Here are the answers to the multiple choice questions about respiratory topics:
1. A, B, E - Streptococcus pneumoniae is the most common cause of community acquired pneumonia in older children and adults, not infants. It can be caused by Staphylococcus aureus or Mycoplasma pneumoniae in infants. Ciprofloxacin would not be appropriate for presumed bacterial pneumonia without a confirmed pathogen. Bordatella pertussis is not usually mild.
2. C, D - 10% of cystic fibrosis patients may not require pancreatic enzyme supplementation. 10-15% of neonates present with meconium ileus. The other statements are false.
3. A, D, E -
Blue Baby Syndrome - A Hope Under THE BLUE
Blue Baby Syndrome - the bluish coloration of A NEONATE
Etiology included... covered briefly
CONGENITAL HEART DEFECTS also briefed whic are related etiology to Blue Baby syndrome like TETRALOGY OF FALLOT, PATENT TRUNCUS ARTERIOSUS, TRICUSPID ATRESIA, TRANSPOSITION OF THE GREAT VESSELS, Anomalous pulmonary venous connection...
Another etiologic reason METHEMOGLOBINEMIA
also covered...
Treatment also included like Blalock–Thomas–Taussig shunt...
THANK YOU - Hope you like it
1) A newborn with cyanosis of the extremities alone is initially assessed for common causes like hypothermia, but peripheral cyanosis can also indicate serious conditions like sepsis and should not be ignored until ruled out.
2) Differential or harlequin cyanosis, where one half of the body is cyanotic while the other is pink, can indicate a PDA or vasomotor instability.
3) In an infant presenting with cyanosis, lethargy and cold extremities on day 4 of life, the physician would perform a full examination, order diagnostic tests like a chest x-ray and echocardiogram, and consider treatments for potential cardiac or pulmonary causes while closely monitoring the
This document discusses various congenital heart diseases that are duct-dependent and require a patent ductus arteriosus to survive, including:
1) Obstructions to the left ventricle like aortic atresia that present with heart failure and absent pulses when the duct closes.
2) Aortic and pulmonary stenosis that are asymptomatic until duct closure causes heart failure or cyanosis respectively.
3) Right to left shunts like tetralogy of Fallot and transposition of the great vessels that present with cyanosis when the duct closes.
Both conditions require surgery, with tetralogy of Fallot treated by closing the ventricular septal defect and adding a shunt, while transposition is treated by
The document discusses various medical emergencies that may occur in a dental practice setting. It classifies life-threatening emergencies into categories such as unconsciousness, respiratory distress, altered consciousness, drug reactions, chest pain, and seizures. For each type of emergency, it describes signs and symptoms and provides guidance on initial management and treatment. Common emergencies discussed in detail include syncope, hyperventilation, stroke, hypoglycemia, anaphylaxis, adrenal crisis, angina, and myocardial infarction. The document emphasizes the importance of dental practitioners being prepared to recognize and respond appropriately to medical emergencies.
Based on the information provided, elemental mercury best explains this patient's clinical presentation and exposure history. Elemental mercury was inhaled from broken thermometers, allowing rapid absorption and distribution throughout the body, including the brain. The neurological and respiratory symptoms are consistent with elemental mercury toxicity.
Acute chest syndrome (ACS) is a life-threatening pulmonary complication in sickle cell anemia characterized by new lung opacity on chest imaging and two of the following: fever, respiratory distress, hypoxia, cough, or chest pain. ACS is commonly caused by infection but can also result from fat emboli, pulmonary infarction from sickled red blood cells blocking blood vessels in the lungs. Patients may present with symptoms like fever, cough, chest pain, and shortness of breath. Prevention focuses on vaccination, antibiotics, hydroxyurea treatment, and chronic blood transfusions for severe cases.
This document defines and discusses acute chest syndrome (ACS) in patients with sickle cell disease. ACS is characterized by fever, respiratory symptoms, and new lung infiltrates seen on chest x-ray. It is commonly caused by infection, fat embolism, or hypoventilation. Clinical features include chest pain and symptoms like cough. Diagnosis can be challenging as symptoms may be mild and radiological signs lag behind. Treatment involves oxygen, IV fluids, pain management, respiratory support like bronchodilators, and antibiotics. Preventing recurrent ACS involves therapies like hydroxyurea and long-term blood transfusions. Distinguishing asthma from wheezing caused by sickle cell disease can also be difficult.
This document provides information on congenital heart defects, including their causes, types, symptoms, and treatments. It discusses several specific defects in detail:
- Atrial septal defects (ASDs) are openings in the atrial septum that allow blood to pass between the left and right atria. They are usually asymptomatic but can cause pulmonary hypertension. Treatment options include medical management if symptoms are mild, and catheter device closure or surgery if indicated.
- Ventricular septal defects (VSDs) are openings in the ventricular septum that allow blood to pass between the left and right ventricles. They are the most common congenital heart defect. Symptoms depend on defect size, and treatment may
Blue Baby Syndrome - A Hope Under THE BLUE
Blue Baby Syndrome - the bluish coloration of A NEONATE
Etiology included... covered briefly
CONGENITAL HEART DEFECTS also briefed whic are related etiology to Blue Baby syndrome like TETRALOGY OF FALLOT, PATENT TRUNCUS ARTERIOSUS, TRICUSPID ATRESIA, TRANSPOSITION OF THE GREAT VESSELS, Anomalous pulmonary venous connection...
Another etiologic reason METHEMOGLOBINEMIA
also covered...
Treatment also included like Blalock–Thomas–Taussig shunt...
THANK YOU - Hope you like it
1) A newborn with cyanosis of the extremities alone is initially assessed for common causes like hypothermia, but peripheral cyanosis can also indicate serious conditions like sepsis and should not be ignored until ruled out.
2) Differential or harlequin cyanosis, where one half of the body is cyanotic while the other is pink, can indicate a PDA or vasomotor instability.
3) In an infant presenting with cyanosis, lethargy and cold extremities on day 4 of life, the physician would perform a full examination, order diagnostic tests like a chest x-ray and echocardiogram, and consider treatments for potential cardiac or pulmonary causes while closely monitoring the
This document discusses various congenital heart diseases that are duct-dependent and require a patent ductus arteriosus to survive, including:
1) Obstructions to the left ventricle like aortic atresia that present with heart failure and absent pulses when the duct closes.
2) Aortic and pulmonary stenosis that are asymptomatic until duct closure causes heart failure or cyanosis respectively.
3) Right to left shunts like tetralogy of Fallot and transposition of the great vessels that present with cyanosis when the duct closes.
Both conditions require surgery, with tetralogy of Fallot treated by closing the ventricular septal defect and adding a shunt, while transposition is treated by
The document discusses various medical emergencies that may occur in a dental practice setting. It classifies life-threatening emergencies into categories such as unconsciousness, respiratory distress, altered consciousness, drug reactions, chest pain, and seizures. For each type of emergency, it describes signs and symptoms and provides guidance on initial management and treatment. Common emergencies discussed in detail include syncope, hyperventilation, stroke, hypoglycemia, anaphylaxis, adrenal crisis, angina, and myocardial infarction. The document emphasizes the importance of dental practitioners being prepared to recognize and respond appropriately to medical emergencies.
