It a case of haemothorax coz I can see fractures of posterior 5 6 7 ribs. Flial chest? More than one fracture within one bone
Multiple fractured ribs visible.. Ask for history of trauma Probably dealing with hemothorax
# at posterior and lateral part of left 5th and 6th ribs with haemothorax left.
Chest trauma with multiple left sided ribs fracture leading to left hemothorax
In india Pulmonary Koch's is the first reason for pleural effusion .
Lt sided chest trauma with rib # and haemothorax
Hemothorax due to frcure ribs and chest trauma
fracture of ribs on left could be haemothorax. effusion should be drained, As blood is a medium for bacterial proliferation. pleural fluid haematocrit shud be done.
Collapse consolidation left lower lobe with ? Left lower lobe bronchial lesion
Post traumatic haemothorax due to rib fracture left side
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ABC OF : NAIL DISORDERS. ( I ). MAY BE USEFUL. *** ANONYCHIA is the absence of nails, an anomaly, which may be the result of a congenital ectodermal defect, ichthyosis, severe infection, severe allergic contact dermatitis, self-inflicted trauma, Raynaud phenomenon, lichen planus, epidermolysis bullosa, or severe exfoliative diseases....... *** PSORIASIS can also affect the fingernails and toenails, leading to thick fingernails with pitting, ridges in the nails, nail lifting away from the nail bed, and irregular contour of the nail....... *** LICHEN PLANUS of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise....... *** FUNGAL nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.....by some dermatophytes, Candida (Monilia) species, etc....... The technical name for a fungal nail infection is “ONYCHOMYCOSIS.”....... *** SPOON-SHAPED or spooning fingernails refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. This growth disturbance in the nail is known as KOILONYCHIA....... In particular, koilonychias is associated with IRON DEFICIENCY. *** Fingernails are made by living skin cells....... So a skin condition such as eczema may lead to fingernail ridges. Skin dryness can also cause these ridges. If the body is low in protein, calcium, zinc.......or vitamin A, a deficiency can sometimes be revealed by ridges in the fingernails. ** HORIZONTAL RIDGES run from side to side on nails and are often referred to as BEAU'S LINES may be a sign of previous injury, underlying health conditions, or in rare cases, arsenic poisoning....... Horizontal ridges can be caused by trauma to the nail and may be deep or discolored. The can also indicate malnutrition, psoriasis or a thyroid problem....... ** VERTICAL RIDGES are usually harmless and a consequence of ageing.......nail injury, or trauma, or underlying medical conditions....... *** The ECTODERMAL DYSPLASIAS (EDs) are genetic disorders affecting the development or function of the teeth, hair, nails and sweat glands....... ** ED is not a single disorder, but a group of closely related conditions of which more than 150 different syndromes have been identified....... *** Nail CLUBBING, also known as digital clubbing, is a deformity of the finger or toe nails associated with a number of diseases, mostly of the heart and lungs. ... Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called "Hippocratic fingers"..... ** Lung cancer is the most common cause of clubbing. Clubbing often occurs in heart and lung diseases that reduce the amount of oxygen in the blood. ... Heart defects that are present at birth (congenital) Chronic lung infections that occur in people with bronchiectasis, cystic fibrosis, or lung abscess....... *** While the NAIL BITING and picking seems to be such a common problem, the psychological and medical research does not agree on the exact motivation for the action. However, it suggests that nail biting can be the result of STRESS, VARIOUS MEDICAL DISORDERS, LEARNED BEHAVIORS, OR JUST PLAIN HABIT....... *** SPLINTER HEMORRHAGES : They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails. Splinter hemorrhages can occur with infection of the heart valves (endocarditis)....... *** YELLOW TOENAILS in an infection by a fungus that attacks the nails..... or, in some cases, they may be a sign of skin cancer. The fungal infection is caused most often by dermatophytes, which eat keratin to grow....... One of the MOST COMMON CAUSES of YELLOW NAILS is a FUNGAL INFECTION. As the infection worsens, the nail bed may retract, and nails may thicken and crumble. In rare cases, yellow nails can indicate a more serious condition such as SEVERE THYROID DISEASE, LUNG DISEASE, DIABETES or PSORIASIS....... *** WHILE NAILS ( LEUKONYCHIA ) : CAUSES : Iron deficiency anemia. Cirrhosis of liver. Kidney disease. Heart failure. Diabetes. Problems with the digestion of proteins. An excessive loss of proteins in the intestines. zinc deficiency........etc....... *** RED NAILS :- CAUSES : LUPUS patients get quirky, angular blood vessels in their nail folds. PSORIASIS starts in the nails up to 10 percent of the time and CAUSES SPLITTING and PITTING of the nail bed. HEART DISEASE can turn the nail beds red....... ** If the NAIL BED is RED, it could be caused by a high content of fatty acids