English language

How to pronounce differential psychology in English?

Full Transcript

welcome welcome to this great playlist
called pulmonology this is mythical
sister fictional for medicine makes
perfect sense we continue talking about
lung diseases today we will talk about
pleural effusion we have four types of
pleural effusion exudate translate kylus
effusion and pseudo kylus effusion
what is pleural effusion it's
accumulation of excessive fluid between
the two layers of the pleura the
visceral pleura which is attached to the
lung and the parietal pleura which is
attached to the chest wall normally
there is a very thin film in between the
layers but when we talk about pleural
effusion which is a pathology there is a
lot of fluid there with that being said
now let's get started when you see cough
and dyspnea it probably means lung
disease and you have five options
obstructive lung disease restrictive
lung disease pulmonary vascular
abnormality infections and malignancy
here is restrictive lung disease and
pleural effusion is here so plural
effusion causes a restrictive lung
disease is it intrinsic or extrinsic
it's extrinsic because it's outside the
lung questions of the last lecture
mentioned six diseases that cause change
date of portal fusion we will talk about
them soon what are the last criteria
what is their clinical significance
we'll talk about this soon the most
common cause of an exudative effusion in
the United States is a bacterial
pneumonia bacterial pneumonia of course
is a lung infection and we are talking
about pleural effusion here types of
metastases okay here is something that
has nothing to do mr. day's topic but we
will learn from it metastasis has three
times lymphatic spread hematogenous
spread and seeding or trans selamat we
have two types of tumors we have benign
tumors and we have malignant tumors and
malignant tumors also known as cancer so
cancer means it's malignant benign is
something else malignant tumors are
divided into primary and secondary
secondary is also has metastasis
so primary is the original location of
the cancer and then if you leave it many
of them can metastasize going to another
location then they are called secondary
metastasis so how do they do it
lymphatic spread such as carcinomas if
it's a carcinoma it loves to go to the
lymph vessels afferent vessels lymph
node producing a painless lymph
adenopathy
so the lymph node is gonna enlarge but
it's gonna be painless
next lymphatic vessels which are the
afferent thoracic duct or the right
lymphatic duct depending on the location
they end up in big veins and they
continue on to the hematogenous spread
but they started as lymphatic
hematogenous spread on the other hand
those sarcomas go straight to the blood
without going to the lymph first they go
to the systemic circulation they will
end up in the right side of the heart
and then the right side of the heart
will pump it to the lung or they go to
the border circulation and they will
arrive at the liver and that's why if
you're talking about lung cancer most
lung cancer is secondary which means it
started in another organ let's say
breast and then it metastasized to the
line why because the lung receives 100%
of the circulation from the heart
specifically the right side of the heart
same thing will deliver secondary liver
cancer which means it came from another
organ is by far more common than primary
hepatocellular carcinoma some organs are
misfortunate because of their location
within the circulation third type is
sitting or transyl ohmic cancer cells
which exfoliate from a serosa surface
including your 3 p's pleura peritoneum 4
accordion then they invade the tissue in
the serosa cavity so inside the pleural
cavity inside virginal cavity or
pericardial cavity respectively can you
give us an example yes lung cancer
that's located peripherally example is
adenocarcinoma and large cell carcinoma
can invade I see it the pleura leading
to malignant pleural effusion and
today's topic is pleural effusion there
is another example called ovarian cancer
it invades and seeds the Ament 'm
leading to a mental caking
sometimes a doctor told his patient hey
I found omental caking in your person a
cake happy birthday to your doctor no
honey I'm sorry I have been
news you have ovarian cancer definition
of plural effusion accumulation of fluid
in the pleural cavity between the
visceral and parietal layers and of
course accumulation we mean excessive
fluid we mean a substantial amount of
flow types exudate translate kyla pseudo
class and even hemorrhagic we call it
