Coarctation Of Aorta CoA

-Is a congenital condition whereby the aorta narrows in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts

-Signs :

.Bp in upper limb increased / Bp in lower limp decreased

.lower limb atrophy

.radio-femoral delay

.systolic murmur in ventricular hypertrophy

.CxR (notching of ribs)

.associated with turners syndrome (45XO)

Pericarditis

-Is an inflammation of the pericardium (the fibrous sac surrounding the heart)

.The pain is relieved by leaning forward

-Symptoms & Signs :

.chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back)

.cough

.fever

.fatigue

.anxiety

-Causes :

.infections of the pericardium by viruses or bacteria (Mycobacterium tuberculosis,Coxsakie B virus)

.secondary to MI

.idiopathic causes

.uremic pericarditis

.post-infarct pericarditis (within 24 hours of a heart attack)

.Dressler's syndrome (weeks to months after a heart attack)

.cardiac tamponade

.ewart's sign

.friction rub (M.C feature)

.venous distension

.SLE

.RA

+ACE inhibitor (is best for hear failure)

-Side effect :

.dry cough

.hyperkalemia

.angioedema

-Contraindications :

.pregnancy

.renal failure

.bilateral renal artery stenosis

+B-blocker

-Side effect:

.bradycardia

.sexual dysfunction

.hyperlipidemia

.mask hypoglycemia

-Contraindication :

.peripheral vascular disease

.chronic lower limp eschemia

+b2-blocker

-Side effect :

.hypotention

.tachycardia

.tremur

.hypokalemia

PULMONOLOGY

Chronic Obstructive Pulmonary Disease

-Most people with chronic bronchitis have COPD

-Symptoms & Signs :

.shortness of breath (dyspnea-M.C symptom)

.cough

.chest tightness and tiredness

.sputum production

.wheezin

.leg swelling

.hypoxia

.cyanosis

.hypercapnea (inc.Co2)

-Classifications :

1.chronic bronchitis (Po2 low / Co2 high)

2.emphysema ‘associated with alph-1-antitrypsin deficiency’ (Po2 low / Co2 low or normal )

+Total lung capacity is increased in emohysema

-Causes :

.M.C.C is smoking

.Air pollution

.Occupational exposures

.Genetics (alpha 1-antitrypsin deficiency AAT)

.Exacerbations (Cold temperature,pulmonary emboli,exposure to personal smoke)

.asthma

.HIV/AIDS

.tuberculosis

.respiratory infections such as pneumonia

-Complications :

.cyanosis

.respiratory failure

.tension pneumotharx (rupture of bulla)

.lung cancer

.pulmonary HTN

.left ventricle failure

.cor pulmonale

.polycythemia (inc.Hb)

+COPD (don`t cause finger clubbing

+COPD cause of Rt side heart failure (not Lt side heart failure)

-Diagnosis :

.spirometry (pulmonary function test)

.FEV1 (forced expiratory volume in 1sr- FEV1<80%)

-Treatment :

.bronchodilators

.B2-agonist (ventalin,terbutaline,salbutamol)

.anticholinergics (salmeterol,formoterol)

.corticosteroid

.antibiotics

.phosphadiesterase inhibito (theophyline)

.Oxygen NOT 100% O2

Asthma

-Is the common chronic inflammatory disease of the airways,charcteraized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm

-Differentiates the asthma from COPD (Variability)

-Symptoms & Signs :

.cough (M.C symptom)

.wheezing

.shortness of breath (dyspnea)

.chest tightness and coughing

.worse at night or in the early morning or in response to exrcise or cold air

.Low PO2

.Pulsus paradoxus

.Cyanosis (severe asthma)

.Restlessness

.Silent chest (severe asthma)

.Tachycardia (more than 130 per min)

.Hypercapnia

+bradycardia and pulsus alternans are NOT

-Causes :

.genetic factors (atopic – inc. IgE,eosinophilia in children)

.environmental factor (Sudden change of air temperature)

.urticaria

.Beta blocker medications ( propranolol),Cardioselective beta-blockers ,ACE inhibitors, aspirin and NSAIDs (Paracetamol injection)

.viral and bacterial infections of the upper respiratory tract

.Psychological stress

.history of atopic disease (eczema,hay fever)

.dust

.smoking

.paint

.allergens perfumes

-Diagnosis :

.FEV <80%

-Treatment :

.long acting beta-adrenoceptor agonist (formetrol)

.short acting beta-adrenoceptor agonist (salbutamol)

.anticholinergic medications (ipratorpium bromide)

.glucocorticoids

.corticosteroids IV

.methylxanthin (aminophylline,theophylline)

.adrenalin IV

.intubation

+B-blocker +NSAID are contraindicated in ASTHMA

+Severe asthma (peak flow <33% / PaO2 is high / silent chest / cyanosis / low Bp)

+Acute severe asthma (peak flow 33-50% / respiratory >25 breaths per min. / heart rate >110 / unable to complete sentences in one brath)

Date: 2016-04-22; view: 509