In a coin test, a coin held against the chest is tapped by another coin on the side where the hydropneumothroax is suspected.
A stethoscope is placed on the back to listen to breath sounds and the sound of the coins.
If a tinkling sound is heard, test is positive for hydropneumothorax
Polysomnography is type of sleep study.Its a level 1 sleep study.
It is done in sleep lab and observed in real time by Registered Polysomnography Technologist.
Fishman's 5 th edition
Split pleura sign is a Contrast enhanced CT finding in which there is enhancement of the thickened inner visceral pleura and outer parietal pleura separated by pleural fluid
It is seen with Empyema in a setting of bacterial pneumonia
This is due to fibrin deposition in the visceral and parietal pleura as empyema progresses
References:
Kraus G. The Split Pleura Sign. Radiology. 2007;243(1):297-8.
This test can be done in sitting or supine position. The diaphragm of the stethoscope is placed at the midpoint of the sternum. The chest wall at point equidistant to the left and right of the instrument is scratched with fingers. When the side containing pneumothorax is scratched, the sound is heard louder.
Massive hemoptysis is blood loss of 400 mL in 24 hours or 100–150 mL expectorated at one time.
The causes of massive hemoptysis are Bronchiectasis, Bronchogenic Carcinoma,Eroding Tuberculous cavity,Rasmussen's aneurysm,mycetoma
Reference: Harrison's principles of internal medicine(20th edition)
1)Pleuritic pain
It is caused by inflammation of pleura commonly by infection of underlying pleura.Sharp and stabbing pain aggrevated on deep breathing or coughing
2) Musculoskeletal pain
Pain can occur after prolonged bouts of coughing.
Referance :Hutchison 24 th edition
Bronchovesicular breath sounds are medium pitched.
Both inspiration and expiration heard.
No pause in between.
Often heard over upper third of anterior chest wall.
Measurement of distance between the inferior angle of scapula and the closest horizontal spinous process of the thoracic spine
Skodaic resonance is a high pitched sound elicited by percussion over a cavity just above the level of pleural effusion.
A.Chest wall
-Boils, Lipoma, Fibroma
B.Ribs and Cartilage
-Osteomyelitis, Costochondritis
C.Pleura
-Encysted pleural effusion, Epyema necessitans
D.CVS
-Enlargement of cardiac chamber, Aortic aneurysm
E.Lungs
-Actinomycosis of lung and chest wall
F.Swelling in pectoral area
-Subpectoral abcess, Pectoral major tendon rupture, Post pectoral implant procedure, Post pacemaker implantation, Pectoral muscle rupture with hematoma
G.Others
-Bony prominence, Surgical emphysema
HISTORY:
1.Duration
2.Mode of onset
3.Associated symptoms
4.Pain
5.Progression
6.Exact site
7.Fever
8.Other lumps
9.Secondary changes
10.Impairment of function
11.Recurrence of swelling
12.Loss of body weight
EXAMINATION:
I.INSPECTION:
1.Site
2.Colour
3.Shape
4.Size
5.Surface
6.Edge
7.Number
8.Pulsation
9.Peristalsis
10.Movement with respiration
11.Impulse on Coughing
12.Movement on deglutition
13.Movement with protrusion of tongue
14.Skin over the swelling
15.Any pressure effect
B.PALPITATION:
1.Temperature
2.Tenderness
3.Size,Shape,Extent
4.Surface
5.Edge
6.Consistency
7.Fluctuation
8.Fluid thrill
9.Translucency
10.Impulse on coughing
11.Reducibility
12.Compressibility
13.Pulsatility
14.Fixity to the overlying skin
15.Relation to surrounding structures
C.STATE OF REGIONAL LYMPH NODES
D.PERCUSSION
F.AUSCULTATION
G.MEASUREMENTS
H.MOVEMENTS
S- Site
O- Onset
C- Character
R- Radiation
A- Associated Symptoms
T- Timing (Duration,Course,Pattern)
E- Exacerbating and Relieving Factors
S- Severity
Are thin walled, air filled structures that often develop early in the course of staphylococcal pneumonia, particularly in infants and young children, and usually disappear over the course of a few months. These cystic spaces are believed to be the consequence of check valve opening between a peribronchial abcess and an adjacent bronchus.
Effusions first become apparent on lateral upright radiographs with blunting of the posterior costophrenic angle. An accumulation of 200 ml of fluid is necessary for the effusion tp affect the lateral angles of frontal standing radiographs. Lateral decubitus radiograph with the affected side down is the more sensible view to identify an effusion of 5 to 15 ml.
-overweight
-hyperinflated lungs
-behind the rib
-pericardial effusion
-dextrocardia
PUO is defined as a temperature persistently above 38 degree celcius for more than 3 weeks, without diagnosis, despite initial investigations during 3 days of inpatient care or after more than 2 outpatient visits.
Conversion from farenheit to celsius = (F-32)*5/9
Conversion from celsius to farenheit = (C*9/5)+32
Acute <3 weeks Harrison's principles of internal medicine, 21st edition
Subacute 3-8 weeks
Chronic > 8 weeks
Reference: Harrison's principles of internal medicine, 21st edition
Clinical/pathological definition:-
Right ventricular hypertrophy and/or dilation occuring as a result of an abnormality of lung structure or function.
Radiological definition:-
The combination of pulmonary artery hypertension and chronic lung disease with /without evidence of enlargement of right heart chambers.
Reference from Fraser.
1.Threatened Organ failure -severe ocular/neurologic/cardiac disease
2.Progressive or persistent pulmonary disease
3.Uveitis unresponsive to topical corticosteroids
4.Persistent Hypercalcemia/ renal or hepatic dysfunction
5.Palpable splenomegaly or hypersplenism
6.Severe myopathy
7.Disfiguring skin disease
8.Painful lymphadenopathy
9.Severe fatigue and weight loss
