2nd Semster Flashcards
explain the Syndrome of lung consolidation , DF , Possible reasons , Location , Complaints,Inspection,Palpation , Percussion , auscultation , Laboratory diagnostics
—DF : Significant reduction or complete disappearance of
airiness of lung tissue in a more or less common area
(segment, lobe, several lobes).
—Possible reasons :
there is 2 types:
1-Inflammatory infiltration:
1.1-Pneumonia
1.2-Infiltrative tuberculous
2-Noninflammatory etiology:
2.1-Pulmonary infarction with pulmonary embolism, thrombosis
2.2-Lung tumor
2.3-Obstructive atelectasis
—Location :
* The tops of the lungs
* The lower parts of the lungs
* Middle lobe
* Subpleural location
—Complaints :
* Cough
* Dyspnea
* Increase tº (fever)
* Pain in the side
—-Inspection :
1-Hyperemia of face (cheeks)
2-The lag part of the chest during respiration
—Palpation :
1-Pain in the intercostal space
2-Increase of vocal (tactile) fremitus
—Percussion : Dull or flat percussion note
—auscultation :
-Breath:
1-Weakened vesicular breathing
2-Bronchial breathing
-Additional respiratory sounds
* Fine cracles
* cracles (small, medium-bubbles)
* Pleural friction
-Bronchofoniya - increase
—-Laboratory diagnostics :
–Blood test:
- Leukocytosis, left shift
- ESR acceleration
–Sputum
- “Rusty”
- mucous
- purulent
explain the Atelectasis , Types , explain each of obstractive and comprassive , Inspection and palpation , Percussion and auscultation , Instrumental diagnostics
— types : we have 3 types >
1. Obstruction - : compression, resulting in blockage of the bronchus
2. Compression -: compression of the lung from the outside
3. Contraction (collapse) : - compression, resulting of pneumothorax
—Compressive atelectasis cuases :
1-pneumothorax
2-pleural effusion syndrome
—Sings:
1-Dyspnea.
2-Asymmetric chest motions in respiration.
3-Increased vocal fremitus in consolidation area
4- At the initial stage of atelectasis (hypoventilation stage) when a small amount of aired alveoli in the collapsed area is still kept, diminished vesicular breath sound may be defined. Then, after air resorption, breath sound becomes bronchial.
—Obturative (obstructive)atelectasis segmental or lobar Causes:
-closure of airing bronchus lumen by:
1-endobronchial tumour,
2-foreign body
-compression of the bronchus from the outside by enlarged lymph nodes or a cancerous tumor.
—Inspection and palpation of the chest :
1-In the presence of severe atelectasis, a decrease in the volume of the affected half is observed (the affected part of the chest sinks due to a drop in intrapulmonary pressure), the intercostal space is narrowed
2-Restriction of mobility on the affected side of the chest
3-Decrease of vocal (tactile) fremitus
—Percussion :Dull or flat percussion note
—auscultation :
-Breath:
1-Weakened vesicular breathing or complete lack of breathing over
the affected side
-Bronhofoniya - decrease
—Instrumental diagnostics :
1-X-ray
2-Computed tomography
3-BRONCHOSCOPY
explain the Lung cavity syndrome , Etiology ,Symptomatology , stages , Clinical signs,Instrumental diagnostics,Laboratory diagnostics
—Etiology :
1-Abscessed pneumonia
2-Tuberculous cavity
3-Abscessed pulmonary infarction
4-Wegener’s granuloma
5-Gangrene
—Symptomatology :
1-Cavity size
2-Depth of its location
3-Cavity contents: air only (empty cavity), air with some amount of fluid (e.g. air and exudates).
