Most common
• Bronchogenic Carcinoma (++)
• Pulmonary Infarction (++)
• T.B. (+)
Common
• Bronchiectasis
• Lung abscess (+ pus)
• Bronchitis (acute; chronic; COPD)
Uncommon
• Tumors of Trachea, Larync
• Bronchial Adenoma
• Lung secondaries
Others
• Chest trauma
• F.B.
• Iatrogenic
¶ S1
• pronounced in MS
• weak in MR/MP
¶ S2
weak in both AS and AR
¶ S3 (blood splash!)
• comes just after S2 (early diastole)
• lub-dub-‘dub’
• normal in children, young adults, athletes, pregnancy, fever
• abnormal in others
• cause:
large poorly contractile left ventricle usually due to volume overload
“blood from pulmonary veins forcefully hits the inside of the LARGE ventricle making this sound”. This is common in MR and AR.
¶ S4 (atrium contracts!)
• comes just before S1 (late diastole)
• ‘da’-lub-dub
• almost always abnormal
• cause:
left ventricle hypertrophy (not enlargement) due to an obstructive cause
“atrium forcefully contracts to get blood into the highly tense muscular ventricle”. It is common in HTN, AS, MS “late”, restrictive cardiomyopathy.
Recently it striked me the prevalence of use of Cortisone, secondary to prevalence of collagen and autoimmune diseases, and inflammatory or allergic conditions. Maybe the incidence is the same, but it’s just the advance of diagnosis and investigations, but the end result is the same, Cortisone is highly used nowadays in many, many conditions.
Well, to understand the side effects (especially of prolonged use of Cortisone), a quick reference to the actions of Glucocorticoids is a must:
1. Maintains metabolic homeostasis:
A. Regulates blood glucose level/permissive effects on gluconeogenesis/increases glycogen synthesis
B. Raises Insulin levels/permissive effects on lipolytic hormones
C. Increases catabolism/decreases anabolism (except fat)/inhibits growth hormone axis
D. Inhibits reproductive axis
E. Mineralocorticoid activity of cortisol
2. Affects connective tissues:
A. Causes loss of collagen & connective tissue
3. Affects calcium homeostasis:
A. Stimulates osteoclasts/inhibits osteoblasts
B. Reduces intestinal calcium absorption/stimulates PTH release/increases urinary calcium excretion/decreases reabsorption of phosphate
4. Maintains cardiovascular function:
A. Increases cardiac output
B. Increases vascular tone
C. Permissive effects on pressor hormones/increases sodium retention
5. Affects behavior and cognitive function
6. Affects immune system:
A. Increases intravascular leukocyte concentration
B. Decreases migration of inflammatory cells to sites of injury
C. Decreases antigen-antibody reaction
D. Suppresses immune system (thymolysis, suppression of cytokines, kinins, serotonin, histamine, collagenase, and plasminogen activator)
7. Antistress/Antishock
About side effects of prolonged use:
1. Edema
2. Hypertension
3. Heart failure
4. Cushing’s syndrome
5. Psychosis
6. Osteoporosis
7. Growth retardation in children
8. Delayed healing of wounds
9. Increases intraocular pressure (glaucoma)
10. May precipitate diabetes mellitus
11. Perforation of peptic ulcer
12. Infections: e.g. Activation of tuberculosis, fungal infection
13. Hirsutism, menstrual irregularities
14. Sudden withdrawal —> Acute adrenocortical insuffieciency/Addisonian crisis
Hello everyone 🙂
So, while I was having my oral exams this year, I came across a question that many people were asked: “ILD”, so I looked it up to find that it includes a very wide range of diseases that I studied individually, but never had them collected, they’re quite interesting actually, especially the pneumoconiosis causes (that rhymes :D), let’s go:
ILD, or Interstitial Lung Diseases, is a term that refers to a group of diseases that affect the “interstitium” of lungs; alveoli, capillaries, the separating basement membrane and the perivascular/lymphatic tissues. Almost everything but the bronchial tree or the (Obstructive Lung Diseases).
They give a diffuse shadowing pattern, or a “miliary pattern” on chest x-ray.
The full classification is after the break.
¶ Reduced Vesicular (normal) breathing
• Reduced airflow
General (bilateral usually):
Emphysema
Local:
» Bronchiolitis
» Tumor causing bronchial obstruction
» Lodged F.B. (esp. in children)
• Reduced conduction (an insulating surface outside the lung)
Pleural effusion
Pneumothorax
Thick chest wall (obesity)
Thick pleura
¶ Bronchial breathing
(d.t. increased conduction i.e. presence of a hard conducting surface inside the lung)
Consolidation/fibrosis/collapse, plus
Relevant major bronchus is patent to let air in.
Medicopedia 