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186

Chronic Pulmonary Aspergillosis by David Denning

Prof. Denning describes chronic pulmonary aspergillosis (CPA) as a long-term invasive disease, generally episodic in nature. Common symptoms are cough, shortness of breath, weight loss, tiredness, coughing up blood and aching or discomfort of the chest.  
Aspergillus Website
almost 9 years ago
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9
115

Respiratory examination OSCE

The respiratory examination aims to pick up on any respiratory (breathing) pathology that may be causing a patient’s symptoms e.g. shortness of breath, cough, wheeze etc  
OSCE Skills
over 5 years ago
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1
38

History Taking - Respiratory

80% of clinical information comes from the history. Shortness of breath Onset – when? How (was it sudden / prolonged)?  - Rapid, slow, subacute (inbetween acute and slow (chronic)) Sudden: Anaphylaxis Anxiety (panic attack) MI PE Acute asthma Anxiety Long term onset of shortness of breath  
almostadoctor.com - free medical student revision notes
over 5 years ago
Www.bmj
1
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A man with fever, a productive cough, and a striking chest radiograph | The BMJ

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day. - currently located behind a paywall. Your institution may have access through Athens/Elservier or similar.  
bmj.com
over 5 years ago
Www.bmj
1
20

A man with fever, a productive cough, and a striking chest radiograph

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day.  
bmj.com
over 5 years ago
Www.bmj
1
17

A man with fever, a productive cough, and a striking chest radiograph

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day.  
bmj.com
over 5 years ago
Www.bmj
1
24

A man with fever, a productive cough, and a striking chest radiograph

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day.  
www.bmj.com
over 5 years ago
Www.bmj
1
12

A man with fever, a productive cough, and a striking chest radiograph

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day.  
www.bmj.com
over 5 years ago
Www.bmj
1
17

Natriuretic peptide tests in suspected acute heart failure

Heart failure should always be considered in patients with shortness of breath and reduced exercise tolerance, especially older people, and irrespective of comorbidities such as chronic obstructive pulmonary disease.1 Symptoms and signs are rarely enough for diagnosis, and additional investigations usually follow.2 Measuring the serum concentration of natriuretic peptides improves diagnostic accuracy in patients with suspected heart failure in the non-acute setting,3 4 5 and evidence for these tests also being helpful in patients with suspected acute heart failure is growing.  
bmj.com
over 4 years ago
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27

A case of progressive bilateral pitting oedema

A 68 year old man presented with a two month history of progressive shortness of breath. He had previously been able to swim three times a week, but was now becoming short of breath on climbing stairs. His associated symptoms included orthopnoea, swollen ankles, weight gain, and anorexia. He was being treated with simvastatin for hypercholesterolaemia and diltiazem for hypertension and had never smoked.  
bmj.com
over 4 years ago
Preview
2
109

Arterial Blood Gas primer- Clinical Respiratory Diseases & Critical Care Medicine, Seattle - Med 610 - University of Washington School of Medicine

Arterial blood gases play an important role in the work-up and management of critically ill patients and patients with a variety of pulmonary complaints and disorders. For example, they are used to guide the adjustment of ventilator parameters on mechanically ventilated patients and are also a standard part of the work-up of patients who present with unexplained hypoxemia or dyspnea. It is, therefore, important that students and physicians be able to interpret the results of arterial blood gas sampling, determine the patient's acid-base status and assess the adequacy of oxygenation.  
courses.washington.edu
over 4 years ago
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Can NYHA's classification of "dyspnea" be used in pneumology?

Some of my professors said that NYHA's classification can only be used in the cardiological context, whiles others said that it can also be used in pneumology. So what is the universally accepted protocol, really?  
Aerosus 2
over 6 years ago
Foo20151013 2023 2njk5o?1444774020
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LWW: Case Of The Month - April 2013

