Chest
Chest
Chest
Atopy……familial, early onset, with other forms of asthma e.g: hay fever,
allergic rhinintis
Expiratory wheezes
INV:
spirometry……..the best
Tests:
TTT:
If no response……. Cortisone
First line………….SABA
If still symptomatic………LABA
Prevention:
Exhaustion
Unable to talk
1st line……….LABA
2nd line……….cromoglycate
Inv:
D-dimer…….if (-)…….exclude PE
CTPA……..inv of choice,,,,imp
V/Q SCAN………MISMATCH
TTT……..
PE and pregnancy:
D-dimer……NOT used
Pneumonia ->
If alcoholic………klebsiella
Percussion ……..dullness
Skin……erythema multiform
Blood ……hemolytic anemia, cold agglutinin
TTT……tetracycline, doxycyclin
Legionella pneumonia:
TTT: erythromycin
Cp……..blood-stained sputum
TTT…..TMP-SMX + iv pentamidine
TTT : tetracyclin
Spontaneous pneumothorax:
Management:
3-Secondary pneumothorax:
Causes:
Management:
Exam:
N :B:
Emphysema:
Exam:
Barrel chest
Percussion……..resonant
X-ray:
Elongated heart
Most imp Spirometry… imp
FEV…….decreased
FVC…….decreased
FEV/FVC…..decreased
Residual volume…..increased
Lung compliance……increased
ABG……HYPOXIA, HYPERCAPNEA
CBC…….polycythemia
1-Home o2 therapy
2-Vaccination
PO2……….decreased
PCO2……..INCREASED)
PH………..RESPIRATORY ACIDOSIS
PO2……..INCREASED
PCO2…….INCREASED
PH…….RESPIRATORY ACIDOSIS
Cyanosis, polcythemia
N:B:
Chronic bronchitis:
Chronic productive cough for at least 3 months per year for at least 2
successive years
bronchiectasis:
bronchiectasis
Sinusitis
Male sterility
dextrocardia…..kartagner syndrome
Investigation:
If infection………amoxicillin-clavulanate or doxycycline
Acute bronchitis:
Cp…..fever, cough and hoarseness of voice …..NO inv needed ….NO ttt
Tuberculosis:
Risk factors:
Immigrant
Cp:
Night sweat
Night fever
Investigation:
First step…….X-RAY
1-isoniazid
3-streptomycin
4-ethambutol……optic neuritis
5-pyrizinamide….hyperurecemia
Bronchogenic carcinoma:
Types:
Cp:
:Endocrine
Cushing syndrome
…..imp………..hyponatremiaSIADH
Hypercalcemia
Carcinoid syndrome
Hypoglycemia
Polycythemia
Neurological
Polymyositis
Mucocutaneous
Dermatomyositis
Acanthosis nigricans
Pyoderma gangrenosum
Hematological
Polycythemia
Clubbing
Investigations:
First step…….CT
Lung fibrosis:
Cp…..more in females
Crepitation
ABG…..hypoxia
FEV…..DECREASED
FVC…decreased
FEV/FVC…..normal
Residual voloume…..decreased
Lung compliance……decreased
Corpulmonale:
Cp:
Family history……(+)
At birth….meconium ielus
Sinuses…..recurrent sinusitis
Rectum……prolapse
Pancreas……DM
Investigation:
Pancreatic functions….impaired
Hypersensitivity pneumonitis:
Oral cortisone
Asbestosis:
Silicosis:
Complication…..increased risk of TB
Mesothelioma:
Risky jobs:
Manufacturers
Shipyards
Metal Works
Power Plants
x-ray…..pleural plaques
Inv ……CT
The best…biopsy
Aspergilloma:
MOBILE fungus ball at the lung
Risk factor…..immunosupression