and cholesterol, due to an excess of dairy products, sugar and salt in the diet. This can lead to an underactive liver and blocked arteries....... To keep the system healthy by replacing refined foods with wholegrain rice and bread, and flush out the system with plenty of fresh vegetables and at least five glasses of water a day....... *** HALF PINK and HALF WHITE nails can be a sign of kidney disease....... *** BRITTLE NAILS :- CAUSES : AGING. CHEMICAL/TOXIN EXPOSURE. LONG-TERM USE OF NAIL POLISH AND POLISH REMOVE. LOW HUMIDITY ENVIRONMENT. MALNUTRITION. NAIL-PATELLA SYNDROME. PROLONGED EXPOSURE TO WATER. TRAUMA. ** B complex vitamins (especially biotin), calcium, and zinc have all been implicated. There are other medical conditions which can cause brittle nails such as ANEMIA (low blood count), THYROID DISORDERS, and skin disorders such as LICHEN PLANUS and PSORIASIS. ** ONYCHOSCHIZIA includes splitting, brittle, soft or thin nails. Onychoschizia is MORE COMMON IN WOMEN. Only VERY RARELY are INTERNAL DISEASE or VITAMIN DEFICIENCIES the reason (IRON DEFICIENCY is the MOST COMMON).......Dr. Puranjoy Saha32 Likes31 Answers
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26 year old male non smoker c/o clubbing of both upper n lower limb fingers since 1 year no c/0 . kindly diagnose n how to evaluate furtherDr. Mohd Anas1 Like8 Answers
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hi friends long time back i come up with my new presentations hope u all gonna enjoy it "Pleural Effusion" (Fluid In the Chest or On the Lung) What is pleural effusion? A pleural effusion is a buildup of fluid in the pleural space, an area between the layers of tissue that line the lungs and the chest cavity. It may also be referred to as effusion or pulmonary effusion. The type of fluid that forms a pleural effusion may be categorized as either transudate or exudate. 1. Transudate is usually composed of ultrafiltrates of plasma due to an imbalance in vascular hydrostatic and oncotic forces in the chest (heart failure, cirrhosis). 2. Exudate is typically produced by inflammatory conditions (lung infection, malignancy). Exudative pleural effusions are usually more serious and difficult to treat. What are the causes of pleural effusion? There are many causes of pleural effusions. The following is a list of some of the major causes. 1. Congestive heart failure 2. Kidney failure 3. Infection 4. Malignancy 5. Pulmonary embolism 6. Hypoalbuminemia 7. Cirrhosis 8. Trauma The development of a pleural effusion occurs from fluid seeping into the pleural space, a thin area between the visceral and pleural membranes in the chest cavity, which normally contains a small amount of fluid to facilitate smooth lung movement. Fluid under pressure, malignant cells, and infectious agents can occasionally enter this space and cause it to expand with abnormal amounts of fluid and other compounds (see diagnosis section). What are the signs and symptoms of pleural effusion? 1. chest pain, 2. difficulty breathing, 3. painful breathing (pleurisy), and 4. cough (either a dry cough or a productive cough). Deep breathing typically increases the pain. Symptoms of fever, chills, and loss of appetite often accompany pleural effusions caused by infectious agents. The potential complications associated with pleural effusion. 1. lung scarring, 2. pneumothorax (collapse of the lung) as a complication of thoracentesis, 3. empyema (a collection of pus within the pleural space), and 4. sepsis (blood infection) sometimes leading to death. Dx 1. patient's history and physical exam may indicate a presumptive diagnose of pleural effusion. 2. a patient with a history of congestive heart failure or cirrhosis with symptoms of cough, difficulty breathing, and pleuritic chest pain may have a pleural effusion. 3. Findings from the physical exam, such as dullness to percussion of the lung area (when tapping the area of the lung with a finger, the percussion or sound is dull - if no fluid exists in the area the sound will be lighter), 4. decreased vibration (decreased tactile fremitus), and asymmetrical chest expansion (the lungs do not inflate or deflate equally ) may also be evidence of a pleural effusion. 5. Other physical exam findings detected with a stethoscope may include reduced or inaudible breath sounds on the affected side, egophony (patient voices the letter "e," but when listening [auscultation] it sounds like "a"), and a friction rub (if there is fluid in the pleural area, the heart will rub against the inflamed or fluid filled space). 6. Chest X-ray can detect pleural effusions, as they usually appear as whitish areas at the lung base, and they may occur on only one side (unilateral) or on both sides (bilateral). 7. If a person lies on their side for a few minutes, most pleural effusions will move and layer out along that side of the chest cavity which is positioned downward (because of the effects of gravity). This movement of the pleural effusion can be seen on an X-ray taken with the person lying on their side (a lateral decubitus X-ray). 8. Other imaging tests, such as CT scan, may be ordered to further identify the possible cause and the extent of the pleural effusion. 