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12.12.17 cPBL - Respiratory

Prostate lumps
  • Location
    • Medial lobe => BPH
    • Lateral lobe => Cancer
  • IPSS => Symptom severity

HAP
  • From 48 hours after admission
  • To 48 hours after discharge

Bronchiectasis
  • From childhood infections
    • Croup
    • Measles
    • Repeated pneumonia
  • Causes
    • Fibrosis
    • Cor pulmonale
    • Respiratory failure
  • Most likely organism to give an infective exacerbation
    • Pseudomonas

Aminophylline
  • Can cause arrhythmias
    • Ask about palpitations, light-headedness
  • Monitor levels

DVT tests
  • Don't palpate too hard!
  • Homans' sign
    • Pain in the calf on dorsiflexion of the patient's foot at the ankle while the knee is fully extended
    • Poor sensitivity and specificity

Pulmonary causes of clubbing
  • Cancer
  • Interstitial lung disease
    • Fibrosis etc.
  • Complicated TB
  • Abscess
  • Empyema
  • Bronchiectasis
  • Cystic fibrosis
  • Mesothelioma
  • AV malformation

Subdural haematoma
  • Can be caused by relatively minor injury in the elderly
  • Consequences
    • Fluctuating consciousness
    • Further falls

Empyema
  • MEDICAL EMERGENCY
  • Do a diagnostic tap immediately
    • If pH <7.2 => Need a chest drain
      • cf Effusion will have pH 7.4 ish
  • Causes clubbing 
    • Over days to weeks
    • Check with Pt if it's a new finding

Light's criteria
  • A pleural effusion is likely exudative if at least one of the following exists:
    • The ratio of pleural fluid protein to serum protein is greater than 0.5
    • The ratio of pleural fluid LDH and serum LDH is greater than 0.6
    • Pleural fluid LDH is greater than 0.6 times the normal upper limit for serum
  • Sensitivity and specificity of Light's criteria for detection of exudates = 98% and 80% respectively

Notes
  • Finasteride = 5-alpha reductase inhibitor
  • The only treatment for cor pulmonale is oxygen
  • COPD => Pneumococcal and flu vaccines
  • TFTs are of no use in a sick patient
  • Mortalities
    • SIRS => 10%
    • Septic shock => 40-60%
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