hemothorax
to know more about hemothorax watch my
two first videos in this playlist they
are called clinically oriented anatomy
what causes pleural effusion I have 19
causes number one left-sided heart
failure leading to a pulmonary edema
diffuse bilateral crackles the old name
is Ra's rowdy l'amour okay so here is
your heart here is your left side of
this heart if he the left side failed it
cannot receive blood when it cannot
receive blood those veins are gonna be
congested and they will end up in the
lung they will end up in lung congestion
and pulmonary edema when there is
pleural effusion there is dullness to
percussion and diminished breath sounds
there is something obscuring the lung
there's water obscuring the air so
number one was due to increased
hydrostatic pressure all of the others
are due to decrease oncotic pressure
let's do them quash your career not
eating protein you have decreased plasma
protein level the into low oncotic
pressure leading to edema ankle edema
ascites poorly fusion cetera and of
course this is a translate severe liver
disease now you are eating protein but
you are not synthesizing enough protein
this will lead to decrease albumin this
will lead to low oncotic pressure and
edema
of course pleural effusion nephrotic
syndrome you're eating protein you're
making protein but you're losing protein
you're paying it out going to decrease
albumin low oncotic pressure and a demon
minute real disease also an S protein
losing gas droppeth e su nephrotic
syndrome is protein losing nephropathy
minute rare disease is protein losing
gas draupathi some other people call it
it's the nephrotic syndrome of the gut
decrease albumin low and high pressure
and demon malabsorption syndrome you are
not absorbing protein decrease albumin
decrease on call pressure and Adeem
including for diffusion all of these are
cause of translate one is
due to increased hydrostatic pressure
two three four five and six do to
decrease
oncotic pressure hydrostatic pressure
and Akali pressure are called Starling
forces we're done with the cause of
transy dative pleural effusions talk
about exudate acute chest syndrome in
sickle-cell disease this is an exudate
pneumonia that's an x-ray
why is it x-ray if it's related to
inflammation especially acute
inflammation and neutrophils it's an
excellent baby tuberculosis infection be
real it has acute inflammation you bet
this will lead to exudate even before
empyema lung abscess can lead to exudate
before or after in pain we call it
empyema not only when it has acute
inflammation but when it has frank pus
bronchiectasis infection can lead to MPN
and exudate when the patient is coughing
tons or cupfuls of pus primary
myelofibrosis there is splenic and
fortune there is left upper quadrant
pain and left-sided pleural effusion
because this plane is on the left is can
puncture through and pass through
causing a pleural effusion so splenic
and fortune will lead to lift upper
quadrant pain left side of pleural
effusion left-sided pleurisy pleural
effusion will lead to dullness to
percussion and diminished breath sounds
pleurisy will lead to biphasic friction
rub why biphasic because we have
inhalation exhalation this is different
from pericarditis where it has three or
triphasic friction rub there is systole
there is early diastole and there is
late diastole deep venous thrombosis
will lead to pulmonary embolism leading
to pulmonary in fortune and plural
infusion this is an exudate of it's also
a hemorrhagic could be
asbestos exposure exudative and
hemorrhagic especially when we're
talking about mesothelioma lupus exudate
rheumatoid arthritis exudate lung cancer
exudate metastatic breast cancer going
to the floor exudate when we say the
word metastatic breast cancer it means
it started in the breast then it's going
somewhere else in the pleura we'll call
secondary pleural cancer and the last
one is radiation induced I have to come
Harrison tables in this lecture that are
way important than the entire lecture
there is the first table exudate versus
translate cause this is local this is
systemic usually pathophysiology to
increase capillary permeability I've
told you that exudate is due to acute
inflammation translate the problem here
is either increased hydrostatic pressure
or decrease on high pressure can you
give me the etiology yes for exudate
think about infections in fortunes
rheumatological disease and cancer with
their primary or secondary translate if
it's due to increased hydrostatic
pressure you have left-sided heart