This month’s case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e, with 15% off using the discount code: MEDUCATION. The case below is followed by a quiz question, allowing you a choice of diagnoses. Select the one letter section that best describes the patient’s condition. The Case A 28-year old woman has an unremarkable pregnancy through her first 28 weeks of gestation, with normal weight gain and no serious complications. She has no previous history of diabetes, hypertension of other systemic disease before or during her current pregnancy. During her 30-week checkup, her blood pressure measures 128/85, and she complains about feeling slightly more “bloated” than usual with swelling in her legs that seems to get more uncomfortable as the day goes on. Her obsterician recommends that she get more bed rest, stay off her feet as much as possible and return for evaluation in one week. At the one-week follow-up, the patient presents with noticable”puffiness” in her face, and a blood pressure of 145/95. She complains she has been developing headaches, sporadic blurred vision, right-sided discomfort and some shortness of breath. She has gained more than 10 lb (4.5kg) in the past week. A urinalysis on the patient revelas no glucose but a 3+ reading for protein. Her obstetrician decides to admit her immediately to a local tertiary care hospital for further evaluation. Over the next 24 hours, the patient’s urine output is recorded as 500mL and contains 6.8 grams of protein. Her plasma albumin level is 3.1 g/dl, hemacrit 48%, indirect bilirubin 1.5mg/dl and blood platelets=77000/uL, respectively. Her blood pressure is now 190/100. It is decided to try to deliver the foetus. The expelled placenta is small and shows signs of widespread ischmic damage. Within a week of delivery, the mother’s blood pressure returns to normal, and her oedema subsides. One month later, the mother shows no ill effects of thos later-term syndrome. Question What is the clinical diagnosis of this patient’s condition and its underlying pathophysiology? A. Gestational Hypertension B. Preeclampsia C. Gestational Diabetes D. Compression of the Inferior Vena Cava Answer The correct answer is "B. Preeclampsia". The patient’s symptoms and laboratory findings are consistent with a diagnosis of Preeclampsia, which is a condition occurring in some pregnancies that causes life-threatening organ and whole body regulatory malfunctions. The patient’s negative urine glucose is inconsistent with gestational diabetes. Gestational hypertension or vena caval compression cannot explain all of the patient findings. The patient has three major abnormal findings- generalised oedema, hypertension and proteinuria which are all common in preeclampsia. Although sequalae of a normal pregnancy can include water and salt retention, bloating, modest hypertension and leg swelling (secondary to capillary fluid loss from increased lower limb capillary hydrostatic pressure due to compression of the inferior vena cava by the growing foetus/uterus), oedema in the head and upper extremities, a rapid 10 pound weight gain and shortness of breath suggests a generalized and serious oedematous state. The patient did not have hypertension before or within 20 weeks gestation (primary hypertension) and did not develop hypertension after the 20th week of pregnancy with no other abnormal findings (gestational hypertension). Hypertension with proteinuria occurring beyond the 20th week of pregnancy however is a hallmark of preeclampsia. In addition, the patient has hemolysis (elevated bilirubin and LDH levels), elevated liver enzyme levels and thrombocytopenia. This is called the HELLP syndrome (HELLP = Hemolysis, Elevated Liver enzymes and Low Platelets.), and is considered evidence of serious patient deterioration in preeclampsia. A urine output of 500 ml in 24 hours is 1/2 to 1/4 of normal output in a hydrated female and indicates renal insufficiency. Protein should never be found in the urine and indicates loss of capillaries integrity in glomeruli which normally are not permeable to proteins. The patient has substantial 24 urine protein loss and hypoalbuminemia. However, generally plasma albumin levels must drop below 2.5 gm/dl to decrease plasma oncotic pressure enough to cause general oedema. The patient’s total urinary protein loss was insufficient in this regard. Capillary hyperpermeability occurs with preeclampsia and, along with hypertension, could facilitate capillary water efflux and generalized oedema. However myogenic constriction of pre-capillary arterioles could reduce the effect of high blood pressure on capillary water efflux. An early increase in hematocrit in this patient suggests hemoconcentration which could be caused by capillary fluid loss but the patient’s value of 48 is unremarkable and of little diagnostic value because increased hematocrit occurs in both preeclampsia and normal pregnancy. PGI2, PGE2 and NO, produced during normal pregnancy, cause vasorelaxation and luminal expansion of uterine arteries, which supports placental blood flow and development. Current theory suggests that over production of endothelin, thromboxane and oxygen radicals in preeclampsia antagonize vasorelaxation while stimulating platelet aggregation, microthrombi formation and endothelial destruction. These could cause oedema, hypertension, renal/hepatic deterioration and placental ischemia with release of vasotoxic factors. The patient’s right-sided pain is consistent with liver pathology (secondary to hepatic DIC or oedematous distention). Severe hypertension in preeclampsia can lead to maternal end organ damage, stroke, and death. Oedematous distension of the liver can cause hepatic rupture and internal hemorrhagic shock. Having this patient carry the baby to term markedly risks the life of the mother and is not considered current acceptable clinical practice. Delivery of the foetus and termination of the pregnancy is the only certain way to end preeclampsia. Read more This case is by David R Bell PhD, co-author of Medical Physiology: Principles for Clinical Medicine, 3e (ISBN: 9781451110395) For more information, or to purchase your copy, visit: http://tiny.cc/Rhoades4e. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at (lww.co.uk)[http://lww.co.uk] when you use the code MEDUCATION when you check out! About LWW/ Wolters Kluwer Health Lippincott Williams and Wilkins (LWW) is a leading publisher of high-quality content for students and practitioners in medical and related fields. Their text and review products, eBooks, mobile apps and online solutions support students, educators, and instiutions throughout the professional’s career. LWW are proud to partner with Meducation.  
Lippincott Williams & Wilkins
over 6 years ago
Foo20151013 2023 1eqve0g?1444774030
1
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LWW: Case Of The Month - May 2013

