Asthma with Pain:
-Paracetamol and tramadol are preferred for pain management.
COX 2 inhibitor can be used.
-NSAIDs like aspirin, diclofenac, etc. should be avoided.
-Steroid may be given, if needed.
-DMARDs are safe.
#Respiratory
-Paracetamol and tramadol are preferred for pain management.
COX 2 inhibitor can be used.
-NSAIDs like aspirin, diclofenac, etc. should be avoided.
-Steroid may be given, if needed.
-DMARDs are safe.
#Respiratory
-Asthma with Arrhythmia:
-Digoxin and amiodarone may be used.
-Aminophylline or theophylline should be avoided.
#Respiratory
-Digoxin and amiodarone may be used.
-Aminophylline or theophylline should be avoided.
#Respiratory
Drug of choice—calcium channel blocker or ARB (losartan, valsartan). ACE inhibitor is avoided as it may induce cough in Asthma.
#Respiratory
#Respiratory
Remember:
-Metformin should be avoided in uncontrolled asthma and contraindicated in acute severe asthma.
#Respiratory
-Metformin should be avoided in uncontrolled asthma and contraindicated in acute severe asthma.
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Cardiac asthma:
-It means left ventricular failure in which the patient usually presents with sudden severe dyspnea and cough with profuse mucoid expectoration.
-On examination, there are bilateral basal crepitations and no rhonchi or wheeze.
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-It means left ventricular failure in which the patient usually presents with sudden severe dyspnea and cough with profuse mucoid expectoration.
-On examination, there are bilateral basal crepitations and no rhonchi or wheeze.
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Gordon’s sign:
-Elicited by pinching the calcaneus tendon.
-If present, there is extensor plantar response.
#Neurology
-Elicited by pinching the calcaneus tendon.
-If present, there is extensor plantar response.
#Neurology
Oppenheim’s sign:
-Elicited by squeezing the calf or pressing heavily along the inner border of the tibia.
-If present, there is extensor plantar response.
#Neurology
-Elicited by squeezing the calf or pressing heavily along the inner border of the tibia.
-If present, there is extensor plantar response.
#Neurology
Hoffman’s sign:
-Elicited by briskly flicking down the patient’s tip of the middle finger with the examiner’s thumb and index. If there is flexion of thumb or all fingers, it is positive.
-It indicates extensive upper motor neuron lesion.
#Neurology
-Elicited by briskly flicking down the patient’s tip of the middle finger with the examiner’s thumb and index. If there is flexion of thumb or all fingers, it is positive.
-It indicates extensive upper motor neuron lesion.
#Neurology
•What are the causes of dyspnea on exertion?
-COPD
-Bronchial asthma
-DPLD (Interstitial lung disease)
-LVF
-Valvular diseases of the heart
-Anemia.
#Respiratory
-COPD
-Bronchial asthma
-DPLD (Interstitial lung disease)
-LVF
-Valvular diseases of the heart
-Anemia.
#Respiratory
•What is Macleod’s syndrome?
-It is a type of unilateral emphysema due to childhood bronchitis or bronchiolitis, resulting in subsequent impairment of alveolar growth.
-t is a rare disease (also called Swyer-James syndrome).
#Respiratory
-It is a type of unilateral emphysema due to childhood bronchitis or bronchiolitis, resulting in subsequent impairment of alveolar growth.
-t is a rare disease (also called Swyer-James syndrome).
#Respiratory
•Why lip pursing is present in emphysema?
-By this in expiration through partly closed lips, there is increased end-expiratory pressure that keeps airway open, helping to minimize air trapping.
#Respiratory
-By this in expiration through partly closed lips, there is increased end-expiratory pressure that keeps airway open, helping to minimize air trapping.
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•What are the types of emphysema?
-Four types:
1-Centriacinar:
-Involves the proximal part of acini, limited to respiratory bronchiole with relatively less change in acinus.As in COPD.
2-Panacinar:
-All the alveoli and alveolar ducts in acinus are involved, both central and peripheral portion. It occurs mostly in a1-antitrypsin deficiency.
3-Paraseptal:
-Along the septa, blood vessels and pleura.
4-Scar or irregular emphysema:
-Scarring and damage affecting the lung parenchyma without involving acinus structure.
