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MPP > Final > Flashcards

Final Flashcards

1
Q

Patient is a heavy smoker, symptoms worse at waking up, high pollution, and cold weather, he had pneumonia multiple times, hyperinflated chest

A

COPD

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2
Q

Obstructive lung diseases

A 
Chronic bronchitis
Bronchiolitis
Asthma
Broncheiectasis
Emphysema (permanent destructive enlargement of airspaces)
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3
Q

What paraclinical investigations would you request for COPD? What would you expect to find?

A

CXR - hyperinflation, flattened diaphragm, hyperlucent lungs
Arterial blood gas - CO2 retention (in severe cases)
ECG
Lung function test (FEV1 and FVC < 70%)

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4
Q

COPD

A

Progressive, non-reversible airflow obstruction which does not change markedly over several months

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5
Q

Emphysema

A

Walls of alveoli are destroyed and lose elasticity, hindering the outflow of air when a person exhales

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6
Q

Risk factors of COPD

A

Smoking, occupation, male, pollution

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7
Q

Management of COPD

A

Smoking cessation
Brochodilators and corticosteroids
Home oxygen therapy in severe cases
Vaccination against pneumonia and flu

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8
Q

Asthma

A

Chronic inflammatory disorder with episodic, reversible airway obstruction and increased airway responsiveness
Increased number of mucus gland cells, infiltration of immune cells, dilation of blood vessels

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9
Q

Risk factors for asthma

A

Multifactorial
Immune system (ie in response to allergens) for early-onset
Drugs (beta blockers, aspirin, antibiotics)
Infection
Smoking during pregnancy

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10
Q

Clinical presentation of asthma

A

Wheezing, dyspnea, cough, chest tightness

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11
Q

Diagnosis of asthma

A

15% improvement in FEV1 or PEF following bronchodilator use

15% improvement during 1 week home monitoring

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12
Q

Management of asthma

A

Acute attack - give oxygen, beta2 agonists, systemic corticosteroids, maybe mechanical ventilation
Chronic - patient education, self-monitoring, avoidance of triggers, drug treatments (relieve w/ b2 agonists, anti-cholinergs or prevent with corticosteroids)

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13
Q

7 common respiratory symptoms

A 
Dyspnea (breathlessness)
High respiratory rate (>12-20)
Cough (dry/productive)
Hemoptysis
Chest pain
Wheeze
Stridor
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14
Q

Wheezing

A

Wheezing is expiratory due to obstruction of small peripheral airways

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15
Q

Stridor

A

Stidor is inspiration due to obstruction of central airways

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16
Q

Crackles

A

Crackles are the popping sound of alveoli when they have fluid, mucus

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17
Q

Paraclinical investigations for respiratory conditions

A 
CXR
Sputum examination
Blood tests
Pulse oximetry
Arterial blood gas analysis
Spirometry and peak expiratory flow (PEF)
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18
Q

Inspection in pneumonia

A

General discomfort, use of accessory respiratory muscles, skin color, respiratory rate

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19
Q

Auscultation in pneumonia

A

Consolidation, crackles

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20
Q

Investigations for pneumonia

A 
CXR
Blood tests (WBC for infection)
Temperature (elevated due to infection)
Blood, sputum culture
Arterial blood gases
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21
Q

Clinical features of pneumonia

A

Fever, breathlessness, cough with purulent sputum, rigor/malaise/anorexia, confusion in elders

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22
Q

Risk factors for pneumonia

A

Smoking (kills cilia), alcohol, corticosteroids (inhibit immune system), age (<2 or >65), comorbidities (asthma, COPD, heart failure)

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23
Q

Severity of pneumonia

A 
Respiratory rate >30
Diastolic BP <60 mm Hg
S-urea >7 mM
Confusion
2+ of these is a 36-fold increase in mortality
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24
Q

Management of pneumonia

A

Supportive therapy (oxygen, fluids)
Antibiotics (broad spectrum, more specific after sensitivity test)
Lung physiotherapy

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25
Q

Complications of pneumonia

A 
Respiratory failure (change antibiotics, consider respirator)
Spreading to other organs (pericarditis, endocarditis, meningitis, arthritis)
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26
Q

Hemoptysis

A

Coughing up blood in sputum

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27
Q

Causes of hemoptysis

A

TB, pneumonia, bronchial/lung cancer, lung embolism, exacerbation of COPD

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28
Q

Investigations to confirm lung cancer

A

CXR - look for mass and fluid
Endoscopy and biopsy - histology of cell (malignancy, staging)
CT/PET - look for metastases

29
Q

Causes of lung cancer

A

Smoking
Environmental (asbestos)
Genetics

30
Q

Clinical features of lung cancer

A

Persistent cough, dyspnea
Signs of infection
Hemoptysis
Constitutional symptoms (weight loss, night sweats, fatigue)
Metastatic symptoms (fractures, pain, headache, seizures, jaundice, hepatomelagy)

31
Q

Management of lung cancer

A

Small cell carcinoma - aggressive chemo

Non-small cell carcinoma - surgery (15% of cases)

32
Q

Tension pneumothorax

A

One way letting air in at inspiration, medical emergency

Treat by decompressing with large cannula and oxygen

33
Q

Questions for headache patient?

