItem.children.push.apply(lastListItem.children,tree);\n\t\tif(classes.length > 0) {\n\t\t\t$tw.utils.addClassToParseTreeNode(lastListItem,classes.join(\" \"));\n\t\t}\n\t\t// Consume any whitespace following the list item\n\t\tthis.parser.skipWhitespace();\n\t}\n\t// Return the root element of the list\n\treturn [listStack[0]];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/macrocallblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/macrocallblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/macrocallblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki rule for block macro calls\n\n```\n<<name value value2>>\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"macrocallblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /<<([^>\\s]+)(?:\\s*)((?:[^>]|(?:>(?!>)))*?)>>(?:\\r?\\n|$)/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Get all the details of the match\n\tvar macroName = this.match[1],\n\t\tparamString = this.match[2];\n\t// Move past the macro call\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\tvar params = [],\n\t\treParam = /\\s*(?:([A-Za-z0-9\\-_]+)\\s*:)?(?:\\s*(?:\"\"\"([\\s\\S]*?)\"\"\"|\"([^\"]*)\"|'([^']*)'|\\[\\[([^\\]]*)\\]\\]|([^\"'\\s]+)))/mg,\n\t\tparamMatch = reParam.exec(paramString);\n\twhile(paramMatch) {\n\t\t// Process this parameter\n\t\tvar paramInfo = {\n\t\t\tvalue: paramMatch[2] || paramMatch[3] || paramMatch[4] || paramMatch[5] || paramMatch[6]\n\t\t};\n\t\tif(paramMatch[1]) {\n\t\t\tparamInfo.name = paramMatch[1];\n\t\t}\n\t\tparams.push(paramInfo);\n\t\t// Find the next match\n\t\tparamMatch = reParam.exec(paramString);\n\t}\n\treturn [{\n\t\ttype: \"macrocall\",\n\t\tname: macroName,\n\t\tparams: params,\n\t\tisBlock: true\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/macrocallinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/macrocallinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/macrocallinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki rule for macro calls\n\n```\n<<name value value2>>\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"macrocallinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /<<([^\\s>]+)\\s*([\\s\\S]*?)>>/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Get all the details of the match\n\tvar macroName = this.match[1],\n\t\tparamString = this.match[2];\n\t// Move past the macro call\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\tvar params = [],\n\t\treParam = /\\s*(?:([A-Za-z0-9\\-_]+)\\s*:)?(?:\\s*(?:\"\"\"([\\s\\S]*?)\"\"\"|\"([^\"]*)\"|'([^']*)'|\\[\\[([^\\]]*)\\]\\]|([^\"'\\s]+)))/mg,\n\t\tparamMatch = reParam.exec(paramString);\n\twhile(paramMatch) {\n\t\t// Process this parameter\n\t\tvar paramInfo = {\n\t\t\tvalue: paramMatch[2] || paramMatch[3] || paramMatch[4] || paramMatch[5]|| paramMatch[6]\n\t\t};\n\t\tif(paramMatch[1]) {\n\t\t\tparamInfo.name = paramMatch[1];\n\t\t}\n\t\tparams.push(paramInfo);\n\t\t// Find the next match\n\t\tparamMatch = reParam.exec(paramString);\n\t}\n\treturn [{\n\t\ttype: \"macrocall\",\n\t\tname: macroName,\n\t\tparams: params\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/macrodef.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/macrodef.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/macrodef.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki pragma rule for macro definitions\n\n```\n\\define name(param:defaultvalue,param2:defaultvalue)\ndefinition text, including $param$ markers\n\\end\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"macrodef\";\nexports.types = {pragma: true};\n\n/*\nInstantiate parse rule\n*/\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /^\\\\define\\s+([^(\\s]+)\\(\\s*([^)]*)\\)(\\s*\\r?\\n)?/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Move past the macro name and parameters\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse the parameters\n\tvar paramString = this.match[2],\n\t\tparams = [];\n\tif(paramString !== \"\") {\n\t\tvar reParam = /\\s*([A-Za-z0-9\\-_]+)(?:\\s*:\\s*(?:\"\"\"([\\s\\S]*?)\"\"\"|\"([^\"]*)\"|'([^']*)'|\\[\\[([^\\]]*)\\]\\]|([^\"'\\s]+)))?/mg,\n\t\t\tparamMatch = reParam.exec(paramString);\n\t\twhile(paramMatch) {\n\t\t\t// Save the parameter details\n\t\t\tvar paramInfo = {name: paramMatch[1]},\n\t\t\t\tdefaultValue = paramMatch[2] || paramMatch[3] || paramMatch[4] || paramMatch[5] || paramMatch[6];\n\t\t\tif(defaultValue) {\n\t\t\t\tparamInfo[\"default\"] = defaultValue;\n\t\t\t}\n\t\t\tparams.push(paramInfo);\n\t\t\t// Look for the next parameter\n\t\t\tparamMatch = reParam.exec(paramString);\n\t\t}\n\t}\n\t// Is this a multiline definition?\n\tvar reEnd;\n\tif(this.match[3]) {\n\t\t// If so, the end of the body is marked with \\end\n\t\treEnd = /(\\r?\\n\\\\end[^\\S\\n\\r]*(?:$|\\r?\\n))/mg;\n\t} else {\n\t\t// Otherwise, the end of the definition is marked by the end of the line\n\t\treEnd = /($|\\r?\\n)/mg;\n\t\t// Move past any whitespace\n\t\tthis.parser.pos = $tw.utils.skipWhiteSpace(this.parser.source,this.parser.pos);\n\t}\n\t// Find the end of the definition\n\treEnd.lastIndex = this.parser.pos;\n\tvar text,\n\t\tendMatch = reEnd.exec(this.parser.source);\n\tif(endMatch) {\n\t\ttext = this.parser.source.substring(this.parser.pos,endMatch.index);\n\t\tthis.parser.pos = endMatch.index + endMatch[0].length;\n\t} else {\n\t\t// We didn't find the end of the definition, so we'll make it blank\n\t\ttext = \"\";\n\t}\n\t// Save the macro definition\n\treturn [{\n\t\ttype: \"set\",\n\t\tattributes: {\n\t\t\tname: {type: \"string\", value: this.match[1]},\n\t\t\tvalue: {type: \"string\", value: text}\n\t\t},\n\t\tchildren: [],\n\t\tparams: params,\n\t\tisMacroDefinition: true\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/prettyextlink.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/prettyextlink.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/prettyextlink.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for external links. For example:\n\n```\n[ext[https://tiddlywiki.com/fractalveg.jpg]]\n[ext[Tooltip|https://tiddlywiki.com/fractalveg.jpg]]\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"prettyextlink\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n};\n\nexports.findNextMatch = function(startPos) {\n\t// Find the next tag\n\tthis.nextLink = this.findNextLink(this.parser.source,startPos);\n\treturn this.nextLink ? this.nextLink.start : undefined;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.nextLink.end;\n\treturn [this.nextLink];\n};\n\n/*\nFind the next link from the current position\n*/\nexports.findNextLink = function(source,pos) {\n\t// A regexp for finding candidate links\n\tvar reLookahead = /(\\[ext\\[)/g;\n\t// Find the next candidate\n\treLookahead.lastIndex = pos;\n\tvar match = reLookahead.exec(source);\n\twhile(match) {\n\t\t// Try to parse the candidate as a link\n\t\tvar link = this.parseLink(source,match.index);\n\t\t// Return success\n\t\tif(link) {\n\t\t\treturn link;\n\t\t}\n\t\t// Look for the next match\n\t\treLookahead.lastIndex = match.index + 1;\n\t\tmatch = reLookahead.exec(source);\n\t}\n\t// Failed\n\treturn null;\n};\n\n/*\nLook for an link at the specified position. Returns null if not found, otherwise returns {type: \"element\", tag: \"a\", attributes: [], isSelfClosing:, start:, end:,}\n*/\nexports.parseLink = function(source,pos) {\n\tvar token,\n\t\ttextNode = {\n\t\t\ttype: \"text\"\n\t\t},\n\t\tnode = {\n\t\t\ttype: \"element\",\n\t\t\ttag: \"a\",\n\t\t\tstart: pos,\n\t\t\tattributes: {\n\t\t\t\t\"class\": {type: \"string\", value: \"tc-tiddlylink-external\"},\n\t\t\t},\n\t\t\tchildren: [textNode]\n\t\t};\n\t// Skip whitespace\n\tpos = $tw.utils.skipWhiteSpace(source,pos);\n\t// Look for the `[ext[`\n\ttoken = $tw.utils.parseTokenString(source,pos,\"[ext[\");\n\tif(!token) {\n\t\treturn null;\n\t}\n\tpos = token.end;\n\t// Look ahead for the terminating `]]`\n\tvar closePos = source.indexOf(\"]]\",pos);\n\tif(closePos === -1) {\n\t\treturn null;\n\t}\n\t// Look for a `|` separating the tooltip\n\tvar splitPos = source.indexOf(\"|\",pos);\n\tif(splitPos === -1 || splitPos > closePos) {\n\t\tsplitPos = null;\n\t}\n\t// Pull out the tooltip and URL\n\tvar tooltip, URL;\n\tif(splitPos) {\n\t\tURL = source.substring(splitPos + 1,closePos).trim();\n\t\ttextNode.text = source.substring(pos,splitPos).trim();\n\t} else {\n\t\tURL = source.substring(pos,closePos).trim();\n\t\ttextNode.text = URL;\n\t}\n\tnode.attributes.href = {type: \"string\", value: URL};\n\tnode.attributes.target = {type: \"string\", value: \"_blank\"};\n\tnode.attributes.rel = {type: \"string\", value: \"noopener noreferrer\"};\n\t// Update the end position\n\tnode.end = closePos + 2;\n\treturn node;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/prettylink.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/prettylink.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/prettylink.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for pretty links. For example:\n\n```\n[[Introduction]]\n\n[[Link description|TiddlerTitle]]\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"prettylink\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\[\\[(.*?)(?:\\|(.*?))?\\]\\]/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Process the link\n\tvar text = this.match[1],\n\t\tlink = this.match[2] || text;\n\tif($tw.utils.isLinkExternal(link)) {\n\t\treturn [{\n\t\t\ttype: \"element\",\n\t\t\ttag: \"a\",\n\t\t\tattributes: {\n\t\t\t\thref: {type: \"string\", value: link},\n\t\t\t\t\"class\": {type: \"string\", value: \"tc-tiddlylink-external\"},\n\t\t\t\ttarget: {type: \"string\", value: \"_blank\"},\n\t\t\t\trel: {type: \"string\", value: \"noopener noreferrer\"}\n\t\t\t},\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\", text: text\n\t\t\t}]\n\t\t}];\n\t} else {\n\t\treturn [{\n\t\t\ttype: \"link\",\n\t\t\tattributes: {\n\t\t\t\tto: {type: \"string\", value: link}\n\t\t\t},\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\", text: text\n\t\t\t}]\n\t\t}];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/quoteblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/quoteblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/quoteblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for quote blocks. For example:\n\n```\n\t<<<.optionalClass(es) optional cited from\n\ta quote\n\t<<<\n\t\n\t<<<.optionalClass(es)\n\ta quote\n\t<<< optional cited from\n```\n\nQuotes can be quoted by putting more <s\n\n```\n\t<<<\n\tQuote Level 1\n\t\n\t<<<<\n\tQuoteLevel 2\n\t<<<<\n\t\n\t<<<\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"quoteblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /(<<<+)/mg;\n};\n\nexports.parse = function() {\n\tvar classes = [\"tc-quote\"];\n\t// Get all the details of the match\n\tvar reEndString = \"^\" + this.match[1] + \"(?!<)\";\n\t// Move past the <s\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t\n\t// Parse any classes, whitespace and then the optional cite itself\n\tclasses.push.apply(classes, this.parser.parseClasses());\n\tthis.parser.skipWhitespace({treatNewlinesAsNonWhitespace: true});\n\tvar cite = this.parser.parseInlineRun(/(\\r?\\n)/mg);\n\t// before handling the cite, parse the body of the quote\n\tvar tree= this.parser.parseBlocks(reEndString);\n\t// If we got a cite, put it before the text\n\tif(cite.length > 0) {\n\t\ttree.unshift({\n\t\t\ttype: \"element\",\n\t\t\ttag: \"cite\",\n\t\t\tchildren: cite\n\t\t});\n\t}\n\t// Parse any optional cite\n\tthis.parser.skipWhitespace({treatNewlinesAsNonWhitespace: true});\n\tcite = this.parser.parseInlineRun(/(\\r?\\n)/mg);\n\t// If we got a cite, push it\n\tif(cite.length > 0) {\n\t\ttree.push({\n\t\t\ttype: \"element\",\n\t\t\ttag: \"cite\",\n\t\t\tchildren: cite\n\t\t});\n\t}\n\t// Return the blockquote element\n\treturn [{\n\t\ttype: \"element\",\n\t\ttag: \"blockquote\",\n\t\tattributes: {\n\t\t\tclass: { type: \"string\", value: classes.join(\" \") },\n\t\t},\n\t\tchildren: tree\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/rules.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/rules.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/rules.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki pragma rule for rules specifications\n\n```\n\\rules except ruleone ruletwo rulethree\n\\rules only ruleone ruletwo rulethree\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"rules\";\nexports.types = {pragma: true};\n\n/*\nInstantiate parse rule\n*/\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /^\\\\rules[^\\S\\n]/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Move past the pragma invocation\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse whitespace delimited tokens terminated by a line break\n\tvar reMatch = /[^\\S\\n]*(\\S+)|(\\r?\\n)/mg,\n\t\ttokens = [];\n\treMatch.lastIndex = this.parser.pos;\n\tvar match = reMatch.exec(this.parser.source);\n\twhile(match && match.index === this.parser.pos) {\n\t\tthis.parser.pos = reMatch.lastIndex;\n\t\t// Exit if we've got the line break\n\t\tif(match[2]) {\n\t\t\tbreak;\n\t\t}\n\t\t// Process the token\n\t\tif(match[1]) {\n\t\t\ttokens.push(match[1]);\n\t\t}\n\t\t// Match the next token\n\t\tmatch = reMatch.exec(this.parser.source);\n\t}\n\t// Process the tokens\n\tif(tokens.length > 0) {\n\t\tthis.parser.amendRules(tokens[0],tokens.slice(1));\n\t}\n\t// No parse tree nodes to return\n\treturn [];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/styleblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/styleblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/styleblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for assigning styles and classes to paragraphs and other blocks. For example:\n\n```\n@@.myClass\n@@background-color:red;\nThis paragraph will have the CSS class `myClass`.\n\n* The `<ul>` around this list will also have the class `myClass`\n* List item 2\n\n@@\n```\n\nNote that classes and styles can be mixed subject to the rule that styles must precede classes. For example\n\n```\n@@.myFirstClass.mySecondClass\n@@width:100px;.myThirdClass\nThis is a paragraph\n@@\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"styleblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /@@((?:[^\\.\\r\\n\\s:]+:[^\\r\\n;]+;)+)?(?:\\.([^\\r\\n\\s]+))?\\r?\\n/mg;\n};\n\nexports.parse = function() {\n\tvar reEndString = \"^@@(?:\\\\r?\\\\n)?\";\n\tvar classes = [], styles = [];\n\tdo {\n\t\t// Get the class and style\n\t\tif(this.match[1]) {\n\t\t\tstyles.push(this.match[1]);\n\t\t}\n\t\tif(this.match[2]) {\n\t\t\tclasses.push(this.match[2].split(\".\").join(\" \"));\n\t\t}\n\t\t// Move past the match\n\t\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t\t// Look for another line of classes and styles\n\t\tthis.match = this.matchRegExp.exec(this.parser.source);\n\t} while(this.match && this.match.index === this.parser.pos);\n\t// Parse the body\n\tvar tree = this.parser.parseBlocks(reEndString);\n\tfor(var t=0; t<tree.length; t++) {\n\t\tif(classes.length > 0) {\n\t\t\t$tw.utils.addClassToParseTreeNode(tree[t],classes.join(\" \"));\n\t\t}\n\t\tif(styles.length > 0) {\n\t\t\t$tw.utils.addAttributeToParseTreeNode(tree[t],\"style\",styles.join(\"\"));\n\t\t}\n\t}\n\treturn tree;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/styleinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/styleinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/styleinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for assigning styles and classes to inline runs. For example:\n\n```\n@@.myClass This is some text with a class@@\n@@background-color:red;This is some text with a background colour@@\n@@width:100px;.myClass This is some text with a class and a width@@\n```\n\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"styleinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /@@((?:[^\\.\\r\\n\\s:]+:[^\\r\\n;]+;)+)?(\\.(?:[^\\r\\n\\s]+)\\s+)?/mg;\n};\n\nexports.parse = function() {\n\tvar reEnd = /@@/g;\n\t// Get the styles and class\n\tvar stylesString = this.match[1],\n\t\tclassString = this.match[2] ? this.match[2].split(\".\").join(\" \") : undefined;\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse the run up to the terminator\n\tvar tree = this.parser.parseInlineRun(reEnd,{eatTerminator: true});\n\t// Return the classed span\n\tvar node = {\n\t\ttype: \"element\",\n\t\ttag: \"span\",\n\t\tattributes: {\n\t\t\t\"class\": {type: \"string\", value: \"tc-inline-style\"}\n\t\t},\n\t\tchildren: tree\n\t};\n\tif(classString) {\n\t\t$tw.utils.addClassToParseTreeNode(node,classString);\n\t}\n\tif(stylesString) {\n\t\t$tw.utils.addAttributeToParseTreeNode(node,\"style\",stylesString);\n\t}\n\treturn [node];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/syslink.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/syslink.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/syslink.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for system tiddler links.\nCan be suppressed preceding them with `~`.\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"syslink\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = new RegExp(\n\t\t\"~?\\\\$:\\\\/[\" +\n\t\t$tw.config.textPrimitives.anyLetter.substr(1,$tw.config.textPrimitives.anyLetter.length - 2) +\n\t\t\"\\/._-]+\",\n\t\t\"mg\"\n\t);\n};\n\nexports.parse = function() {\n\tvar match = this.match[0];\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Create the link unless it is suppressed\n\tif(match.substr(0,1) === \"~\") {\n\t\treturn [{type: \"text\", text: match.substr(1)}];\n\t} else {\n\t\treturn [{\n\t\t\ttype: \"link\",\n\t\t\tattributes: {\n\t\t\t\tto: {type: \"string\", value: match}\n\t\t\t},\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\",\n\t\t\t\ttext: match\n\t\t\t}]\n\t\t}];\n\t}\n};\n\n})();",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/table.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/table.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/table.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text block rule for tables.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"table\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /^\\|(?:[^\\n]*)\\|(?:[fhck]?)\\r?(?:\\n|$)/mg;\n};\n\nvar processRow = function(prevColumns) {\n\tvar cellRegExp = /(?:\\|([^\\n\\|]*)\\|)|(\\|[fhck]?\\r?(?:\\n|$))/mg,\n\t\tcellTermRegExp = /((?:\\x20*)\\|)/mg,\n\t\ttree = [],\n\t\tcol = 0,\n\t\tcolSpanCount = 1,\n\t\tprevCell,\n\t\tvAlign;\n\t// Match a single cell\n\tcellRegExp.lastIndex = this.parser.pos;\n\tvar cellMatch = cellRegExp.exec(this.parser.source);\n\twhile(cellMatch && cellMatch.index === this.parser.pos) {\n\t\tif(cellMatch[1] === \"~\") {\n\t\t\t// Rowspan\n\t\t\tvar last = prevColumns[col];\n\t\t\tif(last) {\n\t\t\t\tlast.rowSpanCount++;\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(last.element,\"rowspan\",last.rowSpanCount);\n\t\t\t\tvAlign = $tw.utils.getAttributeValueFromParseTreeNode(last.element,\"valign\",\"center\");\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(last.element,\"valign\",vAlign);\n\t\t\t\tif(colSpanCount > 1) {\n\t\t\t\t\t$tw.utils.addAttributeToParseTreeNode(last.element,\"colspan\",colSpanCount);\n\t\t\t\t\tcolSpanCount = 1;\n\t\t\t\t}\n\t\t\t}\n\t\t\t// Move to just before the `|` terminating the cell\n\t\t\tthis.parser.pos = cellRegExp.lastIndex - 1;\n\t\t} else if(cellMatch[1] === \">\") {\n\t\t\t// Colspan\n\t\t\tcolSpanCount++;\n\t\t\t// Move to just before the `|` terminating the cell\n\t\t\tthis.parser.pos = cellRegExp.lastIndex - 1;\n\t\t} else if(cellMatch[1] === \"<\" && prevCell) {\n\t\t\tcolSpanCount = 1 + $tw.utils.getAttributeValueFromParseTreeNode(prevCell,\"colspan\",1);\n\t\t\t$tw.utils.addAttributeToParseTreeNode(prevCell,\"colspan\",colSpanCount);\n\t\t\tcolSpanCount = 1;\n\t\t\t// Move to just before the `|` terminating the cell\n\t\t\tthis.parser.pos = cellRegExp.lastIndex - 1;\n\t\t} else if(cellMatch[2]) {\n\t\t\t// End of row\n\t\t\tif(prevCell && colSpanCount > 1) {\n\t\t\t\tif(prevCell.attributes && prevCell.attributes && prevCell.attributes.colspan) {\n\t\t\t\t\t\tcolSpanCount += prevCell.attributes.colspan.value;\n\t\t\t\t} else {\n\t\t\t\t\tcolSpanCount -= 1;\n\t\t\t\t}\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(prevCell,\"colspan\",colSpanCount);\n\t\t\t}\n\t\t\tthis.parser.pos = cellRegExp.lastIndex - 1;\n\t\t\tbreak;\n\t\t} else {\n\t\t\t// For ordinary cells, step beyond the opening `|`\n\t\t\tthis.parser.pos++;\n\t\t\t// Look for a space at the start of the cell\n\t\t\tvar spaceLeft = false;\n\t\t\tvAlign = null;\n\t\t\tif(this.parser.source.substr(this.parser.pos).search(/^\\^([^\\^]|\\^\\^)/) === 0) {\n\t\t\t\tvAlign = \"top\";\n\t\t\t} else if(this.parser.source.substr(this.parser.pos).search(/^,([^,]|,,)/) === 0) {\n\t\t\t\tvAlign = \"bottom\";\n\t\t\t}\n\t\t\tif(vAlign) {\n\t\t\t\tthis.parser.pos++;\n\t\t\t}\n\t\t\tvar chr = this.parser.source.substr(this.parser.pos,1);\n\t\t\twhile(chr === \" \") {\n\t\t\t\tspaceLeft = true;\n\t\t\t\tthis.parser.pos++;\n\t\t\t\tchr = this.parser.source.substr(this.parser.pos,1);\n\t\t\t}\n\t\t\t// Check whether this is a heading cell\n\t\t\tvar cell;\n\t\t\tif(chr === \"!\") {\n\t\t\t\tthis.parser.pos++;\n\t\t\t\tcell = {type: \"element\", tag: \"th\", children: []};\n\t\t\t} else {\n\t\t\t\tcell = {type: \"element\", tag: \"td\", children: []};\n\t\t\t}\n\t\t\ttree.push(cell);\n\t\t\t// Record information about this cell\n\t\t\tprevCell = cell;\n\t\t\tprevColumns[col] = {rowSpanCount:1,element:cell};\n\t\t\t// Check for a colspan\n\t\t\tif(colSpanCount > 1) {\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(cell,\"colspan\",colSpanCount);\n\t\t\t\tcolSpanCount = 1;\n\t\t\t}\n\t\t\t// Parse the cell\n\t\t\tcell.children = this.parser.parseInlineRun(cellTermRegExp,{eatTerminator: true});\n\t\t\t// Set the alignment for the cell\n\t\t\tif(vAlign) {\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(cell,\"valign\",vAlign);\n\t\t\t}\n\t\t\tif(this.parser.source.substr(this.parser.pos - 2,1) === \" \") { // spaceRight\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(cell,\"align\",spaceLeft ? \"center\" : \"left\");\n\t\t\t} else if(spaceLeft) {\n\t\t\t\t$tw.utils.addAttributeToParseTreeNode(cell,\"align\",\"right\");\n\t\t\t}\n\t\t\t// Move back to the closing `|`\n\t\t\tthis.parser.pos--;\n\t\t}\n\t\tcol++;\n\t\tcellRegExp.lastIndex = this.parser.pos;\n\t\tcellMatch = cellRegExp.exec(this.parser.source);\n\t}\n\treturn tree;\n};\n\nexports.parse = function() {\n\tvar rowContainerTypes = {\"c\":\"caption\", \"h\":\"thead\", \"\":\"tbody\", \"f\":\"tfoot\"},\n\t\ttable = {type: \"element\", tag: \"table\", children: []},\n\t\trowRegExp = /^\\|([^\\n]*)\\|([fhck]?)\\r?(?:\\n|$)/mg,\n\t\trowTermRegExp = /(\\|(?:[fhck]?)\\r?(?:\\n|$))/mg,\n\t\tprevColumns = [],\n\t\tcurrRowType,\n\t\trowContainer,\n\t\trowCount = 0;\n\t// Match the row\n\trowRegExp.lastIndex = this.parser.pos;\n\tvar rowMatch = rowRegExp.exec(this.parser.source);\n\twhile(rowMatch && rowMatch.index === this.parser.pos) {\n\t\tvar rowType = rowMatch[2];\n\t\t// Check if it is a class assignment\n\t\tif(rowType === \"k\") {\n\t\t\t$tw.utils.addClassToParseTreeNode(table,rowMatch[1]);\n\t\t\tthis.parser.pos = rowMatch.index + rowMatch[0].length;\n\t\t} else {\n\t\t\t// Otherwise, create a new row if this one is of a different type\n\t\t\tif(rowType !== currRowType) {\n\t\t\t\trowContainer = {type: \"element\", tag: rowContainerTypes[rowType], children: []};\n\t\t\t\ttable.children.push(rowContainer);\n\t\t\t\tcurrRowType = rowType;\n\t\t\t}\n\t\t\t// Is this a caption row?\n\t\t\tif(currRowType === \"c\") {\n\t\t\t\t// If so, move past the opening `|` of the row\n\t\t\t\tthis.parser.pos++;\n\t\t\t\t// Move the caption to the first row if it isn't already\n\t\t\t\tif(table.children.length !== 1) {\n\t\t\t\t\ttable.children.pop(); // Take rowContainer out of the children array\n\t\t\t\t\ttable.children.splice(0,0,rowContainer); // Insert it at the bottom\t\t\t\t\t\t\n\t\t\t\t}\n\t\t\t\t// Set the alignment - TODO: figure out why TW did this\n//\t\t\t\trowContainer.attributes.align = rowCount === 0 ? \"top\" : \"bottom\";\n\t\t\t\t// Parse the caption\n\t\t\t\trowContainer.children = this.parser.parseInlineRun(rowTermRegExp,{eatTerminator: true});\n\t\t\t} else {\n\t\t\t\t// Create the row\n\t\t\t\tvar theRow = {type: \"element\", tag: \"tr\", children: []};\n\t\t\t\t$tw.utils.addClassToParseTreeNode(theRow,rowCount%2 ? \"oddRow\" : \"evenRow\");\n\t\t\t\trowContainer.children.push(theRow);\n\t\t\t\t// Process the row\n\t\t\t\ttheRow.children = processRow.call(this,prevColumns);\n\t\t\t\tthis.parser.pos = rowMatch.index + rowMatch[0].length;\n\t\t\t\t// Increment the row count\n\t\t\t\trowCount++;\n\t\t\t}\n\t\t}\n\t\trowMatch = rowRegExp.exec(this.parser.source);\n\t}\n\treturn [table];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/transcludeblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/transcludeblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/transcludeblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for block-level transclusion. For example:\n\n```\n{{MyTiddler}}\n{{MyTiddler||TemplateTitle}}\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"transcludeblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\{\\{([^\\{\\}\\|]*)(?:\\|\\|([^\\|\\{\\}]+))?\\}\\}(?:\\r?\\n|$)/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Get the match details\n\tvar template = $tw.utils.trim(this.match[2]),\n\t\ttextRef = $tw.utils.trim(this.match[1]);\n\t// Prepare the transclude widget\n\tvar transcludeNode = {\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {},\n\t\t\tisBlock: true\n\t\t};\n\t// Prepare the tiddler widget\n\tvar tr, targetTitle, targetField, targetIndex, tiddlerNode;\n\tif(textRef) {\n\t\ttr = $tw.utils.parseTextReference(textRef);\n\t\ttargetTitle = tr.title;\n\t\ttargetField = tr.field;\n\t\ttargetIndex = tr.index;\n\t\ttiddlerNode = {\n\t\t\ttype: \"tiddler\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: targetTitle}\n\t\t\t},\n\t\t\tisBlock: true,\n\t\t\tchildren: [transcludeNode]\n\t\t};\n\t}\n\tif(template) {\n\t\ttranscludeNode.attributes.tiddler = {type: \"string\", value: template};\n\t\tif(textRef) {\n\t\t\treturn [tiddlerNode];\n\t\t} else {\n\t\t\treturn [transcludeNode];\n\t\t}\n\t} else {\n\t\tif(textRef) {\n\t\t\ttranscludeNode.attributes.tiddler = {type: \"string\", value: targetTitle};\n\t\t\tif(targetField) {\n\t\t\t\ttranscludeNode.attributes.field = {type: \"string\", value: targetField};\n\t\t\t}\n\t\t\tif(targetIndex) {\n\t\t\t\ttranscludeNode.attributes.index = {type: \"string\", value: targetIndex};\n\t\t\t}\n\t\t\treturn [tiddlerNode];\n\t\t} else {\n\t\t\treturn [transcludeNode];\n\t\t}\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/transcludeinline.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/transcludeinline.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/transcludeinline.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for inline-level transclusion. For example:\n\n```\n{{MyTiddler}}\n{{MyTiddler||TemplateTitle}}\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"transcludeinline\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\{\\{([^\\{\\}\\|]*)(?:\\|\\|([^\\|\\{\\}]+))?\\}\\}/mg;\n};\n\nexports.parse = function() {\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Get the match details\n\tvar template = $tw.utils.trim(this.match[2]),\n\t\ttextRef = $tw.utils.trim(this.match[1]);\n\t// Prepare the transclude widget\n\tvar transcludeNode = {\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {}\n\t\t};\n\t// Prepare the tiddler widget\n\tvar tr, targetTitle, targetField, targetIndex, tiddlerNode;\n\tif(textRef) {\n\t\ttr = $tw.utils.parseTextReference(textRef);\n\t\ttargetTitle = tr.title;\n\t\ttargetField = tr.field;\n\t\ttargetIndex = tr.index;\n\t\ttiddlerNode = {\n\t\t\ttype: \"tiddler\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: targetTitle}\n\t\t\t},\n\t\t\tchildren: [transcludeNode]\n\t\t};\n\t}\n\tif(template) {\n\t\ttranscludeNode.attributes.tiddler = {type: \"string\", value: template};\n\t\tif(textRef) {\n\t\t\treturn [tiddlerNode];\n\t\t} else {\n\t\t\treturn [transcludeNode];\n\t\t}\n\t} else {\n\t\tif(textRef) {\n\t\t\ttranscludeNode.attributes.tiddler = {type: \"string\", value: targetTitle};\n\t\t\tif(targetField) {\n\t\t\t\ttranscludeNode.attributes.field = {type: \"string\", value: targetField};\n\t\t\t}\n\t\t\tif(targetIndex) {\n\t\t\t\ttranscludeNode.attributes.index = {type: \"string\", value: targetIndex};\n\t\t\t}\n\t\t\treturn [tiddlerNode];\n\t\t} else {\n\t\t\treturn [transcludeNode];\n\t\t}\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/typedblock.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/typedblock.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/typedblock.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text rule for typed blocks. For example:\n\n```\n$$$.js\nThis will be rendered as JavaScript\n$$$\n\n$$$.svg\n<svg xmlns=\"http://www.w3.org/2000/svg\" width=\"150\" height=\"100\">\n <circle cx=\"100\" cy=\"50\" r=\"40\" stroke=\"black\" stroke-width=\"2\" fill=\"red\" />\n</svg>\n$$$\n\n$$$text/vnd.tiddlywiki>text/html\nThis will be rendered as an //HTML representation// of WikiText\n$$$\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.name = \"typedblock\";\nexports.types = {block: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /\\$\\$\\$([^ >\\r\\n]*)(?: *> *([^ \\r\\n]+))?\\r?\\n/mg;\n};\n\nexports.parse = function() {\n\tvar reEnd = /\\r?\\n\\$\\$\\$\\r?(?:\\n|$)/mg;\n\t// Save the type\n\tvar parseType = this.match[1],\n\t\trenderType = this.match[2];\n\t// Move past the match\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Look for the end of the block\n\treEnd.lastIndex = this.parser.pos;\n\tvar match = reEnd.exec(this.parser.source),\n\t\ttext;\n\t// Process the block\n\tif(match) {\n\t\ttext = this.parser.source.substring(this.parser.pos,match.index);\n\t\tthis.parser.pos = match.index + match[0].length;\n\t} else {\n\t\ttext = this.parser.source.substr(this.parser.pos);\n\t\tthis.parser.pos = this.parser.sourceLength;\n\t}\n\t// Parse the block according to the specified type\n\tvar parser = this.parser.wiki.parseText(parseType,text,{defaultType: \"text/plain\"});\n\t// If there's no render type, just return the parse tree\n\tif(!renderType) {\n\t\treturn parser.tree;\n\t} else {\n\t\t// Otherwise, render to the rendertype and return in a <PRE> tag\n\t\tvar widgetNode = this.parser.wiki.makeWidget(parser),\n\t\t\tcontainer = $tw.fakeDocument.createElement(\"div\");\n\t\twidgetNode.render(container,null);\n\t\ttext = renderType === \"text/html\" ? container.innerHTML : container.textContent;\n\t\treturn [{\n\t\t\ttype: \"element\",\n\t\t\ttag: \"pre\",\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\",\n\t\t\t\ttext: text\n\t\t\t}]\n\t\t}];\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/whitespace.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/whitespace.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/whitespace.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki pragma rule for whitespace specifications\n\n```\n\\whitespace trim\n\\whitespace notrim\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"whitespace\";\nexports.types = {pragma: true};\n\n/*\nInstantiate parse rule\n*/\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = /^\\\\whitespace[^\\S\\n]/mg;\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\tvar self = this;\n\t// Move past the pragma invocation\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// Parse whitespace delimited tokens terminated by a line break\n\tvar reMatch = /[^\\S\\n]*(\\S+)|(\\r?\\n)/mg,\n\t\ttokens = [];\n\treMatch.lastIndex = this.parser.pos;\n\tvar match = reMatch.exec(this.parser.source);\n\twhile(match && match.index === this.parser.pos) {\n\t\tthis.parser.pos = reMatch.lastIndex;\n\t\t// Exit if we've got the line break\n\t\tif(match[2]) {\n\t\t\tbreak;\n\t\t}\n\t\t// Process the token\n\t\tif(match[1]) {\n\t\t\ttokens.push(match[1]);\n\t\t}\n\t\t// Match the next token\n\t\tmatch = reMatch.exec(this.parser.source);\n\t}\n\t// Process the tokens\n\t$tw.utils.each(tokens,function(token) {\n\t\tswitch(token) {\n\t\t\tcase \"trim\":\n\t\t\t\tself.parser.configTrimWhiteSpace = true;\n\t\t\t\tbreak;\n\t\t\tcase \"notrim\":\n\t\t\t\tself.parser.configTrimWhiteSpace = false;\n\t\t\t\tbreak;\n\t\t}\n\t});\n\t// No parse tree nodes to return\n\treturn [];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/rules/wikilink.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/wikilink.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/wikilink.js\ntype: application/javascript\nmodule-type: wikirule\n\nWiki text inline rule for wiki links. For example:\n\n```\nAWikiLink\nAnotherLink\n~SuppressedLink\n```\n\nPrecede a camel case word with `~` to prevent it from being recognised as a link.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.name = \"wikilink\";\nexports.types = {inline: true};\n\nexports.init = function(parser) {\n\tthis.parser = parser;\n\t// Regexp to match\n\tthis.matchRegExp = new RegExp($tw.config.textPrimitives.unWikiLink + \"?\" + $tw.config.textPrimitives.wikiLink,\"mg\");\n};\n\n/*\nParse the most recent match\n*/\nexports.parse = function() {\n\t// Get the details of the match\n\tvar linkText = this.match[0];\n\t// Move past the macro call\n\tthis.parser.pos = this.matchRegExp.lastIndex;\n\t// If the link starts with the unwikilink character then just output it as plain text\n\tif(linkText.substr(0,1) === $tw.config.textPrimitives.unWikiLink) {\n\t\treturn [{type: \"text\", text: linkText.substr(1)}];\n\t}\n\t// If the link has been preceded with a blocked letter then don't treat it as a link\n\tif(this.match.index > 0) {\n\t\tvar preRegExp = new RegExp($tw.config.textPrimitives.blockPrefixLetters,\"mg\");\n\t\tpreRegExp.lastIndex = this.match.index-1;\n\t\tvar preMatch = preRegExp.exec(this.parser.source);\n\t\tif(preMatch && preMatch.index === this.match.index-1) {\n\t\t\treturn [{type: \"text\", text: linkText}];\n\t\t}\n\t}\n\treturn [{\n\t\ttype: \"link\",\n\t\tattributes: {\n\t\t\tto: {type: \"string\", value: linkText}\n\t\t},\n\t\tchildren: [{\n\t\t\ttype: \"text\",\n\t\t\ttext: linkText\n\t\t}]\n\t}];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "wikirule"
},
"$:/core/modules/parsers/wikiparser/wikiparser.js": {
"title": "$:/core/modules/parsers/wikiparser/wikiparser.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/wikiparser.js\ntype: application/javascript\nmodule-type: parser\n\nThe wiki text parser processes blocks of source text into a parse tree.\n\nThe parse tree is made up of nested arrays of these JavaScript objects:\n\n\t{type: \"element\", tag: <string>, attributes: {}, children: []} - an HTML element\n\t{type: \"text\", text: <string>} - a text node\n\t{type: \"entity\", value: <string>} - an entity\n\t{type: \"raw\", html: <string>} - raw HTML\n\nAttributes are stored as hashmaps of the following objects:\n\n\t{type: \"string\", value: <string>} - literal string\n\t{type: \"indirect\", textReference: <textReference>} - indirect through a text reference\n\t{type: \"macro\", macro: <TBD>} - indirect through a macro invocation\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar WikiParser = function(type,text,options) {\n\tthis.wiki = options.wiki;\n\tvar self = this;\n\t// Check for an externally linked tiddler\n\tif($tw.browser && (text || \"\") === \"\" && options._canonical_uri) {\n\t\tthis.loadRemoteTiddler(options._canonical_uri);\n\t\ttext = $tw.language.getRawString(\"LazyLoadingWarning\");\n\t}\n\t// Initialise the classes if we don't have them already\n\tif(!this.pragmaRuleClasses) {\n\t\tWikiParser.prototype.pragmaRuleClasses = $tw.modules.createClassesFromModules(\"wikirule\",\"pragma\",$tw.WikiRuleBase);\n\t\tthis.setupRules(WikiParser.prototype.pragmaRuleClasses,\"$:/config/WikiParserRules/Pragmas/\");\n\t}\n\tif(!this.blockRuleClasses) {\n\t\tWikiParser.prototype.blockRuleClasses = $tw.modules.createClassesFromModules(\"wikirule\",\"block\",$tw.WikiRuleBase);\n\t\tthis.setupRules(WikiParser.prototype.blockRuleClasses,\"$:/config/WikiParserRules/Block/\");\n\t}\n\tif(!this.inlineRuleClasses) {\n\t\tWikiParser.prototype.inlineRuleClasses = $tw.modules.createClassesFromModules(\"wikirule\",\"inline\",$tw.WikiRuleBase);\n\t\tthis.setupRules(WikiParser.prototype.inlineRuleClasses,\"$:/config/WikiParserRules/Inline/\");\n\t}\n\t// Save the parse text\n\tthis.type = type || \"text/vnd.tiddlywiki\";\n\tthis.source = text || \"\";\n\tthis.sourceLength = this.source.length;\n\t// Flag for ignoring whitespace\n\tthis.configTrimWhiteSpace = false;\n\t// Set current parse position\n\tthis.pos = 0;\n\t// Instantiate the pragma parse rules\n\tthis.pragmaRules = this.instantiateRules(this.pragmaRuleClasses,\"pragma\",0);\n\t// Instantiate the parser block and inline rules\n\tthis.blockRules = this.instantiateRules(this.blockRuleClasses,\"block\",0);\n\tthis.inlineRules = this.instantiateRules(this.inlineRuleClasses,\"inline\",0);\n\t// Parse any pragmas\n\tthis.tree = [];\n\tvar topBranch = this.parsePragmas();\n\t// Parse the text into inline runs or blocks\n\tif(options.parseAsInline) {\n\t\ttopBranch.push.apply(topBranch,this.parseInlineRun());\n\t} else {\n\t\ttopBranch.push.apply(topBranch,this.parseBlocks());\n\t}\n\t// Return the parse tree\n};\n\n/*\n*/\nWikiParser.prototype.loadRemoteTiddler = function(url) {\n\tvar self = this;\n\t$tw.utils.httpRequest({\n\t\turl: url,\n\t\ttype: \"GET\",\n\t\tcallback: function(err,data) {\n\t\t\tif(!err) {\n\t\t\t\tvar tiddlers = self.wiki.deserializeTiddlers(\".tid\",data,self.wiki.getCreationFields());\n\t\t\t\t$tw.utils.each(tiddlers,function(tiddler) {\n\t\t\t\t\ttiddler[\"_canonical_uri\"] = url;\n\t\t\t\t});\n\t\t\t\tif(tiddlers) {\n\t\t\t\t\tself.wiki.addTiddlers(tiddlers);\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n};\n\n/*\n*/\nWikiParser.prototype.setupRules = function(proto,configPrefix) {\n\tvar self = this;\n\tif(!$tw.safemode) {\n\t\t$tw.utils.each(proto,function(object,name) {\n\t\t\tif(self.wiki.getTiddlerText(configPrefix + name,\"enable\") !== \"enable\") {\n\t\t\t\tdelete proto[name];\n\t\t\t}\n\t\t});\n\t}\n};\n\n/*\nInstantiate an array of parse rules\n*/\nWikiParser.prototype.instantiateRules = function(classes,type,startPos) {\n\tvar rulesInfo = [],\n\t\tself = this;\n\t$tw.utils.each(classes,function(RuleClass) {\n\t\t// Instantiate the rule\n\t\tvar rule = new RuleClass(self);\n\t\trule.is = {};\n\t\trule.is[type] = true;\n\t\trule.init(self);\n\t\tvar matchIndex = rule.findNextMatch(startPos);\n\t\tif(matchIndex !== undefined) {\n\t\t\trulesInfo.push({\n\t\t\t\trule: rule,\n\t\t\t\tmatchIndex: matchIndex\n\t\t\t});\n\t\t}\n\t});\n\treturn rulesInfo;\n};\n\n/*\nSkip any whitespace at the current position. Options are:\n\ttreatNewlinesAsNonWhitespace: true if newlines are NOT to be treated as whitespace\n*/\nWikiParser.prototype.skipWhitespace = function(options) {\n\toptions = options || {};\n\tvar whitespaceRegExp = options.treatNewlinesAsNonWhitespace ? /([^\\S\\n]+)/mg : /(\\s+)/mg;\n\twhitespaceRegExp.lastIndex = this.pos;\n\tvar whitespaceMatch = whitespaceRegExp.exec(this.source);\n\tif(whitespaceMatch && whitespaceMatch.index === this.pos) {\n\t\tthis.pos = whitespaceRegExp.lastIndex;\n\t}\n};\n\n/*\nGet the next match out of an array of parse rule instances\n*/\nWikiParser.prototype.findNextMatch = function(rules,startPos) {\n\t// Find the best matching rule by finding the closest match position\n\tvar matchingRule,\n\t\tmatchingRulePos = this.sourceLength;\n\t// Step through each rule\n\tfor(var t=0; t<rules.length; t++) {\n\t\tvar ruleInfo = rules[t];\n\t\t// Ask the rule to get the next match if we've moved past the current one\n\t\tif(ruleInfo.matchIndex !== undefined && ruleInfo.matchIndex < startPos) {\n\t\t\truleInfo.matchIndex = ruleInfo.rule.findNextMatch(startPos);\n\t\t}\n\t\t// Adopt this match if it's closer than the current best match\n\t\tif(ruleInfo.matchIndex !== undefined && ruleInfo.matchIndex <= matchingRulePos) {\n\t\t\tmatchingRule = ruleInfo;\n\t\t\tmatchingRulePos = ruleInfo.matchIndex;\n\t\t}\n\t}\n\treturn matchingRule;\n};\n\n/*\nParse any pragmas at the beginning of a block of parse text\n*/\nWikiParser.prototype.parsePragmas = function() {\n\tvar currentTreeBranch = this.tree;\n\twhile(true) {\n\t\t// Skip whitespace\n\t\tthis.skipWhitespace();\n\t\t// Check for the end of the text\n\t\tif(this.pos >= this.sourceLength) {\n\t\t\tbreak;\n\t\t}\n\t\t// Check if we've arrived at a pragma rule match\n\t\tvar nextMatch = this.findNextMatch(this.pragmaRules,this.pos);\n\t\t// If not, just exit\n\t\tif(!nextMatch || nextMatch.matchIndex !== this.pos) {\n\t\t\tbreak;\n\t\t}\n\t\t// Process the pragma rule\n\t\tvar subTree = nextMatch.rule.parse();\n\t\tif(subTree.length > 0) {\n\t\t\t// Quick hack; we only cope with a single parse tree node being returned, which is true at the moment\n\t\t\tcurrentTreeBranch.push.apply(currentTreeBranch,subTree);\n\t\t\tsubTree[0].children = [];\n\t\t\tcurrentTreeBranch = subTree[0].children;\n\t\t}\n\t}\n\treturn currentTreeBranch;\n};\n\n/*\nParse a block from the current position\n\tterminatorRegExpString: optional regular expression string that identifies the end of plain paragraphs. Must not include capturing parenthesis\n*/\nWikiParser.prototype.parseBlock = function(terminatorRegExpString) {\n\tvar terminatorRegExp = terminatorRegExpString ? new RegExp(\"(\" + terminatorRegExpString + \"|\\\\r?\\\\n\\\\r?\\\\n)\",\"mg\") : /(\\r?\\n\\r?\\n)/mg;\n\tthis.skipWhitespace();\n\tif(this.pos >= this.sourceLength) {\n\t\treturn [];\n\t}\n\t// Look for a block rule that applies at the current position\n\tvar nextMatch = this.findNextMatch(this.blockRules,this.pos);\n\tif(nextMatch && nextMatch.matchIndex === this.pos) {\n\t\treturn nextMatch.rule.parse();\n\t}\n\t// Treat it as a paragraph if we didn't find a block rule\n\treturn [{type: \"element\", tag: \"p\", children: this.parseInlineRun(terminatorRegExp)}];\n};\n\n/*\nParse a series of blocks of text until a terminating regexp is encountered or the end of the text\n\tterminatorRegExpString: terminating regular expression\n*/\nWikiParser.prototype.parseBlocks = function(terminatorRegExpString) {\n\tif(terminatorRegExpString) {\n\t\treturn this.parseBlocksTerminated(terminatorRegExpString);\n\t} else {\n\t\treturn this.parseBlocksUnterminated();\n\t}\n};\n\n/*\nParse a block from the current position to the end of the text\n*/\nWikiParser.prototype.parseBlocksUnterminated = function() {\n\tvar tree = [];\n\twhile(this.pos < this.sourceLength) {\n\t\ttree.push.apply(tree,this.parseBlock());\n\t}\n\treturn tree;\n};\n\n/*\nParse blocks of text until a terminating regexp is encountered\n*/\nWikiParser.prototype.parseBlocksTerminated = function(terminatorRegExpString) {\n\tvar terminatorRegExp = new RegExp(\"(\" + terminatorRegExpString + \")\",\"mg\"),\n\t\ttree = [];\n\t// Skip any whitespace\n\tthis.skipWhitespace();\n\t// Check if we've got the end marker\n\tterminatorRegExp.lastIndex = this.pos;\n\tvar match = terminatorRegExp.exec(this.source);\n\t// Parse the text into blocks\n\twhile(this.pos < this.sourceLength && !(match && match.index === this.pos)) {\n\t\tvar blocks = this.parseBlock(terminatorRegExpString);\n\t\ttree.push.apply(tree,blocks);\n\t\t// Skip any whitespace\n\t\tthis.skipWhitespace();\n\t\t// Check if we've got the end marker\n\t\tterminatorRegExp.lastIndex = this.pos;\n\t\tmatch = terminatorRegExp.exec(this.source);\n\t}\n\tif(match && match.index === this.pos) {\n\t\tthis.pos = match.index + match[0].length;\n\t}\n\treturn tree;\n};\n\n/*\nParse a run of text at the current position\n\tterminatorRegExp: a regexp at which to stop the run\n\toptions: see below\nOptions available:\n\teatTerminator: move the parse position past any encountered terminator (default false)\n*/\nWikiParser.prototype.parseInlineRun = function(terminatorRegExp,options) {\n\tif(terminatorRegExp) {\n\t\treturn this.parseInlineRunTerminated(terminatorRegExp,options);\n\t} else {\n\t\treturn this.parseInlineRunUnterminated(options);\n\t}\n};\n\nWikiParser.prototype.parseInlineRunUnterminated = function(options) {\n\tvar tree = [];\n\t// Find the next occurrence of an inline rule\n\tvar nextMatch = this.findNextMatch(this.inlineRules,this.pos);\n\t// Loop around the matches until we've reached the end of the text\n\twhile(this.pos < this.sourceLength && nextMatch) {\n\t\t// Process the text preceding the run rule\n\t\tif(nextMatch.matchIndex > this.pos) {\n\t\t\tthis.pushTextWidget(tree,this.source.substring(this.pos,nextMatch.matchIndex));\n\t\t\tthis.pos = nextMatch.matchIndex;\n\t\t}\n\t\t// Process the run rule\n\t\ttree.push.apply(tree,nextMatch.rule.parse());\n\t\t// Look for the next run rule\n\t\tnextMatch = this.findNextMatch(this.inlineRules,this.pos);\n\t}\n\t// Process the remaining text\n\tif(this.pos < this.sourceLength) {\n\t\tthis.pushTextWidget(tree,this.source.substr(this.pos));\n\t}\n\tthis.pos = this.sourceLength;\n\treturn tree;\n};\n\nWikiParser.prototype.parseInlineRunTerminated = function(terminatorRegExp,options) {\n\toptions = options || {};\n\tvar tree = [];\n\t// Find the next occurrence of the terminator\n\tterminatorRegExp.lastIndex = this.pos;\n\tvar terminatorMatch = terminatorRegExp.exec(this.source);\n\t// Find the next occurrence of a inlinerule\n\tvar inlineRuleMatch = this.findNextMatch(this.inlineRules,this.pos);\n\t// Loop around until we've reached the end of the text\n\twhile(this.pos < this.sourceLength && (terminatorMatch || inlineRuleMatch)) {\n\t\t// Return if we've found the terminator, and it precedes any inline rule match\n\t\tif(terminatorMatch) {\n\t\t\tif(!inlineRuleMatch || inlineRuleMatch.matchIndex >= terminatorMatch.index) {\n\t\t\t\tif(terminatorMatch.index > this.pos) {\n\t\t\t\t\tthis.pushTextWidget(tree,this.source.substring(this.pos,terminatorMatch.index));\n\t\t\t\t}\n\t\t\t\tthis.pos = terminatorMatch.index;\n\t\t\t\tif(options.eatTerminator) {\n\t\t\t\t\tthis.pos += terminatorMatch[0].length;\n\t\t\t\t}\n\t\t\t\treturn tree;\n\t\t\t}\n\t\t}\n\t\t// Process any inline rule, along with the text preceding it\n\t\tif(inlineRuleMatch) {\n\t\t\t// Preceding text\n\t\t\tif(inlineRuleMatch.matchIndex > this.pos) {\n\t\t\t\tthis.pushTextWidget(tree,this.source.substring(this.pos,inlineRuleMatch.matchIndex));\n\t\t\t\tthis.pos = inlineRuleMatch.matchIndex;\n\t\t\t}\n\t\t\t// Process the inline rule\n\t\t\ttree.push.apply(tree,inlineRuleMatch.rule.parse());\n\t\t\t// Look for the next inline rule\n\t\t\tinlineRuleMatch = this.findNextMatch(this.inlineRules,this.pos);\n\t\t\t// Look for the next terminator match\n\t\t\tterminatorRegExp.lastIndex = this.pos;\n\t\t\tterminatorMatch = terminatorRegExp.exec(this.source);\n\t\t}\n\t}\n\t// Process the remaining text\n\tif(this.pos < this.sourceLength) {\n\t\tthis.pushTextWidget(tree,this.source.substr(this.pos));\n\t}\n\tthis.pos = this.sourceLength;\n\treturn tree;\n};\n\n/*\nPush a text widget onto an array, respecting the configTrimWhiteSpace setting\n*/\nWikiParser.prototype.pushTextWidget = function(array,text) {\n\tif(this.configTrimWhiteSpace) {\n\t\ttext = $tw.utils.trim(text);\n\t}\n\tif(text) {\n\t\tarray.push({type: \"text\", text: text});\t\t\n\t}\n};\n\n/*\nParse zero or more class specifiers `.classname`\n*/\nWikiParser.prototype.parseClasses = function() {\n\tvar classRegExp = /\\.([^\\s\\.]+)/mg,\n\t\tclassNames = [];\n\tclassRegExp.lastIndex = this.pos;\n\tvar match = classRegExp.exec(this.source);\n\twhile(match && match.index === this.pos) {\n\t\tthis.pos = match.index + match[0].length;\n\t\tclassNames.push(match[1]);\n\t\tmatch = classRegExp.exec(this.source);\n\t}\n\treturn classNames;\n};\n\n/*\nAmend the rules used by this instance of the parser\n\ttype: `only` keeps just the named rules, `except` keeps all but the named rules\n\tnames: array of rule names\n*/\nWikiParser.prototype.amendRules = function(type,names) {\n\tnames = names || [];\n\t// Define the filter function\n\tvar keepFilter;\n\tif(type === \"only\") {\n\t\tkeepFilter = function(name) {\n\t\t\treturn names.indexOf(name) !== -1;\n\t\t};\n\t} else if(type === \"except\") {\n\t\tkeepFilter = function(name) {\n\t\t\treturn names.indexOf(name) === -1;\n\t\t};\n\t} else {\n\t\treturn;\n\t}\n\t// Define a function to process each of our rule arrays\n\tvar processRuleArray = function(ruleArray) {\n\t\tfor(var t=ruleArray.length-1; t>=0; t--) {\n\t\t\tif(!keepFilter(ruleArray[t].rule.name)) {\n\t\t\t\truleArray.splice(t,1);\n\t\t\t}\n\t\t}\n\t};\n\t// Process each rule array\n\tprocessRuleArray(this.pragmaRules);\n\tprocessRuleArray(this.blockRules);\n\tprocessRuleArray(this.inlineRules);\n};\n\nexports[\"text/vnd.tiddlywiki\"] = WikiParser;\n\n})();\n\n",
"type": "application/javascript",
"module-type": "parser"
},
"$:/core/modules/parsers/wikiparser/rules/wikirulebase.js": {
"title": "$:/core/modules/parsers/wikiparser/rules/wikirulebase.js",
"text": "/*\\\ntitle: $:/core/modules/parsers/wikiparser/rules/wikirulebase.js\ntype: application/javascript\nmodule-type: global\n\nBase class for wiki parser rules\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nThis constructor is always overridden with a blank constructor, and so shouldn't be used\n*/\nvar WikiRuleBase = function() {\n};\n\n/*\nTo be overridden by individual rules\n*/\nWikiRuleBase.prototype.init = function(parser) {\n\tthis.parser = parser;\n};\n\n/*\nDefault implementation of findNextMatch uses RegExp matching\n*/\nWikiRuleBase.prototype.findNextMatch = function(startPos) {\n\tthis.matchRegExp.lastIndex = startPos;\n\tthis.match = this.matchRegExp.exec(this.parser.source);\n\treturn this.match ? this.match.index : undefined;\n};\n\nexports.WikiRuleBase = WikiRuleBase;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/pluginswitcher.js": {
"title": "$:/core/modules/pluginswitcher.js",
"text": "/*\\\ntitle: $:/core/modules/pluginswitcher.js\ntype: application/javascript\nmodule-type: global\n\nManages switching plugins for themes and languages.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\noptions:\nwiki: wiki store to be used\npluginType: type of plugin to be switched\ncontrollerTitle: title of tiddler used to control switching of this resource\ndefaultPlugins: array of default plugins to be used if nominated plugin isn't found\nonSwitch: callback when plugin is switched (single parameter is array of plugin titles)\n*/\nfunction PluginSwitcher(options) {\n\tthis.wiki = options.wiki;\n\tthis.pluginType = options.pluginType;\n\tthis.controllerTitle = options.controllerTitle;\n\tthis.defaultPlugins = options.defaultPlugins || [];\n\tthis.onSwitch = options.onSwitch;\n\t// Switch to the current plugin\n\tthis.switchPlugins();\n\t// Listen for changes to the selected plugin\n\tvar self = this;\n\tthis.wiki.addEventListener(\"change\",function(changes) {\n\t\tif($tw.utils.hop(changes,self.controllerTitle)) {\n\t\t\tself.switchPlugins();\n\t\t}\n\t});\n}\n\nPluginSwitcher.prototype.switchPlugins = function() {\n\t// Get the name of the current theme\n\tvar selectedPluginTitle = this.wiki.getTiddlerText(this.controllerTitle);\n\t// If it doesn't exist, then fallback to one of the default themes\n\tvar index = 0;\n\twhile(!this.wiki.getTiddler(selectedPluginTitle) && index < this.defaultPlugins.length) {\n\t\tselectedPluginTitle = this.defaultPlugins[index++];\n\t}\n\t// Accumulate the titles of the plugins that we need to load\n\tvar plugins = [],\n\t\tself = this,\n\t\taccumulatePlugin = function(title) {\n\t\t\tvar tiddler = self.wiki.getTiddler(title);\n\t\t\tif(tiddler && tiddler.isPlugin() && plugins.indexOf(title) === -1) {\n\t\t\t\tplugins.push(title);\n\t\t\t\tvar pluginInfo = JSON.parse(self.wiki.getTiddlerText(title)),\n\t\t\t\t\tdependents = $tw.utils.parseStringArray(tiddler.fields.dependents || \"\");\n\t\t\t\t$tw.utils.each(dependents,function(title) {\n\t\t\t\t\taccumulatePlugin(title);\n\t\t\t\t});\n\t\t\t}\n\t\t};\n\taccumulatePlugin(selectedPluginTitle);\n\t// Read the plugin info for the incoming plugins\n\tvar changes = $tw.wiki.readPluginInfo(plugins);\n\t// Unregister any existing theme tiddlers\n\tvar unregisteredTiddlers = $tw.wiki.unregisterPluginTiddlers(this.pluginType);\n\t// Register any new theme tiddlers\n\tvar registeredTiddlers = $tw.wiki.registerPluginTiddlers(this.pluginType,plugins);\n\t// Unpack the current theme tiddlers\n\t$tw.wiki.unpackPluginTiddlers();\n\t// Call the switch handler\n\tif(this.onSwitch) {\n\t\tthis.onSwitch(plugins);\n\t}\n};\n\nexports.PluginSwitcher = PluginSwitcher;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/saver-handler.js": {
"title": "$:/core/modules/saver-handler.js",
"text": "/*\\\ntitle: $:/core/modules/saver-handler.js\ntype: application/javascript\nmodule-type: global\n\nThe saver handler tracks changes to the store and handles saving the entire wiki via saver modules.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nInstantiate the saver handler with the following options:\nwiki: wiki to be synced\ndirtyTracking: true if dirty tracking should be performed\n*/\nfunction SaverHandler(options) {\n\tvar self = this;\n\tthis.wiki = options.wiki;\n\tthis.dirtyTracking = options.dirtyTracking;\n\tthis.preloadDirty = options.preloadDirty || [];\n\tthis.pendingAutoSave = false;\n\t// Make a logger\n\tthis.logger = new $tw.utils.Logger(\"saver-handler\");\n\t// Initialise our savers\n\tif($tw.browser) {\n\t\tthis.initSavers();\n\t}\n\t// Only do dirty tracking if required\n\tif($tw.browser && this.dirtyTracking) {\n\t\t// Compile the dirty tiddler filter\n\t\tthis.filterFn = this.wiki.compileFilter(this.wiki.getTiddlerText(this.titleSyncFilter));\n\t\t// Count of changes that have not yet been saved\n\t\tvar filteredChanges = self.filterFn.call(self.wiki,function(iterator) {\n\t\t\t\t$tw.utils.each(self.preloadDirty,function(title) {\n\t\t\t\t\tvar tiddler = self.wiki.getTiddler(title);\n\t\t\t\t\titerator(tiddler,title);\n\t\t\t\t});\n\t\t});\n\t\tthis.numChanges = filteredChanges.length;\n\t\t// Listen out for changes to tiddlers\n\t\tthis.wiki.addEventListener(\"change\",function(changes) {\n\t\t\t// Filter the changes so that we only count changes to tiddlers that we care about\n\t\t\tvar filteredChanges = self.filterFn.call(self.wiki,function(iterator) {\n\t\t\t\t$tw.utils.each(changes,function(change,title) {\n\t\t\t\t\tvar tiddler = self.wiki.getTiddler(title);\n\t\t\t\t\titerator(tiddler,title);\n\t\t\t\t});\n\t\t\t});\n\t\t\t// Adjust the number of changes\n\t\t\tself.numChanges += filteredChanges.length;\n\t\t\tself.updateDirtyStatus();\n\t\t\t// Do any autosave if one is pending and there's no more change events\n\t\t\tif(self.pendingAutoSave && self.wiki.getSizeOfTiddlerEventQueue() === 0) {\n\t\t\t\t// Check if we're dirty\n\t\t\t\tif(self.numChanges > 0) {\n\t\t\t\t\tself.saveWiki({\n\t\t\t\t\t\tmethod: \"autosave\",\n\t\t\t\t\t\tdownloadType: \"text/plain\"\n\t\t\t\t\t});\n\t\t\t\t}\n\t\t\t\tself.pendingAutoSave = false;\n\t\t\t}\n\t\t});\n\t\t// Listen for the autosave event\n\t\t$tw.rootWidget.addEventListener(\"tm-auto-save-wiki\",function(event) {\n\t\t\t// Do the autosave unless there are outstanding tiddler change events\n\t\t\tif(self.wiki.getSizeOfTiddlerEventQueue() === 0) {\n\t\t\t\t// Check if we're dirty\n\t\t\t\tif(self.numChanges > 0) {\n\t\t\t\t\tself.saveWiki({\n\t\t\t\t\t\tmethod: \"autosave\",\n\t\t\t\t\t\tdownloadType: \"text/plain\"\n\t\t\t\t\t});\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\t// Otherwise put ourselves in the \"pending autosave\" state and wait for the change event before we do the autosave\n\t\t\t\tself.pendingAutoSave = true;\n\t\t\t}\n\t\t});\n\t\t// Set up our beforeunload handler\n\t\t$tw.addUnloadTask(function(event) {\n\t\t\tvar confirmationMessage;\n\t\t\tif(self.isDirty()) {\n\t\t\t\tconfirmationMessage = $tw.language.getString(\"UnsavedChangesWarning\");\n\t\t\t\tevent.returnValue = confirmationMessage; // Gecko\n\t\t\t}\n\t\t\treturn confirmationMessage;\n\t\t});\n\t}\n\t// Install the save action handlers\n\tif($tw.browser) {\n\t\t$tw.rootWidget.addEventListener(\"tm-save-wiki\",function(event) {\n\t\t\tself.saveWiki({\n\t\t\t\ttemplate: event.param,\n\t\t\t\tdownloadType: \"text/plain\",\n\t\t\t\tvariables: event.paramObject\n\t\t\t});\n\t\t});\n\t\t$tw.rootWidget.addEventListener(\"tm-download-file\",function(event) {\n\t\t\tself.saveWiki({\n\t\t\t\tmethod: \"download\",\n\t\t\t\ttemplate: event.param,\n\t\t\t\tdownloadType: \"text/plain\",\n\t\t\t\tvariables: event.paramObject\n\t\t\t});\n\t\t});\n\t}\n}\n\nSaverHandler.prototype.titleSyncFilter = \"$:/config/SaverFilter\";\nSaverHandler.prototype.titleAutoSave = \"$:/config/AutoSave\";\nSaverHandler.prototype.titleSavedNotification = \"$:/language/Notifications/Save/Done\";\n\n/*\nSelect the appropriate saver modules and set them up\n*/\nSaverHandler.prototype.initSavers = function(moduleType) {\n\tmoduleType = moduleType || \"saver\";\n\t// Instantiate the available savers\n\tthis.savers = [];\n\tvar self = this;\n\t$tw.modules.forEachModuleOfType(moduleType,function(title,module) {\n\t\tif(module.canSave(self)) {\n\t\t\tself.savers.push(module.create(self.wiki));\n\t\t}\n\t});\n\t// Sort the savers into priority order\n\tthis.savers.sort(function(a,b) {\n\t\tif(a.info.priority < b.info.priority) {\n\t\t\treturn -1;\n\t\t} else {\n\t\t\tif(a.info.priority > b.info.priority) {\n\t\t\t\treturn +1;\n\t\t\t} else {\n\t\t\t\treturn 0;\n\t\t\t}\n\t\t}\n\t});\n};\n\n/*\nSave the wiki contents. Options are:\n\tmethod: \"save\", \"autosave\" or \"download\"\n\ttemplate: the tiddler containing the template to save\n\tdownloadType: the content type for the saved file\n*/\nSaverHandler.prototype.saveWiki = function(options) {\n\toptions = options || {};\n\tvar self = this,\n\t\tmethod = options.method || \"save\";\n\t// Ignore autosave if disabled\n\tif(method === \"autosave\" && this.wiki.getTiddlerText(this.titleAutoSave,\"yes\") !== \"yes\") {\n\t\treturn false;\n\t}\n\tvar\tvariables = options.variables || {},\n\t\ttemplate = options.template || \"$:/core/save/all\",\n\t\tdownloadType = options.downloadType || \"text/plain\",\n\t\ttext = this.wiki.renderTiddler(downloadType,template,options),\n\t\tcallback = function(err) {\n\t\t\tif(err) {\n\t\t\t\talert($tw.language.getString(\"Error/WhileSaving\") + \":\\n\\n\" + err);\n\t\t\t} else {\n\t\t\t\t// Clear the task queue if we're saving (rather than downloading)\n\t\t\t\tif(method !== \"download\") {\n\t\t\t\t\tself.numChanges = 0;\n\t\t\t\t\tself.updateDirtyStatus();\n\t\t\t\t}\n\t\t\t\t$tw.notifier.display(self.titleSavedNotification);\n\t\t\t\tif(options.callback) {\n\t\t\t\t\toptions.callback();\n\t\t\t\t}\n\t\t\t}\n\t\t};\n\t// Call the highest priority saver that supports this method\n\tfor(var t=this.savers.length-1; t>=0; t--) {\n\t\tvar saver = this.savers[t];\n\t\tif(saver.info.capabilities.indexOf(method) !== -1 && saver.save(text,method,callback,{variables: {filename: variables.filename}})) {\n\t\t\tthis.logger.log(\"Saving wiki with method\",method,\"through saver\",saver.info.name);\n\t\t\treturn true;\n\t\t}\n\t}\n\treturn false;\n};\n\n/*\nChecks whether the wiki is dirty (ie the window shouldn't be closed)\n*/\nSaverHandler.prototype.isDirty = function() {\n\treturn this.numChanges > 0;\n};\n\n/*\nUpdate the document body with the class \"tc-dirty\" if the wiki has unsaved/unsynced changes\n*/\nSaverHandler.prototype.updateDirtyStatus = function() {\n\tif($tw.browser) {\n\t\t$tw.utils.toggleClass(document.body,\"tc-dirty\",this.isDirty());\n\t}\n};\n\nexports.SaverHandler = SaverHandler;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/savers/andtidwiki.js": {
"title": "$:/core/modules/savers/andtidwiki.js",
"text": "/*\\\ntitle: $:/core/modules/savers/andtidwiki.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via the AndTidWiki Android app\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false, netscape: false, Components: false */\n\"use strict\";\n\nvar AndTidWiki = function(wiki) {\n};\n\nAndTidWiki.prototype.save = function(text,method,callback,options) {\n\tvar filename = options && options.variables ? options.variables.filename : null;\n\tif (method === \"download\") {\n\t\t// Support download\n\t\tif (window.twi.saveDownload) {\n\t\t\ttry {\n\t\t\t\twindow.twi.saveDownload(text,filename);\n\t\t\t} catch(err) {\n\t\t\t\tif (err.message === \"Method not found\") {\n\t\t\t\t\twindow.twi.saveDownload(text);\n\t\t\t\t}\n\t\t\t}\n\t\t} else {\n\t\t\tvar link = document.createElement(\"a\");\n\t\t\tlink.setAttribute(\"href\",\"data:text/plain,\" + encodeURIComponent(text));\n\t\t\tif (filename) {\n\t\t\t link.setAttribute(\"download\",filename);\n\t\t\t}\n\t\t\tdocument.body.appendChild(link);\n\t\t\tlink.click();\n\t\t\tdocument.body.removeChild(link);\n\t\t}\n\t} else if (window.twi.saveWiki) {\n\t\t// Direct save in Tiddloid\n\t\twindow.twi.saveWiki(text);\n\t} else {\n\t\t// Get the pathname of this document\n\t\tvar pathname = decodeURIComponent(document.location.toString().split(\"#\")[0]);\n\t\t// Strip the file://\n\t\tif(pathname.indexOf(\"file://\") === 0) {\n\t\t\tpathname = pathname.substr(7);\n\t\t}\n\t\t// Strip any query or location part\n\t\tvar p = pathname.indexOf(\"?\");\n\t\tif(p !== -1) {\n\t\t\tpathname = pathname.substr(0,p);\n\t\t}\n\t\tp = pathname.indexOf(\"#\");\n\t\tif(p !== -1) {\n\t\t\tpathname = pathname.substr(0,p);\n\t\t}\n\t\t// Save the file\n\t\twindow.twi.saveFile(pathname,text);\n\t}\n\t// Call the callback\n\tcallback(null);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nAndTidWiki.prototype.info = {\n\tname: \"andtidwiki\",\n\tpriority: 1600,\n\tcapabilities: [\"save\", \"autosave\", \"download\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn !!window.twi && !!window.twi.saveFile;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new AndTidWiki(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/beaker.js": {
"title": "$:/core/modules/savers/beaker.js",
"text": "/*\\\ntitle: $:/core/modules/savers/beaker.js\ntype: application/javascript\nmodule-type: saver\n\nSaves files using the Beaker browser's (https://beakerbrowser.com) Dat protocol (https://datproject.org/)\nCompatible with beaker >= V0.7.2\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSet up the saver\n*/\nvar BeakerSaver = function(wiki) {\n\tthis.wiki = wiki;\n};\n\nBeakerSaver.prototype.save = function(text,method,callback) {\n\tvar dat = new DatArchive(\"\" + window.location),\n\t\tpathname = (\"\" + window.location.pathname).split(\"#\")[0];\n\tdat.stat(pathname).then(function(value) {\n\t\tif(value.isDirectory()) {\n\t\t\tpathname = pathname + \"/index.html\";\n\t\t}\n\t\tdat.writeFile(pathname,text,\"utf8\").then(function(value) {\n\t\t\tcallback(null);\n\t\t},function(reason) {\n\t\t\tcallback(\"Beaker Saver Write Error: \" + reason);\n\t\t});\n\t},function(reason) {\n\t\tcallback(\"Beaker Saver Stat Error: \" + reason);\n\t});\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nBeakerSaver.prototype.info = {\n\tname: \"beaker\",\n\tpriority: 3000,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn !!window.DatArchive && location.protocol===\"dat:\";\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new BeakerSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/download.js": {
"title": "$:/core/modules/savers/download.js",
"text": "/*\\\ntitle: $:/core/modules/savers/download.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via HTML5's download APIs\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar DownloadSaver = function(wiki) {\n};\n\nDownloadSaver.prototype.save = function(text,method,callback,options) {\n\toptions = options || {};\n\t// Get the current filename\n\tvar filename = options.variables.filename;\n\tif(!filename) {\n\t\tvar p = document.location.pathname.lastIndexOf(\"/\");\n\t\tif(p !== -1) {\n\t\t\t// We decode the pathname because document.location is URL encoded by the browser\n\t\t\tfilename = decodeURIComponent(document.location.pathname.substr(p+1));\n\t\t}\n\t}\n\tif(!filename) {\n\t\tfilename = \"tiddlywiki.html\";\n\t}\n\t// Set up the link\n\tvar link = document.createElement(\"a\");\n\tif(Blob !== undefined) {\n\t\tvar blob = new Blob([text], {type: \"text/html\"});\n\t\tlink.setAttribute(\"href\", URL.createObjectURL(blob));\n\t} else {\n\t\tlink.setAttribute(\"href\",\"data:text/html,\" + encodeURIComponent(text));\n\t}\n\tlink.setAttribute(\"download\",filename);\n\tdocument.body.appendChild(link);\n\tlink.click();\n\tdocument.body.removeChild(link);\n\t// Callback that we succeeded\n\tcallback(null);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nDownloadSaver.prototype.info = {\n\tname: \"download\",\n\tpriority: 100\n};\n\nObject.defineProperty(DownloadSaver.prototype.info, \"capabilities\", {\n\tget: function() {\n\t\tvar capabilities = [\"save\", \"download\"];\n\t\tif(($tw.wiki.getTextReference(\"$:/config/DownloadSaver/AutoSave\") || \"\").toLowerCase() === \"yes\") {\n\t\t\tcapabilities.push(\"autosave\");\n\t\t}\n\t\treturn capabilities;\n\t}\n});\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn document.createElement(\"a\").download !== undefined;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new DownloadSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/fsosaver.js": {
"title": "$:/core/modules/savers/fsosaver.js",
"text": "/*\\\ntitle: $:/core/modules/savers/fsosaver.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via MS FileSystemObject ActiveXObject\n\nNote: Since TiddlyWiki's markup contains the MOTW, the FileSystemObject normally won't be available. \nHowever, if the wiki is loaded as an .HTA file (Windows HTML Applications) then the FSO can be used.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar FSOSaver = function(wiki) {\n};\n\nFSOSaver.prototype.save = function(text,method,callback) {\n\t// Get the pathname of this document\n\tvar pathname = unescape(document.location.pathname);\n\t// Test for a Windows path of the form /x:\\blah...\n\tif(/^\\/[A-Z]\\:\\\\[^\\\\]+/i.test(pathname)) {\t// ie: ^/[a-z]:/[^/]+\n\t\t// Remove the leading slash\n\t\tpathname = pathname.substr(1);\n\t} else if(document.location.hostname !== \"\" && /^\\/\\\\[^\\\\]+\\\\[^\\\\]+/i.test(pathname)) {\t// test for \\\\server\\share\\blah... - ^/[^/]+/[^/]+\n\t\t// Remove the leading slash\n\t\tpathname = pathname.substr(1);\n\t\t// reconstruct UNC path\n\t\tpathname = \"\\\\\\\\\" + document.location.hostname + pathname;\n\t} else {\n\t\treturn false;\n\t}\n\t// Save the file (as UTF-16)\n\tvar fso = new ActiveXObject(\"Scripting.FileSystemObject\");\n\tvar file = fso.OpenTextFile(pathname,2,-1,-1);\n\tfile.Write(text);\n\tfile.Close();\n\t// Callback that we succeeded\n\tcallback(null);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nFSOSaver.prototype.info = {\n\tname: \"FSOSaver\",\n\tpriority: 120,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\ttry {\n\t\treturn (window.location.protocol === \"file:\") && !!(new ActiveXObject(\"Scripting.FileSystemObject\"));\n\t} catch(e) { return false; }\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new FSOSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/gitea.js": {
"title": "$:/core/modules/savers/gitea.js",
"text": "/*\\\ntitle: $:/core/modules/savers/gitea.js\ntype: application/javascript\nmodule-type: saver\n\nSaves wiki by pushing a commit to the gitea\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar GiteaSaver = function(wiki) {\n\tthis.wiki = wiki;\n};\n\nGiteaSaver.prototype.save = function(text,method,callback) {\n\tvar self = this,\n\t\tusername = this.wiki.getTiddlerText(\"$:/Gitea/Username\"),\n\t\tpassword = $tw.utils.getPassword(\"Gitea\"),\n\t\trepo = this.wiki.getTiddlerText(\"$:/Gitea/Repo\"),\n\t\tpath = this.wiki.getTiddlerText(\"$:/Gitea/Path\",\"\"),\n\t\tfilename = this.wiki.getTiddlerText(\"$:/Gitea/Filename\"),\n\t\tbranch = this.wiki.getTiddlerText(\"$:/Gitea/Branch\") || \"master\",\n\t\tendpoint = this.wiki.getTiddlerText(\"$:/Gitea/ServerURL\") || \"https://gitea\",\n\t\theaders = {\n\t\t\t\"Accept\": \"application/json\",\n\t\t\t\"Content-Type\": \"application/json;charset=UTF-8\",\n\t\t\t\"Authorization\": \"Basic \" + window.btoa(username + \":\" + password)\n\t\t};\n\t// Bail if we don't have everything we need\n\tif(!username || !password || !repo || !path || !filename) {\n\t\treturn false;\n\t}\n\t// Make sure the path start and ends with a slash\n\tif(path.substring(0,1) !== \"/\") {\n\t\tpath = \"/\" + path;\n\t}\n\tif(path.substring(path.length - 1) !== \"/\") {\n\t\tpath = path + \"/\";\n\t}\n\t// Compose the base URI\n\tvar uri = endpoint + \"/repos/\" + repo + \"/contents\" + path;\n\t// Perform a get request to get the details (inc shas) of files in the same path as our file\n\t$tw.utils.httpRequest({\n\t\turl: uri,\n\t\ttype: \"GET\",\n\t\theaders: headers,\n\t\tdata: {\n\t\t\tref: branch\n\t\t},\n\t\tcallback: function(err,getResponseDataJson,xhr) {\n\t\t\tvar getResponseData,sha = \"\";\n\t\t\tif(err && xhr.status !== 404) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tvar use_put = true;\n\t\t\tif(xhr.status !== 404) {\n\t\t\t\tgetResponseData = JSON.parse(getResponseDataJson);\n\t\t\t\t$tw.utils.each(getResponseData,function(details) {\n\t\t\t\t\tif(details.name === filename) {\n\t\t\t\t\t\tsha = details.sha;\n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t\tif(sha === \"\"){\n\t\t\t\t\tuse_put = false;\n\t\t\t\t}\n\t\t\t}\n\t\t\tvar data = {\n\t\t\t\tmessage: $tw.language.getRawString(\"ControlPanel/Saving/GitService/CommitMessage\"),\n\t\t\t\tcontent: $tw.utils.base64Encode(text),\n\t\t\t\tsha: sha\n\t\t\t};\n\t\t\t$tw.utils.httpRequest({\n\t\t\t\turl: endpoint + \"/repos/\" + repo + \"/branches/\" + branch,\n\t\t\t\ttype: \"GET\",\n\t\t\t\theaders: headers,\n\t\t\t\tcallback: function(err,getResponseDataJson,xhr) {\n\t\t\t\t\tif(xhr.status === 404) {\n\t\t\t\t\t\tcallback(\"Please ensure the branch in the Gitea repo exists\");\n\t\t\t\t\t}else{\n\t\t\t\t\t\tdata[\"branch\"] = branch;\n\t\t\t\t\t\tself.upload(uri + filename, use_put?\"PUT\":\"POST\", headers, data, callback);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\treturn true;\n};\n\nGiteaSaver.prototype.upload = function(uri,method,headers,data,callback) {\n\t$tw.utils.httpRequest({\n\t\turl: uri,\n\t\ttype: method,\n\t\theaders: headers,\n\t\tdata: JSON.stringify(data),\n\t\tcallback: function(err,putResponseDataJson,xhr) {\n\t\t\tif(err) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tvar putResponseData = JSON.parse(putResponseDataJson);\n\t\t\tcallback(null);\n\t\t}\n\t});\n};\n\n/*\nInformation about this saver\n*/\nGiteaSaver.prototype.info = {\n\tname: \"Gitea\",\n\tpriority: 2000,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new GiteaSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/github.js": {
"title": "$:/core/modules/savers/github.js",
"text": "/*\\\ntitle: $:/core/modules/savers/github.js\ntype: application/javascript\nmodule-type: saver\n\nSaves wiki by pushing a commit to the GitHub v3 REST API\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar GitHubSaver = function(wiki) {\n\tthis.wiki = wiki;\n};\n\nGitHubSaver.prototype.save = function(text,method,callback) {\n\tvar self = this,\n\t\tusername = this.wiki.getTiddlerText(\"$:/GitHub/Username\"),\n\t\tpassword = $tw.utils.getPassword(\"github\"),\n\t\trepo = this.wiki.getTiddlerText(\"$:/GitHub/Repo\"),\n\t\tpath = this.wiki.getTiddlerText(\"$:/GitHub/Path\",\"\"),\n\t\tfilename = this.wiki.getTiddlerText(\"$:/GitHub/Filename\"),\n\t\tbranch = this.wiki.getTiddlerText(\"$:/GitHub/Branch\") || \"master\",\n\t\tendpoint = this.wiki.getTiddlerText(\"$:/GitHub/ServerURL\") || \"https://api.github.com\",\n\t\theaders = {\n\t\t\t\"Accept\": \"application/vnd.github.v3+json\",\n\t\t\t\"Content-Type\": \"application/json;charset=UTF-8\",\n\t\t\t\"Authorization\": \"Basic \" + window.btoa(username + \":\" + password)\n\t\t};\n\t// Bail if we don't have everything we need\n\tif(!username || !password || !repo || !path || !filename) {\n\t\treturn false;\n\t}\n\t// Make sure the path start and ends with a slash\n\tif(path.substring(0,1) !== \"/\") {\n\t\tpath = \"/\" + path;\n\t}\n\tif(path.substring(path.length - 1) !== \"/\") {\n\t\tpath = path + \"/\";\n\t}\n\t// Compose the base URI\n\tvar uri = endpoint + \"/repos/\" + repo + \"/contents\" + path;\n\t// Perform a get request to get the details (inc shas) of files in the same path as our file\n\t$tw.utils.httpRequest({\n\t\turl: uri,\n\t\ttype: \"GET\",\n\t\theaders: headers,\n\t\tdata: {\n\t\t\tref: branch\n\t\t},\n\t\tcallback: function(err,getResponseDataJson,xhr) {\n\t\t\tvar getResponseData,sha = \"\";\n\t\t\tif(err && xhr.status !== 404) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tif(xhr.status !== 404) {\n\t\t\t\tgetResponseData = JSON.parse(getResponseDataJson);\n\t\t\t\t$tw.utils.each(getResponseData,function(details) {\n\t\t\t\t\tif(details.name === filename) {\n\t\t\t\t\t\tsha = details.sha;\n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t}\n\t\t\tvar data = {\n\t\t\t\tmessage: $tw.language.getRawString(\"ControlPanel/Saving/GitService/CommitMessage\"),\n\t\t\t\tcontent: $tw.utils.base64Encode(text),\n\t\t\t\tbranch: branch,\n\t\t\t\tsha: sha\n\t\t\t};\n\t\t\t// Perform a PUT request to save the file\n\t\t\t$tw.utils.httpRequest({\n\t\t\t\turl: uri + filename,\n\t\t\t\ttype: \"PUT\",\n\t\t\t\theaders: headers,\n\t\t\t\tdata: JSON.stringify(data),\n\t\t\t\tcallback: function(err,putResponseDataJson,xhr) {\n\t\t\t\t\tif(err) {\n\t\t\t\t\t\treturn callback(err);\n\t\t\t\t\t}\n\t\t\t\t\tvar putResponseData = JSON.parse(putResponseDataJson);\n\t\t\t\t\tcallback(null);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nGitHubSaver.prototype.info = {\n\tname: \"github\",\n\tpriority: 2000,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new GitHubSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/gitlab.js": {
"title": "$:/core/modules/savers/gitlab.js",
"text": "/*\\\ntitle: $:/core/modules/savers/gitlab.js\ntype: application/javascript\nmodule-type: saver\n\nSaves wiki by pushing a commit to the GitLab REST API\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: true */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar GitLabSaver = function(wiki) {\n\tthis.wiki = wiki;\n};\n\nGitLabSaver.prototype.save = function(text,method,callback) {\n\t/* See https://docs.gitlab.com/ee/api/repository_files.html */\n\tvar self = this,\n\t\tusername = this.wiki.getTiddlerText(\"$:/GitLab/Username\"),\n\t\tpassword = $tw.utils.getPassword(\"gitlab\"),\n\t\trepo = this.wiki.getTiddlerText(\"$:/GitLab/Repo\"),\n\t\tpath = this.wiki.getTiddlerText(\"$:/GitLab/Path\",\"\"),\n\t\tfilename = this.wiki.getTiddlerText(\"$:/GitLab/Filename\"),\n\t\tbranch = this.wiki.getTiddlerText(\"$:/GitLab/Branch\") || \"master\",\n\t\tendpoint = this.wiki.getTiddlerText(\"$:/GitLab/ServerURL\") || \"https://gitlab.com/api/v4\",\n\t\theaders = {\n\t\t\t\"Content-Type\": \"application/json;charset=UTF-8\",\n\t\t\t\"Private-Token\": password\n\t\t};\n\t// Bail if we don't have everything we need\n\tif(!username || !password || !repo || !path || !filename) {\n\t\treturn false;\n\t}\n\t// Make sure the path start and ends with a slash\n\tif(path.substring(0,1) !== \"/\") {\n\t\tpath = \"/\" + path;\n\t}\n\tif(path.substring(path.length - 1) !== \"/\") {\n\t\tpath = path + \"/\";\n\t}\n\t// Compose the base URI\n\tvar uri = endpoint + \"/projects/\" + encodeURIComponent(repo) + \"/repository/\";\n\t// Perform a get request to get the details (inc shas) of files in the same path as our file\n\t$tw.utils.httpRequest({\n\t\turl: uri + \"tree/?path=\" + encodeURIComponent(path.replace(/^\\/+|\\/$/g, '')) + \"&branch=\" + encodeURIComponent(branch.replace(/^\\/+|\\/$/g, '')),\n\t\ttype: \"GET\",\n\t\theaders: headers,\n\t\tcallback: function(err,getResponseDataJson,xhr) {\n\t\t\tvar getResponseData,sha = \"\";\n\t\t\tif(err && xhr.status !== 404) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tvar requestType = \"POST\";\n\t\t\tif(xhr.status !== 404) {\n\t\t\t\tgetResponseData = JSON.parse(getResponseDataJson);\n\t\t\t\t$tw.utils.each(getResponseData,function(details) {\n\t\t\t\t\tif(details.name === filename) {\n\t\t\t\t\t\trequestType = \"PUT\";\n\t\t\t\t\t\tsha = details.sha;\n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t}\n\t\t\tvar data = {\n\t\t\t\tcommit_message: $tw.language.getRawString(\"ControlPanel/Saving/GitService/CommitMessage\"),\n\t\t\t\tcontent: text,\n\t\t\t\tbranch: branch,\n\t\t\t\tsha: sha\n\t\t\t};\n\t\t\t// Perform a request to save the file\n\t\t\t$tw.utils.httpRequest({\n\t\t\t\turl: uri + \"files/\" + encodeURIComponent(path.replace(/^\\/+/, '') + filename),\n\t\t\t\ttype: requestType,\n\t\t\t\theaders: headers,\n\t\t\t\tdata: JSON.stringify(data),\n\t\t\t\tcallback: function(err,putResponseDataJson,xhr) {\n\t\t\t\t\tif(err) {\n\t\t\t\t\t\treturn callback(err);\n\t\t\t\t\t}\n\t\t\t\t\tvar putResponseData = JSON.parse(putResponseDataJson);\n\t\t\t\t\tcallback(null);\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nGitLabSaver.prototype.info = {\n\tname: \"gitlab\",\n\tpriority: 2000,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new GitLabSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/manualdownload.js": {
"title": "$:/core/modules/savers/manualdownload.js",
"text": "/*\\\ntitle: $:/core/modules/savers/manualdownload.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via HTML5's download APIs\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Title of the tiddler containing the download message\nvar downloadInstructionsTitle = \"$:/language/Modals/Download\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar ManualDownloadSaver = function(wiki) {\n};\n\nManualDownloadSaver.prototype.save = function(text,method,callback) {\n\t$tw.modal.display(downloadInstructionsTitle,{\n\t\tdownloadLink: \"data:text/html,\" + encodeURIComponent(text)\n\t});\n\t// Callback that we succeeded\n\tcallback(null);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nManualDownloadSaver.prototype.info = {\n\tname: \"manualdownload\",\n\tpriority: 0,\n\tcapabilities: [\"save\", \"download\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new ManualDownloadSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/msdownload.js": {
"title": "$:/core/modules/savers/msdownload.js",
"text": "/*\\\ntitle: $:/core/modules/savers/msdownload.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via window.navigator.msSaveBlob()\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar MsDownloadSaver = function(wiki) {\n};\n\nMsDownloadSaver.prototype.save = function(text,method,callback) {\n\t// Get the current filename\n\tvar filename = \"tiddlywiki.html\",\n\t\tp = document.location.pathname.lastIndexOf(\"/\");\n\tif(p !== -1) {\n\t\tfilename = document.location.pathname.substr(p+1);\n\t}\n\t// Set up the link\n\tvar blob = new Blob([text], {type: \"text/html\"});\n\twindow.navigator.msSaveBlob(blob,filename);\n\t// Callback that we succeeded\n\tcallback(null);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nMsDownloadSaver.prototype.info = {\n\tname: \"msdownload\",\n\tpriority: 110,\n\tcapabilities: [\"save\", \"download\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn !!window.navigator.msSaveBlob;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new MsDownloadSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/put.js": {
"title": "$:/core/modules/savers/put.js",
"text": "/*\\\ntitle: $:/core/modules/savers/put.js\ntype: application/javascript\nmodule-type: saver\n\nSaves wiki by performing a PUT request to the server\n\nWorks with any server which accepts a PUT request\nto the current URL, such as a WebDAV server.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nRetrieve ETag if available\n*/\nvar retrieveETag = function(self) {\n\tvar headers = {\n\t\tAccept: \"*/*;charset=UTF-8\"\n\t};\n\t$tw.utils.httpRequest({\n\t\turl: self.uri(),\n\t\ttype: \"HEAD\",\n\t\theaders: headers,\n\t\tcallback: function(err,data,xhr) {\n\t\t\tif(err) {\n\t\t\t\treturn;\n\t\t\t}\n\t\t\tvar etag = xhr.getResponseHeader(\"ETag\");\n\t\t\tif(!etag) {\n\t\t\t\treturn;\n\t\t\t}\n\t\t\tself.etag = etag.replace(/^W\\//,\"\");\n\t\t}\n\t});\n};\n\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar PutSaver = function(wiki) {\n\tthis.wiki = wiki;\n\tvar self = this;\n\tvar uri = this.uri();\n\t// Async server probe. Until probe finishes, save will fail fast\n\t// See also https://github.com/Jermolene/TiddlyWiki5/issues/2276\n\t$tw.utils.httpRequest({\n\t\turl: uri,\n\t\ttype: \"OPTIONS\",\n\t\tcallback: function(err,data,xhr) {\n\t\t\t// Check DAV header http://www.webdav.org/specs/rfc2518.html#rfc.section.9.1\n\t\t\tif(!err) {\n\t\t\t\tself.serverAcceptsPuts = xhr.status === 200 && !!xhr.getResponseHeader(\"dav\");\n\t\t\t}\n\t\t}\n\t});\n\tretrieveETag(this);\n};\n\nPutSaver.prototype.uri = function() {\n\treturn document.location.toString().split(\"#\")[0];\n};\n\n// TODO: in case of edit conflict\n// Prompt: Do you want to save over this? Y/N\n// Merging would be ideal, and may be possible using future generic merge flow\nPutSaver.prototype.save = function(text,method,callback) {\n\tif(!this.serverAcceptsPuts) {\n\t\treturn false;\n\t}\n\tvar self = this;\n\tvar headers = {\n\t\t\"Content-Type\": \"text/html;charset=UTF-8\"\n\t};\n\tif(this.etag) {\n\t\theaders[\"If-Match\"] = this.etag;\n\t}\n\t$tw.utils.httpRequest({\n\t\turl: this.uri(),\n\t\ttype: \"PUT\",\n\t\theaders: headers,\n\t\tdata: text,\n\t\tcallback: function(err,data,xhr) {\n\t\t\tif(err) {\n\t\t\t\t// response is textual: \"XMLHttpRequest error code: 412\"\n\t\t\t\tvar status = Number(err.substring(err.indexOf(':') + 2, err.length))\n\t\t\t\tif(status === 412) { // edit conflict\n\t\t\t\t\tvar message = $tw.language.getString(\"Error/EditConflict\");\n\t\t\t\t\tcallback(message);\n\t\t\t\t} else {\n\t\t\t\t\tcallback(err); // fail\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\tself.etag = xhr.getResponseHeader(\"ETag\");\n\t\t\t\tif(self.etag == null) {\n\t\t\t\t\tretrieveETag(self);\n\t\t\t\t}\n\t\t\t\tcallback(null); // success\n\t\t\t}\n\t\t}\n\t});\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nPutSaver.prototype.info = {\n\tname: \"put\",\n\tpriority: 2000,\n\tcapabilities: [\"save\",\"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn /^https?:/.test(location.protocol);\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new PutSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/tiddlyfox.js": {
"title": "$:/core/modules/savers/tiddlyfox.js",
"text": "/*\\\ntitle: $:/core/modules/savers/tiddlyfox.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via the TiddlyFox file extension\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false, netscape: false, Components: false */\n\"use strict\";\n\nvar TiddlyFoxSaver = function(wiki) {\n};\n\nTiddlyFoxSaver.prototype.save = function(text,method,callback) {\n\tvar messageBox = document.getElementById(\"tiddlyfox-message-box\");\n\tif(messageBox) {\n\t\t// Get the pathname of this document\n\t\tvar pathname = document.location.toString().split(\"#\")[0];\n\t\t// Replace file://localhost/ with file:///\n\t\tif(pathname.indexOf(\"file://localhost/\") === 0) {\n\t\t\tpathname = \"file://\" + pathname.substr(16);\n\t\t}\n\t\t// Windows path file:///x:/blah/blah --> x:\\blah\\blah\n\t\tif(/^file\\:\\/\\/\\/[A-Z]\\:\\//i.test(pathname)) {\n\t\t\t// Remove the leading slash and convert slashes to backslashes\n\t\t\tpathname = pathname.substr(8).replace(/\\//g,\"\\\\\");\n\t\t// Firefox Windows network path file://///server/share/blah/blah --> //server/share/blah/blah\n\t\t} else if(pathname.indexOf(\"file://///\") === 0) {\n\t\t\tpathname = \"\\\\\\\\\" + unescape(pathname.substr(10)).replace(/\\//g,\"\\\\\");\n\t\t// Mac/Unix local path file:///path/path --> /path/path\n\t\t} else if(pathname.indexOf(\"file:///\") === 0) {\n\t\t\tpathname = unescape(pathname.substr(7));\n\t\t// Mac/Unix local path file:/path/path --> /path/path\n\t\t} else if(pathname.indexOf(\"file:/\") === 0) {\n\t\t\tpathname = unescape(pathname.substr(5));\n\t\t// Otherwise Windows networth path file://server/share/path/path --> \\\\server\\share\\path\\path\n\t\t} else {\n\t\t\tpathname = \"\\\\\\\\\" + unescape(pathname.substr(7)).replace(new RegExp(\"/\",\"g\"),\"\\\\\");\n\t\t}\n\t\t// Create the message element and put it in the message box\n\t\tvar message = document.createElement(\"div\");\n\t\tmessage.setAttribute(\"data-tiddlyfox-path\",decodeURIComponent(pathname));\n\t\tmessage.setAttribute(\"data-tiddlyfox-content\",text);\n\t\tmessageBox.appendChild(message);\n\t\t// Add an event handler for when the file has been saved\n\t\tmessage.addEventListener(\"tiddlyfox-have-saved-file\",function(event) {\n\t\t\tcallback(null);\n\t\t}, false);\n\t\t// Create and dispatch the custom event to the extension\n\t\tvar event = document.createEvent(\"Events\");\n\t\tevent.initEvent(\"tiddlyfox-save-file\",true,false);\n\t\tmessage.dispatchEvent(event);\n\t\treturn true;\n\t} else {\n\t\treturn false;\n\t}\n};\n\n/*\nInformation about this saver\n*/\nTiddlyFoxSaver.prototype.info = {\n\tname: \"tiddlyfox\",\n\tpriority: 1500,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new TiddlyFoxSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/tiddlyie.js": {
"title": "$:/core/modules/savers/tiddlyie.js",
"text": "/*\\\ntitle: $:/core/modules/savers/tiddlyie.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via Internet Explorer BHO extenion (TiddlyIE)\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar TiddlyIESaver = function(wiki) {\n};\n\nTiddlyIESaver.prototype.save = function(text,method,callback) {\n\t// Check existence of TiddlyIE BHO extension (note: only works after document is complete)\n\tif(typeof(window.TiddlyIE) != \"undefined\") {\n\t\t// Get the pathname of this document\n\t\tvar pathname = unescape(document.location.pathname);\n\t\t// Test for a Windows path of the form /x:/blah...\n\t\tif(/^\\/[A-Z]\\:\\/[^\\/]+/i.test(pathname)) {\t// ie: ^/[a-z]:/[^/]+ (is this better?: ^/[a-z]:/[^/]+(/[^/]+)*\\.[^/]+ )\n\t\t\t// Remove the leading slash\n\t\t\tpathname = pathname.substr(1);\n\t\t\t// Convert slashes to backslashes\n\t\t\tpathname = pathname.replace(/\\//g,\"\\\\\");\n\t\t} else if(document.hostname !== \"\" && /^\\/[^\\/]+\\/[^\\/]+/i.test(pathname)) {\t// test for \\\\server\\share\\blah... - ^/[^/]+/[^/]+\n\t\t\t// Convert slashes to backslashes\n\t\t\tpathname = pathname.replace(/\\//g,\"\\\\\");\n\t\t\t// reconstruct UNC path\n\t\t\tpathname = \"\\\\\\\\\" + document.location.hostname + pathname;\n\t\t} else return false;\n\t\t// Prompt the user to save the file\n\t\twindow.TiddlyIE.save(pathname, text);\n\t\t// Callback that we succeeded\n\t\tcallback(null);\n\t\treturn true;\n\t} else {\n\t\treturn false;\n\t}\n};\n\n/*\nInformation about this saver\n*/\nTiddlyIESaver.prototype.info = {\n\tname: \"tiddlyiesaver\",\n\tpriority: 1500,\n\tcapabilities: [\"save\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn (window.location.protocol === \"file:\");\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new TiddlyIESaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/twedit.js": {
"title": "$:/core/modules/savers/twedit.js",
"text": "/*\\\ntitle: $:/core/modules/savers/twedit.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via the TWEdit iOS app\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false, netscape: false, Components: false */\n\"use strict\";\n\nvar TWEditSaver = function(wiki) {\n};\n\nTWEditSaver.prototype.save = function(text,method,callback) {\n\t// Bail if we're not running under TWEdit\n\tif(typeof DeviceInfo !== \"object\") {\n\t\treturn false;\n\t}\n\t// Get the pathname of this document\n\tvar pathname = decodeURIComponent(document.location.pathname);\n\t// Strip any query or location part\n\tvar p = pathname.indexOf(\"?\");\n\tif(p !== -1) {\n\t\tpathname = pathname.substr(0,p);\n\t}\n\tp = pathname.indexOf(\"#\");\n\tif(p !== -1) {\n\t\tpathname = pathname.substr(0,p);\n\t}\n\t// Remove the leading \"/Documents\" from path\n\tvar prefix = \"/Documents\";\n\tif(pathname.indexOf(prefix) === 0) {\n\t\tpathname = pathname.substr(prefix.length);\n\t}\n\t// Error handler\n\tvar errorHandler = function(event) {\n\t\t// Error\n\t\tcallback($tw.language.getString(\"Error/SavingToTWEdit\") + \": \" + event.target.error.code);\n\t};\n\t// Get the file system\n\twindow.requestFileSystem(LocalFileSystem.PERSISTENT,0,function(fileSystem) {\n\t\t// Now we've got the filesystem, get the fileEntry\n\t\tfileSystem.root.getFile(pathname, {create: true}, function(fileEntry) {\n\t\t\t// Now we've got the fileEntry, create the writer\n\t\t\tfileEntry.createWriter(function(writer) {\n\t\t\t\twriter.onerror = errorHandler;\n\t\t\t\twriter.onwrite = function() {\n\t\t\t\t\tcallback(null);\n\t\t\t\t};\n\t\t\t\twriter.position = 0;\n\t\t\t\twriter.write(text);\n\t\t\t},errorHandler);\n\t\t}, errorHandler);\n\t}, errorHandler);\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nTWEditSaver.prototype.info = {\n\tname: \"twedit\",\n\tpriority: 1600,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new TWEditSaver(wiki);\n};\n\n/////////////////////////// Hack\n// HACK: This ensures that TWEdit recognises us as a TiddlyWiki document\nif($tw.browser) {\n\twindow.version = {title: \"TiddlyWiki\"};\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/savers/upload.js": {
"title": "$:/core/modules/savers/upload.js",
"text": "/*\\\ntitle: $:/core/modules/savers/upload.js\ntype: application/javascript\nmodule-type: saver\n\nHandles saving changes via upload to a server.\n\nDesigned to be compatible with BidiX's UploadPlugin at http://tiddlywiki.bidix.info/#UploadPlugin\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSelect the appropriate saver module and set it up\n*/\nvar UploadSaver = function(wiki) {\n\tthis.wiki = wiki;\n};\n\nUploadSaver.prototype.save = function(text,method,callback) {\n\t// Get the various parameters we need\n\tvar backupDir = this.wiki.getTextReference(\"$:/UploadBackupDir\") || \".\",\n\t\tusername = this.wiki.getTextReference(\"$:/UploadName\"),\n\t\tpassword = $tw.utils.getPassword(\"upload\"),\n\t\tuploadDir = this.wiki.getTextReference(\"$:/UploadDir\") || \".\",\n\t\tuploadFilename = this.wiki.getTextReference(\"$:/UploadFilename\") || \"index.html\",\n\t\turl = this.wiki.getTextReference(\"$:/UploadURL\");\n\t// Bail out if we don't have the bits we need\n\tif(!username || username.toString().trim() === \"\" || !password || password.toString().trim() === \"\") {\n\t\treturn false;\n\t}\n\t// Construct the url if not provided\n\tif(!url) {\n\t\turl = \"http://\" + username + \".tiddlyspot.com/store.cgi\";\n\t}\n\t// Assemble the header\n\tvar boundary = \"---------------------------\" + \"AaB03x\";\t\n\tvar uploadFormName = \"UploadPlugin\";\n\tvar head = [];\n\thead.push(\"--\" + boundary + \"\\r\\nContent-disposition: form-data; name=\\\"UploadPlugin\\\"\\r\\n\");\n\thead.push(\"backupDir=\" + backupDir + \";user=\" + username + \";password=\" + password + \";uploaddir=\" + uploadDir + \";;\"); \n\thead.push(\"\\r\\n\" + \"--\" + boundary);\n\thead.push(\"Content-disposition: form-data; name=\\\"userfile\\\"; filename=\\\"\" + uploadFilename + \"\\\"\");\n\thead.push(\"Content-Type: text/html;charset=UTF-8\");\n\thead.push(\"Content-Length: \" + text.length + \"\\r\\n\");\n\thead.push(\"\");\n\t// Assemble the tail and the data itself\n\tvar tail = \"\\r\\n--\" + boundary + \"--\\r\\n\",\n\t\tdata = head.join(\"\\r\\n\") + text + tail;\n\t// Do the HTTP post\n\tvar http = new XMLHttpRequest();\n\thttp.open(\"POST\",url,true,username,password);\n\thttp.setRequestHeader(\"Content-Type\",\"multipart/form-data; charset=UTF-8; boundary=\" + boundary);\n\thttp.onreadystatechange = function() {\n\t\tif(http.readyState == 4 && http.status == 200) {\n\t\t\tif(http.responseText.substr(0,4) === \"0 - \") {\n\t\t\t\tcallback(null);\n\t\t\t} else {\n\t\t\t\tcallback(http.responseText);\n\t\t\t}\n\t\t}\n\t};\n\ttry {\n\t\thttp.send(data);\n\t} catch(ex) {\n\t\treturn callback($tw.language.getString(\"Error/Caption\") + \":\" + ex);\n\t}\n\t$tw.notifier.display(\"$:/language/Notifications/Save/Starting\");\n\treturn true;\n};\n\n/*\nInformation about this saver\n*/\nUploadSaver.prototype.info = {\n\tname: \"upload\",\n\tpriority: 2000,\n\tcapabilities: [\"save\", \"autosave\"]\n};\n\n/*\nStatic method that returns true if this saver is capable of working\n*/\nexports.canSave = function(wiki) {\n\treturn true;\n};\n\n/*\nCreate an instance of this saver\n*/\nexports.create = function(wiki) {\n\treturn new UploadSaver(wiki);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "saver"
},
"$:/core/modules/server/authenticators/basic.js": {
"title": "$:/core/modules/server/authenticators/basic.js",
"text": "/*\\\ntitle: $:/core/modules/server/authenticators/basic.js\ntype: application/javascript\nmodule-type: authenticator\n\nAuthenticator for WWW basic authentication\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nif($tw.node) {\n\tvar util = require(\"util\"),\n\t\tfs = require(\"fs\"),\n\t\turl = require(\"url\"),\n\t\tpath = require(\"path\");\n}\n\nfunction BasicAuthenticator(server) {\n\tthis.server = server;\n\tthis.credentialsData = [];\n}\n\n/*\nReturns true if the authenticator is active, false if it is inactive, or a string if there is an error\n*/\nBasicAuthenticator.prototype.init = function() {\n\t// Read the credentials data\n\tthis.credentialsFilepath = this.server.get(\"credentials\");\n\tif(this.credentialsFilepath) {\n\t\tvar resolveCredentialsFilepath = path.resolve($tw.boot.wikiPath,this.credentialsFilepath);\n\t\tif(fs.existsSync(resolveCredentialsFilepath) && !fs.statSync(resolveCredentialsFilepath).isDirectory()) {\n\t\t\tvar credentialsText = fs.readFileSync(resolveCredentialsFilepath,\"utf8\"),\n\t\t\t\tcredentialsData = $tw.utils.parseCsvStringWithHeader(credentialsText);\n\t\t\tif(typeof credentialsData === \"string\") {\n\t\t\t\treturn \"Error: \" + credentialsData + \" reading credentials from '\" + resolveCredentialsFilepath + \"'\";\n\t\t\t} else {\n\t\t\t\tthis.credentialsData = credentialsData;\n\t\t\t}\n\t\t} else {\n\t\t\treturn \"Error: Unable to load user credentials from '\" + resolveCredentialsFilepath + \"'\";\n\t\t}\n\t}\n\t// Add the hardcoded username and password if specified\n\tif(this.server.get(\"username\") && this.server.get(\"password\")) {\n\t\tthis.credentialsData = this.credentialsData || [];\n\t\tthis.credentialsData.push({\n\t\t\tusername: this.server.get(\"username\"),\n\t\t\tpassword: this.server.get(\"password\")\n\t\t});\n\t}\n\treturn this.credentialsData.length > 0;\n};\n\n/*\nReturns true if the request is authenticated and assigns the \"authenticatedUsername\" state variable.\nReturns false if the request couldn't be authenticated having sent an appropriate response to the browser\n*/\nBasicAuthenticator.prototype.authenticateRequest = function(request,response,state) {\n\t// Extract the incoming username and password from the request\n\tvar header = request.headers.authorization || \"\";\n\tif(!header && state.allowAnon) {\n\t\t// If there's no header and anonymous access is allowed then we don't set authenticatedUsername\n\t\treturn true;\n\t}\n\tvar token = header.split(/\\s+/).pop() || \"\",\n\t\tauth = $tw.utils.base64Decode(token),\n\t\tparts = auth.split(/:/),\n\t\tincomingUsername = parts[0],\n\t\tincomingPassword = parts[1];\n\t// Check that at least one of the credentials matches\n\tvar matchingCredentials = this.credentialsData.find(function(credential) {\n\t\treturn credential.username === incomingUsername && credential.password === incomingPassword;\n\t});\n\tif(matchingCredentials) {\n\t\t// If so, add the authenticated username to the request state\n\t\tstate.authenticatedUsername = incomingUsername;\n\t\treturn true;\n\t} else {\n\t\t// If not, return an authentication challenge\n\t\tresponse.writeHead(401,\"Authentication required\",{\n\t\t\t\"WWW-Authenticate\": 'Basic realm=\"Please provide your username and password to login to ' + state.server.servername + '\"'\n\t\t});\n\t\tresponse.end();\n\t\treturn false;\n\t}\n};\n\nexports.AuthenticatorClass = BasicAuthenticator;\n\n})();\n",
"type": "application/javascript",
"module-type": "authenticator"
},
"$:/core/modules/server/authenticators/header.js": {
"title": "$:/core/modules/server/authenticators/header.js",
"text": "/*\\\ntitle: $:/core/modules/server/authenticators/header.js\ntype: application/javascript\nmodule-type: authenticator\n\nAuthenticator for trusted header authentication\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nfunction HeaderAuthenticator(server) {\n\tthis.server = server;\n\tthis.header = server.get(\"authenticated-user-header\");\n}\n\n/*\nReturns true if the authenticator is active, false if it is inactive, or a string if there is an error\n*/\nHeaderAuthenticator.prototype.init = function() {\n\treturn !!this.header;\n};\n\n/*\nReturns true if the request is authenticated and assigns the \"authenticatedUsername\" state variable.\nReturns false if the request couldn't be authenticated having sent an appropriate response to the browser\n*/\nHeaderAuthenticator.prototype.authenticateRequest = function(request,response,state) {\n\t// Otherwise, authenticate as the username in the specified header\n\tvar username = request.headers[this.header];\n\tif(!username && !state.allowAnon) {\n\t\tresponse.writeHead(401,\"Authorization header required to login to '\" + state.server.servername + \"'\");\n\t\tresponse.end();\n\t\treturn false;\n\t} else {\n\t\t// authenticatedUsername will be undefined for anonymous users\n\t\tstate.authenticatedUsername = username;\n\t\treturn true;\n\t}\n};\n\nexports.AuthenticatorClass = HeaderAuthenticator;\n\n})();\n",
"type": "application/javascript",
"module-type": "authenticator"
},
"$:/core/modules/server/routes/delete-tiddler.js": {
"title": "$:/core/modules/server/routes/delete-tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/delete-tiddler.js\ntype: application/javascript\nmodule-type: route\n\nDELETE /recipes/default/tiddlers/:title\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"DELETE\";\n\nexports.path = /^\\/bags\\/default\\/tiddlers\\/(.+)$/;\n\nexports.handler = function(request,response,state) {\n\tvar title = decodeURIComponent(state.params[0]);\n\tstate.wiki.deleteTiddler(title);\n\tresponse.writeHead(204, \"OK\", {\n\t\t\"Content-Type\": \"text/plain\"\n\t});\n\tresponse.end();\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-favicon.js": {
"title": "$:/core/modules/server/routes/get-favicon.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-favicon.js\ntype: application/javascript\nmodule-type: route\n\nGET /favicon.ico\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/favicon.ico$/;\n\nexports.handler = function(request,response,state) {\n\tresponse.writeHead(200, {\"Content-Type\": \"image/x-icon\"});\n\tvar buffer = state.wiki.getTiddlerText(\"$:/favicon.ico\",\"\");\n\tresponse.end(buffer,\"base64\");\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-file.js": {
"title": "$:/core/modules/server/routes/get-file.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-file.js\ntype: application/javascript\nmodule-type: route\n\nGET /files/:filepath\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/files\\/(.+)$/;\n\nexports.handler = function(request,response,state) {\n\tvar path = require(\"path\"),\n\t\tfs = require(\"fs\"),\n\t\tutil = require(\"util\"),\n\t\tsuppliedFilename = decodeURIComponent(state.params[0]),\n\t\tfilename = path.resolve($tw.boot.wikiPath,\"files\",suppliedFilename),\n\t\textension = path.extname(filename);\n\tfs.readFile(filename,function(err,content) {\n\t\tvar status,content,type = \"text/plain\";\n\t\tif(err) {\n\t\t\tconsole.log(\"Error accessing file \" + filename + \": \" + err.toString());\n\t\t\tstatus = 404;\n\t\t\tcontent = \"File '\" + suppliedFilename + \"' not found\";\n\t\t} else {\n\t\t\tstatus = 200;\n\t\t\tcontent = content;\n\t\t\ttype = ($tw.config.fileExtensionInfo[extension] ? $tw.config.fileExtensionInfo[extension].type : \"application/octet-stream\");\n\t\t}\n\t\tresponse.writeHead(status,{\n\t\t\t\"Content-Type\": type\n\t\t});\n\t\tresponse.end(content);\n\t});\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-index.js": {
"title": "$:/core/modules/server/routes/get-index.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-index.js\ntype: application/javascript\nmodule-type: route\n\nGET /\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar zlib = require(\"zlib\");\n\nexports.method = \"GET\";\n\nexports.path = /^\\/$/;\n\nexports.handler = function(request,response,state) {\n\tvar acceptEncoding = request.headers[\"accept-encoding\"];\n\tif(!acceptEncoding) {\n\t\tacceptEncoding = \"\";\n\t}\n\tvar text = state.wiki.renderTiddler(state.server.get(\"root-render-type\"),state.server.get(\"root-tiddler\")),\n\t\tresponseHeaders = {\n\t\t\"Content-Type\": state.server.get(\"root-serve-type\")\n\t};\n\t/*\n\tIf the gzip=yes flag for `listen` is set, check if the user agent permits\n\tcompression. If so, compress our response. Note that we use the synchronous\n\tfunctions from zlib to stay in the imperative style. The current `Server`\n\tdoesn't depend on this, and we may just as well use the async versions.\n\t*/\n\tif(state.server.enableGzip) {\n\t\tif (/\\bdeflate\\b/.test(acceptEncoding)) {\n\t\t\tresponseHeaders[\"Content-Encoding\"] = \"deflate\";\n\t\t\ttext = zlib.deflateSync(text);\n\t\t} else if (/\\bgzip\\b/.test(acceptEncoding)) {\n\t\t\tresponseHeaders[\"Content-Encoding\"] = \"gzip\";\n\t\t\ttext = zlib.gzipSync(text);\n\t\t}\n\t}\n\tresponse.writeHead(200,responseHeaders);\n\tresponse.end(text);\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-login-basic.js": {
"title": "$:/core/modules/server/routes/get-login-basic.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-login-basic.js\ntype: application/javascript\nmodule-type: route\n\nGET /login-basic -- force a Basic Authentication challenge\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/login-basic$/;\n\nexports.handler = function(request,response,state) {\n\tif(!state.authenticatedUsername) {\n\t\t// Challenge if there's no username\n\t\tresponse.writeHead(401,{\n\t\t\t\"WWW-Authenticate\": 'Basic realm=\"Please provide your username and password to login to ' + state.server.servername + '\"'\n\t\t});\n\t\tresponse.end();\t\t\n\t} else {\n\t\t// Redirect to the root wiki if login worked\n\t\tresponse.writeHead(302,{\n\t\t\tLocation: \"/\"\n\t\t});\n\t\tresponse.end();\n\t}\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-status.js": {
"title": "$:/core/modules/server/routes/get-status.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-status.js\ntype: application/javascript\nmodule-type: route\n\nGET /status\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/status$/;\n\nexports.handler = function(request,response,state) {\n\tresponse.writeHead(200, {\"Content-Type\": \"application/json\"});\n\tvar text = JSON.stringify({\n\t\tusername: state.authenticatedUsername || state.server.get(\"anon-username\") || \"\",\n\t\tanonymous: !state.authenticatedUsername,\n\t\tread_only: !state.server.isAuthorized(\"writers\",state.authenticatedUsername),\n\t\tspace: {\n\t\t\trecipe: \"default\"\n\t\t},\n\t\ttiddlywiki_version: $tw.version\n\t});\n\tresponse.end(text,\"utf8\");\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-tiddler-html.js": {
"title": "$:/core/modules/server/routes/get-tiddler-html.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-tiddler-html.js\ntype: application/javascript\nmodule-type: route\n\nGET /:title\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/([^\\/]+)$/;\n\nexports.handler = function(request,response,state) {\n\tvar title = decodeURIComponent(state.params[0]),\n\t\ttiddler = state.wiki.getTiddler(title);\n\tif(tiddler) {\n\t\tvar renderType = tiddler.getFieldString(\"_render_type\"),\n\t\t\trenderTemplate = tiddler.getFieldString(\"_render_template\");\n\t\t// Tiddler fields '_render_type' and '_render_template' overwrite\n\t\t// system wide settings for render type and template\n\t\tif(state.wiki.isSystemTiddler(title)) {\n\t\t\trenderType = renderType || state.server.get(\"system-tiddler-render-type\");\n\t\t\trenderTemplate = renderTemplate || state.server.get(\"system-tiddler-render-template\");\n\t\t} else {\n\t\t\trenderType = renderType || state.server.get(\"tiddler-render-type\");\n\t\t\trenderTemplate = renderTemplate || state.server.get(\"tiddler-render-template\");\n\t\t}\n\t\tvar text = state.wiki.renderTiddler(renderType,renderTemplate,{parseAsInline: true, variables: {currentTiddler: title}});\n\t\t// Naughty not to set a content-type, but it's the easiest way to ensure the browser will see HTML pages as HTML, and accept plain text tiddlers as CSS or JS\n\t\tresponse.writeHead(200);\n\t\tresponse.end(text,\"utf8\");\n\t} else {\n\t\tresponse.writeHead(404);\n\t\tresponse.end();\n\t}\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-tiddler.js": {
"title": "$:/core/modules/server/routes/get-tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-tiddler.js\ntype: application/javascript\nmodule-type: route\n\nGET /recipes/default/tiddlers/:title\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/recipes\\/default\\/tiddlers\\/(.+)$/;\n\nexports.handler = function(request,response,state) {\n\tvar title = decodeURIComponent(state.params[0]),\n\t\ttiddler = state.wiki.getTiddler(title),\n\t\ttiddlerFields = {},\n\t\tknownFields = [\n\t\t\t\"bag\", \"created\", \"creator\", \"modified\", \"modifier\", \"permissions\", \"recipe\", \"revision\", \"tags\", \"text\", \"title\", \"type\", \"uri\"\n\t\t];\n\tif(tiddler) {\n\t\t$tw.utils.each(tiddler.fields,function(field,name) {\n\t\t\tvar value = tiddler.getFieldString(name);\n\t\t\tif(knownFields.indexOf(name) !== -1) {\n\t\t\t\ttiddlerFields[name] = value;\n\t\t\t} else {\n\t\t\t\ttiddlerFields.fields = tiddlerFields.fields || {};\n\t\t\t\ttiddlerFields.fields[name] = value;\n\t\t\t}\n\t\t});\n\t\ttiddlerFields.revision = state.wiki.getChangeCount(title);\n\t\ttiddlerFields.bag = \"default\";\n\t\ttiddlerFields.type = tiddlerFields.type || \"text/vnd.tiddlywiki\";\n\t\tresponse.writeHead(200, {\"Content-Type\": \"application/json\"});\n\t\tresponse.end(JSON.stringify(tiddlerFields),\"utf8\");\n\t} else {\n\t\tresponse.writeHead(404);\n\t\tresponse.end();\n\t}\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/get-tiddlers-json.js": {
"title": "$:/core/modules/server/routes/get-tiddlers-json.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/get-tiddlers-json.js\ntype: application/javascript\nmodule-type: route\n\nGET /recipes/default/tiddlers/tiddlers.json?filter=<filter>\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar DEFAULT_FILTER = \"[all[tiddlers]!is[system]sort[title]]\";\n\nexports.method = \"GET\";\n\nexports.path = /^\\/recipes\\/default\\/tiddlers.json$/;\n\nexports.handler = function(request,response,state) {\n\tvar filter = state.queryParameters.filter || DEFAULT_FILTER;\n\tif($tw.wiki.getTiddlerText(\"$:/config/Server/AllowAllExternalFilters\") !== \"yes\") {\n\t\tif($tw.wiki.getTiddlerText(\"$:/config/Server/ExternalFilters/\" + filter) !== \"yes\") {\n\t\t\tconsole.log(\"Blocked attempt to GET /recipes/default/tiddlers/tiddlers.json with filter: \" + filter);\n\t\t\tresponse.writeHead(403);\n\t\t\tresponse.end();\n\t\t\treturn;\n\t\t}\n\t}\n\tvar excludeFields = (state.queryParameters.exclude || \"text\").split(\",\"),\n\t\ttitles = state.wiki.filterTiddlers(filter);\n\tresponse.writeHead(200, {\"Content-Type\": \"application/json\"});\n\tvar tiddlers = [];\n\t$tw.utils.each(titles,function(title) {\n\t\tvar tiddler = state.wiki.getTiddler(title);\n\t\tif(tiddler) {\n\t\t\tvar tiddlerFields = tiddler.getFieldStrings({exclude: excludeFields});\n\t\t\ttiddlerFields.revision = state.wiki.getChangeCount(title);\n\t\t\ttiddlerFields.type = tiddlerFields.type || \"text/vnd.tiddlywiki\";\n\t\t\ttiddlers.push(tiddlerFields);\n\t\t}\n\t});\n\tvar text = JSON.stringify(tiddlers);\n\tresponse.end(text,\"utf8\");\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/routes/put-tiddler.js": {
"title": "$:/core/modules/server/routes/put-tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/server/routes/put-tiddler.js\ntype: application/javascript\nmodule-type: route\n\nPUT /recipes/default/tiddlers/:title\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.method = \"PUT\";\n\nexports.path = /^\\/recipes\\/default\\/tiddlers\\/(.+)$/;\n\nexports.handler = function(request,response,state) {\n\tvar title = decodeURIComponent(state.params[0]),\n\tfields = JSON.parse(state.data);\n\t// Pull up any subfields in the `fields` object\n\tif(fields.fields) {\n\t\t$tw.utils.each(fields.fields,function(field,name) {\n\t\t\tfields[name] = field;\n\t\t});\n\t\tdelete fields.fields;\n\t}\n\t// Remove any revision field\n\tif(fields.revision) {\n\t\tdelete fields.revision;\n\t}\n\tstate.wiki.addTiddler(new $tw.Tiddler(state.wiki.getCreationFields(),fields,{title: title},state.wiki.getModificationFields()));\n\tvar changeCount = state.wiki.getChangeCount(title).toString();\n\tresponse.writeHead(204, \"OK\",{\n\t\tEtag: \"\\\"default/\" + encodeURIComponent(title) + \"/\" + changeCount + \":\\\"\",\n\t\t\"Content-Type\": \"text/plain\"\n\t});\n\tresponse.end();\n};\n\n}());\n",
"type": "application/javascript",
"module-type": "route"
},
"$:/core/modules/server/server.js": {
"title": "$:/core/modules/server/server.js",
"text": "/*\\\ntitle: $:/core/modules/server/server.js\ntype: application/javascript\nmodule-type: library\n\nServe tiddlers over http\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nif($tw.node) {\n\tvar util = require(\"util\"),\n\t\tfs = require(\"fs\"),\n\t\turl = require(\"url\"),\n\t\tpath = require(\"path\"),\n\t\tquerystring = require(\"querystring\");\n}\n\n/*\nA simple HTTP server with regexp-based routes\noptions: variables - optional hashmap of variables to set (a misnomer - they are really constant parameters)\n\t\t routes - optional array of routes to use\n\t\t wiki - reference to wiki object\n*/\nfunction Server(options) {\n\tvar self = this;\n\tthis.routes = options.routes || [];\n\tthis.authenticators = options.authenticators || [];\n\tthis.wiki = options.wiki;\n\tthis.servername = $tw.utils.transliterateToSafeASCII(this.wiki.getTiddlerText(\"$:/SiteTitle\") || \"TiddlyWiki5\");\n\t// Initialise the variables\n\tthis.variables = $tw.utils.extend({},this.defaultVariables);\n\tif(options.variables) {\n\t\tfor(var variable in options.variables) {\n\t\t\tif(options.variables[variable]) {\n\t\t\t\tthis.variables[variable] = options.variables[variable];\n\t\t\t}\n\t\t}\t\t\n\t}\n\t$tw.utils.extend({},this.defaultVariables,options.variables);\n\t// Initialise CSRF\n\tthis.csrfDisable = this.get(\"csrf-disable\") === \"yes\";\n\t// Initialize Gzip compression\n\tthis.enableGzip = this.get(\"gzip\") === \"yes\";\n\t// Initialise authorization\n\tvar authorizedUserName = (this.get(\"username\") && this.get(\"password\")) ? this.get(\"username\") : \"(anon)\";\n\tthis.authorizationPrincipals = {\n\t\treaders: (this.get(\"readers\") || authorizedUserName).split(\",\").map($tw.utils.trim),\n\t\twriters: (this.get(\"writers\") || authorizedUserName).split(\",\").map($tw.utils.trim)\n\t}\n\t// Load and initialise authenticators\n\t$tw.modules.forEachModuleOfType(\"authenticator\", function(title,authenticatorDefinition) {\n\t\t// console.log(\"Loading server route \" + title);\n\t\tself.addAuthenticator(authenticatorDefinition.AuthenticatorClass);\n\t});\n\t// Load route handlers\n\t$tw.modules.forEachModuleOfType(\"route\", function(title,routeDefinition) {\n\t\t// console.log(\"Loading server route \" + title);\n\t\tself.addRoute(routeDefinition);\n\t});\n\t// Initialise the http vs https\n\tthis.listenOptions = null;\n\tthis.protocol = \"http\";\n\tvar tlsKeyFilepath = this.get(\"tls-key\"),\n\t\ttlsCertFilepath = this.get(\"tls-cert\");\n\tif(tlsCertFilepath && tlsKeyFilepath) {\n\t\tthis.listenOptions = {\n\t\t\tkey: fs.readFileSync(path.resolve($tw.boot.wikiPath,tlsKeyFilepath),\"utf8\"),\n\t\t\tcert: fs.readFileSync(path.resolve($tw.boot.wikiPath,tlsCertFilepath),\"utf8\")\n\t\t};\n\t\tthis.protocol = \"https\";\n\t}\n\tthis.transport = require(this.protocol);\n}\n\nServer.prototype.defaultVariables = {\n\tport: \"8080\",\n\thost: \"127.0.0.1\",\n\t\"root-tiddler\": \"$:/core/save/all\",\n\t\"root-render-type\": \"text/plain\",\n\t\"root-serve-type\": \"text/html\",\n\t\"tiddler-render-type\": \"text/html\",\n\t\"tiddler-render-template\": \"$:/core/templates/server/static.tiddler.html\",\n\t\"system-tiddler-render-type\": \"text/plain\",\n\t\"system-tiddler-render-template\": \"$:/core/templates/wikified-tiddler\",\n\t\"debug-level\": \"none\",\n\t\"gzip\": \"no\"\n};\n\nServer.prototype.get = function(name) {\n\treturn this.variables[name];\n};\n\nServer.prototype.addRoute = function(route) {\n\tthis.routes.push(route);\n};\n\nServer.prototype.addAuthenticator = function(AuthenticatorClass) {\n\t// Instantiate and initialise the authenticator\n\tvar authenticator = new AuthenticatorClass(this),\n\t\tresult = authenticator.init();\n\tif(typeof result === \"string\") {\n\t\t$tw.utils.error(\"Error: \" + result);\n\t} else if(result) {\n\t\t// Only use the authenticator if it initialised successfully\n\t\tthis.authenticators.push(authenticator);\n\t}\n};\n\nServer.prototype.findMatchingRoute = function(request,state) {\n\tvar pathprefix = this.get(\"path-prefix\") || \"\";\n\tfor(var t=0; t<this.routes.length; t++) {\n\t\tvar potentialRoute = this.routes[t],\n\t\t\tpathRegExp = potentialRoute.path,\n\t\t\tpathname = state.urlInfo.pathname,\n\t\t\tmatch;\n\t\tif(pathprefix) {\n\t\t\tif(pathname.substr(0,pathprefix.length) === pathprefix) {\n\t\t\t\tpathname = pathname.substr(pathprefix.length) || \"/\";\n\t\t\t\tmatch = potentialRoute.path.exec(pathname);\n\t\t\t} else {\n\t\t\t\tmatch = false;\n\t\t\t}\n\t\t} else {\n\t\t\tmatch = potentialRoute.path.exec(pathname);\n\t\t}\n\t\tif(match && request.method === potentialRoute.method) {\n\t\t\tstate.params = [];\n\t\t\tfor(var p=1; p<match.length; p++) {\n\t\t\t\tstate.params.push(match[p]);\n\t\t\t}\n\t\t\treturn potentialRoute;\n\t\t}\n\t}\n\treturn null;\n};\n\nServer.prototype.methodMappings = {\n\t\"GET\": \"readers\",\n\t\"OPTIONS\": \"readers\",\n\t\"HEAD\": \"readers\",\n\t\"PUT\": \"writers\",\n\t\"POST\": \"writers\",\n\t\"DELETE\": \"writers\"\n};\n\n/*\nCheck whether a given user is authorized for the specified authorizationType (\"readers\" or \"writers\"). Pass null or undefined as the username to check for anonymous access\n*/\nServer.prototype.isAuthorized = function(authorizationType,username) {\n\tvar principals = this.authorizationPrincipals[authorizationType] || [];\n\treturn principals.indexOf(\"(anon)\") !== -1 || (username && (principals.indexOf(\"(authenticated)\") !== -1 || principals.indexOf(username) !== -1));\n}\n\nServer.prototype.requestHandler = function(request,response) {\n\t// Compose the state object\n\tvar self = this;\n\tvar state = {};\n\tstate.wiki = self.wiki;\n\tstate.server = self;\n\tstate.urlInfo = url.parse(request.url);\n\tstate.queryParameters = querystring.parse(state.urlInfo.query);\n\t// Get the principals authorized to access this resource\n\tvar authorizationType = this.methodMappings[request.method] || \"readers\";\n\t// Check for the CSRF header if this is a write\n\tif(!this.csrfDisable && authorizationType === \"writers\" && request.headers[\"x-requested-with\"] !== \"TiddlyWiki\") {\n\t\tresponse.writeHead(403,\"'X-Requested-With' header required to login to '\" + this.servername + \"'\");\n\t\tresponse.end();\n\t\treturn;\t\t\n\t}\n\t// Check whether anonymous access is granted\n\tstate.allowAnon = this.isAuthorized(authorizationType,null);\n\t// Authenticate with the first active authenticator\n\tif(this.authenticators.length > 0) {\n\t\tif(!this.authenticators[0].authenticateRequest(request,response,state)) {\n\t\t\t// Bail if we failed (the authenticator will have sent the response)\n\t\t\treturn;\n\t\t}\t\t\n\t}\n\t// Authorize with the authenticated username\n\tif(!this.isAuthorized(authorizationType,state.authenticatedUsername)) {\n\t\tresponse.writeHead(401,\"'\" + state.authenticatedUsername + \"' is not authorized to access '\" + this.servername + \"'\");\n\t\tresponse.end();\n\t\treturn;\n\t}\n\t// Find the route that matches this path\n\tvar route = self.findMatchingRoute(request,state);\n\t// Optionally output debug info\n\tif(self.get(\"debug-level\") !== \"none\") {\n\t\tconsole.log(\"Request path:\",JSON.stringify(state.urlInfo));\n\t\tconsole.log(\"Request headers:\",JSON.stringify(request.headers));\n\t\tconsole.log(\"authenticatedUsername:\",state.authenticatedUsername);\n\t}\n\t// Return a 404 if we didn't find a route\n\tif(!route) {\n\t\tresponse.writeHead(404);\n\t\tresponse.end();\n\t\treturn;\n\t}\n\t// Receive the request body if necessary and hand off to the route handler\n\tif(route.bodyFormat === \"stream\" || request.method === \"GET\" || request.method === \"HEAD\") {\n\t\t// Let the route handle the request stream itself\n\t\troute.handler(request,response,state);\n\t} else if(route.bodyFormat === \"string\" || !route.bodyFormat) {\n\t\t// Set the encoding for the incoming request\n\t\trequest.setEncoding(\"utf8\");\n\t\tvar data = \"\";\n\t\trequest.on(\"data\",function(chunk) {\n\t\t\tdata += chunk.toString();\n\t\t});\n\t\trequest.on(\"end\",function() {\n\t\t\tstate.data = data;\n\t\t\troute.handler(request,response,state);\n\t\t});\n\t} else if(route.bodyFormat === \"buffer\") {\n\t\tvar data = [];\n\t\trequest.on(\"data\",function(chunk) {\n\t\t\tdata.push(chunk);\n\t\t});\n\t\trequest.on(\"end\",function() {\n\t\t\tstate.data = Buffer.concat(data);\n\t\t\troute.handler(request,response,state);\n\t\t})\n\t} else {\n\t\tresponse.writeHead(400,\"Invalid bodyFormat \" + route.bodyFormat + \" in route \" + route.method + \" \" + route.path.source);\n\t\tresponse.end();\n\t}\n};\n\n/*\nListen for requests\nport: optional port number (falls back to value of \"port\" variable)\nhost: optional host address (falls back to value of \"host\" variable)\nprefix: optional prefix (falls back to value of \"path-prefix\" variable)\n*/\nServer.prototype.listen = function(port,host,prefix) {\n\tvar self = this;\n\t// Handle defaults for port and host\n\tport = port || this.get(\"port\");\n\thost = host || this.get(\"host\");\n\tprefix = prefix || this.get(\"path-prefix\") || \"\";\n\t// Check for the port being a string and look it up as an environment variable\n\tif(parseInt(port,10).toString() !== port) {\n\t\tport = process.env[port] || 8080;\n\t}\n\t// Warn if required plugins are missing\n\tif(!$tw.wiki.getTiddler(\"$:/plugins/tiddlywiki/tiddlyweb\") || !$tw.wiki.getTiddler(\"$:/plugins/tiddlywiki/filesystem\")) {\n\t\t$tw.utils.warning(\"Warning: Plugins required for client-server operation (\\\"tiddlywiki/filesystem\\\" and \\\"tiddlywiki/tiddlyweb\\\") are missing from tiddlywiki.info file\");\n\t}\n\t// Create the server\n\tvar server;\n\tif(this.listenOptions) {\n\t\tserver = this.transport.createServer(this.listenOptions,this.requestHandler.bind(this));\n\t} else {\n\t\tserver = this.transport.createServer(this.requestHandler.bind(this));\n\t}\n\t// Display the port number after we've started listening (the port number might have been specified as zero, in which case we will get an assigned port)\n\tserver.on(\"listening\",function() {\n\t\tvar address = server.address();\n\t\t$tw.utils.log(\"Serving on \" + self.protocol + \"://\" + address.address + \":\" + address.port + prefix,\"brown/orange\");\n\t\t$tw.utils.log(\"(press ctrl-C to exit)\",\"red\");\n\t});\n\t// Listen\n\treturn server.listen(port,host);\n};\n\nexports.Server = Server;\n\n})();\n",
"type": "application/javascript",
"module-type": "library"
},
"$:/core/modules/browser-messaging.js": {
"title": "$:/core/modules/browser-messaging.js",
"text": "/*\\\ntitle: $:/core/modules/browser-messaging.js\ntype: application/javascript\nmodule-type: startup\n\nBrowser message handling\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"browser-messaging\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\n/*\nLoad a specified url as an iframe and call the callback when it is loaded. If the url is already loaded then the existing iframe instance is used\n*/\nfunction loadIFrame(url,callback) {\n\t// Check if iframe already exists\n\tvar iframeInfo = $tw.browserMessaging.iframeInfoMap[url];\n\tif(iframeInfo) {\n\t\t// We've already got the iframe\n\t\tcallback(null,iframeInfo);\n\t} else {\n\t\t// Create the iframe and save it in the list\n\t\tvar iframe = document.createElement(\"iframe\");\n\t\tiframeInfo = {\n\t\t\turl: url,\n\t\t\tstatus: \"loading\",\n\t\t\tdomNode: iframe\n\t\t};\n\t\t$tw.browserMessaging.iframeInfoMap[url] = iframeInfo;\n\t\tsaveIFrameInfoTiddler(iframeInfo);\n\t\t// Add the iframe to the DOM and hide it\n\t\tiframe.style.display = \"none\";\n\t\tiframe.setAttribute(\"library\",\"true\");\n\t\tdocument.body.appendChild(iframe);\n\t\t// Set up onload\n\t\tiframe.onload = function() {\n\t\t\tiframeInfo.status = \"loaded\";\n\t\t\tsaveIFrameInfoTiddler(iframeInfo);\n\t\t\tcallback(null,iframeInfo);\n\t\t};\n\t\tiframe.onerror = function() {\n\t\t\tcallback(\"Cannot load iframe\");\n\t\t};\n\t\ttry {\n\t\t\tiframe.src = url;\n\t\t} catch(ex) {\n\t\t\tcallback(ex);\n\t\t}\n\t}\n}\n\n/*\nUnload library iframe for given url\n*/\nfunction unloadIFrame(url){\n\t$tw.utils.each(document.getElementsByTagName('iframe'), function(iframe) {\n\t\tif(iframe.getAttribute(\"library\") === \"true\" &&\n\t\t iframe.getAttribute(\"src\") === url) {\n\t\t\tiframe.parentNode.removeChild(iframe);\n\t\t}\n\t});\n}\n\nfunction saveIFrameInfoTiddler(iframeInfo) {\n\t$tw.wiki.addTiddler(new $tw.Tiddler($tw.wiki.getCreationFields(),{\n\t\ttitle: \"$:/temp/ServerConnection/\" + iframeInfo.url,\n\t\ttext: iframeInfo.status,\n\t\ttags: [\"$:/tags/ServerConnection\"],\n\t\turl: iframeInfo.url\n\t},$tw.wiki.getModificationFields()));\n}\n\nexports.startup = function() {\n\t// Initialise the store of iframes we've created\n\t$tw.browserMessaging = {\n\t\tiframeInfoMap: {} // Hashmap by URL of {url:,status:\"loading/loaded\",domNode:}\n\t};\n\t// Listen for widget messages to control loading the plugin library\n\t$tw.rootWidget.addEventListener(\"tm-load-plugin-library\",function(event) {\n\t\tvar paramObject = event.paramObject || {},\n\t\t\turl = paramObject.url;\n\t\tif(url) {\n\t\t\tloadIFrame(url,function(err,iframeInfo) {\n\t\t\t\tif(err) {\n\t\t\t\t\talert($tw.language.getString(\"Error/LoadingPluginLibrary\") + \": \" + url);\n\t\t\t\t} else {\n\t\t\t\t\tiframeInfo.domNode.contentWindow.postMessage({\n\t\t\t\t\t\tverb: \"GET\",\n\t\t\t\t\t\turl: \"recipes/library/tiddlers.json\",\n\t\t\t\t\t\tcookies: {\n\t\t\t\t\t\t\ttype: \"save-info\",\n\t\t\t\t\t\t\tinfoTitlePrefix: paramObject.infoTitlePrefix || \"$:/temp/RemoteAssetInfo/\",\n\t\t\t\t\t\t\turl: url\n\t\t\t\t\t\t}\n\t\t\t\t\t},\"*\");\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\t// Listen for widget messages to control unloading the plugin library\n\t$tw.rootWidget.addEventListener(\"tm-unload-plugin-library\",function(event) {\n\t\tvar paramObject = event.paramObject || {},\n\t\t\turl = paramObject.url;\n\t\t$tw.browserMessaging.iframeInfoMap[url] = undefined;\n\t\tif(url) {\n\t\t\tunloadIFrame(url);\n\t\t\t$tw.utils.each(\n\t\t\t\t$tw.wiki.filterTiddlers(\"[[$:/temp/ServerConnection/\" + url + \"]] [prefix[$:/temp/RemoteAssetInfo/\" + url + \"/]]\"),\n\t\t\t\tfunction(title) {\n\t\t\t\t\t$tw.wiki.deleteTiddler(title);\n\t\t\t\t}\n\t\t\t);\n\t\t}\n\t});\n\t$tw.rootWidget.addEventListener(\"tm-load-plugin-from-library\",function(event) {\n\t\tvar paramObject = event.paramObject || {},\n\t\t\turl = paramObject.url,\n\t\t\ttitle = paramObject.title;\n\t\tif(url && title) {\n\t\t\tloadIFrame(url,function(err,iframeInfo) {\n\t\t\t\tif(err) {\n\t\t\t\t\talert($tw.language.getString(\"Error/LoadingPluginLibrary\") + \": \" + url);\n\t\t\t\t} else {\n\t\t\t\t\tiframeInfo.domNode.contentWindow.postMessage({\n\t\t\t\t\t\tverb: \"GET\",\n\t\t\t\t\t\turl: \"recipes/library/tiddlers/\" + encodeURIComponent(title) + \".json\",\n\t\t\t\t\t\tcookies: {\n\t\t\t\t\t\t\ttype: \"save-tiddler\",\n\t\t\t\t\t\t\turl: url\n\t\t\t\t\t\t}\n\t\t\t\t\t},\"*\");\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\t// Listen for window messages from other windows\n\twindow.addEventListener(\"message\",function listener(event){\n\t\t// console.log(\"browser-messaging: \",document.location.toString())\n\t\t// console.log(\"browser-messaging: Received message from\",event.origin);\n\t\t// console.log(\"browser-messaging: Message content\",event.data);\n\t\tswitch(event.data.verb) {\n\t\t\tcase \"GET-RESPONSE\":\n\t\t\t\tif(event.data.status.charAt(0) === \"2\") {\n\t\t\t\t\tif(event.data.cookies) {\n\t\t\t\t\t\tif(event.data.cookies.type === \"save-info\") {\n\t\t\t\t\t\t\tvar tiddlers = JSON.parse(event.data.body);\n\t\t\t\t\t\t\t$tw.utils.each(tiddlers,function(tiddler) {\n\t\t\t\t\t\t\t\t$tw.wiki.addTiddler(new $tw.Tiddler($tw.wiki.getCreationFields(),tiddler,{\n\t\t\t\t\t\t\t\t\ttitle: event.data.cookies.infoTitlePrefix + event.data.cookies.url + \"/\" + tiddler.title,\n\t\t\t\t\t\t\t\t\t\"original-title\": tiddler.title,\n\t\t\t\t\t\t\t\t\ttext: \"\",\n\t\t\t\t\t\t\t\t\ttype: \"text/vnd.tiddlywiki\",\n\t\t\t\t\t\t\t\t\t\"original-type\": tiddler.type,\n\t\t\t\t\t\t\t\t\t\"plugin-type\": undefined,\n\t\t\t\t\t\t\t\t\t\"original-plugin-type\": tiddler[\"plugin-type\"],\n\t\t\t\t\t\t\t\t\t\"module-type\": undefined,\n\t\t\t\t\t\t\t\t\t\"original-module-type\": tiddler[\"module-type\"],\n\t\t\t\t\t\t\t\t\ttags: [\"$:/tags/RemoteAssetInfo\"],\n\t\t\t\t\t\t\t\t\t\"original-tags\": $tw.utils.stringifyList(tiddler.tags || []),\n\t\t\t\t\t\t\t\t\t\"server-url\": event.data.cookies.url\n\t\t\t\t\t\t\t\t},$tw.wiki.getModificationFields()));\n\t\t\t\t\t\t\t});\n\t\t\t\t\t\t} else if(event.data.cookies.type === \"save-tiddler\") {\n\t\t\t\t\t\t\tvar tiddler = JSON.parse(event.data.body);\n\t\t\t\t\t\t\t$tw.wiki.addTiddler(new $tw.Tiddler(tiddler));\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\tbreak;\n\t\t}\n\t},false);\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/commands.js": {
"title": "$:/core/modules/startup/commands.js",
"text": "/*\\\ntitle: $:/core/modules/startup/commands.js\ntype: application/javascript\nmodule-type: startup\n\nCommand processing\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"commands\";\nexports.platforms = [\"node\"];\nexports.after = [\"story\"];\nexports.synchronous = false;\n\nexports.startup = function(callback) {\n\t// On the server, start a commander with the command line arguments\n\tvar commander = new $tw.Commander(\n\t\t$tw.boot.argv,\n\t\tfunction(err) {\n\t\t\tif(err) {\n\t\t\t\treturn $tw.utils.error(\"Error: \" + err);\n\t\t\t}\n\t\t\tcallback();\n\t\t},\n\t\t$tw.wiki,\n\t\t{output: process.stdout, error: process.stderr}\n\t);\n\tcommander.execute();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/CSSescape.js": {
"title": "$:/core/modules/startup/CSSescape.js",
"text": "/*\\\ntitle: $:/core/modules/startup/CSSescape.js\ntype: application/javascript\nmodule-type: startup\n\nPolyfill for CSS.escape()\n\n\\*/\n(function(root,factory){\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"css-escape\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\n/*! https://mths.be/cssescape v1.5.1 by @mathias | MIT license */\n// https://github.com/umdjs/umd/blob/master/returnExports.js\nexports.startup = factory(root);\n}(typeof global != 'undefined' ? global : this, function(root) {\n\n\tif (root.CSS && root.CSS.escape) {\n\t\treturn;\n\t}\n\n\t// https://drafts.csswg.org/cssom/#serialize-an-identifier\n\tvar cssEscape = function(value) {\n\t\tif (arguments.length == 0) {\n\t\t\tthrow new TypeError('`CSS.escape` requires an argument.');\n\t\t}\n\t\tvar string = String(value);\n\t\tvar length = string.length;\n\t\tvar index = -1;\n\t\tvar codeUnit;\n\t\tvar result = '';\n\t\tvar firstCodeUnit = string.charCodeAt(0);\n\t\twhile (++index < length) {\n\t\t\tcodeUnit = string.charCodeAt(index);\n\t\t\t// Note: there’s no need to special-case astral symbols, surrogate\n\t\t\t// pairs, or lone surrogates.\n\n\t\t\t// If the character is NULL (U+0000), then the REPLACEMENT CHARACTER\n\t\t\t// (U+FFFD).\n\t\t\tif (codeUnit == 0x0000) {\n\t\t\t\tresult += '\\uFFFD';\n\t\t\t\tcontinue;\n\t\t\t}\n\n\t\t\tif (\n\t\t\t\t// If the character is in the range [\\1-\\1F] (U+0001 to U+001F) or is\n\t\t\t\t// U+007F, […]\n\t\t\t\t(codeUnit >= 0x0001 && codeUnit <= 0x001F) || codeUnit == 0x007F ||\n\t\t\t\t// If the character is the first character and is in the range [0-9]\n\t\t\t\t// (U+0030 to U+0039), […]\n\t\t\t\t(index == 0 && codeUnit >= 0x0030 && codeUnit <= 0x0039) ||\n\t\t\t\t// If the character is the second character and is in the range [0-9]\n\t\t\t\t// (U+0030 to U+0039) and the first character is a `-` (U+002D), […]\n\t\t\t\t(\n\t\t\t\t\tindex == 1 &&\n\t\t\t\t\tcodeUnit >= 0x0030 && codeUnit <= 0x0039 &&\n\t\t\t\t\tfirstCodeUnit == 0x002D\n\t\t\t\t)\n\t\t\t) {\n\t\t\t\t// https://drafts.csswg.org/cssom/#escape-a-character-as-code-point\n\t\t\t\tresult += '\\\\' + codeUnit.toString(16) + ' ';\n\t\t\t\tcontinue;\n\t\t\t}\n\n\t\t\tif (\n\t\t\t\t// If the character is the first character and is a `-` (U+002D), and\n\t\t\t\t// there is no second character, […]\n\t\t\t\tindex == 0 &&\n\t\t\t\tlength == 1 &&\n\t\t\t\tcodeUnit == 0x002D\n\t\t\t) {\n\t\t\t\tresult += '\\\\' + string.charAt(index);\n\t\t\t\tcontinue;\n\t\t\t}\n\n\t\t\t// If the character is not handled by one of the above rules and is\n\t\t\t// greater than or equal to U+0080, is `-` (U+002D) or `_` (U+005F), or\n\t\t\t// is in one of the ranges [0-9] (U+0030 to U+0039), [A-Z] (U+0041 to\n\t\t\t// U+005A), or [a-z] (U+0061 to U+007A), […]\n\t\t\tif (\n\t\t\t\tcodeUnit >= 0x0080 ||\n\t\t\t\tcodeUnit == 0x002D ||\n\t\t\t\tcodeUnit == 0x005F ||\n\t\t\t\tcodeUnit >= 0x0030 && codeUnit <= 0x0039 ||\n\t\t\t\tcodeUnit >= 0x0041 && codeUnit <= 0x005A ||\n\t\t\t\tcodeUnit >= 0x0061 && codeUnit <= 0x007A\n\t\t\t) {\n\t\t\t\t// the character itself\n\t\t\t\tresult += string.charAt(index);\n\t\t\t\tcontinue;\n\t\t\t}\n\n\t\t\t// Otherwise, the escaped character.\n\t\t\t// https://drafts.csswg.org/cssom/#escape-a-character\n\t\t\tresult += '\\\\' + string.charAt(index);\n\n\t\t}\n\t\treturn result;\n\t};\n\n\tif (!root.CSS) {\n\t\troot.CSS = {};\n\t}\n\n\troot.CSS.escape = cssEscape;\n\n}));\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/favicon.js": {
"title": "$:/core/modules/startup/favicon.js",
"text": "/*\\\ntitle: $:/core/modules/startup/favicon.js\ntype: application/javascript\nmodule-type: startup\n\nFavicon handling\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"favicon\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\t\t\n// Favicon tiddler\nvar FAVICON_TITLE = \"$:/favicon.ico\";\n\nexports.startup = function() {\n\t// Set up the favicon\n\tsetFavicon();\n\t// Reset the favicon when the tiddler changes\n\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\tif($tw.utils.hop(changes,FAVICON_TITLE)) {\n\t\t\tsetFavicon();\n\t\t}\n\t});\n};\n\nfunction setFavicon() {\n\tvar tiddler = $tw.wiki.getTiddler(FAVICON_TITLE);\n\tif(tiddler) {\n\t\tvar faviconLink = document.getElementById(\"faviconLink\");\n\t\tfaviconLink.setAttribute(\"href\",\"data:\" + tiddler.fields.type + \";base64,\" + tiddler.fields.text);\n\t}\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/info.js": {
"title": "$:/core/modules/startup/info.js",
"text": "/*\\\ntitle: $:/core/modules/startup/info.js\ntype: application/javascript\nmodule-type: startup\n\nInitialise $:/info tiddlers via $:/temp/info-plugin pseudo-plugin\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"info\";\nexports.before = [\"startup\"];\nexports.after = [\"load-modules\"];\nexports.synchronous = true;\n\nvar TITLE_INFO_PLUGIN = \"$:/temp/info-plugin\";\n\nexports.startup = function() {\n\t// Collect up the info tiddlers\n\tvar infoTiddlerFields = {};\n\t// Give each info module a chance to fill in as many info tiddlers as they want\n\t$tw.modules.forEachModuleOfType(\"info\",function(title,moduleExports) {\n\t\tif(moduleExports && moduleExports.getInfoTiddlerFields) {\n\t\t\tvar tiddlerFieldsArray = moduleExports.getInfoTiddlerFields(infoTiddlerFields);\n\t\t\t$tw.utils.each(tiddlerFieldsArray,function(fields) {\n\t\t\t\tif(fields) {\n\t\t\t\t\tinfoTiddlerFields[fields.title] = fields;\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n\t// Bake the info tiddlers into a plugin. We use the non-standard plugin-type \"info\" because ordinary plugins are only registered asynchronously after being loaded dynamically\n\tvar fields = {\n\t\ttitle: TITLE_INFO_PLUGIN,\n\t\ttype: \"application/json\",\n\t\t\"plugin-type\": \"info\",\n\t\ttext: JSON.stringify({tiddlers: infoTiddlerFields},null,$tw.config.preferences.jsonSpaces)\n\t};\n\t$tw.wiki.addTiddler(new $tw.Tiddler(fields));\n\t$tw.wiki.readPluginInfo([TITLE_INFO_PLUGIN]);\n\t$tw.wiki.registerPluginTiddlers(\"info\");\n\t$tw.wiki.unpackPluginTiddlers();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/load-modules.js": {
"title": "$:/core/modules/startup/load-modules.js",
"text": "/*\\\ntitle: $:/core/modules/startup/load-modules.js\ntype: application/javascript\nmodule-type: startup\n\nLoad core modules\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"load-modules\";\nexports.synchronous = true;\n\nexports.startup = function() {\n\t// Load modules\n\t$tw.modules.applyMethods(\"utils\",$tw.utils);\n\tif($tw.node) {\n\t\t$tw.modules.applyMethods(\"utils-node\",$tw.utils);\n\t}\n\t$tw.modules.applyMethods(\"global\",$tw);\n\t$tw.modules.applyMethods(\"config\",$tw.config);\n\t$tw.Tiddler.fieldModules = $tw.modules.getModulesByTypeAsHashmap(\"tiddlerfield\");\n\t$tw.modules.applyMethods(\"tiddlermethod\",$tw.Tiddler.prototype);\n\t$tw.modules.applyMethods(\"wikimethod\",$tw.Wiki.prototype);\n\t$tw.wiki.addIndexersToWiki();\n\t$tw.modules.applyMethods(\"tiddlerdeserializer\",$tw.Wiki.tiddlerDeserializerModules);\n\t$tw.macros = $tw.modules.getModulesByTypeAsHashmap(\"macro\");\n\t$tw.wiki.initParsers();\n\t$tw.Commander.initCommands();\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/password.js": {
"title": "$:/core/modules/startup/password.js",
"text": "/*\\\ntitle: $:/core/modules/startup/password.js\ntype: application/javascript\nmodule-type: startup\n\nPassword handling\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"password\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\nexports.startup = function() {\n\t$tw.rootWidget.addEventListener(\"tm-set-password\",function(event) {\n\t\t$tw.passwordPrompt.createPrompt({\n\t\t\tserviceName: $tw.language.getString(\"Encryption/PromptSetPassword\"),\n\t\t\tnoUserName: true,\n\t\t\tsubmitText: $tw.language.getString(\"Encryption/SetPassword\"),\n\t\t\tcanCancel: true,\n\t\t\trepeatPassword: true,\n\t\t\tcallback: function(data) {\n\t\t\t\tif(data) {\n\t\t\t\t\t$tw.crypto.setPassword(data.password);\n\t\t\t\t}\n\t\t\t\treturn true; // Get rid of the password prompt\n\t\t\t}\n\t\t});\n\t});\n\t$tw.rootWidget.addEventListener(\"tm-clear-password\",function(event) {\n\t\tif($tw.browser) {\n\t\t\tif(!confirm($tw.language.getString(\"Encryption/ConfirmClearPassword\"))) {\n\t\t\t\treturn;\n\t\t\t}\n\t\t}\n\t\t$tw.crypto.setPassword(null);\n\t});\n\t// Ensure that $:/isEncrypted is maintained properly\n\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\tif($tw.utils.hop(changes,\"$:/isEncrypted\")) {\n\t\t\t$tw.crypto.updateCryptoStateTiddler();\n\t\t}\n\t});\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/plugins.js": {
"title": "$:/core/modules/startup/plugins.js",
"text": "/*\\\ntitle: $:/core/modules/startup/plugins.js\ntype: application/javascript\nmodule-type: startup\n\nStartup logic concerned with managing plugins\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"plugins\";\nexports.after = [\"load-modules\"];\nexports.synchronous = true;\n\nvar TITLE_REQUIRE_RELOAD_DUE_TO_PLUGIN_CHANGE = \"$:/status/RequireReloadDueToPluginChange\";\n\nvar PREFIX_CONFIG_REGISTER_PLUGIN_TYPE = \"$:/config/RegisterPluginType/\";\n\nexports.startup = function() {\n\t$tw.wiki.addTiddler({title: TITLE_REQUIRE_RELOAD_DUE_TO_PLUGIN_CHANGE,text: \"no\"});\n\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\tvar changesToProcess = [],\n\t\t\trequireReloadDueToPluginChange = false;\n\t\t$tw.utils.each(Object.keys(changes),function(title) {\n\t\t\tvar tiddler = $tw.wiki.getTiddler(title),\n\t\t\t\trequiresReload = $tw.wiki.doesPluginRequireReload(title);\n\t\t\tif(requiresReload) {\n\t\t\t\trequireReloadDueToPluginChange = true;\n\t\t\t} else if(tiddler) {\n\t\t\t\tvar pluginType = tiddler.fields[\"plugin-type\"];\n\t\t\t\tif($tw.wiki.getTiddlerText(PREFIX_CONFIG_REGISTER_PLUGIN_TYPE + (tiddler.fields[\"plugin-type\"] || \"\"),\"no\") === \"yes\") {\n\t\t\t\t\tchangesToProcess.push(title);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t\tif(requireReloadDueToPluginChange) {\n\t\t\t$tw.wiki.addTiddler({title: TITLE_REQUIRE_RELOAD_DUE_TO_PLUGIN_CHANGE,text: \"yes\"});\n\t\t}\n\t\t// Read or delete the plugin info of the changed tiddlers\n\t\tif(changesToProcess.length > 0) {\n\t\t\tvar changes = $tw.wiki.readPluginInfo(changesToProcess);\n\t\t\tif(changes.modifiedPlugins.length > 0 || changes.deletedPlugins.length > 0) {\n\t\t\t\t// (Re-)register any modified plugins\n\t\t\t\t$tw.wiki.registerPluginTiddlers(null,changes.modifiedPlugins);\n\t\t\t\t// Unregister any deleted plugins\n\t\t\t\t$tw.wiki.unregisterPluginTiddlers(null,changes.deletedPlugins);\n\t\t\t\t// Unpack the shadow tiddlers\n\t\t\t\t$tw.wiki.unpackPluginTiddlers();\n\t\t\t}\n\t\t}\n\t});\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/render.js": {
"title": "$:/core/modules/startup/render.js",
"text": "/*\\\ntitle: $:/core/modules/startup/render.js\ntype: application/javascript\nmodule-type: startup\n\nTitle, stylesheet and page rendering\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"render\";\nexports.platforms = [\"browser\"];\nexports.after = [\"story\"];\nexports.synchronous = true;\n\n// Default story and history lists\nvar PAGE_TITLE_TITLE = \"$:/core/wiki/title\";\nvar PAGE_STYLESHEET_TITLE = \"$:/core/ui/PageStylesheet\";\nvar PAGE_TEMPLATE_TITLE = \"$:/core/ui/PageTemplate\";\n\n// Time (in ms) that we defer refreshing changes to draft tiddlers\nvar DRAFT_TIDDLER_TIMEOUT_TITLE = \"$:/config/Drafts/TypingTimeout\";\nvar THROTTLE_REFRESH_TIMEOUT = 400;\n\nexports.startup = function() {\n\t// Set up the title\n\t$tw.titleWidgetNode = $tw.wiki.makeTranscludeWidget(PAGE_TITLE_TITLE,{document: $tw.fakeDocument, parseAsInline: true});\n\t$tw.titleContainer = $tw.fakeDocument.createElement(\"div\");\n\t$tw.titleWidgetNode.render($tw.titleContainer,null);\n\tdocument.title = $tw.titleContainer.textContent;\n\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\tif($tw.titleWidgetNode.refresh(changes,$tw.titleContainer,null)) {\n\t\t\tdocument.title = $tw.titleContainer.textContent;\n\t\t}\n\t});\n\t// Set up the styles\n\t$tw.styleWidgetNode = $tw.wiki.makeTranscludeWidget(PAGE_STYLESHEET_TITLE,{document: $tw.fakeDocument});\n\t$tw.styleContainer = $tw.fakeDocument.createElement(\"style\");\n\t$tw.styleWidgetNode.render($tw.styleContainer,null);\n\t$tw.styleElement = document.createElement(\"style\");\n\t$tw.styleElement.innerHTML = $tw.styleContainer.textContent;\n\tdocument.head.insertBefore($tw.styleElement,document.head.firstChild);\n\t$tw.wiki.addEventListener(\"change\",$tw.perf.report(\"styleRefresh\",function(changes) {\n\t\tif($tw.styleWidgetNode.refresh(changes,$tw.styleContainer,null)) {\n\t\t\t$tw.styleElement.innerHTML = $tw.styleContainer.textContent;\n\t\t}\n\t}));\n\t// Display the $:/core/ui/PageTemplate tiddler to kick off the display\n\t$tw.perf.report(\"mainRender\",function() {\n\t\t$tw.pageWidgetNode = $tw.wiki.makeTranscludeWidget(PAGE_TEMPLATE_TITLE,{document: document, parentWidget: $tw.rootWidget});\n\t\t$tw.pageContainer = document.createElement(\"div\");\n\t\t$tw.utils.addClass($tw.pageContainer,\"tc-page-container-wrapper\");\n\t\tdocument.body.insertBefore($tw.pageContainer,document.body.firstChild);\n\t\t$tw.pageWidgetNode.render($tw.pageContainer,null);\n \t\t$tw.hooks.invokeHook(\"th-page-refreshed\");\n\t})();\n\t// Remove any splash screen elements\n\tvar removeList = document.querySelectorAll(\".tc-remove-when-wiki-loaded\");\n\t$tw.utils.each(removeList,function(removeItem) {\n\t\tif(removeItem.parentNode) {\n\t\t\tremoveItem.parentNode.removeChild(removeItem);\n\t\t}\n\t});\n\t// Prepare refresh mechanism\n\tvar deferredChanges = Object.create(null),\n\t\ttimerId;\n\tfunction refresh() {\n\t\t// Process the refresh\n\t\t$tw.hooks.invokeHook(\"th-page-refreshing\");\n\t\t$tw.pageWidgetNode.refresh(deferredChanges);\n\t\tdeferredChanges = Object.create(null);\n\t\t$tw.hooks.invokeHook(\"th-page-refreshed\");\n\t}\n\t// Add the change event handler\n\t$tw.wiki.addEventListener(\"change\",$tw.perf.report(\"mainRefresh\",function(changes) {\n\t\t// Check if only tiddlers that are throttled have changed\n\t\tvar onlyThrottledTiddlersHaveChanged = true;\n\t\tfor(var title in changes) {\n\t\t\tvar tiddler = $tw.wiki.getTiddler(title);\n\t\t\tif(!tiddler || !(tiddler.hasField(\"draft.of\") || tiddler.hasField(\"throttle.refresh\"))) {\n\t\t\t\tonlyThrottledTiddlersHaveChanged = false;\n\t\t\t}\n\t\t}\n\t\t// Defer the change if only drafts have changed\n\t\tif(timerId) {\n\t\t\tclearTimeout(timerId);\n\t\t}\n\t\ttimerId = null;\n\t\tif(onlyThrottledTiddlersHaveChanged) {\n\t\t\tvar timeout = parseInt($tw.wiki.getTiddlerText(DRAFT_TIDDLER_TIMEOUT_TITLE,\"\"),10);\n\t\t\tif(isNaN(timeout)) {\n\t\t\t\ttimeout = THROTTLE_REFRESH_TIMEOUT;\n\t\t\t}\n\t\t\ttimerId = setTimeout(refresh,timeout);\n\t\t\t$tw.utils.extend(deferredChanges,changes);\n\t\t} else {\n\t\t\t$tw.utils.extend(deferredChanges,changes);\n\t\t\trefresh();\n\t\t}\n\t}));\n\t// Fix up the link between the root widget and the page container\n\t$tw.rootWidget.domNodes = [$tw.pageContainer];\n\t$tw.rootWidget.children = [$tw.pageWidgetNode];\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/rootwidget.js": {
"title": "$:/core/modules/startup/rootwidget.js",
"text": "/*\\\ntitle: $:/core/modules/startup/rootwidget.js\ntype: application/javascript\nmodule-type: startup\n\nSetup the root widget and the core root widget handlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"rootwidget\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.before = [\"story\"];\nexports.synchronous = true;\n\nexports.startup = function() {\n\t// Install the modal message mechanism\n\t$tw.modal = new $tw.utils.Modal($tw.wiki);\n\t$tw.rootWidget.addEventListener(\"tm-modal\",function(event) {\n\t\t$tw.modal.display(event.param,{variables: event.paramObject, event: event});\n\t});\n\t// Install the notification mechanism\n\t$tw.notifier = new $tw.utils.Notifier($tw.wiki);\n\t$tw.rootWidget.addEventListener(\"tm-notify\",function(event) {\n\t\t$tw.notifier.display(event.param,{variables: event.paramObject});\n\t});\n\t// Install the copy-to-clipboard mechanism\n\t$tw.rootWidget.addEventListener(\"tm-copy-to-clipboard\",function(event) {\n\t\t$tw.utils.copyToClipboard(event.param);\n\t});\n\t// Install the tm-focus-selector message\n\t$tw.rootWidget.addEventListener(\"tm-focus-selector\",function(event) {\n\t\tvar selector = event.param || \"\",\n\t\t\telement;\n\t\ttry {\n\t\t\telement = document.querySelector(selector);\n\t\t} catch(e) {\n\t\t\tconsole.log(\"Error in selector: \",selector)\n\t\t}\n\t\tif(element && element.focus) {\n\t\t\telement.focus(event.paramObject);\n\t\t}\n\t});\n\t// Install the scroller\n\t$tw.pageScroller = new $tw.utils.PageScroller();\n\t$tw.rootWidget.addEventListener(\"tm-scroll\",function(event) {\n\t\t$tw.pageScroller.handleEvent(event);\n\t});\n\tvar fullscreen = $tw.utils.getFullScreenApis();\n\tif(fullscreen) {\n\t\t$tw.rootWidget.addEventListener(\"tm-full-screen\",function(event) {\n\t\t\tvar fullScreenDocument = event.event ? event.event.target.ownerDocument : document;\n\t\t\tif(event.param === \"enter\") {\n\t\t\t\tfullScreenDocument.documentElement[fullscreen._requestFullscreen](Element.ALLOW_KEYBOARD_INPUT);\n\t\t\t} else if(event.param === \"exit\") {\n\t\t\t\tfullScreenDocument[fullscreen._exitFullscreen]();\n\t\t\t} else {\n\t\t\t\tif(fullScreenDocument[fullscreen._fullscreenElement]) {\n\t\t\t\t\tfullScreenDocument[fullscreen._exitFullscreen]();\n\t\t\t\t} else {\n\t\t\t\t\tfullScreenDocument.documentElement[fullscreen._requestFullscreen](Element.ALLOW_KEYBOARD_INPUT);\n\t\t\t\t}\t\t\t\t\n\t\t\t}\n\t\t});\n\t}\n\t// If we're being viewed on a data: URI then give instructions for how to save\n\tif(document.location.protocol === \"data:\") {\n\t\t$tw.rootWidget.dispatchEvent({\n\t\t\ttype: \"tm-modal\",\n\t\t\tparam: \"$:/language/Modals/SaveInstructions\"\n\t\t});\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup.js": {
"title": "$:/core/modules/startup.js",
"text": "/*\\\ntitle: $:/core/modules/startup.js\ntype: application/javascript\nmodule-type: startup\n\nMiscellaneous startup logic for both the client and server.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"startup\";\nexports.after = [\"load-modules\"];\nexports.synchronous = true;\n\n// Set to `true` to enable performance instrumentation\nvar PERFORMANCE_INSTRUMENTATION_CONFIG_TITLE = \"$:/config/Performance/Instrumentation\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nexports.startup = function() {\n\tvar modules,n,m,f;\n\t// Minimal browser detection\n\tif($tw.browser) {\n\t\t$tw.browser.isIE = (/msie|trident/i.test(navigator.userAgent));\n\t\t$tw.browser.isFirefox = !!document.mozFullScreenEnabled;\n\t}\n\t// Platform detection\n\t$tw.platform = {};\n\tif($tw.browser) {\n\t\t$tw.platform.isMac = /Mac/.test(navigator.platform);\n\t\t$tw.platform.isWindows = /win/i.test(navigator.platform);\n\t\t$tw.platform.isLinux = /Linux/i.test(navigator.platform);\n\t} else {\n\t\tswitch(require(\"os\").platform()) {\n\t\t\tcase \"darwin\":\n\t\t\t\t$tw.platform.isMac = true;\n\t\t\t\tbreak;\n\t\t\tcase \"win32\":\n\t\t\t\t$tw.platform.isWindows = true;\n\t\t\t\tbreak;\n\t\t\tcase \"freebsd\":\n\t\t\t\t$tw.platform.isLinux = true;\n\t\t\t\tbreak;\n\t\t\tcase \"linux\":\n\t\t\t\t$tw.platform.isLinux = true;\n\t\t\t\tbreak;\n\t\t}\n\t}\n\t// Initialise version\n\t$tw.version = $tw.utils.extractVersionInfo();\n\t// Set up the performance framework\n\t$tw.perf = new $tw.Performance($tw.wiki.getTiddlerText(PERFORMANCE_INSTRUMENTATION_CONFIG_TITLE,\"no\") === \"yes\");\n\t// Create a root widget for attaching event handlers. By using it as the parentWidget for another widget tree, one can reuse the event handlers\n\t$tw.rootWidget = new widget.widget({\n\t\ttype: \"widget\",\n\t\tchildren: []\n\t},{\n\t\twiki: $tw.wiki,\n\t\tdocument: $tw.browser ? document : $tw.fakeDocument\n\t});\n\t// Execute any startup actions\n\tvar executeStartupTiddlers = function(tag) {\n\t\t$tw.utils.each($tw.wiki.filterTiddlers(\"[all[shadows+tiddlers]tag[\" + tag + \"]!has[draft.of]]\"),function(title) {\n\t\t\t$tw.rootWidget.invokeActionString($tw.wiki.getTiddlerText(title),$tw.rootWidget);\n\t\t});\n\t};\n\texecuteStartupTiddlers(\"$:/tags/StartupAction\");\n\tif($tw.browser) {\n\t\texecuteStartupTiddlers(\"$:/tags/StartupAction/Browser\");\t\t\n\t}\n\tif($tw.node) {\n\t\texecuteStartupTiddlers(\"$:/tags/StartupAction/Node\");\t\t\n\t}\n\t// Kick off the language manager and switcher\n\t$tw.language = new $tw.Language();\n\t$tw.languageSwitcher = new $tw.PluginSwitcher({\n\t\twiki: $tw.wiki,\n\t\tpluginType: \"language\",\n\t\tcontrollerTitle: \"$:/language\",\n\t\tdefaultPlugins: [\n\t\t\t\"$:/languages/en-GB\"\n\t\t],\n\t\tonSwitch: function(plugins) {\n\t\t\tif($tw.browser) {\n\t\t\t\tvar pluginTiddler = $tw.wiki.getTiddler(plugins[0]);\n\t\t\t\tif(pluginTiddler) {\n\t\t\t\t\tdocument.documentElement.setAttribute(\"dir\",pluginTiddler.getFieldString(\"text-direction\") || \"auto\");\n\t\t\t\t} else {\n\t\t\t\t\tdocument.documentElement.removeAttribute(\"dir\");\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n\t// Kick off the theme manager\n\t$tw.themeManager = new $tw.PluginSwitcher({\n\t\twiki: $tw.wiki,\n\t\tpluginType: \"theme\",\n\t\tcontrollerTitle: \"$:/theme\",\n\t\tdefaultPlugins: [\n\t\t\t\"$:/themes/tiddlywiki/snowwhite\",\n\t\t\t\"$:/themes/tiddlywiki/vanilla\"\n\t\t]\n\t});\n\t// Kick off the keyboard manager\n\t$tw.keyboardManager = new $tw.KeyboardManager();\n\t// Listen for shortcuts\n\tif($tw.browser) {\n\t\t$tw.utils.addEventListeners(document,[{\n\t\t\tname: \"keydown\",\n\t\t\thandlerObject: $tw.keyboardManager,\n\t\t\thandlerMethod: \"handleKeydownEvent\"\n\t\t}]);\n\t}\n\t// Clear outstanding tiddler store change events to avoid an unnecessary refresh cycle at startup\n\t$tw.wiki.clearTiddlerEventQueue();\n\t// Find a working syncadaptor\n\t$tw.syncadaptor = undefined;\n\t$tw.modules.forEachModuleOfType(\"syncadaptor\",function(title,module) {\n\t\tif(!$tw.syncadaptor && module.adaptorClass) {\n\t\t\t$tw.syncadaptor = new module.adaptorClass({wiki: $tw.wiki});\n\t\t}\n\t});\n\t// Set up the syncer object if we've got a syncadaptor\n\tif($tw.syncadaptor) {\n\t\t$tw.syncer = new $tw.Syncer({wiki: $tw.wiki, syncadaptor: $tw.syncadaptor});\n\t}\n\t// Setup the saver handler\n\t$tw.saverHandler = new $tw.SaverHandler({\n\t\twiki: $tw.wiki,\n\t\tdirtyTracking: !$tw.syncadaptor,\n\t\tpreloadDirty: $tw.boot.preloadDirty || []\n\t});\n\t// Host-specific startup\n\tif($tw.browser) {\n\t\t// Install the popup manager\n\t\t$tw.popup = new $tw.utils.Popup();\n\t\t// Install the animator\n\t\t$tw.anim = new $tw.utils.Animator();\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/story.js": {
"title": "$:/core/modules/startup/story.js",
"text": "/*\\\ntitle: $:/core/modules/startup/story.js\ntype: application/javascript\nmodule-type: startup\n\nLoad core modules\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"story\";\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\n// Default story and history lists\nvar DEFAULT_STORY_TITLE = \"$:/StoryList\";\nvar DEFAULT_HISTORY_TITLE = \"$:/HistoryList\";\n\n// Default tiddlers\nvar DEFAULT_TIDDLERS_TITLE = \"$:/DefaultTiddlers\";\n\n// Config\nvar CONFIG_UPDATE_ADDRESS_BAR = \"$:/config/Navigation/UpdateAddressBar\"; // Can be \"no\", \"permalink\", \"permaview\"\nvar CONFIG_UPDATE_HISTORY = \"$:/config/Navigation/UpdateHistory\"; // Can be \"yes\" or \"no\"\nvar CONFIG_PERMALINKVIEW_COPY_TO_CLIPBOARD = \"$:/config/Navigation/Permalinkview/CopyToClipboard\"; // Can be \"yes\" (default) or \"no\"\nvar CONFIG_PERMALINKVIEW_UPDATE_ADDRESS_BAR = \"$:/config/Navigation/Permalinkview/UpdateAddressBar\"; // Can be \"yes\" (default) or \"no\"\n\n\n// Links to help, if there is no param\nvar HELP_OPEN_EXTERNAL_WINDOW = \"http://tiddlywiki.com/#WidgetMessage%3A%20tm-open-external-window\";\n\nexports.startup = function() {\n\t// Open startup tiddlers\n\topenStartupTiddlers({\n\t\tdisableHistory: $tw.boot.disableStartupNavigation\n\t});\n\tif($tw.browser) {\n\t\t// Set up location hash update\n\t\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\t\tif($tw.utils.hop(changes,DEFAULT_STORY_TITLE) || $tw.utils.hop(changes,DEFAULT_HISTORY_TITLE)) {\n\t\t\t\tupdateLocationHash({\n\t\t\t\t\tupdateAddressBar: $tw.wiki.getTiddlerText(CONFIG_UPDATE_ADDRESS_BAR,\"permaview\").trim(),\n\t\t\t\t\tupdateHistory: $tw.wiki.getTiddlerText(CONFIG_UPDATE_HISTORY,\"no\").trim()\n\t\t\t\t});\n\t\t\t}\n\t\t});\n\t\t// Listen for changes to the browser location hash\n\t\twindow.addEventListener(\"hashchange\",function() {\n\t\t\tvar hash = $tw.utils.getLocationHash();\n\t\t\tif(hash !== $tw.locationHash) {\n\t\t\t\t$tw.locationHash = hash;\n\t\t\t\topenStartupTiddlers({defaultToCurrentStory: true});\n\t\t\t}\n\t\t},false);\n\t\t// Listen for the tm-browser-refresh message\n\t\t$tw.rootWidget.addEventListener(\"tm-browser-refresh\",function(event) {\n\t\t\twindow.location.reload(true);\n\t\t});\n\t\t// Listen for tm-open-external-window message\n\t\t$tw.rootWidget.addEventListener(\"tm-open-external-window\",function(event) {\n\t\t\tvar paramObject = event.paramObject || {},\n\t\t\t\tstrUrl = event.param || HELP_OPEN_EXTERNAL_WINDOW,\n\t\t\t\tstrWindowName = paramObject.windowName,\n\t\t\t\tstrWindowFeatures = paramObject.windowFeatures;\n\t\t\twindow.open(strUrl, strWindowName, strWindowFeatures);\n\t\t});\n\t\t// Listen for the tm-print message\n\t\t$tw.rootWidget.addEventListener(\"tm-print\",function(event) {\n\t\t\t(event.event.view || window).print();\n\t\t});\n\t\t// Listen for the tm-home message\n\t\t$tw.rootWidget.addEventListener(\"tm-home\",function(event) {\n\t\t\twindow.location.hash = \"\";\n\t\t\tvar storyFilter = $tw.wiki.getTiddlerText(DEFAULT_TIDDLERS_TITLE),\n\t\t\t\tstoryList = $tw.wiki.filterTiddlers(storyFilter);\n\t\t\t//invoke any hooks that might change the default story list\n\t\t\tstoryList = $tw.hooks.invokeHook(\"th-opening-default-tiddlers-list\",storyList);\n\t\t\t$tw.wiki.addTiddler({title: DEFAULT_STORY_TITLE, text: \"\", list: storyList},$tw.wiki.getModificationFields());\n\t\t\tif(storyList[0]) {\n\t\t\t\t$tw.wiki.addToHistory(storyList[0]);\n\t\t\t}\n\t\t});\n\t\t// Listen for the tm-permalink message\n\t\t$tw.rootWidget.addEventListener(\"tm-permalink\",function(event) {\n\t\t\tupdateLocationHash({\n\t\t\t\tupdateAddressBar: $tw.wiki.getTiddlerText(CONFIG_PERMALINKVIEW_UPDATE_ADDRESS_BAR,\"yes\").trim() === \"yes\" ? \"permalink\" : \"none\",\n\t\t\t\tupdateHistory: $tw.wiki.getTiddlerText(CONFIG_UPDATE_HISTORY,\"no\").trim(),\n\t\t\t\ttargetTiddler: event.param || event.tiddlerTitle,\n\t\t\t\tcopyToClipboard: $tw.wiki.getTiddlerText(CONFIG_PERMALINKVIEW_COPY_TO_CLIPBOARD,\"yes\").trim() === \"yes\" ? \"permalink\" : \"none\"\n\t\t\t});\n\t\t});\n\t\t// Listen for the tm-permaview message\n\t\t$tw.rootWidget.addEventListener(\"tm-permaview\",function(event) {\n\t\t\tupdateLocationHash({\n\t\t\t\tupdateAddressBar: $tw.wiki.getTiddlerText(CONFIG_PERMALINKVIEW_UPDATE_ADDRESS_BAR,\"yes\").trim() === \"yes\" ? \"permaview\" : \"none\",\n\t\t\t\tupdateHistory: $tw.wiki.getTiddlerText(CONFIG_UPDATE_HISTORY,\"no\").trim(),\n\t\t\t\ttargetTiddler: event.param || event.tiddlerTitle,\n\t\t\t\tcopyToClipboard: $tw.wiki.getTiddlerText(CONFIG_PERMALINKVIEW_COPY_TO_CLIPBOARD,\"yes\").trim() === \"yes\" ? \"permaview\" : \"none\"\n\t\t\t});\t\t\t\t\n\t\t});\n\t}\n};\n\n/*\nProcess the location hash to open the specified tiddlers. Options:\ndisableHistory: if true $:/History is NOT updated\ndefaultToCurrentStory: If true, the current story is retained as the default, instead of opening the default tiddlers\n*/\nfunction openStartupTiddlers(options) {\n\toptions = options || {};\n\t// Work out the target tiddler and the story filter. \"null\" means \"unspecified\"\n\tvar target = null,\n\t\tstoryFilter = null;\n\tif($tw.locationHash.length > 1) {\n\t\tvar hash = $tw.locationHash.substr(1),\n\t\t\tsplit = hash.indexOf(\":\");\n\t\tif(split === -1) {\n\t\t\ttarget = decodeURIComponent(hash.trim());\n\t\t} else {\n\t\t\ttarget = decodeURIComponent(hash.substr(0,split).trim());\n\t\t\tstoryFilter = decodeURIComponent(hash.substr(split + 1).trim());\n\t\t}\n\t}\n\t// If the story wasn't specified use the current tiddlers or a blank story\n\tif(storyFilter === null) {\n\t\tif(options.defaultToCurrentStory) {\n\t\t\tvar currStoryList = $tw.wiki.getTiddlerList(DEFAULT_STORY_TITLE);\n\t\t\tstoryFilter = $tw.utils.stringifyList(currStoryList);\n\t\t} else {\n\t\t\tif(target && target !== \"\") {\n\t\t\t\tstoryFilter = \"\";\n\t\t\t} else {\n\t\t\t\tstoryFilter = $tw.wiki.getTiddlerText(DEFAULT_TIDDLERS_TITLE);\n\t\t\t}\n\t\t}\n\t}\n\t// Process the story filter to get the story list\n\tvar storyList = $tw.wiki.filterTiddlers(storyFilter);\n\t// Invoke any hooks that want to change the default story list\n\tstoryList = $tw.hooks.invokeHook(\"th-opening-default-tiddlers-list\",storyList);\n\t// If the target tiddler isn't included then splice it in at the top\n\tif(target && storyList.indexOf(target) === -1) {\n\t\tstoryList.unshift(target);\n\t}\n\t// Save the story list\n\t$tw.wiki.addTiddler({title: DEFAULT_STORY_TITLE, text: \"\", list: storyList},$tw.wiki.getModificationFields());\n\t// Update history\n\tif(!options.disableHistory) {\n\t\t// If a target tiddler was specified add it to the history stack\n\t\tif(target && target !== \"\") {\n\t\t\t// The target tiddler doesn't need double square brackets, but we'll silently remove them if they're present\n\t\t\tif(target.indexOf(\"[[\") === 0 && target.substr(-2) === \"]]\") {\n\t\t\t\ttarget = target.substr(2,target.length - 4);\n\t\t\t}\n\t\t\t$tw.wiki.addToHistory(target);\n\t\t} else if(storyList.length > 0) {\n\t\t\t$tw.wiki.addToHistory(storyList[0]);\n\t\t}\t\t\n\t}\n}\n\n/*\noptions: See below\noptions.updateAddressBar: \"permalink\", \"permaview\" or \"no\" (defaults to \"permaview\")\noptions.updateHistory: \"yes\" or \"no\" (defaults to \"no\")\noptions.copyToClipboard: \"permalink\", \"permaview\" or \"no\" (defaults to \"no\")\noptions.targetTiddler: optional title of target tiddler for permalink\n*/\nfunction updateLocationHash(options) {\n\t// Get the story and the history stack\n\tvar storyList = $tw.wiki.getTiddlerList(DEFAULT_STORY_TITLE),\n\t\thistoryList = $tw.wiki.getTiddlerData(DEFAULT_HISTORY_TITLE,[]),\n\t\ttargetTiddler = \"\";\n\tif(options.targetTiddler) {\n\t\ttargetTiddler = options.targetTiddler;\n\t} else {\n\t\t// The target tiddler is the one at the top of the stack\n\t\tif(historyList.length > 0) {\n\t\t\ttargetTiddler = historyList[historyList.length-1].title;\n\t\t}\n\t\t// Blank the target tiddler if it isn't present in the story\n\t\tif(storyList.indexOf(targetTiddler) === -1) {\n\t\t\ttargetTiddler = \"\";\n\t\t}\n\t}\n\t// Assemble the location hash\n\tswitch(options.updateAddressBar) {\n\t\tcase \"permalink\":\n\t\t\t$tw.locationHash = \"#\" + encodeURIComponent(targetTiddler);\n\t\t\tbreak;\n\t\tcase \"permaview\":\n\t\t\t$tw.locationHash = \"#\" + encodeURIComponent(targetTiddler) + \":\" + encodeURIComponent($tw.utils.stringifyList(storyList));\n\t\t\tbreak;\n\t}\n\t// Copy URL to the clipboard\n\tswitch(options.copyToClipboard) {\n\t\tcase \"permalink\":\n\t\t\t$tw.utils.copyToClipboard($tw.utils.getLocationPath() + \"#\" + encodeURIComponent(targetTiddler));\n\t\t\tbreak;\n\t\tcase \"permaview\":\n\t\t\t$tw.utils.copyToClipboard($tw.utils.getLocationPath() + \"#\" + encodeURIComponent(targetTiddler) + \":\" + encodeURIComponent($tw.utils.stringifyList(storyList)));\n\t\t\tbreak;\n\t}\n\t// Only change the location hash if we must, thus avoiding unnecessary onhashchange events\n\tif($tw.utils.getLocationHash() !== $tw.locationHash) {\n\t\tif(options.updateHistory === \"yes\") {\n\t\t\t// Assign the location hash so that history is updated\n\t\t\twindow.location.hash = $tw.locationHash;\n\t\t} else {\n\t\t\t// We use replace so that browser history isn't affected\n\t\t\twindow.location.replace(window.location.toString().split(\"#\")[0] + $tw.locationHash);\n\t\t}\n\t}\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/startup/windows.js": {
"title": "$:/core/modules/startup/windows.js",
"text": "/*\\\ntitle: $:/core/modules/startup/windows.js\ntype: application/javascript\nmodule-type: startup\n\nSetup root widget handlers for the messages concerned with opening external browser windows\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"windows\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.synchronous = true;\n\n// Global to keep track of open windows (hashmap by title)\nvar windows = {};\n\nexports.startup = function() {\n\t// Handle open window message\n\t$tw.rootWidget.addEventListener(\"tm-open-window\",function(event) {\n\t\t// Get the parameters\n\t\tvar refreshHandler,\n\t\t\ttitle = event.param || event.tiddlerTitle,\n\t\t\tparamObject = event.paramObject || {},\n\t\t\twindowTitle = paramObject.windowTitle || title,\n\t\t\ttemplate = paramObject.template || \"$:/core/templates/single.tiddler.window\",\n\t\t\twidth = paramObject.width || \"700\",\n\t\t\theight = paramObject.height || \"600\",\n\t\t\tvariables = $tw.utils.extend({},paramObject,{currentTiddler: title});\n\t\t// Open the window\n\t\tvar srcWindow,\n\t\t srcDocument;\n\t\t// In case that popup blockers deny opening a new window\n\t\ttry {\n\t\t\tsrcWindow = window.open(\"\",\"external-\" + title,\"scrollbars,width=\" + width + \",height=\" + height),\n\t\t\tsrcDocument = srcWindow.document;\n\t\t}\n\t\tcatch(e) {\n\t\t\treturn;\n\t\t}\n\t\twindows[title] = srcWindow;\n\t\t// Check for reopening the same window\n\t\tif(srcWindow.haveInitialisedWindow) {\n\t\t\treturn;\n\t\t}\n\t\t// Initialise the document\n\t\tsrcDocument.write(\"<html><head></head><body class='tc-body tc-single-tiddler-window'></body></html>\");\n\t\tsrcDocument.close();\n\t\tsrcDocument.title = windowTitle;\n\t\tsrcWindow.addEventListener(\"beforeunload\",function(event) {\n\t\t\tdelete windows[title];\n\t\t\t$tw.wiki.removeEventListener(\"change\",refreshHandler);\n\t\t},false);\n\t\t// Set up the styles\n\t\tvar styleWidgetNode = $tw.wiki.makeTranscludeWidget(\"$:/core/ui/PageStylesheet\",{\n\t\t\t\tdocument: $tw.fakeDocument,\n\t\t\t\tvariables: variables,\n\t\t\t\timportPageMacros: true}),\n\t\t\tstyleContainer = $tw.fakeDocument.createElement(\"style\");\n\t\tstyleWidgetNode.render(styleContainer,null);\n\t\tvar styleElement = srcDocument.createElement(\"style\");\n\t\tstyleElement.innerHTML = styleContainer.textContent;\n\t\tsrcDocument.head.insertBefore(styleElement,srcDocument.head.firstChild);\n\t\t// Render the text of the tiddler\n\t\tvar parser = $tw.wiki.parseTiddler(template),\n\t\t\twidgetNode = $tw.wiki.makeWidget(parser,{document: srcDocument, parentWidget: $tw.rootWidget, variables: variables});\n\t\twidgetNode.render(srcDocument.body,srcDocument.body.firstChild);\n\t\t// Function to handle refreshes\n\t\trefreshHandler = function(changes) {\n\t\t\tif(styleWidgetNode.refresh(changes,styleContainer,null)) {\n\t\t\t\tstyleElement.innerHTML = styleContainer.textContent;\n\t\t\t}\n\t\t\twidgetNode.refresh(changes);\n\t\t};\n\t\t$tw.wiki.addEventListener(\"change\",refreshHandler);\n\t\t// Listen for keyboard shortcuts\n\t\t$tw.utils.addEventListeners(srcDocument,[{\n\t\t\tname: \"keydown\",\n\t\t\thandlerObject: $tw.keyboardManager,\n\t\t\thandlerMethod: \"handleKeydownEvent\"\n\t\t},{\n\t\t\tname: \"click\",\n\t\t\thandlerObject: $tw.popup,\n\t\t\thandlerMethod: \"handleEvent\"\n\t\t}]);\n\t\tsrcWindow.haveInitialisedWindow = true;\n\t});\n\t// Close open windows when unloading main window\n\t$tw.addUnloadTask(function() {\n\t\t$tw.utils.each(windows,function(win) {\n\t\t\twin.close();\n\t\t});\n\t});\n\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "startup"
},
"$:/core/modules/story.js": {
"title": "$:/core/modules/story.js",
"text": "/*\\\ntitle: $:/core/modules/story.js\ntype: application/javascript\nmodule-type: global\n\nLightweight object for managing interactions with the story and history lists.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nConstruct Story object with options:\nwiki: reference to wiki object to use to resolve tiddler titles\nstoryTitle: title of story list tiddler\nhistoryTitle: title of history list tiddler\n*/\nfunction Story(options) {\n\toptions = options || {};\n\tthis.wiki = options.wiki || $tw.wiki;\n\tthis.storyTitle = options.storyTitle || \"$:/StoryList\";\n\tthis.historyTitle = options.historyTitle || \"$:/HistoryList\";\n};\n\nStory.prototype.navigateTiddler = function(navigateTo,navigateFromTitle,navigateFromClientRect) {\n\tthis.addToStory(navigateTo,navigateFromTitle);\n\tthis.addToHistory(navigateTo,navigateFromClientRect);\n};\n\nStory.prototype.getStoryList = function() {\n\treturn this.wiki.getTiddlerList(this.storyTitle) || [];\n};\n\nStory.prototype.addToStory = function(navigateTo,navigateFromTitle,options) {\n\toptions = options || {};\n\tvar storyList = this.getStoryList();\n\t// See if the tiddler is already there\n\tvar slot = storyList.indexOf(navigateTo);\n\t// Quit if it already exists in the story river\n\tif(slot >= 0) {\n\t\treturn;\n\t}\n\t// First we try to find the position of the story element we navigated from\n\tvar fromIndex = storyList.indexOf(navigateFromTitle);\n\tif(fromIndex >= 0) {\n\t\t// The tiddler is added from inside the river\n\t\t// Determine where to insert the tiddler; Fallback is \"below\"\n\t\tswitch(options.openLinkFromInsideRiver) {\n\t\t\tcase \"top\":\n\t\t\t\tslot = 0;\n\t\t\t\tbreak;\n\t\t\tcase \"bottom\":\n\t\t\t\tslot = storyList.length;\n\t\t\t\tbreak;\n\t\t\tcase \"above\":\n\t\t\t\tslot = fromIndex;\n\t\t\t\tbreak;\n\t\t\tcase \"below\": // Intentional fall-through\n\t\t\tdefault:\n\t\t\t\tslot = fromIndex + 1;\n\t\t\t\tbreak;\n\t\t}\n\t} else {\n\t\t// The tiddler is opened from outside the river. Determine where to insert the tiddler; default is \"top\"\n\t\tif(options.openLinkFromOutsideRiver === \"bottom\") {\n\t\t\t// Insert at bottom\n\t\t\tslot = storyList.length;\n\t\t} else {\n\t\t\t// Insert at top\n\t\t\tslot = 0;\n\t\t}\n\t}\n\t// Add the tiddler\n\tstoryList.splice(slot,0,navigateTo);\n\t// Save the story\n\tthis.saveStoryList(storyList);\n};\n\nStory.prototype.saveStoryList = function(storyList) {\n\tvar storyTiddler = this.wiki.getTiddler(this.storyTitle);\n\tthis.wiki.addTiddler(new $tw.Tiddler(\n\t\tthis.wiki.getCreationFields(),\n\t\t{title: this.storyTitle},\n\t\tstoryTiddler,\n\t\t{list: storyList},\n\t\tthis.wiki.getModificationFields()\n\t));\n};\n\nStory.prototype.addToHistory = function(navigateTo,navigateFromClientRect) {\n\tvar titles = $tw.utils.isArray(navigateTo) ? navigateTo : [navigateTo];\n\t// Add a new record to the top of the history stack\n\tvar historyList = this.wiki.getTiddlerData(this.historyTitle,[]);\n\t$tw.utils.each(titles,function(title) {\n\t\thistoryList.push({title: title, fromPageRect: navigateFromClientRect});\n\t});\n\tthis.wiki.setTiddlerData(this.historyTitle,historyList,{\"current-tiddler\": titles[titles.length-1]});\n};\n\nStory.prototype.storyCloseTiddler = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storyCloseAllTiddlers = function() {\n// TBD\n};\n\nStory.prototype.storyCloseOtherTiddlers = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storyEditTiddler = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storyDeleteTiddler = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storySaveTiddler = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storyCancelTiddler = function(targetTitle) {\n// TBD\n};\n\nStory.prototype.storyNewTiddler = function(targetTitle) {\n// TBD\n};\n\nexports.Story = Story;\n\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/storyviews/classic.js": {
"title": "$:/core/modules/storyviews/classic.js",
"text": "/*\\\ntitle: $:/core/modules/storyviews/classic.js\ntype: application/javascript\nmodule-type: storyview\n\nViews the story as a linear sequence\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar easing = \"cubic-bezier(0.645, 0.045, 0.355, 1)\"; // From http://easings.net/#easeInOutCubic\n\nvar ClassicStoryView = function(listWidget) {\n\tthis.listWidget = listWidget;\n};\n\nClassicStoryView.prototype.navigateTo = function(historyInfo) {\n\tvar duration = $tw.utils.getAnimationDuration()\n\tvar listElementIndex = this.listWidget.findListItem(0,historyInfo.title);\n\tif(listElementIndex === undefined) {\n\t\treturn;\n\t}\n\tvar listItemWidget = this.listWidget.children[listElementIndex],\n\t\ttargetElement = listItemWidget.findFirstDomNode();\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\treturn;\n\t}\n\tif(duration) {\n\t\t// Scroll the node into view\n\t\tthis.listWidget.dispatchEvent({type: \"tm-scroll\", target: targetElement});\t\n\t} else {\n\t\ttargetElement.scrollIntoView();\n\t}\n};\n\nClassicStoryView.prototype.insert = function(widget) {\n\tvar duration = $tw.utils.getAnimationDuration();\n\tif(duration) {\n\t\tvar targetElement = widget.findFirstDomNode();\n\t\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\t\tif(!(targetElement instanceof Element)) {\n\t\t\treturn;\n\t\t}\n\t\t// Get the current height of the tiddler\n\t\tvar computedStyle = window.getComputedStyle(targetElement),\n\t\t\tcurrMarginBottom = parseInt(computedStyle.marginBottom,10),\n\t\t\tcurrMarginTop = parseInt(computedStyle.marginTop,10),\n\t\t\tcurrHeight = targetElement.offsetHeight + currMarginTop;\n\t\t// Reset the margin once the transition is over\n\t\tsetTimeout(function() {\n\t\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t\t{transition: \"none\"},\n\t\t\t\t{marginBottom: \"\"}\n\t\t\t]);\n\t\t},duration);\n\t\t// Set up the initial position of the element\n\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t{transition: \"none\"},\n\t\t\t{marginBottom: (-currHeight) + \"px\"},\n\t\t\t{opacity: \"0.0\"}\n\t\t]);\n\t\t$tw.utils.forceLayout(targetElement);\n\t\t// Transition to the final position\n\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t{transition: \"opacity \" + duration + \"ms \" + easing + \", \" +\n\t\t\t\t\t\t\"margin-bottom \" + duration + \"ms \" + easing},\n\t\t\t{marginBottom: currMarginBottom + \"px\"},\n\t\t\t{opacity: \"1.0\"}\n\t]);\n\t}\n};\n\nClassicStoryView.prototype.remove = function(widget) {\n\tvar duration = $tw.utils.getAnimationDuration();\n\tif(duration) {\n\t\tvar targetElement = widget.findFirstDomNode(),\n\t\t\tremoveElement = function() {\n\t\t\t\twidget.removeChildDomNodes();\n\t\t\t};\n\t\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\t\tif(!(targetElement instanceof Element)) {\n\t\t\tremoveElement();\n\t\t\treturn;\n\t\t}\n\t\t// Get the current height of the tiddler\n\t\tvar currWidth = targetElement.offsetWidth,\n\t\t\tcomputedStyle = window.getComputedStyle(targetElement),\n\t\t\tcurrMarginBottom = parseInt(computedStyle.marginBottom,10),\n\t\t\tcurrMarginTop = parseInt(computedStyle.marginTop,10),\n\t\t\tcurrHeight = targetElement.offsetHeight + currMarginTop;\n\t\t// Remove the dom nodes of the widget at the end of the transition\n\t\tsetTimeout(removeElement,duration);\n\t\t// Animate the closure\n\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t{transition: \"none\"},\n\t\t\t{transform: \"translateX(0px)\"},\n\t\t\t{marginBottom: currMarginBottom + \"px\"},\n\t\t\t{opacity: \"1.0\"}\n\t\t]);\n\t\t$tw.utils.forceLayout(targetElement);\n\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms \" + easing + \", \" +\n\t\t\t\t\t\t\"opacity \" + duration + \"ms \" + easing + \", \" +\n\t\t\t\t\t\t\"margin-bottom \" + duration + \"ms \" + easing},\n\t\t\t{transform: \"translateX(-\" + currWidth + \"px)\"},\n\t\t\t{marginBottom: (-currHeight) + \"px\"},\n\t\t\t{opacity: \"0.0\"}\n\t\t]);\n\t} else {\n\t\twidget.removeChildDomNodes();\n\t}\n};\n\nexports.classic = ClassicStoryView;\n\n})();",
"type": "application/javascript",
"module-type": "storyview"
},
"$:/core/modules/storyviews/pop.js": {
"title": "$:/core/modules/storyviews/pop.js",
"text": "/*\\\ntitle: $:/core/modules/storyviews/pop.js\ntype: application/javascript\nmodule-type: storyview\n\nAnimates list insertions and removals\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar PopStoryView = function(listWidget) {\n\tthis.listWidget = listWidget;\n};\n\nPopStoryView.prototype.navigateTo = function(historyInfo) {\n\tvar listElementIndex = this.listWidget.findListItem(0,historyInfo.title);\n\tif(listElementIndex === undefined) {\n\t\treturn;\n\t}\n\tvar listItemWidget = this.listWidget.children[listElementIndex],\n\t\ttargetElement = listItemWidget.findFirstDomNode();\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\treturn;\n\t}\n\t// Scroll the node into view\n\tthis.listWidget.dispatchEvent({type: \"tm-scroll\", target: targetElement});\n};\n\nPopStoryView.prototype.insert = function(widget) {\n\tvar targetElement = widget.findFirstDomNode(),\n\t\tduration = $tw.utils.getAnimationDuration();\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\treturn;\n\t}\n\t// Reset once the transition is over\n\tsetTimeout(function() {\n\t\t$tw.utils.setStyle(targetElement,[\n\t\t\t{transition: \"none\"},\n\t\t\t{transform: \"none\"}\n\t\t]);\n\t\t$tw.utils.setStyle(widget.document.body,[\n\t\t\t{\"overflow-x\": \"\"}\n\t\t]);\n\t},duration);\n\t// Prevent the page from overscrolling due to the zoom factor\n\t$tw.utils.setStyle(widget.document.body,[\n\t\t{\"overflow-x\": \"hidden\"}\n\t]);\n\t// Set up the initial position of the element\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transition: \"none\"},\n\t\t{transform: \"scale(2)\"},\n\t\t{opacity: \"0.0\"}\n\t]);\n\t$tw.utils.forceLayout(targetElement);\n\t// Transition to the final position\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"opacity \" + duration + \"ms ease-in-out\"},\n\t\t{transform: \"scale(1)\"},\n\t\t{opacity: \"1.0\"}\n\t]);\n};\n\nPopStoryView.prototype.remove = function(widget) {\n\tvar targetElement = widget.findFirstDomNode(),\n\t\tduration = $tw.utils.getAnimationDuration(),\n\t\tremoveElement = function() {\n\t\t\tif(targetElement && targetElement.parentNode) {\n\t\t\t\twidget.removeChildDomNodes();\n\t\t\t}\n\t\t};\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\tremoveElement();\n\t\treturn;\n\t}\n\t// Remove the element at the end of the transition\n\tsetTimeout(removeElement,duration);\n\t// Animate the closure\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transition: \"none\"},\n\t\t{transform: \"scale(1)\"},\n\t\t{opacity: \"1.0\"}\n\t]);\n\t$tw.utils.forceLayout(targetElement);\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"opacity \" + duration + \"ms ease-in-out\"},\n\t\t{transform: \"scale(0.1)\"},\n\t\t{opacity: \"0.0\"}\n\t]);\n};\n\nexports.pop = PopStoryView;\n\n})();\n",
"type": "application/javascript",
"module-type": "storyview"
},
"$:/core/modules/storyviews/zoomin.js": {
"title": "$:/core/modules/storyviews/zoomin.js",
"text": "/*\\\ntitle: $:/core/modules/storyviews/zoomin.js\ntype: application/javascript\nmodule-type: storyview\n\nZooms between individual tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar easing = \"cubic-bezier(0.645, 0.045, 0.355, 1)\"; // From http://easings.net/#easeInOutCubic\n\nvar ZoominListView = function(listWidget) {\n\tvar self = this;\n\tthis.listWidget = listWidget;\n\t// Get the index of the tiddler that is at the top of the history\n\tvar history = this.listWidget.wiki.getTiddlerDataCached(this.listWidget.historyTitle,[]),\n\t\ttargetTiddler;\n\tif(history.length > 0) {\n\t\ttargetTiddler = history[history.length-1].title;\n\t}\n\t// Make all the tiddlers position absolute, and hide all but the top (or first) one\n\t$tw.utils.each(this.listWidget.children,function(itemWidget,index) {\n\t\tvar domNode = itemWidget.findFirstDomNode();\n\t\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\t\tif(!(domNode instanceof Element)) {\n\t\t\treturn;\n\t\t}\n\t\tif((targetTiddler && targetTiddler !== itemWidget.parseTreeNode.itemTitle) || (!targetTiddler && index)) {\n\t\t\tdomNode.style.display = \"none\";\n\t\t} else {\n\t\t\tself.currentTiddlerDomNode = domNode;\n\t\t}\n\t\t$tw.utils.addClass(domNode,\"tc-storyview-zoomin-tiddler\");\n\t});\n};\n\nZoominListView.prototype.navigateTo = function(historyInfo) {\n\tvar duration = $tw.utils.getAnimationDuration(),\n\t\tlistElementIndex = this.listWidget.findListItem(0,historyInfo.title);\n\tif(listElementIndex === undefined) {\n\t\treturn;\n\t}\n\tvar listItemWidget = this.listWidget.children[listElementIndex],\n\t\ttargetElement = listItemWidget.findFirstDomNode();\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\treturn;\n\t}\n\t// Make the new tiddler be position absolute and visible so that we can measure it\n\t$tw.utils.addClass(targetElement,\"tc-storyview-zoomin-tiddler\");\n\t$tw.utils.setStyle(targetElement,[\n\t\t{display: \"block\"},\n\t\t{transformOrigin: \"0 0\"},\n\t\t{transform: \"translateX(0px) translateY(0px) scale(1)\"},\n\t\t{transition: \"none\"},\n\t\t{opacity: \"0.0\"}\n\t]);\n\t// Get the position of the source node, or use the centre of the window as the source position\n\tvar sourceBounds = historyInfo.fromPageRect || {\n\t\t\tleft: window.innerWidth/2 - 2,\n\t\t\ttop: window.innerHeight/2 - 2,\n\t\t\twidth: window.innerWidth/8,\n\t\t\theight: window.innerHeight/8\n\t\t};\n\t// Try to find the title node in the target tiddler\n\tvar titleDomNode = findTitleDomNode(listItemWidget) || listItemWidget.findFirstDomNode(),\n\t\tzoomBounds = titleDomNode.getBoundingClientRect();\n\t// Compute the transform for the target tiddler to make the title lie over the source rectange\n\tvar targetBounds = targetElement.getBoundingClientRect(),\n\t\tscale = sourceBounds.width / zoomBounds.width,\n\t\tx = sourceBounds.left - targetBounds.left - (zoomBounds.left - targetBounds.left) * scale,\n\t\ty = sourceBounds.top - targetBounds.top - (zoomBounds.top - targetBounds.top) * scale;\n\t// Transform the target tiddler to its starting position\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transform: \"translateX(\" + x + \"px) translateY(\" + y + \"px) scale(\" + scale + \")\"}\n\t]);\n\t// Force layout\n\t$tw.utils.forceLayout(targetElement);\n\t// Apply the ending transitions with a timeout to ensure that the previously applied transformations are applied first\n\tvar self = this,\n\t\tprevCurrentTiddler = this.currentTiddlerDomNode;\n\tthis.currentTiddlerDomNode = targetElement;\n\t// Transform the target tiddler to its natural size\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms \" + easing + \", opacity \" + duration + \"ms \" + easing},\n\t\t{opacity: \"1.0\"},\n\t\t{transform: \"translateX(0px) translateY(0px) scale(1)\"},\n\t\t{zIndex: \"500\"},\n\t]);\n\t// Transform the previous tiddler out of the way and then hide it\n\tif(prevCurrentTiddler && prevCurrentTiddler !== targetElement) {\n\t\tscale = zoomBounds.width / sourceBounds.width;\n\t\tx = zoomBounds.left - targetBounds.left - (sourceBounds.left - targetBounds.left) * scale;\n\t\ty = zoomBounds.top - targetBounds.top - (sourceBounds.top - targetBounds.top) * scale;\n\t\t$tw.utils.setStyle(prevCurrentTiddler,[\n\t\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms \" + easing + \", opacity \" + duration + \"ms \" + easing},\n\t\t\t{opacity: \"0.0\"},\n\t\t\t{transformOrigin: \"0 0\"},\n\t\t\t{transform: \"translateX(\" + x + \"px) translateY(\" + y + \"px) scale(\" + scale + \")\"},\n\t\t\t{zIndex: \"0\"}\n\t\t]);\n\t\t// Hide the tiddler when the transition has finished\n\t\tsetTimeout(function() {\n\t\t\tif(self.currentTiddlerDomNode !== prevCurrentTiddler) {\n\t\t\t\tprevCurrentTiddler.style.display = \"none\";\n\t\t\t}\n\t\t},duration);\n\t}\n\t// Scroll the target into view\n//\t$tw.pageScroller.scrollIntoView(targetElement);\n};\n\n/*\nFind the first child DOM node of a widget that has the class \"tc-title\"\n*/\nfunction findTitleDomNode(widget,targetClass) {\n\ttargetClass = targetClass || \"tc-title\";\n\tvar domNode = widget.findFirstDomNode();\n\tif(domNode && domNode.querySelector) {\n\t\treturn domNode.querySelector(\".\" + targetClass);\n\t}\n\treturn null;\n}\n\nZoominListView.prototype.insert = function(widget) {\n\tvar targetElement = widget.findFirstDomNode();\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\treturn;\n\t}\n\t// Make the newly inserted node position absolute and hidden\n\t$tw.utils.addClass(targetElement,\"tc-storyview-zoomin-tiddler\");\n\t$tw.utils.setStyle(targetElement,[\n\t\t{display: \"none\"}\n\t]);\n};\n\nZoominListView.prototype.remove = function(widget) {\n\tvar targetElement = widget.findFirstDomNode(),\n\t\tduration = $tw.utils.getAnimationDuration(),\n\t\tremoveElement = function() {\n\t\t\twidget.removeChildDomNodes();\n\t\t};\n\t// Abandon if the list entry isn't a DOM element (it might be a text node)\n\tif(!(targetElement instanceof Element)) {\n\t\tremoveElement();\n\t\treturn;\n\t}\n\t// Abandon if hidden\n\tif(targetElement.style.display != \"block\" ) {\n\t\tremoveElement();\n\t\treturn;\n\t}\n\t// Set up the tiddler that is being closed\n\t$tw.utils.addClass(targetElement,\"tc-storyview-zoomin-tiddler\");\n\t$tw.utils.setStyle(targetElement,[\n\t\t{display: \"block\"},\n\t\t{transformOrigin: \"50% 50%\"},\n\t\t{transform: \"translateX(0px) translateY(0px) scale(1)\"},\n\t\t{transition: \"none\"},\n\t\t{zIndex: \"0\"}\n\t]);\n\t// We'll move back to the previous or next element in the story\n\tvar toWidget = widget.previousSibling();\n\tif(!toWidget) {\n\t\ttoWidget = widget.nextSibling();\n\t}\n\tvar toWidgetDomNode = toWidget && toWidget.findFirstDomNode();\n\t// Set up the tiddler we're moving back in\n\tif(toWidgetDomNode) {\n\t\t$tw.utils.addClass(toWidgetDomNode,\"tc-storyview-zoomin-tiddler\");\n\t\t$tw.utils.setStyle(toWidgetDomNode,[\n\t\t\t{display: \"block\"},\n\t\t\t{transformOrigin: \"50% 50%\"},\n\t\t\t{transform: \"translateX(0px) translateY(0px) scale(10)\"},\n\t\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms \" + easing + \", opacity \" + duration + \"ms \" + easing},\n\t\t\t{opacity: \"0\"},\n\t\t\t{zIndex: \"500\"}\n\t\t]);\n\t\tthis.currentTiddlerDomNode = toWidgetDomNode;\n\t}\n\t// Animate them both\n\t// Force layout\n\t$tw.utils.forceLayout(this.listWidget.parentDomNode);\n\t// First, the tiddler we're closing\n\t$tw.utils.setStyle(targetElement,[\n\t\t{transformOrigin: \"50% 50%\"},\n\t\t{transform: \"translateX(0px) translateY(0px) scale(0.1)\"},\n\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms \" + easing + \", opacity \" + duration + \"ms \" + easing},\n\t\t{opacity: \"0\"},\n\t\t{zIndex: \"0\"}\n\t]);\n\tsetTimeout(removeElement,duration);\n\t// Now the tiddler we're going back to\n\tif(toWidgetDomNode) {\n\t\t$tw.utils.setStyle(toWidgetDomNode,[\n\t\t\t{transform: \"translateX(0px) translateY(0px) scale(1)\"},\n\t\t\t{opacity: \"1\"}\n\t\t]);\n\t}\n\treturn true; // Indicate that we'll delete the DOM node\n};\n\nexports.zoomin = ZoominListView;\n\n})();\n",
"type": "application/javascript",
"module-type": "storyview"
},
"$:/core/modules/syncer.js": {
"title": "$:/core/modules/syncer.js",
"text": "/*\\\ntitle: $:/core/modules/syncer.js\ntype: application/javascript\nmodule-type: global\n\nThe syncer tracks changes to the store and synchronises them to a remote data store represented as a \"sync adaptor\"\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nDefaults\n*/\nSyncer.prototype.titleIsLoggedIn = \"$:/status/IsLoggedIn\";\nSyncer.prototype.titleIsAnonymous = \"$:/status/IsAnonymous\";\nSyncer.prototype.titleIsReadOnly = \"$:/status/IsReadOnly\";\nSyncer.prototype.titleUserName = \"$:/status/UserName\";\nSyncer.prototype.titleSyncFilter = \"$:/config/SyncFilter\";\nSyncer.prototype.titleSyncPollingInterval = \"$:/config/SyncPollingInterval\";\nSyncer.prototype.titleSyncDisableLazyLoading = \"$:/config/SyncDisableLazyLoading\";\nSyncer.prototype.titleSavedNotification = \"$:/language/Notifications/Save/Done\";\nSyncer.prototype.titleSyncThrottleInterval = \"$:/config/SyncThrottleInterval\";\nSyncer.prototype.taskTimerInterval = 1 * 1000; // Interval for sync timer\nSyncer.prototype.throttleInterval = 1 * 1000; // Defer saving tiddlers if they've changed in the last 1s...\nSyncer.prototype.errorRetryInterval = 5 * 1000; // Interval to retry after an error\nSyncer.prototype.fallbackInterval = 10 * 1000; // Unless the task is older than 10s\nSyncer.prototype.pollTimerInterval = 60 * 1000; // Interval for polling for changes from the adaptor\n\n/*\nInstantiate the syncer with the following options:\nsyncadaptor: reference to syncadaptor to be used\nwiki: wiki to be synced\n*/\nfunction Syncer(options) {\n\tvar self = this;\n\tthis.wiki = options.wiki;\n\t// Save parameters\n\tthis.syncadaptor = options.syncadaptor;\n\tthis.disableUI = !!options.disableUI;\n\tthis.titleIsLoggedIn = options.titleIsLoggedIn || this.titleIsLoggedIn;\n\tthis.titleUserName = options.titleUserName || this.titleUserName;\n\tthis.titleSyncFilter = options.titleSyncFilter || this.titleSyncFilter;\n\tthis.titleSavedNotification = options.titleSavedNotification || this.titleSavedNotification;\n\tthis.taskTimerInterval = options.taskTimerInterval || this.taskTimerInterval;\n\tthis.throttleInterval = options.throttleInterval || parseInt(this.wiki.getTiddlerText(this.titleSyncThrottleInterval,\"\"),10) || this.throttleInterval;\n\tthis.errorRetryInterval = options.errorRetryInterval || this.errorRetryInterval;\n\tthis.fallbackInterval = options.fallbackInterval || this.fallbackInterval;\n\tthis.pollTimerInterval = options.pollTimerInterval || parseInt(this.wiki.getTiddlerText(this.titleSyncPollingInterval,\"\"),10) || this.pollTimerInterval;\n\tthis.logging = \"logging\" in options ? options.logging : true;\n\t// Make a logger\n\tthis.logger = new $tw.utils.Logger(\"syncer\" + ($tw.browser ? \"-browser\" : \"\") + ($tw.node ? \"-server\" : \"\") + (this.syncadaptor.name ? (\"-\" + this.syncadaptor.name) : \"\"),{\n\t\tcolour: \"cyan\",\n\t\tenable: this.logging,\n\t\tsaveHistory: true\n\t});\n\t// Make another logger for connection errors\n\tthis.loggerConnection = new $tw.utils.Logger(\"syncer\" + ($tw.browser ? \"-browser\" : \"\") + ($tw.node ? \"-server\" : \"\") + (this.syncadaptor.name ? (\"-\" + this.syncadaptor.name) : \"\") + \"-connection\",{\n\t\tcolour: \"cyan\",\n\t\tenable: this.logging\n\t});\n\t// Ask the syncadaptor to use the main logger\n\tif(this.syncadaptor.setLoggerSaveBuffer) {\n\t\tthis.syncadaptor.setLoggerSaveBuffer(this.logger);\n\t}\n\t// Compile the dirty tiddler filter\n\tthis.filterFn = this.wiki.compileFilter(this.wiki.getTiddlerText(this.titleSyncFilter));\n\t// Record information for known tiddlers\n\tthis.readTiddlerInfo();\n\tthis.titlesToBeLoaded = {}; // Hashmap of titles of tiddlers that need loading from the server\n\tthis.titlesHaveBeenLazyLoaded = {}; // Hashmap of titles of tiddlers that have already been lazily loaded from the server\n\t// Timers\n\tthis.taskTimerId = null; // Timer for task dispatch\n\tthis.pollTimerId = null; // Timer for polling server\n\t// Number of outstanding requests\n\tthis.numTasksInProgress = 0;\n\t// Listen out for changes to tiddlers\n\tthis.wiki.addEventListener(\"change\",function(changes) {\n\t\t// Filter the changes to just include ones that are being synced\n\t\tvar filteredChanges = self.getSyncedTiddlers(function(callback) {\n\t\t\t$tw.utils.each(changes,function(change,title) {\n\t\t\t\tvar tiddler = self.wiki.tiddlerExists(title) && self.wiki.getTiddler(title);\n\t\t\t\tcallback(tiddler,title);\n\t\t\t});\n\t\t});\n\t\tif(filteredChanges.length > 0) {\n\t\t\tself.processTaskQueue();\n\t\t} else {\n\t\t\t// Look for deletions of tiddlers we're already syncing\t\n\t\t\tvar outstandingDeletion = false\n\t\t\t$tw.utils.each(changes,function(change,title,object) {\n\t\t\t\tif(change.deleted && $tw.utils.hop(self.tiddlerInfo,title)) {\n\t\t\t\t\toutstandingDeletion = true;\n\t\t\t\t}\n\t\t\t});\n\t\t\tif(outstandingDeletion) {\n\t\t\t\tself.processTaskQueue();\n\t\t\t}\n\t\t}\n\t});\n\t// Browser event handlers\n\tif($tw.browser && !this.disableUI) {\n\t\t// Set up our beforeunload handler\n\t\t$tw.addUnloadTask(function(event) {\n\t\t\tvar confirmationMessage;\n\t\t\tif(self.isDirty()) {\n\t\t\t\tconfirmationMessage = $tw.language.getString(\"UnsavedChangesWarning\");\n\t\t\t\tevent.returnValue = confirmationMessage; // Gecko\n\t\t\t}\n\t\t\treturn confirmationMessage;\n\t\t});\n\t\t// Listen out for login/logout/refresh events in the browser\n\t\t$tw.rootWidget.addEventListener(\"tm-login\",function() {\n\t\t\tself.handleLoginEvent();\n\t\t});\n\t\t$tw.rootWidget.addEventListener(\"tm-logout\",function() {\n\t\t\tself.handleLogoutEvent();\n\t\t});\n\t\t$tw.rootWidget.addEventListener(\"tm-server-refresh\",function() {\n\t\t\tself.handleRefreshEvent();\n\t\t});\n\t\t$tw.rootWidget.addEventListener(\"tm-copy-syncer-logs-to-clipboard\",function() {\n\t\t\t$tw.utils.copyToClipboard($tw.utils.getSystemInfo() + \"\\n\\nLog:\\n\" + self.logger.getBuffer());\n\t\t});\n\t}\n\t// Listen out for lazyLoad events\n\tif(!this.disableUI && $tw.wiki.getTiddlerText(this.titleSyncDisableLazyLoading) !== \"yes\") {\n\t\tthis.wiki.addEventListener(\"lazyLoad\",function(title) {\n\t\t\tself.handleLazyLoadEvent(title);\n\t\t});\t\t\n\t}\n\t// Get the login status\n\tthis.getStatus(function(err,isLoggedIn) {\n\t\t// Do a sync from the server\n\t\tself.syncFromServer();\n\t});\n}\n\n/*\nShow a generic network error alert\n*/\nSyncer.prototype.displayError = function(msg,err) {\n\tif(err === ($tw.language.getString(\"Error/XMLHttpRequest\") + \": 0\")) {\n\t\tthis.loggerConnection.alert($tw.language.getString(\"Error/NetworkErrorAlert\"));\n\t\tthis.logger.log(msg + \":\",err);\n\t} else {\n\t\tthis.logger.alert(msg + \":\",err);\n\t}\n};\n\n/*\nReturn an array of the tiddler titles that are subjected to syncing\n*/\nSyncer.prototype.getSyncedTiddlers = function(source) {\n\treturn this.filterFn.call(this.wiki,source);\n};\n\n/*\nReturn an array of the tiddler titles that are subjected to syncing\n*/\nSyncer.prototype.getTiddlerRevision = function(title) {\n\tif(this.syncadaptor && this.syncadaptor.getTiddlerRevision) {\n\t\treturn this.syncadaptor.getTiddlerRevision(title);\n\t} else {\n\t\treturn this.wiki.getTiddler(title).fields.revision;\t\n\t} \n};\n\n/*\nRead (or re-read) the latest tiddler info from the store\n*/\nSyncer.prototype.readTiddlerInfo = function() {\n\t// Hashmap by title of {revision:,changeCount:,adaptorInfo:}\n\t// \"revision\" is the revision of the tiddler last seen on the server, and \"changecount\" is the corresponding local changecount\n\tthis.tiddlerInfo = {};\n\t// Record information for known tiddlers\n\tvar self = this,\n\t\ttiddlers = this.getSyncedTiddlers();\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar tiddler = self.wiki.tiddlerExists(title) && self.wiki.getTiddler(title);\n\t\tself.tiddlerInfo[title] = {\n\t\t\trevision: self.getTiddlerRevision(title),\n\t\t\tadaptorInfo: self.syncadaptor && self.syncadaptor.getTiddlerInfo(tiddler),\n\t\t\tchangeCount: self.wiki.getChangeCount(title)\n\t\t};\n\t});\n};\n\n/*\nChecks whether the wiki is dirty (ie the window shouldn't be closed)\n*/\nSyncer.prototype.isDirty = function() {\n\tthis.logger.log(\"Checking dirty status\");\n\t// Check tiddlers that are in the store and included in the filter function\n\tvar titles = this.getSyncedTiddlers();\n\tfor(var index=0; index<titles.length; index++) {\n\t\tvar title = titles[index],\n\t\t\ttiddlerInfo = this.tiddlerInfo[title];\n\t\tif(this.wiki.tiddlerExists(title)) {\n\t\t\tif(tiddlerInfo) {\n\t\t\t\t// If the tiddler is known on the server and has been modified locally then it needs to be saved to the server\n\t\t\t\tif($tw.wiki.getChangeCount(title) > tiddlerInfo.changeCount) {\n\t\t\t\t\treturn true;\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\t// If the tiddler isn't known on the server then it needs to be saved to the server\n\t\t\t\treturn true;\n\t\t\t}\n\t\t}\n\t}\n\t// Check tiddlers that are known from the server but not currently in the store\n\ttitles = Object.keys(this.tiddlerInfo);\n\tfor(index=0; index<titles.length; index++) {\n\t\tif(!this.wiki.tiddlerExists(titles[index])) {\n\t\t\t// There must be a pending delete\n\t\t\treturn true;\n\t\t}\n\t}\n\treturn false;\n};\n\n/*\nUpdate the document body with the class \"tc-dirty\" if the wiki has unsaved/unsynced changes\n*/\nSyncer.prototype.updateDirtyStatus = function() {\n\tif($tw.browser && !this.disableUI) {\n\t\tvar dirty = this.isDirty();\n\t\t$tw.utils.toggleClass(document.body,\"tc-dirty\",dirty);\n\t\tif(!dirty) {\n\t\t\tthis.loggerConnection.clearAlerts();\n\t\t}\n\t}\n};\n\n/*\nSave an incoming tiddler in the store, and updates the associated tiddlerInfo\n*/\nSyncer.prototype.storeTiddler = function(tiddlerFields) {\n\t// Save the tiddler\n\tvar tiddler = new $tw.Tiddler(tiddlerFields);\n\tthis.wiki.addTiddler(tiddler);\n\t// Save the tiddler revision and changeCount details\n\tthis.tiddlerInfo[tiddlerFields.title] = {\n\t\trevision: this.getTiddlerRevision(tiddlerFields.title),\n\t\tadaptorInfo: this.syncadaptor.getTiddlerInfo(tiddler),\n\t\tchangeCount: this.wiki.getChangeCount(tiddlerFields.title)\n\t};\n};\n\nSyncer.prototype.getStatus = function(callback) {\n\tvar self = this;\n\t// Check if the adaptor supports getStatus()\n\tif(this.syncadaptor && this.syncadaptor.getStatus) {\n\t\t// Mark us as not logged in\n\t\tthis.wiki.addTiddler({title: this.titleIsLoggedIn,text: \"no\"});\n\t\t// Get login status\n\t\tthis.syncadaptor.getStatus(function(err,isLoggedIn,username,isReadOnly,isAnonymous) {\n\t\t\tif(err) {\n\t\t\t\tself.logger.alert(err);\n\t\t\t} else {\n\t\t\t\t// Set the various status tiddlers\n\t\t\t\tself.wiki.addTiddler({title: self.titleIsReadOnly,text: isReadOnly ? \"yes\" : \"no\"});\n\t\t\t\tself.wiki.addTiddler({title: self.titleIsAnonymous,text: isAnonymous ? \"yes\" : \"no\"});\n\t\t\t\tself.wiki.addTiddler({title: self.titleIsLoggedIn,text: isLoggedIn ? \"yes\" : \"no\"});\n\t\t\t\tif(isLoggedIn) {\n\t\t\t\t\tself.wiki.addTiddler({title: self.titleUserName,text: username || \"\"});\n\t\t\t\t}\n\t\t\t}\n\t\t\t// Invoke the callback\n\t\t\tif(callback) {\n\t\t\t\tcallback(err,isLoggedIn,username);\n\t\t\t}\n\t\t});\n\t} else {\n\t\tcallback(null,true,\"UNAUTHENTICATED\");\n\t}\n};\n\n/*\nSynchronise from the server by reading the skinny tiddler list and queuing up loads for any tiddlers that we don't already have up to date\n*/\nSyncer.prototype.syncFromServer = function() {\n\tvar self = this,\n\t\tcancelNextSync = function() {\n\t\t\tif(self.pollTimerId) {\n\t\t\t\tclearTimeout(self.pollTimerId);\n\t\t\t\tself.pollTimerId = null;\n\t\t\t}\n\t\t},\n\t\ttriggerNextSync = function() {\n\t\t\tself.pollTimerId = setTimeout(function() {\n\t\t\t\tself.pollTimerId = null;\n\t\t\t\tself.syncFromServer.call(self);\n\t\t\t},self.pollTimerInterval);\n\t\t};\n\tif(this.syncadaptor && this.syncadaptor.getUpdatedTiddlers) {\n\t\tthis.logger.log(\"Retrieving updated tiddler list\");\n\t\tcancelNextSync();\n\t\tthis.syncadaptor.getUpdatedTiddlers(self,function(err,updates) {\n\t\t\ttriggerNextSync();\n\t\t\tif(err) {\n\t\t\t\tself.displayError($tw.language.getString(\"Error/RetrievingSkinny\"),err);\n\t\t\t\treturn;\n\t\t\t}\n\t\t\tif(updates) {\n\t\t\t\t$tw.utils.each(updates.modifications,function(title) {\n\t\t\t\t\tself.titlesToBeLoaded[title] = true;\n\t\t\t\t});\n\t\t\t\t$tw.utils.each(updates.deletions,function(title) {\n\t\t\t\t\tdelete self.tiddlerInfo[title];\n\t\t\t\t\tself.logger.log(\"Deleting tiddler missing from server:\",title);\n\t\t\t\t\tself.wiki.deleteTiddler(title);\n\t\t\t\t});\n\t\t\t\tif(updates.modifications.length > 0 || updates.deletions.length > 0) {\n\t\t\t\t\tself.processTaskQueue();\n\t\t\t\t}\t\t\t\t\n\t\t\t}\n\t\t});\n\t} else if(this.syncadaptor && this.syncadaptor.getSkinnyTiddlers) {\n\t\tthis.logger.log(\"Retrieving skinny tiddler list\");\n\t\tcancelNextSync();\n\t\tthis.syncadaptor.getSkinnyTiddlers(function(err,tiddlers) {\n\t\t\ttriggerNextSync();\n\t\t\t// Check for errors\n\t\t\tif(err) {\n\t\t\t\tself.displayError($tw.language.getString(\"Error/RetrievingSkinny\"),err);\n\t\t\t\treturn;\n\t\t\t}\n\t\t\t// Keep track of which tiddlers we already know about have been reported this time\n\t\t\tvar previousTitles = Object.keys(self.tiddlerInfo);\n\t\t\t// Process each incoming tiddler\n\t\t\tfor(var t=0; t<tiddlers.length; t++) {\n\t\t\t\t// Get the incoming tiddler fields, and the existing tiddler\n\t\t\t\tvar tiddlerFields = tiddlers[t],\n\t\t\t\t\tincomingRevision = tiddlerFields.revision + \"\",\n\t\t\t\t\ttiddler = self.wiki.tiddlerExists(tiddlerFields.title) && self.wiki.getTiddler(tiddlerFields.title),\n\t\t\t\t\ttiddlerInfo = self.tiddlerInfo[tiddlerFields.title],\n\t\t\t\t\tcurrRevision = tiddlerInfo ? tiddlerInfo.revision : null,\n\t\t\t\t\tindexInPreviousTitles = previousTitles.indexOf(tiddlerFields.title);\n\t\t\t\tif(indexInPreviousTitles !== -1) {\n\t\t\t\t\tpreviousTitles.splice(indexInPreviousTitles,1);\n\t\t\t\t}\n\t\t\t\t// Ignore the incoming tiddler if it's the same as the revision we've already got\n\t\t\t\tif(currRevision !== incomingRevision) {\n\t\t\t\t\t// Only load the skinny version if we don't already have a fat version of the tiddler\n\t\t\t\t\tif(!tiddler || tiddler.fields.text === undefined) {\n\t\t\t\t\t\tself.storeTiddler(tiddlerFields);\n\t\t\t\t\t}\n\t\t\t\t\t// Do a full load of this tiddler\n\t\t\t\t\tself.titlesToBeLoaded[tiddlerFields.title] = true;\n\t\t\t\t}\n\t\t\t}\n\t\t\t// Delete any tiddlers that were previously reported but missing this time\n\t\t\t$tw.utils.each(previousTitles,function(title) {\n\t\t\t\tdelete self.tiddlerInfo[title];\n\t\t\t\tself.logger.log(\"Deleting tiddler missing from server:\",title);\n\t\t\t\tself.wiki.deleteTiddler(title);\n\t\t\t});\n\t\t\tself.processTaskQueue();\n\t\t});\n\t}\n};\n\n/*\nForce load a tiddler from the server\n*/\nSyncer.prototype.enqueueLoadTiddler = function(title) {\n\tthis.titlesToBeLoaded[title] = true;\n\tthis.processTaskQueue();\n};\n\n/*\nLazily load a skinny tiddler if we can\n*/\nSyncer.prototype.handleLazyLoadEvent = function(title) {\n\t// Ignore if the syncadaptor doesn't handle it\n\tif(!this.syncadaptor.supportsLazyLoading) {\n\t\treturn;\n\t}\n\t// Don't lazy load the same tiddler twice\n\tif(!this.titlesHaveBeenLazyLoaded[title]) {\n\t\t// Don't lazy load if the tiddler isn't included in the sync filter\n\t\tif(this.getSyncedTiddlers().indexOf(title) !== -1) {\n\t\t\t// Mark the tiddler as needing loading, and having already been lazily loaded\n\t\t\tthis.titlesToBeLoaded[title] = true;\n\t\t\tthis.titlesHaveBeenLazyLoaded[title] = true;\n\t\t}\n\t}\n};\n\n/*\nDispay a password prompt and allow the user to login\n*/\nSyncer.prototype.handleLoginEvent = function() {\n\tvar self = this;\n\tthis.getStatus(function(err,isLoggedIn,username) {\n\t\tif(!err && !isLoggedIn) {\n\t\t\t$tw.passwordPrompt.createPrompt({\n\t\t\t\tserviceName: $tw.language.getString(\"LoginToTiddlySpace\"),\n\t\t\t\tcallback: function(data) {\n\t\t\t\t\tself.login(data.username,data.password,function(err,isLoggedIn) {\n\t\t\t\t\t\tself.syncFromServer();\n\t\t\t\t\t});\n\t\t\t\t\treturn true; // Get rid of the password prompt\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t});\n};\n\n/*\nAttempt to login to TiddlyWeb.\n\tusername: username\n\tpassword: password\n\tcallback: invoked with arguments (err,isLoggedIn)\n*/\nSyncer.prototype.login = function(username,password,callback) {\n\tthis.logger.log(\"Attempting to login as\",username);\n\tvar self = this;\n\tif(this.syncadaptor.login) {\n\t\tthis.syncadaptor.login(username,password,function(err) {\n\t\t\tif(err) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tself.getStatus(function(err,isLoggedIn,username) {\n\t\t\t\tif(callback) {\n\t\t\t\t\tcallback(err,isLoggedIn);\n\t\t\t\t}\n\t\t\t});\n\t\t});\n\t} else {\n\t\tcallback(null,true);\n\t}\n};\n\n/*\nAttempt to log out of TiddlyWeb\n*/\nSyncer.prototype.handleLogoutEvent = function() {\n\tthis.logger.log(\"Attempting to logout\");\n\tvar self = this;\n\tif(this.syncadaptor.logout) {\n\t\tthis.syncadaptor.logout(function(err) {\n\t\t\tif(err) {\n\t\t\t\tself.logger.alert(err);\n\t\t\t} else {\n\t\t\t\tself.getStatus();\n\t\t\t}\n\t\t});\n\t}\n};\n\n/*\nImmediately refresh from the server\n*/\nSyncer.prototype.handleRefreshEvent = function() {\n\tthis.syncFromServer();\n};\n\n/*\nProcess the next task\n*/\nSyncer.prototype.processTaskQueue = function() {\n\tvar self = this;\n\t// Only process a task if the sync adaptor is fully initialised and we're not already performing\n\t// a task. If we are already performing a task then we'll dispatch the next one when it completes\n\tif((!this.syncadaptor.isReady || this.syncadaptor.isReady()) && this.numTasksInProgress === 0) {\n\t\t// Choose the next task to perform\n\t\tvar task = this.chooseNextTask();\n\t\t// Perform the task if we had one\n\t\tif(typeof task === \"object\" && task !== null) {\n\t\t\tthis.numTasksInProgress += 1;\n\t\t\ttask.run(function(err) {\n\t\t\t\tself.numTasksInProgress -= 1;\n\t\t\t\tif(err) {\n\t\t\t\t\tself.displayError(\"Sync error while processing \" + task.type + \" of '\" + task.title + \"'\",err);\n\t\t\t\t\tself.updateDirtyStatus();\n\t\t\t\t\tself.triggerTimeout(self.errorRetryInterval);\n\t\t\t\t} else {\n\t\t\t\t\tself.updateDirtyStatus();\n\t\t\t\t\t// Process the next task\n\t\t\t\t\tself.processTaskQueue.call(self);\t\t\t\t\t\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\t// No task is ready so update the status\n\t\t\tthis.updateDirtyStatus();\n\t\t\t// And trigger a timeout if there is a pending task\n\t\t\tif(task === true) {\n\t\t\t\tthis.triggerTimeout();\t\t\t\t\n\t\t\t}\n\t\t}\n\t} else {\n\t\tthis.updateDirtyStatus();\t\t\n\t}\n};\n\nSyncer.prototype.triggerTimeout = function(interval) {\n\tvar self = this;\n\tif(!this.taskTimerId) {\n\t\tthis.taskTimerId = setTimeout(function() {\n\t\t\tself.taskTimerId = null;\n\t\t\tself.processTaskQueue.call(self);\n\t\t},interval || self.taskTimerInterval);\n\t}\n};\n\n/*\nChoose the next sync task. We prioritise saves, then deletes, then loads from the server\n\nReturns either a task object, null if there's no upcoming tasks, or the boolean true if there are pending tasks that aren't yet due\n*/\nSyncer.prototype.chooseNextTask = function() {\n\tvar thresholdLastSaved = (new Date()) - this.throttleInterval,\n\t\thavePending = null;\n\t// First we look for tiddlers that have been modified locally and need saving back to the server\n\tvar titles = this.getSyncedTiddlers();\n\tfor(var index=0; index<titles.length; index++) {\n\t\tvar title = titles[index],\n\t\t\ttiddler = this.wiki.tiddlerExists(title) && this.wiki.getTiddler(title),\n\t\t\ttiddlerInfo = this.tiddlerInfo[title];\n\t\tif(tiddler) {\n\t\t\t// If the tiddler is not known on the server, or has been modified locally no more recently than the threshold then it needs to be saved to the server\n\t\t\tvar hasChanged = !tiddlerInfo || $tw.wiki.getChangeCount(title) > tiddlerInfo.changeCount,\n\t\t\t\tisReadyToSave = !tiddlerInfo || !tiddlerInfo.timestampLastSaved || tiddlerInfo.timestampLastSaved < thresholdLastSaved;\n\t\t\tif(hasChanged) {\n\t\t\t\tif(isReadyToSave) {\n\t\t\t\t\treturn new SaveTiddlerTask(this,title); \t\t\t\t\t\n\t\t\t\t} else {\n\t\t\t\t\thavePending = true;\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t}\n\t// Second, we check tiddlers that are known from the server but not currently in the store, and so need deleting on the server\n\ttitles = Object.keys(this.tiddlerInfo);\n\tfor(index=0; index<titles.length; index++) {\n\t\ttitle = titles[index];\n\t\ttiddlerInfo = this.tiddlerInfo[title];\n\t\ttiddler = this.wiki.tiddlerExists(title) && this.wiki.getTiddler(title);\n\t\tif(!tiddler) {\n\t\t\treturn new DeleteTiddlerTask(this,title);\n\t\t}\n\t}\n\t// Check for tiddlers that need loading\n\ttitle = Object.keys(this.titlesToBeLoaded)[0];\n\tif(title) {\n\t\tdelete this.titlesToBeLoaded[title];\n\t\treturn new LoadTiddlerTask(this,title);\n\t}\n\t// No tasks are ready\n\treturn havePending;\n};\n\nfunction SaveTiddlerTask(syncer,title) {\n\tthis.syncer = syncer;\n\tthis.title = title;\n\tthis.type = \"save\";\n}\n\nSaveTiddlerTask.prototype.run = function(callback) {\n\tvar self = this,\n\t\tchangeCount = this.syncer.wiki.getChangeCount(this.title),\n\t\ttiddler = this.syncer.wiki.tiddlerExists(this.title) && this.syncer.wiki.getTiddler(this.title);\n\tthis.syncer.logger.log(\"Dispatching 'save' task:\",this.title);\n\tif(tiddler) {\n\t\tthis.syncer.syncadaptor.saveTiddler(tiddler,function(err,adaptorInfo,revision) {\n\t\t\t// If there's an error, exit without changing any internal state\n\t\t\tif(err) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\t// Adjust the info stored about this tiddler\n\t\t\tself.syncer.tiddlerInfo[self.title] = {\n\t\t\t\tchangeCount: changeCount,\n\t\t\t\tadaptorInfo: adaptorInfo,\n\t\t\t\trevision: revision,\n\t\t\t\ttimestampLastSaved: new Date()\n\t\t\t};\n\t\t\t// Invoke the callback\n\t\t\tcallback(null);\n\t\t});\n\t} else {\n\t\tthis.syncer.logger.log(\" Not Dispatching 'save' task:\",this.title,\"tiddler does not exist\");\n\t\t$tw.utils.nextTick(callback(null));\n\t}\n};\n\nfunction DeleteTiddlerTask(syncer,title) {\n\tthis.syncer = syncer;\n\tthis.title = title;\n\tthis.type = \"delete\";\n}\n\nDeleteTiddlerTask.prototype.run = function(callback) {\n\tvar self = this;\n\tthis.syncer.logger.log(\"Dispatching 'delete' task:\",this.title);\n\tthis.syncer.syncadaptor.deleteTiddler(this.title,function(err) {\n\t\t// If there's an error, exit without changing any internal state\n\t\tif(err) {\n\t\t\treturn callback(err);\n\t\t}\n\t\t// Remove the info stored about this tiddler\n\t\tdelete self.syncer.tiddlerInfo[self.title];\n\t\t// Invoke the callback\n\t\tcallback(null);\n\t},{\n\t\ttiddlerInfo: self.syncer.tiddlerInfo[this.title]\n\t});\n};\n\nfunction LoadTiddlerTask(syncer,title) {\n\tthis.syncer = syncer;\n\tthis.title = title;\n\tthis.type = \"load\";\n}\n\nLoadTiddlerTask.prototype.run = function(callback) {\n\tvar self = this;\n\tthis.syncer.logger.log(\"Dispatching 'load' task:\",this.title);\n\tthis.syncer.syncadaptor.loadTiddler(this.title,function(err,tiddlerFields) {\n\t\t// If there's an error, exit without changing any internal state\n\t\tif(err) {\n\t\t\treturn callback(err);\n\t\t}\n\t\t// Update the info stored about this tiddler\n\t\tif(tiddlerFields) {\n\t\t\tself.syncer.storeTiddler(tiddlerFields);\n\t\t}\n\t\t// Invoke the callback\n\t\tcallback(null);\n\t});\n};\n\nexports.Syncer = Syncer;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/tiddler.js": {
"title": "$:/core/modules/tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/tiddler.js\ntype: application/javascript\nmodule-type: tiddlermethod\n\nExtension methods for the $tw.Tiddler object (constructor and methods required at boot time are in boot/boot.js)\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.hasTag = function(tag) {\n\treturn this.fields.tags && this.fields.tags.indexOf(tag) !== -1;\n};\n\nexports.isPlugin = function() {\n\treturn this.fields.type === \"application/json\" && this.hasField(\"plugin-type\");\n};\n\nexports.isDraft = function() {\n\treturn this.hasField(\"draft.of\");\n};\n\nexports.getFieldString = function(field) {\n\tvar value = this.fields[field];\n\t// Check for a missing field\n\tif(value === undefined || value === null) {\n\t\treturn \"\";\n\t}\n\t// Parse the field with the associated module (if any)\n\tvar fieldModule = $tw.Tiddler.fieldModules[field];\n\tif(fieldModule && fieldModule.stringify) {\n\t\treturn fieldModule.stringify.call(this,value);\n\t} else {\n\t\treturn value.toString();\n\t}\n};\n\n/*\nGet the value of a field as a list\n*/\nexports.getFieldList = function(field) {\n\tvar value = this.fields[field];\n\t// Check for a missing field\n\tif(value === undefined || value === null) {\n\t\treturn [];\n\t}\n\treturn $tw.utils.parseStringArray(value);\n};\n\n/*\nGet all the fields as a hashmap of strings. Options:\n\texclude: an array of field names to exclude\n*/\nexports.getFieldStrings = function(options) {\n\toptions = options || {};\n\tvar exclude = options.exclude || [];\n\tvar fields = {};\n\tfor(var field in this.fields) {\n\t\tif($tw.utils.hop(this.fields,field)) {\n\t\t\tif(exclude.indexOf(field) === -1) {\n\t\t\t\tfields[field] = this.getFieldString(field);\n\t\t\t}\n\t\t}\n\t}\n\treturn fields;\n};\n\n/*\nGet all the fields as a name:value block. Options:\n\texclude: an array of field names to exclude\n*/\nexports.getFieldStringBlock = function(options) {\n\toptions = options || {};\n\tvar exclude = options.exclude || [],\n\t\tfields = Object.keys(this.fields).sort(),\n\t\tresult = [];\n\tfor(var t=0; t<fields.length; t++) {\n\t\tvar field = fields[t];\n\t\tif(exclude.indexOf(field) === -1) {\n\t\t\tresult.push(field + \": \" + this.getFieldString(field));\n\t\t}\n\t}\n\treturn result.join(\"\\n\");\n};\n\nexports.getFieldDay = function(field) {\n\tif(this.cache && this.cache.day && $tw.utils.hop(this.cache.day,field) ) {\n\t\treturn this.cache.day[field];\n\t}\n\tvar day = \"\";\n\tif(this.fields[field]) {\n\t\tday = (new Date($tw.utils.parseDate(this.fields[field]))).setHours(0,0,0,0);\n\t}\n\tthis.cache.day = this.cache.day || {};\n\tthis.cache.day[field] = day;\n\treturn day;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "tiddlermethod"
},
"$:/core/modules/upgraders/plugins.js": {
"title": "$:/core/modules/upgraders/plugins.js",
"text": "/*\\\ntitle: $:/core/modules/upgraders/plugins.js\ntype: application/javascript\nmodule-type: upgrader\n\nUpgrader module that checks that plugins are newer than any already installed version\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar UPGRADE_LIBRARY_TITLE = \"$:/UpgradeLibrary\";\n\nvar BLOCKED_PLUGINS = {\n\t\"$:/themes/tiddlywiki/stickytitles\": {\n\t\tversions: [\"*\"]\n\t},\n\t\"$:/plugins/tiddlywiki/fullscreen\": {\n\t\tversions: [\"*\"]\n\t}\n};\n\nexports.upgrade = function(wiki,titles,tiddlers) {\n\tvar self = this,\n\t\tmessages = {},\n\t\tupgradeLibrary,\n\t\tgetLibraryTiddler = function(title) {\n\t\t\tif(!upgradeLibrary) {\n\t\t\t\tupgradeLibrary = wiki.getTiddlerData(UPGRADE_LIBRARY_TITLE,{});\n\t\t\t\tupgradeLibrary.tiddlers = upgradeLibrary.tiddlers || {};\n\t\t\t}\n\t\t\treturn upgradeLibrary.tiddlers[title];\n\t\t};\n\n\t// Go through all the incoming tiddlers\n\t$tw.utils.each(titles,function(title) {\n\t\tvar incomingTiddler = tiddlers[title];\n\t\t// Check if we're dealing with a plugin\n\t\tif(incomingTiddler && incomingTiddler[\"plugin-type\"]) {\n\t\t\t// Check whether the plugin contains JS modules\n\t\t\tvar requiresReload = $tw.wiki.doesPluginInfoRequireReload(JSON.parse(incomingTiddler.text)) ? ($tw.wiki.getTiddlerText(\"$:/language/ControlPanel/Plugins/PluginWillRequireReload\") + \" \") : \"\";\n\t\t\tmessages[title] = requiresReload;\n\t\t\tif(incomingTiddler.version) {\n\t\t\t\t// Upgrade the incoming plugin if it is in the upgrade library\n\t\t\t\tvar libraryTiddler = getLibraryTiddler(title);\n\t\t\t\tif(libraryTiddler && libraryTiddler[\"plugin-type\"] && libraryTiddler.version) {\n\t\t\t\t\ttiddlers[title] = libraryTiddler;\n\t\t\t\t\tmessages[title] = requiresReload + $tw.language.getString(\"Import/Upgrader/Plugins/Upgraded\",{variables: {incoming: incomingTiddler.version, upgraded: libraryTiddler.version}});\n\t\t\t\t\treturn;\n\t\t\t\t}\n\t\t\t\t// Suppress the incoming plugin if it is older than the currently installed one\n\t\t\t\tvar existingTiddler = wiki.getTiddler(title);\n\t\t\t\tif(existingTiddler && existingTiddler.hasField(\"plugin-type\") && existingTiddler.hasField(\"version\")) {\n\t\t\t\t\t// Reject the incoming plugin by blanking all its fields\n\t\t\t\t\tif($tw.utils.checkVersions(existingTiddler.fields.version,incomingTiddler.version)) {\n\t\t\t\t\t\ttiddlers[title] = Object.create(null);\n\t\t\t\t\t\tmessages[title] = requiresReload + $tw.language.getString(\"Import/Upgrader/Plugins/Suppressed/Version\",{variables: {incoming: incomingTiddler.version, existing: existingTiddler.fields.version}});\n\t\t\t\t\t\treturn;\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t\t// Check whether the plugin is on the blocked list\n\t\t\tvar blockInfo = BLOCKED_PLUGINS[title];\n\t\t\tif(blockInfo) {\n\t\t\t\tif(blockInfo.versions.indexOf(\"*\") !== -1 || (incomingTiddler.version && blockInfo.versions.indexOf(incomingTiddler.version) !== -1)) {\n\t\t\t\t\ttiddlers[title] = Object.create(null);\n\t\t\t\t\tmessages[title] = $tw.language.getString(\"Import/Upgrader/Plugins/Suppressed/Incompatible\");\n\t\t\t\t\treturn;\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n\treturn messages;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "upgrader"
},
"$:/core/modules/upgraders/system.js": {
"title": "$:/core/modules/upgraders/system.js",
"text": "/*\\\ntitle: $:/core/modules/upgraders/system.js\ntype: application/javascript\nmodule-type: upgrader\n\nUpgrader module that suppresses certain system tiddlers that shouldn't be imported\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar DONT_IMPORT_LIST = [\"$:/StoryList\",\"$:/HistoryList\"],\n\tDONT_IMPORT_PREFIX_LIST = [\"$:/temp/\",\"$:/state/\",\"$:/Import\"],\n\tWARN_IMPORT_PREFIX_LIST = [\"$:/core/modules/\"];\n\nexports.upgrade = function(wiki,titles,tiddlers) {\n\tvar self = this,\n\t\tmessages = {},\n\t\tshowAlert = false;\n\t// Check for tiddlers on our list\n\t$tw.utils.each(titles,function(title) {\n\t\tif(DONT_IMPORT_LIST.indexOf(title) !== -1) {\n\t\t\ttiddlers[title] = Object.create(null);\n\t\t\tmessages[title] = $tw.language.getString(\"Import/Upgrader/System/Suppressed\");\n\t\t} else {\n\t\t\tfor(var t=0; t<DONT_IMPORT_PREFIX_LIST.length; t++) {\n\t\t\t\tvar prefix = DONT_IMPORT_PREFIX_LIST[t];\n\t\t\t\tif(title.substr(0,prefix.length) === prefix) {\n\t\t\t\t\ttiddlers[title] = Object.create(null);\n\t\t\t\t\tmessages[title] = $tw.language.getString(\"Import/Upgrader/State/Suppressed\");\n\t\t\t\t}\n\t\t\t}\n\t\t\tfor(var t=0; t<WARN_IMPORT_PREFIX_LIST.length; t++) {\n\t\t\t\tvar prefix = WARN_IMPORT_PREFIX_LIST[t];\n\t\t\t\tif(title.substr(0,prefix.length) === prefix && wiki.isShadowTiddler(title)) {\n\t\t\t\t\tshowAlert = true;\n\t\t\t\t\tmessages[title] = $tw.language.getString(\"Import/Upgrader/System/Warning\");\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n\tif(showAlert) {\n\t\tvar logger = new $tw.utils.Logger(\"import\");\n\t\tlogger.alert($tw.language.getString(\"Import/Upgrader/System/Alert\"));\n\t}\n\treturn messages;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "upgrader"
},
"$:/core/modules/upgraders/themetweaks.js": {
"title": "$:/core/modules/upgraders/themetweaks.js",
"text": "/*\\\ntitle: $:/core/modules/upgraders/themetweaks.js\ntype: application/javascript\nmodule-type: upgrader\n\nUpgrader module that handles the change in theme tweak storage introduced in 5.0.14-beta.\n\nPreviously, theme tweaks were stored in two data tiddlers:\n\n* $:/themes/tiddlywiki/vanilla/metrics\n* $:/themes/tiddlywiki/vanilla/settings\n\nNow, each tweak is stored in its own separate tiddler.\n\nThis upgrader copies any values from the old format to the new. The old data tiddlers are not deleted in case they have been used to store additional indexes.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar MAPPINGS = {\n\t\"$:/themes/tiddlywiki/vanilla/metrics\": {\n\t\t\"fontsize\": \"$:/themes/tiddlywiki/vanilla/metrics/fontsize\",\n\t\t\"lineheight\": \"$:/themes/tiddlywiki/vanilla/metrics/lineheight\",\n\t\t\"storyleft\": \"$:/themes/tiddlywiki/vanilla/metrics/storyleft\",\n\t\t\"storytop\": \"$:/themes/tiddlywiki/vanilla/metrics/storytop\",\n\t\t\"storyright\": \"$:/themes/tiddlywiki/vanilla/metrics/storyright\",\n\t\t\"storywidth\": \"$:/themes/tiddlywiki/vanilla/metrics/storywidth\",\n\t\t\"tiddlerwidth\": \"$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth\"\n\t},\n\t\"$:/themes/tiddlywiki/vanilla/settings\": {\n\t\t\"fontfamily\": \"$:/themes/tiddlywiki/vanilla/settings/fontfamily\"\n\t}\n};\n\nexports.upgrade = function(wiki,titles,tiddlers) {\n\tvar self = this,\n\t\tmessages = {};\n\t// Check for tiddlers on our list\n\t$tw.utils.each(titles,function(title) {\n\t\tvar mapping = MAPPINGS[title];\n\t\tif(mapping) {\n\t\t\tvar tiddler = new $tw.Tiddler(tiddlers[title]),\n\t\t\t\ttiddlerData = wiki.getTiddlerDataCached(tiddler,{});\n\t\t\tfor(var index in mapping) {\n\t\t\t\tvar mappedTitle = mapping[index];\n\t\t\t\tif(!tiddlers[mappedTitle] || tiddlers[mappedTitle].title !== mappedTitle) {\n\t\t\t\t\ttiddlers[mappedTitle] = {\n\t\t\t\t\t\ttitle: mappedTitle,\n\t\t\t\t\t\ttext: tiddlerData[index]\n\t\t\t\t\t};\n\t\t\t\t\tmessages[mappedTitle] = $tw.language.getString(\"Import/Upgrader/ThemeTweaks/Created\",{variables: {\n\t\t\t\t\t\tfrom: title + \"##\" + index\n\t\t\t\t\t}});\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t});\n\treturn messages;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "upgrader"
},
"$:/core/modules/utils/base64-utf8/base64-utf8.module.js": {
"text": "(function(){// From https://gist.github.com/Nijikokun/5192472\n//\n// UTF8 Module\n//\n// Cleaner and modularized utf-8 encoding and decoding library for javascript.\n//\n// copyright: MIT\n// author: Nijiko Yonskai, @nijikokun, nijikokun@gmail.com\n!function(r,e,o,t){void 0!==o.module&&o.module.exports?o.module.exports=e.apply(o):void 0!==o.define&&\"function\"===o.define&&o.define.amd?define(\"utf8\",[],e):o.utf8=e.apply(o)}(0,function(){return{encode:function(r){if(\"string\"!=typeof r)return r;r=r.replace(/\\r\\n/g,\"\\n\");for(var e,o=\"\",t=0;t<r.length;t++)(e=r.charCodeAt(t))<128?o+=String.fromCharCode(e):e>127&&e<2048?(o+=String.fromCharCode(e>>6|192),o+=String.fromCharCode(63&e|128)):(o+=String.fromCharCode(e>>12|224),o+=String.fromCharCode(e>>6&63|128),o+=String.fromCharCode(63&e|128));return o},decode:function(r){if(\"string\"!=typeof r)return r;for(var e=\"\",o=0,t=0;o<r.length;)(t=r.charCodeAt(o))<128?(e+=String.fromCharCode(t),o++):t>191&&t<224?(e+=String.fromCharCode((31&t)<<6|63&r.charCodeAt(o+1)),o+=2):(e+=String.fromCharCode((15&t)<<12|(63&r.charCodeAt(o+1))<<6|63&r.charCodeAt(o+2)),o+=3);return e}}},this),function(r,e,o,t){if(void 0!==o.module&&o.module.exports){if(t&&o.require)for(var n=0;n<t.length;n++)o[t[n]]=o.require(t[n]);o.module.exports=e.apply(o)}else void 0!==o.define&&\"function\"===o.define&&o.define.amd?define(\"base64\",t||[],e):o.base64=e.apply(o)}(0,function(r){var e=r||this.utf8,o=\"ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz0123456789+/=\";return{encode:function(r){if(void 0===e)throw{error:\"MissingMethod\",message:\"UTF8 Module is missing.\"};if(\"string\"!=typeof r)return r;r=e.encode(r);for(var t,n,i,d,f,a,h,c=\"\",u=0;u<r.length;)d=(t=r.charCodeAt(u++))>>2,f=(3&t)<<4|(n=r.charCodeAt(u++))>>4,a=(15&n)<<2|(i=r.charCodeAt(u++))>>6,h=63&i,isNaN(n)?a=h=64:isNaN(i)&&(h=64),c+=o.charAt(d)+o.charAt(f)+o.charAt(a)+o.charAt(h);return c},decode:function(r){if(void 0===e)throw{error:\"MissingMethod\",message:\"UTF8 Module is missing.\"};if(\"string\"!=typeof r)return r;r=r.replace(/[^A-Za-z0-9\\+\\/\\=]/g,\"\");for(var t,n,i,d,f,a,h=\"\",c=0;c<r.length;)t=o.indexOf(r.charAt(c++))<<2|(d=o.indexOf(r.charAt(c++)))>>4,n=(15&d)<<4|(f=o.indexOf(r.charAt(c++)))>>2,i=(3&f)<<6|(a=o.indexOf(r.charAt(c++))),h+=String.fromCharCode(t),64!=f&&(h+=String.fromCharCode(n)),64!=a&&(h+=String.fromCharCode(i));return e.decode(h)}}},this,[\"utf8\"]);}).call(exports);",
"type": "application/javascript",
"title": "$:/core/modules/utils/base64-utf8/base64-utf8.module.js",
"module-type": "library"
},
"$:/core/modules/utils/crypto.js": {
"title": "$:/core/modules/utils/crypto.js",
"text": "/*\\\ntitle: $:/core/modules/utils/crypto.js\ntype: application/javascript\nmodule-type: utils\n\nUtility functions related to crypto.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nLook for an encrypted store area in the text of a TiddlyWiki file\n*/\nexports.extractEncryptedStoreArea = function(text) {\n\tvar encryptedStoreAreaStartMarker = \"<pre id=\\\"encryptedStoreArea\\\" type=\\\"text/plain\\\" style=\\\"display:none;\\\">\",\n\t\tencryptedStoreAreaStart = text.indexOf(encryptedStoreAreaStartMarker);\n\tif(encryptedStoreAreaStart !== -1) {\n\t\tvar encryptedStoreAreaEnd = text.indexOf(\"</pre>\",encryptedStoreAreaStart);\n\t\tif(encryptedStoreAreaEnd !== -1) {\n\t\t\treturn $tw.utils.htmlDecode(text.substring(encryptedStoreAreaStart + encryptedStoreAreaStartMarker.length,encryptedStoreAreaEnd-1));\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nAttempt to extract the tiddlers from an encrypted store area using the current password. If the password is not provided then the password in the password store will be used\n*/\nexports.decryptStoreArea = function(encryptedStoreArea,password) {\n\tvar decryptedText = $tw.crypto.decrypt(encryptedStoreArea,password);\n\tif(decryptedText) {\n\t\tvar json = JSON.parse(decryptedText),\n\t\t\ttiddlers = [];\n\t\tfor(var title in json) {\n\t\t\tif(title !== \"$:/isEncrypted\") {\n\t\t\t\ttiddlers.push(json[title]);\n\t\t\t}\n\t\t}\n\t\treturn tiddlers;\n\t} else {\n\t\treturn null;\n\t}\n};\n\n\n/*\nAttempt to extract the tiddlers from an encrypted store area using the current password. If that fails, the user is prompted for a password.\nencryptedStoreArea: text of the TiddlyWiki encrypted store area\ncallback: function(tiddlers) called with the array of decrypted tiddlers\n\nThe following configuration settings are supported:\n\n$tw.config.usePasswordVault: causes any password entered by the user to also be put into the system password vault\n*/\nexports.decryptStoreAreaInteractive = function(encryptedStoreArea,callback,options) {\n\t// Try to decrypt with the current password\n\tvar tiddlers = $tw.utils.decryptStoreArea(encryptedStoreArea);\n\tif(tiddlers) {\n\t\tcallback(tiddlers);\n\t} else {\n\t\t// Prompt for a new password and keep trying\n\t\t$tw.passwordPrompt.createPrompt({\n\t\t\tserviceName: \"Enter a password to decrypt the imported TiddlyWiki\",\n\t\t\tnoUserName: true,\n\t\t\tcanCancel: true,\n\t\t\tsubmitText: \"Decrypt\",\n\t\t\tcallback: function(data) {\n\t\t\t\t// Exit if the user cancelled\n\t\t\t\tif(!data) {\n\t\t\t\t\treturn false;\n\t\t\t\t}\n\t\t\t\t// Attempt to decrypt the tiddlers\n\t\t\t\tvar tiddlers = $tw.utils.decryptStoreArea(encryptedStoreArea,data.password);\n\t\t\t\tif(tiddlers) {\n\t\t\t\t\tif($tw.config.usePasswordVault) {\n\t\t\t\t\t\t$tw.crypto.setPassword(data.password);\n\t\t\t\t\t}\n\t\t\t\t\tcallback(tiddlers);\n\t\t\t\t\t// Exit and remove the password prompt\n\t\t\t\t\treturn true;\n\t\t\t\t} else {\n\t\t\t\t\t// We didn't decrypt everything, so continue to prompt for password\n\t\t\t\t\treturn false;\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/csv.js": {
"title": "$:/core/modules/utils/csv.js",
"text": "/*\\\ntitle: $:/core/modules/utils/csv.js\ntype: application/javascript\nmodule-type: utils\n\nA barebones CSV parser\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nParse a CSV string with a header row and return an array of hashmaps.\n*/\nexports.parseCsvStringWithHeader = function(text,options) {\n\toptions = options || {};\n\tvar separator = options.separator || \",\",\n\t\trows = text.split(/\\r?\\n/mg).map(function(row) {\n\t\t\treturn $tw.utils.trim(row);\n\t\t}).filter(function(row) {\n\t\t\treturn row !== \"\";\n\t\t});\n\tif(rows.length < 1) {\n\t\treturn \"Missing header row\";\n\t}\n\tvar headings = rows[0].split(separator),\n\t\tresults = [];\n\tfor(var row=1; row<rows.length; row++) {\n\t\tvar columns = rows[row].split(separator),\n\t\t\tcolumnResult = Object.create(null);\n\t\tif(columns.length !== headings.length) {\n\t\t\treturn \"Malformed CSV row '\" + rows[row] + \"'\";\n\t\t}\n\t\tfor(var column=0; column<columns.length; column++) {\n\t\t\tvar columnName = headings[column];\n\t\t\tcolumnResult[columnName] = $tw.utils.trim(columns[column] || \"\");\n\t\t}\n\t\tresults.push(columnResult);\t\t\t\n\t}\n\treturn results;\n}\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/diff-match-patch/diff_match_patch.js": {
"text": "(function(){function diff_match_patch(){this.Diff_Timeout=1;this.Diff_EditCost=4;this.Match_Threshold=.5;this.Match_Distance=1E3;this.Patch_DeleteThreshold=.5;this.Patch_Margin=4;this.Match_MaxBits=32}var DIFF_DELETE=-1,DIFF_INSERT=1,DIFF_EQUAL=0;\ndiff_match_patch.prototype.diff_main=function(a,b,c,d){\"undefined\"==typeof d&&(d=0>=this.Diff_Timeout?Number.MAX_VALUE:(new Date).getTime()+1E3*this.Diff_Timeout);if(null==a||null==b)throw Error(\"Null input. (diff_main)\");if(a==b)return a?[[DIFF_EQUAL,a]]:[];\"undefined\"==typeof c&&(c=!0);var e=c,f=this.diff_commonPrefix(a,b);c=a.substring(0,f);a=a.substring(f);b=b.substring(f);f=this.diff_commonSuffix(a,b);var g=a.substring(a.length-f);a=a.substring(0,a.length-f);b=b.substring(0,b.length-f);a=this.diff_compute_(a,\nb,e,d);c&&a.unshift([DIFF_EQUAL,c]);g&&a.push([DIFF_EQUAL,g]);this.diff_cleanupMerge(a);return a};\ndiff_match_patch.prototype.diff_compute_=function(a,b,c,d){if(!a)return[[DIFF_INSERT,b]];if(!b)return[[DIFF_DELETE,a]];var e=a.length>b.length?a:b,f=a.length>b.length?b:a,g=e.indexOf(f);return-1!=g?(c=[[DIFF_INSERT,e.substring(0,g)],[DIFF_EQUAL,f],[DIFF_INSERT,e.substring(g+f.length)]],a.length>b.length&&(c[0][0]=c[2][0]=DIFF_DELETE),c):1==f.length?[[DIFF_DELETE,a],[DIFF_INSERT,b]]:(e=this.diff_halfMatch_(a,b))?(b=e[1],f=e[3],a=e[4],e=this.diff_main(e[0],e[2],c,d),c=this.diff_main(b,f,c,d),e.concat([[DIFF_EQUAL,\na]],c)):c&&100<a.length&&100<b.length?this.diff_lineMode_(a,b,d):this.diff_bisect_(a,b,d)};\ndiff_match_patch.prototype.diff_lineMode_=function(a,b,c){var d=this.diff_linesToChars_(a,b);a=d.chars1;b=d.chars2;d=d.lineArray;a=this.diff_main(a,b,!1,c);this.diff_charsToLines_(a,d);this.diff_cleanupSemantic(a);a.push([DIFF_EQUAL,\"\"]);for(var e=d=b=0,f=\"\",g=\"\";b<a.length;){switch(a[b][0]){case DIFF_INSERT:e++;g+=a[b][1];break;case DIFF_DELETE:d++;f+=a[b][1];break;case DIFF_EQUAL:if(1<=d&&1<=e){a.splice(b-d-e,d+e);b=b-d-e;d=this.diff_main(f,g,!1,c);for(e=d.length-1;0<=e;e--)a.splice(b,0,d[e]);b+=\nd.length}d=e=0;g=f=\"\"}b++}a.pop();return a};\ndiff_match_patch.prototype.diff_bisect_=function(a,b,c){for(var d=a.length,e=b.length,f=Math.ceil((d+e)/2),g=2*f,h=Array(g),l=Array(g),k=0;k<g;k++)h[k]=-1,l[k]=-1;h[f+1]=0;l[f+1]=0;k=d-e;for(var m=0!=k%2,p=0,x=0,w=0,q=0,t=0;t<f&&!((new Date).getTime()>c);t++){for(var v=-t+p;v<=t-x;v+=2){var n=f+v;var r=v==-t||v!=t&&h[n-1]<h[n+1]?h[n+1]:h[n-1]+1;for(var y=r-v;r<d&&y<e&&a.charAt(r)==b.charAt(y);)r++,y++;h[n]=r;if(r>d)x+=2;else if(y>e)p+=2;else if(m&&(n=f+k-v,0<=n&&n<g&&-1!=l[n])){var u=d-l[n];if(r>=\nu)return this.diff_bisectSplit_(a,b,r,y,c)}}for(v=-t+w;v<=t-q;v+=2){n=f+v;u=v==-t||v!=t&&l[n-1]<l[n+1]?l[n+1]:l[n-1]+1;for(r=u-v;u<d&&r<e&&a.charAt(d-u-1)==b.charAt(e-r-1);)u++,r++;l[n]=u;if(u>d)q+=2;else if(r>e)w+=2;else if(!m&&(n=f+k-v,0<=n&&n<g&&-1!=h[n]&&(r=h[n],y=f+r-n,u=d-u,r>=u)))return this.diff_bisectSplit_(a,b,r,y,c)}}return[[DIFF_DELETE,a],[DIFF_INSERT,b]]};\ndiff_match_patch.prototype.diff_bisectSplit_=function(a,b,c,d,e){var f=a.substring(0,c),g=b.substring(0,d);a=a.substring(c);b=b.substring(d);f=this.diff_main(f,g,!1,e);e=this.diff_main(a,b,!1,e);return f.concat(e)};\ndiff_match_patch.prototype.diff_linesToChars_=function(a,b){function c(a){for(var b=\"\",c=0,f=-1,g=d.length;f<a.length-1;){f=a.indexOf(\"\\n\",c);-1==f&&(f=a.length-1);var h=a.substring(c,f+1);c=f+1;(e.hasOwnProperty?e.hasOwnProperty(h):void 0!==e[h])?b+=String.fromCharCode(e[h]):(b+=String.fromCharCode(g),e[h]=g,d[g++]=h)}return b}var d=[],e={};d[0]=\"\";var f=c(a),g=c(b);return{chars1:f,chars2:g,lineArray:d}};\ndiff_match_patch.prototype.diff_charsToLines_=function(a,b){for(var c=0;c<a.length;c++){for(var d=a[c][1],e=[],f=0;f<d.length;f++)e[f]=b[d.charCodeAt(f)];a[c][1]=e.join(\"\")}};diff_match_patch.prototype.diff_commonPrefix=function(a,b){if(!a||!b||a.charAt(0)!=b.charAt(0))return 0;for(var c=0,d=Math.min(a.length,b.length),e=d,f=0;c<e;)a.substring(f,e)==b.substring(f,e)?f=c=e:d=e,e=Math.floor((d-c)/2+c);return e};\ndiff_match_patch.prototype.diff_commonSuffix=function(a,b){if(!a||!b||a.charAt(a.length-1)!=b.charAt(b.length-1))return 0;for(var c=0,d=Math.min(a.length,b.length),e=d,f=0;c<e;)a.substring(a.length-e,a.length-f)==b.substring(b.length-e,b.length-f)?f=c=e:d=e,e=Math.floor((d-c)/2+c);return e};\ndiff_match_patch.prototype.diff_commonOverlap_=function(a,b){var c=a.length,d=b.length;if(0==c||0==d)return 0;c>d?a=a.substring(c-d):c<d&&(b=b.substring(0,c));c=Math.min(c,d);if(a==b)return c;d=0;for(var e=1;;){var f=a.substring(c-e);f=b.indexOf(f);if(-1==f)return d;e+=f;if(0==f||a.substring(c-e)==b.substring(0,e))d=e,e++}};\ndiff_match_patch.prototype.diff_halfMatch_=function(a,b){function c(a,b,c){for(var d=a.substring(c,c+Math.floor(a.length/4)),e=-1,g=\"\",h,k,l,m;-1!=(e=b.indexOf(d,e+1));){var p=f.diff_commonPrefix(a.substring(c),b.substring(e)),u=f.diff_commonSuffix(a.substring(0,c),b.substring(0,e));g.length<u+p&&(g=b.substring(e-u,e)+b.substring(e,e+p),h=a.substring(0,c-u),k=a.substring(c+p),l=b.substring(0,e-u),m=b.substring(e+p))}return 2*g.length>=a.length?[h,k,l,m,g]:null}if(0>=this.Diff_Timeout)return null;\nvar d=a.length>b.length?a:b,e=a.length>b.length?b:a;if(4>d.length||2*e.length<d.length)return null;var f=this,g=c(d,e,Math.ceil(d.length/4));d=c(d,e,Math.ceil(d.length/2));if(g||d)g=d?g?g[4].length>d[4].length?g:d:d:g;else return null;if(a.length>b.length){d=g[0];e=g[1];var h=g[2];var l=g[3]}else h=g[0],l=g[1],d=g[2],e=g[3];return[d,e,h,l,g[4]]};\ndiff_match_patch.prototype.diff_cleanupSemantic=function(a){for(var b=!1,c=[],d=0,e=null,f=0,g=0,h=0,l=0,k=0;f<a.length;)a[f][0]==DIFF_EQUAL?(c[d++]=f,g=l,h=k,k=l=0,e=a[f][1]):(a[f][0]==DIFF_INSERT?l+=a[f][1].length:k+=a[f][1].length,e&&e.length<=Math.max(g,h)&&e.length<=Math.max(l,k)&&(a.splice(c[d-1],0,[DIFF_DELETE,e]),a[c[d-1]+1][0]=DIFF_INSERT,d--,d--,f=0<d?c[d-1]:-1,k=l=h=g=0,e=null,b=!0)),f++;b&&this.diff_cleanupMerge(a);this.diff_cleanupSemanticLossless(a);for(f=1;f<a.length;){if(a[f-1][0]==\nDIFF_DELETE&&a[f][0]==DIFF_INSERT){b=a[f-1][1];c=a[f][1];d=this.diff_commonOverlap_(b,c);e=this.diff_commonOverlap_(c,b);if(d>=e){if(d>=b.length/2||d>=c.length/2)a.splice(f,0,[DIFF_EQUAL,c.substring(0,d)]),a[f-1][1]=b.substring(0,b.length-d),a[f+1][1]=c.substring(d),f++}else if(e>=b.length/2||e>=c.length/2)a.splice(f,0,[DIFF_EQUAL,b.substring(0,e)]),a[f-1][0]=DIFF_INSERT,a[f-1][1]=c.substring(0,c.length-e),a[f+1][0]=DIFF_DELETE,a[f+1][1]=b.substring(e),f++;f++}f++}};\ndiff_match_patch.prototype.diff_cleanupSemanticLossless=function(a){function b(a,b){if(!a||!b)return 6;var c=a.charAt(a.length-1),d=b.charAt(0),e=c.match(diff_match_patch.nonAlphaNumericRegex_),f=d.match(diff_match_patch.nonAlphaNumericRegex_),g=e&&c.match(diff_match_patch.whitespaceRegex_),h=f&&d.match(diff_match_patch.whitespaceRegex_);c=g&&c.match(diff_match_patch.linebreakRegex_);d=h&&d.match(diff_match_patch.linebreakRegex_);var k=c&&a.match(diff_match_patch.blanklineEndRegex_),l=d&&b.match(diff_match_patch.blanklineStartRegex_);\nreturn k||l?5:c||d?4:e&&!g&&h?3:g||h?2:e||f?1:0}for(var c=1;c<a.length-1;){if(a[c-1][0]==DIFF_EQUAL&&a[c+1][0]==DIFF_EQUAL){var d=a[c-1][1],e=a[c][1],f=a[c+1][1],g=this.diff_commonSuffix(d,e);if(g){var h=e.substring(e.length-g);d=d.substring(0,d.length-g);e=h+e.substring(0,e.length-g);f=h+f}g=d;h=e;for(var l=f,k=b(d,e)+b(e,f);e.charAt(0)===f.charAt(0);){d+=e.charAt(0);e=e.substring(1)+f.charAt(0);f=f.substring(1);var m=b(d,e)+b(e,f);m>=k&&(k=m,g=d,h=e,l=f)}a[c-1][1]!=g&&(g?a[c-1][1]=g:(a.splice(c-\n1,1),c--),a[c][1]=h,l?a[c+1][1]=l:(a.splice(c+1,1),c--))}c++}};diff_match_patch.nonAlphaNumericRegex_=/[^a-zA-Z0-9]/;diff_match_patch.whitespaceRegex_=/\\s/;diff_match_patch.linebreakRegex_=/[\\r\\n]/;diff_match_patch.blanklineEndRegex_=/\\n\\r?\\n$/;diff_match_patch.blanklineStartRegex_=/^\\r?\\n\\r?\\n/;\ndiff_match_patch.prototype.diff_cleanupEfficiency=function(a){for(var b=!1,c=[],d=0,e=null,f=0,g=!1,h=!1,l=!1,k=!1;f<a.length;)a[f][0]==DIFF_EQUAL?(a[f][1].length<this.Diff_EditCost&&(l||k)?(c[d++]=f,g=l,h=k,e=a[f][1]):(d=0,e=null),l=k=!1):(a[f][0]==DIFF_DELETE?k=!0:l=!0,e&&(g&&h&&l&&k||e.length<this.Diff_EditCost/2&&3==g+h+l+k)&&(a.splice(c[d-1],0,[DIFF_DELETE,e]),a[c[d-1]+1][0]=DIFF_INSERT,d--,e=null,g&&h?(l=k=!0,d=0):(d--,f=0<d?c[d-1]:-1,l=k=!1),b=!0)),f++;b&&this.diff_cleanupMerge(a)};\ndiff_match_patch.prototype.diff_cleanupMerge=function(a){a.push([DIFF_EQUAL,\"\"]);for(var b=0,c=0,d=0,e=\"\",f=\"\",g;b<a.length;)switch(a[b][0]){case DIFF_INSERT:d++;f+=a[b][1];b++;break;case DIFF_DELETE:c++;e+=a[b][1];b++;break;case DIFF_EQUAL:1<c+d?(0!==c&&0!==d&&(g=this.diff_commonPrefix(f,e),0!==g&&(0<b-c-d&&a[b-c-d-1][0]==DIFF_EQUAL?a[b-c-d-1][1]+=f.substring(0,g):(a.splice(0,0,[DIFF_EQUAL,f.substring(0,g)]),b++),f=f.substring(g),e=e.substring(g)),g=this.diff_commonSuffix(f,e),0!==g&&(a[b][1]=f.substring(f.length-\ng)+a[b][1],f=f.substring(0,f.length-g),e=e.substring(0,e.length-g))),0===c?a.splice(b-d,c+d,[DIFF_INSERT,f]):0===d?a.splice(b-c,c+d,[DIFF_DELETE,e]):a.splice(b-c-d,c+d,[DIFF_DELETE,e],[DIFF_INSERT,f]),b=b-c-d+(c?1:0)+(d?1:0)+1):0!==b&&a[b-1][0]==DIFF_EQUAL?(a[b-1][1]+=a[b][1],a.splice(b,1)):b++,c=d=0,f=e=\"\"}\"\"===a[a.length-1][1]&&a.pop();c=!1;for(b=1;b<a.length-1;)a[b-1][0]==DIFF_EQUAL&&a[b+1][0]==DIFF_EQUAL&&(a[b][1].substring(a[b][1].length-a[b-1][1].length)==a[b-1][1]?(a[b][1]=a[b-1][1]+a[b][1].substring(0,\na[b][1].length-a[b-1][1].length),a[b+1][1]=a[b-1][1]+a[b+1][1],a.splice(b-1,1),c=!0):a[b][1].substring(0,a[b+1][1].length)==a[b+1][1]&&(a[b-1][1]+=a[b+1][1],a[b][1]=a[b][1].substring(a[b+1][1].length)+a[b+1][1],a.splice(b+1,1),c=!0)),b++;c&&this.diff_cleanupMerge(a)};\ndiff_match_patch.prototype.diff_xIndex=function(a,b){var c=0,d=0,e=0,f=0,g;for(g=0;g<a.length;g++){a[g][0]!==DIFF_INSERT&&(c+=a[g][1].length);a[g][0]!==DIFF_DELETE&&(d+=a[g][1].length);if(c>b)break;e=c;f=d}return a.length!=g&&a[g][0]===DIFF_DELETE?f:f+(b-e)};\ndiff_match_patch.prototype.diff_prettyHtml=function(a){for(var b=[],c=/&/g,d=/</g,e=/>/g,f=/\\n/g,g=0;g<a.length;g++){var h=a[g][0],l=a[g][1].replace(c,\"&\").replace(d,\"<\").replace(e,\">\").replace(f,\"¶<br>\");switch(h){case DIFF_INSERT:b[g]='<ins style=\"background:#e6ffe6;\">'+l+\"</ins>\";break;case DIFF_DELETE:b[g]='<del style=\"background:#ffe6e6;\">'+l+\"</del>\";break;case DIFF_EQUAL:b[g]=\"<span>\"+l+\"</span>\"}}return b.join(\"\")};\ndiff_match_patch.prototype.diff_text1=function(a){for(var b=[],c=0;c<a.length;c++)a[c][0]!==DIFF_INSERT&&(b[c]=a[c][1]);return b.join(\"\")};diff_match_patch.prototype.diff_text2=function(a){for(var b=[],c=0;c<a.length;c++)a[c][0]!==DIFF_DELETE&&(b[c]=a[c][1]);return b.join(\"\")};\ndiff_match_patch.prototype.diff_levenshtein=function(a){for(var b=0,c=0,d=0,e=0;e<a.length;e++){var f=a[e][1];switch(a[e][0]){case DIFF_INSERT:c+=f.length;break;case DIFF_DELETE:d+=f.length;break;case DIFF_EQUAL:b+=Math.max(c,d),d=c=0}}return b+=Math.max(c,d)};\ndiff_match_patch.prototype.diff_toDelta=function(a){for(var b=[],c=0;c<a.length;c++)switch(a[c][0]){case DIFF_INSERT:b[c]=\"+\"+encodeURI(a[c][1]);break;case DIFF_DELETE:b[c]=\"-\"+a[c][1].length;break;case DIFF_EQUAL:b[c]=\"=\"+a[c][1].length}return b.join(\"\\t\").replace(/%20/g,\" \")};\ndiff_match_patch.prototype.diff_fromDelta=function(a,b){for(var c=[],d=0,e=0,f=b.split(/\\t/g),g=0;g<f.length;g++){var h=f[g].substring(1);switch(f[g].charAt(0)){case \"+\":try{c[d++]=[DIFF_INSERT,decodeURI(h)]}catch(k){throw Error(\"Illegal escape in diff_fromDelta: \"+h);}break;case \"-\":case \"=\":var l=parseInt(h,10);if(isNaN(l)||0>l)throw Error(\"Invalid number in diff_fromDelta: \"+h);h=a.substring(e,e+=l);\"=\"==f[g].charAt(0)?c[d++]=[DIFF_EQUAL,h]:c[d++]=[DIFF_DELETE,h];break;default:if(f[g])throw Error(\"Invalid diff operation in diff_fromDelta: \"+\nf[g]);}}if(e!=a.length)throw Error(\"Delta length (\"+e+\") does not equal source text length (\"+a.length+\").\");return c};diff_match_patch.prototype.match_main=function(a,b,c){if(null==a||null==b||null==c)throw Error(\"Null input. (match_main)\");c=Math.max(0,Math.min(c,a.length));return a==b?0:a.length?a.substring(c,c+b.length)==b?c:this.match_bitap_(a,b,c):-1};\ndiff_match_patch.prototype.match_bitap_=function(a,b,c){function d(a,d){var e=a/b.length,g=Math.abs(c-d);return f.Match_Distance?e+g/f.Match_Distance:g?1:e}if(b.length>this.Match_MaxBits)throw Error(\"Pattern too long for this browser.\");var e=this.match_alphabet_(b),f=this,g=this.Match_Threshold,h=a.indexOf(b,c);-1!=h&&(g=Math.min(d(0,h),g),h=a.lastIndexOf(b,c+b.length),-1!=h&&(g=Math.min(d(0,h),g)));var l=1<<b.length-1;h=-1;for(var k,m,p=b.length+a.length,x,w=0;w<b.length;w++){k=0;for(m=p;k<m;)d(w,\nc+m)<=g?k=m:p=m,m=Math.floor((p-k)/2+k);p=m;k=Math.max(1,c-m+1);var q=Math.min(c+m,a.length)+b.length;m=Array(q+2);for(m[q+1]=(1<<w)-1;q>=k;q--){var t=e[a.charAt(q-1)];m[q]=0===w?(m[q+1]<<1|1)&t:(m[q+1]<<1|1)&t|(x[q+1]|x[q])<<1|1|x[q+1];if(m[q]&l&&(t=d(w,q-1),t<=g))if(g=t,h=q-1,h>c)k=Math.max(1,2*c-h);else break}if(d(w+1,c)>g)break;x=m}return h};\ndiff_match_patch.prototype.match_alphabet_=function(a){for(var b={},c=0;c<a.length;c++)b[a.charAt(c)]=0;for(c=0;c<a.length;c++)b[a.charAt(c)]|=1<<a.length-c-1;return b};\ndiff_match_patch.prototype.patch_addContext_=function(a,b){if(0!=b.length){for(var c=b.substring(a.start2,a.start2+a.length1),d=0;b.indexOf(c)!=b.lastIndexOf(c)&&c.length<this.Match_MaxBits-this.Patch_Margin-this.Patch_Margin;)d+=this.Patch_Margin,c=b.substring(a.start2-d,a.start2+a.length1+d);d+=this.Patch_Margin;(c=b.substring(a.start2-d,a.start2))&&a.diffs.unshift([DIFF_EQUAL,c]);(d=b.substring(a.start2+a.length1,a.start2+a.length1+d))&&a.diffs.push([DIFF_EQUAL,d]);a.start1-=c.length;a.start2-=\nc.length;a.length1+=c.length+d.length;a.length2+=c.length+d.length}};\ndiff_match_patch.prototype.patch_make=function(a,b,c){if(\"string\"==typeof a&&\"string\"==typeof b&&\"undefined\"==typeof c){var d=a;b=this.diff_main(d,b,!0);2<b.length&&(this.diff_cleanupSemantic(b),this.diff_cleanupEfficiency(b))}else if(a&&\"object\"==typeof a&&\"undefined\"==typeof b&&\"undefined\"==typeof c)b=a,d=this.diff_text1(b);else if(\"string\"==typeof a&&b&&\"object\"==typeof b&&\"undefined\"==typeof c)d=a;else if(\"string\"==typeof a&&\"string\"==typeof b&&c&&\"object\"==typeof c)d=a,b=c;else throw Error(\"Unknown call format to patch_make.\");\nif(0===b.length)return[];c=[];a=new diff_match_patch.patch_obj;for(var e=0,f=0,g=0,h=d,l=0;l<b.length;l++){var k=b[l][0],m=b[l][1];e||k===DIFF_EQUAL||(a.start1=f,a.start2=g);switch(k){case DIFF_INSERT:a.diffs[e++]=b[l];a.length2+=m.length;d=d.substring(0,g)+m+d.substring(g);break;case DIFF_DELETE:a.length1+=m.length;a.diffs[e++]=b[l];d=d.substring(0,g)+d.substring(g+m.length);break;case DIFF_EQUAL:m.length<=2*this.Patch_Margin&&e&&b.length!=l+1?(a.diffs[e++]=b[l],a.length1+=m.length,a.length2+=m.length):\nm.length>=2*this.Patch_Margin&&e&&(this.patch_addContext_(a,h),c.push(a),a=new diff_match_patch.patch_obj,e=0,h=d,f=g)}k!==DIFF_INSERT&&(f+=m.length);k!==DIFF_DELETE&&(g+=m.length)}e&&(this.patch_addContext_(a,h),c.push(a));return c};\ndiff_match_patch.prototype.patch_deepCopy=function(a){for(var b=[],c=0;c<a.length;c++){var d=a[c],e=new diff_match_patch.patch_obj;e.diffs=[];for(var f=0;f<d.diffs.length;f++)e.diffs[f]=d.diffs[f].slice();e.start1=d.start1;e.start2=d.start2;e.length1=d.length1;e.length2=d.length2;b[c]=e}return b};\ndiff_match_patch.prototype.patch_apply=function(a,b){if(0==a.length)return[b,[]];a=this.patch_deepCopy(a);var c=this.patch_addPadding(a);b=c+b+c;this.patch_splitMax(a);for(var d=0,e=[],f=0;f<a.length;f++){var g=a[f].start2+d,h=this.diff_text1(a[f].diffs),l=-1;if(h.length>this.Match_MaxBits){var k=this.match_main(b,h.substring(0,this.Match_MaxBits),g);-1!=k&&(l=this.match_main(b,h.substring(h.length-this.Match_MaxBits),g+h.length-this.Match_MaxBits),-1==l||k>=l)&&(k=-1)}else k=this.match_main(b,h,\ng);if(-1==k)e[f]=!1,d-=a[f].length2-a[f].length1;else if(e[f]=!0,d=k-g,g=-1==l?b.substring(k,k+h.length):b.substring(k,l+this.Match_MaxBits),h==g)b=b.substring(0,k)+this.diff_text2(a[f].diffs)+b.substring(k+h.length);else if(g=this.diff_main(h,g,!1),h.length>this.Match_MaxBits&&this.diff_levenshtein(g)/h.length>this.Patch_DeleteThreshold)e[f]=!1;else{this.diff_cleanupSemanticLossless(g);h=0;var m;for(l=0;l<a[f].diffs.length;l++){var p=a[f].diffs[l];p[0]!==DIFF_EQUAL&&(m=this.diff_xIndex(g,h));p[0]===\nDIFF_INSERT?b=b.substring(0,k+m)+p[1]+b.substring(k+m):p[0]===DIFF_DELETE&&(b=b.substring(0,k+m)+b.substring(k+this.diff_xIndex(g,h+p[1].length)));p[0]!==DIFF_DELETE&&(h+=p[1].length)}}}b=b.substring(c.length,b.length-c.length);return[b,e]};\ndiff_match_patch.prototype.patch_addPadding=function(a){for(var b=this.Patch_Margin,c=\"\",d=1;d<=b;d++)c+=String.fromCharCode(d);for(d=0;d<a.length;d++)a[d].start1+=b,a[d].start2+=b;d=a[0];var e=d.diffs;if(0==e.length||e[0][0]!=DIFF_EQUAL)e.unshift([DIFF_EQUAL,c]),d.start1-=b,d.start2-=b,d.length1+=b,d.length2+=b;else if(b>e[0][1].length){var f=b-e[0][1].length;e[0][1]=c.substring(e[0][1].length)+e[0][1];d.start1-=f;d.start2-=f;d.length1+=f;d.length2+=f}d=a[a.length-1];e=d.diffs;0==e.length||e[e.length-\n1][0]!=DIFF_EQUAL?(e.push([DIFF_EQUAL,c]),d.length1+=b,d.length2+=b):b>e[e.length-1][1].length&&(f=b-e[e.length-1][1].length,e[e.length-1][1]+=c.substring(0,f),d.length1+=f,d.length2+=f);return c};\ndiff_match_patch.prototype.patch_splitMax=function(a){for(var b=this.Match_MaxBits,c=0;c<a.length;c++)if(!(a[c].length1<=b)){var d=a[c];a.splice(c--,1);for(var e=d.start1,f=d.start2,g=\"\";0!==d.diffs.length;){var h=new diff_match_patch.patch_obj,l=!0;h.start1=e-g.length;h.start2=f-g.length;\"\"!==g&&(h.length1=h.length2=g.length,h.diffs.push([DIFF_EQUAL,g]));for(;0!==d.diffs.length&&h.length1<b-this.Patch_Margin;){g=d.diffs[0][0];var k=d.diffs[0][1];g===DIFF_INSERT?(h.length2+=k.length,f+=k.length,h.diffs.push(d.diffs.shift()),\nl=!1):g===DIFF_DELETE&&1==h.diffs.length&&h.diffs[0][0]==DIFF_EQUAL&&k.length>2*b?(h.length1+=k.length,e+=k.length,l=!1,h.diffs.push([g,k]),d.diffs.shift()):(k=k.substring(0,b-h.length1-this.Patch_Margin),h.length1+=k.length,e+=k.length,g===DIFF_EQUAL?(h.length2+=k.length,f+=k.length):l=!1,h.diffs.push([g,k]),k==d.diffs[0][1]?d.diffs.shift():d.diffs[0][1]=d.diffs[0][1].substring(k.length))}g=this.diff_text2(h.diffs);g=g.substring(g.length-this.Patch_Margin);k=this.diff_text1(d.diffs).substring(0,\nthis.Patch_Margin);\"\"!==k&&(h.length1+=k.length,h.length2+=k.length,0!==h.diffs.length&&h.diffs[h.diffs.length-1][0]===DIFF_EQUAL?h.diffs[h.diffs.length-1][1]+=k:h.diffs.push([DIFF_EQUAL,k]));l||a.splice(++c,0,h)}}};diff_match_patch.prototype.patch_toText=function(a){for(var b=[],c=0;c<a.length;c++)b[c]=a[c];return b.join(\"\")};\ndiff_match_patch.prototype.patch_fromText=function(a){var b=[];if(!a)return b;a=a.split(\"\\n\");for(var c=0,d=/^@@ -(\\d+),?(\\d*) \\+(\\d+),?(\\d*) @@$/;c<a.length;){var e=a[c].match(d);if(!e)throw Error(\"Invalid patch string: \"+a[c]);var f=new diff_match_patch.patch_obj;b.push(f);f.start1=parseInt(e[1],10);\"\"===e[2]?(f.start1--,f.length1=1):\"0\"==e[2]?f.length1=0:(f.start1--,f.length1=parseInt(e[2],10));f.start2=parseInt(e[3],10);\"\"===e[4]?(f.start2--,f.length2=1):\"0\"==e[4]?f.length2=0:(f.start2--,f.length2=\nparseInt(e[4],10));for(c++;c<a.length;){e=a[c].charAt(0);try{var g=decodeURI(a[c].substring(1))}catch(h){throw Error(\"Illegal escape in patch_fromText: \"+g);}if(\"-\"==e)f.diffs.push([DIFF_DELETE,g]);else if(\"+\"==e)f.diffs.push([DIFF_INSERT,g]);else if(\" \"==e)f.diffs.push([DIFF_EQUAL,g]);else if(\"@\"==e)break;else if(\"\"!==e)throw Error('Invalid patch mode \"'+e+'\" in: '+g);c++}}return b};diff_match_patch.patch_obj=function(){this.diffs=[];this.start2=this.start1=null;this.length2=this.length1=0};\ndiff_match_patch.patch_obj.prototype.toString=function(){for(var a=[\"@@ -\"+(0===this.length1?this.start1+\",0\":1==this.length1?this.start1+1:this.start1+1+\",\"+this.length1)+\" +\"+(0===this.length2?this.start2+\",0\":1==this.length2?this.start2+1:this.start2+1+\",\"+this.length2)+\" @@\\n\"],b,c=0;c<this.diffs.length;c++){switch(this.diffs[c][0]){case DIFF_INSERT:b=\"+\";break;case DIFF_DELETE:b=\"-\";break;case DIFF_EQUAL:b=\" \"}a[c+1]=b+encodeURI(this.diffs[c][1])+\"\\n\"}return a.join(\"\").replace(/%20/g,\" \")};\nthis.diff_match_patch=diff_match_patch;this.DIFF_DELETE=DIFF_DELETE;this.DIFF_INSERT=DIFF_INSERT;this.DIFF_EQUAL=DIFF_EQUAL;\n}).call(exports);",
"type": "application/javascript",
"title": "$:/core/modules/utils/diff-match-patch/diff_match_patch.js",
"module-type": "library"
},
"$:/core/modules/utils/dom/animations/slide.js": {
"title": "$:/core/modules/utils/dom/animations/slide.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/animations/slide.js\ntype: application/javascript\nmodule-type: animation\n\nA simple slide animation that varies the height of the element\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nfunction slideOpen(domNode,options) {\n\toptions = options || {};\n\tvar duration = options.duration || $tw.utils.getAnimationDuration();\n\t// Get the current height of the domNode\n\tvar computedStyle = window.getComputedStyle(domNode),\n\t\tcurrMarginBottom = parseInt(computedStyle.marginBottom,10),\n\t\tcurrMarginTop = parseInt(computedStyle.marginTop,10),\n\t\tcurrPaddingBottom = parseInt(computedStyle.paddingBottom,10),\n\t\tcurrPaddingTop = parseInt(computedStyle.paddingTop,10),\n\t\tcurrHeight = domNode.offsetHeight;\n\t// Reset the margin once the transition is over\n\tsetTimeout(function() {\n\t\t$tw.utils.setStyle(domNode,[\n\t\t\t{transition: \"none\"},\n\t\t\t{marginBottom: \"\"},\n\t\t\t{marginTop: \"\"},\n\t\t\t{paddingBottom: \"\"},\n\t\t\t{paddingTop: \"\"},\n\t\t\t{height: \"auto\"},\n\t\t\t{opacity: \"\"}\n\t\t]);\n\t\tif(options.callback) {\n\t\t\toptions.callback();\n\t\t}\n\t},duration);\n\t// Set up the initial position of the element\n\t$tw.utils.setStyle(domNode,[\n\t\t{transition: \"none\"},\n\t\t{marginTop: \"0px\"},\n\t\t{marginBottom: \"0px\"},\n\t\t{paddingTop: \"0px\"},\n\t\t{paddingBottom: \"0px\"},\n\t\t{height: \"0px\"},\n\t\t{opacity: \"0\"}\n\t]);\n\t$tw.utils.forceLayout(domNode);\n\t// Transition to the final position\n\t$tw.utils.setStyle(domNode,[\n\t\t{transition: \"margin-top \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"margin-bottom \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"padding-top \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"padding-bottom \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"height \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"opacity \" + duration + \"ms ease-in-out\"},\n\t\t{marginBottom: currMarginBottom + \"px\"},\n\t\t{marginTop: currMarginTop + \"px\"},\n\t\t{paddingBottom: currPaddingBottom + \"px\"},\n\t\t{paddingTop: currPaddingTop + \"px\"},\n\t\t{height: currHeight + \"px\"},\n\t\t{opacity: \"1\"}\n\t]);\n}\n\nfunction slideClosed(domNode,options) {\n\toptions = options || {};\n\tvar duration = options.duration || $tw.utils.getAnimationDuration(),\n\t\tcurrHeight = domNode.offsetHeight;\n\t// Clear the properties we've set when the animation is over\n\tsetTimeout(function() {\n\t\t$tw.utils.setStyle(domNode,[\n\t\t\t{transition: \"none\"},\n\t\t\t{marginBottom: \"\"},\n\t\t\t{marginTop: \"\"},\n\t\t\t{paddingBottom: \"\"},\n\t\t\t{paddingTop: \"\"},\n\t\t\t{height: \"auto\"},\n\t\t\t{opacity: \"\"}\n\t\t]);\n\t\tif(options.callback) {\n\t\t\toptions.callback();\n\t\t}\n\t},duration);\n\t// Set up the initial position of the element\n\t$tw.utils.setStyle(domNode,[\n\t\t{height: currHeight + \"px\"},\n\t\t{opacity: \"1\"}\n\t]);\n\t$tw.utils.forceLayout(domNode);\n\t// Transition to the final position\n\t$tw.utils.setStyle(domNode,[\n\t\t{transition: \"margin-top \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"margin-bottom \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"padding-top \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"padding-bottom \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"height \" + duration + \"ms ease-in-out, \" +\n\t\t\t\t\t\"opacity \" + duration + \"ms ease-in-out\"},\n\t\t{marginTop: \"0px\"},\n\t\t{marginBottom: \"0px\"},\n\t\t{paddingTop: \"0px\"},\n\t\t{paddingBottom: \"0px\"},\n\t\t{height: \"0px\"},\n\t\t{opacity: \"0\"}\n\t]);\n}\n\nexports.slide = {\n\topen: slideOpen,\n\tclose: slideClosed\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "animation"
},
"$:/core/modules/utils/dom/animator.js": {
"title": "$:/core/modules/utils/dom/animator.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/animator.js\ntype: application/javascript\nmodule-type: utils\n\nOrchestrates animations and transitions\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nfunction Animator() {\n\t// Get the registered animation modules\n\tthis.animations = {};\n\t$tw.modules.applyMethods(\"animation\",this.animations);\n}\n\nAnimator.prototype.perform = function(type,domNode,options) {\n\toptions = options || {};\n\t// Find an animation that can handle this type\n\tvar chosenAnimation;\n\t$tw.utils.each(this.animations,function(animation,name) {\n\t\tif($tw.utils.hop(animation,type)) {\n\t\t\tchosenAnimation = animation[type];\n\t\t}\n\t});\n\tif(!chosenAnimation) {\n\t\tchosenAnimation = function(domNode,options) {\n\t\t\tif(options.callback) {\n\t\t\t\toptions.callback();\n\t\t\t}\n\t\t};\n\t}\n\t// Call the animation\n\tchosenAnimation(domNode,options);\n};\n\nexports.Animator = Animator;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/browser.js": {
"title": "$:/core/modules/utils/dom/browser.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/browser.js\ntype: application/javascript\nmodule-type: utils\n\nBrowser feature detection\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nSet style properties of an element\n\telement: dom node\n\tstyles: ordered array of {name: value} pairs\n*/\nexports.setStyle = function(element,styles) {\n\tif(element.nodeType === 1) { // Element.ELEMENT_NODE\n\t\tfor(var t=0; t<styles.length; t++) {\n\t\t\tfor(var styleName in styles[t]) {\n\t\t\t\telement.style[$tw.utils.convertStyleNameToPropertyName(styleName)] = styles[t][styleName];\n\t\t\t}\n\t\t}\n\t}\n};\n\n/*\nConverts a standard CSS property name into the local browser-specific equivalent. For example:\n\t\"background-color\" --> \"backgroundColor\"\n\t\"transition\" --> \"webkitTransition\"\n*/\n\nvar styleNameCache = {}; // We'll cache the style name conversions\n\nexports.convertStyleNameToPropertyName = function(styleName) {\n\t// Return from the cache if we can\n\tif(styleNameCache[styleName]) {\n\t\treturn styleNameCache[styleName];\n\t}\n\t// Convert it by first removing any hyphens\n\tvar propertyName = $tw.utils.unHyphenateCss(styleName);\n\t// Then check if it needs a prefix\n\tif($tw.browser && document.body.style[propertyName] === undefined) {\n\t\tvar prefixes = [\"O\",\"MS\",\"Moz\",\"webkit\"];\n\t\tfor(var t=0; t<prefixes.length; t++) {\n\t\t\tvar prefixedName = prefixes[t] + propertyName.substr(0,1).toUpperCase() + propertyName.substr(1);\n\t\t\tif(document.body.style[prefixedName] !== undefined) {\n\t\t\t\tpropertyName = prefixedName;\n\t\t\t\tbreak;\n\t\t\t}\n\t\t}\n\t}\n\t// Put it in the cache too\n\tstyleNameCache[styleName] = propertyName;\n\treturn propertyName;\n};\n\n/*\nConverts a JS format CSS property name back into the dashed form used in CSS declarations. For example:\n\t\"backgroundColor\" --> \"background-color\"\n\t\"webkitTransform\" --> \"-webkit-transform\"\n*/\nexports.convertPropertyNameToStyleName = function(propertyName) {\n\t// Rehyphenate the name\n\tvar styleName = $tw.utils.hyphenateCss(propertyName);\n\t// If there's a webkit prefix, add a dash (other browsers have uppercase prefixes, and so get the dash automatically)\n\tif(styleName.indexOf(\"webkit\") === 0) {\n\t\tstyleName = \"-\" + styleName;\n\t} else if(styleName.indexOf(\"-m-s\") === 0) {\n\t\tstyleName = \"-ms\" + styleName.substr(4);\n\t}\n\treturn styleName;\n};\n\n/*\nRound trip a stylename to a property name and back again. For example:\n\t\"transform\" --> \"webkitTransform\" --> \"-webkit-transform\"\n*/\nexports.roundTripPropertyName = function(propertyName) {\n\treturn $tw.utils.convertPropertyNameToStyleName($tw.utils.convertStyleNameToPropertyName(propertyName));\n};\n\n/*\nConverts a standard event name into the local browser specific equivalent. For example:\n\t\"animationEnd\" --> \"webkitAnimationEnd\"\n*/\n\nvar eventNameCache = {}; // We'll cache the conversions\n\nvar eventNameMappings = {\n\t\"transitionEnd\": {\n\t\tcorrespondingCssProperty: \"transition\",\n\t\tmappings: {\n\t\t\ttransition: \"transitionend\",\n\t\t\tOTransition: \"oTransitionEnd\",\n\t\t\tMSTransition: \"msTransitionEnd\",\n\t\t\tMozTransition: \"transitionend\",\n\t\t\twebkitTransition: \"webkitTransitionEnd\"\n\t\t}\n\t},\n\t\"animationEnd\": {\n\t\tcorrespondingCssProperty: \"animation\",\n\t\tmappings: {\n\t\t\tanimation: \"animationend\",\n\t\t\tOAnimation: \"oAnimationEnd\",\n\t\t\tMSAnimation: \"msAnimationEnd\",\n\t\t\tMozAnimation: \"animationend\",\n\t\t\twebkitAnimation: \"webkitAnimationEnd\"\n\t\t}\n\t}\n};\n\nexports.convertEventName = function(eventName) {\n\tif(eventNameCache[eventName]) {\n\t\treturn eventNameCache[eventName];\n\t}\n\tvar newEventName = eventName,\n\t\tmappings = eventNameMappings[eventName];\n\tif(mappings) {\n\t\tvar convertedProperty = $tw.utils.convertStyleNameToPropertyName(mappings.correspondingCssProperty);\n\t\tif(mappings.mappings[convertedProperty]) {\n\t\t\tnewEventName = mappings.mappings[convertedProperty];\n\t\t}\n\t}\n\t// Put it in the cache too\n\teventNameCache[eventName] = newEventName;\n\treturn newEventName;\n};\n\n/*\nReturn the names of the fullscreen APIs\n*/\nexports.getFullScreenApis = function() {\n\tvar d = document,\n\t\tdb = d.body,\n\t\tresult = {\n\t\t\"_requestFullscreen\": db.webkitRequestFullscreen !== undefined ? \"webkitRequestFullscreen\" :\n\t\t\t\t\t\t\tdb.mozRequestFullScreen !== undefined ? \"mozRequestFullScreen\" :\n\t\t\t\t\t\t\tdb.msRequestFullscreen !== undefined ? \"msRequestFullscreen\" :\n\t\t\t\t\t\t\tdb.requestFullscreen !== undefined ? \"requestFullscreen\" : \"\",\n\t\t\"_exitFullscreen\": d.webkitExitFullscreen !== undefined ? \"webkitExitFullscreen\" :\n\t\t\t\t\t\t\td.mozCancelFullScreen !== undefined ? \"mozCancelFullScreen\" :\n\t\t\t\t\t\t\td.msExitFullscreen !== undefined ? \"msExitFullscreen\" :\n\t\t\t\t\t\t\td.exitFullscreen !== undefined ? \"exitFullscreen\" : \"\",\n\t\t\"_fullscreenElement\": d.webkitFullscreenElement !== undefined ? \"webkitFullscreenElement\" :\n\t\t\t\t\t\t\td.mozFullScreenElement !== undefined ? \"mozFullScreenElement\" :\n\t\t\t\t\t\t\td.msFullscreenElement !== undefined ? \"msFullscreenElement\" :\n\t\t\t\t\t\t\td.fullscreenElement !== undefined ? \"fullscreenElement\" : \"\",\n\t\t\"_fullscreenChange\": d.webkitFullscreenElement !== undefined ? \"webkitfullscreenchange\" :\n\t\t\t\t\t\t\td.mozFullScreenElement !== undefined ? \"mozfullscreenchange\" :\n\t\t\t\t\t\t\td.msFullscreenElement !== undefined ? \"MSFullscreenChange\" :\n\t\t\t\t\t\t\td.fullscreenElement !== undefined ? \"fullscreenchange\" : \"\"\n\t};\n\tif(!result._requestFullscreen || !result._exitFullscreen || !result._fullscreenElement || !result._fullscreenChange) {\n\t\treturn null;\n\t} else {\n\t\treturn result;\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/csscolorparser.js": {
"title": "$:/core/modules/utils/dom/csscolorparser.js",
"text": "// (c) Dean McNamee <dean@gmail.com>, 2012.\n//\n// https://github.com/deanm/css-color-parser-js\n//\n// Permission is hereby granted, free of charge, to any person obtaining a copy\n// of this software and associated documentation files (the \"Software\"), to\n// deal in the Software without restriction, including without limitation the\n// rights to use, copy, modify, merge, publish, distribute, sublicense, and/or\n// sell copies of the Software, and to permit persons to whom the Software is\n// furnished to do so, subject to the following conditions:\n//\n// The above copyright notice and this permission notice shall be included in\n// all copies or substantial portions of the Software.\n//\n// THE SOFTWARE IS PROVIDED \"AS IS\", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR\n// IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,\n// FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE\n// AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER\n// LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING\n// FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS\n// IN THE SOFTWARE.\n\n// http://www.w3.org/TR/css3-color/\nvar kCSSColorTable = {\n \"transparent\": [0,0,0,0], \"aliceblue\": [240,248,255,1],\n \"antiquewhite\": [250,235,215,1], \"aqua\": [0,255,255,1],\n \"aquamarine\": [127,255,212,1], \"azure\": [240,255,255,1],\n \"beige\": [245,245,220,1], \"bisque\": [255,228,196,1],\n \"black\": [0,0,0,1], \"blanchedalmond\": [255,235,205,1],\n \"blue\": [0,0,255,1], \"blueviolet\": [138,43,226,1],\n \"brown\": [165,42,42,1], \"burlywood\": [222,184,135,1],\n \"cadetblue\": [95,158,160,1], \"chartreuse\": [127,255,0,1],\n \"chocolate\": [210,105,30,1], \"coral\": [255,127,80,1],\n \"cornflowerblue\": [100,149,237,1], \"cornsilk\": [255,248,220,1],\n \"crimson\": [220,20,60,1], \"cyan\": [0,255,255,1],\n \"darkblue\": [0,0,139,1], \"darkcyan\": [0,139,139,1],\n \"darkgoldenrod\": [184,134,11,1], \"darkgray\": [169,169,169,1],\n \"darkgreen\": [0,100,0,1], \"darkgrey\": [169,169,169,1],\n \"darkkhaki\": [189,183,107,1], \"darkmagenta\": [139,0,139,1],\n \"darkolivegreen\": [85,107,47,1], \"darkorange\": [255,140,0,1],\n \"darkorchid\": [153,50,204,1], \"darkred\": [139,0,0,1],\n \"darksalmon\": [233,150,122,1], \"darkseagreen\": [143,188,143,1],\n \"darkslateblue\": [72,61,139,1], \"darkslategray\": [47,79,79,1],\n \"darkslategrey\": [47,79,79,1], \"darkturquoise\": [0,206,209,1],\n \"darkviolet\": [148,0,211,1], \"deeppink\": [255,20,147,1],\n \"deepskyblue\": [0,191,255,1], \"dimgray\": [105,105,105,1],\n \"dimgrey\": [105,105,105,1], \"dodgerblue\": [30,144,255,1],\n \"firebrick\": [178,34,34,1], \"floralwhite\": [255,250,240,1],\n \"forestgreen\": [34,139,34,1], \"fuchsia\": [255,0,255,1],\n \"gainsboro\": [220,220,220,1], \"ghostwhite\": [248,248,255,1],\n \"gold\": [255,215,0,1], \"goldenrod\": [218,165,32,1],\n \"gray\": [128,128,128,1], \"green\": [0,128,0,1],\n \"greenyellow\": [173,255,47,1], \"grey\": [128,128,128,1],\n \"honeydew\": [240,255,240,1], \"hotpink\": [255,105,180,1],\n \"indianred\": [205,92,92,1], \"indigo\": [75,0,130,1],\n \"ivory\": [255,255,240,1], \"khaki\": [240,230,140,1],\n \"lavender\": [230,230,250,1], \"lavenderblush\": [255,240,245,1],\n \"lawngreen\": [124,252,0,1], \"lemonchiffon\": [255,250,205,1],\n \"lightblue\": [173,216,230,1], \"lightcoral\": [240,128,128,1],\n \"lightcyan\": [224,255,255,1], \"lightgoldenrodyellow\": [250,250,210,1],\n \"lightgray\": [211,211,211,1], \"lightgreen\": [144,238,144,1],\n \"lightgrey\": [211,211,211,1], \"lightpink\": [255,182,193,1],\n \"lightsalmon\": [255,160,122,1], \"lightseagreen\": [32,178,170,1],\n \"lightskyblue\": [135,206,250,1], \"lightslategray\": [119,136,153,1],\n \"lightslategrey\": [119,136,153,1], \"lightsteelblue\": [176,196,222,1],\n \"lightyellow\": [255,255,224,1], \"lime\": [0,255,0,1],\n \"limegreen\": [50,205,50,1], \"linen\": [250,240,230,1],\n \"magenta\": [255,0,255,1], \"maroon\": [128,0,0,1],\n \"mediumaquamarine\": [102,205,170,1], \"mediumblue\": [0,0,205,1],\n \"mediumorchid\": [186,85,211,1], \"mediumpurple\": [147,112,219,1],\n \"mediumseagreen\": [60,179,113,1], \"mediumslateblue\": [123,104,238,1],\n \"mediumspringgreen\": [0,250,154,1], \"mediumturquoise\": [72,209,204,1],\n \"mediumvioletred\": [199,21,133,1], \"midnightblue\": [25,25,112,1],\n \"mintcream\": [245,255,250,1], \"mistyrose\": [255,228,225,1],\n \"moccasin\": [255,228,181,1], \"navajowhite\": [255,222,173,1],\n \"navy\": [0,0,128,1], \"oldlace\": [253,245,230,1],\n \"olive\": [128,128,0,1], \"olivedrab\": [107,142,35,1],\n \"orange\": [255,165,0,1], \"orangered\": [255,69,0,1],\n \"orchid\": [218,112,214,1], \"palegoldenrod\": [238,232,170,1],\n \"palegreen\": [152,251,152,1], \"paleturquoise\": [175,238,238,1],\n \"palevioletred\": [219,112,147,1], \"papayawhip\": [255,239,213,1],\n \"peachpuff\": [255,218,185,1], \"peru\": [205,133,63,1],\n \"pink\": [255,192,203,1], \"plum\": [221,160,221,1],\n \"powderblue\": [176,224,230,1], \"purple\": [128,0,128,1],\n \"red\": [255,0,0,1], \"rosybrown\": [188,143,143,1],\n \"royalblue\": [65,105,225,1], \"saddlebrown\": [139,69,19,1],\n \"salmon\": [250,128,114,1], \"sandybrown\": [244,164,96,1],\n \"seagreen\": [46,139,87,1], \"seashell\": [255,245,238,1],\n \"sienna\": [160,82,45,1], \"silver\": [192,192,192,1],\n \"skyblue\": [135,206,235,1], \"slateblue\": [106,90,205,1],\n \"slategray\": [112,128,144,1], \"slategrey\": [112,128,144,1],\n \"snow\": [255,250,250,1], \"springgreen\": [0,255,127,1],\n \"steelblue\": [70,130,180,1], \"tan\": [210,180,140,1],\n \"teal\": [0,128,128,1], \"thistle\": [216,191,216,1],\n \"tomato\": [255,99,71,1], \"turquoise\": [64,224,208,1],\n \"violet\": [238,130,238,1], \"wheat\": [245,222,179,1],\n \"white\": [255,255,255,1], \"whitesmoke\": [245,245,245,1],\n \"yellow\": [255,255,0,1], \"yellowgreen\": [154,205,50,1]}\n\nfunction clamp_css_byte(i) { // Clamp to integer 0 .. 255.\n i = Math.round(i); // Seems to be what Chrome does (vs truncation).\n return i < 0 ? 0 : i > 255 ? 255 : i;\n}\n\nfunction clamp_css_float(f) { // Clamp to float 0.0 .. 1.0.\n return f < 0 ? 0 : f > 1 ? 1 : f;\n}\n\nfunction parse_css_int(str) { // int or percentage.\n if (str[str.length - 1] === '%')\n return clamp_css_byte(parseFloat(str) / 100 * 255);\n return clamp_css_byte(parseInt(str));\n}\n\nfunction parse_css_float(str) { // float or percentage.\n if (str[str.length - 1] === '%')\n return clamp_css_float(parseFloat(str) / 100);\n return clamp_css_float(parseFloat(str));\n}\n\nfunction css_hue_to_rgb(m1, m2, h) {\n if (h < 0) h += 1;\n else if (h > 1) h -= 1;\n\n if (h * 6 < 1) return m1 + (m2 - m1) * h * 6;\n if (h * 2 < 1) return m2;\n if (h * 3 < 2) return m1 + (m2 - m1) * (2/3 - h) * 6;\n return m1;\n}\n\nfunction parseCSSColor(css_str) {\n // Remove all whitespace, not compliant, but should just be more accepting.\n var str = css_str.replace(/ /g, '').toLowerCase();\n\n // Color keywords (and transparent) lookup.\n if (str in kCSSColorTable) return kCSSColorTable[str].slice(); // dup.\n\n // #abc and #abc123 syntax.\n if (str[0] === '#') {\n if (str.length === 4) {\n var iv = parseInt(str.substr(1), 16); // TODO(deanm): Stricter parsing.\n if (!(iv >= 0 && iv <= 0xfff)) return null; // Covers NaN.\n return [((iv & 0xf00) >> 4) | ((iv & 0xf00) >> 8),\n (iv & 0xf0) | ((iv & 0xf0) >> 4),\n (iv & 0xf) | ((iv & 0xf) << 4),\n 1];\n } else if (str.length === 7) {\n var iv = parseInt(str.substr(1), 16); // TODO(deanm): Stricter parsing.\n if (!(iv >= 0 && iv <= 0xffffff)) return null; // Covers NaN.\n return [(iv & 0xff0000) >> 16,\n (iv & 0xff00) >> 8,\n iv & 0xff,\n 1];\n }\n\n return null;\n }\n\n var op = str.indexOf('('), ep = str.indexOf(')');\n if (op !== -1 && ep + 1 === str.length) {\n var fname = str.substr(0, op);\n var params = str.substr(op+1, ep-(op+1)).split(',');\n var alpha = 1; // To allow case fallthrough.\n switch (fname) {\n case 'rgba':\n if (params.length !== 4) return null;\n alpha = parse_css_float(params.pop());\n // Fall through.\n case 'rgb':\n if (params.length !== 3) return null;\n return [parse_css_int(params[0]),\n parse_css_int(params[1]),\n parse_css_int(params[2]),\n alpha];\n case 'hsla':\n if (params.length !== 4) return null;\n alpha = parse_css_float(params.pop());\n // Fall through.\n case 'hsl':\n if (params.length !== 3) return null;\n var h = (((parseFloat(params[0]) % 360) + 360) % 360) / 360; // 0 .. 1\n // NOTE(deanm): According to the CSS spec s/l should only be\n // percentages, but we don't bother and let float or percentage.\n var s = parse_css_float(params[1]);\n var l = parse_css_float(params[2]);\n var m2 = l <= 0.5 ? l * (s + 1) : l + s - l * s;\n var m1 = l * 2 - m2;\n return [clamp_css_byte(css_hue_to_rgb(m1, m2, h+1/3) * 255),\n clamp_css_byte(css_hue_to_rgb(m1, m2, h) * 255),\n clamp_css_byte(css_hue_to_rgb(m1, m2, h-1/3) * 255),\n alpha];\n default:\n return null;\n }\n }\n\n return null;\n}\n\ntry { exports.parseCSSColor = parseCSSColor } catch(e) { }\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom.js": {
"title": "$:/core/modules/utils/dom.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom.js\ntype: application/javascript\nmodule-type: utils\n\nVarious static DOM-related utility functions.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nDetermines whether element 'a' contains element 'b'\nCode thanks to John Resig, http://ejohn.org/blog/comparing-document-position/\n*/\nexports.domContains = function(a,b) {\n\treturn a.contains ?\n\t\ta !== b && a.contains(b) :\n\t\t!!(a.compareDocumentPosition(b) & 16);\n};\n\nexports.removeChildren = function(node) {\n\twhile(node.hasChildNodes()) {\n\t\tnode.removeChild(node.firstChild);\n\t}\n};\n\nexports.hasClass = function(el,className) {\n\treturn el && el.className && el.className.toString().split(\" \").indexOf(className) !== -1;\n};\n\nexports.addClass = function(el,className) {\n\tvar c = el.className.split(\" \");\n\tif(c.indexOf(className) === -1) {\n\t\tc.push(className);\n\t\tel.className = c.join(\" \");\n\t}\n};\n\nexports.removeClass = function(el,className) {\n\tvar c = el.className.split(\" \"),\n\t\tp = c.indexOf(className);\n\tif(p !== -1) {\n\t\tc.splice(p,1);\n\t\tel.className = c.join(\" \");\n\t}\n};\n\nexports.toggleClass = function(el,className,status) {\n\tif(status === undefined) {\n\t\tstatus = !exports.hasClass(el,className);\n\t}\n\tif(status) {\n\t\texports.addClass(el,className);\n\t} else {\n\t\texports.removeClass(el,className);\n\t}\n};\n\n/*\nGet the first parent element that has scrollbars or use the body as fallback.\n*/\nexports.getScrollContainer = function(el) {\n\tvar doc = el.ownerDocument;\n\twhile(el.parentNode) {\t\n\t\tel = el.parentNode;\n\t\tif(el.scrollTop) {\n\t\t\treturn el;\n\t\t}\n\t}\n\treturn doc.body;\n};\n\n/*\nGet the scroll position of the viewport\nReturns:\n\t{\n\t\tx: horizontal scroll position in pixels,\n\t\ty: vertical scroll position in pixels\n\t}\n*/\nexports.getScrollPosition = function(srcWindow) {\n\tvar scrollWindow = srcWindow || window;\n\tif(\"scrollX\" in scrollWindow) {\n\t\treturn {x: scrollWindow.scrollX, y: scrollWindow.scrollY};\n\t} else {\n\t\treturn {x: scrollWindow.document.documentElement.scrollLeft, y: scrollWindow.document.documentElement.scrollTop};\n\t}\n};\n\n/*\nAdjust the height of a textarea to fit its content, preserving scroll position, and return the height\n*/\nexports.resizeTextAreaToFit = function(domNode,minHeight) {\n\t// Get the scroll container and register the current scroll position\n\tvar container = $tw.utils.getScrollContainer(domNode),\n\t\tscrollTop = container.scrollTop;\n // Measure the specified minimum height\n\tdomNode.style.height = minHeight;\n\tvar measuredHeight = domNode.offsetHeight || parseInt(minHeight,10);\n\t// Set its height to auto so that it snaps to the correct height\n\tdomNode.style.height = \"auto\";\n\t// Calculate the revised height\n\tvar newHeight = Math.max(domNode.scrollHeight + domNode.offsetHeight - domNode.clientHeight,measuredHeight);\n\t// Only try to change the height if it has changed\n\tif(newHeight !== domNode.offsetHeight) {\n\t\tdomNode.style.height = newHeight + \"px\";\n\t\t// Make sure that the dimensions of the textarea are recalculated\n\t\t$tw.utils.forceLayout(domNode);\n\t\t// Set the container to the position we registered at the beginning\n\t\tcontainer.scrollTop = scrollTop;\n\t}\n\treturn newHeight;\n};\n\n/*\nGets the bounding rectangle of an element in absolute page coordinates\n*/\nexports.getBoundingPageRect = function(element) {\n\tvar scrollPos = $tw.utils.getScrollPosition(element.ownerDocument.defaultView),\n\t\tclientRect = element.getBoundingClientRect();\n\treturn {\n\t\tleft: clientRect.left + scrollPos.x,\n\t\twidth: clientRect.width,\n\t\tright: clientRect.right + scrollPos.x,\n\t\ttop: clientRect.top + scrollPos.y,\n\t\theight: clientRect.height,\n\t\tbottom: clientRect.bottom + scrollPos.y\n\t};\n};\n\n/*\nSaves a named password in the browser\n*/\nexports.savePassword = function(name,password) {\n\tvar done = false;\n\ttry {\n\t\twindow.localStorage.setItem(\"tw5-password-\" + name,password);\n\t\tdone = true;\n\t} catch(e) {\n\t}\n\tif(!done) {\n\t\t$tw.savedPasswords = $tw.savedPasswords || Object.create(null);\n\t\t$tw.savedPasswords[name] = password;\n\t}\n};\n\n/*\nRetrieve a named password from the browser\n*/\nexports.getPassword = function(name) {\n\tvar value;\n\ttry {\n\t\tvalue = window.localStorage.getItem(\"tw5-password-\" + name);\n\t} catch(e) {\n\t}\n\tif(value !== undefined) {\n\t\treturn value;\n\t} else {\n\t\treturn ($tw.savedPasswords || Object.create(null))[name] || \"\";\n\t}\n};\n\n/*\nForce layout of a dom node and its descendents\n*/\nexports.forceLayout = function(element) {\n\tvar dummy = element.offsetWidth;\n};\n\n/*\nPulse an element for debugging purposes\n*/\nexports.pulseElement = function(element) {\n\t// Event handler to remove the class at the end\n\telement.addEventListener($tw.browser.animationEnd,function handler(event) {\n\t\telement.removeEventListener($tw.browser.animationEnd,handler,false);\n\t\t$tw.utils.removeClass(element,\"pulse\");\n\t},false);\n\t// Apply the pulse class\n\t$tw.utils.removeClass(element,\"pulse\");\n\t$tw.utils.forceLayout(element);\n\t$tw.utils.addClass(element,\"pulse\");\n};\n\n/*\nAttach specified event handlers to a DOM node\ndomNode: where to attach the event handlers\nevents: array of event handlers to be added (see below)\nEach entry in the events array is an object with these properties:\nhandlerFunction: optional event handler function\nhandlerObject: optional event handler object\nhandlerMethod: optionally specifies object handler method name (defaults to `handleEvent`)\n*/\nexports.addEventListeners = function(domNode,events) {\n\t$tw.utils.each(events,function(eventInfo) {\n\t\tvar handler;\n\t\tif(eventInfo.handlerFunction) {\n\t\t\thandler = eventInfo.handlerFunction;\n\t\t} else if(eventInfo.handlerObject) {\n\t\t\tif(eventInfo.handlerMethod) {\n\t\t\t\thandler = function(event) {\n\t\t\t\t\teventInfo.handlerObject[eventInfo.handlerMethod].call(eventInfo.handlerObject,event);\n\t\t\t\t};\t\n\t\t\t} else {\n\t\t\t\thandler = eventInfo.handlerObject;\n\t\t\t}\n\t\t}\n\t\tdomNode.addEventListener(eventInfo.name,handler,false);\n\t});\n};\n\n/*\nGet the computed styles applied to an element as an array of strings of individual CSS properties\n*/\nexports.getComputedStyles = function(domNode) {\n\tvar textAreaStyles = window.getComputedStyle(domNode,null),\n\t\tstyleDefs = [],\n\t\tname;\n\tfor(var t=0; t<textAreaStyles.length; t++) {\n\t\tname = textAreaStyles[t];\n\t\tstyleDefs.push(name + \": \" + textAreaStyles.getPropertyValue(name) + \";\");\n\t}\n\treturn styleDefs;\n};\n\n/*\nApply a set of styles passed as an array of strings of individual CSS properties\n*/\nexports.setStyles = function(domNode,styleDefs) {\n\tdomNode.style.cssText = styleDefs.join(\"\");\n};\n\n/*\nCopy the computed styles from a source element to a destination element\n*/\nexports.copyStyles = function(srcDomNode,dstDomNode) {\n\t$tw.utils.setStyles(dstDomNode,$tw.utils.getComputedStyles(srcDomNode));\n};\n\n/*\nCopy plain text to the clipboard on browsers that support it\n*/\nexports.copyToClipboard = function(text,options) {\n\toptions = options || {};\n\tvar textArea = document.createElement(\"textarea\");\n\ttextArea.style.position = \"fixed\";\n\ttextArea.style.top = 0;\n\ttextArea.style.left = 0;\n\ttextArea.style.fontSize = \"12pt\";\n\ttextArea.style.width = \"2em\";\n\ttextArea.style.height = \"2em\";\n\ttextArea.style.padding = 0;\n\ttextArea.style.border = \"none\";\n\ttextArea.style.outline = \"none\";\n\ttextArea.style.boxShadow = \"none\";\n\ttextArea.style.background = \"transparent\";\n\ttextArea.value = text;\n\tdocument.body.appendChild(textArea);\n\ttextArea.select();\n\ttextArea.setSelectionRange(0,text.length);\n\tvar succeeded = false;\n\ttry {\n\t\tsucceeded = document.execCommand(\"copy\");\n\t} catch (err) {\n\t}\n\tif(!options.doNotNotify) {\n\t\t$tw.notifier.display(succeeded ? \"$:/language/Notifications/CopiedToClipboard/Succeeded\" : \"$:/language/Notifications/CopiedToClipboard/Failed\");\n\t}\n\tdocument.body.removeChild(textArea);\n};\n\nexports.getLocationPath = function() {\n\treturn window.location.toString().split(\"#\")[0];\n};\n\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/dragndrop.js": {
"title": "$:/core/modules/utils/dom/dragndrop.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/dragndrop.js\ntype: application/javascript\nmodule-type: utils\n\nBrowser data transfer utilities, used with the clipboard and drag and drop\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nOptions:\n\ndomNode: dom node to make draggable\ndragImageType: \"pill\" or \"dom\"\ndragTiddlerFn: optional function to retrieve the title of tiddler to drag\ndragFilterFn: optional function to retreive the filter defining a list of tiddlers to drag\nwidget: widget to use as the contect for the filter\n*/\nexports.makeDraggable = function(options) {\n\tvar dragImageType = options.dragImageType || \"dom\",\n\t\tdragImage,\n\t\tdomNode = options.domNode;\n\t// Make the dom node draggable (not necessary for anchor tags)\n\tif((domNode.tagName || \"\").toLowerCase() !== \"a\") {\n\t\tdomNode.setAttribute(\"draggable\",\"true\");\t\t\n\t}\n\t// Add event handlers\n\t$tw.utils.addEventListeners(domNode,[\n\t\t{name: \"dragstart\", handlerFunction: function(event) {\n\t\t\tif(event.dataTransfer === undefined) {\n\t\t\t\treturn false;\n\t\t\t}\n\t\t\t// Collect the tiddlers being dragged\n\t\t\tvar dragTiddler = options.dragTiddlerFn && options.dragTiddlerFn(),\n\t\t\t\tdragFilter = options.dragFilterFn && options.dragFilterFn(),\n\t\t\t\ttitles = dragTiddler ? [dragTiddler] : [],\n\t\t\t \tstartActions = options.startActions;\n\t\t\tif(dragFilter) {\n\t\t\t\ttitles.push.apply(titles,options.widget.wiki.filterTiddlers(dragFilter,options.widget));\n\t\t\t}\n\t\t\tvar titleString = $tw.utils.stringifyList(titles);\n\t\t\t// Check that we've something to drag\n\t\t\tif(titles.length > 0 && event.target === domNode) {\n\t\t\t\t// Mark the drag in progress\n\t\t\t\t$tw.dragInProgress = domNode;\n\t\t\t\t// Set the dragging class on the element being dragged\n\t\t\t\t$tw.utils.addClass(event.target,\"tc-dragging\");\n\t\t\t\t// Invoke drag-start actions if given\n\t\t\t\tif(startActions !== undefined) {\n\t\t\t\t\toptions.widget.invokeActionString(startActions,options.widget,event,{actionTiddler: titleString});\n\t\t\t\t}\n\t\t\t\t// Create the drag image elements\n\t\t\t\tdragImage = options.widget.document.createElement(\"div\");\n\t\t\t\tdragImage.className = \"tc-tiddler-dragger\";\n\t\t\t\tvar inner = options.widget.document.createElement(\"div\");\n\t\t\t\tinner.className = \"tc-tiddler-dragger-inner\";\n\t\t\t\tinner.appendChild(options.widget.document.createTextNode(\n\t\t\t\t\ttitles.length === 1 ? \n\t\t\t\t\t\ttitles[0] :\n\t\t\t\t\t\ttitles.length + \" tiddlers\"\n\t\t\t\t));\n\t\t\t\tdragImage.appendChild(inner);\n\t\t\t\toptions.widget.document.body.appendChild(dragImage);\n\t\t\t\t// Set the data transfer properties\n\t\t\t\tvar dataTransfer = event.dataTransfer;\n\t\t\t\t// Set up the image\n\t\t\t\tdataTransfer.effectAllowed = \"all\";\n\t\t\t\tif(dataTransfer.setDragImage) {\n\t\t\t\t\tif(dragImageType === \"pill\") {\n\t\t\t\t\t\tdataTransfer.setDragImage(dragImage.firstChild,-16,-16);\n\t\t\t\t\t} else {\n\t\t\t\t\t\tvar r = domNode.getBoundingClientRect();\n\t\t\t\t\t\tdataTransfer.setDragImage(domNode,event.clientX-r.left,event.clientY-r.top);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\t// Set up the data transfer\n\t\t\t\tif(dataTransfer.clearData) {\n\t\t\t\t\tdataTransfer.clearData();\t\t\t\t\t\n\t\t\t\t}\n\t\t\t\tvar jsonData = [];\n\t\t\t\tif(titles.length > 1) {\n\t\t\t\t\ttitles.forEach(function(title) {\n\t\t\t\t\t\tjsonData.push(options.widget.wiki.getTiddlerAsJson(title));\n\t\t\t\t\t});\n\t\t\t\t\tjsonData = \"[\" + jsonData.join(\",\") + \"]\";\n\t\t\t\t} else {\n\t\t\t\t\tjsonData = options.widget.wiki.getTiddlerAsJson(titles[0]);\n\t\t\t\t}\n\t\t\t\t// IE doesn't like these content types\n\t\t\t\tif(!$tw.browser.isIE) {\n\t\t\t\t\tdataTransfer.setData(\"text/vnd.tiddler\",jsonData);\n\t\t\t\t\tdataTransfer.setData(\"text/plain\",titleString);\n\t\t\t\t\tdataTransfer.setData(\"text/x-moz-url\",\"data:text/vnd.tiddler,\" + encodeURIComponent(jsonData));\n\t\t\t\t}\n\t\t\t\tdataTransfer.setData(\"URL\",\"data:text/vnd.tiddler,\" + encodeURIComponent(jsonData));\n\t\t\t\tdataTransfer.setData(\"Text\",titleString);\n\t\t\t\tevent.stopPropagation();\n\t\t\t}\n\t\t\treturn false;\n\t\t}},\n\t\t{name: \"dragend\", handlerFunction: function(event) {\n\t\t\tif(event.target === domNode) {\n\t\t\t\t// Collect the tiddlers being dragged\n\t\t\t\tvar dragTiddler = options.dragTiddlerFn && options.dragTiddlerFn(),\n\t\t\t\t\tdragFilter = options.dragFilterFn && options.dragFilterFn(),\n\t\t\t\t\ttitles = dragTiddler ? [dragTiddler] : [],\n\t\t\t \t\tendActions = options.endActions;\n\t\t\t\tif(dragFilter) {\n\t\t\t\t\ttitles.push.apply(titles,options.widget.wiki.filterTiddlers(dragFilter,options.widget));\n\t\t\t\t}\n\t\t\t\tvar titleString = $tw.utils.stringifyList(titles);\n\t\t\t\t$tw.dragInProgress = null;\n\t\t\t\t// Invoke drag-end actions if given\n\t\t\t\tif(endActions !== undefined) {\n\t\t\t\t\toptions.widget.invokeActionString(endActions,options.widget,event,{actionTiddler: titleString});\n\t\t\t\t}\n\t\t\t\t// Remove the dragging class on the element being dragged\n\t\t\t\t$tw.utils.removeClass(event.target,\"tc-dragging\");\n\t\t\t\t// Delete the drag image element\n\t\t\t\tif(dragImage) {\n\t\t\t\t\tdragImage.parentNode.removeChild(dragImage);\n\t\t\t\t\tdragImage = null;\n\t\t\t\t}\n\t\t\t}\n\t\t\treturn false;\n\t\t}}\n\t]);\n};\n\nexports.importDataTransfer = function(dataTransfer,fallbackTitle,callback) {\n\t// Try each provided data type in turn\n\tif($tw.log.IMPORT) {\n\t\tconsole.log(\"Available data types:\");\n\t\tfor(var type=0; type<dataTransfer.types.length; type++) {\n\t\t\tconsole.log(\"type\",dataTransfer.types[type],dataTransfer.getData(dataTransfer.types[type]))\n\t\t}\n\t}\n\tfor(var t=0; t<importDataTypes.length; t++) {\n\t\tif(!$tw.browser.isIE || importDataTypes[t].IECompatible) {\n\t\t\t// Get the data\n\t\t\tvar dataType = importDataTypes[t];\n\t\t\t\tvar data = dataTransfer.getData(dataType.type);\n\t\t\t// Import the tiddlers in the data\n\t\t\tif(data !== \"\" && data !== null) {\n\t\t\t\tif($tw.log.IMPORT) {\n\t\t\t\t\tconsole.log(\"Importing data type '\" + dataType.type + \"', data: '\" + data + \"'\")\n\t\t\t\t}\n\t\t\t\tvar tiddlerFields = dataType.toTiddlerFieldsArray(data,fallbackTitle);\n\t\t\t\tcallback(tiddlerFields);\n\t\t\t\treturn;\n\t\t\t}\n\t\t}\n\t}\n};\n\nvar importDataTypes = [\n\t{type: \"text/vnd.tiddler\", IECompatible: false, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\treturn parseJSONTiddlers(data,fallbackTitle);\n\t}},\n\t{type: \"URL\", IECompatible: true, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\t// Check for tiddler data URI\n\t\tvar match = decodeURIComponent(data).match(/^data\\:text\\/vnd\\.tiddler,(.*)/i);\n\t\tif(match) {\n\t\t\treturn parseJSONTiddlers(match[1],fallbackTitle);\n\t\t} else {\n\t\t\treturn [{title: fallbackTitle, text: data}]; // As URL string\n\t\t}\n\t}},\n\t{type: \"text/x-moz-url\", IECompatible: false, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\t// Check for tiddler data URI\n\t\tvar match = decodeURIComponent(data).match(/^data\\:text\\/vnd\\.tiddler,(.*)/i);\n\t\tif(match) {\n\t\t\treturn parseJSONTiddlers(match[1],fallbackTitle);\n\t\t} else {\n\t\t\treturn [{title: fallbackTitle, text: data}]; // As URL string\n\t\t}\n\t}},\n\t{type: \"text/html\", IECompatible: false, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\treturn [{title: fallbackTitle, text: data}];\n\t}},\n\t{type: \"text/plain\", IECompatible: false, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\treturn [{title: fallbackTitle, text: data}];\n\t}},\n\t{type: \"Text\", IECompatible: true, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\treturn [{title: fallbackTitle, text: data}];\n\t}},\n\t{type: \"text/uri-list\", IECompatible: false, toTiddlerFieldsArray: function(data,fallbackTitle) {\n\t\treturn [{title: fallbackTitle, text: data}];\n\t}}\n];\n\nfunction parseJSONTiddlers(json,fallbackTitle) {\n\tvar data = JSON.parse(json);\n\tif(!$tw.utils.isArray(data)) {\n\t\tdata = [data];\n\t}\n\tdata.forEach(function(fields) {\n\t\tfields.title = fields.title || fallbackTitle;\n\t});\n\treturn data;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/http.js": {
"title": "$:/core/modules/utils/dom/http.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/http.js\ntype: application/javascript\nmodule-type: utils\n\nBrowser HTTP support\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nA quick and dirty HTTP function; to be refactored later. Options are:\n\turl: URL to retrieve\n\theaders: hashmap of headers to send\n\ttype: GET, PUT, POST etc\n\tcallback: function invoked with (err,data,xhr)\n\treturnProp: string name of the property to return as first argument of callback\n*/\nexports.httpRequest = function(options) {\n\tvar type = options.type || \"GET\",\n\t\turl = options.url,\n\t\theaders = options.headers || {accept: \"application/json\"},\n\t\treturnProp = options.returnProp || \"responseText\",\n\t\trequest = new XMLHttpRequest(),\n\t\tdata = \"\",\n\t\tf,results;\n\t// Massage the data hashmap into a string\n\tif(options.data) {\n\t\tif(typeof options.data === \"string\") { // Already a string\n\t\t\tdata = options.data;\n\t\t} else { // A hashmap of strings\n\t\t\tresults = [];\n\t\t\t$tw.utils.each(options.data,function(dataItem,dataItemTitle) {\n\t\t\t\tresults.push(dataItemTitle + \"=\" + encodeURIComponent(dataItem));\n\t\t\t});\n\t\t\tif(type === \"GET\" || type === \"HEAD\") {\n\t\t\t\turl += \"?\" + results.join(\"&\");\n\t\t\t} else {\n\t\t\t\tdata = results.join(\"&\");\n\t\t\t}\n\t\t}\n\t}\n\t// Set up the state change handler\n\trequest.onreadystatechange = function() {\n\t\tif(this.readyState === 4) {\n\t\t\tif(this.status === 200 || this.status === 201 || this.status === 204) {\n\t\t\t\t// Success!\n\t\t\t\toptions.callback(null,this[returnProp],this);\n\t\t\t\treturn;\n\t\t\t}\n\t\t// Something went wrong\n\t\toptions.callback($tw.language.getString(\"Error/XMLHttpRequest\") + \": \" + this.status,null,this);\n\t\t}\n\t};\n\t// Make the request\n\trequest.open(type,url,true);\n\tif(headers) {\n\t\t$tw.utils.each(headers,function(header,headerTitle,object) {\n\t\t\trequest.setRequestHeader(headerTitle,header);\n\t\t});\n\t}\n\tif(data && !$tw.utils.hop(headers,\"Content-type\")) {\n\t\trequest.setRequestHeader(\"Content-type\",\"application/x-www-form-urlencoded; charset=UTF-8\");\n\t}\n\tif(!$tw.utils.hop(headers,\"X-Requested-With\")) {\n\t\trequest.setRequestHeader(\"X-Requested-With\",\"TiddlyWiki\");\n\t}\n\ttry {\n\t\trequest.send(data);\n\t} catch(e) {\n\t\toptions.callback(e,null,this);\n\t}\n\treturn request;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/keyboard.js": {
"title": "$:/core/modules/utils/dom/keyboard.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/keyboard.js\ntype: application/javascript\nmodule-type: utils\n\nKeyboard utilities; now deprecated. Instead, use $tw.keyboardManager\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n[\"parseKeyDescriptor\",\"checkKeyDescriptor\"].forEach(function(method) {\n\texports[method] = function() {\n\t\tif($tw.keyboardManager) {\n\t\t\treturn $tw.keyboardManager[method].apply($tw.keyboardManager,Array.prototype.slice.call(arguments,0));\n\t\t} else {\n\t\t\treturn null\n\t\t}\n\t};\n});\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/modal.js": {
"title": "$:/core/modules/utils/dom/modal.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/modal.js\ntype: application/javascript\nmodule-type: utils\n\nModal message mechanism\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nvar Modal = function(wiki) {\n\tthis.wiki = wiki;\n\tthis.modalCount = 0;\n};\n\n/*\nDisplay a modal dialogue\n\ttitle: Title of tiddler to display\n\toptions: see below\nOptions include:\n\tdownloadLink: Text of a big download link to include\n*/\nModal.prototype.display = function(title,options) {\n\toptions = options || {};\n\tthis.srcDocument = options.variables && (options.variables.rootwindow === \"true\" ||\n\t\t\t\toptions.variables.rootwindow === \"yes\") ? document :\n\t\t\t\t(options.event.event && options.event.event.target ? options.event.event.target.ownerDocument : document);\n\tthis.srcWindow = this.srcDocument.defaultView;\n\tvar self = this,\n\t\trefreshHandler,\n\t\tduration = $tw.utils.getAnimationDuration(),\n\t\ttiddler = this.wiki.getTiddler(title);\n\t// Don't do anything if the tiddler doesn't exist\n\tif(!tiddler) {\n\t\treturn;\n\t}\n\t// Create the variables\n\tvar variables = $tw.utils.extend({currentTiddler: title},options.variables);\n\t// Create the wrapper divs\n\tvar wrapper = this.srcDocument.createElement(\"div\"),\n\t\tmodalBackdrop = this.srcDocument.createElement(\"div\"),\n\t\tmodalWrapper = this.srcDocument.createElement(\"div\"),\n\t\tmodalHeader = this.srcDocument.createElement(\"div\"),\n\t\theaderTitle = this.srcDocument.createElement(\"h3\"),\n\t\tmodalBody = this.srcDocument.createElement(\"div\"),\n\t\tmodalLink = this.srcDocument.createElement(\"a\"),\n\t\tmodalFooter = this.srcDocument.createElement(\"div\"),\n\t\tmodalFooterHelp = this.srcDocument.createElement(\"span\"),\n\t\tmodalFooterButtons = this.srcDocument.createElement(\"span\");\n\t// Up the modal count and adjust the body class\n\tthis.modalCount++;\n\tthis.adjustPageClass();\n\t// Add classes\n\t$tw.utils.addClass(wrapper,\"tc-modal-wrapper\");\n\tif(tiddler.fields && tiddler.fields.class) {\n\t\t$tw.utils.addClass(wrapper,tiddler.fields.class);\n\t}\n\t$tw.utils.addClass(modalBackdrop,\"tc-modal-backdrop\");\n\t$tw.utils.addClass(modalWrapper,\"tc-modal\");\n\t$tw.utils.addClass(modalHeader,\"tc-modal-header\");\n\t$tw.utils.addClass(modalBody,\"tc-modal-body\");\n\t$tw.utils.addClass(modalFooter,\"tc-modal-footer\");\n\t// Join them together\n\twrapper.appendChild(modalBackdrop);\n\twrapper.appendChild(modalWrapper);\n\tmodalHeader.appendChild(headerTitle);\n\tmodalWrapper.appendChild(modalHeader);\n\tmodalWrapper.appendChild(modalBody);\n\tmodalFooter.appendChild(modalFooterHelp);\n\tmodalFooter.appendChild(modalFooterButtons);\n\tmodalWrapper.appendChild(modalFooter);\n\t// Render the title of the message\n\tvar headerWidgetNode = this.wiki.makeTranscludeWidget(title,{\n\t\tfield: \"subtitle\",\n\t\tmode: \"inline\",\n\t\tchildren: [{\n\t\t\ttype: \"text\",\n\t\t\tattributes: {\n\t\t\t\ttext: {\n\t\t\t\t\ttype: \"string\",\n\t\t\t\t\tvalue: title\n\t\t}}}],\n\t\tparentWidget: $tw.rootWidget,\n\t\tdocument: this.srcDocument,\n\t\tvariables: variables,\n\t\timportPageMacros: true\n\t});\n\theaderWidgetNode.render(headerTitle,null);\n\t// Render the body of the message\n\tvar bodyWidgetNode = this.wiki.makeTranscludeWidget(title,{\n\t\tparentWidget: $tw.rootWidget,\n\t\tdocument: this.srcDocument,\n\t\tvariables: variables,\n\t\timportPageMacros: true\n\t});\n\tbodyWidgetNode.render(modalBody,null);\n\t// Setup the link if present\n\tif(options.downloadLink) {\n\t\tmodalLink.href = options.downloadLink;\n\t\tmodalLink.appendChild(this.srcDocument.createTextNode(\"Right-click to save changes\"));\n\t\tmodalBody.appendChild(modalLink);\n\t}\n\t// Render the footer of the message\n\tif(tiddler.fields && tiddler.fields.help) {\n\t\tvar link = this.srcDocument.createElement(\"a\");\n\t\tlink.setAttribute(\"href\",tiddler.fields.help);\n\t\tlink.setAttribute(\"target\",\"_blank\");\n\t\tlink.setAttribute(\"rel\",\"noopener noreferrer\");\n\t\tlink.appendChild(this.srcDocument.createTextNode(\"Help\"));\n\t\tmodalFooterHelp.appendChild(link);\n\t\tmodalFooterHelp.style.float = \"left\";\n\t}\n\tvar footerWidgetNode = this.wiki.makeTranscludeWidget(title,{\n\t\tfield: \"footer\",\n\t\tmode: \"inline\",\n\t\tchildren: [{\n\t\t\ttype: \"button\",\n\t\t\tattributes: {\n\t\t\t\tmessage: {\n\t\t\t\t\ttype: \"string\",\n\t\t\t\t\tvalue: \"tm-close-tiddler\"\n\t\t\t\t}\n\t\t\t},\n\t\t\tchildren: [{\n\t\t\t\ttype: \"text\",\n\t\t\t\tattributes: {\n\t\t\t\t\ttext: {\n\t\t\t\t\t\ttype: \"string\",\n\t\t\t\t\t\tvalue: $tw.language.getString(\"Buttons/Close/Caption\")\n\t\t\t}}}\n\t\t]}],\n\t\tparentWidget: $tw.rootWidget,\n\t\tdocument: this.srcDocument,\n\t\tvariables: variables,\n\t\timportPageMacros: true\n\t});\n\tfooterWidgetNode.render(modalFooterButtons,null);\n\t// Set up the refresh handler\n\trefreshHandler = function(changes) {\n\t\theaderWidgetNode.refresh(changes,modalHeader,null);\n\t\tbodyWidgetNode.refresh(changes,modalBody,null);\n\t\tfooterWidgetNode.refresh(changes,modalFooterButtons,null);\n\t};\n\tthis.wiki.addEventListener(\"change\",refreshHandler);\n\t// Add the close event handler\n\tvar closeHandler = function(event) {\n\t\t// Remove our refresh handler\n\t\tself.wiki.removeEventListener(\"change\",refreshHandler);\n\t\t// Decrease the modal count and adjust the body class\n\t\tself.modalCount--;\n\t\tself.adjustPageClass();\n\t\t// Force layout and animate the modal message away\n\t\t$tw.utils.forceLayout(modalBackdrop);\n\t\t$tw.utils.forceLayout(modalWrapper);\n\t\t$tw.utils.setStyle(modalBackdrop,[\n\t\t\t{opacity: \"0\"}\n\t\t]);\n\t\t$tw.utils.setStyle(modalWrapper,[\n\t\t\t{transform: \"translateY(\" + self.srcWindow.innerHeight + \"px)\"}\n\t\t]);\n\t\t// Set up an event for the transition end\n\t\tself.srcWindow.setTimeout(function() {\n\t\t\tif(wrapper.parentNode) {\n\t\t\t\t// Remove the modal message from the DOM\n\t\t\t\tself.srcDocument.body.removeChild(wrapper);\n\t\t\t}\n\t\t},duration);\n\t\t// Don't let anyone else handle the tm-close-tiddler message\n\t\treturn false;\n\t};\n\theaderWidgetNode.addEventListener(\"tm-close-tiddler\",closeHandler,false);\n\tbodyWidgetNode.addEventListener(\"tm-close-tiddler\",closeHandler,false);\n\tfooterWidgetNode.addEventListener(\"tm-close-tiddler\",closeHandler,false);\n\t// Set the initial styles for the message\n\t$tw.utils.setStyle(modalBackdrop,[\n\t\t{opacity: \"0\"}\n\t]);\n\t$tw.utils.setStyle(modalWrapper,[\n\t\t{transformOrigin: \"0% 0%\"},\n\t\t{transform: \"translateY(\" + (-this.srcWindow.innerHeight) + \"px)\"}\n\t]);\n\t// Put the message into the document\n\tthis.srcDocument.body.appendChild(wrapper);\n\t// Set up animation for the styles\n\t$tw.utils.setStyle(modalBackdrop,[\n\t\t{transition: \"opacity \" + duration + \"ms ease-out\"}\n\t]);\n\t$tw.utils.setStyle(modalWrapper,[\n\t\t{transition: $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms ease-in-out\"}\n\t]);\n\t// Force layout\n\t$tw.utils.forceLayout(modalBackdrop);\n\t$tw.utils.forceLayout(modalWrapper);\n\t// Set final animated styles\n\t$tw.utils.setStyle(modalBackdrop,[\n\t\t{opacity: \"0.7\"}\n\t]);\n\t$tw.utils.setStyle(modalWrapper,[\n\t\t{transform: \"translateY(0px)\"}\n\t]);\n};\n\nModal.prototype.adjustPageClass = function() {\n\tvar windowContainer = $tw.pageContainer ? ($tw.pageContainer === this.srcDocument.body.firstChild ? $tw.pageContainer : this.srcDocument.body.firstChild) : null;\n\tif(windowContainer) {\n\t\t$tw.utils.toggleClass(windowContainer,\"tc-modal-displayed\",this.modalCount > 0);\n\t}\n};\n\nexports.Modal = Modal;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/notifier.js": {
"title": "$:/core/modules/utils/dom/notifier.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/notifier.js\ntype: application/javascript\nmodule-type: utils\n\nNotifier mechanism\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nvar Notifier = function(wiki) {\n\tthis.wiki = wiki;\n};\n\n/*\nDisplay a notification\n\ttitle: Title of tiddler containing the notification text\n\toptions: see below\nOptions include:\n*/\nNotifier.prototype.display = function(title,options) {\n\toptions = options || {};\n\t// Create the wrapper divs\n\tvar self = this,\n\t\tnotification = document.createElement(\"div\"),\n\t\ttiddler = this.wiki.getTiddler(title),\n\t\tduration = $tw.utils.getAnimationDuration(),\n\t\trefreshHandler;\n\t// Don't do anything if the tiddler doesn't exist\n\tif(!tiddler) {\n\t\treturn;\n\t}\n\t// Add classes\n\t$tw.utils.addClass(notification,\"tc-notification\");\n\t// Create the variables\n\tvar variables = $tw.utils.extend({currentTiddler: title},options.variables);\n\t// Render the body of the notification\n\tvar widgetNode = this.wiki.makeTranscludeWidget(title,{\n\t\tparentWidget: $tw.rootWidget,\n\t\tdocument: document,\n\t\tvariables: variables,\n\t\timportPageMacros: true});\n\twidgetNode.render(notification,null);\n\trefreshHandler = function(changes) {\n\t\twidgetNode.refresh(changes,notification,null);\n\t};\n\tthis.wiki.addEventListener(\"change\",refreshHandler);\n\t// Set the initial styles for the notification\n\t$tw.utils.setStyle(notification,[\n\t\t{opacity: \"0\"},\n\t\t{transformOrigin: \"0% 0%\"},\n\t\t{transform: \"translateY(\" + (-window.innerHeight) + \"px)\"},\n\t\t{transition: \"opacity \" + duration + \"ms ease-out, \" + $tw.utils.roundTripPropertyName(\"transform\") + \" \" + duration + \"ms ease-in-out\"}\n\t]);\n\t// Add the notification to the DOM\n\tdocument.body.appendChild(notification);\n\t// Force layout\n\t$tw.utils.forceLayout(notification);\n\t// Set final animated styles\n\t$tw.utils.setStyle(notification,[\n\t\t{opacity: \"1.0\"},\n\t\t{transform: \"translateY(0px)\"}\n\t]);\n\t// Set a timer to remove the notification\n\twindow.setTimeout(function() {\n\t\t// Remove our change event handler\n\t\tself.wiki.removeEventListener(\"change\",refreshHandler);\n\t\t// Force layout and animate the notification away\n\t\t$tw.utils.forceLayout(notification);\n\t\t$tw.utils.setStyle(notification,[\n\t\t\t{opacity: \"0.0\"},\n\t\t\t{transform: \"translateX(\" + (notification.offsetWidth) + \"px)\"}\n\t\t]);\n\t\t// Remove the modal message from the DOM once the transition ends\n\t\tsetTimeout(function() {\n\t\t\tif(notification.parentNode) {\n\t\t\t\tdocument.body.removeChild(notification);\n\t\t\t}\n\t\t},duration);\n\t},$tw.config.preferences.notificationDuration);\n};\n\nexports.Notifier = Notifier;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/popup.js": {
"title": "$:/core/modules/utils/dom/popup.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/popup.js\ntype: application/javascript\nmodule-type: utils\n\nModule that creates a $tw.utils.Popup object prototype that manages popups in the browser\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nCreates a Popup object with these options:\n\trootElement: the DOM element to which the popup zapper should be attached\n*/\nvar Popup = function(options) {\n\toptions = options || {};\n\tthis.rootElement = options.rootElement || document.documentElement;\n\tthis.popups = []; // Array of {title:,wiki:,domNode:} objects\n};\n\n/*\nTrigger a popup open or closed. Parameters are in a hashmap:\n\ttitle: title of the tiddler where the popup details are stored\n\tdomNode: dom node to which the popup will be positioned (one of domNode or domNodeRect is required)\n\tdomNodeRect: rectangle to which the popup will be positioned\n\twiki: wiki\n\tforce: if specified, forces the popup state to true or false (instead of toggling it)\n\tfloating: if true, skips registering the popup, meaning that it will need manually clearing\n*/\nPopup.prototype.triggerPopup = function(options) {\n\t// Check if this popup is already active\n\tvar index = this.findPopup(options.title);\n\t// Compute the new state\n\tvar state = index === -1;\n\tif(options.force !== undefined) {\n\t\tstate = options.force;\n\t}\n\t// Show or cancel the popup according to the new state\n\tif(state) {\n\t\tthis.show(options);\n\t} else {\n\t\tthis.cancel(index);\n\t}\n};\n\nPopup.prototype.findPopup = function(title) {\n\tvar index = -1;\n\tfor(var t=0; t<this.popups.length; t++) {\n\t\tif(this.popups[t].title === title) {\n\t\t\tindex = t;\n\t\t}\n\t}\n\treturn index;\n};\n\nPopup.prototype.handleEvent = function(event) {\n\tif(event.type === \"click\") {\n\t\t// Find out what was clicked on\n\t\tvar info = this.popupInfo(event.target),\n\t\t\tcancelLevel = info.popupLevel - 1;\n\t\t// Don't remove the level that was clicked on if we clicked on a handle\n\t\tif(info.isHandle) {\n\t\t\tcancelLevel++;\n\t\t}\n\t\t// Cancel\n\t\tthis.cancel(cancelLevel);\n\t}\n};\n\n/*\nFind the popup level containing a DOM node. Returns:\npopupLevel: count of the number of nested popups containing the specified element\nisHandle: true if the specified element is within a popup handle\n*/\nPopup.prototype.popupInfo = function(domNode) {\n\tvar isHandle = false,\n\t\tpopupCount = 0,\n\t\tnode = domNode;\n\t// First check ancestors to see if we're within a popup handle\n\twhile(node) {\n\t\tif($tw.utils.hasClass(node,\"tc-popup-handle\")) {\n\t\t\tisHandle = true;\n\t\t\tpopupCount++;\n\t\t}\n\t\tif($tw.utils.hasClass(node,\"tc-popup-keep\")) {\n\t\t\tisHandle = true;\n\t\t}\n\t\tnode = node.parentNode;\n\t}\n\t// Then count the number of ancestor popups\n\tnode = domNode;\n\twhile(node) {\n\t\tif($tw.utils.hasClass(node,\"tc-popup\")) {\n\t\t\tpopupCount++;\n\t\t}\n\t\tnode = node.parentNode;\n\t}\n\tvar info = {\n\t\tpopupLevel: popupCount,\n\t\tisHandle: isHandle\n\t};\n\treturn info;\n};\n\n/*\nDisplay a popup by adding it to the stack\n*/\nPopup.prototype.show = function(options) {\n\t// Find out what was clicked on\n\tvar info = this.popupInfo(options.domNode);\n\t// Cancel any higher level popups\n\tthis.cancel(info.popupLevel);\n\n\t// Store the popup details if not already there\n\tif(!options.floating && this.findPopup(options.title) === -1) {\n\t\tthis.popups.push({\n\t\t\ttitle: options.title,\n\t\t\twiki: options.wiki,\n\t\t\tdomNode: options.domNode,\n\t\t\tnoStateReference: options.noStateReference\n\t\t});\n\t}\n\t// Set the state tiddler\n\tvar rect;\n\tif(options.domNodeRect) {\n\t\trect = options.domNodeRect;\n\t} else {\n\t\trect = {\n\t\t\tleft: options.domNode.offsetLeft,\n\t\t\ttop: options.domNode.offsetTop,\n\t\t\twidth: options.domNode.offsetWidth,\n\t\t\theight: options.domNode.offsetHeight\n\t\t};\n\t}\n\tvar popupRect = \"(\" + rect.left + \",\" + rect.top + \",\" + \n\t\t\t\trect.width + \",\" + rect.height + \")\";\n\tif(options.noStateReference) {\n\t\toptions.wiki.setText(options.title,\"text\",undefined,popupRect);\n\t} else {\n\t\toptions.wiki.setTextReference(options.title,popupRect);\n\t}\n\t// Add the click handler if we have any popups\n\tif(this.popups.length > 0) {\n\t\tthis.rootElement.addEventListener(\"click\",this,true);\t\t\n\t}\n};\n\n/*\nCancel all popups at or above a specified level or DOM node\nlevel: popup level to cancel (0 cancels all popups)\n*/\nPopup.prototype.cancel = function(level) {\n\tvar numPopups = this.popups.length;\n\tlevel = Math.max(0,Math.min(level,numPopups));\n\tfor(var t=level; t<numPopups; t++) {\n\t\tvar popup = this.popups.pop();\n\t\tif(popup.title) {\n\t\t\tif(popup.noStateReference) {\n\t\t\t\tpopup.wiki.deleteTiddler(popup.title);\n\t\t\t} else {\n\t\t\t\tpopup.wiki.deleteTiddler($tw.utils.parseTextReference(popup.title).title);\n \t\t}\n\t\t}\n\t}\n\tif(this.popups.length === 0) {\n\t\tthis.rootElement.removeEventListener(\"click\",this,false);\n\t}\n};\n\n/*\nReturns true if the specified title and text identifies an active popup\n*/\nPopup.prototype.readPopupState = function(text) {\n\tvar popupLocationRegExp = /^\\((-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+)\\)$/;\n\treturn popupLocationRegExp.test(text);\n};\n\nexports.Popup = Popup;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/dom/scroller.js": {
"title": "$:/core/modules/utils/dom/scroller.js",
"text": "/*\\\ntitle: $:/core/modules/utils/dom/scroller.js\ntype: application/javascript\nmodule-type: utils\n\nModule that creates a $tw.utils.Scroller object prototype that manages scrolling in the browser\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nEvent handler for when the `tm-scroll` event hits the document body\n*/\nvar PageScroller = function() {\n\tthis.idRequestFrame = null;\n\tthis.requestAnimationFrame = window.requestAnimationFrame ||\n\t\twindow.webkitRequestAnimationFrame ||\n\t\twindow.mozRequestAnimationFrame ||\n\t\tfunction(callback) {\n\t\t\treturn window.setTimeout(callback, 1000/60);\n\t\t};\n\tthis.cancelAnimationFrame = window.cancelAnimationFrame ||\n\t\twindow.webkitCancelAnimationFrame ||\n\t\twindow.webkitCancelRequestAnimationFrame ||\n\t\twindow.mozCancelAnimationFrame ||\n\t\twindow.mozCancelRequestAnimationFrame ||\n\t\tfunction(id) {\n\t\t\twindow.clearTimeout(id);\n\t\t};\n};\n\nPageScroller.prototype.isScrolling = function() {\n\treturn this.idRequestFrame !== null;\n}\n\nPageScroller.prototype.cancelScroll = function(srcWindow) {\n\tif(this.idRequestFrame) {\n\t\tthis.cancelAnimationFrame.call(srcWindow,this.idRequestFrame);\n\t\tthis.idRequestFrame = null;\n\t}\n};\n\n/*\nHandle an event\n*/\nPageScroller.prototype.handleEvent = function(event) {\n\tif(event.type === \"tm-scroll\") {\n\t\treturn this.scrollIntoView(event.target);\n\t}\n\treturn true;\n};\n\n/*\nHandle a scroll event hitting the page document\n*/\nPageScroller.prototype.scrollIntoView = function(element,callback) {\n\tvar self = this,\n\t\tduration = $tw.utils.getAnimationDuration(),\n\t srcWindow = element ? element.ownerDocument.defaultView : window;\n\t// Now get ready to scroll the body\n\tthis.cancelScroll(srcWindow);\n\tthis.startTime = Date.now();\n\t// Get the height of any position:fixed toolbars\n\tvar toolbar = srcWindow.document.querySelector(\".tc-adjust-top-of-scroll\"),\n\t\toffset = 0;\n\tif(toolbar) {\n\t\toffset = toolbar.offsetHeight;\n\t}\n\t// Get the client bounds of the element and adjust by the scroll position\n\tvar getBounds = function() {\n\t\t\tvar clientBounds = typeof callback === 'function' ? callback() : element.getBoundingClientRect(),\n\t\t\t\tscrollPosition = $tw.utils.getScrollPosition(srcWindow);\n\t\t\treturn {\n\t\t\t\tleft: clientBounds.left + scrollPosition.x,\n\t\t\t\ttop: clientBounds.top + scrollPosition.y - offset,\n\t\t\t\twidth: clientBounds.width,\n\t\t\t\theight: clientBounds.height\n\t\t\t};\n\t\t},\n\t\t// We'll consider the horizontal and vertical scroll directions separately via this function\n\t\t// targetPos/targetSize - position and size of the target element\n\t\t// currentPos/currentSize - position and size of the current scroll viewport\n\t\t// returns: new position of the scroll viewport\n\t\tgetEndPos = function(targetPos,targetSize,currentPos,currentSize) {\n\t\t\tvar newPos = targetPos;\n\t\t\t// If we are scrolling within 50 pixels of the top/left then snap to zero\n\t\t\tif(newPos < 50) {\n\t\t\t\tnewPos = 0;\n\t\t\t}\n\t\t\treturn newPos;\n\t\t},\n\t\tdrawFrame = function drawFrame() {\n\t\t\tvar t;\n\t\t\tif(duration <= 0) {\n\t\t\t\tt = 1;\n\t\t\t} else {\n\t\t\t\tt = ((Date.now()) - self.startTime) / duration;\t\n\t\t\t}\n\t\t\tif(t >= 1) {\n\t\t\t\tself.cancelScroll(srcWindow);\n\t\t\t\tt = 1;\n\t\t\t}\n\t\t\tt = $tw.utils.slowInSlowOut(t);\n\t\t\tvar scrollPosition = $tw.utils.getScrollPosition(srcWindow),\n\t\t\t\tbounds = getBounds(),\n\t\t\t\tendX = getEndPos(bounds.left,bounds.width,scrollPosition.x,srcWindow.innerWidth),\n\t\t\t\tendY = getEndPos(bounds.top,bounds.height,scrollPosition.y,srcWindow.innerHeight);\n\t\t\tsrcWindow.scrollTo(scrollPosition.x + (endX - scrollPosition.x) * t,scrollPosition.y + (endY - scrollPosition.y) * t);\n\t\t\tif(t < 1) {\n\t\t\t\tself.idRequestFrame = self.requestAnimationFrame.call(srcWindow,drawFrame);\n\t\t\t}\n\t\t};\n\tdrawFrame();\n};\n\nexports.PageScroller = PageScroller;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/edition-info.js": {
"title": "$:/core/modules/utils/edition-info.js",
"text": "/*\\\ntitle: $:/core/modules/utils/edition-info.js\ntype: application/javascript\nmodule-type: utils-node\n\nInformation about the available editions\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar fs = require(\"fs\"),\n\tpath = require(\"path\");\n\nvar editionInfo;\n\nexports.getEditionInfo = function() {\n\tif(!editionInfo) {\n\t\t// Enumerate the edition paths\n\t\tvar editionPaths = $tw.getLibraryItemSearchPaths($tw.config.editionsPath,$tw.config.editionsEnvVar);\n\t\teditionInfo = {};\n\t\tfor(var editionIndex=0; editionIndex<editionPaths.length; editionIndex++) {\n\t\t\tvar editionPath = editionPaths[editionIndex];\n\t\t\t// Enumerate the folders\n\t\t\tvar entries = fs.readdirSync(editionPath);\n\t\t\tfor(var entryIndex=0; entryIndex<entries.length; entryIndex++) {\n\t\t\t\tvar entry = entries[entryIndex];\n\t\t\t\t// Check if directories have a valid tiddlywiki.info\n\t\t\t\tif(!editionInfo[entry] && $tw.utils.isDirectory(path.resolve(editionPath,entry))) {\n\t\t\t\t\tvar info;\n\t\t\t\t\ttry {\n\t\t\t\t\t\tinfo = JSON.parse(fs.readFileSync(path.resolve(editionPath,entry,\"tiddlywiki.info\"),\"utf8\"));\n\t\t\t\t\t} catch(ex) {\n\t\t\t\t\t}\n\t\t\t\t\tif(info) {\n\t\t\t\t\t\teditionInfo[entry] = info;\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t}\n\treturn editionInfo;\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils-node"
},
"$:/core/modules/utils/fakedom.js": {
"title": "$:/core/modules/utils/fakedom.js",
"text": "/*\\\ntitle: $:/core/modules/utils/fakedom.js\ntype: application/javascript\nmodule-type: global\n\nA barebones implementation of DOM interfaces needed by the rendering mechanism.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Sequence number used to enable us to track objects for testing\nvar sequenceNumber = null;\n\nvar bumpSequenceNumber = function(object) {\n\tif(sequenceNumber !== null) {\n\t\tobject.sequenceNumber = sequenceNumber++;\n\t}\n};\n\nvar TW_TextNode = function(text) {\n\tbumpSequenceNumber(this);\n\tthis.textContent = text + \"\";\n};\n\nObject.defineProperty(TW_TextNode.prototype, \"nodeType\", {\n\tget: function() {\n\t\treturn 3;\n\t}\n});\n\nObject.defineProperty(TW_TextNode.prototype, \"formattedTextContent\", {\n\tget: function() {\n\t\treturn this.textContent.replace(/(\\r?\\n)/g,\"\");\n\t}\n});\n\nvar TW_Element = function(tag,namespace) {\n\tbumpSequenceNumber(this);\n\tthis.isTiddlyWikiFakeDom = true;\n\tthis.tag = tag;\n\tthis.attributes = {};\n\tthis.isRaw = false;\n\tthis.children = [];\n\tthis._style = {};\n\tthis.namespaceURI = namespace || \"http://www.w3.org/1999/xhtml\";\n};\n\nObject.defineProperty(TW_Element.prototype, \"style\", {\n\tget: function() {\n\t\treturn this._style;\n\t},\n\tset: function(str) {\n\t\tvar self = this;\n\t\tstr = str || \"\";\n\t\t$tw.utils.each(str.split(\";\"),function(declaration) {\n\t\t\tvar parts = declaration.split(\":\"),\n\t\t\t\tname = $tw.utils.trim(parts[0]),\n\t\t\t\tvalue = $tw.utils.trim(parts[1]);\n\t\t\tif(name && value) {\n\t\t\t\tself._style[$tw.utils.convertStyleNameToPropertyName(name)] = value;\n\t\t\t}\n\t\t});\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"nodeType\", {\n\tget: function() {\n\t\treturn 1;\n\t}\n});\n\nTW_Element.prototype.getAttribute = function(name) {\n\tif(this.isRaw) {\n\t\tthrow \"Cannot getAttribute on a raw TW_Element\";\n\t}\n\treturn this.attributes[name];\n};\n\nTW_Element.prototype.setAttribute = function(name,value) {\n\tif(this.isRaw) {\n\t\tthrow \"Cannot setAttribute on a raw TW_Element\";\n\t}\n\tthis.attributes[name] = value + \"\";\n};\n\nTW_Element.prototype.setAttributeNS = function(namespace,name,value) {\n\tthis.setAttribute(name,value);\n};\n\nTW_Element.prototype.removeAttribute = function(name) {\n\tif(this.isRaw) {\n\t\tthrow \"Cannot removeAttribute on a raw TW_Element\";\n\t}\n\tif($tw.utils.hop(this.attributes,name)) {\n\t\tdelete this.attributes[name];\n\t}\n};\n\nTW_Element.prototype.appendChild = function(node) {\n\tthis.children.push(node);\n\tnode.parentNode = this;\n};\n\nTW_Element.prototype.insertBefore = function(node,nextSibling) {\n\tif(nextSibling) {\n\t\tvar p = this.children.indexOf(nextSibling);\n\t\tif(p !== -1) {\n\t\t\tthis.children.splice(p,0,node);\n\t\t\tnode.parentNode = this;\n\t\t} else {\n\t\t\tthis.appendChild(node);\n\t\t}\n\t} else {\n\t\tthis.appendChild(node);\n\t}\n};\n\nTW_Element.prototype.removeChild = function(node) {\n\tvar p = this.children.indexOf(node);\n\tif(p !== -1) {\n\t\tthis.children.splice(p,1);\n\t}\n};\n\nTW_Element.prototype.hasChildNodes = function() {\n\treturn !!this.children.length;\n};\n\nObject.defineProperty(TW_Element.prototype, \"childNodes\", {\n\tget: function() {\n\t\treturn this.children;\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"firstChild\", {\n\tget: function() {\n\t\treturn this.children[0];\n\t}\n});\n\nTW_Element.prototype.addEventListener = function(type,listener,useCapture) {\n\t// Do nothing\n};\n\nObject.defineProperty(TW_Element.prototype, \"tagName\", {\n\tget: function() {\n\t\treturn this.tag || \"\";\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"className\", {\n\tget: function() {\n\t\treturn this.attributes[\"class\"] || \"\";\n\t},\n\tset: function(value) {\n\t\tthis.attributes[\"class\"] = value + \"\";\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"value\", {\n\tget: function() {\n\t\treturn this.attributes.value || \"\";\n\t},\n\tset: function(value) {\n\t\tthis.attributes.value = value + \"\";\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"outerHTML\", {\n\tget: function() {\n\t\tvar output = [],attr,a,v;\n\t\toutput.push(\"<\",this.tag);\n\t\tif(this.attributes) {\n\t\t\tattr = [];\n\t\t\tfor(a in this.attributes) {\n\t\t\t\tattr.push(a);\n\t\t\t}\n\t\t\tattr.sort();\n\t\t\tfor(a=0; a<attr.length; a++) {\n\t\t\t\tv = this.attributes[attr[a]];\n\t\t\t\tif(v !== undefined) {\n\t\t\t\t\toutput.push(\" \",attr[a],\"=\\\"\",$tw.utils.htmlEncode(v),\"\\\"\");\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t\tif(this._style) {\n\t\t\tvar style = [];\n\t\t\tfor(var s in this._style) {\n\t\t\t\tstyle.push($tw.utils.convertPropertyNameToStyleName(s) + \":\" + this._style[s] + \";\");\n\t\t\t}\n\t\t\tif(style.length > 0) {\n\t\t\t\toutput.push(\" style=\\\"\",style.join(\"\"),\"\\\"\");\n\t\t\t}\n\t\t}\n\t\toutput.push(\">\");\n\t\tif($tw.config.htmlVoidElements.indexOf(this.tag) === -1) {\n\t\t\toutput.push(this.innerHTML);\n\t\t\toutput.push(\"</\",this.tag,\">\");\n\t\t}\n\t\treturn output.join(\"\");\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"innerHTML\", {\n\tget: function() {\n\t\tif(this.isRaw) {\n\t\t\treturn this.rawHTML;\n\t\t} else {\n\t\t\tvar b = [];\n\t\t\t$tw.utils.each(this.children,function(node) {\n\t\t\t\tif(node instanceof TW_Element) {\n\t\t\t\t\tb.push(node.outerHTML);\n\t\t\t\t} else if(node instanceof TW_TextNode) {\n\t\t\t\t\tb.push($tw.utils.htmlEncode(node.textContent));\n\t\t\t\t}\n\t\t\t});\n\t\t\treturn b.join(\"\");\n\t\t}\n\t},\n\tset: function(value) {\n\t\tthis.isRaw = true;\n\t\tthis.rawHTML = value;\n\t\tthis.rawTextContent = null;\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"textInnerHTML\", {\n\tset: function(value) {\n\t\tif(this.isRaw) {\n\t\t\tthis.rawTextContent = value;\n\t\t} else {\n\t\t\tthrow \"Cannot set textInnerHTML of a non-raw TW_Element\";\n\t\t}\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"textContent\", {\n\tget: function() {\n\t\tif(this.isRaw) {\n\t\t\tif(this.rawTextContent === null) {\n\t\t\t\treturn \"\";\n\t\t\t} else {\n\t\t\t\treturn this.rawTextContent;\n\t\t\t}\n\t\t} else {\n\t\t\tvar b = [];\n\t\t\t$tw.utils.each(this.children,function(node) {\n\t\t\t\tb.push(node.textContent);\n\t\t\t});\n\t\t\treturn b.join(\"\");\n\t\t}\n\t},\n\tset: function(value) {\n\t\tthis.children = [new TW_TextNode(value)];\n\t}\n});\n\nObject.defineProperty(TW_Element.prototype, \"formattedTextContent\", {\n\tget: function() {\n\t\tif(this.isRaw) {\n\t\t\treturn \"\";\n\t\t} else {\n\t\t\tvar b = [],\n\t\t\t\tisBlock = $tw.config.htmlBlockElements.indexOf(this.tag) !== -1;\n\t\t\tif(isBlock) {\n\t\t\t\tb.push(\"\\n\");\n\t\t\t}\n\t\t\tif(this.tag === \"li\") {\n\t\t\t\tb.push(\"* \");\n\t\t\t}\n\t\t\t$tw.utils.each(this.children,function(node) {\n\t\t\t\tb.push(node.formattedTextContent);\n\t\t\t});\n\t\t\tif(isBlock) {\n\t\t\t\tb.push(\"\\n\");\n\t\t\t}\n\t\t\treturn b.join(\"\");\n\t\t}\n\t}\n});\n\nvar document = {\n\tsetSequenceNumber: function(value) {\n\t\tsequenceNumber = value;\n\t},\n\tcreateElementNS: function(namespace,tag) {\n\t\treturn new TW_Element(tag,namespace);\n\t},\n\tcreateElement: function(tag) {\n\t\treturn new TW_Element(tag);\n\t},\n\tcreateTextNode: function(text) {\n\t\treturn new TW_TextNode(text);\n\t},\n\tcompatMode: \"CSS1Compat\", // For KaTeX to know that we're not a browser in quirks mode\n\tisTiddlyWikiFakeDom: true\n};\n\nexports.fakeDocument = document;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/utils/filesystem.js": {
"title": "$:/core/modules/utils/filesystem.js",
"text": "/*\\\ntitle: $:/core/modules/utils/filesystem.js\ntype: application/javascript\nmodule-type: utils-node\n\nFile system utilities\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar fs = require(\"fs\"),\n\tpath = require(\"path\");\n\n/*\nRecursively (and synchronously) copy a directory and all its content\n*/\nexports.copyDirectory = function(srcPath,dstPath) {\n\t// Remove any trailing path separators\n\tsrcPath = $tw.utils.removeTrailingSeparator(srcPath);\n\tdstPath = $tw.utils.removeTrailingSeparator(dstPath);\n\t// Create the destination directory\n\tvar err = $tw.utils.createDirectory(dstPath);\n\tif(err) {\n\t\treturn err;\n\t}\n\t// Function to copy a folder full of files\n\tvar copy = function(srcPath,dstPath) {\n\t\tvar srcStats = fs.lstatSync(srcPath),\n\t\t\tdstExists = fs.existsSync(dstPath);\n\t\tif(srcStats.isFile()) {\n\t\t\t$tw.utils.copyFile(srcPath,dstPath);\n\t\t} else if(srcStats.isDirectory()) {\n\t\t\tvar items = fs.readdirSync(srcPath);\n\t\t\tfor(var t=0; t<items.length; t++) {\n\t\t\t\tvar item = items[t],\n\t\t\t\t\terr = copy(srcPath + path.sep + item,dstPath + path.sep + item);\n\t\t\t\tif(err) {\n\t\t\t\t\treturn err;\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t};\n\tcopy(srcPath,dstPath);\n\treturn null;\n};\n\n/*\nCopy a file\n*/\nvar FILE_BUFFER_LENGTH = 64 * 1024,\n\tfileBuffer;\n\nexports.copyFile = function(srcPath,dstPath) {\n\t// Create buffer if required\n\tif(!fileBuffer) {\n\t\tfileBuffer = Buffer.alloc(FILE_BUFFER_LENGTH);\n\t}\n\t// Create any directories in the destination\n\t$tw.utils.createDirectory(path.dirname(dstPath));\n\t// Copy the file\n\tvar srcFile = fs.openSync(srcPath,\"r\"),\n\t\tdstFile = fs.openSync(dstPath,\"w\"),\n\t\tbytesRead = 1,\n\t\tpos = 0;\n\twhile (bytesRead > 0) {\n\t\tbytesRead = fs.readSync(srcFile,fileBuffer,0,FILE_BUFFER_LENGTH,pos);\n\t\tfs.writeSync(dstFile,fileBuffer,0,bytesRead);\n\t\tpos += bytesRead;\n\t}\n\tfs.closeSync(srcFile);\n\tfs.closeSync(dstFile);\n\treturn null;\n};\n\n/*\nRemove trailing path separator\n*/\nexports.removeTrailingSeparator = function(dirPath) {\n\tvar len = dirPath.length;\n\tif(dirPath.charAt(len-1) === path.sep) {\n\t\tdirPath = dirPath.substr(0,len-1);\n\t}\n\treturn dirPath;\n};\n\n/*\nRecursively create a directory\n*/\nexports.createDirectory = function(dirPath) {\n\tif(dirPath.substr(dirPath.length-1,1) !== path.sep) {\n\t\tdirPath = dirPath + path.sep;\n\t}\n\tvar pos = 1;\n\tpos = dirPath.indexOf(path.sep,pos);\n\twhile(pos !== -1) {\n\t\tvar subDirPath = dirPath.substr(0,pos);\n\t\tif(!$tw.utils.isDirectory(subDirPath)) {\n\t\t\ttry {\n\t\t\t\tfs.mkdirSync(subDirPath);\n\t\t\t} catch(e) {\n\t\t\t\treturn \"Error creating directory '\" + subDirPath + \"'\";\n\t\t\t}\n\t\t}\n\t\tpos = dirPath.indexOf(path.sep,pos + 1);\n\t}\n\treturn null;\n};\n\n/*\nRecursively create directories needed to contain a specified file\n*/\nexports.createFileDirectories = function(filePath) {\n\treturn $tw.utils.createDirectory(path.dirname(filePath));\n};\n\n/*\nRecursively delete a directory\n*/\nexports.deleteDirectory = function(dirPath) {\n\tif(fs.existsSync(dirPath)) {\n\t\tvar entries = fs.readdirSync(dirPath);\n\t\tfor(var entryIndex=0; entryIndex<entries.length; entryIndex++) {\n\t\t\tvar currPath = dirPath + path.sep + entries[entryIndex];\n\t\t\tif(fs.lstatSync(currPath).isDirectory()) {\n\t\t\t\t$tw.utils.deleteDirectory(currPath);\n\t\t\t} else {\n\t\t\t\tfs.unlinkSync(currPath);\n\t\t\t}\n\t\t}\n\tfs.rmdirSync(dirPath);\n\t}\n\treturn null;\n};\n\n/*\nCheck if a path identifies a directory\n*/\nexports.isDirectory = function(dirPath) {\n\treturn fs.existsSync(dirPath) && fs.statSync(dirPath).isDirectory();\n};\n\n/*\nCheck if a path identifies a directory that is empty\n*/\nexports.isDirectoryEmpty = function(dirPath) {\n\tif(!$tw.utils.isDirectory(dirPath)) {\n\t\treturn false;\n\t}\n\tvar files = fs.readdirSync(dirPath),\n\t\tempty = true;\n\t$tw.utils.each(files,function(file,index) {\n\t\tif(file.charAt(0) !== \".\") {\n\t\t\tempty = false;\n\t\t}\n\t});\n\treturn empty;\n};\n\n/*\nRecursively delete a tree of empty directories\n*/\nexports.deleteEmptyDirs = function(dirpath,callback) {\n\tvar self = this;\n\tfs.readdir(dirpath,function(err,files) {\n\t\tif(err) {\n\t\t\treturn callback(err);\n\t\t}\n\t\tif(files.length > 0) {\n\t\t\treturn callback(null);\n\t\t}\n\t\tfs.rmdir(dirpath,function(err) {\n\t\t\tif(err) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tself.deleteEmptyDirs(path.dirname(dirpath),callback);\n\t\t});\n\t});\n};\n\n/*\nCreate a fileInfo object for saving a tiddler:\n\tfilepath: the absolute path to the file containing the tiddler\n\ttype: the type of the tiddler file (NOT the type of the tiddler)\n\thasMetaFile: true if the file also has a companion .meta file\nOptions include:\n\tdirectory: absolute path of root directory to which we are saving\n\tpathFilters: optional array of filters to be used to generate the base path\n\twiki: optional wiki for evaluating the pathFilters\n*/\nexports.generateTiddlerFileInfo = function(tiddler,options) {\n\tvar fileInfo = {};\n\t// Check if the tiddler has any unsafe fields that can't be expressed in a .tid or .meta file: containing control characters, or leading/trailing whitespace\n\tvar hasUnsafeFields = false;\n\t$tw.utils.each(tiddler.getFieldStrings(),function(value,fieldName) {\n\t\tif(fieldName !== \"text\") {\n\t\t\thasUnsafeFields = hasUnsafeFields || /[\\x00-\\x1F]/mg.test(value);\n\t\t\thasUnsafeFields = hasUnsafeFields || ($tw.utils.trim(value) !== value);\n\t\t}\n\t});\n\t// Check for field values \n\tif(hasUnsafeFields) {\n\t\t// Save as a JSON file\n\t\tfileInfo.type = \"application/json\";\n\t\tfileInfo.hasMetaFile = false;\n\t} else {\n\t\t// Save as a .tid or a text/binary file plus a .meta file\n\t\tvar tiddlerType = tiddler.fields.type || \"text/vnd.tiddlywiki\";\n\t\tif(tiddlerType === \"text/vnd.tiddlywiki\") {\n\t\t\t// Save as a .tid file\n\t\t\tfileInfo.type = \"application/x-tiddler\";\n\t\t\tfileInfo.hasMetaFile = false;\n\t\t} else {\n\t\t\t// Save as a text/binary file and a .meta file\n\t\t\tfileInfo.type = tiddlerType;\n\t\t\tfileInfo.hasMetaFile = true;\n\t\t}\n\t}\n\t// Take the file extension from the tiddler content type\n\tvar contentTypeInfo = $tw.config.contentTypeInfo[fileInfo.type] || {extension: \"\"};\n\t// Generate the filepath\n\tfileInfo.filepath = $tw.utils.generateTiddlerFilepath(tiddler.fields.title,{\n\t\textension: contentTypeInfo.extension,\n\t\tdirectory: options.directory,\n\t\tpathFilters: options.pathFilters,\n\t\twiki: options.wiki\n\t});\n\treturn fileInfo;\n};\n\n/*\nGenerate the filepath for saving a tiddler\nOptions include:\n\textension: file extension to be added the finished filepath\n\tdirectory: absolute path of root directory to which we are saving\n\tpathFilters: optional array of filters to be used to generate the base path\n\twiki: optional wiki for evaluating the pathFilters\n*/\nexports.generateTiddlerFilepath = function(title,options) {\n\tvar self = this,\n\t\tdirectory = options.directory || \"\",\n\t\textension = options.extension || \"\",\n\t\tfilepath;\n\t// Check if any of the pathFilters applies\n\tif(options.pathFilters && options.wiki) {\n\t\t$tw.utils.each(options.pathFilters,function(filter) {\n\t\t\tif(!filepath) {\n\t\t\t\tvar source = options.wiki.makeTiddlerIterator([title]),\n\t\t\t\t\tresult = options.wiki.filterTiddlers(filter,null,source);\n\t\t\t\tif(result.length > 0) {\n\t\t\t\t\tfilepath = result[0];\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n\t// If not, generate a base pathname\n\tif(!filepath) {\n\t\tfilepath = title;\n\t\t// If the filepath already ends in the extension then remove it\n\t\tif(filepath.substring(filepath.length - extension.length) === extension) {\n\t\t\tfilepath = filepath.substring(0,filepath.length - extension.length);\n\t\t}\n\t\t// Remove any forward or backward slashes so we don't create directories\n\t\tfilepath = filepath.replace(/\\/|\\\\/g,\"_\");\n\t}\n\t// Don't let the filename start with a dot because such files are invisible on *nix\n\tfilepath = filepath.replace(/^\\./g,\"_\");\n\t// Remove any characters that can't be used in cross-platform filenames\n\tfilepath = $tw.utils.transliterate(filepath.replace(/<|>|\\:|\\\"|\\||\\?|\\*|\\^/g,\"_\"));\n\t// Truncate the filename if it is too long\n\tif(filepath.length > 200) {\n\t\tfilepath = filepath.substr(0,200);\n\t}\n\t// If the resulting filename is blank (eg because the title is just punctuation characters)\n\tif(!filepath) {\n\t\t// ...then just use the character codes of the title\n\t\tfilepath = \"\";\t\n\t\t$tw.utils.each(title.split(\"\"),function(char) {\n\t\t\tif(filepath) {\n\t\t\t\tfilepath += \"-\";\n\t\t\t}\n\t\t\tfilepath += char.charCodeAt(0).toString();\n\t\t});\n\t}\n\t// Add a uniquifier if the file already exists\n\tvar fullPath,\n\t\tcount = 0;\n\tdo {\n\t\tfullPath = path.resolve(directory,filepath + (count ? \"_\" + count : \"\") + extension);\n\t\tcount++;\n\t} while(fs.existsSync(fullPath));\n\t// Return the full path to the file\n\treturn fullPath;\n};\n\n/*\nSave a tiddler to a file described by the fileInfo:\n\tfilepath: the absolute path to the file containing the tiddler\n\ttype: the type of the tiddler file (NOT the type of the tiddler)\n\thasMetaFile: true if the file also has a companion .meta file\n*/\nexports.saveTiddlerToFile = function(tiddler,fileInfo,callback) {\n\t$tw.utils.createDirectory(path.dirname(fileInfo.filepath));\n\tif(fileInfo.hasMetaFile) {\n\t\t// Save the tiddler as a separate body and meta file\n\t\tvar typeInfo = $tw.config.contentTypeInfo[tiddler.fields.type || \"text/plain\"] || {encoding: \"utf8\"};\n\t\tfs.writeFile(fileInfo.filepath,tiddler.fields.text,typeInfo.encoding,function(err) {\n\t\t\tif(err) {\n\t\t\t\treturn callback(err);\n\t\t\t}\n\t\t\tfs.writeFile(fileInfo.filepath + \".meta\",tiddler.getFieldStringBlock({exclude: [\"text\",\"bag\"]}),\"utf8\",callback);\n\t\t});\n\t} else {\n\t\t// Save the tiddler as a self contained templated file\n\t\tif(fileInfo.type === \"application/x-tiddler\") {\n\t\t\tfs.writeFile(fileInfo.filepath,tiddler.getFieldStringBlock({exclude: [\"text\",\"bag\"]}) + (!!tiddler.fields.text ? \"\\n\\n\" + tiddler.fields.text : \"\"),\"utf8\",callback);\n\t\t} else {\n\t\t\tfs.writeFile(fileInfo.filepath,JSON.stringify([tiddler.getFieldStrings({exclude: [\"bag\"]})],null,$tw.config.preferences.jsonSpaces),\"utf8\",callback);\n\t\t}\n\t}\n};\n\n/*\nSave a tiddler to a file described by the fileInfo:\n\tfilepath: the absolute path to the file containing the tiddler\n\ttype: the type of the tiddler file (NOT the type of the tiddler)\n\thasMetaFile: true if the file also has a companion .meta file\n*/\nexports.saveTiddlerToFileSync = function(tiddler,fileInfo) {\n\t$tw.utils.createDirectory(path.dirname(fileInfo.filepath));\n\tif(fileInfo.hasMetaFile) {\n\t\t// Save the tiddler as a separate body and meta file\n\t\tvar typeInfo = $tw.config.contentTypeInfo[tiddler.fields.type || \"text/plain\"] || {encoding: \"utf8\"};\n\t\tfs.writeFileSync(fileInfo.filepath,tiddler.fields.text,typeInfo.encoding);\n\t\tfs.writeFileSync(fileInfo.filepath + \".meta\",tiddler.getFieldStringBlock({exclude: [\"text\",\"bag\"]}),\"utf8\");\n\t} else {\n\t\t// Save the tiddler as a self contained templated file\n\t\tif(fileInfo.type === \"application/x-tiddler\") {\n\t\t\tfs.writeFileSync(fileInfo.filepath,tiddler.getFieldStringBlock({exclude: [\"text\",\"bag\"]}) + (!!tiddler.fields.text ? \"\\n\\n\" + tiddler.fields.text : \"\"),\"utf8\");\n\t\t} else {\n\t\t\tfs.writeFileSync(fileInfo.filepath,JSON.stringify([tiddler.getFieldStrings({exclude: [\"bag\"]})],null,$tw.config.preferences.jsonSpaces),\"utf8\");\n\t\t}\n\t}\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils-node"
},
"$:/core/modules/utils/logger.js": {
"title": "$:/core/modules/utils/logger.js",
"text": "/*\\\ntitle: $:/core/modules/utils/logger.js\ntype: application/javascript\nmodule-type: utils\n\nA basic logging implementation\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar ALERT_TAG = \"$:/tags/Alert\";\n\n/*\nMake a new logger\n*/\nfunction Logger(componentName,options) {\n\toptions = options || {};\n\tthis.componentName = componentName || \"\";\n\tthis.colour = options.colour || \"white\";\n\tthis.enable = \"enable\" in options ? options.enable : true;\n\tthis.save = \"save\" in options ? options.save : true;\n\tthis.saveLimit = options.saveLimit || 100 * 1024;\n\tthis.saveBufferLogger = this;\n\tthis.buffer = \"\";\n\tthis.alertCount = 0;\n}\n\nLogger.prototype.setSaveBuffer = function(logger) {\n\tthis.saveBufferLogger = logger;\n};\n\n/*\nLog a message\n*/\nLogger.prototype.log = function(/* args */) {\n\tvar self = this;\n\tif(this.enable) {\n\t\tif(this.saveBufferLogger.save) {\n\t\t\tthis.saveBufferLogger.buffer += $tw.utils.formatDateString(new Date(),\"YYYY MM DD 0hh:0mm:0ss.0XXX\") + \":\";\n\t\t\t$tw.utils.each(Array.prototype.slice.call(arguments,0),function(arg,index) {\n\t\t\t\tself.saveBufferLogger.buffer += \" \" + arg;\n\t\t\t});\n\t\t\tthis.saveBufferLogger.buffer += \"\\n\";\n\t\t\tthis.saveBufferLogger.buffer = this.saveBufferLogger.buffer.slice(-this.saveBufferLogger.saveLimit);\t\t\t\n\t\t}\n\t\tif(console !== undefined && console.log !== undefined) {\n\t\t\treturn Function.apply.call(console.log, console, [$tw.utils.terminalColour(this.colour),this.componentName + \":\"].concat(Array.prototype.slice.call(arguments,0)).concat($tw.utils.terminalColour()));\n\t\t}\n\t} \n};\n\n/*\nRead the message buffer\n*/\nLogger.prototype.getBuffer = function() {\n\treturn this.saveBufferLogger.buffer;\n};\n\n/*\nLog a structure as a table\n*/\nLogger.prototype.table = function(value) {\n\t(console.table || console.log)(value);\n};\n\n/*\nAlert a message\n*/\nLogger.prototype.alert = function(/* args */) {\n\tif(this.enable) {\n\t\t// Prepare the text of the alert\n\t\tvar text = Array.prototype.join.call(arguments,\" \");\n\t\t// Create alert tiddlers in the browser\n\t\tif($tw.browser) {\n\t\t\t// Check if there is an existing alert with the same text and the same component\n\t\t\tvar existingAlerts = $tw.wiki.getTiddlersWithTag(ALERT_TAG),\n\t\t\t\talertFields,\n\t\t\t\texistingCount,\n\t\t\t\tself = this;\n\t\t\t$tw.utils.each(existingAlerts,function(title) {\n\t\t\t\tvar tiddler = $tw.wiki.getTiddler(title);\n\t\t\t\tif(tiddler.fields.text === text && tiddler.fields.component === self.componentName && tiddler.fields.modified && (!alertFields || tiddler.fields.modified < alertFields.modified)) {\n\t\t\t\t\t\talertFields = $tw.utils.extend({},tiddler.fields);\n\t\t\t\t}\n\t\t\t});\n\t\t\tif(alertFields) {\n\t\t\t\texistingCount = alertFields.count || 1;\n\t\t\t} else {\n\t\t\t\talertFields = {\n\t\t\t\t\ttitle: $tw.wiki.generateNewTitle(\"$:/temp/alerts/alert\",{prefix: \"\"}),\n\t\t\t\t\ttext: text,\n\t\t\t\t\ttags: [ALERT_TAG],\n\t\t\t\t\tcomponent: this.componentName\n\t\t\t\t};\n\t\t\t\texistingCount = 0;\n\t\t\t\tthis.alertCount += 1;\n\t\t\t}\n\t\t\talertFields.modified = new Date();\n\t\t\tif(++existingCount > 1) {\n\t\t\t\talertFields.count = existingCount;\n\t\t\t} else {\n\t\t\t\talertFields.count = undefined;\n\t\t\t}\n\t\t\t$tw.wiki.addTiddler(new $tw.Tiddler(alertFields));\n\t\t\t// Log the alert as well\n\t\t\tthis.log.apply(this,Array.prototype.slice.call(arguments,0));\n\t\t} else {\n\t\t\t// Print an orange message to the console if not in the browser\n\t\t\tconsole.error(\"\\x1b[1;33m\" + text + \"\\x1b[0m\");\n\t\t}\t\t\n\t}\n};\n\n/*\nClear outstanding alerts\n*/\nLogger.prototype.clearAlerts = function() {\n\tvar self = this;\n\tif($tw.browser && this.alertCount > 0) {\n\t\t$tw.utils.each($tw.wiki.getTiddlersWithTag(ALERT_TAG),function(title) {\n\t\t\tvar tiddler = $tw.wiki.getTiddler(title);\n\t\t\tif(tiddler.fields.component === self.componentName) {\n\t\t\t\t$tw.wiki.deleteTiddler(title);\n\t\t\t}\n\t\t});\n\t\tthis.alertCount = 0;\n\t}\n};\n\nexports.Logger = Logger;\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/parsetree.js": {
"title": "$:/core/modules/utils/parsetree.js",
