This presentation discusses steps in diagnosis of pleural effusion using a simulated patient scenario. Besides talking about different findings we can possibly see in a pt with pleural effusion on examination, CXR, USG, CT and labs, It also briefly discuss the proper steps in performing thoracocentesis.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Histologically, NSCLC is divided into adenocarcinoma, squamous cell carcinoma (SCC) (see the image below), and large cell carcinoma. Small cell lung cancer (SCLC), previously known as oat cell carcinoma, is considered distinct from other lung cancers, which are called non–small cell lung cancers (NSCLCs) because of their clinical and biologic characteristics.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
What is Lymphoma?
Malignant lymphoma is a term given to tumors of the lymphoid system and specifically of lymphocytes and their precursor cells
i.e.
Cancer of the lymphatic system.
Many lymphomas are known to be due to specific genetic mutations.
Apparently a lengthy presentation actually very good for junior physicians as it covers all aspects of assessment, diagnosis and treatment of pleural effusion
Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. Histologically, NSCLC is divided into adenocarcinoma, squamous cell carcinoma (SCC) (see the image below), and large cell carcinoma. Small cell lung cancer (SCLC), previously known as oat cell carcinoma, is considered distinct from other lung cancers, which are called non–small cell lung cancers (NSCLCs) because of their clinical and biologic characteristics.
Pleural effusion may be defined figuratively as the juice, oozing from the leaky lingerie of the lung. However the text book definition is the abnormal accumulation of fluid in the pleural space due to disturbances in the forces that keep the pleural fluid economy in equilibrium...
I have prepared this mainly for residents doing post graduation in respiratory medicine and medicine. Special thanks to Dr. Avinash Babu for the help on malignant pleural effusion. My references are mainly Lights' pleural diseases and BTS guidelines.
It discusses investigations useful in diagnosis of inflammatory bowel disease and their important findings e.g Barium enema, histopathology, a word about indeterminate colitis and followed by discussion of possible etiologies to be ruled out before diagnosing IBD
It discusses various effects of high altitude on human body in detail, acute mountain sickness, chronic mountain sickness, high altitude pulmonary edema, high altitude cerebral edema, acclimatization
It discusses laboratory tests involved in diagnosing meningitis with more emphasis on details of each test and findings, esp useful for microbiologists and medical students.
Prevention & control of exanthematous feverJagjit Khosla
It discusses disease control strategies used in Integrated disease surveillance project (IDSP) India along with types of disease prevention. It is followed by prevention strategies regarding Measles, Dengue and chickenpox
This presentation briefly discuss the polycystic ovary syndrome in terms of pathogenesis, features and management. Then, It moves on to discuss the various guidelines laid down by Endocrine Society in 2013 for the management of patients with polycystic ovary syndrome.
Diabetes and pregnancy - Endocrine society guidelines 2013Jagjit Khosla
This presentation talks about diabetes mellitus in relation to pregnancy. It classifies diabetes in pregnant pts as overt and gestational diabetes. Then it discusses the various guidelines given by Endocrine Society in 2013 for management of diabetic patients during pregnancy
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
4. Clinical Case Scenario
Ms. Manju, a 17 year old female, presented in OPD
with
Dry cough X 10 days
Pain in right lower chest X 10 days
Fever X 10 days
Breathlessness X 4 days
6. History of present illness
Chest pain
Duration – 10 days
Onset – Insidious
Progression – Gradually progressive
Site – Right lower side of anterior chest
Character – sharp, stabbing pain
Severity – Severe initially, now dull
Movement – Not moving anywhere
Aggravating and relieving factors – Aggravated on
coughing, Relieved on left lateral decubitus position
Associated symptoms – low grade fever without chills/
rigors
7. History of present illness
Cough
Duration – 10 days
Onset – Insidious
Progression – Gradually progressive
Dry
Severity – Mild
No hemoptysis TB, Malignancy
8. History of present illness
Breathlessness
Duration – 4 days
Onset – Insidious
Progression – Gradually progressive
Aggravating and relieving Factors – Relieved on lying
down in left lateral decubitus
9. History of present illness
Negative history
No H/o Weight loss, Night sweats
No H/o lower extremity edema
No H/o orthopnea, PND
No H/o recurrent attacks of dyspnea
No H/o Oliguria, Haematuria,
burning micturition
No H/o vomiting, loose stool, pale stools, Jaundice
LVF
TB
GIT
Nephrotic
syndrome
Asthma
20. Ultrasound Chest
As small as 20 mL
pleural fluid can be
detected
Pleural effusion vs
pleural thickening
21. CT scan Chest
Aids in differentiation of
Lung consolidation vs.
Pleural effusion
Cystic vs. Solid lesions
Peripheral lung abscess vs.
