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Semio > Sindrom bronsic si cavitar > Flashcards

Sindrom bronsic si cavitar Flashcards

1
Q

urmari obstructie bronsica

A

hiperinflatie, insu&cien!a respiratorie cronica si cord pulmonar
cronic.

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2
Q

BPOC manifestari clinice

A

I - torace emfizematos
P - reducere vb vocale + scade simetric amplit miscarilor
P - emfizem pulmonar centroacinar => hipersonoritate
A - murmur vez diminuat+ expir prelungit + raluri bronsice ronflante si sibiliante

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3
Q

astm manif clinice

A

Percutie - hipersonoritate in criza de astm
A - murur vez diminuat, expri prel, raluri sibilante caracteristice

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4
Q

bronista acuta mainfestari clinice

A

durere retrosternala cu caracater de arsura
tuse seaca in traheite
exprectoratie muscoasa apoi mucopurulenta
febra pan ain 38
frisoane
mialgie

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5
Q

faze bronsita acuta

A
  1. premonitorie - catar oculonazal + raguseala
  2. uscata - tuse seaca + furere retrosterala
  3. umeda - expectoratie abundenta mucoasa apoi purulenta
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6
Q

auscultatie brinsita acuta

A

raluri ronflante si sibilante

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7
Q

paraclinic br acuta

A

leucocitoza cu neutrofilie
VSH mare
rx normal

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8
Q

BPOC ce e

A

obstr bronhie difuza
alterari parenchim pulmonar
=> hiperinflatie pulmonara + insuf resp

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9
Q

BPOC de tip A

A

emfizem pulmonar obstructiv panlobular

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10
Q

BPOC tip B

A

br cronica obstructiva + emfizem centrolobular

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11
Q

fiziopat BPOC

A
  • mucus mult + suprainfectare bacteriana
  • stenpoze/ cuduri ale peretilor
  • edem parietal
    => scadere surfactant si COLABARE bronhiolara in expir
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12
Q

urmari emfizem pulmonar in BPOC

A

spatii aeriene mari - scadere schimb - distrugere elem de sustinere bronhiolara -> colabare precoce expir

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13
Q

air trapping

A

obstructie bronhiolara in expir + hiperinflatie aeriana

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14
Q

urmari air tra[pping

A
  • hipoventilatie + hipoxie alveolara
  • scade o2 creste co2
  • insuf respiratorie hipoxemica +/- hipercapnie
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15
Q

urmari hipoxie alveolara in br cronica obstr

A

prin reflex alveolo-capilar => VC in AP - HTPulm precoce reversibila => cord pulmonar !!!

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16
Q

BPOC clinic

A
  • tuse si exectoratie mucoasa si mucopurulenta
  • expect matinal sau nocturn
  • dispneea e mai degraba pt emfizem pulm acc la efort
  • crize care asociaza bronhospasm - dispnee + wheezing

-

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17
Q

complicatii tuse

A

sincopa
fracturi costale

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18
Q

bpoc cu cancer

A
  • bronsiectazii
  • expectoratie mai abundenta
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19
Q

BPOC exmanen obiectiv inspectie

A

slanire in ultimele luni
- dispnee de repaus
- dif de vb si respira cu buzele pensate ca sa impodice colabarea expieat a br mici
- torace in butoi dc e emfizem
- in inspir paetea superioara se duce in sus si inainte oiar cea inferioara is scade diam transversal => semnul HOOVER
- expir prel cu folosire musc abd in expir
- tiraj cosal prin ct activa a muschilor ic =? pres inspirat neg + depresie sp supraclav si suprasternale

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20
Q

BPOC EO palpare

A

vb diminutae
ampl redusa a miscarilor resp

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21
Q

BPOC percutie

A

hipersonoritrate difuza

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22
Q

BPOC ausucultatie

A
  • murmur vez dimnuat difuz
  • expir prel
  • raluri ronflante, sibilante uneori subcrepitante
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23
Q

BPOC paraclinic

A

teste ventilatorii
diagn - scadere VEMS si IND TIFFNEAU sub 70 %
- det gaze sangvine => diagn de insuf resp
- sputa cu flora saprofta
- RX - emfizem cu hipetransparenta pulmonara si br cr obst cu accentuare desen pulmonar

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24
Q

astmul bromsic

A

crize de dismnee paroxistca nocturna
cauza a obstructueu reversibile partiala si difuze
- fiziopat - spasm edem si hipersecretie bronsiloara de mucus