"text": "/*\\\ntitle: $:/core/modules/utils/parsetree.js\ntype: application/javascript\nmodule-type: utils\n\nParse tree utility functions.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nexports.addAttributeToParseTreeNode = function(node,name,value) {\n\tnode.attributes = node.attributes || {};\n\tnode.attributes[name] = {type: \"string\", value: value};\n};\n\nexports.getAttributeValueFromParseTreeNode = function(node,name,defaultValue) {\n\tif(node.attributes && node.attributes[name] && node.attributes[name].value !== undefined) {\n\t\treturn node.attributes[name].value;\n\t}\n\treturn defaultValue;\n};\n\nexports.addClassToParseTreeNode = function(node,classString) {\n\tvar classes = [];\n\tnode.attributes = node.attributes || {};\n\tnode.attributes[\"class\"] = node.attributes[\"class\"] || {type: \"string\", value: \"\"};\n\tif(node.attributes[\"class\"].type === \"string\") {\n\t\tif(node.attributes[\"class\"].value !== \"\") {\n\t\t\tclasses = node.attributes[\"class\"].value.split(\" \");\n\t\t}\n\t\tif(classString !== \"\") {\n\t\t\t$tw.utils.pushTop(classes,classString.split(\" \"));\n\t\t}\n\t\tnode.attributes[\"class\"].value = classes.join(\" \");\n\t}\n};\n\nexports.addStyleToParseTreeNode = function(node,name,value) {\n\t\tnode.attributes = node.attributes || {};\n\t\tnode.attributes.style = node.attributes.style || {type: \"string\", value: \"\"};\n\t\tif(node.attributes.style.type === \"string\") {\n\t\t\tnode.attributes.style.value += name + \":\" + value + \";\";\n\t\t}\n};\n\nexports.findParseTreeNode = function(nodeArray,search) {\n\tfor(var t=0; t<nodeArray.length; t++) {\n\t\tif(nodeArray[t].type === search.type && nodeArray[t].tag === search.tag) {\n\t\t\treturn nodeArray[t];\n\t\t}\n\t}\n\treturn undefined;\n};\n\n/*\nHelper to get the text of a parse tree node or array of nodes\n*/\nexports.getParseTreeText = function getParseTreeText(tree) {\n\tvar output = [];\n\tif($tw.utils.isArray(tree)) {\n\t\t$tw.utils.each(tree,function(node) {\n\t\t\toutput.push(getParseTreeText(node));\n\t\t});\n\t} else {\n\t\tif(tree.type === \"text\") {\n\t\t\toutput.push(tree.text);\n\t\t}\n\t\tif(tree.children) {\n\t\t\treturn getParseTreeText(tree.children);\n\t\t}\n\t}\n\treturn output.join(\"\");\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/performance.js": {
"title": "$:/core/modules/utils/performance.js",
"text": "/*\\\ntitle: $:/core/modules/utils/performance.js\ntype: application/javascript\nmodule-type: global\n\nPerformance measurement.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nfunction Performance(enabled) {\n\tthis.enabled = !!enabled;\n\tthis.measures = {}; // Hashmap by measurement name of {time:, invocations:}\n\tthis.logger = new $tw.utils.Logger(\"performance\");\n\tthis.showGreeting();\n}\n\nPerformance.prototype.showGreeting = function() {\n\tif($tw.browser) {\n\t\tthis.logger.log(\"Execute $tw.perf.log(); to see filter execution timings\");\t\t\n\t}\n};\n\n/*\nWrap performance reporting around a top level function\n*/\nPerformance.prototype.report = function(name,fn) {\n\tvar self = this;\n\tif(this.enabled) {\n\t\treturn function() {\n\t\t\tvar startTime = $tw.utils.timer(),\n\t\t\t\tresult = fn.apply(this,arguments);\n\t\t\tself.logger.log(name + \": \" + $tw.utils.timer(startTime).toFixed(2) + \"ms\");\n\t\t\treturn result;\n\t\t};\n\t} else {\n\t\treturn fn;\n\t}\n};\n\nPerformance.prototype.log = function() {\n\tvar self = this,\n\t\ttotalTime = 0,\n\t\torderedMeasures = Object.keys(this.measures).sort(function(a,b) {\n\t\t\tif(self.measures[a].time > self.measures[b].time) {\n\t\t\t\treturn -1;\n\t\t\t} else if (self.measures[a].time < self.measures[b].time) {\n\t\t\t\treturn + 1;\n\t\t\t} else {\n\t\t\t\treturn 0;\n\t\t\t}\n\t\t});\n\t$tw.utils.each(orderedMeasures,function(name) {\n\t\ttotalTime += self.measures[name].time;\n\t});\n\tvar results = []\n\t$tw.utils.each(orderedMeasures,function(name) {\n\t\tvar measure = self.measures[name];\n\t\tresults.push({name: name,invocations: measure.invocations, avgTime: measure.time / measure.invocations, totalTime: measure.time, percentTime: (measure.time / totalTime) * 100})\n\t});\n\tself.logger.table(results);\n};\n\n/*\nWrap performance measurements around a subfunction\n*/\nPerformance.prototype.measure = function(name,fn) {\n\tvar self = this;\n\tif(this.enabled) {\n\t\treturn function() {\n\t\t\tvar startTime = $tw.utils.timer(),\n\t\t\t\tresult = fn.apply(this,arguments);\n\t\t\tif(!(name in self.measures)) {\n\t\t\t\tself.measures[name] = {time: 0, invocations: 0};\n\t\t\t}\n\t\t\tself.measures[name].time += $tw.utils.timer(startTime);\n\t\t\tself.measures[name].invocations++;\n\t\t\treturn result;\n\t\t};\n\t} else {\n\t\treturn fn;\n\t}\n};\n\nexports.Performance = Performance;\n\n})();\n",
"type": "application/javascript",
"module-type": "global"
},
"$:/core/modules/utils/pluginmaker.js": {
"title": "$:/core/modules/utils/pluginmaker.js",
"text": "/*\\\ntitle: $:/core/modules/utils/pluginmaker.js\ntype: application/javascript\nmodule-type: utils\n\nA quick and dirty way to pack up plugins within the browser.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nRepack a plugin, and then delete any non-shadow payload tiddlers\n*/\nexports.repackPlugin = function(title,additionalTiddlers,excludeTiddlers) {\n\tadditionalTiddlers = additionalTiddlers || [];\n\texcludeTiddlers = excludeTiddlers || [];\n\t// Get the plugin tiddler\n\tvar pluginTiddler = $tw.wiki.getTiddler(title);\n\tif(!pluginTiddler) {\n\t\tthrow \"No such tiddler as \" + title;\n\t}\n\t// Extract the JSON\n\tvar jsonPluginTiddler;\n\ttry {\n\t\tjsonPluginTiddler = JSON.parse(pluginTiddler.fields.text);\n\t} catch(e) {\n\t\tthrow \"Cannot parse plugin tiddler \" + title + \"\\n\" + $tw.language.getString(\"Error/Caption\") + \": \" + e;\n\t}\n\t// Get the list of tiddlers\n\tvar tiddlers = Object.keys(jsonPluginTiddler.tiddlers);\n\t// Add the additional tiddlers\n\t$tw.utils.pushTop(tiddlers,additionalTiddlers);\n\t// Remove any excluded tiddlers\n\tfor(var t=tiddlers.length-1; t>=0; t--) {\n\t\tif(excludeTiddlers.indexOf(tiddlers[t]) !== -1) {\n\t\t\ttiddlers.splice(t,1);\n\t\t}\n\t}\n\t// Pack up the tiddlers into a block of JSON\n\tvar plugins = {};\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar tiddler = $tw.wiki.getTiddler(title),\n\t\t\tfields = {};\n\t\t$tw.utils.each(tiddler.fields,function (value,name) {\n\t\t\tfields[name] = tiddler.getFieldString(name);\n\t\t});\n\t\tplugins[title] = fields;\n\t});\n\t// Retrieve and bump the version number\n\tvar pluginVersion = $tw.utils.parseVersion(pluginTiddler.getFieldString(\"version\") || \"0.0.0\") || {\n\t\t\tmajor: \"0\",\n\t\t\tminor: \"0\",\n\t\t\tpatch: \"0\"\n\t\t};\n\tpluginVersion.patch++;\n\tvar version = pluginVersion.major + \".\" + pluginVersion.minor + \".\" + pluginVersion.patch;\n\tif(pluginVersion.prerelease) {\n\t\tversion += \"-\" + pluginVersion.prerelease;\n\t}\n\tif(pluginVersion.build) {\n\t\tversion += \"+\" + pluginVersion.build;\n\t}\n\t// Save the tiddler\n\t$tw.wiki.addTiddler(new $tw.Tiddler(pluginTiddler,{text: JSON.stringify({tiddlers: plugins},null,4), version: version}));\n\t// Delete any non-shadow constituent tiddlers\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tif($tw.wiki.tiddlerExists(title)) {\n\t\t\t$tw.wiki.deleteTiddler(title);\n\t\t}\n\t});\n\t// Trigger an autosave\n\t$tw.rootWidget.dispatchEvent({type: \"tm-auto-save-wiki\"});\n\t// Return a heartwarming confirmation\n\treturn \"Plugin \" + title + \" successfully saved\";\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/transliterate.js": {
"title": "$:/core/modules/utils/transliterate.js",
"text": "/*\\\ntitle: $:/core/modules/utils/transliterate.js\ntype: application/javascript\nmodule-type: utils\n\nTransliteration static utility functions.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nTransliterate string to ASCII\n\n(Some pairs taken from http://semplicewebsites.com/removing-accents-javascript)\n*/\nexports.transliterationPairs = 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:\"o\",\n\t\"ṓ\":\"o\",\n\t\"ṑ\":\"o\",\n\t\"ǫ\":\"o\",\n\t\"ǭ\":\"o\",\n\t\"ø\":\"o\",\n\t\"ǿ\":\"o\",\n\t\"õ\":\"o\",\n\t\"ṍ\":\"o\",\n\t\"ṏ\":\"o\",\n\t\"ȭ\":\"o\",\n\t\"ƣ\":\"oi\",\n\t\"ꝏ\":\"oo\",\n\t\"ɛ\":\"e\",\n\t\"ᶓ\":\"e\",\n\t\"ɔ\":\"o\",\n\t\"ᶗ\":\"o\",\n\t\"ȣ\":\"ou\",\n\t\"ṕ\":\"p\",\n\t\"ṗ\":\"p\",\n\t\"ꝓ\":\"p\",\n\t\"ƥ\":\"p\",\n\t\"ᵱ\":\"p\",\n\t\"ᶈ\":\"p\",\n\t\"ꝕ\":\"p\",\n\t\"ᵽ\":\"p\",\n\t\"ꝑ\":\"p\",\n\t\"ꝙ\":\"q\",\n\t\"ʠ\":\"q\",\n\t\"ɋ\":\"q\",\n\t\"ꝗ\":\"q\",\n\t\"ŕ\":\"r\",\n\t\"ř\":\"r\",\n\t\"ŗ\":\"r\",\n\t\"ṙ\":\"r\",\n\t\"ṛ\":\"r\",\n\t\"ṝ\":\"r\",\n\t\"ȑ\":\"r\",\n\t\"ɾ\":\"r\",\n\t\"ᵳ\":\"r\",\n\t\"ȓ\":\"r\",\n\t\"ṟ\":\"r\",\n\t\"ɼ\":\"r\",\n\t\"ᵲ\":\"r\",\n\t\"ᶉ\":\"r\",\n\t\"ɍ\":\"r\",\n\t\"ɽ\":\"r\",\n\t\"ↄ\":\"c\",\n\t\"ꜿ\":\"c\",\n\t\"ɘ\":\"e\",\n\t\"ɿ\":\"r\",\n\t\"ś\":\"s\",\n\t\"ṥ\":\"s\",\n\t\"š\":\"s\",\n\t\"ṧ\":\"s\",\n\t\"ş\":\"s\",\n\t\"ŝ\":\"s\",\n\t\"ș\":\"s\",\n\t\"ṡ\":\"s\",\n\t\"ṣ\":\"s\",\n\t\"ṩ\":\"s\",\n\t\"ʂ\":\"s\",\n\t\"ᵴ\":\"s\",\n\t\"ᶊ\":\"s\",\n\t\"ȿ\":\"s\",\n\t\"ɡ\":\"g\",\n\t\"ᴑ\":\"o\",\n\t\"ᴓ\":\"o\",\n\t\"ᴝ\":\"u\",\n\t\"ť\":\"t\",\n\t\"ţ\":\"t\",\n\t\"ṱ\":\"t\",\n\t\"ț\":\"t\",\n\t\"ȶ\":\"t\",\n\t\"ẗ\":\"t\",\n\t\"ⱦ\":\"t\",\n\t\"ṫ\":\"t\",\n\t\"ṭ\":\"t\",\n\t\"ƭ\":\"t\",\n\t\"ṯ\":\"t\",\n\t\"ᵵ\":\"t\",\n\t\"ƫ\":\"t\",\n\t\"ʈ\":\"t\",\n\t\"ŧ\":\"t\",\n\t\"ᵺ\":\"th\",\n\t\"ɐ\":\"a\",\n\t\"ᴂ\":\"ae\",\n\t\"ǝ\":\"e\",\n\t\"ᵷ\":\"g\",\n\t\"ɥ\":\"h\",\n\t\"ʮ\":\"h\",\n\t\"ʯ\":\"h\",\n\t\"ᴉ\":\"i\",\n\t\"ʞ\":\"k\",\n\t\"ꞁ\":\"l\",\n\t\"ɯ\":\"m\",\n\t\"ɰ\":\"m\",\n\t\"ᴔ\":\"oe\",\n\t\"ɹ\":\"r\",\n\t\"ɻ\":\"r\",\n\t\"ɺ\":\"r\",\n\t\"ⱹ\":\"r\",\n\t\"ʇ\":\"t\",\n\t\"ʌ\":\"v\",\n\t\"ʍ\":\"w\",\n\t\"ʎ\":\"y\",\n\t\"ꜩ\":\"tz\",\n\t\"ú\":\"u\",\n\t\"ŭ\":\"u\",\n\t\"ǔ\":\"u\",\n\t\"û\":\"u\",\n\t\"ṷ\":\"u\",\n\t\"ü\":\"u\",\n\t\"ǘ\":\"u\",\n\t\"ǚ\":\"u\",\n\t\"ǜ\":\"u\",\n\t\"ǖ\":\"u\",\n\t\"ṳ\":\"u\",\n\t\"ụ\":\"u\",\n\t\"ű\":\"u\",\n\t\"ȕ\":\"u\",\n\t\"ù\":\"u\",\n\t\"ủ\":\"u\",\n\t\"ư\":\"u\",\n\t\"ứ\":\"u\",\n\t\"ự\":\"u\",\n\t\"ừ\":\"u\",\n\t\"ử\":\"u\",\n\t\"ữ\":\"u\",\n\t\"ȗ\":\"u\",\n\t\"ū\":\"u\",\n\t\"ṻ\":\"u\",\n\t\"ų\":\"u\",\n\t\"ᶙ\":\"u\",\n\t\"ů\":\"u\",\n\t\"ũ\":\"u\",\n\t\"ṹ\":\"u\",\n\t\"ṵ\":\"u\",\n\t\"ᵫ\":\"ue\",\n\t\"ꝸ\":\"um\",\n\t\"ⱴ\":\"v\",\n\t\"ꝟ\":\"v\",\n\t\"ṿ\":\"v\",\n\t\"ʋ\":\"v\",\n\t\"ᶌ\":\"v\",\n\t\"ⱱ\":\"v\",\n\t\"ṽ\":\"v\",\n\t\"ꝡ\":\"vy\",\n\t\"ẃ\":\"w\",\n\t\"ŵ\":\"w\",\n\t\"ẅ\":\"w\",\n\t\"ẇ\":\"w\",\n\t\"ẉ\":\"w\",\n\t\"ẁ\":\"w\",\n\t\"ⱳ\":\"w\",\n\t\"ẘ\":\"w\",\n\t\"ẍ\":\"x\",\n\t\"ẋ\":\"x\",\n\t\"ᶍ\":\"x\",\n\t\"ý\":\"y\",\n\t\"ŷ\":\"y\",\n\t\"ÿ\":\"y\",\n\t\"ẏ\":\"y\",\n\t\"ỵ\":\"y\",\n\t\"ỳ\":\"y\",\n\t\"ƴ\":\"y\",\n\t\"ỷ\":\"y\",\n\t\"ỿ\":\"y\",\n\t\"ȳ\":\"y\",\n\t\"ẙ\":\"y\",\n\t\"ɏ\":\"y\",\n\t\"ỹ\":\"y\",\n\t\"ź\":\"z\",\n\t\"ž\":\"z\",\n\t\"ẑ\":\"z\",\n\t\"ʑ\":\"z\",\n\t\"ⱬ\":\"z\",\n\t\"ż\":\"z\",\n\t\"ẓ\":\"z\",\n\t\"ȥ\":\"z\",\n\t\"ẕ\":\"z\",\n\t\"ᵶ\":\"z\",\n\t\"ᶎ\":\"z\",\n\t\"ʐ\":\"z\",\n\t\"ƶ\":\"z\",\n\t\"ɀ\":\"z\",\n\t\"ff\":\"ff\",\n\t\"ffi\":\"ffi\",\n\t\"ffl\":\"ffl\",\n\t\"fi\":\"fi\",\n\t\"fl\":\"fl\",\n\t\"ij\":\"ij\",\n\t\"œ\":\"oe\",\n\t\"st\":\"st\",\n\t\"ₐ\":\"a\",\n\t\"ₑ\":\"e\",\n\t\"ᵢ\":\"i\",\n\t\"ⱼ\":\"j\",\n\t\"ₒ\":\"o\",\n\t\"ᵣ\":\"r\",\n\t\"ᵤ\":\"u\",\n\t\"ᵥ\":\"v\",\n\t\"ₓ\":\"x\",\n\t\"Ё\":\"YO\",\n\t\"Й\":\"I\",\n\t\"Ц\":\"TS\",\n\t\"У\":\"U\",\n\t\"К\":\"K\",\n\t\"Е\":\"E\",\n\t\"Н\":\"N\",\n\t\"Г\":\"G\",\n\t\"Ш\":\"SH\",\n\t\"Щ\":\"SCH\",\n\t\"З\":\"Z\",\n\t\"Х\":\"H\",\n\t\"Ъ\":\"'\",\n\t\"ё\":\"yo\",\n\t\"й\":\"i\",\n\t\"ц\":\"ts\",\n\t\"у\":\"u\",\n\t\"к\":\"k\",\n\t\"е\":\"e\",\n\t\"н\":\"n\",\n\t\"г\":\"g\",\n\t\"ш\":\"sh\",\n\t\"щ\":\"sch\",\n\t\"з\":\"z\",\n\t\"х\":\"h\",\n\t\"ъ\":\"'\",\n\t\"Ф\":\"F\",\n\t\"Ы\":\"I\",\n\t\"В\":\"V\",\n\t\"А\":\"a\",\n\t\"П\":\"P\",\n\t\"Р\":\"R\",\n\t\"О\":\"O\",\n\t\"Л\":\"L\",\n\t\"Д\":\"D\",\n\t\"Ж\":\"ZH\",\n\t\"Э\":\"E\",\n\t\"ф\":\"f\",\n\t\"ы\":\"i\",\n\t\"в\":\"v\",\n\t\"а\":\"a\",\n\t\"п\":\"p\",\n\t\"р\":\"r\",\n\t\"о\":\"o\",\n\t\"л\":\"l\",\n\t\"д\":\"d\",\n\t\"ж\":\"zh\",\n\t\"э\":\"e\",\n\t\"Я\":\"Ya\",\n\t\"Ч\":\"CH\",\n\t\"С\":\"S\",\n\t\"М\":\"M\",\n\t\"И\":\"I\",\n\t\"Т\":\"T\",\n\t\"Ь\":\"'\",\n\t\"Б\":\"B\",\n\t\"Ю\":\"YU\",\n\t\"я\":\"ya\",\n\t\"ч\":\"ch\",\n\t\"с\":\"s\",\n\t\"м\":\"m\",\n\t\"и\":\"i\",\n\t\"т\":\"t\",\n\t\"ь\":\"'\",\n\t\"б\":\"b\",\n\t\"ю\":\"yu\"\n};\n\nexports.transliterate = function(str) {\n\treturn str.replace(/[^A-Za-z0-9\\[\\] ]/g,function(ch) {\n\t\treturn exports.transliterationPairs[ch] || ch\n\t});\n};\n\nexports.transliterateToSafeASCII = function(str) {\n\treturn str.replace(/[^\\x00-\\x7F]/g,function(ch) {\n\t\treturn exports.transliterationPairs[ch] || \"\"\n\t});\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/utils/utils.js": {
"title": "$:/core/modules/utils/utils.js",
"text": "/*\\\ntitle: $:/core/modules/utils/utils.js\ntype: application/javascript\nmodule-type: utils\n\nVarious static utility functions.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar base64utf8 = require(\"$:/core/modules/utils/base64-utf8/base64-utf8.module.js\");\n\n/*\nDisplay a message, in colour if we're on a terminal\n*/\nexports.log = function(text,colour) {\n\tconsole.log($tw.node ? exports.terminalColour(colour) + text + exports.terminalColour() : text);\n};\n\nexports.terminalColour = function(colour) {\n\tif(!$tw.browser && $tw.node && process.stdout.isTTY) {\n\t\tif(colour) {\n\t\t\tvar code = exports.terminalColourLookup[colour];\n\t\t\tif(code) {\n\t\t\t\treturn \"\\x1b[\" + code + \"m\";\n\t\t\t}\n\t\t} else {\n\t\t\treturn \"\\x1b[0m\"; // Cancel colour\n\t\t}\n\t}\n\treturn \"\";\n};\n\nexports.terminalColourLookup = {\n\t\"black\": \"0;30\",\n\t\"red\": \"0;31\",\n\t\"green\": \"0;32\",\n\t\"brown/orange\": \"0;33\",\n\t\"blue\": \"0;34\",\n\t\"purple\": \"0;35\",\n\t\"cyan\": \"0;36\",\n\t\"light gray\": \"0;37\"\n};\n\n/*\nDisplay a warning, in colour if we're on a terminal\n*/\nexports.warning = function(text) {\n\texports.log(text,\"brown/orange\");\n};\n\n/*\nReturn the integer represented by the str (string).\nReturn the dflt (default) parameter if str is not a base-10 number.\n*/\nexports.getInt = function(str,deflt) {\n\tvar i = parseInt(str,10);\n\treturn isNaN(i) ? deflt : i;\n}\n\n/*\nRepeatedly replaces a substring within a string. Like String.prototype.replace, but without any of the default special handling of $ sequences in the replace string\n*/\nexports.replaceString = function(text,search,replace) {\n\treturn text.replace(search,function() {\n\t\treturn replace;\n\t});\n};\n\n/*\nRepeats a string\n*/\nexports.repeat = function(str,count) {\n\tvar result = \"\";\n\tfor(var t=0;t<count;t++) {\n\t\tresult += str;\n\t}\n\treturn result;\n};\n\n/*\nTrim whitespace from the start and end of a string\nThanks to Steven Levithan, http://blog.stevenlevithan.com/archives/faster-trim-javascript\n*/\nexports.trim = function(str) {\n\tif(typeof str === \"string\") {\n\t\treturn str.replace(/^\\s\\s*/, '').replace(/\\s\\s*$/, '');\n\t} else {\n\t\treturn str;\n\t}\n};\n\n/*\nConvert a string to sentence case (ie capitalise first letter)\n*/\nexports.toSentenceCase = function(str) {\n\treturn (str || \"\").replace(/^\\S/, function(c) {return c.toUpperCase();});\n}\n\n/*\nConvert a string to title case (ie capitalise each initial letter)\n*/\nexports.toTitleCase = function(str) {\n\treturn (str || \"\").replace(/(^|\\s)\\S/g, function(c) {return c.toUpperCase();});\n}\n\t\n/*\nFind the line break preceding a given position in a string\nReturns position immediately after that line break, or the start of the string\n*/\nexports.findPrecedingLineBreak = function(text,pos) {\n\tvar result = text.lastIndexOf(\"\\n\",pos - 1);\n\tif(result === -1) {\n\t\tresult = 0;\n\t} else {\n\t\tresult++;\n\t\tif(text.charAt(result) === \"\\r\") {\n\t\t\tresult++;\n\t\t}\n\t}\n\treturn result;\n};\n\n/*\nFind the line break following a given position in a string\n*/\nexports.findFollowingLineBreak = function(text,pos) {\n\t// Cut to just past the following line break, or to the end of the text\n\tvar result = text.indexOf(\"\\n\",pos);\n\tif(result === -1) {\n\t\tresult = text.length;\n\t} else {\n\t\tif(text.charAt(result) === \"\\r\") {\n\t\t\tresult++;\n\t\t}\n\t}\n\treturn result;\n};\n\n/*\nReturn the number of keys in an object\n*/\nexports.count = function(object) {\n\treturn Object.keys(object || {}).length;\n};\n\n/*\nDetermine whether an array-item is an object-property\n*/\nexports.hopArray = function(object,array) {\n\tfor(var i=0; i<array.length; i++) {\n\t\tif($tw.utils.hop(object,array[i])) {\n\t\t\treturn true;\n\t\t}\n\t}\n\treturn false;\n};\n\n/*\nRemove entries from an array\n\tarray: array to modify\n\tvalue: a single value to remove, or an array of values to remove\n*/\nexports.removeArrayEntries = function(array,value) {\n\tvar t,p;\n\tif($tw.utils.isArray(value)) {\n\t\tfor(t=0; t<value.length; t++) {\n\t\t\tp = array.indexOf(value[t]);\n\t\t\tif(p !== -1) {\n\t\t\t\tarray.splice(p,1);\n\t\t\t}\n\t\t}\n\t} else {\n\t\tp = array.indexOf(value);\n\t\tif(p !== -1) {\n\t\t\tarray.splice(p,1);\n\t\t}\n\t}\n};\n\n/*\nCheck whether any members of a hashmap are present in another hashmap\n*/\nexports.checkDependencies = function(dependencies,changes) {\n\tvar hit = false;\n\t$tw.utils.each(changes,function(change,title) {\n\t\tif($tw.utils.hop(dependencies,title)) {\n\t\t\thit = true;\n\t\t}\n\t});\n\treturn hit;\n};\n\nexports.extend = function(object /* [, src] */) {\n\t$tw.utils.each(Array.prototype.slice.call(arguments, 1), function(source) {\n\t\tif(source) {\n\t\t\tfor(var property in source) {\n\t\t\t\tobject[property] = source[property];\n\t\t\t}\n\t\t}\n\t});\n\treturn object;\n};\n\nexports.deepCopy = function(object) {\n\tvar result,t;\n\tif($tw.utils.isArray(object)) {\n\t\t// Copy arrays\n\t\tresult = object.slice(0);\n\t} else if(typeof object === \"object\") {\n\t\tresult = {};\n\t\tfor(t in object) {\n\t\t\tif(object[t] !== undefined) {\n\t\t\t\tresult[t] = $tw.utils.deepCopy(object[t]);\n\t\t\t}\n\t\t}\n\t} else {\n\t\tresult = object;\n\t}\n\treturn result;\n};\n\nexports.extendDeepCopy = function(object,extendedProperties) {\n\tvar result = $tw.utils.deepCopy(object),t;\n\tfor(t in extendedProperties) {\n\t\tif(extendedProperties[t] !== undefined) {\n\t\t\tresult[t] = $tw.utils.deepCopy(extendedProperties[t]);\n\t\t}\n\t}\n\treturn result;\n};\n\nexports.deepFreeze = function deepFreeze(object) {\n\tvar property, key;\n\tif(object) {\n\t\tObject.freeze(object);\n\t\tfor(key in object) {\n\t\t\tproperty = object[key];\n\t\t\tif($tw.utils.hop(object,key) && (typeof property === \"object\") && !Object.isFrozen(property)) {\n\t\t\t\tdeepFreeze(property);\n\t\t\t}\n\t\t}\n\t}\n};\n\nexports.slowInSlowOut = function(t) {\n\treturn (1 - ((Math.cos(t * Math.PI) + 1) / 2));\n};\n\nexports.formatDateString = function(date,template) {\n\tvar result = \"\",\n\t\tt = template,\n\t\tmatches = [\n\t\t\t[/^0hh12/, function() {\n\t\t\t\treturn $tw.utils.pad($tw.utils.getHours12(date));\n\t\t\t}],\n\t\t\t[/^wYYYY/, function() {\n\t\t\t\treturn $tw.utils.getYearForWeekNo(date);\n\t\t\t}],\n\t\t\t[/^hh12/, function() {\n\t\t\t\treturn $tw.utils.getHours12(date);\n\t\t\t}],\n\t\t\t[/^DDth/, function() {\n\t\t\t\treturn date.getDate() + $tw.utils.getDaySuffix(date);\n\t\t\t}],\n\t\t\t[/^YYYY/, function() {\n\t\t\t\treturn date.getFullYear();\n\t\t\t}],\n\t\t\t[/^0hh/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getHours());\n\t\t\t}],\n\t\t\t[/^0mm/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getMinutes());\n\t\t\t}],\n\t\t\t[/^0ss/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getSeconds());\n\t\t\t}],\n\t\t\t[/^0XXX/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getMilliseconds(),3);\n\t\t\t}],\n\t\t\t[/^0DD/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getDate());\n\t\t\t}],\n\t\t\t[/^0MM/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getMonth()+1);\n\t\t\t}],\n\t\t\t[/^0WW/, function() {\n\t\t\t\treturn $tw.utils.pad($tw.utils.getWeek(date));\n\t\t\t}],\n\t\t\t[/^ddd/, function() {\n\t\t\t\treturn $tw.language.getString(\"Date/Short/Day/\" + date.getDay());\n\t\t\t}],\n\t\t\t[/^mmm/, function() {\n\t\t\t\treturn $tw.language.getString(\"Date/Short/Month/\" + (date.getMonth() + 1));\n\t\t\t}],\n\t\t\t[/^DDD/, function() {\n\t\t\t\treturn $tw.language.getString(\"Date/Long/Day/\" + date.getDay());\n\t\t\t}],\n\t\t\t[/^MMM/, function() {\n\t\t\t\treturn $tw.language.getString(\"Date/Long/Month/\" + (date.getMonth() + 1));\n\t\t\t}],\n\t\t\t[/^TZD/, function() {\n\t\t\t\tvar tz = date.getTimezoneOffset(),\n\t\t\t\tatz = Math.abs(tz);\n\t\t\t\treturn (tz < 0 ? '+' : '-') + $tw.utils.pad(Math.floor(atz / 60)) + ':' + $tw.utils.pad(atz % 60);\n\t\t\t}],\n\t\t\t[/^wYY/, function() {\n\t\t\t\treturn $tw.utils.pad($tw.utils.getYearForWeekNo(date) - 2000);\n\t\t\t}],\n\t\t\t[/^[ap]m/, function() {\n\t\t\t\treturn $tw.utils.getAmPm(date).toLowerCase();\n\t\t\t}],\n\t\t\t[/^hh/, function() {\n\t\t\t\treturn date.getHours();\n\t\t\t}],\n\t\t\t[/^mm/, function() {\n\t\t\t\treturn date.getMinutes();\n\t\t\t}],\n\t\t\t[/^ss/, function() {\n\t\t\t\treturn date.getSeconds();\n\t\t\t}],\n\t\t\t[/^XXX/, function() {\n\t\t\t\treturn date.getMilliseconds();\n\t\t\t}],\n\t\t\t[/^[AP]M/, function() {\n\t\t\t\treturn $tw.utils.getAmPm(date).toUpperCase();\n\t\t\t}],\n\t\t\t[/^DD/, function() {\n\t\t\t\treturn date.getDate();\n\t\t\t}],\n\t\t\t[/^MM/, function() {\n\t\t\t\treturn date.getMonth() + 1;\n\t\t\t}],\n\t\t\t[/^WW/, function() {\n\t\t\t\treturn $tw.utils.getWeek(date);\n\t\t\t}],\n\t\t\t[/^YY/, function() {\n\t\t\t\treturn $tw.utils.pad(date.getFullYear() - 2000);\n\t\t\t}]\n\t\t];\n\t// If the user wants everything in UTC, shift the datestamp\n\t// Optimize for format string that essentially means\n\t// 'return raw UTC (tiddlywiki style) date string.'\n\tif(t.indexOf(\"[UTC]\") == 0 ) {\n\t\tif(t == \"[UTC]YYYY0MM0DD0hh0mm0ssXXX\")\n\t\t\treturn $tw.utils.stringifyDate(new Date());\n\t\tvar offset = date.getTimezoneOffset() ; // in minutes\n\t\tdate = new Date(date.getTime()+offset*60*1000) ;\n\t\tt = t.substr(5) ;\n\t}\n\twhile(t.length){\n\t\tvar matchString = \"\";\n\t\t$tw.utils.each(matches, function(m) {\n\t\t\tvar match = m[0].exec(t);\n\t\t\tif(match) {\n\t\t\t\tmatchString = m[1].call();\n\t\t\t\tt = t.substr(match[0].length);\n\t\t\t\treturn false;\n\t\t\t}\n\t\t});\n\t\tif(matchString) {\n\t\t\tresult += matchString;\n\t\t} else {\n\t\t\tresult += t.charAt(0);\n\t\t\tt = t.substr(1);\n\t\t}\n\t}\n\tresult = result.replace(/\\\\(.)/g,\"$1\");\n\treturn result;\n};\n\nexports.getAmPm = function(date) {\n\treturn $tw.language.getString(\"Date/Period/\" + (date.getHours() >= 12 ? \"pm\" : \"am\"));\n};\n\nexports.getDaySuffix = function(date) {\n\treturn $tw.language.getString(\"Date/DaySuffix/\" + date.getDate());\n};\n\nexports.getWeek = function(date) {\n\tvar dt = new Date(date.getTime());\n\tvar d = dt.getDay();\n\tif(d === 0) {\n\t\td = 7; // JavaScript Sun=0, ISO Sun=7\n\t}\n\tdt.setTime(dt.getTime() + (4 - d) * 86400000);// shift day to Thurs of same week to calculate weekNo\n\tvar x = new Date(dt.getFullYear(),0,1);\n\tvar n = Math.floor((dt.getTime() - x.getTime()) / 86400000);\n\treturn Math.floor(n / 7) + 1;\n};\n\nexports.getYearForWeekNo = function(date) {\n\tvar dt = new Date(date.getTime());\n\tvar d = dt.getDay();\n\tif(d === 0) {\n\t\td = 7; // JavaScript Sun=0, ISO Sun=7\n\t}\n\tdt.setTime(dt.getTime() + (4 - d) * 86400000);// shift day to Thurs of same week\n\treturn dt.getFullYear();\n};\n\nexports.getHours12 = function(date) {\n\tvar h = date.getHours();\n\treturn h > 12 ? h-12 : ( h > 0 ? h : 12 );\n};\n\n/*\nConvert a date delta in milliseconds into a string representation of \"23 seconds ago\", \"27 minutes ago\" etc.\n\tdelta: delta in milliseconds\nReturns an object with these members:\n\tdescription: string describing the delta period\n\tupdatePeriod: time in millisecond until the string will be inaccurate\n*/\nexports.getRelativeDate = function(delta) {\n\tvar futurep = false;\n\tif(delta < 0) {\n\t\tdelta = -1 * delta;\n\t\tfuturep = true;\n\t}\n\tvar units = [\n\t\t{name: \"Years\", duration: 365 * 24 * 60 * 60 * 1000},\n\t\t{name: \"Months\", duration: (365/12) * 24 * 60 * 60 * 1000},\n\t\t{name: \"Days\", duration: 24 * 60 * 60 * 1000},\n\t\t{name: \"Hours\", duration: 60 * 60 * 1000},\n\t\t{name: \"Minutes\", duration: 60 * 1000},\n\t\t{name: \"Seconds\", duration: 1000}\n\t];\n\tfor(var t=0; t<units.length; t++) {\n\t\tvar result = Math.floor(delta / units[t].duration);\n\t\tif(result >= 2) {\n\t\t\treturn {\n\t\t\t\tdelta: delta,\n\t\t\t\tdescription: $tw.language.getString(\n\t\t\t\t\t\"RelativeDate/\" + (futurep ? \"Future\" : \"Past\") + \"/\" + units[t].name,\n\t\t\t\t\t{variables:\n\t\t\t\t\t\t{period: result.toString()}\n\t\t\t\t\t}\n\t\t\t\t),\n\t\t\t\tupdatePeriod: units[t].duration\n\t\t\t};\n\t\t}\n\t}\n\treturn {\n\t\tdelta: delta,\n\t\tdescription: $tw.language.getString(\n\t\t\t\"RelativeDate/\" + (futurep ? \"Future\" : \"Past\") + \"/Second\",\n\t\t\t{variables:\n\t\t\t\t{period: \"1\"}\n\t\t\t}\n\t\t),\n\t\tupdatePeriod: 1000\n\t};\n};\n\n// Convert & to \"&\", < to \"<\", > to \">\", \" to \""\"\nexports.htmlEncode = function(s) {\n\tif(s) {\n\t\treturn s.toString().replace(/&/mg,\"&\").replace(/</mg,\"<\").replace(/>/mg,\">\").replace(/\\\"/mg,\""\");\n\t} else {\n\t\treturn \"\";\n\t}\n};\n\n// Converts all HTML entities to their character equivalents\nexports.entityDecode = function(s) {\n\tvar converter = String.fromCodePoint || String.fromCharCode,\n\t\te = s.substr(1,s.length-2), // Strip the & and the ;\n\t\tc;\n\tif(e.charAt(0) === \"#\") {\n\t\tif(e.charAt(1) === \"x\" || e.charAt(1) === \"X\") {\n\t\t\tc = parseInt(e.substr(2),16);\n\t\t} else {\n\t\t\tc = parseInt(e.substr(1),10);\n\t\t}\n\t\tif(isNaN(c)) {\n\t\t\treturn s;\n\t\t} else {\n\t\t\treturn converter(c);\n\t\t}\n\t} else {\n\t\tc = $tw.config.htmlEntities[e];\n\t\tif(c) {\n\t\t\treturn converter(c);\n\t\t} else {\n\t\t\treturn s; // Couldn't convert it as an entity, just return it raw\n\t\t}\n\t}\n};\n\nexports.unescapeLineBreaks = function(s) {\n\treturn s.replace(/\\\\n/mg,\"\\n\").replace(/\\\\b/mg,\" \").replace(/\\\\s/mg,\"\\\\\").replace(/\\r/mg,\"\");\n};\n\n/*\n * Returns an escape sequence for given character. Uses \\x for characters <=\n * 0xFF to save space, \\u for the rest.\n *\n * The code needs to be in sync with th code template in the compilation\n * function for \"action\" nodes.\n */\n// Copied from peg.js, thanks to David Majda\nexports.escape = function(ch) {\n\tvar charCode = ch.charCodeAt(0);\n\tif(charCode <= 0xFF) {\n\t\treturn '\\\\x' + $tw.utils.pad(charCode.toString(16).toUpperCase());\n\t} else {\n\t\treturn '\\\\u' + $tw.utils.pad(charCode.toString(16).toUpperCase(),4);\n\t}\n};\n\n// Turns a string into a legal JavaScript string\n// Copied from peg.js, thanks to David Majda\nexports.stringify = function(s) {\n\t/*\n\t* ECMA-262, 5th ed., 7.8.4: All characters may appear literally in a string\n\t* literal except for the closing quote character, backslash, carriage return,\n\t* line separator, paragraph separator, and line feed. Any character may\n\t* appear in the form of an escape sequence.\n\t*\n\t* For portability, we also escape all non-ASCII characters.\n\t*/\n\treturn (s || \"\")\n\t\t.replace(/\\\\/g, '\\\\\\\\') // backslash\n\t\t.replace(/\"/g, '\\\\\"') // double quote character\n\t\t.replace(/'/g, \"\\\\'\") // single quote character\n\t\t.replace(/\\r/g, '\\\\r') // carriage return\n\t\t.replace(/\\n/g, '\\\\n') // line feed\n\t\t.replace(/[\\x00-\\x1f\\x80-\\uFFFF]/g, exports.escape); // non-ASCII characters\n};\n\n// Turns a string into a legal JSON string\n// Derived from peg.js, thanks to David Majda\nexports.jsonStringify = function(s) {\n\t// See http://www.json.org/\n\treturn (s || \"\")\n\t\t.replace(/\\\\/g, '\\\\\\\\') // backslash\n\t\t.replace(/\"/g, '\\\\\"') // double quote character\n\t\t.replace(/\\r/g, '\\\\r') // carriage return\n\t\t.replace(/\\n/g, '\\\\n') // line feed\n\t\t.replace(/\\x08/g, '\\\\b') // backspace\n\t\t.replace(/\\x0c/g, '\\\\f') // formfeed\n\t\t.replace(/\\t/g, '\\\\t') // tab\n\t\t.replace(/[\\x00-\\x1f\\x80-\\uFFFF]/g,function(s) {\n\t\t\treturn '\\\\u' + $tw.utils.pad(s.charCodeAt(0).toString(16).toUpperCase(),4);\n\t\t}); // non-ASCII characters\n};\n\n/*\nEscape the RegExp special characters with a preceding backslash\n*/\nexports.escapeRegExp = function(s) {\n return s.replace(/[\\-\\/\\\\\\^\\$\\*\\+\\?\\.\\(\\)\\|\\[\\]\\{\\}]/g, '\\\\$&');\n};\n\n// Checks whether a link target is external, i.e. not a tiddler title\nexports.isLinkExternal = function(to) {\n\tvar externalRegExp = /^(?:file|http|https|mailto|ftp|irc|news|data|skype):[^\\s<>{}\\[\\]`|\"\\\\^]+(?:\\/|\\b)/i;\n\treturn externalRegExp.test(to);\n};\n\nexports.nextTick = function(fn) {\n/*global window: false */\n\tif(typeof process === \"undefined\") {\n\t\t// Apparently it would be faster to use postMessage - http://dbaron.org/log/20100309-faster-timeouts\n\t\twindow.setTimeout(fn,4);\n\t} else {\n\t\tprocess.nextTick(fn);\n\t}\n};\n\n/*\nConvert a hyphenated CSS property name into a camel case one\n*/\nexports.unHyphenateCss = function(propName) {\n\treturn propName.replace(/-([a-z])/gi, function(match0,match1) {\n\t\treturn match1.toUpperCase();\n\t});\n};\n\n/*\nConvert a camelcase CSS property name into a dashed one (\"backgroundColor\" --> \"background-color\")\n*/\nexports.hyphenateCss = function(propName) {\n\treturn propName.replace(/([A-Z])/g, function(match0,match1) {\n\t\treturn \"-\" + match1.toLowerCase();\n\t});\n};\n\n/*\nParse a text reference of one of these forms:\n* title\n* !!field\n* title!!field\n* title##index\n* etc\nReturns an object with the following fields, all optional:\n* title: tiddler title\n* field: tiddler field name\n* index: JSON property index\n*/\nexports.parseTextReference = function(textRef) {\n\t// Separate out the title, field name and/or JSON indices\n\tvar reTextRef = /(?:(.*?)!!(.+))|(?:(.*?)##(.+))|(.*)/mg,\n\t\tmatch = reTextRef.exec(textRef),\n\t\tresult = {};\n\tif(match && reTextRef.lastIndex === textRef.length) {\n\t\t// Return the parts\n\t\tif(match[1]) {\n\t\t\tresult.title = match[1];\n\t\t}\n\t\tif(match[2]) {\n\t\t\tresult.field = match[2];\n\t\t}\n\t\tif(match[3]) {\n\t\t\tresult.title = match[3];\n\t\t}\n\t\tif(match[4]) {\n\t\t\tresult.index = match[4];\n\t\t}\n\t\tif(match[5]) {\n\t\t\tresult.title = match[5];\n\t\t}\n\t} else {\n\t\t// If we couldn't parse it\n\t\tresult.title = textRef\n\t}\n\treturn result;\n};\n\n/*\nChecks whether a string is a valid fieldname\n*/\nexports.isValidFieldName = function(name) {\n\tif(!name || typeof name !== \"string\") {\n\t\treturn false;\n\t}\n\tname = name.toLowerCase().trim();\n\tvar fieldValidatorRegEx = /^[a-z0-9\\-\\._]+$/mg;\n\treturn fieldValidatorRegEx.test(name);\n};\n\n/*\nExtract the version number from the meta tag or from the boot file\n*/\n\n// Browser version\nexports.extractVersionInfo = function() {\n\tif($tw.packageInfo) {\n\t\treturn $tw.packageInfo.version;\n\t} else {\n\t\tvar metatags = document.getElementsByTagName(\"meta\");\n\t\tfor(var t=0; t<metatags.length; t++) {\n\t\t\tvar m = metatags[t];\n\t\t\tif(m.name === \"tiddlywiki-version\") {\n\t\t\t\treturn m.content;\n\t\t\t}\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nGet the animation duration in ms\n*/\nexports.getAnimationDuration = function() {\n\treturn parseInt($tw.wiki.getTiddlerText(\"$:/config/AnimationDuration\",\"400\"),10) || 0;\n};\n\n/*\nHash a string to a number\nDerived from http://stackoverflow.com/a/15710692\n*/\nexports.hashString = function(str) {\n\treturn str.split(\"\").reduce(function(a,b) {\n\t\ta = ((a << 5) - a) + b.charCodeAt(0);\n\t\treturn a & a;\n\t},0);\n};\n\n/*\nDecode a base64 string\n*/\nexports.base64Decode = function(string64) {\n\treturn base64utf8.base64.decode.call(base64utf8,string64);\n};\n\n/*\nEncode a string to base64\n*/\nexports.base64Encode = function(string64) {\n\treturn base64utf8.base64.encode.call(base64utf8,string64);\n};\n\n/*\nConvert a hashmap into a tiddler dictionary format sequence of name:value pairs\n*/\nexports.makeTiddlerDictionary = function(data) {\n\tvar output = [];\n\tfor(var name in data) {\n\t\toutput.push(name + \": \" + data[name]);\n\t}\n\treturn output.join(\"\\n\");\n};\n\n/*\nHigh resolution microsecond timer for profiling\n*/\nexports.timer = function(base) {\n\tvar m;\n\tif($tw.node) {\n\t\tvar r = process.hrtime();\n\t\tm = r[0] * 1e3 + (r[1] / 1e6);\n\t} else if(window.performance) {\n\t\tm = performance.now();\n\t} else {\n\t\tm = Date.now();\n\t}\n\tif(typeof base !== \"undefined\") {\n\t\tm = m - base;\n\t}\n\treturn m;\n};\n\n/*\nConvert text and content type to a data URI\n*/\nexports.makeDataUri = function(text,type,_canonical_uri) {\n\ttype = type || \"text/vnd.tiddlywiki\";\n\tvar typeInfo = $tw.config.contentTypeInfo[type] || $tw.config.contentTypeInfo[\"text/plain\"],\n\t\tisBase64 = typeInfo.encoding === \"base64\",\n\t\tparts = [];\n\tif(_canonical_uri) {\n\t\tparts.push(_canonical_uri);\n\t} else {\n\t\tparts.push(\"data:\");\n\t\tparts.push(type);\n\t\tparts.push(isBase64 ? \";base64\" : \"\");\n\t\tparts.push(\",\");\n\t\tparts.push(isBase64 ? text : encodeURIComponent(text));\t\t\n\t}\n\treturn parts.join(\"\");\n};\n\n/*\nUseful for finding out the fully escaped CSS selector equivalent to a given tag. For example:\n\n$tw.utils.tagToCssSelector(\"$:/tags/Stylesheet\") --> tc-tagged-\\%24\\%3A\\%2Ftags\\%2FStylesheet\n*/\nexports.tagToCssSelector = function(tagName) {\n\treturn \"tc-tagged-\" + encodeURIComponent(tagName).replace(/[!\"#$%&'()*+,\\-./:;<=>?@[\\\\\\]^`{\\|}~,]/mg,function(c) {\n\t\treturn \"\\\\\" + c;\n\t});\n};\n\n/*\nIE does not have sign function\n*/\nexports.sign = Math.sign || function(x) {\n\tx = +x; // convert to a number\n\tif (x === 0 || isNaN(x)) {\n\t\treturn x;\n\t}\n\treturn x > 0 ? 1 : -1;\n};\n\n/*\nIE does not have an endsWith function\n*/\nexports.strEndsWith = function(str,ending,position) {\n\tif(str.endsWith) {\n\t\treturn str.endsWith(ending,position);\n\t} else {\n\t\tif (typeof position !== 'number' || !isFinite(position) || Math.floor(position) !== position || position > str.length) {\n\t\t\tposition = str.length;\n\t\t}\n\t\tposition -= ending.length;\n\t\tvar lastIndex = str.indexOf(ending, position);\n\t\treturn lastIndex !== -1 && lastIndex === position;\n\t}\n};\n\n/*\nReturn system information useful for debugging\n*/\nexports.getSystemInfo = function(str,ending,position) {\n\tvar results = [],\n\t\tsave = function(desc,value) {\n\t\t\tresults.push(desc + \": \" + value);\n\t\t};\n\tif($tw.browser) {\n\t\tsave(\"User Agent\",navigator.userAgent);\n\t\tsave(\"Online Status\",window.navigator.onLine);\n\t}\n\tif($tw.node) {\n\t\tsave(\"Node Version\",process.version);\n\t}\n\treturn results.join(\"\\n\");\n};\n\nexports.parseNumber = function(str) {\n\treturn parseFloat(str) || 0;\n};\n\nexports.parseInt = function(str) {\n\treturn parseInt(str,10) || 0;\n};\n\nexports.stringifyNumber = function(num) {\n\treturn num + \"\";\n};\n\n})();\n",
"type": "application/javascript",
"module-type": "utils"
},
"$:/core/modules/widgets/action-createtiddler.js": {
"title": "$:/core/modules/widgets/action-createtiddler.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-createtiddler.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to create a new tiddler with a unique name and specified fields.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw:false, require:false, exports:false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar CreateTiddlerWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nCreateTiddlerWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nCreateTiddlerWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nCreateTiddlerWidget.prototype.execute = function() {\n\tthis.actionBaseTitle = this.getAttribute(\"$basetitle\");\n\tthis.hasBase = !!this.actionBaseTitle;\n\tthis.actionSaveTitle = this.getAttribute(\"$savetitle\");\n\tthis.actionSaveDraftTitle = this.getAttribute(\"$savedrafttitle\");\n\tthis.actionTimestamp = this.getAttribute(\"$timestamp\",\"yes\") === \"yes\";\n\t//Following params are new since 5.1.22\n\tthis.actionTemplate = this.getAttribute(\"$template\");\n\tthis.useTemplate = !!this.actionTemplate;\n\tthis.actionOverwrite = this.getAttribute(\"$overwrite\",\"no\");\n\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nCreateTiddlerWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif($tw.utils.count(changedAttributes) > 0) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nCreateTiddlerWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\tvar title = this.wiki.getTiddlerText(\"$:/language/DefaultNewTiddlerTitle\"), // Get the initial new-tiddler title\n\t\tfields = {},\n\t\tcreationFields,\n\t\tmodificationFields;\n\t$tw.utils.each(this.attributes,function(attribute,name) {\n\t\tif(name.charAt(0) !== \"$\") {\n\t\t\tfields[name] = attribute;\n\t\t}\n\t});\n\tif(this.actionTimestamp) {\n\t\tcreationFields = this.wiki.getCreationFields();\n\t\tmodificationFields = this.wiki.getModificationFields();\n\t}\n\tif(this.hasBase && this.actionOverwrite === \"no\") {\n\t\ttitle = this.wiki.generateNewTitle(this.actionBaseTitle);\n\t} else if (this.hasBase && this.actionOverwrite === \"yes\") {\n\t\ttitle = this.actionBaseTitle\n\t}\n\t// NO $basetitle BUT $template parameter is available\n\t// the title MUST be unique, otherwise the template would be overwritten\n\tif (!this.hasBase && this.useTemplate) {\n\t\ttitle = this.wiki.generateNewTitle(this.actionTemplate);\n\t} else if (!this.hasBase && !this.useTemplate) {\n\t\t// If NO $basetitle AND NO $template use initial title\n\t\t// DON'T overwrite any stuff\n\t\ttitle = this.wiki.generateNewTitle(title);\n\t}\n\tvar templateTiddler = this.wiki.getTiddler(this.actionTemplate) || {};\n\tvar tiddler = this.wiki.addTiddler(new $tw.Tiddler(templateTiddler.fields,creationFields,fields,modificationFields,{title: title}));\n\tif(this.actionSaveTitle) {\n\t\tthis.wiki.setTextReference(this.actionSaveTitle,title,this.getVariable(\"currentTiddler\"));\n\t}\n\tif(this.actionSaveDraftTitle) {\n\t\tthis.wiki.setTextReference(this.actionSaveDraftTitle,this.wiki.generateDraftTitle(title),this.getVariable(\"currentTiddler\"));\n\t}\n\treturn true; // Action was invoked\n};\n\nexports[\"action-createtiddler\"] = CreateTiddlerWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-deletefield.js": {
"title": "$:/core/modules/widgets/action-deletefield.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-deletefield.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to delete fields of a tiddler.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DeleteFieldWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDeleteFieldWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDeleteFieldWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nDeleteFieldWidget.prototype.execute = function() {\n\tthis.actionTiddler = this.getAttribute(\"$tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.actionField = this.getAttribute(\"$field\");\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nDeleteFieldWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"$tiddler\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nDeleteFieldWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\tvar self = this,\n\t\ttiddler = this.wiki.getTiddler(self.actionTiddler),\n\t\tremoveFields = {},\n\t\thasChanged = false;\n\tif(this.actionField && tiddler) {\n\t\tremoveFields[this.actionField] = undefined;\n\t\tif(this.actionField in tiddler.fields) {\n\t\t\thasChanged = true;\n\t\t}\n\t}\n\tif(tiddler) {\n\t\t$tw.utils.each(this.attributes,function(attribute,name) {\n\t\t\tif(name.charAt(0) !== \"$\" && name !== \"title\") {\n\t\t\t\tremoveFields[name] = undefined;\n\t\t\t\thasChanged = true;\n\t\t\t}\n\t\t});\n\t\tif(hasChanged) {\n\t\t\tthis.wiki.addTiddler(new $tw.Tiddler(this.wiki.getCreationFields(),tiddler,removeFields,this.wiki.getModificationFields()));\t\t\t\n\t\t}\n\t}\n\treturn true; // Action was invoked\n};\n\nexports[\"action-deletefield\"] = DeleteFieldWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-deletetiddler.js": {
"title": "$:/core/modules/widgets/action-deletetiddler.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-deletetiddler.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to delete a tiddler.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DeleteTiddlerWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDeleteTiddlerWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDeleteTiddlerWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nDeleteTiddlerWidget.prototype.execute = function() {\n\tthis.actionFilter = this.getAttribute(\"$filter\");\n\tthis.actionTiddler = this.getAttribute(\"$tiddler\");\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nDeleteTiddlerWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"$filter\"] || changedAttributes[\"$tiddler\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nDeleteTiddlerWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\tvar tiddlers = [];\n\tif(this.actionFilter) {\n\t\ttiddlers = this.wiki.filterTiddlers(this.actionFilter,this);\n\t}\n\tif(this.actionTiddler) {\n\t\ttiddlers.push(this.actionTiddler);\n\t}\n\tfor(var t=0; t<tiddlers.length; t++) {\n\t\tthis.wiki.deleteTiddler(tiddlers[t]);\n\t}\n\treturn true; // Action was invoked\n};\n\nexports[\"action-deletetiddler\"] = DeleteTiddlerWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-listops.js": {
"title": "$:/core/modules/widgets/action-listops.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-listops.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to apply list operations to any tiddler field (defaults to the 'list' field of the current tiddler)\n\n\\*/\n(function() {\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\nvar ActionListopsWidget = function(parseTreeNode, options) {\n\tthis.initialise(parseTreeNode, options);\n};\n/**\n * Inherit from the base widget class\n */\nActionListopsWidget.prototype = new Widget();\n/**\n * Render this widget into the DOM\n */\nActionListopsWidget.prototype.render = function(parent, nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n/**\n * Compute the internal state of the widget\n */\nActionListopsWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.target = this.getAttribute(\"$tiddler\", this.getVariable(\n\t\t\"currentTiddler\"));\n\tthis.filter = this.getAttribute(\"$filter\");\n\tthis.subfilter = this.getAttribute(\"$subfilter\");\n\tthis.listField = this.getAttribute(\"$field\", \"list\");\n\tthis.listIndex = this.getAttribute(\"$index\");\n\tthis.filtertags = this.getAttribute(\"$tags\");\n};\n/**\n * \tRefresh the widget by ensuring our attributes are up to date\n */\nActionListopsWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.$tiddler || changedAttributes.$filter ||\n\t\tchangedAttributes.$subfilter || changedAttributes.$field ||\n\t\tchangedAttributes.$index || changedAttributes.$tags) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n/**\n * \tInvoke the action associated with this widget\n */\nActionListopsWidget.prototype.invokeAction = function(triggeringWidget,\n\tevent) {\n\t//Apply the specified filters to the lists\n\tvar field = this.listField,\n\t\tindex,\n\t\ttype = \"!!\",\n\t\tlist = this.listField;\n\tif(this.listIndex) {\n\t\tfield = undefined;\n\t\tindex = this.listIndex;\n\t\ttype = \"##\";\n\t\tlist = this.listIndex;\n\t}\n\tif(this.filter) {\n\t\tthis.wiki.setText(this.target, field, index, $tw.utils.stringifyList(\n\t\t\tthis.wiki\n\t\t\t.filterTiddlers(this.filter, this)));\n\t}\n\tif(this.subfilter) {\n\t\tvar subfilter = \"[list[\" + this.target + type + list + \"]] \" + this.subfilter;\n\t\tthis.wiki.setText(this.target, field, index, $tw.utils.stringifyList(\n\t\t\tthis.wiki\n\t\t\t.filterTiddlers(subfilter, this)));\n\t}\n\tif(this.filtertags) {\n\t\tvar tiddler = this.wiki.getTiddler(this.target),\n\t\t\toldtags = tiddler ? (tiddler.fields.tags || []).slice(0) : [],\n\t\t\ttagfilter = \"[list[\" + this.target + \"!!tags]] \" + this.filtertags,\n\t\t\tnewtags = this.wiki.filterTiddlers(tagfilter,this);\n\t\tif($tw.utils.stringifyList(oldtags.sort()) !== $tw.utils.stringifyList(newtags.sort())) {\n\t\t\tthis.wiki.setText(this.target,\"tags\",undefined,$tw.utils.stringifyList(newtags));\t\t\t\n\t\t}\n\t}\n\treturn true; // Action was invoked\n};\n\nexports[\"action-listops\"] = ActionListopsWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-navigate.js": {
"title": "$:/core/modules/widgets/action-navigate.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-navigate.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to navigate to a tiddler\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar NavigateWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nNavigateWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nNavigateWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nNavigateWidget.prototype.execute = function() {\n\tthis.actionTo = this.getAttribute(\"$to\");\n\tthis.actionScroll = this.getAttribute(\"$scroll\");\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nNavigateWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"$to\"] || changedAttributes[\"$scroll\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nNavigateWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\tevent = event || {};\n\tvar bounds = triggeringWidget && triggeringWidget.getBoundingClientRect && triggeringWidget.getBoundingClientRect(),\n\t\tsuppressNavigation = event.metaKey || event.ctrlKey || (event.button === 1);\n\tif(this.actionScroll === \"yes\") {\n\t\tsuppressNavigation = false;\n\t} else if(this.actionScroll === \"no\") {\n\t\tsuppressNavigation = true;\n\t}\n\tthis.dispatchEvent({\n\t\ttype: \"tm-navigate\",\n\t\tnavigateTo: this.actionTo === undefined ? this.getVariable(\"currentTiddler\") : this.actionTo,\n\t\tnavigateFromTitle: this.getVariable(\"storyTiddler\"),\n\t\tnavigateFromNode: triggeringWidget,\n\t\tnavigateFromClientRect: bounds && { top: bounds.top, left: bounds.left, width: bounds.width, right: bounds.right, bottom: bounds.bottom, height: bounds.height\n\t\t},\n\t\tnavigateSuppressNavigation: suppressNavigation\n\t});\n\treturn true; // Action was invoked\n};\n\nexports[\"action-navigate\"] = NavigateWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-popup.js": {
"title": "$:/core/modules/widgets/action-popup.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-popup.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to trigger a popup.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ActionPopupWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nActionPopupWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nActionPopupWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nActionPopupWidget.prototype.execute = function() {\n\tthis.actionState = this.getAttribute(\"$state\");\n\tthis.actionCoords = this.getAttribute(\"$coords\");\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nActionPopupWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"$state\"] || changedAttributes[\"$coords\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nActionPopupWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\t// Trigger the popup\n\tvar popupLocationRegExp = /^\\((-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+)\\)$/,\n\t\tmatch = popupLocationRegExp.exec(this.actionCoords);\n\tif(match) {\n\t\t$tw.popup.triggerPopup({\n\t\t\tdomNode: null,\n\t\t\tdomNodeRect: {\n\t\t\t\tleft: parseFloat(match[1]),\n\t\t\t\ttop: parseFloat(match[2]),\n\t\t\t\twidth: parseFloat(match[3]),\n\t\t\t\theight: parseFloat(match[4])\n\t\t\t},\n\t\t\ttitle: this.actionState,\n\t\t\twiki: this.wiki\n\t\t});\n\t}\n\treturn true; // Action was invoked\n};\n\nexports[\"action-popup\"] = ActionPopupWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-sendmessage.js": {
"title": "$:/core/modules/widgets/action-sendmessage.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-sendmessage.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to send a message\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar SendMessageWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nSendMessageWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nSendMessageWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nSendMessageWidget.prototype.execute = function() {\n\tthis.actionMessage = this.getAttribute(\"$message\");\n\tthis.actionParam = this.getAttribute(\"$param\");\n\tthis.actionName = this.getAttribute(\"$name\");\n\tthis.actionValue = this.getAttribute(\"$value\",\"\");\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nSendMessageWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(Object.keys(changedAttributes).length) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nSendMessageWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\t// Get the string parameter\n\tvar param = this.actionParam;\n\t// Assemble the attributes as a hashmap\n\tvar paramObject = Object.create(null);\n\tvar count = 0;\n\t$tw.utils.each(this.attributes,function(attribute,name) {\n\t\tif(name.charAt(0) !== \"$\") {\n\t\t\tparamObject[name] = attribute;\n\t\t\tcount++;\n\t\t}\n\t});\n\t// Add name/value pair if present\n\tif(this.actionName) {\n\t\tparamObject[this.actionName] = this.actionValue;\n\t}\n\t// Dispatch the message\n\tthis.dispatchEvent({\n\t\ttype: this.actionMessage,\n\t\tparam: param,\n\t\tparamObject: paramObject,\n\t\ttiddlerTitle: this.getVariable(\"currentTiddler\"),\n\t\tnavigateFromTitle: this.getVariable(\"storyTiddler\"),\n\t\tevent: event\n\t});\n\treturn true; // Action was invoked\n};\n\nexports[\"action-sendmessage\"] = SendMessageWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/action-setfield.js": {
"title": "$:/core/modules/widgets/action-setfield.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/action-setfield.js\ntype: application/javascript\nmodule-type: widget\n\nAction widget to set a single field or index on a tiddler.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar SetFieldWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nSetFieldWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nSetFieldWidget.prototype.render = function(parent,nextSibling) {\n\tthis.computeAttributes();\n\tthis.execute();\n};\n\n/*\nCompute the internal state of the widget\n*/\nSetFieldWidget.prototype.execute = function() {\n\tthis.actionTiddler = this.getAttribute(\"$tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.actionField = this.getAttribute(\"$field\");\n\tthis.actionIndex = this.getAttribute(\"$index\");\n\tthis.actionValue = this.getAttribute(\"$value\");\n\tthis.actionTimestamp = this.getAttribute(\"$timestamp\",\"yes\") === \"yes\";\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nSetFieldWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"$tiddler\"] || changedAttributes[\"$field\"] || changedAttributes[\"$index\"] || changedAttributes[\"$value\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nInvoke the action associated with this widget\n*/\nSetFieldWidget.prototype.invokeAction = function(triggeringWidget,event) {\n\tvar self = this,\n\t\toptions = {};\n\toptions.suppressTimestamp = !this.actionTimestamp;\n\tif((typeof this.actionField == \"string\") || (typeof this.actionIndex == \"string\") || (typeof this.actionValue == \"string\")) {\n\t\tthis.wiki.setText(this.actionTiddler,this.actionField,this.actionIndex,this.actionValue,options);\n\t}\n\t$tw.utils.each(this.attributes,function(attribute,name) {\n\t\tif(name.charAt(0) !== \"$\") {\n\t\t\tself.wiki.setText(self.actionTiddler,name,undefined,attribute,options);\n\t\t}\n\t});\n\treturn true; // Action was invoked\n};\n\nexports[\"action-setfield\"] = SetFieldWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/browse.js": {
"title": "$:/core/modules/widgets/browse.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/browse.js\ntype: application/javascript\nmodule-type: widget\n\nBrowse widget for browsing for files to import\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar BrowseWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nBrowseWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nBrowseWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create element\n\tvar domNode = this.document.createElement(\"input\");\n\tdomNode.setAttribute(\"type\",\"file\");\n\tif(this.browseMultiple) {\n\t\tdomNode.setAttribute(\"multiple\",\"multiple\");\n\t}\n\tif(this.tooltip) {\n\t\tdomNode.setAttribute(\"title\",this.tooltip);\n\t}\n\t// Nw.js supports \"nwsaveas\" to force a \"save as\" dialogue that allows a new or existing file to be selected\n\tif(this.nwsaveas) {\n\t\tdomNode.setAttribute(\"nwsaveas\",this.nwsaveas);\n\t}\n\t// Nw.js supports \"webkitdirectory\" and \"nwdirectory\" to allow a directory to be selected\n\tif(this.webkitdirectory) {\n\t\tdomNode.setAttribute(\"webkitdirectory\",this.webkitdirectory);\n\t}\n\tif(this.nwdirectory) {\n\t\tdomNode.setAttribute(\"nwdirectory\",this.nwdirectory);\n\t}\n\t// Add a click event handler\n\tdomNode.addEventListener(\"change\",function (event) {\n\t\tif(self.message) {\n\t\t\tself.dispatchEvent({type: self.message, param: self.param, files: event.target.files});\n\t\t} else {\n\t\t\tself.wiki.readFiles(event.target.files,{\n\t\t\t\tcallback: function(tiddlerFieldsArray) {\n\t\t\t\t\tself.dispatchEvent({type: \"tm-import-tiddlers\", param: JSON.stringify(tiddlerFieldsArray)});\n\t\t\t\t},\n\t\t\t\tdeserializer: self.deserializer\n\t\t\t});\n\t\t}\n\t\treturn false;\n\t},false);\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nBrowseWidget.prototype.execute = function() {\n\tthis.browseMultiple = this.getAttribute(\"multiple\");\n\tthis.deserializer = this.getAttribute(\"deserializer\");\n\tthis.message = this.getAttribute(\"message\");\n\tthis.param = this.getAttribute(\"param\");\n\tthis.tooltip = this.getAttribute(\"tooltip\");\n\tthis.nwsaveas = this.getAttribute(\"nwsaveas\");\n\tthis.webkitdirectory = this.getAttribute(\"webkitdirectory\");\n\tthis.nwdirectory = this.getAttribute(\"nwdirectory\");\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nBrowseWidget.prototype.refresh = function(changedTiddlers) {\n\treturn false;\n};\n\nexports.browse = BrowseWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/button.js": {
"title": "$:/core/modules/widgets/button.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/button.js\ntype: application/javascript\nmodule-type: widget\n\nButton widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ButtonWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nButtonWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nButtonWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create element\n\tvar tag = \"button\";\n\tif(this.buttonTag && $tw.config.htmlUnsafeElements.indexOf(this.buttonTag) === -1) {\n\t\ttag = this.buttonTag;\n\t}\n\tvar domNode = this.document.createElement(tag);\n\t// Assign classes\n\tvar classes = this[\"class\"].split(\" \") || [],\n\t\tisPoppedUp = (this.popup || this.popupTitle) && this.isPoppedUp();\n\tif(this.selectedClass) {\n\t\tif((this.set || this.setTitle) && this.setTo && this.isSelected()) {\n\t\t\t$tw.utils.pushTop(classes,this.selectedClass.split(\" \"));\n\t\t}\n\t\tif(isPoppedUp) {\n\t\t\t$tw.utils.pushTop(classes,this.selectedClass.split(\" \"));\n\t\t}\n\t}\n\tif(isPoppedUp) {\n\t\t$tw.utils.pushTop(classes,\"tc-popup-handle\");\n\t}\n\tdomNode.className = classes.join(\" \");\n\t// Assign other attributes\n\tif(this.style) {\n\t\tdomNode.setAttribute(\"style\",this.style);\n\t}\n\tif(this.tooltip) {\n\t\tdomNode.setAttribute(\"title\",this.tooltip);\n\t}\n\tif(this[\"aria-label\"]) {\n\t\tdomNode.setAttribute(\"aria-label\",this[\"aria-label\"]);\n\t}\n\t// Set the tabindex\n\tif(this.tabIndex) {\n\t\tdomNode.setAttribute(\"tabindex\",this.tabIndex);\n\t}\t\n\t// Add a click event handler\n\tdomNode.addEventListener(\"click\",function (event) {\n\t\tvar handled = false;\n\t\tif(self.invokeActions(self,event)) {\n\t\t\thandled = true;\n\t\t}\n\t\tif(self.to) {\n\t\t\tself.navigateTo(event);\n\t\t\thandled = true;\n\t\t}\n\t\tif(self.message) {\n\t\t\tself.dispatchMessage(event);\n\t\t\thandled = true;\n\t\t}\n\t\tif(self.popup || self.popupTitle) {\n\t\t\tself.triggerPopup(event);\n\t\t\thandled = true;\n\t\t}\n\t\tif(self.set || self.setTitle) {\n\t\t\tself.setTiddler();\n\t\t\thandled = true;\n\t\t}\n\t\tif(self.actions) {\n\t\t\tself.invokeActionString(self.actions,self,event);\n\t\t}\n\t\tif(handled) {\n\t\t\tevent.preventDefault();\n\t\t\tevent.stopPropagation();\n\t\t}\n\t\treturn handled;\n\t},false);\n\t// Make it draggable if required\n\tif(this.dragTiddler || this.dragFilter) {\n\t\t$tw.utils.makeDraggable({\n\t\t\tdomNode: domNode,\n\t\t\tdragTiddlerFn: function() {return self.dragTiddler;},\n\t\t\tdragFilterFn: function() {return self.dragFilter;},\n\t\t\twidget: this\n\t\t});\n\t}\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\n/*\nWe don't allow actions to propagate because we trigger actions ourselves\n*/\nButtonWidget.prototype.allowActionPropagation = function() {\n\treturn false;\n};\n\nButtonWidget.prototype.getBoundingClientRect = function() {\n\treturn this.domNodes[0].getBoundingClientRect();\n};\n\nButtonWidget.prototype.isSelected = function() {\n return this.setTitle ? (this.setField ? this.wiki.getTiddler(this.setTitle).getFieldString(this.setField) === this.setTo :\n\t\t(this.setIndex ? this.wiki.extractTiddlerDataItem(this.setTitle,this.setIndex) === this.setTo :\n\t\t\tthis.wiki.getTiddlerText(this.setTitle))) || this.defaultSetValue || this.getVariable(\"currentTiddler\") :\n\t\tthis.wiki.getTextReference(this.set,this.defaultSetValue,this.getVariable(\"currentTiddler\")) === this.setTo;\n};\n\nButtonWidget.prototype.isPoppedUp = function() {\n\tvar tiddler = this.popupTitle ? this.wiki.getTiddler(this.popupTitle) : this.wiki.getTiddler(this.popup);\n\tvar result = tiddler && tiddler.fields.text ? $tw.popup.readPopupState(tiddler.fields.text) : false;\n\treturn result;\n};\n\nButtonWidget.prototype.navigateTo = function(event) {\n\tvar bounds = this.getBoundingClientRect();\n\tthis.dispatchEvent({\n\t\ttype: \"tm-navigate\",\n\t\tnavigateTo: this.to,\n\t\tnavigateFromTitle: this.getVariable(\"storyTiddler\"),\n\t\tnavigateFromNode: this,\n\t\tnavigateFromClientRect: { top: bounds.top, left: bounds.left, width: bounds.width, right: bounds.right, bottom: bounds.bottom, height: bounds.height\n\t\t},\n\t\tnavigateSuppressNavigation: event.metaKey || event.ctrlKey || (event.button === 1),\n\t\tevent: event\n\t});\n};\n\nButtonWidget.prototype.dispatchMessage = function(event) {\n\tthis.dispatchEvent({type: this.message, param: this.param, tiddlerTitle: this.getVariable(\"currentTiddler\"), event: event});\n};\n\nButtonWidget.prototype.triggerPopup = function(event) {\n\tif(this.popupTitle) {\n\t\t$tw.popup.triggerPopup({\n\t\t\tdomNode: this.domNodes[0],\n\t\t\ttitle: this.popupTitle,\n\t\t\twiki: this.wiki,\n\t\t\tnoStateReference: true\n\t\t});\n\t} else {\n\t\t$tw.popup.triggerPopup({\n\t\t\tdomNode: this.domNodes[0],\n\t\t\ttitle: this.popup,\n\t\t\twiki: this.wiki\n\t\t});\n\t}\n};\n\nButtonWidget.prototype.setTiddler = function() {\n\tif(this.setTitle) {\n\t\tthis.setField ? this.wiki.setText(this.setTitle,this.setField,undefined,this.setTo) :\n\t\t\t\t(this.setIndex ? this.wiki.setText(this.setTitle,undefined,this.setIndex,this.setTo) :\n\t\t\t\tthis.wiki.setText(this.setTitle,\"text\",undefined,this.setTo));\n\t} else {\n\t\tthis.wiki.setTextReference(this.set,this.setTo,this.getVariable(\"currentTiddler\"));\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nButtonWidget.prototype.execute = function() {\n\t// Get attributes\n\tthis.actions = this.getAttribute(\"actions\");\n\tthis.to = this.getAttribute(\"to\");\n\tthis.message = this.getAttribute(\"message\");\n\tthis.param = this.getAttribute(\"param\");\n\tthis.set = this.getAttribute(\"set\");\n\tthis.setTo = this.getAttribute(\"setTo\");\n\tthis.popup = this.getAttribute(\"popup\");\n\tthis.hover = this.getAttribute(\"hover\");\n\tthis[\"class\"] = this.getAttribute(\"class\",\"\");\n\tthis[\"aria-label\"] = this.getAttribute(\"aria-label\");\n\tthis.tooltip = this.getAttribute(\"tooltip\");\n\tthis.style = this.getAttribute(\"style\");\n\tthis.selectedClass = this.getAttribute(\"selectedClass\");\n\tthis.defaultSetValue = this.getAttribute(\"default\",\"\");\n\tthis.buttonTag = this.getAttribute(\"tag\");\n\tthis.dragTiddler = this.getAttribute(\"dragTiddler\");\n\tthis.dragFilter = this.getAttribute(\"dragFilter\");\n\tthis.setTitle = this.getAttribute(\"setTitle\");\n\tthis.setField = this.getAttribute(\"setField\");\n\tthis.setIndex = this.getAttribute(\"setIndex\");\n\tthis.popupTitle = this.getAttribute(\"popupTitle\");\n\tthis.tabIndex = this.getAttribute(\"tabindex\");\n\t// Make child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nButtonWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.actions || changedAttributes.to || changedAttributes.message || changedAttributes.param || changedAttributes.set || changedAttributes.setTo || changedAttributes.popup || changedAttributes.hover || changedAttributes[\"class\"] || changedAttributes.selectedClass || changedAttributes.style || changedAttributes.dragFilter || changedAttributes.dragTiddler || (this.set && changedTiddlers[this.set]) || (this.popup && changedTiddlers[this.popup]) || (this.popupTitle && changedTiddlers[this.popupTitle]) || changedAttributes.setTitle || changedAttributes.setField || changedAttributes.setIndex || changedAttributes.popupTitle) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.button = ButtonWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/checkbox.js": {
"title": "$:/core/modules/widgets/checkbox.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/checkbox.js\ntype: application/javascript\nmodule-type: widget\n\nCheckbox widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar CheckboxWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nCheckboxWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nCheckboxWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Create our elements\n\tthis.labelDomNode = this.document.createElement(\"label\");\n\tthis.labelDomNode.setAttribute(\"class\",this.checkboxClass);\n\tthis.inputDomNode = this.document.createElement(\"input\");\n\tthis.inputDomNode.setAttribute(\"type\",\"checkbox\");\n\tif(this.getValue()) {\n\t\tthis.inputDomNode.setAttribute(\"checked\",\"true\");\n\t}\n\tthis.labelDomNode.appendChild(this.inputDomNode);\n\tthis.spanDomNode = this.document.createElement(\"span\");\n\tthis.labelDomNode.appendChild(this.spanDomNode);\n\t// Add a click event handler\n\t$tw.utils.addEventListeners(this.inputDomNode,[\n\t\t{name: \"change\", handlerObject: this, handlerMethod: \"handleChangeEvent\"}\n\t]);\n\t// Insert the label into the DOM and render any children\n\tparent.insertBefore(this.labelDomNode,nextSibling);\n\tthis.renderChildren(this.spanDomNode,null);\n\tthis.domNodes.push(this.labelDomNode);\n};\n\nCheckboxWidget.prototype.getValue = function() {\n\tvar tiddler = this.wiki.getTiddler(this.checkboxTitle);\n\tif(tiddler) {\n\t\tif(this.checkboxTag) {\n\t\t\tif(this.checkboxInvertTag) {\n\t\t\t\treturn !tiddler.hasTag(this.checkboxTag);\n\t\t\t} else {\n\t\t\t\treturn tiddler.hasTag(this.checkboxTag);\n\t\t\t}\n\t\t}\n\t\tif(this.checkboxField) {\n\t\t\tvar value;\n\t\t\tif($tw.utils.hop(tiddler.fields,this.checkboxField)) {\n\t\t\t\tvalue = tiddler.fields[this.checkboxField] || \"\";\n\t\t\t} else {\n\t\t\t\tvalue = this.checkboxDefault || \"\";\n\t\t\t}\n\t\t\tif(value === this.checkboxChecked) {\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\tif(value === this.checkboxUnchecked) {\n\t\t\t\treturn false;\n\t\t\t}\n\t\t}\n\t\tif(this.checkboxIndex) {\n\t\t\tvar value = this.wiki.extractTiddlerDataItem(tiddler,this.checkboxIndex,this.checkboxDefault || \"\");\n\t\t\tif(value === this.checkboxChecked) {\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\tif(value === this.checkboxUnchecked) {\n\t\t\t\treturn false;\n\t\t\t}\n\t\t}\n\t} else {\n\t\tif(this.checkboxTag) {\n\t\t\treturn false;\n\t\t}\n\t\tif(this.checkboxField) {\n\t\t\tif(this.checkboxDefault === this.checkboxChecked) {\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\tif(this.checkboxDefault === this.checkboxUnchecked) {\n\t\t\t\treturn false;\n\t\t\t}\n\t\t}\n\t}\n\treturn false;\n};\n\nCheckboxWidget.prototype.handleChangeEvent = function(event) {\n\tvar checked = this.inputDomNode.checked,\n\t\ttiddler = this.wiki.getTiddler(this.checkboxTitle),\n\t\tfallbackFields = {text: \"\"},\n\t\tnewFields = {title: this.checkboxTitle},\n\t\thasChanged = false,\n\t\ttagCheck = false,\n\t\thasTag = tiddler && tiddler.hasTag(this.checkboxTag),\n\t\tvalue = checked ? this.checkboxChecked : this.checkboxUnchecked;\n\tif(this.checkboxTag && this.checkboxInvertTag === \"yes\") {\n\t\ttagCheck = hasTag === checked;\n\t} else {\n\t\ttagCheck = hasTag !== checked;\n\t}\n\t// Set the tag if specified\n\tif(this.checkboxTag && (!tiddler || tagCheck)) {\n\t\tnewFields.tags = tiddler ? (tiddler.fields.tags || []).slice(0) : [];\n\t\tvar pos = newFields.tags.indexOf(this.checkboxTag);\n\t\tif(pos !== -1) {\n\t\t\tnewFields.tags.splice(pos,1);\n\t\t}\n\t\tif(this.checkboxInvertTag === \"yes\" && !checked) {\n\t\t\tnewFields.tags.push(this.checkboxTag);\n\t\t} else if(this.checkboxInvertTag !== \"yes\" && checked) {\n\t\t\tnewFields.tags.push(this.checkboxTag);\n\t\t}\n\t\thasChanged = true;\n\t}\n\t// Set the field if specified\n\tif(this.checkboxField) {\n\t\tif(!tiddler || tiddler.fields[this.checkboxField] !== value) {\n\t\t\tnewFields[this.checkboxField] = value;\n\t\t\thasChanged = true;\n\t\t}\n\t}\n\t// Set the index if specified\n\tif(this.checkboxIndex) {\n\t\tvar indexValue = this.wiki.extractTiddlerDataItem(this.checkboxTitle,this.checkboxIndex);\n\t\tif(!tiddler || indexValue !== value) {\n\t\t\thasChanged = true;\n\t\t}\n\t}\n\tif(hasChanged) {\n\t\tif(this.checkboxIndex) {\n\t\t\tthis.wiki.setText(this.checkboxTitle,\"\",this.checkboxIndex,value);\n\t\t} else {\n\t\t\tthis.wiki.addTiddler(new $tw.Tiddler(this.wiki.getCreationFields(),fallbackFields,tiddler,newFields,this.wiki.getModificationFields()));\n\t\t}\n\t}\n\t// Trigger actions\n\tif(this.checkboxActions) {\n\t\tthis.invokeActionString(this.checkboxActions,this,event);\n\t}\n\tif(this.checkboxCheckActions && checked) {\n\t\tthis.invokeActionString(this.checkboxCheckActions,this,event);\n\t}\n\tif(this.checkboxUncheckActions && !checked) {\n\t\tthis.invokeActionString(this.checkboxUncheckActions,this,event);\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nCheckboxWidget.prototype.execute = function() {\n\t// Get the parameters from the attributes\n\tthis.checkboxActions = this.getAttribute(\"actions\");\n\tthis.checkboxCheckActions = this.getAttribute(\"checkactions\");\n\tthis.checkboxUncheckActions = this.getAttribute(\"uncheckactions\");\n\tthis.checkboxTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.checkboxTag = this.getAttribute(\"tag\");\n\tthis.checkboxField = this.getAttribute(\"field\");\n\tthis.checkboxIndex = this.getAttribute(\"index\");\n\tthis.checkboxChecked = this.getAttribute(\"checked\");\n\tthis.checkboxUnchecked = this.getAttribute(\"unchecked\");\n\tthis.checkboxDefault = this.getAttribute(\"default\");\n\tthis.checkboxClass = this.getAttribute(\"class\",\"\");\n\tthis.checkboxInvertTag = this.getAttribute(\"invertTag\",\"\");\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nCheckboxWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.tag || changedAttributes.invertTag || changedAttributes.field || changedAttributes.index || changedAttributes.checked || changedAttributes.unchecked || changedAttributes[\"default\"] || changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\tvar refreshed = false;\n\t\tif(changedTiddlers[this.checkboxTitle]) {\n\t\t\tthis.inputDomNode.checked = this.getValue();\n\t\t\trefreshed = true;\n\t\t}\n\t\treturn this.refreshChildren(changedTiddlers) || refreshed;\n\t}\n};\n\nexports.checkbox = CheckboxWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/codeblock.js": {
"title": "$:/core/modules/widgets/codeblock.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/codeblock.js\ntype: application/javascript\nmodule-type: widget\n\nCode block node widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar CodeBlockWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nCodeBlockWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nCodeBlockWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar codeNode = this.document.createElement(\"code\"),\n\t\tdomNode = this.document.createElement(\"pre\");\n\tcodeNode.appendChild(this.document.createTextNode(this.getAttribute(\"code\")));\n\tdomNode.appendChild(codeNode);\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.domNodes.push(domNode);\n\tif(this.postRender) {\n\t\tthis.postRender();\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nCodeBlockWidget.prototype.execute = function() {\n\tthis.language = this.getAttribute(\"language\");\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nCodeBlockWidget.prototype.refresh = function(changedTiddlers) {\n\treturn false;\n};\n\nexports.codeblock = CodeBlockWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/count.js": {
"title": "$:/core/modules/widgets/count.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/count.js\ntype: application/javascript\nmodule-type: widget\n\nCount widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar CountWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nCountWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nCountWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar textNode = this.document.createTextNode(this.currentCount);\n\tparent.insertBefore(textNode,nextSibling);\n\tthis.domNodes.push(textNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nCountWidget.prototype.execute = function() {\n\t// Get parameters from our attributes\n\tthis.filter = this.getAttribute(\"filter\");\n\t// Execute the filter\n\tif(this.filter) {\n\t\tthis.currentCount = this.wiki.filterTiddlers(this.filter,this).length;\n\t} else {\n\t\tthis.currentCount = \"0\";\n\t}\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nCountWidget.prototype.refresh = function(changedTiddlers) {\n\t// Re-execute the filter to get the count\n\tthis.computeAttributes();\n\tvar oldCount = this.currentCount;\n\tthis.execute();\n\tif(this.currentCount !== oldCount) {\n\t\t// Regenerate and rerender the widget and replace the existing DOM node\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn false;\n\t}\n\n};\n\nexports.count = CountWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/diff-text.js": {
"title": "$:/core/modules/widgets/diff-text.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/diff-text.js\ntype: application/javascript\nmodule-type: widget\n\nWidget to display a diff between two texts\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget,\n\tdmp = require(\"$:/core/modules/utils/diff-match-patch/diff_match_patch.js\");\n\nvar DiffTextWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDiffTextWidget.prototype = new Widget();\n\nDiffTextWidget.prototype.invisibleCharacters = {\n\t\"\\n\": \"↩︎\\n\",\n\t\"\\r\": \"⇠\",\n\t\"\\t\": \"⇥\\t\"\n};\n\n/*\nRender this widget into the DOM\n*/\nDiffTextWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create the diff\n\tvar dmpObject = new dmp.diff_match_patch(),\n\t\tdiffs = dmpObject.diff_main(this.getAttribute(\"source\"),this.getAttribute(\"dest\"));\n\t// Apply required cleanup\n\tswitch(this.getAttribute(\"cleanup\",\"semantic\")) {\n\t\tcase \"none\":\n\t\t\t// No cleanup\n\t\t\tbreak;\n\t\tcase \"efficiency\":\n\t\t\tdmpObject.diff_cleanupEfficiency(diffs);\n\t\t\tbreak;\n\t\tdefault: // case \"semantic\"\n\t\t\tdmpObject.diff_cleanupSemantic(diffs);\n\t\t\tbreak;\n\t}\n\t// Create the elements\n\tvar domContainer = this.document.createElement(\"div\"), \n\t\tdomDiff = this.createDiffDom(diffs);\n\tparent.insertBefore(domContainer,nextSibling);\n\t// Set variables\n\tthis.setVariable(\"diff-count\",diffs.reduce(function(acc,diff) {\n\t\tif(diff[0] !== dmp.DIFF_EQUAL) {\n\t\t\tacc++;\n\t\t}\n\t\treturn acc;\n\t},0).toString());\n\t// Render child widgets\n\tthis.renderChildren(domContainer,null);\n\t// Render the diff\n\tdomContainer.appendChild(domDiff);\n\t// Save our container\n\tthis.domNodes.push(domContainer);\n};\n\n/*\nCreate DOM elements representing a list of diffs\n*/\nDiffTextWidget.prototype.createDiffDom = function(diffs) {\n\tvar self = this;\n\t// Create the element and assign the attributes\n\tvar domPre = this.document.createElement(\"pre\"),\n\t\tdomCode = this.document.createElement(\"code\");\n\t$tw.utils.each(diffs,function(diff) {\n\t\tvar tag = diff[0] === dmp.DIFF_INSERT ? \"ins\" : (diff[0] === dmp.DIFF_DELETE ? \"del\" : \"span\"),\n\t\t\tclassName = diff[0] === dmp.DIFF_INSERT ? \"tc-diff-insert\" : (diff[0] === dmp.DIFF_DELETE ? \"tc-diff-delete\" : \"tc-diff-equal\"),\n\t\t\tdom = self.document.createElement(tag),\n\t\t\ttext = diff[1],\n\t\t\tcurrPos = 0,\n\t\t\tre = /([\\x00-\\x1F])/mg,\n\t\t\tmatch = re.exec(text),\n\t\t\tspan,\n\t\t\tprintable;\n\t\tdom.className = className;\n\t\twhile(match) {\n\t\t\tif(currPos < match.index) {\n\t\t\t\tdom.appendChild(self.document.createTextNode(text.slice(currPos,match.index)));\n\t\t\t}\n\t\t\tspan = self.document.createElement(\"span\");\n\t\t\tspan.className = \"tc-diff-invisible\";\n\t\t\tprintable = self.invisibleCharacters[match[0]] || (\"[0x\" + match[0].charCodeAt(0).toString(16) + \"]\");\n\t\t\tspan.appendChild(self.document.createTextNode(printable));\n\t\t\tdom.appendChild(span);\n\t\t\tcurrPos = match.index + match[0].length;\n\t\t\tmatch = re.exec(text);\n\t\t}\n\t\tif(currPos < text.length) {\n\t\t\tdom.appendChild(self.document.createTextNode(text.slice(currPos)));\n\t\t}\n\t\tdomCode.appendChild(dom);\n\t});\n\tdomPre.appendChild(domCode);\n\treturn domPre;\n};\n\n/*\nCompute the internal state of the widget\n*/\nDiffTextWidget.prototype.execute = function() {\n\t// Make child widgets\n\tvar parseTreeNodes;\n\tif(this.parseTreeNode && this.parseTreeNode.children && this.parseTreeNode.children.length > 0) {\n\t\tparseTreeNodes = this.parseTreeNode.children;\n\t} else {\n\t\tparseTreeNodes = [{\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: \"$:/language/Diffs/CountMessage\"}\n\t\t\t}\n\t\t}];\n\t}\n\tthis.makeChildWidgets(parseTreeNodes);\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nDiffTextWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.source || changedAttributes.dest || changedAttributes.cleanup) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports[\"diff-text\"] = DiffTextWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/draggable.js": {
"title": "$:/core/modules/widgets/draggable.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/draggable.js\ntype: application/javascript\nmodule-type: widget\n\nDraggable widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DraggableWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDraggableWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDraggableWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Sanitise the specified tag\n\tvar tag = this.draggableTag;\n\tif($tw.config.htmlUnsafeElements.indexOf(tag) !== -1) {\n\t\ttag = \"div\";\n\t}\n\t// Create our element\n\tvar domNode = this.document.createElement(tag);\n\t// Assign classes\n\tvar classes = [\"tc-draggable\"];\n\tif(this.draggableClasses) {\n\t\tclasses.push(this.draggableClasses);\n\t}\n\tdomNode.setAttribute(\"class\",classes.join(\" \"));\n\t// Add event handlers\n\t$tw.utils.makeDraggable({\n\t\tdomNode: domNode,\n\t\tdragTiddlerFn: function() {return self.getAttribute(\"tiddler\");},\n\t\tdragFilterFn: function() {return self.getAttribute(\"filter\");},\n\t\tstartActions: self.startActions,\n\t\tendActions: self.endActions,\n\t\twidget: this\n\t});\n\t// Insert the link into the DOM and render any children\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nDraggableWidget.prototype.execute = function() {\n\t// Pick up our attributes\n\tthis.draggableTag = this.getAttribute(\"tag\",\"div\");\n\tthis.draggableClasses = this.getAttribute(\"class\");\n\tthis.startActions = this.getAttribute(\"startactions\");\n\tthis.endActions = this.getAttribute(\"endactions\");\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nDraggableWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tag || changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.draggable = DraggableWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/droppable.js": {
"title": "$:/core/modules/widgets/droppable.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/droppable.js\ntype: application/javascript\nmodule-type: widget\n\nDroppable widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DroppableWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDroppableWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDroppableWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar tag = this.parseTreeNode.isBlock ? \"div\" : \"span\";\n\tif(this.droppableTag && $tw.config.htmlUnsafeElements.indexOf(this.droppableTag) === -1) {\n\t\ttag = this.droppableTag;\n\t}\n\t// Create element and assign classes\n\tvar domNode = this.document.createElement(tag),\n\t\tclasses = (this[\"class\"] || \"\").split(\" \");\n\tclasses.push(\"tc-droppable\");\n\tdomNode.className = classes.join(\" \");\n\t// Add event handlers\n\tif(this.droppableEnable) {\n\t\t$tw.utils.addEventListeners(domNode,[\n\t\t\t{name: \"dragenter\", handlerObject: this, handlerMethod: \"handleDragEnterEvent\"},\n\t\t\t{name: \"dragover\", handlerObject: this, handlerMethod: \"handleDragOverEvent\"},\n\t\t\t{name: \"dragleave\", handlerObject: this, handlerMethod: \"handleDragLeaveEvent\"},\n\t\t\t{name: \"drop\", handlerObject: this, handlerMethod: \"handleDropEvent\"}\n\t\t]);\t\t\n\t}\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n\t// Stack of outstanding enter/leave events\n\tthis.currentlyEntered = [];\n};\n\nDroppableWidget.prototype.enterDrag = function(event) {\n\tif(this.currentlyEntered.indexOf(event.target) === -1) {\n\t\tthis.currentlyEntered.push(event.target);\n\t}\n\t// If we're entering for the first time we need to apply highlighting\n\t$tw.utils.addClass(this.domNodes[0],\"tc-dragover\");\n};\n\nDroppableWidget.prototype.leaveDrag = function(event) {\n\tvar pos = this.currentlyEntered.indexOf(event.target);\n\tif(pos !== -1) {\n\t\tthis.currentlyEntered.splice(pos,1);\n\t}\n\t// Remove highlighting if we're leaving externally. The hacky second condition is to resolve a problem with Firefox whereby there is an erroneous dragenter event if the node being dragged is within the dropzone\n\tif(this.currentlyEntered.length === 0 || (this.currentlyEntered.length === 1 && this.currentlyEntered[0] === $tw.dragInProgress)) {\n\t\tthis.currentlyEntered = [];\n\t\t$tw.utils.removeClass(this.domNodes[0],\"tc-dragover\");\n\t}\n};\n\nDroppableWidget.prototype.handleDragEnterEvent = function(event) {\n\tthis.enterDrag(event);\n\t// Tell the browser that we're ready to handle the drop\n\tevent.preventDefault();\n\t// Tell the browser not to ripple the drag up to any parent drop handlers\n\tevent.stopPropagation();\n\treturn false;\n};\n\nDroppableWidget.prototype.handleDragOverEvent = function(event) {\n\t// Check for being over a TEXTAREA or INPUT\n\tif([\"TEXTAREA\",\"INPUT\"].indexOf(event.target.tagName) !== -1) {\n\t\treturn false;\n\t}\n\t// Tell the browser that we're still interested in the drop\n\tevent.preventDefault();\n\t// Set the drop effect\n\tevent.dataTransfer.dropEffect = this.droppableEffect;\n\treturn false;\n};\n\nDroppableWidget.prototype.handleDragLeaveEvent = function(event) {\n\tthis.leaveDrag(event);\n\treturn false;\n};\n\nDroppableWidget.prototype.handleDropEvent = function(event) {\n\tvar self = this;\n\tthis.leaveDrag(event);\n\t// Check for being over a TEXTAREA or INPUT\n\tif([\"TEXTAREA\",\"INPUT\"].indexOf(event.target.tagName) !== -1) {\n\t\treturn false;\n\t}\n\tvar dataTransfer = event.dataTransfer;\n\t// Remove highlighting\n\t$tw.utils.removeClass(this.domNodes[0],\"tc-dragover\");\n\t// Try to import the various data types we understand\n\t$tw.utils.importDataTransfer(dataTransfer,null,function(fieldsArray) {\n\t\tfieldsArray.forEach(function(fields) {\n\t\t\tself.performActions(fields.title || fields.text,event);\n\t\t});\n\t});\n\t// Tell the browser that we handled the drop\n\tevent.preventDefault();\n\t// Stop the drop ripple up to any parent handlers\n\tevent.stopPropagation();\n\treturn false;\n};\n\nDroppableWidget.prototype.performActions = function(title,event) {\n\tif(this.droppableActions) {\n\t\tvar modifierKey = event.ctrlKey && ! event.shiftKey ? \"ctrl\" : event.shiftKey && !event.ctrlKey ? \"shift\" : \n\t\t\t\tevent.ctrlKey && event.shiftKey ? \"ctrl-shift\" : \"normal\" ;\n\t\tthis.invokeActionString(this.droppableActions,this,event,{actionTiddler: title, modifier: modifierKey});\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nDroppableWidget.prototype.execute = function() {\n\tthis.droppableActions = this.getAttribute(\"actions\");\n\tthis.droppableEffect = this.getAttribute(\"effect\",\"copy\");\n\tthis.droppableTag = this.getAttribute(\"tag\");\n\tthis.droppableClass = this.getAttribute(\"class\");\n\tthis.droppableEnable = (this.getAttribute(\"enable\") || \"yes\") === \"yes\";\n\t// Make child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nDroppableWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"class\"] || changedAttributes.tag || changedAttributes.enable) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.droppable = DroppableWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/dropzone.js": {
"title": "$:/core/modules/widgets/dropzone.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/dropzone.js\ntype: application/javascript\nmodule-type: widget\n\nDropzone widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DropZoneWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDropZoneWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDropZoneWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create element\n\tvar domNode = this.document.createElement(\"div\");\n\tdomNode.className = this.dropzoneClass || \"tc-dropzone\";\n\t// Add event handlers\n\tif(this.dropzoneEnable) {\n\t\t$tw.utils.addEventListeners(domNode,[\n\t\t\t{name: \"dragenter\", handlerObject: this, handlerMethod: \"handleDragEnterEvent\"},\n\t\t\t{name: \"dragover\", handlerObject: this, handlerMethod: \"handleDragOverEvent\"},\n\t\t\t{name: \"dragleave\", handlerObject: this, handlerMethod: \"handleDragLeaveEvent\"},\n\t\t\t{name: \"drop\", handlerObject: this, handlerMethod: \"handleDropEvent\"},\n\t\t\t{name: \"paste\", handlerObject: this, handlerMethod: \"handlePasteEvent\"},\n\t\t\t{name: \"dragend\", handlerObject: this, handlerMethod: \"handleDragEndEvent\"}\n\t\t]);\t\t\n\t}\n\tdomNode.addEventListener(\"click\",function (event) {\n\t},false);\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n\t// Stack of outstanding enter/leave events\n\tthis.currentlyEntered = [];\n};\n\nDropZoneWidget.prototype.enterDrag = function(event) {\n\tif(this.currentlyEntered.indexOf(event.target) === -1) {\n\t\tthis.currentlyEntered.push(event.target);\n\t}\n\t// If we're entering for the first time we need to apply highlighting\n\t$tw.utils.addClass(this.domNodes[0],\"tc-dragover\");\n};\n\nDropZoneWidget.prototype.leaveDrag = function(event) {\n\tvar pos = this.currentlyEntered.indexOf(event.target);\n\tif(pos !== -1) {\n\t\tthis.currentlyEntered.splice(pos,1);\n\t}\n\t// Remove highlighting if we're leaving externally\n\tif(this.currentlyEntered.length === 0) {\n\t\t$tw.utils.removeClass(this.domNodes[0],\"tc-dragover\");\n\t}\n};\n\nDropZoneWidget.prototype.handleDragEnterEvent = function(event) {\n\t// Check for this window being the source of the drag\n\tif($tw.dragInProgress) {\n\t\treturn false;\n\t}\n\tthis.enterDrag(event);\n\t// Tell the browser that we're ready to handle the drop\n\tevent.preventDefault();\n\t// Tell the browser not to ripple the drag up to any parent drop handlers\n\tevent.stopPropagation();\n};\n\nDropZoneWidget.prototype.handleDragOverEvent = function(event) {\n\t// Check for being over a TEXTAREA or INPUT\n\tif([\"TEXTAREA\",\"INPUT\"].indexOf(event.target.tagName) !== -1) {\n\t\treturn false;\n\t}\n\t// Check for this window being the source of the drag\n\tif($tw.dragInProgress) {\n\t\treturn false;\n\t}\n\t// Tell the browser that we're still interested in the drop\n\tevent.preventDefault();\n\tevent.dataTransfer.dropEffect = \"copy\"; // Explicitly show this is a copy\n};\n\nDropZoneWidget.prototype.handleDragLeaveEvent = function(event) {\n\tthis.leaveDrag(event);\n};\n\nDropZoneWidget.prototype.handleDragEndEvent = function(event) {\n\t$tw.utils.removeClass(this.domNodes[0],\"tc-dragover\");\n};\n\nDropZoneWidget.prototype.handleDropEvent = function(event) {\n\tvar self = this,\n\t\treadFileCallback = function(tiddlerFieldsArray) {\n\t\t\tself.dispatchEvent({type: \"tm-import-tiddlers\", param: JSON.stringify(tiddlerFieldsArray)});\n\t\t};\n\tthis.leaveDrag(event);\n\t// Check for being over a TEXTAREA or INPUT\n\tif([\"TEXTAREA\",\"INPUT\"].indexOf(event.target.tagName) !== -1) {\n\t\treturn false;\n\t}\n\t// Check for this window being the source of the drag\n\tif($tw.dragInProgress) {\n\t\treturn false;\n\t}\n\tvar self = this,\n\t\tdataTransfer = event.dataTransfer;\n\t// Remove highlighting\n\t$tw.utils.removeClass(this.domNodes[0],\"tc-dragover\");\n\t// Import any files in the drop\n\tvar numFiles = 0;\n\tif(dataTransfer.files) {\n\t\tnumFiles = this.wiki.readFiles(dataTransfer.files,{\n\t\t\tcallback: readFileCallback,\n\t\t\tdeserializer: this.dropzoneDeserializer\n\t\t});\n\t}\n\t// Try to import the various data types we understand\n\tif(numFiles === 0) {\n\t\t$tw.utils.importDataTransfer(dataTransfer,this.wiki.generateNewTitle(\"Untitled\"),readFileCallback);\n\t}\n\t// Tell the browser that we handled the drop\n\tevent.preventDefault();\n\t// Stop the drop ripple up to any parent handlers\n\tevent.stopPropagation();\n};\n\nDropZoneWidget.prototype.handlePasteEvent = function(event) {\n\tvar self = this,\n\t\treadFileCallback = function(tiddlerFieldsArray) {\n\t\t\tself.dispatchEvent({type: \"tm-import-tiddlers\", param: JSON.stringify(tiddlerFieldsArray)});\n\t\t};\n\t// Let the browser handle it if we're in a textarea or input box\n\tif([\"TEXTAREA\",\"INPUT\"].indexOf(event.target.tagName) == -1 && !event.target.isContentEditable) {\n\t\tvar self = this,\n\t\t\titems = event.clipboardData.items;\n\t\t// Enumerate the clipboard items\n\t\tfor(var t = 0; t<items.length; t++) {\n\t\t\tvar item = items[t];\n\t\t\tif(item.kind === \"file\") {\n\t\t\t\t// Import any files\n\t\t\t\tthis.wiki.readFile(item.getAsFile(),{\n\t\t\t\t\tcallback: readFileCallback,\n\t\t\t\t\tdeserializer: this.dropzoneDeserializer\n\t\t\t\t});\n\t\t\t} else if(item.kind === \"string\") {\n\t\t\t\t// Create tiddlers from string items\n\t\t\t\tvar type = item.type;\n\t\t\t\titem.getAsString(function(str) {\n\t\t\t\t\tvar tiddlerFields = {\n\t\t\t\t\t\ttitle: self.wiki.generateNewTitle(\"Untitled\"),\n\t\t\t\t\t\ttext: str,\n\t\t\t\t\t\ttype: type\n\t\t\t\t\t};\n\t\t\t\t\tif($tw.log.IMPORT) {\n\t\t\t\t\t\tconsole.log(\"Importing string '\" + str + \"', type: '\" + type + \"'\");\n\t\t\t\t\t}\n\t\t\t\t\tself.dispatchEvent({type: \"tm-import-tiddlers\", param: JSON.stringify([tiddlerFields])});\n\t\t\t\t});\n\t\t\t}\n\t\t}\n\t\t// Tell the browser that we've handled the paste\n\t\tevent.stopPropagation();\n\t\tevent.preventDefault();\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nDropZoneWidget.prototype.execute = function() {\n\tthis.dropzoneClass = this.getAttribute(\"class\");\n\tthis.dropzoneDeserializer = this.getAttribute(\"deserializer\");\n\tthis.dropzoneEnable = (this.getAttribute(\"enable\") || \"yes\") === \"yes\";\n\t// Make child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nDropZoneWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.enable) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.dropzone = DropZoneWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/edit-binary.js": {
"title": "$:/core/modules/widgets/edit-binary.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/edit-binary.js\ntype: application/javascript\nmodule-type: widget\n\nEdit-binary widget; placeholder for editing binary tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar BINARY_WARNING_MESSAGE = \"$:/core/ui/BinaryWarning\";\nvar EXPORT_BUTTON_IMAGE = \"$:/core/images/export-button\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EditBinaryWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEditBinaryWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEditBinaryWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nEditBinaryWidget.prototype.execute = function() {\n\t// Get our parameters\n\tvar editTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tvar tiddler = this.wiki.getTiddler(editTitle);\n\tvar type = tiddler.fields.type;\n\tvar text = tiddler.fields.text;\n\t// Transclude the binary data tiddler warning message\n\tvar warn = {\n\t\ttype: \"element\",\n\t\ttag: \"p\",\n\t\tchildren: [{\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: BINARY_WARNING_MESSAGE}\n\t\t\t}\n\t\t}]\n\t};\n\t// Create download link based on draft tiddler title\n\tvar link = {\n\t\ttype: \"element\",\n\t\ttag: \"a\",\n\t\tattributes: {\n\t\t\ttitle: {type: \"indirect\", textReference: \"!!draft.title\"},\n\t\t\tdownload: {type: \"indirect\", textReference: \"!!draft.title\"}\n\t\t},\n\t\tchildren: [{\n\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: EXPORT_BUTTON_IMAGE}\n\t\t\t}\n\t\t}]\n\t};\n\t// Set the link href to internal data URI (no external)\n\tif(text) {\n\t\tlink.attributes.href = {\n\t\t\ttype: \"string\", \n\t\t\tvalue: \"data:\" + type + \";base64,\" + text\n\t\t};\n\t}\n\t// Combine warning message and download link in a div\n\tvar element = {\n\t\ttype: \"element\",\n\t\ttag: \"div\",\n\t\tattributes: {\n\t\t\tclass: {type: \"string\", value: \"tc-binary-warning\"}\n\t\t},\n\t\tchildren: [warn, link]\n\t}\n\t// Construct the child widgets\n\tthis.makeChildWidgets([element]);\n};\n\n/*\nRefresh by refreshing our child widget\n*/\nEditBinaryWidget.prototype.refresh = function(changedTiddlers) {\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports[\"edit-binary\"] = EditBinaryWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/edit-bitmap.js": {
"title": "$:/core/modules/widgets/edit-bitmap.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/edit-bitmap.js\ntype: application/javascript\nmodule-type: widget\n\nEdit-bitmap widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Default image sizes\nvar DEFAULT_IMAGE_WIDTH = 600,\n\tDEFAULT_IMAGE_HEIGHT = 370,\n\tDEFAULT_IMAGE_TYPE = \"image/png\";\n\n// Configuration tiddlers\nvar LINE_WIDTH_TITLE = \"$:/config/BitmapEditor/LineWidth\",\n\tLINE_COLOUR_TITLE = \"$:/config/BitmapEditor/Colour\",\n\tLINE_OPACITY_TITLE = \"$:/config/BitmapEditor/Opacity\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EditBitmapWidget = function(parseTreeNode,options) {\n\t// Initialise the editor operations if they've not been done already\n\tif(!this.editorOperations) {\n\t\tEditBitmapWidget.prototype.editorOperations = {};\n\t\t$tw.modules.applyMethods(\"bitmapeditoroperation\",this.editorOperations);\n\t}\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEditBitmapWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEditBitmapWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Create the wrapper for the toolbar and render its content\n\tthis.toolbarNode = this.document.createElement(\"div\");\n\tthis.toolbarNode.className = \"tc-editor-toolbar\";\n\tparent.insertBefore(this.toolbarNode,nextSibling);\n\tthis.domNodes.push(this.toolbarNode);\n\t// Create the on-screen canvas\n\tthis.canvasDomNode = $tw.utils.domMaker(\"canvas\",{\n\t\tdocument: this.document,\n\t\t\"class\":\"tc-edit-bitmapeditor\",\n\t\teventListeners: [{\n\t\t\tname: \"touchstart\", handlerObject: this, handlerMethod: \"handleTouchStartEvent\"\n\t\t},{\n\t\t\tname: \"touchmove\", handlerObject: this, handlerMethod: \"handleTouchMoveEvent\"\n\t\t},{\n\t\t\tname: \"touchend\", handlerObject: this, handlerMethod: \"handleTouchEndEvent\"\n\t\t},{\n\t\t\tname: \"mousedown\", handlerObject: this, handlerMethod: \"handleMouseDownEvent\"\n\t\t},{\n\t\t\tname: \"mousemove\", handlerObject: this, handlerMethod: \"handleMouseMoveEvent\"\n\t\t},{\n\t\t\tname: \"mouseup\", handlerObject: this, handlerMethod: \"handleMouseUpEvent\"\n\t\t}]\n\t});\n\t// Set the width and height variables\n\tthis.setVariable(\"tv-bitmap-editor-width\",this.canvasDomNode.width + \"px\");\n\tthis.setVariable(\"tv-bitmap-editor-height\",this.canvasDomNode.height + \"px\");\n\t// Render toolbar child widgets\n\tthis.renderChildren(this.toolbarNode,null);\n\t// // Insert the elements into the DOM\n\tparent.insertBefore(this.canvasDomNode,nextSibling);\n\tthis.domNodes.push(this.canvasDomNode);\n\t// Load the image into the canvas\n\tif($tw.browser) {\n\t\tthis.loadCanvas();\n\t}\n\t// Add widget message listeners\n\tthis.addEventListeners([\n\t\t{type: \"tm-edit-bitmap-operation\", handler: \"handleEditBitmapOperationMessage\"}\n\t]);\n};\n\n/*\nHandle an edit bitmap operation message from the toolbar\n*/\nEditBitmapWidget.prototype.handleEditBitmapOperationMessage = function(event) {\n\t// Invoke the handler\n\tvar handler = this.editorOperations[event.param];\n\tif(handler) {\n\t\thandler.call(this,event);\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nEditBitmapWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.editTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nJust refresh the toolbar\n*/\nEditBitmapWidget.prototype.refresh = function(changedTiddlers) {\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nSet the bitmap size variables and refresh the toolbar\n*/\nEditBitmapWidget.prototype.refreshToolbar = function() {\n\t// Set the width and height variables\n\tthis.setVariable(\"tv-bitmap-editor-width\",this.canvasDomNode.width + \"px\");\n\tthis.setVariable(\"tv-bitmap-editor-height\",this.canvasDomNode.height + \"px\");\n\t// Refresh each of our child widgets\n\t$tw.utils.each(this.children,function(childWidget) {\n\t\tchildWidget.refreshSelf();\n\t});\n};\n\nEditBitmapWidget.prototype.loadCanvas = function() {\n\tvar tiddler = this.wiki.getTiddler(this.editTitle),\n\t\tcurrImage = new Image();\n\t// Set up event handlers for loading the image\n\tvar self = this;\n\tcurrImage.onload = function() {\n\t\t// Copy the image to the on-screen canvas\n\t\tself.initCanvas(self.canvasDomNode,currImage.width,currImage.height,currImage);\n\t\t// And also copy the current bitmap to the off-screen canvas\n\t\tself.currCanvas = self.document.createElement(\"canvas\");\n\t\tself.initCanvas(self.currCanvas,currImage.width,currImage.height,currImage);\n\t\t// Set the width and height input boxes\n\t\tself.refreshToolbar();\n\t};\n\tcurrImage.onerror = function() {\n\t\t// Set the on-screen canvas size and clear it\n\t\tself.initCanvas(self.canvasDomNode,DEFAULT_IMAGE_WIDTH,DEFAULT_IMAGE_HEIGHT);\n\t\t// Set the off-screen canvas size and clear it\n\t\tself.currCanvas = self.document.createElement(\"canvas\");\n\t\tself.initCanvas(self.currCanvas,DEFAULT_IMAGE_WIDTH,DEFAULT_IMAGE_HEIGHT);\n\t\t// Set the width and height input boxes\n\t\tself.refreshToolbar();\n\t};\n\t// Get the current bitmap into an image object\n\tif(tiddler && tiddler.fields.type && tiddler.fields.text) {\n\t\tcurrImage.src = \"data:\" + tiddler.fields.type + \";base64,\" + tiddler.fields.text;\t\t\n\t} else {\n\t\tcurrImage.width = DEFAULT_IMAGE_WIDTH;\n\t\tcurrImage.height = DEFAULT_IMAGE_HEIGHT;\n\t\tcurrImage.onerror();\n\t}\n};\n\nEditBitmapWidget.prototype.initCanvas = function(canvas,width,height,image) {\n\tcanvas.width = width;\n\tcanvas.height = height;\n\tvar ctx = canvas.getContext(\"2d\");\n\tif(image) {\n\t\tctx.drawImage(image,0,0);\n\t} else {\n\t\tctx.fillStyle = \"#fff\";\n\t\tctx.fillRect(0,0,canvas.width,canvas.height);\n\t}\n};\n\n/*\n** Change the size of the canvas, preserving the current image\n*/\nEditBitmapWidget.prototype.changeCanvasSize = function(newWidth,newHeight) {\n\t// Create and size a new canvas\n\tvar newCanvas = this.document.createElement(\"canvas\");\n\tthis.initCanvas(newCanvas,newWidth,newHeight);\n\t// Copy the old image\n\tvar ctx = newCanvas.getContext(\"2d\");\n\tctx.drawImage(this.currCanvas,0,0);\n\t// Set the new canvas as the current one\n\tthis.currCanvas = newCanvas;\n\t// Set the size of the onscreen canvas\n\tthis.canvasDomNode.width = newWidth;\n\tthis.canvasDomNode.height = newHeight;\n\t// Paint the onscreen canvas with the offscreen canvas\n\tctx = this.canvasDomNode.getContext(\"2d\");\n\tctx.drawImage(this.currCanvas,0,0);\n};\n\n/*\n** Rotate the canvas left by 90 degrees\n*/\nEditBitmapWidget.prototype.rotateCanvasLeft = function() {\n\t// Get the current size of the image\n\tvar origWidth = this.currCanvas.width,\n\t\torigHeight = this.currCanvas.height;\n\t// Create and size a new canvas\n\tvar newCanvas = this.document.createElement(\"canvas\"),\n\t\tnewWidth = origHeight,\n\t\tnewHeight = origWidth;\n\tthis.initCanvas(newCanvas,newWidth,newHeight);\n\t// Copy the old image\n\tvar ctx = newCanvas.getContext(\"2d\");\n\tctx.save();\n\tctx.translate(newWidth / 2,newHeight / 2);\n\tctx.rotate(-Math.PI / 2);\n\tctx.drawImage(this.currCanvas,-origWidth / 2,-origHeight / 2);\n\tctx.restore();\n\t// Set the new canvas as the current one\n\tthis.currCanvas = newCanvas;\n\t// Set the size of the onscreen canvas\n\tthis.canvasDomNode.width = newWidth;\n\tthis.canvasDomNode.height = newHeight;\n\t// Paint the onscreen canvas with the offscreen canvas\n\tctx = this.canvasDomNode.getContext(\"2d\");\n\tctx.drawImage(this.currCanvas,0,0);\n};\n\nEditBitmapWidget.prototype.handleTouchStartEvent = function(event) {\n\tthis.brushDown = true;\n\tthis.strokeStart(event.touches[0].clientX,event.touches[0].clientY);\n\tevent.preventDefault();\n\tevent.stopPropagation();\n\treturn false;\n};\n\nEditBitmapWidget.prototype.handleTouchMoveEvent = function(event) {\n\tif(this.brushDown) {\n\t\tthis.strokeMove(event.touches[0].clientX,event.touches[0].clientY);\n\t}\n\tevent.preventDefault();\n\tevent.stopPropagation();\n\treturn false;\n};\n\nEditBitmapWidget.prototype.handleTouchEndEvent = function(event) {\n\tif(this.brushDown) {\n\t\tthis.brushDown = false;\n\t\tthis.strokeEnd();\n\t}\n\tevent.preventDefault();\n\tevent.stopPropagation();\n\treturn false;\n};\n\nEditBitmapWidget.prototype.handleMouseDownEvent = function(event) {\n\tthis.strokeStart(event.clientX,event.clientY);\n\tthis.brushDown = true;\n\tevent.preventDefault();\n\tevent.stopPropagation();\n\treturn false;\n};\n\nEditBitmapWidget.prototype.handleMouseMoveEvent = function(event) {\n\tif(this.brushDown) {\n\t\tthis.strokeMove(event.clientX,event.clientY);\n\t\tevent.preventDefault();\n\t\tevent.stopPropagation();\n\t\treturn false;\n\t}\n\treturn true;\n};\n\nEditBitmapWidget.prototype.handleMouseUpEvent = function(event) {\n\tif(this.brushDown) {\n\t\tthis.brushDown = false;\n\t\tthis.strokeEnd();\n\t\tevent.preventDefault();\n\t\tevent.stopPropagation();\n\t\treturn false;\n\t}\n\treturn true;\n};\n\nEditBitmapWidget.prototype.adjustCoordinates = function(x,y) {\n\tvar canvasRect = this.canvasDomNode.getBoundingClientRect(),\n\t\tscale = this.canvasDomNode.width/canvasRect.width;\n\treturn {x: (x - canvasRect.left) * scale, y: (y - canvasRect.top) * scale};\n};\n\nEditBitmapWidget.prototype.strokeStart = function(x,y) {\n\t// Start off a new stroke\n\tthis.stroke = [this.adjustCoordinates(x,y)];\n};\n\nEditBitmapWidget.prototype.strokeMove = function(x,y) {\n\tvar ctx = this.canvasDomNode.getContext(\"2d\"),\n\t\tt;\n\t// Add the new position to the end of the stroke\n\tthis.stroke.push(this.adjustCoordinates(x,y));\n\t// Redraw the previous image\n\tctx.drawImage(this.currCanvas,0,0);\n\t// Render the stroke\n\tctx.globalAlpha = parseFloat(this.wiki.getTiddlerText(LINE_OPACITY_TITLE,\"1.0\"));\n\tctx.strokeStyle = this.wiki.getTiddlerText(LINE_COLOUR_TITLE,\"#ff0\");\n\tctx.lineWidth = parseFloat(this.wiki.getTiddlerText(LINE_WIDTH_TITLE,\"3\"));\n\tctx.lineCap = \"round\";\n\tctx.lineJoin = \"round\";\n\tctx.beginPath();\n\tctx.moveTo(this.stroke[0].x,this.stroke[0].y);\n\tfor(t=1; t<this.stroke.length-1; t++) {\n\t\tvar s1 = this.stroke[t],\n\t\t\ts2 = this.stroke[t-1],\n\t\t\ttx = (s1.x + s2.x)/2,\n\t\t\tty = (s1.y + s2.y)/2;\n\t\tctx.quadraticCurveTo(s2.x,s2.y,tx,ty);\n\t}\n\tctx.stroke();\n};\n\nEditBitmapWidget.prototype.strokeEnd = function() {\n\t// Copy the bitmap to the off-screen canvas\n\tvar ctx = this.currCanvas.getContext(\"2d\");\n\tctx.drawImage(this.canvasDomNode,0,0);\n\t// Save the image into the tiddler\n\tthis.saveChanges();\n};\n\nEditBitmapWidget.prototype.saveChanges = function() {\n\tvar tiddler = this.wiki.getTiddler(this.editTitle) || new $tw.Tiddler({title: this.editTitle,type: DEFAULT_IMAGE_TYPE});\n\t// data URIs look like \"data:<type>;base64,<text>\"\n\tvar dataURL = this.canvasDomNode.toDataURL(tiddler.fields.type),\n\t\tposColon = dataURL.indexOf(\":\"),\n\t\tposSemiColon = dataURL.indexOf(\";\"),\n\t\tposComma = dataURL.indexOf(\",\"),\n\t\ttype = dataURL.substring(posColon+1,posSemiColon),\n\t\ttext = dataURL.substring(posComma+1);\n\tvar update = {type: type, text: text};\n\tthis.wiki.addTiddler(new $tw.Tiddler(this.wiki.getModificationFields(),tiddler,update,this.wiki.getCreationFields()));\n};\n\nexports[\"edit-bitmap\"] = EditBitmapWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/edit-shortcut.js": {
"title": "$:/core/modules/widgets/edit-shortcut.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/edit-shortcut.js\ntype: application/javascript\nmodule-type: widget\n\nWidget to display an editable keyboard shortcut\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EditShortcutWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEditShortcutWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEditShortcutWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.inputNode = this.document.createElement(\"input\");\n\t// Assign classes\n\tif(this.shortcutClass) {\n\t\tthis.inputNode.className = this.shortcutClass;\t\t\n\t}\n\t// Assign other attributes\n\tif(this.shortcutStyle) {\n\t\tthis.inputNode.setAttribute(\"style\",this.shortcutStyle);\n\t}\n\tif(this.shortcutTooltip) {\n\t\tthis.inputNode.setAttribute(\"title\",this.shortcutTooltip);\n\t}\n\tif(this.shortcutPlaceholder) {\n\t\tthis.inputNode.setAttribute(\"placeholder\",this.shortcutPlaceholder);\n\t}\n\tif(this.shortcutAriaLabel) {\n\t\tthis.inputNode.setAttribute(\"aria-label\",this.shortcutAriaLabel);\n\t}\n\t// Assign the current shortcut\n\tthis.updateInputNode();\n\t// Add event handlers\n\t$tw.utils.addEventListeners(this.inputNode,[\n\t\t{name: \"keydown\", handlerObject: this, handlerMethod: \"handleKeydownEvent\"}\n\t]);\n\t// Link into the DOM\n\tparent.insertBefore(this.inputNode,nextSibling);\n\tthis.domNodes.push(this.inputNode);\n\t// Focus the input Node if focus === \"yes\" or focus === \"true\"\n\tif(this.shortcutFocus === \"yes\" || this.shortcutFocus === \"true\") {\n\t\tthis.focus();\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nEditShortcutWidget.prototype.execute = function() {\n\tthis.shortcutTiddler = this.getAttribute(\"tiddler\");\n\tthis.shortcutField = this.getAttribute(\"field\");\n\tthis.shortcutIndex = this.getAttribute(\"index\");\n\tthis.shortcutPlaceholder = this.getAttribute(\"placeholder\");\n\tthis.shortcutDefault = this.getAttribute(\"default\",\"\");\n\tthis.shortcutClass = this.getAttribute(\"class\");\n\tthis.shortcutStyle = this.getAttribute(\"style\");\n\tthis.shortcutTooltip = this.getAttribute(\"tooltip\");\n\tthis.shortcutAriaLabel = this.getAttribute(\"aria-label\");\n\tthis.shortcutFocus = this.getAttribute(\"focus\");\n};\n\n/*\nUpdate the value of the input node\n*/\nEditShortcutWidget.prototype.updateInputNode = function() {\n\tif(this.shortcutField) {\n\t\tvar tiddler = this.wiki.getTiddler(this.shortcutTiddler);\n\t\tif(tiddler && $tw.utils.hop(tiddler.fields,this.shortcutField)) {\n\t\t\tthis.inputNode.value = tiddler.getFieldString(this.shortcutField);\n\t\t} else {\n\t\t\tthis.inputNode.value = this.shortcutDefault;\n\t\t}\n\t} else if(this.shortcutIndex) {\n\t\tthis.inputNode.value = this.wiki.extractTiddlerDataItem(this.shortcutTiddler,this.shortcutIndex,this.shortcutDefault);\n\t} else {\n\t\tthis.inputNode.value = this.wiki.getTiddlerText(this.shortcutTiddler,this.shortcutDefault);\n\t}\n};\n\n/*\nHandle a dom \"keydown\" event\n*/\nEditShortcutWidget.prototype.handleKeydownEvent = function(event) {\n\t// Ignore shift, ctrl, meta, alt\n\tif(event.keyCode && $tw.keyboardManager.getModifierKeys().indexOf(event.keyCode) === -1) {\n\t\t// Get the shortcut text representation\n\t\tvar value = $tw.keyboardManager.getPrintableShortcuts([{\n\t\t\tctrlKey: event.ctrlKey,\n\t\t\tshiftKey: event.shiftKey,\n\t\t\taltKey: event.altKey,\n\t\t\tmetaKey: event.metaKey,\n\t\t\tkeyCode: event.keyCode\n\t\t}]);\n\t\tif(value.length > 0) {\n\t\t\tthis.wiki.setText(this.shortcutTiddler,this.shortcutField,this.shortcutIndex,value[0]);\n\t\t}\n\t\t// Ignore the keydown if it was already handled\n\t\tevent.preventDefault();\n\t\tevent.stopPropagation();\n\t\treturn true;\t\t\n\t} else {\n\t\treturn false;\n\t}\n};\n\n/*\nfocus the input node\n*/\nEditShortcutWidget.prototype.focus = function() {\n\tif(this.inputNode.focus && this.inputNode.select) {\n\t\tthis.inputNode.focus();\n\t\tthis.inputNode.select();\n\t}\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget needed re-rendering\n*/\nEditShortcutWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes.placeholder || changedAttributes[\"default\"] || changedAttributes[\"class\"] || changedAttributes.style || changedAttributes.tooltip || changedAttributes[\"aria-label\"] || changedAttributes.focus) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else if(changedTiddlers[this.shortcutTiddler]) {\n\t\tthis.updateInputNode();\n\t\treturn true;\n\t} else {\n\t\treturn false;\t\n\t}\n};\n\nexports[\"edit-shortcut\"] = EditShortcutWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/edit-text.js": {
"title": "$:/core/modules/widgets/edit-text.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/edit-text.js\ntype: application/javascript\nmodule-type: widget\n\nEdit-text widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar editTextWidgetFactory = require(\"$:/core/modules/editor/factory.js\").editTextWidgetFactory,\n\tFramedEngine = require(\"$:/core/modules/editor/engines/framed.js\").FramedEngine,\n\tSimpleEngine = require(\"$:/core/modules/editor/engines/simple.js\").SimpleEngine;\n\nexports[\"edit-text\"] = editTextWidgetFactory(FramedEngine,SimpleEngine);\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/edit.js": {
"title": "$:/core/modules/widgets/edit.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/edit.js\ntype: application/javascript\nmodule-type: widget\n\nEdit widget is a meta-widget chooses the appropriate actual editting widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EditWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEditWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEditWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n// Mappings from content type to editor type are stored in tiddlers with this prefix\nvar EDITOR_MAPPING_PREFIX = \"$:/config/EditorTypeMappings/\";\n\n/*\nCompute the internal state of the widget\n*/\nEditWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.editTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.editField = this.getAttribute(\"field\",\"text\");\n\tthis.editIndex = this.getAttribute(\"index\");\n\tthis.editClass = this.getAttribute(\"class\");\n\tthis.editPlaceholder = this.getAttribute(\"placeholder\");\n\tthis.editTabIndex = this.getAttribute(\"tabindex\");\n\tthis.editFocus = this.getAttribute(\"focus\",\"\");\n\t// Choose the appropriate edit widget\n\tthis.editorType = this.getEditorType();\n\t// Make the child widgets\n\tthis.makeChildWidgets([{\n\t\ttype: \"edit-\" + this.editorType,\n\t\tattributes: {\n\t\t\ttiddler: {type: \"string\", value: this.editTitle},\n\t\t\tfield: {type: \"string\", value: this.editField},\n\t\t\tindex: {type: \"string\", value: this.editIndex},\n\t\t\t\"class\": {type: \"string\", value: this.editClass},\n\t\t\t\"placeholder\": {type: \"string\", value: this.editPlaceholder},\n\t\t\t\"tabindex\": {type: \"string\", value: this.editTabIndex},\n\t\t\t\"focus\": {type: \"string\", value: this.editFocus}\n\t\t},\n\t\tchildren: this.parseTreeNode.children\n\t}]);\n};\n\nEditWidget.prototype.getEditorType = function() {\n\t// Get the content type of the thing we're editing\n\tvar type;\n\tif(this.editField === \"text\") {\n\t\tvar tiddler = this.wiki.getTiddler(this.editTitle);\n\t\tif(tiddler) {\n\t\t\ttype = tiddler.fields.type;\n\t\t}\n\t}\n\ttype = type || \"text/vnd.tiddlywiki\";\n\tvar editorType = this.wiki.getTiddlerText(EDITOR_MAPPING_PREFIX + type);\n\tif(!editorType) {\n\t\tvar typeInfo = $tw.config.contentTypeInfo[type];\n\t\tif(typeInfo && typeInfo.encoding === \"base64\") {\n\t\t\teditorType = \"binary\";\n\t\t} else {\n\t\t\teditorType = \"text\";\n\t\t}\n\t}\n\treturn editorType;\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nEditWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\t// Refresh if an attribute has changed, or the type associated with the target tiddler has changed\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes.tabindex || (changedTiddlers[this.editTitle] && this.getEditorType() !== this.editorType)) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.edit = EditWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/element.js": {
"title": "$:/core/modules/widgets/element.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/element.js\ntype: application/javascript\nmodule-type: widget\n\nElement widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ElementWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nElementWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nElementWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Neuter blacklisted elements\n\tvar tag = this.parseTreeNode.tag;\n\tif($tw.config.htmlUnsafeElements.indexOf(tag) !== -1) {\n\t\ttag = \"safe-\" + tag;\n\t}\n\t// Adjust headings by the current base level\n\tvar headingLevel = [\"h1\",\"h2\",\"h3\",\"h4\",\"h5\",\"h6\"].indexOf(tag);\n\tif(headingLevel !== -1) {\n\t\tvar baseLevel = parseInt(this.getVariable(\"tv-adjust-heading-level\",\"0\"),10) || 0;\n\t\theadingLevel = Math.min(Math.max(headingLevel + 1 + baseLevel,1),6);\n\t\ttag = \"h\" + headingLevel;\n\t}\n\t// Create the DOM node\n\tvar domNode = this.document.createElementNS(this.namespace,tag);\n\tthis.assignAttributes(domNode,{excludeEventAttributes: true});\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nElementWidget.prototype.execute = function() {\n\t// Select the namespace for the tag\n\tvar tagNamespaces = {\n\t\t\tsvg: \"http://www.w3.org/2000/svg\",\n\t\t\tmath: \"http://www.w3.org/1998/Math/MathML\",\n\t\t\tbody: \"http://www.w3.org/1999/xhtml\"\n\t\t};\n\tthis.namespace = tagNamespaces[this.parseTreeNode.tag];\n\tif(this.namespace) {\n\t\tthis.setVariable(\"namespace\",this.namespace);\n\t} else {\n\t\tthis.namespace = this.getVariable(\"namespace\",{defaultValue: \"http://www.w3.org/1999/xhtml\"});\n\t}\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nElementWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes(),\n\t\thasChangedAttributes = $tw.utils.count(changedAttributes) > 0;\n\tif(hasChangedAttributes) {\n\t\t// Update our attributes\n\t\tthis.assignAttributes(this.domNodes[0],{excludeEventAttributes: true});\n\t}\n\treturn this.refreshChildren(changedTiddlers) || hasChangedAttributes;\n};\n\nexports.element = ElementWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/encrypt.js": {
"title": "$:/core/modules/widgets/encrypt.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/encrypt.js\ntype: application/javascript\nmodule-type: widget\n\nEncrypt widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EncryptWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEncryptWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEncryptWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar textNode = this.document.createTextNode(this.encryptedText);\n\tparent.insertBefore(textNode,nextSibling);\n\tthis.domNodes.push(textNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nEncryptWidget.prototype.execute = function() {\n\t// Get parameters from our attributes\n\tthis.filter = this.getAttribute(\"filter\",\"[!is[system]]\");\n\t// Encrypt the filtered tiddlers\n\tvar tiddlers = this.wiki.filterTiddlers(this.filter),\n\t\tjson = {},\n\t\tself = this;\n\t$tw.utils.each(tiddlers,function(title) {\n\t\tvar tiddler = self.wiki.getTiddler(title),\n\t\t\tjsonTiddler = {};\n\t\tfor(var f in tiddler.fields) {\n\t\t\tjsonTiddler[f] = tiddler.getFieldString(f);\n\t\t}\n\t\tjson[title] = jsonTiddler;\n\t});\n\tthis.encryptedText = $tw.utils.htmlEncode($tw.crypto.encrypt(JSON.stringify(json)));\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nEncryptWidget.prototype.refresh = function(changedTiddlers) {\n\t// We don't need to worry about refreshing because the encrypt widget isn't for interactive use\n\treturn false;\n};\n\nexports.encrypt = EncryptWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/entity.js": {
"title": "$:/core/modules/widgets/entity.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/entity.js\ntype: application/javascript\nmodule-type: widget\n\nHTML entity widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar EntityWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nEntityWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nEntityWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.execute();\n\tvar entityString = this.getAttribute(\"entity\",this.parseTreeNode.entity || \"\"),\n\t\ttextNode = this.document.createTextNode($tw.utils.entityDecode(entityString));\n\tparent.insertBefore(textNode,nextSibling);\n\tthis.domNodes.push(textNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nEntityWidget.prototype.execute = function() {\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nEntityWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.entity) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn false;\t\n\t}\n};\n\nexports.entity = EntityWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/fieldmangler.js": {
"title": "$:/core/modules/widgets/fieldmangler.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/fieldmangler.js\ntype: application/javascript\nmodule-type: widget\n\nField mangler widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar FieldManglerWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n\tthis.addEventListeners([\n\t\t{type: \"tm-remove-field\", handler: \"handleRemoveFieldEvent\"},\n\t\t{type: \"tm-add-field\", handler: \"handleAddFieldEvent\"},\n\t\t{type: \"tm-remove-tag\", handler: \"handleRemoveTagEvent\"},\n\t\t{type: \"tm-add-tag\", handler: \"handleAddTagEvent\"}\n\t]);\n};\n\n/*\nInherit from the base widget class\n*/\nFieldManglerWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nFieldManglerWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nFieldManglerWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.mangleTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nFieldManglerWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\t\t\n\t}\n};\n\nFieldManglerWidget.prototype.handleRemoveFieldEvent = function(event) {\n\tvar tiddler = this.wiki.getTiddler(this.mangleTitle),\n\t\tdeletion = {};\n\tdeletion[event.param] = undefined;\n\tthis.wiki.addTiddler(new $tw.Tiddler(tiddler,deletion));\n\treturn true;\n};\n\nFieldManglerWidget.prototype.handleAddFieldEvent = function(event) {\n\tvar tiddler = this.wiki.getTiddler(this.mangleTitle),\n\t\taddition = this.wiki.getModificationFields(),\n\t\thadInvalidFieldName = false,\n\t\taddField = function(name,value) {\n\t\t\tvar trimmedName = name.toLowerCase().trim();\n\t\t\tif(!$tw.utils.isValidFieldName(trimmedName)) {\n\t\t\t\tif(!hadInvalidFieldName) {\n\t\t\t\t\talert($tw.language.getString(\n\t\t\t\t\t\t\"InvalidFieldName\",\n\t\t\t\t\t\t{variables:\n\t\t\t\t\t\t\t{fieldName: trimmedName}\n\t\t\t\t\t\t}\n\t\t\t\t\t));\n\t\t\t\t\thadInvalidFieldName = true;\n\t\t\t\t\treturn;\n\t\t\t\t}\n\t\t\t} else {\n\t\t\t\tif(!value && tiddler) {\n\t\t\t\t\tvalue = tiddler.fields[trimmedName];\n\t\t\t\t}\n\t\t\t\taddition[trimmedName] = value || \"\";\n\t\t\t}\n\t\t\treturn;\n\t\t};\n\taddition.title = this.mangleTitle;\n\tif(typeof event.param === \"string\") {\n\t\taddField(event.param,\"\");\n\t}\n\tif(typeof event.paramObject === \"object\") {\n\t\tfor(var name in event.paramObject) {\n\t\t\taddField(name,event.paramObject[name]);\n\t\t}\n\t}\n\tthis.wiki.addTiddler(new $tw.Tiddler(tiddler,addition));\n\treturn true;\n};\n\nFieldManglerWidget.prototype.handleRemoveTagEvent = function(event) {\n\tvar tiddler = this.wiki.getTiddler(this.mangleTitle),\n\t\tmodification = this.wiki.getModificationFields();\n\tif(tiddler && tiddler.fields.tags) {\n\t\tvar p = tiddler.fields.tags.indexOf(event.param);\n\t\tif(p !== -1) {\n\t\t\tmodification.tags = (tiddler.fields.tags || []).slice(0);\n\t\t\tmodification.tags.splice(p,1);\n\t\t\tif(modification.tags.length === 0) {\n\t\t\t\tmodification.tags = undefined;\n\t\t\t}\n\t\t\tthis.wiki.addTiddler(new $tw.Tiddler(tiddler,modification));\n\t\t}\n\t}\n\treturn true;\n};\n\nFieldManglerWidget.prototype.handleAddTagEvent = function(event) {\n\tvar tiddler = this.wiki.getTiddler(this.mangleTitle),\n\t\tmodification = this.wiki.getModificationFields();\n\tif(tiddler && typeof event.param === \"string\") {\n\t\tvar tag = event.param.trim();\n\t\tif(tag !== \"\") {\n\t\t\tmodification.tags = (tiddler.fields.tags || []).slice(0);\n\t\t\t$tw.utils.pushTop(modification.tags,tag);\n\t\t\tthis.wiki.addTiddler(new $tw.Tiddler(tiddler,modification));\t\t\t\n\t\t}\n\t} else if(typeof event.param === \"string\" && event.param.trim() !== \"\" && this.mangleTitle.trim() !== \"\") {\n\t\tvar tag = [];\n\t\ttag.push(event.param.trim());\n\t\tthis.wiki.addTiddler(new $tw.Tiddler({title: this.mangleTitle, tags: tag},modification));\n\t}\n\treturn true;\n};\n\nexports.fieldmangler = FieldManglerWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/fields.js": {
"title": "$:/core/modules/widgets/fields.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/fields.js\ntype: application/javascript\nmodule-type: widget\n\nFields widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar FieldsWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nFieldsWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nFieldsWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar textNode = this.document.createTextNode(this.text);\n\tparent.insertBefore(textNode,nextSibling);\n\tthis.domNodes.push(textNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nFieldsWidget.prototype.execute = function() {\n\t// Get parameters from our attributes\n\tthis.tiddlerTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.template = this.getAttribute(\"template\");\n\tthis.sort = this.getAttribute(\"sort\",\"yes\") === \"yes\";\n\tthis.sortReverse = this.getAttribute(\"sortReverse\",\"no\") === \"yes\";\n\tthis.exclude = this.getAttribute(\"exclude\");\n\tthis.include = this.getAttribute(\"include\",null);\n\tthis.stripTitlePrefix = this.getAttribute(\"stripTitlePrefix\",\"no\") === \"yes\";\n\t// Get the value to display\n\tvar tiddler = this.wiki.getTiddler(this.tiddlerTitle);\n\n\t// Get the inclusion and exclusion list\n\tvar excludeArr = (this.exclude) ? this.exclude.split(\" \") : [\"text\"];\n\t// Include takes precedence\n\tvar includeArr = (this.include) ? this.include.split(\" \") : null;\n\n\t// Compose the template\n\tvar text = [];\n\tif(this.template && tiddler) {\n\t\tvar fields = [];\n\t\tif (includeArr) { // Include takes precedence\n\t\t\tfor(var i=0; i<includeArr.length; i++) {\n\t\t\t\tif(tiddler.fields[includeArr[i]]) {\n\t\t\t\t\tfields.push(includeArr[i]);\n\t\t\t\t}\n\t\t\t}\n\t\t} else {\n\t\t\tfor(var fieldName in tiddler.fields) {\n\t\t\t\tif(excludeArr.indexOf(fieldName) === -1) {\n\t\t\t\t\tfields.push(fieldName);\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t\tif (this.sort) fields.sort();\n\t\tif (this.sortReverse) fields.reverse();\n\t\tfor(var f=0, fmax=fields.length; f<fmax; f++) {\n\t\t\tfieldName = fields[f];\n\t\t\tvar row = this.template,\n\t\t\t\tvalue = tiddler.getFieldString(fieldName);\n\t\t\tif(this.stripTitlePrefix && fieldName === \"title\") {\n\t\t\t\tvar reStrip = /^\\{[^\\}]+\\}(.+)/mg,\n\t\t\t\t\treMatch = reStrip.exec(value);\n\t\t\t\tif(reMatch) {\n\t\t\t\t\tvalue = reMatch[1];\n\t\t\t\t}\n\t\t\t}\n\t\t\trow = $tw.utils.replaceString(row,\"$name$\",fieldName);\n\t\t\trow = $tw.utils.replaceString(row,\"$value$\",value);\n\t\t\trow = $tw.utils.replaceString(row,\"$encoded_value$\",$tw.utils.htmlEncode(value));\n\t\t\ttext.push(row);\n\t\t}\n\t}\n\tthis.text = text.join(\"\");\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nFieldsWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif( changedAttributes.tiddler || changedAttributes.template || changedAttributes.exclude ||\n\t\tchangedAttributes.include || changedAttributes.sort || changedAttributes.sortReverse ||\n\t\tchangedTiddlers[this.tiddlerTitle] || changedAttributes.stripTitlePrefix) {\n\t\t\tthis.refreshSelf();\n\t\t\treturn true;\n\t} else {\n\t\treturn false;\n\t}\n};\n\nexports.fields = FieldsWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/image.js": {
"title": "$:/core/modules/widgets/image.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/image.js\ntype: application/javascript\nmodule-type: widget\n\nThe image widget displays an image referenced with an external URI or with a local tiddler title.\n\n```\n<$image src=\"TiddlerTitle\" width=\"320\" height=\"400\" class=\"classnames\">\n```\n\nThe image source can be the title of an existing tiddler or the URL of an external image.\n\nExternal images always generate an HTML `<img>` tag.\n\nTiddlers that have a _canonical_uri field generate an HTML `<img>` tag with the src attribute containing the URI.\n\nTiddlers that contain image data generate an HTML `<img>` tag with the src attribute containing a base64 representation of the image.\n\nTiddlers that contain wikitext could be rendered to a DIV of the usual size of a tiddler, and then transformed to the size requested.\n\nThe width and height attributes are interpreted as a number of pixels, and do not need to include the \"px\" suffix.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ImageWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nImageWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nImageWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create element\n\t// Determine what type of image it is\n\tvar tag = \"img\", src = \"\",\n\t\ttiddler = this.wiki.getTiddler(this.imageSource);\n\tif(!tiddler) {\n\t\t// The source isn't the title of a tiddler, so we'll assume it's a URL\n\t\tsrc = this.getVariable(\"tv-get-export-image-link\",{params: [{name: \"src\",value: this.imageSource}],defaultValue: this.imageSource});\n\t} else {\n\t\t// Check if it is an image tiddler\n\t\tif(this.wiki.isImageTiddler(this.imageSource)) {\n\t\t\tvar type = tiddler.fields.type,\n\t\t\t\ttext = tiddler.fields.text,\n\t\t\t\t_canonical_uri = tiddler.fields._canonical_uri;\n\t\t\t// If the tiddler has body text then it doesn't need to be lazily loaded\n\t\t\tif(text) {\n\t\t\t\t// Render the appropriate element for the image type\n\t\t\t\tswitch(type) {\n\t\t\t\t\tcase \"application/pdf\":\n\t\t\t\t\t\ttag = \"embed\";\n\t\t\t\t\t\tsrc = \"data:application/pdf;base64,\" + text;\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tcase \"image/svg+xml\":\n\t\t\t\t\t\tsrc = \"data:image/svg+xml,\" + encodeURIComponent(text);\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tdefault:\n\t\t\t\t\t\tsrc = \"data:\" + type + \";base64,\" + text;\n\t\t\t\t\t\tbreak;\n\t\t\t\t}\n\t\t\t} else if(_canonical_uri) {\n\t\t\t\tswitch(type) {\n\t\t\t\t\tcase \"application/pdf\":\n\t\t\t\t\t\ttag = \"embed\";\n\t\t\t\t\t\tsrc = _canonical_uri;\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tcase \"image/svg+xml\":\n\t\t\t\t\t\tsrc = _canonical_uri;\n\t\t\t\t\t\tbreak;\n\t\t\t\t\tdefault:\n\t\t\t\t\t\tsrc = _canonical_uri;\n\t\t\t\t\t\tbreak;\n\t\t\t\t}\t\n\t\t\t} else {\n\t\t\t\t// Just trigger loading of the tiddler\n\t\t\t\tthis.wiki.getTiddlerText(this.imageSource);\n\t\t\t}\n\t\t}\n\t}\n\t// Create the element and assign the attributes\n\tvar domNode = this.document.createElement(tag);\n\tdomNode.setAttribute(\"src\",src);\n\tif(this.imageClass) {\n\t\tdomNode.setAttribute(\"class\",this.imageClass);\t\t\n\t}\n\tif(this.imageWidth) {\n\t\tdomNode.setAttribute(\"width\",this.imageWidth);\n\t}\n\tif(this.imageHeight) {\n\t\tdomNode.setAttribute(\"height\",this.imageHeight);\n\t}\n\tif(this.imageTooltip) {\n\t\tdomNode.setAttribute(\"title\",this.imageTooltip);\t\t\n\t}\n\tif(this.imageAlt) {\n\t\tdomNode.setAttribute(\"alt\",this.imageAlt);\t\t\n\t}\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.domNodes.push(domNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nImageWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.imageSource = this.getAttribute(\"source\");\n\tthis.imageWidth = this.getAttribute(\"width\");\n\tthis.imageHeight = this.getAttribute(\"height\");\n\tthis.imageClass = this.getAttribute(\"class\");\n\tthis.imageTooltip = this.getAttribute(\"tooltip\");\n\tthis.imageAlt = this.getAttribute(\"alt\");\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nImageWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.source || changedAttributes.width || changedAttributes.height || changedAttributes[\"class\"] || changedAttributes.tooltip || changedTiddlers[this.imageSource]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn false;\t\t\n\t}\n};\n\nexports.image = ImageWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/importvariables.js": {
"title": "$:/core/modules/widgets/importvariables.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/importvariables.js\ntype: application/javascript\nmodule-type: widget\n\nImport variable definitions from other tiddlers\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ImportVariablesWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nImportVariablesWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nImportVariablesWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nImportVariablesWidget.prototype.execute = function(tiddlerList) {\n\tvar widgetPointer = this;\n\t// Get our parameters\n\tthis.filter = this.getAttribute(\"filter\");\n\t// Compute the filter\n\tthis.tiddlerList = tiddlerList || this.wiki.filterTiddlers(this.filter,this);\n\t// Accumulate the <$set> widgets from each tiddler\n\t$tw.utils.each(this.tiddlerList,function(title) {\n\t\tvar parser = widgetPointer.wiki.parseTiddler(title);\n\t\tif(parser) {\n\t\t\tvar parseTreeNode = parser.tree[0];\n\t\t\twhile(parseTreeNode && parseTreeNode.type === \"set\") {\n\t\t\t\tvar node = {\n\t\t\t\t\ttype: \"set\",\n\t\t\t\t\tattributes: parseTreeNode.attributes,\n\t\t\t\t\tparams: parseTreeNode.params,\n\t\t\t\t\tisMacroDefinition: parseTreeNode.isMacroDefinition\n\t\t\t\t};\n\t\t\t\tif (parseTreeNode.isMacroDefinition) {\n\t\t\t\t\t// Macro definitions can be folded into\n\t\t\t\t\t// current widget instead of adding\n\t\t\t\t\t// another link to the chain.\n\t\t\t\t\tvar widget = widgetPointer.makeChildWidget(node);\n\t\t\t\t\twidget.computeAttributes();\n\t\t\t\t\twidget.execute();\n\t\t\t\t\t// We SHALLOW copy over all variables\n\t\t\t\t\t// in widget. We can't use\n\t\t\t\t\t// $tw.utils.assign, because that copies\n\t\t\t\t\t// up the prototype chain, which we\n\t\t\t\t\t// don't want.\n\t\t\t\t\t$tw.utils.each(Object.keys(widget.variables), function(key) {\n\t\t\t\t\t\twidgetPointer.variables[key] = widget.variables[key];\n\t\t\t\t\t});\n\t\t\t\t} else {\n\t\t\t\t\twidgetPointer.makeChildWidgets([node]);\n\t\t\t\t\twidgetPointer = widgetPointer.children[0];\n\t\t\t\t}\n\t\t\t\tparseTreeNode = parseTreeNode.children && parseTreeNode.children[0];\n\t\t\t}\n\t\t} \n\t});\n\n\tif (widgetPointer != this) {\n\t\twidgetPointer.parseTreeNode.children = this.parseTreeNode.children;\n\t} else {\n\t\twidgetPointer.makeChildWidgets();\n\t}\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nImportVariablesWidget.prototype.refresh = function(changedTiddlers) {\n\t// Recompute our attributes and the filter list\n\tvar changedAttributes = this.computeAttributes(),\n\t\ttiddlerList = this.wiki.filterTiddlers(this.getAttribute(\"filter\"),this);\n\t// Refresh if the filter has changed, or the list of tiddlers has changed, or any of the tiddlers in the list has changed\n\tfunction haveListedTiddlersChanged() {\n\t\tvar changed = false;\n\t\ttiddlerList.forEach(function(title) {\n\t\t\tif(changedTiddlers[title]) {\n\t\t\t\tchanged = true;\n\t\t\t}\n\t\t});\n\t\treturn changed;\n\t}\n\tif(changedAttributes.filter || !$tw.utils.isArrayEqual(this.tiddlerList,tiddlerList) || haveListedTiddlersChanged()) {\n\t\t// Compute the filter\n\t\tthis.removeChildDomNodes();\n\t\tthis.execute(tiddlerList);\n\t\tthis.renderChildren(this.parentDomNode,this.findNextSiblingDomNode());\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\t\t\n\t}\n};\n\nexports.importvariables = ImportVariablesWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/keyboard.js": {
"title": "$:/core/modules/widgets/keyboard.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/keyboard.js\ntype: application/javascript\nmodule-type: widget\n\nKeyboard shortcut widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar KeyboardWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nKeyboardWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nKeyboardWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar tag = this.parseTreeNode.isBlock ? \"div\" : \"span\";\n\tif(this.tag && $tw.config.htmlUnsafeElements.indexOf(this.tag) === -1) {\n\t\ttag = this.tag;\n\t}\n\t// Create element\n\tvar domNode = this.document.createElement(tag);\n\t// Assign classes\n\tvar classes = (this[\"class\"] || \"\").split(\" \");\n\tclasses.push(\"tc-keyboard\");\n\tdomNode.className = classes.join(\" \");\n\t// Add a keyboard event handler\n\tdomNode.addEventListener(\"keydown\",function (event) {\n\t\tif($tw.keyboardManager.checkKeyDescriptors(event,self.keyInfoArray)) {\n\t\t\tself.invokeActions(self,event);\n\t\t\tif(self.actions) {\n\t\t\t\tself.invokeActionString(self.actions,self,event);\n\t\t\t}\n\t\t\tself.dispatchMessage(event);\n\t\t\tevent.preventDefault();\n\t\t\tevent.stopPropagation();\n\t\t\treturn true;\n\t\t}\n\t\treturn false;\n\t},false);\n\t// Insert element\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\nKeyboardWidget.prototype.dispatchMessage = function(event) {\n\tthis.dispatchEvent({type: this.message, param: this.param, tiddlerTitle: this.getVariable(\"currentTiddler\")});\n};\n\n/*\nCompute the internal state of the widget\n*/\nKeyboardWidget.prototype.execute = function() {\n\tvar self = this;\n\t// Get attributes\n\tthis.actions = this.getAttribute(\"actions\",\"\");\n\tthis.message = this.getAttribute(\"message\",\"\");\n\tthis.param = this.getAttribute(\"param\",\"\");\n\tthis.key = this.getAttribute(\"key\",\"\");\n\tthis.tag = this.getAttribute(\"tag\",\"\");\n\tthis.keyInfoArray = $tw.keyboardManager.parseKeyDescriptors(this.key);\n\tthis[\"class\"] = this.getAttribute(\"class\",\"\");\n\tif(this.key.substr(0,2) === \"((\" && this.key.substr(-2,2) === \"))\") {\n\t\tthis.shortcutTiddlers = [];\n\t\tvar name = this.key.substring(2,this.key.length -2);\n\t\t$tw.utils.each($tw.keyboardManager.lookupNames,function(platformDescriptor) {\n\t\t\tself.shortcutTiddlers.push(\"$:/config/\" + platformDescriptor + \"/\" + name);\n\t\t});\n\t}\n\t// Make child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nKeyboardWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.message || changedAttributes.param || changedAttributes.key || changedAttributes[\"class\"] || changedAttributes.tag) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\t// Update the keyInfoArray if one of its shortcut-config-tiddlers has changed\n\tif(this.shortcutTiddlers && $tw.utils.hopArray(changedTiddlers,this.shortcutTiddlers)) {\n\t\tthis.keyInfoArray = $tw.keyboardManager.parseKeyDescriptors(this.key);\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.keyboard = KeyboardWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/link.js": {
"title": "$:/core/modules/widgets/link.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/link.js\ntype: application/javascript\nmodule-type: widget\n\nLink widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar LinkWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nLinkWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nLinkWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Get the value of the tv-wikilinks configuration macro\n\tvar wikiLinksMacro = this.getVariable(\"tv-wikilinks\"),\n\t\tuseWikiLinks = wikiLinksMacro ? (wikiLinksMacro.trim() !== \"no\") : true,\n\t\tmissingLinksEnabled = !(this.hideMissingLinks && this.isMissing && !this.isShadow);\n\t// Render the link if required\n\tif(useWikiLinks && missingLinksEnabled) {\n\t\tthis.renderLink(parent,nextSibling);\n\t} else {\n\t\t// Just insert the link text\n\t\tvar domNode = this.document.createElement(\"span\");\n\t\tparent.insertBefore(domNode,nextSibling);\n\t\tthis.renderChildren(domNode,null);\n\t\tthis.domNodes.push(domNode);\n\t}\n};\n\n/*\nRender this widget into the DOM\n*/\nLinkWidget.prototype.renderLink = function(parent,nextSibling) {\n\tvar self = this;\n\t// Sanitise the specified tag\n\tvar tag = this.linkTag;\n\tif($tw.config.htmlUnsafeElements.indexOf(tag) !== -1) {\n\t\ttag = \"a\";\n\t}\n\t// Create our element\n\tvar domNode = this.document.createElement(tag);\n\t// Assign classes\n\tvar classes = [];\n\tif(this.overrideClasses === undefined) {\n\t\tclasses.push(\"tc-tiddlylink\");\n\t\tif(this.isShadow) {\n\t\t\tclasses.push(\"tc-tiddlylink-shadow\");\n\t\t}\n\t\tif(this.isMissing && !this.isShadow) {\n\t\t\tclasses.push(\"tc-tiddlylink-missing\");\n\t\t} else {\n\t\t\tif(!this.isMissing) {\n\t\t\t\tclasses.push(\"tc-tiddlylink-resolves\");\n\t\t\t}\n\t\t}\n\t\tif(this.linkClasses) {\n\t\t\tclasses.push(this.linkClasses);\t\t\t\n\t\t}\n\t} else if(this.overrideClasses !== \"\") {\n\t\tclasses.push(this.overrideClasses)\n\t}\n\tif(classes.length > 0) {\n\t\tdomNode.setAttribute(\"class\",classes.join(\" \"));\n\t}\n\t// Set an href\n\tvar wikilinkTransformFilter = this.getVariable(\"tv-filter-export-link\"),\n\t\twikiLinkText;\n\tif(wikilinkTransformFilter) {\n\t\t// Use the filter to construct the href\n\t\twikiLinkText = this.wiki.filterTiddlers(wikilinkTransformFilter,this,function(iterator) {\n\t\t\titerator(self.wiki.getTiddler(self.to),self.to)\n\t\t})[0];\n\t} else {\n\t\t// Expand the tv-wikilink-template variable to construct the href\n\t\tvar wikiLinkTemplateMacro = this.getVariable(\"tv-wikilink-template\"),\n\t\t\twikiLinkTemplate = wikiLinkTemplateMacro ? wikiLinkTemplateMacro.trim() : \"#$uri_encoded$\";\n\t\twikiLinkText = $tw.utils.replaceString(wikiLinkTemplate,\"$uri_encoded$\",encodeURIComponent(this.to));\n\t\twikiLinkText = $tw.utils.replaceString(wikiLinkText,\"$uri_doubleencoded$\",encodeURIComponent(encodeURIComponent(this.to)));\n\t}\n\t// Override with the value of tv-get-export-link if defined\n\twikiLinkText = this.getVariable(\"tv-get-export-link\",{params: [{name: \"to\",value: this.to}],defaultValue: wikiLinkText});\n\tif(tag === \"a\") {\n\t\tdomNode.setAttribute(\"href\",wikiLinkText);\n\t}\n\t// Set the tabindex\n\tif(this.tabIndex) {\n\t\tdomNode.setAttribute(\"tabindex\",this.tabIndex);\n\t}\n\t// Set the tooltip\n\t// HACK: Performance issues with re-parsing the tooltip prevent us defaulting the tooltip to \"<$transclude field='tooltip'><$transclude field='title'/></$transclude>\"\n\tvar tooltipWikiText = this.tooltip || this.getVariable(\"tv-wikilink-tooltip\");\n\tif(tooltipWikiText) {\n\t\tvar tooltipText = this.wiki.renderText(\"text/plain\",\"text/vnd.tiddlywiki\",tooltipWikiText,{\n\t\t\t\tparseAsInline: true,\n\t\t\t\tvariables: {\n\t\t\t\t\tcurrentTiddler: this.to\n\t\t\t\t},\n\t\t\t\tparentWidget: this\n\t\t\t});\n\t\tdomNode.setAttribute(\"title\",tooltipText);\n\t}\n\tif(this[\"aria-label\"]) {\n\t\tdomNode.setAttribute(\"aria-label\",this[\"aria-label\"]);\n\t}\n\t// Add a click event handler\n\t$tw.utils.addEventListeners(domNode,[\n\t\t{name: \"click\", handlerObject: this, handlerMethod: \"handleClickEvent\"},\n\t]);\n\t// Make the link draggable if required\n\tif(this.draggable === \"yes\") {\n\t\t$tw.utils.makeDraggable({\n\t\t\tdomNode: domNode,\n\t\t\tdragTiddlerFn: function() {return self.to;},\n\t\t\twidget: this\n\t\t});\n\t}\n\t// Insert the link into the DOM and render any children\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\nLinkWidget.prototype.handleClickEvent = function(event) {\n\t// Send the click on its way as a navigate event\n\tvar bounds = this.domNodes[0].getBoundingClientRect();\n\tthis.dispatchEvent({\n\t\ttype: \"tm-navigate\",\n\t\tnavigateTo: this.to,\n\t\tnavigateFromTitle: this.getVariable(\"storyTiddler\"),\n\t\tnavigateFromNode: this,\n\t\tnavigateFromClientRect: { top: bounds.top, left: bounds.left, width: bounds.width, right: bounds.right, bottom: bounds.bottom, height: bounds.height\n\t\t},\n\t\tnavigateSuppressNavigation: event.metaKey || event.ctrlKey || (event.button === 1),\n\t\tmetaKey: event.metaKey,\n\t\tctrlKey: event.ctrlKey,\n\t\taltKey: event.altKey,\n\t\tshiftKey: event.shiftKey\n\t});\n\tif(this.domNodes[0].hasAttribute(\"href\")) {\n\t\tevent.preventDefault();\n\t}\n\tevent.stopPropagation();\n\treturn false;\n};\n\n/*\nCompute the internal state of the widget\n*/\nLinkWidget.prototype.execute = function() {\n\t// Pick up our attributes\n\tthis.to = this.getAttribute(\"to\",this.getVariable(\"currentTiddler\"));\n\tthis.tooltip = this.getAttribute(\"tooltip\");\n\tthis[\"aria-label\"] = this.getAttribute(\"aria-label\");\n\tthis.linkClasses = this.getAttribute(\"class\");\n\tthis.overrideClasses = this.getAttribute(\"overrideClass\");\n\tthis.tabIndex = this.getAttribute(\"tabindex\");\n\tthis.draggable = this.getAttribute(\"draggable\",\"yes\");\n\tthis.linkTag = this.getAttribute(\"tag\",\"a\");\n\t// Determine the link characteristics\n\tthis.isMissing = !this.wiki.tiddlerExists(this.to);\n\tthis.isShadow = this.wiki.isShadowTiddler(this.to);\n\tthis.hideMissingLinks = (this.getVariable(\"tv-show-missing-links\") || \"yes\") === \"no\";\n\t// Make the child widgets\n\tvar templateTree;\n\tif(this.parseTreeNode.children && this.parseTreeNode.children.length > 0) {\n\t\ttemplateTree = this.parseTreeNode.children;\n\t} else {\n\t\t// Default template is a link to the title\n\t\ttemplateTree = [{type: \"text\", text: this.to}];\n\t}\n\tthis.makeChildWidgets(templateTree);\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nLinkWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.to || changedTiddlers[this.to] || changedAttributes[\"aria-label\"] || changedAttributes.tooltip) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.link = LinkWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/linkcatcher.js": {
"title": "$:/core/modules/widgets/linkcatcher.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/linkcatcher.js\ntype: application/javascript\nmodule-type: widget\n\nLinkcatcher widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar LinkCatcherWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n\tthis.addEventListeners([\n\t\t{type: \"tm-navigate\", handler: \"handleNavigateEvent\"}\n\t]);\n};\n\n/*\nInherit from the base widget class\n*/\nLinkCatcherWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nLinkCatcherWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nLinkCatcherWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.catchTo = this.getAttribute(\"to\");\n\tthis.catchMessage = this.getAttribute(\"message\");\n\tthis.catchSet = this.getAttribute(\"set\");\n\tthis.catchSetTo = this.getAttribute(\"setTo\");\n\tthis.catchActions = this.getAttribute(\"actions\");\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n\t// When executing actions we avoid trapping navigate events, so that we don't trigger ourselves recursively\n\tthis.executingActions = false;\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nLinkCatcherWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.to || changedAttributes.message || changedAttributes.set || changedAttributes.setTo) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\t\t\n\t}\n};\n\n/*\nHandle a tm-navigate event\n*/\nLinkCatcherWidget.prototype.handleNavigateEvent = function(event) {\n\tif(!this.executingActions) {\n\t\t// Execute the actions\n\t\tif(this.catchTo) {\n\t\t\tthis.wiki.setTextReference(this.catchTo,event.navigateTo,this.getVariable(\"currentTiddler\"));\n\t\t}\n\t\tif(this.catchMessage && this.parentWidget) {\n\t\t\tthis.parentWidget.dispatchEvent({\n\t\t\t\ttype: this.catchMessage,\n\t\t\t\tparam: event.navigateTo,\n\t\t\t\tnavigateTo: event.navigateTo\n\t\t\t});\n\t\t}\n\t\tif(this.catchSet) {\n\t\t\tvar tiddler = this.wiki.getTiddler(this.catchSet);\n\t\t\tthis.wiki.addTiddler(new $tw.Tiddler(tiddler,{title: this.catchSet, text: this.catchSetTo}));\n\t\t}\n\t\tif(this.catchActions) {\n\t\t\tthis.executingActions = true;\n\t\t\tthis.invokeActionString(this.catchActions,this,event,{navigateTo: event.navigateTo});\n\t\t\tthis.executingActions = false;\n\t\t}\n\t} else {\n\t\t// This is a navigate event generated by the actions of this linkcatcher, so we don't trap it again, but just pass it to the parent\n\t\tthis.parentWidget.dispatchEvent({\n\t\t\ttype: \"tm-navigate\",\n\t\t\tparam: event.navigateTo,\n\t\t\tnavigateTo: event.navigateTo\n\t\t});\n\t}\n\treturn false;\n};\n\nexports.linkcatcher = LinkCatcherWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/list.js": {
"title": "$:/core/modules/widgets/list.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/list.js\ntype: application/javascript\nmodule-type: widget\n\nList and list item widgets\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\n/*\nThe list widget creates list element sub-widgets that reach back into the list widget for their configuration\n*/\n\nvar ListWidget = function(parseTreeNode,options) {\n\t// Initialise the storyviews if they've not been done already\n\tif(!this.storyViews) {\n\t\tListWidget.prototype.storyViews = {};\n\t\t$tw.modules.applyMethods(\"storyview\",this.storyViews);\n\t}\n\t// Main initialisation inherited from widget.js\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nListWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nListWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n\t// Construct the storyview\n\tvar StoryView = this.storyViews[this.storyViewName];\n\tif(this.storyViewName && !StoryView) {\n\t\tStoryView = this.storyViews[\"classic\"];\n\t}\n\tif(StoryView && !this.document.isTiddlyWikiFakeDom) {\n\t\tthis.storyview = new StoryView(this);\n\t} else {\n\t\tthis.storyview = null;\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nListWidget.prototype.execute = function() {\n\t// Get our attributes\n\tthis.template = this.getAttribute(\"template\");\n\tthis.editTemplate = this.getAttribute(\"editTemplate\");\n\tthis.variableName = this.getAttribute(\"variable\",\"currentTiddler\");\n\tthis.storyViewName = this.getAttribute(\"storyview\");\n\tthis.historyTitle = this.getAttribute(\"history\");\n\t// Compose the list elements\n\tthis.list = this.getTiddlerList();\n\tvar members = [],\n\t\tself = this;\n\t// Check for an empty list\n\tif(this.list.length === 0) {\n\t\tmembers = this.getEmptyMessage();\n\t} else {\n\t\t$tw.utils.each(this.list,function(title,index) {\n\t\t\tmembers.push(self.makeItemTemplate(title));\n\t\t});\n\t}\n\t// Construct the child widgets\n\tthis.makeChildWidgets(members);\n\t// Clear the last history\n\tthis.history = [];\n};\n\nListWidget.prototype.getTiddlerList = function() {\n\tvar defaultFilter = \"[!is[system]sort[title]]\";\n\treturn this.wiki.filterTiddlers(this.getAttribute(\"filter\",defaultFilter),this);\n};\n\nListWidget.prototype.getEmptyMessage = function() {\n\tvar emptyMessage = this.getAttribute(\"emptyMessage\",\"\"),\n\t\tparser = this.wiki.parseText(\"text/vnd.tiddlywiki\",emptyMessage,{parseAsInline: true});\n\tif(parser) {\n\t\treturn parser.tree;\n\t} else {\n\t\treturn [];\n\t}\n};\n\n/*\nCompose the template for a list item\n*/\nListWidget.prototype.makeItemTemplate = function(title) {\n\t// Check if the tiddler is a draft\n\tvar tiddler = this.wiki.getTiddler(title),\n\t\tisDraft = tiddler && tiddler.hasField(\"draft.of\"),\n\t\ttemplate = this.template,\n\t\ttemplateTree;\n\tif(isDraft && this.editTemplate) {\n\t\ttemplate = this.editTemplate;\n\t}\n\t// Compose the transclusion of the template\n\tif(template) {\n\t\ttemplateTree = [{type: \"transclude\", attributes: {tiddler: {type: \"string\", value: template}}}];\n\t} else {\n\t\tif(this.parseTreeNode.children && this.parseTreeNode.children.length > 0) {\n\t\t\ttemplateTree = this.parseTreeNode.children;\n\t\t} else {\n\t\t\t// Default template is a link to the title\n\t\t\ttemplateTree = [{type: \"element\", tag: this.parseTreeNode.isBlock ? \"div\" : \"span\", children: [{type: \"link\", attributes: {to: {type: \"string\", value: title}}, children: [\n\t\t\t\t\t{type: \"text\", text: title}\n\t\t\t]}]}];\n\t\t}\n\t}\n\t// Return the list item\n\treturn {type: \"listitem\", itemTitle: title, variableName: this.variableName, children: templateTree};\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nListWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes(),\n\t\tresult;\n\t// Call the storyview\n\tif(this.storyview && this.storyview.refreshStart) {\n\t\tthis.storyview.refreshStart(changedTiddlers,changedAttributes);\n\t}\n\t// Completely refresh if any of our attributes have changed\n\tif(changedAttributes.filter || changedAttributes.template || changedAttributes.editTemplate || changedAttributes.emptyMessage || changedAttributes.storyview || changedAttributes.history) {\n\t\tthis.refreshSelf();\n\t\tresult = true;\n\t} else {\n\t\t// Handle any changes to the list\n\t\tresult = this.handleListChanges(changedTiddlers);\n\t\t// Handle any changes to the history stack\n\t\tif(this.historyTitle && changedTiddlers[this.historyTitle]) {\n\t\t\tthis.handleHistoryChanges();\n\t\t}\n\t}\n\t// Call the storyview\n\tif(this.storyview && this.storyview.refreshEnd) {\n\t\tthis.storyview.refreshEnd(changedTiddlers,changedAttributes);\n\t}\n\treturn result;\n};\n\n/*\nHandle any changes to the history list\n*/\nListWidget.prototype.handleHistoryChanges = function() {\n\t// Get the history data\n\tvar newHistory = this.wiki.getTiddlerDataCached(this.historyTitle,[]);\n\t// Ignore any entries of the history that match the previous history\n\tvar entry = 0;\n\twhile(entry < newHistory.length && entry < this.history.length && newHistory[entry].title === this.history[entry].title) {\n\t\tentry++;\n\t}\n\t// Navigate forwards to each of the new tiddlers\n\twhile(entry < newHistory.length) {\n\t\tif(this.storyview && this.storyview.navigateTo) {\n\t\t\tthis.storyview.navigateTo(newHistory[entry]);\n\t\t}\n\t\tentry++;\n\t}\n\t// Update the history\n\tthis.history = newHistory;\n};\n\n/*\nProcess any changes to the list\n*/\nListWidget.prototype.handleListChanges = function(changedTiddlers) {\n\t// Get the new list\n\tvar prevList = this.list;\n\tthis.list = this.getTiddlerList();\n\t// Check for an empty list\n\tif(this.list.length === 0) {\n\t\t// Check if it was empty before\n\t\tif(prevList.length === 0) {\n\t\t\t// If so, just refresh the empty message\n\t\t\treturn this.refreshChildren(changedTiddlers);\n\t\t} else {\n\t\t\t// Replace the previous content with the empty message\n\t\t\tfor(t=this.children.length-1; t>=0; t--) {\n\t\t\t\tthis.removeListItem(t);\n\t\t\t}\n\t\t\tvar nextSibling = this.findNextSiblingDomNode();\n\t\t\tthis.makeChildWidgets(this.getEmptyMessage());\n\t\t\tthis.renderChildren(this.parentDomNode,nextSibling);\n\t\t\treturn true;\n\t\t}\n\t} else {\n\t\t// If the list was empty then we need to remove the empty message\n\t\tif(prevList.length === 0) {\n\t\t\tthis.removeChildDomNodes();\n\t\t\tthis.children = [];\n\t\t}\n\t\t// Cycle through the list, inserting and removing list items as needed\n\t\tvar hasRefreshed = false;\n\t\tfor(var t=0; t<this.list.length; t++) {\n\t\t\tvar index = this.findListItem(t,this.list[t]);\n\t\t\tif(index === undefined) {\n\t\t\t\t// The list item must be inserted\n\t\t\t\tthis.insertListItem(t,this.list[t]);\n\t\t\t\thasRefreshed = true;\n\t\t\t} else {\n\t\t\t\t// There are intervening list items that must be removed\n\t\t\t\tfor(var n=index-1; n>=t; n--) {\n\t\t\t\t\tthis.removeListItem(n);\n\t\t\t\t\thasRefreshed = true;\n\t\t\t\t}\n\t\t\t\t// Refresh the item we're reusing\n\t\t\t\tvar refreshed = this.children[t].refresh(changedTiddlers);\n\t\t\t\thasRefreshed = hasRefreshed || refreshed;\n\t\t\t}\n\t\t}\n\t\t// Remove any left over items\n\t\tfor(t=this.children.length-1; t>=this.list.length; t--) {\n\t\t\tthis.removeListItem(t);\n\t\t\thasRefreshed = true;\n\t\t}\n\t\treturn hasRefreshed;\n\t}\n};\n\n/*\nFind the list item with a given title, starting from a specified position\n*/\nListWidget.prototype.findListItem = function(startIndex,title) {\n\twhile(startIndex < this.children.length) {\n\t\tif(this.children[startIndex].parseTreeNode.itemTitle === title) {\n\t\t\treturn startIndex;\n\t\t}\n\t\tstartIndex++;\n\t}\n\treturn undefined;\n};\n\n/*\nInsert a new list item at the specified index\n*/\nListWidget.prototype.insertListItem = function(index,title) {\n\t// Create, insert and render the new child widgets\n\tvar widget = this.makeChildWidget(this.makeItemTemplate(title));\n\twidget.parentDomNode = this.parentDomNode; // Hack to enable findNextSiblingDomNode() to work\n\tthis.children.splice(index,0,widget);\n\tvar nextSibling = widget.findNextSiblingDomNode();\n\twidget.render(this.parentDomNode,nextSibling);\n\t// Animate the insertion if required\n\tif(this.storyview && this.storyview.insert) {\n\t\tthis.storyview.insert(widget);\n\t}\n\treturn true;\n};\n\n/*\nRemove the specified list item\n*/\nListWidget.prototype.removeListItem = function(index) {\n\tvar widget = this.children[index];\n\t// Animate the removal if required\n\tif(this.storyview && this.storyview.remove) {\n\t\tthis.storyview.remove(widget);\n\t} else {\n\t\twidget.removeChildDomNodes();\n\t}\n\t// Remove the child widget\n\tthis.children.splice(index,1);\n};\n\nexports.list = ListWidget;\n\nvar ListItemWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nListItemWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nListItemWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nListItemWidget.prototype.execute = function() {\n\t// Set the current list item title\n\tthis.setVariable(this.parseTreeNode.variableName,this.parseTreeNode.itemTitle);\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nListItemWidget.prototype.refresh = function(changedTiddlers) {\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.listitem = ListItemWidget;\n\n})();",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/macrocall.js": {
"title": "$:/core/modules/widgets/macrocall.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/macrocall.js\ntype: application/javascript\nmodule-type: widget\n\nMacrocall widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar MacroCallWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nMacroCallWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nMacroCallWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nMacroCallWidget.prototype.execute = function() {\n\t// Get the parse type if specified\n\tthis.parseType = this.getAttribute(\"$type\",\"text/vnd.tiddlywiki\");\n\tthis.renderOutput = this.getAttribute(\"$output\",\"text/html\");\n\t// Merge together the parameters specified in the parse tree with the specified attributes\n\tvar params = this.parseTreeNode.params ? this.parseTreeNode.params.slice(0) : [];\n\t$tw.utils.each(this.attributes,function(attribute,name) {\n\t\tif(name.charAt(0) !== \"$\") {\n\t\t\tparams.push({name: name, value: attribute});\t\t\t\n\t\t}\n\t});\n\t// Get the macro value\n\tvar macroName = this.parseTreeNode.name || this.getAttribute(\"$name\"),\n\t\tvariableInfo = this.getVariableInfo(macroName,{params: params}),\n\t\ttext = variableInfo.text,\n\t\tparseTreeNodes;\n\t// Are we rendering to HTML?\n\tif(this.renderOutput === \"text/html\") {\n\t\t// If so we'll return the parsed macro\n\t\tvar parser = this.wiki.parseText(this.parseType,text,\n\t\t\t\t\t\t\t{parseAsInline: !this.parseTreeNode.isBlock});\n\t\tparseTreeNodes = parser ? parser.tree : [];\n\t\t// Wrap the parse tree in a vars widget assigning the parameters to variables named \"__paramname__\"\n\t\tvar attributes = {};\n\t\t$tw.utils.each(variableInfo.params,function(param) {\n\t\t\tvar name = \"__\" + param.name + \"__\";\n\t\t\tattributes[name] = {\n\t\t\t\tname: name,\n\t\t\t\ttype: \"string\",\n\t\t\t\tvalue: param.value\n\t\t\t};\n\t\t});\n\t\tparseTreeNodes = [{\n\t\t\ttype: \"vars\",\n\t\t\tattributes: attributes,\n\t\t\tchildren: parseTreeNodes\n\t\t}];\n\t} else {\n\t\t// Otherwise, we'll render the text\n\t\tvar plainText = this.wiki.renderText(\"text/plain\",this.parseType,text,{parentWidget: this});\n\t\tparseTreeNodes = [{type: \"text\", text: plainText}];\n\t}\n\t// Construct the child widgets\n\tthis.makeChildWidgets(parseTreeNodes);\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nMacroCallWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif($tw.utils.count(changedAttributes) > 0) {\n\t\t// Rerender ourselves\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.macrocall = MacroCallWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/navigator.js": {
"title": "$:/core/modules/widgets/navigator.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/navigator.js\ntype: application/javascript\nmodule-type: widget\n\nNavigator widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar IMPORT_TITLE = \"$:/Import\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar NavigatorWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n\tthis.addEventListeners([\n\t\t{type: \"tm-navigate\", handler: \"handleNavigateEvent\"},\n\t\t{type: \"tm-edit-tiddler\", handler: \"handleEditTiddlerEvent\"},\n\t\t{type: \"tm-delete-tiddler\", handler: \"handleDeleteTiddlerEvent\"},\n\t\t{type: \"tm-save-tiddler\", handler: \"handleSaveTiddlerEvent\"},\n\t\t{type: \"tm-cancel-tiddler\", handler: \"handleCancelTiddlerEvent\"},\n\t\t{type: \"tm-close-tiddler\", handler: \"handleCloseTiddlerEvent\"},\n\t\t{type: \"tm-close-all-tiddlers\", handler: \"handleCloseAllTiddlersEvent\"},\n\t\t{type: \"tm-close-other-tiddlers\", handler: \"handleCloseOtherTiddlersEvent\"},\n\t\t{type: \"tm-new-tiddler\", handler: \"handleNewTiddlerEvent\"},\n\t\t{type: \"tm-import-tiddlers\", handler: \"handleImportTiddlersEvent\"},\n\t\t{type: \"tm-perform-import\", handler: \"handlePerformImportEvent\"},\n\t\t{type: \"tm-fold-tiddler\", handler: \"handleFoldTiddlerEvent\"},\n\t\t{type: \"tm-fold-other-tiddlers\", handler: \"handleFoldOtherTiddlersEvent\"},\n\t\t{type: \"tm-fold-all-tiddlers\", handler: \"handleFoldAllTiddlersEvent\"},\n\t\t{type: \"tm-unfold-all-tiddlers\", handler: \"handleUnfoldAllTiddlersEvent\"},\n\t\t{type: \"tm-rename-tiddler\", handler: \"handleRenameTiddlerEvent\"}\n\t]);\n};\n\n/*\nInherit from the base widget class\n*/\nNavigatorWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nNavigatorWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nNavigatorWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.storyTitle = this.getAttribute(\"story\");\n\tthis.historyTitle = this.getAttribute(\"history\");\n\tthis.setVariable(\"tv-story-list\",this.storyTitle);\n\tthis.setVariable(\"tv-history-list\",this.historyTitle);\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nNavigatorWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.story || changedAttributes.history) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nNavigatorWidget.prototype.getStoryList = function() {\n\treturn this.storyTitle ? this.wiki.getTiddlerList(this.storyTitle) : null;\n};\n\nNavigatorWidget.prototype.saveStoryList = function(storyList) {\n\tif(this.storyTitle) {\n\t\tvar storyTiddler = this.wiki.getTiddler(this.storyTitle);\n\t\tthis.wiki.addTiddler(new $tw.Tiddler(\n\t\t\t{title: this.storyTitle},\n\t\t\tstoryTiddler,\n\t\t\t{list: storyList}\n\t\t));\t\t\n\t}\n};\n\nNavigatorWidget.prototype.removeTitleFromStory = function(storyList,title) {\n\tif(storyList) {\n\t\tvar p = storyList.indexOf(title);\n\t\twhile(p !== -1) {\n\t\t\tstoryList.splice(p,1);\n\t\t\tp = storyList.indexOf(title);\n\t\t}\t\t\n\t}\n};\n\nNavigatorWidget.prototype.replaceFirstTitleInStory = function(storyList,oldTitle,newTitle) {\n\tif(storyList) {\n\t\tvar pos = storyList.indexOf(oldTitle);\n\t\tif(pos !== -1) {\n\t\t\tstoryList[pos] = newTitle;\n\t\t\tdo {\n\t\t\t\tpos = storyList.indexOf(oldTitle,pos + 1);\n\t\t\t\tif(pos !== -1) {\n\t\t\t\t\tstoryList.splice(pos,1);\n\t\t\t\t}\n\t\t\t} while(pos !== -1);\n\t\t} else {\n\t\t\tstoryList.splice(0,0,newTitle);\n\t\t}\t\t\n\t}\n};\n\nNavigatorWidget.prototype.addToStory = function(title,fromTitle) {\n\tif(this.storyTitle) {\n\t\tthis.wiki.addToStory(title,fromTitle,this.storyTitle,{\n\t\t\topenLinkFromInsideRiver: this.getAttribute(\"openLinkFromInsideRiver\",\"top\"),\n\t\t\topenLinkFromOutsideRiver: this.getAttribute(\"openLinkFromOutsideRiver\",\"top\")\n\t\t});\n\t}\n};\n\n/*\nAdd a new record to the top of the history stack\ntitle: a title string or an array of title strings\nfromPageRect: page coordinates of the origin of the navigation\n*/\nNavigatorWidget.prototype.addToHistory = function(title,fromPageRect) {\n\tthis.wiki.addToHistory(title,fromPageRect,this.historyTitle);\n};\n\n/*\nHandle a tm-navigate event\n*/\nNavigatorWidget.prototype.handleNavigateEvent = function(event) {\n\tevent = $tw.hooks.invokeHook(\"th-navigating\",event);\n\tif(event.navigateTo) {\n\t\tthis.addToStory(event.navigateTo,event.navigateFromTitle);\n\t\tif(!event.navigateSuppressNavigation) {\n\t\t\tthis.addToHistory(event.navigateTo,event.navigateFromClientRect);\n\t\t}\n\t}\n\treturn false;\n};\n\n// Close a specified tiddler\nNavigatorWidget.prototype.handleCloseTiddlerEvent = function(event) {\n\tvar title = event.param || event.tiddlerTitle,\n\t\tstoryList = this.getStoryList();\n\t// Look for tiddlers with this title to close\n\tthis.removeTitleFromStory(storyList,title);\n\tthis.saveStoryList(storyList);\n\treturn false;\n};\n\n// Close all tiddlers\nNavigatorWidget.prototype.handleCloseAllTiddlersEvent = function(event) {\n\tthis.saveStoryList([]);\n\treturn false;\n};\n\n// Close other tiddlers\nNavigatorWidget.prototype.handleCloseOtherTiddlersEvent = function(event) {\n\tvar title = event.param || event.tiddlerTitle;\n\tthis.saveStoryList([title]);\n\treturn false;\n};\n\n// Place a tiddler in edit mode\nNavigatorWidget.prototype.handleEditTiddlerEvent = function(event) {\n\tvar editTiddler = $tw.hooks.invokeHook(\"th-editing-tiddler\",event);\n\tif(!editTiddler) {\n\t\treturn false;\n\t}\n\tvar self = this;\n\tfunction isUnmodifiedShadow(title) {\n\t\treturn self.wiki.isShadowTiddler(title) && !self.wiki.tiddlerExists(title);\n\t}\n\tfunction confirmEditShadow(title) {\n\t\treturn confirm($tw.language.getString(\n\t\t\t\"ConfirmEditShadowTiddler\",\n\t\t\t{variables:\n\t\t\t\t{title: title}\n\t\t\t}\n\t\t));\n\t}\n\tvar title = event.param || event.tiddlerTitle;\n\tif(isUnmodifiedShadow(title) && !confirmEditShadow(title)) {\n\t\treturn false;\n\t}\n\t// Replace the specified tiddler with a draft in edit mode\n\tvar draftTiddler = this.makeDraftTiddler(title);\n\t// Update the story and history if required\n\tif(!event.paramObject || event.paramObject.suppressNavigation !== \"yes\") {\n\t\tvar draftTitle = draftTiddler.fields.title,\n\t\t\tstoryList = this.getStoryList();\n\t\tthis.removeTitleFromStory(storyList,draftTitle);\n\t\tthis.replaceFirstTitleInStory(storyList,title,draftTitle);\n\t\tthis.addToHistory(draftTitle,event.navigateFromClientRect);\n\t\tthis.saveStoryList(storyList);\n\t\treturn false;\n\t}\n};\n\n// Delete a tiddler\nNavigatorWidget.prototype.handleDeleteTiddlerEvent = function(event) {\n\t// Get the tiddler we're deleting\n\tvar title = event.param || event.tiddlerTitle,\n\t\ttiddler = this.wiki.getTiddler(title),\n\t\tstoryList = this.getStoryList(),\n\t\toriginalTitle = tiddler ? tiddler.fields[\"draft.of\"] : \"\",\n\t\toriginalTiddler = originalTitle ? this.wiki.getTiddler(originalTitle) : undefined,\n\t\tconfirmationTitle;\n\tif(!tiddler) {\n\t\treturn false;\n\t}\n\t// Check if the tiddler we're deleting is in draft mode\n\tif(originalTitle) {\n\t\t// If so, we'll prompt for confirmation referencing the original tiddler\n\t\tconfirmationTitle = originalTitle;\n\t} else {\n\t\t// If not a draft, then prompt for confirmation referencing the specified tiddler\n\t\tconfirmationTitle = title;\n\t}\n\t// Seek confirmation\n\tif((this.wiki.getTiddler(originalTitle) || (tiddler.fields.text || \"\") !== \"\") && !confirm($tw.language.getString(\n\t\t\t\t\"ConfirmDeleteTiddler\",\n\t\t\t\t{variables:\n\t\t\t\t\t{title: confirmationTitle}\n\t\t\t\t}\n\t\t\t))) {\n\t\treturn false;\n\t}\n\t// Delete the original tiddler\n\tif(originalTitle) {\n\t\tif(originalTiddler) {\n\t\t\t$tw.hooks.invokeHook(\"th-deleting-tiddler\",originalTiddler);\n\t\t}\n\t\tthis.wiki.deleteTiddler(originalTitle);\n\t\tthis.removeTitleFromStory(storyList,originalTitle);\n\t}\n\t// Invoke the hook function and delete this tiddler\n\t$tw.hooks.invokeHook(\"th-deleting-tiddler\",tiddler);\n\tthis.wiki.deleteTiddler(title);\n\t// Remove the closed tiddler from the story\n\tthis.removeTitleFromStory(storyList,title);\n\tthis.saveStoryList(storyList);\n\t// Trigger an autosave\n\t$tw.rootWidget.dispatchEvent({type: \"tm-auto-save-wiki\"});\n\treturn false;\n};\n\n/*\nCreate/reuse the draft tiddler for a given title\n*/\nNavigatorWidget.prototype.makeDraftTiddler = function(targetTitle) {\n\t// See if there is already a draft tiddler for this tiddler\n\tvar draftTitle = this.wiki.findDraft(targetTitle);\n\tif(draftTitle) {\n\t\treturn this.wiki.getTiddler(draftTitle);\n\t}\n\t// Get the current value of the tiddler we're editing\n\tvar tiddler = this.wiki.getTiddler(targetTitle);\n\t// Save the initial value of the draft tiddler\n\tdraftTitle = this.generateDraftTitle(targetTitle);\n\tvar draftTiddler = new $tw.Tiddler(\n\t\t\ttiddler,\n\t\t\t{\n\t\t\t\ttitle: draftTitle,\n\t\t\t\t\"draft.title\": targetTitle,\n\t\t\t\t\"draft.of\": targetTitle\n\t\t\t},\n\t\t\tthis.wiki.getModificationFields()\n\t\t);\n\tthis.wiki.addTiddler(draftTiddler);\n\treturn draftTiddler;\n};\n\n/*\nGenerate a title for the draft of a given tiddler\n*/\nNavigatorWidget.prototype.generateDraftTitle = function(title) {\n\treturn this.wiki.generateDraftTitle(title);\n};\n\n// Take a tiddler out of edit mode, saving the changes\nNavigatorWidget.prototype.handleSaveTiddlerEvent = function(event) {\n\tvar title = event.param || event.tiddlerTitle,\n\t\ttiddler = this.wiki.getTiddler(title),\n\t\tstoryList = this.getStoryList();\n\t// Replace the original tiddler with the draft\n\tif(tiddler) {\n\t\tvar draftTitle = (tiddler.fields[\"draft.title\"] || \"\").trim(),\n\t\t\tdraftOf = (tiddler.fields[\"draft.of\"] || \"\").trim();\n\t\tif(draftTitle) {\n\t\t\tvar isRename = draftOf !== draftTitle,\n\t\t\t\tisConfirmed = true;\n\t\t\tif(isRename && this.wiki.tiddlerExists(draftTitle)) {\n\t\t\t\tisConfirmed = confirm($tw.language.getString(\n\t\t\t\t\t\"ConfirmOverwriteTiddler\",\n\t\t\t\t\t{variables:\n\t\t\t\t\t\t{title: draftTitle}\n\t\t\t\t\t}\n\t\t\t\t));\n\t\t\t}\n\t\t\tif(isConfirmed) {\n\t\t\t\t// Create the new tiddler and pass it through the th-saving-tiddler hook\n\t\t\t\tvar newTiddler = new $tw.Tiddler(this.wiki.getCreationFields(),tiddler,{\n\t\t\t\t\ttitle: draftTitle,\n\t\t\t\t\t\"draft.title\": undefined,\n\t\t\t\t\t\"draft.of\": undefined\n\t\t\t\t},this.wiki.getModificationFields());\n\t\t\t\tnewTiddler = $tw.hooks.invokeHook(\"th-saving-tiddler\",newTiddler);\n\t\t\t\tthis.wiki.addTiddler(newTiddler);\n\t\t\t\t// If enabled, relink references to renamed tiddler\n\t\t\t\tvar shouldRelink = this.getAttribute(\"relinkOnRename\",\"no\").toLowerCase().trim() === \"yes\";\n\t\t\t\tif(isRename && shouldRelink && this.wiki.tiddlerExists(draftOf)) {\nconsole.log(\"Relinking '\" + draftOf + \"' to '\" + draftTitle + \"'\");\n\t\t\t\t\tthis.wiki.relinkTiddler(draftOf,draftTitle);\n\t\t\t\t}\n\t\t\t\t// Remove the draft tiddler\n\t\t\t\tthis.wiki.deleteTiddler(title);\n\t\t\t\t// Remove the original tiddler if we're renaming it\n\t\t\t\tif(isRename) {\n\t\t\t\t\tthis.wiki.deleteTiddler(draftOf);\n\t\t\t\t}\n\t\t\t\t// #2381 always remove new title & old\n\t\t\t\tthis.removeTitleFromStory(storyList,draftTitle);\n\t\t\t\tthis.removeTitleFromStory(storyList,draftOf);\n\t\t\t\tif(!event.paramObject || event.paramObject.suppressNavigation !== \"yes\") {\n\t\t\t\t\t// Replace the draft in the story with the original\n\t\t\t\t\tthis.replaceFirstTitleInStory(storyList,title,draftTitle);\n\t\t\t\t\tthis.addToHistory(draftTitle,event.navigateFromClientRect);\n\t\t\t\t\tif(draftTitle !== this.storyTitle) {\n\t\t\t\t\t\tthis.saveStoryList(storyList);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\t// Trigger an autosave\n\t\t\t\t$tw.rootWidget.dispatchEvent({type: \"tm-auto-save-wiki\"});\n\t\t\t}\n\t\t}\n\t}\n\treturn false;\n};\n\n// Take a tiddler out of edit mode without saving the changes\nNavigatorWidget.prototype.handleCancelTiddlerEvent = function(event) {\n\tevent = $tw.hooks.invokeHook(\"th-cancelling-tiddler\", event);\n\t// Flip the specified tiddler from draft back to the original\n\tvar draftTitle = event.param || event.tiddlerTitle,\n\t\tdraftTiddler = this.wiki.getTiddler(draftTitle),\n\t\toriginalTitle = draftTiddler && draftTiddler.fields[\"draft.of\"];\n\tif(draftTiddler && originalTitle) {\n\t\t// Ask for confirmation if the tiddler text has changed\n\t\tvar isConfirmed = true,\n\t\t\toriginalTiddler = this.wiki.getTiddler(originalTitle),\n\t\t\tstoryList = this.getStoryList();\n\t\tif(this.wiki.isDraftModified(draftTitle)) {\n\t\t\tisConfirmed = confirm($tw.language.getString(\n\t\t\t\t\"ConfirmCancelTiddler\",\n\t\t\t\t{variables:\n\t\t\t\t\t{title: draftTitle}\n\t\t\t\t}\n\t\t\t));\n\t\t}\n\t\t// Remove the draft tiddler\n\t\tif(isConfirmed) {\n\t\t\tthis.wiki.deleteTiddler(draftTitle);\n\t\t\tif(!event.paramObject || event.paramObject.suppressNavigation !== \"yes\") {\n\t\t\t\tif(originalTiddler) {\n\t\t\t\t\tthis.replaceFirstTitleInStory(storyList,draftTitle,originalTitle);\n\t\t\t\t\tthis.addToHistory(originalTitle,event.navigateFromClientRect);\n\t\t\t\t} else {\n\t\t\t\t\tthis.removeTitleFromStory(storyList,draftTitle);\n\t\t\t\t}\n\t\t\t\tthis.saveStoryList(storyList);\n\t\t\t}\n\t\t}\n\t}\n\treturn false;\n};\n\n// Create a new draft tiddler\n// event.param can either be the title of a template tiddler, or a hashmap of fields.\n//\n// The title of the newly created tiddler follows these rules:\n// * If a hashmap was used and a title field was specified, use that title\n// * If a hashmap was used without a title field, use a default title, if necessary making it unique with a numeric suffix\n// * If a template tiddler was used, use the title of the template, if necessary making it unique with a numeric suffix\n//\n// If a draft of the target tiddler already exists then it is reused\nNavigatorWidget.prototype.handleNewTiddlerEvent = function(event) {\n\tevent = $tw.hooks.invokeHook(\"th-new-tiddler\", event);\n\t// Get the story details\n\tvar storyList = this.getStoryList(),\n\t\ttemplateTiddler, additionalFields, title, draftTitle, existingTiddler;\n\t// Get the template tiddler (if any)\n\tif(typeof event.param === \"string\") {\n\t\t// Get the template tiddler\n\t\ttemplateTiddler = this.wiki.getTiddler(event.param);\n\t\t// Generate a new title\n\t\ttitle = this.wiki.generateNewTitle(event.param || $tw.language.getString(\"DefaultNewTiddlerTitle\"));\n\t}\n\t// Get the specified additional fields\n\tif(typeof event.paramObject === \"object\") {\n\t\tadditionalFields = event.paramObject;\n\t}\n\tif(typeof event.param === \"object\") { // Backwards compatibility with 5.1.3\n\t\tadditionalFields = event.param;\n\t}\n\tif(additionalFields && additionalFields.title) {\n\t\ttitle = additionalFields.title;\n\t}\n\t// Make a copy of the additional fields excluding any blank ones\n\tvar filteredAdditionalFields = $tw.utils.extend({},additionalFields);\n\tObject.keys(filteredAdditionalFields).forEach(function(fieldName) {\n\t\tif(filteredAdditionalFields[fieldName] === \"\") {\n\t\t\tdelete filteredAdditionalFields[fieldName];\n\t\t}\n\t});\n\t// Generate a title if we don't have one\n\ttitle = title || this.wiki.generateNewTitle($tw.language.getString(\"DefaultNewTiddlerTitle\"));\n\t// Find any existing draft for this tiddler\n\tdraftTitle = this.wiki.findDraft(title);\n\t// Pull in any existing tiddler\n\tif(draftTitle) {\n\t\texistingTiddler = this.wiki.getTiddler(draftTitle);\n\t} else {\n\t\tdraftTitle = this.generateDraftTitle(title);\n\t\texistingTiddler = this.wiki.getTiddler(title);\n\t}\n\t// Merge the tags\n\tvar mergedTags = [];\n\tif(existingTiddler && existingTiddler.fields.tags) {\n\t\t$tw.utils.pushTop(mergedTags,existingTiddler.fields.tags);\n\t}\n\tif(additionalFields && additionalFields.tags) {\n\t\t// Merge tags\n\t\tmergedTags = $tw.utils.pushTop(mergedTags,$tw.utils.parseStringArray(additionalFields.tags));\n\t}\n\tif(templateTiddler && templateTiddler.fields.tags) {\n\t\t// Merge tags\n\t\tmergedTags = $tw.utils.pushTop(mergedTags,templateTiddler.fields.tags);\n\t}\n\t// Save the draft tiddler\n\tvar draftTiddler = new $tw.Tiddler({\n\t\t\ttext: \"\",\n\t\t\t\"draft.title\": title\n\t\t},\n\t\ttemplateTiddler,\n\t\tadditionalFields,\n\t\tthis.wiki.getCreationFields(),\n\t\texistingTiddler,\n\t\tfilteredAdditionalFields,\n\t\t{\n\t\t\ttitle: draftTitle,\n\t\t\t\"draft.of\": title,\n\t\t\ttags: mergedTags\n\t\t},this.wiki.getModificationFields());\n\tthis.wiki.addTiddler(draftTiddler);\n\t// Update the story to insert the new draft at the top and remove any existing tiddler\n\tif(storyList && storyList.indexOf(draftTitle) === -1) {\n\t\tvar slot = storyList.indexOf(event.navigateFromTitle);\n\t\tif(slot === -1) {\n\t\t\tslot = this.getAttribute(\"openLinkFromOutsideRiver\",\"top\") === \"bottom\" ? storyList.length - 1 : slot;\n\t\t}\n\t\tstoryList.splice(slot + 1,0,draftTitle);\n\t}\n\tif(storyList && storyList.indexOf(title) !== -1) {\n\t\tstoryList.splice(storyList.indexOf(title),1);\n\t}\n\tthis.saveStoryList(storyList);\n\t// Add a new record to the top of the history stack\n\tthis.addToHistory(draftTitle);\n\treturn false;\n};\n\n// Import JSON tiddlers into a pending import tiddler\nNavigatorWidget.prototype.handleImportTiddlersEvent = function(event) {\n\t// Get the tiddlers\n\tvar tiddlers = [];\n\ttry {\n\t\ttiddlers = JSON.parse(event.param);\n\t} catch(e) {\n\t}\n\t// Get the current $:/Import tiddler\n\tvar importTiddler = this.wiki.getTiddler(IMPORT_TITLE),\n\t\timportData = this.wiki.getTiddlerData(IMPORT_TITLE,{}),\n\t\tnewFields = new Object({\n\t\t\ttitle: IMPORT_TITLE,\n\t\t\ttype: \"application/json\",\n\t\t\t\"plugin-type\": \"import\",\n\t\t\t\"status\": \"pending\"\n\t\t}),\n\t\tincomingTiddlers = [];\n\t// Process each tiddler\n\timportData.tiddlers = importData.tiddlers || {};\n\t$tw.utils.each(tiddlers,function(tiddlerFields) {\n\t\ttiddlerFields.title = $tw.utils.trim(tiddlerFields.title);\n\t\tvar title = tiddlerFields.title;\n\t\tif(title) {\n\t\t\tincomingTiddlers.push(title);\n\t\t\timportData.tiddlers[title] = tiddlerFields;\n\t\t}\n\t});\n\t// Give the active upgrader modules a chance to process the incoming tiddlers\n\tvar messages = this.wiki.invokeUpgraders(incomingTiddlers,importData.tiddlers);\n\t$tw.utils.each(messages,function(message,title) {\n\t\tnewFields[\"message-\" + title] = message;\n\t});\n\t// Deselect any suppressed tiddlers\n\t$tw.utils.each(importData.tiddlers,function(tiddler,title) {\n\t\tif($tw.utils.count(tiddler) === 0) {\n\t\t\tnewFields[\"selection-\" + title] = \"unchecked\";\n\t\t}\n\t});\n\t// Save the $:/Import tiddler\n\tnewFields.text = JSON.stringify(importData,null,$tw.config.preferences.jsonSpaces);\n\tthis.wiki.addTiddler(new $tw.Tiddler(importTiddler,newFields));\n\t// Update the story and history details\n\tif(this.getVariable(\"tv-auto-open-on-import\") !== \"no\") {\n\t\tvar storyList = this.getStoryList(),\n\t\t\thistory = [];\n\t\t// Add it to the story\n\t\tif(storyList && storyList.indexOf(IMPORT_TITLE) === -1) {\n\t\t\tstoryList.unshift(IMPORT_TITLE);\n\t\t}\n\t\t// And to history\n\t\thistory.push(IMPORT_TITLE);\n\t\t// Save the updated story and history\n\t\tthis.saveStoryList(storyList);\n\t\tthis.addToHistory(history);\n\t}\n\treturn false;\n};\n\n//\nNavigatorWidget.prototype.handlePerformImportEvent = function(event) {\n\tvar self = this,\n\t\timportTiddler = this.wiki.getTiddler(event.param),\n\t\timportData = this.wiki.getTiddlerDataCached(event.param,{tiddlers: {}}),\n\t\timportReport = [];\n\t// Add the tiddlers to the store\n\timportReport.push($tw.language.getString(\"Import/Imported/Hint\") + \"\\n\");\n\t$tw.utils.each(importData.tiddlers,function(tiddlerFields) {\n\t\tvar title = tiddlerFields.title;\n\t\tif(title && importTiddler && importTiddler.fields[\"selection-\" + title] !== \"unchecked\") {\n\t\t\tvar tiddler = new $tw.Tiddler(tiddlerFields);\n\t\t\ttiddler = $tw.hooks.invokeHook(\"th-importing-tiddler\",tiddler);\n\t\t\tself.wiki.addTiddler(tiddler);\n\t\t\timportReport.push(\"# [[\" + tiddlerFields.title + \"]]\");\n\t\t}\n\t});\n\t// Replace the $:/Import tiddler with an import report\n\tthis.wiki.addTiddler(new $tw.Tiddler({\n\t\ttitle: event.param,\n\t\ttext: importReport.join(\"\\n\"),\n\t\t\"status\": \"complete\"\n\t}));\n\t// Navigate to the $:/Import tiddler\n\tthis.addToHistory([event.param]);\n\t// Trigger an autosave\n\t$tw.rootWidget.dispatchEvent({type: \"tm-auto-save-wiki\"});\n};\n\nNavigatorWidget.prototype.handleFoldTiddlerEvent = function(event) {\n\tvar paramObject = event.paramObject || {};\n\tif(paramObject.foldedState) {\n\t\tvar foldedState = this.wiki.getTiddlerText(paramObject.foldedState,\"show\") === \"show\" ? \"hide\" : \"show\";\n\t\tthis.wiki.setText(paramObject.foldedState,\"text\",null,foldedState);\n\t}\n};\n\nNavigatorWidget.prototype.handleFoldOtherTiddlersEvent = function(event) {\n\tvar self = this,\n\t\tparamObject = event.paramObject || {},\n\t\tprefix = paramObject.foldedStatePrefix;\n\t$tw.utils.each(this.getStoryList(),function(title) {\n\t\tself.wiki.setText(prefix + title,\"text\",null,event.param === title ? \"show\" : \"hide\");\n\t});\n};\n\nNavigatorWidget.prototype.handleFoldAllTiddlersEvent = function(event) {\n\tvar self = this,\n\t\tparamObject = event.paramObject || {},\n\t\tprefix = paramObject.foldedStatePrefix || \"$:/state/folded/\";\n\t$tw.utils.each(this.getStoryList(),function(title) {\n\t\tself.wiki.setText(prefix + title,\"text\",null,\"hide\");\n\t});\n};\n\nNavigatorWidget.prototype.handleUnfoldAllTiddlersEvent = function(event) {\n\tvar self = this,\n\t\tparamObject = event.paramObject || {},\n\t\tprefix = paramObject.foldedStatePrefix;\n\t$tw.utils.each(this.getStoryList(),function(title) {\n\t\tself.wiki.setText(prefix + title,\"text\",null,\"show\");\n\t});\n};\n\nNavigatorWidget.prototype.handleRenameTiddlerEvent = function(event) {\n\tvar paramObject = event.paramObject || {},\n\t\tfrom = paramObject.from || event.tiddlerTitle,\n\t\tto = paramObject.to;\n\tthis.wiki.renameTiddler(from,to);\n};\n\nexports.navigator = NavigatorWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/password.js": {
"title": "$:/core/modules/widgets/password.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/password.js\ntype: application/javascript\nmodule-type: widget\n\nPassword widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar PasswordWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nPasswordWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nPasswordWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Get the current password\n\tvar password = $tw.browser ? $tw.utils.getPassword(this.passwordName) || \"\" : \"\";\n\t// Create our element\n\tvar domNode = this.document.createElement(\"input\");\n\tdomNode.setAttribute(\"type\",\"password\");\n\tdomNode.setAttribute(\"value\",password);\n\t// Add a click event handler\n\t$tw.utils.addEventListeners(domNode,[\n\t\t{name: \"change\", handlerObject: this, handlerMethod: \"handleChangeEvent\"}\n\t]);\n\t// Insert the label into the DOM and render any children\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tthis.domNodes.push(domNode);\n};\n\nPasswordWidget.prototype.handleChangeEvent = function(event) {\n\tvar password = this.domNodes[0].value;\n\treturn $tw.utils.savePassword(this.passwordName,password);\n};\n\n/*\nCompute the internal state of the widget\n*/\nPasswordWidget.prototype.execute = function() {\n\t// Get the parameters from the attributes\n\tthis.passwordName = this.getAttribute(\"name\",\"\");\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nPasswordWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.name) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.password = PasswordWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/qualify.js": {
"title": "$:/core/modules/widgets/qualify.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/qualify.js\ntype: application/javascript\nmodule-type: widget\n\nQualify text to a variable \n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar QualifyWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nQualifyWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nQualifyWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nQualifyWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.qualifyName = this.getAttribute(\"name\");\n\tthis.qualifyTitle = this.getAttribute(\"title\");\n\t// Set context variable\n\tif(this.qualifyName) {\n\t\tthis.setVariable(this.qualifyName,this.qualifyTitle + \"-\" + this.getStateQualifier());\n\t}\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nQualifyWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.name || changedAttributes.title) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.qualify = QualifyWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/radio.js": {
"title": "$:/core/modules/widgets/radio.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/radio.js\ntype: application/javascript\nmodule-type: widget\n\nSet a field or index at a given tiddler via radio buttons\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar RadioWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nRadioWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nRadioWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\tvar isChecked = this.getValue() === this.radioValue;\n\t// Create our elements\n\tthis.labelDomNode = this.document.createElement(\"label\");\n\tthis.labelDomNode.setAttribute(\"class\",\n \t\t\"tc-radio \" + this.radioClass + (isChecked ? \" tc-radio-selected\" : \"\")\n \t);\n\tthis.inputDomNode = this.document.createElement(\"input\");\n\tthis.inputDomNode.setAttribute(\"type\",\"radio\");\n\tif(isChecked) {\n\t\tthis.inputDomNode.setAttribute(\"checked\",\"true\");\n\t}\n\tthis.labelDomNode.appendChild(this.inputDomNode);\n\tthis.spanDomNode = this.document.createElement(\"span\");\n\tthis.labelDomNode.appendChild(this.spanDomNode);\n\t// Add a click event handler\n\t$tw.utils.addEventListeners(this.inputDomNode,[\n\t\t{name: \"change\", handlerObject: this, handlerMethod: \"handleChangeEvent\"}\n\t]);\n\t// Insert the label into the DOM and render any children\n\tparent.insertBefore(this.labelDomNode,nextSibling);\n\tthis.renderChildren(this.spanDomNode,null);\n\tthis.domNodes.push(this.labelDomNode);\n};\n\nRadioWidget.prototype.getValue = function() {\n\tvar value,\n\t\ttiddler = this.wiki.getTiddler(this.radioTitle);\n\tif (this.radioIndex) {\n\t\tvalue = this.wiki.extractTiddlerDataItem(this.radioTitle,this.radioIndex);\n\t} else {\n\t\tvalue = tiddler && tiddler.getFieldString(this.radioField);\n\t}\n\treturn value;\n};\n\nRadioWidget.prototype.setValue = function() {\n\tif(this.radioIndex) {\n\t\tthis.wiki.setText(this.radioTitle,\"\",this.radioIndex,this.radioValue);\n\t} else {\n\t\tvar tiddler = this.wiki.getTiddler(this.radioTitle),\n\t\t\taddition = {};\n\t\taddition[this.radioField] = this.radioValue;\n\t\tthis.wiki.addTiddler(new $tw.Tiddler(this.wiki.getCreationFields(),{title: this.radioTitle},tiddler,addition,this.wiki.getModificationFields()));\n\t}\n};\n\nRadioWidget.prototype.handleChangeEvent = function(event) {\n\tif(this.inputDomNode.checked) {\n\t\tthis.setValue();\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nRadioWidget.prototype.execute = function() {\n\t// Get the parameters from the attributes\n\tthis.radioTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.radioField = this.getAttribute(\"field\",\"text\");\n\tthis.radioIndex = this.getAttribute(\"index\");\n\tthis.radioValue = this.getAttribute(\"value\");\n\tthis.radioClass = this.getAttribute(\"class\",\"\");\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nRadioWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes.value || changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\tvar refreshed = false;\n\t\tif(changedTiddlers[this.radioTitle]) {\n\t\t\tthis.inputDomNode.checked = this.getValue() === this.radioValue;\n\t\t\trefreshed = true;\n\t\t}\n\t\treturn this.refreshChildren(changedTiddlers) || refreshed;\n\t}\n};\n\nexports.radio = RadioWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/range.js": {
"title": "$:/core/modules/widgets/range.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/range.js\ntype: application/javascript\nmodule-type: widget\n\nRange widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar RangeWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nRangeWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nRangeWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute our attributes\n\tthis.computeAttributes();\n\t// Execute our logic\n\tthis.execute();\n\t// Create our elements\n\tthis.inputDomNode = this.document.createElement(\"input\");\n\tthis.inputDomNode.setAttribute(\"type\",\"range\");\n\tthis.inputDomNode.setAttribute(\"class\",this.elementClass);\n\tif(this.minValue){\n\t\tthis.inputDomNode.setAttribute(\"min\", this.minValue);\n\t}\n\tif(this.maxValue){\n\t\tthis.inputDomNode.setAttribute(\"max\", this.maxValue);\n\t}\n\tif(this.increment){\n\t\tthis.inputDomNode.setAttribute(\"step\", this.increment);\n\t}\n\tthis.inputDomNode.value = this.getValue();\n\t// Add a click event handler\n\t$tw.utils.addEventListeners(this.inputDomNode,[\n\t\t{name: \"input\", handlerObject: this, handlerMethod: \"handleInputEvent\"},\n\t\t{name: \"change\", handlerObject: this, handlerMethod: \"handleInputEvent\"}\t\t\n\t]);\n\t// Insert the label into the DOM and render any children\n\tparent.insertBefore(this.inputDomNode,nextSibling);\n\tthis.domNodes.push(this.inputDomNode);\n};\n\nRangeWidget.prototype.getValue = function() {\n\tvar tiddler = this.wiki.getTiddler(this.tiddlerTitle),\n\t\tfieldName = this.tiddlerField || \"text\",\n\t\tvalue = this.defaultValue;\n\tif(tiddler) {\n\t\tif(this.tiddlerIndex) {\n\t\t\tvalue = this.wiki.extractTiddlerDataItem(tiddler,this.tiddlerIndex,this.defaultValue || \"\");\n\t\t} else {\n\t\t\tif($tw.utils.hop(tiddler.fields,fieldName)) {\n\t\t\t\tvalue = tiddler.fields[fieldName] || \"\";\n\t\t\t} else {\n\t\t\t\tvalue = this.defaultValue || \"\";\n\t\t\t}\n\t\t}\n\t}\n\treturn value;\n};\n\nRangeWidget.prototype.handleInputEvent = function(event) {\n\tif(this.getValue() !== this.inputDomNode.value) {\n\t\tif(this.tiddlerIndex) {\n\t\t\tthis.wiki.setText(this.tiddlerTitle,\"\",this.tiddlerIndex,this.inputDomNode.value);\n\t\t} else {\n\t\t\tthis.wiki.setText(this.tiddlerTitle,this.tiddlerField,null,this.inputDomNode.value);\n\t\t}\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nRangeWidget.prototype.execute = function() {\n\t// Get the parameters from the attributes\n\tthis.tiddlerTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.tiddlerField = this.getAttribute(\"field\");\n\tthis.tiddlerIndex = this.getAttribute(\"index\");\n\tthis.minValue = this.getAttribute(\"min\");\n\tthis.maxValue = this.getAttribute(\"max\");\n\tthis.increment = this.getAttribute(\"increment\");\n\tthis.defaultValue = this.getAttribute(\"default\");\n\tthis.elementClass = this.getAttribute(\"class\",\"\");\n\t// Make the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nRangeWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes['min'] || changedAttributes['max'] || changedAttributes['increment'] || changedAttributes[\"default\"] || changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\tvar refreshed = false;\n\t\tif(changedTiddlers[this.tiddlerTitle]) {\n\t\t\tvar value = this.getValue();\n\t\t\tif(this.inputDomNode.value !== value) {\n\t\t\t\tthis.inputDomNode.value = value;\t\t\t\t\n\t\t\t}\n\t\t\trefreshed = true;\n\t\t}\n\t\treturn this.refreshChildren(changedTiddlers) || refreshed;\n\t}\n};\n\nexports.range = RangeWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/raw.js": {
"title": "$:/core/modules/widgets/raw.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/raw.js\ntype: application/javascript\nmodule-type: widget\n\nRaw widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar RawWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nRawWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nRawWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.execute();\n\tvar div = this.document.createElement(\"div\");\n\tdiv.innerHTML=this.parseTreeNode.html;\n\tparent.insertBefore(div,nextSibling);\n\tthis.domNodes.push(div);\t\n};\n\n/*\nCompute the internal state of the widget\n*/\nRawWidget.prototype.execute = function() {\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nRawWidget.prototype.refresh = function(changedTiddlers) {\n\treturn false;\n};\n\nexports.raw = RawWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/reveal.js": {
"title": "$:/core/modules/widgets/reveal.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/reveal.js\ntype: application/javascript\nmodule-type: widget\n\nReveal widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar RevealWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nRevealWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nRevealWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar tag = this.parseTreeNode.isBlock ? \"div\" : \"span\";\n\tif(this.revealTag && $tw.config.htmlUnsafeElements.indexOf(this.revealTag) === -1) {\n\t\ttag = this.revealTag;\n\t}\n\tvar domNode = this.document.createElement(tag);\n\tvar classes = this[\"class\"].split(\" \") || [];\n\tclasses.push(\"tc-reveal\");\n\tdomNode.className = classes.join(\" \");\n\tif(this.style) {\n\t\tdomNode.setAttribute(\"style\",this.style);\n\t}\n\tparent.insertBefore(domNode,nextSibling);\n\tthis.renderChildren(domNode,null);\n\tif(!domNode.isTiddlyWikiFakeDom && this.type === \"popup\" && this.isOpen) {\n\t\tthis.positionPopup(domNode);\n\t\t$tw.utils.addClass(domNode,\"tc-popup\"); // Make sure that clicks don't dismiss popups within the revealed content\n\t}\n\tif(!this.isOpen) {\n\t\tdomNode.setAttribute(\"hidden\",\"true\");\n\t}\n\tthis.domNodes.push(domNode);\n};\n\nRevealWidget.prototype.positionPopup = function(domNode) {\n\tdomNode.style.position = \"absolute\";\n\tdomNode.style.zIndex = \"1000\";\n\tvar left,top;\n\tswitch(this.position) {\n\t\tcase \"left\":\n\t\t\tleft = this.popup.left - domNode.offsetWidth;\n\t\t\ttop = this.popup.top;\n\t\t\tbreak;\n\t\tcase \"above\":\n\t\t\tleft = this.popup.left;\n\t\t\ttop = this.popup.top - domNode.offsetHeight;\n\t\t\tbreak;\n\t\tcase \"aboveright\":\n\t\t\tleft = this.popup.left + this.popup.width;\n\t\t\ttop = this.popup.top + this.popup.height - domNode.offsetHeight;\n\t\t\tbreak;\n\t\tcase \"right\":\n\t\t\tleft = this.popup.left + this.popup.width;\n\t\t\ttop = this.popup.top;\n\t\t\tbreak;\n\t\tcase \"belowleft\":\n\t\t\tleft = this.popup.left + this.popup.width - domNode.offsetWidth;\n\t\t\ttop = this.popup.top + this.popup.height;\n\t\t\tbreak;\n\t\tdefault: // Below\n\t\t\tleft = this.popup.left;\n\t\t\ttop = this.popup.top + this.popup.height;\n\t\t\tbreak;\n\t}\n\tif(!this.positionAllowNegative) {\n\t\tleft = Math.max(0,left);\n\t\ttop = Math.max(0,top);\n\t}\n\tdomNode.style.left = left + \"px\";\n\tdomNode.style.top = top + \"px\";\n};\n\n/*\nCompute the internal state of the widget\n*/\nRevealWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.state = this.getAttribute(\"state\");\n\tthis.revealTag = this.getAttribute(\"tag\");\n\tthis.type = this.getAttribute(\"type\");\n\tthis.text = this.getAttribute(\"text\");\n\tthis.position = this.getAttribute(\"position\");\n\tthis.positionAllowNegative = this.getAttribute(\"positionAllowNegative\") === \"yes\";\n\tthis[\"class\"] = this.getAttribute(\"class\",\"\");\n\tthis.style = this.getAttribute(\"style\",\"\");\n\tthis[\"default\"] = this.getAttribute(\"default\",\"\");\n\tthis.animate = this.getAttribute(\"animate\",\"no\");\n\tthis.retain = this.getAttribute(\"retain\",\"no\");\n\tthis.openAnimation = this.animate === \"no\" ? undefined : \"open\";\n\tthis.closeAnimation = this.animate === \"no\" ? undefined : \"close\";\n\t// Compute the title of the state tiddler and read it\n\tthis.stateTiddlerTitle = this.state;\n\tthis.stateTitle = this.getAttribute(\"stateTitle\");\n\tthis.stateField = this.getAttribute(\"stateField\");\n\tthis.stateIndex = this.getAttribute(\"stateIndex\");\n\tthis.readState();\n\t// Construct the child widgets\n\tvar childNodes = this.isOpen ? this.parseTreeNode.children : [];\n\tthis.hasChildNodes = this.isOpen;\n\tthis.makeChildWidgets(childNodes);\n};\n\n/*\nRead the state tiddler\n*/\nRevealWidget.prototype.readState = function() {\n\t// Read the information from the state tiddler\n\tvar state,\n\t defaultState = this[\"default\"];\n\tif(this.stateTitle) {\n\t\tvar stateTitleTiddler = this.wiki.getTiddler(this.stateTitle);\n\t\tif(this.stateField) {\n\t\t\tstate = stateTitleTiddler ? stateTitleTiddler.getFieldString(this.stateField) || defaultState : defaultState;\n\t\t} else if(this.stateIndex) {\n\t\t\tstate = stateTitleTiddler ? this.wiki.extractTiddlerDataItem(this.stateTitle,this.stateIndex) || defaultState : defaultState;\n\t\t} else if(stateTitleTiddler) {\n\t\t\tstate = this.wiki.getTiddlerText(this.stateTitle) || defaultState;\n\t\t} else {\n\t\t\tstate = defaultState;\n\t\t}\n\t} else {\n\t\tstate = this.stateTiddlerTitle ? this.wiki.getTextReference(this.state,this[\"default\"],this.getVariable(\"currentTiddler\")) : this[\"default\"];\n\t}\n\tif(state === null) {\n\t\tstate = this[\"default\"];\n\t}\n\tswitch(this.type) {\n\t\tcase \"popup\":\n\t\t\tthis.readPopupState(state);\n\t\t\tbreak;\n\t\tcase \"match\":\n\t\t\tthis.isOpen = this.text === state;\n\t\t\tbreak;\n\t\tcase \"nomatch\":\n\t\t\tthis.isOpen = this.text !== state;\n\t\t\tbreak;\n\t\tcase \"lt\":\n\t\t\tthis.isOpen = !!(this.compareStateText(state) < 0);\n\t\t\tbreak;\n\t\tcase \"gt\":\n\t\t\tthis.isOpen = !!(this.compareStateText(state) > 0);\n\t\t\tbreak;\n\t\tcase \"lteq\":\n\t\t\tthis.isOpen = !(this.compareStateText(state) > 0);\n\t\t\tbreak;\n\t\tcase \"gteq\":\n\t\t\tthis.isOpen = !(this.compareStateText(state) < 0);\n\t\t\tbreak;\n\t}\n};\n\nRevealWidget.prototype.compareStateText = function(state) {\n\treturn state.localeCompare(this.text,undefined,{numeric: true,sensitivity: \"case\"});\n};\n\nRevealWidget.prototype.readPopupState = function(state) {\n\tvar popupLocationRegExp = /^\\((-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+),(-?[0-9\\.E]+)\\)$/,\n\t\tmatch = popupLocationRegExp.exec(state);\n\t// Check if the state matches the location regexp\n\tif(match) {\n\t\t// If so, we're open\n\t\tthis.isOpen = true;\n\t\t// Get the location\n\t\tthis.popup = {\n\t\t\tleft: parseFloat(match[1]),\n\t\t\ttop: parseFloat(match[2]),\n\t\t\twidth: parseFloat(match[3]),\n\t\t\theight: parseFloat(match[4])\n\t\t};\n\t} else {\n\t\t// If not, we're closed\n\t\tthis.isOpen = false;\n\t}\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nRevealWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.state || changedAttributes.type || changedAttributes.text || changedAttributes.position || changedAttributes.positionAllowNegative || changedAttributes[\"default\"] || changedAttributes.animate || changedAttributes.stateTitle || changedAttributes.stateField || changedAttributes.stateIndex) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\tvar currentlyOpen = this.isOpen;\n\t\tthis.readState();\n\t\tif(this.isOpen !== currentlyOpen) {\n\t\t\tif(this.retain === \"yes\") {\n\t\t\t\tthis.updateState();\n\t\t\t} else {\n\t\t\t\tthis.refreshSelf();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t}\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\n/*\nCalled by refresh() to dynamically show or hide the content\n*/\nRevealWidget.prototype.updateState = function() {\n\tvar self = this;\n\t// Read the current state\n\tthis.readState();\n\t// Construct the child nodes if needed\n\tvar domNode = this.domNodes[0];\n\tif(this.isOpen && !this.hasChildNodes) {\n\t\tthis.hasChildNodes = true;\n\t\tthis.makeChildWidgets(this.parseTreeNode.children);\n\t\tthis.renderChildren(domNode,null);\n\t}\n\t// Animate our DOM node\n\tif(!domNode.isTiddlyWikiFakeDom && this.type === \"popup\" && this.isOpen) {\n\t\tthis.positionPopup(domNode);\n\t\t$tw.utils.addClass(domNode,\"tc-popup\"); // Make sure that clicks don't dismiss popups within the revealed content\n\n\t}\n\tif(this.isOpen) {\n\t\tdomNode.removeAttribute(\"hidden\");\n $tw.anim.perform(this.openAnimation,domNode);\n\t} else {\n\t\t$tw.anim.perform(this.closeAnimation,domNode,{callback: function() {\n\t\t\t//make sure that the state hasn't changed during the close animation\n\t\t\tself.readState()\n\t\t\tif(!self.isOpen) {\n\t\t\t\tdomNode.setAttribute(\"hidden\",\"true\");\n\t\t\t}\n\t\t}});\n\t}\n};\n\nexports.reveal = RevealWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/scrollable.js": {
"title": "$:/core/modules/widgets/scrollable.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/scrollable.js\ntype: application/javascript\nmodule-type: widget\n\nScrollable widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ScrollableWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n\tthis.scaleFactor = 1;\n\tthis.addEventListeners([\n\t\t{type: \"tm-scroll\", handler: \"handleScrollEvent\"}\n\t]);\n\tif($tw.browser) {\n\t\tthis.requestAnimationFrame = window.requestAnimationFrame ||\n\t\t\twindow.webkitRequestAnimationFrame ||\n\t\t\twindow.mozRequestAnimationFrame ||\n\t\t\tfunction(callback) {\n\t\t\t\treturn window.setTimeout(callback, 1000/60);\n\t\t\t};\n\t\tthis.cancelAnimationFrame = window.cancelAnimationFrame ||\n\t\t\twindow.webkitCancelAnimationFrame ||\n\t\t\twindow.webkitCancelRequestAnimationFrame ||\n\t\t\twindow.mozCancelAnimationFrame ||\n\t\t\twindow.mozCancelRequestAnimationFrame ||\n\t\t\tfunction(id) {\n\t\t\t\twindow.clearTimeout(id);\n\t\t\t};\n\t}\n};\n\n/*\nInherit from the base widget class\n*/\nScrollableWidget.prototype = new Widget();\n\nScrollableWidget.prototype.cancelScroll = function() {\n\tif(this.idRequestFrame) {\n\t\tthis.cancelAnimationFrame.call(window,this.idRequestFrame);\n\t\tthis.idRequestFrame = null;\n\t}\n};\n\n/*\nHandle a scroll event\n*/\nScrollableWidget.prototype.handleScrollEvent = function(event) {\n\t// Pass the scroll event through if our offsetsize is larger than our scrollsize\n\tif(this.outerDomNode.scrollWidth <= this.outerDomNode.offsetWidth && this.outerDomNode.scrollHeight <= this.outerDomNode.offsetHeight && this.fallthrough === \"yes\") {\n\t\treturn true;\n\t}\n\tthis.scrollIntoView(event.target);\n\treturn false; // Handled event\n};\n\n/*\nScroll an element into view\n*/\nScrollableWidget.prototype.scrollIntoView = function(element) {\n\tvar duration = $tw.utils.getAnimationDuration();\n\tthis.cancelScroll();\n\tthis.startTime = Date.now();\n\tvar scrollPosition = {\n\t\tx: this.outerDomNode.scrollLeft,\n\t\ty: this.outerDomNode.scrollTop\n\t};\n\t// Get the client bounds of the element and adjust by the scroll position\n\tvar scrollableBounds = this.outerDomNode.getBoundingClientRect(),\n\t\tclientTargetBounds = element.getBoundingClientRect(),\n\t\tbounds = {\n\t\t\tleft: clientTargetBounds.left + scrollPosition.x - scrollableBounds.left,\n\t\t\ttop: clientTargetBounds.top + scrollPosition.y - scrollableBounds.top,\n\t\t\twidth: clientTargetBounds.width,\n\t\t\theight: clientTargetBounds.height\n\t\t};\n\t// We'll consider the horizontal and vertical scroll directions separately via this function\n\tvar getEndPos = function(targetPos,targetSize,currentPos,currentSize) {\n\t\t\t// If the target is already visible then stay where we are\n\t\t\tif(targetPos >= currentPos && (targetPos + targetSize) <= (currentPos + currentSize)) {\n\t\t\t\treturn currentPos;\n\t\t\t// If the target is above/left of the current view, then scroll to its top/left\n\t\t\t} else if(targetPos <= currentPos) {\n\t\t\t\treturn targetPos;\n\t\t\t// If the target is smaller than the window and the scroll position is too far up, then scroll till the target is at the bottom of the window\n\t\t\t} else if(targetSize < currentSize && currentPos < (targetPos + targetSize - currentSize)) {\n\t\t\t\treturn targetPos + targetSize - currentSize;\n\t\t\t// If the target is big, then just scroll to the top\n\t\t\t} else if(currentPos < targetPos) {\n\t\t\t\treturn targetPos;\n\t\t\t// Otherwise, stay where we are\n\t\t\t} else {\n\t\t\t\treturn currentPos;\n\t\t\t}\n\t\t},\n\t\tendX = getEndPos(bounds.left,bounds.width,scrollPosition.x,this.outerDomNode.offsetWidth),\n\t\tendY = getEndPos(bounds.top,bounds.height,scrollPosition.y,this.outerDomNode.offsetHeight);\n\t// Only scroll if necessary\n\tif(endX !== scrollPosition.x || endY !== scrollPosition.y) {\n\t\tvar self = this,\n\t\t\tdrawFrame;\n\t\tdrawFrame = function () {\n\t\t\tvar t;\n\t\t\tif(duration <= 0) {\n\t\t\t\tt = 1;\n\t\t\t} else {\n\t\t\t\tt = ((Date.now()) - self.startTime) / duration;\t\n\t\t\t}\n\t\t\tif(t >= 1) {\n\t\t\t\tself.cancelScroll();\n\t\t\t\tt = 1;\n\t\t\t}\n\t\t\tt = $tw.utils.slowInSlowOut(t);\n\t\t\tself.outerDomNode.scrollLeft = scrollPosition.x + (endX - scrollPosition.x) * t;\n\t\t\tself.outerDomNode.scrollTop = scrollPosition.y + (endY - scrollPosition.y) * t;\n\t\t\tif(t < 1) {\n\t\t\t\tself.idRequestFrame = self.requestAnimationFrame.call(window,drawFrame);\n\t\t\t}\n\t\t};\n\t\tdrawFrame();\n\t}\n};\n\n/*\nRender this widget into the DOM\n*/\nScrollableWidget.prototype.render = function(parent,nextSibling) {\n\tvar self = this;\n\t// Remember parent\n\tthis.parentDomNode = parent;\n\t// Compute attributes and execute state\n\tthis.computeAttributes();\n\tthis.execute();\n\t// Create elements\n\tthis.outerDomNode = this.document.createElement(\"div\");\n\t$tw.utils.setStyle(this.outerDomNode,[\n\t\t{overflowY: \"auto\"},\n\t\t{overflowX: \"auto\"},\n\t\t{webkitOverflowScrolling: \"touch\"}\n\t]);\n\tthis.innerDomNode = this.document.createElement(\"div\");\n\tthis.outerDomNode.appendChild(this.innerDomNode);\n\t// Assign classes\n\tthis.outerDomNode.className = this[\"class\"] || \"\";\n\t// Insert element\n\tparent.insertBefore(this.outerDomNode,nextSibling);\n\tthis.renderChildren(this.innerDomNode,null);\n\tthis.domNodes.push(this.outerDomNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nScrollableWidget.prototype.execute = function() {\n\t// Get attributes\n\tthis.fallthrough = this.getAttribute(\"fallthrough\",\"yes\");\n\tthis[\"class\"] = this.getAttribute(\"class\");\n\t// Make child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nScrollableWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports.scrollable = ScrollableWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/select.js": {
"title": "$:/core/modules/widgets/select.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/select.js\ntype: application/javascript\nmodule-type: widget\n\nSelect widget:\n\n```\n<$select tiddler=\"MyTiddler\" field=\"text\">\n<$list filter=\"[tag[chapter]]\">\n<option value=<<currentTiddler>>>\n<$view field=\"description\"/>\n</option>\n</$list>\n</$select>\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar SelectWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nSelectWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nSelectWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n\tthis.setSelectValue();\n\t$tw.utils.addEventListeners(this.getSelectDomNode(),[\n\t\t{name: \"change\", handlerObject: this, handlerMethod: \"handleChangeEvent\"}\n\t]);\n};\n\n/*\nHandle a change event\n*/\nSelectWidget.prototype.handleChangeEvent = function(event) {\n\t// Get the new value and assign it to the tiddler\n\tif(this.selectMultiple == false) {\n\t\tvar value = this.getSelectDomNode().value;\n\t} else {\n\t\tvar value = this.getSelectValues()\n\t\t\t\tvalue = $tw.utils.stringifyList(value);\n\t}\n\tthis.wiki.setText(this.selectTitle,this.selectField,this.selectIndex,value);\n\t// Trigger actions\n\tif(this.selectActions) {\n\t\tthis.invokeActionString(this.selectActions,this,event);\n\t}\n};\n\n/*\nIf necessary, set the value of the select element to the current value\n*/\nSelectWidget.prototype.setSelectValue = function() {\n\tvar value = this.selectDefault;\n\t// Get the value\n\tif(this.selectIndex) {\n\t\tvalue = this.wiki.extractTiddlerDataItem(this.selectTitle,this.selectIndex,value);\n\t} else {\n\t\tvar tiddler = this.wiki.getTiddler(this.selectTitle);\n\t\tif(tiddler) {\n\t\t\tif(this.selectField === \"text\") {\n\t\t\t\t// Calling getTiddlerText() triggers lazy loading of skinny tiddlers\n\t\t\t\tvalue = this.wiki.getTiddlerText(this.selectTitle);\n\t\t\t} else {\n\t\t\t\tif($tw.utils.hop(tiddler.fields,this.selectField)) {\n\t\t\t\t\tvalue = tiddler.getFieldString(this.selectField);\n\t\t\t\t}\n\t\t\t}\n\t\t} else {\n\t\t\tif(this.selectField === \"title\") {\n\t\t\t\tvalue = this.selectTitle;\n\t\t\t}\n\t\t}\n\t}\n\t// Assign it to the select element if it's different than the current value\n\tif (this.selectMultiple) {\n\t\tvalue = value === undefined ? \"\" : value;\n\t\tvar select = this.getSelectDomNode();\n\t\tvar values = Array.isArray(value) ? value : $tw.utils.parseStringArray(value);\n\t\tfor(var i=0; i < select.children.length; i++){\n\t\t\tselect.children[i].selected = values.indexOf(select.children[i].value) !== -1\n\t\t}\n\t} else {\n\t\tvar domNode = this.getSelectDomNode();\n\t\tif(domNode.value !== value) {\n\t\t\tdomNode.value = value;\n\t\t}\n\t}\n};\n\n/*\nGet the DOM node of the select element\n*/\nSelectWidget.prototype.getSelectDomNode = function() {\n\treturn this.children[0].domNodes[0];\n};\n\n// Return an array of the selected opion values\n// select is an HTML select element\nSelectWidget.prototype.getSelectValues = function() {\n\tvar select, result, options, opt;\n\tselect = this.getSelectDomNode();\n\tresult = [];\n\toptions = select && select.options;\n\tfor (var i=0; i<options.length; i++) {\n\t\topt = options[i];\n\t\tif (opt.selected) {\n\t\t\tresult.push(opt.value || opt.text);\n\t\t}\n\t}\n\treturn result;\n}\n\n/*\nCompute the internal state of the widget\n*/\nSelectWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.selectActions = this.getAttribute(\"actions\");\n\tthis.selectTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.selectField = this.getAttribute(\"field\",\"text\");\n\tthis.selectIndex = this.getAttribute(\"index\");\n\tthis.selectClass = this.getAttribute(\"class\");\n\tthis.selectDefault = this.getAttribute(\"default\");\n\tthis.selectMultiple = this.getAttribute(\"multiple\", false);\n\tthis.selectSize = this.getAttribute(\"size\");\n\tthis.selectTooltip = this.getAttribute(\"tooltip\");\n\t// Make the child widgets\n\tvar selectNode = {\n\t\ttype: \"element\",\n\t\ttag: \"select\",\n\t\tchildren: this.parseTreeNode.children\n\t};\n\tif(this.selectClass) {\n\t\t$tw.utils.addAttributeToParseTreeNode(selectNode,\"class\",this.selectClass);\n\t}\n\tif(this.selectMultiple) {\n\t\t$tw.utils.addAttributeToParseTreeNode(selectNode,\"multiple\",\"multiple\");\n\t}\n\tif(this.selectSize) {\n\t\t$tw.utils.addAttributeToParseTreeNode(selectNode,\"size\",this.selectSize);\n\t}\n\tif(this.selectTooltip) {\n\t\t$tw.utils.addAttributeToParseTreeNode(selectNode,\"title\",this.selectTooltip);\n\t}\n\tthis.makeChildWidgets([selectNode]);\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nSelectWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\t// If we're using a different tiddler/field/index then completely refresh ourselves\n\tif(changedAttributes.selectTitle || changedAttributes.selectField || changedAttributes.selectIndex || changedAttributes.selectTooltip) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t// If the target tiddler value has changed, just update setting and refresh the children\n\t} else {\n\t\tvar childrenRefreshed = this.refreshChildren(changedTiddlers);\n\t\tif(changedTiddlers[this.selectTitle] || childrenRefreshed) {\n\t\t\tthis.setSelectValue();\n\t\t} \n\t\treturn childrenRefreshed;\n\t}\n};\n\nexports.select = SelectWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/set.js": {
"title": "$:/core/modules/widgets/set.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/set.js\ntype: application/javascript\nmodule-type: widget\n\nSet variable widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar SetWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nSetWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nSetWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nSetWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.setName = this.getAttribute(\"name\",\"currentTiddler\");\n\tthis.setFilter = this.getAttribute(\"filter\");\n\tthis.setSelect = this.getAttribute(\"select\");\n\tthis.setTiddler = this.getAttribute(\"tiddler\");\n\tthis.setSubTiddler = this.getAttribute(\"subtiddler\");\n\tthis.setField = this.getAttribute(\"field\");\n\tthis.setIndex = this.getAttribute(\"index\");\n\tthis.setValue = this.getAttribute(\"value\");\n\tthis.setEmptyValue = this.getAttribute(\"emptyValue\");\n\t// Set context variable\n\tthis.setVariable(this.setName,this.getValue(),this.parseTreeNode.params,!!this.parseTreeNode.isMacroDefinition);\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nGet the value to be assigned\n*/\nSetWidget.prototype.getValue = function() {\n\tvar value = this.setValue;\n\tif(this.setTiddler) {\n\t\tvar tiddler;\n\t\tif(this.setSubTiddler) {\n\t\t\ttiddler = this.wiki.getSubTiddler(this.setTiddler,this.setSubTiddler);\n\t\t} else {\n\t\t\ttiddler = this.wiki.getTiddler(this.setTiddler);\t\t\t\n\t\t}\n\t\tif(!tiddler) {\n\t\t\tvalue = this.setEmptyValue;\n\t\t} else if(this.setField) {\n\t\t\tvalue = tiddler.getFieldString(this.setField) || this.setEmptyValue;\n\t\t} else if(this.setIndex) {\n\t\t\tvalue = this.wiki.extractTiddlerDataItem(this.setTiddler,this.setIndex,this.setEmptyValue);\n\t\t} else {\n\t\t\tvalue = tiddler.fields.text || this.setEmptyValue ;\n\t\t}\n\t} else if(this.setFilter) {\n\t\tvar results = this.wiki.filterTiddlers(this.setFilter,this);\n\t\tif(this.setValue == null) {\n\t\t\tvar select;\n\t\t\tif(this.setSelect) {\n\t\t\t\tselect = parseInt(this.setSelect,10);\n\t\t\t}\n\t\t\tif(select !== undefined) {\n\t\t\t\tvalue = results[select] || \"\";\n\t\t\t} else {\n\t\t\t\tvalue = $tw.utils.stringifyList(results);\t\t\t\n\t\t\t}\n\t\t}\n\t\tif(results.length === 0 && this.setEmptyValue !== undefined) {\n\t\t\tvalue = this.setEmptyValue;\n\t\t}\n\t} else if(!value && this.setEmptyValue) {\n\t\tvalue = this.setEmptyValue;\n\t}\n\treturn value || \"\";\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nSetWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.name || changedAttributes.filter || changedAttributes.select || changedAttributes.tiddler || (this.setTiddler && changedTiddlers[this.setTiddler]) || changedAttributes.field || changedAttributes.index || changedAttributes.value || changedAttributes.emptyValue ||\n\t (this.setFilter && this.getValue() != this.variables[this.setName].value)) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.setvariable = SetWidget;\nexports.set = SetWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/text.js": {
"title": "$:/core/modules/widgets/text.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/text.js\ntype: application/javascript\nmodule-type: widget\n\nText node widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar TextNodeWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nTextNodeWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nTextNodeWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tvar text = this.getAttribute(\"text\",this.parseTreeNode.text || \"\");\n\ttext = text.replace(/\\r/mg,\"\");\n\tvar textNode = this.document.createTextNode(text);\n\tparent.insertBefore(textNode,nextSibling);\n\tthis.domNodes.push(textNode);\n};\n\n/*\nCompute the internal state of the widget\n*/\nTextNodeWidget.prototype.execute = function() {\n\t// Nothing to do for a text node\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nTextNodeWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.text) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn false;\t\n\t}\n};\n\nexports.text = TextNodeWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/tiddler.js": {
"title": "$:/core/modules/widgets/tiddler.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/tiddler.js\ntype: application/javascript\nmodule-type: widget\n\nTiddler widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar TiddlerWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nTiddlerWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nTiddlerWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nTiddlerWidget.prototype.execute = function() {\n\tthis.tiddlerState = this.computeTiddlerState();\n\tthis.setVariable(\"currentTiddler\",this.tiddlerState.currentTiddler);\n\tthis.setVariable(\"missingTiddlerClass\",this.tiddlerState.missingTiddlerClass);\n\tthis.setVariable(\"shadowTiddlerClass\",this.tiddlerState.shadowTiddlerClass);\n\tthis.setVariable(\"systemTiddlerClass\",this.tiddlerState.systemTiddlerClass);\n\tthis.setVariable(\"tiddlerTagClasses\",this.tiddlerState.tiddlerTagClasses);\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nCompute the tiddler state flags\n*/\nTiddlerWidget.prototype.computeTiddlerState = function() {\n\t// Get our parameters\n\tthis.tiddlerTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\t// Compute the state\n\tvar state = {\n\t\tcurrentTiddler: this.tiddlerTitle || \"\",\n\t\tmissingTiddlerClass: (this.wiki.tiddlerExists(this.tiddlerTitle) || this.wiki.isShadowTiddler(this.tiddlerTitle)) ? \"tc-tiddler-exists\" : \"tc-tiddler-missing\",\n\t\tshadowTiddlerClass: this.wiki.isShadowTiddler(this.tiddlerTitle) ? \"tc-tiddler-shadow\" : \"\",\n\t\tsystemTiddlerClass: this.wiki.isSystemTiddler(this.tiddlerTitle) ? \"tc-tiddler-system\" : \"\",\n\t\ttiddlerTagClasses: this.getTagClasses()\n\t};\n\t// Compute a simple hash to make it easier to detect changes\n\tstate.hash = state.currentTiddler + state.missingTiddlerClass + state.shadowTiddlerClass + state.systemTiddlerClass + state.tiddlerTagClasses;\n\treturn state;\n};\n\n/*\nCreate a string of CSS classes derived from the tags of the current tiddler\n*/\nTiddlerWidget.prototype.getTagClasses = function() {\n\tvar tiddler = this.wiki.getTiddler(this.tiddlerTitle);\n\tif(tiddler) {\n\t\tvar tags = [];\n\t\t$tw.utils.each(tiddler.fields.tags,function(tag) {\n\t\t\ttags.push(\"tc-tagged-\" + encodeURIComponent(tag));\n\t\t});\n\t\treturn tags.join(\" \");\n\t} else {\n\t\treturn \"\";\n\t}\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nTiddlerWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes(),\n\t\tnewTiddlerState = this.computeTiddlerState();\n\tif(changedAttributes.tiddler || newTiddlerState.hash !== this.tiddlerState.hash) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\t\t\n\t}\n};\n\nexports.tiddler = TiddlerWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/transclude.js": {
"title": "$:/core/modules/widgets/transclude.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/transclude.js\ntype: application/javascript\nmodule-type: widget\n\nTransclude widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar TranscludeWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nTranscludeWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nTranscludeWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nTranscludeWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.transcludeTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.transcludeSubTiddler = this.getAttribute(\"subtiddler\");\n\tthis.transcludeField = this.getAttribute(\"field\");\n\tthis.transcludeIndex = this.getAttribute(\"index\");\n\tthis.transcludeMode = this.getAttribute(\"mode\");\n\t// Parse the text reference\n\tvar parseAsInline = !this.parseTreeNode.isBlock;\n\tif(this.transcludeMode === \"inline\") {\n\t\tparseAsInline = true;\n\t} else if(this.transcludeMode === \"block\") {\n\t\tparseAsInline = false;\n\t}\n\tvar parser = this.wiki.parseTextReference(\n\t\t\t\t\t\tthis.transcludeTitle,\n\t\t\t\t\t\tthis.transcludeField,\n\t\t\t\t\t\tthis.transcludeIndex,\n\t\t\t\t\t\t{\n\t\t\t\t\t\t\tparseAsInline: parseAsInline,\n\t\t\t\t\t\t\tsubTiddler: this.transcludeSubTiddler\n\t\t\t\t\t\t}),\n\t\tparseTreeNodes = parser ? parser.tree : this.parseTreeNode.children;\n\t// Set context variables for recursion detection\n\tvar recursionMarker = this.makeRecursionMarker();\n\tthis.setVariable(\"transclusion\",recursionMarker);\n\t// Check for recursion\n\tif(parser) {\n\t\tif(this.parentWidget && this.parentWidget.hasVariable(\"transclusion\",recursionMarker)) {\n\t\t\tparseTreeNodes = [{type: \"element\", tag: \"span\", attributes: {\n\t\t\t\t\"class\": {type: \"string\", value: \"tc-error\"}\n\t\t\t}, children: [\n\t\t\t\t{type: \"text\", text: $tw.language.getString(\"Error/RecursiveTransclusion\")}\n\t\t\t]}];\n\t\t}\n\t}\n\t// Construct the child widgets\n\tthis.makeChildWidgets(parseTreeNodes);\n};\n\n/*\nCompose a string comprising the title, field and/or index to identify this transclusion for recursion detection\n*/\nTranscludeWidget.prototype.makeRecursionMarker = function() {\n\tvar output = [];\n\toutput.push(\"{\");\n\toutput.push(this.getVariable(\"currentTiddler\",{defaultValue: \"\"}));\n\toutput.push(\"|\");\n\toutput.push(this.transcludeTitle || \"\");\n\toutput.push(\"|\");\n\toutput.push(this.transcludeField || \"\");\n\toutput.push(\"|\");\n\toutput.push(this.transcludeIndex || \"\");\n\toutput.push(\"|\");\n\toutput.push(this.transcludeSubTiddler || \"\");\n\toutput.push(\"}\");\n\treturn output.join(\"\");\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nTranscludeWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedTiddlers[this.transcludeTitle]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn this.refreshChildren(changedTiddlers);\t\t\n\t}\n};\n\nexports.transclude = TranscludeWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/vars.js": {
"title": "$:/core/modules/widgets/vars.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/vars.js\ntype: application/javascript\nmodule-type: widget\n\nThis widget allows multiple variables to be set in one go:\n\n```\n\\define helloworld() Hello world!\n<$vars greeting=\"Hi\" me={{!!title}} sentence=<<helloworld>>>\n <<greeting>>! I am <<me>> and I say: <<sentence>>\n</$vars>\n```\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar VarsWidget = function(parseTreeNode,options) {\n\t// Call the constructor\n\tWidget.call(this);\n\t// Initialise\t\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nVarsWidget.prototype = Object.create(Widget.prototype);\n\n/*\nRender this widget into the DOM\n*/\nVarsWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nVarsWidget.prototype.execute = function() {\n\t// Parse variables\n\tvar self = this;\n\t$tw.utils.each(this.attributes,function(val,key) {\n\t\tif(key.charAt(0) !== \"$\") {\n\t\t\tself.setVariable(key,val);\n\t\t}\n\t});\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nRefresh the widget by ensuring our attributes are up to date\n*/\nVarsWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(Object.keys(changedAttributes).length) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t}\n\treturn this.refreshChildren(changedTiddlers);\n};\n\nexports[\"vars\"] = VarsWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/view.js": {
"title": "$:/core/modules/widgets/view.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/view.js\ntype: application/javascript\nmodule-type: widget\n\nView widget\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar ViewWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nViewWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nViewWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tif(this.text) {\n\t\tvar textNode = this.document.createTextNode(this.text);\n\t\tparent.insertBefore(textNode,nextSibling);\n\t\tthis.domNodes.push(textNode);\n\t} else {\n\t\tthis.makeChildWidgets();\n\t\tthis.renderChildren(parent,nextSibling);\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nViewWidget.prototype.execute = function() {\n\t// Get parameters from our attributes\n\tthis.viewTitle = this.getAttribute(\"tiddler\",this.getVariable(\"currentTiddler\"));\n\tthis.viewSubtiddler = this.getAttribute(\"subtiddler\");\n\tthis.viewField = this.getAttribute(\"field\",\"text\");\n\tthis.viewIndex = this.getAttribute(\"index\");\n\tthis.viewFormat = this.getAttribute(\"format\",\"text\");\n\tthis.viewTemplate = this.getAttribute(\"template\",\"\");\n\tthis.viewMode = this.getAttribute(\"mode\",\"block\");\n\tswitch(this.viewFormat) {\n\t\tcase \"htmlwikified\":\n\t\t\tthis.text = this.getValueAsHtmlWikified(this.viewMode);\n\t\t\tbreak;\n\t\tcase \"plainwikified\":\n\t\t\tthis.text = this.getValueAsPlainWikified(this.viewMode);\n\t\t\tbreak;\n\t\tcase \"htmlencodedplainwikified\":\n\t\t\tthis.text = this.getValueAsHtmlEncodedPlainWikified(this.viewMode);\n\t\t\tbreak;\n\t\tcase \"htmlencoded\":\n\t\t\tthis.text = this.getValueAsHtmlEncoded();\n\t\t\tbreak;\n\t\tcase \"urlencoded\":\n\t\t\tthis.text = this.getValueAsUrlEncoded();\n\t\t\tbreak;\n\t\tcase \"doubleurlencoded\":\n\t\t\tthis.text = this.getValueAsDoubleUrlEncoded();\n\t\t\tbreak;\n\t\tcase \"date\":\n\t\t\tthis.text = this.getValueAsDate(this.viewTemplate);\n\t\t\tbreak;\n\t\tcase \"relativedate\":\n\t\t\tthis.text = this.getValueAsRelativeDate();\n\t\t\tbreak;\n\t\tcase \"stripcomments\":\n\t\t\tthis.text = this.getValueAsStrippedComments();\n\t\t\tbreak;\n\t\tcase \"jsencoded\":\n\t\t\tthis.text = this.getValueAsJsEncoded();\n\t\t\tbreak;\n\t\tdefault: // \"text\"\n\t\t\tthis.text = this.getValueAsText();\n\t\t\tbreak;\n\t}\n};\n\n/*\nThe various formatter functions are baked into this widget for the moment. Eventually they will be replaced by macro functions\n*/\n\n/*\nRetrieve the value of the widget. Options are:\nasString: Optionally return the value as a string\n*/\nViewWidget.prototype.getValue = function(options) {\n\toptions = options || {};\n\tvar value = options.asString ? \"\" : undefined;\n\tif(this.viewIndex) {\n\t\tvalue = this.wiki.extractTiddlerDataItem(this.viewTitle,this.viewIndex);\n\t} else {\n\t\tvar tiddler;\n\t\tif(this.viewSubtiddler) {\n\t\t\ttiddler = this.wiki.getSubTiddler(this.viewTitle,this.viewSubtiddler);\t\n\t\t} else {\n\t\t\ttiddler = this.wiki.getTiddler(this.viewTitle);\n\t\t}\n\t\tif(tiddler) {\n\t\t\tif(this.viewField === \"text\" && !this.viewSubtiddler) {\n\t\t\t\t// Calling getTiddlerText() triggers lazy loading of skinny tiddlers\n\t\t\t\tvalue = this.wiki.getTiddlerText(this.viewTitle);\n\t\t\t} else {\n\t\t\t\tif($tw.utils.hop(tiddler.fields,this.viewField)) {\n\t\t\t\t\tif(options.asString) {\n\t\t\t\t\t\tvalue = tiddler.getFieldString(this.viewField);\n\t\t\t\t\t} else {\n\t\t\t\t\t\tvalue = tiddler.fields[this.viewField];\t\t\t\t\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t} else {\n\t\t\tif(this.viewField === \"title\") {\n\t\t\t\tvalue = this.viewTitle;\n\t\t\t}\n\t\t}\n\t}\n\treturn value;\n};\n\nViewWidget.prototype.getValueAsText = function() {\n\treturn this.getValue({asString: true});\n};\n\nViewWidget.prototype.getValueAsHtmlWikified = function(mode) {\n\treturn this.wiki.renderText(\"text/html\",\"text/vnd.tiddlywiki\",this.getValueAsText(),{\n\t\tparseAsInline: mode !== \"block\",\n\t\tparentWidget: this\n\t});\n};\n\nViewWidget.prototype.getValueAsPlainWikified = function(mode) {\n\treturn this.wiki.renderText(\"text/plain\",\"text/vnd.tiddlywiki\",this.getValueAsText(),{\n\t\tparseAsInline: mode !== \"block\",\n\t\tparentWidget: this\n\t});\n};\n\nViewWidget.prototype.getValueAsHtmlEncodedPlainWikified = function(mode) {\n\treturn $tw.utils.htmlEncode(this.wiki.renderText(\"text/plain\",\"text/vnd.tiddlywiki\",this.getValueAsText(),{\n\t\tparseAsInline: mode !== \"block\",\n\t\tparentWidget: this\n\t}));\n};\n\nViewWidget.prototype.getValueAsHtmlEncoded = function() {\n\treturn $tw.utils.htmlEncode(this.getValueAsText());\n};\n\nViewWidget.prototype.getValueAsUrlEncoded = function() {\n\treturn encodeURIComponent(this.getValueAsText());\n};\n\nViewWidget.prototype.getValueAsDoubleUrlEncoded = function() {\n\treturn encodeURIComponent(encodeURIComponent(this.getValueAsText()));\n};\n\nViewWidget.prototype.getValueAsDate = function(format) {\n\tformat = format || \"YYYY MM DD 0hh:0mm\";\n\tvar value = $tw.utils.parseDate(this.getValue());\n\tif(value && $tw.utils.isDate(value) && value.toString() !== \"Invalid Date\") {\n\t\treturn $tw.utils.formatDateString(value,format);\n\t} else {\n\t\treturn \"\";\n\t}\n};\n\nViewWidget.prototype.getValueAsRelativeDate = function(format) {\n\tvar value = $tw.utils.parseDate(this.getValue());\n\tif(value && $tw.utils.isDate(value) && value.toString() !== \"Invalid Date\") {\n\t\treturn $tw.utils.getRelativeDate((new Date()) - (new Date(value))).description;\n\t} else {\n\t\treturn \"\";\n\t}\n};\n\nViewWidget.prototype.getValueAsStrippedComments = function() {\n\tvar lines = this.getValueAsText().split(\"\\n\"),\n\t\tout = [];\n\tfor(var line=0; line<lines.length; line++) {\n\t\tvar text = lines[line];\n\t\tif(!/^\\s*\\/\\/#/.test(text)) {\n\t\t\tout.push(text);\n\t\t}\n\t}\n\treturn out.join(\"\\n\");\n};\n\nViewWidget.prototype.getValueAsJsEncoded = function() {\n\treturn $tw.utils.stringify(this.getValueAsText());\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nViewWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.index || changedAttributes.template || changedAttributes.format || changedTiddlers[this.viewTitle]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\treturn false;\t\n\t}\n};\n\nexports.view = ViewWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/widget.js": {
"title": "$:/core/modules/widgets/widget.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/widget.js\ntype: application/javascript\nmodule-type: widget\n\nWidget base class\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nCreate a widget object for a parse tree node\n\tparseTreeNode: reference to the parse tree node to be rendered\n\toptions: see below\nOptions include:\n\twiki: mandatory reference to wiki associated with this render tree\n\tparentWidget: optional reference to a parent renderer node for the context chain\n\tdocument: optional document object to use instead of global document\n*/\nvar Widget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInitialise widget properties. These steps are pulled out of the constructor so that we can reuse them in subclasses\n*/\nWidget.prototype.initialise = function(parseTreeNode,options) {\n\t// Bail if parseTreeNode is undefined, meaning that the widget constructor was called without any arguments so that it can be subclassed\n\tif(parseTreeNode === undefined) {\n\t\treturn;\n\t}\n\toptions = options || {};\n\t// Save widget info\n\tthis.parseTreeNode = parseTreeNode;\n\tthis.wiki = options.wiki;\n\tthis.parentWidget = options.parentWidget;\n\tthis.variablesConstructor = function() {};\n\tthis.variablesConstructor.prototype = this.parentWidget ? this.parentWidget.variables : {};\n\tthis.variables = new this.variablesConstructor();\n\tthis.document = options.document;\n\tthis.attributes = {};\n\tthis.children = [];\n\tthis.domNodes = [];\n\tthis.eventListeners = {};\n\t// Hashmap of the widget classes\n\tif(!this.widgetClasses) {\n\t\t// Get widget classes\n\t\tWidget.prototype.widgetClasses = $tw.modules.applyMethods(\"widget\");\n\t\t// Process any subclasses\n\t\t$tw.modules.forEachModuleOfType(\"widget-subclass\",function(title,module) {\n\t\t\tif(module.baseClass) {\n\t\t\t\tvar baseClass = Widget.prototype.widgetClasses[module.baseClass];\n\t\t\t\tif(!baseClass) {\n\t\t\t\t\tthrow \"Module '\" + title + \"' is attemping to extend a non-existent base class '\" + module.baseClass + \"'\";\n\t\t\t\t}\n\t\t\t\tvar subClass = module.constructor;\n\t\t\t\tsubClass.prototype = new baseClass();\n\t\t\t\t$tw.utils.extend(subClass.prototype,module.prototype);\n\t\t\t\tWidget.prototype.widgetClasses[module.name || module.baseClass] = subClass;\n\t\t\t}\n\t\t});\n\t}\n};\n\n/*\nRender this widget into the DOM\n*/\nWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nWidget.prototype.execute = function() {\n\tthis.makeChildWidgets();\n};\n\n/*\nSet the value of a context variable\nname: name of the variable\nvalue: value of the variable\nparams: array of {name:, default:} for each parameter\nisMacroDefinition: true if the variable is set via a \\define macro pragma (and hence should have variable substitution performed)\n*/\nWidget.prototype.setVariable = function(name,value,params,isMacroDefinition) {\n\tthis.variables[name] = {value: value, params: params, isMacroDefinition: !!isMacroDefinition};\n};\n\n/*\nGet the prevailing value of a context variable\nname: name of variable\noptions: see below\nOptions include\nparams: array of {name:, value:} for each parameter\ndefaultValue: default value if the variable is not defined\n\nReturns an object with the following fields:\n\nparams: array of {name:,value:} of parameters passed to wikitext variables\ntext: text of variable, with parameters properly substituted\n*/\nWidget.prototype.getVariableInfo = function(name,options) {\n\toptions = options || {};\n\tvar actualParams = options.params || [],\n\t\tparentWidget = this.parentWidget;\n\t// Check for the variable defined in the parent widget (or an ancestor in the prototype chain)\n\tif(parentWidget && name in parentWidget.variables) {\n\t\tvar variable = parentWidget.variables[name],\n\t\t\tvalue = variable.value,\n\t\t\tparams = this.resolveVariableParameters(variable.params,actualParams);\n\t\t// Substitute any parameters specified in the definition\n\t\t$tw.utils.each(params,function(param) {\n\t\t\tvalue = $tw.utils.replaceString(value,new RegExp(\"\\\\$\" + $tw.utils.escapeRegExp(param.name) + \"\\\\$\",\"mg\"),param.value);\n\t\t});\n\t\t// Only substitute variable references if this variable was defined with the \\define pragma\n\t\tif(variable.isMacroDefinition) {\n\t\t\tvalue = this.substituteVariableReferences(value);\t\t\t\n\t\t}\n\t\treturn {\n\t\t\ttext: value,\n\t\t\tparams: params\n\t\t};\n\t}\n\t// If the variable doesn't exist in the parent widget then look for a macro module\n\treturn {\n\t\ttext: this.evaluateMacroModule(name,actualParams,options.defaultValue)\n\t};\n};\n\n/*\nSimplified version of getVariableInfo() that just returns the text\n*/\nWidget.prototype.getVariable = function(name,options) {\n\treturn this.getVariableInfo(name,options).text;\n};\n\nWidget.prototype.resolveVariableParameters = function(formalParams,actualParams) {\n\tformalParams = formalParams || [];\n\tactualParams = actualParams || [];\n\tvar nextAnonParameter = 0, // Next candidate anonymous parameter in macro call\n\t\tparamInfo, paramValue,\n\t\tresults = [];\n\t// Step through each of the parameters in the macro definition\n\tfor(var p=0; p<formalParams.length; p++) {\n\t\t// Check if we've got a macro call parameter with the same name\n\t\tparamInfo = formalParams[p];\n\t\tparamValue = undefined;\n\t\tfor(var m=0; m<actualParams.length; m++) {\n\t\t\tif(actualParams[m].name === paramInfo.name) {\n\t\t\t\tparamValue = actualParams[m].value;\n\t\t\t}\n\t\t}\n\t\t// If not, use the next available anonymous macro call parameter\n\t\twhile(nextAnonParameter < actualParams.length && actualParams[nextAnonParameter].name) {\n\t\t\tnextAnonParameter++;\n\t\t}\n\t\tif(paramValue === undefined && nextAnonParameter < actualParams.length) {\n\t\t\tparamValue = actualParams[nextAnonParameter++].value;\n\t\t}\n\t\t// If we've still not got a value, use the default, if any\n\t\tparamValue = paramValue || paramInfo[\"default\"] || \"\";\n\t\t// Store the parameter name and value\n\t\tresults.push({name: paramInfo.name, value: paramValue});\n\t}\n\treturn results;\n};\n\nWidget.prototype.substituteVariableReferences = function(text) {\n\tvar self = this;\n\treturn (text || \"\").replace(/\\$\\(([^\\)\\$]+)\\)\\$/g,function(match,p1,offset,string) {\n\t\treturn self.getVariable(p1,{defaultValue: \"\"});\n\t});\n};\n\nWidget.prototype.evaluateMacroModule = function(name,actualParams,defaultValue) {\n\tif($tw.utils.hop($tw.macros,name)) {\n\t\tvar macro = $tw.macros[name],\n\t\t\targs = [];\n\t\tif(macro.params.length > 0) {\n\t\t\tvar nextAnonParameter = 0, // Next candidate anonymous parameter in macro call\n\t\t\t\tparamInfo, paramValue;\n\t\t\t// Step through each of the parameters in the macro definition\n\t\t\tfor(var p=0; p<macro.params.length; p++) {\n\t\t\t\t// Check if we've got a macro call parameter with the same name\n\t\t\t\tparamInfo = macro.params[p];\n\t\t\t\tparamValue = undefined;\n\t\t\t\tfor(var m=0; m<actualParams.length; m++) {\n\t\t\t\t\tif(actualParams[m].name === paramInfo.name) {\n\t\t\t\t\t\tparamValue = actualParams[m].value;\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\t// If not, use the next available anonymous macro call parameter\n\t\t\t\twhile(nextAnonParameter < actualParams.length && actualParams[nextAnonParameter].name) {\n\t\t\t\t\tnextAnonParameter++;\n\t\t\t\t}\n\t\t\t\tif(paramValue === undefined && nextAnonParameter < actualParams.length) {\n\t\t\t\t\tparamValue = actualParams[nextAnonParameter++].value;\n\t\t\t\t}\n\t\t\t\t// If we've still not got a value, use the default, if any\n\t\t\t\tparamValue = paramValue || paramInfo[\"default\"] || \"\";\n\t\t\t\t// Save the parameter\n\t\t\t\targs.push(paramValue);\n\t\t\t}\n\t\t}\n\t\telse for(var i=0; i<actualParams.length; ++i) {\n\t\t\targs.push(actualParams[i].value);\n\t\t}\n\t\treturn (macro.run.apply(this,args) || \"\").toString();\n\t} else {\n\t\treturn defaultValue;\n\t}\n};\n\n/*\nCheck whether a given context variable value exists in the parent chain\n*/\nWidget.prototype.hasVariable = function(name,value) {\n\tvar node = this;\n\twhile(node) {\n\t\tif($tw.utils.hop(node.variables,name) && node.variables[name].value === value) {\n\t\t\treturn true;\n\t\t}\n\t\tnode = node.parentWidget;\n\t}\n\treturn false;\n};\n\n/*\nConstruct a qualifying string based on a hash of concatenating the values of a given variable in the parent chain\n*/\nWidget.prototype.getStateQualifier = function(name) {\n\tthis.qualifiers = this.qualifiers || Object.create(null);\n\tname = name || \"transclusion\";\n\tif(this.qualifiers[name]) {\n\t\treturn this.qualifiers[name];\n\t} else {\n\t\tvar output = [],\n\t\t\tnode = this;\n\t\twhile(node && node.parentWidget) {\n\t\t\tif($tw.utils.hop(node.parentWidget.variables,name)) {\n\t\t\t\toutput.push(node.getVariable(name));\n\t\t\t}\n\t\t\tnode = node.parentWidget;\n\t\t}\n\t\tvar value = $tw.utils.hashString(output.join(\"\"));\n\t\tthis.qualifiers[name] = value;\n\t\treturn value;\n\t}\n};\n\n/*\nCompute the current values of the attributes of the widget. Returns a hashmap of the names of the attributes that have changed\n*/\nWidget.prototype.computeAttributes = function() {\n\tvar changedAttributes = {},\n\t\tself = this,\n\t\tvalue;\n\t$tw.utils.each(this.parseTreeNode.attributes,function(attribute,name) {\n\t\tif(attribute.type === \"filtered\") {\n\t\t\tvalue = self.wiki.filterTiddlers(attribute.filter,self)[0] || \"\";\n\t\t} else if(attribute.type === \"indirect\") {\n\t\t\tvalue = self.wiki.getTextReference(attribute.textReference,\"\",self.getVariable(\"currentTiddler\"));\n\t\t} else if(attribute.type === \"macro\") {\n\t\t\tvalue = self.getVariable(attribute.value.name,{params: attribute.value.params});\n\t\t} else { // String attribute\n\t\t\tvalue = attribute.value;\n\t\t}\n\t\t// Check whether the attribute has changed\n\t\tif(self.attributes[name] !== value) {\n\t\t\tself.attributes[name] = value;\n\t\t\tchangedAttributes[name] = true;\n\t\t}\n\t});\n\treturn changedAttributes;\n};\n\n/*\nCheck for the presence of an attribute\n*/\nWidget.prototype.hasAttribute = function(name) {\n\treturn $tw.utils.hop(this.attributes,name);\n};\n\n/*\nGet the value of an attribute\n*/\nWidget.prototype.getAttribute = function(name,defaultText) {\n\tif($tw.utils.hop(this.attributes,name)) {\n\t\treturn this.attributes[name];\n\t} else {\n\t\treturn defaultText;\n\t}\n};\n\n/*\nAssign the computed attributes of the widget to a domNode\noptions include:\nexcludeEventAttributes: ignores attributes whose name begins with \"on\"\n*/\nWidget.prototype.assignAttributes = function(domNode,options) {\n\toptions = options || {};\n\tvar self = this;\n\t$tw.utils.each(this.attributes,function(v,a) {\n\t\t// Check exclusions\n\t\tif(options.excludeEventAttributes && a.substr(0,2) === \"on\") {\n\t\t\tv = undefined;\n\t\t}\n\t\tif(v !== undefined) {\n\t\t\tvar b = a.split(\":\");\n\t\t\t// Setting certain attributes can cause a DOM error (eg xmlns on the svg element)\n\t\t\ttry {\n\t\t\t\tif (b.length == 2 && b[0] == \"xlink\"){\n\t\t\t\t\tdomNode.setAttributeNS(\"http://www.w3.org/1999/xlink\",b[1],v);\n\t\t\t\t} else {\n\t\t\t\t\tdomNode.setAttributeNS(null,a,v);\n\t\t\t\t}\n\t\t\t} catch(e) {\n\t\t\t}\n\t\t}\n\t});\n};\n\n/*\nMake child widgets correspondng to specified parseTreeNodes\n*/\nWidget.prototype.makeChildWidgets = function(parseTreeNodes) {\n\tthis.children = [];\n\tvar self = this;\n\t$tw.utils.each(parseTreeNodes || (this.parseTreeNode && this.parseTreeNode.children),function(childNode) {\n\t\tself.children.push(self.makeChildWidget(childNode));\n\t});\n};\n\n/*\nConstruct the widget object for a parse tree node\n*/\nWidget.prototype.makeChildWidget = function(parseTreeNode) {\n\tvar WidgetClass = this.widgetClasses[parseTreeNode.type];\n\tif(!WidgetClass) {\n\t\tWidgetClass = this.widgetClasses.text;\n\t\tparseTreeNode = {type: \"text\", text: \"Undefined widget '\" + parseTreeNode.type + \"'\"};\n\t}\n\treturn new WidgetClass(parseTreeNode,{\n\t\twiki: this.wiki,\n\t\tvariables: {},\n\t\tparentWidget: this,\n\t\tdocument: this.document\n\t});\n};\n\n/*\nGet the next sibling of this widget\n*/\nWidget.prototype.nextSibling = function() {\n\tif(this.parentWidget) {\n\t\tvar index = this.parentWidget.children.indexOf(this);\n\t\tif(index !== -1 && index < this.parentWidget.children.length-1) {\n\t\t\treturn this.parentWidget.children[index+1];\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nGet the previous sibling of this widget\n*/\nWidget.prototype.previousSibling = function() {\n\tif(this.parentWidget) {\n\t\tvar index = this.parentWidget.children.indexOf(this);\n\t\tif(index !== -1 && index > 0) {\n\t\t\treturn this.parentWidget.children[index-1];\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nRender the children of this widget into the DOM\n*/\nWidget.prototype.renderChildren = function(parent,nextSibling) {\n\tvar children = this.children;\n\tfor(var i = 0; i < children.length; i++) {\n\t\tchildren[i].render(parent,nextSibling);\n\t};\n};\n\n/*\nAdd a list of event listeners from an array [{type:,handler:},...]\n*/\nWidget.prototype.addEventListeners = function(listeners) {\n\tvar self = this;\n\t$tw.utils.each(listeners,function(listenerInfo) {\n\t\tself.addEventListener(listenerInfo.type,listenerInfo.handler);\n\t});\n};\n\n/*\nAdd an event listener\n*/\nWidget.prototype.addEventListener = function(type,handler) {\n\tvar self = this;\n\tif(typeof handler === \"string\") { // The handler is a method name on this widget\n\t\tthis.eventListeners[type] = function(event) {\n\t\t\treturn self[handler].call(self,event);\n\t\t};\n\t} else { // The handler is a function\n\t\tthis.eventListeners[type] = function(event) {\n\t\t\treturn handler.call(self,event);\n\t\t};\n\t}\n};\n\n/*\nDispatch an event to a widget. If the widget doesn't handle the event then it is also dispatched to the parent widget\n*/\nWidget.prototype.dispatchEvent = function(event) {\n\t// Dispatch the event if this widget handles it\n\tvar listener = this.eventListeners[event.type];\n\tif(listener) {\n\t\t// Don't propagate the event if the listener returned false\n\t\tif(!listener(event)) {\n\t\t\treturn false;\n\t\t}\n\t}\n\t// Dispatch the event to the parent widget\n\tif(this.parentWidget) {\n\t\treturn this.parentWidget.dispatchEvent(event);\n\t}\n\treturn true;\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nWidget.prototype.refresh = function(changedTiddlers) {\n\treturn this.refreshChildren(changedTiddlers);\n};\n\n/*\nRebuild a previously rendered widget\n*/\nWidget.prototype.refreshSelf = function() {\n\tvar nextSibling = this.findNextSiblingDomNode();\n\tthis.removeChildDomNodes();\n\tthis.render(this.parentDomNode,nextSibling);\n};\n\n/*\nRefresh all the children of a widget\n*/\nWidget.prototype.refreshChildren = function(changedTiddlers) {\n\tvar children = this.children,\n\t\trefreshed = false;\n\tfor (var i = 0; i < children.length; i++) {\n\t\trefreshed = children[i].refresh(changedTiddlers) || refreshed;\n\t}\n\treturn refreshed;\n};\n\n/*\nFind the next sibling in the DOM to this widget. This is done by scanning the widget tree through all next siblings and their descendents that share the same parent DOM node\n*/\nWidget.prototype.findNextSiblingDomNode = function(startIndex) {\n\t// Refer to this widget by its index within its parents children\n\tvar parent = this.parentWidget,\n\t\tindex = startIndex !== undefined ? startIndex : parent.children.indexOf(this);\nif(index === -1) {\n\tthrow \"node not found in parents children\";\n}\n\t// Look for a DOM node in the later siblings\n\twhile(++index < parent.children.length) {\n\t\tvar domNode = parent.children[index].findFirstDomNode();\n\t\tif(domNode) {\n\t\t\treturn domNode;\n\t\t}\n\t}\n\t// Go back and look for later siblings of our parent if it has the same parent dom node\n\tvar grandParent = parent.parentWidget;\n\tif(grandParent && parent.parentDomNode === this.parentDomNode) {\n\t\tindex = grandParent.children.indexOf(parent);\n\t\tif(index !== -1) {\n\t\t\treturn parent.findNextSiblingDomNode(index);\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nFind the first DOM node generated by a widget or its children\n*/\nWidget.prototype.findFirstDomNode = function() {\n\t// Return the first dom node of this widget, if we've got one\n\tif(this.domNodes.length > 0) {\n\t\treturn this.domNodes[0];\n\t}\n\t// Otherwise, recursively call our children\n\tfor(var t=0; t<this.children.length; t++) {\n\t\tvar domNode = this.children[t].findFirstDomNode();\n\t\tif(domNode) {\n\t\t\treturn domNode;\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nRemove any DOM nodes created by this widget or its children\n*/\nWidget.prototype.removeChildDomNodes = function() {\n\t// If this widget has directly created DOM nodes, delete them and exit. This assumes that any child widgets are contained within the created DOM nodes, which would normally be the case\n\tif(this.domNodes.length > 0) {\n\t\t$tw.utils.each(this.domNodes,function(domNode) {\n\t\t\tdomNode.parentNode.removeChild(domNode);\n\t\t});\n\t\tthis.domNodes = [];\n\t} else {\n\t\t// Otherwise, ask the child widgets to delete their DOM nodes\n\t\t$tw.utils.each(this.children,function(childWidget) {\n\t\t\tchildWidget.removeChildDomNodes();\n\t\t});\n\t}\n};\n\n/*\nInvoke the action widgets that are descendents of the current widget.\n*/\nWidget.prototype.invokeActions = function(triggeringWidget,event) {\n\tvar handled = false;\n\t// For each child widget\n\tfor(var t=0; t<this.children.length; t++) {\n\t\tvar child = this.children[t];\n\t\t// Invoke the child if it is an action widget\n\t\tif(child.invokeAction) {\n\t\t\tchild.refreshSelf();\n\t\t\tif(child.invokeAction(triggeringWidget,event)) {\n\t\t\t\thandled = true;\n\t\t\t}\n\t\t}\n\t\t// Propagate through through the child if it permits it\n\t\tif(child.allowActionPropagation() && child.invokeActions(triggeringWidget,event)) {\n\t\t\thandled = true;\n\t\t}\n\t}\n\treturn handled;\n};\n\n/*\nInvoke the action widgets defined in a string\n*/\nWidget.prototype.invokeActionString = function(actions,triggeringWidget,event,variables) {\n\tactions = actions || \"\";\n\tvar parser = this.wiki.parseText(\"text/vnd.tiddlywiki\",actions,{\n\t\t\tparentWidget: this,\n\t\t\tdocument: this.document\n\t\t}),\n\t\twidgetNode = this.wiki.makeWidget(parser,{\n\t\t\tparentWidget: this,\n\t\t\tdocument: this.document,\n\t\t\tvariables: variables\n\t\t});\n\tvar container = this.document.createElement(\"div\");\n\twidgetNode.render(container,null);\n\treturn widgetNode.invokeActions(this,event);\n};\n\nWidget.prototype.allowActionPropagation = function() {\n\treturn true;\n};\n\nexports.widget = Widget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/widgets/wikify.js": {
"title": "$:/core/modules/widgets/wikify.js",
"text": "/*\\\ntitle: $:/core/modules/widgets/wikify.js\ntype: application/javascript\nmodule-type: widget\n\nWidget to wikify text into a variable\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar WikifyWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nWikifyWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nWikifyWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.computeAttributes();\n\tthis.execute();\n\tthis.renderChildren(parent,nextSibling);\n};\n\n/*\nCompute the internal state of the widget\n*/\nWikifyWidget.prototype.execute = function() {\n\t// Get our parameters\n\tthis.wikifyName = this.getAttribute(\"name\");\n\tthis.wikifyText = this.getAttribute(\"text\");\n\tthis.wikifyType = this.getAttribute(\"type\");\n\tthis.wikifyMode = this.getAttribute(\"mode\",\"block\");\n\tthis.wikifyOutput = this.getAttribute(\"output\",\"text\");\n\t// Create the parse tree\n\tthis.wikifyParser = this.wiki.parseText(this.wikifyType,this.wikifyText,{\n\t\t\tparseAsInline: this.wikifyMode === \"inline\"\n\t\t});\n\t// Create the widget tree \n\tthis.wikifyWidgetNode = this.wiki.makeWidget(this.wikifyParser,{\n\t\t\tdocument: $tw.fakeDocument,\n\t\t\tparentWidget: this\n\t\t});\n\t// Render the widget tree to the container\n\tthis.wikifyContainer = $tw.fakeDocument.createElement(\"div\");\n\tthis.wikifyWidgetNode.render(this.wikifyContainer,null);\n\tthis.wikifyResult = this.getResult();\n\t// Set context variable\n\tthis.setVariable(this.wikifyName,this.wikifyResult);\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nReturn the result string\n*/\nWikifyWidget.prototype.getResult = function() {\n\tvar result;\n\tswitch(this.wikifyOutput) {\n\t\tcase \"text\":\n\t\t\tresult = this.wikifyContainer.textContent;\n\t\t\tbreak;\n\t\tcase \"formattedtext\":\n\t\t\tresult = this.wikifyContainer.formattedTextContent;\n\t\t\tbreak;\n\t\tcase \"html\":\n\t\t\tresult = this.wikifyContainer.innerHTML;\n\t\t\tbreak;\n\t\tcase \"parsetree\":\n\t\t\tresult = JSON.stringify(this.wikifyParser.tree,0,$tw.config.preferences.jsonSpaces);\n\t\t\tbreak;\n\t\tcase \"widgettree\":\n\t\t\tresult = JSON.stringify(this.getWidgetTree(),0,$tw.config.preferences.jsonSpaces);\n\t\t\tbreak;\n\t}\n\treturn result;\n};\n\n/*\nReturn a string of the widget tree\n*/\nWikifyWidget.prototype.getWidgetTree = function() {\n\tvar copyNode = function(widgetNode,resultNode) {\n\t\t\tvar type = widgetNode.parseTreeNode.type;\n\t\t\tresultNode.type = type;\n\t\t\tswitch(type) {\n\t\t\t\tcase \"element\":\n\t\t\t\t\tresultNode.tag = widgetNode.parseTreeNode.tag;\n\t\t\t\t\tbreak;\n\t\t\t\tcase \"text\":\n\t\t\t\t\tresultNode.text = widgetNode.parseTreeNode.text;\n\t\t\t\t\tbreak;\t\n\t\t\t}\n\t\t\tif(Object.keys(widgetNode.attributes || {}).length > 0) {\n\t\t\t\tresultNode.attributes = {};\n\t\t\t\t$tw.utils.each(widgetNode.attributes,function(attr,attrName) {\n\t\t\t\t\tresultNode.attributes[attrName] = widgetNode.getAttribute(attrName);\n\t\t\t\t});\n\t\t\t}\n\t\t\tif(Object.keys(widgetNode.children || {}).length > 0) {\n\t\t\t\tresultNode.children = [];\n\t\t\t\t$tw.utils.each(widgetNode.children,function(widgetChildNode) {\n\t\t\t\t\tvar node = {};\n\t\t\t\t\tresultNode.children.push(node);\n\t\t\t\t\tcopyNode(widgetChildNode,node);\n\t\t\t\t});\n\t\t\t}\n\t\t},\n\t\tresults = {};\n\tcopyNode(this.wikifyWidgetNode,results);\n\treturn results;\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nWikifyWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\t// Refresh ourselves entirely if any of our attributes have changed\n\tif(changedAttributes.name || changedAttributes.text || changedAttributes.type || changedAttributes.mode || changedAttributes.output) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\t// Refresh the widget tree\n\t\tif(this.wikifyWidgetNode.refresh(changedTiddlers)) {\n\t\t\t// Check if there was any change\n\t\t\tvar result = this.getResult();\n\t\t\tif(result !== this.wikifyResult) {\n\t\t\t\t// If so, save the change\n\t\t\t\tthis.wikifyResult = result;\n\t\t\t\tthis.setVariable(this.wikifyName,this.wikifyResult);\n\t\t\t\t// Refresh each of our child widgets\n\t\t\t\t$tw.utils.each(this.children,function(childWidget) {\n\t\t\t\t\tchildWidget.refreshSelf();\n\t\t\t\t});\n\t\t\t\treturn true;\n\t\t\t}\n\t\t}\n\t\t// Just refresh the children\n\t\treturn this.refreshChildren(changedTiddlers);\n\t}\n};\n\nexports.wikify = WikifyWidget;\n\n})();\n",
"type": "application/javascript",
"module-type": "widget"
},
"$:/core/modules/wiki-bulkops.js": {
"title": "$:/core/modules/wiki-bulkops.js",
"text": "/*\\\ntitle: $:/core/modules/wiki-bulkops.js\ntype: application/javascript\nmodule-type: wikimethod\n\nBulk tiddler operations such as rename.\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n/*\nRename a tiddler, and relink any tags or lists that reference it.\n*/\nfunction renameTiddler(fromTitle,toTitle,options) {\n\tfromTitle = (fromTitle || \"\").trim();\n\ttoTitle = (toTitle || \"\").trim();\n\toptions = options || {};\n\tif(fromTitle && toTitle && fromTitle !== toTitle) {\n\t\t// Rename the tiddler itself\n\t\tvar oldTiddler = this.getTiddler(fromTitle),\n\t\t\tnewTiddler = new $tw.Tiddler(oldTiddler,{title: toTitle},this.getModificationFields());\n\t\tnewTiddler = $tw.hooks.invokeHook(\"th-renaming-tiddler\",newTiddler,oldTiddler);\n\t\tthis.addTiddler(newTiddler);\n\t\tthis.deleteTiddler(fromTitle);\n\t\t// Rename any tags or lists that reference it\n\t\tthis.relinkTiddler(fromTitle,toTitle,options)\n\t}\n}\n\n/*\nRelink any tags or lists that reference a given tiddler\n*/\nfunction relinkTiddler(fromTitle,toTitle,options) {\n\tvar self = this;\n\tfromTitle = (fromTitle || \"\").trim();\n\ttoTitle = (toTitle || \"\").trim();\n\toptions = options || {};\n\tif(fromTitle && toTitle && fromTitle !== toTitle) {\n\t\tthis.each(function(tiddler,title) {\n\t\t\tvar type = tiddler.fields.type || \"\";\n\t\t\t// Don't touch plugins or JavaScript modules\n\t\t\tif(!tiddler.fields[\"plugin-type\"] && type !== \"application/javascript\") {\n\t\t\t\tvar tags = tiddler.fields.tags ? tiddler.fields.tags.slice(0) : undefined,\n\t\t\t\t\tlist = tiddler.fields.list ? tiddler.fields.list.slice(0) : undefined,\n\t\t\t\t\tisModified = false;\n\t\t\t\tif(!options.dontRenameInTags) {\n\t\t\t\t\t// Rename tags\n\t\t\t\t\t$tw.utils.each(tags,function (title,index) {\n\t\t\t\t\t\tif(title === fromTitle) {\nconsole.log(\"Renaming tag '\" + tags[index] + \"' to '\" + toTitle + \"' of tiddler '\" + tiddler.fields.title + \"'\");\n\t\t\t\t\t\t\ttags[index] = toTitle;\n\t\t\t\t\t\t\tisModified = true;\n\t\t\t\t\t\t}\n\t\t\t\t\t});\n\t\t\t\t}\n\t\t\t\tif(!options.dontRenameInLists) {\n\t\t\t\t\t// Rename lists\n\t\t\t\t\t$tw.utils.each(list,function (title,index) {\n\t\t\t\t\t\tif(title === fromTitle) {\nconsole.log(\"Renaming list item '\" + list[index] + \"' to '\" + toTitle + \"' of tiddler '\" + tiddler.fields.title + \"'\");\n\t\t\t\t\t\t\tlist[index] = toTitle;\n\t\t\t\t\t\t\tisModified = true;\n\t\t\t\t\t\t}\n\t\t\t\t\t});\n\t\t\t\t}\n\t\t\t\tif(isModified) {\n\t\t\t\t\tvar newTiddler = new $tw.Tiddler(tiddler,{tags: tags, list: list},self.getModificationFields())\n\t\t\t\t\tnewTiddler = $tw.hooks.invokeHook(\"th-relinking-tiddler\",newTiddler,tiddler);\n\t\t\t\t\tself.addTiddler(newTiddler);\n\t\t\t\t}\n\t\t\t}\n\t\t});\n\t}\n};\n\nexports.renameTiddler = renameTiddler;\nexports.relinkTiddler = relinkTiddler;\n\n})();\n",
"type": "application/javascript",
"module-type": "wikimethod"
},
"$:/core/modules/wiki.js": {
"title": "$:/core/modules/wiki.js",
"text": "/*\\\ntitle: $:/core/modules/wiki.js\ntype: application/javascript\nmodule-type: wikimethod\n\nExtension methods for the $tw.Wiki object\n\nAdds the following properties to the wiki object:\n\n* `eventListeners` is a hashmap by type of arrays of listener functions\n* `changedTiddlers` is a hashmap describing changes to named tiddlers since wiki change events were last dispatched. Each entry is a hashmap containing two fields:\n\tmodified: true/false\n\tdeleted: true/false\n* `changeCount` is a hashmap by tiddler title containing a numerical index that starts at zero and is incremented each time a tiddler is created changed or deleted\n* `caches` is a hashmap by tiddler title containing a further hashmap of named cache objects. Caches are automatically cleared when a tiddler is modified or deleted\n* `globalCache` is a hashmap by cache name of cache objects that are cleared whenever any tiddler change occurs\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar widget = require(\"$:/core/modules/widgets/widget.js\");\n\nvar USER_NAME_TITLE = \"$:/status/UserName\",\n\tTIMESTAMP_DISABLE_TITLE = \"$:/config/TimestampDisable\";\n\n/*\nAdd available indexers to this wiki\n*/\nexports.addIndexersToWiki = function() {\n\tvar self = this;\n\t$tw.utils.each($tw.modules.applyMethods(\"indexer\"),function(Indexer,name) {\n\t\tself.addIndexer(new Indexer(self),name);\n\t});\n};\n\n/*\nGet the value of a text reference. Text references can have any of these forms:\n\t<tiddlertitle>\n\t<tiddlertitle>!!<fieldname>\n\t!!<fieldname> - specifies a field of the current tiddlers\n\t<tiddlertitle>##<index>\n*/\nexports.getTextReference = function(textRef,defaultText,currTiddlerTitle) {\n\tvar tr = $tw.utils.parseTextReference(textRef),\n\t\ttitle = tr.title || currTiddlerTitle;\n\tif(tr.field) {\n\t\tvar tiddler = this.getTiddler(title);\n\t\tif(tr.field === \"title\") { // Special case so we can return the title of a non-existent tiddler\n\t\t\treturn title;\n\t\t} else if(tiddler && $tw.utils.hop(tiddler.fields,tr.field)) {\n\t\t\treturn tiddler.getFieldString(tr.field);\n\t\t} else {\n\t\t\treturn defaultText;\n\t\t}\n\t} else if(tr.index) {\n\t\treturn this.extractTiddlerDataItem(title,tr.index,defaultText);\n\t} else {\n\t\treturn this.getTiddlerText(title,defaultText);\n\t}\n};\n\nexports.setTextReference = function(textRef,value,currTiddlerTitle) {\n\tvar tr = $tw.utils.parseTextReference(textRef),\n\t\ttitle = tr.title || currTiddlerTitle;\n\tthis.setText(title,tr.field,tr.index,value);\n};\n\nexports.setText = function(title,field,index,value,options) {\n\toptions = options || {};\n\tvar creationFields = options.suppressTimestamp ? {} : this.getCreationFields(),\n\t\tmodificationFields = options.suppressTimestamp ? {} : this.getModificationFields();\n\t// Check if it is a reference to a tiddler field\n\tif(index) {\n\t\tvar data = this.getTiddlerData(title,Object.create(null));\n\t\tif(value !== undefined) {\n\t\t\tdata[index] = value;\n\t\t} else {\n\t\t\tdelete data[index];\n\t\t}\n\t\tthis.setTiddlerData(title,data,modificationFields);\n\t} else {\n\t\tvar tiddler = this.getTiddler(title),\n\t\t\tfields = {title: title};\n\t\tfields[field || \"text\"] = value;\n\t\tthis.addTiddler(new $tw.Tiddler(creationFields,tiddler,fields,modificationFields));\n\t}\n};\n\nexports.deleteTextReference = function(textRef,currTiddlerTitle) {\n\tvar tr = $tw.utils.parseTextReference(textRef),\n\t\ttitle,tiddler,fields;\n\t// Check if it is a reference to a tiddler\n\tif(tr.title && !tr.field) {\n\t\tthis.deleteTiddler(tr.title);\n\t// Else check for a field reference\n\t} else if(tr.field) {\n\t\ttitle = tr.title || currTiddlerTitle;\n\t\ttiddler = this.getTiddler(title);\n\t\tif(tiddler && $tw.utils.hop(tiddler.fields,tr.field)) {\n\t\t\tfields = Object.create(null);\n\t\t\tfields[tr.field] = undefined;\n\t\t\tthis.addTiddler(new $tw.Tiddler(tiddler,fields,this.getModificationFields()));\n\t\t}\n\t}\n};\n\nexports.addEventListener = function(type,listener) {\n\tthis.eventListeners = this.eventListeners || {};\n\tthis.eventListeners[type] = this.eventListeners[type] || [];\n\tthis.eventListeners[type].push(listener);\t\n};\n\nexports.removeEventListener = function(type,listener) {\n\tvar listeners = this.eventListeners[type];\n\tif(listeners) {\n\t\tvar p = listeners.indexOf(listener);\n\t\tif(p !== -1) {\n\t\t\tlisteners.splice(p,1);\n\t\t}\n\t}\n};\n\nexports.dispatchEvent = function(type /*, args */) {\n\tvar args = Array.prototype.slice.call(arguments,1),\n\t\tlisteners = this.eventListeners[type];\n\tif(listeners) {\n\t\tfor(var p=0; p<listeners.length; p++) {\n\t\t\tvar listener = listeners[p];\n\t\t\tlistener.apply(listener,args);\n\t\t}\n\t}\n};\n\n/*\nCauses a tiddler to be marked as changed, incrementing the change count, and triggers event handlers.\nThis method should be called after the changes it describes have been made to the wiki.tiddlers[] array.\n\ttitle: Title of tiddler\n\tisDeleted: defaults to false (meaning the tiddler has been created or modified),\n\t\ttrue if the tiddler has been deleted\n*/\nexports.enqueueTiddlerEvent = function(title,isDeleted) {\n\t// Record the touch in the list of changed tiddlers\n\tthis.changedTiddlers = this.changedTiddlers || Object.create(null);\n\tthis.changedTiddlers[title] = this.changedTiddlers[title] || Object.create(null);\n\tthis.changedTiddlers[title][isDeleted ? \"deleted\" : \"modified\"] = true;\n\t// Increment the change count\n\tthis.changeCount = this.changeCount || Object.create(null);\n\tif($tw.utils.hop(this.changeCount,title)) {\n\t\tthis.changeCount[title]++;\n\t} else {\n\t\tthis.changeCount[title] = 1;\n\t}\n\t// Trigger events\n\tthis.eventListeners = this.eventListeners || {};\n\tif(!this.eventsTriggered) {\n\t\tvar self = this;\n\t\t$tw.utils.nextTick(function() {\n\t\t\tvar changes = self.changedTiddlers;\n\t\t\tself.changedTiddlers = Object.create(null);\n\t\t\tself.eventsTriggered = false;\n\t\t\tif($tw.utils.count(changes) > 0) {\n\t\t\t\tself.dispatchEvent(\"change\",changes);\n\t\t\t}\n\t\t});\n\t\tthis.eventsTriggered = true;\n\t}\n};\n\nexports.getSizeOfTiddlerEventQueue = function() {\n\treturn $tw.utils.count(this.changedTiddlers);\n};\n\nexports.clearTiddlerEventQueue = function() {\n\tthis.changedTiddlers = Object.create(null);\n\tthis.changeCount = Object.create(null);\n};\n\nexports.getChangeCount = function(title) {\n\tthis.changeCount = this.changeCount || Object.create(null);\n\tif($tw.utils.hop(this.changeCount,title)) {\n\t\treturn this.changeCount[title];\n\t} else {\n\t\treturn 0;\n\t}\n};\n\n/*\nGenerate an unused title from the specified base\n*/\nexports.generateNewTitle = function(baseTitle,options) {\n\toptions = options || {};\n\tvar c = 0,\n\t\ttitle = baseTitle;\n\twhile(this.tiddlerExists(title) || this.isShadowTiddler(title) || this.findDraft(title)) {\n\t\ttitle = baseTitle + \n\t\t\t(options.prefix || \" \") + \n\t\t\t(++c);\n\t}\n\treturn title;\n};\n\nexports.isSystemTiddler = function(title) {\n\treturn title && title.indexOf(\"$:/\") === 0;\n};\n\nexports.isTemporaryTiddler = function(title) {\n\treturn title && title.indexOf(\"$:/temp/\") === 0;\n};\n\nexports.isImageTiddler = function(title) {\n\tvar tiddler = this.getTiddler(title);\n\tif(tiddler) {\t\t\n\t\tvar contentTypeInfo = $tw.config.contentTypeInfo[tiddler.fields.type || \"text/vnd.tiddlywiki\"];\n\t\treturn !!contentTypeInfo && contentTypeInfo.flags.indexOf(\"image\") !== -1;\n\t} else {\n\t\treturn null;\n\t}\n};\n\nexports.isBinaryTiddler = function(title) {\n\tvar tiddler = this.getTiddler(title);\n\tif(tiddler) {\t\t\n\t\tvar contentTypeInfo = $tw.config.contentTypeInfo[tiddler.fields.type || \"text/vnd.tiddlywiki\"];\n\t\treturn !!contentTypeInfo && contentTypeInfo.encoding === \"base64\";\n\t} else {\n\t\treturn null;\n\t}\n};\n\n/*\nLike addTiddler() except it will silently reject any plugin tiddlers that are older than the currently loaded version. Returns true if the tiddler was imported\n*/\nexports.importTiddler = function(tiddler) {\n\tvar existingTiddler = this.getTiddler(tiddler.fields.title);\n\t// Check if we're dealing with a plugin\n\tif(tiddler && tiddler.hasField(\"plugin-type\") && tiddler.hasField(\"version\") && existingTiddler && existingTiddler.hasField(\"plugin-type\") && existingTiddler.hasField(\"version\")) {\n\t\t// Reject the incoming plugin if it is older\n\t\tif(!$tw.utils.checkVersions(tiddler.fields.version,existingTiddler.fields.version)) {\n\t\t\treturn false;\n\t\t}\n\t}\n\t// Fall through to adding the tiddler\n\tthis.addTiddler(tiddler);\n\treturn true;\n};\n\n/*\nReturn a hashmap of the fields that should be set when a tiddler is created\n*/\nexports.getCreationFields = function() {\n\tif(this.getTiddlerText(TIMESTAMP_DISABLE_TITLE,\"\").toLowerCase() !== \"yes\") {\n\t\tvar fields = {\n\t\t\t\tcreated: new Date()\n\t\t\t},\n\t\t\tcreator = this.getTiddlerText(USER_NAME_TITLE);\n\t\tif(creator) {\n\t\t\tfields.creator = creator;\n\t\t}\n\t\treturn fields;\n\t} else {\n\t\treturn {};\n\t}\n};\n\n/*\nReturn a hashmap of the fields that should be set when a tiddler is modified\n*/\nexports.getModificationFields = function() {\n\tif(this.getTiddlerText(TIMESTAMP_DISABLE_TITLE,\"\").toLowerCase() !== \"yes\") {\n\t\tvar fields = Object.create(null),\n\t\t\tmodifier = this.getTiddlerText(USER_NAME_TITLE);\n\t\tfields.modified = new Date();\n\t\tif(modifier) {\n\t\t\tfields.modifier = modifier;\n\t\t}\n\t\treturn fields;\n\t} else {\n\t\treturn {};\n\t}\n};\n\n/*\nReturn a sorted array of tiddler titles. Options include:\nsortField: field to sort by\nexcludeTag: tag to exclude\nincludeSystem: whether to include system tiddlers (defaults to false)\n*/\nexports.getTiddlers = function(options) {\n\toptions = options || Object.create(null);\n\tvar self = this,\n\t\tsortField = options.sortField || \"title\",\n\t\ttiddlers = [], t, titles = [];\n\tthis.each(function(tiddler,title) {\n\t\tif(options.includeSystem || !self.isSystemTiddler(title)) {\n\t\t\tif(!options.excludeTag || !tiddler.hasTag(options.excludeTag)) {\n\t\t\t\ttiddlers.push(tiddler);\n\t\t\t}\n\t\t}\n\t});\n\ttiddlers.sort(function(a,b) {\n\t\tvar aa = a.fields[sortField].toLowerCase() || \"\",\n\t\t\tbb = b.fields[sortField].toLowerCase() || \"\";\n\t\tif(aa < bb) {\n\t\t\treturn -1;\n\t\t} else {\n\t\t\tif(aa > bb) {\n\t\t\t\treturn 1;\n\t\t\t} else {\n\t\t\t\treturn 0;\n\t\t\t}\n\t\t}\n\t});\n\tfor(t=0; t<tiddlers.length; t++) {\n\t\ttitles.push(tiddlers[t].fields.title);\n\t}\n\treturn titles;\n};\n\nexports.countTiddlers = function(excludeTag) {\n\tvar tiddlers = this.getTiddlers({excludeTag: excludeTag});\n\treturn $tw.utils.count(tiddlers);\n};\n\n/*\nReturns a function iterator(callback) that iterates through the specified titles, and invokes the callback with callback(tiddler,title)\n*/\nexports.makeTiddlerIterator = function(titles) {\n\tvar self = this;\n\tif(!$tw.utils.isArray(titles)) {\n\t\ttitles = Object.keys(titles);\n\t} else {\n\t\ttitles = titles.slice(0);\n\t}\n\treturn function(callback) {\n\t\ttitles.forEach(function(title) {\n\t\t\tcallback(self.getTiddler(title),title);\n\t\t});\n\t};\n};\n\n/*\nSort an array of tiddler titles by a specified field\n\ttitles: array of titles (sorted in place)\n\tsortField: name of field to sort by\n\tisDescending: true if the sort should be descending\n\tisCaseSensitive: true if the sort should consider upper and lower case letters to be different\n*/\nexports.sortTiddlers = function(titles,sortField,isDescending,isCaseSensitive,isNumeric,isAlphaNumeric) {\n\tvar self = this;\n\ttitles.sort(function(a,b) {\n\t\tvar x,y,\n\t\t\tcompareNumbers = function(x,y) {\n\t\t\t\tvar result = \n\t\t\t\t\tisNaN(x) && !isNaN(y) ? (isDescending ? -1 : 1) :\n\t\t\t\t\t!isNaN(x) && isNaN(y) ? (isDescending ? 1 : -1) :\n\t\t\t\t\t\t\t\t\t\t\t(isDescending ? y - x : x - y);\n\t\t\t\treturn result;\n\t\t\t};\n\t\tif(sortField !== \"title\") {\n\t\t\tvar tiddlerA = self.getTiddler(a),\n\t\t\t\ttiddlerB = self.getTiddler(b);\n\t\t\tif(tiddlerA) {\n\t\t\t\ta = tiddlerA.fields[sortField] || \"\";\n\t\t\t} else {\n\t\t\t\ta = \"\";\n\t\t\t}\n\t\t\tif(tiddlerB) {\n\t\t\t\tb = tiddlerB.fields[sortField] || \"\";\n\t\t\t} else {\n\t\t\t\tb = \"\";\n\t\t\t}\n\t\t}\n\t\tx = Number(a);\n\t\ty = Number(b);\n\t\tif(isNumeric && (!isNaN(x) || !isNaN(y))) {\n\t\t\treturn compareNumbers(x,y);\n\t\t} else if(isAlphaNumeric) {\n\t\t\treturn isDescending ? b.localeCompare(a,undefined,{numeric: true,sensitivity: \"base\"}) : a.localeCompare(b,undefined,{numeric: true,sensitivity: \"base\"});\n\t\t} else if($tw.utils.isDate(a) && $tw.utils.isDate(b)) {\n\t\t\treturn isDescending ? b - a : a - b;\n\t\t} else {\n\t\t\ta = String(a);\n\t\t\tb = String(b);\n\t\t\tif(!isCaseSensitive) {\n\t\t\t\ta = a.toLowerCase();\n\t\t\t\tb = b.toLowerCase();\n\t\t\t}\n\t\t\treturn isDescending ? b.localeCompare(a) : a.localeCompare(b);\n\t\t}\n\t});\n};\n\n/*\nFor every tiddler invoke a callback(title,tiddler) with `this` set to the wiki object. Options include:\nsortField: field to sort by\nexcludeTag: tag to exclude\nincludeSystem: whether to include system tiddlers (defaults to false)\n*/\nexports.forEachTiddler = function(/* [options,]callback */) {\n\tvar arg = 0,\n\t\toptions = arguments.length >= 2 ? arguments[arg++] : {},\n\t\tcallback = arguments[arg++],\n\t\ttitles = this.getTiddlers(options),\n\t\tt, tiddler;\n\tfor(t=0; t<titles.length; t++) {\n\t\ttiddler = this.getTiddler(titles[t]);\n\t\tif(tiddler) {\n\t\t\tcallback.call(this,tiddler.fields.title,tiddler);\n\t\t}\n\t}\n};\n\n/*\nReturn an array of tiddler titles that are directly linked within the given parse tree\n */\nexports.extractLinks = function(parseTreeRoot) {\n\t// Count up the links\n\tvar links = [],\n\t\tcheckParseTree = function(parseTree) {\n\t\t\tfor(var t=0; t<parseTree.length; t++) {\n\t\t\t\tvar parseTreeNode = parseTree[t];\n\t\t\t\tif(parseTreeNode.type === \"link\" && parseTreeNode.attributes.to && parseTreeNode.attributes.to.type === \"string\") {\n\t\t\t\t\tvar value = parseTreeNode.attributes.to.value;\n\t\t\t\t\tif(links.indexOf(value) === -1) {\n\t\t\t\t\t\tlinks.push(value);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\tif(parseTreeNode.children) {\n\t\t\t\t\tcheckParseTree(parseTreeNode.children);\n\t\t\t\t}\n\t\t\t}\n\t\t};\n\tcheckParseTree(parseTreeRoot);\n\treturn links;\n};\n\n/*\nReturn an array of tiddler titles that are directly linked from the specified tiddler\n*/\nexports.getTiddlerLinks = function(title) {\n\tvar self = this;\n\t// We'll cache the links so they only get computed if the tiddler changes\n\treturn this.getCacheForTiddler(title,\"links\",function() {\n\t\t// Parse the tiddler\n\t\tvar parser = self.parseTiddler(title);\n\t\tif(parser) {\n\t\t\treturn self.extractLinks(parser.tree);\n\t\t}\n\t\treturn [];\n\t});\n};\n\n/*\nReturn an array of tiddler titles that link to the specified tiddler\n*/\nexports.getTiddlerBacklinks = function(targetTitle) {\n\tvar self = this,\n\t\tbacklinksIndexer = this.getIndexer(\"BacklinksIndexer\"),\n\t\tbacklinks = backlinksIndexer && backlinksIndexer.lookup(targetTitle);\n\n\tif(!backlinks) {\n\t\tbacklinks = [];\n\t\tthis.forEachTiddler(function(title,tiddler) {\n\t\t\tvar links = self.getTiddlerLinks(title);\n\t\t\tif(links.indexOf(targetTitle) !== -1) {\n\t\t\t\tbacklinks.push(title);\n\t\t\t}\n\t\t});\n\t}\n\treturn backlinks;\n};\n\n/*\nReturn a hashmap of tiddler titles that are referenced but not defined. Each value is the number of times the missing tiddler is referenced\n*/\nexports.getMissingTitles = function() {\n\tvar self = this,\n\t\tmissing = [];\n// We should cache the missing tiddler list, even if we recreate it every time any tiddler is modified\n\tthis.forEachTiddler(function(title,tiddler) {\n\t\tvar links = self.getTiddlerLinks(title);\n\t\t$tw.utils.each(links,function(link) {\n\t\t\tif((!self.tiddlerExists(link) && !self.isShadowTiddler(link)) && missing.indexOf(link) === -1) {\n\t\t\t\tmissing.push(link);\n\t\t\t}\n\t\t});\n\t});\n\treturn missing;\n};\n\nexports.getOrphanTitles = function() {\n\tvar self = this,\n\t\torphans = this.getTiddlers();\n\tthis.forEachTiddler(function(title,tiddler) {\n\t\tvar links = self.getTiddlerLinks(title);\n\t\t$tw.utils.each(links,function(link) {\n\t\t\tvar p = orphans.indexOf(link);\n\t\t\tif(p !== -1) {\n\t\t\t\torphans.splice(p,1);\n\t\t\t}\n\t\t});\n\t});\n\treturn orphans; // Todo\n};\n\n/*\nRetrieves a list of the tiddler titles that are tagged with a given tag\n*/\nexports.getTiddlersWithTag = function(tag) {\n\t// Try to use the indexer\n\tvar self = this,\n\t\ttagIndexer = this.getIndexer(\"TagIndexer\"),\n\t\tresults = tagIndexer && tagIndexer.subIndexers[3].lookup(tag);\n\tif(!results) {\n\t\t// If not available, perform a manual scan\n\t\tresults = this.getGlobalCache(\"taglist-\" + tag,function() {\n\t\t\tvar tagmap = self.getTagMap();\n\t\t\treturn self.sortByList(tagmap[tag],tag);\n\t\t});\n\t}\n\treturn results;\n};\n\n/*\nGet a hashmap by tag of arrays of tiddler titles\n*/\nexports.getTagMap = function() {\n\tvar self = this;\n\treturn this.getGlobalCache(\"tagmap\",function() {\n\t\tvar tags = Object.create(null),\n\t\t\tstoreTags = function(tagArray,title) {\n\t\t\t\tif(tagArray) {\n\t\t\t\t\tfor(var index=0; index<tagArray.length; index++) {\n\t\t\t\t\t\tvar tag = tagArray[index];\n\t\t\t\t\t\tif($tw.utils.hop(tags,tag)) {\n\t\t\t\t\t\t\ttags[tag].push(title);\n\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\ttags[tag] = [title];\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t},\n\t\t\ttitle, tiddler;\n\t\t// Collect up all the tags\n\t\tself.eachShadow(function(tiddler,title) {\n\t\t\tif(!self.tiddlerExists(title)) {\n\t\t\t\ttiddler = self.getTiddler(title);\n\t\t\t\tstoreTags(tiddler.fields.tags,title);\n\t\t\t}\n\t\t});\n\t\tself.each(function(tiddler,title) {\n\t\t\tstoreTags(tiddler.fields.tags,title);\n\t\t});\n\t\treturn tags;\n\t});\n};\n\n/*\nLookup a given tiddler and return a list of all the tiddlers that include it in the specified list field\n*/\nexports.findListingsOfTiddler = function(targetTitle,fieldName) {\n\tfieldName = fieldName || \"list\";\n\tvar titles = [];\n\tthis.each(function(tiddler,title) {\n\t\tvar list = $tw.utils.parseStringArray(tiddler.fields[fieldName]);\n\t\tif(list && list.indexOf(targetTitle) !== -1) {\n\t\t\ttitles.push(title);\n\t\t}\n\t});\n\treturn titles;\n};\n\n/*\nSorts an array of tiddler titles according to an ordered list\n*/\nexports.sortByList = function(array,listTitle) {\n\tvar self = this,\n\t\treplacedTitles = Object.create(null);\n\t// Given a title, this function will place it in the correct location\n\t// within titles.\n\tfunction moveItemInList(title) {\n\t\tif(!$tw.utils.hop(replacedTitles, title)) {\n\t\t\treplacedTitles[title] = true;\n\t\t\tvar newPos = -1,\n\t\t\t\ttiddler = self.getTiddler(title);\n\t\t\tif(tiddler) {\n\t\t\t\tvar beforeTitle = tiddler.fields[\"list-before\"],\n\t\t\t\t\tafterTitle = tiddler.fields[\"list-after\"];\n\t\t\t\tif(beforeTitle === \"\") {\n\t\t\t\t\tnewPos = 0;\n\t\t\t\t} else if(afterTitle === \"\") {\n\t\t\t\t\tnewPos = titles.length;\n\t\t\t\t} else if(beforeTitle) {\n\t\t\t\t\t// if this title is placed relative\n\t\t\t\t\t// to another title, make sure that\n\t\t\t\t\t// title is placed before we place\n\t\t\t\t\t// this one.\n\t\t\t\t\tmoveItemInList(beforeTitle);\n\t\t\t\t\tnewPos = titles.indexOf(beforeTitle);\n\t\t\t\t} else if(afterTitle) {\n\t\t\t\t\t// Same deal\n\t\t\t\t\tmoveItemInList(afterTitle);\n\t\t\t\t\tnewPos = titles.indexOf(afterTitle);\n\t\t\t\t\tif(newPos >= 0) {\n\t\t\t\t\t\t++newPos;\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t\t// If a new position is specified, let's move it\n\t\t\t\tif (newPos !== -1) {\n\t\t\t\t\t// get its current Pos, and make sure\n\t\t\t\t\t// sure that it's _actually_ in the list\n\t\t\t\t\t// and that it would _actually_ move\n\t\t\t\t\t// (#4275) We don't bother calling\n\t\t\t\t\t// indexOf unless we have a new\n\t\t\t\t\t// position to work with\n\t\t\t\t\tvar currPos = titles.indexOf(title);\n\t\t\t\t\tif(currPos >= 0 && newPos !== currPos) {\n\t\t\t\t\t\t// move it!\n\t\t\t\t\t\ttitles.splice(currPos,1);\n\t\t\t\t\t\tif(newPos >= currPos) {\n\t\t\t\t\t\t\tnewPos--;\n\t\t\t\t\t\t}\n\t\t\t\t\t\ttitles.splice(newPos,0,title);\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t}\n\t}\n\tvar list = this.getTiddlerList(listTitle);\n\tif(!array || array.length === 0) {\n\t\treturn [];\n\t} else {\n\t\tvar titles = [], t, title;\n\t\t// First place any entries that are present in the list\n\t\tfor(t=0; t<list.length; t++) {\n\t\t\ttitle = list[t];\n\t\t\tif(array.indexOf(title) !== -1) {\n\t\t\t\ttitles.push(title);\n\t\t\t}\n\t\t}\n\t\t// Then place any remaining entries\n\t\tfor(t=0; t<array.length; t++) {\n\t\t\ttitle = array[t];\n\t\t\tif(list.indexOf(title) === -1) {\n\t\t\t\ttitles.push(title);\n\t\t\t}\n\t\t}\n\t\t// Finally obey the list-before and list-after fields of each tiddler in turn\n\t\tvar sortedTitles = titles.slice(0);\n\t\tfor(t=0; t<sortedTitles.length; t++) {\n\t\t\ttitle = sortedTitles[t];\n\t\t\tmoveItemInList(title);\n\t\t}\n\t\treturn titles;\n\t}\n};\n\nexports.getSubTiddler = function(title,subTiddlerTitle) {\n\tvar bundleInfo = this.getPluginInfo(title) || this.getTiddlerDataCached(title);\n\tif(bundleInfo && bundleInfo.tiddlers) {\n\t\tvar subTiddler = bundleInfo.tiddlers[subTiddlerTitle];\n\t\tif(subTiddler) {\n\t\t\treturn new $tw.Tiddler(subTiddler);\n\t\t}\n\t}\n\treturn null;\n};\n\n/*\nRetrieve a tiddler as a JSON string of the fields\n*/\nexports.getTiddlerAsJson = function(title) {\n\tvar tiddler = this.getTiddler(title);\n\tif(tiddler) {\n\t\tvar fields = Object.create(null);\n\t\t$tw.utils.each(tiddler.fields,function(value,name) {\n\t\t\tfields[name] = tiddler.getFieldString(name);\n\t\t});\n\t\treturn JSON.stringify(fields);\n\t} else {\n\t\treturn JSON.stringify({title: title});\n\t}\n};\n\nexports.getTiddlersAsJson = function(filter,spaces) {\n\tvar tiddlers = this.filterTiddlers(filter),\n\t\tspaces = (spaces === undefined) ? $tw.config.preferences.jsonSpaces : spaces,\n\t\tdata = [];\n\tfor(var t=0;t<tiddlers.length; t++) {\n\t\tvar tiddler = this.getTiddler(tiddlers[t]);\n\t\tif(tiddler) {\n\t\t\tvar fields = new Object();\n\t\t\tfor(var field in tiddler.fields) {\n\t\t\t\tfields[field] = tiddler.getFieldString(field);\n\t\t\t}\n\t\t\tdata.push(fields);\n\t\t}\n\t}\n\treturn JSON.stringify(data,null,spaces);\n};\n\n/*\nGet the content of a tiddler as a JavaScript object. How this is done depends on the type of the tiddler:\n\napplication/json: the tiddler JSON is parsed into an object\napplication/x-tiddler-dictionary: the tiddler is parsed as sequence of name:value pairs\n\nOther types currently just return null.\n\ntitleOrTiddler: string tiddler title or a tiddler object\ndefaultData: default data to be returned if the tiddler is missing or doesn't contain data\n\nNote that the same value is returned for repeated calls for the same tiddler data. The value is frozen to prevent modification; otherwise modifications would be visible to all callers\n*/\nexports.getTiddlerDataCached = function(titleOrTiddler,defaultData) {\n\tvar self = this,\n\t\ttiddler = titleOrTiddler;\n\tif(!(tiddler instanceof $tw.Tiddler)) {\n\t\ttiddler = this.getTiddler(tiddler);\t\n\t}\n\tif(tiddler) {\n\t\treturn this.getCacheForTiddler(tiddler.fields.title,\"data\",function() {\n\t\t\t// Return the frozen value\n\t\t\tvar value = self.getTiddlerData(tiddler.fields.title,undefined);\n\t\t\t$tw.utils.deepFreeze(value);\n\t\t\treturn value;\n\t\t}) || defaultData;\n\t} else {\n\t\treturn defaultData;\n\t}\n};\n\n/*\nAlternative, uncached version of getTiddlerDataCached(). The return value can be mutated freely and reused\n*/\nexports.getTiddlerData = function(titleOrTiddler,defaultData) {\n\tvar tiddler = titleOrTiddler,\n\t\tdata;\n\tif(!(tiddler instanceof $tw.Tiddler)) {\n\t\ttiddler = this.getTiddler(tiddler);\t\n\t}\n\tif(tiddler && tiddler.fields.text) {\n\t\tswitch(tiddler.fields.type) {\n\t\t\tcase \"application/json\":\n\t\t\t\t// JSON tiddler\n\t\t\t\ttry {\n\t\t\t\t\tdata = JSON.parse(tiddler.fields.text);\n\t\t\t\t} catch(ex) {\n\t\t\t\t\treturn defaultData;\n\t\t\t\t}\n\t\t\t\treturn data;\n\t\t\tcase \"application/x-tiddler-dictionary\":\n\t\t\t\treturn $tw.utils.parseFields(tiddler.fields.text);\n\t\t}\n\t}\n\treturn defaultData;\n};\n\n/*\nExtract an indexed field from within a data tiddler\n*/\nexports.extractTiddlerDataItem = function(titleOrTiddler,index,defaultText) {\n\tvar data = this.getTiddlerDataCached(titleOrTiddler,Object.create(null)),\n\t\ttext;\n\tif(data && $tw.utils.hop(data,index)) {\n\t\ttext = data[index];\n\t}\n\tif(typeof text === \"string\" || typeof text === \"number\") {\n\t\treturn text.toString();\n\t} else {\n\t\treturn defaultText;\n\t}\n};\n\n/*\nSet a tiddlers content to a JavaScript object. Currently this is done by setting the tiddler's type to \"application/json\" and setting the text to the JSON text of the data.\ntitle: title of tiddler\ndata: object that can be serialised to JSON\nfields: optional hashmap of additional tiddler fields to be set\n*/\nexports.setTiddlerData = function(title,data,fields) {\n\tvar existingTiddler = this.getTiddler(title),\n\t\tnewFields = {\n\t\t\ttitle: title\n\t};\n\tif(existingTiddler && existingTiddler.fields.type === \"application/x-tiddler-dictionary\") {\n\t\tnewFields.text = $tw.utils.makeTiddlerDictionary(data);\n\t} else {\n\t\tnewFields.type = \"application/json\";\n\t\tnewFields.text = JSON.stringify(data,null,$tw.config.preferences.jsonSpaces);\n\t}\n\tthis.addTiddler(new $tw.Tiddler(this.getCreationFields(),existingTiddler,fields,newFields,this.getModificationFields()));\n};\n\n/*\nReturn the content of a tiddler as an array containing each line\n*/\nexports.getTiddlerList = function(title,field,index) {\n\tif(index) {\n\t\treturn $tw.utils.parseStringArray(this.extractTiddlerDataItem(title,index,\"\"));\n\t}\n\tfield = field || \"list\";\n\tvar tiddler = this.getTiddler(title);\n\tif(tiddler) {\n\t\treturn ($tw.utils.parseStringArray(tiddler.fields[field]) || []).slice(0);\n\t}\n\treturn [];\n};\n\n// Return a named global cache object. Global cache objects are cleared whenever a tiddler change occurs\nexports.getGlobalCache = function(cacheName,initializer) {\n\tthis.globalCache = this.globalCache || Object.create(null);\n\tif($tw.utils.hop(this.globalCache,cacheName)) {\n\t\treturn this.globalCache[cacheName];\n\t} else {\n\t\tthis.globalCache[cacheName] = initializer();\n\t\treturn this.globalCache[cacheName];\n\t}\n};\n\nexports.clearGlobalCache = function() {\n\tthis.globalCache = Object.create(null);\n};\n\n// Return the named cache object for a tiddler. If the cache doesn't exist then the initializer function is invoked to create it\nexports.getCacheForTiddler = function(title,cacheName,initializer) {\n\tthis.caches = this.caches || Object.create(null);\n\tvar caches = this.caches[title];\n\tif(caches && caches[cacheName]) {\n\t\treturn caches[cacheName];\n\t} else {\n\t\tif(!caches) {\n\t\t\tcaches = Object.create(null);\n\t\t\tthis.caches[title] = caches;\n\t\t}\n\t\tcaches[cacheName] = initializer();\n\t\treturn caches[cacheName];\n\t}\n};\n\n// Clear all caches associated with a particular tiddler, or, if the title is null, clear all the caches for all the tiddlers\nexports.clearCache = function(title) {\n\tif(title) {\n\t\tthis.caches = this.caches || Object.create(null);\n\t\tif($tw.utils.hop(this.caches,title)) {\n\t\t\tdelete this.caches[title];\n\t\t}\n\t} else {\n\t\tthis.caches = Object.create(null);\n\t}\n};\n\nexports.initParsers = function(moduleType) {\n\t// Install the parser modules\n\t$tw.Wiki.parsers = {};\n\tvar self = this;\n\t$tw.modules.forEachModuleOfType(\"parser\",function(title,module) {\n\t\tfor(var f in module) {\n\t\t\tif($tw.utils.hop(module,f)) {\n\t\t\t\t$tw.Wiki.parsers[f] = module[f]; // Store the parser class\n\t\t\t}\n\t\t}\n\t});\n\t// Use the generic binary parser for any binary types not registered so far\n\tif($tw.Wiki.parsers[\"application/octet-stream\"]) {\n\t\tObject.keys($tw.config.contentTypeInfo).forEach(function(type) {\n\t\t\tif(!$tw.utils.hop($tw.Wiki.parsers,type) && $tw.config.contentTypeInfo[type].encoding === \"base64\") {\n\t\t\t\t$tw.Wiki.parsers[type] = $tw.Wiki.parsers[\"application/octet-stream\"];\n\t\t\t}\n\t\t});\t\t\n\t}\n};\n\n/*\nParse a block of text of a specified MIME type\n\ttype: content type of text to be parsed\n\ttext: text\n\toptions: see below\nOptions include:\n\tparseAsInline: if true, the text of the tiddler will be parsed as an inline run\n\t_canonical_uri: optional string of the canonical URI of this content\n*/\nexports.parseText = function(type,text,options) {\n\ttext = text || \"\";\n\toptions = options || {};\n\t// Select a parser\n\tvar Parser = $tw.Wiki.parsers[type];\n\tif(!Parser && $tw.utils.getFileExtensionInfo(type)) {\n\t\tParser = $tw.Wiki.parsers[$tw.utils.getFileExtensionInfo(type).type];\n\t}\n\tif(!Parser) {\n\t\tParser = $tw.Wiki.parsers[options.defaultType || \"text/vnd.tiddlywiki\"];\n\t}\n\tif(!Parser) {\n\t\treturn null;\n\t}\n\t// Return the parser instance\n\treturn new Parser(type,text,{\n\t\tparseAsInline: options.parseAsInline,\n\t\twiki: this,\n\t\t_canonical_uri: options._canonical_uri\n\t});\n};\n\n/*\nParse a tiddler according to its MIME type\n*/\nexports.parseTiddler = function(title,options) {\n\toptions = $tw.utils.extend({},options);\n\tvar cacheType = options.parseAsInline ? \"inlineParseTree\" : \"blockParseTree\",\n\t\ttiddler = this.getTiddler(title),\n\t\tself = this;\n\treturn tiddler ? this.getCacheForTiddler(title,cacheType,function() {\n\t\t\tif(tiddler.hasField(\"_canonical_uri\")) {\n\t\t\t\toptions._canonical_uri = tiddler.fields._canonical_uri;\n\t\t\t}\n\t\t\treturn self.parseText(tiddler.fields.type,tiddler.fields.text,options);\n\t\t}) : null;\n};\n\nexports.parseTextReference = function(title,field,index,options) {\n\tvar tiddler,text;\n\tif(options.subTiddler) {\n\t\ttiddler = this.getSubTiddler(title,options.subTiddler);\n\t} else {\n\t\ttiddler = this.getTiddler(title);\n\t\tif(field === \"text\" || (!field && !index)) {\n\t\t\tthis.getTiddlerText(title); // Force the tiddler to be lazily loaded\n\t\t\treturn this.parseTiddler(title,options);\n\t\t}\n\t}\n\tif(field === \"text\" || (!field && !index)) {\n\t\tif(tiddler && tiddler.fields) {\n\t\t\treturn this.parseText(tiddler.fields.type,tiddler.fields.text,options);\t\t\t\n\t\t} else {\n\t\t\treturn null;\n\t\t}\n\t} else if(field) {\n\t\tif(field === \"title\") {\n\t\t\ttext = title;\n\t\t} else {\n\t\t\tif(!tiddler || !tiddler.hasField(field)) {\n\t\t\t\treturn null;\n\t\t\t}\n\t\t\ttext = tiddler.fields[field];\n\t\t}\n\t\treturn this.parseText(\"text/vnd.tiddlywiki\",text.toString(),options);\n\t} else if(index) {\n\t\tthis.getTiddlerText(title); // Force the tiddler to be lazily loaded\n\t\ttext = this.extractTiddlerDataItem(tiddler,index,undefined);\n\t\tif(text === undefined) {\n\t\t\treturn null;\n\t\t}\n\t\treturn this.parseText(\"text/vnd.tiddlywiki\",text,options);\n\t}\n};\n\n/*\nMake a widget tree for a parse tree\nparser: parser object\noptions: see below\nOptions include:\ndocument: optional document to use\nvariables: hashmap of variables to set\nparentWidget: optional parent widget for the root node\n*/\nexports.makeWidget = function(parser,options) {\n\toptions = options || {};\n\tvar widgetNode = {\n\t\t\ttype: \"widget\",\n\t\t\tchildren: []\n\t\t},\n\t\tcurrWidgetNode = widgetNode;\n\t// Create set variable widgets for each variable\n\t$tw.utils.each(options.variables,function(value,name) {\n\t\tvar setVariableWidget = {\n\t\t\ttype: \"set\",\n\t\t\tattributes: {\n\t\t\t\tname: {type: \"string\", value: name},\n\t\t\t\tvalue: {type: \"string\", value: value}\n\t\t\t},\n\t\t\tchildren: []\n\t\t};\n\t\tcurrWidgetNode.children = [setVariableWidget];\n\t\tcurrWidgetNode = setVariableWidget;\n\t});\n\t// Add in the supplied parse tree nodes\n\tcurrWidgetNode.children = parser ? parser.tree : [];\n\t// Create the widget\n\treturn new widget.widget(widgetNode,{\n\t\twiki: this,\n\t\tdocument: options.document || $tw.fakeDocument,\n\t\tparentWidget: options.parentWidget\n\t});\n};\n\n/*\nMake a widget tree for transclusion\ntitle: target tiddler title\noptions: as for wiki.makeWidget() plus:\noptions.field: optional field to transclude (defaults to \"text\")\noptions.mode: transclusion mode \"inline\" or \"block\"\noptions.children: optional array of children for the transclude widget\noptions.importVariables: optional importvariables filter string for macros to be included\noptions.importPageMacros: optional boolean; if true, equivalent to passing \"[[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\" to options.importVariables\n*/\nexports.makeTranscludeWidget = function(title,options) {\n\toptions = options || {};\n\tvar parseTreeDiv = {tree: [{\n\t\t\ttype: \"element\",\n\t\t\ttag: \"div\",\n\t\t\tchildren: []}]},\n\t\tparseTreeImportVariables = {\n\t\t\ttype: \"importvariables\",\n\t\t\tattributes: {\n\t\t\t\tfilter: {\n\t\t\t\t\tname: \"filter\",\n\t\t\t\t\ttype: \"string\"\n\t\t\t\t}\n\t\t\t},\n\t\t\tisBlock: false,\n\t\t\tchildren: []},\n\t\tparseTreeTransclude = {\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {\n\t\t\t\t\tname: \"tiddler\",\n\t\t\t\t\ttype: \"string\",\n\t\t\t\t\tvalue: title}},\n\t\t\tisBlock: !options.parseAsInline};\n\tif(options.importVariables || options.importPageMacros) {\n\t\tif(options.importVariables) {\n\t\t\tparseTreeImportVariables.attributes.filter.value = options.importVariables;\n\t\t} else if(options.importPageMacros) {\n\t\t\tparseTreeImportVariables.attributes.filter.value = \"[[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\";\n\t\t}\n\t\tparseTreeDiv.tree[0].children.push(parseTreeImportVariables);\n\t\tparseTreeImportVariables.children.push(parseTreeTransclude);\n\t} else {\n\t\tparseTreeDiv.tree[0].children.push(parseTreeTransclude);\n\t}\n\tif(options.field) {\n\t\tparseTreeTransclude.attributes.field = {type: \"string\", value: options.field};\n\t}\n\tif(options.mode) {\n\t\tparseTreeTransclude.attributes.mode = {type: \"string\", value: options.mode};\n\t}\n\tif(options.children) {\n\t\tparseTreeTransclude.children = options.children;\n\t}\n\treturn $tw.wiki.makeWidget(parseTreeDiv,options);\n};\n\n/*\nParse text in a specified format and render it into another format\n\toutputType: content type for the output\n\ttextType: content type of the input text\n\ttext: input text\n\toptions: see below\nOptions include:\nvariables: hashmap of variables to set\nparentWidget: optional parent widget for the root node\n*/\nexports.renderText = function(outputType,textType,text,options) {\n\toptions = options || {};\n\tvar parser = this.parseText(textType,text,options),\n\t\twidgetNode = this.makeWidget(parser,options);\n\tvar container = $tw.fakeDocument.createElement(\"div\");\n\twidgetNode.render(container,null);\n\treturn outputType === \"text/html\" ? container.innerHTML : container.textContent;\n};\n\n/*\nParse text from a tiddler and render it into another format\n\toutputType: content type for the output\n\ttitle: title of the tiddler to be rendered\n\toptions: see below\nOptions include:\nvariables: hashmap of variables to set\nparentWidget: optional parent widget for the root node\n*/\nexports.renderTiddler = function(outputType,title,options) {\n\toptions = options || {};\n\tvar parser = this.parseTiddler(title,options),\n\t\twidgetNode = this.makeWidget(parser,options);\n\tvar container = $tw.fakeDocument.createElement(\"div\");\n\twidgetNode.render(container,null);\n\treturn outputType === \"text/html\" ? container.innerHTML : (outputType === \"text/plain-formatted\" ? container.formattedTextContent : container.textContent);\n};\n\n/*\nReturn an array of tiddler titles that match a search string\n\ttext: The text string to search for\n\toptions: see below\nOptions available:\n\tsource: an iterator function for the source tiddlers, called source(iterator), where iterator is called as iterator(tiddler,title)\n\texclude: An array of tiddler titles to exclude from the search\n\tinvert: If true returns tiddlers that do not contain the specified string\n\tcaseSensitive: If true forces a case sensitive search\n\tfield: If specified, restricts the search to the specified field, or an array of field names\n\tanchored: If true, forces all but regexp searches to be anchored to the start of text\n\texcludeField: If true, the field options are inverted to specify the fields that are not to be searched\n\tThe search mode is determined by the first of these boolean flags to be true\n\t\tliteral: searches for literal string\n\t\twhitespace: same as literal except runs of whitespace are treated as a single space\n\t\tregexp: treats the search term as a regular expression\n\t\twords: (default) treats search string as a list of tokens, and matches if all tokens are found, regardless of adjacency or ordering\n*/\nexports.search = function(text,options) {\n\toptions = options || {};\n\tvar self = this,\n\t\tt,\n\t\tinvert = !!options.invert;\n\t// Convert the search string into a regexp for each term\n\tvar terms, searchTermsRegExps,\n\t\tflags = options.caseSensitive ? \"\" : \"i\",\n\t\tanchor = options.anchored ? \"^\" : \"\";\n\tif(options.literal) {\n\t\tif(text.length === 0) {\n\t\t\tsearchTermsRegExps = null;\n\t\t} else {\n\t\t\tsearchTermsRegExps = [new RegExp(\"(\" + anchor + $tw.utils.escapeRegExp(text) + \")\",flags)];\n\t\t}\n\t} else if(options.whitespace) {\n\t\tterms = [];\n\t\t$tw.utils.each(text.split(/\\s+/g),function(term) {\n\t\t\tif(term) {\n\t\t\t\tterms.push($tw.utils.escapeRegExp(term));\n\t\t\t}\n\t\t});\n\t\tsearchTermsRegExps = [new RegExp(\"(\" + anchor + terms.join(\"\\\\s+\") + \")\",flags)];\n\t} else if(options.regexp) {\n\t\ttry {\n\t\t\tsearchTermsRegExps = [new RegExp(\"(\" + text + \")\",flags)];\t\t\t\n\t\t} catch(e) {\n\t\t\tsearchTermsRegExps = null;\n\t\t\tconsole.log(\"Regexp error parsing /(\" + text + \")/\" + flags + \": \",e);\n\t\t}\n\t} else {\n\t\tterms = text.split(/ +/);\n\t\tif(terms.length === 1 && terms[0] === \"\") {\n\t\t\tsearchTermsRegExps = null;\n\t\t} else {\n\t\t\tsearchTermsRegExps = [];\n\t\t\tfor(t=0; t<terms.length; t++) {\n\t\t\t\tsearchTermsRegExps.push(new RegExp(\"(\" + anchor + $tw.utils.escapeRegExp(terms[t]) + \")\",flags));\n\t\t\t}\n\t\t}\n\t}\n\t// Accumulate the array of fields to be searched or excluded from the search\n\tvar fields = [];\n\tif(options.field) {\n\t\tif($tw.utils.isArray(options.field)) {\n\t\t\t$tw.utils.each(options.field,function(fieldName) {\n\t\t\t\tif(fieldName) {\n\t\t\t\t\tfields.push(fieldName);\t\t\t\t\t\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tfields.push(options.field);\n\t\t}\n\t}\n\t// Use default fields if none specified and we're not excluding fields (excluding fields with an empty field array is the same as searching all fields)\n\tif(fields.length === 0 && !options.excludeField) {\n\t\tfields.push(\"title\");\n\t\tfields.push(\"tags\");\n\t\tfields.push(\"text\");\n\t}\n\t// Function to check a given tiddler for the search term\n\tvar searchTiddler = function(title) {\n\t\tif(!searchTermsRegExps) {\n\t\t\treturn true;\n\t\t}\n\t\tvar notYetFound = searchTermsRegExps.slice();\n\n\t\tvar tiddler = self.getTiddler(title);\n\t\tif(!tiddler) {\n\t\t\ttiddler = new $tw.Tiddler({title: title, text: \"\", type: \"text/vnd.tiddlywiki\"});\n\t\t}\n\t\tvar contentTypeInfo = $tw.config.contentTypeInfo[tiddler.fields.type] || $tw.config.contentTypeInfo[\"text/vnd.tiddlywiki\"],\n\t\t\tsearchFields;\n\t\t// Get the list of fields we're searching\n\t\tif(options.excludeField) {\n\t\t\tsearchFields = Object.keys(tiddler.fields);\n\t\t\t$tw.utils.each(fields,function(fieldName) {\n\t\t\t\tvar p = searchFields.indexOf(fieldName);\n\t\t\t\tif(p !== -1) {\n\t\t\t\t\tsearchFields.splice(p,1);\n\t\t\t\t}\n\t\t\t});\n\t\t} else {\n\t\t\tsearchFields = fields;\n\t\t}\n\t\tfor(var fieldIndex=0; notYetFound.length>0 && fieldIndex<searchFields.length; fieldIndex++) {\n\t\t\t// Don't search the text field if the content type is binary\n\t\t\tvar fieldName = searchFields[fieldIndex];\n\t\t\tif(fieldName === \"text\" && contentTypeInfo.encoding !== \"utf8\") {\n\t\t\t\tbreak;\n\t\t\t}\n\t\t\tvar str = tiddler.fields[fieldName],\n\t\t\t\tt;\n\t\t\tif(str) {\n\t\t\t\tif($tw.utils.isArray(str)) {\n\t\t\t\t\t// If the field value is an array, test each regexp against each field array entry and fail if each regexp doesn't match at least one field array entry\n\t\t\t\t\tfor(var s=0; s<str.length; s++) {\n\t\t\t\t\t\tfor(t=0; t<notYetFound.length;) {\n\t\t\t\t\t\t\tif(notYetFound[t].test(str[s])) {\n\t\t\t\t\t\t\t\tnotYetFound.splice(t, 1);\n\t\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\t\tt++;\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\t// If the field isn't an array, force it to a string and test each regexp against it and fail if any do not match\n\t\t\t\t\tstr = tiddler.getFieldString(fieldName);\n\t\t\t\t\tfor(t=0; t<notYetFound.length;) {\n\t\t\t\t\t\tif(notYetFound[t].test(str)) {\n\t\t\t\t\t\t\tnotYetFound.splice(t, 1);\n\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\tt++;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t}\n\t\t};\n\t\treturn notYetFound.length == 0;\n\t};\n\t// Loop through all the tiddlers doing the search\n\tvar results = [],\n\t\tsource = options.source || this.each;\n\tsource(function(tiddler,title) {\n\t\tif(searchTiddler(title) !== options.invert) {\n\t\t\tresults.push(title);\n\t\t}\n\t});\n\t// Remove any of the results we have to exclude\n\tif(options.exclude) {\n\t\tfor(t=0; t<options.exclude.length; t++) {\n\t\t\tvar p = results.indexOf(options.exclude[t]);\n\t\t\tif(p !== -1) {\n\t\t\t\tresults.splice(p,1);\n\t\t\t}\n\t\t}\n\t}\n\treturn results;\n};\n\n/*\nTrigger a load for a tiddler if it is skinny. Returns the text, or undefined if the tiddler is missing, null if the tiddler is being lazily loaded.\n*/\nexports.getTiddlerText = function(title,defaultText) {\n\tvar tiddler = this.getTiddler(title);\n\t// Return undefined if the tiddler isn't found\n\tif(!tiddler) {\n\t\treturn defaultText;\n\t}\n\tif(!tiddler.hasField(\"_is_skinny\")) {\n\t\t// Just return the text if we've got it\n\t\treturn tiddler.fields.text || \"\";\n\t} else {\n\t\t// Tell any listeners about the need to lazily load this tiddler\n\t\tthis.dispatchEvent(\"lazyLoad\",title);\n\t\t// Indicate that the text is being loaded\n\t\treturn null;\n\t}\n};\n\n/*\nCheck whether the text of a tiddler matches a given value. By default, the comparison is case insensitive, and any spaces at either end of the tiddler text is trimmed\n*/\nexports.checkTiddlerText = function(title,targetText,options) {\n\toptions = options || {};\n\tvar text = this.getTiddlerText(title,\"\");\n\tif(!options.noTrim) {\n\t\ttext = text.trim();\n\t}\n\tif(!options.caseSensitive) {\n\t\ttext = text.toLowerCase();\n\t\ttargetText = targetText.toLowerCase();\n\t}\n\treturn text === targetText;\n}\n\n/*\nRead an array of browser File objects, invoking callback(tiddlerFieldsArray) once they're all read\n*/\nexports.readFiles = function(files,options) {\n\tvar callback;\n\tif(typeof options === \"function\") {\n\t\tcallback = options;\n\t\toptions = {};\n\t} else {\n\t\tcallback = options.callback;\n\t}\n\tvar result = [],\n\t\toutstanding = files.length,\n\t\treadFileCallback = function(tiddlerFieldsArray) {\n\t\t\tresult.push.apply(result,tiddlerFieldsArray);\n\t\t\tif(--outstanding === 0) {\n\t\t\t\tcallback(result);\n\t\t\t}\n\t\t};\n\tfor(var f=0; f<files.length; f++) {\n\t\tthis.readFile(files[f],$tw.utils.extend({},options,{callback: readFileCallback}));\n\t}\n\treturn files.length;\n};\n\n/*\nRead a browser File object, invoking callback(tiddlerFieldsArray) with an array of tiddler fields objects\n*/\nexports.readFile = function(file,options) {\n\tvar callback;\n\tif(typeof options === \"function\") {\n\t\tcallback = options;\n\t\toptions = {};\n\t} else {\n\t\tcallback = options.callback;\n\t}\n\t// Get the type, falling back to the filename extension\n\tvar self = this,\n\t\ttype = file.type;\n\tif(type === \"\" || !type) {\n\t\tvar dotPos = file.name.lastIndexOf(\".\");\n\t\tif(dotPos !== -1) {\n\t\t\tvar fileExtensionInfo = $tw.utils.getFileExtensionInfo(file.name.substr(dotPos));\n\t\t\tif(fileExtensionInfo) {\n\t\t\t\ttype = fileExtensionInfo.type;\n\t\t\t}\n\t\t}\n\t}\n\t// Figure out if we're reading a binary file\n\tvar contentTypeInfo = $tw.config.contentTypeInfo[type],\n\t\tisBinary = contentTypeInfo ? contentTypeInfo.encoding === \"base64\" : false;\n\t// Log some debugging information\n\tif($tw.log.IMPORT) {\n\t\tconsole.log(\"Importing file '\" + file.name + \"', type: '\" + type + \"', isBinary: \" + isBinary);\n\t}\n\t// Give the hook a chance to process the drag\n\tif($tw.hooks.invokeHook(\"th-importing-file\",{\n\t\tfile: file,\n\t\ttype: type,\n\t\tisBinary: isBinary,\n\t\tcallback: callback\n\t}) !== true) {\n\t\tthis.readFileContent(file,type,isBinary,options.deserializer,callback);\n\t}\n};\n\n/*\nLower level utility to read the content of a browser File object, invoking callback(tiddlerFieldsArray) with an array of tiddler fields objects\n*/\nexports.readFileContent = function(file,type,isBinary,deserializer,callback) {\n\tvar self = this;\n\t// Create the FileReader\n\tvar reader = new FileReader();\n\t// Onload\n\treader.onload = function(event) {\n\t\tvar text = event.target.result,\n\t\t\ttiddlerFields = {title: file.name || \"Untitled\", type: type};\n\t\tif(isBinary) {\n\t\t\tvar commaPos = text.indexOf(\",\");\n\t\t\tif(commaPos !== -1) {\n\t\t\t\ttext = text.substr(commaPos + 1);\n\t\t\t}\n\t\t}\n\t\t// Check whether this is an encrypted TiddlyWiki file\n\t\tvar encryptedJson = $tw.utils.extractEncryptedStoreArea(text);\n\t\tif(encryptedJson) {\n\t\t\t// If so, attempt to decrypt it with the current password\n\t\t\t$tw.utils.decryptStoreAreaInteractive(encryptedJson,function(tiddlers) {\n\t\t\t\tcallback(tiddlers);\n\t\t\t});\n\t\t} else {\n\t\t\t// Otherwise, just try to deserialise any tiddlers in the file\n\t\t\tcallback(self.deserializeTiddlers(type,text,tiddlerFields,{deserializer: deserializer}));\n\t\t}\n\t};\n\t// Kick off the read\n\tif(isBinary) {\n\t\treader.readAsDataURL(file);\n\t} else {\n\t\treader.readAsText(file);\n\t}\n};\n\n/*\nFind any existing draft of a specified tiddler\n*/\nexports.findDraft = function(targetTitle) {\n\tvar draftTitle = undefined;\n\tthis.forEachTiddler({includeSystem: true},function(title,tiddler) {\n\t\tif(tiddler.fields[\"draft.title\"] && tiddler.fields[\"draft.of\"] === targetTitle) {\n\t\t\tdraftTitle = title;\n\t\t}\n\t});\n\treturn draftTitle;\n}\n\n/*\nCheck whether the specified draft tiddler has been modified.\nIf the original tiddler doesn't exist, create a vanilla tiddler variable,\nto check if additional fields have been added.\n*/\nexports.isDraftModified = function(title) {\n\tvar tiddler = this.getTiddler(title);\n\tif(!tiddler.isDraft()) {\n\t\treturn false;\n\t}\n\tvar ignoredFields = [\"created\", \"modified\", \"title\", \"draft.title\", \"draft.of\"],\n\t\torigTiddler = this.getTiddler(tiddler.fields[\"draft.of\"]) || new $tw.Tiddler({text:\"\", tags:[]}),\n\t\ttitleModified = tiddler.fields[\"draft.title\"] !== tiddler.fields[\"draft.of\"];\n\treturn titleModified || !tiddler.isEqual(origTiddler,ignoredFields);\n};\n\n/*\nAdd a new record to the top of the history stack\ntitle: a title string or an array of title strings\nfromPageRect: page coordinates of the origin of the navigation\nhistoryTitle: title of history tiddler (defaults to $:/HistoryList)\n*/\nexports.addToHistory = function(title,fromPageRect,historyTitle) {\n\tvar story = new $tw.Story({wiki: this, historyTitle: historyTitle});\n\tstory.addToHistory(title,fromPageRect);\t\t\n};\n\n/*\nAdd a new tiddler to the story river\ntitle: a title string or an array of title strings\nfromTitle: the title of the tiddler from which the navigation originated\nstoryTitle: title of story tiddler (defaults to $:/StoryList)\noptions: see story.js\n*/\nexports.addToStory = function(title,fromTitle,storyTitle,options) {\n\tvar story = new $tw.Story({wiki: this, storyTitle: storyTitle});\n\tstory.addToStory(title,fromTitle,options);\t\t\n};\n\n/*\nGenerate a title for the draft of a given tiddler\n*/\nexports.generateDraftTitle = function(title) {\n\tvar c = 0,\n\t\tdraftTitle,\n\t\tusername = this.getTiddlerText(\"$:/status/UserName\"),\n\t\tattribution = username ? \" by \" + username : \"\";\n\tdo {\n\t\tdraftTitle = \"Draft \" + (c ? (c + 1) + \" \" : \"\") + \"of '\" + title + \"'\" + attribution;\n\t\tc++;\n\t} while(this.tiddlerExists(draftTitle));\n\treturn draftTitle;\n};\n\n/*\nInvoke the available upgrader modules\ntitles: array of tiddler titles to be processed\ntiddlers: hashmap by title of tiddler fields of pending import tiddlers. These can be modified by the upgraders. An entry with no fields indicates a tiddler that was pending import has been suppressed. When entries are added to the pending import the tiddlers hashmap may have entries that are not present in the titles array\nReturns a hashmap of messages keyed by tiddler title.\n*/\nexports.invokeUpgraders = function(titles,tiddlers) {\n\t// Collect up the available upgrader modules\n\tvar self = this;\n\tif(!this.upgraderModules) {\n\t\tthis.upgraderModules = [];\n\t\t$tw.modules.forEachModuleOfType(\"upgrader\",function(title,module) {\n\t\t\tif(module.upgrade) {\n\t\t\t\tself.upgraderModules.push(module);\n\t\t\t}\n\t\t});\n\t}\n\t// Invoke each upgrader in turn\n\tvar messages = {};\n\tfor(var t=0; t<this.upgraderModules.length; t++) {\n\t\tvar upgrader = this.upgraderModules[t],\n\t\t\tupgraderMessages = upgrader.upgrade(this,titles,tiddlers);\n\t\t$tw.utils.extend(messages,upgraderMessages);\n\t}\n\treturn messages;\n};\n\n// Determine whether a plugin by title is dynamically loadable\nexports.doesPluginRequireReload = function(title) {\n\treturn this.doesPluginInfoRequireReload(this.getPluginInfo(title) || this.getTiddlerDataCached(title));\n};\n\n// Determine whether a plugin info structure is dynamically loadable\nexports.doesPluginInfoRequireReload = function(pluginInfo) {\n\tif(pluginInfo) {\n\t\tvar foundModule = false;\n\t\t$tw.utils.each(pluginInfo.tiddlers,function(tiddler) {\n\t\t\tif(tiddler.type === \"application/javascript\" && $tw.utils.hop(tiddler,\"module-type\")) {\n\t\t\t\tfoundModule = true;\n\t\t\t}\n\t\t});\n\t\treturn foundModule;\n\t} else {\n\t\treturn null;\n\t}\n};\n\n})();\n\n",
"type": "application/javascript",
"module-type": "wikimethod"
},
"$:/palettes/Blanca": {
"title": "$:/palettes/Blanca",
"name": "Blanca",
"description": "A clean white palette to let you focus",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #ffffff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background:\nbutton-foreground:\nbutton-border:\ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndirty-indicator: #ff0000\ndownload-background: #66cccc\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333333\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #999999\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #ffffff\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #7897f3\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #000000\nsidebar-controls-foreground: #ccc\nsidebar-foreground-shadow: rgba(255,255,255, 0.8)\nsidebar-foreground: #acacac\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #c0c0c0\nsidebar-tab-background-selected: #ffffff\nsidebar-tab-background: <<colour tab-background>>\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: <<colour tab-divider>>\nsidebar-tab-foreground-selected: \nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #444444\nsidebar-tiddler-link-foreground: #7897f3\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: #ffffff\ntab-background: #eeeeee\ntab-border-selected: #cccccc\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #ffeedd\ntag-foreground: #000\ntiddler-background: <<colour background>>\ntiddler-border: #eee\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #f8f8f8\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #f8f8f8\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #ff9900\ntoolbar-new-button:\ntoolbar-options-button:\ntoolbar-save-button:\ntoolbar-info-button:\ntoolbar-edit-button:\ntoolbar-close-button:\ntoolbar-delete-button:\ntoolbar-cancel-button:\ntoolbar-done-button:\nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/Blue": {
"title": "$:/palettes/Blue",
"name": "Blue",
"description": "A blue theme",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #fff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background:\nbutton-foreground:\nbutton-border:\ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndirty-indicator: #ff0000\ndownload-background: #34c734\ndownload-foreground: <<colour foreground>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333353\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #999999\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #ddddff\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #5778d8\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #000000\nsidebar-controls-foreground: #ffffff\nsidebar-foreground-shadow: rgba(255,255,255, 0.8)\nsidebar-foreground: #acacac\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #c0c0c0\nsidebar-tab-background-selected: <<colour page-background>>\nsidebar-tab-background: <<colour tab-background>>\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: <<colour tab-divider>>\nsidebar-tab-foreground-selected: \nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #444444\nsidebar-tiddler-link-foreground: #5959c0\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: #ccccdd\ntab-border-selected: #ccccdd\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #eeeeff\ntag-foreground: #000\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #666666\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #ffffff\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #ffffff\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #5959c0\ntoolbar-new-button: #5eb95e\ntoolbar-options-button: rgb(128, 88, 165)\ntoolbar-save-button: #0e90d2\ntoolbar-info-button: #0e90d2\ntoolbar-edit-button: rgb(243, 123, 29)\ntoolbar-close-button: #dd514c\ntoolbar-delete-button: #dd514c\ntoolbar-cancel-button: rgb(243, 123, 29)\ntoolbar-done-button: #5eb95e\nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/Muted": {
"title": "$:/palettes/Muted",
"name": "Muted",
"description": "Bright tiddlers on a muted background",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #ffffff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background:\nbutton-foreground:\nbutton-border:\ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndirty-indicator: #ff0000\ndownload-background: #34c734\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333333\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #bbb\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #6f6f70\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #29a6ee\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #000000\nsidebar-controls-foreground: #c2c1c2\nsidebar-foreground-shadow: rgba(255,255,255,0)\nsidebar-foreground: #d3d2d4\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #c0c0c0\nsidebar-tab-background-selected: #6f6f70\nsidebar-tab-background: #666667\nsidebar-tab-border-selected: #999\nsidebar-tab-border: #515151\nsidebar-tab-divider: #999\nsidebar-tab-foreground-selected: \nsidebar-tab-foreground: #999\nsidebar-tiddler-link-foreground-hover: #444444\nsidebar-tiddler-link-foreground: #d1d0d2\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: #ffffff\ntab-background: #d8d8d8\ntab-border-selected: #d8d8d8\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #d5ad34\ntag-foreground: #ffffff\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #f8f8f8\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #f8f8f8\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #182955\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/ContrastLight": {
"title": "$:/palettes/ContrastLight",
"name": "Contrast (Light)",
"description": "High contrast and unambiguous (light version)",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #f00\nalert-border: <<colour background>>\nalert-highlight: <<colour foreground>>\nalert-muted-foreground: #800\nbackground: #fff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: <<colour background>>\nbutton-foreground: <<colour foreground>>\nbutton-border: <<colour foreground>>\ncode-background: <<colour background>>\ncode-border: <<colour foreground>>\ncode-foreground: <<colour foreground>>\ndirty-indicator: #f00\ndownload-background: #080\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: <<colour foreground>>\ndropdown-tab-background: <<colour foreground>>\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #00a\nexternal-link-foreground: #00e\nforeground: #000\nmessage-background: <<colour foreground>>\nmessage-border: <<colour background>>\nmessage-foreground: <<colour background>>\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: <<colour foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour foreground>>\nmodal-header-border: <<colour foreground>>\nmuted-foreground: <<colour foreground>>\nnotification-background: <<colour background>>\nnotification-border: <<colour foreground>>\npage-background: <<colour background>>\npre-background: <<colour background>>\npre-border: <<colour foreground>>\nprimary: #00f\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: <<colour background>>\nsidebar-controls-foreground: <<colour foreground>>\nsidebar-foreground-shadow: rgba(0,0,0, 0)\nsidebar-foreground: <<colour foreground>>\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: <<colour foreground>>\nsidebar-tab-background-selected: <<colour background>>\nsidebar-tab-background: <<colour tab-background>>\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: <<colour tab-divider>>\nsidebar-tab-foreground-selected: <<colour foreground>>\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: <<colour foreground>>\nsidebar-tiddler-link-foreground: <<colour primary>>\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: <<colour foreground>>\ntab-border-selected: <<colour foreground>>\ntab-border: <<colour foreground>>\ntab-divider: <<colour foreground>>\ntab-foreground-selected: <<colour foreground>>\ntab-foreground: <<colour background>>\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #000\ntag-foreground: #fff\ntiddler-background: <<colour background>>\ntiddler-border: <<colour foreground>>\ntiddler-controls-foreground-hover: #ddd\ntiddler-controls-foreground-selected: #fdd\ntiddler-controls-foreground: <<colour foreground>>\ntiddler-editor-background: <<colour background>>\ntiddler-editor-border-image: <<colour foreground>>\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: <<colour background>>\ntiddler-editor-fields-odd: <<colour background>>\ntiddler-info-background: <<colour background>>\ntiddler-info-border: <<colour foreground>>\ntiddler-info-tab-background: <<colour background>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour foreground>>\ntiddler-title-foreground: <<colour foreground>>\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour foreground>>\nvery-muted-foreground: #888888\n"
},
"$:/palettes/ContrastDark": {
"title": "$:/palettes/ContrastDark",
"name": "Contrast (Dark)",
"description": "High contrast and unambiguous (dark version)",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #f00\nalert-border: <<colour background>>\nalert-highlight: <<colour foreground>>\nalert-muted-foreground: #800\nbackground: #000\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: <<colour background>>\nbutton-foreground: <<colour foreground>>\nbutton-border: <<colour foreground>>\ncode-background: <<colour background>>\ncode-border: <<colour foreground>>\ncode-foreground: <<colour foreground>>\ndirty-indicator: #f00\ndownload-background: #080\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: <<colour foreground>>\ndropdown-tab-background: <<colour foreground>>\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #00a\nexternal-link-foreground: #00e\nforeground: #fff\nmessage-background: <<colour foreground>>\nmessage-border: <<colour background>>\nmessage-foreground: <<colour background>>\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: <<colour foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour foreground>>\nmodal-header-border: <<colour foreground>>\nmuted-foreground: <<colour foreground>>\nnotification-background: <<colour background>>\nnotification-border: <<colour foreground>>\npage-background: <<colour background>>\npre-background: <<colour background>>\npre-border: <<colour foreground>>\nprimary: #00f\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: <<colour background>>\nsidebar-controls-foreground: <<colour foreground>>\nsidebar-foreground-shadow: rgba(0,0,0, 0)\nsidebar-foreground: <<colour foreground>>\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: <<colour foreground>>\nsidebar-tab-background-selected: <<colour background>>\nsidebar-tab-background: <<colour tab-background>>\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: <<colour tab-divider>>\nsidebar-tab-foreground-selected: <<colour foreground>>\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: <<colour foreground>>\nsidebar-tiddler-link-foreground: <<colour primary>>\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: <<colour foreground>>\ntab-border-selected: <<colour foreground>>\ntab-border: <<colour foreground>>\ntab-divider: <<colour foreground>>\ntab-foreground-selected: <<colour foreground>>\ntab-foreground: <<colour background>>\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #fff\ntag-foreground: #000\ntiddler-background: <<colour background>>\ntiddler-border: <<colour foreground>>\ntiddler-controls-foreground-hover: #ddd\ntiddler-controls-foreground-selected: #fdd\ntiddler-controls-foreground: <<colour foreground>>\ntiddler-editor-background: <<colour background>>\ntiddler-editor-border-image: <<colour foreground>>\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: <<colour background>>\ntiddler-editor-fields-odd: <<colour background>>\ntiddler-info-background: <<colour background>>\ntiddler-info-border: <<colour foreground>>\ntiddler-info-tab-background: <<colour background>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour foreground>>\ntiddler-title-foreground: <<colour foreground>>\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour foreground>>\nvery-muted-foreground: #888888\n"
},
"$:/palettes/DarkPhotos": {
"title": "$:/palettes/DarkPhotos",
"created": "20150402111612188",
"description": "Good with dark photo backgrounds",
"modified": "20150402112344080",
"name": "DarkPhotos",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #ffffff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: \nbutton-foreground: \nbutton-border: \ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndirty-indicator: #ff0000\ndownload-background: #34c734\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333333\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #ddd\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #336438\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #5778d8\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #ccf\nsidebar-controls-foreground: #fff\nsidebar-foreground-shadow: rgba(0,0,0, 0.5)\nsidebar-foreground: #fff\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #eee\nsidebar-tab-background-selected: rgba(255,255,255, 0.8)\nsidebar-tab-background: rgba(255,255,255, 0.4)\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: rgba(255,255,255, 0.2)\nsidebar-tab-foreground-selected: \nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #aaf\nsidebar-tiddler-link-foreground: #ddf\nsite-title-foreground: #fff\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: #ffffff\ntab-background: #d8d8d8\ntab-border-selected: #d8d8d8\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #ec6\ntag-foreground: #ffffff\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #f8f8f8\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #f8f8f8\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #182955\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/GruvboxDark": {
"title": "$:/palettes/GruvboxDark",
"name": "Gruvbox Dark",
"description": "Retro groove color scheme",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"license": "https://github.com/morhetz/gruvbox",
"text": "alert-background: #cc241d\nalert-border: #cc241d\nalert-highlight: #d79921\nalert-muted-foreground: #504945\nbackground: #3c3836\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: #504945\nbutton-foreground: #fbf1c7\nbutton-border: transparent\ncode-background: #504945\ncode-border: #504945\ncode-foreground: #fb4934\ndiff-delete-background: #fb4934\ndiff-delete-foreground: <<colour foreground>>\ndiff-equal-background: \ndiff-equal-foreground: <<colour foreground>>\ndiff-insert-background: #b8bb26\ndiff-insert-foreground: <<colour foreground>>\ndiff-invisible-background: \ndiff-invisible-foreground: <<colour muted-foreground>>\ndirty-indicator: #fb4934\ndownload-background: #b8bb26\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: #665c54\ndropdown-border: <<colour background>>\ndropdown-tab-background-selected: #ebdbb2\ndropdown-tab-background: #665c54\ndropzone-background: #98971a\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #d3869b\nexternal-link-foreground: #8ec07c\nforeground: #fbf1c7\nmenubar-background: #504945\nmenubar-foreground: <<colour foreground>>\nmessage-background: #83a598\nmessage-border: #83a598\nmessage-foreground: #3c3836\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #504945\nmodal-footer-background: #3c3836\nmodal-footer-border: #3c3836\nmodal-header-border: #3c3836\nmuted-foreground: #d5c4a1\nnotification-background: <<colour primary>>\nnotification-border: <<colour primary>>\npage-background: #282828\npre-background: #504945\npre-border: #504945\nprimary: #d79921\nselect-tag-background: #665c54\nselect-tag-foreground: <<colour foreground>>\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #7c6f64\nsidebar-controls-foreground: #504945\nsidebar-foreground-shadow: transparent\nsidebar-foreground: #fbf1c7\nsidebar-muted-foreground-hover: #7c6f64\nsidebar-muted-foreground: #504945\nsidebar-tab-background-selected: #bdae93\nsidebar-tab-background: #3c3836\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: #bdae93\nsidebar-tab-divider: <<colour page-background>>\nsidebar-tab-foreground-selected: #282828\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #458588\nsidebar-tiddler-link-foreground: #98971a\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #B48EAD\ntab-background-selected: #ebdbb2\ntab-background: #665c54\ntab-border-selected: #665c54\ntab-border: #665c54\ntab-divider: #bdae93\ntab-foreground-selected: #282828\ntab-foreground: #ebdbb2\ntable-border: #7c6f64\ntable-footer-background: #665c54\ntable-header-background: #504945\ntag-background: #d3869b\ntag-foreground: #282828\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #7c6f64\ntiddler-controls-foreground-selected: #7c6f64\ntiddler-controls-foreground: #665c54\ntiddler-editor-background: #282828\ntiddler-editor-border-image: #282828\ntiddler-editor-border: #282828\ntiddler-editor-fields-even: #504945\ntiddler-editor-fields-odd: #7c6f64\ntiddler-info-background: #32302f\ntiddler-info-border: #ebdbb2\ntiddler-info-tab-background: #ebdbb2\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #7c6f64\ntiddler-title-foreground: #a89984\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: #504945\nvery-muted-foreground: #bdae93\nwikilist-background: <<colour page-background>>\nwikilist-button-background: <<colour button-background>>\nwikilist-button-foreground: <<colour button-foreground>>\nwikilist-item: <<colour background>>\nwikilist-toolbar-background: <<colour background>>\nwikilist-toolbar-foreground: <<colour foreground>>\nwikilist-title: <<colour foreground>>\nwikilist-title-svg: <<colour wikilist-title>>\nwikilist-url: <<colour muted-foreground>>\nwikilist-button-open-hover: <<colour primary>>\nwikilist-button-open: <<colour dropzone-background>>\nwikilist-button-remove: <<colour dirty-indicator>>\nwikilist-button-remove-hover: <<colour alert-background>>\nwikilist-droplink-dragover: <<colour dropzone-background>>\nwikilist-button-reveal: <<colour sidebar-tiddler-link-foreground-hover>>\nwikilist-button-reveal-hover: <<colour message-background>>"
},
"$:/palettes/Nord": {
"title": "$:/palettes/Nord",
"name": "Nord",
"description": "An arctic, north-bluish color palette.",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"license": "MIT, arcticicestudio, https://github.com/arcticicestudio/nord/blob/develop/LICENSE.md",
"text": "alert-background: #D08770\nalert-border: #D08770\nalert-highlight: #B48EAD\nalert-muted-foreground: #4C566A\nbackground: #3b4252\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: #4C566A\nbutton-foreground: #D8DEE9\nbutton-border: transparent\ncode-background: #2E3440\ncode-border: #2E3440\ncode-foreground: #BF616A\ndiff-delete-background: #BF616A\ndiff-delete-foreground: <<colour foreground>>\ndiff-equal-background: \ndiff-equal-foreground: <<colour foreground>>\ndiff-insert-background: #A3BE8C\ndiff-insert-foreground: <<colour foreground>>\ndiff-invisible-background: \ndiff-invisible-foreground: <<colour muted-foreground>>\ndirty-indicator: #BF616A\ndownload-background: #A3BE8C\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour background>>\ndropdown-tab-background-selected: #ECEFF4\ndropdown-tab-background: #4C566A\ndropzone-background: #A3BE8C\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #5E81AC\nexternal-link-foreground: #8FBCBB\nforeground: #d8dee9\nmenubar-background: #2E3440\nmenubar-foreground: #d8dee9\nmessage-background: #2E3440\nmessage-border: #2E3440\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #3b4252\nmodal-footer-background: #3b4252\nmodal-footer-border: #3b4252\nmodal-header-border: #3b4252\nmuted-foreground: #4C566A\nnotification-background: <<colour primary>>\nnotification-border: #EBCB8B\npage-background: #2e3440\npre-background: #2E3440\npre-border: #2E3440\nprimary: #5E81AC\nselect-tag-background: #3b4252\nselect-tag-foreground: <<colour foreground>>\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #D8DEE9\nsidebar-controls-foreground: #4C566A\nsidebar-foreground-shadow: transparent\nsidebar-foreground: #D8DEE9\nsidebar-muted-foreground-hover: #4C566A\nsidebar-muted-foreground: #4C566A\nsidebar-tab-background-selected: #ECEFF4\nsidebar-tab-background: #4C566A\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: #4C566A\nsidebar-tab-divider: <<colour page-background>>\nsidebar-tab-foreground-selected: #4C566A\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #A3BE8C\nsidebar-tiddler-link-foreground: #81A1C1\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #B48EAD\ntab-background-selected: #ECEFF4\ntab-background: #4C566A\ntab-border-selected: #4C566A\ntab-border: #4C566A\ntab-divider: #4C566A\ntab-foreground-selected: #4C566A\ntab-foreground: #D8DEE9\ntable-border: #4C566A\ntable-footer-background: #2e3440\ntable-header-background: #2e3440\ntag-background: #A3BE8C\ntag-foreground: #4C566A\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: \ntiddler-controls-foreground-selected: #EBCB8B\ntiddler-controls-foreground: #4C566A\ntiddler-editor-background: #2e3440\ntiddler-editor-border-image: #2e3440\ntiddler-editor-border: #2e3440\ntiddler-editor-fields-even: #2e3440\ntiddler-editor-fields-odd: #2e3440\ntiddler-info-background: #2e3440\ntiddler-info-border: #2e3440\ntiddler-info-tab-background: #2e3440\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #4C566A\ntiddler-title-foreground: #81A1C1\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: #2d3038\nvery-muted-foreground: #2d3038\n"
},
"$:/palettes/Rocker": {
"title": "$:/palettes/Rocker",
"name": "Rocker",
"description": "A dark theme",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #ffffff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background:\nbutton-foreground:\nbutton-border:\ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndirty-indicator: #ff0000\ndownload-background: #34c734\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333333\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #999999\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #000\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #cc0000\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #000000\nsidebar-controls-foreground: #ffffff\nsidebar-foreground-shadow: rgba(255,255,255, 0.0)\nsidebar-foreground: #acacac\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #c0c0c0\nsidebar-tab-background-selected: #000\nsidebar-tab-background: <<colour tab-background>>\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: <<colour tab-divider>>\nsidebar-tab-foreground-selected: \nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #ffbb99\nsidebar-tiddler-link-foreground: #cc0000\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: #ffffff\ntab-background: #d8d8d8\ntab-border-selected: #d8d8d8\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #ffbb99\ntag-foreground: #000\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #f8f8f8\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #f8f8f8\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #cc0000\ntoolbar-new-button:\ntoolbar-options-button:\ntoolbar-save-button:\ntoolbar-info-button:\ntoolbar-edit-button:\ntoolbar-close-button:\ntoolbar-delete-button:\ntoolbar-cancel-button:\ntoolbar-done-button:\nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/SolarFlare": {
"title": "$:/palettes/SolarFlare",
"name": "Solar Flare",
"description": "Warm, relaxing earth colours",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": ": Background Tones\n\nbase03: #002b36\nbase02: #073642\n\n: Content Tones\n\nbase01: #586e75\nbase00: #657b83\nbase0: #839496\nbase1: #93a1a1\n\n: Background Tones\n\nbase2: #eee8d5\nbase3: #fdf6e3\n\n: Accent Colors\n\nyellow: #b58900\norange: #cb4b16\nred: #dc322f\nmagenta: #d33682\nviolet: #6c71c4\nblue: #268bd2\ncyan: #2aa198\ngreen: #859900\n\n: Additional Tones (RA)\n\nbase10: #c0c4bb\nviolet-muted: #7c81b0\nblue-muted: #4e7baa\n\nyellow-hot: #ffcc44\norange-hot: #eb6d20\nred-hot: #ff2222\nblue-hot: #2298ee\ngreen-hot: #98ee22\n\n: Palette\n\n: Do not use colour macro for background and foreground\nbackground: #fdf6e3\n download-foreground: <<colour background>>\n dragger-foreground: <<colour background>>\n dropdown-background: <<colour background>>\n modal-background: <<colour background>>\n sidebar-foreground-shadow: <<colour background>>\n tiddler-background: <<colour background>>\n tiddler-border: <<colour background>>\n tiddler-link-background: <<colour background>>\n tab-background-selected: <<colour background>>\n dropdown-tab-background-selected: <<colour tab-background-selected>>\nforeground: #657b83\n dragger-background: <<colour foreground>>\n tab-foreground: <<colour foreground>>\n tab-foreground-selected: <<colour tab-foreground>>\n sidebar-tab-foreground-selected: <<colour tab-foreground-selected>>\n sidebar-tab-foreground: <<colour tab-foreground>>\n sidebar-button-foreground: <<colour foreground>>\n sidebar-controls-foreground: <<colour foreground>>\n sidebar-foreground: <<colour foreground>>\n: base03\n: base02\n: base01\n alert-muted-foreground: <<colour base01>>\n: base00\n code-foreground: <<colour base00>>\n message-foreground: <<colour base00>>\n tag-foreground: <<colour base00>>\n: base0\n sidebar-tiddler-link-foreground: <<colour base0>>\n: base1\n muted-foreground: <<colour base1>>\n blockquote-bar: <<colour muted-foreground>>\n dropdown-border: <<colour muted-foreground>>\n sidebar-muted-foreground: <<colour muted-foreground>>\n tiddler-title-foreground: <<colour muted-foreground>>\n site-title-foreground: <<colour tiddler-title-foreground>>\n: base2\n modal-footer-background: <<colour base2>>\n page-background: <<colour base2>>\n modal-backdrop: <<colour page-background>>\n notification-background: <<colour page-background>>\n code-background: <<colour page-background>>\n code-border: <<colour code-background>>\n pre-background: <<colour page-background>>\n pre-border: <<colour pre-background>>\n sidebar-tab-background-selected: <<colour page-background>>\n table-header-background: <<colour base2>>\n tag-background: <<colour base2>>\n tiddler-editor-background: <<colour base2>>\n tiddler-info-background: <<colour base2>>\n tiddler-info-tab-background: <<colour base2>>\n tab-background: <<colour base2>>\n dropdown-tab-background: <<colour tab-background>>\n: base3\n alert-background: <<colour base3>>\n message-background: <<colour base3>>\n: yellow\n: orange\n: red\n: magenta\n alert-highlight: <<colour magenta>>\n: violet\n external-link-foreground: <<colour violet>>\n: blue\n: cyan\n: green\n: base10\n tiddler-controls-foreground: <<colour base10>>\n: violet-muted\n external-link-foreground-visited: <<colour violet-muted>>\n: blue-muted\n primary: <<colour blue-muted>>\n download-background: <<colour primary>>\n tiddler-link-foreground: <<colour primary>>\n\nalert-border: #b99e2f\ndirty-indicator: #ff0000\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nmessage-border: #cfd6e6\nmodal-border: #999999\nselect-tag-background:\nselect-tag-foreground:\nsidebar-controls-foreground-hover:\nsidebar-muted-foreground-hover:\nsidebar-tab-background: #ded8c5\nsidebar-tiddler-link-foreground-hover:\nstatic-alert-foreground: #aaaaaa\ntab-border: #cccccc\n modal-footer-border: <<colour tab-border>>\n modal-header-border: <<colour tab-border>>\n notification-border: <<colour tab-border>>\n sidebar-tab-border: <<colour tab-border>>\n tab-border-selected: <<colour tab-border>>\n sidebar-tab-border-selected: <<colour tab-border-selected>>\ntab-divider: #d8d8d8\n sidebar-tab-divider: <<colour tab-divider>>\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-border: #dddddd\ntiddler-subtitle-foreground: #c0c0c0\ntoolbar-new-button:\ntoolbar-options-button:\ntoolbar-save-button:\ntoolbar-info-button:\ntoolbar-edit-button:\ntoolbar-close-button:\ntoolbar-delete-button:\ntoolbar-cancel-button:\ntoolbar-done-button:\nuntagged-background: #999999\nvery-muted-foreground: #888888\n"
},
"$:/palettes/SolarizedLight": {
"title": "$:/palettes/SolarizedLight",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"description": "Precision colors for machines and people",
"license": "MIT, Ethan Schoonover, https://github.com/altercation/solarized/blob/master/LICENSE",
"name": "SolarizedLight",
