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Causes a bronchiolar lesion with neutrophil rich exudate generic zudena 100 mg otc erectile dysfunction doctors in san fernando valley, and bronchiolar metaplasia Pneumocystis Carinii Pneumonia: Extracellular protozoan parasite almost exclusively infects the lung order 100mg zudena fast delivery impotent rage random encounter. Microscopic appearance: interstitial infiltrate of lymphocytes and plasma cells cheap zudena 100mg overnight delivery erectile dysfunction treatment ottawa, and foamy intra-alveolar exudate containing the organism advair diskus 250mcg on-line. Ground glass appearance on X-ray Lipid Pneumonia: Exogenous lipid pneumonia aspirated mineral oil being taken by the elderly for constipation segmental opacification (whiting-out) of the lung and granulomatous fibrous reaction purchase extra super viagra 200 mg with visa. Endogenous lipid pneumonia occurs distal to an obstruction (eg cancer) due to coalescing lipid droplets from dead alveolar macrophages Mixed bacterial flora is normally found in patients with chronic pulmonary infections (eg cystic fibrosis buy tadapox 80mg with mastercard, bronchiectasis). Consider adding erythromycin for above complications Failure to Respond Is treatment failing? If severe, this is a poor prognostic indicator Fever lasts 2 4 days, S pneumoniae resolves quickest Crackles will last beyond 7 days in up to 40%. Reduced antibiotic penetration, especially if loculated Usually heals with pleural fibrosis If blood in a pleural tap then: Hit an artery Haemothorax (need to evacuate. To differentiate from a haemothorax measure the haematocrit Testing pleural fluid: Total protein Albumin: If (effusion albumin)/(serum albumin) > 0. If present then oesophageal rupture or pancreatitis Cytology for malignancy Microscopy and culture: low sensitivity. Of little diagnostic value and theoretically could dislodge a clot Exclude Bakers cyst: herniation from joint space into popliteal space wouldnt cause leg swelling Approx. Can continue longer haemorrhages, if they occur, are usually early on Surgery: really only if limb at risk. Phenytoin, carbamazepine, phenobarbitone, rifampicin Inhibitors: immediate effect warfarin toxicity. Also listen to heart to ensure its not a cardiac cause Respiratory 77 Can you demonstrate reversible bronchial constriction? Most commonly rhinoviruses and coronaviruses (common cold) Allergen exposure in a sensitised individual Drug sensitivity, eg aspirin If severe, then? Due to temporal adaptation if chronically breathless, body turns off perception of breathlessness (cf dont hear trains if living by a railway line). Getting Worse - < 80% Daily symptoms, waking at Start or increase dose unstable night, getting a cold, more of preventer. No one will do it all the time so dont ask them to Asthma in Young Children See Asthma in Young Children, page 613 Principles of management Asthma self-management plans are recommended as essential in the long-term treatment of adult asthma. Those with formal management plans have half the morbidity of those without them, despite the same treatment Also need to establish, avoid and control triggers Factors associated with asthma deaths: Long term: Lack of appreciation of chronic asthma severity and risk Poor compliance Discontinuity of medical care Under utilisation of inhaled steroids Fatal attack: th th 78 4 and 5 Year Notes Delay in seeking medical help Inability to recognise severity Over-reliance on bronchodilator Insufficient systemic steroid use Lack of written information If the management plan is too complicated for the patient, modify (eg just the point at which to see the doctor) Compliance is critical ownership of treatment by the patient is fundamental negotiate and educate Treatment Status asthmaticus: severe acute asthma that does not respond to treatment.

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