This document discusses shortness of breath (dyspnoea), including its definition, grading scales, common causes, history taking, physical examination findings, differential diagnosis, initial investigations, and basic management. It defines dyspnoea as an uncomfortable sensation of breathing that feels inappropriate or disproportionate. Grading scales like the MRC and NYHA are described. Common causes involve the cardiovascular, respiratory, and other body systems. A thorough history and physical exam are important for determining the underlying etiology. Initial tests may include pulse oximetry, peak flow measurement, chest x-ray, ECG, and lung biopsy. Treatment is aimed at addressing the specific cause, and may involve pharmacological therapies, oxygen supplementation, or non-
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
approach to dyspnoea / shortness of breathjonahyounus26
subjective experience of breathing discomfort that consistes of qualitatively distinct sensations that vary in intensity. the experience derives from interactions among multiple physiological, psychological, social and environmental factors and may induce secondary physiological and behavioral responses
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Contents • Definition
• Grades of breathlessness
• Common causes
• History taking
• Abnormalities on physical examination
• Differential diagnosis
• Initial investigations
• Basic management
3. Definition • Undue awareness of breathing and is normal
with strenuous physical exercise
• Sense of awareness of increased respiratory
effort that is unpleasant and that is recognized
by the patient as being inappropriate
• Breathlessness or dyspnoea can be defined as the
feeling of an uncomfortable need to breathe.
• It is unusual among sensations, as it has no
defined receptors, no localized representation in
the brain, and multiple causes both in health
(e.g. exercise) and in diseases of the lungs, heart
or muscles.
• Patients use terms such as ‘shortness of breath’,
difficulty getting enough air in’, ‘tiredness’,
‘difficult, laboured, uncomfortable breathing;
it is an unpleasant type of breathing, though it is
not painful in the usual sense of the word’
4. MRC Dyspnoea Scale
Grade Degree of breathlessness related to activity
1 Not troubled by breathlessness except on strenuous exercise
2
Short of breath when hurrying on a level or when walking up
a slight hill
3
Walks slower than most people on the level, stops after a mile
(1.6 km) or so, or stops after 15 minutes walking at own pace
4
Stops for breath after walking 100 yards (90 m), or after a
few minutes on level ground
5
Too breathless to leave the house, or breathless when
dressing/undressing
5. New York Heart Association (NYHA)
Functional Classification
Grade Symptoms
Grade 1 ( Mild )
No limitation on physical activity. Ordinary physical activity doesn't
cause undue fatigue, palpitation, dyspnoea
Grade 2 ( Mild )
Slight limitation of physical activity. Comfortable at rest but
ordinary physical activity results in fatigue, palpitation, dyspnoea.
Grade 3 ( Moderate )
Marked limitation of physical activity. Comfortable at rest. Less
than ordinary activity causes fatigue, palpitation, or dyspnea.
Grade 4 ( Severe )
Unable to carry out any physical activity without discomfort.
Dyspnoea present at rest, if any physical activity is undertaken the
discomfort increases.
6. Common Causes
System Acute dyspnoea
Cardiovascular Acute pulmonary oedema
Respiratory
Acute severe asthma
Acute exacerbation of COPD
Pneumothorax
Pneumonia
Pulmonary embolus
ARDS
Inhaled foreign body
Lobar collapse
Laryngeal oedema
Others
Metabolic acidosis
Psychogenic hyperventilation
7. System Chronic exertional dyspnoea
Cardiovascular
Chronic heart failure
Myocardial ischaemia
Respiratory
COPD
Chronic asthma
Bronchial carcinoma
Interstitial lung disease
Chronic pulmonary thromboembolism
Lymphatic carcinomatosis
Large pleural effusions
Others
Severe anaemia
Obesity
Deconditioning
Common Causes
8. History taking
• Patient's details :
Name
Age
Sex
Occupation : paint sprayers,
rubber industry workers are
prone to lung disease
Address
Date of Admission
9. History taking • Chief Complaints
oShortness of breath for how many days
/ weeks
• History of Presenting Illness
oOnset : gradual/sudden
oProgression : worsen/better
oSeverity : NYCA/MRCA grading
oDiurnal variability : worsen at night /
morning- asthma
oPostural variability : orthopnoea , PND-
CVS
oAggravating factors : pollen, dust, cold
climate - asthma, sinusitis
oRelieving factors : rest, medication
11. History taking • Associated symptoms :
c) Haemoptysis :
oDuration, onset, progression
oAmount of blood?