"text": "alert-background: #eee8d5\nalert-border: #073642\nalert-highlight: #cb4b16\nalert-muted-foreground: #586e75\nbackground: #fdf6e3\nblockquote-bar: <<colour muted-foreground>>\nbutton-background: #cb4b16\nbutton-foreground: #fdf6e3\nbutton-border: transparent\ncode-background: #eee8d5\ncode-border: #93a1a1\ncode-foreground: #d33682\ndiff-delete-background: #BF616A\ndiff-delete-foreground: <<colour foreground>>\ndiff-equal-background: \ndiff-equal-foreground: <<colour foreground>>\ndiff-insert-background: #859900\ndiff-insert-foreground: <<colour foreground>>\ndiff-invisible-background: \ndiff-invisible-foreground: <<colour muted-foreground>>\ndirty-indicator: #D08770\ndownload-background: #859900\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour background>>\ndropdown-tab-background-selected: #fdf6e3\ndropdown-tab-background: #93a1a1\ndropzone-background: #859900\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: #d33682\nexternal-link-foreground-visited: #b58900\nexternal-link-foreground: #cb4b16\nforeground: #839496\nmessage-background: #586e75\nmessage-border: #586e75\nmessage-foreground: #eee8d5\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #eee8d5\nmodal-footer-background: #eee8d5\nmodal-footer-border: #eee8d5\nmodal-header-border: #eee8d5\nmuted-foreground: #93a1a1\nnotification-background: #EBCB8B\nnotification-border: #D08770\npage-background: #eee8d5\npre-background: #eee8d5\npre-border: #93a1a1\nprimary: #2aa198\nselect-tag-background: #eee8d5\nselect-tag-foreground: <<colour foreground>>\nsidebar-button-foreground: #eee8d5\nsidebar-controls-foreground-hover: #268bd2\nsidebar-controls-foreground: #586e75\nsidebar-foreground-shadow: transparent\nsidebar-foreground: #839496\nsidebar-muted-foreground-hover: #657b83\nsidebar-muted-foreground: #93a1a1\nsidebar-tab-background-selected: #eee8d5\nsidebar-tab-background: #839496\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: #657b83\nsidebar-tab-divider: <<colour page-background>>\nsidebar-tab-foreground-selected: #839496\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #859900\nsidebar-tiddler-link-foreground: #268bd2\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #dc322f\ntab-background-selected: #fdf6e3\ntab-background: #839496\ntab-border-selected: #93a1a1\ntab-border: #93a1a1\ntab-divider: #fdf6e3\ntab-foreground-selected: #839496\ntab-foreground: #eee8d5\ntable-border: #657b83\ntable-footer-background: #657b83\ntable-header-background: #93a1a1\ntag-background: #6c71c4\ntag-foreground: #eee8d5\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #b58900\ntiddler-controls-foreground-selected: #b58900\ntiddler-controls-foreground: #073642\ntiddler-editor-background: #eee8d5\ntiddler-editor-border-image: #eee8d5\ntiddler-editor-border: #eee8d5\ntiddler-editor-fields-even: #eee8d5\ntiddler-editor-fields-odd: #fdf6e3\ntiddler-info-background: #eee8d5\ntiddler-info-border: #eee8d5\ntiddler-info-tab-background: #586e75\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #586e75\ntiddler-title-foreground: #073642\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: #839496\nvery-muted-foreground: #93a1a1\n"
},
"$:/palettes/SpartanDay": {
"title": "$:/palettes/SpartanDay",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"description": "Cold, spartan day colors",
"name": "Spartan Day",
"text": "alert-background: <<colour background>>\nalert-border: <<colour very-muted-foreground>>\nalert-highlight: <<colour very-muted-foreground>>\nalert-muted-foreground: <<colour muted-foreground>>\nbackground: #FAFAFA\nblockquote-bar: <<colour page-background>>\nbutton-background: transparent\nbutton-foreground: inherit\nbutton-border: <<colour tag-background>>\ncode-background: #ececec\ncode-border: #ececec\ncode-foreground: \ndirty-indicator: #c80000\ndownload-background: <<colour primary>>\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: #FFFFFF\ndropdown-border: <<colour dropdown-background>>\ndropdown-tab-background-selected: <<colour dropdown-background>>\ndropdown-tab-background: #F5F5F5\ndropzone-background: <<colour tag-background>>\nexternal-link-background-hover: transparent\nexternal-link-background-visited: transparent\nexternal-link-background: transparent\nexternal-link-foreground-hover: \nexternal-link-foreground-visited: \nexternal-link-foreground: \nforeground: rgba(0, 0, 0, 0.87)\nmessage-background: <<colour background>>\nmessage-border: <<colour very-muted-foreground>>\nmessage-foreground: rgba(0, 0, 0, 0.54)\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: <<colour very-muted-foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour very-muted-foreground>>\nmodal-header-border: <<colour very-muted-foreground>>\nmuted-foreground: rgba(0, 0, 0, 0.54)\nnotification-background: <<colour dropdown-background>>\nnotification-border: <<colour dropdown-background>>\npage-background: #f4f4f4\npre-background: #ececec\npre-border: #ececec\nprimary: #3949ab\nselect-tag-background: <<colour background>>\nselect-tag-foreground: <<colour foreground>>\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #aeaeae\nsidebar-controls-foreground: #c6c6c6\nsidebar-foreground-shadow: transparent\nsidebar-foreground: rgba(0, 0, 0, 0.54)\nsidebar-muted-foreground-hover: rgba(0, 0, 0, 0.54)\nsidebar-muted-foreground: rgba(0, 0, 0, 0.38)\nsidebar-tab-background-selected: <<colour page-background>>\nsidebar-tab-background: transparent\nsidebar-tab-border-selected: <<colour table-border>>\nsidebar-tab-border: transparent\nsidebar-tab-divider: <<colour table-border>>\nsidebar-tab-foreground-selected: rgba(0, 0, 0, 0.87)\nsidebar-tab-foreground: rgba(0, 0, 0, 0.54)\nsidebar-tiddler-link-foreground-hover: rgba(0, 0, 0, 0.87)\nsidebar-tiddler-link-foreground: rgba(0, 0, 0, 0.54)\nsite-title-foreground: rgba(0, 0, 0, 0.87)\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: transparent\ntab-border-selected: <<colour table-border>>\ntab-border: transparent\ntab-divider: <<colour table-border>>\ntab-foreground-selected: rgba(0, 0, 0, 0.87)\ntab-foreground: rgba(0, 0, 0, 0.54)\ntable-border: #d8d8d8\ntable-footer-background: <<colour tiddler-editor-fields-odd>>\ntable-header-background: <<colour tiddler-editor-fields-even>>\ntag-background: #ec6\ntag-foreground: <<colour button-foreground>>\ntiddler-background: <<colour background>>\ntiddler-border: #f9f9f9\ntiddler-controls-foreground-hover: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground-selected: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground: <<colour sidebar-controls-foreground>>\ntiddler-editor-background: transparent\ntiddler-editor-border-image: \ntiddler-editor-border: #e8e7e7\ntiddler-editor-fields-even: rgba(0, 0, 0, 0.1)\ntiddler-editor-fields-odd: rgba(0, 0, 0, 0.04)\ntiddler-info-background: #F5F5F5\ntiddler-info-border: #F5F5F5\ntiddler-info-tab-background: <<colour tiddler-editor-fields-odd>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour muted-foreground>>\ntiddler-title-foreground: #000000\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour very-muted-foreground>>\nvery-muted-foreground: rgba(0, 0, 0, 0.12)\n"
},
"$:/palettes/SpartanNight": {
"title": "$:/palettes/SpartanNight",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"description": "Dark spartan colors",
"name": "Spartan Night",
"text": "alert-background: <<colour background>>\nalert-border: <<colour very-muted-foreground>>\nalert-highlight: <<colour very-muted-foreground>>\nalert-muted-foreground: <<colour muted-foreground>>\nbackground: #303030\nblockquote-bar: <<colour page-background>>\nbutton-background: transparent\nbutton-foreground: inherit\nbutton-border: <<colour tag-background>>\ncode-background: <<colour pre-background>>\ncode-border: <<colour pre-border>>\ncode-foreground: rgba(255, 255, 255, 0.54)\ndirty-indicator: #c80000\ndownload-background: <<colour primary>>\ndownload-foreground: <<colour foreground>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: #424242\ndropdown-border: <<colour dropdown-background>>\ndropdown-tab-background-selected: <<colour dropdown-background>>\ndropdown-tab-background: #050505\ndropzone-background: <<colour tag-background>>\nexternal-link-background-hover: transparent\nexternal-link-background-visited: transparent\nexternal-link-background: transparent\nexternal-link-foreground-hover: \nexternal-link-foreground-visited: #7c318c\nexternal-link-foreground: #9e3eb3\nforeground: rgba(255, 255, 255, 0.7)\nmessage-background: <<colour background>>\nmessage-border: <<colour very-muted-foreground>>\nmessage-foreground: rgba(255, 255, 255, 0.54)\nmodal-backdrop: <<colour page-background>>\nmodal-background: <<colour background>>\nmodal-border: <<colour very-muted-foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour background>>\nmodal-header-border: <<colour very-muted-foreground>>\nmuted-foreground: rgba(255, 255, 255, 0.54)\nnotification-background: <<colour dropdown-background>>\nnotification-border: <<colour dropdown-background>>\npage-background: #212121\npre-background: #2a2a2a\npre-border: transparent\nprimary: #5656f3\nselect-tag-background: <<colour background>>\nselect-tag-foreground: <<colour foreground>>\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #494949\nsidebar-controls-foreground: #5d5d5d\nsidebar-foreground-shadow: transparent\nsidebar-foreground: rgba(255, 255, 255, 0.54)\nsidebar-muted-foreground-hover: rgba(255, 255, 255, 0.54)\nsidebar-muted-foreground: rgba(255, 255, 255, 0.38)\nsidebar-tab-background-selected: <<colour page-background>>\nsidebar-tab-background: transparent\nsidebar-tab-border-selected: <<colour table-border>>\nsidebar-tab-border: transparent\nsidebar-tab-divider: <<colour table-border>>\nsidebar-tab-foreground-selected: rgba(255, 255, 255, 0.87)\nsidebar-tab-foreground: rgba(255, 255, 255, 0.54)\nsidebar-tiddler-link-foreground-hover: rgba(255, 255, 255, 0.7)\nsidebar-tiddler-link-foreground: rgba(255, 255, 255, 0.54)\nsite-title-foreground: rgba(255, 255, 255, 0.7)\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: transparent\ntab-border-selected: <<colour table-border>>\ntab-border: transparent\ntab-divider: <<colour table-border>>\ntab-foreground-selected: rgba(255, 255, 255, 0.87)\ntab-foreground: rgba(255, 255, 255, 0.54)\ntable-border: #3a3a3a\ntable-footer-background: <<colour tiddler-editor-fields-odd>>\ntable-header-background: <<colour tiddler-editor-fields-even>>\ntag-background: #ec6\ntag-foreground: <<colour button-foreground>>\ntiddler-background: <<colour background>>\ntiddler-border: rgb(55,55,55)\ntiddler-controls-foreground-hover: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground-selected: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground: <<colour sidebar-controls-foreground>>\ntiddler-editor-background: transparent\ntiddler-editor-border-image: \ntiddler-editor-border: rgba(255, 255, 255, 0.08)\ntiddler-editor-fields-even: rgba(255, 255, 255, 0.1)\ntiddler-editor-fields-odd: rgba(255, 255, 255, 0.04)\ntiddler-info-background: #454545\ntiddler-info-border: #454545\ntiddler-info-tab-background: <<colour tiddler-editor-fields-odd>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour muted-foreground>>\ntiddler-title-foreground: #FFFFFF\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour very-muted-foreground>>\nvery-muted-foreground: rgba(255, 255, 255, 0.12)\n"
},
"$:/palettes/Twilight": {
"title": "$:/palettes/Twilight",
"tags": "$:/tags/Palette",
"author": "Thomas Elmiger",
"type": "application/x-tiddler-dictionary",
"name": "Twilight",
"description": "Delightful, soft darkness.",
"text": "alert-background: rgb(255, 255, 102)\nalert-border: rgb(232, 232, 125)\nalert-highlight: rgb(255, 51, 51)\nalert-muted-foreground: rgb(224, 82, 82)\nbackground: rgb(38, 38, 38)\nblockquote-bar: rgba(240, 196, 117, 0.7)\nbutton-background: rgb(63, 63, 63)\nbutton-border: rgb(127, 127, 127)\nbutton-foreground: rgb(179, 179, 179)\ncode-background: rgba(0,0,0,0.03)\ncode-border: rgba(0,0,0,0.08)\ncode-foreground: rgb(255, 94, 94)\ndiff-delete-background: #ffc9c9\ndiff-delete-foreground: <<colour foreground>>\ndiff-equal-background: \ndiff-equal-foreground: <<colour foreground>>\ndiff-insert-background: #aaefad\ndiff-insert-foreground: <<colour foreground>>\ndiff-invisible-background: \ndiff-invisible-foreground: <<colour muted-foreground>>\ndirty-indicator: rgb(255, 94, 94)\ndownload-background: #19a974\ndownload-foreground: rgb(38, 38, 38)\ndragger-background: rgb(179, 179, 179)\ndragger-foreground: rgb(38, 38, 38)\ndropdown-background: rgb(38, 38, 38)\ndropdown-border: rgb(255, 255, 255)\ndropdown-tab-background: rgba(0,0,0,.1)\ndropdown-tab-background-selected: rgba(255,255,255,1)\ndropzone-background: #9eebcf\nexternal-link-background: inherit\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-foreground: rgb(179, 179, 255)\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: rgb(153, 153, 255)\nforeground: rgb(179, 179, 179)\nmessage-background: <<colour tag-foreground>>\nmessage-border: #96ccff\nmessage-foreground: <<colour tag-background>>\nmodal-backdrop: rgb(179, 179, 179)\nmodal-background: rgb(38, 38, 38)\nmodal-border: rgba(0,0,0,.5)\nmodal-footer-background: #f4f4f4\nmodal-footer-border: rgba(0,0,0,.1)\nmodal-header-border: rgba(0,0,0,.2)\nmuted-foreground: rgb(255, 255, 255)\nnotification-background: <<colour tag-foreground>>\nnotification-border: <<colour tag-background>>\npage-background: rgb(26, 26, 26)\npre-background: rgb(25, 25, 25)\npre-border: rgba(0,0,0,.2)\nprimary: rgb(255, 201, 102)\nselect-tag-background: \nselect-tag-foreground: \nsidebar-button-foreground: rgb(179, 179, 179)\nsidebar-controls-foreground: rgb(153, 153, 153)\nsidebar-controls-foreground-hover: <<colour tiddler-controls-foreground-hover>>\nsidebar-foreground: rgb(141, 141, 141)\nsidebar-foreground-shadow: transparent\nsidebar-muted-foreground: rgba(0, 0, 0, 0.5)\nsidebar-muted-foreground-hover: rgb(141, 141, 141)\nsidebar-tab-background: rgba(141, 141, 141, 0.2)\nsidebar-tab-background-selected: rgb(26, 26, 26)\nsidebar-tab-border: rgb(127, 127, 127)\nsidebar-tab-border-selected: rgb(127, 127, 127)\nsidebar-tab-divider: rgb(127, 127, 127)\nsidebar-tab-foreground: rgb(179, 179, 179)\nsidebar-tab-foreground-selected: rgb(179, 179, 179)\nsidebar-tiddler-link-foreground: rgb(179, 179, 179)\nsidebar-tiddler-link-foreground-hover: rgb(115, 115, 115)\nsite-title-foreground: rgb(255, 201, 102)\nstatic-alert-foreground: rgba(0,0,0,.3)\ntab-background: rgba(0,0,0,0.125)\ntab-background-selected: rgb(38, 38, 38)\ntab-border: rgb(255, 201, 102)\ntab-border-selected: rgb(255, 201, 102)\ntab-divider: rgb(255, 201, 102)\ntab-foreground: rgb(179, 179, 179)\ntab-foreground-selected: rgb(179, 179, 179)\ntable-border: rgba(255,255,255,.3)\ntable-footer-background: rgba(0,0,0,.4)\ntable-header-background: rgba(0,0,0,.1)\ntag-background: rgb(255, 201, 102)\ntag-foreground: rgb(25, 25, 25)\ntiddler-background: rgb(38, 38, 38)\ntiddler-border: rgba(240, 196, 117, 0.7)\ntiddler-controls-foreground: rgb(128, 128, 128)\ntiddler-controls-foreground-hover: rgba(255, 255, 255, 0.8)\ntiddler-controls-foreground-selected: rgba(255, 255, 255, 0.9)\ntiddler-editor-background: rgb(33, 33, 33)\ntiddler-editor-border: rgb(63, 63, 63)\ntiddler-editor-border-image: rgb(25, 25, 25)\ntiddler-editor-fields-even: rgb(33, 33, 33)\ntiddler-editor-fields-odd: rgb(28, 28, 28)\ntiddler-info-background: rgb(43, 43, 43)\ntiddler-info-border: rgb(25, 25, 25)\ntiddler-info-tab-background: rgb(43, 43, 43)\ntiddler-link-background: rgb(38, 38, 38)\ntiddler-link-foreground: rgb(204, 204, 255)\ntiddler-subtitle-foreground: rgb(255, 255, 255)\ntiddler-title-foreground: rgb(255, 192, 76)\ntoolbar-cancel-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-done-button: \ntoolbar-edit-button: \ntoolbar-info-button: \ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \nuntagged-background: rgb(255, 255, 255)\nvery-muted-foreground: rgba(240, 196, 117, 0.7)\n"
},
"$:/palettes/Vanilla": {
"title": "$:/palettes/Vanilla",
"name": "Vanilla",
"description": "Pale and unobtrusive",
"tags": "$:/tags/Palette",
"type": "application/x-tiddler-dictionary",
"text": "alert-background: #ffe476\nalert-border: #b99e2f\nalert-highlight: #881122\nalert-muted-foreground: #b99e2f\nbackground: #ffffff\nblockquote-bar: <<colour muted-foreground>>\nbutton-background:\nbutton-foreground:\nbutton-border:\ncode-background: #f7f7f9\ncode-border: #e1e1e8\ncode-foreground: #dd1144\ndiff-delete-background: #ffc9c9\ndiff-delete-foreground: <<colour foreground>>\ndiff-equal-background: \ndiff-equal-foreground: <<colour foreground>>\ndiff-insert-background: #aaefad\ndiff-insert-foreground: <<colour foreground>>\ndiff-invisible-background: \ndiff-invisible-foreground: <<colour muted-foreground>>\ndirty-indicator: #ff0000\ndownload-background: #34c734\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: <<colour background>>\ndropdown-border: <<colour muted-foreground>>\ndropdown-tab-background-selected: #fff\ndropdown-tab-background: #ececec\ndropzone-background: rgba(0,200,0,0.7)\nexternal-link-background-hover: inherit\nexternal-link-background-visited: inherit\nexternal-link-background: inherit\nexternal-link-foreground-hover: inherit\nexternal-link-foreground-visited: #0000aa\nexternal-link-foreground: #0000ee\nforeground: #333333\nmessage-background: #ecf2ff\nmessage-border: #cfd6e6\nmessage-foreground: #547599\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: #999999\nmodal-footer-background: #f5f5f5\nmodal-footer-border: #dddddd\nmodal-header-border: #eeeeee\nmuted-foreground: #bbb\nnotification-background: #ffffdd\nnotification-border: #999999\npage-background: #f4f4f4\npre-background: #f5f5f5\npre-border: #cccccc\nprimary: #5778d8\nselect-tag-background:\nselect-tag-foreground:\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #000000\nsidebar-controls-foreground: #aaaaaa\nsidebar-foreground-shadow: rgba(255,255,255, 0.8)\nsidebar-foreground: #acacac\nsidebar-muted-foreground-hover: #444444\nsidebar-muted-foreground: #c0c0c0\nsidebar-tab-background-selected: #f4f4f4\nsidebar-tab-background: #e0e0e0\nsidebar-tab-border-selected: <<colour tab-border-selected>>\nsidebar-tab-border: <<colour tab-border>>\nsidebar-tab-divider: #e4e4e4\nsidebar-tab-foreground-selected:\nsidebar-tab-foreground: <<colour tab-foreground>>\nsidebar-tiddler-link-foreground-hover: #444444\nsidebar-tiddler-link-foreground: #999999\nsite-title-foreground: <<colour tiddler-title-foreground>>\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: #ffffff\ntab-background: #d8d8d8\ntab-border-selected: #d8d8d8\ntab-border: #cccccc\ntab-divider: #d8d8d8\ntab-foreground-selected: <<colour tab-foreground>>\ntab-foreground: #666666\ntable-border: #dddddd\ntable-footer-background: #a8a8a8\ntable-header-background: #f0f0f0\ntag-background: #ec6\ntag-foreground: #ffffff\ntiddler-background: <<colour background>>\ntiddler-border: <<colour background>>\ntiddler-controls-foreground-hover: #888888\ntiddler-controls-foreground-selected: #444444\ntiddler-controls-foreground: #cccccc\ntiddler-editor-background: #f8f8f8\ntiddler-editor-border-image: #ffffff\ntiddler-editor-border: #cccccc\ntiddler-editor-fields-even: #e0e8e0\ntiddler-editor-fields-odd: #f0f4f0\ntiddler-info-background: #f8f8f8\ntiddler-info-border: #dddddd\ntiddler-info-tab-background: #f8f8f8\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: #c0c0c0\ntiddler-title-foreground: #182955\ntoolbar-new-button:\ntoolbar-options-button:\ntoolbar-save-button:\ntoolbar-info-button:\ntoolbar-edit-button:\ntoolbar-close-button:\ntoolbar-delete-button:\ntoolbar-cancel-button:\ntoolbar-done-button:\nuntagged-background: #999999\nvery-muted-foreground: #888888\nwikilist-background: #e5e5e5\nwikilist-item: #fff\nwikilist-info: #000\nwikilist-title: #666\nwikilist-title-svg: <<colour wikilist-title>>\nwikilist-url: #aaa\nwikilist-button-open: #4fb82b\nwikilist-button-open-hover: green\nwikilist-button-reveal: #5778d8\nwikilist-button-reveal-hover: blue\nwikilist-button-remove: #d85778\nwikilist-button-remove-hover: red\nwikilist-toolbar-background: #d3d3d3\nwikilist-toolbar-foreground: #888\nwikilist-droplink-dragover: rgba(255,192,192,0.5)\nwikilist-button-background: #acacac\nwikilist-button-foreground: #000\n"
},
"$:/core/readme": {
"title": "$:/core/readme",
"text": "This plugin contains TiddlyWiki's core components, comprising:\n\n* JavaScript code modules\n* Icons\n* Templates needed to create TiddlyWiki's user interface\n* British English (''en-GB'') translations of the localisable strings used by the core\n"
},
"$:/library/sjcl.js/license": {
"title": "$:/library/sjcl.js/license",
"type": "text/plain",
"text": "SJCL is open. You can use, modify and redistribute it under a BSD\nlicense or under the GNU GPL, version 2.0.\n\n---------------------------------------------------------------------\n\nhttp://opensource.org/licenses/BSD-2-Clause\n\nCopyright (c) 2009-2015, Emily Stark, Mike Hamburg and Dan Boneh at\nStanford University. All rights reserved.\n\nRedistribution and use in source and binary forms, with or without\nmodification, are permitted provided that the following conditions are\nmet:\n\n1. Redistributions of source code must retain the above copyright\nnotice, this list of conditions and the following disclaimer.\n\n2. Redistributions in binary form must reproduce the above copyright\nnotice, this list of conditions and the following disclaimer in the\ndocumentation and/or other materials provided with the distribution.\n\nTHIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS \"AS\nIS\" AND ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED\nTO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A\nPARTICULAR PURPOSE ARE DISCLAIMED. IN NO EVENT SHALL THE COPYRIGHT\nHOLDER OR CONTRIBUTORS BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL,\nSPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED\nTO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR\nPROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON ANY THEORY OF\nLIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING\nNEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THIS\nSOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE.\n\n---------------------------------------------------------------------\n\nhttp://opensource.org/licenses/GPL-2.0\n\nThe Stanford Javascript Crypto Library (hosted here on GitHub) is a\nproject by the Stanford Computer Security Lab to build a secure,\npowerful, fast, small, easy-to-use, cross-browser library for\ncryptography in Javascript.\n\nCopyright (c) 2009-2015, Emily Stark, Mike Hamburg and Dan Boneh at\nStanford University.\n\nThis program is free software; you can redistribute it and/or modify it\nunder the terms of the GNU General Public License as published by the\nFree Software Foundation; either version 2 of the License, or (at your\noption) any later version.\n\nThis program is distributed in the hope that it will be useful, but\nWITHOUT ANY WARRANTY; without even the implied warranty of\nMERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the GNU General\nPublic License for more details.\n\nYou should have received a copy of the GNU General Public License along\nwith this program; if not, write to the Free Software Foundation, Inc.,\n59 Temple Place, Suite 330, Boston, MA 02111-1307 USA"
},
"$:/core/templates/MOTW.html": {
"title": "$:/core/templates/MOTW.html",
"text": "\\rules only filteredtranscludeinline transcludeinline entity\n<!-- The following comment is called a MOTW comment and is necessary for the TiddlyIE Internet Explorer extension -->\n<!-- saved from url=(0021)https://tiddlywiki.com --> "
},
"$:/core/templates/alltiddlers.template.html": {
"title": "$:/core/templates/alltiddlers.template.html",
"type": "text/vnd.tiddlywiki-html",
"text": "<!-- This template is provided for backwards compatibility with older versions of TiddlyWiki -->\n\n<$set name=\"exportFilter\" value=\"[!is[system]sort[title]]\">\n\n{{$:/core/templates/exporters/StaticRiver}}\n\n</$set>\n"
},
"$:/core/templates/canonical-uri-external-image": {
"title": "$:/core/templates/canonical-uri-external-image",
"text": "<!--\n\nThis template is used to assign the ''_canonical_uri'' field to external images.\n\nChange the `./images/` part to a different base URI. The URI can be relative or absolute.\n\n-->\n./images/<$view field=\"title\" format=\"doubleurlencoded\"/>"
},
"$:/core/templates/canonical-uri-external-raw": {
"title": "$:/core/templates/canonical-uri-external-raw",
"text": "<!--\n\nThis template is used to assign the ''_canonical_uri'' field to external raw files that are stored in the same directory\n\n-->\n<$view field=\"title\" format=\"doubleurlencoded\"/>"
},
"$:/core/templates/canonical-uri-external-text": {
"title": "$:/core/templates/canonical-uri-external-text",
"text": "<!--\n\nThis template is used to assign the ''_canonical_uri'' field to external text files.\n\nChange the `./text/` part to a different base URI. The URI can be relative or absolute.\n\n-->\n./text/<$view field=\"title\" format=\"doubleurlencoded\"/>.tid"
},
"$:/core/templates/css-tiddler": {
"title": "$:/core/templates/css-tiddler",
"text": "<!--\n\nThis template is used for saving CSS tiddlers as a style tag with data attributes representing the tiddler fields.\n\n-->`<style`<$fields template=' data-tiddler-$name$=\"$encoded_value$\"'></$fields>` type=\"text/css\">`<$view field=\"text\" format=\"text\" />`</style>`"
},
"$:/core/templates/exporters/CsvFile": {
"title": "$:/core/templates/exporters/CsvFile",
"tags": "$:/tags/Exporter",
"description": "{{$:/language/Exporters/CsvFile}}",
"extension": ".csv",
"text": "\\define renderContent()\n<$text text=<<csvtiddlers filter:\"\"\"$(exportFilter)$\"\"\" format:\"quoted-comma-sep\">>/>\n\\end\n<<renderContent>>\n"
},
"$:/core/templates/exporters/JsonFile": {
"title": "$:/core/templates/exporters/JsonFile",
"tags": "$:/tags/Exporter",
"description": "{{$:/language/Exporters/JsonFile}}",
"extension": ".json",
"text": "\\define renderContent()\n<$text text=<<jsontiddlers filter:\"\"\"$(exportFilter)$\"\"\">>/>\n\\end\n<<renderContent>>\n"
},
"$:/core/templates/exporters/StaticRiver": {
"title": "$:/core/templates/exporters/StaticRiver",
"tags": "$:/tags/Exporter",
"description": "{{$:/language/Exporters/StaticRiver}}",
"extension": ".html",
"text": "\\define tv-wikilink-template() #$uri_encoded$\n\\define tv-config-toolbar-icons() no\n\\define tv-config-toolbar-text() no\n\\define tv-config-toolbar-class() tc-btn-invisible\n\\rules only filteredtranscludeinline transcludeinline\n<!doctype html>\n<html>\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content=\"{{$:/core/templates/version}}\" />\n<meta name=\"format-detection\" content=\"telephone=no\">\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<title>{{$:/core/wiki/title}}</title>\n<div id=\"styleArea\">\n{{$:/boot/boot.css||$:/core/templates/css-tiddler}}\n</div>\n<style type=\"text/css\">\n{{$:/core/ui/PageStylesheet||$:/core/templates/wikified-tiddler}}\n</style>\n</head>\n<body class=\"tc-body\">\n{{$:/StaticBanner||$:/core/templates/html-tiddler}}\n<section class=\"tc-story-river\">\n{{$:/core/templates/exporters/StaticRiver/Content||$:/core/templates/html-tiddler}}\n</section>\n</body>\n</html>\n"
},
"$:/core/templates/exporters/StaticRiver/Content": {
"title": "$:/core/templates/exporters/StaticRiver/Content",
"text": "\\define renderContent()\n{{{ $(exportFilter)$ ||$:/core/templates/static-tiddler}}}\n\\end\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n<<renderContent>>\n"
},
"$:/core/templates/exporters/TidFile": {
"title": "$:/core/templates/exporters/TidFile",
"tags": "$:/tags/Exporter",
"description": "{{$:/language/Exporters/TidFile}}",
"extension": ".tid",
"text": "\\define renderContent()\n{{{ $(exportFilter)$ +[limit[1]] ||$:/core/templates/tid-tiddler}}}\n\\end\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n<<renderContent>>"
},
"$:/core/save/all-external-js": {
"title": "$:/core/save/all-external-js",
"text": "\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\\define saveTiddlerFilter()\n[is[tiddler]] -[prefix[$:/state/popup/]] -[[$:/HistoryList]] -[[$:/core]] -[[$:/boot/boot.css]] -[type[application/javascript]library[yes]] -[[$:/boot/boot.js]] -[[$:/boot/bootprefix.js]] +[sort[title]] $(publishFilter)$\n\\end\n{{$:/core/templates/tiddlywiki5-external-js.html}}\n"
},
"$:/core/templates/tiddlywiki5.js": {
"title": "$:/core/templates/tiddlywiki5.js",
"text": "\\rules only filteredtranscludeinline transcludeinline codeinline\n\n/*\n{{ $:/core/copyright.txt ||$:/core/templates/plain-text-tiddler}}\n`*/\n`<!--~~ Library modules ~~-->\n{{{ [is[system]type[application/javascript]library[yes]] ||$:/core/templates/plain-text-tiddler}}}\n<!--~~ Boot prefix ~~-->\n{{ $:/boot/bootprefix.js ||$:/core/templates/plain-text-tiddler}}\n<!--~~ Core plugin ~~-->\n{{$:/core/templates/tiddlywiki5.js/tiddlers}}\n<!--~~ Boot kernel ~~-->\n{{ $:/boot/boot.js ||$:/core/templates/plain-text-tiddler}}\n"
},
"$:/core/templates/tiddlywiki5.js/tiddlers": {
"title": "$:/core/templates/tiddlywiki5.js/tiddlers",
"text": "`\n$tw.preloadTiddlerArray(`<$text text=<<jsontiddlers \"[[$:/core]]\">>/>`);\n$tw.preloadTiddlerArray([{\n\ttitle: \"$:/config/SaveWikiButton/Template\",\n\ttext: \"$:/core/save/all-external-js\"\n}]);\n`\n"
},
"$:/core/templates/tiddlywiki5-external-js.html": {
"title": "$:/core/templates/tiddlywiki5-external-js.html",
"text": "\\rules only filteredtranscludeinline transcludeinline\n<!doctype html>\n{{$:/core/templates/MOTW.html}}<html lang=\"`<$text text={{{ [{$:/language}get[name]] }}}/>`\">\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<!--~~ Raw markup for the top of the head section ~~-->\n{{{ [all[shadows+tiddlers]tag[$:/tags/RawMarkupWikified/TopHead]] ||$:/core/templates/raw-static-tiddler}}}\n<meta http-equiv=\"X-UA-Compatible\" content=\"IE=Edge\"/>\n<meta name=\"application-name\" content=\"TiddlyWiki\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content=\"{{$:/core/templates/version}}\" />\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n<meta name=\"apple-mobile-web-app-capable\" content=\"yes\" />\n<meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black-translucent\" />\n<meta name=\"mobile-web-app-capable\" content=\"yes\"/>\n<meta name=\"format-detection\" content=\"telephone=no\" />\n<meta name=\"copyright\" content=\"{{$:/core/copyright.txt}}\" />\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<title>{{$:/core/wiki/title}}</title>\n<!--~~ This is a Tiddlywiki file. The points of interest in the file are marked with this pattern ~~-->\n\n<!--~~ Raw markup ~~-->\n{{{ [all[shadows+tiddlers]tag[$:/core/wiki/rawmarkup]] [all[shadows+tiddlers]tag[$:/tags/RawMarkup]] ||$:/core/templates/plain-text-tiddler}}}\n{{{ [all[shadows+tiddlers]tag[$:/tags/RawMarkupWikified]] ||$:/core/templates/raw-static-tiddler}}}\n</head>\n<body class=\"tc-body\">\n<!--~~ Raw markup for the top of the body section ~~-->\n{{{ [all[shadows+tiddlers]tag[$:/tags/RawMarkupWikified/TopBody]] ||$:/core/templates/raw-static-tiddler}}}\n<!--~~ Static styles ~~-->\n<div id=\"styleArea\">\n{{$:/boot/boot.css||$:/core/templates/css-tiddler}}\n</div>\n<!--~~ Static content for Google and browsers without JavaScript ~~-->\n<noscript>\n<div id=\"splashArea\">\n{{$:/core/templates/static.area}}\n</div>\n</noscript>\n<!--~~ Ordinary tiddlers ~~-->\n{{$:/core/templates/store.area.template.html}}\n<!--~~ Raw markup for the bottom of the body section ~~-->\n{{{ [all[shadows+tiddlers]tag[$:/tags/RawMarkupWikified/BottomBody]] ||$:/core/templates/raw-static-tiddler}}}\n</body>\n<script src=\"%24%3A%2Fcore%2Ftemplates%2Ftiddlywiki5.js\" onerror=\"alert('Error: Cannot load tiddlywiki.js');\"></script>\n</html>\n"
},
"$:/core/templates/html-div-skinny-tiddler": {
"title": "$:/core/templates/html-div-skinny-tiddler",
"text": "<!--\n\nThis template is a variant of $:/core/templates/html-div-tiddler used for saving skinny tiddlers (with no text field)\n\n-->`<div`<$fields template=' $name$=\"$encoded_value$\"'></$fields>`>\n<pre></pre>\n</div>`\n"
},
"$:/core/templates/html-div-tiddler": {
"title": "$:/core/templates/html-div-tiddler",
"text": "<!--\n\nThis template is used for saving tiddlers as an HTML DIV tag with attributes representing the tiddler fields.\n\n-->`<div`<$fields template=' $name$=\"$encoded_value$\"'></$fields>`>\n<pre>`<$view field=\"text\" format=\"htmlencoded\" />`</pre>\n</div>`\n"
},
"$:/core/templates/html-tiddler": {
"title": "$:/core/templates/html-tiddler",
"text": "<!--\n\nThis template is used for saving tiddlers as raw HTML\n\n--><$view field=\"text\" format=\"htmlwikified\" />"
},
"$:/core/templates/javascript-tiddler": {
"title": "$:/core/templates/javascript-tiddler",
"text": "<!--\n\nThis template is used for saving JavaScript tiddlers as a script tag with data attributes representing the tiddler fields.\n\n-->`<script`<$fields template=' data-tiddler-$name$=\"$encoded_value$\"'></$fields>` type=\"text/javascript\">`<$view field=\"text\" format=\"text\" />`</script>`"
},
"$:/core/templates/json-tiddler": {
"title": "$:/core/templates/json-tiddler",
"text": "<!--\n\nThis template is used for saving tiddlers as raw JSON\n\n--><$text text=<<jsontiddler>>/>"
},
"$:/core/templates/module-tiddler": {
"title": "$:/core/templates/module-tiddler",
"text": "<!--\n\nThis template is used for saving JavaScript tiddlers as a script tag with data attributes representing the tiddler fields. The body of the tiddler is wrapped in a call to the `$tw.modules.define` function in order to define the body of the tiddler as a module\n\n-->`<script`<$fields template=' data-tiddler-$name$=\"$encoded_value$\"'></$fields>` type=\"text/javascript\" data-module=\"yes\">$tw.modules.define(\"`<$view field=\"title\" format=\"jsencoded\" />`\",\"`<$view field=\"module-type\" format=\"jsencoded\" />`\",function(module,exports,require) {`<$view field=\"text\" format=\"text\" />`});\n</script>`"
},
"$:/core/templates/plain-text-tiddler": {
"title": "$:/core/templates/plain-text-tiddler",
"text": "<$view field=\"text\" format=\"text\" />"
},
"$:/core/templates/raw-static-tiddler": {
"title": "$:/core/templates/raw-static-tiddler",
"text": "<!--\n\nThis template is used for saving tiddlers as static HTML\n\n--><$view field=\"text\" format=\"plainwikified\" />"
},
"$:/core/save/all": {
"title": "$:/core/save/all",
"text": "\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\\define saveTiddlerFilter()\n[is[tiddler]] -[prefix[$:/state/popup/]] -[[$:/HistoryList]] -[[$:/boot/boot.css]] -[type[application/javascript]library[yes]] -[[$:/boot/boot.js]] -[[$:/boot/bootprefix.js]] +[sort[title]] $(publishFilter)$\n\\end\n{{$:/core/templates/tiddlywiki5.html}}\n"
},
"$:/core/save/empty": {
"title": "$:/core/save/empty",
"text": "\\define saveTiddlerFilter()\n[is[system]] -[prefix[$:/state/popup/]] -[[$:/boot/boot.css]] -[type[application/javascript]library[yes]] -[[$:/boot/boot.js]] -[[$:/boot/bootprefix.js]] +[sort[title]]\n\\end\n{{$:/core/templates/tiddlywiki5.html}}\n"
},
"$:/core/save/lazy-all": {
"title": "$:/core/save/lazy-all",
"text": "\\define saveTiddlerFilter()\n[is[system]] -[prefix[$:/state/popup/]] -[[$:/HistoryList]] -[[$:/boot/boot.css]] -[type[application/javascript]library[yes]] -[[$:/boot/boot.js]] -[[$:/boot/bootprefix.js]] +[sort[title]] \n\\end\n\\define skinnySaveTiddlerFilter()\n[!is[system]]\n\\end\n{{$:/core/templates/tiddlywiki5.html}}\n"
},
"$:/core/save/lazy-images": {
"title": "$:/core/save/lazy-images",
"text": "\\define saveTiddlerFilter()\n[is[tiddler]] -[prefix[$:/state/popup/]] -[[$:/HistoryList]] -[[$:/boot/boot.css]] -[type[application/javascript]library[yes]] -[[$:/boot/boot.js]] -[[$:/boot/bootprefix.js]] -[!is[system]is[image]] +[sort[title]] \n\\end\n\\define skinnySaveTiddlerFilter()\n[is[image]]\n\\end\n{{$:/core/templates/tiddlywiki5.html}}\n"
},
"$:/core/templates/server/static.sidebar.wikitext": {
"title": "$:/core/templates/server/static.sidebar.wikitext",
"text": "\\whitespace trim\n<div class=\"tc-sidebar-scrollable\" style=\"overflow: auto;\">\n<div class=\"tc-sidebar-header\">\n<h1 class=\"tc-site-title\">\n<$transclude tiddler=\"$:/SiteTitle\"/>\n</h1>\n<div class=\"tc-site-subtitle\">\n<$transclude tiddler=\"$:/SiteSubtitle\"/>\n</div>\n<h2>\n</h2>\n<div class=\"tc-sidebar-lists\">\n<$list filter={{$:/DefaultTiddlers}}>\n<div class=\"tc-menu-list-subitem\">\n<$link><$text text=<<currentTiddler>>/></$link>\n</div>\n</$list>\n</div>\n<!-- Currently disabled the recent list as it is unweildy when the responsive narrow view kicks in\n<h2>\n{{$:/language/SideBar/Recent/Caption}}\n</h2>\n<div class=\"tc-sidebar-lists\">\n<$macrocall $name=\"timeline\" format={{$:/language/RecentChanges/DateFormat}}/>\n</div>\n</div>\n</div>\n-->\n"
},
"$:/core/templates/server/static.tiddler.html": {
"title": "$:/core/templates/server/static.tiddler.html",
"text": "\\whitespace trim\n\\define tv-wikilink-template() $uri_encoded$\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n<html>\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content={{$:/core/templates/version}} />\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n<meta name=\"apple-mobile-web-app-capable\" content=\"yes\" />\n<meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black-translucent\" />\n<meta name=\"mobile-web-app-capable\" content=\"yes\"/>\n<meta name=\"format-detection\" content=\"telephone=no\">\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<link rel=\"stylesheet\" href=\"%24%3A%2Fcore%2Ftemplates%2Fstatic.template.css\">\n<title><$view field=\"caption\" format=\"plainwikified\"><$view field=\"title\"/></$view>: <$view tiddler=\"$:/core/wiki/title\" format=\"plainwikified\"/></title>\n</head>\n<body class=\"tc-body\">\n<$transclude tiddler=\"$:/core/templates/server/static.sidebar.wikitext\" mode=\"inline\"/>\n<section class=\"tc-story-river\">\n<div class=\"tc-tiddler-frame\">\n<$transclude tiddler=\"$:/core/templates/server/static.tiddler.wikitext\" mode=\"inline\"/>\n</div>\n</section>\n</body>\n</html>"
},
"$:/core/templates/server/static.tiddler.wikitext": {
"title": "$:/core/templates/server/static.tiddler.wikitext",
"text": "\\whitespace trim\n<div class=\"tc-tiddler-title\">\n<div class=\"tc-titlebar\">\n<h2><$text text=<<currentTiddler>>/></h2>\n</div>\n</div>\n<div class=\"tc-subtitle\">\n<$link to={{!!modifier}}>\n<$view field=\"modifier\"/>\n</$link> <$view field=\"modified\" format=\"date\" template={{$:/language/Tiddler/DateFormat}}/>\n</div>\n<div class=\"tc-tags-wrapper\">\n<$list filter=\"[all[current]tags[]sort[title]]\">\n<a href={{{ [<currentTiddler>encodeuricomponent[]] }}}>\n<$macrocall $name=\"tag-pill\" tag=<<currentTiddler>>/>\n</a>\n</$list>\n</div>\n<div class=\"tc-tiddler-body\">\n<$transclude mode=\"block\"/>\n</div>\n"
},
"$:/core/templates/single.tiddler.window": {
"title": "$:/core/templates/single.tiddler.window",
"text": "\\whitespace trim\n\\define containerClasses()\ntc-page-container tc-page-view-$(storyviewTitle)$ tc-language-$(languageTitle)$\n\\end\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\n<$set name=\"tv-config-toolbar-icons\" value={{$:/config/Toolbar/Icons}}>\n\n<$set name=\"tv-config-toolbar-text\" value={{$:/config/Toolbar/Text}}>\n\n<$set name=\"tv-config-toolbar-class\" value={{$:/config/Toolbar/ButtonClass}}>\n\n<$set name=\"tv-show-missing-links\" value={{$:/config/MissingLinks}}>\n\n<$set name=\"storyviewTitle\" value={{$:/view}}>\n\n<$set name=\"languageTitle\" value={{{ [{$:/language}get[name]] }}}>\n\n<div class=<<containerClasses>>>\n\n<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\">\n\n<$transclude mode=\"block\"/>\n\n</$navigator>\n\n</div>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n"
},
"$:/core/templates/split-recipe": {
"title": "$:/core/templates/split-recipe",
"text": "<$list filter=\"[!is[system]]\">\ntiddler: <$view field=\"title\" format=\"urlencoded\"/>.tid\n</$list>\n"
},
"$:/core/templates/static-tiddler": {
"title": "$:/core/templates/static-tiddler",
"text": "<a name=<<currentTiddler>>>\n<$transclude tiddler=\"$:/core/ui/ViewTemplate\"/>\n</a>"
},
"$:/core/templates/static.area": {
"title": "$:/core/templates/static.area",
"text": "<$reveal type=\"nomatch\" state=\"$:/isEncrypted\" text=\"yes\">\n{{{ [all[shadows+tiddlers]tag[$:/tags/RawStaticContent]!has[draft.of]] ||$:/core/templates/raw-static-tiddler}}}\n{{$:/core/templates/static.content||$:/core/templates/html-tiddler}}\n</$reveal>\n<$reveal type=\"match\" state=\"$:/isEncrypted\" text=\"yes\">\nThis file contains an encrypted ~TiddlyWiki. Enable ~JavaScript and enter the decryption password when prompted.\n</$reveal>\n<!-- ensure splash screen isn't shown when JS is disabled -->\n`<style>\n.tc-remove-when-wiki-loaded {display: none;}\n</style>`\n"
},
"$:/core/templates/static.content": {
"title": "$:/core/templates/static.content",
"text": "<!-- For Google, and people without JavaScript-->\nThis [[TiddlyWiki|https://tiddlywiki.com]] contains the following tiddlers:\n\n<ul>\n<$list filter=<<saveTiddlerFilter>>>\n<li><$view field=\"title\" format=\"text\"></$view></li>\n</$list>\n</ul>\n"
},
"$:/core/templates/static.template.css": {
"title": "$:/core/templates/static.template.css",
"text": "{{$:/boot/boot.css||$:/core/templates/plain-text-tiddler}}\n\n{{$:/core/ui/PageStylesheet||$:/core/templates/wikified-tiddler}}\n"
},
"$:/core/templates/static.template.html": {
"title": "$:/core/templates/static.template.html",
"type": "text/vnd.tiddlywiki-html",
"text": "\\define tv-wikilink-template() static/$uri_doubleencoded$.html\n\\define tv-config-toolbar-icons() no\n\\define tv-config-toolbar-text() no\n\\define tv-config-toolbar-class() tc-btn-invisible\n\\rules only filteredtranscludeinline transcludeinline\n<!doctype html>\n<html>\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content=\"{{$:/core/templates/version}}\" />\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n<meta name=\"apple-mobile-web-app-capable\" content=\"yes\" />\n<meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black-translucent\" />\n<meta name=\"mobile-web-app-capable\" content=\"yes\"/>\n<meta name=\"format-detection\" content=\"telephone=no\">\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<title>{{$:/core/wiki/title}}</title>\n<div id=\"styleArea\">\n{{$:/boot/boot.css||$:/core/templates/css-tiddler}}\n</div>\n<style type=\"text/css\">\n{{$:/core/ui/PageStylesheet||$:/core/templates/wikified-tiddler}}\n</style>\n</head>\n<body class=\"tc-body\">\n{{$:/StaticBanner||$:/core/templates/html-tiddler}}\n{{$:/core/ui/PageTemplate||$:/core/templates/html-tiddler}}\n</body>\n</html>\n"
},
"$:/core/templates/static.tiddler.html": {
"title": "$:/core/templates/static.tiddler.html",
"text": "\\define tv-wikilink-template() $uri_doubleencoded$.html\n\\define tv-config-toolbar-icons() no\n\\define tv-config-toolbar-text() no\n\\define tv-config-toolbar-class() tc-btn-invisible\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n`<!doctype html>\n<html>\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content=\"`{{$:/core/templates/version}}`\" />\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n<meta name=\"apple-mobile-web-app-capable\" content=\"yes\" />\n<meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black-translucent\" />\n<meta name=\"mobile-web-app-capable\" content=\"yes\"/>\n<meta name=\"format-detection\" content=\"telephone=no\">\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<link rel=\"stylesheet\" href=\"static.css\">\n<title>`<$view field=\"caption\"><$view field=\"title\"/></$view>: {{$:/core/wiki/title}}`</title>\n</head>\n<body class=\"tc-body\">\n`{{$:/StaticBanner||$:/core/templates/html-tiddler}}`\n<section class=\"tc-story-river\">\n`<$view tiddler=\"$:/core/ui/ViewTemplate\" format=\"htmlwikified\"/>`\n</section>\n</body>\n</html>\n`"
},
"$:/core/templates/store.area.template.html": {
"title": "$:/core/templates/store.area.template.html",
"text": "<$reveal type=\"nomatch\" state=\"$:/isEncrypted\" text=\"yes\">\n`<div id=\"storeArea\" style=\"display:none;\">`\n<$list filter=<<saveTiddlerFilter>> template=\"$:/core/templates/html-div-tiddler\"/>\n<$list filter={{{ [<skinnySaveTiddlerFilter>] }}} template=\"$:/core/templates/html-div-skinny-tiddler\"/>\n`</div>`\n</$reveal>\n<$reveal type=\"match\" state=\"$:/isEncrypted\" text=\"yes\">\n`<!--~~ Encrypted tiddlers ~~-->`\n`<pre id=\"encryptedStoreArea\" type=\"text/plain\" style=\"display:none;\">`\n<$encrypt filter=<<saveTiddlerFilter>>/>\n`</pre>`\n</$reveal>"
},
"$:/core/templates/tid-tiddler": {
"title": "$:/core/templates/tid-tiddler",
"text": "<!--\n\nThis template is used for saving tiddlers in TiddlyWeb *.tid format\n\n--><$fields exclude='text bag' template='$name$: $value$\n'></$fields>`\n`<$view field=\"text\" format=\"text\" />"
},
"$:/core/templates/tiddler-metadata": {
"title": "$:/core/templates/tiddler-metadata",
"text": "<!--\n\nThis template is used for saving tiddler metadata *.meta files\n\n--><$fields exclude='text bag' template='$name$: $value$\n'></$fields>"
},
"$:/core/templates/tiddlywiki5.html": {
"title": "$:/core/templates/tiddlywiki5.html",
"text": "<$set name=\"saveTiddlerAndShadowsFilter\" filter=\"[subfilter<saveTiddlerFilter>] [subfilter<saveTiddlerFilter>plugintiddlers[]]\">\n`<!doctype html>\n`{{$:/core/templates/MOTW.html}}`<html lang=\"`<$text text={{{ [{$:/language}get[name]] }}}/>`\">\n<head>\n<meta http-equiv=\"Content-Type\" content=\"text/html;charset=utf-8\" />\n<!--~~ Raw markup for the top of the head section ~~-->\n`{{{ [<saveTiddlerAndShadowsFilter>tag[$:/tags/RawMarkupWikified/TopHead]] ||$:/core/templates/raw-static-tiddler}}}`\n<meta http-equiv=\"X-UA-Compatible\" content=\"IE=Edge\"/>\n<meta name=\"application-name\" content=\"TiddlyWiki\" />\n<meta name=\"generator\" content=\"TiddlyWiki\" />\n<meta name=\"tiddlywiki-version\" content=\"`{{$:/core/templates/version}}`\" />\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n<meta name=\"apple-mobile-web-app-capable\" content=\"yes\" />\n<meta name=\"apple-mobile-web-app-status-bar-style\" content=\"black-translucent\" />\n<meta name=\"mobile-web-app-capable\" content=\"yes\"/>\n<meta name=\"format-detection\" content=\"telephone=no\" />\n<meta name=\"copyright\" content=\"`{{$:/core/copyright.txt}}`\" />\n<link id=\"faviconLink\" rel=\"shortcut icon\" href=\"favicon.ico\">\n<title>`{{$:/core/wiki/title}}`</title>\n<!--~~ This is a Tiddlywiki file. The points of interest in the file are marked with this pattern ~~-->\n\n<!--~~ Raw markup ~~-->\n`{{{ [enlist<saveTiddlerAndShadowsFilter>tag[$:/core/wiki/rawmarkup]] ||$:/core/templates/plain-text-tiddler}}}\n{{{ [enlist<saveTiddlerAndShadowsFilter>tag[$:/tags/RawMarkup]] ||$:/core/templates/plain-text-tiddler}}}\n{{{ [enlist<saveTiddlerAndShadowsFilter>tag[$:/tags/RawMarkupWikified]] ||$:/core/templates/raw-static-tiddler}}}`\n</head>\n<body class=\"tc-body\">\n<!--~~ Raw markup for the top of the body section ~~-->\n`{{{ [enlist<saveTiddlerAndShadowsFilter>tag[$:/tags/RawMarkupWikified/TopBody]] ||$:/core/templates/raw-static-tiddler}}}`\n<!--~~ Static styles ~~-->\n<div id=\"styleArea\">\n`{{$:/boot/boot.css||$:/core/templates/css-tiddler}}`\n</div>\n<!--~~ Static content for Google and browsers without JavaScript ~~-->\n<noscript>\n<div id=\"splashArea\">\n`{{$:/core/templates/static.area}}`\n</div>\n</noscript>\n<!--~~ Ordinary tiddlers ~~-->\n`{{$:/core/templates/store.area.template.html}}`\n<!--~~ Library modules ~~-->\n<div id=\"libraryModules\" style=\"display:none;\">\n`{{{ [is[system]type[application/javascript]library[yes]] ||$:/core/templates/javascript-tiddler}}}`\n</div>\n<!--~~ Boot kernel prologue ~~-->\n<div id=\"bootKernelPrefix\" style=\"display:none;\">\n`{{ $:/boot/bootprefix.js ||$:/core/templates/javascript-tiddler}}`\n</div>\n<!--~~ Boot kernel ~~-->\n<div id=\"bootKernel\" style=\"display:none;\">\n`{{ $:/boot/boot.js ||$:/core/templates/javascript-tiddler}}`\n</div>\n<!--~~ Raw markup for the bottom of the body section ~~-->\n`{{{ [enlist<saveTiddlerAndShadowsFilter>tag[$:/tags/RawMarkupWikified/BottomBody]] ||$:/core/templates/raw-static-tiddler}}}`\n</body>\n</html>`\n"
},
"$:/core/templates/version": {
"title": "$:/core/templates/version",
"text": "<<version>>"
},
"$:/core/templates/wikified-tiddler": {
"title": "$:/core/templates/wikified-tiddler",
"text": "<$transclude />"
},
"$:/core/ui/AboveStory/tw2-plugin-check": {
"title": "$:/core/ui/AboveStory/tw2-plugin-check",
"tags": "$:/tags/AboveStory",
"text": "\\define lingo-base() $:/language/AboveStory/ClassicPlugin/\n<$list filter=\"[all[system+tiddlers]tag[systemConfig]limit[1]]\">\n\n<div class=\"tc-message-box\">\n\n<<lingo Warning>>\n\n<ul>\n\n<$list filter=\"[all[system+tiddlers]tag[systemConfig]]\">\n\n<li>\n\n<$link><$view field=\"title\"/></$link>\n\n</li>\n\n</$list>\n\n</ul>\n\n</div>\n\n</$list>\n"
},
"$:/core/ui/Actions/new-image": {
"title": "$:/core/ui/Actions/new-image",
"tags": "$:/tags/Actions",
"description": "create a new image tiddler",
"text": "\\define get-type()\nimage/$(imageType)$\n\\end\n<$vars imageType={{$:/config/NewImageType}}>\n<$action-sendmessage $message=\"tm-new-tiddler\" type=<<get-type>> tags={{$:/config/NewTiddler/Tags!!tags}}/>\n</$vars>\n"
},
"$:/core/ui/Actions/new-journal": {
"title": "$:/core/ui/Actions/new-journal",
"tags": "$:/tags/Actions",
"description": "create a new journal tiddler",
"text": "<$vars journalTitleTemplate={{$:/config/NewJournal/Title}} journalTags={{$:/config/NewJournal/Tags!!tags}} journalText={{$:/config/NewJournal/Text}}>\n<$wikify name=\"journalTitle\" text=\"\"\"<$macrocall $name=\"now\" format=<<journalTitleTemplate>>/>\"\"\">\n<$reveal type=\"nomatch\" state=<<journalTitle>> text=\"\">\n<$action-sendmessage $message=\"tm-new-tiddler\" title=<<journalTitle>> tags=<<journalTags>> text={{{ [<journalTitle>get[]] }}}/>\n</$reveal>\n<$reveal type=\"match\" state=<<journalTitle>> text=\"\">\n<$action-sendmessage $message=\"tm-new-tiddler\" title=<<journalTitle>> tags=<<journalTags>> text=<<journalText>>/>\n</$reveal>\n</$wikify>\n</$vars>\n"
},
"$:/core/ui/Actions/new-tiddler": {
"title": "$:/core/ui/Actions/new-tiddler",
"tags": "$:/tags/Actions",
"description": "create a new empty tiddler",
"text": "<$action-sendmessage $message=\"tm-new-tiddler\" tags={{$:/config/NewTiddler/Tags!!tags}}/>\n"
},
"$:/core/ui/AdvancedSearch/Filter": {
"title": "$:/core/ui/AdvancedSearch/Filter",
"tags": "$:/tags/AdvancedSearch",
"caption": "{{$:/language/Search/Filter/Caption}}",
"text": "\\define lingo-base() $:/language/Search/\n<<lingo Filter/Hint>>\n\n<div class=\"tc-search tc-advanced-search\">\n<$edit-text tiddler=\"$:/temp/advancedsearch\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}}/>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/AdvancedSearch/FilterButton]!has[draft.of]]\"><$transclude/></$list>\n</div>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$set name=\"resultCount\" value=\"\"\"<$count filter={{$:/temp/advancedsearch}}/>\"\"\">\n<div class=\"tc-search-results\">\n<<lingo Filter/Matches>>\n<$list filter={{$:/temp/advancedsearch}} template=\"$:/core/ui/ListItemTemplate\"/>\n</div>\n</$set>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Filter/FilterButtons/clear": {
"title": "$:/core/ui/AdvancedSearch/Filter/FilterButtons/clear",
"tags": "$:/tags/AdvancedSearch/FilterButton",
"text": "<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" $field=\"text\" $value=\"\"/>\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Filter/FilterButtons/delete": {
"title": "$:/core/ui/AdvancedSearch/Filter/FilterButtons/delete",
"tags": "$:/tags/AdvancedSearch/FilterButton",
"text": "<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button popup=<<qualify \"$:/state/filterDeleteDropdown\">> class=\"tc-btn-invisible\">\n{{$:/core/images/delete-button}}\n</$button>\n</$reveal>\n\n<$reveal state=<<qualify \"$:/state/filterDeleteDropdown\">> type=\"popup\" position=\"belowleft\" animate=\"yes\">\n<div class=\"tc-block-dropdown-wrapper\">\n<div class=\"tc-block-dropdown tc-edit-type-dropdown\">\n<div class=\"tc-dropdown-item-plain\">\n<$set name=\"resultCount\" value=\"\"\"<$count filter={{$:/temp/advancedsearch}}/>\"\"\">\nAre you sure you wish to delete <<resultCount>> tiddler(s)?\n</$set>\n</div>\n<div class=\"tc-dropdown-item-plain\">\n<$button class=\"tc-btn\">\n<$action-deletetiddler $filter={{$:/temp/advancedsearch}}/>\nDelete these tiddlers\n</$button>\n</div>\n</div>\n</div>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Filter/FilterButtons/dropdown": {
"title": "$:/core/ui/AdvancedSearch/Filter/FilterButtons/dropdown",
"tags": "$:/tags/AdvancedSearch/FilterButton",
"text": "<span class=\"tc-popup-keep\">\n<$button popup=<<qualify \"$:/state/filterDropdown\">> class=\"tc-btn-invisible\">\n{{$:/core/images/down-arrow}}\n</$button>\n</span>\n\n<$reveal state=<<qualify \"$:/state/filterDropdown\">> type=\"popup\" position=\"belowleft\" animate=\"yes\">\n<$set name=\"tv-show-missing-links\" value=\"yes\">\n<$linkcatcher to=\"$:/temp/advancedsearch\">\n<div class=\"tc-block-dropdown-wrapper\">\n<div class=\"tc-block-dropdown tc-edit-type-dropdown\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Filter]]\"><$link to={{!!filter}}><$transclude field=\"description\"/></$link>\n</$list>\n</div>\n</div>\n</$linkcatcher>\n</$set>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Filter/FilterButtons/export": {
"title": "$:/core/ui/AdvancedSearch/Filter/FilterButtons/export",
"tags": "$:/tags/AdvancedSearch/FilterButton",
"text": "<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$macrocall $name=\"exportButton\" exportFilter={{$:/temp/advancedsearch}} lingoBase=\"$:/language/Buttons/ExportTiddlers/\"/>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Shadows": {
"title": "$:/core/ui/AdvancedSearch/Shadows",
"tags": "$:/tags/AdvancedSearch",
"caption": "{{$:/language/Search/Shadows/Caption}}",
"text": "\\define lingo-base() $:/language/Search/\n<$linkcatcher to=\"$:/temp/advancedsearch\">\n\n<<lingo Shadows/Hint>>\n\n<div class=\"tc-search\">\n<$edit-text tiddler=\"$:/temp/advancedsearch\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}}/>\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" $field=\"text\" $value=\"\"/>\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n</div>\n\n</$linkcatcher>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n\n<$list filter=\"[{$:/temp/advancedsearch}minlength{$:/config/Search/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n\n<$set name=\"resultCount\" value=\"\"\"<$count filter=\"[all[shadows]search{$:/temp/advancedsearch}] -[[$:/temp/advancedsearch]]\"/>\"\"\">\n\n<div class=\"tc-search-results\">\n\n<<lingo Shadows/Matches>>\n\n<$list filter=\"[all[shadows]search{$:/temp/advancedsearch}sort[title]limit[250]] -[[$:/temp/advancedsearch]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n\n</div>\n\n</$set>\n\n</$list>\n\n</$reveal>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"match\" text=\"\">\n\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/Standard": {
"title": "$:/core/ui/AdvancedSearch/Standard",
"tags": "$:/tags/AdvancedSearch",
"caption": "{{$:/language/Search/Standard/Caption}}",
"text": "\\define lingo-base() $:/language/Search/\n<$linkcatcher to=\"$:/temp/advancedsearch\">\n\n<<lingo Standard/Hint>>\n\n<div class=\"tc-search\">\n<$edit-text tiddler=\"$:/temp/advancedsearch\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}}/>\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" $field=\"text\" $value=\"\"/>\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n</div>\n\n</$linkcatcher>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$list filter=\"[{$:/temp/advancedsearch}minlength{$:/config/Search/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n<$set name=\"searchTiddler\" value=\"$:/temp/advancedsearch\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]butfirst[]limit[1]]\" emptyMessage=\"\"\"\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]]\">\n<$transclude/>\n</$list>\n\"\"\">\n<$macrocall $name=\"tabs\" tabsList=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]]\" default={{$:/config/SearchResults/Default}}/>\n</$list>\n</$set>\n</$list>\n</$reveal>\n"
},
"$:/core/ui/AdvancedSearch/System": {
"title": "$:/core/ui/AdvancedSearch/System",
"tags": "$:/tags/AdvancedSearch",
"caption": "{{$:/language/Search/System/Caption}}",
"text": "\\define lingo-base() $:/language/Search/\n<$linkcatcher to=\"$:/temp/advancedsearch\">\n\n<<lingo System/Hint>>\n\n<div class=\"tc-search\">\n<$edit-text tiddler=\"$:/temp/advancedsearch\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}}/>\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" $field=\"text\" $value=\"\"/>\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n</div>\n\n</$linkcatcher>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n\n<$list filter=\"[{$:/temp/advancedsearch}minlength{$:/config/Search/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n\n<$set name=\"resultCount\" value=\"\"\"<$count filter=\"[is[system]search{$:/temp/advancedsearch}] -[[$:/temp/advancedsearch]]\"/>\"\"\">\n\n<div class=\"tc-search-results\">\n\n<<lingo System/Matches>>\n\n<$list filter=\"[is[system]search{$:/temp/advancedsearch}sort[title]limit[250]] -[[$:/temp/advancedsearch]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n\n</div>\n\n</$set>\n\n</$list>\n\n</$reveal>\n\n<$reveal state=\"$:/temp/advancedsearch\" type=\"match\" text=\"\">\n\n</$reveal>\n"
},
"$:/AdvancedSearch": {
"title": "$:/AdvancedSearch",
"icon": "$:/core/images/advanced-search-button",
"color": "#bbb",
"text": "<div class=\"tc-advanced-search\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/AdvancedSearch]!has[draft.of]]\" \"$:/core/ui/AdvancedSearch/System\">>\n</div>\n"
},
"$:/core/ui/AlertTemplate": {
"title": "$:/core/ui/AlertTemplate",
"text": "<div class=\"tc-alert\">\n<div class=\"tc-alert-toolbar\">\n<$button class=\"tc-btn-invisible\"><$action-deletetiddler $tiddler=<<currentTiddler>>/>{{$:/core/images/cancel-button}}</$button>\n</div>\n<div class=\"tc-alert-subtitle\">\n<$wikify name=\"format\" text=<<lingo Tiddler/DateFormat>>>\n<$view field=\"component\"/> - <$view field=\"modified\" format=\"date\" template=<<format>>/> <$reveal type=\"nomatch\" state=\"!!count\" text=\"\"><span class=\"tc-alert-highlight\">({{$:/language/Count}}: <$view field=\"count\"/>)</span></$reveal>\n</$wikify>\n</div>\n<div class=\"tc-alert-body\">\n\n<$transclude/>\n\n</div>\n</div>\n"
},
"$:/core/ui/BinaryWarning": {
"title": "$:/core/ui/BinaryWarning",
"text": "\\define lingo-base() $:/language/BinaryWarning/\n<<lingo Prompt>>\n"
},
"$:/core/ui/Components/plugin-info": {
"title": "$:/core/ui/Components/plugin-info",
"text": "\\define lingo-base() $:/language/ControlPanel/Plugins/\n\n\\define popup-state-macro()\n$(qualified-state)$-$(currentTiddler)$\n\\end\n\n\\define tabs-state-macro()\n$(popup-state)$-$(pluginInfoType)$\n\\end\n\n\\define plugin-icon-title()\n$(currentTiddler)$/icon\n\\end\n\n\\define plugin-disable-title()\n$:/config/Plugins/Disabled/$(currentTiddler)$\n\\end\n\n\\define plugin-table-body(type,disabledMessage,default-popup-state)\n<div class=\"tc-plugin-info-chunk tc-plugin-info-toggle\">\n<$reveal type=\"nomatch\" state=<<popup-state>> text=\"yes\" default=\"\"\"$default-popup-state$\"\"\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" set=<<popup-state>> setTo=\"yes\">\n{{$:/core/images/chevron-right}}\n</$button>\n</$reveal>\n<$reveal type=\"match\" state=<<popup-state>> text=\"yes\" default=\"\"\"$default-popup-state$\"\"\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" set=<<popup-state>> setTo=\"no\">\n{{$:/core/images/chevron-down}}\n</$button>\n</$reveal>\n</div>\n<div class=\"tc-plugin-info-chunk tc-plugin-info-icon\">\n<$transclude tiddler=<<currentTiddler>> subtiddler=<<plugin-icon-title>>>\n<$transclude tiddler=\"$:/core/images/plugin-generic-$type$\"/>\n</$transclude>\n</div>\n<div class=\"tc-plugin-info-chunk tc-plugin-info-description\">\n<h1>\n''<$text text={{{ [<currentTiddler>get[name]] ~[<currentTiddler>split[/]last[1]] }}}/>'': <$view field=\"description\"><$view field=\"title\"/></$view> $disabledMessage$\n</h1>\n<h2>\n<$view field=\"title\"/>\n</h2>\n<h2>\n<div><em><$view field=\"version\"/></em></div>\n</h2>\n</div>\n\\end\n\n\\define plugin-info(type,default-popup-state)\n<$set name=\"popup-state\" value=<<popup-state-macro>>>\n<$reveal type=\"nomatch\" state=<<plugin-disable-title>> text=\"yes\">\n<$link to={{!!title}} class=\"tc-plugin-info\">\n<<plugin-table-body type:\"$type$\" default-popup-state:\"\"\"$default-popup-state$\"\"\">>\n</$link>\n</$reveal>\n<$reveal type=\"match\" state=<<plugin-disable-title>> text=\"yes\">\n<$link to={{!!title}} class=\"tc-plugin-info tc-plugin-info-disabled\">\n<<plugin-table-body type:\"$type$\" default-popup-state:\"\"\"$default-popup-state$\"\"\" disabledMessage:\"<$macrocall $name='lingo' title='Disabled/Status'/>\">>\n</$link>\n</$reveal>\n<$reveal type=\"match\" text=\"yes\" state=<<popup-state>> default=\"\"\"$default-popup-state$\"\"\">\n<div class=\"tc-plugin-info-dropdown\">\n<div class=\"tc-plugin-info-dropdown-body\">\n<$list filter=\"[all[current]] -[[$:/core]]\">\n<div style=\"float:right;\">\n<$reveal type=\"nomatch\" state=<<plugin-disable-title>> text=\"yes\">\n<$button set=<<plugin-disable-title>> setTo=\"yes\" tooltip={{$:/language/ControlPanel/Plugins/Disable/Hint}} aria-label={{$:/language/ControlPanel/Plugins/Disable/Caption}}>\n<<lingo Disable/Caption>>\n</$button>\n</$reveal>\n<$reveal type=\"match\" state=<<plugin-disable-title>> text=\"yes\">\n<$button set=<<plugin-disable-title>> setTo=\"no\" tooltip={{$:/language/ControlPanel/Plugins/Enable/Hint}} aria-label={{$:/language/ControlPanel/Plugins/Enable/Caption}}>\n<<lingo Enable/Caption>>\n</$button>\n</$reveal>\n</div>\n</$list>\n<$set name=\"tabsList\" filter=\"[<currentTiddler>list[]] contents\">\n<$macrocall $name=\"tabs\" state=<<tabs-state-macro>> tabsList=<<tabsList>> default={{{ [enlist<tabsList>] }}} template=\"$:/core/ui/PluginInfo\"/>\n</$set>\n</div>\n</div>\n</$reveal>\n</$set>\n\\end\n\n<$macrocall $name=\"plugin-info\" type=<<plugin-type>> default-popup-state=<<default-popup-state>>/>\n"
},
"$:/core/ui/Components/tag-link": {
"title": "$:/core/ui/Components/tag-link",
"text": "<$link>\n<$set name=\"backgroundColor\" value={{!!color}}>\n<span style=<<tag-styles>> class=\"tc-tag-label\">\n<$view field=\"title\" format=\"text\"/>\n</span>\n</$set>\n</$link>"
},
"$:/core/ui/ControlPanel/Advanced": {
"title": "$:/core/ui/ControlPanel/Advanced",
"tags": "$:/tags/ControlPanel/Info",
"caption": "{{$:/language/ControlPanel/Advanced/Caption}}",
"text": "{{$:/language/ControlPanel/Advanced/Hint}}\n\n<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Advanced]!has[draft.of]]\" \"$:/core/ui/ControlPanel/TiddlerFields\">>\n</div>\n"
},
"$:/core/ui/ControlPanel/Appearance": {
"title": "$:/core/ui/ControlPanel/Appearance",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/Appearance/Caption}}",
"text": "{{$:/language/ControlPanel/Appearance/Hint}}\n\n<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Appearance]!has[draft.of]]\" \"$:/core/ui/ControlPanel/Theme\">>\n</div>\n"
},
"$:/core/ui/ControlPanel/Basics": {
"title": "$:/core/ui/ControlPanel/Basics",
"tags": "$:/tags/ControlPanel/Info",
"caption": "{{$:/language/ControlPanel/Basics/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Basics/\n\n\\define show-filter-count(filter)\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" $value=\"\"\"$filter$\"\"\"/>\n<$action-setfield $tiddler=\"$:/state/tab--1498284803\" $value=\"$:/core/ui/AdvancedSearch/Filter\"/>\n<$action-navigate $to=\"$:/AdvancedSearch\"/>\n''<$count filter=\"\"\"$filter$\"\"\"/>''\n{{$:/core/images/advanced-search-button}}\n</$button>\n\\end\n\n|<<lingo Version/Prompt>> |''<<version>>'' |\n|<$link to=\"$:/SiteTitle\"><<lingo Title/Prompt>></$link> |<$edit-text tiddler=\"$:/SiteTitle\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/SiteSubtitle\"><<lingo Subtitle/Prompt>></$link> |<$edit-text tiddler=\"$:/SiteSubtitle\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/status/UserName\"><<lingo Username/Prompt>></$link> |<$edit-text tiddler=\"$:/status/UserName\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/config/AnimationDuration\"><<lingo AnimDuration/Prompt>></$link> |<$edit-text tiddler=\"$:/config/AnimationDuration\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/DefaultTiddlers\"><<lingo DefaultTiddlers/Prompt>></$link> |<<lingo DefaultTiddlers/TopHint>><br> <$edit tag=\"textarea\" tiddler=\"$:/DefaultTiddlers\" class=\"tc-edit-texteditor\"/><br>//<<lingo DefaultTiddlers/BottomHint>>// |\n|<$link to=\"$:/language/DefaultNewTiddlerTitle\"><<lingo NewTiddler/Title/Prompt>></$link> |<$edit-text tiddler=\"$:/language/DefaultNewTiddlerTitle\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/config/NewJournal/Title\"><<lingo NewJournal/Title/Prompt>></$link> |<$edit-text tiddler=\"$:/config/NewJournal/Title\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/config/NewJournal/Text\"><<lingo NewJournal/Text/Prompt>></$link> |<$edit tiddler=\"$:/config/NewJournal/Text\" tag=\"textarea\" class=\"tc-edit-texteditor\" default=\"\"/> |\n|<$link to=\"$:/config/NewTiddler/Tags\"><<lingo NewTiddler/Tags/Prompt>></$link> |<$list filter=\"[[$:/config/NewTiddler/Tags]]\" template=\"$:/core/ui/EditTemplate/tags\"/> |\n|<$link to=\"$:/config/NewJournal/Tags\"><<lingo NewJournal/Tags/Prompt>></$link> |<$list filter=\"[[$:/config/NewJournal/Tags]]\" template=\"$:/core/ui/EditTemplate/tags\"/> |\n|<$link to=\"$:/config/AutoFocus\"><<lingo AutoFocus/Prompt>></$link> |{{$:/snippets/minifocusswitcher}} |\n|<<lingo Language/Prompt>> |{{$:/snippets/minilanguageswitcher}} |\n|<<lingo Tiddlers/Prompt>> |<<show-filter-count \"[!is[system]sort[title]]\">> |\n|<<lingo Tags/Prompt>> |<<show-filter-count \"[tags[]sort[title]]\">> |\n|<<lingo SystemTiddlers/Prompt>> |<<show-filter-count \"[is[system]sort[title]]\">> |\n|<<lingo ShadowTiddlers/Prompt>> |<<show-filter-count \"[all[shadows]sort[title]]\">> |\n|<<lingo OverriddenShadowTiddlers/Prompt>> |<<show-filter-count \"[is[tiddler]is[shadow]sort[title]]\">> |\n"
},
"$:/core/ui/ControlPanel/EditorTypes": {
"title": "$:/core/ui/ControlPanel/EditorTypes",
"tags": "$:/tags/ControlPanel/Advanced",
"caption": "{{$:/language/ControlPanel/EditorTypes/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/EditorTypes/\n\n<<lingo Hint>>\n\n<table>\n<tbody>\n<tr>\n<th><<lingo Type/Caption>></th>\n<th><<lingo Editor/Caption>></th>\n</tr>\n<$list filter=\"[all[shadows+tiddlers]prefix[$:/config/EditorTypeMappings/]sort[title]]\">\n<tr>\n<td>\n<$link>\n<$list filter=\"[all[current]removeprefix[$:/config/EditorTypeMappings/]]\">\n<$text text={{!!title}}/>\n</$list>\n</$link>\n</td>\n<td>\n<$view field=\"text\"/>\n</td>\n</tr>\n</$list>\n</tbody>\n</table>\n"
},
"$:/core/ui/ControlPanel/Info": {
"title": "$:/core/ui/ControlPanel/Info",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/Info/Caption}}",
"text": "{{$:/language/ControlPanel/Info/Hint}}\n\n<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Info]!has[draft.of]]\" \"$:/core/ui/ControlPanel/Basics\">>\n</div>\n"
},
"$:/core/ui/ControlPanel/KeyboardShortcuts": {
"title": "$:/core/ui/ControlPanel/KeyboardShortcuts",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/KeyboardShortcuts/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/KeyboardShortcuts/\n\n\\define new-shortcut(title)\n<div class=\"tc-dropdown-item-plain\">\n<$edit-shortcut tiddler=\"$title$\" placeholder={{$:/language/ControlPanel/KeyboardShortcuts/Add/Prompt}} focus=\"true\" style=\"width:auto;\"/> <$button>\n<<lingo Add/Caption>>\n<$action-listops\n\t$tiddler=\"$(shortcutTitle)$\"\n\t$field=\"text\"\n\t$subfilter=\"[{$title$}]\"\n/>\n<$action-deletetiddler\n\t$tiddler=\"$title$\"\n/>\n</$button>\n</div>\n\\end\n\n\\define shortcut-list-item(caption)\n<td>\n</td>\n<td style=\"text-align:right;font-size:0.7em;\">\n<<lingo Platform/$caption$>>\n</td>\n<td>\n<div style=\"position:relative;\">\n<$button popup=<<qualify \"$:/state/dropdown/$(shortcutTitle)$\">> class=\"tc-btn-invisible\">\n{{$:/core/images/edit-button}}\n</$button>\n<$macrocall $name=\"displayshortcuts\" $output=\"text/html\" shortcuts={{$(shortcutTitle)$}} prefix=\"<kbd>\" separator=\"</kbd> <kbd>\" suffix=\"</kbd>\"/>\n\n<$reveal state=<<qualify \"$:/state/dropdown/$(shortcutTitle)$\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-block-dropdown-wrapper\">\n<div class=\"tc-block-dropdown tc-edit-type-dropdown tc-popup-keep\">\n<$list filter=\"[list[$(shortcutTitle)$!!text]sort[title]]\" variable=\"shortcut\" emptyMessage=\"\"\"\n<div class=\"tc-dropdown-item-plain\">\n//<<lingo NoShortcuts/Caption>>//\n</div>\n\"\"\">\n<div class=\"tc-dropdown-item-plain\">\n<$button class=\"tc-btn-invisible\" tooltip={{$:/language/ControlPanel/KeyboardShortcuts/Remove/Hint}}>\n<$action-listops\n\t$tiddler=\"$(shortcutTitle)$\"\n\t$field=\"text\"\n\t$subfilter=\"+[remove<shortcut>]\"\n/>\n<small>{{$:/core/images/close-button}}</small>\n</$button>\n<kbd>\n<$macrocall $name=\"displayshortcuts\" $output=\"text/html\" shortcuts=<<shortcut>>/>\n</kbd>\n</div>\n</$list>\n<hr/>\n<$macrocall $name=\"new-shortcut\" title=<<qualify \"$:/state/new-shortcut/$(shortcutTitle)$\">>/>\n</div>\n</div>\n</$reveal>\n</div>\n</td>\n\\end\n\n\\define shortcut-list(caption,prefix)\n<tr>\n<$list filter=\"[[$prefix$$(shortcutName)$]]\" variable=\"shortcutTitle\">\n<<shortcut-list-item \"$caption$\">>\n</$list>\n</tr>\n\\end\n\n\\define shortcut-editor()\n<<shortcut-list \"All\" \"$:/config/shortcuts/\">>\n<<shortcut-list \"Mac\" \"$:/config/shortcuts-mac/\">>\n<<shortcut-list \"NonMac\" \"$:/config/shortcuts-not-mac/\">>\n<<shortcut-list \"Linux\" \"$:/config/shortcuts-linux/\">>\n<<shortcut-list \"NonLinux\" \"$:/config/shortcuts-not-linux/\">>\n<<shortcut-list \"Windows\" \"$:/config/shortcuts-windows/\">>\n<<shortcut-list \"NonWindows\" \"$:/config/shortcuts-not-windows/\">>\n\\end\n\n\\define shortcut-preview()\n<$macrocall $name=\"displayshortcuts\" $output=\"text/html\" shortcuts={{$(shortcutPrefix)$$(shortcutName)$}} prefix=\"<kbd>\" separator=\"</kbd> <kbd>\" suffix=\"</kbd>\"/>\n\\end\n\n\\define shortcut-item-inner()\n<tr>\n<td>\n<$reveal type=\"nomatch\" state=<<dropdownStateTitle>> text=\"open\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield\n\t$tiddler=<<dropdownStateTitle>>\n\t$value=\"open\"\n/>\n{{$:/core/images/right-arrow}}\n</$button>\n</$reveal>\n<$reveal type=\"match\" state=<<dropdownStateTitle>> text=\"open\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield\n\t$tiddler=<<dropdownStateTitle>>\n\t$value=\"close\"\n/>\n{{$:/core/images/down-arrow}}\n</$button>\n</$reveal>\n''<$text text=<<shortcutName>>/>''\n</td>\n<td>\n<$transclude tiddler=\"$:/config/ShortcutInfo/$(shortcutName)$\"/>\n</td>\n<td>\n<$list filter=\"$:/config/shortcuts/ $:/config/shortcuts-mac/ $:/config/shortcuts-not-mac/ $:/config/shortcuts-linux/ $:/config/shortcuts-not-linux/ $:/config/shortcuts-windows/ $:/config/shortcuts-not-windows/\" variable=\"shortcutPrefix\">\n<<shortcut-preview>>\n</$list>\n</td>\n</tr>\n<$set name=\"dropdownState\" value={{$(dropdownStateTitle)$}}>\n<$list filter=\"[<dropdownState>match[open]]\" variable=\"listItem\">\n<<shortcut-editor>>\n</$list>\n</$set>\n\\end\n\n\\define shortcut-item()\n<$set name=\"dropdownStateTitle\" value=<<qualify \"$:/state/dropdown/keyboardshortcut/$(shortcutName)$\">>>\n<<shortcut-item-inner>>\n</$set>\n\\end\n\n<table>\n<tbody>\n<$list filter=\"[all[shadows+tiddlers]removeprefix[$:/config/ShortcutInfo/]]\" variable=\"shortcutName\">\n<<shortcut-item>>\n</$list>\n</tbody>\n</table>\n"
},
"$:/core/ui/ControlPanel/LoadedModules": {
"title": "$:/core/ui/ControlPanel/LoadedModules",
"tags": "$:/tags/ControlPanel/Advanced",
"caption": "{{$:/language/ControlPanel/LoadedModules/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/\n<<lingo LoadedModules/Hint>>\n\n{{$:/snippets/modules}}\n"
},
"$:/core/ui/ControlPanel/Modals/AddPlugins": {
"title": "$:/core/ui/ControlPanel/Modals/AddPlugins",
"subtitle": "{{$:/core/images/download-button}} {{$:/language/ControlPanel/Plugins/Add/Caption}}",
"text": "\\define install-plugin-actions()\n<$action-sendmessage $message=\"tm-load-plugin-from-library\" url={{!!url}} title={{$(assetInfo)$!!original-title}}/>\n<$set name=\"url\" value={{!!url}}>\n<$set name=\"currentTiddler\" value=<<assetInfo>>>\n<$list filter=\"[enlist{!!dependents}] [{!!parent-plugin}] +[sort[title]]\" variable=\"dependency\">\n<$action-sendmessage $message=\"tm-load-plugin-from-library\" url=<<url>> title=<<dependency>>/>\n</$list>\n</$set>\n</$set>\n\\end\n\n\\define install-plugin-button()\n<div>\n<$set name=\"libraryVersion\" value={{{ [<assetInfo>get[version]] }}}>\n<$set name=\"installedVersion\" value={{{ [<assetInfo>get[original-title]get[version]] }}}>\n<$set name=\"reinstall-type\" value={{{ [<libraryVersion>compare:version:eq<installedVersion>then[tc-reinstall]] [<libraryVersion>compare:version:gt<installedVersion>then[tc-reinstall-upgrade]] [<libraryVersion>compare:version:lt<installedVersion>then[tc-reinstall-downgrade]] }}}>\n<$button actions=<<install-plugin-actions>> class={{{ [<assetInfo>get[original-title]has[version]then<reinstall-type>] tc-btn-invisible tc-install-plugin +[join[ ]] }}}>\n{{$:/core/images/download-button}}\n<$list filter=\"[<assetInfo>get[original-title]get[version]]\" variable=\"ignore\" emptyMessage=\"{{$:/language/ControlPanel/Plugins/Install/Caption}}\">\n<$list filter=\"[<libraryVersion>compare:version:gt<installedVersion>]\" variable=\"ignore\" emptyMessage=\"\"\"\n<$list filter=\"[<libraryVersion>compare:version:lt<installedVersion>]\" variable=\"ignore\" emptyMessage=\"{{$:/language/ControlPanel/Plugins/Reinstall/Caption}}\">\n{{$:/language/ControlPanel/Plugins/Downgrade/Caption}}\n</$list>\n\"\"\">\n{{$:/language/ControlPanel/Plugins/Update/Caption}}\n</$list>\n</$list>\n</$button>\n<div>\n</div>\n<$reveal stateTitle=<<assetInfo>> stateField=\"requires-reload\" type=\"match\" text=\"yes\">{{$:/language/ControlPanel/Plugins/PluginWillRequireReload}}</$reveal>\n</$set>\n</$set>\n</$set>\n</div>\n\\end\n\n\\define popup-state-macro()\n$:/state/add-plugin-info/$(connectionTiddler)$/$(assetInfo)$\n\\end\n\n\\define display-plugin-info(type)\n<$set name=\"popup-state\" value=<<popup-state-macro>>>\n<div class=\"tc-plugin-info\">\n<div class=\"tc-plugin-info-chunk tc-plugin-info-toggle\">\n<$reveal type=\"nomatch\" state=<<popup-state>> text=\"yes\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" set=<<popup-state>> setTo=\"yes\">\n{{$:/core/images/chevron-right}}\n</$button>\n</$reveal>\n<$reveal type=\"match\" state=<<popup-state>> text=\"yes\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" set=<<popup-state>> setTo=\"no\">\n{{$:/core/images/chevron-down}}\n</$button>\n</$reveal>\n</div>\n<div class=\"tc-plugin-info-chunk tc-plugin-info-icon\">\n<$list filter=\"[<assetInfo>has[icon]]\" emptyMessage=\"\"\"<$transclude tiddler=\"$:/core/images/plugin-generic-$type$\"/>\"\"\">\n<img src={{$(assetInfo)$!!icon}}/>\n</$list>\n</div>\n<div class=\"tc-plugin-info-chunk tc-plugin-info-description\">\n<h1><strong><$text text={{{ [<assetInfo>get[name]] ~[<assetInfo>get[original-title]split[/]last[1]] }}}/></strong>: <$view tiddler=<<assetInfo>> field=\"description\"/></h1>\n<h2><$view tiddler=<<assetInfo>> field=\"original-title\"/></h2>\n<div><em><$view tiddler=<<assetInfo>> field=\"version\"/></em></div>\n<$list filter=\"[<assetInfo>get[original-title]get[version]]\" variable=\"installedVersion\"><div><em>{{$:/language/ControlPanel/Plugins/AlreadyInstalled/Hint}}</em></div></$list>\n</div>\n<div class=\"tc-plugin-info-chunk tc-plugin-info-buttons\">\n<<install-plugin-button>>\n</div>\n</div>\n<$set name=\"original-title\" value={{{ [<assetInfo>get[original-title]] }}}>\n<$reveal type=\"match\" text=\"yes\" state=<<popup-state>>>\n<div class=\"tc-plugin-info-dropdown\">\n<$list filter=\"[enlist{!!dependents}] [<currentTiddler>get[parent-plugin]] +[limit[1]] ~[<assetInfo>get[original-title]!is[tiddler]]\" variable=\"ignore\">\n<div class=\"tc-plugin-info-dropdown-message\">\n<$list filter=\"[<assetInfo>get[original-title]!is[tiddler]]\">\n{{$:/language/ControlPanel/Plugins/NotInstalled/Hint}}\n</$list>\n<$set name=\"currentTiddler\" value=<<assetInfo>>>\n<$list filter=\"[enlist{!!dependents}] [<currentTiddler>get[parent-plugin]] +[limit[1]]\" variable=\"ignore\">\n<div>\n{{$:/language/ControlPanel/Plugins/AlsoRequires}}\n<$list filter=\"[enlist{!!dependents}] [{!!parent-plugin}] +[sort[title]]\" variable=\"dependency\">\n<$text text=<<dependency>>/>\n</$list>\n</div>\n</$list>\n</$set>\n</div>\n</$list>\n<div class=\"tc-plugin-info-dropdown-body\">\n<$transclude tiddler=<<assetInfo>> field=\"readme\" mode=\"block\"/>\n</div>\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[$type$]has[parent-plugin]parent-plugin<original-title>limit[1]]\" variable=\"ignore\">\n<div class=\"tc-plugin-info-sub-plugins\">\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[$type$]has[parent-plugin]parent-plugin<original-title>sort[title]]\" variable=\"assetInfo\">\n<<display-plugin-info \"$type$\">>\n</$list>\n</div>\n</$list>\n</div>\n</$reveal>\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[$type$]has[parent-plugin]parent-plugin<original-title>limit[1]]\" variable=\"ignore\">\n<$reveal type=\"nomatch\" text=\"yes\" state=<<popup-state>> tag=\"div\" class=\"tc-plugin-info-sub-plugin-indicator\">\n<$wikify name=\"count\" text=\"\"\"<$count filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[$type$]has[parent-plugin]parent-plugin<original-title>]\"/>\"\"\">\n<$button class=\"tc-btn-invisible\" set=<<popup-state>> setTo=\"yes\">\n{{$:/language/ControlPanel/Plugins/SubPluginPrompt}}\n</$button>\n</$wikify>\n</$reveal>\n</$list>\n</$set>\n</$set>\n\\end\n\n\\define load-plugin-library-button()\n<$button class=\"tc-btn-big-green\">\n<$action-sendmessage $message=\"tm-load-plugin-library\" url={{!!url}} infoTitlePrefix=\"$:/temp/RemoteAssetInfo/\"/>\n{{$:/core/images/chevron-right}} {{$:/language/ControlPanel/Plugins/OpenPluginLibrary}}\n</$button>\n\\end\n\n\\define display-server-assets(type)\n{{$:/language/Search/Search}}: <$edit-text tiddler=\"\"\"$:/temp/RemoteAssetSearch/$(currentTiddler)$\"\"\" default=\"\" type=\"search\" tag=\"input\"/>\n<$reveal state=\"\"\"$:/temp/RemoteAssetSearch/$(currentTiddler)$\"\"\" type=\"nomatch\" text=\"\">\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"\"\"$:/temp/RemoteAssetSearch/$(currentTiddler)$\"\"\" $field=\"text\" $value=\"\"/>\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n<div class=\"tc-plugin-library-listing\">\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[$type$]search:author,description,original-title,readme,title{$:/temp/RemoteAssetSearch/$(currentTiddler)$}sort[title]]\" variable=\"assetInfo\">\n<$list filter=\"[[$:/temp/RemoteAssetSearch/$(currentTiddler)$]has[text]] ~[<assetInfo>!has[parent-plugin]]\" variable=\"ignore\"><!-- Hide sub-plugins if we're not searching -->\n<<display-plugin-info \"$type$\">>\n</$list>\n</$list>\n</div>\n\\end\n\n\\define display-server-connection()\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/ServerConnection]suffix{!!url}]\" variable=\"connectionTiddler\" emptyMessage=<<load-plugin-library-button>>>\n\n<$set name=\"transclusion\" value=<<connectionTiddler>>>\n\n<<tabs \"[[$:/core/ui/ControlPanel/Plugins/Add/Updates]] [[$:/core/ui/ControlPanel/Plugins/Add/Plugins]] [[$:/core/ui/ControlPanel/Plugins/Add/Themes]] [[$:/core/ui/ControlPanel/Plugins/Add/Languages]]\" \"$:/core/ui/ControlPanel/Plugins/Add/Plugins\">>\n\n</$set>\n\n</$list>\n\\end\n\n\\define close-library-button()\n<$reveal type='nomatch' state='$:/temp/ServerConnection/$(PluginLibraryURL)$' text=''>\n<$button class='tc-btn-big-green'>\n<$action-sendmessage $message=\"tm-unload-plugin-library\" url={{!!url}}/>\n{{$:/core/images/chevron-left}} {{$:/language/ControlPanel/Plugins/ClosePluginLibrary}}\n<$action-deletetiddler $filter=\"[prefix[$:/temp/ServerConnection/$(PluginLibraryURL)$]][prefix[$:/temp/RemoteAssetInfo/$(PluginLibraryURL)$]]\"/>\n</$button>\n</$reveal>\n\\end\n\n\\define plugin-library-listing()\n<div class=\"tc-tab-set\">\n<$set name=\"defaultTab\" value={{{ [all[tiddlers+shadows]tag[$:/tags/PluginLibrary]] }}}>\n<div class=\"tc-tab-buttons\">\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/PluginLibrary]]\">\n<$button set=<<qualify \"$:/state/addplugins/tab\">> setTo=<<currentTiddler>> default=<<defaultTab>> selectedClass=\"tc-tab-selected\">\n<$set name=\"tv-wikilinks\" value=\"no\">\n<$transclude field=\"caption\"/>\n</$set>\n</$button>\n</$list>\n</div>\n<div class=\"tc-tab-divider\"/>\n<div class=\"tc-tab-content\">\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/PluginLibrary]]\">\n<$reveal type=\"match\" state=<<qualify \"$:/state/addplugins/tab\">> text=<<currentTiddler>> default=<<defaultTab>>>\n<h2><$link><$transclude field=\"caption\"><$view field=\"title\"/></$transclude></$link></h2>\n//<$view field=\"url\"/>//\n<$transclude mode=\"block\"/>\n<$set name=PluginLibraryURL value={{!!url}}>\n<<close-library-button>>\n</$set>\n<<display-server-connection>>\n</$reveal>\n</$list>\n</div>\n</$set>\n</div>\n\\end\n\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\n<div>\n<<plugin-library-listing>>\n</div>\n"
},
"$:/core/ui/ControlPanel/Palette": {
"title": "$:/core/ui/ControlPanel/Palette",
"tags": "$:/tags/ControlPanel/Appearance",
"caption": "{{$:/language/ControlPanel/Palette/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Palette/\n\n{{$:/snippets/paletteswitcher}}\n\n<$reveal type=\"nomatch\" state=\"$:/state/ShowPaletteEditor\" text=\"yes\">\n\n<$button set=\"$:/state/ShowPaletteEditor\" setTo=\"yes\"><<lingo ShowEditor/Caption>></$button>\n\n</$reveal>\n\n<$reveal type=\"match\" state=\"$:/state/ShowPaletteEditor\" text=\"yes\">\n\n<$button set=\"$:/state/ShowPaletteEditor\" setTo=\"no\"><<lingo HideEditor/Caption>></$button>\n{{$:/PaletteManager}}\n\n</$reveal>\n\n"
},
"$:/core/ui/ControlPanel/Parsing": {
"title": "$:/core/ui/ControlPanel/Parsing",
"tags": "$:/tags/ControlPanel/Advanced",
"caption": "{{$:/language/ControlPanel/Parsing/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Parsing/\n\n\\define toggle(Type)\n<$checkbox\ntiddler=\"\"\"$:/config/WikiParserRules/$Type$/$(rule)$\"\"\"\nfield=\"text\"\nchecked=\"enable\"\nunchecked=\"disable\"\ndefault=\"enable\">\n<<rule>>\n</$checkbox>\n\\end\n\n\\define rules(type,Type)\n<$list filter=\"[wikiparserrules[$type$]]\" variable=\"rule\">\n<dd><<toggle $Type$>></dd>\n</$list>\n\\end\n\n<<lingo Hint>>\n\n<dl>\n<dt><<lingo Pragma/Caption>></dt>\n<<rules pragma Pragma>>\n<dt><<lingo Inline/Caption>></dt>\n<<rules inline Inline>>\n<dt><<lingo Block/Caption>></dt>\n<<rules block Block>>\n</dl>"
},
"$:/core/ui/ControlPanel/Plugins/Add/Languages": {
"title": "$:/core/ui/ControlPanel/Plugins/Add/Languages",
"caption": "{{$:/language/ControlPanel/Plugins/Languages/Caption}} (<$count filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[language]]\"/>)",
"text": "<<display-server-assets language>>\n"
},
"$:/core/ui/ControlPanel/Plugins/Add/Plugins": {
"title": "$:/core/ui/ControlPanel/Plugins/Add/Plugins",
"caption": "{{$:/language/ControlPanel/Plugins/Plugins/Caption}} (<$count filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[plugin]]\"/>)",
"text": "<<display-server-assets plugin>>\n"
},
"$:/core/ui/ControlPanel/Plugins/Add/Themes": {
"title": "$:/core/ui/ControlPanel/Plugins/Add/Themes",
"caption": "{{$:/language/ControlPanel/Plugins/Themes/Caption}} (<$count filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}original-plugin-type[theme]]\"/>)",
"text": "<<display-server-assets theme>>\n"
},
"$:/core/ui/ControlPanel/Plugins/Add/Updates": {
"title": "$:/core/ui/ControlPanel/Plugins/Add/Updates",
"caption": "<$importvariables filter=\"$:/core/ui/ControlPanel/Plugins/Add/Updates\">{{$:/language/ControlPanel/Plugins/Updates/Caption}} (<<update-count>>)</$importvariables>",
"text": "\\define each-updateable-plugin(body)\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/RemoteAssetInfo]server-url{!!url}sort[title]]\" variable=\"assetInfo\">\n<$set name=\"libraryVersion\" value={{{ [<assetInfo>get[version]] }}}>\n<$list filter=\"[<assetInfo>get[original-title]has[version]!version<libraryVersion>]\" variable=\"ignore\">\n<$set name=\"installedVersion\" value={{{ [<assetInfo>get[original-title]get[version]] }}}>\n<$list filter=\"[<installedversion>!match<libraryVersion>]\" variable=\"ignore\">\n$body$\n</$list>\n</$set>\n</$list>\n</$set>\n</$list>\n\\end\n\n\\define update-all-actions()\n<$macrocall $name=\"each-updateable-plugin\" body=\"\"\"\n<<install-plugin-actions>>\n\"\"\"/>\n\\end\n\n\\define update-count()\n<$wikify name=\"count-filter\" text=<<each-updateable-plugin \"[[<$text text=<<assetInfo>>/>]]\">>><$count filter=<<count-filter>>/></$wikify>\n\\end\n\n<$button actions=<<update-all-actions>> class=\"tc-btn-invisible tc-install-plugin tc-reinstall-upgrade\">\n{{$:/core/images/download-button}} {{||$:/language/ControlPanel/Plugins/Updates/UpdateAll/Caption}}\n</$button>\n\n<div class=\"tc-plugin-library-listing\">\n<$macrocall $name=\"each-updateable-plugin\" body=\"\"\"\n<$macrocall $name=\"display-plugin-info\" type={{{ [<assetInfo>get[original-plugin-type]] }}}/>\n\"\"\"/>\n</div>\n"
},
"$:/core/ui/ControlPanel/Plugins/AddPlugins": {
"title": "$:/core/ui/ControlPanel/Plugins/AddPlugins",
"text": "\\define lingo-base() $:/language/ControlPanel/Plugins/\n\n<$button message=\"tm-modal\" param=\"$:/core/ui/ControlPanel/Modals/AddPlugins\" tooltip={{$:/language/ControlPanel/Plugins/Add/Hint}} class=\"tc-btn-big-green tc-primary-btn\">\n{{$:/core/images/download-button}} <<lingo Add/Caption>>\n</$button>\n"
},
"$:/core/ui/ControlPanel/Plugins/Installed/Languages": {
"title": "$:/core/ui/ControlPanel/Plugins/Installed/Languages",
"caption": "{{$:/language/ControlPanel/Plugins/Languages/Caption}} (<$count filter=\"[!has[draft.of]plugin-type[language]]\"/>)",
"text": "<<plugin-table language>>\n"
},
"$:/core/ui/ControlPanel/Plugins/Installed/Plugins": {
"title": "$:/core/ui/ControlPanel/Plugins/Installed/Plugins",
"caption": "{{$:/language/ControlPanel/Plugins/Plugins/Caption}} (<$count filter=\"[!has[draft.of]plugin-type[plugin]]\"/>)",
"text": "<<plugin-table plugin>>\n"
},
"$:/core/ui/ControlPanel/Plugins/Installed/Themes": {
"title": "$:/core/ui/ControlPanel/Plugins/Installed/Themes",
"caption": "{{$:/language/ControlPanel/Plugins/Themes/Caption}} (<$count filter=\"[!has[draft.of]plugin-type[theme]]\"/>)",
"text": "<<plugin-table theme>>\n"
},
"$:/core/ui/ControlPanel/Plugins": {
"title": "$:/core/ui/ControlPanel/Plugins",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/Plugins/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Plugins/\n\n\\define plugin-table(type)\n<$set name=\"plugin-type\" value=\"\"\"$type$\"\"\">\n<$set name=\"qualified-state\" value=<<qualify \"$:/state/plugin-info\">>>\n<$list filter=\"[!has[draft.of]plugin-type[$type$]sort[title]]\" emptyMessage=<<lingo \"Empty/Hint\">> template=\"$:/core/ui/Components/plugin-info\"/>\n</$set>\n</$set>\n\\end\n\n{{$:/core/ui/ControlPanel/Plugins/AddPlugins}}\n\n<<lingo Installed/Hint>>\n\n<<tabs \"[[$:/core/ui/ControlPanel/Plugins/Installed/Plugins]] [[$:/core/ui/ControlPanel/Plugins/Installed/Themes]] [[$:/core/ui/ControlPanel/Plugins/Installed/Languages]]\" \"$:/core/ui/ControlPanel/Plugins/Installed/Plugins\">>\n"
},
"$:/core/ui/ControlPanel/Saving/DownloadSaver": {
"title": "$:/core/ui/ControlPanel/Saving/DownloadSaver",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/DownloadSaver/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Saving/DownloadSaver/\n\n<<lingo Hint>>\n\n!! <$link to=\"$:/config/DownloadSaver/AutoSave\"><<lingo AutoSave/Hint>></$link>\n\n<$checkbox tiddler=\"$:/config/DownloadSaver/AutoSave\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> <<lingo AutoSave/Description>> </$checkbox>\n"
},
"$:/core/ui/ControlPanel/Saving/General": {
"title": "$:/core/ui/ControlPanel/Saving/General",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/General/Caption}}",
"list-before": "",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/\n\n{{$:/language/ControlPanel/Saving/General/Hint}}\n\n!! <$link to=\"$:/config/AutoSave\"><<lingo AutoSave/Caption>></$link>\n\n<<lingo AutoSave/Hint>>\n\n<$radio tiddler=\"$:/config/AutoSave\" value=\"yes\"> <<lingo AutoSave/Enabled/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/AutoSave\" value=\"no\"> <<lingo AutoSave/Disabled/Description>> </$radio>\n"
},
"$:/core/ui/ControlPanel/Saving/GitHub": {
"title": "$:/core/ui/ControlPanel/Saving/GitHub",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/GitService/GitHub/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Saving/GitService/\n\\define service-name() ~GitHub\n\n<<lingo Description>>\n\n|<<lingo UserName>> |<$edit-text tiddler=\"$:/GitHub/Username\" default=\"\" tag=\"input\"/> |\n|<<lingo GitHub/Password>> |<$password name=\"github\"/> |\n|<<lingo Repo>> |<$edit-text tiddler=\"$:/GitHub/Repo\" default=\"\" tag=\"input\"/> |\n|<<lingo Branch>> |<$edit-text tiddler=\"$:/GitHub/Branch\" default=\"master\" tag=\"input\"/> |\n|<<lingo Path>> |<$edit-text tiddler=\"$:/GitHub/Path\" default=\"\" tag=\"input\"/> |\n|<<lingo Filename>> |<$edit-text tiddler=\"$:/GitHub/Filename\" default=\"\" tag=\"input\"/> |\n|<<lingo ServerURL>> |<$edit-text tiddler=\"$:/GitHub/ServerURL\" default=\"https://api.github.com\" tag=\"input\"/> |"
},
"$:/core/ui/ControlPanel/Saving/GitLab": {
"title": "$:/core/ui/ControlPanel/Saving/GitLab",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/GitService/GitLab/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Saving/GitService/\n\\define service-name() ~GitLab\n\n<<lingo Description>>\n\n|<<lingo UserName>> |<$edit-text tiddler=\"$:/GitLab/Username\" default=\"\" tag=\"input\"/> |\n|<<lingo GitLab/Password>> |<$password name=\"gitlab\"/> |\n|<<lingo Repo>> |<$edit-text tiddler=\"$:/GitLab/Repo\" default=\"\" tag=\"input\"/> |\n|<<lingo Branch>> |<$edit-text tiddler=\"$:/GitLab/Branch\" default=\"master\" tag=\"input\"/> |\n|<<lingo Path>> |<$edit-text tiddler=\"$:/GitLab/Path\" default=\"\" tag=\"input\"/> |\n|<<lingo Filename>> |<$edit-text tiddler=\"$:/GitLab/Filename\" default=\"\" tag=\"input\"/> |\n|<<lingo ServerURL>> |<$edit-text tiddler=\"$:/GitLab/ServerURL\" default=\"https://gitlab.com/api/v4\" tag=\"input\"/> |"
},
"$:/core/ui/ControlPanel/Saving/TiddlySpot": {
"title": "$:/core/ui/ControlPanel/Saving/TiddlySpot",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/TiddlySpot/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Saving/TiddlySpot/\n\n\\define backupURL()\nhttp://$(userName)$.tiddlyspot.com/backup/\n\\end\n\\define backupLink()\n<$reveal type=\"nomatch\" state=\"$:/UploadName\" text=\"\">\n<$set name=\"userName\" value={{$:/UploadName}}>\n<$reveal type=\"match\" state=\"$:/UploadURL\" text=\"\">\n<<backupURL>>\n</$reveal>\n<$reveal type=\"nomatch\" state=\"$:/UploadURL\" text=\"\">\n<$macrocall $name=resolvePath source={{$:/UploadBackupDir}} root={{$:/UploadURL}}>>\n</$reveal>\n</$set>\n</$reveal>\n\\end\n\n<<lingo Description>>\n\n|<<lingo UserName>> |<$edit-text tiddler=\"$:/UploadName\" default=\"\" tag=\"input\"/> |\n|<<lingo Password>> |<$password name=\"upload\"/> |\n|<<lingo Backups>> |<<backupLink>> |\n\n''<<lingo Advanced/Heading>>''\n\n|<<lingo ServerURL>> |<$edit-text tiddler=\"$:/UploadURL\" default=\"\" tag=\"input\"/> |\n|<<lingo Filename>> |<$edit-text tiddler=\"$:/UploadFilename\" default=\"index.html\" tag=\"input\"/> |\n|<<lingo UploadDir>> |<$edit-text tiddler=\"$:/UploadDir\" default=\".\" tag=\"input\"/> |\n|<<lingo BackupDir>> |<$edit-text tiddler=\"$:/UploadBackupDir\" default=\".\" tag=\"input\"/> |\n\n<<lingo TiddlySpot/Hint>>"
},
"$:/core/ui/ControlPanel/Saving/Gitea": {
"title": "$:/core/ui/ControlPanel/Saving/Gitea",
"tags": "$:/tags/ControlPanel/Saving",
"caption": "{{$:/language/ControlPanel/Saving/GitService/Gitea/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Saving/GitService/\n\\define service-name() ~Gitea\n\n<<lingo Description>>\n\n|<<lingo UserName>> |<$edit-text tiddler=\"$:/Gitea/Username\" default=\"\" tag=\"input\"/> |\n|<<lingo Gitea/Password>> |<$password name=\"Gitea\"/> |\n|<<lingo Repo>> |<$edit-text tiddler=\"$:/Gitea/Repo\" default=\"\" tag=\"input\"/> |\n|<<lingo Branch>> |<$edit-text tiddler=\"$:/Gitea/Branch\" default=\"master\" tag=\"input\"/> |\n|<<lingo Path>> |<$edit-text tiddler=\"$:/Gitea/Path\" default=\"\" tag=\"input\"/> |\n|<<lingo Filename>> |<$edit-text tiddler=\"$:/Gitea/Filename\" default=\"\" tag=\"input\"/> |\n|<<lingo ServerURL>> |<$edit-text tiddler=\"$:/Gitea/ServerURL\" default=\"https://gitea/api/v1\" tag=\"input\"/> |\n"
},
"$:/core/ui/ControlPanel/Saving": {
"title": "$:/core/ui/ControlPanel/Saving",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/Saving/Caption}}",
"text": "{{$:/language/ControlPanel/Saving/Hint}}\n\n<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Saving]!has[draft.of]]\" \"$:/core/ui/ControlPanel/Saving/General\">>\n</div>\n"
},
"$:/core/buttonstyles/Borderless": {
"title": "$:/core/buttonstyles/Borderless",
"tags": "$:/tags/ToolbarButtonStyle",
"caption": "{{$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Borderless}}",
"text": "tc-btn-invisible"
},
"$:/core/buttonstyles/Boxed": {
"title": "$:/core/buttonstyles/Boxed",
"tags": "$:/tags/ToolbarButtonStyle",
"caption": "{{$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Boxed}}",
"text": "tc-btn-boxed"
},
"$:/core/buttonstyles/Rounded": {
"title": "$:/core/buttonstyles/Rounded",
"tags": "$:/tags/ToolbarButtonStyle",
"caption": "{{$:/language/ControlPanel/Settings/ToolbarButtonStyle/Styles/Rounded}}",
"text": "tc-btn-rounded"
},
"$:/core/ui/ControlPanel/Settings/CamelCase": {
"title": "$:/core/ui/ControlPanel/Settings/CamelCase",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/CamelCase/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/CamelCase/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/WikiParserRules/Inline/wikilink\" field=\"text\" checked=\"enable\" unchecked=\"disable\" default=\"enable\"> <$link to=\"$:/config/WikiParserRules/Inline/wikilink\"><<lingo Description>></$link> </$checkbox>\n"
},
"$:/core/ui/ControlPanel/Settings/DefaultMoreSidebarTab": {
"title": "$:/core/ui/ControlPanel/Settings/DefaultMoreSidebarTab",
"caption": "{{$:/language/ControlPanel/Settings/DefaultMoreSidebarTab/Caption}}",
"tags": "$:/tags/ControlPanel/Settings",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/DefaultMoreSidebarTab/\n\n<$link to=\"$:/config/DefaultMoreSidebarTab\"><<lingo Hint>></$link>\n\n<$select tiddler=\"$:/config/DefaultMoreSidebarTab\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/MoreSideBar]!has[draft.of]]\">\n<option value=<<currentTiddler>>><$transclude field=\"caption\"><$text text=<<currentTiddler>>/></$transclude></option>\n</$list>\n</$select>\n"
},
"$:/core/ui/ControlPanel/Settings/DefaultSidebarTab": {
"title": "$:/core/ui/ControlPanel/Settings/DefaultSidebarTab",
"caption": "{{$:/language/ControlPanel/Settings/DefaultSidebarTab/Caption}}",
"tags": "$:/tags/ControlPanel/Settings",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/DefaultSidebarTab/\n\n<$link to=\"$:/config/DefaultSidebarTab\"><<lingo Hint>></$link>\n\n<$select tiddler=\"$:/config/DefaultSidebarTab\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SideBar]!has[draft.of]]\">\n<option value=<<currentTiddler>>><$transclude field=\"caption\"><$text text=<<currentTiddler>>/></$transclude></option>\n</$list>\n</$select>\n"
},
"$:/core/ui/ControlPanel/Settings/EditorToolbar": {
"title": "$:/core/ui/ControlPanel/Settings/EditorToolbar",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/EditorToolbar/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/EditorToolbar/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/TextEditor/EnableToolbar\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> <$link to=\"$:/config/TextEditor/EnableToolbar\"><<lingo Description>></$link> </$checkbox>\n\n"
},
"$:/core/ui/ControlPanel/Settings/InfoPanelMode": {
"title": "$:/core/ui/ControlPanel/Settings/InfoPanelMode",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/InfoPanelMode/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/InfoPanelMode/\n<$link to=\"$:/config/TiddlerInfo/Mode\"><<lingo Hint>></$link>\n\n<$radio tiddler=\"$:/config/TiddlerInfo/Mode\" value=\"popup\"> <<lingo Popup/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/TiddlerInfo/Mode\" value=\"sticky\"> <<lingo Sticky/Description>> </$radio>\n"
},
"$:/core/ui/ControlPanel/Settings/LinkToBehaviour": {
"title": "$:/core/ui/ControlPanel/Settings/LinkToBehaviour",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/LinkToBehaviour/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/LinkToBehaviour/\n\n<$link to=\"$:/config/Navigation/openLinkFromInsideRiver\"><<lingo \"InsideRiver/Hint\">></$link>\n\n<$select tiddler=\"$:/config/Navigation/openLinkFromInsideRiver\">\n <option value=\"above\"><<lingo \"OpenAbove\">></option>\n <option value=\"below\"><<lingo \"OpenBelow\">></option>\n <option value=\"top\"><<lingo \"OpenAtTop\">></option>\n <option value=\"bottom\"><<lingo \"OpenAtBottom\">></option>\n</$select>\n\n<$link to=\"$:/config/Navigation/openLinkFromOutsideRiver\"><<lingo \"OutsideRiver/Hint\">></$link>\n\n<$select tiddler=\"$:/config/Navigation/openLinkFromOutsideRiver\">\n <option value=\"top\"><<lingo \"OpenAtTop\">></option>\n <option value=\"bottom\"><<lingo \"OpenAtBottom\">></option>\n</$select>\n"
},
"$:/core/ui/ControlPanel/Settings/MissingLinks": {
"title": "$:/core/ui/ControlPanel/Settings/MissingLinks",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/MissingLinks/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/MissingLinks/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/MissingLinks\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> <$link to=\"$:/config/MissingLinks\"><<lingo Description>></$link> </$checkbox>\n\n"
},
"$:/core/ui/ControlPanel/Settings/NavigationAddressBar": {
"title": "$:/core/ui/ControlPanel/Settings/NavigationAddressBar",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/NavigationAddressBar/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/NavigationAddressBar/\n\n<$link to=\"$:/config/Navigation/UpdateAddressBar\"><<lingo Hint>></$link>\n\n<$radio tiddler=\"$:/config/Navigation/UpdateAddressBar\" value=\"permaview\"> <<lingo Permaview/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/Navigation/UpdateAddressBar\" value=\"permalink\"> <<lingo Permalink/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/Navigation/UpdateAddressBar\" value=\"no\"> <<lingo No/Description>> </$radio>\n"
},
"$:/core/ui/ControlPanel/Settings/NavigationHistory": {
"title": "$:/core/ui/ControlPanel/Settings/NavigationHistory",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/NavigationHistory/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/NavigationHistory/\n<$link to=\"$:/config/Navigation/UpdateHistory\"><<lingo Hint>></$link>\n\n<$radio tiddler=\"$:/config/Navigation/UpdateHistory\" value=\"yes\"> <<lingo Yes/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/Navigation/UpdateHistory\" value=\"no\"> <<lingo No/Description>> </$radio>\n"
},
"$:/core/ui/ControlPanel/Settings/NavigationPermalinkviewMode": {
"title": "$:/core/ui/ControlPanel/Settings/NavigationPermalinkviewMode",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/NavigationPermalinkviewMode/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/NavigationPermalinkviewMode/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/Navigation/Permalinkview/CopyToClipboard\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> <$link to=\"$:/config/Navigation/Permalinkview/CopyToClipboard\"><<lingo CopyToClipboard/Description>></$link> </$checkbox>\n\n<$checkbox tiddler=\"$:/config/Navigation/Permalinkview/UpdateAddressBar\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> <$link to=\"$:/config/Navigation/Permalinkview/UpdateAddressBar\"><<lingo UpdateAddressBar/Description>></$link> </$checkbox>\n"
},
"$:/core/ui/ControlPanel/Settings/PerformanceInstrumentation": {
"title": "$:/core/ui/ControlPanel/Settings/PerformanceInstrumentation",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/PerformanceInstrumentation/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/PerformanceInstrumentation/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/Performance/Instrumentation\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> <$link to=\"$:/config/Performance/Instrumentation\"><<lingo Description>></$link> </$checkbox>\n"
},
"$:/core/ui/ControlPanel/Settings/TitleLinks": {
"title": "$:/core/ui/ControlPanel/Settings/TitleLinks",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/TitleLinks/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/TitleLinks/\n<$link to=\"$:/config/Tiddlers/TitleLinks\"><<lingo Hint>></$link>\n\n<$radio tiddler=\"$:/config/Tiddlers/TitleLinks\" value=\"yes\"> <<lingo Yes/Description>> </$radio>\n\n<$radio tiddler=\"$:/config/Tiddlers/TitleLinks\" value=\"no\"> <<lingo No/Description>> </$radio>\n"
},
"$:/core/ui/ControlPanel/Settings/ToolbarButtonStyle": {
"title": "$:/core/ui/ControlPanel/Settings/ToolbarButtonStyle",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/ToolbarButtonStyle/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/ToolbarButtonStyle/\n<$link to=\"$:/config/Toolbar/ButtonClass\"><<lingo \"Hint\">></$link>\n\n<$select tiddler=\"$:/config/Toolbar/ButtonClass\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ToolbarButtonStyle]]\">\n<option value={{!!text}}>{{!!caption}}</option>\n</$list>\n</$select>\n"
},
"$:/core/ui/ControlPanel/Settings/ToolbarButtons": {
"title": "$:/core/ui/ControlPanel/Settings/ToolbarButtons",
"tags": "$:/tags/ControlPanel/Settings",
"caption": "{{$:/language/ControlPanel/Settings/ToolbarButtons/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/ToolbarButtons/\n<<lingo Hint>>\n\n<$checkbox tiddler=\"$:/config/Toolbar/Icons\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> <$link to=\"$:/config/Toolbar/Icons\"><<lingo Icons/Description>></$link> </$checkbox>\n\n<$checkbox tiddler=\"$:/config/Toolbar/Text\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> <$link to=\"$:/config/Toolbar/Text\"><<lingo Text/Description>></$link> </$checkbox>\n"
},
"$:/core/ui/ControlPanel/Settings": {
"title": "$:/core/ui/ControlPanel/Settings",
"tags": "$:/tags/ControlPanel",
"caption": "{{$:/language/ControlPanel/Settings/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/Settings/\n\n<<lingo Hint>>\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Settings]]\">\n\n<div style=\"border-top:1px solid #eee;\">\n\n!! <$link><$transclude field=\"caption\"/></$link>\n\n<$transclude/>\n\n</div>\n\n</$list>\n"
},
"$:/core/ui/ControlPanel/StoryView": {
"title": "$:/core/ui/ControlPanel/StoryView",
"tags": "$:/tags/ControlPanel/Appearance",
"caption": "{{$:/language/ControlPanel/StoryView/Caption}}",
"text": "{{$:/snippets/viewswitcher}}\n"
},
"$:/core/ui/ControlPanel/Stylesheets": {
"title": "$:/core/ui/ControlPanel/Stylesheets",
"tags": "$:/tags/ControlPanel/Advanced",
"caption": "{{$:/language/ControlPanel/Stylesheets/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/\n\n<<lingo Stylesheets/Hint>>\n\n{{$:/snippets/peek-stylesheets}}\n"
},
"$:/core/ui/ControlPanel/Theme": {
"title": "$:/core/ui/ControlPanel/Theme",
"tags": "$:/tags/ControlPanel/Appearance",
"caption": "{{$:/language/ControlPanel/Theme/Caption}}",
"text": "{{$:/snippets/themeswitcher}}\n"
},
"$:/core/ui/ControlPanel/TiddlerFields": {
"title": "$:/core/ui/ControlPanel/TiddlerFields",
"tags": "$:/tags/ControlPanel/Advanced",
"caption": "{{$:/language/ControlPanel/TiddlerFields/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/\n\n<<lingo TiddlerFields/Hint>>\n\n{{$:/snippets/allfields}}"
},
"$:/core/ui/ControlPanel/Toolbars/EditToolbar": {
"title": "$:/core/ui/ControlPanel/Toolbars/EditToolbar",
"tags": "$:/tags/ControlPanel/Toolbars",
"caption": "{{$:/language/ControlPanel/Toolbars/EditToolbar/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n\n\\define config-base() $:/config/EditToolbarButtons/Visibility/\n\n{{$:/language/ControlPanel/Toolbars/EditToolbar/Hint}}\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$macrocall $name=\"list-tagged-draggable\" tag=\"$:/tags/EditToolbar\" itemTemplate=\"$:/core/ui/ControlPanel/Toolbars/ItemTemplate\"/>\n\n</$set>\n\n</$set>"
},
"$:/core/ui/ControlPanel/Toolbars/EditorItemTemplate": {
"title": "$:/core/ui/ControlPanel/Toolbars/EditorItemTemplate",
"text": "\\define config-title()\n$(config-base)$$(currentTiddler)$\n\\end\n\n<$draggable tiddler=<<currentTiddler>>>\n<$checkbox tiddler=<<config-title>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\"/> <span class=\"tc-icon-wrapper\"><$transclude tiddler={{!!icon}}/></span> <$transclude field=\"caption\"/> -- <i class=\"tc-muted\"><$transclude field=\"description\"/></i>\n</$draggable>\n"
},
"$:/core/ui/ControlPanel/Toolbars/EditorToolbar": {
"title": "$:/core/ui/ControlPanel/Toolbars/EditorToolbar",
"tags": "$:/tags/ControlPanel/Toolbars",
"caption": "{{$:/language/ControlPanel/Toolbars/EditorToolbar/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n\n\\define config-base() $:/config/EditorToolbarButtons/Visibility/\n\n{{$:/language/ControlPanel/Toolbars/EditorToolbar/Hint}}\n\n<$macrocall $name=\"list-tagged-draggable\" tag=\"$:/tags/EditorToolbar\" itemTemplate=\"$:/core/ui/ControlPanel/Toolbars/EditorItemTemplate\"/>\n"
},
"$:/core/ui/ControlPanel/Toolbars/ItemTemplate": {
"title": "$:/core/ui/ControlPanel/Toolbars/ItemTemplate",
"text": "\\define config-title()\n$(config-base)$$(currentTiddler)$\n\\end\n\n<$draggable tiddler=<<currentTiddler>>>\n<$checkbox tiddler=<<config-title>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\"/> <span class=\"tc-icon-wrapper\"> <$transclude field=\"caption\"/> <i class=\"tc-muted\">-- <$transclude field=\"description\"/></i></span>\n</$draggable>\n"
},
"$:/core/ui/ControlPanel/Toolbars/PageControls": {
"title": "$:/core/ui/ControlPanel/Toolbars/PageControls",
"tags": "$:/tags/ControlPanel/Toolbars",
"caption": "{{$:/language/ControlPanel/Toolbars/PageControls/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n\n\\define config-base() $:/config/PageControlButtons/Visibility/\n\n{{$:/language/ControlPanel/Toolbars/PageControls/Hint}}\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$macrocall $name=\"list-tagged-draggable\" tag=\"$:/tags/PageControls\" itemTemplate=\"$:/core/ui/ControlPanel/Toolbars/ItemTemplate\"/>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/ControlPanel/Toolbars/ViewToolbar": {
"title": "$:/core/ui/ControlPanel/Toolbars/ViewToolbar",
"tags": "$:/tags/ControlPanel/Toolbars",
"caption": "{{$:/language/ControlPanel/Toolbars/ViewToolbar/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n\n\\define config-base() $:/config/ViewToolbarButtons/Visibility/\n\n{{$:/language/ControlPanel/Toolbars/ViewToolbar/Hint}}\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$macrocall $name=\"list-tagged-draggable\" tag=\"$:/tags/ViewToolbar\" itemTemplate=\"$:/core/ui/ControlPanel/Toolbars/ItemTemplate\"/>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/ControlPanel/Toolbars": {
"title": "$:/core/ui/ControlPanel/Toolbars",
"tags": "$:/tags/ControlPanel/Appearance",
"caption": "{{$:/language/ControlPanel/Toolbars/Caption}}",
"text": "{{$:/language/ControlPanel/Toolbars/Hint}}\n\n<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel/Toolbars]!has[draft.of]]\" \"$:/core/ui/ControlPanel/Toolbars/ViewToolbar\" \"$:/state/tabs/controlpanel/toolbars\" \"tc-vertical\">>\n</div>\n"
},
"$:/ControlPanel": {
"title": "$:/ControlPanel",
"icon": "$:/core/images/options-button",
"color": "#bbb",
"text": "<div class=\"tc-control-panel\">\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/ControlPanel]!has[draft.of]]\" \"$:/core/ui/ControlPanel/Info\">>\n</div>\n"
},
"$:/core/ui/DefaultSearchResultList": {
"title": "$:/core/ui/DefaultSearchResultList",
"tags": "$:/tags/SearchResults",
"caption": "{{$:/language/Search/DefaultResults/Caption}}",
"text": "\\define searchResultList()\n//<small>{{$:/language/Search/Matches/Title}}</small>//\n\n<$list filter=\"[!is[system]search:title{$(searchTiddler)$}sort[title]limit[250]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n\n//<small>{{$:/language/Search/Matches/All}}</small>//\n\n<$list filter=\"[!is[system]search{$(searchTiddler)$}sort[title]limit[250]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n\n\\end\n<<searchResultList>>\n"
},
"$:/core/ui/EditTemplate/body/preview/diffs-current": {
"title": "$:/core/ui/EditTemplate/body/preview/diffs-current",
"tags": "$:/tags/EditPreview",
"caption": "differences from current",
"list-after": "$:/core/ui/EditTemplate/body/preview/output",
"text": "<$list filter=\"[<currentTiddler>!is[image]]\" emptyMessage={{$:/core/ui/EditTemplate/body/preview/output}}>\n\n<$macrocall $name=\"compareTiddlerText\" sourceTiddlerTitle={{!!draft.of}} destTiddlerTitle=<<currentTiddler>>/>\n\n</$list>\n\n"
},
"$:/core/ui/EditTemplate/body/preview/diffs-shadow": {
"title": "$:/core/ui/EditTemplate/body/preview/diffs-shadow",
"tags": "$:/tags/EditPreview",
"caption": "differences from shadow (if any)",
"list-after": "$:/core/ui/EditTemplate/body/preview/output",
"text": "<$list filter=\"[<currentTiddler>!is[image]]\" emptyMessage={{$:/core/ui/EditTemplate/body/preview/output}}>\n\n<$macrocall $name=\"compareTiddlerText\" sourceTiddlerTitle={{{ [{!!draft.of}shadowsource[]] }}} sourceSubTiddlerTitle={{!!draft.of}} destTiddlerTitle=<<currentTiddler>>/>\n\n</$list>\n\n"
},
"$:/core/ui/EditTemplate/body/preview/output": {
"title": "$:/core/ui/EditTemplate/body/preview/output",
"tags": "$:/tags/EditPreview",
"caption": "{{$:/language/EditTemplate/Body/Preview/Type/Output}}",
"text": "\\import [all[shadows+tiddlers]tag[$:/tags/Macro/View]!has[draft.of]]\n<$set name=\"tv-tiddler-preview\" value=\"yes\">\n\n<$transclude />\n\n</$set>\n"
},
"$:/state/showeditpreview": {
"title": "$:/state/showeditpreview",
"text": "no"
},
"$:/core/ui/EditTemplate/body/editor": {
"title": "$:/core/ui/EditTemplate/body/editor",
"text": "<$edit\n\n field=\"text\"\n class=\"tc-edit-texteditor tc-edit-texteditor-body\"\n placeholder={{$:/language/EditTemplate/Body/Placeholder}}\n tabindex={{$:/config/EditTabIndex}}\n focus={{{ [{$:/config/AutoFocus}match[text]then[true]] ~[[false]] }}}\n\n><$set\n\n name=\"targetTiddler\"\n value=<<currentTiddler>>\n\n><$list\n\n filter=\"[all[shadows+tiddlers]tag[$:/tags/EditorToolbar]!has[draft.of]]\"\n\n><$reveal\n\n type=\"nomatch\"\n state=<<config-visibility-title>>\n text=\"hide\"\n class=\"tc-text-editor-toolbar-item-wrapper\"\n\n><$transclude\n\n tiddler=\"$:/core/ui/EditTemplate/body/toolbar/button\"\n mode=\"inline\"\n\n/></$reveal></$list></$set></$edit>\n"
},
"$:/core/ui/EditTemplate/body/toolbar/button": {
"title": "$:/core/ui/EditTemplate/body/toolbar/button",
"text": "\\define toolbar-button-icon()\n<$list\n\n filter=\"[all[current]!has[custom-icon]]\"\n variable=\"no-custom-icon\"\n\n><$transclude\n\n tiddler={{!!icon}}\n\n/></$list>\n\\end\n\n\\define toolbar-button-tooltip()\n{{!!description}}<$macrocall $name=\"displayshortcuts\" $output=\"text/plain\" shortcuts={{!!shortcuts}} prefix=\"` - [\" separator=\"] [\" suffix=\"]`\"/>\n\\end\n\n\\define toolbar-button()\n<$list\n\n filter={{!!condition}}\n variable=\"list-condition\"\n\n><$wikify\n\n name=\"tooltip-text\"\n text=<<toolbar-button-tooltip>>\n mode=\"inline\"\n output=\"text\"\n\n><$list\n\n filter=\"[all[current]!has[dropdown]]\"\n variable=\"no-dropdown\"\n\n><$button\n\n class=\"tc-btn-invisible $(buttonClasses)$\"\n tooltip=<<tooltip-text>>\n actions={{!!actions}}\n\n><span\n\n data-tw-keyboard-shortcut={{!!shortcuts}}\n\n/><<toolbar-button-icon>><$transclude\n\n tiddler=<<currentTiddler>>\n field=\"text\"\n\n/></$button></$list><$list\n\n filter=\"[all[current]has[dropdown]]\"\n variable=\"dropdown\"\n\n><$set\n\n name=\"dropdown-state\"\n value=<<qualify \"$:/state/EditorToolbarDropdown\">>\n\n><$button\n\n popup=<<dropdown-state>>\n class=\"tc-popup-keep tc-btn-invisible $(buttonClasses)$\"\n selectedClass=\"tc-selected\"\n tooltip=<<tooltip-text>>\n actions={{!!actions}}\n\n><span\n\n data-tw-keyboard-shortcut={{!!shortcuts}}\n\n/><<toolbar-button-icon>><$transclude\n\n tiddler=<<currentTiddler>>\n field=\"text\"\n\n/></$button><$reveal\n\n state=<<dropdown-state>>\n type=\"popup\"\n position=\"below\"\n animate=\"yes\"\n tag=\"span\"\n\n><div\n\n class=\"tc-drop-down tc-popup-keep\"\n\n><$transclude\n\n tiddler={{!!dropdown}}\n mode=\"block\"\n\n/></div></$reveal></$set></$list></$wikify></$list>\n\\end\n\n\\define toolbar-button-outer()\n<$set\n\n name=\"buttonClasses\"\n value={{!!button-classes}}\n\n><<toolbar-button>></$set>\n\\end\n\n<<toolbar-button-outer>>"
},
"$:/core/ui/EditTemplate/body": {
"title": "$:/core/ui/EditTemplate/body",
"tags": "$:/tags/EditTemplate",
"text": "\\define lingo-base() $:/language/EditTemplate/Body/\n\\define config-visibility-title()\n$:/config/EditorToolbarButtons/Visibility/$(currentTiddler)$\n\\end\n<$list filter=\"[all[current]has[_canonical_uri]]\">\n\n<div class=\"tc-message-box\">\n\n<<lingo External/Hint>>\n\n<a href={{!!_canonical_uri}}><$text text={{!!_canonical_uri}}/></a>\n\n<$edit-text field=\"_canonical_uri\" class=\"tc-edit-fields\" tabindex={{$:/config/EditTabIndex}}></$edit-text>\n\n</div>\n\n</$list>\n\n<$list filter=\"[all[current]!has[_canonical_uri]]\">\n\n<$reveal state=\"$:/state/showeditpreview\" type=\"match\" text=\"yes\">\n\n<div class=\"tc-tiddler-preview\">\n\n<$transclude tiddler=\"$:/core/ui/EditTemplate/body/editor\" mode=\"inline\"/>\n\n<div class=\"tc-tiddler-preview-preview\">\n\n<$transclude tiddler={{$:/state/editpreviewtype}} mode=\"inline\">\n\n<$transclude tiddler=\"$:/core/ui/EditTemplate/body/preview/output\" mode=\"inline\"/>\n\n</$transclude>\n\n</div>\n\n</div>\n\n</$reveal>\n\n<$reveal state=\"$:/state/showeditpreview\" type=\"nomatch\" text=\"yes\">\n\n<$transclude tiddler=\"$:/core/ui/EditTemplate/body/editor\" mode=\"inline\"/>\n\n</$reveal>\n\n</$list>\n"
},
"$:/core/ui/EditTemplate/controls": {
"title": "$:/core/ui/EditTemplate/controls",
"tags": "$:/tags/EditTemplate",
"text": "\\define config-title()\n$:/config/EditToolbarButtons/Visibility/$(listItem)$\n\\end\n<div class=\"tc-tiddler-title tc-tiddler-edit-title\">\n<$view field=\"title\"/>\n<span class=\"tc-tiddler-controls tc-titlebar\"><$list filter=\"[all[shadows+tiddlers]tag[$:/tags/EditToolbar]!has[draft.of]]\" variable=\"listItem\"><$reveal type=\"nomatch\" state=<<config-title>> text=\"hide\"><$transclude tiddler=<<listItem>>/></$reveal></$list></span>\n<div style=\"clear: both;\"></div>\n</div>\n"
},
"$:/core/ui/EditTemplate/fields": {
"title": "$:/core/ui/EditTemplate/fields",
"tags": "$:/tags/EditTemplate",
"text": "\\define lingo-base() $:/language/EditTemplate/\n\\define config-title()\n$:/config/EditTemplateFields/Visibility/$(currentField)$\n\\end\n\n\\define config-filter()\n[[hide]] -[title{$(config-title)$}]\n\\end\n\n\\define current-tiddler-new-field-selector()\n[data-tiddler-title=\"$(currentTiddlerCSSescaped)$\"] .tc-edit-field-add-name input\n\\end\n\n\\define new-field-actions()\n<$action-sendmessage $message=\"tm-add-field\" $name={{{ [<newFieldNameTiddler>get[text]] }}} $value={{{ [<newFieldValueTiddler>get[text]] }}}/>\n<$action-deletetiddler $tiddler=<<newFieldNameTiddler>>/>\n<$action-deletetiddler $tiddler=<<newFieldValueTiddler>>/>\n<$action-sendmessage $message=\"tm-focus-selector\" $param=<<current-tiddler-new-field-selector>>/>\n\\end\n\n\\define new-field()\n<$vars name={{{ [<newFieldNameTiddler>get[text]] }}}>\n<$reveal type=\"nomatch\" text=\"\" default=<<name>>>\n<$button tooltip=<<lingo Fields/Add/Button/Hint>>>\n<$action-sendmessage $message=\"tm-add-field\"\n$name=<<name>>\n$value={{{ [<newFieldValueTiddler>get[text]] }}}/>\n<$action-deletetiddler $tiddler=<<newFieldNameTiddler>>/>\n<$action-deletetiddler $tiddler=<<newFieldValueTiddler>>/>\n<<lingo Fields/Add/Button>>\n</$button>\n</$reveal>\n<$reveal type=\"match\" text=\"\" default=<<name>>>\n<$button>\n<<lingo Fields/Add/Button>>\n</$button>\n</$reveal>\n</$vars>\n\\end\n\\whitespace trim\n\n<div class=\"tc-edit-fields\">\n<table class=\"tc-edit-fields\">\n<tbody>\n<$list filter=\"[all[current]fields[]] +[sort[title]]\" variable=\"currentField\" storyview=\"pop\">\n<$list filter=<<config-filter>> variable=\"temp\">\n<tr class=\"tc-edit-field\">\n<td class=\"tc-edit-field-name\">\n<$text text=<<currentField>>/>:</td>\n<td class=\"tc-edit-field-value\">\n<$edit-text tiddler=<<currentTiddler>> field=<<currentField>> placeholder={{$:/language/EditTemplate/Fields/Add/Value/Placeholder}} tabindex={{$:/config/EditTabIndex}}/>\n</td>\n<td class=\"tc-edit-field-remove\">\n<$button class=\"tc-btn-invisible\" tooltip={{$:/language/EditTemplate/Field/Remove/Hint}} aria-label={{$:/language/EditTemplate/Field/Remove/Caption}}>\n<$action-deletefield $field=<<currentField>>/>\n{{$:/core/images/delete-button}}\n</$button>\n</td>\n</tr>\n</$list>\n</$list>\n</tbody>\n</table>\n</div>\n\n<$fieldmangler>\n<div class=\"tc-edit-field-add\">\n<em class=\"tc-edit\">\n<<lingo Fields/Add/Prompt>> \n</em>\n<span class=\"tc-edit-field-add-name\">\n<$edit-text tiddler=<<newFieldNameTiddler>> tag=\"input\" default=\"\" placeholder={{$:/language/EditTemplate/Fields/Add/Name/Placeholder}} focusPopup=<<qualify \"$:/state/popup/field-dropdown\">> class=\"tc-edit-texteditor tc-popup-handle\" tabindex={{$:/config/EditTabIndex}} focus={{{ [{$:/config/AutoFocus}match[fields]then[true]] ~[[false]] }}}/>\n</span> \n<$button popup=<<qualify \"$:/state/popup/field-dropdown\">> class=\"tc-btn-invisible tc-btn-dropdown\" tooltip={{$:/language/EditTemplate/Field/Dropdown/Hint}} aria-label={{$:/language/EditTemplate/Field/Dropdown/Caption}}>{{$:/core/images/down-arrow}}</$button> \n<$reveal state=<<qualify \"$:/state/popup/field-dropdown\">> type=\"nomatch\" text=\"\" default=\"\">\n<div class=\"tc-block-dropdown tc-edit-type-dropdown\">\n<$set name=\"tv-show-missing-links\" value=\"yes\">\n<$linkcatcher to=<<newFieldNameTiddler>>>\n<div class=\"tc-dropdown-item\">\n<<lingo Fields/Add/Dropdown/User>>\n</div>\n<$set name=\"newFieldName\" value={{{ [<newFieldNameTiddler>get[text]] }}}>\n<$list filter=\"[!is[shadow]!is[system]fields[]search:title<newFieldName>sort[]] -created -creator -draft.of -draft.title -modified -modifier -tags -text -title -type\" variable=\"currentField\">\n<$link to=<<currentField>>>\n<$text text=<<currentField>>/>\n</$link>\n</$list>\n<div class=\"tc-dropdown-item\">\n<<lingo Fields/Add/Dropdown/System>>\n</div>\n<$list filter=\"[fields[]search:title<newFieldName>sort[]] -[!is[shadow]!is[system]fields[]]\" variable=\"currentField\">\n<$link to=<<currentField>>>\n<$text text=<<currentField>>/>\n</$link>\n</$list>\n</$set>\n</$linkcatcher>\n</$set>\n</div>\n</$reveal>\n<span class=\"tc-edit-field-add-value\">\n<$set name=\"currentTiddlerCSSescaped\" value={{{ [<currentTiddler>escapecss[]] }}}>\n<$keyboard key=\"((add-field))\" actions=<<new-field-actions>>>\n<$edit-text tiddler=<<newFieldValueTiddler>> tag=\"input\" default=\"\" placeholder={{$:/language/EditTemplate/Fields/Add/Value/Placeholder}} class=\"tc-edit-texteditor\" tabindex={{$:/config/EditTabIndex}}/>\n</$keyboard>\n</$set>\n</span> \n<span class=\"tc-edit-field-add-button\">\n<$macrocall $name=\"new-field\"/>\n</span>\n</div>\n</$fieldmangler>\n"
},
"$:/core/ui/EditTemplate/shadow": {
"title": "$:/core/ui/EditTemplate/shadow",
"tags": "$:/tags/EditTemplate",
"text": "\\define lingo-base() $:/language/EditTemplate/Shadow/\n\\define pluginLinkBody()\n<$link to=\"\"\"$(pluginTitle)$\"\"\">\n<$text text=\"\"\"$(pluginTitle)$\"\"\"/>\n</$link>\n\\end\n<$list filter=\"[all[current]get[draft.of]is[shadow]!is[tiddler]]\">\n\n<$list filter=\"[all[current]shadowsource[]]\" variable=\"pluginTitle\">\n\n<$set name=\"pluginLink\" value=<<pluginLinkBody>>>\n<div class=\"tc-message-box\">\n\n<<lingo Warning>>\n\n</div>\n</$set>\n</$list>\n\n</$list>\n\n<$list filter=\"[all[current]get[draft.of]is[shadow]is[tiddler]]\">\n\n<$list filter=\"[all[current]shadowsource[]]\" variable=\"pluginTitle\">\n\n<$set name=\"pluginLink\" value=<<pluginLinkBody>>>\n<div class=\"tc-message-box\">\n\n<<lingo OverriddenWarning>>\n\n</div>\n</$set>\n</$list>\n\n</$list>"
},
"$:/core/ui/EditTemplate/tags": {
"title": "$:/core/ui/EditTemplate/tags",
"tags": "$:/tags/EditTemplate",
"text": "\\whitespace trim\n\n\\define lingo-base() $:/language/EditTemplate/\n\n\\define tag-styles()\nbackground-color:$(backgroundColor)$;\nfill:$(foregroundColor)$;\ncolor:$(foregroundColor)$;\n\\end\n\n\\define tag-body-inner(colour,fallbackTarget,colourA,colourB,icon)\n\\whitespace trim\n<$vars foregroundColor=<<contrastcolour target:\"\"\"$colour$\"\"\" fallbackTarget:\"\"\"$fallbackTarget$\"\"\" colourA:\"\"\"$colourA$\"\"\" colourB:\"\"\"$colourB$\"\"\">> backgroundColor=\"\"\"$colour$\"\"\">\n<span style=<<tag-styles>> class=\"tc-tag-label tc-tag-list-item\">\n<$transclude tiddler=\"\"\"$icon$\"\"\"/><$view field=\"title\" format=\"text\" />\n<$button message=\"tm-remove-tag\" param={{!!title}} class=\"tc-btn-invisible tc-remove-tag-button\">{{$:/core/images/close-button}}</$button>\n</span>\n</$vars>\n\\end\n\n\\define tag-body(colour,palette,icon)\n<$macrocall $name=\"tag-body-inner\" colour=\"\"\"$colour$\"\"\" fallbackTarget={{$palette$##tag-background}} colourA={{$palette$##foreground}} colourB={{$palette$##background}} icon=\"\"\"$icon$\"\"\"/>\n\\end\n\n<div class=\"tc-edit-tags\">\n<$fieldmangler>\n<$list filter=\"[all[current]tags[]sort[title]]\" storyview=\"pop\">\n<$macrocall $name=\"tag-body\" colour={{!!color}} palette={{$:/palette}} icon={{!!icon}}/>\n</$list>\n<$set name=\"tabIndex\" value={{$:/config/EditTabIndex}}>\n<$macrocall $name=\"tag-picker\"/>\n</$set>\n</$fieldmangler>\n</div>\n"
},
"$:/core/ui/EditTemplate/title": {
"title": "$:/core/ui/EditTemplate/title",
"tags": "$:/tags/EditTemplate",
"text": "<$edit-text field=\"draft.title\" class=\"tc-titlebar tc-edit-texteditor\" focus={{{ [{$:/config/AutoFocus}match[title]then[true]] ~[[false]] }}} tabindex={{$:/config/EditTabIndex}}/>\n\n<$vars pattern=\"\"\"[\\|\\[\\]{}]\"\"\" bad-chars=\"\"\"`| [ ] { }`\"\"\">\n\n<$list filter=\"[all[current]regexp:draft.title<pattern>]\" variable=\"listItem\">\n\n<div class=\"tc-message-box\">\n\n{{$:/core/images/warning}} {{$:/language/EditTemplate/Title/BadCharacterWarning}}\n\n</div>\n\n</$list>\n\n</$vars>\n\n<$reveal state=\"!!draft.title\" type=\"nomatch\" text={{!!draft.of}} tag=\"div\">\n\n<$list filter=\"[{!!draft.title}!is[missing]]\" variable=\"listItem\">\n\n<div class=\"tc-message-box\">\n\n{{$:/core/images/warning}} {{$:/language/EditTemplate/Title/Exists/Prompt}}\n\n</div>\n\n</$list>\n\n<$list filter=\"[{!!draft.of}!is[missing]]\" variable=\"listItem\">\n\n<$vars fromTitle={{!!draft.of}} toTitle={{!!draft.title}}>\n\n<$checkbox tiddler=\"$:/config/RelinkOnRename\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> {{$:/language/EditTemplate/Title/Relink/Prompt}}</$checkbox>\n\n<$list filter=\"[title<fromTitle>backlinks[]limit[1]]\" variable=\"listItem\">\n\n<$vars stateTiddler=<<qualify \"$:/state/edit/references\">> >\n\n<$reveal type=\"nomatch\" state=<<stateTiddler>> text=\"show\">\n<$button set=<<stateTiddler>> setTo=\"show\" class=\"tc-btn-invisible\">{{$:/core/images/right-arrow}} \n<<lingo EditTemplate/Title/References/Prompt>></$button>\n</$reveal>\n<$reveal type=\"match\" state=<<stateTiddler>> text=\"show\">\n<$button set=<<stateTiddler>> setTo=\"hide\" class=\"tc-btn-invisible\">{{$:/core/images/down-arrow}} \n<<lingo EditTemplate/Title/References/Prompt>></$button>\n</$reveal>\n\n<$reveal type=\"match\" state=<<stateTiddler>> text=\"show\">\n<$tiddler tiddler=<<fromTitle>> >\n<$transclude tiddler=\"$:/core/ui/TiddlerInfo/References\"/>\n</$tiddler>\n</$reveal>\n\n</$vars>\n\n</$list>\n\n</$vars>\n\n</$list>\n\n</$reveal>\n"
},
"$:/core/ui/EditTemplate/type": {
"title": "$:/core/ui/EditTemplate/type",
"tags": "$:/tags/EditTemplate",
"text": "\\define lingo-base() $:/language/EditTemplate/\n\\whitespace trim\n<div class=\"tc-type-selector\"><$fieldmangler>\n<em class=\"tc-edit\"><<lingo Type/Prompt>></em> <$edit-text field=\"type\" tag=\"input\" default=\"\" placeholder={{$:/language/EditTemplate/Type/Placeholder}} focusPopup=<<qualify \"$:/state/popup/type-dropdown\">> class=\"tc-edit-typeeditor tc-edit-texteditor tc-popup-handle\" tabindex={{$:/config/EditTabIndex}} focus={{{ [{$:/config/AutoFocus}match[type]then[true]] ~[[false]] }}}/> <$button popup=<<qualify \"$:/state/popup/type-dropdown\">> class=\"tc-btn-invisible tc-btn-dropdown\" tooltip={{$:/language/EditTemplate/Type/Dropdown/Hint}} aria-label={{$:/language/EditTemplate/Type/Dropdown/Caption}}>{{$:/core/images/down-arrow}}</$button> <$button message=\"tm-remove-field\" param=\"type\" class=\"tc-btn-invisible tc-btn-icon\" tooltip={{$:/language/EditTemplate/Type/Delete/Hint}} aria-label={{$:/language/EditTemplate/Type/Delete/Caption}}>{{$:/core/images/delete-button}}</$button>\n</$fieldmangler></div>\n\n<div class=\"tc-block-dropdown-wrapper\">\n<$set name=\"tv-show-missing-links\" value=\"yes\">\n<$reveal state=<<qualify \"$:/state/popup/type-dropdown\">> type=\"nomatch\" text=\"\" default=\"\">\n<div class=\"tc-block-dropdown tc-edit-type-dropdown\">\n<$linkcatcher to=\"!!type\">\n<$list filter='[all[shadows+tiddlers]prefix[$:/language/Docs/Types/]each[group]sort[group-sort]]'>\n<div class=\"tc-dropdown-item\">\n<$text text={{!!group}}/>\n</div>\n<$list filter=\"[all[shadows+tiddlers]prefix[$:/language/Docs/Types/]group{!!group}] +[sort[description]]\"><$link to={{!!name}}><$view field=\"description\"/> (<$view field=\"name\"/>)</$link>\n</$list>\n</$list>\n</$linkcatcher>\n</div>\n</$reveal>\n</$set>\n</div>\n"
},
"$:/core/ui/EditTemplate": {
"title": "$:/core/ui/EditTemplate",
"text": "\\define save-tiddler-actions()\n<$action-sendmessage $message=\"tm-add-tag\" $param={{{ [<newTagNameTiddler>get[text]] }}}/>\n<$action-deletetiddler $tiddler=<<newTagNameTiddler>>/>\n<$action-sendmessage $message=\"tm-add-field\" $name={{{ [<newFieldNameTiddler>get[text]] }}} $value={{{ [<newFieldValueTiddler>get[text]] }}}/>\n<$action-deletetiddler $tiddler=<<newFieldNameTiddler>>/>\n<$action-deletetiddler $tiddler=<<newFieldValueTiddler>>/>\n<$action-sendmessage $message=\"tm-save-tiddler\"/>\n\\end\n<div data-tiddler-title=<<currentTiddler>> data-tags={{!!tags}} class={{{ tc-tiddler-frame tc-tiddler-edit-frame [<currentTiddler>is[tiddler]then[tc-tiddler-exists]] [<currentTiddler>is[missing]!is[shadow]then[tc-tiddler-missing]] [<currentTiddler>is[shadow]then[tc-tiddler-exists tc-tiddler-shadow]] [<currentTiddler>is[system]then[tc-tiddler-system]] [{!!class}] [<currentTiddler>tags[]encodeuricomponent[]addprefix[tc-tagged-]] +[join[ ]] }}}>\n<$fieldmangler>\n<$vars storyTiddler=<<currentTiddler>> newTagNameTiddler=<<qualify \"$:/temp/NewTagName\">> newFieldNameTiddler=<<qualify \"$:/temp/NewFieldName\">> newFieldValueTiddler=<<qualify \"$:/temp/NewFieldValue\">>>\n<$keyboard key=\"((cancel-edit-tiddler))\" message=\"tm-cancel-tiddler\">\n<$keyboard key=\"((save-tiddler))\" actions=<<save-tiddler-actions>>>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/EditTemplate]!has[draft.of]]\" variable=\"listItem\">\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n<$transclude tiddler=<<listItem>>/>\n</$set>\n</$list>\n</$keyboard>\n</$keyboard>\n</$vars>\n</$fieldmangler>\n</div>\n"
},
"$:/core/ui/Buttons/cancel": {
"title": "$:/core/ui/Buttons/cancel",
"tags": "$:/tags/EditToolbar",
"caption": "{{$:/core/images/cancel-button}} {{$:/language/Buttons/Cancel/Caption}}",
"description": "{{$:/language/Buttons/Cancel/Hint}}",
"text": "<$button message=\"tm-cancel-tiddler\" tooltip={{$:/language/Buttons/Cancel/Hint}} aria-label={{$:/language/Buttons/Cancel/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/cancel-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Cancel/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/delete": {
"title": "$:/core/ui/Buttons/delete",
"tags": "$:/tags/EditToolbar $:/tags/ViewToolbar",
"caption": "{{$:/core/images/delete-button}} {{$:/language/Buttons/Delete/Caption}}",
"description": "{{$:/language/Buttons/Delete/Hint}}",
"text": "<$button message=\"tm-delete-tiddler\" tooltip={{$:/language/Buttons/Delete/Hint}} aria-label={{$:/language/Buttons/Delete/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/delete-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Delete/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/save": {
"title": "$:/core/ui/Buttons/save",
"tags": "$:/tags/EditToolbar",
"caption": "{{$:/core/images/done-button}} {{$:/language/Buttons/Save/Caption}}",
"description": "{{$:/language/Buttons/Save/Hint}}",
"text": "\\define save-tiddler-button()\n<$fieldmangler><$button tooltip={{$:/language/Buttons/Save/Hint}} aria-label={{$:/language/Buttons/Save/Caption}} class=<<tv-config-toolbar-class>>>\n<<save-tiddler-actions>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/done-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Save/Caption}}/></span>\n</$list>\n</$button></$fieldmangler>\n\\end\n<<save-tiddler-button>>\n"
},
"$:/core/ui/EditorToolbar/bold": {
"title": "$:/core/ui/EditorToolbar/bold",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/bold",
"caption": "{{$:/language/Buttons/Bold/Caption}}",
"description": "{{$:/language/Buttons/Bold/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((bold))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"''\"\n\tsuffix=\"''\"\n/>\n"
},
"$:/core/ui/EditorToolbar/clear-dropdown": {
"title": "$:/core/ui/EditorToolbar/clear-dropdown",
"text": "''{{$:/language/Buttons/Clear/Hint}}''\n\n<div class=\"tc-colour-chooser\">\n\n<$macrocall $name=\"colour-picker\" actions=\"\"\"\n\n<$action-sendmessage\n\t$message=\"tm-edit-bitmap-operation\"\n\t$param=\"clear\"\n\tcolour=<<colour-picker-value>>\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n\"\"\"/>\n\n</div>\n"
},
"$:/core/ui/EditorToolbar/clear": {
"title": "$:/core/ui/EditorToolbar/clear",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/erase",
"caption": "{{$:/language/Buttons/Clear/Caption}}",
"description": "{{$:/language/Buttons/Clear/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"dropdown": "$:/core/ui/EditorToolbar/clear-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/editor-height-dropdown": {
"title": "$:/core/ui/EditorToolbar/editor-height-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/EditorHeight/\n''<<lingo Hint>>''\n\n<$radio tiddler=\"$:/config/TextEditor/EditorHeight/Mode\" value=\"auto\"> {{$:/core/images/auto-height}} <<lingo Caption/Auto>></$radio>\n\n<$radio tiddler=\"$:/config/TextEditor/EditorHeight/Mode\" value=\"fixed\"> {{$:/core/images/fixed-height}} <<lingo Caption/Fixed>> <$edit-text tag=\"input\" tiddler=\"$:/config/TextEditor/EditorHeight/Height\" default=\"100px\"/></$radio>\n"
},
"$:/core/ui/EditorToolbar/editor-height": {
"title": "$:/core/ui/EditorToolbar/editor-height",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/fixed-height",
"custom-icon": "yes",
"caption": "{{$:/language/Buttons/EditorHeight/Caption}}",
"description": "{{$:/language/Buttons/EditorHeight/Hint}}",
"condition": "[<targetTiddler>type[]] [<targetTiddler>get[type]prefix[text/]] +[first[]]",
"dropdown": "$:/core/ui/EditorToolbar/editor-height-dropdown",
"text": "<$reveal tag=\"span\" state=\"$:/config/TextEditor/EditorHeight/Mode\" type=\"match\" text=\"fixed\">\n{{$:/core/images/fixed-height}}\n</$reveal>\n<$reveal tag=\"span\" state=\"$:/config/TextEditor/EditorHeight/Mode\" type=\"match\" text=\"auto\">\n{{$:/core/images/auto-height}}\n</$reveal>\n"
},
"$:/core/ui/EditorToolbar/excise-dropdown": {
"title": "$:/core/ui/EditorToolbar/excise-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/Excise/\n\n\\define body(config-title)\n''<<lingo Hint>>''\n\n<<lingo Caption/NewTitle>> <$edit-text tag=\"input\" tiddler=\"$config-title$/new-title\" default=\"\" focus=\"true\"/>\n\n<$set name=\"new-title\" value={{$config-title$/new-title}}>\n<$list filter=\"\"\"[<new-title>is[tiddler]]\"\"\">\n<div class=\"tc-error\">\n<<lingo Caption/TiddlerExists>>\n</div>\n</$list>\n</$set>\n\n<$checkbox tiddler=\"\"\"$config-title$/tagnew\"\"\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"false\"> <<lingo Caption/Tag>></$checkbox>\n\n<<lingo Caption/Replace>> <$select tiddler=\"\"\"$config-title$/type\"\"\" default=\"transclude\">\n<option value=\"link\"><<lingo Caption/Replace/Link>></option>\n<option value=\"transclude\"><<lingo Caption/Replace/Transclusion>></option>\n<option value=\"macro\"><<lingo Caption/Replace/Macro>></option>\n</$select>\n\n<$reveal state=\"\"\"$config-title$/type\"\"\" type=\"match\" text=\"macro\">\n<<lingo Caption/MacroName>> <$edit-text tag=\"input\" tiddler=\"\"\"$config-title$/macro-title\"\"\" default=\"translink\"/>\n</$reveal>\n\n<$button>\n<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"excise\"\n\ttitle={{$config-title$/new-title}}\n\ttype={{$config-title$/type}}\n\tmacro={{$config-title$/macro-title}}\n\ttagnew={{$config-title$/tagnew}}\n/>\n<$action-deletetiddler\n\t$tiddler=\"$config-title$/new-title\"\n/>\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n<<lingo Caption/Excise>>\n</$button>\n\\end\n\n<$macrocall $name=\"body\" config-title=<<qualify \"$:/state/Excise/\">>/>\n"
},
"$:/core/ui/EditorToolbar/excise": {
"title": "$:/core/ui/EditorToolbar/excise",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/excise",
"caption": "{{$:/language/Buttons/Excise/Caption}}",
"description": "{{$:/language/Buttons/Excise/Hint}}",
"condition": "[<targetTiddler>type[]] [<targetTiddler>type[text/vnd.tiddlywiki]] +[first[]]",
"shortcuts": "((excise))",
"dropdown": "$:/core/ui/EditorToolbar/excise-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/heading-1": {
"title": "$:/core/ui/EditorToolbar/heading-1",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-1",
"caption": "{{$:/language/Buttons/Heading1/Caption}}",
"description": "{{$:/language/Buttons/Heading1/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"button-classes": "tc-text-editor-toolbar-item-start-group",
"shortcuts": "((heading-1))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"1\"\n/>\n"
},
"$:/core/ui/EditorToolbar/heading-2": {
"title": "$:/core/ui/EditorToolbar/heading-2",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-2",
"caption": "{{$:/language/Buttons/Heading2/Caption}}",
"description": "{{$:/language/Buttons/Heading2/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((heading-2))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"2\"\n/>\n"
},
"$:/core/ui/EditorToolbar/heading-3": {
"title": "$:/core/ui/EditorToolbar/heading-3",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-3",
"caption": "{{$:/language/Buttons/Heading3/Caption}}",
"description": "{{$:/language/Buttons/Heading3/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((heading-3))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"3\"\n/>\n"
},
"$:/core/ui/EditorToolbar/heading-4": {
"title": "$:/core/ui/EditorToolbar/heading-4",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-4",
"caption": "{{$:/language/Buttons/Heading4/Caption}}",
"description": "{{$:/language/Buttons/Heading4/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((heading-4))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"4\"\n/>\n"
},
"$:/core/ui/EditorToolbar/heading-5": {
"title": "$:/core/ui/EditorToolbar/heading-5",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-5",
"caption": "{{$:/language/Buttons/Heading5/Caption}}",
"description": "{{$:/language/Buttons/Heading5/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((heading-5))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"5\"\n/>\n"
},
"$:/core/ui/EditorToolbar/heading-6": {
"title": "$:/core/ui/EditorToolbar/heading-6",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/heading-6",
"caption": "{{$:/language/Buttons/Heading6/Caption}}",
"description": "{{$:/language/Buttons/Heading6/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((heading-6))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"!\"\n\tcount=\"6\"\n/>\n"
},
"$:/core/ui/EditorToolbar/italic": {
"title": "$:/core/ui/EditorToolbar/italic",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/italic",
"caption": "{{$:/language/Buttons/Italic/Caption}}",
"description": "{{$:/language/Buttons/Italic/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((italic))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"//\"\n\tsuffix=\"//\"\n/>\n"
},
"$:/core/ui/EditorToolbar/line-width-dropdown": {
"title": "$:/core/ui/EditorToolbar/line-width-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/LineWidth/\n\n\\define toolbar-line-width-inner()\n<$button tag=\"a\" tooltip=\"\"\"$(line-width)$\"\"\">\n\n<$action-setfield\n\t$tiddler=\"$:/config/BitmapEditor/LineWidth\"\n\t$value=\"$(line-width)$\"\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n<div style=\"display: inline-block; margin: 4px calc(80px - $(line-width)$); background-color: #000; width: calc(100px + $(line-width)$ * 2); height: $(line-width)$; border-radius: 120px; vertical-align: middle;\"/>\n\n<span style=\"margin-left: 8px;\">\n\n<$text text=\"\"\"$(line-width)$\"\"\"/>\n\n<$reveal state=\"$:/config/BitmapEditor/LineWidth\" type=\"match\" text=\"\"\"$(line-width)$\"\"\" tag=\"span\">\n\n<$entity entity=\" \"/>\n\n<$entity entity=\"✓\"/>\n\n</$reveal>\n\n</span>\n\n</$button>\n\\end\n\n''<<lingo Hint>>''\n\n<$list filter={{$:/config/BitmapEditor/LineWidths}} variable=\"line-width\">\n\n<<toolbar-line-width-inner>>\n\n</$list>\n"
},
"$:/core/ui/EditorToolbar/line-width": {
"title": "$:/core/ui/EditorToolbar/line-width",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/line-width",
"caption": "{{$:/language/Buttons/LineWidth/Caption}}",
"description": "{{$:/language/Buttons/LineWidth/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"dropdown": "$:/core/ui/EditorToolbar/line-width-dropdown",
"text": "<$text text={{$:/config/BitmapEditor/LineWidth}}/>"
},
"$:/core/ui/EditorToolbar/link-dropdown": {
"title": "$:/core/ui/EditorToolbar/link-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/Link/\n\n\\define add-link-actions()\n<$action-sendmessage $message=\"tm-edit-text-operation\" $param=\"make-link\" text={{$(linkTiddler)$}} />\n<$action-deletetiddler $tiddler=<<dropdown-state>> />\n<$action-deletetiddler $tiddler=<<searchTiddler>> />\n<$action-deletetiddler $tiddler=<<linkTiddler>> />\n\\end\n\n\\define external-link()\n<$button class=\"tc-btn-invisible\" style=\"width: auto; display: inline-block; background-colour: inherit;\" actions=<<add-link-actions>>>\n{{$:/core/images/chevron-right}}\n</$button>\n\\end\n\n\\define body(config-title)\n''<<lingo Hint>>''\n\n<$vars searchTiddler=\"\"\"$config-title$/search\"\"\" linkTiddler=\"\"\"$config-title$/link\"\"\" linktext=\"\" >\n\n<$vars linkTiddler=<<searchTiddler>>>\n<$keyboard key=\"ENTER\" actions=<<add-link-actions>>>\n<$edit-text tiddler=<<searchTiddler>> type=\"search\" tag=\"input\" focus=\"true\" placeholder={{$:/language/Search/Search}} default=\"\"/>\n<$reveal tag=\"span\" state=<<searchTiddler>> type=\"nomatch\" text=\"\">\n<<external-link>>\n<$button class=\"tc-btn-invisible\" style=\"width: auto; display: inline-block; background-colour: inherit;\">\n<$action-setfield $tiddler=<<searchTiddler>> text=\"\" />\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n</$keyboard>\n</$vars>\n\n<$reveal tag=\"div\" state=<<searchTiddler>> type=\"nomatch\" text=\"\">\n\n<$linkcatcher actions=<<add-link-actions>> to=<<linkTiddler>>>\n\n{{$:/core/ui/SearchResults}}\n\n</$linkcatcher>\n\n</$reveal>\n\n</$vars>\n\n\\end\n\n<$macrocall $name=\"body\" config-title=<<qualify \"$:/state/Link/\">>/>"
},
"$:/core/ui/EditorToolbar/link": {
"title": "$:/core/ui/EditorToolbar/link",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/link",
"caption": "{{$:/language/Buttons/Link/Caption}}",
"description": "{{$:/language/Buttons/Link/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"button-classes": "tc-text-editor-toolbar-item-start-group",
"shortcuts": "((link))",
"dropdown": "$:/core/ui/EditorToolbar/link-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/linkify": {
"title": "$:/core/ui/EditorToolbar/linkify",
"caption": "{{$:/language/Buttons/Linkify/Caption}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"description": "{{$:/language/Buttons/Linkify/Hint}}",
"icon": "$:/core/images/linkify",
"list-before": "$:/core/ui/EditorToolbar/mono-block",
"shortcuts": "((linkify))",
"tags": "$:/tags/EditorToolbar",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"[[\"\n\tsuffix=\"]]\"\n/>\n"
},
"$:/core/ui/EditorToolbar/list-bullet": {
"title": "$:/core/ui/EditorToolbar/list-bullet",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/list-bullet",
"caption": "{{$:/language/Buttons/ListBullet/Caption}}",
"description": "{{$:/language/Buttons/ListBullet/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((list-bullet))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"*\"\n\tcount=\"1\"\n/>\n"
},
"$:/core/ui/EditorToolbar/list-number": {
"title": "$:/core/ui/EditorToolbar/list-number",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/list-number",
"caption": "{{$:/language/Buttons/ListNumber/Caption}}",
"description": "{{$:/language/Buttons/ListNumber/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((list-number))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"prefix-lines\"\n\tcharacter=\"#\"\n\tcount=\"1\"\n/>\n"
},
"$:/core/ui/EditorToolbar/mono-block": {
"title": "$:/core/ui/EditorToolbar/mono-block",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/mono-block",
"caption": "{{$:/language/Buttons/MonoBlock/Caption}}",
"description": "{{$:/language/Buttons/MonoBlock/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"button-classes": "tc-text-editor-toolbar-item-start-group",
"shortcuts": "((mono-block))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-lines\"\n\tprefix=\"\n```\"\n\tsuffix=\"```\"\n/>\n"
},
"$:/core/ui/EditorToolbar/mono-line": {
"title": "$:/core/ui/EditorToolbar/mono-line",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/mono-line",
"caption": "{{$:/language/Buttons/MonoLine/Caption}}",
"description": "{{$:/language/Buttons/MonoLine/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((mono-line))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"`\"\n\tsuffix=\"`\"\n/>\n"
},
"$:/core/ui/EditorToolbar/more-dropdown": {
"title": "$:/core/ui/EditorToolbar/more-dropdown",
"text": "\\define config-title()\n$:/config/EditorToolbarButtons/Visibility/$(toolbarItem)$\n\\end\n\n\\define conditional-button()\n<$list filter={{$(toolbarItem)$!!condition}} variable=\"condition\">\n<$transclude tiddler=\"$:/core/ui/EditTemplate/body/toolbar/button\" mode=\"inline\"/> <$transclude tiddler=<<toolbarItem>> field=\"description\"/>\n</$list>\n\\end\n\n<div class=\"tc-text-editor-toolbar-more\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/EditorToolbar]!has[draft.of]] -[[$:/core/ui/EditorToolbar/more]]\">\n<$reveal type=\"match\" state=<<config-visibility-title>> text=\"hide\" tag=\"div\">\n<<conditional-button>>\n</$reveal>\n</$list>\n</div>\n"
},
"$:/core/ui/EditorToolbar/more": {
"title": "$:/core/ui/EditorToolbar/more",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/down-arrow",
"caption": "{{$:/language/Buttons/More/Caption}}",
"description": "{{$:/language/Buttons/More/Hint}}",
"condition": "[<targetTiddler>]",
"dropdown": "$:/core/ui/EditorToolbar/more-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/opacity-dropdown": {
"title": "$:/core/ui/EditorToolbar/opacity-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/Opacity/\n\n\\define toolbar-opacity-inner()\n<$button tag=\"a\" tooltip=\"\"\"$(opacity)$\"\"\">\n\n<$action-setfield\n\t$tiddler=\"$:/config/BitmapEditor/Opacity\"\n\t$value=\"$(opacity)$\"\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n<div style=\"display: inline-block; vertical-align: middle; background-color: $(current-paint-colour)$; opacity: $(opacity)$; width: 1em; height: 1em; border-radius: 50%;\"/>\n\n<span style=\"margin-left: 8px;\">\n\n<$text text=\"\"\"$(opacity)$\"\"\"/>\n\n<$reveal state=\"$:/config/BitmapEditor/Opacity\" type=\"match\" text=\"\"\"$(opacity)$\"\"\" tag=\"span\">\n\n<$entity entity=\" \"/>\n\n<$entity entity=\"✓\"/>\n\n</$reveal>\n\n</span>\n\n</$button>\n\\end\n\n\\define toolbar-opacity()\n''<<lingo Hint>>''\n\n<$list filter={{$:/config/BitmapEditor/Opacities}} variable=\"opacity\">\n\n<<toolbar-opacity-inner>>\n\n</$list>\n\\end\n\n<$set name=\"current-paint-colour\" value={{$:/config/BitmapEditor/Colour}}>\n\n<$set name=\"current-opacity\" value={{$:/config/BitmapEditor/Opacity}}>\n\n<<toolbar-opacity>>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/EditorToolbar/opacity": {
"title": "$:/core/ui/EditorToolbar/opacity",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/opacity",
"caption": "{{$:/language/Buttons/Opacity/Caption}}",
"description": "{{$:/language/Buttons/Opacity/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"dropdown": "$:/core/ui/EditorToolbar/opacity-dropdown",
"text": "<$text text={{$:/config/BitmapEditor/Opacity}}/>\n"
},
"$:/core/ui/EditorToolbar/paint-dropdown": {
"title": "$:/core/ui/EditorToolbar/paint-dropdown",
"text": "''{{$:/language/Buttons/Paint/Hint}}''\n\n<$macrocall $name=\"colour-picker\" actions=\"\"\"\n\n<$action-setfield\n\t$tiddler=\"$:/config/BitmapEditor/Colour\"\n\t$value=<<colour-picker-value>>\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n\"\"\"/>\n"
},
"$:/core/ui/EditorToolbar/paint": {
"title": "$:/core/ui/EditorToolbar/paint",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/paint",
"caption": "{{$:/language/Buttons/Paint/Caption}}",
"description": "{{$:/language/Buttons/Paint/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"dropdown": "$:/core/ui/EditorToolbar/paint-dropdown",
"text": "\\define toolbar-paint()\n<div style=\"display: inline-block; vertical-align: middle; background-color: $(colour-picker-value)$; width: 1em; height: 1em; border-radius: 50%;\"/>\n\\end\n<$set name=\"colour-picker-value\" value={{$:/config/BitmapEditor/Colour}}>\n<<toolbar-paint>>\n</$set>\n"
},
"$:/core/ui/EditorToolbar/picture-dropdown": {
"title": "$:/core/ui/EditorToolbar/picture-dropdown",
"text": "\\define replacement-text()\n[img[$(imageTitle)$]]\n\\end\n\n''{{$:/language/Buttons/Picture/Hint}}''\n\n<$macrocall $name=\"image-picker\" actions=\"\"\"\n\n<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"replace-selection\"\n\ttext=<<replacement-text>>\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n\"\"\"/>\n"
},
"$:/core/ui/EditorToolbar/picture": {
"title": "$:/core/ui/EditorToolbar/picture",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/picture",
"caption": "{{$:/language/Buttons/Picture/Caption}}",
"description": "{{$:/language/Buttons/Picture/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((picture))",
"dropdown": "$:/core/ui/EditorToolbar/picture-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/preview-type-dropdown": {
"title": "$:/core/ui/EditorToolbar/preview-type-dropdown",
"text": "\\define preview-type-button()\n<$button tag=\"a\">\n\n<$action-setfield $tiddler=\"$:/state/editpreviewtype\" $value=\"$(previewType)$\"/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n<$transclude tiddler=<<previewType>> field=\"caption\" mode=\"inline\">\n\n<$view tiddler=<<previewType>> field=\"title\" mode=\"inline\"/>\n\n</$transclude> \n\n<$reveal tag=\"span\" state=\"$:/state/editpreviewtype\" type=\"match\" text=<<previewType>> default=\"$:/core/ui/EditTemplate/body/preview/output\">\n\n<$entity entity=\" \"/>\n\n<$entity entity=\"✓\"/>\n\n</$reveal>\n\n</$button>\n\\end\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/EditPreview]!has[draft.of]]\" variable=\"previewType\">\n\n<<preview-type-button>>\n\n</$list>\n"
},
"$:/core/ui/EditorToolbar/preview-type": {
"title": "$:/core/ui/EditorToolbar/preview-type",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/chevron-down",
"caption": "{{$:/language/Buttons/PreviewType/Caption}}",
"description": "{{$:/language/Buttons/PreviewType/Hint}}",
"condition": "[all[shadows+tiddlers]tag[$:/tags/EditPreview]!has[draft.of]butfirst[]limit[1]]",
"button-classes": "tc-text-editor-toolbar-item-adjunct",
"dropdown": "$:/core/ui/EditorToolbar/preview-type-dropdown"
},
"$:/core/ui/EditorToolbar/preview": {
"title": "$:/core/ui/EditorToolbar/preview",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/preview-open",
"custom-icon": "yes",
"caption": "{{$:/language/Buttons/Preview/Caption}}",
"description": "{{$:/language/Buttons/Preview/Hint}}",
"condition": "[<targetTiddler>]",
"button-classes": "tc-text-editor-toolbar-item-start-group",
"shortcuts": "((preview))",
"text": "<$reveal state=\"$:/state/showeditpreview\" type=\"match\" text=\"yes\" tag=\"span\">\n{{$:/core/images/preview-open}}\n<$action-setfield $tiddler=\"$:/state/showeditpreview\" $value=\"no\"/>\n</$reveal>\n<$reveal state=\"$:/state/showeditpreview\" type=\"nomatch\" text=\"yes\" tag=\"span\">\n{{$:/core/images/preview-closed}}\n<$action-setfield $tiddler=\"$:/state/showeditpreview\" $value=\"yes\"/>\n</$reveal>\n"
},
"$:/core/ui/EditorToolbar/quote": {
"title": "$:/core/ui/EditorToolbar/quote",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/quote",
"caption": "{{$:/language/Buttons/Quote/Caption}}",
"description": "{{$:/language/Buttons/Quote/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((quote))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-lines\"\n\tprefix=\"\n<<<\"\n\tsuffix=\"<<<\"\n/>\n"
},
"$:/core/ui/EditorToolbar/rotate-left": {
"title": "$:/core/ui/EditorToolbar/rotate-left",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/rotate-left",
"caption": "{{$:/language/Buttons/RotateLeft/Caption}}",
"description": "{{$:/language/Buttons/RotateLeft/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-bitmap-operation\"\n\t$param=\"rotate-left\"\n/>\n"
},
"$:/core/ui/EditorToolbar/size-dropdown": {
"title": "$:/core/ui/EditorToolbar/size-dropdown",
"text": "\\define lingo-base() $:/language/Buttons/Size/\n\n\\define toolbar-button-size-preset(config-title)\n<$set name=\"width\" filter=\"$(sizePair)$ +[first[]]\">\n\n<$set name=\"height\" filter=\"$(sizePair)$ +[last[]]\">\n\n<$button tag=\"a\">\n\n<$action-setfield\n\t$tiddler=\"\"\"$config-title$/new-width\"\"\"\n\t$value=<<width>>\n/>\n\n<$action-setfield\n\t$tiddler=\"\"\"$config-title$/new-height\"\"\"\n\t$value=<<height>>\n/>\n\n<$action-deletetiddler\n\t$tiddler=\"\"\"$config-title$/presets-popup\"\"\"\n/>\n\n<$text text=<<width>>/> × <$text text=<<height>>/>\n\n</$button>\n\n</$set>\n\n</$set>\n\\end\n\n\\define toolbar-button-size(config-title)\n''{{$:/language/Buttons/Size/Hint}}''\n\n<<lingo Caption/Width>> <$edit-text tag=\"input\" tiddler=\"\"\"$config-title$/new-width\"\"\" default=<<tv-bitmap-editor-width>> focus=\"true\" size=\"8\"/> <<lingo Caption/Height>> <$edit-text tag=\"input\" tiddler=\"\"\"$config-title$/new-height\"\"\" default=<<tv-bitmap-editor-height>> size=\"8\"/> <$button popup=\"\"\"$config-title$/presets-popup\"\"\" class=\"tc-btn-invisible tc-popup-keep\" style=\"width: auto; display: inline-block; background-colour: inherit;\" selectedClass=\"tc-selected\">\n{{$:/core/images/down-arrow}}\n</$button>\n\n<$reveal tag=\"span\" state=\"\"\"$config-title$/presets-popup\"\"\" type=\"popup\" position=\"belowleft\" animate=\"yes\">\n\n<div class=\"tc-drop-down tc-popup-keep\">\n\n<$list filter={{$:/config/BitmapEditor/ImageSizes}} variable=\"sizePair\">\n\n<$macrocall $name=\"toolbar-button-size-preset\" config-title=\"$config-title$\"/>\n\n</$list>\n\n</div>\n\n</$reveal>\n\n<$button>\n<$action-sendmessage\n\t$message=\"tm-edit-bitmap-operation\"\n\t$param=\"resize\"\n\twidth={{$config-title$/new-width}}\n\theight={{$config-title$/new-height}}\n/>\n<$action-deletetiddler\n\t$tiddler=\"\"\"$config-title$/new-width\"\"\"\n/>\n<$action-deletetiddler\n\t$tiddler=\"\"\"$config-title$/new-height\"\"\"\n/>\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n<<lingo Caption/Resize>>\n</$button>\n\\end\n\n<$macrocall $name=\"toolbar-button-size\" config-title=<<qualify \"$:/state/Size/\">>/>\n"
},
"$:/core/ui/EditorToolbar/size": {
"title": "$:/core/ui/EditorToolbar/size",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/size",
"caption": "{{$:/language/Buttons/Size/Caption}}",
"description": "{{$:/language/Buttons/Size/Hint}}",
"condition": "[<targetTiddler>is[image]]",
"dropdown": "$:/core/ui/EditorToolbar/size-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/stamp-dropdown": {
"title": "$:/core/ui/EditorToolbar/stamp-dropdown",
"text": "\\define toolbar-button-stamp-inner()\n<$button tag=\"a\">\n\n<$list filter=\"[[$(snippetTitle)$]addsuffix[/prefix]is[missing]removesuffix[/prefix]addsuffix[/suffix]is[missing]]\">\n\n<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"replace-selection\"\n\ttext={{$(snippetTitle)$}}\n/>\n\n</$list>\n\n\n<$list filter=\"[[$(snippetTitle)$]addsuffix[/prefix]is[missing]removesuffix[/prefix]addsuffix[/suffix]!is[missing]] [[$(snippetTitle)$]addsuffix[/prefix]!is[missing]removesuffix[/prefix]addsuffix[/suffix]is[missing]] [[$(snippetTitle)$]addsuffix[/prefix]!is[missing]removesuffix[/prefix]addsuffix[/suffix]!is[missing]]\">\n\n<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix={{{ [[$(snippetTitle)$]addsuffix[/prefix]get[text]] }}}\nsuffix={{{ [[$(snippetTitle)$]addsuffix[/suffix]get[text]] }}}\n/>\n\n</$list>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n<$transclude tiddler=<<snippetTitle>> field=\"caption\" mode=\"inline\">\n\n<$view tiddler=<<snippetTitle>> field=\"title\" />\n\n</$transclude>\n\n</$button>\n\\end\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TextEditor/Snippet]!has[draft.of]sort[caption]]\" variable=\"snippetTitle\">\n\n<<toolbar-button-stamp-inner>>\n\n</$list>\n\n----\n\n<$button tag=\"a\">\n\n<$action-sendmessage\n\t$message=\"tm-new-tiddler\"\n\ttags=\"$:/tags/TextEditor/Snippet\"\n\tcaption={{$:/language/Buttons/Stamp/New/Title}}\n\ttext={{$:/language/Buttons/Stamp/New/Text}}\n/>\n\n<$action-deletetiddler\n\t$tiddler=<<dropdown-state>>\n/>\n\n<em>\n\n<$text text={{$:/language/Buttons/Stamp/Caption/New}}/>\n\n</em>\n\n</$button>\n"
},
"$:/core/ui/EditorToolbar/stamp": {
"title": "$:/core/ui/EditorToolbar/stamp",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/stamp",
"caption": "{{$:/language/Buttons/Stamp/Caption}}",
"description": "{{$:/language/Buttons/Stamp/Hint}}",
"condition": "[<targetTiddler>type[]] [<targetTiddler>get[type]prefix[text/]] +[first[]]",
"shortcuts": "((stamp))",
"dropdown": "$:/core/ui/EditorToolbar/stamp-dropdown",
"text": ""
},
"$:/core/ui/EditorToolbar/strikethrough": {
"title": "$:/core/ui/EditorToolbar/strikethrough",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/strikethrough",
"caption": "{{$:/language/Buttons/Strikethrough/Caption}}",
"description": "{{$:/language/Buttons/Strikethrough/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((strikethrough))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"~~\"\n\tsuffix=\"~~\"\n/>\n"
},
"$:/core/ui/EditorToolbar/subscript": {
"title": "$:/core/ui/EditorToolbar/subscript",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/subscript",
"caption": "{{$:/language/Buttons/Subscript/Caption}}",
"description": "{{$:/language/Buttons/Subscript/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((subscript))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\",,\"\n\tsuffix=\",,\"\n/>\n"
},
"$:/core/ui/EditorToolbar/superscript": {
"title": "$:/core/ui/EditorToolbar/superscript",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/superscript",
"caption": "{{$:/language/Buttons/Superscript/Caption}}",
"description": "{{$:/language/Buttons/Superscript/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((superscript))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"^^\"\n\tsuffix=\"^^\"\n/>\n"
},
"$:/core/ui/EditorToolbar/transcludify": {
"title": "$:/core/ui/EditorToolbar/transcludify",
"caption": "{{$:/language/Buttons/Transcludify/Caption}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"description": "{{$:/language/Buttons/Transcludify/Hint}}",
"icon": "$:/core/images/transcludify",
"list-before": "$:/core/ui/EditorToolbar/mono-block",
"shortcuts": "((transcludify))",
"tags": "$:/tags/EditorToolbar",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"{{\"\n\tsuffix=\"}}\"\n/>\n"
},
"$:/core/ui/EditorToolbar/underline": {
"title": "$:/core/ui/EditorToolbar/underline",
"tags": "$:/tags/EditorToolbar",
"icon": "$:/core/images/underline",
"caption": "{{$:/language/Buttons/Underline/Caption}}",
"description": "{{$:/language/Buttons/Underline/Hint}}",
"condition": "[<targetTiddler>!has[type]] [<targetTiddler>type[text/vnd.tiddlywiki]]",
"shortcuts": "((underline))",
"text": "<$action-sendmessage\n\t$message=\"tm-edit-text-operation\"\n\t$param=\"wrap-selection\"\n\tprefix=\"__\"\n\tsuffix=\"__\"\n/>\n"
},
"$:/core/Filters/AllTags": {
"title": "$:/core/Filters/AllTags",
"tags": "$:/tags/Filter",
"filter": "[tags[]!is[system]sort[title]]",
"description": "{{$:/language/Filters/AllTags}}",
"text": ""
},
"$:/core/Filters/AllTiddlers": {
"title": "$:/core/Filters/AllTiddlers",
"tags": "$:/tags/Filter",
"filter": "[!is[system]sort[title]]",
"description": "{{$:/language/Filters/AllTiddlers}}",
"text": ""
},
"$:/core/Filters/Drafts": {
"title": "$:/core/Filters/Drafts",
"tags": "$:/tags/Filter",
"filter": "[has[draft.of]sort[title]]",
"description": "{{$:/language/Filters/Drafts}}",
"text": ""
},
"$:/core/Filters/Missing": {
"title": "$:/core/Filters/Missing",
"tags": "$:/tags/Filter",
"filter": "[all[missing]sort[title]]",
"description": "{{$:/language/Filters/Missing}}",
"text": ""
},
"$:/core/Filters/Orphans": {
"title": "$:/core/Filters/Orphans",
"tags": "$:/tags/Filter",
"filter": "[all[orphans]sort[title]]",
"description": "{{$:/language/Filters/Orphans}}",
"text": ""
},
"$:/core/Filters/OverriddenShadowTiddlers": {
"title": "$:/core/Filters/OverriddenShadowTiddlers",
"tags": "$:/tags/Filter",
"filter": "[is[shadow]]",
"description": "{{$:/language/Filters/OverriddenShadowTiddlers}}",
"text": ""
},
"$:/core/Filters/RecentSystemTiddlers": {
"title": "$:/core/Filters/RecentSystemTiddlers",
"tags": "$:/tags/Filter",
"filter": "[has[modified]!sort[modified]limit[50]]",
"description": "{{$:/language/Filters/RecentSystemTiddlers}}",
"text": ""
},
"$:/core/Filters/RecentTiddlers": {
"title": "$:/core/Filters/RecentTiddlers",
"tags": "$:/tags/Filter",
"filter": "[!is[system]has[modified]!sort[modified]limit[50]]",
"description": "{{$:/language/Filters/RecentTiddlers}}",
"text": ""
},
"$:/core/Filters/SessionTiddlers": {
"title": "$:/core/Filters/SessionTiddlers",
"tags": "$:/tags/Filter",
"filter": "[haschanged[]]",
"description": "{{$:/language/Filters/SessionTiddlers}}",
"text": ""
},
"$:/core/Filters/ShadowTiddlers": {
"title": "$:/core/Filters/ShadowTiddlers",
"tags": "$:/tags/Filter",
"filter": "[all[shadows]sort[title]]",
"description": "{{$:/language/Filters/ShadowTiddlers}}",
"text": ""
},
"$:/core/Filters/StoryList": {
"title": "$:/core/Filters/StoryList",
"tags": "$:/tags/Filter",
"filter": "[list[$:/StoryList]] -$:/AdvancedSearch",
"description": "{{$:/language/Filters/StoryList}}",
"text": ""
},
"$:/core/Filters/SystemTags": {
"title": "$:/core/Filters/SystemTags",
"tags": "$:/tags/Filter",
"filter": "[all[shadows+tiddlers]tags[]is[system]sort[title]]",
"description": "{{$:/language/Filters/SystemTags}}",
"text": ""
},
"$:/core/Filters/SystemTiddlers": {
"title": "$:/core/Filters/SystemTiddlers",
"tags": "$:/tags/Filter",
"filter": "[is[system]sort[title]]",
"description": "{{$:/language/Filters/SystemTiddlers}}",
"text": ""
},
"$:/core/Filters/TypedTiddlers": {
"title": "$:/core/Filters/TypedTiddlers",
"tags": "$:/tags/Filter",
"filter": "[!is[system]has[type]each[type]sort[type]] -[type[text/vnd.tiddlywiki]]",
"description": "{{$:/language/Filters/TypedTiddlers}}",
"text": ""
},
"$:/core/ui/ImportListing": {
"title": "$:/core/ui/ImportListing",
"text": "\\define lingo-base() $:/language/Import/\n\n\\define messageField()\nmessage-$(payloadTiddler)$\n\\end\n\n\\define selectionField()\nselection-$(payloadTiddler)$\n\\end\n\n\\define previewPopupState()\n$(currentTiddler)$!!popup-$(payloadTiddler)$\n\\end\n\n\\define select-all-actions()\n<$list filter=\"[all[current]plugintiddlers[]sort[title]]\" variable=\"payloadTiddler\">\n<$action-setfield $field={{{ [<payloadTiddler>addprefix[selection-]] }}} $value={{$:/state/import/select-all}}/>\n</$list>\n\\end\n\n<table>\n<tbody>\n<tr>\n<th>\n<$checkbox tiddler=\"$:/state/import/select-all\" field=\"text\" checked=\"checked\" unchecked=\"unchecked\" default=\"checked\" actions=<<select-all-actions>>>\n<<lingo Listing/Select/Caption>>\n</$checkbox>\n</th>\n<th>\n<<lingo Listing/Title/Caption>>\n</th>\n<th>\n<<lingo Listing/Status/Caption>>\n</th>\n</tr>\n<$list filter=\"[all[current]plugintiddlers[]sort[title]]\" variable=\"payloadTiddler\">\n<tr>\n<td>\n<$checkbox field=<<selectionField>> checked=\"checked\" unchecked=\"unchecked\" default=\"checked\"/>\n</td>\n<td>\n<$reveal type=\"nomatch\" stateTitle=<<previewPopupState>> text=\"yes\" tag=\"div\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" setTitle=<<previewPopupState>> setTo=\"yes\">\n{{$:/core/images/right-arrow}} <$text text=<<payloadTiddler>>/>\n</$button>\n</$reveal>\n<$reveal type=\"match\" stateTitle=<<previewPopupState>> text=\"yes\" tag=\"div\">\n<$button class=\"tc-btn-invisible tc-btn-dropdown\" setTitle=<<previewPopupState>> setTo=\"no\">\n{{$:/core/images/down-arrow}} <$text text=<<payloadTiddler>>/>\n</$button>\n</$reveal>\n</td>\n<td>\n<$view field=<<messageField>>/>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\">\n<$reveal type=\"match\" text=\"yes\" stateTitle=<<previewPopupState>> tag=\"div\">\n<$list filter=\"[{$:/state/importpreviewtype}has[text]]\" variable=\"listItem\" emptyMessage={{$:/core/ui/ImportPreviews/Text}}>\n<$transclude tiddler={{$:/state/importpreviewtype}}/>\n</$list>\n</$reveal>\n</td>\n</tr>\n</$list>\n</tbody>\n</table>\n"
},
"$:/core/ui/ImportPreviews/Diff": {
"title": "$:/core/ui/ImportPreviews/Diff",
"tags": "$:/tags/ImportPreview",
"caption": "{{$:/language/Import/Listing/Preview/Diff}}",
"text": "<$macrocall $name=\"compareTiddlerText\" sourceTiddlerTitle=<<payloadTiddler>> destTiddlerTitle=<<currentTiddler>> destSubTiddlerTitle=<<payloadTiddler>>/>\n"
},
"$:/core/ui/ImportPreviews/DiffFields": {
"title": "$:/core/ui/ImportPreviews/DiffFields",
"tags": "$:/tags/ImportPreview",
"caption": "{{$:/language/Import/Listing/Preview/DiffFields}}",
"text": "<$macrocall $name=\"compareTiddlers\" sourceTiddlerTitle=<<payloadTiddler>> destTiddlerTitle=<<currentTiddler>> destSubTiddlerTitle=<<payloadTiddler>> exclude=\"text\"/>\n"
},
"$:/core/ui/ImportPreviews/Fields": {
"title": "$:/core/ui/ImportPreviews/Fields",
"tags": "$:/tags/ImportPreview",
"caption": "{{$:/language/Import/Listing/Preview/Fields}}",
"text": "<table class=\"tc-view-field-table\">\n<tbody>\n<$list filter=\"[<payloadTiddler>subtiddlerfields<currentTiddler>sort[]] -text\" variable=\"fieldName\">\n<tr class=\"tc-view-field\">\n<td class=\"tc-view-field-name\">\n<$text text=<<fieldName>>/>\n</td>\n<td class=\"tc-view-field-value\">\n<$view field=<<fieldName>> tiddler=<<currentTiddler>> subtiddler=<<payloadTiddler>>/>\n</td>\n</tr>\n</$list>\n</tbody>\n</table>\n"
},
"$:/core/ui/ImportPreviews/Text": {
"title": "$:/core/ui/ImportPreviews/Text",
"tags": "$:/tags/ImportPreview",
"caption": "{{$:/language/Import/Listing/Preview/Text}}",
"text": "<$transclude tiddler=<<currentTiddler>> subtiddler=<<payloadTiddler>> mode=\"block\"/>\n"
},
"$:/core/ui/ImportPreviews/TextRaw": {
"title": "$:/core/ui/ImportPreviews/TextRaw",
"tags": "$:/tags/ImportPreview",
"caption": "{{$:/language/Import/Listing/Preview/TextRaw}}",
"text": "<pre><code><$view tiddler=<<currentTiddler>> subtiddler=<<payloadTiddler>> /></code></pre>"
},
"$:/core/ui/KeyboardShortcuts/advanced-search": {
"title": "$:/core/ui/KeyboardShortcuts/advanced-search",
"tags": "$:/tags/KeyboardShortcut",
"key": "((advanced-search))",
"text": "<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\">\n<$action-navigate $to=\"$:/AdvancedSearch\"/>\n<$action-sendmessage $message=\"tm-focus-selector\" $param=\"\"\"[data-tiddler-title=\"$:/AdvancedSearch\"] .tc-search input\"\"\"/>\n</$navigator>\n"
},
"$:/core/ui/KeyboardShortcuts/new-image": {
"title": "$:/core/ui/KeyboardShortcuts/new-image",
"tags": "$:/tags/KeyboardShortcut",
"key": "((new-image))",
"text": "<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\" openLinkFromInsideRiver={{$:/config/Navigation/openLinkFromInsideRiver}} openLinkFromOutsideRiver={{$:/config/Navigation/openLinkFromOutsideRiver}} relinkOnRename={{$:/config/RelinkOnRename}}>\n{{$:/core/ui/Actions/new-image}}\n</$navigator>\n"
},
"$:/core/ui/KeyboardShortcuts/new-journal": {
"title": "$:/core/ui/KeyboardShortcuts/new-journal",
"tags": "$:/tags/KeyboardShortcut",
"key": "((new-journal))",
"text": "<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\" openLinkFromInsideRiver={{$:/config/Navigation/openLinkFromInsideRiver}} openLinkFromOutsideRiver={{$:/config/Navigation/openLinkFromOutsideRiver}} relinkOnRename={{$:/config/RelinkOnRename}}>\n{{$:/core/ui/Actions/new-journal}}\n</$navigator>\n"
},
"$:/core/ui/KeyboardShortcuts/new-tiddler": {
"title": "$:/core/ui/KeyboardShortcuts/new-tiddler",
"tags": "$:/tags/KeyboardShortcut",
"key": "((new-tiddler))",
"text": "<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\" openLinkFromInsideRiver={{$:/config/Navigation/openLinkFromInsideRiver}} openLinkFromOutsideRiver={{$:/config/Navigation/openLinkFromOutsideRiver}} relinkOnRename={{$:/config/RelinkOnRename}}>\n{{$:/core/ui/Actions/new-tiddler}}\n</$navigator>\n"
},
"$:/core/ui/KeyboardShortcuts/sidebar-search": {
"title": "$:/core/ui/KeyboardShortcuts/sidebar-search",
"tags": "$:/tags/KeyboardShortcut",
"key": "((sidebar-search))",
"text": "<$action-sendmessage $message=\"tm-focus-selector\" $param=\".tc-search input\"/>\n"
},
"$:/core/ui/KeyboardShortcut/toggle-sidebar": {
"title": "$:/core/ui/KeyboardShortcut/toggle-sidebar",
"tags": "$:/tags/KeyboardShortcut",
"key": "((toggle-sidebar))",
"text": "<$list filter=\"[[$:/state/sidebar]is[missing]] [{$:/state/sidebar}removeprefix[yes]]\" emptyMessage=\"\"\"\n<$action-setfield $tiddler=\"$:/state/sidebar\" text=\"yes\"/>\n\"\"\">\n<$action-setfield $tiddler=\"$:/state/sidebar\" text=\"no\"/>\n</$list>\n"
},
"$:/core/ui/ListItemTemplate": {
"title": "$:/core/ui/ListItemTemplate",
"text": "<div class=\"tc-menu-list-item\">\n<$link />\n</div>"
},
"$:/Manager/ItemMain/Fields": {
"title": "$:/Manager/ItemMain/Fields",
"tags": "$:/tags/Manager/ItemMain",
"caption": "{{$:/language/Manager/Item/Fields}}",
"text": "<table>\n<tbody>\n<$list filter=\"[all[current]fields[]sort[title]] -text\" template=\"$:/core/ui/TiddlerFieldTemplate\" variable=\"listItem\"/>\n</tbody>\n</table>\n"
},
"$:/Manager/ItemMain/RawText": {
"title": "$:/Manager/ItemMain/RawText",
"tags": "$:/tags/Manager/ItemMain",
"caption": "{{$:/language/Manager/Item/RawText}}",
"text": "<pre><code><$view/></code></pre>\n"
},
"$:/Manager/ItemMain/WikifiedText": {
"title": "$:/Manager/ItemMain/WikifiedText",
"tags": "$:/tags/Manager/ItemMain",
"caption": "{{$:/language/Manager/Item/WikifiedText}}",
"text": "<$transclude mode=\"block\"/>\n"
},
"$:/Manager/ItemSidebar/Colour": {
"title": "$:/Manager/ItemSidebar/Colour",
"tags": "$:/tags/Manager/ItemSidebar",
"caption": "{{$:/language/Manager/Item/Colour}}",
"text": "\\define swatch-styles()\nheight: 1em;\nbackground-color: $(colour)$\n\\end\n\n<$vars colour={{!!color}}>\n<p style=<<swatch-styles>>/>\n</$vars>\n<p>\n<$edit-text field=\"color\" tag=\"input\" type=\"color\"/> / <$edit-text field=\"color\" tag=\"input\" type=\"text\" size=\"9\"/>\n</p>\n"
},
"$:/Manager/ItemSidebar/Icon": {
"title": "$:/Manager/ItemSidebar/Icon",
"tags": "$:/tags/Manager/ItemSidebar",
"caption": "{{$:/language/Manager/Item/Icon}}",
"text": "<p>\n<div class=\"tc-manager-icon-editor\">\n<$button popup=<<qualify \"$:/state/popup/image-picker\">> class=\"tc-btn-invisible\">\n<$transclude tiddler={{!!icon}}>\n{{$:/language/Manager/Item/Icon/None}}\n</$transclude>\n</$button>\n<div class=\"tc-block-dropdown-wrapper\" style=\"position: static;\">\n<$reveal state=<<qualify \"$:/state/popup/image-picker\">> type=\"nomatch\" text=\"\" default=\"\" tag=\"div\" class=\"tc-popup\">\n<div class=\"tc-block-dropdown tc-popup-keep\" style=\"width: 80%; left: 10%; right: 10%; padding: 0.5em;\">\n<$macrocall $name=\"image-picker-include-tagged-images\" actions=\"\"\"\n<$action-setfield $field=\"icon\" $value=<<imageTitle>>/>\n<$action-deletetiddler $tiddler=<<qualify \"$:/state/popup/image-picker\">>/>\n\"\"\"/>\n</div>\n</$reveal>\n</div>\n</div>\n</p>\n"
},
"$:/Manager/ItemSidebar/Tags": {
"title": "$:/Manager/ItemSidebar/Tags",
"tags": "$:/tags/Manager/ItemSidebar",
"caption": "{{$:/language/Manager/Item/Tags}}",
"text": "\\define tag-checkbox-actions()\n<$action-listops\n\t$tiddler=\"$:/config/Manager/RecentTags\"\n\t$subfilter=\"[<tag>] [list[$:/config/Manager/RecentTags]] +[limit[12]]\"\n/>\n\\end\n\n\\define tag-picker-actions()\n<<tag-checkbox-actions>>\n<$action-listops\n\t$tiddler=<<currentTiddler>>\n\t$field=\"tags\"\n\t$subfilter=\"[<tag>] [all[current]tags[]]\"\n/>\n\\end\n\n<p>\n<$list filter=\"[all[current]tags[]] [list[$:/config/Manager/RecentTags]] +[sort[title]] \" variable=\"tag\">\n<div>\n<$checkbox tiddler=<<currentTiddler>> tag=<<tag>> actions=<<tag-checkbox-actions>>>\n<$macrocall $name=\"tag-pill\" tag=<<tag>>/>\n</$checkbox>\n</div>\n</$list>\n</p>\n<p>\n<$macrocall $name=\"tag-picker\" actions=<<tag-picker-actions>>/>\n</p>\n"
},
"$:/Manager/ItemSidebar/Tools": {
"title": "$:/Manager/ItemSidebar/Tools",
"tags": "$:/tags/Manager/ItemSidebar",
"caption": "{{$:/language/Manager/Item/Tools}}",
"text": "<p>\n<$button to=<<currentTiddler>>>{{$:/core/images/link}} open</$button>\n</p>\n<p>\n<$button message=\"tm-edit-tiddler\" param=<<currentTiddler>>>{{$:/core/images/edit-button}} edit</$button>\n</p>\n"
},
"$:/Manager": {
"title": "$:/Manager",
"icon": "$:/core/images/list",
"color": "#bbb",
"text": "\\define lingo-base() $:/language/Manager/\n\n\\define list-item-content-item()\n<div class=\"tc-manager-list-item-content-item\">\n\t<$vars state-title=\"\"\"$:/state/popup/manager/item/$(listItem)$\"\"\">\n\t\t<$reveal state=<<state-title>> type=\"match\" text=\"show\" default=\"show\" tag=\"div\">\n\t\t\t<$button set=<<state-title>> setTo=\"hide\" class=\"tc-btn-invisible tc-manager-list-item-content-item-heading\">\n\t\t\t\t{{$:/core/images/down-arrow}} <$transclude tiddler=<<listItem>> field=\"caption\"/>\n\t\t\t</$button>\n\t\t</$reveal>\n\t\t<$reveal state=<<state-title>> type=\"nomatch\" text=\"show\" default=\"show\" tag=\"div\">\n\t\t\t<$button set=<<state-title>> setTo=\"show\" class=\"tc-btn-invisible tc-manager-list-item-content-item-heading\">\n\t\t\t\t{{$:/core/images/right-arrow}} <$transclude tiddler=<<listItem>> field=\"caption\"/>\n\t\t\t</$button>\n\t\t</$reveal>\n\t\t<$reveal state=<<state-title>> type=\"match\" text=\"show\" default=\"show\" tag=\"div\" class=\"tc-manager-list-item-content-item-body\">\n\t\t\t<$transclude tiddler=<<listItem>>/>\n\t\t</$reveal>\n\t</$vars>\n</div>\n\\end\n\n<div class=\"tc-manager-wrapper\">\n\t<div class=\"tc-manager-controls\">\n\t\t<div class=\"tc-manager-control\">\n\t\t\t<<lingo Controls/Show/Prompt>> <$select tiddler=\"$:/config/Manager/Show\" default=\"tiddlers\">\n\t\t\t\t<option value=\"tiddlers\"><<lingo Controls/Show/Option/Tiddlers>></option>\n\t\t\t\t<option value=\"tags\"><<lingo Controls/Show/Option/Tags>></option>\n\t\t\t</$select>\n\t\t</div>\n\t\t<div class=\"tc-manager-control\">\n\t\t\t<<lingo Controls/Search/Prompt>> <$edit-text tiddler=\"$:/config/Manager/Filter\" tag=\"input\" default=\"\" placeholder={{$:/language/Manager/Controls/Search/Placeholder}}/>\n\t\t</div>\n\t\t<div class=\"tc-manager-control\">\n\t\t\t<<lingo Controls/FilterByTag/Prompt>> <$select tiddler=\"$:/config/Manager/Tag\" default=\"\">\n\t\t\t\t<option value=\"\"><<lingo Controls/FilterByTag/None>></option>\n\t\t\t\t<$list filter=\"[!is{$:/config/Manager/System}tags[]!is[system]sort[title]]\" variable=\"tag\">\n\t\t\t\t\t<option value=<<tag>>><$text text=<<tag>>/></option>\n\t\t\t\t</$list>\n\t\t\t</$select>\n\t\t</div>\n\t\t<div class=\"tc-manager-control\">\n\t\t\t<<lingo Controls/Sort/Prompt>> <$select tiddler=\"$:/config/Manager/Sort\" default=\"title\">\n\t\t\t\t<optgroup label=\"Common\">\n\t\t\t\t\t<$list filter=\"title modified modifier created creator created\" variable=\"field\">\n\t\t\t\t\t\t<option value=<<field>>><$text text=<<field>>/></option>\n\t\t\t\t\t</$list>\n\t\t\t\t</optgroup>\n\t\t\t\t<optgroup label=\"All\">\n\t\t\t\t\t<$list filter=\"[all{$:/config/Manager/Show}!is{$:/config/Manager/System}fields[]sort[title]] -title -modified -modifier -created -creator -created\" variable=\"field\">\n\t\t\t\t\t\t<option value=<<field>>><$text text=<<field>>/></option>\n\t\t\t\t\t</$list>\n\t\t\t\t</optgroup>\n\t\t\t</$select>\n\t\t\t<$checkbox tiddler=\"$:/config/Manager/Order\" field=\"text\" checked=\"reverse\" unchecked=\"forward\" default=\"forward\">\n\t\t\t\t<<lingo Controls/Order/Prompt>>\n\t\t\t</$checkbox>\n\t\t</div>\n\t\t<div class=\"tc-manager-control\">\n\t\t\t<$checkbox tiddler=\"$:/config/Manager/System\" field=\"text\" checked=\"\" unchecked=\"system\" default=\"system\">\n\t\t\t\t{{$:/language/SystemTiddlers/Include/Prompt}}\n\t\t\t</$checkbox>\n\t\t</div>\n\t</div>\n\t<div class=\"tc-manager-list\">\n\t\t<$list filter=\"[all{$:/config/Manager/Show}!is{$:/config/Manager/System}search{$:/config/Manager/Filter}tag:strict{$:/config/Manager/Tag}sort{$:/config/Manager/Sort}order{$:/config/Manager/Order}]\">\n\t\t\t<$vars transclusion=<<currentTiddler>>>\n\t\t\t\t<div style=\"tc-manager-list-item\">\n\t\t\t\t\t<$button popup=<<qualify \"$:/state/manager/popup\">> class=\"tc-btn-invisible tc-manager-list-item-heading\" selectedClass=\"tc-manager-list-item-heading-selected\">\n\t\t\t\t\t\t<$text text=<<currentTiddler>>/>\n\t\t\t\t\t</$button>\n\t\t\t\t\t<$reveal state=<<qualify \"$:/state/manager/popup\">> type=\"nomatch\" text=\"\" default=\"\" tag=\"div\" class=\"tc-manager-list-item-content tc-popup-handle\">\n\t\t\t\t\t\t<div class=\"tc-manager-list-item-content-tiddler\">\n\t\t\t\t\t\t\t<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Manager/ItemMain]!has[draft.of]]\" variable=\"listItem\">\n\t\t\t\t\t\t\t\t<<list-item-content-item>>\n\t\t\t\t\t\t\t</$list>\n\t\t\t\t\t\t</div>\n\t\t\t\t\t\t<div class=\"tc-manager-list-item-content-sidebar\">\n\t\t\t\t\t\t\t<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Manager/ItemSidebar]!has[draft.of]]\" variable=\"listItem\">\n\t\t\t\t\t\t\t\t<<list-item-content-item>>\n\t\t\t\t\t\t\t</$list>\n\t\t\t\t\t\t</div>\n\t\t\t\t\t</$reveal>\n\t\t\t\t</div>\n\t\t\t</$vars>\n\t\t</$list>\n\t</div>\n</div>\n"
},
"$:/core/ui/MissingTemplate": {
"title": "$:/core/ui/MissingTemplate",
"text": "<div class=\"tc-tiddler-missing\">\n<$button popup=<<qualify \"$:/state/popup/missing\">> class=\"tc-btn-invisible tc-missing-tiddler-label\">\n<$view field=\"title\" format=\"text\" />\n</$button>\n<$reveal state=<<qualify \"$:/state/popup/missing\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\">\n<$transclude tiddler=\"$:/core/ui/ListItemTemplate\"/>\n<hr>\n<$list filter=\"[all[current]backlinks[]sort[title]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n</div>\n</$reveal>\n</div>\n"
},
"$:/core/ui/MoreSideBar/All": {
"title": "$:/core/ui/MoreSideBar/All",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/All/Caption}}",
"text": "<$list filter={{$:/core/Filters/AllTiddlers!!filter}} template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/Drafts": {
"title": "$:/core/ui/MoreSideBar/Drafts",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Drafts/Caption}}",
"text": "<$list filter={{$:/core/Filters/Drafts!!filter}} template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/Explorer": {
"title": "$:/core/ui/MoreSideBar/Explorer",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Explorer/Caption}}",
"text": "<<tree \"$:/\">>\n"
},
"$:/core/ui/MoreSideBar/Missing": {
"title": "$:/core/ui/MoreSideBar/Missing",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Missing/Caption}}",
"text": "<$list filter={{$:/core/Filters/Missing!!filter}} template=\"$:/core/ui/MissingTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/Orphans": {
"title": "$:/core/ui/MoreSideBar/Orphans",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Orphans/Caption}}",
"text": "<$list filter={{$:/core/Filters/Orphans!!filter}} template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/Plugins": {
"title": "$:/core/ui/MoreSideBar/Plugins",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/ControlPanel/Plugins/Caption}}",
"text": "\n{{$:/language/ControlPanel/Plugins/Installed/Hint}}\n\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/MoreSideBar/Plugins]!has[draft.of]]\" \"$:/core/ui/MoreSideBar/Plugins/Plugins\">>\n"
},
"$:/core/ui/MoreSideBar/Recent": {
"title": "$:/core/ui/MoreSideBar/Recent",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Recent/Caption}}",
"text": "<$macrocall $name=\"timeline\" format={{$:/language/RecentChanges/DateFormat}}/>\n"
},
"$:/core/ui/MoreSideBar/Shadows": {
"title": "$:/core/ui/MoreSideBar/Shadows",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Shadows/Caption}}",
"text": "<$list filter={{$:/core/Filters/ShadowTiddlers!!filter}} template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/System": {
"title": "$:/core/ui/MoreSideBar/System",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/System/Caption}}",
"text": "<$list filter={{$:/core/Filters/SystemTiddlers!!filter}} template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/MoreSideBar/Tags": {
"title": "$:/core/ui/MoreSideBar/Tags",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Tags/Caption}}",
"text": "<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"\">\n\n{{$:/core/ui/Buttons/tag-manager}}\n\n</$set>\n\n</$set>\n\n</$set>\n\n<$list filter={{$:/core/Filters/AllTags!!filter}}>\n\n<$transclude tiddler=\"$:/core/ui/TagTemplate\"/>\n\n</$list>\n\n<hr class=\"tc-untagged-separator\">\n\n{{$:/core/ui/UntaggedTemplate}}\n"
},
"$:/core/ui/MoreSideBar/Types": {
"title": "$:/core/ui/MoreSideBar/Types",
"tags": "$:/tags/MoreSideBar",
"caption": "{{$:/language/SideBar/Types/Caption}}",
"text": "<$list filter={{$:/core/Filters/TypedTiddlers!!filter}}>\n<div class=\"tc-menu-list-item\">\n<$view field=\"type\"/>\n<$list filter=\"[type{!!type}!is[system]sort[title]]\">\n<div class=\"tc-menu-list-subitem\">\n<$link to={{!!title}}><$view field=\"title\"/></$link>\n</div>\n</$list>\n</div>\n</$list>\n"
},
"$:/core/ui/MoreSideBar/Plugins/Languages": {
"title": "$:/core/ui/MoreSideBar/Plugins/Languages",
"tags": "$:/tags/MoreSideBar/Plugins",
"caption": "{{$:/language/ControlPanel/Plugins/Languages/Caption}}",
"text": "<$list filter=\"[!has[draft.of]plugin-type[language]sort[description]]\" template=\"$:/core/ui/PluginListItemTemplate\" emptyMessage={{$:/language/ControlPanel/Plugins/Empty/Hint}}/>\n"
},
"$:/core/ui/MoreSideBar/Plugins/Plugins": {
"title": "$:/core/ui/MoreSideBar/Plugins/Plugins",
"tags": "$:/tags/MoreSideBar/Plugins",
"caption": "{{$:/language/ControlPanel/Plugins/Plugins/Caption}}",
"text": "<$list filter=\"[!has[draft.of]plugin-type[plugin]sort[description]]\" template=\"$:/core/ui/PluginListItemTemplate\" emptyMessage={{$:/language/ControlPanel/Plugins/Empty/Hint}}>>/>\n"
},
"$:/core/ui/MoreSideBar/Plugins/Theme": {
"title": "$:/core/ui/MoreSideBar/Plugins/Theme",
"tags": "$:/tags/MoreSideBar/Plugins",
"caption": "{{$:/language/ControlPanel/Plugins/Themes/Caption}}",
"text": "<$list filter=\"[!has[draft.of]plugin-type[theme]sort[description]]\" template=\"$:/core/ui/PluginListItemTemplate\" emptyMessage={{$:/language/ControlPanel/Plugins/Empty/Hint}}/>\n"
},
"$:/core/ui/Buttons/advanced-search": {
"title": "$:/core/ui/Buttons/advanced-search",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/advanced-search-button}} {{$:/language/Buttons/AdvancedSearch/Caption}}",
"description": "{{$:/language/Buttons/AdvancedSearch/Hint}}",
"text": "\\whitespace trim\n\\define control-panel-button(class)\n<$button to=\"$:/AdvancedSearch\" tooltip={{$:/language/Buttons/AdvancedSearch/Hint}} aria-label={{$:/language/Buttons/AdvancedSearch/Caption}} class=\"\"\"$(tv-config-toolbar-class)$ $class$\"\"\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/advanced-search-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/AdvancedSearch/Caption}}/></span>\n</$list>\n</$button>\n\\end\n\n<$list filter=\"[list[$:/StoryList]] +[field:title[$:/AdvancedSearch]]\" emptyMessage=<<control-panel-button>>>\n<<control-panel-button \"tc-selected\">>\n</$list>\n"
},
"$:/core/ui/Buttons/close-all": {
"title": "$:/core/ui/Buttons/close-all",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/close-all-button}} {{$:/language/Buttons/CloseAll/Caption}}",
"description": "{{$:/language/Buttons/CloseAll/Hint}}",
"text": "<$button message=\"tm-close-all-tiddlers\" tooltip={{$:/language/Buttons/CloseAll/Hint}} aria-label={{$:/language/Buttons/CloseAll/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/close-all-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/CloseAll/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/control-panel": {
"title": "$:/core/ui/Buttons/control-panel",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/options-button}} {{$:/language/Buttons/ControlPanel/Caption}}",
"description": "{{$:/language/Buttons/ControlPanel/Hint}}",
"text": "\\whitespace trim\n\\define control-panel-button(class)\n<$button to=\"$:/ControlPanel\" tooltip={{$:/language/Buttons/ControlPanel/Hint}} aria-label={{$:/language/Buttons/ControlPanel/Caption}} class=\"\"\"$(tv-config-toolbar-class)$ $class$\"\"\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/options-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/ControlPanel/Caption}}/></span>\n</$list>\n</$button>\n\\end\n\n<$list filter=\"[list[$:/StoryList]] +[field:title[$:/ControlPanel]]\" emptyMessage=<<control-panel-button>>>\n<<control-panel-button \"tc-selected\">>\n</$list>\n"
},
"$:/core/ui/Buttons/encryption": {
"title": "$:/core/ui/Buttons/encryption",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/locked-padlock}} {{$:/language/Buttons/Encryption/Caption}}",
"description": "{{$:/language/Buttons/Encryption/Hint}}",
"text": "\\whitespace trim\n<$reveal type=\"match\" state=\"$:/isEncrypted\" text=\"yes\">\n<$button message=\"tm-clear-password\" tooltip={{$:/language/Buttons/Encryption/ClearPassword/Hint}} aria-label={{$:/language/Buttons/Encryption/ClearPassword/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/locked-padlock}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Encryption/ClearPassword/Caption}}/></span>\n</$list>\n</$button>\n</$reveal>\n<$reveal type=\"nomatch\" state=\"$:/isEncrypted\" text=\"yes\">\n<$button message=\"tm-set-password\" tooltip={{$:/language/Buttons/Encryption/SetPassword/Hint}} aria-label={{$:/language/Buttons/Encryption/SetPassword/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/unlocked-padlock}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Encryption/SetPassword/Caption}}/></span>\n</$list>\n</$button>\n</$reveal>\n"
},
"$:/core/ui/Buttons/export-page": {
"title": "$:/core/ui/Buttons/export-page",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/export-button}} {{$:/language/Buttons/ExportPage/Caption}}",
"description": "{{$:/language/Buttons/ExportPage/Hint}}",
"text": "<$macrocall $name=\"exportButton\" exportFilter=\"[!is[system]sort[title]]\" lingoBase=\"$:/language/Buttons/ExportPage/\"/>"
},
"$:/core/ui/Buttons/fold-all": {
"title": "$:/core/ui/Buttons/fold-all",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/fold-all-button}} {{$:/language/Buttons/FoldAll/Caption}}",
"description": "{{$:/language/Buttons/FoldAll/Hint}}",
"text": "<$button tooltip={{$:/language/Buttons/FoldAll/Hint}} aria-label={{$:/language/Buttons/FoldAll/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-sendmessage $message=\"tm-fold-all-tiddlers\" $param=<<currentTiddler>> foldedStatePrefix=\"$:/state/folded/\"/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\" variable=\"listItem\">\n{{$:/core/images/fold-all-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/FoldAll/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/full-screen": {
"title": "$:/core/ui/Buttons/full-screen",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/full-screen-button}} {{$:/language/Buttons/FullScreen/Caption}}",
"description": "{{$:/language/Buttons/FullScreen/Hint}}",
"text": "<$button message=\"tm-full-screen\" tooltip={{$:/language/Buttons/FullScreen/Hint}} aria-label={{$:/language/Buttons/FullScreen/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/full-screen-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/FullScreen/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/home": {
"title": "$:/core/ui/Buttons/home",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/home-button}} {{$:/language/Buttons/Home/Caption}}",
"description": "{{$:/language/Buttons/Home/Hint}}",
"text": "<$button message=\"tm-home\" tooltip={{$:/language/Buttons/Home/Hint}} aria-label={{$:/language/Buttons/Home/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/home-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Home/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/import": {
"title": "$:/core/ui/Buttons/import",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/import-button}} {{$:/language/Buttons/Import/Caption}}",
"description": "{{$:/language/Buttons/Import/Hint}}",
"text": "<div class=\"tc-file-input-wrapper\">\n<$button tooltip={{$:/language/Buttons/Import/Hint}} aria-label={{$:/language/Buttons/Import/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/import-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Import/Caption}}/></span>\n</$list>\n</$button>\n<$browse tooltip={{$:/language/Buttons/Import/Hint}}/>\n</div>"
},
"$:/core/ui/Buttons/language": {
"title": "$:/core/ui/Buttons/language",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/globe}} {{$:/language/Buttons/Language/Caption}}",
"description": "{{$:/language/Buttons/Language/Hint}}",
"text": "\\whitespace trim\n\\define flag-title()\n$(languagePluginTitle)$/icon\n\\end\n<span class=\"tc-popup-keep\">\n<$button popup=<<qualify \"$:/state/popup/language\">> tooltip={{$:/language/Buttons/Language/Hint}} aria-label={{$:/language/Buttons/Language/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n<span class=\"tc-image-button\">\n<$set name=\"languagePluginTitle\" value={{$:/language}}>\n<$image source=<<flag-title>>/>\n</$set>\n</span>\n</$list>\n<$text text=\" \"/>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Language/Caption}}/></span>\n</$list>\n</$button>\n</span>\n<$reveal state=<<qualify \"$:/state/popup/language\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\">\n{{$:/snippets/languageswitcher}}\n</div>\n</$reveal>\n"
},
"$:/core/ui/Buttons/manager": {
"title": "$:/core/ui/Buttons/manager",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/list}} {{$:/language/Buttons/Manager/Caption}}",
"description": "{{$:/language/Buttons/Manager/Hint}}",
"text": "\\whitespace trim\n\\define manager-button(class)\n<$button to=\"$:/Manager\" tooltip={{$:/language/Buttons/Manager/Hint}} aria-label={{$:/language/Buttons/Manager/Caption}} class=\"\"\"$(tv-config-toolbar-class)$ $class$\"\"\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/list}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Manager/Caption}}/></span>\n</$list>\n</$button>\n\\end\n\n<$list filter=\"[list[$:/StoryList]] +[field:title[$:/Manager]]\" emptyMessage=<<manager-button>>>\n<<manager-button \"tc-selected\">>\n</$list>\n"
},
"$:/core/ui/Buttons/more-page-actions": {
"title": "$:/core/ui/Buttons/more-page-actions",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/down-arrow}} {{$:/language/Buttons/More/Caption}}",
"description": "{{$:/language/Buttons/More/Hint}}",
"text": "\\define config-title()\n$:/config/PageControlButtons/Visibility/$(listItem)$\n\\end\n<$button popup=<<qualify \"$:/state/popup/more\">> tooltip={{$:/language/Buttons/More/Hint}} aria-label={{$:/language/Buttons/More/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/down-arrow}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/More/Caption}}/></span>\n</$list>\n</$button><$reveal state=<<qualify \"$:/state/popup/more\">> type=\"popup\" position=\"below\" animate=\"yes\">\n\n<div class=\"tc-drop-down\">\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"tc-btn-invisible\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]] -[[$:/core/ui/Buttons/more-page-actions]]\" variable=\"listItem\">\n\n<$reveal type=\"match\" state=<<config-title>> text=\"hide\">\n\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$set>\n\n</$reveal>\n\n</$list>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</div>\n\n</$reveal>"
},
"$:/core/ui/Buttons/new-image": {
"title": "$:/core/ui/Buttons/new-image",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/new-image-button}} {{$:/language/Buttons/NewImage/Caption}}",
"description": "{{$:/language/Buttons/NewImage/Hint}}",
"text": "\\whitespace trim\n<$button tooltip={{$:/language/Buttons/NewImage/Hint}} aria-label={{$:/language/Buttons/NewImage/Caption}} class=<<tv-config-toolbar-class>> actions={{$:/core/ui/Actions/new-image}}>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/new-image-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/NewImage/Caption}}/></span>\n</$list>\n</$button>\n"
},
"$:/core/ui/Buttons/new-journal": {
"title": "$:/core/ui/Buttons/new-journal",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/new-journal-button}} {{$:/language/Buttons/NewJournal/Caption}}",
"description": "{{$:/language/Buttons/NewJournal/Hint}}",
"text": "\\whitespace trim\n\\define journalButton()\n<$button tooltip={{$:/language/Buttons/NewJournal/Hint}} aria-label={{$:/language/Buttons/NewJournal/Caption}} class=<<tv-config-toolbar-class>> actions={{$:/core/ui/Actions/new-journal}}>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/new-journal-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/NewJournal/Caption}}/></span>\n</$list>\n</$button>\n\\end\n<<journalButton>>\n"
},
"$:/core/ui/Buttons/new-tiddler": {
"title": "$:/core/ui/Buttons/new-tiddler",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/new-button}} {{$:/language/Buttons/NewTiddler/Caption}}",
"description": "{{$:/language/Buttons/NewTiddler/Hint}}",
"text": "\\whitespace trim\n<$button actions={{$:/core/ui/Actions/new-tiddler}} tooltip={{$:/language/Buttons/NewTiddler/Hint}} aria-label={{$:/language/Buttons/NewTiddler/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/new-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/NewTiddler/Caption}}/></span>\n</$list>\n</$button>\n"
},
"$:/core/ui/Buttons/palette": {
"title": "$:/core/ui/Buttons/palette",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/palette}} {{$:/language/Buttons/Palette/Caption}}",
"description": "{{$:/language/Buttons/Palette/Hint}}",
"text": "\\whitespace trim\n<span class=\"tc-popup-keep\">\n<$button popup=<<qualify \"$:/state/popup/palette\">> tooltip={{$:/language/Buttons/Palette/Hint}} aria-label={{$:/language/Buttons/Palette/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/palette}}\n</$list>\n<$text text=\" \"/>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Palette/Caption}}/></span>\n</$list>\n</$button>\n</span>\n<$reveal state=<<qualify \"$:/state/popup/palette\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\" style=\"font-size:0.7em;\">\n{{$:/snippets/paletteswitcher}}\n</div>\n</$reveal>\n"
},
"$:/core/ui/Buttons/print": {
"title": "$:/core/ui/Buttons/print",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/print-button}} {{$:/language/Buttons/Print/Caption}}",
"description": "{{$:/language/Buttons/Print/Hint}}",
"text": "<$button message=\"tm-print\" tooltip={{$:/language/Buttons/Print/Hint}} aria-label={{$:/language/Buttons/Print/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/print-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Print/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/refresh": {
"title": "$:/core/ui/Buttons/refresh",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/refresh-button}} {{$:/language/Buttons/Refresh/Caption}}",
"description": "{{$:/language/Buttons/Refresh/Hint}}",
"text": "<$button message=\"tm-browser-refresh\" tooltip={{$:/language/Buttons/Refresh/Hint}} aria-label={{$:/language/Buttons/Refresh/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/refresh-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Refresh/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/save-wiki": {
"title": "$:/core/ui/Buttons/save-wiki",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/save-button}} {{$:/language/Buttons/SaveWiki/Caption}}",
"description": "{{$:/language/Buttons/SaveWiki/Hint}}",
"text": "<$button tooltip={{$:/language/Buttons/SaveWiki/Hint}} aria-label={{$:/language/Buttons/SaveWiki/Caption}} class=<<tv-config-toolbar-class>>>\n<$wikify name=\"site-title\" text={{$:/config/SaveWikiButton/Filename}}>\n<$action-sendmessage $message=\"tm-save-wiki\" $param={{$:/config/SaveWikiButton/Template}} filename=<<site-title>>/>\n</$wikify>\n<span class=\"tc-dirty-indicator\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/save-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/SaveWiki/Caption}}/></span>\n</$list>\n</span>\n</$button>"
},
"$:/core/ui/Buttons/storyview": {
"title": "$:/core/ui/Buttons/storyview",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/storyview-classic}} {{$:/language/Buttons/StoryView/Caption}}",
"description": "{{$:/language/Buttons/StoryView/Hint}}",
"text": "\\whitespace trim\n\\define icon()\n$:/core/images/storyview-$(storyview)$\n\\end\n<span class=\"tc-popup-keep\">\n<$button popup=<<qualify \"$:/state/popup/storyview\">> tooltip={{$:/language/Buttons/StoryView/Hint}} aria-label={{$:/language/Buttons/StoryView/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n<$set name=\"storyview\" value={{$:/view}}>\n<$transclude tiddler=<<icon>>/>\n</$set>\n</$list>\n<$text text=\" \"/>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/StoryView/Caption}}/></span>\n</$list>\n</$button>\n</span>\n<$reveal state=<<qualify \"$:/state/popup/storyview\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\">\n{{$:/snippets/viewswitcher}}\n</div>\n</$reveal>\n"
},
"$:/core/ui/Buttons/tag-manager": {
"title": "$:/core/ui/Buttons/tag-manager",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/tag-button}} {{$:/language/Buttons/TagManager/Caption}}",
"description": "{{$:/language/Buttons/TagManager/Hint}}",
"text": "\\whitespace trim\n\\define control-panel-button(class)\n<$button to=\"$:/TagManager\" tooltip={{$:/language/Buttons/TagManager/Hint}} aria-label={{$:/language/Buttons/TagManager/Caption}} class=\"\"\"$(tv-config-toolbar-class)$ $class$\"\"\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/tag-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/TagManager/Caption}}/></span>\n</$list>\n</$button>\n\\end\n\n<$list filter=\"[list[$:/StoryList]] +[field:title[$:/TagManager]]\" emptyMessage=<<control-panel-button>>>\n<<control-panel-button \"tc-selected\">>\n</$list>\n"
},
"$:/core/ui/Buttons/theme": {
"title": "$:/core/ui/Buttons/theme",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/theme-button}} {{$:/language/Buttons/Theme/Caption}}",
"description": "{{$:/language/Buttons/Theme/Hint}}",
"text": "\\whitespace trim\n<span class=\"tc-popup-keep\">\n<$button popup=<<qualify \"$:/state/popup/theme\">> tooltip={{$:/language/Buttons/Theme/Hint}} aria-label={{$:/language/Buttons/Theme/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/theme-button}}\n</$list>\n<$text text=\" \"/>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Theme/Caption}}/></span>\n</$list>\n</$button>\n</span>\n<$reveal state=<<qualify \"$:/state/popup/theme\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\">\n<$linkcatcher to=\"$:/theme\">\n{{$:/snippets/themeswitcher}}\n</$linkcatcher>\n</div>\n</$reveal>\n"
},
"$:/core/ui/Buttons/timestamp": {
"title": "$:/core/ui/Buttons/timestamp",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/timestamp-on}} {{$:/language/Buttons/Timestamp/Caption}}",
"description": "{{$:/language/Buttons/Timestamp/Hint}}",
"text": "\\whitespace trim\n<$reveal type=\"nomatch\" state=\"$:/config/TimestampDisable\" text=\"yes\">\n<$button tooltip={{$:/language/Buttons/Timestamp/On/Hint}} aria-label={{$:/language/Buttons/Timestamp/On/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-setfield $tiddler=\"$:/config/TimestampDisable\" $value=\"yes\"/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/timestamp-on}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Timestamp/On/Caption}}/></span>\n</$list>\n</$button>\n</$reveal>\n<$reveal type=\"match\" state=\"$:/config/TimestampDisable\" text=\"yes\">\n<$button tooltip={{$:/language/Buttons/Timestamp/Off/Hint}} aria-label={{$:/language/Buttons/Timestamp/Off/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-setfield $tiddler=\"$:/config/TimestampDisable\" $value=\"no\"/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/timestamp-off}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/Timestamp/Off/Caption}}/></span>\n</$list>\n</$button>\n</$reveal>\n"
},
"$:/core/ui/Buttons/unfold-all": {
"title": "$:/core/ui/Buttons/unfold-all",
"tags": "$:/tags/PageControls",
"caption": "{{$:/core/images/unfold-all-button}} {{$:/language/Buttons/UnfoldAll/Caption}}",
"description": "{{$:/language/Buttons/UnfoldAll/Hint}}",
"text": "<$button tooltip={{$:/language/Buttons/UnfoldAll/Hint}} aria-label={{$:/language/Buttons/UnfoldAll/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-sendmessage $message=\"tm-unfold-all-tiddlers\" $param=<<currentTiddler>> foldedStatePrefix=\"$:/state/folded/\"/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\" variable=\"listItem\">\n{{$:/core/images/unfold-all-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/UnfoldAll/Caption}}/></span>\n</$list>\n</$button>"
},
"$:/core/ui/PageTemplate/pagecontrols": {
"title": "$:/core/ui/PageTemplate/pagecontrols",
"text": "\\whitespace trim\n\\define config-title()\n$:/config/PageControlButtons/Visibility/$(listItem)$\n\\end\n<div class=\"tc-page-controls\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]]\" variable=\"listItem\">\n<$set name=\"hidden\" value=<<config-title>>>\n<$list filter=\"[<hidden>!text[hide]]\" storyview=\"pop\" variable=\"ignore\">\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n</$set>\n</$list>\n</$set>\n</$list>\n</div>\n"
},
"$:/core/ui/PageStylesheet": {
"title": "$:/core/ui/PageStylesheet",
"text": "\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\n<$set name=\"currentTiddler\" value={{$:/language}}>\n\n<$set name=\"languageTitle\" value={{!!name}}>\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Stylesheet]!has[draft.of]]\">\n<$transclude mode=\"block\"/>\n</$list>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/PageTemplate/alerts": {
"title": "$:/core/ui/PageTemplate/alerts",
"tags": "$:/tags/PageTemplate",
"text": "<div class=\"tc-alerts\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Alert]!has[draft.of]]\" template=\"$:/core/ui/AlertTemplate\" storyview=\"pop\"/>\n\n</div>\n"
},
"$:/core/ui/PageTemplate/drafts": {
"title": "$:/core/ui/PageTemplate/drafts",
"tags": "$:/tags/PageTemplate",
"text": "\\whitespace trim\n<$reveal state=\"$:/status/IsReadOnly\" type=\"nomatch\" text=\"yes\" tag=\"div\" class=\"tc-drafts-list\">\n<$list filter=\"[has[draft.of]!sort[modified]] -[list[$:/StoryList]]\">\n<$link>\n{{$:/core/images/edit-button}} <$text text=<<currentTiddler>>/>\n</$link>\n</$list>\n</$reveal>\n"
},
"$:/core/ui/PageTemplate/pluginreloadwarning": {
"title": "$:/core/ui/PageTemplate/pluginreloadwarning",
"tags": "$:/tags/PageTemplate",
"text": "\\define lingo-base() $:/language/\n\n<$list filter=\"[{$:/status/RequireReloadDueToPluginChange}match[yes]]\">\n\n<$reveal type=\"nomatch\" state=\"$:/temp/HidePluginWarning\" text=\"yes\">\n\n<div class=\"tc-plugin-reload-warning\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"\">\n\n<<lingo PluginReloadWarning>> <$button set=\"$:/temp/HidePluginWarning\" setTo=\"yes\" class=\"tc-btn-invisible\">{{$:/core/images/close-button}}</$button>\n\n</$set>\n\n</div>\n\n</$reveal>\n\n</$list>\n"
},
"$:/core/ui/PageTemplate/sidebar": {
"title": "$:/core/ui/PageTemplate/sidebar",
"tags": "$:/tags/PageTemplate",
"text": "\\whitespace trim\n\\define config-title()\n$:/config/SideBarSegments/Visibility/$(listItem)$\n\\end\n\n<$scrollable fallthrough=\"no\" class=\"tc-sidebar-scrollable\">\n\n<div class=\"tc-sidebar-header\">\n\n<$reveal state=\"$:/state/sidebar\" type=\"match\" text=\"yes\" default=\"yes\" retain=\"yes\" animate=\"yes\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SideBarSegment]!has[draft.of]]\" variable=\"listItem\">\n\n<$reveal type=\"nomatch\" state=<<config-title>> text=\"hide\" tag=\"div\">\n\n<$transclude tiddler=<<listItem>> mode=\"block\"/>\n\n</$reveal>\n\n</$list>\n\n</$reveal>\n\n</div>\n\n</$scrollable>\n"
},
"$:/core/ui/PageTemplate/story": {
"title": "$:/core/ui/PageTemplate/story",
"tags": "$:/tags/PageTemplate",
"text": "\\whitespace trim\n<section class=\"tc-story-river\">\n\n<section class=\"story-backdrop\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/AboveStory]!has[draft.of]]\">\n\n<$transclude/>\n\n</$list>\n\n</section>\n\n<$list filter=\"[list[$:/StoryList]]\" history=\"$:/HistoryList\" template={{$:/config/ui/ViewTemplate}} editTemplate={{$:/config/ui/EditTemplate}} storyview={{$:/view}} emptyMessage={{$:/config/EmptyStoryMessage}}/>\n\n<section class=\"story-frontdrop\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/BelowStory]!has[draft.of]]\">\n\n<$transclude/>\n\n</$list>\n\n</section>\n\n</section>\n"
},
"$:/core/ui/PageTemplate/topleftbar": {
"title": "$:/core/ui/PageTemplate/topleftbar",
"tags": "$:/tags/PageTemplate",
"text": "<span class=\"tc-topbar tc-topbar-left\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopLeftBar]!has[draft.of]]\" variable=\"listItem\" storyview=\"pop\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$list>\n\n</span>\n"
},
"$:/core/ui/PageTemplate/toprightbar": {
"title": "$:/core/ui/PageTemplate/toprightbar",
"tags": "$:/tags/PageTemplate",
"text": "<span class=\"tc-topbar tc-topbar-right\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopRightBar]!has[draft.of]]\" variable=\"listItem\" storyview=\"pop\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$list>\n\n</span>\n"
},
"$:/core/ui/PageTemplate": {
"title": "$:/core/ui/PageTemplate",
"text": "\\whitespace trim\n\\define containerClasses()\ntc-page-container tc-page-view-$(storyviewTitle)$ tc-language-$(languageTitle)$\n\\end\n\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\n<$set name=\"tv-config-toolbar-icons\" value={{$:/config/Toolbar/Icons}}>\n\n<$set name=\"tv-config-toolbar-text\" value={{$:/config/Toolbar/Text}}>\n\n<$set name=\"tv-config-toolbar-class\" value={{$:/config/Toolbar/ButtonClass}}>\n\n<$set name=\"tv-enable-drag-and-drop\" value={{$:/config/DragAndDrop/Enable}}>\n\n<$set name=\"tv-show-missing-links\" value={{$:/config/MissingLinks}}>\n\n<$set name=\"storyviewTitle\" value={{$:/view}}>\n\n<$set name=\"languageTitle\" value={{{ [{$:/language}get[name]] }}}>\n\n<div class=<<containerClasses>>>\n\n<$navigator story=\"$:/StoryList\" history=\"$:/HistoryList\" openLinkFromInsideRiver={{$:/config/Navigation/openLinkFromInsideRiver}} openLinkFromOutsideRiver={{$:/config/Navigation/openLinkFromOutsideRiver}} relinkOnRename={{$:/config/RelinkOnRename}}>\n\n<$dropzone enable=<<tv-enable-drag-and-drop>>>\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageTemplate]!has[draft.of]]\" variable=\"listItem\">\n\n<$transclude tiddler=<<listItem>>/>\n\n</$list>\n\n</$dropzone>\n\n</$navigator>\n\n</div>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</$set>\n"
},
"$:/PaletteManager": {
"title": "$:/PaletteManager",
"text": "\\define lingo-base() $:/language/ControlPanel/Palette/Editor/\n\\define describePaletteColour(colour)\n<$transclude tiddler=\"$:/language/Docs/PaletteColours/$colour$\"><$text text=\"$colour$\"/></$transclude>\n\\end\n\\define edit-colour-placeholder()\n edit $(colourName)$\n\\end\n\\define colour-tooltip(showhide) $showhide$ editor for $(newColourName)$ \n\\define resolve-colour(macrocall)\n\\import $:/core/macros/utils\n\\whitespace trim\n<$wikify name=\"name\" text=\"\"\"$macrocall$\"\"\">\n<<name>>\n</$wikify>\n\\end\n\\define delete-colour-index-actions() <$action-setfield $index=<<colourName>>/>\n\\define palette-manager-colour-row-segment()\n\\whitespace trim\n<$edit-text index=<<colourName>> tag=\"input\" placeholder=<<edit-colour-placeholder>> default=\"\"/>\n<br>\n<$edit-text index=<<colourName>> type=\"color\" tag=\"input\" class=\"tc-palette-manager-colour-input\"/>\n<$list filter=\"[<currentTiddler>getindex<colourName>removeprefix[<<]removesuffix[>>]] [<currentTiddler>getindex<colourName>removeprefix[<$]removesuffix[/>]]\" variable=\"ignore\">\n<$set name=\"state\" value={{{ [[$:/state/palettemanager/]addsuffix<currentTiddler>addsuffix[/]addsuffix<colourName>] }}}>\n<$wikify name=\"newColourName\" text=\"\"\"<$macrocall $name=\"resolve-colour\" macrocall={{{ [<currentTiddler>getindex<colourName>] }}}/>\"\"\">\n<$reveal state=<<state>> type=\"nomatch\" text=\"show\">\n<$button tooltip=<<colour-tooltip show>> aria-label=<<colour-tooltip show>> class=\"tc-btn-invisible\" set=<<state>> setTo=\"show\">{{$:/core/images/down-arrow}} <$text text=<<newColourName>>/></$button><br>\n</$reveal>\n<$reveal state=<<state>> type=\"match\" text=\"show\">\n<$button tooltip=<<colour-tooltip hide>> aria-label=<<colour-tooltip show>> class=\"tc-btn-invisible\" actions=\"\"\"<$action-deletetiddler $tiddler=<<state>>/>\"\"\">{{$:/core/images/up-arrow}} <$text text=<<newColourName>>/></$button><br>\n</$reveal>\n<$reveal state=<<state>> type=\"match\" text=\"show\">\n<$set name=\"colourName\" value=<<newColourName>>>\n<br>\n<<palette-manager-colour-row-segment>>\n<br><br>\n</$set>\n</$reveal>\n</$wikify>\n</$set>\n</$list>\n\\end\n\\define palette-manager-colour-row()\n\\whitespace trim\n<tr>\n<td>\n<span style=\"float:right;\">\n<$button tooltip=<<lingo Delete/Hint>> aria-label=<<lingo Delete/Hint>> class=\"tc-btn-invisible\" actions=<<delete-colour-index-actions>>>\n{{$:/core/images/delete-button}}</$button>\n</span>\n''<$macrocall $name=\"describePaletteColour\" colour=<<colourName>>/>''<br/>\n<$macrocall $name=\"colourName\" $output=\"text/plain\"/>\n</td>\n<td>\n<<palette-manager-colour-row-segment>>\n</td>\n</tr>\n\\end\n\\define palette-manager-table()\n\\whitespace trim\n<table>\n<tbody>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Palette]indexes[]]\" variable=\"colourName\">\n<$list filter=\"[<currentTiddler>indexes[]removeprefix<colourName>suffix[]]\" variable=\"ignore\" emptyMessage=\"\"\"\n<$list filter=\"[{$:/state/palettemanager/showexternal}removeprefix[yes]suffix[]]\" variable=\"ignore\">\n<<palette-manager-colour-row>>\n</$list>\n\"\"\">\n<<palette-manager-colour-row>>\n</$list>\n</$list>\n</tbody>\n</table>\n\\end\n<$set name=\"currentTiddler\" value={{$:/palette}}>\n\n<<lingo Prompt>> <$link to={{$:/palette}}><$macrocall $name=\"currentTiddler\" $output=\"text/plain\"/></$link>\n\n<$list filter=\"[all[current]is[shadow]is[tiddler]]\" variable=\"listItem\">\n<<lingo Prompt/Modified>>\n<$button message=\"tm-delete-tiddler\" param={{$:/palette}}><<lingo Reset/Caption>></$button>\n</$list>\n\n<$list filter=\"[all[current]is[shadow]!is[tiddler]]\" variable=\"listItem\">\n<<lingo Clone/Prompt>>\n</$list>\n\n<$button message=\"tm-new-tiddler\" param={{$:/palette}}><<lingo Clone/Caption>></$button>\n\n<$checkbox tiddler=\"$:/state/palettemanager/showexternal\" field=\"text\" checked=\"yes\" unchecked=\"no\"> <<lingo Names/External/Show>></$checkbox>\n\n<<palette-manager-table>>\n"
},
"$:/core/ui/PluginInfo": {
"title": "$:/core/ui/PluginInfo",
"text": "\\define localised-info-tiddler-title()\n$(currentTiddler)$/$(languageTitle)$/$(currentTab)$\n\\end\n\\define info-tiddler-title()\n$(currentTiddler)$/$(currentTab)$\n\\end\n\\define default-tiddler-title()\n$:/core/ui/PluginInfo/Default/$(currentTab)$\n\\end\n<$transclude tiddler=<<localised-info-tiddler-title>> mode=\"block\">\n<$transclude tiddler=<<currentTiddler>> subtiddler=<<localised-info-tiddler-title>> mode=\"block\">\n<$transclude tiddler=<<currentTiddler>> subtiddler=<<info-tiddler-title>> mode=\"block\">\n<$transclude tiddler=<<default-tiddler-title>> mode=\"block\">\n{{$:/language/ControlPanel/Plugin/NoInfoFound/Hint}}\n</$transclude>\n</$transclude>\n</$transclude>\n</$transclude>\n"
},
"$:/core/ui/PluginInfo/Default/contents": {
"title": "$:/core/ui/PluginInfo/Default/contents",
"text": "\\define lingo-base() $:/language/TiddlerInfo/Advanced/PluginInfo/\n<<lingo Hint>>\n<ul>\n<$list filter=\"[all[current]plugintiddlers[]sort[title]]\" emptyMessage=<<lingo Empty/Hint>>>\n<li>\n<$link />\n</li>\n</$list>\n</ul>\n"
},
"$:/core/ui/PluginListItemTemplate": {
"title": "$:/core/ui/PluginListItemTemplate",
"text": "<div class=\"tc-menu-list-item\">\n<$link to={{!!title}}><$view field=\"description\"><$view field=\"title\"/></$view></$link>\n</div>"
},
"$:/core/ui/SearchResults": {
"title": "$:/core/ui/SearchResults",
"text": "<div class=\"tc-search-results\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]butfirst[]limit[1]]\" emptyMessage=\"\"\"\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]]\">\n<$transclude mode=\"block\"/>\n</$list>\n\"\"\">\n\n<$macrocall $name=\"tabs\" tabsList=\"[all[shadows+tiddlers]tag[$:/tags/SearchResults]!has[draft.of]]\" default={{$:/config/SearchResults/Default}}/>\n\n</$list>\n\n</div>\n"
},
"$:/core/ui/SideBar/More": {
"title": "$:/core/ui/SideBar/More",
"tags": "$:/tags/SideBar",
"caption": "{{$:/language/SideBar/More/Caption}}",
"text": "<div class=\"tc-more-sidebar\">\n<$macrocall $name=\"tabs\" tabsList=\"[all[shadows+tiddlers]tag[$:/tags/MoreSideBar]!has[draft.of]]\" default={{$:/config/DefaultMoreSidebarTab}} state=\"$:/state/tab/moresidebar\" class=\"tc-vertical tc-sidebar-tabs-more\" />\n</div>"
},
"$:/core/ui/SideBar/Open": {
"title": "$:/core/ui/SideBar/Open",
"tags": "$:/tags/SideBar",
"caption": "{{$:/language/SideBar/Open/Caption}}",
"text": "\\whitespace trim\n\\define lingo-base() $:/language/CloseAll/\n\n\\define drop-actions()\n<$action-listops $tiddler=<<tv-story-list>> $subfilter=\"+[insertbefore:currentTiddler<actionTiddler>]\"/>\n\\end\n\n\\define placeholder()\n<div class=\"tc-droppable-placeholder\"/>\n\\end\n\n\\define droppable-item(button)\n\\whitespace trim\n<$droppable actions=<<drop-actions>> enable=<<tv-allow-drag-and-drop>>>\n<<placeholder>>\n<div>\n$button$\n</div>\n</$droppable>\n\\end\n\n<div class=\"tc-sidebar-tab-open\">\n<$list filter=\"[list<tv-story-list>]\" history=<<tv-history-list>> storyview=\"pop\">\n<div class=\"tc-sidebar-tab-open-item\">\n<$macrocall $name=\"droppable-item\" button=\"\"\"<$button message=\"tm-close-tiddler\" tooltip={{$:/language/Buttons/Close/Hint}} aria-label={{$:/language/Buttons/Close/Caption}} class=\"tc-btn-invisible tc-btn-mini\">{{$:/core/images/close-button}}</$button> <$link to={{!!title}}><$view field=\"title\"/></$link>\"\"\"/>\n</div>\n</$list>\n<$tiddler tiddler=\"\">\n<div>\n<$macrocall $name=\"droppable-item\" button=\"\"\"<$button message=\"tm-close-all-tiddlers\" class=\"tc-btn-invisible tc-btn-mini\"><<lingo Button>></$button>\"\"\"/>\n</div>\n</$tiddler>\n</div>\n"
},
"$:/core/ui/SideBar/Recent": {
"title": "$:/core/ui/SideBar/Recent",
"tags": "$:/tags/SideBar",
"caption": "{{$:/language/SideBar/Recent/Caption}}",
"text": "<$macrocall $name=\"timeline\" format={{$:/language/RecentChanges/DateFormat}}/>\n"
},
"$:/core/ui/SideBar/Tools": {
"title": "$:/core/ui/SideBar/Tools",
"tags": "$:/tags/SideBar",
"caption": "{{$:/language/SideBar/Tools/Caption}}",
"text": "\\define lingo-base() $:/language/ControlPanel/\n\\define config-title()\n$:/config/PageControlButtons/Visibility/$(listItem)$\n\\end\n\n<<lingo Basics/Version/Prompt>> <<version>>\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]]\" variable=\"listItem\">\n\n<div style=\"position:relative;\" class={{{ [<listItem>encodeuricomponent[]addprefix[tc-btn-]] }}}>\n\n<$checkbox tiddler=<<config-title>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\"/> <$transclude tiddler=<<listItem>>/> <i class=\"tc-muted\"><$transclude tiddler=<<listItem>> field=\"description\"/></i>\n\n</div>\n\n</$list>\n\n</$set>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/SideBarLists": {
"title": "$:/core/ui/SideBarLists",
"text": "<$transclude tiddler=\"$:/core/ui/SideBarSegments/search\"/>\n\n<$transclude tiddler=\"$:/core/ui/SideBarSegments/tabs\"/>\n\n"
},
"$:/core/ui/SideBarSegments/page-controls": {
"title": "$:/core/ui/SideBarSegments/page-controls",
"tags": "$:/tags/SideBarSegment",
"text": "{{||$:/core/ui/PageTemplate/pagecontrols}}\n"
},
"$:/core/ui/SideBarSegments/search": {
"title": "$:/core/ui/SideBarSegments/search",
"tags": "$:/tags/SideBarSegment",
"text": "\\whitespace trim\n<div class=\"tc-sidebar-lists tc-sidebar-search\">\n\n<$set name=\"searchTiddler\" value=\"$:/temp/search\">\n<div class=\"tc-search\">\n<$edit-text tiddler=\"$:/temp/search\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}} focusPopup=<<qualify \"$:/state/popup/search-dropdown\">> class=\"tc-popup-handle\"/>\n<$reveal state=\"$:/temp/search\" type=\"nomatch\" text=\"\">\n<$button tooltip={{$:/language/Buttons/AdvancedSearch/Hint}} aria-label={{$:/language/Buttons/AdvancedSearch/Caption}} class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" text={{$:/temp/search}}/>\n<$action-setfield $tiddler=\"$:/temp/search\" text=\"\"/>\n<$action-navigate $to=\"$:/AdvancedSearch\"/>\n{{$:/core/images/advanced-search-button}}\n</$button>\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/search\" text=\"\" />\n{{$:/core/images/close-button}}\n</$button>\n<$button popup=<<qualify \"$:/state/popup/search-dropdown\">> class=\"tc-btn-invisible\">\n{{$:/core/images/down-arrow}}\n<$list filter=\"[{$:/temp/search}minlength{$:/config/Search/MinLength}limit[1]]\" variable=\"listItem\">\n<$set name=\"searchTerm\" value={{{ [<searchTiddler>get[text]] }}}>\n<$set name=\"resultCount\" value=\"\"\"<$count filter=\"[!is[system]search<searchTerm>]\"/>\"\"\">\n{{$:/language/Search/Matches}}\n</$set>\n</$set>\n</$list>\n</$button>\n</$reveal>\n<$reveal state=\"$:/temp/search\" type=\"match\" text=\"\">\n<$button to=\"$:/AdvancedSearch\" tooltip={{$:/language/Buttons/AdvancedSearch/Hint}} aria-label={{$:/language/Buttons/AdvancedSearch/Caption}} class=\"tc-btn-invisible\">\n{{$:/core/images/advanced-search-button}}\n</$button>\n</$reveal>\n</div>\n\n<$reveal tag=\"div\" class=\"tc-block-dropdown-wrapper\" state=\"$:/temp/search\" type=\"nomatch\" text=\"\">\n\n<$reveal tag=\"div\" class=\"tc-block-dropdown tc-search-drop-down tc-popup-handle\" state=<<qualify \"$:/state/popup/search-dropdown\">> type=\"nomatch\" text=\"\" default=\"\">\n\n<$list filter=\"[{$:/temp/search}minlength{$:/config/Search/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n\n{{$:/core/ui/SearchResults}}\n\n</$list>\n\n</$reveal>\n\n</$reveal>\n\n</$set>\n\n</div>\n"
},
"$:/core/ui/SideBarSegments/site-subtitle": {
"title": "$:/core/ui/SideBarSegments/site-subtitle",
"tags": "$:/tags/SideBarSegment",
"text": "<div class=\"tc-site-subtitle\">\n\n<$transclude tiddler=\"$:/SiteSubtitle\" mode=\"inline\"/>\n\n</div>\n"
},
"$:/core/ui/SideBarSegments/site-title": {
"title": "$:/core/ui/SideBarSegments/site-title",
"tags": "$:/tags/SideBarSegment",
"text": "<h1 class=\"tc-site-title\">\n\n<$transclude tiddler=\"$:/SiteTitle\" mode=\"inline\"/>\n\n</h1>\n"
},
"$:/core/ui/SideBarSegments/tabs": {
"title": "$:/core/ui/SideBarSegments/tabs",
"tags": "$:/tags/SideBarSegment",
"text": "<div class=\"tc-sidebar-lists tc-sidebar-tabs\">\n\n<$macrocall $name=\"tabs\" tabsList=\"[all[shadows+tiddlers]tag[$:/tags/SideBar]!has[draft.of]]\" default={{$:/config/DefaultSidebarTab}} state=\"$:/state/tab/sidebar\" class=\"tc-sidebar-tabs-main\"/>\n\n</div>\n"
},
"$:/TagManager": {
"title": "$:/TagManager",
"icon": "$:/core/images/tag-button",
"color": "#bbb",
"text": "\\define lingo-base() $:/language/TagManager/\n\\define iconEditorTab(type)\n\\whitespace trim\n<$link to=\"\"><<lingo Icons/None>></$link>\n<$list filter=\"[all[shadows+tiddlers]is[image]] [all[shadows+tiddlers]tag[$:/tags/Image]] -[type[application/pdf]] +[sort[title]] +[$type$is[system]]\">\n<$link to={{!!title}}>\n<$transclude/> <$view field=\"title\"/>\n</$link>\n</$list>\n\\end\n\\define iconEditor(title)\n\\whitespace trim\n<div class=\"tc-drop-down-wrapper\">\n<$button popupTitle={{{ [[$:/state/popup/icon/]addsuffix<__title__>] }}} class=\"tc-btn-invisible tc-btn-dropdown\">{{$:/core/images/down-arrow}}</$button>\n<$reveal stateTitle={{{ [[$:/state/popup/icon/]addsuffix<__title__>] }}} type=\"popup\" position=\"belowleft\" text=\"\" default=\"\">\n<div class=\"tc-drop-down\">\n<$linkcatcher actions=\"\"\"<$action-setfield $tiddler=<<__title__>> icon=<<navigateTo>>/>\"\"\">\n<<iconEditorTab type:\"!\">>\n<hr/>\n<<iconEditorTab type:\"\">>\n</$linkcatcher>\n</div>\n</$reveal>\n</div>\n\\end\n\\define toggleButton(state)\n\\whitespace trim\n<$reveal stateTitle=<<__state__>> type=\"match\" text=\"closed\" default=\"closed\">\n<$button setTitle=<<__state__>> setTo=\"open\" class=\"tc-btn-invisible tc-btn-dropdown\" selectedClass=\"tc-selected\">\n{{$:/core/images/info-button}}\n</$button>\n</$reveal>\n<$reveal stateTitle=<<__state__>> type=\"match\" text=\"open\" default=\"closed\">\n<$button setTitle=<<__state__>> setTo=\"closed\" class=\"tc-btn-invisible tc-btn-dropdown\" selectedClass=\"tc-selected\">\n{{$:/core/images/info-button}}\n</$button>\n</$reveal>\n\\end\n\\whitespace trim\n<table class=\"tc-tag-manager-table\">\n<tbody>\n<tr>\n<th><<lingo Colour/Heading>></th>\n<th class=\"tc-tag-manager-tag\"><<lingo Tag/Heading>></th>\n<th><<lingo Count/Heading>></th>\n<th><<lingo Icon/Heading>></th>\n<th><<lingo Info/Heading>></th>\n</tr>\n<$list filter=\"[tags[]!is[system]sort[title]]\">\n<tr>\n<td><$edit-text field=\"color\" tag=\"input\" type=\"color\"/></td>\n<td>{{||$:/core/ui/TagTemplate}}</td>\n<td><$count filter=\"[all[current]tagging[]]\"/></td>\n<td>\n<$macrocall $name=\"iconEditor\" title={{!!title}}/>\n</td>\n<td>\n<$macrocall $name=\"toggleButton\" state={{{ [[$:/state/tag-manager/]addsuffix<currentTiddler>] }}} /> \n</td>\n</tr>\n<tr>\n<td></td>\n<td colspan=\"4\">\n<$reveal stateTitle={{{ [[$:/state/tag-manager/]addsuffix<currentTiddler>] }}} type=\"match\" text=\"open\" default=\"\">\n<table>\n<tbody>\n<tr><td><<lingo Colour/Heading>></td><td><$edit-text field=\"color\" tag=\"input\" type=\"text\" size=\"9\"/></td></tr>\n<tr><td><<lingo Icon/Heading>></td><td><$edit-text field=\"icon\" tag=\"input\" size=\"45\"/></td></tr>\n</tbody>\n</table>\n</$reveal>\n</td>\n</tr>\n</$list>\n<tr>\n<td></td>\n<td style=\"position:relative;\">\n{{$:/core/ui/UntaggedTemplate}}\n</td>\n<td>\n<small class=\"tc-menu-list-count\"><$count filter=\"[untagged[]!is[system]] -[tags[]]\"/></small>\n</td>\n<td></td>\n<td></td>\n</tr>\n</tbody>\n</table>\n"
},
"$:/core/ui/TagTemplate": {
"title": "$:/core/ui/TagTemplate",
"text": "\\whitespace trim\n<span class=\"tc-tag-list-item\">\n<$set name=\"transclusion\" value=<<currentTiddler>>>\n<$macrocall $name=\"tag-pill-body\" tag=<<currentTiddler>> icon={{!!icon}} colour={{!!color}} palette={{$:/palette}} element-tag=\"\"\"$button\"\"\" element-attributes=\"\"\"popup=<<qualify \"$:/state/popup/tag\">> dragFilter='[all[current]tagging[]]' tag='span'\"\"\"/>\n<$reveal state=<<qualify \"$:/state/popup/tag\">> type=\"popup\" position=\"below\" animate=\"yes\" class=\"tc-drop-down\">\n<$set name=\"tv-show-missing-links\" value=\"yes\">\n<$transclude tiddler=\"$:/core/ui/ListItemTemplate\"/>\n</$set>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TagDropdown]!has[draft.of]]\" variable=\"listItem\"> \n<$transclude tiddler=<<listItem>>/> \n</$list>\n<hr>\n<$macrocall $name=\"list-tagged-draggable\" tag=<<currentTiddler>>/>\n</$reveal>\n</$set>\n</span>\n"
},
"$:/core/ui/TiddlerFieldTemplate": {
"title": "$:/core/ui/TiddlerFieldTemplate",
"text": "<tr class=\"tc-view-field\">\n<td class=\"tc-view-field-name\">\n<$text text=<<listItem>>/>\n</td>\n<td class=\"tc-view-field-value\">\n<$view field=<<listItem>>/>\n</td>\n</tr>"
},
"$:/core/ui/TiddlerFields": {
"title": "$:/core/ui/TiddlerFields",
"text": "<table class=\"tc-view-field-table\">\n<tbody>\n<$list filter=\"[all[current]fields[]sort[title]] -text\" template=\"$:/core/ui/TiddlerFieldTemplate\" variable=\"listItem\"/>\n</tbody>\n</table>\n"
},
"$:/core/ui/TiddlerInfo/Advanced/PluginInfo": {
"title": "$:/core/ui/TiddlerInfo/Advanced/PluginInfo",
"tags": "$:/tags/TiddlerInfo/Advanced",
"text": "\\define lingo-base() $:/language/TiddlerInfo/Advanced/PluginInfo/\n<$list filter=\"[all[current]has[plugin-type]]\">\n\n! <<lingo Heading>>\n\n<<lingo Hint>>\n<ul>\n<$list filter=\"[all[current]plugintiddlers[]sort[title]]\" emptyMessage=<<lingo Empty/Hint>>>\n<li>\n<$link to={{!!title}}>\n<$view field=\"title\"/>\n</$link>\n</li>\n</$list>\n</ul>\n\n</$list>\n"
},
"$:/core/ui/TiddlerInfo/Advanced/ShadowInfo": {
"title": "$:/core/ui/TiddlerInfo/Advanced/ShadowInfo",
"tags": "$:/tags/TiddlerInfo/Advanced",
"text": "\\define lingo-base() $:/language/TiddlerInfo/Advanced/ShadowInfo/\n<$set name=\"infoTiddler\" value=<<currentTiddler>>>\n\n''<<lingo Heading>>''\n\n<$list filter=\"[all[current]!is[shadow]]\">\n\n<<lingo NotShadow/Hint>>\n\n</$list>\n\n<$list filter=\"[all[current]is[shadow]]\">\n\n<<lingo Shadow/Hint>>\n\n<$list filter=\"[all[current]shadowsource[]]\">\n\n<$set name=\"pluginTiddler\" value=<<currentTiddler>>>\n<<lingo Shadow/Source>>\n</$set>\n\n</$list>\n\n<$list filter=\"[all[current]is[shadow]is[tiddler]]\">\n\n<<lingo OverriddenShadow/Hint>>\n\n</$list>\n\n\n</$list>\n</$set>\n"
},
"$:/core/ui/TiddlerInfo/Advanced": {
"title": "$:/core/ui/TiddlerInfo/Advanced",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/Advanced/Caption}}",
"text": "<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TiddlerInfo/Advanced]!has[draft.of]]\" variable=\"listItem\">\n<$transclude tiddler=<<listItem>>/>\n\n</$list>\n"
},
"$:/core/ui/TiddlerInfo/Fields": {
"title": "$:/core/ui/TiddlerInfo/Fields",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/Fields/Caption}}",
"text": "<$transclude tiddler=\"$:/core/ui/TiddlerFields\"/>\n"
},
"$:/core/ui/TiddlerInfo/List": {
"title": "$:/core/ui/TiddlerInfo/List",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/List/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n<$list filter=\"[list{!!title}]\" emptyMessage=<<lingo List/Empty>> template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/TiddlerInfo/Listed": {
"title": "$:/core/ui/TiddlerInfo/Listed",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/Listed/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n<$list filter=\"[all[current]listed[]!is[system]]\" emptyMessage=<<lingo Listed/Empty>> template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/TiddlerInfo/References": {
"title": "$:/core/ui/TiddlerInfo/References",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/References/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n<$list filter=\"[all[current]backlinks[]sort[title]]\" emptyMessage=<<lingo References/Empty>> template=\"$:/core/ui/ListItemTemplate\">\n</$list>"
},
"$:/core/ui/TiddlerInfo/Tagging": {
"title": "$:/core/ui/TiddlerInfo/Tagging",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/Tagging/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n<$list filter=\"[all[current]tagging[]]\" emptyMessage=<<lingo Tagging/Empty>> template=\"$:/core/ui/ListItemTemplate\"/>\n"
},
"$:/core/ui/TiddlerInfo/Tools": {
"title": "$:/core/ui/TiddlerInfo/Tools",
"tags": "$:/tags/TiddlerInfo",
"caption": "{{$:/language/TiddlerInfo/Tools/Caption}}",
"text": "\\define lingo-base() $:/language/TiddlerInfo/\n\\define config-title()\n$:/config/ViewToolbarButtons/Visibility/$(listItem)$\n\\end\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ViewToolbar]!has[draft.of]]\" variable=\"listItem\">\n\n<$checkbox tiddler=<<config-title>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\"/> <$transclude tiddler=<<listItem>>/> <i class=\"tc-muted\"><$transclude tiddler=<<listItem>> field=\"description\"/></i>\n\n</$list>\n\n</$set>\n\n</$set>\n\n</$set>\n"
},
"$:/core/ui/TiddlerInfo": {
"title": "$:/core/ui/TiddlerInfo",
"text": "<div style=\"position:relative;\">\n<div class=\"tc-tiddler-controls\" style=\"position:absolute;right:0;\">\n<$reveal state=\"$:/config/TiddlerInfo/Mode\" type=\"match\" text=\"sticky\">\n<$button set=<<tiddlerInfoState>> setTo=\"\" tooltip={{$:/language/Buttons/Info/Hint}} aria-label={{$:/language/Buttons/Info/Caption}} class=\"tc-btn-invisible\">\n{{$:/core/images/close-button}}\n</$button>\n</$reveal>\n</div>\n</div>\n\n<$macrocall $name=\"tabs\" tabsList=\"[all[shadows+tiddlers]tag[$:/tags/TiddlerInfo]!has[draft.of]]\" default={{$:/config/TiddlerInfo/Default}}/>"
},
"$:/core/ui/TopBar/menu": {
"title": "$:/core/ui/TopBar/menu",
"tags": "$:/tags/TopRightBar",
"text": "<$list filter=\"[[$:/state/sidebar]get[text]] +[else[yes]!match[no]]\" variable=\"ignore\">\n<$button set=\"$:/state/sidebar\" setTo=\"no\" tooltip={{$:/language/Buttons/HideSideBar/Hint}} aria-label={{$:/language/Buttons/HideSideBar/Caption}} class=\"tc-btn-invisible\">{{$:/core/images/chevron-right}}</$button>\n</$list>\n<$list filter=\"[[$:/state/sidebar]get[text]] +[else[yes]match[no]]\" variable=\"ignore\">\n<$button set=\"$:/state/sidebar\" setTo=\"yes\" tooltip={{$:/language/Buttons/ShowSideBar/Hint}} aria-label={{$:/language/Buttons/ShowSideBar/Caption}} class=\"tc-btn-invisible\">{{$:/core/images/chevron-left}}</$button>\n</$list>\n"
},
"$:/core/ui/UntaggedTemplate": {
"title": "$:/core/ui/UntaggedTemplate",
"text": "\\define lingo-base() $:/language/SideBar/\n<$button popup=<<qualify \"$:/state/popup/tag\">> class=\"tc-btn-invisible tc-untagged-label tc-tag-label\">\n<<lingo Tags/Untagged/Caption>>\n</$button>\n<$reveal state=<<qualify \"$:/state/popup/tag\">> type=\"popup\" position=\"below\">\n<div class=\"tc-drop-down\">\n<$list filter=\"[untagged[]!is[system]] -[tags[]] +[sort[title]]\" template=\"$:/core/ui/ListItemTemplate\"/>\n</div>\n</$reveal>\n"
},
"$:/core/ui/ViewTemplate/body": {
"title": "$:/core/ui/ViewTemplate/body",
"tags": "$:/tags/ViewTemplate",
"text": "<$reveal tag=\"div\" class=\"tc-tiddler-body\" type=\"nomatch\" stateTitle=<<folded-state>> text=\"hide\" retain=\"yes\" animate=\"yes\">\n\n<$list filter=\"[all[current]!has[plugin-type]!field:hide-body[yes]]\">\n\n<$transclude>\n\n<$transclude tiddler=\"$:/language/MissingTiddler/Hint\"/>\n\n</$transclude>\n\n</$list>\n\n</$reveal>\n"
},
"$:/core/ui/ViewTemplate/classic": {
"title": "$:/core/ui/ViewTemplate/classic",
"tags": "$:/tags/ViewTemplate $:/tags/EditTemplate",
"text": "\\define lingo-base() $:/language/ClassicWarning/\n<$list filter=\"[all[current]type[text/x-tiddlywiki]]\">\n<div class=\"tc-message-box\">\n\n<<lingo Hint>>\n\n<$button set=\"!!type\" setTo=\"text/vnd.tiddlywiki\"><<lingo Upgrade/Caption>></$button>\n\n</div>\n</$list>\n"
},
"$:/core/ui/ViewTemplate/import": {
"title": "$:/core/ui/ViewTemplate/import",
"tags": "$:/tags/ViewTemplate",
"text": "\\define lingo-base() $:/language/Import/\n\n\\define buttons()\n<$button message=\"tm-delete-tiddler\" param=<<currentTiddler>>><<lingo Listing/Cancel/Caption>></$button>\n<$button message=\"tm-perform-import\" param=<<currentTiddler>>><<lingo Listing/Import/Caption>></$button>\n<<lingo Listing/Preview>> <$select tiddler=\"$:/state/importpreviewtype\" default=\"$:/core/ui/ImportPreviews/Text\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ImportPreview]!has[draft.of]]\">\n<option value=<<currentTiddler>>>{{!!caption}}</option>\n</$list>\n</$select>\n\\end\n\n<$list filter=\"[all[current]field:plugin-type[import]]\">\n\n<div class=\"tc-import\">\n\n<<lingo Listing/Hint>>\n\n<<buttons>>\n\n{{||$:/core/ui/ImportListing}}\n\n<<buttons>>\n\n</div>\n\n</$list>\n"
},
"$:/core/ui/ViewTemplate/plugin": {
"title": "$:/core/ui/ViewTemplate/plugin",
"tags": "$:/tags/ViewTemplate",
"text": "<$list filter=\"[all[current]has[plugin-type]] -[all[current]field:plugin-type[import]]\">\n<$set name=\"plugin-type\" value={{!!plugin-type}}>\n<$set name=\"default-popup-state\" value=\"yes\">\n<$set name=\"qualified-state\" value=<<qualify \"$:/state/plugin-info\">>>\n{{||$:/core/ui/Components/plugin-info}}\n</$set>\n</$set>\n</$set>\n</$list>\n"
},
"$:/core/ui/ViewTemplate/subtitle": {
"title": "$:/core/ui/ViewTemplate/subtitle",
"tags": "$:/tags/ViewTemplate",
"text": "\\whitespace trim\n<$reveal type=\"nomatch\" stateTitle=<<folded-state>> text=\"hide\" tag=\"div\" retain=\"yes\" animate=\"yes\">\n<div class=\"tc-subtitle\">\n<$link to={{!!modifier}} />\n<$view field=\"modified\" format=\"date\" template={{$:/language/Tiddler/DateFormat}}/>\n</div>\n</$reveal>\n"
},
"$:/core/ui/ViewTemplate/tags": {
"title": "$:/core/ui/ViewTemplate/tags",
"tags": "$:/tags/ViewTemplate",
"text": "<$reveal type=\"nomatch\" stateTitle=<<folded-state>> text=\"hide\" tag=\"div\" retain=\"yes\" animate=\"yes\">\n<div class=\"tc-tags-wrapper\"><$list filter=\"[all[current]tags[]sort[title]]\" template=\"$:/core/ui/TagTemplate\" storyview=\"pop\"/></div>\n</$reveal>\n"
},
"$:/core/ui/ViewTemplate/title": {
"title": "$:/core/ui/ViewTemplate/title",
"tags": "$:/tags/ViewTemplate",
"text": "\\whitespace trim\n\\define title-styles()\nfill:$(foregroundColor)$;\n\\end\n\\define config-title()\n$:/config/ViewToolbarButtons/Visibility/$(listItem)$\n\\end\n<div class=\"tc-tiddler-title\">\n<div class=\"tc-titlebar\">\n<span class=\"tc-tiddler-controls\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ViewToolbar]!has[draft.of]]\" variable=\"listItem\"><$reveal type=\"nomatch\" state=<<config-title>> text=\"hide\"><$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\"><$transclude tiddler=<<listItem>>/></$set></$reveal></$list>\n</span>\n<$set name=\"tv-wikilinks\" value={{$:/config/Tiddlers/TitleLinks}}>\n<$link>\n<$set name=\"foregroundColor\" value={{!!color}}>\n<span class=\"tc-tiddler-title-icon\" style=<<title-styles>>>\n<$transclude tiddler={{!!icon}}>\n<$transclude tiddler={{$:/config/DefaultTiddlerIcon}}/>\n</$transclude>\n</span>\n</$set>\n<$list filter=\"[all[current]removeprefix[$:/]]\">\n<h2 class=\"tc-title\" title={{$:/language/SystemTiddler/Tooltip}}>\n<span class=\"tc-system-title-prefix\">$:/</span><$text text=<<currentTiddler>>/>\n</h2>\n</$list>\n<$list filter=\"[all[current]!prefix[$:/]]\">\n<h2 class=\"tc-title\">\n<$view field=\"title\"/>\n</h2>\n</$list>\n</$link>\n</$set>\n</div>\n\n<$reveal type=\"nomatch\" text=\"\" default=\"\" state=<<tiddlerInfoState>> class=\"tc-tiddler-info tc-popup-handle\" animate=\"yes\" retain=\"yes\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TiddlerInfoSegment]!has[draft.of]] [[$:/core/ui/TiddlerInfo]]\" variable=\"listItem\"><$transclude tiddler=<<listItem>> mode=\"block\"/></$list>\n\n</$reveal>\n</div>"
},
"$:/core/ui/ViewTemplate/unfold": {
"title": "$:/core/ui/ViewTemplate/unfold",
"tags": "$:/tags/ViewTemplate",
"text": "<$reveal tag=\"div\" type=\"nomatch\" state=\"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold-bar\" text=\"hide\">\n<$reveal tag=\"div\" type=\"nomatch\" stateTitle=<<folded-state>> text=\"hide\" default=\"show\" retain=\"yes\" animate=\"yes\">\n<$button tooltip={{$:/language/Buttons/Fold/Hint}} aria-label={{$:/language/Buttons/Fold/Caption}} class=\"tc-fold-banner\">\n<$action-sendmessage $message=\"tm-fold-tiddler\" $param=<<currentTiddler>> foldedState=<<folded-state>>/>\n{{$:/core/images/chevron-up}}\n</$button>\n</$reveal>\n<$reveal tag=\"div\" type=\"nomatch\" stateTitle=<<folded-state>> text=\"show\" default=\"show\" retain=\"yes\" animate=\"yes\">\n<$button tooltip={{$:/language/Buttons/Unfold/Hint}} aria-label={{$:/language/Buttons/Unfold/Caption}} class=\"tc-unfold-banner\">\n<$action-sendmessage $message=\"tm-fold-tiddler\" $param=<<currentTiddler>> foldedState=<<folded-state>>/>\n{{$:/core/images/chevron-down}}\n</$button>\n</$reveal>\n</$reveal>\n"
},
"$:/core/ui/ViewTemplate": {
"title": "$:/core/ui/ViewTemplate",
"text": "\\define folded-state()\n$:/state/folded/$(currentTiddler)$\n\\end\n\\import [all[shadows+tiddlers]tag[$:/tags/Macro/View]!has[draft.of]]\n<$vars storyTiddler=<<currentTiddler>> tiddlerInfoState=<<qualify \"$:/state/popup/tiddler-info\">>><div data-tiddler-title=<<currentTiddler>> data-tags={{!!tags}} class={{{ tc-tiddler-frame tc-tiddler-view-frame [<currentTiddler>is[tiddler]then[tc-tiddler-exists]] [<currentTiddler>is[missing]!is[shadow]then[tc-tiddler-missing]] [<currentTiddler>is[shadow]then[tc-tiddler-exists tc-tiddler-shadow]] [<currentTiddler>is[shadow]is[tiddler]then[tc-tiddler-overridden-shadow]] [<currentTiddler>is[system]then[tc-tiddler-system]] [{!!class}] [<currentTiddler>tags[]encodeuricomponent[]addprefix[tc-tagged-]] +[join[ ]] }}}><$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ViewTemplate]!has[draft.of]]\" variable=\"listItem\"><$transclude tiddler=<<listItem>>/></$list>\n</div>\n</$vars>\n"
},
"$:/core/ui/Buttons/clone": {
"title": "$:/core/ui/Buttons/clone",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/clone-button}} {{$:/language/Buttons/Clone/Caption}}",
"description": "{{$:/language/Buttons/Clone/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-new-tiddler\" param=<<currentTiddler>> tooltip={{$:/language/Buttons/Clone/Hint}} aria-label={{$:/language/Buttons/Clone/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/clone-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Clone/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/close-others": {
"title": "$:/core/ui/Buttons/close-others",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/close-others-button}} {{$:/language/Buttons/CloseOthers/Caption}}",
"description": "{{$:/language/Buttons/CloseOthers/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-close-other-tiddlers\" param=<<currentTiddler>> tooltip={{$:/language/Buttons/CloseOthers/Hint}} aria-label={{$:/language/Buttons/CloseOthers/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/close-others-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/CloseOthers/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/close": {
"title": "$:/core/ui/Buttons/close",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/close-button}} {{$:/language/Buttons/Close/Caption}}",
"description": "{{$:/language/Buttons/Close/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-close-tiddler\" tooltip={{$:/language/Buttons/Close/Hint}} aria-label={{$:/language/Buttons/Close/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/close-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text={{$:/language/Buttons/Close/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/edit": {
"title": "$:/core/ui/Buttons/edit",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/edit-button}} {{$:/language/Buttons/Edit/Caption}}",
"description": "{{$:/language/Buttons/Edit/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-edit-tiddler\" tooltip={{$:/language/Buttons/Edit/Hint}} aria-label={{$:/language/Buttons/Edit/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/edit-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Edit/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/export-tiddler": {
"title": "$:/core/ui/Buttons/export-tiddler",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/export-button}} {{$:/language/Buttons/ExportTiddler/Caption}}",
"description": "{{$:/language/Buttons/ExportTiddler/Hint}}",
"text": "\\define makeExportFilter()\n[[$(currentTiddler)$]]\n\\end\n<$macrocall $name=\"exportButton\" exportFilter=<<makeExportFilter>> lingoBase=\"$:/language/Buttons/ExportTiddler/\" baseFilename=<<currentTiddler>>/>"
},
"$:/core/ui/Buttons/fold-bar": {
"title": "$:/core/ui/Buttons/fold-bar",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/chevron-up}} {{$:/language/Buttons/Fold/FoldBar/Caption}}",
"description": "{{$:/language/Buttons/Fold/FoldBar/Hint}}",
"text": "<!-- This dummy toolbar button is here to allow visibility of the fold-bar to be controlled as if it were a toolbar button -->"
},
"$:/core/ui/Buttons/fold-others": {
"title": "$:/core/ui/Buttons/fold-others",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/fold-others-button}} {{$:/language/Buttons/FoldOthers/Caption}}",
"description": "{{$:/language/Buttons/FoldOthers/Hint}}",
"text": "\\whitespace trim\n<$button tooltip={{$:/language/Buttons/FoldOthers/Hint}} aria-label={{$:/language/Buttons/FoldOthers/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-sendmessage $message=\"tm-fold-other-tiddlers\" $param=<<currentTiddler>> foldedStatePrefix=\"$:/state/folded/\"/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\" variable=\"listItem\">\n{{$:/core/images/fold-others-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/FoldOthers/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/fold": {
"title": "$:/core/ui/Buttons/fold",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/fold-button}} {{$:/language/Buttons/Fold/Caption}}",
"description": "{{$:/language/Buttons/Fold/Hint}}",
"text": "\\whitespace trim\n<$reveal type=\"nomatch\" stateTitle=<<folded-state>> text=\"hide\" default=\"show\">\n<$button tooltip={{$:/language/Buttons/Fold/Hint}} aria-label={{$:/language/Buttons/Fold/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-sendmessage $message=\"tm-fold-tiddler\" $param=<<currentTiddler>> foldedState=<<folded-state>>/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\" variable=\"listItem\">\n{{$:/core/images/fold-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Fold/Caption}}/>\n</span>\n</$list>\n</$button>\n</$reveal>\n<$reveal type=\"match\" stateTitle=<<folded-state>> text=\"hide\" default=\"show\">\n<$button tooltip={{$:/language/Buttons/Unfold/Hint}} aria-label={{$:/language/Buttons/Unfold/Caption}} class=<<tv-config-toolbar-class>>>\n<$action-sendmessage $message=\"tm-fold-tiddler\" $param=<<currentTiddler>> foldedState=<<folded-state>>/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\" variable=\"listItem\">\n{{$:/core/images/unfold-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Unfold/Caption}}/>\n</span>\n</$list>\n</$button>\n</$reveal>\n"
},
"$:/core/ui/Buttons/info": {
"title": "$:/core/ui/Buttons/info",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/info-button}} {{$:/language/Buttons/Info/Caption}}",
"description": "{{$:/language/Buttons/Info/Hint}}",
"text": "\\whitespace trim\n\\define button-content()\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/info-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text={{$:/language/Buttons/Info/Caption}}/>\n</span>\n</$list>\n\\end\n<$reveal state=\"$:/config/TiddlerInfo/Mode\" type=\"match\" text=\"popup\">\n<$button popup=<<tiddlerInfoState>> tooltip={{$:/language/Buttons/Info/Hint}} aria-label={{$:/language/Buttons/Info/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$macrocall $name=\"button-content\" mode=\"inline\"/>\n</$button>\n</$reveal>\n<$reveal state=\"$:/config/TiddlerInfo/Mode\" type=\"match\" text=\"sticky\">\n<$reveal state=<<tiddlerInfoState>> type=\"match\" text=\"\" default=\"\">\n<$button set=<<tiddlerInfoState>> setTo=\"yes\" tooltip={{$:/language/Buttons/Info/Hint}} aria-label={{$:/language/Buttons/Info/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$macrocall $name=\"button-content\" mode=\"inline\"/>\n</$button>\n</$reveal>\n<$reveal state=<<tiddlerInfoState>> type=\"nomatch\" text=\"\" default=\"\">\n<$button set=<<tiddlerInfoState>> setTo=\"\" tooltip={{$:/language/Buttons/Info/Hint}} aria-label={{$:/language/Buttons/Info/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$macrocall $name=\"button-content\" mode=\"inline\"/>\n</$button>\n</$reveal>\n</$reveal>"
},
"$:/core/ui/Buttons/more-tiddler-actions": {
"title": "$:/core/ui/Buttons/more-tiddler-actions",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/down-arrow}} {{$:/language/Buttons/More/Caption}}",
"description": "{{$:/language/Buttons/More/Hint}}",
"text": "\\whitespace trim\n\\define config-title()\n$:/config/ViewToolbarButtons/Visibility/$(listItem)$\n\\end\n<$button popup=<<qualify \"$:/state/popup/more\">> tooltip={{$:/language/Buttons/More/Hint}} aria-label={{$:/language/Buttons/More/Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/down-arrow}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/More/Caption}}/>\n</span>\n</$list>\n</$button>\n<$reveal state=<<qualify \"$:/state/popup/more\">> type=\"popup\" position=\"belowleft\" animate=\"yes\">\n\n<div class=\"tc-drop-down\">\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-class\" value=\"tc-btn-invisible\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ViewToolbar]!has[draft.of]] -[[$:/core/ui/Buttons/more-tiddler-actions]]\" variable=\"listItem\">\n\n<$reveal type=\"match\" state=<<config-title>> text=\"hide\">\n\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$set>\n\n</$reveal>\n\n</$list>\n\n</$set>\n\n</$set>\n\n</$set>\n\n</div>\n\n</$reveal>"
},
"$:/core/ui/Buttons/new-here": {
"title": "$:/core/ui/Buttons/new-here",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/new-here-button}} {{$:/language/Buttons/NewHere/Caption}}",
"description": "{{$:/language/Buttons/NewHere/Hint}}",
"text": "\\whitespace trim\n\\define newHereActions()\n<$set name=\"tags\" filter=\"[<currentTiddler>] [{$:/config/NewTiddler/Tags!!tags}]\">\n<$action-sendmessage $message=\"tm-new-tiddler\" tags=<<tags>>/>\n</$set>\n\\end\n\\define newHereButton()\n<$button actions=<<newHereActions>> tooltip={{$:/language/Buttons/NewHere/Hint}} aria-label={{$:/language/Buttons/NewHere/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/new-here-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text={{$:/language/Buttons/NewHere/Caption}}/>\n</span>\n</$list>\n</$button>\n\\end\n<<newHereButton>>\n"
},
"$:/core/ui/Buttons/new-journal-here": {
"title": "$:/core/ui/Buttons/new-journal-here",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/new-journal-button}} {{$:/language/Buttons/NewJournalHere/Caption}}",
"description": "{{$:/language/Buttons/NewJournalHere/Hint}}",
"text": "\\whitespace trim\n\\define journalButtonTags()\n[[$(currentTiddlerTag)$]] $(journalTags)$\n\\end\n\\define journalButton()\n<$button tooltip={{$:/language/Buttons/NewJournalHere/Hint}} aria-label={{$:/language/Buttons/NewJournalHere/Caption}} class=<<tv-config-toolbar-class>>>\n<$wikify name=\"journalTitle\" text=\"\"\"<$macrocall $name=\"now\" format=<<journalTitleTemplate>>/>\"\"\">\n<$action-sendmessage $message=\"tm-new-tiddler\" title=<<journalTitle>> tags=<<journalButtonTags>>/>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/new-journal-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text={{$:/language/Buttons/NewJournalHere/Caption}}/>\n</span>\n</$list>\n</$wikify>\n</$button>\n\\end\n<$set name=\"journalTitleTemplate\" value={{$:/config/NewJournal/Title}}>\n<$set name=\"journalTags\" value={{$:/config/NewJournal/Tags!!tags}}>\n<$set name=\"currentTiddlerTag\" value=<<currentTiddler>>>\n<<journalButton>>\n</$set>\n</$set>\n</$set>\n"
},
"$:/core/ui/Buttons/open-window": {
"title": "$:/core/ui/Buttons/open-window",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/open-window}} {{$:/language/Buttons/OpenWindow/Caption}}",
"description": "{{$:/language/Buttons/OpenWindow/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-open-window\" tooltip={{$:/language/Buttons/OpenWindow/Hint}} aria-label={{$:/language/Buttons/OpenWindow/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/open-window}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/OpenWindow/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/permalink": {
"title": "$:/core/ui/Buttons/permalink",
"tags": "$:/tags/ViewToolbar",
"caption": "{{$:/core/images/permalink-button}} {{$:/language/Buttons/Permalink/Caption}}",
"description": "{{$:/language/Buttons/Permalink/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-permalink\" tooltip={{$:/language/Buttons/Permalink/Hint}} aria-label={{$:/language/Buttons/Permalink/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/permalink-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Permalink/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/core/ui/Buttons/permaview": {
"title": "$:/core/ui/Buttons/permaview",
"tags": "$:/tags/ViewToolbar $:/tags/PageControls",
"caption": "{{$:/core/images/permaview-button}} {{$:/language/Buttons/Permaview/Caption}}",
"description": "{{$:/language/Buttons/Permaview/Hint}}",
"text": "\\whitespace trim\n<$button message=\"tm-permaview\" tooltip={{$:/language/Buttons/Permaview/Hint}} aria-label={{$:/language/Buttons/Permaview/Caption}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/permaview-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text={{$:/language/Buttons/Permaview/Caption}}/>\n</span>\n</$list>\n</$button>"
},
"$:/DefaultTiddlers": {
"title": "$:/DefaultTiddlers",
"text": "GettingStarted\n"
},
"$:/temp/advancedsearch": {
"title": "$:/temp/advancedsearch",
"text": ""
},
"$:/snippets/allfields": {
"title": "$:/snippets/allfields",
"text": "\\define renderfield(title)\n<tr class=\"tc-view-field\"><td class=\"tc-view-field-name\">''$title$'':</td><td class=\"tc-view-field-value\">//{{$:/language/Docs/Fields/$title$}}//</td></tr>\n\\end\n<table class=\"tc-view-field-table\"><tbody><$list filter=\"[fields[]sort[title]]\" variable=\"listItem\"><$macrocall $name=\"renderfield\" title=<<listItem>>/></$list>\n</tbody></table>\n"
},
"$:/config/AnimationDuration": {
"title": "$:/config/AnimationDuration",
"text": "400"
},
"$:/config/AutoFocus": {
"title": "$:/config/AutoFocus",
"text": "title"
},
"$:/config/AutoSave": {
"title": "$:/config/AutoSave",
"text": "yes"
},
"$:/config/BitmapEditor/Colour": {
"title": "$:/config/BitmapEditor/Colour",
"text": "#444"
},
"$:/config/BitmapEditor/ImageSizes": {
"title": "$:/config/BitmapEditor/ImageSizes",
"text": "[[62px 100px]] [[100px 62px]] [[124px 200px]] [[200px 124px]] [[248px 400px]] [[371px 600px]] [[400px 248px]] [[556px 900px]] [[600px 371px]] [[742px 1200px]] [[900px 556px]] [[1200px 742px]]"
},
"$:/config/BitmapEditor/LineWidth": {
"title": "$:/config/BitmapEditor/LineWidth",
"text": "3px"
},
"$:/config/BitmapEditor/LineWidths": {
"title": "$:/config/BitmapEditor/LineWidths",
"text": "0.25px 0.5px 1px 2px 3px 4px 6px 8px 10px 16px 20px 28px 40px 56px 80px"
},
"$:/config/BitmapEditor/Opacities": {
"title": "$:/config/BitmapEditor/Opacities",
"text": "0.01 0.025 0.05 0.075 0.1 0.15 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0"
},
"$:/config/BitmapEditor/Opacity": {
"title": "$:/config/BitmapEditor/Opacity",
"text": "1.0"
},
"$:/config/DefaultMoreSidebarTab": {
"title": "$:/config/DefaultMoreSidebarTab",
"text": "$:/core/ui/MoreSideBar/Tags"
},
"$:/config/DefaultSidebarTab": {
"title": "$:/config/DefaultSidebarTab",
"text": "$:/core/ui/SideBar/Open"
},
"$:/config/DownloadSaver/AutoSave": {
"title": "$:/config/DownloadSaver/AutoSave",
"text": "no"
},
"$:/config/Drafts/TypingTimeout": {
"title": "$:/config/Drafts/TypingTimeout",
"text": "400"
},
"$:/config/EditTemplateFields/Visibility/title": {
"title": "$:/config/EditTemplateFields/Visibility/title",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/tags": {
"title": "$:/config/EditTemplateFields/Visibility/tags",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/text": {
"title": "$:/config/EditTemplateFields/Visibility/text",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/creator": {
"title": "$:/config/EditTemplateFields/Visibility/creator",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/created": {
"title": "$:/config/EditTemplateFields/Visibility/created",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/modified": {
"title": "$:/config/EditTemplateFields/Visibility/modified",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/modifier": {
"title": "$:/config/EditTemplateFields/Visibility/modifier",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/type": {
"title": "$:/config/EditTemplateFields/Visibility/type",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/draft.title": {
"title": "$:/config/EditTemplateFields/Visibility/draft.title",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/draft.of": {
"title": "$:/config/EditTemplateFields/Visibility/draft.of",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/revision": {
"title": "$:/config/EditTemplateFields/Visibility/revision",
"text": "hide"
},
"$:/config/EditTemplateFields/Visibility/bag": {
"title": "$:/config/EditTemplateFields/Visibility/bag",
"text": "hide"
},
"$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-4": {
"title": "$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-4",
"text": "hide"
},
"$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-5": {
"title": "$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-5",
"text": "hide"
},
"$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-6": {
"title": "$:/config/EditorToolbarButtons/Visibility/$:/core/ui/EditorToolbar/heading-6",
"text": "hide"
},
"$:/config/EditorTypeMappings/image/gif": {
"title": "$:/config/EditorTypeMappings/image/gif",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/webp": {
"title": "$:/config/EditorTypeMappings/image/webp",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/heic": {
"title": "$:/config/EditorTypeMappings/image/heic",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/heif": {
"title": "$:/config/EditorTypeMappings/image/heif",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/jpeg": {
"title": "$:/config/EditorTypeMappings/image/jpeg",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/jpg": {
"title": "$:/config/EditorTypeMappings/image/jpg",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/png": {
"title": "$:/config/EditorTypeMappings/image/png",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/image/x-icon": {
"title": "$:/config/EditorTypeMappings/image/x-icon",
"text": "bitmap"
},
"$:/config/EditorTypeMappings/text/vnd.tiddlywiki": {
"title": "$:/config/EditorTypeMappings/text/vnd.tiddlywiki",
"text": "text"
},
"$:/config/Manager/Show": {
"title": "$:/config/Manager/Show",
"text": "tiddlers"
},
"$:/config/Manager/Filter": {
"title": "$:/config/Manager/Filter",
"text": ""
},
"$:/config/Manager/Order": {
"title": "$:/config/Manager/Order",
"text": "forward"
},
"$:/config/Manager/Sort": {
"title": "$:/config/Manager/Sort",
"text": "title"
},
"$:/config/Manager/System": {
"title": "$:/config/Manager/System",
"text": "system"
},
"$:/config/Manager/Tag": {
"title": "$:/config/Manager/Tag",
"text": ""
},
"$:/state/popup/manager/item/$:/Manager/ItemMain/RawText": {
"title": "$:/state/popup/manager/item/$:/Manager/ItemMain/RawText",
"text": "hide"
},
"$:/config/MissingLinks": {
"title": "$:/config/MissingLinks",
"text": "yes"
},
"$:/config/Navigation/UpdateAddressBar": {
"title": "$:/config/Navigation/UpdateAddressBar",
"text": "no"
},
"$:/config/Navigation/UpdateHistory": {
"title": "$:/config/Navigation/UpdateHistory",
"text": "no"
},
"$:/config/NewImageType": {
"title": "$:/config/NewImageType",
"text": "jpeg"
},
"$:/config/OfficialPluginLibrary": {
"title": "$:/config/OfficialPluginLibrary",
"tags": "$:/tags/PluginLibrary",
"url": "https://tiddlywiki.com/library/v5.1.22/index.html",
"caption": "{{$:/language/OfficialPluginLibrary}}",
"text": "{{$:/language/OfficialPluginLibrary/Hint}}\n"
},
"$:/config/Navigation/openLinkFromInsideRiver": {
"title": "$:/config/Navigation/openLinkFromInsideRiver",
"text": "below"
},
"$:/config/Navigation/openLinkFromOutsideRiver": {
"title": "$:/config/Navigation/openLinkFromOutsideRiver",
"text": "top"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/advanced-search": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/advanced-search",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/close-all": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/close-all",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/encryption": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/encryption",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/export-page": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/export-page",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/fold-all": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/fold-all",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/full-screen": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/full-screen",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/home": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/home",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/refresh": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/refresh",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/import": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/import",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/language": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/language",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/tag-manager": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/tag-manager",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/manager": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/manager",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/more-page-actions": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/more-page-actions",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/new-journal": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/new-journal",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/new-image": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/new-image",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/palette": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/palette",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/permaview": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/permaview",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/print": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/print",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/storyview": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/storyview",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/timestamp": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/timestamp",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/theme": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/theme",
"text": "hide"
},
"$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/unfold-all": {
"title": "$:/config/PageControlButtons/Visibility/$:/core/ui/Buttons/unfold-all",
"text": "hide"
},
"$:/config/Performance/Instrumentation": {
"title": "$:/config/Performance/Instrumentation",
"text": "no"
},
"$:/config/RegisterPluginType/plugin": {
"title": "$:/config/RegisterPluginType/plugin",
"text": "yes"
},
"$:/config/RegisterPluginType/theme": {
"title": "$:/config/RegisterPluginType/theme",
"text": "no"
},
"$:/config/RegisterPluginType/language": {
"title": "$:/config/RegisterPluginType/language",
"text": "no"
},
"$:/config/RegisterPluginType/info": {
"title": "$:/config/RegisterPluginType/info",
"text": "no"
},
"$:/config/RegisterPluginType/import": {
"title": "$:/config/RegisterPluginType/import",
"text": "no"
},
"$:/config/SaveWikiButton/Template": {
"title": "$:/config/SaveWikiButton/Template",
"text": "$:/core/save/all"
},
"$:/config/SaverFilter": {
"title": "$:/config/SaverFilter",
"text": "[all[]] -[[$:/HistoryList]] -[[$:/StoryList]] -[[$:/Import]] -[[$:/isEncrypted]] -[[$:/UploadName]] -[prefix[$:/state/]] -[prefix[$:/temp/]]"
},
"$:/config/Search/AutoFocus": {
"title": "$:/config/Search/AutoFocus",
"text": "true"
},
"$:/config/Search/MinLength": {
"title": "$:/config/Search/MinLength",
"text": "3"
},
"$:/config/SearchResults/Default": {
"title": "$:/config/SearchResults/Default",
"text": "$:/core/ui/DefaultSearchResultList"
},
"$:/config/Server/ExternalFilters/[all[tiddlers]!is[system]sort[title]]": {
"title": "$:/config/Server/ExternalFilters/[all[tiddlers]!is[system]sort[title]]",
"text": "yes"
},
"$:/config/ShortcutInfo/add-field": {
"title": "$:/config/ShortcutInfo/add-field",
"text": "{{$:/language/EditTemplate/Fields/Add/Button/Hint}}"
},
"$:/config/ShortcutInfo/advanced-search": {
"title": "$:/config/ShortcutInfo/advanced-search",
"text": "{{$:/language/Buttons/AdvancedSearch/Hint}}"
},
"$:/config/ShortcutInfo/bold": {
"title": "$:/config/ShortcutInfo/bold",
"text": "{{$:/language/Buttons/Bold/Hint}}"
},
"$:/config/ShortcutInfo/cancel-edit-tiddler": {
"title": "$:/config/ShortcutInfo/cancel-edit-tiddler",
"text": "{{$:/language/Buttons/Cancel/Hint}}"
},
"$:/config/ShortcutInfo/excise": {
"title": "$:/config/ShortcutInfo/excise",
"text": "{{$:/language/Buttons/Excise/Hint}}"
},
"$:/config/ShortcutInfo/heading-1": {
"title": "$:/config/ShortcutInfo/heading-1",
"text": "{{$:/language/Buttons/Heading1/Hint}}"
},
"$:/config/ShortcutInfo/heading-2": {
"title": "$:/config/ShortcutInfo/heading-2",
"text": "{{$:/language/Buttons/Heading2/Hint}}"
},
"$:/config/ShortcutInfo/heading-3": {
"title": "$:/config/ShortcutInfo/heading-3",
"text": "{{$:/language/Buttons/Heading3/Hint}}"
},
"$:/config/ShortcutInfo/heading-4": {
"title": "$:/config/ShortcutInfo/heading-4",
"text": "{{$:/language/Buttons/Heading4/Hint}}"
},
"$:/config/ShortcutInfo/heading-5": {
"title": "$:/config/ShortcutInfo/heading-5",
"text": "{{$:/language/Buttons/Heading5/Hint}}"
},
"$:/config/ShortcutInfo/heading-6": {
"title": "$:/config/ShortcutInfo/heading-6",
"text": "{{$:/language/Buttons/Heading6/Hint}}"
},
"$:/config/ShortcutInfo/italic": {
"title": "$:/config/ShortcutInfo/italic",
"text": "{{$:/language/Buttons/Italic/Hint}}"
},
"$:/config/ShortcutInfo/link": {
"title": "$:/config/ShortcutInfo/link",
"text": "{{$:/language/Buttons/Link/Hint}}"
},
"$:/config/ShortcutInfo/list-bullet": {
"title": "$:/config/ShortcutInfo/list-bullet",
"text": "{{$:/language/Buttons/ListBullet/Hint}}"
},
"$:/config/ShortcutInfo/list-number": {
"title": "$:/config/ShortcutInfo/list-number",
"text": "{{$:/language/Buttons/ListNumber/Hint}}"
},
"$:/config/ShortcutInfo/mono-block": {
"title": "$:/config/ShortcutInfo/mono-block",
"text": "{{$:/language/Buttons/MonoBlock/Hint}}"
},
"$:/config/ShortcutInfo/mono-line": {
"title": "$:/config/ShortcutInfo/mono-line",
"text": "{{$:/language/Buttons/MonoLine/Hint}}"
},
"$:/config/ShortcutInfo/new-image": {
"title": "$:/config/ShortcutInfo/new-image",
"text": "{{$:/language/Buttons/NewImage/Hint}}"
},
"$:/config/ShortcutInfo/new-journal": {
"title": "$:/config/ShortcutInfo/new-journal",
"text": "{{$:/language/Buttons/NewJournal/Hint}}"
},
"$:/config/ShortcutInfo/new-tiddler": {
"title": "$:/config/ShortcutInfo/new-tiddler",
"text": "{{$:/language/Buttons/NewTiddler/Hint}}"
},
"$:/config/ShortcutInfo/picture": {
"title": "$:/config/ShortcutInfo/picture",
"text": "{{$:/language/Buttons/Picture/Hint}}"
},
"$:/config/ShortcutInfo/preview": {
"title": "$:/config/ShortcutInfo/preview",
"text": "{{$:/language/Buttons/Preview/Hint}}"
},
"$:/config/ShortcutInfo/quote": {
"title": "$:/config/ShortcutInfo/quote",
"text": "{{$:/language/Buttons/Quote/Hint}}"
},
"$:/config/ShortcutInfo/save-tiddler": {
"title": "$:/config/ShortcutInfo/save-tiddler",
"text": "{{$:/language/Buttons/Save/Hint}}"
},
"$:/config/ShortcutInfo/sidebar-search": {
"title": "$:/config/ShortcutInfo/sidebar-search",
"text": "{{$:/language/Buttons/SidebarSearch/Hint}}"
},
"$:/config/ShortcutInfo/stamp": {
"title": "$:/config/ShortcutInfo/stamp",
"text": "{{$:/language/Buttons/Stamp/Hint}}"
},
"$:/config/ShortcutInfo/strikethrough": {
"title": "$:/config/ShortcutInfo/strikethrough",
"text": "{{$:/language/Buttons/Strikethrough/Hint}}"
},
"$:/config/ShortcutInfo/subscript": {
"title": "$:/config/ShortcutInfo/subscript",
"text": "{{$:/language/Buttons/Subscript/Hint}}"
},
"$:/config/ShortcutInfo/superscript": {
"title": "$:/config/ShortcutInfo/superscript",
"text": "{{$:/language/Buttons/Superscript/Hint}}"
},
"$:/config/ShortcutInfo/toggle-sidebar": {
"title": "$:/config/ShortcutInfo/toggle-sidebar",
"text": "{{$:/language/Buttons/ToggleSidebar/Hint}}"
},
"$:/config/ShortcutInfo/underline": {
"title": "$:/config/ShortcutInfo/underline",
"text": "{{$:/language/Buttons/Underline/Hint}}"
},
"$:/config/SyncFilter": {
"title": "$:/config/SyncFilter",
"text": "[is[tiddler]] -[[$:/HistoryList]] -[[$:/Import]] -[[$:/isEncrypted]] -[prefix[$:/status/]] -[prefix[$:/state/]] -[prefix[$:/temp/]]"
},
"$:/config/Tags/MinLength": {
"title": "$:/config/Tags/MinLength",
"text": "0"
},
"$:/config/TextEditor/EditorHeight/Height": {
"title": "$:/config/TextEditor/EditorHeight/Height",
"text": "400px"
},
"$:/config/TextEditor/EditorHeight/Mode": {
"title": "$:/config/TextEditor/EditorHeight/Mode",
"text": "auto"
},
"$:/config/TiddlerInfo/Default": {
"title": "$:/config/TiddlerInfo/Default",
"text": "$:/core/ui/TiddlerInfo/Fields"
},
"$:/config/TiddlerInfo/Mode": {
"title": "$:/config/TiddlerInfo/Mode",
"text": "popup"
},
"$:/config/Tiddlers/TitleLinks": {
"title": "$:/config/Tiddlers/TitleLinks",
"text": "no"
},
"$:/config/Toolbar/ButtonClass": {
"title": "$:/config/Toolbar/ButtonClass",
"text": "tc-btn-invisible"
},
"$:/config/Toolbar/Icons": {
"title": "$:/config/Toolbar/Icons",
"text": "yes"
},
"$:/config/Toolbar/Text": {
"title": "$:/config/Toolbar/Text",
"text": "no"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/clone": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/clone",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/close-others": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/close-others",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/export-tiddler": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/export-tiddler",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/info": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/info",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/more-tiddler-actions": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/more-tiddler-actions",
"text": "show"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/new-here": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/new-here",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/new-journal-here": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/new-journal-here",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/open-window": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/open-window",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/permalink": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/permalink",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/permaview": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/permaview",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/delete": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/delete",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold-bar": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold-bar",
"text": "hide"
},
"$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold-others": {
"title": "$:/config/ViewToolbarButtons/Visibility/$:/core/ui/Buttons/fold-others",
"text": "hide"
},
"$:/config/shortcuts-mac/bold": {
"title": "$:/config/shortcuts-mac/bold",
"text": "meta-B"
},
"$:/config/shortcuts-mac/italic": {
"title": "$:/config/shortcuts-mac/italic",
"text": "meta-I"
},
"$:/config/shortcuts-mac/underline": {
"title": "$:/config/shortcuts-mac/underline",
"text": "meta-U"
},
"$:/config/shortcuts-mac/new-image": {
"title": "$:/config/shortcuts-mac/new-image",
"text": "ctrl-I"
},
"$:/config/shortcuts-mac/new-journal": {
"title": "$:/config/shortcuts-mac/new-journal",
"text": "ctrl-J"
},
"$:/config/shortcuts-mac/new-tiddler": {
"title": "$:/config/shortcuts-mac/new-tiddler",
"text": "ctrl-N"
},
"$:/config/shortcuts-not-mac/bold": {
"title": "$:/config/shortcuts-not-mac/bold",
"text": "ctrl-B"
},
"$:/config/shortcuts-not-mac/italic": {
"title": "$:/config/shortcuts-not-mac/italic",
"text": "ctrl-I"
},
"$:/config/shortcuts-not-mac/underline": {
"title": "$:/config/shortcuts-not-mac/underline",
"text": "ctrl-U"
},
"$:/config/shortcuts-not-mac/new-image": {
"title": "$:/config/shortcuts-not-mac/new-image",
"text": "alt-I"
},
"$:/config/shortcuts-not-mac/new-journal": {
"title": "$:/config/shortcuts-not-mac/new-journal",
"text": "alt-J"
},
"$:/config/shortcuts-not-mac/new-tiddler": {
"title": "$:/config/shortcuts-not-mac/new-tiddler",
"text": "alt-N"
},
"$:/config/shortcuts/add-field": {
"title": "$:/config/shortcuts/add-field",
"text": "enter"
},
"$:/config/shortcuts/advanced-search": {
"title": "$:/config/shortcuts/advanced-search",
"text": "ctrl-shift-A"
},
"$:/config/shortcuts/cancel-edit-tiddler": {
"title": "$:/config/shortcuts/cancel-edit-tiddler",
"text": "escape"
},
"$:/config/shortcuts/excise": {
"title": "$:/config/shortcuts/excise",
"text": "ctrl-E"
},
"$:/config/shortcuts/sidebar-search": {
"title": "$:/config/shortcuts/sidebar-search",
"text": "ctrl-shift-F"
},
"$:/config/shortcuts/heading-1": {
"title": "$:/config/shortcuts/heading-1",
"text": "ctrl-1"
},
"$:/config/shortcuts/heading-2": {
"title": "$:/config/shortcuts/heading-2",
"text": "ctrl-2"
},
"$:/config/shortcuts/heading-3": {
"title": "$:/config/shortcuts/heading-3",
"text": "ctrl-3"
},
"$:/config/shortcuts/heading-4": {
"title": "$:/config/shortcuts/heading-4",
"text": "ctrl-4"
},
"$:/config/shortcuts/heading-5": {
"title": "$:/config/shortcuts/heading-5",
"text": "ctrl-5"
},
"$:/config/shortcuts/heading-6": {
"title": "$:/config/shortcuts/heading-6",
"text": "ctrl-6"
},
"$:/config/shortcuts/link": {
"title": "$:/config/shortcuts/link",
"text": "ctrl-L"
},
"$:/config/shortcuts/linkify": {
"title": "$:/config/shortcuts/linkify",
"text": "alt-shift-L"
},
"$:/config/shortcuts/list-bullet": {
"title": "$:/config/shortcuts/list-bullet",
"text": "ctrl-shift-L"
},
"$:/config/shortcuts/list-number": {
"title": "$:/config/shortcuts/list-number",
"text": "ctrl-shift-N"
},
"$:/config/shortcuts/mono-block": {
"title": "$:/config/shortcuts/mono-block",
"text": "ctrl-shift-M"
},
"$:/config/shortcuts/mono-line": {
"title": "$:/config/shortcuts/mono-line",
"text": "ctrl-M"
},
"$:/config/shortcuts/picture": {
"title": "$:/config/shortcuts/picture",
"text": "ctrl-shift-I"
},
"$:/config/shortcuts/preview": {
"title": "$:/config/shortcuts/preview",
"text": "alt-P"
},
"$:/config/shortcuts/quote": {
"title": "$:/config/shortcuts/quote",
"text": "ctrl-Q"
},
"$:/config/shortcuts/save-tiddler": {
"title": "$:/config/shortcuts/save-tiddler",
"text": "ctrl+enter"
},
"$:/config/shortcuts/stamp": {
"title": "$:/config/shortcuts/stamp",
"text": "ctrl-S"
},
"$:/config/shortcuts/strikethrough": {
"title": "$:/config/shortcuts/strikethrough",
"text": "ctrl-T"
},
"$:/config/shortcuts/subscript": {
"title": "$:/config/shortcuts/subscript",
"text": "ctrl-shift-B"
},
"$:/config/shortcuts/superscript": {
"title": "$:/config/shortcuts/superscript",
"text": "ctrl-shift-P"
},
"$:/config/shortcuts/toggle-sidebar": {
"title": "$:/config/shortcuts/toggle-sidebar",
"text": "alt-shift-S"
},
"$:/config/shortcuts/transcludify": {
"title": "$:/config/shortcuts/transcludify",
"text": "alt-shift-T"
},
"$:/config/ui/EditTemplate": {
"title": "$:/config/ui/EditTemplate",
"text": "$:/core/ui/EditTemplate"
},
"$:/config/ui/ViewTemplate": {
"title": "$:/config/ui/ViewTemplate",
"text": "$:/core/ui/ViewTemplate"
},
"$:/config/WikiParserRules/Inline/wikilink": {
"title": "$:/config/WikiParserRules/Inline/wikilink",
"text": "enable"
},
"$:/snippets/currpalettepreview": {
"title": "$:/snippets/currpalettepreview",
"text": "\\define swatchStyle()\nbackground-color: $(swatchColour)$;\n\\end\n\\define swatch()\n<$set name=\"swatchColour\" value={{##$(colour)$}}\n><div class=\"tc-swatch\" style=<<swatchStyle>> title=<<colour>>/></$set>\n\\end\n<div class=\"tc-swatches-horiz\"><$list filter=\"\nforeground\nbackground\nmuted-foreground\nprimary\npage-background\ntab-background\ntiddler-info-background\n\" variable=\"colour\"><<swatch>></$list></div>"
},
"$:/snippets/download-wiki-button": {
"title": "$:/snippets/download-wiki-button",
"text": "\\define lingo-base() $:/language/ControlPanel/Tools/Download/\n<$button class=\"tc-btn-big-green\">\n<$action-sendmessage $message=\"tm-download-file\" $param=\"$:/core/save/all\" filename=\"index.html\"/>\n<<lingo Full/Caption>> {{$:/core/images/save-button}}\n</$button>"
},
"$:/language": {
"title": "$:/language",
"text": "$:/languages/en-GB"
},
"$:/snippets/languageswitcher": {
"title": "$:/snippets/languageswitcher",
"text": "\\define flag-title()\n$(languagePluginTitle)$/icon\n\\end\n\n<$linkcatcher to=\"$:/language\">\n<div class=\"tc-chooser tc-language-chooser\">\n<$list filter=\"[[$:/languages/en-GB]] [plugin-type[language]sort[description]]\">\n<$set name=\"cls\" filter=\"[all[current]field:title{$:/language}]\" value=\"tc-chooser-item tc-chosen\" emptyValue=\"tc-chooser-item\"><div class=<<cls>>>\n<$link>\n<span class=\"tc-image-button\">\n<$set name=\"languagePluginTitle\" value=<<currentTiddler>>>\n<$transclude subtiddler=<<flag-title>>>\n<$list filter=\"[all[current]field:title[$:/languages/en-GB]]\">\n<$transclude tiddler=\"$:/languages/en-GB/icon\"/>\n</$list>\n</$transclude>\n</$set>\n</span>\n<$view field=\"description\">\n<$view field=\"name\">\n<$view field=\"title\"/>\n</$view>\n</$view>\n</$link>\n</div>\n</$set>\n</$list>\n</div>\n</$linkcatcher>"
},
"$:/core/macros/CSS": {
"title": "$:/core/macros/CSS",
"tags": "$:/tags/Macro",
"text": "\\define colour(name)\n<$transclude tiddler={{$:/palette}} index=\"$name$\"><$transclude tiddler=\"$:/palettes/Vanilla\" index=\"$name$\"><$transclude tiddler=\"$:/config/DefaultColourMappings/$name$\"/></$transclude></$transclude>\n\\end\n\n\\define color(name)\n<<colour $name$>>\n\\end\n\n\\define box-shadow(shadow)\n``\n -webkit-box-shadow: $shadow$;\n -moz-box-shadow: $shadow$;\n box-shadow: $shadow$;\n``\n\\end\n\n\\define filter(filter)\n``\n -webkit-filter: $filter$;\n -moz-filter: $filter$;\n filter: $filter$;\n``\n\\end\n\n\\define transition(transition)\n``\n -webkit-transition: $transition$;\n -moz-transition: $transition$;\n transition: $transition$;\n``\n\\end\n\n\\define transform-origin(origin)\n``\n -webkit-transform-origin: $origin$;\n -moz-transform-origin: $origin$;\n transform-origin: $origin$;\n``\n\\end\n\n\\define background-linear-gradient(gradient)\n``\nbackground-image: linear-gradient($gradient$);\nbackground-image: -o-linear-gradient($gradient$);\nbackground-image: -moz-linear-gradient($gradient$);\nbackground-image: -webkit-linear-gradient($gradient$);\nbackground-image: -ms-linear-gradient($gradient$);\n``\n\\end\n\n\\define column-count(columns)\n``\n-moz-column-count: $columns$;\n-webkit-column-count: $columns$;\ncolumn-count: $columns$;\n``\n\\end\n\n\\define datauri(title)\n<$macrocall $name=\"makedatauri\" type={{$title$!!type}} text={{$title$}} _canonical_uri={{$title$!!_canonical_uri}}/>\n\\end\n\n\\define if-sidebar(text)\n<$reveal state=\"$:/state/sidebar\" type=\"match\" text=\"yes\" default=\"yes\">$text$</$reveal>\n\\end\n\n\\define if-no-sidebar(text)\n<$reveal state=\"$:/state/sidebar\" type=\"nomatch\" text=\"yes\" default=\"yes\">$text$</$reveal>\n\\end\n\n\\define if-background-attachment(text)\n<$reveal state=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\" type=\"nomatch\" text=\"\">$text$</$reveal>\n\\end\n"
},
"$:/core/macros/colour-picker": {
"title": "$:/core/macros/colour-picker",
"tags": "$:/tags/Macro",
"text": "\\define colour-picker-update-recent()\n<$action-listops\n\t$tiddler=\"$:/config/ColourPicker/Recent\"\n\t$subfilter=\"$(colour-picker-value)$ [list[$:/config/ColourPicker/Recent]remove[$(colour-picker-value)$]] +[limit[8]]\"\n/>\n\\end\n\n\\define colour-picker-inner(actions)\n<$button tag=\"a\" tooltip=\"\"\"$(colour-picker-value)$\"\"\">\n\n$(colour-picker-update-recent)$\n\n$actions$\n\n<span style=\"display:inline-block; background-color: $(colour-picker-value)$; width: 100%; height: 100%; border-radius: 50%;\"/>\n\n</$button>\n\\end\n\n\\define colour-picker-recent-inner(actions)\n<$set name=\"colour-picker-value\" value=\"$(recentColour)$\">\n<$macrocall $name=\"colour-picker-inner\" actions=\"\"\"$actions$\"\"\"/>\n</$set>\n\\end\n\n\\define colour-picker-recent(actions)\n{{$:/language/ColourPicker/Recent}} <$list filter=\"[list[$:/config/ColourPicker/Recent]]\" variable=\"recentColour\">\n<$macrocall $name=\"colour-picker-recent-inner\" actions=\"\"\"$actions$\"\"\"/></$list>\n\\end\n\n\\define colour-picker(actions)\n<div class=\"tc-colour-chooser\">\n\n<$macrocall $name=\"colour-picker-recent\" actions=\"\"\"$actions$\"\"\"/>\n\n---\n\n<$list filter=\"LightPink Pink Crimson LavenderBlush PaleVioletRed HotPink DeepPink MediumVioletRed Orchid Thistle Plum Violet Magenta Fuchsia DarkMagenta Purple MediumOrchid DarkViolet DarkOrchid Indigo BlueViolet MediumPurple MediumSlateBlue SlateBlue DarkSlateBlue Lavender GhostWhite Blue MediumBlue MidnightBlue DarkBlue Navy RoyalBlue CornflowerBlue LightSteelBlue LightSlateGrey SlateGrey DodgerBlue AliceBlue SteelBlue LightSkyBlue SkyBlue DeepSkyBlue LightBlue PowderBlue CadetBlue Azure LightCyan PaleTurquoise Cyan Aqua DarkTurquoise DarkSlateGrey DarkCyan Teal MediumTurquoise LightSeaGreen Turquoise Aquamarine MediumAquamarine MediumSpringGreen MintCream SpringGreen MediumSeaGreen SeaGreen Honeydew LightGreen PaleGreen DarkSeaGreen LimeGreen Lime ForestGreen Green DarkGreen Chartreuse LawnGreen GreenYellow DarkOliveGreen YellowGreen OliveDrab Beige LightGoldenrodYellow Ivory LightYellow Yellow Olive DarkKhaki LemonChiffon PaleGoldenrod Khaki Gold Cornsilk Goldenrod DarkGoldenrod FloralWhite OldLace Wheat Moccasin Orange PapayaWhip BlanchedAlmond NavajoWhite AntiqueWhite Tan BurlyWood Bisque DarkOrange Linen Peru PeachPuff SandyBrown Chocolate SaddleBrown Seashell Sienna LightSalmon Coral OrangeRed DarkSalmon Tomato MistyRose Salmon Snow LightCoral RosyBrown IndianRed Red Brown FireBrick DarkRed Maroon White WhiteSmoke Gainsboro LightGrey Silver DarkGrey Grey DimGrey Black\" variable=\"colour-picker-value\">\n<$macrocall $name=\"colour-picker-inner\" actions=\"\"\"$actions$\"\"\"/>\n</$list>\n\n---\n\n<$edit-text tiddler=\"$:/config/ColourPicker/New\" tag=\"input\" default=\"\" placeholder=\"\"/>\n<$edit-text tiddler=\"$:/config/ColourPicker/New\" type=\"color\" tag=\"input\"/>\n<$set name=\"colour-picker-value\" value={{$:/config/ColourPicker/New}}>\n<$macrocall $name=\"colour-picker-inner\" actions=\"\"\"$actions$\"\"\"/>\n</$set>\n\n</div>\n\n\\end\n"
},
"$:/core/macros/copy-to-clipboard": {
"title": "$:/core/macros/copy-to-clipboard",
"tags": "$:/tags/Macro",
"text": "\\define copy-to-clipboard(src,class:\"tc-btn-invisible\",style)\n<$button class=<<__class__>> style=<<__style__>> message=\"tm-copy-to-clipboard\" param=<<__src__>> tooltip={{$:/language/Buttons/CopyToClipboard/Hint}}>\n{{$:/core/images/copy-clipboard}} <$text text={{$:/language/Buttons/CopyToClipboard/Caption}}/>\n</$button>\n\\end\n\n\\define copy-to-clipboard-above-right(src,class:\"tc-btn-invisible\",style)\n<div style=\"position: relative;\">\n<div style=\"position: absolute; bottom: 0; right: 0;\">\n<$macrocall $name=\"copy-to-clipboard\" src=<<__src__>> class=<<__class__>> style=<<__style__>>/>\n</div>\n</div>\n\\end\n\n"
},
"$:/core/macros/diff": {
"title": "$:/core/macros/diff",
"tags": "$:/tags/Macro",
"text": "\\define compareTiddlerText(sourceTiddlerTitle,sourceSubTiddlerTitle,destTiddlerTitle,destSubTiddlerTitle)\n<$set name=\"source\" tiddler=<<__sourceTiddlerTitle__>> subtiddler=<<__sourceSubTiddlerTitle__>>>\n<$set name=\"dest\" tiddler=<<__destTiddlerTitle__>> subtiddler=<<__destSubTiddlerTitle__>>>\n<$diff-text source=<<source>> dest=<<dest>>/>\n</$set>\n</$set>\n\\end\n\n\\define compareTiddlers(sourceTiddlerTitle,sourceSubTiddlerTitle,destTiddlerTitle,destSubTiddlerTitle,exclude)\n<table class=\"tc-diff-tiddlers\">\n<tbody>\n<$set name=\"sourceFields\" filter=\"[<__sourceTiddlerTitle__>fields[]sort[]]\">\n<$set name=\"destFields\" filter=\"[<__destSubTiddlerTitle__>subtiddlerfields<__destTiddlerTitle__>sort[]]\">\n<$list filter=\"[enlist<sourceFields>] [enlist<destFields>] -[enlist<__exclude__>] +[sort[]]\" variable=\"fieldName\">\n<tr>\n<th>\n<$text text=<<fieldName>>/> \n</th>\n<td>\n<$set name=\"source\" tiddler=<<__sourceTiddlerTitle__>> subtiddler=<<__sourceSubTiddlerTitle__>> field=<<fieldName>>>\n<$set name=\"dest\" tiddler=<<__destTiddlerTitle__>> subtiddler=<<__destSubTiddlerTitle__>> field=<<fieldName>>>\n<$diff-text source=<<source>> dest=<<dest>>>\n</$diff-text>\n</$set>\n</$set>\n</td>\n</tr>\n</$list>\n</$set>\n</$set>\n</tbody>\n</table>\n\\end\n"
},
"$:/core/macros/dumpvariables": {
"title": "$:/core/macros/dumpvariables",
"tags": "$:/tags/Macro",
"text": "\\define dumpvariables()\n<ul>\n<$list filter=\"[variables[]]\" variable=\"varname\">\n<li>\n<strong><code><$text text=<<varname>>/></code></strong>:<br/>\n<$codeblock code={{{ [<varname>getvariable[]] }}}/>\n</li>\n</$list>\n</ul>\n\\end\n"
},
"$:/core/macros/export": {
"title": "$:/core/macros/export",
"tags": "$:/tags/Macro",
"text": "\\define exportButtonFilename(baseFilename)\n$baseFilename$$(extension)$\n\\end\n\n\\define exportButton(exportFilter:\"[!is[system]sort[title]]\",lingoBase,baseFilename:\"tiddlers\")\n<span class=\"tc-popup-keep\"><$button popup=<<qualify \"$:/state/popup/export\">> tooltip={{$lingoBase$Hint}} aria-label={{$lingoBase$Caption}} class=<<tv-config-toolbar-class>> selectedClass=\"tc-selected\">\n<$list filter=\"[<tv-config-toolbar-icons>match[yes]]\">\n{{$:/core/images/export-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>match[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$lingoBase$Caption}}/></span>\n</$list>\n</$button></span><$reveal state=<<qualify \"$:/state/popup/export\">> type=\"popup\" position=\"below\" animate=\"yes\">\n<div class=\"tc-drop-down\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Exporter]]\">\n<$set name=\"extension\" value={{!!extension}}>\n<$button class=\"tc-btn-invisible\">\n<$action-sendmessage $message=\"tm-download-file\" $param=<<currentTiddler>> exportFilter=\"\"\"$exportFilter$\"\"\" filename=<<exportButtonFilename \"\"\"$baseFilename$\"\"\">>/>\n<$action-deletetiddler $tiddler=<<qualify \"$:/state/popup/export\">>/>\n<$transclude field=\"description\"/>\n</$button>\n</$set>\n</$list>\n</div>\n</$reveal>\n\\end\n"
},
"$:/core/macros/image-picker": {
"title": "$:/core/macros/image-picker",
"created": "20170715180840889",
"modified": "20170715180914005",
"tags": "$:/tags/Macro",
"type": "text/vnd.tiddlywiki",
"text": "\\define image-picker-thumbnail(actions)\n<$button tag=\"a\" tooltip=\"\"\"$(imageTitle)$\"\"\">\n$actions$\n<$transclude tiddler=<<imageTitle>>/>\n</$button>\n\\end\n\n\\define image-picker-list(filter,actions)\n<$list filter=\"\"\"$filter$\"\"\" variable=\"imageTitle\">\n<$macrocall $name=\"image-picker-thumbnail\" actions=\"\"\"$actions$\"\"\"/>\n</$list>\n\\end\n\n\\define image-picker(actions,filter:\"[all[shadows+tiddlers]is[image]] -[type[application/pdf]] +[!has[draft.of]$subfilter$sort[title]]\",subfilter:\"\")\n<div class=\"tc-image-chooser\">\n<$vars state-system=<<qualify \"$:/state/image-picker/system\">>>\n<$checkbox tiddler=<<state-system>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"hide\">\n{{$:/language/SystemTiddlers/Include/Prompt}}\n</$checkbox>\n<$reveal state=<<state-system>> type=\"match\" text=\"hide\" default=\"hide\" tag=\"div\">\n<$macrocall $name=\"image-picker-list\" filter=\"\"\"$filter$ +[!is[system]]\"\"\" actions=\"\"\"$actions$\"\"\"/>\n</$reveal>\n<$reveal state=<<state-system>> type=\"nomatch\" text=\"hide\" default=\"hide\" tag=\"div\">\n<$macrocall $name=\"image-picker-list\" filter=\"\"\"$filter$\"\"\" actions=\"\"\"$actions$\"\"\"/>\n</$reveal>\n</$vars>\n</div>\n\\end\n\n\\define image-picker-include-tagged-images(actions)\n<$macrocall $name=\"image-picker\" filter=\"[all[shadows+tiddlers]is[image]] [all[shadows+tiddlers]tag[$:/tags/Image]] -[type[application/pdf]] +[!has[draft.of]sort[title]]\" actions=\"\"\"$actions$\"\"\"/>\n\\end\n"
},
"$:/core/macros/lingo": {
"title": "$:/core/macros/lingo",
"tags": "$:/tags/Macro",
"text": "\\define lingo-base()\n$:/language/\n\\end\n\n\\define lingo(title)\n{{$(lingo-base)$$title$}}\n\\end\n"
},
"$:/core/macros/list": {
"title": "$:/core/macros/list",
"tags": "$:/tags/Macro",
"text": "\\define list-links(filter,type:\"ul\",subtype:\"li\",class:\"\",emptyMessage)\n\\whitespace trim\n<$type$ class=\"$class$\">\n<$list filter=\"$filter$\" emptyMessage=<<__emptyMessage__>>>\n<$subtype$>\n<$link to={{!!title}}>\n<$transclude field=\"caption\">\n<$view field=\"title\"/>\n</$transclude>\n</$link>\n</$subtype$>\n</$list>\n</$type$>\n\\end\n\n\\define list-links-draggable-drop-actions()\n<$action-listops $tiddler=<<targetTiddler>> $field=<<targetField>> $subfilter=\"+[insertbefore:currentTiddler<actionTiddler>]\"/>\n\\end\n\n\\define list-links-draggable(tiddler,field:\"list\",type:\"ul\",subtype:\"li\",class:\"\",itemTemplate)\n\\whitespace trim\n<span class=\"tc-links-draggable-list\">\n<$vars targetTiddler=\"\"\"$tiddler$\"\"\" targetField=\"\"\"$field$\"\"\">\n<$type$ class=\"$class$\">\n<$list filter=\"[list[$tiddler$!!$field$]]\">\n<$droppable actions=<<list-links-draggable-drop-actions>> tag=\"\"\"$subtype$\"\"\" enable=<<tv-enable-drag-and-drop>>>\n<div class=\"tc-droppable-placeholder\"/>\n<div>\n<$transclude tiddler=\"\"\"$itemTemplate$\"\"\">\n<$link to={{!!title}}>\n<$transclude field=\"caption\">\n<$view field=\"title\"/>\n</$transclude>\n</$link>\n</$transclude>\n</div>\n</$droppable>\n</$list>\n</$type$>\n<$tiddler tiddler=\"\">\n<$droppable actions=<<list-links-draggable-drop-actions>> tag=\"div\" enable=<<tv-enable-drag-and-drop>>>\n<div class=\"tc-droppable-placeholder\">\n \n</div>\n<div style=\"height:0.5em;\"/>\n</$droppable>\n</$tiddler>\n</$vars>\n</span>\n\\end\n\n\\define list-tagged-draggable-drop-actions(tag)\n<!-- Save the current ordering of the tiddlers with this tag -->\n<$set name=\"order\" filter=\"[<__tag__>tagging[]]\">\n<!-- Remove any list-after or list-before fields from the tiddlers with this tag -->\n<$list filter=\"[<__tag__>tagging[]]\">\n<$action-deletefield $field=\"list-before\"/>\n<$action-deletefield $field=\"list-after\"/>\n</$list>\n<!-- Save the new order to the Tag Tiddler -->\n<$action-listops $tiddler=<<__tag__>> $field=\"list\" $filter=\"+[enlist<order>] +[insertbefore:currentTiddler<actionTiddler>]\"/>\n<!-- Make sure the newly added item has the right tag -->\n<!-- Removing this line makes dragging tags within the dropdown work as intended -->\n<!--<$action-listops $tiddler=<<actionTiddler>> $tags=<<__tag__>>/>-->\n<!-- Using the following 5 lines as replacement makes dragging titles from outside into the dropdown apply the tag -->\n<$list filter=\"[<actionTiddler>!contains:tags<__tag__>]\">\n<$fieldmangler tiddler=<<actionTiddler>>>\n<$action-sendmessage $message=\"tm-add-tag\" $param=<<__tag__>>/>\n</$fieldmangler>\n</$list>\n</$set>\n\\end\n\n\\define list-tagged-draggable(tag,subFilter,emptyMessage,itemTemplate,elementTag:\"div\",storyview:\"\")\n\\whitespace trim\n<span class=\"tc-tagged-draggable-list\">\n<$set name=\"tag\" value=<<__tag__>>>\n<$list filter=\"[<__tag__>tagging[]$subFilter$]\" emptyMessage=<<__emptyMessage__>> storyview=<<__storyview__>>>\n<$elementTag$ class=\"tc-menu-list-item\">\n<$droppable actions=\"\"\"<$macrocall $name=\"list-tagged-draggable-drop-actions\" tag=<<__tag__>>/>\"\"\" enable=<<tv-enable-drag-and-drop>>>\n<$elementTag$ class=\"tc-droppable-placeholder\"/>\n<$elementTag$>\n<$transclude tiddler=\"\"\"$itemTemplate$\"\"\">\n<$link to={{!!title}}>\n<$view field=\"title\"/>\n</$link>\n</$transclude>\n</$elementTag$>\n</$droppable>\n</$elementTag$>\n</$list>\n<$tiddler tiddler=\"\">\n<$droppable actions=\"\"\"<$macrocall $name=\"list-tagged-draggable-drop-actions\" tag=<<__tag__>>/>\"\"\" enable=<<tv-enable-drag-and-drop>>>\n<$elementTag$ class=\"tc-droppable-placeholder\"/>\n<$elementTag$ style=\"height:0.5em;\">\n</$elementTag$>\n</$droppable>\n</$tiddler>\n</$set>\n</span>\n\\end\n"
},
"$:/core/macros/tabs": {
"title": "$:/core/macros/tabs",
"tags": "$:/tags/Macro",
"text": "\\define tabs(tabsList,default,state:\"$:/state/tab\",class,template,buttonTemplate,retain)\n<div class=\"tc-tab-set $class$\">\n<div class=\"tc-tab-buttons $class$\">\n<$list filter=\"$tabsList$\" variable=\"currentTab\" storyview=\"pop\"><$set name=\"save-currentTiddler\" value=<<currentTiddler>>><$tiddler tiddler=<<currentTab>>><$button set=<<qualify \"$state$\">> setTo=<<currentTab>> default=\"$default$\" selectedClass=\"tc-tab-selected\" tooltip={{!!tooltip}}>\n<$tiddler tiddler=<<save-currentTiddler>>>\n<$set name=\"tv-wikilinks\" value=\"no\">\n<$transclude tiddler=\"$buttonTemplate$\" mode=\"inline\">\n<$transclude tiddler=<<currentTab>> field=\"caption\">\n<$macrocall $name=\"currentTab\" $type=\"text/plain\" $output=\"text/plain\"/>\n</$transclude>\n</$transclude>\n</$set></$tiddler></$button></$tiddler></$set></$list>\n</div>\n<div class=\"tc-tab-divider $class$\"/>\n<div class=\"tc-tab-content $class$\">\n<$list filter=\"$tabsList$\" variable=\"currentTab\">\n\n<$reveal type=\"match\" state=<<qualify \"$state$\">> text=<<currentTab>> default=\"$default$\" retain=\"\"\"$retain$\"\"\">\n\n<$transclude tiddler=\"$template$\" mode=\"block\">\n\n<$transclude tiddler=<<currentTab>> mode=\"block\"/>\n\n</$transclude>\n\n</$reveal>\n\n</$list>\n</div>\n</div>\n\\end\n"
},
"$:/core/macros/tag-picker": {
"title": "$:/core/macros/tag-picker",
"tags": "$:/tags/Macro",
"text": "\\define add-tag-actions()\n<$action-sendmessage $message=\"tm-add-tag\" $param={{{ [<newTagNameTiddler>get[text]] }}}/>\n<$action-deletetiddler $tiddler=<<newTagNameTiddler>>/>\n\\end\n\n\\define tag-button()\n<$button class=\"tc-btn-invisible\" tag=\"a\" tooltip={{$:/language/EditTemplate/Tags/Add/Button/Hint}}>\n<$action-sendmessage $message=\"tm-add-tag\" $param=<<tag>>/>\n<$action-deletetiddler $tiddler=<<newTagNameTiddler>>/>\n<$macrocall $name=\"tag-pill\" tag=<<tag>>/>\n</$button>\n\\end\n\n\\define tag-picker-inner()\n\\whitespace trim\n<div class=\"tc-edit-add-tag\">\n<span class=\"tc-add-tag-name\">\n<$keyboard key=\"ENTER\" actions=<<add-tag-actions>>>\n<$edit-text tiddler=<<newTagNameTiddler>> tag=\"input\" default=\"\" placeholder={{$:/language/EditTemplate/Tags/Add/Placeholder}} focusPopup=<<qualify \"$:/state/popup/tags-auto-complete\">> class=\"tc-edit-texteditor tc-popup-handle\" tabindex=<<tabIndex>> focus={{{ [{$:/config/AutoFocus}match[tags]then[true]] ~[[false]] }}}/>\n</$keyboard>\n</span> <$button popup=<<qualify \"$:/state/popup/tags-auto-complete\">> class=\"tc-btn-invisible\" tooltip={{$:/language/EditTemplate/Tags/Dropdown/Hint}} aria-label={{$:/language/EditTemplate/Tags/Dropdown/Caption}}>{{$:/core/images/down-arrow}}</$button> <span class=\"tc-add-tag-button\">\n<$set name=\"tag\" value={{{ [<newTagNameTiddler>get[text]] }}}>\n<$button set=\"$:/temp/NewTagName\" setTo=\"\" class=\"\">\n<<add-tag-actions>>\n<$action-deletetiddler $tiddler=<<newTagNameTiddler>>/>\n{{$:/language/EditTemplate/Tags/Add/Button}}\n</$button>\n</$set>\n</span>\n</div>\n<div class=\"tc-block-dropdown-wrapper\">\n<$reveal state=<<qualify \"$:/state/popup/tags-auto-complete\">> type=\"nomatch\" text=\"\" default=\"\">\n<div class=\"tc-block-dropdown\">\n<$set name=\"newTagName\" value={{{ [<newTagNameTiddler>get[text]] }}}>\n<$list filter=\"[<newTagName>minlength{$:/config/Tags/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n<$list filter=\"[tags[]!is[system]search:title<newTagName>sort[]]\" variable=\"tag\">\n<<tag-button>>\n</$list></$list>\n<hr>\n<$list filter=\"[<newTagName>minlength{$:/config/Tags/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n<$list filter=\"[tags[]is[system]search:title<newTagName>sort[]]\" variable=\"tag\">\n<<tag-button>>\n</$list></$list>\n</$set>\n</div>\n</$reveal>\n</div>\n\\end\n\\define tag-picker()\n\\whitespace trim\n<$list filter=\"[<newTagNameTiddler>match[]]\" emptyMessage=<<tag-picker-inner>>>\n<$set name=\"newTagNameTiddler\" value=<<qualify \"$:/temp/NewTagName\">>>\n<<tag-picker-inner>>\n</$set>\n</$list>\n\\end\n"
},
"$:/core/macros/tag": {
"title": "$:/core/macros/tag",
"tags": "$:/tags/Macro",
"text": "\\define tag-pill-styles()\nbackground-color:$(backgroundColor)$;\nfill:$(foregroundColor)$;\ncolor:$(foregroundColor)$;\n\\end\n\n\\define tag-pill-inner(tag,icon,colour,fallbackTarget,colourA,colourB,element-tag,element-attributes,actions)\n<$vars foregroundColor=<<contrastcolour target:\"\"\"$colour$\"\"\" fallbackTarget:\"\"\"$fallbackTarget$\"\"\" colourA:\"\"\"$colourA$\"\"\" colourB:\"\"\"$colourB$\"\"\">> backgroundColor=\"\"\"$colour$\"\"\">\n<$element-tag$ $element-attributes$ class=\"tc-tag-label tc-btn-invisible\" style=<<tag-pill-styles>>>\n$actions$<$transclude tiddler=\"\"\"$icon$\"\"\"/><$view tiddler=<<__tag__>> field=\"title\" format=\"text\" />\n</$element-tag$>\n</$vars>\n\\end\n\n\\define tag-pill-body(tag,icon,colour,palette,element-tag,element-attributes,actions)\n<$macrocall $name=\"tag-pill-inner\" tag=<<__tag__>> icon=\"\"\"$icon$\"\"\" colour=\"\"\"$colour$\"\"\" fallbackTarget={{$palette$##tag-background}} colourA={{$palette$##foreground}} colourB={{$palette$##background}} element-tag=\"\"\"$element-tag$\"\"\" element-attributes=\"\"\"$element-attributes$\"\"\" actions=\"\"\"$actions$\"\"\"/>\n\\end\n\n\\define tag-pill(tag,element-tag:\"span\",element-attributes:\"\",actions:\"\")\n<span class=\"tc-tag-list-item\">\n<$macrocall $name=\"tag-pill-body\" tag=<<__tag__>> icon={{{ [<__tag__>get[icon]] }}} colour={{{ [<__tag__>get[color]] }}} palette={{$:/palette}} element-tag=\"\"\"$element-tag$\"\"\" element-attributes=\"\"\"$element-attributes$\"\"\" actions=\"\"\"$actions$\"\"\"/>\n</span>\n\\end\n\n\\define tag(tag)\n{{$tag$||$:/core/ui/TagTemplate}}\n\\end\n"
},
"$:/core/macros/thumbnails": {
"title": "$:/core/macros/thumbnails",
"tags": "$:/tags/Macro",
"text": "\\define thumbnail(link,icon,color,background-color,image,caption,width:\"280\",height:\"157\")\n<$link to=\"\"\"$link$\"\"\"><div class=\"tc-thumbnail-wrapper\">\n<div class=\"tc-thumbnail-image\" style=\"width:$width$px;height:$height$px;\"><$reveal type=\"nomatch\" text=\"\" default=\"\"\"$image$\"\"\" tag=\"div\" style=\"width:$width$px;height:$height$px;\">\n[img[$image$]]\n</$reveal><$reveal type=\"match\" text=\"\" default=\"\"\"$image$\"\"\" tag=\"div\" class=\"tc-thumbnail-background\" style=\"width:$width$px;height:$height$px;background-color:$background-color$;\"></$reveal></div><div class=\"tc-thumbnail-icon\" style=\"fill:$color$;color:$color$;\">\n$icon$\n</div><div class=\"tc-thumbnail-caption\">\n$caption$\n</div>\n</div></$link>\n\\end\n\n\\define thumbnail-right(link,icon,color,background-color,image,caption,width:\"280\",height:\"157\")\n<div class=\"tc-thumbnail-right-wrapper\"><<thumbnail \"\"\"$link$\"\"\" \"\"\"$icon$\"\"\" \"\"\"$color$\"\"\" \"\"\"$background-color$\"\"\" \"\"\"$image$\"\"\" \"\"\"$caption$\"\"\" \"\"\"$width$\"\"\" \"\"\"$height$\"\"\">></div>\n\\end\n\n\\define list-thumbnails(filter,width:\"280\",height:\"157\")\n<$list filter=\"\"\"$filter$\"\"\"><$macrocall $name=\"thumbnail\" link={{!!link}} icon={{!!icon}} color={{!!color}} background-color={{!!background-color}} image={{!!image}} caption={{!!caption}} width=\"\"\"$width$\"\"\" height=\"\"\"$height$\"\"\"/></$list>\n\\end\n"
},
"$:/core/macros/timeline": {
"title": "$:/core/macros/timeline",
"created": "20141212105914482",
"modified": "20141212110330815",
"tags": "$:/tags/Macro",
"text": "\\define timeline-title()\n\\whitespace trim\n<!-- Override this macro with a global macro \n of the same name if you need to change \n how titles are displayed on the timeline \n -->\n<$view field=\"title\"/>\n\\end\n\\define timeline(limit:\"100\",format:\"DDth MMM YYYY\",subfilter:\"\",dateField:\"modified\")\n<div class=\"tc-timeline\">\n<$list filter=\"[!is[system]$subfilter$has[$dateField$]!sort[$dateField$]limit[$limit$]eachday[$dateField$]]\">\n<div class=\"tc-menu-list-item\">\n<$view field=\"$dateField$\" format=\"date\" template=\"$format$\"/>\n<$list filter=\"[sameday:$dateField${!!$dateField$}!is[system]$subfilter$!sort[$dateField$]]\">\n<div class=\"tc-menu-list-subitem\">\n<$link to={{!!title}}><<timeline-title>></$link>\n</div>\n</$list>\n</div>\n</$list>\n</div>\n\\end\n"
},
"$:/core/macros/toc": {
"title": "$:/core/macros/toc",
"tags": "$:/tags/Macro",
"text": "\\define toc-caption()\n<$set name=\"tv-wikilinks\" value=\"no\">\n <$transclude field=\"caption\">\n <$view field=\"title\"/>\n </$transclude>\n</$set>\n\\end\n\n\\define toc-body(tag,sort:\"\",itemClassFilter,exclude,path)\n<ol class=\"tc-toc\">\n <$list filter=\"\"\"[all[shadows+tiddlers]tag<__tag__>!has[draft.of]$sort$] -[<__tag__>] -[enlist<__exclude__>]\"\"\">\n <$vars item=<<currentTiddler>> path={{{ [<__path__>addsuffix[/]addsuffix<__tag__>] }}}>\n <$set name=\"excluded\" filter=\"\"\"[enlist<__exclude__>] [<__tag__>]\"\"\">\n <$set name=\"toc-item-class\" filter=<<__itemClassFilter__>> emptyValue=\"toc-item-selected\" value=\"toc-item\">\n <li class=<<toc-item-class>>>\n <$list filter=\"[all[current]toc-link[no]]\" emptyMessage=\"<$link><$view field='caption'><$view field='title'/></$view></$link>\">\n <<toc-caption>>\n </$list>\n <$macrocall $name=\"toc-body\" tag=<<item>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<excluded>> path=<<path>>/>\n </li>\n </$set>\n </$set>\n </$vars>\n </$list>\n</ol>\n\\end\n\n\\define toc(tag,sort:\"\",itemClassFilter:\"\")\n<$macrocall $name=\"toc-body\" tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> />\n\\end\n\n\\define toc-linked-expandable-body(tag,sort:\"\",itemClassFilter,exclude,path)\n<!-- helper function -->\n<$qualify name=\"toc-state\" title={{{ [[$:/state/toc]addsuffix<__path__>addsuffix[-]addsuffix<currentTiddler>] }}}>\n <$set name=\"toc-item-class\" filter=<<__itemClassFilter__>> emptyValue=\"toc-item-selected\" value=\"toc-item\">\n <li class=<<toc-item-class>>>\n <$link>\n <$reveal type=\"nomatch\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"open\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/right-arrow}}\n </$button>\n </$reveal>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"close\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/down-arrow}}\n </$button>\n </$reveal>\n <<toc-caption>>\n </$link>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$macrocall $name=\"toc-expandable\" tag=<<currentTiddler>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<__exclude__>> path=<<__path__>>/>\n </$reveal>\n </li>\n </$set>\n</$qualify>\n\\end\n\n\\define toc-unlinked-expandable-body(tag,sort:\"\",itemClassFilter,exclude,path)\n<!-- helper function -->\n<$qualify name=\"toc-state\" title={{{ [[$:/state/toc]addsuffix<__path__>addsuffix[-]addsuffix<currentTiddler>] }}}>\n <$set name=\"toc-item-class\" filter=<<__itemClassFilter__>> emptyValue=\"toc-item-selected\" value=\"toc-item\">\n <li class=<<toc-item-class>>>\n <$reveal type=\"nomatch\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"open\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/right-arrow}}\n <<toc-caption>>\n </$button>\n </$reveal>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"close\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/down-arrow}}\n <<toc-caption>>\n </$button>\n </$reveal>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$macrocall $name=\"toc-expandable\" tag=<<currentTiddler>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<__exclude__>> path=<<__path__>>/>\n </$reveal>\n </li>\n </$set>\n</$qualify>\n\\end\n\n\\define toc-expandable-empty-message()\n<$macrocall $name=\"toc-linked-expandable-body\" tag=<<tag>> sort=<<sort>> itemClassFilter=<<itemClassFilter>> exclude=<<excluded>> path=<<path>>/>\n\\end\n\n\\define toc-expandable(tag,sort:\"\",itemClassFilter:\"\",exclude,path)\n<$vars tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> path={{{ [<__path__>addsuffix[/]addsuffix<__tag__>] }}}>\n <$set name=\"excluded\" filter=\"\"\"[enlist<__exclude__>] [<__tag__>]\"\"\">\n <ol class=\"tc-toc toc-expandable\">\n <$list filter=\"\"\"[all[shadows+tiddlers]tag<__tag__>!has[draft.of]$sort$] -[<__tag__>] -[enlist<__exclude__>]\"\"\">\n <$list filter=\"[all[current]toc-link[no]]\" emptyMessage=<<toc-expandable-empty-message>> >\n <$macrocall $name=\"toc-unlinked-expandable-body\" tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=\"\"\"itemClassFilter\"\"\" exclude=<<excluded>> path=<<path>> />\n </$list>\n </$list>\n </ol>\n </$set>\n</$vars>\n\\end\n\n\\define toc-linked-selective-expandable-body(tag,sort:\"\",itemClassFilter,exclude,path)\n<$qualify name=\"toc-state\" title={{{ [[$:/state/toc]addsuffix<__path__>addsuffix[-]addsuffix<currentTiddler>] }}}>\n <$set name=\"toc-item-class\" filter=<<__itemClassFilter__>> emptyValue=\"toc-item-selected\" value=\"toc-item\" >\n <li class=<<toc-item-class>>>\n <$link>\n <$list filter=\"[all[current]tagging[]$sort$limit[1]]\" variable=\"ignore\" emptyMessage=\"<$button class='tc-btn-invisible'>{{$:/core/images/blank}}</$button>\">\n <$reveal type=\"nomatch\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"open\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/right-arrow}}\n </$button>\n </$reveal>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"close\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/down-arrow}}\n </$button>\n </$reveal>\n </$list>\n <<toc-caption>>\n </$link>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$macrocall $name=\"toc-selective-expandable\" tag=<<currentTiddler>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<__exclude__>> path=<<__path__>>/>\n </$reveal>\n </li>\n </$set>\n</$qualify>\n\\end\n\n\\define toc-unlinked-selective-expandable-body(tag,sort:\"\",itemClassFilter,exclude,path)\n<$qualify name=\"toc-state\" title={{{ [[$:/state/toc]addsuffix<__path__>addsuffix[-]addsuffix<currentTiddler>] }}}>\n <$set name=\"toc-item-class\" filter=<<__itemClassFilter__>> emptyValue=\"toc-item-selected\" value=\"toc-item\">\n <li class=<<toc-item-class>>>\n <$list filter=\"[all[current]tagging[]$sort$limit[1]]\" variable=\"ignore\" emptyMessage=\"<$button class='tc-btn-invisible'>{{$:/core/images/blank}}</$button> <$view field='caption'><$view field='title'/></$view>\">\n <$reveal type=\"nomatch\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"open\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/right-arrow}}\n <<toc-caption>>\n </$button>\n </$reveal>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$button setTitle=<<toc-state>> setTo=\"close\" class=\"tc-btn-invisible tc-popup-keep\">\n {{$:/core/images/down-arrow}}\n <<toc-caption>>\n </$button>\n </$reveal>\n </$list>\n <$reveal type=\"match\" stateTitle=<<toc-state>> text=\"open\">\n <$macrocall $name=\"toc-selective-expandable\" tag=<<currentTiddler>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<__exclude__>> path=<<__path__>>/>\n </$reveal>\n </li>\n </$set>\n</$qualify>\n\\end\n\n\\define toc-selective-expandable-empty-message()\n<$macrocall $name=\"toc-linked-selective-expandable-body\" tag=<<tag>> sort=<<sort>> itemClassFilter=<<itemClassFilter>> exclude=<<excluded>> path=<<path>>/>\n\\end\n\n\\define toc-selective-expandable(tag,sort:\"\",itemClassFilter,exclude,path)\n<$vars tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> path={{{ [<__path__>addsuffix[/]addsuffix<__tag__>] }}}>\n <$set name=\"excluded\" filter=\"\"\"[enlist<__exclude__>] [<__tag__>]\"\"\">\n <ol class=\"tc-toc toc-selective-expandable\">\n <$list filter=\"\"\"[all[shadows+tiddlers]tag<__tag__>!has[draft.of]$sort$] -[<__tag__>] -[enlist<__exclude__>]\"\"\">\n <$list filter=\"[all[current]toc-link[no]]\" variable=\"ignore\" emptyMessage=<<toc-selective-expandable-empty-message>> >\n <$macrocall $name=\"toc-unlinked-selective-expandable-body\" tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=<<__itemClassFilter__>> exclude=<<excluded>> path=<<path>>/>\n </$list>\n </$list>\n </ol>\n </$set>\n</$vars>\n\\end\n\n\\define toc-tabbed-external-nav(tag,sort:\"\",selectedTiddler:\"$:/temp/toc/selectedTiddler\",unselectedText,missingText,template:\"\")\n<$tiddler tiddler={{{ [<__selectedTiddler__>get[text]] }}}>\n <div class=\"tc-tabbed-table-of-contents\">\n <$linkcatcher to=<<__selectedTiddler__>>>\n <div class=\"tc-table-of-contents\">\n <$macrocall $name=\"toc-selective-expandable\" tag=<<__tag__>> sort=<<__sort__>> itemClassFilter=\"[all[current]] -[<__selectedTiddler__>get[text]]\"/>\n </div>\n </$linkcatcher>\n <div class=\"tc-tabbed-table-of-contents-content\">\n <$reveal stateTitle=<<__selectedTiddler__>> type=\"nomatch\" text=\"\">\n <$transclude mode=\"block\" tiddler=<<__template__>>>\n <h1><<toc-caption>></h1>\n <$transclude mode=\"block\">$missingText$</$transclude>\n </$transclude>\n </$reveal>\n <$reveal stateTitle=<<__selectedTiddler__>> type=\"match\" text=\"\">\n $unselectedText$\n </$reveal>\n </div>\n </div>\n</$tiddler>\n\\end\n\n\\define toc-tabbed-internal-nav(tag,sort:\"\",selectedTiddler:\"$:/temp/toc/selectedTiddler\",unselectedText,missingText,template:\"\")\n<$linkcatcher to=<<__selectedTiddler__>>>\n <$macrocall $name=\"toc-tabbed-external-nav\" tag=<<__tag__>> sort=<<__sort__>> selectedTiddler=<<__selectedTiddler__>> unselectedText=<<__unselectedText__>> missingText=<<__missingText__>> template=<<__template__>>/>\n</$linkcatcher>\n\\end\n\n"
},
"$:/core/macros/translink": {
"title": "$:/core/macros/translink",
"tags": "$:/tags/Macro",
"text": "\\define translink(title,mode:\"block\")\n<div style=\"border:1px solid #ccc; padding: 0.5em; background: black; foreground; white;\">\n<$link to=\"\"\"$title$\"\"\">\n<$text text=\"\"\"$title$\"\"\"/>\n</$link>\n<div style=\"border:1px solid #ccc; padding: 0.5em; background: white; foreground; black;\">\n<$transclude tiddler=\"\"\"$title$\"\"\" mode=\"$mode$\">\n\"<$text text=\"\"\"$title$\"\"\"/>\" is missing\n</$transclude>\n</div>\n</div>\n\\end\n"
},
"$:/core/macros/tree": {
"title": "$:/core/macros/tree",
"tags": "$:/tags/Macro",
"text": "\\define leaf-link(full-title,chunk,separator: \"/\")\n<$link to=<<__full-title__>>><$text text=<<__chunk__>>/></$link>\n\\end\n\n\\define leaf-node(prefix,chunk)\n<li>\n<$list filter=\"[<__prefix__>addsuffix<__chunk__>is[shadow]] [<__prefix__>addsuffix<__chunk__>is[tiddler]]\" variable=\"full-title\">\n<$list filter=\"[<full-title>removeprefix<__prefix__>]\" variable=\"chunk\">\n<span>{{$:/core/images/file}}</span> <$macrocall $name=\"leaf-link\" full-title=<<full-title>> chunk=<<chunk>>/>\n</$list>\n</$list>\n</li>\n\\end\n\n\\define branch-node(prefix,chunk,separator: \"/\")\n<li>\n<$set name=\"reveal-state\" value={{{ [[$:/state/tree/]addsuffix<__prefix__>addsuffix<__chunk__>] }}}>\n<$reveal type=\"nomatch\" stateTitle=<<reveal-state>> text=\"show\">\n<$button setTitle=<<reveal-state>> setTo=\"show\" class=\"tc-btn-invisible\">\n{{$:/core/images/folder}} <$text text=<<__chunk__>>/>\n</$button>\n</$reveal>\n<$reveal type=\"match\" stateTitle=<<reveal-state>> text=\"show\">\n<$button setTitle=<<reveal-state>> setTo=\"hide\" class=\"tc-btn-invisible\">\n{{$:/core/images/folder}} <$text text=<<__chunk__>>/>\n</$button>\n</$reveal>\n<span>(<$count filter=\"[all[shadows+tiddlers]removeprefix<__prefix__>removeprefix<__chunk__>] -[<__prefix__>addsuffix<__chunk__>]\"/>)</span>\n<$reveal type=\"match\" stateTitle=<<reveal-state>> text=\"show\">\n<$macrocall $name=\"tree-node\" prefix={{{ [<__prefix__>addsuffix<__chunk__>] }}} separator=<<__separator__>>/>\n</$reveal>\n</$set>\n</li>\n\\end\n\n\\define tree-node(prefix,separator: \"/\")\n<ol>\n<$list filter=\"[all[shadows+tiddlers]removeprefix<__prefix__>splitbefore<__separator__>sort[]!suffix<__separator__>]\" variable=\"chunk\">\n<$macrocall $name=\"leaf-node\" prefix=<<__prefix__>> chunk=<<chunk>> separator=<<__separator__>>/>\n</$list>\n<$list filter=\"[all[shadows+tiddlers]removeprefix<__prefix__>splitbefore<__separator__>sort[]suffix<__separator__>]\" variable=\"chunk\">\n<$macrocall $name=\"branch-node\" prefix=<<__prefix__>> chunk=<<chunk>> separator=<<__separator__>>/>\n</$list>\n</ol>\n\\end\n\n\\define tree(prefix: \"$:/\",separator: \"/\")\n<div class=\"tc-tree\">\n<span><$text text=<<__prefix__>>/></span>\n<div>\n<$macrocall $name=\"tree-node\" prefix=<<__prefix__>> separator=<<__separator__>>/>\n</div>\n</div>\n\\end\n"
},
"$:/core/macros/utils": {
"title": "$:/core/macros/utils",
"text": "\\define colour(colour)\n$colour$\n\\end\n"
},
"$:/snippets/minifocusswitcher": {
"title": "$:/snippets/minifocusswitcher",
"text": "<$select tiddler=\"$:/config/AutoFocus\">\n<$list filter=\"title tags text type fields\">\n<option value=<<currentTiddler>>><<currentTiddler>></option>\n</$list>\n</$select>\n"
},
"$:/snippets/minilanguageswitcher": {
"title": "$:/snippets/minilanguageswitcher",
"text": "<$select tiddler=\"$:/language\">\n<$list filter=\"[[$:/languages/en-GB]] [plugin-type[language]sort[title]]\">\n<option value=<<currentTiddler>>><$view field=\"description\"><$view field=\"name\"><$view field=\"title\"/></$view></$view></option>\n</$list>\n</$select>"
},
"$:/snippets/minithemeswitcher": {
"title": "$:/snippets/minithemeswitcher",
"text": "\\define lingo-base() $:/language/ControlPanel/Theme/\n<<lingo Prompt>> <$select tiddler=\"$:/theme\">\n<$list filter=\"[plugin-type[theme]sort[title]]\">\n<option value=<<currentTiddler>>><$view field=\"name\"><$view field=\"title\"/></$view></option>\n</$list>\n</$select>"
},
"$:/snippets/modules": {
"title": "$:/snippets/modules",
"text": "\\define describeModuleType(type)\n{{$:/language/Docs/ModuleTypes/$type$}}\n\\end\n<$list filter=\"[moduletypes[]]\">\n\n!! <$macrocall $name=\"currentTiddler\" $type=\"text/plain\" $output=\"text/plain\"/>\n\n<$macrocall $name=\"describeModuleType\" type=<<currentTiddler>>/>\n\n<ul><$list filter=\"[all[current]modules[]]\"><li><$link><<currentTiddler>></$link>\n</li>\n</$list>\n</ul>\n</$list>\n"
},
"$:/palette": {
"title": "$:/palette",
"text": "$:/palettes/Vanilla"
},
"$:/snippets/paletteeditor": {
"title": "$:/snippets/paletteeditor",
"text": "<$transclude tiddler=\"$:/PaletteManager\"/>\n"
},
"$:/snippets/palettepreview": {
"title": "$:/snippets/palettepreview",
"text": "<$set name=\"currentTiddler\" value={{$:/palette}}>\n{{||$:/snippets/currpalettepreview}}\n</$set>\n"
},
"$:/snippets/paletteswitcher": {
"title": "$:/snippets/paletteswitcher",
"text": "<$linkcatcher to=\"$:/palette\">\n<div class=\"tc-chooser\"><$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Palette]sort[name]]\"><$set name=\"cls\" filter=\"[all[current]prefix{$:/palette}]\" value=\"tc-chooser-item tc-chosen\" emptyValue=\"tc-chooser-item\"><div class=<<cls>>><$link to={{!!title}}>''<$view field=\"name\" format=\"text\"/>'' - <$view field=\"description\" format=\"text\"/>{{||$:/snippets/currpalettepreview}}</$link>\n</div></$set>\n</$list>\n</div>\n</$linkcatcher>\n"
},
"$:/snippets/peek-stylesheets": {
"title": "$:/snippets/peek-stylesheets",
"text": "\\define expandable-stylesheets-list()\n<ol>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Stylesheet]!has[draft.of]]\">\n<$vars state=<<qualify \"$:/state/peek-stylesheets/open/\">>>\n<$set name=\"state\" value={{{ [<state>addsuffix<currentTiddler>] }}}>\n<li>\n<$reveal type=\"match\" state=<<state>> text=\"yes\" tag=\"span\">\n<$button set=<<state>> setTo=\"no\" class=\"tc-btn-invisible\">\n{{$:/core/images/down-arrow}}\n</$button>\n</$reveal>\n<$reveal type=\"nomatch\" state=<<state>> text=\"yes\" tag=\"span\">\n<$button set=<<state>> setTo=\"yes\" class=\"tc-btn-invisible\">\n{{$:/core/images/right-arrow}}\n</$button>\n</$reveal>\n<$link>\n<$view field=\"title\"/>\n</$link>\n<$reveal type=\"match\" state=<<state>> text=\"yes\" tag=\"div\">\n<$set name=\"source\" tiddler=<<currentTiddler>>>\n<$wikify name=\"styles\" text=<<source>>>\n<pre>\n<code>\n<$text text=<<styles>>/>\n</code>\n</pre>\n</$wikify>\n</$set>\n</$reveal>\n</li>\n</$set>\n</$vars>\n</$list>\n</ol>\n\\end\n\n\\define stylesheets-list()\n<ol>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/Stylesheet]!has[draft.of]]\">\n<li>\n<$link>\n<$view field=\"title\"/>\n</$link>\n<$set name=\"source\" tiddler=<<currentTiddler>>>\n<$wikify name=\"styles\" text=<<source>>>\n<pre>\n<code>\n<$text text=<<styles>>/>\n</code>\n</pre>\n</$wikify>\n</$set>\n</li>\n</$list>\n</ol>\n\\end\n\n<$vars modeState=<<qualify \"$:/state/peek-stylesheets/mode/\">>>\n\n<$reveal type=\"nomatch\" state=<<modeState>> text=\"expanded\" tag=\"div\">\n<$button set=<<modeState>> setTo=\"expanded\" class=\"tc-btn-invisible\">{{$:/core/images/chevron-right}} {{$:/language/ControlPanel/Stylesheets/Expand/Caption}}</$button>\n</$reveal>\n<$reveal type=\"match\" state=<<modeState>> text=\"expanded\" tag=\"div\">\n<$button set=<<modeState>> setTo=\"restored\" class=\"tc-btn-invisible\">{{$:/core/images/chevron-down}} {{$:/language/ControlPanel/Stylesheets/Restore/Caption}}</$button>\n</$reveal>\n\n<$reveal type=\"nomatch\" state=<<modeState>> text=\"expanded\" tag=\"div\">\n<<expandable-stylesheets-list>>\n</$reveal>\n<$reveal type=\"match\" state=<<modeState>> text=\"expanded\" tag=\"div\">\n<<stylesheets-list>>\n</$reveal>\n\n</$vars>\n"
},
"$:/temp/search": {
"title": "$:/temp/search",
"text": ""
},
"$:/tags/AdvancedSearch": {
"title": "$:/tags/AdvancedSearch",
"list": "[[$:/core/ui/AdvancedSearch/Standard]] [[$:/core/ui/AdvancedSearch/System]] [[$:/core/ui/AdvancedSearch/Shadows]] [[$:/core/ui/AdvancedSearch/Filter]]"
},
"$:/tags/AdvancedSearch/FilterButton": {
"title": "$:/tags/AdvancedSearch/FilterButton",
"list": "$:/core/ui/AdvancedSearch/Filter/FilterButtons/dropdown $:/core/ui/AdvancedSearch/Filter/FilterButtons/clear $:/core/ui/AdvancedSearch/Filter/FilterButtons/export $:/core/ui/AdvancedSearch/Filter/FilterButtons/delete"
},
"$:/tags/ControlPanel": {
"title": "$:/tags/ControlPanel",
"list": "$:/core/ui/ControlPanel/Info $:/core/ui/ControlPanel/Appearance $:/core/ui/ControlPanel/Settings $:/core/ui/ControlPanel/Saving $:/core/ui/ControlPanel/Plugins $:/core/ui/ControlPanel/Tools $:/core/ui/ControlPanel/Internals"
},
"$:/tags/ControlPanel/Info": {
"title": "$:/tags/ControlPanel/Info",
"list": "$:/core/ui/ControlPanel/Basics $:/core/ui/ControlPanel/Advanced"
},
"$:/tags/ControlPanel/Plugins": {
"title": "$:/tags/ControlPanel/Plugins",
"list": "[[$:/core/ui/ControlPanel/Plugins/Installed]] [[$:/core/ui/ControlPanel/Plugins/Add]]"
},
"$:/tags/EditTemplate": {
"title": "$:/tags/EditTemplate",
"list": "[[$:/core/ui/EditTemplate/controls]] [[$:/core/ui/EditTemplate/title]] [[$:/core/ui/EditTemplate/tags]] [[$:/core/ui/EditTemplate/shadow]] [[$:/core/ui/ViewTemplate/classic]] [[$:/core/ui/EditTemplate/body]] [[$:/core/ui/EditTemplate/type]] [[$:/core/ui/EditTemplate/fields]]"
},
"$:/tags/EditToolbar": {
"title": "$:/tags/EditToolbar",
"list": "[[$:/core/ui/Buttons/delete]] [[$:/core/ui/Buttons/cancel]] [[$:/core/ui/Buttons/save]]"
},
"$:/tags/EditorToolbar": {
"title": "$:/tags/EditorToolbar",
"list": "$:/core/ui/EditorToolbar/paint $:/core/ui/EditorToolbar/opacity $:/core/ui/EditorToolbar/line-width $:/core/ui/EditorToolbar/rotate-left $:/core/ui/EditorToolbar/clear $:/core/ui/EditorToolbar/bold $:/core/ui/EditorToolbar/italic $:/core/ui/EditorToolbar/strikethrough $:/core/ui/EditorToolbar/underline $:/core/ui/EditorToolbar/superscript $:/core/ui/EditorToolbar/subscript $:/core/ui/EditorToolbar/mono-line $:/core/ui/EditorToolbar/mono-block $:/core/ui/EditorToolbar/quote $:/core/ui/EditorToolbar/list-bullet $:/core/ui/EditorToolbar/list-number $:/core/ui/EditorToolbar/heading-1 $:/core/ui/EditorToolbar/heading-2 $:/core/ui/EditorToolbar/heading-3 $:/core/ui/EditorToolbar/heading-4 $:/core/ui/EditorToolbar/heading-5 $:/core/ui/EditorToolbar/heading-6 $:/core/ui/EditorToolbar/link $:/core/ui/EditorToolbar/excise $:/core/ui/EditorToolbar/picture $:/core/ui/EditorToolbar/stamp $:/core/ui/EditorToolbar/size $:/core/ui/EditorToolbar/editor-height $:/core/ui/EditorToolbar/more $:/core/ui/EditorToolbar/preview $:/core/ui/EditorToolbar/preview-type"
},
"$:/tags/Manager/ItemMain": {
"title": "$:/tags/Manager/ItemMain",
"list": "$:/Manager/ItemMain/WikifiedText $:/Manager/ItemMain/RawText $:/Manager/ItemMain/Fields"
},
"$:/tags/Manager/ItemSidebar": {
"title": "$:/tags/Manager/ItemSidebar",
"list": "$:/Manager/ItemSidebar/Tags $:/Manager/ItemSidebar/Colour $:/Manager/ItemSidebar/Icon $:/Manager/ItemSidebar/Tools"
},
"$:/tags/MoreSideBar": {
"title": "$:/tags/MoreSideBar",
"list": "[[$:/core/ui/MoreSideBar/All]] [[$:/core/ui/MoreSideBar/Recent]] [[$:/core/ui/MoreSideBar/Tags]] [[$:/core/ui/MoreSideBar/Missing]] [[$:/core/ui/MoreSideBar/Drafts]] [[$:/core/ui/MoreSideBar/Orphans]] [[$:/core/ui/MoreSideBar/Types]] [[$:/core/ui/MoreSideBar/System]] [[$:/core/ui/MoreSideBar/Shadows]] [[$:/core/ui/MoreSideBar/Explorer]] [[$:/core/ui/MoreSideBar/Plugins]]",
"text": ""
},
"$:/tags/PageControls": {
"title": "$:/tags/PageControls",
"list": "[[$:/core/ui/Buttons/home]] [[$:/core/ui/Buttons/close-all]] [[$:/core/ui/Buttons/fold-all]] [[$:/core/ui/Buttons/unfold-all]] [[$:/core/ui/Buttons/permaview]] [[$:/core/ui/Buttons/new-tiddler]] [[$:/core/ui/Buttons/new-journal]] [[$:/core/ui/Buttons/new-image]] [[$:/core/ui/Buttons/import]] [[$:/core/ui/Buttons/export-page]] [[$:/core/ui/Buttons/control-panel]] [[$:/core/ui/Buttons/advanced-search]] [[$:/core/ui/Buttons/manager]] [[$:/core/ui/Buttons/tag-manager]] [[$:/core/ui/Buttons/language]] [[$:/core/ui/Buttons/palette]] [[$:/core/ui/Buttons/theme]] [[$:/core/ui/Buttons/storyview]] [[$:/core/ui/Buttons/encryption]] [[$:/core/ui/Buttons/timestamp]] [[$:/core/ui/Buttons/full-screen]] [[$:/core/ui/Buttons/print]] [[$:/core/ui/Buttons/save-wiki]] [[$:/core/ui/Buttons/refresh]] [[$:/core/ui/Buttons/more-page-actions]]"
},
"$:/tags/PageTemplate": {
"title": "$:/tags/PageTemplate",
"list": "[[$:/core/ui/PageTemplate/topleftbar]] [[$:/core/ui/PageTemplate/toprightbar]] [[$:/core/ui/PageTemplate/sidebar]] [[$:/core/ui/PageTemplate/story]] [[$:/core/ui/PageTemplate/alerts]]",
"text": ""
},
"$:/tags/PluginLibrary": {
"title": "$:/tags/PluginLibrary",
"list": "$:/config/OfficialPluginLibrary"
},
"$:/tags/SideBar": {
"title": "$:/tags/SideBar",
"list": "[[$:/core/ui/SideBar/Open]] [[$:/core/ui/SideBar/Recent]] [[$:/core/ui/SideBar/Tools]] [[$:/core/ui/SideBar/More]]",
"text": ""
},
"$:/tags/SideBarSegment": {
"title": "$:/tags/SideBarSegment",
"list": "[[$:/core/ui/SideBarSegments/site-title]] [[$:/core/ui/SideBarSegments/site-subtitle]] [[$:/core/ui/SideBarSegments/page-controls]] [[$:/core/ui/SideBarSegments/search]] [[$:/core/ui/SideBarSegments/tabs]]"
},
"$:/tags/TiddlerInfo": {
"title": "$:/tags/TiddlerInfo",
"list": "[[$:/core/ui/TiddlerInfo/Tools]] [[$:/core/ui/TiddlerInfo/References]] [[$:/core/ui/TiddlerInfo/Tagging]] [[$:/core/ui/TiddlerInfo/List]] [[$:/core/ui/TiddlerInfo/Listed]] [[$:/core/ui/TiddlerInfo/Fields]]",
"text": ""
},
"$:/tags/TiddlerInfo/Advanced": {
"title": "$:/tags/TiddlerInfo/Advanced",
"list": "[[$:/core/ui/TiddlerInfo/Advanced/ShadowInfo]] [[$:/core/ui/TiddlerInfo/Advanced/PluginInfo]]"
},
"$:/tags/ViewTemplate": {
"title": "$:/tags/ViewTemplate",
"list": "[[$:/core/ui/ViewTemplate/title]] [[$:/core/ui/ViewTemplate/unfold]] [[$:/core/ui/ViewTemplate/subtitle]] [[$:/core/ui/ViewTemplate/tags]] [[$:/core/ui/ViewTemplate/classic]] [[$:/core/ui/ViewTemplate/body]]"
},
"$:/tags/ViewToolbar": {
"title": "$:/tags/ViewToolbar",
"list": "[[$:/core/ui/Buttons/more-tiddler-actions]] [[$:/core/ui/Buttons/info]] [[$:/core/ui/Buttons/new-here]] [[$:/core/ui/Buttons/new-journal-here]] [[$:/core/ui/Buttons/clone]] [[$:/core/ui/Buttons/export-tiddler]] [[$:/core/ui/Buttons/edit]] [[$:/core/ui/Buttons/delete]] [[$:/core/ui/Buttons/permalink]] [[$:/core/ui/Buttons/permaview]] [[$:/core/ui/Buttons/open-window]] [[$:/core/ui/Buttons/close-others]] [[$:/core/ui/Buttons/close]] [[$:/core/ui/Buttons/fold-others]] [[$:/core/ui/Buttons/fold]]"
},
"$:/snippets/themeswitcher": {
"title": "$:/snippets/themeswitcher",
"text": "<$linkcatcher to=\"$:/theme\">\n<div class=\"tc-chooser\"><$list filter=\"[plugin-type[theme]sort[title]]\"><$set name=\"cls\" filter=\"[all[current]field:title{$:/theme}] [[$:/theme]!has[text]addsuffix[s/tiddlywiki/vanilla]field:title<currentTiddler>] +[limit[1]]\" value=\"tc-chooser-item tc-chosen\" emptyValue=\"tc-chooser-item\"><div class=<<cls>>><$link to={{!!title}}>''<$view field=\"name\" format=\"text\"/>'' <$view field=\"description\" format=\"text\"/></$link></div>\n</$set>\n</$list>\n</div>\n</$linkcatcher>"
},
"$:/core/wiki/title": {
"title": "$:/core/wiki/title",
"text": "{{$:/SiteTitle}} --- {{$:/SiteSubtitle}}"
},
"$:/view": {
"title": "$:/view",
"text": "classic"
},
"$:/snippets/viewswitcher": {
"title": "$:/snippets/viewswitcher",
"text": "\\define icon()\n$:/core/images/storyview-$(storyview)$\n\\end\n<$linkcatcher to=\"$:/view\">\n<div class=\"tc-chooser tc-viewswitcher\">\n<$list filter=\"[storyviews[]]\" variable=\"storyview\">\n<$set name=\"cls\" filter=\"[<storyview>prefix{$:/view}]\" value=\"tc-chooser-item tc-chosen\" emptyValue=\"tc-chooser-item\"><div class=<<cls>>>\n<$link to=<<storyview>>><$transclude tiddler=<<icon>>/><$text text=<<storyview>>/></$link>\n</div>\n</$set>\n</$list>\n</div>\n</$linkcatcher>"
}
}
}
\define list-links(filter,type:"ul",subtype:"li",class:"",emptyMessage)
\whitespace trim
<$type$ class="$class$">
<$list filter="$filter$" emptyMessage=<<__emptyMessage__>>>
<$subtype$>
<$link to={{!!title}}>
<$transclude field="caption">
<$view field="title"/>
</$transclude>
</$link>
</$subtype$>
</$list>
</$type$>
\end
\define list-links-draggable-drop-actions()
<$action-listops $tiddler=<<targetTiddler>> $field=<<targetField>> $subfilter="+[insertbefore:currentTiddler<actionTiddler>]"/>
\end
\define list-links-draggable(tiddler,field:"list",type:"ul",subtype:"li",class:"",itemTemplate)
\whitespace trim
<span class="tc-links-draggable-list">
<$vars targetTiddler="""$tiddler$""" targetField="""$field$""">
<$type$ class="$class$">
<$list filter="[list[$tiddler$!!$field$]]">
<$droppable actions=<<list-links-draggable-drop-actions>> tag="""$subtype$""" enable=<<tv-enable-drag-and-drop>>>
<div class="tc-droppable-placeholder"/>
<div>
<$transclude tiddler="""$itemTemplate$""">
<$link to={{!!title}}>
<$transclude field="caption">
<$view field="title"/>
</$transclude>
</$link>
</$transclude>
</div>
</$droppable>
</$list>
</$type$>
<$tiddler tiddler="">
<$droppable actions=<<list-links-draggable-drop-actions>> tag="div" enable=<<tv-enable-drag-and-drop>>>
<div class="tc-droppable-placeholder">
</div>
<div style="height:0.5em;"/>
</$droppable>
</$tiddler>
</$vars>
</span>
\end
\define list-tagged-draggable-drop-actions(tag)
<!-- Save the current ordering of the tiddlers with this tag -->
<$set name="order" filter="[<__tag__>tagging[]]">
<!-- Remove any list-after or list-before fields from the tiddlers with this tag -->
<$list filter="[<__tag__>tagging[]]">
<$action-deletefield $field="list-before"/>
<$action-deletefield $field="list-after"/>
</$list>
<!-- Save the new order to the Tag Tiddler -->
<$action-listops $tiddler=<<__tag__>> $field="list" $filter="+[enlist<order>] +[insertbefore:currentTiddler<actionTiddler>]"/>
<!-- Make sure the newly added item has the right tag -->
<!-- Removing this line makes dragging tags within the dropdown work as intended -->
<!--<$action-listops $tiddler=<<actionTiddler>> $tags=<<__tag__>>/>-->
<!-- Using the following 5 lines as replacement makes dragging titles from outside into the dropdown apply the tag -->
<$list filter="[<actionTiddler>!contains:tags<__tag__>]">
<$fieldmangler tiddler=<<actionTiddler>>>
<$action-sendmessage $message="tm-add-tag" $param=<<__tag__>>/>
</$fieldmangler>
</$list>
</$set>
\end
\define list-tagged-draggable(tag,subFilter,emptyMessage,itemTemplate,elementTag:"div",storyview:"")
\whitespace trim
<span class="tc-tagged-draggable-list">
<$set name="tag" value=<<__tag__>>>
<$list filter="[<__tag__>tagging[]$subFilter$]" emptyMessage=<<__emptyMessage__>> storyview=<<__storyview__>>>
<$elementTag$ class="tc-menu-list-item">
<$droppable actions="""<$macrocall $name="list-tagged-draggable-drop-actions" tag=<<__tag__>>/>""" enable=<<tv-enable-drag-and-drop>>>
<$elementTag$ class="tc-droppable-placeholder"/>
<$elementTag$>
<$transclude tiddler="""$itemTemplate$""">
<$link to={{!!title}}>
<$view field="title"/><$list filter="[all[current]has[caption]]"> ({{!!caption}})</$list>
</$link>
</$transclude>
</$elementTag$>
</$droppable>
</$elementTag$>
</$list>
<$tiddler tiddler="">
<$droppable actions="""<$macrocall $name="list-tagged-draggable-drop-actions" tag=<<__tag__>>/>""" enable=<<tv-enable-drag-and-drop>>>
<$elementTag$ class="tc-droppable-placeholder"/>
<$elementTag$ style="height:0.5em;">
</$elementTag$>
</$droppable>
</$tiddler>
</$set>
</span>
\end
<$button tooltip={{$:/language/Buttons/SaveWiki/Hint}} aria-label={{$:/language/Buttons/SaveWiki/Caption}} class=<<tv-config-toolbar-class>>>
<$wikify name="site-title" text={{$:/config/SaveWikiButton/Filename}}>
<$action-setfield $tiddler="Velg stadium" loadonstartup="TRUE" />
<$action-sendmessage $message="tm-save-wiki" $param={{$:/config/SaveWikiButton/Template}} filename=<<site-title>>/>
</$wikify>
<span class="tc-dirty-indicator">
<$list filter="[<tv-config-toolbar-icons>match[yes]]">
{{$:/core/images/save-button}}
</$list>
<$list filter="[<tv-config-toolbar-text>match[yes]]">
<span class="tc-btn-text"><$text text={{$:/language/Buttons/SaveWiki/Caption}}/></span>
</$list>
</span>
</$button>
\whitespace trim
<span class="tc-tag-list-item">
<$set name="transclusion" value=<<currentTag>>>
<$macrocall $name="tag-pill-body" tag=<<currentTag>> icon={{!!icon}} colour={{!!color}} palette={{$:/palette}} element-tag="""$button""" element-attributes="""popup=<<qualify "$:/state/popup/tag">> dragFilter='[<currentTag>]tagging[]]' tag='span'"""/>
<$reveal state=<<qualify "$:/state/popup/tag">> type="popup" position="below" animate="yes" class="tc-drop-down">
<$set name="tv-show-missing-links" value="yes">
<$tiddler tiddler=<<currentTag>> >
<$transclude tiddler="$:/core/ui/ListItemTemplate"/>
</$tiddler>
</$set>
<$list filter="[all[shadows+tiddlers]tag[$:/tags/TagDropdown]!has[draft.of]]" variable="listItem">
<$tiddler tiddler=<<currentTag>> >
<$transclude tiddler=<<listItem>>/>
</$tiddler>
</$list>
<hr>
<$macrocall $name="list-tagged-draggable" tag=<<currentTag>> subFilter="stage{Hjem!!stage}" />
</$reveal>
</$set>
</span>
\whitespace trim
<$reveal type="nomatch" stateTitle=<<folded-state>> text="hide" tag="div" retain="yes" animate="yes">
<div class="tc-subtitle">
<$link to={{!!modifier}} />
<$view field="modified" format="date" template={{$:/language/Tiddler/DateFormat}}/>
</div>
</$reveal>
<$reveal type="nomatch" stateTitle=<<folded-state>> text="hide" tag="div" retain="yes" animate="yes">
<div class="tc-tags-wrapper"><$list filter="[all[current]tags[]sort[title]]" variable="currentTag" template="$:/core/ui/TagTemplate2" storyview="pop"/></div>
</$reveal>
[has[loadonstartup]sort[homeorder]]
\define imgLink(imgsrc:"NaN" size:320)
<center>
<$link to="$imgsrc$">[img width=$size$ [images/$imgsrc$]]</$link>
</center>
\end
\define imgTiddler() [img[images/$(currentTiddler)$]]
The following tiddlers were imported:
# [[IIC - 2021 - Oppgave 1 - Del 2]]
@@.noprint
<$list filter="[all[current]has[exercise]]" variable="cTiddler">
<$set name="qNumber" value={{!!question}}>
<hr/>
<div>
<div style="float:right">
<$set name="nQuestion" filter="[<qNumber>add[1]]" >
<$list filter="[stage{!!stage}year{!!year}exercise{!!exercise}question<nQuestion>]">
<$link>Neste >></$link>
</$list>
</$set>
</div>
<div style="float:left">
<$set name="pQuestion" filter="[<qNumber>subtract[1]]" >
<$list filter="[stage{!!stage}year{!!year}exercise{!!exercise}question<pQuestion>]">
<$button to=<<currentTiddler>> class="tc-btn-invisible tc-tiddlylink">
<$action-listops $tiddler="$:/StoryList" $field="list" $filter="[enlist{$:/StoryList!!list}] [<currentTiddler>] +[putbefore<cTiddler>]" />
<< Forrige
</$button>
</$list>
</$set>
</div>
</div>
</$set>
</$list>
@@
<$list filter="[all[current]tag[Fagfelt]]">
<$list filter="[stage{Hjem!!stage}tag<currentTiddler>]">
!!! <$link />
{{!!text}}
<hr />
</$list>
</$list>
<$button class="tc-btn-invisible">
<$list filter='[all[tiddlers]has[exercise]]'>
<$action-setfield showanswer="closed" />
<$action-setfield showpoints="closed" />
</$list>
{{$:/core/images/fold-button}}
</$button>
<div style = "display: none;" class = "myfooter"><small>http://ununderstandable.com/ - AHJ 2020 - <<now "DDth mmm YYYY 0hh:0mm:0ss">></small></div>
@media print {
@page {
size: A4;
margin: 2cm;
}
.tc-sidebar-scrollable, .tc-topbar, .tc-tiddler-controls{
display: none !important;
}
.tc-titlebar, .tc-tiddler-title{
position: static;
top: 0mm;
}
.noprint{
display: none;
}
h2.tc-title{
font-size: xx-large !important;
}
.tc-story-river{
display: block;
margin-top: 0mm;
}
.tc-tiddler-frame{
background-color: white;
display: block;
}
.tc-tiddler-body{
page-break-after: always;
page-break-within: avoid;
}
.utstyr, .dørtekst, .sensorveiledning, .spørsmål, .pasientinfo{
page-break-inside: avoid;
}
}
<div style="padding-top: 10px;">
Velg: <$select tiddler='Hjem' field="stage">
<option value='IAB'>Stadium IAB</option>
<option value='ICD'>Stadium ICD</option>
<option value='IIAB'>Stadium IIAB</option>
<option value='IIC'>Stadium IIC</option>
<option value='IIIC'>Stadium IIIC</option>
<option value='IIID'>Stadium IIID</option>
</$select>
</div>
summary{
font-weight: bold;
}
details.points{
background-color: #B23CFD09;
border: solid 1px #B23CFDFF;
border-left: solid 5px #B23CFDFF;
}
details, .oppgave{
line-height: 18px;
padding: 12px;
margin-bottom: 20px;
}
div.oppgave{
background-color: #39C0ED09;
border: solid 1px #39C0EDFF;
border-left: solid 5px #39C0EDFF;
}
details.answer{
background-color: #00B74A09;
border: solid 1px #00B74AFF;
border-left: solid 5px #00B74AFF;
}
.tc-drop-down{
overflow-x: visible;
z-index: 500;
min-width: 720px !important;
}
.blokk h3{
font-weight: 600;
}
.tc-tiddler-frame{
overflow: auto;
}
.editlink{
float: right;
margin: 0px;
fill: #c6c6c6;
width: 22px;
}
blockquote{
border-left: 5px solid #707070 !important;
}
div.utstyr{
background-color: #FFA90009;
border: solid 1px #FFA900FF;
border-left: solid 5px #FFA900FF;
line-height: 18px;
padding: 12px;
margin-bottom: 20px;
}
div.spørsmål{
background-color: #B23CFD09;
border: solid 1px #B23CFDFF;
border-left: solid 5px #B23CFDFF;
line-height: 18px;
padding: 12px;
margin-bottom: 20px;
}
div.sensorveiledning{
background-color: #F9315409;
border: solid 1px #F93154FF;
border-left: solid 5px #F93154FF;
line-height: 18px;
padding: 12px;
margin-bottom: 20px;
}
<$button class="tc-btn-invisible">
<$list filter='[all[tiddlers]has[exercise]]'>
<$action-setfield showanswer="open" />
<$action-setfield showpoints="open" />
</$list>
{{$:/core/images/unfold-button}}
</$button>
$:/themes/jd/Mono/Palette/SpartanDay
{
"tiddlers": {
"$:/plugins/felixhayashi/respawn/respawn.js": {
"text": "/*\\\n\ntitle: $:/plugins/felixhayashi/respawn/respawn.js\ntype: application/javascript\nmodule-type: startup\n\n@preserve\n\n\\*/\n\n(function(){\n \n /*jslint node: true, browser: true */\n /*global $tw: false */\n \"use strict\";\n \n var configTRef = \"$:/plugins/felixhayashi/respawn/config\";\n \n var changeListener = function(changedTiddlers) {\n \n if(!changedTiddlers[\"$:/StoryList\"]) return;\n \n var tObj = $tw.wiki.getTiddler(\"$:/StoryList\");\n if(tObj && !tObj.fields[\"list\"].length) {\n \n var confTObj = $tw.wiki.getTiddler(configTRef);\n var config = confTObj ? confTObj.fields : {};\n \n window.setTimeout(function() {\n $tw.rootWidget.dispatchEvent({\n type: \"tm-home\"\n });\n }, parseInt(config.delay) || 500);\n }\n \n };\n \n exports.name = \"respawn\";\n exports.platforms = [\"browser\"];\n exports.after = [\"story\"];\n exports.synchronous = true;\n \n exports.startup = function() {\n \n $tw.wiki.addEventListener(\"change\", changeListener);\n \n };\n\n})();\n",
"title": "$:/plugins/felixhayashi/respawn/respawn.js",
"type": "application/javascript",
"module-type": "startup"
},
"$:/plugins/felixhayashi/respawn/Configuration": {
"title": "$:/plugins/felixhayashi/respawn/Configuration",
"text": "<!-- The config output is not written to this tiddler! -->\n\nPlease see the [[GitHub page|https://github.com/felixhayashi/TW5-Respawn]] for more information on the options.\n\nYou may have to save and reload the wiki to activate changes.\n\n<table>\n <tr>\n <th align=\"left\">Delay (seconds):</th>\n <td>\n <$edit-text\n tiddler=\"$:/plugins/felixhayashi/respawn/config\"\n field=\"delay\"\n tag=\"input\"\n default=\"500\" />\n </td>\n </tr>\n</table>"
},
"$:/plugins/felixhayashi/respawn/License": {
"title": "$:/plugins/felixhayashi/respawn/License",
"text": "This code is released under the BSD license. For the exact terms visit:\n\nhttps://github.com/felixhayashi/TW5-Respawn/blob/master/LICENSE"
},
"$:/plugins/felixhayashi/respawn/Readme": {
"title": "$:/plugins/felixhayashi/respawn/Readme",
"text": "Please visit the [[GitHub page|https://github.com/felixhayashi/TW5-Respawn]] for more information."
