General questions 1 Flashcards
What is the mont common allergen that can cause allergy and asthma in children?
Dust mites
> Use dustproof covers for bedding
Polish floors and replace carpets
Wash bed clothes in hot water > 55º weekly
Dont use sheepsking bedding
What is the risk of being exposed to Asbestos?
Increased risk of bronchogenic carcinoma, GI cancer and asbestosis
What is the population most at risk for asbestos?
Occupationally exposed workers
What is the current “screening” for asbestos-relates diseases?
Theres is no adequate screening yet.
Current recommendations:
> Take complete history e physical exam
> Order a chest X ray for all patients with exposure
> Repeat the X ray in 3 to 5 year intervals (time that takes for asbestos exposure to be evident on X-ray)
> Simple pulmonary function tests can help recognize restrictive patterns
What are the symptons of tension pneumothorax besides low blood pressure and tachycardia? [3]
- Shifted trachea away from site of injury
- Hyper resonance
- Decreased chest wall movements on the affected side
What are the symptoms of cardiac tamponade besides low blood pressure and tachycardia?
- Decreased diastolic flow to the heart
- Pulsos paradoxus
- Hypotension
What is the best choice of antihypertensive therapy for a 50 year old man with CKD with decreased GFR and asthma
AVOID:
-Beta blockers due to ASTHMA
- ACE inhibitors or ARBS due to decreased GFR because this drugs relax the efferent glomerular arteriole, deteriorating the GFR
- Diuretics: the antihypertensive effects of diuretics is reduced in patients with renal disease making them inappropriate and less reliable options for hypertension control
In which case ACE inhibitors and ARBS are useful for patients with kidney disease?
Associated hypertension and proteinuria but with preserved GFR
Why are ACE inhibitors and BRAs contraindicated in patients with disease like bilateral renal artery stenosis, hypertensive nephroesclerosis or polycystic kidney disease ?
Intrarenal perfusion pressure is already reduced
Glomerular filtration rate is maintained by angiotensin II induced increase in resistance of the efferent (post glomerular) arteriole
Blocking this response will relax the efferent arteriole, lower intra glomerular pressure and reducing GFR
What is intersticial lung disease?
Chronic inflammation + fibrosis of the insterstitium and lung parenchyma
What are common features of intersticial lung disease? [7]
- Dyspnea: all patients with IDL will develop exertional dyspnea - MOST COMMON COMPLAINT
- Non productive cough
- Bibasal inspiratory crackles
- Evidence of pulmonary hypertension in advanced disease (right heart failure, etc)
- Clubbing (not always) especially in idiopathic pulmonary fibrosis and asbestosis
- Reticular or reticulonodular pattern (ground-glass appearance) on chest X ray
- Intrapulmonary restrictive pattern and decrease DLCO on pulmonary function testing
What is mesothelioma?
Rare malignancy of pleural and peritoneum
Highly associated with asbestos exposure (only known cause)
What are the main symptoms of mesothelioma?
Weight loss, recurrent pleural effusions and pleural thickening and calcification on imaging
Dyspneaand nonpleuriticchest pain(most common)
Fever, sweats,weight loss, fatigue
Features ofpleural effusion: dull percussion;absent or reduced breath sounds on affected side
What is sarcoidosis?
Multisystem disease characterized by non-caseating granuloma formation in different organ systems
Classified as ILD, but 90% of patients are asymptomatic
What are the main symptoms of sarcoidosis?
90% : asymptomatic
Symptoms resemble pulomary TB
What are the 3 main symptoms of horners syndrome?
- Miosis (an abnormally small pupil)
- Partial ptosis (drooping of the upper eyelid)
- Facial anhidrosis (absence of sweating).
Always ipsilateral as damaged nerve
SPAM: sympathetic fibers, ptosis, anhidrosis, miosis
What is horners syndrome?
Problem with sympathetic nerve supply to one side of the face (damage along the oculosympathetic pathway)
Describe causes for horners syndrome:
1st order lesion: lesion above T1 (stroke, tumors, syringomyelia)
2nd order lesion: compression from a pancoast tumor (apex of lungs)
3rd orde lesion: dissection of internal carotid artery
What are some tests for horner symptom?
- Eye drop test with cocaine or apraclonidine: blocks reuptake of norepinephrine, causing pupil dilatation. If the oculosympathetic pathway is blocked, midriasis wont happen
- CT or MRI: identifies underlying causes
What is vertebrobasilar insufficiency?
Insuficciency of the vertebrobasilar arterial systems that supplies blood to the medulla, cerebellum, pons, midbrain, thalamus and occipital cortex
What are features of vertebrobasilar insuficciency?
Vertigo, nausea, vomiting, nistagmus = vertebrobasilar strokes
Unilateral horder syndrome = brainstem lesions
Cerebellar signs = dysmetria, ataxia
Dysarthria, dysphagia
Occipital lobe lesions result in visual field loss
May affect the dorsal column of the medulla, resulting in dissociated sensory loss
!! Cortical deficits such as aphasia and cognitive impairments are absent!!
What are symptoms of left inferior cerebellar artery (PICA) occlusion?
Symptoms:
Ipsilateral sensory deficits to face and cranial nerves
Contralateral sensory deficits on the trunk and extremities
Ataxia
Difference in temperature sensation between body sides
Dysphagia
Vertigo
Nystagmus
Disarthria
Horner syndrome
Palatal myoclonus
Hoarseness
Nausea and vomitng
Bradycardia and dysregulation of blood pressure
What is PICA syndrome?
PICA is the largest branch of the vertebral artery, one of 3 main arteries that supply the cerebellum
PICA syndrome is also called lateral medullary syndrome or wallenberg syndrome
What is Meniere’s disease? What is the most common age group affected?
Disorder of the inner ear caused by impaired endolymph resorption
Most commonly manifests in adults between 40–50 years of age.
