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huggingfacepremium

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Lll

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Hyperchloremic

Yes

Yes

Yes

acidosis Urine Ph

>5.5

<5.5

<5.5

K

Low

Low

High

Serum Defect

Reduce H+ excretion in distal tubules

Impaired HCO3reabsorption in proximal tubule

Impaired cation exchange in distal tubule

Associated conditions

Renal stone

osteomalacia + rickets

Mild- mode renal insufficiency

Causes

1. Sporadic 2- Autoimmune disease (SLE, Sjogren syndrome) 3- Drugs: amphotericin, lithium, analgesics, 4- Nephrocalcinosis, sickle cell, chronic infect 5- Familial 6- Chronic hepatitis.

I- Fanconi syndrome 2- Wilson disease 3- Amyloidosis 4- myeloma, 5- acetazolamide 6- vit D deficiency 7- Hyperparathyroidis m 8- chronic hypoca 9- heavy metals 10- chronic hepatitis 11 - autoimmune (SLE, Sjogren syndrome)

1. Aldosterone deficiency 2. DM 3. Addison disease 4. Sick cell disease. 5. Renal insufficiency

Type 1 respiratory failure

Type 2 respiartory failure

Hyperventilation with relatively patent airway washout of CO2

No washout of CO2 either due to hypoventilation or sever bronchial obstruction or chest deformity

Decrease PO2 < 60 mmhg with normal or low CO2

Decrease PO2 with increase CO2

Called hypoxemic RF

Called hypercapnic RF

Causes: 1- Emphysema 2- Pneumonia 3- Asthma 4- PE 5- Plu HTN 6- Bronchiectasis

Causes: 1. Chronic bronchitis 2- Narcotics 3- Hypoventilation 4- Chest wall abnormalities

Answer: B

Causes Transudate pleural effusion

Causes Exudate pleural effusion

1- Heart failure

3- Parapneumonic effusion

2- Nephrotic syndrome

4- Malignancy ( lung, breast, lymphoma)

3- Liver disease

5- Tuberculosis

4- Pulmonary embolism

6- Pulmonary embolism

5- Atelectasis

7- Collagen vascular disease (rheumatoid arthritis, SLE)

8- Drug induced

9- Pancreatitis

Types of pleural fluid

Transudate

Exudate

Definition

Effusions that are caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure.

Effusions caused by changes to the local factors that influence the formation and absorption of pleural fluid.

Causes

Congestive heart failure Liver cirrhosis Severe hypoalbuminemia Nephrotic syndrome

Malignancy Infection (e.g. empyema due to bacterial pneumonia) Trauma Pulmonary infarction Pulmonary embolism

Diagnosis

Protein <30 g/L (in patients with a normal serum protein level)

Protein >30 g/L (in patients with a normal serum protein level)

Light's criteria

Light's criteria are more accurate for the diagnosis The fluid is considered an exudate if any of the The ratio of pleural fluid to serum protein is The ratio of pleural fluid to serum LDH is The pleural fluid LDH value is greater than normal serum value If a patient is thought to have a transudative pleural suggest an exudate, the serum-pleural fluid protein

of exudative effusions. following are present: greater than 0.5 greater than 0.6 two-thirds of the upper limit of the effusion but the Light's Criteria gradient should be examined.

Features of

thromboembolism

Acute massive PE

Acute small / medium PE

Chronic PE

Pathophysiology

Major hemodynamic effect: low cardiac output, acute right heart failure

Occlusion of segmental pulmonary artery> infarction, effusion

Chronic occlusion of pulmonary microvasculature, right heart failure

Symptoms

Faintness or collapse, crushing central chest pain . apprehension, sever dyspnea

Pleuritic chest pain, restricted breathing, haemoptysis

Exertional dyspnea, late symptoms of pulmonary hypertension or right heart failure

Signs

Major circulatory collapse: tachycardia, hypotension, high JVP, right ventricular gallop rhythm, loud P2, sever cyanosis, low urinary output

Tachycardia, pleural rub, raised hemidiaphragm, crackles, effusion, low- grade fever

May be minmal early in disease later RV heave, loud P2. Terminal: signs of right heart failure