Based on the information provided, elemental mercury best explains this patient's clinical presentation and exposure history. Elemental mercury was inhaled from broken thermometers, allowing rapid absorption and distribution throughout the body, including the brain. The neurological and respiratory symptoms are consistent with elemental mercury toxicity.
Acute chest syndrome (ACS) is a life-threatening pulmonary complication in sickle cell anemia characterized by new lung opacity on chest imaging and two of the following: fever, respiratory distress, hypoxia, cough, or chest pain. ACS is commonly caused by infection but can also result from fat emboli, pulmonary infarction from sickled red blood cells blocking blood vessels in the lungs. Patients may present with symptoms like fever, cough, chest pain, and shortness of breath. Prevention focuses on vaccination, antibiotics, hydroxyurea treatment, and chronic blood transfusions for severe cases.
This document defines and discusses acute chest syndrome (ACS) in patients with sickle cell disease. ACS is characterized by fever, respiratory symptoms, and new lung infiltrates seen on chest x-ray. It is commonly caused by infection, fat embolism, or hypoventilation. Clinical features include chest pain and symptoms like cough. Diagnosis can be challenging as symptoms may be mild and radiological signs lag behind. Treatment involves oxygen, IV fluids, pain management, respiratory support like bronchodilators, and antibiotics. Preventing recurrent ACS involves therapies like hydroxyurea and long-term blood transfusions. Distinguishing asthma from wheezing caused by sickle cell disease can also be difficult.
This document provides information on congenital heart defects, including their causes, types, symptoms, and treatments. It discusses several specific defects in detail:
- Atrial septal defects (ASDs) are openings in the atrial septum that allow blood to pass between the left and right atria. They are usually asymptomatic but can cause pulmonary hypertension. Treatment options include medical management if symptoms are mild, and catheter device closure or surgery if indicated.
- Ventricular septal defects (VSDs) are openings in the ventricular septum that allow blood to pass between the left and right ventricles. They are the most common congenital heart defect. Symptoms depend on defect size, and treatment may
This document discusses pleural effusions, which are collections of fluid in the pleural space. Pleural effusions are usually secondary to other diseases rather than primary. There are two main types - transudative effusions which occur without inflammation from conditions like heart failure, and exudative effusions which occur with inflammation from things like infections or cancer. Diagnosis involves chest imaging and analyzing fluid obtained via thoracentesis. Treatment focuses on resolving the underlying cause as well as draining fluid to relieve symptoms. Nursing care centers around maintaining normal breathing patterns and monitoring for complications.
Acute respiratory distress syndrome (ARDS) is a Sudden failure of the respiratory system. It Can occur in anyone over the age of one who is critically ill. It is a Life- threatening because normal gas exchange does not take place due to severe fluid buildup in both lungs.
Prevention can be achieved by Limiting Blood Loss so decreasing transfusion requirements, Early Stabilization Of unstable Fractures and Early prophylactic mechanical Ventilation.
Established cases with ARDS is treated in the Intensive Care Unit By Mechanical ventilation and Oxygen therapy through a ventilator, Fluids through an IV line to improve blood flow and provide nutrition and medicine to prevent and treat infections and to relieve pain.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document discusses drowning, near-drowning, and immersion syndrome. It defines drowning as death within 24 hours of suffocation from submersion in liquids. Near-drowning is defined as survival after more than 24 hours. Immersion syndrome refers to syncope resulting from cardiac arrhythmias after sudden contact with cold water. The document outlines some risk factors for drowning, including alcohol consumption near water, poor swimming ability, and medical conditions like seizures. It also discusses factors that determine subsequent pulmonary issues, such as the quantity rather than composition of aspirated water, whether it is fresh or salt water. Prognostic factors for survival are provided.
Endocarditis is inflammation of the inner lining of the heart (endocardium) that usually involves the heart valves. It is commonly caused by bacteria like Staphylococcus that enter the bloodstream through invasive procedures or wounds in the mouth, respiratory tract, GI tract, or GU tract. Risk factors include prior heart damage, dental procedures, heart surgery, and certain medical devices. Symptoms include fever, weakness, weight loss, and chest pain. Diagnosis involves blood cultures, echocardiography, and imaging tests. Treatment consists of intravenous antibiotics for 4-6 weeks to eliminate the infecting bacteria.
Approach to Cyanosis [Paediatrics presentation for medical (MBBS) students]Rushali Riah
This is the presentation on 'Approach to Cyanosis' for Paediatrics under MBBS curriculum. It focuses of peripheral, central, and differential cyanosis along with their history/examination findings, investigations, and treatment. Good luck!
1. Ebstein's anomaly is a rare congenital heart defect where the tricuspid valve is displaced downward into the right ventricle, causing obstruction of blood flow.
2. This leads to a shunt of deoxygenated blood from the right to left atrium, causing cyanosis.
3. Surgical options include tricuspid valve repair or replacement, closure of intra-atrial communications, and reduction of the enlarged right atrium and right ventricle. The goal is to improve valve function and cardiac output while eliminating arrhythmias.
This document defines and describes near drowning, its causes, signs and symptoms, pathophysiology, diagnostic workup, and management. Near drowning occurs when a person suffers respiratory impairment from submersion in liquid. Common causes are accidents near water and inability to swim. Signs include cold skin, coughing, and shortness of breath. Pathophysiology involves involuntary inhalation of water leading to hypoxia, tissue damage, and cardiac issues. Diagnostic workup includes blood gases, imaging, and monitoring for arrhythmias and hypothermia. Management focuses on airway support, oxygen, treating hypothermia and hypoxia, and monitoring for pulmonary edema.
Dissecting the Medical Issues in Pediatric DrowningSuncoastMeetings
This document discusses pediatric submersion and drowning. It begins with an overview of prevention strategies and the importance of early recognition, rescue, and medical treatment. It then tells the story of Allan, a 3-year-old boy who was submerged in a pool and unresponsive when rescued. Despite extensive medical treatment, he had severe brain and lung injuries and required long-term care. The document emphasizes the critical importance of early CPR, epinephrine administration on scene, and rapid transport. It also discusses debates around oxygen administration, ABC vs CAB sequencing, and the role of hypothermia in outcomes. Throughout, it stresses analyzing every step of the response and customizing resuscitation to the individual child.
Alterations in cardiovascular function in children fall 2017Shepard Joy
This document discusses alterations in cardiovascular function in children. It begins with learning outcomes related to anatomy and physiology of the cardiovascular system, pathophysiology of congenital heart defects, and nursing care of infants and children with heart defects. It then covers topics such as overview of the cardiovascular system, fetal circulation, transition to postnatal circulation, pediatric cardiac assessment, diagnostics, and types of heart disease in children. Nursing care is discussed for conditions such as congestive heart failure and for procedures like cardiac catheterization.