}
}
}
{
"tiddlers": {
"$:/plugins/telmiger/details/details.css": {
"text": "/* details and summary */\n\ndetails {\n transition: height 1s ease;\n padding: 0 0.5em 0 0.66em;\n margin-top: 0.66em;\n margin-bottom: 0.66em;\n}\n\ndetails + details {\n margin-top: -0.46em;\n}\n\ndetails[open] {\n padding-bottom: 1em;\n}\n\ndetails:not([open]) { \n cursor: pointer;\n}\n\ndetails > summary {\n display: list-item;\n margin: 0 -0.5em 0 -0.66em;\n padding: 0.2em 0.5em 0.2em 0.66em;\n padding-left: 1.76em; /* adjust for indentation */\n text-indent: -1.1em;\n cursor: pointer;\n}\n\ndetails[open] > summary {\n margin-bottom: 1em;\n}\n\ndetails[open] > *:first-child:not(summary) {\n margin-top: 1em;\n}\n",
"title": "$:/plugins/telmiger/details/details.css",
"tags": "$:/tags/Stylesheet",
"modifier": "Thomas Elmiger",
"modified": "20180929131615369",
"creator": "Thomas Elmiger",
"created": "20170122140815442"
},
"$:/plugins/telmiger/details/details.js": {
"text": "/*\\\ntitle: $:/plugins/telmiger/details/details.js\ntype: application/javascript\nmodule-type: widget\n\nDetails widget v 0.8\n\nWill output an HTML 5 <details> section including a <summary>\n\n```\n\t<details>\n\t\t<summary>This sums it up</summary> \n\t\tAll the details follow here.\n\t</details>\n```\n\n|Parameter |Description |h\n|summary |Optional text to display as summary. Wins over field (see below). |\n|open |Optional initial state, set to \"open\" to show details on load. Defaults to \"\". |\n|state |An optional TextReference containing the state. Wins over open. |\n|field |Optionally, the summary is taken from the field with this name in a given tiddler. Defaults to \"title\". |\n|tiddler |Optional title of a tiddler to watch, connected to field. Defaults to current tiddler. |\n|class |Optional CSS classes to be assigned to the details tag. |\n\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar DetailsWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nDetailsWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nDetailsWidget.prototype.render = function(parent,nextSibling) {\n\t// Save the parent dom node\n\tthis.parentDomNode = parent;\n\t// Compute attributes\n\tthis.computeAttributes();\n\t// Execute logic\n\tthis.execute();\n\t// Create elements\n\tthis.detailsDomNode = this.document.createElement(\"details\");\n\tif(this.detailsClass !== \"\") {\n\t\t// this.detailsClass += \" \";\n\t\t// this.detailsClass += \"tc-details\";\n\t\tthis.detailsDomNode.setAttribute(\"class\",this.detailsClass);\n\t}\n\tif(this.detailsOpen == \"open\") {\n\t\tthis.detailsDomNode.setAttribute(\"open\",\"open\");\n\t}\n\tif(this.detailsSummary !== \"\") {\n\t\tthis.summaryDomNode = this.document.createElement(\"summary\");\n\t\t// this.summaryDomNode.setAttribute(\"class\",\"tc-summary\");\n\t\tthis.detailsDomNode.appendChild(this.summaryDomNode);\n\t\tthis.summaryDomNode.appendChild(this.document.createTextNode(this.detailsSummary));\n\t}\n// register an event listener\n/* Maybe this can be reactivated later, see below.\n\tif(this.detailsStateTitle) {\n\t\t$tw.utils.addEventListeners(this.detailsDomNode,[\n\t\t\t{name: \"toggle\", handlerObject: this, handlerMethod: \"handleToggleEvent\"},\n\t\t]);\n\t}\n*/\n// As iOS mobile browsers lack support of toggle events on details \n// we emulate the toggle event using click\n\tif(this.detailsStateTitle && this.summaryDomNode) {\n\t\t$tw.utils.addEventListeners(this.summaryDomNode,[\n\t\t\t{name: \"click\", handlerObject: this, handlerMethod: \"handleToggleEvent\"},\n\t\t]);\n\t} else {\n\t\tif(this.detailsStateTitle) {\n\t\t\t$tw.utils.addEventListeners(this.detailsDomNode,[\n\t\t\t\t{name: \"click\", handlerObject: this, handlerMethod: \"handleToggleEvent\"},\n\t\t\t]);\n\t\t}\n\t}\n\t// Insert the details into the DOM and render any children\n\tthis.parentDomNode.insertBefore(this.detailsDomNode,nextSibling);\n\tthis.renderChildren(this.detailsDomNode,null);\n\tthis.domNodes.push(this.detailsDomNode);\n};\n\n/*\nRetrieve the value of the summary\n*/\nDetailsWidget.prototype.getSummary = function() {\n\tvar summary = \"\";\n\tif(this.summaryTitle === \"Tiddler not found\" && this.summaryField === \"\") {\n\t// nothing defined: leave empty \n\t\tsummary = \"\";\n\t} else {\n\t\t// tiddler defined? use defined field or title\n\t\tif(this.myTiddler) {\n\t\t\tif(this.summaryField === \"title\" || this.summaryField === \"\") {\n\t\t\t\tsummary = this.summaryTitle;\n\t\t\t} else {\n\t\t\t\tif(this.summaryField === \"text\") {\n \t\t// getTiddlerText() triggers lazy loading of skinny tiddlers\n\t\t\t\t\tsummary = this.wiki.getTiddlerText(this.summaryTitle);\n\t\t\t\t} else {\n\t\t\t\t\tsummary = this.myTiddler.fields[this.summaryField];\n\t\t\t\t}\n\t\t\t}\n\t\t} else {\n\t\t\tif(this.summaryField !== \"\" && this.summaryField !== \"text\") {\n\t\t\t\t// try defined field in current tiddler\n\t\t\t\tvar tiddler = this.wiki.getTiddler(this.getVariable(\"currentTiddler\"));\n\t\t\t\tsummary = tiddler.fields[this.summaryField];\n\t\t\t} else {\n\t\t\t\tsummary = \"\";\n\t\t\t}\n\t\t}\n\t}\n return summary;\n};\n\n/*\nRetrieve the value of the state text reference\n*/\nDetailsWidget.prototype.getStateFromReference = function() {\n var state = this.detailsStateTitle ? this.wiki.getTextReference(this.detailsStateTitle,\"\",this.getVariable(\"currentTiddler\")) : \"\";\n return state;\n};\n\n/*\nCheck all open signals, state fields/tiddlers get priority\n*/\nDetailsWidget.prototype.getOpenState = function() {\n\tvar result = \"\";\n\tif((this.detailsOpenDefault !== \"\" && this.detailsOpenDefault !== \"no\") \n\t || this.detailsState === \"open\") {\n\t\tresult = \"open\";\n\t } \n\tif(this.detailsStateTitle !==\"\" && this.detailsState !== \"open\") {\n\t\tresult = \"\";\n\t}\n\treturn result;\n};\n\n/*\nUpdate the state text reference after click event\n*/\nDetailsWidget.prototype.updateState = function(openState) {\n\tvar fieldValue = \"false\";\n\tvar currentTiddler = this.getVariable(\"currentTiddler\");\n // get the title for the (existing/new) tiddler\n\tvar tr = $tw.utils.parseTextReference(this.detailsStateTitle);\n\tvar tidTitle = tr.title || currentTiddler;\n // is it an existing state tiddler?\n\tvar isStateTiddler = (tr.title === this.detailsStateTitle);\n\tvar hasStateTiddler = this.wiki.tiddlerExists(tr.title);\n\tvar currentStateTiddler = (tr.title === currentTiddler);\n\tif(isStateTiddler || hasStateTiddler || (currentStateTiddler && tr.field !== \"text\")) { \n\t\t// Set the state field (but never overwrite the current tiddler’s text field\n\t\tthis.wiki.setText(tidTitle,tr.field,tr.index,openState);\n\t} else {\n\t\tif(!hasStateTiddler && tidTitle !== currentTiddler) {\n\t\t\tthis.createTiddler(tidTitle);\n\t\t\tthis.wiki.setText(tidTitle,tr.field,tr.index,openState);\n\t\t} else {\n\t\t\tconsole.log (\"Something went wrong in updateState\");\n\t\t}\n\t}\n};\n\n/*\nCreate a tiddler with a title only\n*/\nDetailsWidget.prototype.createTiddler = function(tidTitle) {\n\tthis.wiki.addTiddler(new $tw.Tiddler(\n\t\tthis.wiki.getCreationFields(),\n\t\tthis.wiki.getModificationFields(),\n\t\t{\n\t\t\ttitle: tidTitle,\n\t\t\ttags: []\n\t\t}\n\t));\n};\n\n/*\nSet openState according to click\n*/\nDetailsWidget.prototype.handleToggleEvent = function(event) {\n\t// check if an open attribute is present\n\tvar newState = this.detailsDomNode.open ? \"\" : \"open\";\n\t// update only, if the node has a new state\n\tif(newState !== this.detailsState) {\n\t\tthis.updateState(newState);\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nDetailsWidget.prototype.execute = function() {\n\t// Get the parameters from the attributes \n\tvar tryTiddler = this.getAttribute(\"tiddler\");\n\tthis.myTiddler = this.wiki.getTiddler(tryTiddler);\n\tthis.summaryTitle = this.myTiddler ? tryTiddler : \"Tiddler not found\";\n\tthis.summaryField = this.getAttribute(\"field\",\"\");\n\tthis.detailsSummary = this.getAttribute(\"summary\") || this.getSummary();\n\tthis.detailsStateTitle = this.getAttribute(\"state\",\"\");\n\tthis.detailsState = this.getStateFromReference();\n\tthis.detailsOpenDefault = this.getAttribute(\"open\",\"\");\n\tthis.detailsOpen = this.getOpenState();\n\tthis.detailsClass = this.getAttribute(\"class\",\"\");\n\t// Construct the child widgets\n\tthis.makeChildWidgets();\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nDetailsWidget.prototype.refresh = function(changedTiddlers) {\n\tvar changedAttributes = this.computeAttributes();\n\tif(changedAttributes.tiddler || changedAttributes.field || changedAttributes.summary || changedAttributes.state || changedAttributes.open || changedAttributes[\"class\"]) {\n\t\tthis.refreshSelf();\n\t\treturn true;\n\t} else {\n\t\tvar refreshed = false;\n\t\tvar testState = this.getStateFromReference();\n\t\tif(testState !== this.detailsState) {\n\t\t\t// state change\n\t\t\tthis.refreshSelf();\n\t\t\trefreshed = true;\n\t\t} \n\t\treturn this.refreshChildren(changedTiddlers) || refreshed;\n\t}\n};\n\nexports.details = DetailsWidget;\n\n})();",
"type": "application/javascript",
"title": "$:/plugins/telmiger/details/details.js",
"tags": "Plugins",
"module-type": "widget",
"modifier": "Thomas Elmiger",
"modified": "20180929212032187",
"creator": "Thomas Elmiger",
"created": "20170124173619910"
},
"$:/plugins/telmiger/details/icon": {
"created": "20170205205314072",
"text": "<svg class=\"tc-image-button telmiger-icon\" viewBox=\"0 0 128 128\" xmlns=\"http://www.w3.org/2000/svg\" fill-rule=\"evenodd\" viewBox=\"0 0 128 128\" role=\"img\" aria-labelledby=\"title\"><title id=\"title\">T</title><path class=\"circle\" d=\"M64 2C30 2 2 29.753 2 64c0 34.235 27.753 62 62 62s62-27.752 62-62C126 29.753 98.221 2 64 2z\"/><path class=\"t\" d=\"M100.41 63.254c-2.886 1.92-7.544 2.883-13.979 2.883h-8.008c-4.246 0-7.331.845-9.254 2.536-1.922 1.69-3.449 5.086-4.576 10.19 0 0-.181 1.481-.503 1.481s-.369-.877-.518-1.586a37.897 37.897 0 0 0-.721-2.754c-.631-2.137-1.262-3.753-1.894-4.847-.764-1.359-1.727-2.452-2.889-3.28-1.162-.83-2.49-1.326-3.985-1.492l-2.092-.248H41.73c-6.144 0-10.711-.962-13.7-2.884-4.976-3.159-7.649-9.129-8.02-17.91-.03-.706.003-1.351.132-2.171h.585c.399 3.975 3.679 7.048 6.086 9.219 2.408 2.172 6.269 3.258 11.581 3.258h9.313c5.347 0 9.257 1.226 11.731 3.68 2.231 2.213 3.701 5.68 4.406 10.4.076.511.03.736.178.736.149 0 .11-.256.17-.783.713-6.122 3.085-10.219 7.117-12.294 2.487-1.292 6.434-1.906 11.841-1.839l6.368.1c4.311.066 7.942-.788 10.893-2.56 2.953-1.773 6.447-5.079 6.844-9.917h.595c.183.478.16 1.576.127 2.333-.371 8.752-2.894 14.668-7.567 17.749z\"/></svg>\n<style>\n.telmiger-icon .circle { fill: #e2001a }\n.telmiger-icon .t { fill: #fff }\n</style>",
"title": "$:/plugins/telmiger/details/icon",
"tags": "",
"modified": "20171219183752113"
},
"$:/plugins/telmiger/details/license": {
"text": "!! Plugin license\n!!!The MIT License (MIT)\n\n```\nCopyright © 2017/2018 Thomas Elmiger – thomas-elmiger.ch\n\nPermission is hereby granted, free of charge, to any person obtaining a copy of this software and associated documentation files (the “Software”), to deal in the Software without restriction, including without limitation the rights to use, copy, modify, merge, publish, distribute, sublicense, and/or sell copies of the Software, and to permit persons to whom the Software is furnished to do so, subject to the following conditions:\n\nThe above copyright notice and this permission notice shall be included in all copies or substantial portions of the Software.\n\nTHE SOFTWARE IS PROVIDED “AS IS”, WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.\n```",
"title": "$:/plugins/telmiger/details/license",
"tags": "",
"modified": "20170205214435064",
"created": "20170205213335455"
},
"$:/plugins/telmiger/details/readme": {
"created": "20170205212323032",
"text": "! ~DetailsWidget\n\n{{$:/plugins/telmiger/details/about}}\n\nDocumentation can be found at http://tid.li/tw5/plugins.html#DetailsWidget\n",
"title": "$:/plugins/telmiger/details/readme",
"tags": "",
"modified": "20200603211110057"
},
"$:/plugins/telmiger/details/colours.css": {
"text": "/* details and summary colours */\n\ndetails {\n background-color: <<colour tiddler-info-tab-background>>;\n color: <<colour foreground>>;\n}\n\ndetails summary {\n background-color: <<colour dropdown-tab-background>>;\n}\n\ndetails.notification summary {\n background-color: <<colour notification-background>>;\n /* TW leaves color undefined/uses foreground */\n}\n\ndetails.warning summary {\n background-color: #ffbbaf;\n color: #000;\n}\n\ndetails.success summary {\n background-color: #88edc5;\n color: #000;\n}\n",
"title": "$:/plugins/telmiger/details/colours.css",
"tags": "$:/tags/Stylesheet",
"modifier": "Thomas Elmiger",
"modified": "20180926204140772",
"creator": "Thomas Elmiger",
"created": "20180925155320737"
},
"$:/plugins/telmiger/DetailsWidget/support": {
"created": "20200603204816640",
"text": "{{$:/plugins/telmiger/support}}",
"title": "$:/plugins/telmiger/DetailsWidget/support",
"tags": "",
"modified": "20200603204849180"
},
"$:/plugins/telmiger/support": {
"created": "20200604213259310",
"text": "!! Support the Author\n\n''Hi!'' I’m Thomas, the author of [[tid.li/tw5/plugins.html|https://tid.li/tw5/plugins.html]]. Feedback is always welcome, as well as funding for maintenance, support and new projects :)\n\n---\n\n!!! One Time Support\n\nIf using my plugins just makes you happy, consider a one time payment via ~PayPal to reward the effort:\n\nhttps://www.paypal.me/telmiger\n\n---\n\n!!! Permanent Support\n\nIf my tools make you more productive or save you time in your job or your everyday life, you can support me as a Patron: \n\nhttps://www.patreon.com/telmiger\n\n---\n\n!!! Thank You\n\nSubstantial parts of my availabe time go to the deveopment of useful plugins for [[TiddlyWiki|https://tiddlywiki.com/]]. – Many others do the same and I would like to thank them all, especially [[Jeremy Ruston|https://tiddlywiki.com/#JeremyRuston]] and all the active members of the community!\n\n//Hereby I promise to share future revenues (if any) with other developers who’s works I use or who inspired me.//\n\nIf you like my work, I would be very happy to hear from you.\n\n''Thank you very much for your support!''<br>\n//Thomas//\n\nhttps://thomas-elmiger.ch",
"title": "$:/plugins/telmiger/support",
"tags": "",
"modifier": "Thomas Elmiger",
"modified": "20200604213305050",
"creator": "Thomas Elmiger"
},
"$:/plugins/telmiger/details/about": {
"created": "20200603211101398",
"modified": "20200603211101398",
"title": "$:/plugins/telmiger/details/about",
"text": "Create HTML 5 `<details>` elements including a `<summary>` using this widget.\n\n<$details summary=\"The details element – W3C definition\">\n\n<<<\nThe [[details|http://w3c.github.io/html/interactive-elements.html#elementdef-details]] element represents a disclosure widget from which the user can obtain additional information or controls.\n<<< W3C\n\n</$details>\n\n<$details summary=\"Code example\" open=\"no\">\n\n```\n<$details summary=\"This should be open\" open=\"yes\">\n\nContent will be immediately visible if open is set to \"yes\".\n\n</$details>\n```\n\n</$details>",
"tags": ""
}
}
}
/* details and summary colours */
details {
background-color: <<colour tiddler-info-tab-background>>;
color: <<colour foreground>>;
}
details summary {
background-color: <<colour dropdown-tab-background>>;
}
details.notification summary {
background-color: <<colour notification-background>>;
/* TW leaves color undefined/uses foreground */
}
details.warning summary {
background-color: #ffbbaf;
color: #000;
}
details.success summary {
background-color: #88edc5;
color: #000;
}
Kortsvarsoppgaver for medisinstudiet ved NTNU
\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]
\rules only filteredtranscludeinline transcludeinline macrocallinline
<div class="tc-remove-when-wiki-loaded">
<style scoped>
.tc-splash-text {
font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Helvetica, Arial, sans-serif, "Apple Color Emoji", "Segoe UI Emoji", "Segoe UI Symbol";
font-size: 16px;
text-rendering: optimizeLegibility;
-webkit-font-smoothing: antialiased;
margin: 20px auto 0;
width: 200px;
text-align: center;
color: <<colour foreground>>;
fill: <<colour foreground>>;
}
html body.tc-body {
background: <<colour page-background>>;
}
.line-wrapper {
width: 100%;
height: 80vh;
display: flex;
flex-direction: column;
justify-content: center;
align-items: center;
}
.line {
width: 50px;
height: 1px;
background: <<colour muted-foreground>>;
-webkit-animation: line 2s infinite;
-moz-animation: line 2s infinite;
-o-animation: line 2s infinite;
animation: line 2s infinite;
}
@-webkit-keyframes line {
0% { width: 10px; }
50% { width: 200px; }
100% { width: 10px; }
}
@keyframes line {
0% { width: 10px; }
50% { width: 200px; }
100% { width: 10px; }
}
.linetwo {
width: 50px;
height: 1px;
background: <<colour muted-foreground>>;
-webkit-animation: linetwo 2s infinite;
-moz-animation: linetwo 2s infinite;
-o-animation: linetwo 2s infinite;
animation: linetwo 2s infinite;
margin: 5px 0;
}
@-webkit-keyframes linetwo {
0% { width: 5px; }
70% { width: 180px; }
100% { width: 5px; }
}
@keyframes linetwo {
0% { width: 5px; }
70% { width: 180px; }
100% { width: 5px; }
}
.linethree {
width: 50px;
height: 1px;
background: <<colour muted-foreground>>;
-webkit-animation: linethree 2s infinite;
-moz-animation: linethree 2s infinite;
-o-animation: linethree 2s infinite;
animation: linethree 2s infinite;
margin: linethree 0;
}
@-webkit-keyframes linethree {
0% { width: 0; }
80% { width: 160px; }
100% { width: 0; }
}
@keyframes linethree {
0% { width: 0; }
80% { width: 160px; }
100% { width: 0; }
}
</style>
<div class="line-wrapper">
<div class="tc-splash-text">{{$:/SiteTitle}}</div>
<div class="line"></div>
<div class="linetwo"></div>
<div class="linethree"></div>
</div>
</div>
$:/core/ui/AdvancedSearch/Standard
$:/core/ui/AdvancedSearch/Filter
$:/core/ui/ControlPanel/Toolbars
$:/core/ui/ControlPanel/Plugins/Installed/Themes
$:/core/ui/TiddlerInfo/References
$:/core/ui/ControlPanel/Plugins
$:/core/ui/TiddlerInfo/Advanced
$:/core/ui/MoreSideBar/System
<$list filter='[all[current]title[Velg stadium]]'>
[data-tiddler-title='{{!!title}}'] {
background-image: url(https://image.forskning.no/131618.webp?imageId=131618&width=2116&height=1208&format=webp);
background-position: center;
background-repeat: no-repeat;
background-size: cover;
}
.stageMenuItem {
background-color: #B23CFD40 !important;
}
</$list>
.oppgave {
background-image: linear-gradient(rgba(0, 0, 0, 0.7), rgba(0, 0, 0, 0.7)), url(https://image.forskning.no/131618.webp?imageId=131618&width=2116&height=1208&format=webp);
background-position: center;
background-repeat: no-repeat;
background-size: cover;
}
{
"tiddlers": {
"$:/info/browser": {
"title": "$:/info/browser",
"text": "yes"
},
"$:/info/node": {
"title": "$:/info/node",
"text": "no"
},
"$:/info/url/full": {
"title": "$:/info/url/full",
"text": "file:///C:/Users/anderhja/Lokal_folder/exam/kortsvar.html"
},
"$:/info/url/host": {
"title": "$:/info/url/host",
"text": ""
},
"$:/info/url/hostname": {
"title": "$:/info/url/hostname",
"text": ""
},
"$:/info/url/protocol": {
"title": "$:/info/url/protocol",
"text": "file:"
},
"$:/info/url/port": {
"title": "$:/info/url/port",
"text": ""
},
"$:/info/url/pathname": {
"title": "$:/info/url/pathname",
"text": "/C:/Users/anderhja/Lokal_folder/exam/kortsvar.html"
},
"$:/info/url/search": {
"title": "$:/info/url/search",
"text": ""
},
"$:/info/url/origin": {
"title": "$:/info/url/origin",
"text": "file://"
},
"$:/info/browser/screen/width": {
"title": "$:/info/browser/screen/width",
"text": "3440"
},
"$:/info/browser/screen/height": {
"title": "$:/info/browser/screen/height",
"text": "1440"
},
"$:/info/browser/language": {
"title": "$:/info/browser/language",
"text": "en-US"
}
}
}
{
"tiddlers": {
"$:/themes/jd/Mono/TopBarSegments/search": {
"created": "20190130163600391",
"creator": "jd",
"text": "\\define NewTidActions(searcharea)\n<$action-createtiddler $basetitle={{$searcharea$}} $savetitle=\"$:/temp/NewTidTitle\"/>\n<$action-sendmessage $message=\"tm-edit-tiddler\" $param={{$:/temp/NewTidTitle}}/>\n<$action-deletetiddler $tiddler=\"$:/temp/NewTidTitle\"/>\n<$action-setfield $tiddler=\"$searcharea$\" text=\"\"/>\n\\end\n\\define searchbar()\n<$list variable=\"stateCheck\" filter=\"[[$:/config/TopRightBar/$:/themes/jd/Mono/TopBarSegments/search]!text[hide]]\">\n<div class=\"tc-sidebar-lists\">\n\n<$set name=\"searchTiddler\" value=\"$:/temp/advancedsearch\">\n<$keyboard class=\"tc-search\" tag=\"div\" key=\"enter\" actions=<<NewTidActions \"$:/temp/advancedsearch\">>>\n<$edit-text tiddler=\"$:/temp/advancedsearch\" type=\"search\" tag=\"input\" focus={{$:/config/Search/AutoFocus}} focusPopup=<<qualify \"$:/state/popup/search-dropdown\">> class=\"tc-popup-handle\" default=\"\" placeholder=\"search, [enter] to create\"/>\n<$reveal state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n<$button tooltip=\"Create new tiddler with this title\" class=\"tc-btn-invisible\" actions=<<NewTidActions \"$:/temp/advancedsearch\">>>\n{{$:/core/images/new-button}}\n</$button>\n<$button class=\"tc-btn-invisible\">\n<$action-setfield $tiddler=\"$:/temp/advancedsearch\" text=\"\" />\n{{$:/core/images/close-button}}\n</$button>\n<$button popup=<<qualify \"$:/state/popup/search-dropdown\">> class=\"tc-btn-invisible\">\n{{$:/core/images/down-arrow}}\n</$button>\n<$list filter=\"[is[system]prefix[$:/state/searchtab]text[$:/core/ui/AdvancedSearch/Filter]limit[1]]\" variable=\"tabCheck\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/AdvancedSearch/FilterButton]!has[draft.of]]-$:/core/ui/AdvancedSearch/Filter/FilterButtons/clear\"><$transclude/></$list></$list>\n</$reveal>\n</$keyboard>\n\n<$reveal tag=\"div\" class=\"tc-block-dropdown-wrapper\" state=\"$:/temp/advancedsearch\" type=\"nomatch\" text=\"\">\n\n<$reveal tag=\"div\" class=\"tc-block-dropdown tc-search-drop-down tc-popup-handle\" state=<<qualify \"$:/state/popup/search-dropdown\">> type=\"nomatch\" text=\"\" default=\"\">\n\n<style>.tc-block-dropdown.tc-search-drop-down { display: flex; }</style>\n<<tabs \"[all[shadows+tiddlers]tag[$:/tags/AdvancedSearch]!has[draft.of]]\" \"$:/core/ui/AdvancedSearch/System\" \"$:/state/searchtab\">>\n\n</$reveal>\n\n</$reveal>\n\n</$set>\n\n</div>\n\n</$list>\n\n\\end\n\n<div class=\"mobile-only\">\n\n<$list filter=\"[[$:/state/searchbar]text[show]]\">\n\n<<searchbar>>\n\n</$list>\n\n</div>\n\n<div class=\"desktop-only\">\n\n<<searchbar>>\n\n</div>\n",
"title": "$:/themes/jd/Mono/TopBarSegments/search",
"tags": "$:/tags/TopRightBar",
"modifier": "jd",
"modified": "20190203083032524"
},
"$:/themes/jd/Mono/TopBarSegments/buttons": {
"created": "20190201105717721",
"creator": "jd",
"text": "<div class=\"tc-page-controls\">\n\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n\n<$list filter=\"[enlist{$:/themes/jd/Mono/Database!!list}] +[!has[draft.of]]\" variable=\"listItem\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$list>\n\n</$set>\n\n</div>\n",
"title": "$:/themes/jd/Mono/TopBarSegments/buttons",
"tags": "$:/tags/TopLeftBar",
"modifier": "jd",
"modified": "20190203014153431"
},
"$:/themes/jd/Mono/Stylesheet": {
"created": "20190130145325995",
"creator": "jd",
"text": "\\define bkrpnt() {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}\n\\define sidebar() {{$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth}}\n\\define fontsize() {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}}\n\n\n\n/* MAIN */\n\n@media (min-width: <<bkrpnt>>) {\n.tc-sidebar-scrollable {\n position: fixed;\n top: {{$:/themes/jd/Mono/Database##header-position-desktop}};\n left: 0;\n bottom: 0;\n right: unset;\n width: <<sidebar>>;\n margin: 0;\n padding: 0 2em 2em 2em;\n}\n.tc-story-river {\n width: calc(100% - <<sidebar>>);\n padding: 0 2em 4em 2em;\n}\n<$list filter=\"[[$:/view]!text[zoomin]]\">\n.tc-story-river { top: 0.25em; }\n</$list>\n<$list filter=\"[[$:/view]text[zoomin]]\">\n.tc-story-river {\n top: calc({{$:/themes/jd/Mono/Database##header-position-desktop}} + 0.25em);\n}\n</$list>\n<$list filter=\"[[$:/state/sidebar]!text[no]]\" variable=\"stateCheck\">\n.tc-story-river {\n left: <<sidebar>>;\n right: 0;\n}\n</$list>\n<$list filter=\"[[$:/state/sidebar]text[no]]\" variable=\"stateCheck\">\n.tc-story-river {\n left: calc(<<sidebar>> / 2);\n right: calc(<<sidebar>> / 2);\n}\n</$list>\n.tc-tiddler-frame {\n margin: 0 0 2em 0;\n width: 100%;\n border-radius: 1px;\n <<box-shadow \"2px 2px 5px rgba(0, 0, 0, 0.15)\">>\n}\n.tc-storyview-zoomin-tiddler {\n width: calc(100% - 4em) !important;\n}\n}\n\n@media (max-width: <<bkrpnt>>) {\n.tc-sidebar-scrollable { padding: 0 1em 2em 1em; }\n.tc-sidebar-header { padding: 0; }\n.tc-tiddler-frame { margin-bottom: 2px !important; }\n}\n\n<$list filter=\"[[$:/state/sidebar]!text[no]]\" variable=\"stateCheck\">\n@media (max-width: <<bkrpnt>>) {\n.tc-story-river { display: none; }\n}\n</$list>\n\n<$list filter=\"[[$:/state/sidebar]text[no]]\" variable=\"stateCheck\">\n@media (max-width: <<bkrpnt>>) {\n.tc-sidebar-scrollable { padding-top: 0; padding-bottom: 0; }\n}\n</$list>\n\n<$list filter=\"[[$:/themes/tiddlywiki/vanilla/options/stickytitles]text[yes]]\" variable=\"stateCheck\">\n@media (min-width: <<bkrpnt>>) {\n.tc-tiddler-title {\n top: calc({{$:/themes/jd/Mono/Database##header-position-desktop}} - .25em);\n}\n}\n\n.tc-titlebar {\n line-height: 0;\n}\n\n@media (max-width: <<bkrpnt>>) {\n<$list filter=\"[[$:/state/searchbar]text[show]]\">\n.tc-tiddler-edit-frame .tc-tiddler-title {\n top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};\n}\n.tc-tiddler-view-frame .tc-tiddler-title {\n top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};\n}\n</$list>\n<$list filter=\"[[$:/state/searchbar]!text[show]]\">\n.tc-tiddler-title {\n top: {{$:/themes/jd/Mono/Database##header-position-mobile-no-searchbar}};\n}\n</$list>\n}\n</$list>\n\n.tc-sidebar-scrollable .tc-tab-buttons,\n.tc-topbar .tc-page-controls button,\n.tc-topbar .tc-search button {\n padding: 0;\n}\n\n/* TOPBAR */\n\n<$list filter=\"[[$:/view]!text[zoomin]]\">\n<$list filter=\"[[$:/config/topbar/sticky]!text[no]]\">\n.tc-topbar { position: sticky; }\n@media (max-width: <<bkrpnt>>) { \n.tc-story-river { margin-top: -2.5em; }\n}\n</$list>\n<$list filter=\"[[$:/config/topbar/sticky]text[no]]\">\n.tc-topbar { position: fixed; }\n@media (min-width: <<bkrpnt>>) { \n.tc-topbar { height: 56px; }\n.tc-story-river { margin-top: 56px; }\n}\n<$list filter=\"[[$:/state/searchbar]!text[hide]]\">\n@media (max-width: <<bkrpnt>>) { \n.tc-topbar { height: 94px; }\n.tc-story-river { margin-top: calc(48px + 1em); }\n}\n</$list>\n<$list filter=\"[[$:/state/searchbar]text[hide]]\">\n@media (max-width: <<bkrpnt>>) { \n.tc-topbar { height: 48px; }\n.tc-story-river { margin-top: 1em; }\n}\n</$list>\n</$list>\n</$list>\n\n<$list filter=\"[[$:/view]text[zoomin]]\">\n.tc-topbar { position: fixed; }\n</$list>\n\n.tc-topbar {\n top: 0;\n width: 100%;\n display: flex;\n flex-wrap: wrap;\n align-items: center;\n justify-content: space-between;\n padding: 0.25em 1em;\n background: <<colour page-background>>;\n z-index: 900;\n}\n\n@media (min-width: <<bkrpnt>>) {\n.tc-topbar {\n padding: 1em 2em;\n max-height: {{$:/themes/jd/Mono/Database##header-position-desktop}};\n}\n}\n\n@media (max-width: <<bkrpnt>>) {\n.tc-topbar > * {\n width: 100%;\n}\n.tc-topbar .tc-topbar-left {\n padding: 0.75em 0;\n}\n.tc-topbar .tc-topbar-right .tc-search {\n margin-bottom: 0.5em;\n}\n.tc-topbar-right {\n font-size: 1.25em !important;\n}\n.tc-topbar .tc-page-controls {\n justify-content: space-between;\n width: 100%;\n}\n}\n\n.tc-topbar .tc-page-controls,\n.tc-topbar .tc-search {\n display: flex;\n align-items: center;\n}\n\n/* TOPBAR SEARCH */\n\n.tc-topbar .tc-search {\n border: 1px solid <<colour table-border>>;\n background: <<colour page-background>>;\n border-radius: 0;\n padding: 0.25em;\n}\n.tc-topbar .tc-search input {\n border: none;\n background: transparent;\n width: 100%;\n}\n.tc-topbar .tc-search .tc-reveal {\n display: flex;\n}\n\n/* controls */\n\n.tc-topbar .tc-page-controls {\n margin: 0;\n}\n.tc-topbar .tc-page-controls button > span,\n.tc-topbar .tc-page-controls button {\n display: flex;\n align-items: center;\n justify-content: center;\n}\n\n/* DROPDOWNS */\n\n.tc-drop-down,\n.tc-block-dropdown {\n <<box-shadow \"2px 2px 5px rgba(0, 0, 0, 0.25)\">>\n border-radius: 1px;\n}\n\n@media (max-width: <<bkrpnt>>) {\n\n.tc-search .tc-drop-down,\n.tc-search .tc-block-dropdown,\n.tc-page-controls .tc-drop-down,\n.tc-page-controls .tc-block-dropdown {\n position:fixed;\n left:1em;\n min-width: calc(100% - 2em);\n max-width: calc(100% - 2em);\n max-height: calc(100% - 10em);\n overflow: auto;\n}\n\n.tc-drop-down,\n.tc-block-dropdown {\n max-height: 22em;\n overflow: auto;\n font-size: calc(<<fontsize>>*1.2) !important;\n font-weight: normal;\n line-height: 1.2;\n}\n}\n\n/* TOPBAR SEARCH DROPDOWN */\n\n.tc-block-dropdown.tc-search-drop-down {\n padding: 0.5em;\n}\n\n.tc-block-dropdown.tc-search-drop-down .tc-tab-buttons {\n margin-bottom: -3px;\n padding-top: 0;\n}\n\n.tc-block-dropdown.tc-search-drop-down .tc-search-results { width: 100%; }\n\n.tc-block-dropdown.tc-search-drop-down .tc-search { display: none; }\n\n@media (min-width: <<bkrpnt>>) {\n.tc-block-dropdown.tc-search-drop-down {\n margin: 0 0 0 -24em;\n width: calc(100% + 24em);\n max-height: 42em;\n overflow: auto;\n}\n.tc-topbar-right .tc-search .tc-block-dropdown,\n.tc-topbar-right .tc-search .tc-drop-down {\n position: absolute;\n right: 0;\n}\n.tc-topbar-right .tc-search .tc-drop-down {\n padding: 1em;\n min-width: 10em;\n max-width: 10em;\n}\n}\n\n@media (max-width: <<bkrpnt>>) {\n.tc-block-dropdown.tc-search-drop-down {\n margin: 0;\n width: 100%;\n overflow: auto;\n}\n}\n\n/* TOPBAR SEARCH DROPDOWN FLEX */\n\n/* .tc-block-dropdown.tc-search-drop-down { display: flex; } on searchbar template under reveal */\n\n.tc-block-dropdown.tc-search-drop-down > p {\n display: flex;\n margin: 0;\n width: 100%;\n}\n\n.tc-block-dropdown.tc-search-drop-down > p >.tc-tab-set {\n display: flex;\n flex-direction: column;\n width: 100%;\n}\n\n.tc-block-dropdown.tc-search-drop-down > p >.tc-tab-set > .tc-tab-content {\n display: flex;\n flex: 1 1 auto;\n overflow: auto;\n margin-top: 0;\n}\n\n\n<$reveal type=\"match\" state=\"$:/state/styled-frames\" text=\"yes\" default=\"yes\">\n\n/* VIEW & EDIT FRAME */\n\n.tc-subtitle,\n.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor,\n.tc-tiddler-view-frame .tc-titlebar h2.tc-title {\n font-family: monospace;\n}\n\n/* VIEW FRAME */\n\n.tc-tiddler-view-frame .tc-title {\n font-weight: bold;\n}\n\n.tc-tiddler-view-frame .tc-tiddler-title {\n font-size: 1.5em;\n margin: 0 -1em;\n padding: 0.25em 1em;\n}\n\n.tc-tiddler-view-frame .tc-titlebar {\n font-size: 1em;\n}\n\n.tc-tiddler-view-frame .tc-titlebar h2.tc-title {\n font-size: 0.75em;\n}\n\n.tc-tiddler-view-frame .tc-tiddler-controls {\n font-size: 1.5em;\n}\n\n.tc-tiddler-view-frame .tc-tiddler-controls,\n.tc-tiddler-view-frame .tc-tiddler-controls > span > button, \n.tc-tiddler-view-frame .tc-tiddler-controls > span > span > button, \n.tc-tiddler-view-frame .tc-tiddler-controls > span > span > span > button {\n display: flex;\n align-items: center;\n justify-content: center;\n}\n\n.tc-tiddler-view-frame .tc-tiddler-title-icon svg {\n max-height: 0.65em;\n}\n\n/* EDIT FRAME */\n\n.tc-tiddler-edit-frame .tc-tiddler-edit-title {\n color: transparent;\n line-height: 0;\n}\n\n.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor {\n font-size: 1.2em; \n}\n\n.tc-tiddler-edit-frame .tc-message-box { margin: 0; }\n\n.tc-tiddler-edit-frame iframe.tc-edit-texteditor { margin-top: 0 !important; }\n\n.tc-tiddler-edit-frame .tc-editor-toolbar { background: <<colour tiddler-editor-border>>; }\n\n.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible { background: transparent; }\n\n.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible {\n transition: 200ms fill;\n fill: <<colour foreground>>;\n}\n\n.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible:hover {\n background: transparent;\n fill: <<colour primary>>;\n}\n\ninput::placeholder {\n font-size: 0.9em; \n}\n\n.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor, \n.tc-tiddler-edit-frame .tc-edit-tags, \n.tc-tiddler-edit-frame .tc-edit-field-add-name input.tc-edit-texteditor, \n.tc-tiddler-edit-frame .tc-edit-field-add-value input.tc-edit-texteditor, \n.tc-tiddler-edit-frame input.tc-edit-typeeditor.tc-popup-handle, \n.tc-tiddler-edit-frame input.tc-edit-texteditor.tc-popup-handle {\n border: 1px solid <<colour background>>; \n border-bottom: 1px solid <<colour tiddler-editor-border>>;\n <<box-shadow \"none\">>\n} \n\n.tc-tiddler-edit-frame textarea { \n border: 1px solid <<colour tiddler-editor-border>>;\n <<box-shadow \"none\">>\n} \n\n.tc-tiddler-edit-frame textarea,\n.tc-tiddler-edit-frame iframe.tc-edit-texteditor {\n font-size: {{$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize}};\n border: 1px solid <<colour background>>; \n <<box-shadow \"none\">>\n}\n\n.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor {\n font-weight: bold;\n}\n\n.tc-tiddler-edit-frame .tc-type-selector {\n padding-bottom: 10px;\n border-bottom: 1px solid <<colour tiddler-editor-border>>;\n}\n\n</$reveal>\n\n\n/* TIMELINE */\n\n.jd-timeline-wrapper {\n position: relative;\n}\n@media (max-width: <<bkrpnt>>) {\n.jd-timeline-wrapper {\n padding: 0 1em;\n width: 100%;\n}\n}\n .jd-paperview-wrapper {\n display: flex;\n flex-wrap: wrap;\n margin: 0.25em 0;\n}\n.jd-paperview {\n position:relative;\n width: 31%;\n margin: 1%;\n overflow:hidden;\n border: 0.5px solid {{$:/themes/jd/Mono/Database##grid-item-border}};\n border-radius: 1px;\n <<box-shadow \"2px 2px 5px rgba(0, 0, 0, 0.09)\">>\n text-align: left;\n}\n@media (min-width: <<bkrpnt>>) {\n.jd-paperview { height: 26em; }\n}\n@media (max-width: <<bkrpnt>>) {\n.jd-paperview { height: 12em; }\n}\n.jd-paperview,\n.jd-paperview-end {\n background: {{$:/themes/jd/Mono/Database##grid-item-background}} !important;\n}\n.jd-paperview-end {\n position: absolute;\n bottom: 0;\n left:0;\n width: 100%;\n height: 5px;\n}\n.jd-paperview-internal {\n transform: scale(0.7);\n position: absolute;\n width: 110%;\n height: 100%;\n top: -5%;\n left: -5%;\n pointer-events: none;\n}\n.jd-paperview-wrapper .tc-menu-list-subitem { width: 100%; }\n\n@media (min-width: <<bkrpnt>>) {\n.jd-paperview-end {\n box-shadow: 0 0 10px 10px {{$:/themes/jd/Mono/Database##grid-item-background}};\n}\n}\n\n@media (max-width: <<bkrpnt>>) {\n.jd-paperview-end {\n box-shadow: 0 0 5px 5px {{$:/themes/jd/Mono/Database##grid-item-background}};\n}\n\n}\n.jd-paperview-date {\n padding: 0.1em 0;\n}\n.jd-paperview-date {\n position: sticky;\n z-index: 1;\n background: {{$:/themes/jd/Mono/Database##header-background}};\n box-shadow: 0 0 2px 2px {{$:/themes/jd/Mono/Database##header-background}};\n}\n\n@media (min-width: <<bkrpnt>>) {\n.jd-paperview-date {\n top: {{$:/themes/jd/Mono/Database##header-position-desktop}};\n}\n}\n\n@media (max-width: <<bkrpnt>>) {\n<$list filter=\"[[$:/state/searchbar]text[show]]\">\n.jd-paperview-date {\n top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};\n}\n</$list>\n<$list filter=\"[[$:/state/searchbar]!text[show]]\">\n.jd-paperview-date {\n top: {{$:/themes/jd/Mono/Database##header-position-mobile-no-searchbar}};\n}\n</$list>\n}\n\n\n/* MISC */\n\nhr {\n border: none;\n border-top: 1px solid <<colour table-border>>;\n height: 1px;\n}\n\n.tc-sidebar-scrollable .tc-tab-buttons,\n.tc-tiddler-frame .tc-tab-buttons {\n margin-bottom: -3px;\n}\n\n.tc-story-river .tc-tab-buttons.tc-vertical button {\n border-top: 1px solid <<colour tab-border>>;\n border-left: 1px solid <<colour tab-border>>;\n border-bottom: 1px solid <<colour tab-border>>;\n border-right: 1px solid transparent;\n}\n\n.tc-story-river .tc-tab-buttons.tc-vertical .tc-tab-selected {\n border-top: 1px solid <<colour tab-border-selected>>;\n border-left: 1px solid <<colour tab-border-selected>>;\n border-bottom: 1px solid <<colour tab-border-selected>>;\n border-right: 1px solid transparent;\n}\n\n.tc-sidebar-lists .tc-tab-set .tc-tab-divider {\n border-top: none;\n height: 1px;\n background-image: linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);\n background-image: -o-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);\n background-image: -moz-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);\n background-image: -webkit-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);\n background-image: -ms-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);\n}\n\n/* SIDEBAR MORE TAB BUTTONS */\n\n.tc-more-sidebar .tc-tab-buttons.tc-vertical {\n margin-top: 1em;\n}\n\n.tc-more-sidebar .tc-tab-buttons.tc-vertical > button {\n margin-bottom: -1px;\n border-top: 1px solid <<colour sidebar-tab-border>>;\n border-right: 1px solid transparent;\n border-bottom: 1px solid <<colour sidebar-tab-border>>;\n border-left: 1px solid <<colour sidebar-tab-border>>;\n}\n\n.tc-more-sidebar .tc-tab-buttons.tc-vertical > button.tc-tab-selected {\n border-top: 1px solid <<colour sidebar-tab-border-selected>>;\n border-right: 1px solid transparent;\n border-bottom: 1px solid <<colour sidebar-tab-border-selected>>;\n border-left: 1px solid <<colour sidebar-tab-border-selected>>;\n}\n\n.tc-more-sidebar .tc-tab-content.tc-vertical {\n margin-left: 1px;\n}\n\nul, li {\n white-space: nowrap; \n overflow: hidden;\n text-overflow: ellipsis;\n}\n\n.tc-menu-list-item {\n padding-left: 5px;\n text-indent: -5px;\n white-space: normal !important;\n word-wrap: break-word !important;\n -webkit-word-break: break-all !important;\n -moz-word-break: break-all !important;\n -ms-word-break: break-all !important;\n -o-word-break: break-all !important;\n word-break: break-all !important;\n}\n\nbutton, input { outline: none; }\n\nbutton, input:not([type]) {\n border-radius: 2px;\n}\n\ninput:not([type]) {\n border: 1px solid <<colour tiddler-editor-border>>;\n padding: 2px 4px;\n margin: 2px;\n}\n\nbutton {\n border: 1px solid <<colour button-border>>;\n padding: 6px 16px;\n margin: 2px;\n}\n\n@media (max-width: <<bkrpnt>>) {\n.desktop-only {\n display: none !important; pointer-events: none;\n}\n}\n\n@media (min-width: <<bkrpnt>>) {\n.mobile-only {\n display: none !important; pointer-events: none;\n}\n}\n\n.tc-topbar.tc-topbar-left,\n.tc-topbar.tc-topbar-right {\n display: none; pointer-events: none;\n}\n\n.tc-dropzone > p,\n.tc-topbar p,\n.tc-sidebar-lists-template > p,\n.tc-topbar .tc-sidebar-lists > p { margin: 0; }\n\n@media (min-width: <<bkrpnt>>) {\ndiv::-webkit-scrollbar { background: rgba(0, 0, 0, 0.12); }\ndiv::-webkit-scrollbar-thumb { background: rgba(0, 0, 0, 0.12); }\n}\n\n.tc-notification {\n <<box-shadow \"2px 2px 5px rgba(0, 0, 0, 0.45)\">>\n border-radius: 1px;\n}",
"title": "$:/themes/jd/Mono/Stylesheet",
"tags": "$:/tags/Stylesheet",
"modifier": "jd",
"modified": "20190205153021408"
},
"$:/themes/jd/Mono/Palette/SpartanNight": {
"created": "20180624055725870",
"creator": "jd",
"text": "alert-background: <<colour background>>\nalert-border: <<colour very-muted-foreground>>\nalert-highlight: <<colour very-muted-foreground>>\nalert-muted-foreground: <<colour muted-foreground>>\nbackground: #303030\nblockquote-bar: <<colour page-background>>\nbutton-background: transparent\nbutton-foreground: inherent\nbutton-border: <<colour tag-background>>\ncode-background: <<colour pre-background>>\ncode-border: <<colour pre-border>>\ncode-foreground: rgba(255, 255, 255, 0.54)\ndirty-indicator: #c80000\ndownload-background: <<colour primary>>\ndownload-foreground: <<colour foreground>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: #424242\ndropdown-border: <<colour dropdown-background>>\ndropdown-tab-background-selected: <<colour dropdown-background>>\ndropdown-tab-background: #050505\ndropzone-background: <<colour tag-background>>\nexternal-link-background-hover: transparent\nexternal-link-background-visited: transparent\nexternal-link-background: transparent\nexternal-link-foreground-hover: \nexternal-link-foreground-visited: #7c318c\nexternal-link-foreground: #9e3eb3\nforeground: rgba(255, 255, 255, 0.7)\nmessage-background: <<colour background>>\nmessage-border: <<colour very-muted-foreground>>\nmessage-foreground: rgba(255, 255, 255, 0.54)\nmodal-backdrop: <<colour page-background>>\nmodal-background: <<colour background>>\nmodal-border: <<colour very-muted-foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour background>>\nmodal-header-border: <<colour very-muted-foreground>>\nmuted-foreground: rgba(255, 255, 255, 0.54)\nnotification-background: <<colour dropdown-background>>\nnotification-border: <<colour dropdown-background>>\npage-background: #212121\npre-background: #2a2a2a\npre-border: transparent\nprimary: white\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #494949\nsidebar-controls-foreground: #5d5d5d\nsidebar-foreground-shadow: transparent\nsidebar-foreground: rgba(255, 255, 255, 0.54)\nsidebar-muted-foreground-hover: rgba(255, 255, 255, 0.54)\nsidebar-muted-foreground: rgba(255, 255, 255, 0.38)\nsidebar-tab-background-selected: <<colour page-background>>\nsidebar-tab-background: transparent\nsidebar-tab-border-selected: <<colour table-border>>\nsidebar-tab-border: <<colour sidebar-tab-border-selected>>\nsidebar-tab-divider: <<colour table-border>>\nsidebar-tab-foreground-selected: rgba(255, 255, 255, 0.87)\nsidebar-tab-foreground: rgba(255, 255, 255, 0.54)\nsidebar-tiddler-link-foreground-hover: rgba(255, 255, 255, 0.7)\nsidebar-tiddler-link-foreground: rgba(255, 255, 255, 0.54)\nsite-title-foreground: rgba(255, 255, 255, 0.7)\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: transparent\ntab-border-selected: <<colour table-border>>\ntab-border: <<colour tab-border-selected>>\ntab-divider: <<colour table-border>>\ntab-foreground-selected: rgba(255, 255, 255, 0.87)\ntab-foreground: rgba(255, 255, 255, 0.54)\ntable-border: #3a3a3a\ntable-footer-background: <<colour tiddler-editor-fields-odd>>\ntable-header-background: <<colour tiddler-editor-fields-even>>\ntag-background: #ec6\ntag-foreground: <<colour button-foreground>>\ntiddler-background: <<colour background>>\ntiddler-border: rgb(55,55,55)\ntiddler-controls-foreground-hover: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground-selected: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground: <<colour sidebar-controls-foreground>>\ntiddler-editor-background: transparent\ntiddler-editor-border-image: \ntiddler-editor-border: rgba(255, 255, 255, 0.08)\ntiddler-editor-fields-even: rgba(255, 255, 255, 0.1)\ntiddler-editor-fields-odd: rgba(255, 255, 255, 0.04)\ntiddler-info-background: #454545\ntiddler-info-border: #454545\ntiddler-info-tab-background: <<colour tiddler-editor-fields-odd>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour muted-foreground>>\ntiddler-title-foreground: #FFFFFF\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour very-muted-foreground>>\nvery-muted-foreground: rgba(255, 255, 255, 0.12)",
"type": "application/x-tiddler-dictionary",
"title": "$:/themes/jd/Mono/Palette/SpartanNight",
"tags": "$:/tags/Palette",
"revision": "16-bb276562b7c93c8ace69907892d92eed",
"name": "Spartan Night",
"modifier": "jd",
"modified": "20190202100758570",
"description": "Spartan night colors",
"caption": "Spartan Night"
},
"$:/themes/jd/Mono/Palette/SpartanDay": {
"created": "20180624055639361",
"creator": "jd",
"text": "alert-background: <<colour background>>\nalert-border: <<colour very-muted-foreground>>\nalert-highlight: <<colour very-muted-foreground>>\nalert-muted-foreground: <<colour muted-foreground>>\nbackground: #FAFAFA\nblockquote-bar: <<colour page-background>>\nbutton-background: transparent\nbutton-foreground: inherit\nbutton-border: <<colour tag-background>>\ncode-background: #ececec\ncode-border: #ececec\ncode-foreground: rgba(0, 0, 0, 0.54)\ndirty-indicator: #c80000\ndownload-background: <<colour primary>>\ndownload-foreground: <<colour background>>\ndragger-background: <<colour foreground>>\ndragger-foreground: <<colour background>>\ndropdown-background: #FFFFFF\ndropdown-border: <<colour dropdown-background>>\ndropdown-tab-background-selected: <<colour dropdown-background>>\ndropdown-tab-background: #F5F5F5\ndropzone-background: <<colour tag-background>>\nexternal-link-background-hover: transparent\nexternal-link-background-visited: transparent\nexternal-link-background: transparent\nexternal-link-foreground-hover: \nexternal-link-foreground-visited: \nexternal-link-foreground: \nforeground: rgba(0, 0, 0, 0.87)\nmessage-background: <<colour background>>\nmessage-border: <<colour very-muted-foreground>>\nmessage-foreground: rgba(0, 0, 0, 0.54)\nmodal-backdrop: <<colour foreground>>\nmodal-background: <<colour background>>\nmodal-border: <<colour very-muted-foreground>>\nmodal-footer-background: <<colour background>>\nmodal-footer-border: <<colour very-muted-foreground>>\nmodal-header-border: <<colour very-muted-foreground>>\nmuted-foreground: rgba(0, 0, 0, 0.54)\nnotification-background: <<colour dropdown-background>>\nnotification-border: <<colour dropdown-background>>\npage-background: #f4f4f4\npre-background: #ececec\npre-border: #ececec\nprimary: #3949ab\nsidebar-button-foreground: <<colour foreground>>\nsidebar-controls-foreground-hover: #aeaeae\nsidebar-controls-foreground: #c6c6c6\nsidebar-foreground-shadow: transparent\nsidebar-foreground: rgba(0, 0, 0, 0.54)\nsidebar-muted-foreground-hover: rgba(0, 0, 0, 0.54)\nsidebar-muted-foreground: rgba(0, 0, 0, 0.38)\nsidebar-tab-background-selected: <<colour page-background>>\nsidebar-tab-background: transparent\nsidebar-tab-border-selected: <<colour table-border>>\nsidebar-tab-border: <<colour sidebar-tab-border-selected>>\nsidebar-tab-divider: <<colour table-border>>\nsidebar-tab-foreground-selected: rgba(0, 0, 0, 0.87)\nsidebar-tab-foreground: rgba(0, 0, 0, 0.54)\nsidebar-tiddler-link-foreground-hover: rgba(0, 0, 0, 0.87)\nsidebar-tiddler-link-foreground: rgba(0, 0, 0, 0.54)\nsite-title-foreground: rgba(0, 0, 0, 0.87)\nstatic-alert-foreground: #aaaaaa\ntab-background-selected: <<colour background>>\ntab-background: transparent\ntab-border-selected: <<colour table-border>>\ntab-border: <<colour tab-border-selected>>\ntab-divider: <<colour table-border>>\ntab-foreground-selected: rgba(0, 0, 0, 0.87)\ntab-foreground: rgba(0, 0, 0, 0.54)\ntable-border: #d8d8d8\ntable-footer-background: <<colour tiddler-editor-fields-odd>>\ntable-header-background: <<colour tiddler-editor-fields-even>>\ntag-background: #ec6\ntag-foreground: <<colour button-foreground>>\ntiddler-background: <<colour background>>\ntiddler-border: #f9f9f9\ntiddler-controls-foreground-hover: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground-selected: <<colour sidebar-controls-foreground-hover>>\ntiddler-controls-foreground: <<colour sidebar-controls-foreground>>\ntiddler-editor-background: transparent\ntiddler-editor-border-image: \ntiddler-editor-border: #e8e7e7\ntiddler-editor-fields-even: rgba(0, 0, 0, 0.1)\ntiddler-editor-fields-odd: rgba(0, 0, 0, 0.04)\ntiddler-info-background: #F5F5F5\ntiddler-info-border: #F5F5F5\ntiddler-info-tab-background: <<colour tiddler-editor-fields-odd>>\ntiddler-link-background: <<colour background>>\ntiddler-link-foreground: <<colour primary>>\ntiddler-subtitle-foreground: <<colour muted-foreground>>\ntiddler-title-foreground: #000000\ntoolbar-new-button: \ntoolbar-options-button: \ntoolbar-save-button: \ntoolbar-info-button: \ntoolbar-edit-button: \ntoolbar-close-button: \ntoolbar-delete-button: \ntoolbar-cancel-button: \ntoolbar-done-button: \nuntagged-background: <<colour very-muted-foreground>>\nvery-muted-foreground: rgba(0, 0, 0, 0.12)",
"type": "application/x-tiddler-dictionary",
"title": "$:/themes/jd/Mono/Palette/SpartanDay",
"tags": "$:/tags/Palette",
"revision": "16-1f6eabb9816382603cfa899327890536",
"name": "Spartan Day",
"modifier": "jd",
"modified": "20190202100822086",
"description": "Spartan day colors",
"caption": "Spartan Day"
},
"$:/themes/jd/Mono/PageTemplate/topbar": {
"text": "<div class=\"tc-topbar tc-adjust-top-of-scroll\">\n\n<div class=\"tc-topbar-left\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopLeftBar]!has[draft.of]]\" variable=\"listItem\">\n\n<$transclude tiddler=<<listItem>>/>\n\n</$list>\n\n</div>\n\n<div class=\"tc-topbar-right\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopRightBar]!has[draft.of]]\" variable=\"listItem\">\n\n<$transclude tiddler=<<listItem>>/>\n\n</$list>\n\n</div>\n\n</div>\n",
"title": "$:/themes/jd/Mono/PageTemplate/topbar",
"tags": "$:/tags/PageTemplate",
"modifier": "jd",
"modified": "20190201113453598",
"list-before": "",
"creator": "jd",
"created": "20190130160503644"
},
"$:/themes/jd/Mono/Config": {
"created": "20190202083644385",
"creator": "jd",
"text": "<$checkbox tiddler=\"$:/config/TopRightBar/$:/themes/jd/Mono/TopBarSegments/search\" field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\" actions=\"\"\"\n<$action-setfield $tiddler=\"$:/state/searchbar\" text=\"show\"/>\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $field=\"list\" $subfilter=\"$:/themes/jd/Mono/Buttons/searchbar\"/>\n<$action-setfield $tiddler=\"$:/themes/jd/Mono/Database\" $index=\"header-position-desktop\" $value=\"calc(56px + .25em)\"/>\n<$action-setfield $tiddler=\"$:/themes/jd/Mono/Database\" $index=\"header-position-mobile-yes-searchbar\" $value=\"calc(4px + 3em + 6px + {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}} + .25em)\"/>\n\"\"\" uncheckactions=\"\"\"\n<$action-setfield $tiddler=\"$:/config/TopLeftBar/Button/$:/themes/jd/Mono/Buttons/searchbar\" text=\"hide\"/>\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $field=\"list\" $subfilter=\"-$:/themes/jd/Mono/Buttons/searchbar\"/>\n<$action-setfield $tiddler=\"$:/themes/jd/Mono/Database\" $index=\"header-position-mobile-yes-searchbar\" $value=\"calc(2px + 2.25em)\"/>\n\"\"\"> Use searchbar and button (the toggle button only shows up on mobile)</$checkbox>\n\n<$checkbox tiddler=\"$:/themes/jd/Mono/Database\" index=\"button-fontscroller\" checked=\"show\" unchecked=\"hide\" actions=\"\"\"\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $field=\"list\" $subfilter=\"$:/themes/jd/Mono/Buttons/font-scroller\"/>\"\"\" uncheckactions=\"\"\"\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $field=\"list\" $subfilter=\"-$:/themes/jd/Mono/Buttons/font-scroller\"/>\n\"\"\"> Use font scroller button </$checkbox>\n\n<$checkbox tiddler=\"$:/SplashScreen\" field=\"text\" checked={{$:/themes/jd/Mono/SplashScreen!!text}} actions=\"\"\"\n<$action-setfield $tiddler=\"$:/SplashScreen\" tags=\"$:/tags/RawMarkupWikified/TopBody\"/>\"\"\"> Use splashscreen</$checkbox>\n\n<$checkbox tiddler=\"$:/config/EmptyStoryMessage\" field=\"text\" checked=\"\"\"{{$:/themes/jd/Mono/EmptyStoryMessage}}\"\"\"> Use timeline grid when story river is empty (grid preview of 10 recent dates for modified tiddlers)</$checkbox>\n\n<$checkbox tiddler=\"$:/state/styled-frames\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"yes\"> Style tiddler frames</$checkbox>\n\n<$checkbox tiddler=\"$:/config/topbar/sticky\" field=\"text\" checked=\"no\" unchecked=\"yes\" default=\"yes\"> Tick this checkbox if using ''Internet Explorer'', or if the topbar position is not working properly (position: sticky; incompatibility)</$checkbox>\n\nKeep updated on `MonoTheme` here: ''[[http://j.d.mono.tiddlyspot.com/]]''\n\n<<tabs \"$:/themes/jd/Mono/Config/SidebarSegments $:/themes/jd/Mono/Config/TopbarButtons $:/themes/jd/Mono/Config/PaletteSwitcher $:/themes/jd/Mono/Config/VanillaTweaks $:/themes/jd/Mono/Config/DatabaseValues\" \"$:/themes/jd/Mono/Config/TopbarButtons\" class:\"tc-vertical\">>",
"title": "$:/themes/jd/Mono/Config",
"tags": "$:/tags/ControlPanel/Appearance",
"modifier": "jd",
"modified": "20190205153009029",
"caption": "Mono Tweaks"
},
"$:/themes/jd/Mono/Buttons/switch-palette": {
"created": "20180718101345840",
"creator": "jd",
"text": "<$list filter=\"[[$:/palette]!text{$:/themes/jd/Mono/Database##night-palette}]\">\n<$button set=\"$:/palette\" setTo={{$:/themes/jd/Mono/Database##night-palette}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>prefix[yes]]\">\n{{ $:/core/images/tip}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>prefix[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text=\"night\"/>\n</span>\n</$list>\n</$button>\n</$list>\n<$list filter=\"[[$:/palette]text{$:/themes/jd/Mono/Database##night-palette}]\">\n<$button set=\"$:/palette\" setTo={{$:/themes/jd/Mono/Database##day-palette}} class=<<tv-config-toolbar-class>>>\n<$list filter=\"[<tv-config-toolbar-icons>prefix[yes]]\">\n{{ $:/core/images/tip}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>prefix[yes]]\">\n<span class=\"tc-btn-text\">\n<$text text=\" \"/>\n<$text text=\"day\"/>\n</span>\n</$list>\n</$button>\n</$list>\n",
"type": "text/vnd.tiddlywiki",
"title": "$:/themes/jd/Mono/Buttons/switch-palette",
"tags": "$:/tags/PageControls",
"revision": "6-0bdaa9022f44b4d8d5b1a71f193803af",
"modifier": "jd",
"modified": "20190202134636973",
"description": "Toggle palette",
"caption": "{{$:/core/images/tip}} palette"
},
"$:/themes/jd/Mono/Buttons/searchbar": {
"created": "20190130164005014",
"creator": "jd",
"text": "<$button class={{{ [<tv-config-toolbar-class>addsuffix[ mobile-only]] }}} tooltip=\"searchbar\">\n<$list filter=\"[<tv-config-toolbar-icons>prefix[yes]]\">\n{{$:/core/images/advanced-search-button}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>prefix[yes]]\">\n<span class=\"tc-btn-text\"><$text text={{$:/language/Buttons/AdvancedSearch/Caption}}/></span>\n</$list>\n<$list filter=\"[[$:/state/searchbar]!text[show]]\">\n<$action-setfield $tiddler=\"$:/state/searchbar\" text=\"show\"/>\n</$list>\n<$list filter=\"[[$:/state/searchbar]text[show]]\">\n<$action-setfield $tiddler=\"$:/state/searchbar\" text=\"hide\"/>\n</$list>\n</$button>",
"title": "$:/themes/jd/Mono/Buttons/searchbar",
"tags": "$:/tags/PageControls",
"modifier": "jd",
"modified": "20190202153859733",
"description": "Mono searchbar toggler",
"caption": "{{$:/core/images/advanced-search-button}} mono searchbar"
},
"$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/page-controls": {
"created": "20190201102601467",
"creator": "jd",
"text": "hide",
"title": "$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/page-controls",
"modifier": "jd",
"modified": "20190202133339913"
},
"$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/search": {
"created": "20190201102714829",
"creator": "jd",
"text": "hide",
"title": "$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/search",
"modifier": "jd",
"modified": "20190202133211221"
},
"$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/site-subtitle": {
"text": "hide",
"title": "$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/site-subtitle",
"modifier": "jd",
"modified": "20190201102704659",
"creator": "jd",
"created": "20190201102652423"
},
"$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/site-title": {
"text": "hide",
"title": "$:/config/SideBarSegments/Visibility/$:/core/ui/SideBarSegments/site-title",
"modifier": "jd",
"modified": "20190202160543142",
"creator": "jd",
"created": "20190201102745176"
},
"$:/core/ui/TopBar/menu": {
"created": "20190201145933072",
"creator": "jd",
"text": "<$reveal state=\"$:/state/sidebar\" type=\"nomatch\" text=\"no\">\n<$button set=\"$:/state/sidebar\" setTo=\"no\" tooltip={{$:/language/Buttons/HideSideBar/Hint}} aria-label={{$:/language/Buttons/HideSideBar/Caption}} class=\"tc-btn-invisible\">{{$:/core/images/chevron-left}}</$button>\n</$reveal>\n<$reveal state=\"$:/state/sidebar\" type=\"match\" text=\"no\">\n<$button set=\"$:/state/sidebar\" setTo=\"yes\" tooltip={{$:/language/Buttons/ShowSideBar/Hint}} aria-label={{$:/language/Buttons/ShowSideBar/Caption}} class=\"tc-btn-invisible\">{{$:/core/images/chevron-right}}</$button>\n</$reveal>\n",
"title": "$:/core/ui/TopBar/menu",
"modifier": "jd",
"modified": "20190203083157565",
"caption": "{{$:/core/images/chevron-right}} sidebar",
"description": "Toggle sidebar"
},
"$:/themes/jd/Mono/EmptyStoryMessage": {
"created": "20190202111910887",
"creator": "jd",
"text": "\\whitespace trim\n<div class=\"jd-timeline-wrapper\">\n<$list filter=\"[!is[system]!has[draft.of]!sort[modified]has[modified]limit[10]eachday[modified]]\">\n<div class=\"jd-paperview-date\">\n<$view field=\"modified\" format=\"date\" template=\"DDth MMM YYYY\"/>\n</div>\n<div class=\"jd-paperview-wrapper\">\n<$list filter=\"[sameday:modified{!!modified}!is[system]!has[draft.of]!sort[modified]]\">\n<$button to={{!!title}} class=\"jd-paperview\">\n<div class=\"jd-paperview-internal\">\n<b><$view field=\"title\"/></b>\n<$transclude mode=\"block\"/>\n</div>\n<div class=\"jd-paperview-end\">\n</div>\n</$button>\n</$list>\n</div>\n</$list>\n</div>\n",
"title": "$:/themes/jd/Mono/EmptyStoryMessage",
"tags": "",
"modifier": "jd",
"modified": "20190203153408764"
},
"$:/themes/jd/Mono/Config/TopbarButtons": {
"created": "20190202123433451",
"creator": "jd",
"text": "\\define config-title()\n$:/config/TopLeftBar/Button/$(currentTiddler)$\n\\end\n\n!!! ''Remove from ~TopLeftBar''\n//Click to remove from ~TopLeftBar, rearrange by dragging//\n\n<$list filter=\"[enlist{$:/themes/jd/Mono/Database!!list}]\">\n<$droppable actions=\"\"\"\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $field=\"list\" $subfilter=\"+[insertbefore:currentTiddler<actionTiddler>]\"/>\n\"\"\">\n<div class=\"tc-droppable-placeholder\"> </div>\n<$draggable tiddler=<<currentTiddler>>>\n<$button class=\"tc-btn-invisible\" actions=\"\"\"\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $subfilter=\"-[<currentTiddler>]\"/>\n\"\"\">\n<span class=\"tc-icon-wrapper\"> <$transclude field=\"caption\"/> <i class=\"tc-muted\">-- <$transclude field=\"description\"/></i></span> \n</$button>\n</$draggable>\n</$droppable>\n</$list>\n\n!!! ''Add to ~TopLeftBar''\n//Click to add to ~TopLeftBar//\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageControls]] $:/core/ui/TopBar/menu $:/themes/jd/Mono/Buttons/searchbar -[enlist{$:/themes/jd/Mono/Database!!list}]\">\n<$button class=\"tc-btn-invisible\" style=\"width: 100%; text-align: left;\" actions=\"\"\"\n<$action-listops $tiddler=\"$:/themes/jd/Mono/Database\" $subfilter=<<currentTiddler>>/>\n\"\"\">\n<span class=\"tc-icon-wrapper\"> <$transclude field=\"caption\"/> <i class=\"tc-muted\">-- <$transclude field=\"description\"/></i></span> \n</$button>\n</$list>\n",
"title": "$:/themes/jd/Mono/Config/TopbarButtons",
"tags": "",
"modifier": "jd",
"modified": "20190203014157409",
"caption": "Topbar buttons"
},
"$:/themes/jd/Mono/Database": {
"created": "20190202114537700",
"creator": "jd",
"text": "{\n \"grid-sticky-header-background\": \"<<colour page-background>>\",\n \"grid-item-background\": \"<<colour background>>\",\n \"grid-item-border\": \"<<colour tiddler-border>>\",\n \"header-background\": \"<<colour page-background>>\",\n \"header-position-mobile-no-searchbar\": \"calc(2px + 2.25em)\",\n \"header-position-mobile-yes-searchbar\": \"calc(4px + 3em + 6px + {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}} + .25em)\",\n \"header-position-desktop\": \"calc(56px + .25em)\",\n \"day-palette\": \"$:/themes/jd/Mono/Palette/SpartanDay\",\n \"night-palette\": \"$:/themes/jd/Mono/Palette/SpartanNight\",\n \"button-fontscroller\": \"hide\"\n}",
"type": "application/json",
"title": "$:/themes/jd/Mono/Database",
"tags": "",
"modifier": "jd",
"modified": "20190205153057281",
"list": "$:/core/ui/Buttons/new-tiddler $:/core/ui/Buttons/control-panel $:/core/ui/Buttons/save-wiki $:/themes/jd/Mono/Buttons/switch-palette $:/core/ui/TopBar/menu $:/themes/jd/Mono/Buttons/searchbar"
},
"$:/themes/jd/Mono/Config/SidebarSegments": {
"created": "20190202123345136",
"creator": "jd",
"text": "\\define config-title()\n$:/config/SideBarSegments/Visibility/$(currentTiddler)$\n\\end\n\n!!! ''Sidebar segments''\n//Uncheck to remove from ~SideBar, rearrange by dragging//\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/SideBarSegment]]\">\n<$droppable actions=\"\"\"\n<$action-listops $tiddler=\"$:/tags/SideBarSegment\" $field=\"list\" $subfilter=\"+[insertbefore:currentTiddler<actionTiddler>]\"/>\n\"\"\">\n<div class=\"tc-droppable-placeholder\"> </div>\n<$draggable tiddler=<<currentTiddler>>>\n<$checkbox tiddler=<<config-title>> field=\"text\" checked=\"show\" unchecked=\"hide\" default=\"show\"> <$text text=<<currentTiddler>>/>\n</$checkbox><br>\n</$draggable>\n</$droppable>\n</$list>",
"title": "$:/themes/jd/Mono/Config/SidebarSegments",
"modifier": "jd",
"modified": "20190202135551740",
"tags": "",
"caption": "Sidebar segments"
},
"$:/themes/jd/Mono/Config/DatabaseValues": {
"created": "20190202123554778",
"creator": "jd",
"text": "!!! ''Advanced''\n\n<$list filter=\"[[$:/themes/jd/Mono/Database]indexes[]search[position]]\" variable=\"index\">\n\n<<index>>:\n\n<$edit-text tiddler=\"$:/themes/jd/Mono/Database\" index=<<index>> tag=\"input\"/>\n\n</$list>",
"title": "$:/themes/jd/Mono/Config/DatabaseValues",
"modifier": "jd",
"modified": "20190203084020856",
"tags": "",
"caption": "Advanced"
},
"$:/themes/jd/Mono/Config/PaletteSwitcher": {
"created": "20190202135356197",
"creator": "jd",
"text": "!!! ''Palette switcher''\n\n<$list filter=\"day-palette night-palette\" variable=\"index\" >\n\n<<index>>:\n\n<$edit-text tiddler=\"$:/themes/jd/Mono/Database\" index=<<index>> tag=\"input\"/>\n\n</$list>",
"title": "$:/themes/jd/Mono/Config/PaletteSwitcher",
"modifier": "jd",
"modified": "20190202135417323",
"tags": "",
"caption": "Palette switcher"
},
"$:/themes/jd/Mono/SplashScreen": {
"text": "\\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]\n\\rules only filteredtranscludeinline transcludeinline macrocallinline\n<div class=\"tc-remove-when-wiki-loaded\">\n<style scoped>\n\n.tc-splash-text {\n font-family: -apple-system, BlinkMacSystemFont, \"Segoe UI\", Helvetica, Arial, sans-serif, \"Apple Color Emoji\", \"Segoe UI Emoji\", \"Segoe UI Symbol\";\n font-size: 16px;\n text-rendering: optimizeLegibility;\n -webkit-font-smoothing: antialiased;\n\tmargin: 20px auto 0;\n\twidth: 200px;\n\ttext-align: center;\n\tcolor: <<colour foreground>>;\n\tfill: <<colour foreground>>;\n}\n\nhtml body.tc-body {\n background: <<colour page-background>>;\n}\n.line-wrapper {\n width: 100%;\n height: 80vh;\n display: flex;\n flex-direction: column;\n justify-content: center;\n align-items: center;\n}\n.line {\n width: 50px;\n height: 1px;\n background: <<colour muted-foreground>>;\n -webkit-animation: line 2s infinite; \n -moz-animation: line 2s infinite; \n -o-animation: line 2s infinite; \n animation: line 2s infinite; \n}\n@-webkit-keyframes line {\n 0% { width: 10px; }\n 50% { width: 200px; }\n 100% { width: 10px; }\n}\n@keyframes line {\n 0% { width: 10px; }\n 50% { width: 200px; }\n 100% { width: 10px; }\n}\n.linetwo {\n width: 50px;\n height: 1px;\n background: <<colour muted-foreground>>;\n -webkit-animation: linetwo 2s infinite; \n -moz-animation: linetwo 2s infinite; \n -o-animation: linetwo 2s infinite; \n animation: linetwo 2s infinite; \n margin: 5px 0;\n}\n@-webkit-keyframes linetwo {\n 0% { width: 5px; }\n 70% { width: 180px; }\n 100% { width: 5px; }\n}\n@keyframes linetwo {\n 0% { width: 5px; }\n 70% { width: 180px; }\n 100% { width: 5px; }\n}\n.linethree {\n width: 50px;\n height: 1px;\n background: <<colour muted-foreground>>;\n -webkit-animation: linethree 2s infinite; \n -moz-animation: linethree 2s infinite; \n -o-animation: linethree 2s infinite; \n animation: linethree 2s infinite; \n margin: linethree 0;\n}\n@-webkit-keyframes linethree {\n 0% { width: 0; }\n 80% { width: 160px; }\n 100% { width: 0; }\n}\n@keyframes linethree {\n 0% { width: 0; }\n 80% { width: 160px; }\n 100% { width: 0; }\n}\n</style>\n\n<div class=\"line-wrapper\">\n<div class=\"tc-splash-text\">{{$:/SiteTitle}}</div>\n<div class=\"line\"></div>\n<div class=\"linetwo\"></div>\n<div class=\"linethree\"></div>\n</div>\n\n</div>",
"type": "text/vnd.tiddlywiki",
"title": "$:/themes/jd/Mono/SplashScreen",
"modifier": "jd",
"modified": "20190202152051851",
"creator": "jd",
"created": "20180927082601825"
},
"$:/themes/jd/Mono/Buttons/font-scroller": {
"created": "20180930054903341",
"creator": "jd",
"text": "<$wikify name=\"fontUp\" text=\"\"\"\n<$list filter=\"[{$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize}previous[$:/themes/jd/Mono/Buttons/font-scroller]]\" emptyMessage=\"40px\"/>\n\"\"\">\n<$wikify name=\"fontDown\" text=\"\"\"\n<$list filter=\"[{$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize}next[$:/themes/jd/Mono/Buttons/font-scroller]]\" emptyMessage=\"10px\"/>\n\"\"\">\n<$button class=\"tc-btn-invisible\" tooltip=\"Decrease font size\">\n<$action-setfield $tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\" text=<<fontDown>>/>\n<$action-setfield $tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\" text=\"1.25\"/>\n\n\n<$list filter=\"[<tv-config-toolbar-icons>prefix[yes]]\">\n{{$:/core/images/chevron-down}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>prefix[yes]]\">\n<span class=\"tc-btn-text\"><$text text=\"font down\"/></span>\n</$list>\n\n</$button>\n<$button class=\"tc-btn-invisible\" tooltip=\"Increase font size\">\n<$action-setfield $tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\" text=<<fontUp>>/>\n<$action-setfield $tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\" text=\"1.25\"/>\n\n<$list filter=\"[<tv-config-toolbar-icons>prefix[yes]]\">\n{{$:/core/images/chevron-up}}\n</$list>\n<$list filter=\"[<tv-config-toolbar-text>prefix[yes]]\">\n<span class=\"tc-btn-text\"><$text text=\"font up\"/></span>\n</$list>\n\n</$button>\n</$wikify>\n</$wikify>",
"title": "$:/themes/jd/Mono/Buttons/font-scroller",
"tags": "$:/tags/PageControls",
"modifier": "jd",
"modified": "20190203035107351",
"list": "40px 34px 30px 24px 20px 18px 17px 15px 14px 13px 12px 10px",
"caption": "{{$:/core/images/chevron-up}} font scroller",
"description": "Font scroller"
},
"$:/themes/jd/Mono/Config/VanillaTweaks": {
"text": "\\define lingo-base() $:/language/ThemeTweaks/\n\n\\define replacement-text()\n[img[$(imageTitle)$]]\n\\end\n\n\\define backgroundimage-dropdown()\n<div class=\"tc-drop-down-wrapper\">\n<$button popup=<<qualify \"$:/state/popup/themetweaks/backgroundimage\">> class=\"tc-btn-invisible tc-btn-dropdown\">{{$:/core/images/down-arrow}}</$button>\n<$reveal state=<<qualify \"$:/state/popup/themetweaks/backgroundimage\">> type=\"popup\" position=\"belowleft\" text=\"\" default=\"\">\n<div class=\"tc-drop-down\">\n<$macrocall $name=\"image-picker\" actions=\"\"\"\n\n<$action-setfield\n\t$tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\"\n\t$value=<<imageTitle>>\n/>\n\n\"\"\"/>\n</div>\n</$reveal>\n</div>\n\\end\n\n\\define backgroundimageattachment-dropdown()\n<$select tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment\" default=\"scroll\">\n<option value=\"scroll\"><<lingo Settings/BackgroundImageAttachment/Scroll>></option>\n<option value=\"fixed\"><<lingo Settings/BackgroundImageAttachment/Fixed>></option>\n</$select>\n\\end\n\n\\define backgroundimagesize-dropdown()\n<$select tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize\" default=\"scroll\">\n<option value=\"auto\"><<lingo Settings/BackgroundImageSize/Auto>></option>\n<option value=\"cover\"><<lingo Settings/BackgroundImageSize/Cover>></option>\n<option value=\"contain\"><<lingo Settings/BackgroundImageSize/Contain>></option>\n</$select>\n\\end\n\n<style> .vanillatweaks table { width: 100%; } .vanillatweaks td:first-child { width: 60%; } .vanillatweaks td input { width: 100%; }</style>\n\n<div class=\"vanillatweaks\">\n\nInherited tweaks from ''Vanilla'' theme.\n\n!!! ''<<lingo Options>>''\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/options/stickytitles\"><<lingo Options/StickyTitles>></$link><br>//<<lingo Options/StickyTitles/Hint>>// |<$select tiddler=\"$:/themes/tiddlywiki/vanilla/options/stickytitles\"><option value=\"no\">{{$:/language/No}}</option><option value=\"yes\">{{$:/language/Yes}}</option></$select> |\n\n!!! ''<<lingo Settings>>''\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/fontfamily\"><<lingo Settings/FontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/fontfamily\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/codefontfamily\"><<lingo Settings/CodeFontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/codefontfamily\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/editorfontfamily\"><<lingo Settings/EditorFontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/editorfontfamily\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\"><<lingo Settings/BackgroundImage>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\" default=\"\" tag=\"input\"/><<backgroundimage-dropdown>> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment\"><<lingo Settings/BackgroundImageAttachment>></$link> |<<backgroundimageattachment-dropdown>> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize\"><<lingo Settings/BackgroundImageSize>></$link> |<<backgroundimagesize-dropdown>> |\n\n!!! ''<<lingo Metrics>>''\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/fontsize\"><<lingo Metrics/FontSize>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/fontsize\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/lineheight\"><<lingo Metrics/LineHeight>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/lineheight\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\"><<lingo Metrics/BodyFontSize>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\"><<lingo Metrics/BodyLineHeight>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint\"><<lingo Metrics/SidebarBreakpoint>></$link><br>//<<lingo Metrics/SidebarBreakpoint/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth\"><<lingo Metrics/SidebarWidth>></$link><br>//<<lingo Metrics/SidebarWidth/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth\" default=\"\" tag=\"input\"/> |\n\n</div>",
"title": "$:/themes/jd/Mono/Config/VanillaTweaks",
"modifier": "jd",
"modified": "20190203084506755",
"creator": "jd",
"created": "20190203083516565",
"caption": "Vanilla tweaks"
}
}
}
{
"grid-sticky-header-background": "<<colour page-background>>",
"grid-item-background": "<<colour background>>",
"grid-item-border": "<<colour tiddler-border>>",
"header-background": "<<colour page-background>>",
"header-position-mobile-no-searchbar": "calc(2px + 2.25em)",
"header-position-mobile-yes-searchbar": "calc(4px + 3em + 6px + {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}} + .25em)",
"header-position-desktop": "calc(56px + .25em)",
"day-palette": "$:/themes/jd/Mono/Palette/SpartanDay",
"night-palette": "$:/themes/jd/Mono/Palette/SpartanNight",
"button-fontscroller": "hide"
}
\define bkrpnt() {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}
\define sidebar() {{$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth}}
\define fontsize() {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}}
/* MAIN */
@media (min-width: <<bkrpnt>>) {
.tc-sidebar-scrollable {
position: fixed;
top: {{$:/themes/jd/Mono/Database##header-position-desktop}};
left: 0;
bottom: 0;
right: unset;
width: <<sidebar>>;
margin: 0;
padding: 0 2em 2em 2em;
}
.tc-story-river {
width: calc(100% - <<sidebar>>);
padding: 0 2em 4em 2em;
}
<$list filter="[[$:/view]!text[zoomin]]">
.tc-story-river { top: 0.25em; }
</$list>
<$list filter="[[$:/view]text[zoomin]]">
.tc-story-river {
top: calc({{$:/themes/jd/Mono/Database##header-position-desktop}} + 0.25em);
}
</$list>
<$list filter="[[$:/state/sidebar]!text[no]]" variable="stateCheck">
.tc-story-river {
left: <<sidebar>>;
right: 0;
}
</$list>
<$list filter="[[$:/state/sidebar]text[no]]" variable="stateCheck">
.tc-story-river {
left: calc(<<sidebar>> / 2);
right: calc(<<sidebar>> / 2);
}
</$list>
.tc-tiddler-frame {
margin: 0 0 2em 0;
width: 100%;
border-radius: 1px;
<<box-shadow "2px 2px 5px rgba(0, 0, 0, 0.15)">>
}
.tc-storyview-zoomin-tiddler {
width: calc(100% - 4em) !important;
}
}
@media (max-width: <<bkrpnt>>) {
.tc-sidebar-scrollable { padding: 0 1em 2em 1em; }
.tc-sidebar-header { padding: 0; }
.tc-tiddler-frame { margin-bottom: 2px !important; }
}
<$list filter="[[$:/state/sidebar]!text[no]]" variable="stateCheck">
@media (max-width: <<bkrpnt>>) {
.tc-story-river { display: none; }
}
</$list>
<$list filter="[[$:/state/sidebar]text[no]]" variable="stateCheck">
@media (max-width: <<bkrpnt>>) {
.tc-sidebar-scrollable { padding-top: 0; padding-bottom: 0; }
}
</$list>
<$list filter="[[$:/themes/tiddlywiki/vanilla/options/stickytitles]text[yes]]" variable="stateCheck">
@media (min-width: <<bkrpnt>>) {
.tc-tiddler-title {
top: calc({{$:/themes/jd/Mono/Database##header-position-desktop}} - .25em);
}
}
.tc-titlebar {
line-height: 0;
}
@media (max-width: <<bkrpnt>>) {
<$list filter="[[$:/state/searchbar]text[show]]">
.tc-tiddler-edit-frame .tc-tiddler-title {
top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};
}
.tc-tiddler-view-frame .tc-tiddler-title {
top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};
}
</$list>
<$list filter="[[$:/state/searchbar]!text[show]]">
.tc-tiddler-title {
top: {{$:/themes/jd/Mono/Database##header-position-mobile-no-searchbar}};
}
</$list>
}
</$list>
.tc-sidebar-scrollable .tc-tab-buttons,
.tc-topbar .tc-page-controls button,
.tc-topbar .tc-search button {
padding: 0;
}
/* TOPBAR */
<$list filter="[[$:/view]!text[zoomin]]">
<$list filter="[[$:/config/topbar/sticky]!text[no]]">
.tc-topbar { position: sticky; }
@media (max-width: <<bkrpnt>>) {
.tc-story-river { margin-top: -2.5em; }
}
</$list>
<$list filter="[[$:/config/topbar/sticky]text[no]]">
.tc-topbar { position: fixed; }
@media (min-width: <<bkrpnt>>) {
.tc-topbar { height: 56px; }
.tc-story-river { margin-top: 56px; }
}
<$list filter="[[$:/state/searchbar]!text[hide]]">
@media (max-width: <<bkrpnt>>) {
.tc-topbar { height: 94px; }
.tc-story-river { margin-top: calc(48px + 1em); }
}
</$list>
<$list filter="[[$:/state/searchbar]text[hide]]">
@media (max-width: <<bkrpnt>>) {
.tc-topbar { height: 48px; }
.tc-story-river { margin-top: 1em; }
}
</$list>
</$list>
</$list>
<$list filter="[[$:/view]text[zoomin]]">
.tc-topbar { position: fixed; }
</$list>
.tc-topbar {
top: 0;
width: 100%;
display: flex;
flex-wrap: wrap;
align-items: center;
justify-content: space-between;
padding: 0.25em 1em;
background: <<colour page-background>>;
z-index: 900;
}
@media (min-width: <<bkrpnt>>) {
.tc-topbar {
padding: 1em 2em;
max-height: {{$:/themes/jd/Mono/Database##header-position-desktop}};
}
}
@media (max-width: <<bkrpnt>>) {
.tc-topbar > * {
width: 100%;
}
.tc-topbar .tc-topbar-left {
padding: 0.75em 0;
}
.tc-topbar .tc-topbar-right .tc-search {
margin-bottom: 0.5em;
}
.tc-topbar-right {
font-size: 1.25em !important;
}
.tc-topbar .tc-page-controls {
justify-content: space-between;
width: 100%;
}
}
.tc-topbar .tc-page-controls,
.tc-topbar .tc-search {
display: flex;
align-items: center;
}
/* TOPBAR SEARCH */
.tc-topbar .tc-search {
border: 1px solid <<colour table-border>>;
background: <<colour page-background>>;
border-radius: 0;
padding: 0.25em;
}
.tc-topbar .tc-search input {
border: none;
background: transparent;
width: 100%;
}
.tc-topbar .tc-search .tc-reveal {
display: flex;
}
/* controls */
.tc-topbar .tc-page-controls {
margin: 0;
}
.tc-topbar .tc-page-controls button > span,
.tc-topbar .tc-page-controls button {
display: flex;
align-items: center;
justify-content: center;
}
/* DROPDOWNS */
.tc-drop-down,
.tc-block-dropdown {
<<box-shadow "2px 2px 5px rgba(0, 0, 0, 0.25)">>
border-radius: 1px;
}
@media (max-width: <<bkrpnt>>) {
.tc-search .tc-drop-down,
.tc-search .tc-block-dropdown,
.tc-page-controls .tc-drop-down,
.tc-page-controls .tc-block-dropdown {
position:fixed;
left:1em;
min-width: calc(100% - 2em);
max-width: calc(100% - 2em);
max-height: calc(100% - 10em);
overflow: auto;
}
.tc-drop-down,
.tc-block-dropdown {
max-height: 22em;
overflow: auto;
font-size: calc(<<fontsize>>*1.2) !important;
font-weight: normal;
line-height: 1.2;
}
}
/* TOPBAR SEARCH DROPDOWN */
.tc-block-dropdown.tc-search-drop-down {
padding: 0.5em;
}
.tc-block-dropdown.tc-search-drop-down .tc-tab-buttons {
margin-bottom: -3px;
padding-top: 0;
}
.tc-block-dropdown.tc-search-drop-down .tc-search-results { width: 100%; }
.tc-block-dropdown.tc-search-drop-down .tc-search { display: none; }
@media (min-width: <<bkrpnt>>) {
.tc-block-dropdown.tc-search-drop-down {
margin: 0 0 0 -24em;
width: calc(100% + 24em);
max-height: 42em;
overflow: auto;
}
.tc-topbar-right .tc-search .tc-block-dropdown,
.tc-topbar-right .tc-search .tc-drop-down {
position: absolute;
right: 0;
}
.tc-topbar-right .tc-search .tc-drop-down {
padding: 1em;
min-width: 10em;
max-width: 10em;
}
}
@media (max-width: <<bkrpnt>>) {
.tc-block-dropdown.tc-search-drop-down {
margin: 0;
width: 100%;
overflow: auto;
}
}
/* TOPBAR SEARCH DROPDOWN FLEX */
/* .tc-block-dropdown.tc-search-drop-down { display: flex; } on searchbar template under reveal */
.tc-block-dropdown.tc-search-drop-down > p {
display: flex;
margin: 0;
width: 100%;
}
.tc-block-dropdown.tc-search-drop-down > p >.tc-tab-set {
display: flex;
flex-direction: column;
width: 100%;
}
.tc-block-dropdown.tc-search-drop-down > p >.tc-tab-set > .tc-tab-content {
display: flex;
flex: 1 1 auto;
overflow: auto;
margin-top: 0;
}
<$reveal type="match" state="$:/state/styled-frames" text="yes" default="yes">
/* VIEW & EDIT FRAME */
.tc-subtitle,
.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor,
.tc-tiddler-view-frame .tc-titlebar h2.tc-title {
font-family: monospace;
}
/* VIEW FRAME */
.tc-tiddler-view-frame .tc-title {
font-weight: bold;
}
.tc-tiddler-view-frame .tc-tiddler-title {
font-size: 1.5em;
margin: 0 -1em;
padding: 0.25em 1em;
}
.tc-tiddler-view-frame .tc-titlebar {
font-size: 1em;
}
.tc-tiddler-view-frame .tc-titlebar h2.tc-title {
font-size: 0.75em;
}
.tc-tiddler-view-frame .tc-tiddler-controls {
font-size: 1.5em;
}
.tc-tiddler-view-frame .tc-tiddler-controls,
.tc-tiddler-view-frame .tc-tiddler-controls > span > button,
.tc-tiddler-view-frame .tc-tiddler-controls > span > span > button,
.tc-tiddler-view-frame .tc-tiddler-controls > span > span > span > button {
display: flex;
align-items: center;
justify-content: center;
}
.tc-tiddler-view-frame .tc-tiddler-title-icon svg {
max-height: 0.65em;
}
/* EDIT FRAME */
.tc-tiddler-edit-frame .tc-tiddler-edit-title {
color: transparent;
line-height: 0;
}
.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor {
font-size: 1.2em;
}
.tc-tiddler-edit-frame .tc-message-box { margin: 0; }
.tc-tiddler-edit-frame iframe.tc-edit-texteditor { margin-top: 0 !important; }
.tc-tiddler-edit-frame .tc-editor-toolbar { background: <<colour tiddler-editor-border>>; }
.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible { background: transparent; }
.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible {
transition: 200ms fill;
fill: <<colour foreground>>;
}
.tc-tiddler-edit-frame .tc-editor-toolbar .tc-btn-invisible:hover {
background: transparent;
fill: <<colour primary>>;
}
input::placeholder {
font-size: 0.9em;
}
.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor,
.tc-tiddler-edit-frame .tc-edit-tags,
.tc-tiddler-edit-frame .tc-edit-field-add-name input.tc-edit-texteditor,
.tc-tiddler-edit-frame .tc-edit-field-add-value input.tc-edit-texteditor,
.tc-tiddler-edit-frame input.tc-edit-typeeditor.tc-popup-handle,
.tc-tiddler-edit-frame input.tc-edit-texteditor.tc-popup-handle {
border: 1px solid <<colour background>>;
border-bottom: 1px solid <<colour tiddler-editor-border>>;
<<box-shadow "none">>
}
.tc-tiddler-edit-frame textarea {
border: 1px solid <<colour tiddler-editor-border>>;
<<box-shadow "none">>
}
.tc-tiddler-edit-frame textarea,
.tc-tiddler-edit-frame iframe.tc-edit-texteditor {
font-size: {{$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize}};
border: 1px solid <<colour background>>;
<<box-shadow "none">>
}
.tc-tiddler-edit-frame input.tc-titlebar.tc-edit-texteditor {
font-weight: bold;
}
.tc-tiddler-edit-frame .tc-type-selector {
padding-bottom: 10px;
border-bottom: 1px solid <<colour tiddler-editor-border>>;
}
</$reveal>
/* TIMELINE */
.jd-timeline-wrapper {
position: relative;
}
@media (max-width: <<bkrpnt>>) {
.jd-timeline-wrapper {
padding: 0 1em;
width: 100%;
}
}
.jd-paperview-wrapper {
display: flex;
flex-wrap: wrap;
margin: 0.25em 0;
}
.jd-paperview {
position:relative;
width: 31%;
margin: 1%;
overflow:hidden;
border: 0.5px solid {{$:/themes/jd/Mono/Database##grid-item-border}};
border-radius: 1px;
<<box-shadow "2px 2px 5px rgba(0, 0, 0, 0.09)">>
text-align: left;
}
@media (min-width: <<bkrpnt>>) {
.jd-paperview { height: 26em; }
}
@media (max-width: <<bkrpnt>>) {
.jd-paperview { height: 12em; }
}
.jd-paperview,
.jd-paperview-end {
background: {{$:/themes/jd/Mono/Database##grid-item-background}} !important;
}
.jd-paperview-end {
position: absolute;
bottom: 0;
left:0;
width: 100%;
height: 5px;
}
.jd-paperview-internal {
transform: scale(0.7);
position: absolute;
width: 110%;
height: 100%;
top: -5%;
left: -5%;
pointer-events: none;
}
.jd-paperview-wrapper .tc-menu-list-subitem { width: 100%; }
@media (min-width: <<bkrpnt>>) {
.jd-paperview-end {
box-shadow: 0 0 10px 10px {{$:/themes/jd/Mono/Database##grid-item-background}};
}
}
@media (max-width: <<bkrpnt>>) {
.jd-paperview-end {
box-shadow: 0 0 5px 5px {{$:/themes/jd/Mono/Database##grid-item-background}};
}
}
.jd-paperview-date {
padding: 0.1em 0;
}
.jd-paperview-date {
position: sticky;
z-index: 1;
background: {{$:/themes/jd/Mono/Database##header-background}};
box-shadow: 0 0 2px 2px {{$:/themes/jd/Mono/Database##header-background}};
}
@media (min-width: <<bkrpnt>>) {
.jd-paperview-date {
top: {{$:/themes/jd/Mono/Database##header-position-desktop}};
}
}
@media (max-width: <<bkrpnt>>) {
<$list filter="[[$:/state/searchbar]text[show]]">
.jd-paperview-date {
top: {{$:/themes/jd/Mono/Database##header-position-mobile-yes-searchbar}};
}
</$list>
<$list filter="[[$:/state/searchbar]!text[show]]">
.jd-paperview-date {
top: {{$:/themes/jd/Mono/Database##header-position-mobile-no-searchbar}};
}
</$list>
}
/* MISC */
hr {
border: none;
border-top: 1px solid <<colour table-border>>;
height: 1px;
}
.tc-sidebar-scrollable .tc-tab-buttons,
.tc-tiddler-frame .tc-tab-buttons {
margin-bottom: -3px;
}
.tc-story-river .tc-tab-buttons.tc-vertical button {
border-top: 1px solid <<colour tab-border>>;
border-left: 1px solid <<colour tab-border>>;
border-bottom: 1px solid <<colour tab-border>>;
border-right: 1px solid transparent;
}
.tc-story-river .tc-tab-buttons.tc-vertical .tc-tab-selected {
border-top: 1px solid <<colour tab-border-selected>>;
border-left: 1px solid <<colour tab-border-selected>>;
border-bottom: 1px solid <<colour tab-border-selected>>;
border-right: 1px solid transparent;
}
.tc-sidebar-lists .tc-tab-set .tc-tab-divider {
border-top: none;
height: 1px;
background-image: linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);
background-image: -o-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);
background-image: -moz-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);
background-image: -webkit-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);
background-image: -ms-linear-gradient(left, <<colour sidebar-tab-divider>> 20%, transparent 100%);
}
/* SIDEBAR MORE TAB BUTTONS */
.tc-more-sidebar .tc-tab-buttons.tc-vertical {
margin-top: 1em;
}
.tc-more-sidebar .tc-tab-buttons.tc-vertical > button {
margin-bottom: -1px;
border-top: 1px solid <<colour sidebar-tab-border>>;
border-right: 1px solid transparent;
border-bottom: 1px solid <<colour sidebar-tab-border>>;
border-left: 1px solid <<colour sidebar-tab-border>>;
}
.tc-more-sidebar .tc-tab-buttons.tc-vertical > button.tc-tab-selected {
border-top: 1px solid <<colour sidebar-tab-border-selected>>;
border-right: 1px solid transparent;
border-bottom: 1px solid <<colour sidebar-tab-border-selected>>;
border-left: 1px solid <<colour sidebar-tab-border-selected>>;
}
.tc-more-sidebar .tc-tab-content.tc-vertical {
margin-left: 1px;
}
.tc-menu-list-item {
padding-left: 5px;
text-indent: -5px;
white-space: normal !important;
word-wrap: break-word !important;
-webkit-word-break: break-all !important;
-moz-word-break: break-all !important;
-ms-word-break: break-all !important;
-o-word-break: break-all !important;
word-break: break-all !important;
}
button, input { outline: none; }
button, input:not([type]) {
border-radius: 2px;
}
input:not([type]) {
border: 1px solid <<colour tiddler-editor-border>>;
padding: 2px 4px;
margin: 2px;
}
button {
border: 1px solid <<colour button-border>>;
padding: 6px 16px;
margin: 2px;
}
@media (max-width: <<bkrpnt>>) {
.desktop-only {
display: none !important; pointer-events: none;
}
}
@media (min-width: <<bkrpnt>>) {
.mobile-only {
display: none !important; pointer-events: none;
}
}
.tc-topbar.tc-topbar-left,
.tc-topbar.tc-topbar-right {
display: none; pointer-events: none;
}
.tc-dropzone > p,
.tc-topbar p,
.tc-sidebar-lists-template > p,
.tc-topbar .tc-sidebar-lists > p { margin: 0; }
@media (min-width: <<bkrpnt>>) {
div::-webkit-scrollbar { background: rgba(0, 0, 0, 0.12); }
div::-webkit-scrollbar-thumb { background: rgba(0, 0, 0, 0.12); }
}
.tc-notification {
<<box-shadow "2px 2px 5px rgba(0, 0, 0, 0.45)">>
border-radius: 1px;
}
{
"tiddlers": {
"$:/themes/tiddlywiki/snowwhite/base": {
"title": "$:/themes/tiddlywiki/snowwhite/base",
"tags": "[[$:/tags/Stylesheet]]",
"text": "\\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline\n\n.tc-sidebar-header {\n\ttext-shadow: 0 1px 0 <<colour sidebar-foreground-shadow>>;\n}\n\n.tc-tiddler-info {\n\t<<box-shadow \"inset 1px 2px 3px rgba(0,0,0,0.1)\">>\n}\n\n@media screen {\n\t.tc-tiddler-frame {\n\t\t<<box-shadow \"1px 1px 5px rgba(0, 0, 0, 0.3)\">>\n\t}\n}\n\n@media (max-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\t.tc-tiddler-frame {\n\t\t<<box-shadow none>>\n\t}\n}\n\n.tc-page-controls button svg, .tc-tiddler-controls button svg, .tc-topbar button svg {\n\t<<transition \"fill 150ms ease-in-out\">>\n}\n\n.tc-tiddler-controls button.tc-selected,\n.tc-page-controls button.tc-selected {\n\t<<filter \"drop-shadow(0px -1px 2px rgba(0,0,0,0.25))\">>\n}\n\n.tc-tiddler-frame input.tc-edit-texteditor {\n\t<<box-shadow \"inset 0 1px 8px rgba(0, 0, 0, 0.15)\">>\n}\n\n.tc-edit-tags {\n\t<<box-shadow \"inset 0 1px 8px rgba(0, 0, 0, 0.15)\">>\n}\n\n.tc-tiddler-frame .tc-edit-tags input.tc-edit-texteditor {\n\t<<box-shadow \"none\">>\n\tborder: none;\n\toutline: none;\n}\n\ntextarea.tc-edit-texteditor {\n\tfont-family: {{$:/themes/tiddlywiki/vanilla/settings/editorfontfamily}};\n}\n\ncanvas.tc-edit-bitmapeditor {\n\t<<box-shadow \"2px 2px 5px rgba(0, 0, 0, 0.5)\">>\n}\n\n.tc-drop-down {\n\tborder-radius: 4px;\n\t<<box-shadow \"2px 2px 10px rgba(0, 0, 0, 0.5)\">>\n}\n\n.tc-block-dropdown {\n\tborder-radius: 4px;\n\t<<box-shadow \"2px 2px 10px rgba(0, 0, 0, 0.5)\">>\n}\n\n.tc-modal {\n\tborder-radius: 6px;\n\t<<box-shadow \"0 3px 7px rgba(0,0,0,0.3)\">>\n}\n\n.tc-modal-footer {\n\tborder-radius: 0 0 6px 6px;\n\t<<box-shadow \"inset 0 1px 0 #fff\">>;\n}\n\n\n.tc-alert {\n\tborder-radius: 6px;\n\t<<box-shadow \"0 3px 7px rgba(0,0,0,0.6)\">>\n}\n\n.tc-notification {\n\tborder-radius: 6px;\n\t<<box-shadow \"0 3px 7px rgba(0,0,0,0.3)\">>\n\ttext-shadow: 0 1px 0 rgba(255,255,255, 0.8);\n}\n\n.tc-sidebar-lists .tc-tab-set .tc-tab-divider {\n\tborder-top: none;\n\theight: 1px;\n\t<<background-linear-gradient \"left, rgba(0,0,0,0.15) 0%, rgba(0,0,0,0.0) 100%\">>\n}\n\n.tc-more-sidebar > .tc-tab-set > .tc-tab-buttons > button {\n\t<<background-linear-gradient \"left, rgba(0,0,0,0.01) 0%, rgba(0,0,0,0.1) 100%\">>\n}\n\n.tc-more-sidebar > .tc-tab-set > .tc-tab-buttons > button.tc-tab-selected {\n\t<<background-linear-gradient \"left, rgba(0,0,0,0.05) 0%, rgba(255,255,255,0.05) 100%\">>\n}\n\n.tc-message-box img {\n\t<<box-shadow \"1px 1px 3px rgba(0,0,0,0.5)\">>\n}\n\n.tc-plugin-info {\n\t<<box-shadow \"1px 1px 3px rgba(0,0,0,0.5)\">>\n}\n"
}
}
}
{
"tiddlers": {
"$:/themes/tiddlywiki/vanilla/themetweaks": {
"title": "$:/themes/tiddlywiki/vanilla/themetweaks",
"tags": "$:/tags/ControlPanel/Appearance",
"caption": "{{$:/language/ThemeTweaks/ThemeTweaks}}",
"text": "\\define lingo-base() $:/language/ThemeTweaks/\n\n\\define replacement-text()\n[img[$(imageTitle)$]]\n\\end\n\n\\define backgroundimage-dropdown()\n<div class=\"tc-drop-down-wrapper\">\n<$button popup=<<qualify \"$:/state/popup/themetweaks/backgroundimage\">> class=\"tc-btn-invisible tc-btn-dropdown\">{{$:/core/images/down-arrow}}</$button>\n<$reveal state=<<qualify \"$:/state/popup/themetweaks/backgroundimage\">> type=\"popup\" position=\"belowleft\" text=\"\" default=\"\">\n<div class=\"tc-drop-down\">\n<$macrocall $name=\"image-picker\" actions=\"\"\"\n\n<$action-setfield\n\t$tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\"\n\t$value=<<imageTitle>>\n/>\n\n\"\"\"/>\n</div>\n</$reveal>\n</div>\n\\end\n\n\\define backgroundimageattachment-dropdown()\n<$select tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment\" default=\"scroll\">\n<option value=\"scroll\"><<lingo Settings/BackgroundImageAttachment/Scroll>></option>\n<option value=\"fixed\"><<lingo Settings/BackgroundImageAttachment/Fixed>></option>\n</$select>\n\\end\n\n\\define backgroundimagesize-dropdown()\n<$select tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize\" default=\"scroll\">\n<option value=\"auto\"><<lingo Settings/BackgroundImageSize/Auto>></option>\n<option value=\"cover\"><<lingo Settings/BackgroundImageSize/Cover>></option>\n<option value=\"contain\"><<lingo Settings/BackgroundImageSize/Contain>></option>\n</$select>\n\\end\n\n<<lingo ThemeTweaks/Hint>>\n\n! <<lingo Options>>\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/options/sidebarlayout\"><<lingo Options/SidebarLayout>></$link> |<$select tiddler=\"$:/themes/tiddlywiki/vanilla/options/sidebarlayout\"><option value=\"fixed-fluid\"><<lingo Options/SidebarLayout/Fixed-Fluid>></option><option value=\"fluid-fixed\"><<lingo Options/SidebarLayout/Fluid-Fixed>></option></$select> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/options/stickytitles\"><<lingo Options/StickyTitles>></$link><br>//<<lingo Options/StickyTitles/Hint>>// |<$select tiddler=\"$:/themes/tiddlywiki/vanilla/options/stickytitles\"><option value=\"no\">{{$:/language/No}}</option><option value=\"yes\">{{$:/language/Yes}}</option></$select> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/options/codewrapping\"><<lingo Options/CodeWrapping>></$link> |<$select tiddler=\"$:/themes/tiddlywiki/vanilla/options/codewrapping\"><option value=\"pre\">{{$:/language/No}}</option><option value=\"pre-wrap\">{{$:/language/Yes}}</option></$select> |\n\n! <<lingo Settings>>\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/fontfamily\"><<lingo Settings/FontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/fontfamily\" default=\"\" tag=\"input\"/> | |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/codefontfamily\"><<lingo Settings/CodeFontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/codefontfamily\" default=\"\" tag=\"input\"/> | |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/editorfontfamily\"><<lingo Settings/EditorFontFamily>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/editorfontfamily\" default=\"\" tag=\"input\"/> | |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\"><<lingo Settings/BackgroundImage>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimage\" default=\"\" tag=\"input\"/> |<<backgroundimage-dropdown>> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment\"><<lingo Settings/BackgroundImageAttachment>></$link> |<<backgroundimageattachment-dropdown>> | |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize\"><<lingo Settings/BackgroundImageSize>></$link> |<<backgroundimagesize-dropdown>> | |\n\n! <<lingo Metrics>>\n\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/fontsize\"><<lingo Metrics/FontSize>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/fontsize\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/lineheight\"><<lingo Metrics/LineHeight>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/lineheight\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\"><<lingo Metrics/BodyFontSize>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\"><<lingo Metrics/BodyLineHeight>></$link> |<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/storyleft\"><<lingo Metrics/StoryLeft>></$link><br>//<<lingo Metrics/StoryLeft/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/storyleft\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/storytop\"><<lingo Metrics/StoryTop>></$link><br>//<<lingo Metrics/StoryTop/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/storytop\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/storyright\"><<lingo Metrics/StoryRight>></$link><br>//<<lingo Metrics/StoryRight/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/storyright\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/storywidth\"><<lingo Metrics/StoryWidth>></$link><br>//<<lingo Metrics/StoryWidth/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/storywidth\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth\"><<lingo Metrics/TiddlerWidth>></$link><br>//<<lingo Metrics/TiddlerWidth/Hint>>//<br> |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint\"><<lingo Metrics/SidebarBreakpoint>></$link><br>//<<lingo Metrics/SidebarBreakpoint/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint\" default=\"\" tag=\"input\"/> |\n|<$link to=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth\"><<lingo Metrics/SidebarWidth>></$link><br>//<<lingo Metrics/SidebarWidth/Hint>>// |^<$edit-text tiddler=\"$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth\" default=\"\" tag=\"input\"/> |\n"
},
"$:/themes/tiddlywiki/vanilla/base": {
"title": "$:/themes/tiddlywiki/vanilla/base",
"tags": "[[$:/tags/Stylesheet]]",
"text": "\\define custom-background-datauri()\n<$set name=\"background\" value={{$:/themes/tiddlywiki/vanilla/settings/backgroundimage}}>\n<$list filter=\"[<background>is[image]]\">\n`background: url(`\n<$list filter=\"[<background>!has[_canonical_uri]]\">\n`\"`<$macrocall $name=\"datauri\" title={{$:/themes/tiddlywiki/vanilla/settings/backgroundimage}}/>`\"`\n</$list>\n<$list filter=\"[<background>has[_canonical_uri]]\">\n`\"`<$view tiddler={{$:/themes/tiddlywiki/vanilla/settings/backgroundimage}} field=\"_canonical_uri\"/>`\"`\n</$list>\n`) center center;`\n`background-attachment: `{{$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment}}`;\n-webkit-background-size:` {{$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize}}`;\n-moz-background-size:` {{$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize}}`;\n-o-background-size:` {{$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize}}`;\nbackground-size:` {{$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize}}`;`\n</$list>\n</$set>\n\\end\n\n\\define if-fluid-fixed(text,hiddenSidebarText)\n<$reveal state=\"$:/themes/tiddlywiki/vanilla/options/sidebarlayout\" type=\"match\" text=\"fluid-fixed\">\n$text$\n<$reveal state=\"$:/state/sidebar\" type=\"nomatch\" text=\"yes\" default=\"yes\">\n$hiddenSidebarText$\n</$reveal>\n</$reveal>\n\\end\n\n\\define if-editor-height-fixed(then,else)\n<$reveal state=\"$:/config/TextEditor/EditorHeight/Mode\" type=\"match\" text=\"fixed\">\n$then$\n</$reveal>\n<$reveal state=\"$:/config/TextEditor/EditorHeight/Mode\" type=\"match\" text=\"auto\">\n$else$\n</$reveal>\n\\end\n\n\\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline macrocallblock\n\n/*\n** Start with the normalize CSS reset, and then belay some of its effects\n*/\n\n{{$:/themes/tiddlywiki/vanilla/reset}}\n\n*, input[type=\"search\"] {\n\tbox-sizing: border-box;\n\t-moz-box-sizing: border-box;\n\t-webkit-box-sizing: border-box;\n}\n\nhtml button {\n\tline-height: 1.2;\n\tcolor: <<colour button-foreground>>;\n\tbackground: <<colour button-background>>;\n\tborder-color: <<colour button-border>>;\n}\n\n/*\n** Basic element styles\n*/\n\nhtml {\n\tfont-family: {{$:/themes/tiddlywiki/vanilla/settings/fontfamily}};\n\ttext-rendering: optimizeLegibility; /* Enables kerning and ligatures etc. */\n\t-webkit-font-smoothing: antialiased;\n\t-moz-osx-font-smoothing: grayscale;\n}\n\nhtml:-webkit-full-screen {\n\tbackground-color: <<colour page-background>>;\n}\n\nbody.tc-body {\n\tfont-size: {{$:/themes/tiddlywiki/vanilla/metrics/fontsize}};\n\tline-height: {{$:/themes/tiddlywiki/vanilla/metrics/lineheight}};\n\tword-wrap: break-word;\n\t<<custom-background-datauri>>\n\tcolor: <<colour foreground>>;\n\tbackground-color: <<colour page-background>>;\n\tfill: <<colour foreground>>;\n}\n\n<<if-background-attachment \"\"\"\n\nbody.tc-body {\n background-color: transparent;\n}\n\n\"\"\">>\n\nh1, h2, h3, h4, h5, h6 {\n\tline-height: 1.2;\n\tfont-weight: 300;\n}\n\npre {\n\tdisplay: block;\n\tpadding: 14px;\n\tmargin-top: 1em;\n\tmargin-bottom: 1em;\n\tword-break: normal;\n\tword-wrap: break-word;\n\twhite-space: {{$:/themes/tiddlywiki/vanilla/options/codewrapping}};\n\tbackground-color: <<colour pre-background>>;\n\tborder: 1px solid <<colour pre-border>>;\n\tpadding: 0 3px 2px;\n\tborder-radius: 3px;\n\tfont-family: {{$:/themes/tiddlywiki/vanilla/settings/codefontfamily}};\n}\n\ncode {\n\tcolor: <<colour code-foreground>>;\n\tbackground-color: <<colour code-background>>;\n\tborder: 1px solid <<colour code-border>>;\n\twhite-space: {{$:/themes/tiddlywiki/vanilla/options/codewrapping}};\n\tpadding: 0 3px 2px;\n\tborder-radius: 3px;\n\tfont-family: {{$:/themes/tiddlywiki/vanilla/settings/codefontfamily}};\n}\n\nblockquote {\n\tborder-left: 5px solid <<colour blockquote-bar>>;\n\tmargin-left: 25px;\n\tpadding-left: 10px;\n\tquotes: \"\\201C\"\"\\201D\"\"\\2018\"\"\\2019\";\n}\n\nblockquote > div {\n\tmargin-top: 1em;\n\tmargin-bottom: 1em;\n}\n\nblockquote.tc-big-quote {\n\tfont-family: Georgia, serif;\n\tposition: relative;\n\tbackground: <<colour pre-background>>;\n\tborder-left: none;\n\tmargin-left: 50px;\n\tmargin-right: 50px;\n\tpadding: 10px;\n border-radius: 8px;\n}\n\nblockquote.tc-big-quote cite:before {\n\tcontent: \"\\2014 \\2009\";\n}\n\nblockquote.tc-big-quote:before {\n\tfont-family: Georgia, serif;\n\tcolor: <<colour blockquote-bar>>;\n\tcontent: open-quote;\n\tfont-size: 8em;\n\tline-height: 0.1em;\n\tmargin-right: 0.25em;\n\tvertical-align: -0.4em;\n\tposition: absolute;\n left: -50px;\n top: 42px;\n}\n\nblockquote.tc-big-quote:after {\n\tfont-family: Georgia, serif;\n\tcolor: <<colour blockquote-bar>>;\n\tcontent: close-quote;\n\tfont-size: 8em;\n\tline-height: 0.1em;\n\tmargin-right: 0.25em;\n\tvertical-align: -0.4em;\n\tposition: absolute;\n right: -80px;\n bottom: -20px;\n}\n\ndl dt {\n\tfont-weight: bold;\n\tmargin-top: 6px;\n}\n\nbutton, textarea, input, select {\n\toutline-color: <<colour primary>>;\n}\n\ntextarea,\ninput[type=text],\ninput[type=search],\ninput[type=\"\"],\ninput:not([type]) {\n\tcolor: <<colour foreground>>;\n\tbackground: <<colour background>>;\n}\n\ninput[type=\"checkbox\"] {\n vertical-align: middle;\n}\n\n.tc-muted {\n\tcolor: <<colour muted-foreground>>;\n}\n\nsvg.tc-image-button {\n\tpadding: 0px 1px 1px 0px;\n}\n\n.tc-icon-wrapper > svg {\n\twidth: 1em;\n\theight: 1em;\n}\n\nkbd {\n\tdisplay: inline-block;\n\tpadding: 3px 5px;\n\tfont-size: 0.8em;\n\tline-height: 1.2;\n\tcolor: <<colour foreground>>;\n\tvertical-align: middle;\n\tbackground-color: <<colour background>>;\n\tborder: solid 1px <<colour muted-foreground>>;\n\tborder-bottom-color: <<colour muted-foreground>>;\n\tborder-radius: 3px;\n\tbox-shadow: inset 0 -1px 0 <<colour muted-foreground>>;\n}\n\n/*\nMarkdown likes putting code elements inside pre elements\n*/\npre > code {\n\tpadding: 0;\n\tborder: none;\n\tbackground-color: inherit;\n\tcolor: inherit;\n}\n\ntable {\n\tborder: 1px solid <<colour table-border>>;\n\twidth: auto;\n\tmax-width: 100%;\n\tcaption-side: bottom;\n\tmargin-top: 1em;\n\tmargin-bottom: 1em;\n\t/* next 2 elements needed, since normalize 8.0.1 */\n\tborder-collapse: collapse;\n\tborder-spacing: 0;\n}\n\ntable th, table td {\n\tpadding: 0 7px 0 7px;\n\tborder-top: 1px solid <<colour table-border>>;\n\tborder-left: 1px solid <<colour table-border>>;\n}\n\ntable thead tr td, table th {\n\tbackground-color: <<colour table-header-background>>;\n\tfont-weight: bold;\n}\n\ntable tfoot tr td {\n\tbackground-color: <<colour table-footer-background>>;\n}\n\n.tc-csv-table {\n\twhite-space: nowrap;\n}\n\n.tc-tiddler-frame img,\n.tc-tiddler-frame svg,\n.tc-tiddler-frame canvas,\n.tc-tiddler-frame embed,\n.tc-tiddler-frame iframe {\n\tmax-width: 100%;\n}\n\n.tc-tiddler-body > embed,\n.tc-tiddler-body > iframe {\n\twidth: 100%;\n\theight: 600px;\n}\n\n/*\n** Links\n*/\n\nbutton.tc-tiddlylink,\na.tc-tiddlylink {\n\ttext-decoration: none;\n\tfont-weight: 500;\n\tcolor: <<colour tiddler-link-foreground>>;\n\t-webkit-user-select: inherit; /* Otherwise the draggable attribute makes links impossible to select */\n}\n\n.tc-sidebar-lists a.tc-tiddlylink {\n\tcolor: <<colour sidebar-tiddler-link-foreground>>;\n}\n\n.tc-sidebar-lists a.tc-tiddlylink:hover {\n\tcolor: <<colour sidebar-tiddler-link-foreground-hover>>;\n}\n\nbutton.tc-tiddlylink:hover,\na.tc-tiddlylink:hover {\n\ttext-decoration: underline;\n}\n\na.tc-tiddlylink-resolves {\n}\n\na.tc-tiddlylink-shadow {\n\tfont-weight: bold;\n}\n\na.tc-tiddlylink-shadow.tc-tiddlylink-resolves {\n\tfont-weight: normal;\n}\n\na.tc-tiddlylink-missing {\n\tfont-style: italic;\n}\n\na.tc-tiddlylink-external {\n\ttext-decoration: underline;\n\tcolor: <<colour external-link-foreground>>;\n\tbackground-color: <<colour external-link-background>>;\n}\n\na.tc-tiddlylink-external:visited {\n\tcolor: <<colour external-link-foreground-visited>>;\n\tbackground-color: <<colour external-link-background-visited>>;\n}\n\na.tc-tiddlylink-external:hover {\n\tcolor: <<colour external-link-foreground-hover>>;\n\tbackground-color: <<colour external-link-background-hover>>;\n}\n\n/*\n** Drag and drop styles\n*/\n\n.tc-tiddler-dragger {\n\tposition: relative;\n\tz-index: -10000;\n}\n\n.tc-tiddler-dragger-inner {\n\tposition: absolute;\n\ttop: -1000px;\n\tleft: -1000px;\n\tdisplay: inline-block;\n\tpadding: 8px 20px;\n\tfont-size: 16.9px;\n\tfont-weight: bold;\n\tline-height: 20px;\n\tcolor: <<colour dragger-foreground>>;\n\ttext-shadow: 0 1px 0 rgba(0, 0, 0, 1);\n\twhite-space: nowrap;\n\tvertical-align: baseline;\n\tbackground-color: <<colour dragger-background>>;\n\tborder-radius: 20px;\n}\n\n.tc-tiddler-dragger-cover {\n\tposition: absolute;\n\tbackground-color: <<colour page-background>>;\n}\n\n.tc-dropzone {\n\tposition: relative;\n}\n\n.tc-dropzone.tc-dragover:before {\n\tz-index: 10000;\n\tdisplay: block;\n\tposition: fixed;\n\ttop: 0;\n\tleft: 0;\n\tright: 0;\n\tbackground: <<colour dropzone-background>>;\n\ttext-align: center;\n\tcontent: \"<<lingo DropMessage>>\";\n}\n\n.tc-droppable > .tc-droppable-placeholder {\n\tdisplay: none;\n}\n\n.tc-droppable.tc-dragover > .tc-droppable-placeholder {\n\tdisplay: block;\n\tborder: 2px dashed <<colour dropzone-background>>;\n}\n\n.tc-draggable {\n\tcursor: move;\n}\n\n.tc-sidebar-tab-open .tc-droppable-placeholder, .tc-tagged-draggable-list .tc-droppable-placeholder,\n.tc-links-draggable-list .tc-droppable-placeholder {\n\tline-height: 2em;\n\theight: 2em;\n}\n\n.tc-sidebar-tab-open-item {\n\tposition: relative;\n}\n\n.tc-sidebar-tab-open .tc-btn-invisible.tc-btn-mini svg {\n\tfont-size: 0.7em;\n\tfill: <<colour muted-foreground>>;\n}\n\n/*\n** Plugin reload warning\n*/\n\n.tc-plugin-reload-warning {\n\tz-index: 1000;\n\tdisplay: block;\n\tposition: fixed;\n\ttop: 0;\n\tleft: 0;\n\tright: 0;\n\tbackground: <<colour alert-background>>;\n\ttext-align: center;\n}\n\n/*\n** Buttons\n*/\n\nbutton svg, button img, label svg, label img {\n\tvertical-align: middle;\n}\n\n.tc-btn-invisible {\n\tpadding: 0;\n\tmargin: 0;\n\tbackground: none;\n\tborder: none;\n \tcursor: pointer;\n\tcolor: <<colour foreground>>;\n}\n\n.tc-btn-boxed {\n\tfont-size: 0.6em;\n\tpadding: 0.2em;\n\tmargin: 1px;\n\tbackground: none;\n\tborder: 1px solid <<colour tiddler-controls-foreground>>;\n\tborder-radius: 0.25em;\n}\n\nhtml body.tc-body .tc-btn-boxed svg {\n\tfont-size: 1.6666em;\n}\n\n.tc-btn-boxed:hover {\n\tbackground: <<colour muted-foreground>>;\n\tcolor: <<colour background>>;\n}\n\nhtml body.tc-body .tc-btn-boxed:hover svg {\n\tfill: <<colour background>>;\n}\n\n.tc-btn-rounded {\n\tfont-size: 0.5em;\n\tline-height: 2;\n\tpadding: 0em 0.3em 0.2em 0.4em;\n\tmargin: 1px;\n\tborder: 1px solid <<colour muted-foreground>>;\n\tbackground: <<colour muted-foreground>>;\n\tcolor: <<colour background>>;\n\tborder-radius: 2em;\n}\n\nhtml body.tc-body .tc-btn-rounded svg {\n\tfont-size: 1.6666em;\n\tfill: <<colour background>>;\n}\n\n.tc-btn-rounded:hover {\n\tborder: 1px solid <<colour muted-foreground>>;\n\tbackground: <<colour background>>;\n\tcolor: <<colour muted-foreground>>;\n}\n\nhtml body.tc-body .tc-btn-rounded:hover svg {\n\tfill: <<colour muted-foreground>>;\n}\n\n.tc-btn-icon svg {\n\theight: 1em;\n\twidth: 1em;\n\tfill: <<colour muted-foreground>>;\n}\n\n.tc-btn-text {\n\tpadding: 0;\n\tmargin: 0;\n}\n\n/* used for documentation \"fake\" buttons */\n.tc-btn-standard {\n\tline-height: 1.8;\n\tcolor: #667;\n\tbackground-color: #e0e0e0;\n\tborder: 1px solid #888;\n\tpadding: 2px 1px 2px 1px;\n\tmargin: 1px 4px 1px 4px;\n}\n\n.tc-btn-big-green {\n\tdisplay: inline-block;\n\tpadding: 8px;\n\tmargin: 4px 8px 4px 8px;\n\tbackground: <<colour download-background>>;\n\tcolor: <<colour download-foreground>>;\n\tfill: <<colour download-foreground>>;\n\tborder: none;\n\tborder-radius: 2px;\n\tfont-size: 1.2em;\n\tline-height: 1.4em;\n\ttext-decoration: none;\n}\n\n.tc-btn-big-green svg,\n.tc-btn-big-green img {\n\theight: 2em;\n\twidth: 2em;\n\tvertical-align: middle;\n\tfill: <<colour download-foreground>>;\n}\n\n.tc-primary-btn {\n \tbackground: <<colour primary>>;\n}\n\n.tc-sidebar-lists input {\n\tcolor: <<colour foreground>>;\n}\n\n.tc-sidebar-lists button {\n\tcolor: <<colour sidebar-button-foreground>>;\n\tfill: <<colour sidebar-button-foreground>>;\n}\n\n.tc-sidebar-lists button.tc-btn-mini {\n\tcolor: <<colour sidebar-muted-foreground>>;\n}\n\n.tc-sidebar-lists button.tc-btn-mini:hover {\n\tcolor: <<colour sidebar-muted-foreground-hover>>;\n}\n\nbutton svg.tc-image-button, button .tc-image-button img {\n\theight: 1em;\n\twidth: 1em;\n}\n\n.tc-unfold-banner {\n\tposition: absolute;\n\tpadding: 0;\n\tmargin: 0;\n\tbackground: none;\n\tborder: none;\n\twidth: 100%;\n\twidth: calc(100% + 2px);\n\tmargin-left: -43px;\n\ttext-align: center;\n\tborder-top: 2px solid <<colour tiddler-info-background>>;\n\tmargin-top: 4px;\n}\n\n.tc-unfold-banner:hover {\n\tbackground: <<colour tiddler-info-background>>;\n\tborder-top: 2px solid <<colour tiddler-info-border>>;\n}\n\n.tc-unfold-banner svg, .tc-fold-banner svg {\n\theight: 0.75em;\n\tfill: <<colour tiddler-controls-foreground>>;\n}\n\n.tc-unfold-banner:hover svg, .tc-fold-banner:hover svg {\n\tfill: <<colour tiddler-controls-foreground-hover>>;\n}\n\n.tc-fold-banner {\n\tposition: absolute;\n\tpadding: 0;\n\tmargin: 0;\n\tbackground: none;\n\tborder: none;\n\twidth: 23px;\n\ttext-align: center;\n\tmargin-left: -35px;\n\ttop: 6px;\n\tbottom: 6px;\n}\n\n.tc-fold-banner:hover {\n\tbackground: <<colour tiddler-info-background>>;\n}\n\n@media (max-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n\t.tc-unfold-banner {\n\t\tposition: static;\n\t\twidth: calc(100% + 59px);\n\t}\n\n\t.tc-fold-banner {\n\t\twidth: 16px;\n\t\tmargin-left: -16px;\n\t\tfont-size: 0.75em;\n\t}\n\n}\n\n/*\n** Tags and missing tiddlers\n*/\n\n.tc-tag-list-item {\n\tposition: relative;\n\tdisplay: inline-block;\n\tmargin-right: 7px;\n}\n\n.tc-tags-wrapper {\n\tmargin: 4px 0 14px 0;\n}\n\n.tc-missing-tiddler-label {\n\tfont-style: italic;\n\tfont-weight: normal;\n\tdisplay: inline-block;\n\tfont-size: 11.844px;\n\tline-height: 14px;\n\twhite-space: nowrap;\n\tvertical-align: baseline;\n}\n\nbutton.tc-tag-label, span.tc-tag-label {\n\tdisplay: inline-block;\n\tpadding: 0.16em 0.7em;\n\tfont-size: 0.9em;\n\tfont-weight: 400;\n\tline-height: 1.2em;\n\tcolor: <<colour tag-foreground>>;\n\twhite-space: nowrap;\n\tvertical-align: baseline;\n\tbackground-color: <<colour tag-background>>;\n\tborder-radius: 1em;\n}\n\n.tc-sidebar-scrollable .tc-tag-label {\n\ttext-shadow: none;\n}\n\n.tc-untagged-separator {\n\twidth: 10em;\n\tleft: 0;\n\tmargin-left: 0;\n\tborder: 0;\n\theight: 1px;\n\tbackground: <<colour tab-divider>>;\n}\n\nbutton.tc-untagged-label {\n\tbackground-color: <<colour untagged-background>>;\n}\n\n.tc-tag-label svg, .tc-tag-label img {\n\theight: 1em;\n\twidth: 1em;\n\tmargin-right: 3px; \n\tmargin-bottom: 1px;\n\tvertical-align: text-bottom;\n}\n\n.tc-edit-tags button.tc-remove-tag-button svg {\n\tfont-size: 0.7em;\n\tvertical-align: middle;\n}\n\n.tc-tag-manager-table .tc-tag-label {\n\twhite-space: normal;\n}\n\n.tc-tag-manager-tag {\n\twidth: 100%;\n}\n\nbutton.tc-btn-invisible.tc-remove-tag-button {\n\toutline: none;\n}\n\n/*\n** Page layout\n*/\n\n.tc-topbar {\n\tposition: fixed;\n\tz-index: 1200;\n}\n\n.tc-topbar-left {\n\tleft: 29px;\n\ttop: 5px;\n}\n\n.tc-topbar-right {\n\ttop: 5px;\n\tright: 29px;\n}\n\n.tc-topbar button {\n\tpadding: 8px;\n}\n\n.tc-topbar svg {\n\tfill: <<colour muted-foreground>>;\n}\n\n.tc-topbar button:hover svg {\n\tfill: <<colour foreground>>;\n}\n\n.tc-sidebar-header {\n\tcolor: <<colour sidebar-foreground>>;\n\tfill: <<colour sidebar-foreground>>;\n}\n\n.tc-sidebar-header .tc-title a.tc-tiddlylink-resolves {\n\tfont-weight: 300;\n}\n\n.tc-sidebar-header .tc-sidebar-lists p {\n\tmargin-top: 3px;\n\tmargin-bottom: 3px;\n}\n\n.tc-sidebar-header .tc-missing-tiddler-label {\n\tcolor: <<colour sidebar-foreground>>;\n}\n\n.tc-advanced-search input {\n\twidth: 60%;\n}\n\n.tc-search a svg {\n\twidth: 1.2em;\n\theight: 1.2em;\n\tvertical-align: middle;\n}\n\n.tc-page-controls {\n\tmargin-top: 14px;\n\tfont-size: 1.5em;\n}\n\n.tc-page-controls .tc-drop-down {\n font-size: 1rem;\n}\n\n.tc-page-controls button {\n\tmargin-right: 0.5em;\n}\n\n.tc-page-controls a.tc-tiddlylink:hover {\n\ttext-decoration: none;\n}\n\n.tc-page-controls img {\n\twidth: 1em;\n}\n\n.tc-page-controls svg {\n\tfill: <<colour sidebar-controls-foreground>>;\n}\n\n.tc-page-controls button:hover svg, .tc-page-controls a:hover svg {\n\tfill: <<colour sidebar-controls-foreground-hover>>;\n}\n\n.tc-menu-list-item {\n\twhite-space: nowrap;\n}\n\n.tc-menu-list-count {\n\tfont-weight: bold;\n}\n\n.tc-menu-list-subitem {\n\tpadding-left: 7px;\n}\n\n.tc-story-river {\n\tposition: relative;\n}\n\n@media (max-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n\t.tc-sidebar-header {\n\t\tpadding: 14px;\n\t\tmin-height: 32px;\n\t\tmargin-top: {{$:/themes/tiddlywiki/vanilla/metrics/storytop}};\n\t}\n\n\t.tc-story-river {\n\t\tposition: relative;\n\t\tpadding: 0;\n\t}\n}\n\n@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n\t.tc-message-box {\n\t\tmargin: 21px -21px 21px -21px;\n\t}\n\n\t.tc-sidebar-scrollable {\n\t\tposition: fixed;\n\t\ttop: {{$:/themes/tiddlywiki/vanilla/metrics/storytop}};\n\t\tleft: {{$:/themes/tiddlywiki/vanilla/metrics/storyright}};\n\t\tbottom: 0;\n\t\tright: 0;\n\t\toverflow-y: auto;\n\t\toverflow-x: auto;\n\t\t-webkit-overflow-scrolling: touch;\n\t\tmargin: 0 0 0 -42px;\n\t\tpadding: 71px 0 28px 42px;\n\t}\n\n\thtml[dir=\"rtl\"] .tc-sidebar-scrollable {\n\t\tleft: auto;\n\t\tright: {{$:/themes/tiddlywiki/vanilla/metrics/storyright}};\n\t}\n\n\t.tc-story-river {\n\t\tposition: relative;\n\t\tleft: {{$:/themes/tiddlywiki/vanilla/metrics/storyleft}};\n\t\ttop: {{$:/themes/tiddlywiki/vanilla/metrics/storytop}};\n\t\twidth: {{$:/themes/tiddlywiki/vanilla/metrics/storywidth}};\n\t\tpadding: 42px 42px 42px 42px;\n\t}\n\n<<if-no-sidebar \"\n\n\t.tc-story-river {\n\t\twidth: calc(100% - {{$:/themes/tiddlywiki/vanilla/metrics/storyleft}});\n\t}\n\n\">>\n\n}\n\n@media print {\n\n\tbody.tc-body {\n\t\tbackground-color: transparent;\n\t}\n\n\t.tc-sidebar-header, .tc-topbar {\n\t\tdisplay: none;\n\t}\n\n\t.tc-story-river {\n\t\tmargin: 0;\n\t\tpadding: 0;\n\t}\n\n\t.tc-story-river .tc-tiddler-frame {\n\t\tmargin: 0;\n\t\tborder: none;\n\t\tpadding: 0;\n\t}\n}\n\n/*\n** Tiddler styles\n*/\n\n.tc-tiddler-frame {\n\tposition: relative;\n\tmargin-bottom: 28px;\n\tbackground-color: <<colour tiddler-background>>;\n\tborder: 1px solid <<colour tiddler-border>>;\n}\n\n{{$:/themes/tiddlywiki/vanilla/sticky}}\n\n.tc-tiddler-info {\n\tpadding: 14px 42px 14px 42px;\n\tbackground-color: <<colour tiddler-info-background>>;\n\tborder-top: 1px solid <<colour tiddler-info-border>>;\n\tborder-bottom: 1px solid <<colour tiddler-info-border>>;\n}\n\n.tc-tiddler-info p {\n\tmargin-top: 3px;\n\tmargin-bottom: 3px;\n}\n\n.tc-tiddler-info .tc-tab-buttons button.tc-tab-selected {\n\tbackground-color: <<colour tiddler-info-tab-background>>;\n\tborder-bottom: 1px solid <<colour tiddler-info-tab-background>>;\n}\n\n.tc-view-field-table {\n\twidth: 100%;\n}\n\n.tc-view-field-name {\n\twidth: 1%; /* Makes this column be as narrow as possible */\n\ttext-align: right;\n\tfont-style: italic;\n\tfont-weight: 200;\n}\n\n.tc-view-field-value {\n}\n\n@media (max-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\t.tc-tiddler-frame {\n\t\tpadding: 14px 14px 14px 14px;\n\t}\n\n\t.tc-tiddler-info {\n\t\tmargin: 0 -14px 0 -14px;\n\t}\n}\n\n@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\t.tc-tiddler-frame {\n\t\tpadding: 28px 42px 42px 42px;\n\t\twidth: {{$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth}};\n\t\tborder-radius: 2px;\n\t}\n\n<<if-no-sidebar \"\n\n\t.tc-tiddler-frame {\n\t\twidth: 100%;\n\t}\n\n\">>\n\n\t.tc-tiddler-info {\n\t\tmargin: 0 -42px 0 -42px;\n\t}\n}\n\n.tc-site-title,\n.tc-titlebar {\n\tfont-weight: 300;\n\tfont-size: 2.35em;\n\tline-height: 1.2em;\n\tcolor: <<colour tiddler-title-foreground>>;\n\tmargin: 0;\n}\n\n.tc-site-title {\n\tcolor: <<colour site-title-foreground>>;\n}\n\n.tc-tiddler-title-icon {\n\tvertical-align: middle;\n\tmargin-right: .1em;\n}\n\n.tc-system-title-prefix {\n\tcolor: <<colour muted-foreground>>;\n}\n\n.tc-titlebar h2 {\n\tfont-size: 1em;\n\tdisplay: inline;\n}\n\n.tc-titlebar img {\n\theight: 1em;\n}\n\n.tc-subtitle {\n\tfont-size: 0.9em;\n\tcolor: <<colour tiddler-subtitle-foreground>>;\n\tfont-weight: 300;\n}\n\n.tc-subtitle .tc-tiddlylink {\n\tmargin-right: .3em;\n}\n\n.tc-tiddler-missing .tc-title {\n font-style: italic;\n font-weight: normal;\n}\n\n.tc-tiddler-frame .tc-tiddler-controls {\n\tfloat: right;\n}\n\n.tc-tiddler-controls .tc-drop-down {\n\tfont-size: 0.6em;\n}\n\n.tc-tiddler-controls .tc-drop-down .tc-drop-down {\n\tfont-size: 1em;\n}\n\n.tc-tiddler-controls > span > button,\n.tc-tiddler-controls > span > span > button,\n.tc-tiddler-controls > span > span > span > button {\n\tvertical-align: baseline;\n\tmargin-left:5px;\n}\n\n.tc-tiddler-controls button svg, .tc-tiddler-controls button img,\n.tc-search button svg, .tc-search a svg {\n\tfill: <<colour tiddler-controls-foreground>>;\n}\n\n.tc-tiddler-controls button svg, .tc-tiddler-controls button img {\n\theight: 0.75em;\n}\n\n.tc-search button svg, .tc-search a svg {\n height: 1.2em;\n width: 1.2em;\n margin: 0 0.25em;\n}\n\n.tc-tiddler-controls button.tc-selected svg,\n.tc-page-controls button.tc-selected svg {\n\tfill: <<colour tiddler-controls-foreground-selected>>;\n}\n\n.tc-tiddler-controls button.tc-btn-invisible:hover svg,\n.tc-search button:hover svg, .tc-search a:hover svg {\n\tfill: <<colour tiddler-controls-foreground-hover>>;\n}\n\n@media print {\n\t.tc-tiddler-controls {\n\t\tdisplay: none;\n\t}\n}\n\n.tc-tiddler-help { /* Help prompts within tiddler template */\n\tcolor: <<colour muted-foreground>>;\n\tmargin-top: 14px;\n}\n\n.tc-tiddler-help a.tc-tiddlylink {\n\tcolor: <<colour very-muted-foreground>>;\n}\n\n.tc-tiddler-frame .tc-edit-texteditor {\n\twidth: 100%;\n\tmargin: 4px 0 4px 0;\n}\n\n.tc-tiddler-frame input.tc-edit-texteditor,\n.tc-tiddler-frame textarea.tc-edit-texteditor,\n.tc-tiddler-frame iframe.tc-edit-texteditor {\n\tpadding: 3px 3px 3px 3px;\n\tborder: 1px solid <<colour tiddler-editor-border>>;\n\tbackground-color: <<colour tiddler-editor-background>>;\n\tline-height: 1.3em;\n\t-webkit-appearance: none;\n\tfont-family: {{$:/themes/tiddlywiki/vanilla/settings/editorfontfamily}};\n}\n\n.tc-tiddler-frame .tc-binary-warning {\n\twidth: 100%;\n\theight: 5em;\n\ttext-align: center;\n\tpadding: 3em 3em 6em 3em;\n\tbackground: <<colour alert-background>>;\n\tborder: 1px solid <<colour alert-border>>;\n}\n\ncanvas.tc-edit-bitmapeditor {\n\tborder: 6px solid <<colour tiddler-editor-border-image>>;\n\tcursor: crosshair;\n\t-moz-user-select: none;\n\t-webkit-user-select: none;\n\t-ms-user-select: none;\n\tmargin-top: 6px;\n\tmargin-bottom: 6px;\n}\n\n.tc-edit-bitmapeditor-width {\n\tdisplay: block;\n}\n\n.tc-edit-bitmapeditor-height {\n\tdisplay: block;\n}\n\n.tc-tiddler-body {\n\tclear: both;\n}\n\n.tc-tiddler-frame .tc-tiddler-body {\n\tfont-size: {{$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize}};\n\tline-height: {{$:/themes/tiddlywiki/vanilla/metrics/bodylineheight}};\n}\n\n.tc-titlebar, .tc-tiddler-edit-title {\n\toverflow: hidden; /* https://github.com/Jermolene/TiddlyWiki5/issues/282 */\n}\n\nhtml body.tc-body.tc-single-tiddler-window {\n\tmargin: 1em;\n\tbackground: <<colour tiddler-background>>;\n}\n\n.tc-single-tiddler-window img,\n.tc-single-tiddler-window svg,\n.tc-single-tiddler-window canvas,\n.tc-single-tiddler-window embed,\n.tc-single-tiddler-window iframe {\n\tmax-width: 100%;\n}\n\n/*\n** Editor\n*/\n\n.tc-editor-toolbar {\n\tmargin-top: 8px;\n}\n\n.tc-editor-toolbar button {\n\tvertical-align: middle;\n\tbackground-color: <<colour tiddler-controls-foreground>>;\n\tcolor: <<colour tiddler-controls-foreground-selected>>;\n\tfill: <<colour tiddler-controls-foreground-selected>>;\n\tborder-radius: 4px;\n\tpadding: 3px;\n\tmargin: 2px 0 2px 4px;\n}\n\n.tc-editor-toolbar button.tc-text-editor-toolbar-item-adjunct {\n\tmargin-left: 1px;\n\twidth: 1em;\n\tborder-radius: 8px;\n}\n\n.tc-editor-toolbar button.tc-text-editor-toolbar-item-start-group {\n\tmargin-left: 11px;\n}\n\n.tc-editor-toolbar button.tc-selected {\n\tbackground-color: <<colour primary>>;\n}\n\n.tc-editor-toolbar button svg {\n\twidth: 1.6em;\n\theight: 1.2em;\n}\n\n.tc-editor-toolbar button:hover {\n\tbackground-color: <<colour tiddler-controls-foreground-selected>>;\n\tfill: <<colour background>>;\n\tcolor: <<colour background>>;\n}\n\n.tc-editor-toolbar .tc-text-editor-toolbar-more {\n\twhite-space: normal;\n}\n\n.tc-editor-toolbar .tc-text-editor-toolbar-more button {\n\tdisplay: inline-block;\n\tpadding: 3px;\n\twidth: auto;\n}\n\n.tc-editor-toolbar .tc-search-results {\n\tpadding: 0;\n}\n\n/*\n** Adjustments for fluid-fixed mode\n*/\n\n@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n<<if-fluid-fixed text:\"\"\"\n\n\t.tc-story-river {\n\t\tpadding-right: 0;\n\t\tposition: relative;\n\t\twidth: auto;\n\t\tleft: 0;\n\t\tmargin-left: {{$:/themes/tiddlywiki/vanilla/metrics/storyleft}};\n\t\tmargin-right: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth}};\n\t}\n\n\t.tc-tiddler-frame {\n\t\twidth: 100%;\n\t}\n\n\t.tc-sidebar-scrollable {\n\t\tleft: auto;\n\t\tbottom: 0;\n\t\tright: 0;\n\t\twidth: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth}};\n\t}\n\n\tbody.tc-body .tc-storyview-zoomin-tiddler {\n\t\twidth: 100%;\n\t\twidth: calc(100% - 42px);\n\t}\n\n\"\"\" hiddenSidebarText:\"\"\"\n\n\t.tc-story-river {\n\t\tpadding-right: 3em;\n\t\tmargin-right: 0;\n\t}\n\n\tbody.tc-body .tc-storyview-zoomin-tiddler {\n\t\twidth: 100%;\n\t\twidth: calc(100% - 84px);\n\t}\n\n\"\"\">>\n\n}\n\n/*\n** Toolbar buttons\n*/\n\n.tc-page-controls svg.tc-image-new-button {\n fill: <<colour toolbar-new-button>>;\n}\n\n.tc-page-controls svg.tc-image-options-button {\n fill: <<colour toolbar-options-button>>;\n}\n\n.tc-page-controls svg.tc-image-save-button {\n fill: <<colour toolbar-save-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-info-button {\n fill: <<colour toolbar-info-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-edit-button {\n fill: <<colour toolbar-edit-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-close-button {\n fill: <<colour toolbar-close-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-delete-button {\n fill: <<colour toolbar-delete-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-cancel-button {\n fill: <<colour toolbar-cancel-button>>;\n}\n\n.tc-tiddler-controls button svg.tc-image-done-button {\n fill: <<colour toolbar-done-button>>;\n}\n\n/*\n** Tiddler edit mode\n*/\n\n.tc-tiddler-edit-frame em.tc-edit {\n\tcolor: <<colour muted-foreground>>;\n\tfont-style: normal;\n}\n\n.tc-edit-type-dropdown a.tc-tiddlylink-missing {\n\tfont-style: normal;\n}\n\n.tc-type-selector .tc-edit-typeeditor {\n\twidth: 20%;\n}\n\n.tc-edit-tags {\n\tborder: 1px solid <<colour tiddler-editor-border>>;\n\tpadding: 4px 8px 4px 8px;\n}\n\n.tc-edit-add-tag {\n\tdisplay: inline-block;\n}\n\n.tc-edit-add-tag .tc-add-tag-name input {\n\twidth: 50%;\n}\n\n.tc-edit-add-tag .tc-keyboard {\n\tdisplay:inline;\n}\n\n.tc-edit-tags .tc-tag-label {\n\tdisplay: inline-block;\n}\n\n.tc-edit-tags-list {\n\tmargin: 14px 0 14px 0;\n}\n\n.tc-remove-tag-button {\n\tpadding-left: 4px;\n}\n\n.tc-tiddler-preview {\n\toverflow: auto;\n}\n\n.tc-tiddler-preview-preview {\n\tfloat: right;\n\twidth: 49%;\n\tborder: 1px solid <<colour tiddler-editor-border>>;\n\tmargin: 4px 0 3px 3px;\n\tpadding: 3px 3px 3px 3px;\n}\n\n<<if-editor-height-fixed then:\"\"\"\n\n.tc-tiddler-preview-preview {\n\toverflow-y: scroll;\n\theight: {{$:/config/TextEditor/EditorHeight/Height}};\n}\n\n\"\"\">>\n\n.tc-tiddler-frame .tc-tiddler-preview .tc-edit-texteditor {\n\twidth: 49%;\n}\n\n.tc-tiddler-frame .tc-tiddler-preview canvas.tc-edit-bitmapeditor {\n\tmax-width: 49%;\n}\n\n.tc-edit-fields {\n\twidth: 100%;\n}\n\n\n.tc-edit-fields table, .tc-edit-fields tr, .tc-edit-fields td {\n\tborder: none;\n\tpadding: 4px;\n}\n\n.tc-edit-fields > tbody > .tc-edit-field:nth-child(odd) {\n\tbackground-color: <<colour tiddler-editor-fields-odd>>;\n}\n\n.tc-edit-fields > tbody > .tc-edit-field:nth-child(even) {\n\tbackground-color: <<colour tiddler-editor-fields-even>>;\n}\n\n.tc-edit-field-name {\n\ttext-align: right;\n}\n\n.tc-edit-field-value input {\n\twidth: 100%;\n}\n\n.tc-edit-field-remove {\n}\n\n.tc-edit-field-remove svg {\n\theight: 1em;\n\twidth: 1em;\n\tfill: <<colour muted-foreground>>;\n\tvertical-align: middle;\n}\n\n.tc-edit-field-add-name {\n\tdisplay: inline-block;\n\twidth: 15%;\n}\n\n.tc-edit-field-add-value {\n\tdisplay: inline-block;\n\twidth: 40%;\n}\n\n.tc-edit-field-add-button {\n\tdisplay: inline-block;\n\twidth: 10%;\n}\n\n/*\n** Storyview Classes\n*/\n\n.tc-viewswitcher .tc-image-button {\n\tmargin-right: .3em;\n}\n\n.tc-storyview-zoomin-tiddler {\n\tposition: absolute;\n\tdisplay: block;\n\twidth: 100%;\n}\n\n@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n\t.tc-storyview-zoomin-tiddler {\n\t\twidth: calc(100% - 84px);\n\t}\n\n}\n\n/*\n** Dropdowns\n*/\n\n.tc-btn-dropdown {\n\ttext-align: left;\n}\n\n.tc-btn-dropdown svg, .tc-btn-dropdown img {\n\theight: 1em;\n\twidth: 1em;\n\tfill: <<colour muted-foreground>>;\n}\n\n.tc-drop-down-wrapper {\n\tposition: relative;\n}\n\n.tc-drop-down {\n\tmin-width: 380px;\n\tborder: 1px solid <<colour dropdown-border>>;\n\tbackground-color: <<colour dropdown-background>>;\n\tpadding: 7px 0 7px 0;\n\tmargin: 4px 0 0 0;\n\twhite-space: nowrap;\n\ttext-shadow: none;\n\tline-height: 1.4;\n}\n\n.tc-drop-down .tc-drop-down {\n\tmargin-left: 14px;\n}\n\n.tc-drop-down button svg, .tc-drop-down a svg {\n\tfill: <<colour foreground>>;\n}\n\n.tc-drop-down button.tc-btn-invisible:hover svg {\n\tfill: <<colour foreground>>;\n}\n\n.tc-drop-down .tc-drop-down-info {\n\tpadding-left: 14px;\n}\n\n.tc-drop-down p {\n\tpadding: 0 14px 0 14px;\n}\n\n.tc-drop-down svg {\n\twidth: 1em;\n\theight: 1em;\n}\n\n.tc-drop-down img {\n\twidth: 1em;\n}\n\n.tc-drop-down a, .tc-drop-down button {\n\tdisplay: block;\n\tpadding: 0 14px 0 14px;\n\twidth: 100%;\n\ttext-align: left;\n\tcolor: <<colour foreground>>;\n\tline-height: 1.4;\n}\n\n.tc-drop-down .tc-tab-set .tc-tab-buttons button {\n\tdisplay: inline-block;\n width: auto;\n margin-bottom: 0px;\n border-bottom-left-radius: 0;\n border-bottom-right-radius: 0;\n}\n\n.tc-drop-down .tc-prompt {\n\tpadding: 0 14px;\n}\n\n.tc-drop-down .tc-chooser {\n\tborder: none;\n}\n\n.tc-drop-down .tc-chooser .tc-swatches-horiz {\n\tfont-size: 0.4em;\n\tpadding-left: 1.2em;\n}\n\n.tc-drop-down .tc-file-input-wrapper {\n\twidth: 100%;\n}\n\n.tc-drop-down .tc-file-input-wrapper button {\n\tcolor: <<colour foreground>>;\n}\n\n.tc-drop-down a:hover, .tc-drop-down button:hover, .tc-drop-down .tc-file-input-wrapper:hover button {\n\tcolor: <<colour tiddler-link-background>>;\n\tbackground-color: <<colour tiddler-link-foreground>>;\n\ttext-decoration: none;\n}\n\n.tc-drop-down .tc-tab-buttons button {\n\tbackground-color: <<colour dropdown-tab-background>>;\n}\n\n.tc-drop-down .tc-tab-buttons button.tc-tab-selected {\n\tbackground-color: <<colour dropdown-tab-background-selected>>;\n\tborder-bottom: 1px solid <<colour dropdown-tab-background-selected>>;\n}\n\n.tc-drop-down-bullet {\n\tdisplay: inline-block;\n\twidth: 0.5em;\n}\n\n.tc-drop-down .tc-tab-contents a {\n\tpadding: 0 0.5em 0 0.5em;\n}\n\n.tc-block-dropdown-wrapper {\n\tposition: relative;\n}\n\n.tc-block-dropdown {\n\tposition: absolute;\n\tmin-width: 220px;\n\tborder: 1px solid <<colour dropdown-border>>;\n\tbackground-color: <<colour dropdown-background>>;\n\tpadding: 7px 0;\n\tmargin: 4px 0 0 0;\n\twhite-space: nowrap;\n\tz-index: 1000;\n\ttext-shadow: none;\n}\n\n.tc-block-dropdown.tc-search-drop-down {\n\tmargin-left: -12px;\n}\n\n.tc-block-dropdown a {\n\tdisplay: block;\n\tpadding: 4px 14px 4px 14px;\n}\n\n.tc-block-dropdown.tc-search-drop-down a {\n\tdisplay: block;\n\tpadding: 0px 10px 0px 10px;\n}\n\n.tc-drop-down .tc-dropdown-item-plain,\n.tc-block-dropdown .tc-dropdown-item-plain {\n\tpadding: 4px 14px 4px 7px;\n}\n\n.tc-drop-down .tc-dropdown-item,\n.tc-block-dropdown .tc-dropdown-item {\n\tpadding: 4px 14px 4px 7px;\n\tcolor: <<colour muted-foreground>>;\n}\n\n.tc-block-dropdown a:hover {\n\tcolor: <<colour tiddler-link-background>>;\n\tbackground-color: <<colour tiddler-link-foreground>>;\n\ttext-decoration: none;\n}\n\n.tc-search-results {\n\tpadding: 0 7px 0 7px;\n}\n\n.tc-image-chooser, .tc-colour-chooser {\n\twhite-space: normal;\n}\n\n.tc-image-chooser a,\n.tc-colour-chooser a {\n\tdisplay: inline-block;\n\tvertical-align: top;\n\ttext-align: center;\n\tposition: relative;\n}\n\n.tc-image-chooser a {\n\tborder: 1px solid <<colour muted-foreground>>;\n\tpadding: 2px;\n\tmargin: 2px;\n\twidth: 4em;\n\theight: 4em;\n}\n\n.tc-colour-chooser a {\n\tpadding: 3px;\n\twidth: 2em;\n\theight: 2em;\n\tvertical-align: middle;\n}\n\n.tc-image-chooser a:hover,\n.tc-colour-chooser a:hover {\n\tbackground: <<colour primary>>;\n\tpadding: 0px;\n\tborder: 3px solid <<colour primary>>;\n}\n\n.tc-image-chooser a svg,\n.tc-image-chooser a img {\n\tdisplay: inline-block;\n\twidth: auto;\n\theight: auto;\n\tmax-width: 3.5em;\n\tmax-height: 3.5em;\n\tposition: absolute;\n\ttop: 0;\n\tbottom: 0;\n\tleft: 0;\n\tright: 0;\n\tmargin: auto;\n}\n\n/*\n** Modals\n*/\n\n.tc-modal-wrapper {\n\tposition: fixed;\n\toverflow: auto;\n\toverflow-y: scroll;\n\ttop: 0;\n\tright: 0;\n\tbottom: 0;\n\tleft: 0;\n\tz-index: 900;\n}\n\n.tc-modal-backdrop {\n\tposition: fixed;\n\ttop: 0;\n\tright: 0;\n\tbottom: 0;\n\tleft: 0;\n\tz-index: 1000;\n\tbackground-color: <<colour modal-backdrop>>;\n}\n\n.tc-modal {\n\tz-index: 1100;\n\tbackground-color: <<colour modal-background>>;\n\tborder: 1px solid <<colour modal-border>>;\n}\n\n@media (max-width: 55em) {\n\t.tc-modal {\n\t\tposition: fixed;\n\t\ttop: 1em;\n\t\tleft: 1em;\n\t\tright: 1em;\n\t}\n\n\t.tc-modal-body {\n\t\toverflow-y: auto;\n\t\tmax-height: 400px;\n\t\tmax-height: 60vh;\n\t}\n}\n\n@media (min-width: 55em) {\n\t.tc-modal {\n\t\tposition: fixed;\n\t\ttop: 2em;\n\t\tleft: 25%;\n\t\twidth: 50%;\n\t}\n\n\t.tc-modal-body {\n\t\toverflow-y: auto;\n\t\tmax-height: 400px;\n\t\tmax-height: 60vh;\n\t}\n}\n\n.tc-modal-header {\n\tpadding: 9px 15px;\n\tborder-bottom: 1px solid <<colour modal-header-border>>;\n}\n\n.tc-modal-header h3 {\n\tmargin: 0;\n\tline-height: 30px;\n}\n\n.tc-modal-header img, .tc-modal-header svg {\n\twidth: 1em;\n\theight: 1em;\n}\n\n.tc-modal-body {\n\tpadding: 15px;\n}\n\n.tc-modal-footer {\n\tpadding: 14px 15px 15px;\n\tmargin-bottom: 0;\n\ttext-align: right;\n\tbackground-color: <<colour modal-footer-background>>;\n\tborder-top: 1px solid <<colour modal-footer-border>>;\n}\n\n/*\n** Notifications\n*/\n\n.tc-notification {\n\tposition: fixed;\n\ttop: 14px;\n\tright: 42px;\n\tz-index: 1300;\n\tmax-width: 280px;\n\tpadding: 0 14px 0 14px;\n\tbackground-color: <<colour notification-background>>;\n\tborder: 1px solid <<colour notification-border>>;\n}\n\n/*\n** Tabs\n*/\n\n.tc-tab-set.tc-vertical {\n\tdisplay: -webkit-flex;\n\tdisplay: flex;\n}\n\n.tc-tab-buttons {\n\tfont-size: 0.85em;\n\tpadding-top: 1em;\n\tmargin-bottom: -2px;\n}\n\n.tc-tab-buttons.tc-vertical {\n\tz-index: 100;\n\tdisplay: block;\n\tpadding-top: 14px;\n\tvertical-align: top;\n\ttext-align: right;\n\tmargin-bottom: inherit;\n\tmargin-right: -1px;\n\tmax-width: 33%;\n\t-webkit-flex: 0 0 auto;\n\tflex: 0 0 auto;\n}\n\n.tc-tab-buttons button.tc-tab-selected {\n\tcolor: <<colour tab-foreground-selected>>;\n\tbackground-color: <<colour tab-background-selected>>;\n\tborder-left: 1px solid <<colour tab-border-selected>>;\n\tborder-top: 1px solid <<colour tab-border-selected>>;\n\tborder-right: 1px solid <<colour tab-border-selected>>;\n}\n\n.tc-tab-buttons button {\n\tcolor: <<colour tab-foreground>>;\n\tpadding: 3px 5px 3px 5px;\n\tmargin-right: 0.3em;\n\tfont-weight: 300;\n\tborder: none;\n\tbackground: inherit;\n\tbackground-color: <<colour tab-background>>;\n\tborder-left: 1px solid <<colour tab-border>>;\n\tborder-top: 1px solid <<colour tab-border>>;\n\tborder-right: 1px solid <<colour tab-border>>;\n\tborder-top-left-radius: 2px;\n\tborder-top-right-radius: 2px;\n\tborder-bottom-left-radius: 0;\n\tborder-bottom-right-radius: 0;\n}\n\n.tc-tab-buttons.tc-vertical button {\n\tdisplay: block;\n\twidth: 100%;\n\tmargin-top: 3px;\n\tmargin-right: 0;\n\ttext-align: right;\n\tbackground-color: <<colour tab-background>>;\n\tborder-left: 1px solid <<colour tab-border>>;\n\tborder-bottom: 1px solid <<colour tab-border>>;\n\tborder-right: none;\n\tborder-top-left-radius: 2px;\n\tborder-bottom-left-radius: 2px;\n\tborder-top-right-radius: 0;\n\tborder-bottom-right-radius: 0;\n}\n\n.tc-tab-buttons.tc-vertical button.tc-tab-selected {\n\tbackground-color: <<colour tab-background-selected>>;\n\tborder-right: 1px solid <<colour tab-background-selected>>;\n}\n\n.tc-tab-divider {\n\tborder-top: 1px solid <<colour tab-divider>>;\n}\n\n.tc-tab-divider.tc-vertical {\n\tdisplay: none;\n}\n\n.tc-tab-content {\n\tmargin-top: 14px;\n}\n\n.tc-tab-content.tc-vertical {\n\tdisplay: inline-block;\n\tvertical-align: top;\n\tpadding-top: 0;\n\tpadding-left: 14px;\n\tborder-left: 1px solid <<colour tab-border>>;\n\t-webkit-flex: 1 0 70%;\n\tflex: 1 0 70%;\n\toverflow: auto;\n}\n\n.tc-sidebar-lists .tc-tab-buttons {\n\tmargin-bottom: -1px;\n}\n\n.tc-sidebar-lists .tc-tab-buttons button.tc-tab-selected {\n\tbackground-color: <<colour sidebar-tab-background-selected>>;\n\tcolor: <<colour sidebar-tab-foreground-selected>>;\n\tborder-left: 1px solid <<colour sidebar-tab-border-selected>>;\n\tborder-top: 1px solid <<colour sidebar-tab-border-selected>>;\n\tborder-right: 1px solid <<colour sidebar-tab-border-selected>>;\n}\n\n.tc-sidebar-lists .tc-tab-buttons button {\n\tbackground-color: <<colour sidebar-tab-background>>;\n\tcolor: <<colour sidebar-tab-foreground>>;\n\tborder-left: 1px solid <<colour sidebar-tab-border>>;\n\tborder-top: 1px solid <<colour sidebar-tab-border>>;\n\tborder-right: 1px solid <<colour sidebar-tab-border>>;\n}\n\n.tc-sidebar-lists .tc-tab-divider {\n\tborder-top: 1px solid <<colour sidebar-tab-divider>>;\n}\n\n.tc-more-sidebar > .tc-tab-set > .tc-tab-buttons > button {\n\tdisplay: block;\n\twidth: 100%;\n\tbackground-color: <<colour sidebar-tab-background>>;\n\tborder-top: none;\n\tborder-left: none;\n\tborder-bottom: none;\n\tborder-right: 1px solid #ccc;\n\tmargin-bottom: inherit;\n}\n\n.tc-more-sidebar > .tc-tab-set > .tc-tab-buttons > button.tc-tab-selected {\n\tbackground-color: <<colour sidebar-tab-background-selected>>;\n\tborder: none;\n}\n\n/*\n** Manager\n*/\n\n.tc-manager-wrapper {\n\t\n}\n\n.tc-manager-controls {\n\t\n}\n\n.tc-manager-control {\n\tmargin: 0.5em 0;\n}\n\n.tc-manager-list {\n\twidth: 100%;\n\tborder-top: 1px solid <<colour muted-foreground>>;\n\tborder-left: 1px solid <<colour muted-foreground>>;\n\tborder-right: 1px solid <<colour muted-foreground>>;\n}\n\n.tc-manager-list-item {\n\n}\n\n.tc-manager-list-item-heading {\n display: block;\n width: 100%;\n text-align: left;\t\n\tborder-bottom: 1px solid <<colour muted-foreground>>;\n\tpadding: 3px;\n}\n\n.tc-manager-list-item-heading-selected {\n\tfont-weight: bold;\n\tcolor: <<colour background>>;\n\tfill: <<colour background>>;\n\tbackground-color: <<colour foreground>>;\n}\n\n.tc-manager-list-item-heading:hover {\n\tbackground: <<colour primary>>;\n\tcolor: <<colour background>>;\n}\n\n.tc-manager-list-item-content {\n\tdisplay: flex;\n}\n\n.tc-manager-list-item-content-sidebar {\n flex: 1 0;\n background: <<colour tiddler-editor-background>>;\n border-right: 0.5em solid <<colour muted-foreground>>;\n border-bottom: 0.5em solid <<colour muted-foreground>>;\n white-space: nowrap;\n}\n\n.tc-manager-list-item-content-item-heading {\n\tdisplay: block;\n\twidth: 100%;\n\ttext-align: left;\n background: <<colour muted-foreground>>;\n\ttext-transform: uppercase;\n\tfont-size: 0.6em;\n\tfont-weight: bold;\n padding: 0.5em 0 0.5em 0;\n}\n\n.tc-manager-list-item-content-item-body {\n\tpadding: 0 0.5em 0 0.5em;\n}\n\n.tc-manager-list-item-content-item-body > pre {\n\tmargin: 0.5em 0 0.5em 0;\n\tborder: none;\n\tbackground: inherit;\n}\n\n.tc-manager-list-item-content-tiddler {\n flex: 3 1;\n border-left: 0.5em solid <<colour muted-foreground>>;\n border-right: 0.5em solid <<colour muted-foreground>>;\n border-bottom: 0.5em solid <<colour muted-foreground>>;\n}\n\n.tc-manager-list-item-content-item-body > table {\n\tborder: none;\n\tpadding: 0;\n\tmargin: 0;\n}\n\n.tc-manager-list-item-content-item-body > table td {\n\tborder: none;\n}\n\n.tc-manager-icon-editor > button {\n\twidth: 100%;\n}\n\n.tc-manager-icon-editor > button > svg,\n.tc-manager-icon-editor > button > button {\n\twidth: 100%;\n\theight: auto;\n}\n\n/*\n** Alerts\n*/\n\n.tc-alerts {\n\tposition: fixed;\n\ttop: 28px;\n\tleft: 0;\n\tright: 0;\n\tmax-width: 50%;\n\tz-index: 20000;\n}\n\n.tc-alert {\n\tposition: relative;\n\tmargin: 14px;\n\tpadding: 7px;\n\tborder: 1px solid <<colour alert-border>>;\n\tbackground-color: <<colour alert-background>>;\n}\n\n.tc-alert-toolbar {\n\tposition: absolute;\n\ttop: 7px;\n\tright: 7px;\n line-height: 0;\n}\n\n.tc-alert-toolbar svg {\n\tfill: <<colour alert-muted-foreground>>;\n}\n\n.tc-alert-subtitle {\n\tcolor: <<colour alert-muted-foreground>>;\n\tfont-weight: bold;\n font-size: 0.8em;\n margin-bottom: 0.5em;\n}\n\n.tc-alert-body > p {\n\tmargin: 0;\n}\n\n.tc-alert-highlight {\n\tcolor: <<colour alert-highlight>>;\n}\n\n@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {\n\n\t.tc-static-alert {\n\t\tposition: relative;\n\t}\n\n\t.tc-static-alert-inner {\n\t\tposition: absolute;\n\t\tz-index: 100;\n\t}\n\n}\n\n.tc-static-alert-inner {\n\tpadding: 0 2px 2px 42px;\n\tcolor: <<colour static-alert-foreground>>;\n}\n\n/*\n** Floating drafts list\n*/\n\n.tc-drafts-list {\n\tz-index: 2000;\n\tposition: fixed;\n\tfont-size: 0.8em;\n\tleft: 0;\n\tbottom: 0;\n}\n\n.tc-drafts-list a {\n\tmargin: 0 0.5em;\n\tpadding: 4px 4px;\n\tborder-top-left-radius: 4px;\n\tborder-top-right-radius: 4px;\n\tborder: 1px solid <<colour background>>;\n\tborder-bottom-none;\n\tbackground: <<colour dirty-indicator>>;\n\tcolor: <<colour background>>;\n\tfill: <<colour background>>;\n}\n\n.tc-drafts-list a:hover {\n\ttext-decoration: none;\n\tbackground: <<colour foreground>>;\n\tcolor: <<colour background>>;\n\tfill: <<colour background>>;\n}\n\n.tc-drafts-list a svg {\n\twidth: 1em;\n\theight: 1em;\n\tvertical-align: text-bottom;\n}\n\n/*\n** Control panel\n*/\n\n.tc-control-panel td {\n\tpadding: 4px;\n}\n\n.tc-control-panel table, .tc-control-panel table input, .tc-control-panel table textarea {\n\twidth: 100%;\n}\n\n.tc-plugin-info {\n\tdisplay: flex;\n\tborder: 1px solid <<colour muted-foreground>>;\n\tfill: <<colour muted-foreground>>;\n\tbackground-color: <<colour background>>;\n\tmargin: 0.5em 0 0.5em 0;\n\tpadding: 4px;\n align-items: center;\n}\n\n.tc-plugin-info-sub-plugins .tc-plugin-info {\n margin: 0.5em;\n\tbackground: <<colour background>>;\n}\n\n.tc-plugin-info-sub-plugin-indicator {\n\tmargin: -16px 1em 0 2em;\n}\n\n.tc-plugin-info-sub-plugin-indicator button {\n\tcolor: <<colour background>>;\n\tbackground: <<colour foreground>>;\n\tborder-radius: 8px;\n padding: 2px 7px;\n font-size: 0.75em;\n}\n\n.tc-plugin-info-sub-plugins .tc-plugin-info-dropdown {\n\tmargin-left: 1em;\n\tmargin-right: 1em;\n}\n\n.tc-plugin-info-disabled {\n\tbackground: -webkit-repeating-linear-gradient(45deg, #ff0, #ff0 10px, #eee 10px, #eee 20px);\n\tbackground: repeating-linear-gradient(45deg, #ff0, #ff0 10px, #eee 10px, #eee 20px);\n}\n\n.tc-plugin-info-disabled:hover {\n\tbackground: -webkit-repeating-linear-gradient(45deg, #aa0, #aa0 10px, #888 10px, #888 20px);\n\tbackground: repeating-linear-gradient(45deg, #aa0, #aa0 10px, #888 10px, #888 20px);\n}\n\na.tc-tiddlylink.tc-plugin-info:hover {\n\ttext-decoration: none;\n\tbackground-color: <<colour primary>>;\n\tcolor: <<colour background>>;\n\tfill: <<colour foreground>>;\n}\n\na.tc-tiddlylink.tc-plugin-info:hover .tc-plugin-info > .tc-plugin-info-chunk > svg {\n\tfill: <<colour foreground>>;\n}\n\n.tc-plugin-info-chunk {\n margin: 2px;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-toggle {\n\tflex-grow: 0;\n\tflex-shrink: 0;\n\tline-height: 1;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-icon {\n\tflex-grow: 0;\n\tflex-shrink: 0;\n\tline-height: 1;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-description {\n\tflex-grow: 1;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-buttons {\n\tfont-size: 0.8em;\n\tline-height: 1.2;\n\tflex-grow: 0;\n\tflex-shrink: 0;\n text-align: right;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-description h1 {\n\tfont-size: 1em;\n\tline-height: 1.2;\n\tmargin: 2px 0 2px 0;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-description h2 {\n\tfont-size: 0.8em;\n\tline-height: 1.2;\n\tmargin: 2px 0 2px 0;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-description div {\n\tfont-size: 0.7em;\n\tline-height: 1.2;\n\tmargin: 2px 0 2px 0;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-toggle img, .tc-plugin-info-chunk.tc-plugin-info-toggle svg {\n\twidth: 1em;\n\theight: 1em;\n}\n\n.tc-plugin-info-chunk.tc-plugin-info-icon img, .tc-plugin-info-chunk.tc-plugin-info-icon svg {\n\twidth: 2em;\n\theight: 2em;\n}\n\n.tc-plugin-info-dropdown {\n\tborder: 1px solid <<colour muted-foreground>>;\n\tbackground: <<colour background>>;\n\tmargin-top: -8px;\n}\n\n.tc-plugin-info-dropdown-message {\n\tbackground: <<colour message-background>>;\n\tpadding: 0.5em 1em 0.5em 1em;\n\tfont-weight: bold;\n\tfont-size: 0.8em;\n}\n\n.tc-plugin-info-dropdown-body {\n\tpadding: 1em 1em 0 1em;\n\tbackground: <<colour background>>;\n}\n\n.tc-plugin-info-sub-plugins {\n\tpadding: 0.5em;\n margin: 0 1em 1em 1em;\n\tbackground: <<colour notification-background>>;\n}\n\n.tc-install-plugin {\n\tfont-weight: bold;\n\tbackground: green;\n\tcolor: white;\n\tfill: white;\n\tborder-radius: 4px;\n\tpadding: 3px;\n}\n\n.tc-install-plugin.tc-reinstall-downgrade {\n\tbackground: red;\n}\n\n.tc-install-plugin.tc-reinstall {\n\tbackground: blue;\n}\n\n.tc-install-plugin.tc-reinstall-upgrade {\n\tbackground: orange;\n}\n\n.tc-check-list {\n\tline-height: 2em;\n}\n\n.tc-check-list .tc-image-button {\n\theight: 1.5em;\n}\n\n/*\n** Message boxes\n*/\n\n.tc-message-box {\n\tborder: 1px solid <<colour message-border>>;\n\tbackground: <<colour message-background>>;\n\tpadding: 0px 21px 0px 21px;\n\tfont-size: 12px;\n\tline-height: 18px;\n\tcolor: <<colour message-foreground>>;\n}\n\n.tc-message-box svg {\n\twidth: 1em;\n\theight: 1em;\n vertical-align: text-bottom;\n}\n\n/*\n** Pictures\n*/\n\n.tc-bordered-image {\n\tborder: 1px solid <<colour muted-foreground>>;\n\tpadding: 5px;\n\tmargin: 5px;\n}\n\n/*\n** Floats\n*/\n\n.tc-float-right {\n\tfloat: right;\n}\n\n/*\n** Chooser\n*/\n\n.tc-chooser {\n\tborder-right: 1px solid <<colour table-header-background>>;\n\tborder-left: 1px solid <<colour table-header-background>>;\n}\n\n\n.tc-chooser-item {\n\tborder-bottom: 1px solid <<colour table-header-background>>;\n\tborder-top: 1px solid <<colour table-header-background>>;\n\tpadding: 2px 4px 2px 14px;\n}\n\n.tc-drop-down .tc-chooser-item {\n\tpadding: 2px;\n}\n\n.tc-chosen,\n.tc-chooser-item:hover {\n\tbackground-color: <<colour table-header-background>>;\n\tborder-color: <<colour table-footer-background>>;\n}\n\n.tc-chosen .tc-tiddlylink {\n\tcursor:default;\n}\n\n.tc-chooser-item .tc-tiddlylink {\n\tdisplay: block;\n\ttext-decoration: none;\n\tbackground-color: transparent;\n}\n\n.tc-chooser-item:hover .tc-tiddlylink:hover {\n\ttext-decoration: none;\n}\n\n.tc-drop-down .tc-chosen .tc-tiddlylink,\n.tc-drop-down .tc-chooser-item .tc-tiddlylink:hover {\n\tcolor: <<colour foreground>>;\n}\n\n.tc-chosen > .tc-tiddlylink:before {\n\tmargin-left: -10px;\n\tposition: relative;\n\tcontent: \"» \";\n}\n\n.tc-chooser-item svg,\n.tc-chooser-item img{\n\twidth: 1em;\n\theight: 1em;\n\tvertical-align: middle;\n}\n\n.tc-language-chooser .tc-image-button img {\n\twidth: 2em;\n\tvertical-align: -0.15em;\n}\n\n/*\n** Palette swatches\n*/\n\n.tc-swatches-horiz {\n}\n\n.tc-swatches-horiz .tc-swatch {\n\tdisplay: inline-block;\n}\n\n.tc-swatch {\n\twidth: 2em;\n\theight: 2em;\n\tmargin: 0.4em;\n\tborder: 1px solid #888;\n}\n\ninput.tc-palette-manager-colour-input {\n\twidth: 100%;\n\tpadding: 0;\n}\n\n/*\n** Table of contents\n*/\n\n.tc-sidebar-lists .tc-table-of-contents {\n\twhite-space: nowrap;\n}\n\n.tc-table-of-contents button {\n\tcolor: <<colour sidebar-foreground>>;\n}\n\n.tc-table-of-contents svg {\n\twidth: 0.7em;\n\theight: 0.7em;\n\tvertical-align: middle;\n\tfill: <<colour sidebar-foreground>>;\n}\n\n.tc-table-of-contents ol {\n\tlist-style-type: none;\n\tpadding-left: 0;\n}\n\n.tc-table-of-contents ol ol {\n\tpadding-left: 1em;\n}\n\n.tc-table-of-contents li {\n\tfont-size: 1.0em;\n\tfont-weight: bold;\n}\n\n.tc-table-of-contents li a {\n\tfont-weight: bold;\n}\n\n.tc-table-of-contents li li {\n\tfont-size: 0.95em;\n\tfont-weight: normal;\n\tline-height: 1.4;\n}\n\n.tc-table-of-contents li li a {\n\tfont-weight: normal;\n}\n\n.tc-table-of-contents li li li {\n\tfont-size: 0.95em;\n\tfont-weight: 200;\n\tline-height: 1.5;\n}\n\n.tc-table-of-contents li li li li {\n\tfont-size: 0.95em;\n\tfont-weight: 200;\n}\n\n.tc-tabbed-table-of-contents {\n\tdisplay: -webkit-flex;\n\tdisplay: flex;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents {\n\tz-index: 100;\n\tdisplay: inline-block;\n\tpadding-left: 1em;\n\tmax-width: 50%;\n\t-webkit-flex: 0 0 auto;\n\tflex: 0 0 auto;\n\tbackground: <<colour tab-background>>;\n\tborder-left: 1px solid <<colour tab-border>>;\n\tborder-top: 1px solid <<colour tab-border>>;\n\tborder-bottom: 1px solid <<colour tab-border>>;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item > a,\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item-selected > a {\n\tdisplay: block;\n\tpadding: 0.12em 1em 0.12em 0.25em;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item > a {\n\tborder-top: 1px solid <<colour tab-background>>;\n\tborder-left: 1px solid <<colour tab-background>>;\n\tborder-bottom: 1px solid <<colour tab-background>>;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item > a:hover {\n\ttext-decoration: none;\n\tborder-top: 1px solid <<colour tab-border>>;\n\tborder-left: 1px solid <<colour tab-border>>;\n\tborder-bottom: 1px solid <<colour tab-border>>;\n\tbackground: <<colour tab-border>>;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item-selected > a {\n\tborder-top: 1px solid <<colour tab-border>>;\n\tborder-left: 1px solid <<colour tab-border>>;\n\tborder-bottom: 1px solid <<colour tab-border>>;\n\tbackground: <<colour background>>;\n\tmargin-right: -1px;\n}\n\n.tc-tabbed-table-of-contents .tc-table-of-contents .toc-item-selected > a:hover {\n\ttext-decoration: none;\n}\n\n.tc-tabbed-table-of-contents .tc-tabbed-table-of-contents-content {\n\tdisplay: inline-block;\n\tvertical-align: top;\n\tpadding-left: 1.5em;\n\tpadding-right: 1.5em;\n\tborder: 1px solid <<colour tab-border>>;\n\t-webkit-flex: 1 0 50%;\n\tflex: 1 0 50%;\n}\n\n/*\n** Dirty indicator\n*/\n\nbody.tc-dirty span.tc-dirty-indicator, body.tc-dirty span.tc-dirty-indicator svg {\n\tfill: <<colour dirty-indicator>>;\n\tcolor: <<colour dirty-indicator>>;\n}\n\n/*\n** File inputs\n*/\n\n.tc-file-input-wrapper {\n\tposition: relative;\n\toverflow: hidden;\n\tdisplay: inline-block;\n\tvertical-align: middle;\n}\n\n.tc-file-input-wrapper input[type=file] {\n\tposition: absolute;\n\ttop: 0;\n\tleft: 0;\n\tright: 0;\n\tbottom: 0;\n\tfont-size: 999px;\n\tmax-width: 100%;\n\tmax-height: 100%;\n\tfilter: alpha(opacity=0);\n\topacity: 0;\n\toutline: none;\n\tbackground: white;\n\tcursor: pointer;\n\tdisplay: inline-block;\n}\n\n/*\n** Thumbnail macros\n*/\n\n.tc-thumbnail-wrapper {\n\tposition: relative;\n\tdisplay: inline-block;\n\tmargin: 6px;\n\tvertical-align: top;\n}\n\n.tc-thumbnail-right-wrapper {\n\tfloat:right;\n\tmargin: 0.5em 0 0.5em 0.5em;\n}\n\n.tc-thumbnail-image {\n\ttext-align: center;\n\toverflow: hidden;\n\tborder-radius: 3px;\n}\n\n.tc-thumbnail-image svg,\n.tc-thumbnail-image img {\n\tfilter: alpha(opacity=1);\n\topacity: 1;\n\tmin-width: 100%;\n\tmin-height: 100%;\n\tmax-width: 100%;\n}\n\n.tc-thumbnail-wrapper:hover .tc-thumbnail-image svg,\n.tc-thumbnail-wrapper:hover .tc-thumbnail-image img {\n\tfilter: alpha(opacity=0.8);\n\topacity: 0.8;\n}\n\n.tc-thumbnail-background {\n\tposition: absolute;\n\tborder-radius: 3px;\n}\n\n.tc-thumbnail-icon svg,\n.tc-thumbnail-icon img {\n\twidth: 3em;\n\theight: 3em;\n\t<<filter \"drop-shadow(2px 2px 4px rgba(0,0,0,0.3))\">>\n}\n\n.tc-thumbnail-wrapper:hover .tc-thumbnail-icon svg,\n.tc-thumbnail-wrapper:hover .tc-thumbnail-icon img {\n\tfill: #fff;\n\t<<filter \"drop-shadow(3px 3px 4px rgba(0,0,0,0.6))\">>\n}\n\n.tc-thumbnail-icon {\n\tposition: absolute;\n\ttop: 0;\n\tleft: 0;\n\tright: 0;\n\tbottom: 0;\n\tdisplay: -webkit-flex;\n\t-webkit-align-items: center;\n\t-webkit-justify-content: center;\n\tdisplay: flex;\n\talign-items: center;\n\tjustify-content: center;\n}\n\n.tc-thumbnail-caption {\n\tposition: absolute;\n\tbackground-color: #777;\n\tcolor: #fff;\n\ttext-align: center;\n\tbottom: 0;\n\twidth: 100%;\n\tfilter: alpha(opacity=0.9);\n\topacity: 0.9;\n\tline-height: 1.4;\n\tborder-bottom-left-radius: 3px;\n\tborder-bottom-right-radius: 3px;\n}\n\n.tc-thumbnail-wrapper:hover .tc-thumbnail-caption {\n\tfilter: alpha(opacity=1);\n\topacity: 1;\n}\n\n/*\n** Diffs\n*/\n\n.tc-diff-equal {\n\tbackground-color: <<colour diff-equal-background>>;\n\tcolor: <<colour diff-equal-foreground>>;\n}\n\n.tc-diff-insert {\n\tbackground-color: <<colour diff-insert-background>>;\n\tcolor: <<colour diff-insert-foreground>>;\n}\n\n.tc-diff-delete {\n\tbackground-color: <<colour diff-delete-background>>;\n\tcolor: <<colour diff-delete-foreground>>;\n}\n\n.tc-diff-invisible {\n\tbackground-color: <<colour diff-invisible-background>>;\n\tcolor: <<colour diff-invisible-foreground>>;\n}\n\n.tc-diff-tiddlers th {\n\ttext-align: right;\n\tbackground: <<colour background>>;\n\tfont-weight: normal;\n\tfont-style: italic;\n}\n\n.tc-diff-tiddlers pre {\n margin: 0;\n padding: 0;\n border: none;\n background: none;\n}\n\n/*\n** Errors\n*/\n\n.tc-error {\n\tbackground: #f00;\n\tcolor: #fff;\n}\n\n/*\n** Tree macro\n*/\n\n.tc-tree div {\n \tpadding-left: 14px;\n}\n\n.tc-tree ol {\n \tlist-style-type: none;\n \tpadding-left: 0;\n \tmargin-top: 0;\n}\n\n.tc-tree ol ol {\n \tpadding-left: 1em; \n}\n\n.tc-tree button { \n \tcolor: #acacac;\n}\n\n.tc-tree svg {\n \tfill: #acacac;\n}\n\n.tc-tree span svg {\n \twidth: 1em;\n \theight: 1em;\n \tvertical-align: baseline;\n}\n\n.tc-tree li span {\n \tcolor: lightgray;\n}\n\nselect {\n color: <<colour select-tag-foreground>>;\n background: <<colour select-tag-background>>;\n}\n\n/*\n** Utility classes for SVG icons\n*/\n\n.tc-fill-background {\n\tfill: <<colour background>>;\n}"
},
"$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/bodyfontsize",
"text": "15px"
},
"$:/themes/tiddlywiki/vanilla/metrics/bodylineheight": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/bodylineheight",
"text": "22px"
},
"$:/themes/tiddlywiki/vanilla/metrics/fontsize": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/fontsize",
"text": "14px"
},
"$:/themes/tiddlywiki/vanilla/metrics/lineheight": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/lineheight",
"text": "20px"
},
"$:/themes/tiddlywiki/vanilla/metrics/storyleft": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/storyleft",
"text": "0px"
},
"$:/themes/tiddlywiki/vanilla/metrics/storytop": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/storytop",
"text": "0px"
},
"$:/themes/tiddlywiki/vanilla/metrics/storyright": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/storyright",
"text": "770px"
},
"$:/themes/tiddlywiki/vanilla/metrics/storywidth": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/storywidth",
"text": "770px"
},
"$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth",
"text": "686px"
},
"$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint",
"text": "960px"
},
"$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth": {
"title": "$:/themes/tiddlywiki/vanilla/metrics/sidebarwidth",
"text": "350px"
},
"$:/themes/tiddlywiki/vanilla/options/stickytitles": {
"title": "$:/themes/tiddlywiki/vanilla/options/stickytitles",
"text": "no"
},
"$:/themes/tiddlywiki/vanilla/options/sidebarlayout": {
"title": "$:/themes/tiddlywiki/vanilla/options/sidebarlayout",
"text": "fixed-fluid"
},
"$:/themes/tiddlywiki/vanilla/options/codewrapping": {
"title": "$:/themes/tiddlywiki/vanilla/options/codewrapping",
"text": "pre-wrap"
},
"$:/themes/tiddlywiki/vanilla/reset": {
"title": "$:/themes/tiddlywiki/vanilla/reset",
"type": "text/plain",
"text": "/*! normalize.css v8.0.1 | MIT License | github.com/necolas/normalize.css */\n\n/* Document\n ========================================================================== */\n\n/**\n * 1. Correct the line height in all browsers.\n * 2. Prevent adjustments of font size after orientation changes in iOS.\n */\n\nhtml {\n line-height: 1.15; /* 1 */\n -webkit-text-size-adjust: 100%; /* 2 */\n}\n\n/* Sections\n ========================================================================== */\n\n/**\n * Remove the margin in all browsers.\n */\n\nbody {\n margin: 0;\n}\n\n/**\n * Render the `main` element consistently in IE.\n */\n\nmain {\n display: block;\n}\n\n/**\n * Correct the font size and margin on `h1` elements within `section` and\n * `article` contexts in Chrome, Firefox, and Safari.\n */\n\nh1 {\n font-size: 2em;\n margin: 0.67em 0;\n}\n\n/* Grouping content\n ========================================================================== */\n\n/**\n * 1. Add the correct box sizing in Firefox.\n * 2. Show the overflow in Edge and IE.\n */\n\nhr {\n box-sizing: content-box; /* 1 */\n height: 0; /* 1 */\n overflow: visible; /* 2 */\n}\n\n/**\n * 1. Correct the inheritance and scaling of font size in all browsers.\n * 2. Correct the odd `em` font sizing in all browsers.\n */\n\npre {\n font-family: monospace, monospace; /* 1 */\n font-size: 1em; /* 2 */\n}\n\n/* Text-level semantics\n ========================================================================== */\n\n/**\n * Remove the gray background on active links in IE 10.\n */\n\na {\n background-color: transparent;\n}\n\n/**\n * 1. Remove the bottom border in Chrome 57-\n * 2. Add the correct text decoration in Chrome, Edge, IE, Opera, and Safari.\n */\n\nabbr[title] {\n border-bottom: none; /* 1 */\n text-decoration: underline; /* 2 */\n text-decoration: underline dotted; /* 2 */\n}\n\n/**\n * Add the correct font weight in Chrome, Edge, and Safari.\n */\n\nb,\nstrong {\n font-weight: bolder;\n}\n\n/**\n * 1. Correct the inheritance and scaling of font size in all browsers.\n * 2. Correct the odd `em` font sizing in all browsers.\n */\n\ncode,\nkbd,\nsamp {\n font-family: monospace, monospace; /* 1 */\n font-size: 1em; /* 2 */\n}\n\n/**\n * Add the correct font size in all browsers.\n */\n\nsmall {\n font-size: 80%;\n}\n\n/**\n * Prevent `sub` and `sup` elements from affecting the line height in\n * all browsers.\n */\n\nsub,\nsup {\n font-size: 75%;\n line-height: 0;\n position: relative;\n vertical-align: baseline;\n}\n\nsub {\n bottom: -0.25em;\n}\n\nsup {\n top: -0.5em;\n}\n\n/* Embedded content\n ========================================================================== */\n\n/**\n * Remove the border on images inside links in IE 10.\n */\n\nimg {\n border-style: none;\n}\n\n/* Forms\n ========================================================================== */\n\n/**\n * 1. Change the font styles in all browsers.\n * 2. Remove the margin in Firefox and Safari.\n */\n\nbutton,\ninput,\noptgroup,\nselect,\ntextarea {\n font-family: inherit; /* 1 */\n font-size: 100%; /* 1 */\n line-height: 1.15; /* 1 */\n margin: 0; /* 2 */\n}\n\n/**\n * Show the overflow in IE.\n * 1. Show the overflow in Edge.\n */\n\nbutton,\ninput { /* 1 */\n overflow: visible;\n}\n\n/**\n * Remove the inheritance of text transform in Edge, Firefox, and IE.\n * 1. Remove the inheritance of text transform in Firefox.\n */\n\nbutton,\nselect { /* 1 */\n text-transform: none;\n}\n\n/**\n * Correct the inability to style clickable types in iOS and Safari.\n */\n\nbutton,\n[type=\"button\"],\n[type=\"reset\"],\n[type=\"submit\"] {\n -webkit-appearance: button;\n}\n\n/**\n * Remove the inner border and padding in Firefox.\n */\n\nbutton::-moz-focus-inner,\n[type=\"button\"]::-moz-focus-inner,\n[type=\"reset\"]::-moz-focus-inner,\n[type=\"submit\"]::-moz-focus-inner {\n border-style: none;\n padding: 0;\n}\n\n/**\n * Restore the focus styles unset by the previous rule.\n */\n\nbutton:-moz-focusring,\n[type=\"button\"]:-moz-focusring,\n[type=\"reset\"]:-moz-focusring,\n[type=\"submit\"]:-moz-focusring {\n outline: 1px dotted ButtonText;\n}\n\n/**\n * Correct the padding in Firefox.\n */\n\nfieldset {\n padding: 0.35em 0.75em 0.625em;\n}\n\n/**\n * 1. Correct the text wrapping in Edge and IE.\n * 2. Correct the color inheritance from `fieldset` elements in IE.\n * 3. Remove the padding so developers are not caught out when they zero out\n * `fieldset` elements in all browsers.\n */\n\nlegend {\n box-sizing: border-box; /* 1 */\n color: inherit; /* 2 */\n display: table; /* 1 */\n max-width: 100%; /* 1 */\n padding: 0; /* 3 */\n white-space: normal; /* 1 */\n}\n\n/**\n * Add the correct vertical alignment in Chrome, Firefox, and Opera.\n */\n\nprogress {\n vertical-align: baseline;\n}\n\n/**\n * Remove the default vertical scrollbar in IE 10+.\n */\n\ntextarea {\n overflow: auto;\n}\n\n/**\n * 1. Add the correct box sizing in IE 10.\n * 2. Remove the padding in IE 10.\n */\n\n[type=\"checkbox\"],\n[type=\"radio\"] {\n box-sizing: border-box; /* 1 */\n padding: 0; /* 2 */\n}\n\n/**\n * Correct the cursor style of increment and decrement buttons in Chrome.\n */\n\n[type=\"number\"]::-webkit-inner-spin-button,\n[type=\"number\"]::-webkit-outer-spin-button {\n height: auto;\n}\n\n/**\n * 1. Correct the odd appearance in Chrome and Safari.\n * 2. Correct the outline style in Safari.\n */\n\n[type=\"search\"] {\n -webkit-appearance: textfield; /* 1 */\n outline-offset: -2px; /* 2 */\n}\n\n/**\n * Remove the inner padding in Chrome and Safari on macOS.\n */\n\n[type=\"search\"]::-webkit-search-decoration {\n -webkit-appearance: none;\n}\n\n/**\n * 1. Correct the inability to style clickable types in iOS and Safari.\n * 2. Change font properties to `inherit` in Safari.\n */\n\n::-webkit-file-upload-button {\n -webkit-appearance: button; /* 1 */\n font: inherit; /* 2 */\n}\n\n/* Interactive\n ========================================================================== */\n\n/*\n * Add the correct display in Edge, IE 10+, and Firefox.\n */\n\ndetails {\n display: block;\n}\n\n/*\n * Add the correct display in all browsers.\n */\n\nsummary {\n display: list-item;\n}\n\n/* Misc\n ========================================================================== */\n\n/**\n * Add the correct display in IE 10+.\n */\n\ntemplate {\n display: none;\n}\n\n/**\n * Add the correct display in IE 10.\n */\n\n[hidden] {\n display: none;\n}\n"
},
"$:/themes/tiddlywiki/vanilla/settings/fontfamily": {
"title": "$:/themes/tiddlywiki/vanilla/settings/fontfamily",
"text": "-apple-system, BlinkMacSystemFont, \"Segoe UI\", Helvetica, Arial, sans-serif, \"Apple Color Emoji\", \"Segoe UI Emoji\", \"Segoe UI Symbol\""
},
"$:/themes/tiddlywiki/vanilla/settings/codefontfamily": {
"title": "$:/themes/tiddlywiki/vanilla/settings/codefontfamily",
"text": "\"SFMono-Regular\",Consolas,\"Liberation Mono\",Menlo,Courier,monospace"
},
"$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment": {
"title": "$:/themes/tiddlywiki/vanilla/settings/backgroundimageattachment",
"text": "fixed"
},
"$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize": {
"title": "$:/themes/tiddlywiki/vanilla/settings/backgroundimagesize",
"text": "auto"
},
"$:/themes/tiddlywiki/vanilla/sticky": {
"title": "$:/themes/tiddlywiki/vanilla/sticky",
"text": "<$reveal state=\"$:/themes/tiddlywiki/vanilla/options/stickytitles\" type=\"match\" text=\"yes\">\n``\n.tc-tiddler-title {\n\tposition: -webkit-sticky;\n\tposition: -moz-sticky;\n\tposition: -o-sticky;\n\tposition: -ms-sticky;\n\tposition: sticky;\n\ttop: 0px;\n\tbackground: ``<<colour tiddler-background>>``;\n\tz-index: 500;\n}\n\n``\n<$list filter=\"[range[100]]\">\n`.tc-story-river .tc-tiddler-frame:nth-child(100n+`<$text text=<<currentTiddler>>/>`) {\nz-index: `<$text text={{{ [[200]subtract<currentTiddler>] }}}/>`;\n}\n`\n</$list>\n</$reveal>\n"
}
}
}
Anders Hagen Jarmund. [ext[Kontakt meg|mailto:ajarmund@gmail.com]]
\define tag2(tag)
<$set name=currentTag value="$tag$">
{{||$:/core/ui/TagTemplate2}}
</$set>
\end
\define countButton()
<$button class="tc-btn-invisible">
<$action-sendmessage $message="tm-close-tiddler" $param="Hjem" />
<$list filter='[all[tiddlers]has[exercise]stage{Hjem!!stage}tag<tags>year<year>!nsort[]]'>
<$action-navigate $to=<<currentTiddler>> />
</$list>
<$list filter="[all[tiddlers]has[exercise]stage{Hjem!!stage}tag<tags>year<year>count[]]"><<currentTiddler>></$list>
</$button>
\end
\define yearButton()
<$button class="tc-btn-invisible">
<$action-sendmessage $message="tm-close-tiddler" $param="Hjem" />
<$list filter='[all[tiddlers]has[exercise]stage{Hjem!!stage}year<year>!nsort[]]'>
<$action-navigate $to=<<currentTiddler>> />
</$list>
<b><<year>></b>
</$button>
\end
<style>
.alert {
padding: 20px;
background-color: #f44336;
color: white;
opacity: 0.83;
transition: opacity 0.6s;
margin-bottom: 15px;
}
</style>
<$list filter=[{Hjem!!stage}match[X]]>
<div class="alert">
<strong>Kjære ICD!</strong> <br />
Min tid som medisinstudent nærmer seg slutten og det er behov for at noen andre tar over vedlikeholdet av denne siden. Kanskje er det en oppgave som passer for akkurat deg? Det er nyttig med noe interesse for data og enkel kjennskap til f. eks. HTML, men det er ikke noe behov for erfaring med programmering el.l. <a href="mailto:ajarmund@gmail.com">Ta kontakt</a> om du er interessert!<br/>
- <i>Anders</i>
</div>
</$list>
<$list filter=[{Hjem!!stage}match[X]]>
<div class="alert">
<strong>Kjære IAB!</strong> <br />
Min tid som medisinstudent nærmer seg slutten og det er behov for at noen andre tar over vedlikeholdet av denne siden. Kanskje er det en oppgave som passer for akkurat deg? Det er nyttig med noe interesse for data og enkel kjennskap til f. eks. HTML, men det er ikke noe behov for erfaring med programmering el.l. <a href="mailto:ajarmund@gmail.com">Ta kontakt</a> om du er interessert!<br/>
- <i>Anders</i>
</div>
</$list>
<$list filter=[{Hjem!!stage}match[X]]>
<div class="alert">
<strong>Kjære IIAB!</strong> <br />
Min tid som medisinstudent nærmer seg slutten og det er behov for at noen andre tar over vedlikeholdet av denne siden. Kanskje er det en oppgave som passer for akkurat deg? Det er nyttig med noe interesse for data og enkel kjennskap til f. eks. HTML, men det er ikke noe behov for erfaring med programmering el.l. <a href="mailto:ajarmund@gmail.com">Ta kontakt</a> om du er interessert!<br/>
- <i>Anders</i>
</div>
</$list>
<$list filter=[{Hjem!!stage}match[X]]>
<div class="alert">
<strong>Kjære kull 18!</strong> <br />
Da var oversikten oppdatert for IIIC. Lykke til med lesing!<br/>
- <i>Anders</i>
</div>
</$list>
Trykk på et av tallene i tabellen (enten årstall eller et annet tall) for å åpne alle tilhørende oppgaver. Trykk på den gule "pillen" for å få oversikt over enkeltoppgavene.
Hvis du roter deg bort, vil hjem-knappen oppe til venstre ({{$:/core/ui/Buttons/home}}) ta deg hit igjen. Du kan også lagre denne databasen til din egen pc ved å trykke på {{$:/core/ui/Buttons/save-wiki}}. #-tegnet gir deg link til en bestemt oppgave, og {{$:/me/unfold}} lar deg vise alle svar (nyttig hvis du skal skrive ut), mens {{$:/me/fold}} skjuler dem igjen.
Merk at feil kan forekomme, ikke nøl med å ta kontakt med meg: <a href="mailto:ajarmund@gmail.com">ajarmund@gmail.com</a>
<hr/>
!! Sortert på fagfelt
<style>
tr:hover {background-color:#f5f5f5;}
</style>
<table style="width:100%">
<tr>
<th>Fagfelt</th>
<$list filter="[all[tiddlers]has[exercise]stage{Hjem!!stage}each[year]nsort[]get[year]]" variable="year">
<th><<yearButton>></th>
</$list>
</tr>
<$list filter="[all[tiddlers]has[exercise]stage{Hjem!!stage}tags[]nsort[]]">
<$list filter="[all[current]tag[Fagfelt]]" variable="tags">
<tr>
<td><$macrocall $name="tag2" tag=<<tags>> /></td>
<$list filter="[all[tiddlers]has[exercise]stage{Hjem!!stage}each[year]nsort[]get[year]]" variable="year">
<td style="text-align: center"><<countButton>></td>
</$list>
</tr>
</$list>
</$list>
</table>
<hr />
<small>Denne siden er laget og vedlikeholdt av [[Anders H. Jarmund|AHJ]]. Oppgavene er utarbeidet av forelesere ved NTNU. Disse er navngitt der de er oppgitt i oppgavesettene. Original-oppgavene kan finnes på NTNUs [ext[hjemmeside|https://innsida.ntnu.no/wiki/-/wiki/Norsk/Eksamensoppgaver+-+Medisin+-+MH]]. Det er gjort mindre endringer i typografi og skrivefeil kan være rettet opp. NTNU er ikke formelt knyttet til prosjektet, og jeg tar ikke ansvar for ev. feil eller mangler.
Siden ble laget etter idé fra Sverre H. Sørgjerd på [ext[CAME|https://www.ntnu.no/came]].
Siden er bygget på den åpne programvaren [ext[TiddlyWiki|https://tiddlywiki.com]].</small>
<div class="oppgave">
<div class="vignett">
!!Vignett
Enzymer fungerer som biologiske katalysatorer i cellen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Enzymer: beskriv hva slags biokjemiske forbindelser de er, gjør rede for deres funksjon i biologiske systemer og for virkningsmekanismen for denne funksjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enzymer er stoffer som dannes i levende celler og som setter cellen i stand til å utføre og regulere det tusentall av kjemiske reaksjoner som er nødvendige for dens livsprosesser.
De fleste enzymer er proteiner, noen er RNA (også kalt ribozymer; f.eks. i RNA spleising eller i protein-translasjon).
Bare ved hjelp av sine enzymer kan cellene holde stoffskifteprosessene i gang og avpasse deres
hastigheter. Enzymer inngår i praktisk talt alle prosesser i en levende celle.
Enzymene er katalysatorer. En katalysator er i kjemisk forstand et stoff som deltar i en prosess og øker dens hastighet uten selv å bli forbrukt. Katalysatoren gjendannes eller frigjøres uforandret og blir ikke bundet i de produktene som den medvirker til å danne. På samme måte fungerer enzymene i cellen: De er biologiske katalysatorer som katalyserer (fremskynder) cellens stoffskifteprosesser.
Aktiveringsenergi er den formen for ekstra energi som kreves for å starte en reaksjon. Den kan oppfattes som en prosess hvor reaktantene får et ekstra puff (dvs. en energitilførsel og økning i fri energi hos reaktantene) for å komme over en energibarriere (dvs. en ustabil tilstand kalt en overgangstilstand "Transition state") slik at en "nedoverbakke-reaksjon" kan komme i gang med dannelse av produktene. For noen reaksjoner vil romtemperatur gi tilstrekkelig termisk energi til at reaktantene når overgangstilstanden på kort tid . I de fleste reaksjoner vil dette imidlertid først kunne skje etter oppvarming.
Enzymet virker ved å nedsette aktiveringsenergi-barrieren slik at reaksjonen kan foregå ved normal temperatur. Enzymet kan ikke endre ΔG for en reaksjon dvs. kan ikke gjøre en endergon reaksjon exergon.
Enzymer er spesifikke dvs. de virker kun på bestemte reaktanter eller substrater. Enzymet får ofte navn etter substratet ved tillegg av endelsen ”- ase” (f.eks. virker enzymet sukrase på disakkaridet sukrose). Men - mange enzymer har navn som ikke følger dette mønster (f.eks. trypsin som er et fordøyelsesenzym som nedbryter proteiner)
Enzymenes tredimensjonale struktur danner såkalte aktive sentra som interagerer særlig hensiktsmessig med overgangstilstanden av substratet/reaktantene. Substratmolekylene/reaktantene, som i forhold til enzymene er meget små molekyler, tiltrekkes av de aktive sentrene og fastholdes av fysiske eller kjemiske krefter mens de "overvinner" aktiveringsenergi-barrieren for den katalyserte biokjemiske reaksjonen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi eksempler på tre hovedgrupper av enzymer og deres funksjon
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nukleaser, syntaser, polymeraser, kinaser, fosfataser, ATPase
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags kjemiske og fysiske faktorer påvirker reaksjonshastigheten i den katalyserte prosessen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Reaksjonshastigheten er påvirket av konsentrasjonen av substratet(-ene) og av enzymet som virker på det. I tillegg vil en rekke kjemiske og fysiske faktorer - som endrer enzymets 3D-form - påvirke aktiviteten:
* temperatur
* pH
* enzym-cofaktorer
* inhibitorer og aktivatorer
Enzym-hastigheten øker med temperaturen opp til et punkt (temperatur-optimum), for så å falle. Årsaken er at her er den induserte tilpassing (induced fit) optimal for enzymets funksjon. Ved høye temperaturer denaturerer enzymet. I kroppen vår er optimumstemperaturen 37.5*C.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Karsten, 69 år ble innlagt i sykehuset med økende plager i form av tung pust ved lettere anstrengelse og økende hevelse i beina, først omkring anklene og etter hvert opp til knærne. Karsten hadde fra før kjent hjertesvikt etter gjennomgått hjerteinfarkt 8 år tidligere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du nevne tre andre vanlige årsaker til utvikling av hjertesvikt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hypertensjon, kardiomyopatier, hjerterytmeforstyrrelser, thyreotoxikose, anemi, kronisk lungesykdom, alkohol, NSAIDS
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Karstens hjertesvikt med tung pust begrenset hans aktivitetsnivå. Like før han ble lagt inn i sykehuset klarte han ikke å gå en hel etasje i trapp uten å måtte stoppe opp for å hvile en liten stund før han kunne gå videre.
Hjertesvikt klassifiseres ofte i henhold til funksjonsklasser, som oftest ved hjelp av kriteriene beskrevet av New York Heart Association (NYHA).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken NYHA-klasse passer best Karstens funksjonsnivå slik det var like før han ble lagt inn i sykehuset?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
NYHA-klasse III helt korrekt og gir 2 poeng, NYHA-klasse II gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved innkomst i sykehuset ble det foretatt en registrering av hjertets aktivitet med et elektrokardiogram (EKG).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er benevnelsen på de markerte elementene 1, 2 og 3 i elektrokardiogrammet som vist nedenfor?
<<imgLink "IAB-2015-2-A.PNG" 500>>
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# T-bølge
# P-bølge
# R-takk, subsidiært QRS-kompleks
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke elementer i elektrokardiogrammet markerer depolariseringen av myokard henholdsvis i ventriklene og i atriene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
QRS og P
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Standardavledningene i et 12-kanalers EKG blir registret fra elektroder plassert henholdsvis på høyre og venstre over- og underekstremitet
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mellom hvilke elektroder registreres elektrisk aktivitet i standardavledning I?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mellom venstre overekstremitet og høyre overekstremitet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siri og Rolf har 4 barn. Datteren Kari fikk en gutt, Ole, som ble født med en muskelsykdom. Ole er mentalt tilbakestående og han har myotoni (forsinket avstiving av muskler) og muskelsvakhet. Etter utredning hos pediater og genetiker, får han diagnosen dystrofia myotonika. På konsultasjon med utredende lege, kommer det frem at Kari også har myotoni og Siri har grå stær. Kari har en søster og to brødre.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tegn familietre. Kan Oles diagnose skyldes arv, eller er det noe som er nyoppstått i fosterutviklingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dystrofia myotonika (DM) er en autosomalt dominant arvelig tilstand som kan forverres fra generasjon til generasjon.
<<imgLink "IAB-2015-3-A.PNG" 400>>
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dystrofia myotonika er en triplettekspansjonssykdom. Hva er dette og hva menes med at det er en tilstand med antisipering?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
DM skyldes mutasjoner som kan endres fra generasjon til generasjon. Antisipering betyr at sykdom i en familie opptrer ved stadig yngre alder og gir alvorligere sykdom for hver generasjon. Dette skyldes økende antall av en repeterende enhet - tripletter av nukleotider. DM type 1 er den vanligste formen av DM, og den skyldes en repetisjon av CTG i DMPK genet. Normalt er det mellom 5-37 repetisjoner, mens 50 til tusener av repetisjoner gir sykdom. Dess flere repetisjoner, dess alvorligere sykdom.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
En av Karis brødre ønsker å få barn. Hva er risikoen for at han også skal få et barn med dystrofia myotonika?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Risiko for at barnet til Karis bror skal få DM er 25%. Det er 50% risiko for at broren skal ha arvet DM fra mor Siri. Videre er det 50% sannsynlighet for at hans barn igjen skal arve genfeilen. Dette gir 0.5x0.5=0.25
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr det at dystrofia myotonika er en tilstand med locus heterogenisitet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Locus heterogenisitet betyr at mutasjoner i forskjellige gener kan føre til den samme fenotypiske sykdommen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 30 år gammel dame kommer til deg som fastlege på grunn av vedvarende tendens til diaré og diffuse magesmerter, slapphet og 3 kg vekttap over de siste 6 månedene. Endoskopisk biopsi fra tolvfingertarmen viser uttalt ødeleggelse av tarmtottene (totteatrofi) og kronisk betennelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor en slik ødelagt slimhinne kan gi redusert absorpsjon av næringsstoffer (malabsorpsjon). Nevn to andre prinsipielle grunner relatert til magetarm-systemet som kan gi malabsorpsjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Redusert overflate av slimhinnen på grunn av totteatrofien, betennelsen gir ødeleggelse av enterocyttene og manglende «brush border» med alle fordøyelsesenzymene lokalisert der, manglende kontakt mellom innholdet i tarmlumen og enterocyttene på grunn av betennelsen hindrer også selve opptaket over enterocyttene. Manglende enteropeptidase(/kinase) fra enterocyttene vil også hemme aktiveringen av de pankreatiske proteasene
Andre prinsipielle grunner i tillegg til ødeleggelse/betennelse av tarmslimhinne:
* Reduksjon eller mangel på fordøyelsesenzym; medfødt mangel av enzym (eks laktasemangel), mangel av pankreasenzym på grunn av pankreassvikt (i tillegg til mangel av enzym pga ødelagt slimhinne som nevnt over)
* Reduksjon eller mangel på andre nødvendige faktorer som gallesalter (nedsatt galleproduksjon eller avløp, eller manglende enterohepatisk resirkulasjon) eller intrinsisk faktor fra parietalceller i magesekken (Vit B12 mangel)
* Endret miljø i tarmen; redusert pH i duodenum (eks pga manglende nøytralisering, økt syreproduksjon), bakterieovervekst i tynntarm
* For lite tarm ("short bowel syndrome" etter reseksjoner av tarm)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Videre undersøkelser påviser malabsorpsjon og mangel av blant annet jern.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv mekanismene for fordøyelse og absorpsjon av proteiner i tarmen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ingen direkte lagring av protein i kroppen, har et visst dagsbehov. Inntaket er ca likt fordelt mellom proteiner i kosten og proteiner i utskilt mage/tarmsekret og avskalling av epitel. Nedbrytningen skjer ved proteaser som alle skilles ut som inaktive proenzym; starter i magesekken der pepsinogen skilles ut fra hovedceller ("chief cells") i corpus/fundusslimhinnen. Dette aktiveres i den sure pH i magesekken ved auto-proteolyse. Den største mengden proteaser skilles ut i tarmen fra eksokrine celler i pankreas. Disse aktiveres av et enzym som kalles enterokinase (eller enteropeptidase) som produseres i enterocyttene og skilles ut i lumen/sitter i mikrovilli. Dette enzymet spalter trypsinogen fra pankreas til aktivt trypsin, som igjen spalter de andre pankreatiske proenzymene, inkludert flere trypsinogen til flere trypsin som igjen spalter flere osv ("positiv feed-forward").
Pepsin og pankreasenzymene har alle proteinkjeder/polypeptider som substrat, med noe ulik spesifisitet på hvilke type bindinger de helst spalter (kalles endo- eller eksopeptidase avhengig av om de spalter inni eller på endende), og spalter de ned til peptider, oligopeptider, dipeptider og noe aminosyrer. I tillegg sitter det en mengde ulike enzym (peptidase, aminopeptidaser, dipeptidaser, dipeptidyl aminopeptidaser) i mikrovilli og i cytoplasma på innsiden av cellemembranen som spalter disse mindre produktene videre ned til aminosyrer, som i all hovedsak er det som transporteres ut i blodet fra den basolaterale siden av enterocyttene.
Det
finnes flere ulike system i både luminal og basolateral membran som transporterer produktene over membranene. Aminosyrer diffunderer også i stor grad ut av enterocyttene til blodet. Både i mengde og effektivitet er transporterne for di-, tri-og oligopeptider og de cytoplasmiske peptidasene som spalter videre ned til aminosyrer viktigst. (Så i motsetning til karbohydrater som må spaltes ned til minste enhet, monomer, før de kan absorberes til enterocyttene, tas proteiner opp som mellomprodukter og spaltes til minste enhet, aminosyrer, inni cellen før de går ut i blodet).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vognett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort mekanismene for absorpsjon av jern i tarmen. Hvilket hormon regulerer i stor grad denne absorpsjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jern finnes som heme-jern (ca 10 %) og som treverdig jern (hydroksider) (ca 90%) i kosten. Treverdig jernhydroksid må ioniseres til Fe^^3+^^ og reduseres til Fe^^2+^^ før det kan tas opp. Finnes enzym (ferroreduktasen Dcytb) i brushborder av enterocyttene som katalyserer dette, men denne prosessen blir også godt hjulpet av magesyre og for eksempel askorbinsyre, eller også hemmet av for eksempel stoffer i te, kaffe, kornprodukter. Den spesifikke Fe^^2+^^ transporteren (metalliontransportør 1, DMT1) frakter jernet inn i enterocyttene der det kan lagres bundet til ferritin og som lavmolekylære ferroforbindelser i cellens "labile jern-pool" (og dermed tapes igjen når epitelcellene avskalles), eller transporteres til den basolaterale membranen hvor det transporteres ut via transporteren ferroportin, oksideres tilbake til Fe^^3+^^ via ferriooksidasen hefestin og raskt bindes til transferrin i blodet og transporteres til alle cellene i kroppen. Heme-jern spaltes fra globinet i magesekken og tas effektivt opp i enterocytter via en spesifikk hemetransporter. Heme spaltes i cytoplasma og frigjort jern inngår deretter i cellens labile jern-pool sammen med annet absorbert jern.
Jernabsorpsjonen er i prinsippet avhengig av kostens innhold av jern (og andre påvirkende faktorer) og kroppens behov for jern. Små jernlagre eller økt produksjon av røde blodlegemer fremmer absorpsjon ved å regulere proteinnivået av de ulike enzymene og transporterne involvert i prosessen, og dette styres av peptidhormonet hepcidin som produseres i leveren.
Normale eller store jernlagre gir høy transferrinmetning i blodet som stimulerer hepatocyttene til å produsere mer hepcidin. Dette binder seg ferroportin på enterocytter, makrofager og hepatocytter til et kompleks som internaliseres og degraderes slik at eksporten av jern til plasma går ned.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Jern er en essensiell komponent i mange biologiske prosesser, og transport av oksygen ved hjelp av binding til den jernholdige heme-gruppen i hemoglobin er en av de viktigste
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hvordan heme brytes ned og skilles ut fra kroppen. Hvilke andre typer hemeproteiner finnes i kroppen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Store mengder heme, først og fremst fra hemoglobin, brytes ned i kroppen daglig. Røde blodceller har kort levetid (ca 120 dager) og gamle og ødelagte tas opp av det retikuloendoteliale systemet (RES) som er makrofager diffust spredt i vev som milt, lymfeknuter, tonsiller, lever osv. Det skjer også noe hemolyse i blodbanen. I RES brytes hemoglobin ned til globiner som degraderes videre til aminosyrer og til fritt jern som inngår i cellens jern-poole, og til heme som brytes ned til pigmentstoffene biliverdin og videre til bilirubin av enzymene heme oxidase og biliverdin reduktase. Dette ukonjugerte bilirubinet er fettløselig og vanskelig for kroppen å bli kvitt via nyrene. Derfor fraktes det i plasma bundet til albumin til lever og tas opp av hepatocytter via ulike mekanismer med høy kapasitet. Der konjugeres bilirubin hovedsakelig til to glukuronat og blir konjugert bilirubin (bilirubin diglukoronat) som er mer vannløselig, slik at det kan skilles ut i gallen.Dette skjer via aktive pumpemekanismer. Nedover i tarmen dekonjugeres bilirubin og omgjøres til urobilinogener av bakterieenzyme, hvorav det meste (ca 90%) oksideres videre til brunfarget sterkobilin som gir farge til og forsvinner ut av kroppen med avføringen. Resten (ca 10%) reabsorberes i terminale ileum og kolon og inngår i enterohepatisk resirkulasjon, men en liten andel av dette (ca 1-4%) går ut i blodsirkulasjonen og til nyrene hvor det omdannes til gulaktig urobilin som gir farge til og skilles ut av kroppen i urin.
Heme finnes først og fremst i hemoglobin i erytrocytter, men også i myoglobin i skjelettmuskulatur og i enzymer som catalase, peroksidase og cytokromer i lever.
Ikke nødvendig at studentene har med absolutt alle detaljer for å få full score, viktigst er de mest sentrale detaljene og at studentene beskriver og forstår hovedprinsippene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne oppgaven omhandler det endomembrane systemet hvor de største strukturene er endoplasmatisk reticulum og golgiapparatet.
Forklar oppbygning og funksjon av det endomembrane systemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre strukturer i tillegg til endoplasmatisk reticulum og golgiapparatet inngår?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Endoplasmatisk retikulum (glatt og ru; forklare forskjell) – proteinsyntese, membran(protein)syntese, lipid-syntese
* Golgiapparatet – protein-modifiseringer, lipidsyntese, transport fra ER/RER til andre deler av det endomembrane systemet
* Sekretoriske vesikler – transport ut av cella
* Endosomer – endocyterte vesikler (transport inn i cella), dynamisk samspill med andre vesikler, bl. a. lysosom-forstadier
* Lysosomer – nedbrytning av makromolekyler og bakterier
* Peroksysomer – stoffskifte, særlig lipidAlle strukturene er forbundet med hverandre gjennom membrantraffikk
* Membrantrafikken er muliggjort ved biologiske membraners egenskaper (flytende lipid-dobbeltlag, ikke kovalente bindinger
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Denne oppgaven omhandler det endomembrane systemet hvor de største strukturene er endoplasmatisk reticulum og golgiapparatet.
Forklar oppbygning og funksjon av det endomembrane systemet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan står de ulike strukturene i forbindelse med hverandre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alle strukturene er forbundet med hverandre gjennom membrantraffikk
* Membrantrafikken er muliggjort ved biologiske membraners egenskaper (flytende lipid-dobbeltlag, ikke kovalente bindinger
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ei 11 år gammel jente hadde et uhell mens hun syklet, slik at hun falt på utstrakt høyre arm. Da hun kom til skadepoliklinikken, hadde hun så vondt i armen at hun ikke klarte å bevege albuen. Hun var litt hoven lateralt på overarmen og ved undersøkelse var det innskrenket bevegelighet i albuen. Særlig var fleksjonsevnen redusert. Leddet virket stabilt, og det var ikke tegn til alvorlig sirkulasjonsforstyrrelse.
Det ble tatt røntgenbilder av albuen. Side- og skråbilde så slik ut:
<<imgLink "IAB-2015s-2-A.PNG" 500>>
Det ble gjort åpen reposisjon i narkose og det løse fragmentet ble fiksert med to skruer. Undersøkelse etter operasjonen viste god stabilitet og bevegelighet, og to dager senere ble pasienten utskrevet. Hun fikk hjelp av fysioterapeut til gradvis mobilisering, og ved kontroll et år etter skaden hadde hun tilnærmet full funksjon i albuen. Røntgenbildet så slik ut:
<<imgLink "IAB-2015s-2-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvilke knokler som inngår i albuleddet, og forklar hvordan disse artikulerer med hverandre. Angi hvor mange frihetsgrader det er i albuleddet og hvordan de ulike bevegelsene benevnes
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Albuleddet er et sammensatt ledd, hvori inngår //humerus//, //radius// og //ulna//. Det har en sammenhengende leddhule, men kan inndeles i tre ledd med ulike bevegelser: //articulationes// (a) //humeroradialis//, (b) //humeroulnaris et// (c) //radioulnaris proximalis//). De to første utgjør til sammen et hengselledd, med en frihetsgrad: fleksjon og ekstensjon, mens det siste er et dreieledd (pivotledd) med en frihetsgrad: supinasjon-pronasjon. Til sammen blir dette to frihetsgrader i albuleddet som helhet. (//Articulatio humeroradialis// betraktet alene har også to frihetsgrader: fleksjon-ekstensjon og rotasjon.)
# Leddskåla på //caput radii// artikulerer med //capitulum humeri// (den halvkuleformede, laterale delen av distale leddflate på //humerus//)
# Proksimale //ulna// (//incisura trochlearis ulnae//) artikulerer med den mediale delen av //humeri// leddflate (//trochlea humeri//)
# Siden av //caput radii// (//circumferentia articularis capitis//) artikulerer med laterale side av //ulna// (//incisura radialis ulnae//).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett
<<<
Ei 11 år gammel jente hadde et uhell mens hun syklet, slik at hun falt på utstrakt høyre arm. Da hun kom til skadepoliklinikken, hadde hun så vondt i armen at hun ikke klarte å bevege albuen. Hun var litt hoven lateralt på overarmen og ved undersøkelse var det innskrenket bevegelighet i albuen. Særlig var fleksjonsevnen redusert. Leddet virket stabilt, og det var ikke tegn til alvorlig sirkulasjonsforstyrrelse.
Det ble tatt røntgenbilder av albuen. Side- og skråbilde så slik ut:
<<imgLink "IAB-2015s-2-A.PNG" 500>>
Det ble gjort åpen reposisjon i narkose og det løse fragmentet ble fiksert med to skruer. Undersøkelse etter operasjonen viste god stabilitet og bevegelighet, og to dager senere ble pasienten utskrevet. Hun fikk hjelp av fysioterapeut til gradvis mobilisering, og ved kontroll et år etter skaden hadde hun tilnærmet full funksjon i albuen. Røntgenbildet så slik ut:
<<imgLink "IAB-2015s-2-B.PNG">>
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken knokkel er skadet hos den aktuelle pasienten, og hvor sitter skaden? Hvilken del av leddet er affisert? Hvilken av bevegelsene i albuleddet kan antas å være mest affisert av skaden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det foreligger et brudd av distale humerus, slik at capitulum humeri er slått løs og dislosert oppad foran humerus. Dette fragmentet kan komme i beknip ved fleksjon, som må forventes å være den bevegelsen som er mest affisert.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi de viktigste musklene som bevirker de ulike bevegelsene i albuleddet, forklar i grove trekk hvordan de forløper og angi hvordan de er innervert.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Viktigste fleksorer er m. biceps brachii og m. brachialis springer ut fra hhv scapula og humerus, går omtrent midt foran leddet og fester hhv. på radius (tuberositas radii - men også margo posterior ulnae)og ulna (processus coronoideus). Innerveres av n. musculocutaneus.
M. brachioradialis (samt i mindre grad mm. extensores carpi radiales og m. pronator teres) har også fleksjonsvirkning. Den springer ut fra laterale kant av distale humerus, fester distalt på radius, innerveres av n. radialis.
M. triceps brachii er eneste ekstensor (idet m. anconeus har liten effekt), springer ut fra scapula og baksida av humerus, fester på olecranon (ulna), innerveres av n. radialis.
M. biceps brachii er den vikigste supinator ved bøyd albuledd. Viktig er også m. supinator, som går fra proksimale ulna, rundt på baksida av radius og fester på radius. Innervasjon n. medianus.
Pronatorer er mm. pronatores teres et quadratus, fra ulna til radius på forsida, innerveres av n. medianus.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett
<<<
Ei 11 år gammel jente hadde et uhell mens hun syklet, slik at hun falt på utstrakt høyre arm. Da hun kom til skadepoliklinikken, hadde hun så vondt i armen at hun ikke klarte å bevege albuen. Hun var litt hoven lateralt på overarmen og ved undersøkelse var det innskrenket bevegelighet i albuen. Særlig var fleksjonsevnen redusert. Leddet virket stabilt, og det var ikke tegn til alvorlig sirkulasjonsforstyrrelse.
Det ble tatt røntgenbilder av albuen. Side- og skråbilde så slik ut:
<<imgLink "IAB-2015s-2-A.PNG" 500>>
Det ble gjort åpen reposisjon i narkose og det løse fragmentet ble fiksert med to skruer. Undersøkelse etter operasjonen viste god stabilitet og bevegelighet, og to dager senere ble pasienten utskrevet. Hun fikk hjelp av fysioterapeut til gradvis mobilisering, og ved kontroll et år etter skaden hadde hun tilnærmet full funksjon i albuen. Røntgenbildet så slik ut:
<<imgLink "IAB-2015s-2-B.PNG">>
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
//Nervus ulnaris// går forbi albuleddet med nær relasjon til bein, på en slik måte at den kan bli skadet ved brudd i albuområdet. Er det sannsynlig at nerven er affisert i det aktuelle tilfellet? Begrunn svaret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
//N. ulnaris// passerer bak mediale humerusepikondyl, og er neppe skadd, siden skaden sitter på lateralsida av leddet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den generelle oppbyggingen av et synovialledd. Beskriv særlig hvordan
synovialmembran og brusk er oppbygd, og forklar hva slags funksjon disse strukturene
har for leddets funksjon
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
To knokler støter mot hverandre, slik at kontaktflatene er dekt av et lag hyalin brusk, leddbrusk, cartilago articularis. Brusk er et spesialisert bindevev, med celler som ligger enkeltvis eller i små grupper (to-fire celler) i lakuner i intracellulærsubstansen. Sistnevnte består av kollagen (tynne fibre av særlig type 2) (strekkbestandighet) og rikelig grunnsubstans som inneholder store mengder proteoglykaner (protein + gykosaminoglykaner), mukopolysakkarider (trykkbestandighet). Brusk mangler blodkar.
Leddet er omgitt av en synovialmembran som spenner seg mellom de to knoklene, ved overgangen mellom bein og brusk, slik at det dannes ei lukka leddhule (cavum articulare).
Synovialmembranen består av et løst, karrikt, fibrøst bindevev, som inn mot leddhula er kledd av et sammenhengende lag med ganske cytoplasmarike celler, som har en viss likhet med epitel. Disse er ansvarlige for produksjonen av den gjennomsiktige, strågule leddvæska (synovia) - et ultrafiltrat av plasma tilsatt proteoglykaner slik at den blir ganske seig, som ligger som en film mellom de to bruskflatene og nedsetter friksjonen, og som sørger for ernæring til brusken.
Utenfor synovialmembranen (og tilheftet denne) ligger den fibrøse leddkapselen, som holder de to knoklene sammen og sørger for mekanisk styrke til leddet. Mange ledd har i tillegg sterke fibrøse bånd som spenner seg mellom knoklene og som gir ytterligere styrke.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 48 år kommer på kontoret med smerter i høyre skulder som har vart i 2 måneder. Smertene startet etter at hun klippet hekken rundt huset. Hun har problemer i hverdagen når hun skal hente noe i høye kjøkkenskap, henge opp klær samt at hun våkner om natten når hun snur seg på høyre side.
Skuldersmerter er et hyppig forekommende problem i befolkningen. I skulderen er det flere diagnostiske kategorier som kan knyttes til komplekse anatomiske forhold med flere ledd involvert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ledd inngår ved bevegelser i skulderen? (ta med både synovialledd og glideflater)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
3 "ekte", dvs synovial ledd (AC leddet, gleno-humeral leddet og sternoclaviculær leddet) og 2 "falske" ledd (Scapulothoracal "leddet"; glideflaten mellom scapula og thorax og Subacromial "leddet" - glideflaten som utgjøres av subacromialbursa).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2.5 poeng til sammen: 0.5 pr riktig svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter musklene som er involvert i bevegelse og stabilisering av skulderleddet og nevn
samlebetegnelsen for disse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rotator-cuffen utgjøres av m. supraspinatus, m. infraspinatus, m.subscapularis, m. teres minor.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng til sammen: 1.0 for "rotator-cuffen" + 1.0 for de fire musklene som inngår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å undersøke henne, blant annet ved å se på aktiv bevegelighet. Du finner at hun har smerter ved aktiv abduksjon mellom 60 og 120 grader; dvs. såkalt "painfularc". I tillegg gjør du en del andre kliniske undersøkelser inklusive tre spesialtester: Hawkins test (som er positiv), Jobes test (som er negativ) og Compression-rotation test (som er negativ).
Fra tidligere vignett:
<<<
En kvinne på 48 år kommer på kontoret med smerter i høyre skulder som har vart i 2 måneder. Smertene startet etter at hun klippet hekken rundt huset. Hun har problemer i hverdagen når hun skal hente noe i høye kjøkkenskap, henge opp klær samt at hun våkner om natten når hun snur seg på høyre side.
Skuldersmerter er et hyppig forekommende problem i befolkningen. I skulderen er det flere diagnostiske kategorier som kan knyttes til komplekse anatomiske forhold med flere ledd involvert.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I tillegg til abduksjon, hvilke andre retninger for aktiv bevegelse bør du undersøke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Aktiv fleksjon, abduksjon og innad- / utadrotasjon. (I tillegg kan adduksjon også undersøkes, men dette har klinisk mindre betydning hos en slik pasient).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng dersom alle 4 er riktig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignetter:
<<<
Du bestemmer deg for å undersøke henne, blant annet ved å se på aktiv bevegelighet. Du finner at hun har smerter ved aktiv abduksjon mellom 60 og 120 grader; dvs. såkalt "painfularc". I tillegg gjør du en del andre kliniske undersøkelser inklusive tre spesialtester: Hawkins test (som er positiv), Jobes test (som er negativ) og Compression-rotation test (som er negativ).
En kvinne på 48 år kommer på kontoret med smerter i høyre skulder som har vart i 2 måneder. Smertene startet etter at hun klippet hekken rundt huset. Hun har problemer i hverdagen når hun skal hente noe i høye kjøkkenskap, henge opp klær samt at hun våkner om natten når hun snur seg på høyre side.
Skuldersmerter er et hyppig forekommende problem i befolkningen. I skulderen er det flere diagnostiske kategorier som kan knyttes til komplekse anatomiske forhold med flere ledd involvert.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I tillegg til aktiv bevegelse og spesialtestene som er nevnt, hvilke andre enkle kliniske
undersøkelser vil du gjøre hos Kari?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Undersøkelse av passiv bevegelse og isometriske kraft må være med (abduksjon, fleksjon, innad og utadrotasjon (Adduksjon kan også nevnes, men har klinisk mindre betydning). I tillegg hører det med å gjøre en orienterende nevrologisk undersøkelse inklusive nakkeundersøkelse (helst med spurlings prøve) for å utelukke nerverotsmerte som differensial diagnose. Inspeksjon og palpasjon kan også nevnes.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2.0 poeng: For å få full score kreves at både passiv bevegelse og isometrisk kraft-testing er nevnt. Dersom undersøkelse av nakken er nevnt i tillegg, bør dette dra opp dersom kandidaten viser usikkerhet i svar på denne eller de andre oppgavene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignetter:
<<<
Du bestemmer deg for å undersøke henne, blant annet ved å se på aktiv bevegelighet. Du finner at hun har smerter ved aktiv abduksjon mellom 60 og 120 grader; dvs. såkalt "painfularc". I tillegg gjør du en del andre kliniske undersøkelser inklusive tre spesialtester: Hawkins test (som er positiv), Jobes test (som er negativ) og Compression-rotation test (som er negativ).
En kvinne på 48 år kommer på kontoret med smerter i høyre skulder som har vart i 2 måneder. Smertene startet etter at hun klippet hekken rundt huset. Hun har problemer i hverdagen når hun skal hente noe i høye kjøkkenskap, henge opp klær samt at hun våkner om natten når hun snur seg på høyre side.
Skuldersmerter er et hyppig forekommende problem i befolkningen. I skulderen er det flere diagnostiske kategorier som kan knyttes til komplekse anatomiske forhold med flere ledd involvert.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Med utgangspunkt i din kunnskap om normal anatomi, nevrologi og fysiologi:
# Hvilke strukturer tester man ved vanlig klinisk undersøkelse av skulder?
# Gi et kort resonnement for hvilke strukturer som kan være affisert hos denne pasienten.
# Angi hva tror du er den mest sannsynlige årsaken til Karis skulderplager.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ved passiv bevegelse testes de passive strukturene som ledd, leddkapsel og leddbånd. Ved isometriske tester testes kontraktile strukturer som muskel og sene samt at nevrologiske forutsetninger for kraftutvikling i muskulatur er til stede. Ved aktive tester får man testet en kombinasjon av overstående og får innblikk i funksjon.
# "painful arc" er en test hvor pasienten gjør aktiv abduksjon og en tester således både passive og kontraktile strukturer samt nødvendig nevrogene forutsetning for aktiv abduksjon. Positiv "painful arc" innebærer smerter lateralt i skulderen i en bue med typisk området 60-120 grader. En kan finne positiv smertebue ved mange ulike tilstander i skulderen, men typisk er "impingement syndrom", dvs. smerter som utløses ved kompresjon av subacromiale strukturer som supraspinatus og subacromialbursa ut fra et biomekanisk rasjonale. Blant mer spissfindig er biomekaniske resonnementer inngår at svak eller skadet supraspinatus muskel kan føre til inneklemming og subacromial smerte fordi samlet kraft-vektor drar caput humeri mot taket i acromion. Positiv Hawkins test bygger på samme prinsipp hvor man i 90 grader fleksjon passivt innadroterer humerus slik at tuberculum majus komprimprimerer subacromiale strukturer og framprovoserer smerte. Testen er positiv dersom dette utløser smerte lateralt i skulderen og dette tyder også på "impingement syndrom" som årsak. Jobes (supraspinatus test) er en isometrisk test hvor armen holdes elevert til 90 grader i scapulas plan (ca 30 grader fleksjon) og tommelen peker mot gulvet (innarotasjon i glenohumeralleddet). Positiv test er svakhet som kan indikere ruptur av rotator-cuff muskulatur (spesielt supraspinatus). Siden Jobes test var negativ indikerer dette normal funksjon og integritet av rotatorcuffen (spesielt supraspinatus) inklusive normal nervefunksjon (C5 roten primært). Aktuelle strukturer som med mindre sannsynlighet er affisert er dermed: Nevrogene strukturer (slik som C5 radikulopati eller plexus nevritt). Artrose eller artritt i glenohumeral-ledd samt adhesiv kapsulitt/frozen shoulder som villle gitt nedsatt passiv bevegelse. AC ledds utløste smerter som ikke gir painful arc, men mer typisk smerte mot toppen av abduksjonsbevegelsen og lokalisering mer proximalt over AC leddet. Imidlertid kan de fleste tilstander i skulderen, inklusive labrum lesjoner (SLAP-lesjon), glenohumeral instabilitet og myalgi, gi sekundære impingementplager på grunn av endret muskelfunksjon under smertepåvirkning.
# Mest sannsynlig årsak er "impingement syndrom", i tillegg kan det godkjennes supraspinatus tendinopati/tendinose, supraspinatus(del)ruptur, subacromialbursitt og rotatorcuff syndrom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Samlet 1.5 poeng: 0.5 poeng per punkt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Diffusjonskapasiteten (diffusjonsevnen) for oksygen i lungene er en prosess som utgjør et av flere trinn som har betydning for gassvekslingen i kroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar med enkle ord hva diffusjon for oksygen i lungene innebærer. Når oksygen diffunderer i lungene, passerer gassen over en viktig anatomisk struktur. Hva heter den og hvordan er den bygd opp?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungenes diffusjonskapasitet for oksygen (O,,2,,) beskriver hvordan (hvor lett og uhindret) O,,2,, passerer fra lungenes alveoler og over i blodet.
På sin vei fra alveol-luften i lungene til blodbanen (lungekapillærene) passerer oksygenet den alveolokapillære membran = den respiratoriske membran. Den består av (fra alveolside til kapillærside) et lag surfaktant (som ikke er en anatomisk del av membranen), et epitellag (på alveolsiden-alveolepitel), denne hviler på epitellagets basalmembran, så et passerer oksygenet et tynt interstitielt-sjikt, så igjen en basalmembran (endotel-lagets basalmembran) og deretter et tynt lag kapillær-endotel. I den respiratoriske membran mangler ofte basalmembranen slik at epitel og endotel ligger mot hverandre. Membranen blir således svært tynn slik at avstanden som oksygen må diffundere ("diffusjonsveien") blir svært kort.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anatomiske og fysiologiske forhold er avgjørende for lungenes gass-diffusjon? Hvorfor diffunderer karbondioksid mye lettere enn oksygen og hvilken klinisk konsekvens har det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Størrelsen av gassvekslings-arealet (dvs. den alveolokapillære membran) mellom alveol og kapillær og dermed lungevolumet (det alveolære lungevolum)
* Veggtykkelsen fra alveol til erytrocytt (dvs. tykkelsen av den alveolokapillære membran)
* Drivtrykket for oksygen mellom alveol og blod, altså forskjellen i oksygentrykket i alveolen og i kapillærene, oksygentrykket er høyest i alveolene slik at oksygen diffunderer fra alveol til blod.
* Tilgjengelig mengde hemoglobin i blodet
Diffusjonskapasiteten er også avhengig av gassens oppløselighet i en væskefase. Karbondioksyd er 20 ganger mer løselig enn oksygen og diffunderer tilsvarende lettere i lungene. Ved isolert nedsatt diffusjonskapasitet i lungene får man ofte okygenereringssvikt, men (omtrent) aldri problemer med å skille ut karbondioksyd.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved lungesykdom er det i hovedsak to ulike patofysiologiske forhold som er av betydning ved nedsatt diffusjonskapasitet for oksygen i lungene. Hvilke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved lungesydommer som gir nedsatt diffusjonskapasitet for oksygen vil der enten foreligge fortykket alveolo-kapillær membran (oksygenet "får lenger vei å gå") eller så foreligger der redusert diffusjonsflate ved at alveoler og alveolkapillærer er destruerte hvilket gir en redusert diffusjonsflate med også mindre kapillærnett til å motta oksygenet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør skjematisk kort rede for hvilke trinn oksygentransporten omfatter helt fra vi puster inn til oksygenet blir tatt opp i vevet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Oksygenet transporteres ved ventilasjonen fra atmosfæreluft og fordeles i luftveiene ut til lungenes alveoler.
* Deretter transporteres det ved diffusjon over alveolmembranen og til blodet hvor det bindes til hemoglobin i erytrocytene for videre transport.
* Videre transport skjer ved hjelp av sirkulasjonen slik at det transporteres og fordeles ut i kroppen til cellenes mitokondrier i arbeidende vev.
* Etter at oksygenet er fraktet til arbeidende vev, transporteres det fra erytrocyten til vevscellenes mitochondrier.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Benjamin, 3 år, ble lagt inn i barneavdelingen med kramper, lungebetennelse og pustevanskeligheter. Han var godt kjent i avdelingen etter flere innleggelser og konsultasjoner pga. infeksjoner, dårlig motorisk utvikling med ataktisk (rykkvis og ustø) gange samt mental retardasjon. Man fikk allerede før han fylte ett år mistanke om at Benjamin hadde en medfødt stoffskifteforstyrrelse og det ble tatt en del blodprøver. Disse prøvene viste
* Lett acidose (pH 7.3, normalt 7.35-7.45)
* Høyt laktat (5 mmol/l, normalt 0.3-1.5 mmol/l)
* Lav standard bikarbonat (17 mmol/l, normalt 21-27 mmol/l)
* Lav pCO2 (4.0, normal 4.5-6.0 kPa)
* O2 -metning var normal (97%)
* Hemoglobin var normal (12 g/dl).
Det ble også tatt en hudbiopsi som man startet fibroblastkulturer fra. Disse fibroblastene ble benyttet til biokjemiske og genetiske analyser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Biokjemiske analyser avslørte at Benjamin hadde en mutasjon i en av subenhetene i pyruvat dehydrogenase-komplekset (PDH). En fant at PDH-aktiviteten i cellene fra gutten bare var ca. 15 % av normal aktivitet. Hvorfor vil dette gi seg utslag i laktacidose slik som påvist for Benjamin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved defekt i PDHC vil acetylgruppen i pyruvat bli omdannet til Acetyl-CoA med mye lavere effektivitet og sitronsyresyklus vil tilføres mindre substrat. Pyruvat vil derfor i stedet delvis bli omdannet til laktat selv under normale areobe forhold. Laktat vil derfor hope seg opp og føre til laktacidosen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for å nevne manglende omdanning av pyruvat til Acetyl-CoA og 0.5 poeng for at når pyruvat ikke kan omsettes i sitronsyresyklus fører dette i stedet til omdanning til lactat og laktacidose.
Totalt mulig 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
PDHC er et stort enzymkompleks som består av mange kopier
av 3 protein-subenheter samt flere kofaktorer, dvs koenzymer
og prostetiske grupper som dannes fra vitaminer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er et koenzym?
Hva er en prostetisk gruppe?
Hva er et vitamin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Koenzym: Et koenzym (kofaktor) et kjemisk stoff som ikke er et protein som er nødvendig for aktiviteten til et enzym.
Prostetisk gruppe, Kofaktor/koenzym som er kovalent bundet til et enzym
Vitamin er en organisk forbindelse som er et vitalt næringsstoff som en organisme trenger.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delspørsmål gir 1 poeng, dvs totalt 3 poeng mulig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sitronsyresyklus foregår i lumen i mitokondrier og fører til
dannelse av elektronbærerene NADH og FADH2 ved
oksidasjon
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva menes med oksidasjons- og reduksjons-reaksjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Oksidasjon av et stoff innebærer fjerning av elektroner, enten elektroner alene eller i form av hydrogenatomer.
Reduksjon innebærer binding av elektroner, enten alene eller som H.
NAD^^+^^ (Nicotin Adenin Dinukleotid) er et oksiderende agens som binder elektroner (og H^^+^^) og dermed blir redusert. Dette former NADH som så kan bli oksidert ved å gi fra seg elektroner (og H^^+^^).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis kandidaten beskriver enten oksydasjon eller reduksjon gis 2 poeng (vet man det ene, så vet man det andre)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Acetyl-CoA (acetyl-Coenzym A) er et thioester som produseres i nedbrytning av glukose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er Acetyl-CoA av så stor betydning også i metabolisme av andre stoffer enn glukose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetyl-CoA er et energirikt thioester som produseres også ved nedbryting av fettsyrer (og andre lipider) og aminosyrer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng hvis både fettsyrer/lipider og aminosyrer er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved elektrontransport og oksidativ fosforylering genererer cellene ATP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan fører elektrontransport til generering av ATP?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Elektrontransporten utnyttes til å pumpe protoner (H^^+^^) ut av lumen (matrix) av mitokontriene. Dette fører til en konsentrasjonsforskjell (ca 10x) i H^^+^^ mellom matrix (lumen) og rommet mellom indre og ytre membran ("intermembrane space") i mitokondriene. H^^+^^ kan bare strømme tilbake til matrix (utligne konsentrasjonsforskjellen) ved å passere gjennom protonspesifikke kanaler (F,,o,,). Disse kanalene er koblet sammen med en ATP syntase (kompleks V) som utnytter energifrigjøringen ved at H^^+^^ strømmer tilbake til å syntetisere ATP fra ADP.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for å nevne at elektrontransporten fører til H^^+^^-gradient over matrix-membranen og 1 poeng for å nevne ATP-syntasen og hva denne gjør, til sammen 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Per på 13 år har blitt diagnostisert med en blodsykdom. Hans tre søstre er friske. Pers foreldre (Kari og Ola) og deres søsken er også friske. Mor har en søster og far har en bror.
Pers farmor, farfar og mormor er friske. Morfar, som nå er død, hadde den samme blodsykdommen som Per. Etter genetisk testing ved medisinsk genetisk laboratorium, blir det bekreftet at blodsykdommen er en arvelig tilstand.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tegn et genetisk slektskart og angi de syke.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "IAB-2016-2-A.PNG" >>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekt opptegnet slektskart: 2 poeng (Merk: det er flere korrekte måter å tegne kartet på; f.eks hvor mann – kvinne plasseres i forhold til hverandre i hver generasjon).
Feil bruk av symboler for kjønn – men ellers korrekt innplassering av syke personer: 1 poeng
Glemt angivelse av død person – men ellers riktig slektskart: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Per på 13 år har blitt diagnostisert med en blodsykdom. Hans tre søstre er friske. Pers foreldre (Kari og Ola) og deres søsken er også friske. Mor har en søster og far har en bror.
Pers farmor, farfar og mormor er friske. Morfar, som nå er død, hadde den samme blodsykdommen som Per. Etter genetisk testing ved medisinsk genetisk laboratorium, blir det bekreftet at blodsykdommen er en arvelig tilstand.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv og argumenter for ulike typer mulige arvemønstre for denne blodsykdommen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi har oppgitt for lite informasjon til å kunne si at det bare er ett mulig arvemønster. Mulige arvemønstre er:
''Recessive X-bundet arv'': oftest menn (bare ett Xkromosom) som får sykdommen. Kvinnene er oftest bærere. Pers mor, Kari og hennes søster, er bærere, og de har arvet mutert X-kromosom fra sin syke far. Det er 50% risiko for at Kari gir dette videre til sine barn. Karis døtre har 50 risiko for å være bærere, og sønner har 50% risiko for å få sykdommen, hvis det er en sykdom med full penetrans
<<imgLink "IAB-2016-2-B.PNG">>
''Recessive autosomal arv'': Både kvinner og menn blir syke. I denne familien over 3 generasjoner, ser vi ingen syke kvinner, men dette kan være tilfeldig. De som er syke, må ha arvet ett mutert allel fra hver av sine foreldre. I dette tilfellet må både Kari og Ola være bærere, og Kari har arvet mutert X-kromosom fra sin syke far. Det er 25% risiko for Kari og Olas barn å arve mutert allel fra begge, slik at de blir syke. Det er 50% risiko for å arve ett mutert allel og være bærer.
<<imgLink "IAB-2016-2-C.PNG">>
''Dominant autosomal arv med redusert penetrans'': Både kvinner og menn blir syke. I denne familien over 3 generasjoner, ser vi ingen syke kvinner, men dette kan være tilfeldig. De som er syke, må ha arvet ett mutert allel fra en av sine foreldre. Med redusert penetrans kan sykdommen hoppe over en generasjon, slik det er med Kari. Hun er bærer av mutert variant arvet fra far, men har vært heldig og ikke fått sykdommen selv. Det er 50% risiko for arv av mutert allel for avkom, og risiko for å bli syk, avhenger av penetransen.
<<imgLink "IAB-2016-2-D.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle tre alternativer rett: 6 poeng
To riktige alternativer: 4 poeng
Ett riktig alternativ: 2 poeng
HER ER DET SIKKERT MULIG Å GI POENG FOR DELVIS RETTE SVAR INNENFOR HVER KATEGORI
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva som menes med penetrans for genetiske sykdommer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Penetrans'' betyr den andelen av individer som har en spesifikk genotype som også uttrykker den assosierte fenotypen. Det er en "enten-eller" tilstand ("All-or-none trait"). Ved fulle penetrans (100%), vil alle som har arvet en bestemt genvariant, bli syke. Eks: Neurofibromatose type er en autosomal dominant sykdom med full penetrans.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva som menes med ekspressivitet for genetiske sykdommer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekspressivitet: Alvorlighetsgraden av fenotypen hos individer med en bestemt genotype. Ved variabel ekspressivitet, vil fenotypen uttrykkes i ulik grad blant individer med samme genotype (selv i samme slekt). Noen kan få veldig alvorlig sykdom, men andre kan bli veldig lett affisert. Årsak til den variable ekspressiviteten er ofte ukjent (miljøfaktorer, andre modifiserende gener).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann i 50-årene ble innlagt på sykehus pga. brått innsettende magesmerter (akutt abdomen). Ved undersøkelse med rtg. (computer tomografi (CT)) ble det påvist en forsnevring av lumen i kolon på høyre side av buken. Dette ble også verifisert endoskopisk (koloskopi). Pasienten ble så operert med fjerning av høyre deler av kolon til og med colon transversum, såkalt høyresidig hemikolektomi. Selve operasjonen var teknisk vanskelig pga. betydelige adheranser (sammenvoksninger) mellom tarmslynger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det som skiller tykktarm fra tynntarm ved utvendig, makroskopisk inspeksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kolon er makroskopisk karakterisert av:
# Er mer fiksert til bakre bukvegg mens tynntarmen er mer mobil
# Større diameter
# Haustra
# Tenier (taeniae coli)
# Appendices epiploicae
# Kolons vegg er sakkulert ("buklet"), tynntarmen er mer jamn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
4 av 6 delsvar gir fullt hus, 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Oversett begrepet //hemikolektomi// til norsk og forklar hvordan uttrykket er konstruert
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
//Hemikolektomi// er den norske skrivemåten for //hemicolectomia// som betyr operativ fjerning av halve tykktarmen (gr. //hemi-//: halv, lat. //colon//: tykktarm, gr. //ektomein//: skjære ut) (Ref.: Norsk medisinsk ordbok. Det norske samlaget).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis poeng for om kandidaten beskriver at //hemi// betyr halv, at //kole//... omfatter kolon og at //-ectomi// betyr ta ut, fjerne
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved operasjoner for kolonkanser gjør man vanligvis enten en høyresidig eller venstresidig reseksjon (operativ fjerning), slik at "grensen" mellom disse to inngrepene går ved overgangen mellom den tversgående og den nedadgånde delen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan denne kolonkirurgiske praksisen forklares ut fra blodforsyningen til kolon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Denne kirurgiske praksisen har sitt utgangspunkt i kolons arterielle blodforsyning. Høyre del av kolon til distale del av //colon transversum// (embryologisk del av midttarm) forsynes av //art. mesenterica sup.// (SMA). Videre distalt til analkanalen (embryologisk baktarm) får blod fra //art. mesenterica sin.// (IMA). Dermed blir området omkring //flexura coli sin.// et "vannskille" når det gjelder arteriell blodforsyning, dvs. at blodgjennomstrømningen her kan bli dårlig. Av den grunn går skillet mellom en høyresidig og venstresidig kolonreseksjon i dette området for å unngå problemer med dårlig blodsirkulert tarm med de konsekvenser det har i form av infarktutvikling og tarmperforasjon.
Det viser seg at det vanligvis er anastomoser mellom SMA og IMA (mellom //art. colica med.// fra SMA og //art. colia sin.// fra IMA, gjerne med dannelse av en såkalt marginalarterie, //art. marginalis coli//) som i varierende grad kan kompensere for evt. dårlig blodforsyning, for eks. ved trombosering av enten SMA eller IMA. Til tross for dette er kolon i området utsatt for dårlig blodgjennomstrømning og derfor hyppig sete for såkalt iskemisk kolitt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.5 p for at hhv. ''art. mesenterica sup. og inf.'' nevnes. For fullt hus må også ''deres forsyningsområde av kolon'' beskrives samt at det er ''anastomoser'' mellom SMA og IMA finnes området omkring distale colon transversum/flexura coli sin.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tarmkanser kan spre seg, metastasere, i kroppen via blodkar og lymfekar. Under pasientens sykehusopphold ble det oppdaget knuter i leveren og i //fossa supraclavicularis sin.// som ga mistanke om metastaser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke drenasje- eller spredningsveier kan forklare disse metastasesuspekte forandringene i henholdsvis lever og //fossa supraclavicularis sin.//?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hematogen spredning skjer via //v. mesenterica sup. et inf.// til //vena portae// og videre til lever.
Lymfogen spredning til lymfeknuter i //fossa supraclavicularis sin.// skjer via lymfeknuter langsmed de større tarmarteriene til //trunci intestinales// som tømmes i //cisterna chyli//. Herfra går lymfen videre gjennom //ductus thoracicus// som munner ut i vinkelen mellom //vena subclavia sin.// og //vena jugularis interna sin.// Dermed kan det bli metastaser til supraklavikulære lymfeknuter på venstre side. (Ved maligne sykdommer i abdominalorganer kan man altså finne lymfeknutespredning her; slike metastatiske lymfeknuter har fått navnet Virchoffs glandler etter en kjent tysk patolog [Rudolf Virchoff, 1821-1902, blir betraktet som den moderne patologiens grunnlegger gjennom verket //Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre//]).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.5 p for //vena portae// og 0.5 p for //ductus thoracicus//
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Operasjonspreparatet ble sendt til patologiavdelingen for makroskopisk og mikroskopisk undersøkelse. Her ble det bl. a. undersøkt hvor dypt i tarmveggen kanseren hadde vokst. Dette relateres til de ulike lag tarmveggen består av. En slik dybdevekst har med stadium av en malign tumor å gjøre og er en viktig prognostisk faktor.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort beskrivelse av den histologiske oppbygningen av kolonveggen med angivelse av de ulike lag med deres viktigste celletyper og vevsstrukturer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tykktarmveggen består skjematisk av følgende lag:
# //tunica mucosa//, som igjen er inndelt i
## //lamina epithelialis//
## //lamina propria//
## //lamina muscularis mucosae//
# //submucosa//
# //tunica muscularis (muscularis proper)//
# //tunica serosa/adventitia//.
''Mucosa''. Slimhinnen er glatt, ingen villi, overflateepitelet er enlaget sylindrisk, fra denne tubulære kjertler, såkalte Lieberkünske krypter, med ulike celletyper som begerceller, nevroendokrine (enteroendokrine) celler og stamceller. Lamina propria består av løst bindevev (I histologiboka til Genese angis det retikulært bindevev). Av celler fins lymfocytter og spredte lymfefollikler, plasmaceller, makrofager og noen få andre typer inflammatoriske celler (eosinofile granulocytter m.m.). Videre er det blodkapillærer, lymfekapillærer forekommer for det meste nær ved lamina muscularis mucosae. Dette muskellaget består av glatt muskulatur, indre sirkulært og ytre longitudinelt lag.
''Submucosa'' (tela submucosa). Består av løst bindevev og fettvev, blodog lymfekar samt perifere nerver og plexus med ganglieceller som ligger like under lamina muscularis mucosae, plexus submucous (Meissneri).
''Tunica muscularis (muscularis proper)''. Består innerst av et tydelig sirkulært lag (stratum circulare) med bunter av glatt muskulatur, utenpå dette et mer ufullstendig langsgående glatt muskellag (stratum longitudinale) som danner tre tydelige bånd, taenia coli, mellom disse er det ytre muskellaget tynt eller kan mangle helt. Mellom det indre og ytre muskellaget er det også perifere nerver og et nerveplexus med ganglieceller, plexus myentericus (Auerbachi).
''Tunica serosa/adventitia''. Mot abdominalhulen ligger serosa med mesotel og et subserøst bindevevslag (tela subserosa) som også danner appendices epiploicae. Mot krøstilheftningen mangler mesotel og det er bare et bindevevslag, adventitia, mot det omentale fettvevet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For 4 p kreves:
* at alle lag nevnt i kursiv i første avsnitt over, er med.
* at følgende celler/vev i de ulike lag nevnes:
** Mucosa. Epitel: overflateepitel, krypter og begerceller; lamina propria: lymfocytter, plasmaceller, kar; lamina muscularis mucosae: glatt muskulatur.
**Submucosa. Bindevev, fettvev, kar, nervepleksus (selve navnet plexus submucosus (evt. Meissners nerveplexus)) trengs ikke oppgis).
**Tunica muscularis. Glatt muskulatur, ytre og indre lag, nervepleksus (selve navnet, plexus myentericus (Auerbachs nerveplexus) trengs ikke oppgis).
**Tunica serosa/adventitia. Det må fremgå at serosa har relasjon til abdominalhulen med peritoneum viscerale/mesotel, mens adventitia representerer et bindevevslag som ligger an mot omentalt fettvev.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved svulster i kolon må man også vurdere muligheten for at svulsten kan ha vokst gjennom tarmveggen og videre inn i organer som har nær relasjon til kolon
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke store intraabdominale organ har nær relasjon til colon transversum og flexura coli sin.?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Colon transversum: pancreas
Flexura coli sin.: milt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 72 år gammel tidligere frisk kvinne opplevde like etter at hun hadde stått opp om morgenen raskt innsettende brystmerter av klemmende karakter. Smertene startet bak brystbeinet, etter hvert med utstråling opp mot kjeven og venstre skulder. Hun følte seg tiltakende uvel og etter hvert også tyngre i pusten.
Hennes ektefelle ringte i løpet av kort tid til telefonnummer ”113” (Medisinsk nødmeldetjeneste/AMK-sentral).
Etter noen korte, avklarende spørsmål ble det sendt ut ambulanse til pasienten på grunn av mistanke om akutt hjerteinfarkt.
Så snart ambulansen var fremme hos pasienten ble det gjort EKG-registrering med oversending av EKG-opptaket til nærmeste lokalsykehus. Vakthavende assistentlege ble tilkalt for tolking av EKG og konklusjonen var klar: EKG viste normofrekvent regelmessig sinusrytme, upåfallende QRS, men med tydelig og typiske ST-elevasjoner i avledningene V3 til V6 og i aVL. Konklusjon: Sannsynlig akutt ST-elevasjonsinfarkt (STEMI) under utvikling i fremre og laterale deler av venstre ventrikkels myokard.
På diagnosetidspunktet var det gått ca 45 minutter etter start av brystsmertene. Transporttid til nærmeste lokalsykehus er estimert til 45 minutter, mens transporttid til nærmeste sykehus med mulighet for angiografi av kransårer og eventuelt perkutan intervensjonsbehandling (PCI) er estimert til 120 minutter.
Med disse opplysningene om tid fra smertedebut og kunnskap om transporttider beslutter vakthavende assistentlege at det skal iverksettes intravenøs trombolytisk behandling så snart som mulig og før transport til lokalsykehus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det er tydelig av sykehistorien og dokumentert med EKG at pasienten sannsynlig er i ferd med å utvikle et transmuralt hjerteinfarkt. Hvorfor har ikke teamet rundt pasienten og vakthavende lege ønske om å vente med trombolytisk behandling til pasienten er fraktet til sykehus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Størst effekt av tromoblytisk behandling oppnås når behandlingen kan gies og reperfusjon kan oppnås så tidlig som mulig etter at diagnosen er stilt. Tap av myocard tiltar med tid som medgår før reperfusjon oppnås
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tidsforløpet i en situasjon med ischemi/opphørt blodforsyning i myocard er kritisk med tanke på skadebegrensning/grad av iscemisk skade/myocardnekrose.
Godt beskrevet på UpToDate: http://www.uptodate.com/contents/search?search=stemi+emergency&sp=0&searchType=PLAIN_TEXT&source=USER_INPUT&searchControl=TOP_PULLDOWN&searchOffset=&autoComplete=true
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det ble gitt intravenøs trombolytisk behandling supplert av en moderat dose morfin og acetylsalisylsyre før start av transport til lokalsykehuset.
Pasienten merket nærmest umiddelbart lindring av brystsmertene og gradvis bedring av den opplevde tungpust.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlige årsak til at pasienten i tillegg til brystsmertene også opplevde økende grad av tungpust i forbindelse utviklingen av det akutte hjerteinfarktet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved en tilstand med ischemi i myokard vil deler av muskelmasen tape kontraksjonskraft og kontraksjonsbevegelse. Hjertets kontraktile funksjon (kontraktilitet) reduseres. Dette medfører økende fylningstrykk i venstre hjertekammer, dette økte fylningstrykk medfører økte trykk også i lungevener/lungekar som i sin tur gir lungestuvning og i de alvorligste tilfellene lungeødem.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ischemi gir redusert muskelfunksjon.
Redusert muskelfunksjon i venstre hjertekammer fører til økte fylningstrykk – ”Frank-Starlingmekanisme” – ”Starlings hjertelov”.
Økte fylningstrykk til venstre ventrikkel innebærer økte trykk også i lungekarsengen – stuvning og med det tungpust/dyspnoe.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved ankomst lokalsykehuset finner vakthavende turnuslege at de første EKG-forandringene synes å ha gått pent tilbake og det konkluderes med vellykket trombolytisk behandling.
Pasienten er ved ankomst smertefri og helt uten opplevelse av tungpust.
Ved den kliniske undersøkelsen finnes det ved auskultasjon over hjertet en systolisk bilyd
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelse er best egnet for raskt å avklare årsaken til pasientens systoliske bilyd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ultralydundersøkelse av hjertet med fremstilling av blodstrømshastigheter, Doppler ekkokardiografi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ekkokardiografi med fremstilling av blodstrømshastigheter, Doppler ekkokardiografi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelse er best egnet for raskt å vurdere hjertets pumpefunksjon / kontraksjonsbevegelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ultralydundersøkelse av hjertet med dynamisk fremstilling av hjertetrukturene/myokard; ekkokardiografi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ultralydundersøkelse av hjertet med dynamisk fremstilling av hjertetrukturene/myokard; ekkokardiografi
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende prosedyre er best egnet for å avdekke og behandle forsnevringer i hjertets kransårer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Venstresidig hjertekatetereisering med selektiv coronar angiografi, eventuelt supplert med intervensjonsbehandling (vanligst ballongblokking av stenose med eller uten implatasjon av stent i kransåren)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Venstresidig hjertekateterisering med selektiv coronar angiografi og eventuell intervensjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 68 år gammel kvinne blir innlagt på St. Olavs Hospital på grunn av redusert allmenntilstand, betydelig vekttap (11 kg på 2 mnd) og positivt utslag på fekal okkult blod-test. Koloskopi avslører at hun har kolonkreft med metastase til lever. Under anamnese kommer det frem at hun har flere nære slektninger, blant annet en søster, som er døde av kolonkreft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Figuren viser pasientens (III,3) slektstre hvor flere medlemmer har blitt rammet av kolonkreft. Dette kan tyde på at det er en arvelig kreftform inne i bildet. Hvilken type arv er det i så fall mest sannsynlig snakk om her (autosomal/kjønnsbundet, dominant/recessiv)?
<<imgLink "IAB-2016s-1-A.PNG">>
<$details class="answer" summary="Svar" state="!!showanswer">
I og med at både kvinner og menn er affisert av sykdommen, er det snakk om autosomal arv. I generasjon III og IV er 50% av avkommet affisert, noe som tyder på dominant nedarving.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for autosomal og 0.5 poeng for dominant.
Totalt mulig 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
DNA-sekvensering av isolerte blodceller fra pasienten viste mutasjon i av ett av allelene som koder for DNA polymerase ε (POLE). I tillegg viste DNA-sekvensering av en biopsi fra pasientens kolontumor svært mange enkeltbaseparmutasjoner.
Tegn en generell skisse av et humant proteinkodende gen, og sett navn på de ulike regionene. Skisser også pre-mRNA og modent mRNA som dannes ved transkripsjon av genet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Skissen av genet bør minst illustrere promoter-region, eksoner og introner (fritt antall av hvert) Skissen av pre-mRNAet bør inneholde cap, 5’-utranslatert region (5’-UTR, også kalt leader), eksoner og introner (fritt antall), 3’-utranslatert region (3’-UTR, også kalt trailer), samt polyA-hale
Skissen av det modne mRNAet skal være som premRNAet, men uten introner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver av delpunktene under gen- og pre-mRNA gir 0.3 poeng, og riktig modent mRNA 0.3 poeng. Til sammen 10x0.3 poeng = 3 poeng mulig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke 5 hovedtyper DNA polymeraser finner en i humane celletyper. Hvor i cellene finnes disse og hva er deres hovedfunksjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Polymerase α (cellekjernen – deltar i syntese av RNA primere og initiering av Okazaki-fragment)
* Polymerase β (cellekjernen-deltar i DNA reparasjonsprosesser)
* Polymerase δ (cellekjernen – forlengelse av «lagging strand»)
* Polymerase ε (cellekjernen – forlengelse av «leading strand»)
* Polymerase γ (mitokondriene – kopiering av mitokondrielt DNA)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver av polymerasene gir 0.2 poeng og hver av
funksjonene gir 0.2 poeng hver. Tilsammen 2 poeng mulig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
DNA-sekvenseringen viste at mutasjonen befant seg i ekson 13 i POLE-genet. Dette eksonet koder for en del av eksonukleasedomenet i DNA polymerase ε og den aktuelle mutasjonen vil her føre til en aminosyresubstitusjon.
Forklar hvorfor en slik mutasjon i POLE-genet kan være årsak til det høye antallet mutasjoner observert i pasientens tumor.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Feilinnsetting av baser kan skje under DNA replikasjonen. Polymerase ε har et sekundært katalytisk sete med en 3’-5’-eksonukleasefunksjon (rettefunksjon = proofreading). Hvis feil base settes inn i polymerase-setet, kan enden av den nydannede tråden «flyttes» over i eksonuklease-setet, og den feilinnsatte basen (samt ofte noen ekstra baser) fjernes. Enden settes deretter tilbake i polymerase-setet og normal replikasjon gjenopptas.
Hvis mutasjoner i eksonukleasesetet gjør det defekt, vil ikke polymerasen effektivt fjerne feilinnsatte baser, og antallet enkeltbasemutasjoner vil øke i hele genomet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.5 poeng hvis elementene over er med
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tegn en skisse av en replikasjonsgaffel i en human cellekjerne og sett navn på de ulike delene av gaffelen (inkludert retningsangivelse på DNA-trådene). Skisser og navngi de viktigste proteinene som deltar i replikasjonsprosessen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "IAB-2016s-1-B.PNG" 400>>
Forenklet versjon av replikasjonsgaffel
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Riktig angivelse av leading/lagging strand: 0.5 poeng
* Riktig retningsangivelse. 0.5 poeng
* Riktig plassering og navngiving av Okazakifragment 0.3 poeng
* Riktig plassering og navngiving av polymeraser (Polymerase α initierer Okazakifragment, Polymerase ε ved leading strand og polymerase δ ved lagging strand: 0.8 poeng.
* Riktig plassering av Helikase: 0.2 poeng
* Riktig plassering av single-strand binding proteins (RPA): 0.2 poeng
Totalt mulig 2.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ulike arbeidsoppgaver krever ulik kraft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan reguleres kraftutviklingen på ryggmargsnivå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Aktivering: Aksjonspotensialenes fyringsfrekvens
* Rekruttering: Antall motoriske enheter der de største og sterkest rekrutteres til slutt (vanskeligst å rekruttere)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Aksjonspotensialenes fyringsfrekvens 1p
* Antall motoriske enheter som rekrutteres 1p
* Og aktivering av de største/sterkeste og tyngst aktiverbare motoriske enhetene (de siste som rekrutteres) 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typiske forskjeller er det mellom store og små motoriske enheter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Store: Stor kraft, lite utholdende
* Små: Presis motorisk kontroll og utholdende
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Store: Stor kraft, lite utholdende 0.5px2
* Små: Presis motorisk kontroll og utholdende 0.5px2
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva avgjør kraftutvikling på muskelnivå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Muskelfiberposisjon (optimalt er middels strukket)
* Muskelfibersammensetning
* Muskeldiameter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Muskelfiberposisjon (optimalt er middels strukket) 0.5p
* Muskelfibersammensetning 0.5p
* Muskeldiameter 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv ulike typer muskelfibertyper
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Langsomme oksidative, raske oksidative og raske glykolytiske muskelfibre
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Langsomme oksidative 0.5p
* Raske oksidative og raske 0.5p
* Glykolytiske muskelfibre 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er en sarkomer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Minste kontraktile enhet i en muskel bestående av myosin i midten som kan trekke aktinet i hver ende mot hverandre
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Minste kontraktile enhet 1p
* Myosin 0.5p
* Aktin 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har en 20 år gammel pasient som i løpet av det siste året har hatt økende voluminøs, gråglinsende og illeluktende avføring og 10 kg vekttap. Undersøkelse viser at han har malabsorpsjon av fett (steatore).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to prinsipielle årsaker (ikke diagnoser) relatert til magetarmsystemet som kan gi malabsorpsjon av fett.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Mangel på pankreasenzym som lipase og ko-lipase (for eksempel pankreassvikt)
* Mangel på gallesalter (for eksempel leversviktmanglende produksjon, gallegangobstruksjon, manglende / dårlig reabsorpsjon, bakteriell overvekst med nedbrytning av gallesalter)
* Endret miljø i duodenum (for eksempel sur ph-økt produksjon av magesyre i forhold til bikarbonat fra pankreassekret og galle som buffer, bakteriell overvekst)
* Ødelagt slimhinne (for eksempel betennelse, tottetatrofi)
* Motilitetsforstyrrelser i ventrikkel og tarm
* Hindret lymfetransport
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver riktig. Det er prinsippene med mangel på de nødvendige faktorene for opptak; enzymer, gallesalter, riktig pH/miljø og intakt slimhinne som er viktig, ikke om de skriver nøyaktig riktig detaljer om grunn/årsak.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hvordan triglyserider fordøyes og absorberes fra tarmlumen og over i blodet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Triglyserider (TG) utgjør hovedmengden av fettstoff i maten (i tillegg til fosfolipider og steroler som kolesterol).
Gallesalter produseres i hepatocytter i lever og skilles ut i duodenum sammen med pankreasenzym som lipase og ko-lipase (i tillegg til andre enzym og bikarbonat). På grunn av den amfifatiske egenskapen vil gallesalter danne miceller når de er i vandige løsninger (sånn som gallen er og sånn som man har i tarmen), der kjernen en hydrofob ("fettløselig") og utsiden er hydrofil ("vannløselig").
Gallesaltene gjør fettet "løselig" i vann ved at TG i tarmen vil diffundere inn i kjernen av slike miceller istedenfor å samle seg i store fettdråper. Dette øker overflaten som fordøyelsesenzymene lipase og ko-lipase er avhengig av å jobbe på for å bryte ned TG til fettsyrer og monoglycerid.
Micellene kan så diffundere gjennom det urørte laget av væske langs tarmslimhinnen ("unstirred water layer"), inn mellom mikrovilliene og i kontakt med enterocyttenes cellemembran, slik at nedbrytningstoffene kan diffundere inn i cellene (evt tas opp via spesifikke mekansimer for noen typer). I glatt endoplasmatisk retikulum (sER) i enterocyttene blir nedbrytningsproduktene satt sammen igjen til opprinnelige fettstoff, pakket sammen med apolipoprotein B til chylomicroner, som går ut av enterocyttene i andre enden ved eksocytose og diffunderer til lymfesystemet som via ductus thoracicus tømmes ut venstre vena subclavia og ut i blodbanen (fettstoff går altså ikke direkte ut i blodet og gjennom leveren før det kommer ut i den systemiske sirkulasjonen).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene:
* 0.5 poeng - micellefunksjon
* 0.5 poeng - pankreasenzym
* 0.5 poeng - nærhet til enterocytten og diffusjon inn
* 0.5 poeng - skilles ut i blodet via lymfen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Absorpsjon av hvilke andre stoffer er nært knyttet til fett og kan bli redusert ved fett-malabsorpsjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fett-løselige vitaminer (som A, D, E, K)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng - fett-løselige vitaminer
* 0.5 poeng - å nevne >= 2 spesifikke
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Leveren er et organ som står svært sentralt i å samordne kroppens håndtering av næringsstoffer som fettstoff, karbohydrater og proteiner som blir absorbert i tarmen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er prinsippene for hvordan leveren samordner metabolismen av næringsstoffene og hva er hovedfunksjonen med dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De fleste metabolske spor for nedbrytning/omsetning av næringsstoff og syntese av anvendelige andre produkt, foregår og er nøye koordinert i levercellene. Leveren fungerer som et senter for alle disse metabolske sporene. Hensikten med denne felles håndtering og kontrollen med næringsstoffer og omsetningen av disse, er å hele tiden sørge for å opprettholde nogenlunde jevn og adekvat tilgang av næring og energi for cellene i resten av kroppen.
Leveren har evnen til å lagre og modulere tilgjengeligheten for næringsstoffer i blodet. Under og rett etter måltid hvor det er store mengde næringsstoffer i portalblodet, skal leveren derfor evne å ta opp store mengder av disse slik at det ikke kommer et "rush" og overskudd ut i blodsirkulasjonen. Leveren må så metabolisere de absorberte næringsstoffene, modulere for lagring i lever eller fettvev, eller gjøre de tilgjengelig for andre organ som energi. Og i perioder med lav tilgang (mellom måltid/faste) må leveren ha omsatt og lagret næringsstoffene på en slik måte at det kan posjoneres ut og holdes jevnt på det nivået kroppen trenger. Dette er nøye regulert av hormoner fra blant annet pankreas, binyrer og tyroidea, og via nervesignal.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* 0.5 poeng - metabolske spor for alle næringsstoffer henger sammen og nøye koordinert i levercellene
* 0.5 poeng – kunne ta imot og omsette store mengder under/rett etter måltid
* 0.5 poeng – posjonere ut jevn og adekvat mengde næring til blodet i perioder med faste
* 0.5 poeng – alle disse prosessene nøye regulert av hormoner og nervesignal
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er lipoproteiner og hvilken generell funksjon har de?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lipoproteiner medierer transport av ulike fettstoff rundt i blodet (og lymfe), enten til leveren for omsetning eller fra leveren ut til resten av kroppen. Leveren er viktig i å regulere nivået av liporpoteiner i blodet. De består av apolipoproteiner av ulike typer produsert i leveren og/eller tarmepitelet og ulik sammensetning av i hovedsak triglyserider, fosfolipider, kolesterol og kolesterolestere.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* 0.5 poeng - transport av fettstoff til/fra lever i blodet
* 0.5 poeng - består av apolipoprotein og ulike fettstoff
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Leveren har også mange andre funksjoner som er viktig for flere prosesser i kroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to av leverens andre funksjoner som er relatert til nedbrytning og utskillelse av ulike stoffer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Utskillelse av avfallsstoffer som ikke går via nyrer (eks bilirubin, kolesterol, xenobiotika)
* Metabolisme/detoksifisering av medikamenter og xenobiotika (fase I og fase II reaksjoner)
* Metabolisme/nedbrytning av ulike hormoner (som kjønnshormoner, ulike peptidhormoner)
* "Filtrering og rensning"/nedbrytning av gamle blodceller, diverse proteinkomplekser, bakterieprod. osv (del av RES-systemet) i blod
* Ureasyklus for håndtering av nitrogen fra nedbrytning av protein
* (Utskillelse av gallesyrer i galle)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver riktig funksjon. Det er prinsippene som er viktigst
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 48 år kommer på kontoret med smerter i muskulaturen både rundt nakke, skuldre og hofter som har vart i 7 måneder. Hun plages også med uttalt tretthet, hodepine og søvnvansker.
Du har utelukket alvorlig sykdom i ledd, nakke og hofter og tror hun har fibromyalgi. Fibromyalgi er en av flere tilstander som også har fått betegnelsen MUPS (Medically unexplained physical symptoms)/subjektive helseplager
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kjennetegner MUPS (Medically unexplained physical symptoms)/subjektive helseplager?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Langvarige tilstander med betydelige symptomer.
* Subjektive symptomer uten objektive funn, diagnosen baserer seg på kriterier baser på symptomer
* Ukjent årsak
* Mer enn vanlige helseplager
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Full poengsscore ved minst 2 av punktene over
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En kvinne på 48 år kommer på kontoret med smerter i muskulaturen både rundt nakke, skuldre og hofter som har vart i 7 måneder. Hun plages også med uttalt tretthet, hodepine og søvnvansker.
Du har utelukket alvorlig sykdom i ledd, nakke og hofter og tror hun har fibromyalgi. Fibromyalgi er en av flere tilstander som også har fått betegnelsen MUPS (Medically unexplained physical symptoms)/subjektive helseplager.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Slike plager forstås ofte ut fra en såkalt biopsykososial modell. Hva betyr det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
At smerten kan ha startet av biomedisinske årsaker, men at psykologiske og sosiale faktorer forsterker plagene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis kandidaten angir at det er sammenheng mellom bio-psyko og sosiale faktorer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å undersøke hoftene hennes, blant annet ved å se på aktiv bevegelighet. Hun har smerter ved aktiv abduksjon i hofta
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I tillegg til abduksjon, hvilke andre retninger for aktiv bevegelse bør du undersøke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Aktiv fleksjon, ekstensjon, adduksjon og innad- / utadrotasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,0 poeng dersom alle tre er riktig. 0,5 poeng dersom færre enn tre riktige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du bestemmer deg for å undersøke hoftene hennes, blant annet ved å se på aktiv bevegelighet. Hun har smerter ved aktiv abduksjon i hofta
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I tillegg til aktiv bevegelse, hvilke andre leddundersøkelser vil du gjøre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Passiv bevegelse og isometrisk testing (evt spesialtester, men det kreves ikke i svaret)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.5 poeng hvis bade passive og isometriske tester nevnes. 0.5 hvis bare en av disse nevnes
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du bestemmer deg for å undersøke hoftene hennes, blant annet ved å se på aktiv bevegelighet. Hun har smerter ved aktiv abduksjon i hofta
<<<
Forrige punkt:
<<<
I tillegg til aktiv bevegelse, hvilke andre leddundersøkelser vil du gjøre?
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke strukturer tester du ved de forskjellige testene du kom fram til i pkt 4?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Passiv bevegelse'': Ved passive tester testes de passive strukturene som ledd, leddkapsel og leddbånd.
''Isometrisk test'': Ved isometriske tester testes kontraktile strukturer som muskel og sene. En vil også få testet kraft i muskulatur og kan således avdekke rupturer eller pareser.
Ved ''aktive tester'' får man testet en kombinasjon av overstående og får innblikk i funksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng hvis kandidaten vet at ledd, leddkapsel og leddbånd testes ved passive tester.
* 0.5 poeng hvis kandidaten vet at kontraktile strukturer testes ved isometriske tester.
* 0.5 p hvis kandidaten ved at aktive tester gir smerter ved tilstander i alle disse strukturer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Smertene hennes har vart i 7 måneder, og hun har dermed langvarige (kroniske) smerter.
# Hva er de viktigste forskjellene på akutte og langvarige smerter?
# Hva vil du fokusere på i behandlingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hva er de viktigste forskjellene på akutte og langvarige smerter?
#* Akutt smerte:
#** Ofte kjent årsak
#** Kortvarig
#** Presis beskrivelse
#* Langvarig smerte:
#** Oftest ukjent årsak
#** Vedvarer over 3 mnd
#** Smertene sprer seg ofte i et område
# Hva vil du fokusere på i behandlingen?
#* Akutt – behandle årsak, ofte selvbegrensende
#* Langvarig – eliminere vedlikeholdende faktorer, smertekontroll, økt funksjon, aktivisering
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må kandidaten vite at:
* langvarige smerter ofte har sammensatt årsak og at andre faktorer enn opprinnleig årsak kan bidra til at smertene vedvarer
* Forskjellen på akutt og langvarig kun dreier seg om varighet (ca 12 uker, men def varierer en del (8 uker til 6 mnd)
* At selv om årsaken ofte er kompleks ved langvarige smerter så kan en hjelpe pasientene ved å bryte onde sirkler og øke funksjon.
* Det trekker opp om aktivitet nevnes som viktig ved langvarige smerter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du spiser et stykke biff. I kjøttets myoglobin er det bundet jernatomer.
Du skal følge disse jernatomene på veien fra magesekken din til de bygges inn i hemoglobinmolekyler i beinmargen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvordan forhold i magesekk og øvre tynntarm kan påvirke jernabsorpsjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jern kan absorberes bundet til heme. Det meste absorberes som Fe++ (toverdig jern). Jern i kosten må omdannes til toverdig. HCL (magesyre) øker omdannelse til Fe++. Chelaterende og jernbindende stoffer i maten kan binde jern og nedsette jernmengden tilgjengelig for absorpsjon. Luminale membran i tarmepitelet inneholder en ferrireduktase som omdanner jern til Fe++
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nedsatt jernopptak ved anaciditet (0.5p), jernbindende (chelaterende) føde/tarminnhold (0.5p), tarmsykdom som nedsetter epitelial funksjon eller areal, ex cøliaki (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hvordan jernatomet tas opp i tarmepitelet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jernatomet tas vesentlig opp i tarmepitecellen gjennom Divalent metalltransportør 1 (DMT1), et transmembranprotein som transporterer Fe++ over luminale membran
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kjenne til at det finnes en transportør for divalent jern (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvordan jerntransport inn i tarmepitelet kan reguleres
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Antallet DMT1 kanaler i luminale membran bestemmer jernopptaket. Syntesen av DMT1-molekyler i epitelcellen er regulert av intracellulær jernkonsentrasjon gjennom jernregulerende proteiner (IRP) som senser jernkonsentrasjonen og påvirker proteinsyntesen i epitelcellen ved binding til m-RNA
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vite at jerninnholdet i epitelcellen regulerer opptaket (1p), beskrive at epitelcellens jerninnhold regulerer syntese av et spesifikt transportmolekyl (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan jerntransport fra tarmepitelet til blod foregår, og hvordan transporten kan reguleres
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tarmepitelet eksporterer jern til blod gjennom kanalproteinet ferroportin i basale membran (1 poeng).
Mengden ferroportinkanaler reguleres av hormonet hepcidin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vite at jerntransport epitelcelle-blod skjer gjennom et kanalprotein (1p), at kanalproteinet reguleres av hormonet hepcidin (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan jerntransporten fra tarmepitelet til beinmargen foregår og kan reguleres
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fe++ omdannes til Fe+++ av basalt lokalisert coeruloplasmin. Fe+++ bindes til transferrin i plasma for transport til beinmargen. Transportkapasiteten øker ved jernmangel ved at transferrinkonsentrasjonen og dermed antall bindingsseter for jern (TIBC) øker. Regulering av transferrinkonsentrasjonen skjer via IRP
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Omdanning til Fe+++ (0.5p), transferrin for transport (0.5p), kompensatorisk økning av transportkapasitet (transferrin) ved jernmangel (0.5p), jern regulerer transferrinsyntesen
(0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan jern tas opp i beinmargens celler, og hvordan opptaket er regulert
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Transferrin med bundet Fe+++ bindes til transferrrinreseptorer (TfR) på beinmargscellenes membran og endocyteres. Opptaket reguleres ved antall uttrykte transferrinreseptorer på cellen. Syntese av TfR i cellen er regulert av intracellulær jernkonsentrasjon via IRP binding til m-RNA for TfR
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
TfR på beinmargcellene (1p), regulert ved antallet TfR (0.5p), syntese av TfR reguleres av jernregulert proteinsyntese (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bruken av legemidlet salbutamol (Ventoline) hos idrettsutøvere uten lungesykdom er omdiskutert, særlig bruken av høye doser. Ved terapeutisk konsentrasjon stimulerer stoffet primært beta-2-adrenerge reseptorer. Ved høye doser stimuleres også beta-1-adrenerge reseptorer. Disse egenskapene har betydning for å forstå effekter og mulige bivirkninger av medikamentet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av salbutamol i bronkialmuskulaturen og signalveien fra reseptor til den cellulære effekten. Hvilken virkning har stoffet på luftstrøms-motstanden i luftveiene, og hvilke molekyler er involvert i denne biokjemiske signalveien i bronkialmuskelcellene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Salbutamol reduserer luftstrømsmotstanden ved å relaksere glatt muskulatur i bronkialveggen (0.5 poeng). Når salbutamol aktiverer beta-2-reseptoren, spaltes det GTP-bindende proteinet G,,s,, og frigjør sub-enheten alfas som aktiverer enzymet adenylyl cyklase (AC) (0.5 poeng). AC katalyserer dannelsen av syklisk AMP (cAMP) og øker den intracellulære konsentrasjonen av cAMP. cAMP aktiverer enzymet protein kinase A (PKA) (0.5 poeng). PKA fosforylerer myosin light chain kinase (MLCK) og reduserer MLCK-aktiviteten. Redusert MLCK-aktivitet fører til mindre fosforylering av lette myosin kjeder (MLC), og derved reduseres kontraktiliteten i bronkialmuskulaturen (0.5 poeng).
Mekanismen er den samme som i karvegg, men er neppe gjennomgått eksplisitt ved undervisningen i lungefysiologi. Det er likevel mulig å slutte seg til svaret ut fra kunnskap om mekanismen for relaksasjon av glatt muskulatur i karveggen. Denne deloppgaven regnes derfor som resonnerende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Relaksasjon av glatt muskulatur og redusert luftstrømsmotstand (0.5 poeng). Aktivering av adenylyl cyklase via G-protein (0.5 poeng). Aktivering av PKA og fosforylering av MLCK (0.5 poeng). Hemming av MLC og redusert kontraktilitet (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Bruken av legemidlet salbutamol (Ventoline) hos idrettsutøvere uten lungesykdom er omdiskutert, særlig bruken av høye doser. Ved terapeutisk konsentrasjon stimulerer stoffet primært beta-2-adrenerge reseptorer. Ved høye doser stimuleres også beta-1-adrenerge reseptorer. Disse egenskapene har betydning for å forstå effekter og mulige bivirkninger av medikamentet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av salbutamol i sinusknuten i hjertet og signalveien fra reseptor til den cellulære effekten. Hvilken virkning har stoffet på pulsen (slag per minutt)? Hva er effekten på pacemakerpotensialet, og hvilke molekyler er involvert i den biokjemiske signalveien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Salbutamol øker pulsen ved å stimulere beta-adrenerge reseptorer i sinusknuten (0.5 poeng). Stigningshastigheten på pacemakerpotensialet øker, og dermed nås terskelen for depolarisering raskere, det vil si kortere tid mellom hvert hjerteslag (0.5 poeng). Det er to parallelle signalveier:
Salbutamol aktiverer beta-1- og beta-2-reseptorer som beskrevet i deloppgave 1, Gs spaltes og dermed frigjøres sub-enheten alfas. Dette trinnet er felles. Den ene signalveien går via AC, cAMP og PKA, som aktiverer kalsiumkanalen ICa,L i cellemembranen. Dermed øker stigningshastigheten på pacemakerpotensialet (0.5 poeng).
Den andre signalveien er at alfas aktiverer ionekanalen I,,f,, (I,,funny,,) ved en direkte effekt på ionekanalen (ikke via AC, cAMP og PKA). Dermed øker stigningshastigheten (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Salbutamol øker pulsen via stimulering av beta-reseptorer i sinusknuten (0.5 poeng). Stigningshastigheten på pacemakerpotensialet øker (0.5 poeng). Aktivering av kalsiumkanalen via beta-reseptor, AC, G-protein og PKA (0.5 poeng). Direkte aktivering av ionekanalen If via beta-reseptor og G-protein/alfas, ikke via AC, cAMP, PKA (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Bruken av legemidlet salbutamol (Ventoline) hos idrettsutøvere uten lungesykdom er omdiskutert, særlig bruken av høye doser. Ved terapeutisk konsentrasjon stimulerer stoffet primært beta-2-adrenerge reseptorer. Ved høye doser stimuleres også beta-1-adrenerge reseptorer. Disse egenskapene har betydning for å forstå effekter og mulige bivirkninger av medikamentet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av salbutamol i hjertemuskelcellene utenom ledningssystemet, samt signalveien fra reseptor til den cellulære effekten. Hvilken virkning har stoffet på hjertemuskelcellenes kontraksjon og relaksasjon, og hvilke molekyler er involvert i disse biokjemiske signalveiene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Salbutamol øker hjertemuskelcellenes kontraktilitet / inotropi (0.5 poeng) og relaksasjonshastighet / lusitropi (0.5 poeng) ved å stimulere beta-adrenerge reseptorer i cellemembranen. Første del av signalveien er som beskrevet i deloppgave 1. Når salbutamol aktiverer beta-reseptorene, spaltes det GTP-bindende proteinet G,,s,, og frigjør sub-enheten alfas som aktiverer enzymet adenylyl cyklase, øker den intracellulære konsentrasjonen av cAMP og aktiverer PKA.
Mekanismen for økt kontraktilitet / inotropi er at PKA aktiverer kalsiumkanalen ICa,L og gir en større innstrømning av kalsium (Ca) under aksjonspotensialet. Dette fører til større frisetting av Ca fra sarkoplasmatisk retikulum. Det gir større økning av den intracellulære Ca-konsentrasjonen, og dermed blir konsentrasjonen raskere og kraftigere (0.5 poeng).
Hovedmekanismen for økt relaksasjonshastighet / lusitropi er at PKA øker aktiviteten av transportenzymet kalsium-ATP-ase i sarko(endo)plasmatisk retikulum (SERCA) via regulatorproteinet fosfolamban. Dermed fjernes Ca raskere fra cytolsol, og relaksasjonshastigheten øker (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Økt kontraktilitet / inotropi (0.5 poeng) og økt relaksasjonshastighet / lusitropi (0.5 poeng). Mekanisme for økt kontraktilititet: Gs / alfas, AC, PKA, økt Ca-innstrømming over cellemembranen, økt Ca-frigjøring fra sarkoplamatisk retikulum (0.5 poeng). Mekanismen for økt relaksasjonshastighet / lusitropi er at PKA fosforylerer fosfolamban og dermed øker aktiviteten av SERCA (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Bruken av legemidlet salbutamol (Ventoline) hos idrettsutøvere uten lungesykdom er omdiskutert, særlig bruken av høye doser. Ved terapeutisk konsentrasjon stimulerer stoffet primært beta-2-adrenerge reseptorer. Ved høye doser stimuleres også beta-1-adrenerge reseptorer. Disse egenskapene har betydning for å forstå effekter og mulige bivirkninger av medikamentet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av salbutamol på glatt muskulatur i koronarkar og signalveien fra reseptor til den cellulære effekten. Hvilken virkning har stoffet på karmotstanden, og hvilke molekyler er involvert i den biokjemiske signalveien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Salbutamol reduserer strømningsmotstanden i koronarkar ved å relaksere glatt muskulatur i karveggen (0.5 poeng). Mekanismen (og poenggivningen) er ellers den samme som i [[deloppgave 1|IAB - 2017 - Oppgave 2]] om bronkialmuskulatur.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Salbutamol reduserer strømningsmotstanden i koronarkar ved å relaksere glatt muskulatur i karveggen (0.5 poeng). Aktivering av adenylyl cyklase via G-protein (0.5 poeng). Aktivering av PKA og fosforylering av MLCK (0.5 poeng). Hemming av MLC og redusert kontraktilitet (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I skjelettmuskelceller økes aktiviteten av transportenzymet natriumkalium-ATP-ase av salbutamol og andre stoffer som stimulerer beta2-adrenerge reseptorer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvilken effekt salbutamol har på ekstracellulær kaliumkonsentrasjon i muskelvevet og kaliumkonsentrasjonen i blodplasma, og angi mekanismen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Salbutamol reduserer ekstracellulær kaliumkonsentrasjon i musklene (0.5 poeng) og reduserer kaliumkonsentrasjonen i blodplasma (0.5 poeng) ved at beta-adrenerg stimulering øker aktiviteten av transportenzymet natrium-kalium-ATP-ase (NKA) i skjelettmusklenes cellemembran. Mekanismen er at NKA øker transporten av kalium inn i skjelettmuskelcellene. Siden skjelettmuskulaturen utgår en stor del av kroppens væskevolum, kan dette gi et betydelig fall i kaliumkonsentrasjonen i ekstracelluærveæsken og dermed også i blodplasma (1 poeng), opptil 1 mM. Denne effekten kan også opptre ved kraftig aktivering av det sympatiske nervesystem, f.eks. i akuttfasen av hjerteinfarkt og hjertesvikt. Og hypokalemien som derved oppstår, øker risikoen for alvorlige forstyrrelser av hjerterytmen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Redusert ekstracellulær kaliumkonsentrasjon i musklene (0.5 poeng) og reduserert kaliumkonsentrasjonen i blodplasma (0.5 poeng) / (hypokalemi). Økt kaliumtransport inn i skjelettmuskelcellene gir betydelig fall i kaliumkonsentrasjonen i ekstracelluærveæsken og dermed også i blodplasma (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I det norske helsevesenet er såkalt "aktiv dødshjelp" ikke tillatt, mens begrensning av livsforlengende behandling anses som både akseptabelt og endog ønskelig i enkelte situasjoner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du angi en eller flere grunner til at vi anser begrensning av livsforlengende behandling som vesensforskjellig fra aktiv dødshjelp?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ved begrensning av livsforlengende behandling dør pasienten av sin grunnsykdom. Ved aktiv dødshjelp tar legen livet av pasienten ved å injisere medikamenter, eller ved å gjøre tilgjengelig medikamenter som pasienten selv kan ta sitt liv med.
# I det første tilfellet er legens intensjon med ikke å igangsette/avslutte aktiv behandling, å la sykdommen gå sin gang. I det andre tilfelle er legens intensjon å drepe eller bidra til selvdrap.
# Vi anser det som en grunnleggende rettighet for alle pasienter i Norge å kunne nekte (ytterligere) behandling (med mindre det finnes gode grunner for tvang). Vi anser det ikke som en grunnleggende rettighet å kunne kreve at et annet menneske (legen) tar vårt liv eller hjelper med å ta vårt liv
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dette er tre varianter av riktig svar på oppgaven. Til sammen rommer de kjernen i det vi mener er en vesensforskjell mellom begrensning av livsforlengende behandling og eutanasi. 2 poeng gis til studentene som rimelig godt og presist klarer å beskrive denne kjernen. Redusert poengsum gis til studentene med mindre presise svar.
Til orientering: Begrepet "aktiv dødshjelp" rommer både "eutanasi" (legen tar livet av pasienten på pasientens forespørsel), og "legeassistert selvmord" (legen skriver ut medikamenter som vil ta livet av pasienten). Begge disse variantene av aktiv dødshjelp er tatt høyde for i svaret over.
Helt andre svar enn de som ligger i området 1-3 er vanskelig å se for seg kan gi poeng.
Studenter som f.eks. svarer at de ikke ser noen forskjell på de to situasjonene, får ikke poeng. Spørsmålet er ikke hva studentene selv mener, men hva det offisielle "vi" mener. Dette "vi"-et kommer til uttrykk gjennom norsk lovregulering, praksis, retningslinjer og veiledere
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du gi noen eksempler på når begrensning av livsforlengende behandling kan være en aktuell problemstilling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Begrensning av livsforlengende behandling er et aktuelt spørsmål når (1) pasienten ber om det og/eller (2) behandlingen forlenger en plagsom dødsprosess eller forlenger et liv med store plager.
Utdyping:
En "døende" pasient har en særskilt rett i loven til å motsette seg behandling. Det betyr at pasientens ønske om å avslutte/avstå fra aktiv behandling, er en akseptabel grunn i seg selv (pasientautonomi). I tillegg vil alle situasjoner hvor aktiv behandling forlenger en plagsom dødsprosess eller forlenger et liv med store plager, være situasjoner hvor begrensning av livsforlengende behandling kan være aktuelt å diskutere.
Dersom pasienten selv ikke er kompetent, kan det være aktuelt å diskutere med pårørende – ikke primært for å finne ut hva pårørende ønsker, men for å forsøke å avklare nærmere hva pasientens ønske kan sies å være.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng gis når studenten trekker frem og kan forklare både dette med pasientens ønske (1 poeng) og dette med faren for å gjøre mer skade enn godt/forlenge en plagsom dødsprosess/overbehandle (1 poeng)
Det gir ikke poeng å trekke frem prioritering som begrunnelse. Diskusjonen om begrensning av livsforlengende behandling er ikke primært motivert utfra et prioriteringsønske, selv om ressursbesparelser er en mulig følge av begrensning av livsforlengende behandling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er det rimelig å hevde at pasientautonomi står sterkt i livets sluttfase i norsk helsetjeneste, selv om aktiv dødshjelp er forbudt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fordi det er mye fokus på pasientens vilje i livets sluttfase i norsk helsetjeneste. Det er laget en egen veileder for begrensning av livsforlengende behandling hvor vilje og valg står helt sentralt.
Videre vektlegges det i norsk lovverk at all behandling i utgangspunktet skal være samtykkebasert. Som om ikke det er nok, er det skrevet inn i lovverket at døende pasienter har en særskilt rett til å nekte livsforlengende behandling. Det er stor tradisjon for å lytte til pårørende når pasienten er inkompetent. Dette er også i den hensikt å få avklart pasientens egentlige vilje eller ønske om behandlingsvalg.
Generelt er det et økende fokus på uheldige sider ved overbehandling i livets sluttfase i helsevesenet både nasjonalt og internasjonalt (internasjonalt gjennom f.eks. Too-much-medicine-campaign), og dermed også pasienters rett og mulighet til å si nei til livsforlengende behandling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det vi kan forvente av studentene her, er at de kan si litt om at adgangen til å nekte behandling i livets sluttfase er ganske omfattende og at det er et uttrykk for en vektlegging av pasientautonomi – altså en verdsetting av pasienters vilje og deres valg. Full pott for en god beskrivelse av dette (jfr svaret over – men her må sensor bruke skjønn)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva legger man i helsetjenesten i begrepet "passiv dødshjelp", og hvorfor mener man at det er et uheldig begrep?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fordi man mener at begrensning av livsforlengende behandling ikke har noe med aktiv dødshjelp å gjøre. "Passiv" dødshjelp synes å fremstå som bare en annen variant av dødshjelp enn "aktiv". Bruker man dette uttrykket, synes det altså som om vi har akseptert en type dødshjelp, og da burde vi kanskje også akseptere den andre.
Begrensning av livsforlengende behandling handler offisielt om pasienters rett til å nekte behandling. Selv om døden blir en konsekvens, så er ikke tanken fra helsetjenestens side at man hjelper folk med å dø. Man aksepterer deres behandlingsvalg.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her må studentene først kunne si noe om hva som ligger i "passiv dødshjelp"-begrepet – at dette er det samme som vi i dag kaller begrensning av livsforlengende behandling. Videre må man kunne si noe om de uheldige sidene ved å benytte dette begrepet, som beskrevet ovenfor.
Har man begge disse elementene, gir det full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Formuler ett pliktetisk og to konsekvensetiske argumenter mot å legalisere aktiv dødshjelp
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Eksempler på pliktetiske argumenter:
* Legers oppgave er å redde liv, og det er prinsipielt galt at leger må bli drapsmenn
* Menneskelivet er ukrenkelig (argumentet finnes i religiøs og sekulær utgave)
Eksempler på konsekvensetiske argumenter:
* Legalisering kan lede til et press på eldre om at de aktivt bør avslutte livet
* Legalisering kan lede til utglidning i kriterier (slippery slope.. slik vi har sett i Nederland)
* Legalisering kan lede til et «kaldere» samfunn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det vesentligste at studentene har fått med seg forskjellen på pliktetiske argumenter (når noe kan sies å være galt i seg selv uavhengig av hvilke konsekvenser det evt får) og konsekvensetiske argumenter (hvor det avgjørende er hvilke negative konsekvenser som kan oppstå). Over er det listet noen eksempler på slike argumenter fra hver leir. Det er mange flere som kan anses å være relevante og riktige.
1 poeng gis når studenten åpenbart har fanget opp forskjellen mellom argumentasjonstypene, og full pott gis når også argumentene man har valgt å trekke frem er relevante
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svein Erik, 37 år, liker å holde seg i god form med løpetrening tre-fire ganger i uka. Han deltar jevnlig i både kortere og lengre bedriftsidrettsløp, opptil halvmaraton (21 km). Han er også nøye med kostholdet, særlig før lengre løp, etter at han en gang opplevde det som han beskriver som "å gå helt tom" under et halvmaratonløp, til tross for at han var i god form.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke næringsstoffer er det vi utvinner energi fra ved fysisk arbeid hos et ungt individ med et balansert kosthold?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi utvinner energi vesentlig fra fettsyrer og karbohydrat, i mye mindre grad fra aminosyrer så lenge kosten er tilstrekkelig og balansert. Ved langvarig faste vil imidlertid proteiner, bl.a. muskelproteiner (som det er mest av) brytes ned til aminosyrer og brukes til energi dannelse (ATP).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Både fettsyrer, karbohydrat (eventuelt spesifisert som glykogen og/eller glukose) og aminosyrer bør være nevnt. 1p for fettsyrer, 1 poeng for karbohydrater og 1 poeng for aminosyrer. Totalt 3 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svein Erik har grublet over årsaker til at han en gang følte at han ganske plutselig og uventet ble utmattet, "gikk helt tom", og måtte bryte løpet. Han mente at farten ikke var større enn det han fint skulle beherske.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort beskrivelse av sannsynlige årsaker knyttet til
energidannelsen i metabolismen som kan forklare at han ble
utmattet i løpet nevnt ovenfor.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved lengre løp utvinnes en stor del av energien ved oksidasjon av fettsyrer ved den såkalte β-oksidasjonen. I tillegg trengs metabolitter fra karbohydrat, særlig oksaloacetat (og acetyl-CoA), for å holde trikarboksylsyresyklus (TCA-syklus, også kalt Krebssyklus) fullt operativ i bl.a. hjerte- og skjelettmuskulatur. Allerede etter kort tids anstrengelse (~ 1 min eller mindre) må man bryte ned glykogen i muskulatur og lever for å få tilgang på tilstrekkelige mengder glukose til dannelse av oksaloacetat.
Ved lengre løp kan glykogenlagrene gå tomme og føre til mangel på oksaloacetat, hypoglykemi og en følelse av utmattelse. Dette skjer særlig i tilfeller der glykogenlagrene ikke er bygget opp ved tilstrekkelig KH-inntak før en langvarig anstrengelse. Laktat som dannes (i små til moderate mengder) transporteres tilbake til lever og bygges opp til glukose ved glukoneogenese, men dette er ikke tilstrekkelig for å oppnå energibalanse.
(NB! Det finnes selvsagt flere alternative forklaringer, alt fra dårligere fysisk form enn antatt til kronisk hjertelungesykdom og akutte tilstander av ulike slag, for eksempel infeksjonssykdom).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vite at energien utvinnes ved oksidasjon av fettsyrer ved lengre løp. 1 poeng for å vite at det er nødvendig å bryte ned glykogen etter kort tids anstrengelse. 1 poeng for å vite hva som er konsekvensene av at glykogen lagrene går tomme. 1 poeng for å vite at laktat transporteres tilbake til lever og bygges opp til glukose ved glukogenese. Totalt 4 poeng. Bra med fornuftige «alternative forklaringer», men det gir i seg selv ikke poeng slik spørsmålet er stilt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svein Erik har merket at både han selv og andre "puster og peser" i flere minutter etter spurter så korte som 100 m, mens han i liten grad gjør dette etter lange løp.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en biokjemisk-fysiologisk forklaring på forskjellene i respirasjonsmønster etter korte løp ("spurter") i forhold til lengre løp.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved korte spurter trengs så stor tilgang på ATP som mulig. ATP lagrene i cellene er ikke tilstrekkelig selv for korte spurter på for eksempel 100 m. Det trengs maksimal tilgang både på energibærende molekyler (fettsyrer og glukose), samt O,,2,, til aerobt stoffskifte. Fettsyreoksidasjon og aerob omsetning av glukose er imidlertid ikke tilstrekkelig, derfor omsettes også store mengder glukose ved glykolyse til store mengder pyruvat som omsettes videre til store mengder laktat. Ved dannelsen av laktat omsettes NADH + H^^+^^ til NAD^^+^^ som er nødvendig for å drive glykolysen. Uten NAD^^+^^ bremses glykolysen. Glykolysen er lite økonomisk i ATP-dannelsen i forhold til TCA-syklus koblet til aerob ATPdannelse. Men glykolysen er mye raskere enn TCA syklus og den totale mengden ATP som dannes anaerobt ved glykolyse blir derfor stor. Laktat er en syre som senker pH i blodet. Det dannes mye laktat ved kortvarig intens fysisk anstrengelse. I tillegg dannes det mye CO,,2,, som lungene trenger tid på å lufte ut. CO,,2,, fører til pH fall ved omsetning av CO,,2,, og H,,2,,O til H,,2,,CO,,3,, som dissosierer til HCO,,3,,^^-^^ og H^^+^^.
Det er altså pH fall pga. laktat og CO,,2,, som fører til høy respirasjon ved kortvarig anstrengelse.
Ved langvarig, mer moderat anstrengelse er stoffskiftet overveiende aerobt. Det er da balanse mellom anstrengelsen og aerob ATPdannelse og lungene bidrar til tilstrekkelig CO,,2,, utskillelse i
forhold til dannelsen. pH fallet blir derfor lite og pusten tilnærmet normal.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten bør ha hovedtrekkene i svaret rimelig forklart. Jeg forventer adskillig spredning i svarene som må vurderes i hvert tilfelle. (Svar bør kanskje utvides)
1 poeng for å vite at fettsyreoksidasjon og aerob omsetning av glukose ikke er tilstrekkelig ved korte spurter. 1 poeng for å vite at store mengder glukose omsettes ved glykolyse til store mengder pyruvat som omsettes videre til store mengder laktat. 0.5 poeng for å vite at ved dannelsen av laktat omsettes NADH + H^^+^^ til NAD^^+^^ som er nødvendig for å drive glykolysen. 0.5 poeng for å vite at ATP dannelse i glykolysen er lite økonomisk i forhold til TCA-syklus koblet til aerob ATP-dannelse. Men glykolysen er mye raskere enn TCA syklus og den totale mengden ATP som dannes anaerobt ved glykolyse blir derfor stor. Totalt 3 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En ung gutt har pustevansker. Det tas røntgen thorax og det påvises pneumothorax (luft i pleurahulen) på venstre side. Pasienten er såpass påvirket at man velger å legge inn dren i pleurahulen lateralt på thoraxveggen som behandling
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke strukturer går drenet igjennom på vei inn i pleurahulen fra hud til pleurahulen? Strukturene benevnes i riktig rekkefølge fra hud mot lunge.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fortløpende fra hud: subkutis-den dype fascie (fascia profunda, som også representerer musklenes epimysium)-m. intercostalis externus- m. intercostalis internus- m. intercostalis intimus-den endotorakale fascie-pleura
parietalis.
Nb! Avhengig av hvor man stikker vil andre muskler også kunne bli gjennomstukket, mest aktuelt for musculus serratus anterior, men dette ligger ikke inn under oppgaven
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hud gir ikke poeng, oppgitt i tekst. 0.5 poeng for hver anatomisk struktur, bortsett fra den dype fascie og den endotorakale fascie som til sammen gir 0.5 poeng. Mangel av den ene av disse gir ikke trekk, men mangel av begge gir altså 0.5 poeng trekk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En ung gutt har pustevansker. Det tas røntgen thorax og det påvises pneumothorax (luft i pleurahulen) på venstre side. Pasienten er såpass påvirket at man velger å legge inn dren i pleurahulen lateralt på thoraxveggen som behandling
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Legen som legger drenet velger å stikke like i overkant av
ribbenet. Hvilke(n) anatomisk(e) struktur(er) i intercostalrommet
vil han unngå å skade ved å stikke like i overkant av ribbenet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den nevrovaskulære bunten som består av intercostalvenen,- arterien og -nerven. Disse forløper rett i underkant av overliggende ribben, dels i sulcus costae.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per struktur (nerve, vene, arterie). Nevner man bare en av de tre gir dette 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ben inngår i det som kalles thoraxveggen (brystkasseveggen) inkludert anteriore, posteriore og lateralte deler?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
12 thorakale ryggvirvler (vertebrae), 12 ribben (costae), sternum med manubrium, corpus og processus xiphoideus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng hver for vertebrae, costae og sternum, men det trekkes ikke om antallet ikke oppgis. Ikke trekk for å nevne scapula eller clavicula, selv om disse ikke er med og danner thoraxveggen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken muskel er hovedmuskelen for respirasjon og hvilken nerve innerverer denne muskelen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diaphragma (mellomgulvet)
Nervus phrenicus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige oppgave:
<<<
Hvilken muskel er hovedmuskelen for respirasjon og hvilken nerve innerverer denne muskelen?
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke(t) nerverotsnivå i ryggmargen kommer denne nerven fra og hvordan forløper den i thorax frem til denne hovedrespirasjonsmuskelen? (Hovedtrekkene i forløpet i thorax)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den kommer fra tredje til femte cervikale nerverot (C3-C5, hovedsakelig C4).
Forløp i thorax: Den forløper på fremsiden av m. scalenus anterior, bak v. subclavia, foran lungeroten mellom det fibrøse pericard og pleura paietale pars mediastinalis ned til diaphragma
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Utspring gir 1.5 poeng. Nevner man plexus cervicalis gir dette 1 poeng, men nivået er det mest ønskelige svar. Den mottar også en mindre andel fibre fra cervicale deler av plexus brachialis, men dette gir ikke poeng.
Forløp: Det viktigste her er å skjønne at den må gå ned i gjennom mediastinum, mellom mediastinums pleura parietalis og pericardium parietale for å komme seg ned til diaphragma. Har man skjønt dette prinsipp gis det 0.5 poeng. Mer detaljerte forløp er ikke nødvendig for denne besvarelsen. Det er også noe ulikt forløp av venstre og høyre nervus phrenicus, men dette er ikke nødvendig for full uttelling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Maja er en 24 år gammel kvinne adoptert til Norge fra Korea som småbarn. Hun kommer til Gastrolab for kolonoskopi (undersøkelse av tykktarmen). Bakgrunnen for henvisningen er plager over de siste 10 år i form av mye tarmgass og knipaktige magesmerter. Disse plagene har økt på de siste 2-3 årene og hun har også fått temmelig løs avføring. I perioder kan avføringen være tyntflytende og tømmingen nærmest eksplosiv. Hun ser ikke blod eller slim i avføringen.
Pga hennes genetiske bakgrunn mistenker legen at Majas tilstand kan ha sammenheng med intoleranse for melk, og han rekvirerte en laktosebelastning-prøve. Ved denne undersøkelsen drikker pasienten en mengde laktose (50 g for en voksen person) og det tas blodprøver med måling av glukose på bestemte tidspunkter etter inntaket.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hos pasienten fant man ingen økning i glukose-nivå i blodet etter inntak av laktose,- kravet for normalitet er en stigning i blodglukose i løpet av de 2 timene etter laktoseinntak på minimum 1.8 mmol/l. Hva kan være årsaken til at Majas blodglukose ikke øker etter inntak av laktose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Negativ laktosebelastningstest gir diagnosen laktoseintoleranse. Laktose kan ikke tas opp i cellene i tynntarmen, men må spaltes av intestinal laktase. Dette er et enzym som sitter i den luminale membranen av epitelcellene i tynntarmen og spalter laktose til galaktose og glukose hvoretter disse transporteres inn i cellen via spesifikke opptaksmekanismer.
0.5 poeng for å vite at laktose må spaltes (til glukose og galaktose) for opptak og 0.5 poeng for å nevne laktase
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt mulig 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Laktose er det dominerende melkesukkeret.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er et monosakkarid og nevn et eksempel på et slikt molekyl?
# Hva er et disakkarid og nevn et eksempel på et disakkarid?
# Hva er et polysakkarid og gi et eksempel på et slikt molekyl?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Monosakkarid; den enkleste typen karbohydrat, består av ett sukkermolekyl, f.eks glukose eller galaktose
# Disakkarid; to monosakkarider kovalent bundet sammen, f.eks laktose
# Poly-sakkarid; polymerer av karbohydrater som består av en kjede av mono eller disakkarid enheter, f.eks glykogen, stivelse, cellulose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delspørsmål gir 1 poeng, dvs totalt 3 poeng mulig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Glukose fra blodet tas opp i celler slik at cellene danner ATP som kan drive mange cellulære prosesser. Elektroner fra glukose transporteres ved såkalte elektronbærere som reduseres og oksideres i prosessene som fører til dannelse av ATP
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn den reduserte formen av to slike elektronbærere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Riktige svar kan være 2 riktige blant:
NADH, FADH,,2,,, NADPH, Ubiquinol (QH,,2,,), ev. Cytochrom C
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar, dvs totalt 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Acetyl-CoA (acetyl-Coenzym A) er et thioester som produseres i nedbrytning av glukose
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er Acetyl-CoA av så stor betydning også i metabolisme av andre stoffer enn glukose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetyl-CoA er et energirikt thioester som er viktig også ved nedbryting av fettsyrer (og andre lipider) og aminosyrer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng hvis både fettsyrer/lipider og aminosyrer er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
ATP genereres ved elektrontransport og oksidativ fosforylering i cellene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan fører elektrontransport til generering av ATP?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Elektrontransporten utnyttes til å pumpe protoner (H^^+^^) ut av lumen (matrix) av mitokontriene. Dette fører til en konsentrasjonsforskjell (ca 10x) i H^^+^^ mellom matrix (lumen) og rommet mellom indre og ytre membran ("intermembrane space") i mitokondriene. H^^+^^ kan bare strømme tilbake til matrix (utligne konsentrasjonsforskjellen) ved å passere gjennom protonspesifikke kanaler (F,,o,,). Disse kanalene er koblet sammen med en ATP syntase (kompleks V) som utnytter energifrigjøringen ved at H^^+^^ strømmer tilbake til å syntetisere ATP fra ADP.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.5 p for å nevne at elektrontransporten fører til H^^+^^-gradient over matrix membranen og 1.5 poeng for å nevne ATP syntasen og hva denne gjør, til sammen 3 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har en pasient som i lengre tid har hatt betennelsessykdommen Crohns sykdom med affeksjon av hele tynntarmen. På grunn av dette har pasienten malabsorpsjon og har fått påvist beinskjørhet (osteoporose).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den generelle oppbyggingen av slimhinnen i tynntarmen og forklar hva hensikten er med nettopp en slik oppbygging
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tynntarmslimhinnen har et stort antall sirkulære folder (plicae circulares) inn mot lumen av tarmen. På overflaten av foldene er det videre en mengde tarmtotter (villi intestinales) som er dekket av et enlaget sylinderepitel (enterocytter) som på den apikale (luminale) siden er tettepakket med mikrovilli ("brush border"). Opp i tarmtottene går det et nettverk av blod- og lymfekar. Det går også tubulære kjertler eller krypter fra basen av tarmtottene og ned til muskularis mucosa. Mellom disse kjertlene finner vi lamina propria med bindevev, bindevevsceller og immunceller.
<<imgLink "IAB-2017s-3-A.PNG">>
Hovedhensikten med en slik oppbygging er å øke overflaten mest mulig for kontakten mellom lumeninnholdet og slimhinnen slik at effektiviteten av både fordøyelses- og absorpsjonsprosesser øker
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippet og ha med de viktigste momentene;
* Plica (0,25), villi (0,25), enlaget sylinderepitel (0,25), mikrovilli (0,25), nettverk blod-lymfeårer i villi (0,25), lamina propria (0,25) – 1,5p
* Øker overflaten (0,5) for mest mulig effektiv fordøyelse og absorpsjon (0,5) – 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan kalsium absorberes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kalsium absorberes via to parallelle prosesser; en aktiv transcellulær (gjennom enterocyttene) hovedsakelig i duodenum, og en passiv paracellulær (mellom enterocyttene) i alle deler av tynntarmen. Den aktive transporten involverer opptak via kalsiumkanalen i den luminale cellemembranen i enterocyttene, transport gjennom enterocytten ned den intracellulære elektrokjemiske gradienten bundet til kalsiumtransportproteinet calbindin, og ut av cellen via en kalsiumATPasepumpe
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippet og ha med de viktigste momentene;
* Aktiv absorpsjon gjennom celler i øvre del – 0,5p
* Passiv absorpsjon mellom celler hele tynntarm – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket vitamin er viktig for denne absorpsjonen [av kalsium] og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vitamin D er viktig for den aktive kalsiumabsorpsjonen ved at vitamin D er nødvendig for å ha nok calbindin i enterocyttene. Den intracellulære konsentrasjonen av calbindin er det hastighetsbestemmende trinnet i kalsiumabsorpsjonen. Vitamin D øker genuttrykket av calbindin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Vitamin D – 0.5p
* Regulerer mengden calbindin – 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten var også plaget med halsbrann og sure oppstøt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvordan sekresjon av magesyre reguleres og hvilke viktigste signalsubstanser som er involvert.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vagusnerven stimuleres av tanke, syn, lukt osv (=cephalisk fase) og stimulerer parietalceller direkte via acetylcholin (og også ECL celler via mediatorer som PACAP fra det enteriske nervesystemet, og også G-celler og D-celler enten direkte og/eller indirekte via enteriske nervesystem). G-celler i antrumdelen av magesekken er normalt under hemming av den sure pH i magesekken. "Måltid" stimulerer G-celler ved at maten nøytraliserer pH og ulike komponenter i maten, spesielt peptider, stimulerer cellene direkte. G-celler produserer hormonet gastrin som skilles ut i blodbanen og når corpusdelen av magesekken, der det stimulerer ECL celler til å skille ut histamin. Histamin virker hovedsakelig parakrint på parietalceller og stimulerer til syresekresjon. Økt mengde magesyre (H^^+^^ ioner, synkende pH) virker så inhiberende tilbake på prosessen (=negativ feedback), hovedsakelig ved å stimulere antrale D-celler til å skille ut somatostatin som inhiberer G-celler
<<imgLink "IAB-2017s-3-B.PNG" 400>>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippet og ha med de viktigste momentene;
* Acetylcholin fra vagus før/ved måltid – 0,5p
* Måltid nøytraliserer pH og stimulerer gastrin – 0,5p
* Gastrin fra G-celler i antrum stimulerer ECL/histamin – 0,5p
* Histamin fra ECLceller i corpus stimulerer parietalceller i corpus – 0,5p
* Prosessen stoppes ved negativ feedback av økt syre på gastrinutskillelsen – 0,5p
* Somatostatin (fra D-celler) inhiberer syresekresjon – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket hormon skilles ut, og fra hvor, når det kommer innhold med lav pH til duodenum?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hormonet er sekretin som produseres i enteroendokrine S-celler i tarmslimhinnen i duodenum og jejunum.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Hormonet er sekretin – 0.5p
* Fra s-celler/enteroendokrine celler i tynntarmslimhinnen – 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige spørsmål:
<<<
Hvilket hormon skilles ut, og fra hvor, når det kommer innhold med lav pH til duodenum?
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilken virkning dette hormonet har på fordøyelsen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sekretin skilles ut i blodet (portasirkulasjonen) når cellene registrerer lav pH i tarmlumen, og hormonet stimulerer sekresjon av bikarbonat og vann fra pankreasgangepitelet. Dette nøytraliserer det sure innholdet (pga magesyren) som kommer fra magesekken, og gir dermed riktig og nødvendig ph for at alle fordøyelsesenzymene fra pankreas kan virke.
Hormonet har dermed den effekten at det tilrettelegger og øker spalting (fordøyelse) av alle de tre viktigste næringsstoffene - både karbohydrater (amylase), fettstoff (lipase, ko-lipase, fosfolipase, esterase) og protein (proteaser som trypsin, chymotrypsin, karboksypeptidase, elastase)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippet og ha med de viktigste momentene;
* Stimulerer sekresjon av bikarbonat og vann fra pankreas(gangepitel) – 0,5p
* Dette nøytraliserer pH – 0,5p
* Viktig for virkning av pankreasenzym som bidrar til nedbrytning av alle de viktigste næringsstoff – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 70 år gammel mann med kjent kols (som er en obstruktiv lungesykdom) kommer til Mottakelsesavdelingen på St Olavs Hospital fordi der har inntrådt en forverring av tilstanden. Han har betydelig dyspne (tungpust) og må legges inn. Der tas bl a arteriell blodgasser som uten oksygentilførsel viser forhøyet PaCO2 7,1 kPa (øvre grense er 6,0 kPa) og noe nedsatt PaO2 8,1 kPa (nedre grense ikke under 10,0 kPa for en mann på denne alderen).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles denne typen respirasjonssvikt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette er en type 2 respirasjonssvikt (ventilasjonssvikt)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å nevne type 2 respirasjonssvikt. (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hovedstimulus for ventilasjonen og hvor er hovedsetet for denne reguleringen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hovedstimulus for økt ventilasjon er forhøyet PaCO2, setet for denne reguleringen er de sentrale kjemoreseptorene i medulla oblongata (den forlengete marg). PaCO2 passerer blod – hjernebarrieren og fører til senket pH (altså økt H^^+^^) i cerebrospinalvæsken. Økt H^^+^^ stimulerer sentrale reseptorer og gir økt ventilasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Høy PaCO2 som hovedstimulus gir 1.5 poeng, at PaCO2 passerer til CNS og stimulerer (via økt H^^+^^) gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor sitter de perifere kjemoreseptorene? Hva responderer de primært på og hvordan?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De sitter ved aortabuen og ved delingen av arteria carotis (carotisbifurkaturen)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nevne aortabuen 0.5 poeng, nevne carotis 0.5 poeng, at de responderer på hypoksemi med økt ventilasjon gir 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<<
En 70 år gammel mann med kjent kols (som er en obstruktiv lungesykdom) kommer til Mottakelsesavdelingen på St Olavs Hospital fordi der har inntrådt en forverring av tilstanden. Han har betydelig dyspne (tungpust) og må legges inn. Der tas bl a arteriell blodgasser som uten oksygentilførsel viser forhøyet PaCO2 7,1 kPa (øvre grense er 6,0 kPa) og noe nedsatt PaO2 8,1 kPa (nedre grense ikke under 10,0 kPa for en mann på denne alderen).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er potensiell fare med å gi ukontrollert oksygentilførsel til en slik pasient?
# Og hva er mekanismen bak denne potensielle faren?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man tenker seg at pasienten er tilvent høy PaCO2 slik at dette ikke lenger er det sentrale stimulus for ventilasjon. Da får lav PaO2 en sterkere rolle her enn til vanlig (pasienten "puster på lav PaO2"): Ved å gi ukontrollert oksygentilførsel kan man risikere og ta bort "driven" for ventilasjonen hos disse pasientene slik at de ventilerer (puster) enda dårligere med ytterligere økende PaCO2 som konsekvens.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Å nevne at faren er at man ved ukontrollert oksygentilførsel får ytterligere CO,,2,,-stigning og risikerer å gli inn i CO,,2,,-narkose gir 1 poeng
# Å nevne at ventilasjonen hos disse drives av lav PaO2 og at man ved å gi ukontrollert O,,2,, risikerer å ta bort lav oksygen som stimulus til ventilasjonen hvilket resulterer i ytterligere CO,,2,,-stigning gir 1.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det som spirometrisk karakteriserer en obstruktiv ventilasjonsinnskrenkning? Og hvilket typisk utseende har flow-volumkurven ved en obstruktiv ventilasjonsinnskrenkning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Per definisjon nedsatt FEV1/FVC < 0.70. Flow – volumkurven har typisk "hengekøypreget" utseende (ev. "salryggpreget" utseende.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for FEV1/FVC < 0.70 og 1 poeng for å nevne at "hengekøypreg" av flow-volumkurven er det typiske utseende
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ei 78 år gammel kvinne kom haltende inn på sykehusets akuttmottak et døgn etter at hun hadde falt og slått seg i venstre hofte. Seks måneder tidligere hadde hun hatt en bruddskade gjennom samme sides trochanter major, og var den gang blitt behandlet med innsetting av plate på femur og skrue gjennom bruddstedet. Operasjonen hadde gått greit og bruddet var grodd. Røntgenbilde viste nå bakoverforskyvning (luksasjon) av caput femoris (A). Ved undersøkelsen var det tydelig at venstre underekstremitet var forkortet og innoverrotert, og pasienten klaget over smerter i venstre hofte.
<<imgLink "IAB-2018-1-A.PNG">>
Pasienten ble klargjort for operativ behandling for å redusere forskyvningen av caput femoris. Blodprøvene tydet imidlertid på infeksjon, og under perasjonen fant kirurgen at det var betennelsesforandringer i hofteleddet. En del av caput femoris var erodert. Noe vevsmateriale ble sendt til undersøkelse, og det ble bekreftet at det forelå en betennelse, og det kom oppvekst av bakterier. Etter at alle plater og skruer var fjernet, ble pasienten lagt i beinstrekk og fikk antibiotikabehandling i seks uker. Deretter ble hun operert på nytt og fikk satt inn totalprotese i hofteleddet (B). Ved kontroll tre år etterpå kunne hun gå uten smerter og uten å halte, og det var ingen kliniske eller laboratoriemessige tegn til infeksjon.
<<imgLink "IAB-2018-1-B.PNG">>
//(Kasusbeskrivelse og røntgenbilde er fra Tzurbakis et al.: Deep wound
infection after a trochanteric fracture internal fixation presenting with
hip dislocation, Cases Journal, 2010;3:19)//
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er forskjellen på symptomer og kliniske funn? Hvilke symptomer og kliniske funn ville du ha notert i denne pasientens journal ved innkomst?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Symptom:'' Det pasienten subjektivt oppfatter (smerter i ve hofte, problemer med å gå, etc.)
''Kliniske funn:'' Det legen observerer, måler og finner ved undersøkelse (forkortet og utadrotert underekstremitet, evt. inflammasjonsfunn lokalt, smerter ved palpasjon, etc.).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekt definisjon på symptomer og kliniske funn (1 poeng).
Korrekte eksempler på hver av dem (½ poeng).
</$details>
Neste: [[IAB - 2018 - Oppgave 1 - Del 2]]
Forrige: [[IAB - 2018 - Oppgave 1]]
!! Vignett
Brudd i lårhalsen er svært vanlig hos eldre personer. Hos noen pasienter ser vi at caput femoris går til grunne på grunn av manglende blodtilførsel etter slike brudd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan forsynes caput femoris med blod? Hvilken egenskap ved bruddet er avgjørende for om det skal føre til ødeleggelse av caput femoris?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dels gjennom arterie i lig. capitis femoris (ramus acetabularis fra a. obturatoria), dels ved arterier gjennom kapselen (a. circumflexa femoris lateralis og – medialis fra a. profunda femoris) som så følger arterier i beinvevet langs collum femoris til caput femoris. Ved brudd medialt for kapselens tilhefting på femur, vil caput bli avhengig av tilførsel gjennom lig capitis femoris, noe som kan være utilstrekkelig, slik at caput nekrotiserer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To ulike blodforsyninger:
- Fra lig. capitis femoris = ½ poeng.
Fra to cirkumflex-arterier langs femur gjennom kapselen = ½
poeng.
</$details>
Neste: [[IAB - 2018 - Oppgave 1 - Del 3]]
Forrige: [[IAB - 2018 - Oppgave 1 - Del 2]]
!! Vignett
Pasientens brudd gikk gjennom trochanter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskrive hvordan de to trochanterene på femur er lokalisert, og angi de viktigste muskelgruppene som er festet på disse og disse muskegruppenes funksjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Trochanter major ligger lateralt på øvre ende av femurskaftet. Feste for den dype gluetal-/hofteleddsmuskulaturen, dvs. hofteleddets viktigste abduktorer, ekstensorer og utadrotatorer (mm. glutei minimus, medius og utoverrotatorer: m. piriformis,
mm obturatorii (m./mm. gemelli), mens m. quadratus femoris fester mellom trochanter major og minor (crista intertrochanterica). I tillegg er trochanter major utspring for m. vastus medialis.
Trochanter minor ligger medialt på øvre ende av femurskaftet, like under overgangen til collum. Dette er festet for m. iliopsoas, den viktigste fleksormuskelen i hofteleddet.
I tillegg til de ulike bevegelsene, er all denne muskulaturen også med å stabilisere hofteleddet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Trochanter majors lokalisasjon (lateralt + øvre ende av femurskaftet) = ½ poeng.
Musklene som er festet på trochanter major er den dype gluteal-/hofteleddsmuskulaturen som abduserer, utadroterer og ekstenderer hoften = ½ poeng.
Trochanter minors lokalisasjon (medialt + øvre ende av femurskaftet) = ½ poeng.
M. iliopsoas som er festet på trochanter minor flekterer hoften = ½ poeng.
</$details>
Neste: [[IAB - 2018 - Oppgave 1 - Del 4]]
Forrige: [[IAB - 2018 - Oppgave 1 - Del 3]]
!! Vignett
Pasientens tidligere bruddskade hadde grodd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort den stegvise reparasjonsprosessen fra beinbrudd til tilhelet beinvev.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hematom, med erytrocytter, leukocytter og fibrinutfelling.
# Innvekst av blodkar/endotel, fibroblaster/osteoprogenitorceller fra periost og beinmarg (første uke) og omdanning av fibrøst bindevev til brusk-kallus.
# Omdanning av brusk-kallus til beinvev ved syntese av osteoid og utfelling av kalk (primært beinvev) (måneder).
# Remodellering av beinvevet til lamellært beinvev ved osteoklast- og osteoblast-aktivitet (flere år).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for korrekt beskrivelse av hvert punkt.
</$details>
Neste: [[IAB - 2018 - Oppgave 1 - Del 5]]
Forrige: [[IAB - 2018 - Oppgave 1 - Del 4]]
!! Vignett
<<imgLink "IAB-2018-1-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
De hvite pilene på røntgenbildet peker på fire mørke linjer som markerer tre ulike ledd. Hva heter disse leddene og hvilke beinstrukturer inngår i disse leddene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Artt. sacroiliacae: Os sacrum og ossa ilii.
# Art. coxae: Femur (caput) og acetabulum (ossa ilii, ischii, pubis)
# Symphysis pubis: Synchondrose mellom ossa pubis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for korrekt navn og beskrivelse av hvert ledd
</$details>
Neste: [[IAB - 2018 - Oppgave 1 - Del 6]]
Forrige: [[IAB - 2018 - Oppgave 1 - Del 5]]
!! Vignett
I påvente av at infeksjonen skulle bli slått tilbake, ble pasienten lagt i beinstrekk, dvs. en metallpinne gjennom tuberositas tibiae festet til et vektsystem som trekker femur i distal retning. Dette gjøres for å motvirke sammentrekning av de musklene som ellers ville ha ført til ytterligere forkortelse av underekstremiteten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke funksjonelle muskelgrupper strekker seg over hofteleddet og dermed kan forkorte underekstremiteten ved brudd? Hvilke nerver innerverer disse muskelgruppene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Abduktorer/ekstensorer: Mm. glutei maximus, medius, minimus, m. tensor fasciae latae (nn. glutei).
# Adduktorer: Mm. adductores brevis, longus, magnus, m. pectineus, m. gracilis (n. obturatorius (for m. pectineus er det vanligvis n. femoralis))
# Fleksorer: M. iliopsoas. Innervasjon: Mm. psoas major et minor: Fremre greiner fra plexus lumbalis (L1-3); m. iliacus: n. femoralis – L2-4). I tillegg de som strekker seg fra hofte til tibia: M. sartorius, m. rectus femoris (n. femoralis).
# Hasemuskler (ekstensorer): Mm. biceps (caput longum), semitenidosus, semimembranosus (n. ischiadicus).
Flere av disse gruppene er også involvert i utad-/innadrotasjon uten at dette er spesifisert her.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for korrekt angivelse av de fire hovedmuskelgruppene som strekker seg over hofteleddet (ekstensor-, adduktor-, fleksor- og ekstensorgruppen med noen av de viktigste musklene i hver gruppe nevnt) og korrekt innervasjon for hver av gruppene.
</$details>
Oversikt IAB: [[IAB]]
<div class="oppgave">
<div class="vignett">
!!Vignett
En 25 år gammel kvinne bringes bevistløs til akuttmottaket av kjæresten. Hun driver med «bodybuilding» og «fitness» og har tatt to «slankepiller» for å oppnå et hurtig vekttap før en
konkurranse. Hun klaget over hodepine, feber, brystsmerter, kraftig svetting og slapphet. Funn ved ankomst i akuttmottaket er kroppstemperatur 40,8^^o^^C, puls 151, respirasjonsfrekvens 56 pr. min., og blodtrykk 40/10. Livet hennes var ikke mulig å redde og hun dør 15 min etter ankomst i akuttmottaket. Hennes kroppstemperatur fortsetter å øke til 46^^o^^C 15 min etter døden. I ettertid ble det klart at hun hadde fått «slankepillene» fra en venn. Og det viste seg at virkestoffet i disse pillene var 2,4-dinitrofenol.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
2,4-dinitrofenol er en proton-ionofor, dvs et stoff som binder og kan overføre protoner over cellemembraner. Dette fører til at protongradienten over den indre mitokondriemembranen reduseres. Hvorfor kan inntak av dette stoffet føre til temperaturtigning hos kvinnen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
2,4 dinitrophenol vil ødelegge protongradienten over den indre mitokondriemembranen, og dermed redusere ATP (Adenosine Trifosfat) produksjonen ved oksidativ fosforylering. I stedet for å generere ATP går energien som normalt omdannes til ATP i Krebs-syklus og ved oksidativ fosforylering tapt som varmeproduksjon, dvs energien omdannes til varmeenergi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for å nevne at protongradienten over den indre membranen er nødvendig for å generere ATP ved oksidativ fosforylering.
0.5 poeng for å nevne at når energien ikke går til ATP-produksjon omdannes denne i stedet til varmeenergi.
Totalt mulig 1 poeng
</$details>
Neste: [[IAB - 2018 - Oppgave 2 - Del 2]]
<div class="oppgave">
<div class="vignett">
!!Vignett
Acetyl-CoA (acetyl-Coenzym A) er et thioester som produseres i nedbrytning av glukose
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* Hva er et koenzym?
* Hva er en prostetisk gruppe?
* Hva er et vitamin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Koenzym: Kjemisk stoff (ko-faktor) som ikke er et protein, men som er nødvendig for aktiviteten til et enzym.
Prostetisk gruppe: Kofaktor/koenzym som er kovalent bundet til et enzym.
Vitamin er en organisk forbindelse som er et vitalt næringsstoff som en organisme trenger.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delspørsmål gir 1 poeng, dvs totalt 3 poeng mulig.
</$details>
Forrige: [[IAB - 2018 - Oppgave 2 - Del 2]]
<div class="oppgave">
<div class="vignett">
!!Vignett
Energien i glukose omdannes til ATP ved oksidasjons- og reduksjons-reaksjoner i nedbrytning av glukose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva menes med oksidasjons- og reduksjons-reaksjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Oksidasjon av et stoff innebærer fjerning av elektroner, enten elektroner alene eller i form av hydrogenatomer.
Reduksjon innebærer binding av elektroner, enten alene eller som H.
NAD^^+^^ (Nicotin Adenin Dinukleotid) er et oksiderende agens som binder elektroner (og H^^+^^) og dermed blir redusert. Denne reaksjonen resulterer i NADH som så kan bli oksidert ved å gi fra seg elektroner (og H^^+^^).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis kandidaten enten vet hva oksidasjon eller reduksjon er gis 2 poeng.
</$details>
Neste: [[IAB - 2018 - Oppgave 2 - Del 4]]
<div class="oppgave">
<div class="vignett">
!!Vignett
Acetyl-CoA (Coenzym A) er av stor betydning ved fullstendig omdanning av energien i glukose til ATP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er Acetyl-CoA av så stor betydning også i metabolisme av andre stoffer enn glukose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetyl-CoA er en energirik thioester som produseres også ved nedbryting av fettsyrer (og andre lipider) og aminosyrer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng hvis både fettsyrer/lipider og aminosyrer er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når celler har nok oksygen omdannes energien i glukose effektivt til ATP ved elektrontransport og oksidativ fosforylering.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan fører elektrontransport til generering av ATP?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Elektrontransporten utnyttes til å pumpe protoner (H^^+^^) ut av lumen (matrix) av mitokontriene. Dette fører til en konsentrasjonsforskjell (ca 10x) i H^^+^^ mellom matrix (lumen) og rommet mellom indre og ytre membran («intermembrane space») i mitokondriene. H^^+^^ kan bare strømme tilbake til matrix (utligne konsentrasjonsforskjellen) ved å passere gjennom proton-spesifikke kanaler (F,,o,,). Disse kanalene er koblet sammen med en ATP syntase (kompleks V) som utnytter energifrigjøringen ved at H^^+^^ strømmer tilbake for syntese av ATP fra ADP.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for å nevne at elektrontransporten fører til H^^+^^ gradient over matrix membranen og 1 poeng for å nevne ATP syntasen og hva denne gjør, tilsammen 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 51 år gammel kvinne har hatt anfall med gallekolikk i flere år og har påvist stein i galleblæra. Nå blir hun innlagt med vedvarende smerter, feber og klart avvikende svar på blodprøver rettet mot galleveier/lever.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv i korte trekk oppbygningen av galleveissystemet fra hepatocyttnivå til innløpet i duodenum.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kanalikuli mellom hepatocyttene, mikroskopiske intrahepatiske galleganger, intrahepatiske galleganger, høyre/venstre hovedgren, ductus hepaticus communis, ductus choledochus, papilla Vateri mot duodenum. Ductus cysticus med galleblære som vedheng til ductus choledochus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kanalikuli (0,5 poeng), intrahepatisk samlesystem (0,5 poeng), ductus choledochus (0,5 poeng), ductus cysticus med galleblære (0,5 poeng)
</$details>
Neste: [[IAB - 2018 - Oppgave 3]]
<div class="oppgave">
<div class="vignett">
!!Vignett
Blant mange andre prøver finner du at bilirubin i serum er betydelig forhøyet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ut fra bakgrunnsopplysningene om pasienten, hva er den mest sannsynlige årsaken til dette blodprøvesvaret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Stein har forlatt galleblæra, har kilt seg fast i ductus choledochus og blokkerer avløpet fra galletreet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir ett poeng
</$details>
Neste: [[IAB - 2018 - Oppgave 3 - Del 3]]
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
De fleste gallestein i Norge inneholder mye kolesterol. Forklar hvordan man tenker seg at kolesterolkrystaller og stein oppstår i galleblæra og hvorfor det sjelden skjer ellers i gallegangsystemet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kolesterol (lite vannnløselig) holdes i suspensjon i miceller hvor interfasen mot vann utgjøres av amfifatiske molekyler, stort sett gallesalter og noe fosfaditylcholin. Stein dannes ved et misforhold mellom kolesterolkonsentrasjon i gallen og mengde tilgjengelig gallesalt, kolesterol krystalliseres ut og begynner å danne stein.
Dette skjer i galleblæra fordi gallen er stillestående her over tid og gallen konsentreres opp 10-15x.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Micelleprinsippet (1 poeng), gallesalter som det primære amfifatiske elementet (1 poeng), stillestående og konsentrert galle som predisponerende (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er gallesaltenes rolle i fordøyelsen, og hva mener vi med enterohepatisk sirkulasjon av gallesalter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gallesalter sekreres fra hepatocytter til gallen og tømmes ut i tarmen ved måltid. Her deltar gallesaltene i emulsifering av fett, og danner etter spalting av komplekse fettmolekyler miceller med spaltingsproduktene inntil absorpsjon finner sted. Enterohepatisk sirkulasjon er at fri gallesalter tas opp av tynntarmslimhinnen
generelt (uspesifikt opptak), og gjennom et spesifikt opptaksystem i distale ileum og bringes tilbake til leveren gjennom v. portae for «gjenbruk».
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Emulsifering av fett og micelledannelse i tarm (1 poeng), gjenopptaksystemet og resirkulering til lever (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket gastrointestinalt reguleringspeptid (hormon) stimulerer tømming av galle og av pankreasenzymer til tarm?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cholecystokinin (CCK)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig hormon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den fysiologiske logikken i at galle og pankreasenzymer tømmes til tarm samtidig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spalting av fett (stort sett triglyserid) gjøres av pankreasenzymer, emulsifering av fettet bidrar til denne prosessen (større overflate, bl.a.).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Forståelse av sammenhengen mellom gallesaltenes emulsiferende effekt (stor overflate) og enzymaktivitet gir ett poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tora, en 76 år gammel kvinne, legges inn på sykehuset på grunn av økende tung pust de siste tre døgnene. Fra tidligere har hun kjent, stabil hjertesvikt.
Hun har av sin allmennlege vært vurdert til å være i NYHA funksjonsklasse II. (NYHA = New York Heart Association)
Det siste døgnet har hun opplevd tung pust ved moderate anstrengelser, hun har måttet stoppe opp og hvile for å "ta igjen pusten" etter å gått en etasje i trapp opp fra kjøkkenet til badet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken NYHA funksjonsklasse vurderer du at pasienten er i nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
NYHA funksjonsklasse III
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
NYHA-klassifisering av hjertesvikt er en standardisert måte for å karakterisere hjertesviktpasientenes funksjonsnivå.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de vanligste kardiovaskulære årsakene til hjertesvikt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Iskemisk hjertesykdom og hypertensjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Iskemisk hjertesykdom og hypertensjon gir 3 poeng.
Iskemisk hjertesykdom gir alene 2 poeng.
Andre årsaker som kan telle er kardiomyopatier, medfødte hjertefeil og arytmier.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten opplyser at hun de siste måneden har hatt episoder med følelse av hjertebank der hun har merket seg at pulsen har vært rask og uregelmessig. Ved palpasjon av pulsen i arteria radialis kan du bekrefte at hun har uregelmessig puls som varierer fra 110 til 140 pulsstøt per minutt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den primære supplerende undersøkelsesmetoden for å dokumentere mistanke om atrieflimmer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Elektrokardiogram = EKG
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle former for elektrokardiogram som er egnet til fremstille QRS-komplekser og å verifisere tilstedeværelse eller fravær av P-bølger og relasjonen til QRS-kompleksene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved auskultasjon over lungenes bakflater hører du tydelige fremmedlyder over basalflatene bilateralt. Du mistenker at det foreligger lungestuvning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den primære supplerende bildeundersøkelsen for å dokumentere mistanke om lungestuvning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen thorax
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Røntgen thorax er standardmetode og gir 2 poeng.
CT / MRI /ultralyd er alternative metoder og kan alene eller sammen gi inntil 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved auskultasjon over hjertet hører du uregelmessig hjerterytme, det er tydelige hjertetoner og du hører en tydelig systolisk bilyd av blåsende karakter, best hørbar over 3. intercostalrom til høyre for sternum. Du mistenker at pasienten har aortastenose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den primære supplerende undersøkelsesmetoden for å dokumentere mistanke om aortastenose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekkokardiografi med Dopplermodalitet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ultralyd av hjertet:
* Avbildingsmodus gir opplysning om klaffemorfologi
* Dopplermodus med måling av blodstrømshastighet gir kvantitativ opplysning om alvorlighetsgrad
Øvrige metoder som kan bekrefte mistanke, men som ikke gir full uttelling:
* Hjertekatereinsering kan benyttes, men er ikke førstevalg
* Røntgen CT kan gi noe opplysning om klaffemorfologi
* Røntgen thorax kan vise kalknedslag i klaffer, men er ikke tilstrekkelig for diagnose
* MR-avbilding gir opplysning om klaffemorfologi, men er ikke egnet for kvantitering
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kreftceller vokser uten å respektere ytre omgivelser eller indre betingelser som normalt skal gi celledød. Cellesyklus beskriver de ulike fasene cellen går gjennom under celledeling. Hva heter de fire fasene cellesyklus inndeles i? Bruk gjerne en skisse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fire faser inngår i cellesyklus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fire faser i cellesyklus: G1 -> S -> G2 -> M. Noen vil også inkludere G0 som en fase cellen går inn i fra G1, og som er en fase utenfor syklusen og hvor en celle kan oppholde seg på ubestemt tid. G står for «gap», S står for «syntese» og M står for Mitose. Opprinnelig var cellesyklus inndelt i to faser: Mitose (som var synlig i lysmikroskop pga kondensert kromatin) og Interfase, som var alt mellom hver mitose, altså G1+S+G2.
