1) Cardinal symptoms of CNS disease:
Headache, vomiting, seizures, altered consciousness, focal neurological deficit (motor or sensory), visual disturbance, and gait or balance disturbance.
2) Acceptable pH range in Type 2 respiratory failure:
pH 7.25 – 7.35 (permissive hypercapnia range during management).
Massive hemoptysis - definition
Massive hemoptysis is blood loss of 400 mL in 24 hours or 100–150 mL expectorated at one time.
Causes-
Bronchiectasis,
Bronchogenic Carcinoma,
Eroding Tuberculous cavity,
Rasmussen's aneurysm,
mycetoma
Ref: Harrison's principles of internal medicine(20th edition)
Small airways are defined as airways with an internal diameter less than 2 mm and lacking cartilage, consisting mainly of the terminal bronchioles and respiratory bronchioles located distal to the segmental bronchi. Although individually small, they collectively contribute to about 98–99 % of the total cross-sectional airway area of the lungs, which is why they normally produce little airflow resistance and are called the “silent zone” of the lung. Terminal bronchioles represent the last part of the conducting zone, are lined by simple cuboidal epithelium with club (Clara) cells, contain smooth muscle, do not have alveoli in their walls, and therefore do not participate in gas exchange. In contrast, respiratory bronchioles are the first part of the respiratory zone, arise from terminal bronchioles, have scattered alveoli opening from their walls, and therefore participate in the beginning of gas exchange, eventually continuing as alveolar ducts and alveolar sacs.
Direct signs
1.Displacement of interlobar fissures
2.Crowding of vessels and bronchi
Indirect signs
1.local increase in opacity
2.elevation of hemidiaphragm
3.displacement of the mediastinum
4.compensatory over inflation
5. Approximation of the ribs
6.Absence of an air bronchogram(resorption atelectasis only)
7.Absence of visibility of interlobar artery(in lower lobe atelectasis only)
Reference -Fraser volume 1 page 529
CASTELL’S METHOD:
Patient lying on supine position, asked to do expiration and full inspiration. Percussion at left lower intercostal space along anterior axillary line.
Positive if it Becomes dull
Lateral winging of scapula
Lateral winging → lateral border of scapula protrudes
Cause: paralysis of trapezius (due to spinal accessory nerve injury, CN XI).
Also from rhomboid paralysis (dorsal scapular nerve),
Scapula drifts laterally and downward, shoulder droops, difficulty elevating arm above head.
Bedside evaluation - Ask the patient to push against a wall
Causes of lateral winging -
Neck dissection / lymph node biopsy (iatrogenic CN XI injury).
Trauma to posterior triangle of neck.
SYMPTOMS OF GASTROINTESTINAL SYSTEM
1)Dysphagia and odynophagia.
2)Heartburn and reflux
3)Indigestion
4)Flatulence
5)Vomiting
6)Anorexia
7)Constipation
8)Diarrhea
9)Alternation of bowel pattern
10)Abdominal pain
11)Abdominal distention
12)Weight loss
13)Hematemesis
14)Rectal bleeding
15)Malena
16)Jaundice
17)Itching
18)Urinary symptoms
Ref :Hutchison's clinical methods 24th edition
3.Pasteurella multocida
From dog bites, licks, or close contact.
Can cause pneumonia, empyema, or lung abscess, especially in people with chronic lung disease.
