Respiratory Part 4
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Respiratory Part 4 as PDF for free.
More details
- Words: 404
- Pages: 18
Respiratory part 4
28 year XFL 6’7”, 350 lb. • Knee surgery • Chest pain on physiotherapy • Dead soon after • Globe and Mail 2001 06 12.
30 year old woman, on OC • Abdominal liposuction, unwell, intense chest pain, SOB, tachycardia. • pH 7.50 (7.35-7.45) • pCO2 30 mmHg (35-45) • Bicarbonate 23 mmol/L (22-30) • pO2 65 mmHg (60-90)
30 year old woman, liposuction: • Plasma sodium 143 mmol/L (135-147) • Plasma potassium 4.1 mmol/L (3.5-5.0) • Serum urea 3.6 mmol/L (3-7) • What risk factors, test, treatment?
Pulmonary embolus/infarct: • Chest pain • Obese, surgery, smoker, oral contraceptives. • Serum LD, coagulation factors, C reactive proteins, troponin… • Thrombolytic therapy.
Some general cancer symptoms: • • • • • •
Significant weight loss in a short time. Infections slow to clear. General malaise Lumps Change in bowel habit. Pain.
Lung cancers: 22,200 new case/year in Canada:
Non small cell carcinomas (squamous): • Half of lung cancers. • Metastasize readily. • Hypercalcaemia / parathyroid hormone related peptide. Small cell (oat) carcinoma: • Amine precursor uptake decarboxyl APUD • Ectopic hormones e.g. ADH, ACTH.
Lung cancer symptoms: • • • • •
Persistent cough or breathlessness. Infections slow to clear. Chest pain, none to severe. Haemoptysis. Symptoms from a distant metastasis possible. • Paraneoplastic syndrome.
Lung cancer issues: • Cancers may spread to the lung from pancreas, liver, stomach, uterus, ovary or thyroid. Tests for these cancers exist. • Chemotherapy: destroys liver and kidney. Tests for this RFT and LFT. • Paraneoplastic syndrome:
Paraneoplastic syndrome: • • • • • • • • •
Anorexia. Finger clubbing. Hypertrophic osteoarthropathy. Peripheral neuropathy. Polymyopathy. Dermatomyositis. Cerebellar degeneration. Hypercalcaemia, hyponatraemia. Gynecomastia.
Lung cancer making ADH
Lung cancer making ACTH
Lung cancer: laboratory tests • Electrolytes, calcium, lipids. • Tests for the primary cancer. • Hormone or hormone like materials produced by the cancer. • Tests for effects of chemotherapy. • Methotrexate if used. • Trace metals.
70 year old man, retired scientist: • • • • • • • •
Former smoker, quit at age 50. Increasing tiredness. No appetite. Some weight loss. Haemoptysis for 3 weeks. Trachea is deviated to the left (X ray). Wheeze is localized to left side of chest. Loss of volume in upper left lobe.
70 year old man, retired scientist: • What is likely diagnosis? • What laboratory work is appropriate? • What do you think will happen next?
28 year XFL 6’7”, 350 lb. • Knee surgery • Chest pain on physiotherapy • Dead soon after • Globe and Mail 2001 06 12.
30 year old woman, on OC • Abdominal liposuction, unwell, intense chest pain, SOB, tachycardia. • pH 7.50 (7.35-7.45) • pCO2 30 mmHg (35-45) • Bicarbonate 23 mmol/L (22-30) • pO2 65 mmHg (60-90)
30 year old woman, liposuction: • Plasma sodium 143 mmol/L (135-147) • Plasma potassium 4.1 mmol/L (3.5-5.0) • Serum urea 3.6 mmol/L (3-7) • What risk factors, test, treatment?
Pulmonary embolus/infarct: • Chest pain • Obese, surgery, smoker, oral contraceptives. • Serum LD, coagulation factors, C reactive proteins, troponin… • Thrombolytic therapy.
Some general cancer symptoms: • • • • • •
Significant weight loss in a short time. Infections slow to clear. General malaise Lumps Change in bowel habit. Pain.
Lung cancers: 22,200 new case/year in Canada:
Non small cell carcinomas (squamous): • Half of lung cancers. • Metastasize readily. • Hypercalcaemia / parathyroid hormone related peptide. Small cell (oat) carcinoma: • Amine precursor uptake decarboxyl APUD • Ectopic hormones e.g. ADH, ACTH.
Lung cancer symptoms: • • • • •
Persistent cough or breathlessness. Infections slow to clear. Chest pain, none to severe. Haemoptysis. Symptoms from a distant metastasis possible. • Paraneoplastic syndrome.
Lung cancer issues: • Cancers may spread to the lung from pancreas, liver, stomach, uterus, ovary or thyroid. Tests for these cancers exist. • Chemotherapy: destroys liver and kidney. Tests for this RFT and LFT. • Paraneoplastic syndrome:
Paraneoplastic syndrome: • • • • • • • • •
Anorexia. Finger clubbing. Hypertrophic osteoarthropathy. Peripheral neuropathy. Polymyopathy. Dermatomyositis. Cerebellar degeneration. Hypercalcaemia, hyponatraemia. Gynecomastia.
Lung cancer making ADH
Lung cancer making ACTH
Lung cancer: laboratory tests • Electrolytes, calcium, lipids. • Tests for the primary cancer. • Hormone or hormone like materials produced by the cancer. • Tests for effects of chemotherapy. • Methotrexate if used. • Trace metals.
70 year old man, retired scientist: • • • • • • • •
Former smoker, quit at age 50. Increasing tiredness. No appetite. Some weight loss. Haemoptysis for 3 weeks. Trachea is deviated to the left (X ray). Wheeze is localized to left side of chest. Loss of volume in upper left lobe.
70 year old man, retired scientist: • What is likely diagnosis? • What laboratory work is appropriate? • What do you think will happen next?
Related Documents
Respiratory Part 4
November 2019 6
Respiratory 4
June 2020 5
Respiratory System Part Four
April 2020 9
Respiratory System Part One
April 2020 12
Respiratory Part 1
November 2019 6