This document discusses various types of chest injuries including blunt injuries, penetrating injuries, crush injuries, and inhalation burns. It covers the mechanisms, clinical features, investigations, and management of different chest traumas. Specific injuries discussed in more detail include tension pneumothorax, open pneumothorax, cardiac tamponade, and massive hemothorax which require immediate intervention due to their life-threatening nature. The document emphasizes the importance of airway management, oxygenation, and treatment of associated injuries in chest trauma patients.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are considered part of the same spectrum of disease. ARDS was first described in 1967 and involves acute respiratory failure from pulmonary edema without heart failure. In 1994, diagnostic criteria were established for ALI and ARDS based on severity. A landmark 2000 study found that using low tidal volume ventilation (6-8 mL/kg) compared to conventional volumes (10-12 mL/kg) reduced mortality in ARDS patients by 22%. Low tidal volumes are now the standard of care for reducing mortality and improving outcomes in ARDS.
Pericardiocentesis is a procedure to remove fluid from the pericardium, the sac surrounding the heart. It is used diagnostically and therapeutically to treat cardiac tamponade, a dangerous buildup of fluid in the pericardium that reduces heart function. The procedure involves inserting a needle under ultrasound or echocardiogram guidance to drain the fluid. Risks include puncturing the heart or blood vessels. It provides rapid relief of symptoms for tamponade but the fluid must be analyzed to determine the underlying cause.
This document discusses the management of chest injuries. It begins with an introduction stating that chest trauma is a significant cause of morbidity and mortality worldwide. It then covers the epidemiology, relevant anatomy, causes, pathophysiology, investigations, management, and complications of various chest injuries. The pathophysiology section describes the mechanisms and types of injuries that can occur to the chest wall, pleura, lungs, heart, and major vessels. Management involves following ATLS protocols, administering analgesics and antibiotics, and performing procedures such as tube thoracostomy or thoracotomy when needed to treat injuries such as hemothorax, flail chest, or cardiac tamponade. Complications include wound infections, dehiscence,
1. The document discusses several chest CT and histology cases showing abnormalities including nodules, consolidation, and ground-glass opacity.
2. One case shows centrilobular nodules connected by linear structures, known as a tree-in-bud pattern, indicative of endobronchial infection.
3. Histology slides illustrate granulomas with necrosis, palisading histiocytes, and aerated alveolar parenchyma consistent with tuberculosis. Differential diagnoses include fungal infection and Wegener's granulomatosis.
The abnormality seen on this HRCT image is predominantly subpleural and basal. There are bilateral reticular opacities in the subpleural regions extending into the bases posteriorly. The lung apices and upper lobes appear relatively spared.
The blood gas results show a respiratory acidosis with a pH of 7.25 and a PCO2 of 7.5 kPa. This is consistent with type I respiratory failure due to an acute process like pneumonia. Bronchopulmonary dysplasia and asthma are chronic conditions unlikely to cause such an acute deterioration. While intubation may be required, the immediate priority should be supportive care and treating the underlying cause rather than intubation alone. Bicarbonate is usually not required to correct a respiratory acidosis as the kidney can compensate.
The best answer is:
B - Blood gases suggest type 1 respiratory failure.
The characteristic presentations of cystic fibrosis include:
A- A 26 week gestation infant with x-ray appearance of meconium ileus.
B- An 8 month old girl admitted the second time with lower respiratory tract changes on chest x- ray.
C- A 9 month old Indian girl with failure to thrive.
The key presentations are meconium ileus in a preterm infant, and recurrent or chronic lung infections leading to changes on chest x-ray in an infant or child. Failure to thrive can also be seen. Prolonged jaundice and nasal obstruction are not characteristic of cystic fibrosis.
This document discusses a case of a 64-year-old female patient with chronic obstructive pulmonary disease (COPD). It provides her medical history, physical exam findings, diagnostic test results including pulmonary function tests and imaging, and discusses gender differences in COPD presentations. It also includes two multiple choice questions about gender differences in COPD and indices used to evaluate COPD severity and mortality.
The document discusses various chest X-ray, clinical case, and CT scan cases related to respiratory diseases. It includes images and descriptions of cases involving conditions like lymphoma, sarcoidosis, lung metastases, radiation pneumonitis, and sarcoidosis. The document also presents clinical cases on recurrent pneumothoraces and catamenial pneumothorax and includes related questions and discussions.
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesSean M. Fox
This document provides an overview of the monthly adult chest x-ray cases from the Emergency Medicine department. It discusses cases submitted from partners in Brazil and Tanzania. The cases this month included alveolar hemorrhage from Goodpasture's syndrome, rib fractures with tension hemothorax from a motor vehicle collision, rib fractures with flail chest from a fall, traumatic aortic disruption from a pedestrian being struck, active tuberculosis, and transfusion related acute lung injury. The goal is to promote widespread mastery of chest x-ray interpretation and share cases between various international contributors.
Drs. Milam and Thomas's CMC X-Ray Mastery Project: August CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on: Aortic Dissection, Hiatal Hernia, Pleural Effusion, Metastatic Cancer, Cystic Fibrosis, Pulmonary Contusions, Esophageal-pleural Fistula, Diaphragmatic Hernia, Pulmonary Artery Hypertension, Hemorrhagic Pericardial Effusion, Pulmonary Infarct
This document discusses pleural effusions, which are collections of fluid in the pleural space. Pleural effusions are usually secondary to other diseases rather than primary. There are two main types - transudative effusions which occur without inflammation from conditions like heart failure, and exudative effusions which occur with inflammation from things like infections or cancer. Diagnosis involves chest imaging and analyzing fluid obtained via thoracentesis. Treatment focuses on resolving the underlying cause as well as draining fluid to relieve symptoms. Nursing care centers around maintaining normal breathing patterns and monitoring for complications.
Acute respiratory distress syndrome (ARDS) is a Sudden failure of the respiratory system. It Can occur in anyone over the age of one who is critically ill. It is a Life- threatening because normal gas exchange does not take place due to severe fluid buildup in both lungs.
Prevention can be achieved by Limiting Blood Loss so decreasing transfusion requirements, Early Stabilization Of unstable Fractures and Early prophylactic mechanical Ventilation.
Established cases with ARDS is treated in the Intensive Care Unit By Mechanical ventilation and Oxygen therapy through a ventilator, Fluids through an IV line to improve blood flow and provide nutrition and medicine to prevent and treat infections and to relieve pain.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document discusses drowning, near-drowning, and immersion syndrome. It defines drowning as death within 24 hours of suffocation from submersion in liquids. Near-drowning is defined as survival after more than 24 hours. Immersion syndrome refers to syncope resulting from cardiac arrhythmias after sudden contact with cold water. The document outlines some risk factors for drowning, including alcohol consumption near water, poor swimming ability, and medical conditions like seizures. It also discusses factors that determine subsequent pulmonary issues, such as the quantity rather than composition of aspirated water, whether it is fresh or salt water. Prognostic factors for survival are provided.
