Signs and symptoms Signs decreased chest movement reduced

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Signs and symptoms • Signs: decreased chest movement , reduced breath sounds, dull to

Signs and symptoms • Signs: decreased chest movement , reduced breath sounds, dull to percussion (all on affected side) • Symptoms: SOB, cough, chest pain Investigations • Is there a pleural effusion? CXR: white (fluid), CT scan, ultrasound, Listen to the chest: dull to percussion (tap on chest), reduced breath sounds • What caused the pleural effusion? Thoracocentesis. Appearance Protein content Transudate Clear <25 g/L Exudate Cloudy >29 g/L Treatment Depends on the underlying cause. • Aspirate / chest drain • Pleurodesis

Pneumothorax What is it? Build up of AIR in the pleural space ‘sudden onset,

Pneumothorax What is it? Build up of AIR in the pleural space ‘sudden onset, sharp, one sided pleuritic chest pain and SOB’ Causes • Trauma: rib fracture, gunshot, catheter, etc • Primary: damage to the lungs with no underlying lung pathology • Secondary: damage to the lungs resulting from underlying lung pathology e. g. Signs and Symptoms • Signs: low blood pressure, low oxygen levels, diminished breath sounds on the affected side • Symptoms: SOB, sharp, ONE SIDED chest pain, altered consciousness

Investigations • Gold standard: CXR Treatment • Heal spontaneously • Treat the underlying cause,

Investigations • Gold standard: CXR Treatment • Heal spontaneously • Treat the underlying cause, e. g. close the hole if there is an open wound causing it • Chest drain • Surgery

TENSION PNEUMOTHORAX: MEDICAL EMERGENCY, trachea deviated AWAY from the affected lung, need to insert

TENSION PNEUMOTHORAX: MEDICAL EMERGENCY, trachea deviated AWAY from the affected lung, need to insert a chest drain immediately.

Mesothelioma (in the case of the lungs) a cancer of the pleura that surround

Mesothelioma (in the case of the lungs) a cancer of the pleura that surround the lungs. Cause: ASBESTOS!!! Symptoms: FEVER, WEIGHT LOSS, FATIGUE, SOB, persistent cough, clubbed fingers Investigations: X-ray, CT Treatment: Poor prognosis, therefore palliative.

Lung Cancer What is it • Carcinoma of the bronchus or pleura • Small

Lung Cancer What is it • Carcinoma of the bronchus or pleura • Small Cell (10 -15%) • Non Small Cell (80 -85%) (1. squamous, 2. adenocarcinoma) Causes • SMOKING! • Others; asbestos, chromium, arsenic Signs and Symptoms • Symptoms: Cough, Haemoptysis, Dyspnoea, Chest pain • Signs: Weight loss, Anaemia, Clubbing, Supraclavicular or axillary nodes

Investigations • CXR • Chest CT • Bronchoscopy • Needle or surgical biopsy Management

Investigations • CXR • Chest CT • Bronchoscopy • Needle or surgical biopsy Management • Stage I/II surgical excision and radical deep x-ray therapy • Stage III/IV Palliative chemotherapy, chemotherapy and radiotherapy, palliative care

Cystic Fibrosis What is it? • Chronic disease • GENETIC disorder: Autosomal recessive, causing

Cystic Fibrosis What is it? • Chronic disease • GENETIC disorder: Autosomal recessive, causing defect in CTFR channel protein (Cl-), resulting in thick mucus clogging ducts • Presents in childhood • Affects: airways, pancreas, GI tract, etc.

Normal state Cystic Fibrosis

Normal state Cystic Fibrosis

Signs and symptoms • Signs: steatorrhea, children with a failure to thrive, finger clubbing,

Signs and symptoms • Signs: steatorrhea, children with a failure to thrive, finger clubbing, rectal prolapse • Symptoms: heavy mucus production, cough Investigations • 90% diagnosed before the age of 8. • Sweat (Na. Cl) test (parents taste salt when kissing baby) • Genetics testing Complications • INFERTILITY • Pancreatitis • RESP TRACT NFECTIONS • Bronchiectasis Treatment • NO CURE, therefore symptom management • Non-pharmalogical: physio for airway clearance • Pharmalogical: antibiotics, anti-mucinolytics, bronchodilators, enzymes, insulin, bisphonates • Surgery: Lung transplant

Bronchiectasis What is it? • Irreversible dilation of the bronchioles • Build up of

Bronchiectasis What is it? • Irreversible dilation of the bronchioles • Build up of mucus, increased chance of infection Causes • End point / complication of lots of lung diseases e. g. COPD, CF • Infection Investigations: • HRCT • Sputum culture: look for the infectious agents Treatment Cant be cured, therefore symptom control • Non-pharmalogical: stop smoking, airway clearance exercises • Pharmalogical: bronchodilators, steroids, antibiotics

Occupational Lung Disorders What is it? • Lung diseases caused by exposure to agents

Occupational Lung Disorders What is it? • Lung diseases caused by exposure to agents at work • Can cause: bronchitis (irritants such as silicon), fibrosis, carcinoma (asbestos), asthma, hypersensitivity pneumonitis Causes • Various agents- look over asbestosis and silicon Hypersensitivity Pneumonitis • Inflammatory response to innocuous substances- usually associated to hobbies and jobs (usually in response to mould spores) • Farmers Lung, Pigeon Fancier’s Lung, Winemakers Lung • Presents with chronic cough and dyspnoea, fatigue etc. Managament • avoid the antigen!!!! • Corticosteroids for acute symptomatic relief

Thank you! mbrewster 1@sheffield. ac. uk & rsyeed 1@sheffield. ac. uk

Thank you! mbrewster [email protected] ac. uk & rsyeed [email protected] ac. uk

General Exam Tips(even tho its ages away) EXAM CONTENT • LOTS of public health!

General Exam Tips(even tho its ages away) EXAM CONTENT • LOTS of public health! • There will be 1 -2 microbiology questions – antibiotics, appearance under microscope, staining techniques and what you’d find • Learn the COMMON conditions well • (in terms of the 90 core clinical conditions): They will either ask for a cause, SIGNS AND SYMPTOMS (e. g. hypothyroid we were asked for 6 symptoms), investigation or treatment HOW SHOULD I WORK? • 90 conditions: Structured notes, learn them! • Microbiology: flow charts and conditions • Public health: Document, add to it from lectures • GP: Notes for the objectives RESOURCES: • OXFORD CLINICAL HANDBOOK is a babe • Osmosis (You. Tube) • Armando Hassadungan (You. Tube) • Kumar and Clarke’s • Peer Teaching Powerpoint’s • Brainscape (Ella Kulman’s & loads of other students)