CP 3,19

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CP 3,19
2010-10-11 08:10:34
Acute dyspnoea

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  1. What are the 3 components of the virchow's triad and name 3 examples each.
    • Venous stasis - immobility, AF, LV dysfunction
    • Vascular injury - catheter, trauma, surgery
    • Hypercoagulability -protein C & S deficiencies, malignancy, anti-thrombin deficiency, smoking
  2. For suspected PE, what are the 4 essential investigations and what is the golden standard test to perform?
    • Essential
    • CXR (focal oligemia, peripheral wedged-shaped density)
    • ECG - AF, tachycardia, large PE (S1Q3T3)
    • V/Q scan - mismatch
    • ABC - decrease in PaO2

    Golden standard to Dx - CTPA

    Other tests: doppler ultrasound, DVT venogram, D-dimer, helical CT
  3. What drug therapies are needed?
    • LMWH - enoxaparin OR dalteparin may be used
    • Oral anticoag - warfarin
  4. Name 4 pathological findings at autopsy of a smoker woman died of saddle embolus after a DVT/PE.
    • Large saddle embolus located in the pulmonary artery or at the bifurcation
    • Haemorrhagic infarction – lower right lobe, wedge shaped (apex point towards the hilus)
    • Anthracosis due to smoking
    • Coronary artery disease / atherosclerosis e.g. aorta, carotid and vertebrobasilar system
  5. What are 3 complications if she didn't die?
    • Recurrence of thrombus formation
    • Cor-pulmonale (right heart overload) with pulmonary hypertension
    • V/Q mismatching -- changed pneumocytes type II's function & reduced compliance
  6. What 6 investigations would be perform if brochial ca. is suspected?
    • Aspiration of pleural effusion
    • CXR
    • CT
    • PET scan
    • Bronchoscopy
    • FBC, LFT
  7. What are the 4 types pf histopathology of bronchial/lung cancer?
    - Small cell - metastasise early, scant scytoplasm, small hyperchromatic nuclei, paraneoplastic syndromes, central lesions

    • - NSCC (respond to surgery):
    • *Squamous - associated with PTH-like peptide and hypercalcemia
    • *Adenocarcinoma - peripheral lesions
    • *Large cell
  8. Describe the natural Hx and prognosis of lung cancer (4 points).
    • Direct spread to pleura and ribs
    • Lymphatic and haematogenous spread - bone, brain,liver
    • Paraneoplastic syndromes e.g. hypercalcemia
    • Clubbing, HPOA
  9. The lung cancer pt died of pneumonia. What would you find at autopsy (2 points)?
    • DVT/PE saddle embolus
    • Cerebral mets/ herniation