Signs and symptoms • Signs: decreased chest movement , reduced breath sounds, dull to percussion (all on affected side) • Symptoms: SOB, cough, chest pain Investigations • Is there a pleural effusion? CXR: white (fluid), CT scan, ultrasound, Listen to the chest: dull to percussion (tap on chest), reduced breath sounds • What caused the pleural effusion? Thoracocentesis. Treatment Depends on the underlying cause. • Aspirate / chest drain • Pleurodesis
Pneumothorax What is it? Build up of AIR in the pleural space ‘sudden onset, sharp, one sided pleuritic chest pain and SOB’ Causes • Trauma: rib fracture, gunshot, catheter, etc • Primary: damage to the lungs with no underlying lung pathology • Secondary: damage to the lungs resulting from underlying lung pathology e.g. Signs and Symptoms • Signs: low blood pressure, low oxygen levels, diminished breath sounds on the affected side • Symptoms: SOB, sharp, ONE SIDED chest pain, altered consciousness
Investigations • Gold standard: CXR • Treatment • Heal spontaneously • Treat the underlying cause, e.g. close the hole if there is an open wound causing it • Chest drain • Surgery
TENSION PNEUMOTHORAX: MEDICAL EMERGENCY, trachea deviated AWAY from the affected lung, need to insert a chest drain immediately.
Mesothelioma (in the case of the lungs) a cancer of the pleura that surround the lungs. Cause: ASBESTOS!!! Symptoms: FEVER, WEIGHT LOSS, FATIGUE, SOB, persistent cough, clubbed fingers Investigations: X-ray, CT Treatment: Poor prognosis, therefore palliative.
Lung Cancer What is it • Carcinoma of the bronchus or pleura • Small Cell (10-15%) • Non Small Cell (80-85%) (1. squamous, 2. adenocarcinoma) Causes • SMOKING! • Others; asbestos, chromium, arsenic Signs and Symptoms • Symptoms: Cough, Haemoptysis, Dyspnoea, Chest pain • Signs: Weight loss, Anaemia, Clubbing, Supraclavicular or axillary nodes
Investigations • CXR • Chest CT • Bronchoscopy • Needle or surgical biopsy Management • Stage I/II surgical excision and radical deep x-ray therapy • Stage III/IV Palliative chemotherapy, chemotherapy and radiotherapy, palliative care
Cystic Fibrosis What is it? • Chronic disease • GENETIC disorder: Autosomal recessive, causing defect in CTFR channel protein (Cl-), resulting in thick mucus clogging ducts • Presents in childhood • Affects: airways, pancreas, GI tract, etc.
Normal state Cystic Fibrosis
Complications • INFERTILITY • Pancreatitis • RESP TRACT NFECTIONS • Bronchiectasis Signs and symptoms • Signs: steatorrhea, children with a failure to thrive, finger clubbing, rectal prolapse • Symptoms: heavy mucus production, cough Investigations • 90% diagnosed before the age of 8. • Sweat (NaCl) test (parents taste salt when kissing baby) • Genetics testing Treatment • NO CURE, therefore symptom management • Non-pharmalogical: physio for airway clearance • Pharmalogical: antibiotics, anti-mucinolytics, bronchodilators, enzymes, insulin, bisphosphonates • Surgery: Lung transplant
Bronchiectasis What is it? • Irreversible dilation of the bronchioles • Build up of mucus, increased chance of infection Causes • End point / complication of lots of lung diseases e.g. COPD, CF • Infection Investigations: • HRCT • Sputum culture: look for the infectious agents Treatment Cant be cured, therefore symptom control • Non-pharmalogical: stop smoking, airway clearance exercises • Pharmalogical: bronchodilators, steroids, antibiotics
Occupational Lung Disorders What is it? • Lung diseases caused by exposure to agents at work • Can cause: bronchitis (irritants such as silicon), fibrosis, carcinoma (asbestos), asthma, hypersensitivity pneumonitis Causes • Various agents- look over asbestosis and silicon Hypersensitivity Pneumonitis • Inflammatory response to innocuous substances- usually associated to hobbies and jobs (usually in response to mould spores) • Farmers Lung, Pigeon Fancier’s Lung, Winemakers Lung • Presents with chronic cough and dyspnoea, fatigue etc. Managament • avoid the antigen!!!! • Corticosteroidsfor acute symptomatic relief
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General Exam Tips(even thoits ages away) • RESOURCES: • OXFORD CLINICAL HANDBOOK is a babe • Osmosis (YouTube) • Armando Hassadungan (YouTube) • Kumar and Clarke’s • Peer Teaching Powerpoint’s • Brainscape (Ella Kulman’s & loads of other students) EXAM CONTENT • LOTS of public health! • There will be 1-2 microbiology questions – antibiotics, appearance under microscope, staining techniques and what you’d find • Learn the COMMON conditions well • (in terms of the 90 core clinical conditions): They will either ask for a cause, SIGNS AND SYMPTOMS (e.g. hypothyroid we were asked for 6 symptoms), investigation or treatment HOW SHOULD I WORK? • 90 conditions: Structured notes, learn them! • Microbiology: flow charts and conditions • Public health: Document, add to it from lectures • GP: Notes for the objectives