Final Flashcards
Patient is a heavy smoker, symptoms worse at waking up, high pollution, and cold weather, he had pneumonia multiple times, hyperinflated chest
COPD
Obstructive lung diseases
Chronic bronchitis Bronchiolitis Asthma Broncheiectasis Emphysema (permanent destructive enlargement of airspaces)
What paraclinical investigations would you request for COPD? What would you expect to find?
CXR - hyperinflation, flattened diaphragm, hyperlucent lungs
Arterial blood gas - CO2 retention (in severe cases)
ECG
Lung function test (FEV1 and FVC < 70%)
COPD
Progressive, non-reversible airflow obstruction which does not change markedly over several months
Emphysema
Walls of alveoli are destroyed and lose elasticity, hindering the outflow of air when a person exhales
Risk factors of COPD
Smoking, occupation, male, pollution
Management of COPD
Smoking cessation
Brochodilators and corticosteroids
Home oxygen therapy in severe cases
Vaccination against pneumonia and flu
Asthma
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
Risk factors for asthma
Multifactorial
Immune system (ie in response to allergens) for early-onset
Drugs (beta blockers, aspirin, antibiotics)
Infection
Smoking during pregnancy
Clinical presentation of asthma
Wheezing, dyspnea, cough, chest tightness
Diagnosis of asthma
15% improvement in FEV1 or PEF following bronchodilator use
15% improvement during 1 week home monitoring
Management of asthma
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)
7 common respiratory symptoms
Dyspnea (breathlessness) High respiratory rate (>12-20) Cough (dry/productive) Hemoptysis Chest pain Wheeze Stridor
Wheezing
Wheezing is expiratory due to obstruction of small peripheral airways
Stridor
Stidor is inspiration due to obstruction of central airways
Crackles
Crackles are the popping sound of alveoli when they have fluid, mucus
Paraclinical investigations for respiratory conditions
CXR Sputum examination Blood tests Pulse oximetry Arterial blood gas analysis Spirometry and peak expiratory flow (PEF)
Inspection in pneumonia
General discomfort, use of accessory respiratory muscles, skin color, respiratory rate
Auscultation in pneumonia
Consolidation, crackles
Investigations for pneumonia
CXR Blood tests (WBC for infection) Temperature (elevated due to infection) Blood, sputum culture Arterial blood gases
Clinical features of pneumonia
Fever, breathlessness, cough with purulent sputum, rigor/malaise/anorexia, confusion in elders
Risk factors for pneumonia
Smoking (kills cilia), alcohol, corticosteroids (inhibit immune system), age (<2 or >65), comorbidities (asthma, COPD, heart failure)
Severity of pneumonia
Respiratory rate >30 Diastolic BP <60 mm Hg S-urea >7 mM Confusion 2+ of these is a 36-fold increase in mortality
Management of pneumonia
Supportive therapy (oxygen, fluids)
Antibiotics (broad spectrum, more specific after sensitivity test)
Lung physiotherapy
Complications of pneumonia
Respiratory failure (change antibiotics, consider respirator) Spreading to other organs (pericarditis, endocarditis, meningitis, arthritis)
Hemoptysis
Coughing up blood in sputum
Causes of hemoptysis
TB, pneumonia, bronchial/lung cancer, lung embolism, exacerbation of COPD
Investigations to confirm lung cancer
CXR - look for mass and fluid
Endoscopy and biopsy - histology of cell (malignancy, staging)
CT/PET - look for metastases
Causes of lung cancer
Smoking
Environmental (asbestos)
Genetics
Clinical features of lung cancer
Persistent cough, dyspnea
Signs of infection
Hemoptysis
Constitutional symptoms (weight loss, night sweats, fatigue)
Metastatic symptoms (fractures, pain, headache, seizures, jaundice, hepatomelagy)
Management of lung cancer
Small cell carcinoma - aggressive chemo
Non-small cell carcinoma - surgery (15% of cases)
Tension pneumothorax
One way letting air in at inspiration, medical emergency
Treat by decompressing with large cannula and oxygen
Questions for headache patient?