failure if you're talking about decrease
oncotic pressure
you're not eating protein you're not
making protein you are urinating protein
you are defecating protein and you are
not absorbing protein what's the nature
of the fluid in exudate it's rich in
cells
I mean neutrophils and it's rich in
protein it's inflammation baby retinas
hotness swelling pain loss of function
and those cytokines remember the
cytokines are proteins translate ultra
full trait of plasma it's basically
water or very close to it
fluid pH when you have inflammation
you're increasing the metabolism of the
local tissue when you increase
metabolism metabolism secretes acids
that's why you have an alkaline reserve
in your body and you do not have an
acidic reserve because you don't need an
acidic reserve your body is producing
acids you need an alkaline reserve
called bicarbonate to counteract the
acidosis
that's why pH of the pleural fluid in an
exudate is low but in the translate is
hi-lites criteria go light your candle
okay life's criteria are positive if
it's an exudate they are negative if
it's a translate let's say I want to
confirm a diagnosis of an exudate you
only need to one of the following
criteria alright first effusion to serum
protein ratio more than 0.5 exudate
exudative fluid is rich in protein
contrast that with translate you have
less than 0.5 it's protein poor LDH in
the pleural effusion if it's an exudate
it's high
actually everything is high if it's an
extra day but if it's a translate it's
low less than 200 effusion to serum LDH
ratio if it's a translate it's gonna be
less than 0.6 management treat the
underlying cause of course you're gonna
need more tests to know if it's
disinfection it's unfortunate it's a
rheumatoid you'll need more tests but if
it's a tragedy just go ahead give
diuretics and maybe albumin if there is
low oncotic pressure what's the
difference between Kyla's and pseudo
coitus kylus it's called pylus so it's
gonna have chylomicrons called common
sense so what's the pathogenesis if you
interrupt a thoracic duct thoracic duct
is rich in chylomicron that we got by
absorbing fat in your intestine but
pseudo callus is just related to
information and some necrotic debris has
nothing to do with chylomicrons causes
malignancy such as lymphoma trauma or
surgery because surgery caused trauma
here it's just inflammation with
necrosis or rheumatoid arthritis name
two lung problem this is one of the
extra-articular manifestations of
rheumatoid appearance the aspect also
has clarity and the color colors is
turbid or milky this is turbid or milky
it looks like milk and it's turbid but
why in case of callous effusion is
turbulent milky because of the
chylomicron they are rich in
triglycerides that were absorbed from
the intestine so karo microns are
present in kylus absent in pseudo colors
because they are pseudo triglyceride
level if the chylomicrons are rich in
triglycerides you'll find lots of
triglycerides in Kyla's very little
triglycerides in the pseudo pilus the
opposite is with cholesterol no
cholesterol impalas lots of cholesterol
in pseudo callous pleural effusion
presents with this Nia cough and some
sputum may be signs by inspection there
is unequal chest movement because there
is a fusion in one side if it's
unilateral you'll find disparities
between the two sides of the chest but
if it's bilateral and it's equal you're
not gonna notice that
palpation you'll see increased diameter
on the affected side again if it's
unilateral decrease tactile vocal
fremitus or tvf why is the tactile vocal
from it is decreased okay waves are
divided into mechanical and
electromagnetic mechanical such as sound
elect my registers light light travels
faster in air then water then solid
sound is the opposite it travels the
best or the fastest in solid faster than
water and faster than air that's why
when you have con solid asian such as
pneumonia you have increased tactile
vocal fremitus because the air is
traveling faster you will hear it or
feel it louder but if there is something
obscuring the air in your lungs such as
this ugly pleural effusion and you are
putting your hand on the patient's chest
or back to try to feel the air in the
lung but there is something obscuring
your ability to transmit that sound this
is called decreased tactile vocal
fremitus because normally the two layers
of the pleura are almost the same
they are almost fused only a teeny tiny
film so consider them as solid but now
this solid has been changed into liquid
thanks to the pleural effusion when you
make the solid into liquid you are