Endocarditis is inflammation of the inner lining of the heart (endocardium) that usually involves the heart valves. It is commonly caused by bacteria like Staphylococcus that enter the bloodstream through invasive procedures or wounds in the mouth, respiratory tract, GI tract, or GU tract. Risk factors include prior heart damage, dental procedures, heart surgery, and certain medical devices. Symptoms include fever, weakness, weight loss, and chest pain. Diagnosis involves blood cultures, echocardiography, and imaging tests. Treatment consists of intravenous antibiotics for 4-6 weeks to eliminate the infecting bacteria.
Approach to Cyanosis [Paediatrics presentation for medical (MBBS) students]Rushali Riah
This is the presentation on 'Approach to Cyanosis' for Paediatrics under MBBS curriculum. It focuses of peripheral, central, and differential cyanosis along with their history/examination findings, investigations, and treatment. Good luck!
1. Ebstein's anomaly is a rare congenital heart defect where the tricuspid valve is displaced downward into the right ventricle, causing obstruction of blood flow.
2. This leads to a shunt of deoxygenated blood from the right to left atrium, causing cyanosis.
3. Surgical options include tricuspid valve repair or replacement, closure of intra-atrial communications, and reduction of the enlarged right atrium and right ventricle. The goal is to improve valve function and cardiac output while eliminating arrhythmias.
This document defines and describes near drowning, its causes, signs and symptoms, pathophysiology, diagnostic workup, and management. Near drowning occurs when a person suffers respiratory impairment from submersion in liquid. Common causes are accidents near water and inability to swim. Signs include cold skin, coughing, and shortness of breath. Pathophysiology involves involuntary inhalation of water leading to hypoxia, tissue damage, and cardiac issues. Diagnostic workup includes blood gases, imaging, and monitoring for arrhythmias and hypothermia. Management focuses on airway support, oxygen, treating hypothermia and hypoxia, and monitoring for pulmonary edema.
Dissecting the Medical Issues in Pediatric DrowningSuncoastMeetings
This document discusses pediatric submersion and drowning. It begins with an overview of prevention strategies and the importance of early recognition, rescue, and medical treatment. It then tells the story of Allan, a 3-year-old boy who was submerged in a pool and unresponsive when rescued. Despite extensive medical treatment, he had severe brain and lung injuries and required long-term care. The document emphasizes the critical importance of early CPR, epinephrine administration on scene, and rapid transport. It also discusses debates around oxygen administration, ABC vs CAB sequencing, and the role of hypothermia in outcomes. Throughout, it stresses analyzing every step of the response and customizing resuscitation to the individual child.
Alterations in cardiovascular function in children fall 2017Shepard Joy
This document discusses alterations in cardiovascular function in children. It begins with learning outcomes related to anatomy and physiology of the cardiovascular system, pathophysiology of congenital heart defects, and nursing care of infants and children with heart defects. It then covers topics such as overview of the cardiovascular system, fetal circulation, transition to postnatal circulation, pediatric cardiac assessment, diagnostics, and types of heart disease in children. Nursing care is discussed for conditions such as congestive heart failure and for procedures like cardiac catheterization.
This document discusses various types of chest injuries including blunt injuries, penetrating injuries, crush injuries, and inhalation burns. It covers the mechanisms, clinical features, investigations, and management of different chest traumas. Specific injuries discussed in more detail include tension pneumothorax, open pneumothorax, cardiac tamponade, and massive hemothorax which require immediate intervention due to their life-threatening nature. The document emphasizes the importance of airway management, oxygenation, and treatment of associated injuries in chest trauma patients.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are considered part of the same spectrum of disease. ARDS was first described in 1967 and involves acute respiratory failure from pulmonary edema without heart failure. In 1994, diagnostic criteria were established for ALI and ARDS based on severity. A landmark 2000 study found that using low tidal volume ventilation (6-8 mL/kg) compared to conventional volumes (10-12 mL/kg) reduced mortality in ARDS patients by 22%. Low tidal volumes are now the standard of care for reducing mortality and improving outcomes in ARDS.
Pericardiocentesis is a procedure to remove fluid from the pericardium, the sac surrounding the heart. It is used diagnostically and therapeutically to treat cardiac tamponade, a dangerous buildup of fluid in the pericardium that reduces heart function. The procedure involves inserting a needle under ultrasound or echocardiogram guidance to drain the fluid. Risks include puncturing the heart or blood vessels. It provides rapid relief of symptoms for tamponade but the fluid must be analyzed to determine the underlying cause.
This document discusses the management of chest injuries. It begins with an introduction stating that chest trauma is a significant cause of morbidity and mortality worldwide. It then covers the epidemiology, relevant anatomy, causes, pathophysiology, investigations, management, and complications of various chest injuries. The pathophysiology section describes the mechanisms and types of injuries that can occur to the chest wall, pleura, lungs, heart, and major vessels. Management involves following ATLS protocols, administering analgesics and antibiotics, and performing procedures such as tube thoracostomy or thoracotomy when needed to treat injuries such as hemothorax, flail chest, or cardiac tamponade. Complications include wound infections, dehiscence,
1. The document discusses several chest CT and histology cases showing abnormalities including nodules, consolidation, and ground-glass opacity.
2. One case shows centrilobular nodules connected by linear structures, known as a tree-in-bud pattern, indicative of endobronchial infection.
3. Histology slides illustrate granulomas with necrosis, palisading histiocytes, and aerated alveolar parenchyma consistent with tuberculosis. Differential diagnoses include fungal infection and Wegener's granulomatosis.
The abnormality seen on this HRCT image is predominantly subpleural and basal. There are bilateral reticular opacities in the subpleural regions extending into the bases posteriorly. The lung apices and upper lobes appear relatively spared.
The blood gas results show a respiratory acidosis with a pH of 7.25 and a PCO2 of 7.5 kPa. This is consistent with type I respiratory failure due to an acute process like pneumonia. Bronchopulmonary dysplasia and asthma are chronic conditions unlikely to cause such an acute deterioration. While intubation may be required, the immediate priority should be supportive care and treating the underlying cause rather than intubation alone. Bicarbonate is usually not required to correct a respiratory acidosis as the kidney can compensate.
The best answer is:
B - Blood gases suggest type 1 respiratory failure.
The characteristic presentations of cystic fibrosis include:
A- A 26 week gestation infant with x-ray appearance of meconium ileus.
B- An 8 month old girl admitted the second time with lower respiratory tract changes on chest x- ray.
C- A 9 month old Indian girl with failure to thrive.
The key presentations are meconium ileus in a preterm infant, and recurrent or chronic lung infections leading to changes on chest x-ray in an infant or child. Failure to thrive can also be seen. Prolonged jaundice and nasal obstruction are not characteristic of cystic fibrosis.
This document discusses a case of a 64-year-old female patient with chronic obstructive pulmonary disease (COPD). It provides her medical history, physical exam findings, diagnostic test results including pulmonary function tests and imaging, and discusses gender differences in COPD presentations. It also includes two multiple choice questions about gender differences in COPD and indices used to evaluate COPD severity and mortality.