9. Thoracentesis (a procedure to remove the fluid from the pleural space) followed by laboratory analysis of the fluid can differentiate between transudate and exudate. The results from the fluid obtained from the thoracentesis are compared to certain blood tests (for example, LDH, glucose, protein, pH, cholesterol and others). Additional testing of the pleural fluid may also include a cell count, cytology, and cultures. Criteria are then used to differentiate exudate from transudate. Exudate has the following characteristics: 1. Pleural fluid LDH > 0.45 of the upper limits of normal blood values 2. Pleural fluid protein level > 2.9g/dL 3. Pleural fluid cholesterol level > 45mg/dL 10. ratio of pleural fluid to serum protein levels > 0.5, LDH ratio > 0.6 and LDH ratio > 2/3 the upper limits of normal. Other pleural fluid test results (cytology or amylase, for example) may also reveal the source of the effusion. Rx 1. drainage of the pleural fluid. This is done by thoracentesis (this procedure may be both diagnostic and therapeutic), where a tube is inserted into the effusion, and the effusion is drained out. This procedure needs monitoring, and in some instances, the tube may need to remain in the pleural space for a longer period of time for continued drainage. The need for repeated thoracentesis varies from patient to patient depending on the underlying cause, the amount of effusion fluid, the type of effusion (thick, thin, malignant, or infectious, for example) and if there is recurrence of the pleural effusion. 2. Some pleural effusions (mainly exudative) may require surgery to break up adhesions, while others may require pleurodesis (pleural sclerosis), a procedure whereby different irritant substances or medications are inserted into the pleural space in order to fibrose and scar the visceral and pleural surfaces together. This procedure seals the pleural space so that pleural effusions have difficulty reaccumulating. 3. The use of medications for pleural effusions depends on the underlying cause. Antibiotics are used when there is an infectious cause, whereby diuretics such as furosemide (Lasix) may be used to slowly help reduce the size of the pleural effusion. thanks you for reading soon i will comeup with more presentation Dr. Ravindra Tomar MBBS / MD firstname.lastname@example.org @Dr. Rishav Raj @Dr. Rishav Raj @Dr. Priyanka Singh Tomar @Prasenjit MajumdarDr. Ravindra Tomar9 Likes4 Answers
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A 65 years old female admitted to the ICU with Urosepsis. Past history of anemia and Interstitial Lung Disease. Please describe is there are any pathological changes in the nails ?Dr. Mohammed Parvez5 Likes24 Answers
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Dear Friends We often get cases of haemoptysis to manage. Let's have a detailed update…. HAEMOPTYSIS Differential Diagnosis of Hemoptysis PULMONARY PARENCHYMAL SOURCE.. Tuberculosis Pneumonia Lung abscess Lung contusion Mycetoma Idiopathic pulmonary hemosiderosis Wegener granulomatosis Lupus pneumonitis Goodpasture syndrome TRACHEO-BRONCHIAL SOURCE.. Bronchiectasis Neoplasm Bronchitis Broncholithiasis Airway trauma Foreign body PRIMARY VASCULAR SOURCE Arteriovenous malformation Pulmonary embolism Elevated pulmonary venous pressure Pulmonary artery rupture MISCELLANEOUS AND RARE CAUSES Systemic coagulopathy or thrombolytic agents Catamenial hemoptysis (pulmonary endometriosis) PSEUDO HAEMOPTYSIS Upper airway source(like nose) Gastrointestinal source(haematemesis) Serratia marcescens (gram-negative bacterium that produces a red pigment that may be mistaken for blood) Malingering HOW HISTORY SUGGESTS…. ETIOLOGY OF HAEMOPTYSIS… (1)h/o ANTICOAGULANT USE.. Coagulopathy (2)h/o COUGH… Bronchiectasis, COPD, foreign body, pneumonia, tuberculosis (3)h/o FEVER.. Tuberculosis, Bronchitis, lung abscess, neoplasm, pneumonia, pulmonary embolism, (4)h/oHEART DISEASE.. Congestive heart failure (5)h/o RECENT SURGERY OR IMMOBILIZATION… Pulmonary embolism (6)h/o SMOKING… Bronchitis, COPD, neoplasia (7)h/o SPUTUM PRODUCTION Bronchiectasis, COPD, pneumonia, tuberculosis (8)h/o TRAUMA Airway trauma, pulmonary embolism (9)h/o WEIGHT LOSS COPD, neoplasia, tuberculosis WORKUP AND MANAGEMENT Chest radiography.. Plain x-ray or CT thorax may provide clues about the etiology, as well as guide further resuscitation and evaluation. Treatment of the possible cause of haemoptysis should be initiated. Once the bleeding site has been determined, the patient should be placed in the lateral decubitus position with the affected lung down to prevent pooling of blood in the unaffected bronchial system. Rapid bleeding warrants immediate airway control with rigid bronchoscopy or endotracheal intubation Flexible bronchoscopy is less effective in maintaining a patent airway, but can provide useful diagnostic information. For stable patients with no identifiable cause detected.. chest CT angiography and/or bronchial artery arteriography with or without embolization should be performed. Thanks I hope this information on HAEMOPTYSIS will be HELPFUL to most of us Dr K N PoddarDr. K N Poddar26 Likes27 Answers