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Final Flashcards

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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
Complications of pneumonia
``` Respiratory failure (change antibiotics, consider respirator) Spreading to other organs (pericarditis, endocarditis, meningitis, arthritis) ```
26
Hemoptysis
Coughing up blood in sputum
27
Causes of hemoptysis
TB, pneumonia, bronchial/lung cancer, lung embolism, exacerbation of COPD
28
Investigations to confirm lung cancer
CXR - look for mass and fluid Endoscopy and biopsy - histology of cell (malignancy, staging) CT/PET - look for metastases
29
Causes of lung cancer
Smoking Environmental (asbestos) Genetics
30
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)
31
Management of lung cancer
Small cell carcinoma - aggressive chemo | Non-small cell carcinoma - surgery (15% of cases)
32
Tension pneumothorax
One way letting air in at inspiration, medical emergency | Treat by decompressing with large cannula and oxygen
33
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) ```
34
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
35
Aura for migraine
Transient neurological symptom, gradually evolves over 5-10 minutes, visual, sensory, motor (palsy), speech, one sided (contralateral to migraine)
36
Tension type headache
``` Bilateral Pressing/tightening Mild/moderate pain Sore muscles No aggravation by physical activity No nausea/vomiting No sound/light sensitivity ```
37
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
38
Treatment of migraine
Acute - simple analgesics (paracetamol, acetylsalicylic acid, ibuprofen) or triptans Severe - prophylactic treatment
39
Common GI symptoms
``` Abdominal pain Nausea Vomiting Dysphagia (swallowing) Dyspepsia (indigestion) Bleeding Diarrhea or constipation Jaundice Weight loss ```
40
Important details about abdominal pain
``` Site Radiation? Character (dull, stabbing, aching, burning) Constant or intermittent Severity ```
41
Common causes of abdominal pain
Inflammation Perforation Obstruction (like chest pain, can have to do with other systems)
42
70 year old man with constipation and weight loss
Order a colonoscopy, potential cancer
43
Alarm symptoms
Weight loss, blood in stools, anemia, nightly fever Persistent change in bowel habits Persistent unexplained pain Persistent difficulty swallowing
44
Diarrhea treatment
Oral rehydration, antibiotics imodium
45
Fresh blood in stools cause
Hemorrhoids, ulcerative colitis, colorectal cancer
46
Tarry blood in stools
Duodenal ulcer, bleeding from upper GI tract
47
Hematemesis
Vomiting blood Severe if fresh with clots Less severe if black, coffee ground like
48
Possible causes of hematemesis
Peptic ulcer Gastritis Anti-inflammatory drugs (aspirin) After intensive vomiting
49
Possible causes of jaundice
Hepatitis, alcoholic liver disease, malaria, obstruction of bile system, neonatal jaundice, gall stones
50
Paraclinical investigations in GI disease`
``` X-ray CT scan MRI Ultrasound Endoscopy ```
51
Types of ulcers
Esophageal ulcer Gastric ulcer Duodenal ulcer
52
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
53
Clinical features of gastric ulcer
Hunger pain Pain in epigastrium that comes and goes Heartburn Vomiting
54
Confirming an ulcer
``` Endoscopy Urea breath test Blood test (anemia) ```
55
Perforation of the stomach
Erect x-ray of abdomen | Manage with resusitation, IV antibiotics, and immediate surgery
56
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
57
IBD
Inflammatory bowel disease includes ulcerative colitis and Crohn's Less common in smokers
58
Ulcerous colitis
Non-specific, superficial inflammation of rectum and colon Peak onset at 15-40 years Symptoms are belly cramps, diarrhea, blood in stools
59
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
60
UC vs Crohn's
Crohn's - cobblestoning | UC - ulcerations
61
Managing IBD
Treat acute attacks Prevent relapse Detect carcinoma at early stages Surgery when needed Fluid balance and nutritional support Corticosteroids when active Immunosuppresants
62
Signs of acute inflammation
Redness Heat Swelling Pain
63
Patient presents with polyuria and dysurea (pain during urination)
Bladder infection (cystitis) or kidney infection (pyelonephritis)
64
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 ```
65
CRP
Protein released by liver during inflammation Used to monitor inflammation Higher for bacteria than virus
66
OOOTTAFVGVAH | SSMMBMBSBBMM
``` Olfactory Optic Oculomotor Trochlear Trigenimal Abducens Fascial Vestibulocochlear Glossopharayngeal Vagus Accessory Hypoglossal ```
67
How to asses consciousness?
Glasgow coma scale (out of 15 pts)
68
Two types of stroke
Ischemic - blood clot | Hemorrhagic - rupture, leakage
69
Diagnosis and treatment of ischemic stroke
``` Acute CT (angiography) Blood tests ``` Thrombolysis Acetylsalicylic acid

MPP (4 decks)

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