Loculated emypema
Aids in identification of
Necrotic areas
Pleural thickening,
nodules, masses
Extent of tumor
33. Exudative Pleural Effusion
Further tests are ordered –
P. Fluid glucose <60 mg/dL
P. Fluid amylase
P. Fluid ADA > 40 IU/L
P. Fluid Cytology
Differential Cell count
Culture and senstivity
Bacterial infections
like TB, pneumonia;
Malignancy
Pancreatic Pleural
effusion, Malignancy
TB
Malignancy
34. Clinical Case Scenario
Blood Analysis
Analyte Observed values Normal values
Haemoglobin 7.8 mg/dL 12-15 mg/dL
TLC 8,600 / mm3 4000 – 11000/mm3
ESR 27 mm/hr 3-15 mm/hr
Platelet count 178 X 103/mm3 165-415 X 103 /mm3
RBC 2.6 X 106 /mm3 4.0-5.2 X 106 /mm3
Total S. Protein 5.1 g/dL 6.7-8.6 g/dL
S. Albumin 2.8 g/dL 3.5-5.5 g/dL
S. Globulin 2.6 g/dL 2.0-3.5 g/dL
LFT and KFT were normal
35. Clinical Case Scenario
PLEURAL FLUID ANALYSIS
Volume 10 mL
Colour Yellowish
Turbidity Turbid
Coagulum - ve
Blood - ve
Deposit - ve
WBC 19,800
Neutrophils 92%
Lymphocytes 6%
Protein 4.7 g/dL
P. Fluid Protein = 0.92
S. Protein
36. Clinical Case Scenario
PLEURAL FLUID ANALYSIS
Glucose 46 mg/dL
ADA 24.5
ZN stain No AFB
Gram stain Gram positive bacilli seen
Blood culture Strep. pneumoniae
37. The Diagnosis is :
Right Lower Zone
Pneumonia with
Pleural Effusion
The upper limit of dullness is at least a space higher in the axilla compared to the limits of dullness anteriorly and posteriorly. Because of the shape of the upper border of dullness, this is called Ellis’s ‘S’ curve, a phenomenon, which can also be observed radiologically.
Special Circumstances
Contraindications: none absolute, relative risk > benefit, bleeding diathesis, small effusion, mechanical ventilation, anticoagulation One must consider the following special circumstances:
1. Loculated Effusion:
The primary concern in loculated effusions is the selection of the Thoracentesis site. The choice of methods available for site selection are:
* Fluoroscopy
* Ultrasound
* CT
Unless there is Empyema necessitates, it is not a good idea to rely on a physical examination to select the site of loculation. You will end up puncturing multiple sites. This is of great pain to the patient. CT is a cumbersome and elaborate test. Ultrasound localization is ideal for this purpose. It may be done at the bedside. The needle can be placed through the probe and evacuation can also be ensured in the same sitting.
2. Patient on a Ventilator:
There are two considerations for a Thoracentesis when the patient is on a ventilator:
1. Risk of Collapsing a Lung:
The fear is whether positive pressure breathing will increase the risk of a puncture to the lung! My advise is:
* Do not tap small effusions.
* Leave it to an experienced physician.
* Postpone the procedure if the indication is not that urgent.
* Get a post-tap chest film routinely.
2. Seating and Positioning:
You will normally be able to position the patient by the side edge of the bed. You can have the patient rest on an adjustable table. This position will permit you to proceed with the Thoracentesis in the usual fashion.
If you are unable to seat the patient due to hemodynamic status, mental status or because of tubes and indwelling lines, the Thoracentesis has to be done in the supine position. Turn the patient on his side and bring his back to the edge of the bed. You will be able to accomplish the Thoracentesis in this position.
Be aware that the dependent diaphragm moves up. Let me show you a lateral decubitus chest x-ray to demonstrate the upward movement of the dependent diaphragm.
Select the 5th or 6th interspace to avoid possible injury to the diaphragm. The selected site should be close to the surface of the bed.
3. Patient with a Coagulation Defect:
Postpone the Thoracentesis until the coagulation defect can be corrected. If the defect cannot be corrected, avoid proceeding with the Thoracentesis. In my opinion, suspected Empyema will be the only acceptable indication for an emergency Thoracentesis. Leave it to an experienced physician to perform this procedure. Use a size 21 or 22 needle. Proceed to attempt with a single stick. Do not give any local anesthetic. Enter the pleural space with one stroke. Do not try multiple attempts. Closely monitor for a Hemothorax by HGB, vital signs and a chest x-ray.
Position patient sitting on side of bed with arms up on side table.
Posterior gutter is deep
Interspaces are wider in back
Neurovascular bundle is closer to inferior margin of rib
Patient don’t get scared
The ideal interspace is the 7th, 8th or 9th space, midway between the posterior axillary line and midline.