This month’s case is by Barbara J. Mroz, M.D. and Robin R. Preston, Ph.D., author of Lippincott’s Illustrated Reviews: .Physiology (ISBN: 9781451175677). For more information, or to purchase your copy, visit: http://tiny.cc/PrestonLIR, with 15% off using the discount code: MEDUCATION. The case below is followed by a choice of diagnostic tests. Select the one lettered selection that would be most helpful in diagnosing the patient’s condition. The Case A 54-year-old male 2 pack-per-day smoker presents to your office complaining of cough and shortness of breath (SOB). He reports chronic mild dyspnea on exertion with a daily cough productive of clear mucus. During the past week, his cough has increased in frequency and is now productive of frothy pink-tinged sputum; his dyspnea is worse and he is now short of breath sometimes even at rest. He has had difficulty breathing when lying flat in bed and has spent the past two nights sleeping upright in a recliner. On physical examination, he is a moderately obese male with a blood pressure of 180/80 mm Hg, pulse of 98, and respiratory rate of 22. His temperature is 98.6°F. He becomes winded from climbing onto the exam table. Auscultation of the lungs reveals bilateral wheezing and crackles in the lower posterior lung fields. There is pitting edema in the lower extremities extending up to the knees.  Question Which if the following tests would be most helpful in confirming the correct diagnosis? A. Spirometry B. Arterial blood gas C. Complete blood count D. B-type natriuretic peptide blood test E. Electrocardiogram Answer? The correct answer is B-type natriuretic peptide blood test. Uncomfortable breathing, or feeling short of breath, is a common medical complaint with multiple causes. When approaching a patient with dyspnea, it is helpful to remember that normal breathing requires both a respiratory system that facilitates gas exchange between blood and the atmosphere, and a cardiovascular system that transports O2 and CO¬2 between the lungs and tissues. Dysfunction in either system may cause dyspnea, and wheezing (or bronchospasm) may be present in both cardiac and pulmonary disease. In this patient, the presence of lower extremity edema and orthopnea (discomfort when lying flat) are both suggestive of congestive heart failure (CHF). Elevated blood pressure (systolic of 180) and a cough productive of frothy pink sputum may also be associated symptoms. While wheezing could also be caused by COPD (chronic obstructive pulmonary disease) in the setting of chronic tobacco use, the additional exam findings of lung crackles and edema plus systolic hypertension are all more consistent with CHF. What does the B-type natriuretic peptide blood test tell us? When the left ventricle (LV) fails to maintain cardiac output (CO) at levels required for adequate tissue perfusion, pathways are activated to increase renal fluid retention. A rising plasma volume increases LV preload and sustains CO via the Frank-Starling mechanism. Volume loading also stimulates cardiomyocytes to release atrial- (ANP) and B-type (BNP) natriuretic peptides. BNP has a longer half-life than ANP and provides a convenient marker for volume loading. Plasma BNP levels are measured using immunoassay; levels >100 pg/mL are suggestive of overload resulting in heart failure. How does heart failure cause dyspnea? Increasing venous pressure increases mean capillary hydrostatic pressure and promotes fluid filtration from the vasculature. Excess filtration from pulmonary capillaries causes fluid accumulation within the alveoli (pulmonary edema) and interferes with normal gas exchange, resulting in SOB. Physical signs and symptoms caused by high volume loading include: (1) Lung crackles, caused by fluid within alveoli (2) Orthopnea. Reclining increases pulmonary capillary hydrostatic pressure through gravitational effects, worsening dyspnea when lying flat. (3) Pitting dependent edema caused by filtration from systemic capillaries, an effect also influenced by position (causing edema in the lower legs as in our ambulatory patient or in dependent areas like the sacrum in a bedridden patient). What would an electrocardiogram show? Heart failure can result in LV hypertrophy and manifest as a left axis deviation on an electrocardiogram (ECG), but some patients in failure show a normal ECG. An ECG is not a useful diagnostic tool for dyspnea or CHF per se. Wouldn’t spirometry be more suitable for diagnosing the cause of dyspnea in a smoker? Simple spirometry will readily identify the presence of airflow limitation (obstruction) as a cause of dyspnea. It's a valuable test to perform in any smoker and can establish a diagnosis of chronic obstructive pulmonary disease (COPD) if abnormal. While this wheezing patient is an active smoker who could have airflow obstruction, the additional exam findings above point more to a diagnosis of CHF. What would an arterial blood gas show? An arterial blood gas measures arterial pH, PaCO¬2, and PaO2. While both CHF and COPD could cause derangements in the values measured, these abnormalities would not necessarily be diagnostic (e.g., a low PaO2 could be seen in both conditions, as could an elevated PaCO¬2). Would a complete blood count provide useful information? A complete blood count could prove useful if anemia is a suspected cause of dyspnea. Test result BNP was elevated (842 pg/mL), consistent with CHF. Diuretic treatment was initiated to help reduce volume overload and an afterload reducing agent was started to lower blood pressure and improve systolic function.  
Lippincott Williams & Wilkins
over 6 years ago
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21

