Internal Medicine at Sefako Makgatho Health Sciences University | Flashcards & Summaries

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Definition of ARDS
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A type of respiratory failure characterized by the acute onset of bilateral alveolar infiltrates and hypoxemia
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Clinical Features and Investigations of Bronchiectasis 
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History and physical: complaints: cough, dyspnoea, copious sputum production, haemoptysis.
- On Examination: clubbing, inspiratory crackles, wheezing.

INVESTIGATIONS

- Imaging: CXR, CT Chest.
- Lung Function test: obstructive pattern
- Laboratory studies: complete blood count, CRP, U/E, IgA, lgG, IgM, lgG, autoimmune studies, alpha 1 antitrypsin level, IgE, eosinophils, dynein mutation, colonoscopy, bowel biopsy, sweat test, CFTR mutation
- Microbiologic studies: sputum: TB, gram stain and culture of the sputum.
- ECG

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Pathophysiology of Bronchiectasis 
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- An infectious insult with mucus production within the airway. 
- impaired drainage, airway obstruction, or a defect in host defense. 
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Clinical Features of ARDS
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  • ARDS should be suspected in patients with progressive symptoms of dyspnoea, an increasing requirement for oxygen and alveolar infiltrates on chest imaging within 6-72 hours of an inciting event. 
  • History and physical. Dyspnoea and a reduction in arterial oxygen saturation after 6 to 72 hours (or up to a week) following an inciting event
  • On examination: tachypnoea, tachycardia, and diffuse crackles.
  • In Severe cases: acute confusion, respiratory distress, cyanosis, and diaphoresis may be evident.
  • Cough, chest pain, wheeze, haemoptysis, and fever are inconsistent and mostly driven by the underlying aetiology.


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Treatment of ARDS
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  • Goals: maintain gas exchange, sustain life and avoid ventilation-induced lung injury.
  • Management of hypoxemia: supplemental oxygen (high flow, mechanical ventilation), fluids management.
  • Supportive care: sedation, paralysis, venous access nutritional support, glucose control, DVT prophylaxis, Ulcer prophylaxis, steroids.

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Etiology of ARDS
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- Direct Injury : Pneumonia, aspiration, near drowning, inhalation, lung contusion. 
- Indirect injury - Sepsis, shock, pancreatis, trauma/multiple fractures. 
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Etiology of Bronchiectasis 
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  • Chronic infections: recurrent childhood respiratory infections, PTB, Allergic Bronchopulmonar. 
  • Primary biliary dyskinesia: sinusitis, infertility, otitis
  • Immunodefiency syndromes
  • Autoimmune diseases: RA, SLE
  • Inflammatory Bowel Disease
  • alpha1- antitrypsin deficiency
  • Cystic Fibrosis

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1. Epidemiology 
2. Pathophysiology 
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1. 10-15% patients admitted to ICU. Higher incidence with advanced age. 

2. Healthy lungs regulate the movement of fluid to maintain a small amount of interstitial fluid and dry alveoli. In patients with ARDS, this regulation is interrupted by lung injury, causing excess fluid in both the interstitium and alveoli. Consequences include impaired gas exchange, decreased compliance, and increased pulmonary arterial pressure
- There are 3 stages : exudative stage, proliferative stage, fibrotic stage.
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Risk factors for Asthma 
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  • Neonatal viral infections
  • Allergens 
  • Occupational agents 
  • Drugs 
  • Personal or family history of atopy
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Clinical Features of Asthma 
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  • Wheezing 
  • Chest Tightness 
  • Breathlessness 
  • Cough
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Investigations for Asthma 
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  • CXR
  • FBC, DIFF COUNTY CRP, UREA, CREATINE, ELECTROLYTES, IgE
  • Sputum 
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Complications and Treatment of Bronchiectasis 
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COMPLICATIONS

- Respiratory: Recurrent Pneumoniae, Respiratory failure, lung abscess, empyema, pneumothorax
- Non-respiratory: Pulmonary hypertension, Cor pulmonale.