Chest X ray

Normal

Pleuropulmonary pcacities, pleural effusion, linear shadow, raised hemidiaphragm

Enlarged pulmonary trunk, enlarged heart, prominent RV

ECG

SIQ3T3 anterior T- wave inversion, RBBB

Sinus tachycardia

RV hypertrophy and strain

ABG

Low PaO2, low PaCO2, metabolic acidosis

Normal or low PaO2, PaCO2

Exertional ow PaO2 or desaturation on formal exercise testing

Causes of hemorrhagic

pleural effusion

Traumatic

Iatrogenic

Non-traumatic

blunt or penetrating chest trauma

1- Pleural procedures (thoracentesis, tube

1- Malignancy

thoracostomy insertion, pleural biopsy)

2- Pulmonary embolism with pulmonary infarction

3- Anticoagulant therapy

2- Cardiothoracic surgery

4- Bleeding diathesis

3- Placement of central venous lines

5- Spontaneous hemopneumotherax 6- Aortic dissection or rupture

4- Extra-vascular migration of central venous line

7- Aneurysm rupture or dissection of internal mammary artery

& Post-cardiac injury syndrome

9- Infections such as dengue hemorrhagic fever, pulmonary tuberculosis

10-Thoracic endometriosis with catamenial hemothorax

11-Vascular and connective tissue anomalies (Ehlers-Danlos type 4, neurofibromatosis, hereditary hemorrhagic telangiectasis)

12-Exostoses

13-Catamenial hemothorax

14-Extralobar pulmonary sequestration

15-Extramedullary hematopoiesis

16-Congenital diseases, such as Ehlers- Danlos type 4, neurofibromatosis, hereditary hemorrhagic telangiectasis, and Bean's blue rubber nevus syndrome

Answer:

A

Life

threating features of asthma:

1-

PERF < 33%of predicted normal vaule

2-

Silent chest: absence of wheeze

3-

Diminished respiratory effort

4-

Bradycardia

5-

Hypotension

6-

Exhaustion

7-

Confusion and agitation

8-

Sign of hypercarbia: sweating, red florid complexion, bounding pulse, peripheral tremors

9-

Coma

"Red as a beet"

:flushed, red skin due to cutaneous vasodilatation

"Dry as a bone"

dry skin (anhydrosis) due to inability

"Hot as a hair"

anhydrotic hyperthermia

"Blind as a bat"

:mydriasis

"Mad as a hatter"

: delirium, psychosis, hallucination.

"Full as a flask"

: urinary retention and absent bowel sounds

Tachycardia

Stages

Time Post ingestion

Description

I

0 - 24 hours

Anorexia, nausea, vomiting

II

24 - 72 hours

Right upper quadrant abdominal pain (common)

AST, ALT, and, if poisoning is severe, bilirubin and PT (usually reported as the INR) sometimes elevated

II

72 - 96 hours

Vomiting and symptoms of liver failure Peaking of AST, ALT, bilirubin, and INR Sometimes renal failure and pancreatitis

IV

>5 days

Resolution of hepatotoxicity or progression to multiple organ failure (sometimes fatal)

1-

Symmetric proximal and distal muscles

2-

Gradually over days to even weeks

3-

May have tenderness, pain, paresthesias early

4-

Bulbar involvement: dysphagia, facial weakness, respiratory insufficiency

5-

autonomic involvement: blood pressure lability, bradycardia, asystole

6-

Spontaneous recovery begins in 2-3 weeks

7-

improvement in inverse direction

-

High blood pressure (hypertension) is the most significant risk factor for stroke.

-

Hypertension may also cause thickening of the artery walls, resulting in narrowing and eventual blockage of the vessel (ischaemic stroke).

Risk factor of stroke:

1.

high blood pressure

2.

cigarette smoking

3.

diabetes

4.

high blood cholesterol levels

5.

heavy drinking

6.

a diet high in fat (particularly saturated) and salt, but low in fibre, fruit and vegetables

7.

lack of regular exercise

8.

obesity.

1.

Rapid plasma reagin and/or venereal disease research laboratory test or fluorescent treponemal antibody absorption test

2.

HIV screening by enzyme-linked immunosorbent assay and/or Western blot

3.

Complete blood count

4.

Erythrocyte sedimentation rate