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Sindrom bronsic si cavitar Flashcards

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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
triada Widal
astm + hipersensibilitate la aspirina + polipoza nazala
26
astm manif clinice
! 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
27
astm tuse
initial uscata apoi umeda cu expectoratie muacoasa ”sputa perlata”
28
atacul astmatic
crize subintrante care se repeta in 24h dispnee usoara expir prel si raluri sinilante reversibile sub trat
29
astm bronsic cu dispnee continua
- starea subastematica - intalnita la batrani - rezistanta la bronhodilatatoare - se ajunfe la insuf resp cronica, astm umed
30
starea de rau astmatic
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
starea de rau astmatic EO
- cianoza la extremitati - paloare fata - transpiratii - torace blocat in inspir - fara expectoratie - nu are wheezing - tahicardie - coma - existus
32
stare de rau astmatic cauze
med care inhiba reflexul de tuse !! - opaicee barbiturice
33
astm EO
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
astm paraclinic
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
diagn dis BPOC si astm
teste farmacidin cu substr bronhodilatatoare - in astm VEMS creste cu peste 15%
36
BPOC semne de gravitate
folosire muschi resp accesori - miscari toracice paradoxale - cianoza recent - edeme periferice - instabilitate hemodinamica
37
astm semne e agravare
- wheezing accentuat - imposibilitate decubit - flaringul nazal - duere toracica - musc resp accesoirie - tahocardie si tahipneici
38
criza de astm br culmineaza cu starea de rau astmatic simptome
* 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
chisturile
dimensiuni mici, cu diametru mai mic de 3 mm au de obicei continut aeric. rx - hipetransparenta cu perete subtire
40
cavitatile
- peste 3 mm - uneori in masa de tesut tumoral / inflamator - rx: hipertransparenta cu oerete mai gros
41
cavitati exemple
abcese oulmonare caverne tbc apar semne si simptome ale sd cav - emfizem+bronsiectazii
42
bula de emfizem
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
bronsiectazia
dilatare permanenta, localizata rx - corespund distributiei topografoice a arb bronsic
44
cavitati cauze
infectioasa ichemice obstructive
45
cavitate prin eliminare tesut pulm necrozat
tbc fungi pneumonii cu stafilococ/ prode de klebsiella
46
cavitati cauza ichemica - prin necroza aseptica
infarct pulmonar vasculite tumori
47
cavitati prin dilatatia chistica a str pulmonare dupa o obstructie
mec de supapa pneumocystis carinii
48
cavitati focale si multifocale
neoplazie infarct pulmonar pneumoconicoze bronsietazii granulomatoza wegener inf cu gram neg
49
cavitati difuze
limfangioleimiomatoza pulmonara pneumonia intersititala fibroza pulmonara
50
sd cavitar manif clinice specifice
- dispnee - tuse - hemoptizie - durere toracica
51
sd cavitar semne asociate
- febra - paloare si coloratia teroasa - anemie cronica - transporatii - halena fetida -: inf cu anaerobi, abece, bronsiectazii - hemoptizii - slabit - adenopatii
52
sd cavitar EO
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
Sd cav ausculatatie
* 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
abcesul pulmonar
zona pulmonara de necroza parenchimatoasa localizata, datorata unei infec"ii cu germeni piogen
55
abces secundar
colonizate si cu flora aeroba chisturi aerice caverne tbc infarcte pulm tumori
56
sd cavitar manif clince
- 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
sd cv EO
- 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
sd cavitar ex local
primele 5 zile -sd de condensare - dupa evacuare devine sd cavitar - 25% asociaza pleurezie
59
abcese pulm primitive localizari frecv
segm post al lb sup drept segm sup al lb inferior drept
59
abcese pulm primitive localizari frecv
60
Abcesele supradiafragmatice
„coloratura abdominala” a simptomatologiei $i se înso"esc de durere, sughi" $i de grea"a.
61
abcesele sunt localizate la nivelul lobilor superiori
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
gangrena
supuratie difuza microabcese cu diam <2cm la imunodeprimati sputa negricioasa si fetita
62
gangrena
supuratie difuza microabcese cu diam <2cm la imunodeprimati sputa negricioasa si fetita
63
paraclinic abces pulmonar
rx - opacitate neomogena -> dupa drenare devine o imagine hidro-aerica ovalara CT bronhoscopie ex bacteriologic sputa
64
bronsiectazia
dilatatii permanente ireversibile calibru mediu - tuse cu brnhoree purulenta pluristratificata - caracter recurent si tendinta la cronicizare
65
Sindrom Mounier-Kuhn
- Absen"a musculaturii bron#ice - Polipoza nazala - Etmoidita - Traheobronhomegalia
66
Sindrom Williams-Campbell
Hipoplazia sau agenezia cartilajelor bron#ice
67
Sindrom Kartagener
Situs inversus - Diskinezie ciliara - Sterilitate masculinã - Sinuzita paranazala
68
bronsiectaziile devin simptomatice cu ocazia unei infectii si se manfiecta clinic prin
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
bronsiectazii EO
teg palid-teroase hipocratism A - r creptiante in inspir + r sibilante si ronflante in zona de proiectie a bronsiectaziiei, bazal
70
bronsiectazii paraclinic
rx - opacitati/ imag cavitare cu aspect fagure de miere / sina de tramvai
71
semn imp pe CT bronsiectazii
lipsa scaderii calibrului spre perficeria pl vizualizare lumen bronhic la mai putin de 1 cm de pleura

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