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25
Q

triada Widal

A

astm + hipersensibilitate la aspirina + polipoza nazala

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26
Q

astm manif clinice

A

! Apari!ie nocturna
! Debut brusc
! Durata peste 2-3 ore
! Treze#te bolnavul din somn
! Se înso$e#te de anxietate #i sufocare
! Dispneea este cu bradipnee expiratorie
! Se înso$e#te de wheezing

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27
Q

astm tuse

A

initial uscata apoi umeda cu expectoratie muacoasa ”sputa perlata”

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28
Q

atacul astmatic

A

crize subintrante care se repeta in 24h
dispnee usoara
expir prel si raluri sinilante reversibile sub trat

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29
Q

astm bronsic cu dispnee continua

A
  • starea subastematica
  • intalnita la batrani
  • rezistanta la bronhodilatatoare
  • se ajunfe la insuf resp cronica, astm umed
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30
Q

starea de rau astmatic

A

simpt respiratorii, circulatorii si neuropsihive
- dispnee intensa permanenta, durata de ore/zile
- tuse oositiare
- cianoza
- tahipnee si tahicardie
- creste TA DIAST
- transpiratii reci
- nu exista per de acalmie si nu e ef trat
- insuf acuta continua cu prgnostoc grav

31
Q

starea de rau astmatic EO

A
  • cianoza la extremitati
  • paloare fata
  • transpiratii
  • torace blocat in inspir
  • fara expectoratie
  • nu are wheezing
  • tahicardie - coma - existus
32
Q

stare de rau astmatic cauze

A

med care inhiba reflexul de tuse !!
- opaicee barbiturice

33
Q

astm EO

A

I - torace destin coaste oriz si cianoza
P - scadere vb vocale
P - hipersonoritate
A - murmur vez scazut + expir prel + raluri bronsice sibilante, ronflante, subcreptinante
zgomot de porumbar!!

34
Q

astm paraclinic

A

rx - hipertransp campuri pulmonare , coaste orizontalizate, diafragm coborat in criza
- gaze sangv - po2 scazut si pco2 crescut + acidoza met in starea de rau astmatic

35
Q

diagn dis BPOC si astm

A

teste farmacidin cu substr bronhodilatatoare
- in astm VEMS creste cu peste 15%

36
Q

BPOC semne de gravitate

A

folosire muschi resp accesori
- miscari toracice paradoxale
- cianoza recent
- edeme periferice
- instabilitate hemodinamica

37
Q

astm semne e agravare

A
  • wheezing accentuat
  • imposibilitate decubit
  • flaringul nazal
  • duere toracica
  • musc resp accesoirie
  • tahocardie si tahipneici
38
Q

criza de astm br culmineaza cu starea de rau astmatic simptome

A
  • distensie tor max
  • dureaza peste 24 h
  • depresiune sp ic
  • cianoza
  • hipoxemie
  • hipercapnie
  • acidoza gaziasa si metabolica
    EKG
  • supraincarcare dreapta
  • tahicardie
  • puls paradoxal
    fara trat - IC dr si asfixie
39
Q

chisturile

A

dimensiuni mici,
cu diametru mai mic de 3 mm
au de obicei continut aeric.
rx - hipetransparenta cu perete subtire

40
Q

cavitatile

A
  • peste 3 mm
  • uneori in masa de tesut tumoral / inflamator
  • rx: hipertransparenta cu oerete mai gros
41
Q

cavitati exemple

A

abcese oulmonare
caverne tbc
apar semne si simptome ale sd cav - emfizem+bronsiectazii

42
Q

bula de emfizem

A

diam peste 1 cm
grosime perete mai mare de 1 mm
loc subpleural de onicei
rx - hipertransparenta fara perete sau mai subtire de 1 mm

43
Q

bronsiectazia

A

dilatare permanenta, localizata
rx - corespund distributiei topografoice a arb bronsic

44
Q

cavitati cauze

A

infectioasa
ichemice
obstructive

45
Q

cavitate prin eliminare tesut pulm necrozat

A

tbc
fungi
pneumonii cu stafilococ/ prode de klebsiella

46
Q

cavitati cauza ichemica - prin necroza aseptica

A

infarct pulmonar
vasculite
tumori

47
Q

cavitati prin dilatatia chistica a str pulmonare dupa o obstructie

A

mec de supapa
pneumocystis carinii

48
Q

cavitati focale si multifocale

A

neoplazie
infarct pulmonar
pneumoconicoze
bronsietazii
granulomatoza wegener
inf cu gram neg