The document discusses various chest X-ray, clinical case, and CT scan cases related to respiratory diseases. It includes images and descriptions of cases involving conditions like lymphoma, sarcoidosis, lung metastases, radiation pneumonitis, and sarcoidosis. The document also presents clinical cases on recurrent pneumothoraces and catamenial pneumothorax and includes related questions and discussions.
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesSean M. Fox
This document provides an overview of the monthly adult chest x-ray cases from the Emergency Medicine department. It discusses cases submitted from partners in Brazil and Tanzania. The cases this month included alveolar hemorrhage from Goodpasture's syndrome, rib fractures with tension hemothorax from a motor vehicle collision, rib fractures with flail chest from a fall, traumatic aortic disruption from a pedestrian being struck, active tuberculosis, and transfusion related acute lung injury. The goal is to promote widespread mastery of chest x-ray interpretation and share cases between various international contributors.
Drs. Milam and Thomas's CMC X-Ray Mastery Project: August CasesSean M. Fox
Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on: Aortic Dissection, Hiatal Hernia, Pleural Effusion, Metastatic Cancer, Cystic Fibrosis, Pulmonary Contusions, Esophageal-pleural Fistula, Diaphragmatic Hernia, Pulmonary Artery Hypertension, Hemorrhagic Pericardial Effusion, Pulmonary Infarct
Based on the discussion, the best therapeutic management for this patient is E) Aggressive antibiotic therapy and airway clearance maneuvers. The goals of treatment for PCD are to treat pulmonary infections aggressively with antibiotics tailored to sputum cultures and regular airway clearance to help maintain lung function.
This document provides clinical materials for self-learning in clinical medicine. It contains 19 case studies presented as images and descriptions. Each case asks the reader to examine the images, describe any abnormalities, and provide interpretations or suggestions for management. The cases cover a wide range of organ systems and medical conditions commonly seen in clinical practice.
This document provides clinical materials for self-learning in clinical medicine. It includes 12 clinical cases with descriptions, examination findings, imaging results, and summaries. The objective is to examine each case carefully and analyze the findings to aid in learning. Suggestions and feedback can be provided to the author via email. The author acknowledges and thanks the patients, teachers, and colleagues who contributed to developing this resource.
case presentation on small cell lung cancer(sclc)ssuser6e4201
Mr. X, a 51-year-old male smoker, presented with symptoms of dyspnea, dry cough, loss of appetite, and fatigue for 6 months. Tests revealed limited stage small cell lung cancer. Small cell lung cancer is an aggressive form of lung cancer linked to smoking that has spread to nearby lymph nodes in this case. Treatment involves chemotherapy with cisplatin, etoposide, and irinotecan to shrink the tumor and prevent further spread, as surgery is typically not an option for small cell lung cancer.
This document lists and defines common medical abbreviations used in various anatomical systems and contexts. It includes abbreviations for parts of the body, medical procedures, diseases, medications, lab tests, and more. The abbreviations are organized alphabetically from A to X. Some examples included are ACL for anterior cruciate ligament, AIDS for acquired immune deficiency syndrome, and ETOH for alcohol. Over 100 common medical abbreviations are defined in the document.
A 59-year-old male smoker presented with recurrent attacks of blood-tinged sputum over 12 years. Imaging revealed a right lower lobe opacity and calcification. Further CT angiography identified a right intralobar pulmonary sequestration (ILS) receiving a dual arterial blood supply from the right pulmonary artery and abdominal aorta, with venous drainage into the right pulmonary vein. Pulmonary sequestration is a congenital malformation where non-functioning lung tissue receives a blood supply directly from the systemic circulation instead of the pulmonary arteries. Surgical resection is typically recommended to prevent infections, though recent options include video-assisted thoracoscopic surgery or arterial embolization of feeding vessels.
This document provides an overview of respiratory imaging modalities and how to interpret chest radiographs. It lists the learning outcomes as understanding various imaging modalities for respiratory pathologies and how to systematically evaluate a normal and abnormal chest x-ray. Key points include identifying the structures on a normal CXR, differentiating abnormal opacity patterns, and recognizing common conditions like pneumonia that appear as airspace filling or consolidation on CXR.
This document provides a collection of clinical case studies for self-learning in clinical medicine. It includes 13 case studies with relevant patient histories, examination findings, test results and radiological images. Learners are asked to examine the information and materials provided to make diagnoses and identify any abnormalities. The goal is to enhance clinical reasoning skills through active engagement with real medical cases.
A 56-year-old man presented with chest pain after the sudden death of his son. Tests showed ST elevation but normal coronary arteries. He was diagnosed with stress (takotsubo) cardiomyopathy. Treatment involves alpha blockers and beta blockers. The document then provides 10 additional multiple choice questions and answers about various cardiac topics, including ECG findings, heart anatomy, cardiomyopathies, congenital heart defects, and cardiac drugs.
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: September CasesSean M. Fox
Drs. Breeanna Lorenzen and Travis Barlock are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides. This set will cover:
• Aortic Transection
• Hemothorax
• Innominate Artery Transection
• Dextrocardia
• Situs Inversus
• Pneumonia
• Complete Lung Consolidation
• Septic Pulmonary Emboli
• Pulmonary Metastases
• Pneumothorax
Congenital diaphragmatic hernia (CDH) is a birth defect where the diaphragm fails to fully form, allowing abdominal organs to migrate into the chest cavity and compress the lungs during development. CDH occurs in approximately 1 in 2,000-5,000 live births. Prenatal ultrasound can detect CDH and allow for prenatal counseling. After birth, infants require immediate respiratory support, surgery to repair the diaphragmatic defect, and treatment of pulmonary hypertension. While survival has improved, CDH infants still face risks of chronic lung disease and long-term developmental issues. The prognosis depends on the severity of pulmonary hypoplasia assessed by measures like blood gas levels and ventilator
1) The document defines key terms related to venous thromboembolism (VTE) such as Wells score, provoked and unprovoked DVT/PE, and defines the Wells clinical prediction rules.
2) It then presents three case scenarios (Susan, Nita, Harry) and walks through evaluating each patient for suspected DVT or PE using the Wells criteria, performing appropriate tests, and determining next steps in management.
3) Tables are included defining the two-level Wells score for DVT and PE to estimate probability of each.
This document contains information about various chest radiograph and CT scan cases. It includes 10 chest CT cases with images and descriptions of findings such as parenchymal bands, subpleural lines, centrilobular nodules, lobular remodeling, architectural distortion, and more advanced disease. It also provides 2 chest clinical cases describing patients with progressive dyspnea and worsening radiographic findings consistent with coal workers' pneumoconiosis and progressive massive fibrosis.
This document provides a guide for summarizing chest x-rays. It outlines key areas to examine including position, quality, lesions, masses, cavitary findings, linear patterns, and mediastinal anatomy. Key items to note include opacity, margins, calcification, location, associated abnormalities, and comparison to prior x-rays. Common pathologies are described based on appearance including nodules, infiltrates, fibrosis, and more.