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)
Migraine characteristics
4-72 hours
2+ of: one sided, pulsating, moderate to severe, aggravation by physical activity
1+ of: nausea, vomiting, sound sensitivity, light sensitivity
Aura for migraine
Transient neurological symptom, gradually evolves over 5-10 minutes, visual, sensory, motor (palsy), speech, one sided (contralateral to migraine)
Tension type headache
Bilateral Pressing/tightening Mild/moderate pain Sore muscles No aggravation by physical activity No nausea/vomiting No sound/light sensitivity
Cluster headache
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
Treatment of migraine
Acute - simple analgesics (paracetamol, acetylsalicylic acid, ibuprofen) or triptans
Severe - prophylactic treatment
Common GI symptoms
Abdominal pain Nausea Vomiting Dysphagia (swallowing) Dyspepsia (indigestion) Bleeding Diarrhea or constipation Jaundice Weight loss
Important details about abdominal pain
Site Radiation? Character (dull, stabbing, aching, burning) Constant or intermittent Severity
Common causes of abdominal pain
Inflammation
Perforation
Obstruction
(like chest pain, can have to do with other systems)
70 year old man with constipation and weight loss
Order a colonoscopy, potential cancer
Alarm symptoms
Weight loss, blood in stools, anemia, nightly fever
Persistent change in bowel habits
Persistent unexplained pain
Persistent difficulty swallowing
Diarrhea treatment
Oral rehydration, antibiotics imodium
Fresh blood in stools cause
Hemorrhoids, ulcerative colitis, colorectal cancer
Tarry blood in stools
Duodenal ulcer, bleeding from upper GI tract
Hematemesis
Vomiting blood
Severe if fresh with clots
Less severe if black, coffee ground like
Possible causes of hematemesis
Peptic ulcer
Gastritis
Anti-inflammatory drugs (aspirin)
After intensive vomiting
Possible causes of jaundice
Hepatitis, alcoholic liver disease, malaria, obstruction of bile system, neonatal jaundice, gall stones
Paraclinical investigations in GI disease`
X-ray CT scan MRI Ultrasound Endoscopy
Types of ulcers
Esophageal ulcer
Gastric ulcer
Duodenal ulcer
Common cause of peptic ulcer
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
Clinical features of gastric ulcer
Hunger pain
Pain in epigastrium that comes and goes
Heartburn
Vomiting
Confirming an ulcer
Endoscopy Urea breath test Blood test (anemia)
Perforation of the stomach
Erect x-ray of abdomen
Manage with resusitation, IV antibiotics, and immediate surgery
Clinical presentation of colorectal cancer
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
IBD
Inflammatory bowel disease includes ulcerative colitis and Crohn’s
Less common in smokers
Ulcerous colitis
Non-specific, superficial inflammation of rectum and colon
Peak onset at 15-40 years
Symptoms are belly cramps, diarrhea, blood in stools
Crohn’s disease
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
UC vs Crohn’s
Crohn’s - cobblestoning
UC - ulcerations
Managing IBD
Treat acute attacks
Prevent relapse
Detect carcinoma at early stages
Surgery when needed
Fluid balance and nutritional support
Corticosteroids when active
Immunosuppresants
Signs of acute inflammation
Redness
Heat
Swelling
Pain
Patient presents with polyuria and dysurea (pain during urination)
Bladder infection (cystitis) or kidney infection (pyelonephritis)
Paraclinical investigations for infection
Urine stix (WBC) and culture Blood sample (look for elevated CRP, WBC, SR) Culture and sensitivity for blood/sputum/urine/CSF
CRP
Protein released by liver during inflammation
Used to monitor inflammation
Higher for bacteria than virus
OOOTTAFVGVAH
SSMMBMBSBBMM
Olfactory Optic Oculomotor Trochlear Trigenimal Abducens Fascial Vestibulocochlear Glossopharayngeal Vagus Accessory Hypoglossal
How to asses consciousness?
Glasgow coma scale (out of 15 pts)
Two types of stroke
Ischemic - blood clot
Hemorrhagic - rupture, leakage
Diagnosis and treatment of ischemic stroke
Acute CT (angiography) Blood tests
Thrombolysis
Acetylsalicylic acid