4-Cavity communication with respiratory tract (via drainage bronchus) or isolated cavity
—Stages :
1-inflammatory infltraion of lung tissue
2-formation of pus in lung cavity
3-occures of obulitration ofthe cavity with formation of penumoscolorosis
—Clinical signs : there is 2
1- first Stage - before communication with the bronchus (isolated cavity):
1.1-Hectic fever
1.2-Cough - dry or with a small amount of sputum
1.3-General weakness
1.4-Decrease of vocal (tactile)fremitus
1.5-Dullness of percussion sound
1.6-Weakened vesicular breathing
2- second Stage - after communication with the bronchus:
2.1-Reducing signs of intoxication
2.2-Productive cough with a big amount of purulent sputum
2.3-Increased vocal fremitus
2.4-Tympanic sound
—Instrumental diagnostics:
1- Xray
2-CT
—Laboratory diagnostics:
1-Blood:
1.1-Leukocytosis
1.2-Shift left of leykoformula
1.3-ESR acceleration
1.4-Toxic granularity of neutrophils
2-Sputum:
2.1-Pus mixed with blood
explain Emphysema pulmonary syndrome , DF , Etiology , Forms of emphysema ,Causes,Complaints,Inspection,Palpation,Percussion
,Auscultation , inestrumnetal dignostic
—-DF : is characterized by a pathological expansion of air spaces
located distal to the terminal bronchi, and is caused by
a decrease in the elastic properties of the alveolar septa.
—-Etiology:
1-Obstructive bronchitis (CORD)
2-Bronchial asthma
3-Emphysema
—Forms of emphysema:
1. Interstitial
2. Alveolar:
2.1 nonobstructive
2.3 focal
2.4 diffuse
3-.Primary emphysema is a genetically determined deficiency of 1-antitrypsin.
4-Secondary emphysema develops against the background of chronic lung diseases.
—- Causes:
1-frequent cough (chronic bronchitis);
2-chronic obstructive pulmonary disease (COPD);
3-genetically determined deficiency of 1-antitrypsin;
4-mechanical stretching of the alveoli during forced expiration (for glass blowers, singers), musicians playing wind instruments)
—Complaints:
-Dyspnea, shortness of breath, which is expiratory in
nature and can manifest itself first with physical
exertion, and then at rest, characterizing a varyin degree of respiratory failure.
—Inspection:
1-Barrel chest
2-Diffuse cyanosis
—Palpation:
1-Rigid chest
2-Vocal fremitus weakened:
right side = lift side
—Percussion:
1-Hyperresonant percussion note
2-The lower boundary of the lung omitted
3-Tops expanded
—Auscultation:
1-Symmetrical weakened vesicular breathing
2-Common wheezing
3-Single crackles
—inestrumnetal dignostic:
1-X-ray
2-Spirography
explain the Pleural effusion syndrome , Df , classificaion of Eitology , The main pathogenetic mechanisms of the occurrence of
pleural effusion , Complaints,palpation,percussion,Laboratory and instrumental diagnostic ,
—DF : this is a symptom complex due to the presence of fluid
between the layers of the pleura, due to damage to the
pleura or in connection with general disorders of water and
electrolyte metabolism in the body
–Types:
1-hydrothorax : accumulation in the pleural cavity of transudate - noninflammatory fluid;
2-exudative pleurisy : an inflammatory process of the pleura, accompanied by the accumulation of exudate in the pleural cavity - an inflammatory fluid;
3-empyema of the pleura (pyothorax): a purulent inflammatory process of the
pleura, accompanied by accumulation of pus in the pleural cavity;
4-hemothorax: accumulation of blood in the pleural cavity; most often occurs with chest injuries
5-hylothorax - accumulation of lymph in the pleural cavity,
—classificaion of Eitology :
1-infectious : most often caused by bacteria: Streptococcus pneumoniae
2-non-infectious or aseptic : accumulation of fluid in the pleural cavity due to other (noninfectious) mechanisms such as malignant tumors
—-The main pathogenetic mechanisms of the occurrence of pleural effusion:
* 1. increased permeability of pleural sheets;
* 2. increased pressure in the pulmonary capillaries;
* 3. reduction of negative intrapleural pressure
–pleural effusions are classically divided into transudates and exudates:
1-Transudative (edematous) pleural effusions develop under the influence of
extrapleural factors on the filtration of the pleural fluid. Ex > heart failure,
,cirrhosis of the liver,hypoalbuminemia
2-Exudative pleural effusions are observed in cases where pathological changes in the pleura itself develop Ex> malignant diseases,parapneumonic effusion,bacterial pleurisy, tuberculosis
—Complains:
1. Shortness of breath appears when more than 1 liter of fluid accumulates in
the pleural cavity due to a decrease in lung capacity
2. Pain in the chest occurs when the affected visceral and parietal layers of the pleura come into contact.
3. Dry cough.
—palpation : - Increased resistance chest, Vocal fremitus weakened or not determined,
—percussion:a dull sound is dull; on auscultation,
sharply weakened vesicular breathing or its absence; ↓ bronchophony
—Laboratory and instrumental diagnostic :
1-X-ray
2-Ultrasound of the pleural cavities
3-thoracoscopy
explain Syndrome of air accumulation in the pleural cavity (pneumothorax) , Df , Mechnasim , types , Spontaneous pneumothorax , Complaints,Palpation ,Percussion , Auscultation ,method for diagnosing pneumothorax
–DF : Pneumothorax is an accumulation of air in the pleural cavity. The air
penetrating into the pleural cavity due to ↑ intrapleural pressure
-mechansim :is based on two groups of causes:
1. Mechanical damage to the chest or lungs
2. Diseases of the lungs and chest organs
—Three types of pneumathorax:
1-closed pneumothorax, the pleural cavity is not communicated with the
environment and the volume of air entering the pleural cavity does not increase. A small amount of air can be absorbed on its own.
2-Open pneumothorax is characterized by the presence of a defect in the chest
wall, through which there is a free communication of the pleural cavity with the external environment. The pressure in the pleural cavity becomes equal to atmospheric pressure, which leads to the collapse of the lung and turning it off from breathing
3-Valvular (tense) pneumothorax,: due to damage to the lung tissue, a kind
of valve arises that allows air to pass into the pleural cavity at the moment of inhalation and blocks its exit at the moment of exhalation
—Spontaneous pneumothorax : they are two types
1-Primary : occurs in people who do not suffer from lung disease, usually in tall, thin old and men aged 20–30 years. Caused by spontaneous destruction of the subpleural apical vesicles or bullae through smoking or heredity.
* Usually pneumothorax develops at rest, in some cases - during physical work
2-Secondary : occurs in patients with existing progressive pulmonary pathology:
* Respiratory diseases – COPD, asthma, cystic fibrosis
—Complaints:
1. strong sudden stabbing pains in the chest on the side of the lesion
2. acute shortness of breath
3. dry cough,
—Palpation :
– ↑ resistance of the chest on the side of the lesion
– ↓ or even absence of vocal fremitus on the affected side
—Percussion : - tympanic sound on the side of the lesion
—Auscultation :
– ↓ or absence of vesicular breathing on the side of the lesion;
- Negative bronchophony on the side of the lesion
—main method for diagnosing pneumothorax : Chest X-ray
explain Syndrome of bronchial obstruction , DF ,Diseases accompanied by bronchial obstruction ,Main mechanisms of bronchial obstruction,Complaints,
palpation,percussion,auscultation,Laboratory and instrumental diagnostics , Instrumental methods of investigation
–DF : a clinical symptom complex that occurs as a result of airflow limitation in the bronchial tree, mainly on exhalation,
–Diseases accompanied by bronchial obstruction :
1-Mandatory obstruction : COPD , Bronchial asthma.