Figur 17-9 fra Alberts Molecular Biology of the Cell s 968:
<<imgLink "IAB-2018s-1-A.PNG" 500>>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
G1 (0,5), S (0,5), G2 (0,5), M (0,5)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedsjekkpunkter må cellen passere gjennom cellesyklus, hvor er de lokalisert i forhold til de fire fasene fra spørsmål 1, og hvilke faktorer sjekkes ved hvert sjekkpunkt? Bruk gjerne en skisse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De tre hovedsjekkpunktene som det fokuseres på i lærebøker og forelesning er følgende:
# G1/S (eller "start")
# G2/M
# Metafase-til-anafase
Navn på sjekkpunktet angir hvor i cellesyklus de er lokalisert/hvilken faseovergang de kontrollerer. For metafase-tilanafase er dette en overgang ca midtveis i M-fasen. Følgende faktorer sjekkes:
* Ytre faktorer -> G1/S
* Indre faktor: DNA-skade -> G2/M
* Indre faktor: Spindelapparat-sjekk, er alle kromosomer korrekt posisjoner, slik at to søsterkromatider går til hver sin spindelpol -> metafase til anafase
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sjekkpunkt:
* G1/S (0,5 poeng),
* G2/M (0,5 poeng),
* metafase-til-anafase (0,5 poeng)
Faktorer:
* Ytre faktorer -> G1/S (0,5 poeng)
* Indre faktor: DNA-skade -> G2/M (0,5 poeng)
* Indre faktor: Spindelapparat-sjekk (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket stoff i cellen ‘kondenserer’ i cellesyklus slik at det blir synlig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kromatin (kromatin = DNA + proteiner)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
DNA eller kromatin (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dersom en tar en suspensjon av celler kan fraksjonen som er i celledeling måles ved å måle mengde DNA per celle, f.eks ved hjelp av flow cytometri. Mengden DNA per celle kan se ut som i figuren under:
<<imgLink "IAB-2018s-1-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke deler av figuren representerer celler som med sikkerhet er under celledeling? Hvilke(n) cellesyklusfase(r) er disse cellene i?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cellene med mer enn normal mengde DNA er i celledeling, fordi de enten har fullstendig duplisert sett DNA (cellene omkring toppen til høyre) eller delvis duplisert sett DNA (cellene mellom venstre og høyre topp). Cellene i venstre topp kan i prinsippet også være i ferd med å dele seg, og kan ikke skilles fra celler i f.eks G0-fase i denne figuren. Cellene i høyre topp er enten i, G2-fase eller M-fase. Cellene i venstre topp er enten i G0 eller G1. Cellene mellom toppene er i S-fase.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Celler under celledeling: Høyre topp (1 poeng) og området mellom toppene (1 poeng).
G2 og M-fase for høyre topp: 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Cellesyklus koordineres av spesialiserte proteiner med nøye regulert aktivitet. En klasse proteiner kalt syklin-avhengige kinaser (Cdk) har en aktivitet som reguleres av sykliner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan regulerer sykliner aktiviteten til Cdk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mengden syklin regulerer aktivitet til gitte Cdk-proteiner. Cdkproteinene er konstant uttrykt, mens syklinet er ‘syklisk. F.eks vil Cyclin D (også kalt G1-syklin) binde Cdk4 og Cdk6 og aktivere disse, som er med på å føre cellen over G1/S-sjekkpunktet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mengden syklin regulerer aktivitet til gitte Cdk-proteiner (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hemostase trengs ved vaskulær diskontinuitet, f.eks et knivkutt. Dette forutsetter at trombocytter adhererer til skadestedet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 molekyler som er viktige for adhesjonen av plater
mot matrixproteiner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
von Willebrand faktor (vWF)
gp Ib:V:IX
gp Ia:IIa
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for vWF, ett poeng for hver av de andre. Dersom studenten svarer "integrin", men ikke de riktige navnene på gpene får hun 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I trombocyttenes granula er det blant annet mye Ca^^++^^ og ADP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er funksjonen til fritt Ca^^++^^ og ADP i hemostasen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ca^^++^^ bedrer funksjon av koagulasjonsfaktorene
ADP befremmer aggregasjon av trombocytter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for funksjonen av Ca^^++^^
1p for funksjonen av ADP
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Platepluggen holdes sammen (plate til plate) av et integrinmolekyl og fibrinogen. Hva heter dette integrinet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
gpIIb:IIIa
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Plateadhesjon-aktivering-aggregasjon står i nær sammenheng med plasmakoagulasjonen på skadestedet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Koagulasjonsfaktorene får svært mye bedre funksjon fordi platenes cellemembran endrer sine egenskaper drastisk. Hva skjer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cellemembranen hos ferdigaktiverte plater får negativ ladning pga at et fosfolipid, fosfatidylserin, vrenges på utsiden. Dette gir mye bedre funksjon av koagulasjonsfaktorene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tissue Factor (TF, vevsfaktor) produseres i fibroblaster og andre bindevevsceller som omgir blodkar. Når et blodkar kuttes kommer TF i kontakt med blod.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan befremmer TF hemostasen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den binder FVII og dette komplekset spalter FX.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Den binder FVII (1p) og komplekset spalter FX. (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 66 år gammel mann kommer på lungepoliklinikken fordi han har hatt økende tungpust ved anstrengelser siste 1-2 år. Han har vært fysisk aktiv og meget sprek og bl.a. gått Birkebeinerrennet flere ganger, men har nå store problemer med å holde følge med mindre aktive jevnaldrende f. eks. i motbakker. Han har aldri røkt. Undersøkelsene viser at han begynt å utvikle fibrose i lungene, og diffusjonsmåling viser at lungenes diffusjonskapasitet er nedsatt.
Diffusjonskapasiteten (diffusjonsevnen) for oksygen i lungene er en prosess som utgjør et av flere trinn som har betydning for gassvekslingen i kroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar med enkle ord hva diffusjon for oksygen i lungene innebærer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungenes diffusjonskapasitet for oksygen (O,,2,,) beskriver hvordan (hvor lett og uhindret) O,,2,, passerer fra lungenes alveoler og over i blodet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Overnevnte svar gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når oksygen diffunderer fra lungene og over i blodet, passerer gassen over en viktig anatomisk struktur. Hva heter den og hvordan er den bygd opp?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
På sin vei fra alveol-luften i lungene til blodbanen (lungekapillærene) passerer oksygenet den __alveolokapillære membran = den respiratoriske membran__. Den består av (fra alveolside til kapillærside) et lag __surfaktant__ (som ikke er en anatomisk del av membranen), et __epitellag__ (på alveolsidenalveolepitel), denne hviler på epitellagets __basalmembran__, så et passerer oksygenet et tynt __interstitie-sjikt__, så igjen en basalmembran (endotel-lagets basalmembran) og deretter et tynt lag __kapillær-endotel__. I den respiratoriske membran mangler ofte basalmembranen slik at epitel og endotel ligger mot hverandre. Membranen blir således svært tynn slik at avstanden som oksygen må diffundere ("diffusjonsveien") blir svært kort
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å vite navnet, 1 poeng for å redegjøre for oppbygning (fortsatt 1 poeng om man mangler et av lagene i oppbygningen).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anatomiske og fysiologiske forhold er bestemmende for lungenes gass-diffusjon (dvs for mengden oksygen som diffunderer)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Størrelsen av gassvekslings-arealet (dvs. den alveolokapillære membran) mellom alveol og kapillær.
# Veggtykkelsen fra alveol til erytrocytt (dvs. tykkelsen av den alveolokapillære membran) som er den distansen oksygenet må passere under dffusjon
# Drivtrykket for oksygen mellom alveol og blod, altså forskjellen i oksygentrykket i alveolen og i kapillærene. (oksygentrykket er høyest i alveolene slik at oksygen diffunderer fra alveol til blod).
# Tilgjengelig mengde hemoglobin i blodet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.75 poeng for hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Karbondioksyd diffunderer (forskjellig) mye lettere enn oksygen. Hvilken klinisk konsekvens har det ved nedsatt diffusjonskapasitet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved isolert nedsatt diffusjonskapasitet i lungene får man ofte okygenereringssvikt, men (omtrent) aldri problemer med å skille ut karbondioksyd.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vite at nedsatt diffusjon gir problemer med oksygenering, men at det fortsatt går greit å bli kvitt karbondioksyd som altså ikke hoper seg opp
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved lungesykdom er der i hovedsak to ulike patoanatomiske forhold som er av betydning ved nedsatt diffusjonskapasitet for oksygen i lungene. Hvilke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved lungesydommer som gir nedsatt diffusjonskapasitet for oksygen vil der enten foreligge fortykket __alveolo-kapillær membran__ (eks fibrose, oksygenet "får lenger vei å gå") eller så foreligger der redusert diffusjonsflate ved at alveoler og alveolkapillærer er destruerte hvilket gir en __redusert diffusjonsflate__ med også mindre kapillærnett til å motta oksygenet (eks emfysem).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for å nevne fortykket membran og 0,5 poeng for å nevne
redusert diffusjonsflate.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør skjematisk kort rede for hvilke trinn oksygentransporten omfatter helt fra vi puster inn til oksygenet blir tatt opp perifert i vevet/cellene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Oksygenet transporteres ved ventilasjonen fra atmosfæreluft og fordeles i luftveiene ut til lungenes alveoler.
# Deretter transporteres det ved diffusjon over alveolmembranen og til blodet hvor det bindes til hemoglobin i erytrocytene for videre transport.
# Videre transport skjer ved hjelp av sirkulasjonen slik at oksygen bundet til hemoglobin transporteres og fordeles ut i kroppen til cellenes mitokondrier i arbeidende vev.
# Etter at oksygenet er fraktet til arbeidende vev, transporteres det fra erytrocyten til vevscellenes mitochondrier.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.75 poeng for hvert trinn
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Patellarrefleksen utløses av et kort slag på senen til m. quadriceps femoris.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvordan forbindelsen mellom afferent og efferent ledd er i denne refleksen, og hvor reflekssenteret sitter
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Reflekssenteret sitter lumbalt (L2-L3-L4) i ryggmargen. Dette er en monosynaptisk refleks, dvs. at det i denne refleksbuen bare er en synapse mellom afferent og efferent ledd (I tillegg til den direkte forbindelsen mellom afferente Ia-fibre fra muskelspolen og α-motornevroner, virker også Ia-fibre på α-motornevronene polysynaptisk via internevroner).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ryggmargen/medulla spinalis gir 0,5 poeng. Monosynaptisk og/eller at reflekssenteret har en synapse gir 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Reseptoren for patellarrefleksen er muskelspolene i m. quadriceps femoris. Dette er den muskelen på kroppen som har høyest antall muskelspoler. Tettheten av muskelspoler er imidlertid langt høyere i enkelte andre muskler.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hva funksjonen til muskelspolene er, og nevn et område på kroppen der vi finner muskler med særlig høy tetthet av dem?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Muskelspolene er lengdemålere, og måler både muskelens absolutte lengde og endringer av musklenes lengde.
Det er særlig høy tetthet av muskelspoler i muskler som utfører presise/ fingraderte bevegelser, det vil si små håndmuskler (hendene) og ytre øyemuskler (ved øyet), samt små muskler i nakken (i nakken)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Lengdemåler (0,5 p).
Hånden/ hendene, ved øynene, i nakken (1 poeng for et sted). Fingermuskler, øyemuskler etc. godkjennes også.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort den sensoriske nerveforsyningen til en
muskelspole, og forklar hva som skjer med muskelspolen
og fyringsraten i dens sensoriske fibre når en strekkrefleks
utløses
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kort forklaring: Muskelspolen innerveres av gruppe Ia (eller tykke myeliniserte fibre) og II-fibre (middels tykke myeliniserte fibre). Når en strekkrefleks utløses vil muskelspolen strekkes hurtig. Dette vil gi økt fyringsfrekvens av aksjonspotensialer i de sensoriske fibrene fra muskelspolen.
Mer detaljert forklaring (ikke nødvendig for å få maksimal poengsum): Muskelspolen består av intrafusale muskelfibre som er parallellkoblet med vanlige tverrstripete muskelfibre. Det er to hovedtyper intrafusale muskelfibre, «nuclear bag»-fiber og «nuclear chain»-fiber. Endeforgreninger fra tykke sensoriske fibre (gruppe Ia, den tykkeste typen myeliniserte fibre) slynger seg rundt begge typer intrafusale muskelspoler, mens «nuclear chain»-fiber også får nerveforsyning fra noe tynnere fibre (gruppe II, middels tykke myeliniserte fibre). Strekk av de intrafusale fibrene (som ved utløsning av refleksen) vil gi økt fyringsfrekvens av aksjonspotensialer i sensoriske fibre).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Innervasjon av gruppe Ia (eller tykke myeliniserte fibre) (trenger ikke nevne II-fibre for å få poeng) (0,5 poeng).
Muskelspolen strekkes (0,5 poeng) og fyringsfrekvens av aksjonspotensialer i de sensoriske fibrene fra muskelspolen øker (eller lignende forklaring) (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De sensoriske fibre som utgjør det afferente leddet i refleksen har høy ledningshastighet fordi de er myeliniserte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvorfor myelinisering gir økt nerveledningshastighet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Impulsledning i aksoner foregår ved at aksjonspotensialer regenereres/ fornyes (eller «flytter seg») langs aksonet. I myeliniserte aksoner foregår denne regenereringen kun ved ranvierske innsnøringer (Nodes of Ranvier), der aksonet mangler myelin. Dermed brer ikke aksjonspotensialene seg med en jevn hastighet langs aksonet, slik som i umyeliniserte aksoner, men går direkte til neste innsnøring.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Aksjonspotensialene beveger seg mellom Nodes of Ranvier/ranvierske innsnøringer (2 poeng) eller lignende forklaring som demonstrerer at studenten har forstått prinsippet. Kun 1 poeng dersom delvis riktig forklaring (f.eks. dersom Nodes of Ranvier/ranvierske innsnøringer ikke nevnes)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken egenskap ved nervefibrene bortsett fra myelinisering er særlig viktig for ledningshastigheten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fibertykkelsen (Ev. også temperatur som også påvirker ledningshastighet.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fibertykkelse (eller temperatur) gir poeng (1 poeng)
Her spørres det egentlig etter fibertykkelse, men studenter som svarer temperatur får også 1 poeng da dette også har betydning for nerveledningshastighet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
M. quadriceps femoris aktiveres ved utløsning av patellarrefleksen, mens ekstensormusklene på baksiden av låret hemmes.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva som skjer når antagonistisk muskulatur hemmes ved en slik refleks, og hvorfor dette er en nyttig mekanisme?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De sensoriske nervefibrene i refleksen sender kollateraler til internevroner i ryggmargen som hemmer motornevronene til antagonistisk muskulatur. Dette kalles resiprok inhibisjon, og gjør at muskulaturen som utfører en bevegelse ikke motarbeides av antagonistisk muskulatur.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hemming av motornevroner for antagonistisk muskulatur i ryggmargen (1 poeng). Viktig for å unngå at antagonistisk muskulatur motvirker leddbevegelse eller lignende forklaring (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Senereflekser brukes innen nevrologi og nevrofysiologi for å lokalisere skader i nervesystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med patellarrefleksene ved ensidig skade på nervefibrene som innerverer m. quadriceps femoris?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Refleksen vil være svakere på den siden der nervefibrene er skadet. Dette kan man f.eks. se ved lumbalt skiveprolaps med affeksjon av L4-roten på den ene siden.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Svakere/ svekket refleks på affisert side (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgave om koagulasjon/ hemostase. Du renser en fisk du har kjøpt til middag fra byfiskeren i Ravnkloa. Dessverre er du uforsiktig og skjærer deg på fingeren. Det blør så vidt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv et umiddelbart tiltak for å stoppe blødningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kompresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bare rett svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet (karskade) stimulerer til dannelse av plateplugg. Hvordan adhererer platen til stroma (bindevev rundt åren)?
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan platene adhererer til stroma (bindevevet rundt åren) og nevn spesielt viktige molekyler i denne prosessen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Integrin''familiens molekyler spiller rolle, der gpIaIIa binder kollagen direkte. gpI-gpV-gpIX komplekset forbinder ''von Willebrand''-faktor
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Enten integrin 1 p. Alternativt presis angivelse av gpIa-gpIIa 0.5p + gpIb-V-IX 0.5 p hver, dvs til sammen maks 1p.
von Willebrandfaktor 1p, altså til sammen 2 p maksimalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet (karskade) starter koagulasjonsfaktorsystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer starter koagulasjonsfaktorsystemet og hva gjør de som første trinn i kaskadereaksjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
FVIIa og TF (tissue faktor) (norsk: vevsfaktor) danner et kompleks som spalter FX til FXa.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kompleks TF og FVIIa 1p (0.5 for hvert)
FX til FXa gir 1 poeng. Spalting av FIX til FIXa er også rett og gir 0.5p. Totalt max 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det dannes nå en plateplugg
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar i korte trekk hvordan platepluggen dannes
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# aggregasjon (gpIIb-IIIa-komplekset)
# aktivering (archidonsyre metabolitter (prostaglandiner) ADP trombin)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Aggregasjon og aktivering gir 1 p hver
gpIIb-IIIa, ADP, trombin, prostaglandiner gir alle 0.5 p opp til max 1p til sammen
Totalt 3p her
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Platehemmere er vanlige legemidler.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan virker acetylsalicylsyre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemmer prostaglandinsyntese via hemming av cykloxygenase (COX) -1 og -2)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1p – Både hemming av COX og prostaglandinsyntese er greie svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Trombin er den store dirigenten i koagulasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 viktige funksjoner til trombin
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Fibrinogen spaltes til fibrin
# Aktiverer indre vei (intrinsic pathway) via FXI og FVIII
# Aktiverer plater
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 rette gir 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Musklene på leggen ligger i muskelgrupper avgrenset av stramme bindevevshinner, de såkalte muskellosjene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor mange muskellosjer finnes i leggen? Hvordan er muskellosjene plassert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi har 4 muskellosjer, hvorav 2 er fortil og 2 baktil på leggen. De fremre muskellosjene omfatter en medialt beliggende, egentlig fremre muskellosje, og en lateral muskellosje (peroneuslosjen/fibularis-losjen).
De bakre muskellosjene omfatter en dyp (profund) og en overfladisk (superficiell) bakre muskellosje.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for korrekt angitt antall, 0.5 poeng for hver losje med korrekt beliggenhet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke muskler/muskelgrupper ligger i de ulike muskellosjene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Fremre losje: Ekstensormusklene: m. Tibialis anterior, mm. Extensores hallucis et digitorum longi
* Laterale losje: Peroneergruppen (fibularisgruppen): mm. Peronei (fibulares) longus et brevis
* Overflatiske bakre losje: M. Triceps surae, som omfatter m.Gastrocnemius og m. Soleus
* Dype bakre losje: Fleksormusklene: m. Tibialis posterior, mm. Flexores hallucis et digitorum longi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver muskelgruppe korrekt angitt (for overflatisk,
bakre losje kreves navn på musklene)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved kraftig trening kan musklene svulme opp slik at trykket øker inne i muskellosjen. Musklene blir smertefulle, og det gjør vondt å bruke dem, noe som kalles losjesyndrom. Dersom trykkøkningen er stor, kan det medføre at blodkar og nerver inne i muskellosjene blir klemt sammen, og funksjonen nedsettes.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom en pasient med losjesyndrom har "dropfot", det vil si nedsatt evne til dorsalfleksjon i ankelen, hvilken nerve er sannsynligvis affisert? Beskriv denne nervens forløp (med de forskjellige grener) og angi hvilke muskelgrupper den forsyner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
N. peroneus (fibularis)
N. peroneus communis går vertikalt gjennom fossa poplitea,
svinger lateralt mot collum fibulae som den passerer subcutant,
og ligger dermed utsatt til for skade. Nerven går så inn i peroneer
muskulaturen (fibularis) som den forsyner via en overflatisk
grein, mens den dype fortsetter inn i fremre losje og forsyner
ekstensor muskulaturen her.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
N. peroneus gir 0.5 poeng, ytterligere 0.5 dersom kandidaten angir at det er den profunde greina.
1 poeng for forløpet av n. Peroneus communis, med forløp av deling i to greiner.
0.5 poeng for funksjon og hvilken muskelgruppen til hver av greinene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Ved kraftig trening kan musklene svulme opp slik at trykket øker inne i muskellosjen. Musklene blir smertefulle, og det gjør vondt å bruke dem, noe som kalles losjesyndrom. Dersom trykkøkningen er stor, kan det medføre at blodkar og nerver inne i muskellosjene blir klemt sammen, og funksjonen nedsettes.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved mistanke om nedsatt blodtilførsel til foten, forsøker man å kjenne etter pulsasjon i to arterier som fører blod forbi ankelen. Disse to arterier er fortsettelsen av to arterier på leggen. Hvilke to arterier på leggen er dette? Hvordan forløper de forbi kneet og videre på leggen? Hvordan er deres relasjon til ankelleddet? Hvilken av disse arteriene kan affiseres ved den typen losjesyndrom som er beskrevet i spørsmål 3?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
A. tibiales anterior et posterior kommer begge fra a. Poplitea i knehasen. Denne deler seg og a. Tibialis anterior passerer gjennom membrana interossea like distalt for art. Tibiofibularis proximalis, og blir i dypet liggende i fremre losje. A. Tibialis posterior blir liggende dypt i bakre losje, nær skillet mellom den dype og overflatiske delen.
A. tibialis posterior går i den dype, bakre losjen og går ned i foten bak (postero-inferiort for) malleolus medialis.
A. tibialis anterior går i fremre losje og kan bli affisert ved fremre losjesyndrom. Arterien passerer foran ankelleddet, der den går over i a. Doralis pedis, som ligger på fotryggen mellom senene til mm. Extensores hallucis longus et digitorum longus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for a. Poplitea
* 0.5 poeng (maks 1. poeng) for hver av de to aa. Tibiales med navn og korrekt posisjon i leggen
* 0.5 poeng for hver arterie og korrekt beskrivelse av relasjon til ankel
* 0.5 poeng for affeksjon av a. Tibialis anterior ved fremre losjesyndrom
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kolesterol er en viktig substans både for normal funksjon av kroppen og i relasjon til enkelte sykdomstyper.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de viktigste funksjonene for kolesterol i menneskekroppen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kolesterol bidrar til å danne biologiske membraner og er utgangspunkt for dannelse av en rekke hormoner. Kolesterol inngår også i lipoproteiner, som er nødvendige for transport av bl.a. triglyserid, apolipoproteiner og kolesterol i blodet. Kolesterol omdannes til gallesyrer/gallesalter som skilles ut med gallen og bidrar til opptak av triglyserid og fettløselige forbindelser fra tarmen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.75p: biologiske membraner/cellemebraner
* 0.75p: hormoner/steroider
* 0.75p: lipoproteiner
* 0.75p: opptak av fett fra tarm
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv det enterohepatiske kretsløpet for kolesterol.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kolesterol i leveren skilles ut som gallesyrer / gallesalter i gallen til tynntarmen. Ca 95% av gallesyrene tas opp i lenger distalt i tarmen og transporteres tilbake til leveren som kylomikroner, først via lymfesystemet og deretter via blodet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.25p: skilles ut med gallen til tarmen
* 0.25p: skilles ut i gallen som gallesyrer/gallesalter
* 0.25p: tas opp i tarmen
* 0.25p: transporteres tilbake til lever
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv innhold, struktur og funksjon for LDL (low density lipoprotein)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
LDL inneholder ca 50% kolesterol, ca 20% protein og noe fosfolipid og triglyserid.
LDL-partikkelen er en sfærisk struktur hvor fosfolipid og fritt kolesterol kler overflaten med hydrofile endre vendt mot vannfasen. Det meste av kolesterolet i LDL finnes som kolesterolestere, som er svært lite vannløselige. Kolesterolestere befinner seg sentralt i partikkelen, sammen med triglyserid som også er svært lipofilt.
I tillegg inneholder LDL ett molekyl av apolipoproteinet apoB100, som er viktig for partikkelens struktur og funksjon. Utgangspunktet for dannelse av LDL er VLDL dannet i leveren. Etter avgivelse av triglyserid fra VLDL til perifere vev dannes LDL, som inneholder relativt lite triglyserid, men mye kolesterol.
LDL transporterer kolesterol fra hovedsakelig lever til perifere vev. Ved binding av apoB til LDL-receptoren på celleoverflaten blir LDL endocytert inn i cellen og innholdet frigjort og dermed tilgjengelig for cellen. Cellene kan bruke kolesterolet for produksjon av bl.a. steroidhormoner og membraner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1p: en partikkel sammensatt av bl.a. kolesterol og protein
* 1p: inneholder mye kolesterol
* 0.5p: inneholder lite triglyserid
* 0.5p: inneholder apoB100 (ikke tilstrekkelig med apolipoprotein)
* 1p: transporterer kolesterol fra lever til perifere vev
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Enzymet HMG-CoA-reduktase bidrar til dannelse av kolesterol. Beskriv hvorfor dette enzymet er spesielt viktig.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enzymet er hastighetsregulerende for kolesterolsyntesen. Det aktiveres av insulin og inhiberes av glukagon og kolesterol. Dette er viktig for normal regulering av kolesterolproduksjonen, som er mest aktiv når kroppen har god tilgang til karbohydrater og mindre aktiv ved lav tilgang til karbohydrater, samt ved stress/aktivering.
Enzymet er også angrepspunkt for medikamentgruppen statiner, som er mye brukt for å redusere kolesterolkonsentrasjonen i blodet hos pasienter med hyperkolesterolemi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.25p: hastighetsbestemmende/regulerende for syntese av kolesterol
* 0.25p: aktiveres av insulin
* 0.25p: inhiberes av glukagon/kolesterol
* 0.25p: angrepspunkt for statiner/kolesterolsenkende medisiner
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Øvre referansegrense for totalkolesterol i serum for en mann på 60 år er 7.8 mmol/L. Forklar hvorfor en mann på 60 år med kolesterol på 7.5 mmol/L ofte får kolesterolsenkende medisin, selv om konsentrasjonen er i referanseområdet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Referanseområdet angir hvilke konsentrasjoner man ofte finner hos friske personer. 97.5% av friske menn eldre enn 50 år vil ha en konsentrasjon av totalkolesterol i serum lavere enn 7.8 mmol/L.
Beslutningen om å behandle med kolesterolsenkende medikamenter er basert på risiko for kardiovaskulær sykdom. Denne risikoen øker med økende konsentrasjon av kolesterol. Ved en totalkolesterol på 7 mmol/L eller høyere er risikoen for å utvikle kardiovaskulær sykdom så høy at man ofte anbefaler behandling for å redusere konsentrasjonen.
Det er således ikke slik at referansegrenser alltid sammenfaller med hvilke verdier som er forenelig med sykdom eller så høy risiko for sykdom at man iverksetter tiltak.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p: referansegrenser beskriver vanlige konsentrasjoner hos friske personer/en definert populasjon
0.5p: risikoen for kardiovaskulær sykdom er avhengig av kolesterolkonsentrasjonen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann på 30 år kommer i ambulanse til legevakten etter å ha falt av sykkelen i høy fart en ½ time tidligere. Han brukte ikke sykkelhjelm og har åpenbart slått seg i hodet. Han sier at han ikke husker noe fra selve ulykken. Først og fremst klager han imidlertid over sterke smerter i venstre ankel og venstre hofte, og han klarer ikke å stå på foten.
På mistanke om bruddskade blir det gjort røntgen-undersøkelse.
<<imgLink "IAB-2019-4-A.PNG" 600>>
<<imgLink "IAB-2019-4-B.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Her er bildene av venstre ankel. Er det et brudd i ankelen? Kan du i så fall beskrive i hvilket ben og hvor i benet bruddet er?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har et brudd i distale fibula.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ser at pasienten har et brudd 0.5p, beskriver at bruddet sitter i fibula 0.5p. beskriver at bruddet er distalt i fibula 0.5p. Totalt maks 1.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På grunn av smertene i venstre hofte, blir det også tatt røntgenbilde av hoften.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Her er røntgen-bilde av venstre hofte, frontbilde.
<<imgLink "IAB-2019-4-C.PNG" 400>>
Sett navn på de anatomiske strukturene som er merket med bokstaver fra A til D.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* A: Trochanter major
* B: Trochanter minor
* C: Collum femoris
* D: Femurdiafysen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert riktig navn gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hovedprinsippene for avbildning med standard røntgen-undersøkelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgenstråler er ''elektromagnetisk stråling'' som dannes i et ''røntgenrør''. I røntgenrøret sendes elektroner med høy fart mot en anode av metall og det dannes fotoner med høy energi som sendes ut gjennom en åpning i røret og gjennom pasienten. ''Vev med høy tetthet'' (som f. eks. bein) ''absorberer/bremser/reflekterer mye stråler'', og ''vev med lav tetthet'' (som f. eks. luft) ''absorberer lite stråler'', altså mye stråler går gjennom luft. Stråler som går gjennom pasienten treffer en detektor (eller en film) som danner et 2-dimensjonalt bilde. Jo flere stråler som treffer detektoren (eller filmen) jo mørkere blir bildet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Elektromagnetisk stråling/røntgenstråling 0.5p. Dannes i et røntgenrør 0.5p. Tettheten på vevet avgjør hvor mye stråling som går gjennom (eller absorberes av) vevet 0.5p. Strålene treffer en detektor/film som danner et bilde 0.5p (maks 2p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På mistanke om hodeskade blir det gjort CT av hodet (uten intravenøs kontrast) for å avdekke om han også kan ha en hjerneblødning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de viktigste forskjellene mellom standard røntgenundersøkelse og CT-undersøkelse, teknisk og praktiskdiagnostisk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT (Computed tomography) bruker også røntgenstråler, men har et mye mer ''sensitivt deteksjonssystem'' enn ved vanlig (konvensjonell) røntgen. CT kan detektere svært små forskjeller i absorpsjon av røntgenstråler i ulike vev, og kan derfor fremstille ulike tettheter i vevene minst 10 ganger bedre enn vanlig røntgen. Både vanlig røntgen og CT fremstiller benvev godt, men CT fremstiller også ''de ulike bløtvevene'' i kroppen, samt væske og luft veldig godt, i motsetning til vanlig røntgen. Når CT-bildene tas, ligger pasienten inni en ring (gantry) med ett (eller to) ''røntgenrør og multiple detektorer som roterer rundt
pasienten'', samtidig som pasienten flyttes (liggende) gjennom ringen. Det tas da mange tynne snitt med bilder av kroppen, og disse bildene prosesseres av en datamaskin som bygger opp et ''volum'' av det avbildete området. Bildene kan rekonstrueres i alle plan og man kan lage ''3D-bilder''. CT tar mye bedre bilder en vanlig røntgen, men CT påfører også mye ''mer'' ioniserende (og potensielt skadelig) ''stråling'' enn vanlig røntgen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mer sensitivt deteksjonssystem som fremstiller ulike vev (bløtvev, benvev, væske, luft) godt 0.5p Røntgenrør og detektorer roterer rundt pasienten 0.5p Lager et volum eller et 3D bildeopptak 0.5p Mye mer stråling enn vanlig røntgen 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ettersom CT-bildene viser en liten hjerneblødning og dessuten forandringer i hjernevevet av usikker betydning, blir det også gjort MR-undersøkelse av hodet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hovedprinsippene for avbildning med MR, og nevn fordeler og ulemper med MR sammenlignet med CT.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MR-maskinen danner et sterkt magnetfelt som gjør at en liten andel av hydrogenatomene (protonene) i vann og fett (lipider) innretter seg parallelt med magnetfeltet. MR-maskinen sender så ut en eller flere radiofrekvenspulser som får protonene til å endre retning. Etter at pulsen slås av så innretter protonene seg tilbake i opprinnelig posisjon, og dette danner signaler som kan detekteres og lokaliseres ved hjelp av kobberspiraler lokalisert rundt pasienten. Maskinen kan da bygge opp bilder basert på protonmengde (både distribusjon og tetthet) og tiden det tar for protonene å innrette seg med magnetfeltet (går tilbake til utgangsposisjon). I motsetning til CT, så kan MR danne mange ulike bildesekvenser for å fremstille ulike typer vev og patologi.
Fordeler med MR er at bilder kan lages direkte i alle tenkelige plan, men ved CT så lages bildene i ett plan (mange snitt med bilder i ett plan) og må rekonstrueres i andre plan hvis dette er ønskelig. MR fremstiller bløtvev bedre enn CT. MR produserer heller ingen skadelig ioniserende stråling i motsetning til CT.
Ulemper med MR er at det tar lang tid og derfor lett for at bevegelse kan forstyrre bildene, slik som ved urolig pasient, pusting, pulseringer og tarmbevegelse. MR er mer ressurskrevende sammenlignet med CT. MR fremstiller ikke kalk. Magnetfeltet kan føre til uheldige bivirkninger ved å påvirke pacemakere, metalklips i hjernen, fremmedlegemer av metall i øyet. Metall i kroppen kan også forstyrre og ødelegge bildene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Prinsipp: protoner innretter seg parallelt med magnetfeltet, radiofrekvenspuls som endrer retning på protoner og signal som fanges opp av coiler/spiraler 1 poeng. Ulike bildesekvenser 0,5 poeng
Fordeler: bløtvev bra, ingen skadelig stråling 0.5p
Ulemper: tar lang tid, følsomt for bevegelse, ressurskrevende, uheldige bivirkninger i forhold til metall i kroppen 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Endotelfunksjonen i en middels stor arterie kan vurderes eksperimentelt ved å måle kraftutviklingen (tensjonen) når en bit av karveggen utsettes for økende doser med acetylkolin. Målingen gjøres under påvirkning av fenylefrin, som selektivt stimulerer alfa-1-adrenerge reseptorer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av fenylefrin på de glatte muskelcellene i karveggen, samt signalveien fra reseptor til den cellulære effekten. Hvordan reagerer karveggsmuskulaturen, og hvilke molekyler er involvert i den biokjemiske signalveien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fenylefrin kontraherer de glatte muskelcellene i karveggen (0.5 poeng). Når fenylefrin bindes til alfa-1 reseptoren, aktiveres fosfolipase C (PLC) via det GTP-bindende proteinet Gaq, og derved katalyserer PLC spalting av fosfatidyl-inositol til inositol-tris fosfat (IP3) og diacyl-glycerol (0.5 poeng). IP3 aktiverer kalsiumfrigjøringskanalen i sarkoplasmatisk retikulum (SR) og øker derved intracellulær kalsiumkonsentrasjon. Kalsium binder seg til kalmodulin (CaM) og danner et kompleks som aktiverer enzymet myosin-lettkjede-kinase (MLCK) (0.5 poeng). MLCK fosforylerer lette myosinkjeder (MLC), og øker derved kryssbrokoblingen og kraftutviklingen i de glatte muskelfibrene (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fenylefrin kontraherer muskelcellene (0,5 poeng). Aktiverer PLC via G-protein og øker IP3 (0.5 poeng). IP3 aktiverer kalsiumfrigjøring fra SR, kalsium binder til CaM og aktiverer MLCK (0.5 poeng). MLCK fosforylerer MLC og øker kontraktiliteten (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Endotelfunksjonen i en middels stor arterie kan vurderes eksperimentelt ved å måle kraftutviklingen (tensjonen) når en bit av karveggen utsettes for økende doser med acetylkolin. Målingen gjøres under påvirkning av fenylefrin, som selektivt stimulerer alfa-1-adrenerge reseptorer
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med arteriolediameter, perifer karmotstand og blodtrykk i systemkretsløpet ved intravenøs infusjon av fenylefrin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ateriolediameter reduseres (0.5 poeng), perifer karmotstand øker og blodtrykket øker (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Arteriolediameter reduseres (0.5 poeng), karmotstand øker og blodtrykket øker (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av å stimulere muskarinreseptorene på glatte muskelceller i karveggen med acetylkolin, samt signalveien fra reseptor til den cellulære effekten. Hva skjer med tensjonen, og hvilke molekyler er involvert i signalveien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effekten av å stimulere muskarinreseptorene (subtype M2) på glatte muskelceller er økt tensjon (0.5 poeng). Når M2 aktiveres, hemmes enzymet adenylyl cyklase (AC) via det GTP-bindende proteinet Gai. Siden AC katalyserer dannelsen av syklisk adenosin monofosfat (cAMP), reduseres den intracellulære konsentrasjonen av cAMP. Dermed reduseres aktiviteten av enzymet protein kinase A (PKA), siden det ellers ville vært stimulert av cAMP (0.5 poeng). PKA fosforylerer vanligvis myosin light chain kinase (MLCK) og reduserer MLCK-aktiviteten, men når cAMP går ned, skjer det omvendte. Økt MLCK-aktivitet fører til mer fosforylering av lette myosin kjeder (MLC), og derved øker kontraksjonen i karveggen (0.5 poeng).
Denne mekanismen er gjennomgått ved undervisningen om kartonus, men er kanskje ikke nevnt så tydelig i lærebøkene. Det er likevel mulig å slutte seg til svaret ut fra kunnskap om mekanismen for relaksasjon av glatt muskulatur i karveggen via PKA. Denne deloppgaven regnes derfor som resonnerende
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
M2-stimulering øker tensjonen (0.5 poeng). Hemmer AC via Gai og reduserer cAMP og PKA aktiviteten (0.5 poeng). Derved øker MLCKaktiviteten (på grunn av redusert hemming fra PKA). Dette gir mer fosforylering av MLC og sterkere kontraksjon av glatt muskulatur (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av acetylkolin på et normalt karveggspreparat med intakt endotel, samt signalveien fra reseptor til effekt på tensjonen. Hva er effekten på tensjonen, hvilke celletyper er involvert, og hvilke molekyler er involvert i de biokjemiske signalveien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effekten av å stimulere et normalt karveggspreparat med acetylkolin er redusert tensjon. Både endotelceller og glatte muskelceller er involvert i effekten (0.5 poeng). Stimulering av muskarinreseptorene i endotelceller (subtype M3) aktiverer fosfolipase C (PLC) via det GTPbindende proteinet Gaq, og derved katalyserer PLC spalting av fosfatidyl-inositol til inositol-tris fosfat (IP3) og diacyl-glycerol. IP3 aktiverer kalsiumfrigjøringskanalen i sarkoplasmatisk retikulum (SR) og øker derved intracellulær kalsiumkonsentrasjon (0.5 poeng), som i sin tur øker aktiviteten av nitrogenoksid (NO) syntase (NOS) og fører til økt produksjon av NO ved spalting av aminosyren L-arginin (0.5 poeng). NO diffunderer fra endotelcellen inn i glatte muskelceller og stimulerer NO-reseptorer på enzymet guanylyl syklase (GC). Derved økes syklisk guanosin monofosfat (cGMP), som stimulerer protein kinase G (PKG) (0.5 poeng). PKG forsforylerer MLCK, derved hemmes aktiviteten, det blir mindre fosforylering av MLC, og kryssbrokoblingen og kraftutvilingen i de glatte muskelcellene går ned (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Acetylkolin reduserer tensjonen i karpreparatet. Endotelceller og glatte muskelceller er involvert (0.5 poeng). Stimulerer M3 reseptorer, aktiverer PLC via G-protein, øker IP3, stimulerer kalsiumfrigjøring fra SR og øker kalsium intracellulært (0.5 poeng). Kalsium stimulerer NOS og øker NO-produksjon (0.5 poeng). NO diffunderer inn i glatte muskelceller, stimulerer GC, øker cGMP og stimulerer PKG (0.5 poeng). PKG fosforylerer og hemmer MLCK, og reduserer dermed fosforyleringen av MLC og tensjonen i preparatet (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av acetylkolin på tensjonen i et karpreparat hvor enzymet nitrogenoksid-syntase er blokkert. Hva er effekten på tensjonen, hvilke(n) celletype(r) er involvert, og hvilke molekyler er involvert i de(n) biokjemiske signalveien(e)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetylkolin øker tensjonen i karpreparat hvor NOS er blokkert og skyldes stimulering av M2-reseptorene på glatte muskelceller (0.5 poeng). Stimulering av M2 hemmer AC via Gai og reduserer cAMP og PKA aktiviteten. Derved øker MLCK-aktiviteten (på grunn av redusert hemming fra PKA). Dette gir mer fosforylering av MLC og sterkere kontraksjon av glatt muskulatur (0.5 poeng). Denne mekanismen er gjennomgått ved undervisningen om kartonus, men er kanskje ikke nevnt så tydelig i lærebøkene. Det er likevel mulig å slutte seg til svaret ut fra kunnskap om mekanismen for relaksasjon av glatt muskulatur i karveggen via PKA. Denne deloppgaven regnes derfor som resonnerende. Dette er den samme biokjemiske signalveien som beskrevet i [[oppgave 3|IAB - 2019s - Oppgave 1 - Del 3]], derfor gis færre poeng for samme svar her.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Acetylkolin øker tensjonen ved stimulering av muskarinerge reseptorer på glatte muskelceller (0.5 poeng). Effekten er som beskrevet i [[oppgave 3|IAB - 2019s - Oppgave 1 - Del 3]] (0.5 poeng). Hvis signalveien er korrekt beskrevet i [[oppgave 3|IAB - 2019s - Oppgave 1 - Del 3]], er det nok å vise til at det er den samme i oppgave 5. Det vil si: Stimulering av M2 hemmer AC via Gai og reduserer cAMP og PKA aktiviteten. Derved øker MLCK-aktiviteten (på grunn av redusert hemming fra PKA). Dette gir mer fosforylering av MLC og sterkere kontraksjon av glatt muskulatur (0.5 poeng). Dersom signalveien er korrekt som beskrevet i oppgave 5, men ikke i [[oppgave 3|IAB - 2019s - Oppgave 1 - Del 3]], kan det gis 0.5 poeng ekstra.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Endotelfunksjonen i arteria brachialis kan vurderes klinisk ved å måle endringen i kardiameter etter en total avklemming av karet i fem minutter ved hjelp av en blodtrykksmansjett. Kardiameteren måles proksimalt for mansjetten umiddelbart før avklemming og ved maksimal endring 1-2 minutter etter at avklemmingen er over.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort endringen i kardiameter i en arterie med normal endotelfunksjon i måleoppsettet som er beskrevet over, og forklar mekanismen. Hva er det lokale stimulus for endring i kardiameter, hvordan påvirkes tensjonen i karveggen, hvilke(n) celletype(r) er involvert, og hvilke molekyler er involvert i de(n) biokjemiske signalveien(e)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved normal endotelfunksjon øker kardiameteren proksimalt for avklemmingsstedet 1-2 minutter etter at avklemmingen er over (0.5 poeng). På grunn av reaktiv hyperemi i det avklemte området øker blodføringen i karet. Dermed øker blodtrømshastigheten og kraftoverføringen mellom blodet og mekaniske reseptorer i karveggen. Dette fører til økning av intracellulært kalsium, stimulering av NOS og økt produksjon og overføring av NO til glatte muskelceller. Signalveien i glatte muskelceller er som beskrevet i [[oppgave 4|IAB - 2019s - Oppgave 1 - Del 4]]: NO stimulerer GC, øker cGMP og stimulerer PKG. PKG fosforylerer og hemmer MLCK, og reduserer dermed fosforyleringen av MLC. Dermed relakseres de glatte muskelcellene og karet utvides (0.5 poeng).
Måleoppsettet for måling av endotelfunksjon er gjennomgått i undervisningen, men er kanskje ikke så klart beskrevet i alle lærebøker. Det er likevel mulig å slutte seg til svaret når man kjenner til at kar med normal endotelfunksjon utvider seg ved økt blodføring, samt kombinerer dette med kunnskap om reaktiv hyperemi etter avklemming av sirkulasjon. Oppgaven regnes derfor som resonnerende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Karet utvides 1-2 minutter etter at avklemmingen av karet er avsluttet (0.5 poeng). Dette skyldes økt blodføring, økt blodstrømshastighet og stimulering av mekanoreseptorer i karveggen. Dette øker intracellulær kalsium og stimulerer NO produksjon via NOS. Det biokjemiske signalveien er som beskrevet i [[oppgave 4|IAB - 2019s - Oppgave 1 - Del 4]]: NO stimulerer GC, øker cGMP og stimulerer PKG. PKG fosforylerer og hemmer MLCK, og reduserer dermed fosforyleringen av MLC. Dermed relakseres de glatte muskelcellene og karet utvides (0.5 poeng).
Hvis signalveien er korrekt beskrevet i [[oppgave 4|IAB - 2019s - Oppgave 1 - Del 4]], er det nok å vise til at det er den samme i oppgave 6. Dersom signalveien er korrekt beskrevet i oppgave 6, men ikke i [[oppgave 4|IAB - 2019s - Oppgave 1 - Del 4]], kan det gis inntil 1.0 poeng ekstra i oppgave 6.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sildenafil (Viagra) er en potent og selektiv hemmer av en type fosfodiesterase som særlig finnes i penisvev og som har cGMP (syklisk guanylyl monofosfat) som substrat (cGMP-spesifikk fosfodiesterase type 5, PDE5).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort effekten av sildenafil på glatt muskulatur i karveggen og angi hvilke molekyler som er involvert i den biokjemiske signalveien.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sildenafil relakserer glatt muskulatur i karveggen i svamplegemene (corpus cavernosum) i penis (0.5 poeng). Hemming av PDE5 reduserer nedbrytningen av cGMP, og dermed øker konsentrasjonen av cGMP i de glatte muskelcellene. Dette øker aktiviteten av PKG, som fosforylerer og hemmer MLCK, og dermed reduseres fosforyleringen av MLC. Dette relakserer de glatte muskelcellene og karet utvides (0.5 poeng). Den biokjemiske signalveien for relaksasjon er den samme som i oppgave [[4|IAB - 2019s - Oppgave 1 - Del 4]] og [[6|IAB - 2019s - Oppgave 1 - Del 6]].
Effekt av sildenafil er ikke gjennomgått i undervisningen, men ut fra allmenn kjennskap til effekten av Viagra, opplysningene i oppgaveteksten og kunnskap til mekanismene for regulering av kartonus, er det mulig å slutte seg til svaret. Oppgaven regnes derfor som resonnerende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sildenafil relakserer glatt muskulatur i karveggen (0.5 poeng).
Hemming av PDE5 reduserer nedbrytningen av cGMP, øker cGMP og stimulerer PKG, som fosforylerer og hemmer MLCK. Dermed reduseres fosforyleringen av MLC og de glatte muskelcellene relakseres (0.5 poeng). Den biokjemiske signalveien er den samme som beskrevet i oppgave [[4|IAB - 2019s - Oppgave 1 - Del 4]] og [[6|IAB - 2019s - Oppgave 1 - Del 6]], og det er nok å henvise til en av disse, dersom signalveien er korrekt beskrevet der.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 25 år gammel person oppholder seg over flere uker i Mexico
City som ligger 2250 meter over havet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan endres lungenes diffusjonskapasitet i denne høyden? Vi tenker oss da at dette er i den tidlige perioden av oppholdet før hemoglobinverdien har rukket å endre seg. Og hva er årsaken til det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diffusjonskapasiteten vil reduseres. Årsaken er at man i denne høyden vil ha lavere partialtrykk av oksygen i den atmosfæriske luften og dermed i alveolen. Gradienten mellom oksygenets partialtrykk i alveolen og partialtrykket av oksygen i blodet reduseres, noe som gir lavere diffusjonskapasitet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vite at diffusjonskapasiteten reduseres, 2 poeng for å forklare årsak/mekanisme.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En 25 år gammel person oppholder seg over flere uker i Mexico City som ligger 2250 meter over havet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil trykket i lungekretsløpet forandres i slik høyde? Og hva er mekanismen bak dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Trykket i lungekretsløpet vi øke. Årsaken er at lungearterietrykket reguleres av partialtrykket av oksygen i alveolen (P,,A,,O,,2,,). Lav P,,A,,O,,2,, gir vasokonstriksjon og økt trykk i lungekretsløpet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vite at lungearterietrykket øker, 2 poeng for å redegjøre for mekanismen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ventilasjons-perfusjonsforholdet beskriver sammenhengen mellom ventilasjonen og blodgjennomstrømningen i lungene og bør være best mulig samstemt ("matchet")
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva som vil skje med ventilasjonsperfusjonsforholdet og hvorfor. Får vi økt dødromsventilasjon eller økt shunting?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Siden vi får en vasokonstriksjon i lungekretsløpet, vil perfusjonen gå ned mens ventilasjonen heller vil øke (hyperventilasjon i høyden). Dette gjør at forholdet mellom ventilasjon og perfusjon øker. Dette kalles økt dødromsventilasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vite hvordan ventilasjons-perfusjonsforholdet endres, 1 poeng for å forklare hvordan/hvorfor og 1 poeng for å kjenne til at dette er det samme som økt dødromsventilasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vi tenker oss at etter lang tid i denne høyden (f eks 7 uker) har hemoglobinverdien steget fra på forhånd 14 g/liter fra før til 16 g/liter. Pga den store høyden vil imidlertid oksygenmetningen (saturasjonen – SaO2) ha falt fra 98% i lavlandet før avreise til Mexico City til 90% i høyden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil denne situasjonen gi bedret eller forverret oksygentransport i blodet? Svaret må begrunnes.
Du har følgende opplysninger til å hjelpe deg med å svare på dette spørsmålet:
Oksygen transporteres i blodet hovedsaklig bundet til hemoglobin. Hemoglobinets bindingskapasitet er slik at 1 g Hb binder max 1.34 ml O,,2,, per 100 ml blod ved SaO2 (oksygenmetning) 100%. Der er dessuten i normalt arterieblod fysiologisk løst oksygen 0.3 ml O,,2,, per 100 ml blod som vi imidlertid lar være konstant ifm denne oppgaven og som vi dermed kan se bort fra.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Lavland: (1.34 x 14) x 0.98 = 18.4
* Høyde: (1.34 x 16) x 0.90 = 19.3
Mao best oksygentransport i høyden etter at man har fått økning i Hb
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar dersom det er begrunnet (0 poeng for rett svar uten begrunnelse).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 66 år gammel mann innlegges på sykehus etter lengre tid med lette smerter sentralt i magen, lys fettrik avføring og ufrivillig vekttap.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
<<imgLink "IAB-2019s-3-A.PNG" 600>>
Bildet til venstre viser et normalt CT-bilde av abdomen sett i retning opp mot hodet (transversalt snitt). Den hvite streken på bildet til høyre illustrerer transveralsnittets nivå. Hvilket organ peker pilene på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pankreas/bukspyttkjertelen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha riktig organ for å få uttelling
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Andre aktuelle undersøkelser kan være gastroskopi og koloskopi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hovedprinsippene for bruk av fiberoptiske endoskopiundersøkelser.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Metode for å undersøke innsiden av kroppshulrom eller lignende innenfra med en bøyelig og fleksibel fiberoptisk slange med kamera og lys for visualisering av slimhinner, og egen arbeidskanal med mulighet for å ta biopsier og gjøre ulike prosedyrer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* Undersøkelse av fysiologiske hulrom og kanaler – 0.25 poeng
* Fleksibel og bøyelig slange – 0.25 poeng
* Kamera/lys for visualisering – 0.25 poeng
* Mulighet til å ta biopsier – 0.25 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten hadde en svulst i pankreas som blokkerte både hovedgangen i pankreas og ductus choledochus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor kan denne svulsten gi pasienten fettrik avføring?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fettrik avføring tyder på manglende fordøyelse og absorpsjon av fettstoff slik at det heller går ut i avføringen. Siden svulsten blokkerer både hovedkanalen for pankreas (det vil si den eksokrin utskillelsen) og ductuc choledochus, vil tilførsel av både fordøyelsesenzym, bikarbonat og galle til tynntarmen reduseres/falle bort. Opptaket av spesielt fett vil da påvirkes fordi både fordøyelsesenzym (lipase/co-lipase) og gallesalter mangler.
I tillegg vil ikke fordøyelsesenzym virke like godt om det utskilles for lite bikarbonat til å heve pH. Svulst i pankreas vil også kunne gi generelt svikt i den eksokrine funksjonen til organet, og med det også lavere produksjon av fordøyelsesenzym.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Redusert absorpsjon av fettstoff gir fettrik avføring. På grunn av
* Manglende utskillelse av pankreasenzym + bikarbonat – 0.5 poeng
* Manglende utskillelse av gallesalter i galle – 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv det viktigste innholdet i pankreassaft, og mekanismene for hvordan de ulike enkeltkomponentene bidrar i fordøyelsesprosessen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pankreassaft skilles ut fra acinarceller og ductale celler og inneholder i hovedsak flere pankreasenzym, vann, natrium og bikarbonat
Fordøyelse av protein: Trypsin, chymotrypsin, karboksypeptidaser, elastase. Spalter proteiner og polypeptider til peptider og aminosyrer i tynntarmslumen. Fordøyelse av karbohydrat: α-Amylase. Spalter α, 1-4 bindinger i stivelse og glykogen til maltose, maltooligosakkarid og α-limit dekstrin.
Fordøyelse av fettstoff: lipase, co-lipase, kolesteroester hydrolase, fosfolipase. Spalter (henholdsvis) triglyserider på overflatene av miceller der co-lipasen binder seg og er nødvendig for funksjon av lipasen, fosfolipider og kolesterolestere og andre mer komplekse fettstoff.
Bikarbonat (vann): nøytraliserer det sure innholdet som tømmes i tynntarmen fra magesekken slik at pH stiger til rundt 7.4 som pankreasenzymene trenger for å fungere.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* Må ha med at pankreassaft inneholder fordøyelsesenzymer og bikarbonat (og vann) – 0.5 poeng
* Må ha med at pankreas bidrar med fordøyelsesenzym for alle de tre viktigste næringsstoffene protein, karbohydrat og fett – 0.5 poeng
* Må beskrive i korte trekk hvordan de viktigste enzymene trypsin/chymptypsin (proteaser), α-Amylase og lipase/co-lipase virker – 0.5 poeng
* Bikarbonat (spesielt fra duktale celler) viktig for å heve pH for at pankreaeenzymene kan virke – 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten hadde gulsott (ikterus), og det ble målt forhøyede nivåer av spesielt konjugert bilirubin
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige årsaken til gulsott hos denne pasienten? Beskriv den normale utskillelsen av bilrubin, fra utgangsproduktet til det er helt ute av kroppen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Svulsten blokkerer ductus choledochus og dermed avløp for galle ut fra galleblære/lever, slik at det hoper seg opp med konjugert bilirubin produsert i hepatocyttene (posthepatisk årsak).
Heme (hovedsakelig fra røde blodceller) brytes ned i det retikuloendoteliale system (RES) til (globiner -> aminosyrer og jern) pigmentstoffene biliverdin og bilirubin. Ukonjugert bilirubin fraktes i plasma bundet til albumin (fordi det er fettløselig, ingen filtrering i nyrene), tas opp av hepatocyttene via ulike mekansimer, hvor det konjugeres til glukuronat (fase II reaksjon).
Konjugert bilirubin skilles ut i gallen og videre ut i tarmen hvor bakterienzymer i terminale ileum og kolon omdanner 80-90% videre via sterkobilinogen til sterkobilin som skilles ut i avføringen. De resterende 10-20% reabsorberes i terminale ileum og kolon tilbake til portalblodet og enten tas opp av lever og resirkuleres til galle eller går til nyre, oksideres til urobilinogen og skilles ut i urin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* Gulsott pga blokkering av galle (konjugert bilirubin) fra lever – 0.5 poeng
* Fra heme (via biliverdin) til ukjonjugert bilirubin i RES, fraktes videre i blodet bundet til albumin – 0.5 poeng
* Tas opp av lever, konjugeres og skilles ut i galle – 0.5 poeng
* Det meste av konjugert bilirubin omdannes av bakterier i tarm til sterkobilin som går ut i avføringen – 0.5 poeng
* Noe går inn i enterohepatisk resirkulasjon, hvorav en liten del går til nyre og skilles ut i urin som urobilin – 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvor og hvordan hormonene sekretin og cholesystokinin (CCK) blir skilt ut og hvilke virkninger de har.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Begge hormoner produseres i enteroendokrine celler i tarmslimhinnen i duodenum og jejunum og skilles ut i blodet (portasirkulasjonen); CCK fra I-celler og sekretin fra S-celler.
CCK skilles ut når cellene registrerer økt mengde fett og proteiner i tarmlumen, og hormonet stimulerer til kontraksjon av galleblæren og sekresjon av pankreasenzym, slik at galle og pancreasenzym tømmes ut i tarmlumen.
Sekretin skilles ut når cellene registrerer lav pH i tarmlumen, og hormonet stimulerer sekresjon av bikarbonat og vann fra pankreasgangepitelet.
Begge hormonene har dermed effekter som tilrettelegger og øker spalting (fordøyelse) av både karbohydrater, fettstoff og protein ved at det skilles ut gallesalter, enzymer for nedbrytning av alle tre næringsstoff og bikarbonat som nøytraliserer magesyren og gir riktig pH for at alle disse enzymene kan virke.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må studenten ha skjønt prinsippene og ha med de viktigste momentene;
* Enteroendokrine celler (I og S-celler) i tarmslimhinnen i øvre del av tynntarm – 0.5 poeng
* Registrerer endringer i tarmlumen og skiller ut hormoner til blodet - 0.5 poeng
* CCK stimuleres av fett og protein - 0.5 poeng
* Sekretin stimuleres av lav pH - 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blodprøver viste at pasienten hadde mangel på vitaminene A, D, E og K
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er opptaket av akkurat disse vitaminene mest påvirket hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alle disse vitaminene er fettløselige og deres normale opptak er dermed via akkurat samme mekanisme som opptak av andre fettstoff. Ved svikt i eksokrin pankreasfunksjon og blokkering av galletilførsel til tarmen som hos denne pasienten, vil opptak av fettstoff og fettløselige vitaminer påvirkes. De andre vitaminer har egne opptaksmekanismer/passiv diffusjon som ikke direkte er avhengig av galle eller pankreasenzym. Lite unntak er vitamin B12 der det trengs proteaser (trypsin) fra pankreas for å frigjøre B12 fra R-faktor slik at intrinsisk faktor kan binde
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fettløselige vitaminer, følger fettstoff-absorpsjon – 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 62 år gammel stort sett frisk og sporty kvinne oppsøker fastlegen fordi hun synes at når hun ser seg selv i speilet oppdager hun stadig nye rynker i ansiktet. I tillegg synes hun at hun har merket noe stivhet og smerter i et kneledd. Kort sagt synes hun at hun begynner å bli gammel, og hun husker med gru sin mor som alltid klaget over "gikta" på sine eldre dager.
Av en venninne har hun hørt om et kosttilskudd som heter "Collagen Plus" som skal hjelpe både mot rynker i huden og leddsmerter. Preparatet er dyrt. Hun lurer derfor på hva fastlegen mener om dette produktet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I konsultasjonen tar fastlegen pasienten på alvor og googler "Collagen Plus" for å prøve å finne ut hva produktet inneholder. "Collagen Plus" inneholder ikke-denaturert kollagen type II fra kylling, lakseolje (uten noen nærmere presisering hva dette er), og noe C- og D-vitamin. Dette er pakket i en gelatinkapsel (som egentlig er denaturert kollagen fra storfe). Fastlegen forteller pasienten at dette virker som bortkastede penger og at hun ikke får økt kollageninnhold i ledd og hud av å spise dette. Hvorfor mener fastlegen dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kollagen er en klasse proteiner som har mange viktige funksjoner i organismen, inkludert i ledd og hud. Når en inntar et protein gjennom kosten vil dette bli brutt ned til aminosyrer i fordøyelsen (hovedsakelig i magen). Disse aminosyrene kan så tas opp i kroppen, transporteres til celler der disse kan inngå i nysyntese av proteiner. Det nytter derfor ikke å spise kollagen framfor andre proteiner for å øke kollageninnhold i ledd og hud.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p for å vite at kollagen er et protein. 1 poeng for å nevne at å spise kollagen framfor andre proteiner ikke hjelper på syntese av kollagen. Totalt mulig 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten godtar ikke uten videre legens forklaring og ber om utfyllende forklaring til legens standpunkt. Legen husker da en figur hun så i første klasse på legestudiet (se under), og prøver med utgangspunkt i denne figuren å overbevise henne om sitt standpunkt. Pasienten er fortsatt skeptisk og peker på at figuren viser at kollagen inneholder helt spesielle aminosyrer, og hun lurer på om det ikke hjelper å spise disse aminosyrene.
<<imgLink "IAB-2019s-4-A.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor bør legen fortsatt holde fast på sitt råd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hydroksylysin (og hydroxyprolin) dannes gjennom posttranslasjonell modifikasjon av kollagen. 0.5 poeng for å nevne at i proteinsyntesen brukes ikke-modifiserte aminosyrer (som en like gjerne kan få fra et egg, en biff, en torskefilet eller annen proteinrik mat), og 0.5 poeng for å nevne at kollagenstrukturen skyldes post-translasjonelle modifikasjoner av aminosyrene.
Totalt 1p.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delspørsmål gir 0.5 poeng, dvs totalt 1 poeng mulig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er middels fornøyd med forklaringene, men bestemmer seg for å følge legens råd. Noen måneder seinere er hun uheldig og faller når hun vasker kjøkkengolvet. Hun får et brudd i håndleddet, men håndleddet gror fint etter bruddet og hun oppnår full funksjonalitet av leddet etter en stund. Etter at håndleddet er grodd, oppsøker hun fastlegen igjen. Denne gangen lurer hun på om hun kan ha blitt beinskjør i sin etter hvert modne alder. Hun har hørt at D-vitamin skal være viktig for å motvirke beinskjørhet, og hun husker også at dette vitaminet var en bestanddel av "Collagen Plus". Fastlegen tar en blodprøve og finner at pasienten har litt lave nivå av 25-hydroxy Vitamin D
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er et vitamin?
# Hva er den biokjemisk viktigste forskjellen på Vit C og D?
# Hva er et mineral?
# Hva er de viktigste mineralene i beinvev?
# Hvorfor er Vit D viktig i beinhomeostase?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vitamin er livsnødvendige (små) forbindelser som er viktige i stoffskiftereaksjoner.
# fett- og vann-løseligheten (D fettløselig, C vannløselig)
# Mineral er et naturlig forekommende uorganisk stoff (dannet i geologiske prosesser)
# Kalsium og fosfat (Kalsiumfosfat, hydroksyapatitt)
# Viktig for opptak av kalsium og fosfat i tarmen
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng pr. riktig svar, til sammen 5 poeng.
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!!Vignett
B-vitaminer er en annen gruppe vitaminer som er viktige i dannelse av ATP både gjennom karbohydrat- og lipidmetabolisme.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to stoffer som inngår i disse metabolske prosessene der et B-vitamin er en nødvendig byggestein.
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<$details class="answer" summary="Svar" state="!!showanswer">
Noen mulige svar:
* NAD^^+^^/NADH (Nikotin adenin dinukleotid), niacin, nikotinsyre (Vit B3)
* NADP^^+^^/NADPH, niacin (Vit B3)
* FAD/FADH,,2,, (Flavin adenin dinukleotid), riboflavin (Vit B2)
* CoA (Koenzym A), pantotensyre (B5)
* TTP (Tiamin pyrofosfat), (Vit B2)
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng hvis minst to stoffer nevnes.
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!!Vignett
Aksjonspotensialer ledes langs aksonet til et alfa-motornevron.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ionekanaler er viktige for henholdsvis depolarisering og repolarisering under et aksjonspotensial?
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<$details class="answer" summary="Svar" state="!!showanswer">
* Spenningsstyrte Na-kanaler er viktig for depolariseringen
* Spenningsstyrte K-kanaler er viktig for repolariseringen
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 p. Spenningsstyrte Na-kanaler er viktig for depolariseringen
* 0.5 p. (Spenningsstyre) K-kanaler er viktig for repolariseringen
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!!Vignett
Den eksitatoriske påvirkningen på dette alfa-motornevronet i ryggmargen øker kraftig.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer da med aksjonspotensialene som ledes i alfamotornevronets aksoner?
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<$details class="answer" summary="Svar" state="!!showanswer">
Frekvensen av aksjonspotensialer øker (det enkelte aksjonspotensial er "alt eller intet" respons og kan i seg selv ikke bli sterkere eller svakere). Resultatet er økt kontraksjon av muskelfibrene som innerveres av aksonet.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p Frekvensen av aksjonspotensialer øker
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!!Vignett
Når aksjonspotensialet kommer fram til den nevromuskulære overgangen åpnes Ca^^2+^^-kanaler og Ca^^2+^^-ioner strømmer inn i cellen.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva gjør at det er netto ionestrøm av Ca^^2+^^ inn i cellen når disse ionekanalene åpner seg?
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<$details class="answer" summary="Svar" state="!!showanswer">
Både konsentrasjonsgradienten (høyere konsentrasjonen av Ca^^2+^^ på utsiden sammenlignet med innsiden av cellen) og det negative membranpotensialet vil gi strøm av positivt ladde Ca^^2+^^ inn i cellen.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1p Konsentrasjonsgradient (høyere konsentrasjon av Ca^^2+^^ på utsiden sammenlignet med innsiden av cellen)
* 1p Negativt membranpotensial
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!!Vignett
Ved Lambert-Eaton myastent syndrom angripes de presynaptiske Ca^^2+^^-kanalene.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor vil tap av slike ionekanaler forstyrre nevromuskulær transmisjon?
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<$details class="answer" summary="Svar" state="!!showanswer">
Åpning av Ca^^2+^^-kanaler gir økt konsentrasjon av Ca^^2+^^-ioner presynaptisk, noe som gir frigjøring av acetylkolin (nevrotransmitter). Tap av slike ionekanaler vil medføre redusert frigjøring av acetylkolin, noe som gir mindre binding av acetylkolin til acetylkolinreseptorer på muskelendeplaten.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.p Tap av ionekanaler gir mindre frigjøring av acetylkolin
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!!Vignett
Myastenia Gravis er en autoimmun sykdom som angriper acetylkolinreseptorer i den nevromuskulære overgangen
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor sitter disse reseptorene og hva skjer når acetylkolin binder seg til dem?
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<$details class="answer" summary="Svar" state="!!showanswer">
Reseptorene sitter postsynaptisk i cellemembranen til muskelfiberen
Nikotinreseptorene er ionotrope, dvs at de er ligandstyrte ionekanaler der binding av nevrotransmitter vil gi åpning av ionekanalene og strøm av positive ioner (kationer) inn i cellen. Det vil da dannes et endeplatepotensial (eksitatorisk postsynaptisk potensial).
I en normalt fungerende nevromuskulær overgang vil endeplatepotensialet være stort nok til at dette også dannes aksjonspotensialer i muskelfiberen.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1p Postsynaptisk i den nervromuskulære overgangen (på muskelfiberen)
* 1p reseptoren er en ionekanal og denne åpnes ved binding av nevrotransmitter
* 1p Dannelse av endeplatepotensial (eller postsynaptisk potensial, aksjonspotensial og eksitatorisk postsynaptisk potensial ikke er det samme)
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor vil tap av fungerende acetylkolinreseptorer gi forstyrrelse av nevromuskulære transmisjon?
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<$details class="answer" summary="Svar" state="!!showanswer">
Det vil være mindre acetylkolinreseptorer som acetylkolin kan binde seg til. Det åpnes da færre ionekanaler, de postsynaptiske potensialene blir lavere, og det dannes derfor færre aksjonspotensialer i muskelfiberen.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 p De postsynaptiske potensialene blir lavere
* 1 p Det dannes færre muskelaksjonspotensialer
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!!Vignett
Et par, begge 40 år, har akkurat fått barn. Du kjenner straks igjen ansiktstrekkene og ser at det minner om Downs syndrom.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skyldes Downs syndrom?
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<$details class="answer" summary="Svar" state="!!showanswer">
Trisomi 21 – dvs et ekstra kromosom 21 – eller en kromosmfeil som involverer translokasjon av kromomosom 21 til et annet akrosentrisk kromosom.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng: Helt rett svar, dvs kromosom 21 "overskudd"
* Bare "trisomi" gir 0.5 poeng
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<div class="oppgave">
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!!Vignett
Du ønsker å bestille en genetisk analyse for å bekrefte din kliniske mistanke.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken analyse bestiller du?
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<$details class="answer" summary="Svar" state="!!showanswer">
Standard kromosomundersøkelse (lysmikroskopisk undersøkelse), PCR-basert trisomitest eller kopitallsundersøkelse
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for ett av de svarene. Alle tre er riktige (totalt oppnåelig 1 poeng).
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<div class="oppgave">
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!!Vignett
Kromosomfeilen som forårsaker Downs syndrom kan være resultat av to ulike genetiske mekanismer, hvorav den ene er sporadisk og den andre kan nedarves.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det genetiske grunnlaget for hver av de to ulike mekanismene?
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<$details class="answer" summary="Svar" state="!!showanswer">
Downs syndrom kan skyldes:
# Aneuploiditet som oppstår ved deling av kjønnsceller (dvs nondisjunction i meiosen enten hos mor eller far), forårsaker ca 95% av tilfellene
# En (Robertsonsk) translokasjon som er oppstått mellom kromosom 21 og et annet akrosentrisk kromosom (i meiosen enten hos mor eller far – eller i tidligere generasjon), forårsaker ca 5% av tilfellene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for translokasjon som involverer kromosom 21
* 0.5 poeng for begrepet akrosentrisk
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<div class="oppgave">
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!!Vignett
Mor forteller at hun har et søskenbarn med Marfan syndrom. Dette er en genetisk bindevevssykdom som skyldes punktmutasjon i fibrillin-1-genet.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken analyse ville du bestille for å undersøke punktmutasjoner?
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<$details class="answer" summary="Svar" state="!!showanswer">
Sangersekvensering eller gensekvensering eller panelsekvensering.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for en av dem. Alle tre er riktige.
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<div class="oppgave">
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!!Vignett
Missense mutasjon er en vanlig årsak til Marfan syndrom.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er en missense mutasjon?
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<$details class="answer" summary="Svar" state="!!showanswer">
Mutasjon som medfører utbytting av en aminosyre i det ferdige proteinproduktet.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar – 1poeng
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!!Vignett
Figuren viser et familiekart hvor de affiserte familiemedlemmene har Marfan syndrom.
<<imgLink "IAB-2020-2-A.PNG">>
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken arvegang er sannsynlig for Marfan syndrom? Begrunn svaret ditt
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<$details class="answer" summary="Svar" state="!!showanswer">
Autosomal dominant arvegang er riktig (1 poeng)
Studentene kan resonnere seg frem til at det er autosomal arvegang, ut fra at:
* begge kjønn kan få sykdommen (0,5 poeng)
* sykdommen forekommer i alle generasjoner, med ca 50% affiserte i hver generasjon (0,5 poeng)
For å få full score og 2 poeng bør disse tre forhold være med
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Se «Svar» over
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<div class="oppgave">
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!!Vignett
Kvinner har to X-kromosomer, mens menn bare har ett, men dette betyr ikke at kvinner uttrykker dobbel dose av alle proteiner kodet for av gener på X-kromosomet.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det mekanistiske grunnlaget for dette?
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<$details class="answer" summary="Svar" state="!!showanswer">
Det mekanistiske grunnlaget er en epigenetisk mekanisme, sk. X-kromosominaktivering som innebærer at i celler med minst to X-kromosomer så vil de fleste gener på ett av X-kromosomene undergå X-kromosominaktivering, dvs ikke være uttrykt. Mekanismen involverer uttrykk av et RNA molekyl (XIST) som tvinner seg rundt X-kromosomet, danner heterokromatin og dermed forhindrer genuttrykk fra det X-kromosomet
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for X-kromosominaktivering på ett av normalt to Xkromosomer hos kvinner
* 0.5 poeng for heterokromatin, evt XIST RNA, evt epigenetikk
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!!Vignett
Takotsubo syndrom er en tilstand der symptomer og klinisk presentasjon minner om akutt hjerteinfarkt. Kontraktiliteten er forandret i deler av myokard, og hjertet har en karakteristisk, krukkelignende form. Høy sympatikustonus og endogene katekolaminer antas å være viktige mekanismer. Tilstanden kan utløses av psykiske belastninger. Den skiller seg fra infarkt ved at koronarkarene er åpne, og ved at kontraktiliteten vanligvis normaliseres innen et halvt år.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
"Myocardial stunning" ("hjertestølhet") eller "hibernernating myocardium" ("hjertedvale") er betegnelser er som brukes ved reversibel reduksjon av kontraktiliteten i myokard i forbindelse med iskemi. Definer begrepene stunning og hibernering, og forklar kort forskjellen.
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<$details class="answer" summary="Svar" state="!!showanswer">
Stunning er en reversibel reduksjon av myokards kontraktilitet etter iskemi og reperfusjon, som vanligvis vedvarer i flere dager etter at vevsperfusjonen er gjenopprettet, og som ikke skyldes varig celleskade. Hibernering er en reversibel reduksjon av myokards kontraktilitet som skyldes pågående kronisk iskemi. Forskjellen er følgende. Stunning kommer etter en kortvarig, (nær) total okklusjon samt gjenoppretting av (nær) normal perfusjon - og går over spontant etter en viss tid. Hibernering vedvarer mens vevsperfusjonen er nedsatt og går tilbake når den er normalisert. Mekanismene for for varig nedsatt kontraktilitet ved stunning og hibernering er ikke sikkert avklart, men lavere nivå av høyenergifosfater, forstyrrelser i kalsiumtransport i sarkoplasmatisk retikulum, redusert kalsiumsensitivtet i myofibrillene og skifte fra aerob til anaerobt stoffskifte er sannsynlige årsaker.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Stunning: Nedsatt kontraktilitet ''etter iskemi og reperfusjon'' uten vesentlig celleskade, tross reetablert perfusjon, funksjonen normaliseres spontant (0.5 poeng).
* Hibernering: Nedsatt kontraktilitet ''under'' pågående iskemi uten vesentlig celleskade, funksjonen normaliseres etter reperfusjon (0.5 poeng).
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<div class="oppgave">
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!!Tidligere vignett
Takotsubo syndrom er en tilstand der symptomer og klinisk presentasjon minner om akutt hjerteinfarkt. Kontraktiliteten er forandret i deler av myokard, og hjertet har en karakteristisk, krukkelignende form. Høy sympatikustonus og endogene katekolaminer antas å være viktige mekanismer. Tilstanden kan utløses av psykiske belastninger. Den skiller seg fra infarkt ved at koronarkarene er åpne, og ved at kontraktiliteten vanligvis normaliseres innen et halvt år.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
En sannsynlig mekanisme ved Takotsubo er konstriksjon av mikrovaskulære kar i myokard. Beskriv kort hvordan hyperaktivitet i det autonome nervesystem kan gi karkonstriksjon i myokard. Forklar signalveien fra frigjøring av transmitter fra nerveterminaler til kontraksjon av glatte muskelceller i karveggen. Hvilke(n) transmitter(e) og hvilke(n) reseptor(er) i cellemembranen er involvert? Hva er de(n) intracellulære signalveien(e) fra reseptorstimulering til kontraksjon av myofilamentene?
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<$details class="answer" summary="Svar" state="!!showanswer">
Høy sympatikustonus kan gi stor frigjøring og svært høye konsentrasjoner av katekolaminer lokalt i myokard, hovedsakelig noradrenalin, men også noe adrenalin. Begge transmitterne binder seg til alfa-1-reseptorene i cellemembranen og kontraherer de glatte muskelcellene i karveggen (1 poeng). Ved binding til alfa-1 reseptoren, aktiveres fosfolipase C (PLC) via det GTP-bindende proteinet Gaq, og derved katalyseres PLC spalting av fosfatidylinositol til inositol-tris fosfat (IP3) og diacyl-glycerol (1 poeng). IP3 aktiverer kalsiumfrigjøringskanalen i sarkoplasmatisk retikulum (SR) og øker derved intracellulær kalsiumkonsentrasjon. Kalsium binder seg til kalmodulin (CaM) og danner et kompleks som aktiverer enzymet myosin-lettkjede-kinase (MLCK) (0.5 poeng). MLCK fosforylerer lette myosinkjeder (MLC), og øker derved kryssbrokoblingen og kraftutviklingen i de glatte muskelfibrene (0.5 poeng). Selv om beta-reseptorene også aktiveres (relakserende/dilaterende effekt), dominerer alfa-1 effekten ved høye katekolaminkonsentrasjoner. Det finnes eksempler på at høye konsentrasjoner av karkonstringerende medikamenter kan utløse Takotsubo.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Høye konsentrasjoner av noradrenalin og adrenalin kontraherer muskelcellene (''1 poeng''). Aktiverer PLC via G-protein og øker IP3 (''1 poeng''). IP3 aktiverer kalsiumfrigjøring fra SR, kalsium binder til CaM og aktiverer MLCK (''0.5 poeng''). MLCK fosforylerer MLC og øker kontraktiliteten (''0.5 poeng''). Tilleggsopplysningene om at alfa-1-stimulering og kontraherende/ konstringerende effekt dominerer over beta-2-stimulerende / relakserende effekt på karet ved svært høye konsentrasjoner av katekolaminer kan kompensere med inntil ''0.5 poeng'' dersom svaret S2 ellers er mangelfullt, men S2 gir ikke mer enn 3 poeng til sammen.
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!!Vignett
(Ikke egen vignett)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort forskjellen på iskemi og hypoksemi.
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<$details class="answer" summary="Svar" state="!!showanswer">
Med iskemi menes full stans eller alvorlig nedsatt perfusjon til et organ eller deler av et organ. Med hypoksemi menes (alvorlig) nedsatt oksygeninnhold i blod. I begge tilfelle er oksygentilførselen helt eller delvis opphørt. Ved iskemi er sirkulasjonen helt eller delvis opphørt, mens ved hypoksemi er sirkulasjonen bevart, og perfusjonen kan være kompensatorisk økt
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Iskemi er nedsatt eller opphør perfusjon (0.5 poeng). Hypoksemi er nedsatt oksygeninnhold i blod (0.5 poeng)
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<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort de viktigste metabolske forandringene i myokard ved akutt iskemi. Forklar hvordan iskemi påvirker myofilamentenes sensitivitet for kalsium
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<$details class="answer" summary="Svar" state="!!showanswer">
Ved akutt iskemi stanser sirkulasjonen, og på grunn av det høye stoffskiftet i myokard er oksygenet i vevet oppbrukt på meget kort tid (sekunder - minutter). Dette fører til at metabolismen endres fra aerobt til anaerobt stoffskifte med laktatproduksjon og acidose (''0.5 poeng''). Energilageret i form av ATP og kreatinfosfat brukes opp, ved nedbrytningen akkumuleres fosfat og adenosin, og etter hvert stanser energikrevende prosesser som muskelkontraksjon, ionetransport over cellemembran (Na,K-ATPase) og kalsiumtranport (Ca-ATPaser) (''0.5 poeng''). Etter hvert overbelastes hjertemuskelcellene med kalsium, og det oppstår irreversibel skade (''0.5 poeng''). Intracellulær acidose og hyperfosfatemi reduserer kalsium-sensitiviteten i myofilamentene og gir redusert kontraktilitet lenge før ATP og kreatinfosfat er oppbrukt (''0.5 poeng'').
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Omlegging til anaerobt stoffskifte med laktatproduksjon og acidose (''0.5 poeng''). Nedbrytning og fall i kreatinfosfat og ATP (''0.5 poeng''). Overbelastning av hjertemuskelcellene med kalsium, og irreversibel celleskade (''0.5 poeng''). Intracellulær acidose og hyperfosfatemi gir redusert kalsium-sensitivitet i myofilamentene og redusert kontraktilitet (''0.5 poeng'')
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med ionebalansen i myocardcellene ved akutt iskemi? Hvordan endres intracellulære og ekstracellulære konsentrasjoner av Na^^+^^, K^^+^^, Ca^^2+^^ og H^^+^^-ioner?
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<$details class="answer" summary="Svar" state="!!showanswer">
Iskemi øker den ekstracellulære konsentrasjonen av K^^+^^ (redusert Na,K-ATPase) og H^^+^^/acidose (laktat) (0.5 poeng); og øker den intracellulære konsentrasjonen av Na^^+^^ (redusert Na,K-ATPase), Ca^^2+^^ (reduserte Ca-ATPaser og Na,Ca-bytte) og H^^+^^/acidose (laktacidose) (0.5 poeng).
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ekstracellulært økt K^^+^^ og H^^+^^/acidose (,,0.5 poeng,,), intracellulært økt Na^^+^^, Ca^^2+^^ og H^^+^^/acidose (,,0.5 poeng,,).
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan endres kontraktiliteten i myokardcellene ved akutt iskemi? Redegjør kort for mekanismen(e).
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<$details class="answer" summary="Svar" state="!!showanswer">
Intracellulær acidose (og hyperfosfatemi) reduserer kalsiumsensitiviteten i myofilamentene og gir redusert kontraktilitet lenge før ATP og kreatinfosfat er oppbrukt. Det antas at H^^+^^ konkurrerer med Ca^^2+^^ ved bindingssetene på myofilamentene (''0.5 poeng''). Energilageret i form av ATP og kreatinfosfat brukes opp, og etter hvert stanser energikrevende prosesser som muskelkontraksjon, og kalsiumtranport (Ca-ATPaser) (''0.5 poeng'').
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Redusert kalsiumsensitivitet i myofilamentene (''0.5 poeng'') og redusert konsentrasjon av høyenergifosfatbindinger som ATP og kreatinfosfat (''0.5 poeng''). Merk at de utfyllende svarene på S4 og S6 overlapper fordi effekter og mekanismer er nevnt begge steder, mens det som gis poeng for er forskjellig. Hvis både effekt og mekanisme er beskrevet i ett av svarene, er det tilstrekkelig å henvise til det.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved reperfusjon av myokard etter relativt kortvarig iskemi sees ofte hjerterytmeforstyrrelser som skyldes økning av intracellulær Ca^^2+^^. Forklar kort mekanismen(e) for denne økningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved iskemi øker intracellulær Ca^^2+^^ i hjertemuskelcellene fordi funksjonen til de energikrevende kalsium-ATPasene er nedsatt (0.5 poeng). Ved reperfusjon vaskes H^^+^^ ut ekstracellulært, og det oppstår en gradient som driver H^^+^^ ut og Na^^+^^ inn ved hjelp av Na,H-bytteren. Økt intracellulær Na^^+^^ vil i sin tur øke intracellulær Ca^^2+^^ via Na,Cabytteren (0,5 poeng). Økt intracellulær Ca^^2+^^ øker forekomsten av forsinkede etter-depolariseringer (delayed after-depolarizations), som kan utløse ventrikulær takykardi. Under iskemi er hjertemuskelcellene depolarisert på grunn av ekstracellulær hyperkalemi, og dermed oppstår hverken aksjonspotensialer eller etter-depolariseringer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Høy intracellulær Ca^^2+^^ under repolarisering skyldes både stigning på grunn av redusert funksjon av Kalsium-ATPasene under den forutgående iskemien, og stigning på grunn av utvasking av H^^+^^, økt intracellulær natrium via Na,H-bytte (''0.5 poeng'') og økt Na,Ca-bytte (''0.5 poeng'').
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En av dine pasienter er en 46 år gammel mann som er levertransplantert på grunn av sykdommen primær skleroserende cholangitt (PSC). Dette er en kronisk betennelse i de små gallegangene i leveren slik at det oppstår arr/fibrose og etter hvert varig skade og svikt i normal leverfunksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 4 hovedfunksjoner som leveren har
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mulige funksjoner:
* Håndtering og kontroll med næringsstoffer, sørge for å opprettholde adekvat næringstilgang for cellene i resten av kroppen (''Fettstoffer; B-oksidasjon, lipogenese'', kolesterolmetabolisme, produksjon av ketonlegemer, lipoproteiner og apolipoproteiner. ''Karbohydrater''; glukoneogenese, glukogenese og glukogenolyse. ''Aminosyrer''; ureasyklus, danning av ikke-essensielle aminosyrer og omdanning mellom ulike typer aminosyrer)
* Produksjon av mange ulike plasmaproteiner (albumin, transferrin, ferritin, koagulasjonsfaktorer, komplementfaktorer, CRP osv, osv)
* Produksjon og utskillelse av gallesalter (fordøyelse og absorpsjon av fettstoffer)
* Utskillelse av ulike stoffer som ikke går via nyrer (eks bilirubin, kolesterol, xenobiotika)
* Detoksifisering/nedbrytning av medikamenter og xenobiotika (fase I og fase II reaksjoner)
* Metabolisme (kjønnshormoner, ulike peptidhormoner) og aktivering av ulike hormoner (vitamin-D, tyroksin)
* Drenering av veneblod fra en stor mengde GI-organer og «rensing» av blod (del av RES systemet, immunforsvar)
* Lagring (eks fettløselige vitaminer, vitamin B12, jern, kobber)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver riktig funksjon av de som er nevnt over (totalt maks 2 poeng). Trenger ikke ha samme «inndeling» av funksjoner som over, så lenge det følger et visst system. Ikke full skåre dersom kun ramser opp elementer innenfor samme kategori.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken overordnet funksjon har portvenen (v.portae)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Portvenen (portåren) drenerer veneblod fra magetarm-organer som magesekk, tynntarm, tykktarm, pankreas og milt. Dette blodet er oksygenfattig, men inneholder masse absorberte stoffer fra tarmen. På den måten går både næringsstoffer og uønskede absorberte stoffer (giftstoffer, mikrobeprodukter osv, osv) direkte til leveren for håndtering der før det går ut i hovedkretsløpet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5p - Drenere veneblod fra mange organ i gastrointestinaltraktus (spesielt tarm)
* 0,5p – absorberte næringsstoffer og «avfall»/uønsket materialefraktes rett til lever for håndtering før ut i hovedkretsløp
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skisser kort hvordan blodet strømmer i en leverlobulus og forklar hvordan egenskapene til kapillærnettverket der understøtter leverens funksjoner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Leverlobulusen har heksagonal form med en sentralvene i midten og grener av portvenen og arteria hepatica (leverarterien) i de seks hjørnene. Forgreiningene fra de to karene går sammen og fusjoneres til kapillærnettverket av sinusoider som ligger mellom bjelkene av leverceller i lobulusen. I midten av lobulusen er sentralvenen. Blodet strømmer inn via portvenene og leverarteriene, i sinusoidene blandes oksygenfattig blod fra venen med oksygenrikt blod fra arterien, og dreneres til sentralvenen og videre til vena hepatica (levervene) og ut av leveren.
Kapillærene i leveren kalles sinusoider og har større diameter enn vanlige kapillærer, har manglende eller ufullstendig basalmembran og er fenestrert med store porer (ikke-kontinuerlig endotel). Endotelcellene er spesialiserte med mange ulike scavenger-reseptorer og høy evne til endocytose. Innimellom endotelcellene sitter også stasjonære makrofager kalt Kupfferceller. Disse egenskapene bidrar til transport av molekyler mellom blod og leverceller, eksempelvis kan store molekyler lett passere fra blodet til leveren, det er effektiv klarering/«rensing» av blodbårent «avfall», og leveren gir et viktig bidrag til det medfødte immunforsvaret.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5p – om vet at blodet strømmer fra grener av vena portae og leverarterien i hver av de seks hjørnene av lobulusen, som så blandes i kapillærnettverket (sinusoidene) og tømmes i sentralvenen i midten (og så ut av leveren)
* 1p – om vet at sinusoidene har a) større diameter, b) ufullstendig basalmembran, c) fenestrering,d) består av spesialiserte endotelceller (med bl.a. aktiv endocytose av substanser) og e) at stasjonære makrofager = Kupfferceller er i endotelveggen. 0,2p for hvert riktige punkt
* 1p – om vet at disse egenskapene gir effektiv transport og opptak av store molekyler fra blodet og til leveren, som del av en «rensing»/»filtrering» av blodet og del av immunforsvaret
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar prinsippet for enterohepatisk sirkulasjon
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enterohepatisk sirkulasjon (kretsløp/resirkulasjon/reabsorpsjon) er det systemet der visse stoffer (eks bilirubin, gallesalter, kobalaminer, diverse legemidler) blir skilt ut fra leveren via gallen til tarmen, for deretter å bli tatt opp igjen lengre ned i tarmen og ført via portveneblodet tilbake til leveren, som på nytt skiller stoffene ut i tarmen via gallen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,75p - om vet at det innebærer utskillelse av stoffer i galle og videre ut i tarmen
* 0,75p - om også vet at innebærer reopptak fra tarmen tilbake til leveren.
Full skåre om beskriver riktig prinsipp med sirkelen lever-galletarm-tilbake til lever (-galle-tarm igjen)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten din har også den kroniske inflammatoriske tarmsykdommen Crohn’s sykdom, med aktiv betennelse spesielt i tynntarmen, og har tidligere fjernet mye av ileum.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar på hvilken måte tynntarmslimhinnen er involvert i fordøyelse (nedbrytningen) av karbohydrater og protein, og mekanismene for denne delen av nedbrytningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tynntarmsslimhinnen har svært stor overflate tilrettelagt for fordøyelse og absorpsjon, med sirkulære folder, villi (tarmtotter) og mikrovilli («børstesøm»/«brush border») på tarmepitelcellene. I denne børstesømmen ligger flere ulike enzymsystem som er viktig for fordøyelse av disse to næringsstoffene:
''Karbohydrat'': Enzymsystem som spalter videre oligo- og disakkarider som sukrose, maltose/maltooligosakkarid og alfalimit dekstriner, som er forgreningsresten etter at alfa-amylase
(fra spyttkjertler og pankreas) har brutt ned stivelse og glykogen. Karbohydrater må brytes ned til sine minste enheter monosakkarider (glukose, fruktose, galaktose) for å kunne bli absorbert av transportsystemer i tarmepitelcellen.
''Protein'': Enzymsystem som spalter videre (etter pepsin i magesekken) peptider, oligo- og dipeptider og dipeptider til enda mindre enheter (oligo- og dipeptider, noen aminosyrer) som kan absorberes inn i tarmepitelet. Der finnes det et system av cytoplasma-peptidaser som spalter de siste delene helt ned til sine ulike aminosyrer som så transporteres ut i blodet. Et enzym i denne børstesømmen er enterokinase/enteropeptidase er ansvarlig for aktivering av trypsinogen til trypsin som igjen er viktig for aktiveringen av alle proenzym i sekretet fra eksokrine pankreas.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5p – om vet at den store overflaten tiln tynntarmslimhinnen, med villi og mikrovilli (=børsesøm/brush border) på enterocyttene, er viktig
* 0,5p – om vet at det i denne børstesømmen finnes ulike enzymsystem som katalyserer spaltingen av disse to næringsstoffene
* 0,5p – om forklarer riktig hvordan disse enzymsystemene utgjør siste del av nedbrytningen og spalter de produktene som dannes etter at nedbrytningen er kommet igang. Bør vite at disse produktene er oligo- og disakkarider for karbohydrater og peptider, oligo- og dipeptider for proteiner.
* 0,5p - Bør vite at karbohydrater må brytes ned til sine minste enheter (monosakkarider) for å absorberes inn i cellene, mens det for proteiner er et siste nedbrytningstrinn i cytosol av enterocyttene som resulterer i de minste enhetene (aminosyrer)
* 0,5p – om nevner at et av enzymene i børstesømmen (enterokinase) er viktig for aktivering av trypsinogen som så videre aktiverer de andre pankreas-proteasene, som er helt nødvendig for nedbrytning av proteiner.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten var plaget med vandig diare.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken malabsorpsjon er mest sannsynlig årsak til diareen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gallesyreindusert diare. Betennelse i, eller kirurgisk fjerning av, distale del av tynntarm kan nedsette enterohepatisk resirkulasjon av gallesyrer, som da kommer over i tykktarm og gir økt væskeog elektrolyttsekresjon fra tykktarmsepitelcellene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må klare å resonere at det har noe med manglende reabsorpsjon av gallesalter å gjøre (pga betennelse/fjerning av tynntarm).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Plexus Brachialis
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke spinale nerver er det vanligvis som danner plexus brachialis?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hovedsakelig (C4) C5 til Th 1
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Nevner cervical og thoracal 1 poeng
* Korrekt spinalhøyde 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Scalenus-porten
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mellom hvilke to muskler kommer plexus brachialis ut av nakken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
m. scalenus anterior og m. scalenus medius
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å nevne scalenus er 1 poeng og riktig muskel benevning 0.5 poeng for hver muskel
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Beskrive flettverket av plexus brachialis
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv flettverket frem til overekstremitets nervene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det starter med 3 trunci som er truncus superior, truncus medialis og truncus inferior.
Disse flettes sammen til 3 fasikler som nevnes som fasciculus lateralis, fasciculus posterior og fasciculus medialis
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig antall trunci og antall fascikler 1 poeng, riktig navngivelse av trunci og fascikler 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Overekstremitet nerver
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Navngi fem nerver i overekstremitetene som kommer fra plexus brachialis?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
N. axillaris, n. musculocutaneus, n. radialis, n.medianus og n. ulnaris.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle riktig (2 poeng), 3 av 5 riktig (1poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bevegelse
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke nerver innerverer hhv. fleksjon i albue og ekstensjon i håndledd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fleksorer i albue er n.musculocutaneus og ekstensorer i håndledd n.radialis
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
N. musculocutaneus (1 poeng) n. radialis (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En jente på 15 år kommer til deg på legekontoret. Hun bor sammen med mor og tre yngre halvsøsken, har ingen kontakt med far. Du vet fra tidligere at mor til jenta har hatt rusproblemer og vært utsatt for vold fra flere av sine samboere. Jenta selv er oppløst i gråt og fortvilet. Hun har funnet ut at hun er gravid og har kranglet med mor. Hun er tidligere frisk, men har hatt et stort fravær fra skolen de siste 2-3 månedene samtidig med at hun brukt hasj og har drukket alkohol nesten hver helg det siste året.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv typiske psykososiale og kognitive utviklingstrekk i alderen 14-16 år? (Nevn minst fire punkter)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Individnivå:
* Frigjøringsprosess
* Personrettet seksuell orientering
Familienivå:
* Maktkamp mellom ungdom og foreldre
Sosiale relasjoner:
* Skiftende vennerelasjoner
* Politisk engasjement
* Opptatt av rettferdighet/urettferdighet
Kognitivt:
* Økende abstrakt tenkning
* Kontrollsentre i hjernen mindre utviklet enn emosjonelle
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fysiske endringer skjer i puberteten? (nevn minst 2 punkter)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Høydevekst
* Primære kjønnskarakteristika
** Modning av kjønnsorganer for reproduksjon
* Sekundære kjønnskarakteristika
** Brystutvikling
** Behåring
** Menstruasjon
** Stemmeskifte
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fire måneder senere kommer hun tilbake, gravid i svangerskapsuke 30. Hun er bekymret for om hun vil bli en god nok mor for barnet sitt
Fra tidligere vignett:
<<<
En jente på 15 år kommer til deg på legekontoret. Hun bor sammen med mor og tre yngre halvsøsken, har ingen kontakt med far. Du vet fra tidligere at mor til jenta har hatt rusproblemer og vært utsatt for vold fra flere av sine samboere. Jenta selv er oppløst i gråt og fortvilet. Hun har funnet ut at hun er gravid og har kranglet med mor. Hun er tidligere frisk, men har hatt et stort fravær fra skolen de siste 2-3 månedene samtidig med at hun brukt hasj og har drukket alkohol nesten hver helg det siste året.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du fortelle henne er god omsorg for barn de første levemånedene? (Nevn minst seks punkter innenfor 3 ulike områder)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Emosjonelt:
* Varm og kjærlig omsorg for babyen
* Kroppskontakt
* Kommunisere med barnet, synge for/snakke med
* Regulere barnet når det har ubehag, f.eks vugge, bære, trøste
* Tolke barnets signaler – når det trenger trøst og når det trenger pause
Kognitivt:
* Kommunisere med barnet, synge for/snakke med
* Respondere på barnets signaler/tegn til kontakt
* Etter hvert leke med barnet og la barnet utforske omgivelser under nødvendig tilsyn
Mat:
* Sørge for at barnet får mat i forhold til sitt behov
Søvn:
* Sørge for at barnet får tilstrekkelig søvn og hvile i forhold til sin alder
Stell:
* Ivareta god hygiene gjennom bading, bleieskift o.l.
Helse:
* Følge opp anbefalinger fra helsestasjon
* Følge vaksinasjonsprogram
* Ta kontakt med helsestasjon eller fastlege dersom babyen har symptomer eller tegn på sykdom
Sikkerhet:
* Tilse at barnet har trygge omgivelser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar, minst tre ulike områder må være dekket. Inntil 3 poeng totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
Fra tidligere vignetter:
<<<
En jente på 15 år kommer til deg på legekontoret. Hun bor sammen med mor og tre yngre halvsøsken, har ingen kontakt med far. Du vet fra tidligere at mor til jenta har hatt rusproblemer og vært utsatt for vold fra flere av sine samboere. Jenta selv er oppløst i gråt og fortvilet. Hun har funnet ut at hun er gravid og har kranglet med mor. Hun er tidligere frisk, men har hatt et stort fravær fra skolen de siste 2-3 månedene samtidig med at hun brukt hasj og har drukket alkohol nesten hver helg det siste året.
<<<
<<<
Fire måneder senere kommer hun tilbake, gravid i svangerskapsuke 30. Hun er bekymret for om hun vil bli en god nok mor for barnet sitt
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke risikofaktorer for psykisk sykdom har jenta på 15 år? (nevn minst to faktorer)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Bruk av alkohol/hasj
* Mor med rusmisbruk, mulig utsatt for omsorgssvikt
* Vitne til vold mot mor
* Skolefravær
* Sosialt utenforskap
* Belastning ved tenåringsgraviditet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar, inntil to poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter to uker får du vite at jenta har født en liten gutt.
Fra tidligere vignetter:
<<<
En jente på 15 år kommer til deg på legekontoret. Hun bor sammen med mor og tre yngre halvsøsken, har ingen kontakt med far. Du vet fra tidligere at mor til jenta har hatt rusproblemer og vært utsatt for vold fra flere av sine samboere. Jenta selv er oppløst i gråt og fortvilet. Hun har funnet ut at hun er gravid og har kranglet med mor. Hun er tidligere frisk, men har hatt et stort fravær fra skolen de siste 2-3 månedene samtidig med at hun brukt hasj og har drukket alkohol nesten hver helg det siste året.
<<<
<<<
Fire måneder senere kommer hun tilbake, gravid i svangerskapsuke 30. Hun er bekymret for om hun vil bli en god nok mor for barnet sitt
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke risikofaktorer for psykisk sykdom har gutten? (Nevn minst to faktorer)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Utsatt for rus i svangerskapet
* Utsatt for mors stress i svangerskapet
* Ung og umoden omsorgsperson
* Arvelig belastning for rus/ psykisk sykdom
* Prematuritet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar, inntil 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hvite blodceller har ulike oppgaver i vårt infeksjonsforsvar. Mest tallrike av de hvite blodcellene er nøytrofile granulocytter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I forsvaret mot hvilke typer infeksjoner er de nøytrofile granulocyttene særlig viktige?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forsvar mot bakterie- eller soppinfeksjoner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bakterie- og soppinfeksjoner. Studentene kan nevne ord som medfødt eller uspesifikt immunforsvar, men det svarer ikke dirkete på spørsmålet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles prosessen som i løpet av minutter får nøytrofile granulocytter fra blodbanen og til det stedet til trengs for mikrobedrap?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Prosessen kalles kjemotaksi og er benevnelsen for bevegelse av celler mot eller fra en kjemisk gradient.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kjemotaksi må være nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv trinnvis denne prosessen som rekrutterer granulocyttene til vevet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Først ruller granulocyttene langs endotel i karsengen. Det kalles marginalisering og kan skje grunnet selektiner på celleoverflaten. Neste trinn er adhesjon til karveggen ved integriner. Tredje trinn er transmigrasjon gjennom porer i endotelet . Det er binding av bakterie-molekyler via G-protein koblede reseptorer på celleoverflaten av nøytrofile granulocytter som direkte stimulerer motiliteten til cellen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begrepene marginalisering – adhesjon og diapedese/transmigrasjon må være nevnt. Studentene kan også nevne begrep som locomotion og cytoskjelettets betydning for cellenes bevegelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nøytrofile granulocytter hører til gruppen av fagocyterende celler
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv trinnene i prosessen for mikrobedrap som kalles fagocytose
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gjenkjennelse av patogener skjer ved såkalte pattern recognition receptors (PRR), komplementreseptor eller FC-reseptor på immunglobulin (opsonisering). Mikrobe/mikrobeprodukt tas opp i granulocytten ved endocytose: avsnøring av cellemembranen med dannelse av en intracellulær vakuole. Denne vakuolen/fagosomet smelter sammen med et lysosom inne i cellen og danner et fagolysosom. Selve mikrobedrapet skjer i fagolysosomet vha enzymer som lysozym og hydrolaser som bryter ned bakteriecelleveggen. I membranen til fagolysosomet dannes oksygenradikaler som er toksiske også for den nøytrofile granulocytten selv, og denne dør til slutt som følge av akkumulasjon av toksiske produkter fra mikrobedrapet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Første del (gjenkjennelse av patogen) er ikke direkte etterspurt i oppgaven og må ikke være med for å gi poeng). Begrepene endocytose- fagolysosom (evt fagosom + lysosom) – toksiske oksygenradikaler, lysozym og laktoferrin – cytokinfrigjøring og celledød.
Noen vil kanskje også nevne «respiratory burst» som er hvordan fagocyterende celler kan øke oksygenforbruket og danne flere oksygenradikaler til mikrobedrapet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Man mener i dag at nøytrofile granulocytter også spiller en rolle i ekstracellulært mikrobedrap
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort mekanismene for slikt ekstracelleulært mikrobedrap utøvd av nøytrofile granulocytter
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det kalles Neutrophil Extracellular Traps (NET) og består av et nettverk av fibre med kjerneinnhold (histoner) og granula fra nøytrofile granulocytter som danner feller for mikrober. Mikrober som fanges i disse nettverkene vil gå i apoptose. Mekanismene er ikke fullstendig klarlagt, men granula og histoner fra granulocytter spiller en rolle
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
NET må være nevnt og kort forklart.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Steroidhormoner er en viktig gruppe av hormoner som medierer sin aktivitet gjennom binding til en rekke spesifikke reseptorer. På delspørsmål 1 og 4 kan du gjerne bruke eksempler i tillegg til å gi en mer generell beskrivelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvilke vev/organer blir steroidhormonene produsert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Steroidhormonene produseres i binyrebarken, testikler og ovarier. Hos gravide produseres også steroidhormoner i placenta.
* Eksempel 1: Testosteron produseres i testikler hos menn, mens det også produseres små mengder i ovariene, binyrebarken og i placenta hos gravide.
* Eksempel 2: Østrogene produseres hovedsakelig i eggstokkene og i placenta. Noe østrogen blir også produsert i testikler og i binyrebarken.
* Eksempel 3: Kortisol (glukokortikoid) produseres i binyrebarken.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Viktigst er at steroidhormonene produseres i binyrebarken, testikler og ovarier. Gir ett poeng. To poeng om man har med et eksempel i tillegg.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket molekyl er utgangspunktet for produksjonen av steroidhormoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alle steroidhormoner produseres med utgangspunkt i kolesterol.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kolesterol
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er karakteristisk for reseptorene som binder steroidhormoner (lokalisering og struktur)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Selv om det også finnes reseptorer som binder steroidhormoner på cellemembranen er reseptorene i all hovedsak lokalisert i cytoplasma og i kjernen. Dette fordi steroidhormonene er fettløselige og kan passere cellemembranen. Reseptorene består av to hovedelementer, et ligandbindende domene som hormonet binder seg til, og et DNA-bindende domene som gjør at den stimulerte reseptoren binder til DNA
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Lokalisering: cytoplasma og kjernen.
* Struktur: DNA-bindende og hormon-bindende domene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
Fra tidligere vignett:
<<<
Steroidhormoner er en viktig gruppe av hormoner som medierer sin aktivitet gjennom binding til en rekke spesifikke reseptorer. På delspørsmål 1 og 4 kan du gjerne bruke eksempler i tillegg til å gi en mer generell beskrivelse.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan er virkningsmekanismen for steroidhormoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fordi steroidhormonene er fettløselige passerer de cellemembranen og binder reseptorer intracellulært. Steroidreseptorene er transkripsjonsfaktorer og vil når de stimuleres binde til DNA og regulere DNA-transkripsjonen (produksjonen av mRNA).
For eksempel er signal fra testosteron nødvendig for spermatogenesen og fertilitet hos menn. Det betyr at de genene som stimulerer disse prosessene blir aktivert vha. testosteron og dens reseptorer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dersom det ikke tidligere er sagt at steroidhormoner er fettløselige og kan passere cellemembranen, må det med her. Videre må studenten ha med at reseptorer for steroidhormoner er transkripsjonsfaktorer. For full uttelling bør studenten ha med et eksempel som f.eks. testosteron.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 52 år gammel kvinne kommer med ambulanse til skadepoliklinikken kl. 02.30. En time tidligere hadde hun sklidd på den islagt verandaen da hun skulle ut å se på stjernene. Hun holdt seg fast i gelenderet da hun falt. Hun fikk først en vridning i venstre arm og slo deretter armen i bakken. Hun har nå sterke smerter i venstre skulder og overarm. Ved ankomst til sykehuset blir det gjennomført bildediagnostikk.
<<imgLink "IAB-2021-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Se på bilde 1. Hvilken type radiologisk undersøkelse er gjennomført, og hvilke(t) skjelettavvik foreligger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er gjennomført røntgen av venstre overarm og skulder. Det foreligger en fraktur (mer presist en tverrfraktur) i midtre del av humerus, samt en fraktur i proksimale humerus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at det er gjennomført røntgen. 0.5 poeng for angivelse av hver aktuelle fraktur
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det blir besluttet at pasienten skal opereres, og ortopeden ønsker mer omfattende og detaljerte bilder av pasientens skader som ledd i operasjonsplanleggingen. Det blir gjennomført en ny radiologisk undersøkelse. Se bilde 2 og bilde 3.
<<imgLink "IAB-2021-B.PNG">>
<<imgLink "IAB-2021-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hovedprinsippet bak bildedannelse ved hjelp av denne type bildeundersøkelse, og kan du beskrive to fordeler med og en potensielt skadelig effekt av undersøkelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved computertomografi (CT) ligger pasienten inne i en maskin, omgitt av en roterende bue. På denne buen står det på den ene siden et røntgenrør, og på motsatt side er det montert en røntgenstråle-detektor. Når buen står i en posisjon, vil røntgenstråler sendes inn mot pasientens kropp. Noen av røntgenstrålene blir absorbert i pasienten. Dette skjer i større grad i de områdene av pasienten som er røntgentette (områder med mye og tettpakkede eller store atomer, som for eksempel kalkholdig skjelett). De fleste av de resterende røntgenstrålene passerer gjennom kroppen, og treffer detektoren som er plassert på den andre siden. Når røret står i en bestemt posisjon, vil det tredimensjonale volumet som kroppen representerer bli registrert som et 2-dimensjonelt bilde. Dette bildet kalles et tomogram.
Ved CT roterer buen med rør og detektor rundt pasienten, og gjør røntgenregistreringer/tar bildeopptak i mange ulike retninger. Basert på de mange ulike registreringene/bildeopptakene, kan man ved hjelp av datamaskiner (derav computerized) regne seg frem til tettheten til vevet inne i det tredimensjonale volumenet som kroppen representerer.
Fordeler med CT er at undersøkelsen kan gjennomføres raskt, og gir derfor informasjon om mye volum på kort tid. CT kan gi samtidig informasjon om både bløtvev, blodårer og skjelett. Videre er CT smertefri og ikke-invasiv, og gir bildefremstilling med høy oppløsning. I tillegg kan bildene rekonstrueres til alle ønskelige plan.
CT benytter seg av røntgenstråler, som har ioniserende egenskaper. Med dette menes at røntgenstrålene har evnen til å slå elektroner ut av sine skall/orbitaler, og skaper et ion. Molekyler som er ioniske har større reaksjonsevne med andre atomer/molekyler, og hvis det dannes ioner i DNA, kan dette medføre mutasjoner, som igjen kan være kreftfremkallende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å beskrive at CT benytter seg av et roterende apparat med røntgenrør og detektor. 0.5 poeng for å beskrive at det tas bilder i mange ulike retninger, og at dette kan benyttes til å regne ut og lage bilder av hva som befinner seg inne i kroppen (computerized tomography eller computertomografi). 0.5 poeng for å nevne en fordel med CT, 1 poeng for å nevne to fordeler. 1 poeng for å forklare at CT benytter røntgenstråler som er ioniserende stråling med potensiell skadelig effekt.
Maks 2.5 poeng. Dersom studenten velger feil modalitet gis det ingen poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir operert. To dager senere får hun sterke smerter i øvre del av magen, og blir innlagt på sykehuset igjen. Legen i mottaket ønsker å utelukke at smertene skyldes en blødning fra en skade i lever. Det blir gjennomført både MR- og CT-avbildning, se bilde 4 og 5.
<<imgLink "IAB-2021-D.PNG">>
<<imgLink "IAB-2021-E.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket bilde er tatt med henholdsvis CT og MR? Kan du tenke deg hvorfor det ene bildet er så mye mer uklart enn det andre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bilde 4 er et MR-bilde, og bilde 5 er et CT-bilde. På CT er skjelettstrukturer hvite, og fettvev (som for eksempel subkutant vev) er mørkt. På MR blir kortikalt beinvev (som inneholder mye kalk og få hydrogenatomer) stort sett sort på alle sekvenser, og fett blir lyst på både vanlige T1- og T2-sekvenser.
CT-undersøkelse gjennomføres raskt, opptaket over abdomen er gjort i løpet av få sekunder. MR-undersøkelse tar lang tid, mange sekvenser kan ta flere minutter. For å unngå artefakter fra bevegelser, som for eksempel pustebevegelser, kan det gjennomføres relativt raske sekvenser hvor pusten holdes. Alternativt kan det tas multiple delbildeopptak kun i samme del av respirasjonen, som settes sammen til et helt bilde. Årsaken til at MR-bildet er mer uklart enn CT-bildet, er derfor at bildeopptak med MR tar lang tid, hvilket øker sjansen for bevegelsesartefakter (i dette tilfellet forårsaket av pusting/bevegelse av diafragma).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for korrekt angivelse av MR- og CT-bilder. 1 poeng for å angi at bildeopptak med MR tar mye lengre tid enn opptak ved CT, og at dette disponerer for bevegelsesartefakter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Se på bilde 6.
<<imgLink "IAB-2021-F.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anatomiske strukturer er det satt piler på? Benevningen strekker seg fra A-F.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* A: Lever
* B: Milt
* C: Aorta (i avgangen av truncus cøliacus)
* D: Magesekk, ventrikkelen
* E: Nyre
* F: Vena cava inferior
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng for hvert riktige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar prinsippet bak avbildning med magnetisk resonans (på maks 300 ord).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MR-bilder skapes ved å manipulere kjernen til hydrogenatomer (=protoner). Et proton er positivt ladet, og har et egenspinn omkring egen akse. Elektrisitet i rotasjon gir magnetisme, og derfor kan et proton oppfattes som en liten stavmagnet. Vann og fett inneholder mye protoner, og menneskekroppen inneholder mye av begge disse substansene. Protoner i kroppen (og for så vidt for øvrig) har magnetisk vektor som er tilfeldig orientert. De mange protonene som befinner seg i et bestemt volum vil ha ulike magnetiske vektorer, slik at summen av vektorene (resultatvektoren) vil være 0.
Hvis en legger et volum i et eksternt magnetfelt (som en MRmaskin har), vil de enkelte protonene rette sitt magnetfelt inn parallelt eller antiparallelt med det eksterne magnetfeltet. Det vil være en liten overvekt av protoner som stiller seg inn parallelt, og resultatvektoren av disse vil derfor være rettet parallelt.
I tillegg til å ha et egenspinn, slingrer også den roterende aksen til protonene, med en såkalt presesjon. Denne presesjonen har for protoner en bestemt frekvens som korrelerer med feltstyrken til det eksterne magnetiske feltet. Ved 1.5 tesla er denne frekvensen 63.8 MHz.
Den magnetiske resultatvektoren av de parallelle protonene i et magnetfelt er fryktelig liten i forhold til det eksterne magnetfeltet, og derfor ikke målbart. Hvis en kunne bikket vektoren ut fra denne retningen, til en retning 90 grader på magnetfeltet, kunne man imidlertid ved hjelp av en coil registrert de roterende magnetiske protonene og fått signaler som en kunne lagd et bilde av. Det er her begrepet resonans i «magnetisk resonans» kommer inn. Hvis en sender inn en radiofrekvenspuls som har samme frekvens som presesjonsfrekvensen (63.8 MHz ved 1.5 tesla), vil en bikke den magnetiske vektoren til protonene fra parallell retning til etter hvert 90 grader på parallell retning. En måler da i dette planet, kjent som transversalplanet, roterende magnetisme, som er det samme som elektrisitet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for å ha med at protoner brukes til bildedannelse, og at protonene er magnetiske. Begge deler må være med.
* 0.5 poeng for å ha med at protonene orienteres i samme retning som et eksternt magnetfelt.
* 0.5 poeng for å beskrive fenomenet presesjon og at denne kan påvirkes av en resonnerende radiofrekvenspuls. Begge deler må være med.
* 0.5 poeng for å beskrive at signalene til de roterende protonene kan måles i transversalplanet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 45 år gammel mann som malte huset sitt falt 3 meter ned fra en stige.
Han er tungpustet og har brystsmerter. På røntgen ses forandringer forenlig med høyresidig trykkpneumotoraks, med forskyving av hjerte mot venstre side. Dette må avlastes ved å legge inn et toraksdren. Ved innleggelse av toraksdrenet skal man ta høyde for nerver, kar og årer mellom ribbein (den nevrovaskulære intercostale bunt).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du beskrive hvor den neurovaskulære intercostale bunt ligger i forhold til ribbein og rygg, samt hvordan nerver, arterier og vener ligger i forhold til hverandre.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den nevrovaskulære bunt ligger under hver costa. Derfor skal et toraksdren føres inn over costa.
Øverst på den nevrovaskulære bunt ligger vena intercostalis, nedenfor der ligger arteria intercostalis og så nervus intercostalis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for korrekt beliggenhet og i forhold til hverandre,
** 0.5 poeng for korrekt beliggenhet
** 0.5 poeng for beliggenhet i forhold til hverandre.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når mann legge inn et toraksdren er det viktig å være sikker på at man er i torakshulen. Derfor sjekker man med en finger om man har gått gjennom det innerste lag på toraksveggen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket lag er innerst på toraksveggen og hvilket lag omgir lungene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Pleura parietalis ligger innerst på toraksveggen
* Pleura visceralis omgir lungene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.0 poeng for hvert korrekt navn på lagene (pleura parietalis og visceralis). (Pars cervicalis av parietalis godkjennes også)
0.5 poeng for hver korrekt plassering av lagene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved et pneumotoraks legges et toraksdren oppover og ved et hematotoraks nedover
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Toraksdrenet ved en pneumotoraks skal ligge øverst i lungehulen. Det er samme området hvor apex av lungen ligger. Hva heter dette område?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cupula (pleuræ)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Cupula
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Da det ble påvist høyresidig trykkpneumotoraks ble det sett forskyving av hjerte mot venstre på røntgen toraks.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter den delen av torakshulen som inneholder hjerte og de store kar? Kan du beskrive inndelingen av de forskjellige delene denne delen av torakshulen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den delen av torakshulen heter mediastinum. Mediastinum er delt inn i en mediastinum superius og inferius. Mediastinum inferius er delt inn i mediastinum anterius, mediastinum medium og mediastinum posterius.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Mediastinum 1 poeng
* Riktig benevning i superius og inferius 1 poeng
* Riktig inndeling av mediastinum inferius 1 poeng
* Terminologi hvor andre inklinasjoner er brukt godkjennes (f.eks. superior, inferior, fremre, øvre og bakre).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gjennom mediastinum går det to store nerver. En er den tiende hjernenerve mens den andre kommer fra rami anterior av nervus cervicales III-V.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter disse to nervene og beskriv beliggenhet i forhold til hverandre i høyde med lungehilus? Beskriv hvilke strukturer disse to nervene hovedsakelig innerverer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nervus vagus er den tiende hjernenerve, mens nervus phrenicus kommer fra nervus cervicales III-V.
Nervus vagus ligger baktil lungehilum mens nervus phrenicus ligger foran.
Nervus vagus innerver de fleste organer i kroppen vår (hjerte, lungene og indre organer.
Nervus phrenicus innerverer diaphragma
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Riktig navn på hver nerve (0.5 poeng hver)
* Riktig beliggenhet på hver nerve (0.5 poeng hver)
* Riktig innervasjon av struktur på hver nerve (0.5 poeng hver)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du renser en torsk du har fanget selv. Dessverre skjærer du deg på fingeren. Det blør litt
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv et umiddelbart tiltak for å stoppe blødningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kompresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p. Bare rett svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet stimulerer til dannelse av plateplugg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Trombocyttene benytter integrinkompleksene gp Ia-IIa og gp I-V-IX på celleoverflaten for å adherere til stroma (bindevevet rundt blodåren). Hvilke proteiner binder disse integrinkompleksene til?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Kollagen binder gpIa-IIa
* gpI-gpV-gpIX komplekset binder von Willebrand faktor (vWF)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kollagen 1p + vWF 1p hver, dvs til sammen maks 2p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet starter koagulasjonsfaktorsystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tissue factor (TF, vevsfaktor) bidrar til å starte koagulasjonskaskaden. Hvor lages TF og hvilket molekyl danner kompleks med TF for å spalte FX til FXa?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
TF syntetiseres i stromale celler som omgir blodkarene (f.eks fibroblaster). FVII er partner til TF
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Stromale celler eller fibroblaster gir 1p
* FVIIa 1p. FVII er også akseptabelt
* Totalt max 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det dannes nå en plateplugg
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar i korte trekk hvordan platepluggen dannes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# aggregasjon (via gpIIb-IIIa-komplekset)
# aktivering (archidonsyre metabolitter (prostaglandiner, tromboxan) ADP trombin)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Aggregasjon og aktivering gir 1 p hver
* gpIIb-IIIa, ADP, trombin, prostaglandiner eller tromboxan gir alle 0.5 p
* Totalt 3 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Platehemmere er vanlige legemidler
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan virker acetylsalicylsyre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemmer prostaglandinsyntese via hemming av cykloxygenase (COX) -1 og -2)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1p – Både hemming av COX, produksjon av tromboxan eller prostaglandiner er godt nok svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Trombin er den store dirigenten i koagulasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken koagulasjonsfaktor hemmes av koagulasjonshemmerkomplekset av protein C og S? Denne mekanismen reduserer dannelsen av trombin.
Hvilket enzym spalter fibrin til d-dimerer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# FVa (FV er akseptabelt også)
# Plasmin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert svar gir 0.5p Maks 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det finnes to hovedtyper celler, prokaryote og eukaryote
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi minst fire forskjeller mellom prokaryote og humane eukaryote celler.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* De fleste humane eukaryote celler har cellekjerne
* Humane eukaryote celler er ofte større enn prokaryote celler
* Enkelte prokaryote celler har en cellevegg i tillegg til cellemembranen
* Humane eukaryote celler har organeller
* DNA er lineært i cellekjernen i humane eukaryote celler. I prokaryote celler er DNA sirkulært.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha nevnt 4 forskjeller for å få 2 poeng. 0.5 poeng for hver rette. Maks 2 poeng på oppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sykdommen Progeria skyldes en mutasjon i genet som koder for lamin A.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil dette kunne påvirke cellene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lamin A er en type intermediært filament, som sammen med lamin B1, B2 og C danner kjernelamina, som er et nettverk som ligger under kjernemembranen og støtter opp denne. Svekket kjernelamina gir en mer ustabil kjernembran, og økt risiko for feil under celledeling og økt celledød. Cellene hos pasienter med progeria vil typisk kunne ha deformert kjernemembran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At kjernemembranen vil kunne være deformert, eller andre resonnement som knytter lamin A til funksjon i kjernelamina.
Bør nevne ustabil kjernemembran og svekket kjernelamina for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Immunceller vil kunne indusere apoptose i en målcelle (infisert celle, tumorcelle).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvordan dette skjer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Immunceller utrykker ligander i TNF-familien (feks. Fas-ligand) som kan binde til og aktivere dødsreseptorer» på infiserte celler/tumorceller. Dødsreseptorer (feks. Fas) har alle et såkalt dødsdomene som ved aktivering vil føre til danning av et dødsinduserende signalkompleks (DISC). Dette fører til spalting og aktivering av initiator-caspaser (typisk caspase 8) som vil sette i gang en kaskadereaksjon og aktivering av effektor-caspase 3. Effektor caspaser vil spalte viktige cellulære proteiner som feks anti-apoptotiske proteiner, cytoskjelettet, inibitor av DNAse osv, som vil føre til celledød. Denne type apoptose kalles for også for den «eksterne vei» til apoptose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Type apoptose: Dødsreseptor/ekstern signalvei til apoptose
* TNF-familie reseptorer/ligander
* DISC
* Aktivering av caspaser
* Initiator caspase, effektor caspase
* Spalting av viktige cellulære proteiner
Minst 2 av punktene over for 2 poeng, 1av punktene for 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil en mangel på makrofager eller andre fagocyterende celler føre til i situasjonen beskrevet ovenfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Apoptotiske celler vil vanligvis gjenkjennes av fagocyterende celler som makrofager som vil fjerne de døde cellene. Mangel på makrofager/fagocytter og vil føre til et «hav» av døde celler i vev som ikke vil bli fjernet, noe som vil kunne føre til en betennelsesreaksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Beskrive at det vil føre til opphoping av apoptotiske celler i vev (2 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skiller apoptotisk og nekrotisk celledød?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved nekrose sveller cellene, og plasmamembranen går i stykker. Cellens innhold lekker ut i omgivelsene og tiltrekker seg betennelsesceller. Ved apoptose vil cellen skrumpe, kjernen kondenseres, DNA fragmenteres og cellefragmenter vil pakkes i små «pakker» kalt apoptotiske legemer (apoptotic bodies). Cellemembranen er intakt gjennom hele prosessen. Celleinnholdet vil derfor ikke slippes ut i omkringliggende vev, og betennelsesceller vil ikke tiltrekkes. En annen årsak til at det ikke blir betennelse ved apoptose, er at apoptotiske celler gjenkjennes (via fosfatidylserin på celleoverflaten) og fagocyteres av makrofager. Dermed forsvinner den døde cellen fra vevet, og betennelse forhindres. Ved fagocytose av apoptotiske celler skilles det også ut anti-inflammatoriske cytokiner som feks TGFb og IL-10 som vil bidra til å hindre en immunreaksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha med:
* frigjøring av celleinnhold ved nekrose, ikke ved apoptose
* betennelse vs ikke betennelse
* fagocytose av apoptotiske celler
3 av punktene gir 2 poeng, 1-2 av punktene gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 52 år gammel kvinne kommer med ambulanse til skadepoliklinikken kl. 02.30. En time tidligere hadde hun sklidd på den islagt verandaen da hun skulle ut å se på stjernene. Hun holdt seg fast i gelenderet da hun falt. Hun fikk først en vridning i venstre arm og slo deretter armen i bakken. Hun har nå sterke smerter i venstre skulder og overarm. Ved ankomst til sykehuset blir det gjennomført bildediagnostikk.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Se på bilde 1. Hvilken type radiologisk undersøkelse er gjennomført, og hvilke(t) skjelettavvik foreligger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er gjennomført røntgen av venstre overarm og skulder. Det foreligger en fraktur (mer presist en tverrfraktur) i midtre del av humerus, samt en fraktur i proksimale humerus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at det er gjennomført røntgen. 0.5 poeng for angivelse av hver aktuelle fraktur
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det blir besluttet at pasienten skal opereres, og ortopeden ønsker mer omfattende og detaljerte bilder av pasientens skader som ledd i operasjonsplanleggingen. Det blir gjennomført en ny radiologisk undersøkelse. Se bilde 2 og bilde 3.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hovedprinsippet bak bildedannelse ved hjelp av denne type bildeundersøkelse, og kan du beskrive to fordeler med og en potensielt skadelig effekt av undersøkelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved computertomografi (CT) ligger pasienten inne i en maskin, omgitt av en roterende bue. På denne buen står det på den ene siden et røntgenrør, og på motsatt side er det montert en røntgenstråle-detektor. Når buen står i en posisjon, vil røntgenstråler sendes inn mot pasientens kropp. Noen av røntgenstrålene blir absorbert i pasienten. Dette skjer i større grad i de områdene av pasienten som er røntgentette (områder med mye og tettpakkede eller store atomer, som for eksempel kalkholdig skjelett). De fleste av de resterende røntgenstrålene passerer gjennom kroppen, og treffer detektoren som er plassert på den andre siden. Når røret står i en bestemt posisjon, vil det tredimensjonale volumet som kroppen representerer bli registrert som et 2-dimensjonelt bilde. Dette bildet kalles et tomogram.
Ved CT roterer buen med rør og detektor rundt pasienten, og gjør røntgenregistreringer/tar bildeopptak i mange ulike retninger. Basert på de mange ulike registreringene/bildeopptakene, kan man ved hjelp av datamaskiner (derav computerized) regne seg frem til tettheten til vevet inne i det tredimensjonale volumenet som kroppen representerer.
Fordeler med CT er at undersøkelsen kan gjennomføres raskt, og gir derfor informasjon om mye volum på kort tid. CT kan gi samtidig informasjon om både bløtvev, blodårer og skjelett. Videre er CT smertefri og ikke-invasiv, og gir bildefremstilling med høy oppløsning. I tillegg kan bildene rekonstrueres til alle ønskelige plan.
CT benytter seg av røntgenstråler, som har ioniserende egenskaper. Med dette menes at røntgenstrålene har evnen til å slå elektroner ut av sine skall/orbitaler, og skaper et ion. Molekyler som er ioniske har større reaksjonsevne med andre atomer/molekyler, og hvis det dannes ioner i DNA, kan dette medføre mutasjoner, som igjen kan være kreftfremkallende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å beskrive at CT benytter seg av et roterende apparat med røntgenrør og detektor. 0.5 poeng for å beskrive at det tas bilder i mange ulike retninger, og at dette kan benyttes til å regne ut og lage bilder av hva som befinner seg inne i kroppen (computerized tomography eller computertomografi). 0.5 poeng for å nevne en fordel med CT, 1 poeng for å nevne to fordeler. 1 poeng for å forklare at CT benytter røntgenstråler som er ioniserende stråling med potensiell skadelig effekt.
Maks 2.5 poeng. Dersom studenten velger feil modalitet gis det ingen poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir operert. To dager senere får hun sterke smerter i øvre del av magen, og blir innlagt på sykehuset igjen. Legen i mottaket ønsker å utelukke at smertene skyldes en blødning fra en skade i lever. Det blir gjennomført både MR- og CT-avbildning, se bilde 4 og 5.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket bilde er tatt med henholdsvis CT og MR? Kan du tenke deg hvorfor det ene bildet er så mye mer uklart enn det andre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bilde 4 er et MR-bilde, og bilde 5 er et CT-bilde. På CT er skjelettstrukturer hvite, og fettvev (som for eksempel subkutant vev) er mørkt. På MR blir kortikalt beinvev (som inneholder mye kalk og få hydrogenatomer) stort sett sort på alle sekvenser, og fett blir lyst på både vanlige T1- og T2-sekvenser.
CT-undersøkelse gjennomføres raskt, opptaket over abdomen er gjort i løpet av få sekunder. MR-undersøkelse tar lang tid, mange sekvenser kan ta flere minutter. For å unngå artefakter fra bevegelser, som for eksempel pustebevegelser, kan det gjennomføres relativt raske sekvenser hvor pusten holdes. Alternativt kan det tas multiple delbildeopptak kun i samme del av respirasjonen, som settes sammen til et helt bilde. Årsaken til at MR-bildet er mer uklart enn CT-bildet, er derfor at bildeopptak med MR tar lang tid, hvilket øker sjansen for bevegelsesartefakter (i dette tilfellet forårsaket av pusting/bevegelse av diafragma).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for korrekt angivelse av MR- og CT-bilder. 1 poeng for å angi at bildeopptak med MR tar mye lengre tid enn opptak ved CT, og at dette disponerer for bevegelsesartefakter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Se på bilde 6. Hvilke anatomiske strukturer er det satt piler på? Benevningen strekker seg fra A-F.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* A: Lever
* B: Milt
* C: Aorta (i avgangen av truncus cøliacus)
* D: Magesekk, ventrikkelen
* E: Nyre
* F: Vena cava inferior
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1/4 poeng for hvert riktige svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar prinsippet bak avbildning med magnetisk resonans (på maks 300 ord).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MR-bilder skapes ved å manipulere kjernen til hydrogenatomer (=protoner). Et proton er positivt ladet, og har et egenspinn omkring egen akse. Elektrisitet i rotasjon gir magnetisme, og derfor kan et proton oppfattes som en liten stavmagnet. Vann og fett inneholder mye protoner, og menneskekroppen inneholder mye av begge disse substansene. Protoner i kroppen (og for så vidt for øvrig) har magnetisk vektor som er tilfeldig orientert. De mange protonene som befinner seg i et bestemt volum vil ha ulike magnetiske vektorer, slik at summen av vektorene (resultatvektoren) vil være 0.
Hvis en legger et volum i et eksternt magnetfelt (som en MRmaskin har), vil de enkelte protonene rette sitt magnetfelt inn parallelt eller antiparallelt med det eksterne magnetfeltet. Det vil være en liten overvekt av protoner som stiller seg inn parallelt, og resultatvektoren av disse vil derfor være rettet parallelt.
I tillegg til å ha et egenspinn, slingrer også den roterende aksen til protonene, med en såkalt presesjon. Denne presesjonen har for protoner en bestemt frekvens som korrelerer med feltstyrken til det eksterne magnetiske feltet. Ved 1,5 tesla er denne frekvensen 63,8 MHz.
Den magnetiske resultatvektoren av de parallelle protonene i et magnetfelt er fryktelig liten i forhold til det eksterne magnetfeltet, og derfor ikke målbart. Hvis en kunne bikket vektoren ut fra denne retningen, til en retning 90 grader på magnetfeltet, kunne man imidlertid ved hjelp av en coil registrert de roterende magnetiske protonene og fått signaler som en kunne lagd et bilde av. Det er her begrepet resonans i «magnetisk resonans» kommer inn. Hvis en sender inn en radiofrekvenspuls som har samme frekvens som presesjonsfrekvensen (63,8 MHz ved 1,5 tesla), vil en bikke den magnetiske vektoren til protonene fra parallell retning til etter hvert 90 grader på parallell retning. En måler da i dette planet, kjent som transversalplanet, roterende magnetisme, som er det samme som elektrisitet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ poeng for å ha med at protoner brukes til bildedannelse, og at protonene er magnetiske. Begge deler må være med.
* ½ poeng for å ha med at protonene orienteres i samme retning som et eksternt magnetfelt.
* ½ poeng for å beskrive fenomenet presesjon og at denne kan påvirkes av en resonnerende radiofrekvenspuls. Begge deler må være med.
* ½ poeng for å beskrive at signalene til de roterende protonene kan måles i transversalplanet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 45 år gammel mann som malte huset sitt falt 3 meter ned fra en stige.
Han er tungpustet og har brystsmerter. På røntgen ses forandringer forenlig med høyresidig trykkpneumotoraks, med forskyving av hjerte mot venstre side. Dette må avlastes ved å legge inn et toraksdren. Ved innleggelse av toraksdrenet skal man ta høyde for nerver, kar og årer mellom ribbein (den nevrovaskulære intercostale bunt).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du beskrive hvor den neurovaskulære intercostale bunt ligger i forhold til ribbein og rygg, samt hvordan nerver, arterier og vener ligger i forhold til hverandre.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den nevrovaskulære bunt ligger under hver costa. Derfor skal et toraksdren føres inn over costa.
Øverst på den nevrovaskulære bunt ligger vena intercostalis, nedenfor der ligger arteria intercostalis og så nervus intercostalis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for korrekt beliggenhet og i forhold til hverandre,
* 0.5 poeng for korrekt beliggenhet
* 0.5 poeng for beliggenhet i forhold til hverandre.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når mann legge inn et toraksdren er det viktig å være sikker på at man er i torakshulen. Derfor sjekker man med en finger om man har gått gjennom det innerste lag på toraksveggen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket lag er innerst på toraksveggen og hvilket lag omgir lungene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pleura parietalis ligger innerst på toraksveggen Pleura visceralis omgir lungene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.0 poeng for hvert korrekt navn på lagene (pleura parietalis og visceralis). (Pars cervicalis av parietalis godkjennes også)
0.5 poeng for hver korrekt plassering av lagene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved et pneumotoraks legges et toraksdren oppover og ved et hematotoraks nedover.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Toraksdrenet ved en pneumotoraks skal ligge øverst i lungehulen. Det er samme området hvor apex av lungen ligger. Hva heter dette område?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cupula (pleuræ)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Cupula
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Da det ble påvist høyresidig trykkpneumotoraks ble det sett forskyving av hjerte mot venstre på røntgen toraks
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter den delen av torakshulen som inneholder hjerte og de store kar? Kan du beskrive inndelingen av de forskjellige delene denne delen av torakshulen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den delen av torakshulen heter mediastinum. Mediastinum er delt inn i en mediastinum superius og inferius. Mediastinum inferius er delt inn i mediastinum anterius, mediastinum medium og mediastinum posterius.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mediastinum 1 poeng
Riktig benevning i superius og inferius 1 poeng
Riktig inndeling av mediastinum inferius 1 poeng
Terminologi hvor andre inklinasjoner er brukt godkjennes (f.eks. superior, inferior, fremre, øvre og bakre).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gjennom mediastinum går det to store nerver. En er den tiende hjernenerve mens den andre kommer fra rami anterior av nervus cervicales III-V
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter disse to nervene og beskriv beliggenhet i forhold til hverandre i høyde med lungehilus? Beskriv hvilke strukturer disse to nervene hovedsakelig innerverer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nervus vagus er den tiende hjernenerve, mens nervus phrenicus kommer fra nervus cervicales III-V.
Nervus vagus ligger baktil lungehilum mens nervus phrenicus ligger foran.
Nervus vagus innerver de fleste organer i kroppen vår (hjerte, lungene og indre organer.
Nervus phrenicus innerverer diaphragma
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig navn på hver nerve (0.5 poeng hver)
Riktig beliggenhet på hver nerve (0.5 poeng hver)
Riktig innervasjon av struktur på hver nerve (0.5 poeng hver)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du renser en torsk du har fanget selv. Dessverre skjærer du deg på fingeren. Det blør litt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv et umiddelbart tiltak for å stoppe blødningen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kompresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p. Bare rett svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet stimulerer til dannelse av plateplugg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Trombocyttene benytter integrinkompleksene gp Ia-IIa og gp I-V-IX på celleoverflaten for å adherere til stroma (bindevevet rundt blodåren). Hvilke proteiner binder disse integrinkompleksene til?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kollagen binder gpIa-IIa
gpI-gpV-gpIX komplekset binder von Willebrand faktor (vWF)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kollagen 1p + vWF 1p hver, dvs til sammen maks 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaskulær diskontinuitet starter koagulasjonsfaktorsystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tissue factor (TF, vevsfaktor) bidrar til å starte koagulasjonskaskaden. Hvor lages TF og hvilket molekyl danner kompleks med TF for å spalte FX til FXa?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
TF syntetiseres i stromale celler som omgir blodkarene (f.eks fibroblaster)
FVII er partner til TF
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Stromale celler eller fibroblaster gir 1p
FVIIa 1p. FVII er også akseptabelt
Totalt max 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det dannes nå en plateplugg
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar i korte trekk hvordan platepluggen dannes
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# aggregasjon (via gpIIb-IIIa-komplekset)
# aktivering (archidonsyre metabolitter (prostaglandiner, tromboxan) ADP trombin)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Aggregasjon og aktivering gir 1 p hver
gpIIb-IIIa, ADP, trombin, prostaglandiner eller tromboxan gir alle 0.5 p
Totalt 3 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Platehemmere er vanlige legemidler
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan virker acetylsalicylsyre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemmer prostaglandinsyntese via hemming av cykloxygenase (COX) -1 og -2
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1p – Både hemming av COX, produksjon av tromboxan eller prostaglandiner er godt nok svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Trombin er den store dirigenten i koagulasjonen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken koagulasjonsfaktor hemmes av koagulasjonshemmerkomplekset av protein C og S? Denne mekanismen reduserer dannelsen av trombin.
Hvilket enzym spalter fibrin til d-dimerer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# FVa (FV er akseptabelt også)
# Plasmin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert svar gir 0.5p Maks 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det finnes to hovedtyper celler, prokaryote og eukaryote
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi minst fire forskjeller mellom prokaryote og humane eukaryote celler
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* De fleste humane eukaryote celler har cellekjerne
* Humane eukaryote celler er ofte større enn prokaryote celler
* Enkelte prokaryote celler har en cellevegg i tillegg til cellemembranen
* Humane eukaryote celler har organeller
* DNA er lineært i cellekjernen i humane eukaryote celler. I prokaryote celler er DNA sirkulært.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha nevnt 4 forskjeller for å få 2 poeng. 0.5 poeng for hver rette. Maks 2 poeng på oppgaven
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sykdommen Progeria skyldes en mutasjon i genet som koder for lamin A. Hvordan vil dette kunne påvirke cellene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lamin A er en type intermediært filament, som sammen med lamin B1, B2 og C danner kjernelamina, som er et nettverk som ligger under kjernemembranen og støtter opp denne. Svekket kjernelamina gir en mer ustabil kjernembran, og økt risiko for feil under celledeling og økt celledød. Cellene hos pasienter med progeria vil typisk kunne ha deformert kjernemembran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At kjernemembranen vil kunne være deformert, eller andre resonnement som knytter lamin A til funksjon i kjernelamina
Bør nevne ustabil kjernemembran og svekket kjernelamina for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Immunceller vil kunne indusere apoptose i en målcelle (infisert celle, tumorcelle). Forklar kort hvordan dette skjer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Immunceller utrykker ligander i TNF-familien (feks. Fas-ligand) som kan binde til og aktivere «dødsreseptorer» på infiserte celler/tumorceller. Dødsreseptorer (feks. Fas) har alle et såkalt døds-domene som ved aktivering vil føre til danning av et dødsinduserende signalkompleks (DISC). Dette fører til spalting og aktivering av initiator-caspaser (typisk caspase 8) som vil sette i gang en kaskadereaksjon og aktivering av effektor-caspase 3. Effektor caspaser vil spalte viktige cellulære proteiner som feks anti-apoptotiske proteiner, cytoskjelettet, inibitor av DNAse osv, som vil føre til celledød. Denne type apoptose kalles for også for den «eksterne vei» til apoptose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Type apoptose: Dødsreseptor/ekstern signalvei til apoptose
* TNF-familie reseptorer/ligander
* DISC
* Aktivering av caspaser
* Initiator caspase, effektor caspase
* Spalting av viktige cellulære proteiner
Minst 2 av punktene over for 2 poeng, 1 av punktene for 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil en mangel på makrofager eller andre fagocyterende celler føre til i situasjonen beskrevet ovenfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Apoptotiske celler vil vanligvis gjenkjennes av fagocyterende celler som makrofager som vil fjerne de døde cellene. Mangel på makrofager/fagocytter og vil føre til et «hav» av døde celler i vev som ikke vil bli fjernet, noe som vil kunne føre til en betennelsesreaksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Beskrive at det vil føre til opphoping av apoptotiske celler i vev (2 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skiller apoptotisk og nekrotisk celledød?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved nekrose sveller cellene, og plasmamembranen går i stykker. Cellens innhold lekker ut i omgivelsene og tiltrekker seg betennelsesceller. Ved apoptose vil cellen skrumpe, kjernen kondenseres, DNA fragmenteres og cellefragmenter vil pakkes i små «pakker» kalt apoptotiske legemer (apoptotic bodies). Cellemembranen er intakt gjennom hele prosessen. Celleinnholdet vil derfor ikke slippes ut i omkringliggende vev, og betennelsesceller vil ikke tiltrekkes. En annen årsak til at det ikke blir betennelse ved apoptose, er at apoptotiske celler gjenkjennes (via fosfatidylserin på celleoverflaten) og fagocyteres av makrofager. Dermed forsvinner den døde cellen fra vevet, og betennelse forhindres. Ved fagocytose av apoptotiske celler skilles det også ut anti-inflammatoriske cytokiner som feks TGFb og IL-10 som vil bidra til å hindre en immunreaksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha med:
* frigjøring av celleinnhold ved nekrose, ikke ved apoptose
* betennelse vs ikke betennelse
* fagocytose av apoptotiske celler
3 av punktene gir 2 poeng, 1 -2 av punktene gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under ser du et bilde av overgangen mellom tynntarmen og tykktarmen.
<<imgLink "IAB-2022-1-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
1: Hvilken del av tykktarmen ser vi på bildet?
2: Kan du angi navnet på strukturene som de angitte bokstavene peker på?
* A:
* B:
* C:
* D:
* E:
(Hvert delsvar gir 0,25 poeng, maks. 1,5 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 1: Cøkum (ileocøkalovergangen godtas også)
* 2A: Valva ileocoecalis (Bauhins klaff, ileocøkalklaffen)
* 2B: Ileum (terminale ileum)
* 2C: Appendixostiet, åpningen til appendix godtas også
* 2D: Appendix vermiformis (blindtarmsvedhenget, blindtarmen)
* 2E: Tenia coli (tenia libra)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,25 poeng, maks. 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved blindtarmsvedhenget forenes de tre muskellagene som ligger som bånd utenpå tarmoverflaten
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Disse båndene er ett av de tre kjennetegnene til colon. Hva heter disse båndene, og hvilke to andre kjennetegn til colon finnes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tænia coli
* Haustra coli
* Appendices epiploicæ
På utsiden har den tre langsgående bånd (taenia coli) av glatt muskulatur, samt innsnøringer (haustra coli) av tversgående ringmuskulatur, noe som gir tykktarmen et bobleaktig utseende. Mellom 'boblene' og muskelbåndene er det større eller mindre ansamlinger av fett (appendices epiploicae).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig delsvar, totalt 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Colon er delt opp i flere avsnitt som hver har sitt eget anatomiske navn
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er navnene til de forskjellige tykktarmsavsnittene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Coecum (blindtarm)
* Colon ascendens (oppadstigende tykktarm)
* Colon transversum (tverrdelen av tykktarm)
* Colon descendens (oppadstigende tykktarm)
* Colon sigmoideum (S-formede delen, gresk S av Sigma)
* Rectum (endetarmen)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne inntil fire av disse. Maks 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Noen av tykktarmsavsnittene ligger retroperitonealt (bak bukhinnen) og noen andre ligger intraperitoneal (omgitt av bukhinnen). De avsnittene som ligger intraperitonealt har et egen mesocolon (krøs).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke avsnitt ligger intraperitonealt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er i hovedsak colon transversum og colon sigmoideum som har et eget mesocolon / krøs og dermed ligger intraperitonealt. Appenidx vermiformis er også lokalisert intraperitonealt, noe som er lett å glemme.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,75 poeng for hvert delsvar av transversum og sigmoideum. Ytterligere 0,5 poeng for å nevne appendix vermiformis. Maks. 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Peritoneum (bukhinnen) beskrives som en lukket pose som har mye til felles med pleura og pericard. Hva er navnet på de to forskjellige peritoneumlagene. Et lag dekker bukveggen og et lag som dekker bukorganene
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er navnene til disse lagene? Hvilket dekker bukorganene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
//Peritoneum parietalis// og //peritoneum visceralis//
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert lag av peritoneum. 0,5 poeng for å angi visceralis som dekker bukorganene. Til sammen 0,5 poeng for hvert riktige delsvar, maks 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under leveren er det en sving i tykktarmen ved navn //Flexura coli dextra//
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket tarmavsnitt ligger dorsalt for colon i dette området?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Duodenum
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blodforsyning til tykktarm forsynes av to abdominale hovedgrener fra aorta abdominalis. Embryologisk består nemlig tykktarmen av både midttarm og baktarm.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedgrener er dette, og hvor går skillet mellom midttarm og baktarm?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den embyologiske midttarm forsynes av arteria mesenterica superior (øvre krøsarterien) og baktarm forsynes av a.- mesenterica inferior (nedre krøsarterien). Skille mellom disse er frem til flexura coli sinistra
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hver arterie, maks 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Lipider er en viktig klasse av organiske stoffer i mennesket, i tillegg til hovedklassene proteiner og karbohydrater
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedklasser kan lipider deles inn i?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
"Organiske stoffer som er løselige i upolare løsemidler"
* Fettsyrer CH3-(CH2)n-COOH - plasma
* Fettsyrer koblet til sukkermolekyler (glyserider) - fettvev
* Fettsyrer koblet til fosfatforbindelser (fosfolipider) - cellemembraner
* Steroler – aromatiske forbindelser (ringstrukturer) som kolesterol
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fettsyrer (0,5), triglyserider (0,5), fosfolipider (0,5), steroler (0,5). Det er også ok å si kolesterol om steroler, selv om steroler er bredere og inkluderer testosteron/østradiol/progesteron/aldosteron/m.fl
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fettstoffer er en viktig del av maten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan tas fett opp fra maten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fettstoffer som triglyserider tas opp i tarmen. Gallesalter skilles ut fra galleblæra, og gallesaltene løser opp fett i mindre strukturer kalt miceller. Triglyseridene brytes ned til frie fettsyrer og monoglyserider, som tas opp av enterocytter i tarmveggen. I enterocyttene settes fettsyrer og monoglyserider sammen til triglyserider, og transporteres videre med blodbanen i lipoproteiner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Gallesalter (0,5), miceller (0,5), triglyserider (0,5), lipoproteiner (0,5). Om studenten har skjønt poenget er det ok om navnet ikke er brukt, f.eks ‘micelle’ må ikke være eksplisitt nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En medisinstudent har gjennom en langvarig eksamensperiode spist brownies flere ganger i uka, og nå når eksamen er unnagjort er det også dessverre klart at vedkommende må gjøre noen livsstilsendringer. Rett etter avlagt eksamen henter derfor studenten fram igjen læreboka om lipidmetabolisme
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er ketogen, og hvordan kan slik diett bidra til fettvevsreduksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ketogen diett er diett med svært lavt inntak av karbohydrat. Kroppen sikrer raske energikilder i blodbanen for bl.a hjernen, som ikke kan forbrenne fettsyrer, ved å holde et visst blodsukkernivå. Glukose kan ikke produseres direkte fra fettsyrer. Dersom karbohydratinntak er lavt over tid, slik at glykogenlagrene tømmes, vil kroppen måtte starte fettforbrenning og produsere ketoner, og dette er en måte å tvinge fram kontinuerlig fettforbrenning. Det bemerkes at akkurat denne medisinstudenten valgte å satse på regelmessig aktivitet og mindre brownies, og det gikk fint
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ketogenese som respons på lavt inntak karbohydrat (1 poeng), ketogenese gir direkte fettforbrenning (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er på sommerferie og blir spurt av dine besteforeldre, som lurer på om de kan smake forskjell på godt og dårlig kolesterol
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er godt og dårlig kolesterol, og hvorfor brukes disse navnene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Godt og dårlig kolesterol er folkelige ord for å beskrive intrikat biokjemi. I blodbanenen transporteres kolesterol sammen med andre lipider i lipoproteiner. Lipoproteinene navngis etter tettheten, fra ‘veldig lav tetthets lipoproteiner’ til ‘høy tetthets lipoproteiner’, på engelsk brukes forkortelsene VLDL (very low density lipoprotein), LDL (low), IDL (intermediate), og HDL (high).
Kolsterol transporteres til perifert vev ved VLDL, IDL, LDL, og fra vev til lever ved HDL. Kolesterol som måles i blodet bundet i HDL-partikler kalles ‘godt kolesterol’, mot non-HDL-kolesterol som kan kalles ‘dårlig kolesterol’. Høy verdi av HDL-kolesterol beskytter mot hjerteinfarkt og hjerneslag.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
HDL og non-HDL-kolesterol (1 poeng), sammenheng med karsykdom og kolesterol (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vinett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det viktigste hastighetsbegrensende enzymet i kolesterolsyntese, og hvilke medisiner brukes for å hemme kolesterolsyntesen ved å virke på dette enzymet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
HMG CoA reductase, eller 3-hydroxy-3-metylglutarly coenzym A reduktase. Statiner virker ved å hemme enzymet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
HMG CoA reductase (1 poeng), statiner (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har så lenge du kan huske «hatt noe med magen» og vært plaget med oppblåsthet og romling, smerter og løs vandig avføring. Du merker at det har sammenheng med hva du spiser, og melkeprodukter er en av de tingene som gjør det spesielt ille.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan laktose fordøyes og absorberes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alle karbohydrater må spaltes til monosakkarid for absorpsjon. Disakkaridet laktose spaltes til sine komponenter glukose og galaktose av enzymet laktase, som ligger i mikrovilli / brush border av tynntarmsepitelet. Både glukose og galaktose fraktes over den apikale enterocyttmembranen via et bærerprotein («glukose carrier») som også tar med seg et Na+ ion samme vei (glukose-Na+ symporter), dvs ned den elektrokjemiske gradienten til Na+. Det er en form for aktiv transport (sekundær aktiv transport) som bruker energien fra å frakte Na+ med sin gradient til å ta med seg glukose/galaktose. Både glukose og galaktose går ut av den basolaterale membranen av enterocyttene ved fasilitert transport ned sin osmotiske gradient gjennom et bærerprotein (GLUT2).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Disakkaridet laktose spaltes av enzymet laktase i tynntarmsepiteles brush border til sine enheter glukose og galaktose – 0,75p
Monosakkaridene glukose og galaktose fraktes inn i enterocyttene via sekundær aktiv transport med Na+ og ut av enterocyttene ved fasilitert transport ned sin osmotiske gradient (GLUT2 kanal) – 0,75p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Laktose som passerer til tykktarmen vil kunne gi diare.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor det skjer, basert på det du vet om hvordan vann i hovedsak blir absorbert i tarmen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vann er ikke aktivt absorbert over tarmveggen, men beveger seg i all hovedsak passivt mellom celler (paracellulær vei) sekundært til osmotiske krefter som skapes av transport av molekyler over tarmveggen dvs elektrolytter og næringsstoffer. Absorpsjon av andre stoffer gir altså konsentrasjonsgradienter (osmotiske gradienter), sånn at vann strømmer fra der det er lav konsentrasjon til der det er høy konsentrasjon av andre stoffer. Netto retning på vannstrømmen er avhengig av forskjellen på osmolaritet på det som er i lumen mot det som er interstitielt/i blodet. Normalt har det aller meste av næringsstoffer, inkludert laktose, blitt fordøyd og absorbert i øvre del av tynntarmen og konsentrasjonen videre distalt er lav. Dersom laktose likevel passerer nedover vil det gi høy konsentrasjon og ved osmotiske krefter trekke vann inn i tarmlumen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vann absorberes ikke aktivt i tarmen, men beveges passivt paracellulært sekundært til osmotiske krefter som oppstår når absorpsjon av næringsstoffer og elektrolytter gir lavere konsentrasjon av disse inni lumen enn utenfor – 0,75p
Laktose fordøyes og absorberes normalt i tynntarm, hvis det likevel passerer videre til tykktarm vil det gi mye høyere konsentrasjon av dette i lumen enn det normalt skal være, slik at vann trekkes ut i lumen og gir vandig avføring – 0,75p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det som gjør at motiliteten i tarmen øker ved denne tilstanden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt volum og distensjon av lumen i tarmen vil stimulere til økt motilitet. Når laktose binder vann, vil volumet og fekalmassen øke og dermed også motiliteten øke. Dette er det samme prinsippet som benyttes av både volumøkende midler og osmotiske virkende midler mot forstoppelse, som består av naturlige polysakkarid fibre eller kunstige disakkarider.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Laktose «binder» vann/drar til seg vann slik at volum/massen i tarmen øker – 0,5p
Økt volum/masse i tarmen stimulerer til økt motilitet – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hva peristaltikk og segmentering i tarmen er, og hvilken funksjon de har.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Peristaltikk'' er organisert framdrift av innholdet i tarmen fra ett sted til et annet via kontraksjon. Det foregår ved bølger av muskulære kontraksjoner som beveger seg langs lengden av kanalen. Bak (proksimalt for) materialet som skal flyttes kontraherer det sirkulære muskellaget og det longitudinale laget relakserer, samtidig som tarmen foran (distalt for) det som skal flyttes klargjøres for å ta imot ved at det longitudinale muskellaget kontraherer og det sirkulære relakserer.
''Segmentering'' er sirkulære kontraksjoner vekslende med relaksasjoner i løpet av sekunder som dytter føden fram og tilbake og på den måten elter og blander den. Dette styres av programmer og reflekssløyfer i ENS, stor grad av antroduodenal koordinasjon ettersom åpning av pylorus og tømming av ventrikkelen. Begge bevegelsesmønstrene er typisk under/etter måltid
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Peristaltikk er en type motilitet der koordinerte kontraksjoner i de sirkulære og longitudinelle muskellagene som gir fremdrift av innholdet i tarmen og beveger det fra ett sted til et annet – 0,75p
Segmentering er en type motilitet der vekslende kontraksjoner og relaksasjoner i det sirkulære muskellaget gir bevegelser som blander/mikser/elter innholdet i tarmen – 0,75p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du går til lege og undersøkelse viser at du også har anemi som sannsynligvis skyldes malabsorpsjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort i hvilken form jern finnes i kosten og hva det er som påvirker og regulerer mengden som absorberes fra en normal tarm
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effektiviteten i opptaket av jern i tarmen er i prinsippet avhengig av tre ting:
1. ''Kostens innhold av jern''. I kosten finnes jern hovedsakelig (ca 90%) som treverdig jern (hydroksider, Fe3+) bundet til ulike organiske molekyler, typisk i planter og melkeprodukter. I tillegg finnes det som heme-jern (ca 10 %), bundet til globiner typisk i kjøtt. Absorpsjon av jern er i utgangspunktet relativt lite effektiv og utgjør kun en liten andel (ca 10%) av det totale jerninnholdet i kosten. Heme-jern spaltes fra globinet i magesekken og tas effektivt opp i enterocytter via en spesifikk hemetransporter. Man vet minst om opptak av heme-jern, og selv om det opptaket er mest effektivt, utgjør ikkeheme-jern hovedtyngden.
2. ''Kostens sammensetning for øvrig og innhold av såkalte kostfaktorer''. Treverdig jernhydroksid (Fe3+) må reduseres til Fe2+ før det kan tas opp. Det finnes enzym (ferroreduktasen Dcytb) i brushborder av enterocyttene som katalyserer dette, men denne prosessen blir også godt hjulpet av magesyre. I tillegg påvirkes dette av kostfaktorer som enten stimulerer reduksjon til Fe2+ som for eksempel askorbinsyre (vitamin C) eller hemmer reduksjonen ved for eksempel å danne uløselige salter eller komplekser med jern, for eksempel fosfat og kalsium i melkeprodukter, garvesyre i te/kaffe, fytinsyre i korn, oksalat i grønnsaker.
3. ''Kroppens behov for jern/jernlagerstatus''. Kroppens jernstatus regulerer også opptaket: Høy transferrinmetning i blodet (mye jern bundet til transportproteinet i blod transferrin) øker produksjonen av peptidehormonet hepcidin i levercellene. Hepcidin hemmer jern-absorpsjonen ved å binde til og gi internalisering av transportproteinet som frakter jern ut av enterocyttene (ferroportin). Når jern ikke kommer seg ut av enterocyttene, vil det intracellulære nivået av jern øke. Dette gir signal om å redusere syntesen av transportproteinet som frakter jern inn i enterocyttene (DMT1 divalent metalliontransporter1) og absorpsjonen vil da gå ned. Økt akkumulering av jern intracellulært i enterocyttene vil også gjøre at kroppen kvitter seg med jern ved at epitelcellene regelmessig erstattes og avskalles ut i tarmlumen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Jern i kosten finnes hovedsakelig som Fe3+ jern (ikke-hemejern) men også litt som heme-jern – 0,25p
Prinsippet tre ting som normalt påvirker jernabsorpsjonen:
* Mengden jern i kosten og hvilken form det jernet er i – 0,5p
* Andre kostfaktorer påvirker tilgjengelig jern i kosten ved å enten stimulere eller hemme omdanningen av ikke-hemejern fra Fe3+ til Fe2+ eller danne uløselige salter og komplekser – 0,5p
* Ved høy jernstatus i kroppen vil høy transferrinmetning gi økt produksjon av leverhormonet hepcidin som hemmer transport av jern ut av enterocyttene. Dette gir økt intracellulær konsentrasjon av jern i enterocyttene som så hemmer produksjonen av proteinet som transporterer jern inn i enterocyttene fra lumen, og dermed redusert absorpsjon – 0,75p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan vitamin B12 absorberes fra tarmen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vitamin B12 (kobalaminer) frigis fra de bestanddelene det er bundet til i maten i magesekken ved hjelp av pepsin og syre. Proteinet R-faktor (haptocorrin) produseres i spyttkjertler og skilles ut i spytt i munnhulen. R-faktor har høy affinitet for vitamin B12 og i magesekken bindes disse sammen til et kompleks som beskytter vitamin B12 fra å bli ødelagt av magesyren. Komplekset R-faktor-vitB12 går videre til duodenum hvor proteolytiske pankreasenzymer spalter R-faktor slik at vitamin B12 igjen frigis. I den nøytrale pH i duodenum bindes vitamin B12 så til ”intrinsic factor” som produseres i parietalcellene i magesekken. Komplekset intrinsic factor-vitB12 går videre nedover tarmen til terminale ileum, hvor komplekset bindes til en spesialisert overflatereseptor på enterocyttene (cubilin), blir internalisert via endocytose, intrinsic factor degradert og vitamin B12 transportert over den basolaterale membranen, frigitt til portalblodet hvor det transporteres bundet til transkobalamin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vitamin B12 spaltes fra maten av pepsin og syre i magesekken og bindes til R-faktor fra spytt – 0,5p
Komplekset vitB12-R faktor spaltes av proteolytiske enzym i duodenum og bindes til intrinsisk faktor fra parietalcellene/den syreproduserende cellen i magesekken – 0,5p
Komplekset vitB12-Intrinsisk faktor tas opp av spesifikke reseptorer hovedsakelig i terminale ileum – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter hvert får du stilt diagnosen cøliaki. Du starter behandling med glutenfri diett og blir etter det også helt kvitt problemene du opplevde etter inntak av melkeprodukter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig forklaringen på det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved ubehandlet cøliaki vil det være en betennelse i tynntarmsslimhinnen og histologisk ses totteatrofi (svinn av tarmtotter/villi), hypertrofi av kjertler og økt infiltrasjon av immunceller i lamina propria og epitelet. Siden laktose brytes ned til glukose og galaktose av enzymet laktase i mikrovilli / brush border av tynntarmsepitelet, vil en slik betennelse i slimhinnen gi en forbigående reduksjon i laktasefunksjon og redusert evne til å bryte ned laktose (Sekundær laktoseintoleranse). Denne funksjonen vil komme tilbake igjen når behandling med glutenfri diett gjør at slimhinnen også går tilbake til normalen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Cøliaki gir betennelse i tynntarmsslimhinnen og totteatrofi – 0,5p
Det vil redusere aktiviteten/ta helt bort enzymet laktase som ligger i epitelcellenes brush border og som er nødvendig for absorpsjon av laktose – 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Benjamin er 74 år gammel og oppsøker allmennlegekontoret på grunn av opplevelse av økende hevelse i beina. I tillegg har han de siste månedene merket klemmende smerte foran i brystet og tung pust ved lette til moderate fysiske anstrengelser. Typisk når han går to etasjer i trapp i rolig tempo. De anstrengelsesutløste plagene gir seg raskt når han holder opp med aktiviteten
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
For å beskrive hjertesviktpasienters funksjonsnivå benyttes ofte NYHA-klassifisering. (Funksjonsnivå beskrives som NYHA-klasse 1 til 4. (NYHA = New York Heart Association)).
Hvilken NYHA-klasse er mest korrekt for Benjamins funksjonsnivå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
NYHA-klasse 3
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kun NYHA-klasse 3 gir poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Benjamin angir at han av og til merker uro i brystet, uregelmessig hjertebank og ujevn puls. Også dette har økt både i hyppighet og varighet, faktisk har han denne opplevelsen nå under konsultasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelsesmetode er best egnet for å dokumentere din mistanke om at pasienten har atrieflimmer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Elektrokardiogram, EKG.
Alle typer EKG der hjertefrekvens og tilstedeværelse eller fravær av P-bølger kan dokumenteres er velegnet. Vanligst brukt er standard 12-kanalers EKG, eventuelt kan langtidsregistrering av hjerterytmen være hensiktsmessig der atrieflimmer opptrer anfallsvis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Undersøkelsesmetoder basert på elektrokardiogram/EKG gir poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved den kliniske undersøkelsen finner du ved perkusjon over hjertet at området med dempning er større enn forventet og ictus cordis (spiss-støtet) observeres beliggende lateralt for medioclaviculærlinjen. Du mistenker at hjertet er forstørret.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelse er best egnet for å avbilde hjertet og vurdere hjertets pumpefunksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekkokardiografi (ultralydundersøkelse av hjertet) er lettest tilgjengelig og oftest mest hensiktsmessig for å angi hjertets dimensjoner og pumpebevegelser. MRI og Røntgen CT kan også benyttes i helt spesielle tilfeller.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ekkokardiografi gir 2 poeng.
MRI og/eller Røntgen CT gir 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved auskultasjon over hjertet hører du normale hjertetoner, det foreligger en systolisk bilyd grad 3 (3 av 6), best hørbar over apex og med utstråling mot venstre aksille. Du mistenker at Benjamin har lekkasje i mitralklaffen (bicuspidalklaffen).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelse er best egnet for å underbygge din mistanke om klaffelekkasje?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Doppler ekkokardiografi (Doppler ultralydundersøkelse) er lettest tilgjengelig og oftest mest hensiktsmessig for å påvise og kvantitere (bedømme grad av) klaffelekkasjer.
MRI kan benyttes for diagnostikk og kvantitering av klaffelekkasjer i spesielle situasjoner
Venstresidig hjertekaterisering med kontrastinjeksjon i venstre ventrikkel (ventrikulografi) er lite brukt. Metoden var tidligere ( før introduksjon av Doppler utlralyd) den rådende metoden for påvisning og bedømming av alvorlighetsgrad av klaffelekkasjer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Doppler ekkokardiografi/ ultralydundersøkelse gir 2 poeng
MRI og/eller venstre ventrikulografi gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved auskultasjon over lungenes bakflater hører du fremmedlyder over lungenes basale deler. Du mistenker at Benjamin har hjertesvikt med lungestuvning (væskeoverskudd i lungevev og dels også i alveolene).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken supplerende undersøkelsesmetode er vanligst for å dokumentere mistanke om at pasienten har lungestuvning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen thorax er den vanligste metoden.
Ultralyd av lunger kan i øvede hender benyttes.
Røntgen CT kan avdekke lungestuvning, da oftest som et bifunn ved andre indikasjoner for slik undersøkelse
MRI kan avdekke lungestuvning, men metoden benyttes ikke på slik indikasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Røntgen thorax gir 2 poeng.
Øvrige modaliteter gir enkeltvis eller samlet 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 36 årig kvinne blir funnet ved siden av en stige og klager over dyspne (tung pust) og ømhet i høyre side av brystet, hun fraktes til sykehus i ambulanse. Som Lis1 tilser du pasienten i akuttmottaket. Hun har dyspne, men kan ikke helt redegjøre for om dette oppstod i forbindelse med fallet. Du mistenker en pneumothorax (luft mellom lunge og brystvegg) som årsak til dyspne og henviser til et stående røntgenbilde av thorax.
<<imgLink "IAB-2022s-1-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vedlagte bilder viser et rtg thorax, front og side. Redegjør for hvordan røntgenstråler dannes, deretter redegjør kort for hvordan røntgenbildene dannes
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dannelse av røntgenstråler: elektroner frigis fra en katode, akselererer og treffer anoden. Nedbremsingen av elektroner danner fotoner.
Dannelse av bilder: ulikt vev bremser / absorberer fotoner i ulik grad. Mengden fotoner som trenger gjennom objektet registreres av en detektor.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Elektroner frigis fra katode 1
* Nedbremsing danner fotoner 1
* Vev absorberer fotoner 1
* Fotoner registreres på en detektor 1
Totalt 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Røntgenbilde viste ikke pneumothorax. Nå tror pasienten kanskje hun fikk dyspne allerede før hun falt av stigen. Du mistenker lungeemboli (blodpropp i lungearterier). Siden hun har et mulig svangerskap gjøres det først ultralyd av dype vener på underekstremitetene med tanke på dyp venetrombose (blodpropp i dype vener i underekstremitetene vil sannsynliggjøre mistanken)
<<imgLink "IAB-2022s-1-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vedlagt er et ultralydbilde av arterie og vene på låret, inkl. fargedoppler. Redegjør for prinsippet bak ultralyd og doppler
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
UL-probe sender ut lydbølger. Lydbølgene vil dels penetrere og dels kastes tilbake (ekko). Lydbølgeekko fanges opp av proben. Ved doppler vil ekko fra lydbølger som kastes tilbake fra et objekt i bevegelse endre bølgelengde. Hastighet og retning på objektet avgjør hvor stor endringen i bølgelengde blir
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Utsendte lydbølger og ekko som fanges opp 2,0
* Doppler måler endret bølgelengde 2,0
Totalt 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siden det ikke ble påvist dyp venetrombose må lungeemboli avklares med en CT-undersøkelse av brystet inkl. lungeaterier.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for prinsippet bak computertomografi.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgenrør og detektor roterer rundt mens pasienten kjøres gjennom CT-maskinen. Røntgenstrålene som slipper igjennom pasienten registreres i detektoren. En datamaskin regner ut tettheten i det avbildede området og lager anatomiske snittbilder.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alt med gir 2,5 poeng, kun delvis med gir 1,5 poeng
Totalt 2,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vedlagt er 2 bilder fra en CT-undersøkelse av thorax.
<<imgLink "IAB-2022s-1-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 1 ulempe og 1 fordel med røntgenkontrast. Er undersøkelsen kontrastforsterket?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Fordeler er bedre kontrast i bildet
* Ulempe er risiko for redusert nyrefunksjon.
* Undersøkelsen er med kontrast
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for ulempe + fordel + bilde med kontrast.
Totalt 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Samme to CT-bilder
<<imgLink "IAB-2022s-1-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Pek og benevn 5 anatomiske strukturer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er et utall anatomiske strukturer avbildet, studenten kan angi strukturer etter eget ønske. Sensor forventes å kunne vite om strukturene studenten avgir er korrekte.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver anatomisk struktur Totalt 2,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under et mosjonsløp over 20 km får du etter halvveis løp relativt hurtig innsettende symptomer i form av utmattelse, svette, lett skjelving, svimmelhet og sterk sultfølelse. Du får lyst til å bryte løpet, men fortsetter i lavere tempo og etter noen minutter går det bedre
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige årsaken til de beskrevne symptomene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fysiologisk hypoglykemi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hypoglykemi gir 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blodsukkernivået er nøye regulert og sikrer jevn tilførsel av energi til kroppens organer. Flere hormoner bidrar til å holde blodglukosenivået innenfor normalområdet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hormoner har en særlig viktig rolle i blodsukkerreguleringen i situasjonene som beskrives nedenfor, og hvilke kjertler og (eventuelt) celler produserer disse hormonene: A) etter et karbohydratrikt måltid; B) når blodsukkernivået synker før neste måltid; C) en periode med høyt stressnivå; D) under kortvarig ekstremt stress.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
A) Insulin fra betacellene i pankreas, B) glukagon fra alfacellene i pankreas, C) kortisol (=hydrokortison) fra binyrebarken (zona fasciculata), D) adrenalin og noradrenalin fra binyremargen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
A) Insulin og betacellene i pankreas (½ poeng), B) glukagon og alfacellene i pankreas (½ poeng), C) kortisol (eventuelt hydrokortison) fra binyrebarken (zona fasciculata) (½ poeng) (zona fasciculata ble nevnt på forelesning, men sensor får vurdere om det skal ha betydning for poengtildeling), D) adrenalin og noradrenalin fra binyremargen (½ poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kroppens organer er avhengige av en relativt jevn tilførsel av energi, mens tilbudet av energiholdige næringsstoffer fra tarmen kan være svært varierende gjennom døgnet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke er de viktigste molekylene for lagring av kjemisk energi til bruk under normale fysiologiske forhold (se bort fra langvarig faste)? I hvilke organer finnes disse molekylene? Nevn fordeler og ulemper knyttet til hvert av dem?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Monosakkarider (særlig glukose) utgjør nærlageret av energi som hurtig kan omsettes til ATP gjennom glykolyse og oksidativ fosforylering. Alle kroppens celler har et visst nivå av glukose under normale betingelser. Ulempen er at forrådet av glukose i blodet og i cellene ikke er tilstrekkelig til å dekke energibehovet i perioder med økt forbruk eller lav tilførsel (Aminosyren glutamin kunne vært nevnt her som viktig brennstoff for Krebs syklus, men har ikke vært nevnt under forelesningene). Fjernlager av energi utgjøres av glykogen og triglyserider (fett). Glykogen finnes i lever- (25 %) og i muskelceller (75 %). Glykogen kan raskt brytes ned til glukose og videre til ATP når glukosenivået i blodet er lavt, men energiinnholdet per vektenhet (17 kJ/g) er lavere enn i triglyserider (37 kJ/g). Triglyserider lagres hovedsakelig i fettceller (adipocytter). Energiinnholdet er høyere enn i glykogen per vektenhet. Det er ulempe med triglyserider at fettsyrer ikke i vesentlig grad kan omdannes til glukose i glukoneogense. Når fett omsettes til energi, må nødvendig glukoseproduksjon hovedsakelig baseres på omdanning av såkalte glykogene aminosyrer eller andre glykogene molekyler som f.eks. laktat.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Glukose som umiddelbart kan omsettes til energi, men med kort varighet: 1 poeng. Glykogen i lever og muskulatur, raskt omsettelig, men mindre energiinnhold enn fett: 1 poeng. Triglyserider/fett i adipocytter (fettceller). Høyt energiinnhold, men kan ikke omdannes til glukose i noen særlig grad: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fullstendig nedbryting av glukose og fettsyrer til ATP er avhengig av Krebssyklus og oksidativ fosforylering i cellene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvilken organelle i cellene foregår Krebssyklus og oksidativ fosforylering?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mitokondrier 2p
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mitokondrier 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
For at Krebssyklus og oksidativ fosforylering skal gå er disse prosessene avhengig av at cellene har tilgang på co-faktorer som er nødvendige i disse biokjemiske prosessene. Flere av disse cofaktorene dannes fra vitaminer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* Tilgang på hvilket vitamin er nødvendig for at cellene skal danne den viktig co-faktoren NAD+ (Nikotin Adenin Dinukleotid) slik at disse prosessene kan gå?
* Hva kalles mangelsykdommen som opptrer ved mangel på NAD+?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Vit. B3 eller niacin 1 p
* Pellagra 1 p
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Vit. B3 eller niacin 1 p
* Pellagra 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 67 år gammel mann som har røkt mye i over 40 år er undersøkt ved en lungepoliklinikk pga økende tungpust over tid. Spirometri viser en uttalt obstruktiv ventilasjonsinnskrenkning og det blir fastslått at han har kols (kronisk obstruktiv lungesykdom).
Hos en slik pasient blir luftveiene/bronkiene forsnevrede og trange ved ekspirasjon og det blir tungt å puste ut. Dette fenomenet oppstår også hos friske ved forsert ekspirasjon under en spirometri, men hos pasienter med alvorlig kols vil det også kunne skje ved normal respirasjon/ekspirasjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen her og hva kalles dette fenomenet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Høyere trykk intratorakalt enn intrabronkialt gjør at bronkiene presses sammen, kalles dynamisk luftveiskollaps
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for mekanisme og 0,5 poeng for å nevne dynamisk luftveiskollaps
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tilleggsundersøkelser viser at RV (residualvolumet) er økt, noe som passer med hyperinflasjon/emfysem
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil dette påvirke volumet av vitalkapasiteten og evt. hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, økt residualvolum okkuperer volum i toraks og gir redusert VK (RV = TLC – VK)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å angi hvordan vitalkapasiteten påvirkes og 1 poeng for å forklare hvorfor
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne pasienten har hypoksemi (lavt oksygeninnhold i arterieblod) med PaO2 7,1 kPa. Normalt for en frisk person på hans alder vil være PaO2 minst ca. 10 kPa
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn (ikke nødvendig å forklare/utdype) hvilke mekanismer som kan gi hypoksemi hos en person? (generelt, ikke spesifikt for denne pasienten).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fire mekanismer:
# hypoventilasjon/lavt oksygeninnhold i inspirasjonsluften
# diffusjonsbarriere
# ventilasjons/perfusjonsmisforhold
# shunt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
3 poeng for 3 riktige av 4; 2 poeng for 2 av 4; 1 poeng for en av fire.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken autoreguleringsmekanisme skjer i lungekarene på grunn av lavt oksygeninnhold i alveolene? (dvs. pga alveolokapillære enheter med lav PO2)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det gir kontraksjon av pulmonalkar for å dirigere blod fra alveolokapillære enheter med lav PO2 til enheter med høyere PO2 (blodet går dit det er mest oksygen å hente).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil langvarig hypoksemi påvirke trykket i lungekretsløpet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kontraksjonen av pulmonalkar gir høyt trykk i lungekretsløpet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken konsekvens kan dette (dvs. langvarig hypoksemi) ha for hjertets funksjon og arbeid?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette gir økt motstand å arbeide mot for høyre hjertehalvdel, altså økt belastning og kan over tid resultere i høyresidig hjertesvikt (cor pulmonale)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne pasienten har røkt betydelig og røyker forsatt. Tobakksrøyk inneholder CO (karbonmonoksid)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilken måte påvirker denne gassen oksygentransporten i blodet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gir redusert oksygentransport fordi CO bindes til Hb med større affinitet enn oksygen og hindrer/reduserer dermed binding av oksygen til Hb
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Alle blodets celler har sitt opphav fra den multipotente stamcellen. Av blodets celler er erytrocyttene antallsmessig mest dominerende. Etter et akutt blodtap (blødning) trer fysiologiske kompensasjonsmekanismer inn for å erstatte tapt erytrocyttmasse
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan akutt blødning aksellererer erytropoiesen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nedsatt hemoglobinkonsentrasjon fører til nedsatt O2-tilbud i nyrene. Dette igjen stimulerer til økt produksjon av erytropoetin (EPO). EPO øker celledelingshastigheten og modningshastigheten i erytropoiesen og en raskere uttømming av reticulocytter fra benmargen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må nevne erytropoetin (1p), at denne produseres i nyrene (1p) og at stimuli for økt EPO er hypoksi eller nedsatt hgb-konsentrasjon (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Cirka hvor lang tid tar utviklingen fra delende erytroid forstadium i benmargen til moden erytrocytt i blodet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
3-7 dager. Mer presist: ca 3 dager der hvor EPO har sin virkning. Celledelingsevnen er høyest i de tidlige utviklingsstadiene (proerytoblast og basofil erytroblast) mens hemoglobinsyntesen er høyest i de senere utviklingsstadiene (orthokromatisk erytroblast)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det kan være litt ulikt hvordan studentene svarer her, men alt fra 3-7 dager bør gi poeng. Prosessen fra de helt umodne erytroide progenitorvellene (BFU-E) tar ca 1 uke, mens prosessen fra de hurtigst delende forstadiene (CFU-E) tar 3 dager. EPO virker imidlertid kun fra CFU-E og utover, og etter en akutt blødning er det nettopp fra dette trinnet i erytropoiesen porsessen er speedet opp. Det er ikke nødvendig å navngi de ulike utviklingstrinnene i erytropoiesen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter en slik akutt blødning kan andelen reticulocytter i blod øke
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilke måter skiller reticulocytter seg fra modne erytrocytter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Reticulocyttene har ribosomer. Det foregår fortsatt litt hemoglobinsyntese. De er større og har en mer blålilla farge, mens de ved vitalfarging får en nettverksmønster av blåfarge som er klumpet ribosomrester
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må nevne at de har ribosomer, i motsetning til modne erytrocytter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ferdige erytrocytter vil så sirkulere i blodet i ca 120 dager
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor og hvordan foregår nedbrytningen av røde blodceller?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fagocytose av makrofager, først og fremst i milten (rød pulpa) og lever. Eldre erytrocytter er mindre fleksible og har problemer med å passere mellom slitsene inn til venesinusoidene. De blir «fanget» utenfor sinusoidene og fagocytert av makrofager. Yngre erytrocytter beskytter seg mot slik fagocytose fordi de har et «ikke spis meg»- signalmolekyl på celleoverflaten
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Makrofager (1p), milten (1p) (rød pulpa)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Menn har gjennomsnittlig litt høyere hemoglobinkonsentrasjon enn kvinner
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan være årsaken til det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mannlig kjønnshormoner (androgener) stimulerer til EPO-produksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må nevne androgener for poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ola ble født med keisersnitt i uke 34 på grunn av sviktende morkakefunksjon. Mor drakk noe alkohol i svangerskapet, også etter at hun visste at hun var gravid. Gutten veide kun 1,5 kg ved fødselen (gjennomsnittsvekt ved denne gestasjonsalder: 2.3 kg) og hadde litt spesielle ansiktstrekk.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan alkoholbruk i svangerskapet skade fosteret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alkohol skader fosteret særlig ved sin __innvirkning på sentralnervesystemets utvikling__. Sentralnervesystemet __utvikler seg gjennom hele svangerskapet__ og er dermed særlig sårbart for skadelige effekter av alkohol. Alkohol hemmer dannelsen av nerveceller, fører til feilvandring (malmigrasjon) av nerveceller, skader støttevevet og påvirker normal myelinisering og synapsefunksjon. Dette kan føre til __strukturelle endringer i hjernen, mikrocefali__ og til __ulike grader av nevrologisk funksjonsnedsettelse__: Lærevansker, atferdsvansker, hukommelsesvansker, oppmerksomhetsvansker/ADHD, sosiale vansker, motoriske vansker etc. Grad av fosteraffeksjon er avhengig av: tidspunkt for eksposisjon i fosterlivet, hyppighet, og mengde alkohol (mange usikkerhetsfaktorer), genetisk disposisjon, sårbarhets/ beskyttelsesfaktorer. Alkoholinntak skjer ofte i kombinasjon med andre uheldige prenatale og postnatale eksponeringer/risikofaktorer (polydrugs, røyking, dårlig ernæring, vanskjøtsel).
I tillegg til å gi skader på sentralnervesystemet, påvirker alkohol __vekst, ansiktstrekk og kan gi medfødte misdannelser__ også i andre organsystemer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0-2 poeng avhengig av hvor mye som nevnes av understreket tekst over
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er karakteristisk for barn med medfødt alkoholskade (FAS) med tanke på vekst og ansiktstrekk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Karakteristika for barn med medfødt alkoholsyndrom (FAS): __Nedsatt vekst__ – både av
vekt, lengde og hodeomkrets - __mikrocefali__. __Spesielle ansiktstrekk__: Liten øyespalte,
dårlig definert filtrum, lite lepperødt på overleppa.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng hvis nevner både vekstkarakteristika og minst ett ansikts-karakteristika, 1/2 poeng dersom kun vekst __eller__ ansikt nevnes korrekt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På helsestasjonskontrollen ved 12 måneders alder gjør du som helsestasjonslege en utviklingsvurdering av Ola. Han kravler og har nettopp begynt å komme opp i 4–fots krabbing. Han sitter alene uten støtte. Han reiser seg ikke opp fra sittende til stående stilling. Han griper etter småting med et helhåndsgrep. Han har ingen sikre ord ennå.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Synes du utviklingen til Ola virker aldersadekvat? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ola er noe forsinket i sin utvikling da han mangler en del milepæler som en ville forvente ved 12 mnds alder (1 poeng). Hans utvikling passer best med et barn på ca. 8-10 mnd (1 poeng) – han sitter, kravler, men krabber ikke, og reiser seg ikke opp ennå. Han har ikke utviklet pinsettgrep. Han har heller ikke noen ord ennå.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du observerer også at når Ola sitter på mors fang, så smiler han og strekker armene ut mot deg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv markører for normal utvikling av barnets forhold til og samspill med primær omsorgsperson i de første 1½ leveår
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Første 3 mndr: Interessert i ansikter – __sosialt smil, liksomgråt – første sosiale gråt__
3 mndr: __tristhet ved atskillelse, emosjonsregulering karakterisert av at foreldre trøster.__
3-6 mndr: økt orientering mot primære omsorgspersoner, egenregulering av emosjoner begynner, foreldre tilpasser stimulering.
4-12mndr: __Fremmedfrykt__ oppstår gradvis (peak ~9 mndr). Foreldre er tilgjengelige og responderer på barnets behov.
Fra 10 mndr: __sosial referering__: barnet bruker andres emosjonelle uttrykk for å avgjøre hva de skal gjøre i usikre situasjoner. Omsorgsperson og barn kan ha felles oppmerksomhet mot noe utenfor dem selv og dele emosjoner.
Ca. 1 ½ år: omsorgsgiver er __trygg base__ for barnets utforskning av omgivelsene, og som barnet stadig vender tilbake til.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Før 1 ½ år: 2 poeng hvis nevner flere aspekter av understreket tekst, 1 poeng dersom kun nevner et par av punktene, 1/2 poeng dersom kun nevner ett av punktene.
Ca. 1 ½ år: 1 poeng hvis nevner understreket tekst.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som 8-åring er han en aktiv gutt som er upopulær blant barna i klassen. Han dominerer i lek, vil være først i alt som skal foregå, og hører ikke etter når lærer ber ham ta hensyn til andre
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke trekk kjennetegner barn som viser god sosial samhandling? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et barn som har __innlærte holdninger og regler for atferd__, dvs. hva man gjør og ikke gjør overfor andre individer. God sosial samhandling krever også __forståelse av andres sinn__: ulike individer kan oppfatte samme situasjon ulikt, og en må kunne trekke slutninger om andres oppfatninger, tanker og følelser. Andre momenter som kan telle positivt i besvarelsen: Må kunne opprettholde turer i samspill, være villig til å dele, være positiv og lite aggressiv, kunne forhandle konflikter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng hvis nevner understreket tekst, 1 poeng dersom kun nevner ett av punktene (men utover de stikkord som er gitt i oppgaven).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 38 år gammel kvinne kontakter deg som hennes fastlege. Hun er samboer og har 2 friske barn på 10 og 6 år. Hennes mor fikk for 5 år siden påvist diabetes som kunne behandles med tabletter, 64 år gammel.
Pasienten har de siste 2-3 månedene ikke følt seg helt i form. Hun har vært litt slapp og tørst, har hatt økt søvnbehov, økt urinmengde med minst én nattlig vannlating, og hun har gått ned 3-4 kg i vekt tross ganske god matlyst. Hun har ikke vært i form til å trene.
Ved klinisk undersøkelse finner du at pasienten er i god allmenntilstand. Blodtrykket er 155/95, pulsen 84 og regelmessig. Høyde 168 cm, vekt 78 kg. Normale forhold ved undersøkelse av hjerte og lunger. Abdomen er bløt og uøm, litt adipøs med økt bukomfang. På grunn av tidsnød rekker du ikke å undersøke føttene.
Blodprøver ble tatt kl. 1100, 3 timer etter frokost: Hemoglobin 15,4 g/dL (referanseområde 11,7 – 15,3 g/dL), plasmaglukose 10,7 mmol/L (referanseområde for fastende prøve: 4,2 – 6,3 mmol/L), ~HbA,,1c,, (glykosylert hemoglobin) 8,6 % (referanseområde 4,3 – 5,6 %). Urinprøve undersøkt med strimmeltest: Glukose +++, ketoner negativ, blod negativ, protein negativ, leukocytter negativ.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken kroppsmasseindeks (body mass index, BMI) har denne pasienten? Oppgi svaret med én desimal
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
BMI 27,6 (78 / (1,68 x 1,68))
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen for at personer med høyt blodsukker (plasmaglukose) ofte plages med økt tørste?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt p-osmolalitet (pga. økt p-glukose) trigger osmoreseptorer og tørstesenteret i hypothalamus. Økt osmotisk diurese gir et mindre bidrag til tørsten.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du mistenker at pasienten har diabetes mellitus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Begrunn hvor sikker diabetesdiagnosen er. Forklar om det er behov for ytterligere tester for å kunne stille diagnosen diabetes mellitus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den er sikker. Hun har symptomer på diabetes, klart forhøyet ~HbA1c (≥ 6,5 % som er Helsedirektoratets anbefalte foretrukne diagnostiske kriterium for diabetes). Hun er ikke fastende, så man kan ikke si at p-glukose bekrefter diagnosen, men p-glukose ligger nær oppunder et nivå som også ville ha bekreftet diagnosen (≥ 11,1 mmol/L). Det er ikke behov for flere tester/prøver for å stille diabetesdiagnosen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke argumenter kan i dette tilfellet tale for henholdsvis type-1 og type-2 diabetes mellitus? Nevn minst 2 prøver eller tester som kan tas for å klassifisere hennes (mulige) diabetes sikrere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Følgende argumenter bør være med:
''For type 1 taler:'' Vekttap, alder (svakt argument), ikke veldig overvektig, kan godt ha autoimmun diabetes (LADA) selv om en del kliniske kjennetegn taler for type 2. Sykehistorien er nokså kortvarig.
''For type 2 taler:'' Moderat vekttap, alder, overvekt (selv om den er beskjeden), abdominal fedme, familiehistorie, flere måneders sykehistorie, forhøyet blodtrykk. Minst 2 prøver som kan tas: Insulin C-peptid, diabetesrelaterte autoantistoffer (antiGAD, anti-IA2, anti-ZnT8). Vesentlig mer avansert svar: Tester for å utelukke Cushings syndrom, akromegali eller andre årsaker til sekundær diabetes.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det viser seg neste dag at fastende plasmaglukose er 8,4 mmol/L (referanseområde 4,2 – 6,3 mmol/L)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen for forhøyet fastende plasmaglukose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt hepatisk glukoseproduksjon (glykogenolyse og glukoneogenese) pga. for liten insulineffekt på leveren
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom du hadde tatt deg tid til å undersøke pasientens føtter nærmere på legekontoret, hvilke undersøkelsesmetoder vil vært aktuelle? Hvilke funn vil du spesielt sett etter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Undersøkelse av sensibilitet ved hjelp av monofilament og stemmegaffel, eller mer avanserte undersøkelsesmetoder, og palpasjon av puls i fotarterier, evt. vurdering av arteriell sirkulasjon ved hjelp av mer avanserte metoder (BT-måling med utregning av ankel/arm-indeks). Tegn til nedsatt sensibilitet (berøringssans, vibrasjonssans, andre sansekvaliteter) og tegn til nedsatt arteriell sirkulasjon (nedsatt puls og/eller blodtrykk i ankelnivå eller lenger opp i underekstremiteten).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv mekanismen for at ~HbA,,1c,, stiger med økende gjennomsnittlig plasmaglukose.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jo høyere gjennomsnittlig p-glukose over tid, jo høyere andel av hemoglobinmolekylene blir glykert eller glykosylert, dvs. inngår en varig forbindelse med glukose. Dette er en non-enzymatisk langsom, irreversibel prosess (Hemoglobin + glukose <-> Schiff base -> ~HbA,,1c,,), som gjør at ~HbA,,1c,, reflekterer gjennomsnittlig p-glukosenivå plasma over 6-8 uker.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnostiske prøver/tester kan brukes som alternativ i de tilfeller der ~HbA1c ikke er tilgjengelig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fastende p-glukose og/eller peroral glukosebelastning (2-timers, 75 g glukose, blodprøve 0 og 120 minutter).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Infeksjonssykdommer er fortsatt en viktig årsak til sykdom og død, særlig i lavinntektsland. For å kunne påvise og behandle slike sykdommer er det viktig å kjenne til mikrobene, hvordan de forårsaker sykdom, og hvordan de kan forebygges og behandles.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv prinsippet for Gram-farging, og forklar hvorfor bakterier får forskjellig farge ved denne teknikken
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gram 1 (krystallfiolett) bindes til celleveggen, Gram 2 (jod) danner kompleks med krystallfiolett og binder denne til celleveggen, Gram 3 (etanol eller aceton) avfarger bakteriecellene, og Gram 4 (safranin) kontrastfarger alt som ikke er blått. Den tykke celleveggen (pga tykt peptidoglycanlag) hos Gram positive bakterier holder bedre på krystallfiolett enn den tynne celleveggen (med lite peptidoglycan) hos Gram negative bakterier.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bakterier kan erverve genmateriale fra omverdenen. Beskriv tre ulike måter som dette kan skje på.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Transduksjon (via bakteriofag), konjugasjon (via pilus- plasmid) og transformasjon (opptak av nakent DNA)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Enkelte bakterier har spesielle egenskaper som gjør dem i stand til å forårsake sykdom hos mennesker. Nevn type og funksjon for de viktigste virulensegenskaper hos humanpatogene bakterier.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kapsel (kamuflasje-hindre fagocytose), evne til adheranse (kolonisering), produksjon av toksiner (ekso/ endo-toksiner, påvirke funksjon, cytotoksisitet), evne til å invadere vev/celler (enzymer), evne til bevegelighet (flageller, pili), evne til å overleve intracellulært, resistens mot antibiotika, induksjon av inflammasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Både mikroskopi, dyrkning og PCR er nyttige metoder for påvisning av årsak ved bakterieinfeksjoner. Beskriv fordeler og begrensinger ved hver av disse metodene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mikroskopi: rask og billig, men dårlig sensitivitet.
Dyrkning: vanligvis bedre sensitivitet enn mikroskopi, kan finne noe en ikke har tenkt på, viktig for å teste antibiotikafølsomhet og for genotyping, men tar lengre tid, og avhengig at mikroben fortsatt er i live.
PCR: rask, sensitiv og spesifikk, men finner kun det en leter etter. Kan detekter rester av døde mikrober.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan fastsettes brytningspunkt for om en bakterieart er følsom overfor ett bestemt antibiotikum?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mikrobiologisk respons (bakteriens naturlige følsomhet, in vitro følsomhet og resistensmekanismer), farmakokinetikk (opptak, distribusjon etc), farmakodynamikk (dose-respons,maks effekt, varighet av effekt etc), toksisitet, og klinisk respons (kliniske studier, dyrestudier).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 77 år gammel mann fikk akutt innsettende høyresidige lammelser i arm og ben og ble innlagt nevrologisk avdeling. Han hadde ellers en kronisk obstruktiv lungesykdom og skulle visstnok ha hatt problemer med hjertet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket blodkar er rammet dersom dette er en cerebrovaskulær hendelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Arteria cerebri media på venstre side.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mannen fikk økende hoste og feber og fikk antibiotika grunnet mistanke om lungebetennelse. Han ble funnet død i sengen seks dager etter innleggelsen. Legene ønsket å rekvirere (medisinsk) obduksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den generelle grunnen til at man rekvirerer obduksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette gjøres av medisinske grunner for å stadfeste eller kartlegge dødsårsaken.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva må legen alltid først si til pårørende før obduksjon eventuelt blir rekvirert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
At man ønsker å rekvirere obduksjon og at obduksjonsmateriale (organer) kan bli brukt til undervisning og forskning. Videre at pårørende kan nekte at obduksjon blir utført, eller at organer blir brukt til forskning og undervisning.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Obduksjon ble utført. Den utvendige undersøkelsen av hjernen var normal. Den ble fiksert i formalin for nærmere undersøkelse etter noen uker. Videre ble det påvist makroskopiske forandringer som ved akutt lungebetennelse i høyre lunge, et hvitt område i bakre vegg av venstre hjertekammer, tre hvite, faste, rundovale tumorer med største tverrmål 4 cm i lever, og i tykktarmens nedre del en vollformet ulcererende tumor med største tverrmål 5 cm.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort det viktigste du ser ved mikroskopi av lungevev med akutt betennelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Neutrofile granulocytter i alveolene (og ev. granulocytter i bronkiene/bronkiolene)
</$details>
<div class="oppgave">
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!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags vev er det hvite vevet i hjertet og hva er diagnosen? Hvilket blodkar er mest sannsynlig involvert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hvit er arrvev. Arrvev i hjertet representerer gammelt (tilhelet) infarkt. Arteria circumflexa eller høyre koronararterie, avhengig av individuell anatomi.
</$details>
<div class="oppgave">
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!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den sannsynlige diagnosen på forandringene i tykktarm og lever?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Adenokarsinom i tykktarmen med metastaser til lever.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter noen uker blir storehjernen undersøkt ved at den blir skåret i 1 cm tynne skiver i frontalplanet. Sentralt i venstre storehjerne var det en grågul, bløt forandring som er 2 cm stor.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor er denne forandringen lokalisert, og hva er diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Capsula interna og diagnosen er ferskt infarkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Jesper er en gutt på 3 år som blir innlagt for andre gang med lungebetennelse. Ved analyse av en blodprøve oppdages det at serumet til Jesper inneholder veldig mye IgM, mens nivået av IgG og IgA er lavt. En genetisk undersøkelse viser at Jesper har en mutasjon i genet for CD40 ligand (CD40L = CD154). Jesper blir diagnostisert med x-linked hyper-IgM syndrom (XHIGM).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
CD40L er et protein som er høyt uttrykt på T-celler etter aktivering. Beskriv kort hvordan mutert CD40L protein på T-celleoverflaten kan føre til Jespers tilstand med mye IgM, men lave nivåer av IgG og IgA.
Hvorfor er det viktig at B-cellene har evne til å lage forskjellige typer antistoff?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Isotypeskifte fra IgM til andre isotyper antistoff er avhengig av B cellekontakt med T hjelperceller (CD4+ Tfh –follikulære T hjelperceller) via CD40/CD40L. Mutasjoner i CD40L kan føre til redusert T cellehjelp til isotypeskifte og dermed reduserte nivåer av andre typer antistoff enn IgM (1 poeng). ''Bakgrunn'' (ikke påkrevd for full poengsum): Isotypeskifte skjer i aktiverte B celler etter somatisk hypermusjon og krever interaksjon med T celler (Tfh) via CD40/CD40L, cytokiner bestemmer hvilken isotype av antistoff som lages.
Forskjellige isotyper antistoff kan mediere forskjellige effektorfunksjoner i forsvar mot patogener (1 poeng). ''Bakgrunn'' (ikke påkrevd for full poengsum): Forskjellige isotyper antistoff har samme spesifisitet, men utløser forskjellige effektorfunksjoner (se delspørsmål b), ikke nødvendig med noen eksempler eller mer utdypende forklaring her
</$details>
<div class="oppgave">
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!!Vignett
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</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skisser strukturen av et antistoff-molekyl, og angi ovedbestanddelene og deres viktigste funksjoner på skissen. Hva er de viktigste effektormekanismene mediert av antistoffmolekyler?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hovedbestanddelene og viktigste funksjoner (1 poeng, informasjon i parentes er ikke påkrevd for full poengsum):
* 2 tunge og 2 lette kjeder (holdes sammen av disulfidbroer)
* variabel og konstant del på både tung og lett kjede
* 2 identiske antigen-bindende seter (sammensatt av variable deler på tung og lett kjede)
* konstant del av tung kjede bestemmer effektorfunksjon.
Effektormekanismer (1 poeng hvis 3 av 4 blir nevnt):
* Nøytralisering
* Komplementaktivering
* Opsonisering
* Antibody-Dependent Cell-mediated Cytotoxicity (ADCC)
<<imgLink "ICD-2015s-1-A.PNG" 500>>
</$details>
<div class="oppgave">
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!!Vignett
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</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv mekanismen(e) som under B-cellemodningen sikrer at B-celler ikke blir autoreaktive og gjenkjenner kroppens egne strukturer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Negativ seleksjon av B celler på slutten av modningsprosessen i beinmargen: Celler som har en sterk binding til egne celleoverflateantigener (sterk binding til multivalente antigener) dør i apoptose eller gjennomgår "receptor editing" (re-arrangement av ny lett kjede). Hvis den nye B cellereseptoren fortsatt er selv-reaktiv dør cellene i apoptose ("clonal deletion"). B celler som har en svak binding til egne monovalente løselige antigener blir anergiske (cellen blir ikke-responsiv).
For full poengsum bør nevnes negativseleksjon og gi en kort forklaring av begrepet (1 poeng) med mulig utfall hvis cellen oppdages som autoreaktiv (arrangement av ny reseptor, celledød, celler blir ikkeresponsiv, det er ikke krav å ha med fagtermene "receptor editing", "apoptose", "anergi", 1 poeng)
</$details>
<div class="oppgave">
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!!Vignett
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</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv forskjellene mellom en primær- og en hukommelses B-cellerespons.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Raskere og mer effektiv- respons med antistoff som har høyere affinitet: Økt antall spesifikke hukommelsesceller som kan reagere mot antigenet sammenlignet med antall naive B celler under en primærrespons.
Hukommelses-B celler har en lavere terskel for aktivering enn naive B celler (konstitutiv uttrykk av B7). Hukommelses-B celler har gått gjennom affinitetsmodning (somatisk hypermutasjon) og isotypeskifte -> produserer antistoff med høyere affinitet enn under en primærrespons, isotype-skifte fra IgM til for eksempel IgG.
</$details>
<div class="oppgave">
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!!Vignett
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</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hovedforskjellene i måten B-cellereseptorer og T-cellereseptorer gjenkjenner antigen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
B cellereseptor gjenkjenner nativt antigen direkte (ikke presentert på MHC)
T cellereseptor gjenkjenner prosessert antigen presentert på MHC I eller II på overflaten av antigenpresenterende celler (korte lineare peptide som gjenkjennes i kontekst med MHC molekylet). For full poengsum bør nevnes at T celler identifiseres korte peptider presentert på MHC og at B celler identifiserer antigener direkte (informasjon som står i parentes er ikke påkrevd for full poengsum).
<<imgLink "ICD-2015s-1-B.PNG" 600>>
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 51 år gammel mann ble innlagt for elektiv brokkoperasjon. Under operasjonen ble det funnet en stor tumor i abdomen, og derfor ble hele colon transversum og deler av magesekken fjernet.
Undersøkelse av patolog konkluderte med at det dreide seg om en «gastrointestinal stromal tumor» (GIST). Dette er en type ondartet tumor som er karakterisert ved aktiverende mutasjoner i genet for en tyrosin-kinase.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mange tumortyper er forbundet med overaktivitet i ulike tyrosin-kinaser. Hva er tyrosinkinase? Forklar kort hvilken rolle slike enzymer spiller i celler og vev, og forklar ut fra dette hvordan de kan være involvert i tumorutvikling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tyrosin-kinaser er enzymer som katalyserer fosforylering av proteiner ved å kople fosfatgruppe på tyrosin. Slik fosforylering har ofte dramatisk effekt på proteinets funksjon, ofte i form av økt aktivitet, så tyrosin-kinaser spiller derigjennom stor rolle som regulatorer av mange cellulære funksjoner, særlig slike som har med vekst og differensiering å gjøre. Mange vekstfaktorer virker via tyrosin-kinaser og proteinfosforylering. Mange vekstfaktorer binder seg til en cellemembranbundet reseptor, som har et ekstracellulært, ligandbindende sete, en transmembran-del, som går gjennom cellemembranen, og en intracellulær, enzymatisk aktiv del som er en tyrosin-kinase.
Binding av ligand utløser en endring i reseptorproteinet som formidles gjennom membranen og fører til økt aktivitet i den intracellulære kinasen, med påfølgende fosforylering og endret aktivitet i de proteinene som er substrat for det aktuelle enzymet. Derved gis et intracellulært signal, som via ulike trinn, fører til cellevekst og -deling.
Endringer i tyrosin-kinaser, typisk mutasjoner, kan føre til økt aktivitet og ikke sjelden til konstitutivt uttrykt aktivitet i den intracellulære delen av en reseptor selv uten binding til ligand. Dermed kan et vekstsignal bli stående konstant «påslått» og de affiserte cellene går inn i ukontrollert celledeling, en av faktorene som bidrar til svulstutvikling.
</$details>
<div class="oppgave">
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!!Vignett
<<imgLink "ICD-2015s-2-A.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dette er et CT-bilde fra øvre del av abdomen hos den aktuelle pasienten, pilene viser metastaser. Hvilket organ er dette og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT-bildet viser et tverrsnitt av øvre del av abdomen, med ryggen nedad på bildet, og med høyre side til venstre på bildet (dette er konvensjon, og dessuten er bildet markert med en "R"). Den store skyggen med to ulike nyanser i grått som fyller ut pasientens høyre side, som strekker seg fortil og over på venstre side, må altså være leveren. De tre runde områdene merket med sort pil, fortil og til venstre for midtlinja, hos en pasient med stor, ondartet tumor i tarmkanalen (magesekk eller tykktarm), passer med sekundærsvulster (metastaser) i leveren. Det store, buklete området i høyre side, merket med pilhoder, har noenlunde samme grånyanse (med litt lokal variasjon), og det er rimelig å oppfatte også dette som et stort, sammenhengende område med samme type, metastatisk tumor. (Det samme gjelder også for det store området svarende til leverhilus, som er merket med hvite piler). Leveren er et hyppig fokus for metastaser.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Godartede og ondartede tumorer navngis i praktisk diagnostikk ut fra deres histologiske opprinnelse. Forklar hovedtrekkene i denne praksisen. Hvilken kategori faller GIST [gastrointestinal stromal
tumor] under?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den typiske betegnelsen for godartede svulst er suffikset «-om» hengt på et substantiv som angir hvilken vevstype tumor er gått ut fra. Ondartede svulster benevnes med suffikset «-karsinom» dersom de er av epitelial opprinnelse, «-sarkom» dersom de har startet i bindevev eller muskulatur. Noen ganger er denne navnsettingen litt avvikende, dels fordi det kan være vanskelig å avgjøre helt sikkert om en gitt svulst er ondartet eller godartet, dels av historiske grunner: F.eks. er lymfom, og gliomer ondartete svulster utgått fra henholdsvis lymfatisk vev og fra gliaceller i sentralnervesystemet, mens pheokromocytom er en type svulst som det er notorisk vanskelig å angi prognosen for. GIST er en type stromal tumor, altså en tumor utgått fra bindevev. I og med at det dreier seg om en ondartet tumor, er det en slags sarkom
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mange pasienter med GIST som behandles med tyrosin-kinase-inhibitorer får symptomer på hypotyreose. Tross behandling med tyroksin substitusjon ble det hos den aktuelle pasienten funnet følgende verdier i serum:
* Tyroksin (T4): ''18-54'' nmol/l (normalt 64 - 142 nmol/l)
* Trijodtyronin (T3): ''0.3 - 0.6'' nmol/l (normalt 1,1-2,6 nmol/l)
* Tyreotropin (TSH): ''70-181'' mU/l (normalt 0,5-5,0 mU/l)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv disse tre hormonene; hvordan de dannes, deres virkemåte og deres effekter i kroppen. Kommenter serumverdiene til pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Thyroideahormoner dannes ut fra aminosyren tyrosin, som inkorporeres i proteinet thyroglobulin og skilles ut fra thyroideacellene til follikkellumen, der de utgjør det meste av kolloidet. Cellene pumper også iodatomer ut i follikkellumen, der de oksyderes. Slik iod er svært reaktiv og interagerer med tyrosin på thyroglobulin, ved å binde seg til den aromatiske ringen, først ett iodatom, deretter eventuelt et til på samme tyrosin. Deretter koples to tyrosiner sammen. Et par av tyrosiner kan således ha bundet til seg tre eller fire iodatomer, og disse har potensiell hormonvirkning. Hormonmolekyler med tre iodatomer, kalles triiodthyronin (T3), mens dersom molekylet har fire iodatomer, kalles det thyroxin (T4).
Når hormonet frisettes, tar follikkelcellene opp kolloid ved endocytose, kolloidet spaltes proteolytisk og hormonet frisettes. En del T4 endres i periferien (særlig lever og nyre) ved avspalting av iod, og derved omdannes det til T3, som er det mest potente av de to. Thyroideahormonene er lipofile og passerer gjennom cellemembraner. De binder seg til en intracellulær reseptor, som transporterer til kjernen, der den påvirker modifiserer cellenes proteinsyntesemønster.
Thyroideahormonene øker basalmetabolismen og har katabol virkning på metabolismen av fett og karbohydrat, og de fører til økt hjerte- og respirasjonsfrekvens, samt økt varmeproduksjon. De påvirker proteinsyntesen, regulerer vekst av knokler og dermed av kroppsstørrelsen, samt modningen av sentralnervesystemet. De øker effekten av katekolaminer og påvirker vekst og modning av så å si alle organer og vev i kroppen.
Utskillelsen av thyroideahormoner stimuleres av TSH (thyroidea-stimulerende hormon, thyrotropin) fra hypofysen, styrt av TRH («TSH releasing factor»)fra hypothalamus. Dersom nivået av hormon blir lavt, vil hypofysen skille ut mer TSH. I det foreliggende tilfellet er verdiene av thyroideahormoner lavt og TSH-nivået er høyt. Det viser at affeksjonen av thyroidea-hormoner er primær, mens økningen i TSH er sekundær.
<<imgLink "ICD-2015s-2-B.PNG" 500>>
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Digitalisglykosider er en av de eldste «skolemedisinene» vi har. Bruken har avtatt, men ett slikt middel, digoksin, brukes fortsatt i begrenset grad i behandling av hjertesvikt og atrieflimmer. Nedenfor finner du opplistet noen av de farmakologiske egenskapene til preparatet:
|! |!Digoksin |
|Absorpsjon |Ca. 75% |
|Levermetabolisme|Minimal |
|Renal eliminasjon|80% |
|Proteinbindingsgrad |25% |
|Fettløselighet|Lav |
|Halveringstid |1.5-2 døgn |
|Effekt etter |1-2 timer |
|Terapiområde (nmol/liter) |0.6-1.3 |
Du er fastlege for Anna Karlsen, en dame på 83 år som i en årrekke har brukt digoksin. Anna har vært og besøkt sønnen sin, som arbeider og bor i Australia, i en hel måned. Hun hadde et fint opphold, men allerede etter en uke gikk hun tom for digoksin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Basert på data fra tabellen over, hvor lenge etter seponering vil digoksin gjenfinnes i blodet til en pasient?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ifølge gjeldende konvensjon er alle legemidler ut av kroppen etter 5 halveringstider. I tilfelle digoksin vil det si 7.5-10 dager.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du og Annas kardiolog kommer i fellesskap fram til at dere bør starte med digoksinterapien igjen. Kardiologen sier at du skal starte med «den vanlige, gamle dosen» (digoksin 62.5 µg morgen og kveld) og måle digoksinnivået i serum når Anna er i likevekt («steady state»).
|! |!Digoksin |
|Absorpsjon |Ca. 75% |
|Levermetabolisme|Minimal |
|Renal eliminasjon|80% |
|Proteinbindingsgrad |25% |
|Fettløselighet|Lav |
|Halveringstid |1.5-2 døgn |
|Effekt etter |1-2 timer |
|Terapiområde (nmol/liter) |0.6-1.3 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor lang tid bør det gå fra oppstart til serumprøven tas? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Serumprøven bør ikke tas før pasienten er i farmakokinetisk likevekt (steady-state). Dette oppnås etter 5 halveringstider. Prøven bør derfor ikke tas før 10 dager etter oppstart.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Da Anna kommer for å få tatt blodprøve for måling av digoksin, forteller hun at hun de siste dagene har følt seg kvalm, appetittløs og at synet har endret seg. Anoreksi og gul/grønnsyn er tegn på digitalisoverdosering. Det viser seg at Anna har en konsentrasjon av digoksin i serum på 2,1 nmol/liter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det finnes i prinsippet to typer bivirkninger, type A og type B. Beskriv begge. Hvilken type bivirkning står vi overfor i dette tilfellet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Type A bivirkninger er doseavhengige og derfor forutsigbare. De har ofte sammenheng med legemidlets virkemekanisme(r) og er vanligvis raskt reversible etter dosereduksjon eller seponering. Type B bivirkninger er ikke-doseavhengige og derfor ikke forutsigbare, ofte betinget av en idiosynkratisk reaksjon, og kan være farlige/livstruende. I Annas tilfelle dreier det seg om en type A bivirkning (overdosering).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I fellesskap kommer du og kardiologen fram til at du bør redusere Annas digoksindosering slik at likevektskonsentrasjonen halveres.
|! |!Digoksin |
|Absorpsjon |Ca. 75% |
|Levermetabolisme|Minimal |
|Renal eliminasjon|80% |
|Proteinbindingsgrad |25% |
|Fettløselighet|Lav |
|Halveringstid |1.5-2 døgn |
|Effekt etter |1-2 timer |
|Terapiområde (nmol/liter) |0.6-1.3 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor lenge må du seponere behandlingen før serumkonsentrasjonen halveres?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Serumkonsentrasjonen vil per definisjon være halvert etter 1 halveringstid, dvs. 1.5-2 dager. Av praktiske grunner vil man i dette tilfelle seponere i 2 dager før gjenoppstart i lavere dosering.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter å ha seponert behandlingen i det aktuelle tidsrommet, starter du opp igjen med en redusert dose digoksin. Det finnes i prinsippet to måter du kan endre doseringen på slik at likevektsnivået av et legemiddel reduseres.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to strategier har du til rådighet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enten dosereduksjon eller lengre doseringsintervall
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Anna fikk tegn på overdosering etter å ha brukt digoksin i en dose hun tidligere – altså før Australiaturen - tålte godt.
|! |!Digoksin |
|Absorpsjon |Ca. 75% |
|Levermetabolisme|Minimal |
|Renal eliminasjon|80% |
|Proteinbindingsgrad |25% |
|Fettløselighet|Lav |
|Halveringstid |1.5-2 døgn |
|Effekt etter |1-2 timer |
|Terapiområde (nmol/liter) |0.6-1.3 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest nærliggende årsaken til at digoksinnivåene i Annas serum øker, med påfølgende bivirkninger, med en dose hun tidligere har tolerert godt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Siden digoksin utskilles for det meste umetabolisert gjennom nyrene, er den mest sannsynlige årsaken at Annas nyrefunksjon ble dårligere.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Inntil for få år siden hadde vi et digitalispreparat til, digitoksin, på det norske markedet. Digitoksin er forskjellig fra digoksin blant annet når det gjelder farmakokinetikk og terapiområde, som for digitoksins vedkommende er på 8-15 nmol/liter. Annas kardiolog er kritisk til at digitoksin ikke lenger er å få tak i, og begrunner dette med at «terapiområdet var mye videre, slik at midlet både var tryggere i bruk og lettere å dosere.»
|! |!Digoksin |
|Absorpsjon |Ca. 75% |
|Levermetabolisme|Minimal |
|Renal eliminasjon|80% |
|Proteinbindingsgrad |25% |
|Fettløselighet|Lav |
|Halveringstid |1.5-2 døgn |
|Effekt etter |1-2 timer |
|Terapiområde (nmol/liter) |0.6-1.3 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Har hjertespesialisten rett i dette? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kardiologen tar feil. Et terapivindu er et relativt begrep, og terapibredden kan med fordel betraktes som et forholdstall mellom den lave grensen (grensen der midlet går fra å være uvirksomt til å fungere) og den høye grensen (hvor midlet går fra å være virksomt til å bli toksisk). For både digoksin og digitoksin er dette forholdet omtrent 2, noe som betyr at midlene i så måte er like.
</$details>
<div class="oppgave">
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!!Vignett
Nyrene har en sentral rolle i reguleringen av ekstracellulært volum og osmolalitet, hvor volumreguleringen stort sett har førsteprioritet. Ved fall i ekstracellulært volum, for eksempel etter betydelig oppkast, diare eller blødning, vil nyrene forsøke å opprettholde det effektivt sirkulerende volumet (ESV), som er volumet på arteriesiden i sirkulasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan og hvor i kroppen registreres et fall i ESV?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Via baroreseptorer (trykkreseptorer) i aortabuen og i carotidene, samt i afferente arterioler i nyrene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken effekt har et fall i ESV på det sympatiske nervesystem og på renin-angiotensinaldosteron-systemet (RAAS)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sympaticus stimuleres. Det vil igjen stimulere reninfrigjøring, og derved aktivere RAAS. (1p).
Renin vil også stimuleres direkte via trykkfall i afferente arterioler, som utvider seg. (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan responderer hjertet, blodkarene og nyrene på fall i ESV?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hjertet; ved økt hjertefrekvens og økt kontraktilitet i forsøk på å gi større slagvolum. Dette gir igjen større minuttvolum. (1p). Blodkar; ved økt vasokonstriksjon på arteriell og venøs side (1p).
Nyrene; ved å øke saltreabsorpsjonen (Na+) i proksimale tubuli og i samlerør (og dermed øker også vannretensjon). (Angiotensin II og Noradrenalin øker Na+ reabsorpsjonen proksimale tubuli, og Aldosteron øker Na+ reabsorpsjonen i samlerør.) Angiotensin II vil dessuten føre til efferent vasokonstriksjon for å opprettholde den glomerulære filtrasjonen (GFR) (2p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved et betydelig fall i sirkulerende volum (over 10 %) vil dette også påvirke frigjøringen av antidiuretisk hormon (ADH). Hvordan skjer dette og hva er effekten? Hvorfor er det hensiktsmessig i en slik situasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
På grunn av fallet i effektivt sirkulerende volum, vil det gå et nerve-signal til de ADHproduserende cellene i hypotalamus, noe som gir økt produksjonen av ADH som så bringes rundt i kroppen av blodet. Dette vil føre til at aquaporin 2 blir satt inn i den apicale cellemembranen i de prinsipale cellene i samlerørene. Dette gir økt reabsorpsjon av vann i samlerørene, noe som vil bidra til å opprettholde sirkulasjonen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 71-årig kvinne har følt seg uvel i 1 1/2 døgn. Det startet brått med hodepine og deretter intens verking i musklene. Så fikk hun sår hals og tørrhoste. Hun begynte å fryse og følte seg varm. Temperaturen har nå
steget til 39^^o^^C. Hun har lest i lokalavisen at mange i bygda har influensa og antar at hun er blitt smittet. En celletype fra det medfødte forsvaret er viktigst for virusbekjempelsen de første dagene av infeksjonen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for hvordan disse cellene bekjemper infeksjonen de første dagene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
NK-celler er det viktigste forsvaret i starten av en virusinfeksjon. Virus befinner seg i hovedsak intracellulært i epitelcellene på slimhinnene i luftveiene. NK-cellene binder seg til infiserte celler (se også spm. 3) ved hjelp av adhesjonsmolekyler som passer med adhesjonsmolekyler på målcellen. De skiller ut perforin/granzym i kontaktområdet mellom cellene. NK-cellen løsner deretter fra målcellen. De utskilte molekylene induserer apoptose av målcellen. Perforins viktigste funksjon er å lage porer i membranen slik at granzymene komme inn i målcellen. NK-cellene produserer også cytokiner som bidrar til aktivering av dendrittiske celler (interferon gamma), et nødvendig ledd i aktivering av det ervervede forsvaret.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å nevne NK-celler gir 1/2 poeng. Fullt hus for mekanismen krever binding med adhesjonsmolekyler, utskillelse av perforin/granzymer, apoptose og cytokinproduksjon. Manglende cytokinproduksjon trekker 1/2 poeng.
Svar med hovedvekt på nøytrofile granulocytter og fagocytose gir ikke poeng fordi dette ikke er den viktigste mekanismen. Fagocytose spiller en viss rolle, men virus er bare ekstracellulære en kort stund, ikke i flere dager. Når virus er intracellulære, er de ikke tilgjengelige for granulocyttene.
Svar med hovedvekt på mekanismen antistoffmediert direkte cytotoksisitet (ADDC) av NK-celler eller andre celler gir ikke poeng. Denne mekanismen forutsetter at kvinnen har passende antistoff fra tidligere infeksjon med samme virustype. I så fall forventer man ikke at kvinnen får såpass sterke symptomer på ny infeksjon i så lang tid. Denne mekanismen har også betydning når infeksjonen er i ferd med å gå over og det er dannet antistoff som følge av den aktuelle infeksjonen, men det skjer mye senere i forløpet.
Svar om T-celler gir ikke poeng fordi de hører til det ervervede forsvaret.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Senere i forløpet bidrar også celler fra det ervervede forsvaret til bekjempelse av influensaen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan disse cellene bidrar i forsvaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
T-celler begynner å spille en rolle for drap av infiserte celler tidligst etter 5 dager. Mekanismen går imidlertid over to trinn: Først aktiveres naive CD4 positive hjelperceller med antigenreseptor som gjenkjenner virusrelaterte peptider. Responsen vris i retning av Th1, blant annet på grunn av primingcytokinet interferon gamma fra aktiverte NK-celler (og interleukin 12 fra dendrittiske celler). De resulterende hjelpereffektorcellene kan deretter bidra i neste trinn, som er aktivering av CD8 positive T-celler med passende antigenreseptor. Det dannes cytotoksiske T-effektor-celler. De dreper infiserte celler ved en mekanisme som ligner den som er beskrevet for NK-celler
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fullstendig svar må ha med både CD4^^+^^ og CD8^^+^^ celler fordi begge typer er nødvendige for å få slutteffekten på infiserte celler. Mekanismene med hjelp fra hjelperceller og deretter med drap ved kontakt må nevnes. Det er OK om det mangler detaljer vedrørende forskjeller i effektormolekyler eller adhesjonsmolekyler mellom NK- og T-celler.
Svar om nøytrofile eller monocytter gir ikke poeng - er ikke ervervet forsvar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De aktuelle cellene fra det medfødte og det ervervede forsvaret har ulike måter å oppdage influensainfeksjonen på.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv mekanismene de bruker med vekt på å nevne forskjellene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
NK-celler: gjenkjenner endret selv som summen av mange signaler:
Nedregulert HLA klasse I på målcellen, som er en vanlig konsekvens ved virusinfeksjon i en celle. Cytokiner i vevet (bl.a. IL-12 og IL-15) som regulerer NK-cellenes aktiveringsgrad og påvirker uttrykket av reseptorer og adhesjonsmolekyler. Om NK-cellen er bundet til en målcelle via adhesjonsmolekyler (dvs. de oppfatter signaler fra adhesjonsmolekylene når disse er bundet til sine ligander). NK-cellene har også reseptorer for andre ligander på målcellen: HLA, collagen, sialinsyre, MIC-A og MIC-B, virale hemagglutininer m.fl.
T-cellene gjenkjenner "ikke selv" = virusrelaterte peptider, som de må få må få presentert på HLA av korrekt klasse. De CD4 positive cellene: for aktivering skjer presentasjonen av HLA Klasse II på dendrittiske celler. Når de ferdigutviklede CD4 positive effektorcellene skal hjelpe CD8 positive celler til aktivering, må virusrelaterte peptider fremvises på HLA klasse I. Da skjer også antigenpresentasjon av dendrittiske celler, som har både HLA klasse I og II. Derved kan den CD4 positive og den CD8 positive cellen samlokaliseres og den CD8 positive cellen kan få hjelp til differensiering til cytotoksiske effektorceller av den dendrittiske cellen og hjelpercellen i samarbeid. De cytotoksiske T effektorcellene gjenkjenner infiserte celler som skal drepes ved at disse fremviser virusrelaterte peptider på HLA klasse I.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1/2 poeng for å nevne at NK-celler gjenkjenner endret selv, men uten mer forklaring. Fullt poeng krever detaljert mekanisme, men ikke navn på reseptorene og alle ligander som er involvert.
1/2 poeng for å nevne at T-celler gjenkjenner virusrelaterte peptider på HLA. Fullt poeng krever korrekte HLA-klasser og dendrittiske celler.
Generelle svar om pattern recognition receptors (PRR) i det medfødte forsvaret og / eller spesifikke antigenreseptorer i det ervervede forsvaret gir ikke poeng - spørsmålet er knyttet til de aktuelle cellene ved influensainfeksjonen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen fikk influensavaksine for tre år siden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor hun allikevel er blitt syk i år
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vaksinen gir immunologisk hukommelse som særlig bygger på antistoff (fordi det er vanskelig å få sterke cytotoksiske vaksineresponser med drepte vaksiner). Antistoffene er i stor grad spesifikke for virusets hemagglutinin og neuraminidase, som skifter noe fra år til år og mye enkelte år. Derfor lages det ny vaksine årlig med antigener som er tilpasset årets influensavariant/-er. Effektene av drepte vaksiner varer heller ikke så lenge. Kvinnen har derfor for lav antistoffkonsentrasjon og antistoff med for lav affinitet til at hun er beskyttet 3 år etter vaksinasjonen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for antistoffspesifisitet og virusantigener som skifter. ½ poeng for kortvarig effekt av drepte vaksiner.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter en uke føler kvinnen seg verre. Hun hoster opp mye grønt og gult slim og har vondt i høyre side av brystet når hun puster eller hoster. Hun får nesten ikke i seg mat eller drikke. Fastlegen stiller diagnosen pneumoni og legger henne inn på lokalsykehuset.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige årsaken til pneumonien? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kvinnen har typiske symptomer på en bakteriell superinfeksjon. Purulent ekspektorat er typisk for bakterieinfeksjoner. Det består for en stor del av døde nøytrofile granulocytter og døde vevsceller (debris).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Selv om studentene ikke har hatt så mye sykdomslære skal de vite mekanismen for dannelse av puss og kunne resonnere seg frem til bakterieinfeksjon (evt. bakteriell superinfeksjon) ut fra det. Dessuten gir mange virusinfeksjoner redusert aktivitet av fagocytter (via mange forskjellige mekanismer som studentene ikke behøver å kjenne til) og derved økt risiko for sekundære bakterieinfeksjoner. Det er ikke nødvendig å vite hvilke bakterier som er vanligst ved bakteriell superinfeksjon etter influensa.
1/2 poeng for bakterieinfeksjon uten forklaring. Fullt poeng krever begrunnelsen med puss som nøkkelord for å skille fra ren gjetting. Ikke poeng for influensa, som også kan gi pneumoni, men med blankt ekspektorat.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved innkomsten måles forhøyet C-reaktivt protein (CRP).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor konsentrasjonen av CRP er forhøyet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt konsentrasjon av CRP skyldes proinflammatoriske cytokiner som skilles ut av forskjellige typer celler i det infiserte området, særlig IL-6. Cytokinene virker på hepatocytter som syntetiserer og secernerer CRP og andre molekyler som trengs til immunforsvaret ved infeksjonen. Dette er ledd i akutt fase-reaksjonen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poeng krever proinflammatoriske cytokiner og akutt fasereaksjon - beskrivelse er greit også uten begrepet akutt fase. Det er ikke nødvendig å angi celletypene som kan skille ut cytokiner. Det er ikke nok å nevne «akutt fase» uten forklaring
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan immunforsvarets bekjempelse av pneumonien påvirkes av forhøyet CRP.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved bakterieinfeksjon er hovedforsvaret fagocytose. CRP kan bindes til bakterier og aktivere klassisk vei av komplementkaskaden. Aktiveringsprodukter av komplement som sitter på bakterieoverflaten opsoniserer dem slik at fagocytosen blir mer effektiv fordi fagocyttenes komplementresptorer stimuleres. Derved bidrar akutt fase-reaksjonen og CRP-produksjonen til mer effektiv bekjempelse av en bakteriell pneumoni.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 1/2 poeng for mekanismen for opsonisering og fagocytose. 1 poeng hvis ikke pathway for komplementaktivering er nevnt eller forklaring mangler på hva opsonisering er (bare begrepet er nevnt).
Mekanismesvar som bare går på at CRP øker antistoffrespons fordi komplement-aktiverende antigener reduserer B-cellers aktiveringsterskel gir 1/2 poeng (er korrekt, men ikke det mest sentrale. Derfor ikke nødvendig å ha med dette for fullgodt svar).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved laboratoriearbeid, enten det er på sykehus eller innen undervisning og forskning, kan laboranter og andre bli utsatt for forskjellige arbeidsmiljøpåvirkninger. En av disse er eksponering for kjemikalier.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire andre hovedgrupper av påvirkninger som vi kan finne i laboratorier og som kan ha betydning for helsa til de som arbeider der.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fysikalske påvirkninger bør nevnes. Her kan støy og radioaktiv/ioniserende/UV stråling godkjennes som to separate svar, mens Fysikalske påvirkninger og enten støy eller radioaktiv/ioniserende/UV stråling ikke godkjennes som to svar siden fysikalske påvirkninger er det overordnete begrepet. Vibrasjonspåvirkning godkjennes ikke fordi det ikke er noe typisk for laboratorier.
Mikrobiologiske påvirkninger bør nevnes. Her kan også smitte og bakterier, virus og sopp godkjennes, men ikke som flere riktige siden vi sier hovedgrupper.
Psykososiale/organisatoriske påvirkninger bør nevnes. Her kan også stress, mobbing, og seksuell- eller annen trakassering godkjennes, men ikke som flere riktige siden vi sier hovedgrupper.
Ergonomiske forhold bør nevnes. Dette dreier seg om tilpasning mellom mennesket og arbeidet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kjemiske påvirkninger framgår av spørsmålet, og står i ingressen, så det gir ikke poeng.
Gi 0,5 poeng for hver riktig hovedgruppe
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På en arbeidsplass i et laboratorium er støynivået 78 dBA.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke virkninger kan slik støy ha for den som arbeider der, og hvordan kan man best forebygge støyskader generelt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# 78 dBA er ikke regnet som hørselskadelig støy, men et slikt støynivå kan føre til konsentrasjonsvansker og økt tretthet i forbindelse med arbeidet.
# For forebygging av støyskader regner man alltid at det første tiltaket er å redusere støykilden enten ved å fjerne, modifisere eller bygge inn denne.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 poeng.
# 1 poeng. Personlig verneutstyr med hørselsvern kommer alltid i siste rekke og bør ikke gi poeng hvis bare dette nevnes.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Formalin (40-50% vandig løsning av formaldehyd) er en reaktiv løsning en kan eksponeres for i enkelte laboratorier. Formaldehyd er sterkt polart og elimineres raskt fra blodet (plasma t,,1/2,, i størrelsesorden 2 minutter).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil en forvente at formaldehyd distribueres til fett, og vil en forvente at formaldehyd akkumuleres i kroppen fra den ene arbeidsdagen til den neste? Forklar
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Svaret er nei. På grunn av sin høye vannløselighet finner du nesten ikke formaldehyd i fett.
# Svaret er nei. I løpet av 5 x t,,1/2,,, dvs 10-15 minutter etter opphør av formalin eksponeringen, vil så godt som alt formaldehyd være eliminert fra kroppen (ca 97%). En vil derfor møte opp neste arbeidsdag uten formaldehyd i kroppen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1,0 poeng. Korrekt svar uten forklaring gir 0,5 poeng. Korrekt svar med gal forklaring gir 0 poeng.
# 1,0 poeng. Ikke tilstrekkelig å kun svare nei og referere til rask eliminasjon (gir kun 0,5 poeng). For å få full score må en i svaret konkret referere til faktoren 5 x t,,1/2,,. (eller 4 x t,,1/2,,)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Formaldehyd (fra formalin) kan gi mange effekter i kroppen ved langtidseksponering for høye doser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilke måter kan formaldehyd påvirke reproduksjon og fosterutvikling, og hvilke mekanismer kan være involvert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Formaldehydeksponering kan hos kvinner påvirke reproduksjon gjennom uregelmessig menstruasjon, økt forekomst av endometriose og redusert fruktbarhet. For menn foreligger det ikke sikre studier på mennesker som påviser sammenheng mellom formaldehydeksponering og reproduksjonsskader. Generelt kan fosterskader uttrykkes ved spontanaborter, dødfødsler, for tidlige fødsler, redusert fødselsvekt og skader av forskjellige typer hos levende fødte barn.
# De viktigste mekanismene for fosterskader og reproduksjonsskader etter formaldehydeksponering hos både kvinner og menn er gentoksisitet av forskjellige typer (kromosomabberasjoner, mikronuklei, søsterkromatidutbytte, DNA-brudd, kryssbinding mellom DNA og proteiner) og oksidativt stress. I tillegg knyttes apoptose, redusert aktivitet av enzymer (LDH og SDH) som er involvert i modning av mannlige kjønnsceller, redusert testosteron, epigenetiske forandringer og stress via hormoner i aksen hypothalamus - hypofyse – binyrebark til formaldehydeksponering. Disse mekanistiske sammenhengene er framkommet ved studier på både dyr og mennesker.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 poeng. Både reproduksjon og fosterskader må omtales. Ufullstendig svar gir kun 0,5 poeng
# 1 poeng. Både gentoksisitet og oksidativt stress må være med for å gi 1 poeng. Det kan aksepteres at noen av tilleggsmomentene i andre del av svaret ikke er med uten at det trekkes poeng. Uten tilleggsmomenter gis kun 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn i prioritert rekkefølge de fem hovedtiltakene som er vanlige for å beskytte arbeidstakere mot skadelig kjemisk påvirkning.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Eliminasjon (fjerning av den skadelige påvirkningen)
# Substitusjon (bytte ut et helsefarlig kjemikalium med et annet som representerer en lavere helserisiko ved eksponering)
# Innkapsling eller lukking av prosesser (herunder regner vi avtrekkskap på laboratorier)
# Ventilasjon/avtrekk (herunder regner vi allmennventilasjon og punktventilasjon)
# Personlig verneutstyr (maske, klær, briller m.m.). Et av disse kan godkjennes, men ikke flere.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Gi 0,3 poeng for hvert riktig tiltak og 0,5 poeng hvis også rekkefølgen er riktig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Les det følgende sammendraget fra en vitenskapelig artikkel:
<<<
The purpose of this study was to determine the risk for divorce among cancer patients. We conducted a nationwide, population-based study of 46,303 persons aged 30-60 years in whom selected cancers were diagnosed in 1981-2000 and 221,028 randomly sampled, cancer-free persons. Information on socioeconomic status, demographics and comorbidity was obtained from Danish administrative registries. We analysed the risk for divorce, adjusted for several potential confounders, during follow-up. We found that cancer patients had the following relative risks for divorce compared to the general population: Relative risk (RR), 1.01 and 0.99 for women and men, respectively.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Konklusjonen er slettet fra sammendraget. Trenger kreftpasienter frykte for ekteskapet sitt mer enn andre? Hvorfor, eller hvorfor ikke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, ingen grunn til større frykt enn hos andre. Den relative risikoen er tilnærmet lik 1, hvilket betyr at kreft og skilsmisse ikke er assosiert. Med andre ord: Kreftpasienter har samme risiko for skilsmisse som sammenlikningsgruppa.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng gis for svaret ”nei”. Ytterligere 1 poeng gis for forklaringen over.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Relativ risiko (RR) var 1,01 blant menn og 0,99 blant kvinner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan dette alene indikere at kjønn er en konfunder (confounder) for sammenhengen mellom kreft og skilsmisse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Svaret ”nei” er tilstrekkelig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
Relativ risiko (RR) var 1,01 blant menn og 0,99 blant kvinner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan dette alene indikere at kjønn modifiserer sammenhengen mellom kreft og skilsmisse (effektmodifikasjon)? Hvorfor, eller hvorfor ikke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei. RR i begge subgrupper er tilnærmet lik 1 (1 poeng). Hvis studenten skriver at 1,01 og 0,99 er veldig like slik at effektmodifikasjonen er veldig liten, blir det også godtatt som korrekt svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
Relativ risiko (RR) var 1,01 blant menn og 0,99 blant kvinner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan dette alene indikere at sammenhengen mellom kreft og skilsmisse medieres via kjønn? Hvorfor, eller hvorfor ikke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei. De subgruppe-spesifikke relative risikoene, uten informasjon om relativ risiko for hele studiepopulasjonen, kan ikke hjelpe oss til å avgjøre om det foreligger mediering (1 poeng). Alternativt godtas det også som korrekt svar dersom studenten skriver at mediering er utelukket fordi kjønn ikke kan være en konsekvens av eksponeringen (kreft).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forfatterne skriver at de "analysed the risk for divorce, adjusted for //several potential confounders//."
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er kriteriene for at en variabel skal være en konfunder (confounder) for sammenhengen mellom kreft og skilsmisse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Variabelen må (1) være assosiert med både kreft (eksponeringen) og skilsmisse (sykdommen), (2) men den må ikke være påvirket av (være en følge av) kreft eller skilsmisse.
Begge kriteriene må være oppfylt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begge kriteriene må være nevnt for at det skal gis 2 poeng. Dersom bare 0 eller 1 kriterium nevnes, gis 0 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et par oppsøker sin fastlege på grunn av ufrivillig barnløshet. Kvinnen er 41 år, og mannen er 35 år. Mannen har i mange år drevet med kroppsbygging, og han fremstår svært muskuløs. Du bestiller en sædundersøkelse ved Fertilitetsenheten på St Olavs hospital. Svaret viser at det er sædceller i prøven, men i betydelig redusert antall og med dårlig motilitet. Ved klinisk undersøkelse finner man to testikler i scrotum. Disse har normal konsistens ved palpasjon, men er knapt halvparten så store som forventet. Mannen innrømmer å ha brukt anabole steroider gjennom flere år, og dette vurderes som den mest sannsynlige årsaken til redusert spermiekvalitet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke årsaksmekanismer (organer, celler og hormoner) ligger bak den reduserte spermiekvaliteten i dette tilfellet? Tegn og forklar.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spermieproduksjonen skjer i testes og reguleres via negativ feedback til hypofyse (FSH og LH) og hypothalamus (~GnRH=gonadotropin releasing hormon). Ved eksogen tilførsel av testosteron (inntak av anabole steroider) vil hypofysen svare med å supprimere LH og testosteron, hvilket i neste omgang medvirker til redusert ny-syntese av testosteron fra Leydigcellene og redusert spermiogenese fra germinalcellene i testes. Sistnevnte er i varierende grad reversibelt om misbruket av anabole steroider opphører. (2 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dersom svaret inneholder: «Negativ feedback» – gis 0. 5 poeng, «FSH, LH og GnRH gis 0.25 poeng, «Leydigceller og germinalceller i testes» gis 0. 5 poeng, «suppresjon av testosteronsyntese i testes» gis 1 poeng.
Instruktiv tegning med riktige benevnelser og inntegnet ± kan erstatte tekst og gi full score.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to faktorer hos kvinnen som også gjør det vanskelig å bli gravid.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hennes eggreserver vil være redusert både kvantitativt (færre primordialfollikler) (1poeng) og kvalitativt (dvs. relativt større andel av gjenværende eggceller vil ha genetisk feil) (1 poeng).
Begge deler forverres jo eldre kvinnen er
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Paret får tilbud om assistert befruktning. Eggproduksjonen hos kvinnen forsøkes stimulert med FSH (folikkelstimulerende hormon). På tross av at hun får maksimalt høye doser FSH lykkes man ikke med å få ut mer enn 3 oocytter. Disse forsøkes befruktet med mannens sædceller. På dag 2 etter befruktning tilbakeføres et 2-celle embryo til kvinnens livmor. To uker senere har hun en positiv graviditetstest.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva måles ved en graviditetstest og hvilke(t) prøvemateriale kan benyttes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Graviditetstesten er positiv hCG i urin (0.5 poeng) eller kvantitativ hCG i serum. (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter noen uker får kvinnen en vaginalblødning. Hun får time til ultralydundersøkelse ved NFSM (Nasjonalt senter for fostermedisin) ved St Olavs Hospital. Ultralydundersøkelsen utføres transvaginalt. Ved undersøkelsen kan man blant annet se at fosterhjertet slår med en frekvens på 105 slag per minutt
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan dannes det primitive hjerterøret og når i svangerskapet skjer det? Når begynner fosterhjertet å slå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hjertet begynner å slå etter fem fullgåtte uker basert på siste menstruasjon, ca. 22 eller 23 dager etter unnfangelsen. Med transvaginal ultralyd ser man et lite blafrende hjerteslag. Hjertet er svært primitivt og rør-formet, men funksjonelt. Hjerterøret er oppstått som følge av embryoets laterale folding med etterfølgende sammensmelting (apoptose) av de to endokardiale tuber/ rør.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av de to utviklingstrinnene; embryoets laterale folding og etterfølgende sammensmelting (apoptose) av de to endokardiale tuber/rør.
0,5 poeng for å vite når dannelsen av hjerterøret skjer
0,5 poeng for når hjertet begynner å slå
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På grunn av kvinnens alder henvises hun til ytterligere undersøkelser i svangerskapsuke 11 for å vurdere sannsynligheten for kromosomfeil/utviklingsavvik hos fosteret. Det er vanskelig å få oversikt over hjertets anatomi, men legen lurer på om det kan foreligge en defekt i skilleveggen mellom hjertekamrene. Det synes å mangle tommel på begge hender, det ses kun en navlearterie, og fosteret har et nakkeødem som ses som en oppklaring ved nakken. På bakgrunn av funnene tilbys paret kromosomundersøkelse, noe de takker ja til.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv aktuelle prøvetakingsmetoder av fosteret, og hvilke farer som er forbundet med selve prøvetakingen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fostervannsprøve tas vanligvis først etter uke 15, da det ofte er for få celler i fostervannet før den tid.
CVS (Chorion villus sampling) er morkakeprøve som tas rundt uke 10-12, og det vil være den mest aktuelle prøvetakingsmetoden her. Begge prosedyrene assisteres av ultralyd. Både fostervannsprøve og CVS medfører en økt risiko for spontanabort med 0.5-1 %.
Det kan også tas prøve av navlestrengsblod.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Man ønsker å utføre en genetisk undersøkelse på prøvematerialet. Hvordan fungerer den mest aktuelle undersøkelsen, og hva kan den gi svar på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Karyotyping er den mest aktuelle analysen å rekvirere på CVS prøven. G-bånd-karyotyping er mest vanlig. Det er en lysmikroskopisk undersøkelse av celler i delingsfase, det vil si at cellene må dyrkes. De kondenserte metafase-kromosomene trypsinbehandles og Giemsa-farges. Det er en ressurs- og tidkrevende analyse som tar 2-3 uker før svar foreligger.
Karyotyping egner seg godt til å se på numeriske kromosomavvik (trisomier og Turner), samt større delesjoner eller duplikasjoner av kromosombiter. Kromosomfeil under en viss størrelse oppdages ikke med karyotyping (dvs <5 – 15 Mb).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svaret på prøven viser at fosteret har trisomi 18.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige hjertefeilen hos dette fosteret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En ventrikkelseptumdefekt er den mest sannsynlige hjertefeilen hos dette fosteret.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Åse kommer til deg som allmennlege. Hun er 21 år, samboer, og arbeider som frisør. Hun forteller at hun nå siste ukene har hatt flere anfall. Først trodde hun det var noe alvorlig galt med hjerte, men tror nå det handler om angstanfall. Siste dagene har hun vegret seg for å gå på jobb da hun er redd hun skal få anfall på mens hun jobber med kundene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn symptomer på frykt og angst og angi hvilke funksjon disse symptomene har.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hjertebank (øke arbeidskapasitet)
* Økt respirasjon (øke arbeidskapasitet)
* Økt spenning i muskulatur (økt arbeidskapasitet)
* Svette (resultat av økt muskelaktivitet)
* Rødme (fordele blod mer perifert for å øke muskelkapasitet)
* Skjelve (økt spenning i muskulatur)
* Tørr i munnen (nedprioritering av fordøyelse)
* Store pupiller (slippe inn mer lys, øke synsevnen).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mer enn fem symptomer=1p.
Mer enn fem forklaringer=1p. Forklaring som sier noe om at det handler om å gjøre kroppen klar til økt funksjon (fight/flight) kan også godtas
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke system i kroppen er ansvarlig for samordnet aktivering av disse symptomene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Samordnet aktivering av disse symptomene styres av sympatikus(/parasympatikus) i det autonome nervesystemet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sympatikus(/parasympatikus)=1p. Kun autonome nervesystem er ikke nok.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typiske reaksjonsmønstre ser vi i frykt- og angstsituasjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
“Fight, flight, freeze and faint” (eller tilsvarende forklaringer på norsk)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1-2 riktige svar=1p
3-4 riktige svar=1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de viktigste risikofaktorene for psykisk sykdom.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Traumer (tidlige og nylige, inkludert seksuelt/fysisk overgrep, ulykker, tap)
* Psykisk sykdom i nær familie (genetisk sårbarhet/arv)
* Somatisk sykdom (kreft, hjertesjukdom, nevrologiske lidelser, alvorlig sykdom)
* Rusmisbruk (alkohol, tablettmisbruk og narkotika)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Navn på hovedgrupper eller eksempler på de enkelte hovedgrupper gir poeng.
1 hovedgruppe=1p
2 hovedgrupper=2p
3-4 hovedgrupper=3 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Arne (35) jobber som lærer i ungdomsskolen. Han er stort sett frisk, bruker ingen faste medisiner og har knapt vært til legen de siste 10 årene. Han har imidlertid blitt gradvis mer slapp og uvel de siste månedene. Han er kvalm, har dårlig matlyst og har også litt hudkløe.
Du mistenker at han har utviklet alvorlig nyresvikt, og du ønsker å få bekreftet dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Glomerulær filtrasjonsrate (GFR) brukes som et mål på nyrefunksjon. Hva baseres dette prinsippet på? Forklar hva GFR er rent fysiologisk med utgangspunkt i oppbygning av glomerulus, og forklar hvilke krefter som avgjør GFR.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Forklare kort om oppbygning av filtrasjonsmembranen (endotel med karbohydratlag, basalmembranen, podocytter med nefrin i spalten) (1p),
* virker som en semipermeabel membran, cut off-verdi omkring albuminets størrelse, det dannes pre-urin ved mekanisk filtrasjon og mengden som produseres per minutt = GFR (1p)
* GFR= (glomerulært kapillært hydrostatisk trykk – hydrostatisk trykk i Bowmans kapsel – glomerulært kapillært osmotisk trykk + Bowmans osmotisk trykk) x arealet av membranen (x konstant) (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nyrene har flere funksjoner utover filtrasjon. Hvilke av disse funksjonene samvarierer med GFR?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, GFR er tydelig assosiert til andre funksjoner slik som evne til å regulere salt/vann/blodtrykk, tubulære funksjoner, syre-base og hormonproduksjon.
(Bør vel klare 4 av disse 6 for å få ett poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan vi direkte måle GFR?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Måling av endogene (kreatinin, karbamid) eller eksogene (inulin, ~CrEDTA, iohexol, etc) substanser som filtreres fritt uten påfølgende reabsorpsjon eller sekresjon. Man kan måle hvor mye som utskilles i urin per tid, eller man kan måle hvor fort de eksogene stoffene forsvinner fra blodet. (1p)
* GFR=konsentrasjon i urin x urin volum per tid/konsentrasjon i plasma (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ikke-invasive metoder finnes for å estimere nyrefunksjonen? Beskriv kort hvordan dette gjøres.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Estimering av GFR gjøres ved hjelp av serum-kreatinin og en eller annen form for justering for muskelmasse ved hjelp av alder, kjønn og etnisitet. Cockgroft Gault formel, MDRD formel, CKD-epi formel eller andre. (1,5 p)
* Man kan også måle nyrefunksjon non invasivt ved kreatinin clearance, dvs måle s-kreatinin og u-kreatinin og urinvolum, men kreatinin clearance overestimerer GFR (spesielt ved lave verdier) og har en betydelig måleusikkerhet pga at pasientene måler feil urin volum (0,5 p)
</$details>
⚠ Spørsmålet i denne oppgaven er feil, men det er vanskelig å korrigere da originalen er utilgjengelig
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ikke-invasive metoder finnes for å estimere nyrefunksjonen? Beskriv kort hvordan dette gjøres.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Serum-kreatinin øker med økende muskelmasse.
* Kan øke etter kraftig trening, etter stor kjøttmåltid eller etter lavt væskeinntak.
* Kan øke etter medikamenter som hindrer tubulær sekresjon.
* Forholdet mellom s-kreatinin og GFR er ikke lineært, men eksponensielt.
(0,5 p for hvert av punktene)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du jobber som allmennlege på et legekontor og har besøk av en mannlig pasient på 50 år. Han har ukarakteristisk svimmelhet og ustøhet. Han har ingen øresus, men han sier at hørselen er litt dårligere på venstre øre, noe den har vært i flere år.
Du bestemmer deg for å gjøre en otoskopi. Ved undersøkelsen får du greit innsyn på trommehinnen. Du synes du ser et lite hull i trommehinnen tilsvarende lysrefleksen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan inndeler du trommehinnen i kvadranter og hvor plasserer du lysrefleksen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fire kvadranter, deles i en linje langs hammerskaftet i fremre/bakre og med en linje 90 grader på denne gjennom umbo (enden på hammerskaftet) i øre og nedre kvadranter.
Lysrefleksen ligger i nedre fremre kvadrant.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for første del, definisjon av kvadrantene
1 poeng for riktig plassering.
</$details>
⚠ Spørsmålet i denne oppgaven er feil, men det er vanskelig å korrigere da originalen er utilgjengelig
<div class="oppgave">
<div class="vignett">
!!Vignett
Du vil undersøke om det foreligger et mekanisk tap av hørsel, og bestemmer deg for å bruke en stemmegaffel til dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan inndeler du trommehinnen i kvadranter og hvor plasserer du lysrefleksen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Webers prøve går mot det syke øret, Rinnes prøve er negativ på det syke øret (sterkest mot benet, gjerne mot ørebensknuten).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver av de 2, reduseres til ½ dersom navn mangler.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det viser seg at det foreligger et moderat nevrogent høretap og at pasienten har jobbet i støyfylte omgivelser i flere år
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er øvre grense for tillatt støy i løpet av en 8-timers arbeidsdag når det gjelder langvarig støy og impulsstøy? Nevn tre yrker som er særlig utsatt for støyskader.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Grense 85 dB i 8 timer, impulsstøy 130 dB
# Mekanisk industri, Verkstedindustri, Bygg/anlegg, Tungtransport, Sjøfart/fiske, Skogbruk
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert av momentene i (1)
½ poeng for å ha 3 av de i (2), reduseres til ¼ ved 2
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å teste det perifere balansesystemet ved å dreie raskt på hodet til pasienten i sittende stilling og observere øyebevegelsene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken del av vestibulærapparatet er det du da tester og hvilken refleks? Hvilke andre bevegelser registreres i andre deler av vestibulærapparatet, og hvor registreres de?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Buegang og vestibulookulære refleks, rotasjon
* Makula: Lineær akselerasjon
* Sacculus: Stilling i rommet (vertikal akselerasjon)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver del, halveres hvis ett av elementene mangler
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Refleksen er utslukket - det viser seg at pasienten har fått intravenøs antibiotika som er toksisk for vestibulærapparatet, og i en slik dose at funksjonen her sannsynligvis er utslokket.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to situasjoner hvor pasienten da kan bli ekstra ustø basert på de to gjenværende elementene i det posturale systemet (balansesystemet). Hvilke er de?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# I mørke eller dårlig lys (når det visuelle input er redusert i tillegg til de vestibulære)
# Ved svømming eller lignende når de proprioceptive input (fra leddsansen) er redusert
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for situasjon og/eller navn på posturale input (visuelle og proprioreceptive)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er lillehjernens (cerebellums) tre funksjonelle hoveddeler i motorisk kontroll, og hvilke oppgaver har disse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cerebrocerebellum (planlegging), vestibulocerebellare (balanse), spinocerebellum (utførelse)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hver av de tre (en eller begge av navn eller funksjon er nok)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I hjernens basalarterier kan det oppstå trombosering og aneurismer som kan gi opphav til infarkter og blødninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Lag en enkel skisse av hjernens basalarterier.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "ICD-2016s-4-A.PNG">>
(Fig. ref.: imgarcade.com).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For 3 p kreves følgende arterier nevnt:
* art. carotis interna
* art. cerebri ant./med./post.
* art. communicans ant./post.
* art. basilaris,
* art. vertebralis
* art. cerebelli sup./art. superior cerebelli
* art. cerebelli inferior superior/art. inferior anterior cerebelli
* art. cerebelli inferior posterior/art. inferior posterior cerebelli.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er definisjonen på et infarkt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et infarkt omfatter et velavgrenset område med nekrotisk vev som følge av opphør/redusert blodtilførsel og redusert oksygenforsyning, eg. område med nekrose på iskemisk grunnlag.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nekrose (vevsdød) pga redusert blodtilførsel = full score, 2 poeng
Bare nevne «Nekrose» = 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I tilhelingsprosessen ved et hjerneinfarkt vil det skje en fagocytose av dødt vev
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type celle i hjernen er involvert ved slik fagocytose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mikroglia (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type celle i blodet rekrutteres fra blodbanen ved en slik prosess?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Monocytter (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved sykdom og skade i hjernen kan ventrikkelsystemet affiseres og gi komplikasjoner som hydrocefalus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type celle i blodet rekrutteres fra blodbanen ved en slik prosess?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CSF dannes i plexus choroideus som finnes i samtlige ventrikler. Den strømmer fra sideventriklene gjennom begge interventrikulærhull (foramen interventriculare/Monro) til 3. ventrikkel, derfra gjennom aquaeductus cerebri (akvedukten) til 4. ventrikkel, derfra ut i subaraknoidalrommet i cisterner her, gjennom tre hull under cerebellum, to laterale hull, apartura lateralis/foramen Luschkae, og et midtre hull, apertura mediana/foramen Magendii, derfra sirkulasjon i subaraknoidalrommet, også omkring medulla spinalis, bl.a. til cisterna lumbalis, til slutt drenasje gjennom villi/granulationes arachnoidalis inn i hjernens venesinus, sinus sagittalis superior.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
''Første del:'' CSF dannes i ventriklene eller CSF dannes i plexus choroideus = 1 poeng
''Andre del:'' Fra sideventriklene til 3. ventrikkel så gjennom akvadukten til 4. ventrikkel så til subarachnoidalrommet og til slutt sinus sagitallis superior (venesystemet) = full score, 2 poeng
Om bare nevner «Fra sideventriklene til fjerdeventrikkel til subarachnoidal til venesystemet» = 1 poeng
Om bare nevner «Fra sideventriklene til subarachnoidalrommet til venesystemet» = 0,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Cytologisk undersøkelse av cerebrospinalvæske kan være en viktig prosedyre ved utredninger av nevrologiske sykdommer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags type betennelse og infeksiøse agens kan foreligge når det i CSF påvises 1) nøytrofile granulocytter; 2) lymfocytter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Akutt betennelse, oftest som ledd i en bakteriell infeksjon. (1 poeng)
# Kronisk betennelse, kan forekomme ved infeksjoner med virus, sopp og atypiske mycobakterier (tbc). (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antibiotika er en av våre aller viktigste legemiddelgrupper. I denne oppgaven skal vi ta opp en del sentrale farmakologiske prinsipper og begreper og applisere disse på ulike typer antibiotika.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer er det som bestemmer hvor høy konsentrasjon man får av et legemiddel ved konsentrasjonslikevekt (”steady state”) i plasma?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den dosen som gis per tidsenhet (dose/tau), legemidlets biotilgjengelighet (F), og legemidlets clearance (Cl). Matematisk er konsentrasjonen i steady state = [(dose/tau) x F] / Cl.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis alle tre faktorene (eller 4 hvis man tar med tiden mellom dosene som en separat faktor) er med, gis det 2 poeng. Hvis to av de tre er med, gis 1,5 poeng, hvis en av de tre er med, gis 1 poeng (altså ingen poeng ekstra hvis man har tiden som egen faktor)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Doksysyklin har en halveringstid på 20 timer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor lang tid vil det ta før det oppnås konsentrasjonslikevekt (”steady state”) i plasma for dette midlet, og hvordan kan man sikre at pasienten oppnår en terapeutisk effektiv konsentrasjon raskere enn dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 5 ganger halveringstiden, dvs. 100 timer eller ca. 4 døgn. (4 ganger halveringstiden, dvs. 80 timer) aksepteres også).
* Ved å gi en metningsdose (også kalt ladningsdose), altså å gi en høyere dose initialt enn det som er aktuell dose ved langtidsbehandling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,75 poeng for hvert riktig delsvar, til sammen 1,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva som menes med begrepet ”terapeutisk indeks” (”terapeutisk bredde”) og nevn antibiotikagrupper (en av hver) som har henholdsvis svært høy terapeutisk indeks (svært stor terapeutisk bredde) og svært lav terapeutisk indeks (svært liten terapeutisk bredde).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Terapeutisk indeks uttrykker forskjellen mellom den dosen/konsentrasjonen som gir den ønskede effekten og den dosen/konsentrasjonen som gir uønskede effekter/bivirkninger/toksiske effekter (eller tilsvarende formuleringer). Formelt er terapeutisk indeks ratioen LD50/ED50. Begge typer svar godtas. Antibiotikagruppe med svært høy terapeutisk indeks: Penicillin. Antibiotikagruppe med svært lav terapeutisk indeks: Aminoglykosider
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig definisjon.
0,5 poeng for et eksempel på en gruppe med høy og 0,5 poeng for et eksempel på en gruppe med lav. Hvis de nevner andre eksempler enn de to som er de aller mest typiske, må poengsettingen vurderes individuelt – da kan det eventuelt være aktuelt å gi 0,5 poeng i stedet for 1 på dette delspørsmålet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
De to vanligste, prinsipielt forskjellige bivirkningstypene kalles type A og type B. Forklar hva som ligger i disse begrepene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Type A (”augmented”): Bivirkninger som kan opptre hos alle, og som er forutsigbare ut fra legemidlets farmakologiske virkning og doserelaterte (“intoleranse”).
Type B (”bizarre”): Bivirkninger som kun opptrer hos et fåtall, og som verken kan forutses eller relateres til dose (“idiosynkrasi”).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,75 poeng for hver riktig, maksimalt 1 poeng. Hvis «halvveisriktig» på begge, gis til sammen 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn én vanlig type A-bivirkning og én viktig type B-virkning for fenoksymetylpenicillin (penicillin V).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Type A: diaré, kvalme, mageproblemer etc.
Type B: Alle former for allergiske reaksjoner godkjennes, som allergi, urticaria, anafylaksi, utslett etc.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for korrekt eksempel under hver type, til sammen 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hvilke momenter er mest sentrale for å vurdere om et symptom eller en tilstand hos er pasient kan være en legemiddelbivirkning?
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn én vanlig type A-bivirkning og én viktig type B-virkning for fenoksymetylpenicillin (penicillin V).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De viktigste momentene er
# at det skal være et rimelig tidsforløp mellom eksponering og reaksjon,
# at reaksjonen skal være beskrevet tidligere,
# at reaksjonen går tilbake når midlet seponeres (eller dosen reduseres),
# at reaksjonen kommer tilbake etter fornyet eksponering for legemidlet, og
# det skal ikke foreligge alternative forklaringer på reaksjonen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver, maksimalt 2 poeng hvis 4 eller 5 er riktige.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er legevaktslege og det kommer en 21-årig mann til deg med en tre-ukers sykehistorie med slapphet og hoste. Ut fra klinikk og labanalyser vurderer du at diagnosen
mycoplasma-pneumoni er den absolutt mest sannsynlige. Du ønsker å starte antibiotikabehandling med en gang, men siden det er helg og apoteket er stengt må du starte opp med et av de to midlene som du har tilgjengelig på legevakta: Fenoksymetylpenicillin og erytromycin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket av disse to bør du velge, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Erytromycin. Siden Mycoplasma-bakterien ikke har cellevegg, vil ikke penicillin virke. Erytromycin virker på ribosomnivå/proteinsyntesen til bakterien, og har derfor effekt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for rett middel og 1,5 poeng for rett begrunnelse (0,75 poeng for hvorfor penicillin ikke virker, og 0,75 poeng for hvorfor erytromycin virker).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nervesystemet vårt består av flere typer celler og vev, deriblant nevroner og gliaceller.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Navngi de ulike delene av et nevron (A-D).
<<imgLink "ICD-2017-2-A.PNG">>
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
A=Dendritt
B=Soma
C=Aksonterminal
D=Her godtas to alternativer; både akson og myelin (som utgjøres av de schwannske cellene i det perifere nervesystemet og oligodendrocyttene i det sentrale nervesystemet)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng pr riktig bokstav. Maks 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire typer støtteceller/gliaceller i det sentrale nervesystemet og beskriv kort hvilke oppgaver de har.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Astrocytter:'' Har både strukturelle og fysiologiske funksjoner;
* utgjør barrierer mot blodkar (blod-hjernebarriere) og meninger (glia limitans)
* kontroll av nervecellenes miljø (transmittorsubstanser, elektrolytter) – sikre homeostase
* danner astrocyttnettverk (via «gap junctions»: elektriske impulser, Ca^^2+^^-ioner)
* danner gliose (arrvev) som respons på skader/tumor
''Oligodendrocytter'' lager myelinskjeder til flere nervefibre
''Mikroglia:''
* hjernens makrofager med evne til fagocytose
* utgjør i hovedsak hjernens immunforsvar
* fjerner patogener, døde nevroner, plakk
''Ependym:''
* kler ventrikler, akvedukten og sentralkanalen
* involvert i produksjon av cerebrospinalvæske (CSF)
* drifter sirkulasjon av CSF og absorbsjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for å navngi hver av gliacellene (maks 1 poeng). Deretter 0,5 poeng for å angi en av de overnevnte funksjonene til hver av gliacellene (maks 2 poeng). Tilsammen maks 3 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nervesystemet vårt kan deles inn i flere funksjonelle enheter. En av disse funksjonelle enhetene er ikke viljestyrt og kontrollerer blant annet fordøyelsen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles denne funksjonelle enheten i nervesystemet vårt og hvilke deler består den av? Nevn to eksempler på oppgaver denne delen av nervesystemet utfører.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det autonome nervesystemet. Vi deler det autonome nervesystemet inn i det sympatiske, det parasympatiske og det enteriske nervesystemet. Det autonome nervesystemet styrer aktiviteten i glatt muskulatur, hjertemuskulatur og kjertler, det vil si så godt som alle våre indre organer unntatt skjelettmusklene og skjelettet. Eksempler på oppgaver:
* regulering av kroppstemperatur
* regulering av blodtrykk
* regulering av åndedrett
* sekresjon og absorpsjon fra tarmslimhinnen og
* regulering av den rytmiske sammentrekningen i tarmene og blodkarenes diameter
<<imgLink "ICD-2017-2-B.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for å navngi det autonome nervesystemet og 0,25 poeng for de riktige delene sympatiske, parasympatiske og enteriske. 0,25 poeng for hvert eksempel på funksjoner (maks 0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne funksjonelle enheten av nervesystemet har også fibre i fire hjernenerver.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter disse hjernenervene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nervefibrene fra det autonome nervesystemet inngår også ifire av de tolv hjernenervene:
* nervus occulomotorius
* nervus facialis
* nervus glossopharyngeus
* nervus vagus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hver riktig hjernenerve
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan undersøker man hjernenerve VII?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hjernenerve VII: ''N. facialis''. Undersøkes ved
* å teste funksjonen i mimisk muskulatur. Man ser etter asymmetri. La pasienten rynke pannen, knipe igjen øynene, smile, blåse opp kinnene og stramme platysma.
* tester for smakssans i fremre 2/3 av tungen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert av punktene over
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva menes med begrepet somatotopi? Nevn to typiske områder i hjernebarken med somatotopisk ordning.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Somatotopi/ somatotopisk organisering er at ulike kroppsdeler/punkter på kroppen er representert i spesifikke deler av hjernebarken. Nevroner som står i forbindelse med samme område på kroppen løper sammen.
Både de motoriske og sensoriske barkområdene i hjernen har somatotopisk organisering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert av punktene over
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Les det følgende forkortede og lett modifiserte sammendraget (abstractet) fra en vitenskapelig artikkel:
<<<
''BAKGRUNN:'' Valget av medikamentavgivende stent i behandlingen av pasienter med diabetes mellitus og koronarsykdom som gjennomgår perkutan koronar intervensjon (PCI), har vært omdiskutert. Studier som har sammenliknet paclitaxel-avgivende stenter med stenter som avgir everolimus, har gitt motstridende resultater.
''METODE:'' Vi randomiserte 1830 pasienter med diabetes mellitus og koronarsykdom som gjennomgikk PCI til å få enten paclitaxelavgivende eller everolimus-avgivende stent. Det primære endepunktet var behandlingssvikt definert som kardial død eller hjerteinfarkt eller revaskulariseringskrevende iskemi i den behandlede arteriens forsyningsområde i løpet av 1 års oppfølging.
''RESULTATER:'' I løpet av 1 års oppfølging var risikoen for behandlingssvikt 5,6% i gruppa som fikk paclitaxel-avgivende og 2,9% i gruppa som fikk everolimus-avgivende stent. Risikodifferansen var 2,7 prosentpoeng (95% konfidensintervall 0,8-4,5), og relativ risiko var 1,9 (95% konfidensintervall 1,2-3,0).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste fordelen med en randomisert kontrollert studie sammenliknet med andre studiedesign?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Randomiserte studier er generelt betydelig mindre konfundert enn andre studiedesign.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det er akseptabelt om studenten skriver at randomiserte studier teoretisk sett ikke er konfunderte, eller skriver at randomiserte studier har mindre systematisk feil, eller skriver at den systemiske feilen som kan være til stede, er slik at den undermen ikke overestimerer de sanne effektene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to av de viktigste ulempene med randomiserte kontrollerte studier sammenliknet med andre studiedesign.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* En randomisert studie er ikke etisk akseptabelt for mange forskningsspørsmål
* Det er umulig å randomisere i mange situasjoner selv om det ville være etisk akseptabelt,
* Høye kostnader,
* Generelt kan bare de som samtykker bli inkludert,
* Det er alltid en eksperimentell situasjon,
* Compliance-problemer fra deltakerens side,
* Generelt bare kort oppfølgingstid
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To av punktene over, 1 poeng for hver riktig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
"Risikodifferansen var 2,7 prosentpoeng." Tolk dette med egne ord.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Risikoen for behandlingssvikt var 2,7 prosentpoeng høyere blant dem som fikk paclitaxel- sammenliknet med everolimusavgivende stent
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det må fremkomme at risikoen var 2,7 prosentpoeng høyere med paclitaxel
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
"Relativ risiko var 1,9." Tolk dette med egne ord.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienter som fikk paclitaxel-avgivende stent hadde 1,9 ganger høyere risiko for behandlingssvikt sammenliknet med dem som fikk everolimus-avgivende stent.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det må fremkomme at med paclitaxel var risikoen 1,9 ganger høyere
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Konklusjonen var slettet fra abstractet. Hvilken behandling bør anbefales basert på disse resultatene, en paclitaxel-avgivende stent eller en everolimus-avgivende stent? Hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det var betydelig lavere risiko for behandlingssvikt ved bruk av everolimus-avgivende stent (1 poeng) og derfor bør bruk av everolimus-avgivende stent anbefales framfor bruk av paclitaxelavgivende stent basert på disse resultatene (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne i 50-årene søkte lege pga. hodepine og synsfeltutfall. I forbindelse med utredningen ble det påvist en tumor i hypofyseområdet. Hun ble operert, og det ble tatt et frysesnitt av tumorvevet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er et frysesnitt? Gi noen eksempler på bruken av frysesnitt. Angi også kort noen fordeler og ulemper/usikkerhetsmomenter ved denne metodikken.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Frysesnitt er en hurtigdiagnostikk som patologiavdelingene tilbyr og som anvendes i forbindelse med kirurgiske inngrep. Ferskt vev tas ut peroperativt og blir raskt fraktet til patologiavdelingen. Dette vevet blir lagt i et nedfrysningsmedium og frosset ned. Derpå blir det skåret 4-5µm tynne vevssnitt som blir farget med hematoksylin/eosin som så blir mikroskopert av en patolog. En diagnose blir så meddelt kirurgen telefonisk så raskt som mulig, vanligvis innen ca. 15 min. Frysesnitt gir således kirurgen svar under selve operasjonen (peroperativt), og kan således være retningsgivende for inngrepets art/omfang. Frysesnittsdiagnosen er å betrakte som en foreløpig diagnose.
Eksempler på anvendelsesområder: ved spørsmål om det foreligger en malign diagnose eller ikke, reseksjonskantenes forhold ved tumorkirurgi (tumorvev eller ikke her), om det er infeksjon eller ikke, påvisning av ulike typer vev (eks.: lymfeknuter, gl. parathyroidea m.fl.).
Fordeler: rask metode, kan bestemme omfanget av et kirurgisk inngrep, kan forhindre reoperasjon.
Ulemper: frysesnittet er av dårligere morfologi slik at mistolkninger kan skje, både med falske positive/negative svar.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For at studenten skal få 1 p kreves at studenten har et visst begrep om metodikken og dens fordeler/ulemper og kan nevne ett bruksområde.
For en 2 p-besvarelse trengs følgende: peroperativ teknikk, hurtigdiagnostikk, ferskt materiale til patologisk avd., nevne minst to bruksområder.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det endelige histologisvaret fra patologiavdelingen var at detforelå et hypofyseadenom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er et adenom?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Med adenom forstås en godartet (benign) epitelial neoplasme utgått fra et kjertel- eller sekretorisk epitel. Et adenom kan ha et kjertelpreg eller et glandulært mønster, men trenger ikke alltid vise dette.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
I svaret må det fremgå for å få poeng at dette er en benign epitelial tumor relatert til kjertelvev.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mange hypofyseadenomer skiller ut ulike typer hormoner, og for å undersøke tumorvevet med henblikk på dette anvendes immunhistokjemi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort beskrivelse av prosedyren immunhistokjemi og minst to bruksområder.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Immunhistokjemi er en metode der tilstedeværelse av antigener i vevssnitt kan detekteres ved hjelp av antistoffer som er reaktive mot disse antigene. Denne immunologiske bindingen kan visualiseres mikroskopisk med ulike fargemetoder, enten enzymatisk eller ved et fluorokrom.
Eksempler på anvendelsesområder: sykdomsprosesser (antigen/antistoffkomplekser), påvisning av infeksiøse agens, kanser [type, invasjon (in situ vs karsinom), metastase, proliferativ aktivitet (Ki67/MIB-1 proliferativ indeks), reseptorstatus (østrogen- og progesteronreseptor, HER2, EGFR, muterte protein].
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få minst 1 poeng må det fremgå at dette er en antigen/antistoff reaksjon, altså en immunologisk metode, samt et eksempel på bruk.
For en 2 p-besvarelse trengs: Metode for påvisning av antigener i vev ved bruk av antistoff, at det er en immunologisk metode, at både enzymatisk og fluorescens er deteksjonsmåter, videre minst to bruksområder.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Økt sekresjon av hypofyseadenomer kan medføre hyperplastiske forandringer i diverse indre organer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hyperplasi? Gi to eksempler på fysiologisk og to eksempler på patologisk hyperplasi.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hyperplasi er en økning av antall celler i et vev eller organ som følge av økt celledeling hvilket medfører vanligvis en økning i et organs størrelse og vekt. En slik prosess kan bare skje i celler og vev som har evne til celledeling (altså ikke skjelett eller hjertemuskulatur eller nervevev).
Eksempler på hyperplasi:
* Hyperplasi kan være både fysiologisk og patologisk. En fysiologisk hyperplasi kan være både hormonelt betinget: eks.: brystkjertler ved pubertet og graviditet, endometriet under menstruasjonssyklus) eller kompensatorisk: eks.: en hyperplasi som skjer når et organ beskadiges eller fjernes/tapes (lever, nyre), bindevev i forbindelse med sårtilheling (fibrose), benmargshyperplasi med økt dannelse av erytrocytter ved f. eks. opphold i høyden.
* Patologisk hyperplasi: ved f. eks. økt hormonell påvirkning eller vekstfaktorstimulering: hypofyseadenom med økt utskillelse av veksthormon [gigantisme (før lukking av epifyseskiver) og akromegali), ACTH (binyrebarkhyperplasi)], lav serum-kalsium gir hyperplasi av gl. parathyroidea, gynekomasti (østrogenstimulering), prostatahyperplasi, struma (ved jodmangel), lymfoid hyperplasi ved inflammasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For 1 p: stikkord for hva som må være med: økt celletall, celledeling, det må være nevnt minst ett eksempel på hyperplasi
For 2 p: økt celletall, celledeling, minst ett eksempel på hhv. fysiologisk og patologisk hyperplasi.
For 3 p: økt celletall, celledeling (økt mitoseaktivitet), og to eksempler på hhv. fysiologisk og patologisk hyperplasi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen utviklet i 60-års alder en uttalt kronisk obstruktiv lungesykdom (KOLS). I forbindelse med et røntgenbilde av lungene ble det også funnet en tumor i høyre lunges overlapp. Denne ble operativt fjernet, og histopatologisk undersøkelse av tumorvevet viste et adenokarsinom. Noen dager etter inngrepet ble hun en morgen funnet død i sin seng. Obduksjon ble begjært for å påvise dødsårsaken, og det ble da funnet dyp venetrombose i høyre underekstremitet og en lungeemboli i truncus pulmonalis med utstrekning inn i begge pulmonalarterier.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sett opp en dødsmelding for denne pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ia: Sentral lungeemboli (sadelemboli)
Ib: Dyp venetrombose
Ic: Adenokarsinom høyre lunge, operert
II: Kronisk obstruktiv lungesykdom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det viktige her er forståelsen av hvilke tilstander som skal under I og II og rekkefølgen av sykdommene/tilstandene.
</$details>
<div class="oppgave">
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!!Vignett
Antibiotikaresistens har de senere årene blitt et stadig større problem internasjonalt, og vi frykter at vi snart kan stå overfor en situasjon der vi regelmessig ser pasienter med infeksjoner som er resistent mot alle kjente antibiotika. Dersom vi skal unngå å havne i denne situasjonen er det viktig at leger kjenner godt til dette temaet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre ulike virkningsmekanismer for hvordan antibiotika kan hemme vekst av eller drepe bakterier. For hver av disse, nevn et antibiotika som benytter denne mekanismen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Celleveggsyntese (betalaktamer, glykopeptider)
* Nukleinsyresyntese (eks: kinoloner)
* Proteinsyntese (eks: aminoglykosider)
* Hemming av metabolisme (eks: trimetoprim/sulfa).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tre forskjellige mekanismer med eksempel på antibiotikum for hver av disse kreves for maks poeng, to mekanismer og antibiotika kreves for 1 p, en mekanisme og antibiotikum 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bakterier som er naturlig følsomme kan utvikle resistens mot et gitt antibiotikum.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan slik resistens kan oppstå, og forklar hvordan en resistent bakterie etter hvert kan utvikles til å bli en dominerende del av bakteriefloraen i et miljø.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En bakterie kan utvikle ervervet resistens gjennom mutasjoner i sitt arvemateriale eller gjennom opptak av fremmed arvemateriale som inneholder resistensgener. Horisontal overføring skjer via tre ulike prinsipper:
* opptak av nakent DNA (transformasjon)
* overføring gjennom direkte kontakt med en annen bakterie (konjugasjon)
* via en bakteriofag (transduksjon)
I en bakterieflora kan en av mange bakterier være resistente. Over tid vil denne bakterien i utgangspunktet ikke ha noen fordel sammenlignet andre bakterier. Dersom det tilsettes antibiotika til miljøet vil følsomme bakterier hemmes mens den resistente subpopulasjonen vil unne ta over ledig plass og dominere populasjonen (dette kalles seleksjon)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Utvikling av resistens (1,5 p): 0,5 p for å nevne mutasjoner, 0,5 p for å nevne horisontal overføring, pluss 0,5 dersom minst to av tre typer horisontal resistens nevnes.
Beskrivelse av prinsippet for seleksjon av resistens (0,5 - 1 p), maks forutsetter en god beskrivelse av fenomenet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et mye omtalt tema innen antibiotikaresistens er ekstendert spektrum betalaktamase (ESBL) hos bakterier innen familien //Enterobacteriaceae//.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv prinsippet for hvordan ESBL gir resistens, hvilke hovedgrupper av ESBL som finnes og hvilke klasser av antibiotika de gir resistens mot.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enzym som spalter betalaktamringen hos betalaktamantibiotika. Det finnes to (tre er også korrekt) hovedgrupper av ESBLer: de som hemmer penicilliner og betalaktamantibiotika t.o.m. 3 gen. cefalosporiner, men ikke karbapenemer, og de (ESBLcarba) som også hemmer karbapenemer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for å beskrive hvordan ESBL gir resistens, 0,5 p for å nevne penicilliner, cefalosporiner, og evt karbapenemer, og 0,5 p for å nevne skillet mellom vanlig ESBL og karbapenemaser.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I beskrivelsen av bakteriers følsomhet overfor antibiotika benyttes begrepene «epidemiologisk cut-off» forkortet ECOFF og «klinisk brytningspunkt».
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hva de to begrepene betyr (gjerne med en illustrasjon), og forklar hvilken nytte vi kan ha av å benytte begge begrepene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Epidemiologisk cut-off: den MIC-verdi som skiller mellom bakterier innen en bakterieart som ikke har ervervet resistens (villtypebakterier) og bakterier innen samme art som har ervervet resistens.
Klinisk brytningspunkt: den MIC-verdi som benyttes til å skille mellom bakterieisolater som klassifiseres som følsomme vs resistente (dvs. resistens: tolererer en antibiotika-konsentrasjon som er høyere enn det som er oppnåelig i infeksjonsfokus og som derfor innebærer høy risiko for behandlingssvikt) overfor et bestemt antibiotikum.
Nytte av å benytte begge begrepene: Epidemiologisk cut-off er nyttig til epidemiologisk overvåkning, spesielt for å vurdere hvor stor andel av bakterier innen en bakterieart som er i ferd med å utvikle (ervervet) resistens. Kliniske brytningspunkter er bedre egnet når en skal vurdere om en kan forvente klinisk effekt av en bestemt antibiotikabehandling hos en konkret pasient med infeksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p poeng for korrekt svar ECOFF, 1 p for korrekt svar klinisk brytningspunkt, og 1 p for god beskrivelse av nytten av begrepene. For maks poeng må beskrivelsen vise at studenten forstår at begrepet klinisk brytningspunkt sier noe om forventet klinisk effekt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan vi gjøre for å hindre utvikling av antibiotikaresistens?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Overvåkning av antibiotikaforbruk og antibiotikaresistens, unngå overforbruk av antibiotika, øke kunnskapen om antibiotika og resistens hos helsepersonell og publikum generelt, fokus på smittevern, bedre diagnostikk, nye antibiotika.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for hvert delsvar. Må inkludere delsvarene overvåkning, unngå overforbruk, smittevern for å få maks poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vanlige nociceptive smertetilstander begynner med aktivering av en perifer nociceptor, og slutter med at vår erkjennelse av smerten leder til en smerteatferd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typer stimuli kan aktivere perifere nociceptorer? Skisser kort hvordan et enkelt, akutt smertesignal leder til smerteerkjennelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Varme
* Trykk
* Skjæring
* Kulde
* Ischemi
* Inflammasjon
Ved en enkel akutt smerte aktiveres en primær afferent nociseptor i det perifere nervesystemet, aksjonspotensialet ledes inn til bakhornet i ryggmargen der transmittorstoffer frigjøres fra den primære afferente i synapsespalten og overføres til den sekundære afferente nociseptoren. Ved aktivering av den sekundære afferente, vil smerteimpulsene bli ledet opp tractus spinothalamicus, flesteparten på motsatt side av ryggmargen sammenlignet med smertens lokalisasjon, til «smerte-matrix» = hjernestamme, periakveduktale grå substans (PAG), thalamus, ulike områder i cortex. I noen situasjoner vil nedadstigende hemmende baner til dorsalhornet modulere transmisjonen av nociceptive signaler.
<<imgLink "ICD-2017s-2-A.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å nevne punktene over: 5 av 6 bør gi 1 poeng, 3 av 6 bør gi 0,5 poeng.
Deretter 2 poeng for å ha med - at det primære nevronet går inn til bakhornet i ryggmargen, - at et sekundært nevron aktiveres der, - at det krysser over til motsatt sides tractus spinothalamicus, og – at det går videre opp til ulike strukturer i CNS som er med i oppfattelsen av smerte (=smerte-matrix). 0,5 poeng reduksjon ved hvert manglende punkt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved vevsskade fører celleskade/-død til inflammasjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilke måter påvirker de inflammatoriske substansene primære afferente nociceptorer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De inflammatoriske substansene (produkter fra hvite blodceller og bestanddeler fra ødelagte celler) kan føre til enten direkte aktivering av nociceptorer eller øke følsomheten til nociceptorer. De aktiverer også stille nociceptorer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 for direkte aktivering, 0.25 for å øke følsomheten, 0,5 poeng for å aktivere stille nociceptorer.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Begrepene hyperalgesi og allodyni beskriver to ulike former for økt følsomhet for smerte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hyperalgesi og hva er allodyni?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hyperalgesi innebærer at et stimulus som til vanlig gir smerte, gir sterkere smerte enn vanlig (økt smerte), mens allodyni innebærer at et stimuli som til vanlig ikke gir smerte, er smertefullt (noe som vanligvis ikke gir smerte, gir smerte).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver riktig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Smerte og nocicepsjon er beslektede begreper, men er ikke synonymer. Å forstå forskjellen mellom smerte og nocicepsjon er avgjørende for å gi god smertebehandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er forskjellen mellom smerte og nocicepsjon? Hvilke behandlingsmessige konsekvenser vil det ha dersom man tenker at smerte og nocicepsjon er det samme?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Smerte er en subjektiv opplevelse av vevsskade eller truende vevsskade, mens nocicepsjon er aktivering av perifere nociceptorer. Man kan oppleve smerte uten aktivering av nociceptorer, og man kan ha nocicepsjon uten å oppleve smerte.
Dersom man tenker at det er et proporsjonalt forhold mellom nocicepsjon og smerte, står man i fare for å basere smertebehandlingen for mye på medikamenter og intervensjonsprosedyrer. Når man forstår forskjellen, velger man en helhetlig og ofte tverrfaglig vurdering/behandling av smerten.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for forskjellen mellom smerte og nocicepsjon.
0,5 poeng for at det er fare for overbehandling med analgetika dersom man gjør feilen med å anta proporsjonalt forhold mellom nocicepsjon og smerte.
0,5 poeng for å formidle at smerte må vurderes helhetlig, og ofte trenger tverrfaglig behandling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Den samme nociceptive input til hjernen vil ikke alltid gi opphav til samme smerteatferd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer påvirker smerteatferden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Smerteatferden bestemmes av fortolkning av smerten. Fortolkningen påvirkes av blant annet kunnskap, tidligere erfaringer og tendens til verstefallstenkning.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Å angi fortolkning
# Å angi faktorer som påvirker fortolkningen av smerte.
1 poeng for å angi «fortolkning», 2 poeng dersom man utdyper
om hvilke faktorer som bidrar til fortolkningen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En tidligere frisk kvinne på 36 år oppsøker fastlegekontoret. De siste 3-4 ukene har hun vært slapp og sliten. Hun har hatt økt tørste og hyppig vannlating, den siste uken med toalettbesøk 1-2 ganger hver natt. Hun har gått ned 4 kg i vekt og veier nå 72 kg (BMI 24,6 kg/m^^2^^)(normal 18,5-24,9 kg/m^^2^^). Ved undersøkelse er hun i relativt god allmenntilstand. BT 121/68, puls 79 regelmessig. Du måler et kapillært blodsukker på 28,2 mmol/l, og ~HbA1c er 11,6 % (4,3 – 5,6%).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
For å avgjøre hvilken type diabetes slike pasienter har, hvilke opplysninger (anamnestiske og/eller kliniske observasjoner/funn) er viktigst å vurdere, og hvilke supplerende undersøkelser (til det som er nevnt) er aktuelle?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasientens alder, vekt/BMI, tidligere sykehistorie (autoimmune sykdommer?) og arv (diabetes type 2 i familien, autoimmunitet) er faktorer som bør vurderes.
Supplerende undersøkelser: p-glukose og insulin C-peptid for evaluering av egenproduksjon av insulin. Antistoff mtp autoimmun diabetes, viktigst anti-GAD og anti-IA2.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng ved diskusjon av opplysninger som vurderes, bør inkludere minst 2 av faktorene alder/BMI/arv/tidligere sykdommer.
1 poeng for supplerende undersøkelser; minimum autoantistoff (0,5 poeng), og C-peptid (0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er underliggende årsak/mekanisme bak de to hovedtypene diabetes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Type 1 diabetes: nedsatt, etter hvert helt fraværende insulinproduksjon som følge av autoimmun ødeleggelse av betaceller i pankreas. Noen grad av arvelig predisposisjon, HLA-assosiasjon.
Type 2 diabetes: nedsatt insulinfølsomhet (insulinresistens) som følge av overvekt (spesielt visceralt (buk) fett), metabolsk syndrom, inaktivitet, genetisk predisposisjon (arvelighet), samt nedsatt insulinproduksjon – pga arvelig predisposisjon, uttretting av beta-celler som følge av vedvarende kompensasjon for manglende insulinfølsomhet, vedvarende høyt blodsukker og inflammasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Type 1: 1 poeng for autoimmun destruksjon av betaceller i pankreas (som gir nedsatt/fraværende insulin).
Type 2: 0,5 poeng for insulinresistens og mulige årsaker (minst én) og 0,5 poeng for nedsatt insulinproduksjon og mulige årsaker
(minst én).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hormoner deltar i blodsukkerreguleringen, i hvilke organ lages de og hvordan virker de i regulering av blodsukkeret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blodglukosenivået holdes stabilt ved kombinert hormonell regulering av spesielt lever, muskelvev og fettvev ved balansering av glukoselagring, glukosedannelse og energiproduksjon.
''Insulin'' (lages i bukspyttkjertel, beta-celler) signaliserer for høyt blodsukkernivå. Stimulerer opptak av glukose og omdanning til glykogen (lever, muskler) og triglycerider (lever, fettvev).
''Glukagon'' (lages i bukspyttkjertel, alfa-celler) signaliserer for lavt blodsukkernivå. Mobiliserer glukose ved å stimulere glykogennedbrytning (glykogenolyse i lever og muskler), glukoneogenese (nysyntese av glukose i lever) og fett-oksidering (fettvev, lever) for å produsere glukose som kan frigjøres.
''Adrenalin'' (lages i binyremarg) frigjøres i blodet for å klargjøre muskler, lunger og hjerte raskt for høyere aktivitet. Økt tilgjengelighet av glukose
''Kortisol'' (lages i binyrebark) bidrar til kroppens håndtering av stress over tid. Økt tilgjengelighet av glukose.
''Veksthormon'' (GH, lages i hypofysens forlapp) virker ved å mobilisere fettsyrer fra fettvev og senke utnyttelsen av glukose.
''Glukagon'', ''adrenalin'', ''kortisol'' og ''veksthormon'' er motreguleringshormoner ved hypoglykemi.
I tillegg vil peptidhormoner fra tarm (inkretiner, i hovedsak ''GLP-1'' og ''GPI'') virke ved å senke blodsukkeret i forbindelse med måltid ved å stimulere insulinsekresjon og hemme glukagonsekresjon fra pankreas.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for insulin og glukagon og hvor de lages, 1 poeng for hvordan de regulerer blodsukkeret.
1 poeng for adrenalin og kortisol, hvor de lages og hvordan de påvirker blodsukkeret. (Beskrivelse av veksthormon og inkretiner kan brukes i oppjustering av poeng om noe annet mangler).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn prinsippene i behandlingen av type-1 diabetes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Insulinbehandling. Insulin settes subkutant. Hovedprinsipp er basalinsulin (oftest langsomtvirkende insulin/insulinanalog, evt insulinpumpe), samt måltidsinsulin (hurtigvirkende insulinanalog).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for insulinbehandling
0,5 poeng for å nevne hovedprinsippet basalt insulin + måltidsinsulin
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort mekanismen bak de to akutte komplikasjonene som kan oppstå ved type 1 diabetes. Nevn de viktigste umiddelbare tiltak.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hypoglykemi oppstår når en har dosert mer insulin enn en hadde behov for. Dette medfører for lavt blodsukker. Tiltak: tilføre sukker (drikke/mat, evt intravenøst)
# Ketoacidose oppstår ved insulinmangel, hvor glukose ikke kommer inn i cellene. Insulinets hemming av hormonsensitiv lipase opphører. Fett spaltes som alternativ energikilde, og fettsyrer dannes og frigjøres til sirkulasjonen. Disse omdannes til acetyl CoA som omdannes til ketoner i leveren. Tiltak: tilføre insulin (og væske, da pasientene ofte er dehydrerte pga glukosuri med vanntap).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver komplikasjon, hovedårsak og tiltak
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 78 år begynner å føle at kroppen ikke fungerer like godt som før. Konkret plages hun av dårligere syn og hørsel. Hun synes disse funksjonene har endret seg mye siden hun var ung, og er i tvil om hvilke endringer man må regne med og hva som kan være tegn på underliggende sykdom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke anatomiske og fysiologiske forandringer som normalt oppstår hos eldre når det gjelder syn og hørsel, og hva personen selv opplever som følge av disse forandringene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Syn: presbyopi = «gammelmannssyn»: Stivere / mindre elastisk linse. Merker økt nærpunktsavstand og nedsatt akkomodasjonsevne (ser ikke godt på nært hold), men ser fortsatt skarpt på lang avstand. Atrofi av tårekjertel, færre slimproduserende celler i conjunctiva: merker tørre øyne. Grålig cornea og linse: merker endret farvesyn.
Mange merker også nedsatt mørkeadaptasjon, redusert dybdesyn og snevrere synsfelt.
Hørsel: presbyacusis = «gammelmansshørsel»: Hårcelledegenerasjon, tap av nerveceller i hørselsbanene, økt stivnet i mellomøreknoklene, kjemiske forandringer i det indre øret. Merker dårligere hørsel og særlig problemer med å høre lyse toner, nedsatt evne til å skille lyder fra hverandre, blir mer plaget av bakgrunnsstøy.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for syn, 1 poeng for hørsel. ½ poeng ved ufullstendige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen slo seg mot et bordben og fikk et sår på leggen. Etter et par dager oppdager kvinnen gulgrønt puss i såret. Huden omkring er rød og vond. Kvinnen går til lege, og mikrobiologisk undersøkelse viser oppvekst av streptokokker
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi hvilke leukocytter som spiller den viktigste rollen for bekjempelse av sårinfeksjonen de første par dagene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bakterieinfeksjoner bekjempes særlig ved fagocytose. De første dagene er nøytrofile granulocytter viktigst.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Monocytter/makrofager gir ikke poeng fordi disse først blir viktige senere i infeksjonsforløpet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar detaljert de to viktigste mekanismene som disse leukocyttene bruker for å bekjempe infeksjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tre aktuelle mekanismer som kan nevnes her:
# Fagocytose: Granulocytten må ha direkte kontakt med bakterien som skal fagocyteres. Bakterien __bindes til ulike reseptorer__, bl.a. komplementreseptorer, antistoffreseptorer hvis kvinnen har antistoff fra tidligere infeksjon, og andre pattern recognition receptors (PRR) som CD11b/CD18. Faresignaler som kjemokinreseptorer, FMLP-reseptor og Toll-like reseptorer binder ligander som __aktiverer granulocytten__. Det gir __endringer i cytoskjelettet__ som dytter ut cellemembranen til bakterien ender i en dump. Deretter lukkes membranen over bakterien og det er dannet et __fagosom__.
# Intracellulært drap i fagolysosomer: Fagosomet smelter sammen med et lysosom og det dannes et __fagolysosom__. Ved aktiveringen av granulocytten samles de ulike komponentene av __NADPH-oksydasen__ og superoksyd frigjøres inn i fagolysosomet. Det dannes __ROS__ – reaktive oksygenforbindelser. Noen er kortlivede, som hydrogen peroksyd (H,,2,,O,,2,,). Videre omdannelse ved hjelp av enzymet __myeloperoksidase__ fører til produksjon av langlivede reaktive forbindelser som hypokloritt/hypoklorsyre og kloraminer. Det dannes også __reaktive nitrogenforbindelser__. __Degranulering inn i fagolysosomet__ tilfører proteinaser og andre bakteriedrepende substanser. Disse, ROS og reaktive nitrogenforbindelser dreper bakteriene.
# NETose: Dannelse av «neutrophil extracellular traps». Intracellulære membraner brytes ned og granula-komponenter som laktoferrin og myeloperoksidase vandrer til kjernen. Kromatin-biter og granulaproteiner skilles ut av cellen som et nett med stor overflate. Bakteriene kan fanges i nettet og immobiliseres, evt. også drepes
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
De to viktigste mekanismene er fagocytose og drap i fagolysosomer, mens NETose trolig særlig har betydning når fagocytosekapasiteten overskrides. For full poengsum må derfor fagocytose og intracellulært drap være beskrevet. For full poengsum kreves noen detaljer om mekanismene. Bare NETose gir inntil 1 poeng. NETose pluss en av de andre mekanismene gir inntil 3 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan komplementsystemet kan aktiveres ved en streptokokkinfeksjon, og hvordan det kan bidra til bekjempelse av denne infeksjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Streptokokker er Gram positive bakterier. Komplementaktivering kan skje via binding av CRP til bakteriekapselen og deretter aktivering av __klassisk komplementvei__, og via __lektin pathway__ med binding av mannose-bindende lektin (MBL) til karbohydratstrukturer i bakteriekapselen. __Alternativ pathway__ kan aktiveres av bakterieoverflaten fordi den ikke har humane komplementhemmere og vil dessuten alltid delta som forsterkning når C3b er dannet, uansett pathway som startet aktiveringen.
Pga. tykk kapsel vil dannelse av det terminal komplementkompleks ikke lett føre til lyse fordi TCC er for kort til å nå gjennom bakteriekapselen. Derfor er de viktigste effektene dannelse av __analafylatoksiner (C3a og C5a) som øker inflammasjonen og aktiverer fagocyttene__, samt at bakteriene dekkes med C3b og andre komplement-aktiveringsprodukter som fungerer som __opsoniner__ for fagocytose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For full poengsum må mekanismene for alle aktiveringsveiene være nevnt (1 poeng), samt økt inflammasjon, opsonisering og ikke lyse (1 ½ poeng). Spørsmålet er formulert som «forklar hvordan», så det forventes korte begrunnelser for svarene.
Streptokokker har imidlertid måter å unngå komplement: Mproteinet degraderer C3b på bakterieoverflaten og noen species kan produsere et enzym som degraderer C5a. Det er ikke forventet at studentene tar med dette poenget i svaret.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen er urolig for om hun feiler noe mer alvorlig enn sårinfeksjonen, og legen tar ulike blodprøver. De aller fleste prøvene viser seg å være normale, men screeningtesten mot antinukleære antistoffer er svakt positiv.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke hovedmekanismer som sørger for at de fleste autoreaktive B-celler ikke utvikler seg til plasmaceller
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De to viktigste mekanismene er sentral og perifer toleranse.
Sentral toleranse for B-celler: Selv-reaktive B-celler fjernes under modningen i benmargen når B-cellereseptoren dannes, mens B-cellene er i kontakt med stromaceller. Dette kalles __negativ seleksjon__ fordi cellene som overlever mangler en egenskap = de mangler selv-reaktivitet. Selvreaktive celler gjennomgår enten __apoptose__ (multivalente selv-antigener som HLA) eller __anergi__ (løselige selv-antigener). Anerge celler dør deretter raskt. Hvis noen nevner muligheten for receptor editing for å unngå selvreaktivitet på dette stadiet, er det fint, men det kreves ikke.
Perifer toleranse for B-celler: Det viktigste er trolig __at det ikke finnes tilsvarende autoreaktive T-celler__ som kan gi autoreaktive B-celler hjelp ved aktivering. Derved vil B-cellene isteden bli anerge og deretter dø. Et annet forhold som kan være med her, men som ikke kreves er __høydosetoleranse__, dvs. at de fleste selvantigener finnes i høy konsentrasjon og at lymfocytter oftest ikke reagerer hvis antigendosen er svært høy. Det er heller ikke nødvendig å ha med at vanlige selvantigener presenteres når vevsceller gjennomgår apoptose. Dette starter vanligvis ingen immunreaksjon eller B-celleaktivering fordi det mangler faresignaler som kunne aktivere antigenpresenterende celler.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Både sentral og perifer toleranse må nevnes for fullt poeng - om ikke begrepene, så minst hovedinnholdet i dem. Spørsmålet lyder «forklar» så fullgodt svar må inneholde noe om mekanismer.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 57 år gammel mann kommer til akuttmottaket etter å ha hatt langvarig oppkast og diare. Blodtrykk er 96/54 mmHg og puls 110 regelmessig. Han har tørre slimhinner og gir uttrykk for tørste. Ekstremitetene er kalde perifert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Pasienten er åpenbart hypovolem. Hvordan registrerer kroppen det reduserte sirkulerende volumet i en slik situasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Via trykkreseptorer på den arterielle siden av sirkulasjonen, i aortabuen, i carotidene og i de afferente arteriolene i nyrene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Trykkreseptorer på den arterielle siden av sirkulasjonen (høytrykksreseptorer) gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved redusert effektivt sirkulerende volum aktiveres det sympatiske nervesystem som i sin tur stimulerer reninangiotensin-aldosteron systemet (RAAS).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan påvirker disse to systemene tonus i afferente og efferente arterioler i nyrene, og hvordan påvirker dette glomerulær filtrasjonsrate (GFR) og filtrasjonsfraksjonen (FF)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sympatikus (adrenalin/noradrenalin) og Angiotensin II (ATII) gir begge vasokonstriksjon av efferente og afferente arterioler, men ATII gir sterkere efferent vasokonstriksjon.
Resultatet er fall i GFR.
På grunn av kraftigere efferent vasokonstriksjon av Angiotensin II, vil filtrasjonsfraksjonen (FF) øke slik at fallet i GFR blir mindre enn det ellers ville ha blitt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* efferent og afferent vasokonstriksjon gir 1 poeng
* fall i GFR gir 1 poeng
* økt FF gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Reabsorpsjon av salt og vann til interstitiet og videre til de peritubulære kapillærer, er viktig for å øke det sirkulerende volumet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke faktorer intrakapillært i de peritubulære kapillærene som fremmer reabsorpsjon i en tilstand av hypovolemi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
På grunn av vasokonstriksjonen i de afferente og efferente arteriolene, vil det hydrostatiske trykket i de peritubulære kapillærene bli redusert, slik at reabsorpsjonen fra interstitiet øker.
Siden filtrasjonsfraksjonen er økt, vil det kolloid-osmotiske (onkotiske) trykket i de peritubulære kapillærene øke, noe som også fremmer reabsorpsjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* fall i intrakapillært hydrostatisk trykk gir 1 poeng
* økt intrakapillært kolloid-osmotisk (onkotisk) trykk gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Serum-osmolalitet er normal (285 mmol/kg), men likevel er det økt frigjøring av antidiuretisk hormon (ADH).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen bak den økte frigjøring av ADH i denne kliniske situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fall i blodtrykk eller blodvolum fører til aktivering av baroreflekser som via hjernenerver sender signaler til de hypotalamiske sentra som i sin tur øker syntesen og utskillelsen av ADH, selv om osmolaliteten er normal/lav.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fall i blodtrykk/blodvolum registreres av baroreseptorer og signalene overføres til hypotalamiske sentra som skiller ut ADH. Gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nyrene forsøker i en slik klinisk situasjon å opprettholde sirkulasjonen så godt det lar seg gjøre. Urinvolumet er redusert, og inneholder lite Na^^+^^.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke mekanismer i nyrene fører til det reduserte urinvolumet og den lave Na^^+^^-konsentrasjonen i urinen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Aktivering av det sympatiske nervesystem og RAAS-systemet fører til fall i glomerulær filtrasjons rate (GFR), og til økt reabsorpsjon av Na^^+^^ langs store deler av nefronet.
Frigjøring av ADH øker vann-reabsorpsjonen distalt i nefronet, og gir redusert urinvolum.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* sympatikus og RAAS-systemet fører til økt reabsorpsjon av Na^^+^^ langs nefronet gir 1 poeng
* fall i GFR gir 1 poeng
* frigjøring av ADH gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I bukhulen finnes en tynn, fuktig hinne (peritoneum) som kler hele bukhulens overflate. Noen organer er helt omgitt av denne hinnen (intraperitoneale), mens andre ligger bak eller er bare
delvis omgitt av den (retroperitoneale). Ved embryogenesen vandrer noen organer og går fra å være intraperitoneale til å bli retroperitoneale.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor blir binyrene og nyrene dannet __under__ organogenesen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nyrene og binyrene (og ureter) er helt retroperitoneale, også under organogenesen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for nyrer og 0,5 poeng for binyrer. Ureter gir ikke poeng da det ikke regnes som et organ.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Binyrer er et eksempel på organer som er lokalisert retroperitonealt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort binyrenes makroskopiske oppbygning.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Binyrene, to hormonproduserende kjertler som ligger oppå hver sin nyre og er delvis omgitt av nyrekapselens fettvev.
Binyrene består av bark (cortex) og marg (medulla). De to lagene har forskjellig opprinnelse, og de produserer forskjellige hormoner med ulike oppgaver i organismen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne cortex og 1 poeng for å nevne medulla. Maks 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Binyrene er et hormonproduserende organ, og som alle hormonproduserende organer har de god blodforsyning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke eller hvilken arterie(r) sørger for blodforsyning til binyrene og hvor avgår den/de fra?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Binyrene suppleres av tre arterier:
* arteria suprarenalis superior, som avgår fra arteria phrenica inferior
* arteria suprarenalis media, som avgår fra aorta
* arteria suprarenalis inferior, som avgår fra arteria renalis
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne arteria suprarenalis, 0,5 poeng for å vite at det er flere enn èn arterie til binyrene og 0,5 poeng for å nevne enten avgang fra aorta eller fra arteria renalis, maks 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ingen vignett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den mikroskopiske oppbygningen av binyrene og nevn eksempler på hvilke hormoner de ulike cellene produserer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Binyrebarken deles histologisk inn i tre cellelag, regnet utenfra:
* zona glomerulosa,
* zona fasciculata,
* zona reticularis.
Hormonene fra binyrebarken (cortex) kalles kortikosteroider. Vi inndeler binyrebarkhormonene i
* mineralokortikoider som regulerer natriumbalansen (aldosteron),
* glukokortikoider som virker på omsetningen av karbohydrater, salter, fett og proteiner i kroppen (kortisol),
* androgener (testosteron).
Binyremargen er i virkeligheten en funksjonell del av det autonome nervesystemet og regnes til de såkalte paragangliene. I det sympatiske nervesystemet overføres impulsene fra nerveendene til organene ved hjelp av noradrenalin. Både dette og det beslektede adrenalin dannes i binyremargens celler. Det viktigste hormonet som produseres i binyremargen er adrenalin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av zonaene i binyrebarken, maks 1,5 poeng, og 0,5 poeng for hvert av de 3 hormonene som nevnes, maks 2 poeng. Både generell benevnelse (mineralokortikoider) og
spesiell benevnelse (aldosteron) kan godtas. Navngivelse av adrenalin eller noradrenalin gir 0,5 poeng, ingen ekstra poeng for å nevne begge. Til sammen maks 3,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ingen vignett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Binyrene dannes embryonalt fra to kimblad. Hvilke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Binyrebarken dannes embryonalt av det midterste kimblad (mesoderm). Binyremargen dannes embryonalt fra det ytterste kimblad (ectoderm, nevrallisten).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert kimblad med riktig del av binyret, maks 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forstyrrelser i binyrebarkens funksjon kan gi opphav til sykdom. Akutt mangel på binyrebarkhormoner kan utløse en livstruende tilstand, en såkalt Addison krise. Denne tilstanden kan skyldes en primær svikt i binyrebarken, eller den kan oppstå hos pasienter som brått har stanset en langvarig behandling med kortison.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er typiske symptomer ved en Addison krise?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Typiske symptomer ved Addison krise er __hypovolemi__ og __hypotensjon__. Pasientene har ofte __feber__ på grunn av underliggende infeksjon. De kan ha __sterke magesmerter__, __kvalme__ og __brekninger__. Andre symptomer er __motorisk uro__, __akutt forvirring__ og __krampeanfall__. Uten behandling vil pasienten gå i __koma__.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne et av de understrekede symptomene, maks 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har fått jobb som fastlegevikar ved et legekontor. En 37 år gammel mann har time for helsesjekk. Han jobber som trailersjåfør, og arbeidsgiveren har tilbudt å betale helsesjekk for alle sine ansatte. Mannen er lett overvektig (BMI: 25), men rapporterer ingen spesielle plager. Du finner heller ingenting unormalt ved rutinemessig undersøkelse. Du rekvirerer likevel noen blodprøver.
Etter noen dager får du svar som viser forhøyede kolesterolverdier i blodet (totalkolesterol 9.4 mmol/L; referanseområde 30-49 år: 3,3 - 6,9 mmol/L). På bakgrunn av resultatet inviterer du pasienten til ditt kontor for en samtale. Du orienterer om funnet og spør samtidig om det er andre i familien som har høyt kolesterol. Han er noe usikker på dette, men vet i alle fall at moren ble satt på kolesterolsenkende medisin etter et hjerteinfarkt for tre år siden. Mannen har for øvrig to barn, på 6 og 9, som begge er tilsynelatende friske.
Du mistenker en mulig arvelig tilstand og ønsker å rekvirere en gentest. Pasienten gir sitt muntlige samtykke til dette. Gentesting er regulert i Bioteknologiloven, som skiller mellom ulike typer gentester
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type gentest vil det her være snakk om?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En diagnostisk gentest. Pasienten har allerede symptomer (dvs. høyt kolesterol), og testen utføres for å bekrefte (eller avkrefte) en genetisk tilstand. Påvist mutasjon gir 100 % sikker diagnose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Spørsmålet søker å avdekke om studentene har kunnskap om de ulike gentester som bioteknologiloven skiller mellom. Andre gentester omfatter prediktive-, pre-symptomatiske, eller bærerdiagnostiske tester. I de to førstnevnte utføres gentesten før symptomer på sykdommen er manifest. I det siste tilfellet vil ikke personen selv ha sykdommen, men vil kunne overføre den til sine barn.
Loven plasserer også genetiske undersøkelser for kjønnsbestemmelse i en egen gruppe (unntatt for identifikasjonsformål).
Bare riktig svar (diagnostisk gentest) gir uttelling (1 poeng).
Referanse [[Lovdata|https://lovdata.no/dokument/NL/lov/2003-12-05-100?q=bioteknologiloven]]
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft hvilke lovmessige og praktiske forutsetninger som gjelder for at du skal kunne rekvirere en slik test?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Genetiske undersøkelser deles inn etter formålet med undersøkelsen. Det er et viktig lovmessig skille mellom det å genteste en syk person (med klinisk fenotype) i diagnostisk og/eller behandlingsmessig øyemed, i forhold til det å genteste en klinisk frisk (evt. presymptomatisk) person. //I henhold til Bioteknologiloven stilles det ikke krav til genetisk veiledning ved diagnostisk testing.//
Testing av friske innebærer derimot at det skal foreligge skriftlig samtykke, og det er krav om genetisk veiledning før, under og etter testingen.
Av praktiske forutsetninger gjelder at det eksisterer en gentest for denne tilstanden, og at slik testing er etablert som et helsetilbud i Norge.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Når en person er syk, er formålet med den genetiske testen først og fremst å stille en diagnose, forklare hvorfor sykdommen/tilstanden inntraff, eller for å tilpasse behandling.
At en person oppsøker helsevesenet på egne vegne er å regne som et stilltiende samtykke til undersøkelser, og har en klar forventning om at helsevesenet gjør sitt ytterste for å stille en diagnose og gi den beste behandling. //Da kreves det ikke skriftlig samtykke// (i dette tilfellet ble det gitt muntlig samtykke). //Loven krever heller ikke at det gis genetisk veiledning siden pasienten allerede får oppfølging av helsevesenet// (riktig svar på disse to punktene gir 1,5 poeng).
At det faktisk eksisterer en test er en forutsetning. For at den skal kunne rekvireres må den være etablert som et helsetilbud (riktig svar på dette punktet gir 0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tilstanden du mistenker er familiær hyperkolesterolemi (FH). Inntil 25.000 personer i Norge har FH, men bare én fjerdedel er klar over sin diagnose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den vanligste årsaken til FH, og hvilken arvegang utviser den?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
FH er en autosomal dominant arvelig tilstand med høyt nivå av LDL-kolesterol i blodet, som oftest forårsaket av mutasjoner i genet som koder for LDL-reseptor.
Autosomal betyr at kvinner og menn har samme risiko for å arve sykdommen (genet ikke på kjønnskromosomer). Dominant arvegang betyr at det er tilstrekkelig å arve én mutert genkopi (dvs. fra en av foreldrene) for fenotypisk manifestasjon (dvs. forhøyet kolesterol og sekundært økt risiko for hjertekarsykdom).
Med FH menes i de fleste tilfeller heterozygot FH, med ca. 50 % reduksjon i opptaket av LDL. Det er den heterozygote formen som forekommer hos inntil 25 000 nordmenn (prevalens 1:300 til 1:200). Homozygot form forekommer hos ca 1 av 500.000 til en million, og kan være en livstruende tilstand.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Angivelse av den vanligste årsaken til FH (mutasjon i genet for LDL-reseptor) (1 poeng). Autosomal dominant arvegang (1 poeng).
I noen tilfeller kan FH være forårsaket av mutasjon i APOB-genet eller i PCS9 genet, men disse tilfellene er betydelig mindre frekvent.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter tre uker får du svar på gentesten som bekrefter at pasienten har FH. Han blir funnet å være heterozygot for FH-mutasjonen. Arvelige tilstander kan ha betydning for slektninger av den berørte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke rammer norsk lov setter for oppfølging av pasientens familiemedlemmer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Udiagnostisert og ubehandlet FH kan få store konsekvenser for både den enkelte pasient og dens familiemedlemmer. En stor andel av nydiagnostiserte blir funnet ved å screene slektninger til den som er affisert gjennom den genetiske veiledningen (kaskadescreening).
Opplysninger om helseforhold og slektskap er imidlertid beskyttet av personopplysningsloven, og oppsøkende genetisk virksomhet er per i dag ikke tillatt i Norge. //Helsevesenet kan derfor ikke ta direkte kontakt med pasientens slektninger.//
Det er pasienten selv som må informere slektningene, og så må slektningene selv ta kontakt med helsevesenet (f.eks. fastlege) for mulig gentesting. //Det er derfor viktig å minne pasienten om dette.//
Pasienter bør gis veiledning i hvordan de kan informere sine slektninger og hvordan slektningene kan ta kontakt med helsevesenet.
NB! I henhold til bioteknologilovens paragraf 5-8, annet ledd, så er det i utgangspunktet forbudt å spørre om genetiske undersøkelser eller om systematisk kartlegging av arvelig sykdom i en familie har vært utført. //Helsepersonell som trenger opplysningene i diagnostisk og behandlingsmessig øyemed er unntatt fra dette forbudet.// Referanse: [[Lovdata|https://lovdata.no/dokument/NL/lov/2003-12-05-100?q=bioteknologiloven]].
I enkelttilfeller der pasienten av praktiske årsaker ikke selv kan opplyse slektninger, kan helsepersonell søke Helsedirektoratet om godkjenning til genetisk oppsøkende virksomhet. Referanse: [[Helsedirektoratet|https://helsedirektoratet.no/Documents/Lovfortolkninger/Bioteknologiloven/15-9890-2%20Svar%20p%C3%A5%20s%C3%B8knad%20om%20godkjennelse%20til%20%C3%A5%20drive%20opps%C3%B8kende%20genetisk%20virksomhet%20vedr.%20famili%C3%A6r%20hyperkolesterolemi.pdf]].
Pasientens barn er 6 og 9 år gamle. Barn og ungdom under 16 år //kan bare gentestes for sykdomsrisiko hvis undersøkelsen kan påvise forhold som kan forhindre eller redusere helseskade hos barnet dersom det får rett behandling. Barnets foresatte har i tilfeller hvor genetisk testing anbefales krav på å få genetisk veiledning.//
Ved FH kan det være viktig å starte forebyggende behandling allerede i ung alder, og man bør derfor anbefale å genteste barna.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Anledning til oppsøkende genetisk virksomhet strengt lovregulert, og det er i utgangspunktet ikke anledning til å drive oppsøkende genetisk virksomhet (riktig svar gir 1 poeng).
Det er derfor viktig å informere pasienten om mulige konsekvenser for familiemedlemmer, at pasienten selv bør informere sine familiemedlemmer, anbefale at disse blir informert om resultatet av gentesten, og anbefale at disse oppsøker helsevesenet for genetisk veiledning og evt. gentesting (riktig svar gir 1 poeng)
Riktig svar i forhold til testing av barn (nedre grense 16 år), men at det i de tilfeller hvor det kan foreligge en alvorlig tilstand som det eksisterer effektiv behandling for (eller hvor behandlingen reduserer symptomutvikling og som gir betydelig helsegevinst) kan barn under 16 år gentestes. FH er en slik tilstand hvor det er viktig å få tidlig behandling for å motvirke seneffekter (riktig svar her gi 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får senere vite at mannens kone ''ikke ''har FH. De har to barn sammen (6 og 9 år).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er sannsynligheten for at __ingen__ av barna har arvet FHmutasjonen? Hva er sannsynligheten for at __minst ett__ av barna har arvet FH-mutasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
FH er en autosomal dominant sykdom. Om far er heterozygot vil hvert av barna ha 50% risiko for å arve sykdomsallelet – og 50% sjanse for å arve det friske allelet. Sannsynligheten for at ingen av barna har arvet FH-mutasjonen (dvs. begge er friske) blir derfor 50% x 50% = 25%, (eller 0.5 x 0.5 = 0.25)¨.
Sannsynligheten at minst et av barna har arvet FH-mutasjonen blir 1 minus sannsynligheten at begge barna er friske; dvs. 1 – 0.25 = 0.75 (=75%).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar på hver av de to deloppgavene gir 1 poeng – til sammen 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Marit er førstegangs gravid. Hun har hatt et normalt svangerskap frem til uke 30, da hun får spontane rier. Hun oppsøker nærmeste fødeavdeling der hun blir innlagt med truende prematur fødsel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort i hvilket stadium lungeutviklingen er ved 30 ukers svangerskap og hva som karakteriserer dette stadiet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungeutviklingen er i den sakkulære fasen. Distale luftveier består av alveolære ducter som alveolene dannes fra. Surfaktantproduksjonen er i gang, men ikke moden (fra uke 23-24 til uker 34).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sakkulær fase gir 0.5 poeng.
Beskrivelse av alveolære ducter gir 0.5 poeng. Det holder for å få poeng å beskrive differensiering av respiratoriske bronkioler med begynnende alveoledannelse uten at begrepet alveolære ducter brukes.
Umoden surfaktantproduksjon gir 0.5 poeng (ikke nødvendig å angi ukene).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Marit føder en gutt som veier 1600g, og han har symptomer på respirasjonsbesvær rett etter fødselen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske symptomer og tegn brukes for å vurdere respirasjonsbesvær hos et nyfødt barn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Respirasjonsfrekvens
# Inndragninger
# Grynting/pressing (ekspiratorisk presselyd)
# Nesevingespill
# Behov for ekstra oksygen/hypoksi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det kreves minst to av de fire første for å få poeng. 0.25 poeng per parameter unntatt for hypoksi som gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gutten har symptomer på respiratorisk distress syndrom (RDS) og han legges på CPAP («continuous positive airway pressure»).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for den viktigste årsaken til RDS og hvordan den påvirker forholdet mellom trykk og volum i lungene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Årsaken til RDS er surfaktantmangel. Surfaktant produseres i type II pneumocytter fra ca 24 uker i svangerskapet. Mangel på surfaktant fører til redusert «compliance» («stive» lunger). Det fører til at
trykkvolumkurven blir flat og det trengs høyere trykk for å oppnå adekvate lungevolum sammenlignet med lunger med høy compliance.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for å nevne surfaktantmangel som årsak til RDS.
* 0.5 poeng for at surfaktant produseres i type II pneumocytter.
* 0.5 poeng for at surfaktantmangel gir redusert compliance eller stive lunger
* 0.5 poeng for korrekt beskrivelse av effekten av redusert compliance på trykk-volumkurven
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gutten utvikler etter hvert en hyperbilirubinemi (gulsott)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste faktoren som gjør at premature har høyere forekomst av gulsott enn barn født til termin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nedsatt enzymaktivitet i leveren som nedsetter konjugeringen til vannløselig bilirubin. Det godtas som riktig å bruke begrepet nedsatt konjugering, nedsatt glukuronidering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir 1 poeng. Ved bruk av begrepet nedsatt enzymaktivitet (uspesifisert hvilke enzymsystem), gis 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Premature barn har også risiko for lavt blodsukker etter fødsel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste årsaken til denne risikoen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Små glykogenlagre p.g.a. at disse akkumuleres i siste trimester.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det holder med små glykogenlagre/energilagre for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barn som fødes av mødre med diabetes har også risiko for hypoglykemi etter fødsel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for den viktigste årsaken til dette.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Relativ hyperinsulinisme hos barnet p.g.a. eksponering for høye blodsukkere i svangerskapet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poeng krever at det redegjøres for at det er en sammenheng mellom mors blodsukkere i svangerskapet som gjør at fosteret får høyt blodsukker og produserer mer insulin. 0,75 poeng
Ved fødselen nedreguleres ikke insulinproduksjonen umiddelbart, mens sukkertilførselen via placenta forsvinner umiddelbart når navlesnora kuttes. 0,75 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kliniske symptomer på en persisterende åpenstående ductus arteriosus etter fødsel vil gi ulike tegn og symptomer avhengig av trykkforholdene på høyre og venstre side i hjertet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for hvordan retningen på blodstrømmen over ductus blir når lungetrykket faller og trykket på venstre side av hjertet blir høyere enn på høyre side. Beskriv kort hvordan dette kan påvirke blodstrømmen til henholdsvis hjerne, lunger, tarm og nyrer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved høyere trykk på venstre side vil blodstrømmen over ductus gå fra aorta til a.pulmonalis. 1poeng
Dette vil gi lavere blodstrøm til hjerne, tarm og nyrer, mens blodstrømmen blir større til lungene. 1 poeng.
Det kreves at både hjerne, nyrer og tarm beskrives med lavere blodstrøm og at der er økt flow til lungene for å få 1 poeng på denne delen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Stine er 22 år og oppsøker deg som fastlege fordi hun mistenker at hun er gravid. Hun bruker p-piller og graviditeten er således ikke planlagt. Du tar en urinprøve som bekrefter graviditet. Stine innrømmer at hun nok ofte kan glemme en pille eller to, men trodde ikke det hadde så mye å si. Hun tenker at hun ønsker å gjennomføre svangerskapet. Hun hadde en vanlig bortfallsblødning på forrige p-pillebrett for ca. 6 uker siden, og du antar derfor at hun kan være ca. 6 uker gravid. Det er anbefalt å bruke folattilskudd i første trimester for å forebygge ryggmargsbrokk, og du anbefaler Stine å begynne med dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den normale menstruasjonssyklus med vekt på de ulike fasene (navn, varighet, hvilke hormoner som er involvert og hva deres oppgave er).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "ICD-2018s-1-A.PNG">>
Folikellfase, frem til eggløsning.
Lutealfase; fra eggløsning til menstruasjonsblødningen starter.
Hypofysens gonadotropiner (FSH, LH) stimulerer veksten av eggfolliklene, eggløsning og gule legemer i eggstokkene. I disse dannes østrogener (østradiol) og i det gule legemet progesteron, som stimulerer veksten til livmorslimhinnen etter menstruasjonen. Når mengden av progesteron i blodet øker, blir livmorslimhinnen ekstra tykk og rik på stoffer som kan ernære et befruktet egg etter at det har festet seg. Kommer det ikke noe befruktet egg, tilbakedannes det gule legemet, det fører til sterkt fall i ovariets hormonproduksjon, og livmorslimhinnen blir avstøtt sammen med menstruasjonsblodet.
FSH og LH stiger rundt eggløsning. Østradiol stiger frem mot eggløsning og synker deretter. Progesteron stiger i lutealfasen og synker mot menstruasjonsblødningens start.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1/2 poeng for hver av fasene med varighet (varighet er nødvendig for å få poeng), ½ poeng for hvert hormon med funksjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil folattilskudd kunne forebygge ryggmargsbrokk hos Stine sitt embryo? Hvorfor/hvorfor ikke? Beskriv neurulasjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, fordi neuralrøret allerede er lukket i svangerskapsuke 5. (1 poeng)
Neurulasjonen er dannelsen av nevralrøret. Vi får først dannet neural plate (neuroektoderm) og det defineres en cranial og caudal retning. Deretter får vi dannet neural fold og neural groove. Neural folds fusjonerer og vi får dannet neuralrøret. Neural crest-celler oppstår og gir opphav til det perifere nervesystemet. (1 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar og begrunnelse på folattilskudd.
½ poeng for å ha med at neurulasjonen er dannelsen av nevralrøret. Et helt poeng for å ha med mer detaljer i hvordan det skjer (neural platen, neural fold og neural groove og neural-crest cellene som opphav til det perifere nervesystem).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gastrulasjonen er en annen vesentlig hendelse i den tidlige embryoutviklingen. Når foregår denne? Beskriv hva som skjer i gastrulasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Gastrulasjonen finner sted i uke 3 av embryoutviklingen. Dette er dannelsen av de 3 kimlagene (germ layers) som videre gir opphav til forskjellige typer vev i kroppen.'' Ved start av gastrulasjonen er embryoet en bilaminar disk bestående av to cellelag. Primitive streak oppstår og vi får definert retning cranialt, caudalt, høyre og venstre.
Primitive node og primitive groove oppstår. Prosessen med invaginasjon starter, hvor celler fra epiblast migrerer gjennom primitive streak og inn mellom cellelagene hvor disse cellene først erstatter hypoblast og blir til definitive endoderm. Epiblastcellene som er igjen er nå definert som ectoderm og celler som migrerer inn og blir liggende i midten kallen mesoderm.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for det vesentlige ''uthevet'', 1/2 poeng å ha med dannelsen av primitive streak og dannelsen av retning, ½ poeng for å ha med en beskrivelse av invaginasjonen opprinnelsen til de tre kimlagene; endo-, ecto- og mesoderm.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Stine forteller videre at hun var på fest forrige helg og drakk ”ganske mye” alkohol. Du kjenner Stines historie og vet at hun har testet forskjellige rusmidler, men hun forsikrer nå spontant om at hun ikke bruker noen form for rusmidler lenger. Du spør om barnefar. Hun sier at han er motivert for å slutte med rusmidler dersom han skal bli far.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor mye alkohol er det trygt å drikke i svangerskapet for å være sikker på at fosteret ikke tar skade av det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi vet ikke, og det finnes ingen definert nedre grense for hva som er trygt av alkoholinntak (1 poeng).
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du føler deg usikker på om Stine fortsatt bruker rusmidler
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er din primære oppgave som fastlege dersom du er bekymret forat en gravid kvinne ruser seg?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fastlegens primære oppgave er å identifisere problemet og varsle videre til riktig instans (holder å skrive dette, for riktig instans kan variere fra kommune til kommune og man må bli kjent med rutinene i sin kommune)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar. Videre utdyping av svaret med for eksempel flere kontroller, mer detaljer om innholdet i kontrollene med tanke på omsorg for mor osv, vil ikke gi mer poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Stine har katt. Hvorfor kan nærkontakt med katter være farlig i svangerskapet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Katt kan være bærer av toxoplasmose. Dersom Stine ikke har gjennomgått toxoplasmose infeksjon tidligere kan det være farlig å bli smittet i svangerskapet. Toksoplasmoseinfeksjon i svangerskapet kan føre til store hjernemisdannelser eller øyeskader, alt etter når i svangerskapet smitten oppstår.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for toxoplasmose og førstegangssmitte og ½ poeng for mulige fosterskadelige effekter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Abort og fosterdiagnostikk er temaer som vekker debatt både innenfor og utenfor helsetjenesten. Abort er regulert i Abortloven, og fosterdiagnostikk er regulert i Bioteknologiloven. I denne kortsvarsoppgaven ønsker vi dels å få deg til å reflektere rundt tilbudet av abort og fosterdiagnostikk i Norge som lovene gir rom for. Dels ønsker vi at du demonstrerer en forståelse av debattene rundt disse temaene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Abortloven gir kvinnen rett til selvbestemt abort innen utgangen av 12. uke. Hvorfor har vi som samfunn frem til nå ment at det er rimelig å gi kvinner selvbestemmelse i dette spørsmålet, men ikke menn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et sentralt forsvar for abortloven, er kvinners råderett over egen kropp. «Selvbestemmelse» handler sånn sett ikke bare om å kunne bestemme over sitt eget liv, men mer presist, å kunne bestemme over egen kropp. Siden fosteret er og må være plassert i kvinnens kropp, og ikke mannens kropp, så er kvinnens råderett over egen kropp relevant, mens mannens råderett over egen kropp er irrelevant. Skulle mannen gis selvbestemmelse i abortspørsmålet, ville hans selvbestemmelse fort kunne føre til begrensning av kvinnens rett til å bestemme over egen kropp, som vi ville anse som uakseptabelt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng gis til den som knytter selvbestemmelse til egen kropp og som dermed klarer å vise asymmetrien mellom gravid kvinne vs mann. Jo svakere man klarer å forklare asymmetrien mellom kvinne og mann i abortspørsmålet, desto mindre poeng. Om noen trekker inn refleksjoner rundt «juridisk abort», så er det bra og kan trekke opp, men fravær av dette skal ikke trekke ned, siden vi ikke rakk å diskutere dette med studentene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fosterdiagnostikk og abort ved fosteravvik som Downs syndrom diskuteres mye mer i dagens samfunn, enn abort i situasjoner hvor fosterdiagnostikk og fosteravvik ikke er involvert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi noen forskjeller på de to abort-situasjonene som kan hevdes å være etisk relevant?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er to tydelige forskjeller på disse abort-situasjonene som en del har ment er etisk relevant:
# De generelle abortene er typisk preget av at man ikke ønsket barn, mens aborter ved fosteravvik er typisk kjennetegnet av at man ønsket barn, men ikke dette barn med den bestemte skaden eller avviket.
# De generelle abortene handler ikke om noen som allerede lever. Abortene basert på funn fra fosterdiagnostikken, må imidlertid ofte handle om mennesker som lever med tilsvarende avvik og diagnoser, siden det er nettopp hvordan disse livene er å leve som kan informere beslutningene. Så mens generell abort lett kan betraktes som en privat sak, så vil selektiv abort ha en større signaleffekt ut i samfunnet, og dermed også bli en politisk sak.
Det er også mulig å peke på en rekke andre forskjeller som riktignok ikke er like markante: De generelle abortene vil som regel handle om selvbestemte aborter tidlig i svangerskapet, mens selektive aborter vil måtte være senaborter. Sen vil for mange være mer problematisk enn tidlig. Man kan også snu fokuset helt rundt, og hevde at abortene rundt alvorlige fosteravvik som regel handler om ekstremt store belastninger på et familieliv, mens dette sjeldnere er tilfelle for situasjonene rundt generell abort i dagens samfunn. I så fall taler dette for at abortene ved fosteravvik burde problematiseres mindre.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det rom for at ulike svar kan gi poeng, men hovedfokuset i undervisningen har ligget på de to første grunnene nevnt ovenfor. Finnes begge disse i teksten, så gis det to poeng. Finnes de ikke, så kan det fremdeles gis poeng, dersom det finnes andre gode og rimelige argumenter, som forskjellen mellom sene og tidlige aborter, mm. Men har man ikke med de to nevnte, så har man gått glipp av den vesentligste kritikken, og da skal det litt til for å få full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Alle gravide i Norge tilbys en ultralydundersøkelse rundt uke 18 i svangerskapet – ofte kalt «rutineultralyd». Undersøkelsen er ukontroversiell og anses som en naturlig del av svangerskapsomsorgen. Samtidig er ultralydundersøkelsen i første trimester – ofte kalt «tidlig ultralyd» eller «KUB» (kombinert ultralydundersøkelse og blodprøve), politisk kontroversiell, og tilbys bare et fåtall gravide.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor disse undersøkelsene oppfattes så ulikt? Er det rimelig etter din mening å behandle de to såpass ulikt? (Begrunn svaret ditt)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rutineultralyd oppfattes i politisk og juridisk sammenheng som del av en god og trygg svangerskapsomsorg hvor hensynet til kvinnen og barnet står i fokus. Tidlig ultralyd anses som en undersøkelse som mye er motivert utfra å gi en risikovurdering for trisomier og i særdeleshet trisomi 21. Siden Downs syndrom, «sorteringssamfunn», o.l., har blitt et politisk minefelt, så vil undersøkelser i svangerskapet som tydelig har til hensikt å identifisere slike fostre bli etisk problematiske, mens de som har fokus på omsorg for mor og barn blir uproblematiske. Politisk har dette skillet blitt betegnet som skillet mellom fostermedisin og fosterdiagnostikk.
Det er neppe rimelig å behandle de to undersøkelsene så fryktelig ulikt. Rutineultralyden undersøker fosterets anatomi i detalj og kan absolutt sies å være fosterdiagnostikk. Hos en rekke gravide vil man gjøre funn på rutineultralyden som vil lede til en abortavgjørelse. «Tidlig ultralyd»/«KUB» er dårligere til å oppdage en del strukturelle avvik, men er bedre på å oppdage Downs syndrom. Hvorvidt man så mener at denne forskjellen med tanke på Downs syndrom er så avgjørende at forskjellsbehandling er rettferdiggjort, blir til en viss grad en subjektiv vurdering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det to spørsmål, med da mulighet for 1 poeng på hver. Ett poeng på den første gis når man har fått med seg at tidlig ultralyd/KUB bl.a. er et verktøy for risikovurdering for trisomier. Det er vanskelig å se for seg poeng for svar som ikke er inne på dette.
I del 2 er det større rom for subjektive meninger, men de må være velbegrunnet. Man behøver ikke å ha enten-eller-svar. Studenten må ha skjønt at flere fostre med Downs vil bli oppdaget om alle ble tilbudt tidlig diagnostikk. Men de bør også ha fått med seg at rutineultralyden aktivt leter etter avvik.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Eldre gravide – kvinner over 38 år – har i dag rett til fosterdiagnostikk slik det defineres i Bioteknologiloven, mens yngre gravide ikke har det.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor har man ment at alder er en relevant faktor for hvem som skal få tilbudet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er svaret enkelt og greit at gravides risiko for å få et barn med kromosomfeil er aldersbetinget. Alder har historisk sett vært relevant fordi man da kunne tilby testing til de med høyest bakgrunnsrisiko, noe som virker rimelig.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng gis til de som har fått med seg at risiko for kromosomfeil er aldersavhengig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kritikere av fosterdiagnostikken hevder ofte at fosterdiagnostikk uttrykker en medisinsk forståelse av funksjonshemming og ikke tar høyde for at funksjonshemming bør forstås gjennom en sosial modell.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva mener de med det? Hva tenker du om det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I all teoretisering rundt funksjonshemming er man opptatt av å skille mellom en medisinsk modell og en sosial modell. I den sosiale modellen, ligger ikke funksjonshemmingen primært i den enkeltes kropp. Snarere er det samfunnet, med sine funksjonshemmende barrierer, som forhindrer et individ i å realisere sitt potensial. Ved å forsøke å vri funksjonshemming vekk fra kroppen og medisinen, og over mot samfunnets utforming og tilbud, har funksjonshemmingsorganisasjonene lykkes i å gjøre funksjonshemming til et politisk spørsmål. I fosterdiagnostikken kritiserer ofte funksjonshemmede medisinen for å ha for stort fokus på «avviket» og den individuelle kroppen, og at de dermed undergraver innsikten om at det avgjørende for god livskvalitet er samfunnets utforming.
Dette er utfordrende debatter for vår tid (jfr «kan et menneske med Downs leve et fullverdig liv»). Den sosiale modellen har viktige innsikter. Samtidig har den også blitt kritisert fra funksjonshemmede selv som mener den overser hindringer og begrensinger som ligger i den individuelle personens funksjonsnedsettelser og aldri kan oppheves av noe som helst samfunn vi kan forestille oss. Dessuten er det mulig å hevde at medisinen nettopp i mange tilfeller (som eksempelvis i veiledningen i fosterdiagnostikken) tar høyde for samspillet mellom en individuell kropp og det samfunnet man eventuelt skal fungere i.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng får studenten for å kunne si noe fornuftig om forskjellen på den medisinske modellen og den sosiale modellen i funksjonshemmingssammenheng. Ett til får hun for å kunne gjøre noen rimelig fornuftige avveininger om realismen i kritikken.
Studenter som ikke har hørt om den sosiale modellen, blir poengløse her.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I Norge har vi satt det som kalles «levedyktighetsgrensen» til utgangen av 22. uke (21+6).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du redegjøre kort for hva som juridisk følger av denne grensen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Levedyktighetsgrensen er den juridiske grensen for når et foster kan aborteres i Norge. Det eneste unntak fra dette er en situasjon hvor fosteret har et dødelig avvik.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Siden dette er en 1-poengs oppgave, så bør man få full pott dersom man klarer å si at levedyktighetsgrensen bestemmer siste frist for når (nemndbestemt) abort kan gjøres i Norge – med andre ord at abort ikke kan gjøres på fostre som anses å kunne overleve utenfor livmor.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kari, 45 år, har hatt lavt stoffskifte i flere år og har vært behandlet med tyroksin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort syntesen av tyreoideahormoner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tyreoglobulin (TG) er et protein som blir jodinert på tyrosiner i follikkelcellene og lagres i kolloid (1 poeng).
Tyroksin og trijodtyronin dannes ved proteolyse av dette (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar samspillet mellom TSH og tyroksin og trijodtyronin.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
TSH produseres i hypofysens forlapp og er den overordnede regulatoren av blodnivået av T3 og T4 ved en klassisk negativ feedback-mekanisme (0,5 poeng). TSH stimulerer produksjonen og sekresjonen av T3 og T4 (0,5 poeng). Lavt nivå av T3 og T4 øker produksjonen av TSH, slik at produksjonen og sekresjonen av T3 og T4 igjen øker (0,5 poeng). Høye nivåer av T3 og T4 reduserer produksjonen av TSH ved negativ feedback (0,5 poeng). Det er i hovedsak T3 som står for den negative feedbacken (0,25 poeng). T3 hemmer i tillegg frigjøring av TRH (thyrotropin releasing hormone) fra hypothalamus (0,25 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun oppsøker fastlegekontoret fordi hun over en tid har følt seg slapp, har hatt dårlig matlyst og gått litt ned i vekt de siste 2-3 månedene. Hun synes også at hun er brunere enn hun pleier å være. Det blir tatt blodprøver som viser lav kortisol og høy ACTH. Videre har hun høyt kalium og lavt natrium, samt noe lavt blodsukker forenlig med primær binyrebarksvikt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hormoner produseres i binyrebarken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kortisol, aldosteron, androgener
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha med kortisol og aldosteron for å få 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for den økte pigmenteringen hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved kortisolmangel får man økt produksjon av proopiomelanocortin (POMC) som er forstadiet til ACTH (0,5 poeng). Det blir også økte nivåer av melanocytt-stimulerende hormon (MSH) som spaltes av fra POMC, og dette er årsaken til økt pigmentering (0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for elektrolyttforstyrrelsene hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Aldosteronmangel. Aldosteron bidrar til at reabsorpsjon av natrium øker samtidig som kalium skilles ut. Mangel vil derfor medføre lavt natrium og høyt kalium.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Aldosteronmangel (1 poeng), beskrivelse av mekanismen (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Binyrebarksvikt kan medføre lavt blodsukker
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fire av kroppens hormoner er viktige for å motvirke hypoglykemi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kortisol, glukagon, adrenalin, veksthormon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng hvis 3 riktige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken substans er utgangspunktet for syntese av binyrebarkhormonene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kolesterol
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne i 50-årene tok kontakt med sin fastlege på grunn av hodepine og økende tretthet de siste ukene. Det ble rekvirert MR-undersøkelse som viste en intrakraniell tumor. Hun ble innlagt på nevrokirurgisk avdeling for operasjon. Under operasjonen ble det tatt biopsier fra tumorvevet som ble sendt til patologiavdelingen for frysesnittsundersøkelse. Frysesnittsdiagnosen fra patologen var «benign mesenkymal tumor».
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi fem eksempler på benigne mesenkymale tumores.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Eks. på benigne mesenkymale tumores (bløtdelssvulster): fibrom, lipom, angiom, lymfangiom, hemangiom, kondrom, osteom, meningeom, leiomyom, rhabdomyom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for hvert delsvar, maks. 2,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under operasjonen tilkom det komplikasjoner i form av et hjerneinfarkt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er definisjonen på et infarkt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Infarkt er iskemisk nekrose i et avgrenset område/lokalt på grunn av nedsatt/utilstrekkelig blodforsyning, for eksempel som følge av karokklusjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p gis ved angivelse av iskemisk nekrose, 0,5 p om de angir avgrenset område og nedsatt/utilstrekkelig blodforsyning.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bildediagnostisk viste det seg å være noe resttumor igjen, og det var indikasjon for postoperativ strålebehandling. Denne behandlingen tolererte pasienten godt, men en del år senere utviklet hun økende kognitiv svikt. Strålebehandling er kjent å kunne gi forsinket stråleskade av hjernen, blant annet i form av strålenekrose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Rent morfologisk fins det ulike former for nekroser. Beskriv tre ulike typer nekroser og kort om deres patologiske særtrekk.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det fins flere typer nekroser:
# ''Koagulativ nekrose'' er en form for nekrose der vevsarkitekturen er rimelig godt bevart i noen tid etter hendelsen, og man aner konturene av cellene i det nekrotiske området. Dette er den vanligste formen for nekrose og forekommer i alle solide organer unntatt hjerne.
# ''Likvifaktiv nekrose'' (eng. liquefactive/colliquative necrosis) skjer ved infeksjoner som tiltrekker leukocytter som ved fagocytose «fordøyer» det døde vevet. Ved en bakteriell infeksjon vil det døde vevet ende opp som puss. I hjernen gir hypoksi-/anoksiskade en slik type nekrose.
# ''Kaseøs nekrose'' (ostet nekrose) er typisk ved tuberkulose. Vevet har en gulig-hviltlig osteaktig konsistens. Mikroskopisk ses nekrotisk vev, amorft, rødlig til rosa, all vevsstruktur er utvisket, perifert brem av makrofager (histiocytære celler), deriblant flerkjernede kjempeceller (langerhanske kjempeceller), videre er det tilblanding av lymfocytter, mer perifert også en bindevevsreaksjon med proliferasjon av fibroblaster. Dette gir samlet sett en såkalt kronisk nekrotiserende granulomatøs betennelse.
# ''Gangren (gangrenøs nekrose)'' er en nekroseform som mest har en klinisk anvendelse og refererer gjerne til en ekstremitet som har undergått en iskemisk nekrose (koagulativ nekrose) som derpå er blitt misfarget pga. degradert blod. Som en komplikasjon kan dette vevet bli infisert som fører til en likvifaktiv nekrose, og man får da et såkalt «vått gangren».
# ''Fettvevsnekrose'' skyldes fokalt ødelagt fettvev som følge av enten direkte traume (traumatisk fettvevsnekrose) eller enzymatisk destruksjon pga. frigjorte lipaser som ved akutt pankreatitt.
# ''Fibrinoid nekrose'' omfatter en type nekrose som kan sees ved uttalt hypertensjon (malign hypertensjon) med skade/nekrose av karvegg og med lekkasje av plasmaproteiner og deponering av fibrin som gir et lyst rosa/rødaktig og glassaktig utseende som kan minne om nekrotisk vev, derav navnet «nekrose». Tilstanden kan også sees ved immunologiske reaksjoner og liknende sykdommer med deponering av antigen/antistoffkomplekser i karveggen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Navn på nekrosetype gir 0,5 p, supplerende relevant patologi gir til sammen 1 p for hver type, maks. 3 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Noen år senere i forbindelse med en influensaepidemi pådro hun seg en lungebetennelse (pneumoni). Hun ble behandlet med antibiotika med god effekt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
En akutt infeksjon kan forløpe på ulikt vis. Nevn fire eksempler på forløpet av en akutt infeksjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En akutt infeksjon kan ha følgende forløp:
# Resolusjon (tilheling)
# Abscessutvikling (suppurasjon, puss)
# Reparasjon og fibrose
# Vedvarende kronisk infeksjon (som evt. senere vil gå over i fibrose)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ulike infeksiøse agens kan gi ulike typer betennelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags type inflammasjon gir vanligvis 1) bakterier, 2) virus og 3) atypiske mykobakterier?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Bakterier: akutt (purulent/suppurativ) betennelse
# Virus: kronisk (uspesifikk)/serøs betennelse
# Atypiske mykobakterier: kronisk nekrotiserende granulomatøs betennelse
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,5 p, totalt 1,5 p. For delsvar 3) godtas også bare granulomatøs betennelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne (32 år) er gravid for andre gang. Hun leser om svangerskap på nettet, og finner at NK-celler (naturlige dreperceller) bidrar til at fosteret ikke forkastes under svangerskapet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv forskjellene i funksjon mellom uterine NK-celler og NK-celler som deltar i infeksjonsforsvaret hvis kvinnen for eksempel blir forkjølet. Stikkord om mekanismer forventes i svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Uterine NK-celler:'' Har som oppgave å bidra til toleranse for fosteret (dette er gitt i vignetten). Mekanismer: De er __dårlige til å drepe__ fordi de hemmes av HLA-E og HLA-C, som uttrykkes på trofoblasten. De er viktige __cytokinprodusenter__: __hemmer antigen-presenterende celler__ så disse induserer T-celletoleranse, utskiller IFN-gamma som oppregulerer IDO i antigenpresenterende celler så disse dreper cytotoksiske T-celler. De bidrar også til å regulere placentas dybde, bl.a. ved utskillelse av proangiogene faktorer.
''NK-celler i infeksjonsforsvaret:'' Har som oppgave å bekjempe virusinfeksjon: __dreper virusinfiserte celler__ tidlig i infeksjonsforløpet ved å gjenkjenne __«manglende selv»__ = nedregulert HLA klasse I og «stresset selv» = molekyler som MIC-A og MIC-B m.fl. som celler bl.a. uttrykker når de er infiserte. NK-cellene er viktige __cytokinprodusenter__, bl.a. av IFN-gamma, som __aktiverer antigenpresenterende celler__ og drar immunresponsen i retning av Th1-responser. Sent i infeksjonsforløpet kan de også drepe infiserte celler ved __antistoffmediert direkte cytotoksisitet__.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver av celletypene, hvor man har med egenskaper med stikkord om mekanismer når det gjelder drapsevne, cytokinproduksjon og effekter av denne, og henholdsvis proangiogene faktorer/antistoffmediert cytotoksisitet, Reduksjon til ½ p eller 0 p for hver celletype avhengig av hvor mye som mangler i svaret.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svangerskapet forløp normalt, og kvinnen fødte en frisk gutt til termin.
Gutten er blitt 5 måneder gammel, og storesøsteren hans blir smittet av streptokokker i barnehagen. Kvinnen er bekymret for om lillegutten kan bli alvorlig syk. Hun blir litt beroliget da hun leser at småbarn har naturlig antistoff.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hva som karakteriserer disse antistoffene, hvordan de oppstår, og i hvilke situasjoner de dannes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Naturlige antistoffer karakteriseres ved særlig å være __~IgM eller ~IgA__ (på slimhinner). De er __polyreaktive__ = binder til flere ulike epitoper som ligner på hverandre; kan også kalles kryssreaktivitet. De har ofte __lav affinitet__. Naturlig antistoff er rettet mot __selv__ (kan være viktig for selvtoleranse), __endret og stresset selv__ (beskytter mot oksydativ skade, bidrar ved fjernelse av apoptotiske celler) og mot konserverte epitoper på __vanlige virus, bakterier og sopp__ (inngår som naturlig frontlinjeforsvar), og samme antistoff kan fungere i flere av disse settingene (= polyreaktivitet).
__Produseres uten antigenstimulering__ (dvs. uten at vi først må møte antigenet ved en infeksjon) av en spesiell type B-lymfocytter (__B1-celler__) som særlig finnes i peritoneum og pleura, noen i milt og lymfeknuter. Disse cellene er pre-programmert til å lage antistoff.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hver del: ~IgM/~IgA av lav affinitet; polyreaktivitet; hva de er rettet mot; produseres uten antigenstimulering av B1-celler.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gutten får vaksinasjoner i samsvar med barnevaksinasjonsprogrammet. Ved 3- og 5-måneders alder får han blant annet vaksiner mot stivkrampe (tetanus), difteri og kikhoste (pertussis). Dette er drepte vaksiner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor disse tre vaksinene blir gjentatt flere ganger, herunder mekanismene for at gjentatt vaksinering øker effekten
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Generelt: Førstegangs vaksinering gir en __primærrespons__, mens gjentatt eksponering for antigenene fører til en __sekundærrespons__ med mer effektivt forsvar og sterkere / mer langvarig hukommelse. Drepte vaksiner gir __svake faresignaler__ = lite inflammasjon og derfor en svak immunrespons. Dette fører til liten dannelse av hukommelsesceller og __kortvarig hukommelse__.
Mer spesifikt: Formålet med disse vaksinene er å danne __antistoff som kan nøytralisere__ toksin ved infeksjon. Ved primærresponsen dannes __~IgM, som har lav affinitet__. Nøytralisering __krever antistoff med svært høy affinitet__ slik at det kan utkonkurrere binding til de cellulære målmolekylene som utløser symptomer ved sykdom. Som ledd i sekundærresponsen skjer det __isotypeskifte til IgG__ og __somatisk hypermutasjon__ (= affinitetsmodning av antistoffet), dvs. to viktige mekanismer for fintilpasning og bedre beskyttelse av antistoff. I tillegg __øker plasmakonsentrasjonen__ av antistoff med aktuelle spesifisiteter som ledd i sekundærresponsen, slik at mer toksin raskt kan nøytraliseres.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Generell beskrivelse av egenskaper ved primær- og sekundærrespons, svake faresignaler: ½ poeng.
Angitt at beskyttelsen er via antistoff /nøytralisering av toksin: ½ poeng
Nevnt antistoff av ~IgM og ~IgG type og at det skjer isotypeskifte: ½ poeng,
Forklart hvilke egenskaper ved ~IgM og ~IgG som er viktige, nevnt somatisk hypermutasjon: ½ poeng.
Nevnt økt konsentrasjon av antistoff: ½ poeng
Svar som fokuserer på T-celler og mangler B-celler/antistoff får evt. poeng for generell forståelse av primær- og sekundærrespons, men er ikke tilpasset korrekt mekanisme for vaksineeffektene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er det som oftest ikke nødvendig med gjentatt vaksinering med levende vaksiner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Levende vaksiner inneholder svekkede mikroorganismer som har stor nok likhet med de sykdomsfremkallende mikroorganismene til at vaksinen gir beskyttelse. Ved levende vaksiner utløses det __kraftige faresignaler fordi man får en infeksjon__, selv om infeksjonen ikke har like alvorlige konsekvenser eller risiko for alvorlige bivirkninger. Det utløses en __sterk immunrespons__ som varer inntil infeksjonen er bekjempet. Derfor gir levende vaksiner sterk immunitet som oftest varer livet ut.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Forklaring som omfatter infeksjon/faresignaler og kraftig immunrespons. Studentene kan resonnere seg frem til uten å ha hatt detaljert undervisning om ulike typer vaksiner.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Da gutten var 1 1/2 år gammel, fikk han utslett i lyskene under bleien. Det ble påvist oppvekst av //Candida albicans//.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi de mikrobiologiske kjennetegnene ved denne mikroorganismen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
//Candida albicans// er en gjærsopp, og består av eukaryote celler som reproduseres ved knoppskyting. Kan også danne pseudohyfer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1/4p for hver av opplysningene gjærsopp, eukaryote celler, knoppskyting, pseudohyfer. Svar om type infeksjoner (hud/slimhinner, systemiske infeksjoner hos immunsvekkede etc.) teller ikke fordi spørsmålet er om mikroorganismen, ikke infeksjonene den gir.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan komplementsystemet inngår i forsvaret mot en //Candida//-infeksjon, herunder aktiveringsmåte og effektormekanismer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Aktiveringsmåte:'' Komplement aktiveres av //Candida// via alternativ pathway (fremmed overflate som binder C3b, bl.a. til chitin => chitin ikke nødvendig for poeng) og via lektin pathway (mannose på overflaten gjenkjennes av mannose-bindende lektin = MBL).
''Effektormekanismer:'' Komplementaktivering fører til at det deponeres komplementaktiveringsprodukter på soppens overflate, bl.a. C3b, iC3b og C4b, som fungerer som opsoniner for fagocytose, bl.a. av nøytrofile granulocytter (evt. makrofager ved kronisk infeksjon). Dette skjer ved at komplementfragmentene bindes til komplementreseptorer på fagocyttene (C3b og C4b: bindes til CR1, iC3b: bindes til CR3 og CR4 – reseptorene ikke nødvendig i svaret). Binding kombinert med andre aktiveringssignaler (faresignaler) gir aktivering av fagocytten og effektiv fagocytose og drap.
Komplementaktivering fører til dannelse av anafylatoksinene C3a og C5a, som gir økt inflammasjon med kjemotakse av nøytrofile, og bidrar til nøytrofilaktivering.
//Candida// har tykk cellevegg, så terminal komplementaktivering med dannelse av det terminale komplementkompleks (TCC, MAC) vil ikke gi lyse av soppen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Aktiveringsmåte med to korrekte pathways: ½ p. Forventer ikke at de beskriver detaljene i de to aktuelle pathways.
Mekanismen for opsonisering: ½ p
Økt inflammasjon/kjemotakse: ½ p
Vet at komplement ikke klarer å lysere //Candida// pga. tykk cellevegg: ½ p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 50 år gammel mann kommer på legevakten på grunn av hjertebank. Ved start av undersøkelsen har han regelmessig puls på 120. Du finner ellers ikke noe galt ved en enkel klinisk undersøkelse. Når du er ferdig med undersøkelsen har han rolig puls og er sliten. Du mistenker at han har en angstlidelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre symptomer kan du spørre om for å finne ut om han har en angstlidelse? Nevn minst fire symptomer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Følelse av frykt, frykt for å dø, frykt for å bli gal, uro, svette, skjelving, rødming, svimmelhet, uvirkelighetsfølelse, tørr munn, brystsmerter, kvelningsfornemmelse/ snører seg i halsen, ”urolig mage”/ trang til å gå på do, kvalme.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hvert av disse symptomene inntil maks 2 poeng (ikke poeng for hjertebank som er nevnt i oppgaveteksten). Frykt teller bare en gang.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre symptomer kan du spørre om for å finne ut om han har en angstlidelse? Nevn minst fire symptomer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Somatisk undersøkelse
Blodprøver inkl stoffskifte
Systematisk psykiatrisk vurdering mot diagnosekriterier
Anamnese, forløp, tidligere plager
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
(man får poeng for å nevne minst et av svarene som skilles med skråstrek)
Somatisk undersøkelse/evt henvisning kardiolog/EKG: 1 poeng
Blodprøve/måle stoffskifte: 1/2 poeng
(Systematisk) psykiatrisk vurdering (med kriterier for angstlidelse/spørreskjema): ½ poeng
Anamnese/forløp/ tidligere psykiske plager: ½ poeng
Får maks skåre 2 poeng, men må nevne somatisk undersøkelse/kardiolog/ EKG for å få 2 poeng, kan ellers få maks 1 ½ poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Han forteller at hans mor og morfar var engstelige for alt og at han hadde det svært vanskelig da hans foreldre ble skilt da han var 10 år. Han har fått økende angst og fastlegen diagnostiserte en angstlidelse etter at han ble permittert for 3 måneder siden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn en modell for psykiatrisk forståelse som kan brukes for å forklare at han har fått en angstlidelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bio-psyko-sosial modell
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ hvis to av elementene er med
1 poeng hvis alle tre elementene er med
½ poeng for å svare stress-sårbarhetsmodellen i stedet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved utredning hos fastlegen forteller han at han var med i en trafikkulykke for 15 år siden. Han hadde mareritt om ulykken, unngikk å sitte på i bil og var svært skvetten. Dette gikk over etter noen år da han gradvis begynte å sitte på bil igjen selv om han fortsatt var redd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken psykisk lidelse kan forklare disse symptomene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Post traumatisk stresslidelse (PTSD)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Post traumatisk stresslidelse/ PTSD: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved samtaler med fastlegen forteller pasienten at han har mindre psykiske plager fordi han unngår steder og situasjoner som gjør at han får angst.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du nevne minst to negative konsekvenser med en slik atferd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Begrenser livsutfoldelse/reduserer mulighet for aktivitet
Hindrer bedring av angstlidelsen/opprettholder angstlidelsen
Kan gi generalisering av angsten/kan få angst for å få angst
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begrenser livsutfoldelse/ muligheter i livet/livskvalitet: ½ poeng
Hindrer bedring/ opprettholder angstlidelse: ½ poeng
Kan gi generalisering av angsten, får angst for å få angst: ½ poeng
Maks skåre ved å nevne to, siste moment er vanskelig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sist sommer ble pasienten sittende inne det meste av tiden fordi han var redd for at han kunne komme i nærheten av en edderkopp. Når han så en edderkopp på terrassen fikk han hjertebank og så for seg at edderkoppen kunne hoppe på ham.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles en slik lidelse og hva er hovedprinsippet for behandling av lidelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fobi, edderkoppfobi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fobi (for edderkopp, for insekter)/spesifikk fobi/isolert fobi/enkel fobi/fobisk angstlidelse: 1 poeng
Eksponeringsbehandling/eksponering: 1 poeng
Får ikke poeng for å si angstlidelse uten nærmere spesifisering
Får ikke poeng for å nevne noen medikamenter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved nærmere samtale kommer det frem at han har vært sliten og nedfor, har sovet dårlig med tidlig oppvåkning og har hatt svært dårlig matlyst den siste måneden samtidig som han har fått angst.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Basert på opplysningene i denne vignetten, hvilken annen psykisk lidelse kan foreligge sammen med angst for denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Depresjon. Angstsymptomene skyldes en pågående depresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Depresjon/Angst pga depresjon/angst som del av en depresjon: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På formiddagslista på legekontoret er det en baker, en maler, en frisør, en fabrikkarbeider på en skumplastfabrikk, en bonde, en bensintankbilsjåfør, en førskolelærer, en ortopedisk sykepleier, en tunnelarbeider, og en tidligere maskinist (sjøfart).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvilke av disse yrkene er det mest sannsynlig å finne følgende eksponeringer? (en eksponering for hvert yrke)
Ammoniakk, isocyanater, organiske løsningsmidler, alfaamylase, smitte, UV-stråling, asbest, kvartsstøv, ioniserende stråling, benzen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Baker / alfa-amylase
* Frisør / ammoniakk
* Skumplastfabrikkarbeider / isocyanater
* Tankbilsjåfør / benzen
* Førskolelærer / smitte
* Ortopedisk sykepleier / ioniserende stråling
* Tunnelarbeider / kvartsstøv
* Tidligere maskinist / asbest
* Bonde / UV-stråling
* Maler / organiske løsningsmidler
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,2 poeng for hver riktig kobling – maks 2 poeng. Andre mulige koblinger er:
* Smitte / bonde eller sykepleier
* UV stråling / sykepleier
* Ammoniakk / tankbilsjåfør
Slike bør også gi 0,2 poeng, samtidig som studenten da får problemer med å få alt rett (2 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vi som jobber i helsevesenet har en god del arbeidsmiljøutfordringer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to andre påvirkninger enn det du svarte i spørsmål 1 som man utsettes for i helsevesenet og som er kjent for å være kreftfremkallende.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Noen av følgende:
* Cytostatika / cellegift
* Formaldehyd
* Radionukleider
(Ioniserende stråling (hvis det ikke ble svart for sykepleieren i spørsmål 1) og nattarbeid)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det som er angitt i parentes over bør også gi poeng. Nattarbeid gir poeng fordi det for tiden diskuteres om utstrakt nattarbeid gir økt risiko for bl.a. brystkreft. Radionukleider brukes i nukleærmedisinsk diagnostikk og behandling og bør gi poeng selv om det også der strengt tatt dreier seg om ioniserende stråling.
I tidligere tider ble det i helsevesenet også brukt benzensprit, men ikke nå lenger og det gir ikke poeng, ei heller passiv røyking som til nød kan være aktuelt noen steder, men det er ikke lenger noen typisk eksponering.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasientene på legekontoret denne formiddagen hadde henholdsvis astma, hypersensitivitetspneumonitt (allergisk alveolitt), anemi, lungekreft, irritativ rhinitt, blodkreft, forkjølelse, silikose, katarakt og hodepine.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke av eksponeringene ovenfor kan settes i sammenheng med de respektive sykdommene?
(Ammoniakk, isocyanater, organiske løsningsmidler, alfaamylase, smitte, UV-stråling, asbest, kvartsstøv, ioniserende stråling, benzen)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alfa-amylase / astma
* Ammoniakk / irritativ rhinitt
* Isocyanater / hypersensitivitetspneumonitt (allergisk alveolitt), evt astma
* Benzen / blodkreft (anemi)
* Smitte / forkjølelse
* Ioniserende stråling / anemi (blodkreft)
* Kvartsstøv / silikose
* Asbest / lungekreft
* UV-stråling / katarakt
* Organiske løsningsmidler / hodepine
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,2 poeng for hver riktig kobling – maks 2 poeng. Andre mulige koblinger er:
* Isocyanater / astma
* Benzen / anemi
* Ioniserende stråling / blodkreft
Dette bør også isolert sett gi poeng, men hvis de kobler isocyanater med astma så får de problemer med å koble hypersensitivitetspneumonitten til en eksponering.
Benzen har vært nevnt som mulig årsak til lungekreft, men det er ikke etablert.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Isocyanater er kjent for å kunne forårsake to av sykdommene som er nevnt i spørsmål 3.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den andre sykdommen i forhold til det du svarte?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Astma eller hypersensitivitetspneumonitt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
En av de to (alt ettersom hvilken diagnose studenten tilordnet isocyanater i sitt svar på spørsmål 2) gir 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bakeren lurer på hva som kan gjøres for å redusere eksponeringen på sin arbeidsplass.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket forebyggingsprinsipp er mest aktuelt i et bakeri?
Hvordan kan dette forebyggingsprinsippet best oppnås, og hvilken instans bør allmennlegen primært samarbeide med?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forebyggingsprinsipp: Støvreduksjon (eksponeringsreduksjon). Reduksjon av eksponering (støvreduksjon) er det overordnete prinsippet her. Det oppnås gjennom innebygging av prosesser, kanskje særlig når mel tappes fra silo og ned i bakekar og annen håndtering av råvarer som tømming av sekker. Også at man er påpasselig med håndtering og lagring av tomme sekker. Særlig må man være forsiktig med håndtering av såkalte bakeforsterkere som ofte inneholder alfa-amylase som er et potent allergen ved siden av selve melet. Og så er det viktig med gode renholdsrutiner. Tidligere brukte man ofte trykkluft til å blåse bort mel og annet støv fra bakebenker. Dette ga rimeligvis mye støveksponering. Dersom man bruker støvsuger til rengjøring bør det helst være en sentralstøvsuger, eller en med et godt filter (totalfilter) som ikke redistribuerer det fineste støvet til arbeidslokalene.
Instans: Både arbeidstilsynet, bedriftshelsetjenesten, arbeidsmedisinsk avdeling, NAV og arbeidsgiver er aktuelle samarbeidspartnere. Men, det er bedriftshelsetjenesten som er den primære.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Støvreduksjon som forebyggingsprinsipp gir 0,5 p.
Innebygging av mel, det å droppe bakeforsterkere (f.eks. alfaamylase), endrede rengjøringsrutiner eller håndtering av emballasje kan alle gi 0,5 p hver (men maks 1 poeng). Forslag om redusert arbeidstid eller personlig verneutstyr (åndedrettsvern) gir ikke poeng.
Bedriftshelsetjeneste som primær instans å samarbeide med gir 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det å være bonde er på mange måter et utsatt yrke
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
For hvilken uønsket hendelse topper bøndene den offisielle statistikken i Norge (sett i forhold til antall sysselsatte)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Arbeidsrelaterte dødsfall.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her kan selvfølgelig også dødsulykker og lignende godkjennes
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 25 år kommer til svangerskapspoliklinikken i svangerskapsuke 37. Hun er henvist fra fastlegen pga. usikkert fosterleie, og ved ultralyd påvises seteleie. Fødselslegen bestiller CT pelvimetri for å avgjøre om de anatomiske forhold i bekkenet ligger til rette for at kvinnen kan føde vaginalt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved CT pelvimetri vil røntgenlege bl.a. måle «sum utgang». Hvilke mål må gjøres for å beregne «sum utgang»? Angi navnet på beinstrukturene som må identifiseres for å gjøre denne beregningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Målene som må gjøres:
# Interspinalavstand
# Intertubaravstand
# Sagital utgang: Mellom nedre del av os sacrum og nedre del av symfysen.
Navn på beinstrukturer:
# Spinae ischiadica
# Tuber ischiadicum
# Nedre del av os sacrum
# Nedre del av symfysen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Målene: 0,5 p. for hvert mål som gjøres, maksimalt 1,5 p.
Navn på beinstrukturer: 0,25 p for hvert svar, maksimalt 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke muskler danner den nedre begrensningen av bekkenet, og kalles samlet bekkenets diafragma (pelvic diaphragm)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Mm. Levator ani
* Mm. Coccygeus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for hvert svar, maksimalt 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de viktigste funksjonene til bekkenets diafragma?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Bekkenets diafragma støtter viscera i abdomen og bekken.
* Hever bekkenbunnen, noe som er viktig ved forsert utpust, hosting, oppkast, vannlatning og ved tunge løft.
* Støtter prostata og bakre del av vagina.
* Løfter analkanalen opp, og påvirker derfor defekasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Støtte av viscera
* Involvert i forsert utpust, hosting, oppkast, eller tunge løft
* Involvert i vannlatning
* Involvert ved defekasjon
* Støtter prostata eller bakre del av vagina
0,5 p for hvert svar, men maksimalt 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under fødsel er man opptatt av å unngå skader i mm. sphincter ani
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar oppbygningen, lokalisasjonen og funksjonen til mm. sphincter ani.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Sirkulær rundt endetarmen
* Indre (involuntær) sphincter: Fortykning av det sirkulære muskellaget i tarmen. Omgir øvre del (øvre 2/3) av analkanalen.
* Ytre (voluntært) sphincter: To brede bånd på hver side av analkanalen. Omgir nedre del (nedre 2/3) av analkanalen.
* Funksjon: Lukkemuskel for endetarmen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p på hver, maksimalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv de viktigste forskjellene mellom det kvinnelige og det mannlige bekkenskjelettet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Formen på bekkeninngangen (kvinnelig bekken ovalt, mannlig bekken hjerteformet).
* Mannlige bekken tyngre, kraftigere beinstrukturer
* Kvinnelige sylinderformet, mannlige traktformet
* Laterale deler av bekkenet er flatere og bredere hos kvinner
* Vinkelen under symfysen (Menn: Angulus subpubicus; Kvinner: Arcus pubis) er større hos kvinner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p på hver, maksimalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken plage kan en kvinne få dersom bekkenets diafragma skades under fødsel?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Inkontinens for urin og avføring
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maksimalt 0,5 p, evt 0,25 p dersom kun nevner enten urin eller avføring
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bakterien //Staphylococcus epidermidis// er en del av hudens normalflora, men kan også forårsake alvorlig infeksjon hos mennesker.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken nytte har vi av normalflorabakterier som //S. epidermidis// og andre bakterier på hud og slimhinner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Beskytter mot patogene bakterier (for eksempel ved prod. av antibakterielle peptider) (0.5p)
# har en rolle i utvikling av lokal immunitet/ stimulerer sekresjon av interleukiner (0.5p)
# metabolisme (eks. syntese av vitaminer, metabolisme av karsinogener, fermenteringav ellers ufordøyelige elementer i mat) (0,5 p per element, maks 1,0p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvilke egenskaper //S. epidermidis// har ved Gramfarging, og hva som er hovedforskjellene i oppbygning av celleveggen mellom Gram-positive og Gram-negative bakterier.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Gram positive kokker (oftest i hauger) (0.5p)
# peptidoglycan (tykt lag med peptidoglykan hos GP, tynt peptidoglykanlag hos GN) (0.5p)
# yttermembran og periplasmisk rom hos GN, men ikke hos GP (0.5p)
# lipopolysakkarid hos GN, ikke hos GP(0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
//S. epidermidis// og andre koagulase-negative stafylokokker er kjent for å gi infeksjoner hos pasienter med proteser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken egenskap hos disse bakteriene gjør de spesielt egnet til dette, og hvilke konsekvenser har dette for
antimikrobiell behandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# evne til å danne biofilm (0.5p) på overflaten av fremmedlegemer
# bakterien dekkes av biofilmen (0.5p)
# beskyttes derved mot antibiotika som trenger dårlig inn i biofilm (0.5p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
//S. epidermidis// er ofte meticillin-resistent, men er likevel vanligvis følsom for glykopeptider (eks. vankomycin) som også angriper bakteriecelleveggen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv virkningsmekanismene for penicillinasestabile penicilliner og glykopeptider. Forklar hvorfor en bakterie kan være meticillinresistent og samtidig følsom for glykopeptider.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Betalaktamer generelt binder PBP som er transpeptidaser og hindrer derved transpeptidering av peptidsidekjeder i peptidoglykanet i celleveggen; i tillegg er penicillinasestabile penicilliner resistente for betalaktamaser som bryter ned betalaktamringen (0.5 p)
# glykopeptider som vankomycin utøver sin virkning ved å bindes til enden av peptidsidekjeder og derved sterisk hindre at PBP (transpeptidasen) kommer til og får utøve sin virkning (0.5 p)
# Ved meticillinresistens danner bakterien alternativt penicillinbindende protein (PBP2a) som ikke bindes/hemmes av Pc-stabile penicilliner, men glykopeptider hinder tilgang til aktivt sete på peptidsidekjeden for både vanlige PBPer og alternative PBPer (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De senere årene har det blitt betydelig fokus på hvilke
konsekvenser økt antibiotikaresistens vil kunne ha for behandling
av infeksjoner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan vi som leger gjøre for hindre utvikling av
antibiotikaresistens?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Redusere bruken av antibiotika/ AB kun når nødvendig/ benytte alternativ behandling (0.5p)
# korrekt bruk, følge nasjonale retningslinjer/ helst smalspektrede midler når mulig (0.5p)
# smitteverntiltak for å hindre smitte av resistente bakterier i helseinstitusjoner (0.5p)
# andre poenger (maks 1p dersom minst to andre faktorer nevnes): for eksempel unngå langvarige antibiotikakurer når ikke nødvendig, oppfordre til vaksinasjon dersom aktuelt, overvåkning av antibiotikabruk og antibiotikaresistens, venteresept, forbedret diagnostikk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mor kommer til deg som helsestasjonslege med to av sine barn, en gutt på 4 måneder og en jente på 5 år. Hun uttrykker bekymring for gutten fordi han spiser lite, ikke løfter hodet fra mageleie og gråter mye. Moren er alene med barna, og veldig sliten av søvnmangel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer relatert til svangerskap og fødsel er viktige for å vurdere spedbarnets psykiske helse? (Nevn minst fire faktorer totalt).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alkohol/rusmidler/medikamenter i svangerskap
* Infeksjoner i svangerskapet
* Stress/traumer/belastning i svangerskapet (fattigdom, vold, krig)
* Mors og fars psykiske helse i svangerskapet
* Mors og fars fysiske helse i svangerskapet
* Prematuritet
* Fødselsskade/komplikasjon som påvirker barnets psykomotoriske utvikling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 2 poeng
For å få poeng, må det være nevnt faktorer som er relatert til svangerskap eller fødsel, ikke generelle risikofaktorer for dårlig psykisk helse.
Ref:
# Hantsoo, L. et al. Inflammation: A Proposed Intermediary Between Maternal Stress and Offspring Neuropsychiatric Risk. Biological psychiatry 2018 Sep 5. pii: S0006-3223(18)31795-5.
# Grøholt, B. et al Lærebok i barnepsykiatri. 5. utgave. Universitetforlaget 2015. ISBN 978-82-15-02285-7
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En mor kommer til deg som helsestasjonslege med to av sine barn, en gutt på 4 måneder og en jente på 5 år. Hun uttrykker bekymring for gutten fordi han spiser lite, ikke løfter hodet fra mageleie og gråter mye. Moren er alene med barna, og veldig sliten av søvnmangel.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du vurdere for å kunne beskrive samspillet mellom mor og gutten? (Nevn minst fire faktorer totalt).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Blikk-kontakt mellom gutt og mor
* Hvordan mor snakker //om// gutten
* Hvordan mor snakker //til// gutten
* Kvaliteten på fysisk kontakt mellom mor og gutt
* Mors fokusering og felles oppmerksomhet ved å følge med på hva gutten er opptatt av, hva han ser på og er interessert i.
* Om mor smiler til gutten, og får smil tilbake fra gutten
* Om det oppstår turtaking mellom gutt og mor
* Om mor prøver roe barnet om det blir urolig i løpet av konsultasjonen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 2 poeng
Vi ønsker med dette spørsmålet å kartlegge om studenten har forståelse for begrepet samspill, og om studenten er i stand til å vurdere elementer ved samspill mellom foreldre og barn
Ref:
# Tetzchner, S. Utviklingspsykologi, 2. utgave, Gyldendal forlag 2012. ISBN/EAN: 9788205390782
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Storesøster på 5 år skal begynne på skolen om ett halvt år. Hun er adoptert fra Colombia, og kom til familien da hun var 2 år gammel. Hun er motorisk urolig, har hyppige sinneutbrudd, sovner seint og har mareritt. I barnehagen har de uttrykt bekymring for at hun har dårlig språk, og det blir ofte konflikt mellom henne og jevnaldrende. Hun foretrekker lek med barn som er 1-2 år yngre enn seg selv
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan man normalt forvente av et barn på 5 år når det gjelder motorisk, psykologisk og sosial utvikling? (Nevn minst fire utviklingsmessige milepæler totalt, og minst ett i hvert område).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Motorisk:
** Løper
** Hopper
** Hinker
** Klatrer
** Tegner menneske
* Psykologisk:
** Leker alene
** Nysgjerrig og interessert
* Sosialt:
** Godt utviklet språk
** Kler på seg alene
** Leker med andre
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver riktig milepæl koblet til riktig område, inntil 1.5 poeng totalt. I tillegg 0.5 p for ytterligere en riktig faktor
Ref.:
# https://www.helsebiblioteket.no/pediatriveiledere?menuitemkeylev1=5962&menuitemkeylev2=5973&key=144638
# Noritz GH, Murphy NA, Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics 2013; 131:e2016.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du avtaler en egen time med mor og datter for å snakke om
hennes emosjonsregulering og sosiale fungering.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du spørre moren om for å avklare risiko- og
beskyttelsesfaktorer for jentas psykiske helse? (Nevn minst
to risikofaktorer og to beskyttelsesfaktorer for barnets psykiske
helse).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Risikofaktorer:
* Prematuritet
* Utsatt for rus i svangerskap
* Komplikasjoner i svangerskap eller fødsel
* Oppvekstvilkår/omsorg før hun kom til familien (adoptert 2 år)
* Familiære sykdommer (psykisk eller fysisk, både biologisk og adoptivfamilie)
* Kronisk sykdom hos barnet
* Utviklingsforstyrrelser
* Funksjonshemming
* Traumatiske opplevelser (inkludert vold, omsorgssvikt, seksuelle overgrep)
* Belastninger i familien (økonomi, rus)
Beskyttelsesfaktorer:
* God familiefungering
* Sosial støtte
* Sosial kompetanse
* Gode kognitive evner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 2 poeng
Ref
# Johnson S et al. Preterm Birth and Childhood Psychiatric Disorders. Pediatric research, Vol. 69, No. 5, Pt. 2, 2011
# Plessen K.J. Hjernen og følelser –fra barn til voksen. Tidsskr Nor Legeforen nr. 9, 2010; 130
# Kolb B. et al. Principles of plasticity in the developing brain. Developmental Medicine & Child Neurology 2017, 59: 1218–1223
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du etablere kontakt med jenta på 5 år? (Nevn minst 4 punkter).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Informere om hvem du er
* Informere om hensikten med samtalen
* Bruke kunnskap om hennes alder/ utviklingsnivå
* Gjør barnet trygg
* Være konkret (direkte spørsmål)
* Bruke fantasien
* Vise interesse og engasjement
* Aktiv bruk av nonverbal kommunikasjon (smile, gi blikkontakt,
* bruke gester, vise med kroppen)
* Unngå å bringe barnet i lojalitetskonflikt
* Triangulering (bruke felles fokus for å gjøre kommunikasjon mindre intens)
* Lytt til barnet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar, inntil 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Synsskarpheten er best i den delen av synsfeltet som faller på fovea.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forhold ved netthinnen og hjernebarken bidrar til at synsskarpheten er best her?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Minst konvergens i fovea: De enkelte ganglieceller mottar signaler fra relativt få fotoreseptorer (gangliecellene her har små reseptoriske felter).
# Tetthet av fotoreseptorer (tapper) er høyest i fovea.
# Lyset forstyrres i mindre grad før det treffer fotoreseptorer i fovea: Mesteparten av netthinnen er organisert slik at lyset må passere gjennom de andre cellelagene før det treffer fotoreseptorer. Sentralt i fovea (foveola) er ganglieceller og bipolare celler skjøvet til siden slik at lyset ikke må passere gjennom disse cellelagene før det treffer fotoreseptorer (denne delen av fovea har dessuten ingen blodkar).
# Sentralnervøs signalbehandling: Langt flere nerveceller i hjernen brukes på å behandles synsinntrykk fra denne delen av netthinnen enn andre deler av netthinnen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.75 poeng for hvert riktig punkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et relativt kraftig lysglimt treffer et lite område i netthinnen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med membranpotensialet til, og frigjøring av nevrotransmitter fra, en fotoreseptor når lyset treffer dens ytre segment?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fotoreseptoren hyperpolariseres og den slipper ut mindre nevrotransmitter (glutamat).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hyperpolariseres (0.5 poeng), mindre nevrotransmitter (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Lyset treffer sentrum av det reseptoriske feltet til en OFF-center bipolar celle (også kalt AV-bipolar) og en ON-center gangliecelle (også kalt PÅ-gangliecelle).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med membranpotensialet og frekvensen av aksjonspotensialene til disse cellene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den bipolare cellen hyperpolariseres. Dette er en gradert endring av membranpotensialet. Bipolare celler lager ikke aksjonspotensialer.
ON-center ganglicellen depolariseres og frekvens av aksjonspotensialer fra cellen øker
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bipolare celler hyperpolariseres (0.5 poeng), fyrer ikke aksjonspotensialer (0.5 poeng)
ON-center gangliecelle depolariseres (0.5 poeng), høyere frekvens av aksjonspotensialer (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En skygge faller over hele det reseptoriske feltet til en OFF-center gangliecelle (AV-gangliecelle).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skjer med frekvensen av aksjonspotensialer fra denne cellen og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Frekvensen av aksjonspotensialer endrer seg lite.
Ganglieceller har typisk et todelt reseptorisk felt. OFF-center celler stimuleres når det blir mørkere i sentrum av deres reseptoriske felt, og hemmes når det blir mørkere i den perifere delen av feltet. Stimulus som beskrives i denne oppgaven vil derfor totalt sett ha liten effekt på cellen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Liten/ingen endring gir 0.5 poeng. 0.5 poeng for riktig forklaring.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Aksonene til gangliecellene i netthinnen går til ulike deler av sentralnervesystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 4 ulike områder som disse aksonene går til, og beskriv kort hva som er hovedfunksjonen til disse banene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Corpus geniculatum laterale (thalamus): Nevroner her sender aksoner til primære synskorteks. Signalene i denne banen er grunnlaget for bevisste synsinntrykk
Pretektum: Fibrene til pretektum utgjør den afferente delen av lysrefleksen(Signalene går videre til parasympatisk aksessorisk oculomotorius kjerne (Edinger-Westphal kjernen) på begge sider)
Colliculus superior: Viktig for koordinering av øyebevegelser.
Hypothalamus (nucleus suprachiasmaticus): Viktig for døgnrytme.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.75 poeng for hvert punkt inkludert riktig beskrivelse av funksjonen, maks 3 poeng (0.25 poeng for bare riktig område, maks 1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En studie undersøkte om det var sammenheng mellom røyking og insidens av hoftefraktur hos eldre. Alle innbyggere i et fylke ble invitert til studien hvis de var minst 70 år gamle og ikke allerede hadde hatt hoftebrudd eller hoftekirurgi ved studiens oppstartdato 1. januar 2008. Blant personer som oppfylte disse kriteriene og som takket ja til å delta i studien, identifiserte forskerne 5 000 personer som røykte og 20 000 personer som ikke røykte ved studiens start. Alle disse personene ble fulgt opp fram til 31. desember 2017. I oppfølgingstida ble første gangs hoftefraktur registrert, og dødsfall blant deltakerne ble også registret.
Insidensen av hoftefraktur i oppfølgingstida ble sammenliknet mellom røykerne og ikke-røykerne.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket design har denne studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kohortstudie. I en kohortstudie identifiseres eksponerte (her: røykere) og ikke-eksponerte (her: ikke-røykere). Studiepopulasjonen følges opp over tid for å finne ut hvem som får utfallet (her: hoftefraktur), og insidensen av utfallet sammenliknes mellom eksponerte og ikke-eksponerte
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kohortstudie gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blant de 5 000 som røykte, oppstod 600 hoftefrakturer i løpet av 40 000 person-år. Blant de 20 000 ikke-røykerne oppstod 1800 hoftefrakturer i løpet av 180 000 person-år
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var risikoen (insidensandelen eller incidence proportion) for å få hoftefraktur blant røykerne? Og hva var denne risikoen blant ikke-røykerne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blant røykerne: 600/5000 = 0.12 eller 12%.
Blant ikke-røykerne: 1800/20 000 = 0.09 eller 9%.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for angi at risikoen blant røykerne var enten 0.12 eller 12%
0.5 poeng for å angi at risikoen blant ikke-røykerne var enten 0.09 eller 9%.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Blant de 5 000 som røykte, oppstod 600 hoftefrakturer i løpet av 40 000 person-år. Blant de 20 000 ikke-røykerne oppstod 1800 hoftefrakturer i løpet av 180 000 person-år
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var risikoratioen (risk ratio) for å få hoftefraktur blant røykerne sammenliknet med ikke-røykerne? Tolk risikoratioen med egne ord.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
0,12/0,09 = 1,33 (≈1,3)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at risikoratioen var 1,33 (eller 1,3).
1 poeng for å angi at det betyr at risikoen for hoftefraktur var 33% (eller 30%) høyere blant dem som røykte sammenliknet med ikke-røykerne. Alternativt kan det angis at risikoen for hoftefraktur var 1,33 (eller 1,3) ganger høyere blant dem som røykte sammenliknet med ikke-røykerne.
