•Why lip pursing is present in emphysema?
-By this in expiration through partly closed lips, there is increased end-expiratory pressure that keeps airway open, helping to minimize air trapping.
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-By this in expiration through partly closed lips, there is increased end-expiratory pressure that keeps airway open, helping to minimize air trapping.
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•What are the types of emphysema?
-Four types:
1-Centriacinar:
-Involves the proximal part of acini, limited to respiratory bronchiole with relatively less change in acinus.As in COPD.
2-Panacinar:
-All the alveoli and alveolar ducts in acinus are involved, both central and peripheral portion. It occurs mostly in a1-antitrypsin deficiency.
3-Paraseptal:
-Along the septa, blood vessels and pleura.
4-Scar or irregular emphysema:
-Scarring and damage affecting the lung parenchyma without involving acinus structure.
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-Four types:
1-Centriacinar:
-Involves the proximal part of acini, limited to respiratory bronchiole with relatively less change in acinus.As in COPD.
2-Panacinar:
-All the alveoli and alveolar ducts in acinus are involved, both central and peripheral portion. It occurs mostly in a1-antitrypsin deficiency.
3-Paraseptal:
-Along the septa, blood vessels and pleura.
4-Scar or irregular emphysema:
-Scarring and damage affecting the lung parenchyma without involving acinus structure.
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•Why low concentration O2 given in COPD? Or what happens when high flow O2 given?
-In COPD, the patient is dependent on hypoxic drive for respiration.
-High flow oxygen blunts the chemoresponsiveness of the respiratory center in the medulla (part of the brainstem) and thus aggravates respiratory failure (RF2).
-To avoid this, low flow oxygen is given.
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-In COPD, the patient is dependent on hypoxic drive for respiration.
-High flow oxygen blunts the chemoresponsiveness of the respiratory center in the medulla (part of the brainstem) and thus aggravates respiratory failure (RF2).
-To avoid this, low flow oxygen is given.
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•Poor prognostic factors in COPD:
-Increasing age (inversely related)
-Fall of FEV1 over time
-Weight loss
-Pulmonary hypertension.
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-Increasing age (inversely related)
-Fall of FEV1 over time
-Weight loss
-Pulmonary hypertension.
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•What organisms are associated with acute exacerbation of COPD?
-Common organisms:
Haemophilus influenzae
Streptococcus pneumoniae.
-Less common organisms:
Moraxella catarrhalis
Chlamydia pneumoniae
Pseudomonas aeruginosa.
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-Common organisms:
Haemophilus influenzae
Streptococcus pneumoniae.
-Less common organisms:
Moraxella catarrhalis
Chlamydia pneumoniae
Pseudomonas aeruginosa.
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•What are the types of cor pulmonale?
1-Acute:
-It occurs following massive pulmonary embolism with acute pulmonary HTN causing right ventricular dilatation and failure (no RVH).
-May occur in ARDS.
2-Chronic:
-It's defined as “right ventricular hypertrophy or dilatation with or without right sided heart failure due to causes of lung parenchyma, pulmonary vasculature or chest wall.
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1-Acute:
-It occurs following massive pulmonary embolism with acute pulmonary HTN causing right ventricular dilatation and failure (no RVH).
-May occur in ARDS.
2-Chronic:
-It's defined as “right ventricular hypertrophy or dilatation with or without right sided heart failure due to causes of lung parenchyma, pulmonary vasculature or chest wall.
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Remember:
•Unilateral bronchiectasis in:
-Resolution stage of pneumonia
-Lung abscess
-Localized fibrosis of lung.
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•Unilateral bronchiectasis in:
-Resolution stage of pneumonia
-Lung abscess
-Localized fibrosis of lung.
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•What is post-tussive crepitation? What is its significance?
-Crepitation which appears after cough is called posttussive crepitation.
-It's usually at the apex, indicates TB.
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-Crepitation which appears after cough is called posttussive crepitation.
-It's usually at the apex, indicates TB.
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Remember:
•Causes of bilateral crepitation with clubbing:
-Bilateral bronchiectasis
-IPF (fibrosing alveolitis or ILD).
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•Causes of bilateral crepitation with clubbing:
-Bilateral bronchiectasis
-IPF (fibrosing alveolitis or ILD).
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•What is dry bronchiectasis (bronchiectasis sicca)?
-It is a type of bronchiectasis in which dry cough is associated with intermittent episodes of hemoptysis.
-It may be massive, even life-threatening as bleeding is from bronchial vessels with systemic pressure.
-Common in patient with granulomatous infection, especially TB and usually involves upper lobe.
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-It is a type of bronchiectasis in which dry cough is associated with intermittent episodes of hemoptysis.
