Diagnosis Flashcards

1
Q

Care sunt simptomele BPOC ?

A
  • dispnee care este progresiva , la efort si persistenta
  • tuse cronica intermitenta si wheezing
  • tuse productiva
  • istoric recurent de infectii respiratorii
  • istoric de expunere la factori toxici:fumat, biomasa folosita la gatit , vapori ,fum ,gaze
  • istoric de :greutate mica la nastere ,infectii in copilarie .
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2
Q

Spirometria in BPOC - de avut in vedere

A
  • calibrare
  • test de bronhodilatatie ( cu 400 mcg salbutamol ( 10-15 min - apoi masurat VEMS )sau 160 mcg anticolinergic ( dupa 30-45 min masurat VEMS )
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3
Q

I Tiffeneau sub 0.7 sau LLN - limite

A
  • I Tiffeneau sub 0,7 - bun la batrani dar mai rateaza tinerii sub 45 ani cu obstructie comparativ cu LLN
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4
Q

Classificarea BPOC - GOLD

I Tiffeneau sub 0,7 dupa bronhodilatatie

A

I VEMS peste 80
II VEMS intre 50-80
III VEMS intre 30-50
IV VEMS sub 30 %

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5
Q

Scara dispneii - m MRC (modified Medical research Questionnaire )

A

0 - dispnee la efort intens
1-dispnee atunci cand merg repede sau pe o panta inclinata
2-merg mai incet decat alte persioane de aceeasi varsta sau trebuie sa ma opresc sa imi trag sufletul cand merg in ritmul meu
3. ma opresc dupa 100 metri
4. dispnee la activitati obisnuite ( imbracat ) , nu ies din casa

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6
Q

Preventia si terapia de mentinere ptr BPOC

A
  • sevrajul tabagic
  • medicamentele
  • reabilitarea
  • vaccinarea
  • oxigen/VNI
  • interv chir
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7
Q

Care sunt contraindicatiilor suplimentelor cu nicotina ?

A
  • infarct miocardic in ultimele 2 saptamani

- la gume : mestacareacontinua si cu inghitirea ei mai degraba decat absorbtia duce la greata .

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8
Q

Care sunt efectele secundare ale tigaretei electronice ?

A
  • hemoragie alveolara
  • bronsiolita respiratorie
  • ALI ( acute lung injury )- leziuni pulmonare acute
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9
Q

Ce contine tigareta electronica ?

A
  • tetrahidrocanabinol
  • ulei canabionid
  • vitamina E
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10
Q

Care este strategia ptr sevrajul tabagic ?- 5 A (intreaba, sfatuieste , vointa,ajuta , controleaza)

A
ask 
advice
asses - Vreti sa va lasati de fumat ? ( vointa ) 
ajuta 
aranjeaza follow up
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11
Q

Vaccinarea

A
  • antigripala
  • antipneumococica : Pneumovax 23 , Synflorix 23 - ( tineri sub 65 de ani ,cu VEMS sub 40 % si comorbiditati

Prevenar 13 ptr batrani peste 65 de ani .

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12
Q

Care este cel mai important efect al beta 2 agonistilor ?

A
  • relaxarea musculaturii netede prin stimularea receptorilor beta 2 adrenergici care creste AMP c si furnizeaza antagnosim ptr bronhosconstrictie.

Efecte secundare - tahicardie sinusala , tulburari de ritm , tremor

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13
Q

Cum actioneaza antimuscarinicile?

A
  • blocheazaefectul bronhoconstrictor al acetilcolinei pe receptorii muscarinici
  • efect mai bun peexacerbari decat LABA

Efecte secundare :uscaciunea gurii , pot da tulburari mictionale,gust metalic,
- administrati in aerosoli pot cauza glaucom

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14
Q

Metilxantinele

A
  • dozaterapeutica este aproape de doza toxica

- pot cauza : palpitatii , covulsii , cefale, insomnie , greata ,pirozis.

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15
Q

Candse prescriu ICS?

A
  • evidenta inalta ( 4 ) : - istoric de exacerbare sau spitalizare ptr BPOC
    - peste 2 exacerbari/an
    - eozinofile peste 300
    - Astm asociat
  • ar putea fi folosite ( 2 ) : - o exacerbare/an
    - eozinofile intre 100-300
  • nu sunt recomandate : - pneumonii repetate
    - eozinofile sub 100
    - istoric TBC sau infectie cu micobacterii
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16
Q

efecte secundare ICS

A
  • candidoza orala
  • disfonie
  • vanatai
  • pneumonie
17
Q

Risc de pneumonie sub ICS:

A

-pacienti peste 55 ani
-care fumeaza
-istoric anterior de pneumonie
- BMI sub 25
mMRC crescut
-( independent de acestea , un procent de sub 2 % eozinofile creste riscul de pneumonie )

18
Q

Riscuri ICS

A
  • diabet
  • cataracta
  • TBC
19
Q

Inhibitori de fosfodiesteraza( PDE4 )

A
  • nu are efect bronhodilatator
  • reduce exacerbarile la pacientii cu BPOC
    sever tratati cu OCS or ICS
    -efecte secundare : greata , varsaturi ,scadere in greutate , insomnie,cefalee
20
Q

Tratament cu BD

A

1BPOC I A- 1 bronhodilatator
BPOC B - LABAsau LAMA
C - LAMA
D - LAMA sau LAMA- LABAsau ICS- LABA

21
Q

Oxigen - indicatii

A
  • Pa O 2 sub 55 mm Hg sau SaO 2 sub 88% sau Pa O2 intre 55-60 si una dintre CPC , HTP , poliglobulie
22
Q

Transplantul pulmonar - indicatii

A
  • BODE : 5-6 :body mass index, airflow obstruction, dyspnoea, exercise capacity
  • VEMS sub 15-20 %
  • 3 sau mai multeexacerbari in ultimul an
  • o exacerbaresevera cu insuficienta respiratorie hipercapnica sau HTP moderata /severa