oAssociated with melena or epistaxis?
oMight be due to malignancy
d) Chest pain :
oOnset, duration, progression
oSite? Bilateral/ unilateral
oType of pain
oRadiating - CVS pathology
oPain on deep inspiration, pain relief
when lie on same side- pleuritic chest
pain
12. History taking • Associated symptoms:
e) Fever :
oOnset, progression, duration
oAssociated with chills or rigor,
night sweats
oHigh / low grade
oEvening rise of temp - TB
f) Wheezing – asthma
g) Weight lost - TB, malignancy
h) Palpitation - CVS pathology
i) Sinusitis
j) Rhinitis
13. History taking • Past History :
oHistory of TB, Measle/whopping cough,
Asthma/ allergy, IHD, chest trauma/
surgery , similar complains, DM/HTN
• Personal History :
oDiet, Addiction, Bowel/Bladder
movement, Sleep, Appetite
oSmoking- highly ass with Emphysema
oAlcoholism - Aspiration Pneumonia
oLost of appetite & weight - TB,
Malignancy
• Family History :
oAsthma, TB, Cystic Fibrosis,
Malignancy
oAnyone with similar complaints
14. History taking • Social history :
oEconomic status, income, type of house,
water source, no. of people staying in
one house
oCongested homes/ low economic status -
risk of lung pathology
• Menstrual history :
oTo rule out pregnancy
16. General Physical Examination
• BMI –
• Normal : 18.5 – 22.9 ( Asian )
18.5 – 24.9 ( Non-Asian )
• Obesity might be the cause of the
breathlessness
oExtra weight in the chest and
abdomen
Increased work load on muscles
that control breathing
17. Vital Signs :
a) Pulse Rate – Normal
(60-90 beats/min)
Tachycardia : Pneumonia ,
Atrial Fibrillation
Bradycardia : Myocardial
Infarction
b) Blood Pressure – Normal
(120/80 mmHg)
Hypotension : Pneumothorax ,
Myocardial Infarction
Hypertension : Cardiac
Failure
c) Temperature
High : Tuberculosis,
Pneumonia
d) Respiratory Rate – Normal
(14-16 breaths/min)
Tachypnoea : Pulmonary
Embolism , Anxiety
Bradypnoea : Myocardial
Infarction
18. Head to Toe Examination
1. Nails and Hands
Pallor ( Left Heart Failure ,COPD)
Cyanosis ( Cardiac Failure , COPD , Pulmonary oedema )
Clubbing ( Carcinoma of Bronchus , Pulmonary Fibrosis
,Bronchiectasis , Lung Abscess , Pleural Empyema )
Koilonychia ( Anaemia )
2. Neck :
JVP increased ( Right Heart Failure caused by Chronic
Pulmonary Hypertension in severe lung disease such as COPD )
19. Head to Toe Examination
3. Face :
Eyes – Pallor ( Anaemia )
Lips and Tongue – Cyanosis ( Cardiac Failure , COPD )
oIndicate poor oxygenation of blood
4. Lower limb :
Pitting Pedal Oedema
oUnilateral – DVT
oBilateral – Congestive Heart Failure
20. Respiratory System Examination
Auscultation
• Stridor ( Laryngeal Oedema ,
Foreign bodies )
• Diminished Vesicular Breath
Sounds ( Obesity , Pleural
Effusion , Pneumothorax , COPD ,
Lung collapse )
• Bronchial Breath Sounds ( Lung
consolidation in pneumonia )
• Vocal Resonance ( over
consolidated lung , the spoken
numbers are clearly audible but
over an effusion or collapse they
are muffled )
• Rhonchi / Wheeze ( COPD ,
Bronchial Asthma )
• Pleural Rub ( Pneumonia , TB )
• Crackles
21. Examination Sequence
1. Note the patient’s general
appearance and demeanour.