-It may be massive, even life-threatening as bleeding is from bronchial vessels with systemic pressure.
-Common in patient with granulomatous infection, especially TB and usually involves upper lobe.
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Remember:
•Pleural fluid normally present: 5 to 15 mL.
•At least 500 mL of fluid is necessary to detect clinically.
•At least 300 mL of fluid is necessary to detect radiologically in PA view.
•At least 100 mL of fluid is necessary to detect radiologically in lateral decubitus position.
•Less than 100 mL or small amount of fluid is detected by ultrasonography (even 20 to 25 mL fluid can be detected).
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•Pleural fluid normally present: 5 to 15 mL.
•At least 500 mL of fluid is necessary to detect clinically.
•At least 300 mL of fluid is necessary to detect radiologically in PA view.
•At least 100 mL of fluid is necessary to detect radiologically in lateral decubitus position.
•Less than 100 mL or small amount of fluid is detected by ultrasonography (even 20 to 25 mL fluid can be detected).
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•How to confirm if there is small effusion?
-(if not detected by chest X-ray PA view.)
By doing:
1-X-ray in lateral decubitus position
2-Ultrasonogram (USG) of lower part of the chest
3-Occasionally, CT scan of chest may be needed.
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-(if not detected by chest X-ray PA view.)
By doing:
1-X-ray in lateral decubitus position
2-Ultrasonogram (USG) of lower part of the chest
3-Occasionally, CT scan of chest may be needed.
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•What are the definitive signs of pleural effusion?
-Stony dullness on percussion and reduced or absent breath sound (confirmed by aspiration).
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-Stony dullness on percussion and reduced or absent breath sound (confirmed by aspiration).
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•Causes of right-sided pleural effusion
1-Liver abscess
2-Meig’s syndrome
3-Dengue hemorrhagic fever.
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1-Liver abscess
2-Meig’s syndrome
3-Dengue hemorrhagic fever.
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•Causes of left-sided pleural effusion
1-Acute pancreatitis
2-Rheumatoid arthritis
3-Dressler’s syndrome
4-Esophageal rupture (Boerhaave’s syndrome)
5-Dissecting aneurysm.
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1-Acute pancreatitis
2-Rheumatoid arthritis
3-Dressler’s syndrome
4-Esophageal rupture (Boerhaave’s syndrome)
5-Dissecting aneurysm.
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•What is yellow nail syndrome?
-It is a congenital disorder characterized by:
•Nails—yellow, thick, onycholysis
•Lymphedema of legs
•Pleural effusion or bronchiectasis.
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-It is a congenital disorder characterized by:
•Nails—yellow, thick, onycholysis
•Lymphedema of legs
•Pleural effusion or bronchiectasis.
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Remember:
-Pleural fluid cholesterol level < 60 mg dl indicates transudate.
-In all malignant effusion, pleural fluid cholesterol > 60 mg/dL. So, this test is useful to separate these two types of effusion.
-High pleural fluid ADA indicates tubercular pleural effusion.
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-Pleural fluid cholesterol level < 60 mg dl indicates transudate.
-In all malignant effusion, pleural fluid cholesterol > 60 mg/dL. So, this test is useful to separate these two types of effusion.
-High pleural fluid ADA indicates tubercular pleural effusion.
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•Why lung abscess is more common on the right side?
-It's due to less obliquity of the right major bronchus.
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-It's due to less obliquity of the right major bronchus.
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•What are the pathological stages of Pneumonia?
1-Stage of congestion—persists for 1 to 2 days
2-Stage of red hepatization(red and solid like liver)—persists for 2 to 4 days
3-Stage of grey hepatization—persists for 4 to 8 days
4-Stage of resolution—8 to 9 days or more.
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1-Stage of congestion—persists for 1 to 2 days
2-Stage of red hepatization(red and solid like liver)—persists for 2 to 4 days
3-Stage of grey hepatization—persists for 4 to 8 days
4-Stage of resolution—8 to 9 days or more.
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•What is atypical pneumonia?
-When pneumonia is caused by mycoplasma, legionella, coxiella, chlamydia.
-In these cases, constitutional symptoms are more than respiratory symptoms.
-Features are:
Gradual onset
Dry cough
Low grade fever
Constitutional symptoms are more than respiratory symptoms (headache, myalgia, fatigue, nausea, vomiting)
Less physical finding in the chest.
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-When pneumonia is caused by mycoplasma, legionella, coxiella, chlamydia.
-In these cases, constitutional symptoms are more than respiratory symptoms.
-Features are:
Gradual onset
Dry cough
Low grade fever
Constitutional symptoms are more than respiratory symptoms (headache, myalgia, fatigue, nausea, vomiting)
Less physical finding in the chest.
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