2-Facultative obstruction : Acute bronchitis , pneumonia , Pulmonary tuberculosis
—Main mechanisms of bronchial obstruction :
1-Functional (reversible) : Mucosal edema
2-Organic (irreversible) : Peribronchial fibrosis
—Complaints :
1-asthma attacks of expiratory type
2-cough (initially dry, )
3-widespread dry wheezing, mainly on exhalation
—palpation : resistance of the chest and symmetrical ↓ vocal fremitus are noted.
—percussion :
1-comparative percussion: there is a box lung (hyperresonant)
2-topographic percussion - an increase in the upper and lower boundaries of the lungs, limited mobility of the lower lung edge
— auscultation : weakened vesicular breathing with prolonged exhalation
—Laboratory and instrumental diagnostics :
1-General blood analysis :
- polycythemia
- increase hemoglobin
- The decrease in ESR
2-Sputum
- Bright, viscous, scanty, vitreous
—-Instrumental methods of investigation :
1-Fibrobronchoscopy
explain the Syndrome of respiratory failure (RF , DF , types ,Significant signs,Pulmonary heart disease
—DF : is the inability of the respiratory system to supply the oxygen needed tosaturate hemoglobin and remove carbon dioxide.
—types:
1-obstractive
2-restractive
3-diffusion
4-mixed
—signs :
* dyspnea
* central (diffuse) cyanosis
* enhanced work of respiratory muscles
—Pulmonary heart disease :
* is the enlargement and failure of the right ventricle of
the heart as a response to increased vascular resistance or high blood pressure in the lungs.
explain the Mitral stenosis , hemodynamics abnormalities , complaints ,
Physical examination, Percussion ,Auscultatoion , Blood pressure and pulse ,Complications
—hemodynamics abnormalities :
1-Compensation stage: the area of mitral ostium is significantly less than normal (4-6 cm to 2cm ) leads to left atrium repletion with blood. This blood had not time to move to the left ventricle, and there is also blood, arrived from pulmonary veins. It results in left atrium hypertrophy
2-Decompensation stage : left atrium contractility is decreased pressure within it increases, that leads to the pressure rise within the pulmonary veins and pulmonary capillaries. The pressure rise within the pulmonary veins ostii causes the narrowing of the pulmonary arterioles- and when pressure rising within the pulmonary artery and further overload and hypertrophy of the right ventricle
—-complaints :
1-Breathlessness, cough
2-Chest pain
3-Haemoptysis
—Physical examination :
1-Mitral facies
2-Jugular vein distension
3-Diastolic thrill at the apex
–Percussion : Increase in absolute dullness of the heart (dilatation of the right ventricle)
—Auscultatory signs :
* Accentuated S1 at the apex
* Accentuated pulmonary S2
* The diastolic murmur of mitral stenosis is of low pitch
—Blood pressure and pulse :
1-* In significant left atrium hypertrophy the left clavicular artery is compressed and pulse filling on the left arm is decreased – pulsus differens.
2-* In decreased filling of left ventricle and diminished cardiac stroke volume – pulsus parvus
3-* Mitral stenosis is frequently complicated by atrial fibrillation – pulsus irregular.
4-* Blood pressure is usually normal, sometimes the systolic pressure is slightly decreased and diastolic – increased.
—Complications :
1-Thromboembolic complications
2-Chronic heart failure
explain the MITRAL INCOMPETENCE(REGURGITATION) , Causes , hemodynamics abnormalities, Physical examination , Percussion ,Auscultation,Complications
— Causes : we have 2 types :
1-* Absolute (destruction of valvular leaflets):
-Rheumatic heart disease
-Mitral valve prolapse
-Infective endocarditis
2-* Relative (dilation of left ventricle):
-Cardiomyopathy
—hemodynamics abnormalities:
-left atrium increases, dilates and hypertrophies
-overfilling and dilatation of the left ventricle
-congestion in the pulmonary circulation
-right ventricle hypertrophy
—Physical examination:
1-On precordium palpation apical impulse displacement to the left and sometimes downward is disclosed
2-Pulse and blood pressure in compensated mitral incompetence don’t change
—Percussion:
* mitral configuration with smoothed cardiac waist
* right ventricle hypertrophy cardiac dullness also shifts to the right.
