What are the discharge criteria of COPD patient?

-The patient should be clinically stable and no parenteral therapy for 24 hours
-Inhaled bronchodilators are required less than 4 hourly
-Oxygen delivery has ceased for 24 hours
-The patient is able to eat and sleep without significant episodes of dyspnea
-The patient or caretaker understands and is able to administer medications
-Follow up and home care arrangements (As for example home oxygen, home care, Meals on Wheels, community nurse, allied health, GP, specialist) have been completed
-The patient is ambulating safely and independently, and performing activities of daily living.

#Respiratory

-Pneumonia is the eighth leading cause of death, and the number 1 cause of death from infectious disease, in the United States. 

-Globally, pneumonia is the leading cause of death in children under 5 years old.

#Respiratory

-The classic etiologic agents of atypical pneumonia are Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae.

-Many other diseases, caused by various pathogens, should be considered in the differential diagnosis. Such etiologic agents include fungi, mycobacteria, parasites, and viruses (eg, influenza virus, adenovirus, respiratory syncytial virus, human parainfluenza virus, measles, varicella zoster, Hantavirus)

#Respiratory

Interpretation of thyroid function tests.

#Thyroid

Remember:

-Primaquine is contraindicated in pregnant women,
infants and known G6PD deficient patients.

-Primaquine can lead to hemolysis in G6PD deficiency.

#Infections

It is recommended to delay elective non-cardiac surgery until
- 6 months after elective PCI and
- 12 months after an ACS.

#Cardiology

Remember:

The three commonest causes of persistent dry cough with a normal chest X-ray are:
1-Asthma (50 ٪),
2-Sinusitis
3-Postnasal drip (25 ٪)
4-Reflux oesophagitis (20٪).

-Asthma may present as a cough (cough-variant asthma) with little or no airflow obstruction initially, although this develops later.

#Respiratory

Serum procalcitonin (PCT):

-Procalcitonin is an acute phase reactant that can help to diagnose bacterial lower respiratory tract infections. It is increased.

-Low PCT level after 2–3 days of antibiotic therapy can help facilitate the decision to discontinue antibiotics in treatment of Pneumonia.

#Respiratory

Asthma

-Chest x-ray is most often normal in asthma, but may show hyperinflation.


-The best initial test in an acute exacerbation is peak expiratory flow (PEF) or arterial blood gas (ABG).

Peak flow can be used by the patient to determine function.

#Respiratory

-REMEMBER:

•Causes of HTN with hypokalemia include:

1-Conn's syndrome
2-Cushing syndrome
3-liddel's syndrome
4-11 beta hydroxylaze enz. defeciency
5-Renal artery stenosis.

#Cardiology

Remember:

-Drug of choice for pt suffering of gout and hypertension is Losartan.

Because it increase the excretion of uric acid by kidney.

-Drug of choice for pt suffering of gout and hyperlipidemia is fenofibrate.

Uricosuric action increase renal excretion uric acid.

#Cardiology

Remember:

-Malabsorption symptoms + macrocytosis in young patient👉🏼 coeliac disease.

-Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs👉🏼Lactose intolerance .

-Malabsorption + joint pain + Bradycardia in middle age👉🏼 Whipple's disease ( positive PAS biopsy).

-Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA👉🏼 think in tropical sprue .

-Malabsorption + recurrent epigastric pain to back + positive fecal elastase 👉🏼 chronic pancreatitis .

-Malabsorption + symptoms of bronchiectasis 👉🏼 cystic fibrosis.

-mrcp1
#GIT

Vitamin deficiency symptoms & treatment.

#Metabolic

Pulmonary function tests (PFTs) in asthma show:

• Decrease in FEVl of more than 20% with the use of methacholine or histamine.
• Increase in the diffusion capacity of the lung for carbon monoxide (DLCO).

#Respiratory

Asthma

Additional testing options include:
• CBC may show an increased eosinophil count.
• Skin testing is used to identify specific allergens that provoke bronchoconstriction.

#Respiratory

Asthma

Acetylcholine and histamine provoke bronchoconstriction and an increase in bronchial secretions.

Note:
Methacholine is an artificial form of acetylcholine used in diagnostic testing.

#Respiratory

Asthma

-Increased IgE levels suggest an allergic etiology.

-IgE levels may also helpguide therapy such as the use of the anti-IgE medication omalizumab.

#Respiratory

Pathophysiology in MS:

•Mitral valve stenosis → obstruction of blood flow into the left ventricle (LV) → limited diastolic filling of the LV (↓ end-diastolic LV volume) → decreased stroke volume → decreased cardiac output (forward heart failure)

•Mitral valve stenosis → increase in left atrial pressure → backup of blood into lungs → increased pulmonary capillary pressure → cardiogenic pulmonary edema.

#Cardiology

Remember:

-In presence of ECG changes with hyperkalaemia, 1st step should be infusion of 10 mL 10% calcium gluconate slowly.

-In presence of magnesium depletion, replacement of Mg may also be required for hypokalaemia to be corrected. "since low cell magnesium can enhance the mechanism for tubular potassium secretion, causing ongoing urinary losses".

-If low magnesium is associated with low Ca, 50mmol Mg chloride IV over 24hours.

-Hypercalcemia should initially be treated with intravenous 0.9% saline " to improve renal function and increase urinary calcium excretion".

#Metabolic

-Viral Infections Causes Aplastic Anemia:

●Acute viral hepatitis 👉🏼 Hepatitis A+B
●Parvovirus B19
●Epstein-Barr
●Cytomegalovirus
●HIV

-USMLE
#Blood

In case of ACAS:

-Half the deaths occur within 24 hours of the onset of symptoms and about 40% of all affected patients die within the first month.

-The prognosis of those who survive to reach hospital is much better, with a 28-day survival of more than 85%.

#Cardiology