Differential Diagnosis - Acute Chest pain- Respiratory Flashcards Preview

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Flashcards in Differential Diagnosis - Acute Chest pain- Respiratory Deck (16):
1

Pulmonary Embolism - Classical History

  • Sharp and pleuritic in nature;
  • shortness of breath;
  • Haemoptysis may occur if pulmonary infarction develops;
  • massive PE results in syncope;
  1. risk factors:
  2. history of immobilisation, orthopaedic procedures,
  3. oral contraceptive use,
  4. previous PE, hypercoagulable states,
  5. or recent travel over long distances; 
  6. unilateral swollen lower leg that is red and painful suggests DVT; 

2

Pulmonary Embolism - Classic History?

  • tachycardia,
  • loud P2,
  • right-sided S4 gallop,
  • jugular venous distention,
  • fever,
  • right ventricular lift;
  • massive PE may cause hypotension

3

Pulmonary Embolism - Investigations?

  • ECG: sinus tachycardia; presence of S1, Q3, and T3 More
  • D-dimer: non-specific if positive; PE excluded if result negative in patients with low probability of having a PE
  • CXR: decreased perfusion in a segment of pulmonary vasculature (Westermark sign); presence of pleural effusion
  • CT pulmonary angiography:identification of thrombus in the pulmonary circulation

4

Pulmonary Embolism - Treatment?

  • Treatment dose LWMH
  • Thrombolysis if massive PE

5

Pneumonia - Classical History?

  • productive or dry cough,
  • fever,
  • pleuritic pain associated with shortness of breath;
  • may have rigors,
  • myalgias, and arthralgias;
  • recent history of travel or infectious exposures 

6

Pneumonia - Classic Examination?

  • decreased breath sounds,
  • rales,
  • wheezing,
  • bronchial breath sounds,
  • dullness to percussion,  
  • increased tactile fremitus observed with severe consolidation

7

Pneumonia - Investigations?

  • CXR: pulmonary infiltration, air bronchograms, and pleural effusion
  • WBC count: elevated with left shift (increased neutrophil count)
  • sputum culture: may reveal culprit organisms, but not sensitive or specific 
  • blood culture: may reveal culprit organisms, but not sensitive or specific 

8

Pneumonia - Treatment?

  • Antbiotics

9

Pneumathorax - Classical History?

  • acute, pleuritic chest pain,
  • shortness of breath;
  • primary spontaneous between ages 20 and 40 years;
  • secondary spontaneous in patients with COPD;
  • traumatic due to acute trauma or iatrogenic;
  • shock may occur if rapidly increasing (tension pneumothorax)

10

Pneumathorax - Classical Examination?

  • Ipsilateral
  • absent breath sounds,
  • increased resonance to percussion; (hyperresonance)
  • jugular venous distention,
  • trachea deviation,
  • hypotension if tension pneumothorax (due to compromise of the great vessels)
  • reduced chest expansion

11

Pneumathorax - Investigation? 

  • CXR

12

Pneumathorax - Treatment? 

Primary

  • <2cm CXR monitoring
  • >2cm or Sx aspirate

Secondary

  • <1cm observe for 24hrs
  • 1-2cm aspirate
  • >2cm or Sx chest drain 

13

Pleurisy - Classic History?

  • prodrome of viral illness
  • (myalgias, malaise, rhinorrhoea, cough, nasal congestion, low-grade temperatures);
  • sick contacts

14

Pleurisy - Classic Examination Findings?

  • pleural friction rub with or without low-grade fever;
  • sometimes reproducible tenderness to palpation of chest when perichondritis or pleurodynia accompanies pleuritis

15

Pleurisy - Investigations?

  • CXR: usually normal but can uncommonly have effusion 
  • FBC: normal, or leukocytosis with lymphocytic predominance

16

Pleurisy - Treatment?

  • NSAIDS
  • Treat Cause
  • Treat complications, effusion, pneumathorax