TREATMENT

- Acute exacerbations: antibiotics
- Chronic management: treat underlying disease, chest physio, mucous clearance, bronchodilators
- Lung transplant


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Q:
Definition of ARDS
A:
A type of respiratory failure characterized by the acute onset of bilateral alveolar infiltrates and hypoxemia
Q:
Clinical Features and Investigations of Bronchiectasis 
A:
History and physical: complaints: cough, dyspnoea, copious sputum production, haemoptysis.
- On Examination: clubbing, inspiratory crackles, wheezing.

INVESTIGATIONS

- Imaging: CXR, CT Chest.
- Lung Function test: obstructive pattern
- Laboratory studies: complete blood count, CRP, U/E, IgA, lgG, IgM, lgG, autoimmune studies, alpha 1 antitrypsin level, IgE, eosinophils, dynein mutation, colonoscopy, bowel biopsy, sweat test, CFTR mutation
- Microbiologic studies: sputum: TB, gram stain and culture of the sputum.
- ECG

Q:
Pathophysiology of Bronchiectasis 
A:
- An infectious insult with mucus production within the airway. 
- impaired drainage, airway obstruction, or a defect in host defense. 
Q:
Clinical Features of ARDS
A:
  • ARDS should be suspected in patients with progressive symptoms of dyspnoea, an increasing requirement for oxygen and alveolar infiltrates on chest imaging within 6-72 hours of an inciting event. 
  • History and physical. Dyspnoea and a reduction in arterial oxygen saturation after 6 to 72 hours (or up to a week) following an inciting event
  • On examination: tachypnoea, tachycardia, and diffuse crackles.
  • In Severe cases: acute confusion, respiratory distress, cyanosis, and diaphoresis may be evident.
  • Cough, chest pain, wheeze, haemoptysis, and fever are inconsistent and mostly driven by the underlying aetiology.


Q:
Treatment of ARDS
A:
  • Goals: maintain gas exchange, sustain life and avoid ventilation-induced lung injury.
  • Management of hypoxemia: supplemental oxygen (high flow, mechanical ventilation), fluids management.
  • Supportive care: sedation, paralysis, venous access nutritional support, glucose control, DVT prophylaxis, Ulcer prophylaxis, steroids.

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Q:
Etiology of ARDS
A:
- Direct Injury : Pneumonia, aspiration, near drowning, inhalation, lung contusion. 
- Indirect injury - Sepsis, shock, pancreatis, trauma/multiple fractures. 
Q:
Etiology of Bronchiectasis 
A:
  • Chronic infections: recurrent childhood respiratory infections, PTB, Allergic Bronchopulmonar. 
  • Primary biliary dyskinesia: sinusitis, infertility, otitis
  • Immunodefiency syndromes
  • Autoimmune diseases: RA, SLE
  • Inflammatory Bowel Disease
  • alpha1- antitrypsin deficiency
  • Cystic Fibrosis

Q:
1. Epidemiology 
2. Pathophysiology 
A:
1. 10-15% patients admitted to ICU. Higher incidence with advanced age. 

2. Healthy lungs regulate the movement of fluid to maintain a small amount of interstitial fluid and dry alveoli. In patients with ARDS, this regulation is interrupted by lung injury, causing excess fluid in both the interstitium and alveoli. Consequences include impaired gas exchange, decreased compliance, and increased pulmonary arterial pressure
- There are 3 stages : exudative stage, proliferative stage, fibrotic stage.
Q:
Risk factors for Asthma 
A:
  • Neonatal viral infections
  • Allergens 
  • Occupational agents 
  • Drugs 
  • Personal or family history of atopy
Q:
Clinical Features of Asthma 
A:
  • Wheezing 
  • Chest Tightness 
  • Breathlessness 
  • Cough
Q:
Investigations for Asthma 
A:
  • CXR
  • FBC, DIFF COUNTY CRP, UREA, CREATINE, ELECTROLYTES, IgE
  • Sputum 
Q:
Complications and Treatment of Bronchiectasis 
A:
COMPLICATIONS

- Respiratory: Recurrent Pneumoniae, Respiratory failure, lung abscess, empyema, pneumothorax
- Non-respiratory: Pulmonary hypertension, Cor pulmonale.

TREATMENT

- Acute exacerbations: antibiotics
- Chronic management: treat underlying disease, chest physio, mucous clearance, bronchodilators
- Lung transplant


Internal Medicine

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