This document outlines various pulmonary issues that can affect women, including those related to pregnancy. It discusses topics like tuberculosis and pneumonia in pregnancy, acute respiratory failure during pregnancy covering things like sepsis, mechanical ventilation concerns, amniotic fluid embolism, and venous air embolism. It also briefly touches on tobacco-related lung diseases in women and catamenial pneumothorax and hemoptysis. For many of the conditions, it provides details on presentation, management considerations, and treatment approaches.
CXR-2 is most likely to belong to this patient based on the clinical scenario provided. The patient presents with shortness of breath, fever, and crackles on lung exam suggestive of pneumonia. CXR-2 shows bilateral infiltrates consistent with pneumonia.
1. The document provides guidance on interpreting chest CT scans by describing common patterns seen in interstitial lung diseases.
2. It outlines different types of nodules seen on CT scans including dot-like, ill-defined centrilobular, and tree-in-bud nodules and associates each with specific conditions.
3. The document also discusses the distribution of nodules and how this can provide clues to different diseases, such as perilymphatic nodules suggesting sarcoidosis.
The patient has a history consistent with cystic fibrosis. The chest x-ray shows bilateral cystic lesions in the upper zones. Physical exam will likely reveal clubbing and spirometry will show a mixed obstructive and restrictive pattern. Treatment should include starting an anti-pseudomonas antibiotic regimen.
1. A 50-year-old woman presents with progressive shortness of breath, cough, and low-grade fever after working in maintenance jobs around boats for many years. Chest x-ray shows bilateral lower lung zone reticular infiltrates and hazy angles.
2. The most likely diagnosis is silicosis given her occupational exposure history involving inorganic dust. Silicosis is associated with decreased diffusion on pulmonary function tests.
3. Key findings include bilateral lower lung zone reticular infiltrates on chest x-ray, occupational exposure history involving inorganic dust, and decreased diffusion capacity expected on pulmonary function tests.
This document contains information from Dr. Anas Sahle regarding chest CT cases and a collicum exam. For the chest CT cases, there are images and descriptions of findings for HRCT-1, including linear opacities, centrilobular nodules, tree-in-bud patterns and bronchial wall thickening. After treatment, there is marked resolution of the findings. Histology shows a bronchiole with lymphoid follicles, consistent with chronic follicular bronchiolitis. The collicum exam contains 12 multiple choice questions on various respiratory topics like teratomas, Hounsfield units, findings associated with ARDS, and appropriate treatments for conditions like lung abscesses. Contact information
1) Ground-glass opacity and consolidation are the main patterns of increased lung attenuation seen on chest CT.
2) Ground-glass opacity indicates mild decrease in airspace or mild increase in soft tissue and is potentially treatable, while consolidation obscures vessels/airways and indicates more severe disease.
3) The distribution, associated patterns, and clinical context can help determine if an interstitial lung disease is acute/potentially treatable versus chronic/not treatable.
This document provides a guide for reading chest x-rays. It outlines key areas to examine including position, quality, lesions, masses, consolidation, and other findings. Specific features to evaluate for solitary pulmonary nodules and cavitary lesions are described such as appearance, size, location, and associated abnormalities. Causes of common chest x-ray findings are listed for conditions like pneumonia, lymphoma, and sarcoidosis.
This document provides guidance on interpreting chest CT scans by summarizing common appearance patterns, distributions, and what various patterns may indicate. Appearance patterns include increased or decreased lung attenuation, nodular or linear opacities. Distribution patterns include upper/lower lung involvement or diffuse/central/peripheral localization. Together, appearance and distribution patterns can provide clues to conditions like infections, interstitial lung disease, or tumors.
The chest x-ray shows bilateral hazy opacities and a peripherally located ill-defined opacity, suggesting adenocarcinoma as the likely diagnosis given its common peripheral presentation as an incidental finding; a CT-guided biopsy revealed malignant cells consistent with adenocarcinoma, which is often an incidentally detected peripheral carcinoma on chest x-ray in smokers.
The normal chest CT shows an aortic arch landmark in the mediastinum window. The brachiocephalic trunk and left common carotid artery are seen originating from the arch. In the lung window, the trachea provides a landmark and the lungs are divided into three sections based on the carina: above is the upper lobe, at the carina is the anterior and superior segments, and below is the lingula (left) and middle lobe (right).
Based on the clinical history of excessive secretions, elevated pressures, and fever, aspiration pneumonia with right upper lobe atelectasis is the most likely diagnosis. An important next step in management would be fiberoptic bronchoscopy, antibiotic therapy, and chest physiotherapy.
1. The chest X-ray shows a cavitary lesion in the right upper lobe containing a dense ball within an air crescent, indicative of a mycetoma likely caused by Aspergillus colonizing a preexisting cavity from the patient's history of tuberculosis.
2. Common causes of cavitary lung lesions include infections, tumors, and sequelae of conditions like tuberculosis that can result in cavitation.
3. This patient presented with massive hemoptysis, a potential complication of mycetoma that may require bronchial embolization for control of bleeding.
1. This document provides guidance on how to read chest x-rays and summarizes 5 case examples.
2. Key elements to evaluate on a CXR are described such as position, quality, lesions, mediastinal structures, and other findings.
3. The case examples demonstrate different pathologies such as pneumonia, pulmonary edema, and infiltrates. Each case provides the patient history and radiographic findings.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
4. Cxr-18
Diagnosis is:??
S Curve of Golden
When there is a mass adjacent to a fissure, the fissure takes the shape of an "S".
The proximal convexity is due to a mass, and the distal concavity is due to atelectasis.
Note the shape of the left oblique fissure in the lateral view below.
This example represents a LUL mass with atelectasis.
6. Cxr-19
SIGN NAME IS:…
Wedge Shaped
This case Density
represents a
pulmonary infarct.
Wedge Shaped Density
The wedge's base is pleural and the apex is towards the hilum, giving a triangular shape.
You can encounter either of the following:
Vascular wedges:
Infarct
Invasive aspergillosis
Bronchial wedges:
Consolidation
Atelectasis
7. Cxr-20
Acinar or interstitial nodules?
Name DDX:…….
13. Cxr-23
Mass density is seen in the lateral view, but not in the PA view .
This finding suggests a chest wall or external problem.
In the film below, an amputated shoulder is projecting as a mass.
19. chest clinical cases
A 27-Year-Old With a Non-
Resolving Cavitary Lung
Lesion
Submitted by
Lokesh Venkateshaiah, MD
Fellow
Division of Pulmonary, Critical Care and Sleep Medicine
Case Western Reserve University
Cleveland, Ohio
J. Daryl Thornton, MD MPH
Assistant Professor
Division of Pulmonary, Critical Care and Sleep Medicine
Case Western Reserve University
Cleveland, Ohio
20. History
• A 27-year-old man presented to the pulmonary clinic for evaluation of a non-resolving lung
cavity.
• Four months earlier, he had been diagnosed with pulmonary tuberculosis and was started on
four-drug anti-tuberculous directly observed therapy.
• A PPD placed at that time measured 22 mm of induration.
• During the pulmonary clinic visit, the patient stated that over the last year and a half he had a
cough occasionally productive of minimal blood-streaked sputum.