2. Look for central cyanosis of the
lips and tongue.
3. Examine the skin for rashes and
nodules.
4. Listen for hoarseness and stridor.
5. Examine the hands for finger
clubbing, peripheral cyanosis and
tremor.
6. Measure the blood pressure.
7. Examine the neck for raised JVP
and cervical lymphadenopathy.
8. Record the respiratory rate.
9. Observe the breathing pattern,
and look for use of accessory
muscles.
10. Inspect the chest front and back
for abnormalities of shape and
scars.
11. Feel the trachea and cardiac apex
beat for evidence of mediastinal
shift.
12. Percuss the chest front and back
for areas of dullness or
hyperresonance.
13. Listen to the chest front and back
for altered breath sounds and
added sounds.
Certain groups of physical signs are
typically associated with particular
pathological changes in the lungs.
26. Bedside investigations
Pulse Oximetry
• A spectrophotometric device that
measures arterial oxygen saturation by
determining the differential absorption
of light by oxyhaemoglobin and
deoxyhaemoglobin .
• This allows detection and ongoing
monitoring of hypoxaemia with
initiation of oxygen supplementation as
necessary, while undertaking diagnostic
work-up for its cause
Peak Flow Rate
• Person's maximum speed of expiration.
• Normal test results depends on age year
gender and sometimes occupation.
• Helps to differentiate between
pulmonary and cardiac causes of
dyspnoea. Low peak flow rates are
associated with obstructive lung disease
such as asthma, COPD, and cystic
fibrosis.
• Normal: 80-100 per cent of usual flow
rate.
28. Radiology
Chest X-Ray
• To determine the lobe / area in which
the lung is affected.
• Make out any cardiomegaly in the PA
view of the x-ray
• Check for any fluid / consolidation of
the lungs.
• Check for any structural damage such
as a broken rib
Chest fluoroscopy / Sniff test
• Determines how well lungs,
diaphragm, or other parts of your
chest are working.
• Uses more radiation than a standard
chest X-ray.
• It detects the movement of the
diaphragm when the patient breathes.
• Hence able to detect any abnormal
diaphragmatic conditions.
30. Electrocardiogram
• To detect underlying causes of cardiac origin that causes breathlessness.
• Coronary artery diseases can be a major causes of breathlessness.
• If needed an angiogram can be done to make out any blockage to the
coronary arteries.
31. Lung Biopsy
• Invasive procedure.
• Involves removal of a small piece of lung tissue which can be sent for
investigations.
• Types: bronchioscopic, needle, open, video associated thoracoscopic surgery.
• Diagnose certain condition such as sarcoidosis or pulmonary fibrosis and
even lung cancers.
33. Pharmacological
• The treatment of breathlessness is complex. It depends on the
underlying causes.
• Opioids-either oral or parenteral-are now considered to be the
gold standard in reducing ventilator demand. A slow release
preparation of morphine has been found to be beneficial
• Anxiolytics such as benzodiazepines may assist in the anxiety
component of breathlessness. However, these may be poorly
tolerated in some patients, especially in those with liver
failure.
• Long acting beta agonists may be beneficial in breathlessness
due to COPD in reducing the work of breathing.
• Bronchodilators help in relaxing muscles and improving
muscle tone in the airways.
34. Oxygen Treatment
• Evidence have shown oxygen treatment is of no
use in a patient with breathlessness WITHOUT
hypoxia.
• Otherwise, high flow oxygen of >60 percent is
used except in COPD patients.
35. Non-pharmacological
• There does seem to be a relationship between anxiety
and breathlessness, however, which one comes first is
difficult to tell. Strategies such as relaxation training
and distraction do seem to help as do cognitive
behavioural therapies.
• Controlled breathing exercises and techniques such as
an upright leaning forward position and pursed lip
breathing are also beneficial therapies.
• Chest wall vibration, neuro-electrical muscle
stimulation, walking aides, and breathing training.