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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.


#Respiratory
Why lung abscess is more common on the right side?

-It's due to less obliquity of the right major bronchus.

#Respiratory
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.

#Respiratory
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.

#Respiratory
What is typical pneumonia?

-Typical pneumonia is characterized by high temperature with cough, pleuritic chest pain, features of consolidation, caused by Streptococcus pneumoniae, Staphylococcus aureus, etc.


-Respiratory symptoms are more
with constitutional symptoms.

#Respiratory
What is the usual presentation of pneumothorax?

-The patient usually presents with sudden onset of unilateral pleuritic chest pain and breathlessness.

What are the definitive signs of pneumothorax?

-Hyper-resonance on percussion and diminished or absent breath sound.

#Respiratory
What is Hamman-Rich syndrome?

-It is a type of acute form of IPF, occurs in a small proportion of cases.

#Respiratory
•What is the bedside test of hydropneumothorax?

-Succusion splash.

#Respiratory
-Cardinal features of tension pneumothorax are progressively increasing dyspnea and features of shock.

#Respiratory
In esophageal Cancer:

-Adenocarcinoma: most common type of esophageal cancer in the US.
Mostly in lower third.

-Squamous cell carcinoma(SCC): most common type of esophageal cancer worldwide.
Mostly middle&upper third.

#Esophagus
Remember:


-GRRD 👉🏼 Adenocarcinoma
-Achalasia 👉🏼 SCC.

#Esophagus
Note

Hyponatremia occurs in those with hyperglycemia, for every 100 mg/dL increment in plasma Glucose there is about 1.4 mEq/L drop in serum sodium level.

#Metabolic
What is erythema nodosum?

-It is an inflammatory disorder characterized by non-suppurative, painful, palpable, tender, erythematous nodular lesion in the skin, common in shin below the knee.

#Infections
•Causes of Erythema nodosum:

-Acute sarcoidosis
-S.β-hemolyticus (in throat)
-Primary pulmonary T.B.
-Drugs (sulfonamide, penicillin, estrogen-containing OCP, salicylates, barbiturates, sulfonylureas, bromides and iodides)
-IBD (Crohn’s disease, UC)
-Fungal infections (histoplasmosis, coccidioidomycosis and blastomycosis)
-Protozoal (toxoplasmosis)
-Leprosy (erythema nodosum leprosum (ENL)
-Idiopathic (up to 50% cases)
-Physiological: Pregnancy (often unilateral).
-Others: Salmonella, Shigella, Yersinia, brucellosis, Chlamydia, rickettsial and mycoplasma infection, viral infection, lymphoma, cat-scratch disease, Behçet’s syndrome and SLE.

#Infections
Causes of postural hypotension:
-Drop of systolic blood pressure 20 mmHg &drop of diastolic blood pressure 10 mmHg on standing.

1. Hypovolemia-dehydration, bleeding, hypopituitarism
2. Addisons
3. Neuropathy-autonomic as in DM, Amyloidosis, Shy-drager syndrome
4. Drugs-nitrates, antihypertensive, TCA, antipsychotic, diuretics
5. Idiopathic orthostatic hypotension-progressive degeneration of the autonomic nervous system usually in elderly.

#Cardiology
Liver cirrhosis

-In the micronodular form, the nodules are less than 3 mm across with uniform liver involvement - seen in alcohol or biliary disease.

-In the macronodular form there are larger nodules, classically seen in chronic viral hepatitis.

#Liver
How is the appetite in Kala-azar?

-Usually good.

Remember:
-Usually no anorexia, no malaise, no coated tongue.

#Infections
Leishmania has two forms:
amastigote and promastigote.


-Amastigote form "oval" is found in human, LD body is found in monocyte macrophage system. It's the diagnostic stage.

-Promastigote form (flagellate) is found in sandfly, and in culture media.It's the infective stage.

#Infections
In Kala-azar:

•Detection of antigen—done by latex agglutination test (Katex) for detecting leishmanial antigen in urine.
-This test is very simple ,more specific than antibody-based test, highly sensitive (96%) and also specific(100%)
-This test indicates active disease.
-The antigen is detected in urine within a week, disappears from urine within 3 weeks following successful treatment.
-Hence, this test is helpful for early diagnosis and also to see the response to therapy.

#Infections
What are the complications of kala-azar?

1-Secondary infection (pneumonia, tuberculosis)
2-Anemia
3-Bleeding
4-Gastroenteritis, bacillary dysentery
5-Liver disease (cirrhosis of liver)
6-PKDL
7-Rarely, cancrum oris.

#Infections
-Painless terminal haematuria is usually the first and most common symptom in chronic S. haematobium infection.

-There is association of S. haematobium infection with squamous cell carcinoma of the bladder.

-Both S.haematobium and S.mansoni cause Pulmonary HTN, but only S.mansoni causes Portal HTN.

#Infections