• He had denied other symptoms including nocturnal diaphoresis, anorexia, weight loss, or fevers.
• The patient’s past medical history was remarkable for an abnormal chest radiogram that was
noted one and a half years ago and one episode of malaria.
• Other than his recent antituberculous therapy he took no regular medications.
• He smoked one-half pack daily for the past 12 years.
• He occasionally snorted cocaine but did not use alcohol or other recreational drugs.
• He emigrated from Malaysia to the United States 8 months ago.
• He was originally from Burma but was a refugee in Malaysia.
• It was in Malaysia that he was noted to have an abnormal chest radiogram.
• He underwent additional investigations while there but was not given a diagnosis nor treatment.
Saturday, December 15, 2012
21. Physical Exam
• The patient appeared comfortable and was in no acute
distress.
• Vital signs were unremarkable.
• The cardiac exam demonstrated regular rate and rhythm, a
normal S1 and S2, and no murmur, gallop or rub.
• Breath sounds were equal bilaterally and absent of
adventitious sounds.
• The abdomen was soft and without organomegaly.
• The patient’s extremities were without clubbing or edema.
• There was a scar on the left upper arm from a prior BCG
injection.
• No other skin lesions were noted.
Saturday, December 15, 2012
22. Lab
• White blood cell count was 10,000 per mm3 with
66% Neutrophils, 14% Lymphocytes and 12%
eosinophils
• Hematocrit 49%
• Platelet count was 309,000 per mm3
• Urea nitrogen was 12 mg /dl, and serum
creatinine was 0.7 mg/dl
• Liver function tests were within normal limits
• Stools and sputum for ova and parasites were
negative
• Sputum for AFB times five was negative
Saturday, December 15, 2012
24. at presentation
(4 months following initiation of antituberculous therapy)
Saturday, December 15, 2012
25. Question 1
• What is the diagnosis?
• A. Pulmonary tuberculosis
• B. Acute Bronchitis
• C. Paragonimiasis
• D. Schistosomiasis
Saturday, December 15, 2012
26. • Cysts for Paragonimus were identified on BAL and transbronchial biopsy.
• Paragonimiasis is caused by lung flukes of the genus Paragonimus.
• There are 43 species of Paragonimus, 12 of which infect humans.
• Paragonimus westermani is the most prevalent, especially in eastern and Southeast Asia.
• Infection with these organisms occurs worldwide but predominantly in several parts of Central
and South America, West Africa, and Asia (1).
• In the United States, the disease is diagnosed most commonly in immigrants from endemic
countries (2).
• Endogenous infections do occur and usually are caused by Paragonimus kellicot mainly in the
midwestern and eastern United States (3-6).
• Pulmonary tuberculosis is less likely given several negative sputum AFB stains and cultures.
• Alveolar lavage by bronchoscopy elso exhibited negative AFB stain and culture.
• In addition, the cavitation worsened on computed tomography despite receiving multidrug direct
observed therapy.
• Acute bronchitis is not a common cause of pulmonary cavitation.
• Pulmonary manifestations of chronic schistosomiasis are generally found in patients with a heavy
infectious burden and significant clinical symptoms.
• Schistozome eggs may embolize from the liver to the pulmonary circulation where they may lead
to granulomatous endarteritis, pulmonary hypertension, and cor pulmonale.
Saturday, December 15, 2012
27. Question 2
• How do humans acquire Paragonimiasis?
• A. Inhalation
• B. Ingestion
• C. Innoculation
• D. Inconclusive
Saturday, December 15, 2012
29. Question 3
• What is the drug of choice in the treatment
of Paragonimus westermani?
• A. Peptobismol
• B. Cipro
• C. Praziquantel
• D. Albendazole
Saturday, December 15, 2012
30. Treatment
• Praziquantel is the drug of choice to treat
paragonimiasis.
• The recommended dosage of 75 mg/kg per day
orally, divided into 3 doses over 2 days has
proven to eliminate P. westermani in adults and
children .
• Praziquantel should be taken with liquids during a
meal.
• Patients with chronic empyema due to
paragonimiasis may require decortication in
addition to anthelmintic treatment .
Saturday, December 15, 2012
34. HRCT-1
• What is the major abnormality in this case?
• a) Linear opacities
• b) Nodules
• c) Consolidation
• d) Ground-glass opacity
• 2. Which lung is involved?
• a) Left
• b) Right
• c) Both
35. HRCT-1
• What is the distribution of the lesions?
• a) Bronchovascular interstitium
• b) Interlobular septa
• c) Centrilobular region
• d) Pleura
37. HRCT-1
• Find multiple, connected, thickened
interlobular septa in the right lung.
• Find an example of thickened bronchovascular
interstitium in the right lung.
• Find 2 examples of polygonal lobules with
centrilobular nodules in the right lung.
40. HRCT-2
• Find the thickened fissural pleura in the right
lung.
• Find 2 lobules with thickened interlobular
septa and centrilobular nodules in the right
lung.
• Find an example of thickened bronchovascular
interstitium in the right lung.
43. Differential diagnosis
• Differential diagnosis of thickened
bronchovascular, interlobular septal, and
pleural interstitium on HRCT:
• Lymphangitic tumor,
• Lymphoma.
• Kaposi's sarcoma.
• edema.
• The uni-laterality would be very unusual for
Kaposi's sarcoma or edema.
45. Summary
Summary of diagnostic features of lymphangitic tumor on
HRCT:
• Thickening of
• bronchovascular,
• interlobular septal,
• centrilobular, and
• pleural interstitium
• Smooth or nodular thickening
• Lack of architectural distortion
Comment:
• Unilateral lymphangitic tumor is most commonly seen in
cases of primary pulmonary adenocarcinoma, as in this
case.
48. Q1
• Regarding community acquired pneumonia
in infancy:
A -Streptococcus pneumoniae is the most
common pathogen.
B- It may be caused by Staphylococcus aureus.
C- Ciprofloxacin is an appropriate treatment if
blood cultures are negative.
D- Bordatella pertussis infection is usually mild.
E- It may be caused by mycoplasma urealiticum.
12/15/2012
49. A1
• Regarding community acquired pneumonia
in infancy:
A -Streptococcus pneumoniae is the most common
pathogen. (False)
B- It may be caused by Staphylococcus aureus.
(True)
C- Ciprofloxacin is an appropriate treatment if blood
cultures are negative. (False)
D- Bordatella pertussis infection is usually mild. (False)
E- It may be caused by mycoplasma urealiticum.
(True)
12/15/2012
50. Q2
• The following are true of cystic fibrosis:
A -Infertility in men is a result of testicular atrophy.
B- In children under one year of age the commonest
cause of pneumonia is Staphylococcus.
C -10% of patients will not require pancreatic enzyme
supplementation.
D -In neonates 10 - 10% present with meconium
ileus.
E -In the school age child, it usually presents with
hepatic fibrosis.