Det gis også poeng dersom regnestykket er riktig satt opp/fortolkningen er rett, men feil utregning i spørsmål 2 gjør at svaret på spørsmål 3 blir feil.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Blant de 5 000 som røykte, oppstod 600 hoftefrakturer i løpet av 40 000 person-år. Blant de 20 000 ikke-røykerne oppstod 1800 hoftefrakturer i løpet av 180 000 person-år
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var insidensraten av hoftefraktur blant røykerne? Og hva var denne insidensraten blant ikke-røykerne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blant røykerne: 600 / 40 000 personår = 0,015 per personår eller 150 per 10 000 personår
Blant ikke-røykerne: 1800 / 180 000 personår = 0,01 per personår eller 100 per 10 000 personår
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0,5 poeng for å angi at insidensraten blant røykerne var enten 0,015 per personår, 15 per 1000 personår eller 150 per 10 000 personår osv (det er også ok å angi f eks per 100 000 personår)
Tilsvarende gis 0,5 poeng for å angi at insidensraten blant ikkerøykerne var 0,01 per personår eller 10 per 1000 personår osv.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Blant de 5 000 som røykte, oppstod 600 hoftefrakturer i løpet av 40 000 person-år. Blant de 20 000 ikke-røykerne oppstod 1800 hoftefrakturer i løpet av 180 000 person-år
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var insidensrate-ratioen (incidence rate ratio) for hoftefraktur blant røykerne sammenliknet med ikke-røykerne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
(150 / 100 000 personår) / (100 / 100 000 personår) = 1,5
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,5 gir 1 poeng. Det gis også poeng dersom regnestykket er rett satt opp, men feil utregning i spørsmål 4 gir feil svar på spørsmål 5.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Svarene i spørsmål [[3|ICD - 2019s - Oppgave 4 - Del 3]] og [[5|ICD - 2019s - Oppgave 4 - Del 5]] er begge relative mål på sammenhengen mellom røyking og insidens av hoftefraktur.
Hvorfor er de to målene forskjellige, og hvilket av dem er det beste målet for sammenhengen mellom røyking og insidens av hoftefraktur?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De to målene er forskjellige fordi beregning av risikoratio ikke tar hensyn til at endringer i oppfølgingstida kan være ulike mellom de to gruppene på grunn av konkurrerende risiko (competing risks) og loss to follow-up. Insidensrateratioen er det beste målet, fordi den tar hensyn til disse forholdene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at insidensrateratioen tar hensyn til konkurrerende risiko (competing risks) (evt loss to follow-up).
Alternativt gis 1 poeng for å angi at risikoratioen ikke tar hensyn til disse.
1 poeng for å angi at insidensrateratioen er det beste målet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sammenhengen mellom røyking og hoftefrakturrisiko skyldes i alle fall delvis at røyking fører til lavere beintetthet. Det er derimot liten grunn til å tro at beintettheten påvirker folks røykevaner. Da forskerne i denne studien justerte for deltakernes beintetthet i de statistiske analysene, ble sammenhengen mellom røyking og hoftefrakturrisiko sterkt svekket, slik at den relative risikoen var tilnærmet lik 1.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil du etter dette konkludere med at røyking er assosiert med økt insidens av hoftefraktur? Hvorfor eller hvorfor ikke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, røyking er assosiert med økt hoftefrakturinsidens. I denne situasjonen er beintettheten en mediator i sammenhengen mellom røyking og hoftefraktur, og en mediator er ikke en feilkilde som man skal justere for (tvert imot kan justering for en mediator introdusere bias i resultatet).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å konkludere med at røyking er assosiert med økt hoftefrakturinsidens.
1 poeng for å angi at beintetthet i denne situasjonen er en mediator (som derfor ikke skal justeres for).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne (23 år) har plager om våren med nesetetthet og nysing, samt kløende og røde øyne. Etter utredning konkluderte legen med at hun er allergisk mot bjørk.
4 hovedgrupper celler fra immunforsvaret er involvert i mekanismen for plagene hennes fra hun første gang var i kontakt med bjørkepollen til hun nå får symptomer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Fyll ut det som mangler i tabellen nedenfor slik at du navngir og karakteriserer disse 4 celletypene (A-D). Rekkefølgen i listen er ikke nødvendigvis logisk.
| !Celletype | !Tilhører naturlig (medfødt) eller ervervet (spesifikt) forsvar | !Viktig cellereseptor ved aktiveringen | !Stikkord for hovedfunksjoner |
|A) | | ICOS-ligand | |
|B) | | CD19 | |
|C) | | Fc-reseptor FcεR1 | |
|D) | | CD40 | |
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
| !Celletype | !Tilhører naturlig (medfødt) eller ervervet (spesifikt) forsvar | !Viktig cellereseptor ved aktiveringen | !Stikkord for hovedfunksjoner |
|A) Tfh-celle, T follikulær hjelpercelle (//NB Se kommentar i Hva gir poeng?//) | Ervervet | ICOS-ligand |Hjelpe ved aktivering av B-cellen |
|B) B-lymfocytt/B-celle | Ervervet | CD19 |Utvikles til plasmaceller som produserer IgE |
|C) Mastcelle | Naturlig | Fc-reseptor FcεR1 |<ol><li>Binde IgE og</li><li>Degranulere/skille ut proinflammatoriske mediatorer</li></ol> |
|D) Dendrittisk celle | Naturlig | CD40 |<ol><li>Presentere antigen for T-cellen (signal 1),</li><li>kostimulering av T-cellen (signal 2),</li><li>produksjon av primingcytokiner ("signal 3").</li></ol> |
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Pga. feil i oppgaveteksten er fasit Tfh på linje A feil. Riktig svar her blir isteden dendrittisk celle. Se informasjonen på linje D. Hvis man har svart dendrittisk celle på A, blir det ingen logiske steder å sette T-celle (Tfh). Eneste riktige svar på B er B-celle. Eneste riktige svar på C er mastcelle. D blir tvetydig fordi man har «brukt opp» både B-celle og dendrittisk celle tidligere i oppgaven, og oppgaven ber om 4 ulike celletyper. Både dendrittiske celler og B-celler kan uttrykke CD40.
Ved retting har vi derfor gitt poeng for dendrittisk celle både på linje A og D, og for B-celle på linje B og D. Noen studenter har oppdaget feilen og inkludert T-celle (Tfh eller Th2) i svaret sitt, evt. med ekstra forklaring. De har fått poeng for dette.
Ved poenggivningen har vi tatt hensyn til at oppgaven er blitt forvirrende og vært rause med poengene for celletypene. Detaljene om cellenes funksjoner er vurdert i henhold til fasit nedenfor.
Navn på de 4 celletypene: 0,5 p.
~~Ut fra overflatemolekylet ICOS-L forventes Tfh og ikke «T-celle/Tlymfocytt» for fullt poeng.~~ Det forventes også bruk av betegnelsen dendrittisk celle istedenfor antigenpresenterende celle fordi ikke alle
typer antigenpresenterende celler kan fungere i den aktuelle sammenhengen. Dendrittiske celler er ikke alene om å uttrykke CD40, men med kunnskap om hvilke celler som er involvert, blir svaret opplagt.
Riktig karakterisering av naturlig/ervervet immunforsvar: 0,5 p.
Riktig beskrivelse av hovedfunksjoner:
* 0,5 p for Tfh-celle (med forklaring) eller dendrittisk celle på linje A
* 0,5 p for B-cellen, må inkludere IgE. B-celle godkjennes også på linje D.
* Mastcellen: 0,5 p for binding av IgE, 0,5 p for degranulering
* Dendrittisk celle: 1 p hvis har med alle tre elementer i svaret, 0,5 p hvis har med to av de tre elementene, 0,25 p hvis har med ett av de tre elementene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Noen måneder senere reagerer kvinnen med magesmerter, diare og kløende øyne når hun spiser hasselnøtter. Det samme gjentar seg senere. Legen sier at hun har fått en allergisk kryssreaksjon, som er nokså vanlig ved bjørkeallergi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for kryssreaksjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forskjellige planter kan inneholde samme antigen eller antigener som har svært lik struktur. __En B-celles reseptor kan binde flere slike nesten like antigener, evt. med litt forskjellig styrke. Dette kalles en kryssreaksjon__. Også antistoffene som dannes etter aktivering av en B-celle, for eksempel antistoff mot bjørkepollen, kan gi kryssreaksjoner.
__Fordi allergi er antistoffmediert, kan dette utløse allergiske symptomer ved kontakt med noe annet enn det man opprinnelig ble allergisk mot__
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten behøver ikke kjenne til at bjørk og hassel ofte gir kryssreaksjoner, men skal kunne forklare hva en kryssreaksjon er (binding av samme antistoff til strukturlike antigener; 0,5p) og at dette kan gi allergiske symptomer fra ulike, men lignende allergener (allergisk kryssreaksjon) (0,5p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen oppdager at hun tåler å spise melkesjokolade som inneholder biter av hasselnøtter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er forklaringen på dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Når proteiner varmes opp, denatureres de. B-celler kan binde __konformasjonsepitoper som ødelegges ved denaturering__ av proteinet. I dette tilfellet __kan derfor ikke antistoffet som utløser allergien lenger binde allergenet__. Da utløses __ikke mastcelledegranulering__ og kvinnen får ikke allergiske symptomer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Har med noe om denaturering av protein og endret binding til antistoff (0,5p). Behøver ikke nevne ordet konformasjonsepitop. Manglende allergenbinding utløser ikke mastcelledegranulering (0,5p).
Selv om man ikke vet mye om sjokoladeproduksjon, forventes at man forstår at sjokolade må varmes/smeltes for å lages til et salgbart produkt.
Noen studenter har nevnt at lav konsentrasjon av nøtter i sjokoladen er årsak til manglende reaksjon. Dette gir ikke poeng fordi allergikere vanligvis reagerer på svært små allergenmengder og oppgaven angir «biter av hasselnøtter» (ikke «spor» slik det blir hvis man f.eks. lager flere sorter sjokolade på samme maskiner og rengjøringen ikke er fullgod)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
For å dempe allergiplagene, bruker kvinnen tabletter med antihistamin i pollensesongen. Antihistaminer blokkerer histaminreseptorer i ulike vev
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for at kvinnen får mindre plager fra nesen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved allergi er histamin er en av de sentrale mediatorene som skilles ut når mastceller degranulerer. Histamin gir vasodilatasjon, økt vasopermeabilitet og kløe. Når reseptorene for histamin er blokkert, reduseres derfor ødem, nesetetthet, nesesekresjon og nasal kløe.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vet at histamin er en viktig mediator for allergi (0,5 p) og forklarer mekanismen for symptomlindring (0,5p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Senere begynner kvinnen med allergivaksine. Hun får lave doser bjørkepollen injisert subkutant. Dette fører bl.a. til dannelse av IgG4 og IgA
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor vaksineringen resulterer i reduserte allergiplager.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
IgG og IgA bindes ikke til Fc-reseptorene på mastceller. Fordi disse antistoffene skyldes immunisering med bjørkepollen, fanger de opp pollen på (IgA) og i (IgG4) slimhinnene. Derved forhindrer de at sensibiliserte mastceller kommer i kontakt med pollen. Disse antistoffisotypene aktiverer heller ikke komplement, som bidrar til redusert inflammasjon i slimhinnene.
(Allergivaksinering påvirker også andre deler av immunforsvaret, men dette er ikke tema for oppgaven)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
IgG og IgA kan ikke bindes til mastceller (0,5p), antistoffene fanger opp pollen så mastceller ikke degranulerer (0,5p), IgA og IgG4 aktiverer ikke komplement (0,5p) => Det er ikke sikkert alle tenker på dette, men de mest kunnskapsrike får derved litt ekstra. Det at oppgaven presiserer IgG4 og ikke IgG, gir litt hjelp.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antistoffresponser med dannelse av IgG som i dette eksempelet, er resultat av isotypeskifte
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismen for isotypeskifte.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Isotypeskifte er betegnelsen på at __antistoff bytter konstantdelen på tung kjede__ med en annen konstantdel, som fører til et antistoff med andre egenskaper (mht. Fc-reseptorbinding / komplementaktivering etc.). Dette skjer ved __looping out av DNA-tråden__ i den aktuelle cellen, og __utkutting__ av de delene av DNA-tråden som ligger mellom gensegmentet for variabel del og gensegmentet for den nye konstantdelen. Såkalte __switch-regioner__ i tungkjede-genet må først __aktiveres av cytokiner__. Flere enzymer (bl.a. AID og UNG) bidrar til __dobbelttrådede DNA-brudd__, før DNA skjøtes sammen igjen ved hjelp av andre enzymer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vet hva isotypeskifte er – bytte konstantdel på tung kjede (0,5p), looping out og utkutting av DNA (0,5p), har med mer detaljer om cytokinaktivering, switch-regioner, dobbelttrådede brudd, ligaser etc. (0,5p). Det forventes ikke detaljer om enzym-navn eller hvilke cytokiner som gir skifte til ulike isotyper.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Legeerklæringen om dødsfall (melding om unaturlig dødsfall) sendes til Dødsårsaksregisteret
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hva dødsårsaksoppsettet betyr? (Ia, Ib, Ic, II)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Den umiddelbare dødsårsaken føres opp på linje Ia''. Her skal det ikke føres uspesifikke tilstander eller terminale hendelser slik som hjertestans, arytmi eller kardiorespiratorisk svikt. Bakenforliggende tilstander føres opp på linje Ib og Ic.
''Den underliggende dødsårsaken'' er definert som «den sykdom eller skade som startet rekken av sykelige tilstander som førte direkte til døden» og ''føres på den nederste linje som benyttes''.
Hvis den sykdom eller tilstand som føres på Ia beskriver hendelsesforløpet fullstendig, er det ikke nødvendig å bruke linje Ib og Ic. En årsakssammenheng omfatter ikke bare direkte medisinsk sammenheng, men også der en grunnlidelse kan ha ført til den umiddelbare dødsårsaken på grunn av funksjonsnedsettelse.
''På linje II føres medvirkende dødsårsaker'', det vil si andre vesentlige tilstander som kan ha bidratt til dødens inntreden, men uten å stå i direkte årsaksforhold til den tilstand som forårsaket døden. Hvis det er flere tilstander på II, skal den mest betydningsfulle angis først.
Varigheten av tilstandene på I og II angis dersom den er kjent.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne umiddelbare dødsårsak på linje Ia. 1 poeng for å nevne underliggendedødsårsak på siste linje (Ib eller c). 0,5 poeng for å nevne medvirkende dødsårsak på linje II.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som turnuslege på et sykehus blir du tilkalt til avdelingen for å fylle ut en legeerklæring om dødsfall på en eldre og dement pasient som sovnet stille inn. Pasienten var innlagt grunnet lungeemboli og det ble ikke igangsatt gjenoppliving. Ved rask gjennomgang av journal finner du at pasienten hadde flere diagnoser: Adenokarsinom i mamma med utbredt metastaserende sykdom, lungeemboli, KOLS, hjertehypertrofi, vaskulær demens og aterosklerose av aorta.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest riktige måten å angi Ia og Ib (evt Ic) i dødsårsaksoppsettet på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ia: Lungeemboli
Ib: Adenokarsinom i mamma med metastaser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for lungeemboli på Ia. 1 poeng for adenokarsinom med metastaser på Ib. Samme poengsum selv om det er delt opp i Ib metastaser og Ic adenokarsinom i mamma. Ingen poeng for riktige diagnoser, men feil rekkefølge
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som turnuslege i distrikt blir du tilkalt av politiet for å skrive ut en legeerklæring om dødsfall på en person som har skutt seg.
Politiet opplyser om at avdøde var observert beruset noen timer i forveien og at han hadde flere diagnoser: Hjertesykdom, KOLS, alkoholmisbruk samt at han tidligere var behandlet for depresjon og angst
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør føres som II i dødsårsaksoppsettet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
II: Alkoholpåvirket tilstand
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det naturlig å anta at avdødes alkoholpåvirkede tilstand trolig har vært medvirkende til dødsfallet. Vi har ingen opplysninger om avdødes psykiske helse på dødstidspunktet og tidligere angst og depresjon antas ikke å ha vært en medvirkende faktor. 1 poeng for å angi alkoholpåvirkning. Ingen poeng for de andre alternativene/diagnosene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Obduksjon er åpning av lik for å kunne studere forandringer i kroppens organer og vev forårsaket av sykdom eller skade, og for å fastslå dødsårsaken.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hvordan en obduksjon rent teknisk gjennomføres.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Obduksjon utføres ved at et y-formet snitt legges langs begge krageben og inn mot brystbenet og videre ned mot skambenet.
<img src="images/ICD-2020-2-A.jpg" />
<img src="images/ICD-2020-2-B.jpg" />
<img src="images/ICD-2020-2-C.jpg" />
<img src="images/ICD-2020-2-D.jpg" />
Brystbensskjoldet fjernes ved at brystbena klippes av. Organblokken løsnes ved å skjære tungen fri fra øvre del av strupen og ved å dele av rektum ned mot anus. Organblokken løsnes deretter fra bakre feste langs ryggraden og ved å løsne mellomgulvet før organblokken så undersøkes.
Hjernen hentes ut ved å løsne huden fra skallen, vrenge huden frem over ansiktet og sage ut calvariet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne y-snitt eller organblokk. 1,0 poeng for å huske at å undersøke hjernen også inngår i undersøkelsen og hvordan man tar ut denne.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dødsfallet i [[spørsmål 2|ICD - 2020 - Oppgave 2 - Del 2]] er ikke meldepliktig til politiet, men du ønsker å få utført en medisinsk obduksjon av pasienten.
Pårørende ønsker imidlertid __ikke__ at obduksjon skal utføres.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du likevel få utført en obduksjon? Begrunn svaret ditt
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei.
«Lov om obduksjon og avgjeving av lik til undervisning og forsking» (obduksjonslova) regulerer vanlige obduksjoner av personer som dør i sykehus eller annen helseinstitusjon. Avdødes pårørende kan motsette seg at slik obduksjon utføres.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar, 0,5 poeng om kun riktig og ikke begrunner
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som turnuslege i sykehus blir du tilkalt til avdelingen for å skrive legeerklæring om dødsfall på en person som var innlagt med KOLS (kronisk obstruktiv lungesykdom) og som ble funnet død i sengen på morgenen. Ved gjennomgang av journal finner du at avdøde hadde gjennomgått behandling for en pneumoni og det var planlagt hjemreise samme dag. Du finner også at pasienten kvelden i forveien hadde fått sovemedisin av en sykepleier grunnet uro
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er dødsfallet meldepliktig til politiet? Begrunn svaret ditt.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja
* Her har døden inntrådt plutselig og uventet da pasienten var oppfattet å være i bedring (hjemreise/utskriving var planlagt). __Plutselige og uventede dødsfall er meldepliktige__ til politiet, men vi har ingen opplysninger om avdødes grad av KOLS. Dersom denne var svært alvorlig, ville kanskje ikke dødsfallet være så uventet.
* Det er også opplysninger om uro og at sovemedisin var gitt. Det vites ikke om avdøde var urolig grunnet symptomer eller om det ble gitt videre oppfølging etter dette. __Feil, forsømmelse eller uhell ved undersøkelse eller behandling av sykdom er også meldepliktig__ til politiet.
Det er ikke alltid klart om et dødsfall er naturlig eller ikke. Ofte kan dette bare avklares ved politiets etterforskning og sakkyndig likundersøkelse. Dødsårsaksforskriften angir derfor at __legen skal melde på mistanke__. Det er ikke legens oppgave å avgjøre hvorvidt et dødsfall skyldes en straffbar handling, det er opp til politiet å etterforske.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å svare ja. 1 poeng for å diskutere noen av de nevnte momenter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barns vekst og utvikling defineres av deres genetiske potensial, fravær av sykdom, god ernæring og en god familie å vokse opp i.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan defineres det genetiske potensiale for kroppshøyde hos en jente?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
((Fars høyde + mors høyde) – 13 cm) / 2 (+/- 9 cm)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig formel
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fem typiske sykdommer (sykdomskategorier) som er assosiert med vekstavvik?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Alle kroniske sykdommer som hjertesykdom, gastro-intestinal sykdom, alvorlig nyresykdom,
# endokrinologiske sykdommer,
# medfødt; sykdommer som CMV-infeksjon, født SGA, rusmisbruk mor (FAS),
# de fleste syndromer,
# skjelettdysplasier
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å vise innsikt i at det er sykdommer som tar tid å utvikles og diagnostisere, hvor vekstavvik rekker å bli et aktuelt klinisk symptom. Orienterende gis 0,5 poeng for hver delkategori 1-5.
Genetisk kortvokshet/konstitusjonelt forsinket vekst er ikke sykdommer og gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et barns vekst fram til voksen høyde deles inn i tre vekstfaser som alle karakteriseres av hormoner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort de ulike vekstfasene hva gjelder start, varighet og hormonelle drivere.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Foster/spedbarnsalder (Infancy):
** Intrauterint til 4-6 mndr’s alder
** Hormoner: ''Insulin'', IGF-BP 1 og 2
* Småbarns/barnealder (Childhood):
** Fra og med uti første leveår og til pubertetsstart
** Hormoner: ''Veksthormon'', thyroxin
* Pubertet:
** Fra pubertetsstart (normalt 12 år for gutter og 11 år for jenter) og til utvokst.
** Hormoner: ''kjønnshormoner (østrogen og testosteron)'', thyroxin og veksthormon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng hvis bare benevnelse av kategoriene, +0,5 poeng med rett angivelse varighet, + totalt 1p for benevning insulin, veksthormon, kjønnshormoner i riktig fase, +0,5 hvis alle inkl. IGF-BP 1 og 2 nevnes i tillegg til insulin i foster/spedbarnsalder-fasen, thyroxin i tillegg til veksthormon nevnes i småbarns/barne-fasen, og thyroxin og veksthormon i tillegg til kjønnshormoner i pubertets-fasen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når starter puberteten for gutter og jenter, og hvordan defineres pubertetsstarten for begge kjønn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Gutter: 12 år, testikkelvolum 4 ml (Tanner 2)
* Jenter: 11 år, "knoppskyting" med brystkjertelvekst (Tanner 2)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Halv score hvis bare definisjonen er angitt, full score med alder i tillegg. Aldersavvik < +/-1 år.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det vanligste ernæringsproblemet for barn globalt, og også i Norge, er overernæring med utvikling av overvekt og fedme.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan defineres overvekt og fedme hos barn i Norge?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Overvekt: isoBMI25 ≥ BMI < isoBMI30
* Fedme: BMI ≥ isoBMI30
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver riktig definisjon. Ingen annen definisjon av overvekt og fedme er aktuelle eller poenggivende bortsett fra vekt/høyde ratio > 0,5 som definisjon på fedme som gir 0,25 poeng. Det må sies isoBMI for å vise forståelse for at barns BMI er avhengig av alder og kjønn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barn har spesielle næringsbehov fram til 3-årsalder. Fem viktige forhold ved anbefalt sped- og småbarnskost avviker fra voksenkostholdet
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de fem forholdene og beskriv i detalj hva anbefalingene er innenfor hver av dem.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Fett: Bør utgjøre 50% av total kalorimengde fra fødsel, reduseres til 30% fra 3 år
* Proteiner: 2,7 g/kg ved fødsel og ned til 1,0 g/kg ved 1 års alder og videre i voksenalder.
* Salt: Redusert salttilskudd fram til 1 års alder.
* Kaloribehov: 108 kcal/kg ved fødsel, reduseres til 60(mann)/40(kvinne) i voksen alder.
* Vitamin/mineraltilskudd: Vit D trengs fra 4 uker, Vit C og jern fra 6 mndr.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle punktene må nevnes for full poengpott (0,5 poeng for hvert forhold).
Morsmelk/formula fram til 1 års alder kan evt erstatte en av de fem og også gi full pott.
Hva gjelder kalorier kan et slingringsmonn på +/- 10 kcal ved fødsel og for kvinner og menn også gi fulle poeng. De bør vite at proteinbehovet er 2-3 ggr høyere pr kg ved fødsel enn ved 1 års alder og resten av livet, og det kan gi max poeng. Også for fett kan de få noe poeng ved å vite at behovet er større de første årene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fersk lege på et ambulant akutteam ved et distriktspsykiatrisk senter (DPS) og med på en vurderingssamtale med en pasient som du ikke kjenner fra før.
Han håndhilser og presenterer seg høflig.
Pasienten forteller at han fikk schizofrenidiagnosen da han var 25 år, etter et alvorlig selvmordsforsøk med innleggelse på både akuttpost og DPS. Han ble satt på et antipsykotisk medikament og en sovetablett, og dette har han tatt siden da sammen med et medikament mot høyt blodtrykk som han fikk av fastlegen sin.
Han sier at han nå har begynt å se sin døde far som begikk selvmord for 12 år siden. Faren dukker opp flere ganger om dagen og kommenterer mye av det pasienten gjør.
Han kjenner mye på angst og uro. Han sier at dette skyldes at hans forfølger (faren) også overvåker ham via TV. Han kjenner at hele situasjonen gjør ham trist. Under samtalen kikker han seg mye rundt og vrir hendene sine.
På grunn av grubling tar det litt tid før han sovner, men ellers sover han godt. Han har ikke sykmeldt seg, noe han synes er bra, fordi det er familie og jobb som gir ham trygghet og økonomisk stabilitet. Utenom familien er hans eneste venn hunden sin som han tar med seg på rypejakt. Tanker eller planer om selvmord avkrefter han.
Samtalen pågår en stund fordi pasienten hver gang bruker litt tid før han svarer. Ofte svarer han litt omstendelig og mister også tråden.
Etter samtalen skriver du innkomstjournalen til pasienten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire hovedkategorier i et psykiatrisk journalopptak som det finnes opplysninger om i vignetten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Psykiatrisk sykehistorie
* Aktuell problemstilling
* Legemidler i bruk
* Psykisk status presens
* Suicidrisikovurdering
* Naturlige funksjoner
* Somatisk sykehistorie
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig kategori av disse, totalt 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mens du skriver innkomstjournalen, merker du at du har glemt å spørre om en del.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to hovedkategorier i et psykiatrisk journalopptak som det ikke finnes opplysninger om i vignetten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Rusanamnese
* Seksualanamnese
* Komparentopplysninger
* Formalia (f.eks. henvisende instans, paragraf)
* Tiltak, evt. videre utredning
* Somatisk undersøkelse
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig kategori av disse, totalt 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et viktig ledd mellom pasientens beskrivelse og din observasjon, tolkning og vurdering av situasjonen, ligger i beskrivelsen av pasientens psykiske status presens.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire opplysninger i vignetten som er viktige for, og en del av, det å beskrive pasientens psykiske status presens.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hører kommenterende stemmer
* Ser ofte sin døde far ved siden av ham
* Svarer omstendelig eller mister tråden
* Overbevisning at han blir forfulgt
* Overbevisning at han blir overvåket på TV
* Angir tristhet og fremstår engstelig
* Det er rimelig å vurdere at han er våken og klar
* Svarer med latenstid
* Grubling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig opplysning, totalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!! Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tilordne opplysningene fra spørsmål 3 til de passende hovedkategoriene som finnes i en psykisk status presens.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hører kommenterende stemmer → Persepsjonsforstyrrelse eller hørselshallusinasjoner eller akustiske hallusinasjoner
* Ser ofte sin døde far ved siden av ham → Persepsjonsforstyrrelse eller synshallusinasjoner eller optiske hallusinasjoner
* Svarer omstendelig eller mister tråden → (Formelle) tankeforstyrrelser
* Overbevisning at han blir forfulgt → (Innholdsmessig) tankeforstyrrelse, vrangforestilling
* Overbevisning at han blir overvåket på TV → (Innholdsmessig) tankeforstyrrelse, vrangforestilling
* Tristhet → Stemningsleie, affekt
* Fremstår engstelig → Affekt, basisemosjon
* Det er rimelig å vurdere at han er våken og klar → Bevissthet
* Svarer med latenstid → (Formell) tankeforstyrrelse
* Grubling → (Formell) tankeforstyrrelse eller tvang
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 riktige tilordninger gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!! Vignett
Du vurderer pasientens selvmordsrisiko som lav, selv om han har en del risikofaktorer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire risikofaktorer for selvmord som det finnes opplysninger om i vignetten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alvorlig psykisk lidelse
* Tidligere selvmordsforsøk
* Selvmord i familien
* Våpen tilgjengelig
* Lite sosialt nettverk
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig faktor, totalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!! Vignett
Begrunnelse for din vurdering ligger i de beskyttende faktorene som du mener bidrar til at selvmordsrisikoen er lav.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to beskyttende faktorer det finnes opplysninger om
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tilhørighet til familien
* Økonomisk sikkerhet/stabilitet
* Trygg arbeidsplass
* Fravær av konkrete tanker eller planer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig faktor, totalt 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!! Vignett
Situasjonen hadde vært veldig annerledes dersom du hadde vurdert pasienten med akutt forhøyet og overhengende selvmordsrisiko.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to akutte tiltak som er viktigst for å håndtere pasienter med akutt forhøyet og overhengende selvmordsrisiko.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Innleggelse på psykiatrisk akuttpost
* Kontinuerlig observasjon
* Beroligende medikasjon f.eks. benzodiazepiner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig tiltak, totalt 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Arbeidslivet er en viktig bærebjelke i samfunnet, og forholdene på den enkelte arbeidsplass kan også ha stor innvirkning på helsa til de ansatte. Blant annet i helsevesenet har mange mennesker sin arbeidsplass på forskjellige laboratorier.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fem hovedgrupper av påvirkninger som vi kan finne i laboratorier og som kan ha betydning for helsa til de som arbeider der. Gi to konkrete eksempler for hver hovedgruppe
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ''Fysiske arbeidsmiljøfaktorer'' bør nevnes. Som eksempler godkjennes:
## Støy
## Radioaktiv/ioniserende stråling
## UV stråling godkjennes.
## Andre eksempler som vurderes klart relevante. (Vibrasjonspåvirkning godkjennes ikke som eksempel fordi det ikke er noe typisk for laboratorier.)
# ''Biologiske arbeidsmiljøfaktorer'' bør nevnes. Som eksempler godkjennes:
## "Smittefare" fra bakterier / virus / sopp.
## Allergener fra biologiske faktorer, f.eks ekskrementer, flass etc i dyrestall
## Andre eksempler som vurderes klart relevante.
# ''Kjemiske arbeidsmiljøfaktorer'' bør nevnes. Som eksempler godkjennes:
## Formaldehyd
## Desinfeksjonsmidler/rengjøringsmidler
## Reagenser/reaktive kjemikalier.
## Forurensning generert i prosesser
## Andre kjemikalier eller faktorer som kan vurderes klart relevante.
# ''Psykososiale/organisatoriske arbeidsmiljøfaktorer'' bør nevnes. Som eksempler godkjennes:
#* Psykososiale:
#*# Krav til arbeidstempo/produksjonspress/ "stress"
#*# Krav til særlig forsiktighet ved håndtering av farlige kjemikalier/farlige smittestoff og risiko for konsekvenser ved uhell.
#*# Mobbing/ seksuell- eller annen trakassering.
#*# Andre eksempler som vurderes klart relevante.
#* Organisatoriske:
#*# Ubekvem arbeidstid: Skiftarbeid/nattarbeid/helgearbeid
#*# Potensielt lite variert arbeid/mye rutiner.
#*# Potensielt lite medbestemmelse, rigide strukturer for oppgaveløsning.
#*# Andre eksempler som vurderes klart relevante.
# ''Ergonomiske forhold'' bør nevnes. Dette dreier seg om tilpasning mellom mennesket og arbeidet. Som eksempler godkjennes:
## Ensidig gjentakende arbeid.
## Ubekvemme arbeidsstillinger.
## Tunge løft.
## Andre eksempler som vurderes klart relevante.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig hovedområde som har to relevante eksempler, inntil 5 hovedområder, (0,25 poeng for hvert relevante eksempel.) Ut fra at Arbeidstilsynet gjerne slår sammen biologiske og kjemiske arbeidsmiljøfaktorer og deler opp psykososiale og organisatoriske faktorer, så vil en slik alternativ inndeling også kunne gi full uttelling, så lenge man har med minst to relevante eksempler for hver av de 5 hovedområdene man har svart.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De tre hovedveiene for opptak av kjemikalier i kroppen er gjennom hud, luftveier og mage/tarmsystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv i grove trekk omfanget av kontakt mellom en gjennomsnittlig voksen persons luftveier og omgivelsesluften i løpet av en dag ved å angi omtrentlig mengde luft som kommer i kontakt med luftveiene og luftveienes samlede overflate.
Nevn kort hvordan minuttvolumet som en arbeidstaker har under en arbeidsoppgave, kan påvirkes av selve arbeidsoppgaven.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungene er i kontakt med omtrent 10 m^^3^^ luft daglig (og dermed også med forurensning i luften.) (vel å merke i hvile/rolig arbeid.)
Lungenes samlede overflate er omtrent 140 m^^2^^.
Fysisk krevende arbeidsoppgaver medfører økt oksygenbehov og dermed økt lungeventilasjon/minuttvolum.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,25 poeng for omtrentlig beskrivelse av mengden luft lungene kommer i kontakt med i løpet av en dag (7-14 m^^3^^ godkjennes).
* 0,25 poeng for omtrentlig beskrivelse av lungenes samlede overflate (90 – 170 m^^2^^ godkjennes).
* 0,5 poeng for riktig beskrivelse av sammenhengen mellom fysisk krevende arbeidsoppgaver og økt minuttvolum.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv i korte trekk fire hovedmekanismer i luftveienes forsvar mot skadelig luftforurensning.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Nedsatt inhalasjon
## Grovt luftfilter (nesehår)
## (Flukt (lukt))
## (Bronchokonstriksjon)
# Inaktivering
## Sekresjon av mucus
## Metabolisme (enzymer ex. Cytokrom P450)
# Fjerning
## Hoste
## Mucociliær transport
## Fagocytose
# Innkapsling
## Fagocytose
## Bindevevsdannelse (fibrose)
Annen fornuftig inndeling kan også gi poeng.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hver riktige mekanisme.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Luftforurensning på arbeidsplasser kan blant annet bestå av ulike partikler med ulike egenskaper.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke egenskaper ved partiklene i luftforurensning har størst betydning for hvor i luftveiene de deponeres, og hva kjennetegner partikler som deponeres perifert i luftveiene?
Gi minst ett eksempel på partikler som kan deponeres perifert i luftveiene, og som kan føre til arbeidsrelaterte luftveisplager/sykdom.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Veldig forenklet så kan man si at dette avgjøres av partiklenes «størrelse», ved at «små» partikler følger luftstrømmen lettere, og dermed også kan deponeres mer perifert i luftveiene.
Et riktigere svar er imidlertid at dette avgjøres av hvor godt partiklene klarer å følge luftstrømmen inn i lungene, hvilket igjen er avhengig av hvor godt partiklene svever i luften. Partiklenes sveveegenskaper kan også beskrives som hvor sakte partiklene faller mot bakken i stillestående luft. Dette påvirkes hovedsakelig av partiklenes volum, tetthet og fasong. Partikler som har gode svevegenskaper, og har lett for å følge luftstrømmen, vil kunne deponeres mer perifert enn partikler som ikke svever like godt, og dermed ikke klarer å følge luftstrømmen. Sveveegenskapene til partiklene oppgis som aerodynamisk diameter. Dess raskere fallhastighet/dårligere sveveegenskaper en partikkel har, jo høyere aerodynamisk diameter defineres for partikkelen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Full skår krever at man nevner volum, tetthet og fasong, samt at partikler med gode sveveegenskaper deponeres mer perifert enn partikler med dårligere svevegenskaper. I tillegg må det nevnes minst ett konkret relevant eksempel, f.eks asbeststøv, α-kvarts, sveiserøyk, stekeos m.f.
Svar som nevner at aerodynamisk diameter er avgjørende og at partikler med liten aerodynamisk diameter deponeres mer perifert enn partikler med større aerodynamisk diameter, kan også gi full pott.
Svar som kun nevner størrelse, og at små partikler deponeres mer perifert enn store partikler gis 1 poeng.
Svar som kun nevner størrelse, uten noe mer forklaring gir 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En av arbeidsmedisinens sentrale prinsipper er at det er bedre å hindre at sykdom oppstår enn bare å være opptatt av å behandle/rehabilitere arbeidstakere som har blitt syke/sykmeldte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn, __i prioritert rekkefølge__, det som i fagmiljøet anses som hovedgrupper av forebyggende tiltak for å beskytte arbeidstakere mot skadelig luftforurensning i arbeidsmiljøet (maks 6 hovedgrupper). Gi minst ett (men maks tre) konkrete eksempel for hver hovedgruppe.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Eliminasjon (fjerning av den skadelige påvirkningen, f.eks avslutte produksjonen av en vare.)
# Substitusjon (bytte ut et helsefarlig kjemikalium med et annet som representerer en lavere helserisiko ved eksponering)
# Innkapsling eller lukking av prosesser (herunder regner vi avtrekkskap på laboratorier)
# Ventilasjon/avtrekk (herunder regner vi allmennventilasjon og punktventilasjon)
# Organisatoriske forhold (herunder arbeidstidsbegrensninger, rullering, opplæring, skriftlige arbeidsinstrukser)
# Personlig verneutstyr, er alltid siste utvei, som kun skal brukes dersom man ikke klarer å sikre et fullt ut forsvarlig arbeidsmiljø med øvrige tiltak. (Eks. maske, klær, briller m.m.). Et av disse kan godkjennes, men ikke flere.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Gi 0,3 poeng for hver riktig hovedgruppe med relevant eksempel, opp til maks 1,5 poeng, og 0,5 poeng hvis også rekkefølgen er stort sett riktig. (Dersom noen bytter plass på nr 3 og 4 fører ikke dette til trekk. Det er også i orden å plassere punktavsug sammen med innkapsling.)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På slutten av en arbeidsdag viser det seg at det har vært en gasslekkasje på en arbeidsplass. Lekkasjen blir stanset, og de fem ansatte som er på jobb i det aktuelle lokalet blir evakuert til en annen del av bygningen.
Ved nærmere undersøkelser viser det seg at gasslekkasjen har oppstått like etter arbeidsdagens start, og medført at luften de ansatte har pustet inn mesteparten av arbeidsdagen sannsynligvis har vært forurenset med gass.
Ingen av de fem ansatte har lagt merke til noe spesielt i løpet av arbeidsdagen, men når de kjenner etter, bemerker noen av dem at de kanskje kjenner seg litt tunge i hodet og litt uvel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken egenskap ved en gass som virker lokalt i luftveiene, er av størst betydning for hvilke deler av luftveiene som affiseres av eksponeringen? Drøft med to forskjellige gasser som eksempel hvilken betydning dette kan ha hatt for de fem ansatte?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er gassens vannløselighet som bestemmer hvor i luftveiene en gass har sin vesentlige virkning. Det betyr at lite vannløselige gasser har virkning mer distalt i luftveiene.
Dersom gassen hadde vært nitrogendioksid, (evt fosgen som er lite sannsynlig) som er svært lite vannløselig, så ville virkningene kunne være distalt i luftveiene med i verste fall alvorlige virkninger og mulige senvirkninger.
Dersom lekkasjen hadde vært av ammoniakkgass som er godt vannløselig så ville virkningen i tilfelle vært proksimalt i luftveiene, d.v.s. nese munn svelg. Ammoniakk har også en sterk lukt og derfor kan man si at konsentrasjonen i tilfelle ikke under noen omstendighet har vært høy siden ingen merket noe mens lekkasjen sto på.
Andre gasser kunne være ozon, formaldehyd, svoveldioksid, klorgass, hydrogensulfid m.fl.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kunnskap om vannløselighetens betydning gir 0,6 poeng, mens hvert av to eksempler gir 0,7 poeng hver.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 40 år oppsøker fastlegen på grunn av hjertebank og svetting/økt varmefølelse de siste månedene. Hun har gått litt ned i vekt til tross for at hun spiser mer enn vanlig. Hun har også utviklet struma. Blodprøver viser at hun har høye verdier av fritt tyroksin (fT4) og trijodtyronin (fT3), mens thyreoideastimulerende hormon (TSH) er lavt (under referanseområdet). Det påvises også høyt nivå av antistoff mot TSH-reseptor i blodet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort syntesen av thyreoideahormoner. Hvilket hormon er det aktive?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Syntesen består av fem trinn
# Opptak og konsentrering av jodid (I^^-^^) i gl. thyreoidea
# Oksidasjon av I^^-^^ til I^^+^^ (jodinium-ion) ved enzymet tyreoperoksidase (TPO)
# Jodinering av tyrosin i tyreoglobulin (TPO)
# Kobling av mono- og dijodert tyrosin (ved TPO?)
# Proteolyse av tyreoglobulin og frigjøring av T3 og T4
T3 er det aktive hormon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bør kjenne til minst tre av trinnene (2 poeng), samt at T3 er det aktive hormon (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
En kvinne på 40 år oppsøker fastlegen på grunn av hjertebank og svetting/økt varmefølelse de siste månedene. Hun har gått litt ned i vekt til tross for at hun spiser mer enn vanlig. Hun har også utviklet struma. Blodprøver viser at hun har høye verdier av fritt tyroksin (fT4) og trijodtyronin (fT3), mens thyreoideastimulerende hormon (TSH) er lavt (under referanseområdet). Det påvises også høyt nivå av antistoff mot TSH-reseptor i blodet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan forklarer du pasientens blodprøvesvar?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<img src="ICD-2020s-2-A.jpg" />
Det er påvist antistoffer mot TSH-reseptor som medfører økt syntese av thyreoideahormoner.
Høye nivåer av T3 og T4 hemmer utskillelsen av TSH, (mens lave nivåer medfører økning av TSH). Det er i hovedsak T3 som er regulatoren. T3 har en negativ feedback både på hypofyse og hypothalamus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må kjenne til effekten av antistoffer mot reseptoren og feedbackreguleringen via hypothalamus og hypofyse for å få full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
En kvinne på 40 år oppsøker fastlegen på grunn av hjertebank og svetting/økt varmefølelse de siste månedene. Hun har gått litt ned i vekt til tross for at hun spiser mer enn vanlig. Hun har også utviklet struma. Blodprøver viser at hun har høye verdier av fritt tyroksin (fT4) og trijodtyronin (fT3), mens thyreoideastimulerende hormon (TSH) er lavt (under referanseområdet). Det påvises også høyt nivå av antistoff mot TSH-reseptor i blodet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan forklarer du pasientens symptomer på bakgrunn av thyreoideahormonenes effekter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effekter av T3:
* Stimulerer varmeproduksjonen og regulerer energiomsetningen
* Øker det sympatiske nervesystemets virkning
* Stimulerer impulsledningshastigheten i nervesystemet
Som følge av disse effektene vil overproduksjon av thyreoideahormoner medføre svetting, vekttap, hjertebank
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bør ha med alle disse tre punktene for full pott, to gir to, en gir ett poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan transporteres thyreoideahormonene i blodbanen og hvordan transporteres de inn i cellen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Transport i blodbanen:
** T3 og T4 er bundet til proteiner i plasma:
*** tyroksinbindende globulin (TBG) 70-80%
*** transtyretin (prealbumin)
*** albumin
* Transport over cellemembranen:
** Spesifikke TH- transportere
*** Monocarboxylate transporter (MCT)8
*** MCT10
*** Organic anion-transporting polypeptide (OATP1C1)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må minst kjenne til TBG for transport i blodbanen og at transport inn i cellen skjer ved spesifikke transportere for å få full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken effekt har thyreoideahormonene på karbohydratmetabolismen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Stimulerer karbohydratmetabolismen:
* Økt glykolyse
* Økt glukoneogenese
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha med begge effekter for full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fragilt X-syndrom affiserer ca. 1 av 4000 levendefødte gutter. Symptomene omfatter ofte mild mental retardasjon, og pasientene har ofte et særpreget utseende. Syndromet ble tidligere klassifisert som X-bundet dominant – med variabel ekspressivitet og muligens redusert penetrans.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva menes med begrepene variabel ekspressivitet og redusert penetrans i denne sammenheng?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Variabel ekspressivitet'': Individer med samme mutasjon utviser ulik grad av sykdom (debutalder, alvorlighetsgrad).
''Redusert penetrans'': Ikke alle som har samme mutasjon uttrykker sykdommen. F.eks. 80% penetrans innebærer at 20 av 100 med mutasjon ikke uttrykker sykdommen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar (totalt 2 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fragilt X-syndrom skyldes i mer enn 98% av tilfellene ekspansjon av en trinukleotid-repetisjon (CGG) i 5’ utranslaterte del av FMR1-genet. I normal-alleler er lengden <55 CGG repetisjoner. Ekspansjon til >200 CGG repetisjoner er i de fleste tilfeller forbundet med bortfall av transkripsjon av genet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken mekanisme er involvert som fører til at transkripsjonen opphører?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekspansjon til >200 CGG-repetisjoner er assosiert med hypermetylering av cytosiner i CGG repetisjonene (i CpG kontekst) til 5-metylcytosin (5meC).
Dette fører igjen til rekruttering av metylbindende proteinkomplekser som modifiserer histoner/nukleosomer slik at det dannes en tett kromatinstruktur, som også omfatter genets promotor. I en slik tett kromatinstruktur kan ikke nødvendige transkripsjonsfaktorer bindes til promotoren, og transkripsjonen av genet opphører.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å forklare at CpG metylering er involvert.
1 poeng for å forklare at dette fører til dannelsen av en tett kromatinstruktur som hindrer transkripsjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
PCR (eng. //polymerase chain reaction//) kan anvendes til å bestemme temmelig nøyaktig lengden på CGG repetisjonen hos personer med mistanke om Fragilt X-syndrom. Likevel er denne metoden ikke tilstrekkelig til å si med sikkerhet at FMR1-genet er inaktivert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er det sånn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
PCR-analysen kan fortelle om lengden er ≤200 CGG repetisjoner – eller >200 repetisjoner. PCR-analysen forteller imidlertid ingenting om metyleringsstatusen i genet, og hvor hypermetylering er den egentlige årsaken til at genet inaktiveres.
PCR er en //in vitro//-metode som er upåvirket av metyleringsstatus av cytosin i templatet.
(For å sjekke metyleringsstatus anvendes som regel kutting av DNA med metyleringssensitive restriksjonsenzymer, etterfulgt av Southern blot analyse. Alternativt kan en nå anvende metyleringsanalyse med next generation DNA sekvensering. En tredje metode er RT-PCR (reverse transcription-PCR, som kan anvendes for å se om mRNA er uttrykt – og danner utgangspunkt for neste spørsmål).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar på den del av svaret som beskriver at PCR, når anvendt for kun å detektere lengde, ikke kan si noe om metyleringsstatus i genet – som er den direkte årsaken til at gentranskripsjonen inaktiveres. Selv ved >200 CGG-repetisjoner må man verifisere at genet faktisk ikke er uttrykt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
FMR1-genet er normalt også uttrykt i hvite blodceller
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken metode ville kunne være egnet for å demonstrere at FMR1-genet med stor sannsynlighet ikke var uttrykt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# RT-PCR (reverse transcription-PCR) anvender RNA som templat og kan anvendes for å påvise om FMR1 mRNA er til stede i blod eller isolerte hvite blodceller. Negativ test ville indikere at genet ikke er uttrykt.
# Påvisning av FMRP (FMR1 proteinet) i hvite blodceller ved bruk av spesifikke antistoffer. Negativ test ville indikere at genet ikke er uttrykt.
(I begge tilfeller måtte man inkludere egnede og validerte positive kontroller).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne minst en av disse
Om ingen av metodene over nevnes, så kan det gis 1 poeng om studenten beskriver en annen metode som enten 1) bruk av metyleringssensitive restriksjonsenzymer etterfulgt av Southern blot analyse – eller 2) beskriver hvordan metyleringsstatus kan analyseres ved bisulfittbehandling og next generation sequencing, men det forventes ikke at studentene har detaljkunnskap om disse metodene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I en familie har far blitt påvist å være en pre-mutasjonsbærer med 150 CGG-repetisjoner i FMR1-genet (premutasjon: 55-200 CGG repetisjoner). Mor har normal lengde på sine repetisjoner (henholdsvis 17 og 26).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du vurdere risikoen for å få Fragilt X-syndrom for 1) en sønn, 2) en datter og 3) en sønn av denne datteren (barnebarn)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Sønnen har ingen eller svært lav risiko siden han arver sitt X-kromosom fra mor (som har <50 repetisjoner).
# Datteren har liten risiko siden det er far som er bærer av premutasjonen (CGG ekspansjonen skjer primært i oogenesen, og ikke i spermatogenesen). Selv om datteren vil arve X-kromosomet fra far, så er det liten sannsynlighet at FMR1-allelet har økt i lengde til fullmutasjon (>200 CGG repetisjoner).
# Det er 50% sjanse for at en sønn av denne datteren vil arve et FMR1 allel som nå med stor sannsynlighet har ekspandert til en full-mutasjon i oogenesen – det vil derfor være ca. 50% sannsynlighet for Fragilt X-syndrom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig delspørsmål (til sammen 3 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En stor kjønnsforskjell i antall affiserte personer er ofte karakteristisk for X-bundne sykdommer. Noen autosomale sykdommer kan også utvise store kjønnsforskjeller, et fenomen kjent som kjønnsbegrensning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan du best, uten å kjenne selve mutasjonen eller teste etter mutasjonen, finne ut om en sykdom er autosomal heller enn X-bundet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dersom en i familiestudier kan påvise overføring av sykdommen fra far til sønn, så vil dette utelukke X-bundet arv (siden en gutt arver sitt X-kromosom fra mor).
(Her er vi ikke på jakt etter å direkte påvise mutasjonen på et av de autosomale kromosomene).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En pasient kommer til undersøkelse hos fastlegen og forteller om lammelse i halve ansiktet de siste dagene og problemer med å lukke det ene øyet på samme side. Fastlegen gjør en nevrologisk undersøkelse med fokus på noen av hjernenervene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Med tanke på pasientens symptomer, hvilke spesifikke hjernenerver kan det her være aktuelt å undersøke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten forteller om motorisk lammelse i halve ansiktet og motoriske øyesymptomer. Her er det derfor viktig å sjekke flere hjernenerver og som minimum:
* III: Nn. oculomotorius.
* V: N. trigeminus.
* VII: N. facialis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av nervene som er nevnt. Det gir ikke fratrekk i poeng hvis man nevner flere enn disse, men dersom alle 12 hjernenervene blir nevnt utgjør dette kun 0,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved nevrologisk undersøkelse finner fastlegen at pasienten har svakhet i både øvre og nedre ansiktshalvdel, med utvisking av nasolabialfuren, asymmetrisk smil, redusert evne til å løfte øyebryn, rynke panne og knipe sammen øyet. Det var ingen øvrig hjernenerveaffeksjon eller andre nevrologiske utfall.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken hjernenerve er affisert og hva er den sannsynlige diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
VII: N. facialis. (Idiopatisk) perifer facialisparese (Bells parese)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne N. facialis og 0,5 poeng for å nevne perifer facialisparese (Bells parese).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fastlegen undersøker spesifikt om lammelsen rammer både øvre og nedre halvdel av ansiktet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort (maks 10 setninger) hvorfor det er viktig å avklare utbredelsen av lammelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er viktig å avklare om det er en sentral eller perifer facialisparese. Sentral facialisparese rammer bare nedre del av ansiktet, pannen er spart. Sentral facialisparese kan skyldes en skade eller sykdom i den forbindelsen som finnes mellom ansiktsområdet i hjernebarken og ansiktsnervens utspring i hjernestammen. Årsaken kan være hjerneslag, hjernesvulst eller en annen sykdom eller skade i hjernen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å beskrive at og hvordan det skiller mellom perifer og sentral årsak. 0,5 poeng for å nevne skade i hjernen. Maks 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tre av hjernenervene våre kalles samlet for øynenes bevegelsesnerver.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles disse tre hjernenervene og beskriv kort hvilke muskler de innerverer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 3. hjernenerve, nervus oculomotorius. Forsyner den øverste rette øyemuskel (musculus rectus superior), den nederste rette (musculus rectus inferior), den innerste rette (musculus rectus medialis) og den nederste skrå øyemuskel (musculus obliquus inferior). Denne hjernenerven forsyner også den muskelen som hever øvre øyelokk (musculus levator palpebrae).
* 4. hjernenerve, nervus trochlearis. Forsyner den øverste skrå øyemuskel (musculus obliquus superior).
* 6. hjernenerve, nervus abducens forsyner den ytterste rette øyemuskel (musculus rectus lateralis).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å navngi hver av hjernenervene. 0,5 poeng for å nevne musklene de innerverer, og man må nevne minst 2 muskler til 3. hjernenerve
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et hypofyseadenom er en tumor som utgår fra hypofysen og som kan affisere synsnerven
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv i korte trekk synsbanen (formidling av synsinntrykk fra nervus opticus til synscortex) og angi hvilken type synsfeltutfall en hypofysesvulst kan forårsake
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<img src="images/ICD-2020s-4-A.jpg" />
En hypofysesvulst kan vokse inn i chiasma og gi bitemporal hemianopsi; samtidig synsfeltutfall til høyre for det høyre øyet og til venstre for det venstre øyet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,75 poeng for å tegne eller beskrive synsbanen i grove trekk; nervus opticus (synsnerven), chiasma (synsnervekrysningen), tractus opticus (synstrakten), thalamus (evt. corpus geniculatum laterale (knekroppen)), radiatio optica (synsnervestrålingen) og area striata (synscortex) bør nevnes.
0,75 poeng for å angi at en hypofysesvulst vil vokse inn ved chiasma og gi bitemporal hemianopsi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et hypofyseadenom kan også vokse inn i sinus cavernosus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hjernenerver og grener av hjernenerver kan bli affisert ved tumorinnvekst i sinus cavernosus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 3. Nervus oculomotorius
* 4. Nervus trochlearis
* 5. Nervus trigeminus; 1. gren n. ofthalmicus og 2. gren n. maxillaris
* 6. Nervus abduscens
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,3 poeng for å navngi hver av hjernenervene. Begge grener av nervus trigeminus må nevnes for å gi 0,6 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 70 år gammel mann kommer til deg som LIS1 i allmennpraksis. Han har blitt sendt av kona som de siste 10 årene har angitt at han responderer dårlig når hun snakker til ham. Han har siden 18-års alder jobbet som snekker på store byggeplasser, men brukt hørselsvern kun fra 50-årsalder.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvilke deler av hørselssystemet som kan få skade ved 1) kronisk støypåvirkning og 2) presbyakusis (aldersbetinget hørselssvekkelse), og angi patogenesen for presbyakusis.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Kronisk støypåvirkning kan skade hårcellene i cochlea, fortrinnsvis nærmest mellomøret der diskanthørselen formidles
# Alderdomshørselssvekkelse kan skade hårcellene i cochlea og nervefibrene, både nærmest mellomøret der diskanthørselen formidles, men også lenger opp i cochlea der mellomfrekvensene formidles
Det er 3 forskjellige mekanismer:
# Nedbrytning av hårcellene basalt i cochlea
# Nedbrytning av stria vaskularis (blodtilførselen)
# Nedbrytning av nervefibrene i cochlea
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av de to beskrivelsene av skade. For 1) holder hårcellene i cochlea og for 2) holder hårcellene i cochlea eller nervefibrene i cochlea.
0,5 poeng for 1 av 3 mekanismer rett. 1,0 poeng for 2 av 3 rett.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort (stikkordsmessig) hvordan lydoverføringen skjer fra en lydkilde utenfor øret til lyd oppfattes i hørselskorteks.
Angi alle lokaliseringer der det skjer overføring av lydenergi og hvordan dette skjer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Fra en lydkilde utenfor øret oppstår lydbølger (lydtrykkvariasjon) som beveger seg inn gjennom øregangen
# Trommehinnen og de 3 mellomørebeina (hammeren, ambolten og stigbøylen) settes i bevegelse
# Bølgebevegelse i væsken i cochlea setter hårcellene i bevegelse. (Bølgebevegelse i perilymfen i øvre hulrom (scala vestibuli) i cochlea (sneglehuset) til toppen (apex) av cochlea og ned gjennom nedre hulrom i cochlea (scala tympani) samt fra øvre hulrom tvers gjennom midtre hulrom (ductus cochlearis) til nedre hulrom).
# Bøyning av flimmerhår på hårcellene, åpning av K^^+^^ kanaler, depolarisering av hårcellen, åpning av Ca^^2+^^ kanaler.
# Transmittorsubstans i synapsen ved hårcellen initierer nervesignal gjennom hørselsnerven til cochleariskjernene i hjernestammen.
# Fra synapse i cochleariskjernene overføres nervesignalene til de sentrale hørebaner, de aller fleste nervene krysser midtlinjen på vei til neste synapsepunkt som er oliva superior i hjernestammen
# Fra synapse i oliva superior går nervesignalene til hørselskorteks via 2 andre synapsepunkter, colliculus inferior og corpus geniculatum mediale.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av de 7 delpunktene:
# Fra lydkilde dannes lydbølger gjennom øregangen
# Trommehinnen og de 3 mellomørebeina settes i bevegelse
# Bølgebevegelse i væsken i cochlea setter hårcellene i bevegelse.
# Bøyning av flimmerhår på hårcellen, åpning av K^^+^^ kanaler, depolarisering av hårcellen, åpning av Ca^^++^^ kanaler, transmittorsubstanser i synapsen.
# Fra synapse ved hårcellen initieres nervesignal gjennom hørselsnerven til cochleariskjernene i hjernestammen.
# Fra synapse i cochleariskjernene nervesignal til oliva superior i hjernestammen, de aller fleste krysser midtlinjen.
# Fra synapse i oliva superior nervesignal til hørselskorteks.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasientens rentoneaudiogram er nærmest normalt til og med 2000 Hz (20 dB eller bedre), deretter faller høreterskelkurven brått til dårligst 80 dB ved 8000 Hz.
<<imgLink "ICD-2021-1-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig årsak til pasientens hørselstap? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kronisk støyskade etter mange års arbeid i bygningsindustrien uten bruk av hørselsvern. Bratt fall i høreterskelkurven er karakteristisk for støyskade og avgjørende for å skille støyskade fra presbyakusis.
Alternativt svar: Presbyakusis gir også dårligst hørsel i diskanten, men da er det typisk slakkere fall på høreterskelkurven.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,0 poeng: Kronisk støyskade etter mange års arbeid i bygningsindustrien uten bruk av hørselsvern
0,5 poeng: Bratt fall i høreterskelkurven er avgjørende for å skille støyskade fra presbyakusis.
Angis presbyakusis pga. diskanttap gis 1,0 poeng totalt på oppgaven.
//Kommentar til eksamenskommisjonen og sensor: Noen vil kanskje kommentere at «bratt» og «slakt» fall på høreterskelkurven er lite presist i en fasit. I klinisk audiologi har vi grenser på stigningstallet til hørselskurven for å skille bratt og slakt fall på høreterskelkurven som bl.a. brukes i forsikringssaker, men stigningstallet på høreterskelkurven faller utenfor studentenes pensum.//
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi den mest aktuelle hørselsforbedrende behandlingen for hver av tilstandene kronisk støypåvirkning og presbyakusis (aldersbetinget hørselssvekkelse).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
For begge tilstandene er høreapparat hovedbehandlingen. Dessuten aktuelt med hørselsteknisk tilleggsutstyr som teleslynge eller liknende tilleggsutstyr.
Alternativt svar ved presbyakusis: Samtaleforsterker ved betydelig nedsatt kognitiv funksjon.
Alternativt svar for kronisk støyskade: Støydempning av støykilden og/eller hørselsvern som sekundærprofylakse mot ytterligere hørselstap
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av tilstandene. Kun høreapparat gir full score.
Kun hørselsteknisk tilleggsutstyr gir 0,25 poeng for hver av tilstandene. De alternative svarene gir 0,25 poeng (for hver av tilstandene).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi en utfordring ved behandlingen for hver av tilstandene presbyakusis og akutt/kronisk støyskade.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved presbyakusis kan nedsatt talediskriminasjon redusere nytten av høreapparat. Dessuten kan nedsatt kognitiv funksjon redusere evnen til nødvendig innlæring av nytt lydbilde og vanskeliggjøre håndtering av et teknisk utstyr som høreapparat.
Ved akutt støyskade kan frekvensområdet med hørselstap være så smalt at høreapparat blir vanskelig å innstille godt nok til at det gir hørselsforbedring. Ved akutt/kronisk støyskade kan fallet i høreterskelkurven være så bratt at høreapparatet ikke gir bedre hørselsfunksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av tilstandene. Tilstrekkelig med et svar for hver av tilstandene for full score.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du tenke deg en utfordring ved den hørselsforbedrende behandlingen av den aktuelle pasienten som ikke skyldes hørselstapet? Har du et forslag til å løse denne utfordringen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten kan være lite motivert for høreapparat ettersom det var kona som sendte ham til legen.
Du kan sannsynligvis bedre hans motivasjon for høreapparatbruk hvis du forteller at nedsatt kognitiv stimulering ved hørselstap øker risikoen for demensutvikling og at høreapparatbruk kan motvirke demensfaren.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En ung mor kommer til deg som fastlege med sitt barn på 3 mnd. Barnet gråter og virker utilpass. Far til barnet er på jobbreise de neste 3 ukene. De har også et barn på 7 år som går 2. trinn på barneskolen. Mor er sliten, gråter under samtalen, har ikke sovet mer enn 3 timer i døgnet den siste uka.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi hvilke elementer som inngår i en generell psykiatrisk status presens ved vurderingen av moren.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Førsteinntrykk/ fremtoning (kontaktfunksjon, hygiene, påkledning)
* Orientering
* Bevissthet
* Kognitive funksjoner
* Emosjoner/affekt/selvoppfatning
* Hukommelse
* Tale
* Psykomotorikk
* Tvang
* Persepsjon/hallusinasjoner
* Tankeforstyrrelser
* Suicidalitetsvurdering
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig punkt, inntil 3 poeng totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner at mor har en fødselsdepresjon
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilken måte kan mors fødselsdepresjon kan innebære en risiko for barnets sosio-emosjonelle utvikling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det vil være risiko for at en deprimert mor ikke greier å være en tilstrekkelig emosjonell støtte for barnets tidlige utvikling
* Vansker med å reagere på barnets signaler som gråt og uro
* Manglende oppmerksomhet på barnets positive emosjoner
* Mest fokus på barnets negative emosjoner
* Risiko for tilknytningsvansker hos barnet
* Mor emosjonalitet med stemmebruk og ansiktsuttrykk kan påvirke samspillet negativt
* Kan være en begynnende negativ transaksjonsprosess som kan få konsekvenser på lang sikt både for barnet og for mor
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar, inntil 2 poeng totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv faktorer i svangerskapet som kan påvirke utviklingen av fosterets hjerne
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Maternelle faktorer (Infeksjoner, strukturelle intrauterine forhold, mors livsstil, ernæring og bruk av rusmidler inkl røyk, sykdom inkl svangerskapsrelatert sykdom (eks preeklampsi)) * Faktorer ved barnet (genetiske avvik, misdannelser, infeksjoner (sekundært til infeksjon av mor))
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar, inntil totalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
To uker senere kommer mor tilbake sammen med datteren på 7 år. Hun har vansker med å sovne om kvelden og er mye sint på dagtid.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du legge til rette og forberede deg for å kartlegge psykisk status presens av jenta?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Sikre at barnet føler seg trygt, snakke med barnet sammen med forelder, snakke til forelder på en respektfull måte foran barnet
* Ha nok tid
* Snakk til barnet på dets eget nivå, bruk barnets ord, bruke konkret språk
* Ting å aktivere barn med på kontoret: tegnesaker, leker, bøker
* Vite hva som er normalt for ulike aldre i forhold til kognisjon, motorikk, språk, atferd og samspill med foreldre/omsorgspersoner
* Generalisere vansker «det er vanlig at barn..»
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar, inntil totalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er annerledes ved å vurdere psykisk status presens hos et barn sammenlignet med hos voksne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alder og utviklingsnivå – evne til å sette ord på egne vansker og symptomer
* Prevalens av psykiske sykdommer
* Hvem gir informasjon – komparenter
* Observasjon av atferd, samspill med forelder
* Motivasjon – ønsker hjelp selv eller andre som ønsker bedring?
* Grad av selvinnsikt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver riktig faktor, inntil 1 poeng totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Virus kan kalles for obligate intracellulære molekylære parasitter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort beskrivelse av de syv trinnene i et virus’ livssyklus
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Binding
# Entring («entry»)
# Frisetting av genom («uncoating»)
# Biosyntese av genom og proteiner
# Partikkeldannelse («assembly»)
# Frigjøring fra vertscelle («exit», «release»)
# Modning
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for 6 av punktene, 1 poeng for tre av dem osv
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Virus inndeles på flere måter. Den mest brukte klassifiseringen baserer seg på virusgenomenes bestanddeler og kalles Baltimore-klassifiseringen, oppkalt etter David Baltimore som fikk Nobelprisen i medisin i 1975.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke karakteristika ved virus’ genomer baserer denne klassifiseringen seg på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# DNA og RNA
# Dobbelttrådet eller enkelttrådet
# For RNA-virus: positiv og negativ polaritet
# Revers-transkriberende virus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for de tre første. Punkt fire kan kompensere hvis punkt tre mangler
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Virus er ofte svært kresne med hvilke arter og hvilke celler de infiserer. De fleste infiserer kun én art, og kun et fåtall celler hos denne arten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan forklare denne høye spesifisiteten i interaksjonen mellom virus og vert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bindingen mellom virus og målcelle medieres av interaksjon mellom overflatemolekyler på både viruset og målcellen. Dette er ofte glykoproteiner på virusets overflate. På celleoverflaten kan dette være flere typer molekyler (proteiner og/eller karbohydrater), og kalles her reseptorer og koreseptorer. Cellens permissivitet er også en faktor her (medfødt immunitet, transkripsjonsfaktorer, celledelingsfase m.m). En permissiv celle lar virus omgå eller modulere dens innebygde cellulære forsvaret.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Overflatemolekyler på virus (0,5 poeng), reseptor og koreseptor (0,5 poeng) på celleoverflaten. Oftest svært spesifikk binding (0,5 poeng). Evolusjonære betraktninger og omtale av cellens permissivitet (kan også kompensere for mangler ellers i besvarelsen) (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
HIV-viruset er et eksempel på et slikt kresent (eller spesifikt) virus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken celletype er den primære målcellen for HIV-viruset?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CD4- lymfocytter/T-hjelpe-celler/T-lymfocytter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
CD4-celler/T-hjelpe-celler er mest presist og gir 1 poeng, Tlymfocytter er mindre presist og gir 0,5 poeng, tilsvarende gir lymfocytter 0,5 poeng og leukocytter eller hvite blodlegemer 0,5 poeng. Makrofager og mikroglia kan gi 0,5 poeng. Viruset kan infisere disse cellene, men dette er ikke de primære målcellene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
HIV-virusets binding til målcellen kjenner vi i detalj. Denne er en kompleks interaksjon som omfatter minst fire proteiner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan denne interaksjonen er mellom to virusproteiner og to overflatemolekyler på cellemembranen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Virusproteinene (glykoprotein) gp41 og gp120 danner henholdsvis hals og hode på molekylet som binder seg til cellens reseptor. Binding skjer både til reseptor og en såkalt koreseptor (hhv CD4 og CCR5/CXCR4). Bindingen utløser konformasjonsforandringer i proteinene som fører til at virusets membran føres mot cellens membran og man får fusjon mellom membranene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Overflateprotein på viruset samt «reseptor» og «koreseptor» på celleoverflaten samt «fusjon» må beskrives og gir 0,5 poeng. Hvis man nevner gp41, gp120 og CD4 får man 0,5 poeng til. CCR5/CXCR4 forventes ikke, men nevner man dette kan det erstatte andre mangler i besvarelsen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Cellekjernen er arena for vertscellens gen-replikasjon, men de fleste RNA-virus har en livssyklus der vertscellens cellekjerne ikke er direkte involvert. Det vil si at virusets genom er ikke innom cellekjernen der vertscellens replikasjon foregår.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan er dette mulig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
RNA-virus’ genom kan fungere direkte som mRNA og starte proteinsyntesen umiddelbart ved RER (ru endoplasmatisk retikulum) i cytoplasma. Andre RNA-virusgenomer har negativ polaritet, men bringer med seg et enzym (RNA-polymerase) som sørger for at mRNA-syntesen skjer i cytoplasma.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Omtale av RNA-avhengig RNA-polymerase, av at genomet kan fungere som mRNA, og at det går direkte til RER eller proteinsynteseapparatet i cytoplasma gir full score – 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege og en 38 år gammel kvinne kommer til deg på legekontoret den 2. april. Hun forteller at hun tror hun er gravid, fordi hun har tatt en positiv graviditetstest hjemme. Hun sier at hun ikke bruker prevensjon, har regelmessig menstruasjon og at siste menstruasjon startet 12. februar
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor langt kommet i svangerskapet vil du anta at kvinnen er ut fra siste menstruasjon? Omtrent hvor gammelt vil du anta at embryoet er (regnet fra fertilisering)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
7 uker (7+0) og ca 5 uker
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng 7 uker og ½ poeng for 5 uker
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen spør om hjertet har begynt å slå enda.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Har embryoets hjerte begynt å slå? Hvilken dag etter fertilisering og omtrent hvilken dag etter siste menstruasjon begynner hjertet å slå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, hjertet har begynt å slå.
Dag 22 etter fertilisering og ca dag 32 etter siste menstruasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ poeng for ja på hjertet
* ½ poeng for da 22
* ½ poeng for ca dag 32
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen forteller videre at svangerskapet ikke var planlagt og at hun ikke har brukt folat-tilskudd. Hun lurer på om det er noe vits i å begynne med det nå.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er det anbefalt å bruke folat i svangerskapet? Ut fra dine antagelser om hvor langt kvinnen har kommet i svangerskapet og dine kunnskaper om den embryonale utvikling; vil du anbefale henne å begynne med folat?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er anbefalt å bruke folat i svangerskapet for å forebygge nevralrørsdefekter og leppe/kjeve/ganespalte.
Nevralrøret vil være lukket på dette tidspunktet, men ikke leppe/kjeve/gane. Det er anbefalt å bruke folat i første trimester (første 12 uker) så ja, ville anbefalt å begynne med folat.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for hvorfor (ev ½ for nevralrør defekter + ½ for l/k/g)
* ½ poeng for ja til å anbefale folat
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv i korte trekk ansiktets utvikling i svangerskapet fra tidlig embryoutvikling.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Utvikles hovedsakelig mellom uke 4-8
Underkjeven utvikles først
Det ferdige ansiktets proporsjoner utvikles helt til fødsel, og fortsetter utviklingen også etter fødselen og helt til voksen alder (f.eks tenner, bihuler, skjelett)
* Tidlig i uke 4 oppstår det fem folder i ansiktet” primordial swellings”
* For det meste bestående av mesenchyme fra neural crest
* Foldene formes rundt ”stomodeum"
* 1 frontonasal prominence
* 2 maxillære prominenser
* 2 mandibulære prominenser
Munnen dannes først, men med en membran som senere brytes ned for å opprette forbindelse til GI traktus)
Neseborene dannes etter munnen.
Ganen er ikke fullstendig lukket før uke 10
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ poeng for tidsperspektiv (uke 4-8 + at utvikler seg til voksen)
* ½ poeng for primordial swellings og mesenchyme fra neural crest
* ½ poeng for de 3 prominencene
* ½ poeng for munnen først, deretter nesen og at ganen ikke lukkes fullstendig før uke 10
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen forteller videre at hun har drukket MYE alkohol ved to anledninger etter siste menstruasjon og før hun fant ut at hun var gravid. Hun lurer på om det er fare for at embryoet er skadet
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du svare? Hvor mye alkohol regnes som trygt å drikke i svangerskapet for å være sikker på at fosteret ikke tar skade?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi vet ikke om embryoet kan ha tatt skade av dette. Vi anbefaler ikke abort på bakgrunn av dette. Vi vet ikke om noen grense for trygt alkoholinntak i svangerskapet og anbefalingen er derfor totalavhold hele svangerskapet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ poeng for vet ikke om embryoet har tatt skade
* ½ poeng for ikke anbefale abort
* ½ poeng for vet ikke om grense for trygt inntak
* ½ poeng for anbefaler totalavhold
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom du skulle få mistanke om at denne kvinnen misbruker alkohol eller andre rusmidler og vil fortsette med dette i svangerskapet, hva er dine oppgaver som fastlege?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Være fastlege for mor og foster, informere, veilede
Melde fra til sosialtjenesten (ikke fastlegens jobb å tvangsinnlegge)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for være fastlege, informere, veilede
* 1 poeng for melde til sosialtjenesten
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege, og en av dine pasienter (en 23 år gammel mann) har nettopp vært innlagt på Medisinsk avdeling på grunn av slapphet og diffuse plager i flere år. Han har ingen kjente sykdommer fra før. Han har nå fått diagnosen «Fanconi syndrom», og i en lang og komplisert epikrise merker du deg følgende beskrivelser/kommentarer:
* Metabolsk acidose
* Hypokalemi
* Glukosuri
* Polyuri
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags type sykdom er Fanconi syndrom, det vil si hvilket organ/substruktur/celletype er affisert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En generell dysfunksjon av tubuluscellene i proximale tubulus i nyre. Dette kan man resonere seg frem til når man kjenner til hvordan tubulusfunksjonene er plassert langs nefronet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Proximale tubulus i nyre må spesifiseres for å gi poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør kort rede for begrepene pH, acidose og alkalose, og forklar kort og prinsipielt hvordan metabolsk acidose og metabolsk alkalose oppstår.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* pH er en logaritmisk skala for konsentrasjonen av H^^+^^-ioner i blodet
* normal pH er 7,4, acidose <7,35 alkalose >7,45
* metabolsk acidose skyldes overproduksjon av syre i kroppen
* metabolsk acidose kan skyldes manglende evne til å filtrere ut syre i nyrene
* metabolsk acidose kan også skyldes manglende evne til å reabsorbere og / eller produsere bikarbonat i nyrene
* metabolsk acidose kan skyldes gastrointestinale tap av bikarbonat
* metabolsk alkalose skyldes ofte bruk av diuretika som fører til dehydering og elektrolyttforstyrrelser som stimulerer nyrene til økt bikarbonat reabsorbsjon
* metabolsk alkalose kan skyldes tap av syre ved brekninger eller bruk av nasogastrisk sonde slik at kroppen taper H^^+^^ og klorid ioner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hvert av punktene ovenfor
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke mekanismer har kroppen for å motvirke acidose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I prinsippet har vi følgende mekanismer for å motvirke acidose:
# ''Bikarbonat/CO2 buffersystemet'': Dette er det viktigste systemet ettersom det kan endres (justeres opp/ned etter behov):
#* Kontroll/endring av CO2 innholdet i blodet ved å endre ventilasjonen slik at karbonsyre likningen forskyves
#* Kontroll/endring av HCO3 (bikarbonat) innholdet i blodet ved at nyrenes utskilling / reabsorbsjon av bikarbonat endres
# ''Protein buffer'': ulike aminosyrer i både intra- og ekstracellulære proteiner har muligheten til å binde til seg H^^+^^. Hemoglobin er det viktigste proteinet.
# ''Fosfat buffer'': både organisk og uorganisk fosfat har god evne til å binde H^^+^^
# ''Ammonium buffer i urin'': viktig mekanisme for å regulere endringer i syrebase ettersom man påvirker hvor mye syre som fjernes fra kroppen, ikke bare midlertidig bufring.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for 1, 0,5 p for 2, 0,25 p for 3 og 0,25 p for 4
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke transportmekanismer som prinsipielt finnes for å reabsorbere molekyler fra tubulus-lumen (0.5 p for hver mekanisme).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* ''ATP-krevende aktiv transport'' ved hjelp av relativt store proteiner som sitter i cellemembranen og som ved å endre form eller lokalisering transporterer molekylet til innsiden (ATPase). Dvs en primær aktiv transport imot konsentrasjonsgradienten.
* ''Co-transportere (synporter)'' som frakter to ulike molekyler inn samtidig uten bruk av ATP (sekundær aktiv transport). Dette skjer ved at ett av molekylene transporteres med sin konsentrasjons- eller elektrokjemiskegradient (downhill) og får selve transporten til å skje, mens det andre molekylet som er koblet på utnytter denne bevegelsen og transporteres mot sin konsentrasjonsgradient (uphill).
* ''Counter-transportere (antiporter)'' er helt likt cotransporterne beskrevet ovenfor bare at transporten av de to molekylene foregår i motsatt retning av hverandre (en inn og en ut av cellen). - Kanaler er cellemembranproteiner med en åpning/tunell som i de fleste tilfeller kan åpnes og lukkes ved hjelp av ulike signaler, og som gjør at en elektrolytt kan passivt strømme gjennom (ned sin gradient).
* ''Osmose'': vann reabsorberes ved at det strømmer inn paracellulært gjennom tight junctions langs den osmotiske gradienten. Da vil det også følge med småmolekylære stoffer.
* ''Pinocytos(=endocytose)'': store molekyler blir reabsorbert ved at de fester seg til børstesømmen som invagineres og snøres av. Vesiklen kan enten tømme seg intracellulært for nedbrytning eller tømme innholdet til utsiden ved å fusjonere med cellemembranen på den basolaterale siden (exocytose).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert av punktene ovenfor
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvor og hvordan filtrert K^^+^^ reabsorberes.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# K^^+^^ reabsorberes stort sett i proximale tubulus og Henles sløyfe (kun 10% lenger distalt)
# Reabsorbes passivt ved at Na^^+^^ pumpes aktivt inn i tubuluscellene og videre til interstitiet og dermed dras vann og K^^+^^ inn paracellulært (mellom cellene) og inn til interstitiet
# Økende elektropositivitet i tubulusvæsken litt lenger distalt i proximale tubulus bidrar også til at K^^+^^ diffunderer ut fra tubuluslumen og mellom cellene til interstitiet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for punkt 1 og 3, 0,5 poeng for punkt 2
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvor og hvordan glukose reabsorberes
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Nær fullstendig i første del av proximale tubuli
# SGLT2 pumper Na^^+^^ og glukose inn i tubuluscellene
# Glukose kan metaboliseres til ATP eller pumpes videre ut i intersitiet (GLUT2), for så å fraktes bort med blodet.
# Stor kapasitet, fullstendig reabsorpsjon opp til glukoseterskel på ca 11-12 mM i blod, som tilsvarer definisjonen av diabetes (ikke-fastende prøve)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 p for hvert av punktene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Øyet er sanseorganet som reagerer på lys, og synet er nok menneskets viktigste sans. Oppbygningen av øyet er kompleks, og kunnskap om dette er viktig i diagnostisk og terapeutisk øyemed. Kornea er den strukturen i øyet der det meste av øyets lysbryting skjer, og sykdom og skader av korneas ulike lag kan gi svekket syn.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke lag består kornea av?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lag i kornea fra ytterst og innover:
# Epithelium anterius corneae (korneaepitelet)
# Lamina limitans anterior (Bowmanns lag)
# Substantia propria corneae (korneastroma)
# Lamina limitans posterior (Descemets membran)
# Epithelium posterius (endothelium camerae anterioris)
NB! Det er også rapportert et sjette lag, //Duas lag//, liggende mellom stroma og Descemets membran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0,5 p for hvert lag, i alt 2,5 p.
Ang. //Duas lag//: Dette er nevnt i kursmanualen, så det er mulig noen studenter vil kunne nevne dette laget. Om noen skulle nevne dette i stedet for et av de andre ovenfornevnte lagene, så vil det gi 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan noen av lagene i kornea fortsetter over i andre anatomiske strukturer perifert for limbus.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Epithelium anterius corneae (korneaepitelet) går i limbus over i konjunktiva
# Lamina limitans anterior (Bowmanns lag) ender i limbusregionen, men noen beskriver at det går over i konjunktivas substantia propria og Tenons kapsel
# Substantia propria corneae (korneastroma) går over i sklera
# Lamina limitans posterior (Descemets membran) ender i limbus som Schwalbes linje, men noen beskriver at det går over i trabekelverket (reticulum trabeculare, ligamentum pectinatum)
# Epithelium posterius (endothelium camerae anterioris) vil gå over i trabekulære celler som kler de kollagene fibre i trabekelverket
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her kan studentene gi i prinsippet fem riktige svar, men det gis bare poeng for to. 0,5 p for hver, maks 1p på hele deloppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer i kornea er det som bidrar til at den er glassklar? (Det er flere faktorer, én gir 0,5 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Korneas tårefilm som glatter ut uregelmessigheter på korneas overflate
# Meget regelmessig oppbygd flerlaget plateepitel over hele kornea som er konstant fem cellelag tykt
# Ingen blod- eller lymfekar, dvs. at kornea er avaskulær
# Ingen myeliniserte nervefibre
# I stroma er det kollagene mikrofibriller med lik tykkelse og som ligger parallelt med lik avstand seg imellom. De kollagene fibrillene i de ulike lamellene ligger vinkelrett på hverandre (ortogonal array) som vil danne et diffraksjonsgitter
# Tynt epithelium posterius (endothelium camerae anterioris)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver faktor gir i prinsippet 0,5 p, men her må man vise skjønn i poenggivingen da det kan være litt overlapp mellom svarene.
F.eks. når det gjelder stroma, vil angivelse av bare et av punktene her gi poeng. Totalt 1,5 p for hele deloppgaven
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vedvarende økt intraokulært trykk fører til glaukom (grønn stær) som kan skade øyet og medføre irreversibelt synstap. En konsekvens av et slikt langvarig økt intraokulært trykk er en utbuling, ekskavering, av discus opticus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke strukturer går igjennom denne delen av øyet og hva er grunnen til at utbulingen skjer i dette området?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gjennom dette området går nervefibre (aksoner fra nervefiberlaget i retina som vil danne synsnerven) og a. v. centralis retinae
I dette området, kalt lamina cribrosa, er sklera svekket ved at laget er perforert, og discus vil bli presset ut, ekskavert, ved langvarig økt intraokulært trykk.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,5 p, i alt 1 p.
I første del vil angivelse av enten nervefibre og/eller blodkar gi poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Netthinneavløsning er en annen alvorlig tilstand i øyet som kan gi synstap. Da skjer det en løsning av pars nervosa retinae fra pigmentepitelet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er bakgrunnen for at en slik avløsning kan skje nettopp mellom disse to lagene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Under øyets utvikling invagineres øyeblæren og danne et øyebeger (optic cup), med to lag; det indre lag blir retinas pars nervosa, det ytre til pars pigmentosa. Sistnevnte gror sammen med det utenforliggende mesenkymale lag, som etter hvert vil bli Bruchs membran. Forbindelsen mellom de to retinalagene er mer løst og uten noen kontaktkomplekser og vil danne et intraretinalt rom utfylt med en matrix rik på bl.a. glykosaminoglykaner. Ved ulike sykelige tilstander representerer dette et svakt punkt, noe som medfører at pars nevrosa løsner mens pars pigmentosa sitter igjen festet til Bruchs membran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Henvisning til både embryologi, det intraretinale rom og ingen intercellulærkontakter mellom fotoreceptorer og pigmentepitel gir 1 p. Bare deler av dette svaret gir 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi hvilke oppgaver pigmentepitelet ivaretar og forklar hvilken betydning dette har for retinafunksjonen.
(Det er flere faktorer, angivelse av én gir 0,5 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pigmentepitelet har mange funksjoner i så henseende, bl.a.:
* Blodforsyning fra kapillærnettet i lamina choriocapillaris dekker ytre deler av retina (til og med stratum plexiforme externum)
* Pigmentepitelet utgjør en viktig del av den ytre blodretinabarrieren (den indre utgjøres av endotel), bl.a. pga. zonula occludens (tight junctions) mellom cellene i deres apikale deler. Dette regulerer bl.a. opptak av ioner, glukose, A-vitamin (retinol) og fettsyrer, m.m., samt beskytter retina mot toksiske stoffer, plasmakomponenter m.m.
* Pigmentepitelet produserer ulike vekstfaktorer og cytokiner for å opprettholde og bevare retinas funksjon m.m. (maintaince of the structural integrity of retina): kan ha beskyttende effekt på sanseceller, regulering av matrix, vaskularisering, osv.
* Pigmentepitelet regulerer og opprettholder retinas mikromiljø (homeostase) mhp. elektrolytter, pH, osv.
* Pigmentepitelet fagocyterer og degraderer fotoreseptorenes ytre segment (disci)
* Pigmentepitelet absorberer lys som bl.a. forhindrer dannelse av frie radikaler, som ellers kan ødelegge cellene
* Pigmentepitelet syntetiserer komponenter til Bruchs membran
* Pigmentepitelet utgjør en del av synssyklus ved regenerering av fotopigment (rhodopsin) (enzymatisk omdannelse av all-trans-retinal til 11-cis-retinal)
* Pigmentepitelet tar opp og omdanner A-vitamin (retinol) som inngår i syntesen av rhodopsin (som består av opsin og retinal, som er derivat av A-vitamin)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ovenfor er det oppgitt flere funksjoner, noen kanskje litt overlappende, så man får vise skjønn i poenggivingen, men i prinsippet gir angivelse av en funksjon el oppgave 0,5p, i alt 2p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Makuladegenerasjon er en sykdom som svekker skarpsynet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer i makulaområdet er det som bidrar til dette skarpsynet?
(Det er flere faktorer, angivelse av én 0,5 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Macula lutea med fovea centralis ligger der synsaksen treffer bak i øyet. Mot macula lutea øker antallet tapper på bekostning av staver, og sentralt i makulaområdet, fovea centralis, er det bare tapper og ingen staver. Her er også retina tynnere fordi den her består bare av fotoreseptorer, mens de øvrige av retinas lag er skjøvet lateralt. Det innebærer også at tappenes «aksoner» løper parallelt med retina til de danner synaptisk kontakt utenfor fovea. Dermed når lyset fotoreseptorene mer direkte. Tappene i dette området er også tynnere og lengre enn ellers i retina, de står tettere og helt parallelt. Hver tapp danner også bare synaptisk kontakt med en bipolar celle som igjen har kontakt med bare en gangliecelle (hvilket gir høy grad av bildeoppløselighet, dvs. flere pixler per arealenhet). Det er ingen blodkar på og retinas innside over fovea (dvs. mot corpus vitreum). Makulas gule pigment (utgjøres av xanthofyll (karotenoider danner to hovedgrupper: karotener og xanthofyll, xanthofyllene zeaxantin og lutein utgjør pigmentene i makula hos mennesket) avleiret i gangliecellene og i de bipolare cellene, bidrar til at lyset i større grad rettes mot tappene, videre absorberes eller filtreres skadelig lys (kortbølget lys) og ikke spres for mye, videre har dette laget antioksidativ effekt som beskytter tappene (fotobeskyttelse).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
I svaret over er det beskrevet flere faktorer som bidrar til skarpsynet, og man må vise skjønn i poenggivingen, men i prinsippet gir angivelse av en funksjon eller faktor 0,5 p, i alt 1 p.
Bare svaret «fovea centralis» gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antibiotika er en mye anvendt legemiddelgruppe. To viktige undergrupper er penicilliner og aminoglykosider
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort virkningsmekanismen til penicilliner og aminoglykosider.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Penicillin: Virker ved å hemme celleveggsyntesen (syntesen av peptidolykaner) slik at bakterien sprenges (https://www.legemiddelhandboka.no/L1.2.1/Antimikrobielle_midl er)
Aminoglykosider: virker ved å binde seg til ribosomer slik at bakterienes egen dannelse av proteiner hemmes. (https://sml.snl.no/aminoglykosider)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert riktige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Penicilliner har tidsavhengig bakteriedrap. Aminoglykosider har konsentrasjonsavhengig bakteriedrap.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hva som ligger i begrepene «tidsavhengig bakteriedrap» og «konsentrasjonsavhengig bakteriedrap», og fortell hvordan du prinsipielt vil dosere et penicillin og et aminoglykosid gjennom døgnet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tidsavhengig bakteriedrap: Tiden med legemiddelkonsentrasjon over MIC (T>MIC) er avgjørende for effekten. Selve konsentrasjonen av antibiotikumet har mindre betydning, så lenge den er over MIC-verdien. Konsentrasjonsavhengig bakteriedrap: Dette fenomenet innebærer at en høy toppkonsentrasjon vil resultere i et raskere og mer omfattende bakteriedrap.
https://tidsskriftet.no/sites/default/files/pdf2008--2750.pdf
Ved tidsavhengig bakteriedrap må en dosere hyppig når halveringstiden er kort, som for penicilliner. Ved konsentrasjonsavhengig bakteriedrap kan en dosere sjeldnere, men dosen må være høy nok hver gang. For eksempel dosere 1 gang daglig ved aminoglykosider, selv om halveringstiden skulle tilsi hyppigere dosering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for riktig svar på hver av de to definisjonene, 1 poeng for riktig resonnement omkring dosering
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dikloksacillin er et betalaktamasestabilt penicillin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva det innebærer at et antibiotikum er betalaktamasestabilt og gi et eksempel på en infeksjonstype der det er riktig å starte med et betalaktamasestabilt penicillin.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bakterier blir ufølsomme for penicilliner ved at det vokser frem varianter av bakteriene som klarer å inaktivere penicillinet. Inaktiveringen gjøres ved hjelp av et bakterielt enzym som kalles betalaktamase (penicillinase); det spalter betalaktamringen i penicillinmolekylet. Dette kan hindres ved å endre penicillinmolekylet, slik at betalaktamase ikke lenger kommer til, og gjør at antibiotikumet blir betalaktamasesatbilt.
Bakterietyper/infeksjonstyper: Stafylokokk-infeksjoner. Hudinfeksjoner. Osteomyelitter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for mekanisme. 0,5 poeng for infeksjonstype.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tilser en 34 år gammel kvinne i allmennpraksis. Pasienten er tidligere frisk, men har pådratt seg en pneumoni
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I din hypotetiske legekoffert har du kun to typer antibiotika: fenoksymetylpenicillin og amoksicillin. Hvilket av disse to legemidlene bør du velge til denne pasienten, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fenoksymetylpenicillin fordi det er mest smalspektret, men samtidig virksomt mot de fleste samfunnserhvervede pneumonier hos tidligere friske
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for rett legemiddel, 0,5 poeng for riktig begrunnelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Åtte dager senere kommer den samme pasienten tilbake til deg på legekontoret. Hun har tatt ferdig kuren du forskrev, men hun forteller at hun i forigårs brått utviklet et rødt utslett på brystet. Det klør ikke, men har etter hvert bredt seg utover hele overkroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det er flere måter å kategorisere bivirkninger på, men de fleste tilhører to hovedkategorier. Hva kaller vi disse bivirkningskategoriene og hva kjennetegner de?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Dose-relaterte, forutsigbare (type A)
* Ikke-dose-relaterte, uforutsigbare (type B)
(noen vil kanskje nevne c og d også, men dette er ikke «hovedkategorier». Om noen nevner disse kategoriene også kan det dra opp helhetsinntrykket av besvarelsen, men siden det ikke spørres om så skal det ikke gis poeng for) https://www.legemiddelhandboka.no/legacy/chapter/G5
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver riktig kategori
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
> Åtte dager senere kommer den samme pasienten tilbake til deg på legekontoret. Hun har tatt ferdig kuren du forskrev, men hun forteller at hun i forigårs brått utviklet et rødt utslett på brystet. Det klør ikke, men har etter hvert bredt seg utover hele overkroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan pasienten få samme antibiotikum senere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, pasienten kan bruke penicilliner senere. Dette er ikke straksallergi / type I-reaksjon / utrikarielt / IgE-mediert (da er senere bruk kontraindisert) – dette er mest sannsynlig en immunkompleksreaksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for «ja», 0,5 poeng for riktig begrunnelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
> Åtte dager senere kommer den samme pasienten tilbake til deg på legekontoret. Hun har tatt ferdig kuren du forskrev, men hun forteller at hun i forigårs brått utviklet et rødt utslett på brystet. Det klør ikke, men har etter hvert bredt seg utover hele overkroppen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er denne bivirkningen meldepliktig til RELIS/legemiddelverket? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei
Bivirkninger skal meldes ved mistanke om at bruk av ett/flere legemidler har gitt:
* Dødelige eller livstruende bivirkninger,
* Bivirkninger som har gitt varige alvorlige følger, eller
* Uventede eller nye bivirkninger (ikke omtalt i preparatomtalen)
https://legemiddelverket.no/bivirkninger-og-sikkerhet/meldbivirkninger/bivirkningsmelding-helsepersonell
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for «nei», 0,5 poeng for riktig begrunnelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Les det følgende forkortede og modifiserte sammendraget (abstractet) fra en vitenskapelig artikkel:
<<<
''Objective'': To investigate the risk of osteoporotic fracture with warfarin vs dabigatran in patients with atrial fibrillation (AF).
''Design'': Cohort study Exposures: Warfarin or dabigatran use during the study period
''Main outcomes and measures'': Risk of osteoporotic hip fracture and vertebral fracture was compared between warfarin and dabigatran users after adjustment for several potential confounders.
''Results'': The risk ratio was 2.6 when users of warfarin were compared to those using dabigatran. The association with lower risk for dabigatran use was shown in patients with a history of falls, fractures, or both but not in those without such a history.
''Conclusions'': … (deleted sentence) … Additional study, perhaps including randomized clinical trials, may be warranted to further understand the relationship between use of warfarin vs dabigatran and risk of fracture.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Første setning I konklusjonen er slettet fra abstractet. Hvilken behandling bør anbefales basert på disse resultatene, warfarin eller dabigatran? Hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dabigatran bør anbefales framfor warfarin fordi det var betydelig lavere risiko for brudd ved bruk av dabigatran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dabigatran bør anbefales framfor warfarin (1p)
Fordi det var betydelig lavere risiko for brudd ved bruk av dabigatran enn ved warfarin (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
”The risk ratio was 2.6 when users of warfarin were compared to those using dabigatran”
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tolk dette med egne ord.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienter som fikk warfarin hadde 2,6 ganger så høy risiko for hoftebrudd sammenliknet med dem som fikk dabigatran.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
«2,6 ganger så høy risiko»
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
«…adjusted for several potential confounders»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er kriteriene for at en variabel skal være en konfunder (confounder) for sammenhengen mellom eksponeringen (warfarin eller dabigatran) og sykdommen (hoftebrudd)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Variabelen må (1) være assosiert med både eksponeringen (warfarin eller dabigatran) og utfallet (hoftebrudd og vertebrale brudd), (2) men den må ikke være påvirket av (være en følge av) eksponeringen eller utfallet. Begge kriteriene må være oppfylt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Variabelen må (1) være assosiert med både eksponeringen (warfarin eller dabigatran) og utfallet (hoftebrudd og vertebrale brudd) (1 poeng), (2) men den må ikke være påvirket av (være en følge av) eksponeringen eller utfallet (1 poeng). Studenten angir at begge kriteriene må være oppfylt (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
«The association with lower risk for dabigatran use was shown in patients with a history of falls, fractures, or both but not in those without such a history.»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan det indikere hvis sammenhengen mellom eksponeringen og utfallet er forskjellig i en undergruppe?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det kan indikere interaksjon (effektmodifikasjon)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
effektmodifikasjon eller interaksjon (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
“Additional study, perhaps including randomized clinical trials, may be warranted to further understand the relationship between use of warfarin vs dabigatran and risk of fracture”
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste fordelen med en randomisert kontrollert studie sammenlignet med andre studiedesign?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Randomiserte studier er generelt betydelig mindre konfundert enn andre studiedesign.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Randomiserte studier er generelt betydelig mindre konfundert enn andre studiedesign. Det er akseptabelt om studenten skriver at randomiserte studier teoretisk sett ikke er konfunderte, eller skriver at randomiserte studier har mindre systematisk feil, eller skriver at den systematiske feilen som kan være til stede, er slik at den under- men ikke overestimerer de sanne effektene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to av de viktigste ulempene med randomiserte kontrollerte studier sammenlignet med andre studiedesign.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* En randomisert studie er ikke etisk akseptabelt for mange forskningsspørsmål
* Det er umulig å randomisere i mange situasjoner selv om det ville være etisk akseptabelt
* Høye kostnader
* Generelt kan bare de som samtykker bli inkludert
* Det er alltid en eksperimentell situasjon
* Compliance-problemer fra deltakerens side
* Generelt bare kort oppfølgingstid
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To av punktene over, 1 poeng for hver riktig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Immunresponsene ved infeksjoner varierer avhengig av typen patogen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilken betydning antistoff har ved primære og sekundære virusinfeksjoner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Antistoff har to hovedeffekter ved virusinfeksjoner: de kan ''forhindre opptak'' av virus i målcellene (''nøytralisasjon''), og de kan ''målstyre antistoff-mediert direkte cytotoksisitet'' (ADDC) som særlig utføres av NK-celler. Ved en primærinfeksjon har vi ikke spesifikt antistoff mot det aktuelle viruset på forhånd, men aktivering av B-celler og dannelse av plasmaceller som produserer antistoff inngår ofte som en del av responsen (selv om cytotoksisitet er vanligvis er hovedresponsen!). ''ADDC kan derfor først skje mot slutten av en primærinfeksjon''. Antistoffmediert ''virusnøytralisasjon er viktig ved sekundærinfeksjoner''. Det er mer effektivt å bekjempe en infeksjon ved å hindre virus i å etablere seg enn å skulle ta hånd om virus inni infiserte celler. Ved sekundærinfeksjon kan ADDC også starte raskt og bidra til å begrense infeksjonen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ p for nøytralisasjon
* ½ p for ADDC
* ½ p for primær- vs. sekundærinfeksjoner mht. Bcelleresponsene
* ½ p for NK-celler
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort de øvrige immunresponsene ved primære og sekundære virusinfeksjoner (dvs. de delene av responsen som ikke dekkes i deloppgave 1).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hovedforsvaret ved virusinfeksjoner er vanligvis ''drap av infiserte celler, utført av NK-celler og cytotoksiske T-celler''. Dette er nødvendig for å utrydde virus, som er intracellulære patogener.
NK-celler klarer sjelden å utrydde virus alene, selv om de spiller en stor rolle for forsvaret i tiden før effektorceller fra ervervet forsvar er utviklet. Derfor er T-cellemediert immunitet med dannelse av ''CD4+ hjelperceller'' som kan bidra til aktivering av ''CD8+ dreperceller'' svært sentrale immunresponser ved primære virusinfeksjoner. Ved sekundærinfeksjon vil ''hukommelsesceller'' raskt føre til effektiv T-cellemediert drap av infiserte celler og gjøre at infeksjonen raskere bekjempes. T-cellehjelp er også sentralt for de fleste antistoffresponser.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ p for hjelperceller og cytotoksiske T-celler
* ½ p for hukommelsesceller
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når ulike vaksiner mot SARS-CoV-2 blir testet ut, bruker man bl.a. telling av antall smittede i gruppene som har fått vaksine eller placebo til å måle vaksineeffekten. I tillegg inkluderer flere studier målinger av mengden spesifikt antistoff mot virus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken annen immunologisk respons enn antistoffdannelse ville vært nyttig å måle for å vurdere vaksineeffekten, og hvordan måles det? Hva er de mest sannsynlige grunnene til at undersøkelse av denne responsen oftest ikke blir inkludert i studiene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det ville vært nyttig å undersøke om den vaksinerte har utviklet en T-cellerespons. Den mest sentrale responsen her er ''T-cellemediert drap'' av SARS-CoV-2-infiserte celler. Det gjøres ved å isolere lymfocytter fra de vaksinerte personene og tilsette dem i ''cellekulturer hvor det også finnes antigenpresenterende celler''. Cellekultur er ''arbeidskrevende og tar tid''. For å unngå HMS-utfordringer ved arbeid med levende virus, kan man også kunstig syntetisere aktuelle virusproteiner som T-cellene kan reagere på. Også dette er en arbeidskrevende metode. Derfor blir T-celleundersøkelser bare inkludert hos et mindre antall av studiedeltagerne i enkelte studier. Man antar isteden at de som har en god spesifikk antistoffrespons, også har en adekvat Tcellerespons.
T-celler er også involvert ved antistoffresponsen på vaksinen. Testing av CD4+ T-cellers cytokinproduksjon er en metode for å måle dette. Krever også cellekultur. Men det er mye enklere å teste selve antistoffresponsen direkte, så dette er ikke et godt svar selv om det omtaler T-celler.
"Harde endepunkter" som antall smittede/alvorlige syke med og uten vaksine er det viktigste, fordi det avspeiler den samlede effektiviteten av forsvarsreaksjonen mot infeksjon. Men dette er ikke hva oppgaven mener med en immunologisk respons, fordi det også avhenger av mange andre faktorer som ligger utenfor immunforsvaret.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 p for T-cellefunksjoner – bør nevne cytotoksiske T-celler for fullt poeng
* ½ p for cellekultur, evt. at også trenger antigenpresenterende celler
* ½ p for tid- og arbeidskrevende
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
For de fleste typene vaksine mot SARS-CoV-2 benyttes to doser, evt. også senere boosterdoser. Denne fremgangsmåten brukes også for virusinfeksjoner hvor det ikke oppstår nye virusvarianter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor det er behov for å gi vaksinen flere ganger, og særlig til de eldste innbyggerne. Fokuser på årsaker knyttet til immunsystemet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vaksineresponsen er eksempel på effektene av immunologisk hukommelse, trigget av at innholdet i vaksinen eller protein som uttrykkes pga. vaksinen (mRNA-vaksine eller DNA-vaksine) oppfattes som fremmed.
# Sekundærresponsen (dvs. etter 2. vaksinedose) blir sterkere og gir derfor bedre beskyttelse. Det vil også skje isotypeskifte og affinitetsmodning av antistoffet (pga. somatisk hypermutasjon), som bidrar til bedre beskyttelse. (Den cytotoksiske T-celleresponsen vil også bli mer effektiv og det dannes flere T-hukommelsesceller).
# Uten ny kontakt med antigenet vil responsen gradvis avta, bl.a. ved at antistoffmengden reduseres, selv om det fortsatt finnes hukommelsesceller (T- og B-celler) som raskt kan aktiveres hvis man utsettes for SARS-CoV-2-smitte. Alle immunresponser nedreguleres når antigenmengden blir liten nok. Boosterdoser sørger for å vedlikeholde vaksineresponsen.
# Eldre har et mindre effektivt immunsystem, både for B- og T-celleresponser. De har bl.a. dårligere evne til å aktivere nye T-celler og er i stor grad avhengig av hukommelsesceller, som er en betydelig ulempe når de eksponeres for et "nytt" patogen som SARS-CoV-2. Med flere vaksinedoser er det mer sannsynlig at immunresponsen blir sterk nok til å gi beskyttelse, og den må i større grad holdes ved like for å være effektiv nok. Eldre har også dårligere evne til å produsere antistoff (bl.a. på grunn av dårligere T-cellehjelp og færre naive B-celler) og mindre effektivt medfødt forsvar, inkl. NK-celler.
# Eldre har generelt dårligere helse / flere tilleggssykdommer og mindre organreserver, og tåler infeksjoner dårligere. Dette punktet er ikke direkte knyttet til immunsystemet og går derfor utenfor forventet svar.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ p for sekundærrespons generelt
* ½ p for isotypeskifte, affinitetsmodning
* 1 p for nedregulering av immunresponsen og boosterdose for å opprettholde stimuleringen
* 1 p for mindre effektivt immunforsvar hos eldre (med noe presisering)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mange virus, inkludert SARS-CoV-2, gjennomgår hyppige mutasjoner som kan påvirke immunresponsene mot de ulike variantene. Slike mutasjoner kan også påvirke beskyttelsen fra vaksinene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar mekanismene for hvorfor små endringer i virusproteinene ofte ikke har stor betydning for antistoffbeskyttelsen fra vaksinene hvis man utsettes for smitte med SARS-CoV-2, mens større endringer kan føre til betydelig redusert beskyttelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Binding mellom antistoff og virusprotein er avhengig av "passformen" mellom dem ("nøkkel som passer i en lås"). Ved små endringer i virus vil antistoffet kunne bindes med noe redusert affinitet fordi konformasjonen av virusproteinet ikke endres dramatisk. Dessuten vil aktiverte B-hukommelsesceller kunne gjennomgå en ny runde med somatisk hypermutasjon som resulterer i bedre tilpasning av antistoffet til virusproteinet (affinitetsmodning). Ved store endringer vil antistoffet passe dårligere til virusproteinets konformasjon og gi dårligere evne til nøytralisasjon av virus. Dessuten vil tilstedeværelse av antistoff fra vaksinasjonen (selv om det ikke har så høy affinitet) hemme aktivering av nye naive B-celler. Derved er det vanskelig å få en sterk, ny respons mot et antigen som er relativt tett beslektet med et antigen man har møtt før. Vi vet ennå ikke i hvor stor grad blir bli et klinisk problem med SARS-CoV-2. Seleksjonspresset på viruset gjør at mutasjoner som reduserer immuniteten eller øker spredningsevnen vil velges ut, slik vi har sett med delta- og omikron-variantene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ½ p for binding med lavere affinitet
* ½ p for ny affinitetsmodning
* ½ p for dårligere nøytralisasjon ved mer endret antigen
* ½ p for hemmet aktivering av naive celler ("the original antigenic sin")
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
For å kunne vurdere sykelige forandringer i og omkring øyet, må man kjenne til normalanatomien.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Her ses et bilde av det ytre øyet med bokstavmarkeringer a-e som har tilhørende spørsmål under (Bilde: SH Torp).
<<imgLink "ICD-2022-2-A.PNG">>
# Hva heter det ytre glinsende vevslaget som kler det hvite på øyet?
# Hva heter det hvite laget under?
# Hva heter det lett eleverte området i mediale øyevinkel?
# Hva kalles dette fremre gjennomskinnelige laget på øyet?
# Hva heter den ytre sirkulære grunne furen som pilene peker på?
# Hva kaller man dette overgangsområdet i øyet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Tunica conjunctiva bulbi (øyets bindehinne)
# Sclera (senehinnen)
# Caruncula lacrimalis
# Cornea (hornhinnen)
# Sulcus sclerae
# Limbus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,25 poeng, maks. 1,5 poeng.
Ang. 1) bare «conjunctiva» og «øyets bindehinne» godtas også som riktige svar
Poengberegning: 1-2 riktige svar: 0,5 poeng, 3-4 riktige svar, 1 poeng; 5-6 riktige svar: 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved fare for skade av øyet er blunkerefleksen en viktig beskyttelsesmekanisme
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved opphevet blunkerefleks hvilke nerveforbindelser kan da være affiserte?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sensoriske afferenter går via n. trigeminus (n. ophthalmicus) (5. hjernenerve), motoriske via n. facialis (7. hjernenerve).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktig svar på hver hjernenerve, totalt 1 poeng.
Ang. sensorisk del (n. trigeminus): her får man poeng også om man svarer «n. trigeminus» eller bare «n. ophthalmicus».
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tørre øyne kan være forårsaket av flere ulike sykdommer, og dette kan medføre skade av øyets epitelbekledning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn noen av de strukturene som bidrar til å holde øyets overflate fuktig og på hvilken måte de bidrar.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Tårekjertel (gl. lacrimalis) produserer tårevæske
# Meibomske kjertler (glandulae tarsales) er store talgkjertler som skiller ut fettholdige produkter som forhindrer fordamping av tårevæske
# Conjunctiva inneholder begerceller som skiller ut mucin (slim) som bidrar til å holde øyet fuktig
# Corneas plateepitel har mikrovilli som binder tårefilmen og dermed beskytter dette epitelet. Dette epitelet bidrar, sammen med epitelet i conjunctiva, til dannelse og opprettholdelse av glykokalyks som utgjør et viktig og beskyttende lag av tårefilmen.
Andre kjertler: Aksessoriske tårekjertler (Wolfrings og Krauses kjertler) bidrar også til å lage/beholde tårefilmen, glandulae ciliares (Molls kjertler) nevnes også
Ref.: Brüel et al. Genesers histologi. Munksgaard. 2012; W Pawlina. Histology. A text and atlas. Walters Kluwer. 2016
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar med struktur og funksjon gir 0,5 poeng, inkludert også de angitt med liten skrift, maks. 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Alexander Fleming oppdaget penicillin i 1928. Kliniske studier, hvor den australske farmakologen Walter Howard Florey og den tyskjødiske biokjemikeren Ernst Boris Chain var sentrale, ble ikke igangsatt før etter en 10-årsperiode. Arbeidet, som stor grad foregikk i hemmelighet pga. utbruddet av 2. verdenskrig, fant sted ved universitetet i Oxford. En kollega av Florey og Chain omtalte penicillin som «a remarkable substance, grown in bedpans and purified by passage through the Oxford police force” (PNAS 1983; 80: 4572). Dyrking i bekken (bedpans) refererer til datidas primitive dyrkingsmetode for penicillumsoppen, og «passage through the Oxford police force» viser, avhengig av hva vi velger å tro, til en av de første penicillin-behandlede pasientene (som altså var en politimann som ble behandlet i 1941) eller de første «friske frivillige» i de kliniske utprøvingene – hvor man samlet urin og gjenvant midlet derfra.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kunne det ha seg at penicillin kunne gjenvinnes fra urinen til de første brukerne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Penicillin utskilles uomdannet i urinen, og kunne – i den tiden de hadde små mengder – isoleres og renses fra pasienturin – og deretter injiseres til samme pasient …. eller nestemann…...
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
«Utskilles uomdannet i urin» holder for 1p. Intet annet duger
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
En av dine pasienter ringer deg og forteller følgende: Han var på legevakta i helga og ble satt på en ukes behandling med fenoksymetylpenicillin pga. lungebetennelse. Pasienten har stått på CYP2D6-hemmeren paroksetin (Seroxat®) det siste halvåret pga. tilbakevendende depresjonsepisoder, og drikker 1-2 glass av CYP3A4- hemmeren grapefruktjuice til frokost hver dag. «På apoteket sier de at begge disse stoffene kan påvirke andre legemidler», sier pasienten. «Kan det også påvirke penicillinbehandlingen?» Hva svarer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, fenoksymetylpenicillin metaboliseres ikke, og påvirkes følgelig heller ikke av CYP-hemmere.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
«Utskilles uomdannet i urin” (jfr. spm. 1) ”metaboliseres ikke” eller liknende varianter gir full pott; intet annet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Penicillin er ofte implisert ved type B-bivirkninger. Hva står B’en for, hva slags bivirkninger er dette og hvor stor andel av alle bivirkninger er av denne typen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Type B står for «bisarr» (0,25 p). Dette er bivirkninger som kun opptrer hos et fåtall, og som hverken kan forutses eller relateres til dose (0,5 p).
Type B-bivirkninger utgjør 20-25% av alle bivirkninger; resten er av type A (0,25 p).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Se over
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
To andre viktige undergrupper av antibiotika er makrolider og cefalosporiner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kortfattet virkningsmekanismen til makrolider og cefalosporiner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Minimum som trengs for å få poeng er følgende:
Makrolider: Makrolidene bindes til bakterienes ribosomer og hindrer proteinsyntesen. L1.2.8 Makrolider | Legemiddelhåndboka (legemiddelhandboka.no)
Cefalosporiner: Som andre betalaktamantibiotika virker de ved å hemme celleveggsyntesen. L1.2.4 Cefalosporiner | Legemiddelhåndboka (legemiddelhandboka.no)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Et halvt poeng for hvert riktige svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Erytromycin er et makrolid. Et av problemene med å bruke erytromycin er at middelet gir interaksjoner med mange andre legemidler. En interaksjon kan være farmakodynamisk eller farmakokinetisk. Forklar kort hva en farmakokinetisk og en farmakodynamisk interaksjon er. Hva er den viktigste mekanismen bak interaksjoner utløst av erytromycin, og er dette en farmakodynamisk eller en farmakokinetisk interaksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Farmakokinetiske interaksjoner oppstår ved at et legemiddel forandrer absorpsjonen, distribusjonen, metabolismen eller ekskresjonen til et annet legemiddel slik at konsentrasjonen i kroppen endres. Farmakodynamiske interaksjoner oppstår ved at et legemiddel direkte eller indirekte påvirker effekten av et annet legemiddel uten at legemidlets konsentrasjon forandres. G6 Interaksjoner | Legemiddelhåndboka (legemiddelhandboka.no)
Makrolider metaboliseres i leveren via cytokrom P-450 systemet gjennom isoenzymene CYP1A2 og CYP3A4. Makrolidene hemmer CYP3A4, og dermed også metabolismen av andre legemidler som omsettes av dette enzymet. Bruk av makrolider innebærer derfor en betydelig risiko for legemiddelinteraksjoner i form av økt konsentrasjon av bl.a. antiepileptika, ciklosporin, ergotamin, metylprednisolon, lovastatin, warfarin og en rekke andre legemidler. L1.2.8 Makrolider | Legemiddelhåndboka (legemiddelhandboka.no). Dette er en farmakokinetisk interaksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver riktig definisjon. 0,5 poeng for mekanismen, 0,5 poeng for riktig type interaksjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vi sier gjerne at antibiotika kan være smalspektrede eller bredspektrede. Forklar kort hva vi legger i disse to begrepene og hvorfor det er viktig å ha kunnskap om denne forskjellen. Gi et typisk eksempel på et smalspektret og et bredspektret antibiotisk legemiddel.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Noen antibiotika virker bare på et begrenset utvalg av bakterier, for eksempel særlig på de grampositive, og kalles derfor smalspektrede (effektive mot et fåtall ulike bakterier). Andre angriper grampositive og gramnegative bakterier mer likt og kalles bredspektrede (altså effektive mot mange ulike bakterier).
Benzyl- og fenoksymetylpenicillin er eksempel på et smalspektret antibiotikum
Ciprofloksacin er eksempel på et bredspektret antibiotikum antibiotika – Store medisinske leksikon (snl.no)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig def, 0,5 poeng for hvert eksempel. Her må en vise litt skjønn og kanskje ikke være VELDIG streng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det første kommersielt tilgjengelige antibiotikum var ikke et penicillinpreparat, men representant for en type bakteriostatiske midler som ble utviklet på 1930-tallet av den tyske patologen og bakteriologen Gerhard Johannes Paul Domagk. Slike midler er i dag i begrenset bruk. Hva kalles de?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sulfapreparater eller sulfonamider. Det første – som Domagk stod bak – het prontosil.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sulfa, sulfapreparater eller sulfonamider gir alle 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En av dine pasienter (en 75 år gammel kvinne) har nettopp vært innlagt på Medisinsk avdeling på grunn av vekttap, slapphet og dårlig matlyst over de siste 3-5 månedene. Hun har kjent diabetes mellitus type 2 fra før, men den har hele tiden vært godt regulert. I en lang og komplisert epikrise er det kommentert at hun har «nyresvikt», og du merker deg følgende laboratorieverdier / data:
Høyde 166 cm, vekt 52 kg,
s-kreatinin 155 μmol/l (50-90)
eGFR 28 ml/min/1.73 m2
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv / definer Glomerulær Filtrasjons Rate (GFR) og en ideell filtrasjonsmarkør, og hva som er forskjellen mellom kreatinin clearance og GFR?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# GFR er den totale mengden filtrat/pre-urin som produseres og flyter ut i Bowmans rom per minutt, ofte normalisert til en standard kroppsoverflate på 1.73m2
# En ideell markør filtreres fritt over membranen, og det er ingen reabsorbsjon fra eller sekresjon til tubulus.
# Kreatinin clearance er ca 20% høyere enn GFR fordi kreatinin sekreres fra blod og ut i tubuli i tillegg til å bli fritt filtrert over glomerulus membranen. Clearance er altså hvor mye av blodet som blir renset per minutt, dvs summen av filtrasjon og sekresjon av et stoff
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p per underspørsmål.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke nyrefunksjoner er direkte og indirekte assosiert med GFR?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Direkte: utskillelse av nitrogenholdige avfallsprodukter, fremmede stoffer, vann, elektrolytter,
Indirekte: syre-base kontroll, hormon produksjon (Epo, vit D),
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hvert av punktene ovenfor, max 1.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvilke kliniske og anatomiske forhold som påvirker GFR, herunder hvilke fysiske krefter som bestemmer effektivt filtrasjonstrykk over filtrasjonsmembranen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
GFR= total overflate av filtrasjonsmembranen x filtrasjonstrykket.
Overflaten bestemmes av antall nefroner og om nyresykdom har gjort at antall/lengde av glomeruluskapillærene er redusert pga celleinfiltrater eller bindevev som presser kapillærene sammen og til slutt oblitererer sirkulasjonen. Filtrasjonstrykket bestemmes av systemisk blodtrykk, balansen mellom motstanden i afferente og efferente arteriole, og kreftene over membranen (hydrostatisk trykk glom cap – hydrostatisk trykk bowman – osmotisk trykk glom cap + osmotisk trykk bowman (men dette er nesten alltid=0 da det ikke er proteiner i filtratet, og man kan dermed se bort fra dette))
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for momenter markert i gult, 0,2 p for momenter markert i grønt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan måler man GFR direkte ved norske sykehus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I Norge måles GFR ved å injisere en nøyaktig oppmålt mengde av et stoff intravenæst, og så ta blodprøver ved ett eller flere tidspunkter for å se hvor raskt stoffet fjernes fra kroppen. Man bruker enten radioaktivt merket bærermolekyl (Cr EDTA, Tc DTPA, el) eller Iohexol (rtg kontrast). Det finnes så formler som beregner GFR utfra injisert mengde og serum konsentrasjoner på de ulike tidspunkter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hvert av punktene ovenfor
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke problemer er det med å bruke s-kreatinin til å bedømme nyrefunksjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sammenhengen mellom s-kreatinin og GFR er ikke linjær, men eksponentiell slik at det er vanskelig å beregne i hodet. Skreatinin varierer også med andre variabler enn GFR: muskelmassen har stor innvirkning på s-kreatinin og denne varierer med flere generelle / gruppevariabler (synker med alder, lavere hos kvinner), og i tillegg varierer s-kreatinin med en rekke individuelle variabler som inntak av kjøtt, om man trener og bygger muskler, hydreringsgrad, sykdom og underernæring gir muskeltap, hard trening kan gi muskelskade og utslipp av kreatinin til blodet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,33 p for hvert moment marker med grønt (eksponentiell gir 0,66 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan man beregne kreatinin clearance, og hvilke fordeler og ulemper har denne metoden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kreat clearance (ml per minutt) = u kreat x u volum (ml per minutt) / s kreat.
Fordelen er at kreatinin er en endogen markør slik at man slipper å injisere noe stoff.
Problemet er at det er tubulær sekresjon slik at clearance er større enn GFR (men dette kan være en fordel ved vurdering av en del medikamentdoseringer da en del medikamenter også sekreres), og dessuten forutsetter man korrekt urinvolum-måling hvilket er vanskelig i praksis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for formelen, 0,25 p for grønne momenter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siri er en 44 år gammel tobarnsmor bosatt i Trondheim. Den siste tiden har hun følt et diffust ubehag i abdomen og en dag oppdager hun friskt blod i avføringen. Hun tar umiddelbart kontakt med sin fastlege som henviser henne videre til gastroenterologisk avdeling på St. Olavs Hospital for videre utredning. Ved koloskopi blir det påvist en tumor (2 x 3 cm) i nedre del av tykktarmen (sigmoideum). En biopsi bekrefter at tumoren er malign (ondartet). Tumoren blir fjernet lapraskopisk (kikkhullsteknikk) og sendt til Avd. for Molekylær Patologi for ytterligere analyse. Analysen påviser betydelig mikrosatellittinstabilitet (MSI-H; MSI-high).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken molekylærgenetisk metode vil være egnet til å påvise mikrosatellitt-instabilitet? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Polymerase chain reaction (PCR) og påfølgende fragmentanalyse (som regel ved kapillærelektroforese). Som regel anvendes et panel bestående av >5 utvalgte mikrosatellitter for denne analysen. Normalvev inkluderes som kontroll.
Ved MSI vil mikrosatellittene (som er repeterte sekvenser av 2-6 nukleotider; eks. ''CAG''CAG''CAG''CAG) variere i lengde i ulike tumorceller. Metoden som velges må derfor være i stand til å bestemme lengde på fragmenter. Ved PCR anvendes primere som flankerer mikrosatellitten(e). Amplifiserte mikrosatellitter blir deretter lengdebestemt ved kapillærelektroforese, hvor det anvendes standarder med kjent lengde. Ved MSI vil en for en gitt mikrosatellitt få mange ulike lengder av de amplifiserte fragmentene. I normalt vev vil en person være heterozygot, med én definert lengde for hvert allel.
DNA sekvensering ved Next generation sequencing KAN være en metode som er egnet, men dette er nylig utviklede metoder som ennå ikke godt utprøvd og validert, og som krever spesiell bioinformatisk analyse for klassifisering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
PCR + fragmentanalyse for å bestemme lengdene av mikrosatellittene. (1 poeng)
Om studenten svarer NGS bør det legges vekt på hvilken begrunnelse studenten oppgir før det evt. gir poeng. NGS er ikke angitt som foretrukken metode for MSI analyse i forelesninger, og er (ennå) ikke standard metode for å påvise MSI i molekylær patologi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På grunn av Siris unge alder (44 år) blir det tatt en blodprøve som blir sendt til Avd. for Medisinsk Genetikk for genetisk analyse. Denne viser at Siri er heterozygot for en inaktiverende mutasjon i MSH2, et protein involvert i DNA mismatch reparasjon (MMR).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hovedprinsippene ved DNA mismatch reparasjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MMR er et multiprotein reparasjonsspor som korrigerer ulike typer DNA replikasjonsfeil (unike misinkorporeringer, samt insersjoner og delesjoner). Heterodimerer av MSH2 og MSH6 (komplekset kalles MutS) detekterer mismatcher og enkeltbase insersjoner/delesjoner, mens heterodimerer av MSH2 og MSH3 (komplekset kalles MutSβ) detekterer større «replikasjonsbobler»på opptil 13 baser. Deretter rekrutteres en annen heterodimer, MLH1/PMS2 (kalt MutL) sammen med PCNA. Dette stimulerer tilbakekutting (ved eksonukleasen EXO1) forbi replikasjonsfeilen i dattertråden. Det «tomme» området fylles så igjen med DNA polymerase og ligeres med DNA ligase 1. MMR- systemet foretar alltid korrigeringene i den nysyntetiserte DNA-tråden, men eksakt hvordan templat/dattertråd blir identifisert er enda ikke helt klart. En tror det med jevne mellomrom oppstår midlertidige trådbrudd i den nysyntetiserte tråden (kanskje fordi RNA-baser feilinnsettes oftere enn før antatt, og disse fjernes ved at det først dannes et trådbrudd ved RNA-basen), og at disse tjener til å dirigere reparasjon til riktig tråd.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvilke skader som gjenkjennes (0.5 poeng), at reparasjon er dirigert til nysyntetisert tråd (0.5 poeng), + navn og funksjon på protein(kompleksene) involvert (tot 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forskning har vist at mikrosatellitt-instabilitet skyldes feil som oppstår under DNA-replikasjonen. I cellene våre finnes flere mekanismer som skal sikre at den akkumulerte feilfrekvensen (Accumulated Error Frequency, AEF) skal holdes på et lavt nivå (under 1 feil per cellegenerasjon). Her spiller blant annet ulike DNA-reparasjonsprosesser en viktig rolle.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre mekanismer kjenner du til som bidrar til å senke AEF?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Preferensiell baseparing (A:T/C:G), induced fit (i DNA polymerasen), balansert nivå av A, T, C og G, proofreading (eksonukleaseaktivitet i DNA polymerasen)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av de fire mekanismene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siri opplyser at hennes 68 år gamle pappa fikk påvist kreft i tykktarmen for tre år siden, og at også hans mamma (Siris farmor) fikk påvist endometriekreft før hun var 60 år. Mutasjon i gener involvert i DNA mismatch reparasjon (MMR) er typisk for Lynch syndrom. Sykdommen nedarves autosomalt dominant, og er karakterisert av tidlig debut av flere kreftformer (kolorektal, i endometrium, duodenum, nyrebekken/ureter, ventrikkel, lever- og galleganger, bukspyttkjertel, eggstokker mfl.), hvorav kolorektal-kreft dominerer i de fleste familier. At Siri er heterozygot for mutasjonen betyr at hennes celler har noe redusert evne til å reparere DNA-skader via MMR, men ikke tilstrekkelig redusert til at det i seg selv fører til kreft
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen som fører til at Lynch syndrom nedarves dominant?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MMR-gener inngår i klassen tumor suppressor gener. Begge kopiene av et tumor suppressor-gen må inaktiveres eller tapes før en person vil utvikle kreft (Knudsons two-hit hypotese, loss of heterozygosity, LOH). Hvorvidt en person som har en kjønnscelle-mutasjon vil utvikle kreft og hvor kreften vil utvikle seg, avhenger av hvor (hvilken celletype) den andre mutasjonen oppstår.
Ved arv av mutasjon vil alle somatiske celler ha mutasjonen (og da som regel i heterozygot form). Risikoen er derfor stor for at det andre (normale allelet) på et eller annet tidspunkt i en eller annen celle inaktiveres eller tapes. Derfor sees høyere risiko for kreft og tidligere debutalder enn ved sporadisk kreft.
Life time risk for kreft (enhver form) med inaktiverende mutasjon i MSH2 er anslått til 70-80%.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At MMR gener defineres som tumor suppressor-gener (1 poeng) – samt beskrivelse av prinsippet bak Knudsons two-hit hypotese (1 poeng) (behøver ikke nevne Knudson/LOH, men prinsippet må beskrives)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siri har to barn, Marius på 19 og Anne på 15 år. Siri har også en søster, Maren, som er 47 år. Siris fastlege har nå fått beskjed fra Medisinsk genetisk avdeling at Siri har en arvelig mutasjon i MHS2 som gir betydelig økt risiko for kreft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør fastlegen foreta seg i forhold til Siris barn og til Maren?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ifølge bioteknologiloven §5.9 kan ikke fastlegen på eget initiativ velge å kontakte Maren eller Siris barn.
Det er den som har testet seg som avgjør om familien skal informeres om testresultatet. Vedkommende kan få hjelp av helsepersonell til å gjøre dette dersom han/hun ønsker det. Et unntak gjelder dersom vedkommende ikke kan informere (fordi han/hun er uten bevissthet eller er død). Da kan helsepersonell på eget initiativ oppsøke familien forutsatt at visse kriterier er oppfylt.
Fastlegen bør derfor oppfordre Siri til selv å informere barna og Maren om mutasjonen.
Gentesting av barn skal normalt utsettes til de er fylt 16 år og selv kan bestemme, med mindre testingen gjør at man kan starte forebyggende behandling.
I denne sammenheng kan Marius velge å teste seg om han vil. Anne, som er 15, bør vente til hun er 16 år og selv kan bestemme. Kolorektalkreft ved Lynch syndrom debuterer ofte i yngre alder, og man anbefaler derfor koloskopi annet hvert år fra 25 års alder.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At fastlegen på egen hånd ikke kan velge å kontakte Maren eller Siris barn (0.5 poeng).
Et svar som at fastlegen ikke bør foreta seg noe gir IKKE poeng.
Fastlegen bør oppfordre Siri til selv å fortelle barna og Maren om mutasjonen. Det er den som har testet seg som avgjør om familien skal informeres om testresultatet (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Maren er frisk, men har nå valgt å teste seg for å se om hun kan ha arvet samme mutasjon som Siri.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type test er det her snakk om (diagnostisk, presymptomatisk, prediktiv, bærerdiagnostisk), og hva sier bioteknologiloven om denne typen test?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gentesting av friske personer er strengt lovregulert. I denne situasjon er det snakk om en ''prediktiv test'' – som sier noe om fremtidig risiko for sykdom (det er viktig å huske at gentester for sykdomsrisiko ikke gir svar på om du helt sikkert kommer til å utvikle sykdommen).
* En presymptomatisk test derimot, som f.eks. ved Huntingtons sykdom, sier noe om du vil, eller ikke vil, utvikle sykdommen.
* En bærerdiagnostisk test sier noe om risikoen for å videreføre en sykdomsassosiert mutasjon til neste generasjon. Ved en bærertilstand (heterozygot) vil ikke den som tester seg selv utvikle sykdommen.
* En diagnostisk test tas innenfor helsevesenet med den hensikt å bekrefte eller avkrefte en diagnose.
Dersom en frisk, voksen person vurderer å ta en gentest som kan gi prediktiv, presymptomatisk eller bærerdiagnostisk informasjon, har du også krav på genetisk veiledning før du eventuelt tar testen. Det er fordi du skal kunne gjøre et valg basert på best mulig informasjon før du eventuelt gir samtykke til å gjennomføre testen. Dette skal gis skriftlig.
Det er stor forskjell på om en syk person blir testet for å kunne få en diagnose og om en helt frisk person ønsker å teste seg for å få vite noe om fremtidig risiko for sykdom hos seg selv eller hos fremtidige barn. De sykdommene man ønsker å teste friske personer for, må derfor godkjennes for dette. Institusjonene som skal utføre gentestingen, må også godkjennes.
Det er ikke krav om skriftlig samtykke for å gjennomføre diagnostiske gentester (som var tilfelle med Siri).
<<imgLink "ICD-2022s-1-A.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Prediktiv test (0.5 poeng) – og at det skal gis genetisk veiledning før du eventuelt tar testen. Evt. samtykke skal være skriftlig (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mutasjonen som Siri fikk påvist i MSH2 var tap av ett basepar (A:T basepar) tidlig i exon 3.
MSH2-genet har 16 exons som til sammen koder for 934 aminosyrer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvorfor denne mutasjonen med stor sannsynlighet vil gi opphav til et ikke-funksjonelt MSH2 proteinet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tap av ett basepar gir leserammeskift. I de aller fleste tilfeller fører den endrede leserammen etter mutasjonen til dannelsen av et prematurt STOP-kodon, og kraftig avkortet polypeptidkjede. I dette tilfellet ligger mutasjonen tidlig i exon 3 (av totalt 16 exons), noe som tilsier at det ikke vil produseres noe funksjonelt MSH2 protein.
Ca 80% av inaktiverende mutasjoner i MSH2 er «truncation mutations» (dvs. gir opphav til leserammeskift og prematurt stopkodon).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar (dvs. leserammeskift og prematurt stop-kodon. At det er tidlig i polypeptidkjeden øker sannsynligheten for inaktivt produkt).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er lege på en helsestasjon. Du møter mor og et barn (jente) på 3 mnd. Mor forteller om et svangerskap uten komplikasjoner. Hun opplevde fødselen noe traumatisk da den endte i et hastekeisersnitt. Det var startvansker med amming, men det gikk seg til etter noen uker. Hun forteller at jenta smilte da hun var 5 uker gammel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vurderer du jentas sosiale utvikling (normal/unormal) ut ifra disse opplysningene? Begrunn kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Normal
* Sosialt smil skal senest være til stede ved 6 uker.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Normal (0.5 poeng)
* Begrunnelse at sosialt smil skal være til stede senest ved 6 uker (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre milepæler/ferdigheter ser du etter sammen med det sosiale smilet i løpet av spedbarnets første leveuker? Nevn minst en.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Riktig svar kan være:
* Blikkontakt
* Løfte hodet eller snu hodet i mageleie
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for et av de overstående alternativene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke reflekser er det aktuelt å undersøke ved dette helsestasjonsbesøket (3 mnd)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Søke-sugerefleks
* Mororefleks
* Palmar griperefleks
* Plantar griperefleks
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver riktig refleks
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mor er litt bekymret for at jenta virker litt slapp i muskulaturen når hun holder henne
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du undersøke dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Traksjonsreaksjon
* Generell observasjon av tonus i ulike stillinger
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for traksjonsreaksjon (eller en beskrivelse som passer med traksjonsreaksjon), 0,5 poeng for generell observasjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mor og barn kommer tilbake til deg på 6 mnd kontroll på helsestasjonen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva forventer du av jentas motoriske utvikling på dette tidspunktet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Riktige svar kan være:
* God hodekontroll
* Underarmstøtte/strakarmstøtte i mageleie
* Ruller fra mage til rygg
* Forsøk på krabbebevegelser
* Pivotering i mageleie
* Leker med hendene i midtlinjen i ryggleie
* Griper etter leker
* Snur hodet mot lydkilder
* Sitter med støtte
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for et av overstående alternativer (inntil 4 riktige = 2 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Jenta kommer til 1-års kontroll sammen med mor. Mor er bekymret for at jenta ikke går ennå og lurer fortsatt på om noe kan være galt. Du observerer at jenta setter seg opp selv og reiser seg opp fra gulvet og støtter seg til mors knær.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva gjør du? Begrunn hvorfor.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Samtale. Trygger mor på at det er normalt at ikke alle barn går ved 1 års alder, da median alder for å gå i Norge er 13 måneder og det først er ved 18 mnd at det anses som seint og noe som bør undersøkes videre. Du blir ikke bekymret fordi du ser at jenta setter seg opp selv og reiser seg opp til stående med støtte.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for samtale om at dette er normalt.
* 0,5 poeng for å begrunne med en av tidsangivelsene
* 0,5 poeng for at jenta setter seg opp selv
* 0,5 poeng for at jenta reiser seg
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kristian bor sammen med sin søster Lise. Kristian har en alvorlig sinnslidelse og går på medisiner. Ofte vil han ikke ta medisinene, og problemet hans med vrangforestillinger øker. Lise vurderer å blande medisinen i maten hans.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan er de legale og etiske forholdene omkring det å blande medisiner i maten til en pasient?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I helsetjenesten er det å blande medisiner i maten forstått som tvang. Det kreves et vedtak på tvang før man kan gjøre dette. Å blande medisiner i maten kan i noen tilfeller være risikofylt med tanke på tillit. Om det oppdages, kan det være ødeleggende for tillitsforholdet mellom helsearbeider og pasient.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å påpeke at dette er å anse som tvangsbehandling når det skjer i helsetjenestens regi. 1 poeng for å ha drøftet tillitsaspektet som er relevant både innenfor og utenfor helsetjenesten.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kristian har blitt dårligere. Lise mener han bør innlegges for psykiatrisk behandling. Kristian ønsker ikke slik behandling. Behandling under tvang blir da et tema.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan tvang i helsetjenesten etisk forsvares, når vi samtidig ønsker å respektere pasientens selvbestemmelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det viktigste etiske forsvaret for tvang, er omsorg – at vi bryr oss. Samtidig vil vi mene at tvang ikke nødvendigvis bryter så sterkt mot selvbestemmelsen dersom det er «sykdommen som snakker» og ikke pasienten selv. I så fall er ikke pasienten samtykkekompetent, og vedkommende må respekteres må en annen måte (gjennom økt innslag av omsorg) enn ved respekt for selvbestemmelsen. Mennesker skal ha lov til å velge å gå til grunne i samfunnet vårt, men da må det være som et resultat av et valg, og ikke som et resultat av sykdom.
Videre kan tvang forsvares utfra at pasienten vil være takknemlig for dette, dersom pasienten hadde vært seg selv, eller når pasienten blir seg selv.
I tillegg har samfunnet enn etisk og legitim rett til å beskytte seg mot psykisk syke pasienter som er farlige for andre.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det mange måter å formulere gode svar på, og de kan skjønnsmessig vurderes fra 1-3 poeng avhengig av hvor mange av momentene beskrevet ovenfor som er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I psykisk helsevern vurderer man å legge inn Kristian på tvang. Først av alt må samtykkekompetansen vurderes.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil det egentlig si å ha samtykkekompetanse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Samtykkekompetanse vil i hovedsak si at pasienten har innsikt i og er i stand til å vurdere konsekvensen av sine valg etter at tilstrekkelig informasjon er gitt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full pott her, er det viktig at studenten har skjønt at samtykkekompetanse i bunn og grunn er konsekvensforståelse. Om noen studenter velger å fokusere på hva som skal til for at en pasient //mangler// samtykkekompetanse, så er det greit. Men også her er det mest sentrale at pasienten åpenbart ikke er i stand til å ta valg eller forstå rekkevidden av egne valg.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når Kristian vurderes innlagt med tvang, er det av hensyn til hans egen helse og muligheten til å gi ham god behandling. Det finnes imidlertid et annet kriterium for tvangsinnleggelse i psykisk helsevernloven som ikke primært er begrunnet i den mulige behandlingsgevinsten for pasienten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags begrunnelse kan gis for tvunget psykisk helsevern dersom det ikke primært handler om behandlingsgevinst for pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I loven er det to ulike veier inn til tvang - det såkalte «behandlingskriteriet» og «farekriteriet». Her er det altså «farekriteriet» vi er ute etter. Da er det samfunnshensynet som står på spill – hensynet til andre borgeres liv og helse. Pasienten behandles da egentlig ikke for sin egen skyld, men for å verne samfunnet mot fare. Farekriteriet rommer imidlertid også muligheten for tvang når pasienten utgjør en alvorlig fare for sitt eget liv.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studentene har kun fått en enkel innføring i helseretten på dette feltet, og derfor skal ikke lista legges før høyt. 1 poeng til alle som klarer å si noe om «farekriteriet» eller på en eller annen måte nevner «samfunnshensyn» som er den vesentlige forskjellen fra behandlingskriteriet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Behandling med tvang står i direkte motsetning til samtykkebasert behandling. Likevel er det mulig å peke på en dypere etisk forbindelse mellom de to. «Antatt samtykke» er et uttrykk som ofte dukker opp i etiske debatter rundt tvangsbehandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan «antatt samtykke» hjelpe oss til å tenke etisk godt rundt tvangsbehandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
«Antatt samtykke» er ikke nevnt i lovgivningen vår, men har dukket opp i utredninger om psykiatrien ved flere anledninger. Tanken er at når pasienter behandles med tvang etter behandlingskriteriet, så bør behandlingen kunne bestå en test om at pasienten ville ha ønsket denne behandlingen om han/hun hadde tenkt klart. Eller sagt på en annen måte; pasienten vil være takknemlig for denne behandlingen når han/hun blir frisk. Denne måten å tenke på, er interessant etisk sett. Det ville eksempelvis være en stor etisk utfordring for oss om det store flertallet av pasienter som behandles med tvang i psykiatrien, i ettertid (når samtykkekompetansen er på plass) ikke opplevde tvangen som riktig, nyttig eller nødvendig. «Antatt samtykke» gjør det mulig å se en dypere etisk forbindelse mellom tvang og samtykke, slik at de ikke bare fremstår som enkle motpoler. Legitim tvang skal vi tenke som at tvangen må kunne være ønsket/villet fra pasienten når han/hun er seg selv igjen og sykdommen ikke lenger snakker.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dette er den mest «filosofiske» og kanskje mest krevende delen av besvarelsen. Samtidig ligger noe av svaret allerede implisitt i begrepet «antatt samtykke». Her må det brukes skjønn og sensor må vurdere hvor solid studentens forståelse er fra 0-2 poeng gitt svar-beskrivelsen ovenfor. Temaet er gjennomgått i forelesning
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Marianne er 35 år og gravid med sitt første barn. Ved kontroll i svangerskapsuke 28 måler legen et blodtrykk på 145/96. Dette er litt for høyt. Pga blodtrykket sendes hun til kontroll ved sykehuset. På sykehuset gjør man ultralyd som viser at barnet er litt lite i vekst og det besluttes derfor også å gjøre en blodstrømsmåling av uterinarterien
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv forløpet til uterinarterien fra aorta til kapillærene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Aorta deler seg i to, høyre og venstre A. Iliaca communis,
# denne deler seg i A. iliaca interna og A. iliaca externa.
# A. uterina går av fra A. iliaca interna.
# A. uterina kommer inn ved nedre del av uterus (istmus) og går oppover laterale side av uterus og
# spiralarteriene går av fra A. uterina og inn i uterus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½-1 poeng for delvis beskrivelse, 1,5 for komplett
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Siden Marianne er gravid, har hun en placenta i uterus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv placenta og navlesnorens anatomi makroskopisk
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Svaret må inneholde disse tre poengene:
# Maternell side med lobes mot livmorveggen
# Føtal side med hinner (chorion og amnion) og navlesnor,
# 3 kar i navlesnor
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ -1 poeng for delvis beskrivelse, 1,5 for komplett
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mariannes blodtrykk fortsetter å stige til tross for at hun får blodtrykkssenkende medisiner. Det er også proteiner i urinen. Hun diagnostiseres med svangerskapsforgiftning. Fordi tilstanden til Marianne er alvorlig bestemmes det at hun må forløses med keisersnitt i svangerskapsuke 34.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved et keisersnitt er det mange strukturer i bekkenet kirurgen må ta hensyn til. Hvilke organer finner vi i bekkenet hos kvinner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Urinblæren, uterus, 2 eggledere, 2 ovarier (eggstokker), rektum
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,4 poeng per organ, totalt 2 (maks)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket organ er det viktigste organet å tenke på i forbindelse med et keisersnitt (foruten uterus)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Urinblæren
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mariannes lille gutt ble født i svangerskapsuke 34^^+0^^
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor mange uker er det da siden fertilisering fant sted?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
32 uker
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv utviklingen fra fertilisering til implantasjon (uke 1).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Utviklingen kan deles i flere stadier:
# Fertilisering, hovedsakelig i egglederen. Celledeling;
# 2-cellestadiet,
# 4-cellestadiet,
# morula,
# blastocyst, og
# implantasjon dag 6-8
<<imgLink "ICD-2022s-4-A.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ca ½ poeng pr stadium, maks 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann 50 år oppsøkte fastlegen pga. dyspepsi, og han ble henvist til gastroskopi. Biopsier fra ventrikkelslimhinnen viste forandringer forenlig med helicobactergastritt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke histopatologiske forandringer i ventrikkelslimhinnen vil patologen kunne beskrive hos pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Histopatologi ved helicobactergastritt:
# Kronisk uspesifikk gastritt med lymfocytter, plasmaceller og makrofager i lamina propria, evt. med lymfocyttaggregat og lymfefollikler. 0.5 p
# Kronisk aktiv gastritt med infiltrasjon av nøytrofile granulocytter i lamina propria og i kjertler. 0.5 p
# Atrofisk gastritt: langvarig helicobactergastritt disponerer for en kronisk atrofisk gastritt. 0.5 p
# Intestinal metaplasi. 0.5 p
# Helicobacterkolonier i slimlaget på overflateepitelet (overveiende i antrumregionen). 0.5 p
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kommentar: for å få 1 p totalt på disse to delspørsmålene kreves det i svaret fra studenten at det skal være både mononukleære celler (lymfocytter og plasmaceller (makrofager ikke så viktig i denne sammenhengen) og nøytrofile granulocytter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke premaligne/maligne lesjoner disponerer helicobactergastritt for i ventrikkelen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Helicobactergastritt disponerer for følgende maligne tilstander i ventrikkel:
# Dysplasiutvikling i kjertelepitelet. 0.5 p
# Adenokarsinom i ventrikkel av intestinal type. 0.5 p (bare adenokarsinom 0.25 p)
# Lavgradig malignt B-cellelymfom av typen MALT-lymfom («mucosa-associated lymphoid tissue»). 0.5 p (bare lymfom 0.25 p)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kommentar: for å få 1 p totalt på disse to delspørsmålene kreves det i svaret fra studenten at det skal være både mononukleære celler (lymfocytter og plasmaceller (makrofager ikke så viktig i denne sammenhengen) og nøytrofile granulocytter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten fikk antibiotika for utrydding av helicobacterinfeksjonen med god effekt. Etter noen år fikk han på ny sterke smerter i epigastriet. Ved gastroskopi ble det nå påvist en akutt gastritt samt et ulcus pepticum i duodenum.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke komplikasjoner til ulcus pepticum i duodenum kan utvikles hos pasienten? (Nevn minst fire)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Komplikasjoner til ulcus pepticum:
# Blødninger: enten sivblødning med anemi eller en mer alvorlig arteriell blødning.
# Ulcus perforatum (perforasjon ut i fri bukhule).
# Ulcus penetrans (penetrasjon i naboorganer).
# Arrdannelse med fibrose og obstruksjon.
# Peritonitt.
Duodenalsår antas ikke å bli maligne.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann i 70-årene ble innlagt medisinsk avdeling med diagnosen hjerneslag. Røntgenologisk undersøkelse bekreftet diagnosen. Pasienten kom ikke til bevissthet. Etter noen dager utviklet han feber og hoste, og han sovnet stille inn. Det ble rekvirert obduksjon. Nevropatologisk undersøkelse avslørte i høyre storehjerne-hemisfære et akutt hemorragisk infarkt samt en fersk tromboembolus i arteria cerebri media dxt. I tillegg ble det påvist betydelige trombemasser i høyre karotisbifurkatur samt en akutt bronkopneumoni. Det viste seg også at pasienten hadde en insulinkrevende diabetes mellitus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre ikke-traumatiske årsaker til intracerebrale/parenkymatøse hjerneblødninger forekommer hos voksne? (Nevn minst fem)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Andre årsaker til ikke-traumatiske parenkymatøse hjerneblødninger:
# Hypertensjonsblødning.
# Cerebral amyloid angiopati med lobær hjerneblødning. (Én av disse betegnelsene er tilstrekkelig for poeng)
# Blødning i tumor
#* Kommentar: typiske tumores med blødninger er gliomer (især glioblastom) og metastaser (især metastatisk malignt melanom). (Type tumor ikke påkrevet)
# Arteriovenøse malformasjoner.
# Hemangiomer (kavernomer).
# Aneurismeblødninger (som sakkulære aneurismer)
#* Kommentar: slike aneurismeblødninger kan også bare gi subaraknoidalblødning, som er vanligst).
# Hematoproliferative sykdommer (som leukemier).
# Antikoagulantia.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige supplerende vignett:
En mann i 70-årene ble innlagt medisinsk avdeling med diagnosen hjerneslag. Røntgenologisk undersøkelse bekreftet diagnosen. Pasienten kom ikke til bevissthet. Etter noen dager utviklet han feber og hoste, og han sovnet stille inn. Det ble rekvirert obduksjon. Nevropatologisk undersøkelse avslørte i høyre storehjerne-hemisfære et akutt hemorragisk infarkt samt en fersk tromboembolus i arteria cerebri media dxt. I tillegg ble det påvist betydelige trombemasser i høyre karotisbifurkatur samt en akutt bronkopneumoni. Det viste seg også at pasienten hadde en insulinkrevende diabetes mellitus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sett opp en dødsmelding basert på de funn som ble gjort under obduksjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Punkt Ia: Akutt bronkopneumoni
* Punkt Ib: (i denne rekkefølgen:)
** Ferskt hemorrhagisk hjerneinfarkt
**Tromboemboli i art. cererbri media dxt.
**Aterosklerose i karotisbifurkaturen
* Punkt II: Diabetes mellitus
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 45 år gammel mann med diabetes type 1 av 15 års varighet kommer på allmennlegekontoret ditt. Han forteller at han for to dager siden merket akutt innsettende flytere i synsfeltet på høyre side. Dette har han ikke oppøevd tidligere. Du undersøker pasienten. Du dilaterer pasientens pupille og finner i rød refleks sorte flak som beveger seg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diagnosen er corpusblødning. 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 45 år gammel mann med diabetes type 1 av 15 års varighet kommer på allmennlegekontoret ditt. Han forteller at han for to dager siden merket akutt innsettende flytere i synsfeltet på høyre side. Dette har han ikke oppøevd tidligere. Du undersøker pasienten. Du dilaterer pasientens pupille og finner i rød refleks sorte flak som beveger seg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er begrunnelsen for diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sykehistorien (akutt innsettende flytere i synsfeltet som han ikke har sett tidligere) og rødrefleksfunnet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for hvert delsvar, totalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 45 år gammel mann med diabetes type 1 av 15 års varighet kommer på allmennlegekontoret ditt. Han forteller at han for to dager siden merket akutt innsettende flytere i synsfeltet på høyre side. Dette har han ikke oppøevd tidligere. Du undersøker pasienten. Du dilaterer pasientens pupille og finner i rød refleks sorte flak som beveger seg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige årsaken til pasientens symptomgivende tilstand?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Karnydannelse i netthinnen som følge av diabetisk proliferativ retinopati.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 45 år gammel mann med diabetes type 1 av 15 års varighet kommer på allmennlegekontoret ditt. Han forteller at han for to dager siden merket akutt innsettende flytere i synsfeltet på høyre side. Dette har han ikke oppøevd tidligere. Du undersøker pasienten. Du dilaterer pasientens pupille og finner i rød refleks sorte flak som beveger seg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste alternative årsak til pasientens symptomer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Retinal rift med påfølgende corpusblødning.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 45 år gammel mann med diabetes type 1 av 15 års varighet kommer på allmennlegekontoret ditt. Han forteller at han for to dager siden merket akutt innsettende flytere i synsfeltet på høyre side. Dette har han ikke oppøevd tidligere. Du undersøker pasienten. Du dilaterer pasientens pupille og finner i rød refleks sorte flak som beveger seg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom pasienten hadde merket subakutt innsettende flytere; hvilke diagnoser ville du da ha tenkt på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Posterior (bakre uveitt), retinal vaskulitt og chorioretinitt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p dersom 1 riktig svar, ikke ekstrapoeng dersom 2 eller 3 riktige.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det sentrale momentet i utviklingen av proliferativ retinopati og hvilket cytokin er sentralt i denne prosessen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Retinal ischemi med produksjon av VEGF
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for hvert delsvar, totalt 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to tilstander i netthinnen som primært kan betegnes som vaskulært betingede retinopatier
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
*Retinal sentral/grenarterieokklusjon
* Retinal sentral/grenveneokklusjon
* Prematuritetsretinopati.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver diagnose oppad begrenset til 2.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har vakt på medisinsk avdeling på et lokalsykehus da en 25 år gammel mann fra Iran legges inn med feber (39*C), frysninger og slapphet. Hans faste lege har funnet en bilyd over hjertet og legger pasienten inn med mistanke om infeksiøs endokarditt (IE). Mannen har ingen kjent hjertesykdom, men sier han hadde mange halsinfeksjoner med streptokokker som barn og at han har fått diagnosen reumatisk feber i hjemlandet. Han har også vært innlagt i hjemlandet med IE tidligere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke risikofaktorer har denne pasienten for IE?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tidligere gjennomgått infeksiøs endokarditt (IE) utgjør en sterk risikofaktor for ny IE. Reumatisk feber fører til økt risiko for klaffesykdom og IE
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 for hvert riktig svar – totalt 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner også en diastolisk bilyd over hjertet, og blir styrket i din mistanke om at dette kan være IE. Etter å ha undersøkt pasienten konferer du med din bakvakt, og hun/han spør om det er noen immunologiske eller vaskulære tegn som styrker mistanken om infeksiøs endokarditt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke immunologiske eller vaskulære tegn er det bakvakten tenker på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Immunologiske tegn (1 poeng):
#* Glomerulonefritt (urin)
#* Oslers knuter (fingerpulpa)
#* Roths flekker (retina).
# Vaskulære tegn (1 poeng):
#* Arterielle embolier (CNS, nyre, milt, tær)
#* Septiske lungeinfarkter (ved høyresidig IE)
#* Mykotiske aneurysmer (CNS)
#* Intrakraniell blødning
#* Janeway lesjoner (hud)
#* Splintblødninger (negleseng)
#* Konjunktivablødninger
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2 poeng for begge svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Grunnet styrket mistanke om IE legger du pasienten inn på medisinsk avdeling til videre utredning og behandling. Det er lørdag ettermiddag og lav aktivitet på sykehuset ellers.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke undersøkelser mener du bør utføres i løpet av helgen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Repeterte blodkulturer
# Røntgen thorax
# EKG
# Ekkokardiografi (transøsofagal ved sterk mistanke).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av de 4 undersøkelsene. Maks 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Videre undersøkelser viser at det er en stor vegetasjon på 1.5 cm i diameter på fremre mitralseil. Vakthavende mikrobiolog ringer også neste dag og sier de finner fule stafylokokker forenlig med Staphylococcus aureus i blodkultur.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling starter du og hvordan skal pasienten følges opp videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Behandling'': dicloxacillin i.v. (Diclocil 2g x 4-6) og gentamicin i.v. (Garamycin 1-2 mg/kg x3).
''Oppfølging'': Staphylococcus aureus i blodkultur gir ofte en rask destruksjon av hjerteklaffene og store vegetasjoner (over 1 cm) gir økt risiko for embolisering. Begge disse faktorene indikerer behov for kirurgi. Diskuter derfor pasienten med hjertespesialist og hjertekirurg for å bli enig om videre behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver antibiotika, totalt 1 p. 1 poeng for vurdering for kirurgi.
Totalt 2 poeng for begge svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter 1 uke med antibiotika blir pasienten plutselig veldig tung i pusten. Et røntgenbilde viser betydelig lungestuvning. Pasienten virker hemodynamisk ustabil.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva tror du har skjedd og hvordan skal pasieten behandles videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har sannsynligvis fått akutt hjertesvikt. Bakenforliggende årsak kan være perforasjon av klaffeseil, ruptur av mitral chordae, klaffeobstruksjon av stor vegetasjon eller plutselig oppstått intrakardiell shunt på bakgrunn av fisteldannelse.
Ta umiddelbart kontakt med hjertespesialist for ekkokardiografi og gi beskjed til hjertekirurg om situasjonen som har oppstått. Pasienten trenger sannsynligvis raskt kirurgi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hjertesvikt. 0.5 poeng for hvert tiltak – maks 1 poeng.
Maks 2 poeng for alt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten overlever denne episoden og ett år etter kommer han til deg for å få råd om hvilke tiltak han skal gjennomføre for å hindre at han får dette tilbake. Han tenker spesielt på en visdomstann han skal operere ut neste uke
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forebyggende råd gir du til denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bakteremi med munnhulebakterier som viridans streptokokker utgjør en risiko for IE. Generelt er god munnhygiene viktig for å redusere denne risikoen.
I tillegg anbefales det antibiotika-profylakse til pasienter med gjennomgått IE i forbindelse med kirurgiske inngrep i munnhulen som involverer manipulering av gingiva eller periapikalt tannområde område eller perforasjon av oral mucosa. Denne pasienten trenger derfor profylakse som består av amoxicillin p.o. (Imacillin tbl. 2 g x 1) 30-60 minutter før inngrepet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for forebyggende antibiotika og 0.5 poeng for korrekt valg – totalt 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nedre luftveisinfeksjoner (i praksis pneumoni) er hyppigste infeksjonsrelaterte dødsårsak. Når det gjelder pneumoni ervervet utenfor sykehus kan vi se et vidt spektrum av kliniske manifestasjoner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør greie for hva som er karakteristisk for henholdsvis atypisk pneumoni versus akutt alvorlig pneumoni med henblikk på:
# Hyppigste agens
# Kliniske særtrekk
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hyppigste agens
#* Akutt pneumoni: Viktigst S. pneumoniae (pneumokokker) som må være med. Neste alternativer vil kunne variere men vanligst ses H. influenzae, S. aureus og i enkelte geografiske områder L. pneumophila (0.5p)
#* Atypisk pneumoni: Mycoplasma pneumoniae og Chlamydophila pneumonia (0.5p)
# Kliniske særtrekk
#* Akutt pneumoni: Oftest akutt debut, kraftige ledsagesymptomer som høy feber evt frostanfall, frysninger, hodepine og uttalt sykdomsfølelse. Etter hvert mer lokaliserte symptomer som hoste, ekspektorasjon etter hvert mer purulent ekspektorat, evt pleurasmerter. (1p)
#* Atypisk pneumoni: Snikende, mer langtrukket forløp, som regel hatt symptomer på øvre luftveisinfeksjon noen tid forut(dager til 1-2 uker) før symptomene peker klart på pneumoni, ofte mindre feber, allmentilstanden ofte relativt god (kalles av og til "walking pneumonia") (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør greie for hvilke mikrobiologiske analyser og hvorfor du vil rekvirere disse hos en innlagt pasient med pneumoni for å kartlegge etiologisk agens.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Blodkulturer hører med i utredningen; ved pneumokokk-pneumoni vil mange (kanskje opp mot 30 %) ha positiv blodkultur (1p).
* Mikroskopi av ekspektorert materiale vil kunne gi en god indikasjon på aktuell bakterie (forutsetter representativt materiale fra nedre luftveier). (0.5p)
* Dyrkning av ekspektorat gjøres ofte, men vil ofte kunne være noe misvisende på grunn av tilblanding fra øvre luftveier. (0.5p)
* For atypisk pneumoni vil analyse av materiale fra øvre luftveier også være av verdi da det ikke er vanlig med normal flora av Mycoplasma pneumoniae, Chlamydophila pneumoniae. For sistnevnte agens vil PCR analyse være mest hensiktsmessig (halssekret evt nasopharynx aspirat). Ved problemstilling mulig viral årsak vil også PCR analyser være hensiktsmessig (f.eks influensa, metapneumovirus, RSvirus m.fl). (0.5p)
* Ved mistanke om Legionella vil urinantigen kunne være positiv i ca 75 %, men det er viktig å vite at antigentesten bare tar serogruppe 1. PCR er utmerket analyse på materiale fra nedre luftveier. Hvis man ønsker Legionella-dyrkning må dette rekvireres spesifisert da denne bakterien ikke vokser på rutinemessig benyttede dyrkningsmedier (blod og sjokoladeagar). (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken antibiotikabehandling vil du initialt påbegynne ved en alvorlig, antatt bakteriell pneumoni, med henblikk på aktuelle agens og deres følsomhet/resistens for antibiotika? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Siden det her er spesifisert alvorlig pneumoni vil flere regimer kunne være aktuelle. Primært ville foretrekkes at studenten svarer 3. generasjon cefalosporin + et makrolid (1poeng) da cefalosporinet gir god og bred dekning (inkl resistente H. influenzae, pneumokokker ved evt nedsatt penicillinfølsomhet, S. aureus og mange Gram-negative) og makrolidet dekker Legionella og årsaker ved atypisk pneumoni) (1 poeng). Dette er stresset i forelesning, men samtidig gjort oppmerksom på at nasjonale retningslinjer anbefaler benzylpenicillin + aminoglykosid og evt tillegg av makrolid ved klinisk mistanke om Mycoplasma eller Legionella (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mikroskopi av ekspektorat kan være en god indikator på aktuell etiologi. Hvilke momenter ved mikroskopi skal vektlegges for å vurdere om et prøvemateriale er representativt for nedre luftveier?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Primært ønskes spesifisert at materialet skal inneholde lite eller intet med plateepitelceller (mye plateepitel viser tilblanding fra munnhule og materialet vil da ikke være representativt). Tilstedeværelse av mange leukocytter støtter infeksjonsvurdering og funn av dominerende mikrobe vil kunne være en brukbarindikator på etiologisk agens. Jeg synes ikke eksakt tallangivelse trenger å være med (i undervisning sagt: representativt hvis <10 plateepitelceller og > 25 leukocytter per synsfelt ved 100X forstørrelse).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar – maks 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mannlig pasient på 55 år kommer til deg på allmennlegekontoret fordi han har en kul på 2x2 cm under det venstre øret. Den har vokst gradvis siden han oppdaget den for ca. ett år siden. Du tenker at det kan være en infeksjon i ørespyttkjertelen (glandula parotis) og vil se om det kommer puss ut fra utførselsgangen når du masserer over kulen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor munner utførselsgangen fra ørespyttkjertelen ut?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
På innsiden av kinnet like lateralt for nest bakerste molar i overkjeven (17 og 27).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det kommer intet puss og kulen er uøm. Det har ikke vært sikre infeksjonstegn, og blodprøver inklusive CRP og hvite blodlegemer er innenfor det normale. Det har ikke vært noen sikker størrelsesvariasjon. Du tenker nå at det kan dreie seg om en svulst.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det vanligst med ondartede eller godartede svulster i ørespyttkjertelen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er vanligst med godartede svulster (80% godartede og 20% ondartede)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken er den vanligste godartede svulsten som forekommer her [ørespyttkjertelen]?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den vanligste er pleomorft adenom (spyttkjertel blandingstumor).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør godartede svulster i ørespyttkjertelen fjernes? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Disse spyttkjertelsvulstene bør fjernes kirurgisk da de kan transformeres til ondartede svulster over tid, særlig ette 10 år. Antatt transformasjonsrate ca 10% etter 15 år. Man må da selvsagt også ta hensyn til pasientens alder og forventede gjenværende levealder når dette vurderes, sammen med komorbiditet og operasjonsrisiko for øvrig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kulen sitter nokså overflatisk under huden [ørespyttkjertelen], og det kan synes som det er ganske enkelt å ta en biopsi i lokalbedøvelse for å få et godt histologisk materiale til rask og nøyaktig diagnose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er ikke dette rett fremgangsmåte? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, en kan lett skade facialisnerven – spesielt hvis tumor sitter i den dype lappen og løfter nerven opp mot huden.
Dersom det er en ondartet svulst kan kreftceller spres ut i det omkringliggende vevet og huden og det gjør det vanskeligere å oppnå radikal behandling.
Dersom det er et pleomorft adenom (som er mest sannsynlig) kan dette recidivere (multifokalt) hvis man åpner kapselen og da øker faren for ondartet transformasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den riktige fremgangsmåten for å få riktig diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det tryggeste er å få utført en punksjonscytologisk prøve. En unngår da problemene ovenfor og en får
vanligvis rikelig materiale til at en erfaren patolog kan stille riktig diagnose, i alle fall skille mellom en ondartet og en godartet svulst i de fleste tilfeller.
En trygg måte å gjøre dette på er ved å henvise til en ”tumor colli poliklinikk” eller annen poliklinikk hvor det tas punksjonscytologiske prøver med samtidig ultralydveiledning. Billeddiagnostikk alene gir ingen eller liten informasjon om histologi (selv om PET er mer sensitiv mhp malignitet).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når du gjør en orienterende nevrologisk undersøkelse finner du at pasienten har litt svekket evne til å rynke pannen og lukke øyet skikkelig på venstre side. Han klarer heller ikke å trekke munnviken like langt ut til siden når han blir bedt om dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det som foreligger her og hvordan forklarer du dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det foreligger en perifer facialisparese (til forskjell fra sentral facialisparese). Dette skyldes at svulsten infiltrerer nerven som passerer gjennom glandula parotis.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tenker nå at dette også kan dreie seg om en ondartet svulst i ørespyttkjertelen som alternativ til en godartet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre funn ved en slik klinisk undersøkelse kan støtte at det kan dreie seg om en ondartet svulst?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# At konsistensen er hard og knudrete (i motsetning til myk og elastisk).
# At tumor er fiksert til hud eller underlag (i motsetning til fritt bevegelig).
# At det foreligger sekundærsvulster (metastaser) på halsen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ondartede svulster i en lokalisasjon i kroppen kan være enten primære eller sekundære (metastaser)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken histologi er vanligst ved metastaser i parotis? Hvor skal en lete etter en mulig primærsvulst?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, det finnes lymfeknuter inne i parotis som kan inneholde metastase. Dette er oftest fra plateepitelcarcinomer (eller maligne melanomer noe sjeldnere). Utgangspunktet er oftest hud fra samme side av hodet, helst tinning, øre og hodebunn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har forvakt på medisinsk avdeling på et mellomstort sykehus, og tilkalles til akuttmottaket for å undersøke en 55 år gammel mann som er innlagt pga økende tung pust, slapphet og respirasjonsavhengige smerter siste døgn. Du tar opp anamnese og gjør en klinisk undersøkelse.
Han er tidligere stort sett frisk, bruker ingen faste medisiner, og sluttet å røyke for ca. 5 år siden.
Han har hatt hoste, sykdomsfølelse og feber ca. 38,5 grader i ca. 10 dager. For 5 dager siden kontaktet han fastlegen og fikk penicillin tabletter for sannsynlig pneumoni, men han har ikke merket bedring etter dette.
Ved klinisk undersøkelse perkuterer du dempning et lite område baktil over høyre lunge. Du hører spredte inspiratoriske knatrelyder over både høyre og venstre lunges bakflater, mest uttalt i midtfeltene. BT 130/90; temperatur 38,6 grader. For øvrig er status normal.
Oksygenmetningen er 95% med 2 liter oksygen på nesekateter
Du får svar på noen blodprøver som er tatt i akuttmottaket: CRP 105 (Ref : <5); Kreatinin clearance normal, litt lav NaCl, men ellers normale elektrolytter.
Du mener pneumoni er mest sannsynlig diagnose og rekvirerer videre utredning, oppfølging og behandling
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser til pneumoni bør du vurdere, og hvilke undersøkelser kan du
utføre eller rekvirere for å utelukke eller bekrefte disse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungeemboli og akutt hjerteinfarkt. Forhøyet D-dimer kan indikere tromboembolisk sykdom, men svært usikkert parameter når CRP er forhøyet. Vurderer indikasjon for CT lungearterier ut fra algoritme for sannsynlighet for lungeemboli. Tar EKG for å utelukke hjerteinfarkt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 2 poeng; 1 poeng for lungeemboli med forslag CT lungearterier og 1 poeng for akutt
hjertesykdom med EKG (eller ultralyd av hjertet)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du har forvakt på medisinsk avdeling på et mellomstort sykehus, og tilkalles til akuttmottaket for å undersøke en 55 år gammel mann som er innlagt pga økende tung pust, slapphet og respirasjonsavhengige smerter siste døgn. Du tar opp anamnese og gjør en klinisk undersøkelse.
Han er tidligere stort sett frisk, bruker ingen faste medisiner, og sluttet å røyke for ca. 5 år siden.
Han har hatt hoste, sykdomsfølelse og feber ca. 38,5 grader i ca. 10 dager. For 5 dager siden kontaktet han fastlegen og fikk penicillin tabletter for sannsynlig pneumoni, men han har ikke merket bedring etter dette.
Ved klinisk undersøkelse perkuterer du dempning et lite område baktil over høyre lunge. Du hører spredte inspiratoriske knatrelyder over både høyre og venstre lunges bakflater, mest uttalt i midtfeltene. BT 130/90; temperatur 38,6 grader. For øvrig er status normal.
Oksygenmetningen er 95% med 2 liter oksygen på nesekateter
Du får svar på noen blodprøver som er tatt i akuttmottaket: CRP 105 (Ref : <5); Kreatinin clearance normal, litt lav NaCl, men ellers normale elektrolytter.
Du mener pneumoni er mest sannsynlig diagnose og rekvirerer videre utredning, oppfølging og behandling
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan resonerer du m.h.t at pneumoni er sannsynlig diagnose, og det faktum at pasienten allerede har fått fem dagers behandling med penicillin, og ellers er tidligere frisk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten kan ha pneumoni forårsaket av bakterie som ikke er følsom for penicillin, eks Hemofilus Influenzae. Man må også mistenke en virusinfeksjon som har gitt pneumoni eller en atypisk pneumoni med mycoplasma eller Chlamydia eller legionella som ikke responderer på penicillin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 3 poeng; 1 poeng for Hemofilus Influenzae og 1 poeng for atypisk pneumoni virus/mycoplasma/chlamydia; 1 poeng for Legionella
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du har forvakt på medisinsk avdeling på et mellomstort sykehus, og tilkalles til akuttmottaket for å undersøke en 55 år gammel mann som er innlagt pga økende tung pust, slapphet og respirasjonsavhengige smerter siste døgn. Du tar opp anamnese og gjør en klinisk undersøkelse.
Han er tidligere stort sett frisk, bruker ingen faste medisiner, og sluttet å røyke for ca. 5 år siden.
Han har hatt hoste, sykdomsfølelse og feber ca. 38,5 grader i ca. 10 dager. For 5 dager siden kontaktet han fastlegen og fikk penicillin tabletter for sannsynlig pneumoni, men han har ikke merket bedring etter dette.
Ved klinisk undersøkelse perkuterer du dempning et lite område baktil over høyre lunge. Du hører spredte inspiratoriske knatrelyder over både høyre og venstre lunges bakflater, mest uttalt i midtfeltene. BT 130/90; temperatur 38,6 grader. For øvrig er status normal.
Oksygenmetningen er 95% med 2 liter oksygen på nesekateter
Du får svar på noen blodprøver som er tatt i akuttmottaket: CRP 105 (Ref : <5); Kreatinin clearance normal, litt lav NaCl, men ellers normale elektrolytter.
Du mener pneumoni er mest sannsynlig diagnose og rekvirerer videre utredning, oppfølging og behandling
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke prøver kan du rekvirere for å få en spesifikk mikrobiologisk diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blodkulturer, prøve fra nese/svelg for direkte påvisning av mikrober, antigen hurtigtest for påvisning av pneumokokker eller legionella i urin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 1 poeng; må ha med blodkulturer pluss enten prøve fra nese/svelg og/eller antigen test for å få 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du har forvakt på medisinsk avdeling på et mellomstort sykehus, og tilkalles til akuttmottaket for å undersøke en 55 år gammel mann som er innlagt pga økende tung pust, slapphet og respirasjonsavhengige smerter siste døgn. Du tar opp anamnese og gjør en klinisk undersøkelse.
Han er tidligere stort sett frisk, bruker ingen faste medisiner, og sluttet å røyke for ca. 5 år siden.
Han har hatt hoste, sykdomsfølelse og feber ca. 38,5 grader i ca. 10 dager. For 5 dager siden kontaktet han fastlegen og fikk penicillin tabletter for sannsynlig pneumoni, men han har ikke merket bedring etter dette.
Ved klinisk undersøkelse perkuterer du dempning et lite område baktil over høyre lunge. Du hører spredte inspiratoriske knatrelyder over både høyre og venstre lunges bakflater, mest uttalt i midtfeltene. BT 130/90; temperatur 38,6 grader. For øvrig er status normal.
Oksygenmetningen er 95% med 2 liter oksygen på nesekateter
Du får svar på noen blodprøver som er tatt i akuttmottaket: CRP 105 (Ref : <5); Kreatinin clearance normal, litt lav NaCl, men ellers normale elektrolytter.
Du mener pneumoni er mest sannsynlig diagnose og rekvirerer videre utredning, oppfølging og behandling
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de respirasjonsfysiologiske forklaringene på hypoksemi ved pneumoni?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved interstitiell pneumoni er årsaken primært ventilasjons/perfusjonsforstyrrelser. Ved bronkopneumoni og især lobær pneumoni spiller shunting en større rolle.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 2 poeng; 1 poeng for ventilasjons/perfusjonsforstyrrelser og 1 poeng for shunting
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du konkluderer med at pasienten har en alvorlig pneumoni ervervet utenfor sykehus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken medikamentell behandling vil du gi pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Behandling av alvorlig pneumoni erhvervet utenfor institusjon:
Dersom tilstanden oppfattes som atypisk pneumoni forårsaket av mykoplasma eller klamydia er riktig antibiotika valg Erytromycin eller doksycyklin. Ved bakteriell pneumoni uten sikker effekt av penicillin (eks H. Influenzae) kan man legge til et aminoglykosid (eks gentamicin) eller seponere pecicillin og gi et tredje generasjons cefalosporin (eks Cefotaksim).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 2 poeng; 1 poeng for erytromycin og/eller doksylin; 1 poeng for å legge et aminoglykosid til penicillin og/eller seponere penicillin og gi et tredje generasjons cefalosporin (eks Cefotaksim).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke virulensfaktorer gjør tarmpatogene mikrober i stand til å forårsake infeksiøs gastroenteritt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# toksiner (entero, cyto, nevro)
# evne til adheranse til tarmslimhinnen
# evne til å invadere tarmslimhinnen (lokal- systemisk)
# selektiv inhibisjon/destruksjon av absorptive celler i mikrovilli
# andre faktorer (bevegelighet, kjemotaksiner, mucinproduksjon, proteinsekresjonssystem etc)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det viktig å kartlegge i anamnesen hos en pasient med mistanke om infeksiøs gastroenteritt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# for å vurdere alvorlighetsgrad: hvor lenge har hun/han vært syk, hvor hyppige uttømninger, diurese, feber, blod i avføringen?
# vurdere etiologi: reiseanamnese
# vertsfaktorer: kroniske sykdommer, graviditet?
# smittevern: flere syke (utbrudd), hvilken jobb har hun/han (arbeid med pasienter i helseinstitusjon, med næringsmidler, i barnehage)?
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan tas og forsendes prøve til det mikrobiologiske laboratoriet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Prøven tas på transportmedium når den skal dyrkes for å sikre at mikroben overlever transporten. Viktig med kort transporttid dersom mistanke om Shigella/ E. histolytica.
Andre prøver kan sendes på steril/ ren beholder. Må være godt skrudd til for å unngå lekkase.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvordan mikrober som forårsaker diare kan påvises i det mikrobiologiske laboratoriet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Dyrkning med standard dyrkningsagar. For enkelte agens (feks Vibrio cholera) må en i tillegg benytte egne dyrkningsmedier.
# Mikroskopi (ulike fargemetoder inkl immunfluorescens) for påvisning av protozoer og helminter
# Antigenpåvisning med feks ELISA kan benyttes for tarmpatogene virus
# PCR benyttes i økende grad for både bakterier, virus og parasitter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de to vanligste årsakene til infeksiøs gastroenteritt oppstått i sykehus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Clostridium difficile og Norovirus
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du arbeider som allmennlege i en bypraksis, og har bl.a. ansvar for et ektepar som er småbarnsforeldre. En dag kommer kona (38 år) til deg og klager over knip i magen og diare med hyppigere toalett-besøk enn vanlig. Hun sier at ektemannen er utro, og at det vanskelig hjemme for tiden. Hun lurer på hva som feiler henne og ønsker hjelp. Hun er nedtrykt, og plagene virker sammensatte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke umiddelbare tanker gjør du deg om pasientens plager?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Stress-symptomer, somatoforme plager, funksjonell magetarm-lidelse, kreft? Psykologbehandling,familieterapi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng hvis 3 momenter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er en tests sensitivitet, spesifisitet, positiv prediktiv verdi (PPV) og negativ prediktiv verdi (NPV)? Vis hvordan man beregner disse uttrykkene med en tenkt tabell hvor disse begrepene belyses
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Med en analyses diagnostiske sensitivitet forstås analysens evne til å identifisere syke individer (optimalt
så nær 100% som mulig), og med spesifisitet forstås analysens evne til å ekskludere friske individer
(optimalt så nær 100% som mulig). Diagnostisk sensitivitet og spesifisitet er tekniske egenskaper ved en
test, og angir testens evne til å identifisere friske og syke individer i en gruppe.
Ved screening i en generell populasjon er gjerne prevalensen lav av de sykdomsforandringer man leter etter, og andel falsk positive svar blir derfor mange. Behovet for en klinisk utvelgelse (fremskaffe pre-test sannsynlighet for sykdom 0.3-0.6) før prøverekvirering er derfor større i primærhelsetjenesten, fordi det ved innleggelse i sykehus foretas selektering av pasienter. Det er større forekomst av sykdom i utvalget som legges inn i sykehus sammenlignet med de som er utenfor sykehus. Dette fører til at den prediktive verdi av spesielle analyser er større i en sykehuspopulasjon p.g.a det selekterte pasientmaterialet som prøvene tas fra.
Eksempel: Gitt en sykdom. Man har en gruppe på 100 personer, 53 syke og 47 friske. Testen man bruker plukker ut 48 syke som positiv, men også 2 friske som positiv (falsk positiv). Testen angir 45 friske som negativ, men også 5 syke som negativ (falsk negativ).
| | !Sykdom pos. (+) | !Sykdom neg. (-) | |
| !Test pos. (+) | 48 | 2 | Positiv prediktiv verdi: PPV = 48/50 = 96% |
| !Test neg. (-) | 5 | 45 | Negativ prediktiv verdi: NPV = 45/50 = 90% |
| | Sensitivitet: 48/53 = 91% | Spesifisitet: 45/47 = 96% | |
Positiv prediktiv verdi (PPV)= 96% betyr at pasienten har 96 % sjanse (0.96) for sykdom når testen er positiv.
Negativ prediktiv verdi (NPV)= 90 % betyr at pasienten har 90% sjanse for å ikke ha sykdom ("være frisk") når testen er negativ.
Prediktiv verdi av en test avhenger av/ varierer med forekomsten av aktuell sykdom (prevalens) i den befolkning pasienten kommer fra. [1 moment x 0.5 poeng = 2poeng]. Totalt 2 p
Det forventes å tegne opp en 2x2 tabell
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar pasienten tilbake til kontroll etter 3 uker. Diare og allmenntilstanden er forverret og hun har sterk mageknip. Hb-hurtigtesten på kontoret viser lavere resultat enn sist. Hemofec på hanske er positiv etter 3 sekunder.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva gjør du videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemofec positiv, vurdere falsk positiv? obs røde flagg! Ikke slipp pasienten! Menstruasjons/gyn-anamnese. Rektal eksplorasjon.
Viktig: Henvise til endoskopi (obs endoskopien kan være falsk negativ). Undersøkelse i forhold til blødningsanemi. Psykolog/familieterapeut er uansett indisert.
''PASIENTEN HADDE CANCER COLON CUM MET OG DØDE ETTER KORT SYKELEIE''
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Henvise videre, og forklare hvorfor: 0.5 poeng.
Blødningsanemiutredning eller famileterapi: 0.25 poeng; "Ikke slippe pasienten"/"følge pasienten tett": 0.25 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du arbeider som allmennlege i en bypraksis, og har bl.a. ansvar for et ektepar som er småbarnsforeldre. En dag kommer kona (38 år) til deg og klager over knip i magen og diare med hyppigere toalett-besøk enn vanlig. Hun sier at ektemannen er utro, og at det vanskelig hjemme for tiden. Hun lurer på hva som feiler henne og ønsker hjelp. Hun er nedtrykt, og plagene virker sammensatte.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anamnestiske betraktninger og kliniske undersøkelser kan være relevante å vurdere her og nå, innen rammen av en 15‐20 minutters allmennpraksis-konsultasjon? Begrunn svarene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det 2 spørsmål, det vil si: anamnese og status/kliniske undersøkelser Anamnestiske momenter: Varighet av aktuelle symptomer, avføringsanamnese, arvelige sykdommer, spesielt mage/tarm, naturlige funksjoner, kosthold, medisiner, psykiske symptomer. Stimulansia (inkl. alkohol). Klinisk us: Palpere/undersøke abdomen. Hepatomegali? Evt. rektal eksplorasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 korrekte svar på hver av de 2 gir 0.5poeng hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tenker at pasientens symptomer kan indikere en funksjonell mage-tarm-lidelse, men rekvirerer blodprøver, avføringsprøve og urinprøve (dvs. supplerende undersøkelser).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke regnes som de to viktigste funksjonelle mage-tarm-lidelsene? Beskriv hovedtrekkene i ROMA III kriteriene for __en__ av disse lidelsene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Irritabel colon syndrom = IBS og funksjonell dyspepsi= NUD. [0.5 poeng].
Neste spørsmål: Det kreves minst 2 momenter for å få poeng. (Skille Roma III-kriterier for IBS og NUD; f.eks IBS: Symptomvarighet > 3 mnd + bedring ved defekasjon; http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf). 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør kort rede for de antatte mekanismer for de to viktigste funksjonelle mage-tarm-lidelsene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mekanisme er henholdsvis økt tarmmotilitet og visceral sensitivitet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken klinisk relevans har kalprotektin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diagnostisere inflammatorisk tarmsykdom IBD
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<<
Du arbeider som allmennlege i en bypraksis, og har bl.a. ansvar for et ektepar som er småbarnsforeldre. En dag kommer kona (38 år) til deg og klager over knip i magen og diare med hyppigere toalett-besøk enn vanlig. Hun sier at ektemannen er utro, og at det vanskelig hjemme for tiden. Hun lurer på hva som feiler henne og ønsker hjelp. Hun er nedtrykt, og plagene virker sammensatte.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to hovedgrupper av somatiske magetarm-lidelser bør utelukkes ut i fra de opplysningene som foreligger? Nevn minst 3 alarm-symptomer ("røde flagg") for disse lidelsene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mage-tarm cancer og inflammatorisk tarmsykdom IBD [0,5 poeng hvis begge ].
Over 45 år ved debut, ufrivillig vekttap >3 kg, nedsatt matlyst, sykdomsfølelse, blødning, anemi, svelgvansker, nattsmerter, smerter som forstyrrer daglige aktiviteter. [0.5 poeng hvis 3 eller flere symptomer].
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar pasienten tilbake til kontroll etter 1 uke. Blodprøver viser Hb = 10.2 g/dL (Hb < 12 g/dL for ikke gravide kvinner i befruktningsdyktig alder regnes som anemi); og ferritin = 5 ug/L (normalverdi 10 – 170 ug/L). Urin stix og hemofec prøve var normale
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du tolke blodprøvesvaret i forhold til denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lav hb og ferritin kan skyldes: Menstruasjonsblødninger? Jernmangel? Kosthold? Blødning fra GI tractus?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for minst 2 momenter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er sensitiviteten og spesifisiteten for hemofec?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henholdsvis ca. 70 % og 85 %
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng hvis begge +/- 5 prosentpoeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft kort resultatet og nytten av en enkeltstående negativ hemofec-prøve i forhold til falske negative prøveresultater.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En enkelt negativ hemofec blir ofte falsk negativ ved intermitterende blødninger i magetarm
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kolbjørn (65) er kystskipper på Mørekysten. Han er uheldig og faller om bord på båten. Han slår seg nesten ikke, men får en kink i ryggen. I løpet av få dager utvikler han sterke smerter i ryggen som stråler ned i høyre ben. Han oppsøker deg på kommunelegekontoret.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser er relevante?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nevrologisk status ved mistenkt isjias:
* Columna: Lasegues prøve. Evt. omvendt Lasegue.
* Inspeksjon av ryggen: Avvergeskoliose, utrettet lordose, smertefokus, palpasjonsømhet.
* Motilitet/muskelkraft: Pareser? Evt. for hvilke bevegelser?
* Sensibilitet: Utfall som passer med et dermatom?
* Reflekser: Bortfall av patellar- eller achillesrefleks?
* Plantarrefleks bør testes rutinemessig for å utelukke sentralnervøs årsak.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må nevne tester fra minst 3 av 4 domener (gir 1p):
* Columna
* Motilitet
* Sensibilitet
* Reflekser
Hvis alle 4 domener er med og relevante tester er oppført, selv om ikke riktig alle tester i fasit er med: 2p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved undersøkelsen finner du ingen sikre nevrologiske utfall, men Kolbjørn forteller at smertene stråler helt ut i stortåa, og han kjenner det prikke i huden på fotryggen og foran på leggen, og det forverres hvis han sitter lenge.
Ved kontroll 1 måned senere er han fortsatt plaget, sover dårlig og må bruke analgetika. Du finner nå svekket hudfølelse på fotryggen og foran på leggen, og som sist vil han helst ligge eller stå, da han blir verre av å sitte. Det er ellers normale forhold ved nevrologisk undersøkelse. Du bestemmer deg for å utrede ham nærmere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse er det mest relevant å henvise til, og hva er det mest sannsynlig at undersøkelsen vil vise? Begrunn svaret kort ut fra klinikken.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# MR-undersøkelse av lumbosakralkolumna.
# Bildene vil sannsynligvis vise et prolaps som påvirker høyre L5-rot. Som regel vil et slikt prolaps utgå fra skiven L4/L5.Begrunnelse: Intakte reflekser taler imot at L4- eller S1-roten er affisert.
Sensibilitetsutfallet på fotryggen og fortil på leggen passer bra med L5-dermatomet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# MR-undersøkelse 0.5 p
# L5-roten: 0.5 p.
Tillegg av god begrunnelse (intakte reflekser og typisk sensibilitetsutfall nevnes): 1p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Plagene går gradvis over og etter ca. 4 måneder er høyre ben helt i orden igjen. Men i mellomtiden har han tråkket over to ganger med venstre ben, og synes det er tungt å løfte foten når han setter seg inn i bilen. Han har ingen smerter eller parestesier nå. Ved ny undersøkelse finner du at han er svak for både hoftefleksjon og ankeldorsalfleksjon, men kraften er god for de øvrige bevegelsene. Du kan ikke utelukke atrofi av lårmuskulaturen. Samtidig finner du at knerefleksen er livligere på venstre enn på høyre side, og plantarrefleksen er invertert. Sensibiliteten er som før litt svekket fortil på høyre legg, men normal på venstre side.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du diskutere disse symptomene og utfallene i lys av hva som peker mot henholdsvis sentral og perifer patologi?
Finnes det en enkelttilstand som kan forklare alle symptomer og funn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Spørsmål 1:
#* Motilitet: Atrofien i låret taler for perifer skade, da sentral skade gir lite atrofi. Paresene for hoftefleksjon og ankeldorsalfleksjon, men ikke for kneekstensjon og heller ikke for øvrige bevegelser, taler imot sentral skade, da det ville forventes at sentral skade ga pareser i alle muskelgrupper. Paresegrad: Ved sentral skade svekkes muskelkraften forholdsvis mindre enn ved perifer skade.
#* Reflekser: Livligere reflekser taler for sentral skade. Invertert plantarrefleks er et sikkert tegn på sentral skade.
#* Den normale sensibiliteten kan ikke vektlegges så mye, men kunne tale for en dominerende motorisk tilstand.
#* Funnene stemmer ikke så godt overens, for ved perifer parese burde det vært refleksbortfall, ikke livligere reflekser som her. Sentral skade kunne forklart de livlige refleksene, men da burde det ikke vært atrofi, og som regel ville det vært sensibilitetsforstyrrelser.
# Spørsmål 2:
#* En motornevronsykdom kunne imidlertid forklart alle symptomer og funn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten viser kunnskap om typiske utfallsmønster i motilitet og reflekser ved hhv. Sentral og perifer skade: 1p.
Studenten drøfter funnene mer inngående som i løsningsforslaget: 2p.
Studenten viser evne til å sette funnene i sammenheng, drøfter hvorfor funnene ikke stemmer og foreslår motornevronsykdom som en mulighet: 3p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kolbjørn spinalpunkteres. Blant annet ønsker man å utelukke infeksjonssykdom i sentralnervesystemet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken infeksjonssykdom er det særlig relevant å utelukke?
Hvilke funn i spinalvæsken kan generelt forventes ved aktuell infeksjonssykdom i CNS?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Borreliose er den sykdommen som hyppigst forekommer hos nordmenn bosatt i Norge (1p). Syfilis og tuberkulose sees fra tid til annen (0.5 p hvis en av disse nevnes, men ikke borreliose).
# Funn i spinalvæsken ved infeksjonssykdom:
#* Forhøyet celletall. Normalt 0-5 hvite blodlegemer per kubikkmm, ved infeksjon ofte betydelig forhøyet. Dominerende mononukleære celler.
#* Proteinmengden kan være moderat forhøyet
#* Antistoffer mot aktuelle infeksiøse agens kan påvises, ~IgM-klasse kommer først, men funnet er ofte upålitelig
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Borreliose 1p.
# Forhøyet celletall 1p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan måles trykket i spinalvæsken, og hva er normalt intraspinalt trykk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Trykk måles ved avlesning av væskenivået i en slange som holdes vertikalt mot en linjal med nullpunktet på nivå med columna. Trykket angis i cm vannsøyle.
# Normalt trykk er 10-15 cm vann.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Vertikal vannsøyle og cm vann målt mot en "linjal": 0.5 p.
# Grensene for hva man regner som normalt trykk varierer. Konsensus er at normalt trykk ligger mellom 7 og 18 cm vann, men åpningstrykket hos en stresset pasient er ikke sjelden over 20. Alle svar som inkluderer området 10-15 cm vann, og ikke går under 7 eller over 20 godtas: 0.5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 45 år gammel mann kommer til mottaksavdelingen etter at han har hatt smerter i venstre legg i 3 dager. Det startet gradvis. Etter en dag kom det hevelse i nedre del av låret og leggen og noe rødhet. Han er afebril og kjenner seg for øvrig frisk. Du har mistanke om dyp venetrombose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er mest aktuelle?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Erysipelas (1), muskelruptur (1), Baker cyste (1), overflatisk tromboflebitt (1), lymfødem (1)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Som anført ovenfor: 0.5 p for hvert riktig svar. Maksimum 2 poeng.
Dyp venetrombose er nevnt i oppgaven og gir ikke poeng her
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse bør du gjøre for å bekrefte/avkrefte dyp venetrombose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ultralyd vener på underekstremitet (1p)
Evt: Venografi (0,5 p), d-dimer (0,25 p)
D-dimer er med å øke eller redusere sannsynligheten for trombose. Her spørres det om en undersøkelse for å bekrefte/avkrefte diagnosen, og da må vi opp et hakk til de definitive undersøkelsene ultralyd eller venografi. Ultralyd er den undersøkelsen som foretrekkes og er understreket i undervisningen. Noen sykehus gjør venografi og vi kan ikke si at det er galt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Som anført ovenfor hvis det svares med ett ord. Hvis studenten redegjør for alle 3 på riktig måte, gir det full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dyp venetrombose i distale del av lår og i knehase ble bekreftet, og du skal starte behandling. Du er i tvil om du skal starte behandling med lavmolekylært heparin/warfarin eller med nyere
antikoagulasjonsmidler (trombinhemmere/faktor Xahemmere).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fordeler og ulemper har warfarin og nyere antikoagulasjonsmedikamenter (trombinhemmere og faktor Xa-hemmere)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Warfarin.
#* Fordeler:
#*# Velprøvd behandling som er godt innarbeidet
#*# Regelmessig kontroll som sikrer at tablettene blir tatt og som fanger opp eventuelle bivirkninger
#*# Lang halveringstid gjør at antikoagulasjonseffekten vedvarer selv om pasienten glemmer å ta en dose.
#* Ulemper:
#*# Tungvint behandling i oppstartsfasen med samtidig bruk av heparin og hyppige kontroller for innstilling av warfarindosen i startfasen
#*# Tungvint med regelmessig monitorering antikoagulasjonsnivå i hele behandlingsperioden.
#*# Relativt lite bivirkninger, men noe mer blødningstendens enn trombinhemmere/faktor Xahemmere.
# Trombinhemmere/faktor Xa-hemmere:
#* Fordeler:
#*# Praktisk mye enklere enn warfarin da de doseres etter vekt og trenger ikke monitorering
#*# Faktor Xa-hemmere trenger ikke midlertidig heparinbehandling i startfasen. Dette gjelder ikke dabigatran
#*# Studier indikerer en lett reduksjon av blødningskomplikasjoner.
#* Ulemper:
#*# Pasienten behøver ikke å gå til kontroll, pasienter som reduserer eller slutter med behandling blir derfor ikke fanget opp,
#*# Kort halveringstid, pasienter som glemmer å ta dosen får flere timer med mangelfull antikoagulasjon
#*# Ved blødninger fins det i dag ikke antidot som reverserer antikoagulasjonseffekten.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det er angitt i alt 12 momenter som gir 0,5 poeng hver. Det må angis minst 1 fordel og 1 ulempe for begge grupper for full pott.
Maks 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du skal ta stilling til pasientens risiko for å få ny venetrombose da dette kan ha betydning for hvor lenge han skal ha behandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du gi en punktvis oversikt over risikofaktorer for å få dyp venetrombose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Risikofaktorer for å få dyp venetrombose:
# Alder
# Immobilisering
# Større operasjoner, traumer
# Kreft
# Østrogenholdige medikamenter (substitusjon, østrogenholdige p-piller, andre medisiner)
# Arvelige faktorer (Leiden-mutasjon, mangel på antitrombin, protein S eller protein C pluss flere andre)
# Svangerskap, fødsler og i puerperiet
# Lange flyreiser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det er angitt 8 momenter, flere av de inneholder flere delmomenter. Hvert hovedmoment (nummerert 1-8) gir 0,5 poeng
Maks 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du gi en kort forklaring på hvorfor vi må starte med heparin i tillegg til warfarin når vi ønsker å antikoagulere med warfarin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det tar 5 dager før full effekt av warfarin setter inn. Det trengs antikoagulasjon også i dette tidsrommet. Heparin virker etter 30 min ved subkutan administrering og brukes de første 5 dagene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må få frem dette poenget for å få poeng.
Spørsmålet er vektet: 1 poeng
Utdypende svar er ikke påkrevet for full pott. Eksempel på utdypende svar er for eksempel at warfarin hemmer karboxylering og produksjon av K vitamin-avhengige koagulasjonsfaktorer (II, VII, IX og X). Faktorer som allerede er produsert vil imidlertid være i sirkulasjonen tilsvarende sin halveringstid.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
NSAIDs er en av våre viktigste og mest brukte legemiddelgrupper. Samtidig har gruppen en rekke problemer knyttet til midlenes bivirkningsprofil.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr forkortelsen NSAIDs?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Non-steroidal antiinflammatory drugs / ikke-steriode antinflammatoriske (betennelsesdempende) legemidler.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Enten engelsk eller norsk gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er virkningsmekanismen til NSAIDs?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemming av COX-enzymer (syklooksygenase-enzymer) som omdanner arakidonsyre til prostanoider/prostaglandiner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hemming av COX; 0.5 poeng for nedsatt produksjon av prostanoider/prostaglandiner
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du nevne __tre__ risikofaktorer for å utvikle blødende magesår under behandling med NSAIDs?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Høy alder
* Magesår i sykehistorien og/eller pågående magesår
* Bruk av antikoagulantia
* Bruk av glukokortikoider
* Bruk av lavdose acetylsalisylsyre
* Bruk av flere NSAIDs samtidig
* Bruk av høye doser NSAIDs
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig svar opp til maks 1.5.
Hvis noen skriver mer enn tre forslag, teller bare de tre første med i beregningen av poengsum
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
NSAIDs kan føre til nyresvikt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den tilgrunnliggende mekanismen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nyregjennomblødningen reguleres av prostanoider/prostaglandiner hvis produksjon hemmes av NSAIDs (jfr. spm. 2). Redusert nyregjennomblødning (redusert GFR) kan videreutvikles til en nyresvikt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poengsetting ut fra en totalvurdering av svaret, totalt 1.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke pasientgrupper er særlig utsatt for å utvikle nyresvikt under behandling med NSAIDs?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gamle, pasienter med nyresykdom/eksisterende nedsatt nyrefunksjon, med hjertesvikt, diabetes mellitus eller hypovolemi, pasienter som samtidig bruker andre legemidler som kan gi nedsatt nyrefunksjon (som ACE-hemmere, angiotensinreseptor-antagonister m.m.).
Felles for disse pasientgruppene er at de alle er spesielt avhengige av at fungerende prostaglandinsystem for å opprettholde nyrefunksjonen – de har i utgangspunktet økt aktivitet i de vasokonstringerende systemene i nyrene (altså renin-angiotensin-systemet og det adrenerge systemet).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poengsetting ut fra en totalvurdering av svaret, der sykdomsgruppene er viktigst. Den underliggende mekanismen kan gi inntil 1 poeng hvis det ikke oppnås full score på sykdommene. Totalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
NSAIDs kan føre til hypertensjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen bak hypertensjonsutvikling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nyreeffektene formidles av nedsatt prostaglandinsyntese (jfr. spm. 4) som fører til følgende:
# nedsatt GFR,
# økte nivåer av antidiuretisk hormon og
# økte nivåer av bl.a. endotelin-1, noe som gir vasokonstriksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert delsvar 1-3, totalt 1.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
NSAID-bruk assosieres også med arteriell tromboembolisk sykdom, som kan føre til bivirkninger som hjerteinfarkt, hjerneslag og plutselig død. Epidemiologisk forskning har vist at nesten alle NSAIDs – med ett unntak (og det er ikke acetylsalisylsyre!) - i større eller mindre grad er beheftet med slike bivirkninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket mye brukt NSAID er ikke vist å gi slike tromboemboliske bivirkninger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Naproksen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett svar gir 1 poeng, alt annet gir 0
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 60-år gammel mann oppsøkte sin fastlege pga. sure oppstøt og litt svie i epigastriet. Av og til hadde han også registrert svelgvansker og litt hoste, oftest om natten. Det fremkom også at han hadde et alkoholproblem.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Epigastriet utgjør en av flere regioner som abdomen er inndelt i. Tegn en enkel skisse av abdomen og angi hvor epigastriet er lokalisert.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "IIAB-2016-4-A.PNG">>
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Han ble henvist til gastroskopi, og distalt i øsofagus ble det påvist områder med rødlig misfarget slimhinne forenlig med en refluks-øsofagitt. Det ble tatt biopsier herfra som viste kronisk øsofagitt og metaplasi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva forstår du med metaplasi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Metaplasi er i prinsippet en reversibel prosess der en celletype (både epitel og mesenkymalt vev) erstattes av en annen celletype som ledd i en cellulær tilpasning (adaptasjon), for eks. som følge av kronisk irritasjon. Forandringene kan gi redusert funksjon og kan disponere for malignitetsutvikling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Man får poeng for selve definisjon, kommentarer mhp. funksjon, malignitet osv. er ikke nødvendig for "fullt hus"
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typer metaplasi forekommer hyppigst ved refluks-øsofagitt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gastrisk og intestinal metaplasi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for hver entitet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken klinisk konsekvens har de ulike typer metaplasi som forekommer ved refluks-øsofagitt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Gastrisk metaplasi'' oppfattes per i dag ikke å være assosiert med malignitetsutvling. I ''intestinal metaplasi'' kan det derimot utvikles dysplasi i kjertelepitelet. Denne dysplasien kan progrediere fra lett til moderat til grov; ved grov dysplasi er det stor risiko for adenokarsinomutvikling i øsofagus. Pasienter med intestinal metaplasi må derfor følges opp regelmessig med biopsier for å fange opp en evt. dysplasi eller et karsinom..
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kommentar for hver type metaplasi gir 0.5p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pga. svelgvanskene ble det rekvirert rtg. av øsofagus med kontrast som viste et divertikkel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags type divertikkel er det mest sannsynlig at denne pasienten hadde og hvor er de gjerne lokalisert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Zenkers’ divertikkel, pharynx/hypopharynx
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble et par år senere innlagt som øyeblikkelig hjelp pga. hematemese.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn mulige årsaker til denne pasientens hematemese (4 årsaker: 2p, 6 årsaker: 3 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det kan hos denne pasienten være flere årsaker til hans hematemese, bl.a.:
#Relatert til alkohol: laserasjoner (rifter) i øsofagus eller i den øsofagokardiale overgang (Mallory-Weiss syndrom), refluks-øsofagitt, levercirrhose med utvikling av leversvikt og portal hypertensjon som kan gi øsofagvaricer, akutt erosiv gastritt og ulcus pepticum. Leversvikten kan også gi koagulopati med blødningstendens som følge.
# Relatert til malignitet: pasienten kan ha hatt intestinal metaplasi som har kunnet utviklet seg til et adenokarsinom i øsofagus. Dette alene kan gi blødning, men tumors infiltrerende vekst kan også gi perforasjon/ruptur av øsofagus og fisteldannelse mellom øsofagus og aorta.
# Andre: øsofagusperforasjon/ruptur (eks.: som ledd i Boerhaave syndrom), andre former for øsofagitt (infeksiøs, tabletter m.m.), vaskulitt, plateepitelkarsinom, ulcus oesophagi (mange årsaker), hiatushernie.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir i prinsippet 0.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mannens liv lot seg ikke berge, og han døde på operasjonsbordet. Det ble rekvirert obduksjon. Av obduksjonsfunn kan nevnes:
# Betydelig forstørret hjerte med utvidede ventrikler, ingen påfallende fortykket vegg av ventriklene.
# Lett forstørret lever med områder med normal snittflate, men det var også store områder som var inntatt av en diffust voksende tumor med rødlig-rødgul snittflate og spredte områder med blødninger og nekroser (ingen andre tumores ble funnet hos pasienten ved obduksjonen).
# Mikroskopisk undersøkelse av skjelettmuskulatur viste spredtliggende mindre muskelfibre, ingen fibertypegruppering.
# Cerebellum med slanke folier og få Purkinjeceller
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnoser er det mest sannsynlig foreligger her i hhv. hjerte, lever, skjelettmuskulatur og cerebellum? (hvert delsvar gir 0,5 p)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De beskrevne lesjoner er alkoholrelaterte sykdommer og omfatter:
# Hjerte: dilatert kardiomyopati.
# Lever: hepatocellulært karsinom.
# Muskulatur: type-2 atrofi.
# Cerebellum: cerebellar atrofi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er turnuslege i en kommune 15 mil fra ditt lokalsykehus. Mannen til en 68 år gammel kvinne ringer en kveld du har vakt og forteller at kona om ettermiddagen, plutselig fikk problemer med å snakke, og hadde vanskelig for å bevege høyre arm. I løpet av en halvtime forsvant symptomene, og hun er nå helt frisk. Han forteller også at kona har god helse, men har fått påvist BT ved legekontroller på 160-170/90-95. Det har ikke vært startet noen behandling. En nabo som er sykepleier har i kveld målt blodtrykket til 170/95.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mannen spør hva som kan være årsaken til det anfallet som kona nå har hatt. Hva ville du svare mannen for å gi han en forståelse av hva dette anfallet sannsynligvis er?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Anfallet er sannsynligvis et transitorisk iskemisk anfall- TIA - (en forbigående forstyrrelse av blodsirkulasjonen til hjernen - også kalt "hjernedrypp").
I svaret til mannen bør inngå at dette er en forbigående forstyrrelse i blodsirkulasjonen til en del av hjernen, som oftest pga en blodpropp. Blodsirkulasjonen blir gjenopprettet før det har blitt noen permanent skade og symptomene blir derfor ikke varige.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sannsynlig diagnose TIA: 0.5 poeng. Tilleggsforklaring om hva som forårsaker TIA: 0.5 poeng
Det er ingen god forklaring til en pårørende kun å anføre transitorisk iskemisk anfall (TIA), så derfor kreves for full poengsum at det også er med en tilleggsforklaring.
Max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Du er turnuslege i en kommune 15 mil fra ditt lokalsykehus. Mannen til en 68 år gammel kvinne ringer en kveld du har vakt og forteller at kona om ettermiddagen, plutselig fikk problemer med å snakke, og hadde vanskelig for å bevege høyre arm. I løpet av en halvtime forsvant symptomene, og hun er nå helt frisk. Han forteller også at kona har god helse, men har fått påvist BT ved legekontroller på 160-170/90-95. Det har ikke vært startet noen behandling. En nabo som er sykepleier har i kveld målt blodtrykket til 170/95.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 typiske kjennetegn ved den tilstanden du oppfatter som den mest sannsynlige forklaring på dette anfallet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Typiske kjennetegn:
# Plutselig debut
# Av fokale nevrologiske utfall (ev godkjennes også ''FAST''-symptomer- ''F''acialis-parese - ''A''rm-parese, ''S''pråk- eller ''T''aleproblemer)
# Tilbakegang av alle symptomer innen kort tid (vanligvis «frisk» innen 1-2 timer (90 % av alle TIA). Tilbakegang innen 24 timer godkjennes også.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 3 av 3 kjennetegn: 1 poeng
* 2 av 3 kjennetegn: 0.5 poeng
* 1 av 3 kjennetegn: 0 poeng
Max: 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Du er turnuslege i en kommune 15 mil fra ditt lokalsykehus. Mannen til en 68 år gammel kvinne ringer en kveld du har vakt og forteller at kona om ettermiddagen, plutselig fikk problemer med å snakke, og hadde vanskelig for å bevege høyre arm. I løpet av en halvtime forsvant symptomene, og hun er nå helt frisk. Han forteller også at kona har god helse, men har fått påvist BT ved legekontroller på 160-170/90-95. Det har ikke vært startet noen behandling. En nabo som er sykepleier har i kveld målt blodtrykket til 170/95.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva ville du som legevaktslege gjøre med denne henvendelsen? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du bør som legevaktlege når du får en slik henvendelse:
# Tilse pasienten samme dag som anfallet har vært/samme dag som henvendelsen til legevakten- altså i kveld.
# Starte med acetylsalisylsyremedikasjon i tilknytning til konsultasjonen.
# Undersøke, vurdere og avgjøre om pasienten skal innlegges som ø. hjelp eller om raskt poliklinisk behandling i løpet av 1-2 dager kan være et alternativ avhengig av risiko for å få et manifest hjerneslag.
''Begrunnelse'': Uten raskt tilsyn/undersøkelse og start av acetylsalisylsyre er risiko for etterfølgende hjerneslag ved TIA stor. Risikoen reduseres med tidlig medikasjon med acetylsalisylsyre. Hvis pasienten vurderes til å ha høy risiko for hjerneslag skal hun henvises til spesialisthelsetjenesten i form av innlegges som ø. hjelp. Ved lav risiko kan avtales rask poliklinisk utredning (Helsedirektoratets retningslinjer anbefaler i løpet av 1-2 dager).
Hvis svaret inneholder opplysninger om at legen kontakter sykehuset for å drøfte/avgjøre behovet for videre utredning og når, så godkjennes dette.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Tilsyn/undersøkelse samme dag: 1 poeng
* Starte med ASA: 0,5 poeng
* Vurdere innleggelse /henvise til innleggelse eller undersøkelse i spesialisthelsetjenesten sykehus: 0,5 poeng
Max: 2 poeng
''Tillegg'':
Vedr ASA: Med 15 mil til sykehus bør pasienten få acetylsalisylsyre enten det blir ø.-hjelp innleggelse i sykehus eller henvising til rask poliklinisk undersøkelse (1 poeng)
Vedr innleggelse: Hvis det her anføres kun innleggelse og ikke nevnes poliklinisk u.s godkjennes det da denne pasienten har høy risiko for manifest hjerneslag etter TIA Men anføres bruk av helikopter til transport ved innleggelse av denne TIA pasient så gis ikke poeng. (Helikopter= misbruk av akutte kostbare transportressurser - uten sikker medisinsk nytte).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Du er turnuslege i en kommune 15 mil fra ditt lokalsykehus. Mannen til en 68 år gammel kvinne ringer en kveld du har vakt og forteller at kona om ettermiddagen, plutselig fikk problemer med å snakke, og hadde vanskelig for å bevege høyre arm. I løpet av en halvtime forsvant symptomene, og hun er nå helt frisk. Han forteller også at kona har god helse, men har fått påvist BT ved legekontroller på 160-170/90-95. Det har ikke vært startet noen behandling. En nabo som er sykepleier har i kveld målt blodtrykket til 170/95.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er ABCD2-skår, og hvilken nytte kan en ha av et slikt skåringssystem ved en slik tilstand?
Bør denne pasienten innlegges som ø-hjelp? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
ABCD2 skår er en skår for å vurdere risiko for manifest hjerneslag i den første tiden etter TIA.
Skåren kan være til nytte for vurdering av om pasienten har så høy risiko for å få hjerneslag at hun bør innlegges som ø hjelp eller om hun har såpass lav risiko at hun kan utredes raskt poliklinisk/ev.som dagpasient.
Ja, pasienten bør innlegges som ø-hjelp.
''Begrunnelse'': Med de symptomer pasienten har er ø hjelp innleggelse indisert fordi pasienten har høy risiko for å få et manifest hjerneinfarkt i de første dager. Dette pga. pasientens symptomer, varighet av symptomer alder og blodtrykk som tilsier høy risiko og dette medfører høy skår på den risikoskår (ABCD2-skår) som benyttes for å vurdere risiko og indikasjon for ø hjelp innleggelse ved TIA.
''Tillegg'':
(Det er ikke nødvendig at svaret inneholder nedenstående detaljerte informasjon om ABCD2 skår for å få poeng)
ABCD2 skår med poeng i henhold til den aktuelle pasient (kreves ikke skåring av pasienten for å få poeng):
* ''A'': Alder > 60 år: 1 poeng
* ''B'': BT >140/90: 1 poeng
* ''C'': Clinical symptoms. Afasi og pareser: 2 poeng
* ''D'': Duration (varighet av symptomer) > 10 min: 1 poeng
* ''D''; Diabetes: Trolig nei: 0 poeng
Sum for den aktuelle pasienten: 5 poeng
Spesifikk angivelse av skåren (poengsummen) er altså ikke nødvendig for poeng da det holder å vite at en slik sykehistorie og slike symptopmer tilsier høy risiko og gir indikasjon for innleggelse som ø hjelp.
Når det gjelder detaljert informasjon så har den aktuelle pasienten sannsynligvis 5 poeng på ABCD2 skår, og alle poengsummer over 3 poeng tilsier ø.-hjelp innleggelse.
* Risiko ved poengsum 0-3: < 1 % risk for manifest slag første uka
* Rask poliklinikk er adekvat reaksjon
* Risiko ved poengsum 4-7: 3-10 % risiko for slag første uka
* Ø.-hjelp innleggelse er den riktige reaksjonen
Ref: Helsedirektoratets Nasjoinale retningslinjer for behandling av hjerneslag
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* ABCD2-skår er en skår for å vurdere risiko for slag: 0.5 poeng
* Nyttig for å vurdere indikasjon for innleggelse som ø-hjelp: 0.5 poeng
* Den aktuelle pasient vil ha så høy risiko for hjerneslag at innleggelse som ø hjelp er indisert. (se svaret ovenfor): 1 poeng
Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Du er turnuslege i en kommune 15 mil fra ditt lokalsykehus. Mannen til en 68 år gammel kvinne ringer en kveld du har vakt og forteller at kona om ettermiddagen, plutselig fikk problemer med å snakke, og hadde vanskelig for å bevege høyre arm. I løpet av en halvtime forsvant symptomene, og hun er nå helt frisk. Han forteller også at kona har god helse, men har fått påvist BT ved legekontroller på 160-170/90-95. Det har ikke vært startet noen behandling. En nabo som er sykepleier har i kveld målt blodtrykket til 170/95.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke undersøkelser/utredning bør en pasient med slike symptomer (en slik tilstand) gjennomgå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Klinisk undersøkelse (inkludert en vurdering av nevrologiske utfall f. eks i form av National Institute of Health Stroke Scale (NIHSS) + innhenting sykehistorie om mulige risikofaktorer –levevaner (1 poeng)
# Bildeundersøkelser (1 poeng)
#* av hjernen CT caput eller MR caput
#* av karsystemet spesielt halspulsårene (karotis-arterien) enten med CT eller MR angio eller ultralyd undersøkelse.
# Hjertefunkjsonsvurdering
#* Hjerterytmeundersøkelse EKG og helst monitorering av hjerterytme i misnt 24 timer (det klart viktigste og gir full skår alene (1 poeng)
#* Ekkokardiografi kan være en suplerende undersøkelse, men ikke nødvendig som rutine og det gir ikke poeng hvis kun ekkokardiografi anføres uten å nevne EKG. Men det gis full skår om ekkokardiografi ikke nevnes.
# Blodprøver for kartlegging av aktuell status og risikofaktorer
#* Glukose, lipider, troponiner, infeksjon/inflammasjon (CRP)
#* Øvrige prøver: Hb . Nyrefunksjon. Saltbalanse ( na,K) Koagulasjonsstatus ( eg INR)
#* Anføres bare blodprøver uten noen spesifikasjon gir det 0.5 poeng. Full skår krever: glukose + minst 2 andre prøver
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Se over. Max 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som allmennlege har du oppfølgingsansvar for Marco, en 28 år gammel mann som nå har fått fast oppholdstillatelse etter å ha søkt asyl i vårt land. Det er sparsomt med opplysninger om tidligere helsetilstand. Marco kan fortelle at han har gått til kontroller hos lege på grunn av en hjerteklaffefeil, mitralstenose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den viktigste årsaken til mitralstenose i et globalt perspektiv?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Giktfeber
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Som allmennlege har du oppfølgingsansvar for Marco, en 28 år gammel mann som nå har fått fast oppholdstillatelse etter å ha søkt asyl i vårt land. Det er sparsomt med opplysninger om tidligere helsetilstand. Marco kan fortelle at han har gått til kontroller hos lege på grunn av en hjerteklaffefeil, mitralstenose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den bilyd du forventer å høre ved auskultasjon av Marcos hjerte.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Diastolisk bilyd
* Lavfrekvent, "roulement"
* "Opening snap"
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Diastolisk bilyd. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det vanligste og mest fremtredende symptom hos pasienter med moderat til alvorlig mitralstenose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tungpust
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tungpust eller dyspnoe. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva ønsker du å oppnå med medikamentell behandling av pasienter med symptomgivende mitralstenose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Senke hjertefrekvensen for å bedre diastolisk fylning av venstre ventrikkel
* Forlenge diastolen
* Typisk vil betablokkere gi tilsiktet virkning
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å senke hjertefrekvensen. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når vil du starte med antikoagulasjonsbehandling hos pasienter med mitralstenose og atrieflimmer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Så snart det praktisk er mulig
CHADS-VASC-score har ingen betydning, den gjelder for "non-valvulær"-atrieflimmer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Oppstart av antikoagulasjonsbehandling så snart som mulig. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 58 år gammel kvinne innlegges på sykehus etter 2 døgn med akutt oppstått kald og smertefull høyre underekstremitet. Hun er tidligere behandlet med stentimplantasjon i høyre arteria iliaca communis og har et kjent abdominalt aortaaneurisme. Etter innleggelse ble hun henvist til CT-angiografi. Bilde 1 er en kurvet multiplanar rekonstruksjon fra CT-undersøkelsen.
Bilde 1:
<<imgLink "IIAB-2016s-3-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken tilstand finner du på CT-bildet (bilde 1) som kan forklare pasientens symptomer? (1
poeng)
Med hvilken minimal invasiv bildeveiledede teknikk kan tilstanden behandles? (1 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Tilstand'': Akutt trombosering av høyre arteria iliaca communis
''Behandling'':
* Kateterbasert trombolyse
* Kateterbasert trombektomi er også en mulighet og må da også gis poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 1 poeng per spørsmål og det må utvises noe skjønn da ordlyden kan variere. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det er først og fremst 2 bildediagnostiske modaliteter som er egnet for kontroll av abdominale aorta-aneurismer. Hvilke 2 modaliteter er det? Nevn minst 1 fordel og 1 ulempe til hver av modalitetene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ultralyd:
** Fordeler er lite ressurskrevende, ingen ioniserende stråler eller risiko for kontrastnefropati.
** Ulemper er operatøravhengighet, begrenset innsyn ved tarmluft og adipositas/lang avstand fra hud til abdominalaorta.
* CT(-angio):
**Fordeler er rask undersøkelse, meget god avgrensing av kontrastmarkerte kar, rekonstruksjoner.
** Ulemper er ioniserende stråler og risiko for kontrastnefropati hos pasienter med nyresvikt, relativt ressurskrevende.
* Alternativt MR (-angio):
**Fordeler er at man ikke bruker ioniserende stråling, mulighet for rekonstruksjon av bilder.
** Ulemper er bruk av kontrast, ressurskrevende og langvarig undersøkelse, enkelte kontraindikasjoner og pasienter som ikke orker å være i trommel på grunn av klaustrofobi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver modalitet gir 0.5 poeng. 1 fordel/ulempe gir 0.25 poeng. Ultralyd må alltid være med som ett alternativ, CT og MR teller likt ellers.
Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under oppholdet blir pasienten gradvis mer dyspneisk, temperatur måles til 38.1*C i øret. Blodprøver viser CRP 103 og leukocytter 12.9. Som ledd i generell infeksjonsutredning henvises hun til et røntgen thorax. Bilde 2 og 3 viser røntgen thorax front og side.
Bilde 2:
<<imgLink "IIAB-2016s-3-B.PNG">>
Bilde 3:
<<imgLink "IIAB-2016s-3-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du skal vurdere normalitetskravene til røntgenbilde 2 og 3 (altså at det er riktige og gode røntgen projeksjoner). Hvilke normalitetskrav bruker du (nevn minst 4)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Normalitetskrav'':
* Frontbilde: Caput claviculae står symmetrisk mot midten, processus spinosi står over hverandre midt på trachea, både apex og pleurasinus er med på opptaket, god inspirsjon (kan telle 9 costae baktil)
* Sidebilde: Sternum truffet tangentielt så bare anteriore og dorsale corticalis er synlig, thoracale mellomvirvelskiver truffet tangentialt (ser i mellom virvelcorpora), bakre sinus og costae inkludert.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.25 poeng for hvert riktig svar. Max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Bilde 2:
<<imgLink "IIAB-2016s-3-B.PNG">>
Bilde 3:
<<imgLink "IIAB-2016s-3-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Og hvilke strukturer gransker du systematisk i røntgenbildene (nevn minst 6)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diafragma, pleurasinus, pleura, mediastinum, lungehili, hjertekontur, lungeparenkym, skjelett, kartegninger, trachea/carina/hovedbronkus, thyroidea, subfreniske strukturer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.5 poeng for hvert riktig svar. Max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På grunn av vedvarende infeksjonsklinikk ble det utført et røntgen thorax frontbilde noen dager senere (bilde 4). På bildet fremkommer en fortetning i lungen.
Bilde 4:
<<imgLink "IIAB-2016s-3-D.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På hvilken side og i hvilken lapp sitter den? Begrunn svaret ditt (1,5 poeng)
Under diafragma på venstre side er det luft, kan du angi i hvilket organ luften befinner seg? (0,5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fortetningen ligger i underlappen (hadde den ligget i midtlappen ville høyre hjertekontur vært utvisket/sløret, silhouette-tegn). Den subphreniske luften befinner seg i ventrikkelen (pga luft-væskespeil, dvs ikke fri luft og ikke colon, i colon ville man forvente haustrae)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 1 poeng for hvert riktig svar. Max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 60 år gammel mann innlegges i sykehus etter to uker med oppkast, kvalme og lett feber. Han ble operert for cancer coli to år tidligere. Han behandles for hypertensjon og har det siste året vært plaget av tung pust. Han går nå knapt en trapp uten å stanse. Om natten må han opp tre ganger for å late vannet og ligger med to puter under hodet. Han røker en pakke tobakk om uken (ca. 50g). Bruker 2-3 nitroglyserin for dagen. I mottagelsen på sykehuset diagnostiseres mekanisk ileus og han settes opp til operativt inngrep. Medikamenter: Selozok 100 mg (betablokker), Esidrex 25 mg (klortiazid diureticum), Symbicort Forte (inhalasjonssteroid + beta2 adrenergicum), Spiriva inhalasjon (tiotropium – anticholinergicum).
Blodprøver (normalverdier i parentes):
* Hemoglobin 18.4 g/dl (13.5 – 16)
* Levkocytter 13 (5-10)
* Trombocytter 250 (150 – 400)
* Kreatinin 180 micromol/l (60-105)
* Natrium 154 mM
* Blodsukker 5 mM (4.2-6.3)
* pH (urin) 3.0 (5-7)
Arteriell blodgass:
* pH 7,57 (7.36 – 7.45)
* PCO2 6.23 kPa (4.5-5.5)
* BE + 12,4 (+/- 3)
* PO2 7.0 kPa (> 10)
* Oxygenmetning 88%
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan operativ risiko før non-kardial kirurgi vurderes og kvantiteres, og hvilke
tilstander gir økt risiko for hjerteskade i forbindelse med inngrepet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Revised Cardiac Risk Index (RCRI) kan gi et rimelig eksakt svar på økt risiko for kardial skade de første 30 dager etter et non-kardialt inngrep. Pasienten har nyresvikt (økt kreatinin), hjertesvikt (klinisk vurdert), koronarsykdom (AP). Alle vil addere seg til risiko ved inngrepet. Revised Cardiac Index gir poeng for 5 lidelser og type kirurgisk inngrep (koronarsykdom, hjertesvikt, insulinkrevende diabetes, nyresvikt (kreatinin > 180), TIA eller slag, høyrisiko kirurgi). Antall poeng er godt relatert til utkomme etter non-kardial kirurgi. ungesykdom har ikke vist seg å øke risiko for hjerte-hendelser etter non-kardial kirurgi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 60 år gammel mann innlegges i sykehus etter to uker med oppkast, kvalme og lett feber. Han ble operert for cancer coli to år tidligere. Han behandles for hypertensjon og har det siste året vært plaget av tung pust. Han går nå knapt en trapp uten å stanse. Om natten må han opp tre ganger for å late vannet og ligger med to puter under hodet. Han røker en pakke tobakk om uken (ca. 50g). Bruker 2-3 nitroglyserin for dagen. I mottagelsen på sykehuset diagnostiseres mekanisk ileus og han settes opp til operativt inngrep. Medikamenter: Selozok 100 mg (betablokker), Esidrex 25 mg (klortiazid diureticum), Symbicort Forte (inhalasjonssteroid + beta2 adrenergicum), Spiriva inhalasjon (tiotropium – anticholinergicum).
Blodprøver (normalverdier i parentes):
* Hemoglobin 18.4 g/dl (13.5 – 16)
* Levkocytter 13 (5-10)
* Trombocytter 250 (150 – 400)
* Kreatinin 180 micromol/l (60-105)
* Natrium 154 mM
* Blodsukker 5 mM (4.2-6.3)
* pH (urin) 3.0 (5-7)
Arteriell blodgass:
* pH 7,57 (7.36 – 7.45)
* PCO2 6.23 kPa (4.5-5.5)
* BE + 12,4 (+/- 3)
* PO2 7.0 kPa (> 10)
* Oxygenmetning 88%
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du beskrive pasientens kliniske tilstand, og hvilke tiltak vil du ev. gjøre før planlagt operasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten er dehydrert (klinikk + høy hemoglobin) og væsketap bør erstattes. Han er metabolsk alkalotisk og bør behandles med kaliumklorid / natrium klorid intravenøst. Han er lett hypoksisk, men en bør overvåke nøye når man gir oxygen pga allerede høy PCO2 som kan stige ved bortfall av ev hypoksisk drive (sannsynligheten for videre PCO2 stigning er liten ettersom denne er en kompensasjon for metabolsk alkalose og ikke en primær hyperkapni pga lungesykdom).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Arteriell blodgass:
* pH 7,57 (7.36 – 7.45)
* PCO2 6.23 kPa (4.5-5.5)
* BE + 12,4 (+/- 3)
* PO2 7.0 kPa (> 10)
* Oxygenmetning 88%
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en beskrivelse og forklaring på blodgassverdiene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alkalose. Metabolsk alkalose med delvis kompenserende respiratorisk acidose. Hypoksi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Blodprøver (normalverdier i parentes):
* Hemoglobin 18.4 g/dl (13.5 – 16)
* Levkocytter 13 (5-10)
* Trombocytter 250 (150 – 400)
* Kreatinin 180 micromol/l (60-105)
* Natrium 154 mM
* Blodsukker 5 mM (4.2-6.3)
* pH (urin) 3.0 (5-7)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan forventer du at kaliumverdien vil være hos denne pasienten, og hva er årsaken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sur urin og metabolsk alkalose er et klassisk uttrykk for intracellulær / ekstracellulær hypokalemi. Kaliumtap gjennom oppkast / diuretika
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er turnuskandidat som kjører legevakt, og kommer hjem til en dame på 80 år som virker nokså desorientert. Datteren forteller at hun de siste par ukene har blitt dårlig til beins med flere fall, og i dag har hun blitt ganske forvirret. Hun har tidligere bodd alene, men har trengt litt hjelp og tilsyn fra familien for å håndtere innkjøp, betaling av regninger og ta medisinene sine riktig. Hun virker litt varm, puster fint og har fyldig, rolig radialispuls. Det er ingen sikre patologiske funn ved klinisk undersøkelse. Du ønsker å legge henne inn på lokalsykehuset.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skriv en __kort__ henvisning til lege i akuttmottak med angivelse av årsak til henvisning, hastegrad og tentativ diagnose.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henvisningen bør inneholde følgende momenter:
# Sosiale forhold.
# Akutt forvirring/ delirium.
# Akutt funksjonssvikt, falltendens.
# Funn ved klinisk undersøkelse og gjerne en tentativ diagnose.
Forslag: «80 år gammel kvinne som bor alene uten offentlig
hjelp, kun litt bistand fra familien. De siste to ukene flere fall, i
dag nyoppstått forvirring. Hun virker varm, ellers ingen sikre
funn. Hun innlegges som øyeblikkelig hjelp for utredning av
nyoppstått falltendens og delirium. Infeksjon? Malignitet?
Hodeskade?»
(Tentativ diagnose trenger ikke være med for å få full pott, men
kan telle positivt i tvilstilfeller)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver av momentene ovenfor gir 0,5 p, maks 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På sykehuset diagnostiseres pneumoni. Under oppholdet er pasienten preget av kognitiv svikt. Hun husker svært dårlig, sover dårlig og hallusinerer. I perioder er hun urolig og vandrende med stor taleflom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer taler for at hun har akutt delirium?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det bør komme fram at den kognitive svikten er oppstått i forbindelse med akutt sykdom, og at tilstanden er fluktuerende, preget av symptomer som uro, forvirring, kognitiv svikt, døgnrytmeforstyrrelser og hallusinasjoner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kognitive symptomer som er oppstått i forbindelse med akutt sykdom gir 1p. I tillegg gis 0,5 p for å angi hhv fluktuerende forløp, hallusinasjoner, søvnvansker og uro (ingen av disse er patognomoniske ved delirium), maks 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det noe som kan gi mistanke om en underliggende demenstilstand?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
At hun trenger hjelp / tilsyn fra familien til innkjøp, håndtering av økonomi og medisinering. At hun har delirium kan også peke i retning av underliggende demens.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å påpeke at hun trenger en del hjelp av familien (1 p) i tillegg til å nevne at symptomer på delirium kan peke i retning av underliggende demens (1 p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
MMSE under oppholdet gir kun 10 poeng, hun har nedsatt skår på tidsorientering, stedsorientering, hoderegning, gjenkalling, figurkopiering og 3-trinnskommando.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du tolke dette resultatet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Testsvaret er vanskelig tolkbart da det åpenbart er gjort mens pasienten er syk / i en akutt forvirringstilstand.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å påpeke at testsvaret må tolkes med stor forsiktighet ved interkurrent somatisk sykdom eller forvirring.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn kort hva som må gjøres for å fullføre en demensutredning.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pårørendesamtale, medikamentgjennomgang, ny kognitiv testing og bildediagnostikk (CT eller MR) av hodet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Pårørendesamtale (0,5 p), CT eller MR av hodet (0,5 p), ny kognitiv testing om noen uker/mnd (0,5 p) medikamentgjennomgang (0,5 p). Vi anser at klinisk undersøkelse og blodprøver er gjort under oppholdet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Magnus Lien som er 25 år, går til fastlegen fordi han har kjent seg oppfylt i magen, særlig i øvre venstre del. Du undersøker han og mener du kjenner en forstørret milt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de vanligste tilstandene (minst 5) som kan gi forstørret milt hos pasienter i denne aldersgruppen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vaskulære årsaker maksimalt 1 poeng:
#* Vaskulær årsak uten nærmere angivelse gir 0,5 poeng, trombose (miltvenetrombose eller andre lokalisasjoner) 0,5p, karanomalier 0,5p. (Familiær disposisjon, angivelse av en eller flere genetiske disposisjon mm som kan forklare hvorfor en ung person får trombose er ikke nødvendig og gir heller ikke poeng.)
# Infeksjon, maksimalt 1 poeng:
#* Mononukleose 1 p. Andre infeksjoner uten å nevne mononukleose gir 0,5 p uansett hvor mange som nevnes.
# Maligne blodsykdommer maksimalt 1 poeng.
#* KML, myelofibrose, Hodgkins lymfom, ALL, lymfom gir alle 0,5 p.
#* KLL, hårcelleleukemi, AML, akutt leukemi, myelomatose gir ikke poeng (KLL forekommer ikke under 30 år),
#* Gaucher sykdom og andre avleiringssykdommer 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å utrede de vanligste årsakene til miltforstørrelse i hans alder.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser ut over undersøkelse av magen er viktig hos denne pasienten?
Gi en kort begrunnelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Undersøkelse av glandler.
# Infeksjonstegn (inkludert feber)
# Undersøkelse av hals. Begrunnelse: Alle er viktige for undersøkelse av mulig mononukleose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 for hvert av svarene. Totalt 2,0 p. Hvis riktig begrunnelse mangler (d.v.s.undersøkelse på mulig mononucleose), reduseres poengsummen med 1 p selv om de andre svarene er riktige
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke laboratorieprøver vil du ta for å komme nærmere en diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hgb, hvite, differensialtelling av hvite, blodutstryk, CRP, ALAT, d-dimer, EB virus, hurtigtest mononukleose, JAK2 mutasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng for hver av de 10 prøvene, max 2.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken bildediagnostisk undersøkelse er førstevalget i utredningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enten Thoracal/abominal CT eller rtg. thorax/ultralyd (likestilt)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
En av disse to modalitetene må nevnes for 1 poeng. MR er ikke direkte galt, men er ikke førstevalget på dette tidspunktet og gir derfor evt. 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 funksjoner som milten har i kroppen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Lymfoid organ som produserer og deltar i modningen av lymfocytter og vårt immunforsvar.
# Renser ut celler på grunn av alder (120 dager for erytrocytter), skade (endret form, sfærocytter, defekte røde), røde som er dekket med antistoffer (autoimmun hemolytisk anemi).
# Reservoir for alle typer blodceller
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av punktene, max 1,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 69 år gammel kvinne kommer til konsultasjon hos deg på fastlegekontoret. Hun har følt seg noe slapp og uopplagt i flere måneder. Hun har vært innom laboratoriet på legekontoret før timen og det ble målt en Hb på 9,2 g/dl (Ref.verdi:.11,5-16,0). Hun har nettopp skiftet fastlege. Du har ikke fått oversendt journal slik at du ikke har opplysninger om henne fra tidligere, men hun forteller at hun ikke har vært blodfattig før.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan være mulige årsaker til hennes lave Hb? (Nevn tre hovedområder og minimum 4 underpunkter til disse)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Blødning:
#* Ulcus pepticum, GI cancer, blødninger hud, blødninger slimhinner, blødning urinveier
# Kroniske sykdommer:
#* Inflammatoriske sykdommer, revmatiske sykdommer, nyresvikt, leversykdommer, andre gastrointestinale sykdommer, hypotyreose
# Primær blodsykdom:
#* Jernmangelanemi, megaloblastanemi, hemolytisk anemi, aplastisk anemi, leukemi, lymfom, myelomatose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her spørres ganske bredt om mulige årsaker til anemi hos en 69 år gammel kvinne uten andre symptomer enn slapphet og uopplagthet. Man får 0,25 poeng for hver mulige årsak, maksimum 1 poeng innenfor hver av de tre hovedområdene skissert over og totalt inntil 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Anamnese, klinisk undersøkelse og noen få tilleggsundersøkelser er verktøyet du råder over på fastlegekontoret.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke spørsmål vil du stille for å komme nærmere en diagnose? (I tillegg til spørsmål om tidligere sykdommer)
Nevn minst 4 sentrale spørsmål.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spørsmål: Blødninger (underliv, tarm, hud), sykdomsfølelse, vekttap, feber, nattesvette, medikamenter, kosthold, alkohol.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her spør en om sentrale elementer ved anamneseopptak hos denne pasienten. Det gis 0,25 poeng for hvert spørsmål og inntil 1 poeng.
Spørsmål om bakenforliggende sykdom (jfr andre kroniske sykdommer under Deloppgave 1) gir ikke poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du gjør en klinisk undersøkelse med normale funn.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke blodprøver vil du rekvirere (både fra eget laboratorium og fra sentrallaboratorium) (1 poeng), og hvilke andre
laboratorieundersøkelser som du kan gjøre på fastlegekontoret er relevante for å komme nærmere en diagnose? (0,5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blodprøver: LPK, trombocytter, SR, CRP, retikulocytter, MCV, ferritin, vitamin B12, folat, kreatinin, FT4, TSH, blodutstryk.
Andre undersøkelser: Blod i avføringen (hemofec), urinstix på blod i urin.
Kontroll av Hb bør gjøres. Fint om det nevnes, men det gir ikke poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.1 poeng for en riktig blodprøve, max 1 poeng for blodprøver.
0.4 poeng for undersøkelse på blod i avføringen da denne undersøkelsen anses som obligatorisk. 0.1 poeng for urinundersøkelse.
Totalt inntil 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blant blodprøvesvarene finner du vitamin B12 på 80 pmol/L (referanseområde 186 - 645 pmol/L) og du mistenker at hun kan ha perniciøs anemi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre blodprøver kan bekrefte eventuelt avkrefte denne diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
MCV, anti-IF (antistoff mot intrinsic factor), blodutstryk, MMA (metylmalonat), homocystein
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng for hver blodprøve, inntil 1 poeng.
Makrocytær anemi, vitamin B12-mangel og påvist antistoff mot intrinsic factor (IF) er diagnostisk for perniciøs anemi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling vil du forordne hvis denne diagnosen blir bekreftet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vitamin B12 injeksjoner i depotform.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kun parenteralt tilskudd av vitamin B12 gir poeng (0,5 poeng).
Andre forslag kan være korreksjon av kostholdsvaner eller tilskudd av B12 i tablettform, men dette gir ikke poeng. Peroralt tilført vitamin B12 absorberes kun i helt ubetydelige mengder når intrinsic factor mangler, hos denne pasienten som har utviklet perniciøs anemi er injeksjoner den eneste riktige behandlingen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for hvilken rolle vitamin B12 spiller i kroppen, og mulige årsaker til vitamin B12-mangel generelt (ikke bare hos denne pasienten).
Forventet omfang opptil 10-15 linjer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vitamin B12 - kobalamin - er et vitamin som er livsnødvendig og viktig for normal nervefunksjon og dannelse av blodceller. Vitaminet kan ikke lages i kroppen og må derfor tilføres gjennom kosten. Kjøtt, fisk, sjømat, egg og melkeprodukter utgjør den eneste kostholdskilden for vitamin B12.
Mulige årsaker til vitamin B12-mangel kan være utilstrekkelig inntak (ensidig kosthold, ses hos vegetarianere og spesielt hos veganere) eller redusert opptak fra tarmen. Redusert opptak fra tarmen (malabsorbsjon) ses hos pasienter med ulike gastrointestinale sykdommer: Syremangel, atrofisk gastritt, ventrikkel- eller ileumreseksjon, sykdommer i tynntarm (cøliaki, Crohns sykdom,ileitt), medikamentbruk (protonpumpehemmere, H2-reseptor blokkere og biguanider (metformin).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vitamin B12 sin rolle: 1 poeng for nervesystem, 1 poeng for bloddanning.
0.5 poeng for eksempel på utilstrekkelig inntak og 0.5 poeng for eksempel på malabsorbsjon. Totalt inntil 3 poeng hvis adekvat omfang som antydet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 75 år gammel kvinne kommer alene til deg i mottakelsen for innleggelse på medisinsk avdeling. Hun forteller at hun for 3 timer siden fikk sterk frontal hodepine og samtidig problemer med å bruke høyre arm. Ved klinisk undersøkelse framstår hun lett forvirret med feber (39 grader), og du finner en lettgradig parese i høyre arm. Du mistenker at det kan være hjernesykdom som gir henne disse symptomene, og ønsker å utrede dette med en gang med bildediagnostikk.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke 4 hovedmodaliteter har man i radiologi og hvilke fysiske prinsipper benytter de seg av? Svar kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ultralyd (0,25p) - lydbølger (0,25p) som reflekteres fra det som avbildes.
* Røntgen (0,25p) - røntgenstråler (0,25p) som dempes»/absorberes når de går gjennom det som skal avbildes.
* Computer Tomografi (CT) (0,25p) - røntgenstråler (0,25p) benyttet til å lage et tredimensjonalt volum av det som avbildes.
* Magnetresonanstomografi (MR) (0,25p)- radiobølger som påvirker protoner i et statisk magnetfelt (0,25p).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Understrekede ord må være med for å få full uttelling. Disse
fire er de tradisjonelle «modalitetene» i (nevro)-radiologi.
PET/CT og PET/MR er hybridmodaliteter, og forsåvidt riktig,
men trenger ikke være med for å få full uttelling (skal heller ikke
gi poeng). Digital Subtraksjons Angiografi (DSA) /
gjennomlysnings-røntgen regnes her som en undersøkelse
under røntgen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken bildeundersøkelse vil du nå som hovedregel henvise denne 75 år gamle kvinnen til først? Hva er det viktigste å påvise/utelukke på nåværende tidspunkt? Begrunn begge svarene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT (0.5 poeng) fordi den er __lett tilgjengelig__, __rask__ og __avklarer det som haster mest__ (0.5 poeng, må da ha med minst 2 av de 3 punktene).
Det viktigste på nåværende tidspunkt er å utelukke blødning/hematom (0.5 poeng), fordi det da er:
# kontraindikasjon for trombolyse hvis det er aktuelt å gi det,
# man kan vurdere om en blødning/hematom skal evakueres med operasjon (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Understrekede deler (eller tilsvarende forklaring) må være med for å få den poenguttellingen som står i parentes etter understrekingen. CT Caput (både med og uten CT angiografi) godkjennes og gir 0.5 poeng. MR er ikke riktig og gir ikke poeng.
Både begrunnelse A) og B) til hva som er viktigst å påvise/utelukke gir 0,5 poeng hver for seg, men ikke mer uttelling enn 0.5 poeng selv om begge er nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sykehistorien til denne kvinnen kan passe med flere ulike diagnoser. Dersom man hadde tatt CT av hjernen til denne pasienten, kunne man f.eks. ha fått følgende beskrivelse: "Blod i subarachnoidalrommet, det meste beliggende i basale cisterner".
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva hadde i så fall vært den mest sannsynlige årsaken til bildefunnet? Hvilke invasive metoder for behandling av denne tilstanden har vi? Svar kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rumpert aneurysme (1 poeng). Endovaskulær coiling (0,5 poeng) eller åpen kirurgi med klipsing (0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et annet mulig CT-svar ville ha vært: "Det foreligger et hyperdens media tegn på venstre side og lavattenuerende insula cortex på venstre side"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du forklare hvert av disse to funnene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hyperdens media tegn – __trombe__ i a. cerebri media (0.5 poeng)
Lavattenuerende insula cortex – __ødemutvikling__ som følge av __ischemi__ (0.5 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Svarene som er understreket over eller tilsvarende forklaring. Ødem eller ischemi hver for seg gir 0,5 poeng, men ikke mer uttelling enn 0,5 poeng selv om begge er nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dersom man hadde tatt MR av hjernen til denne pasienten, kunne man ha fått til svar at diffusjonsbildene viser områder med sterk diffusjonsrestriksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke patologiske tilstander er det som typisk har slik sterk diffusjonsrestriksjon? Nevn minst 2.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fersk ischemi, abscess og lymfom. Alternativt kan småcellet metastase, medulloblastom, blødnings/hematom-komponenter, eller aktiv demyelinisering også gi diffusjonsrestriksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fersk ischemi (0,5 poeng) må være med og ett av de andre alternativene (0,5 poeng) må være med for å få full uttelling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dersom man hadde tatt MR av hjernen til denne pasienten, kunne man ha fått til svar at det forelå bilaterale lett asymmetriske FLAIR forandringer i mediale temporallapper og insula.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken tilstand bør man da mistenke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Encephalitt (1 poeng). Først og fremst herpes encephalitt, men også andre encephalitter er mulige (for eksempel andre agens eller paraneoplastisk limbisk encephalitt).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Encephalitt (eller herpes encephalitt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når ektemannen kommer til mottakelsen viser det seg at pasienten er dement og har konfabulert hele sykehistorien. Dersom du da hadde tatt CT av hjernen til denne pasienten, kunne du ha fått følgende svar: "Hematom med høy attenuasjon beliggende mellom
hjerneparenkymet og kraniet i nivå med midtre del av gyrus precentralis, og som strekker seg forbi suturene i kraniet"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type hematom er dette og hvor gammelt er det basert på CT-beskrivelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Subduralt hematom. Epidurale hematomer krysser ikke kraniesuturene. Høyattenuasjon tilser et ferskt/akutt hematom (<= 7
dager).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Subduralt hematom (0,5 poeng). «Ferskt»/ «akutt»/<= 7 dager (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har besøk av en mannlig pasient på 45 år på fastlegekontoret. Han har merket en kul like under øreflippen på venstre side av hodet. Den har vært der ca. ett år og vokst gradvis men er ca. 2 cm i diameter, beliggende like under huden. Du mistenker at det kan være en kul i relasjon til en spyttkjertel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken spyttkjertel ligger i dette området, og hvilke andre spyttkjertler har vi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Aktuell kjertel: Ørespyttkjertel (gl parotis)
* Andre (3):
** Gl submandibularis
** Sublingualis
** De små spyttkjertler (500-800 stk)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng pr svar, maks 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ønsker å få denne undersøkt og fjernet. Han vet at du gjør mye småkirurgi på kontoret så han spør om du ikke kan ta en liten skjæreprøve (biopsi) for å få en diagnose raskt og kostnadseffektivt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er dette greit? Anfør minst to argumenter for din avgjørelse overfor pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Nei'', dette er ikke greit. Årsåker:
* Facialisnerven kan skades
* Cancerceller kan spres dersom den er ondartet
* Oftest pleomorft adenom i spyttkjertler og økt sjanse for multiple recidicer og malignisering dersom dette åpnes
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for "nei", 1 poeng for hvert punkt som årsak, maks 2.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten spør også om en ultralydundersøkelse eller MR kan fastslå hvilken type svulst som foreligger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er dette riktig? Hva er beste metode for å få riktig diagnose og hva vil du foreta deg?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, billeddiagnostikk kan ikke gi diagnose. Det riktige er finnålsprøve, du kan henvise til tumor colli poliklinikk, spesialist eller gjøre det selv
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for "nei", 1 poeng for finnålsprøve eller henvisning. Maks 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Spyttkjertlene er kjent for å kunne ha svært mange typer svulster.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den vanligste svulsttypen i spyttkjertler, hvordan behandles denne og i såfall hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pleomorft adenom (blandingscelletumor).
Kirurgisk fjerning er riktig. Dette fordi den kan bli ondartet over tid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng pr delsvar, maks 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når du evt skal henvise en pasient er det viktig med opplysninger som gjør at pasienten blir prioritert riktig i spesialisthelsetjenesten. Et av de viktigste prioriteringskriteriene er om det foreligger en ondartet tilstand
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre kliniske funn som kan tyde på at svulsten i denne spyttkjertelen er ondartet og ikke godartet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hard og knudrete konsistens
* Fiksert til hud eller underlag
* Perifer facialisparese (ansiktsnervelammelse)
* Suspekte metastaser på halsen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver, maks 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når du nevner spyttkjertler så forteller pasienten at han har hørt at spyttstein kan være årsak til hevelse i spyttkjertler. Han lurer på om dette kan være årsaken.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du spørre om for å skille mellom stein og svulst?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spørre om det er hevelse i relasjon til måltid
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er allmennlege og oppsøkes av Tora som klager over at hun de siste månedene er blitt mer tung i pusten ved fysisk aktivitet. Tora er 72 år gammel, og for noen år siden gjennomgikk hun et hjerteinfarkt lokalisert i deler av nedre og laterale vegg av venstre hjertekammer. I epikrisen ble det opplyst at hjertet ved ekkokardiografisk undersøkelse hadde upåfallende størrelse, det var lett redusert kontraksjonsbevegelse i det infarktrelaterte området og det ble påvist en moderat mitralinsuffisiens.
For øvrig ble det ikke påvist klaffefeil. Hennes eneste faste medisin er acetylsalisylsyre 75 mg daglig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv den bilyd du forventer å høre ved auskultasjon av Toras hjerte
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Systolisk bilyd
* Blåsende og høyfrekvent karakter
* Utstråling til aksillen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systolisk bilyd
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Du er allmennlege og oppsøkes av Tora som klager over at hun de siste månedene er blitt mer tung i pusten ved fysisk aktivitet. Tora er 72 år gammel, og for noen år siden gjennomgikk hun et hjerteinfarkt lokalisert i deler av nedre og laterale vegg av venstre hjertekammer. I epikrisen ble det opplyst at hjertet ved ekkokardiografisk undersøkelse hadde upåfallende størrelse, det var lett redusert kontraksjonsbevegelse i det infarktrelaterte området og det ble påvist en moderat mitralinsuffisiens.
For øvrig ble det ikke påvist klaffefeil. Hennes eneste faste medisin er acetylsalisylsyre 75 mg daglig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke årsaker til Toras dyspnoe vil du utrede først?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hjertesvikt
* Lungesykdom / KOLS / restriktive lungelideselr
* Thyroideasykdom
* Anemi
* Infeksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hjertesvikt og lungesykdom må nevnes
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Du er allmennlege og oppsøkes av Tora som klager over at hun de siste månedene er blitt mer tung i pusten ved fysisk aktivitet. Tora er 72 år gammel, og for noen år siden gjennomgikk hun et hjerteinfarkt lokalisert i deler av nedre og laterale vegg av venstre hjertekammer. I epikrisen ble det opplyst at hjertet ved ekkokardiografisk undersøkelse hadde upåfallende størrelse, det var lett redusert kontraksjonsbevegelse i det infarktrelaterte området og det ble påvist en moderat mitralinsuffisiens.
For øvrig ble det ikke påvist klaffefeil. Hennes eneste faste medisin er acetylsalisylsyre 75 mg daglig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke blodprøver vil du benytte for å avklare årsaker til hennes dyspnoe?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* NTproBNP evt BNP
* TSH, fritt T4
* Hb
* CRP
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
NT-proBNP /BNP må nevnes. De øvrige er relevante
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Du er allmennlege og oppsøkes av Tora som klager over at hun de siste månedene er blitt mer tung i pusten ved fysisk aktivitet. Tora er 72 år gammel, og for noen år siden gjennomgikk hun et hjerteinfarkt lokalisert i deler av nedre og laterale vegg av venstre hjertekammer. I epikrisen ble det opplyst at hjertet ved ekkokardiografisk undersøkelse hadde upåfallende størrelse, det var lett redusert kontraksjonsbevegelse i det infarktrelaterte området og det ble påvist en moderat mitralinsuffisiens.
For øvrig ble det ikke påvist klaffefeil. Hennes eneste faste medisin er acetylsalisylsyre 75 mg daglig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke supplerende undersøkelser vil være nyttige i avklaringen av Toras plager?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
EKG, ekkokardiografi, arbeidsekg, spirometri/lungefunksjonstester, rtg
thorax
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
EKG, ekkokardiografi og arbeidsekg
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under konsultasjonen tar du et EKG som i tillegg til forandringene forårsaket av det gjennomgåtte hjerteinfarktet også viser atrieflimmer med akseptabel ventrikkelfrekvens.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke behandlingstiltak vil du vurdere nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Antikoagulasjonsbehandling med Marevan eller ett av de nye antikoagulasjonsmedikamentene (NOAK).
Konf CHADS-VASc skåringsskjema.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Antikoagulasjonsbehandling (Platehemming med ASA eller Plavix/Brilque er ikke tilstrekkelig)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 37 år gammel kvinne ble innlagt ved hjerteavdelingen med det hun beskrev som brystsmerter. Det ble ikke funnet kardiell årsak. Pasienten hadde imidlertid svakt forhøyede lever- og galleprøver. Man lurte på om pasienten hadde gallesten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke 3 modaliteter egner seg til påvisning av galleblærekonkrementer (1.5 poeng)?
Ranger disse fra 1-3, der 1 er best egnet (0.5 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ultralyd
# MR
# CT
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng pr riktige modalitet, 0.5 poeng for riktig rangering.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn i stikkordsform fordeler og ulemper ved de forskjellige modalitetene ved utredning av konkrementer i galleblære. Nevn minst 1 fordel og ulempe for hver modalitet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* UL
** Fordeler
*** tilgjengelig
*** ikke stråling
*** høy sensitivitet
** Ulemper
*** operatøravhengig
*** redusert innsyn pga tarmluft
* MR
** Fordeler
*** høy sensitivitet (også for choledochuskonkrementer)
** Ulemper
*** ikke tilgjengelig akutt
*** kostbart
*** ikke alle er mr-kompatible
*** artefakter
* CT
** Fordeler
*** tilgjengelig
*** god for å avdekke komplikasjoner
*** god anatomisk oversikt
** Ulemper
*** stråling
*** lav sensitivitet (ca 70%)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for 1 fordel og 1 bakdel pr modalitet. Ellers skjønnsmessig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Supplerende blodprøver viste også forhøyet bilirubin, ALP, gamma-GT, lipase og amylase. Billeddiagnostikk bekrefter galleblæresten
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse bestiller du nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Må mistenke obstruksjon på papillenivå. Her gir ultralyd dårlig oversikt pga tarmluft. CT vil være å foretrekke om man mistenker malign sykdom, MRCP om man mistenker stensykdom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for at ultralyd gir dårlig oversikt over papilleområdet. 0.5 poeng for MRCP ved stensykdom. 0.5 poeng for CT ved mistanke om
pankreascancer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten anga også å ha hatt smerter i nedre abdomen samt diare over lengre tid. Det ble gjort CT av abdomen og bekken hos pasienten. Det ble her påvist forandringer som ga mistanke om Crohns sykdom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke radiologiske funn kjennetegner Crohns sykdom (nevn minst 4)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Veggfortykkelser (ofte terminale ileum)
* Stenoser
* Økt kontrastoppladning
* Økt tetthet i fettvev
* Reaktive lymfeknuter
* Ev. fistulering/abscesser.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng pr funn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten fikk behandling og ble utskrevet. Hun kom tilbake etter 1 mnd med økende magesmerter og følelse av oppblåsthet. Hun hadde ikke hatt luftavgang eller avføring på 1 døgn. Man mistenkte tarmobstruksjon på bakgrunn av Crohns sykdom. Det ble rekvirert røntgen oversikt abdomen.
<<imgLink "IIAB-2017f-3-A.PNG" 700>>
<<imgLink "IIAB-2017f-3-B.PNG" 700>>
<<imgLink "IIAB-2017f-3-C.PNG" 700>>
<<imgLink "IIAB-2017f-3-D.PNG" 700>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Se vedlagte 4 bilder av pasienten (2 bilder i ryggleie, 1 stående bilde, 1 innskutt bilde).
Beskriv relevante funn (minst 4).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Dilatert tynntarm med luft-/væskespeil
* Væskespeil i ventrikkel
* Ventrikkelretensjon
* Luft i høyre colon og rektum
* Sammenfalt colon
* Ingen fri luft
* Høygradig obstruksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng pr funn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 57 år gammel kvinne ble innlagt på sykehus grunnet vekttap og vedvarende hoste siste 2 måneder. CT thorax viste en perifer 2 cm stor tumor i venstre lunges overlapp. Det ble tatt en ultralydveiledet transthorakal nålebiopsi av tumor. Biopsien ble sendt til patologiavdelingen ved sykehuset. Det ble ikke påvist symptomer eller tegn til sykdommer i andre organer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved mikroskopisk undersøkelse av biopsien ble det påvist atypiske cytoplasmarike epiteliale celler og flere mitoser.
Hva er diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Atypiske epiteliale celler med mitoser viser at dette er et karsinom.
Cellene er cytoplasmarike. Derfor er ikke dette et småcellet karsinom (SCLC har lite cytoplasma), men altså et NSCLC. Beskrivelsen gir ikke mulighet til å avgjøre om karsinomet er et plateepitelkarsinom, adenokarsinom eller eventuelt storcellet karsinom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
''NSCLC (Non-Small Cell Lung Cancer = ikke småcellet lungekarsinom) = 2 poeng''.
Karsinom (omfatter bade SCLC og NCLC) blir derfor bare delvis rett = 0.5 poeng
Plateepitelkarsinom, adenokarsinom eller eventuelt storcellet karsinom blir mer presist enn den oppgitte beskrivelsen gir grunnlag for = 0.5 poeng
Metastase = 0 poeng ("Det ble ikke påvist symptomer eller tegn til
sykdommer i andre organer")
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen ble operert. Venstre lunge var normalt fritt bevegelig. Det ble utført lobektomi av venstre overlapp og fjerning av mediastinale lymfeknuter. Lungelappen og lymfeknutene ble sent til patologiavdelingen hvor lappen først ble undersøkt makroskopisk
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke observasjoner/registreringer ved den makroskopiske undersøkelsen av tumor i lungelappen er viktige for videre behandling og prognose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
TNM klassifikasjon har betydning for videre behandling og prognose. For å gjøre en slik klassifikasjon komplett (utover det klinikere allerede har påvist) må følgende registreringer foretas ved den makroskopiske undersøkelsen: tumor størrelse (største tverrmål/diameter) og relasjon til pleura viscerale (ev. infiltrasjon verifiseres mikroskopisk). Disse observasjonene har betydning for T i TNM-klassifisering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng = tumors størrelse + relasjon til pleura
* 1.5 poeng = tumors størrelse (som er viktigere enn relasjon til peura, og som er et gjennomgående prinsipp i T)
* 0.5 poeng = relasjon til pleura Invasjon av naboorganene ikke relevant ("lappen var fritt bevegelig"), og om det var fri reseksjonsrand i lappebronkus er heller ikke relevant for T i pTNM.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svaret fra patologen viste at det ikke var metastaser til lymfeknuter fjernet fra mediastinum.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er 5 års overlevelse ved kreft i lungene samlet (lokalisert sykdom + regional sykdom + fjernmetastaser), og hva er 5 års overlevelse dersom sykdommen er lokalisert som hos denne kvinnen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Menn samlet perioden 2010-2014: 13 %
* Menn lokalisert 2010-2014: 38 %
* Kvinner samlet 2010-2014: 19 %
* Kvinner lokalisert 2010-2014: 50 %
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng = all lungekreft for menn og kvinner < 20 % og lokalisert menn og kvinner 40 til 50 %
* 0.5 poeng = kvinner lever lengre enn menn med denne sykdommen, og de med lokalisert sykdom lever lengre enn gruppen som helhet
* 0.5 poeng = av de store kreftgruppene (etter organ) er kreft i lungene den med dårligst overlevelse.
Her blir det sikkert mange svarvarianter. Håper de tre eksemplene på poeng er tilstrekkelig veiledende
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fire år senere ble kvinnen innlagt sykehus med metastaser og lungebetennelse.
Lungebetennelsen gikk tilbake med antibiotikabehandling. En morgen ble hun funnet død i sengen og nå oppdaget man hevelse i den ene leggen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva mener du kan ha skjedd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
DVT (dyp venetrombose) med embolisering til lunge
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng = DVT med lungeemboli
* 1.5 poeng = lungeemboli
* 1 poeng = DVT
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får beskjed om å fylle ut dødsmelding på kvinnen.
Fra forrige vignett:
<<<
Fire år senere ble kvinnen innlagt sykehus med metastaser og lungebetennelse.
Lungebetennelsen gikk tilbake med antibiotikabehandling. En morgen ble hun funnet død i sengen og nå oppdaget man hevelse i den ene leggen.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skriver du om årsaker til død på henholdsvis Ia (umiddelbar dødsårsak) og Ic
(underliggende dødsårsak)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ia: Lungeemboli
* Ic: Lungekreft
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng = Ia: Lungeemboli Ic: Lungekreft
* 1.5 poeng = Ic: Lungekreft (det er denne underliggende tilstand som mht til dødsårsaksstatistikken er viktigst)
* 1.5 poeng = Ia: Lungeemboli Ib: DVT Ic: Lungekreft (dette er jo også riktig, men det spørres ikke om mellomliggende dødsårsak Ib i oppgaven
* 1 poeng = Ia: Lungeemboli
* 0.5 poeng = svar av typen: lungekreft førte til lungeemboli (uten angivelse av Ia eller Ic)
* 0 poeng = Ia: Lungekreft Ic: Lungeemboli (da sier man at lungeemboli førte til lungekreft, og det er jo snudd på hodet)
Ellers: Ia er den umiddelbare DÅ mens Ic er den underliggende DÅ (Ia er altså forårsaket av Ic og ev. bruk av Ib forklarer sekvensen fra Ic til Ia om dette er nødvendig. Så i dette tilfelle kunne man helt fullstendig ha skrevet det slik:
* Ia: Lungeemboli
* Ib: DVT. Metastaser.
* Ic: Lungekreft (NSCLC)
Men, igjen det spørres kun om Ia og Ic.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Legevaktslegen blir tilkalt hjem til Markus (21) søndag formiddag. Markus kom akkurat hjem etter å ha vært på fest i går kveld med påfølgende overnatting hos en venninne. Da han kom hjem reagerte foreldrene hans på at han oppførte seg underlig. Han klarte ikke låse opp ytterdøra og snakket ikke til dem. De ble bekymret og ringte 113. Foreldrene forteller at Markus kom hjem fra ferie i Vietnam for noen dager siden og hadde med seg sprit som var kjøpt der. Når legevaktslegen kommer inn, sitter Markus på senga si, klarer ikke å snakke og sikler litt ut av den høyre munnviken.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to diagnoser som legevaktslegen bør tenke på og hvilke kliniske undersøkelser legevaktslegen bør prioritere i denne situasjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Legevaktslegen bør ta seg tid til en rask generell og nevrologisk status for å avklare nærmere: Hvorfor snakker ikke pasienten? Ansiktet undersøkes for mulig facialisparese (i og med at han sikler). Kraft og smertereaksjon undersøkes i armer og bein. Samtidig er det naturlig å se etter skader.
Det er relevant å mistenke intoksikasjon. Generell undersøkelse bør inkludere blodtrykk, puls, temperatur, respirasjonsfrekvens, hudfarge og pupillestørrelse. I og med at foreldrene presenterer sprit bør legen tenke på metanol. Det kan gi metabolsk acidose og hyperventilasjon. Så tidlig i sykehistorien kan man ikke utelukke andre årsaker som f.eks. hodeskade (vurdere Glasgow Coma Scale skår) eller CNS-infeksjon.
På grunn av mistanke om akutt og alvorlig tilstand skal pasienten innlegges sykehus. Hvis det ikke er tid til å lage innleggelsesskriv, bør legen ringe vakthavende lege på sykehuset og informere om sine funn og vurderinger.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Mistenke og gjøre rask nevrologisk undersøkelse mhp hjerneslag (1 p).
Mistenke annen årsak enn hjerneslag og undersøke mhp dette, f.eks. intoksikasjon, hodeskade eller CNS-infeksjon (1 p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
AMK har i tillegg til å sende ut legevakten, også sendt en ambulanse. Ambulansen kommer før legevaktslegen får undersøkt pasienten særlig godt. Siden det ikke er så langt til sykehuset lar legevaktslegen ambulansepersonellet ta Markus med seg. Turnuslegen som tar i mot pasienten i akuttmottaket mottar ingen informasjon utover en kort ambulanserapport hvor det står ”intoksikasjon?” I mottagelsen har pasienten normale vitale parametere, men virker fortvilet og veiver stadig med venstre arm. Legen forsøker å snakke med pasienten, men får ikke svar
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken bildediagnostisk undersøkelse er særlig relevant i denne situasjonen og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bildediagnostikk: CT caput er indisert fordi pasienten ikke kan snakke og virker forvirret. Funn ved klinisk undersøkelse kan også understøtte dette. MR-undersøkelse kan eventuelt gjøres akutt, men dette fører ofte til forsinkelse. Derfor utføres oftest CT caput først for å unngå forsinkelse i diagnostiseringen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p for CT caput og begrunnelse for hvorfor dette bør gjøres (bare CT eller CT caput alene gir ikke poeng, både CT caput og riktig begrunnelse må være med).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Turnuslegen forsøker å undersøke pasienten, men syns dette er vanskelig fordi pasienten samarbeider dårlig. Turnuslegen bestiller en CT-undersøkelse som blir beskrevet som normal. Pasienten sendes deretter til sengeposten. En halv time senere kikker en annen lege som er på sengeposten over pasientens journal og synes sykehistorien er noe merkelig. Hun går inn til Markus og finner raskt ut at han har en høyresidig facialisparese og slapp parese i høyre arm, samt afasi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan skal dette håndteres videre og er det aktuelt å starte noen type behandling på dette tidspunktet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er en akutt oppstått hemiparese, og hjerneslag må mistenkes. I og med at CT caput var beskrevet som negativ er det ingen hjerneblødning.
Det kan da være indikasjon for akutt intravenøs trombolyse. Legen må slå alarm og sørge for at dette iverksettes, så fremt pasienten vurderes å være innenfor tidsvinduet for behandling.
Fordi man ikke kjenner til når symptomene oppsto, kan trombolyse i utgangspunktet ikke gis. Selv om hemiparesen først blir erkjent på sengeposten, betyr ikke dette at pasientens symptomer oppsto da. Markus hadde symptomer allerede da foreldrene så at han kom hjem, og symptomene må derfor ha oppstått før dette. Behandlingen må gis innen maksimalt 4,5 timer. Etter dette anses risikoen for å utløse en hjerneblødning å være for høy.
Det vil i denne situasjonen være viktig å kontakte foreldrene og evt. venner av Markus for å få nærmere klarhet i når han sist ble observert frisk.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten foreslår akutt trombolyse på grunn av hjerneslag (0.5 p).
Studenten drøfter tidsaspektet og konkluderer med at trombolyse likevel ikke er indisert (0.5 p).
Studenten foreslår å etterforske når symptomene kan ha oppstått (1 p). (se evt. i svaret på deloppgave 4)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke lenge etter tilkommer det ny informasjon fra radiologen som ringer og forteller at CT-bildene ikke er helt normale likevel, men viser et ”hyperdens media-tegn” på venstre side.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr dette tegnet? Hvilken betydning kan dette ha for behandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
"Hyperdens media-tegn" brukes om funn av en hvit stripe på CT caput svarende til proksimale deler av arteria cerebri media. Funnet taler for en stor trombe i karet, og innebærer at det vil kunne utvikle seg et stort hjerneslag.
Intravenøs trombolyse har liten effekt i denne situasjonen, og er dessuten ikke indisert pga manglende debuttidspunkt. Intraarteriell trombektomi kan derimot gjøres innen et noe lengre tidsrom. Det er svært viktig å få klarhet i når Markus sist ble observert frisk.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rett forklaring av CT- funnet (trombe i a. cerebri media som gir hjerneslag)1p
Studenten foreslår intraarteriell trombektomi – 1p.
Etterforske når symptomene debuterte – hvis det først foreslås her gir det 1 poeng i forrige deloppgave.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dessverre var ikke behandlingen vellykket, og tilstanden er uendret. Pasienten vurderes som stabil og er våken, men flyttes likevel til en overvåkningsavdeling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken komplikasjon er det særlig grunn til å frykte i dette tilfellet, og hvilken kirurgisk prosedyre bør man da ha beredskap for?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt intrakranialt trykk (ICP) pga. hjerneødem (cytotoksisk ødem) i det infarserte hjerneområdet. Dette kan i verste fall føre til herniering (og eventuelt tamponade). Yngre pasienter er mer utsatt for dette enn eldre slagpasienter. Det må være beredskap for å gjøre hemikraniektomi, og da må om nødvendig pasienten flyttes til sykehus med nevrokirurgisk avdeling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Økt ICP og hernieringsfare (1p).
Hemikraniektomi (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tross intensiv behandling dør pasienten av komplikasjoner 4 dager senere. Foreldrene er sinte og fortvilte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hvilken informasjon som bør gis til foreldrene og hvordan de bør få denne informasjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Foreldrene bør møtes med åpenhet. De bør i samtaler få forelagt all informasjon og forklares hele hendelsesforløpet, også det man føler har gått galt eller burde vært gjort annerledes. Det bør settes av tid til å forklare dette på en grundig og forståelig måte. Foreldrene skal informeres om Norsk pasientskadeerstatning, og om nødvendig få hjelp til å fylle ut meldeskjema. Dersom sykehuset mener det har skjedd et plutselig og uventet dødsfall hvor behandlingssvikt helt eller delvis er en årsaksfaktor, skal saken meldes til Helsetilsynet innen 24 timer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p dersom studentene nevner to av poengene som er listet opp ovenfor (åpenhet, muntlig informasjon gjennom samtaler, helhetlig informasjon til pårørende, informasjonen gis på en forståelig måte, informasjon om NPE/klagemulighet, sykehusets meldingsplikt ved mulig behandlingssvikt) i løsningsforslaget.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 72 år gammel mann oppsøker legevakten kl 18. Han er pensjonert lærer og storrøyker med kjent KOLS, men er hjertefrisk og uten annen kjent sykdom. Han kommer fordi han de siste 4 timene har hatt akutte stikkende brystsmerter, lokalisert til venstre side av brystet, vesentlig postero-lateralt, og som forverres ved inspirasjon. Brystsmertene har ingen utstråling og er ledsaget av hoste og dyspnoe. Temperaturen er målt til 38.4^^o^^C rektalt. Ikke vekttap eller redusert allmenntilstand før det aktuelle.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 4 differensialdiagnoser.
Hva er sannsynlig smertemekanisme (årsak) bak differensialdiagnosene du foreslo? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Studenten må kunne resonnere:
* Hvilke organ og mekanismer som kan utløse smerte:
** Smertereceptorer – nerveender, aktivert av inflammasjon, traume, strekk av hulorgan etc. Akutte smerter – uten sensitisering, hypestesi og kronifisering, perifer vs sentral, fantomsmerter, «mixed pain»
** Nociceptiv, nevropatisk, visceral, psykogen smerte. Akutt vs kronisk, start-intermitterende-vedvarende, lokasjon, karakter, intensitet, utstråling, forverrende – lindrende forhold
* Akutt dyspnoe og diagnoser / tilstander i dette perspektiv:
** Akutte lungeemboluser – pleuritisk smerte (nociceptiv – somatisk)
** Lungebetennelse – pleuritisk smerte (nociceptiv – somatisk)
** Pneumothorax – pleuritisk smerte (nociceptiv – somatisk)
** Lungekreft – pleuritisk smerte (evt fra skelettmetastaser) (nociceptiv – somatisk)
** KOLS-forverring – m/ pleuropneumoni, pleuritisk smerte (nociceptiv – somatisk)
** Primær infeksiøs pleuritt / empyem (evt immunologisk) – pleuritisk smerte (nociceptiv – somatisk)
** Pericarditt – pericarditisk smerte (nociceptiv – somatisk)
** Mindre sannsynlige:
*** Akutt hjerteinfarkt – ischemisk smerte (nociceptiv – visceral)
*** Akutt abdomen – peritonitisk (nociceptiv – visceral) smerte (inflammasjon / distensjon av hulorgan)
*** Aortadisseksjon – nociceptiv – visceral smerte
*** Hyperventilasjonsanfall – nevromuskulær smerte/intercostalnevralgi (nevropatisk – psykogen)
*** Nevromuskulær tilstand / muskulær hypertensjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
4 Differensialdiagnoser (mest sannsynlige) (á 0.5p) med begrunnelse for smertetype i de 4 diffdiagnoser (á 0.5p). Mindre sannsynlige gir ikke poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten forteller at han nylig har vært innlagt sykehus med lårhalsbrudd og blitt operert for 1-2 uker siden. Han har observert litt blodtilblandet oppspytt. Han fremstår mentalt adekvat og anamnestisk er urin / avføring u.a.
Funn ved undersøkelse: BT er 140/85, puls er 110/min reg, respirasjonsraten er 24/min, og han litt klam i huden. Auskultasjon avslører sidelik vesikulær respirasjonslyd, litt knatrelyd basalt venstre side, og lett dempet perkusjonslyd samme område. Ingen bilyder over cor, ingen ødem i underekstremiteter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de to nå (mest) sannsynlige differensialdiagnoser, og begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
1) Akutte lungeemboluser og 2) Akutt pneumoni (pleuropneumoni)
''Begrunnelse:'' Anamnesen er mest forenlig med ''akutt lungeemboli'' (LE) og/eller ''akutt lungebetennelse'' hvor begge kan gi smertefull pleuraaffeksjon, og anamnesen gir holdepunkt for pleuritisk smerte (smerter forverres ved inspirasjon). Sykdommen har kommet akutt og videre ledsaget av feber, hoste og dyspnoe, samt lett blodtilblande oppspytt. Begge diagnoser kan gi feber, hoste og dyspnoe og hemoptyse og det er ikke opplysninger om lengre tids sykdom, vekttap eller redusert allmenntilstand. Derfor er akutt sykdom mer sannsynlig enn kronisk progredierende sykdom, om enn operasjon og evt lungekreft kan disponere for både lungeemboli og lungebetennelse. ''Lungebetennelse'' og ''lungeembolus'' er ikke sjelden komplikasjon til lengre narkose, operasjon og immobilisering for lårhalsbrudd i pasientens alder, hypoventilasjon / overfladisk grunnet smerte (samt har KOLS). Hemoptyse tyder på at ”primær lungesykdom” er mer sannsynlig enn primær coronarischemisk hjertesykdom, aortadisseksjon, perikarditt, alene infeksiøs pleuritt, hyperventilasjon eller akutt abdomen. ''Primær lungekreft'' debuterer ofte ikke så akutt (men kan naturligvis debutere med komplikasjoner som LE og pneumoni). ''Pneumothorax'' med så betydelige symptomer ville sannsynlig gitt lokal hypersonor perkusjonslyd og redusert respirasjonslyd. Pneumothorax pleier ikke gi feber. Pasienten hadde lette krepitasjoner og perkusjonsdempning, tydende på økt væskeinnhold i lunge som kan forekomme ved begge tilstander (pneumonitis / atelektase og pleuravæske). ''Perikarditt'' pleier ikke være assosiert til respirasjonssyklus (derimot mer kontinuerlig, hjerterytme og frekvens), ei heller med blodig oppspytt, spesielt ikke uten hjertesvikt (pasienten hadde lette krepitasjoner basalt unilateralt – lokalisert sykdom) og pasienten hadde ingen «hjertefrekvenssynkron» bilyd / gnidningslyd over hjertet (ikke oppgitt).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Akutte lungeemboluser (0.5p)
# Akutt lungebetennelse (pleuropneumoni) (0.5p)
# Begrunnelse for 1) og 2) (á 0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du vil bruke et klinisk skåringsverktøy for å bestemme hva slags supplerende undersøkelser du bør bestille
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to skårings-metoder for slik vurdering, disses funksjon, og aktuell blodprøve med indikasjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Metoder: Wells skår og Geneva skår (original, revidert, forenklet)
# Funksjon: vurdering av klinisk sannsynlighet for lungeemboli (lav, middels eller høy grad), basert på anamnese og funn
# D-dimer: diskriminerer mht etiologi, sannsynlig venøs trombose eller ikke (hhv positiv eller negativ D-dimer) – tas ved lav/middels klinisk sannsynlighet, mens en avstår fra slik prøve om høy klinisk sannsynlighet for lungeemboli
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Wells (0.5p) og Geneva (0.5p)
# Funksjon: inndeling – lav/middels/høy eller lav /høy (1p)
# D-dimer: diskriminere på etiologi – vurdere indikasjon (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble henvist til utredning på sykehus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn aktuelle bildeundersøkelser som kan gjøres for å komme nærmere en diagnose, og begrunn hva de er egnet til å påvise.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# De tre vanligste undersøkelser er: rtg thorax, for differensialdiagnotikk (utelukke to relativt vanlige tilstander), mens Ventilasjons-Perfusjons scintigrafi (påviser redusert perfusjon perifert for embolus) og CT lungearterier (påviser selve embolus) er to bildeundersøkelser for diagnostisering av lungeemboluser
# Rtg thorax – blant annet for å utelukke pneumoni og pneumothorax
# CT lungearterier: er beste undersøkelse for å påvise LE og evt differensialdiagnose hos denne pasienten, tilstand og kveldstid. CT lungearterier kan utføres hele døgnet, gir opplysninger om differensialdiagnoser i ulike thorakale organ, som pneumothorax, lungebetennelse, atelektaser, hjertesvikt, LE, aortaaneurisme - ruptur etc (andre parenchym- og thoraxsykdommer) som alltid er viktig, uavhengig av KOLS og emfysem
# Ventilasjons-perfusjonsscintegrafi (VP-scan) er ofte et alternativ, men egner seg mindre grunnet opplysninger om betydelig røykeanamnese og KOLS, som vanskeliggjør vurdering av match- og mis-match perfusjonsdefekter, som kan være hyppig hos pasienter med obstruktiv lungesykdom. VP-scan gjøres kun på dagtid (mest 09 – 15) og egner seg mindre som Øhj undersøkelse. VP-scan bare gir utsagnsverdi om grad av sannsynlighet for LE, verken mer eller mindre
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Ventilasjons-Perfusjons scintigrafi (0.5p)
# CT lungearterier (0.5p)
# Begrunnelse (i kvalitet og tilgjengelighet) (1p for hver us)
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kombinasjonspreparater med kodein og paracetamol er utbredt i Norge; med salgstall på nær 10 DDD/1000/døgn er vi storforbrukere av slike ikke helt ukontroversielle kombinasjonspreparater i europeisk målestokk. Kombinasjonspreparatene inneholder vanligvis 500 mg paracetamol og 30 mg kodein per tablett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Morfinliknende preparater – hvor kodein er et eksempel – omtales gjerne med samlebetegnelsene «opiat» og «opioid». Hva betyr disse to begrepene, og hvor vil du plassere kodein?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Opiater er legemidler fremstilt fra opium, og er enten naturlig forekommende eller semisyntetiske derivater fra komponenter i opiumsvalmuen. Opioider er stoffer med morfinliknende effekter; altså stoffer som virker via opioide my-reseptorer.
Kodein er både et opiat og et opioid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekte definisjoner gir ett poeng. Korrekt plassering av kodein gir ett poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I vanlige terapeutiske doser er kodein avhengig av metabolsk aktivering for å utøve en smertestillende effekt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter de to farmakologisk aktive metabolittene til kodein?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Morfin og morfin-6-glukuronid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert riktig svar
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det første trinnet i den metabolske aktiveringen av kodein utøves av et polymorft distribuert isoenzym i cytokrom P450-familien.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter de to farmakologisk aktive metabolittene til kodein?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CYP2D6
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ingen andre alternativer gir poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Paracetamol har også et annet generisk navn, som bl.a. er enerådende i amerikansk faglitteratur.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles paracetamol i USA?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetaminofen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ingen andre alternativer (unntatt annen skrivemåte; acetaminophen etc.) gir poeng
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Paracetamol har to kvantitativt dominerende metabolitter, som begge utskilles i urinen og er farmakologisk inaktive.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er navnet på disse to metabolittene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Paracetamol-glukuronid og paracetamol-sulfat
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert riktig svar.
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Paracetamol kan være levertoksisk i overdose. Store overdoser behandles med en motgift.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter denne motgiften, og hvordan virker den?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
N-acetylcystein (NAC). Stoffet har, på samme måte som glutation (det tripeptidet som gjør denne jobben fysiologisk, og som NAC skal «kopiere») sulfhydrylgrupper som kan binde seg til den toksiske paracetamolmetabolitten NAPQI og inaktivere denne før det får utrettet skade på hepatocyttene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
N-acetylcystein og gangbare varianter av forklaringen (her må sensor bruke skjønn) gir to poeng, kun N-acetylcystein gir ett poeng. En redegjørelse for scavengermekanismen (uten å nevne NAC spesifikt) gir også ett poeng
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 65 år gammel mann innlegges i kirurgisk avdeling pga. økende magesmerter, kvalme og oppkast. Når du undersøker ham i kirurgisk mottak ser du at abdomen er utspilt. Du synes sykdomsbildet er mest forenlig med ileus
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire mulige årsaker til ileus
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Adheranser (sammenvoksninger), strengileus, alle typer brokk, cancer, tumor, Meckels divertikkel, Crohn med stenose, gallestensileus, fremmedlegemer, diverticulitt, volvulus, invaginasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for hvert svar, maks 2p
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen egen vignett)
En 65 år gammel mann innlegges i kirurgisk avdeling pga. økende magesmerter, kvalme og oppkast. Når du undersøker ham i kirurgisk mottak ser du at abdomen er utspilt. Du synes sykdomsbildet er mest forenlig med ileus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to røntgenundersøkelser er indisert for å kartlegge diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen oversikt abdomen og CT abdomen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p for hvert riktig svar
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det viser seg at årsaken til hans ileus er en cancer lokalisert i coecum og som stenoserer tarmlumen ved den ileocoecale overgangen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken operasjon er indisert for denne mannen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Høyresidig hemicolectomi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hemicolectomi gir også 2 p. Andre forslag gir ikke poeng
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
De første par dagene etter operasjonen er han i stadig bedring, men ved morgenvisitten 4. postoperative dag klager han over stikkende smerter i venstre thorax, uten utstråling, de er mest intense ved inspirasjon. Han har ikke feber og ingen hoste.
Pulsoksimeteret viser ~PaO,,2,, 90. Ved auskultasjon er det ingen sikre fremmedlyder, og det er ingen dempning ved perkusjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lungeemboli
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ikke noe annet svar gir poeng
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
En ukes tid senere kan han utskrives og han kommer til kontroll ved kirurgisk poliklinikk ca. 3-4 uker etter operasjonen. Du vet da at verken de pre-operative undersøkelsene eller de operative funnene viste tegn til fjernmetastaser. Du har også rapporten fra patologen som bl.a. viser: «Største tumordiameter er 4 cm, det er ingen vekst av tumor gjennom tarmveggen, det er frie reseksjonskanter. Det finnes 16 lymfeknuter hvorav 4 har malign infiltrasjon.»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva innebærer dette mht. valg av strategi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Postoperativ kjemoterapi (6 mndr.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Adjuvant kjemoterapi gir også 2 poeng
Kjemoterapi gir også 2 poeng
Radiokjemoterapi gir 0 poeng
</$details><br/>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 80 år gammel tidligere frisk mann tar kontakt på legevakt fordi han våknet i dag med nedsatt syn på venstre øye. Han har ingen smerter og er ellers i fin form. I tillegg har han merket at synet er blitt gradvis svekket på begge øyne over de siste to år og det er vanskelig å kjøre bil i tunneler når det kommer motgående trafikk. Orienterende nevrologisk undersøkelse er normal bortsett fra innskrenket synsfelt ad modum Donders i øvre kvadranter venstre øye. Ukorrigert visus oculus dexter (od): 0.2, oculus sinister (os): fingertelling. Korrigert visus od:(-3.00, -0.00 i 180°): 0.5; os:(-3.00, -0.00 i 180°): fingertelling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det korrigert eller ukorrigert visus som er mest nyttig diagnostisk i denne situasjonen? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Visus med beste korreksjon er mest relevant i en utredning av plutselig synstap. Grunnen til at dette er riktig svar er at du vil ved en slik øyeblikkelig hjelp utredning være mest interessert i synstap som skyldes andre forhold i synsaksen enn refraksjonsfeil.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar visus med beste korreksjon gir 1 poeng. Hvis studenten vet den riktige forklaringen gir dette 1 poeng i tillegg.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 80 år gammel tidligere frisk mann tar kontakt på legevakt fordi han våknet i dag med nedsatt syn på venstre øye. Han har ingen smerter og er ellers i fin form. I tillegg har han merket at synet er blitt gradvis svekket på begge øyne over de siste to år og det er vanskelig å kjøre bil i tunneler når det kommer motgående trafikk. Orienterende nevrologisk undersøkelse er normal bortsett fra innskrenket synsfelt ad modum Donders i øvre kvadranter venstre øye. Ukorrigert visus oculus dexter (od): 0.2, oculus sinister (os): fingertelling. Korrigert visus od:(-3.00, -0.00 i 180°): 0.5; os:(-3.00, -0.00 i 180°): fingertelling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Basert på alder og det du fant ved undersøkelsen, nevn de tre mest aktuelle diagnosene som kan forklare det nyoppståtte synstapet på venstre øye.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sentralarterieokklusjon. Grenveneokklusjon. Våt AMD med gjennombruddsblødning. Amotio retina.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar er 3 av disse som gir 3 poeng. Hvis studenten nevner kun en eller to riktige gir dette ett poeng per årsak
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 80 år gammel tidligere frisk mann tar kontakt på legevakt fordi han våknet i dag med nedsatt syn på venstre øye. Han har ingen smerter og er ellers i fin form. I tillegg har han merket at synet er blitt gradvis svekket på begge øyne over de siste to år og det er vanskelig å kjøre bil i tunneler når det kommer motgående trafikk. Orienterende nevrologisk undersøkelse er normal bortsett fra innskrenket synsfelt ad modum Donders i øvre kvadranter venstre øye. Ukorrigert visus oculus dexter (od): 0.2, oculus sinister (os): fingertelling. Korrigert visus od:(-3.00, -0.00 i 180°): 0.5; os:(-3.00, -0.00 i 180°): fingertelling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan pasienten kjøre bil hjem? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten skal ikke kjøre bil, heller ikke hjem fra undersøkelsen. Dette er begrunnet i Førerkortforskriften. Selv om pasienten har visus 0.5 på høyre øye, skal han ikke kjøre bil på grunn av en plutselig og betydelig visusreduksjon på ett øye (til under 0.3). Det er også mulig at han har en sentralarterieokklusjon som regnes som et slag. Dette er også grunn nok i seg selv til at han ikke skal kjøre nå.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar med begrunnelse gir 2 poeng, d.v.s. at pasienten ikke kan kjøre hjem med minst en av årsakene som er hjemlet i Førerkortforskriften. Ingen poeng uten begrunnelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 80 år gammel tidligere frisk mann tar kontakt på legevakt fordi han våknet i dag med nedsatt syn på venstre øye. Han har ingen smerter og er ellers i fin form. I tillegg har han merket at synet er blitt gradvis svekket på begge øyne over de siste to år og det er vanskelig å kjøre bil i tunneler når det kommer motgående trafikk. Orienterende nevrologisk undersøkelse er normal bortsett fra innskrenket synsfelt ad modum Donders i øvre kvadranter venstre øye. Ukorrigert visus oculus dexter (od): 0.2, oculus sinister (os): fingertelling. Korrigert visus od:(-3.00, -0.00 i 180°): 0.5; os:(-3.00, -0.00 i 180°): fingertelling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skal pasienten hjem eller skal han henvises videre? Hva vil du si om hastegraden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved plutselig synstap bør pasienten henvises som øyeblikkelig hjelp til vurdering av øyelege.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir 1 poeng (henvise øyelege som øyeblikkelig hjelp).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 80 år gammel tidligere frisk mann tar kontakt på legevakt fordi han våknet i dag med nedsatt syn på venstre øye. Han har ingen smerter og er ellers i fin form. I tillegg har han merket at synet er blitt gradvis svekket på begge øyne over de siste to år og det er vanskelig å kjøre bil i tunneler når det kommer motgående trafikk. Orienterende nevrologisk undersøkelse er normal bortsett fra innskrenket synsfelt ad modum Donders i øvre kvadranter venstre øye. Ukorrigert visus oculus dexter (od): 0.2, oculus sinister (os): fingertelling. Korrigert visus od:(-3.00, -0.00 i 180°): 0.5; os:(-3.00, -0.00 i 180°): fingertelling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er en sannsynlig årsak til pasientens gradvise synsreduksjon på begge øyne? Begrunn kort hvorfor dette er en aktuell diagnose.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Katarakt er sannsynlig årsak gitt pasientens alder, at han får bedre visus med -3 sfærisk korreksjon (myopiserende katarakt) og at han beskriver gradvis synsreduksjon med blendingsfenomen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar katarakt gir 1 poeng. Hvis studenten i tillegg nevner enten myopisering eller blending fra motgående trafikk som er nevnt i sykehistorien, så gir dette 1 poeng i tillegg.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 54 år gammel overvektig mann har fått ytterligere økende bukomfang den siste tiden og går til fastlegen. Det tas blodprøver som viser forhøyet ALAT 187 (15-70 U/L), ASAT 110 (10-45 U/L), ALP 210 (35-105 U/L)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ytterligere blodprøver kan fastlegen ta nå for å kartlegge pasientens leverfunksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
INR, bilirubin, albumin. Ammoniakk kan også nevnes, men forlanges ikke.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle tre gir 1 poeng. To gir 0.5 poeng. Ammoniakk kan også nevnes, men forlanges ikke
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
En 54 år gammel overvektig mann har fått ytterligere økende bukomfang den siste tiden og går til fastlegen. Det tas blodprøver som viser forhøyet ALAT 187 (15-70 U/L), ASAT 110 (10-45 U/L), ALP 210 (35-105 U/L)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de vanligste kroniske leversykdommene som kan gi slike endringer i blodprøvene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Infeksjoner (hepatittvirus)
# Fettlever: Alkoholisk og non-alkoholisk
# Avleiringssykdommer inkludert hemochromatose
# Autoimmune leversykdommer (autoimmun hepatitt, primær biliær cirrhose / cholangitt, primær skleroserende cholangitt).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fire grupper gir 3 poeng. Tre grupper gir 2 poeng, en-to grupper gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det tas blodprøver som tyder på at pasienten også har diabetes mellitus. Hvilke sammenhenger kan det være mellom diabetes og forhøyede leverprøver?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienter med overvekt og diabetes har økt risiko for å utvikle non-alkoholisk steatose (NAFLD) og steatohepatitt (NASH). NAFLD/NASH ses ofte på som en hepatisk manifestasjon av det metabolisk syndrom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Essensen (se over) bør komme frem i besvarelsen og gir 2 poeng. Delvis svar gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det tas i dette tilfellet en CT abdomen. Hvilke tegn til kronisk leversykdom, samt tegn til minst to komplikasjoner av en kronisk leversykdom vil man kunne finne på en CT?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Leverens utseende og kontur kan gi mistanke om cirrhose.
* Lever og milt kan sammenliknes i samme bilde og gi informasjon om sannsynlighet for steatose.
* Komplikasjoner til leversykdom: Tegn til portal hypertensjon med ascites, kollateraler og splenomegali.
* Fokale leverlesjoner (HCC). Portalvenetrombose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Muligheten for å se tegn til cirrhose gir 1 poeng. Minst to komplikasjoner bør nevnes for å gi ytterligere 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken nytte kan leverbiopsi ha hos pasienter med spørsmål om kronisk leversykdom?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Leverbiopsi kan
* i noen tilfeller gi informasjon om leversykdommens etiologi.
* skille ut pasienter med NASH (fra de mange med NAFLD) som har større risiko for fibrose, cirrhose og leversvikt.
* si noe om pasienten allerede har utviklet fibrose eller cirrhose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To eller tre av punktene over gir 2 poeng. Ett av punktene gir 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne oppgaven fokuserer på det mest grunnleggende hygientiltaket: håndhygiene.
Du er lege som skal gå visitt. Du vil utføre håndhygienen på korrekt måte etter WHOs fem anledninger for håndhygiene. Du husker at disse baserer seg på skillet mellom helsetjenestesonen og pasientsonen.
<<imgLink "IIAB-2018f-3.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved inngangen til sengeposten er det hengt opp en hånddesinfeksjonsdispenser som du benytter. Du forsyner deg og mens du utfører hånddesinfeksjonen på vei til vaktrommet funderer du over om denne hånddesinfeksjonen var en av de fem anledningene for håndhygiene ifølge WHOs anbefalinger. Hva mener du og hvilken av de fem anledningene fulgte du i så fall?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Denne oppgaven i smittevern tar studentene gjennom en vanlig visittgang og ser om de er i stand til å identifisere anledninger der håndhygiene skal utføres. For videre konsept og teoretisk bakgrunn se [ext[Folkehelseinstituttets Håndhygiene - Nasjonal veileder|https://www.fhi.no/nettpub/handhygiene/]]. Her beskrives også de fem momenter for håndhygiene i detalj.
De fem momentene for håndhygiene har som sentral konsept at det skal utføres håndhygiene når man er i
pasientsonen, altså nær pasienten. Korridoren er i utgangspunktet del av helsetjenestesone og håndhygiene utført der tilhører ikke de fem anledningene. (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Noe senere går du og en sykepleier visitt hos en pasient, og du bestemmer deg for at du vil undersøke pasienten. Du har holdt kurveboken under visittsamtalen og må legge den fra deg for å undersøke pasienten. Hvor ville du ha plassert boken og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gi den til sykepleier. Ikke legg den på senga eller andre plasser i pasientsonen (1 poeng). Boka tilhører helsetjenesteområdet mens alt i pasientrommet må oppfattes som pasientsone. (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<imgLink "IIAB-2018f-3.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Undersøkelsen av pasienten under visittbesøket vil generere en eller flere anledninger for
håndhygiene etter "dine 5 anledninger for håndhygiene". Når eksakt i forløpet av
undersøkelsen vil du derfor ha utført håndhygiene? Kan du referere hvilke av de fem
anledninger du benytter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette genererer to anledninger
# etter at man ha gitt visittboka til sykepleier og før fysisk kontakt med pasienten (Indikasjon 1 - Før kontakt med pasient eller pasientens omgivelser)
# Etter undersøkelse av pasient (anledning 4 - etter kontakt med pasient)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver av anledningene, 0,5 poeng hver hvis man
vet tall på anledningene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<imgLink "IIAB-2018f-3.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Visitten foregår i en tomannsstue og du fortsetter hos nabopasienten. Du utførte håndhygiene etter at du var ferdig med første pasient (deloppgave 3) og kan egentlig gå i gang med å undersøke den andre pasienten. Beskriv eventuelle hendelser som vil føre til at du likevel utfører en ny håndhygiene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved kontakt med helsetjenestesone eller første pasients sone. F.eks. Ta i kurveboka eller skyve bort den andre pasientens nattbord. (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Visitten går videre, og i neste tomannsstue har første pasient et leggsår og du vil fjerne bandasjen for å inspisere det. Du vil ta på hansker. Når skal du utføre håndhygiene ved hanskebruk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Før man tar på hansker og etter at man tar de av. (1 poeng hver)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<imgLink "IIAB-2018f-3.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nabopasienten trenger ingen undersøkelse, men du slår av en alarm på en overvåkningsmonitor over pasientens seng. Vil det være en indikasjon for håndhygiene? Gi en kort begrunnelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette er kontakt med pasientens omgivelser (Indikasjon 5 - etter kontakt med pasientens omgivelser)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for ja, 0.5 for begrunnelsen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 71 år gammel mann med kjent KOLS legges inn kl 19:00 som øyeblikkelig hjelp. Han har
hatt funksjonsdyspne i motbakke frem til det aktuelle. Fra formiddagen innleggelsesdagen
fikk han akutt innsettende og økende tungpust i hvile. Han utviklet feber opp mot 39o C og
smerter i venstre hemithorax.
Du er turnuslege på et lokalsykehus og får presenterte følgende observasjoner av sykepleier
* Blodtrykk 130/67
* Puls 120, regelmessig
* Temperatur 38,5 (temporalt)
* Respirasjonsfrekvens 28/minutt, ubesværet
* O2-saturasjon 93% (med 1 liter O2)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser kan forklare de aktuelle symptomer og funn hos denne KOLS pasienten? (Nevn minst 4)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Akutt infeksiøs forverring av KOLS
* Akutt lungeemboli /lunge infarkt
* Ve. sidig pneumothorax
* Ve. sidig pneumoni / pleuropneumoni
* Ve sidig pleuritt
* Ve.sidig pleuraeffusjon
* Pneumomediastinum
* Akutt perikarditt
* Akutt abdomen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Spørsmålet dreier seg om differensial diagnoser ved akutt forverring av dyspne, feber og brystsmerter hos en pasient med kjent KOLS. Man får 0.5 poeng for hver man nevner, inntil 2 poeng.
Brystsmerter beskrives som stikkende. Lite sannsynlighet for at dette skyldes akutt myokard iskemi som ustabil angina pectoris eller hjerteinfarkt. Disse svarene gir ingen poeng. Det kan være akutt perikarditt, pneumothorax/ pleuropneumoni, pleuritt, pleuraeffusjon eller pneumomediastinum. Det gis 0.5 poeng for følgende svar:
# Akutt perikarditt
# Pneumothorax/ pleuropneumoni
# Pleuritt, pleuraeffusjon
# Pneumomediastinum
Akutt forverring av funksjonsdyspne med feber hos en KOLS pasient kan være forårsaket av
# Akutt infeksiøs forverring av KOLS (0.5 poeng)
# Akutt lungeemboli /lunge infarkt (0.5 poeng)
Akutt forverring av funksjonsdyspne med feber og stikkende brystsmerter kan en sjelden gang være forårsaket av en akutt abdomen (0.5 poeng) . Det er viktig å ikke glemme at en akutt sykdom nedenfor diagfragma også kan gi akutt dyspne, feber og brystsmerter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
En 71 år gammel mann med kjent KOLS legges inn kl 19:00 som øyeblikkelig hjelp. Han har
hatt funksjonsdyspne i motbakke frem til det aktuelle. Fra formiddagen innleggelsesdagen
fikk han akutt innsettende og økende tungpust i hvile. Han utviklet feber opp mot 39o C og
smerter i venstre hemithorax.
Du er turnuslege på et lokalsykehus og får presenterte følgende observasjoner av sykepleier
* Blodtrykk 130/67
* Puls 120, regelmessig
* Temperatur 38,5 (temporalt)
* Respirasjonsfrekvens 28/minutt, ubesværet
* O2-saturasjon 93% (med 1 liter O2)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer bør du spørre om for å komme frem til den mest sannsynlige diagnose? Nevn minst 4. Gi en kort begrunnelse for dine spørsmål.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hoste
* Ekspektorat - (økt) mengde, farge
* Frostrier
* Svetting
* Kvalme / oppkast
* Hevelse og smerter i underekstremitetene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hensikten er å kartlegge om studenten kan komme nærmere en avklaring av en av diagnosene nevnt i spørsmål 1.
Man får 0.25 poeng per følgende svar og inntil 1 poeng.
* Hoste
* Ekspektorat - (økt) mengde, farge
* Frostrier
* Svetting
* Kvalme / oppkast
* Hevelse og smerter i underekstremitetene
Man får 0.25 poeng for følgende begrunnelse for spørsmålene og inntil 1 poeng.
* Forverrelse av KOLS kjennetegnes ved pipelyder, økning av hoste og eller ekspektorat mengde i tillegg til økning i dyspneplager
* Infeksjon er assosiert med frostrier og svetting, og kan gi kvalme og oppkast
* infeksjon i nedre luftveien som bronkitt/ infeksiøs KOLS forverring eller pneumoni er assosiert med hoste og mukopurulent ekspektorat
* Dyp vene trombose kan gi hevelse og smerter i underekstremitetene og føre til lungeemboli med utvikling av en lungeinfarkt, pleuritt og pleuraeffusjon
* Hemoptyse kan være forårsaket av lungeemboli
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved undersøkelse av thorax og lungene finner du følgende:
* Inspeksjon: Tønneformet thorax form, symmetrisk thorax ekspansjon, ingen inndragning
* Palpasjon: Ingen ømhet, ingen deviasjon av trakea, sidelike thorax ekspansjon og stemmefremitus
* Perkusjon: Hypersonor perkusjonslyder bilateralt, utvidete lungegrenser, ingen dempning
* Auskultasjon: Sidelike svake respirasjonslyder, stedvis lett forlengelse av ekspirasjon, knatrelyder basalt baktil på venstre side og inspiratorisk gnidningslyd lokalisert til område med knatrelyder
* Over cor høres det regelmessig hjerteaksjon, normale hjertetoner uten bilyder eller andre fremmedlyder.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tilstander er funnene ved klinisk undersøkelse forenlig med?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Emfysem, ve sidig pleuropneumoni
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Emfysemdiagnose (1 poeng) er svært sannsynlig grunnet tønneformet thorax form, utvidete lungegrenser, hypersonor perkusjonslyder bilateralt og svake respirasjonslyder.
Ve sidig pleuropneumoni (1 poeng) er svært sannsynlig grunnet knatrelyderbasalt baktil på venstre side samt inspiratorisk gnidningslyd lokalisert til område med knatrelyder.
Ve sidig pneumoni gis 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Ved undersøkelse av thorax og lungene finner du følgende:
* Inspeksjon: Tønneformet thorax form, symmetrisk thorax ekspansjon, ingen inndragning
* Palpasjon: Ingen ømhet, ingen deviasjon av trakea, sidelike thorax ekspansjon og stemmefremitus
* Perkusjon: Hypersonor perkusjonslyder bilateralt, utvidete lungegrenser, ingen dempning
* Auskultasjon: Sidelike svake respirasjonslyder, stedvis lett forlengelse av ekspirasjon, knatrelyder basalt baktil på venstre side og inspiratorisk gnidningslyd lokalisert til område med knatrelyder
* Over cor høres det regelmessig hjerteaksjon, normale hjertetoner uten bilyder eller andre fremmedlyder.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke undersøkelser bør du bestille som ledd i utredning av dine hypoteser etter deloppgave 3?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blodprøver: Infeksjonsblodprøver som CRP, leukocytter og differensial telling av leukocytter. D -dimer
Mikrobiologiske prøver: blodkulturer x2 for aerob dyrkning, sputum- og nasofarynx sekret prøve til aerob dyrkning, PCR for influenza virus, mycoplasma og chlamydia.
Rtg thorax
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tentativ diagnose er ve sidig pleuropneumoni. Det er viktig å sannsynliggjøre dette ved tilleggsundersøkelser, og forsøke å identifisere mikrobiologiske agens. Kun følgende undersøkelser anses som relevante og gir poeng:
* Infeksjonsblodprøver som CRP (0.12 poeng) , leukocytter (0.13 poeng) og differensial telling av leukocytter (0.25 poeng) .
* D-dimer ( 0.25 poeng) – D dimer i normal område tilsier lite sannsynlighet for lungeemboli
* Mikrobiologiske prøver: blodkulturer x2 for aerob dyrkning (0.25 poeng), sputum prøver til aerob dyrkning (0.25 poeng), nasofarynx prøver til aerob dyrkning og PCR-undersøkelse (0.25 poeng)
* Rtg thorax (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIAB-2018f-4-A.PNG" 400>>
<<imgLink "IIAB-2018f-4-B.PNG" 400>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 4 unormale funn ved granskningen av rtg thorax undersøkelsen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Dråpeformet hjerte
* Økt retrosternal luft
* Avflatete diafragma kontur
* Løst mettet fortetning basalt baktil ve lunge Hyperinflasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Man får 0.25 poeng per følgende svar, og inntil 1 poeng:
* Dråpeformet hjerte
* Økt retrosternal luft
* Avflatete diafragma kontur
* Løst mettet fortetning basalt baktil ve lunge. Hyperinflasjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIAB-2018f-4-C.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder og beskriv spirometri undersøkelse til pasienten i denne kortsvarsoppgaven.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tilfredsstillende utført undersøkelse. FVC er normal, nedsatt FEV1, FEV/FVC ratio og PEF, samt hengekøye-preget flow -volum kurve. Forenlig med en obstruktiv ventilasjonsinnskrenkning, GOLD stadium III KOLS
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tilfredsstillende utført undersøkelse - ekspirasjonstid er > 6 s (0.25 poeng)
FVC er normal (0.1 poeng ), nedsatt FEV1 (0.1 poeng ), FEV/FVC ratio(0.1 poeng ) og PEF (0.1 poeng ), samt hengekøy preget flow volum kurve (0.1 poeng ). obstruktiv ventilasjonsinnskrenkning (0.12 poeng ), GOLD stadium III KOLS (0.13 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege for en 24 år gammel kvinne. Hun kommer til deg som øyeblikkelig hjelp på fastlegekontoret. Hun merket at hun så litt tåkete på det venstre øyet for noen dager siden, men tenkte ikke så mye over det. I dag oppdaget hun imidlertid at hun så enda dårligere på det venstre øyet, og ringte legen. Hun har hatt litt vondt i det samme øyet en ukes tid, spesielt når hun flytter på blikket. Når hun kommer på kontoret har hun ingen andre smerter og føler seg i fin form.
Du gjør en orienterende nevrologisk undersøkelse som er normal. Du gjør en øyeundersøkelse:
* Visus på høyre øye er 1.25.
* Visus på venstre øye er håndbevegelser ad oculum.
* Yttergrenser ved synsfeltundersøkelse ad modum Donders er normal.
Du undersøker øyemuskelbevegelse og finner nedsatt adduksjon på venstre øye og samtidig nystagmus på høyre øye ved blikk mot høyre. Hun har også smerter i og rundt det venstre øyet når hun beveger øyet. Når du undersøker pupillene er det isokore pupiller. Venstre pupille reagerer tregt på direkte belysning og normalt på indirekte belysning. Du gjør en "swinging-flashlight test", og finner at det foreligger en relativ afferent pupilledefekt (RAPD) på venstre øye.
Det er normal rød refleks. Undersøkelse av fremre segment er normal. Undersøkelse av bakre segment ved oftalmoskopi er normal.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlige diagnose? Begrunn kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hos en ung kvinne med denne sykehistorien og slike funn, er det overveiende sannsynlig med en retrobulbær demyeliniserende opticusnevritt.
Begrunnelse:
Symptomer/ sykehistorie som støtter diagnosen: Ensidig synstap som kom ganske raskt (blir ofte verre over flere dager). Ubehag/smerter, som blir verre, eller oppstår ved øyebevegelse. Smertene kommer gjerne i forkant av synssvekkelsen, slik som hos denne pasienten. Ung person (optikusnevritt vanligst mellom 20-45 år). Kvinner er også noe oftere rammet enn menn (kvinne:mann -ratio ved optikusnevritt er 3:2). Denne sykehistorien er ganske klassisk for en optikusnevritt.
Funn som støtter diagnosen:
Relativ afferent pupilledefekt med visus håndbevegelser ad oculum tyder på en lesjon i nervus opticus, eller alvorlig skade av retina/netthinnen,(som sentralarterieokklusjon, sentralveneokklusjon eller stor netthinneløsning). Normal fundoskopi utelukker imidlertid stor retinal skade. Dersom det var en stor netthinneløsning ville en dessuten sett dette som svekkelse i rød refleks, men undersøkelse av rød refleks var normal. Netthinneskade vil heller ikke gi smerter
Pasienten har normale yttergrenser ved undersøkelse av synsfelt ad modum Donders. Synsfeltsutfall er typisk ved optikusnevritt. Det kan være sentralskotom (vil ikke avdekkes hvis en bare tester yttergrenser ved synsfelt ad modum Donders), eller andre typer synsfeltsutfall. Ved iskemisk optikusskade får en ofte horisontale synsfeltsufall, noe som ville gitt innskrenket synsfelt ved undersøkelse ad modum Donders. Yttergrensene ved undersøkelse av synsfelt ad modum Donders vil også være innskrenket ved en stor netthinneløsning.
Visus er svært nedsatt hos denne kvinnen. Visusnedsettelsen hos en pasient med optikusnevritt kan være alt fra nærmest normal visus, til svært nedsatt visus.
Merknad 1: Pasienten har i tillegg en internukleær oftalmoplegi. Dette gir vanligvis dobbeltsyn, men siden pasienten har så dårlig visus på sitt venstre øye, har hun ikke fått dobbeltsyn.
Merknad 2: For å skille mellom skade i synsnerven og netthinnen kunne en undersøkt fargesynet. Ved affeksjon av synsnerven er dette ofte svekket (kan undersøkes med Ishiara fargeplater eller rødt objekt). Dette ble ikke undersøkt hos denne pasienten, og ville nok vært vanskelig på grunn av svært dårlig visus.
Alt i alt peker funnene ved undersøkelsen mot skade av synsnerven. Det kan være ulike årsaker til synsnerveaffeksjon (iskemi, kompresjon, traume, optikusnevritt etc). Smerter ved øyebevegelse er ikke typisk for iskemisk optikusskade, og gir mistanke om inflammasjon av synsnerven, optikusnevritt. Normal fundoskopi innebærer at papillen ser normal ut, det foreligger ikke papilleødem. Det vil si at betennelsen må sitte lenger bak i synsnerven, altså retrobulbær optikusnevritt. Hun har også nedsatt adduksjon på venstre øye og samtidig nystagmus på høyre øye ved blikk mot høyre, altså internuklær oftalmoplegi. Optikusnevritt og internuklær ofalmoplegi (skade i fasciculus longitudinalis mediallis) er begge typisk ved mulitppel sklerose/MS (demyelinserende lidelse).
I sum støtter både sykehistorie og funn opp mot sannsynlig demyelinserende lidelse, og at diagnosen hos denne pasienten er retrobulbær optikusnevritt. Det blir også påvist en internuklær oftalmoplegi.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir 1 poeng. Hvis studenten grunngir diagnosen med minst tre typiske element fra sykehistorien og/eller funn, gir dette 1 poeng i tillegg (1/3 poeng for hvert element). (Typiske element er skrevet i kursiv i sensorveiledningen, og er ment som en hjelp for sensor.)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvordan utføres «swinging-flashlight test» rent praktisk?
# Hvilket funn ved «swinging-flashlight test» vil avdekke en relativ afferent pupilledefekt (RAPD)?
# Forklar kort mekanismen for dette funnet (anatomiske detaljer er ikke påkrevd).
# Forklar hvorfor venstre pupille reagerer normalt på indirekte belysning. Henvis til lysrefleksens baner.
# Hvilken anatomisk del av øyet er vanligvis rammet dersom det foreligger en relativ afferent pupilledefekt (RAPD)?
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<$details class="answer" summary="Svar" state="!!showanswer">
''Punkt 1'': "Swinging-flashlight test" utføres ved at en lyser i vekselsvis høyre og venstre øye. En lyser i det ene øyet i ca. tre sekunder, før en svinger lyset over til det andre øyet. Etter ca. tre nye sekunder svinger en lyset tilbake til det første øyet. Dette gjentas tre-fire ganger, inntil en ser et mønster. (På uketjenesten har studentene blitt lært å si "kurumpa-kurumpa" inni seg, for å få et riktig tempo ved denne undersøkelsen. Ok om de angir dette).
''Punkt 2'': En relativ afferent pupilledefekt (RAPD) vil avdekkes ved at pupillen til øyet med en RAPD ser ut til å utvide seg når en svinger lyset fra det friske øyet og over til øyet med en RAPD. (Dersom en ser etter, vil en se at begge pupillene "vider seg ut" like mye, men i praksis vil en fokusere på det øyet en lyser på.)
''Punkt 3'': Mekanismen for at pupillen med en RAPD ser ut til å vide seg ut når en lyser på dette øyet ved en "swingingflashlight test":
Bakgrunn: Ved "swinging-flashlight test" kan man sammenligne ledningen av synsimpulser i de to synsnervene. Et øye med sykdom i synsnerven, vil lede synsimpulsene dårligere. Pupillene vil derfor trekke seg sammen langsommere, og kun delvis. Det syke/affiserte øyet registrerer fremdeles lys, men i mindre grad enn det friske øyet. Det foreligger en afferent pupilledefekt. (På grunn av at de pupillomotoriske fibrene fra synsnerven krysser i mesencephalon, blir den efferente pupilleresponsen lik på begge øyne. Begge pupiller vil derfor trekke seg sammen like mye/like lite.) Denne forskjellen i reaksjon på direkte lys kan være ganske subtil, og vanskelig å oppdage dersom en ikke direkte sammenligner de to øynene ved å svinge lyset vekselsvis frem og tilbake mellom de to øynene ("swinging-flashlight test"). Når en oppdager den afferente pupilledefekten ved å sammenligne de to øynenes lysrespons ved «swingingflashlight test», benevnes det en relativ afferent pupilledefekt (RAPD).
Riktig svar: Dersom en av øynene har en afferent pupilledefekt, vil pupillene trekker seg sammen i mindre grad (og det virker derfor som de utvider seg!) når lyset svinges fra det friske øyet over til øyet med en afferent pupilledefekt.
Merknad: RAPD kan også observeres dersom begge øynene har nedsatt afferent lysreaksjon, men med asymmetrisk affeksjon. Da vil også pupillene reagere ulikt på lys avhengig av hvilket øye som stimuleres.
''Punkt 4'': Det er normal lysreaksjon i både høyre og venstre øye
ved belysning av venstre øye. (Det er altså normal indirekte lysreaksjon på høyre øye). Forklaringen på dette er at det er normal afferent høyre synsbane inn til hjernestammen (i midthjernen), til første synapse i pretectal nucleus. Fra pretectal nukleus går det fibre frem til både høyre og venstre Edinger Westphal kjerne. Det skjer altså en overkrysning av nervefibre i hjernestammen. Pupillekonstriksjonen starter i Edinger Westphal kjerne, der parasympatiske efferente fibre strekker seg frem til m. constrictor pupillae via ggl. ciliare, og gir lik pupillekonstriksjon på begge øyne.
Merknad: Det skjer også en overkrysning av lysrefleksens baner i chiasma, men det er ikke nødvendig å oppgidette for å få riktig svar.
''Punkt 5'': Den vanligste årsaken til relativ afferent pupilledefekt (RAPD) er skade/sykdom i synsnerven. En RAPD kan imidlertid også ses ved veldig stor skade/sykdom i netthinnen, men riktig svar er synsnerven / nervus opticus, da dette er den vanligste årsaken.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Riktig forklaring på utførelsen av «swinging-flashlight test» gir 1 poeng. (Det er nok å angi at en svinger lyset frem og tilbake mellom de to øynene. Det er ikke nødvendig å angi hvor mange sekund en skal lyse på hvert øye).
# Riktig beskrivelse av funnet som avdekker en RAPD ved "swinging-flashlight test" gir 1 poeng.
# Riktig forklaring på mekanismen funnet beskrevet i delsvar 3. gir 1poeng. Avsnittet der det står "riktig svar" er tilstrekkelig for å få 1 poeng.
# Riktig forklaring gir 1 poeng. Svaret må inneholde at lysrefleksens baner kobles i hjernestammen, og at det derfra går friske fibre ut til begge øyne.
# N.opticus/synsnerven som svar på hvilken anatomisk struktur som vanligvis er rammet ved RAPD gir 1 poeng.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke(n) tilstand(er) bør pasienten utredes for?
# Hvilke to andre ikke-oftalmologiske undersøkelser bør gjøres i den videre utredningen?
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<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten bør utredes videre med tanke på MS (eller demyeliniserende lidelse). Hos denne pasienten er det internuklær oftalmoplegi (hjernestammen), og mistanke om optikusnevritt. Det er derfor aktuelt å gjøre MR medulla og MR orbita, i tillegg til MR caput. MR undersøkelsen bør gjøres med kontrast for å avdekke gamle og nye lesjoner (kriteriet for disseminasjon i tid- for å stille en MS diagnose). I tillegg spinalpunksjon.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Pasienten bør utredes for MS (eventuelt demyelinserende lidelse): 1 poeng.
# To ikke oftalmologiske undersøkelser:
#* MR undersøkelse: 0.5 poeng (se under hva som kreves for poeng). Her må studenten minst angi MR caput for å få poeng. Fint om studenten også angir MR medulla og MR orbita, men ikke nødvendig for å få poeng. Fint om studenten angir bruk av kontrast, men ikke nødvendig for å få poeng. Dersom studenten angir MR undersøkelse etter MS-protokoll, gir dette også poeng. Dersom studenten angir MR med kontrast er dette også riktig.
#* Spinalpunksjon gir 0.5 poeng.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan pasienten kjøre bil hjem fra undersøkelsen hos deg? Begrunn svaret.
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<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten kan ikke kjøre bil, heller ikke hjem fra undersøkelsen. Dette er begrunnet i Førerkortforskriften og er på grunn av en plutselig og betydelig visusreduksjon på ett øye (til visus under 0.1).
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar (kan ikke kjøre bil) gir 1 poeng. Riktig begrunnelse gir 1 poeng.
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!!Vignett
En kvinne på 25 år har kjent astma og bruker Ventoline inhalasjonspulver 4-6 ganger per uke grunnet tung pust. Hun innlegges som øyeblikkelig hjelp pga. akutt innsettende tung pust i forbindelse med løpetur. Ved klinisk undersøkelse er respirasjonsfrekvensen 18/min og ekspiriet forlenget. Ved auskultasjon over lungene høres pipelyder over alle lungeavsnitt.
Arteriell blodgass:
* pO2 7.9 (normalområdet 11-13);
* pCO2 4.9 (normalområdet 4.7-5.5)
* pH 7.37 (normalområdet 7.35-7.45).
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type respirasjonssvikt er dette?
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<$details class="answer" summary="Svar" state="!!showanswer">
Respirasjonssvikt, type 1
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Respirasjonssvikt, type 1
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken medikamentell behandling vil du starte med i akuttmottaket?
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<$details class="answer" summary="Svar" state="!!showanswer">
Beta-2-agonist til inhalasjon på forstøver og steroid peroralt
eller som injeksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Beta-2 agonist eller SABA til inhalasjon på forstøver må nevnes for å få poeng (1p), dersom i tillegg steroid tablett eller injeksjon (1p)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre tiltak/behandling bør igangsettes i akuttmottaket?
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<$details class="answer" summary="Svar" state="!!showanswer">
Oksygenbehandling
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Oksygenbehandling
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tilleggsundersøkelser vil du rekvirere?
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<$details class="answer" summary="Svar" state="!!showanswer">
Rtg thorax (1), infeksjonsstatus med CRP (1)
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rtg thorax (1) og CRP (1)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er diagnostisk funn ved astma på en spirometriundersøkelse?
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<$details class="answer" summary="Svar" state="!!showanswer">
Positiv spirometri reversibilitetstest (1), minimum 12 % og minimum 200 ml økning i FEV1 etter inhalasjon av beta-2-agonist (1)
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må ha med positiv reversibilitetstest (1), dersom også minimum 12 % (1)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved mistanke om astma, men normal spirometri, hvilken undersøkelse kan gjøres for å bekrefte/ avkrefte astma diagnosen?
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<$details class="answer" summary="Svar" state="!!showanswer">
Methacholine bronkoprovokasjonstest
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Methacholine test eller provokasjonstest (1)
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vil du gjøre endringer i hennes faste medisiner? Beskriv i så fall hvilke endringer du vil gjøre.
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<$details class="answer" summary="Svar" state="!!showanswer">
Ja, bør ha inhalasjonssteroid i tillegg til beta-2 agonist Inhalasjonssteroid gir poeng (1)
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!!Vignett
En 72 år gammel kvinne oppsøker sin fastlege på grunn av at hun det siste året har hatt økende plager med smerter i bena. Hun har registrert at smertene kommer når hun går, de er ikke tilstede når hun sitter eller ligger. Smertene er lokalisert til både lår og legger. Smertene i bena er nå av en slik karakter at hun typisk må stoppe opp og ta en pause etter å ha gått 2-300 meter
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de to diagnosene du mener mest sannsynlig kan være årsaken til de symptomene hun beskriver i underekstremitetene.
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<$details class="answer" summary="Svar" state="!!showanswer">
Spinal stenose (spinal claudicatio), Aterosklerose (claudicatio intermittens)
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten bør ut fra denne sykehistorien først og fremst tenke på spinal stenose (spinal claudicatio) eller aterosklerose (claudicatio intermittens) som årsak til smertene. Bare disse svarene gir riktig poeng og for å få 2 poeng må studenten nevne begge disse diagnosene. Dersom bare en av dem nevnes gis 1 poeng. Spinal stenose og/ eller spinal claudicatio regnes som ett riktig svar. Aterosklerose og/ eller claudicatio intermittens regnes som ett riktig svar.
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!!Vignett
Forrige vignett:
En 72 år gammel kvinne oppsøker sin fastlege på grunn av at hun det siste året har hatt økende plager med smerter i bena. Hun har registrert at smertene kommer når hun går, de er ikke tilstede når hun sitter eller ligger. Smertene er lokalisert til både lår og legger. Smertene i bena er nå av en slik karakter at hun typisk må stoppe opp og ta en pause etter å ha gått 2-300 meter
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anamnestiske opplysninger vil være avgjørende for åskille mellom aktuelle diagnoser?
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<$details class="answer" summary="Svar" state="!!showanswer">
# Lindres smertene i bena når du stopper og bøyer deg forover, bøyer ryggen?
# Hjelper det å lene seg forover f.eks over en handlevogn?
# Har du smerter i bena når du sykler?
# Er det mest smerter når du går oppover eller nedover bakke?
# Har du smerter i korsryggen?
# Har pasienten vært røyker?
# Har bena blitt hvite/blå/kalde?
# Har hår på bena blitt borte?
# Har du hatt sår på bena som ikke vil gro?
# Nattesmerter?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten forventes å stille minst ett spørsmål som belyser om pasienten har lindring av smertene i bena ved fleksjon (bøy) av ryggen (smertene lindres ved spinal stenose/spinal claudicatio). Stilles ett spørsmål som belyser dette gis 1 poeng. De 4 første svaralternativene regnes som slike spørsmål.
For å få 2 poeng må studenten svare minst 1 av de 4 første svarene, og minst eller minst ett spørsmål på symptomer som er vanligere ved claudicatio intermittens (spørsmål 7-10).
0.5 poeng for spørsmålet om pasienten har vært røyker er relevant for diagnosen aterosklerose, røyking disponerer for aterosklerose/claudicatio intermittens.
* 1 poeng for minst ett av spørsmål 1-4
* 0.5 poeng for røyking (spørsmål 6)
* 1 poeng for spørsmål 7-10
Spørsmålet om smerter i korsryggen er relevant for spinal stenose, de fleste pasienter med spinal stenose har ryggsmerter og kan trekke opp 0,5 dersom studenten ikke allerede har full skår
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser vil du gjøre for å komme nærmere diagnosen? Forklar kort punkter i undersøkelsen du velger å gjøre
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<$details class="answer" summary="Svar" state="!!showanswer">
* Nevrologisk undersøkelse av underekstremitetene med vurdering av kraft, reflekser, sensibilitet og (Laseques prøve).
* Undersøkelse av sirkulasjon, palpasjon av puls i underekstremitetene (ADP og ATP).
* Hofteundersøkelse
* Ryggundersøkelse
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten bør ut fra denne sykehistorien først og fremst tenke på spinal stenose (spinal claudicatio) eller aterosklerose (claudicatio intermittens) som årsak til smertene. For å få 2 poeng må studenten svare både ryggundersøkelse med nevrologisk undersøkelse av underekstremitetene, og undersøkelse av sirkulasjon i underekstremitetene.
Under undersøkelse av rygg og underekstremiteter må det nevnes undersøkelse av rygg (akser og bevegelse) samt kraft, sensibilitet og reflekser for å få 1 poeng. For å få 1 poeng for undersøkelse av sirkulasjon i underekstremitetene må det svares palpasjon av perifer puls. Det kan gis 0,5 poeng for hver av disse undersøkelsene ved ufullstendig beskrivelse.
Det er bra om studentene never hofteundersøkelse, men det gir ikke poeng i seg selv. Ved mangelfull beskrivelse av undersøkelse av rygg og nevrologi kan hofteundersøkelse trekke opp slik at det gis 1 poeng.
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Symptomene er av en slik art at du blir enig med henne om at det må gjøres videre bildediagnostisk utredning. Hvilken undersøkelse vil du bestille for å avgjøre om symptomene kommer fra ryggen?
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<$details class="answer" summary="Svar" state="!!showanswer">
MR av LS-columna.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
MR er et klart den riktige undersøkelsen for å (CT bare dersom MR ikke kan gjennomføres). Ved mistanke om spinal stenose vil MR være riktig og nødvendig undersøkelse.
Svar MR av LS-columna gir 2 poeng. Ingen andre svar gir poeng
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom det viser seg at symptomene kommer fra ryggen, hvilken informasjon (kortfattet) vil du gi pasienten om mulighet for behandling av en slik tilstand?
</div>
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<$details class="answer" summary="Svar" state="!!showanswer">
Rask progresjon av symptomer eller parese forekommer sjeldent. Symptomatisk behandling av spinal stenose bør utprøves først. Tilstanden kan opereres dersom plagene er så uttalte at pasienten føler at det er nødvendig. Operasjonen går primært ut på å skaffe plass for nervene i ryggmargskanalen, det vil si dekompresjon av lumbale nerverøtter.
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<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det forventes at studenten kan informere om at tilstanden (spinal stenose) først bør forsøkes behandlet ikke-operativt, f. eks. smertestillende og fysioterapi, eller at pasienten akseptere tilstanden slik den er. Det forventes videre at studenten vet at tilstanden kan opereres med bra resultat om symptomene er så uttalte at pasienten i samråd med legen finner operasjon nødvendig. Det bør nevnes kort at operasjon går ut på å skaffe plass for nerverøttene i ryggmargskanalen/spinalkanalen.
For å få 2,5 poeng må det besvares både at tilstanden bør behandles ikke-operativt i første omgang, og at tilstanden kan opereres dersom symptomene er uttalte.
Dersom det bare gjøres rede for ikke-operativ behandling gis 1 poeng, dersom det bare gjøres rede for operativ behandling gis 1 poeng.
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!!Vignett
Du ønsker å finne ut mer om effekten av PCSK9-hemmere, en ny gruppe kolesterolsenkende medikamenter. Gjennom litteratursøk finner du en artikkel om effekten av slike medikamenter, og her er et utdrag av artikkelens sammendrag:
<<<
We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease who were receiving statin therapy. Patients were randomly assigned to receive the PCSK9 inhibitor evolocumab or matching placebo. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The median duration of follow-up was 2.2 years. Relative to placebo, evolocumab treatment significantly reduced the risk of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%]; hazard ratio (relative risk) 0.85, 95% confidence interval 0.79 to 0.92; P value =0.001).
<<<
</div>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bruk ''PICO'' til å presentere forskningsspørsmålet som besvares her.
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<$details class="answer" summary="Svar" state="!!showanswer">
* P (populasjon/pasient) = statin-behandlede pasienter med kjent (aterosklerotisk) kardiovaskulær sykdom
* I (intervensjon) = PCSK9-hemmeren (-inhibitoren) evolocumab
* C (comparison) = placebo
* O (outcome) = kardiovaskulære hendelser (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization)
Har statin-behandlede pasienter med kjent kardiovaskulær sykdom som får PCSK9-hemmeren endret risiko for kardiovaskulære hendelser sammenlignet med dem som får placebo?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert rett punkt av P, I, C og O.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr det at relativ risiko var 0.85?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De som fikk PCSK9-hemmer hadde 15% lavere risiko for det primære endepunktet sammenliknet med dem som fikk placebo.
Alternativ formulering: De som fikk PCSK9-hemmer hadde 0.85 ganger så stor risiko for det primære endepunktet sammenliknet med dem som fikk placebo
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 av alternativene over gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Du ønsker å finne ut mer om effekten av PCSK9-hemmere, en ny gruppe kolesterolsenkende medikamenter. Gjennom litteratursøk finner du en artikkel om effekten av slike medikamenter, og her er et utdrag av artikkelens sammendrag:
<<<
We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease who were receiving statin therapy. Patients were randomly assigned to receive the PCSK9 inhibitor evolocumab or matching placebo. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The median duration of follow-up was 2.2 years. Relative to placebo, evolocumab treatment significantly reduced the risk of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%]; hazard ratio (relative risk) 0.85, 95% confidence interval 0.79 to 0.92; P value =0.001).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke(t) mål på presisjon er oppgitt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Konfidensintervall. (P-verdi er også delvis rett, men P-verdien påvirkes både av presisjon og av effektstørrelse, så konfidensintervall er et riktigere svar).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Konfidensintervall gir 1 poeng (uavhengig av om p-verdi også er nevnt).
Bare p-verdi (men ikke konfidensintervall) gir 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr det at p-verdien var 0.001?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Resultatene er ikke forenelige med nullhypotesen, som er at risikoen for det primære endepunktet er lik blant dem som får PCSK9-hemmer og dem som får placebo.
Alternativt: Sannsynligheten for å observere en så stor forskjell (eller større) mellom gruppene gitt at nullhypotesen er sann (dvs. at risikoen for det primære endepunktet i virkeligheten er lik blant dem som får PCSK9-hemmer og dem som får placebo), er 0.001.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 av alternativene over gir 1 poeng.
Det gir ikke poeng å hevde at sannsynligheten for nullhypotesen er 0.001 (merk forskjellen fra formulering nr. 2 over, "gitt at nullhypotesen er sann" er noe annet enn "sannsynligheten for nullhypotesen"), eller å hevde at sannsynligheten for at tilfeldigheter forklarer funnene i den konkrete studien, er 0.001.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Studien var randomisert, dobbeltblind og placebokontrollert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er fordeler med dette designet, sammenliknet med en kohortstudie?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Randomisering innebærer at konfundere, både kjente og ukjente, vil fordele seg tilfeldig mellom gruppene, slik at en kan trekke slutninger om årsakssammenheng basert på de observerte forskjellene mellom gruppene.
Blinding og placebokontroll reduserer risiko for bias som følge av at studiedeltaker eller –personell agerer eller rapporterer annerledes som følge av at de vet hvilken intervensjon deltakeren får.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at randomisering fjerner konfundering.
1 poeng for å angi at blinding og placebokontroll gjøres for å redusere bias
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
PSCK9-hemmere reduserer nivået av LDL-kolesterol, og vil som følge av dette redusere risikoen for kardiovaskulær sykdom.
I denne studien hadde gruppa som fikk PCSK9-hemmer lavere LDL-kolesterolnivå i oppfølgingstida enn gruppa som fikk placebo. Forskerne justerte ikke for deltakernes LDLkolesterolnivå i oppfølgingstida i de statistiske analysene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du trekke en gyldig konklusjon om PCSK9-hemmerens effekt på det primære endepunktet når slik justering ikke ble gjort? Forklar.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det at slik justering ikke ble gjort, innebærer at studieresultatet ble korrekt og en gyldig konklusjon kan trekkes. Dersom forfatterne i stedet hadde justert for LDL-kolesterol, ville de ha justert for en mediator og således feilaktig maskert effekten de faktisk var ute etter å finne.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for å svare at en kan trekke en gyldig konklusjon (studieresultatet er riktig) uten at det justeres for LDL-kolesterol.
0.5 poeng for å forklare at LDL-kolesterol er en mediator og derfor ikke skal justeres for.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Studien ble gjennomført blant voksne i alderen 50-70 år i Danmark, Tyskland og Storbritannia, og det var ikke forskjell i studieresultatene mellom disse landene. Men ingen nordmenn var inkludert i studien
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Anser du studieresultatet som generaliserbart til statinbehandlede nordmenn i alderen 50-70 år med kjent kardiovaskulær sykdom? Og anser du studieresultatet som generaliserbart til norske barn uten kjent kardiovaskulær sykdom? Begrunn vurderingen din.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Resultatet er høyst trolig generaliserbart til statin-behandlede nordmenn i alderen 50-70 år med kjent kardiovaskulær sykdom, for denne gruppen er svært lik deltakerne i studien, og det er ingen biologisk grunn til å tro at nordmenn skulle reagere annerledes på medisinen enn de nasjonalitetene som var inkludert.
Resultatet er ikke generaliserbart til norske barn uten kjent kardiovaskulær sykdom, for i denne gruppen er det primære endepunktet tilnærmet ikke-forekommende (alternativt kan det angis at risikoen for endepunktene er mye lavere, eller at en ikke kan forvente samme patofysiologiske endringer i denne aldersgruppa); det er først i betydelig høyere alder disse endepunktene vil forventes å oppstå.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Resultatet er høyst trolig generaliserbart til statin-behandlede nordmenn i alderen 50-70 år med kjent kardiovaskulær sykdom (0,5 poeng), for denne gruppen er svært lik deltakerne i studien, og det er ingen biologisk grunn til å tro at nordmenn skulle reagere annerledes på medisinen enn de nasjonalitetene som var inkludert (0,5 poeng).
Resultatet er ikke generaliserbart til norske barn uten kjent kardiovaskulær sykdom (0,5 poeng), for i denne gruppen er det primære endepunktet tilnærmet ikke-forekommende (alternativt kan det angis at risikoen for endepunktene er mye lavere, eller at en ikke kan forvente samme patofysiologiske endringer i denne aldersgruppa) (0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I turnustjeneste har du legevakt på ettermiddagen i Rennebu. En erfaren lege er din bakvakt. Kort tid etter vakten starter kommer en pasient du har tilsett noen dager tidligere. Pasienten er en eldre dame som bor alene og som var hos deg pga. lette anginaplager. Hun hadde nylig vært på kontroll på sykehuset og du hadde samstemt hennes legemiddelliste. Pasienten bruker Albyl-E. Pasienten har nå hatt epistaxis på og av siden i dag tidlig. Du tar inn pasienten på legekontoret. Akkurat nå er det ingen blødning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan klassifiseres epistaxis?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Klassifisering etter ''lokalisasjon'': I hovedsak klassifiseres som fremre og bakre blødninger hvor det mest vanlige er fremre blødninger fra locus Kiselbachii ca 90% av alle blødninger. Locus kiselbachii består av anastomoser fra flere små kar (blant annet a ethmodidale anterior og posterior, A sphenopalatina). Bakre blødninger er ofte større blødninger og kommer fra kar i bakre nesekavitet og eller nasofarynx.
Kan også klassifiseres etter ''årsak'':
* erosjon
* fraktur
* neoplasme
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig klassifisering (enten iht lokalisasjon eller årsak) 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
I turnustjeneste har du legevakt på ettermiddagen i Rennebu. En erfaren lege er din bakvakt. Kort tid etter vakten starter kommer en pasient du har tilsett noen dager tidligere. Pasienten er en eldre dame som bor alene og som var hos deg pga. lette anginaplager. Hun hadde nylig vært på kontroll på sykehuset og du hadde samstemt hennes legemiddelliste. Pasienten bruker Albyl-E. Pasienten har nå hatt epistaxis på og av siden i dag tidlig. Du tar inn pasienten på legekontoret. Akkurat nå er det ingen blødning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan du undersøker pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jeg tar på frakk, hansker og munnbind med visir, samt beskytter pasientens klær med en duk. Deretter inspiserer jeg i vestibulum nasi. Jeg ser/ser ikke et mulig blødningsfokus på lokus Kiesselbachii. Jeg ser/ser ikke et sannsynlig blødningsfokus på concha inferior eller concha media. Lenger bak i nesen får jeg ikke innsyn.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 ½ poeng for undersøkelsen og ½ poeng for forebygging av blodsøl.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I forbindelse med manipulasjon i nesen starter blødningen igjen…
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan du gir akutt initial behandling til pasienten
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jeg legger inn en tampong med adrenalin og lokalbedøvelse. Pasienten sitter oppreist med tampongen i 10-15 minutter før tampongen fjernes. Tamponeringsteknikk for å få best mulig kompresjon anlegges ved å legge tampongstrimlen lengst mulig inn i nesen, deretter lagvis tamponering. Alternativt bruker jeg tilgjengelig tampongmateriale fra legevakten innsatt med adrenalin og lokalbedøvelse.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bedøvelse, adrenalin og sitter oppreist 1p
Tamponering 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blødningen vedvarer på tross av akutt initial behandling og du greier ikke å identifisere pågående blødning på den mest vanlige lokalisering. Pasienten begynner å bli påvirket og du må forsøke å stanse blødningen på en annen måte. Din bakvakt gir deg utstyret (et foley kateter) og spør deg om du er kjent med prosedyren.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan utføres denne prosedyren?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Foley kateteret settes inn med gel og føres bak i epipharynx. Det blåses opp med 7-8 ml væske og kateteret holdes stramt på plass. Fremre tamponade legges sirkulært og lagvis rundt foley kateteret slik at det blir en tett fremre tamponade og en oppnår høyde slik at navlesnorklemmen ikke ligger an mot nesevingen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Praktisk prosedyre: Foley kateteret settes inn med gel og føres bak i epipharynx. Det blåses opp med 7-8 ml væske. 1p
kateteret holdes stramt på plass. 0,5 p
Fremre tamponade legges sirkulært og lagvis rundt foley kateteret slik at det blir en tett fremre tamponade og en oppnår høyde slik at navlesnorklemmen ikke ligger an mot nesevingen 1,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
Blødningen vedvarer på tross av akutt initial behandling og du greier ikke å identifisere pågående blødning på den mest vanlige lokalisering. Pasienten begynner å bli påvirket og du må forsøke å stanse blødningen på en annen måte. Din bakvakt gir deg utstyret (et foley kateter) og spør deg om du er kjent med prosedyren.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak gjøres videre etter at den overnevnte prosedyren i spørsmål 4 er gjennomført (før konsultasjonen avsluttes)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bakre tamponade er smertefullt. Smertelindring er derfor viktig. Ved lang transport bør pasienten få en stor veneflon og vitale parametre må overvåkes. Alle pasienter med bakre tamponade skal legges inn i sykehus/observeres på sykestue el.l. For å vurdere grad av blødning bør man ta en Hb.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Smertelindring 0,5p, henvise sykehus/observere/overvåke vitale parametre 1,5p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 69 år gammel mann kommer til akuttmottaket ved sykehuset etter gradvis økende tungpust fra i går. Han har kjent KOLS. Til vanlig har han funksjonsdyspne ved små/moderate anstrengelser, men ikke i hvile og når han går i svært rolig tempo. Han har nå utviklet hviledyspne og han har fått mer hoste med gulgrønt ekspektorat. Han har feber 38.5ºC.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser overveier du? Nevn fire årsaker (andre enn kols) til akutt dyspne
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Differensialdiagnoser:
* Lungeemboli
* Pneumoni
* Astma
* Pneumothorax
* Akutt bronkitt
* Forverring av interstitielle lungesykdommer
* Hjertesykdom (svikt, infarkt og arytmier)
* Anemi
* Hyperventilasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng pr. årsak til akutt dyspne (maks 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva forårsaker forverring av kols?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Utløses vanligvis av akutte infeksjoner, der virusinfeksjoner ser ut til å være hyppigere enn bakterielle infeksjoner. Hos noen kan miljøfaktorer som for eksempel økt luftforurensning utøse forverring. Kolonisering med bakterier i de nedre luftveiene er en prediktor for hyppigheten av moderate og alvorlige kolsforverringer. For mange pasienter er årsakene til og mekanismene ved forverringene ukjent
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 for infeksjonsutløst kols forverring (bakterier og virus) og 0.5 poeng for miljø/annet/ukjent (maks 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar en blodgass på romluft i mottakelsen som viser følgende verdier:
* pH 7.28 (normalområdet 7,35 – 7,45),
* ~PaO2 5.0 kPa (normalområdet 11.0-14.4)
* ~PaCO2 11.2 kPa (normalområdet 4,5 – 5,7)
* O2-metning 63.1% (normalt over 95%)
* Bikarbonat 39 (normalt 22-26)
* BE 8,6 (normalområdet – 3 til +3).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type respirasjonssvikt foreligger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her foreligger en respiratorisk acidose (høy ~PaCO2 og acidotisk pH < 7.35) og lav ~PaO2, dvs respirasjonssvikt type 2. Den lave pH tyder på en akutt, ikke – kompensert situasjon. Samtidig er BE så høy som 8,6, noe som tyder på at der fra før har foregått en kompensasjon over tid, og at han derfor forut for denne forverrelsen har en kronisk respirasjonssvikt med metabolsk kompensasjon i bunnen. Altså foreligger akutt-på-kronisk respiratorisk acidose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for type 2 respirasjonssvikt og 0.5 for akutt på kronisk (høy bikarbonat/BE)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedtyper deler man vanligvis respirasjonssvikt inn i?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* hypoksisk respirasjonssvikt ofte betegnet som type 1
* hyperkapnisk respirasjonssvikt ofte betegnet som type 2
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hypoksisk respirasjonssvikt og betegnet som type 1 og 0.5 poeng for hyperkapnisk respirasjonssvikt ofte betegnet som type 2
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en patofysiologisk inndeling i årsaker til hypoksemisk respirasjonssvikt
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Patofysiologisk inndeling:
# ventilasjons-/perfusjonsforstyrrelser
# shunt
# nedsatt diffusjon
# hypoventilasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p pr riktig svar, maks 0.5 x 4= 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke supplerende (ikke-kliniske) undersøkelser vil du rekvirere i første omgang?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hb tas alltid, viktig å vite om der foreligger anemi som vil gi ytterligere problem med oksygeneringen.
* Videre viktig å få kartlagt om han har tegn på bakteriell infeksjon, ta CRP, hvite med differensialtelling.
* Elektrolytter (Na, K) og kreatinin er rutineprøver som alltid tas i denne situasjonen.
* D – dimer synes ikke jeg er direkte indisert her (ikke spesielt sterk embolimistanke, stor sannsynlighet for forhøyet D – dimer uansett).
* Rtg thorax: Obs tegn til infeksjon/fortetning, pneumothorax, annet), dvs utløsende/kompliserende forhold med tanke på denne forverringen.
* EKG.
* Mikrobiologisk diagnostikk, blodkulturer, dyrkning av ekspektorat.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for blodprøver med begrunnelse, 0.5 for rtg thorax og 0.5 for mikrobiologisk diagnostikk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ut fra sykehistorie og undersøkelser mistenker du at pasienten har en KOLS eksaserbasjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling vil du starte (medikamentell og ikke-medikamentell)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bronkodilaterende behandling på forstøver (beta2-stimulator som f. eks ventoline og anticholinerg behandling på forstøver som f. eks atrovent).
Steroider, og da er det greit å gi prednisolon 30 – 40 mg per os pga rask og nærmest fullstendig absorbsjon ved denne adminstrasjonsmåten. Evt gi ~SoluMedrol 30 – 40 mg intravenøst dersom der er grunner som taler mot peroral administrasjon.
Antibiotika, han er klinisk påvirket, har feber og purulent ekspekorat da rimelig å starte med et gram-negativt preparat her, f. eks Ampicillin (Pentrexyl), dersom han klinisk vurderes som dårlig f. eks 2. el 3. generasjons cefalosporin.
Vurdere væsketilførsel.
Der foreligger kritisk lav ~PaO2, noe som normalt gjør at oksygentilførsel er absolutt nødvendig, men oksygen må da gis forsiktig (initialt f. eks 1 liter på nese-brillekateter). Dette siden denne pasienten har kronisk respirasjonssvikt type 2 og er tilvendt forhøyet ~PaCO2 slik at fall i ~PaO2 blir viktig for å drive ventilasjonen her. Ukritisk tilførsel av ~PaO2 vil kunne ta bort «driven» som hypoksemi blir i denne situasjonen.
Så metabolsk sur som denne personen er foreligger imidlertid indikasjon for non-invasiv ventilasjonsstøtte (NIV) med ~BiPAP (ved pH < 7,35) slik at i denne situasjonen vil NIV gis framfor oksygentilførsel alene uten NIV.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for antiobstruktiv behandling (forstøver+prednisolon), 0.5p for antibiotika, 0,5p for oksygenbehandling og 0.5 for NIV.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Legemidler som inneholder kombinasjonen paracetamol og kodein, som for eksempel Pinex forte® (500 mg paracetamol og 30 mg kodein) og Paralgin forte® (400 mg paracetamol og 30 mg kodein), er svært populære her til lands. Forbruket har de siste årene vært stabilt rundt 10 definerte døgndoser per 1000 innbyggere per døgn.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar svært kortfattet paracetamols virkningsmekanisme
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Ukjent'' (1 poeng). Det er lov å tenke litt høyt rundt diverse foreslåtte mekanismer (COX-3, interferens med cannabinoidsystemet etc.), men usikkerheten er hovedpoenget – og MÅ med.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ukjent (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter paracetamols to kvantitativt dominerende inaktive metabolitter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Paracetamol-glukuronid og paracetamol-sulfat
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av de to metabolittene. Ingen andre alternativer godtas.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor lang er paracetamols halveringstid?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
2-3 timer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Man må være «innenfor» (1-3 timer, 3-4 timer etc.) for å få poenget, for store spenn (som 2-8 timer) godtas heller ikke
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Paracetamol har en potensielt toksisk metabolitt som heter Nacetyl-p-benzoquinon-imin, forkortet NAPQI. NAPQI dannes av et alkoholinduserbart isoenzym i cytokrom P-450-familien, og kan utøve potensielt livstruende toksisitet ved å binde seg til makromolekyler i leverceller og derved føre til hepatocellulær nekrose. Det finnes en «motgift» som – forutsatt at den gis tidsnok – kan forebygge eller hindre slik leverskade.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter det NAPQI-dannende isoenzymet, og hva heter motgiften?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det NAPQI-dannende isoenzymet heter CYP2E1 og motgiften heter N-acetylcystein (NAC).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,5 poeng totalt, 0,5 poeng for riktig svar på isoenzymet og 1 poeng for riktig svar på motgiften. Ingen andre alternativer godtas.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kodein er et såkalt prodrug. Dette innebærer at det må metaboliseres til aktivt stoff for å utøve effekt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter de to aktive kodeinmetabolittene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kodeins aktive metabolitter heter morfin og morfin-6-glukuronid
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktige svar, ingen andre alternativer godtas.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de viktigste bivirkningene etter inntak av kodein.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Respirasjonsdepresjon, obstipasjon, eufori (dysfori)/rus, sedasjon, hostestilling/sekretstagnasjon, emese, miose, kardilatasjon/blodtrykksfall, galleveisdyskinesi, urinretensjon, hudkløe/rødming.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Respirasjonsdepresjon og obstipasjon gir 1 poeng hver, de andre bivirkningene gir 0,5 poeng hver, men maksimum 1 poeng. Hvis ikke respirasjonsdepresjon og obstipasjon er nevnt gis det altså maximum 1 poeng. «Like» bivirkninger (kvalme + oppkast etc.) regnes poengmessig som én bivirkning.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Den metabolske bioaktiveringen av kodein er avhengig av et polymorft enzym.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter enzymet, og hvor vanlig er forekomsten av de forskjellige variantene av enzymet i en etnisk norsk befolkning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Enzymet heter CYP2D6. Forekomsten er: 7% PM (langsomme metabolisører), 90% EM (raske metabolisører, kan eventuelt fordeles på 35 % intermediære metabolisører, også kalt heterozygot raske metabolisører, og 55 % homozygot raske metabolisører, men dette kreves ikke for poeng), og 2-4% UM (ultraraske metabolisører).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for CYP2D6 (ingen andre riktige svar her), 1 poeng for (noenlunde) korrekt fordeling av enzymaktivitet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 75 år gammel kvinne henvises til deg på Karkirurgisk poliklinikk for hevelse i bena. Hun sluttet å røyke for mange år siden, er frisk så vidt hun vet og mener hun er normalt sprek for alderen. Hun har hatt tyngdefølelse i bena i flere år og noe hevelse, men synes kanskje det har blitt noe mer plagsomt det siste året. Ved undersøkelse ser du at begge ben er hovne, men høyre mer enn venstre.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 4 mulige sykdomstilstander som kan gi hovne ben hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Venøs insuffisiens. Lymfødem. Lipødem. Hjertesvikt. Nyresvikt. DVT
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 poeng for hver av følgende:
* Venøs insuffisiens (men det skal ikke gies poeng for varicer, som er et tegn på venøs insuffisiens)
* Hjertesvikt
* Nyresvikt
* Lymfødem
* Lipødem
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved klinisk undersøkelse ser du varicer medialt på begge lår. Pasienten bemerker at disse oppstod under sist svangerskap for 40 år siden. Det er hudforandringer distalt på begge legger med noe pigmentering, men ingen tegn til sår.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig diagnose? Forklar hvorfor
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Primær overfladisk venøs insuffisiens. Pasienten bruker ingen medisiner, synes selv hun er sprek og har hatt relativt uendret hevelse i bena i flere år. Dette tyder på at det ikke er annen underliggende årsak, som hjerte- eller nyresvikt. Hun har sykehistorie med debut av varicer etter svangerskap og klinisk funn forenelig med overfladisk primær venøs insuffisiens. Dette er derfor den mest sannsynlige diagnosen. Det er heller ingen opplysninger i sykehistorien om tidligere DVT eller kliniske funn som sikkert peker mot dyp venøs insuffisiens.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Primær overfladisk venøs insuffisiens. (2 poeng)
Venøs insuffisiens. (1 poeng)
I begge tilfeller bør studenten inkludere debut av varicer, varighet av plagene og resonnere rundt hvorfor dette ikke er dyp venøs insuffisiens for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvilket spesifikt anatomisk område antar du at problemet sitter og hvordan har det oppstått? Forklar hvordan du resonnerer ut fra de opplysninger du har i sykehistorien.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved venøs insuffisiens er primær overfladisk venøs insuffisiens vanligst. Videre er det beskrevet i teksten at varicer er lokalisert i vena saphena magnas forløp (medialt på begge lår) som er den vanligste affiserte venen ved overfladisk venøs insuffisiens. Det er ingen opplysninger i teksten som tyder på insuffisiens i det dype systemet, verken hva angår tidligere sykehistorie (DVT med utvikling av posttrombotisk syndrom) eller plager som da ofte er mer uttalte med f.eks venøse sår. Det dype venøse systemet transporterer den største mengde venøst blod, og nedsatt transportevne her vil derfor gi de mest uttalte plagene.
Vanligste årsak til utvikling av venøs insuffisiens og varicer er genetisk predisposisjon. Debut under svangerskap er vanlig grunnet hormonelle faktorer samt økt mottrykk mot venøs retur i bekkenet. Eldre har mindre elastiske fibrer i veneveggen og er mer utsatt for dilatasjon av vener. Faktorer som bør nevnes av studenten er: -Venøs refluks grunnet veneklaffesvikt. Svekkelse og dilatasjon av venevegg. Økt hydrostatisk trykk mot veneveggen. Siv fra kapillærer som gir hevelse.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vena saphena magna /VSM (3 poeng).
Det overfladiske venøse systemet (1 poeng).
I begge tilfeller må studenten ha nevnt klaffesvikt, dilatasjon av venevegg og økt trykk for poenggiving. Graviditeten og pasientens alder bør også kommenteres for full poenggiving.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse gjør du for å bekrefte din tentative diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Duplex/UL av underekstremitetsvener er eneste riktige svar. Alle pasienter som utredes for venøs insuffisiens skal undersøkes med ultralyd av underekstremitetsvener, hvor fargekoding og spektraldoppler inngår. Denne vurdering gjøres sammen bruk av trykkmansjett på leggen som gir en oppadrettet blodstrøm. Når mansjetten desuffleres kan man si noe om refluks av venøst blod tilbake forbi veneklaffer, hvor reflukstid over 0.5 s ansees for å være patologisk og tyder på klaffesvikt. Man vurderer både det overfladiske og det dype venøse systemet for å avgjøre hvor det er insuffisient.
I eldre lærebøker nevnes klinisk undersøkelser som Perthes og Trendelenburg test. Disse har lav sensitivitet og bør ikke lenger brukes i diagnostikk.
CT-/MR venografi har ingen plass i primær utredning, men om man har funn på ultralyd som er inkonklusive og tydende på patologi i det dype systemet supplerer man med dette.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Duplex/UL (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ingen supplerende vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke behandlingsalternativer finnes og hva anbefaler du denne pasienten? Forklar hvorfor.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kompresjonsstrømper klasse II (ved hevelse) eller III (ved sår, posttrombotisk syndrom eller dyp venøs insuffisens av andre årsaker) er primær behandling for venøs insuffisiens.
CEAP-klassifikasjon brukes til å vurdere alvorlighetsgraden av venøs insuffisiens. C -inndeling (clinical classification) brukes også for å vurdere om pasienten kvalifiserer for operativ behandling i det offentlig helsevesen. Denne pasienten har venøs sykdom tilsvarende C3 (ødem) og vil ved behov tilbyes operativ behandling. Førstevalget er da endovenøs behandling med laser eller radiofrekvensablasjon i dette tilfellet av vena saphena magna. Dette gjøres poliklinisk i lokal bedøvelse. Hos pasienter hvor det anatomisk ikke ligger til rette for endovenøs behandling (veldig overfladisk forløpende og/eller slynget vene) kan åpen kirurgi med stripping av vena saphena magna utføres.
Det er ingen opplysning om at pasienten har forsøkt behandling med kompresjonsstrømper tidligere. Det er ingen grunn til operativ behandling om hun har god effekt av og tolererer behandling med kompresjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må ha kunnskap om kompresjonsbehandling og at det finnes grader av dette. Studenten må vite at det finnes to operative alternativ: endovenøs og åpen kirurgi. Hos denne pasienten er rett behandling kompresjonsstrømper klasse II (evnt bare kompresjonstrømper). Alle disse faktorer bør med for 3 poeng.
Nevnes kun kompresjonsbehandling og operativ behandling uten spesifisering gies 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 32 år gammel kvinne sitter i kassen på en Kiwi-butikk når hun merker at det utvikler seg en økende nummenhet i høyre arm. Noen minutter senere oppdager hun at hun ikke klarer å snakke klart til kunden som står foran henne. Selv om hun prøver flere ganger blir det bare uforståelige ord. Noen varer som hun skal scanne glipper ut av høyrehånden hennes. Hun ser fortvilet på kunden, en pensjonert lærer som bor like ved. Han minnes å ha sett en TV-reklame om noe slikt som dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer tror du kunden har hørt om, og hva bør kunden gjøre i denne situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Kunden bør ringe 113 fordi dette er symptomer som kan tyde på hjerneslag
# Det har vært flere opplysningskampanjer om dette:
#* Luftambulansens ''SOS''-symptomer: ''S''mile - ''o''ver hodet – ''s''nakke
#* Helsedirektoratets kampanje: Løfte, smile, prate.
#* Internasjonalt bruker vi oftest ''FAST''-symptomene: ''F''ace, ''A''rm, ''S''peech, ''T''ime
#** Oversatt til norsk: ''F''jes, ''A''rm, ''S''pråk, ''T''ale/''T''id
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p for hvert riktige delspørsmål
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bare 20 minutter senere befinner hun seg i nærmeste akuttmottak. I ambulansen er blodtrykket målt til 145/95, puls 90 regelmessig. Sykepleierne rapporterer at pasienten er afebril og at blodprøver er tatt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske og supplerende undersøkelser er det viktig å gjøre nå, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved mistanke om hjerneslag er det bildediagnostikk som haster mest. Det skal så raskt som mulig gjøres CT caput. Målet med undersøkelsen er å utelukke akutt hjerneblødning (lett å se, et hematom utgjør et hvitt område i det ellers grå hjerneparenkymet på CT). Det er også nødvendig å se etter hypodense områder som kan tale for et noe eldre hjerneslag (dette kan man se etter noen få timer), og eventuelt differensialdiagnoser som hjernesvulst.
I tillegg må det gjøres en målrettet nevrologisk status med vekt på funksjonsvurdering for å kartlegge eventuelle nevrologiske utfall. Dette graderer vi vanligvis ved hjelp av NIHSS-skalaen.
Oppgaven spør ikke om dette, men det er også viktig å avklare anamnestiske faktorer som medfører at trombolyse er kontraindisert:
* Tidligere hjerneblødning, kjent AVM,
* Økt blødningsrisiko: antikoagulasjon med INR >1.7, NOAK siste 48 timer, heparin/klexane siste 24t, større kirurgi siste 2-3 uker, øsofagusvariser, kjent ulcus, alvorlig leversyk, spinalpunksjon siste døgn
* Svær hypertensjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 for CT; 0.5 for klinisk nevrologisk status, og 0.5p tildeles svar som (kort) konkretiserer formålet eller presiserer funn man er spesielt ute etter å påvise eller utelukke på hver av disse (totalt 1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten får en infusjon. En halvtime senere er nummenheten i armen gått tilbake og talen er blitt mye tydeligere. Hun kan fortelle at hun også har hatt synsforstyrrelser oppad i høyre synsfelt, men at det nesten er borte nå. Men hun har hodepine og er litt kvalm.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to differensialdiagnoser ut fra det vi nå vet. Var behandlingen effektiv?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hjerneslag, TIA-anfall og migreneanfall.
Et eventuelt hjerneslag kan ha blitt kupert av behandlingen. Et TIA-anfall kan ha gått tilbake spontant, evt. som følge av behandlingen. Et migreneanfall (komplisert migrene/migraine accompagne) kan ha gått over og skapt en illusjon av effektiv terapi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p for hver fornuftige diff.diagnose som nevnes (opp til 1p). 1p for betraktning rundt hvorvidt behandlingen var effektiv sett i lys av de foreslåtte diff.diagnoser.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen overnatter på sykehuset. Neste dag har hun fortsatt hodepine, men er ellers i god form. Rutinemessig blir det gjort EKG og ekko cor, begge med normalt resultat. Det gjøres også MR-undersøkelse med bl.a. diffusjonsvektede bilder. Diffusjonsforandringer sees ikke. Derimot beskrives bildene med uvanlig mange hvitsubstanslesjoner for alderen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 3 mulige årsaker til at det foreligger flere hvitsubstanslesjoner enn normalt hos denne pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Generelt skal ikke en 32 år gammel kvinne ha mer enn maksimalt en håndfull hvitsubstanslesjoner (tommelfingerregel: 1 hvitsubstanslesjon for hvert 10. leveår).
Migrenepasienter kan ha flere hvitsubstanslesjoner enn normalbefolkningen.
Hypertensjon er en viktig risikofaktor for hjerneslag. Ved langvarig hypertensjon oppstår det et økt antall hvitsubstanslesjoner. Dette kan derfor være en aktuell årsak hos denne pasienten. Men MR-forandringer som følge av hypertensjon er på den annen side nokså uvanlige i denne aldersgruppen.
Multippel sklerose er en annen viktig årsak til hvitsubstanslesjoner i denne aldersgruppen.
Distribusjonen av lesjonene er ulik ved MS og ved hypertensjon, og dette kan bidra til differensialdiagnostikken.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p per årsak (MS gir ikke poeng) opp til 1 poeng. De vanligste: Migrene og tilstander med småkarssykdom/vaskulære risikofaktorer (hypertensjon, diabetes, røyking).
Følgende forventes ikke at studenten skal kunne, men taes med i sensorveiledningen i tilfelle noen foreslår de:
* Sjeldne, men mulig, og gir poeng: NMO, ADEM, Lyme, SLE
* Sjeldne, og passer ikke med beskrevet pasient/bildefunn, skal ikke gi poeng: PML, PRES, CADASIL, MELAS, Susac, CNS Lymfom, vaskulitt (ikke diffusjonsforandringer(altså ikke fersk ischemi som forventet ved vaskulitt))
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved utredningen forteller pasienten at en tante har MS, mens to av besteforeldrene døde av kreft. Hun har hatt litt høyt blodtrykk, men ikke slik at fastlegen har villet behandle henne.
For tre år siden hadde hun en periode hvor hun var litt svimmel, og mens hun gikk på videregående skole hadde hun en del migrene. Ellers er hun tidligere frisk. På grunn av tantens sykdom og informasjon om MR-funnet er hun nå blitt veldig bekymret for at hun kan ha MS.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft om det er indikasjon for MS-utredning i denne situasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# MS-sykdom i familien medfører en viss risikoøkning
# Den tidligere svimmelhetsepisoden kan ha representert et symptom på MS, og slik gi økt mistanke om sykdommen.
# MS defineres ved hendelser i CNS adskilt i tid og lokalisasjon. Her er det uklart om det har vært mer enn en episode (svimmelhet), da migrene er sannsynlig årsak til aktuelle hendelse. Det er derfor ikke uten videre anamnestisk grunnlag for å stille diagnosen.
# Det er ikke opplysning om utbredelsesmønsteret eller lokaliseringen av hvitsubstanslesjonene på MR-bildene. Hvordan lesjonene er utbredt kan gi viktig informasjon og gjøre MS som årsak mer eller mindre sannsynlig.
# Pasientens engstelse kan i mange tilfeller i seg selv tilsi at man bør avklare saken.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
En drøfting som inneholder minst 2 av poengene ovenfor gir 1p. Tillegg 0.5p for flere relevante drøftingspunkter. Ytterligere 0.5p for utvist god forståelse i resonneringen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke undersøkelser er sentrale i utredningen av MS?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Klinisk nevrologisk status (for å påvise utfall knyttet til sentralnervesystemet)
# MR caput og medulla spinalis (påvisning av hvitsubstanslesjoner med typisk utbredelse og utseende)
# Spinalvæskeundersøkelse (påvisning av økt antall leukocytter som tegn på inflammasjon, og påvisning av oligoklonale bånd som tegn på immunreaksjon med IgG-syntese i CNS)
# Klinisk nevrofysiologiske undersøkelser (som VEP, SEP og BAER)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p for hhv. klinisk status, MR caput og medulla, og spinalvæskeundersøkelser, i alt 1.5p. 0.5p for ytterligere punkter, eller hvis studenten viser god forståelse gjennom detaljerte svar (tilsvarende det som står i parentes i svarforslaget).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann i 60 årene oppsøkte sin fastlege pga. at han hadde registrert at hans avføring var blitt så mørk de siste ukene. Ved rektal eksplorasjon ble det verifisert mørk avføring og det ble påvist blod i den.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles det 1) å kaste opp friskt blod eller kaffegrutlignende oppkast og hva kalles det å ha 2) tynn, tjærefarget og illeluktende avføring?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hematemese
# Melena
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
En mann i 60 årene oppsøkte sin fastlege pga. at han hadde registrert at hans avføring var blitt så mørk de siste ukene. Ved rektal eksplorasjon ble det verifisert mørk avføring og det ble påvist blod i den.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke årsaker fra nedre gastrointestinaltraktus kan være årsak til blodig avføring hos denne pasienten? (Hvert delsvar 0.5 p, maks 2 p.)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Blant de mer vanlige årsaker kan nevnes: adenomatøse kolonpolypper (tubulært, tubulovilløst og villøst adenom), kolorektal kanser, angiodysplasi (også kalt vaskulære ektasier eller arteriovenøs malformasjon), divertikulose, iskemisk kolitt, ulcerøs kolitt, infeksiøs kolitt, Mb. Crohn, hemorider, medikamentell tarmblødning
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar 0.5 p, maks. 2 p (for adenomatøse polypper gis det bare poeng for en av typene (tubulært, tubulovilløst og villøst)). Følgende diagnoser bør være med: kolorektalt karsinom, inflammatorisk tarmsykdom og karlesjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble koloskopert uten at det ble observert patologi. Han ble derfor også gastroskopert, og det ble da påvist en ulcerende tumor på majorsiden, diameter 3.5 cm, biopsier herfra viste et adenokarsinom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typer adenokarsinomer er vanligst i ventrikkel og hvilken type er det mest sannsynlig foreligger her? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Laurens klassifikasjon av adenokarsinomer i ventrikkel er vel utbredt og det som er undervist: adenokarsinomer av intestinal og diffus type.
Det er den intestinale typen som mest sannsynlig foreligger her pga. at det makroskopisk er en ulcererende tumor. Den diffuse typen infiltrerer diffust i ventrikkelveggen, gjerne i form av signetringceller, og induserer en desmoplasi som gjør veggen fibrøst fortykket og stiv, derav navnet linitis plastica ("lærflaske"-ventrikkel).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.5 p for hhv. adenokarsinom av intestinal og diffus type.
Videre gis det 0.5 p for at det er intestinal type som mest sannsynlig foreligger og 0.5 p for begrunnelsen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Pasienten ble koloskopert uten at det ble observert patologi. Han ble derfor også gastroskopert, og det ble da påvist en ulcerende tumor på majorsiden, diameter 3.5 cm, biopsier herfra viste et adenokarsinom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre typer maligne svulster i ventrikkelen kan være mulige differensialdiagnoser om det ennå ikke hadde foreligget noe histologisk svar?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gastrointestinal-stromal tumor (GIST), sarkom, malignt lymfom, metastase.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for hvert delsvar, maks. 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke usikkerhetsmomenter foreligger når man skal vurdere svar på biopsier tatt i eller ved en ulcerasjon som viser irregulært epitel?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Biopsier tatt nær en ulcerasjon kan vise irregulært epitel som kan være vanskelig å vurdere med sikkerhet om er reaktivt som en følge av ulcerasjonen eller representerer et malignt epitel, dvs. dysplasi/karsinom. Videre trenger ikke biopsien være representativ, slik at man kan få et falskt negativt svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Maligne svulster i ventrikkelen kan infiltrere og metastasere på ulike
måter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør kort rede for spredningsmønstre for ventrikkelkarsinomer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hematogen spredning via v. portae til lever
# Lymfogen spredning, først til regionale lymfeknuter, så evt. via ductus thoracicus til lymfeknuter i fossa supraclav. sin. (her med evt. Virchoffs glandel)
# Gjennomvekst av serosa og spredning ut i abdomen til andre organer (abdominal karsinomatose) (andre tarmavsnitt, oment osv. (hos kvinner til ovarier, såkalt Krukenberg tumor) og samt direkte innvekst i naboorganer (omentum majus, omentus minus, pancreas, duodenum).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for hvert delsvar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ragnhild er 68 år og har følt seg slappere siste par måneder, spesielt ved gange i motbakke/motvind. Hun er også plaget med hjertebank. Det blir derfor mye stillesitting. I de siste dagene har hun notert et prikkformet utslett på bena som du mistenker at er petekkialt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke blodprøver trengs for å vurdere om benmargen fungerer? Angi maksimalt 4 enkeltanalyser
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemoglobin, trombocytter, granulocytter. Retikulocytter. Leukocytter og differensialtelling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hemoglobin, granulocytter, og trombocytter gir 1 poeng hver. Maksimalt 3 poeng
Retikulocyttall, leukocytter og differensialtelling er ikke helt feil heller og gir 0.5 p hver opp til max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken blodprøve kan bidra til din vurdering av benmargsfunksjonen i erytropoesen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Retikulocytt-tallet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Retikulocytt-tallet 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du tenke deg benigne benmargslidelser som årsaker til lav Hb, lave granulocytter og lave trombocytter samtidig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mangel av B12, folat. Aplastisk anemi. Legemiddelbivirkning. Arvelige benmargssviktssyndromer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p for hvert alternativ maksimalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Om man har mistanke om malign lidelse bør man gjøre en benmargsundersøkelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Diagnosen akutt leukemi baseres på andel blaster.
# Angi minste prosentandel blaster for diagnosen akutt leukemi.
# Foruten mikroskopi benytter man ofte en annen teknikk for å skille på om blastene er lymfatiske eller myeloide. Hvilken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# 20%
# Flowcytometri
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Angivelse 20%-30% gir 1 poeng
# Flowcytometri 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En annen pasient har fått utført utført den cytogenetiske undersøkelsen karyotypering (også kalt G-banding, dvs inspeksjon kromosomene i 20 metafaser) for karakterisere sin antatte akutte myelogene leukemi. Der finner man translokasjon mellom kromosom 15 og 17, såkalt t(15:17).
Tumorcellene har uttalt blokkering sitt differensieringsprogram, karakteriseres av uttalt blødningstendens pga hyperfibrinolyse og skal i tillegg til cytostatikabehandling behandles med høye doser vitamin A (retin-syre eller ATRA). Akutt behandling og rask diagnose angis som spesielt viktig ved denne typen AML
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Akutt promyelocyttleukemi APL
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Synonymene akutt promyelocyttleukemi, APL eller AML-M3 gir alle det maksimale 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ragnhild får cytostatikabehandling for sin akutte leukemi og blir deretter benmargstransplantert med søster som stamcelledonor.
Ragnhild utvikler et rødprikket utslett og betydelig diare, noe legen behandler med corticosteroider i høy dose og andre sterke midler og forklarer som en avstøtningsreaksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva heter komplikasjonen Ragnhild har fått på fagspråk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Graft vs host disease (eng)/Transplantat mot vertssykdom (no)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
GVHD 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 74 år gammel mann fra Glomfjord er på juleferie hos sin datter og innlegges grunnet dyspne i sykehuset du er turnuslege på vakt i mottak. Han sier at han hadde hjerteinfarkt for 3 år siden og ble da utskrevet etter 3 dager uten komplikasjoner. Han har ellers vært frisk, men grunnet hofteplager har han vært lite aktiv de siste årene. Han har ikke bedrevet trening eller harde anstrengelser i senere tid. Dyspneen har utviklet seg over uker.
EKG fra mottak:
<<imgLink "IIAB-2019f-4.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv EKG-funn som gjør det mer eller mindre sannsynlig at pasienten har hatt et tidligere hjerteinfarkt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
EKG viser Q-takk i avledning II, III og aVF. Det er derfor sannsynlig at pasienten har gjennomgått et nedreveggsinfarkt tidligere. For øvrig noe uspesifikke EKG forandringer med T-inversjon i V5-V6.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for beskrivelse av Q-takkene i nedveggsavledningene og 1 poeng for å sannsynliggjøre tidligere hjerteinfarkt. Øvrige EKG-funn gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved klinisk undersøkelse finner du pitting-ødemer på føtter, ankler og legger og ved auskultasjon hører du en nokså tydelig holosystolisk bilyd, med blåsende karakter. Du finner at bilyden er tydeligst ved apex og du synes også at du hører en kort, svak lyd ganske tidlig i diastolen. Du mistenker mitrallekkasje.
* Blodtrykk er 120/80
* Puls 86, regelmessig
* Temperatur 37,3 grader målt rektalt
* Respirasjonsfrekvens 17 per minutt
* Saturasjon 95% uten oksygentilførsel
* Hemoglobin 11,7 (referanse 13,4-17,0) g/dl
* Leukocytter 6,0x109 /L (referanse 4,1-9,8x109/L)
* CRP 8 (referanse <5) mg/L.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi de mest sannsynlige årsakene til mitrallekkasje hos pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mest sannsynlig er årsaken knyttet til tidligere gjennomgått hjerteinfarkt. Etiologisk kan det dreie seg om iskemisk papillemuskeldysfunksjon, dilatasjon av venstre ventrikkel og sekundær lekkasje, men (partiell) papillemuskelruptur etter hjerteinfarktet er også aktuell etiologi. Chordaruptur og mitralprolaps er også aktuelle etiologier, men mindre sannsynlig enn de foregående. Det vil også være riktig å svare etter klasseinndeling; dvs type 1 (normale seilbevegelser, med annulusdilatasjon), type 2 (økte klaffebevegelser pga patologi i papillemuskel eller chorda) og type IIIB (restriktiv klaffebevegelse grunnet som en følge av remodellering etter infarktet).
Det er angitt at pasienten i hovedsak har vært frisk, foruten hjerteinfarktet. Det er videre oppgitt at han er afebril og uten forhøyede inflammasjonsmarkører. Derfor er medfødte tilstander og infeksiøs endokarditt mindre sannsynlig. Revmatisk mitrallekkasje er sjelden etiologi i vestlig verden (Mitrallekkasje type IIIA vil derfor være minst sannsynlig).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng må minst 2 av de aktuelle etiologiene inkludert tilknytning til forandring etter gjennomgått nedreveggsinfarkt nevnes. For øvrig gis 0.5 poeng for hver aktuell etiologi som beskrives, men maksimalt 1.0 poeng om ikke til etiologiene er knyttet til tidligere gjennomgått nedreveggsinfarkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tidligere vignetter:
En 74 år gammel mann fra Glomfjord er på juleferie hos sin datter og innlegges grunnet dyspne i sykehuset du er turnuslege på vakt i mottak. Han sier at han hadde hjerteinfarkt for 3 år siden og ble da utskrevet etter 3 dager uten komplikasjoner. Han har ellers vært frisk, men grunnet hofteplager har han vært lite aktiv de siste årene. Han har ikke bedrevet trening eller harde anstrengelser i senere tid. Dyspneen har utviklet seg over uker.
EKG fra mottak:
<<imgLink "IIAB-2019f-4.PNG" 600>>
Ved klinisk undersøkelse finner du pitting-ødemer på føtter, ankler og legger og ved auskultasjon hører du en nokså tydelig holosystolisk bilyd, med blåsende karakter. Du finner at bilyden er tydeligst ved apex og du synes også at du hører en kort, svak lyd ganske tidlig i diastolen. Du mistenker mitrallekkasje.
* Blodtrykk er 120/80
* Puls 86, regelmessig
* Temperatur 37,3 grader målt rektalt
* Respirasjonsfrekvens 17 per minutt
* Saturasjon 95% uten oksygentilførsel
* Hemoglobin 11,7 (referanse 13,4-17,0) g/dl
* Leukocytter 6,0x109 /L (referanse 4,1-9,8x109/L)
* CRP 8 (referanse <5) mg/L.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skriv en kortfattet henvisning til ekkokardiografi og inkluder de 4 momentene du synes er viktigst fra sykehistorie, undersøkelse og funn
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alder, kjønn og adresse antas være gitt av identifikasjon. De mest sentrale opplysningene i sykehistorie, undersøkelse og funn er: Tidligere (nedreveggs) hjerteinfarkt, symptomer i form av dyspne, utvikling over tid, funn av bilyd og sannsynlig 3. hjertetone, afebril, ingen tegn til infeksjon i blodprøver. Kvantitering av dyspne i form av respirasjonsfrekvens oppfattes også som et sentralt moment.
Saturasjon, blodtrykk, funn av deklive ødemer og lettgradig anemi momenter er ikke uten klinisk informasjon, men de er i denne situasjonen ganske uspesifikke og oppfattes derfor ikke som sentrale momenter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per sentralt moment, maks 2 poeng totalt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv sentrale deler av patofysiologien bak dyspne ved mitrallekkasje i stikkordsform?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sentral momenter er: Regurgitasjonsvolum/lekkasjevolum til venstre atrium gir trykkstigning i venstre atrium og lungekapillærene. Trykkstigningen i lungekapillærene er årsak til lungestuvning som gir opphav til dyspne.
Det er en ubalanse mellom drivkraften som presser væske ut i alveoli og mekanismene for fjerning av væsken. Den initiale endringen er trykkøkningen (drivkraften).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Om de sentrale momentene regurgitasjonsvolum/lekkasjevolum, trykkstigning i lungekapillærene og stuvning er med gis 2 poeng. Trekk 0.5poeng for hver som mangler, 0 poeng om ingen av de tre er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hjertespesialist gjennomfører ekkokardiografisk undersøkelse basert på din henvisning. Hun beskriver blant annet følgende funn; ejeksjonsfraksjon 50% (normalverdi; ≥50%), endediastolisk volum 250 ml (normalverdi; <150 ml), stor mitrallekkasje
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du vurdere venstre hjertekammers systoliskefunksjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Basert på oppgitte tall tømmes 125 ml blod ut fra venstre ventrikkel per systoliske fase, dette volumet utgjøres av blodstrøm som leveres til aorta og lekkasjevolumet til venstre atrium. Ved stor mitrallekkasje er lekkasjevolumet signifikant og oftest minst 60 ml. Stor mitrallekkasje gir derfor redusert afterload for venstre ventrikkel da trykket i venstre atrium er vesentlig lavere enn i systemkretsløpet. Lekkasjevolumet vil derfor inngå i likningen for beregning av ejeksjonsfraksjonen, og bidra til at funksjonen av venstre ventrikkel feilaktig kan vurderes som bedre enn den.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng kreves det at studenten beskriver at venstre ventrikkels funksjon kan være nedsatt eller betydelig nedsatt. Beskrivelse av at venstre hjertekammer er dilatert, eller at venstre hjertekammer har god funksjon gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er lege på helsestasjon og hjelper en dag helsesøster med 4 årskontroll av ei jente. Hun har hatt normal utvikling frem til nå, men mor synes hun skjeler innover av og til. Du forsøker å gjennomføre visustesting med Lea-tavle, men hun vil ikke samarbeide. Du får henne ikke til å si noen av symbolene, men du får til cover/uncovertest som er normal.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to andre øyeundersøkelser er det viktig å gjennomføre og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Corneal lysrefleks'' (Hirschberg) som viser om øynene er rettstilte og ''rød refleks'' som viser om det er klare medier
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir 2 poeng, 1 poeng for hvert av de to teknikkene med begrunnelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hun vil ikke samarbeide til visustesting og mor lurer på om datteren skjeler. Hvordan håndterer du dette videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved manglende samarbeid til visusundersøkelse på helsestasjon ved 4-årsalder skal testen gjentas etter 1-2 måneder. I tillegg indikerer det at mor har sett innoverskjeling at barnet bør undersøkes av øyelege mtp. strabisme.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar om oppfølging om 1-2 måneder. 1 tilleggspoeng for å nevne foreldrenes observasjon og at hun bør oppfølges mtp strabisme.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du treffer barnet noen måneder senere når hun følger mor og en yngre bror på kontroll på helsestasjon. Denne gangen samarbeider hun til test av visus:
* o.d.: 0.63
* o.s.: 0.3
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er dette forventet visus for en 4 åring?(begrunn svaret)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Visus på høyre øye (0,63 ved 4 års alder) er normalt, men visus på venstre øye er for lavt.
Det er ikke normalt at det er sideforskjell i visus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for svaret: visus er normalt på høyre, men for lavt på venstre.
1 poeng for kommentar om at det ikke skal være sideforskjell i visus mellom øynene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mor forteller at venstre øyet hennes glir inn av og til, hun synes det har blitt verre i det siste.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hun lurer på om det er noen grunn til bekymring? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, nyoppstått skjeling kan skyldes alvorlig øyesykdom som kreft og mindre alvorlige tilstander som refraksjonsfeil, som kan medføre amblyopi om det ikke blir oppdaget og behandlet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for at det er grunn til bekymring. 1 poeng for å svare at alvorlig øyesykdom kan være årsak til skjeling
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan være årsaker til funn hos dette barnet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Funnene du gjør er at visus er nedsatt på det venstre øyet, og at det er sideforskjell i visus mellom høyre og venstre øye. Årsaker til dette kan være
* amblyopi av det venstre øyet (som igjen kan skyldes ulike ting som skjeling, brytningsfeil/brillebehov, uklarhet i brytende medier,
* dvs. hornhinne, linse, corpus vitreum etc, eller sykdom/skade i netthinne eller synsnerve). Barnet vil bruke det øyet som gir det skarpeste bildet. Det andre øyet får ikke en normal synsutvikling og blir amblyopt. Hos dette barnet ville en spesielt tenkt på skjeling som årsak til amblyopi, da mor forteller at hun har sett barnet skjele.
* Viktige differensialdiagnoser er sykdom i øyet som hindrer/endrer bildedannelsen på netthinnen. Alvorlige sykdommer som retinoblastom og Coats sykdom, kan debutere de første leveårene.
* Medfødt katarakt er heller ikke uvanlig (1/3000 barn).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for amblyopi
1 poeng for angi minst to mulige årsaker til amblyopi hos denne pasienten, der skjeling må være en av dem (1 grunn: 0.5 poeng).
Andre årsaker kan være brillebehov/brytningsfeil, katarakt, corpus vitreum blødning, skade/uklarhet av hornhinne, ptose, sykdom i netthinne (som retinoblastom eller Coats), eller synsnerve.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 66 år gammel mann kommer til kontroll hos deg som fastlege
grunnet hypertensjon og kostregulert diabetes mellitus. LDL-kolesterol er tidligere målt til 5,5 mmol/L (2,2-5,8) uten bruk av kolesterolsenkende medikasjon. Han hadde en episode med brystsmerter og generell uvelhet for 2 måneder siden og oppfattet selv dette som influensa. Du tar et EKG og mistenker ut fra det at han har gjennomgått et hjerteinfarkt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er det mest spesifikke funnet i EKG for gjennomgått hjerteinfarkt? Det er ikke nødvendig å oppgi tallverdier for funnet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Signifikante Q-takker i minst 2 avledninger som registrerer samme område i hjertet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Q-takker er obligatorisk og gir 1 poeng alene. Det må opplyses om at det må være Q-takker i minst 2 avledninger som registrerer samme del av hjertet for å få full skår 1.5 poeng.
"Nærliggende avledninger" eller andre adekvate begreper godtas. Krever ikke spesifisering av hvilke avledninger som hører sammen (II, III og aVF, V1-V4, eller V5, V6, aVL og I).