decreasing sound transmission and
decreasing tactile vocal fremitus if the
pleural effusion is massive it's gonna
shift the trachea to the opposite side
towards the unaffected side and away
from the affected side percussion you'll
find dullness on that side why because
you are trying to perk us the lung but
now there is a layer of fluid obscuring
the lung so it's decreased or dullness
to percussion normally your chest should
be a resonant but when it's dull there
is something weird auscultation you'll
find diminished breath sounds again here
is your nice stethoscope when you are
trying to auscultate you're trying to
listen to the lung but there is a layer
of fluid obscuring that sound that's why
you have decreased breath sounds how to
diagnose for the future need clinical
signs and symptoms you need radiology
poster and a chest x-ray you'll find the
cost ro phrenic angle obliterated or
blunted normally you should see it like
this this is the angle costophrenic
but here you see there is no angle it
has been obliterated because of the
fluid also the diaphragm is obscured
again here is normal because the
diaphragm is here but when you have all
of this fluid here you're not going to
see the diaphragm it's obscured by the
fluid you can do thoracentesis or
tapping this fluid in the plural by
needle and then send it to the lab if
it's an exudate you'll need to do more
tests to determine the etiology is it
infection is unfortunate malignancy what
kind of tests are you talking about I'm
talking about cell count with
differential psychology for cancer Gram
stain for bacteria and culture for the
same flippin region glucose because it's
low in rheumatoid arthritis amylase
serum 2 pleural fluid albumin ratio and
then for tuberculosis adenosine
deaminase level interferon gamma release
si or if you want to go further PCR is
very accurate what are the complications
of those crazy plural effusion if you
have a large effusion it can compresses
the lung gun that slightly into
compression 8 electors as 8 electives
means collapse para mnemonic effusion
why did we call it paraná Manik because
it happens in correspondence with
pneumonia you start with pneumonia you
see this ugly consolidation of the upper
lobe of the left lung with increased
egophony whispering picture alla qui and
increased tactile vocal fremitus because
now it's a solid organ we got
consolidation then next before in ever t
have an exudate of pleural effusion it's
an exudate it's an acute inflammation
now reaching the pleura
next is fibro purulent you see this
canal or channel between the pneumonia
and the pleura
we call this para mnemonic empyema at
this stage the patient will start
coughing frank
pus tons of it the last stage is the
organizing stage by organizing we mean
fibrosis aids over the pleura is over
and it forms a very thick layer called
pleural peel it's like an orange
now the lung cannot expand this is an
actual restrictive lung disease and the
surgeon will have to remove this very
thick layer of the
Laura my favorite part of the lecture
how would you know if a test tube
contains chylomicrons put it in the
refrigerator the calamari will float on
the service list called each supernatant
what's on the surface is the dead gum
layer of chylomicrons and they are rich
in triglycerides that's why they float
on top of the water because the density
of fat is less than the density of water
it's called physics baby the most common
cause of an exudative effusion in the
nine states is bacterial pneumonia the
second most common cause is cancer which
one is the most common lung cancer
breast cancer and lymphoma
how could Bruce cans will lead to a
pleural effusion it metastasizes honey
this is called aesthetic breast cancer
or a lymphoma left-sided heart fear can
lead to bilateral pleural effusion with
Rawls or as they say today crackles but
I had a patient with lifts a heart
failure and only unilateral effusion is
the known and it's very common okay
nothing is perfect nothing is
bilaterally equal you're right biceps is
not as strong as your left bicep your
right
pterygoid muscle is not as strong as the
left just get over yourself
pancreatitis believe it or not can lead
to isolated left-sided pleural effusion
post abdominal surgery sometimes you end
up with translated pleural effusion this
is common this is benign if the
patient's history is clear and
diagnostic I'm sure this patient has a
CHF he has all the signs and symptoms
for cirrhosis or nephrotic syndrome
there is no need to tap the pleura there
is no need to perform a play rosen