Saturday, December 15, 2012
51. A2
• The following are true of cystic fibrosis:
A -Infertility in men is a result of testicular atrophy. (False)
B- In children under one year of age the commonest
cause of pneumonia is Staphylococcus. (False)
C -10% of patients will not require pancreatic enzyme
supplementation. (True)
D -In neonates 10 - 10% present with meconium
ileus. (True)
E -In the school age child, it usually presents with hepatic
fibrosis. (False)
Saturday, December 15, 2012
52. Q3
• The following are recognised complications
of foreign body inhalation:
A- Pulmonary abscess
B- Asthma
C- Angioneurotic oedema
D- Hyperinflation of the affected lung
E- Hyperinflation of the opposite lung
Saturday, December 15, 2012
53. A3
• The following are recognised complications
of foreign body inhalation:
A- Pulmonary abscess (True)
B- Asthma (False)
C- Angioneurotic oedema (False)
D- Hyperinflation of the affected lung
(True)
E- Hyperinflation of the opposite lung
(True)
Saturday, December 15, 2012
54. Q4
• Which of the following statements are true of
childhood asthma.
A- over 90% of patients show exercise-induced
bronchoconstriction
B- hypercapnia is the first physiological
disturbance in status asthmaticus
C- infants are unresponsive to bronchodilators
D- spontaneous cure occurs before adolescence
E- cough may be the only symptom
Saturday, December 15, 2012
55. A4
• Which of the following statements are true of
childhood asthma.
A- over 90% of patients show exercise-induced
bronchoconstriction (True)
B- hypercapnia is the first physiological disturbance
in status asthmaticus (False)
C- infants are unresponsive to bronchodilators
(True)
D- spontaneous cure occurs before adolescence
(False)
E- cough may be the only symptom (True)
Saturday, December 15, 2012
56. Q5
• Regarding inhaler devices:
A- Metered dose inhalers can usually be used
from the age of about 7 years.
B- The Spinhaler requires co-ordination of device
actuation with inhalation.
C- The Turbohaler can usually be used from
about 3 years of age.
D- Salbutamol can be used with the Nebuhaler.
E- A face mask can be attached to a spacer, so
that it can be used in infants.
Saturday, December 15, 2012
57. A5
• Regarding inhaler devices:
A- Metered dose inhalers can usually be used from
the age of about 7 years. (False)
B- The Spinhaler requires co-ordination of device
actuation with inhalation. (False)
C- The Turbohaler can usually be used from
about 3 years of age. (True)
D- Salbutamol can be used with the Nebuhaler.
(False)
E- A face mask can be attached to a spacer, so
that it can be used in infants. (True)
Saturday, December 15, 2012
58. Q6
• Concerning Cystic Fibrosis:
A- There is a carrier frequency of 1/220 in the
general population.
B- A sibling of an affected individual has a 2/3
chance of being a carrier.
C- It can usually be diagnosed antenatally in a
family with a surviving affected member.
D- Linkage disequilibrium probes may be useful
in epidemiological studies.
E- In suspected cases, the sweat test is the most
appropriate first investigation.
Saturday, December 15, 2012
59. A6
• Concerning Cystic Fibrosis:
A- There is a carrier frequency of 1/220 in the
general population. (False)
B- A sibling of an affected individual has a 2/3
chance of being a carrier. (False)
C- It can usually be diagnosed antenatally in a
family with a surviving affected member. (True)
D- Linkage disequilibrium probes may be useful
in epidemiological studies. (True)
E- In suspected cases, the sweat test is the most
appropriate first investigation. (True)
Saturday, December 15, 2012
60. Q7
• Hypoxaemic respiratory failure (Type I):
A- Can be caused by respiratory muscle
weakness and fatigue.
B- Is found in mountain sickness.
C- Can lead to pulmonary hypertension.
D- Can lead to CO retention if treated with
2
100% oxygen.
E- Can lead to ventricular failure.
Saturday, December 15, 2012
61. A7
• Hypoxaemic respiratory failure (Type I):
A- Can be caused by respiratory muscle
weakness and fatigue. (False)
B- Is found in mountain sickness. (True)
C- Can lead to pulmonary hypertension.
(True)
D- Can lead to CO retention if treated with
2
100% oxygen. (False)
E- Can lead to ventricular failure. (True)
Saturday, December 15, 2012
62. Q8
• Regarding idiopathic primary pulmonary
haemosiderosis:
A- It is inherited as an autosomal recessive.
B- The absence of digital clubbing is usual.
C- Fever is generally absent.
D- Patients usually have associated
polycythaemia.
E- There is often immunoglobulin of
complement deposition in the histology of
lung biopsies.
Saturday, December 15, 2012
63. A8
• Regarding idiopathic primary pulmonary
haemosiderosis:
A- It is inherited as an autosomal recessive. (False)
B- The absence of digital clubbing is usual. (False)
C- Fever is generally absent. (False)
D- Patients usually have associated polycythaemia.
(False)
E- There is often immunoglobulin of complement
deposition in the histology of lung biopsies. (False)
Saturday, December 15, 2012
64. Q9
• Which of the following may cause
pulmonary hypertension?
• A- coarctation of the aorta
• B- pulmonary stenosis
• C- patent ductus arteriosus
• D- kyphoscoliosis
• E- schistosomiasis
Saturday, December 15, 2012
65. A9
• Which of the following may cause
pulmonary hypertension?
• A- coarctation of the aorta (False)
• B- pulmonary stenosis (False)
• C- patent ductus arteriosus (True)
• D- kyphoscoliosis (True)
• E- schistosomiasis (True)
Saturday, December 15, 2012
66. Q10
• Frequent episodic asthma:
• A- Is suffered by 42% of all children with
asthma.
• B- Is defined as an attack rate of ever 2-4
months.
• C- Should be treated with inhaled regular
prophylactic therapy, such as inhaled steroids.
• D- Is characterised by normal growth rate.
• E- Usually requires a burst of oral steroids to
bring under control.
Saturday, December 15, 2012
67. A10
• Frequent episodic asthma:
• A- Is suffered by 42% of all children with asthma.
(False)
• B- Is defined as an attack rate of ever 2-4 months.
(False)
• C- Should be treated with inhaled regular
prophylactic therapy, such as inhaled steroids.
(True)
• D- Is characterised by normal growth rate.
(True)
• E- Usually requires a burst of oral steroids to bring
under control. (False)
Saturday, December 15, 2012
68. Comments:
• Types of chronic asthma include:
• Infrequent episodic asthma: affects 75% of asthmatic children, with
fewer than 4 episodes per
• year. Intermittent bronchodilators are given.
• Frequent episodic asthma: 20%, symptoms 2-4 weekly. Low dose
inhaled prophylactic therapy
• plus intermittent bronchodilator.
• Persistent asthma: 5%, high dose inhaled prophylaxis plus
intermittent bronchodilators ± longacting
• bronchodilators such as salmeterol. These children need regular
monitoring in an asthma
• clinic and recording of growth and asthma diary.
• Exercise-induced: pre-exercise bronchodilator. The British Asthma
Society Guidelines have
• recently been updated (1997), and you are strongly advised to
familiarise yourself with the step
• up and step down approach.
Saturday, December 15, 2012