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%