Grenseverdier for dybde og vidde av Q i ulike avledninger gir ikke ekstrapoeng. Ingen av følgende svar gir poeng: Manglende R eller R-progresjon; er lite spesifikt. ST-elevasjon; er tegn på akutt hjerteinfarkt. T-inversjon; er uspesifikt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er uten plager og klinisk undersøkelse er normal. Du velger å starte med medikamenter for å forebygge nye koronare hendelser og henviser han til utredning ved sykehuset.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to medikamenttyper er det riktig å starte med, og hvilke to undersøkelser er det viktigst å få utført ved sykehuset?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Acetylsalisylsyre (platehemmer) og kolesterolsenkende medikasjon i form av et statin (HMG-CoA reduktasehemmer).
Ekkokardiografi og koronar angiografi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar.
Det er ikke spurt om dose av medikament. Om det oppgis annen platehemmer i tillegg til acetylsalisylsyre er det greit. Betablokker gir ikke poeng.
Indikasjonen er usikker og det antas at betablokker ikke hindrer nye koronare episoder. Ved mistanke om hjerteinfarkt vil det være vesentlig å gjøre ekkokardiografi for å vurdere myokardskade og koronar angiografi for å vurdere koronarpatologi.
Arbeidsbelastning vil neppe bli utført før koronar angiografi. Annen vurdering av koronar anatomi og funksjon som CT-koronarkar og stressekko vurderes som ikke klinisk adekvat.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten hadde gjennomgått et stort infarkt i nedrevegg av venstre ventrikkel og ble behandlet for dette ved sykehuset. Han kommer nå direkte til legekontoret grunn et anfall med hjertebank og uvelhet. Du tar et EKG som du tolker som atrieflimmer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke 3 funn er typiske i EKG ved atrieflimmer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Uregelmessig QRS-avstand
# Fravær av P-bølger
# Uregelmessig grunnlinje
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Atrieflimmer er forbundet med økt risiko for embolier fra hjertet. En kan bruke CHADSVASc-skår for å vurdere slik risiko.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kriterier inngår i CHADSVASc-skår, hvilke to kriterier gir 2 poeng i skåren og hva er pasientens skår?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hjertesvikt, hypertensjon, alder over 65 år, diabetes mellitus,
tidligere slag eller TIA, kjent karsykdom, alder over 75 år, kvinne.
Alder > 75 år og tidligere slag/TIA gir 2 poeng i skåren, de andre
1 poeng.
Pasientens skår er 4.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng for hvert kriterium. Fratrekk med 0.25 poeng for hvert 2-poengskriterium som ikke er nevnt. 0.5 poeng for riktig pasientskår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ett år senere legges pasienten inn på lokalsykehuset med akutt oppstått uvelhet og tung pust. EKG viser en regelmessig takykardi 180/min med brede QRS-komplekser. Han er dårlig perifert sirkulert og har systolisk blodtrykk på 90 mmHg
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 mulige arytmidiagnoser ved regelmessig takykardi med brede QRS-komplekser?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Supraventrikulær takykardi med grenblokk (kalles også aberrasjon)
# Supraventrikulær takykardi over aksessorisk bane
# Ventrikkeltakykardi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver arytmidiagnose jfr punkt 1, 2, 3. En spesifikk supraventrikulær arytmi som AVNRT, AVRT, atrietakykardi eller atrieflutter med grenblokk godtas under punkt 1. og over aksessorisk bane godtas under punkt 2., men det gis ikke flere poeng dersom flere er nevnt under hvert punkt. Dersom noen mot formodning angir supraventrikulær takykardi med ventrikkelpacing som et alternativ, må det godtas.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig arytmidiagnose hos pasienten og hva er riktig akuttbehandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ventrikkeltakykardi. Sedasjon og elektrokonvertering
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ventrikkeltakykardi er overveiende sannsynlig og gir 0.5 poeng. Atrieflutter med grenblokk er mindre sannsynlig med frekvens på 180/min.
Elektrokonvertering gir 0.5 poeng. Sedasjon trenger ikke være nevnt. Behandling med antiarytmikum som for eksempel amiodaron (Cordarone) anses ikke som adekvat behandling i sykehus med så sirkulatorisk påvirket pasient.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Den diagnostiske nøyaktigheten for en test beskriver hvordan testen er i stand til å skille mellom personer som har en spesifikk tilstand, dvs. en sykdom, og de som ikke har tilstanden. Sentrale begreper for å beskrive den diagnostiske nøyaktigheten er sensitivitet og spesifisitet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar begrepet diagnostisk spesifisitet og beskriv viktige faktorer som påvirker denne
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Den diagnostiske spesifisiteten for en test angir andelen av de som ikke har den aktuelle tilstanden som har negativt testresultat, dvs andelen friske som får negativt testresultat. Begrepet forutsetter at resultatene for testen er dikotome, dvs. er enten positive eller negative. For diagnostiske undersøkelser med kontinuerlige resultater innebærer det bruk av en beslutningsgrense ("cut-off") for å klassifisere resultater som enten positive eller negative, avhengig av om resultatet er over eller under beslutningsgrensen.
# Spesifisiteten påvirkes av beslutningsgrense og resultatfordeling blant de friske.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5p: Andelen friske med negativt resultat eller TN/(TN+FP) eller lignende beskrivelser
# 0.5p: beslutningsgrense eller resultatfordeling blant friske
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar begrepet positiv prediktiv verdi (prediktiv verdi av positivt testresultat) og viktige faktorer som påvirker denne
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Positiv prediktiv verdi (PPV) angir andelen av de med positivt testresultat som har den aktuelle tilstanden. Positiv prediktiv verdi er først og fremst bestemt av testens diagnostiske spesifisitet og pretestsannsynligheten (prevalensen av den aktuelle tilstanden). Begrepet forutsetter at resultatene for testen er dikotome, dvs. er enten positive eller negative. For diagnostiske undersøkelser med kontinuerlige resultater innebærer det bruk av en beslutningsgrense ("cut-off") for å klassifisere resultater som enten positive eller negative, avhengig av om de er over eller under beslutningsgrensen.
# Positiv prediktiv verdi påvirkes av testens spesifisitet (og i mindre grad sensitivitet), som igjen er avhengig av resultatfordeling blant friske (og syke) og valg av eventuell beslutningsgrense. I tillegg påvirkes PPV av prevalens av tilstanden i populasjonen som testes.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5p: andelen syke av de positive, TP/(TP+FP) e.l.
# 0.5p: spesifisitet/diagnostisk nøyaktighet og sykdomsprevalens/pretestsannsynlighet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør man tolke et positivt resultat for en test med høy diagnostisk spesifisitet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Resultatet innebærer høy sannsynlighet for den aktuelle tilstanden foreligger hos pasienten. I tillegg til spesifisitet vil pretestsannsynlighet (prevalens av tilstanden) i stor grad være bestemmende for tolkningen. Ved svært lav pretestsannsynlighet vil derfor sannsynligheten for at tilstanden foreligger hos pasienten kunne være relativt lav
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Høy sannsynlighet for at pasienten har tilstanden og lignende angivelser. Det kan eventuelt problematiseres at denne tolkningen er avhengig av pretestsannsynlighet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør man tolke et negativt resultat for en test med
høy negativ prediktiv verdi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Resultatet medfører lav sannsynlighet for at pasienten har den aktuelle tilstanden. I tillegg til sensitivitet vil pretestsannsynlighet (prevalens av tilstanden) i stor grad være bestemmende for tolkningen. Ved svært høy pretestsannsynlighet vil derfor sannsynligheten for at tilstanden foreligger hos pasienten kunne være relativt høy
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Lav sannsynlighet for at tilstanden foreligger eller at tilstanden er "utelukket" o.l. Det kan eventuelt problematiseres at denne tolkningen er avhengig av pretestsannsynlighet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan man gjøre for at en diagnostisk test med et kvantitativt resultat, f.eks. en konsentrasjonsmåling, skal bli mer sensitiv for å påvise en spesifikk tilstand?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Diagnostisk sensitivitet er bl.a. avhengig av beslutningsgrense. Ved å endre beslutningsgrensen kan man endre sensitiviteten for en kvantitativ test. Hvis personer med aktuell tilstand vanligvis har høyere verdier enn de uten tilstanden, så vil en lavere beslutningsgrense gi en mer sensitiv test. Hvis personer med den aktuelle tilstanden har lavere resultatverdier, så vil en høyere beslutningsgrense gi økt sensitivitet.
Man kan også tenke seg andre løsninger, som å gjenta undersøkelsen, f.eks. etter noe tid eller benytte en bedre analysemetode o.l., men det gir ikke poeng slik spørsmålet er formulert
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Endre beslutningsgrense
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I en klinisk studie ønsket man å undersøke hvor effektiv en test var for å påvise en bestemt tilstand ved screening. To ulike populasjoner ble studert og man fant at positiv prediktiv verdi for testen i de to populasjonene var ganske forskjellig. Hvilke faktorer kan forklare denne forskjellen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mest sannsynlig skyldes forskjellen ulik i sykdomsprevalens i de to populasjonen, f.eks. pga ulike alderssammensetning, kjønnsfordeling eller andre egenskaper som er assosiert med sannsynligheten for å ha den aktuelle tilstanden. Forskjellen kan også skyldes at graden av sykdom i gjennomsnitt var ulik for de med den aktuelle tilstanden i de to populasjonen, dvs at det var en tendens til at de syke var mer alvorlig syke i den ene populasjonen. Man kan også ha benyttet ulike beslutningsgrenser for de to populasjonene, men det vil være en elementær feil og gjøre resultatene vanskelig å sammenligne i utgangspunktet. Man kan også ha benyttet to ulike målemetoder eller måleinstrumenter i de to populasjonene, eventuelt behandlet prøvene ulikt. Dersom de ulike målemetodene i gjennomsnitt gav noe ulike resultater, så vil det ha samme effekt som å operere med ulike beslutningsgrenser i de to populasjonene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1p: ulik prevalens/pretestsannsynlighet i populasjonene, eller ulik sammensetning mht faktorer som er assosiert med sannsynligheten for å ha tilstanden (kjønn, alder) o.l.
* 1p: ulik sykdomsgrad i populasjonene, f.eks. pasienter ved sykehus vs. i allmennpraksis
* 1p: ulike beslutningsgrenser eller ulike målemetoder
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIAB-2019s-3.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Figuren viser 2 ROC-kurver som beskriver to forskjellige kvantitative laboratorieanalyser benyttet for diagnostikk av den samme tilstanden. Forklar hva kurvene beskriver og beskriv forskjellen i diagnostisk nøyaktighet mellom den røde og den blå analysen.
ROC: receiver operating characteristics
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Del en'': ROC-kurver er ofte nyttige for å beskrive den diagnostiske nøyaktigheten for undersøkelser som gir kontinuerlige resultater, hvor valg av ulike beslutningsgrenser gir ulik sensitivitet og spesifisitet. ROC-kurver kan benyttes for å sammenligne den diagnostiske nøyaktigheten for ulike tester, eller for å sammenligne den diagnostiske nøyaktigheten for en test i ulike populasjoner eller ved bruk på ulike problemstillinger.
ROC-kurven viser verdier for diagnostisk sensitivitet og spesifisitet ved ulike beslutningsgrenser. På y-aksen vises sensitiviteten som prosent eller fraksjon. På X-aksen vises falsk positiv fraksjon, som tilsvarer 1-spesifisitet eller, som her, at xaksen viser spesifisitet på en akse med omvendt akseretning, dvs. høyeste akseverdier mot venstre på aksen. I tillegg til å vise sensitivitet og spesifisitet for ulike beslutningsgrenser vil arealet under kurven være uttrykk for testens diagnostiske nøyaktighet, uavhengig av beslutningsgrense. Ved en "perfekt" test, med 100% sensitivitet og spesifisitet ved en spesifikk beslutningsgrense, vil ROC-kurven gå igjennom punktet øverst til venstre i diagrammet (0%,100%, dvs 100% sensitivitet og spesifisitet) og ha arealet 100%. En test uten diskriminerende evne vil ha arealet 50% og gå langs diagonalen fra nedre venstre hjørne (0%,0%) til øvre høyre hjørne (100%,100%).
''Del to'': Det presenterte diagrammet viser at rød test har bedre diagnostisk nøyaktighet enn blå test fordi den røde kurven ved enhver beslutningsgrense har både høyere sensitivitet og høyere spesifisitet enn blå test.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1p: kurvene viser sensitivitet og spesifisitet/falsk positiv fraksjon ved ulike beslutningsgrenser
# 1p: den røde testen er bedre enn den blå (til å skille mellom syke og friske, for alle/de fleste beslutningsgrenser), eller sensitivitet OG spesifisitet er høyere for rød test for alle beslutningsgrenser
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som vakthavende lege mottar du telefon fra en legevaktslege. Legen har rykket ut til en 65 år gammel mann som er funnet forkommen på sofaen av kona. Hun så ham frisk 30 minutter tidligere. Rommet er mørkt, og han nekter å bevege seg, da han sier han ikke ønsker dette. Han klager over hodepine, er svimmel og har kastet opp. Han er kaldsvett og har en regelmessig, fyldig pulsasjon over a. radialis på 100 slag/min. Legevaktslegen tror han har feber (men har ikke målt).
Din bakvakt ber deg forberede et mottak med spørsmål om bakteriell meningitt og ønsker at du gjennomfører en lumbal spinalpunksjon
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke vurderinger vil du gjøre for å bestemme om pasienten skal spinalpunkteres eller ikke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Indikasjonsstillingen: Er det grunnlag for meningitt-mistanke (eller andre tilstander hvor spinalpunksjon er indisert) når du har vurdert pasienten
# Kontraindikasjoner
#* Viktigste kontraindikasjoner
#** Økt intrakranielt trykk grunnet ekspansiv prosess (fare for herniering)
#** Hemorrhagisk diatese uavhengig av årsak
#* Øvrige kontraindikasjoner
#** Spinal epidural abscess
#** Infeksjon i eller nær innstikksstedet
#** Ikke-kommuniserende obstruktiv hydrocefalus
#** Spinal stenose eller ryggmargskompresjon over punksjonssted
#** Spinale eller craniale utviklingsanomalier
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studentene får 0.5p for 1 nevne 1, 1.5p for å nevne 2 og 2.5p for å nevne alle tre punkter under
* Drøfte indikasjonsstilling
* Nevne ekspansiv prosess/hernieringsfare/undersøke etter stasepapille med oftalmoskopi
* Nevne vurdering av blødningsfare
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får oppdatert informasjon når pasienten er i ambulansen. Du får du vite at hjerterytmen er 100, regelmessig, Temperatur 37.1℃, respirasjonsfrekvens 16, blodtrykk 175/95. Glasgow coma scale (GCS) 14 (lukkede øyne). Glucose 9 mmol/L. Pasienten er kaldsvett og har en gusten ansiktsfarge.
Det rapporteres at han var ute av stand til å sitte eller gå stødig, i en slik grad at han måtte transporteres med båre fra sofa ut i ambulansen. Han har kastet opp flere ganger
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn andre differensialdiagnoser enn bakteriell meningitt som du vurderer er viktigst å avklare basert på det du nå vet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har meningealia (hodepine, kvalme/oppkast), men ikke infeksjonsklinikk for øvrig. Meningitt fortsatt aktuell diffdiagnose, men andre årsaker til meningealea må også vurderes:
* Høyt ICP grunnet raskt ekspanderende prosess (mest sannsynlig blødning)
* Varselblødning/subarachnoidal blødning
* Andre alvorlige hodepinetilstander: Sinusvenetrombose
* Alvorlig intoksikasjon/annet alvorlig metabolsk avvik
* Sirkulasjonsforstyrrelse i bakre gebet (infarkt/blødning cerebellum)
* Perifere vestibulære sykdommer
Mindre sannsynlig, men kan nevnes hos en klinisk dårlig pasient
* Hypovolemi, sepsis, anafylaksi. Takykardi forenlig med dette, men blodtrykket er høyere enn forventet, slik at sirkulatorisk sjokk ikke er riktig. 1 av 4 SIRS (lpk ikke kjent) og qSOFA 0-1/3 (man kan argumentere for endret mental status ut i fra GCS på 14). Det er ikke feil å tenke på sepsis hos en klinisk dårlig pasient, men ikke den mest sannsynlige diagnosen.
Mindre viktig å avklare i akuttfasen
* Migrene
* Gastroenteritt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 p for å vise en overordnet strukturert tilnærming til problemstillingen hvor man viser at man vurderer alvorlige tilstander viktigere enn ufarlige tilstander
* 0.5 p for å vise at man tenker på meningealea (lysskyhet, hodepine, kvalme/oppkast, nakkestivhet) og nevner tilstander som høyt ICP/SAB o.l.
* 0.5 p for å nevne akutt intoksikasjon, alvorlig metabolsk avvik, sinusvenetrombose eller andre relevante indremedisinske tilstander
* 0.5 p for sentrale vestibulære årsaker
Primært skal helgarderinger, altså tilfeller hvor mange mindre aktuelle/irrelevante diff.diagnoser nevnes, føre til at man ikke får poeng for strukturert besvarelse (første setning denne rubrikk). I særlige tilfeller kan man trekke ytterligere poeng der besvarelsen tydelig mangler forståelse for problemstillingen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I mottaket angir pasienten at han har en vedvarende svimmelhetsfølelse med en opplevelse av å være på en karusell. Det oppstod brått. Du oppfatter at pasienten har et akutt vestibulært syndrom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er mest relevant ved et akutt vestibulært syndrom?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vestibularisnevritt
Slag i bakre sirkulasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng kun ved begge diagnosene (virus på balansenerven godtas som betegnelse på vestibularisnevritt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du undersøker etter NIHSS, men finner ingen nevrologiske utfall etter denne scoringsmetoden. Du finner imidlertid at pasienten er betydelig ustø sittende og stående. Det er ingen hørselssymptomer som tinnitus eller hørselstap.
Du rekvirerer en standard CT undersøkelse av hodet som ikke påviser patologi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke(n) nevrologisk klinisk undersøkelse(r) bør du gjøre i tillegg til NIHSS?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten bør undersøkes for å differensiere vestibularisnevritt mot sentralnervøs årsak. Dette gjøres med HINTS test, altså hodeimpulstest, vurdering av nystagmus og alternerende cover test (test of skew)
Det er også rimelig å undersøke etter truncal ataxi og i stående
stilling (Rombergs prøve hvis mulig). Øvrige aktuelle
* Plantarrefleks
* Øyemotilitetsundersøkelse utover de som inngår i NIHSS (f.eks. sakkadetesting)
* Utvalgte hjernenerver (ganeseglsparese, tungedeviasjon, gnissetest ad choncam, pupillemotorikk) , men ikke lukt, visus etc.
* Oftalmoskopi
* Andre cerebellære prøver: f.eks. diadokokinese
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne HINTS test (eller elementene som inngår i denne). Det kan gjøres trekk hvis studenten ramser opp unødvendige mange undersøkelser i tillegg til HINTs, da det må sees mer som en helgardering, og i praksis ville vært en betydelig tidstyv som ville forsinket behandlingen. Tilleggsundersøkelser nevnt i fasit gir ikke trekk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du gjør undersøkelsene og ringer din bakvakt for råd om det skal gis intravenøs trombolyse
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke vurderinger og opplysninger er viktigst for vurderingen om det skal gis intravenøs trombolyse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Indikasjonsstilling: Er det grunnlag for å mistenke en akutt cerebrovaskulær hendelse ut i fra klinikken?
Kontraindikasjoner
* Absolutt: intracraniell blødning
* Tidsvindu: 4,5 timer siden sist sett frisk eller debuttidspunkt
Øvrige viktige relative kontraindikasjoner
* etablerte infarktforandinger > 1/3 av mediagebetet
* Pågående blødning andre steder i kroppen
* Bruk av antikoagulasjon
** INR >1.7
** Nye perorale antikoagulasjonsmidler (NOAK) inntatt for < 12 timer siden.
* BT skal være < 185/110 før, under og etter trombolyse. Rask behandling av BT hvis høyere.
Øvrige mindre viktige relative kontraindikasjoner
* Trombocytter < 100.000/ml;
* Glukose <2,8 eller >22,0 umol/l
* Heparin siste 48 timer
* Tidligere hjerneblødning/SAB, intrakranielt aneurysme (se under), CNS-nevrokirurgi <2 mnd, hjerneslag <2 mnd, nylig gjennomgått blødning, hemorragisk retinopati, øsofagusvariser, aortaaneurisme (kontraindikasjon ved kjent/mistenkt aortadisseksjon, forsiktighet ved stort aneurysme (>5 cm)), ulcererende GI sykdom <3 mnd, større kirurgi eller traume <2 uker, punksjon av ikke komprimerbart kar <10 døgn, graviditet, fødsel <10 døgn, infeksiøs endokarditt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Oppgaven slik den er laget, kan gi inntrykk av at indikasjonsstillingen allerede er vurdert. Således godtas at man ikke diskuterer selve indikasjonsstillingen (dvs. studentene trekkes ikke for å ikke nevne at det må foreligge sannsynlig mistanke om akutt hjerneslag)
Det gis 0.5 p for tidsvindu på 4.5 timer, 0.5 p for absolutt kontraindikasjon i intracraniell blødning (alternativt formulert som et absolutt krav om fravær av blødning på CT caput før initiering av behandling).
Øvrige 1 p for å diskutere andre relative kontraindikasjoner, men her må utvises skjønn. Minst 2 fra listen over bør være nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Disse MR-bildene ble tatt av pasienten.
<<imgLink "IIAB-2019s-4.PNG">>
Bildetekst: MR-bilder (FLAIR) som fremstiller pasientens infarktforandringer. For sagitalt og coronalt snitt mangler er dessverre nedre aspekt av cerebellum ikke med i bilde, det presiseres derfor at infarktforandringene streker seg helt ned til nedre cerebellære pol.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket blodkar mistenker du er okkludert i dette tilfellet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Arteria cerebellaris inferior posterior (PICA)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 62 år gammel mann med kjent hypertensjon og diabetes mellitus får sterke, sentrale brystsmerter med utstråling til venstre arm under jakttur. Jaktkameraten ringer 113 og ambulanse kommer etter 20 minutter</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv tre tiltak ambulansepersonalet bør iverksette umiddelbart.</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ta EKG, legge venflon, gi morfin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poeng hvis tre tiltak er nevnt. I tillegg til enkelttiltakene nevnt over godkjennes også som ett av tre tiltak: Gi kvalmestillend, gi ASA, gi nitroglycerin under tungen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
EKG viser akutt fremreveggsinfarkt med 4 mm ST-elevasjon i prekordialavledningene. Det er mer enn to timer biltur til nærmeste lokalsykehus og ca. to timer transport til PCI-senter med bruk av helikopter (litt usikkert flyvær).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken reperfusjonsstrategi vil du velge - prehospital trombolyse eller primær PCI? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Prehospital trombolyse.
Begrunnelse: Kort sykehistorie, da har trombolyse god effekt. Store EKG-forandringer som kan føre til stort infarkt om ikke rask reperfusjon. Usikker transporttid til PCI-sykehus og det kan ta mer enn to timer før PCI. Ingen opplysninger om kontraindikasjoner mot trombolyse.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Må svare prehospital trombolyse for å få poeng. Som begrunnelse kreves ett av punktene: Kort sykehistorie, usikker transporttid, ingen kjente kontraindikasjoner, risiko for stort infarkt om ikke rask reperfusjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I forløpet får pasienten utført PCI av LAD med medikamentavgivende stent. Ekko viser at han kun har fått en moderat infarktskade i fremre vegg
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken antitrombotisk behandling vil du gi pasienten ved utreise?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dobbel platehemming (acetylsalicylsyre og ADPreceptoranatgonist)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dobbel platehemming, evt. med navn på preparater gir poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignetter
<<<
En 62 år gammel mann med kjent hypertensjon og diabetes mellitus får sterke, sentrale brystsmerter med utstråling til venstre arm under jakttur. Jaktkameraten ringer 113 og ambulanse kommer etter 20 minutter.
EKG viser akutt fremreveggsinfarkt med 4 mm ST-elevasjon i prekordialavledningene. Det er mer enn to timer biltur til nærmeste lokalsykehus og ca. to timer transport til PCI-senter med bruk av helikopter (litt usikkert flyvær).
I forløpet får pasienten utført PCI av LAD med medikamentavgivende stent. Ekko viser at han kun har fått en moderat infarktskade i fremre vegg.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke livsstilsråd vil du gi pasienten ved utreise. Svar med stikkord på hvilke tema du vil ta opp.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tobakk, kosthold, mosjon, vekt, evt. forhold relatert til jobbsituasjon (stress)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis tre av disse momentene er nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignetter
<<<
En 62 år gammel mann med kjent hypertensjon og diabetes mellitus får sterke, sentrale brystsmerter med utstråling til venstre arm under jakttur. Jaktkameraten ringer 113 og ambulanse kommer etter 20 minutter.
EKG viser akutt fremreveggsinfarkt med 4 mm ST-elevasjon i prekordialavledningene. Det er mer enn to timer biltur til nærmeste lokalsykehus og ca. to timer transport til PCI-senter med bruk av helikopter (litt usikkert flyvær).
I forløpet får pasienten utført PCI av LAD med medikamentavgivende stent. Ekko viser at han kun har fått en moderat infarktskade i fremre vegg.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Pasienten skrives ut med statinbehandling. Hvor lenge vil du anbefale at han bruker statin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Statinbehandling gis på ubestemt tid, i utgangspunktet livslangt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ubestemt tid. Livslangt
</$details>
<div class="oppgave">
<div class="vignett">
!! Vignett
Du er invitert til å undervise for ambulansepersonell om behandling av STEMI-pasienter. Det blir en diskusjon om oksygenbehandling ved akutt hjerteinfarkt. Pasienten beskrevet i denne oppgaven hadde en arteriell oksygenmetning på 92% uten surstoff.
!!Tidligere vignetter
<<<
En 62 år gammel mann med kjent hypertensjon og diabetes mellitus får sterke, sentrale brystsmerter med utstråling til venstre arm under jakttur. Jaktkameraten ringer 113 og ambulanse kommer etter 20 minutter.
EKG viser akutt fremreveggsinfarkt med 4 mm ST-elevasjon i prekordialavledningene. Det er mer enn to timer biltur til nærmeste lokalsykehus og ca. to timer transport til PCI-senter med bruk av helikopter (litt usikkert flyvær).
I forløpet får pasienten utført PCI av LAD med medikamentavgivende stent. Ekko viser at han kun har fått en moderat infarktskade i fremre vegg.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Var det indikasjon for oksygenbehandling av denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei. Retningslinjene sier at pasienten med metning > 90 % ikke skal ha surstoff.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At det svares nei.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du blir som legevakt i Volda tilkalt til en 40 år gammel mann som er tidligere frisk. I forbindelse med vedhogst i går fikk han en plutselig innsettende hodepine, som har vedvart. Når du ankommer virker han noe sløv, men gir adekvate svar. Du mistenker at han har fått en subaraknoidal blødning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer vil du spørre pasienten om, og hva vil du se etter ved din klinisk-nevrologiske undersøkelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Anamnese (akutt hodepine, nakkesmerter, lysskyhet, kvalme/oppkast)
* Klinisk-nevrologisk undersøkelse: Fokalnevrologiske utfall, nakkestivhet, bevissthetsnivå (Glasgow coma scale (GCS)), pupillereaksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Studenten må i sitt svar få frem om det er en intens og (hyper)akutt innsettende hodepine. Mange pasienter beskriver den ofte som den verste hodepinen noensinne, helt annerledes enn tidligere hodepine. Spørsmål omkring hodepinekarakter (intens og akutt innsettende hodepine) og relevante tilleggssymptomer som nakkesmerter, lysskyhet, kvalme/oppkast gir 1p.
* Svar hvor man får frem at det er undersøkt for mulige nevrologiske utfall (inkl hjernenerver), nakkestivhet og bevissthetsnivå (GCS) gir totalt 1 poeng. Studenten trenger ikke å beskrive delundersøkelse som inngår i GCS for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter å ha undersøkt pasienten mistenker du fortsatt subaraknoidal blødning, og bestemmer deg for å legge ham inn på nærmeste sykehus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type bildediagnostikk vil mest sannsynlig bli utført på sykehuset for å utrede pasienten for subaraknoidal blødning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT caput + CT angio
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
CT caput alene gir 0.5p. CT angio gir ytterligere 0.5p. MR alene gir 0 poeng da det ikke er den mest sannsynlige undersøkelsen (lite praktisk i akuttsituasjoner).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det gjøres en helt normal billedundersøkelse, men man mistenker fortsatt at det er snakk om en subaraknoidal blødning.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken annen undersøkelse/prosedyre bør man da utføre for å bekrefte/avkrefte mistanken? Når skal den gjøres, og hvordan skal den fortolkes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved normal CT og sterk mistanke om subaraknoidalblødning skal spinalpunksjon utføres. Man bør vente minst 12 timer fra hodepinedebut. Utseende av spinalvæsken bedømmes av legen, og på laboratoriet før og etter sentrifugering. Spektrofotometri må gjøres for å kunne avgjøre med sikkerhet om det foreligger bilirubin i spinalvæsken, som tegn på nedbryting av blod in vivo. Er punksjonen foretatt 12 timer etter debut, og spektrofotometri negativ, kan SAB utelukkes.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Spinalpunksjon 1p.
* Riktig tidsangivelse før spinalpunksjon gir 0.5p.
* Spektrofotometri med riktig fortolkning gir ytterligere 0.5p.
Kun visuell bedømmelse av utseende av spinalvæske gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Diagnosen subaraknoidal blødning har nå blitt bekreftet, og supplerende utredning med konvensjonell røntgen angiografi påviser et lite aneurysme på a. communicans anterior, som ble oversett på undersøkelsene utført tidligere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to behandlingsmetoder vil nå være aktuelle for å hindre reblødning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Endovaskulær okklusjon av aneurysme (coiling).
* Operasjon (kranotomi) med klipsligatur (klipsing).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Coiling gir 0.5p
* Operasjon med klipsligatur (klipsing) gir 0.5p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke problemer i tillegg til reblødning kan true pasientens liv i akuttfasen etter en subaraknoidal blødning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Høyt intrakranielt trykk og medfølgende sekundær hjerneiskemi med infarktutvikling i forbindelse med selve blødningen.
* Hydrocefalus kan oppstå både akutt og forsinket som følge av blod i spinalvæsken.
* Karspasmer (vasospasmer) kan oppstå i forløpet, og gi hypoperfusjon og sekundære hjerneinfarkter.
* Per- og postoperative komplikasjoner som blødning, infarkt og infeksjoner ved operasjon. Okklusjon av intrakranielle kar, intrakranielle tromboser/embolier, infarkt og perforasjon/reblødning ved coiling.
* Intensivmedisinske komplikasjoner (som pneumoni, dyp venetrombose med lungeemboli, elektrolyttforstyrrelser++)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Betraktninger omkring
* Høyt intrakranielt trykk og iskemi i forbindelse med selve blødningen gir 0.5p
* Akutt eller forsinket hydrocefalus gir 0.5p.
* Karspasmer/vasospasme gir 0.5p.
* Per-/Postoperative komplikasjoner gir 0.5p.
* Intensivmedisinske tilstander gir 0.5p (max 2p totalt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Arterielle aneurysmer er den vanligste årsaken til subaraknoidale blødninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre årsaker/tilstander kan gi blod i subaraknoidalrommet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Subaraknoidal blødning betyr at det er blod i subaraknoidalrommet. Dette kan skyldes flere forhold. Andre årsaker kan være
* blødning fra arteriovenøse malformasjoner (AVM)
* venøse aneurysmer
* perimesencephale venøse blødninger
* traume
* postoperativt betinget
* cerebrale infeksjoner
* vaskulitter
* iatrogent etter spinalpunksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hver av punktene gir 0.5p, max 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann i 60-årene falt om, fikk kramper og ble innlagt på sykehuset pga. redusert bevissthet. Etter en uke på intensiv avdeling sovnet han rolig inn. Det ble rekvirert obduksjon. Ved undersøkelse av hjernen fant man forandringer som vist på bildet ([[kilde|http://neuropathology-web.org/]])
<<imgLink "IIAB-2020-3-A.jpg">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen? (0.5 poeng). Nevn noen aktuelle differensialdiagnoser. (Hvert delsvar 0.5 poeng, maks 1.5 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lesjonen representerer mest sannsynlig et akutt hemorrhagisk hjerneinfarkt pga. lokalisasjonen (typisk for mediagebetet) og at man ser hjernevev med blødning (ikke et rent hematom). Aktuelle differensialdiagnoser kan være:
* lobær hjerneblødning
* blødning i tumor (især gliomer som glioblastom og metastaser fra malignt melanom)
* blødning i arterviovenøs malformasjon
* blødning i hemangiom
* blødning ved bruk av rusmidler ("drug abuse" kokain, heroin, amfetamin, alkohol)
* blødning ved blodsykdom (f.eks. leukemi (bl.a. pga. trombocytopeni))
* blødning som komplikasjon til medikasjon (især antikoagulantia)
* blødning ved vaskulitt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar, inkludert sprs. a) og b), gir 0.5 poeng, maks. 2 poeng. (For tumores og rusmidler får man bare 0.5 poeng selv om flere eksempler nevnes).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I kanten av lesjonen fant man forandringer mikroskopisk som vist på bildet:
<<imgLink "IIAB-2020-3-B.jpg">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv kort de histopatologiske forandringene som her foreligger. (1 poeng).
# Hva representerer/betyr disse forandringene? (1 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lesjonen representerer mest sannsynlig et akutt hemorrhagisk hjerneinfarkt pga. lokalisasjonen (typisk for mediagebetet) og at man ser hjernevev med blødning (ikke et rent hematom). Aktuelle differensialdiagnoser kan være:
# Mikroskopisk sees såkalte røde nevroner.
# Dette representerer en irreversibel anoksiskade som har inntrådt akutt, som ved et akutt/ferskt hjerneinfarkt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for 1 og 2, totalt 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som et bifunn ble det funnet et lite gammelt infarkt i oksipitallappen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken hjernearterie kan her ha vært okkludert? (0.5 poeng).
# Beskriv kort de histopatologiske forandringene som er typiske for et gammelt hjerneinfarkt. (0.5 poeng for hvert histopatologisk trekk, maks 1.5 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Arteria cerebri posterior kan her ha vært okkludert.
# Ved et gammelt infarkt finner man mikroskopisk vanligvis
## svinn av nevroner,
## gliose,
## cystisk degenerasjon,
## makrofag (mikroglia)ansamling,
## demyelinisering,
## mineraliserte/ferrugeniserte nevroner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Navn på riktig arterie gir 0.5 poeng.
# Hvert histologisk trekk gir 0.5 poeng, maks. 1.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ulike typer betennelsesceller kan gi en indikasjon på infarktets alder samt type infarkt
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke inflammatoriske celler finner man i et akutt hjerneinfarkt av to dagers alder? (0.5 poeng).
# Hva slags type infarkt kan ha foreligget om man finner rikelig med hemosiderinmakrofager? (0.5 poeng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Nøytrofile granulocytter.
# Hemorrhagisk infarkt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5 poeng for riktig svar. Bare angivelse av «granulocytter» gir ikke poeng.
# 0.5 poeng for riktig svar. Angivelse av blødning gir også poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En slik lesjon som her kan medføre herniering og komplikasjoner derav.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken arterie kan bli avklemt ved herniering under falx cerebri?
# Hvilken arterie kan bli avklemt ved herniering gjennom tentorialslissen (incisura tentorii)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Art. cerebri ant.
# Art. cerebri post.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0.5 poeng, i alt 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Også ved //hjerteinfarkt// foreligger det typiske histopatologiske forandringer som kan indikere dets alder
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er de typiske histopatologiske forandringene for et hjerteinfarkt av en ukes alder? (0.5 poeng for hvert delsvar, maks. 1.5 poeng).
# Hva er en fryktet komplikasjon til infarktet ved dette tidspunktet? (0.5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Typiske histopatologiske forandringer etter en uke omfatter
## Kontraksjonsbånd,
## nekrotiske muskelfibre,
## makrofager,
## granulasjonsvev
# Ruptur og hjertetamponade
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Hvert delsvar gir 0.5 poeng, maks. 2 poeng.
# Angivelse av en eller begge tilstander gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det kommer en gammel mann, 77 år, til deg på legekontoret. Han plages med tungpust og svelgsmerte Han føler seg i dårlig form og sover ikke bra. Han har gått ned flere kg i vekt. Du gjennomfører ØNH status og kjenner en kul på halsen på høyre side.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du henviser til tumor colli poliklinikken på ØNH. Hva skjer der?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 anamnese
* 0.5 p ØNH status
* 0.5 p ultralyd collum
* 0.5 p PNAC (punksjonscytologi av tumor)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Prøvene og undersøkelsene på ØNH gir viser kreft i lymfeknuten og en tumor bak i hypofarynx.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er vanligste histologi i forbindelse med ØNH cancer og hvilke behandlingsalternativer foreligger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 1.0 p plateepithel cancer
* 0.5 p kirurgisk fjerning
* 0.5 p strålebehandling ( 2 svar gir poeng)
* 0.5 p cytostatika
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten legges inn for staging
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* Hvordan klassifiseres tumor?
* Hvilke undersøkelser trenger man for å klassifisere tumor og velge behandlingsstrategi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p TNM klassifikasjon
* 0.5 p CT collum evt MR collum
* 0.5 p CT thorax og abdomen
* 1.0 p Panskopi og biopsi av primærtumor
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten legges inn for behandling. Under oppholdet blir pusten verre og han plages veldig med pusten, det piper og surkler når han puster.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlige årsak til at han puster så dårlig tror du? Hvordan kan man behandle dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 1 p. tumor vokser sannsynligvis inn i larynx og fører til trange luftveier
* 1 p det kan gjøres tracheostomi for at pusten kan bedres
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter ferdig behandling på ØNH sengepost kan pasienten reise hjem.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Trenger han videre oppfølging og hvordan gjør man det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p ja han må følges opp, første behandlings kontroll 2-3 mnd etter utskrivelse med billeddiagnostikk
* 0.5 p deretter hver 3 mnd 2 første år, deretter hver 6 mnd inntil 5 år etter avsluttet behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann på 64 år kommer til mottakelsen 3 timer etter at han fikk symptomer på slag. Bildediagnostikk viser et hjerneinfarkt som affiserer store deler av høyre a. cerebri medias forsyningsområde.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke utfall er det sannsynlig at du vil finne ved nevrologisk undersøkelse (minst 5)? Angi også sidelokalisasjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Venstresidige pareser i arm
* Venstresidig sensibilitetstap
* Synsfeltutfall mot venstre
* Venstresidig facialisparese
* Dysfagi
* Dysartri
* Neglekt
* Invertert plantarrefleks venstre side
* Hyperrefleksi venstre side
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.2 poeng per utfall. Maks 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Han får trombolysebehandling, og allerede dagen etter hjerneslaget begynner han å få tilbake noe funksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke prosesser foregår i hjernen når en pasient blir bedre den første tiden etter et hjerneslag (timer-uker)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fysiologiske prosesser bedres/ normaliseres, ev. penumbrasonen «reddes» (ødem går tilbake, perfusjon bedres, oksygenering bedres, blødning resorberes)
Plastiske endringer, dvs lokal omforming. Det skjer da cellulære prosesser med knoppskyting, nye synapser, modulering av synapser.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2 poeng. 1 poeng på hvert punkt. Trekk ned til 0.5
hvis veldig knapt. F.eks er ikke bare ordet «plastisitet» nok
til å få 1 p på siste del. De må ha med noe om mekanismer
(at det handler om synapser f.eks).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter en uke på slagenhet har han fortsatt store funksjonsvansker og må ha hjelp i de fleste aktiviteter, men han har stadig litt økende funksjon. Du tenker at han har behov for videre rehabilitering, selv om det faktisk ser ut til at en del bedring skjer uansett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er antatt som forklaringer på at rehabilitering i tidlig fase (timer-uker) gir en bedre funksjon enn spontan forbedring alene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rehabilitering tilfører et «brukspress». Ved at pasienten samtidig med spontanbedringen utfører målrettete bevegelser og repeterer på ønskete bevegelser og aktiviteter, styrkes de nye synapsene som trenger å være sterke, mens uviktige, nye synapser svekkes (noe som antakelig er bra).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 1 poeng. Det gir poeng å si at det tilføres et brukspress. Det gir også poeng om dette forklares omtrent sånn som det står i veiledningen, selv om ikke ordet brukspress er nevnt. Men det må gå fram at studenten har skjønt at det er nyttig å forsterke de forbindelsene som inngår i ønsket aktivitet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Teamet på rehabiliteringsavdelingen tar utgangspunkt i WHO sin International classification of functioning, disability and health (ICF) når de skal sette opp en rehabiliteringsplan.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv og forklar de 5 elementene i ICF. Gi eksempler på hvert av de ulike elementene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Kroppsstruktur og kroppsfunksjon'': skader på organer og kroppsdeler (eks infarkt i hjernen, brudd i ekstremitet) og redusert kroppsfunksjon (eks nevrologiske utfall, lammelser, afasi, dårlig balanse mm)
''Aktivitet'': funksjon, ferdighet i utøvelse av daglige aktiviteter (eks: grad av gangfunksjon, ADL funksjon, kommunikasjonsevne mm)
''Deltakelse'': evne til å delta i samfunnet (eks utføre oppgaver i arbeidslivet, ha en rolle i familieliv, omgås venner, delta i organiserte fritidsaktiviteter mm)
''Personlige faktorer'': beskriver egenskaper og forhold knyttet spesifikt til den personen som beskrives (eks: helsetilstand forøvrig, personlighet, strategier for å møte utfordringer, tidligere kunnskap og erfaringer, rusmiddelbruk mm)
''Miljøfaktorer'': beskriver forholdene rundt personen (eks nettverk, bolig, arbeidsforhold, tilgang på transport mm)
Tegning av modellen
<<imgLink "IIAB-2020f-1.PNG">>
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.2 poeng per riktig element, maks 1 poeng. 0.2 poeng per eksempel som viser at studenten har forstått elementet, maks 1 poeng
Referanse:
* Pran F. ICF et felles språk for funksjon.
* Fagartikkel i Fysioterapeuten nr. 7/2007
* http://www.who.int/classifications/icf/en/
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke elementer / prinsipper er viktige i rehabilitering av funksjonstap etter hjerneskader?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tidlig start av rehabilitering
* Høy treningsintensitet (eks trening mer enn en gang om dagen, mengdetrening).
* Funksjonsrettet trening (eks: gangtrening ute og inne, trappegang, trening på sammensatte motoriske handlinger som ledd i ADL trening).
* Spesifikk trening rettet mot utfallene (eks balanseøvelser, styrketrening, koordinasjonsøvelser).
* Motivasjon for trening, opplevelse av å trene mot viktige mål, opplevelse av mestring.
* Rehabilitering i hjemlig miljø, relevante aktiviteter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert svar som direkte eller indirekte inneholder dette. Maks 2 poeng
Referanse: Nasjonal faglig retningslinje for behandling og rehabilitering ved hjerneslag.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kognitive og emosjonelle endringer er vanlige etter store hjerneslag i høyre hjernehalvdel?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Neglekt (halvsidig uoppmerksomhet)
* Rom-retnings vansker (visuospatiale problemer)
* Generelle oppmerksomhetsvansker
* Anosognosi (manglende innsikt i egen funksjonssvikt)
* Apati (likegyldighet, manglende motivasjon)
* Egosentrisitet (mindre interesse for andre)
* Fatigue
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 pr punkt på lista inntil 2 poeng. Ett av ordene i parentes kan også godkjennes innenfor punktet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 26 år med to barn på 2 og 4 år kommer til fastlegen etter noen anfall med smerter i epigastriet og under høyre costalbue den siste mnd. Smertene stråler ofte opp i høyre thorax/hø skulder og er av 1-4 timers varighet, og ledsages noen ganger av kvalme. Pas bruker P-piller.
Du tar blodprøver som viser:
* Hb 13,8 g/dL (13,4–17,0)
* CRP 2 (2-12)
* Hvite 6,0 (4,0–11)
* Bilirubin 23 micromol/L (5–25)
* ALP 90 U/L (35–105)
* ALAT 66 U/L (10–70)
* ASAT 98 U/L (15–45)
* GT 99 U/L (15–115)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er mest sannsynlige årsak til pasientens symptomer?
# Hvordan vil du utrede pasienten videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Gallestein 1 p
# Ultralyd galleveier 1p
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
En kvinne på 26 år med to barn på 2 og 4 år kommer til fastlegen etter noen anfall med smerter i epigastriet og under høyre costalbue den siste mnd. Smertene stråler ofte opp i høyre thorax/hø skulder og er av 1-4 timers varighet, og ledsages noen ganger av kvalme. Pas bruker P-piller.
Du tar blodprøver som viser:
* Hb 13,8 g/dL (13,4–17,0)
* CRP 2 (2-12)
* Hvite 6,0 (4,0–11)
* Bilirubin 23 micromol/L (5–25)
* ALP 90 U/L (35–105)
* ALAT 66 U/L (10–70)
* ASAT 98 U/L (15–45)
* GT 99 U/L (15–115)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke overveininger kan tale for operasjon? Hvilke overveininger kan tale mot operasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Gjentatte plagsomme gallestensanfall taler for operasjon med laparoskopisk kolecystectomi.
Sjeldne anfall og lette smerter taler mot operasjon, og likeså pasientenes ønske.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Konservativ behandling kan anbefales om pas har sjeldne anfall og tolererer smertene: 2 poeng
Hvis pasienten får symptomer på steinvandring med forhøyede leverprøver eller pancreatitt eller gjentatte anfall med sterke smerter må operasjon anbefales: 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pas ønsker å se det hele an uten operasjon.
2 år senere kommer pasienten til fastlegen som øhj med smerter i epigastriet av 8 timers varighet. Smerteutstråling til hø skulder og rygg, takvis forverrelse. Ingen effekt av Voltaren 100 mg supp. Pas er sterkt smertepåvirket, kaldsvett men greier såvidt å gå selv inn på legekontoret. BT 90/60, puls 120
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke årsaker kan man tenke seg til pasientens symptomer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Cholangitt
# Pancreatitt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 riktig svar gir 1 poeng
2 riktige svar gir 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar blodprøver som viser:
* Hb 15,8 g/dL (13,4–17,0)
* CRP 80 (2-12)
* Hvite 23,0 (4,0–11)
* Kreatinin 130 U/L (35-105)
* Bilirubin 50 micromol/L (5–25)
* ALP 90 U/L (35–105)
* ALAT 66 U/L (10-70)
* ASAT 98 (15–45)
* GT 99 U/L (15–115)
* Amylase 3000 U/L (60–180)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er beste tiltak for denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Øhj. innleggelse i sykehus til videre utredning og behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for riktig svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
* Hb 15,8 g/dL (13,4–17,0)
* CRP 80 (2-12)
* Hvite 23,0 (4,0–11)
* Kreatinin 130 U/L (35-105)
* Bilirubin 50 micromol/L (5–25)
* ALP 90 U/L (35–105)
* ALAT 66 U/L (10-70)
* ASAT 98 (15–45)
* GT 99 U/L (15–115)
* Amylase 3000 U/L (60–180)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre aktuelle radiologiske prosedyrer for denne pasienten slik hennes tilstand er nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ultralyd galleveier, CT abdomen, MRCP, MR pancreas
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar inntil 3 stk
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne i 50-årene ble lagt inn på kirurgisk avdeling fra den lokale legevakten under diagnosen «akutt abdomen». Hun var tidligere frisk og brukte ingen faste medisiner, men hun hadde de siste månedene vært plaget med litt takvise smerter i nedre del av magen samt litt løs avføring, intet blod per rectum.
Det aktuelle var relativt akutt innsettende smerter i nedre høyre del av buken. Ved klinisk undersøkelse var hun smertepåvirket, hun hadde lett forhøyet blodtrykk og puls, var subfebril og var trykk- og slippøm i
buken, især i nedre høyre del, ingen blod på hansken etter rektal eksplorasjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Presis angivelse av lokalisasjon av abdominale smerter er viktig. Abdomen er inndelt i ni anatomiske regioner. Hva er navnene på disse områdene? (0.25 p for hvert delsvar, maks 2 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Regio hypochondrica dxt./sin., evt. hø. og ve. hypokondrium
# Regio epigastrica/epigastriet
# Regio lumbalis dxt./sin., evt. regio abdominis/lateralis dxt./sin., evt. hø. og ve. flanke
# Regio umbilicalis/umbilicalregionen (navleregionen)
# Regio inguinalis dxt./sin., evt. hø. og ve. fossa iliaca
# Regio pubica/hypogastrium/hypogastriet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 p for hvert delsvar, maks. 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi noen aktuelle differensialdiagnoser for akutte smerter i nedre høyre del av buken som kan være relevante for denne pasienten (ikke tumorrelaterte tilstander og ikke tilstander relatert til urogenitalia (organsystem for St. IID)). (0.5 p for hvert delsvar, maks. 3 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Noen aktuelle differensialdiagnoser er bl.a.: akutt appendicitt, divertikulitt, volvulus, ileus, duodenalsår, Mb. Crohn, betent Meckels divertikkel, kolecystitt, trombose/emboli av mesenteriale blodkar, abscesser (psoasabscess).
Det kan her være andre relevante tilstander som ikke er nevnt over, så her må det vises skjønn ved poengberegningen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for hvert forslag, maks. 3 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble operert, og det viste seg å være en obstruerende tumor i cøcum som hadde gitt pasienten de akutte abdominalsmertene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke typer premaligne og maligne tumores kan forekomme i colon? (0.5 p for hvert delsvar, maks 2 p).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Adenomatøse polypper (tubulært/tubulovilløst/villøst adenom (angivelse av en av disse entitetene regnes som én tumor), adenokarsinom (kolorektalt adenokarsinom), nevroendokrin tumor, nevroendokrint karsinom, metastase, gastrointestinal stromal tumor (GIST), lymfom (også sjeldne tumores som sarkomer o.l. kan forekomme)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for hvert delsvar, maks 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det ble utført en høyresidig kolektomi. Peroperativt ble det også påvist en solitær velavgrenset lesjon i venstre leverlapp med diameter ca. 2 cm. Denne ble eksidert, og resektatene ble sendt til Avd. for patolog for undersøkelse. Mikrobildene er fra leverlesjonen (øverste bilde med 100x forstørrelse, bildet under 200 x forstørrelse).
<<imgLink "IIAB-2020f-3-A.PNG" 700>>
<<imgLink "IIAB-2020f-3-B.PNG" 700>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv bildene (1.5 p). Hvilke/hvilken diagnose/-r er det mest sannsynlig foreligger her i cøcum og lever? (1.5 p). (Totalt på hele oppgaven 3 p)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Histologibeskrivelse'': Det foreligger levervev med tilstedeværelse av irregulære kjertler bekledt med atypiske epitelceller. Kjertlene varierer i form og størrelse. Kjertelepitelet er flerradet, det er svinn av begerceller. Det atypiske kjertelepitelet viser celle- og kjernevariasjon (pleomorfi), mange av kjernene er hyperkromatiske, andre mer vesikuløse, nukleoler er lite fremtredende, enkelte apoptotiske figurer og mitoser sees, ingen nekroser.
''Diagnoser'': Det foreligger atypiske kjertler i lever forenlig med et adenokarsinom. Ut i fra sykehistorien med obstruerende tumor i cøcum, er det mest sannsynlig at det her foreligger et primært adenokarsinom i cøcum som har metastasert til lever (adenokarsinommetastase i lever)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
''Ang. histologibeskrivelse'': For hver histopatologisk forandring som nevnes, gis 0.5 p, eksempelvis: flerradethet, irregulær/-e kjertler/kjertelarkitektur/vekstmønster, kjerneatypi, celle- og kjerneatypi (om begge nevnes; angivelse av atypi uansett gir bare 0.5 p), pleomorfi, kjernevariasjon, hyperkromasi, vesikuløse kjerner, nukleoler, mitoser, apoptoser, nekroser (fravær av).
Det må her brukes skjønn når poengberegning skal gjøres. Maks. poengsum: 1.5 p.
''Ang. diagnose'': Angivelse av adenokarsinom i kolon med metastase til lever gir 1.5 p. Poengsetting her må også baseres på skjønn ut i fra kandidatens formuleringer, eksempelvis gir bare angivelse av karsinom 0.5 p, angivelse av karsinom pluss metastase 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinne 25 år oppsøkte fastlegen grunnet hevelse på halsen som hun har hatt i tre måneders tid. De har variert litt i størrelse, samtidig har allmenntilstand vært dårligere enn vanlig. Hun er fra før nyretransplantert og står på immunsuppressiv behandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de vanligste tilstandene (minst 4) som kan gi hevelse på halsen hos pasienter i denne aldersgruppen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Infeksjon av ulike slag
# Inflammasjon
# Autoimmune sykdommer.
# Maligne blodsykdommer.
#* KML, myelofibrose, Hodgkins lymfom, ALL, lymfom gir alle 0.5 p.
#* KLL, hårcelleleukemi, AML, akutt leukemi, myelomatose gir ikke poeng (KLL forekommer ikke under 30 år),
# Metastaser fra annen kreftsykdom
# Cyster
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maligne blodsykdommer, infeksjon, autoimmun sykdom, cyste: 0.5 p hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Kvinne 25 år oppsøkte fastlegen grunnet hevelse på halsen som hun har hatt i tre måneders tid. De har variert litt i størrelse, samtidig har allmenntilstand vært dårligere enn vanlig. Hun er fra før nyretransplantert og står på immunsuppressiv behandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser ut over undersøkelse av halsen er viktig hos denne pasienten? Gi en kort begrunnelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Undersøkelse av alle overfladiske glandelstasjoner.
# Infeksjonstegn (inkludert feber)
# Innvendig undersøkelse av hals.
# Undersøkelse av abdomen inkl lever og milt
# Utelukke infeksjon f eks mononukleose
# Utelukke sykdom i skjoldbrukskjertel
# Utelukke malignitet som følge av immunsuppresiv behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Undersøkelse av overfladiske glandelstasjoner, og abdomen inkl milt må være med for å gi full score
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten frykter hun kan ha fått en ondartet sykdom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer og funn skal i et slikt tilfelle gi mistanke om lymfekreft?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økt infeksjonstendens; vedvarende feber av ukjent årsak; blødningstendens; blodpropp i armer/bein eller lunger; utilsiktet vekttap; nattesvette; forstørrede lymfeknuter; forstørret milt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for hver av følgende feber, nattesvette, vekttap, forstørret glandelsvulst/forstørret milt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Fra hvilke celler oppstår lymfomer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lymfomer oppstår i forskjellige stadier I lymfocyttenes differensiering fra umodne lymfoide forstadier i benmarg og thymus til modne lymfocytter og terminalt differensierte plasmaceller
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle elementene må være nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 4 normale funksjoner som milten har i kroppen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Lymfoid organ som produserer lymfocytter, deltar i modningen av lymfocytter, deltar i immunforsvaret
# Renser ut celler på grunn av alder (120 dager for erytrocytter), skade (endret form, sfærocytter, defekte røde), røde som er dekket med antistoffer (autoimmun hemolytisk anemi)
# Reservoir for alle typer blodceller
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av punktene, max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Pasienten står på immunsuppressiv behandling. Hva er den viktigste årsaken til at immunsuppressiv behandling gir økt kreftrisiko?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den viktigste kjente risikofaktor for å utvikle B-celle neoplasier er forandringer i immunsystemet, enten ved immunsuppresjon eller autoimmunitet. Såkalt posttransplantasjons-lymfoproliferative tilstander (oftest B-celle lymfomer) forekommer hos pasienter som er organtransplanterte og bruker immundempende medikamenter i den hensikt å forhindre "graft versus host"-sykdom og avstøting av transplantater. Her er sannsynligvis redusert immunstatus sammen viktig for patogenesen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nedsatt immunstatus
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er tumorlysesyndrom, og hvordan kan det forebygges og behandles?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette betegner en tilstand med hyperkalemi, hypermagnesemi, hyperfosfatemi, hyperurikemi samt forhøyet kreatinin og urinstoff som tegn på nyresvikt og som oppstår når et stort antall kreftceller går raskt i oppløsning. (1 p) Det er viktig å være oppmerksom på og forebygge utvikling av denne livstruende komplikasjonen ved kreftformer der oppstart av behandling medfører raskt celledrap. Problemet ses ofte ved akutte leukemier, lymfoblastlymfom og Burkitt lymfom, mindre hyppig ved andre aggressive B og T-celle lymfomer, og fortrinnsvis der det foreligger store tumormasser.
Profylakse mot tumorlyse syndrom består av forsert diurese (alkalinisert diurese ved forhøyet urinsyre og / eller ved bruk av høydose metotreksat), man tilstreber en diurese på 4–5 l per døgn med pH helst over 7 døgnet før og de første 2–3 døgn etter oppstart av terapi, samt behandling med allopurinol tabletter i 2–3 uker. (1p ) Alkalinisert diurese øker presipitasjon av kalsiumfosfatkrystaller i nyrene, men nedsetter utfelling av urinsyrekrystaller og gir lavere nyretoksisitet av metotreksat.
Pasientene bør observeres nøye de første døgn og undersøkes daglig mht elektrolytt-forstyrrelser og stigning i urinsyre, kreatinin og urea. Pasienter som på forhånd har redusert nyrefunksjon, er mer utsatt.. Rasburicase (Fasturtec®) hindrer og reduserer hyperurikemi. Dette er en rekombinant urinsyre oksydase og er svært effektivt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Elektrolyttforstyrrelsene og nyresvikt må nevnes for å få 1 p
Profylakse med forsert diurese og alkalinisert diurese m virkningsmekanismer 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som fastlege vet du at du har mulighet for å beregne risiko for at en pasient har en gitt tilstand ved å kjenne til hvilke symptomer og funn pasienten har.
Mange pasienter kommer innom med halsvondt og du ønsker å finne de som har en sannsynlig streptokokk halsbetennelse, og vet at det finnes et sett med kriterier som kan hjelpe deg med dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva heter disse kriteriene?
# Hvilke kriterier er det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# De kalles Centorkriteriene
## Akutte halssmerter,
## Feber over 38.5°C
## Belegg eller pusspropper på tonsillene
## Hovne, ømme fremre cervikale lymfeknuter
## Fravær av hoste
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Centorkriteriene (0.5 poeng)
# 0.5 poeng per kriterium
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 25 år gammel kvinne kommer til deg som fastlege. Hun har følt seg syk i 3 dager med halsvondt, svelgsmerter og feber. Hun hadde ingen sekresjon fra nesen og ingen hoste. Du ser pusspropper på begge tonsillene
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er mest sannsynlige diagnose? Begrunn svaret kort
# Hvordan skal dette behandles?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# A. Streptokokk tonsilitt. Alle Centor kriterier er ikke listet opp i teksten, men likevel har man nok opplysninger til å argumentere for diagnosen.
# Fenoksymetylpenicillin (660mg x3-4 i 10 dager)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Streptokokk tonsilitt (1 poeng). Bakteriell tonsilitt gir også 1 poeng, det står ikke noe om strep test i oppgave teksten. Bare tonsilitt gir 0.5 poeng
# Penicillin/fenoksymetylpenicillin gir 1 poeng. Kun antibiotika gir 0.5 poeng. Ikke krav at vet lengden eller styrken på behandlingen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun kommer tilbake til ny time en uke senere fordi hun for 3 dager siden ble økende medtatt, fikk kraftig halssmerte på høyre side og gradvis vansker med å gape (kjevesperre).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er mest sannsynlige diagnose nå?
# Hva er et typisk klinisk funn ved undersøkelse av svelg og munnhulen ved denne tilstanden?
# Hvordan er det riktigst å behandle denne tilstanden nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Symptomene pasienten presenterer nå er typisk for en peritonsillær abscess (1p).
# Man forventer å se en forskyvning av tonsillen mot medialt (svelg) og hevelse peritonsillært (munnhule), evt også deviasjon av uvula og asymmetri av ganebuer (1p)
# Behandlingen er incisjon (primært) og målrettet antibiotika (0.5p).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for (1) og (2). 0.5 poeng for (3). Gir poeng dersom står kun incisjon/tømme abscessen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne kvinnen har hatt samme tilstand en gang tidligere. Hun kommer tilbake til deg etter avsluttet behandling og ønsker å drøfte forebyggende tiltak som kan gi best mulig beskyttelse mot samme tilstand i fremtiden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken forebyggende behandling er det riktigste for denne pasienten?
# Medfører dette tiltaket noen i risiko? Begrunn kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Du anbefaler pasienten tonsillektomi.
# Den kirurgiske prosedyren har risiko for smerte, ernæringsvegring med dehydrering og vekttap, blødning, postoperativ infeksjon og narkoserisiko
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Tonsillektomi 0.5 poeng
# Risiko ved tonsillektomi må minimum angi blødning (0.5p). I tillegg minimum 2 av disse 3 ytterligere 0,5p: smerte (0.25p), ernæringsvegring (0.25p) og narkoserisiko (0,25p)
Maks 1,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Om det var indisert eller ikke, så ble pasienten anbefalt en prosedyre. Denne prosedyren kan utføres som kurativ behandling, symptomlindrende behandling eller som diagnostisk avklaring
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 3 andre tilstander hvor denne prosedyren er indisert. Skriv om det er ment kurativt, symptomlindrende eller diagnostisk.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Residiverende tonsillitter (3-4 ganger årlig), kurativ behandling
* Tonsillehypertrofi og OSAS voksne, symptomlindring
* Tumor i tonsillen og/eller tumor colli uten kjent primætumor, diagnostisk.
* Kroniske svelgsmerter/tonsilitt, kurativ
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktige svar, maks 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann 76 år gammel kommer til fastlege på grunn av økende slapphet siste uken. Han har ingen magesmerter og avføringen har normal farge. Han har fra tidligere hatt et hjerteinfarkt og bruker acetylsalisylsyre (Albyl E 75 mg x 1). Han har hypertensjon og nyresvikt og bruker en angiotensin-II-hemmer.
Du tar blodprøver som viser
|! |! | !Referanseområde |
| Hb | 8.6 | 13.4 – 17.0 g/dL |
| MCV | 73 | 81-95 fL |
| MCH | 26.1 | 27.1-32.6 pg |
| ferritin | 15 | 30-383 µg/L |
| folat | 15 | 7-29 nmol/L |
| vitamin B12 | 214 | 186-645 pmol/L |
| CRP | <5 | <5 mg/L |
| kreatinin | 194 | 60-105 µmol/L |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du klassifisere anemien hans?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Jernmangelanemi. Mikrocytær, hypochrom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Jernmangelanemi: 1 poeng
* Mikrocytær og hypochrom 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Albyl-E øker risiko for GI-blødning. Hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Albyl-E er ulcerogent og øker risiko for magesår som i seg selv kan blø.
# Albyl-E hemmer blodplatefunksjon og øker derfor risiko for blødning fra blødningskilder som i seg selv ikke er forårsaket av Albyl-E, f.eks svulster i tykktarm.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert av svarene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er i god form og vil gjerne dra hjem.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnostiske tiltak iverksetter du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henvise til gastroskopi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for gastroskopi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir to dager seinere akutt uvel og svimmel før han kortvarig mister bevisstheten. Han hadde en stor tømning løs, svart, illeluktende avføring tilblandet med litt friskere blod i forkant av denne episoden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Mistenker du nå en øvre eller nedre gastrointestinal blødning? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En øvre GI-blødning. Ut fra beskrivelsen har pasienten melena.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for øvre. 1 poeng for en begrunnelse som inkluderer mistanke om melena.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du følger ambulansen på hjemmebesøk og tilser pasienten en halv time etter at han mistet bevisstheten. Du måler BT 96/62, puls 92 regelmessig. Han er varm og tørr i huden
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vurderer du blødningens alvorlighetsgrad og pasientfaktorer som gir økt risiko for død? Begrunn svarene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Alvorlig GI-blødning. Bevissthetstap, hypotensjon, lav Hb før akutt blødningsepisode. Mistanke om blodtilblandet melena og dermed et fokus i øvre GI-tractus med betydelig blodtap.
* Pasient med høy alder og komorbiditet (coronarsykdom og nyresvikt) har økt risiko for død.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng dersom blødningen vurderes som alvorlig.
* 1 poeng dersom 3-4 av faktorene som tyder på alvorlig blødning nevnes. 0 poeng dersom kun 1-2 faktorer nevnes
* 1 poeng for alder som risikofaktor
* 1 poeng for komorbiditet som risikofaktor (coronarsykdom og eller nyresvikt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir innlagt på sykehus. Albyl-E seponeres. Man finner et ulcus ventriculi og stanser blødningen. Det startes behandling med protonpumpehemmer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør pasienten starte Albyl-E igjen? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja. Blødningskilden er lokalisert og pasienten er stabil. Pasienten har coronarsykdom og har en god indikasjon for bruk av Albyl-E. Seponering av Albyl-E øker risiko for død hos pasienter med coronarsykdom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar og begrunnelse, som over. 1 poeng for riktig svar. 1 for en god begrunnelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten var Helicobacter pylori positiv og du gir en eradikasjonskur. Ved kontrollgastroskopi er magesåret tilhelet og han er H pylori negativ.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør han fortsette behandlingen med protonpumpehemmer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja. Pasienten har god indikasjon for Albyl-E og bør fortsette med protonpumpehemmer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar Ja = 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 23 år henvender seg til akuttmottaket da hun opplever at bena ikke bærer henne lenger. Hun forteller at hun i de to forutgående dagene har opplevd endring i hudfølelsen i bena. Hun beskriver en nummenhet som startet i tærne og som har steget oppover begge bena. Det er først i dag hun har opplevd at bena svikter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn diagnoser du tenker er særlig viktig å avklare med denne sykehistorien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Inflammatorisk polynevropati (Guillain Barre syndrom, AIDP)
# Inflammatorisk tilstand i medulla (myelopati)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng gis hvis inflammatoriske polynevropatier (eller tilsvarende betegnelser som AIDP eller Guillain Barre syndrom) er nevnt. Hvis dette ikke er nevnt gis ingen poeng.
Tilstander som gir en gradvis utviklende myelopati bør nevnes i tillegg, men da dette behandles i senere oppgaver, er det tilstrekkelig og nødvendig å nevne inflammatoriske tilstander i det perifere nervesystemet for å få full uttelling her.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har grad 4 pareser i alle stasjoner i begge underekstremiteter. Din nevrologiske undersøkelse finner holdepunkter for centralmotorisk årsak til paresene
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ledsagende tegn ved parese i underekstremitetene gir mistanke om affeksjon av øvre motornevron?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hypertoni av typen spastisitet
* Økte reflekser
* Temposvikt som er større en paresens grad
* Oppadvendt plantarrefleks
* (ingen facikulasjoner)
* (ikke større atrofi (ikke aktuelt da så kort sykehistorie))
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 for 2/4 kulepunkt, 1 p for 4/4 kulepunkt. Punktene i parentes er ikke direkte feil, men mindre relevante her.
Det kan skjønnsmessig trekkes poeng hvis det er angitt mange gale svar (helgardering)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved undersøkelse av sensorikk finner du at pasienten har god sensibilitet for lett berøring og vibrasjon i begge bena. Hun kan ikke skille stikk fra lett berøring eller varme fra kalde gjenstander fra et nivå med navlen og nedenfor (kaudalt). Kranialt for dette nivået er sensibilitetsundersøkelsen helt normal.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sanseinformasjon for modalitetene stikk og vibrasjon formidles i forskjellige signalsystemer. Beskriv nervestrukturene som leder signaler for disse to modalitetene fra hudreseptorer i underekstremiteter til thalamus, inkludert plassering av synapser og krysninger.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vibrasjonssans:
* Mekanoreseptorer i huden
* A-alfa/Abeta (tykke myeliniserte fibre) fibre til medulla spinalis
* Fortsetter direkte i bakstrengen (fasciculus gracilis)
* Synapse i nucleus gracilis (medulla oblongata)
* 2. ordens nevron løper som lemniscus medialis og krysser i decussatio lemniscorum medianum og videre til thalamus.
Stikk:
* Frie nerveender (nociseptorer)
* Aδ fibre/tynne myeliniserte fibre, i mindre grad C-fibre (umyeliniserte fibre)
** Skarp, stikkende smerte formidles særlig via Aδ fibre
** Varme, brennende, pressende smerte formidles særlig i C-fibre
* Synapse i dorsalhornet i lumbale medulla spinalis
* 2 ordens nevron krysser i anteriore commissur (commisura alba anterior)
* Løper i tracus spinothalamicus i det anterolaterale system til thalamus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Vibrasjon: For 0.5p må korrekt angivelse av sted for synapsene og hvor kryssningen skjer. For 1p må riktig betegnelse av perifere fibre*, bakstreng og lemniscus-systemet fremgå av besvarelsen,
Smerte: For 0.5p må korrekt angivelse av sted for synapsene og hvor kryssningen skjer foreligger. For 1p må riktig betegnelse av perifere fibre*, anterior kommisur og tractus spinothalamicus fremgå av besvarelsen
*Beskrivelsen av perifere fibre bør vise at kandidaten kjenner til at det er forskjellige typer perifere fibre for de forskjellige modalitetene. Detaljer som navn på fibre, eller å skille mellom A-delta/c-fibre for nocicepsjon er ikke nødvendig for å få poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ut i fra det du vet, hvor er det rimelig å anta at lesjonen sitter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Anterior-syndrom, ca nivå Th10
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Examinanden må få frem at det mistenkes en partiell affeksjon av ryggmargen, i dette tilfelle kun fremre del. I tillegg bør det være en beskrivelse av nivå, men besvarelser som midtre/nedre thorakale medulla er tilstrekkelig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvis det var en akutt (vaskulær) debut av dette sensoriske og motoriske utfallet, hvilken paraklinisk undersøkelse ville du prioritere først i akuttmottaket?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT angiografi av aorta. Denne bildeundersøkelse er tilgjengelig i akuttmottak og kan påvise disseksjon aorta abdominalis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng: CT angiografi av aorta
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I dette tilfelle fant man grunn til å mistenke demyeliniserende lidelse. Sykehistorien gav mistanke om et tidligere schub med forbigående styringsvansker i venstre arm og L’Hermittes fenomen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redgjør kort for de overordnede krav som gjelder for å stille diagnosen multippel sklerose (MS)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ekskludere andre årsaker, da MS er en eksklusjonsdiagnose.
# Fravær av andre påviste årsaker er ikke tilstrekkelig, man må oppfylle et eget kriteriesett for å stille diagnosen (MacDonald-kriteriene). Et sentralt prinsipp i dette kriteriesettet er kravet om å dokumentere spredning (disseminasjon) i tid og sted.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for å ekskludere andre årsaker (at eksaminanden viser forståelse for at MS er en eksklusjonsdiagnose)
* 0.5 poeng hvis kandidaten i besvarelsen viser forståelse for at man må oppfylle et kriteriesett for diagnosen. (Kriterisettes navn eller detaljene om dette er ikke forventet i en overordnet besvarelse)
* 1 poeng for å nevne prinsippet om spredning (disseminasjon) i tid og rom.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke supplerende diagnostiske undersøkelser (i tillegg til nevrologisk status og anamense) er det vanlig å gjennomføre for å stille MS diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* MR nevroakse (både hjerne og ryggmarg) med intravenøs kontrast
* Spinalpunksjon for undersøkelse etter oligoklonale bånd.
* Relevante nevrofysiologiske undersøkelser, VEP/SEP/BAER
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 hver av kulepunktene (MR nevroakse, spinalpunksjon, evoked potential undersøkelse)
* 0.5 ekstra hvis det er presisert at det skal gjøres MR av hele nevroaksen med intravenøs kontrast.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 61 år gammel mann oppsøker legekontoret da han et par ganger har merket blod på toalettpapiret etter avføring. Han er tidligere stort sett frisk, og er i full jobb. Han har hatt "litt urolig mage" i senere tid samt tidvis magesmerter, men tilskriver dette økt stress i arbeidssituasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke opplysninger er viktige å få svar på i anamnesen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vekttap, friskt eller mørkt blod på papiret eller i avføring. Endret farge på avføringen Endret avføringsmønster. Redusert almenntilstand, Familieanamnese
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Friskt eller mørkt blod (0.5p), vekttap (0.5p), endret avføringsmønster (0.5p) de øvrige max 0.5p tilsammen
</$details>
<div class="oppgave">
<div class="vignett">
!!Forrige vignett
<<<
En 61 år gammel mann oppsøker legekontoret da han et par ganger har merket blod på toalettpapiret etter avføring. Han er tidligere stort sett frisk, og er i full jobb. Han har hatt "litt urolig mage" i senere tid samt tidvis magesmerter, men tilskriver dette økt stress i arbeidssituasjonen.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de vanligste tilstandene (minst 4) som kan gi blod i avføringen hos pasienter i denne aldersgruppen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Colorektal cancer, inflammatorisk tarmsykdom, fissurer og haemorrhoider. Divertikulitt, Infeksiøs eller ischemisk kolitt kan også være relevant.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kreft, inflammatorisk tarmsykdom og fissur eller hemorrhoider må være med for å få max poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å utrede de vanligste årsakene til blod i avføringen hos denne pasientgruppen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de viktigste kliniske undersøkelsene du bør gjøre under konsultasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Klinisk undersøkelse av abdomen. Rektaleksplorasjon, undersøkelse av overfladiske glandelstasjoner, lytte på lunger.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng hver for us av abdomen og rektaleksplorasjon, 0.5 dersom en eller begge de øvrige punktene er med
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke laboratorieprøver vil du ta for å komme nærmere en diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hemoglobin, hemofec og CRP. SR, ferritin, ASAT eller ALAT, GT og ALP kan også være aktuelt,
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hemoglobin, hemofec må være med for å max poeng, de øvrige max 0.5 for ett av disse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har fått svar på laboratorieprøvene, og mener det er viktig å henvise pasienten til videre undersøkelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse er førstevalget i utredningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Endoskopi, primært colon/rektoskopi for å vurderer blødningskilde
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av punktene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake etter at videre undersøkelser er gjennomført. Du har fått tilbakemelding fra patologisk avdeling om at biopsi fra tarm viser adenocarcinom. Du ser også at pasienten er registrert i et pakkeforløp
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags kreftdiagnose er mest sannsynlig hos pasienten, hva er pakkeforløp og hva formidler du til pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mest sannsynlig dreier det seg om colorektal cancer. Dette er blant de hyppigste kreftypene i pasientens aldersklasse og er økende i forekomst i Norge. Som fastlege bør man si at det er påvist ondartet sykdom (kreft) og at han er henvist til sykehuset for behandling. Hovedbehandling er kirurgi. Enkelte skal ha neoeller adjuvant kjemoterapi etter kirurgi.
Pakkeforløp er Retningslinjer utgitt av Helsedirektoratet som skal sikre at pasienten utredes og kommer til behandling innen de oppgitte tidsfristene som er utarbeidet av faggruppen for de enkelte diagnosene. Implementert jan 2015
De er ikke juridisk bindende, men veiledende i forhold til tid fra henvisning mottatt for utredning til start behandling. Fra henvisning mottatt til behandling starter 35 kalenderdager (kirurgi/kjemoterapi), 39 dager (strålebehandling)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Diagnose (0.5p), og hovedbehandling (0.5p), til sammen 0.5 for de to, prinsipper for pakkeforløp (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten rapporterer at han siden siste kontroll har blitt mer slapp og trenger å hvile hver dag etter jobb. Du bestemmer deg for å ta utvidede blodprøver, og kontakte pasienten når svar foreligger. Blodprøvene viser forhøyet ALAT, GT og ALP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn mest sannsynlig differensialdiagnose Hva gjør du videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Levermetastaser.
Andre differential-diagnoser (mindre sannsynlige): Gallesten er ofte ledsaget av smerter. Hepatitt er som regel infeksjonspreget, ingen opplysning om reiseanamnese (HepA) og lite sannsynlig blodsmitte (Hep B). Cholangiocarcinom; sjelden tilstand i forhold til colorektal cancer med levermetastaser. Leverchirrose.
Primærlegen bør bestille billediagnostikk snarlig hvis det allerede ikke er gjort for å avklare om det foreligger metastatisk sykdom. Både CT, UL og MR har høy sensitivitet for å avdekke levermetastaser. Vanligvis brukes CT abdomen eller UL lever/abdomen. MR mer kostnadskrevende og som regel lenger ventetid. Ved mistanke om spredning til lever skal pasienten henvises til UL-eller CT veiledet biopsi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Levermetastaser (0.5) Billedundersøkelse (0.5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Noen pasienter trenger systemisk kreftbehandling i tillegg til lokalbehandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedgrupper medikamenter til bruk i kreftbehandling finnes, og nevn typiske trekk ved de forskjellige gruppene mht bivirkninger
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cytostatika (synonym: kjemoterapi, cellegift) – virker i stor grad også på raskt delende normalvev, akutte bivirkninger som hematologisk toksisitet, mucositt, polynevropati osv. Langtidsbivirkninger som kardiomyopati, sekundær malignitet, kronisk tretthet (fatigue) mfl
Ikke-cytostatika
* Monoklonale Antistoff -infusjonsrelaterte bivirkninger, lite akutte bivirkninger, langtidsbivirkninger?
* Småmolekylære hemmere/signal hemmere (TKI og andre) bivirkningsprofil er ulik avhengig av angrepspunkt, generelt mer tolererbar enn cytostatika, i liten grad hematologisk toksisitet, langtidsbivirkninger dels ukjent
* Immunterapi (PD-1 hemmere mfl) generelt lite bivirkninger, men ulike autoimmune manifestasjoner er et hovedtrekk, ukjent langtidsbivirkninger?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Cytostatika 0.5 p. Ikke-cytostatika, minst en av de tre undergruppene her bør nevnes for 0.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 75 år gammel kvinne oppsøker fastlegen med subjektivt nedsatt kraft i venstre hånd som har kommet snikende siste 2 uker. Hun forteller også at hun har vært kvalm og svimmel i noen dager, og føler seg mer søvnig enn vanlig. Hennes mann forteller at hun for 3 uker siden falt i trappen hjemme, hvor hun slo hodet. Hun var ikke bevistløst, men har begynte «å rote» mer den siste uken. Fra tidligere stort sett frisk, men bruker warfarin grunnet en dyp venetrombose i låret for 3 måneder siden.
Du som fastlege er bekymret og henviser henne til en bildediagnostisk undersøkelse samme dag.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke modaliteter har man i radiologi (1 poeng) og hvilke fysiske prinsipper benytter de seg av (1 poeng)? Svar kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
__Ultralyd __(0,25p) - __lydbølger __(0,25p) som reflekteres fra det som avbildes
__Røntgen __(0,25p) - __røntgenstråler __(0,25p) som «dempes»/absorberes når de går gjennom det som skal avbildes
__Computer Tomografi __(CT) (0,25p)- __røntgenstråler __(0,25p) benyttet til å lage et tredimensjonalt volum av det som avbildes
__Magnetresonanstomografi __(MR) (0,25p) - __radiobølger __som påvirker __protoner __i et statisk __magnetfelt __(0,25p)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Understrekede ord må være med for å få full uttelling. Disse fire er de tradisjonelle «modalitetene» i radiologi. PET/CT og PET/MR er hybridmodaliteter, og forsåvidt riktig, men trenger ikke være med for å få full uttelling (skal heller ikke gi poeng). Digital Subtraksjons Angiografi (DSA) / gjennomlysnings-røntgen regnes her som en undersøkelse under røntgen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bilder fra undersøkelsen du henviste henne til er vedlagt (figur 1).
<<imgLink "IIAB-2021-1-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken modalitet er dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
CT
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
<<imgLink "IIAB-2021-1-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er undersøkelsen normal eller foreligger det patologiske funn og i så fall hvilke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Patologisk (0,25 poeng) CT Caput med et subakutt subdural hematom (1poeng) med kompresjon av venstre sideventrikkel (0,25poeng) og midtlinjeoverskyting (0,5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dersom studenten glemmer å skrive at CT Caput er patologisk, men det framgår klart at han/hun tolker det slik i form av bildefunnene som oppgis, kan det likevel gies 0,25 poeng som ledd i en samlet vurdering.
Det er noe bevegelses-artefakter på høyre side, så dersom studentene nevner dette som mulig patologi skal det ikke trekkes for dette.
Feil tidsangivelse (akutt vs subakutt vs kronisk) av hematomet skal ikke gi trekk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir lagt inn på sykehuset. Pasienten har KOLS noe som er kjent i fra før. I løpet av sykehusoppholdet blir hun tungpust, får hoste med ekspektorat (hoster opp slim), smerter på den ene siden av thorax. Hun blir svært dårlig med sepsisutvikling. CRP måles til 400 mg/L (Referanseområde < 5 mg/L). Leukocytter 25 x 10^^9^^ /L (Referanseområde 4,1 – 9,8 x 10^^9^^ /L).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig årsak til kvinnens tilkomne symptomer og funn? Man ønsker å undersøke pasienten ytterligere med bildediagnostikk, hvilken undersøkelse er førstevalget å henvise til?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har høyst sannsynlig fått en bakteriell pneumoni (høy CRP og typisk klinikk). Hvis det er aktuelt med bildediagnostikk ved utredning av infeksjon i luftveier, så skal man alltid starte med rtg. thorax. Ved typisk funn på rtg. thorax så bekreftes diagnosen. Man skal ikke starte utredning med CT som førstevalg. Dette gir sjeldent tilleggsinformasjon til røntgen thorax, men kan bl.a. brukes ved mistanke om komplikasjoner til pneumoni som f.eks. spørsmål om empyem, abscess, alternative diagnoser eller mistanke om bakenforliggende årsak til infeksjon f.eks. lungekreft
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nedre luftveisinfeksjon/Pneumoni (0,5 poeng). Hvis man sier luftveisinfeksjon så gir ikke dette poeng, man må si at det er nedre luftveisinfeksjon eller pneumoni.
Røntgen thorax (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bilder fra undersøkelsen du henviste henne til er vedlagt (figur 2 a og b).
<<imgLink "IIAB-2021-1-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du beskrive patologien på bildene og hva det kan representere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Basalt på venstre side ses en stor, diffust avgrenset fortetning også kalt konsolidering. Man ser i tillegg luftbronkogram retrokardielt. På sidebildet ser man fortetningen basalt posteriort/dorsalt. Dette er typisk utseende som en lobær pneumoni. Man ser i tillegg avrundet venstre pleurasinus på frontbildet som kan indikere litt pleuravæske, og i såfall høyst sannsynlig parapneumonisk effusjon pga. infeksjon i lungen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig lokalisasjon: Venstre side (0,25 poeng). Basalt eller nedre del (0,25 poeng). Retrokardielt eller dorsalt eller posteriort eller baktil (0,25 poeng).
Utseende på fortetning: Diffust avgrenset eller konsolidering eller infeksiøst utseende fortetning (0,25 poeng). Det er ikke forventet at man beskriver eller ser luftbronkogram, men noen vil nok kanskje også beskrive dette og gir ytterligere 0,25 poeng.
Forandring kan representere eller passer med pneumoni eller nedre luftveisinfeksjon (0,25 poeng). Lobær pneumoni gir ikke tilleggspoeng. Om man foreslår type agens, f. eks. sannsynlig streptokokk-pneumoni, så gir ikke det tilleggspoeng, selv om dette er mest sannsynlig, men bildefunn er ikke spesifikk med tanke på type agens.
Hvis man beskriver pleuravæske så gir dette 0,5 poeng. Ingen tilleggspoeng for lokalisasjon av denne. Ingen tilleggspoeng om man nevner at dette sannsynligvis representerer parapneumonisk effusjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble behandlet og skrevet ut av sykehuset. Du er pasientens fastlege og bestiller et kontroll røntgen thorax ca. 2 måneder etter utskrivelse. Når røntgenbilder ble tatt, så hadde pasienten ingen symptomer. Kontroll røntgen thorax er vedlagt (figur 3a og 3b).
<<imgLink "IIAB-2021-1-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan du beskrive hovedfunnet på bildene og si hva det mest sannsynlig kan representere? Som hennes fastlege, hvordan håndterer du bildefunn videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Basalt dorsalt på venstre side ses en rund, skarpt avgrenset fortetning, som kan passe med tumor. Man vet ikke om dette er en benign eller malign tumor, men funn kan representere primær lungecancer, spesielt med tanke på pasientens alder, hun har kjent KOLS, og man ser en stor tumor.
Riktig håndtering blir å henvise videre til pakkeforløp for lungecancer, evt. henvise til lungeavdelingen eller tilsvarende avdeling som utreder med tanke på lungekreft.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig lokalisasjon gir ikke poeng på denne oppgaven.
Utseende: rund (0,25 poeng), skarpt avgrenset (0,25 poeng)
Kan passe med tumor eller primær lungecancer (0,5 poeng). Om man sier tumor, så gir det full uttelling.
Henvisning til pakkeforløp eller lungeavdelingen (1 poeng). Hvis man sier henvisning til CT (thorax eller thorax/abdomen) så gir også poeng, men kun 0,25 poeng i stedet for 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er LIS-lege i akuttmottaket. En 62 år gammel mann er henvist fra legevakt for smerter og hevelse i venstre legg siste fire dager. Han fikk diagnostiert hjerteinfarkt for 10 år siden og diabetes mellitus type II for syv år siden. Han opplyser om tørste siste tid, samt vekttap 5 kg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er aktuelle? (Nevn minst 5)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dyp venetrombose (DVT), rumpert bakercyste, bløtdelsinfeksjon, blødning, hjertesvikt, tumor i bekkenet med lymfødem eller venøs stase
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
En mann i denne alderen og med underliggende hjertesykdom og diabetes har mange differensialdiagnoser ved hevelse og smerte i leggen. Artrose er ikke uvanlig i denne alderen og vil kunne disponere for bakercyste. Diabetes vil øke risikoen for bløtdelsinfeksjon. Postinfarkt hjertesvikt med asymmetrisk ødem (ofte mere ødem i venstre ben fordi v. iliaca klemmes av ved krysningen over promontoriet) er heller ikke usannsynlig. Etter hjerteinfarkt er det vanlig å bruke platehemmer, som igjen vil disponere for blødning. Dyp venetrombose vil også være aktuelt, både alder og diabetes vil kunne disponere for dette. Alder og vekttap gjør at også kreftsykdom er aktuelt.
Man får 1 poeng for DVT og 0.5 poeng for øvrige riktige differensialdiagnoser inntil 3 poeng maksimalt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer vil du spørre om for å komme nærmere en sikker diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Slapphet, dyspne ved aktivitet, dyspne om natten (ligge flatt?), hoste, hemoptyse, feber, frostrier/frostanfall, andre smerter (eks kne, mage, bekken, rygg, bryst), svimmelhet/syncope, hjertebank, traume, polyuri.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Slapphet over lang tid vil gi mistanke om kreftsykdom. Hvis DVT vil man også kunne ha lungeemboli som kan gi dyspne, hemoptyse og pleurale brystsmerter. Bløtdelsinfeksjon vil være forbundet med feberfølelse, og frostanfall vil indikere alvorlig infeksjon. Klemmende brystsmerter kan bety koronare stenoser med mulighet for nytt hjerteinfarkt eller ischemirelatert hjertesvikt. Svimmelhet/syncope/hjertebank er relevant mhp massiv lungeemboli eller hjerterytmeforstyrrrelse. Traume mot venstre ben vil øke sannsynligheten for blødning. Polyuri vil indikere dårlig regulert diabetes, som igjen vil kunne forklare tørste og vekttap.
Man får 0.5 poeng per symptom inntil 2 poeng. Dyspne og feber/frostrier må med for å få full skår. Hvis ingen av disse er nevnt kan man maksimalt oppnå 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under anamneseopptak kommer det fram at pasienten har hatt funksjonsdyspne i 1-2 uker. Han har ellers vært i god allmentilstand og har ikke hatt feberfølelse. Blodtrykket er 130/80, Puls 85 og regelmessig. Temperatur er 38.3 grader Celcius målt rektalt. O2 saturasjon 95% uten oksygentilførsel. EKG viser dyp S-takk i avledning I, og i avledning III dyp Q-takk og invertert T-takk.
Ved undersøkelse finner du:
* Venstre legg er hoven. Det er spent/konsistensøket tykklegg med smerter ved palpasjon av denne. Rødme i huden med uskarp avgrensning til normal hud.
* Orofarynx: Tørre slimhinner.
* Cor: Regelmessig aksjon. Ingen bilyder.
* Pulm: Sonor perkusjonslyd, normale lungegrenser, normale og sidelike respirasjonslyder.
* Andre organsystemer som ikke er beskrevet ble funnet normale.
Laboratorieverdiene viser:
|!Analyse |!Verdi |!Referanseverdi |
|CRP |85 mg/l |<5 mg/l |
|D-dimer |8.9 mg/l |<0.5 mg/l |
|Glukose |28 mmol/l |4.2-6.3 mmol/l |
|Troponin T |26 ng/l |<14 ng/l |
|Leukocytter |7.5 x10^^9^^/l |3.7-10.0 x10^^9^^/l |
Trombocytter, alat, alp, kreatinin: Normale.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva anser du nå som mest sannsynlige diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
DVT
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kun riktig svar gir 1 poeng. Lokale funn på leggen sammen med lungeembolisymptomer og funn (EKG og troponin) åpner ikke for andre sannsynlige diagnoser. Bløtdelsinfeksjon er viktigste differensialdiagnose og gir 0.5 poeng. Ingen andre diagnoser gir poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse vil du rekvirere for å støtte din mistanke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
UL dype vener.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kun riktig svar gir 1 poeng. Hvis studenten har svart bløtdelsinfeksjon på spørsmål 3 vil blodkultur også gi 1 poeng. Venografi er kun aktuelt ved inkonklusiv UL og gir 0.5 poeng. Ekko Cor vil kunne vise hø belastning ved LE og gir også 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken medikamentell behandling vil du forordne hvis den diagnosen du har foreslått er sikker?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
DOAK
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
DOAK er førstevalg ved VTE. Man får 1 poeng hvis man kun svarer DOAK. Warfarin/LMWH er et godt alternativ, men gir litt større fare for hjerneblødning og bør bare velges hvis det er kontraindikasjoner mot DOAK (lever/nyresvikt eller interagerende medikamenter på Cyp3A4/P-gp systemet). Denne pasienten har normale lever og nyrefunksjonsverdier og kan sånn sett få DOAK. Unntaket vil være hvis han står på medisiner som interagerer. Hvis man svarer warfarin/LMWH uten begrunnelse gir dette 0.5 poeng. Med god begrunnelse og med beskrivelse av «warfarinisering» (dobbeltbehandling med LMWH første fem dager og i tillegg INR over 2.0 i minst ett døgn før LMWH-seponering) kan man gi 1 poeng.
Ved følgefeil, f.eks hvis man svarer penicillin som behandling av bløtdelsinfeksjon, kan dette gi full skår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv virkningsmekanismen for den medikamentelle behandlingen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved VTE: Hemming av fibrindannelse.
DOAK:
* Apixaban/Rivaroxaba/Edoxaban: Faktor Xa.
* Dabigatran: Faktor II
Warfarin: K-vitaminavhengige faktorer (II, VII, IX og X)
LMWH: Faktor Xa
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ved VTE er det hemming av fibrindannelse (antikoagulasjon) som gjelder, til forskjell fra platehemming på arteriesiden. Har man med dette gir det 1 poeng. I tillegg får man 1 poeng for å angi hvilke(n) koagulasjonsfaktor som hemmes ved foreslåtte behandling som angitt over.
Ved følgefeil, f.eks hvis man beskriver virkningsmekanismen av penicillin, kan dette gi full skår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Karen 56 år, tidligere frisk, kommer til sin fastlege på grunn av hoste, feber og nedsatt allmenntilstand. Ved auskultasjon av lungene høres basale knatrelyder høyre side. Temperatur måles til 39,5°C og CRP er 110 (< 5mg/L). Fastlegen konkluderer med at hun har en nedre luftveisinfeksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to vanlige kliniske diagnoser forbundet med infeksjon i nedre luftveier, og de vanligste mikrobielle agens som kan forårsake disse
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kliniske diagnoser: Bronkitt og pneumoni (0,5p) Evt. Trakeitt, bronkiolitt, empyem kan også gi poeng.
Bakterier: S. pneumoniae/pneumokokker, M. pneumoniae, C. pneumoniae, H. influenzae (0,5p)
Virus: Influensavirus, RS virus, metapneumovirus, parainfluensavirus, coronavirus, rhinovirus (0,5p)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Oppgaven tester studentenes grunnleggende kunnskap om nedre luftveisinfeksjoner.
To vanlige nedre luftveisinfeksjoner må nevnes for å få 0,5 p i del 1
To vanlige patogener ved nedre luftveisinfeksjoner (pneumokokker/S. pneumoniae, Mycoplasma pneumoniae, Chlamydia/chlamydophila pneumoniae, Influensavirus, SARSCoV-2/koronavirus, RS virus, metapneumovirus, parainfluensa, rhinovirus) gir 0,5 poeng, 4 vanlige patogener gir 1 poeng.
Ved mindre fullstendige svar i hver del kan studenten gis inntil 1p totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nasofarynksprøve, halsprøve og ekspektoratprøve er materialer som kan brukes til mikrobiologisk diagnostikk av luftveisinfeksjoner. Hvilke mikrobiologiske analyser (metoder og agens) er disse tre prøvematerialene egnet/uegnet til ved diagnostikk av nedre luftveisinfeksjon? Svar kort/stikkordsmessig.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* ''Nasofarynksprøve ''(maks 1p): Egnet for PCR undersøkelse for luftveisvirus, M. pneumoniae og C. pneumoniae (0,5 p). Ikke egnet for bakteriedyrkning ved nedre luftveisinfeksjon (0,5 p).
* ''Halsprøve ''(maks 1p): Egnet for PCR undersøkelser for luftveisvirus, M. pneumoniae og C. pneumoniae (0,5 p). Ikke egnet for bakteriedyrkning ved nedre luftveisinfeksjon (0,5 p).
* ''Ekspektoratprøve ''(maks 1p): Egnet for bakteriedyrkning ved nedre luftveisinfeksjon (0,5p) og til PCR undersøkelser for luftveisvirus, M. pneumoniae og C. pneumoniae, L. pneumophila (0,5 p).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Se over – hvert svar vektlegges likt. Her ønsker vi å kartlegge hvorvidt studenten forstår at ulike prøvematerialer fra luftveiene har ulik nytteverdi avhengig av mistenkt infeksjonsfokus og agens.
Studenten må gi minimum ett eksempel på en agens som undersøkes med PCR for å få poeng for å svare PCR som en fordel.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fastlegen starter empirisk behandling for samfunnservervet pneumoni og pasienten reiser hjem. Nasopharynxprøve til PCR for atypiske luftveispatogener (Mycoplasma pneumoniae, Chlamydia pneumoniae) og influensa ble tatt, og senere besvart negative. To dager senere blir fastlegen kontaktet av pasientens ektefelle fordi kona har blitt betydelig verre. Pasienten klarer ikke prate på grunn av dyspne, har målt temperatur på 41 grader og kommer seg ikke opp av sengen. Du rekvirerer ambulanse og legger pasienten inn på lokalsykehuset. Ved ankomst sykehuset er pasientens tilstand så alvorlig at hun innlegges på intensivavdelingen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
På sykehuset rekvireres det ekspektorat til aerob dyrkning. Hvilke andre prøver bør også tas til mikrobiologisk diagnostikk og hvilke mikrobiologiske analyser bør rekvireres?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Urin til Legionella antigen-test/pneumokokkantigen-test
* Blodkultur
* Legionella PCR/legionella dyrkning av ekspektoratet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Urin til Legionella antigen-test /pneumokokkantigen-test (0,5p)
* Blodkultur (0,5p)
* Legionella PCR/legionella dyrkning av ekspektorat (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Neste dag kommer det svar fra mikrobiologisk avdeling at ekspektoratprøven som ble tatt i akuttmottaket ikke var representativ for nedre luftveier
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør ekspektorat tas, og hvordan kan man vurdere hvorvidt materialet er representativt for nedre luftveier (makroskopisk og mikroskopisk)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ekspektoratprøve bør tas om morgenen etter å ha skylt munnen med vann
* Makroskopisk bør man se slimklatter/purulente klatter og prøven bør ikke kun bestå av serøst slim
* Mikroskopisk skal den inneholde <10 plateepitelceller/synsfelt når man mikroskoperer ved 100x forstørrelse/10x ocularet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Studenten må nevne at det skal tas om morgenen, inneholde slimklatter/purulente klatter + ikke inneholde ≥10 plateepitelceller/synsfelt for å få 1 poeng.
* Et mindre utfyllende svar som inneholder noe av det i svarteksten gir 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På førstedagsvisitt forteller pasienten at hun har hatt hoste, ufrivillig vekttap, uvelhetsfølelse og nattesvette i flere uker i forkant av det aktuelle. Hun forteller at hun bodde med sine foreldre i en liten landsby i Kongo fra hun var 9 til 14 år. Du mistenker at pasienten kan ha tuberkulose. Hun er fortsatt ikke i stand til å produsere representativt ekspektorat
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Basert på den informasjonen du nå har, hvilke prøver er aktuelle til mikrobiologisk diagnostikk, hvordan bør de tas og hvilke analyser bør rekvireres?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Prøver: Indusert sputum (1/2 p), BAL/bronkialskyllevæske (1/2 p)
* Hvordan prøvene tas: Indusert sputum tas etter saltvannsforstøver (1/2 p), BAL tas med bronkoskopi og skylling med NaCl (1/2 p)
* Analyser: Mycobacterium tuberculosis PCR (1/2 p), mykobakteriedyrkning (1/2 p), mikroskopi av Ziehl-Neelsen preparat/auraminpreparat/mtp syrefastestaver (1/2 p)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Se over – hvert svar vektlegges likt, maks 3 p totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
EKari, 25 år kommer til kontroll hos deg i allmennpraksis. Hun er tidligere frisk.
For 2 måneder siden utførte du rhinoskopia anterior og diagnostiserte forandringer i begge nesekavitetene hos Kari som på vedlagte bilde.
<<imgLink "IIAB-2021-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved ØNH undersøkelseskurs blir dere trent i hvordan dere skal beskrive rhinoskopia anterior. Hvordan vil du beskrive en normal rhinoskopia anterior?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rhinoskopia anterior beskrives som følger: Septum er midtstilt, slimhinne er blek, ingen patologisk sekresjon og god luftpassasje (Det er 4 punkter som skal beskrives ved rhinoskopia anterior)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng Septum midtstilt
* 1 poeng Slimhinne blek
* 1 poeng Sekresjon
* 1 poeng Luftpassasje
TOTALT: 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Kari, 25 år kommer til kontroll hos deg i allmennpraksis. Hun er tidligere frisk.
For 2 måneder siden utførte du rhinoskopia anterior og diagnostiserte forandringer i begge nesekavitetene hos Kari som på vedlagte bilde.
<<imgLink "IIAB-2021-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du beskrive rhinoskopia anterior hos denne
pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I venstre nesekavitet har pasienten en ''romoppfyllende/blokkerende/obstruerende forandring/tumor som obstruerer/blokkerer'' nesen. Evt svarer nesepolypp.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for romoppfyllende/blokkerende/obstruerende forandring/tumor (evt nesepolypp) i venstre nesekavitet (dvs at studenten må beskrive at det er en forandring eller tilsvarende ord som blokkerer nesekaviteten)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Kari, 25 år kommer til kontroll hos deg i allmennpraksis. Hun er tidligere frisk.
For 2 måneder siden utførte du rhinoskopia anterior og diagnostiserte forandringer i begge nesekavitetene hos Kari som på vedlagte bilde.
<<imgLink "IIAB-2021-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer er vanligvis til stede ved tilstanden som er vist på vedlagte bilde?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved symptomer på nesepolypper er de vanligste symptomene nesetetthet, nasal sekresjon og tap/redusert luktesans
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for nesetetthet
* 0.5 poeng for nasal sekresjon
* 0.5 poeng for tap/redusert luktesans
Totalt 1.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Kari, 25 år kommer til kontroll hos deg i allmennpraksis. Hun er tidligere frisk.
For 2 måneder siden utførte du rhinoskopia anterior og diagnostiserte forandringer i begge nesekavitetene hos Kari som på vedlagte bilde.
<<imgLink "IIAB-2021-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling er viktig å iverksette ved diagnosetidspunkt ved denne tilstanden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lokale nasale steroider/steroid nesespray
Lokale nasale steroider/steroid nesespray er viktigste behandling for å redusere størrelsen på nesepolyppene. Saltvannskyllinger kan brukes i tillegg for å rense nesen, men gir ingen reduksjon i størrelsen på nesepolyppene. Lokale nasale slimhinneavsvellende medikamenter slik som Rhinox/Otrivin m.fl. virker karkontraherende slik at blodårene i nesen trekker seg sammen, og gir således en kortvarig reduksjon i slimhinnevolum. Lokale nasale slimhinneavsvellende medikamenter reduserer ikke størrelsen på selve nesepolyppene, og anbefales ikke som behandling av nesepolypper (har også et avhengighetsskapende potensiale)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for lokale nasale steroider/steroid nesespray
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Kari, 25 år kommer til kontroll hos deg i allmennpraksis. Hun er tidligere frisk.
For 2 måneder siden utførte du rhinoskopia anterior og diagnostiserte forandringer i begge nesekavitetene hos Kari som på vedlagte bilde.
<<imgLink "IIAB-2021-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan håndterer du dette videre dersom medikamentell behandling ikke er tilstrekkelig for å oppnå symptomkontroll ved denne tilstanden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten bør utredes med CT av bihulene for å få oversikt over omfanget av tilstanden samt henvises til ØNH lege for vurdering kirurgi. CT gir god oversikt over bein og slimhinne i bihulene og avgrensning til orbita og cerebrale strukturer. For nesepolypper er dette er god metode for å kartlegge omfanget av polypputbredelsen.
MR gir oversikt over bløtvev, men ikke de beinede begrensninger til bihulene, og ved henvisning til bihulekirurgi er det viktig å ha oversikt over disse beinede begrensningene.
Blodprøver gir ikke tilleggsinformasjon ved ukompliserte nesepolypper.
Bakteriologisk dyrkning kan gjøres, men antibiotika behandling fører ikke til reduksjon av nesepolyppene. Det kan være aktuelt med bakteriologisk dyrkning dersom man ser nesepolypper med puss, og deretter behandle en bakteriell superinfeksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* CT bihuler 1 poeng
* Henvise ØNH lege 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble operert og fikk fjernet forandringene. Pasienten kommer til kontroll, og forteller at hun har det bedre.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken medikamentell behandling er det viktig at pasienten fortsetter med?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er veldig viktig at lokale nasale steroider kontinueres også etter kirurgisk fjerning av nesepolypper
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng Lokale nasale steroider
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 70 år gammel kvinne Oppdal henvises grunnet dyspne til poliklinikken hvor du jobber. Hun har ellers vært frisk, men grunnet hofteplager har hun vært mindre aktiv de siste årene. Det siste halvåret har hun utviklet dyspne og et lettere trykk i brystet når hun går trapper eller bakker. Disse symptomene har økt på litt siste to uker. EKG fra poliklinikken:
(EKG-bildet ikke publisert)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv EKG-funn som gjør det mer eller mindre sannsynlig at pasienten unormal myokardstruktur?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Rytme: Sinus.
* Akse: Venstredreid QRS-akse (R er rent positiv i avledningene I og aVL).
* QRS: Høyvoltsutslag. Dyp S i V1-V3 og høy R i V5-V6.
**(Sokolow-Lyon-kriterier: S i V1+ R i V5 eller V6 ≥35 mm (her ca 38 mm) og Cornell voltage kriteriene: S in V3 + R in aVL > 20 mm (kvinne) – her ca 39 mm.
* ST-segment: Sekundære forandringer («belastningstegn»):
* ST-senkning og asymmetrisk T-inversjon i V4–V6, samt I, II og aVL.
* EKG viser tegn til hypertrofi, og ingen funn er spesifikke for hjerteinfarkt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for beskrivelse av høyvoltsutslag og 1 poeng for å knytte ST-forandringene til dette. Øvrige EKG-funn gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Blodtrykk er 177/92, puls 64, regelmessig. Temperatur 37,3 grader målt rektalt. Respirasjonsfrekvens 13 per minutt, saturasjon 96% uten oksygentilførsel. Hemoglobin 11,7 (referanse 11,7-15,3) g/dL, leukocytter 6,0x10^^9^^/L (referanse 4,1-9,8x10^^9^^/L), CRP 8 (referanse <5) mg/L.
Ved klinisk undersøkelse finner du lette pitting-ødemer på føtter og ved auskultasjon hører du en nokså tydelig ru systolisk bilyd, som initialt øker i styrke før den avtar i siste del av systolen. Du finner at bilyden er tydeligst i andre høyre interkostalrom. Du synes også at du hører en systolisk bilyd over begge siders halsårer. Du mistenker aortastenose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skriv en kortfattet henvisning til ekkokardiografi og inkluder de 3 momentene du synes er viktigst fra sykehistorie, undersøkelse og funn
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De mest sentrale opplysningene i sykehistorie, undersøkelse og funn er:
* Gradvis økende anstrengelsessymptomer i form av dyspne og trykk for brystet.
* Funn av bilyd med angitte karakteristika for aortastenose (ru/crescendo-decrescendo/pm aortastedet/svekket andre hjertetone/forplantning halskar).
* Funn av høyvoltsutslag forenlig med venstre ventrikkelhypertrofi i EKG.
Mindre sentrale momenter: Alder, kjønn og adresse antas være gitt av identifikasjon. Kvantitering av dyspne i form av respirasjonsfrekvens oppfattes som mindre sentralt moment nå, da symptomene er anstrengelsesrelaterte. Saturasjon, blodtrykk, funn av deklive ødemer og lettgradig anemi momenter er ikke uten klinisk informasjon, men de er i denne situasjonen ganske uspesifikke og oppfattes derfor ikke som sentrale momenter
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng må alle de tre sentrale momentene (anstrengelsesrelaterte symptomer, bilyd med minst en av karakteristikkene typisk for aortastenose og EKG-forandringer) være inkludert, men alle karakteristika hørt ved auskultasjon og alle komponentene i EKG analyse trenger ikke være med. Ellers gis 0.5 poeng per sentralt moment og ingen poenger for de mindre sentrale momentene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor alvorlig tror du hennes klaffesykdom er? Begrunn svaret (stikkord)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette fremstår som en alvorlig aortastenose. Ved auskultasjon er det beskrevet at maksimal styrke kommer sent i systolen og at andre hjertetone er svekket. Bilyden har også klassisk forplantning til halskar. I EKG er det tegn til betydelig venstre ventrikkelhypertrofi. Pasienten har økende anstrengelsesrelaterte symptomer med dyspne og brystsmerter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng må det svares alvorlig aortastenose (0.5 poeng), og begrunnes med alle tre momentene: sykehistorie med anstrengelsesrelaterte symptomer, EKG funn av venstre ventrikkel hypertrofi og auskultasjonsfunnene beskrevet over, som gir 0.5 poeng hver.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ble henvist hjertemedisinsk dagpost og det ble utført ekkokardiografi og venstresidig hjertekateterisering. Det forelå normale koronarkar uten stenoser
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv sentrale deler av patofysiologien som kan forklare dyspne og brystsmerter ved aortastenose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sentral momenter er: Aortastenosen gir økt afterload til venstre ventrikkel. Økt myokardmasse og økt afterload gir økt oksygenforbruk av myokard. Ejeksjonstiden forlenges også (stenosen forsinker tømming av venstre ventrikkel), med følgelig fall av tid til diastole. Som en følge av obstruksjonen (aortastenosen) faller trykket i aorta (og dermed perfusjonstrykket i koronarkarene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 0.5 poeng for hvert av de fire sentrale momentene:
* økt afterload
* venstre ventrikkel hypertrofi
* redusert tid for diastol
* redusert perfusjonstrykk.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En hjertespesialist gjennomfører ekkokardiografisk undersøkelse basert på din henvisning. Hun beskriver blant annet følgende funn; max blodstrømshastighet gjennom aortaklaffen er 4.4 m/s, middelgradient 46 mmHg. Estimert klaffeareal basert på kontinuitetslikningen er 0.8 cm^^2^^
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er prinsippene for beregning av aortastenosens areal basert på kontinuitetslikningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kontinuitetslikningen: Areal,,1,, x Flow,,1,, = Areal,,2,, x Flow,,2,,
For en aortastenose betyr det at ligningen over løses med tanke på areal av aortastenose. Det vanlige er at «1» svarer til venstre ventrikkels utløpstrakt og «2» til aortastenosen.
Arealet av aortastenosen beregnes basert på måling av følgende tre parametre. Areal i venstre ventrikkels utløpstrakt, blodstrømsmål i venstre ventrikkels utløpstrakt og blodstrømsmål gjennom aortastenosen. Arealet av venstre ventrikkels utløpstrakt estimeres ved å måle diameter basert på formel for areal (π x r^^2^^ ), hvor r (radien) er 0.5 x diameter.
Blodstrøm (flow) måles med Doppler, hhv pulset Doppler i venstre ventrikkels utløpstrakt og kontinuerlig Doppler gjennom aortaostiet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng kreves det at studenten beskriver at kontinuitetslikningen tilsier at det er en gitt sammenheng mellom blodstrøm (hastighet) og areal, og hvor man benytter seg av å måle blodstrømshastigheten før stenosen (venstre ventrikkels utløpstrakt) og gjennom stenosen, samt at arealet (evt størrelsen) måles før stenosen. Dersom kun blodstrømsmål eller areal før stenosen er angitt gis 1 poeng.
Det gis ikke poeng for andre svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det indikasjon for å anbefale kvinnen klaffeoperasjon? Begrunn svaret med stikkord.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hun har en symptomgivende alvorlig aortastenose. Beregnet åpningsareal er 0.8 cm^^2^^. Maksimal blodstrømshastighet er 4.4 m/s. Middelgradient er oppgitt til 46 mmHg.
Symptomgivende alvorlig aortastenose gir indikasjon for kirurgi. Alvorlig aortastenose klassifiseres med bakgrunn i areal <1.0 cm^^2^^, maksimal hastighet >4,0 m/s eller middelgradient >40 mmHg.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få 2 poeng må studenten beskrive at hun har symptomgivende alvorlig aortastenose (1 poeng) og gi tilleggsopplysninger som indikerer at ekkokardiografi har avdekket alvorlig aortastenose (areal, blodstrømshastighet og/eller gradient) (0.5 poeng) som gir indikasjon for kirurgi (0.5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke symptomer og tegn søker du for å verifisere din mistanke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man må angi de 5 P som er klassisk ved akutt ischemi:
* Pulsless,
* Pain,
* Paralysis,
* Pallor,
* Paresthesia.
Pas plager kom plutselig
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 2 poeng hvis 4 av de fem er på plass. 1,5 poeng for 3 variabler. Et poeng hvis 2 er på plass og ingen poeng for kun en eller ingen av ovenstående. Ordene kan være skrevne på norsk.
</$details>
<div class="oppgave">
<div class="vignett">
!! Forrige vignett
<<<
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du undersøker pulsene i beinet og finner alle pulser som går å palpere på motsatt side(ve). Ingen puls på noen plass til hø. Hvilke pulser palperer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du palperer pulsene a. femoralis, poplitea, dorsalis pedis og tibialis posterior.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
3 av fire pulser må være riktig for et poeng. 2 pulser eller mindre 0 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!! Tdligere vignett
<<<
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den mest sannsynlige diagnosen er a/arteriell emboli i hø lyske siden det ikke fantes noen puls på noen plass på aktuell side (hø) og normal pulsstatus kontralateralt (ve). Pas har ikke hatt plager tidligere i beina.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 1.0 poeng for rett diagnose
</$details>
<div class="oppgave">
<div class="vignett">
!! Tdligere vignett
<<<
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva gjør du nå på mottakelsen i den akutte situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du gir b/ 5000 IE Heparin, c/smertestillende og bestiller en d/CTa
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.0 poeng for to av tre (b/ - d/) 0.5 poeng for en av tre (b/ - d/)
</$details>
<div class="oppgave">
<div class="vignett">
!! Tdligere vignett
<<<
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke behandlingsmuligheter er det i den akutte situasjonen? Hvilken behandling anbefaler du og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Akutt arteriell emboli kan prinsipielt behandles med trombolyse eller åpen embolectomi. I dette tilfelle dreier det seg om en pasient med nedsatt kraft i beinet hvilket er tegn på kraftig nedsatt sirkulasjon og derved må revaskulariseringen skje raskt. Det kan bare nås via åpen embolectomi. Trombolyse kan ta 2 døgn.
I tillegg er det sannsynlig at embolien finnes i femoralisbifurkasjonen siden det ikke fantes noen puls i beinet (inkluderer ingen puls i a femoralis). Da er åpen kirurgi å foretrekke grunnet anatomisk lokalisasjon av embolien.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Et poeng hvis begge behandlingsalternativene er på plass. 0.5 poeng for et riktig alternativ. Trekk i total summen hvis ord som bypass eller stent finnes med som svar.
Et poeng for riktig behandlingsforslag og et poeng hvis et av de to motivene er gidd.
</$details>
<div class="oppgave">
<div class="vignett">
!! Tdligere vignett
<<<
En 70-årig røykende mann oppsøker deg som lege på mottakelsen på et sykehus. Han har plutselig fått dårlig kraft i hø bein. Han har atrieflimmer og har hatt et hjerteinfarkt tidligere. Det er første gang han har plager i noen bein. Du mistenker at tilstanden kan være avhengig av dårlig sirkulasjon i beinet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når den akutte tilstanden er avklart så må forebyggende tiltak vurderes. Hvilke og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Pasienten har atrieflimmer og dette er en sannsynlig embolikilde. Hvis pas ikke har antikoagulasjon så skal slik behandling begynnes.
# I tillegg så må røykestopp komme på plass. Røyking øker risikoen for trombedannelse.
# Pas er røykere og har tegn på atherosklerotisk sykdom siden han har hatt et hjerteinfarkt. Han skal derved ha platehemmende medisin og statin behandling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis en poeng for hver 1-3 om forslag og motiv er til stede. Kun 0.5 poeng om bare behandlingsforslag er på plass.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 23 år kommer inn til akuttmottaket med redusert bevissthet. En venninne fra studentkollektivet fant henne liggende lite kontaktbar på soverommet om morgenen.
Venninnen oppgir at pasienten skal ha klaget over noe hodepine de siste dagene.
Ved undersøkelse virker pasienten urolig, hun ligger med øynene igjen og mumler på tiltale. Pupillene er sidelike, med normal reaksjon på belysning. Under undersøkelsen dreier blikket mot venstre og hun har lette rytmiske bevegelser i underkjeven. Det er ingen sikre fokalnevologiske utfall for øvrig, men det er lite bevegelse i ekstremitetene. BT 140/90, puls 100 regelmessig, kjernetemperatur 39 C.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva mer vil du spørre venninnen om?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tidligere sykehistorie
** Epilepsi – beskrivelse av pasienten ved undersøkelsen gir mistanke om at hun har et epileptiske anfall. Det er relevant å avdekke om hun har kjent epilepsi eller om dette er hennes første anfall
** Kjent hodepine – man bør se hodepinen de siste dagene i sammenheng med det aktuelle (for eksempel forårsaket av neoplasi eller meningitt).
* Gjøremål siste dager
** Søvn
** Aktiviteter
** Rusmiddelbruk
* Debut og utvikling av aktuell sykehistorie (hodepine), inkludert når pasienten ble sett sist før hun ble funnet; hvordan pasienten ble funnet (i seng/utenfor, urinavgang).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert moment:
* For tidligere sykehistorie må epilepsi være nevnt for å få 1 poeng, ellers gis et halvt poeng.
* For gjøremål siste dager må minst 2 av underpunktene være nevnt for 1p, ellers gis et halvt poeng.
* For å få 1 poeng for det tredje momentet (debut og utvikling av aktuelle sykehistorie) er det viktig at studenten får fram at det er viktig å kartlegge hva som har skjedd, og kommer med relevante eksempler på hva man bør spørre om.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
En kvinne på 23 år kommer inn til akuttmottaket med redusert bevissthet. En venninne fra studentkollektivet fant henne liggende lite kontaktbar på soverommet om morgenen.
Venninnen oppgir at pasienten skal ha klaget over noe hodepine de siste dagene.
Ved undersøkelse virker pasienten urolig, hun ligger med øynene igjen og mumler på tiltale. Pupillene er sidelike, med normal reaksjon på belysning. Under undersøkelsen dreier blikket mot venstre og hun har lette rytmiske bevegelser i underkjeven. Det er ingen sikre fokalnevologiske utfall for øvrig, men det er lite bevegelse i ekstremitetene. BT 140/90, puls 100 regelmessig, kjernetemperatur 39 C.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser utover den nevrologiske vil du gjennomføre av denne pasienten i akuttmottaket?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tester for nakkestivhet
* Inspeksjon av hud (petekkier, stikkmerker, tegn til traume)
* Inspeksjonav eventuelt tunge-/leppebitt/urinavgang
* Auskultasjon av hjerte og lunger
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for hvert moment: To poeng ved tre eller flere kliniske undersøkelser. Ett poeng ved to kliniske undersøkelser, et halvt poeng for en klinisk undersøkelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
En kvinne på 23 år kommer inn til akuttmottaket med redusert bevissthet. En venninne fra studentkollektivet fant henne liggende lite kontaktbar på soverommet om morgenen.
Venninnen oppgir at pasienten skal ha klaget over noe hodepine de siste dagene.
Ved undersøkelse virker pasienten urolig, hun ligger med øynene igjen og mumler på tiltale. Pupillene er sidelike, med normal reaksjon på belysning. Under undersøkelsen dreier blikket mot venstre og hun har lette rytmiske bevegelser i underkjeven. Det er ingen sikre fokalnevologiske utfall for øvrig, men det er lite bevegelse i ekstremitetene. BT 140/90, puls 100 regelmessig, kjernetemperatur 39 C.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er mest aktuelle?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Postiktal fase etter gjennomgått FTK (fokalt til tonisk klonisk) anfall
# Fokale epileptiske anfall med utgangspunkt i høyre hemisfære på bakgrunn av meningitt/encefalitt;
# blødning/ischemi i høyre eller venstre hemisfære;
# evt neoplasi høyre hemisfære.
# Rusmiddelutløst anfall (abstinens).
# Intoksikasjon.
# Systemisk infeksjon med påvirkning av sentralnervesystemet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tre poeng ved tre eller flere diff.diagnoser, to poeng ved to diff.diagnoser, ett poeng ved en diff.diagnose. Lokalisasjon (hemisfære) må ikke oppgis. Oppgis flere årsaker til meningitt/encefalitt gis det ett poeng; oppgis flere årsaker til blødning/ischemi (inkludert subarachnoidalblødning og sinusvenetrombose) gis ett poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
En kvinne på 23 år kommer inn til akuttmottaket med redusert bevissthet. En venninne fra studentkollektivet fant henne liggende lite kontaktbar på soverommet om morgenen.
Venninnen oppgir at pasienten skal ha klaget over noe hodepine de siste dagene.
Ved undersøkelse virker pasienten urolig, hun ligger med øynene igjen og mumler på tiltale. Pupillene er sidelike, med normal reaksjon på belysning. Under undersøkelsen dreier blikket mot venstre og hun har lette rytmiske bevegelser i underkjeven. Det er ingen sikre fokalnevologiske utfall for øvrig, men det er lite bevegelse i ekstremitetene. BT 140/90, puls 100 regelmessig, kjernetemperatur 39 C.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke parakliniske undersøkelser er aktuelle å gjennomføre i akuttmottaket og hvilke kan eventuelt være aktuelle senere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Mottak: CT caput,spinalpunksjon, blodprøver, blodgass
* Senere: MR caput og EEG
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To poeng dersom CT, spinalpunksjon, MR og EEG nevnes. Ett poeng dersom CT/MR eller spinalpunksjon. Null poeng dersom CT/MR og spinalpunksjon mangler. Blodprøver og blodgass gir ikke poeng, selv om de også er relevante for eksempel ved metabolske årsaker til kramper.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det kommer en ung mann, 27 år, til deg på legekontoret. Han plages med nesetetthet og sekresjon fra nesen. Han føler seg i dårlig form og sover ikke bra.
Du tror han har allergi
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan behandles allergisk rhinitt? Angi 4 vanlige alternativer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Antihistaminer
# Nasale steroider
# Systemiske steroider
# Allergivaksinasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig svar maks 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter tre måneder kommer pasienten tilbake til deg. Han har fortsatt plager med sekresjon og nesetetthet. Den siste tiden har luktesansen blitt nesten borte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du gjør fremre rhinoskopi. Hva kan man vanligvis inspisere ved fremre rhinoskopi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p neseskilleveggen
* 1 p concha inferior + ev. concha media
* 0.5 p neseslimhinnen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Undersøkelsen gir lite informasjon, bortsett fra at du ser litt sekret i midtre nesegang. Pasienten føler seg slapp og ikke i form. Du tar CRP, men den er ikke forhøyet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du henviser til ØNH. Hvilke undersøkelser er det rimelig å gjøre hos ØNH lege?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p ØNH status med endoskopi i nesen
* 0.5 p CT bihuler/MR bihuler
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 1.0 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Endoskopi viser puss i midtre nesegang, og polypper som fyller store deler av nesen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan behandles vanligvis kronisk bihulebetennelse? Nevn 4 mulige tiltak.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p nasale steroider for å redusere inflammasjon og polypper
* 0.5 p systemiske steroider noen dager for å krympe polyppene
* 0.5 p målrettet antibiotika etter dyrkningssvar
* 0.5 saltvannskylling av nesen for skylle ut sekret og event puss
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Totalt 2 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er vanlige differensial diagnoser ved nesetetthet? Nevn opptil 7 differensial diagnoser
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 0.5 p septum deviasjon
* 0.5 p allergisk rhinitt
* 0.5 p kronisk bihulebetennelse uten polypper
* 0.5 p kronisk bihulebetennelse med nesepolypper
* 0.5 p hypertrofi av nesemuslinger
* 0.5 p misbruk av avsvellende nesespray (otrivin, rhinox etc)
* 0.5 p forstørret adenoid vev hos barn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p pr svar, max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På prenatal ultralyd finner jordmor et guttefoster med utvidelse av venstre nyrebekken. Nyrebekkenet måler 20 mm i anteroposterior diameter. Det er normalt nyreparenchym og ingen utvidelse av ureter. Ved øvrige kontroller i svangerskapet er tilstanden stabil, og fødselen går ukomplisert. Mor er førstegangsfødende og får ikke i gang melkeproduksjonen før på tredje dag. Hun får derfor 3 dagers liggetid på barsel. Barnet følges opp av barnekirurg, som bestiller en bildeundersøkelse som gjøres på tredje levedag.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken bildeundersøkelse er best egnet for dette og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ultralyd (1 poeng, trenger ikke ha med nyrer/urinveier for å få full score). Denne undersøkelsen kan gjennomføres uten større forberedelse (som f.eks. sedering), enkelt å utføre, lite ressurskrevende, ingen ioniserende stråling, lett å repetere og da sammenligne resultater, ikke invasiv. (Må ha tre punkter for å få 1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
På prenatal ultralyd finner jordmor et guttefoster med utvidelse av venstre nyrebekken. Nyrebekkenet måler 20 mm i anteroposterior diameter. Det er normalt nyreparenchym og ingen utvidelse av ureter. Ved øvrige kontroller i svangerskapet er tilstanden stabil, og fødselen går ukomplisert. Mor er førstegangsfødende og får ikke i gang melkeproduksjonen før på tredje dag. Hun får derfor 3 dagers liggetid på barsel. Barnet følges opp av barnekirurg, som bestiller en bildeundersøkelse som gjøres på tredje levedag.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva har opplysningene om manglende melkeproduksjon å si for vurderingen av størrelsen på nyrebekkenet på denne første bildeundersøkelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Barnet er __dehydrert og har lav urinproduksjon__, så dette må tas med i beregningen når man vurderer størrelse på nyrebekkenet (0,5 poeng). Størrelsen på nyrebekkenet vil nå __sannsynligvis være mindre enn den reelle størrelsen__ gitt stabilisert urinproduksjon (0,5 poeng). Det kan ta over 1 uke (evt. flere før urinproduksjonen er stabilisert, slik at klinikerne kan vurdere videre oppfølging/utredning. (Understreket del må være med for å få poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barnets far (39 år) får etter hjemkomst fra sykehuset sterke anfallsvise smerter på venstre side av ryggen som stråler ned mot venstre lyskeregion. Han har fra tidligere hypertensjon og er plaget med residiverende urinveisinfeksjoner (3-4 ganger per år). Han nyter 2 enheter alkohol i helgene, men aldri ellers. Ingen faste medisiner. Etter 1 døgn med flere anfall oppsøker han sin fastlege. Ved klinisk undersøkelse og laboratorietester finner fastlegen: uøm abdomen med unntak av bankeøm venstre nyrelosje, 3+ på blod i urinen (urinstix), CRP < 5 (normalverdi < 5). Mens pasienten er på fastlegekontoret får han et nytt anfall, som ikke lar seg kupere av diclofenac (Voltaren) gitt intramuskulært. Fastlegen velger derfor å legge inn pasienten som ø.hjelp med en henvisning til en bildeundersøkelse på bakgrunn av tentativ diagnose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Lag en kort og konsis henvisningstekst til den aktuelle bildeundersøkelsen, hvor du:
# tar med informasjon som du oppfatter som relevante å ha med på en henvisning til denne bildeundersøkelsen (1,5 poeng)
# hvor du foreslår den mest sannsynlige diagnosen (1 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Relevant:
#* Tidligere sykdommer: Hypertensjon. Hyppige UVI (3-4 ganger/år).
#* Sykehistorie: 1 døgn med sterke anfallsvise smerter venstre side rygg med utstråling til venstre lyske. Lar seg ikke kupere med tiltak på fastlegekontoret.
#* Klinisk undersøkelse/Funn: Uøm abdomen, men unntak av bankeøm venstre nyrelosje, 3+ blod urinstix, CRP < 5. Nyre/Ureter-stein?
#* Overnevnte bør være med for å få full score (1,5 poeng)
# Nyre/Ureter-konkrement/steins-anfall (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Barnets far (39 år) får etter hjemkomst fra sykehuset sterke anfallsvise smerter på venstre side av ryggen som stråler ned mot venstre lyskeregion. Han har fra tidligere hypertensjon og er plaget med residiverende urinveisinfeksjoner (3-4 ganger per år). Han nyter 2 enheter alkohol i helgene, men aldri ellers. Ingen faste medisiner. Etter 1 døgn med flere anfall oppsøker han sin fastlege. Ved klinisk undersøkelse og laboratorietester finner fastlegen: uøm abdomen med unntak av bankeøm venstre nyrelosje, 3+ på blod i urinen (urinstix), CRP < 5 (normalverdi < 5). Mens pasienten er på fastlegekontoret får han et nytt anfall, som ikke lar seg kupere av diclofenac (Voltaren) gitt intramuskulært. Fastlegen velger derfor å legge inn pasienten som ø.hjelp med en henvisning til en bildeundersøkelse på bakgrunn av tentativ diagnose.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken bildeundersøkelse er hyppigst brukt rutinemessig for å påvise denne tilstanden og akutte komplikasjoner til denne (1 poeng)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lavdose CT Urinveier uten intravenøs, per oral eller rektal kontrast (1 poeng). Følgende svar skal også gi full uttelling: Stein-CT, Lavdose CT Urinveier, Lavdose CT urinveier uten kontrast.
Kun «CT» eller CT Urinveier gir 0,5 poeng.
Følgende svar skal ikke gi uttelling: Røntgen, Røntgen urinveier, Røntgen oversikt abdomen. Ultralyd. Ultralyd nyrer. Ultralyd urinveier. Ultralyd abdomen. MR. Scintigrafi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved den aktuelle undersøkelsen i oppgave 3 gjør man følgende funn, eksemplifisert ved bilde 1, 2 og 3 (disse bildene er fra 3 forskjellige pasienter med 3 ulike modaliteter).
''Bildene mangler i oppgaven som er lagt ut''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilket funn er dette? (1 poeng)
# Hvilken modalitet er brukt til å lage de ulike bildene? (1 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hydronefose (1 poeng). Utvidet/dilatert samlesystem/calyces i nyren kan også godtas men gir da kun 0.5 poeng. Studentene trenger ikke angi hvilken grad av hydronefrose som foreligger. Det er ulik grad av hydronefrose på de ulike bildene, eventuell gradering av hydronefrosen skal ikke vektlegges ved poenggiving.
# Bilde 1: Ultralyd. Bilde 2: CT. Bilde 3: MR. (1/3 poeng for hvert rett svar, totalt 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved hematuriutredning gjøres det ofte en 3-fase-CT. Forklar kort hva dette innebærer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En tre-fase CT er en CT undersøkelse hvor man har gjort 3 avbildninger av det man ønsker å avbilde, hvor det er ulik tid for hvor lenge siden det er den intravenøse kontrasten ble gitt (uten kontrast kan også være en fase (da lik t=0)). Urologer omtaler gjerne en tre-fase CT som en CT urinveier, hvor de tre ulike fasene er 1. __uten kontrast__, 2. med kontrast 80 sekunder etter injeksjon (__venøs/parenchymatøs corticomedullær/nefrogram fase/hvor kontrasten lades i nyreparenchymet__) og 3. med kontrast etter 10 minutter hvor kontrasten har fylt opp __samlesystemet (nyrebekken), ureters og urinblæren (utskillelsesfase)__. Understrekede deler må være med for få full uttelling (1,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Per og Kari er besteforeldre til Ola som fikk tykktarmskreft 27 år gammel. Per ble operert for tykktarmskreft da han var 40 år, mens Kari fikk brystkreft 73 år gammel. Per og Karis datter, Lise, er Olas mor. Lise fikk påvist endometriekreft og tykktarmskreft, henholdsvis 36 og 48 år gammel. Lise har to brødre, Tom og Inge, som ikke har hatt noen form for kreft. Toms datter Mari, fikk tykktarmskreft 32 år gammel. Som familiens fastlege, henviser du familien til genetisk utredning på grunn av mistanke om arvelig kreft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tegn slektstre for denne familien og angi de som har hatt kreft
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
<<imgLink "IIC-2015-2-A.PNG" 600>>
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Per og Kari er besteforeldre til Ola som fikk tykktarmskreft 27 år gammel. Per ble operert for tykktarmskreft da han var 40 år, mens Kari fikk brystkreft 73 år gammel. Per og Karis datter, Lise, er Olas mor. Lise fikk påvist endometriekreft og tykktarmskreft, henholdsvis 36 og 48 år gammel. Lise har to brødre, Tom og Inge, som ikke har hatt noen form for kreft. Toms datter Mari, fikk tykktarmskreft 32 år gammel. Som familiens fastlege, henviser du familien til genetisk utredning på grunn av mistanke om arvelig kreft.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket arvemønster er mest sannsynlig? (1 poeng) Gjør en vurdering av penetransen for kreftrisiko i denne familien (2 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Autosomal dominant arv med redusert penetrans er mest sannsynlig. Dominant fordi kreft forekommer i alle 3 generasjoner. Autosomal fordi den arves til og fra begge kjønn. Redusert penetrans fordi Lisas bror selv ikke har hatt kreft, mens hans datter har det. Kari, som fikk brystkreft 73 år gammel, har trolig en sporadisk kreft (ikke arvelig kreftsyndrom).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Per og Kari er besteforeldre til Ola som fikk tykktarmskreft 27 år gammel. Per ble operert for tykktarmskreft da han var 40 år, mens Kari fikk brystkreft 73 år gammel. Per og Karis datter, Lise, er Olas mor. Lise fikk påvist endometriekreft og tykktarmskreft, henholdsvis 36 og 48 år gammel. Lise har to brødre, Tom og Inge, som ikke har hatt noen form for kreft. Toms datter Mari, fikk tykktarmskreft 32 år gammel. Som familiens fastlege, henviser du familien til genetisk utredning på grunn av mistanke om arvelig kreft.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Inge har en sønn. Hva er risikoen for at denne sønnen skal få kreft?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Selv om Inge er frisk selv, kan Inge ha arvet genfeil fra far (Per), siden det ikke er full penetrans. Det er 50% risiko for at Inge har arvet fars genfeil. Videre er det 50% risiko igjen for at hans sønn arver denne feilen. Risikoen blir da 0,5x0,5=0,25 (25%).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Per og Kari er besteforeldre til Ola som fikk tykktarmskreft 27 år gammel. Per ble operert for tykktarmskreft da han var 40 år, mens Kari fikk brystkreft 73 år gammel. Per og Karis datter, Lise, er Olas mor. Lise fikk påvist endometriekreft og tykktarmskreft, henholdsvis 36 og 48 år gammel. Lise har to brødre, Tom og Inge, som ikke har hatt noen form for kreft. Toms datter Mari, fikk tykktarmskreft 32 år gammel. Som familiens fastlege, henviser du familien til genetisk utredning på grunn av mistanke om arvelig kreft.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken oppfølging kan denne familien tilbyes fra helsevesenet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Familien kan få tilbud om jevnlig koloskopi for å finne kreft på tidlig stadium, for å forhindre at de får utvikling av alvorlig kreftsykdom. De kan også få tilbud om gentesting i gener som er kjent å være involvert i arvelig tarmkreft. I denne familien kan det mistenkes Lynch syndrom (HNPCC), siden det er mange tilfeller av tarmkreft og også et tilfelle av endometriekreft. Hvis genfeilen blir identifisert, kan de som er mutasjonsbærere få tilbud om årlig koloskopi og ultralydundersøkelse av endometriene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Jeg mener det bare er oppgave 4 som kan vektes, og der synes jeg de bør ha med Lynch syndrom og tilbud om årlig koloskopi og UL for å få 3 poeng, 2 poeng hvis de bare beskriver dette generelt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På legevakt blir du oppsøkt av en mann på 65 år med dysuri. Han forteller om svie ved
vannlating. Han forteller at han den siste tiden har vært oppe 3-4 ganger hver natt med plutselig
trang til vannlating.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke to diagnoser er mest sannsynlige (0,5 poeng)
# Hvilken utredning bør du gjøre på fastlegekontoret? (1,5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ''Cystit/ nedre urinveisinfeksjon, prostatisme'' (0,5 poeng)
# Anamnese (''tegn på prostatisme'': hesitanse, strålekraft, etterdrypp), Klinisk undersøkelse (''Prostatapalpasjon''/måling av resturin) og Lab: ''Urin stix/dyrkning'', CRP/leukocytter, ''PSA'' (svakhet ved samtidig infeksjon) (1,5 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Uthevninger i fet skrift i veiledningen angir momenter som skal være med for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er i god allmenntilstand, og du bestemmer deg for å behandle han med perorale antibiotika.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken mikrobe er mest sannsynlig årsak til infeksjonen? (0,5 poeng)
# Nevn to ulike antimikrobielle midler som vil være aktuelle ved denne tilstanden. (1 poeng)
# Hvor mange dager bør behandlingen gis, basert på pasientens alder og kjønn? (0,5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ''E. coli'' (0,5poeng)
# ''Trimetoprim-sulfa (Bactrim)'' eller ''mecillinam (Selexid)'' tabletter (1poeng)
# ''7-10 dager'' behandling, ikke 3-dagers kurer til menn hvor prostata kan være et reservoar for bakterier (0,5poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Uthevninger i fet skrift i veiledningen angir momenter som skal være med for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et halvt år senere møter du igjen pasienten som primærvakt på Medisinsk avdeling. Ved undersøkelsen finner du at han har nedsatt bevissthet og har blodtrykk (BT) på 75/50, puls: 130, respirasjonsrate (RR): 36 og feber (39.5˚C). Han har 3 dager forut for innleggelsen vært hos fastlegen og fått foreskrevet Trimetoprim tabletter grunnet mistanke om urinveisinfeksjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken diagnose er mest sannsynlig. Begrunn svaret. (1 poeng)
# Hvilken videre utredning bør du gjøre før oppstart med antibiotika? (0,5 poeng)
# Hvilke tiltak bør du sette i gang i akuttmottaket før oppstart med antibiotika? (0,5 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Diagnose: Alvorlig ''urosepsis''. Sepsis mistenker man da det foreligger 3 av 4 tegn på systemisk inflammasjonssyndrom (SIRS, puls >90, RR>20, Temp>38˚C) og det er mistenkt infeksjon. Dette er en ''alvorlig sepsis'' siden han er hypotensiv (systolisk BT<100 mmHg) og har tegn på ''organ-dysfunksjon'' (redusert bevissthet) (1 poeng).
# Utredning: Urinstix/dyrkning, blodprøver, ''blodkultur, arteriell blodgass'', røntgen thorax (0,5 poeng)
# Tiltak: Etablere intravenøs tilgang og starte infusjon av ''parenteral væske''. Legge inn ''urinveiskateter'' for å måle timediurese (0.5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Uthevninger i fet skrift i veiledningen angir momenter som skal være med for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å starte behandling med antibiotika i akuttmottaket. Du har ikke svar på
blodprøvene som er tatt ennå.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken antibiotikabehandling bør du starte? (1 poeng)
# Begrunn svaret ut fra sannsynlige mikrober som kan gi denne infeksjonen? (1 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ''Ampicillin'' 2g x4 og ''gentamicin'' 5 mg/kg x1 i.v. Alternativt kan man gi et 3. generasjons cefalosporin (cefotaksim eller ceftriaxon), men det er understreket at ampi/genta er førstevalg (1 poeng).
# Begrunnelse: De mest sannsynlige bakteriene er ''E. coli'' og andre gram-negative staver, men her må vi også dekke for ''enterokokker'' som er relativt vanlig ved kompliserte urinveisinfeksjoner (spesielt hos menn). Derfor ampicillin som enterokokkdekning (dette medikamentet er også bedre mot gram-negative staver enn vanlig penicillin) og gentamicin som dekning mot gram-negative staver (E.coli, Klebsiella, Proteus) (1 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Uthevninger i fet skrift i veiledningen angir momenter som skal være med for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Neste natt ringer sykepleier fra sengeposten og ber deg om å komme for å tilse pasienten som er blitt dårligere. Sykepleieren sier at pasienten responderte til å begynne med på den behandlingen du satte i gang, men nå er tilstanden ganske lik som da han kom inn. Siste måling viste BT: 80/50, puls: 115 og RR: 32. Den samme ettermiddagen er det gjort ultralyd av urinveiene. Denne viser betydelig hydronefrose på høyre side. Radiologen antyder at det kan være snakk om pyonefrose (puss i urinbekkenet).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak bør du gjøre i denne situasjonen? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ta ny ''blodgass'' (0,5 poeng).
* Ta kontakt med anestesilege for å diskutere overflytting til intensiv for ''pressorbehandling'' (0,5 poeng).
* Ta kontakt med urolog evt. radiolog for innleggelse av ''nefrostomikateter'' (0,5 poeng).
* Vurder å ''skifte ut gentamicin'' med et 3. generasjons cefalosporin for å få bedre effekt i surt miljø (pyonefrose er å anse som en abscess med lav pH) (0,5 poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Uthevninger i fet skrift i veiledningen angir momenter som skal være med for å få 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 65 år gammel mann kommer til fastlegen. Det er egentlig kona som har sendt han da hun er bekymret for et sår som mannen har fått på høyre fot. Mannen er ikke sikker på hvor lenge han har hatt såret. Egentlig har han ikke noen plager fra foten, bortsett fra at forfoten har hovnet opp i løpet av de siste fjorten dagene. Han har ikke hatt feber. Mannen bedyrer at han for øvrig er frisk, bortsett fra at han hadde hjerteinfarkt for snart 10 år siden, og han tar tabletter for sukkersyke. Han hadde dessuten en manisk episode for vel et år siden og bruker olanzapin 10mg vesp. Han har gått en del opp i vekt i løpet av dette året, men legen hans sier han må fortsette med forebyggende medisin mot mani. Når fastlegen ber mannen ta av seg skoene og strømpene, ser han at mannen har et ganske stort sår under første metatarshode på høyre fot (bilde 1).
<<imgLink "IIC-2015-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket tilleggsspørsmål bør fastlegen stille?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Følgende tilleggsspørsmål bør stilles: Hvordan har blodsukkeret vært i det siste?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dette gir skåre 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fastlegen undersøker pasienten og finner at pasienten ikke har vibrasjonssans i foten. Da fastlegen ikke kan palpere puls i ankelnivå, måler han ankeltrykket og finner at ankel/arm indeksen er 1,3.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en vurdering av denne indeksen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Da fastlegen ikke kan palpere puls i ankelnivå, er det her med stor sannsynlighet snakk om et ''falskt forhøyet ankeltrykk''. Dette er et uttrykk for neuropati. Patofysiologien skyldes ''mediaforkalkning''. Dette gir en ''stiv og lite komprimerbar arterievegg''.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max skåre 2 poeng dersom minst 3 av de fete markeringene er med. 1 poeng for 2 faktorer nevnt, 0.5 poeng for en faktor
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved videre undersøkelse finner fastlegen at såret går inn til beinvev.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ut fra de opplysningene som hittil er gitt, hva taler for at fastlegen bør få pasienten innlagt/undersøkt ved nærmeste kirurgiske/ortopediske avdeling så fort som mulig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har ''ikke palpabel puls'' i ankelnivå. Såret er ''dypt''.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max skåre 2 poeng dersom begge med fet skrift er nevnt, 1 poeng dersom et punkt er nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det blir tatt røntgenbilde av foten (bilde 2). Ortopeden som vurderer røntgenbildet, mener pasienten har en kronisk osteomyelitt.
<<imgLink "IIC-2015-4-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke røntgenfunn gjør at ortopeden kommer til denne diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgenbildet viser ''destruksjon av beinvev og av leddet'' (1. metatarsofalangeal ledd). Slike forandringer kommer først etter flere uker og er uttrykk for en kronisk tilstand.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng dersom svarer det med fet skrift.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en vurdering av betydningen av olanzapin for tilstanden, og foreslå en endring i psykiatrisk medikamentell behandling som kan bedre helsetilstanden på lengre sikt.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Olanzapin kan føre til ''redusert blodsukkerkontroll samt gi vektøkning'' som indirekte også indirekte forverrer diabetes (1 poeng). Han bør ''bytte til et medikament'' som virker mot mani, men som gir mindre vektøkning og kanskje også mindre påvirkning av blodsukker, feks risperidon/ Risperdal, aripiprazol (Abilify) (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de viktigste medisinske konsekvensene av denne typen sår?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Sykdommer i foten er den vanligste årsaken til sykehusopphold/innleggelse'' hos pasienter med diabetes mellitus. ''2-8 %'' av pasienter med diabetes mellitus har et diabetisk fotsår. Diabetiske fotsår er ''bakgrunnen for ca. 85 % av alle amputasjoner'' på underekstremitetene hos de som har diabetes mellitus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max skåre 2 poeng dersom alle momentene i fet skrift er belyst. 1 poeng og 1/2 poeng dersom henholdsvis 2 eller ett moment er nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tilkalles på legevakt til en mann på 35 år. Broren forteller at mannen har vært i arbeid og fungert godt, men har vært sykemeldt de siste to uker fordi han har vært sliten. Broren mener pasienten drikker for mye, men han vet ikke hvor mye. De siste tre dagene har pasienten blitt gradvis mer urolig med perioder med sinne, han snakker i ett sett uten at broren alltid forstår hva pasienten mener, og han har sovet lite og avbrutt. Han mener en lokal motorsykkelbande vil drepe ham. Når du undersøker pasienten, er han avvisende til samtale, vandrer sint rundt i rommet og virker engstelig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire sannsynlige diagnoser
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mani med psykose, mixed state/ blandet episode med psykose, akutt (polymorf) psykose, abstinens med delir, intoksikasjon og rusutløst psykose. 0,5 poeng for hvert rett svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du velger å legge ham inn på psykiatrisk avdeling mot hans vilje
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke innleggelsesparagrafer er aktuelle, og hva må man ha med av opplysninger i innleggelsesskrivet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tvungen observasjon (3-2) og tvungent psykisk helsevern (3-3) godtas.
Studenten trenger ikke huske sifrene for paragrafen. 0,5 poeng for begge.
Innleggelsesskrivet må inneholde opplysninger om at pasienten er undersøkt personlig med sted og dato for undersøkelsen. En beskrivelse av opplysninger og funn ved undersøkelse som underbygger at det er sannsynlig eller sikker psykotisk tilstand. Konklusjonen må inneholde at det er mistanke om («overveiende sannsynlig») eller foreligger en psykotisk tilstand/ alvorlig sinnslidelse. 1,5 poeng.
Bakgrunnsinformasjon for sensor: Det forventes ikke at studenten kan alle detaljer fra forskriften, og den er heller ikke vist i undervisningen:
<<<
Psykisk helsevernforskriften §8: § 8.Uttalelse etter legeundersøkelse
Legens skriftlige uttalelse etter psykisk helsevernloven § 3-1 skal gi opplysninger om
a) hvem som har begjært legeundersøkelsen
b)tidspunkt og sted for undersøkelsen
c) pasientens syn på tilbud om psykisk helsevern
d)relevante pasientopplysninger som legen har mottatt fra andre
e) de observasjoner av medisinsk eller annen art som er gjort, herunder om det antas å foreligge en alvorlig sinnslidelse
f) hvilket grunnlag som anses å være til stede for å etablere tvungen observasjon eller tvungent psykisk helsevern, jf. psykisk helsevernloven § 3-2 og § 3-3.
Opplysninger fra legeundersøkelsen skal legges ved i lukket konvolutt, eller sendes direkte fra den
lege som har foretatt undersøkelsen.
<<<
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn tre medikamentgrupper med forskjellig virkningsmekanismer som kan brukes i den akutte fasen for å oppnå symptomatisk bedring og/eller som brukes for å hindre skade.
Begrunn valgene og angi kort virkningsmekanisme
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Benzodiazepiner (forsterker den hemmende effekten av GABA på GABA-A reseptoren (GABA-A hemmer)(Godtar GABA hemmer som tilstrekellig svar)) (GABA = (gamma amino smørsyre (butyric acid), antipsykotika (dopamin 2 blokkade og antihistaminerg effekt (høydosemedikamenter) og tiamin/ vitamin B1 (kofaktor i glukosemetabolismen). 0,5 poeng for hver, totalt 1,5 poeng.
Begrunnelse: for å oppnå beroligende og/eller sederende effekt (man oppnår ikke antipsykotisk effekt i akuttsituasjon), for tiamin å unngå skade i form av Wernickes encefalopati i tilfelle alkoholmisbruk (eller alvorlig ernæringssvikt av annen grunn,). 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De første to døgnene varierer han mye i atferd fra å være tilnærmet adekvat og rolig til stor uro og aggresjon kombinert med forvirring. Under uroperiodene har han en oppfatning av at det kryper små dyr rundt på kroppen hans. Søvnen er kortvarig og avbrutt, og han sover til varierende tider på døgnet. Etter noen dager er han rolig og adekvat. Han er deprimert uten selvmordstanker.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Redegjør for symptomer/forhold i sykehistorien som bør kartlegges nærmere for å velge
eventuell profylaktisk medikasjon
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Kvantifisering av forbruket av alkohol, 0,5 poeng, og om det foreligger annet rusmisbruk, 0,5 poeng.
* Om han har vært deprimert, antallet depresjoner, varighet av depresjonene og hyppighet av depresjonene. 1 poeng.
* Om han har hatt oppstemte perioder, varighet, hyppighet og alvorlighet av slike perioder. 1 poeng.
* Om han har hatt psykotiske symptomer, 0,5 poeng.
* Om det har vært suicidalforsøk eller suicidalfare, 0,5 poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For full skåre må minst 4 av nevnte faktorer under være nevnt, og man må ha med både depresjon og mani)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Peder er en 6 mnd. gammel gutt som kommer til undersøkelse på helsestasjonen. Han er mors første barn, født med gestasjonsalder 39 uker, fødselsvekt 3,5 kg (50 – 75 persentil), lengde 50 cm (50 persentil) og hodeomkrets 35 cm (25 – 50 persentil). Ukomplisert svangerskap og fødsel, han har vært frisk fram til nå og har fulgt vanlig opplegg ved helsestasjonen. Han har fått kun morsmelk fram til 4 mnd. alder, etter dette litt tillegg med NAN og siste mnd. også grøt. Mor har ikke bodd sammen med guttens far. Mor er 20 år og skoleelev, men er nå stort sett hjemmeværende med Peder. Hun har en kjæreste som av og til passer gutten. Du er helsestasjonslege og blir hentet av helsesøster som har stusset over at Peder har påfallende hudmisfarginger. Du undersøker gutten og finner følgende:
6 mnd. gammel gutt som framstår litt sutrete, men gir fin kontakt. Temp. 36,8. Lengde: 68 cm (50 – 75 persentil), vekt: 8,4 kg (50 – 75 persentil), hodeomkrets 46 cm (90 – 97,5 persentil). Fontanellen er mulig litt spent, men gutten virker ikke nakkestiv. Det er normale forhold ved undersøkelse av ører, munnhule, hjerte, lunger, buk, genitalia og anus.
Hudstatus: På høyre seteregion sees tre parallelle blå hudmisfarginger, som er tversgående og som hver måles til ca. 3 x 1 cm. I panna sees en blåbrun oval hudmisfarging, som måles til 4 x 2 cm. Bortsett fra dette er det ikke noe utslett, petekkier eller andre hudforandringer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke viktige spørsmål vil du stille til mor og/eller finne ut av fra helsestasjonspapirene for å utrede barnet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ad almenntilstand: Har gutten vært sutrete lenge? Andre symptomer som f.eks. oppkast og diare? Hoste og snørr? Spiser han godt? (1/2 poeng)
Ad hodeomkrets og fontanelle: Fra helsestasjonspapirene: Hvor har hodeomkretsen ligget før? Har det tidligere vært anmerket fyldig eller spent fontanelle? (1/2 poeng)
Ad hudmisfargingene: Når oppstod disse? Hadde han gjort seg noe eller skadet seg? Er gutten i stand til å bevege seg / kravle? Hvem passet gutten når han fikk disse? Har han hatt hudsykdom? Har han fødselsmerker? Har han hatt eller finnes det sykdom med økt blødningstendens i familien? (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Peder er en 6 mnd. gammel gutt som kommer til undersøkelse på helsestasjonen. Han er mors første barn, født med gestasjonsalder 39 uker, fødselsvekt 3,5 kg (50 – 75 persentil), lengde 50 cm (50 persentil) og hodeomkrets 35 cm (25 – 50 persentil). Ukomplisert svangerskap og fødsel, han har vært frisk fram til nå og har fulgt vanlig opplegg ved helsestasjonen. Han har fått kun morsmelk fram til 4 mnd. alder, etter dette litt tillegg med NAN og siste mnd. også grøt. Mor har ikke bodd sammen med guttens far. Mor er 20 år og skoleelev, men er nå stort sett hjemmeværende med Peder. Hun har en kjæreste som av og til passer gutten. Du er helsestasjonslege og blir hentet av helsesøster som har stusset over at Peder har påfallende hudmisfarginger. Du undersøker gutten og finner følgende:
6 mnd. gammel gutt som framstår litt sutrete, men gir fin kontakt. Temp. 36,8. Lengde: 68 cm (50 – 75 persentil), vekt: 8,4 kg (50 – 75 persentil), hodeomkrets 46 cm (90 – 97,5 persentil). Fontanellen er mulig litt spent, men gutten virker ikke nakkestiv. Det er normale forhold ved undersøkelse av ører, munnhule, hjerte, lunger, buk, genitalia og anus.
Hudstatus: På høyre seteregion sees tre parallelle blå hudmisfarginger, som er tversgående og som hver måles til ca. 3 x 1 cm. I panna sees en blåbrun oval hudmisfarging, som måles til 4 x 2 cm. Bortsett fra dette er det ikke noe utslett, petekkier eller andre hudforandringer.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi de mest sannsynlige differensialdiagnoser. Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spent fontanelle og sutrete barn: Infeksjon? CNS infeksjon? Serøs eller bakteriell meningitt? (1/2 poeng)
Spent fontanelle og økende hodeomkrets: Tumor cerebri? Andre cerebrale romoppfyllende tilstander? (1/2 poeng)
Spent fontanelle, økende hodeomkrets og påfallende blåmerke på setet: Hodeskade (spesielt SDH) og påført hudskade. Kombinasjonen er suspekt på barnemishandling. (1,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
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Peder er en 6 mnd. gammel gutt som kommer til undersøkelse på helsestasjonen. Han er mors første barn, født med gestasjonsalder 39 uker, fødselsvekt 3,5 kg (50 – 75 persentil), lengde 50 cm (50 persentil) og hodeomkrets 35 cm (25 – 50 persentil). Ukomplisert svangerskap og fødsel, han har vært frisk fram til nå og har fulgt vanlig opplegg ved helsestasjonen. Han har fått kun morsmelk fram til 4 mnd. alder, etter dette litt tillegg med NAN og siste mnd. også grøt. Mor har ikke bodd sammen med guttens far. Mor er 20 år og skoleelev, men er nå stort sett hjemmeværende med Peder. Hun har en kjæreste som av og til passer gutten. Du er helsestasjonslege og blir hentet av helsesøster som har stusset over at Peder har påfallende hudmisfarginger. Du undersøker gutten og finner følgende:
6 mnd. gammel gutt som framstår litt sutrete, men gir fin kontakt. Temp. 36,8. Lengde: 68 cm (50 – 75 persentil), vekt: 8,4 kg (50 – 75 persentil), hodeomkrets 46 cm (90 – 97,5 persentil). Fontanellen er mulig litt spent, men gutten virker ikke nakkestiv. Det er normale forhold ved undersøkelse av ører, munnhule, hjerte, lunger, buk, genitalia og anus.
Hudstatus: På høyre seteregion sees tre parallelle blå hudmisfarginger, som er tversgående og som hver måles til ca. 3 x 1 cm. I panna sees en blåbrun oval hudmisfarging, som måles til 4 x 2 cm. Bortsett fra dette er det ikke noe utslett, petekkier eller andre hudforandringer.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer er viktige å legge vekt på i vurderingen av om barnet skal legges inn på sykehus?
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<$details class="answer" summary="Svar" state="!!showanswer">
Mulig sykdom/skade i CNS, progredierende forløp, potensielt alvorlig og uavklart tilstand. (1/4 poeng)
Suspekt med tanke på barnemishandling, og fare for at barne kan bli utsatt for ytterligere skade. Innleggelse kan sikre barnet med tanke på dette. (3/4 poeng)
</$details>
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!!Vignett
Forrige vignett:
<<<
Peder er en 6 mnd. gammel gutt som kommer til undersøkelse på helsestasjonen. Han er mors første barn, født med gestasjonsalder 39 uker, fødselsvekt 3,5 kg (50 – 75 persentil), lengde 50 cm (50 persentil) og hodeomkrets 35 cm (25 – 50 persentil). Ukomplisert svangerskap og fødsel, han har vært frisk fram til nå og har fulgt vanlig opplegg ved helsestasjonen. Han har fått kun morsmelk fram til 4 mnd. alder, etter dette litt tillegg med NAN og siste mnd. også grøt. Mor har ikke bodd sammen med guttens far. Mor er 20 år og skoleelev, men er nå stort sett hjemmeværende med Peder. Hun har en kjæreste som av og til passer gutten. Du er helsestasjonslege og blir hentet av helsesøster som har stusset over at Peder har påfallende hudmisfarginger. Du undersøker gutten og finner følgende:
6 mnd. gammel gutt som framstår litt sutrete, men gir fin kontakt. Temp. 36,8. Lengde: 68 cm (50 – 75 persentil), vekt: 8,4 kg (50 – 75 persentil), hodeomkrets 46 cm (90 – 97,5 persentil). Fontanellen er mulig litt spent, men gutten virker ikke nakkestiv. Det er normale forhold ved undersøkelse av ører, munnhule, hjerte, lunger, buk, genitalia og anus.
Hudstatus: På høyre seteregion sees tre parallelle blå hudmisfarginger, som er tversgående og som hver måles til ca. 3 x 1 cm. I panna sees en blåbrun oval hudmisfarging, som måles til 4 x 2 cm. Bortsett fra dette er det ikke noe utslett, petekkier eller andre hudforandringer.
<<<
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gutten legges inn på sykehus. Som vakthavende barnelege, hvilke supplerende undersøkelser (kliniske, blodprøver, bildediagnostikk, mikrobiologi) bør du vurdere å gjøre i tillegg til den generelle kliniske undersøkelsen i den akutte fasen?
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<$details class="answer" summary="Svar" state="!!showanswer">
* Blodprøver: Hb, Hvite, diff, trc, CRP, syre/base-status, Na, K, kreatinin, bl.s, ALAT, amylase, PT-INR, cephotest (blødningsstatus). (1/2 poeng for å ha med flere av disse)
* Bildediagnostikk: Cerebral CT, rtg. totalskjelett (1 poeng for begge, 1/2 poeng for en).
* Øyenbunnsundersøkelse. Vurder spinalpunksjon (diskuter problemstillingen mot sannsynlig forhøyet CNS trykk, først oftalmoskopi og/eller cerebral CT) (1/2 poeng dersom minst 1 av disse er med).
* Mikrobiologi: urin stix og dyrkning, virus nasopharynx, virus avføring (1/2 poeng dersom minst 1 av disse er med).
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det andre instanser du som vakthavende barnelege må vurdere å koble inn?
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<$details class="answer" summary="Svar" state="!!showanswer">
Denne kasuistikken er svært suspekt på påførte skader, det mest åpenbare er hudmisfargingen på høyre seteregion. Det er imidlertid også forhold som gjør at hodeskade kan mistenkes, men dette er litt mer uklart. Uansett, hudmisfargingen på høyre seteregion er såpass suspekt at ''barnevern'' må nevnes (1 ½ poeng, hjemlet i Helsepersonell-loven og Lov om barnevernstjenester). Dersom studenten også drøfter å kople inn ''politi'', gis det poeng også for dette (1/2 poeng, hjemlet i Avvergeplikten).
</$details>
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!!Vignett
En 67 år gammel mann er i over 20 år blitt behandlet for hypertensjon og glomerulonefritt. For 2 år siden fikk han diagnosen cancer prostatae. Da kreftdiagnosen ble stilt, hadde han allerede skjelettmetastaser. Han er blitt behandlet med kirurgi, cellegift og hormonterapi. Hovedproblemet hans er "tannverklignende" smerter, som lokaliseres tilsvarende skjelettmetastasene. Han har en GFR på 24 mL/min/1,73 m^^2^^, noe som plasserer ham i stadium 4 på skalaen fra 1 til 5 over grad av kronisk nyresykdom (CKD). Han har tidligere blitt genotypet og tilhører CYP2D6 PM («poor metabolizer»; langsom metabolisør)-varianten. Du er hans fastlege og ansvarlig for medisineringen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hans hovedproblem er verkende smerter. Du har lært at farmakoterapi ved smerte bør inkludere paracetamol, som har en opioidsparende effekt. Kan han få paracetamol?
Begrunn svaret.
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<$details class="answer" summary="Svar" state="!!showanswer">
Ja (0,5 poeng). Begrunnelse: Paracetamol metaboliseres i all hovedsak til inaktive metabolitter i leveren og kan gis i uendret (eller eventuelt lett redusert) dosering ved CKD4 (0,5 poeng)
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Et av de andre alternativene som du vurderer, er et NSAID. Er han kandidat for NSAID-terapi? Begrunn svaret.
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<$details class="answer" summary="Svar" state="!!showanswer">
Nei, NSAIDs er kontraindisert (0,5 poeng). Begrunnelse: NSAIDs kan indusere nyrefunksjonsnedsettelse, spesielt hos pasienter som allerede har en kompromittert nyrefunksjon (0,5 poeng).
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Trinn 2 på smertetrappen utgjøres av såkalte «svake opioider». Hvilke svake opioider har vi registrert i Norge? Kan noen av disse brukes i dette tilfellet?
Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hvilke svake opioider har vi registrert i Norge? Kodein (0,25 poeng) og tramadol (0,25 poeng).
Kan noen av disse brukes i dette tilfellet? Nei, de er begge avhengig av CYP2D6 for bioaktivering til aktiv metabolitt (hhv. morfin og Odesmetyltramadol), som er disse midlenes primære aktive prinsipp. Han vil derfor ikke få noen klar analgetisk effekt av disse midlene (0,5 poeng).
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du vurderer i alle tilfelle at han er opioidtrengende, og du har lært at morfin er førstevalget blant de såkalte «sterke opioidene». Hva er viktig å tenke på ved valg av «sterkt opioid» hos denne pasienten? Er det ut fra dette noe som tilsier at morfin ikke bør velges her?
Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
På grunn av pasientens nedsatte nyrefunksjon bør man behandle pasienten med et opioid __som ikke utskilles renalt__, og som heller ikke har aktive metabolitter som er avhengige av en intakt nyrefunksjon for utskillelse (0,75 poeng). Er det noe som tilsier at morfin ikke bør velges her? Morfinterapi er uegnet i dette tilfellet.
Begrunnelse: Morfin metaboliseres i leveren. En av metabolittene (morfin-6-glukuronid; M6G) er aktiv – trolig i vesentlig større grad enn morfin. M6G utskilles renalt. Morfinterapi vil i dette tilfellet resultere i opphopning av M6G og økt/protrahert/ukontrollerbar effekt og er derfor uegnet (0,75 poeng).
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre «sterke opioider» kan være alternativer for denne pasienten? Begrunn svaret.
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<$details class="answer" summary="Svar" state="!!showanswer">
Fentanyl og (sannsynligvis, men her er dokumentasjonen ikke like god) oksykodon (og eventuelt hydromorfon) (0,5 poeng). Disse utskilles ikke renalt, og har heller ikke aktive metabolitter som er avhengige en intakt nyrefunksjon for utskillelse. (0,5 poeng). (Buprenorfin og metadon utskilles heller ikke renalt, så dette er også alternativer som kan gis, men de har en svært lang halveringstid, noe som vanskeliggjør doseringen generelt sett).
</$details>
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!!Vignett
På grunn av dårlig nyrefunksjon og hypertensjon behandles han med et diuretikum. Én gruppe blant de prinsipielt fire forskjellige typer diuretika er virksomt og indisert ved nyresvikt.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken gruppe er dette, hvor og hvordan (helt summarisk og stikkordsmessig) utøver midlene i denne gruppen sin diuretiske effekt, og hva er disse midlenes vanligste bivirkning?
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<$details class="answer" summary="Svar" state="!!showanswer">
Loop-diuretika (0,5 poeng). Virkningssted og -mekanisme: De virker i Henles sløyfe i nefronet ved å hemme natriumresorpsjonen (1 poeng). Vanligste bivirkning er hypokalemi (0,5 poeng)
</$details>
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!!Vignett
Forrige vignett:
<<<
På grunn av dårlig nyrefunksjon og hypertensjon behandles han med et diuretikum. Én gruppe blant de prinsipielt fire forskjellige typer diuretika er virksomt og indisert ved nyresvikt.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles de tre andre hovedgruppene diuretisk virkende legemidler?
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<$details class="answer" summary="Svar" state="!!showanswer">
Osmotisk virkende diuretika, tiaziddiuretika og kaliumsparende diuretika
</$details>
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!!Vignett
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du bestemmer deg for å sjekke hans blodtrykksmedisiner. Hvilke hovedgrupper antihypertensiva (utover diuretika) bør man følge ekstra nøye opp ved nyresvikt?
Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
ACE-hemmere og AT2-antagonister (1 poeng). Begrunnelse: Midlene må doseres svært forsiktig – hvis dosen blir for høy, eller hvis pasienten blir dehydrert, kan nyresvikten forverres ytterligere (0,5 poeng).
</$details>
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!!Vignett
Du er allmennlege i en norsk fjellbygd, og dagens første pasient er en ung mann på 21 år. Han kommer for å sjekke seg for kjønnssykdom. Han er ikke i noe fast forhold, men hadde ubeskyttet samleie med en kvinne på en fest for 3 uker siden. Jenta var fra nabobygda. Han har ingen symptomer og har ikke hatt andre seksuelle kontakter enn denne jenta siste halvåret.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags prøve(r) er mest hensiktsmessig(e) å ta av denne mannen, og hva slags metode(r) utfører mikrobiologen på innsendt(e) prøve(r) for å påvise en eventuell kjønnssykdom?
</div>
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<$details class="answer" summary="Svar" state="!!showanswer">
Han har ingen symptomer og sannsynligvis ikke hatt samleie med en risikopartner.
Det er nok å levere en __førstestråle urinprøve__ til avdeling for mikrobiologi, og krysse av for Chlamydia trachomatis og evt Mycoplasma genitalium (ved St.Olavs Hospital vil det i tillegg automatisk bli sjekket for Neisseria gonorrhoea). Det vil bli utført PCR på prøven, ikke dyrkning. Det er ikke nødvendig å ta pinneprøver fra urethra eller blodprøve til serologi (HIV, syfilis, Hepatitt B).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Førstestråle urinprøve til sjekk av Chlamydia trachomatis/Klamydia gir 0,5 poeng.
Mikrobiologen gjør PCR gir 0,5 poeng.
</$details>
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!!Vignett
Idet mannen skal til å gå ut av kontoret ditt, forteller han at han har en del kviser og lurer på om du kan hjelpe ham. Du tar en titt på ham og finner følgende status:
Spredt i hele ansiktet er det rikelig med erythematøse papler og pustler, i T-sonen mange åpne og lukkede comedoner. På ryggen er tilsvarende status som i ansiktet, men også enkelte større noduli samt arr etter tidligere lesjoner.
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling bør du som allmennlege, gi denne mannen?
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<$details class="answer" summary="Svar" state="!!showanswer">
Han har moderat til uttalt acne med arrdannelse. Det er ikke nok med kun lokalbehandling her. Fastlege bør skrive ut tetracyklin tabletter samt lokalbehandling som retinoider og et antiseptikum som f.eks benzoylperoxid. Azelainsyre er også et godt alternativ. Det er lurt å gi en fuktighetskrem beregnet på acne-hud når lokalmidler som retinoider brukes.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systemisk behandling med tetracykliner gir 1 poeng.
Lokalbehandling (retinoider og/eller benzoylperoxid, evt azelainsyre,- en av disse er nok) gir 1 poeng.
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
I tillegg til genetisk disposisjon er det fire hovedpunkter i patogenesen ved acne. Beskriv kort disse fire punktene (gjerne med en enkel tegning) og angi hvilke punkter du angriper med behandlingen som du har foreslått i [[spørsmål nr. 2|IIC - 2015s - Oppgave 4 - Del 2]]
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<$details class="answer" summary="Svar" state="!!showanswer">
Patogenetiske mekanismer, kort beskrevet (og illustrert nedenfor):
# Obstruksjon av utførselgang fra hår-talgkjertel-enhet: keratinocytter og keratin
# Økt talgproduksjon grunnet stimulering med androgener
# Inflammasjon i dermis grunnet mekanisk irritasjon og trykk i talgkjertel
# Gode vekstforhold for bakterier, spesielt Propionebacterium acnes
Det gis ett poeng for hver av de patogenetiske mekanismene, og ett poeng for angivelse av behandling i henhold til mekanisme. Se illustrasjon:
<<imgLink "IIC-2015s-2-A.PNG" 500>>
</$details>
<div class="oppgave">
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!!Vignett
Noen dager etter at mannen var på ditt kontor, får du svar på prøven(e) du tok av ham, og får beskjed om at han har //Chlamydia trachomatis//
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan skal dette behandles (presisér type antibiotika) og følges opp?
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<$details class="answer" summary="Svar" state="!!showanswer">
Han bør få doxycyclin (en ukes kur 100mg x 2), eventuelt azitromycin om du mistenker dårlig compliance (1g som engangsdose). Seksuell avholdenhet under behandlingen.
Det kan være lurt å ta en kontrollprøve av urin til ny PCR etter 5 uker, men er ikke strengt tatt nødvendig da behandling som regel fungerer (ved positiv mycoplasma genitalium derimot, er det resistensproblematikk, og da anbefales alltid kontrollprøve). Det er ingen vits i å ta kontrollprøve etter 1-2 uker da det da er fare for falskt positiv svar. Viktig med smitteoppsporing!
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekt behandling gir 1 poeng. Diskusjon omkring kontrollprøve gir 0,5 poeng. Smitteoppsporing gir 0,5 poeng
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Selektive serotoninreopptakshemmere (SSRI) er en av våre mest brukte legemiddelgrupper. Samtidig har disse legemidlene en rekke bivirkninger
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor god har effekten av SSRI vist seg å være i randomiserte kontrollerte kliniske studier ved mild depresjon?
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<$details class="answer" summary="Svar" state="!!showanswer">
Ved mild depresjon er effekten av SSRI ikke dokumentert å være bedre enn placebo (1 poeng)
</$details>
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!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den vanligste umiddelbare bivirkningen ved bruk av SSRI?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kvalme (1 poeng). "Kvalme og oppkast" gir også 1 poeng.
"Gastrointestinale bivirkninger" er ikke tilstrekkelig spesifikt, men gir 0.5 poeng.
</$details>
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken informasjon bør man gi pasienten ved oppstart med et SSRI når det gjelder tidsforløpet av effekt og bivirkninger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bivirkningene kommer gjerne tidlig – helt i oppstarten av behandlingen (og kan gå over etter hvert; unntaket er nedsatt libido/impotens som gjerne kommer sent, men dette kreves ikke for å få poeng). På den annen side tar det gjerne flere uker før effekten kommer (1 poeng for bivirkningene, 1 poeng for effekten, til sammen 2 poeng)
</$details>
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Seponeringssymptomer kan noen ganger oppstå når man avslutter behandling med SSRI-preparater. Hvordan arter dette seg og hva kan man gjøre for å unngå dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Symptomer: Allmenne sykdomssymptomer (for eksempel svimmelhet, hodepine) og psykiske symptomer (for eksempel irritabilitet, angst). Det helt typiske er "strømstøt som går gjennom kroppen" – dette er ansett for å være en spesiell form for parestesier. Unngås ved å trappe ned langsomt (over anslagsvis flere uker). (0,5 poeng hvis "strømstøt" er med; 0,5 poeng for ett eller flere andre seponeringssymptomer (eventuelt 1 poeng hvis alle symptomer bortsett fra "strømstøt" er med); 0,5 poeng for langsom nedtrapping – maksimalt 1,5 poeng)
</$details>
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør doseringen av SSRI være ved panikkangst og hva bør pasienten informeres spesielt om?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det må startes med en ytterst lav dose, som må økes svært forsiktig. Pasienten må informeres om at panikkanfallene kan øke i frekvens i starten av behandlingen. (0,5 poeng for doseringen; 0,5 poeng for at anfallsfrekvensen kan øke i starten)
</$details>
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
SSRI kan også brukes på andre indikasjoner enn depresjon og panikkangst. Nevn tre andre tilstander der SSRI har godkjent indikasjon (i tillegg til at fluoksetin har indikasjonen bulimi).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Generalisert angst, tvangslidelse (obsessiv-kompulsiv sykdom), posttraumatisk stresslidelse (PTSD), sosial fobi. (0,5 poeng for hvert riktig svar, opp til maksimalt 1,5 poeng. Hvis det er delt opp i "tvangstanker" og "tvangshandlinger" gir dette kun 0,5 poeng til sammen).
</$details>
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Noen SSRI-er, som paroksetin og fluoksetin, hemmer aktiviteten til leverenzymet CYP2D6. Hvilken betydning får dette hvis pasienten samtidig skal behandles med kombinasjonen kodein/paracetamol? Hva er mekanismen bak denne effekten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
: Effekten av kodein oppheves. Dette skyldes at kodein må metaboliseres til morfin via CYP2D6 for at man skal få noen analgetisk effekt (0,5 poeng for at effekten oppheves (eller blir dårlig/mye dårligere); 0,5 poeng for mekanismen)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Halveringstiden til SSRI-preparatet escitalopram er ca. 30 timer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
a) Hvor lang tid tar det før konsentrasjonen har nådd likevekt ("steady state")?
b) Hvor lang tid tar det fra avsluttet behandling til legemidlet er helt ute av kroppen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Både på a) og b) er svaret 5 halveringstider, dvs. 150 timer (0,5 poeng for rett svar på delspørsmål a og 0,5 poeng for rett svar på delspørsmål
b) Hvis noen skriver "4-5 halveringstider" eller regner ut fra 4 halveringstider (dvs. får 120 timer) gir også dette full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det er september, og du jobber som turnuslege på et større lokalsykehus (uten hudavdeling) der du får innlagt en 75 år gammel mann. Han har kjent angina pectoris, diabetes mellitus type II (kostregulert), hypertensjon og artrose i begge hofter. Han bruker nitroglycerin ved behov, i tillegg til ACE-hemmer og et NSAID preparat. Han nyter solen så ofte han kan, liker å stelle med blomstene i hagen og hygger seg gjerne og ofte med et glass øl eller vin. De siste 4 månedene har han vært ille plaget med kløe i huden. Det har nesten daglig vært erythematøse, kløende hudlesjoner som har flyttet på seg i løpet av noen timer, og de siste 2 uker har det også tilkommet flere og flere spente blemmer med serøst innhold på truncus, over håndrygger og distalt på underekstremiteter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er mest aktuelle hos denne pasienten?
(nevn minst 3 hvor den mest sannsynlige utifra sykehistorie får 1 poeng, og øvrige aktuelle får 0,5 poeng hver, maks 2 poeng totalt)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mest sannsynlige diagnose:
* Bulløs pemfigoid
Øvrige differensialdiagnoser:
* Pemfigus vulgaris
* Bulløs legemiddelreaksjon
* Porfyria cutanea tarda
* Pseudoporfyri
* Bulløs kontaktallergi
* Epidermolysis bullosa akvisita
* Dermatitis herpetiformis
* Bullosis diabeticorum
* Bulløs impetigo
* Photophytodermatitt ( margarita dermatitt, bartenders dermatitt)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
I denne oppgaven er vi ute etter differensialdiagnoser ved bulløse dermatoser hos eldre pasienter der symptomene har vært av en viss varighet.
Bulløs pemfigoid er mest sannsynlig, og gir 1 poeng. I tillegg gir hvert av de andre svarene 0,5 poeng hver inntil max 1 poeng, slik at hele oppgaven totalt kan gi 2 poeng. Det gis ikke poeng for følgende diagnoser: insektstikk, forbrenning, bulløs mastocytose, cicatriciell pemfigoid, friksjonsbulla, pomfolyx
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du undersøker pasienten og finner på trunkus, over håndrygger og distalt på begge underekstremiteter spente bulla på erythematøs bunn i tillegg til en del kruster og erosjoner der noen blemmer ser ut til å ha sprukket. Stedvis på trunkus og underekstremiteter sees også spredte nummulate til diskoide erythematøse, hevede hudforandringer som du tror er urticarielle lesjoner. Det er ingen lesjoner i slimhinner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du tar pinneprøve til bakteriedyrkning fra et av områdene med sår og kruster, og bestemmer deg for å ta biopsi til histologisk undersøkelse. Hvor i utslettet bør biopsien tas?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Biopsi (mest praktisk med stanse) på formalin til vanlig histologisk undersøkelse tas fra overgang lesjonell/perilesjonell hud
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poeng gis dersom kandidaten svarer biopsi fra overgang lesjonell/perilesjonell hud, ev. overgang mellom frisk og syk hud, eller i blemmekanten. Ikke biopsi fra urticarielle lesjoner
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken analyse fra blod bør tas av pasienten for å komme nærmere en diagnostisk avklaring? (1 poeng)
Du henviser pasienten til hudlege på nærmeste hudavdeling. Hvilken tilleggsprøve kan hudlegen ta som gir ytterligere diagnostisk avklaring? (1 poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Turnuslegen bestiller blodprøve til anti-hud (antistoff mot hud, autoantistoff mot hud) (1 poeng)
Hudlegen tar biopsi til direkte immunfluorescens undersøkelse (IF-biopsi) fra perilesjonell hud (1 poeng)
Det gis ikke ekstra poeng for orienterende blodprøver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I påvente av svar på prøvene du har rekvirert ønsker du å iverksette behandling av pasienten da han er svært plaget av kløe. Du ringer hudlege, og diskuterer pasienten. I henhold til mest sannsynlige diagnose anbefaler hudlegen å starte med lokalbehandling, men avvente systemisk behandling inntil diagnosen er bekreftet da systemisk behandling spesielt vil kunne påvirke en av hans andre sykdommer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type lokalbehandling er mest aktuelt å iverksette hos denne pasienten, og hvilken type systemisk behandling er aktuelt å vurdere i tillegg når diagnosen er bekreftet? (1 poeng for type lokalbehandling og 1 poeng for type systemisk behandling)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lokalbehandling (1 poeng):
Ved kløende hudlidelser der man mistenker blemmesykdom vil lokalbehandlingen være potente steroider (gruppe III eller gruppe IV). Siden flere blemmer har sprukket er det lurt å applisere antiseptisk behandling i tillegg. Et godt alternativ da er kombinasjon av steroid og antiseptisk behandling som f.eks Betnovat med chinoform.
Forslag om behandling med middels potente/potente steroider (gruppe II, III eller IV) gir 1 poeng. Det gis ingen poeng dersom kandidaten kun nevner godt hudstell, punktering av blemmer, antiseptiske kremer, desinfiserende bad og lignende dersom det ikke samtidig presiseres at det skal smøres med lokale steroider.
Systemisk behandling (1 poeng): Systemiske steroider. Det gis poeng dersom kandidaten foreslår systemisk behandling med prednisolon, prednison, systemisk kortikosteroid eller systemisk glucokortikoid.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten får time til hudlege etter få dager. Etter en drøy ukes tid får du svar på den biopsien du har tatt. Denne viser subepidermal bulladannelse med infiltrasjon av eosinofile granulocytter i epidermis og dermis. Tilleggsanalysen du bestilte fra blod er positiv
Hudlegens tilleggsprøve viser nedslag av IgG og C3 langs basalmembransonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose stilles på bakgrunn av sykehistorie og prøvene som er tatt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bulløs pemfigoid gir 1 poeng.
Lineær IgA kan også ha tilsvarende IgG/C3 nedslag, det vanligste er imidlertid nedslag av IgA. Dette er en svært sjelden blemmesykdom som rammer både barn og voksne. Lineær IgA dermatose har ikke sirkulerende antistoff mot hud.
Ved lupus erythematosus kan man også ha nedslag av IgG og/eller C3 langs basalmembransonen. Det er imidlertid ikke blemmer ved lupus erythematosus.
Slimhinnepemfigoid vil også ha tilvarende nedslag av IgG og C3, men denne pasienten har ikke affeksjon av slimhinner.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Glukokortikoider brukes ofte i behandling av hudlidelser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke bivirkninger og risikofaktorer er forbundet med langtidsbehandling av henholdsvis topikale og systemiske steroider? (Oppgi minst to bivirkninger/ risikofaktorer i hver gruppe hvor 1 poeng er maks score for bivirkninger ved topikal behandling og 1 poeng er maks score ved systemisk behanding)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Topikale/lokale steroider:
Ved langtidsbehandling kan det bli atrofi av huden. I tillegg kan det også bli økt mengde teleangiektasier, økt hårvekst, striae distensae, kontaktallergi, perioral dermatitt, rosacea, steroidacne og systemisk absorbsjon.
Det gis 0,5 poeng for hudatrofi, og 0,5 poeng for hvilket som helst av de andre nevnte bivirkningene, max 1 poeng totalt.
Systemiske steroider:
Ved langtidsbehandling må man primært være obs på blodsukker med utvikling/forverring av diabetes og benskjørhet/osteoporose. I tillegg kan pasienten også få nedsatt immunforsvar, atrofisk hud, dårlig sårheling, magesår og suppresjon av binyrebarkens funksjon.
Det gis 0,5 poeng for hvert av forslagene over, maks 1 poeng totalt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er turnuskandidat i allmennpraksis. Jamila er 38 år gammel, gravida III, para I. Hun er gift og arbeider som hjelpepleier. Hun er 168 cm og veier 85 kg. Hun har en 18 år gammel datter, Mouna fra sitt første ekteskap. Datteren ble født ved keisersnitt i Damaskus, 7 uker før termin og veide 1500g. Mouna er frisk i dag. Jamila forteller at hun fikk høyt blodtrykk i graviditeten og legene i Damaskus sa at "hun hadde gift i graviditeten". Hun ber deg fjerne kobberspiralen som ble satt inn for 4 år siden. Hun og ektemannen har bestemt seg for å prøve å få barn. Du ser at siste gynekologiske undersøkelse og journalnotat er fra 2012. Din forgjenger satte inn en Flexi-T kobberspiral ukomplisert.
Jamila lurer på hva hun kan gjøre for at en eventuell graviditet skal forløpe best mulig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 3 råd du vil gi henne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ta ''folat'' daglig, fra og med nå
* ''Vekt''kontroll /
* Regelmessig ''mosjon''
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maksimalt 1,5 poeng; 0.5 poeng for hvert riktig svar i forhold
til fasit
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du er turnuskandidat i allmennpraksis. Jamila er 38 år gammel, gravida III, para I. Hun er gift og arbeider som hjelpepleier. Hun er 168 cm og veier 85 kg. Hun har en 18 år gammel datter, Mouna fra sitt første ekteskap. Datteren ble født ved keisersnitt i Damaskus, 7 uker før termin og veide 1500g. Mouna er frisk i dag. Jamila forteller at hun fikk høyt blodtrykk i graviditeten og legene i Damaskus sa at "hun hadde gift i graviditeten". Hun ber deg fjerne kobberspiralen som ble satt inn for 4 år siden. Hun og ektemannen har bestemt seg for å prøve å få barn. Du ser at siste gynekologiske undersøkelse og journalnotat er fra 2012. Din forgjenger satte inn en Flexi-T kobberspiral ukomplisert.
Jamila lurer på hva hun kan gjøre for at en eventuell graviditet skal forløpe best mulig.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst 2 undersøkelser du foretar ved dagens konsultasjon før du fjerner spiralen? Begrunn nødvendigheten av undersøkelsene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Celleprøve fra cervix
** Begrunnelse: fordi hun trolig ikke har tatt noen celleprøve siden 2009. Celleprøve er anbefalt å tas hvert 3.år
* Blodtrykk
** Begrunnelse: fordi hun har hatt tidligere preeklampsi som disponerer for seinere hypertensjon og det er viktig å vite hva hennes BT er før graviditeten. Høyt BT før graviditet er også en risiko faktor for preeklampsi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maksimalt 1poeng; 0.5 poeng for hvert riktig svar med korrekt begrunnelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du er turnuskandidat i allmennpraksis. Jamila er 38 år gammel, gravida III, para I. Hun er gift og arbeider som hjelpepleier. Hun er 168 cm og veier 85 kg. Hun har en 18 år gammel datter, Mouna fra sitt første ekteskap. Datteren ble født ved keisersnitt i Damaskus, 7 uker før termin og veide 1500g. Mouna er frisk i dag. Jamila forteller at hun fikk høyt blodtrykk i graviditeten og legene i Damaskus sa at "hun hadde gift i graviditeten". Hun ber deg fjerne kobberspiralen som ble satt inn for 4 år siden. Hun og ektemannen har bestemt seg for å prøve å få barn. Du ser at siste gynekologiske undersøkelse og journalnotat er fra 2012. Din forgjenger satte inn en Flexi-T kobberspiral ukomplisert.
Jamila lurer på hva hun kan gjøre for at en eventuell graviditet skal forløpe best mulig.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn inntil 5 komplikasjoner som Jamila og/eller hennes foster vil være spesielt
disponert for i eventuell framtidig graviditet på bakgrunn av sykehistorie og
status? Begrunn svaret kort
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Preeklampsi (PE)
** Begrunnelse: Tidligere PE, vekstretardert barn, høy BMI, høy alder (Maksimalt 1poeng)
* Svangerskapsdiabetes
** Begrunnelse: Alder og BMI (kommer fra Midt-Østen) (Maksimalt 0,5 poeng)
* Kromosomavvik hos fostret
** Begrunnelse: Høy alder (0,5 poeng)
* Vekstavvik hos fostret
** Begrunnelse: Hun kan ha økt risiko for å føde både SGA og LGA barn (Maksimalt 0,5 poeng)
* Preterm fødsel
** Begrunnelse: Hun har hatt en preterm fødsel tidligere. Både preeklampsi og veksthemming hos barnet kan ha gitt det (Maksimalt 0,5poeng
* Placenta acreta/uterus ruptur
** Begrunnelse: Tidligere keisersnitt (Maksimalt 0,5poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Jamila kommer tilbake til deg 5 måneder senere, akkurat før du skal avslutte din distriktturnus. Hun er kvalm og trett, men lykkelig over at hun er blitt gravid. Siste menstruasjon var for 8 uker siden. Du fyller nøye ut helsekortet. BT 135/84, Urin stix negativ, vekt 82 kg. Du tar blodprøver, gjentar info gitt tidligere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke er det 3 mest relevante ytterligere tiltak du skal iverksette? Hvilken informasjon gir du? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Starter opp med Albyl E (starter opp med dette i uke 8, eller venter til uke 12, eller henviser til vurdering om oppstart av Albyl E; - alle svaralternativene er bra.)
* Informerer om og evt henviser til tidlig fosterdiagnostikk på aldersindikasjon.
* Oral glukosetoleranse test = "glukosebelastning" = "sukkerbelastning" Dette med tanke på hennes risiko for svangerskapsdiabetes
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert tiltak/råd med korrekt begrunnelse.
NB! Å ta de vanlige svangerskap blodprøvene skal det IKKE gis poeng for, da det er for tidlig
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får tilbud om å fortsette å jobbe som fastlege etter din sommerferie og du møter Jamila neste gang i svangerskapsuke 20, etter at hun har vært på rutineultralyd. Hun er i fin form, alle undersøkelser inntil nå har vært normale, hun er ikke kvalm lenger. Vekt 92 kg. BT 135/ 87.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak/undersøkelser (utenom rutineundersøkelsene som gjøres hos alle gravide) planlegger du med tanke på hennes risikofaktorer? Nevn inntil 3 tiltak og gi en kort begrunnelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Repetere glukosebelastning i uke 28
** Begrunnelse: Høy BMI, alder, fra Midt-Østen
* Doppler blodstrøms undersøkelser i arteria uterina i svangerskapsuke 24
** Begrunnelse: preeklampsi er en placentasykdom som gir nedsatt blodstrøm i placenta og til foster. Dette kan lede til vekstretardasjon. Hun har økt risiko for å utvikle PE med den obstetriske historien.
* Føtometri i svangerskapsuke 24 (evt. senere også)
** Begrunnelse: Tidligere veksthemmet barn og økt risiko for PE, høy BMI
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er turnuslege i distrikt. Foreldrene kommer med deres 20-årige sønn. Du kjenner ingen av dem fra før. Foreldrene forteller at sønnen har vært relativt frisk før. Han har nå i løpet av de siste par uker utviklet mye uro, vrangforestillinger og sannsynligvis hallusinasjoner. Du blir overbevist om at pasienten må være psykotisk
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire forskjellige hovedtyper psykiske lidelser (tilsvarer hovedkategorier i ICD 10) som inneholder aktuelle psykoselidelser.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* F 00-09 Organiske lidelser (eksempel epileptisk psykose)
* F 10-19 Ruslidelser (eksempel rusutløst psykose (av amfetamin))
* F 20-29 Schizofreni, schizotyp lidelse og paranoide lidelser. Nøyktig navn på gruppen kreves ikke. Kan også kalles funksjonelle psykoser, primærpsykoser eller evt bare "psykoser" hvis det fremgår av besvarelsen at man tenker på denne gruppen. (eksempel akutt psykose)
* F 30-39 Affektive lidelser (eksempel mani med psykose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per hovedkategori, totalt inntil 2 poeng.
Halv skåre hvis man i stedet for hovedkategori angir et konkret eksempel fra en gruppe
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten gir deg bare sparsomt med opplysninger. Du må nøye deg med å observere hans atferd og mimikk. Han virker plaget og redd. Ifølge foreldrene har han de siste årene episodisk brukt mer alkohol enn de fleste jevnaldrende. De mistenker at han også i det siste kan ha brukt andre rusmidler, men de er ikke sikre. Pasienten blir enda mer sparsom med opplysninger når temaet rusmidler bringes opp
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre forskjellige metoder som kan anvendes for å få mer informasjon om rusmiddelbruk, og angi hvilke svakheter de forskjellige metodene kan ha.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Psykometriske instrumenter (spørreskjema) som evaluerer rusmiddelbruk.
#* Svakhet: Avhengig av samarbeid fra pasienten.
# «Hurtig» («on-site», immunologiske) urin-tester for rusmidler.
#* Svakhet: Avhengig av at pasienten gir prøve. Lite reliable svar.
# Urinprøver med kromatografisk teknikk som undersøkes i Klinisk farmakologisk avdeling.
#* Svakhet: Pas må samtykke og avgi prøve. Tar lengre tid før svar foreligger
# Innhente komparentopplysninger
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver metode og 0,5 poeng for svakhet ved hver metode. Hvis to metoder og svakheter ved disse nevnes gis 1,5 poeng. For å få 2 poeng må minst 3 metoder med svakheter nevnes. Hvis noen svarer
innhenting av komparentopplysninger gir det 0,5 poeng. Dog, maks 2 poeng for oppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du spør pasienten om naturlige funksjoner, men får lite svar. Foreldrene mener matlysten har vært minimal over tid, og at han er blitt merkbart tynnere. Disse opplysningene indikerer at pasienten raskt trenger en spesifikk ernæring.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket preparat bør man gi og i hvilken form?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten trenger tiamin. Dette må gis parenteralt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for tiamin
1 poeng i tillegg hvis man også nevner parenteral
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du blir usikker på om pasienten kan være deprimert, og spør om eventuelle suicidaltanker. Han svarer ikke. Foreldrene sier de har vært bekymret for det samme fordi han har vandret hvileløst rundt, vært søvnløs og plaget
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire symptomer/ faktorer som kan indikere at pasienten har økt fare for suicid
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# (Akutt) psykose.
# Depressive symptomer/ mulig psykotisk depresjon.
# Forøket rusmisbruk i det siste/ aktuell rusbruk.
# Agitasjon (hvileløs vandring)
# Kronisk rusmiddelbruk
# Alder
# Kjønn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av 1-3: psykose, depressive symptomer/ lidelse (depressiv psykose) og rusbruk/ ruslidelse. 0.5 poeng for minst en av de øvrige (4-7).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner at pasienten må legges inn som øyeblikkelig hjelp. Han nekter og
du beslutter å legge ham inn uten eget samtykke
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken paragraf i psykisk helsevernloven er mest rimelig å anvende?
Hvilke kriterier skal til for å anvende denne paragrafen?
Hvilke av disse kriteriene er oppfylt hos pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spørsmål 1: §3-2/ tvungen observasjon, evt § 3.3/ tvungent psykisk helsevern
Spørsmål 2: Pasienten skal være alvorlig sinnslidende (3.3) eller mistanke om alvorlig sinnslidelse (3.2). Dette er med noen få unntak synonymt med psykotisk. Minst ett av to tilleggskriterier skal være oppfylt (fare eller behandling). Innleggelsen skal fremstå som den klart beste løsningen for vedkommende (men dette kravet faller bort hvis farekriteriet foreligger).
Spørsmål 3: Pasienten er sannsynligvis psykotisk og således alvorlig sinnslidende. Han er trolig suicidal. Han trenger tiamin for å hindre alvorlig helseskade. Han vil raskt bli vesentlig bedret med adekvat behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Spørsmål 1: 0,5 poeng for å nevne en av paragrafene (ikke nødvend med tallbetegnelse)
* Spørsmål 2: 0,5 poeng for alvorlig sinnslidelse/ psykose og minst ett tilleggskriterie
* Spørsmål 3: 0,5 poeng for psykose og 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En mann på 50 år kommer sammen med kona. Han er utøvende kunstner med betydelig suksess. I den siste måneden har han sovet lite, kjent seg nedfor og spist lite, hatt lite energi og en stor indre uro og konsentrasjonsvansker. Han forteller at han har hatt flere slike perioder tidligere som har vart en til to måneder. I tillegg har han hatt flere perioder på et par uker der han har arbeidet hardt, sovet lite, hatt stor kunstnerisk produksjon med god inntjening og tatt mange sosiale kontakter. Kona mener han i de samme periodene har vært svært irritabel mot henne.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bipolar lidelse med aktuell depressiv episode.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bare depresjon eller bare bipolar lidelse gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Han er ikke interessert i psykologisk behandling men vil ha medikamenter både for å komme ut av denne situasjonen og å hindre at han blir dårlig igjen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medikamenter bør man anbefale? Nevn minst fire aktuelle medikamenter.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Stemningsstabiliserende: Lamotrigin, valproat, litium, karbamazepin og quetiapin gir rett.
Antidepressiva alene er feil. Antidepressiva i tillegg til stemningsstabiliserende aksepteres som rett.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert riktige medikament til maksimalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kona ringer to uker senere og ber deg komme på sykebesøk samme dag fordi mannen er svært endret. Når du kommer frem snakker han i ett sett, hopper fra det ene tema til det andre, forteller at han har evner til å styre både deg og andre myndighetspersoner via tankens kraft, at han har som oppgave å ta kontrollen i Norge for å redde landet fra en økologisk katastrofe. Det står en tom vinflaske på bordet. Kona er redd ham og du legger ham inn på psykiatrisk avdeling mot hans vilje.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken paragraf bør du bruke og hvordan begrunner du bruken av paragrafen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Både innlegelse til tvungen observasjon (§3-2) og til tvungent psykisk helsevern (§3-3) aksepteres. Studenten trenger ikke å huske de presise paragrafsifrene.
Studenten må både ha med hovedkriteriet: Mistanke om alvorlig sinnslidelse ved tvungen observasjon, alvorlig sinnslidelse ved innleggelse på tvang, kan akseptere psykose som uttrykk.
Tilleggskriteriet behandlingskriteriet (får sin utsikt til helbredelse eller vesentlig bedring i betydelig grad redusert) må være med i svaret.
Fare for seg selv eller andre hverken gir poeng eller trekker ned (det kan diskuteres om det foreligger da det skal være nærliggende og alvorlig).
Det skal gjøres en helhetsvurdering der innleggelsen skal fremstå som den klart beste løsningen for vedkommende (ikke et krav hvis farekriteriet er til stede).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver av følgende:
* en av de to aktelle paragrafene
* hovedkriteriet
* behandlingskriteriet
* helhetsvurdering
til sammen maksimalt 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar imot pasienten som LIS lege på psykiatrisk avdeling. Ved undersøkelsen synes du han svetter og er skjelven, ut over det er det ikke noe vesentlig nytt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to differensialdiagnoser er mest sannsynlige?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mani, mani med psykose og mani utløst av farmaka aksepteres.
Abstinens/ delir/ rusutløst psykose, aksepterer alle varianter av abstinens/ delir/ rusutløst psykose.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for mani
1 poeng for abstinens/ delir/ rusuløst psykose
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mannen kommer seg etter noe tid på sykehuset, utskrives og gjenvinner etter hvert full funksjon. Han er nå interessert i å lære mer om sin tilstand og hva han selv kan gjøre for å redusere risiko for nye episoder med sykdom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre råd som du bør gi ham
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Regulering av søvn og døgnrytme.
# Unngå rusmidler.
# Forsøke å holde den aktiviteten han har i normalt stemningsleie også når han er deprimert eller oppstemt.
# Øve seg i å fange opp de første tegn til ny episode med depresjon eller mani.
# Legge en plan for hva han skal gjøre ved tegn til ny episode med depresjon eller mani
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for 1 riktig svar, 1 poeng for 2 rette og 2 poeng for 3 rette svar. Maks 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mann, 50 år. Tidligere hudfrisk. Ingen tilfeller av hudsykdom i nærmeste familie. Kommer til deg som er hans fastlege på grunn av en hudforandring som i følge kona har endret farge (blitt mørkere) siste ukene. Du inspiserer en pigmentert hudlesjon lokalisert i høyre flanke som måler 11 mm i diameter:
<<imgLink "IIC-2016s-2-A.PNG">>
Bilde-kilde http://www.portamedicus.no
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør en systematisk klinisk vurdering av den pigmenterte lesjonen i henhold til gjeldende algoritme.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systematisk klinisk vurdering med begrunnelse:
* A (asymmetri)
* B (begrensning)
* C (kulør)
* D (diameter)
* E (endring)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Spørsmålet tester hvorvidt studenten kan gjengi ABCDE-algoritmen som benyttes som klinisk verktøy i vurdering av pigmenterte lesjoner. Pasienten gir også informasjon til sin fastlege om at lesjonen har endret seg siste tiden, noe som uansett utseende bør få legen til å tenke malignt melanom som mulig differensialdiagnose.
''Man får 1 poeng for å nevne alle fem kriteriene og 1 poeng dersom man har begrunnet/forklart hva alle bokstavene i akronymet betyr''. Dersom ikke alle kriteriene er nevnt, får man ingen poeng, det forventes at kriteriene er innlært som én enhet. Likeledes får man ingen poeng dersom man ikke kan forklare hva alle fem bokstavene betyr. Vi tillater også gjengivelse på engelsk. Fordi akronymet brukes litt ulikt må vi også tillate elevation på E og different/diverse structures på D
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å fjerne lesjonen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den beste måten å fjerne lesjonen på? Begrunn svaret.
Hvordan bør prøvematerialet forsendes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Eksisjonsbiopsi kan foretas av allmennlege eller hudlege ved mistanke om malignt melanom, eller ved forekomst av pigmenterte lesjoner som pasienten mener har forandret seg eller oppstått raskt. Eksisjonsbiopsi av en melanomsuspekt hudlesjon skal gjøres ved at hele tumor fjernes med en båtformet incisjon 2–5 mm (klinisk fri kant) ut i normal hud og med en pute av subdermalt fett. Dette gjør en histologisk undersøkelse av hele lesjonen mulig, med bestemmelse av Breslows tykkelse, som igjen danner grunnlag for videre kirurgisk behandling. Primæreksisjonen kan med fordel foregå i primærhelsetjenesten, men ved spesielle lokalisasjoner eller andre omstendigheter er det naturlig å henvise pasienten videre (ikke aktuelt her). Preparatet sendes til histologisk undersøkelse, og bør ved begrunnet mistanke om malignitetsutvikling merkes CITO.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Eksisjonsbiopsi med fjerning av hele tumor med en båtformet incisjon (1/2 poeng), klinisk fri (alternativt 2-5 mm) kant ut i normal hud (1/2 poeng) og ned til subkutant fett (1/2 poeng). Innsending til histopatologisk undersøkelse på formalin med merking CITO (1/2 poeng). Incisjonsbiopsi, stansebiopsi, shavebiopsi og laserbehandling anbefales ikke (gir 0 poeng). At man angir bruk av bedøvelse gir ikke ekstra poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Svar fra patologen: Hud med malignt melanom, superfisiell spredningstype. Tumortykkelse a.m. Breslow 0.8mm. Ingen ulcerasjon. Minste avstand reseksjonskant 3mm til sidene og 5mm i dypet. Mitoseaktivitet 2 per mm^^2^^
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags behandling/oppfølging skal pasienten ha videre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienter med malignt melanom mistenkt eller verifisert skal fra høsten 2015 inn i pakkeforløp. Dersom mistanken om malignt melanom bekreftes histologisk, skal pasienten snarest mulig henvises til kyndig kirurg for utvidet eksisjon og mange skal også til vaktpostlymfeknutediagnostikk. Det er viktig at det kommer klart frem i henvisningen at det dreier seg om et malignt melanom og kopi av histologibesvarelse bør vedlegges dersom dette er mulig.
Ved malignt melanom med Breslows tykkelse < 1 mm anbefales kontroll hver 3. måned i tre år, deretter ved behov. I de fleste tilfeller kan de etterfølgende kliniske kontrollene utføres av fastlege, men det anbefales at den første kontrollen skjer hos spesialist med spesiell interesse for melanom, slik at de siste anbefalingene om oppfølging og behandling kan formidles.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Henvisning til utvidet eksisjon/re-eksisjon (1,5 poeng).
Det må skisseres et kontrollopplegg for pasienten som er i tråd med gjeldende retningslinjer (1,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er ferdigbehandlet kirurgisk og det er ingen tegn til metastaser
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det aktuelt med adjuvant behandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, det finnes p.t. (mars 2016) ingen livsforlengende adjuvant behandling tilgjengelig ved malignt melanom bortsett fra i kliniske studier ved påvist spredning (0.5p).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nei er rett svar (0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer til klinisk kontroll hos deg (fastlegen) etter å ha vært innom spesialisthelsetjenesten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skal den kliniske undersøkelsen hos fastlegen bestå av?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Generell hudundersøkelse/hudstatus inkludert arr-inspeksjon og palpasjon av lymfeknuter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Generell hudundersøkelse/hudstatus (1/2 p). Inspeksjon av arrområdet (1/2 p). Palpasjon lymfeknuter (1/2 p).
Referanser deloppgave 1-5
* https://helsedirektoratet.no/retningslinjer/pakkeforlop-for-foflekkreft
* https://helsedirektoratet.no/retningslinjer/nasjonalt-handlingsprogram-medretningslinjer-for-diagnostikk-behandling-og-oppfolging-av-malignemelanomer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Årene går og de rutinemessige kontrollene er avsluttet. Han oppsøker deg på nytt på konas initiativ på grunn av en lesjon på ryggen som kan ha kommet ila siste året. Den kjennes vorteaktig/furete i overflaten og er gulbrun. Når du ser over ryggen hans synes du at du ser flere lignende lesjoner
<<imgLink "IIC-2016s-2-B.PNG>>
Bilde (kilde: mydermpath.org)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlige diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Seborroiske keratoser er en meget vanlig form for keratose som ofte er lette å kjenne igjen og som vises som fete, lysebrune til svarte, vorteaktige dannelser på huden. Lesjonene opptrer særlig hos eldre. Ofte er det mange av dem, mest på rygg, mage, bryst og i ansikt. De kan skrapes bort og under finner man som oftest tilnærmet normal, lettblødende hud.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Følgende varianter godtas: seborrorisk keratose/vorte og senil keratose/vorte og talgkjertelvorte
Referanse deloppgave 6:
* http://www.dermnetnz.org/lesions/seborrhoeic-keratosis.html
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har vakt på medisinsk avdeling da en 65 år gammel mann legges inn med feber (39.5 °C), frysninger og redusert bevissthet. Han er under behandling for blærekreft som involverer blæreutløpet av høyre ureter. I akuttmottaket har pasienten blodtrykk: 80/40, puls: 130, respirasjonsrate: 30
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest nærliggende diagnosen og hva gjør du i akuttrommet for å sikre diagnosen? Hvilken empirisk behandling starter du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sannsynlig diagnose: Urosepsis.
Diagnostikk: Klinisk undersøkelse, blodgassanalyse, blodkultur og urinprøve til stix og dyrkning.
Behandling: Parenteral væske og antibiotika etter urosepsisregime (ampicillin og gentamicin).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for urosepsis. 1 poeng for diagnostikk (blodgass, blodkultur og urinprøve er minimum). 1 poeng for riktig empirisk behandling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Noen timer seinere får du et prøvesvar som viser nyoppstått nyresvikt (serum kreatinin: 450). Samme kveld blir det derfor gjort en ultralydundersøkelse av urinveiene som viser høyresidig hydronefrose
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak vil du vurdere på bakgrunn av denne informasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er aktuelt å gjøre avlastning av høyre nyrebekken. Det mest aktuelle er innleggelse av nefrostomikateter i høyre nyrebekken. I tillegg bør gentamicin seponeres grunnet nefrotoksisitet. Gentamicin erstattes av et 3. generasjons cefalosporin.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for nefrostomi. 1 poeng for seponering av gentamicin
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Situasjonen stabiliseres etter dine tiltak, men i løpet av natten blir pasienten gradvis mer tungpusten og du teller en respirasjonsrate på 38. Røntgenbilde av lungene viser normale forhold. Blodgass viser pH: 7.2, pCO2: 2.5 kPa og base excess: - 8.2 mEq/L
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles denne syrebase-forstyrrelsen? Beskriv mekanismen for syrebase-fortyrrelsen og den mest sannsynlige årsaken til høy respirasjonsrate hos pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Organ hypoperfusjon gir anaerob metabolisme med opphoping av laktat (høy base excess) og utvikling av metabolsk acidose (lav pH). Denne acidosen forsøkes korrigert ved å ventilere ut CO,,2,, (lav pCO,,2,,) noe som gir økt respirasjonsrate.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for metabolsk acidose. 0.5 poeng for ventilering av CO,,2,,
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasientens situasjon blir betydelig dårligere neste dag med tegn til at flere organer svikter. Blodprøver viser at INR har steget til 3.2.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de to mest sannsynlige årsakene til så høy INR hos denne pasienten og hvilke ytterligere blodprøver tar du for å kartlegge dette nærmere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Årsaker: 1) Disseminert intravaskulær coagulasjon (DIC) med økt forbruk av koagulasjonsfaktorer. 2) Leversvikt med fallende produksjon av koagulasjonsfaktorer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begge årsaker må med for full skår = 1 poeng; 0.5 poeng for bare ett av alternativene.
Ytterligere blodprøver: Trombocytter, D-dimer, fibrinogen, ALAT, bilirubin (minimum Trombocytter, bilirubin og fibrinogen må være nevnt for full skår =1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På andre dag ringer en lege fra Avdeling for medisinsk mikrobiologi og sier at det er funnet både gram-positiv kokker og gram-negative staver i blodkultur. Typing og resistenstesting vil bli utført neste dag.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de mest sannsynlige bakteriene som er funnet i blodkultur?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er mest trolig enterokokker og E. coli som er påvit i blodkultur. Dette er de vanligste mikrobene ved kompliserte urinveisinfeksjoner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for enterokokker og 1 poeng for E. coli.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinne 35 år oppsøker fastlegen på grunn av hjertebank og svetting av et par måneders varighet. Hun har gått ned i vekt til tross for økt appetitt. Pasienten har vært frisk tidligere. Du ordinerer blodprøver og det påvises betydelig forhøyet fritt tyroksin og supprimert TSH.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er den mest sannsynlige årsaken til hypertyreose hos denne pasienten?
# Hvilke kliniske funn er typiske for denne formen av hypertyreose?
# Hvilken supplerende serumanalyse vil du gjøre for å verifisere at pasienten har denne tilstanden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Graves sykdom
# Diffust struma uten knuter, oftalmopati/eksoftalmus (dette er typisk, men forekommer ikke hos alle)
# Antistoff mot TSH-reseptor (evt. også anti TPO: tyroksin peroksidase)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig svar på (1.)
1 poeng for riktig svar på (2.) (0.5 poeng for hvert av alternativene)
0.5 poeng for (3.) (antistoff mot TSH-receptor)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er førstevalg av behandling for denne tilstanden og hvordan vil du følge opp pasienten?
Hvilke bivirkninger kan denne behandlingen gi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Carbimazole (Neomercazol) alene, evt i kombinasjon med Levaxin litt ut i forløpet («block and replace»)
# Følges med fritt T4 og TSH, relativt hyppig i starten, på det har stabilisert seg litt sjeldnere. Viktig å unngå stigning av TSH da dette muligens kan forverre evt. eksoftalmus. Følge med granulocytter de første mnd.
# Allergi, granulocytopeni, trombocytopeni
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for (1.), da må de svare carbimazole for å få poeng
0.5 poeng for (2.)
0.5 poeng for (3.), da må de minimum svare granlocytopeni
for å få 0.5 poe
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre årsaker kjenner du til hypertyreose? Nevn minst 4 årsaker.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Toksisk adenom, knutestruma , subakutt tyreoiditt, Postpartumtyreoiditt, medikamentelt indusert (Amiodaron, overdosering med Levaxin), for høyt inntak av jod, sekundær hypertyreose grunnet TSHproduserende hypofyseadenom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.5 poeng, da må toksisk adenom og knutestruma være med og minst to av de andre alternativene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre behandlingsalternativer kjenner du for hypertyreose generelt, og hva taler for og imot de ulike alternativene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
#Radioiodbehandling
#* For: kan være aktuelt ved residiv av Graves sykdom, ved bivirkninger av medikamentell behandling, behandling av toksisk adenom og knutestruma;
#* Mot:graviditet og oftalmopati.
# Tyreoidectomi
#* For: Svært struma, frykt for radioaktivitet, residiv av Graves, oftalmopati, bivirkninger av medikamentell behandling.
#* Mot: postoperative komplikasjoner som recurrensparese, hypoparatyreoidisme og selvfølgelig hypotyreose.
# (Propylthiouracil. For: Hvis bivirkninger av carbimazole, alternativ i graviditeten)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1.5 poeng for (1): for å få full pott bør alt være med
1.5 poeng for (2): alt bør være med for full pott, bortsett for angst for radioaktivitet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er blitt 50 år og oppsøker nå fastlegen på grunn av en underarmsfraktur i forbindelse med et lite traume. Hun lurer på om hun har osteoporose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan stiller du diagnosen og hva er førstevalg av behandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Beintetthetsmåling med dobbel x-ray absorbsjonsmetri (DXA), T-score<-2.5
# Tilskudd av kalsium og vitamin D, bisfosfonat peroralt (Alendronat) (HRT er også et alternativ, spesielt hvis også klimakteriske plager)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5 poeng
# 0.5 poeng
For å få full pott må alt som er nevnt under (1) og (2) være nevnt. HRT kan godtas som et alternativ
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I allmennpraksis blir du oppsøkt av en kvinne på 28 år som er tidligere helt frisk. I løpet av våren (siste 8 uker) har hun følt seg i dårlig form, og hun har for første gang fått utslett i ansiktet (panne, nese, kinn) av å være i solen. Hun har følt seg økende slapp og trett siste måned, og har stadig litt feber rundt 38 grader. Siste måned har hun også fått smerter tilsvarende PIP- og MCP-ledd i hender. Hun har også fått noen sår i munnslimhinnen.
Ved undersøkelse ser du at hun er lett rød over panne, kinn og neserygg, og hun har to sår i munnslimhinnen. Hun er litt hoven over PIP II og III i høyre hånd. BT 100/80
Som ledd i undersøkelsen tar du noen prøver:
|!Analyse |!Resultat |!Referanseområde |
|Hb |9,8 g/dL |11,7-15,3 g/dL |
|SR |45 mm/time |<20 mm/time |
|CRP |5 mg/L |<5 mg/L |
|LPK/leukocytter |2,5 x10^^9^^ /L |3,5 -10,0 x10^^9^^ /L |
|Trombocytter |180 x 10^^9^^ /L |164-370 x10^^9^^ /L |
|Kreatinin |70 µmol /L |45 – 90 µmol /L |
|Urin stix | albumin +++, blod ++++ |Negativ for blod, albumin og leukocytter |
Du tenker at du må henvise pasienten videre til spesialist.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Til hvilken spesialist bør pasienten henvises, og hvilken grad av hast har dette? (henvise innen en uke eller en måned?)
Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Revmatolog eller nefrolog (0,5 p)
* Innen en uke (0,5 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
I allmennpraksis blir du oppsøkt av en kvinne på 28 år som er tidligere helt frisk. I løpet av våren (siste 8 uker) har hun følt seg i dårlig form, og hun har for første gang fått utslett i ansiktet (panne, nese, kinn) av å være i solen. Hun har følt seg økende slapp og trett siste måned, og har stadig litt feber rundt 38 grader. Siste måned har hun også fått smerter tilsvarende PIP- og MCP-ledd i hender. Hun har også fått noen sår i munnslimhinnen.
Ved undersøkelse ser du at hun er lett rød over panne, kinn og neserygg, og hun har to sår i munnslimhinnen. Hun er litt hoven over PIP II og III i høyre hånd. BT 100/80
Som ledd i undersøkelsen tar du noen prøver:
|!Analyse |!Resultat |!Referanseområde |
|Hb |9,8 g/dL |11,7-15,3 g/dL |
|SR |45 mm/time |<20 mm/time |
|CRP |5 mg/L |<5 mg/L |
|LPK/leukocytter |2,5 x10^^9^^ /L |3,5 -10,0 x10^^9^^ /L |
|Trombocytter |180 x 10^^9^^ /L |164-370 x10^^9^^ /L |
|Kreatinin |70 µmol /L |45 – 90 µmol /L |
|Urin stix | albumin +++, blod ++++ |Negativ for blod, albumin og leukocytter |
Du tenker at du må henvise pasienten videre til spesialist.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket prøvesvar er viktigst å få fram i henvisningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Urinfunn (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten henvises, og får time hos spesialist på sykehuset.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken ytterligere undersøkelse bør nå gjøres av urinen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Maks 1 poeng!
* Urin-mikroskopi (1 p)
* Kvantitering av protein og kreatinin (0,5 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vgnett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken annen spesifikk utredning er det aktuelt å gjøre på bakgrunn av urinfunn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nyrebiopsi (1 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På sykehuset tas følgende utvidede blodprøver:
* ANA positiv
* Anti-ds-DNA positiv
* Anti-Sm positiv
* Anti-SSA / SSB negativ
* Revmatoid faktor IgM negativ,
* Anti-CCP negativ
* ANCA serologi negativ
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig hos denne pasienten basert på klinikk og blodprøver?
Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systemisk Lupus Erythematosus/ SLE (1 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst to andre organer enn det som er affisert hos denne pasienten som kan gi et alvorlig sykdomsbilde ved denne tilstanden.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Maks 1 p tilsammen på oppgaven.
* 0,5 p for hvert av følgende svar: CNS, Hjerte (myositt, myokardittt), serøse hinner hjerte/lunge (serositt pleura eller perikard)
* 0,25 poeng for å nevne hud som organ
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Følgende medikamenter er aktuelle ved behandling av bindevevssykdommer:
* Steroider (Prednisolon)
* Azathioprin (Imurel)
* Hydroksyklorokin (Plaquenil)
* Mykofenolat mofetil (Cell Cept)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilket av disse medikamentene kan brukes for å dempe betennelsesaktiviteten raskt ved systemiske revmatiske sykdommer?
# Hvilket av disse medikamentene anbefales brukt fast over ubestemt tid ved systemisk bindevevssykdom?
# Hvilke to av medikamentene over brukes over tid spesifikt i behandlingen av nefritt som kan skyldes revmatisk sykdom?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Steroider (0,5 p)
# Hydroksyklorokin (0,5 p)
# Azathioprin (0,5 p), mykofenolat mofetil (0,5 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten innlegges, og etter en uke på sykehuset får hun akutt hevelse og smerte i venstre legg og klarer ikke å trå på foten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør sykehuslegen mistenke at dette kan være, og hvilken blodprøve tas for å finne ut om pasienten kan ha økt risiko for denne type komplikasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Dyp venetrombose (1 p).
* Antikardiolipin eller antifosfolipidantistoffer (1 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som allmennpraktiker møter du mange pasienter med migrene. Du får flere spørsmål om alternativ behandling, særlig akupunktur, og bestemmer deg for å lese deg opp på temaet slik at du kan gi pasientene dine gode svar når de spør deg om råd.
Du finner en artikkel i Cochrane-databasen: Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. (Artikkelen er ikke vedlagt, relevant informasjon for å løse oppgaven er gitt under.)
Artikkelen sammenligner blant annet akupunktur med a) imitert (placebo/"sham") akupunktur og b) ingen behandling, med tanke på å redusere hyppigheten av hodepineanfall med minst 50% etter behandling.
For sammenligningen av akupunktur og placebo finner du denne figuren (Figur 7 i "Acupuncture for the prevention of episodic migraine"):
<<imgLink "IIC-2016v-2-A.PNG" 600>>
"Events" i figur 7 er definert som at en pasient har respondert på behandling, det vil si at vedkommende har minst 50% reduksjon av hodepine.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags studie er "Acupuncture for the prevention of episodic migraine"?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette er en metaanalyse.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Metaanalyse (1p). Gir ikke poeng dersom man bare svarer "systematisk oversikt"
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Som allmennpraktiker møter du mange pasienter med migrene. Du får flere spørsmål om alternativ behandling, særlig akupunktur, og bestemmer deg for å lese deg opp på temaet slik at du kan gi pasientene dine gode svar når de spør deg om råd.
Du finner en artikkel i Cochrane-databasen: Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. (Artikkelen er ikke vedlagt, relevant informasjon for å løse oppgaven er gitt under.)
Artikkelen sammenligner blant annet akupunktur med a) imitert (placebo/"sham") akupunktur og b) ingen behandling, med tanke på å redusere hyppigheten av hodepineanfall med minst 50% etter behandling.
For sammenligningen av akupunktur og placebo finner du denne figuren (Figur 7 i "Acupuncture for the prevention of episodic migraine"):
<<imgLink "IIC-2016v-2-A.PNG" 600>>
"Events" i figur 7 er definert som at en pasient har respondert på behandling, det vil si at vedkommende har minst 50% reduksjon av hodepine.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor mange studier og hvor mange pasienter bygger analysen i figur 7 i "Acupuncture for the prevention of episodic migraine" på?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Figuren bygger på analyse av 14 studier, med til sammen 1825 inkluderte pasienter (1055 som fikk akupunktur + 770 som fikk placebo/"sham" akupunktur).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
14 inkluderte studier (0.5p), 1055+770 = 1825 pasienter (0.5p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Som allmennpraktiker møter du mange pasienter med migrene. Du får flere spørsmål om alternativ behandling, særlig akupunktur, og bestemmer deg for å lese deg opp på temaet slik at du kan gi pasientene dine gode svar når de spør deg om råd.
Du finner en artikkel i Cochrane-databasen: Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. (Artikkelen er ikke vedlagt, relevant informasjon for å løse oppgaven er gitt under.)
Artikkelen sammenligner blant annet akupunktur med a) imitert (placebo/"sham") akupunktur og b) ingen behandling, med tanke på å redusere hyppigheten av hodepineanfall med minst 50% etter behandling.
For sammenligningen av akupunktur og placebo finner du denne figuren (Figur 7 i "Acupuncture for the prevention of episodic migraine"):
<<imgLink "IIC-2016v-2-A.PNG" 600>>
"Events" i figur 7 er definert som at en pasient har respondert på behandling, det vil si at vedkommende har minst 50% reduksjon av hodepine.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket mål på effekt er angitt i figur 7 i "Acupuncture for the prevention of episodic migraine"?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effektmålet her er relativ risiko/risk ratio (RR) for reduksjon av hodepinefrekvens med minst 50%. («Risiko» er her altså brukt om sannsynlighet for et ønsket utfall.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Relativ risiko og risk ratio er alternative begrep, begge gir uttelling (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Som allmennpraktiker møter du mange pasienter med migrene. Du får flere spørsmål om alternativ behandling, særlig akupunktur, og bestemmer deg for å lese deg opp på temaet slik at du kan gi pasientene dine gode svar når de spør deg om råd.
Du finner en artikkel i Cochrane-databasen: Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. (Artikkelen er ikke vedlagt, relevant informasjon for å løse oppgaven er gitt under.)
Artikkelen sammenligner blant annet akupunktur med a) imitert (placebo/"sham") akupunktur og b) ingen behandling, med tanke på å redusere hyppigheten av hodepineanfall med minst 50% etter behandling.
For sammenligningen av akupunktur og placebo finner du denne figuren (Figur 7 i "Acupuncture for the prevention of episodic migraine"):
<<imgLink "IIC-2016v-2-A.PNG" 600>>
"Events" i figur 7 er definert som at en pasient har respondert på behandling, det vil si at vedkommende har minst 50% reduksjon av hodepine.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor stor er den samlede effekten av akupunktur estimert å være (i henhold til figur 7 i "Acupuncture for the prevention of episodic migraine")? Formuler svaret slik du ville ha formidlet resultatet for en pasient.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man fant 23% større sjanse (risiko) for at hodepinefrekvens ble redusert med minst halvparten etter behandling med akupunktur sammenlignet med behandling med imitert akupunktur.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
23% større sjanse/risiko for bedring hos de som fikk akupunktur (1p). Presisjon (konfidensintervall) kan også angis, men er ikke nødvendig for poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Som allmennpraktiker møter du mange pasienter med migrene. Du får flere spørsmål om alternativ behandling, særlig akupunktur, og bestemmer deg for å lese deg opp på temaet slik at du kan gi pasientene dine gode svar når de spør deg om råd.
Du finner en artikkel i Cochrane-databasen: Linde K, Allais G, Brinkhaus B et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016. (Artikkelen er ikke vedlagt, relevant informasjon for å løse oppgaven er gitt under.)
Artikkelen sammenligner blant annet akupunktur med a) imitert (placebo/"sham") akupunktur og b) ingen behandling, med tanke på å redusere hyppigheten av hodepineanfall med minst 50% etter behandling.
For sammenligningen av akupunktur og placebo finner du denne figuren (Figur 7 i "Acupuncture for the prevention of episodic migraine"):
<<imgLink "IIC-2016v-2-A.PNG" 600>>
"Events" i figur 7 er definert som at en pasient har respondert på behandling, det vil si at vedkommende har minst 50% reduksjon av hodepine.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder grad av heterogenitet mellom studiene som er inkludert i figur 7 i "Acupuncture for the prevention of episodic migraine" og hvilken betydning dette har for tolkingen av resultatene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dersom det er stor spredning mellom effektestimater og konfidensintervaller for de ulike studiene som er inkludert i en metaanalyse, sier vi at det er høy grad av heterogenitet. Graden av heterogenitet kan også angis med statistiske mål som I^^2^^.
Høy grad av heterogenitet tilsier at resultatene må tolkes med forsiktighet, i og med at det kan være betydningsfulle forskjeller mellom de studiene som er forsøkt slått sammen.
I denne metaanalysen er det inkludert flere små studier og fire noe større studier. Mens effektestimatene spriker betydelig på de små studiene, er det bedre samsvar mellom de fire største studiene. Konfidensintervallene overlapper i ganske stor grad, med unntak av den første studien (Weinschütz 1994).
Denne analysen viser moderat grad av heterogenitet, i samsvar med I^^2^^ på 48%.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Moderat heterogenitet (0.5p). Resonnerer rundt samsvar/sprik mellom estimater og konfidensintervall (1p). Heterogene studier tyder på forskjeller som gjør at man må tolke samlede resultater med forsiktighet (0.5p). I^^2^^ som mål for heterogenitet trenger ikke nevnes eller tolkes for å gi full uttelling på spørsmålet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Artikkelen sammenlignet også akupunktur med ingen forebyggende behandling. I denne analysen ble den samlede effekten av akupunktur estimert til en risk ratio på 2.40 (95% CI 2.08-2.76).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv forskjellen mellom det samlede effektestimatet fra analysen som sammenligner akupunktur med imitert/"sham" akupunktur og det samlede effektestimatet fra analysen som sammenligner akupunktur med ingen behandling, og gi en forklaring på denne forskjellen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Av resultatene ser vi at det er en mye sterkere sammenheng mellom akupunktur og redusert smerte når man sammenligner med ingen behandling versus imitert akupunktur.
Når man sammenligner akupunktur med ingen behandling, vil man kunne se en placebo-effekt av akupunkturbehandlingen. Denne effekten reduseres når man sammenligner med imitert (placebo) akupunktur. Blinding av behandler er derimot ikke mulig i en slik setting, og kan fortsatt være en feilkilde.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Identifisere sterkere sammenheng når man sammenligner med ingen behandling (1 poeng). Placeboeffekt av behandling (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Studien har brukt skåringssystemet GRADE og vurderer kunnskapsgrunnlaget for resultatene som moderat når det gjelder akupunktur versus placebo for reduksjon av hodepine (med minst 50%).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke faktorer bør man ta i betraktning når man skal vurdere kunnskapsgrunnlaget for resultater basert på analyser av den typen som er gjort i "Acupuncture for the prevention of episodic migraine"?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
GRADE er et verktøy for systematisk vurdering av kunnskapsgrunnlag og danner et godt utgangspunkt for vurdering av kunnskapsgrunnlaget i metaanalyser. Faktorer som vurderes i GRADE er:
* Design: Kunnskapsgrunnlaget vurderes som bedre hvis det baserer seg på randomiserte, kliniske forsøk enn observasjonsstudier. I tillegg er det viktig hvor mange studier og personer som inngår.
* Bias: Stor risiko for bias trekker ned. Vanlige problemer i RCT-studier er ufullstendig blinding og at deltakere faller ut av studien («loss to follow-up»). For få observasjoner (for små studier) trekker også ned.
* Overensstemmelse: Høy grad av heterogenitet trekker ned. Dose-respons-sammenheng trekker opp.
* Overførbarhet: Det trekker ned hvis sammenhengene ikke kan generaliseres til den aktuelle gruppa/det utfallet man er interessert i.
* Effektstørrelse: Sterke effektestimater trekker opp.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For hver faktor av 1) design 2) antall inkluderte studier/personer 3) bias 4) overensstemmelse 5) overførbarhet og 6) effektstørrelse gis 0,5 poeng, inntil maks 2 poeng. (Dvs det kreves bare 4 av 6 momenter for å få full score).
Det forventes ikke noen utførlig beskrivelse av GRADE som skåringssystem.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 60 år gammel kvinne faller på isen en dag i februar og vrir høyre ankel. Hun hører et knekk og registrerer at ankelen står i en merkelig stilling. Hun kan ikke trå på ankelen på grunn av smerter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken primærbehandling vil du gi på skadestedet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forsikre seg om at pasienten ikke har livstruende skader, andre medisinske tilstander som påvirker bevisstheten (epilepsi, hypoglykemi), har frie luftveier samt sjekke bevissthet i tillegg: Forsøke å forhindre hypotermi/tenke på dette før en går videre med primærbehandling av ankelen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Fjerne skotøy, forsøke reponering – 1 poeng.
# I tillegg til A: Sørge for at pasienten ikke blir hypoterm – 1 poeng.
# I tillegg til A og B: Tenke ABC først før en går videre – 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun blir fraktet til sykehus. Der blir det tatt et røntgenbilde.
<<imgLink "IIC-2017-1-A.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du beskrive skaden(e) du ser på bildene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette er en trimalleolær luksasjonsfractur i ankelen. Talus står luksert lateralt, noe som sees best i AP plan og i posterior retning, noe som sees best i sideplan
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Ankelbrudd – 1 poeng
# Trimalleolær fraktur i ankel – 1/2 poeng
# I tillegg påpeke at det dreier seg om en luksasjonsfractur – 1/2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du står nå i mottagelsen med pasienten. Hvilke kliniske undersøkelser og overveielser gjør du etter at røntgenbildet er tatt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Status lokalis vil være viktig å oppgi:
# Vurdere sirkulasjon: Palpere ATP og/eller ADP samt kapillær fylning i tærne. Pasienten er ute og det er kaldt slik at puls ikke alltid vil kjennes. Imidlertid bør studenten markere at det kjennes etter puls.
# Vurdere hudstatus: Merke seg evt. tegn til anstrengt ”hvit” hud som tegn på at benstrukturer presser på under. Sårskader evt. tegn til åpent brudd. Perifer nevrologi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng - Palpere puls.
1 poeng - Gjengi status på hud og perifer nevrologi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du håndtere denne pasienten i mottagelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgenbilde viser fremdeles luksert ankel. Riktig primærbehandling vil nå være å reponere ankelen ev. etter å ha gitt smertestillende først dersom pasienten har fått etablert venflon (per oral smertestillende på dette tidspunktet vil ikke ha forventet effekt på minst 30 min).
Deretter stabilisering i skinne samt evt gi smertestillende pr os dersom det ikke er gitt i.v. og pasienten ikke har venflon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Reponering av ankel, skal være utført og gitt poeng for i oppgave 1. ikke poeng her også.
# Stabilisering i skinne – 1 poeng
# Gi smertestillende – 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vi tenker oss at du gir primærbehandlingen i mottakelsen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hun har tidligere hatt flere brudd. Hvordan påvirker dette din håndtering av pasienten etter ferdigbehandling av det aktuelle bruddet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten er altså en kvinne, 60 år gammel med tidligere brudd i anamnesen. Hun er i risikogruppen for benskjørhet. Videre utredning på osteoporose (blodprøver, DEXA-måling) vil være på sin plass. Vurdere oppstart med
antiosteoporotika </$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tenke på/nevne benskjørhet – og kunne nevne generell utredning for benskjørhet: DEXA- måling og blodprøver – 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege, og en frisk eldre herre med lite hår kommer til deg for en konsultasjon. Han har det siste året vært plaget med skjellende, litt diffuse, rødlige områder i panne/hodebunn. Han har sparsomt med kløe, og kona er irritert over at han stadig pirker på disse tørre lesjonene. Han har ikke noe utslett ellers på kroppen. Han har vært friluftsmann hele livet.
Se følgende bilde av mannen:
<<imgLink "IIC-2017-2-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er aktuelle hos denne pasienten? Nevn minst 3
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Aktinsk/Solar keratose
* Seborreisk dermatitt
* Psoriasis
* Lupus erythematosus
* Kutant T-celle lymfom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Denne oppgaven tester kandidatens evne til å gjenkjenne en vanlig forekommende hudforandring. I og med at oppgaven ledsages av et bilde, gis det 1 poeng for riktig svar som er aktinsk keratose. Det gis ellers ½ poeng for hhv seborroisk dermatitt, psoriasis, lupus erythematosus og til nød kutant T-celle lymfom (maks 2 poeng totalt) som alle er hudlidelser som kan gi skjellende, diffust utslett i hodebunnen. Det gis ikke poeng for andre forslag, som eksem eller andre typer hudlidelser.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å ta en biopsi av en av hudforandringene i det aktuelle området. Det histologiske snittet ser slik ut:
<<imgLink "IIC-2017-2-B.PNG">>
Følgende beskrivelse ligger ved: Moderat atypisk epitelproliferasjon i nedre og midtre del av epidermis. Lett hyper- og para- keratose på overflaten.
Du føler deg nå sikker på diagnosen, og bestemmer deg for å behandle pasienten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke behandlingsmodaliteter er aktuelle for denne tilstanden? Nevn minst 3 ulike alternativ
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Spørsmålet skal teste om kandidaten kjenner til ulike behandlingsmodaliteter for en svært vanlig forekommende hudforandring. Flere av disse kan utføres i primærhelsetjeneten.
Selv om det hos denne pasienten er mest aktuelt å tenke på behandlingsmodaliteter som dekker større områder med aktinske keratoser ("field treatment") aksepteres også kryoterapi og mindre kirurgi (shave/curretage) som løsningsforslag da dette kan være aktuelt ved enkelt-lesjoner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hva gir poeng: kryoterapi, mindre kirurgi (shave/curretage), fotodynamisk terapi, imiquimod (Aldara©, Zyclara©), ingenolmebutat (Picato©), 5-fluorouracil (5-FU), diclofenac natrium (Solaraze©)
Hvert forslag gir 0.5 poeng, maks 1,5 poeng.
Det gis ikke poeng for forslag om omfattende kirurgi, topikale steroider, soppbehandling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar pasienten til kontroll 3 måneder etter gjennomført behandling. Han forteller da at det har tilkommet en ny hudforandring på håndryggen de siste 3-4 ukene. Den ser slik ut:
<<imgLink "IIC-2017-2-C.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke differensialdiagnoser er aktuelle? Nevn minst 2.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hurtigvoksende tumores i hud skal få kandidaten til å være obs på cancer utvikling. Mest aktuelle diagnose her er keratoacanthom basert på rask vekst og klinisk utseende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis poeng for Keratoacanthom (1 poeng), spinocellulær cancer (1 poeng), aktinsk keratose 0.5 poeng, basalcellecarcinom 0.5 poeng (passer med utseende, men mindre sannsynlig da det er raskt vekst), verruca vulgaris 0.5 poeng (dog mindre sannsynlig).
Det gis ikke poeng for andre differensialdiagnostiske forslag.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du føler deg relativt sikker på hva dette er basert på klinisk utseende og rask vekst.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan håndteres lesjonen best?
(vi er ute etter én behandlingsmodalitet som er den beste, og kun denne gir poeng)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Riktig behandling av hurtigvoksende tumores i hud er ''kirurgisk eksisjon''. I dette tilfellet vil patologen som regel ikke kunne skille histologisk mellom en spinocellulær cancer og et keratoacanthom. Særlig om det kun tas en stansebiopsi. Det er derfor klinikken som vil være avgjørende for hvilken diagnose man lander på. I dette tilfellet er både anamnese (hurtig vekst) og klinisk utseende mest forenelig med et keratoacanthom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Svaralternativ kirurgisk eksisjon gir 2 poeng, alle andre svar gir ingen poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tar en beslutning angående videre håndtering av lesjonen på hånden, og informerer pasienten om dette.
Da du er i ferd med å avslutte konsultasjonen ber han om å få snakke med deg om noe han har gruet seg for å ta opp lenge. Han har i årevis vært plaget med trang forhud, og nå har det blitt så ille at han ikke får trukket den tilbake i det hele tatt. Det er stramt og ubehagelig med tendens til sår/sprekkdannelse.
Han tar av seg og du ser følgende forandringer på penis:
<<imgLink "IIC-2017-2-D.PNG>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig her, og hva er en viktig
differensialdiagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I denne oppgaven bør kandidaten kjenne igjen de hvitlige, arraktige forandringene på preputiet, og velge en av følgende to diagnoser som mest sannsynlig diagnose:
''Lichen sclerosus'' (det same som lichen sclerosus et atrophicus (LSA) og balanitis xerotica obliterans (BXO))
eller
''Lichen planus'' (Lichen ruber planus)
En viktig differensialdiagnose er begynnende hudkreft eller etablert hudkreft, og kandidaten må da nevne en av følgende to:
* Morbus Bowen (Bowen disease)/ Precancrose i hud
* Plateepitelcarcinom (Spinocelluært carcinom)/ hudcancer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Om et av lichen-forslagene nevnes gir dette 1 poeng, og øvrige diagnoser 0.5 poeng, maks 1.5 poeng totalt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å behandle uten å ta biopsi først.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling er best å velge i dette tilfellet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Intensiv smøring med potente til superpotente (gruppe 3-4) steroider i flere uker: f.eks daglig i 4 uker, så annenhver dag i 4 uker, så to ganger pr uke i 4 uker eller mer.
Ev. circumcisio/dorsal spalting 0.5 poeng, men skal da ha forsøkt optimal behandling med steroider topikalt først.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Intensiv smøring med potente til superpotente steroider (gruppe 3-4) i flere uker gir 1 poeng.
* Om steroider nevnes generelt gir dette ½ poeng
* Ev. circumcisio/dorsal spalting gir ½ poeng
* Maksimalt 1 poeng tilsammen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 68 år gammel kvinne kommer til din primærlegepraksis. Hun har over tid utviklet smerter i venstre lyske, over trochanter major, samt utstrålende smerter til leggens bakside. Smertene er verst under aktivitet, sier hun.
Du observerer at hun har en haltende gange.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke 3 diagnoser er de mest aktuelle? (Det er kun anledning til å foreslå 3 diagnoser)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Isjialgi
* Trochanterbursitt
* Coxartrose
* Referert smerte fra lumbosacral/sakroilialledd
* Aortoileal vaskulær okklusiv sykdom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Isjialgi, prolaps, spinalstenose, rotkanalstenose 0,5 poeng
* Trochantertendinitt, bursitt, tendinitt 0,5 poeng
* Coxartrose 1 poeng
* Referert smerte fra lumbosacral (LS)/sakroilialledd (IS-ledd) 0,5 poeng
* Aortoileal vaskulær okklusiv sykdom 0,5 poeng
Her er vi ute etter å kartlegge om studentene kan gjenkjenne vanlige tilstander i hofte/bekken/rygg som kan ramme eldre pasienter.
Totalt max 2 poeng, Coxarthrose gir 1 poeng, de andre 0,5, max 3 forslag totalt, studenten får ikke noe poeng for de diagnosene som nevnes ut over de 3 første forslagene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En 68 år gammel kvinne kommer til din primærlegepraksis. Hun har over tid utviklet smerter i venstre lyske, over trochanter major, samt utstrålende smerter til leggens bakside. Smertene er verst under aktivitet, sier hun.
Du observerer at hun har en haltende gange.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du klinisk undersøke for de 3 tilstandene du har foreslått i [[oppgave 1|IIC - 2017s - Oppgave 1]]?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Lasegues prøve, muskelstyrke, reflekser, sensibilitet
* Palpasjon over trochanter major
* Undersøke hofteledd
* Undersøke LS-columna/IS-ledd
* Distal status med pulser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Lasegues prøve, muskelstyrke, reflekser, sensibilitet (undersøkelser for isjialgi, prolaps, spinalstenose, rotkanalstenose) 0,5 poeng
* Palpasjon over trochanter major (undersøkelser for trochantertendinitt, bursitt, tendinitt) 0,5 poeng
* Trendelenburgs test (test for styrke av abduktormuskulaturen i hoften), bevegelsesutslag i hofteleddet (undersøkelser for coxartrose) 0,5 poeng
* Palpasjon av LS-columna, bevegelsesutslag ved stående fleksjon av columna (bøy framover), sammenpress av bekken, åpning av bekken, trykk over symfysen/IS-ledd. (Undersøkelser av LS-columna/IS-ledd) 0,5 poeng
* Palpere pulser over fotrygg, i fossa poplitea og i lysker, blodtrykksgradient mellom armtrykk og distalt fottrykk, gang-/tredemølle-test (BT/puls før og etter gange) (undersøke for aortoileal vaskulær okklusiv sykdom) 0,5 poeng
Totalt max 1,5 poeng, hvis studenten oppgir minst en av de kliniske undersøkelsene/testene for hver av diagnosene (foreslått i [[oppgave 1|IIC - 2017s - Oppgave 1]]) får han/hun 0,5 poeng for hver. Hvis han/hun har foreslått mange tester for hver tilstand får han/hun ikke noe ekstra poeng for dette.
Studentene skal få poeng hvis de foreslår adekvat kliniske undersøkelse/test selv om diagnoseforslaget er "feil".
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En 68 år gammel kvinne kommer til din primærlegepraksis. Hun har over tid utviklet smerter i venstre lyske, over trochanter major, samt utstrålende smerter til leggens bakside. Smertene er verst under aktivitet, sier hun.
Du observerer at hun har en haltende gange.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke billeddiagnostiske (eller tekniske) undersøkelser vil du rekvirere for å utrede de 3 aktuelle diagnosene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* MR eller CT av LS-columna
* MR us av bekken
* Rtg Bekken
* Rtg LS-columna/IS-ledd
* Doppler eller angiografi av aortoileale kar
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* MR eller CT av LS-columna (undersøkelser for isjialgi, prolaps, spinalstenose, rotkanalstenose) 0,5 poeng
* MR us av bekken(skjelett) (undersøkelser for trochantertendinitt, bursitt, tendinitt) 0,5 poeng
* Rtg bekken (hofter) (undersøkelser for coxartrose) 0,5 poeng
* Rtg eller MR av LS-columna/IS-ledd (Undersøkelser for LS-columna/IS-ledd) 0,5 poeng
* Doppler eller angiografi av aortoileale kar 0,5 poeng
Totalt max 1,5 poeng, hvis studenten oppgir mist en av de billeddiagnostiske undersøkelsene for hver av diagnosene (foreslått i oppgave 1) får de 0,5 poeng for hver.
Studentene skal få poeng hvis de foreslår adekvat billeddiagnostiske undersøkelse selv om diagnoseforslaget er "feil".
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Nedenfor ser du et røntgenbilde av hofte/bekken fra en annen, mannlig pasient.
<<imgLink "IIC-2017s-1-A.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Røntgenbildet viser 3 typiske funn for en aktuell tilstand. Hvilke funn er det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Sclerose
* Avsmalnet leddspalte
* Randosteofytter og cyster
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Sclerose 0,5 poeng
* Avsmalnet leddspalte 0,5 poeng
* Randosteofytter og cyster 0,5 poeng
Totalt max. 1,5 poeng for alle 3 funnene.
Her er det ingen krav om å skrive rett diagnose (dette er underforstått, dvs. coxartrose som er et sentralt tema i ortopedien). Hvis studenten ikke klarer diagnosen her fortjener studenten et lavt totalt poengskår på denne kortsvarsoppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Nedenfor ser du et røntgenbilde av hofte/bekken fra en annen, mannlig pasient.
<<imgLink "IIC-2017s-1-A.PNG" 600>>
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du i første omgang behandle pasienten med den tilstanden du diagnostiserte fra røntgenbildet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tilrettelegging av ADL (aktiviteter i dagliglivet)
* Fysioterapi for å bedre bevegelsesutslag, styrketrening av gluteus medius og quadriceps
* NSAIDS , Analgetica
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Tilrettelegging av ADL gir 0,5 poeng
* Fysioterapi gir 0,5 poeng
* NSAIDs gir 0,25 poeng og andre analgetika gir 0,25 poeng (det er nok å foreslå en type analgetika eller analgetika generelt for å få 0,25 poeng)
Totalt max. 1,5 poeng for alle 3 av de konservative behandlingsforslagene. Her får man ingen poeng hvis man foreslår protesekirurgi
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Den mannlige pasienten har gjennomført behandlingen du foreslo. Han kommer tilbake etter 3 måneder og har bedret bevegelighet, men har funksjonssmerter og hvilesmerter. Han får smerter kun etter 500 meters ganglengde. Han våkner om natten av smertene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket behandlingstiltak blir det riktigst å anbefale nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henvise til protesekirurgi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Henvise til protesekirurgi gir 1 poeng
Her får man 0 poeng hvis man foreslår fysioterapi, ADL, analgetika eller annen konservativ behandling
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten forteller at venstre underekstremitet visner bort når han går. Tilstanden bedrer seg når han stopper opp.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de to viktigste differensialdiagnosene som kan passe med slike symptomer.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Claudicatio intermittens
* Spinalstenose / rotkanalstenose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Claudicatio intermittens gir 0,5 poeng
* Spinalstenose / rotkanalstenose (en av disse er nok) gir 0.5 poeng
Hvis studenten er inne på "dårlig sirkulasjon" eller "trange forhold i spinalkanalen" uten å nevne navn på tilstand kan en ev. vurdere poenggiving.
Det gis her 0 poeng hvis studenten nevner komplikasjoner til protesekirurgi som caputnekrose, perifer nevropati, arteriell emboli
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antipsykotika har en rekke bivirkninger og interaksjoner. I denne oppgaven skal vi ta opp en del sentrale bivirkninger og også komme inn på noen interaksjoner som er aktuelle for denne legemiddelgruppen.
Akutte dystonier og tardive dyskinesier er to typer bivirkninger som kan forekomme ved bruk av antipsykotika
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva kjennetegner disse to typene bivirkninger?
# Hvilken undertype av antipsykotika gir slike bivirkninger i størst grad?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Del en:
## ''Akutte dystonier''. Økt muskeltonus, typisk i munn/svelg/tunge. Kan bl.a. gi problemer med å snakke (grøtet/utydelig tale). Kommer kort tid etter oppstart. Vanligst hos unge menn.
## ''Tardive dyskinesier''. Ufrivillige bevegelser, særlig i hode/ansikt og hender/fingre. Kommer gjerne sent i forløpet. Er i prinsipp irreversibelt, og vil forverres initialt etter seponering av utløsende middel.
# Førstegenerasjons lavdoseantipsykotika – også kalt førstegenerasjons høypotente antipsykotika. (Eksempler: haloperidol, zuklopentiksol, perfenzazin. Hvis noen nevner risperidon, er det heller ikke feil, selv om det er et annengenerasjonsmiddel).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Akutte dystonier: 0,5 poeng for symptomene, 0,5 poeng for de andre kjennetegnene. Tardive dyskinesier: 0,5 poeng for symptomene, 0,5 poeng for de andre kjennetegnene.
# 0,5 poeng for "førstegenerasjons lavdoseantipsykotika". 0,25 hvis ett eller flere korrekte enkeltlegemidler nevnes uten at det er angitt noe navn på gruppen. Hvis navnet på gruppen er feil, gir det 0 poeng og da heller ikke poeng for korrekte enkeltlegemidler
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mange antipsykotika blokkerer kolinerge reseptorer (muskarinreseptorer) og alfa-1-adrenerge reseptorer
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke bivirkninger kan man se på grunn av blokade av muskarinreseptorer?
# Hvilke bivirkninger kan man se på grunn av blokade av alfa1-adrenerge reseptorer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Munntørrhet, akkomodasjonsforstyrrelser, forstoppelse, urinretensjon, takykardi, forvirring.
# Perifer vasodilatasjon – og sekundært til dette følgende: Blodtrykksfall/ortostatisk hypotensjon/svimmelhet, lushing/rødming, tett nese, deklive ødemer, reflektorisk takykardi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0,25 poeng per rett bivirkning opp til maks 1 poeng.
# 0,25 poeng per rett bivirkning opp til maks 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antipsykotika har også metabolske bivirkninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke former for metabolsk påvirkning er vanligst?
# Nevn ett antipsykotikum som gir metabolsk påvirkning i svært stor grad.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vektøkning, økt blodsukker (eventuelt med utvikling av type 2-diabetes), økte nivåer av kolesterol, økte nivåer av triglyserider.
# Klozapin og olanzapin gir dette i størst grad
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0,25 poeng per rett bivirkning opp til 1 poeng.
# Bare __ett__ middel kreves. Enten olanzapin eller klozapin (eller begge!) gir 0,5 poeng. Quetiapin/kvetiapin kommer i en mellomposisjon og gir 0,25 poeng hvis bare dette (og ingen andre) nevnes. Hvis man har "gardert" og nevner andre midler enn disse tre, får man 0 poeng uansett om noen av de riktige tre er angitt også. (Man må kunne vise at man kan lese en oppgave og svare på det det spørres om...)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mekanismen bak at antipsykotika kan gi menstruasjonsforstyrrelser, brystspreng og nedsatt libido som bivirkninger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Økte prolaktinnivåer. Siden dopamin hemmer utskillelsen av prolaktin fra hypofysen, vil nivåene av prolaktin øke når dopaminsystemet hemmes (dopaminreseptorene blokkeres) her
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for økte prolaktinnivåer. 0,5 poeng for å beskrive at dette skyldes redusert dopaminaktivitet, siden dopamin hemmer utskillelsen av prolaktin
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Antipsykotika har interaksjoner med en rekke andre legemidler.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva vil skje hvis man kombinerer et antipsykotikum med antiparkinsonmiddel?
# Hva er mekanismen bak dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Antiparkinsonmidler og antipsykotika motvirker hverandres effekter – man risikerer altså både en redusert antiparkinsoneffekt og en redusert antipsykotisk effekt.
# Dette skyldes at antiparkinsonmidler stimulerer dopaminerg nevrotransmisjon (for eksempel ved å gi dopa, som metaboliseres til dopamin, ved å gi hemmere av de enzymene som bryter ned dopamin, eller ved å gi dopaminreseptoragnoister), mens antipsykotika hemmer dopaminerg nevrotransmisjon ved å blokkere dopaminreseptorer (mer spesifikt dopamin-D2-reseptorer).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 poeng for "motvirker hverandres effekter" eller tilsvarende, altså at effekten av begge midlene reduseres samtidig. 0,5 poeng for kun redusert antiparkinson-effekt, 0,5 poeng for kun redusert antipsykotisk effekt. (maks 1 poeng på denne deloppgaven altså)
# 0,5 poeng for at effektene motvirkes på dopaminnivå / på reseptornivå, dessuten 0,5 poeng i tillegg hvis dette forklares mer utfyllende.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Antipsykotika har interaksjoner med en rekke andre legemidler.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken prinsipiell type legemiddelinteraksjon må man være spesielt opp?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Karbamazepin er en kraftig enzyminduktor (gjelder spesielt CYP-enzymer, men også andre enzymer). Dette fører til lavere konsentrasjoner av antipsykotika, siden disse i all hovedsak metaboliseres via CYP-systemet. (Derfor kan det bli nødvendig å øke dosen av det antipsykotiske legemidlet ved kombinasjonsbehandling med karbamazepin. For visse antipsykotika kan konsentrasjonen bli så lav at effekten av midlet helt opphører – da er det urasjonelt å øke dosen og kombinasjonen bør helt unngås.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å skrive at karbamazepin er en enzyminduktor. 0,5 poeng for å utbrodere litt mer rundt dette med CYP-enzymer. Informasjonen i parentes er ekstraopplysninger som ikke kreves.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 40 år gammel kvinne kommer til fastlegen og angir at hun det siste året har hatt perioder med prikkinger og nummenhet i tommel, pekefinger og langfinger høyre hånd. Periodene har blitt mer hyppige og mer langvarige i det siste og hun har begynt å våkne opp om natten og må riste på hendene.
I tillegg har hun de siste tre månedene hatt konstant nummenhet i de to ulnare fingrene i venstre hånd. Hun har fått redusert fingerferdighet og mindre kraft i hånden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de mest sannsynlige diagnosene for høgre og venstre hånd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Carpal tunnel syndrom høgre hånd
# Cubital tunnel syndrom venstre hånd
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Carpal tunnel syndrom høgre hånd gir, 1 poeng
# Cubital tunnel venstre hånd, gir 1 poeng
Trykk på disse to nervene på andre kjente steder gir 0.5 poeng. Maksimalt 2 poeng for dette spørsmålet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En 40 år gammel kvinne kommer til fastlegen og angir at hun det siste året har hatt perioder med prikkinger og nummenhet i tommel, pekefinger og langfinger høyre hånd. Periodene har blitt mer hyppige og mer langvarige i det siste og hun har begynt å våkne opp om natten og må riste på hendene.
I tillegg har hun de siste tre månedene hatt konstant nummenhet i de to ulnare fingrene i venstre hånd. Hun har fått redusert fingerferdighet og mindre kraft i hånden.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser kan hjelpe oss med diagnostiseringen?
Nevn minst 2 undersøkelser for hver av nervene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# For medianus nerven: Tinnels test og Phalens test, 0.5 poeng for hver test
# For ulnaris nerven : Tinnels test og Albuefleksjons test, 0.5 poeng for hver test
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver test. Hvis studenten har angitt andre nerver i spørsmål 1. Hvis Tinnel test er nevnt for Medianus gjelder den også for Ulnaris.
Atrofi av muskulatur gir 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
En 40 år gammel kvinne kommer til fastlegen og angir at hun det siste året har hatt perioder med prikkinger og nummenhet i tommel, pekefinger og langfinger høyre hånd. Periodene har blitt mer hyppige og mer langvarige i det siste og hun har begynt å våkne opp om natten og må riste på hendene.
I tillegg har hun de siste tre månedene hatt konstant nummenhet i de to ulnare fingrene i venstre hånd. Hun har fått redusert fingerferdighet og mindre kraft i hånden.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke to undersøkelser kan du bestille til å bekrefte eller komme nærmere diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ENG, (Elektronevrografi). 1 poeng.
# MR undersøkelse til å se på plassforhold for nerven. 1 poeng.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ultralyd gir 0.5 poeng.
Nevrografi og Elektromyografi samme som ENG
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Din kliniske undersøkelse er positiv. En av tilleggsundersøkelsene viser begynnende skade (Demyelinisering) av nerve både på høyre og venstre side
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling ville du anbefale til tilstanden på:
# Høgre side?
# Venstre side?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Spalting av carpal tunnel høgre side (1 poeng)
# Enkel dekompresjon av ulnaris nerven på venstre side.
(1 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kirurgisk behandling med dekompresjon av den nervenene som studenten angir i spørsmål 1. (1-2 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere vignett:
<<<
En 40 år gammel kvinne kommer til fastlegen og angir at hun det siste året har hatt perioder med prikkinger og nummenhet i tommel, pekefinger og langfinger høyre hånd. Periodene har blitt mer hyppige og mer langvarige i det siste og hun har begynt å våkne opp om natten og må riste på hendene.
I tillegg har hun de siste tre månedene hatt konstant nummenhet i de to ulnare fingrene i venstre hånd. Hun har fått redusert fingerferdighet og mindre kraft i hånden.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 2 andre steder der nerven på høyre side kan få trykk på seg og en annen sted der nerven på venstre side kan få trykk på seg.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Nervus medianus, Lacertus fibrosus, pronator, Superficialis arch. Struthers ligament. 1 poeng
# Nervus ulnaris, Canalis Guyong. Arcade of Struthers. 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I en diskusjon blant yngre leger i en lunsjpause ble navnsetting av tumores tatt opp.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kalles __maligne__ tumores som er utgått fra
# ektoderm?
# mesoderm?
# fra flere kimblad?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Karsinom
# Sarkom
# Malignt teratom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5p for hvert delsvar, totalt 1,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Og hva kalles __maligne__ tumores utgått fra
# fettvev?
# senevev?
# tverrstripet muskulatur?
# bruskvev?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Liposarkom
# Synovialt sarkom
# Rhabdomyosarkom
# Kondrosarkom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5p for hvert delsvar, totalt 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En dag hadde en av legene ved ortopedisk poliklinikk en pasient med kneproblematikk. Det var en middelaldrende mann som i lengre tid hadde hatt noe ubehag i kneet, især ved bøying og strekking av leddet. Ved klinisk undersøkelse ble det sentralt i fossa poplitea palpert en ikke-smertefull, fluktuerende, ikke pulserende tumor i midtlinjen som ble noe mindre ved kompresjon og ved full ekstensjon av kneet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er den mest sannsynlige diagnosen?
# Hva er årsaken/mekanismen til denne sykdommen?
# Hvilke predisponerende tilstander i kneet kan foreligge? (to forslag nødvendig for 0,5 p)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Bakers cyste (popliteacyste)
# Økt trykk i leddhulen vil gi opphav til et trykkdivertikkel med herniering av denne gjennom leddkapselen med dannelse av en væskefylt sekk i fossa poplitea
# Artrose, meniskskade, artritt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,5 p, totalt 1,5 p.
Ang. delspørsmål c) så kreves to forslag for å få 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På hudpoliklinikken var det en dag to pasienter med sår som ikke ville gro. Hos begge hadde sårene vært tilstede i flere måneder.
Pasient A var en 85 år gammel mann med en 12 mm stor lesjon på høyre kinn med erythem, hyperkeratose og underliggende sår. Øvrig hud i ansiktet viste tegn på solskade.
Pasient B var en kvinne med et hudområde på 16 mm på høyre skulder med erythem, sentral sårdannelse og opphøyde sårkanter med krypende teleangiectasier.
Det ble tatt biopsier, og histologipatologien for disse to pasientene er vist på bildene under.
<<imgLink "IIC-2017v-2-A.PNG" 500>>
<<imgLink "IIC-2017v-2-B.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen for henholdsvis pasient A og pasient B?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
A: Plateepitelkarsinom. B: Basalcellekarsinom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 1 p, totalt 2 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En annen dag på hudpoliklinikken kom en kvinne på 35 år med noen rød-lilla papler i et arr på høyre underarm. Paplene hadde dukket opp siste måned mens arret tidligere hadde vært reaksjonsløst. Den siste måneden hadde hun også vært plaget av ømme, erythematøse, diffust avgrensede nummulate infiltrater fortil på begge legger, og smerter og hevelse i begge ankler. Hun hadde litt tungpust ved anstrengelse, men hadde ikke registrert noe vekttap, og matlysten var uendret. Det ble tatt en stansebiopsi fra en av paplene på høyre underarm, og histopatologien er vist på bildet under.
<<imgLink "IIC-2017v-2-C.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type patologisk prosess foreligger?
Hva er den mest sannsynlige diagnosen til denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det foreligger en ikke-nekrotiserende granulomatøs betennelse.
Den mest sannsynlige diagnosen er sarkoidose. Dette støttes av at pasienten i sykehistorien har klinikk forenlig med Löfgrens syndrom med erythema nodosum på leggene og leddplager. Det ble tatt rtg. thorax i dette tilfellet som viste bilaterale hilusglandler.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 1 p, totalt 2 p.
For første delspørsmål holder det med "granulomatøs betennelse" for å få 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På revmatologisk poliklinikk hadde det nylig vært to pasienter med henholdsvis rheumatoid artritt (RA) og urinsyregikt med subkutane lesjoner i albueregionen. Bildediagnostikk gav ikke mistanke om malignitet hos noen av dem, og histologi av begge lesjonene viste en reaktiv prosess typisk for sykdommene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke lesjoner er det mest sannsynlig at pasienten med RA og pasienten med urinsyregikt hadde? (To forskjellige diagnoser. Den ene typisk for RA, og den andre typisk for urinsyregikt)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
For pasienten med rheumatoid artritt er rheumatoid knute den mest sannsynlige diagnosen, for pasienten med urinsyregikt tofus (knute av urinsyre-krystaller).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert delsvar gir 0,5 p, totalt 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En pasient på 45 år legges inn som øyeblikkelig hjelp til tvungent vern i henhold til § 3-3 i Psykisk helsevernloven pga forverring av kronisk psykose. Ved innleggelse er han preget av hørselshallusinasjoner, vrangforestillinger og affektlabilitet inkludert tendens til utagering.
Han har hatt diagnose schizofreni i mer enn 20 år. Han står fast på et antipsykotikum i depotform. Etter forverring siste to uker er det lagt til et annet peroralt antipsykotikum. Pasienten er betydelig overvektig, har diabetes 2, hypertensjon, og er storrøyker. Han har et langvarig overforbruk av alkohol. Dette har blitt mer uttalt parallelt med forverring siste uker.
Rett etter ankomst trenger pas å roe seg ned.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket type medikament bør man velge?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten er agitert og urolig. Han er sannsynlig abstinent. Han bruker allerede to antipsykotika. Mer antipsykotika kan medføre fare for arrytmier.
Rett svar her er benzodiazepiner. Alternativt stemningsstabiliserende antiepileptikum
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Forslag om konkrete benzodiazepiner bør gi poeng. Det samme gjelder forslag om et stemningsstabiliserende antiepileptikum.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter to dager i avdelingen blir pasienten økende urolig. Han har nå et svingende bevissthetsnivå. I lange perioder er han nå også blitt akutt synshallusinert. Han ser ikke-eksisterende figurer og dyr på veggene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlige årsak til disse symptomene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har utviklet delirium. Dette er sannsynlig på bakgrunn av alkoholabstinens.
Alkoholabstinens delir er også riktig svar.
Delirium tremens er også rett.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Abstinensreaksjon på rusmidler/alkohol gir poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den primære, psykofarmakologiske behandlingsstrategi for denne tilstand?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Benzodiazepiner er igjen rett. Det er et førstevalg i nesten alle land. Her er indikasjonen enda mer økt pga allerede bruk av to antipsykotika. Stemningsstabiliserende antiepileptika kan vurderes.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Benzodiazepiner gir 1 poeng. Hvis et benzopreparatnavn nevnes (eks Sobril) bør det gi et poeng. 0,5 poeng hvis forslaget er stemningsstabiliserende antiepileptika.
Tillegg 31/5: det skal gis 1/2 poeng for å svare tiamin. Man må svare (et) benzodiazepin for å få full skåre/ 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten er urolig. Han forlanger røyk. Det er et røykfritt sykehus. Han er for syk til å gå ut og røyke.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør denne situasjonen håndteres?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Han må tilbys alternativ nikotinsubstitusjon så som plaster, tyggegummi, snus eller lignende.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Forslag om tilførsel av nikotin som ikke har potensiale for å skade andre.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter tre ukers behandling er pasienten fortsatt psykotisk, men han har nå symptomer og funksjon på samme nivå som han har hatt de siste år. Han kan reflektere relativt fornuftig om sin sykdom og de aktuelle behandlingsalternativ. Han er i alle fall delvis enig i at han trenger litt hjelp og oppfølging en periode framover.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det fortsatt hjemmel for bruk av tvungent psykisk helsevern? Gi begrunnelse for svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rett svar er nei. Det er ikke lenger åpenbart at pasienten mangler samtykkekompetanse, og han har ikke i perioden vært til fare for andre.
Tvilsomt bør også godtas hvis begrunnelsen er som over
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alle svar som uttrykker og begrunner tvil om kriterier fortsatt er tilstede
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved utskrivelse er han relativt kjekk. Han vil samarbeide om behandling og ettervern. I samtalen merker du imidlertid at han er motorisk urolig. Han har vansker med å sitte stille. På spørsmål forteller han om "uro i beina"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan dette skyldes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekstrapyramidale bivirkninger i form av akatisi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bivirkninger av antipsykotika
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved utskrivelse medisineres fortsatt pasienten med en relativt stor dose
antipsykotika.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan dette influere på hans somatiske helse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her bør flere ting nevnes som går på metabolske bivirkninger og riskofaktorer. Forverret effekt på overvekt, hypertensjon og røyking og fare for kardiovaskulær sykdom som fører til økt risiko for tidlig død.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Minst 3 av det ovennevnte for full pott. 1 eller 2 av det ovennevnte gir 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har nettopp begynt å jobbe på en barneavdeling og har allerede flere ganger tatt imot barn med feberkramper, samt deres ofte traumatiserte foreldre. Du har brukt "Akuttveileder i pediatri" (Norsk barnelegeforening/Den Norske legeforening) for å oppdatere deg om utredning og behandling, men la merke til at veilederen sist ble oppdatert i 2012. Alle barna du har møtt har blitt utskrevet i fin form, med resept på Buccolam oralsprøyte til bruk ved senere krampeanfall med en viss varighet. Foreldrene til et av barna som hadde hatt flere anfall var imidlertid svært bekymrede og lurte på om det fantes noe forebyggende medisin som reduserte sannsynligheten for nye anfall.
Du vil undersøke om det fins ny kunnskap om forebyggende behandling, f. eks medikamenter med antiepileptisk effekt. Du søker i Cochrane-databasen, hvor du finner artikkelen "Prophylactic drug management for febrile seizures in children" fra 2017.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags type studier kan du finne i Cochrane-databasen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Systematiske oversikter/gjennomganger (kvalitetskontrollerte)
* Systematic reviews (evt også meta-analyser)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for variant av systematisk oversikt.
* Kun 0,5 poeng for metaanalyse (uten systematisk oversikt).
* Kun 0,5 poeng for kunnskapsbasert/forskningsbasert kunnskap (uten systematisk oversikt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ifølge resultatene i artikkelen synes det å være en viss effekt av forebyggende behandling med intermitterende (dvs gitt ved feber) diazepam. Resultatene er presentert i tabellform:
<<imgLink "IIC-2018-2-A.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke grupper er sammenlignet her, og hvilke utfall er vurdert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Intermitterende bruk av diazepam (oralt/rektalt) sammenlignes med placebo eller ingen behandling for barn med feberkramper som ikke er innlagt/poliklinisk.
Sammenligningen er gjort for tilbakevendende anfall ved 6, 12, 18, 24, 36, 48 og >60 mnd (7 ulike utfall)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Intermitterende diazepam vs placebo/ingen behandling (1p)
For barn med feberkramper i en poliklinisk setting (0,5 p)
Utfall: Tilbakevendende anfall ved 6, 12, 18, 24, 36, 48 og >60 mnd (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIC-2018-2-A.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Se på resultatet for tilbakevendende anfall ved 24 måneder (Recurrent seizure at 24 months). Hvilket effektmål er benyttet for å sammenligne effekten av intermitterende diazepam med placebo/ingen behandling? Gi en tolkning av effektestimatet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Relativ risiko (RR) evt risk ratio
De som fikk intermitterende diazepam hadde 27% lavere risiko for anfall sammenlignet med de som fikk placebo/ingen behandling
De som fikk intermitterende diazepam hadde 0,73 ganger så stor risiko for anfall sammenlignet med de som fikk placebo/ingen behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Relativ risiko (RR) evt risk ratio (1p)
En av variantene over (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I denne studien er kvaliteten på kunnskapsgrunnlaget vurdert med GRADE. Forklar graderingen i GRADE og hva denne er basert på
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
GRADE Working Group grades of evidence
* ''High quality'': We are very confident that the true effect lies close to that of the estimate of the effect
* ''Moderate quality'': We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
* ''Low quality'': Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
* ''Very low quality'': We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
Type studie av betydning (RCT starter på "høy", observasjonsstudie på "lav")
Kvaliteten på studiene av betydning (kan graderes opp eller ned ved hhv god og dårlig kvalitet (lav /høy risiko for bias)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne alle fire kategorier rett (0.5 hvis nesten rett)
1 poeng for å gi supplerende info om fortolkning eller nevne typen studier og kvaliteten på disse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIC-2018-2-A.PNG" 600>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken kvalitet ble kunnskapsgrunnlaget for tilbakevendende anfall ved 24 mnd vurdert til (figur 1)? Hva kan vi anta om studiene som ligger til grunn for denne vurderingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Høy/high
Basert på RCT-studier av god kvalitet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Høy/high (1 p)
Basert på RCT-studier (0,5 p)
av god kvalitet/lav risiko for bias (også poeng hvis nevner forhold som gir lav risiko for bias – god randomisering, lite frafall, blinding eller lav heterogenitet mellom inkluderte studier (0,5 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forebyggende behandling med diazepam eller andre medikamenter er ikke anbefalt til barn med feberkramper (på tross av resultatene over). Hva kan være begrunnelsen for dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Godartet tilstand.
Små kliniske effekter.
Bivirkninger
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng om et av ovennevnte
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En dame på 75 år faller på isen. I det hun treffer bakken tar hun seg for med dorsalflektert venstre håndledd. Hun hører et knekk og får akutte smerter. Det er gaffelfeilstilling i håndleddet. Du legger merke til at hun har ringer på 2 fingre i skadet hånd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken primærbehandling vil du gi på skadestedet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ta av ringer på skadet hånd.
* Gi smertestillende.
* Legge på stabiliserende skinne
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1/3 poeng: Ta av ringer på skadet hånd
* 1/3 poeng: Gi smertestillende
* 1/3 poeng: legge på en stabiliserende skinne
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten ankommer skadepoliklinikken og du har vakt. Du undersøker pasienten og mistenker brudd i håndleddet
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* Hvordan vil du undersøke pasienten?
* Pasienten angir nummenhet i 1.- 3. finger volart – hva kan årsake dette?
* Hva er neste steg i utredningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Gjøre en klinisk undersøkelse av pasientens skadde håndledd. Sjekker puls distalt. Sjekker sensibilitet.
* Affeksjon av nervus medianus gir nummenhet i 1-3- finger.
* Henvise til røntgen av venstre håndledd.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng: Gjøre en klinisk undersøkelse av pasientens skadde håndledd. Sjekke puls distalt. Sjekke sensibilitet. (alle punkt må nevnes
* 1 poeng: Affeksjon av nervus medianus gir nummenhet i 1-3-finger.
* 1 poeng: Henvise til røntgen av venstre håndledd.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har en dislosert distal radiusfraktur av Colles type, se bilde 1 a og b.
<<imgLink "IIC-2018v-1-A.PNG" 400>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvilken type feilstilling som karakteriserer denne feilstillingen. Hvilke andre typer frakturmønster kan en distal radiusfraktur i hovedtrekk ha?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Feilstillingen som karakteriserer en colles fraktur er radial forkortning, redusert inklinasjon og dorsal vinkling av radius
I hovedtrekk har man to andre frakturmønster: Smiths fraktur der man har volar vinkling av distal fragmentet og Bartons fraktur som enten er en volar eller dorsal intraartikulær skråfraktur,
Sjåfør fraktur er også riktig svar.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng: Radial forkortning, redusert inklinasjon og dorsal vinkling av radius
0.5 poeng: Smiths fraktur : volar vinkling av distal fragmentet
0.5 poeng: Bartons fraktur: volar eller dorsal intraartikulær fraktur.
Sjåfør-fraktur gir 0.5 poeng hvis den er nevnt men ikke Smith eller Barton.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er videre behandling av denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved feilstilt Colles fraktur er det anbefalt reponering i lokalanestesi og gipsing
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng: Reponering i lokalanestesi og anleggelse av gips. Begge punkter må til for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du stabiliserer bruddet. Hvilken gips legger du? Beskriv hvordan en korrekt gips ser ut for denne pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten skal alltid ha en halvgips på grunn av fare for hevelse og for å unngå trang gips.
Gipsen skal ikke gå lenger distalt enn til mcp-leddene og 2-3 fingerbredder fra albuebøyen. Tommelen skal ha fri bevegelighet. Gipsen skal ikke trykke på huden
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng: Pasienten skal alltid ha en halvgips på grunn utvikling av hevelse og fare for trang gips
* 0.5 poeng: Gipsen skal ikke gå lenger distalt enn til mcp-leddene
* 0.5 poeng: Gipsen skal ikke gå lenger proksimalt mot albuen enn 2-3 fingerbredder fra albuebøyen.
* 0.5 poeng: Tommelen skal ha fri bevegelighet. Og gipsen skal ikke trykke på huden.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken informasjon er viktig og gi til en pasient med et ferskt håndleddsbrudd etter behandlingen på skaden og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten skal holde hånda høyt og bevege fingrene for å motvirke hevelse/ ødem i fingre.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng: Pasienten skal holde hånda høyt og bevege fingrene.
* 0.5 poeng: Dette vil motvirke hevelse/ødem i fingrene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 35 år blir lagt inn for første gang i psykiatrisk sykehus i hht § 3.2 i Psykisk helsevernloven. Familien har vært bekymret. Hun har tidligere i livet hatt et par perioder hvor hun har vært forandret med noe mer aktivt og utadvendt levesett enn vanlig. Hun har da også vært mer oppstemt og hatt søvnløshet uten at det har bragt henne til behandling. Hun har nå over mer enn seks uker blitt mer og mer søvnløs, engstelig, og fortvilet. Matinntak har vært minimalt de siste ukene. Ektemannen er i tvil om væskeinntak. De siste par netter har hun knapt sovet. Hun ble innlagt etter at ektemannen oppdaget at hun var på vei ut av huset tynnkledd midt på natten.
Legevakt fikk ikke motivert henne til frivillig innleggelse. Pasienten ga dårlig emosjonell kontakt, maktet knapt å svare og samarbeidet ikke ved somatisk undersøkelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige diagnosen? Spesifiser så langt du kan.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bipolar lidelse type 2 med aktuell episode alvorlig depresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Bipolar depresjon. Bipolar lidelse. Alvorlig depressiv episode. En av disse tilfredsstillende for 1 poeng. Bare depresjon gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det grunnlag for innleggelse til tvungen observasjon (§ 3-2) i Psykisk helsevernloven? Gi begrunnelse for svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja. Hun er alvorlig deprimert og det er mistanke om psykose. Hun er til fare for seg selv pga næringsvegring og atferd som indikerer suicidal intensjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Pasienten har en depressiv psykose og er alvorlig sinnslidende. Hun er deprimert, agitert, søvnløs og kanskje psykotisk og dermed til fare for seg selv.
1 poeng for sannsynlig alvorlig sinnslidelse, 1 poeng for at hun er til fare for seg selv.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er pasienten i behov av spesielle vitaminer eller mineraler?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tiamin gitt parenteralt. (på grunn av lite matinntak i flere uker)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tiamin. Vit B-1.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten forblir svært urolig, engstelig og nesten desperat i avdelingen. Hun nekter helt for at hun har noen tanker eller planer om suicid.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør hun passes på i avdelingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten må vurderes som i stor fare for suicidale handlinger. Hun må følges tett og bør ha intervallobservasjon med maksimalt fem minutters intervall. Ernæringssituasjon og væskebalanse tilsier også behov for tett oppfølging.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hun må passes godt på og følges tett opp på avdeling fordi hun har forhøyet suicidalrisiko. Dette er tilstrekkelig for 1 poeng.
Hun er til fare for seg selv pga ernæringssituasjonen og væskebalansen. Dette svaret alene gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner grunn til å gi farmakologisk behandling for pasientens desperasjon, angst, agitasjon og søvnløshet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken medikamentgruppe er mest fornuftig å tilby for å gi rask bedring av tilstanden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Benzodiazepiner.
Lav dose annen generasjons antipsykotika kan også benyttes, e.t i tillegg til benzodiazepiner
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Benzodiazepin alene gir 2 poeng, eksempel diazepam, clonazepam, lorazepam osv.
Lav dose annen generasjons antipsykotika gir også poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner ut at pasienten må ha en depresjon. Du tenker først at du skal starte med antidepressiva.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan være grunner til ikke å bruke antidepressiva her?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten er agitert, desperat og sannsynligvis suicidal.
Antidepressiva kan øke desperasjon og suicidfare
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Antidepressiva kan øke suicidfare.
Antidepressiva kan øke uro, desperasjon og angst.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du tenker at pasienten trenger stemningsstabiliserende medikasjon. Du lurer på om valproat (Orfiril) kan være et godt valg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det noen grunn til at du skal være tilbakeholden med valproat til denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er en ung kvinne, preparatet skal i utgangspunktet ikke brukes til kvinner i fertil alder grunnet sitt høye teratogene potensiale. Vi har heller ikke utelukket svangerskap.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tilfredsstillende for 1 poeng om en problematiserer at hun er en ung kvinne og at bivirkningsprofilen tilsier forsiktighet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er ortoped i mottak på et mellomstort sykehus. Du møter en 80-årig mann som har falt hjemme og nå plages med sterke smerter i høyre hofte. Han kan ikke belaste på høyre ben. Han har ingen kjente sykdommer. Det er ikke gjort noen bildediagnostikk før du møter pasienten så du velger å henvise til røntgen av bekken og høyre hofte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor henviser du til røntgen og hva er styrkene ved røntgenundersøkelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen er anbefalt som primær undersøkelse for deteksjon og kartlegging/klassifisering av antatt hoftefraktur. Lav stråledose, lett tilgjengelig, lite resurskrevende, relativ rask undersøkelse, fleksible projeksjoner og at den gir prognostisk informasjon er eksempel på styrker ved røntgen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Deteksjon 0,5p, kartlegging/klassifisering 0,5p. Lav stråledose, lett tilgjengelig, lite resurskrevende, relativ rask undersøkelse, fleksible projeksjoner, gir prognostisk informasjon gir 0,5p hver.
Totalt maks 3p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten blir sendt til røntgen av bekken og høyre hofte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke røntgenfunn indikerer at det kan foreligge en fraktur (på generelt grunnlag)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Cortical diskontinuitet, forstyrret trabekulering, mangel på kalk, økt tetthet ved komprimerte brudd, løse fragmenter, bløtdelshevelse
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5p hver (maks 2p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake fra røntgen. Bildene er beskrevet som negative av radiologen. Du vurderer at det likevel kan foreligge en fraktur som ikke vises på røntgen (okkult fraktur) og henviser pasienten til MR
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 4 faktorer som kan utgjøre kontraindikasjoner mot MR og som må vurderes før pasienten kan sendes til MR.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pacemaker, cochleaimplantat, andre elektroniske komponenter, metall i pasientens kropp, motorisk uro, smerter som gjør at pasienten ikke kan ligge i ro, klaustrofobi, kommunikasjonsproblem, nyresvikt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p hver, maks 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake fra MR-undersøkelsen. Radiologen sier at det foreligger en udislosert fraktur i høyre collum femoris
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan MR fremstille som indikerer at det kan foreligge en skjelettskade?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ødem i ben, ødem i bløtvev, frakturlinje
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5p hver, maks 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du diskuterer pasienten med din bakvakt på ortopeden og dere kommer frem til å anbefale pasienten operasjon med fiksering av frakturen med 2 skruer i collum femoris.
Pasienten gjennomgår en vellykket operasjon og mobiliseres på sengepost. Overlegen på sengeposten ber deg om å sende en henvisning til en post-operativ bildediagnostisk undersøkelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse henviser du til? Hva er formålet med den undersøkelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen av bekken og høyre hofte. Dokumentasjon av postoperative forhold, for å se etter komplikasjoner til operasjon, som utgangspunkt for senere røntgenkontroller, for å vurdere feilstilling i bruddet, for å vurdere om osteosyntesen er intakt og korrekt plassert, for å vurdere leddflatene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Første delen av spørsmålet (1p) skal få studenten til å velge riktig modalitet. Flere svar er mulige, men svaret må inneholde en røntgen-undersøkelse som fremstiller høyre hofte (bekken, protesebekken, innskutt bilde av høyre hofte).
I den andre delen av spørsmålet gir hver svarskomponent 0.5p, maks 1p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er student i 6.-års praksis i Brekfast kommune og får i oppdrag av kommunelegen å revidere en brosjyre for overvektige til bruk i kommunens Frisklivssentral "Overvektig? 5 enkle råd i hverdagen". Du tenker at det er viktig at slik informasjon må være kunnskapsbasert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er kunnskapsbasert praksis?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kunnskapsbasert praksis er å ta faglige avgjørelser basert på systematisk innhentet forskningsbasert kunnskap, erfaringsbasert kunnskap og pasientens ønsker og behov i en gitt situasjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng hvis alle:
* forskningsbasert kunnskap
* erfaringsbasert kunnskap og
* pasientens ønsker og behov
ev. også hvis to av disse + kontekst/gitt situasjon er presisert 0.5 poeng hvis kun forskningsbasert kunnskap er angitt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Brosjyren ser gammel ut, virker utdatert og du betviler at den holder den nødvendige kvaliteten som kreves i dag. Du bestemmer deg for å søke etter relevant kunnskap på nett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skisser kort en strategi for hvordan du vil innhente kunnskap. Hvilken type kunnskap leter du etter, hvor starter du, og hvilke kilder eller nettsider benytter du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det gjelder å finne rett informasjon, og det vil være viktig å formulere hva vi ønsker kunnskap om på en presis måte.
Når vi skal finne oppdatert kunnskap som grunnlag for anbefaling til pasienter bør vi starte på toppen av kunnskapspyramiden – dvs lete etter oppsummert kunnskap først. Oppsummert kunnskap har den fordelen at andre allerede har gjort jobben for oss med å finne, vurdere og samle all relevant kunnskap på en kritisk og systematisk måte.
Kliniske oppslagsverk – hva fins på UpToDate, BMJ Best Practice evt NEL?
Foreligger det kunnskapsbaserte (nasjonale) retningslinjer eller veiledere?
Hva foreligger av oppsummert forskning eller kunnskapsoversikter?
I praksis kan vi f. eks. gå inn på Helsebiblioteket. Her kan vi gjøre et pyramidesøk, som vil gi oss aktuelle treff i alle nivåene på kunnskapspyramiden. Vi kan også gå inn i de kliniske oppslagsverkene direkte. Og vi kan gå inn på ulike deler av Helsebiblioteket (retningslinjer, oppsummert forskning). Vi kan etter hvert og for mer avgrensede problemstillinger søke etter oppdaterte oversiktsartikler eller systematiske oversikter (f. eks. på Cochrane).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for å skissere en strategi som starter på toppen av kunnskapspyramiden/oppsummert kunnskap.
* 0.5 poeng for å nevne et klinisk oppslagsverk
* 0.5 poeng for å nevne ytterligere en av kildene navngitt over (Helsebiblioteket, pyramidesøk, retningslinjer, Cochrane) eller annet som er relevant for oppsummert kunnskap
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I den gamle brosjyren er et av de fem enkle rådene knyttet til viktigheten av å spise frokost, og overvektige er frarådet å hoppe over dette måltidet. Du bestemmer deg for å sjekke kunnskapsgrunnlaget for dette rådet mer spesifikt, og under leting etter nyere forskning fatter du derfor interesse for artikkelen "Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials" publisert av Sievert et al. i BMJ i januar 2019.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dette er en systematisk oversikt og metaanalyse. Hva kjennetegner dette studiedesignet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En systematisk oversikt er en oversikt over flere artikler om samme emne som kjennetegnes ved at det er benyttet en systematisk og beskrevet fremgangsmåte for å finne, vurdere og oppsummere enkeltstudier (gjennomsiktig og reproduserbar fremgangsmåte). En godt utført studie gir et balansert bilde av forskningen som foreligger.
Når det i tillegg er gjort en meta-analyse betyr det at de enkelte studiene er analysert sammen for å gi et samlet resultat for flere eller alle studiene som inngår i den systematiske oversikten – en kvantitativ sammenstilling av resultatene fra enkeltstudiene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for å beskrive systematisk oversikt som en studie som
** gir oversikt over/oppsummerer enkeltstudier OG
** kjennetegnes av systematisk metode/fremgangsmåte i alle ledd (1/2 poeng hvis bare en av disse)
* 1 poeng for å si at en systematisk oversikt med meta-analyse også inneholder en felles analyse av resultater fra enkeltstudier og med et samlet resultat (samle-estimat).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I sammendraget er resultatet fra studien oppsummert slik:
<<<
RESULTS
Of 13 included trials, seven examined the effect of eating breakfast on weight change, and 10 examined the effect on energy intake. Meta-analysis of the results found a small difference in weight favouring participants who skipped breakfast (mean difference 0.44 kg, 95% confidence interval 0.07 to 0.82), but there was some inconsistency across trial results (I2=43%). Participants assigned to breakfast had a higher total daily energy intake than those assigned to skip breakfast (mean difference 259.79 kcal/day, 78.87 to 440.71; 1 kcal=4.18 kJ), despite substantial inconsistency across trial results (I2=80%). All of the included trials were at high or unclear risk of bias in at least one domain and had only short term follow-ups (mean period seven weeks for weight, two weeks for energy intake). As the quality of the included studies was mostly low, the findings should be interpreted with caution.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hva analysen for vektendring viser på en slik måte at det er forståelig for sykepleieren som jobber på Frisklivssentralen. Hva blir konklusjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man fant 13 studier som så på betydningen av det å spise frokost for vektendring. Konklusjonen fra disse studiene var at de som stod over frokosten faktisk i gjennomsnitt gikk ned litt mer (0,4 kg) i vekt enn de som spiste frokost.
Selv om det er noe usikkerhet rundt hvor stor forskjellen i vektendring var, er det ut ifra denne studien ingenting som tilsier at vi på et generelt grunnlag bør anbefale frokost dersom målet er å gå ned i vekt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng hvis beskriver på en grei måte at de som ikke spiste frokost i gjennomsnitt gikk litt mer ned i vekt (evt mindre opp i vekt) eller at de som spiste frokost i gjennomsnitt gikk mer opp i vekt (evt mindre ned i vekt)
0.5 poeng for å beskrive at man på grunnlag av dette ikke kan anbefale frokost for vektreduksjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
RESULTS
Of 13 included trials, seven examined the effect of eating breakfast on weight change, and 10 examined the effect on energy intake. Meta-analysis of the results found a small difference in weight favouring participants who skipped breakfast (mean difference 0.44 kg, 95% confidence interval 0.07 to 0.82), but there was some inconsistency across trial results (I2=43%). Participants assigned to breakfast had a higher total daily energy intake than those assigned to skip breakfast (mean difference 259.79 kcal/day, 78.87 to 440.71; 1 kcal=4.18 kJ), despite substantial inconsistency across trial results (I2=80%). All of the included trials were at high or unclear risk of bias in at least one domain and had only short term follow-ups (mean period seven weeks for weight, two weeks for energy intake). As the quality of the included studies was mostly low, the findings should be interpreted with caution.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I sammendraget fremgår det at de inkluderte studiene hadde dels høy risiko for bias. Hvilke er de viktigste kildene til bias i den typen studier som er inkludert her (generelt for den typen studier), og hvilken type bias tror du gjennomgående er tilstede i alle studiene (spesielt for studiene som er inkludert i dette tilfellet)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det inkludert randomiserte kontrollerte studier (RCTstudier). Hovedkilder til bias i RCT-studier er knyttet til randomiseringsprosedyren, manglende blinding (av deltakere, studiepersonell og forskere), manglende compliance, crossover og frafall (loss to follow-up).
I RCT-studiene som er inkludert her er studiedeltakerne randomisert til frokost vs. ingen frokost. Blinding av deltakerne er umulig med en slik intervensjon, og dette vil være en viktig kilde til mulig bias
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng hvis nevner minst tre (1/2 poeng hvis 2)
0.5 poeng hvis spesifiserer manglende blinding
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
<<imgLink "IIC-2019-2-A.PNG" 400>>
I sammendraget er det kommentert at det dels er stor "inconsistency across trial results".
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket begrep brukes ofte for å betegne slik inkonsistens og hvordan kan du vurdere dette i figuren som er visualisert over?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Heterogenitet
Heterogenitet kan vurderes ved å se på graden av spredning av estimatene og konfidensintervallene i et forest plot.
I begge plotene som er visualisert i figuren er det en del spredning, og med enkeltestimater på begge sider av 0 (punktet for ingen forskjell mellom gruppene). På plot’et for vektendring synes konfidensintervallene i stor grad å overlappe, mens de er mer spredt på plot’et for energiinntak.
Den beskrevne inkonsistensen samsvarer altså godt med det vi ser på figurene, og den synes størst for energiinntak.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for heterogenitet
1 poeng for å vurdere spredning/sprik/overlapp av estimater og konfidensintervaller i forest plot.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har nå utarbeidet en revidert brosjyre basert på forskningsbasert kunnskap, klar for bruk i Brekfast Frisklivssentral.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan du inkludere også de andre bestanddelene av kunnskapsbasert praksis (fra spørsmål 1) før du trykker brosjyren i 500 eksemplarer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
For å ta inn den erfaringsbaserte kunnskapen kan du sende ut brosjyren til dine kolleger og de som jobber på frisklivssentralen. Med sin erfaring kan de bidra med innspill på hvordan de forskningsbaserte rådene passer inn i den praktiske hverdagen.
For å ta inn pasientperspektivet kan du la noen pasienter lese brosjyren og gi innspill på form og innhold. Forstår de informasjonen? Er den nyttig? Er noe problematisk?
I tillegg kan du be f. eks kommunelegen vurdere hvorvidt rådene passer med kommunens sammensetning og den lokale konteksten. Er det så mange utlendinger at man bør oversette brosjyren?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å beskrive et av perspektivene og et relevant tiltak.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege. Anne Bang er en 27 år gammel kvinne som tidligere har vært fallskjermjeger i forsvaret. Hun hadde siktet seg inn mot en karriere som yrkesmilitær, men ble dimittert for halvannet år siden på grunn av systemisk lupus erytematosus (SLE). Anne har de siste åtte månedene blitt behandlet med prednisolon. Hun har nettopp flyttet til kommunen og til fastlegelisten din, og bruker nå prednisolon i en dose på 15 mg daglig. Dere blir raskt enige om at Anne skal følges opp hos deg.
Prednisolon har hovedsakelig glukokortikoide egenskaper. Det kvantitativt dominerende endogene kortikosteroidet, kortisol, har både glukokortikoide og mineralokortikoide egenskaper.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de to viktigste – og lettest påvisbare med vanlige laboratorietester – komponentene i denne mineralokortikoide effekten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hypernatremi og hypokalemi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
To år etter er Annes prednisolondose oppe i 20 mg daglig. Hun holder seg fremdeles i full aktivitet, og skal nå på tur til Sør-Amerika sammen med bl.a. kjæresten. I den forbindelse er reisefølget blitt anbefalt å ta en rekke vaksiner. Anne ringer deg og spør om dette er et problem, eller om hun kan la seg vaksinere "slik som de fleste andre" på tross av steroidbruken.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva svarer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Inaktiverte (døde) vaksiner er i prinsipp uproblematisk (selv om det er en teoretisk risiko for nedsatt effekt av vaksinen), men levende vaksiner (både bakterielle og virale) kan gi alvorlige bivirkninger/sykdom; Anne er i utgangspunktet immunsupprimert av steroidmedikasjonen sin, og skal ikke ha levende vaksiner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poenget om at levende vaksiner ikke skal gis til immunsupprimerte holder for 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Du er fastlege. Anne Bang er en 27 år gammel kvinne som tidligere har vært fallskjermjeger i forsvaret. Hun hadde siktet seg inn mot en karriere som yrkesmilitær, men ble dimittert for halvannet år siden på grunn av systemisk lupus erytematosus (SLE). Anne har de siste åtte månedene blitt behandlet med prednisolon. Hun har nettopp flyttet til kommunen og til fastlegelisten din, og bruker nå prednisolon i en dose på 15 mg daglig. Dere blir raskt enige om at Anne skal følges opp hos deg.
Prednisolon har hovedsakelig glukokortikoide egenskaper. Det kvantitativt dominerende endogene kortikosteroidet, kortisol, har både glukokortikoide og mineralokortikoide egenskaper.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Skisser kort hovedpunktene i den generelle bivirkningsovervåkningen av Anne.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Anne skal tilses regelmessig med monitorering av bl. a. kroppsvekt, BT, serum glukose og kalium, samt spørsmål om ryggsmerter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Skjønnsmessig. Det meste må være med for å gi 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Anne forteller at hun og kjæresten har planlagt å dra på motorsykkeltur til Sør-Europa og være borte i flere måneder. Hun spør om det er spesielle hensyn hun bør ta når hun skal på langtur.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva svarer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du informerer henne om viktigheten av compliance/adherence, forsikrer deg om at hun har med seg tilstrekkelig av legemidlet og om at hun er velinformert om hva hun skal foreta seg ved sykdom, stress, etc. Det er dessuten viktig at hun har med seg skriftlig informasjon om steroidbehandlingen – f.eks. i form av Norsk endokrinologisk forenings informasjonskort eller utskrift av e-resept fra apotek.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poengene om informasjon og compliance gir 0,5 p hver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Seks uker senere ringer Anne fra Tessaloniki og forteller at hun samme dag er blitt frastjålet bagasjen med alle medisinene sine. Hun spør om hva hun skal gjøre.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva svarer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du ber henne oppsøke gresk lege/sykehus og legge fram den (forhåpentligvis skriftlige) informasjonen hun har med seg (informasjonskort fra Norsk endokrinologisk forening, annet) om sykdom og steroiddose for straks å erstatte stjålet legemiddel, slik at behandlingen fortsetter uten avbrudd.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Også her bør det meste med for å gi 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I den samme samtalen forteller Anne at hun de siste par dagene har hatt feber på 38.5 grader og smerter i halsen og i magen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva tenker du om dette, og hvilke råd gir du til Anne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hun bør overveie å doble prednisolondosen så lenge temperaturen er over 38 grader. I alle tilfelle bør nok Anne søke medisinsk hjelp på stedet pga. risiko for behandlingstrengende underliggende infeksjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begge poengene gir 0,5 p hver.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Anne kommer hjem fra turen i velbefinnende to måneder senere. Ved påfølgende kontroller er SLE-symptomene nærmest fraværende, og dere blir – i samråd med revmatologi-spesialisten på sykehuset – enige om å forsøke å seponere prednisolon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor vil du ikke seponere prednisolondosen brått?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Anne er langtidsbruker av høye doser av et potent glukokortikoid legemiddel, og hun har en suppresjon av den hypotalamiskhypofysær-adrenale feedback-mekanismen som vanligvis regulerer endogen kortisolproduksjon. Hvis hun seponerer prednisolonterapien brått, vil hun raskt utvikle en Addisonliknende sykdomsbilde som vil være livstruende.
Prednisolonbehandlingen skal derfor trappes ned langsomt og gradvis. Dette vil også kunne redusere risiko for tilbakefall av SLE-symptomer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Påpeking av Addison-faren er tilstrekkelig for 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Senere får Anne en oppblussing av sine SLE-symptomer, og det blir til at hun må fortsette med en lavere prednisolondose (5 mg daglig) for symptomkontroll. Ved en av kontrollene senere på året forteller Anne at hun og kjæresten planlegger å få et barn, men at hun har hørt at graviditet er lite ønskelig for pasienter som bruker steroider. Hun har blant annet hørt at barn av steroidbrukende mødre kan få misdannelser og andre skader.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke misdannelser og skader dreier det seg om?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mors steroidbruk kan føre til binyrebarksuppresjon og veksthemming hos barnet. Steroidbruk assosieres dessuten med leppe/gane-spalte hos barnet, men risiko er ikke stor.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2/3 gir 1 p, 1/3 gir 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du må naturligvis forhold deg til Annes graviditetsønske.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør du gi Anne råd om ikke å få barn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei. Slike vurderinger tilligger spesialisthelsetjenesten, og Anne bør i alle tilfelle henvises til revmatolog hvis hun planlegger å bli gravid. Når man justerer steroiddosen ned til laveste nivå og ev. intensiverer kontrollene og overvåkningen, er det i prinsippet ikke noe i veien for å gjennomføre graviditet under pågående steroidterapi. Noen gravide opplever at sykdomssymptomene avtar under graviditet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Positivitet og optimisme ift legemiddelterapien gir 0,5 p.
Spesialisthenvisning og/eller diskusjon av grunnsykdom som problematisk ift fosteret gir 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
To dager senere ringer Anne deg. Hun forteller at hun har vrikket ankelen, og forteller at kjæresten har et glass naproksen – et legemiddel som hun fra militæret vet at virker godt ved denne type smerter. Du har imidlertid fortalt henne at hun ikke skal bruke andre medisiner uten på forhånd å ha diskutert det med deg "pga. fare for interaksjoner".
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det noen interaksjon mellom prednisolon og naproksen? I så fall hvilken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Behandling med systemiske steroider øker faren for NSAID-induserte mageplager (gastritt, blødende magesår, ev. følgetilstander) med en faktor på ca. 2
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Påpeking av selve interaksjonen (uten å tallfeste risikoøkningen) gir 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 20 år gammel mann kommer inn på Skaden etter at han falt under fotballkamp for to dager siden. Han tok seg for med høyre hånd og fikk smerter i håndleddet, men klarte å spille resten av kampen. Siden har smertene ikke blitt bedre og han har redusert bevegelse og litt hevelse over håndleddet. Ved undersøkelse har han ikke vondt ved palpasjon av radius, men det er mer ømt radialt i selve håndleddet. Det er normal distal status
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva menes det med distal status, hvordan sjekkes det?
# Hva er din arbeidsdiagnose og hvilken undersøkelse bestiller du for å komme nærmere diagnosen den samme dagen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Undersøker sirkulasjon og sensibilitet distal for skaden, som en ledd i grundig klinisk undersøkelse.
# Scaphoid-fraktur, bestille røntgen av høgre håndledd.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Sjekke sirkulasjon og sensibilitet gir 1 poeng.
* Scaphoid-fraktur gir 0.5 poeng
* Røntgen av høgre håndledd eller rtg scaphoid, carpus gir 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har fått resultatet fra den supplerende undersøkelses som du bestilte i ledd1B og fikk gjort den samme dagen. Den viser negativt funn. Du føler at dette stemmer ikke med din kliniske oppfatning, her må det være noen patologi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvordan vil du behandle denne pasienten på skaden?
# Ville du ha tatt ham inn til kontroll og evt. når?
# Hvilken supplerende undersøkelse ville du ha bestilt ved eventuelt kontroll?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Sett på en gipslaske til å gi smertelindring og i påvente av supplerende undersøkelse.
# Sette pasienten opp til en kontroll om 2 uker, fjerne gips, ny klinisk undersøkelse og CT
# Bestill CT eller MR med spørsmål om fraktur i carpus\håndroten spesielt scaphoid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Sette på en gipslaske som smertelindring (1 poeng)
# Settes opp til kontroll 1-3 uker (1 poeng)
# Bestill CT eller MR av håndleddet med spørsmål om fraktur i scaphoid
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Håndroten, carpus, har mange små bein med store leddflater. De lager to rekker med bein, den proksimale og distale rekke.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvor mange ben er det i håndroten, carpus, og hva heter de?
# Hvilke bena er i proksimale og hvilke er i distale rekke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Det er 8 ben i carpus, scaphoid, lunatum triquitrum, pisiformis, trapezium,trapezoid, capitatum og hamatum.
# Del to:
#* I proksimale er : Scaphoid, lunatum triquitrum, pisiformis,
#* I distale er : trapezium,trapezoid, capitatum og hamatum
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 8 ben gir 0.5 poeng, 8 rett navn gir 0.5 poeng,
* 4 riktig navn i proksimale gir 0.5 poeng og 4 riktige navn i distale rekke gir 4 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilket bein i håndroten for oftest fraktur og hva er prosentvis hyppigheten av den i forhold til de andre bena i carpus?
# Hva er behandlingen for en udislokert fraktur igjennom midten av dette ben?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Scaphoid fraktur er 80 % av alle frakturer i carpus.
# 8 til 12 uker i scaphoid gips
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Scaphoid fraktur ( 0.5 poeng) og 80% ( 0.5 poeng)
# Scaphoid gips i 8-12 uker 1 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved undersøkelsen på skaden kunne det ha vært til hjelp å undersøke om det var palpasjonsømhet i bunnen av fossa tabatiere eller anatomisk snusdåse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke strukturer definerer radiale, ulnare begrensinger og bunnen i denne snusdåsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Radial begrensning EPB og APL senen 0.25 poeng
# Ulnare begrensning er EPL 0.25 poeng
# Bunnen er Scaphoid 0.5 poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Det holder med enten APL eller EPB 0.25 poeng)
# EPL 0.25 poeng.
# Scaphoid 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 20 år gammel kvinne oppsøker deg på allmennlegekontoret fordi hun har hatt feber 38,5 grader om kvelden de siste 14 dagene etter at hun kom hjem fra påskefjellet. Samtidig har hun fått plager med migrerende leddsmerter og tretthet. Hun har tidligere vært frisk, og det samme gjelder nærmeste familie. Hun bruker p-piller, ellers ingen medisiner.
Ved den kliniske undersøkelsen har hun friskt utseende, men hun er kraftig solbrent i ansiktet. BT 120/80 mmHg. Temp 38.3 grader. Hun er palpasjonsøm over MCP-ledd 2 og 3 begge hender, men det er ingen sikker hevelse. Ellers normal organstatus.
Supplerende undersøkelser på kontoret:
|! |!Resultat |!Normalverdi |
|! Hb |11.9 g/dl |11.7 – 15.3 g/dl |
|!Leukocytter |2.4 x10^^9^^/L |3.6-9.3x10^^9^^/L |
|!Trombocytter |145 x 10^^9^^/L |165-370x10^^9^^/L |
|!SR |69 mm/time |1-13 mm/time |
|!CRP |7 mg/L |<5 mg/L |
|!Urinstix |>|Blod ++; Albumin+; Leukocytter 0; Nitritt 0 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest aktuell, og hvilke differensialdiagnoser har du? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Systemisk Lupus Erythematosus (SLE): (artritt, solømfintlighet, leukopeni, feber, mulig pleuritt, mulig nefritt. Høy SR, normal CRP og leukopeni er vanlig).
# Akutt debut av revmatoid artritt (RA) eller annen systemsykdom med artritt. (Må utredes med autoantistoffer)
# Infeksjon (feber og høy SR)
# Malignitet (feber og høy SR)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne SLE. +0.5 for å nevne 1 differentialdiagnose i tillegg, 1 poeng for å nevne 2 eller 3 differentialdiagnoser i tillegg. +0.5 poeng for begrunnelse for diagnosene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
En 20 år gammel kvinne oppsøker deg på allmennlegekontoret fordi hun har hatt feber 38,5 grader om kvelden de siste 14 dagene etter at hun kom hjem fra påskefjellet. Samtidig har hun fått plager med migrerende leddsmerter og tretthet. Hun har tidligere vært frisk, og det samme gjelder nærmeste familie. Hun bruker p-piller, ellers ingen medisiner.
Ved den kliniske undersøkelsen har hun friskt utseende, men hun er kraftig solbrent i ansiktet. BT 120/80 mmHg. Temp 38.3 grader. Hun er palpasjonsøm over MCP-ledd 2 og 3 begge hender, men det er ingen sikker hevelse. Ellers normal organstatus.
Supplerende undersøkelser på kontoret:
|! |!Resultat |!Normalverdi |
|! Hb |11.9 g/dl |11.7 – 15.3 g/dl |
|!Leukocytter |2.4 x10^^9^^/L |3.6-9.3x10^^9^^/L |
|!Trombocytter |145 x 10^^9^^/L |165-370x10^^9^^/L |
|!SR |69 mm/time |1-13 mm/time |
|!CRP |7 mg/L |<5 mg/L |
|!Urinstix |>|Blod ++; Albumin+; Leukocytter 0; Nitritt 0 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du tenker at du må henvise pasienten videre til spesialist. Hvor vil du henvise pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nyrespesialist 1 poeng;
Revmatolog 1 poeng;
Indremedisiner 0.5 poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
En 20 år gammel kvinne oppsøker deg på allmennlegekontoret fordi hun har hatt feber 38,5 grader om kvelden de siste 14 dagene etter at hun kom hjem fra påskefjellet. Samtidig har hun fått plager med migrerende leddsmerter og tretthet. Hun har tidligere vært frisk, og det samme gjelder nærmeste familie. Hun bruker p-piller, ellers ingen medisiner.
Ved den kliniske undersøkelsen har hun friskt utseende, men hun er kraftig solbrent i ansiktet. BT 120/80 mmHg. Temp 38.3 grader. Hun er palpasjonsøm over MCP-ledd 2 og 3 begge hender, men det er ingen sikker hevelse. Ellers normal organstatus.
Supplerende undersøkelser på kontoret:
|! |!Resultat |!Normalverdi |
|! Hb |11.9 g/dl |11.7 – 15.3 g/dl |
|!Leukocytter |2.4 x10^^9^^/L |3.6-9.3x10^^9^^/L |
|!Trombocytter |145 x 10^^9^^/L |165-370x10^^9^^/L |
|!SR |69 mm/time |1-13 mm/time |
|!CRP |7 mg/L |<5 mg/L |
|!Urinstix |>|Blod ++; Albumin+; Leukocytter 0; Nitritt 0 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken hastegrad vil du angi på henvisningen?
# Mindre enn 1 uke
# Innen en måned
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henvisning mindre enn en uke
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Henvisning mindre enn en uke 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Videre utredning viser ANA og anti-ds DNA i høyt titer.
Kreatinin er 170 μmol/l (50 – 90 μmol/l)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systemisk Lupus Erythematosus, SLE
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systemisk Lupus Erythematosus, SLE 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
Videre utredning viser ANA og anti-ds DNA i høyt titer.
Kreatinin er 170 μmol/l (50 – 90 μmol/l)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 3 andre organer som kan affiseres ved denne tilstanden
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Sentralnervesystemet/ CNS (også psykisk affeksjon)
# Myocard
# Muskler (Myositt)
# Pleura (serositt)
# Pericard (serositt)
# Hud
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
3 organsystem gir 2 poeng
2 organsystem gir 1 poeng, 1 organsystem 0.5 poeng
Ledd, nyrer og hematologiske avvik gir ikke poeng da de er
nevnt tidligere
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under er det listet 6 medikamenter som kan brukes ved denne tilstanden
* Steroider (Prednisolon)
* Azathioprin (Imurel)
* Hydroksyklorokin (Plaquenil)
* Mykofenolat mofetil (Cell Cept)
* Cyklofosfamid (Sendoxan)
* Rituximab (MabThera)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Nevn to av disse medikamentene som kan brukes akutt for å få ned alvorlig sykdomsaktivitet (Induksjonsbehandling)
# Hvilke to av disse medikamentene brukes som basis for å få ned betennelsesaktiviteten generelt ved systemiske bindevevssykdommer (Vedlikeholdsbehandling)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
#Steroider, cyklofosfamid, rituximab, 0.25 poeng hver, max 0.5 poeng
# Hydroxyklorokin og Steroider, 0.5 poeng hver, max 1 poeng
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.25 poeng hver, max 0.5 poeng
# 0.5 poeng hver, max 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter en uke på sykehuset får pasienten akutt hevelse og
smerte i høyre tykklegg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva mistenker du at dette kan være?
# Hvilken blodprøve kan du ta for å finne ut om pasienten kan ha økt risiko for denne type komplikasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# DVT
# Antikardiolipin eller antifosfolipidantistoffer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 poeng
# 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ei 42 år gammel kvinne kommer til deg på fastlegekontoret. Hun er hudfrisk forut for det aktuelle, og har ingen andre kjente sykdommer. Hun bruker ingen faste medisiner.
For omtrent ett år siden dukket det opp hudforandringer i form av små flekker i hodebunnen og på albuer og knær. Hun ble noe bedre sist sommer, men utslettet tok seg opp igjen utover høsten. Hun har ikke forsøkt annen behandling enn fuktighetskrem. Du ber henne kle av seg, og du ser følgende hudforandringer:
<<imgLink "IIC-2019v-2-A.PNG">>
<<imgLink "IIC-2019v-2-B.PNG">>
<<imgLink "IIC-2019v-2-C.PNG">>
<<imgLink "IIC-2019v-2-D.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv utslettet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lokalisasjon: Symmetriske hudforandringer lokalisert til hodebunnen og rundt ører, på og under bryst, i axiller, på strekkesider av over- og underekstremiteter samt fortil på legger.
Efflorescenser: Består av velavgrensede, erytematøse plakk med skjelling. Mindre skjelling på intertriginøse områder (axiller og mellom/under bryst
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Symmetri (0.5 poeng)
* Lokalisasjon (0.5 poeng)
* Plakk (0.5 poeng)
* Skjelling (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Psoriasis
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Psoriasis (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling er mest aktuell å starte opp med i allmennpraksis hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Avskjelling med salisylvaselin (0,5)
* Lokale/ topikale steroider (0,5):
** Gruppe 3-4 på kropp (0,25)
** Gruppe 2 intertriginøst (0,25)
* På kroppen kan brukes krem eller salve, i hodebunnen helst oppløsning eller liniment (0,25)
** Ev. i kombinasjon med D-vitaminanaloger (kalsipotriol) (0,25)
* Fuktighetsbehandling (0,25)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per svar for de to første. 0.25 poeng for de neste, maks 2 poeng totalt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake etter 5 uker. Hun har brukt behandlingen slik du foreskrev, og hadde noe effekt, men ble ikke helt bra. Plagene har blusset opp igjen. Ved undersøkelse finner du stort sett lik utbredelse som da hun var hos deg første gang. Du henviser henne til hudlege, og hun ønsker i utgangspunktet å unngå tablettbehandling dersom dette er mulig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling er mest aktuell for hudlegen å igangsette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lysbehandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Lysbehandling (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved kontroll hos hudlegen etter 3 måneder har hun fremdeles utbredte forandringer til tross for adekvat behandling. Hudlegen mener det nå er indikasjon for systemisk behandling. Pasienten har to barn, og hun har ikke barneønske.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva slags behandling bør være førstevalg hos hudlegen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Methotrexate. Acitretin (retinoider, Neotigason) kan også være et alternativ, men Methotrexate er vanligvis førstevalg dersom det ikke er kontraindikasjoner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Methotrexate (1 poeng)
Acitretin (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har hatt god effekt av behandlingen som ble startet hos hudlegen, og følges opp med regelmessige kontroller.
Siste to måneder har hun imidlertid begynt å få utslett i ansiktet. Hun synes det særlig blusser opp når hun drikker kaffe og spiser krydret mat. Hun har forsøkt å smøre med litt kortison, men føler selv at dette gjorde det verre. Ved undersøkelse ser du følgende forandringer som ser likt ut på begge sider av ansiktet:
<<imgLink "IIC-2019v-2-E.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hudforandringene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Symmetriske forandringer i kinn, på nese og hake bestående av erytem (teleangiektasier) og papler
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Lokalisasjon:
** symmetri (0.5 poeng)
** kinn, nese, hake (0.5 poeng)
* Erytem/teleangiektasier (0.5 poeng)
* Papler (0.5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi mest sannsynlig diagnose og minst to differensialdiagnoser
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Rosacea er mest sannsynlig
Differensialdiagnoser: Acne (men fravær av komedoner samt alder taler imot), lupus (men sommerfuglerytem ville vært mest på kinn og ikke bestå av papler), perioral dermatitt (mer sannsynlig dersom bare rundt munnen, har mindre papler)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Rosacea (0,5 poeng)
Differensialdiagnoser: Acne, lupus, perioral dermatitt (0,25 poeng pr diagnose, maks 0,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var hensikten med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hensikten var å sammenlikne utfall etter implantasjon av nye typer medikamentavgivende stenter (new-generation drug-eluting stents) med rene metallstenter (bare-metal stents) blant pasienter som gjennomgår PCI-behandling. Alternativt kan studenten angi at hensikten var å sammenlikne sikkerhetsprofilen mellom disse to behandlingene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må kunne gjengi hensikten. Her gis ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket studiedesign ble brukt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systematisk oversikt (systematic review) og meta-analyse av randomiserte intervensjonsstudier. Studenten kan også nevne at det er anvendt data på individnivå (individual-level) i metaanalysen, men det kreves ikke for å få poeng.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systematisk oversikt (1/2 poeng) og meta-analyse (1/2 poeng) av randomiserte intervensjonsstudier (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var det primære endepunktet i studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et samleendepunkt (composite endpoint) av hjertedød eller hjerteinfarkt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det primære endepunktet må kunne gjengis. Her gis ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Studieresultatene er oppgitt som hazard ratio, som er en form for relativ risiko. Hva var studiens hovedfunn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Risikoen for det primære endpunktet var 16% lavere blant dem som fikk medikamentavgivende stent sammenliknet med dem som fikk ren metallstent.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må angi at risikoen for det primære endepunktet var lavere blant dem som fikk medikamentavgivende stent sammenliknet med dem som fikk ren metallstent (1 poeng) og også angi hvor sterk sammenhengen var, enten ved å angi 16% lavere risiko eller hazard ratio 0,84 (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
For sammenlikning av det primære endepunktet mellom de to behandlingsgruppene var p-verdien <0,001. Hva betyr det?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det betyr at det er meget liten sannsynlighet for å finne en minst så stor forskjell mellom de to behandlingsgruppene dersom nullhypotesen er sann (dvs. dersom risikoen for utfallet i virkeligheten er lik ved de to behandlingene). Alternativt kan det presiseres at denne sannsynligheten er <0,001. Alternativt kan det angis at resultatene i meget liten grad er forenlige med nullhypotesen om at sannsynligheten for utfallet er likt ved de to behandlingene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Angivelse som over gir 1 poeng. Det gis ikke poeng for å angi at sannsynligheten for nullhypotesen er <0,001, at sannsynligheten for at funnet er tilfeldig er <0,001 eller liknende.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
Oppgaven baserer seg på utdelt artikkelsammendrag fra artikkelen Piccolo et al. //Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.// Lancet 2019; 393: 2503–10
<<<
''Background'': New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear.
''Methods'': We did an individual patient data meta-analysis of randomised clinical trials to compare outcomes after implantation of new-generation DES or BMS among patients undergoing percutaneous coronary intervention. The primary outcome was the composite of cardiac death or myocardial infarction. Data were pooled in a one-stage random-effects meta-analysis and examined at maximum follow-up and a 1-year landmark. Risk estimates are reported as hazard ratios (HRs) with 95% CIs. This study is registered in PROSPERO, number CRD42017060520.
''Findings'': We obtained individual data for 26 616 patients in 20 randomised trials. Mean follow-up was 3·2 (SD 1·8) years. The risk of the primary outcome was reduced in DES recipients compared with BMS recipients (HR 0·84, 95% CI 0·78-0·90, p<0·001) owing to a reduced risk of myocardial infarction (0·79, 0·71-0·88, p<0·001) and a possible slight but non-significant cardiac mortality benefit (0·89, 0·78-1·01, p=0·075). All-cause death was unaffected (HR with DES 0·96, 95% CI 0·88-1·05, p=0·358), but risk was lowered for definite stent thrombosis (0·63, 0·50-0·80, p<0·001) and target-vessel revascularisation (0·55, 0·50-0·60, p<0·001). We saw a time-dependent treatment effect, with DES being associated with lower risk of the primary outcome than BMS up to 1 year after placement. While the effect was maintained in the longer term, there was no further divergence from BMS after 1 year.
''Interpretation'': The performance of new-generation DES in the first year after implantation means that BMS should no longer be considered the gold standard for safety. Further development of DES technology should target improvements in clinical outcomes beyond 1 year.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fortrinn har dette studiedesignet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systematiske oversikter med metaanalyser gir, sammenliknet med enkeltstudier, en balansert og samlet framstilling av kunnskapen om problemstillingen og gir større presisjon /statistisk styrke enn enkeltstudiene. Enkeltstudiene som inngår i denne metaanalysen er randomiserte intervensjonsstudier, som har den fordelen framfor observasjonsstudier at konfundering unngås fordi behandlingen blir tilfeldig tilordnet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systematiske oversikter med metaanalyser gir, sammenliknet med enkeltstudier, en balansert og samlet framstilling av kunnskapen om problemstillingen (1 poeng) og gir større presisjon/statistisk styrke enn enkeltstudiene (1 poeng).
Enkeltstudiene som inngår i denne metaanalysen er randomiserte intervensjonsstudier, som har den fordelen framfor observasjonsstudier at konfundering unngås (1 poeng) fordi behandlingen blir tilfeldig tilordnet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Denne oppgaven handler om legemiddelbehandling ved bipolar lidelse.
En 28-årig kvinne som tidligere har hatt en depressiv episode, debuterer med en akutt manisk episode av moderat grad, uten psykotiske symptomer. Hun bruker ingen legemidler fra tidligere.
I akutt manisk fase sier Helsedirektoratets generelle behandlingsretningslinjer at følgende tre alternativer er likestilte førstevalg:
* Litium
* Valproat
* Et antipsykotisk middel
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket av disse tre bør du unngå hos denne pasienten, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Valproat. Dette midlet skal i utgangspunktet ikke brukes til kvinner i fertil alder på grunn av risikoen for fosterskade hvis kvinnen blir gravid. (Kan tillates hvis kvinnen følger et spesielt graviditetsforebyggende program. Dette kreves ikke for rett svar, men hvis noen har svart det, er det ikke feil).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for valproat og 0,5 poeng for rett begrunnelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En pasient kommer inn i akuttmottaket med en alvorlig litiumforgiftning. Det bestemmes at det skal utføres hemodialyse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke egenskaper ved litium er det som gjør at hemodialyse er så effektivt for å fjerne midlet fra kroppen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lite distribusjonsvolum. Lav proteinbinding. Lav molekylvekt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hver. Med andre ord er det nok med to av de tre alternativene for å få full pott.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvor stor grad er det nyttig og viktig å følge opp med serumkonsentrasjonsmålinger av henholdsvis litium, valproat og et antipsykotisk middel hvis disse brukes ved bipolar lidelse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er obligatorisk å følge opp litiumbehandling med serumkonsentrasjonsmålinger. For behandling med valproat og antipsykotika kan serumkonsentrasjonsmålinger være til hjelp i behandlingen, men det er av mindre betydning; klinikken er det viktigste. (Det er mindre viktig å følge behandlingen med valproat på indikasjon bipolar lidelse enn på indikasjon epilepsi, så ved bipolar lidelse kan valproat likestilles med antipsykotika.
Det gis likevel ikke trekk til de som skriver at det er viktigere å følge konsentrasjonen av valproat enn av antipsykotika).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for riktig svar på litium. 0,5 poeng til sammen for korrekt resonnement rundt valproat og antipsykotika.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når en pasient behandles med litium bør pasienten følges med medisinsk biokjemiske blodprøver, blant annet for å fange opp utviklingen av bivirkninger
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke blodprøver dreier det seg om, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# TSH og fritt T4. Risiko for hypotyreose.
# Kreatinin/eGFR. Risiko for nedsatt nyrefunksjon som bivirkning (svært liten, men viktigere er det at litium må doseres ut fra nyrefunksjon siden det utskilles umetabolisert via nyrene).
# Kalsium. Økt risiko for hyperkalsemi.
# Na og K. Følges gjerne med tanke på litiums effekter på nyrene (og effekten av elektrolyttforstyrrelser på litiumkonsentrasjonen).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,25 for hver av de fire
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hos en pasient som starter opp med litium, hvilke andre organsystemer bør du være oppmerksom på bivirkninger fra? (Altså bivirkninger som ikke fanges opp ved hjelp av blodprøver). Nevn fire organsystemer med tilhørende eksempler på bivirkninger. («Helgarderinger» med mer enn fire organsystemer, honoreres ikke.)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* CNS: Nevrologiske/nevromuskulære bivirkninger (ikke minst tremor og muskelsvakhet) og psykiske bivirkninger (forvirring, tretthet/sedasjon m.m.)
* Gastrointestinaltraktus (diare, magesmerter, kvalme osv).
* Hud (akne, psoriasis m.m.)
* Nyre (tørste, polyuri m.m.)
* Hjerte (i hovedsak uspesifikke EKG-forandringer hvis ikke konsentrasjonen blir høy, da kan arytmier forekomme)
* Vektøkning (som en separat generell bivirkning som ikke kommer fra noe spesielt organsystem)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 for hvert organsystem opp til maksimalt fire. Hvis det nevnes __mer enn fire__ organsystemer og noen av disse er feil, gis det 0.25 poeng i fratrekk for hvert organsystem som ikke er riktig.
(Helgarderinger honoreres med andre ord ikke!). Men hvis noen har delt opp CNS i to systemer (nevrologiske og psykiske) gir det til sammen 0.5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved oppstart med litium, er det noe spesielt du bør si til pasienten når det gjelder samtidig bruk av reseptfrie legemidler? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Unngå bruk av NSAIDs (ibuprofen, diklofenak, acetylsalisylsyre osv). Velg heller paracetamol. NSAIDs kan øke konsentrasjonen av litium pga. effekter på nyrene, spesielt hos pasienter som allerede har tendens til eller manifest nedsatt nyrefunksjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
"Unngå bruk av NSAIDs" gir 0,5 poeng. Begrunnelsen gir 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når en pasient starter opp med det antipsykotiske midlet olanzapin, bør pasienten følges med medisinsk biokjemiske blodprøver med tanke på bivirkninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke blodprøver dreier det seg om, og hvorfor?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Glukose og/eller HbA1c. Risiko for utvikling av diabetes
* Kolesterol (totalkolesterol, evt. LDL/HDL). Risiko for utvikling av forhøyede (LDL-) kolesterolnivåer.
* Triglyserider. Risiko for utvikling forhøyede triglyseridnivåer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5 poeng for glukose ("blodsukker") / HbA1c
* 0,25 poeng for kolesterol (eventuelt med varianter)
* 0,25 poeng for triglyserider
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ett år senere kommer pasienten i deloppgave 1 tilbake med en depressiv episode. Det viser seg at hun på egenhånd har avsluttet behandlingen med det midlet hun brukte som residivprofylakse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tanker gjør du deg når det gjelder oppstart med et antidepressivt legemiddel i denne situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Oppstart med et antidepressivt middel i monoterapi bør unngås (selv om risikoen for switch til en mani trolig er svært uvanlig/ikke-forekommende med moderne midler som SSRI-er).
Antidepressiva kombinert med for eksempel et antipsykotisk middel som olanzapin kan gis, men det kan være minst like rasjonelt å heller velge for eksempel litium.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Skjønnsmessig vurdering. Godt resonnement rundt bruk i monoterapi gir 0,5 poeng og godt resonnement rundt bruk som ledd i kombinasjonsbehandling gir 0,5 poeng. Skriver man bare at antidepressiva ikke bør brukes, men at pasienten i stedet bør behandles med et stemningsstabiliserende middel, kan dette gi full pott hvis svaret er vel begrunnet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten i den innledende vignetten er i stedet en 28-årig mann med kroppsmasseindeks (BMI) på 32,0 kg/m^^2^^ , dvs. har fedme grad I.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør du tenke spesielt på ved bruk av tre midlene litium, valproat og olanzapin hos denne pasienten? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alle de tre midlene kan påvirke kroppsvekten, men olanzapin trolig i størst grad. Det viktige i svaret er imidlertid ikke å kunne differensiere mellom de tre midlene, men å føre er OK resonnement basert på det som gir poeng.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å si at alle tre midlene kan øke kroppsvekten, og at dette er spesielt uheldig hos en slik pasient. Hvis noen sier at dette gjør at olanzapin bør unngås, er det like riktig og gir samme poengskåre. Dessuten 0,5 poeng for å si at det er spesielt viktig å følge opp med hyppige målinger av kroppsvekt hos en slik pasient (og å seponere i tide).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En annen pasient, som bruker valproat og olanzapin på grunn av sin bipolare lidelse, var hos en annen lege for seks måneder siden og fikk karbamazepin i tillegg. Dette har ikke hatt noen ønsket tilleggseffekt, og du bestemmer deg for å seponere karbamazepin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det noe spesielt å tenke på ved seponering av karbamazepin hos denne pasienten når det gjelder bruken av valproat og olanzapin?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Karbamazepin er en kraftig enzyminduktor (gjelder spesielt CYP-enzymer, men også andre enzymer og transportpumper).
Ved seponering av karbamazepin vil induksjonseffekten opphøre (i løpet av en uke eller to), og (forutsatt at dosen av valproat og olanzapin har vært tilsvarende økt under pågående behandling med karbamazepin), må dosen av valproat og olanzapin reduseres. Hvis ikke vil pasienten kunne bli kraftig overdosert for disse to midlene. Eventuelt kan noen velge å skrive at pasienten bør følges med serumkonsentrasjonsmåling av valproat og olanzapin. Det er helt riktig, men kreves ikke for å full pott.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å vise til at karbamazepin er en induktor. 0,5 poeng for å skrive at induksjonseffekten nå opphører, og at dosen av de midlene som påvirkes (må ikke nødvendigvis spesifiseres) må reduseres
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Martin er en tre år gammel gutt som er tidligere frisk. Han går i barnehage, og er aktiv som sine jevnaldrende. For 2 uker siden var han hjemme i 3 dager på grunn av forkjølelse og feber.
I går utviklet han igjen litt feber, og ville ikke belaste venstre underekstremitet. Intet sikkert traume i sykehistorien
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan dette være? Nevn arbeidsdiagnosen, og to mulige differensialdiagnoser.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Purulent coxitt
* Serøs coxitt
* Brudd, Uregistrert fall i barnehage.
* Juvenil RA, Epifysiolyse, Malignitet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng: Purulent coxitt
* 1 poeng: Serøs coxitt
* 1 poeng: En av disse: Bruddskade, JRA, Epifysiolyse, Malignitet
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
Martin er en tre år gammel gutt som er tidligere frisk. Han går i barnehage, og er aktiv som sine jevnaldrende. For 2 uker siden var han hjemme i 3 dager på grunn av forkjølelse og feber.
I går utviklet han igjen litt feber, og ville ikke belaste venstre underekstremitet. Intet sikkert traume i sykehistorien
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken utredning vil du gjøre for å komme nærmere diagnosen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Klinisk us av hoften, palpasjon i lysken, bevegelse og smertekartlegning.
# Kochers fire kjennetegn for purulent coxitt: vil ikke belaste/smerter hofte/lyske/lår, feber, CRP>40, leuko>12)
# Ultralydundersøkelse for væske i hofteleddet
# Røntgen bilde av hoften til å se om det er brudd
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng: Klinisk us av hoften, palpasjon i lysken, bevegelse og smertekartleggning.
* 1 poeng: Kochers fire kjennetegn, anamnese og CRP, hvite
* 0.5 poeng: Ultralydundersøkelse av hofteleddet
* 0.5 poeng: Røntgen av hoften
Her må en unngå følgefeil og vurdere poeng utfra det som er angitt som svar i sp 1.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
Martin er en tre år gammel gutt som er tidligere frisk. Han går i barnehage, og er aktiv som sine jevnaldrende. For 2 uker siden var han hjemme i 3 dager på grunn av forkjølelse og feber.
I går utviklet han igjen litt feber, og ville ikke belaste venstre underekstremitet. Intet sikkert traume i sykehistorien
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er behandlingen for de tre tilstandene du svarte i spørsmål 1?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Purulent coxitt: Hvis full score på Kochers fire kjennetegn, operativ behandling i narkose med punksjon av hofte med mikroskopisk us av væsken, gramfarging og dyrkning, og deretter i samme narkose skylling av ledd. iv. antibiotikabehandling i sepsisdoser.
# Serous coxitt, med avlastning og smertestillende. Palalgin minor ev paracet
# Brudd behandling med strekkbehandling. Hvis det er svart noe annet en fraktur, Må dette svaret vurderes mht det som er angitt i oppgave 1 og ev gi poeng for fornuftig svar til å unngå følgefeil.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 Poeng: Purulent coxitt: Hvis full score på Kochers fire kjennetegn, operativ behandling i narkose med punksjon av hofte med mikroskopisk us av væsken, gramfarging og dyrkning, og deretter i samme narkose skylling av ledd.
* 1 poeng: Serous coxitt, med avlastning og smertestillende. Palalgin minor ev paracet
* 1 poeng: Brudd behandling med strekkbehandling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Tidligere vignett
<<<
Martin er en tre år gammel gutt som er tidligere frisk. Han går i barnehage, og er aktiv som sine jevnaldrende. For 2 uker siden var han hjemme i 3 dager på grunn av forkjølelse og feber.
I går utviklet han igjen litt feber, og ville ikke belaste venstre underekstremitet. Intet sikkert traume i sykehistorien
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest fryktede komplikasjon til den alvorligste diagnosen som du svarte i spørsmål 1?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Destruksjon av hofteleddet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng: Destruksjon av hofteleddet/brusk
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 45 år gammel kvinne oppsøker deg som sin fastlege. Hun har i løpet av de siste fem måneder fått økende hard hud fra metacarpofalangial (MCP) rekkens ledd og distalt begge hender.
Hun har i cirka fire år hatt tendens til Raynauds fenomen (likfingre) begge hender ved kuldeeksponering.
Ved undersøkelse ser og kjenner du at huden er hard og fortykket distalt på fingrene. Huden kan verken rynkes eller løftes. Hun har tendens små sårdannelser på to fingre, og hun sier disse sårene ikke vil gro.
Blodprøver viser SR 18mm (referanseverdi <20mm) og CRP<5 (referanseverdi<5 mm).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sklerodermi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sklerodermi, systemisk sklerose
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å henvise henne til revmatolog.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn spesifikt tre elementer du vil ønske å fremheve i henvisningen med tanke på å få henne prioritert for undersøkelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Raynauds fenomen, sårdannelser, hard hud, relativt kort varighet (5 mndr) av hudfortykkelse, mistanke om revmatisk systemsykdom, potensiell fare for affeksjon av indre organer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tre av følgende: Raynauds fenomen, sårdannelse, hard hud, relativt kort varighet (5 mndr) av hudfortykkelse, mistanke om revmatisk systemsykdom, fare for organkomplikasjon, potensiell fare for affeksjon av indre organer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På spørsmål opplyser pasienten opplyser at hun røyker fem sigaretter daglig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor er det spesielt viktig å råde denne pasienten til å slutte å røyke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røykestopp er første anbefalte tiltak ved Raynauds fenomen.
Røyking kan forverre Raynauds fenomen og gi økt sårtendens pga redusert kapillær blodtilførsel.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Forverring av Raynauds fenomen 0,5.
* Forverring av sårtendens ved røyking 0,5.
* Røyking kan gi dårligere blodtilførsel ut i fingrene 0,5.
Maks 1 poeng til sammen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten får raskt time ved revmatologisk poliklinikk. Hun er positiv for ANA og anti-centromer antistoff.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig ved positivitet for anticentromer antistoff?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Systemisk sklerose av begrenset type (CREST)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Systemisk sklerose av begrenset type. CREST-syndrom
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har som vi vet Raynauds fenomen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn en enkel undersøkelse revmatologen kan gjøre for å få en vurdering av patologi i forbindelse med Raynauds fenomen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kapillærmikroskopi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kapillærmikroskopi, mikroskopi av kapillærer
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn 2 andre tilstander hvor Raynauds fenomen kan være et element
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sklerodermi (hvis de mot formodning har svart noe annet lenger opp), SLE, MCTD, primær Raynaud
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert forslag men maks 2 poeng til sammen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket av følgende medikament er vanligst prøve ut ved Raynauds fenomen: Betablokker, ACE-hemmer, Albyl E eller Calsiumblokker?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Calsiumblokker
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ca-blokker, adalat, nifedepin, vasodilatator
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 9 måneder gammel jente som fra tidligere er frisk kommer til deg sammen med mor og far på legekontoret der du jobber som fastlege. De siste par månedene har hun hatt utslett i ansiktet som har økt på i det siste. Hun har også vært generelt tørr i huden, og foreldrene har observert at hun virker å ha en del kløe. Tidligere hadde hun også noen røde og tørre flekker på strekkesiden av armene, men dette forsvant etter at de brukte fuktighetskrem.
''SETT INN BILDE''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv utslettet på bildet.
# Hva er mest sannsynlige diagnose?
# Hvordan vil du behandle utslettet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Erytematøse plakk og papler i begge kinn, overleppe og hake med litt fin skjelling og kruster
# Atopisk eksem
# Topikale steroider (gr. I-II) daglig i noen få uker, etterfulgt av eventuelt nedtrapping. I tillegg rikelig med fet fuktighetskrem på hele kroppen daglig på ubestemt tid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 poeng totalt. Beliggenhet av utslettet må nevnes. Erytematøse plakk må nevnes. Dersom ikke kruster og fin skjelling nevnes trekkes 0,5 poeng.
# 0,5 poeng. Atopisk eksem er helt klart mest sannsynlige diagnose.
# 0,5 poeng. Smøring med gruppe 1-2 topikale steroider (hydrokortison, locoid). Behandlingen bør være intensiv i starten (1-2 ganger daglig i noen få uker) eventuelt nedtrapping (men her ikke obligatorisk). Rikelig bruk av fuktighetskrem på hele kroppen (pga generalisert tørr hud og kløe) må også nevnes
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Jenta dukker opp en kveld du har legevakt. Hun er nå 10 år og du har ikke sett henne siden hun var baby. Hun har fått et symmetrisk generalisert intenst kløende utslett siste døgnet med affeksjon av slimhinner. Det er i liten grad affeksjon av håndflater og fotsåler. Hun er i fin form
''SETT INN BILDE''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv utslettet.
# Hva er mest sannsynlig diagnose og hva skyldes tilstanden?
# Hvilken supplerende undersøkelse kan bekrefte tilstanden hvis du er usikker?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Multiple vesikler med klart og blakket innhold av ulik størrelse med umbilisering samt enkelte papler og kruster.
# Varicella/vannkopper eller varicella-zoster-virus
# Pinneprøve til PCR-us fra vesikkelinnhold for viruspåvisning
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Multiple vesikler må være med (gir 0,5 poeng). Umbilisering/umbodannelse sentralt (typisk virustegn) gir i tillegg 0,25 poeng. Polymorft bilde med papler og kruster i tillegg gir 0,25 i tillegg. 1 poeng mulig totalt
# Kun varicella som gir poeng, typiske funn og symptomer. Eczema herpeticum ville gitt allmennsymptomer, gir et mer monoformt bilde og man ville forventet aktivitet i eksemet i tillegg. Symmetri taler mot herpes zoster, generalisert zoster er sjeldent og lite sannsynlig hos frisk person. Enterovirus er også ofte vesikuløst, men er typisk lokalisert akralt i tillegg til munn. Gir heller ikke så distinkte vesikler. Immunologiske bulløse hudsykdommer er svært sjeldent hos barn, har mindre akutt sykdomsbilde og det er heller ikke typiske bilde her som ved dermatitis herpetiformis eller lineær IgA-dermatose som kan sees i denne aldersgruppen. 0.5 p.
# Kun pinneprøve til pcr som er riktig svar. Serologi har ikke plass i akuttdiagnostikken. 0.5p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det går en ukes tid og foreldrene bestiller time til ny vurdering. Utslettet på kroppen har tørket inn og klør mindre etter noen netter med intens kløe. I ansiktet har det bare blitt verre, men det klør ikke lenger. De har ikke forsøkt noen behandling foreløpig, kun hvitvask mot kløen. Når du undersøker henne ser du følgende:
''SETT INN BILDE''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv utslettet.
# Hva er mest sannsynlig diagnose og hva skyldes tilstanden?
# Hvordan behandler du dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Erytematøse plakk dekket av tykke (honning)gule kruster lokalisert rundt munnen.
# Impetigo/brennkopper. Skyldes bakterier, oftest staf. aureus ev. betahemolytiske streptokokker gruppe A.
# Lokalbehandling. Kan starte med lokal antiseptisk behandling (Microcid, Brulidine, Pyrisept) og evt. lokal antibiotikabehandling med Bacimycin. Kruster fjernes forsiktig etter bløtgjøring, kun det som er løst. Vanlig rengjøring. Dekke til med bandasjer for å hindre økt utbredelse/smitte.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Gule kruster og lokalisasjon må være med. 0.5 poeng
# Ikke typisk lokalisasjon for eksem i denne aldersgruppen og veldig velavgrensede forandringer med uttalt krustedannelse i forløpet av varicella hos atopiker med økt risiko for utvikling av impetigo. Det er ikke beskrevet aktive eksemforandringer eller kløe, heller ikke noe på bildet som indikerer det og derfor er superinfisert eksem ikke sannsynlig. Det er ikke vesikler som ved herpesinfeksjon og eczema herpeticum gir vanligvis allmennsymptomer. (1 poeng)
# Lokalbehandling må være med i form av antiseptisk behandling, ev. lokal antibiotikabehandling og rengjøring. Det trekkes 0,25 poeng dersom fucidinsyre angis som aktuell behandling. Det gis ikke trekk i poeng dersom systemisk antibiotika angis i tillegg. Hvis systemisk antibiotika navngis må det være dikloxacillin/kloxacillin som er førstevalget, oppgis andre agens som førstevalg trekkes 0,25 poeng. 0,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det går to uker, og på nytt har de bestilt time. Hun bruker fortsatt behandlingen de startet med, men nå blir det bare mer og mer utslett. Formen er fortsatt fin, men det klør og svir. Mest uttalt utslett nedre del av ansiktet, men brer seg også nedover halsen.
''SETT INN BILDE''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv utslettet.
# Hva er mest sannsynlig årsak til utslettet.
# Hvordan vil du behandle dette?
# Hvordan kan man utrede årsaken?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Papler diffust utbredt venstre side hals. Noe bakgrunnserytem.
# Allergisk kontaktdermatitt mot lokalbehandling (krem, plasterlim)
# Seponering av pågående behandling. Lokale steroider gr 1-2 og fuktighetskrem
# Epicutantest, evt brukertest
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Papler venstre side hals må være med. 0,5 poeng
# Allergisk kontaktdermatitt gir 0,5 poeng. Bare kontaktdermatitt, irritativ kontaktdermatitt eller forverring atopisk eksem kan gi 0,25 poeng. Systemisk legemiddelreaksjon gir ikke poeng.
# Seponering av pågående behandling gir 0,25 poeng. Lokale steroider gir 0,25 poeng. 0,5 poeng.
# Kun epicutantest, evt brukertest som gir poeng. 0,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På vei ut spør de om du kan se på en flekk på ryggen som de er litt bekymret for, hun har hatt denne siden fødselen. Det måler ca 2x 3 cm, er såvidt palpabel og ser slik ut:
''SETT INN BILDE''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv dette «fødselsmerket».
# Hva er riktig diagnose?
# Hvilke anamnestiske opplysninger er mest viktige?
# Anamnesen gir ikke opplysninger som gir bekymring. Skal denne fjernes eller henvises til dermatolog?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Symmetrisk velavgrenset ovalt mellombrunt homogent pigmentert plaque med litt behåring.
# Kongenital melanocyttnevus
# Familiær risiko for melanom? Endring utenom økt størrelse med barnets vekst? Blødning?
# Det er ingen «røde flagg» og små og mellomstore kongenitale nevi skal ikke eksideres rutinemessig fordi det ikke foreligger noen sikker økt risiko slik at de skal følges som alle andre melanocyttnevi. Det er heller ikke nødvendig med vurdering eller oppfølging hos dermatolog ved helt benigne funn etter ABCDE-regelen med mindre det foreligger familiær risiko
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# ABC-beskrivelse må foreligge (Symmetrisk, pen avgrensning, homogen farge). 0,5 poeng Trekk 0,25 hvis de beskriver det som en makel.
# Melanocyttnevus eller nevus gir 0,25 poeng. Medfødt eller kongenital melanocyttnevus gir 0,5 poeng.
# Alle tre gir 0,5 poeng. Familiær risiko gir 0,2, endring gir 0,2 og blødning gir 0,1.
# Ikke eksisjon og ikke rutinemessig henvisning til dermatolog gir 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 72 år gammel kvinne tar kontakt med fastlegen på grunn av smerter i lysken og på fremsiden av låret. Hun har hatt plager i noen måneder uten at det er noe kjent traume i sykehistorien. Smertene er såpass plagsomme nå at hun må være mer i ro enn hun pleier.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er tentative diagnose og nevn to differensialdiagnoser?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
*Td: Coxartrose
* Ddx:
** prolaps eller spinal stenose med rotaffeksjon L3/L4
** karstenose
** trokantersmerter/tendinitt
** avaskulær nekrose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Coxartrose må være med for å få 1 poeng
* Coxartrose + 2 differensialdiagnoser 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den primære tilleggsundersøkelsen (utenom klinisk undersøkelse) ved utredning av hofteleddsmerter?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vanlig røntgen av bekken/hofte er primærundersøkelse utenom klinisk undersøkelse
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Røntgen bekken eller hofte angitt som modalitet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort beskrivelse av en hofteleddsundersøkelse og relater funn til vanlige diagnoser i hofteleddet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* inspeksjon av gange og akser
* palpasjon av trokanter major og sitteknute
* undersøkelse av aktiv/passiv bevegelighet
* FABER/FADIR test
Coxartrose gir nedsatt bevegelighet for passiv bevegelighet, først for fleksjon og innadrotasjon
Coxartrose gir smerter i ytterstillinger
Trokantertendinitt gir smerter ved palpasjon
FABER/FADIR test er smertefull ved impingement
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Passiv/aktiv bevegelighet og palpasjon av trokanter 1 poeng
# Nedsatt bevegelighet ved coxartrose gir 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det viser seg at pasienten er operert for et brudd i øvre del av lårbenet for 3 år siden. Det postoperative forløpet var upåfallende og hun har hatt det fint helt til de siste månedene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn de tre vanligste formene for brudd i proksimale del av femur
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Fractura colli femoris
* Pertrokantær fraktur
* Subtrokantær fraktur
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 type brudd gir 1 poeng, alle 3 gir 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de vanligste hofterelaterte komplikasjoner etter operasjon med hemiprotese (halvprotese) i hofteleddet. Er det tiltak man kan gjøre for å unngå slike komplikasjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Infeksjon - kan forebygges med antibiotikaprofylakse
* Luksasjon - mindre risiko når man opererer i lateral tilgang
* Periprostetisk brudd – kan forebygges med sementert femurstamme
* Halting
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng ved en komplikasjon
* 2 poeng ved 2 komplikasjoner og forebyggende tiltak på minst ett punkt
* 3 poeng ved 3 komplikasjoner og forebyggende tiltak på minst ett punkt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 60 år gammel kvinne kommer til konsultasjon hos deg som sin nye fastlege. Hun forteller om sterke brennende og sviende smerter i nakken og skuldrene som gjør at hun ikke får sove, og hun er derfor sliten hele dagen og orker ikke gjøre noe. Dette har vart i minst et år, og hun har vært sykemeldt fra vaskejobb det siste halve året. Hun har forsøkt paracetamol (Paracet), ibuprofen (Ibux) og paracetamol/ kodein (Paralgin forte) for plagene med liten eller kortvarig virkning, og må dessuten ha sovemedisin av typer zopiklon (et benzodiazepinderivat) hver kveld for å få sove. Fastlegen ser at hun har omfattende journal som han ikke rekker å lese, men at hun har hatt flere innleggelser for brystsmerter, tungpust, ryggsmerter, magesmerter og smerter i bena de siste 10 årene, og at man har funnet varierende forhøyet blodtrykk, enkelte divertikler i kolon, lett spondylose (degenerative forandringer i ryggen) på røntgen, varierende forhøyede leverprøver og diabetes type II. Hun mener hun ikke har fått hjelp av tidligere fastlege. Hun var tidligere gift med en alkoholisert mann men ble skilt i fjor. Hun sluttet å røyke i fjor. Hun ber om diazepam (Vival, et benzodiazepin) fordi hun trenger å slappe av etter en konflikt med datteren
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du tenker at hun kanskje har en somatoform smertelidelse. Nevn fire opplysninger i vignetten som støtter en slik diagnose.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Vedvarende smerter (minst 1 år, med andre smerter flere år)
* Alvorlig og plagsom smerte
* Kan ikke forklares (fullstendig) av oppgitte somatiske forhold, spesielt ikke smertene i nakken og skuldrene
* Psykososial påkjenning alkoholisert mann, skilsmisse, konflikter og sannsynlig dårlig økonomi som enslig med vaskejobb samt mulig ensomhet pga orker ikke noe
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert riktig element
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du ønsker å undersøke om det kan være somatiske årsaker til hennes smerter (tidligere og aktuelle smerter)
Fra tidligere:
<<<
En 60 år gammel kvinne kommer til konsultasjon hos deg som sin nye fastlege. Hun forteller om sterke brennende og sviende smerter i nakken og skuldrene som gjør at hun ikke får sove, og hun er derfor sliten hele dagen og orker ikke gjøre noe. Dette har vart i minst et år, og hun har vært sykemeldt fra vaskejobb det siste halve året. Hun har forsøkt paracetamol (Paracet), ibuprofen (Ibux) og paracetamol/ kodein (Paralgin forte) for plagene med liten eller kortvarig virkning, og må dessuten ha sovemedisin av typer zopiklon (et benzodiazepinderivat) hver kveld for å få sove. Fastlegen ser at hun har omfattende journal som han ikke rekker å lese, men at hun har hatt flere innleggelser for brystsmerter, tungpust, ryggsmerter, magesmerter og smerter i bena de siste 10 årene, og at man har funnet varierende forhøyet blodtrykk, enkelte divertikler i kolon, lett spondylose (degenerative forandringer i ryggen) på røntgen, varierende forhøyede leverprøver og diabetes type II. Hun mener hun ikke har fått hjelp av tidligere fastlege. Hun var tidligere gift med en alkoholisert mann men ble skilt i fjor. Hun sluttet å røyke i fjor. Hun ber om diazepam (Vival, et benzodiazepin) fordi hun trenger å slappe av etter en konflikt med datteren
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire vanlige somatiske tilstander som hver kan gi noen av de smertene (aktuelt og tidligere) som er nevnt i vignetten, og angi hvilke opplysninger i vignetten som øker sannsynligheten for disse lidelsene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Gastritt/ulcus (magesmerter og bruk av ibuprofen)
* Polynevropati (smerter i føttene og diabetes)
* Gallesten (magesmerter og leverprøver)
* Forstoppelse (magesmerter, kodein, lite aktivitet, divertikler)
* Angina (brystsmerter, tidligere røkt (tungpust, orker ikke noe))
* Ikke poeng for alkoholmisbruk pga ikke somatisk tilstand
* Ikke poeng for lett spondylose, siden de fleste har ikke sterke smerter av dette og det kan ikke bekreftes som årsak
* Ikke poeng for divertikler/ divertikulitt pga bare enkelte divertikler som neppe gir plager og ikke nevnt tegn til infeksjon
* Ikke poeng for KOLS pga gir ikke smerte..
* Ikke poeng for osteoporose pga ikke begrunnet i vignett
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for hver tilstand med begrunnelse
* Bare poeng for hver lidelse hvis den er begrunnet
* Andre somatiske tilstander som passer med symptomene og kan begrunnes godt kan også gi 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett. Fra tidligere:
<<<
En 60 år gammel kvinne kommer til konsultasjon hos deg som sin nye fastlege. Hun forteller om sterke brennende og sviende smerter i nakken og skuldrene som gjør at hun ikke får sove, og hun er derfor sliten hele dagen og orker ikke gjøre noe. Dette har vart i minst et år, og hun har vært sykemeldt fra vaskejobb det siste halve året. Hun har forsøkt paracetamol (Paracet), ibuprofen (Ibux) og paracetamol/ kodein (Paralgin forte) for plagene med liten eller kortvarig virkning, og må dessuten ha sovemedisin av typer zopiklon (et benzodiazepinderivat) hver kveld for å få sove. Fastlegen ser at hun har omfattende journal som han ikke rekker å lese, men at hun har hatt flere innleggelser for brystsmerter, tungpust, ryggsmerter, magesmerter og smerter i bena de siste 10 årene, og at man har funnet varierende forhøyet blodtrykk, enkelte divertikler i kolon, lett spondylose (degenerative forandringer i ryggen) på røntgen, varierende forhøyede leverprøver og diabetes type II. Hun mener hun ikke har fått hjelp av tidligere fastlege. Hun var tidligere gift med en alkoholisert mann men ble skilt i fjor. Hun sluttet å røyke i fjor. Hun ber om diazepam (Vival, et benzodiazepin) fordi hun trenger å slappe av etter en konflikt med datteren
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire psykiske lidelser som er vanlige komorbide tilstander for pasienter med somatoform smertelidelse (bortsett fra andre somatoforme lidelser), og angi hvilke symptomer eller opplysninger som kan gi mistanke om disse lidelsene.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Depresjon (søvn, sliten, smerter)
* Angst (flere typer mulig, brystsmerter, tungpust, ønsker benzodiazepin). Ikke poeng for mer enn en angstlidelse.
* PTSD (muskelsmerter pga muskelspenning, søvnvansker, tidligere gift med alkoholisert mann som kan ha mishandlet)
* Avhengighet av medikamenter (Paralgin forte/ sovemedisin, ønsker benzodiazepin)
* Misbruk evt avhengighet av alkohol (eksmann og leverprøver)
* Personlighetsforstyrrelse (konflikter med tidligere fastlege og med datter)
* Ikke poeng for hypokondri
* Ikke poeng for noen type psykose
* Ikke poeng for bipolar alene, men poeng for bipolar depresjon som depresjon
* Ikke poeng for kognitiv svikt/ demens
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av depresjon og angst og 0.5 for enten misbruk av medikamenter eller alkohol
Bare poeng hvis begrunnelse for hver lidelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du finner grunn til å tilby behandling for somatoform lidelse for pasienten i din allmennpraksis
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire sentrale elementer i en slik behandling for den aktuelle pasienten. Navn på terapiform gir ikke poeng i seg selv.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Terapeutisk allianse og samarbeid
* Nøyaktig anamnese og høre på alle opplysninger som pasienten ønsker å gi (inkl lese journal hvis tid..)
* Støtte og evt hjelp pga økonomi, sosialt, praktisk
* Regelmessige planlagte timer uavhengig av pasientens aktuelle plager og hjelpesøkeatferd hvis hun stadig ønsker (akutt)timer
* Ikke gjenta samme undersøkelser for samme plager hvis ikke god medisinsk begrunnelse (for eksempel nye symptomer)
* Psykoedukasjon med kunnskap om årsaker til/ mekanisme for smerter
* Belyse sammenhenger mellom symptomer, tanker og følelser (som i kognitiv terapi)
* Avspenningsøvelser og lett trening for muskelspenning/ myalgi
* Ikke foreskriv avhengighetsskapende medikamenter (trappe gradvis ned men ikke før allianse og annen hjelp er i gang)
* Evt medikamentell behandling med antihistamin, SSRI, SNRI, amitriptylin (Sarotex), eller mirtazapin (Remeron) etter individuell vurdering (evt gabapentin (Neurontin), pregabalin (Lyrica) mm for polynevropati)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per riktig element, inntil maks 2 poeng.
Ikke poeng for Kognitiv terapi alene, det er en betegnelse og ikke et element i behandlingen som det spørres om her
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du avslår å skrive ut diazepam (Vival) til pasienten
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du begrunne svaret for pasienten? Nevn minst fire argumenter for å ikke foreskrive diazepam.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* __Kortvarig lindring__ som ikke hjelper i lengden
* __Langvarig ulempe__ pga bivirkninger
* Avhengighet som bla kan gi behov for økende doser
* Fare for fall, skader, redusert funksjon, passivitet, (demens)
* Finnes bedre behandling (som du vil tilby)
* Ikke evidens for effekt på tilstand
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver av nevnte argumenter inntil 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kunnskap genereres over tid og ofte tar det lang tid før ny forskning når ut i den kliniske hverdagen. I forbindelse med Koronavirus-pandemien i 2020-21 har imidlertid generering av kunnskap og utprøving av tiltak/behandling gått hånd i hånd og kunnskapsdeling har skjedd på et helt nytt nivå enn tidligere.
For å svare på spørsmålet: «Hvilke medikamenter har/har ikke effekt på pasienter med Covid-19 infeksjon?» har BMJ/WHO laget en «living systematic review» med en tilhørende «living guideline» som til enhver tid inkluderer ny forskning om medikamentell behandling i et oppdatert kunnskapssystem.
Her er den første delen av sammendraget fra publikasjonen Siemieniuk RAC, Bartoszko JJ, Ge L, et al. Drug treatments for covid-19: living systematic review and network meta-analysis [Update 2]. BMJ 2020;370:m2980, [[doi:10.1136/bmj.m2980|https://doi.org/10.1136/bmj.m2980]]
<<<
!!! Abstract
''Objective'' To compare the effects of treatments for coronavirus disease 2019 (covid-19).
''Design'' Living systematic review and network meta-analysis.
''Data sources'' WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 1 December 2021 were included in the analysis.
''Study selection'' Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* Hva er en systematic review/systematisk oversikt?
* Hva kjennetegner denne typen publikasjon generelt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En systematisk oversikt er en oversikt over flere artikler om samme emne – en kunnskapsoppsummering. Det er viktig at det er brukt en systematisk og beskrevet fremgangsmåte for å finne, vurdere og oppsummere enkeltstudiene
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 poeng for å beskrive oppsummering
* 0.5 poeng for å beskrive systematikk
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er en meta-analyse?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En meta-analyse er en statistisk analyse som sammenstiller de kvantitative estimatene fra flere ulike studier i en samlet analyse som gir et samleestimat.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å beskrive en kvantitativ sammenstilling av resultatene fra flere enkeltstudier til et samle-estimat.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Basert på blant annet funnene fra den systematiske oversikten og metaanalysen er det laget en anbefaling som også er «levende». Under ser dere anbefalingene for ulike medikamenter/«interventions» for pasienter i henhold til sykdomsalvorlighet (tre grupper).
''Sett inn bilde''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Anbefalingene vi ser her – hvordan er de gitt, og hvilke ''hoved''alternativer fins for graderingen av anbefalinger i dette systemet?
# Hvilke andre elementer enn forskning (dvs. kvaliteten på kunnskapsgrunnlaget) er vanligvis med når man skal avgjøre styrken på en anbefaling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Anbefalinger er gitt med GRADE- systemet. Her kan anbefalinger være svake eller sterke, og de kan være for og mot behandling.
#* Sterk anbefaling for
#* Svak anbefaling for
#* Svak anbefaling mot
#* Sterk anbefaling mot
# I tillegg til kvaliteten på kunnskapsgrunnlaget (certainty of evidence) vurderes følgende 3 elementer systematisk:
#* Benefits and harms (fordeler og ulemper)
#* Preferences and values (Verdi og preferanser) - pasientperspektivet
#* Resources (ressurshensyn) – kostnader
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne GRADE, samt sterk og svak anbefaling. (½ poeng dersom bare GRADE eller bare sterk/svak)
1 poeng for å nevne minst 2 av de ovennevnte faktorene. (1/2 poeng for å nevne kun en eller nevne flere perspektiver, men på en usystematisk måte)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Her vises anbefalingen for kortikosteroider for de med alvorlig eller kritisk sykdom i utdypet form
''Sett inn bilde''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I delen «evidence profile» er «Evidence quality” presentert i kolonnen til høyre (sammen med stjernene).
# Hvilket verktøy er benyttet i graderingen?
# Hvilke alternativer fins i tillegg til de som er presentert («moderate» og «low»)?
# Hva betyr studiedesignet for graderingen i dette tilfellet?
# Nevn minst to faktorer (utenom studiedesignet) som kan påvirker denne graderingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# GRADE er benyttet i graderingen
# Alternativene er høy – moderat – lav – svært lav
# Studiedesignet som er benyttet legger grunnlaget for graderingen – RCT studier starter på «høy», mens observasjonsstudier starter på «lav». I denne publikasjonen er kun RCT studier benyttet – altså i utgangspunktet «høy»
# Nedgradering kan gjøres ved
#* Risiko for bias (f.eks for manglende blinding, frafall)
#* Lav presisjon
#* Indirekte mål (ikke direkte sammenheng mellom intervensjonen og det utfallet man ønsker å studere)
#* Inkonsistens/heterogenitet/sprikende funn
#* Publiseringbias
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Et poeng for rett svar på hvert element
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kortfattet tolkning av funnene som er presentert her.
Forklar med et presist og enkelt språk (som om du skulle ''forklart til en medstudent'') hvorfor behandling med kortikosteroider er anbefalt for de med alvorlig eller kritisk sykdom, og hva det vil si i praksis (''bruk gjerne tallene fra figuren'').
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienter som får kortikosteroider har lavere dødelighet (både pasienter som er alvorlig og kritisk syke), men flere episoder med hyperglykemi, sammenlignet med pasienter form får vanlig behandling. Her er kunnskapsgrunnlaget vurdert som moderat – dvs. at vi har grunn til å tro at tallene som presenteres //sannsynligvis// ligger i nærheten av den sanne effekten.
Anbefalingen bygger både på den sannsynlige reduksjonen i dødelighet, samt at det trolig ikke er alvorlige bivirkninger annet enn hyperglykemi. I tillegg er behandlingen gjennomførbar, ikke veldig kostbar og pasienter ville trolig valgt dette.
Dersom vi behandler 1000 kritisk syke pasienter med kortikosteroider vil sannsynligvis 87 færre dø (sammenlignet med uten behandling).
Dersom vi behandler 1000 alvorlig syke pasienter med kortikosteroider vil sannsynligvis 67 færre dø (sammenlignet med uten behandling).
Dersom vi behandler 1000 alvorlig eller kritisk syke pasienter med kortikosteroider vil 47 flere få hyperglykemi (sammenlignet med uten behandling).
Behandling av alvorlig eller kritisk syke pasienter med kortikosteroider endrer sannsynligvis ikke forekomsten av GI-blødning, superinfeksjoner, nevromuskulær styrke eller nevropsykiatriske effekter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for å beskrive
* redusert dødelighet med tall (1/2 p)
* sannsynlig (1/2 p)
* minst en av følgende: bivirkninger, gjennomførbarhet, kostnader og pasientens preferanser (1/2 p)
* enkel og presis fremstilling (1/2 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 25 år gammel mann forsøker å slukke flammene i en frityrgryte med vann. Det fører til en eksplosiv brann og genseren hans tar fyr. Han greier etter hvert å rive av seg genseren og gå inn i dusjen for avkjøling. Han får kameraten til å kjøre ham til lokalsykehuset, hvor han ankommer 30 minutter etter ulykken.
Du har vakt og skal ta imot pasienten. Han kommer gående inn i akuttmottaket. Han gjør godt rede for seg, men er smertepåvirket.
Du ser raskt at ansiktet, begge armer og store deler av hele overkroppen er forbrent. Du ser sot omkring nese og munn
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva skal du som mottakende lege foreta deg? Pasienten ankommer akuttmottaket nå…
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Pasienten skal tas imot som en traumepasient med et «Traumemottak».
* Forsøke å ta en kjapp anamnese
* Sikre luftveier grunnet raskt innsettende ødem (han har sannsynligvis pustet inn varme og røyk ettersom han har sot omkring nese og munn).
* Sikre gode venetilganger
* Smertelindring
* Kontrollere ABCDE:
** Airways (luftveier),
**Breathing (respirasjon),
** Circulation (sirkulasjon),
** Disability (bevissthet, nevrologi),
** Expose / environment (oversikt og omgivelser)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng
* Studenten skal vite at pasienten skal tas imot som en traumepasient.
* Studenten skal kontrollere ABC (evt. også -DE)
* Student skal vite at luftveiene bør raskt sikres
* Studenten bør vite at pasienten trenger gode venetilganger grunnet store mengder i.v. væske det første døgnet
Studenten får 0,5 poeng for hvert av disse svarene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får vite at han er fra før helt frisk og i god fysisk form.
Kroppshøyde: 185 cm
Vekt: 75 kg.
Pasienten tas inn på operasjonsstuen. Han legges i generell anestesi. Du vasker, reviderer og undersøker skadene. Følgende hudområder er affisert:
* Hele ansikt: Huden har blemmer og under blemmene er huden lys rød/ rosa.
* Begge overekstremiteter: Sirkulære skader. Huden har blemmer og under blemmene er huden dyp rød.
* Anteriore side av trunkus: Halve arealet har blek, læraktig hud, ingen blemmer eller kapillærfylning. Den andre halvparten har store blemmer, og under blemmene er huden hvitaktig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du beskrive dybden av disse brannskadene, og hva bør sannsynligvis gjøres med brannskadene på armene i løpet av de første timene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Alt er sannsynligvis dyp skade. Flammeskader blir oftest dype, mens skoldingsskader blir vanligvis mer overfladisk.
''Ansikt'': Muligens er brannskadene i ansiktet noe mer overfladisk (muligens overfladisk 2.grad), men dybden kan være vanskelig å bedømme dybden initialt. Etter 2-3 dager kan dybden av brannskadene bedømmes mer nøyaktig.
''Begge overekstremiteter'': Sannsynligvis dyp delhudsskade (dyp 2. grad), men dybden er vanskelig å bedømme dybden initialt. Etter 2-3 dager kan dybden av brannskadene bedømmes mer nøyaktig.
Ettersom det er sirkulære skader, må eskarotomi (incisjoner
gjennom brannskadet hud og ned i subkutant fettvev) langsmed
overekstremitetene vurderes for å unngå avklemming av kar og
nerver som følge av ødemdannelse.
''Anteriore side av trunkus'': Halve arealet har en sikker fullhudskade (3. grad; vanligvis enkel
å bedømme).
''Andre halvdel'': Sannsynligvis dyp delhudsskade (dyp 2. grad), men dybden er vanskelig å bedømme dybden initialt. Etter 2-3 dager kan dybden av brannskadene bedømmes mer nøyaktig.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng
* Studenten må skrive at skadene sannsynligvis er dype, dvs. dyp 2. grad (dyp delhudsskade) og 3. grad (fullhudskade). Studenten trenger ikke å beskrive spesifikk dybde av skadene for hver kroppsdel. Skadene i ansiktet kan være mer overfladisk, men det trenger studenten ikke å beskrive for å få poeng.
* Student må vite at det bør vurderes å gjøre eskarotomi. Det er greit at studenten ikke husker navnet «eskarotomi», men da bør prosedyren beskrives. Det kreves ikke at studenten beskriver nøyaktig hvordan
eskarotomi gjøres.
Studenten får 1 poeng for hvert av disse svarene.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett. Fra tidligere:
<<<
Følgende hudområder er affisert:
* Hele ansikt: Huden har blemmer og under blemmene er huden lys rød/ rosa.
* Begge overekstremiteter: Sirkulære skader. Huden har blemmer og under blemmene er huden dyp rød.
* Anteriore side av trunkus: Halve arealet har blek, læraktig hud, ingen blemmer eller kapillærfylning. Den andre halvparten har store blemmer, og under blemmene er huden hvitaktig.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Estimer hvor stort kroppsareal (TBSA%) som er skadet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Ansikt: ca 4%
* Anteriore trunkus: ca 18%
* Begge armer: ca 18%
* TBSA% = Ca. 40%
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng
* Studenten skal kunne 9-er-regelen.
* Svaret bør være 40 +/- 3 % for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Med hjelp av Parkland-formelen kan man estimere mengde av væske pasienten trenger det første døgnet etter skaden
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den største feilkilden når du skal regne ut væskemengden?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Parkland-formelen: 4 ml x kroppsareal (%) x kroppsvekt (kg)
Feilkilden er kroppsarealet. Vekten vet vi, men beregningen av kroppsarealet er ofte vanskelig. Estimerer man for stort areal, kommer pasienten til å bli overvæsket.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng. Studenten må svare «Kroppsareal» eller «TBSA%» (total body surface area %) for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor trenger han væskebehandling?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Væsketilførsel er viktig for å unngå nyresvikt som følge av hypovolemi. I brannskadet hud tilkommer økt kapillær lekkasje og økt transkapillært filtrasjonstrykk («sug» i vevet). Dette fører til at vann, salter og plasmaproteiner lekker til interstitiet og gir raskt innsettende ødem.
Omfatter skaden > 25 % av kroppsoverflaten, vil det i tillegg til lokal ødemdanning være generalisert lekkasje av proteinholdig væske fra blodbanen til interstitiet. Dette fører til ødemer også i uskadet hud, muskulatur og indre organer.
Volumstatus vurderes fortløpende på bakgrunn av timediurese, pulsfrekvens og blodtrykk
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng
* Studenten må svare at det skjer en (kapillær-) lekkasje fra blodbanen og skadet vev til interstitiet (extracellulært vev; bindevevet som utfyller mellomrommet mellom organene i kroppen)
* Studenten må svare at det er stor fare for nyresvikt ved ingen væsketilførsel.
Studenten får 0,5 poeng for hvert av disse svarene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten må overflyttes til Brannskadeavdelingen ved Haukeland universitetssykehus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type behandling kommer pasienten til å få i Bergen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Intensivbehandling
* Kirurgisk nedskjæring av dype brannskadene
* Hudtransplantasjon
* Sårbehandling
* Rehabilitering
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng
For å få poeng må studenten svare at pasienten vil trenge nedskjæring/ operasjon for sine dype brannskader og hudtransplantasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter noen dager skal du ha en samtale med foreldrene til pasienten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil du si til foreldrene vedr hvilke senskader brannskadene hans kan gi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
En 25 år gammel, frisk mann overlever vanligvis en slik skade dersom han får adekvat behandling, men sekvelene kan bli alvorlige. De vanligste senskadene:
* Arrvev som gir kontrakturer, for eksempel redusert bevegelighet av ledd.
* Permanente arr som kan bli et kosmetisk problem, spesielt i ansikt.
* Transplantert hud vil ikke ha samme kvalitet (f.eks. elastistitet) som uskadet hud. Vevet er hardere, mindre elastisk og har endret/ manglende sensibilitet (paresthesia)
* Hypertrofiske arr/ keloider
* Psykiske problemer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng. For å få to poeng må studenten beskrive to av disse punktene. Studenten får ett poeng dersom det beskrives kun et punkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du arbeider som LIS 2 ved en Ortopedisk Avdeling. I dag jobber du ved Ortopedisk poliklinikk og tar imot en tidligere frisk mann i 60-årene. Han fikk innsatt protese i høyre hofte for om lag 1 år siden. Et par måneder etter innsetting av hofteprotesen fikk han smerter og nedsatt funksjon i hofta. Du samtaler med pasienten, gjør en klinisk undersøkelse og bestemmer deg for å henvise pasienten til en radiologisk undersøkelse
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken radiologisk utredning vil du begynne med for å utrede pasientens plager?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Røntgen bekken og/eller høyre hofte.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Røntgen bekken og/eller høyre hofte = 1 poeng.
* Røntgen bekken = 1 poeng.
* Røntgen høyre hofte = 1 poeng.
* Røntgen Lauenstein eller røntgen innskutt hoftebilde = 0,5 poeng.
* Røntgen = 0,5 poeng.
Øvrige radiologiske (og eventuelt nukleærmedisinske) undersøkelser gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake 1 uke senere etter å ha gjennomført den radiologiske utredningen. Pasienten gjennomgikk et standard forløp ved innsetting av protesen, og operasjonen var vellykket uten komplikasjoner.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken undersøkelse ble gjort i forbindelse med operasjonen som du nå kan benytte deg av for å komme nærmere årsaken til pasientens plager?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Postoperative røntgenbilder (som du kan sammenligne med røntgenbilder tatt nå).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poenggivende: postoperative røntgenbilder.
Ikke poenggivende: blodprøver, klinisk undersøkelse, andre perioperative undersøkelser.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fremdeles usikker på årsaken til pasientens plager. Du ringer vakthavende nukleærmedisiner og konfererer pasienten. Vakthavende nukleærmedisiner anbefaler at du henviser pasienten til en skjelettscintigrafi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst fire generelle indikasjoner for å henvise pasienter til skjelettscintigrafi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tidlig diagnostikk / evaluere / følge utbredelsen av skjelettmetastaser.
* Leddprotesekomplikasjoner.
* Osteomyelitt / infeksjon.
* Påvise artritt / artrose.
* Tidlig diagnostikk av traumatiske skjelettskader.
* Uavklart smerteproblematikk.
* Evaluering av primære beintumores (?).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert av følgende svar gir 0,5 poeng per punkt til maksimalt 2 poeng.
* Skjelettmetastaser = 0,5 poeng.
* Leddprotesekomplikasjoner = 0,5 poeng.
* Osteomyelitt / infeksjon = 0,5 poeng.
* Påvise artritt / artrose = 0,5 poeng.
* Traumatiske skjelettskader / fraktur = 0,5 poeng.
* Uavklarte smerter = 0,5 poeng.
* Beintumores = 0,5 poeng (selv om dette ikke lenger er en veldig god indikasjon).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du blir i samråd med vakthavende nukleærmedisiner enig om å henvise pasienten til en skjelettscintigrafi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan en vanlig skjelettscintigrafi utføres
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved en vanlig skjelettscintigrafi visualiseres osteoblastaktivitet/beinnydanning. Pasienten injiseres pasienten med 99mTc bundet til en fosfatforbindelse på et injeksjonsrom. Deretter ventes det flere timer (gjerne 3 timer) mellom injeksjon og billedtakning. Pasienten later vannet like før billedtakning. Det tas planare helkroppsbilder forfra og bakfra på et gammakamera og det suppleres med SPECT(/CT) ved behov.
Ved en 3-fase skjelettscintigrafi tas 3 ulike bildeopptak på 3 ulike tidspunkt. Hovedindikasjonen for 3-fase skjelettscintigrafi er leddprotesekomplikasjoner og tidlig påvisning av osteomyelitt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert av følgende svar gir 0,5 poeng per punkt til maksimalt 2 poeng.
# Skjelettscintigrafi visualiserer osteoblastaktivitet / beinnydannelse.
# Pasienten injiseres med 99mTc (eventuelt «noe radioaktivt»).
# 99mTc («noe radioaktivt») bindes til en fosfatforbindelse.
# Venter flere (3) timer mellom injeksjon og billedtakning.
# Planare helkroppsbilder (forfra og bakfra).
# Bildene tas på et gammakamera / supplerer med SPECT/CT ved behov/funn på de planare bildene.
# Dersom 3-fase skjelettscintigrafi nevnes.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Skjelettscintigrafien viser et uventet funn i høyre kne. Du velger å utrede funnet videre med en røntgen og deretter CT, som viser dette:
''Sett inn bilde''
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tror du denne lesjonen er benign eller malign? Hva er typiske røntgenfunn ved en benign og en malign tumor i bein?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lesjonen viser malign tumor (1 poeng).
Typiske funn ved malign tumor er diffus avgrensning av tumor mot tilstøtende benvev og/eller bløtvev. Andre tegn som trekker i malign retning er at tumor protruderer fra bein ut i bløtvev, permeativ vekst/møllspist matrix, avbrutt periostreaksjon. (hver komponent gir 0,5 poeng, til maksimalt 2 poeng)
Funn som trekker i benign retning er skarp avgrensning mot tilstøtende benvev og/eller bløtvev, mangel på periostreaksjon. Ingen eller ubrutt/jevn cortical reaksjon/formendring. (hver komponent gir 0,5 poeng, til maksimalt 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du jobber som fastlegevikar i en bykommune. Neste pasient er Pawel Novak (52 år). Han har bestilt hastetime, i timeboka står det "Kne". Han har tilhørt legesenteret i ca. ett år. Du ser han har vært der for en kuttskade, en akutt rygg-episode med kort sykmelding, og for å få resept på et middel mot psoriasis. Under familie/sosialt står det. "Fra Polen. Bodd i Norge siden 2013. Gift, tre barn. Snekker. Stort sett frisk" Du henter pasienten på venterommet, på veien inn til kontoret observerer du at han halter litt. Du starter konsultasjonen åpent, inviterer ham til å fortelle om sitt ærend. Han sier, på veldig famlende norsk:
"Jeg kommer for kneet. Jeg skal ha MR og vil til spesialist"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn noen grunnleggende trekk ved norsk helsetjeneste som kan oppleves uvant og kan hende frustrerende for (im)migranter, for eksempel fra Polen. Stikkord: Organisering, legerollen, ev. andre forhold.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Bakgrunn for sensor: Migranter utgjør en mangfoldig gruppe med stor variasjon i migrasjonsårsak, sosial og kulturell bakgrunn, ikke minst helsetilstand og behov for helsetjenester. I utgangspunktet har migranter generelt bedre helse enn «normalbefolkningen» når de ankommer landet – men mange utvikler etter hvert betydelige helseproblemer. Mange sør/øst-europeere er arbeidsinnvandrere dvs. at det er viktig å holde seg frisk – slik at de kan jobbe og tjene penger. Mange forsørger familie i hjemlandet.
Svar til selve oppgaven: Både i et land som Polen og Norge spiller allmennleger en rolle i helsesystemet, men fastlegerollen er mye klarere definert i Norge (formell portvakt/døråpner/koordinator), mens det andre steder er mer tradisjon for rask henvisning og bruk av spesialister. Helt private aktører har ikke så sentral plass i Norge, og de koster betydelig mer å oppsøke enn det offentlige systemet. Legerollen i mange andre land, inkludert Sør- og Øst-Europa, er dernest tradisjonelt mere autoritativ/paternalistisk, og medisinen mer preget av prøvetaking/supplerende undersøkelser og terapitiltak (eks medisiner). Norske fastleger kan med sitt mer pasientsentrerthet, fokus på «low tech» medisin og partnerskapsorienterte fremgangsmåte, fremstå som passive og mindre kompetente – dersom forventningen er å møte et paternalistisk og autoritativt system. Språklige og kulturelle forskjeller/barrierer påvirker også opplevelsen av organisasjon og legerolle.
Supplerende info – forventes ikke av studentene: En del arbeidsinnvandrere fra Øst-Europa bruker erfaringsmessig helsevesenet i sine hjemland som «supplement» til det som finnes i Norge – f. eks. å få undersøkelser, autorative uttalelser etc. Privat medisinsk sektor i for eksempel Polen er relativt rimelig, innen rekkevidde for pasienter med norsk arbeidsinntekt.
Ut fra forelesninger forventes de fleste å svare som angitt over. Oppgaven kan imidlertid også tolkes som et spørsmål om organisering og regulering på makronivå. Dette bør også godtas som riktig svar.
Dette inkluderer svar som diskuterer regulering av kommunenes ansvar for å sørge for fastleger (jfr Helse- og omsorgstjenesteloven med fastlegeforskriften), rett på en avtale med fastlege, rett til å skifte fastlege, og rett til vurdering hos annen lege (jfr Pasient og brukerrettighetsloven), at fastleger har en dobbeltrolle i forhold til en del rettighetsfestede velferdsytelser (sykmelding, uførepensjon osv) hvor legen er både pasientens advokat og forvalter av ytelsene, i betydning av at ytelsene ikke blir misbrukt eller ikke brukt etter lov og forskrift, at spesialisthelsetjenester krever henvisning, og den tredelte finansieringen av fastleger (hodetilskudd, refusjon fra NAV og egenandel)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dette er en oppgave om et stadig mer aktuelt tema. Tematikken har vært drøftet på forelesning men ikke på måter som inviterer til enkel opplisting av stikkord. Studentene kan derfor komme til å streve litt med å formulere besvarelsen og det må utvises skjønn også her.
Men svaret må omtale både helsetjenesten og legerollen for å gi tre poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På en blanding av norsk, engelsk og kroppsspråk får du vite at Pawel fikk en vridning av venstre kne på jobb for to dager siden, da han skled og falt i en gressbakke mens han bar noen planker på skulderen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke overordnede, differensialdiagnostiske overveielser gjør du deg, basert på anamnesen og det du til nå har observert?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Skademekanismen er vridning/kontusjon av kneet, et lavenergitraume. Pasienten kommer gående på egne bein. Han halter bare lett.
Anamnese og observasjoner kan tyde på skade av sideligament (strekk eller partiell overriving), dette er en vanlig skade og den mest sannsynlige diagnosen i dette tilfellet. Skademekanismen er også forenlig med en mulig meniskskade. Korsbåndsskader oppstår ofte ved rotasjon i kneet mens foten er låst mot bakken eller ved hyperekstensjon av kne. Ved større kneskader er det ofte skade på flere strukturer samtidig.
Det er ikke sannsynlig at pasienten har noen alvorlig skade ut fra anamnese og observasjoner så langt, men kneet må undersøkes før man konkluderer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
OBS dette er en 1-poengs deloppgave og det forventes ikke noe langt resonnement her; oppgavens fokus er ikke kneskader (komplett eksaminering i klinisk allmennmedisin tilhører stadium IIID). Her kreves relevante stikkord knyttet til ligamenter, menisk, korsbånd. Fraktur ikke nødvendig å nevne.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du undersøker pasientens kne. Du registrerer at det er litt hovent, men finner ingen tegn til alvorlig skade som krever umiddelbar intervensjon.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Om du ser bort fra den aktuelle pasientens uttrykte forventinger, hvilken faglig strategi vil du helst velge? Beskriv dine valg med referanse til aktuelle allmennmedisinske arbeidsteknikker.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved mye smerter (og ingen tegn til «akutt, ØH ortopedi» som f eks akutt låsning av kneet) er det klokt å ta pasienten tilbake etter 3-4 dager når tilstanden har roet seg - for ny undersøkelse (= å bruke tiden som diagnostikum, å ta pasienten tilbake for ny undersøkelse, å sette opp til kontroll). Ro, evt. støttebandasje og evt. elevasjon (det siste ikke så viktig hvis liten skade). Evt. avlastning med krykker noen dager. Smertestillende – paracetamol/NSAIDS. Sykmelding hvis behov (som det nok er i denne situasjonen). I og med at skaden skjedde på arbeidsplassen, bør det vurderes om dette er en yrkesskade. Noter dette i journalen. Pasienten kan dernest oppfordres til å be arbeidsgiver melde dette som mulig yrkesskade.
Dersom ny undersøkelse viser det samme – stabilt kne – vil neste råd være å se det an videre, evt. sykemelding fortsettes. I tilfeller ved strekk på sideleddbånd vil skaden gradvis tilheles dersom belastningen tilpasses – her er det viktig å avdramatisere saken og berolige. Fortelle pasienten at billeddiagnostikk eller annen utredning generelt ikke er indisert i denne fasen etter en slik skade.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Avventende holdning må skisseres. Temaet yrkesskade bør nevnes (journalføring kan vel holde så lenge skaden er såpass liten), men ikke trekk mer enn 0,2 hvis det ikke nevnes.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du legger en plan for videre oppfølging av pasienten. En uke
senere går det imidlertid opp for deg at han har avbestilt neste
time. Men etter et par uker dukker han opp igjen. Han halter ikke
lenger. Han har med seg polske MRI bilder av hhv. venstre kne og
lumbal-sacral columna, tatt for tre dager siden.
<<<
MR venstre kne (din oversettelse): Lett ødem rundt mediale kollaterale ligament og tendens til tendinitt. Noe degenerative forandringer. Liten cyste 3x4 mm i fossa poplitea (Bakers cyste)
MR LS columna (din oversettelse): De tre øverste skiverom er upåfallende med gode plassforhold. L4 skive er dehydrert, høyderedusert. Lite, høyrestillet prolaps L5 skiverom, men ingen rotaffeksjon. Litt sideleddsartrose.