A 
Onset (time/speed)
Frequency
Duration
Prodromal symptoms
Past episodes
Localization
Pain characteristics and severity
Alleviating factors
Medication
Other symptoms (nausea, vomiting, photophobia, phonophobia, autonomic symptoms)
34
Q

Migraine characteristics

A

4-72 hours
2+ of: one sided, pulsating, moderate to severe, aggravation by physical activity
1+ of: nausea, vomiting, sound sensitivity, light sensitivity

35
Q

Aura for migraine

A

Transient neurological symptom, gradually evolves over 5-10 minutes, visual, sensory, motor (palsy), speech, one sided (contralateral to migraine)

36
Q

Tension type headache

A 
Bilateral
Pressing/tightening
Mild/moderate pain
Sore muscles
No aggravation by physical activity
No nausea/vomiting
No sound/light sensitivity
37
Q

Cluster headache

A

Very strong headache in/around one eye
15 min-3 hours
1-8 per day
Accompanied by: red/watery eyes, runny nose, Horner’s syndrome, restlessness

38
Q

Treatment of migraine

A

Acute - simple analgesics (paracetamol, acetylsalicylic acid, ibuprofen) or triptans
Severe - prophylactic treatment

39
Q

Common GI symptoms

A 
Abdominal pain
Nausea
Vomiting
Dysphagia (swallowing)
Dyspepsia (indigestion)
Bleeding
Diarrhea or constipation
Jaundice
Weight loss
40
Q

Important details about abdominal pain

A 
Site
Radiation?
Character (dull, stabbing, aching, burning)
Constant or intermittent
Severity
41
Q

Common causes of abdominal pain

A

Inflammation
Perforation
Obstruction
(like chest pain, can have to do with other systems)

42
Q

70 year old man with constipation and weight loss

A

Order a colonoscopy, potential cancer

43
Q

Alarm symptoms

A

Weight loss, blood in stools, anemia, nightly fever

Persistent change in bowel habits
Persistent unexplained pain
Persistent difficulty swallowing

44
Q

Diarrhea treatment

A

Oral rehydration, antibiotics imodium

45
Q

Fresh blood in stools cause

A

Hemorrhoids, ulcerative colitis, colorectal cancer

46
Q

Tarry blood in stools

A

Duodenal ulcer, bleeding from upper GI tract

47
Q

Hematemesis

A

Vomiting blood
Severe if fresh with clots
Less severe if black, coffee ground like

48
Q

Possible causes of hematemesis

A

Peptic ulcer
Gastritis
Anti-inflammatory drugs (aspirin)
After intensive vomiting

49
Q

Possible causes of jaundice

A

Hepatitis, alcoholic liver disease, malaria, obstruction of bile system, neonatal jaundice, gall stones

50
Q

Paraclinical investigations in GI disease`

A 
X-ray
CT scan
MRI
Ultrasound
Endoscopy
51
Q

Types of ulcers

A

Esophageal ulcer
Gastric ulcer
Duodenal ulcer

52
Q

Common cause of peptic ulcer

A

H. pylori causes an intense inflammatory response (gastritis), weakens epithelial walls, adheres to wall, secretes enzyme to break down urea into toxic compounds
Tobacco
Alcohol
Aspirin

53
Q

Clinical features of gastric ulcer

A

Hunger pain
Pain in epigastrium that comes and goes
Heartburn
Vomiting

54
Q

Confirming an ulcer

A 
Endoscopy
Urea breath test
Blood test (anemia)
55
Q

Perforation of the stomach

A

Erect x-ray of abdomen

Manage with resusitation, IV antibiotics, and immediate surgery

56
Q

Clinical presentation of colorectal cancer

A

Change in bowel habits, rectal bleeding, chronic abdominal pain, bloating, fullness
Fatigue, weight loss, gever, anorexia, nightly sweating
Consider for anyone over 40 with recent onset symptoms

57
Q

IBD

A

Inflammatory bowel disease includes ulcerative colitis and Crohn’s
Less common in smokers

58
Q

Ulcerous colitis

A

Non-specific, superficial inflammation of rectum and colon
Peak onset at 15-40 years
Symptoms are belly cramps, diarrhea, blood in stools

59
Q

Crohn’s disease

A

Inflammatory bowel disease that may affect any part (or a scattering of parts) of the GI tract from mouth to anus
Symptoms include abdominal pain, severe diarrhea, weight loss, fatigue

60
Q

UC vs Crohn’s

A

Crohn’s - cobblestoning

UC - ulcerations

61
Q

Managing IBD

A

Treat acute attacks
Prevent relapse
Detect carcinoma at early stages
Surgery when needed

Fluid balance and nutritional support
Corticosteroids when active
Immunosuppresants

62
Q

Signs of acute inflammation

A

Redness
Heat
Swelling
Pain

63
Q

Patient presents with polyuria and dysurea (pain during urination)

A

Bladder infection (cystitis) or kidney infection (pyelonephritis)

64
Q

Paraclinical investigations for infection

A 
Urine stix (WBC) and culture
Blood sample (look for elevated CRP, WBC, SR)
Culture and sensitivity for blood/sputum/urine/CSF
65
Q

CRP

A

Protein released by liver during inflammation
Used to monitor inflammation
Higher for bacteria than virus

66
Q

OOOTTAFVGVAH

SSMMBMBSBBMM

A 
Olfactory
Optic
Oculomotor
Trochlear
Trigenimal
Abducens
Fascial
Vestibulocochlear
Glossopharayngeal
Vagus
Accessory
Hypoglossal
67
Q

How to asses consciousness?

A

Glasgow coma scale (out of 15 pts)

68
Q

Two types of stroke

A

Ischemic - blood clot

Hemorrhagic - rupture, leakage

69
Q

Diagnosis and treatment of ischemic stroke

A 
Acute CT (angiography)
Blood tests

Thrombolysis
Acetylsalicylic acid

MPP (4 decks)

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