Cases in general internal medicine 2 Flashcards
At what level of Hb would you probably see SoB at
Why might you have a raised JVP in COPD
Below 80
Because of right heart failure secondary to pulmonary hypertension secondary to COPD
Onset of breathlessness; seconds
- Pneumothorax
- PE
- FB (foreign body! Don’t forget this one)
Onset of breathlessness; mins/hrs
- Airways (inflammation/obstruction)
- Chest infection (pus)
- Acute heart failure (fluid)
Onset of breathlessness; days/weeks
These(chronic/not resolving):
- Airways (inflammation/obstruction)
- Chest infection (pus)
- Acute heart failure (fluid)
AND:
- Interstitial lung disease
- Malignancy/ Large pleural effusion
- Neuromuscular
- Anaemia/ Thyrotoxicosis
What is a primary pneumothorax
A primary spontaneous pneumothorax is one that occurs without an apparent cause and in the absence of significant lung disease
What is the management of primary pneumothorax
< 2 cm:
– Discharge, repeat CXR
> 2 cm OR THEY HAVE SOB:
– Aspiration
– If unsuccessful: chest drain
What is management of secondary pneumothorax
< 2 cm:
– Aspiration
> 2 cm:
– Chest drain
What could cause breathlessness after a chest drain insertion
Re-expansion pulmonary oedema
What is are lung bullae
A bulla is a permanent, air-filled space within the lung parenchyma that is at least 1 cm in size and has a thin or poorly defined wall;
NOT to be confused with pneumothorax!
You wouldn’t put a chest drain in for bullae.
Aka vanishing lung disease
When can it be called asbestosis
You can only call it asbestosis when there is pulmonary fibrosis
Asbestos lung disease gives you plaques, but this is not asbestosis
What are the types of opacity on xray and what are their respective DDx
- Interstitial/alveolar shadowing (=fluid, pus, blood)
- Reticulo‐nodular shadowing (fibrosis)
- Homogeneous shadowing (pleural effusion)
- Masses/cavitations
If a patient has a PE what drug do you think about in the first instance
LMWH (e.g. dalteparin)
If the x ray is very white, what can you say about penetration
Too white= underpenetrated
Should you be able to see the left hemidiaphragm behind the heart?
Yes you should! If you can’t, there’s something going on (e..g tumour or consolidation)
Air fluid level on X-ray/CT and reduced BS, hyper-resonant percussion notes
Bullous disease. Do not put drain in
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Causes of hepatomegaly
• Cancer (primary or secondary deposits) • Cirrhosis (early, usually alcoholic) • Cardiac: – Congestive cardiac failure – Constrictive pericarditis
Infiltration
Give examples of infiltration causing hepatomegaly
Fatty infiltration, haemochromatosis, amyloidosis,
sarcoidosis, lymphoproliferative diseases
Causes of liver disease
Alcohol • Autoimmune • Drugs • Viral • Biliary disease
Causes of splenomegaly
H (portal Hypertension)
H (Haematological)
Infection
Inflammation
- 75 year old man
- Epigastric pain
- Back pain
- PR: 130 bpm
- BP: 80/50 mm Hg
Likely diagnosis?
A. Peptic ulcer B. Pancreatitis C. Gastritis D. GORD E. Ruptured aortic aneurysm
E. Ruptured aortic aneurysm
Endo causes of acute abdominal pain
DKA
Addison’s
Epigastric pain DDx
Peptic ulcer
Gastritis
GORD
Malignancy
Acute pancreatitis
MI
ALSO:
• Above (heart) – MI • Below (Aorta) – ruptured aortic aneurysm • Right: (liver/gall bladder) – Cholecystitis – Hepatitis
What things point to acute pancreatitis
- Pain
* High amylase
What is the test for chronic pancreatitis
Normal amylase Faecal elastase (so need a stool sample)
What things point toward chronic pancreatitis
Pain, wt loss
• Loss of exocrine function
• Loss of endocrine function