#Respiratory
-Four types:
1-Centriacinar:
-Involves the proximal part of acini, limited to respiratory bronchiole with relatively less change in acinus.As in COPD.
2-Panacinar:
-All the alveoli and alveolar ducts in acinus are involved, both central and peripheral portion. It occurs mostly in a1-antitrypsin deficiency.
3-Paraseptal:
-Along the septa, blood vessels and pleura.
4-Scar or irregular emphysema:
-Scarring and damage affecting the lung parenchyma without involving acinus structure.
#Respiratory
•Why low concentration O2 given in COPD? Or what happens when high flow O2 given?
-In COPD, the patient is dependent on hypoxic drive for respiration.
-High flow oxygen blunts the chemoresponsiveness of the respiratory center in the medulla (part of the brainstem) and thus aggravates respiratory failure (RF2).
-To avoid this, low flow oxygen is given.
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-In COPD, the patient is dependent on hypoxic drive for respiration.
-High flow oxygen blunts the chemoresponsiveness of the respiratory center in the medulla (part of the brainstem) and thus aggravates respiratory failure (RF2).
-To avoid this, low flow oxygen is given.
#Respiratory
•Poor prognostic factors in COPD:
-Increasing age (inversely related)
-Fall of FEV1 over time
-Weight loss
-Pulmonary hypertension.
#Respiratory
-Increasing age (inversely related)
-Fall of FEV1 over time
-Weight loss
-Pulmonary hypertension.
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•What organisms are associated with acute exacerbation of COPD?
-Common organisms:
Haemophilus influenzae
Streptococcus pneumoniae.
-Less common organisms:
Moraxella catarrhalis
Chlamydia pneumoniae
Pseudomonas aeruginosa.
#Respiratory
-Common organisms:
Haemophilus influenzae
Streptococcus pneumoniae.
-Less common organisms:
Moraxella catarrhalis
Chlamydia pneumoniae
Pseudomonas aeruginosa.
#Respiratory
•What are the types of cor pulmonale?
1-Acute:
-It occurs following massive pulmonary embolism with acute pulmonary HTN causing right ventricular dilatation and failure (no RVH).
-May occur in ARDS.
2-Chronic:
-It's defined as “right ventricular hypertrophy or dilatation with or without right sided heart failure due to causes of lung parenchyma, pulmonary vasculature or chest wall.
#Respiratory
1-Acute:
-It occurs following massive pulmonary embolism with acute pulmonary HTN causing right ventricular dilatation and failure (no RVH).
-May occur in ARDS.
2-Chronic:
-It's defined as “right ventricular hypertrophy or dilatation with or without right sided heart failure due to causes of lung parenchyma, pulmonary vasculature or chest wall.
#Respiratory
Remember:
•Unilateral bronchiectasis in:
-Resolution stage of pneumonia
-Lung abscess
-Localized fibrosis of lung.
#Respiratory
•Unilateral bronchiectasis in:
-Resolution stage of pneumonia
-Lung abscess
-Localized fibrosis of lung.
#Respiratory
•What is post-tussive crepitation? What is its significance?
-Crepitation which appears after cough is called posttussive crepitation.
-It's usually at the apex, indicates TB.
#Respiratory
-Crepitation which appears after cough is called posttussive crepitation.
-It's usually at the apex, indicates TB.
#Respiratory
Remember:
•Causes of bilateral crepitation with clubbing:
-Bilateral bronchiectasis
-IPF (fibrosing alveolitis or ILD).
#Respiratory
•Causes of bilateral crepitation with clubbing:
-Bilateral bronchiectasis
-IPF (fibrosing alveolitis or ILD).
#Respiratory
•What is dry bronchiectasis (bronchiectasis sicca)?
-It is a type of bronchiectasis in which dry cough is associated with intermittent episodes of hemoptysis.
-It may be massive, even life-threatening as bleeding is from bronchial vessels with systemic pressure.
-Common in patient with granulomatous infection, especially TB and usually involves upper lobe.
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-It is a type of bronchiectasis in which dry cough is associated with intermittent episodes of hemoptysis.
-It may be massive, even life-threatening as bleeding is from bronchial vessels with systemic pressure.
-Common in patient with granulomatous infection, especially TB and usually involves upper lobe.
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