—Auscultation:
Systolic murmur: a high pitched pansystolic murmur at the apex is transmitted to the left axilla.
—Complications :
* Thromboembolic complications
* Episodes of acute pulmonary edema (acute heart failure)
* Chronic heart failure
explain the TRICUSPID VALVE INCOMPETENCE , Causes , hemodynamics abnormalities , Clinical manifestations ,Physical examination ,Percussion ,Auscultation,Complications
—Causes: we have 2 types
1-* Organic (rarely): endocarditis, frequently
rheumatic
2-* Relative (more frequently)- right ventricular
dilatation and right atrioventricular orifice
distension
—hemodynamics abnormalities :
-During right ventricular systole because of incomplete closure of valve leaflets part of blood regurgitates back to the right atrium, in which usual volume of blood from venas cava simultaneously passes right atrium dilatation and hypertrophy
— Clinical manifestations:
1-Significant venous congestion in systemic
circulation in tricuspid incompetence:
edema, ascites
2-Skin acquires cyanotic colouring
—Physical examination :
* Neck veins swelling and pulsation,
* Positive vein pulse,
* Liver pulsation,
—Percussion :
* On percussion significant displacement of cardiac dullness borders to the right owing to right atrium and right ventricular hypertrophy is detected.
—Auscultation :
1-Diminished S1 at the xyphoid process base is found;
2-Diminished S2 at the pulmonary artery
—-Complications:
1-severe circulatory insufficiency
2-cardiac cirrhosis.
explain the Aortic stenosis , DF , Causes , hemodynamics
abnormalities,Clinical manifestations ,
,Percussion ,auscultation, Blood pressure and pulse,Complications
—DF : A narrowing of the outflow tract of the left ventricle in the aortic valve area with impaired blood flow from the left
ventricle to the aorta in systole
—Causes :
1- Atherosclerotic
2-Rheumatic heart disease
—hemodynamics abnormalities:
1-Decompensation stage: decrease of left ventricular
contractile capacity,
2-The left ventricular dilatation occurs, then hypertrophy and dilatation of the left atrium, followed by hypertrophy and dilation of the right heart.
—Clinical manifestations:
* anginal pains
* dizziness and syncope due to small cardiac output
* arrhythmias
— Percussion :
* displacement of relative dullness borders to
the left and aortic heart configuration
—Heart auscultation:
* diminished S1 at the apex, connected with left ventricle
overfilling and lengthening of its systole
* diminished S2 at the aorta
* rough systolic murmur,
—Blood pressure :
* pulse becomes small, slow and rare (pulsus parvus,
tardus et rarus)
* pulse pressure becomes decreased.
—Complications :
* Heart failure
* signs of decompensation stage (dyspnea, edema, swelling neck veins, liver enlargemen)
explain the Aortic incompetence , DF , Causes , Clinical manifestations ,General examination ,Percussion , auscultation,Blood pressure and pulse,Complications
—DF : a non-closure of the aortic valve leaflets resulting in
regurgitation of blood from the aorta to the left
ventricle during diastole.
—Causes:
* infectious endocarditis
* atherosclerotic lesion
* rheumatic fever
* syphilis
—Clinical manifestations :
* anginal pains
* dizziness and syncope
—General examination :
* skin pallor
* peripheral arteries pulsation: carotids
(”carotid’s dance’’- Corrigan pulse)
—Percussion data :
* displacement of relative dullness borders to the left and aortic heart configuration
—auscultation:
* diminished S1 at the apex,
diminished S2 at the aorta
* diastolic murmur
—-Blood pressure and pulse :
* pulse fast, high, big (pulsus celer, altus, magnus)
* pulse pressure is high
—Complications :
- left ventricular heart failure
- cardiac asthma attack
- coronary insufficiency with development angina syndrome;
- rhythm disturbance;
explain Syndrome of arterial
hypertension / DF, Types , Causes , grades , Target Organs ,Complaints, Physical data,General examination ,Stages ,
–DF : Arterial hypertension is a persistent increase in blood pressure - systolic over 140, diastolic over 90 mm Hg.
