Massive hemoptysis

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)

TYPES OF FEVER

Types of fever 

Continuous (Sustained) Fever

Definition:

Fever in which the temperature remains above normal throughout the day and does not fluctuate more than 1°C in 24 hours.

2. Remittent Fever

Definition:

Fever in which the temperature fluctuates more than 1°C in 24 hours but never returns to normal

3. Intermittent Fever

Definition:

Fever in which the temperature elevation is present only for several hours of the day and returns to normal for the remaining hours.

4. Relapsing Fever

Definition:

Fever characterized by episodes of fever lasting several days separated by periods of normal temperature lasting several days.

Causes of Trepopnea and platypnea

Platypnea - Dyspnea in upright position 

Always associated with Orthodeoxia

Occurs in 

- Hepatopulmonary syndrome

- Pulmonary AV malformations

Trepopnea- Dyspnea in Lateral decubitus position 

- Unilateral severe pneumonia or pleural effusion 

Patient feels better on lying on normal side to improve V/Q matching 

Define small airways and % of small airways in lungs, Terminal vs Respiratory bronchioles

 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.

Collapse Radiologic signs

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

SURFACE MARKING OF SPLEEN

 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 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

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

Dog related infections of the lung

Dog related infections of the lung

• PARASITIC INFECTIONS - 

1.  Echinococcus granulosus (hydatid disease) - Dogs are definitive hosts.
2. Toxocara canis (dog roundworm)

      

•  BACTERIAL INFECTIONS -

      1.Capnocytophaga - 

• Capnocytophaga canimorsus is a gram-negative bacterium, which is found in the normal flora of the oropharyngeal tract of dogs and cats.

• Transmitted to human by dogs bite and causes an overwhelming sepsis, particularly in elderly, immunocompromised or asplenic patients  

• Causes meningitis, osteomyelitis, arthritis, lung abscess or empyema and endocarditis,  thrombotic thrombocytopenic purpura and hemolytic uremic syndrome

      2.Bordetella bronchiseptica  - 

• A gram-negative rod bacterium , normally lives in the upper respiratory tract of the mammals such as dogs and cats and is transmitted to humans by aerosol.  

• Human infection with B. bronchiseptica is very rare; however, it can also cause pneumonia and upper respiratory tract infection in dog owners.

      3.Pasteurella multocida

• From dog bites, licks, or close contact.

• Can cause pneumonia, empyema, or lung abscess, especially in people with chronic lung disease.

      4.Coxiella burnetii - causes Q fever in humans. The pathogen normally infects individuals via aerosol and direct contact with the body fluids of the infected animals.

      5. Leptospira  - L. interrogans is an aerobic spirochete

• Rodents are the major reservoirs for Leptospirosis; however, domestic animals including dogs can play an important role in leptospirosis transmission in endemic regions.

• Fungal (less common)

• Blastomycosis, Histoplasmosis, Cryptococcus

       

Berryliosis

 Berylliosis- causes

-Inhalation of dust or fumes of beryllium

Occupational risk in :

1)primary beryllium factory workers 2)workersprocessing beryllium (foundry workers, furnace tenders, machinists, welders)

 3)Individuals working with beryllium products (dental technicians, golf club manufacturers, bike parts manufacturers), 4)select industries (e.g., aerospace, automotive, defense, electronics, energy, telecommunications)

-Genetic predisposition with HLA DP1 gene