thesis or thoracentesis you already know
it's a transudate
as Hippocrates said rule number one do
no harm
when should I tap the pleural effusion
if its unilateral because it's
suspicious if it's asymmetric because
it's suspicious and if it's not
responding to treatment so you have a
patient with CHF you're giving him lots
of diuretic and the pleural effusions
not responding time to tap it maybe if
the patient has bacterial pneumonia and
an exudative effusion should you do
parents and teachers to remove the fluid
or just give antibiotics to treat the
pneumonia here is the answer
it depends do a chest x-ray CT scan
even ultrasound and measure the distance
between the chest wall and the lung
surface if it's less than 10 millimeter
just treat the pneumonia he will be fine
if it's more than 10 millimeter this
pleural effusion is actually
contributing to the problem and it's
making the treatment more difficult this
is an effusion worth tapping because
when you tap this effusion and empty the
pleura from this ugly effusion you're
making the patient more likely to
respond to the antibiotic treatment what
if the lights criteria reveal an exudate
but all other tests are negative and the
patient still has this me and tachypnea
do a CT pulmonary angiography because
this could be pulmonary embolism maybe
this patient can die pay attention
complicated pleural effusion
what are the criteria just one of the
following is diagnostic lucky Latian
makes it complicated very low pH makes
it complicated Gram stain and culture if
they are positive makes it complicated
blue glucose makes it complicated and
they are worth tapping how to manage
them
chest tube thoracostomy not just needle
and surgery if while aspiring the
pleural fluid do you found blood oh yeah
this is called hemothorax what is the
cause it's a a Trojan ik probably you're
an idiot you injured a vessel while
going in that's totally okay or trauma
the patient had been in a car accident
two hours ago pulmonary embolism or
mesothelioma and among others exam
question let's say they have a patient
hold a prison inmate complains of fever
hemoptysis weight loss night sweats ooh
productive cough poor effusion reveals
increased lymphocytes diagnosis TV what
other disease can have increased
lymphocytes in an exudative pleural
effusion cancer yellow nail syndrome is
a genetic disease is a clinical trial of
primary lymphedema yellow dystrophic
nail and chronic exudative full effusion
and they might have bronchiectasis
after pleurisy and theses or throw
echoes and teases or thoracentesis you
can find white blood cells
interpretation if you find very few
RBC's this is could be normal or could
be a translate management if it's a
translate give diuretics if it's due to
decrease oncotic pressure add
albumen if the white blood cell count is
more than a thousand this is an exudate
treat the underlying cause if it's more
than ten thousand that's complicated
that Parana Monica fusion could be
secondary to Moni or to long abscess
this needs a chest tube thoracostomy
more than 100 thousand this is getting
serious this is empyema this is Frank
poss
this says purulent effusion could be
bronchiectasis lung abscess or
complicated para mnemonic effusion this
will require a chest tube drained and if
it's in the late stage of organization
or fibrosis you will even need surgery
to remove this plural peel we have
talked about the three stages of Parana
Monica fusion you start with pneumonia
then stage one is exudative pleural
effusion stage two is fibro purulent
state and stage three is organizing or
fibrosis thick pleural peel and this is
called empyema thoracis and empyema
thoracis you find pus please share
subscribe hit the bell and smash like
follow me on Facebook I have more than
100 cases there you can get my notes my
cases and the slides of this video and
my premium videos and my audio notes
organized in Dropbox folder at
patreon.com slash medic OSes thank you
so much for watching as always be safe
stay happy and study hard this is mini
coasters perfection elsewhere medicine
makes perfect sense

welcome welcome to this great playlist

Toggle Transcript

differential psychology::noun | Spocien Dictionary

differential psychology

noun

/,dɪfə'rɛnʃəl_saɪ'kɑlədʒi/

the branch of psychology that studies measurable differences between individuals

Type	Words
Type of	psychological science, psychology

How to pronounce differential psychology in English?

differential psychology::noun | Spocien Dictionary

abandonment

Related words

Related

Subscribe to our Newslatter