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%