A case of progressive bilateral pitting oedema

A 68 year old man presented with a two month history of progressive shortness of breath. He had previously been able to swim three times a week, but was now becoming short of breath on climbing stairs. His associated symptoms included orthopnoea, swollen ankles, weight gain, and anorexia. He was being treated with simvastatin for hypercholesterolaemia and diltiazem for hypertension and had never smoked.  
feeds.bmj.com
over 4 years ago
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0
28

Signs of shock and raised jugular venous pressure

A 38 year old white man presented to the emergency department with a three month history of progressively worsening shortness of breath. He had also experienced other vague symptoms over the same period, including muscle aches, weakness, pains associated with fatigue, and noticeable weight loss. Having previously been fit and well, he was now struggling to climb the stairs at home. The onset of symptoms coincided with an episode of food poisoning; he denied any recent travel.  
feeds.bmj.com
over 4 years ago
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0
20

Peritoneal ultrafiltration effective in end-stage chronic heart disease

Patients with End stage chronic heart disease suffer a lot. Characteristic are fluid retention, fatigue and shortness of breath.  
medicalnewstoday.com
over 4 years ago
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0
11

Cardiac Tamponade - The Original Kings of County

The Case: 60 yo M PMH metastatic lung cancer, HTN, DM, former smoker presents to the ED with acute onset shortness of breath. Vitals in triage revealed tachypnea and tachycardia. Initial work-up revealed low voltage on EKG, enlarged cardiac silhouette on chest x-ray, bedside ECHO with pericardial effusion without tamponade, and CTA with large left lobe mass and segmental pulmonary embolism. The patient was anticoagulated with heparin infusion. While boarding in CCT and awaiting a non emergent pericardial window, he became acutely dyspneic with elevated heart rate and subsequently asystolic. Pericardiocentesis was performed bedside with return of spontaneous circulation. The patient was brought to the OR for pericardial window and admitted to the ICU. A short while later the patient expired.  
blog.clinicalmonster.com
over 4 years ago
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Asthma in Adults

Say what? Chronic inflammation of your patient’s bronchi. Their bronchi are hypersensitive to environmental or intrinsic stimuli, leading to reversible episodes of bronchial constriction and mucosal edema. Your patient will report: Wheezing Cough Dyspnea Chest tightness Chest pain You will ask about: Comorbid diseases - you do not want to overlook another etiology to your…  
foamneedssoap.com
over 4 years ago
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Pigtail Insertion - Emergency Physicians Monthly

It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.  
epmonthly.com
over 4 years ago