What are the important risk factors for developing COPD?
Smoking, air pollution/irritants, antitrypsin1 deficiency, family history, history of childhood resp. infections
How does smoking contribute to the development of COPD?
The smoke particles damage the lungs. This leads to less air flow in and out of the air pathways due to stiffening of air sacs, degradation of wall bw air sacs, thickening and inflammation of air pathway walls and increasing mucus in the tract, causing build-up and air obstruction
Match the lung function test w its purpose:
- arterial blood gas
- body plethysmography
- Diffusing capacity
- Forced expiratory volume (FEV)
- Pulse oximetry
- Sputum culture
- Peak expiratory flow
- Checks oxygenation status and acid balance
- Estimates O2 content in arterial blood using light
- Measures how quickly you can exhale
- Measures thoracic volume and airway resistance
- Tests how much air you can exhale in 1 sec
- Tests O2 transfer from the alveoli to circulation
- Used to diagnose bacterial lung infection
1=1 2=4 3=6 4=5 5=2 6=7 7=3
Which lab tests would you expect for a routine COPD admission?
- blood gases and pH
- sputum sample
Which investigations would you expect for a routine COPD admission?
- chest X-ray
- ECG
- pulmonary function tests
Signs and symptoms of COPD
- blue tinged lips
- barrel chest
- chronic cough
- deflated lung
- finger clubbing
- increased anteroposterior chest diameter
- Incr. RR
- Incr. WOB (use of accessory mm)
- SOBOE
Risk factors for CVD
which did Mike have?
atherosclerosis smoking/tobacco use* obesity hyperlipidemia/hypercholesterolemia diabetes hypertension physical inactivity poor diet raised blood glucose
family history*
age
gender*
Which laboratory tests would you expect for a routine chest pain admission?
FBC cardiac enzymes (troponin) urea and electrolytes thyroid function tests blood glucose
Which investigations would you expect for a routine chest pain admission?
ECG
chest x-ray
angiogram
Describe typical cardiac chest pain
sudden onset, severe pain usually tight or crushing
can radiate into arms/back or jaw
lasts >15mins
commonly accompanied by nausea/vomiting, sweating, SOB
Why is it recommended that Mike take his Simvastatin in the evening?
Bc cholesterol synthesis occurs mostly at night
Troponin T is a protein which is released when?
Mike’s Troponin T was 9.04micrograms/L. What is the normal reference range?
when myocardial necrosis occurs
0-0.03micrograms/L
Describe coronary atherosclerosis
A chronic progressive disorder wherein deposits of cholesterol and calcium build-up on the inner lining of the artery walls.
Eventually the plaque obstructs the lumen of the artery, causing ischemia.
Under stress the plaque can rupture causing a cascade of clotting factors, and sudden thrombus formation further in the coronary vessels.
Write a short summary of the differences seen in the x-rays between a ‘normal’ chest and the chest of a patient with COPD
COPD x-ray will show:
- expanded/overinflated lungs which take up a lot more of the chest cavity
- the clavicles will be positioned much higher due to the action of the accessory muscles.
- heart is pushed out of position by over-inflated lungs
Which region of the brain is involved in coordinating and adjusting movement?
Cerebellum
Which of the following statements regarding the medulla is incorrect?
- It contains areas that are involved in cardiovascular regulation.
- It contains motor and sensory nuclei for the mouth and throat.
- It is not involved in respiratory control.
- It is not involved in respiratory control.
The pons (of the brainstem) contains nuclei involved in ___?
Respiration
Why can damage to the medulla (of the brainstem) be life-threatening?
Because respiratory and cardiovascular centers are found there
Which of the following statements regarding the cerebellum are correct?
- It initiates motor activity
- Is it involved in controlling the rate, range and direction of movements
- It is involved in the processing of sensory information from the skin
- It regulates balance and eye movements
- Is it involved in controlling the rate, range and direction of movements
- It regulates balance and eye movements
Which part of the brainstem are the following cranial nerves found in (exiting)
- Oculomotor nerve (III)
- Trigemial nerve (V)
- Hypoglossal nerve (XII)
- Facial nerve (VII)
- Glossopharyngeal nerve (IX)
Midbrain: oculomotor nerve (III)
Pons: Trigemial nerve (V) Facial nerve (VII)
Medulla oblongata: Hypoglossal nerve (XII) Glossopharyngeal nerve (IX)
Stroke risk factors
which did Barry have?
diabetes* high cholesterol physical inactivity smoking alcohol family history age >60 atherosclerosis* artery abnormalities atrial fibrillation blood disorders drugs sex hypertension* obesity previous stroke/TIA* ethnic origin
outline your observations of Barry’s responses to each of the neurological tests performed:
- Visual field (peripheral vision)
- Facial movement
- Facial sensation
- Corneal reflex
- Leg movement(leg lift)
- Arm movement (arm lift)
- Visual field (peripheral vision):
very limited peripheral vision on the right side in both eyes - Facial movement: significant weakness on right side of face
- Facial sensation: no sensation on right side of his face
- Corneal reflex: nil corneal reflex on RHS
- Leg movement(leg lift): some weakness on RHS
- Arm movement (arm lift): significant weakness on RHS
What recommendations do you think you might make to Barry’s primary caregiver, based on the knowledge you have of his complications/neuro exam
Be mindfulof these symptoms and and seek medical advice if they become concerned. Also recommend to them some of the support services available in case they need them.
What symptoms did Ben have of diabetes upon his initial hospital arrival?
acute abdominal pain glycosuria hyperglycemia ketoacidosis Polyuria polydipsia
