Key 1-7 (BE,Treatening Asthma, Mesothelioma, Atlectasis, Pneumothorax)

Bronchiectasis is __________ of airways secondary to(due to)_____ or _______

permanent dilatation

chronic infection or inflammation

most common organism in patient with Bronchiectasis?

1. Haemophilus influenza(most common)

2. Pseudomonas auruginosa

3. Klebsiella spp(all species in klepsiella)

4. Streptococcus pneumonia

Main feature of Bronchiectasis:

if these suspect BE

Other features on chest xray:

1. Chronic Persistent Cough +

2. Copious Excessive Sputum +

3. Recurrent respiratory tract infection +-

4. Others: weight loss, clubbing, dullness, crackles

Other features: chest xray:

1. tramlines(tram track)“cyst/ring opacities”

2. thick rings

3. Hemoptysis 1/3 pt

Gold standard to diagnose Bronchiectasis:

HRCT

1. Bronchial dilatation

2. Wall thickening with GGO ground glass opacity

Chronic cough in Bronchiectasis may cause______

Hemoptysis

Hemoptysis means coughing up blood from the lungs or airways.

Management for Bronchiectasis

1. Physical Training (inspiratory muscle training)

2. Postural Drainage

3. Antibiotic for exacerbation

4. Immunisation

5. Surgery in selected dz(localised dz)

Criteria features for Life Threatening Asthma: must memorise

1. Altered mental status with drowsiness

2. Silent chest (no chest sound)

3. Poor respiratory effort

4. Exhaustion

5. Cynosis

6. Arrhythmia

7. Hypotension

8. PEF < 33% predicted or best

9. Sp02 < 92% (hypoxemia)

10. Pa02 < 8 kPa

11. PaCO2 is normal(4.6-6kPa)

Example (1)

A 3yr old boy with asthma presents to the A&E with acute attack of wheeze.

He is drowsy and has cold periphery. His HR is 180bpm, he has intercostal recession and widespread wheeze. What is the most significant feature that shows impending respiratory failure?

A. Cold periphery

B.Drowsiness

C. HR of 180bpm

D. Intercostal recession

E. Widespread wheeze

Example (2)

A 3yr old boy with asthma presents to the A&E with acute attack of wheeze. He is cyanotic and has RR of 45. His HR is 180bpm, he has intercostal recession and widespread wheeze. What is the most significant feature that shows impending respiratory failure?

A. RR of 45

B. Cyanosis

C. HR of 180bpm

D. Intercostal recession

E. Widespread wheeze

Example (3)

A patient recently diagnosed of asthma which has been well controlled, now presents with increase respiratory rate, temp 36.7, auscultation reveals absent breath sound.

Which of the following will indicate life threatening asthma?

1. Absent breath sound

2. Increased respiratory rate

3. Intercoastal recession

1. Mesothelioma

2. Bronchial Carcinoma

   Name the features to suspect these above conditions

(Question 1)

• Hx of being a worker "e.g., builder, a shipyard worker" (exposed to asbestos) [+]

• Shortness of breath | Chest pain | Weight loss [+-]

• Clubbing, Recurrent Pleural Effusion

  what should we suspect?

(Question 3)

A 60 YO retired builder has been having shortness of breath and chest pain for the past 6 months. He is a smoker. His chest x-ray shows mediastinal lymphadenopathy and right-sided pleural effusion. CT scan shows irregular pleural thickening.

Likely Dignosis?

Likely cause?

If he dies, what to do?

The likely Dx →

Mesothelioma.

The likely cause →

Asbestos.

"80% of mesothelioma are due to asbestos".

If he dies →

refer to a coroner.

1. Mesothelioma

2. Bronchial Carcinoma

How to confirm diagnosis?

Pleural Biopsy(not cytology)

Malignant Pleural Effusion due to mesothelioma may require:

(Management)

Long term indwelling pleural drain

Mesothelioma is seen in people exposed to asbestos such as:

1. Blue Collar Workers

• firefighters

• Construction workers

• Power plant workers

• Shipyard workers

• Other blue collar

2. Veterans - military

So, it is considered an industrial disease, leading to "unnatural death".

Therefore, deaths of mesothelioma should be reported to and consulted with →

a coroner as compensation is often available.

Atlectasis