R: lette degenerative forandringer i L4 og L5 skiverom, lite prolaps L5 uten sikker rotkompresjon
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er ditt resonnement når du fortolker billedsvarene og implikasjonene av dem? Hvordan vil du formidle dette til pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er poenget at ingen av røntgensvarene gir holdepunkter for at pasienten bør henvises eller opereres.
Formidles til pasienten: Bifunn som Bakers cyste og et lite prolaps (her altså uten klinisk rot-affeksjon) setter ofte i gang tanker og bekymringer hos pasienter. Obs Overdiagnostikk – som kan lede til overbehandling etc. Røntgenfunnene styrker ellers din kliniske mistanke om overstrekk av ligamenter i kneet ev. i kombinasjon med lette degenerative forandringer, som er å forvente utfra alder/yrke. Din strategi med avlastning og «aktiv ekspektans» er fortsatt riktig/innenfor god medisin.
Når det gjelder ryggen – så behøver ikke et slikt funn å bety at det foreligger et klinisk problem. Og selv om pasienten skulle ha noen ryggplager, må det en nøye anamnese og klinisk undersøkelse hvis man skal kunne konkludere at det er samsvar mellom symptomer og røntgenfunn. (Det er ikke nødvendig å utrede med mindre ryggen nevnes som et problem av pas)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studenten må ha et gyldig resonnement for hvorfor det ikke er indisert med videre utredning eller operasjon (1poeng) og bør skissere hvordan funnene presenteres for pasienten (1 poeng)
Både konklusjonen ikke indikasjon for videre utredning og resonnementet bør inngå. Litt avveining i poengfordeling, avhengig av hvordan studenten bygger opp sitt svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det er fortsatt svært utfordrende å kommunisere på grunn av språket. Pawel Novak sier at kneet har blitt bedre og er ikke lengre bekymret for det. Derimot oppfatter du at han nå er bekymret for ryggen sin. Pawel sier at han har hatt vondt i ryggen, og «bildene er ikke normale». Du får ikke helt tak i hva han tenker på, men han nevner ordet operasjon to ganger, og sier noe om at broren hans kan dø fordi han kom for sent til operasjon. Stemningen mellom dere preges av frustrasjon, og du innser at språkproblemet er såpass stort at dere ikke kommer videre. Noen må tolke for dere.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Nevn ulike tolke-løsninger som brukes jevnlig i helsetjenesten og nevn fordeler og ulemper med de ulike løsningene.
# Hvem betaler for innleide tolketjenester på legekontoret?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Profesjonelle tolker: Telefontolk, videotolk (fjerntolking) eller fremmøte-tolk
* Privat tolking: typisk slekt/venn som tolk
* Gullstandard er tilstedeværende tolk som er profesjonell.
''Fordeler med fremmøtetolk'' er at tolken kan få med seg ikke-verbale signaler hos samtalepartnere. Tolken kan bruke kroppsspråk til å støtte sin kommunikasjon. Anbefales særlig ved kompliserte helsekonsultasjoner/operasjoner, Større møter med flere deltakere, Samtaler med psykisk syke personer, Tilfeller hvor man skal lære bruk av nytt utstyr, Samtaler med små barn.
''Fordeler med telefontolk'': Rimeligste alternativ som gir tolkebrukere mye fleksibilitet, Tilgjengelig på meget kort varsel, ofte døgnåpent, mange tilgjengelige språk, uavhengig av tolkested og tid på døgnet, tolken er mindre i veien for samtalepartnere, Ved helseoppdrag med smittefare
Ulemper: Tolken går glipp av nonverbale signaler, vanskelig med flere personer i rommet – og mindre mulighet til å kunne følge med hva som skjer, flytte seg fra rom til rom etc.
''Fordeler ved videotolking'' (kan bli fremtidens fremmøte tolking): Mange av de samme som ved telefontolk, men tolken får nå også med seg non-verbale signaler. I geografisk vanskelig tilgjengelige områder. Større møter med flere deltakere
Det er fint om studentene også viser at de har fått med seg at det ofte er stor forskjell på nivået på tolkene (i hvilken grad det bare har avgitt språktest – eller har tolken faktisk også fått opplæring i tolking- tolkefaget/ blitt autorisert som tolk). Problemet er at det mange steder ikke finnes tolk som kan være tilstede – og da er telefontolk et alternativ. Familie/ slekt/venner bør som hovedregel unngås – så lenge ikke akutt/ øyeblikkelig hjelp. Men selvfølgelig også bedre enn ingenting. Når det gjelder barn så er det en alminnelig oppfatning at disse bør skånes for belastningen med å ta tolkeoppdrag. Med bakgrunn i dette ble det fra og med 1. juli 2016 forbudt å bruke barn som tolk. (Ifølge § 11 e. i forvaltningsloven skal ikke barn brukes «til tolking eller annen formidling av informasjon mellom forvaltningen og personer som ikke har tilstrekkelige språkferdigheter».)
Kommunen er pålagt å tilby og betale for tolketjenester: https://helsedirektoratet.no/Lists/Publikasjoner/Attachments/242/Veileder%20om%20kommunikasjon%20via%20tolk%20for%20ledere%20og%20personell%20i%20helse%20og%20omsorgstjenesten%20fullversjon%20IS-1924.pdf
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Også her må det utvises skjønn. Sensorveiledningen er mer omfattende enn det detaljnivå som kreves for å kunne få 2 poeng
Max 1,5 p for typer tolk og fordeler/ulemper 0,5 p poeng for kommunal betaling
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har fått lagt til rette for bedre kommunikasjon med Pawel Novak. Du kommer dermed i posisjon til å stille mer åpne, pasientsentrerte spørsmål
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Med henvisning til læreboka Allmennmedisin der pasientsentrert arbeidsmetode omtales: Nevn de 4 (evt 5) F-ene som i stikkords form oppsummerer pasientsentrert metode (1p)
# Velg dernest tre av F-ene og formuler pasientsentrerte spørsmål knyttet til disse, med relevans i den aktuelle situasjonen (2 p.).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Se nedenfor, 1 poeng hvis 4 eller 5 F-er nevnes. Ev. sier de «Pasienten som person» som alternativ til denne 5. F-en (Den 5. F kalles ellers Forutsetninger)
Her må det være åpent for litt ulike varianter – men bør kunne knyttes an til «F-ene»:
* ''Forestillinger'' og ''Forventninger'': Hva tenker du selv om disse plagene? Evt om røntgenbildet? Hvordan ser du for deg at saken/sakene skal håndteres?
* ''Frykt''/bekymringer (– for hva?) Hva er det med broren din?
* ''Funksjon'' – hvordan fungerer du i det daglige (i og utenfor jobb)?
* ''Forutsetninger'' (kan også betegnes Pasienten som person): hvordan er livet generelt, hvem utgjør ditt sosiale nettverk, osv – her er mange tema relevante.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å oppgi forestillinger, forventninger, frykt (eller tilsvarende begrep) og funksjon (eller tilsvarende begrep), med eller uten forutsetninger.
½ poeng for 3-4 F’er der ikke alle av forestillinger, forventninger, frykt og funksjon kategoriene er med.
Max 2 poeng for tre relevante spørsmål i henhold til F-enes tema. Fleksibilitet i sensur er OK.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I løpet av den samme tolkede konsultasjonen forteller Pawel Novak at da han nylig var hjemme i Polen, fikk han vite at en halvbror på 67 år (felles far) har fått diagnostisert prostatakreft. Da diagnosen ble stilt hadde broren allerede fått metastaser til skjelettet. Pawel er naturligvis berørt av dette og sier han tenker på sin egen familie som er avhengig av ham. Han vil ha sjekket sin prostata så godt det overhodet lar seg gjøre. Han har hørt om en «kreft-prøve» som kan avklare det hele.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke overveielser gjør du nå, og hvilken strategi bør du velge?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Overveielser: Dette er ikke noen rett-fram situasjon. Generell PSA-screening for menn er ikke anbefalt på grunn av fare for overdiagnostikk/ overbehandling og følgende fare for bivirkninger med vannlatingsbesvær og impotens (mange må behandles for å unngå ett dødsfall av prostatakreft)
Ved ev. vesentlige vannlatingsplager er PSA testing mer aktuelt. Det samme hvis ca. prostatae i nær familie (som her), og selvsagt hvis klinisk undersøkelse (rektal eksplorasjon) skulle gi grunn til mistanke.
Strategi: Saken må drøftes med pasienten, uansett hva man velger. Forklare PSA-dilemmaet for pasienten, inkludert mulighet for overdiagnostikk/-behandling. I dette tilfelle er det nok rimelig å la pasienten avgjøre (pga. mulig genetikk og derav økt bekymring). I andre tilfeller (yngre symptomfri menn som bare vil ha en «helsjekk» kan det være naturlig å være mer tydelig restriktiv i forhold til PSA-testing).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Å vise til PSA test-dilemmaet og forklare hva det består i (mulig overdiagnostikk og overbehandling), og samtidig å resonnere seg fram til at i dette tilfellet vil pasientens (informerte) valg være ganske avgjørende – sterkere indikasjon her enn hos en mann uten tilsvarende slektsanamnese.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er legevaktslege i og tilkalles til en arbeidsulykke 5 – 6 minutters kjøring fra St Olavs hospital. Luftambulansen er opptatt i et annet oppdrag.
En 1 – 2 tonn tung sementblokk har veltet over en 28 år gammel mann. Pasienten har blitt liggende i klem. Etter hva som opplyses har hode, armer og øvre thorax stukket ut og pasienten vært våken hele tiden. Før du kommer til stedet har sementblokka blitt løftet bort.
Ambulansepersonell har kommet til. De har gitt pasienten oksygen på maske og satt på et pulsoksymeter. Pasienten ligger på bakken, er våken, beveger begge armer og løfter på hodet. Han har tydelig store smerter. Høyre bein ligger i en unormal stilling. Mens du hjelper til med å legge inn veneflon bemerker du at pasienten er blek og kjølig perifert, men du kjenner samtidig en kraftig radialispuls med rask frekvens. Pulsoksymeteret viser SaO2 92 %, pulsfrekvens 130. Du ser ingen tegn til betydelige ytre blødninger.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke potensielle farer truer pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har potensielt store indre blødninger og truende blødningssjokk. Han er ung og kan kompensere med økt krono- og inotropi til han plutselig dekompenserer.
Det kan ikke utelukkes at han også har en lungekontusjon med begynnende lungesvikt, selv om funnene kan forklares ut fra kompenserte store blødninger aleine. Pasienten kan også ha skade på rygg og ryggmarg.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det kan utvises skjønn i poenggivingen. Det viktigste er å diskutere blødningsrisiko og risiko for dekompensasjon/blødningssjokk. Skade på rygg og ryggmarg trenger ikke være med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke umiddelbare tiltak bør settes i gang?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er kort vei til sykehuset og han bør snarest mulig dit. Dette er det viktigste tiltaket i denne situasjonen. Legen må overvåke pasienten under transport og evt gi væske.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for rask transport med overvåking.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du bestemmer deg for å ta pasienten inn i ambulansen før videre behandling . Men først må han opp på en båre. Det er opplagt at han trenger smertelindring før flytting. Fra ambulansepersonellet blir du spurt om hvilket medikament de skal gi. De har følgende intravenøse medikamenter: morfin (Morfin), diazepam (Stesolid), esketamin (Ketanest/Ketamin).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi fordeler og ulemper med å gi morfin (Morfin®) intravenøst i denne situasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Fordeler'': morfin er et opioid og gir smertelindring
''Ulemper'': Pasienten er (sannsynligvis) avhengig av høy sympaticustonus. Morfin vil redusere denne og dette kan gi et vanskelig traktabelt blodtrykksfall. I tillegg er morfin respirasjonsdempende og kan forverre en eventuell lungesvikt,
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fordeler: smertelinding 0,5 p. Ulemper: 0,5 p for enten respirasjonsdepresjon eller redusert sympatikustonus Studentene er ikke bedt om å konkludere om hvilket medikament som skal gis.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du bestemmer deg for å ta pasienten inn i ambulansen før videre behandling . Men først må han opp på en båre. Det er opplagt at han trenger smertelindring før flytting. Fra ambulansepersonellet blir du spurt om hvilket medikament de skal gi. De har følgende intravenøse medikamenter: morfin (Morfin), diazepam (Stesolid), esketamin (Ketanest/Ketamin).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi fordeler og ulemper med å gi diazepam (Stesolid®) intravenøst i denne situasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Fordeler'': diazepam er et benzodiazepin som er angstdempende og sederende. Ikke sterkt nok sedativum til å ha særlig nytteeffekt i denne situasjonen
''Ulemper'': Pasienten er (sannsynligvis) avhengig av høy sympaticustonus. Diazepam vil redusere denne noe men vil neppe gi et svært blodtrykksfall. Diazepam er sløvende og svekker reflekser som beskytter pasientens respirasjon og sirkulasjon.
Det ville være feil å gi denne pasienten diazepam for smertelindring.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for angstdempende eller «sederende, men ikke tilstrekkelig nyttig her», 0,5 poeng for «diazepam vil redusere sypatikustonus, men antagelig ikke gi et stort blodtrykksfall» eller «diazepam er sløvende og svekker reflekser som beskytter pasientens respirasjon og sirkulasjon». Studentene er ikke bedt om å konkludere om hvilket medikament som skal gis.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra forrige vignett:
<<<
Du bestemmer deg for å ta pasienten inn i ambulansen før videre behandling . Men først må han opp på en båre. Det er opplagt at han trenger smertelindring før flytting. Fra ambulansepersonellet blir du spurt om hvilket medikament de skal gi. De har følgende intravenøse medikamenter: morfin (Morfin), diazepam (Stesolid), esketamin (Ketanest/Ketamin).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi fordeler og ulemper med å gi esketamin (Ketanest®/Ketamin) intravenøst i denne situasjonen
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Fordeler'': Ketamin er smertedempende og gir såkalt «dissosiativ anestesi» - pasienten opplever ikke situasjonen. Pasienten er i narkose med bevart egenrespirasjon. Ketamin er sympatikusstimulerende og hever blodtrykk og hjertefrekvens ved akutte situasjoner som denne.
''Ulemper'': Dissosiativ anestesi kan for noe innebære marerittlignende «bad trips».
Ketamin er det klart beste valget i denne situasjonen (studenten er ikke bedt om å velge preparat, og det er derfor ikke nødvendig å angi dette).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det viktigste her er smertedempende (0,5p) og sympatikusstimulerende effekt (0,5p). Studentene er ikke bedt om å konkludere om hvilket medikament som skal gis.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En av pasientene i ditt fastlegevikariat er en 84 år gammel enke som bor alene. Hun har hjemmesykepleie en gang ukentlig til utlevering av medisindosett og hjelp til dusj, i tillegg har hun middagsombringing tre dager pr uke. Hun har alltid hatt dårlig rygg, i tillegg har hun pga osteoporose hatt flere kompresjonsfrakturer de siste årene. Hun har også hypertensjon og mulig angina.
Du blir kontaktet av hjemmesykepleien fordi pasienten har vært i redusert form siste uker. Hun har vært mye sengeliggende og har klaget over smerter i kropp og mage til tross for at hun har tatt Paralgin forte og Ibux. Har tidvis virket forvirret og hjemmesykepleien er usikker på hvor mye mat og drikke hun har fått i seg. Du drar på hjemmebesøk. Pasienten er slapp og noe desorientert. Blodtrykket er 102/58, puls 98 regelmessig, temp 36,0.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du velger å legge pasienten inn på sykehus. Lag en liste over pasientens problemstillinger (symptomer, mulige årsaker og/eller aktuelle differensialdiagnoser) som er relevante å ta med i henvisningen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Smerter – ulcus? obstipasjon?
* Lite matinntak
* Lite væskeinntak – sannsynlig dehydrering
* Forvirring/delirium
* Akutt funksjonssvikt/redusert allmenntilstand
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert punkt, maks 2 poeng totalt
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ut fra de opplysningene du har - hvilke forhold hos denne pasienten bør du vektlegge når du vurderer om hun er i risiko for ernæringsvansker?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er flere forhold ved pasienten som gjør at man bør være oppmerksom på risikoen for ernæringsproblematikk: Høy __alder__, bor __alene__, har __kroniske sykdommer__, __forvirring__ (mulig kognitiv svikt), __smerter__. Det at hun har et __bistandsbehov__ ift ernæring (middagsombringing) indikerer også at hun allerede har, eller er sårbar for, et ernæringsproblem.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert punkt som er understreket, maks 2 poeng totalt.
</$details>
<div class="oppgave">
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!!Vignett
Pasienten havner på medisinsk avdeling. Hun er slapp og mager. Angir at hun føler seg i dårlig form, ubehag i magen, men redegjør ellers dårlig for sine plager. Fram til innleggelsen har hun brukt følgende medisiner: Calcigran forte (kalk/vitamin D3), Diovan Comp (valsartan/hydroklortiazid, dvs A2- blokker og diuretikum), Albyl-E og Ferromax (jerntilskudd). Ved behov tar hun Paralgin forte (kodein/ paracetamol) og Ibux (ibuprofen).
Blodprøver ved innkomst:
|! |!Aktuell verdi |!Normalverdi |
|Kreatinin (mikromol/l) | 153 | 45- 90 |
|Kalium (mmol/l) | 5,3 | 3,5- 4,4 |
|Natrium (mmol/l) | 130 | 137- 145 |
|Hemoglobin (g/dl) | 9,1 | 11,7- 15,3 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kan noen av pasientens medikamenter ha bidratt til at hun nå er dårlig?
Angi de medisinene som er aktuelle, og nevn hvordan hver enkelt av dem kan ha bidratt til den aktuelle sykehistorien.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Diovan Comp – kan ha bidratt til dehydrering og nyresvikt, samt elektrolyttforstyrrelser
* Ibux – kan ha bidratt til nyresvikt, kan også føre til gastritt/ulcus med lav Hb og dårlig matlyst til følge
* Albyl-E – kan føre til gastritt/ ulcus (spesielt i kombinasjon med NSAIDS), med lav Hb og dårlig matlyst til følge
* Ferromax - kan bidra til obstipasjon og magesmerter og dermed dårlig matlyst
* Calcigran forte – kan bidra til obstipasjon og dermed dårlig matlyst
* Paralgin Forte – kan bidra til obstipasjon og dermed dårlig matlyst, samt bidra til å utløse forvirring/delirium)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert medikament med forklaring, maks 2 poeng totalt
</$details>
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!!Vignett
Under oppholdet blir det utført rutinemessig ernæringsscreening. Hun er 163 cm høy og veier 48 kg, dvs har BMI 18,1. Kostregistrering etter noen dager viser at hun får i seg 1100 kcal, 30 gram protein og 1,5 liter væske pr døgn
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder pasientens inntak av henholdsvis kalorier og proteiner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Både kalori- og proteininntaket er for lavt. Energibehovet er på minst 1500 kcal (30 kcal/kg – men egentlig noe høyere da hun er underernært og nå har akutt sykdom). Proteinbehovet er ca 1,5 g/kg, dvs ca 70 g pr døgn.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hver (kalorier, proteiner), totalt maks 1 poeng. Det er ikke nødvendig å angi normalt behov, men studenten må kunne angi at inntaket er for lite.
</$details>
<div class="oppgave">
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!!Vignett
Pasienten er uheldig og pådrar seg en infeksjon i løpet av oppholdet. Hun får høy feber, får påvist et infiltrat på røntgen thorax og CRP- stigning til nærmere 300. Det blir startet antibiotika og væske intravenøst, men til tross for dette er matinntaket tilnærmet lik null hele påfølgende uke. Etter forespørsel fra avdelingssykepleier får pasienten anlagt ernæringssonde og det blir startet sondeernæring i henhold til kroppsvekt. Få dager senere utvikler hun perifere ødemer og blir økende tungpust.
Kontroll-blodprøver viser:
|! |!Aktuell verdi |!Normalverdi |
|Kreatinin (mikromol/l) | 123 | 45- 90 |
|Kalium (mmol/l) | 2,8 | 3,5- 4,4 |
|Fosfat | 0,48 | 0,71- 1,23 |
|Magnesium | 0,53 | 0,71- 0,94 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnostiske overveielser gjør du nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ut fra sykehistorien (undervektig, tilnærmet null inntak siste uke og deretter oppstart ernæring uten forsiktig opptrapping), kliniske funn (ødemer og mulig hjertesvikt) og labfunn (lav kalium, magnesium og fosfat) er tilstanden forenlig med re-ernæringssyndrom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for riktig diagnose
</$details>
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling bør iverksettes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Behandling: Pasienten bør snarest få tiamin iv el im (burde vært startet før ernæring). Elektrolytter må korrigeres. Det anbefales også vitamintilskudd med Berocca el tilsvarende.) Det bør vurderes å redusere mengde sondeernæring.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert bandlingsforslag (totalt 1 poeng for behandling).
</$details>
<div class="oppgave">
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!!Vignett
Etter et langtrukkent sykeleie blir pasienten utskrevet tilbake til hjemmet. Som fastlegevikar mottar du epikrise. Det er angitt at pasienten er i "ernæringsmessig risiko"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva innebærer dette begrepet for videre oppfølging?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I følge nasjonale retningslinjer for forebygging og behandling av underernæring, skal alle pasienter som fyller kriterier for «ernæringsmessig risiko» ha en individuell ernæringsplan. I planen skal det være angitt ernæringsstatus, beregnet næringsbehov, inntak, aktuelle tiltak, mål (for eksempel holde stabil vekt eller vektøkning) og anbefalt oppfølging.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for ernæringsplan (svar som forklarer innholdet i begrepet aksepteres, selv om ordet "ernæringsplan" ikke er nevnt)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
Liu X, et al. (2017): Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ 2017;358:j3668 http://dx.doi.org/10.1136/bmj.j3668
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var hensikten med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hensikten var å studere sammenhengen mellom eksponering for antidepressiva under svangerskapet og risiko for at barna skulle få en psykiatrisk diagnose.
</$details>
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gir denne studien grunnlag for å redusere bruken av medikamenter mot depresjon i svangerskapet? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her bør kandidaten drøfte avveining mellom mors helse, barnets helse, relativt små forskjeller, samt problemer med konfundering fra underliggende familiær risiko. Kandidaten bør nevne at en slik studie ikke kan benyttes som grunnlag for å endre klinisk praksis i seg selv.
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket design har studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kohortstudie
</$details>
<div class="oppgave">
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke primære og sekundere utfallsmål har studien?
# Hvordan begrunner forfatterne valg av utfallsmål?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Utfallsmålene er basert på dato for første psykiatrisk diagnose hos avkom. Diagnose ble satt ved kontakt med døgn- eller poliklinisk spesialisert psykiatrisk behandling. Primære utfallsmål var diagnose i kapittel F00-F99 (ICD10). Sekundære utfallsmål var et utvalg av underkategorier av psykiatriske diagnoser.
# Forfatterne gjør et poeng av at man kan gå glipp av viktig informasjon ved kun å undersøke enkelttilstander ved eksponering for antidepressiva i svangerskapet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Kandidaten må nevne både psykiatriske diagnoser og underkategorier (ikke nødvendig med navn) for å få 1p. Hvis kandidaten kun skriver psykiatriske diagnoser, gis 0,5 poeng.
# 0,5 p
</$details>
<div class="oppgave">
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket effektmål og mål på presisjon er brukt i Table 2?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Effektmålet er hazard ratio som er et mål på relativ risiko og målet på presisjon er 95% konfidensintervall
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
HR 0,5 p, 95%CI 0,5 p
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva betyr konfundering (confounding)? Hvilke konfunderende faktorer kan tenkes å være relevante for denne studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Konfundering betyr effektforveksling hvor en felles årsak til eksponering og utfall skaper en «feil» sammenheng mellom eksponering og utfall.
I denne studien kan vi anta at familiær risiko for psykiatrisk sykdom er viktig årsak til behandling av mor under svangerskapet og årsak til psykiatrisk sykdom hos barna.
Forfatterne har også listet opp flere potensielle konfunderende faktorer i Tabell 1.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekt definisjon av konfundering gir 0,5 poeng. Drøfting av konfunderende faktorer fra Tabell 1 gir 0,5 poeng. Drøfting av familiær risiko som kanskje viktigste konfunderende faktor gir 1 poeng.
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan har forfatterne forsøkt å ta hensyn til konfundering?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forfatterne har justert for mulige konfunderende faktorer (1 p).
Ved å dele inn i ueksponerte (ingen bruk av antidepressiva før eller under svangerskapet), de som hadde brukt før, men ikke under svangerskapet (discontinuation group), brukte før og under svangerskapet (continuation group) og nye brukere under svangerskapet, så kan forfatterne til en viss grad skille mellom grad av eksponering og potensiell innvirkning av familiær risiko (0,5 p). De har også sett på om fars eksponering for antidepressiva er assosiert med utfallet. Det er ikke sannsynlig at fars eksponering når mor er gravid skal påvirke barnets psykiatriske sykdomsrisiko (0,5 p)
</$details>
<div class="oppgave">
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!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I en supplerende analyse (suplementary figure), viser forfatterne en analyse av fedres eksponering for medikamenter mot depresjon før og under svangerskapet. Hvordan tolker du disse resultatene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sammenhengen til fedres bruk av antidepressiva under svangerskapet og barnas psykiatriske sykdomsrisiko er mye svakere enn tilsvarende for mors. Dette er en god test på om sammenhengen er drevet av underliggende familiær risiko (den skulle være samme for far som for mor). Samtidig er det en sterkere sammenheng for psykiatriske diagnoser blant de som brukte før og under svangerskapet (continuation group) enn for de om brukte før, men ikke under svangerskapet /(discontinoued use). Dette kan ses som en indikasjon på confounding for underliggende familiær risiko.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At kandidaten beskriver at dette er en test på underliggende confounding fra familiær risiko gir 0,5 p. Minst ett av følgende må bli nevnt for å få 0,5 p: (1) Drøfting av betydningen av den reduserte effekten for far versus mor. (2) Sammenhengen for continuation group hos far.
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er hovedkonklusjonen til forfatterne?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forfatterne konkluderer ganske forsiktig med at mors bruk av antidepressiva under svangerskapet er assosiert med barnas risiko for psykiatrisk sykdom. De skriver videre at dette kan henge sammen med både mors underliggende psykiatriske morbiditet og in utero eksponering for antidepressiva.
</$details>
<div class="oppgave">
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!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en vurdering av om resultatene i denne studien er generaliserbare
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forfatterne har brukt data fra en dansk populasjon. Det er en antatt biologisk mekanisme (antidepressiva under svangerskapet og avkommets risiko for psykiatrisk sykdom). Dette taler for høy generaliserbarhet. På den andre siden, så har Danmark et velfungerende velferdssystem. Ubehandlet depresjon hos mor kan tenkelig få større konsekvenser i andre land hvor man ikke har tilsvarende støttesystemer.
</$details>
<div class="oppgave">
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!!Vignett
Lise på 32 år er skilt og har aleneomsorg for ei lita jenta på 2 år. Barnefaren bodde sammen med dem inntil han brøt all kontakt da barnet var vel 1 år gammelt. Lises mor døde brått og uventet for en uke siden etter et akutt hjerteinfarkt. Lise har i over 6 år jobbet som resepsjonist på et hotell (IA bedrift) og har nå brukt egenmelding for å være hjemme den første uken etter dødsfallet.
Du har vært fastlege for Lise i over 10 år, men hun har kun vært hos deg i forbindelse med svangerskap og fødsel og du har ikke sykmeldt henne tidligere. I dag er første gang du ser henne opprørt og ute av seg. Hun tar til tårene flere ganger og ser trist og sliten ut. Hun sier at hun har knapt sovet den siste uken. Hun føler seg helt utslitt, og opplever at hun ikke helt har forstått at moren virkelig er borte. Hun kan ta seg selv i å snakke høyt til moren som om de var i samme rom, men bryter deretter ut i gråt i visshet om at moren aldri vil kunne svare. Lise ber nå om en forlenget sykmelding på en uke. Hun sier at hun ikke makter å forholde seg til andre mennesker på jobben (redd for å bryte ut i gråt og klarer ikke å samle tankene om annet enn dødsfallet/begravelsen og hvordan hun skal klare å ta vare på barnet). Om fire dager må hun reise til en annen del av landet for å delta i begravelsen. Hun ber også om sovemedisin fordi hun merker at hun må sove mer hvis hun skal klarer å ta vare på barnet på 2 år. I går hadde hun satt en kjele på kokeplaten og sovnet fra dette. Datterens gråt og røykvarsleren som ulte hadde vekket henne.
''Du skal ta stilling til pasientens forespørsel om 100% sykmelding''.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Foreligger det egen sykdom i henhold til et anerkjent sykdomsbegrep som kan gi rett til sykmelding? Redegjør for argumenter __for__ og __imot__, før du gir en begrunnet konklusjon
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det ''IKKE'' kun ett fasit svar. Viktig med en god begrunnelse. Eksempelsvar:
''Taler imot'': Sosiale årsaker gir ikke rett til sykepenger. Det må anses som naturlig at en mors dødsfall utløser en tydelig sorgreaksjon.
''Taler for'': Sykehistorien tyder på at dette kan dreie seg om utvikling av en patologisk sorgreaksjon: alvorlige søvnvansker, konsentrasjonsvansker, problemer med å forholde seg til andre mennesker, fornektelse/kortvarig virkelighetsbrist (snakker til den døde moren) i forhold til det som har skjedd, egen bekymring for omsorgsevne for barnet. I dette tilfellet skjedde dødsfallet brått og uventet og dette kan bidra til å forklare en kraftig reaksjon.
Ja, det foreligger sykdom i henhold til et anerkjent sykdomsbegrep (symptomdiagnoser godtas). Mest aktuelle diagnoser: P02 Psykisk ubalanse situasjonsbetinget. P06 Søvnforstyrrelse.
(Ad regelverket: se rundskriv til kap. 8 om sykepenger. Der står det blant annet: ”Sorg er i seg selv ikke en sykdom, men i enkelte særlige tilfeller kan sorgreaksjonen gå utover det normale på en slik måte at man må si at vedkommende er arbeidsufør på grunn av sykdom”)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det må generelt utvises skjønn ved poengsettingen i denne oppgaven, alle deloppgaver.
Studenten må diskutere for og imot og vise forståelse for at sorg normalt sett ikke er sykdom, men at det kan finnes tilfeller hvor reaksjonen kan sies å gjøre pasienten arbeidsufør pga sykdom.
Både ja og nei kan godtas som konklusjon, så lenge diskusjonen er tilfredsstillende.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
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<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Foreligger det helseplager av en slik alvorlighetsgrad at de fører til nedsatt funksjonsevne som kan ha innvirkning på arbeidsevnen? Redegjør for argumenter __for__ og __imot__, før du gir en begrunnet konklusjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det ''IKKE'' kun ett fasit svar. Viktig med en god begrunnelse. Eksempelsvar:
''Taler for'': Hun beskriver helseplager (uttalte tretthet pga. søvnvansker, konsentrasjonsvansker, gråtelabil) som er hemmende for daglig fungering både på jobb og hjemme.
Alvorlig søvnmangel alene kan ha betydelig innvirkning funksjonsevnen og videre på arbeidsevnen. Samlet funksjonssvikt bør vurderes. Nedsatt fungering i arbeidssituasjoner kombinert med sviktende omsorgsevne er et viktig tegn på at det bør settes inn tiltak. Sykmelding en kort periode kan vær et slikt tiltak. Gradering av sykmelding kan drøftes. Utover dødsfall i nær familie, er det ikke opplyst om andre ikke-medisinske faktorer som kan forklare nedsatt arbeidsevne.
''Taler imot'': Tidsmessig fremstår helsesvikt som en normal reaksjon på morens dødsfall.
''Konklusjon'': Ja, det vurderes å foreligge årsakssammenheng mellom helseplager av en viss alvorlighetsgrad, funksjonssvikt og nedsatt arbeidsevne (se nærmere beskrivelse under "taler for")
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Også her er argumentasjonen viktigere enn konklusjonen. Studenten må diskutere grad av funksjonssvikt, og konsekvenser for arbeidsevne for full skår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Foreligger det risikofaktorer for langvarig sykefravær eller kontraindikasjoner til det å sykmelde? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, ingen kjente. Hun har hatt samme fastlege i 10 år og har vært lite syk. Hun fremstår som robust ved at hun har fungert i jobb uten sykmelding gjennom flere år inkludert gjennom et svangerskap og gjennom et samlivsbrudd.
Riskofaktorer man ser etter er eksempelvis hyppige eller langvarige tidligere sykmeldinger samt sosial belastning som kan tenkes å innvirke på arbeidsevnen (eks. konflikt på arbeidsplassen, store omsorgsoppgaver hjemme ved kronisk sykt barn eller ektefelle som er alkoholiker).. Det opplyses ikke om denne type risikofaktorer i forhistorien. En ev. risikofaktor er det at hun er kvinne og har aleneomsorg for et barn, men dette er statistisk og mindre relevant i den individuelle kliniske vurderingen som gjøres her.
Et kortvarig fravær kan virke preventivt i forhold til langvarig sykdom og fremtidig langvarig fravær.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør studenten konkludere med at det ikke foreligger risikofaktorer for full skår. 0.5 poeng viss studenten diskuterer noen relevante momenter og lander på konklusjon om at risikofaktorer foreligger.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Foreligger det åpenbare medisinske grunner til at pasienten ikke kan delta i noen som helst slags form for tilrettelagt arbeidsrettet aktivitet? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nei, det finnes ingen åpenbare medisinske grunner til at tilrettelagt arbeid ikke kan prøves ut. Basert på de medisinske opplysningen vi har foreligger det ikke et sykdomsbilde som er så alvorlig at det vil være "medisinsk kontraindisert" for henne å være i tilrettelagt arbeidsrettetaktivitet. Hun kan sannsynligvis trygt prøve seg i gradert jobb med tilrettelagte og enkle kontoroppgaver i skjermede omgivelser. (Det kan drøftes om det er hensiktsmessig å kreve at hun prøver seg i jobb. I den gitte situasjonen kan 100% sykmelding i inntil en uke fremstå som mest hensiktsmessig. Det er snakk om korttidsfravær i en situasjon der hun fungerer dårlig i jobbsituasjonen og der omsorgsevnen for barnet er redusert. Det å stå i jobb på tross av plagene kan øke risiko for forlenget helsesvikt. Andre moment kan drøftes: for eksempel hensyn til barnet, behov for å delta i begravelsen, men da omtaler vi omgivelsesfaktorer og ikke det som er relevant ved sykepenger, dvs egen sykdom).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for riktig konklusjon, 0.5 poeng for adekvat begrunnelse
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Uavhengig av om hun skal sykmeldes eller ikke, bør du som lege kjenne til om det finnes alternativ til sykmelding i en slik situasjon. Beskriv kort ett alternativ til sykmelding som kan drøftes med pasienter som ber om sykmelding ved dødsfall i nær familie.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Velferdspermisjon. Velferdspermisjon ved dødsfall i nær familie er ikke en lovfestet rett men noe svært mange arbeidsgivere vil innvilge, ofte med lønn.
(For eksempel: For statlig ansatte er velferdspermisjon ved dødsfall omtalt i Hovedtariffavtalen 7.3.22. NB! Velferdspermisjon er en lovfestet rett ved en rekke andre situasjoner ved for eksempel omsorg for og pleie av nærstående – se Arbeidsmiljøloven§12-10.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Velferdspermisjon 0,5 p, beskrivelse av denne (ikke lovfestet, innvilget av arbeidsgiver, ofte med lønn) 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Harald er 35 år, singel og har bodd hele livet i barndomshjemmet sammen med foreldrene sine. Han er yngste sønn i en søskenflokk på seks. Han forteller at han aldri var skoleflink og at etter fullført ungdomsskole begynte han å jobbe i farens bilverksted. Foreldrene har alltid forsørget ham og han har kun hatt lommepenger. Faren døde for et års tid siden og verkstedet ble da lagt ned. Mor på 67 år og sønn lever nå kun av hennes alderspensjon (minstepensjon).
Han oppsøker deg som fastlege for første gang og sier at moren har sagt at han må søke om trygd hvis de skal klare seg økonomisk. Du forstår det slik på Harald at han er frisk. Ifølge journal har han ikke vært hos legen siden han hadde en halsinfeksjon mens han gikk på ungdomsskolen.
I løpet av samtalen merker du at Harald ikke klarer å holde en vanlig samtale gående. Han svarer på mange av spørsmålene på en litt barnslig måte og med et svært enkelt ordforråd. Du får mistanke om at han har betydelig nedsatt mentalt og kognitiv fungering. Du finner overraskende nok ingen opplysninger om dette i tidligere legejournal.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft hvem og hvilke instanser (både i og utenfor NAV) det kan være aktuelt å samarbeid med i den videre utredningen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Komparentopplysninger fra mor (sykehistorie, svangerskap/fødsel, barndom/skolegang, fungering som voksen på verkstedet med faren og på fritiden). Ev. fra andre i familien eller nær omgangskrets
# Helsestasjon/skolen: finne frem rapporter fra skoleårene som kan si noe om funksjonsnivået, om det har vært kontakt med pedagogisk-psykologisk tjeneste (PPT), osv.)
# Spesialisthelsetjenesten: Henvise til nevropsykolog, voksen (re)habilitering og avklare om det er gjort kartlegginger av eldre dato ved f.eks. Barne- og ungdomspsykiatrisk enhet (BUP).
# NAV: Lokalt NAV kontor er første instans som bør kontaktes. Det kan være aktuelt å trekke inn NAV Arbeidsrådgivning (utredning av lese/skrivevansker, evt. nevropyskologisk utredning , karriere rådgivning).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
3 av 4 punkt bør være med for 2 poeng (ev. et halvt poeng for hvert riktig svar).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du blir bedre kjent med Harald gjennom det videre forløp. Det avdekkes ingen tegn til somatisk sykdom. Fysisk er han sterk.
Nevropsykologisk utredning konkluderer med redusert evne til læring og hukommelse, samt redusert konsentrasjon og vansker med oppmerksomhet over tid. Han har relativt god innsikt i egne begrensinger. Det konkluderes med at Haralds kognitive vansker mest sannsynligvis skyldes en medfødt hjerneskade og at det er overraskende at han ikke har vært i kontakt med lege og NAV tidligere.
Det beskrives at Harald som barn var en stille, blid og samarbeidsvillig gutt som sparket mye fotball og hadde noen få gode venner. Skoleprestasjoner var gjennomgående svært dårlige i alle fag. Familien ønsket imidlertid minst mulig oppmerksomhet rundt dette. De sa at "gud hadde skapt ham slik og da fikk det holde". Ellers beskrives en harmonisk familie og at faren på fritiden alltid var tilstede og hjalp sønnen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Han har ingen jobb og er ikke i stand til å forsørge seg selv slik situasjonen er per i dag. Beskriv kort hvilke stønader/ytelser som kan komme til anvendelse for å sikre økonomien til Harald.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Uføretrygd (hvis det konkluderes med at arbeidsevnen er betydelig nedsatt i forhold til ett hvert hensiktsmessig arbeid. Medisinske inngangsvilkår.)
# Arbeidsavklaringspenger (i en utredningsfaser der arbeidsevnen skal avklares. Medisinske inngangsvilkår.)
# Sosial stønad (hvis han ikke fyller medisinske inngangsvilkår, ev. inntil dette er avklart. Stønad som er forbeholdt den som er "ute av stand til å forsørge seg selv ved arbeid, egne midler eller ved andre økonomiske ytelser de kan ha krav på"
# Kvalifiseringsstønad (som for sosial stønad, dvs. aktuell når det ikke foreligger medisinsk årsak til nedsatt arbeids- og inntektsevne. Krav til at han deltar i et fastsatt program med arbeidstrening og oppfølging)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Som hovedregel 0.5 poeng for hvert av punktene ovenfor som er med.
Trekk 0.5 poeng hvis dagpenger eller sykepenger foreslås. Ikke aktuelt med dagpenger eller sykepenger pga. manglende inntektsgrunnlag.
Teller positivt hvis studentene husker tillegget som ung ufør, men det kreves ikke at ung ufør nevnes for å få full poengskår. Tilleggsytelse som "ung ufør" kan komme i tillegg til uføretrygd og AAP, dette vurderes individuelt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som fastlege blir du bedt av NAV om å skrive en legeerklæring. Det bes spesielt om at denne inneholder en grundig funksjonsvurdering slik at dette kan danne grunnlag for det videre arbeidet med å vurdere om det er aktuelt å prøve ut tilrettelagt arbeidsrelatert aktivitet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedpunkter bør være med i en funksjonsvurdering til bruk i NAV? Sett opp en stikkordsmessig tabell eller oversikt som viser:
# hvilke generelle momenter som bør være med i en funksjonsvurdering
# hvilke av de nevnte momenter (punkt 1) kan du si noe konkret om i dette tilfellet
# hvilke av de nevnte momenter (punkt 1) mangler du opplysninger om
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Studenten skal klare å identifisere hvilke punkter man faktisk har opplysninger om og hva slags informasjon som bør etterspørres.
# Legens vurdering av nåsituasjonen (tidsaktuelle, ikke utdaterte opplysninger).
# Beskrivelse av legens egne observasjoner/vurderinger av funksjonsnivå
# Gjerne supplert med pasientens egen beskrivelse og eventuelt observasjoner/vurderinger fra andre instanser (rehabiliteringsinstitusjon, arbeidsmarkedsbedrift). Kilde angis.
# Bredde i funksjonsområder som beskrives, bør inkludere både psykisk og fysisk fungering. Gjerne opplysninger om sosial fungering. (Stikkord: biopsykososial kartlegging av funksjon)
# Ta med både begrensninger og ressurser
# Om funksjonsevnens "tidsprofil" ( er funksjonsnivået stabilt eller svingende, eventuelt hvor hyppig og hvor mye svinger det, hvor lenge varer en periode med funksjonsfall eller en funksjonstopp og hvordan er funksjonsnivået i gjennomsnitt.
# Tempo. Trengs det økt tid på å gjennomføre oppgaver?
# Er funksjonssvikten relatert til bestemte situasjoner? F. eks. sammenligne funksjon på jobb og fritid. Utløsende situasjoner?
# Si noe om hvilke konsekvenser redusert funksjonsnivå kan ha eller helt konkret har hatt for arbeidsevnen (i den grad du har grunnlag for å si noe om dette)
Eksempelsvar: Kort oppsummert om de funksjonsopplysninger vi har (svar på punkt 2) og de vi mangler(svar på punk 3)
# Legen har gjort en nylig gjennomgang av saken. Vi har en del tidsaktuelle opplysninger.
# Legens egne observasjoner/funn: Fysisk sterk, Problemer med å holde en samtale gående
# Vi mangler pasientens egen beskrivelse av fungering per i dag. Opplysninger fra andre instanser: Det foreligger en nevropsykologisk vurdering av nylig dato. Ingen observasjoner fra andre instanser (rehabiliteringsinstitusjon, arbeidsmarkedsbedrift)
# Biopsykososialfungering: kognitiv fungering : redusert – se svar fra nevropsykolog. fysisk fungering: ingen svikt beskrevet. emosjonell fungering: lite kjent. Sosial fungering: bra som barn, lite beskrevet nå.
# begrensninger (kognitiv, nevnt ovenfor) og ressurser (fysisk sterk, sosialt omgjengelig?)
# Tidsprofil. INGEN OPPLYSNINGER
# Tempo. INGEN OPPLYSNINGER
# Situasjonsbestemt funksjonssvikt: INGEN OPPLYSNINGER
# Konsekvenser for arbeidsevnen: Resultater fra nevropsykologisk vurdering tilsier at kognitiv svikt vil kunne ha stor betydning for arbeidsevnen i forhold til de fleste yrker. Men, vi mangler et observasjonsgrunnlag for å kunne si noe om hvordan han faktisk fungerer i konkrete situasjoner. Ingen informasjon om hvilke oppgaver han hadde i farens bedrift, hvor selvstendig jobbet han? Hva slags tilrettelegging ble gjort? Hvordan fungerte han i denne jobben?
(Funksjonsvurderingen er ufullstendig og bør suppleres før den
kan brukes av NAV til å konkludere vedrørende arbeidsevne.
NB! Oppgaveteksten spør ikke etter en sluttvurdering og det
stilles ikke krav til at studenten har gjort dette).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Som hovedregel kreves det at 8 av 9 punkter er nevnt og at opplysninger eller mangel på opplysninger er registrert på disse. Poeng beregnes slik:
* 1 rett 0.5 poeng,
* 2 rett 1 poeng
* 3 rett 2 poeng
* 4 rett 3 poeng
* 5 rett 3.5 poeng
* 6 rett 4 poeng
* 7 rett 4.5 poeng
* 8-9 rett 5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du jobber som fastlege i en veletablert 4-legepraksis. Neste pasient er Eva Olsen (66 år). Hun står på en øyeblikkelig hjelptime på timeboka med stikkordet "Utslett".
Du ser at hun er ny på lista di. Det er ennå ikke lagt inn noen opplysninger i den elektroniske journalen, men du minnes at du så en tynn papirjournal (oversendt fra forrige fastlege) i posthylla di, og skjønner at den tilhører Eva Olsen.
Du henter henne på venterommet og hilser før dere går inn på legekontoret. Hun er ved første øyekast i allment god form, men ser dradd og sliten ut. På ditt spørsmål om hva hun ønsker hjelp med, forteller hun: "De siste 2 dagene har jeg fått et rart utslett bak på venstre skulder". Hun viser deg et bilde tatt med mobiltelefonen den første dagen det dukket opp. "Før utslettet kom, kjente jeg en rar svie i huden der, skjønte først ikke hva det var".
Bildet viser Evas utslett Dag 1.
<<imgLink "IIIC-2018-1-A.PNG" 400>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken diagnose er mest sannsynlig, basert på bildet og anamnesen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Herpes zoster
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Herpes zoster må nevnes. Om de nevner diffdiagnoser er det greit.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En velkjent allmennmedisinsk arbeidsteknikk er å bruke tiden som diagnostikum.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør man bruke tiden som diagnostikum i dette tilfellet? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Å avvente og se an en problemstilling er et aktivt valg og en arbeidsteknikk i allmennmedisinen. Dette kan være en aktuell løsning ved eksem og lignende hudlidelser i allmennpraksis.
I dette tilfellet bør man ut fra anamnesen mistenke herpes zoster – og hvis antiviral behandling er indisert, er det viktig å starte behandlingen tidsnok, og det er derfor ikke lurt å vente og ta pasienten tilbake. Antiviral terapi bør, om indisert, starte innen 72 timer. Pasientens alder kan tilsi at antiviral terapi er indisert, men hovedpoenget her er ikke et entydig svar på det, men kjennskap til at det kan være aktuelt og at man bør konsultere et oppslagsverk hvis man er i tvil om cut-off for alder og evt varighet av plagene før legesøkning.
Eks slå opp i NEL, Best practice aller andre autoritative oppslagsverk.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
At de forklarer på en grei måte at det å automatisk se tiden an ikke er lurt i en situasjon der tidlig diagnose og intervensjon kan bedre prognosen på en klinisk betydningsfull måte. Om de kan cut-off-punktet 72 timer eller sier at de vet at det finnes og vil slå det opp, spiller ingen vesentlig rolle.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du synes pasienten ser sliten ut, og hun nevner at det har vært mye stress den siste tiden. Du kjenner henne ikke fra før og vil gjerne vite mer om henne og hva dette handler om
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan du si eller spørre pasienten om? Formuler alternative formuleringer og knytt disse opp mot konsultasjonsteori.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tankegangen her er at du som ny fastlege ikke kjenner henne eller hennes helseproblemer fra tidligere og det kan være relevant å ta en runde på det. I tillegg kan det være relevant å høre om hvordan hun har det ellers – pasienten har nevnt stress, og det er kjent at dette kan være en utløsende årsak til herpes zoster (men trenger heller ikke være det).
Konsultasjonstekniske poeng; her kan man f eks kommentere at pasienten ser litt sliten ut (et nonverbalt hint) – spørre om hvordan er det/ har du det for tiden, refleksjon: «stress, sier du/fortell?». Andre innganger: «Nå kjenner ikke jeg deg fra før/ettersom du er ny pasient her hos oss; kan du fortelle litt om deg selv?» Screening-spørsmål vedrørende forhold rundt familie/sosialt/tidligere sykdommer/jobb – kan også gjøres ganske raskt – f eks med begrunnelse i at det er behov for å oppdatere journalens familie/sosialt seksjon.
Det er også relevant om studenten nevner de fire eller 5 F-ene (5. F: forutsetninger (pasienten som person). Ref: Hunskår, Allmennmedisin (2013) kap 1.4 og formulerer spørsmål basert på disse.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fleksibilitet her- studenten må vise at de ser poenget med å kartlegge litt om pasienten som person. Studentene må formulere alternativer som enten kan inkludere nonverbale hint, refleksjon, åpne spørsmål.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Eva Olsen forteller at hun ble skilt for mange år siden og jobber i en skobutikk. Økonomien er anstrengt, men hun klarer seg. På grunn av sykdom hos en kollega har hun måttet jobbe en del overtid i det siste. Det har også vært mye å tenke på den siste tiden ettersom hennes yngste datter (29 år) har vært på ryggsekkreise i Tyrkia hvor det for 10 dager siden var et stort jordskjelv. I tre dager hørte hun ikke fra datteren, men så fikk hun vite at hun var i sikkerhet. Sønnen (39 år) står midt oppe i en vanskelig skilsmisse og EO har stadig større bekymringer for barnebarnet Trine på 5 år– som havner midt i konfliktsonen mellom foreldrene. Siste gang hun var på besøk, gråt hun og spurte "Kan jeg ikke få bo her hos deg?"
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Identifiser potensielle stressorer fra sykehistorien over.
# Redegjør for en relevant modell som viser sammenhenger mellom belastende livserfaringer (stress) og helseproblemer
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Anamnestisk: Stressorer – datteren i fare – dramatisk uvisshet i flere døgn. Sønnens uhåndterlige parkonflikt, barnebarnet som lider overlast. Selv ellers robuste mennesker kan få en fysiologisk helseknekk under slike betingelser. Og dette kommer hos Eva oppå et vanlig litt strevsomt liv (butikkjobb, presset økonomi).
# Ved NTNU underviser vi ut fra modellen om Allostase (Hunskår 2013 kap 1.8).
#* Belastninger over lang tid – allostatisk overbelastning fysiologisk dysregulering av immunsystem. Endokrint system (HPA aksen), CNS og autonomt nervesystem, økt sjanse for sykdomsgjennombrudd
Det er likevel OK om andre stressteorier som logisk peker mot svekket forsvar mot sykdom beskrives.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må både anamnestiske clues nevnes(1p) (se over) og en stressmodell (2p)må beskrives. Litt fleksibilitet tolereres nåer det gjelder vektlegging.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Oppsummer konsultasjonen med Eva Olsen i form av et PSOAP-notat.
Hvis du savner opplysninger som ikke har framkommet i oppgaven fram til nå, føl deg fri til å supplere litt med realistisk informasjon. For å få full poengskår må notatet ditt ha korrekt struktur, være faglig adekvat og tekstlig kompakt.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fasit: PSOAP struktur: Problem- Sykehistorie- Observasjon-Analyse-Plan.
Ut fra de opplysningene som er gitt så langt, er det ikke forventet at studentene beskriver noen plan for oppfølging av barnebarnet Trine, men de skal heller ikke trekkes hvis de inkluderer dette i notatet. Man kan gi pasienten råd om å tilråde sønnen å søke hjelp for å takle utfordringene (familievernkontor, egen fastlege, helsesøster).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full score må notatet være både godt innholdsmessig og kompakt. Urimelig langt notat trekker ned 0.5 poeng selv om struktur og innhold er bra.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vi foretar nå et sceneskifte:
Du er fastlegen også for Eva Olsens sønn og barnebarn Trine på 5 år (barnet som er nevnt ovenfor). Trines far går til støttesamtaler hos deg i forbindelse med samlivsbruddet. Samlivsbruddet er konfliktfylt, og ektefellene er overhode ikke på talefot. Konfliktnivået er blitt høyere i det siste, relatert til en krangel om hvorvidt datteren Trine bør bruke bleie på dagtid eller ikke. Trine sliter med at hun tisser seg ut (enurese) og til dels også har dårlig kontroll på avføringen (enkoprese). Problemene har åpenbart tiltatt etter at foreldrene gikk fra hverandre. Den siste krangelen startet etter at far mente at de nå bør forsøke å avvikle bleien. Eks-konen ble da rasende fordi hun var uenig (hun mener "ting får ta den tiden de tar", og det er strevsomt med så mye tøy/sengeklær å vaske).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Reflekter rundt barnets situasjon og helseproblem, og hvordan du bør håndtere situasjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette barnet kan lide overlast og det er ikke usannsynlig at hennes helseproblemer har sammenheng (forverres betydelig av) hennes livssituasjon. Det er din plikt å finne ut mer. Det må også gjøres en klinisk vurdering med tanke på for eksempel obstipasjon.
''Anbefalt strategi'':
Ta barnet inn på time sammen med far– fullstendig anamnese, klinisk undersøkelse (obstipasjon?) evt supplerende prøvetaking (urinprøve etc). Anamnestiske poenger: har problemene oppstått den senere tid (har barnet vært tørt tidligere?) Observer evt. samspill far og barn. Tilstrebe å få koblet inn mor også.
Snakke åpent med far/mor og evt. barnet (hver for seg – kan helsesekretær ha Trine hos seg noen minutter?). Forklar at du har en viss bekymring for at foreldrekonflikten går utover barnet – formidle bekymring for situasjonen på en respektfull og ivaretakende måte. Hvordan fungerer far og mor i det daglige, hvordan kan konflikten håndteres bedre, andre omsorgspersoner inne i bildet? Søsken? Hvem kan hjelpe? Her må noe gjøres. Ulike tiltak aktuelle.
''Samarbeidspartnere/andre hjelpeinstanser'':
Er familievernkontoret en mulighet? De har trolig allerede vært der til pålagt mekling ifb med planlagt seperasjon/ skilsmisse (lovpålagt for alle foreldre som er samboere/gift og som har barn < 16 år). Andre muligheter: Koble inn helsesøster, PPT, henvise til psykolog i kommunen. BUP-tjenesten er ikke aktuelt i første omgang, det vil kreve at forholdene er avklart på kommunalt nivå, men dersom problemene er omfattende vil dette kunne være aktuelt.
Det er nok ikke aktuelt å sende bekymringsmelding til barnevernet i første omgang, men dette skal gjøres når/hvis du har grunn til å tro at det foreligger omsorgssvikt, at barnet ikke blir tilstrekkelig ivaretatt.
Se neste spørsmål.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Max 1 poeng her for å si adekvate ting om bekymring og ev. meldeplikt, fordi det omfattes av neste spørsmål. Her gir vi mest poeng for strategien å involvere foreldrene på respektfull måte som første skritt i videre håndtering og foreslå adekvate tiltak i forkant av barnevern.
Poenggivningen her avveies mot neste spørsmål. Poenget er at dette og neste spm. til sammen gir et helhetlig bilde/strategi
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter noen uker konkluderer du med at Trines livssituasjon ikke blir bedre, tross dine (og andres) forsøk på å gi råd og støtte familien hennes. Barnet lider overlast, så langt du kan bedømme. Idet du innser dette, er du bundet av lover og regelverk som pålegger deg å gripe inn.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi noen stikkord om aktuelle lover og hva de innebærer og drøft hvordan du skal forholde deg til taushetsplikten
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi forventer ikke lange svar. Litt generelt om taushetsplikt og fritak fra taushetsplikt hvis mistanke om at barn lider overlast. Nevne navn på lovverk og stikkord om innhold – se nedenfor
Ved uklar/tvil om bekymring – ev. forhåndskonferer – gjerne med barnevernstjenesten eller kollegaer om hvordan du kan håndtere situasjonen. ''Husk å ikke nevne familiens navn'' dersom du drøfter saken med kolleger/andre fagfolk (taushetsplikt). Du kan diskutere saken anonymt med BVT, hvis du er usikker på om du bør melde.
Grunnlag for å melde bekymring til Barnevernet bør vurderes dersom ikke mulig med dialog med foreldrene. Nedenfor om lovverket.
''Lov og regelverk''
__Taushetsplikt – helsepersonelloven § 21__; Utgangspunktet etter helsepersonelloven er at legen har taushetsplikt om alle helse- og personopplysninger om den enkelte pasient. Det følger av __helsepersonelloven § 21__ at "helsepersonell skal hindre at andre får adgang eller kjennskap til opplysninger om folks legems- eller sykdomsforhold eller andre personlige forhold som de får vite om i egenskap av å være helsepersonell".
Lovverk som hjemler __unntak fra taushetsplikten__ er:
* Barnevernloven § 6-4 Innhenting av opplysninger, og
* Helsepersonelloven § 33. Opplysninger til barneverntjenesten
Her er det gitt bestemmelser som gjør unntak fra taushetsplikten i situasjoner der hensynet til å avdekke forhold i hjemmet som kan skade barnet veier tyngre enn hensynet til å bevare taushet om personlige forhold. Legen plikter å gi opplysninger til barneverntjenesten (gjerne i form av en __bekymringsmelding__) når: "det er grunn til å tro at et barn blir mishandlet i hjemmet eller det foreligger andre former for alvorlig omsorgssvikt, jf. lov om barneverntjenester § 4-10, § 4-11, og § 4-12. Det samme gjelder når et barn har vist vedvarende og alvorlige adferdsvansker, jf. nevnte lov § 4-24".
Det følger også av __barnevernloven § 6-4__ og __helsepersonelloven § 33__ at legen må gi barneverntjenesten nødvendige opplysninger om barnet når dette pålegges av barnevernet i en sak. Barnevernet må da henvise til lovhjemmel som begrunner behovet for opplysningene fra legen. Pålegg om informasjon kommer ofte i form av en bestilling fra barneverntjenesten med en del spørsmål som legen skal svare på og det blir da aktuelt for legen å avgi en erklæring.
Meldeplikten er hjemlet i __Barnevernloven § 6-4 Innhenting av opplysninger__ og __helsepersonelloven § 33__. Opplysninger til barneverntjenesten Her er det gitt bestemmelser som gjør unntak fra taushetsplikten i situasjoner der hensynet til å avdekke forhold i hjemmet som kan skade barnet veier tyngre enn hensynet til å bevare taushet om personlige forhold.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For full score forutsetter navn på relevant lovverk: Barnevernloven og
Helsepersonell-loven (ikke paragrafer men stikkord om innhold)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 40 år gammel mann blir lagt inn på sykehus med akutt dyspné. Han er tidligere frisk og bruker ingen faste medisiner.
Dagen før innleggelse var han i habituell tilstand, men våknet kl. 06.00 og følte at han ikke fikk puste. Det er ingen andre ledsagende symptomer bortsett fra litt hoste. Prehospital oksygenmetning i ambulansen var 82 % uten O2. Han jobber som bonde, og de siste par dagene før innleggelsen hadde han arbeidet med legging av gress i en tårnsilo.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I arbeidet med silolegging kan man bli eksponert for ulike gasser. Gi eksempler på to gasser som kan være aktuelle eksponeringer ved silolegging.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nitrøse gasser og CO2.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng for nitrøse gasser. Man får også poeng om man skriver NO (nitrogenoksid), NO2 (nitrogendioksid), eller NOx
Ett poeng for CO2 (karbondioksid).
Andre gasser gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er primærvakt i mottak og får kl. 08.00 meldt at pasienten beskrevet ovenfor er på vei til sykehus og er forventet til sykehuset om 45 minutter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn fire relevante faglige instanser/rådgivningstjenester (i eller utenfor sykehus) du kan snakke med/ringe for å få informasjon om aktuelle eksponeringer og diskutere behandling med.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Giftinformasjonssentralen.
* NBC-Senteret Ullevål
* Bakvakt
* Arbeidsmedisinsk Avdeling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert av alternativene som nevnt over.
Yrkeshygieniker som sådan er ikke godkjent som et poenggivende svar, men hvis man nevner yrkeshygieniker tilknyttet arbeidsmedisinsk avdeling gir dette poeng.
Andre leger på sykehuset i sekundær eller tertiærsjiktet med relevant erfaring er likestilt med «Bakvakt», herunder lungelege eller annen spesialist med toksikologisk kompetanse.
Nevnes BHT som en faglig instans, gir det ikke poeng. BHT driver viktig forebyggende arbeid, inkludert risikoanalyse, men er ikke en instans med akuttmedisinsk funksjon/kompetanse.
Nevnes Helsebiblioteket og lignende som en faglig instans, gir det ikke poeng. Helsebiblioteket har gode artikler om akutte forgiftninger på sine hjemmesider, men tilbyr ikke rådgivning i enkeltsaker og anses derfor ikke å fylle vilkåret om at "du kan snakke med/ringe og diskutere behandling
med".
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Når pasienten ankommer sykehuset kl. 08.45, gjør du en vanlig somatisk status i mottakelsen. Vitale parametere viser BT 142/82, puls 82, respirasjonsfrekvens 26. O2 metningen er 96 % med 2,5 liter O2 på nesebrille. Du antar gasseksponering som årsak til hans pustebesvær.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du rekvirerer relevante blodprøver, men hvilke andre undersøkelser bør også gjøres i akuttfasen i dette tilfellet? Nevn minst 3 relevante primære utredningstiltak med kort begrunnelse for hvert av dem.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Røntgen toraks/CT thorax''. Billeddiagnostikken tas primært grunnet mistanke om utvikling av lungeødem, men er også relevant for differensial diagnostikk som f.eks.
pneumothoraks.
''Arteriell blodgass''. Arteriell blodgass tas på grunn av pasientens respirasjonssvikt og mulig gassforgiftning og gir et raskt bilde på blant annet syre/basestatus, pH, laktat, CO2 og CO som alle gir relevante opplysninger i en akuttfase for vurdering av differensialdiagnostikk og behandling.
''EKG''. EKG tas på grunn av at man er i en akuttfase i mottaket, og man må tenke differensialdiagnostikk. Selv om man antar gasseksponering som årsak må man utelukke blant annet kardiell patologi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng for 3 relevante undersøkelser med indikasjon/begrunnelse for disse
* 1 poeng for 2 relevante undersøkelser med indikasjon/begrunnelse for disse
* 0.5 poeng for 1 relevant undersøkelse med indikasjon/begrunnelse
CT thorax er likestilt med røntgen thoraks, selv om man tenker seg at røntgen thoraks er mer tilgjengelig i akuttfasen ved de fleste sykehus.
Blodgass er likestilt med "Arteriell blodgass"
Nevnes håndholdt ultralydapparet (Vscan), gir det ikke poeng. Det er presisert i vignetten at man antar gasseksponering som årsak. Håndholdt ultralydapparat ville vært mer relevant ved mistanke om f.eks. kardiell årsak.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter at pasienten nå har ligget med O2 på nesebrille i et par timer føler han seg i god form og er ikke lenger tungpustet. Ved auskultasjon av lunger hører du grove knatrelyder over begge lungeflater og mest uttalt basalt venstre side. Det er fullt på avdelingen og du er bedt om å være tilbakeholden med å legge inn pasientene
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sender du pasienten hjem? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man bør ikke sende pasienten hjem. Det er sagt i supplerende vignett til deloppgave 3 at man mistenker gasseksponering som årsak til hans pustebesvær. Ulike gasser har ulik vannløselighet, og såkalte «tørre» gasser, dvs. gasser med lav vannløselighet, kan komme dypt ned i luftveiene (bronkioler og alveoler) og øker risikoen for alvorlige komplikasjoner som lungeødem. Latenstiden kan være opp til 24 timer. Selv om pasienten føler seg kvikk, bør man ikke sende pasienten hjem før man har observert sykdomsforløpet en viss tid. Pasienten bør derfor legges inn til observasjon.
I hovedvignetten til denne oppgaven er det sagt at pasienten jobber som bonde og de siste par dagene før innleggelsen har arbeidet med silolegging. Han kan derfor ha vært eksponert for nitrøse gasser og CO2. Nitrøse gasser er «tørre» og kan forårsake lungeødem etter en latenstid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng hvis man ikke sender pasienten hjem, og samtidig også klarer å resonnere rundt gasseksponering, latenstid og risiko for alvorlige komplikasjoner. Det er ikke tilstrekkelig å kun begrunne innleggelsen med gasseksponering.
Kandidaten må også dokumentere kunnskap om sammenhengen mellom gasseksponering, latenstid og alvorlige komplikasjoner.
Ett poeng dersom man i tillegg konkret nevner lungeødem som aktuell alvorlig komplikasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved sykdom forårsaket av eksponering i arbeid, er du som lege pålagt å melde på fastsatt skjema.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvor skal meldingen sendes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Skjema 154b skal sendes til Arbeidstilsynet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ett poeng hvis kandidaten vet at skjemaet skal sendes til Arbeidstilsynet.
Alle leger har plikt til å melde fra til Arbeidstilsynet om sykdom som legen antar skyldes pasientens arbeidssituasjon. Se Arbeidsmiljølovens § 5-3. Meldeplikten gjelder uavhengig av om tilstanden er godkjent som yrkessykdom eller ikke. Meldingen skal sendes på skjema 154b.
Nevnes NAV gis det ikke poeng. Ved yrkesskade derimot skal melding sendes til NAV, men dette er arbeidsgivers plikt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Mange bønder blir også eksponert for organisk materiale via luftveiene, og hos noen kan dette utløse lungesykdom.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn to lungesykdommer som kan relateres til inhalasjon av organisk materiale?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Astma
* KOLS
* Hypersensitivitetspneumonitt (allergisk alveolitt)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
To poeng hvis man lister 2 av de 3 som er nevnt over. Ett poeng hvis man lister 1 av de 3 som er nevnt over
Hypersensitivitetspneumonitt er en mangefasettert sykdom som kan ha ulik klinisk presentasjon, intensitet og forløp. Sykdommen skyldes en allergisk reaksjon i lungealveolene, og går også under navnet allergisk alveolitt. Tilstanden har dessuten fått ulike navn etter de ulike yrkesgruppene som er utsatt: Farmers lung/bondelunge, fugleholderlunge, justerverksjukan, luftfuktersykdom, kornarbeiderlunge osv. Alle disse er likestilt som svar med hypersensitivitetspneumonitt og gir ett poeng.
Obstruktiv lungesykdom som fellesbetegnelse for astma og KOLS gir kun ett poeng.
Forekomsten av astma hos bønder er ikke høyere enn i befolkningen for øvrig, men bønder kan utvikle astma grunnet eksponering for biologiske faktorer som organisk støv, bakterier, muggsopp, endotoksiner.
Eksponering for organisk støv er kjent for å øke risikoen for utvikling av KOLS hos bønder. Det kan dreie seg om støv fra f.eks husdyr, mikroorganismer, endotoksiner, fòr, høy og halm
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: David P. Fisher, et al. (2017): Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. JAMA 2018; 320: 1570-1582
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var hensikten med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Målet var å finne ut om pasienter med type 2 diabetes som fikk bariatrisk kirurgi opplevde færre makrovaskulære komplikasjoner (det vil si koronar hjertesykdom eller cerebrovaskulær sykdom) enn pasienter som fikk vanlig oppfølging (det vil si medikamenter og livsstilsintervensjon).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne forklare at man ønsker å sammenlikne omfanget av makrovaskulære komplikasjoner (det vil si koronar hjertesykdom eller cerebrovaskulær sykdom) for de om fikk bariatrisk kirurgi sammenliknet med enn pasienter som fikk vanlig oppfølging (det vil si medikamenter og livsstilsintervensjon). Her gis det ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var forfatternes begrunnelse for valg av forskningsdesign?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tidligere observasjonelle studier har antydet at bariatrisk kirurgi kan redusere makrovaskulære komplikasjoner av type 2 diabetes sammenlignet med vanlig medisinsk omsorg. Det er imidlertid begrenset kunnskap om nyere typer kirurgiske behandlingsmetoder, særlig fordi man ikke har hatt tilgang til store nok antall pasienter. Det har også vært mangelfullt grunnlag for å sammenlikne med personer som ikke har gjennomgått bariatrisk kirurgi (bl.a. utilgjengelighet av Kroppsmasseindeksmålinger).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må angi begrensninger fra tidligere kunnskap og hva som denne studien kan bidra med. Her gis det ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I Table 3 er det vist til 95% konfidensintervall. Hva er fordelen med å vurdere presisjon ut fra slike konfidensintervall sammenlignet med p-verdi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Konfidensintervall gir informasjon om styrke på sammenheng og hvor presis sammenhengen er. P-verdier er en blanding av styrke på sammenheng og størrelse på studien.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må vise at et konfidensintervall gir informasjon om styrke på sammenheng og hvor presis sammenhengen er. P-verdier er en blanding av styrke på sammenheng og størrelse på studien. Det gis ikke poeng for å beskrive om konfidensintervallet inneholder 1 eller ikke for relativ risiko, eller 0 eller ikke for absolutte forskjeller. Her gis det ikke delpoeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi er fortolkning av resultatene fra Table 3.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er gjennomgående lavere risiko for makrovaskulære komplikasjoner for de som har gjennomgått bariatrisk kirurgi enn blant kontrollpasientene. Denne sammenhengen er stabil gjennom ut over oppfølgingsperioden. Effektestimatene er noenlunde i samme størrelsesorden. Resultatene er mest presise for den sammensatte indeksen. Der angir øvre del av konfidensintervallet en betydningsfull sammenheng for første år. Resultatet blir noe mer upresist gjennom perioden, noe som nok henger sammen med færre hendelser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten vise at det det er betydelig lavere risiko for de som har gjennomgått bariatrisk kirurgi sammenliknet med kontrollpasientene (1 poeng). Det må også gis en vurdering av presisjon (1). Det gis ikke poeng for å kommentere om hvorvidt konfidensintervallet inneholder 1 eller ikke.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva forstår du med en konfundering (confounding)? Hvilke mulige problemer med konfundering kan du anta at en slik studie har?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Konfundering betyr effektforveksling som skyldes en felles årsak mellom eksponering og utfall. I denne studien vil vi anta at indikasjoner for valg av kirurgi eller ikke kan være nærliggende grunner for konfundering. Man kunne tro at de sykeste mest sannsynlig blir henvist til kirurgi, men det er kanskje ikke sikkert. For eksempel hvis helsetilstanden tilsier at pasienten ikke tåler en kirurgisk prosedyre.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne forklare at konfundering innebærer en effektforveksling som skyldes en felles årsak mellom eksponering og utfall (0,5). Mulige indikasjonene for kirurgisk behandling må være nevnt for full skåre.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
La oss anta at noen av kontrollpasientene likevel hadde fått utført bariatrisk kirurgi, hvilken type bias ville det medføre, og hva ville konsekvensen av en slik bias være?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ikke-differensiell målefeil (informasjonsbias og misklassifisering). Konsekvensen ville være en redusert sammenheng mellom eksponering (bariatrisk kirurgi) og utfallsmålene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ikke-differensiell (0,5 p) målefeil (informasjonsbias og misklassifisering godtas) (0,5 p). Konsekvensen ville være en redusert sammenheng mellom eksponering (bariatrisk kirurgi) og utfallsmålene (1 p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en vurdering av om resultatene i denne studien er generaliserbare
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ekstern validitet kan tenkes å være påvirket av flere forhold. For eksempel kan man tenke seg at ulike helsesystemer vil gi forskjellig oppfølging etter behandling. Pasientene i denne studien er i overveiende grad finansiert gjennom kommersielle forsikringsordninger. Hvordan dette ville slå ut for mer utsatte grupper av pasienter er vanskelig å si.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full skår bør kandidaten ha en vurdering av settingen og pasientgrunnlaget for denne studien. Dette bør settes i sammenheng med hvilken oppfølging og helsetilbud som gis for øvrig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gir denne studien grunnlag for å anbefale bruk av bariatrisk kirurgi for personer med type 2 diabetes og fedme? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hvorvidt man skal anbefale bariatrisk kirurgi eller ikke må hvile på en lang rekke faktorer ut over det som kommer fram i denne studien. Det er et omfattende inngrep som kan ha betydning for mange livsområder. Det er også verdt å merke seg at denne studien er observasjonell og ikke kan gi et dekkende bilde på hvorvidt det er en kausal sammenheng eller ikke. I tråd med forfatternes konklusjoner, så kan man tenke seg at resultatene fra denne studien, kan danne grunnlag for drøfting mellom lege og pasient av mulige alternativer i fedmebehandling. Da bør også annen kunnskap om mulige bivirkninger av slik omfattende kirurgisk behandling tas med.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full skåre bør kandidaten trekke fram at man ikke bør bruke enkeltstudier for vurdering av kliniske tiltak. Kandidaten bør også vektlegge at dette er en studie basert på et observasjonelt design. Dette er særlig utfordrende i vurdering av behandlingseffekt. Andre virkninger og bivirkninger av prosedyren bør også vektlegges for å bedre pasientens mulighet til å ta et informert valg
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Livmorhalsprogrammet er et screeningprogram som ble innført i Norge i 1995 for kvinner i alderen 25-69 år.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva menes med et screeningprogram?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et screeningprogram er en organisert, systematisk undersøkelse av personer som føler seg friske (symptomfrie) for å påvise sykdom (eller risiko for sykdom) i en tidlig (subklinisk) fase
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å nevne at målgruppa er frisk/symptomfri
0,5 poeng for å nevne påvisning av subklinisk/tidlig tilstand
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Analyse av celleprøve fra livmorhalsen er en sentral undersøkelse i Livmorhalsprogrammet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke krav bør stilles til undersøkelser som skal brukes som verktøy i screeningprogrammer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Testene bør være
* Akseptable for befolkningen som skal tilbys screening
* Pålitelige (reproduserbare/validerte og ha høy sensitivitet, høy spesifisitet)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert krav, til sammen max 2 poeng. For siste punkt er sensitivitet den minst viktige, så dersom kun dette er nevnt uten noen av de andre bør det trekkes litt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En hensikt med Livmorhalsprogrammet er å forebygge død av livmorhalskreft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar hvordan Livmorhalsprogrammet kan forebygge død av livmorhalskreft.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et sentralt prinsipp i screening er at tidlig diagnose gir mulighet for tidlig behandling. Tidlig diagnose kan gi gevinst kun hvis den etterfølges av behandling. En forutsetning for at screening skal forebygge død av livmorhalskreft er derfor at behandlingen har bedre effekt i tidlig fase enn senere (f eks etter spredning). I tillegg må sykdommen (livmorhalskreft) ha en tidlig/preklinisk fase som varer lenge nok til at den kan påvises.
Gjennom Livmorhalsprogrammet påvises både invasiv livmorhalskreft (men fortsatt asymptomatisk), forstadier (celleforandringer) og infeksjon med onkogene HPV-typer (som kan gi celleforandringer etter lang tid – ofte flere tiår). Behandling av forstadier reduserer forekomst av livmorhalskreft og dermed også død av livmorhalskreft.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Behandling må gis og være mer effektiv i tidlig fase (0.5), tidlig fase må være påvisbar i praksis (0.5), påvisning av både forstadier (0.5) og invasiv sykdom (0.5).
Det skal ikke trekkes poeng for informasjon som går ut over oppgaven, men som i seg selv er korrekt. Hvis besvarelsen inneholder alle momenter som kreves, men i tillegg opplysninger som ikke er korrekte, bør det trekkes poeng hvis disse tyder på grunnleggende mangel på forståelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Figuren nedenfor er hentet fra Kreftregisterets rapport «Cancer in Norway 2016», utgitt i 2018, og viser utvikling av 5-års overlevelse fra diagnosedato (brun, øverst), nye tilfeller (rød, i midten) og dødelighet (rosa, nederst) av livmorhalskreft over tid i Norge.
<<imgLink "IIIC-2018-4-A.PNG" 500>>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre teoretisk mulige forklaringer på endringen du ser i overlevelse etter innføringen av Livmorhalsprogrammet i 1995.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forklaringer direkte relatert til screening:
* Lead time: Tidligere diagnose gir lengre målt overlevelse, selv uten at livet forlenges
* Overdiagnostikk: Svulster som ikke ville gitt plager og dermed ikke ville blitt oppdaget uten screening, vil bidra med flere «overlevere» blant pasientene
* Effekt av screening: En reell gevinst av screening i form av forlenget liv, vil også gi økt overlevelse
Andre mulige forklaringer:
* Bedre behandling over tid kan øke overlevelse uavhengig av screening.
* Bedre diagnostiske metoder kan gi tidligere diagnose også blant personer med symptomatisk sykdom.
* Endring i «awareness»: Raskere legesøkning ved symptomer
* Endring i faktorer i befolkningen som påvirker sykdommens aggressivitet eller respons på behandling, for eksempel samsykelighet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng per forklaring, uavhengig av hvilke som er nevnt (max 3 poeng)
Det skal ikke trekkes poeng for informasjon som går ut over oppgaven, men som i seg selv er korrekt. Hvis besvarelsen inneholder alle momenter som kreves, men i tillegg opplysninger som ikke er korrekte, bør det trekkes poeng hvis disse tyder på grunnleggende mangel på forståelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vaksine mot humant papillomavirus ble innført i barnevaksinasjonsprogrammet for jenter i 7. klasse i 2009.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan vi forvente at dette tiltaket vil påvirke dødeligheten av livmorhalskreft i befolkningen fremover? Forklar kort hvorfor.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Genital infeksjon med enkelte typer humant papillomavirus (HPV) er en hovedårsak til livmorhalskreft fordi langvarig infeksjon kan gi celleforandringer i livmorhalsepitelet som kan utvikle seg til kreft. HPV 16 og 18 er til sammen involvert i ~70% av alle tilfeller av livmorhalskreft, mens HPV 31, 33, 45, 52 og 58 til sammen er involvert i ~20% av tilfellene.
Vaksine mot HPV er vist å gi 90-100% beskyttelse mot forstadier til livmorhalskreft hos jenter/kvinner som ikke var smittet ved vaksinasjonstidspunktet. Det fins foreløpig svært få studier av livmorhalskreft etter HPV-vaksine, men kunnskap om sammenhengen mellom forstadier og utvikling av livmorhalskreft gir grunn til å tro at HPV-vaksine beskytter mot livmorhalskreft også, ikke bare mot forstadier. I så fall kan vi forvente en reduksjon i dødelighet av livmorhalskreft gjennom primærforebygging av sykdommen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
HPV årsak til livmorhalskreft (1), vaksine gir beskyttelse mot forstadier (0,5), antatt reduksjon i dødelighet gjennom redusert forekomst (0.5), til sammen max 2 poeng.
Det skal ikke trekkes poeng for informasjon som går ut over oppgaven, men som i seg selv er korrekt. Hvis besvarelsen inneholder alle momenter som kreves, men i tillegg opplysninger som ikke er korrekte, bør det trekkes poeng hvis disse tyder på grunnleggende mangel på forståelse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinne på 26 år oppsøker deg som fastlege. Hun er overvektig (vekt 130 kg, BMI 45) og sier at hun ønsker henvisning til fedmepoliklinikken ved sykehuset.
Hun forteller at hun har slitt mye med depresjoner og angst. Hun ble mye mobbet under oppveksten. Hun har fullført 2 år på videregående skole som barne- og ungdomsarbeider, men klarte ikke å fullføre lærlingetiden og har ikke tatt fagbrev. Hun sier at hun var mye deprimert mens hun var lærling og følte at hun ble mobbet på arbeidsplassen. Hun er singel og bor hjemme hos sine foreldre. Hun beskriver seg selv som beskjeden, trives best hjemme og har noen gode venninner som hun har en del kontakt med, mest via sosiale medier. Hun har jobbet det siste halvåret i en barnehage. Hun sier at hun har det bedre psykisk nå. Foruten sykelig overvekt, finner du normal psykisk og somatisk status.
Dere drøfter ulike livsstilstiltak og du henviser til fedmepoliklinikken.
Hun nevner avslutningsvis at hun trenger en sykmelding fordi hun var borte fra jobben onsdag og torsdag (2 hele dager) i forrige uke pga. angstanfall. Hun kontaktet ikke lege eller arbeidsgiver da, men planla å levere egenmelding på fredag. På jobben fredag fikk hun høre fra arbeidsgiver at hun hadde brukt opp egenmeldingsdagene sine og måtte ha en legeerklæring.
Hun tenkte at det kunne være praktisk å ordne dette i dag ettersom hun hadde time til lege allikevel.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ta begrunnet stilling til kvinnens ønske om tilbakedatert sykmelding for fraværet som ikke dekkes av egenmelding.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det foreligger ikke grunnlag for å tilbakedatere. Pasienten har ikke vært forhindret fra å oppsøke lege og legen kan ikke sannsynliggjøre at pasienten var arbeidsufør i det aktuelle tidsrommet. Utvidet svar: Det er som hovedregel ikke tillatt med tilbakedatering av sykmelding. Hvis tilbakedatering skal være tillatt må to vilkår være oppfylt:
# Pasienten skal ha vært forhindret fra å oppsøke lege, og
# det må kunne godtgjøres (sannsynliggjøres) at pasienten var arbeidsufør fra før tilbakedateringsdatoen.
Se FTRL §8-7. Tilbakedatering kan være aktuelt hvis legen vurderer at pasienten var forhindret fra å oppsøke lege, f.eks. pga. alvorlig psykisk lidelse med manglende sykdomsinnsikt. Dette er ikke tilfelle i denne saken. Pasienten har varslingsplikt til arbeidsgiver fra første fraværsdag (FTRL § 8-18) og burde ha kontaktet lege samme dag for å be om en sykmelding. Her har det gått mange dager og pasienten har åpenbart vært arbeidsfør og i stand til å kontakte lege før dagens konsultasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Svaret må være nei til tilbakedatering (1/2 p) og en begrunnelse må foreligge (1 p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten kommer tilbake etter 3 måneder og sier at hun trenger en sykmelding. Hun er tydelig nedstemt og sier at hun sover mye og har mistet kontroll over matinntaket. Hun kan gå 1-2 dager uten mat, for deretter å spise alt hun kommer over helt til hun ikke makter mer og blir liggende uvel resten av dagen. Hun tenker på alle situasjonene der hun har dummet seg ut på arbeidsplassen og alt det negative kollegene tenker om henne.
Hun klarer ikke å konsentrere seg på jobben, og har fått flere irettesettelser i situasjoner der hun ikke har fulgt god nok med barna når de er på lekeplassen eller går tur i nærmiljøet. Det fremkommer at hun har hatt flyktige selvmordstanker den siste måneden. Montgomery And Åsberg Depression Rating Scale (MADRS) skår er 32 (20-34 tolkes som moderat deprimert). Du stiller diagnosen depressiv episode, moderat til alvorlig(stryke: og henviser henne til nærmeste distriktspsykiatriske senter (DPS) til en ø-hjelps vurdering.)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Foreligger det egen sykdom i henhold til et anerkjent sykdomsbegrep som kan gi rett til sykmelding? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ja, her foreligger det sykdom i henhold til et anerkjent sykdomsbegrep. Her er det symptomer av et slikt omfang og av en slik alvorlighetsgrad at det fyller kriterier for sykdom. P76 Depressiv lidelse. Her foreligger det sykdom med innvirkning på fungering og arbeidsevne, slik det spørres om i neste spørsmål. (Det vil kunne være situasjoner der sykmelding ikke er beste løsning men der sykdomskriteriet allikevel er oppfylt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få riktig svar: Må svaret være ja til at sykdomskriteriet er oppfylt, med en begrunnelse. (Sykmelding er sannsynligvis beste løsning, men det er ikke feil å argumentere for at det ikke er eneste løsning.)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan påvirker helseplagene hennes fungering, og er dette relevant for vurdering av arbeidsmulighet. Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det ''IKKE'' kun ett fasit svar. Viktig med en god begrunnelse. Eksempelsvar:
Hun beskriver psykiske symptomer som er hemmende for daglig fungering (mistet kontroll over matinntak) og som kan ha betydelig innvirkning på arbeidsevnen: nedsatt konsentrasjonsevne, flere irettesettelser pga. dette. Sviktende omsorgsevne for barna hos en barnehageansatt er et alvorlig tegn på at arbeidsevnen er nedsatt. Det er sannsynliggjort at det er årsakssammenheng mellom helseplager, funksjonssvikt og nedsatt arbeidsevne.
Det vises til diagnosespesifikk veileder for sykmelder:
https://helsedirektoratet.no/retningslinjer/sykmelderveileder/seksjon?Tittel=diagnosespesifikke-anbefalinger-for-sykmelding-1398#depressivlidelse-(p76)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar: For å få riktig svar må det fremkomme at konsentrasjonsvansker er vurdert som alvorlig funksjonssvikt i dette tilfellet der hun har omsorg for små barn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du treffer henne igjen etter 12 måneder. Hun behandles med antidepressiva og går til samtaleterapi hos en psykolog. Hun er nå 100% sykmeldt fra jobben. Hun føler seg mye bedre. Din objektive vurdering er at hun fortsatt har en mild depresjon. Hun beskriver at hun fungerer relativt godt i det daglige. Du drøfter med henne at det kan være aktuelt å prøve seg delvis i jobb igjen. Hun ser bekymret ut og sier at hun ikke tror de liker henne på arbeidsplassen. Hun er redd for tilbakefall og ønsker en periode med ro slik at hun kan bygge seg opp og bli helt frisk før hun prøver seg igjen i jobb.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kriterier må være oppfylt for å få AAP(arbeidsavklaringspenger) i denne situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Nedsatt arbeidsevne pga. sykdom skade og lyte. §11-5
#* Minst 50% arbeidsufør ved inngang AAP (0,5p)
#* arbeidsuførhet med årsakssammenheng til nedsatt funksjon pga. Sykdom (0,5p)
# Sykdom skal være en vesentlig årsak til arbeidsuførheten. Helse er kun en av flere faktorer som vektlegges ved vurdering av den nedsatte arbeidsevne. (0,5p)
# Aktivitetskrav. §11-6. Det skal lages en aktivitets plan som beskriver aktiv behandling, arbeidsrettede tiltak og/eller annen oppfølging av NAV med sikte på å komme i jobb. (0,5p)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar: 1 og 3 må være med for å få riktig svar (Redusert arbeidsevne på grunn av sykdom + aktivitetsplan (utredning, behandling og eller arbeidsrettet tiltak). Full skår hvis også 2 er med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Over de neste tre årene prøver hun seg i flere typer deltidsarbeid (ordinær jobb med lønn fra arbeidsgiver) kombinert med arbeidsavklaringspenger. Hun sender inn meldekort til NAV hver 14. dag der hun oppgir hvor mye hun til enhver tid jobber. Hun har hatt 3-4 depressive episoder, hver gang med 100% sykefravær i 1-2 måneder, og deretter gradvis tilbakeføring. For 1 år siden ble det gjennomført overvektskirurgi (gastric bypass). Hun har etter det gått ned 40 kg og hatt mange komplikasjoner som langvarig sårinfeksjon, kvalme og diare (7-8 tømninger daglig). Hun har problemer med å rekke frem til toalettet og har hatt flere uhell hvis hun ikke har tilgang til toalett i løpet av få minutter. Hun har gitt opp tanken på jobb og sier at hun ønsker å søke om uførepensjon. Som hennes fastlege ser du på dette som en dårlig løsning, mye pga. av hennes unge alder og fordi du vurderer at det på lengre sikt bør være utsikter til bedring. Du avtaler et møte med NAV for å drøfte hvilke muligheter hun har.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Utover de krav som stilles ved inngang til AAP, hvilke medisinske krav må være oppfylt for å få AAP på unntak utover 3 år?
Hvor lenge kan det gis forlengelse på AAP utover tre år?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Riktig svar: Arbeidsavklaringspenger kan forlenges utover tre år hvis
# sykdom, skade eller lyte er hovedårsaken til at medlemmets arbeidsevne ikke er avklart tidligere (1/2 poeng)
# pasienten i tillegg har enten hatt langvarig medisinsk utredning eller har vært forhindret fra å kombinere medisinsk behandling og arbeidsrettet tiltak (1/2 poeng)
# Loven åpner for å forlenge perioden med arbeidsavklaringspenger i inntil to år (1/2 poeng)
For mer informasjon se § 11-12 andre ledd – Unntak fra hovedregel: https://www.nav.no/rettskildene/Rundskriv/11-12-varighet
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For riktig svar: 2 av 3 punkt må være med. 0.5 poeng for hvert punkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medisinske krav må være oppfylt for å få varig uførepensjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hensiktsmessig utredning og behandling skal være forsøkt (§12-5). (0,5p)
# Hensiktsmessig arbeidsrettet aktivitet skal være forsøkt (§12-5) Det må foreligge medisinske hinder som sannsynliggjør at ytterligere arbeidsrettede tiltak ikke er hensiktsmessig. (0,5p)
# Varig sykdom, skade, lyte – krav til årsakssammenheng (§12-6) (Den medisinske lidelsen må ha medført en varig funksjonsnedsettelse av en slik art og grad at den utgjør hovedårsaken til nedsettelsen av inntektsevnen/arbeidsevnen.) (1 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For riktig svar: Må ha med 3 (1 poeng). I tillegg må enten 1 (0,5 poeng) eller 2 (0,5 poeng) være nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
FREMTIDSSCENARIO: Pasienten har fylt 32 år. Hun fikk innvilget 100% varig uføretrygd ett år tidligere. Du har hatt lite kontakt med henne etter dette. Hun har i dag bestilt time til fjerning av en føflekk. Du møter en smilende og normalvektig kvinne og merker at hun har blitt mye tryggere på seg selv. Hun forteller at hun for et år siden totalt endret livsstil fordi hun ble så desperat av alle senplagene etter overvektsoperasjonen, Disse klarer hun nå holde i sjakk hvis hun trener regelmessig, spiser hyppige men små måltider og har et sunt kosthold. BMI er 30.
Hun bor i egen leilighet, har kjæreste og de vurderer nå å flytte sammen. Hun føler at hun takler hverdagen godt, og savner det å ha en jobb å gå til. Hun sier at hun ønsker å prøve seg i jobb, og har tilbud om en 40% stilling. Hun er usikker på om hun kan klarer full jobb og er redd for å miste uføretrygden.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke råd kan du gi henne om mulighetene hun som uførepensjonert har for å prøve seg i en jobb?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Uførepensjon og reaktivisering. (rundskriv til §12-14 tredje ledd)
# Det viktigste er å ta kontakt med NAV og varsle om at hun tenker å prøve seg i lønnet arbeid.
# Det er fullt mulig å prøve seg i lønnet arbeid uten å miste retten til uføretrygd.
# Uføretrygden vil bli avkortet ved inntekt over en viss grense. Hvor mye vil avhenge av størrelse på arbeidsinntekten hun får.
For utvidet info se rundskriv til Lov om Folketrygd, kap 12 Uføretrygd. https://www.nav.no/rettskildene/lov/L19970228-19_P12-14#L19970228-19_P12-14
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar: Totalt må 2 av 3 punkt være med.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du jobber som fastlege. Du ser i timeboka at Abena Okeke (26 år) står oppført med en dobbeltime i morgen med «Første svangerskapskontroll».
Du kjenner ikke Abena Obeke fra før, men ser at hun var på legekontoret for helsesjekk i forbindelse med at hun ble bosatt i kommunen for et år siden. Utover vitamin D mangel var det den gang ikke noe å bemerke ved undersøkelsen. Det står intet om gynekologiske problemstillinger i journalen.
Under Familie/sosialt står det fra siste besøk: «Fra Somalia. Bodd i Norge siden 2015. Gift, i introduksjonsprogrammet»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du vil forberede deg til konsultasjonen:
* Hvordan bør du forberede deg til konsultasjonen, og hvilke hjelpemidler (faglig ressurser og utstyr) trenger du, for en første, rutinemessig svangerskapskontroll?
* Er det noen spesielle problemstillinger det kan være viktig å ha tenkt gjennom før denne konkrete konsultasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Generelt om forberedelser – introduksjon til informasjon for sensor:
Studentene undervises i betydningen av å forberede seg til konsultasjonen. Inngår som første ledd i «konsultasjonens anatomi»:
* Forberedelse
*# Åpning
*# Pasient-del
*# Lege-del
*# Felles del
*# Avslutning
* Etterarbeid
som er nøye forelest for studentene.
Begrepet «housekeeping» kan komme opp; et begrep som har blitt brukt i forelesning både om det å «holde orden i konsultasjonen» (få unna arbeidet under veis) og om å «rydde hodet» (mentalt) mellom pasienter (konsultasjoner).
Forberedelser til konsultasjonen:
Det legges i undervisningen av den allmennmedisinske konsultasjonen vekt på betydningen av å forberede seg til/ før konsultasjonen. I dette tilfelle kan det handle om flere ting;
# sjekke journalen for opplysninger om tidligere kontaktårsaker, familie/sosialt, kroniske sykdommer og medikasjon. I dette tilfelles er det opplyst om vitamin D mangel – da aktuelt å sjekke om det er foreskrevet medikament på resept, ev. siste blodprøvestatus.
# Behov for tolk, sjekke journalen om det står noe der om bruk av tolk fra forrige konsultasjon. Tolk bør bestilles om du har grunn til å tro at pasienten ikke snakker godt norsk.
# Faglige hjelpemidler:
#* Ved denne konsultasjonen kan det være nødvendig å ta en kikk på «Helsekort for gravide» – og oppdatere seg på Retningslinjen for svangerskapsomsorg mtp hva som skal inngå i første svangerskapskontroll. Oppdaterte råd om levevaner for gravide; kosthold, vitaminer (anbefalinger for tilskudd folat, vitamin D), avhold fra rusmidler etc (ligger på nett, Hdir sine sider).
#* Videre også sjekke hva som er anbefalt vedrørende vitamin Dmangel (slå opp i NEL el lignende elektronisk oppslagsverk) og medisinering i svangerskapet (eks RELIS-databasen og/eller legemiddelhåndboka).
# Utstyr: Ved førstegangs sv skaps us gjøres vanligvis grundig anamnese, blodtrykksmåling, u-stix og blodprøver (i uke 12). Dvs blodtrykksmåler, utstyr for å teste urin (stix) finnes på alle fastlegekontor og mulighet for å ta enkle blodprøver lokalt (Hb) – og sende inn prøver til sykehus for analyse. Verktøy for terminbestemmelse f eks (e) Snurra
(Hvis noen kommer på allerede her at kjønnslemlestelse kan være en problemstilling å ha i bakhodet – så er det flott, men ikke påkrevet – det dukker uansett opp senere i oppgaven)
Stud kan selvsagt også lure på om det er noe spesielt medisinsk de bør tenke på («tropemedisin»), men vi har ikke noe spesielt i tankene der.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Sjekke journalen etter viktige opplysninger – 1 poeng
# Faglige hjelpemidler knyttet til svangerskapsomsorg– 1 poeng
# Utstyr tilgjengelig for blodtrykksmåling, ustix, blodprøver og terminbestemmelse – 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har ikke mye erfaring med innvandrere fra Somalia, kjenner ikke språket og vet lite om kulturen. Dette gir deg litt utilstrekkelighetsfølelse. Det hadde selvsagt vært fint om du hadde mulighet til å lære mer om den aktuelle kulturen før konsultasjonen i morgen, men som lege må du være forberedt på konsultasjoner der du mangler spesifikk kulturkunnskap.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke prinsipper fra pasient-sentrert metode kan du anvende for å kommunisere på en rimelig «kultursensitiv» måte i en situasjon som dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Studentene har mye undervisning om __pasient-sentrert metode__ som bygger på følgende prinsipper:
* å stimulere pasienten til SELV å fortelle fremfor å stille mange spørsmål
* bruke av åpne spørsmål i starten av konsultasjonen
* god balanse mellom åpne og lukkede spørsmål
* utforske pasientperspektivet aktivt gjennom de 4 F’ene
* og den 5.F’en – Pasienten som person (forutsetninger) (se nedenunder)
__Kultursensitivitet__ har blitt undervist som kompatibel med den pasientsentrert mode
Hovedprinsippene handler om å fokusere på hva som i situasjonen kan ansees som hhv:
* Allmennmenneskelig?
* Individuelt?
* Kulturbetinget?
Videre vektlegges empati og forståelse, samt narrativ tilnærming (å legge vekt på historien, pasientens egen problemdefinering)
(F’ene i Pasientsentrert metode:
* Forestillinger: Hva tenker du selv om disse plagene (her: situasjonen, altså svangerskapet)?
* Forventninger: Hvordan ser du for deg at saken/sakene skal håndteres?
* Frykt/bekymringer/følelser knyttet til saken/tema (– for hva?)
* Funksjon/følger – hvordan fungerer du i det daglige (i og utenfor evt. jobb)?
* Forutsetninger (kan også betegnes Pasienten som person): hvordan er livet generelt, hvem utgjør ditt sosiale nettverk, osv – her er mange tema relevante.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Studentene MÅ vise at de kjenner pasient sentrert metode og gjengi hovedpoenget her som er utforskning av pasientperspektivet – gjennom bruk av F’ene (1 poeng).
# Hvis de dernest formulerer kloke tanker knyttet til det å møte en pasient fra en fremmed kultur med en passe blanding av gode pasientsentrerte spørsmål og styring av egen agenda, får de nok et poeng. Poenget er at kultursensitivitet er kompatibelt med pasientsentrert metode. (1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du får vite at Adena er gift med Mohammed, 27 år. De fikk begge innvilget asyl for 1 år siden, er bosatt i kommunen og går begge i Introduksjonsprogrammet. Du har forstått at de flyktet pga. politisk/religiøse overbevisninger, men det er neppe aktuelt å gå inn i detaljer rundt dette nå.
Du er godt i gang med å fylle ut helsekortet, da du kommer i tanker om at Adena kan ha gjennomgått kjønnslemlestelse som i verste fall kan lede til komplikasjoner i forbindelse med fødsel. Dette vil du gjerne finne ut av, men innser at spørsmålet er litt sensitivt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan du kommunikativt kan komme i posisjon til å introdusere sensitive/private tema i en konsultasjon. Formuler et konkret forslag som kan passe i den aktuelle situasjonen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Den pasientsentrerte metoden fokuserer på varsomhet når man skal snakke/ spørre pasienten om sensitive spørsmål. Noen momenter:
* «Sign-posting» (veg-skilting) dvs at man introduserer tema før man spør. Gjerne bruke alminneliggjøring/
generaliseringer: «Nå vil jeg gjerne stille deg noen spørsmål som har betydning i forbindelse med…», osv
* Spørre om tillatelse før man spør; «Er det greit at jeg stiller deg et litt privat spørsmål som har betydning i denne situasjonen»,ell.l.
* Bruk av åpne spørsmål
Hvis man ikke får godt svar er det ikke urimelig å spørre om det er OK å gjennomføre en GU (for eksempel en gang senere)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Nevne «veiskilting» og spørre om tillatelse gir 0,5 p. Et godt forslag som er kompatibelt med dette gir 0,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Adena har også oppfølging hos jordmor, og du ser henne ikke igjen før i svangerskapsuke 32.
Du gjennomfører vanlige rutiner og finner at Adena er i brukbar form, men hun sier hun kjenner seg veldig trett. Ved undersøkelse finner du Blodtrykk=125/80 U-stix; negativ, Fosterlyd=140. Ditt Symfyse-fundus (SF)-mål er 27 cm. Når du plotter dette inn i skjema ser du at kurven har flatet noe ut. Målet ligger nå på 2,5 percentilen, mot tidligere 10
percentilen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du bestemmer deg for å skrive en henvisning til sykehusets
Fødepoliklinikk på bakgrunn av ditt funn. Skriv et allmennmedisinsk, problembasert journalnotat fra denne konsultasjonen (PSOAP struktur).
Skriv deretter en henvisning til fødepoliklinikken der dagens PSOAP notat utgjør «kjernen», og du legger til annet du mener bør være med.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Henvisninger bygger i hovedsak på journalnotatet (PSOAP) som er problemorientert. I tillegg er det vanlig å ta med relevant opplysninger innen familie/sosial historikk, tidligere sykdommer, medikamentbruk (Legemidler i bruk). Vanligvis bruker man også en diagnosekode på henvisningen (ICPC).
PSOAP- notatet skal ha følgende struktur:
* P= problem
* S= sykehistorie, subjektivt
* O= observasjon, objektivt
* A= analyse
* P= plan, hva skal skje videre evt råd/ behandling, råd, videre utredning eller henvisning etc.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Korrekt oppbygget notat der PSOAP elementene er innbakt på en bra måte gir 1 poeng. Beste poeng for innholdet. Kompakt men tilstrekkelig innholdsrikt notat – altså en realistisk lengde – gir full score. Ikke gi ekstra uttelling for veldig langt og detaljert notat.
1 poeng for tillegg så det blir en komplett henvisning. Her bør familie/sosialt og tidligere sykdommer inngå. De fleste journalsystemer vil «automatisk» ta med Familie/sosialt, Tidligere sykdommer, Allergier (cave) og Medikamenter – men studentene bør kunne gjengi oppsettet i en Henvisning, slik gjengitt i Praksisveilederen (henvisninger er «nødvendig» læringsmål
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I følge nye retningslinjer for svangerskapsdiabetes, anbefales at Adena skal gjennomføre en sukkerbelastningstest (peroral glukosebelastning) i uke 24 - 28. Indikasjonen er at hun er førstegangsgravid og > 25 år (alder er et isolert kriterium for testen).
Det har vært mye debatt om de nye retningslinjene. Det hevdes blant annet at de kan føre til uheldig medikalisering av svangerskapet, samt overdiagnostikk.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan defineres henholdsvis medikalisering og overdiagnostikk, og på hvilken måte kan begrepene ha relevans for denne aktuelle retningslinje-debatten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vi er her i grensen mellom to beslektede begreper som vi i Allmennmedisin introduserer for 6. års studentene. Studentene kan sikkert komme til å svare litt sprikende her, og det får vi tåle. Men det er noen sentrale definisjoner de skal kjenne til og evne å si noe om (se abstract fra Hofmann-artikkel nedenfor)
Generell innledende kommentar: Man kan snakke om både Medikalisering og Overdiagnostikk i denne situasjonen, i det et fagmiljø velger å et legge cut-off for å screene for en vesentlig risikofaktor (svangerskapsdiabetes) i et ellers normalt svangerskap ved alder 25 år som eneste kriterium. Hvis man dernest legger til kriteriet knyttet til økt BMI (Kroppsmasseindeks) vil ennå flere behøve testen. Dvs man gjør med disse retningslinjene svangerskapet ennå mer «risikopreget» - uten at det per i dag (2018) finnes god evidens for dette. Vi har dernest ikke solid evidens for at det å diagnostisere de minst uttalte tilfellene av «reell» svangerskapsdiabetes vil føre til bedre helse for barn og mor, derfor er det aktuelt å snakke om overdiagnostikk.
* ''Medikalisering'' defineres gjerne som en prosess der ikkemedisinske aspekter av livet defineres som medisinske problemstillinger.
* ''Overdiagnostikk'' dreier seg derimot om at man diagnostiserer en tilstand/sykdom som aldri ville komme til å volde problemer for pasienten/personen. Dvs. diagnosen er teknisk sett korrekt, problemet ligger i at medisinen ikke greier å skille farlige fra ufarlige varianter (for eksempel noe som patologisk ser ut som kreft)
* ''Falsk positive funn'' er IKKE del av den egentlige overdiagnostikken, for de vil avkreftes i den diagnostiske prosessen. Helt greit om noen nevner fenomenet, men det er ikke sentralt i svaret.
''UTDYPNING'':
Svaret overfor gjenspeiler en artikkelen av Bjørn Hofmann i Med Health Care Philos. 2016 Jun;19(2):253-64. doi: 10.1007/s11019-016-9693-6.
<<<
''Medicalization and overdiagnosis: different but alike.''
Medicalization is frequently defined as ''a process by which some non-medical aspects of human life become to be considered as medical problems''. Overdiagnosis, on the other hand, is most often defined as ''diagnosing a biomedical condition that in the absence of testing would not cause symptoms or death in the person's lifetime''.
Medicalization and overdiagnosis are related concepts as both expand the extension of the concept of disease. They are both often used to critique unwarranted or contested expansion of medicine and to address health services that are considered to be unnecessary, futile, or even harmful. However, there are important differences between the concepts, as ''not all cases of overdiagnosis are medicalizations and not all cases of medicalizations are overdiagnosis''. The objective of this article is to clarify the differences between medicalization and overdiagnosis. It will demonstrate how the subject matter of ''medicalization traditionally has been non-medical'' (social or cultural everyday life) phenomena, while the subject matter of ''overdiagnosis has been biological'' or biomolecular conditions or processes acknowledged being potentially harmful. They also refer to different types of uncertainty: medicalization is concerned with indeterminacy, while overdiagnosis is concerned with lack of prognostic knowledge. Medicalization is dealing with sickness (sick role) while overdiagnosis with disease. Despite these differences, medicalization and overdiagnosis are becoming more alike (…).
<<<
Her er ellers NFAs policydokument (det har vi ikke gitt til studentene men sensor kan jo lese dette hvis behov) https://legeforeningen.no/PageFiles/253324/160506%20Policydokument%20overdiagnostikk%20.pdf
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver definisjon, og 1 poeng for gode refleksjoner
knyttet til den aktuelle situasjonen
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Helsestasjon for barn 0-5 år en er en arena for helsefremmende og forebyggende arbeid.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Forklar kort hva som menes med de to begrepene «helsefremmende» og «forebyggende» arbeid. Du trenger ikke gå inn på definisjonen av undergrupper av helsefremmende eller forebyggende arbeid.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forebygging kan defineres som «Å treffe tiltak eller å innrette handling for å hindre at noe skjer eller blir resultatet» eller «Å fjerne eller minimere virkningen av sykdom og funksjonstap, eller om mulig forsinke progresjon av sykdom og funksjonstap».
Helsefremming handler om å «gjøre det mulig å øke kontrollen over og forbedre sin helse».
Tradisjonelt har man brukt forebygging om tiltak som legger vekt på risiko, sykdom og uheldig adferd, mens helsefremming legger mer vekt på funksjon, mening og mestring.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det finnes ulike definisjoner, vi krever derfor ikke at svaret inneholder én bestemt definisjon/ordlyd.
1 poeng for en definisjon av forebygging som innebærer at dette skal forhindre sykdom/ negative konsekvenser av sykdom
1 poeng for en definisjon av helsefremmende som innebærer at dette er tiltak for å bedre helse, med en definisjon som tilsier at studenten har forstått at helse er mer enn fravær av sykdom
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi minst tre eksempler på arbeid/aktiviteter som gjennomføres i regi av helsestasjon for barn og angi hvilke forebyggende og/eller helsefremmende hensikter disse har.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det finnes mange ulike eksempler som kan benyttes, for eksempel vaksinasjon (primærforebygging av sykdom), helseundersøkelse (screening for sykdom, forebygge konsekvenser av sykdom, beroligelse om normalitet etter undersøkelse kan eventuelt ha helsefremmende effekt), organisering av barselgruppe (helsefremmende), samtaler, individuelt eller i grupper, om kosthold, søvn, samspill, rus, vold etc (kan ha både helsefremmende og forebyggende effekter), undersøke psykomotorisk utvikling og veilede foreldre om normal psykomotorisk utvikling (forebygging og helsefremming), kontroll av vekst (sekundærforebyggende (kan oppdage sykdom som medfører redusert vekst), )
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert eksempel som er knyttet opp mot forebyggende/helsefremmende effekter. Det kreves ikke nivåinndeling av forebyggende effekter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er dine oppgaver som helsestasjonslege?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Helsestasjonen skal tilby helseundersøkelser med lege. Dette er spesifisert i retningslinjen og har støtte i lov/forskrift. Disse helseundersøkelsene bør gjennomføres som en del av helsestasjonsprogrammet på konsultasjonene når barnet er 6 uker, 6 måneder, 1 år og 2 år
En av legens oppgaver er altså å skal undersøke barnet. Formålet med legeundersøkelsen er å forebygge og fange opp risikofaktorer for sykdom og avvikende eller forsinket fysisk, psykisk og atferdsmessig utvikling på et hensiktsmessig tidspunkt. Ved de rutinemessige undersøkelsene, bør legen gjennom sykehistorie og klinisk undersøkelse identifisere risikofaktorer for utvikling av fysiske og psykiske helseproblemer og uheldig utvikling.
Som helsestasjonslege arbeider man tverrfaglig, i tett samarbeid med helsesøster og eventuelt i samarbeid med andre profesjoner. Dette er fremhevet som sterke anbafalinger i retningslinjen.
*Sterk anbefaling: Helsesøster og lege bør samarbeide om forberedelser og oppfølgning av alle helseundersøkelser der lege er tilstede
*Sterk anbefaling: Helsesøster og lege bør særlig samarbeide med fysioterapeuten om barnets motoriske utvikling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Helseundersøkelse 0,5 p
* Identifisere risikofaktorer 0,5 p
* Fange opp tegn på avvikende/forsinket utvikling 0,5 p
* Råd og veiledning for å fremme fysisk og psykisk helse 0,5 p
* Samhandling med annet personell 1 p
(Totalt max 2,5 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK.Amit V. Khera, et al. (2016): Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva var hensikten med studien?
# Hvorfor er dette en interessant problemstilling å studere?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hensikten med studien var å undersøke om registrert penicillinallergi var assosiert med utvikling av meticillinresistent Staphylococcus aureus (MRSA) og C difficile.
# Å være registrert med penicillinallergi medfører økt bruk av bredspektret antibiotika, og man forventer at det derfor også medfører økt forekomst av MRSA og C difficile. En betydelig andel av pasienter med registrert penicillinallergi har ikke hypersensitivitetsreaksjon mot penicillin, og kunne derfor brukt penicillin likevel. Hvis registrering av penicillinallergi øker risiko for MRSA/C difficile, er det viktig å unngå feilaktig registrering av allergi mot penicillin. Man har liten mulighet til å intervenere på faktisk penicillinallergi, men stor mulighet til å intervenere på feilaktig registrering av allergi. Man forutsetter at en assosiasjon mellom registrert allergi og infeksjon opptrer uansett om den registrerte allergien er reell eller ikke.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1p. Kandidaten må kunne gjengi problemstillingen. Her gis det ikke delpoeng
# 2 p. Må fremgå at en sammenheng mellom registrert allergi og infeksjon er relevant fordi man i så fall kan redusere forekomst av infeksjon ved å unngå feilaktig registrering av diagnose.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK.Amit V. Khera, et al. (2016): Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Tabell 2 viser fordelingen av ulike pasientkjennetegn for hhv deltakere med og uten penicillinallergi. Gi en kort, oppsummert sammenligning av deltakere med og uten penicillinallergi basert på informasjon fra tabell 2.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De to gruppene er gjennomgående like på de fleste pasientkjennetegnene som er vist. Det er noe høyere andel med annen type antibiotikaallergi i gruppa som har penicillinallergi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full skåre må kandidaten vurdere hvor sammenliknbar de to gruppene er. Basert på informasjonen i tabellen er de svært lik på de kjennetegnene som er listet opp.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: Blumenthal KG, Lu N, Zhang Y, Li Y, Walensky RP, Choi HK.Amit V. Khera, et al. (2016): Risk of meticillin resistant Staphylococcus aureus and Clostridium difficile in patients with documented penicillin allergy: population based matched cohort study. BMJ. 2018 Jun 27;361:k2400. doi: 10.1136/bmj.k2400.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du fortolke resultatene fra Table 3?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er gjennomgående høyere risiko for både resistent MRSA og C difficile for deltakerne med penicillinallergi sammenliknet med de som ikke har slik allergi. Sammenhengen er sterkere for MRSA.
Resultatene er forholdsvis presise hvor nedre del av konfidensintervallet indikerer betydelig økning for MRSA.
Resultatet endrer seg relativt lite ved justering, noe som kan indikere at sammenhengen ikke er sensitiv for de konfunderende faktorene som er inkludert i analysen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vise til økt risiko ved p-allergi.
1 poeng for en vurdering av presisjon. Det gis ikke poeng for å kommentere om hvorvidt konfidensintervallet inneholder 1 eller ikke.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er forskjellen mellom mediering og konfundering?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Konfundering betyr effektforveksling som skyldes en felles årsak mellom eksponering og utfall. Mediering er en effekt av eksponering som igjen påvirker utfallet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne forklare at konfundering innebærer en effektforveksling som skyldes en felles årsak mellom eksponering og utfall (2p), og at mediering er en effekt av eksponering som igjen påvirker utfallet (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som fastlege har du en konsultasjon med en kvinne som er 35 år. Hun har vært til flere konsultasjoner for symptomer på depresjon og ulike somatiske symptomer. Du har tidligere satt inn en IUD hos henne. Nå kommer hun til deg på grunn av blødningsforstyrrelser, og du tenker at du eventuelt må fjerne den for å undersøke om blødningene stabiliserer seg. Når kvinnen legger seg på benken og legger bena i benholdere, ser du flere mindre blåmerker på innsiden av begge lår. Under undersøkelsen begynner hun å gråte.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør du håndtere denne situasjonen? Gi en kort begrunnelse for svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Funnet bør vekke mistanke på grunn av uvanlig lokalisasjon for en tilfeldig skade. I denne situasjonen er det viktig at du våger å spørre pasienten om hva som har skjedd/hvordan hun kan ha fått blåmerkene. For å legge til rette for en god samtale, bør du be kvinnen gå ned av GU-stolen og kle på seg før du starter en samtale med henne.
Skadene bør dokumenteres i journalen, særlig om pasienten ikke har en god forklaring på hvordan blåmerkene har oppstått (kampsport, kontaktidrett, annen sannsynlig skademekanisme).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Nevner at det kan være en uvanlig skade (1 p).
* Spør pasienten hvordan blåmerker har oppstått (1p).
* Legger til rette for samtalen ved å la pasienten kle på seg (1p).
* Skadedokumentasjon gir ikke poengmessig uttelling her, da det kommer senere i oppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Som fastlege har du en konsultasjon med en kvinne som er 35 år. Hun har vært til flere konsultasjoner for symptomer på depresjon og ulike somatiske symptomer. Du har tidligere satt inn en IUD hos henne. Nå kommer hun til deg på grunn av blødningsforstyrrelser, og du tenker at du eventuelt må fjerne den for å undersøke om blødningene stabiliserer seg. Når kvinnen legger seg på benken og legger bena i benholdere, ser du flere mindre blåmerker på innsiden av begge lår. Under undersøkelsen begynner hun å gråte.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forhold kan bli skjult, dersom du ikke stiller direkte spørsmål?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vold, alkohol, annen form for rus
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per nevnte forhold, full skår om to forhold er nevnt, eventuelt andre relevante forhold (for eksempel psykisk helse).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen bor sammen med sin ektefelle, de har ingen barn. Hun forteller etter hvert om gjentatte episoder hvor ektefellen har utsatt henne for vold. Dette har pågått over flere år. Ektefellen har slått, sparket, kløpet og tatt kvelertak på henne. Hun får stadig høre at hun er verdiløs, og at «det kommer til å få konsekvenser» om hun ikke føyer ham. Du blir etter hvert bekymret for hennes sikkerhet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak vurderer du?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Informasjon om krisesenter
# Anbefale politianmeldelse.
# Dokumentere i journal funnene på innsiden av lårene, og at hun har snakket om vold.
# Gir henne en trygghetsplan, dvs forberedelser for å kunne forlate hjemmet hurtig og kunne gi beskjeder i koder. Det forventes ikke at studenten gjengir innholdet i en trygghetsplan, men denne kan for eksempel inneholde:
#* Ha nøkler tilgjengelig
#* Kode til nettverk dersom hun trenger å si at hun er i fare mens han hører på
#* Avtale med naboer at de ringer politi dersom de høre bråk
#* Fjerne våpen i huset
#* Ha alle viktig papirer og kort tilgjengelig
#* Ekstra simkort for å ringe
#* Ferdigpakket bag slik at hun kan forlate huset fort
# Ta henne tilbake til kontroll.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert av følgende tiltak: Krisesenter, forslag om anmeldelse, trygghetsplan, kontrolltime, dokumentasjon av skader, inntil max 2 poeng.
Studenten behøver ikke beskrive innholdet i kriseplanen for å få uttelling.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kvinnen vil dra hjem til sin ektefelle. Hun vil ikke at noen skal få vite om hva hun blir utsatt for
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Diskuter kort om du kan kontakte politiet til tross for at kvinnen motsetter seg dette.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Du har i utgangspunktet taushetsplikt etter Helsepersonelloven om det pasienten har fortalt deg. Du kan likevel melde fra uten hensyn til taushetsplikten dersom du kan avverge en kriminell handling.
I følge straffelovens generelle bestemmelse om avverge er enhver forpliktet til å «avverge en straffbar handling eller følgene av den, på et tidspunkt da dette fortsatt er mulig og det fremstår som sikkert eller mest sannsynlig at handlingen er eller vil bli begått.» Den generelle avvergeplikten innbefatter også deg som fagperson. Lovbestemmelsen er begrenset til noen definerte straffbare handlinger, inkludert alvorlig eller gjentatt mishandling eller overgrep i nære relasjoner. Hensynet til å verne om liv og helse vil i disse tilfellene veie tyngre og går foran taushetsplikten du har som fagperson.
Avvergeplikten inntrer altså når du holder for sikkert eller mest sannsynlig at den straffbare handlingen vil bli eller er begått. Du er da forpliktet til å avverge handlingen ved å anmelde forholdet til politiet eller på annen måte å avverge.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her må studenten nevne både taushetsplikten (1p) og avvergeplikten (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Dersom pasienten hadde hatt barn, men fortsatt ville dra hjem uten å fortelle noen om hva som har skjedd, hva ville vært det riktige å gjøre?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dersom du har grunn til å tro at et barn blir eller vil bli mishandlet, utsatt for alvorlige mangler ved den daglige omsorgen eller annen form for alvorlig omsorgssvikt, har du plikt til å melde fra til barnevernet etter lov om barneverntjenester.
Du bør ta opp med pasienten kontakt med barnevernet, og informere om at du har meldeplikt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for meldeplikt til barnevernet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 23 år gammel musiker kommer til legevakten i Trondheim, der du har vakt. Han har vært på oppdrag på en festival i Henningsvær i Lofoten for vel 4 uker siden og så på Trænafestivalen for ca. to uker siden. Han har nå vært lett febril i 2 dager og fra i går har han blitt øm og fått hevelse på kinnet foran øret og har litt vondt når han tygger. Du mistenker at pasienten har kusma og rekvirerer serologisk prøve og hals- og munnsekret/spyttprøve med tanke på dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Kusma er meldepliktig sykdom i gruppe A. Hva innebærer dette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Meldepliktige sykdommer i gruppe A meldes med full pasientidentitet både fra medisinsk-mikrobiologiske laboratorium og fra diagnostiserende lege til MSIS, Folkehelseinstituttet. Kopi av meldingen fra diagnostiserende lege går også til kommuneoverlegen i pasientens bostedskommune.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sykdommer i gruppe A skal meldes med full pasientidentitet (1p)
Melding skal sendes MSIS, Folkehelseinstituttet med kopi til kommuneoverlegen i pasientens bostedskommune (1p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du slår opp kriteriene for melding av kusma og finner følgende:
<<<
Kriterier for melding er et klinisk forenlig tilfelle med epidemiologisk tilknytning eller laboratioriepåvisning av parotittvirus eller antistoff mot parotittvirus, i fravær av nylig vaksinasjon. Kliniske kriterier er feber og minst én av følgende symptomer: uni- eller bilateral hevelse av parotis eller andre spyttkjertler uten annen åpenbar årsak, orkitt, meningitt. Med epidemiologisk tilknytning menes overføring fra person til person.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gi en kort vurdering av om du bør melde dette tilfellet nå eller avvente svar på laboratoriediagnostikk.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten har et klinisk bilde forenlig med kusma, med feber og hevelse over parotis. Det foreligger så langt i oppgaven ikke opplysninger om tilknytning til kjente tilfeller av kusma, men det foreligger opplysninger om en situasjon hvor smitte typisk kan forekomme (festival).
Man bør forsøke å få avklart hvorvidt pasienten kjenner til at det har vært andre tilfeller av kusma blant dem han har hatt kontakt med, i så fall bør tilfellet meldes da det er epidemiologisk tilknytning.
Dersom det ikke er andre kjente tilfeller av kusma, kan man avvente melding. Et argumentet for å likevel melde allerede nå, er behovet for å raskt identifisere det som kan vise seg å være et stort utbrudd med smitte av pasienter i flere landsdeler.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her må det utvises skjønn, diskusjonen er viktigere enn konklusjonen om å melde eller ikke melde før laboratoriesvar, konklusjonen må være basert på relevante argumenter.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I tillegg til melding skal man i noen tilfeller varsle om smittsomme sykdommer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når og til hvem skal man som allmennlege varsle om kusma?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Noen utpekte sykdommer i gruppe A skal varsles om ved enkeltsykdom, men kusma er ikke en av disse sykdommene. Det er ikke forventet at studentene vet hvilke sykdommer som skal varsles ved enkelttilfeller, dette er informasjon som endrer seg over tid og som de må oppdatere seg på når det er akutelt.
Ved mistenkt eller påvist utbrudd utenfor helseinstitusjon skal lege varsle kommuneoverlegen, som på sin side skal varsle fylkesmannen og Folkehelseinstituttet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Varsle kommuneoverlege (0,5p) ved mistanke om eller påvist (0,5p) utbrudd (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter noen dager kommer bekreftende svar på prøvene som ble tatt av pasienten. Smittevernoverlegen i Trondheim mottar også varsel om at flere unge voksne som har vært på samme festival har blitt syke. Flere av dem bor i Trondheim og nabokommuner, men det er varslet at det er tilfeller både i Nordland fylke og på Østlandet. Det kan altså tyde på at det er et stort utbrudd på gang.
Både behandlende lege og kommuneoverlege vil ha en rolle i begrensingen av utbruddet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak er aktuelt at ulike parter iverksetter i denne situasjonen? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved lokale sykdomsutbrudd skal Folkehelseinstituttet i henhold til smittevernlovens § 7-9 gi bistand, råd, veiledning og informasjon ved oppklaring og håndtering av utbruddet, dersom kommuneoverlegen ønsker det. Ved nasjonale utbrudd der flere kommuner er rammet (som i denne oppgaven), har Folkehelseinstituttet ansvaret for å drive og koordinere det faglige oppklaringsarbeidet innen befolkningen.
# Melding til MSIS av (nye) tilfeller (diagnostiserende lege og laboratorium)
# Varsling (hvis det ikke alt er gjort). Kommuneoverlegen skal varsle fylkesmannen og Folkehelseinstituttet.
# Smitteoppsporing. Smittevernloven gir plikt til smitteoppsporing «når dette er gjennomførbart og at hensynet til smittevernet kreve det» (Smittevernloven §3-6). Ved enkelttilfeller har diagnostiserende lege et ansvar for individrettet smitteoppsporing, men ved utbrudd vil smittevernlegen/kommunelegen overta koordinering av smitteoppsporing. Se neste punkt.
# Informasjonsarbeid. Informasjon om: at det er utbrudd, symptomer, risikogrupper, tiltak (vaksine, unngå sosiale samlinger, basale smittevernrutiner mot dråpesmitte). Dette er det naturlig at smittevernoverlege og FHI tar ansvar for.
# Vaksinering. Ved utbrudd av kusma anbefales at de som har vært i nær kontakt med den syke tilbys MMR-vaksine hvis de ikke allerede er fullvaksinerte. Hvis det er gått mange år siden dose 2, kan disse nærkontaktene tilbys en tredje vaksinedose selv om effekten av dette tiltaket er ikke godt undersøkt. Som nærkontakter regnes husstandsmedlemmer, partnere, eller andre som har hatt mye nær kontakt med den syke. Vaksinen kan ha liten eller ingen effekt hvis man allerede er smittet. Man blir imidlertid beskyttet mot smitte fra nye tilfeller som måtte komme. Personer som med sikkerhet tidligere har gjennomgått kusma har ikke behov for vaksine da de er immune. FHI kommer med anbefaling om slik vaksinering etter samarbeid med lokalt smittervern, kommuneoverlegen kommuniserer anbefalingene og iverksetter evt. sammen med fastleger/vaksinasjonskontor vaksineringstilbud.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dersom varsling videre fra kommunelege er angitt i svar på spørsmål 4 gir dette også uttelling her.
Det må utvises noe skjønn i poengsettingen her. Full skår om tre av fem punkter er beskrevet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under ser du en tabell over meldinger av kusma de senere årene
|! |!2010 |!2011 |!2012 |!2013 |!2014 |!2015 |!2016 |!2017 |
|Under 1 år | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
|1-9 | 0 | 3 | 6 | 1 | 3 | 0 | 3 | 2 |
|10-19 | 2 | 0 | 5 | 2 | 0 | 7 | 6 | 3 |
|20-49 | 8 | 9 | 13 | 21 | 8 | 166 | 58 | 11 |
|50 og over | 2 | 1 | 6 | 11 | 7 | 7 | 16 | 2 |
|Totalt | 12 | 16 | 30 | 35 | 18 | 180 | 83 | 18 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan du si om forekomsten av kusma ut fra Tabell 1?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Beskrivelse: En betydelig økning, faktisk en 10 dobling av forekomsten fra 2014 til 2015, som avtok men vedvarte også inn i 2016 før det kom til en mer vanlig forekomst i 2017. Utbruddet kom blant unge voksne i alderen 20-49.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Betydelig økning (1p), aldersgruppe (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
Under ser du en tabell over meldinger av kusma de senere årene
|! |!2010 |!2011 |!2012 |!2013 |!2014 |!2015 |!2016 |!2017 |
|Under 1 år | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
|1-9 | 0 | 3 | 6 | 1 | 3 | 0 | 3 | 2 |
|10-19 | 2 | 0 | 5 | 2 | 0 | 7 | 6 | 3 |
|20-49 | 8 | 9 | 13 | 21 | 8 | 166 | 58 | 11 |
|50 og over | 2 | 1 | 6 | 11 | 7 | 7 | 16 | 2 |
|Totalt | 12 | 16 | 30 | 35 | 18 | 180 | 83 | 18 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva kan årsakene til et slikt funn som Tabell 1 over viser, være?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Spørsmål om vaksinasjonsgrad (hvor mange i denne gruppa var vaksinert), er vaksinasjonsgraden tilstrekkelig for flokkimmunitet
# Spørsmål om vaksinen faktisk hadde effekt - om man har indikasjoner på avtagende effekt? Nye mutasjoner av virus som gir redusert effekt av vaksine? (Utfyllende kommentar, ikke forventet av studentene: I 2015 var det et utbrudd av kusma i studentmiljøer flere steder i landet, særlig i Trondheim hvor det per desember 2015 var bekreftet 143 tilfeller. De fleste av de syke studentene var vaksinerte, og det ble påvist en spesiell variant av kusmaviruset som ikke dekkes like godt av MMRvaksinen)
# Varighet av immunitet etter vaksine. Det er holdepunkter for at MMR-vaksinen gir kortere varighet av beskyttelse mot kusma enn mot meslinger og rubella.
# Innvandring (av uvaksinerte eller smittede)? Man har mistanke om at det var uvaksinerte/delevis vaksinert utlandsstudent som var smittet før han kom til Trondheim og at det var starten på utbruddet i 2015.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Forhold rundt vaksinasjonsgrad (1p), forhold rundt effekt av
vaksine (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlege til Bjørn på 24 år som bor på hybel og er heltidsstudent (grunnskolelærerutdanningen). Han går på tredje året og har inntil forrige semester vært svært aktiv i studentmiljøet. Han har tidligere vært frisk og trent myt. Han har jobbet et par uker hver sommer men har ellers ingen jobberfaring. Han hadde en mononukleoseinfeksjon for et halvt år siden, var da sengeliggende en uke og har etter det ikke følt at han har kommet helt til hektene.
Han har gått glipp av svært mye undervisning det siste halvåret. Han innså at han ikke vil klare å følge ordinær studieprogresjon dette semesteret. I samråd med studiekonsulent og deg som fastlege har han meldt midlertidig avbrudd i studiene pga sykdom.
Tilstanden har blitt verre de siste 6 ukene. Han kommer seg ikke opp om morgenen. Han bruker mye tid på selv enkle rutineoppgaver som å kle på seg. Han går ut fra hybelleiligheten ca. 3 ganger i uken, da først og fremst for å handle mat. Han sier at han ikke er deprimert, men at han er nå ganske oppgitt og fortvilet over sin egen situasjon. Han har noen gode kompiser som har vært innom et par ganger i uken, og han har mye kontakt med dem daglig via sosiale medier.
Han oppsøker deg som fastlege fordi han er bekymret for både helsen og økonomien.
Hovedsymptomet hans er langvarig utmattelse, som forverres selv av lett fysisk anstrengelse. Andre symptomer: sår hals, søvnvansker, konsentrasjonsproblemer, muskelsmerter, fryser lett og blir svimmel hvis han reiser seg opp fort fra sittende eller liggende. Han beskriver nedsatt utholdenhet både fysisk og psykisk.
Han er blek og tynn, og snakker med litt langsom og lav stemme. Han gir god blikkontakt og kommuniserer godt under samtalen. Han har tidvis glimt i øyet og en god porsjon galgenhumor når han snakker om situasjonen. Eller er status upåfallende.
Som fastlege igangsetter du utredning med tanke på bakenforliggende årsak. Du utreder ham henhold til anbefalinger i nasjonal veileder for kronisk utmattelsessyndrom (CFS/ME). Etter eksklusjonsdiagnostikk, konkludert du med at det mest sannsynligvis dreier seg om kronisk utmattelsessyndrom. Pasienten henvises til et rehabiliteringsopphold for unge voksne med CFS/ME og får tilbud om plass med kort ventetid.
Etter en del avklaringer med NAV og Lånekassen konkluderes det med at Bjørn har brukt opp sine rettigheter hos lånekassen og skal nå vurderes i forhold til eventuelle ytelser fra NAV.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken ytelse vurderer du som mest aktuell for Bjørn i den foreliggende situasjon
# Drøft om han fyller vilkårene for denne ytelsen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Arbeidsavklaringspenger (AAP) er mest aktuelt.
* Ikke opptjent rett til sykepenger
* Ikke aktuelt med uføretrygd av flere årsaker. Ikke varig. Ikke gjennomført hensiktsmessig beh. og arbeidsrettet aktivitet.
* Sosialstønad kan vurderes.
§ 11-14.Arbeidsavklaringspenger til studenter: Det kan gis arbeidsavklaringspenger til en student som har avbrutt studiet, og som har behov for aktiv behandling for å kunne gjenoppta studiet.
Vilkår for AAP:
* Nedsatt arbeidsevne pga. sykdom skade og lyte. §11-5
* Minst 50% arbeidsufør ved inngang AAP
* Arbeidsuførhet med årsakssammenheng til nedsatt funksjon pga. sykdom
* Aktivitetskrav
Sykdom skal være en vesentlig årsak til arbeidsuførheten. Helse er kun en av flere faktorer som vektlegges ved vurdering av den nedsatte arbeidsevne.
Aktivitetskrav. §11-6. Det skal lages en aktivitetsplan som beskriver aktiv behandling som er nødvendig for at medlemmet skal kunne gjenoppta et avbrutt studium
Kriterier for AAP til studenter er i hovedsak som for AAP for øvrig, men for studenter med avbrudd i studiene gis det unntak fra vilkåret om at man skal vurderes i forhold til ethvert arbeid. Fra rundskrivet til §11-4: Arbeidsavklaringspenger kan tilstås i en periode med aktiv behandling som er nødvendig for at medlemmet skal kunne gjenoppta et avbrutt studium. Dette innebærer at det ikke skal vurderes hvorvidt andre tiltak vil fåmedlemmet raskere i arbeid.
NB! Eksamenskandidaten bør kjenne til at AAP kan tilstås studenter. Det forventes ikke at kandidaten kjenner til det nevnte unntaket fra vurdering i forhold til ethvert arbeid. Det trekker opp hvis kandidaten har innsikt i dette.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
AAP mest aktuelle ytelse: 1 poeng
Poenggivende momenter i drøftingen:
* Redusert arbeidsevne med minst 50% 1 poeng
* Sykdom som ikke er helt kortvarig som vesentlig årsak 1 poeng
* Aktivitetsplan 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som fastlege blir du skriftlig bedt om å skrive en legeerklæring til NAV. Det er bedt spesielt om at legen sender med en funksjonsvurdering
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedpunkter bør være med i en funksjonsvurdering til bruk i NAV? Sett opp en stikkordsmessig tabell eller oversikt som viser:
* a) hvilke generelle momenter som bør være med i en funksjonsvurdering
* b) hvilke av de nevnte momenter kan du si noe konkret om i dette tilfellet
* c) hvilke av de nevnte momenter mangler du opplysninger om i dette konkrete tilfellet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Studenten skal klare åidentifisere hva slags informasjon som bør etterspørres. (dette er momenter for a)
# Legens vurdering av nåsituasjonen (tidsaktuelle, ikke utdaterte opplysninger).
# Beskrivelse av legens egne observasjoner/vurderinger av funksjonsnivå̊: Lite vurderinger fremgår men legens observasjoner er med: Pasienten snakker med litt langsom og lav stemme. God blikkontakt og kommuniserer godt under samtalen. Glimt i øyet og galgenhumor. Eller er status upåfallende.
# Gjerne supplert med pasientens egen beskrivelse og eventuelt observasjoner/vurderinger fra andre instanser (rehabiliteringsinstitusjon, arbeidsmarkedsbedrift). Kilde angis.
# Bredde i funksjonsområder som beskrives, bør inkludere både psykisk og fysisk fungering. Gjerne opplysninger om sosial fungering. (Stikkord: biopsykososial kartlegging av funksjon)
# Ta med både begrensninger og ressurser
# Om funksjonsevnens ”tidsprofil” ( er funksjonsnivået stabilt eller svingende, eventuelt hvor hyppig og hvor mye svinger det, hvor lenge varer en periode med funksjonsfall eller en funksjonstopp og hvordan er funksjonsnivået i gjennomsnitt.
# Tempo. Trengs det økt tid påågjennomføre oppgaver?
# Er funksjonssvikten relatert til bestemte situasjoner? F.eks. sammenligne funksjon påjobb og fritid. Utløsende situasjoner?
# Si noe om hvilke konsekvenser redusert funksjonsnivå̊kan ha eller helt konkret har hatt for arbeidsevnen (i den grad du har grunnlag for åsi noe om dette)
Eksempelsvar: Kort oppsummert om de funksjonsopplysninger vi har (svar påoppg b) og de vi mangler (svar påoppg. c)
''Svar b)''
# Legen har gjort en nylig gjennomgang av saken. Vi har en del tidsaktuelle opplysninger.
# Legens egne observasjoner/funn som brukes:
# Vi har pasientens egen beskrivelse av fungering per i dag. Opplysninger fra andre instanser: Ingen observasjoner fra andre instanser (studiested, rehabiliteringsinstitusjon, arbeidsmarkedsbedrift)
# Begrensninger (Generell tretthet, slitenhet, økt behov for hvile og søvn. Opplevelse av utmattelse som gjør selv dagligdagse aktiviteter som påkledning og å gå på butikken og ressurser (beskriver seg selv som psykisk sterk, sosialt omgjengelig).
# Tempo. Bruker mer tid på selv enkle daglige oppgaver. Klarer ikke å henge med på vanlig studieprogresjon.
''Svar c)''
# Biopsykososial fungering: fysisk fungering: redusert, økte symptomer selv etter lett fysisk belastning. emosjonell fungering: lite kjent, ingen opplysninger som gir mistanke om dårlig fungering. kognitiv fungering: redusert konsentrasjonsevne nå. NB! For kort tid siden en velfungerende student. Sosial fungering: aktiv som student tidligere. Uklart nå.
# Tidsprofil. INGEN OPPLYSNINGER
# Situasjonsbestemt funksjonssvikt: INGEN OPPLYSNINGER
# Konsekvenser for studie/arbeidsevnen: Redusert fungering med innvirkning på studie/arbeidsevne per dags dato. Vi mangler et observasjonsgrunnlag for åkunne si noe om hvordan han faktisk fungerer i konkrete situasjoner.
# (Funksjonsvurderingen er ufullstendig og bør suppleres før den kan brukes av NAV til åkonkludere vedrørende arbeidsevne. NB! Oppgaveteksten spør ikke etter en sluttvurdering og det stilles ikke krav til at studenten har gjort dette).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* a)
** 1 og 2 må være med for poeng (1/2p for hvert),
** 1 og 2 + 2 andre momenter=1 poeng,
** 1 og 2 + 3-4 andre momenter=1 1/2 p,
** 1 og 2 +5 eller flere momenter= 2 p
* b) ½ poeng for hvert element inntil 2 p
* c) 1 poeng for nr 1, ½ p i tillegg for hvert av de to andre (ev. andre relevante)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du arbeider som allmennlege i en liten industrikommune. En morgen blir en 34 år gammel maskinfører brakt av brannvesenet til konsultasjon som øyeblikkelig hjelp. Det viser seg at han hele natta har vært innesperret i en tunnel fordi et snøras hadde stengt for både inngangen og ventilasjonsanlegget. I tunnelen ble det drevet anleggsvirksomhet med bl.a. sprengning. Før raset gikk var det foretatt en sprengning og han har arbeidet hele natta med en hjullaster for å forsøke å grave seg ut. Pasienten sier at det etter hvert ble mye eksos inne i tunnelen og brannvesenet sier at det også kan ha vært igjen en del nitrogenoksid på stedet etter sprengningen. Etter å ha blitt reddet ut ble han på morgenen kjørt direkte til legekontoret av brannvesenet.
Han kommer gående til konsultasjonen, men kjenner seg «rar» og ønsker hjelp. Han klager over hodepine, litt svimmelhet, hoste og noe tungpust og framstår ganske engstelig
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anamnestiske opplysninger er relevante å innhente i denne konsultasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kartlegge hendelsen: Hvor lenge var han innestengt? Hvordan var omstendighetene i tunnelen? Hvor mange maskiner/kjøretøy var i drift inne i tunnelen? Diesel- eller bensinmotorer? Ble motorene slått av? Var det foretatt sprengning? Var det mørkt? Følte han seg truet på livet? Hvordan ble han befridd?
Symptombeskrivelse: Debut og karakteristika av hvert symptom. Opplevd liknende symptomer tidligere? Tidsrelasjon til hendelsen.
Tidligere sykdommer/sykehistorie: kjent lungesykdom?
Stress/psykiske symptomer/lidelser?
Røyking
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for tilfredsstillende kartlegging av hendelsen.
1 poeng for tilfredsstillende symptombeskrivelse.
0,5 poeng for andre relevante anamnestiske opplysninger som røyking og tidligere sykdommer.
Det må utvises skjønn i vurderingen om hva som er tilfredsstillende kartlegging her.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter at du har skaffet oversikt over den akutte situasjonen lurer du på hvordan du skal gå videre med dette.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kliniske undersøkelser er relevante i denne konsultasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vurder pasientens hudfarge (cyanose, blek, kaldsvett?), Puls, blodtrykk. Kort lungestatus med lungestetoskopi (ut fra hoste og tungpust). Orienterende nevrologisk undersøkelse (ut fra hodepine og svimmelhet). Mental tilstand og bevissthet (ut fra mulig forgiftning).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Pasienten kommer gående til konsultasjonen, men ellers gir vignetten lite opplysninger som sier noe om pasientens allmenntilstand. Vurdering av behov for akuttmedisinsk behandling er dermed det viktigste. Vitale parametere (1p).
Lungeundersøkelse (0,5p). Nevrologisk status (0,5p).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten mener at han i løpet av natta har pustet inn mye eksos og frykter at han kan ha blitt forgiftet på noe vis.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke gasser i eksos er særlig relevante med tanke på toksisitet, og med hvilke virkningsmekanismer lokalt i luftveiene og systemisk?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nitrogenoksid (NOx) er en gass som vesentlig finnes i dieseleksos. Mekanisme: Nitrøse gasser irriterer luftveiene. Slik gass er relativt lite vannløselig og gir effekter distalt i luftveiene med risiko for alvorlige komplikasjoner som lungeødem. Dette er en langsom reaksjon med peroksidasjon av fett i cellemembraner og lungeødemet kan derfor manifestere seg flere timer etter eksponeringen.
NOx virker også oksiderende i blodet slik at hemoglobin som inneholder 2-verdig jern (Fe^^2+^^) omdannes til MetHb med 3-vedig jern (Fe^^3+^^) som ikke kan transportere oksygen.
Karbonmonoksid (CO) er en gass som vesentlig stammer fra bensinmoterer. Utslipp av CO har gått ned etter innføring av katalysatorer i nyere biler. CO binder seg til hemoglobin med større affinitet enn O2 og hemmer dermed oksygentransport.
Det binder seg også til hem-proteiner i perifert vev og reduserer oksidativ fosforylering. Dessuten fører opptak av CO også til relaksasjon av glatt muskulatur og vasodilatasjon. Nevrologiske senskader etter alvorlige forgiftninger forklares sannsynligvis av cellulær toksisitet i kombinasjon med hypoksi.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
CO – 0,5 p, binding til Hb – 0,5 p, redusert oksygentransport -0,5
NOx- 0,5 p. Irritasjon i distale luftveier pga lav vannløselighet-0,5 p, MetHb med redusert oksygentransport 0,5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved dine enkle kliniske undersøkelser framkommer ikke klar
patologi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan håndterer du denne pasienten videre etter at du har gjennomført konsultasjonen og hva er din begrunnelse for tiltaket?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Symptomer kan komme sent etter innånding av NOx (konf skademekanisme i lungene). Ved antagelse av at det kan ha vært høy eksponering skal selv pasienter uten symptomer og uten funn observeres i 12-24 timer. Med mindre man kan sørge for forsvarlig overvåking på annen måte, og man har tilgang til rask og adekvat behandling i tilfelle utvikling av lungeødem skal pasienten derfor legges inn.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Innleggelse eller annen adekvat overvåking (1 p) med begrunnelse (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det videre forløpet etter den akutte konsultasjonen forløp komplikasjonsfritt.
Det har etter hvert gått to måneder siden pasienten ble innestengt i tunnelen. Pasienten har vedvarende diffuse symptomer. Han klager over hoste og tidvis åndenød, hodepine, utmattelse og generelle muskelsmerter. Han virker nedstemt og har konsentrasjonsvansker.
Han forteller at han reagerer sterkt på eksos og bensinlukt. Dette gjør det vanskelig å fylle bensin på bilen og oppholde seg på sterkt trafikkerte steder. Han opplever også sterkt ubehag med hodepine og hjertebank ved kjøring i tunnel. Han unngår derfor all kjøring i tunnel. Det kommer fram at pasienten opplevde at han var i livsfare da han ble innestengt i tunnelen.
Pasienten selv er nå overbevist om at symptomene hans skyldes eksosforgiftning.
Gitt at du ikke kommer i mål med utredning og tiltak som allmennlege alene, kan det være aktuelt å henvise pasienten til spesialister eller andre samarbeidende profesjoner i helsevesenet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Angi tre spesialiteter eller samarbeidende profesjoner det kan være relevant å henvise pasienten til som ledd i utredning/behandling. Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Lungelege'' – kan vurdere hyperreaktivitet i luftveier og om pasienten har tegn til nedsatt lungefunksjon. Begrunnelsen for dette er at han angir hoste og tidvis åndenød som kan gi mistanke om irritantutløst astma eller RADS. Utrede eventuelle andre årsaker til lungeplager.
''Arbeidsmedisiner'' – kan vurdere eksponeringen som pasienten har vært utsatt for, både ved den aktuelle hendelsen og eventuelt tidligere i yrkeslivet. Kan vurdere om eksponeringen kan gi symptomer samsvarende med det pasienten opplever.
''Psykolog/psykiater'' – kan utrede pasienten med tanke på posttraumatisk stress og ev depresjon. (Oppgaven gir mindre holdepunkter for depresjonsdiagnose)
''Fysikalsk medisiner'' eller ''Fysioterapeut'' er ikke så aktuelt mtp eksosforgiftning eller PTSD, men kan være aktuelt mtp smerter og utmattelse
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver spesialist eller profesjon med relevant begrunnelse. Det må utvises skjønn i vurderingen av hva som er relevant, men studenten må vise at de har en tanke basert på det som foreligger av opplysninger og kunnskap om ulike spesialiteter eller andre profesjoners kompetanse.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det har gått snart et år siden pasienten ble stengt inne i tunnelen. Pasientens symptomer vedvarer og medfører betydelige plager og unngåelse av situasjoner som forverrer dem. Unngåelse av eksos samt generelt dårlig funksjon gjør at han ikke klarer arbeidet som maskinfører.
Relevant utredning har ikke funnet somatiske årsaker som kan forklare pasientens plager.
Hvilken diagnose som settes, og dermed implisitt hvilken forklaringsmodell pasientens symptomer forstås ut fra, kan også få trygdemedisinske konsekvenser.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder hvilke anerkjente eller mindre anerkjente diagnoser som er mest aktuelle for denne pasienten.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ettersom relevant utredning ikke finner somatisk årsak til plagene, er senvirkninger av eksosforgiftning mindre sannsynlig, i hvert fall at han skulle ha noe varig men av en i tilfelle lettgradig forgiftning.
Pasienten har opplevd en traumatisk hendelse, og det kan argumenteres for at denne er så alvorlig at det er tilstrekkelig for å utløse PTSD. De fysiske symptomene som beskrives (hodepine, svimmelhet, kvalme og palpitasjoner) er forenlig med PTSD, det samme gjelder søvnvansker, anhedoni og konsentrasjonsvansker. Pasienten har klar unnvikelse av situasjoner som minner om den traumatiske hendelsen. Det er ikke beskrevet typiske flashbacks i vignettene, men økt aktivering ved tunnelkjøring kan tolkes som en form for intrusjon.
MUPS (medisinsk uforklarte symptomer/sykdommer)/MCS (multippel kjemisk overfølsomhet) bør overveies. MCS oppstår typisk etter en episode med høy eksponering for et luktsterkt kjemikalium, gir symptomer fra flere organsystemer (nesten alltid inkludert fra CNS), og symptomene reproduseres ved gjentatt eksponering. Pasienten reagerer ofte på nivåer som ikke skulle forventes å gi toksikologisk effekt. Etter hvert kan pasienten reagere på flere ubeslektede stoff. Tilstanden kan ikke påvises ved fysiologiske tester. Pasientens symptombilde er forenlig med MCS.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 for MUPS/MCS, alternative begreper som miljørelatert overfølsomhet eller kjemisk intoleranse godtas også. 1 for PTSD (post-traumatisk stresslidelse). Post traumatisk stress symptomer = PTSS, kan gi samme antall poeng
''Epilog til sensor''
Pasienten har ikke fått en sikker og endelig diagnose, men han har sannsynligvis en blanding av MCS og PTSD. 2 spesialister (psykiater og psykologspesialist) har gitt han en PTSD diagnose. Pasienten ville opprinnelig ikke godta en psykiatrisk diagnose, og han tapte nok derfor en erstatningssak mot arbeidsgiver fordi retten mente han hadde MCS og ikke PTSD. I ettertid ser han at tilstanden er en blanding, og han har hatt best nytte av psykologisk behandling i forhold til bedret livskvalitet og arbeidsførhet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har vært sykemeldt i ett år og han klarer fortsatt ikke å komme tilbake i arbeid.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kriterier må være oppfylt for at pasienten skal kunne få arbeidsavklaringspenger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Formålet med arbeidsavklaringspenger er å sikre inntekt for et medlem som på grunn av sykdom, skade eller lyte har fått nedsatt arbeidsevne, som har brukt opp retten til sykepenger og fortsatt får aktiv behandling, eller deltar på et arbeidsrettet tiltak, eller får annen oppfølging med sikte på å skaffe seg eller beholde arbeid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Sykdom/skade – 0,5p
Nedsatt arbeidsevne – 0,5p
+ inntil 1 p for: enten aktiv behandling (0,5p), arbeidsrettet tiltak(0,5p) eller annen oppfølgning (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten har gått gjennom massiv utredninger og behandlinger over flere år, men med liten fremgang når det gjelder livskvalitet og arbeidsliv
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er kriteriene for å få innvilget uføretrygd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
«Pasienten har en varig nedsatt arbeidsfunksjon > 50 % for ethvert yrke av medisinske årsaker. Han har gjennomgått omfattende og tilstrekkelig utredning, samt prøvd ut relevant behandling og arbeidsutprøving uten at dette har bedret hans arbeidsfunksjon».
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Varig 0,5p
* >50% 0,5 p
* Medisinsk årsak 0,5 p
* For ethvert yrke 0,5 p (ikke restarbeidsevne)
* Utredet 0,5 p
* Arbeidsprøving forsøkt 0,5
Inntil 2.5 poeng totalt (5 av 6 punkter er nok for full skår)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: Jiménez et. al: Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study. BMJ. 2019 Jul 29;366:l4416. doi: 10.1136/bmj.l4416.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var hensikten med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hensikten med studien var å undersøke om sykehusvolum, målt som antall tilfeller med lungeemboli per år, var assosiert med 30-dagers årsaksspesifikk dødelighet (primærendepunkt).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne gjengi problemstillingen. Her gis det ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type studiedesign ble brukt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kohortstudie
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det nok at kandidaten angir kohortstudie.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sykehus av ulik størrelse vil ofte ha forskjellig oppgaver. Dette kan føre til at pasientene som behandles ved store sykehus ikke er helt sammenliknbare med de som behandles ved små. I tillegg kan pasientene som bor i nærheten av store vs. små sykehus ha ulik alvorlighetsgrad av tilstanden.
# Hvilken feilkilde kan slike forskjeller medføre?
# Hvordan vil du vurdere forskjellene i pasientkjennetegn basert på resultatene som er listet opp i Table 1?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Slike forskjeller i pasientkjennetegn kan føre til confounding. Resultatene i Table 1 viser noen forskjeller, men på disse observerbare kjennetegnene er de forholdvis like.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få full skåre må kandidaten angi at confounding kan være et problem her (1 poeng). Kandidaten må også vurdere hvor sammenliknbare gruppene er. Basert på informasjonen i tabellen er de relativt lik på de kjennetegnene som er listet opp (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er studiens hovedfunn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det er reduksjon i dødelighet ved større sykehusvolum.
Resultatene er forholdsvis presise, og de er robuste for ulike justeringer og sensitivitetsanalyser
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vise til at økt volum er assosiert med redusert dødelighet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Sentralisering av sykehusfunksjoner er en pågående debatt i Norge. I hvilken grad kan resultatene fra denne studien være relevant i spørsmålet om oppgaver som skal legges til små og store sykehus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette er en observasjonell studie hvor det er uklart hvorvidt man har klart å ta hensyn til confounding på en tilstrekkelig måte og det er relativt små absolutte forskjeller i dødelighet. Det er også kun knyttet til dødelighet ved lungeemboli. Vi vet lite om de potensielle mekanismene som skal resultere i økt dødelighet ved mindre sykehus. Dette indikerer at det er vanskelig å si om dette understøtter sentralisering av sykehusoppgaver også for lungeemboli. Samtidig er dette en stor studie med data fra ulike land hvor resultatene er robuste for forskjellige tester. Man kan derfor si at resultatene støtter opp under sterke antakelser som er gjort angående betydningen av en viss størrelse på fagmiljø for å yte adekvat sykehusbehandling. Funn knyttet til lungeemboli og komplikasjoner antas å ha høy generaliserebarhet fordi dette er biologisk betinget. Forskjeller i organisering av helsevesenet kan likevel ha betydning for generaliserbarhet til Norge. Relevante poeng her kan være mulighet til å velge sykehus ved akutt sykdom, reisetid til sykehus (geografiske forskjeller).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten drøfte svakhetene ved studiedesignet (1 poeng), at det gjelder kun en tilstand (1 poeng) og at det er relativt små absolutte forskjeller (1 poeng). Det er en fordel om kandidaten også setter dette i sammenheng med betydningen av store nok fagmiljø.1 poeng for å diskutere om funnene er generaliserbare til Norge.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På fastlegekontoret får du besøk av en 7 år gammel gutt i følge med far. Far forteller at sønnen for to uker siden fikk noe som de vurderte som en vanlig forkjølelse, men at han etter en uke med rennende nese og litt feber har fått økende plager med hoste. Han får voldsomme hosteanfall om natta, noen ganger med brekninger. På dagtid er han i nokså fin form, men blir fortere sliten enn han pleier. Han har ikke hatt feber siste uka.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn minst tre tilstander du vurderer som aktuelle basert på sykehistorien.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det mange mulige tilstander. Kikhoste vil vel de fleste nevne etter å ha lest resten av oppgaven. Både infeksjon med mykoplasma, viral luftveisinfeksjon, akutt bronkitt (viral eller bakteriell) og astma er aktuelle differensialdiagnoser, men en infeksjon er mer sannsynlig enn astma på dette tidspunktet i konsultasjonen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1p hvis de nevner minst tre aktuelle tilstander. 0.5 p hvis færre enn tre muligheter nevnes. Hvis det nevnes tilstander som ikke er forenlig med sykehistorien, får studenten max 0.5 p, selv om det også nevnes tilstander som er aktuelle (riktige).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved klinisk undersøkelse finner du lett rubor i svelget, men ellers normale funn. Hvite blodceller er lett forhøyet. Du bestemmer deg for å starte behandling med erytromycin, men tar først en dyp neseprøve som sendes til PCR-undersøkelse samme dag. Neste dag får du følgende svar fra mikrobiologisk avdeling: PCR positiv for Bordetella pertussis. Sykdommen er nominativt meldepliktig (gruppe A).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Når og til hvem skal det meldes om sykdommer i gruppe A og hva betyr nominativt meldepliktig?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Melding sendes samme dag til MSIS – meldesystem for smittsomme sykdommer – som er et sentralt helseregister for overvåkning av smittsomme sykdommer i Norge. Det skal også meldes til kommunelegen, noe som vanligvis gjøres ved at kopi av meldingen til MSIS sendes til kommunelegen. Nominativt meldepliktig betyr at sykdomstilfellet meldes med full identitet på pasienten (navn, personnummer, adresse), noe som kan gjøre uten hinder av taushetsplikt og uten pasientens samtykke i denne situasjonen
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
MSIS (1p) og kommunelegen (1p) nominativt=full identitet (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du kontakter faren til den 7 år gamle gutten for å informere om resultatet av undersøkelsen og om hva som skjer videre.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke plikter utover meldeplikt har du som behandlende lege når det gjelder smittevern i dette tilfellet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Informere pasienten (i dette tilfellet foreldrene) om at det meldes til MSIS og kommunelegen, samt hva som meldes.
* Gi smittevernveiledning til familien: Forklare om dråpesmitte, hygiene, unngå kontakt med andre (f eks ved å holde sønnen hjemme første dagene etter behandlingsstart, til smittefaren er over, vurdere vaksinebehov).
* Smitteoppsporing: Spørre etter mulige smittekilder og kontakter som den smittede kan ha videreført smitten til. Kontakte disse, evt via den smittede (her via foreldrene) for videre undersøkelser. Hvis behandlende lege ikke er i stand til å utføre smitteoppsporing skal kommunelegen underrettes om dette og overta smitteoppsporingen.
* Plikt til å undersøke personer ved mistanke om smittsom sykdom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Informere 0,5 p.
* Veiledning 1 p.
* Smitteoppsporing 1 p.
* Undersøkelsesplikt 0,5 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I samtalen med far kommer det frem at også han har hostet en del de siste ukene. Han tror det startet før sønnen ble syk. På direkte spørsmål bekrefter han at hosten ofte kommer som anfall
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva gjør du på bakgrunn av disse opplysningene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved kikhoste gir klinisk grunnlag med epidemiologisk tilknytning meldeplikt. Her er klinisk grunnlag oppfylt fordi han har hostet i minst 2 uker og har anfallsvis hoste. Epidemiologisk grunnlag er også oppfylt fordi sønnen har laboratoriepåvist kikhoste. Dermed skal farens sykdom også meldes til MSIS og kommunelegen med full identitet samme dag. Han må undersøkes for å få diagnosen bekreftet mikrobiologisk. Det er vanligvis ikke aktuelt med behandling av voksne når sykdommen har vart såpass lenge.
(Selv om det nå er snakk om 2 tilfeller av meldepliktig sykdom, er det ikke mistanke om at de har felles smittekilde siden det er to tilfeller i samme husstand. I tillegg opptrer kikhoste med jevne mellomrom i befolkningen, dvs den er endemisk. Det er derfor ikke mistanke om utbrudd ).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fars sykdom meldepliktig 1 p, undersøke mikrobiologi 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Kommunen hvor du arbeider som fastlege er en liten kommune med rundt ett tusen innbyggere. En uke senere ringer mikrobiologisk avdeling ved sykehuset til kommunelegens kontor med beskjed om at de har påvist 15 tilfeller av Bordetella pertussis blant kommunens innbyggere de siste to ukene, mot normalt 0-2 tilfeller per måned på denne tida av året.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du karakterisere denne situasjonen? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Opplysningene gir mistanke om utbrudd, fordi det nå er snakk om et antall tilfeller som klart overskrider det man ville forvente (det endemiske nivået - det normale bakgrunnsnivået av sykdommen) innenfor et område i et gitt tidsrom.
Den andre situasjonen som gir mistanke om utbrudd er to eller flere tilfeller av samme sykdom som mistenkes å ha felles kilde, men foreløpig er det for tidlig å si noe om felles smittekilde her.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dette er et utbrudd av smittsom sykdom (1p), pga flere tilfeller enn forventet (1p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør kommunelegen i første omgang gjøre basert på disse opplysningene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Først: Varsle Folkehelseinstituttet og Fylkesmannen om mistanke om utbrudd, samt starte smitteoppsporing.
(Deretter: følge utbruddets utvikling, vurdere smitteverntiltak og informasjon til befolkningen etter hvert som mer informasjon skaffes til veie. )
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Varsle FHI (0,5 p) og Fylkesmannen (0,5 p), starte smitteoppsporing (1 p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 32 år gammel kvinne oppsøker deg som fastlege. Hun har aleneomsorg for en jente på 8 år som nylig har fått påvist barneleddgikt av systemisk type. Barnet går til kontroller ved det lokale sykehuset. Sykdomsforløpet har vært svært svingende. Barnet klarer ofte ikke å delta på skolen grunnet nedsatt allmenntilstand samt smerter og hevelse i affiserte ledd. Barnet plages med magesmerter og tidvis svært løs avføring.
Moren har 100% stilling som lærer i grunnskolen. Familien har et godt sosialt nettverk. Barnet er nå inne i en dårlig periode, og mor har brukt opp retten til omsorgspenger. Hun er engstelig og fortvilet ved tanken på at hun må la barnet være hjemme alene på dagtid. Hun sier at hun ikke har råd til å ta seg fri fra jobb og ikke makter økte økonomiske bekymringer i tillegg til datterens sykdom. Hun ber om en sykmelding.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvorfor sykmelding ikke er en aktuell løsning i dette tilfellet
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sykmelding er ikke aktuelt i dette tilfellet fordi det ikke fremkommer at dette dreier seg om egen sykdom hos mor (eller annen gyldig grunn etter §8-4).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Ikke egen sykdom hos mor – 1p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke muligheter har mor for å få fri fra jobb med inntektssikring?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Utvidet rett til omsorgspenger'' (1p)
Hun kan ha utvidet rett til omsorgspenger men dette må forhåndsgodkjennes. Hun bør søke om dette hvis det ikke allerede gjort.
Utdrag fra Lov om folketrygd §9-5,Stønadssituasjonen for omsorgspenger: Til en arbeidstaker, frilanser eller selvstendig næringsdrivende som har omsorg for barn, ytes det omsorgspenger dersom han eller hun er borte fra arbeide på grunn av nødvendig tilsyn med og pleie av et sykt barn i hjemmet eller i helseinstitusjon. Videre står det:
* Dersom en arbeidstaker har kronisk syke eller funksjonshemmete barn og dette fører til en markert høyere risiko for fravær fra arbeidet, ytes det omsorgspenger etter reglene i første ledd med tillegg av 10 stønadsdager for hvert kronisk sykt eller funksjonshemmet barn. Når arbeidstakeren er alene om omsorgen, dobles antall stønadsdager
* For at arbeidstakeren skal få utvidet rett til omsorgspenger etter andre ledd, må Arbeids- og velferdsetaten ha godtatt at barnet er kronisk sykt eller funksjonshemmet.
* Departementet gir forskrifter om gjennomføringen av bestemmelsene i denne paragrafen, herunder om hvilke sykdommer og funksjonshemninger som skal gi utvidet rett til omsorgspenger etter andre ledd. Se https://lovdata.no/nav/forskrift/1997-03-25-263. I listen over forhåndsgodkjente sykdommer inngår «Leddgikt og andre kroniske revmatiske sykdommer» (punkt 14).
''Velferdspermisjon'' (0,5p)
Mor kan søke om velferdspermisjon fra arbeidsgiver (med eller uten lønn). Dette er særlig aktuelt for perioden frem til rett til utvidede omsorgspenger er forhåndsgodkjent.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Utvidet rett til omsorgspenger (1p)
* Velferdspermisjon (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barnet blir mye dårligere i løpet av den påfølgende uken og er innlagt på sykehus i en uke før det skrives ut med avtale om hyppige polikliniske kontroller. Barnet har respondert dårligere enn forventet på medikamentell behandling. Mor forespeiles av pediater at hun bør være hjemme på heltid og at det kan ta flere måneder før barnet er i stand til å delta fullt på skolen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvilke(n) ytelse(r) fra NAV som er aktuelle for å sikre økonomien til familien i perioden mens barnet krever kontinuerlig tilsyn og pleie? Nevn de viktigste medisinske vilkår som skal være oppfylt for hver ytelse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Pleiepenger'' MÅ nevnes (1 poeng)
https://lovdata.no/nav/folketrygdloven/kap9
Medisinske vilkår for pleiepenger etter §9-10 (1.5 poeng hvis (1.) ,(2.) og (3.) er med). Et medlem som har omsorg for barn under 18 år har rett til pleiepenger
# når barnet på grunn av sykdom, skade eller lyte (0,5p)
# har behov for kontinuerlig tilsyn og pleie (0,5p)
# og medlemmet derfor må være borte fra arbeidet (0,5p).
''Hjelpestønad'' bør nevnes (0,5p) og drøftes med de begrensinger som foreligger (hvis (1.) eller (2.) nevnes 0.5p)
# Hjelpestønad alene vil ikke kunne kompensere for tapt inntekt.
# Det er uklart om hjelpebehovet er varig i dette tilfellet. (Fra rundskriv til kap 6: «Formålet med grunnstønad og hjelpestønad er å kompensere helt eller delvis for ekstrautgifter og hjelpebehov av mer varig art. Ifølge langvarig praksis er det ikke bare livsvarige lidelser som kommer i betraktning. Den lidelsen som er årsak til medlemmets ekstrautgifter eller hjelpebehovet må etter lang praksis vare i 2-3 år eller mer for å kunne betraktes som varig. I enkelte tilfeller vil det være usikkert om lidelsen vil vare så lenge som nevnt. Da bør man i rimelig grad la tvilen komme medlemmet til gode».
''Omsorgsstønad'' (0,5p)
Omsorgsstønad er en kommunal stønad som kan være aktuell særlig når folktrygdens ytelser ikke kommer til anvendelse, f.eks hvis mor ikke hadde hatt inntektstap.:
* Hvis du har særlig tyngende omsorgsarbeid og utfører oppgaver som ellers måtte vært utført av kommunen, kan du få omsorgsstønad. Omsorgsstønad skal gjøre det mulig for private omsorgspersoner å opprettholde omsorgsarbeidet for sine nærmeste.
* Ordningen omfatter både omsorgsytere uten omsorgsplikt og foreldre som har omsorgsplikt for sine mindreårige barn.
* Ingen har en lovfestet rett til omsorgsstønad, men kommunen har en plikt til å tilby ordningen.
For mer info: https://helsenorge.no/hjelpetilbud-ikommunen/omsorgsstonad
''Sykepenger'' er ikke riktig ytelse hvis mor ikke er syk selv.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* Pleiepenger 1 p, vilkår får disse 1,5 p
* Hjelpestønad 0,5 p, vilkår (kompensere for ekstra utgifter ved varig hjelpebehov) 0,5 p
* Omsorgsstønad 0,5 p, vilkår (kommunal stønad – må søkes om, tenkt å kompensere for at privat omsorgsperson utfører oppgaver som elles ville vært utført av kommunen) 0,5p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Barnet har i tillegg fått påvist cøliaki. Ved overgang til glutenfri kost forsvinner symptomer som diare og abdominale smerter. Dietten medfører økte kostutgifter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken stønad kan gis ved økte diettutgifter og nevn de medisinske vilkår som skal være oppfylt for å få slik stønad?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Grunnstønad'' må nevnes (1p)
Medisinske vilkår (minst 3 av 4 punkt (a, b, c og d) nevnes (2p):
a) Varighet 2-3 år
b) Det skal være er en godkjent diett, dvs. den skal være skal være alminnelig anerkjent i medisinsk praksis.
c) Krav til diagnostikk ved relevant spesialist.
d) Spesifikke krav er diagnoseavhengige. Spesifikke medisinske krav ved cøliaki hos barn er at det er dokumentert:
# relevante symptomer
# forhøyede antistoffnivåer mot vevstransglutaminase (>10 x øvre grense) eller tilsvarende test
# disponerende vevstype (HLA-DQ eller HLA-DQ8)
# Hvis nevnte kriterier er oppfylt er det ikke krav om tynntarmsbiopsi, slik det er for voksne. Det vil som hovedregel foreligge et biopsikrav hvis nevnte kriterier ikke er oppfylt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Grunnstønad 1p, Medisinske vilkår (minst 3 av 4 punkt (a, b, c og d) nevnes -2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
For alle som arbeider med smittevern og forebygging av utbrudd av smittsom sykdom, gjelder det å ha oppmerksomhet på alle leddene i smittekjeden, slik at man eventuelt kan sette inn tiltak som forhindrer sykdom.
For at epidemier, store og omfattende eller mindre lokale, skal kunne bryte ut, må visse betingelser være oppfylt
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke fire basale betingelser må foreligge for at det skal kunne bryte ut epidemier?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* ''Smittestoff'' (bakterier, virus, sopp eller parasitter, og nå ev. også prioner)
* ''Smittekilde'' (syke mennesker, friske smittebærere, mennesker eller dyr – altså evt zoonoser)
* ''Smittemåte'' (kontakt, inhalasjon, gjennom næringsmidler og inokulasjon)
* ''Mottakelige individer'' (tilstrekkelig antall, og her kan gjerne nevnes at også flokkimmunitet kan hindre epidemier)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 p for hver av de fire faktorene. Det finnes i litteraturen eksempler på ytterligere oppstykking i flere enn disse fire faktorene – men de fire er essensielle
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva forstår vi med monokulturer?
# Gjør rede for monokulturers betydning for behovet for pesticider og antibiotika i landbruket.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Monokulturer er når det er mange individer, oftest planter eller kulturvekster, av samme genus på samme sted, som en åker. Men stadig mer aktuelt også som med laksemerder eller svinefjøs med svært mange individer på et lite, konsentrert område, der smittepresset blir høyt. Eller som definert i Store norske leksikon: «Monokultur er dyrking av samme planteart eller kulturvekst på samme jordstykke i år etter år, uten å skifte med andre arter eller vekster. Monokulturer utarmer jorden, gjør den avhengig av stadig gjødsling og gjør vekstene sårbare for skadegjørere».
# Naturen har en innebygget tilbøyelighet til å gjenskape mangfold/diversitet. Monokulturer gir gode vilkår for oppblomstring av artens naturlige fiender, «skadegjørere», som i denne betydningen blir agenter for gjenopprettelse av mangfold. For å opprettholde «rene» monokulturer bruker vi derfor pesticider av ulike slag, som ugressdrepere, ulike antiparasittiske midler og ev. antibiotika. Behovet for slik bruk øker med monokulturenes størrelse. Studentene kan eventuelt knytte monokulturene opp mot begrepene i første delspørsmål; ved tilstedeværelse av agens vil det være mange mottakelige individer og høy sannsynlighet for smitteoverføring fra smittekilde til mottakelig individ.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Mange individer av samme genus på samme sted (1)
# Når studentene viser at de har forstått denne dynamikken, og hvorfor det er sammenheng mellom monokulturers størrelse og behovet for å holde den sykdomsfrie med pesticider/antibiotika (2p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Øresundbroen laget en forbindelse mellom København i Danmark og Malmø i Sverige fra 1999. Under planlegging og bygging av broen ble behovet for spredningsbarrierer mellom Danmark (kontinentet) og Norge/Sverige diskutert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva forstår vi med spredningsbarrierer?
# Hvilke sykdommer ønsket man særlig å forebygge i denne sammenhengen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Spredningsbarrierer kan være naturlige (som med Øresund eller som i Norge med fjord og fjell), eller kunstige, som ved tiltak for å hindre at fremmed arter settes ut i naturen. Begrepet får økende betydning
både for smittevern og for å forstå hva som truer biologisk mangfold/diversitet.
# Først og fremst var det for å forhindre at vi får rabies til Norge/Sverige – og det var rabiesinfiserte rever eller hunder som var mest diskutert, men også evt andre dyr som kan bli «rabiate» og løpe ut og bite ville dyr. Dernest var det også stor uro for spredning av dvergbendelorm – som kan gi ekinokokksykdom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Fullt hus 1) når de kan skrive noe fornuftig om betydningen av spredningsbarrierer (1p), og 2) i det minste liste opp en av de to aktuelle sykdommene (rabies og ekinokokksykdom) (1p).
Kommentar etter sensur: Ved sensur ble det også gitt uttelling for besvarelser som inneholdt andre momenter/sykdommer enn de som var tenkt på da oppgaven ble laget.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva forstår vi med zoonoser?
# Hvorfor er zoonoser av interesse i forbindelse med antibiotikaresistens?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Av zoo – dyr, nose – sykdom, smittesykdommer som overføres fra dyr til mennesker (og iblant også fra mennesker til dyr). Listen over zoonoser er meget lang, og kan omfatte både direkte og indirekte smitte.
# Oftest dreier det seg om smitte fra kjæledyr eller husdyr, som i en viss utstrekning kan dele vårt mikrobiologiske miljø. Derfor er det også viktig å vite at bruk av antibiotika blant kjæledyr og husdyr kan skape resistente mikrober som i neste omgang også kan ramme oss mennesker.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 25 år gammel mann møter på fastlegekontoret i august. Han kommer til konsultasjon fordi han følt seg slapp og sliten siste 4 måneder. Han har også følt hjertebank i perioder.
Pasienten er nest eldst av 4 søsken, foreldrene er skilt og det er høyt konfliktnivå mellom foreldrene. Han har vært frisk i oppveksten, ingen kroniske sykdommer.
Han droppet ut av videregående skole og han har ingen formell utdanning. Han er arbeidssøker gjennom NAV og arbeider nå på et lager med lønnstilskudd fra NAV. Han trives godt i jobben. Da han droppet ut av skolen brukte han en periode ulike rusmidler, Kokain, MDMA/Ecstacy, speed, hasj, alkohol (1 episode med intox). Han injiserte aldri rusmidler. Etter at han ble samboer har han sluttet å ruse seg og bruker nå 3-4 enheter alkohol en vanlig uke.
Ved klinisk undersøkelse gjøres følgende funn:
* Det er ingen cyanose, icterus eller generell glandelsvulst.
* Tyreoidea er ikke følbart forstørret, ingen knuter.
* BT: 135/90 puls 104 regelmessig
* Hjerte: Normale hjertetoner, ingen bilyd
* Lunger: respirasjonsfrekvens 16, normalt respirasjonsmønster, ingen fremmedlyder, ingen dempning ved perkusjon.
* EKG: Sinusrytme, frekvens 100, normal morfologi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
* 1a) Gjør rede for hvilken kommunikativ strategi det er anbefalt å bruke i den diagnostiske prosessen?
* 1b) Gi eksempler på 3 spørsmål det kan være aktuelt å bruke med denne kommunikative strategien/tilnærmingen.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 1a)
** Pasientsentrert tilnærming/åpen modus
** Pasientsentrert metode er en arbeidsform der pasientens bekymringer og oppfatninger tillegges stor vekt i både diagnostikk og behandling. Pasienten definerer hva som skal tas opp i konsultasjonen og er medansvarlig i det medisinske arbeidet.
* 1b)
** Hva tror du selv trettheten skyldes?
** Hvordan påvirker trettheten hverdagen din?
** Har du gjort deg noen tanker før du kom om hva du så for deg at jeg skulle gjøre for deg?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1a) Pasientsentrert tilnærming med forklaring 1 poeng
* 1b) 0.5 p per formulert spørsmål som fanger opp enten:
** Forventninger
** Frykt
** Forutsetninger
** Forestillinger
** Funksjon
(For å unngå følgefeil, kan man se spørsmål a og b i sammenheng. Dersom studenten skriver åpen modus og formulerer spørsmål deretter, gir dette også uttelling. Her må altså sensor bruke skjønn, flere spørsmål kan gi poeng, men max 1,5 poeng på 1b).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn tre hovedpunkt det er viktig å kartlegge anamnestisk under utredning av tretthet. Gi eksempler på anamnestiske spørsmål under hvert hovedpunkt.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* «Tretthetens natur»
** Episodisk eller kontinuerlig?
** Situasjonsbestemt?
** Utløsende faktorer?
** Varighet?
* Ledsager symptomer
** Infeksjonstegn (feber)
** Vekttap, allmenntilstand
** Endringer vannlatning/avføring, matlyst, tørste
** Søvnmønster (snorking, mobil)
** Medikamentbruk
* Psykososiale forhold
** Hjemme og på jobb; stress, hvile/ restitusjon
** Viktige livshendelser?
** Stemningsleie (nedstemt, angstplager?)
** Rusmidler (alkohol)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5 poeng for hvert hovedpunkt (max 1,5 poeng for hovedpunkter)
* 0,5 poeng for >= 6 spørsmål
* 1 poeng for >=10 spørsmål
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved manglende funn i sykehistorien og den kliniske
undersøkelsen av pasienter med slapphet er det sjelden at
laboratorieprøver avdekker patologi.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I hvor stor andel påvises patologiske blodprøver?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Patologiske blodprøver påvises i ca. 5% av tilfellene.
Til informasjon, men dette er ikke spurt om:
Likevel; det tas supplerende prøver hos ca. 50% av pasientens som søker allmennlege for tretthet (studier). Når tretthet har vart > 4 uker; supplerende undersøkelser har større betydning.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Anslag i området 3-7% gir 0.5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I dette tilfellet ble det tatt følgende blodprøver:
|!Prøve |!Resultat |!Referanseverdi |
|Hb |15,4 |13,4-17,0 |
|Ferritin |263 |30-383 |
|HbA1c |34 |20-42 |
|ALAT |80 |10-70 |
|GT |65 |10-80 |
|Kobalamin (B12) |269 |186 – 645 |
|Folat |9 |9-36 |
|TSH |6,22 |0,24-3,78 |
|Fritt tyroksin |14,6 |11,6 – 19,1 |
|Kreatinin |84 |60-105 |
|GFR est/1,73m^^2^^ |>90 | |
|Vitamin D |27 |35-117 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
4a) Vurder prøveresultatene og angi hvilket organsystem prøvene sier noe om
4b) Er det sannsynlig at noen av prøveresultatene kan forklare pasientens tretthet? I så fall hvilke(t)? Begrunn svarene
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 4a)
** Hematologi: Ikke anemi eller jernmangel
** Normal langtidsregulering av blodsukkeret
** Leverenzymer: ALAT lett forhøyet, uten klinisk betydning
** Normal GT
** B-vitaminstatus: Kobalamin normal
** Folat i nedre referanseområde, inadekvat kosthold?
** Stoffskiftet: TSH lett forhøyet, i et område hvor prøven bør observeres om 3-6 måneder
** FT4 er normal
** Nyrefunksjon: normal kreatinin
** Lavt vitamin D etter årstiden, sammen med lav folat kan det indikere inadekvat kosthold
* 4b) Ingen av blodprøvene er så mye utenfor referanseområdet at de per se kan forklare pasientens slapphet. Lavt folat og lavt Vitamin D i august måned kan gi mistanke om et inadekvat kosthold og en grundig kostholdsanamnese er indisert. Dårlige spisevaner er en livsstilsfaktor som kan påvirke energinivået og gi følelse av tretthet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 4a)
** Adekvat vurdering av >=7 prøvesvar 1.5 poeng
** Adekvat vurdering av alle prøvesvar 2.5 poeng
* 4b) hvis det er anført som lite sannsynlig med begrunnelse 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
|!Prøve |!Resultat |!Referanseverdi |
|Hb |15,4 |13,4-17,0 |
|Ferritin |263 |30-383 |
|HbA1c |34 |20-42 |
|ALAT |80 |10-70 |
|GT |65 |10-80 |
|Kobalamin (B12) |269 |186 – 645 |
|Folat |9 |9-36 |
|TSH |6,22 |0,24-3,78 |
|Fritt tyroksin |14,6 |11,6 – 19,1 |
|Kreatinin |84 |60-105 |
|GFR est/1,73m^^2^^ |>90 | |
|Vitamin D |27 |35-117 |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan er det anbefalt å følge opp dette stoffskiftesvaret? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Normal FT4 og TSH 6-10 kan observeres med nye prøver etter 3-6 måneder. Ved rask stigning av TSH kan behandling begynne.
Anti TPO kan rekvireres, hvis denne er forhøyet kan behandling mot subklinisk hypotyreose tilbys.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvis begrunnet og anført at dette kan observeres med ny prøve. 1 poeng
Hvis anti TPO er anbefalt og den er forhøyet og behandling anbefalt oppstartet 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Tyreoideascreening har blitt innført i noen land. Dette har ført til en dramatisk økning i insidensen av tyreoideakreft, mens mortaliteten av tyreoideakreft ikke har økt
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for begrepene:
* Feildiagnose
* Overdiagnose
* Overbehandling
(Her forventes korte svar, 1-2 setninger per begrep)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Feildiagnose'' er diagnostisering av sykdom hos en pasient som ikke har det. Det vil føre til unødvendige videre undesøkelser.
''Overdiagnose'' er påvisning av sykdom som progredierer så langsomt at det ikke vil føre til symptomer eller død i pasientens naturlige levetid (dvs. fram til død av andre årsaker). Dette fører ofte til unødvendig behandling, dvs. ''overbehandling'', altså behandling som ikke bedrer pasientens symptomer eller prognose
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert riktig svar , totalt max 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En ny screeningtest for kreft oppdager kreftsykdommen tidligere enn den tradisjonelle testen, men det er ingen effektiv behandling for kreftsykdommen. Pasientene som har blitt screenet med den nye testen lever lengre med kreftsykdommen og mange ivrer etter å ta testen i bruk.
Når man analyserer sammenhengen mellom screeningtest og overlevelse, kan resultatet påvirkes av kilder til systematiske feil (i spørsmålet under referert til som metodefeil).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken metodefeil må det her tas hensyn til før man vurderer å ta i bruk testen? Begrunn svaret
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Lead time bias er den bias som oppstår når 2 tester blir sammenliknet, og en test (den nye eksperimentelle) diagnostiserer sykdommen tidligere, men det er ingen effekt på utkommet av sykdommen. Tilsynelatende er det forlenget overlevelse med sykdommen, mens testen i virkeligheten bare resulterte i tidligere diagnose sammenliknet med den tradisjonelle metoden.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tilsynelatende bedre overlevelse/ lead time bias 1 poeng
(Det er ikke nødvendig å bruke begrepet lead time bias for uttelling om studenten forklarer konsekvensen av biaset.)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du arbeider som fastlege. Neste pasient på listen er en 62 år gammel mann som kommer til konsultasjon som øyeblikkelig hjelp. Som kontaktårsak er det oppgitt «brystsmerter». Pasienten er ny på lista di, og du finner ikke tidligere journal.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn ti differensialdiagnoser du bør overveie ved brystsmerter hos middelaldrende menn, når du skal tenke bredt differensialdiagnostisk og samtidig få med de vanligste og alvorligste diagnosene?
(Du trenger ikke begrunne svaret her.)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Kardial årsak:
** Stabil/ustabil angina pectoris
** Hjerteinfarkt gammelt/ferskt
** Klaffestenoser/-insuffisiens
** Perikarditt/endokarditt.
*Aorta:
** Disseksjon
** Aneurisme/ruptur
*Lunge/luftveier:
** Lungeemboli
** Lungebetennelse
** Pneumothorax
** Pleuritt/pleuraeffusjon primær/metastatisk kreft
* Øvre GI-traktus:
** Refluks
** Ulcus
** Pankreas/galle-relatert smerte.
* Muskel/bindevev:
** Interkostalmyalgi/kostokondritt
** Herpes zoster
** Smerter fra thorakalkolumna/ribben (ulike årsaker)
* Blod:
** Anemi (med sekundær kardial iskemi)
* Psykisk betinget
** Panikkangst, stress/somatoform tilstand.
Årsaker til kontakt grunnet brystsmerter i allmennpraksis har en slik fordeling (Klinkman et al., J Fam Pract. 1994 Apr;38(4):345- 52), selv om oppgaven ber studentene vektlegge både alvorlighetsgrad og hyppighet:
* 36% - muskelskjelett
* 19% - gastrointestinal
* 10% - stabil angina
* 2% - ustabil angina
* 4% - annen kardial årsak
* 8% - psykiatrisk sykdom
* 5% - lungerelatert
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.25 poeng per diagnose (for inntil 10 diagnoser). I tillegg vektlegges det:
# Evne til å tenke bredt differensialdiagnostisk (inkluderer diagnoser fra ulike organsystemer (hjerte, lunge, kar, gastro, muskel/skjelett) og med ulike mekanismer: vaskulær-, infeksiøs/inflammatorisk -, neoplastisk -, og psykisk betinget årsak). -0.5 p
# At studenten ikke gå glipp av de mest alvorlige diagnosene som krever akutt avklaring (infarkt, disseksjon, etc.). -0.5 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke anamnestiske opplysninger er viktig å få fram ved brystsmerter hos middelaldrende menn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her er det viktig med en detaljert symptombeskrivelse, eksempelvis ved bruk av «SOCRATES pain assessment» eller lignende (Site, Onset, Character, Radiation, Associated sympt., Timing, Exacerbation/alleviation, Severity):
* S - Hvor sitter smertene?
* O - Hvordan begynte smertene (plutselig/gradvis)?
* C - Smertenes karakter (trykkende/stikkende/...)?
* R - Flytter eller stråler smertene ut andre steder (hals/arm/kjeve/rygg/høyre scapula...)?
*A - Er det andre symptomer assosiert med smertene (kvalme, hoste, oppspytt, sure oppstøt, tung pust, hyperventilering/prikking i fingre, vekttap/kreftsymptomer)?
* T - Når begynte smertene? Hvor lenge varer smertene? Forsvinner smertene når du hviler, og i så fall hvor raskt?
* E - Hva forverrer/letter smertene (anstrengelse/hvile, mat, inspirasjon/hoste, sure oppstøt)?
* S - Hvor sterke er smertene (eksempelvis fra 1-10)?
Studentene er undervist i «symptomattributtene»:
* Lokalisasjon
* Kvalitet
* Kvantitet
* Tidsaspektet
* Sammenhenger
* Påvirkningsfaktorer
* Assosierte manifestasjoner
Andre viktige momenter er standard anamnestisk kartlegging av:
* SOSIAL SITUASJON (stress/bekymringer/yrkesanamnese/…)
* ARV (hjerte/kar-sykdom/kreft/…)
* TIDLIGERE SYKDOMMER
* MEDIKAMENTER
* STIMULANTIA (røyk/alkohol/…)
* NATULIGE FUNKSJONER (urin/avføring/…)
* Skader
Studentene er også undervist i de fem F-ene (Forestillinger, Forventninger, Frykt/bekymringer, Funksjon og Forutsetninger).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Studentene bør vise at de kan å ta opp en full anamnese og symtombeskrivelse. God og detaljert symptombeskrivelse 2 p; god øvrig anamnese 2 p. For full skår må alle sentrale elementer være med i svaret.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasientens hovedsymptomer er venstresidige brystveggsmerter og dyspne. Symptomene har tilkommet gradvis i løpet av de siste tre ukene. Han har god allmenntilstand; god matlyst, har ikke gått ned i vekt og er i vanlig fysisk aktivitet.
Du henviser ham til røntgen thorax som øyeblikkelig hjelp. Røntgen thorax viser: «Venstresidig økt mengde pleuravæske og tumoraktig fortykkelse av pleurahinnen i laterale deler av pleura parietale. Upåfallende lungeparenkym.»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er nå de mest aktuelle differensialdiagnoser?
(Nevn minst tre aktuelle diagnoser)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Mesoteliom er mest aktuelt
* Primær lungekanser med pleural affeksjon.
* Metastase
* Lymfom.
* Sarkoidose/tuberkulose/...
* Benign tumor/ reaktiv pleuritt: Benign pleural tumor / reaktiv mesotelhyperplasi / infeksiøs pleuritt / asbestutløst / autoimmun...)
* Hemothorax, empyem, chylothorax, evt. medikamentutløst pleuraeffusjon (mindre sannsynlig mtp. fortykket pleurahinne).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 p for mesoteliom, 1 p for minst to aktuelle diff-diagnoser
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Pasientens hovedsymptomer er venstresidige brystveggsmerter og dyspne. Symptomene har tilkommet gradvis i løpet av de siste tre ukene. Han har god allmenntilstand; god matlyst, har ikke gått ned i vekt og er i vanlig fysisk aktivitet.
Du henviser ham til røntgen thorax som øyeblikkelig hjelp. Røntgen thorax viser: «Venstresidig økt mengde pleuravæske og tumoraktig fortykkelse av pleurahinnen i laterale deler av pleura parietale. Upåfallende lungeparenkym.»
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tilleggsundersøkelser bør gjøres for å avkrefte/bekrefte differensialdiagnosene dine om du nå er pasientens lege på et sentralsykehus (maks tre tilleggsundersøkelser)?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
CT thorax med kontrast. Diagnose bør ved kansermistanke videre bekreftes histologisk/cytologisk ved pleurabiopsi/pleuravæske-cytologi. Ev. bronkoskopi med biopsi/BAL, men angitt upåfallende lungeparenkym.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
CT thorax med kontrast 1 p, histologisk/cytologisk verifisering 1 p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Pasientens hovedsymptomer er venstresidige brystveggsmerter og dyspne. Symptomene har tilkommet gradvis i løpet av de siste tre ukene. Han har god allmenntilstand; god matlyst, har ikke gått ned i vekt og er i vanlig fysisk aktivitet.
Du henviser ham til røntgen thorax som øyeblikkelig hjelp. Røntgen thorax viser: «Venstresidig økt mengde pleuravæske og tumoraktig fortykkelse av pleurahinnen i laterale deler av pleura parietale. Upåfallende lungeparenkym.»
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gitt det aktuelle funnet på røntgen thorax, hva er mest aktuelt å kartlegge angående pasientens yrkesanamnese?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Asbesteksponering er mest aktuelt, men også andre karsinogen bør kartlegges:
Tidligere/nåværende yrke med aktuelle arbeidsoppgaver som kunne gi eksponering for asbest evt. annen karsinogen eksponering, samt om det ble det brukt verneutstyr.
* Bygningsarbeidere, skipsverftansatte, smelteverksarbeidere, jernbanearbeidere, mekanikere, maskinister har økt forekomst av mesoteliom.
Beskrive grad, varighet og tidsrom for evt. eksponering for asbest. Kronologisk oversikt over yrker og arbeidsplasser med angivelse av tidsrom. Når og hvor lenge skjedde den sannsynlige eksponeringen?
* forekomsten av malignt mesoteliom er høyest 30-50 år etter asbesteksponeringen. Hos yngre pasienter, spør om foreldrenes yrke.
* Risikoen for mesoteliom øker med asbesteksponering, men risikoen kan være økt selv etter liten eksponering, og ca. en fjerdedel har ingen kjent asbesteksponering.
Kartlegge evt. andre sykdommer som assosiert med eksponering for asbest:
* sykdommer i pleura
* asbestose
* kronisk obstruktiv lungesykdom (KOLS)
* lungekreft, ev. andre kreftformer.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Asbest – 0.5 p
Yrke, arbeidsoppgaver, beskyttelsesutstyr -1 p
Grad, varighet, tidsrom 1 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Anta at pasienten ble diagnostisert med den tilstanden du
vurderte som mest sannsynlig på [[delspørsmål 4|IIIC - 2019s - Oppgave 2 - Del 4]].
Årsaksrettet behandling hadde ikke ønsket effekt og ble derfor avsluttet. Noen måneder senere blir pasienten innlagt på sykehus med høy feber, hoste med plommefarget oppspytt og tungpust. Røntgen thorax viser infiltrat på venstre side som ved forrige kontroll og nyoppstått infiltrat i høyre underlapp. CRP er 205. Både blodkultur og ekspektorat viser oppvekst av Streptococcus Pneumoniae. Pasienten blir raskt dårligere og dør under oppholdet. Fra pasientjournalen finner du for øvrig at pasienten fra tidligere har kjent ikke insulinkrevende diabetes mellitus type II.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnoser skal registreres under hvilket felt på legeerklæring om dødsfall, basert på de opplysningene som er gitt i vignetten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* 1 a Sepsis
* 1 b Pneumoni
* 1 c Mesoteliom
* 2 Diabetes mellitus type II.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Formålet er å teste oppsett i legeerklæring ved dødsfall – 1a er umiddelbar dødsårsak, 1 b/c er underliggende dødsårsaker. Til sammen skal de utgjøre de en forklarende «dødsårsaksekvens» slik at 1c er primære underliggende tilstanden/dødsårsaken, som forårsaket tilstand 1b, som igjen forårsaket den tilstanden som umiddelbart førte til døden (1a). Om det kun foreligger to sekvensielle tilstander/dødsårsaker (1a og 1b) angir 1b den primære underliggende dødsårsaken slik 1c gjør med tre sekvensielle tilstander. 2 er andre vesentlig medvirkende tilstander som kan ha bidratt til døden, men uten å stå i direkte årsaksforhold til den tilstanden som framkalte døden.
2 poeng hvis studenten oppgir diagnoser forenlig med de opplysninger som er gitt, samt at 1c->1b->1a er i logisk rekkefølge og at diabetes er oppført under 2.
Det skal ikke gis trekk for følgefeil om studenten mener annen diagnose enn mesoteliom er mest sannsynlig på [[delspørsmål 4|IIIC - 2019s - Oppgave 2 - Del 4]]. Dersom studenten har vurdert annen diagnose som mest sannsynlig, kan dette påvirke om tilstanden skal føres opp som underliggende dødsårsak.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel: Pincus et. al: Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery. JAMA 2017
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var begrunnelsen for å studere sammenhengen mellom tid til operasjon for hoftebrudd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tid til operasjon er et vanlig brukt mål på kvalitet i behandling ved hoftebrudd. Man antar at det er økt risiko for komplikasjoner hos pasienten hvis det tar for lang tid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne gjengi begrunnelsen fra forfatterne. Her gis det ikke delpoeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken type studiedesign ble brukt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kohortstudie
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her må kandidaten angi kohortstudie. Om kandidaten bruker prospektiv kohortdesign, pasientkohort eller endog populasjonsbasert kohort, så kan dette godkjennes.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Man kan tenke seg at det er forskjellige grunner for at det går tid til pasienten blir operert ved hoftebrudd. For eksempel kan pasienten ha behov for å bli stabilisert før en operasjon kan finne sted, og slike pasienter kan ha dårligere prognose.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken betydning kan dette få for hvordan sammenhengen mellom tid til operasjon og mortalitet slik det framstår i studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette kan føre til confounding. Dette kan gi både sterkere eller svakere effektestimat. Dette er faktorer som er felles årsaker til tid til operasjon og dødelighet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få poeng må kandidaten angi at confounding kan være et problem her (1 poeng). Hvis kandidaten skriver seleksjon eller seleksjonsbias, så skal dette ikke gis poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er studiens hovedfunn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Opp til 24 timer er det ingen særlig endring i dødelighet ved ulik tid til operasjon. Etter 24 timer stiger dødeligheten.
Resultatene er forholdsvis presise. Det er også en lignende sammenheng for flere av sekundærendepunkter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å vise at det er en økning først etter 24 timer. 0,5 poeng for vurdering av sekundære endepunkter. 0,5 poeng for å vurdere presisjon. Referanse til statistisk signifikans eller ikke, skal ikke gi poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Det er store forskjeller for tid til operasjon for pasienter med hoftebrudd, også i Norge.
Hva kan slike forskjeller skyldes? (Svar kort)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Årsakene til ulik tid til operasjon vil være en blanding mellom forhold ved pasienten (komorbiditet, overvekt, bruk av blodfortynnende medisin e.l.), ledig operasjonskapasitet, prioritering mellom pasientgrupper og hvilke tidspunkt man opererer på de enkelte sykehus.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten få fram at det er forskjeller i organisatoriske forhold (1p) og forhold ved pasienten (1p) som vil gi lengre tid til operasjon.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
(Ikke egen vignett)
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Diskuter kort om denne studien gir grunnlag for å redusere tid til operasjon for alle hoftebruddpasienter, sett i lys av både studiens kvalitet og mulige konsekvenser av en eventuell reduksjon i tid til operasjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Denne studien gir støtte til at operasjoner bør gjennomføres innen 24 timer for optimal prognose hos hoftebruddpasienter.
Likevel er det mange forbehold:
Dette er en observasjonell studie hvor det er uklart hvorvidt man har klart å ta hensyn til confounding på en tilstrekkelig måte. Hvis pasienter som trenger tid for stabilisering får raskere operasjon, kan dette være negativt.
Hvis man ikke endrer rammebetingelsene for operasjonskapasitet, så må andre pasientgrupper prioriteres ned. Det sier denne studien ikke noe om.
Noe av forskjellene i tid til operasjon kan skyldes at man legger operasjonsaktivitet til dagtid eller arbeidsuke. Det er ikke gitt at kvaliteten på behandlingen blir bedre ved at man opererer 24/7
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten trekke fram:
* Konklusjon om at dette støtter at det kan være viktig med rask tid til operasjon ved hoftebrudd (1p)
* Residual confounding/observasjonelt design (0,5p)
* Vridning av ressurser/prioritering/organisatoriske følgeeffekter som kan gå ut over andre pasientgrupper (0,5p)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 87 år gammel kvinne legges inn på sykehuset etter å ha falt hjemme om natta. Hun har gjennomgått et hjerneslag for tre år siden, med lettgradig sekvele i venstre sides ekstremiteter. For øvrig behandles hun for høyt blodtrykk og søvnvansker. Hun har de siste to årene vært plaget med brystsmerter som har vært tolket som mulig angina pectoris, men har aldri hatt hjerteinfarkt eller vært igjennom koronarutredning. Datteren beskriver henne som glemsk og forteller at hun det siste året sjelden har beveget seg utenfor leiligheten sin.
I akuttmottaket har hun blodtrykk
110/70 og utslag på leukocytter og nitritt på urinstiks. Hun bruker følgende faste medisiner: kandesartan og hydroklortidazid i kombinasjonstablett (angiotensin II-antagonist og diuretikum), acetylsalisylsyre (platehemmer), metoprolol i depotform (selektiv betablokker), isosorbidmononitrat i depotform (nitroglycerin), simvastatin (kolesterolsenkende middel), amlodipin (kalsiumantagonist), oksazepam (benzodiazepin) og zopiklone (benzodiazepinlignende sovemiddel).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mulige årsaker til pasientens falltendens?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Sekvele etter hjerneslag
* Lavt blodtrykk (kan skyldes forhold ved pasienten i tillegg til at hun bruker mange medisiner som virker på blodtrykket)
* Mulig urinveisinfeksjon
* Mulig kognitiv svikt (ikke diagnostisert, men man må mistenke det siden datteren beskriver henne som glemsk)
* Mulig skrøpelighet (svært lavt fysisk aktivitetsnivå gir høy mistanke om skrøpelighet)
* Bivirkninger av sederende legemidler (benzodiazepiner og benzodiazepinlignende legemidler)
* Polyfarmasi
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per årsak, maksimalt 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Røntgenbilder av hofta viser et lårhalsbrudd. Det er svært travelt på operasjonsstua når hun blir innlagt på sykehuset, men man håper i det lengste at hun skal få bli operert raskt og holder henne fastende for sikkerhets skyld. Til slutt blir hun operert etter ett og et halvt døgns venting. Til tross for god smertelindring med morfin utvikler hun delirium postoperativt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mulige årsaker til delirium hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kognitiv svikt, slagsekvele og polyfarmasi er underliggende årsaker, som var til stede før lårhalsbruddet. Brudd, urinveisinfeksjon, smerter, morfin, faste, immobilisering, mulig obstipasjon som følge av bruk av opioider er mulige utløsende årsaker som har kommet nå. (Studenten trenger ikke nevne at noen årsaker er underliggende og andre utløsende for å få poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per årsak, maksimalt 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Som vakthavende lege på ortopedisk avdeling blir du oppringt om at pasienten har begynt å bli økende urolig og amper.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke tiltak vil du iverksette?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Miljøtiltak (skjerming på enerom, pårørende til stede hvis mulig, ellers kan ofte fastvakt være nødvendig, unngå forstyrrelser som slanger/ledninger/støy så langt mulig, minst mulig forstyrrelser på natt, sørg for at hjelpemidler for nedsatt syn og hørsel er på plass). Optimalisere medisinsk behandling (behandle alt som kan være med på å utløse eller vedlikeholde delirium).
(bruk av benzodiazepiner eller antipsykotika gir ikke poeng).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert av de to (miljøtiltak og behandling av utløsende årsak til delirium), til sammen 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Under innleggelsen har pasienten vedvarende blodtrykk 110/70. EKG viser atrieflimmer. Blodprøver tatt under innleggelsen viser
|!Prøve |!Verdi |!Referanseområde |
|kreatinin |89 μmmol/L |45 – 90 μmmol/L |
|estimert GFR |46 mL/min/m^^2^^ |>90 mL/min/m^^2^^ |
|kalsium |1,20 mmol/L |1,14-1,28 mmol/L |
|vitamin D |19 nmol/L |35-117 nmol/L |
|fritt tyroksin (T4) |15,2 pmol/L |13,5 – 21,2 pmol/L |
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke endringer bør gjøres i hennes medisiner i lys av det som er kommet fram under innleggelsen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Osteoporoseprofylakse bør startes. Det bør gis tilskudd med kalsium og D-vitamin. Ved hoftebrudd etter fall fra egen høyde er det hos en eldre og skrøpelig person ikke nødvendig å gjøre beintetthetsmåling (ref. Behandlingsveileder ved lavenergibrudd: lavenergibrudd.no). Siden GFR er >35 bør hun starte med bisfosfanat, hadde GFR vært lavere ville behandling med denosumab (benserpsjonshemmer, humant monoklonalt antistoff) vært aktuelt. (Både kalsium, vitamin D og bisfosfonat må være med for å få poeng)
# Antikoagulasjon med DOAK eller warfarin bør vurderes gitt pga. atrieflimmer for å forebygge hjerneslag. Hvis antikoagulasjon startes, bør acetylsalisylsyre seponeres (for å få poeng på dette punktet er det nok å nevne at antikoagulasjon bør vurderes).
# Antall og doser av legemidler med virkning på blodtrykket bør reduseres slik at hun har normalt blodtrykk og unngår ortostatisk hypotensjon. Nitroglycerin bør tas bort. (Reduksjon av antihypertensiva eller nitroglycerin er nok til å gi poeng)
# Bruk av sederende legemidler bør trappes ned og begrenses mest mulig framover (helst unngås helt, og i hvert fall ikke tas fast)
# Ved symptomer på urinveisinfeksjon dyrkes urin og behandles med antibiotika etter resistens.
# Det er ikke indisert å gi legemidler mot en eventuell demenstilstand før denne er utredet og det bør man vente med å gjøre til pasienten har kommet seg etter lårhalsbruddet.
# Når det gjelder statin, er det intet fasitsvar. Det kan argumenteres for å ta det bort siden pasienten bruker mange medisiner, legemiddelet ofte gir muskelbivirkninger hos eldre og pasienten har falt, og det har gått flere år siden hjerneslaget. Det kan argumenteres for at hun skal fortsette på statin fordi det er sekundærprofylakse, som er relativt godt indisert også hos eldre
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
De fem første punktene gir 0,5 poeng hver, inntil maksimalt 2 poeng til sammen. De to siste punktene gir ikke poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter sykehusoppholdet er pasienten på korttidsopphold på et sykehjem for opptrening. Ved innkomst på sykehjemmet veier hun 45 kg. Hun er 158 cm høy og har BMI 18,0. Det gjøres en kostregistrering som viser at hun får i seg 1100 kcal og 30 g proteiner i døgnet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vurderer du hennes ernæringsstatus?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten er alvorlig underernært og har for lavt daglig inntak både av kalorier og av proteiner.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å angi at pasienten er alvorlig underernært. 0,5 poeng for å angi at daglig kaloriinntak er for lavt. 0,5 poeng for å angi at daglig proteininntak er for lavt. Til sammen 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ved sykehjemmet lager man en plan for å bedre hennes ernæringsstatus.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ernæringsmessige tiltak bør forsøkes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Små, hyppige måltider med næringstett mat
* Berikelse av maten (fete meieriprodukter, olje ol)
* Næringsdrikker
* Eventuelt også konsentrerte kaloritilskudd
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert av tiltakene ovenfor, maksimalt 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er fastlegevikar. En kvinne på 46 år oppsøker deg. Hun forteller at hun har vært 50 % sykmeldt fra jobben som regnskapsfører i ni måneder i forbindelse med en depressiv reaksjon i etterkant av en skilsmisse. Du ser at tidligere utredning har vært sparsom. Hun behandles med Cipralex og har hatt månedlige telefonsamtaler med tidligere fastlege. Hun forteller at hun sover dårlig, sjelden føler seg uthvilt og fryser lett. Hun beskriver konsentrasjonsvansker på jobb. Hun har opplevd å gjøre pinlige småfeil i jobben og har måttet beklage dette til kunder i etterkant.
Du observerer at hun ser blek og sliten ut. Hun gir imidlertid god kontakt og kan være kvikk i replikkene. MADRS skår viser 20 (skår 12 – 20 indikerer en mulig eller mild depresjon).
Du igangsetter en utvidet medisinsk utredning og avtaler et nytt møte om en uke. Blodprøvesvar viser at Lise har en uttalt hypotyreose. Ellers normale prøvesvar.
Substitusjonsbehandling med Levaxin (levothyroxin) igangsettes. Hun har med brev fra NAV hvor du bes om å skrive en legeerklæring med spørsmål om arbeidsuførhet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke momenter bør være med i legeerklæring ved arbeidsuførhet? Lag en kort disposisjon (ca. 0.5 side).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* A. Generelt (identifisere pasienten og legen, beskrive formålet med erklæringen og kjennskap til pasienten
* B. Diagnose (r)
* C. Sykehistorie – (symptomer, forløp, pasientens egen historie)
* D. Status presens (oppgi dato, objektive funn)
* E. Gjennomført og eventuell videre plan for medisinsk utredning og behandling
* F. Forslag til ikke-medisinske tiltak (arbeidsrettede tiltak)
* G. Medisinsk begrunnet vurdering av FUNKSJONSEVNE og innvirkning av medisinske forhold på arbeidsevnen (legens vurdering)
* H. Prognose (varighet)
* I. Årsakssammenheng mellom sykdommen og arbeidsuførheten.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar: B, C, D, E, G, H og I er hovedelement (dvs alle unntatt A og F). Fire av disse må være med. Punktene i "legeerklæring ved arbeidsuførhet" kan enten beskrives summarisk eller med faktaopplysninger knyttet direkte opp mot dette tilfellet.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Forrige vignett:
<<<
Du er fastlegevikar. En kvinne på 46 år oppsøker deg. Hun forteller at hun har vært 50 % sykmeldt fra jobben som regnskapsfører i ni måneder i forbindelse med en depressiv reaksjon i etterkant av en skilsmisse. Du ser at tidligere utredning har vært sparsom. Hun behandles med Cipralex og har hatt månedlige telefonsamtaler med tidligere fastlege. Hun forteller at hun sover dårlig, sjelden føler seg uthvilt og fryser lett. Hun beskriver konsentrasjonsvansker på jobb. Hun har opplevd å gjøre pinlige småfeil i jobben og har måttet beklage dette til kunder i etterkant.
Du observerer at hun ser blek og sliten ut. Hun gir imidlertid god kontakt og kan være kvikk i replikkene. MADRS skår viser 20 (skår 12 – 20 indikerer en mulig eller mild depresjon).
Du igangsetter en utvidet medisinsk utredning og avtaler et nytt møte om en uke. Blodprøvesvar viser at Lise har en uttalt hypotyreose. Ellers normale prøvesvar.
Substitusjonsbehandling med Levaxin (levothyroxin) igangsettes. Hun har med brev fra NAV hvor du bes om å skrive en legeerklæring med spørsmål om arbeidsuførhet.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Med utgangspunkt i de opplysninger du har fått, hva vil du si til NAV om sammenhengen mellom sykdomsbildet og den nedsatte arbeidsevnen (årsakssammenheng).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Årsakssammenheng.
Her er det ikke ett korrekt svar. Måten man resonnerer seg frem til svaret er det viktigste. Viktige punkt (2 av 3 bør fremgå av besvarelsen):
# Samsvar mellom diagnose(r) og symptombilde. Beskrives av legen men gir alene ikke nok opplysninger til å konkludere vedrørende arbeidsevnen.
# Funksjonsvurderingen er et viktig mellomledd ved vurdering av sammenheng mellom symptomer/diagnose og arbeidsevne. Legen skal beskrive og vurdere om diagnosen(e)/symptomene innvirker på evnen til å fungere og om dette igjen kan påvirke evnen til å utføre konkrete arbeidsoppgaver.
# Ikke-medisinske faktorer virker også inn på arbeidsevnen (arbeidsplassens krav, psykososial situasjon, alder, utdanning/arbeidserfaring, arbeidsmarked, alder, osv). Legen sier noe om i hvilken grad sykdomsbildet alene kan forklare nedsatt fungering i arbeidssituasjonen. Legen kan ha innsikt i andre medvirkende faktorer. Pasienten, NAV, arbeidsgiver og andre kan redegjøre for ikke-medisinske faktorer. NAV har ansvar for å gjennomføre arbeidsevnevurderingen til slutt
Oppgavetekst gir rom for flere tolkninger. Nedenfor er et eksempel på hvordan sakens opplysninger kan sorteres.
* Hoveddiagnose: Hypotyreose. Bidiagnose: Mulig mild depresjon. Søvnvansker.
* Viktigste symptom: slapphet/tretthet. Kan relateres til alle diagnosene. Hypotyreose antas mest utslagsgivende.
* Funksjon: Hun beskriver selv problemer på arbeidsplassen, i forhold til konsentrasjon og generelt i forhold til det å mestre krav som stilles til henne. Det er ikke beskrevet åpenbar fysisk funksjonsnedsettelse.
* Sammenheng mellom medisinske forhold og arbeidsevne: Det vurderes å være rimelig god sammenheng mellom diagnoser, symptomer og den nedsatte fungering som beskrives. Nedsatt fungering uttrykkes i problemer med konkrete arbeidsoppgaver (Gjør feil pga. nedsatt konsentrasjon). Arbeidsevnen er selvrapportert og den er ikke kartlagt systematisk. Hun beskriver redusert evne til å klare ordinære oppgaver på den aktuelle arbeidsplass
* Ikke-medisinske forhold: Aleneansvar for sykt barn. Hun har tilsynelatende taklet dette relativt greit og omsorgsbyrden er fortsatt stort. Det er ikke beskrevet andre faktorer som kan forklare pågående nedsatt fungering/arbeidsevne.
</$details>
<div class="oppgave">
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!!Vignett
En 36 år gammel kvinne som er gift og har to barn på åtte og ti år. Hun oppsøker deg på fastlegekontoret. Du har vært hennes fastlege i ti år. Hun ble diagnostisert med kronisk utmattelsessyndrom (CFS/ME) 4 år tilbake i tid. Utmattelsestilstanden debuterte i etterkant av en kraftig halsinfeksjon der det ble påvist at hun hadde mononukleose. Etter dette har hun hatt flere lengre sykmeldingsperioder og har nå mottatt arbeidsavklaringspenger (AAP) i snart tre år. Hun gjennomførte et arbeidsrettet rehabiliterings opphold for pasienter med CFS/ME og hadde god nytte av dette. Hun er nå tilbake i deltidsarbeid som butikkmedarbeider (ordinær jobb med lønn fra arbeidsgiver) kombinert med arbeidsavklaringspenger. Hun trives godt i jobben.
Hun har nettopp fått påvist cancer mamma med spredning til lokale lymfeknuter. Hun skal opereres om en uke og det skal deretter igangsettes adjuvant behandling.
Hun er bunnløst fortvilet over hele situasjonen. Hun tenker mest på barna og hvordan hun skal klare å være tilstede for dem i den vanskelige tiden som kommer. Hun sier at hun er helt sikker på at hun ikke klarer å være i jobb. Hun ønsker å søke om uføretrygd med en gang og spør deg om råd.
hvor du bes om å skrive en legeerklæring med spørsmål om arbeidsuførhet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medisinske krav må være oppfylt for å få varig uføretrygd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* J. Hensiktsmessig utredning og behandling skal være forsøkt (§12-5). (0,5p)
* K. Hensiktsmessig arbeidsrettet aktivitet skal være forsøkt (§12-5) Det må foreligge medisinske hinder som sannsynliggjør at ytterligere arbeidsrettede tiltak ikke er hensiktsmessig. (0,5p)
* L. Varig sykdom, skade, lyte med krav til årsakssammenheng (§12-6): Den medisinske lidelsen må ha medført en varig funksjonsnedsettelse av en slik art og grad at den utgjør hovedårsaken til nedsettelsen av inntektsevnen/arbeidsevnen. (1 poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Behandling/utredning forsøkt – 0,5 p
Aktivitet forsøkt – 0,5 p
Varighet og årsakssammenheng – 1 p
</$details>
<div class="oppgave">
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!!Vignett
Hun sier at hun føler seg svært usikker på fremtiden. Prognosen
er usikker og hun vet at det blir en tøff periode fremover. Hun er
svært glad i jobben sin og sier at det er trist å tenke på at hun
aldri skal være i jobb igjen. Hun drømmer om at alt går bra og
håper å kunne jobbe igjen en gang i fremtiden. Hun lurer på om
det i så fall er mulig.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke råd kan du gi henne om mulighetene hun som uføretrygdet har for å prøve seg i en jobb?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Uførepensjon og reaktivisering. (rundskriv til §12-14 tredje ledd)
# Det viktigste er å ta kontakt med NAV og varsle om at hun tenker å prøve seg i lønnet arbeid.
# Det er fullt mulig å prøve seg i lønnet arbeid uten å miste retten til uføretrygd.
# Uføretrygden vil bli avkortet ved inntekt over en viss grense. Hvor mye vil avhenge av størrelse på arbeidsinntekten hun får.
For utvidet info se rundskriv til Lov om Folketrygd, kap 12 Uføretrygd. https://www.nav.no/rettskildene/lov/L19970228-19_P12-14#L19970228-19_P12-14
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng om 2 av 3 momenter er nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Dere drøfter ulike alternativ. Du støtter hennes plan om å søke uføretrygd. Hun spør om du kan søke for henne.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil være et rimelig svar på hennes spørsmål basert på
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Pasienten må selv søke om uføretrygd men hun kan få hjelp med dette fra NAV hvis behov. Uansett bør hun drøfte saken med NAV som kan gi nærmere informasjon om de ulike alternativene og fremgangsmåten.
* NAV sender forespørsel til lege om legeerklæring ved arbeidsuførhet. Dette blir ditt bidrag som fastlege.
* Som fastlege vurder du samtidig om hun er i en såpass sårbar situasjon at hun trenger hjelp fra dere på legekontoret med å kontakte NAV.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng om 2 av 3 punkter er nevnt
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var formålet med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Formålet med studien var å undersøke om det er sammenheng mellom antibiotikabehandling og risiko for å utvikle blodbaneinfeksjon blant personer >=65 år som fikk påvist nedre urinveisinfeksjon i allmennpraksis.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne gjengi begrunnelsen fra forfatterne. Her gis det ikke delpoeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv forskjellen på kohort-design og kasus-kontroll-design (case control-design).
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
I en case control-studie vil man undersøke forskjeller i eksponering mellom case og control-gruppen. I en kohort-studie undersøker man forekomst av sykdom blant eksponerte og ueksponerte (eller grader av eksponering) i en oppfølgingsperiode.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må kunne forklare forskjellen mellom kohort- og case control-studie.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Man kan tenke seg flere grunner til at legen avventer med å forskrive antibiotika blant pasientene i denne studien. Dette betyr at det kan være forskjeller mellom pasientene som får og ikke får antibiotika ved konsultasjon.
Hvilken betydning kan dette få i denne studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette kan føre til confounding. Dette kan gi både sterkere eller svakere effektestimat. Confounding kan forstås som felles årsaker til eksponering og utfall. I dette tilfellet kan man anta at indikasjonene for å gi antibiotika trolig er sterk assosiert med utfallsmålet. Det kan for eksempel bety at legen ikke vil avvente med antibiotika i tilfeller der pasienten har mer alvorlige symptomer
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
For å få poeng må kandidaten angi at confounding kan være et problem her (0,5 poeng). Hvis kandidaten skriver seleksjon eller seleksjonsbias, så skal dette gi 0 poeng. Det er ikke nødvendig at kandidaten skriver confounding by indication, men det bør beskrives at indikasjonene for forskriving kan være sterke årsaker til utfallsmålet. Det er også bra hvis kandidaten beskriver forskjellene i fra Table 1. Kandidaten for 0.5 poeng for å beskrive at effektestimatet kan bli feil, uten at vi vet retning på feilen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilket studiedesign hadde vært best egnet for å undersøke om antibiotikabehandling har betydning for risiko for blodbaneinfeksjon blant personer med urinveisinfeksjon (med minst systematiske feilkilder)? Hvilke utfordringer ville et slikt design gi?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Et randomisert kontrollert forsøk ville vært å foretrekke. Analyser av forskjeller i behandlingseffekt mellom pasientgrupper er svært krevende grunnet confounding (confounding by indication). Grunnen til at en lege velger å starte behandling eller ikke, er vanskelig å kontrollere for. Hovedgrunnen for å anvende RCT er å fjerne confounding. (0.5 poeng)
En RCT ville gi betydelige etiske utfordringer. Det kunne også være vanskelig å gjennomføre, siden det vil være vanskelig å få leger til å fravike det de tror er best behandling. Samtidig er det utfordringer med retningslinjer for redusert bruk, uten at man kan undersøke konsekvenser.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for RCT. 0.5 poeng for drøfting av etiske utfordringer.
Oppgaven forutsetter at kandidaten svarer RCT på første del for å få poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva var forfatternes hovedkonklusjon?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forfatterne konkluderte med at det er usikkerhet omkring det å utsette eller tilbakeholde antibiotikabehandling og effekt på blodbaneinfeksjon fra UVI. Og at man trenger gode verktøy for å guide antibiotikaforskrivning for å unngå økende resistens.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten gjengi forfatternes hovedkonklusjon for å få poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gir denne studien grunnlag for å hevde at man i større grad bør utsette oppstart av antibiotika-behandling blant eldre pasienter med urinveisinfeksjon? Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Denne studien viser at man ikke fant klare sammenhenger mellom utsatt bruk av antibiotika og risiko for alvorlig infeksjon i form av blodbaneinfeksjon. Utfordringen er at designet ikke kan gi noe godt svar på problemstillingen. Det er vanskelig å trekke slutninger fra basert på det designet man har anvendt. Studien gir interessante deskriptive estimat på forskjeller mellom grupper som får antibiotika på konsultasjon og ikke. Den er imidlertid lite egnet til si noe om hvorvidt utsatt tid til antibiotika kan påvirke pasientsikkerheten til denne pasientgruppen. Forfatterne er da også forsiktig i sin konklusjon, hvor de trekker fram betydningen av residual confounding for deres resultater
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten få klart fram at det er svært usikkert om man kan trekke slutninger basert på et design som er anvendt i denne studien. (1 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Shallcross L, Rockenschaub P, Blackburn R, Nazareth I, Freemantle N, and Hayward A: Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: A cohort study using electronic health records in England. PLoS Med. 2020 Sep; 17(9): e1003336. Published online 2020 Sep 21. doi: 10.1371/journal.pmed.1003336|https://doi.org/10.1371/journal.pmed.1003336]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvorfor kan det være et poeng å begrense antibiotikabruk for urinveisinfeksjoner?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kandidaten bør ta med utfordringer av et høyt forbruk av antibiotika kan ha for resistensutvikling. Videre nevnes det i artikkelen at det kan være vanskelig å diagnostisere UVI, og at det er grunn til å anta at mange eldre blir overbehandlet med antibiotika. Samtidig kan det å utsette eller tilbakeholde nødvendig behandling utsette pasienten for et mer alvorlig sykdomsforløp.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må ta med at høy bruk av antibiotika gi negative effekter med resistensutvikling på folkehelsenivå. For pasienten kan det være vanskelig å diagnostisere urinveisinfeksjon, og at det er grunn til å anta at mange eldre blir overbehandlet med antibiotika. På den andre siden kan utsatt behandling gi et forverret sykdomsforløp. Her gis det 0,5 poeng for å nevne resistensproblematikk og 0.5 poeng for å nevne forhold rundt pasientsikkerheten til den behandlede pasienten (overbehandling/alvorligere sykdomsforløp ved utsatt behandling)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det er store forskjeller mellom land i hvor mange som er registrert som døde av Covid-19. For eksempel var det i midten av november registrert henholdsvis 132,5 døde per 100 000 innbyggere i Belgia og 76,5 per 100 000 innbyggere i USA mot 5,7 per 100 000 innbyggere i Norge.
For hvert av spørsmålene i denne oppgaven forventes det utfyllende svar, (ca ½ side for spørsmål som gir 5 poeng).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for 3-5 ulike faktorer som kan bidra til slike forskjeller. Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det forventes at noen relevant forhold trekkes fram og begrunnes/reflekteres over.
Eksempel på aktuelle forhold kan være, men er ikke begrenset til:
* forskjeller i registrering/koding av dødsfall. Kriteriene for å bli registrert som død av Covid-19 varierer mellom land, noen registrerer smittede uavhengig av om dødsfallet kunne ha andre årsaker. Noen land kan ha mindre fullstendig registrering av dødsfall enn andre.
* forskjeller i tilgjengelighet av testing, andelen som testes, hvem som oppfordres til å teste seg, kriterier for testing.
* demografiske forskjeller - dødeligheten er størst blant eldre og alderssammensettingen av befolkningen er derfor viktig
* forekomst av ulike sykdommer som øker risikoen for død dersom man blir smittet varierer mellom ulike populasjoner
* ulik befolkningstetthet og ulike muligheter for å holde avstand
* forskjeller i smitteverntiltak. Mange land har innført betydelige restriksjoner for befolkningen (for eksempel karantene, reiserestriksjoner, begrensninger i opphold utendørs, begrensing i arrangementer og samling av mennesker, påbud om bruk av ansiktsmasker m fl)
* noen land har allerede godkjent vaksiner
* forskjeller i velferdssystemet – for eksempel i rettigheter til sykmelding og god dekning av tapt arbeidsinntekt ved sykdom som gjør det økonomisk mulig å være borte fra jobb når man er syk
* forskjeller i organisering av helsetjenesten, f.eks svak primærhelsetjeneste har vært nevnt som årsak til at enkelte land har samlet alle syke på sykehus i stedet for oppfølging lokalt, tilgjengelighet av og kostnad ved medisinsk behandling
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Full skår ved minst 3 godt begrunnede, relevante momenter. Flere relevante momenter veier opp for tynnere begrunnelse for hvert. Det er lov å utvise skjønn.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett. Fra tidligere:
<<<
Det er store forskjeller mellom land i hvor mange som er registrert som døde av Covid-19. For eksempel var det i midten av november registrert henholdsvis 132,5 døde per 100 000 innbyggere i Belgia og 76,5 per 100 000 innbyggere i USA mot 5,7 per 100 000 innbyggere i Norge.
For hvert av spørsmålene i denne oppgaven forventes det utfyllende svar, (ca ½ side for spørsmål som gir 5 poeng).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for kommuneoverlegens oppgaver ved smittevern og relater det til dennes rolle i håndtering av Covid-19-pandemien.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Flere av kommuneoverlegens oppgaver i hht smittevernloven bør beskrives (smittevernloven §7.2 er gjengitt under.)
«Kommunelegen skal
# utarbeide forslag til plan for helse- og omsorgstjenestens arbeid med vern mot smittsomme sykdommer, herunder beredskapsplaner og -tiltak, og organisere og lede dette arbeidet,
# ha løpende oversikt over de infeksjonsepidemiologiske forholdene i kommunen,
# utarbeide forslag til forebyggende tiltak for kommunen,
# bistå kommunen, helsepersonell og andre i kommunen som har oppgaver i arbeidet med vern mot smittsomme sykdommer,
# gi informasjon, opplysninger og råd til befolkningen om vern mot smittsomme sykdommer,
# utføre alle andre oppgaver som følger av loven eller bestemmelser i medhold av loven, og medvirke til effektive tiltak for å forebygge smittsomme sykdommer og motvirke at de blir overført.»
Det forventes at studentene gjennom beskrivelsen kommer inn på og viser forståelse for kommuneoverlegen som medisinsk faglig rådgiver. Det bør videre legges vekt på ansvaret for planlegging av smittevern i kommunen, overvåking av smitteforekomst i kommunen, og håndtering av eventuelle utbrudd
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her må det utvises skjønn. Beskrivelse av hvert av følgende punkter kan gi 1 poeng, inntil totalt tre poeng
* arbeidet med smittevernplaner
* oversikt over infeksjonsepidemiologi
* informasjons mot befolkningen
* rolle som medisinsk faglig rådgiver
* tiltak ved utbrudd
1 poeng ved kopi av smittevernloven uten utfyllende kommentarer som viser forståelse av innholdet/relaterer det til arbeidet med Covid-19
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er kommuneoverlege og observerer økende smitte i kommunen med flere mindre utbrudd. I kommunen er det et bofellesskap for voksne personer med psykisk utviklingshemming. De seks beboerne har egne leiligheter i tillegg til fellesarealer. Bofellesskapet har personalbase med døgnbemanning.
Fra tidligere:
<<<
For hvert av spørsmålene i denne oppgaven forventes det utfyllende svar, (ca ½ side for spørsmål som gir 5 poeng).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forebyggende tiltak vil du anbefale å sette inn for å unngå Covid-smitte ved dette bofellesskapet? Begrunn tiltakene ved å vise fordeler og ulemper.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her kan studentene diskutere ulike tiltak, inkludert, men ikke begrenset til:
* opplæring av ansatte i smittevernrutiner, inkludert alle nytilsatte, studenter og vikarer
* opplæring av ansatte i bruk av beskyttelsesutstyr
* sikre tilgjengelig smittevernutstyr
* informasjon til beboere/pårørende, inkludert tilpasset informasjon til beboere - organisering av vakter/arbeidstakere med faste kohorter og færrest mulig arbeidssteder
* tilrettelegging for avstand ved bruk av fellesarealer, daglig rengjøring
* fravær ved sykdom/symptomer hos ansatte
* eventuelt restriksjoner på bruk av fellesarealer
* NB: Besøksrestriksjoner i private hjem (deriblant omsorgsbolig og bofellesskap) kan bare besluttes av tjenestemottakeren selv, ev. i samråd med tjenesteyterne, pårørende og/eller verge. Ansatte bør bidra til at tjenestemottakere får tilpasset informasjon og nødvendig hjelp til å vurdere om omfang av besøk og sosial kontakt er iht. nasjonale og lokale smittevernråd.
* Vurdering av beboernes risiko for alvorlig sykdom
Tiltak knyttet til opplæring og informasjon er ganske uproblematiske. Endret organisering og endrede rutiner kan medføre ekstra kostnader og mindre ressurser til andre oppgaver, men er viktige smitteverntiltak. Innkjøp/tilgjengelig beskyttelsesutstyr i tilfelle påvist smitte er også essensielt, men innebærer ekstra kostnad. Endret bruk/restriksjoner på/stenging av fellesarealer vil kunne få sosiale konsekvenser for beboere og restriksjoner på besøk utenfra vil være særlig inngripende. At beboerne kan ha ulik forståelse for tiltak kan være særlig utfordrende.
Se https://www.fhi.no/nettpub/coronavirus/helsepersonell/tiltak-ihjemmetjenesten/
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Dersom studenten velger inngripende tiltak, er det viktig med en god diskusjon av fordeler/ulemper ved disse. Enklere tiltak krever mindre begrunnelse. For full skår må studenten ha diskutert minst tre tiltak. Her er det lov å utvise skjønn
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Til deg som fastlege kommer en ny pasient, en 83 år gammel kvinne som har klart seg alene etter at mannen døde for 2 år siden. Hun er bekymret fordi det er vanskeligere å finne igjen ting i huset og hun synes det er vanskelig å huske enkelte ting. Hun lurer på om hun er i ferd med å få demens
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva skal fastlegen vektlegge ved videre anamneseopptak?
# Hvordan skal fastlegen utrede denne pasienten videre?
# Hvilke to differensialdiagnoser er viktigst?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hva skal fastlegen vektlegge ved videre anamneseopptak?
#* Hvordan dette har utviklet seg: trinnvis/eller gradvis?
#*Hvor lenge har det vart?
#* Er det andre ting enn hukommelse som er vanskeligere enn før?
# Flere strategier er riktige:
#* Somatisk undersøkelse
#* Medikamentgjennomgang
#* ADL-vurdering
#* Vurdere mtp depresjon, MADRS, Cornell skala.
#* Blodprøver
#* CT/MR av hodet
#* Snakke med pårørende
#* Kognitive tester: MMSE/MMS, MoCA, Klokketest, Trailmaking (nevn 2 for poeng).
#* Benytte utredningsverktøy f.eks. fra Aldring og helse
#* Involvere hukommelsesteam/demensteam
#* Henvisning til geriatrisk/nevrologisk/alderspsykiatrisk avd.
# Demens, depresjon
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Varighet, trinnvis/gradvis og andre svekkelser: 1,5 p
# Minst 4 riktige: 1 poeng
#* Minst 6 riktige: 2 poeng
#* Minst 8 riktige: 2,5 poeng
#* Om studenten trekker inn momenter fra B under A (for eksempel medikamenter og ADL), vil det gi samme uttelling som å nevne disse under B
# 0,5 poeng for hver av demens og depresjon
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun kommer til deg igjen fordi hun nå snart er tom for sovemedisiner og «beroligende». Du ser av journalen at den forrige fastlegen pleide å gi henne resept på 100 stk zopiclone 7,5 mg og 100 stk diazepam 5 mg. Hun sier hun har brukt én av hver av disse daglig i mange år, og de virker godt. Angsten blir borte hver gang hun tar tabletten. Du er usikker på om du skal fornye disse reseptene på samme måte som den forrige fastlegen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke konsekvenser kan denne medisinbruken ha for henne?
# Hvordan vil du håndtere denne problemstillingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Avhengighet, abstinenser, ustøhet/fall, kognitiv påvirkning, kan ikke kjøre bil.
# Flere svar kan være riktige.
#* spørre om alkoholbruk
#* snakke med henne om slikt som avhengighet, fallfare, vedlikeholdt angst, svekket toleranse pga økt alder
#* forsøke komme til enighet om nedtrapping eller redusert dose
#* forskrive mindre pakninger
#* overgang fra benzodiasepiner til SSRI mot angst
Direkte seponering er feil.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0,5 p per rikitg moment inntil 2 p
# Minst 2 av nevnte punkter gir 2 p (ved bråseponering gis 0 p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du treffer henne igjen 3 måneder senere, nå på en kort akutttime. Hun har vært mer ustødig i det siste og har falt senest i dag. Det kommer frem at hun falt og slo hodet for ca 1 mnd siden. Hun har siden forrige konsultasjon betydelig svekket hukommelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Nevn ulike mulige årsaker til falltendens hos eldre generelt (minst 8)?
# Hvilke mulige årsaker til svekket språk og hukommelse bør man vurdere her? (minst 4)
# Hvilke undersøkelser vil du prioritere å gjøre og/eller henvise til ved denne akutt-timen? (minst 4)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Svekket syn, hypotensjon, ortostatisme, arytmi, medikamentpåvirkning, svake bein (muskelatrofi), alkoholbruk, hjerneslag, kronisk subduralhematom (kSDH), urinveisinfeksjon, hypoglykemi, normaltrykkshydrocephalus, svekket balansesans.
# kSDH, hjerneslag, normaltrykkshydrocephalus, delirium, infeksjon, depresjon.
# Nevrologi (inkl Romberg), BT, EKG, U-stix, Hb, CRP/diff, CT caput, MADRS, Cornell skala.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0,5 poeng: minst 4 riktige svar. 1 poeng: minst 8 riktige
# 0,5 poeng: minst 2 riktige. 1,5 poeng: kSDH og minst 3 andre riktige
# 1,5 poeng: Må ha med CT caput og minst 3 andre riktige, men ikke mer enn 2 forslag ut over listede riktige svar.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun kommer seg gjennom det foregående, men er fremdeles noe svekket. Hun klarer seg ikke helt på egenhånd lengre, og har nå hjemmesykepleie til hjelp med medisiner og ukentlig dusj. Mat ordner hun med selv etter hva hun har lyst på. Vekten har gått ned flere kilo i løpet av siste 2-3 mnd. Hun har mange medisiner og har klaget til sykepleierne på tørrhet og smerter i munnen
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilken legemiddeleffekt er den viktigste årsak til munntørrhet?
# Hvilke andre bivirkninger kan denne legemiddeleffekten gi?
# Hva er de helsemessige konsekvensene av munntørrhet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Antikolinerg effekt
# Delirium, kognitiv svekkelse, forvirring, arytmi, forstoppelse, synsforstyrrelse, urinretensjon.
# Svekket tannhelse, tannråte, underernærin
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0,5 poeng: antikolinerg
# 0,5 poeng: delirium/kognitiv svikt/forvirring 1 poeng: i tillegg minst 2 andre bivirkninger. Ved feil i A gis 0,5 poeng ved 2 eller flere relevante bivirkninger for svart legemiddeleffekt i A.
# 0,5 poeng: tannhelseproblemer/tannråte/karies (nok å nevne en av disse)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På fastlegekontoret kommer Anna (27) til kontroll etter fødsel. Hun har med seg Vetle (4 uker). Anna er helt ny på lista di og forteller at hun flyttet tilbake hit til hjemkommunen like etter fødselen. Vetle gråter mye, og samtalen blir stadig avbrutt av at Anna forsøker å trøste han på ulike måter. Da du spør hvordan det egentlig går med henne begynner hun å gråte, før hun unnskylder seg og sier “jeg er bare så sliten”. Hun angir smerter i kroppen og i underlivet, men har vanskelig for å samle seg om spørsmålene du stiller henne. Dere blir enige om at Anna skal ringe moren sin for å få litt hjelp og at hun bestiller seg en ny snarlig time for samtale og undersøkelse på et tidspunkt da mormor kan passe Vetle.
En uke senere har du fortsatt ikke hørt noe mer fra Anna. Du lurer på om dette er et godt eller dårlig tegn, men er såpass bekymret at du prøver å ringe henne et par ganger, uten svar. Du bestemmer deg for å ta kontakt med helsestasjonen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort hva helsestasjon (0-5 år) er gjennom å svare på følgende:
# Hva er formålet?
# Hvilke(n) lov(er) og/eller forskrift(er) regulerer tilbudet og hvem har ansvar for driften?
# Hva er helsestasjonsprogrammet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Helsestasjon 0-5: lovpålagt kommunal helsetjeneste som jobber helsefremmende og forebyggende rettet mot barn 0-5 år og deres familier. Mer spesifikt er formålet å fremme god helse og gode oppvekstkår, forebygge sykdom og skade, forebygge, avdekke og avverge vold og omsorgssvikt og bidra til utjevning av sosiale helseforskjeller (§1 i forskrift).
Helsestasjonen er regulert gjennom Lov om kommunale helse- og omsorgs-tjenester m.m. (helse- og omsorgs-tjenesteloven) og videre gjennom Forskrift om helsestasjons- og skolehelsetjenesten. Kommunen har ansvaret.
Helsestasjonsprogrammet: Tilbudet i helsestasjon 0-5 år følger standardisert program med 14 konsultasjoner (inkludert et hjemmebesøk til nyfødte)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0,5 dersom både helsefremming og forebygging er nevnt som formål.
* 0,5 for å beskrive helsestasjonsprogrammet som et standardisert program
* 1 for å navngi rett lov, rett forskrift og kommunalt ansvar (0,5 for to av disse)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du ønsker å oppdatere deg på hvilken oppfølging helsestasjonen har den første tiden etter fødsel, og finner Nasjonal Faglig retningslinje for helsestasjon og skolehelsetjenesten på nett. Her ser du at det er anbefalt hjemmebesøk av helsesykepleier etter 7-10 dager. Dette står som en “Sterk anbefaling”
<<imgLink "IIIC-2022-4-A.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva bygger en slik anbefaling på?
# Hva bestemmer styrken på anbefalingen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Retningslinjen er en kunnskapsbasert retningslinje – og et eksempel på kunnskasbasert praksis satt i system. En slik anbefaling bygger på den beste tilgjengelige kunnskap, inkludert forskningsbasert kunnskap, erfaringsbasert kunnskap, hensynet til brukere/pasienter og innefor konteksten av det norske samfunnet og norsk lov. Styrken på anbefalingene avhenger av:
* kvaliteten på dokumentasjonen
* hvor stor nytte vi har av et anbefalt tiltak sett opp mot mulige negative konsekvenser
* om det er enighet om verdier og preferanser knyttet til anbefalingene
* om eventuell positiv effekt er verdt kostnadene
Til dette benyttes retningslinjemetodikk og verktøy som GRADE. En sterk anbefaling indikerer at det er klart at fordelene veier opp for ulempene. Dette innebærer at brukere og helse- og omsorgspersonell i de fleste situasjoner vil mene at det er riktig å følge anbefalingen (alternativer er svak anbefaling eller ingen anbefaling)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 for å nevne kunnskapsbasert retningslinje.. Det godtas om studenten beskriver dette med andre ord, så lenge de ulike ingrediensene i kunnskapsbasert praksis er inkludert i tillegg til forskning.
0,5 for å nevne to av kulepunktene eller nevne GRADE (eller tilsvarende)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du lurer særlig på hva slags oppfølging som gjøres i forhold til mors psykiske helse, og finner at «Foreldres psykiske helse: Foreldre bør få spørsmål om egen psykiske helse og trivsel» også er en sterk anbefaling i retningslinja. Under «Praktisk-slik kan anbefalingen følges» finner du følgende om barseldepresjon:
<<imgLink "IIIC-2022-4-B.PNG">>
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du vet at helsesykepleierne i din kommune benytter EPDS for kartlegging av depresjonssymptomer hos alle nybakte mødre, men at metoden foreløpig ikke er innført som systematisk screening nasjonalt. Gjør kort rede for hva som kreves for at denne screeningen for barseldepresjon samlet sett skal være nyttig.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Tilstanden det screenes for må være et viktig helseproblem, dvs ramme mange og/eller ha store konsekvenser for dem som rammes. Barseldepresjon kan sies å oppfylle begge disse. Ifølge retningslinjer for barselomsorgen er forekomsten 10-16% målt med screeningverktøy, 3-5 % har klinisk depresjon. Kan ha konsekvenser for morsrollen, samspill og ernæring av barnet.
Det må finnes behandling som er mer effektiv hvis den gis tidlig. Det fins behandling mot depresjon og flere gode tiltak som kan iverksettes særlig for nybakte mødre, bl a sosial støtte og hjelp til amming. For barnets utvikling er det viktig at tilstanden fanges opp tidlig. Det må være enighet om hvem som trenger oppfølging og finnes kapasitet til å ta hånd om dem.
Det må være mulig å oppdage tilstanden tidligere enn den ellers ville blitt oppdaget og screeningverktøyet (testen, EDPS) må være akseptabel for de nybakte mødrene og ha høy sensitivitet og spesifisitet.
Det må være et rimelig forhold mellom kostnader og ulemper på den ene siden og gevinst på den andre. Ulemper kan blant annet være overbehandling, stigma knyttet til å trenge hjelp til morsrollen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 0.5 for viktig helseproblem inkl vurdering av barseldepresjon som dette,
* 0.5 for effektiv tidlig behandling og oppfølging,
* 0.5 for testkriterier og
* 0.5 for å nevne kostnader og ulemper.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du ringer helsesykepleier, som deler din bekymring rundt Anna og Vetle. Anna har fortalt helsesykepleier om en vanskelig barndom preget av mobbing og etter hvert spiseforstyrrelser, angstplager og problemer med å fungere i jobb. Hun flyttet til kommunen for å være i nærheten av sin egen mor etter samlivsbrudd. Bortsett fra sin mor har Anna lite nettverk, og står nå på bar bakke med lite ressurser og dårlig råd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft kort hvorfor helsestasjonen vil kunne bidra til sosial utjevning og hindre sosial ulikhet i helse.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Universelt tilbud, når alle, uavhengig av bakgrunn. Gratis. Har et helsefremmende og forebyggende fokus, med mål å fremme god utvikling, mestring og samspill i tillegg til å forebygge vold og omsorgssvikt og å sikre adekvat oppfølging og henvisning videre ved behov.
Mulighet for å styrke/målrette tilbud til de som trenger det mest (proporsjonal universalisme).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 for å beskrive universelt (evt befolkningsrettet) tiltak (0,5 hvis beskrivelse av innhold uten rett begrep)
* 1 for å nevne målretting i tillegg
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du og helsesykepleier blir enige om å snakkes etter 6-ukers kontrollen, og at Anna skal oppmuntres til å bestille ny legetime hos deg. Dere er enige om å følge den lille familien tett fremover. Etter samtalen blir du sittende å tenke på hvilke muligheter som fins i kommunen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv minst to eksisterende helsefremmende og/eller forebyggende støtteordninger eller gratis tilbud utenom det ordinære helsestasjonsog vaksinasjonsprogrammet som kan være til hjelp for Vetle og Anna i årene fremover. Karakteriser disse som universelle eller målrettede.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Her vil mye være aktuelt:
* Barselgruppe på helsestasjonen (universelt)
* Foreldreveiledningsprogrammer (ICDP, trygghetssirkelen mm)- kan være både universelle og målrettede
* Barnehage - universelt
* Bostøtte - målrettet
* Økonomisk støtte / yrkes/arbeidsveiledning mor - målrettet
* Barnetrygd - universelt
* Hjelpetilbud i regi av frivillige organisasjoner (familiekontakten HomeStart, Barnas stasjon) - målrettet
* Familietiltak i regi av barnevernet - målrettet
* Sosiale tilbud i regi av frivillige organisasjoner (turgruppe, babysang i kirka)- universelt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert relevante forslag (max 2) som fyller beskrivelsen (helsefremmende/forebyggende/gratis og som ikke først og fremst er behandlende tjenester) og er rett karakterisert
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En kvinnelig student på 25 år kontakter deg som fastlege. Hun bor fortsatt hos foreldrene. Pasienten forteller at hun har slitt psykisk siden 16-årsalderen. Hun begynte i samme periode å eksperimentere med hasj og alkohol. Hun sliter nå med konsentrasjonsvansker, indre uro, tristhetsfølelse og opplevelse av å «være utenfor». Hun har lite sosial kontakt, ingen fritidsaktiviteter og ingen jobberfaring. Hun har heller ikke klart å delta på skolen de siste to månedene.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvilke ytelser til livsopphold hun kan ha rett til som student. Begrunn svaret.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Lånekassen: Studenter som faller ut av studiet på grunn av sykdom, kan ha rett til å få omgjort lån og stipend til sykestipend. Det er krav om studieprogresjon for omgjøring av lån til stipend og retten til støtte bortfaller om hun er blitt mer enn ett år forsinket i studieprogresjon) Nærmere informasjon finnes på lanekassen.no.: Hvis du er syk i mer enn 2 uker, kan du få stipend og lån som du har fått utbetalt i perioden du var syk, omgjort til sykestipend. Du kan maksimalt få sykestipend i 4 måneder og 15 dager i løpet av et studieår. https://lanekassen.no/nb-NO/Stipendog-lan/utdanning-i-norge/Hoyere-utdanning/Sykdom/
# AAP: Studenter kan i noen tilfeller ha rett til arbeidsavklaringspenger. Det anbefales å kontakte NAV for informasjon om regelverket. Se aktuelle rundskriv for mer informasjon: https://lovdata.no/nav/rundskriv/r11-00#KAPITTEL_65
# Økonomisk sosialhjelp: Alle har rett til å søke om økonomisk sosialhjelp og til å få en individuell vurdering av søknaden sin. Det er ingen medisinske vilkår for å kunne motta sosialhjelp.
# Hun har ikke vært i jobb tidligere og har derfor ikke rett til sykepenger eller andre ytelser som krever tidligere deltagelse i arbeid (opptjent rett)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert punkt inntil 1,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten din kommer i konflikt med foreldrene og flytter på hybel. Hun dropper studiene helt og jobber i en bar på kveldene og i helgene. En dag ringer en av naboene til legevakten. Din pasient har knust rommet sitt, hamrer på veggene og nekter å komme ut. Hun blir innlagt. Tilstanden forstås som en rusutløst psykose. Hun blir utskrevet etter 10 dager. Hun ønsker ikke videre behandling og glir straks tilbake i rusmiljøet. Alkoholmisbruket er dominerende. Hun dukker opp på kontoret ditt en dag. Hun er blek, tynn og ser svært sliten ut. Hun skjelver på hendene og spør om en sykmelding fordi hun ikke makter å gå på jobb samme kveld.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Gjør rede for hvilke medisinske vilkår som skal være oppfylt hvis bruk/misbruk av alkohol skal gi rett til sykepenger fra NAV.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Sykdomsvilkåret:
# ''Diagnostisert kronisk alkoholisme'' eller ''sykdom som følge av dette'' kan gi rett til sykepenger
#* Alkoholisme kan godtas som medisinsk årsak til nedsatt arbeidsevne forutsatt at en rekke andre kriterier er oppfylt. Se rundskriv til §11-5: " Brukere som er alvorlig og kronisk rusmiddelavhengige fyller som utgangspunkt lovens krav til sykdom. En bruker som får innvilget helsehjelp etter pasientrettighetsloven på grunn av rusmiddelavhengighet, eller som er i behandling i regi av spesialisthelsetjenesten vil som utgangspunkt også fylle lovens krav til sykdom. Dersom det bare foreligger mistanke om rusproblemer, vil lovens krav til sykdom som utgangspunkt ikke være oppfylt. Det samme vil gjelde for brukere som har periodevis, eller annen uklar rusproblematikk. Det må imidlertid alltid vurderes om det foreligger andre helseplager som tilfredsstiller lovens krav til sykdom.
# Årsakssammenheng: Dersom sykdom (som nevnt i A) medfører nedsatt funksjonsevne med innvirkning på arbeidsevnen
Det foreligger i tillegg et ''Behandlingskrav'':
* ''Under behandling i institusjon'' foreligger vanligvis rett til sykepenger med hjemmel i § 8-4 tredje ledd, enten bokstav a eller bokstav b avhengig av om det dreier seg om innleggelse eller om behandlingen skjer poliklinisk.
* Rett til sykepenger etter bestemmelsen i bokstav b vil foreligge tilsvarende for personer som er ''under aktiv legebehandling for sin lidelse utenfor institusjon'', eventuelt under forsvarlig ettervern etter avsluttet opphold i institusjon når arbeidsuførheten er tilstrekkelig dokumentert av behandlende lege
* Dersom behandling gis av et medisinsk team, kan vanligvis kontakt med et av team-medlemmene anses som behandling selv om kontaktpersonen ikke selv er lege. Det er imidlertid et krav at en lege har overoppsyn med behandlingen og bekrefter arbeidsuførheten, eller at behandlingen gjør det nødvendig at vedkommende ikke arbeider
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne sykdomsvilkåret med både punkt A og B.
0,5 poeng for å nevne behandlingskravet, 0,5 poeng for utdyping av behandlingskravet.
</$details>
<div class="oppgave">
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!!Vignett
Kort tid etter mister pasient jobben og flytter hjem til foreldrene Hun unngår å oppsøke lege og først etter halvt år kommer hun til ny konsultasjon sammen med moren. De siste ukene har hun hørt stemmer. Stemmene demper seg når hun bruker hasj. Mor forteller at datteren har snudd på døgnet og neglisjerer den personlige hygienen. I det siste har hun i tillegg blitt mer aggressiv mot de andre i familien. Du mistenker at pasienten er psykotisk og ønsker å undersøke henne med tanke på innleggelse ved psykiatrisk institusjon. Pasienten nekter undersøkelse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvordan skal du gå fram for å kunne undersøke pasienten med tanke på innleggelse i psykiatrisk institusjon?
# Hvilke vilkår må oppfylles for en eventuell tvangsinnleggelse?
# Hvilke lover og/eller forskrifter kommer til anvendelse her?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Når det er grunn til å tro at pasienten er alvorlig psykisk syk, men ikke ønsker å la seg undersøke kan kommunelegen bestemme at slik undersøkelse skal gjøres. Det betyr at fastlegen må kontakte en overordnet kommunelege og få tillatelse. (Se lov om etablering og gjennomføring av psykisk helsevern §3-1)
# Hvilke vilkår må oppfylles for en eventuell tvangsinnleggelse?
#*Alvorlig sinnslidelse der a) pasienten vil raskt bli bedre ved bruk av tvang, eller bli verre uten bruk av tvang eller b) er til fare for seg selv eller andre (for tvungent psykisk helsevern) eller dette er overveiende sannsynlig (for tvungen observasjon)
#* Frivillighet er forsøkt eller åpenbart hensiktsløst.
#* Det mangler samtykkekompetanse (unntak: ved fare for eget liv eller andres bortfaller dette kravet).
#* Ut fra en helhetsvurdering må bruk av tvang fremstå som det klart beste for pasienten.
# Lov om etablering og gjennomføring av psykisk helsevern (også kalt psykisk helsevernlov), spesielt paragraf/kapittel 3
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 1 p,
# 2 p,
# 0,5 p
</$details>
<div class="oppgave">
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!!Vignett
Moren tar opp med deg at datteren ikke har hatt inntekt siste halvår og har levd på foreldrene. Hun lurer på om datteren har krav på AAP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke kriterier må være oppfylt for å få AAP i denne situasjonen? Gi din vurdering av om de medisinske kriteriene er oppfylt
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Kriterier:
# Nedsatt arbeidsevne pga sykdom skade og lyte. §11-5
#* Minst 50% arbeidsufør ved inngang AAP
#* arbeidsuførhet med årsakssammenheng til nedsatt funksjon pga sykdom
# Sykdom en vesentlig årsakHelse kun en av flere faktorer som vektlegges ved vurdering av den nedsatte arbeidsevne.
# Aktivitetskrav. §11-6. Det skal lages en aktivitetsplan som beskriver aktiv behandling, arbeidsrettede tiltak og/eller annen oppfølging av NAV med sikte på å komme i jobb.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar: A og C må være med for å få riktig svar =1 p. (Redusert arbeidsevne på grunn av sykdom + aktivitetsplan (utredning, behandling og eller arbeidsretta tiltak)
Full skår om kriteriene er understøttet av punkter fra sykehistorien
</$details>
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!!Vignett
I løpet av det neste tre årene er pasienten innlagt fire ganger ved nærmeste Distrikts psykiatriske senter (DPS) med økende lengde på innleggelsene. Hun har fått diagnosen schizofreni og bor nå i en vernet bolig. Hun klarer stort sett å ivareta personlig hygiene og daglig stell i hjemmet, men fungerer dårlig sosialt sammen med andre og trenger hjelp til å klare å opprettholde kontakt med hjelpeapparatet og verden utenfor hjemmet. Hun følges opp i spesialisthelsetjenesten og vurderes i en fase med behov for langvarig stabilisering.
Pasienten ønsker å søke om uføretrygd. På tross av hennes unge ung alder tenker du at dette kan være hensiktsmessig på nåværende tidspunkt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medisinske kriterier må være oppfylt for å få varig uførepensjon? Drøft om de medisinske kriteriene er oppfylt i dette tilfellet.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hensiktsmessig utredning og behandling skal være forsøkt. (§12-5): Hensiktsmessig utredning og behandling synes å være gjennomført og pasienten er under behandling i spesialisthelsetjenesten for en alvorlig psykiatrisk sykdom
# Medisinske hinder for (ytterligere) arbeidsrettet aktivitet. (§125) Sykdommen er alvorlig, hun er ikke vurdert til å være i en stabil fase nå. Funksjonsnivået fremstår ikke som kompatibelt med det å fungere i arbeidslivet. Dette utgjør medisinske hinder for arbeidsrettet aktivitet.
# Varig sykdom, skade, lyte og krav til årsakssammenheng: Den medisinske lidelsen har medført en varig funksjonsnedsettelse av en slik art og grad at den utgjør hovedårsaken til nedsettelsen av inntektsevnen/arbeidsevnen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Poeng: For riktig svar: må ha med C som skal inkludere tre delsvar: VARIG (0.5) + sykdom/skade/lyte (0.5)+ årsakssammenheng med nedsatt arbeidsevne (0.5). I tillegg må enten A eller B være nevnt. (0.5) Full skår om kriteriene er drøftet i lys av punkter fra sykehistorien
</$details>
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!!Vignett
5 år har gått og din pasient kommer til kontroll. Hun står på antipsykotisk medikamentell behandling og fungerer bra i hverdagen. Hun overrasker deg ved å si at hun ønsker å komme i jobb igjen. Hun hadde lest i en brosjyre på sykehuset der det sto noe om et tilbud som het individuell jobbstøtte (også kalt IPS = Indiviual placement and support). Det handlet om å få hjelp til å komme seg ut i jobb. Hun hadde fått vite at dette var et samarbeid mellom NAV og sykehuset.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv kort viktige prinsipp ved Individuell jobbstøtte (IPS)
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De 8 IPS prinsippene
IPS-programmene er basert på en samling sentrale prinsipper som må følges for å få ønsket effekt. Det er lagt opp til å måle/evaluere hvorvidt prinsippene følges, gjennom en IPS-kvalitetsskala/Fidelity scale. Se også Håndbok i kvalitetsevaluering IPS Supported Employment. IPS bygger på følgende åtte grunnleggende prinsipper (Drake, Bond & Becker, 2012):
# Målet er ordinært, lønnet arbeid
# Tilbudet gis basert på jobbsøkers eget ønske; man kan ikke ekskluderes med bakgrunn i diagnose, symptomer, rus eller sykdomshistorie
# Individuell jobbstøtte er en integrert del av behandlingen
# Jobbsøk skal basere seg på den enkeltes interesser og ferdigheter
# Økonomisk rådgivning: Oppfølgingen inkluderer rådgivning om søknader om offentlige ytelser og trygd
# Hurtig jobbsøk: Man skal ikke ha lengre perioder med forberedelse, trening eller rådgivning før man prøver seg i arbeid
# Systematisk Jobbutvikling: IPS-jobbspesialisten bruker en stor andel av tiden sin på å bygge nettverk blant arbeidsgivere basert på finne aktuelle jobber som passer den enkelte
# Individuell oppfølging uten tidsbegrensning
For mer info: https://www.napha.no/content/20131/Individuelljobbstotte-IPS
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for hvert prinsipp som nevnes inntil maks 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Kan pasienten begynne å jobbe samtidig som hun mottar uføretrygd?
# Hvilke råd kan du gi henne om mulighetene hun som uføretrygdet har for å prøve seg i en jobb?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ja, Uførepensjon og reaktivisering. (rundskriv til §12-14 tredje ledd)
# Hvilke råd kan du gi henne om mulighetene hun som uføretrygdet har for å prøve seg i en jobb?
#* Det viktigste er å ta kontakt med NAV og varsle om at hun tenker å prøve seg i lønnet arbeid.
#* Det er fullt mulig å prøve seg i lønnet arbeid uten å miste retten til uføretrygd.
#* Uføretrygden vil bli avkortet ved inntekt over en viss grense. Hvor mye vil avhenge av størrelse på arbeidsinntekten hun får.
For utvidet info se rundskriv til Lov om Folketrygd, kap 12 Uføretrygd. https://www.nav.no/rettskildene/lov/L1997022819_P12- 14#L19970228-19_P12-14
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per punkt
</$details>
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Muskelplager er ofte oppgitt som vanlig bivirkning ved bruk av statiner. Hva var begrunnelsen for å gjennomføre en randomisert kontrollert studie for å undersøke sammenhengen mellom statinbruk og muskelplager?
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</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Til tross for at muskelplager er en hyppig nevnt bivirkning, er det ikke enkelt for verken lege eller pasient å avklare om det er selve statinbruken som er årsaken til plagene. Hensikten med en RCT er å unngå konfundering. Blinding vil redusere eventuell noceboeffekt hvor pasienten attribuerer plager til medikamentet. Det vil si at dette designet gir bedre informasjon om det er statinbruken som påvirker plagene eller ikke.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten må angi at dette designet unngår konfundering fra for eksempel alder, kroppsmasse o.a. (1 poeng) Blinding reduserer placebo-effekt. (1 poeng). Designet er derfor egnet til å avklare om statinbruk er årsak til muskelplager hos pasientene (1 poeng)
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Statiner gis ofte i en alder hvor muskelplager er vanlige. Forklar hva dette kan bety for pasientene som får statiner.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dette kan føre til at pasienten feilaktig tror at muskelplager skyldes statiner mens det egentlig skyldes alder. I verste fall kan dette føre til at pasienten slutter med statin i tilfeller hvor dette kan forhindre alvorlig hjertesykdom på sikt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten forklare hvordan det kan oppstå psykologisk effekter hvor pasienten attribuerer kroppslige plager til statin-bruk
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I denne studien valgte man å gi atorvastatin i dose på 20 mg daglig. Forfatterne var spesielt interessert i effekten av statin på muskelplager.
Hvordan kan dosering være av interesse for å vurdere effekten av dette medikamentet på bivirkninger i denne studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Denne studien retter seg mot mulige bivirkninger av medikamentet og ikke effekten på å senke nivået av lipider og andre fettstoffer (triglyserider) i blodet. Atorvastatin kan doseres fra 10-80 mg daglig. Ved å legge seg på et såpass lavt dosenivå som 20 mg, kan man kanskje anta at mulige bivirkninger blir lavere enn om de hadde valgt høyere dosering.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten vurdere om dosen er for lav til å gi muskelplager. Ville resultatet vært det samme hvis man la seg på en høyere dose, men som likevel var innenfor akseptabel nivå for dagsdose?
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Diskuter kort hvilken nytte resultatene av denne studien kan ha.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Statiner har vist god effekt på hjerte- og karsykdom i mange studier. Mulige bivirkninger har også fått stor oppmerksomhet. Dobbeltblindede RCT er det beste designet for å studere effekter og bivirkninger. Dette er likevel en enkelt studie, og selv om den har høy kvalitet, er den ikke alene nok til å avklare sammenhengen mellom statiner og smerte. Som nevnt i spm 3, kan det også hende at man hadde funnet andre sammenhenger ved høyere statindoser.
Studier som denne kan likevel være til hjelp for at pasienten og legen sammen kan ta bedre valg og beslutninger.
Bedre forståelse (hos leger og pasienter) av at smerter kan være en noceboeffekt, kan være til hjelp for å forhindre uønsket avslutning av statinbehandling.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten reflektere over hvordan slike studier kan brukes for å informere best mulig om virkninger og bivirkninger av slike medikamenter.
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
I artikkelen skriver forfatterne: “We found no evidence of an effect of statins on the occurrence of muscle symptoms overall (odds ratio 1.11; 99% confidence interval 0.62 to 1.99) or for muscle symptoms that could not be attributed to another cause (1.22; 0.77 to 1.94) among the 152 participants who contributed at least one secondary outcome measurement in a statin period and one in a placebo period...” Forfatterne konkluderer altså at det er ingen bevis for effekt.
Diskuter denne konklusjonen. Basert på informasjonen i setningen over, hvordan vil du vurdere presisjonen til disse estimatene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Forfatterne bruker nullhypotese-testing til å slutte at det ikke er noen bevis for sammenheng overhodet. Det er høyere odds for muskelplager, men resultatet har noe usikkerhet. Man kan også tolke resultatet dit hen at det er svært usikkert hvorvidt man har en økt eller redusert risiko for muskelplager, siden konfidensintervallet er bredt. I tabellen er også andelen med plager i gruppene oppgitt. 62,5 prosent oppga muskelsymptomer i statin-periodene og 61,6 prosent i placebo-periodene. Dette antyder at forekomsten av muskelsymptomer er høy uavhengig av statinbruk, og at den faktiske forskjellen mellom periodene er små.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidaten bør vurdere presisjonen på estimatet og at manglende sammenheng dermed er usikker (3 p). For å få full skåre må kandidaten også reflektere over absolutt-nivå av plager blant deltakerne (1p).
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Deltagerne til studien ble rekruttert blant statinbrukere som vurderte å stoppe eller hadde stoppet å bruke statiner på grunn av muskelplager.
Diskuter kort om den høye forekomsten av muskelplager denne rekrutteringsmetoden medfører kan påvirke resultatene og generaliserbarheten av studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Vil ikke føre til bias, men kan bidra til lavere kontrast i utfallsmålet og dermed redusere statistisk styrke til å konkludere med at det foreligger en forskjell. En kan stille spørsmål om studien er generaliserbar siden deltagerne var rekruttert blant tidligere statinbrukere m/muskelsmerter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her bør kandidaten reflektere over generaliserbarheten (1,5 poeng) og lavere kontrast (1,5 p).
</$details>
<div class="oppgave">
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!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n135 (Publishe d 24 February 2021)Cite this as: BMJ 2021;372:n135|https://doi.org/10.1136/bmj.n135]]
Bakgrunnsinfo: https://www.thelancet.com/journals/lancet/article/PIIS01406736(16)31357-5/fulltext
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Ved bruk av dette designet (serie av n-of 1 trials) i medikamentstudier er det mulig å se individbaserte resultater, og i tillegg estimere samlet effekt av de individbaserte resultatene.
Nevn noen sentrale fordeler og ulemper med et slikt design.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Fordeler:
# Kan oppnå høyere presisjon ved å se på innen individ da en unngår støy relatert til forskjeller mellom individ.
# Mulig å gi individbasert tilbakemelding (spesielt i denne studien) - noe som også kan tenkes brukt i en klinisk setting og ha betydning for individtilpasset behandling. Dette kan også motivere til deltagelse i studien fordi det oppleves nyttig for den enkelte.
Ulemper:
# Krever ofte washoutperioder- kan være usikkert hvor lenge medikamentet påvirker utfallet.
# Kan være problematisk å tolke resultater basert på ett individ (risiko for confounding).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Kandidat bør kunne liste opp minst en relevant fordel og en relevant ulempe. Dette spørsmålet krever at de har søkt opp litt litteratur, i og med at artikkelen er kjent i forkant av eksamen har de hatt anledning til å forberede seg.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du jobber som fastlege en dag i juni. Din siste pasient før lunsj er Kari Karlsen (63 år). Kontaktårsak oppført i timeboka: «Blodtrykk, resept +++»
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan kan du på beste måte forberede deg til konsultasjonen før du tar inn denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
__Generelle om «Forberedelser»__
Studentene undervises i betydningen av å forberede seg til konsultasjonen. Inngår som første ledd i «konsultasjonens anatomi»: *Forberedelse, 1) Åpning 2) Pasient-del 3) Lege- del 4) Felles del 5) Avslutning * Etterarbeid) som er nøye forelest for studentene.
__To forhold bør være med:__
# Sjekke journalen for opplysninger om tidligere kontaktårsaker, familie/sosialt, kroniske sykdommer og medikasjon
# Slå opp i fag-litteratur eller veiledninger hvis relevant ut fra sykehistorien. Sjekke at utstyr du regner med å trenge er på plass/klart.
Begrepet «housekeeping» kan komme opp; et begrep som har blitt brukt i forelesning både om det å «holde orden i konsultasjonen» (få unna arbeidet underveis) og om å «rydde hodet» (mentalt) mellom pasienter (konsultasjoner).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å sjekke journal, 1 poeng for å forberede deg ved å slå opp i faglitteratur/veileder. Ettersom blodtrykksapparatet sannsynligvis står fremme, er dette ikke nødvendig for full skår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du henter Kari på venteværelset. Når dere kommer inn på kontoret og har satt dere ned, tar hun opp en liten huske-lapp fra vesken og ser forventningsfull på deg.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Beskriv hvordan du kommunikasjonsmessig bør gå frem når en pasient ser ut til å komme med flere problemstillinger på en vanlig legetime (20 minutter).
Du kan illustrere med eksempler på egnede utsagn fra legens side i en slik situasjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Generelle råd for ALLE konsultasjoner er å ''skaffe fullt overblikk'' over agenda tidlig i konsultasjonen (unngå dørklinke-spørsmål etc)
#* Kan gjøres ved å stille følgende spørsmål etter at pasienten har nevnt kontaktårsak for å ''kartlegge alle problem'': «Var det noe annet du ville ta opp i dag/ har på hjertet?»
#* Det er særlig viktig hvis/når du har forstått at pasienten har flere det er problemstillinger. Vær generøs i holdningen, ikke gå i forsvar. Spør evt om å få se evt «Handlelisten» – eller lag egen! (lov/lurt å notere i journalen: P1, P2, P3, P4...)
# Ta grep: ''Juster forventningene''
#* «Her er det en del å ta fatt på... Jeg ser allerede nå at vi ikke rekker alt i dag – men jeg kan love deg at vi skal ordne med en ny time til resten»
# Ta grep: ''Prioriter i samråd med pasienten, men hovedansvaret for å legge en plan er ditt''
#* «Hva er viktigst for deg å få gjort noe med i dag?» (mest plagsomt?, evt haster?) «Jeg synes i tillegg at .. er viktig å ta tak i..» (eks blod i avføringen, vekttap...
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis 1 poeng for hver «kategori» som omtales. Det er ikke nødvendig å ha med eksempelutsagn for poeng, men kan være god måte å illustrere poenget.
Full pott 3 poeng hvis alle nevnes.
1,5 poeng: Å kartlegge alle problemstillingene pasienten har/ lage liste
1,5 poeng: Å justere forventninger (0 poeng hvis studenten foreslår å ta alt på samme time)
1,5 poeng; Å prioritere i samråd med pasienten. (Vurdere hva kan/bør håndteres på denne timen – hva kan vente)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det er nå desember. Du har hatt seks måneders forskningspermisjon og har nettopp startet i klinisk praksis på legekontoret igjen. Kari kommer til deg på vanlig time.
I siste notat for to uker siden fremkommer det at Karis ektemann Hans (70 år), som du også er fastlege for, fikk påvist coloncancer med spredning for noen måneder siden.
I konsultasjonen med Kari får du høre at det planlegges hjemreise for Hans om ikke så lenge, og Hans har uttrykt et sterkt ønske om å få dø hjemme. Kari forteller at hun har tatt på seg hovedansvaret for stell og pleie av sin mann, og det er først i det siste at hjemmesykepleien har kommet litt på banen. Hun sier at hun kjenner seg «sliten helt inn til margen» - og ofte strever med å sove fordi hun bekymrer seg for hvordan de skal få det til hjemme. Men hun ønsker likevel å «stå i det» så lenge mannen ønsker å dø hjemme.
Kari er ansatt som daglig leder i en travel, liten klesforretning (lønnstaker).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke(n) økonomiske ytelse(r) det er akutelt å vurdere i denne sammenhengen – og hvilke krav stilles?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De mest aktuelle ytelsene er:
# Sykepenger (sykemeldt for egen sykdom)
# Pleiepenger
__Om sykepenger__
Må fylle sykdomskreiteriene. Mest aktuelle diagnoser er søvnforstyrrrelse eller P02 – Psykisk ubalanse situasjonsbetinget - kan brukes ved reaksjoner på belastende livshendelser. Det er store variasjoner i hva som oppleves som alvorlig belastning- og situasjonen kan utvikle seg på en slik måte at de gir symptomtrykk og funksjonstap på linje med sykdom. Hvis sykdomskriteriene er oppfylt kan sykemelding vurderes – for en periode, gradert eller helt etter vanlige prinsipper om hva som er mulig/ hensiktsmessig utfra problemer/ arbeidssituasjonen
https://www.helsedirektoratet.no/veiledere/sykmelderveileder/diagnosespesifik ke-anbefalinger-for-sykmelding/psykisk-p
__Om pleiepenger__
Personer som pleier en nærstående i livets sluttfase kan ha rett til pleiepenger. En nærstående=et familiemedlem eller en person i en nær relasjon til. Pleien må foregå i hjemmet til den som er syk eller i hjemmet til den som pleier. Pleiepenger kan gis for inntil 60 dager for hver pasient/pleietrengende.
Andre aktuelle ytelser er:
# ''Hjelpestønad''. Pasienten kan søke om hjelpestønad fra NAV dersom han har pleiebehov / nødvendig tilsyn som utføres av pårørende / nærstående. Sykdommen må være varig eller ha en varighet på minst 2–3 år. Det er tilstrekkelig at et hjelpebehov på 2,5 timer per uke er påvist. Hjelpestønad kan ytes også om pasienten får hjemmesykepleie.
# ''Velferdspermisjon fra arbeidsgiver''. Arbeidstaker har rett til permisjon i inntil 10 dager hvert kalenderår for å gi nødvendig omsorg til foreldre, ektefelle, samboer eller registrert partner. Det er arbeidsgiver som avgjør om velferdspermisjon blir gitt med eller uten lønn. Flere arbeidsplasser, særlig i det offentlige, har tariffestet rett til velferdspermisjon med lønn ved alvorlig sykdom og død i nær familie. Velferdspermisjon vil sannsynligvis ikke være tilstrekkelig i dette tilfellet, men kan være aktuelt i påvente av at søknad om pleiepenger blir behandlet eller etter at pleiepengeperioden er oppbrukt. Velferdspermisjon er oftere aktuelt ved begravelse, pårørende til terminal pasient på sykehus og lignende
I tillegg til overnevnte kan omsorgslønn innvilges av kommunen etter søknad ved særlig tyngende omsorgsarbeid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 2 poeng for pleiepenger med krav (1 poeng uten krav)
* 2 poeng for sykepenger med krav (1 poeng uten krav)
* 2 poeng for hjelpestønad med krav (1 poeng uten krav)
* 1 poeng for velferdspermisjon med relevant kommentar ang begrensingene av denne ytelsen i denne situasjonen
Til sammen maks 6 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I en rapport fra SINTEF står det beskrevet at «fastlegen er spilt av banen» når det gjelder palliative forløp, og at det er ønskelig at fastlegen involveres mer når pasienter med palliative behov ønsker å dø hjemme.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Med utgangpunkt i Hans og Karis situasjon og din generelle kunnskap om fastlegens nøkkelrolle i helsetjenesten: Beskriv hvilke(n) rolle(r) du som fastlege kan ha/ta i et palliativt forløp.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# ''Medisinsk behandling/lindring'': Fastlegen kan vanligvis og ut fra sin medisinske kompetanse ivareta pasienten med grunnleggende symptomlindring mot bl.a. smerte, kvalme etc. Her kan man støtte seg til faglige veiledere (guidelines) og konferanse med 2. linjen. Evt. samarbeid med kreftsykepleier osv. for smerte-pumpebehandling etc.
# ''Koordinerende rolle'' innad i primærhelsetjenesten og i forhold til spesialisthelsetjenesten: Ofte skjer oppfølging/behandling i livets sluttfase i samarbeid med kreftsykepleier i kommunen, hjemmesykepleie og med støtte fra palliativt team på sykehuset
# ''Støttefunksjon for (pasient og) familie - pårørende''. Palliasjon innebærer ofte mye mer enn bare symptomlindring og pleie av pasienten. Fastlegen kjenner ofte pasienten fra før, og noen ganger også familien, og kan være den som bidrar med betydelig støtte i en slik situasjon. Et blikk for helhet, relasjoner, skape trygghet, etc. Fastlegen har ofte en sentral rolle i å ivareta pårørende (dersom man også er fastlege for disse). Mobilisering av ressurser rundt familien; hvem i nettverket kan mobiliseres for å skaffe Kari noe avlastning og støtte?
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Medisinsk behandling som fastlegen kan bidra med (symptomlindring; smertebehandling, kvalme etc) evt «lindrende skrin» (1,5 poeng)
# Koordinerende rolle; hj spl/ sykehus ( 1,5 poeng)
# Støttefunksjon for pasienten og pårørende (1,5 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du ser i journalen at Kari har vært flere ganger på akutt-time hos dine kollegaer de siste par månedene med både en langvarig luftveisinfeksjon og to urinveisinfeksjoner på kort tid. I tillegg behandles hun for høyt blodtrykk, kostholdsregulert diabetes og forsøker stadig å gå litt ned i vekt.
Den kliniske undersøkelsen (inkludert testresultater) samsvarer med din kunnskap om at Kari for tiden lever under betydelig belastning. Et faglig begrep for å beskrive slike sammenhenger mellom livserfaringer og helse, er allostase.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvordan defineres allostatisk overbelastning?
# Hvordan defineres multimorbiditet?
# Gjør rede for hvordan modellen for allostatisk overbelastning kan ha relevans for forståelse av årsaksforholdene bak multimorbiditetsbegrepet. Du kan bruke Kari som eksempel.
# Om man ser bort fra kjønn, hvilke to faktorer predikerer multimorbiditet sterkest på befolkningsnivå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Definisjon av allostatisk overbelastning:
#> Langvarig overbelastning av menneskets fysiologiske tilpasningsevne kan lede til helseskade.
# Definisjon av multimorbiditet:
#>En person med ''flere samtidige diagnoser'' har multimorbiditet. «Kari har multimorbiditet fordi hun har mange etablerte sykdomsdiagnosene og helseproblemer»
#* Studentene nevner kanskje ko-morbide lidelser til forskjell:
#*> Hvis ''en gitt diagnose'' (indekssykdom) foreligger, vil'' andre samtidige diagnoser''/ helseproblemer være komorbide lidelser. «Typisk komorbide lidelser som forekommer sammen med hjerte-karsykdom er diabetes og depresjon»
#* Obs Andre forelesere definerer komorbiditet som følgetilstander av indeks-sykdom. Det er ikke galt men en litt annen definisjon enn den mer epidemiologiske «samtidige tilstander til en indekssykdom» som ikke innebærer henvisning til årsakssammenheng.
# Modellen for allostatisk overbelastning tilsier at sterke og/eller vedvarende trusler mot et individs eksistens og integritet kan etter hvert føre til utmattelse av kroppens fleksibilitet. Påkjenninger som i vår kultur karakteriseres som ''fysiske'' (f.eks. under-/over-/feilernæring, forurensning, søvnmangel, infeksjoner, støy) viser seg å konvergere på samme fysiologiske «nivå» som belastninger vi tradisjonelt omtaler som ''psykiske'' (f.eks. et liv preget av trusler, neglekt, krenkelser eller overveldende omsorgsbyrder). Begge former for påvirkning kan lede til bl.a. autonom dysfunksjon, endringer i immunforsvaret, kronisk lavgradig inflammasjon, endokrine forstyrrelser og raskere cellealdring målt på blant annet telomernivå.
#* Modellen for allostatisk overbelastning muliggjør en forståelse av sammensatte bilder av feil og svikt som tradisjonelt har vært oppfattet som samtidige, men ulike sykdommer, med andre ord såkalt ko- og multi-morbiditet.
#*> “Årsaker bak årsakene” (begrep brukt av M Marmot); kronisk stress, avmakt, sosial ufordelaktighet. Sykdommer «klumper seg sammen», grensen fysiske/psykiske lidelser viskes ut. Jfr allostasebegrepet omtalt tidligere i oppgaven. Oftest en klar sosial gradient i kompleks sykdom – det gjelder også uheldig livsstil. Her kan vi bygge faglige broer mellom klinisk allmennmedisin og sosialmedisin, forebygging og helsefremming som undervises av andre, men basert på samme tenkning
#* Begrepene PNI og PNEI (psyko-nevro-(endokrino)-immunologi) kan godt bli nevnt, men er ikke forutsetning for full score.
# Alder og sosioøkonomisk status
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
* 1 poeng for rett definisjon av allostatisk overbelastning. Vekten legges på meningsinnholdet i definisjonen.
* 1 poeng for rett definisjon av multimorbiditet. Om de i stedet definerer komorbiditet gir dette ikke poeng.
* 3 poeng for en forklaring som viser at modellen for allostatisk overbelastning og sammenheng med multimorbiditet. For full skår skal det være med at både fysiske og psykiske påkjenninger er relevante.
* ½ poeng for hver av alder og SES
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Lise på 27 år kommer til deg på legekontoret for en ø. hjelp time torsdag etter lunsj. Hun hinker inn fra venterommet, forklarer at hun falt på ski onsdag kveld og at hun etter dette ikke klarer å gå på foten. Ved nærmere anamnese og klinisk undersøkelse får du fram et supinasjonstraume i høyre ankel og et klinisk bilde av distorsjon i høyre ankel uten klar frakturmistanke. Du informerer henne om din vurdering og anbefaler henne fysioterapi. Lise syns det var litt flaut å skulle levere sykmelding allerede 5 uker etter hun begynte i sin aller første jobb som ferdig sykepleier. Hun spør om hun trenger sykmelding.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du har nå rollen som medisinsk sakkyndig ovenfor NAV. Det er flere kriterier som må være oppfylt for at Lise skal kunne få sykepenger. Hvilke vurderinger må du gjøre med tanke på sykmelding?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De medisinske årsaksforholdene har du allerede vurdert for den aktuelle problemstillingen, jfm. vignetten, men din medisinske vurdering må dokumenteres i journal. I tillegg er det viktig å innhente informasjon om arbeidets krav for å vurdere arbeidsuførhet med tanke på den aktuelle jobben.
Medisinsk årsak, ankeldistorsjon, er mulig grunnlag for arbeidsuførhet på grunn av redusert gangfunksjon. Hvis arbeidets art tilsier at hun lett kan tilrettelegge jobbhverdagen slik at hun slipper å stå/gå og periodevis kan sitte med foten høyt, vil arbeidssituasjonen ikke forverre helsetilstand og helbred. Hun kan i så fall være i arbeid og skal ikke sykmeldes.
Utfyllende informasjon:
Sykepenger reguleres i folketrygdloven §8 hvor formålet er å gi kompensasjon for bortfall av arbeidsinntekt for yrkesaktive medlemmer som er arbeidsufør på grunn av sykdom eller skade (§8-1). For at Lise skal få utbetalt sykepenger er det flere forhold som må være oppfylt og vurdert iht. folketrygdeloven (se nedenfor. I rollen som «medisinsk sakkyndig» skal du vurdere:
# §8-4; Arbeidsuførhet: Sykdom eller skade, dvs. medisinsk årsak til arbeidsuførhet, kreves for å ha krav på sykepenger.
# §8-7; Dokumentasjon av arbeidsuførhet: For å få sykepengeutbetaling fra NAV kreves en legeerklæring (sykmelding) hvor vurderingen
## «... skal ta utgangspunkt i en funksjonsvurdering»
## «Legen skal alltid vurdere om medlemmet kan være i arbeid eller arbeidsrelativt aktivitet.»
I tillegg ligger ikke-medisinske krav i folketrygdloven, men dette er det ikke primært legen som skal vurdere, og dette forventes derfor ikke i svaret fra studentene:
* §8-2; opptjeningstid: Lise må ha vært i arbeid i 4 uker før hun skadet seg for at hun skal ha rett på sykepenger fra NAV. Dersom Lise f.eks. har vært fulltidsstudent og startet i jobb for kun 14 dager siden vil hun ikke fylle lovkravet. Dette forholdet vurderer NAV. Legen gjør i prinsippet kun medisinske vurderinger og kan skrive en sykmelding uansett, men det kan være greit både for legen og Lise å vite om dette.
* §8-10; Sykepengegrunnlag: Sykepengegrunnlaget utregnes forskjellig for arbeidstakere og selvstendig næringsdrivende. Dersom Lise f.eks.er selvstendig næringsdrivende, for eksempel musiker, må hun selv dekke arbeidsgiverperioden og får kun ca. 66% dekket ved sykmelding deretter med mindre hun har tegnet tilleggsforsikring. Dette vurderer NAV, men det kan være greit for legen å vite for å kunne ta best mulig vare på Lise
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det er kun de medisinske kravene som gir poeng, men dersom studentene også nevner momentene under pkt. 3 og 4 bør det trekke opp ved tvil i den helhetlige vurderingen. Det forventes ikke at studentene angir paragrafer i lovteksten.
__For å få 3 poeng må studentene resonere iht. punkt 1 og 2__, dvs. medisinsk vurdering av sykdom/skade og om den medisinske tilstanden gir en funksjonsnedsettelse som fører til arbeidsuførhet. ''Funksjonsvurdering i relasjon til vurdering av jobbkrav og mulighet for å være i arbeid må være nevnt''. Det viktigste vurderingsgrunnlaget studentene må få fram her er hvilke jobbkrav som stilles i relasjon til den reduserte funksjonen.
Hovedmomentene er følgende:
* Sykdomsvilkåret
* Funksjonsvurdering
* Nedsatt arbeidsevne i aktuelt yrke
* Årsakssammenheng
Sensurering av oppgave 1 og 2 må sees i sammenheng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Lise på 27 år kommer til deg på legekontoret for en ø. hjelp time torsdag etter lunsj. Hun hinker inn fra venterommet, forklarer at hun falt på ski onsdag kveld og at hun etter dette ikke klarer å gå på foten. Ved nærmere anamnese og klinisk undersøkelse får du fram et supinasjonstraume i høyre ankel og et klinisk bilde av distorsjon i høyre ankel uten klar frakturmistanke. Du informerer henne om din vurdering og anbefaler henne fysioterapi. Lise syns det var litt flaut å skulle levere sykmelding allerede 5 uker etter hun begynte i sin aller første jobb som ferdig sykepleier. Hun spør om hun trenger sykmelding.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft hvilke alternativer til 100 % sykmelding som kan være aktuelle i dette tilfellet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Følgende momenter kan drøftes:
# Tilrettelegging mulig uten behov for sykmelding?
# Avventende sykmelding
# Gradert sykmelding
# Man kunne også tenke seg at Lise kunne ta ut egenmelding, f.eks. til over helgen (to eller tre dager avhengig av om hun har en jobb med planlagt arbeidstid på lørdag) og ta kontakt på mandag hvis hun fremdeles opplever behov for sykmelding. Etter bare 5 uker i jobb, har hun ikke opparbeidet rett til egenmelding. Se veilederen.
# Ordningen med «reisetilskudd» fra NAV kan også nevnes selv om NAV ikke dekker slike kostnader i arbeidsgiverperioden. Arbeidsgiver må vurdere mulighetene, se veilederen.
(Lise syns det var litt flaut å skulle levere sykmelding allerede 5 uker etter hun begynte i sin aller første jobb som ferdig sykepleier. Hun valgte derfor å halte seg inn i den nye jobben. Med litt tilrettelegging fra arbeidsgiver i starten gikk det seg til fint.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hvert alternativ iht. pkt. 1-5, til sammen maks 4 poeng
Det er ikke nødvendig å diskutere retten til egenmelding.
Det forventes ikke at studentene angir paragrafer i lovteksten.
Sensurering av oppgave 1 og 2 må sees i sammenheng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
3 år senere har du Lise til svangerskapskontroller. Hun er gravid med tvillinger. Hun var fryktelig kvalm i første trisemester. Hun er nå 5 måneder på vei og sier hun er sliten av å gå nattevakter. Hun tar opp spørsmålet om sykmelding
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Drøft kort forhold du //spesielt// må vurdere ved spørsmål om sykmelding av gravide?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Kan det være snakk om et Fosterskadelig arbeidsmiljø? Er det aktuelt å vurdere Svangerskapspenger framfor sykepenger?
#* Svangerskapspenger gis der visse forhold i arbeidsmiljøet (av fysisk, kjemisk, psykisk eller organisatorisk art) kan være skadelige for fosteret).
#* Attesteres av lege eller jordmor på skjema 474b # Er det risikosvangerskap (eks. flerlinger) som tilsier lavere terskel for sykemelding?
# Ordinære kriterier for sykmelding gjelder, det må vurderes om pasienten har vanlige plager eller sykdom.
# Kan det tross svangerskap også være positive helseeffekter av å holde seg i jobb?
(Se helsedirektoratets veileder for spesielle og generelle betraktninger)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Elementer i besvarelsen gir 1,5 poeng for hver av kategoriene ovenfor som dekkes, til sammen maks 4,5 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I en alder av 38 år har Lise 3 barn, er skilt og har utviklet diffuse helseplager, bla. fatigue, magesmerter, smerter ulike steder i kroppen og kroniske søvnvansker. Din medisinske utredning har ennå ikke avdekket noen spesifikk medisinsk tilstand som kan forklare helheten av plager. Etter en meniskoperasjon med påfølgende sykmelding klarer hun imidlertid ikke å komme tilbake til jobb. Etter 9 måneder med 100% sykemelding pga. sammensatte plager får du overtalt henne til å prøve gradert sykmelding. Du tviler imidlertid nå på at hun vil returnere til 100% jobb før «sykepengeåret» er omme.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Du har igjen rollen som medisinsk sakkyndig ovenfor NAV. Hvilke vurderinger må du gjøre når hun nå vurderer å søke arbeidsavklaringspenger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Følgende momenter bør være med:
# Medisinsk vurdering vedrørende hvorvidt sykdom, skade og/eller lyte er vesentlig årsak til den nedsatte arbeidsevnen («årsaks kriteriet»)
# Medisinsk vurdering av aktivt behandlingsbehov og prognosen ved medisinsk behandling i relasjon til (økt) arbeidsfunksjon («behandlingskriteriet»). (Det kreves utsikt til bedring arbeidsevnen for å få AAP, enten som følge av medisinsk behandling og/eller ved tiltak fra NAV)
# I tillegg til årsaks og behandlingskriteriene, kreves det at arbeidsevnen er nedsatt med minst 50% for ethvert yrke. Denne vurderingen er det i prinsippet NAV som gjør, men for de fleste medisinske resonnement kan og bør sykdom, skade eller lyte relateres til grad av nedsatt funksjon, herunder arbeidsfunksjon. I det minste bør det framgå et resonnement rundt medisinsk grunnlag for pasientens funksjonsnedsettelse som er godt nok til at NAVs saksbehandlere / Rådgivende overlege i NAV kan gjøre en vurdering.
Utfyllende informasjon:
Arbeidsavklaringspenger reguleres i folketrygdelovens kapittel 11. Fra lovteksten fremgår mange krav som må være oppfylt for at medlemmet skal ha krav på AAP, hvorav følgende er mest relevant for resonnement rundt rollen som medisinsk sakkyndig:
# ''§11-5. Nedsatt arbeidsevne'' – krav til årsakssammenheng Det er et vilkår for rett til arbeidsavklaringspenger at medlemmet har fått arbeidsevnen nedsatt med minst halvparten. Sykdom, skade eller lyte må være en vesentlig medvirkende årsak til den nedsatte arbeidsevnen. Ved vurderingen av om arbeidsevnen er nedsatt, skal det blant annet legges vekt på helse, alder, evner, utdanning, yrkesbakgrunn og arbeidsmuligheter på steder der det er rimelig at medlemmet tar arbeid.
# ''§11-6. Behov for bistand til å skaffe seg eller beholde arbeid''. Det er et vilkår for rett til arbeidsavklaringspenger at medlemmet for å skaffe seg eller beholde arbeid som han eller hun kan utføre
#* har behov for aktiv behandling, eller
#* har behov for arbeidsrettet tiltak, eller
#* etter å ha prøvd tiltakene etter bokstav a eller b fortsatt anses for å ha en viss mulighet for å komme i arbeid, og får annen oppfølging fra Arbeids- og velferdsetaten.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,5 poeng for hvert hovedmoment (punkt 1-3).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter å ha vært i allmennpraksis i 15 år, kjenner du behov for litt forandring og tar et vikariat som rådgivende overlege i NAV. Den første saken din gjelder en søknad om AAP. Saken minner deg om Lise som fikk innvilget 100% AAP like før du fikk en vikar inn i praksisen din, men i denne saken vurder du at vilkårene for AAP ikke er oppfylt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Nevn alternative økonomiske støtteordninger for livsopphold som kan være aktuelle for NAV å vurdere selv om det gis avslag på AAP.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Statlige ytelser:
# Uføretrygd
# Tiltakspenger (Ytelse til livsopphold og kan gis for dager medlemmet deltar på arbeidsrettede tiltak i regi av NAV)
# Friskmelding til arbeidsformidling/ dagpenger
Kommunale ytelser:
# Sosialstønad (Hjemlet i sosialtjenesteloven: behovsprøvd økonomisk sikring til livsopphold uten krav til dokumenter sykdom som årsak eller at arbeid er målet.)
# Kvalifiseringsprogrammet (Hjemlet i sosialtjenesteloven: oppfølging og arbeidstrening hvor målet er å komme i arbeid eller aktivitet)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per riktig svar, maks 2 poeng totalt. Det er nok å nevne ordningen uten lovhjemmel
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death NEJM 2022 doi: DOI: 10.1056/NEJMoa2208375|https://doi.org/10.1056/NEJMoa2208375]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Formuler forskningsspørsmålet i denne studien presist
# Hvordan vil du kort oppsummere resultatene av studien?
# Beskriv styrker og svakheter med studien
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Har friske nordeuropeiske menn og kvinner mellom 55 og 64 år som ble invitert til screening med koloskopi redusert 10-års risiko for forekomst og død av kolorektal kreft sammenlignet med de som ikke ble invitert til screening?
# ''Hovedfunn'': denne type screening reduserer hyppigheten av kolorektalkreft, men resultatene for årsakspesifikk dødelig av kolorektalkreft og total dødelighet er uavklart (bifunn)
# Styrker og svakheter
#* ''Styrker'': Randomisering for å unngå konfundering, pragmatisk design som mimikerer et populajonsbasert screeningprogram, og analysemetoder som inkluderer intention to screen (ITT) og adekvate per protokoll analyser.
#* ''Svakheter'': Betydelige frafall knyttet til manglende deltagelse og at betydelig mengde data fra Nederland ikke kunne innhentes (pga GDPR). Frafall kan gi bias (spesielt i per protokoll-analyser) og vil også redusere statistisk styrke. Annen svakhet vil kunne være lav styrke knyttet til oppfølgingstid og antall screenede. Her vil også andre forhold kunne betegnes som styrker og svakheter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Har friske nordeuropeiske menn og kvinner mellom 55 og 64 år som ble invitert til screening med koloskopi redusert 10-års risiko for forekomst og død av kolorektal kreft sammenlignet med de som ikke ble invitert til screening?
#* Poeng: 1 poeng ved å ta de fleste elementene, 0,5 poeng hvis en formulerer spørsmålet lite presist (feks: reduserer screening med koloskopi risikoen for å få eller død av kolorektalkreft?).
# Kandidaten må nevne at studien viser at denne type screening reduserer hyppigheten av kolorektalkreft som hovedfunn, og i tillegg at resultatene for årsakspesifikk dødelig av kolorektalkreft og total dødelighet er uavklart.
#* Alle tre må være med for å få full score (1p), hvis bare deler av dette er nevnt får de 0,5 p.
# Relevante styrker med studien er randomisering for å unngå konfundering, pragmatisk design som mimikerer et populajonsbasert screeningprogram, og analysemetoder som inkluderer intention to screen (ITT) og adekvate per protokoll analyser. Eksempler på svakheter er det betydelige frafallet knyttet til manglende deltagelse og at betydelig mengde data fra Nederland ikke kunne innhentes (pga GDPR). Annen svakhet vil kunne være lav styrke knyttet til oppfølgingstid og antall screenede. Her vil også andre forhold kunne betegnes som styrker og svakheter, men flere av de ovennevnte bør nevnes for å få full score.
#* Hvis kandidaten er i stand til å peke på minst en relevant styrke og en svakhet, gis 0,5p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Screening kan avdekke sykdom på et tidlig stadium og gi bedre prognose for pasienten. Samtidig kan man også avdekke mindre alvorlige tilfeller av sykdom hvor man kanskje kun oppnår behandlingens eventuelle negative bivirkninger uten særlig helsegevinst. I denne randomiserte studien har man sett på effekten av screening for kolorektalkreft.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hvilke forutsetninger og prinsipper bør legges til grunn for innføring av screening generelt?
# Hvilke avveininger bør man gjøre for å vurdere hensiktsmessigheten av screening for denne kreftformen spesielt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Her er det relevant å oppgi noen av WHO eller Helsedirektoratet sine prinsipper for screening;
#* Sykdommen må være et viktig helseproblem.
#* Sykdommen må være godt definert og dens naturlige forløp bør være tilstrekkelig forstått
#* Det må finnes en symptomfri fase hvor det er mulig å påvise sykdommen
#* Det må finnes effektiv behandling, som er mer effektiv i tidlig fase av sykdommen
#* Det må finnes en test som er akseptabel for befolkningen og har høy pålitelighet. Merk at det ikke fins krav om at testen skal være billig eller at den skal gi den endelige diagnosen.
#* Det må finnes et system (helsevesen) som kan gi nødvendig oppfølging til personer som plukkes ut ved screening
#* Kostnader må stå i rimelig forhold til gevinst. Kostnader ved screening er både penger/ressurser og medisinske/menneskelige. Her må bruk av samfunnets ressurser til screening versus andre viktige formål vurderes.
# Peke på kost-nytteverdi av å innføre screening for kolorektalkreft. Kolorektalkreft er en av våre vanligste kreftformer, både når det gjelder forekomst og død, og er utvilsomt et viktig helseproblem. Denne kreftformen har definerte forstadier som kan påvises og behandles, slik at det er mulig å forebygge sykdom og død. Flere tester er aktuelle: blod i avføring og ulike grader/nivåer av skopi. Det kan diskuteres om full koloskopi er en akseptabel test for befolkningen, dette vil utrullingen av denne screeningmetoden i Tarmkreftscreeningen kunne si noe om i løpet av noen år, hvor lav deltakelse kan være et tegn på at testen oppleves som for ubehagelig. Utbygging av koloskopi-kapasiteten er nødvendig i Norge før denne screeningmetoden kan brukes overalt. Mulig gevinst er forebygging av kolorektalkreft og død av kolorektalkreft. I en kost-nytte-analyse vil også andre uheldige konsekvenser av kolorektalkreft telle i det totale regnestykket (sykelighet/ressursbruk i helsetjenesten/tap av arbeidskraft etc...) Mulige uheldige virkninger av screeningen er direkte komplikasjoner av koloskopi, bekymring, overdiagnostikk med risiko for overbehandling og bivirkninger av slik behandling. I tillegg kommer risiko for forsinket diagnose ved falske negative screeningfunn
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Her er det relevant å oppgi de fleste av WHOs og ev. Helsedirektoratets prinsipper for screening for å få 1,5 poeng. 1 poeng hvis minst tre relevante prinsipper er nevnt.
# Kandidaten bør peke på kost-nytteverdi av å innføre screening for kolorektalkreft og om prinsipper for screening er oppfylt. Kandidaten gis fra 0,5 p til 1.5 poeng avhengig av om vedkommende gir en balansert fremstilling av fordeler og mulige ulemper. Gis ikke poeng hvis en bare vektlegger fordeler eller ulemper med screening.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Diskuter kort bruk av årsaksspesifikk død av kolorektalkreft og total død som utfallsmål med tanke på å estimere nytteverdi av screening for kolorektalkreft?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Ved effektiv forebygging av kolorektalkreft (insidens) vil en på sikt forvente effekt også for årsaksspesifikk dødelighet. For denne studien vil begrenset statistisk styrke (som igjen avhenger av studiestørrelse og frafall), forekomsten av kolorektalkreft og oppfølgingstid være begrensende faktorer for å studere årsakspesifikk dødelighet for kolorektalkreft.
På den den andre siden vil det styrke evidensen for nytte av screening hvis en fant en tydelig forskjell også på årsakspesifikk dødelighet av kolorektalkreft. Årsaksspesifikk dødelighet vil derfor ofte være godt egnet som utfallsmål ved tilstrekkelig statistisk styrke.
Fordelen med å inkludere totaldød som utfall, er imidlertid at det rommer uønskede virkninger av screeningen (f eks død av behandlingskomplikasjoner) i tillegg til de ønskede. Når det gjelder total død, vil den lille andelen som dør av kolorektalkreft gjøre det vanskelig å bruke totaldød som utfallsmål fordi andre dødsårsaker vil skape mye støy (=tilfeldig variasjon).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Årsaksspesifikk død av kolorektalkreft : 0.5 poeng hvis en nevner at årsaksspesifikk dødelighet er et relevant utfallsmål og at det vil kunne styrke evidensen for screening, og 0,5 poeng hvis en nevner at statistisk styrke kan være utfordrende
Total død: Her bør en nevne at det er utfordrende å studere totaldød når dødeligheten av kreftformen utgjør en liten andel av alle dødsfall (1 poeng). Bør veie opp å nevne at totaldød også inkluderer mulige uheldig konsekvenser av screening, men det er feil å hevde at det kun er totaldød som avgjør om screening er hensiktsmessig.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bare 42 % av de som ble invitert til screening ble faktisk screenet. I artikkelen er det gjort både intention to treat -analyse (intention to screen i denne studien) og en per protokoll-analyse.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er en intention to treat-analyse?
# Hva er en per protokoll-analyse?
# Hvordan vil du fortolke resultatet av per-protokoll-analysen i denne studien sammenliknet med ITT-analysen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Intention to treat-analyse (ITT) er at man analyserer alle deltagerne i studien på grunnlag av hvilke(n) gruppe en ble randomisert til (i denne studien tilsvarer det om en ble randomisert til å bli invitert til screening eller ikke). Dette gjøres for å unngå bias. ITT estimerer effekten av allokering («altså invitasjon til screening») og ikke effekten av behandling eller screening i seg selv.
# Per-protokoll-analyse er et forsøk på å estimere effekten av selve behandlingen/screeningen. Ofte gjøres dette ved en sammenligning av behandlingsgruppene som inkluderer bare de pasientene som gjennomførte studien slik de var randomisert (fulgte protokoll).
# Ulempen med ITT er at resultatet er studie- og populasjons-spesifikt, ofte gir et konservativt effektestimat og avhenger av deltagernes vilje og evne til å gjennomføre studien etter protokollen. ITT-analyser vil kunne undervurdere negative effekter av screening eller behandling. Per-protokoll-analyse er derimot et forsøk på å estimere effekten av selve behandlingen. Noe som ofte vil kunne være relevant for personen (individet) som skal screenes. Per protokoll-analysen i denne studien ga et sterkere effektestimat enn ITT.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Intention to treat-analyse er at man analyserer alle deltagerne i studien på grunnlag av hvilke(n) gruppe en ble randomisert til (i denne studien tilsvarer det om en ble randomisert til å bli invitert til screening eller ikke). 1p
# Per-protokoll-analyse er et forsøk på å estimere effekten av selve behandlingen. Ofte gjøres dette ved en sammenligning av behandlingsgruppene som inkluderer bare de pasientene som gjennomførte studien slik de var randomisert (fulgte protokoll). 1p
# Ulempen med ITT er at resultatet er studie- og populasjons-spesifikt, ofte gir et konservativt effektestimat (spesielt uheldig for negative effekter) og avhenger av deltagernes vilje og evne til å gjennomføre studien etter protokollen.0,5 poeng Per-protokoll-analyse er derimot et forsøk på å estimere effekten av selve behandlingen, noe som ofte vil kunne være relevant for personen (individet) som skal screenes. En svakhet med per protokoll-analyser er at de kan gi bias (ofte kalt selvseleksjon) fordi det ikke er tilfeldig hvem som velger å møte til screening (særlig slik det er analysert i denne studien). 0,5 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Number needed to screen (mest kjent som number needed to treat) i denne studien var 445 (95%CI, 270 to 1429).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva betyr tallet 455 i denne sammenhengen og hvordan beregnes det?
# Vil oppfølgingstiden i denne studien ha noe å si for tolkningen av «number to invite to undergo screening» i denne studien? Begrunn svaret kort.
# Hvilke eventuelle effekter av screening fanges ikke opp av tallet 455?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Det betyr at en basert på resultatene i denne studien (gitt oppmøte og oppfølgingstid) vil måtte invitere 455 personer for å forebygge ett tilfelle av kolorektalkreft. Er en form for det som vanligvis kalles number needed to treat (NNT). I denne studien ble dette beregnet som 1 delt på forskjellen i absolutt risiko (risikodifferansen) for kolorektalkreft mellom inviterte og ikke inviterte.
# Insidensandelen (risiko) er avhengig av oppfølgingstid og risikodifferansen vil som regel øke med økende oppfølgingstid hvis intervensjonen har effekt. Hvis oppfølgingstida i denne studien var kortere, ville «number to invite» øke da effektestimatet i denne studien endret seg betydelig gjennom oppfølgingstiden med kryssende overlevelseskurver for gruppene.
# Andre gevinster av screening enn redusert forekomst fanges ikke opp i dette tallet, heller ikke uønskede effekter. Eksempler på slike kan være forebygging av mer omfattende inngrep (f.eks. stomi), endring i livskvalitet og funksjonsnivå og samfunnskostnader.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Det betyr at en basert på resultatene i denne studien (gitt oppmøte og oppfølgingstid) vil måtte invitere 455 for å forebygge ett tilfelle av kolorektalkreft. (0,5 p) Er en form for det som vanligvis kalles number needed to treat (NNT). I denne studien ble dette beregnet som 1 delt på forskjellen i absolutt risiko (risikodifferansen) for kolorektalkreft mellom inviterte og ikke inviterte. (0,5 p)
# Insidensandelen (risiko) er avhengig av oppfølgingstid (1p) og risikodifferansen vil som regel øke med økende oppfølgingstid hvis intervensjonen gir effekt. Hvis oppfølgingstid i denne studien var kortere, ville «number to invite» øke da effektestimatet i denne studien endret seg betydelig gjennom oppfølgingstiden med kryssende overlevelses kurver for gruppene.
# Andre utfall som ikke måles vil også kunne være relevante. Forebygging av mer omfattende inngrep (f.eks. stomi). Andre eksempler kan være livskvalitet, funksjonsnivå og samfunnskostnader. Her bør kandidaten nevne at det finnes andre gunstige og ugunstige effekter enn hyppighet av kolorektalkreft som ikke inngår i NNT (0,5 p)- kandidaten bør nevne flere slike for å få full score som er 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
På legekontoret der du jobber møter du Sara, en 28 år gammel førstegangsgravid kvinne som kommer til første svangerskapskontroll sammen med barnefar. Hun er nå i uke 7, er tidligere frisk og bruker ingen medisiner. Hun jobber som flyvertinne.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er hensikten med førstegangskontroll av gravide?
# Beskriv kort innholdet for første svangerskapskontroll for Sara?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Hensikten med den første samtalen tidlig i svangerskapet er å identifisere behov for veiledning, støtte og for å oppmuntre til sunne levevaner og å avdekke risikosvangerskap.
# Første svangerskapskontroll bør inneholde:
#* Systematisk anamneseopptak og utfylling av Helsekort for gravide (Inkl svangerskapslengde og beregnet termin, tidligere svangerskap inkl utfall, familieanamnese, sosiale forhold, vold i nære relasjoner, somatisk sykdom med betydning for svangerskap, psykiske lidelser, medikamenter, …)
#* Samtale om livsstil (kosthold, nikotinbruk, fysisk aktivitet)
#* Screening/blodprøver/rutineundersøkelser (cytologi hvis indisert, blodtyping, Hb, ferritin, hepatitt, HIV, syfilis, blodtrykk, høyde og vekt)
#* Informasjon til kvinnen (om svangerskapsomsorgen, veiledning og støtte for gode levevaner)
#* Henvise til UL
Kilde NEL: [[Oversikt over anbefalte undersøkelser og innhold i konsultasjonene|https://legehandboka.no/siteassets/pdf/algoritme-oversikt-over-anbefalt-innhold-i-svangerskapsomsorgen-pdf]]
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Det må utvises skjønn med tanke på hvordan formålene er formulert. Det gis 0.5 p for råd/informasjon og 0.5 p for å identifisere risikosvangerskap.
# 0.5p for hver av de 5 punktene, men maks 2 poeng. Det kreves ikke detaljert oversikt over for eksempel hvilke blodprøver som bør tas eller hvilke tema som bør diskuteres.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
De siste to ukene har Sara blitt tiltagende kvalm. Hun har gått ned 2 kg, får i seg lite mat. Siste 24 timer har hun kastet opp 5-6 ganger og vært kvalm og hatt brekninger nesten hele tiden. Hun sier hun ikke klarer å jobbe.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Beskriv kort hvordan du avklarer hvor alvorlig kvalmen hennes er.
# Hvilke behandlingsalternativ foreligger, og hva ville du valgt? Begrunn kort
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Anamnese: Vekttap (2kg), hyppig oppkast/brekninger og nedsatt form (klarer ikke å jobbe).
#* Vignetten inneholder ikke sikre opplysninger om væskeog elektrolyttforstyrrelser, men hun er sannsynligvis dehydrert med såpass hyppig oppkast og at hun har fått i seg lite mat.
#* For å gradere kvalmen kan man bruke SUKK-score
#* Det bør tas blod og urinprøver. Forslag fra NEL:
#** Hb, EVF (Hb er ofte forhøyet og kan være maskert som følge av fysiologisk hemodilusjon)
#** Na, K og ved lang varighet, Mg, P og Ca 8 (Elektrolyttforstyrrelser ved forstyrret væskebalanse)
#** Evt. ASAT, ALAT, LD, albumin (Leversykdom som årsak til kvalme og oppkast?)
#** Evt. TSH og FT4 (Ved klinisk mistanke om hypertyreose)
#** Urin: Ketoner, albumin, leukocytter og nitritt, dyrkningsprøve ved mistanke om infeksjon
# Behandling. Oppgaven spør om behandlingsmuligheter først, deretter om behandlingen for Sara. Behandlingsmuligheter:
#* Ikke-medikamentell behandling/tiltak:
#** Unngå kost eller andre faktorer som utløser kvalme
#*** Tung luft, sterke lukter, varme, høy luftfuktighet, høye lyder og lys i bevegelse, eller egen bevegelse (kjøre bil), er eksempler på dette
#** Kostråd, akupressur/ingefær kan forsøkes ved lett til moderat grad av svangerskapskvalme men har IKKE dokumentert effekt ved alvorlig svangerskapskvalme/hyperemesis
#** Sykmelding
#* Medikamentell behandling:
#** Medikamentell behandling kan forsøkes i allmennpraksis
#** Som regel velges antihistaminer (Postafen, Phenergan), ev. også pyridoksin (vitamin B6), dokumentasjonen er mangelfull
#* Henvisning til sykehuset (poliklinisk behandling eller innleggelse)
Behandling av Sara:
Sara har alvorlig kvalme/hyperemesis (SUKK-score 14) og må behandles deretter. Normalt sett vil dette innebære at hun trenger innleggelse eller henvisning til sykehuset for væske- og ev ernæringsbehandling, men det kan også være forsvarlig å forsøke med sykmelding og medisiner og ta henne tilbake til en snarlig kontroll før videre vurdering.
Definisjon av hyperemesis er: «Vedvarende kvalme, brekninger og oppkast i svangerskap som debuterer før 20 uker og fører til redusert allmenntilstand med dehydrering, vekttap, væske- og elektrolytt-forstyrrelser som ikke skyldes annen kvalmefrembringende sykdom». (Trovik et al 2020)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5p for anamnesen (studenten bør skjønne at kvinnen er dårlig), 0.5p for SUKK-score og 0.5p for blodprøver/urinprøver. Maks 1.5p på oppg A. Den nøyaktige SUKK-scoren kreves ikke og gir ingen poeng, men studenten skal vite at verktøyet finnes.
# Behandlingsmuligheter: 0.5 p for hver av de tre behandlingsmulighetene (ikkemedikamentell, medikamentell og akutt henvisning), maks 1p for delen om behandlingsmuligheter.
Tiltak for Sara:
Studenten bør kunne forskjell på emesis og hyperemesis, samt kunne forstå at Sara har hyperemesis. 0.5p for innleggelse /henvisning til sykehus og 0.5p for begrunnelse. Det gis tilsvarende poeng for medikamentell behandling med snarlig kontroll + begrunnelse dersom studenten skjønner at Sara har hyperemesis. Dersom studenten svarer kun ikke-medikamentelle tiltak gir det 0p. Svak/manglende begrunnelse gir også 0p. Maks 1p på oppg om behandling for Sara.
Maks poeng på B 2p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Sara bestiller ny time i uke 14. Hun forteller at kvalmen har gitt seg, men hun vil ikke fly lenger nå som hun er gravid og spør om sykmelding resten av svangerskapet.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan bør du håndtere denne forespørselen? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hun er ikke arbeidsufør på grunn av egen sykdom. Hun skal derfor ikke ha sykmelding.
Men hun har hun en jobb som potensielt kan utsette barnet for fare. Her er det litt kompliserte regler fra Luftfartstilsynet som studenten ikke trenger å kunne detaljert. Men det er rimelig å fylle ut skjema for skjema for tilrettelegging og omplassering ved graviditet (svangerskapspenger). Sara må levere dette til arbeidsgiver som må angi om det er mulig med tilrettelegging eller omplassering (for eksempel å settes på bakken med andre oppgaver). Dersom dette ikke er mulig må dette dokumenteres skriftlig, og den gravide kan da fremme krav om svangerskapspenger.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Begrunnet vurdering av svangerskapspenger gir 1.5p (Det kan ikke forventes at studentene har detaljert kunnskap om hvorvidt arbeid som kabinpersonale er skadelig eller ikke, men de skal kjenne til svangerskapspenger og vilkårene for denne ytelsen)
Bare svangerskapspenger uten begrunnelse gir 0.5p. Om studenten skriver sykmelding noen dager frem til avklaring er det i orden, men gir ikke poeng. Å godta sykmelding ut svangerskapet gir 0p
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I uke 24 kommer hun sendt fra jordmor for å ta glukosebelastning. Hun er etnisk norsk, har en kusine med diabetes type 1, men ingen andre i familien med diabetes. Før svangerskapet veide hun 65kg. Hun er 173cm høy. Undersøkelser i svangerskapet så langt har vært normale
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Diskuter kort fordeler og ulemper med glukosebelastning
# Skal hun i henhold til norske retningslinjer ta glukosebelastning? Begrunn svaret kort
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Fordeler og ulemper. Fordelen er å avdekke og behandle evt svangerskapsdiabetes for å redusere risiko for komplikasjoner. Ulempen er sykeliggjøring av friske gravide kvinner. Dessuten er testen der det må drikkes glucose ubehagelig for en del gravide samt tidkrevende da man bruker flere timer på dette.
# Skal Sara ta glukosebelastning?
#* Diagnostikk av og screening for svangerskapsdiabetes
#** Screening utføres i uke 24 - 28 ved en eller flere risikofaktorer:
#** Alder:
#*** > 25 år for førstegangsfødende
#*** > 40 år for flergangsfødende uten noen andre risikofaktorer
#** KMI > 25 kg/m² (pregravid vekt)
#** Alle gravide med etnisk bakgrunn fra Asia eller Afrika
#** Alle som har førstegradsslektninger med diabetes
#** For flergangsfødende:
#*** Tidligere påvist svangerskapsdiabetes eller
#*** Nedsatt glukosetoleranse eller
#*** Svangerskaps- og fødselskomplikasjoner som er assosiert med svangerskapsdiabeteseller
#*** Tidligere født barn med fødselsvekt > 4500 g
#* Ved mistanke om hyperglykemi i svangerskap eller svangerskapsdiabetes, f.eks. ved påvist glukosuri i svangerskap
#* Diagnostikk av diabetes mellitus i pasientgrupper der analyse av HbA1c ikke kan benyttes (jernmangelanemi, hemolytisk anemi, moderat eller alvorlig nyresvikt, kronisk malaria, større blødninger og blodtransfusjon siste måneder
#* Ikke-fastende glukose i venøst plasma er >11,0 mmol/L og
#** HbA1c < 48 mmol/mol (6,5%) eller
#** etterfølgende fastende plasma-glukose er < 7,0 mmol/L
Konklusjon: Ifølge dagens norske retningslinjer er det riktig å ta glucosebelastning. Men den eneste risikofaktoren hos Sara er at hun er >25 år (28 år), og denne anbefalingen er omdiskutert
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# 0.5p for reduksjon risiko, 0.5p for sykeliggjøring, 0,5 p for andre fordeler/ulemper (for eksempel kostnader, ubehag)
# 0.5p for å gjennomføre glucosebelastning + 0.5p for hvorfor. Dersom man velger å ikke ta testen, men begrunner godt for dette, gir dette 0.5p. Oppgaven spør ikke om alle risikofaktorer, og oppramsing av disse gir ingen ekstra poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
2 uker etter fødsel kommer kvinnen på en øyeblikkelig hjelp-time sammen med barnefaren. Hun forteller at fødselen gikk fint, hun fødte en frisk pike på 3250g. Men etter at barnet kom har hun følt seg sliten, tom og etter hvert trist. Gleden hun hadde forventet å kjenne på etter å bli mor har uteblitt. Amming har vært komplisert og til tider smertefullt, men hun fullammer barnet fortsatt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan er det riktigst å håndtere denne situasjonen med tanke på utredning, aktuelle diagnoser og tiltak?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Viktig med god ''anamnese'' der det utforskes mer hvordan hun har det, og hvilke symptomer hun har for å avgjøre om hun er «normalt» sliten etter svangerskap og fødsel eller om dette er sykelig. Det bør spørres om hjemmesituasjonen, søvn, blødning under fødsel og etterpå. Dessuten forventninger til barseltid, om hun har støtte av andre personer mm. Tett oppfølging (snarlig ny time) vil nok være viktig her.
# Orienterende ''blodprøver'' (Hb, ferritin, stoffskifte mm for å utelukke evt somatiske årsaker)
# Vurdere andre ''støttetiltak'' (Helsestasjon, andre kommunale tilbud, ammehjelp mm)
# Det må også ''vurderes svangerskapsdepresjon'', gjerne vha Edinburgh postnatal depresjonsskår (''EPDS'').
# (Å henvise til psykiatrisk poliklinikk kan bli aktuelt for kvinnen etterhvert, men litt tidlig å ta stilling til det enda. Vignetten inneholder heller ikke nok informasjon til å vurdere det sikkert.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 p for anamnesen, 0.5 p for lab, 0.5p for støttetiltak, 0.5 p for vurdering av svangerskapsdepresjon, og 0.5p for å nevne EPDS. Innholdet i EPDS gir ingen flere poeng. Henv DPS gir ikke poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 87 år gammel kvinne ble funnet liggende på golvet av hjemmesykepleien da de kom innom henne om morgenen. Hjemmesykepleien hadde hjulpet henne i seng kvelden før, men pasienten husker ikke hva som hadde skjedd etterpå. Du er LIS1 og tar imot henne i akuttmottaket samme formiddag.
Pasienten virker forvirret og klager over ryggsmerter. Hun gjør dårlig rede for seg og det er ingen pårørende som følger henne. Ifølge tidligere journal bor hun alene etter at ektefellen døde for to år siden, er tidligere røyker og pleier å drikke to glass vin daglig. Til vanlig går hun med stokk inne, men går sjelden ute alene.
Hun har fra før KOLS, gastroøsofageal reflukssykdom, diabetes type 2 og gjennomgikk et TIA-anfall tre år tidligere. Hun bruker amlodipin, acetylsalisylsyre, omeprazol, simvastatin og metformin tabletter og inhalasjonsbehandling med flutikasjon og salmeterol fast, samt salbutamol ved behov.
Funn ved somatisk undersøkelse: lukter av urin. Hjerterate 100, regelmessig, respirasjonsrate 18, oksygensaturasjon 89% på romluft, spredte krepitasjoner basalt over høyre lunge, ømhet over lumbalcolumna, problemer med å lene seg framover i sittende stilling pga. ryggsmertene. Normal kroppstemperatur, normalt blodtrykk og ingen fokalnevrologiske utfall.
Blodprøver:
| !Analyse | !Prøvesvar | !Referanseverdi |
| Hemoglobin | 10,1 g/dL | 11,7 - 15,3 g/dL |
| MCV (mean corpuscular volume) | 108 fL | 81-95 fL |
| Leukocytter | 14,2x10^^9^^/L | 4,1 - 9,8 x 10^^9^^/L |
| hvorav nøytrofile granulocytter | 85% | 39-73% |
| Trombocytter | 88 x 10^^9^^/L | 164-370 x 10^^9^^/L |
| Natrium | 133 mmol/L | 137-145 mmol/L |
| Kalium | 3,1 mmol/L | 3,5-4,4 mmol/L |
| Karbamid | 10,3 mmol/L | 3,1-7,9 mmol/L |
| Kreatinin | 188 umol/L | 45 - 90 µmol/L |
| Estimert GFR | 20 ml/min/1,73m^^2^^ | >90 ml/min/1,73m^^2^^ |
| Kalsium | 2,60 mmol/L | 2,15-2,51 mmol/L |
| Alanin transaminase (ALAT) | 66 U/L | 10-45 U/L |
| Bilirubin | 30 umol/L | 5-25 umol/L |
| Alkalisk fosfatase (ALP) | 654 U/L | 35-105 U/L |
| Albumin | 24 g/L | 34-45 g/L |
| C-reaktivt protein (CRP) | 88 mg/L | <5 mg/L |
| Etanol | 36 mmol/L | <2,2 mmol/L |
Røntgen thorax: sløret fortetning basalt høyre side.
Urin stix: positiv for protein og leukocytter, nitritt negativ.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke diagnoser bør ut fra det du vet så langt vurderes som årsak til ryggsmertene?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Kompresjonsfraktur (vanligste årsak ved nyoppståtte sterke ryggsmerter etter fall hos eldre)
* Diskitt (må alltid vurderes ved ryggsmerter og samtidig tegn til infeksjon. Rammer ofte lumbalcolumna. Ryggsmertene trenger ikke ha oppstått som følge av fallet; det er mulig at pasienten falt fordi hun var påvirket av infeksjon og ryggsmerter)
* Prolaps (forekommer også hos eldre, men er sjelden relatert til fall)
* Lungeemboli (kan gi redusert oksygensaturasjon, ryggsmerter som kan være respirasjonsavhengige og fall hos den skrøpelige)
* Pleuritt (kan gi respirasjonsavhengige ryggsmerter)
* Malignitet/metastaser eller myelom (mindre sannsynlige årsaker, men bør vurderes hvis smertene vedvarer og man ikke har funnet annen årsak)
* Pyelonefritt
* Referert smerte fra hjerteinfarkt, sykdom i galleveier
* Pancreatitt
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for hver av de to første punktene. De andre punktene gir 1/2 poeng hver, men maks to poeng totalt på oppgaven.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
En 87 år gammel kvinne ble funnet liggende på golvet av hjemmesykepleien da de kom innom henne om morgenen. Hjemmesykepleien hadde hjulpet henne i seng kvelden før, men pasienten husker ikke hva som hadde skjedd etterpå. Du er LIS1 og tar imot henne i akuttmottaket samme formiddag.
Pasienten virker forvirret og klager over ryggsmerter. Hun gjør dårlig rede for seg og det er ingen pårørende som følger henne. Ifølge tidligere journal bor hun alene etter at ektefellen døde for to år siden, er tidligere røyker og pleier å drikke to glass vin daglig. Til vanlig går hun med stokk inne, men går sjelden ute alene.
Hun har fra før KOLS, gastroøsofageal reflukssykdom, diabetes type 2 og gjennomgikk et TIA-anfall tre år tidligere. Hun bruker amlodipin, acetylsalisylsyre, omeprazol, simvastatin og metformin tabletter og inhalasjonsbehandling med flutikasjon og salmeterol fast, samt salbutamol ved behov.
Funn ved somatisk undersøkelse: lukter av urin. Hjerterate 100, regelmessig, respirasjonsrate 18, oksygensaturasjon 89% på romluft, spredte krepitasjoner basalt over høyre lunge, ømhet over lumbalcolumna, problemer med å lene seg framover i sittende stilling pga. ryggsmertene. Normal kroppstemperatur, normalt blodtrykk og ingen fokalnevrologiske utfall.
Blodprøver:
| !Analyse | !Prøvesvar | !Referanseverdi |
| Hemoglobin | 10,1 g/dL | 11,7 - 15,3 g/dL |
| MCV (mean corpuscular volume) | 108 fL | 81-95 fL |
| Leukocytter | 14,2x10^^9^^/L | 4,1 - 9,8 x 10^^9^^/L |
| hvorav nøytrofile granulocytter | 85% | 39-73% |
| Trombocytter | 88 x 10^^9^^/L | 164-370 x 10^^9^^/L |
| Natrium | 133 mmol/L | 137-145 mmol/L |
| Kalium | 3,1 mmol/L | 3,5-4,4 mmol/L |
| Karbamid | 10,3 mmol/L | 3,1-7,9 mmol/L |
| Kreatinin | 188 umol/L | 45 - 90 µmol/L |
| Estimert GFR | 20 ml/min/1,73m^^2^^ | >90 ml/min/1,73m^^2^^ |
| Kalsium | 2,60 mmol/L | 2,15-2,51 mmol/L |
| Alanin transaminase (ALAT) | 66 U/L | 10-45 U/L |
| Bilirubin | 30 umol/L | 5-25 umol/L |
| Alkalisk fosfatase (ALP) | 654 U/L | 35-105 U/L |
| Albumin | 24 g/L | 34-45 g/L |
| C-reaktivt protein (CRP) | 88 mg/L | <5 mg/L |
| Etanol | 36 mmol/L | <2,2 mmol/L |
Røntgen thorax: sløret fortetning basalt høyre side.
Urin stix: positiv for protein og leukocytter, nitritt negativ.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ytterligere undersøkelser eller prøver bør gjøres? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Glukose (må alltid undersøkes hos pasienter med forvirring eller redusert bevissthet)
* Sjekke for resturin med blærescanning, ultralyd eller engangskateterisering (urinretensjon må alltid utelukkes ved nyoppståtte forvirringstilstander)
* Urin dyrkning
* Blodkulturer (ikke bare med tanke på luftveisinfeksjonen; dette kan også være en diskitt)
* B12, folat, thyroideastatus (utredning av makrocytær anemi)
* EKG (pga. fallhistorikk; fallet kan skyldes arytmi)
* Røntgen av columna (hvis ikke kompresjonsfrakturer som passer med klinikken identifiseres, må man gå videre med MR eller CT av columna for å utelukke andre årsaker)
* CT caput bør vurderes (utelukke subduralblødning)
* Ortostatisk blodtrykksmåling (pga. fall)
* Ultralyd av abdomen for å undersøke nyrer og urinveier (pga. nyresvikt) og leveren (pga. avvikende leverprøver)
* 4AT som screeningtest på delirium (hun framstår forvirret)
* Anamnese fra pårørende for å avklare om forvirringstilstanden er nyoppstått og om det er mistanke om kognitiv svikt fra før
* Ernæringsscreening (lav albumin, drikker en del alkohol)
* Blodgass
* CK (mulig rabdomyolyse etter å ha ligget på gulvet)
* Amylase/lipase (alkoholforbruk risiko for pankreatitt)
* (CT thorax/abdomen kunne vært aktuelt som utredning av ryggsmerter, uavklart infeksjon og forhøyede lever/staseparametre, men pasienten har nyresvikt og har også brukt metformin fram til innleggelsen. Det er dermed ugunstig å gi kontrastvæske, i hvert fall til situasjonen er mer avklart.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for hvert av punktene over med relevant indikasjon (unntatt det siste om CT thorax/abdomen, som ikke gir poeng). Totalt kan det oppnås 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
En 87 år gammel kvinne ble funnet liggende på golvet av hjemmesykepleien da de kom innom henne om morgenen. Hjemmesykepleien hadde hjulpet henne i seng kvelden før, men pasienten husker ikke hva som hadde skjedd etterpå. Du er LIS1 og tar imot henne i akuttmottaket samme formiddag.
Pasienten virker forvirret og klager over ryggsmerter. Hun gjør dårlig rede for seg og det er ingen pårørende som følger henne. Ifølge tidligere journal bor hun alene etter at ektefellen døde for to år siden, er tidligere røyker og pleier å drikke to glass vin daglig. Til vanlig går hun med stokk inne, men går sjelden ute alene.
Hun har fra før KOLS, gastroøsofageal reflukssykdom, diabetes type 2 og gjennomgikk et TIA-anfall tre år tidligere. Hun bruker amlodipin, acetylsalisylsyre, omeprazol, simvastatin og metformin tabletter og inhalasjonsbehandling med flutikasjon og salmeterol fast, samt salbutamol ved behov.
Funn ved somatisk undersøkelse: lukter av urin. Hjerterate 100, regelmessig, respirasjonsrate 18, oksygensaturasjon 89% på romluft, spredte krepitasjoner basalt over høyre lunge, ømhet over lumbalcolumna, problemer med å lene seg framover i sittende stilling pga. ryggsmertene. Normal kroppstemperatur, normalt blodtrykk og ingen fokalnevrologiske utfall.
Blodprøver:
| !Analyse | !Prøvesvar | !Referanseverdi |
| Hemoglobin | 10,1 g/dL | 11,7 - 15,3 g/dL |
| MCV (mean corpuscular volume) | 108 fL | 81-95 fL |
| Leukocytter | 14,2x10^^9^^/L | 4,1 - 9,8 x 10^^9^^/L |
| hvorav nøytrofile granulocytter | 85% | 39-73% |
| Trombocytter | 88 x 10^^9^^/L | 164-370 x 10^^9^^/L |
| Natrium | 133 mmol/L | 137-145 mmol/L |
| Kalium | 3,1 mmol/L | 3,5-4,4 mmol/L |
| Karbamid | 10,3 mmol/L | 3,1-7,9 mmol/L |
| Kreatinin | 188 umol/L | 45 - 90 µmol/L |
| Estimert GFR | 20 ml/min/1,73m^^2^^ | >90 ml/min/1,73m^^2^^ |
| Kalsium | 2,60 mmol/L | 2,15-2,51 mmol/L |
| Alanin transaminase (ALAT) | 66 U/L | 10-45 U/L |
| Bilirubin | 30 umol/L | 5-25 umol/L |
| Alkalisk fosfatase (ALP) | 654 U/L | 35-105 U/L |
| Albumin | 24 g/L | 34-45 g/L |
| C-reaktivt protein (CRP) | 88 mg/L | <5 mg/L |
| Etanol | 36 mmol/L | <2,2 mmol/L |
Røntgen thorax: sløret fortetning basalt høyre side.
Urin stix: positiv for protein og leukocytter, nitritt negativ.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke behandlingstiltak bør iverksettes?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Antibiotika mot luftveisinfeksjon og muligens urinveisinfeksjon, vurderer tillegg av steroider pga. KOLS.
* Rehydrering og korreksjon av hypokalemi
* Stoppe metformin pga. nyresvikt, ved ev. behov for antidiabetika gi insulin inntil videre (til situasjonen er mer avklart)
* Smertestillende behandling
* Miljøtiltak for delirium (skjerming, hjelp til orientering, mobilisering, hjelp til å holde normal døgnrytme, besøk av pårørende hvis mulig, fastvakt ved behov)
* Mobilisering
* CIWA-skår
* (Osteoporoseprofylakse -startes ikke akutt, aktuelt etter hvert)
* (Tiamin og B-vitaminer hvis mistanke om sviktende ernæring forut for innleggelse eller alkoholmisbruk)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng per punkt over, maksimalt 3 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Pasienten fikk god behandling med flere ulike tiltak og var i begynnende bedring. Men om kvelden dagen etter innleggelse ble hun mer forvirret og utviklet visuelle hallusinasjoner. Ved undersøkelse hadde hun puls 102, oksygensaturasjon 92% på romluft og normal kroppstemperatur. Hun var skjelven og agitert, så det var bare mulig å gjennomføre en begrenset undersøkelse, men hun virket ikke respiratorisk besværet og abdomen var myk og uøm
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er den mest sannsynlige årsaken til denne forverringen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Akutt alkoholabstinens (som gir delirium tremens). (Blodprøvene ved innkomst viser høy MCV, lave trombocytter, lav albumin og påvirkede leverprøver forenlig med langvarig alkoholmisbruk. Det rapporterte daglige alkoholinntaket fra tidligere har vært høyt. Kvinner i alle aldre som drikker over 14 alkoholenheter ukentlig har høy risiko for alkoholrelaterte plager. Eldre har lavere toleranse enn yngre, men det finnes ikke aldersjusterte retningslinjer. Alkoholmisbruk hos eldre erkjennes ofte ikke og kan lett overses som en årsak til delirium.)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Alkoholabstinens og/eller delirium tremens gir 1 poeng. "Forverret delirium" uten angivelse av alkoholabstinens som årsak gir ikke poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Pasienten fikk god behandling med flere ulike tiltak og var i begynnende bedring. Men om kvelden dagen etter innleggelse ble hun mer forvirret og utviklet visuelle hallusinasjoner. Ved undersøkelse hadde hun puls 102, oksygensaturasjon 92% på romluft og normal kroppstemperatur. Hun var skjelven og agitert, så det var bare mulig å gjennomføre en begrenset undersøkelse, men hun virket ikke respiratorisk besværet og abdomen var myk og uøm
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilken behandling bør iverksettes nå?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Tiamin i høy dose intravenøst eller intramuskulært for å unngå å utvikle Wernicke-Korsakoffs syndrom pga. tiaminmangel utløst av alkoholisme
* Tilskudd av andre B-vitaminer (det kan oppstå mangel også på niacin)
* Systematisk observasjon av vitale mål og nedtrappingsregime med benzodiazepiner mot akutt alkoholabstinens
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Tiamin gir 1 poeng. Tilskudd med B-vitaminer gir 0,5 poeng. Observasjons- og nedtrappingsregime med benzodiazepiner gir 0,5 poeng. Maksimalt kan det oppnås 1 poeng.
Dersom studenten ikke har svart riktig på spørsmål 4, men angir relevant tiltak for det studenten har angitt som sannsynlig årsak gir dette 0,5 poeng (max 0,5 poeng).
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bente er sykepleier og 39 år gammel. Hun er alenemor med Martin, 7 år. Martin sin far utviklet et rusmisbruk, og etter flere turbulente år ble det brudd mellom dem for tre år siden. Han er for tiden i aktiv rus, og bidrar ikke med omsorgsoppgaver. Bente har anstrengt økonomi, og det skjer stadig at hun ikke har penger igjen når ny lønn kommer. Hun har en kredittkortgjeld på 20 000 kroner som hun håper å betale ned i løpet av ett år. Martin har astma, og relativt hyppige infeksjoner hvor hun må være hjemme med ham. Bente fikk da hun var 35 år gammel kreft i en eggstokk. Hun er operert, og har ikke fått tilbakefall så langt, hun går til kontroll med CT bilder hvert halvår. Etter kreftsykdommen opplever hun lavere energinivå enn tidligere.
De siste ukene har Bente blitt mer og mer sliten. Hun har fått vansker med å sove, og ligget mye våken på nettene. Hun føler seg trett på dagtid. Etter jobb har hun ligget mye og hvilt, og ikke klart å følge opp sønnen slik hun ønsker med lekser og hans aktiviteter. Hun kjenner seg nedtrykt og opplever lite glede. Hun har hatt perioder med hjertebank og urofølelse i brystet. Martin har også vært syk med feber og hoste, hvor hun har vært borte fra arbeid for å passe ham. Hun går så til deg som fastlege og ber om en «timeout» (hennes ord) fra jobb, altså om sykemelding.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke momenter taler ''for'' og hvilke momenter taler ''mot'', å gi henne sykemelding?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Taler for:
* Totalsituasjonen må vurderes. Fysiske og psykiske symptomer/sykdomstrekk som øker på over tid (sliten, nedtrykt, opplever lite glede)
* Hun beskriver redusert funksjonsevne på fritiden: klarer ikke å følge opp sønnen med lekser o.l, må hvile mye etter jobb. Funksjonsevne i forhold til jobb er lite beskrevet
* Bente viser tegn til sykdomsutvikling (foreløpig er vi i en utredningsfase og mange diagnoser er mulige for eksempel Fatigue - kreft - P02 - slitenhet - søvnvansker - depresjon - hvorav noen, som den siste, foreløpig er tentative) og en kort sykmelding kan være riktig i en fase der hun får hvilt seg, utredes for å utelukke annen underliggende sykdom og selv iverksetter tiltak som kan være til hjelp i hverdagen (mobilisere pårørende og eget nettverk).
* Pasienten forventer å få sykemelding i en eller annen grad, og vil oppleve sykemelding som en empatisk handling.
Taler imot:
* Underliggende sosiale årsaker (alene om omsorgsoppgaver, sykt barn). Ikke egen sykdom, men barnets sykdom.
* Jobbsituasjon er ikke beskrevet og det er ikke mulig å svare på om hun opplever funksjonsbegrensninger på jobb, evt om enkle tiltak på jobb kan avlaste situasjonen.
* Sykmelding i seg selv løser ikke de underliggende problemene. Fare for at det blir behov for en langtidssykmelding.
* Det er behov for langsiktige tiltak som kan snu utviklingen i Bentes totalsituasjon. Sykmelding vil kun være et kortsiktig tiltak og bør antagelig ikke brukes alene.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det ikke et klart fasitsvar, men det bør komme flere argumenter både for og imot. 0.5 poeng per moment, inntil 2 poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du har kartlagt Bentes hjemmesituasjon, økonomi og sykehistorie slik den er skissert over.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det andre momenter du trenger å vite noe om når du vurderer om du kan gi henne sykemelding, i så fall hvilke?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Man bør kartlegge funksjon og funksjonstap på jobb, hvilke oppgaver som er vanskelige å utføre, dessuten mulighet for tilrettelegging, om det har vært dialog med leder
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng for å nevne funksjon i arbeidssituasjon, 0.5 poeng for å nevne oppgaver i jobb og/eller tilrettelegging
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvis barnets sykdom her er hovedårsak til Bentes fravær fra jobb, hvilken ytelse kan da være aktuell? Begrunn svaret kort
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
''Omsorgsdager''. Se [[sykmelderveileder|https://www.helsedirektoratet.no/veiledere/sykmelderveileder/alternativer-til-sykmelding-tilrettelegging-egenmelding-pleiepengermfl/pleiepenger-og-omsorgspenger-ved-barnsbarnepasserssykdom-og-pleie-ved-livets-slutt]]. https://www.nav.no/omsorgspenger
Hvis det er snakk om kronisk sykdom kan det være aktuelt med: Utvidet antall omsorgsdager pga kronisk sykt barn. Foreldre som har et kronisk sykt eller funksjonshemmet barn kan ha rett til ekstra antall dager med omsorgspenger, for å ta seg av sitt syke barn. Forledrene må forhåndssøke på dette. Som lege må du i så fall skrive legeopplysninger på skjema NAV 09-06.09. Se sykmelderveilederen
''Pleiepenger'' er ikke aktuelt av flere årsaker, 1) fordi det ikke er dokumentert behov for kontinuerlig tilsyn og pleie og 2) det er ikke dokumentert oppfølging i spesialisthelsetjenesten (legeerklæring ved pleiepenger skrives av lege i spesialsithelsetjenesten).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for omsorgsdager eller utvidet antall omsorgsdager med begrunnelse, ½ poeng hvis bare utvidet antall omsorgsdager (uten begrunnelse) Kasuistikken spesifiserer ikke omfanget av barnets sykdom, både omsorgsdager eller utvidet antall omsorgsdager godtas derfor.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du utreder Bente med fysisk undersøkelse og blodprøver uten å få patologiske svar. Du gjør et psykiatrisk intervju og vurderer henne som moderat deprimert. Under intervjuet kommer Bente i svarene sine stadig tilbake til den vanskelige livssituasjonen, økonomien og til at hun generelt har lite energi. Etter 2-3 måneder blir søvnproblemene mer fremtredende. Bente jobber gradert og klarer 50% arbeid, et uttalt problem er at hun ikke får sove i flere dager etter at hun har hatt nattevakter.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke former for tiltak og behandling kan være aktuelle for Bente?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Oppfølgende samtaler med terapeutisk innhold, søvnhygiene.
* Hjelp til å håndtere hverdagsutfordringer.
* Økonomisk/gjeldsrådgivning
* Tilrettelegging på jobb, spesielt opp mot nattevakter.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hvert punkt inntil maks 1 ½ poeng. Tverrfaglig rehabilitering kan dekke flere av disse punktene, men dersom studenten skriver «tverrfaglig» uten å presisere hva som bør inngå i dette for denne pasienten, teller det som ett punkt (½ poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter ni måneder med sykemelding hvor forsøk på å jobbe mer enn 50% mislykkes flere ganger ønsker Bente å søke AAP. Hun er da i mindre grad deprimert, og sykemeldt under diagnose «P06 Søvnforstyrrelse». Hun ser på nattevakt som et hovedproblem, både fordi det er vanskelig å forene med omsorgen for Martin, og fordi hun ikke får sove etter nattevakt. Hun ønsker derfor å omskoleres til helsesøster.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder situasjonen til Bente opp mot medisinske vilkår for AAP.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
KRAV TIL SYKDOM:
Det er et vilkår for rett til arbeidsavklaringspenger at medlemmet har fått arbeidsevnen nedsatt med minst halvparten. Sykdom, skade eller lyte må være en vesentlig medvirkende årsak til den nedsatte arbeidsevnen.
BEHOV FOR BISTAND TIL Å SKAFFE SEG ELLER BEHOLDE ARBEID:
Det er et vilkår for rett til arbeidsavklaringspenger at medlemmet for å skaffe seg eller beholde arbeid som han eller hun kan utføre
# har behov for aktiv behandling, eller
# har behov for arbeidsrettet tiltak, eller
# etter å ha prøvd tiltakene etter bokstav a eller b fortsatt anses for å ha en viss mulighet for å komme i arbeid, og får annen oppfølging fra Arbeids- og velferdsetaten.
''Det er ikke dokumentert behov for behandling eller arbeidsrettede tiltak for Bente.''
KRAV TIL AKTIVITET:
Det er et vilkår for rett til arbeidsavklaringspenger at medlemmet bidrar aktivt i prosessen med å komme i arbeid. Aktivitetskravene fastsettes i aktivitetsplanen, se arbeids- og velferdsforvaltningsloven § 14 a tredje ledd. Medlemmet skal medvirke ved utarbeidelsen av aktivitetsplanen. Kravene til egenaktivitet skal tilpasses medlemmets funksjonsnivå, og aktivitetsplanen skal endres ved behov.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for vurdering av hvert av de tre kravene
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Bente får avslag på søknaden om AAP og ønsker å klage på avslaget.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke instanser behandler klager på et AAP avslag?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Saken behandles først med en ny runde i førstelinjen i NAV (NAV lokal/NAV Arbeid og ytelser), ved opprettholdelse behandles saken i Klageinstansen. Saksgang og aktuelle instanser nevnes nedenfor.
# Førstelinjen i NAV vurderer saken.
#* Hvis avslag kan bruker klage på avslaget.
#* NAV lokal/NAV Arbeid og Ytelser vurderer saken for andre gang inkl evt tilleggsopplysninger.
#* Hvis NAV lokal/Nav Arbeid og Ytelser opprettholder avslag sendes saken automatisk til NAV Klageinstans
# Andrelinjen i NAV (NAV Klageinstans) vurderer saken på selvstendig grunnlag.
#* Hvis fortsatt avslag kan bruker anke avslaget.
#* NAV Klageinstans ser på saken for andre gang inkl evt tilleggsopplysninger.
#* Hvis NAV Klageinstans fortsatt opprettholder avslaget går saken til Trygderetten
# Trygderetten vurderer saken. Hvis fortsatt avslag kan bruker gå til sak mot staten.
# Lagmannsrett (evt)
# Høyesterett (evt, sjelden)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for NAV Klageinstans, ½ poeng for å nevne minst en annen av de fire første instansene (til sammen 1 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Hun oppsøker selv en psykiater. Psykiateren skriver en kort erklæring hvor det kun står: «Det tilrås sterkt at pasienten unngår nattevakter».
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Bør erklæringen fra psykiateren endre Bente sin AAP sak? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Psykiaters oppdrag er primært å tilføre saken medisinske opplysninger og synliggjøre sammenheng mellom sykdom, nedsatt funksjon som innvirker på mulighet for å jobbe i nåværende eller andre typer arbeid. Konklusjonen om at hun bør unngå nattevakter mangler en (medisinsk) begrunnelse, basert på det vi har fått opplyst.
Tilleggsmoment. Det er ikke at man ikke aksepterer problemet med nattevakter, men det fins jobbmuligheter uten nattevakt som ikke krever utdanning.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1,5 poeng for å identifisere at attesten ikke inneholder medisinsk begrunnelse for konklusjonen og derfor ikke vil påvirke saken. Hvis tilleggsmomentet er nevnt, trekker det opp.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Etter avslaget, og et helt år med sykemelding, klarer Bente å jobbe på sykehjemmet i full stilling i fire måneder da det ved en kontroll på kreftavdelingen påvises ascites og carcinomatose i buken. Bente blir satt på cellegiftkur, som gjør henne i svært dårlig form. Hun må ha hjelp i hjemmet med pass av sønnen, og hun må også ha kommunal hjelp i hjemmet for renhold.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Har Bente nå mulighet for sykepenger? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hun har IKKE krav på sykepenger, fordi det har gått under 6 måneder siden hun var sykemeldt i et år.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for angitt svar
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Både AAP og uføretrygd kan nå være aktuelle ytelser i tiden fremover. I Bente sitt tilfelle progredierer sykdommen og prognosen vurderes som svært dårlig, og hun får derfor innvilget uføretrygd.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medisinske krav er det som her er innfridd, og som gjør at hun kan få uføretrygd?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Hun har sykdom
* Sykdommen gir det aktuelle funksjonstapet
* Sykdommen er varig, i dette tilfelle fordi det er en kjent prognose som tilsier at det ikke vil oppstå bedring. Dette gjør at observasjonstid ikke er nødvendig.
* Hun er hensiktsmessig forsøkt behandlet, det vil si at hun har fått og får den behandling vi har tilgjengelig ved lidelsen.
* Arbeidsrettede tiltak er enten utført, eller som her, vurdert uten mening på grunn av den dårlige prognosen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hvert moment, inntil maks 2 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Oppgaven baserer seg på utdelt artikkel:
[[Once-Weekly Semaglutide in Adults with Overweight or Obesity NEJM 2021 doi: DOI: 10.1056/NEJMoa2032183|https://doi.org/10.1056/NEJMoa2032183]]
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Formuler forskningsspørsmålet i denne studien presist
# Hvordan vil du kort oppsummere resultat for primære endemål samt styrker og svakheter med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vil voksne>18 år med BMI>30 (eller BMI>27 med en vektrelatert tilstand) og som ikke har diabetes som ukentlig får 2,4 mg semaglutide i tillegg til livsstilsintervensjon oppnå vekttap? Poeng: 1
# Kandidaten må nevne at studien viser et betydelig vekttap etter uke 68 fra baseline (gjerne også at det var langvarig og at 86% av deltagerne hadde ett vekttap over 5%). (1p) Relevante styrker med studien er randomisering for å unngå konfundering, placebokontroll, blinding, relativt stor studie som inkluderte deltagere fra mange land i ulike deler av verden, tilstrekkelig statistisk styrke samt ITT og per protokoll analyser (1p). Eksempler på svakheter kort oppfølgingstid, lav styrke til å detektere mer sjeldne og mer alvorlige bivirkninger 1p). Her vil også andre forhold feks. at det er en industri-studie kunne betegnes som svakhet, men noen av de ovennevnte bør nevnes for å få full score.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Vil voksne med BMI>30 og som ikke har diabetes som ukentlig får 2,4 mg semaglutide i tillegg til livsstilsintervensjon oppnå vekttap? Poeng: 1 (0,5 p hvis lite presist formulert)
# Kandidaten må nevne at studien viser et betydelig vekttap etter uke 68 fra baseline. (1p) Relevante styrker med studien er randomisering for å unngå konfundering, placebokontroll, blinding, relativt stor studie med tilstrekkelig statistisk styrke og ITT og per protokoll analyser (1p). Eksempler på svakheter kort oppfølgingstid, lav styrke til å detektere mer sjeldne og mer alvorlige bivirkninger (1p). Her vil også andre forhold kunne betegnes som styrker og svakheter, men noen av de ovennevnte bør nevnes for å få full score.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Gjennomsnittlig kroppsmasseindeks (KMI) har økt betydelig fra 1980- tallet i Norge. Denne økningen var ikke bare et resultat av at andelen med fedme økte, men av at hele KMI-fordelingen ble forskjøvet mot høyere vekt – altså at KMI økte både blant personer med høy og lav KMI. I denne randomiserte studien fant man en betydelig vektnedgang ved Semaglutide.
Hvilke //samfunnsmessige// og //individuelle/kliniske avveininger// bør man gjøre før man tar i bruk dette medikamentet i behandling av overvekt og fedme?
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Formuler forskningsspørsmålet i denne studien presist
# Hvordan vil du kort oppsummere resultat for primære endemål samt styrker og svakheter med studien?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* Behandling av høy vekt versus forebygging, forebyggingsparadokset kan trekkes inn her
* Andre alternative behandlingsformer (kirurgi, livsstilsråd, andre medikamenter etc..)
* Effekt
* Bivirkninger
* Kostnader for individ og samfunn av å sette store deler av befolkningen på livsvarig behandling/ medikalisering
* ++
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Her er det ikke et klart fasitsvar, og ulike momenter kan være relevant å trekke inn. For full skår må studenten nevne fem relevante momenter, derav noen av de momentene som er nevnt i fasiten.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Oppgaven baserer seg på utdelt artikkel:
[[Once-Weekly Semaglutide in Adults with Overweight or Obesity NEJM 2021 doi: DOI: 10.1056/NEJMoa2032183|https://doi.org/10.1056/NEJMoa2032183]]
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva var den estimerte intention to treat (ITT)-effekten på vektnedgang, og hva måler en med ITT-analyser?
# Hva var den estimerte per protokoll-effekten på vektnedgang, og hva måler en med per-protokoll-analyser?
# Vurder konfidensintervallene til disse estimatene. Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Studien viste en estimert ITT behandlingseffekt av Semaglutide på - 12,4 prosentpoeng (95% CI, −13.4 to −11.5), sammenlignet med placebo. Intention to treat-analyse (ITT) er at man analyserer alle deltagerne i studien på grunnlag av hvilke(n) gruppe en ble randomisert til. Dette gjøres for å unngå bias. ITT estimerer effekten av allokering til behandling og ikke effekten av behandling eller screening i seg selv. 1p
# For per protokoll-analysen var samme estimat −14.4 prosentpoeng; 95% CI, −15.3 to −13.5). Per-protokoll-analyse er et forsøk på å estimere effekten av selve behandlingen/screeningen. Ofte gjøres dette ved en sammenligning av behandlingsgruppene som inkluderer bare de pasientene som gjennomførte studien slik de var randomisert (fulgte protokoll).1p
# Konfidensintervallene viser at estimatene er presise. For ITT var konfidensintervallet fra -13, 4 til -11,5, noe som indikerer at data er forenlig med betydelig vektnedgang for hele intervallet. Dette gjelder også for per protokoll-analysen.1p
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Studien viste en estimert ITT behandlingseffekt av Semaglutide på - 12,4 prosentpoeng (95% CI, −13.4 to −11.5), sammenlignet med placebo. Intention to treat-analyse (ITT) er at man analyserer alle deltagerne i studien på grunnlag av hvilke(n) gruppe en ble randomisert til. Dette gjøres for å unngå bias. ITT estimerer effekten av allokering til behandling og ikke effekten av behandling eller screening i seg selv. 1p (0,5 poeng gis ved delvis korrekte svar)
# For per protokoll-analysen var samme estimat −14.4 prosentpoeng; 95% CI, −15.3 to −13.5). Per-protokoll-analyse er et forsøk på å estimere effekten av selve behandlingen/screeningen. Ofte gjøres dette ved en sammenligning av behandlingsgruppene som inkluderer bare de pasientene som gjennomførte studien slik de var randomisert (fulgte protokoll).1p(0,5 poeng gis ved delvis korrekte svar)
# Konfidensintervallene viser at estimatene er presise. For ITT var konfidensintervallet fra -13, 4 til -11,5, noe som indikerer at data er forenlig med betydelig vektnedgang for hele intervallet. Dette gjelder også for per protokoll-analysen.1p. Full skåre hvis de resonerer på presisjon. Null poeng hvis de kun viser til at intervallet ikke inneholder 0 og er statistisk signifikant.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Studien viste også effekten av Semaglutide på en rekke sekundære utfallsmål og mulige bivirkninger
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva viste resultatene på sekundære utfallsmål/mulige bivirkninger?
# Er resultatene som presenteres i denne studien tilstrekkelig for å vurdere alle mulige bivirkninger av medikamentet?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Bør nevne at medikamentet har en rekke både gunstige og uheldige bivirkninger, men at de fleste av disse ikke synes å være svært alvorlige
# Her er det relevant å peke på at det kan finnes andre mer alvorlige og mer sjeldne bivirkninger som ikke fanges opp
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
# Bør nevne at medikamentet har en rekke både gunstige og uheldige bivirkninger, men at de fleste av disse ikke synes å være svært alvorlige. 1.p
# Her er det relevant å peke på at det kan finnes andre mer alvorlige og mer sjeldne bivirkninger som ikke fanges opp. 1p.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Yasmin Ali er 54 år og jobber som hjelpepleier på et sykehjem. Hun starter en øyeblikkelig hjelp konsultasjon i allmennpraksis med å si: «Jeg vil ha MR av venstre skulder». Hun forteller videre at hun i flere måneder har hatt økende vondt i venstre skulder. Det har så de siste ukene blitt vanskelig å bevege skulderen, hun har bl.a. problemer med å nå opp på hodet når hun skal vaske håret. Hun klarer heller ikke å gjøre pleieoppgaver på jobb i samme tempo som før, ofte må hun bruke kun den høyre armen på grunn av smerter. Hun har også smerter i hvile. Om natten sover hun dårlig på grunn av smerter. Hun klarer ikke å ligge på den vonde skulderen.
Ved undersøkelse finner du at hun har betydelige problemer med å ta av og på klær. Du finner normale forhold på høyre skulder. På venstre skulder finner du nedsatt bevegelighet i et kapsulært mønster.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke funn er typisk for en skulder med nedsatt bevegelighet i et kapsulært mønster?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Nedsatt passiv beveglighet, mest for utadarotasjon, nest mest for abduksjon, minst for innadrotasjon.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det er nødvendig å nevne minst to av disse i rett rekkefølge for å få 1 poeng. For full score må det også nevnes at det er passiv bevegelighet som er nedsatt.
Det er ikke nødvendig å nevne noe om aktiv bevegelighet eller isometrisk testing, men det gir ikke trekk å nevne noe om det.
Om kun at passiv beveglighet er nedsatt nevnes: ½ poeng.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Vi skiller gjerne mellom «kontraktile» og «ikke kontraktile» elementer når vi undersøker et ledd
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva er forskjellen på kontraktile og ikke-kontraktile elementer
# Er det kontraktile eller ikke-kontraktile elementer som er rammet i Yasmin sitt tilfelle?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
De «kontraktile elementer» utgjøres av: Muskel, sene, senefeste, disse kjennetegnes av at de er involvert i aktiv bevegelighet. De «ikke kontraktile» utgjøres av ligamenter, leddkapsel, bursa, corpus labrum og begrenser leddets bevegelighet passivt. Hos Yasmin er de ikkekontraktile rammet fordi det også er passiv bevegelighet som er nedsatt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å ha med korrekt hvilke strukturerer (2 riktige strukturer fra hver gruppe) og/eller deres funksjon, og 1 poeng for å angi rett hos Yasmin.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du er ut fra sykehistorie og funn i stand til å stille en diagnose hos Yasmin.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er korrekt diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Frossen skulder/skulderkapsulitt.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Det gis kun poeng for denne tilstanden
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Informasjon til pasienten er en viktig del av omsorg og behandling.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva bør Yasmin informeres om når du nå skal fortelle om tilstanden hun har?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Informasjon om (her ukjent) årsak.
# Forventet forløp, spesielt at nedsatt bevegelighet vil vedvare over flere måneder, kanskje opp mot to år.
# At prognosen er god, og nesten alle blir bra.
# At man kan bevege fritt innenfor smertefritt område.
# At det ikke har noen hensikt å bevege i smertefullt område.
# Hva som er aktuell behandling, og hva vi kan forvente av effekt av behandlingen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Av disse 6 delområdene må minst fire nevnes for full score. 0,5 poeng per punkt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva vil være mest aktuelt som behandling hos henne? Svar kort i stikkordsform
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Intraartikulær injeksjon med kortison. Analgetika/nsaid.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for å nevne kun intraartikulær injeksjon av steroider, ½ poeng for å nevne kun smertestillende medikamenter, eller nevne eksempler på slike, som paracet, nsaid og eller svake opioder. ½ poeng for å nevne kun intraartikulær injeksjon uten å si at det er av sterioder.
Effekten av fysioterapi er omdiskutert, det gis ikke poeng for fysioterapi.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Ikke egen vignett
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Yasmin starter samtalen på kontoret med å be om å få utført MR av den vonde skulderen. Nevn noen medisinske argumenter mot å ta MR i hennes tilfelle
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# MR er ikke påkrevd ved denne tilstanden, diagnosen er klinisk og sikker nok.
# Det er ingen kjente «røde flagg» hos denne pasienten.
# Risiko for bifunn.
# Kostnad
# Tidsspille.
# Øker forventning om billeddiagnostikk i befolkningen.
# Uhensiktsmessig ressursbruk
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng for å nevne minst 3 av disse momenter
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Yasmin kan her oppleves som en «bestillerpasient». Du syns ikke MR er indisert.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvordan vil du gå frem i samtalen for å oppnå en aksept og en enighet om ikke å ta MR? Svar kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vente/utsette det å gi et svar.
# Vise empati for plagene
# Karlegge pasientens egne forestillinger, bekymringer og forventninger
# Bygge tillitt gjennom samtalen og grundig klinisk undersøkelse.
# Gi uttrykk for aksept og legitimitet overfor hennes ønske om MR.
# Forklare hvorfor det ikke vil få noen konsekvenser å ta et MR bilde.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
2 poeng om minst 3 av disse nevnt. 1 poeng for å nevne 2. ½ poeng for å nevne 1.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Yasmin klarer ikke å utføre sitt arbeid på en normal måte, og ber om sykmelding.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke alternativer til full sykmelding finnes her?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Vurdere tilretteleggingsmuligheter (ved å snakke med pasienten om hvilke oppgaver hun utfører i jobben, og hvilke av disse som er vanskelige, og om det fins alternative oppgaver).
# Avventende sykmelding.
# Gradert sykmelding.
# Dialog direkte med arbeidsgiver mens pasienten er på kontoret eller som dialogmøte
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng om to av disse er nevnt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
En 71 år gammel kvinne, pensjonert realfagsprofessor, kommer til fastlege i følge med sin datter. Hun er bekymret for egen hukommelse og sier hun lurer på om hun holder på å bli dement fordi hun glemmer så mye. Fastlegen kjenner pasienten som en litt engstelig type som lett bekymrer seg for sykdom. Datteren bekrefter at mor de siste årene har fått litt tendens til å gjenta seg selv og å spørre opp igjen. Hun holder imidlertid god orden hjemme, har kontroll over økonomien og er aktiv med bl.a. senioruniversitet. Fastlege gjør kognitiv testing og finner følgende: MMSE 27/30 (mister 2 poeng på utsatt gjenkalling og 1 poeng på 3-leddet kommando). Klokketest 4/5 (byttet om på visere).
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke andre undersøkelser bør fastlegen gjøre ved utredning av kognitiv svikt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
klinisk us, nevrologisk us, blodprøver, bildediagnostikk (CT/MR) av hjernen, medikamentgjennomgang.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert riktige svar gir 0,5 poeng, maks 2 poeng totalt
(spinalpunksjon gjøres ikke hos fastlege og gir derfor ikke poeng her)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
En 71 år gammel kvinne, pensjonert realfagsprofessor, kommer til fastlege i følge med sin datter. Hun er bekymret for egen hukommelse og sier hun lurer på om hun holder på å bli dement fordi hun glemmer så mye. Fastlegen kjenner pasienten som en litt engstelig type som lett bekymrer seg for sykdom. Datteren bekrefter at mor de siste årene har fått litt tendens til å gjenta seg selv og å spørre opp igjen. Hun holder imidlertid god orden hjemme, har kontroll over økonomien og er aktiv med bl.a. senioruniversitet. Fastlege gjør kognitiv testing og finner følgende: MMSE 27/30 (mister 2 poeng på utsatt gjenkalling og 1 poeng på 3-leddet kommando). Klokketest 4/5 (byttet om på visere).
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig diagnose hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Mild kognitiv svikt (MCI).
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Riktig svar gir 1 poeng. («kognitiv svikt» er for upresist og gir 0 poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
To år senere faller pasienten og pådrar seg en radiusfraktur. Legen på skadepoliklinikken ser i journal at pasienten har vært innom for sjekk etter fall flere ganger det siste året. Pasienten blir anbefalt å kontakte fastlege for fallutredning
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forhold bør kartlegges hos fastlege under fallutredning?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Anamnese, EKG, BT, ortostatisk BT, nevrologisk us (inkludert balanse), medikamentgjennomgang, test for fysisk funksjon (ganghastighet, SPPB etc), syn.
I tillegg til fastlegens kartlegging er det nyttig å involvere kommunens ergoterapeut (ev fysioterapeut) for vurdering av fallforebygging i hjemmet.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert riktige svar gir 0,5 poeng, maks 2 poeng totalt.
(hvis flere fysiske tester nevnes gis bare poeng for en av testene)
Fallforebygging ved ergoterapeut kreves ikke for poeng, men trekker opp om det er nevnt.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Et år senere faller pasienten og pådrar seg et lårhalsbrudd. Hun kommer seg ganske bra etter dette, og går en periode på treningssenter. Treningssenteret blir etter hvert stengt som følge av koronarestriksjoner. Over de neste par årene legger datter merke til at mor blir stadig mer passiv. Blir ofte sittede foran TVen, og viser stadig mindre interesse for å følge med på politikk og nyheter, noe hun har vært veldig opptatt av tidligere. Hun er blitt mer småspist, tynnere (BMI 18), og hun ringer stadig oftere datteren i fortvilelse over at hun ikke kommer seg inn i nettbanken eller fordi hun får overraskende purringer. Pasienten kommer nok en gang til fastlege i følge med sin datter
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er mest sannsynlig diagnose?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Demens ved Alzheimers sykdom
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Demens ved Alzheimers sykdom gir 1 poeng, bare demens eller bare Alzheimer gir 0,5 poeng.
(kognitiv svikt er for upresist og gir ikke poeng)
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Et år senere faller pasienten og pådrar seg et lårhalsbrudd. Hun kommer seg ganske bra etter dette, og går en periode på treningssenter. Treningssenteret blir etter hvert stengt som følge av koronarestriksjoner. Over de neste par årene legger datter merke til at mor blir stadig mer passiv. Blir ofte sittede foran TVen, og viser stadig mindre interesse for å følge med på politikk og nyheter, noe hun har vært veldig opptatt av tidligere. Hun er blitt mer småspist, tynnere (BMI 18), og hun ringer stadig oftere datteren i fortvilelse over at hun ikke kommer seg inn i nettbanken eller fordi hun får overraskende purringer. Pasienten kommer nok en gang til fastlege i følge med sin datter
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke ikke-medikamentelle tiltak bør settes inn?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Dagsenter, trening, middagsombringing, hjelpemidler i hjemmet, demenskontakt/demensteam/hukommelsesteam i kommunen, innkobling hj. Spl for oppfølging ernæring.
(bare «hjemmesykepleie» er for upresist og gir ikke poeng)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Hvert riktige gir 0,5 poeng, maks 1,5 poeng totalt
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fastlegen vurderer om pasienten bør behandles med kolinesterasehemmer.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke forhold taler //mot// en slik behandling hos denne pasienten?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Hos denne pasienten taler underernæring/ernæringsvansker/lav BMI mot behandling. Gastrointestinale bivirkninger er vanlige og vil kunne forverre ernæringstilstanden.
Mer generelle betraktninger:
* Det er viktig å ha observasjonsgrunnlag for å kunne evaluere effekten av kolinesterasehemmeren. Her vil det være behov for gode komparentopplysninger, slik at medikamentet kan seponeres dersom effekten ikke overgår bivirkningene.
* Totalvurderingen av pasienten er også viktig. Hvis pasienten er svært skrøpelig og har en rekke andre utfordringer, kanskje med polyfarmasi, vil det være lite hensiktsmessig å starte med en kolinesterasehemmer. Hvis Alzheimer er hovedproblemet, er potensialet for nytte større.
* Hvis fastlege er usikker på diagnose vil det også tale mot å starte kolinesterasehemmer (bør komme til diagnostisk avklaring før behandlingsforsøk).
* Andre ting som vil tale mot slik behandling (generelt) er kjent kardial ledningsforstyrrelse, uavklart synkopetendens, kramper el andre vanlige bivirkninger iht til felleskatalogen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0,5 poeng for å angi underernæring/ernæringsvansker/lav BMI
Svar med utgangspunkt i en totalvurdering av pasienten eller som vektlegger muligheten for å evaluere effekt av behandlingen godtas også.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det har gått fem år. Pasienten har blitt ytterligere kognitivt svekket og bor nå i omsorgsbolig tilknyttet en døgnbemannet base. En kald novembernatt kl 03.30 ser personalet at hun er på vei ut gjennom ytterdøra, bare iført nattklær. Nattevakten prøver å overtale pasienten til å la være å gå ut, men lykkes ikke i dette, pasienten mener bestemt at hun har en legetime. Det er ikke fattet noen tvangsvedtak angående tilbakeholdelse eller overvåkning av denne pasienten.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
# Hva bør nattevakten gjøre
# Hvilket lovverk bør han anvende i denne situasjonen?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Pasienten bør holdes tilbake med tvang (ikke i stand til å ivareta seg selv, fare for å fryse i hjel mm.)
Lovverk: Nødrett (Straffeloven §17) eller Øyeblikkelig hjelp-plikten (Helsepersonelloven § 7.Øyeblikkelig hjelp) (ett av alternativene gir ett poeng)
4A-vedtak etter PBR-loven gir ikke poeng fordi du kan ikke fatte vedtak om tilbakeholdelse med tvang i pasientens eget hjem (bare i institusjon) og et eventuelt vedtak om døralarm, GPS eller lignende får du ikke satt i verk i akuttsituasjonen.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Maks 2 poeng totalt, dvs:
Holdes tilbake med tvang – 1 poeng
Referering til riktig lovverk – 1 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
//I denne oppgaven vil vi at du skal svare kort – det vil si maksimum fem-seks linjer på hvert av spørsmålene. Men mange av spørsmålene kan besvares enda kortere og i stikkordsform.//
Peder er 38 år og bor i en bygd i innlandet fylke. Han har aldri vært alvorlig syk, og har ingen kroniske sykdommer. Han bruker ingen medisiner. Han har utdanning som maskinist, og jobber i en bedrift som foredler tømmer. Her betjener han store maskiner. Arbeidet er fysisk krevende og må ofte utføres stående. Daglig gjør han reparasjoner og vedlikehold hvor han løfter tungt. Sist helg var han på fjelltur og falt ned en skrent. Han fikk da en vridning og sterke smerter i høyre kne. Med stor møye kom han seg ned til folk. Han oppsøkte ikke lege, men holdt seg hjemme i en uke på grunn av smerter. Han varslet sin arbeidsgiver om årsak til fravær første fraværsdag. Smertene avtar ikke og han kontakter deg som fastlege seks dager etter skaden. Han møter med krykker, men klarer å gå inn på kontoret ditt uten disse, men da med haltende, smertepreget og langsom gange. Du finner hydrops i høyre kne, men ellers ikke sikre funn. Undersøkelsen er vanskelig fordi det gjør vondt å bevege i kneet. Det blir tatt vanlig røntgen samme dag og det er negativt. Du bestiller MR av kneet, og skriver ut smertestillende. Peder spør om du som fastlege kan skrive en sykmelding og tilbakedatere til ulykkesdagen.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hva er de formelle medisinske kravene som må være innfridd for å ha rett til sykepenger?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Det må foreligge sykdom eller skade.
# Sykdommen/skaden må føre til et funksjonsfall.
# Funksjonsfallet må gi nedsettelse av arbeidsevnen i det aktuelle arbeidet.
# Tilrettelegging må være vurdert
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
Punkt 1,2 og 3 må nevnes for å få full skår. 0,5 poeng hvis kun punkt 2 nevnes. Punkt fire er en ikke-medisinsk vurdering som henger tett sammen med den medisinske vurderingen og det trekker opp hvis dette punktet er med
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Peder er 38 år og bor i en bygd i innlandet fylke. Han har aldri vært alvorlig syk, og har ingen kroniske sykdommer. Han bruker ingen medisiner. Han har utdanning som maskinist, og jobber i en bedrift som foredler tømmer. Her betjener han store maskiner. Arbeidet er fysisk krevende og må ofte utføres stående. Daglig gjør han reparasjoner og vedlikehold hvor han løfter tungt. Sist helg var han på fjelltur og falt ned en skrent. Han fikk da en vridning og sterke smerter i høyre kne. Med stor møye kom han seg ned til folk. Han oppsøkte ikke lege, men holdt seg hjemme i en uke på grunn av smerter. Han varslet sin arbeidsgiver om årsak til fravær første fraværsdag. Smertene avtar ikke og han kontakter deg som fastlege seks dager etter skaden. Han møter med krykker, men klarer å gå inn på kontoret ditt uten disse, men da med haltende, smertepreget og langsom gange. Du finner hydrops i høyre kne, men ellers ikke sikre funn. Undersøkelsen er vanskelig fordi det gjør vondt å bevege i kneet. Det blir tatt vanlig røntgen samme dag og det er negativt. Du bestiller MR av kneet, og skriver ut smertestillende. Peder spør om du som fastlege kan skrive en sykmelding og tilbakedatere til ulykkesdagen.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Har Peder rett til sykmelding? Begrunn svaret kort.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
# Ja
# Begrunnelse: fordi han fyller sykdomsvilkåret (Egen sykdom + det synes medisinsk rimelig å anta at det er årsakssammenheng mellom sykdomsbildet, funksjonsnedsettelsen og nedsatt arbeidsevne). Tilrettelegging bør nok diskuteres med pasienten.
NB! Ikke-medisinske vilkår for å ha rett til sykepenger kreves ikke for å få riktig svar
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for å ha svart JA og ½ poeng for adekvat begrunnelse knyttet opp mot punkt 2.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
Peder er 38 år og bor i en bygd i innlandet fylke. Han har aldri vært alvorlig syk, og har ingen kroniske sykdommer. Han bruker ingen medisiner. Han har utdanning som maskinist, og jobber i en bedrift som foredler tømmer. Her betjener han store maskiner. Arbeidet er fysisk krevende og må ofte utføres stående. Daglig gjør han reparasjoner og vedlikehold hvor han løfter tungt. Sist helg var han på fjelltur og falt ned en skrent. Han fikk da en vridning og sterke smerter i høyre kne. Med stor møye kom han seg ned til folk. Han oppsøkte ikke lege, men holdt seg hjemme i en uke på grunn av smerter. Han varslet sin arbeidsgiver om årsak til fravær første fraværsdag. Smertene avtar ikke og han kontakter deg som fastlege seks dager etter skaden. Han møter med krykker, men klarer å gå inn på kontoret ditt uten disse, men da med haltende, smertepreget og langsom gange. Du finner hydrops i høyre kne, men ellers ikke sikre funn. Undersøkelsen er vanskelig fordi det gjør vondt å bevege i kneet. Det blir tatt vanlig røntgen samme dag og det er negativt. Du bestiller MR av kneet, og skriver ut smertestillende. Peder spør om du som fastlege kan skrive en sykmelding og tilbakedatere til ulykkesdagen.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Vurder forespørselen om tilbakedatering. Begrunn svaret kort
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Det foreligger ikke grunnlag for å tilbakedatere. Hovedregelen er at en sykmelding ikke kan godtas for tidsrommet før pasienten ble undersøkt av sykmelder. Det finnes en unntaksbestemmelse der to vilkår må være oppfylt:
# pasienten har vært forhindret fra å få kontakt med sykmelder, eksempelvis et par dagers ventetid ved legekontoret, legestreik, psykiatriske pasienter som på grunn av manglende sykdomsinnsikt har unnlatt å søke lege
# det må kunne godtgjøres at pasienten har vært arbeidsufør på grunn av sykdom/skade fra en tidligere dato.
Begge vilkår er ikke oppfylt i dette tilfellet. Du har ingen opplysninger, verken medisinske eller ikke-medisinske, som tilsier at han var forhindret fra å kontakte lege. Du vet blant annet at han klarte å kontakte arbeidsgiver.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
½ poeng for hvert av de to punktene som er nevnt. Svaret må være nei til tilbakedatering for å få full skår.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
MR viser at han har røket fremre korsbånd. Han er skeptisk til operasjon og i samråd med ortoped bestemmes det at han ikke skal opereres, men starte aktiv opptrening i regi av fysioterapeut.
Over de neste 6 mnd. opplever han gradvis en viss bedring. Han er fortsatt sykmeldt og sier at han ikke makter jobben som maskinoperatør. NAV ber deg om å skrive en funksjonsvurdering samt si noe om hvordan nedsatt funksjonsevne vil kunne påvirke arbeidsevnen i arbeidspraksis. Dette skal brukes i forbindelse med planlegging og tilrettelegging av arbeidspraksis med nye arbeidsoppgaver i en annen bedrift enn den han er ansatt i.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke hovedmomenter bør være med i en funksjonsvurdering til bruk i NAV?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Svar: 9 av 11 punkt bør være med for å få full skår.
# Legens vurdering av nåsituasjonen (tidsaktuell, ikke utdaterte opplysninger)
# Legens observasjonsgrunnlag (for eksempel månedlige konsultasjoner hos fastlegen over en to års periode)
# Beskrivelse av legens egne observasjoner av funksjonsnivå
# Gjerne supplert med pasientens egen beskrivelse og eventuelt observasjoner fra andre instanser (rehabiliteringsinstitusjon, arbeidsmarkedsbedrift). Kilde angis.
# Bredde i funksjonsområder som beskrives, bør inkludere både psykisk og fysisk fungering. Gjerne opplysninger om sosial fungering.
# Ta med både begrensninger og ressurser
# Ta med informasjon om svingninger i funksjonsnivå
# Ta med informasjon om tempo ved utførelse av daglige aktiviteter/arbeidsoppgaver
# Ta med informasjon om restitusjonsevne etter anstrengelse (som forventet eller forlenget restitusjonstid)
# Ta med informasjon om triggere for funksjonsnedsettelse
# Si noe om konsekvenser for arbeidsevne (i den grad du har grunnlag for det)
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
0.5 poeng per punkt inntil 4 poeng
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Fra tidligere:
<<<
MR viser at han har røket fremre korsbånd. Han er skeptisk til operasjon og i samråd med ortoped bestemmes det at han ikke skal opereres, men starte aktiv opptrening i regi av fysioterapeut.
Over de neste 6 mnd. opplever han gradvis en viss bedring. Han er fortsatt sykmeldt og sier at han ikke makter jobben som maskinoperatør. NAV ber deg om å skrive en funksjonsvurdering samt si noe om hvordan nedsatt funksjonsevne vil kunne påvirke arbeidsevnen i arbeidspraksis. Dette skal brukes i forbindelse med planlegging og tilrettelegging av arbeidspraksis med nye arbeidsoppgaver i en annen bedrift enn den han er ansatt i.
<<<
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Er det noen tilleggsopplysninger du må ha for å kunne adekvat besvare NAVs forespørsel.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
For å kunne svare utfyllende på hvordan sykdommen og funksjonsnivået påvirker arbeidsevnen må du vite noe om bedriften og de arbeidsoppgavene han faktisk skal prøves ut i. Arbeidsevne er relasjonelt, og en vurdering av hvordan sykdom og funksjonsnedsettelse kan innvirke på arbeidsevnen blir svært begrenset hvis man ikke vet noe om hva slags arbeidspraksis det er snakk om.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for bedrift/arbeidsoppgaver
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Det har nå gått 11 måneder siden Peder ble sykemeldt. Fremgangen har stoppet helt opp, og han er heller blitt noe verre. Han har jobbet litt med kontorarbeid i en bedrift hvor han hospiterte, men det er lite behov i egen bedriften for at han gjør slike oppgaver, og han trives dårlig med det, «Jeg har aldri vært skoleflink, og jeg har lese og skrivevansker», sier Peder selv. Han har bestemt seg for at han ønsker å bli operert med rekonstruksjon av korsbånd. Det er forventet at han må vente tre måneder på slik operasjon, og så forventes et forløp med opptrening over flere nye måneder. Målet hans er å bli frisk nok til å komme tilbake i den jobben og de oppgavene han tidligere har hatt.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke medisinske forhold bør du som lege redegjøre for i dette tilfellet hvis NAV skal kunne vurdere om kriterier for å få AAP i denne situasjonen er oppfylt?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Medisinske forhold er uthevet sammen med aktuelle kriterier som NAV skal vurdere:
# Nedsatt arbeidsevne pga. sykdom skade og lyte. §11-5
#* Minst 50% nedsatt arbeidsevne ved inngang AAP
#* Sykdom, skade eller lyte skal være en vesentlig medvirkende årsak til den nedsatte arbeidsevnen.
# Helse er kun en av flere faktorer som vektlegges ved vurdering av den nedsatte arbeidsevne. Andre faktorer er alder, evner, utdanning, yrkesbakgrunn og arbeidsmuligheter på stedet.
# Aktivitetskrav. §11-6. Det skal lages en aktivitetsplan som beskriver
## aktiv behandling
## arbeidsrettede tiltak
## og/eller annen oppfølging av NAV med sikte på å komme i jobb.
I forhold til punkt 2 er det legen som bør opplyse hvis det foreligger «et rødt lys»i form av medisinske årsaker til at arbeidsrettede tiltak absolutt ikke kan prøves ut eller klare medisinske begrensinger til hva som kan prøves ut. Legen kan også gi medisinske råd i forhold til tilretteleggingsmuligheter hvis han/hun har kompetanse på dette området.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for A, 1 poeng for C. Begge må være med for å få riktig svar. (Redusert arbeidsevne på grunn av sykdom + aktivitetsplan (utredning, behandling og eller arbeidsrettede tiltak) med sikte på å øke arbeidsevnen.
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
Du blir bedt om å skrive en ny legeerklæring i forbindelse med vurdering av rett til AAP.
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Hvilke momenter bør være med i legeerklæring ved arbeidsuførhet? Lag en kort disposisjon.
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
Momenter til legeerklæring ved arbeidsuførhet.
# Generelt (identifisere pasienten og legen, beskrive formålet med erklæringen og kjennskap til pasienten
# Diagnose (r)
# Sykehistorie – (symptomer, forløp, pasientens egen historie)
# Status presens (oppgi dato, objektive funn)
# Gjennomført og eventuell videre plan for medisinsk utredning og behandling
# Forslag til ikke-medisinske tiltak (arbeidsrettede tiltak)
# Medisinsk begrunnet vurdering av FUNKSJONSEVNE og innvirkning av medisinske forhold på arbeidsevnen (legens vurdering)
# Prognose (varighet)
# Årsakssammenheng mellom sykdommen og arbeidsuførheten
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
B,C,D,E,G, H og I er hovedelement (dvs. alle unntatt A og F). Fire av disse må være med. Punktene i ”legeerklæring ved arbeidsuførhet” kan enten beskrives summarisk eller med faktaopplysninger knyttet direkte opp mot dette tilfellet
</$details>
<div class="oppgave">
<div class="vignett">
!!Vignett
I samtalen med deg nevner Peder den muligheten at han aldri blir bra nok i kneet til å tåle så fysisk krevende arbeid som han har hatt. Han er bekymret for hva han da skal gjøre, og har tenkt på om det tross operasjon kan bli nødvendig å ta en eller annen form for utdanning
</div>
<div class="question">
!!Spørsmål {{!!question}} ({{!!points}} poeng)
Peder spør om han i så fall har rett til omskolering på Navs regning. Hva er det rimelig at du som lege vet om dette og hva er det mest riktig at du svarer?
</div>
</div>
<$details class="answer" summary="Svar" state="!!showanswer">
* NAV skal vurdere dette spørsmålet (avgrense din rolle som lege)
* NAV har særlig de siste årene utvidet tilbudet innen kompetansehevende tiltak og pasienten bør drøfte dette spørsmålet med NAV.
* Legen bør vite at det er ingen automatikk i at man får støtte til utdanning selv om man ikke kan gå tilbake til eget yrke. (Eksisterende kompetanse vurderes opp mot alle andre aktuelle yrker. Strengere regler hvis under 26 år fordi det å være i en studiesituasjon anses å være en normalsituasjon for denne aldersgruppen. Unntak: Ordinær utdanning for tiltaksdeltakere under 26 år kan likevel gis dersom deltaker på grunn av sykdom, skade eller lyte er i en utdanningssituasjon som avviker vesentlig fra den som gjelder for annen ungdom.
</$details>
<$details class="points" summary="Hva gir poeng?" state="!!showpoints">
1 poeng for angitt svar
</$details>
\define stageButton(stage)
<$button class="tc-btn-invisible">
<$action-setfield $tiddler="Hjem" stage=$stage$ />
<$action-deletefield $tiddler="Velg stadium" loadonstartup />
<$action-sendmessage $message="tm-close-tiddler"/>
<div class="stageMenuItem">
<h2><b>Stadium $stage$</b></h2>
</div>
</$button>
\end
<style>
.stageMenu{
width: 100%;
display: grid;
passing 10px;
grid-template-columns: auto auto auto;
grid-gap: 5%;
}
.stageMenuItem{
display: flex;
min-width: 20vw;
min-height: 5vw;
align-items: center;
background-color: #B23CFD09;
border: solid 1px #B23CFDFF;
padding: 5px;
justify-content: center;
}
.stageMenuItem:hover{
background-color: #B23CFD19;
}
</style>
<div class="stageMenu">
<<stageButton "IAB">>
<<stageButton "ICD">>
<<stageButton "IIAB">>
<<stageButton "IIC">>
<<stageButton "IIIC">>
<<stageButton "IIID">>
</div>
<$list filter="[stage{Hjem!!stage}tag<currentTiddler>]">
!!! <$link />
{{!!text}}
<hr />
</$list>