–Types:
1. Primary:, essential arterial hypertension (AH) - 90– 95%: is established in the absence of a secondary cause of increased blood pressure.
- Secondary:, symptomatic hypertension (5-10%)
–Casues : - Renal
- Endocrine :
– pheochromocytoma - Hypertension caused by damage to
large arterial vessels (hemodynamic),
atherosclerosis.
—Features of Arterial Hypertension for symptomatic (secondary) types :
* 1) relatively young age of patients with
hypertension (up to 30 years);
* 2) acute onset of the disease with rapid stabilization of blood pressure at high levels.
—Grades :
- Norm : S less then 140 / D less then 90
-stage 1 : S 140-160 / D 90-100
-Stage 2 : S 160-180 / D 100-110
-stage 3 : S more then 180 /
D more then 110
-Hypertension in DM,RF :
its should be mess then 130/80
–Target Organs :
1-Brain : Cerebrovascular disease: ischemic or hemorrhagic stroke, transient ischemic attack; chronic circulatory encephalopathy;
2-Heart:LVH, angina pectoris, MI,
acute and chronic heart
failure, arrhythmias;
3-kidneys : Microalbuminuria, ↓GFR,
nephrosclerosis, acute and chronic
renal failure;
4-Vessels : dissecting aneurysm,
damage to peripheral
arteries;
—Complaints :
1-due to myocardial damage :
* Cardialgia * Palpitation, arrhythmia
2-due to brain damage :
* Headaches in the occipital and temporal regions
* dizziness, visual disturbances
3-due to excessive activation of the RAAS :
* Edema
* nocturia
–General examination :
* Overweight or obesity
* Signs of lipid metabolism disorders
* swelling of the face, limbs
* Corneal arch
–Physical data:
* Apical beat – is displaced to the left
* S1 tone at the apex - weakened.
* S2 tone on the aorta - enhanced
* With severe LVH and its dilatation - systolic murmur of mitral regurgitation.
* Pulse - hard, tense, large.
–Stages :
Stage I - mild or moderate arterial
hypertension without target organ
damag
Stage II - moderate or significant
arterial hypertension with target
organ damage
Stage III - moderate or significant
arterial hypertension in the
presence of complications or
associated clinical conditions
explain Heart Faliur : DF, Causes , types ,
–DF : it is a syndrome or a pathological condition in which the heart is unable to deliver to the organs and tissues the amount of
oxygen and nutrients necessary for normal functioning,
–Causes :
1- Impaired systolic function :
1-1. Damage to the heart muscle
* primary (myocarditis, myocardial infarction, chronic ischemic heart disease,
cardiosclerosis)
* secondary (hypo- or hyperthyroidism, anemia, obesity)
1-2. Hemodynamic myocardial overload
* pressure (hypertension of a large or small circle of blood circulation, stenotic defects)
* volume (valvular heart failure, intracardiac shunts)
* combined (combined heart defects, concomitant heart disease)
2-Disturbance of diastolic filling of ventricles :
* myocardial hypertrophy
* cardiosclerosis,
* adhesive pericarditis,
3-Heart rhythm disorders:
* atrial fibrillation, tachycardia/bradycardia.
-Types :
1-By heart dysfunction :
-systolic
-diastolic
2-By the rate of development of symptoms :
-Acute
-Chronic
3-Depending on the primary lesion of the left, right or both ventricles :
1-left ventricular (stagnation in the pulmonary circulation)
2-right ventricular (stagnation in the systemic circulation) total
