Medical Semiology II

compressive vs obstructive atelectasis

compressive vs obstructive atelectasis

compressive has increased tactile fremitus

tactile fremitus in pneumonia vs pleural effusion

pneumonia - increased effusion - decreased

a solitary pul nodule w/ mediastinum widening and atelectasis is seen in which patho

lung cancer

why do we percuss supraclavicular area

Pancoast Tobias tumour (apical lung)

trousseau's syndrome occurs in which patho

lung cancer (vascular syndrome)

neurologic syndromes from lung cancer

eaton-lambert

endocrine syndromes from lung cancer

hypercalcemia, oliguria, Cushing

when is there hoarseness in lung cancer

laryngeal n paralysis from left side tumour

manifestations of lung cancer

• asymptomatic

• non specific (weight loss, anemia)

• pul lesion -> cough, hemoptysis, dsypnea, wheeze, atelectasis

• intrathoracic spread -> dysphagia, hiccups, horner's, pleural effusion

• extrathoracic spread -> bone, liver, adrenal, brain

• paraneoplastic syndrome

lung cancer is divided into

NSCLC (adeno, squamous + large cell carcinoma) and SCLC

risk factors for lung cancer

smoking, carcinogens, copd, women who smoke, black men, HIV, inheritance

ECG w/ increase S1 and T3 pattern is indicate of which patho

pul embolism

signs of pul embolism on xray

Westermark (dilation of pul vessel), Hampton hump (triangular infiltrate)

physical exam in pul embolism

unilateral leg swell, tachycardia, hypotension, consolidation signs of lungs, d-dimer

symptoms of pul embolism

pleuritis chest pain, hemoptysis, back + shoulder + upper abd pain

consequences of pul embolism are primarily

hemodynamic (emboli, resp insufficiency)

patient-related predisoping factors of pul embolism

age, history of prevout VTE, cancer, major surgery, MI, estrogen use

hereditaroy factors for v thromboemebolism are those related to

thrombophilia (AT3, protein C, S)

etiology of pul embolism

DVT -> thromboembolism

DD bw abscess and lobar pneumonia

coarse crackles in abscess

physical findings of lung asbcess

clubbing, consolidation sounds (coarse crackles, decreased sounds), pleural rub

manifestations of lung asbcess

chill, low fever, foul smell sputum, hemoptysis, dyspnea, night sweats

classifcation of lung abscess

primary by aspiration secondary by bronchiectasis, immunocompromised or tumour

patients with mouth diseases, seizures and dysphagia + impaired consciousness are at higher risk of what

lung abscess

pleural effusion

collection of fluid in pleural linings

causes of pleural effusion

congestive hf, malignancy, infections and pul emboli

transudate vs exudate pleural effusion

transudate - ultrafiltrates of plasma in pleura from hydrostatic and oncotic forc imbalance, protein

manifestations of pleural effusion

unilateral + sharp pain, worsens w/ inspiration and cough dyspnea dry cough

xray of pleural effusion

hemidiaphragm elevated

thoracentesis

removal fluid from pleural effusion, diagnostic or therapeutic

therapeutic thoracentesis (+limit)

removes larger amounts pleural effusion to alleviate dyspnea, max 1500ml

putrid odor pleural fluid in effusion suggests

anaerobic empyema

ammonia odor pleural fluid in effusion suggests

urinothorax

black pleural fluid in effusion suggests

aspergillosis

yellow/green pleural fluid in effusion suggests

rheumatoid pleural effusion

bloody pleural fluid in effusion suggests

trauma, malignancy, high amounts is hemothorax

when is pleural effusion considered an exudate

high protein and LDH

pleural fluid ldh levels >1000 IU/L suggests

empyema, malignant effusion or rheumatoid effusion

low pleural fluid glucose in effusion suggests

malignancy, TB or empyema

how to test for TB pleural effusion

acid-fast bacillus stain or ADA (adenosine deaminase)

high triglycerides, chol and milky pleural fluids suggests

chylothorax

in patients with pleural effusion, bronchoscopy is only done when

patient has parenchymal abnormalities or hemopytsis

causes of pleural transudate effusions

congestive heart failure, cirrhosis, nephrotic syndrome

congestive HF causing pleural transudate effusions

biventricular failure causing bilateral effusions, also called hydrothorax

forms of pleural exudative effusions caused by infections

parapneumonic effusion

• uncomplicated (pneumonia)

• complicated (bacteria, increased neutrophils)

• empyema (loculated pus)

causes of empyema

trauma, lung abscess rupture, septic infarction, infection, esophageal rupture

manifestations of parapneumonic effusions

symptoms of effusion (pain, dyspnea, dry cough) with fever

anaerobic bacterial parapneumonic effusion manifestation

weight loss

physical exam of pleural effusion

febrile, tachypnea, tachycardia (looks like SIRS), diaphragm in upper position, dullness, decreased breath sounds + fremitus, tracheal shift