49
Q

cavitati difuze

A

limfangioleimiomatoza pulmonara
pneumonia intersititala
fibroza pulmonara

50
Q

sd cavitar manif clinice specifice

A
  • dispnee
  • tuse
  • hemoptizie
  • durere toracica
51
Q

sd cavitar semne asociate

A
  • febra
  • paloare si coloratia teroasa - anemie cronica
  • transporatii
  • halena fetida -: inf cu anaerobi, abece, bronsiectazii
  • hemoptizii
  • slabit
  • adenopatii
52
Q

sd cavitar EO

A

Palpare - vb diminuate dc sunt cav mari/ bule de emfizem
!! in tumori mari avem intarirea vb vocale , la fel si in sd de condensare
P - daca are continut e matitate -: abces
- daca are continut gazos sau mixt e hipersonoritate
A - mullr

53
Q

Sd cav ausculatatie

A
  • suflu caviatr/ amforic
    Cav cu diam :5-6 cm -: sulfu amorfic, muzical sau metalic
  • suflu tubar -> dc e cav cu chestie solida - sd de condensare din pneumonia cu br libera
  • pectorilocvie afona - cav mare care rezoneaza si fac sa se intareasca vocea
54
Q

abcesul pulmonar

A

zona pulmonara de necroza parenchimatoasa
localizata, datorata unei infec”ii cu germeni piogen

55
Q

abces secundar

A

colonizate si cu flora aeroba
chisturi aerice
caverne tbc
infarcte pulm
tumori

56
Q

sd cavitar manif clince

A
  • stere generala proasta
  • junghi tor
  • durere abd
  • tuse seaca initial apoi prodcutiva
  • pana la erodarea uneoi bronhii tabloul clinicc e ca la pneumonia bacteriana
57
Q

sd cv EO

A
  • febril, transporat
  • teg teroase, palide
  • halena fetida
  • necroza progreseaza- se erodeaza br -> continutul purulent e evacuat sub forma vomica 500-600 ml
  • fetida din cauza florei anaerobe si pluristratificata
58
Q

sd cavitar ex local

A

primele 5 zile -sd de condensare
- dupa evacuare devine sd cavitar
- 25% asociaza pleurezie

59
Q

abcese pulm primitive localizari frecv

A

segm post al lb sup drept
segm sup al lb inferior drept

59
Q

abcese pulm primitive localizari frecv

A
60
Q

Abcesele supradiafragmatice

A

„coloratura abdominala” a
simptomatologiei $i se înso”esc de durere, sughi” $i de grea”a.

61
Q

abcesele sunt
localizate la nivelul lobilor superiori

A

evolutia este nefavorabila datorita drenajului deficitar.
La fel $i în cazul pacientilor cu abcese mari, la care ramân cavitati restante care se pot suprainfecta ulterior.

62
Q

gangrena

A

supuratie difuza
microabcese cu diam <2cm
la imunodeprimati
sputa negricioasa si fetita

62
Q

gangrena

A

supuratie difuza
microabcese cu diam <2cm
la imunodeprimati
sputa negricioasa si fetita

63
Q

paraclinic abces pulmonar

A

rx - opacitate neomogena -> dupa drenare devine o imagine hidro-aerica ovalara
CT
bronhoscopie
ex bacteriologic sputa

64
Q

bronsiectazia

A

dilatatii permanente ireversibile
calibru mediu
- tuse cu brnhoree purulenta pluristratificata
- caracter recurent si tendinta la cronicizare

65
Q

Sindrom Mounier-Kuhn

A
  • Absen”a musculaturii bron#ice
  • Polipoza nazala
  • Etmoidita
  • Traheobronhomegalia
66
Q

Sindrom Williams-Campbell

A

Hipoplazia sau agenezia cartilajelor bron#ice

67
Q

Sindrom Kartagener

A

Situs inversus
- Diskinezie ciliara
- Sterilitate masculinã
- Sinuzita paranazala

68
Q

bronsiectaziile devin simptomatice cu ocazia unei infectii si se manfiecta clinic prin

A

tuse matinala productiva
expectoratie abundenta fara efort
febra
slabire
dc e colonizata cu anaerobi e fetita expectoratia
- 4 str - spumos, mucopurulent, mucus filant, purulent

69
Q

bronsiectazii EO

A

teg palid-teroase
hipocratism
A - r creptiante in inspir + r sibilante si ronflante in zona de proiectie a bronsiectaziiei, bazal

70
Q

bronsiectazii paraclinic

A

rx - opacitati/ imag cavitare cu aspect fagure de miere / sina de tramvai

71
Q

semn imp pe CT bronsiectazii

A

lipsa scaderii calibrului spre perficeria pl
vizualizare lumen bronhic la mai putin de 1 cm de pleura

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