Pulmonology Flashcards
Pneumonia(Consolidation)
Fairly acute onset
Increased vocal resonance (Whispering pectoriloquy, aegophony)
Bronchial breathing
Crackles
Dullness
Increased vocal fremitus
COPD (Asthma)
Mostly strong smoking history
Barrel shape
Decreased air entry
Prolonged expiration
Wheezes
Resonant
Reduced cardiac dullness
Liver dullness downward
Decreased expansion
Pleural Effusion
Depend on cause
Potential pleuritic chest pain
Possibly reduced chest movement
Reduced vocal resonance
Reduced / Absent breath sounds
Maybe Bronchial breathing at top of effusion
Stony Dullness
Trachea shifted away if massive
Bronchiectasis
Significant sputum production
Localised & longstanding = reduced movement over the specific area
Coarse crackles over area
wheeze due to element of obstruction
maybe some dullness
upper lobe is affected and it is severe, the trachea may be shifted towards
clubbing
Lung Cancer
Smoking history
Chronic cough
Weight loss
educed movement over the specific area
clubbing
Nodes
Horner’s / SVC syndrome
Pneumothorax
Acute onset
Pleuritic chest pain
Decreased chest expansion on the side
Decreased / Absent breath sounds
Resonant
Decreased expansion on side
Trachea shifted away if Tension
Possible Surgical emphysema
Interstitial fibrosis
Chronic history of progressive dyspnea
Dry cough
Fine inspiratory crackles (becomes coarse as disease progress)
Decreased expansion
Clubbing
Maybe signs of underlying connective tissue disease
Collapse
Decreased chest expansion
Decreased breath sounds
Dullness
Trachea shifted towards
Depend on cause – maybe loss of weight
Liver Failure
Jaundice
Bruising
Encephalopathy
Chronic liver disease (failure)
Palmar erythema
Dupuytren’s
Spider Nevi
Gynecomastia
Testicular Atrophy
Portal Hypertension
Ascites
Varices
Splenomegaly
Liver Function tests
Bilirubin
INR
Albumin
Cholesterol
Hepatocellular damage
Raised ALT (AST)
Look for: Viral, Drugs, AIH
Cannicular / Obstructive
Raised GGT (ALP)
Look for: Malignancies, Infiltrative process (TB), Drugs, Ultrasound
Ascites (High SAAG)
> 12
Portal Hpt
Cirrhosis
CCF
Etc
Do Ultrasound, liver functions, hepatitis studies etc
Asites (Low SAAG)
<11
Non Portal Hpt (so membrane damage)
Infective
Malignancy
Inflammatory (sarcoid, SLE etc)
Do MC&S, cell-count, ADA, cytology etc depending on suspected cause
Jaundice (Pre-Hepatic)
( = Haemolysis )
Increased unconjugated bilirubin, normally not severe (40 - 80)
ALT normal, AST raised
LDH raised
Reticulocytes
Jaundice (Hepatic)
(Hepatocellular vs Canicular)
Frequently mixed picture
Hepatitis
Specific syndromes like Gilbert’s
Jaundice (Post Hepatic)
Can be very severe, deeply jaundiced, bilis > 300
Conjugated to Unconjugated bilirubin > 65%
Gull stones
Head of Pancreas
Sclerosing Cholangitis
(pale stools, dark urine)
Cirrhosis
signs of chronic liver disease
Causes
ETOH
Hepatitis B
Other Hepatitis
Metabolic
Hemochromatosis, Wilson’s
Autoimmune
PBC, AIH
Complications
Portal Hypertension
HCC
Liver failure
Rx of liver failure
Find the cause and treat the cause
Supportive:
Avoid liver toxins
Address clotting
Watch for Hypoglycaemia
Low threshold for antibiotics
Transplantation
Parvolex:
No RCT data
But natural anti-oxidant in liver, working via glutathione
Especially in Paracetamol OD, but potentially any over cause
Hepatitis B (Clinical pic)
Via bodily fluids
Long incubation 12/52
Symptomatic 4-8/52
10% become chronic – go on to cirrhosis without Rx
Hepatitis B (Dx)
HepB Ag – you currently have the virus
HepBs Ab – gives immunity, so you had it, but cleared it
HepBc Ab – does NOT give immunity, so shows you have been exposed and now:
Is in early phase and still may develop s Ab
If you do not develop s Ab, you will develop Chr HepB
Hepatitis B (Treatment)
Acute = Supportive
Avoid hepato-toxins
Regular small, non fatty meals
Rest
Chronic = Tenofovir / Lamividine
Hep A
Fecal-oral transmission
Short incubation 1-2/52
99% recovery, NO chronic state
Hep C
90% becomes chronic
Portal Circulation
Portal vain – liver sinusses – hepatic vain - IVC
Hepatic
Cirrhosis
Post-hepatic
Hepatic vein or IVC
Budd Chiari
Congestive cardiac failure
Pre-Hepatic
Portal Vein thrombosis
Bilharzia
Hemoptysis (Causes)
Bronchiectasis / Post TB structural lung disease
Any pneumonia which causing cavitation
TB
Necrotising pneumonia
Lung abscess
Aspergiloma
Bronchus carcinoma
Autoimmune disease
Wegener’s / SLE / Goodpasture’s
AV malformation / aneurism
Pulmonary embolism
LV disease (mitral stenosis)
massive hemoptysis
If hemodynamic unstable
OR
More than 400ml
Hemoptysis (Management)
Supportive:
ABC’s
Opioids
Treat the cause
Definitive treatment
Bronchial artery embolization
Lobectomy
Less evidence
Vasopressin nebs
Tranexamic acid
Antibiotics
