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Dysphagia with solid or liquid. Chest pain that radiates to arm and jaw (mimics angina). Nitroglycerine (NO) relieves.
Diffuse Esophageal Spasm
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Treatment Ca2+ channel blockers, Nitrates, Myotomy (cut out distal esophagus)
Diffuse Esophageal Spasm
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Diffuse Esophageal Spasm (mechanical or motor)
Motor
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Dysphagia with solid or liquid. Chest pain. Not relieved by NO. Bird's beak X-ray.
Achalasia (inability of LES to relax)
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Treatment Botox, Nitrates, Dilation, Myotomy
Achalasia (inability of LES to relax)
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Achalasia (mechanical or motor)
Motor
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Dysphagia progresses from solid to liquid over months. Intermittent pain in chest or back. Weight loss. Coughing up blood. Laryngeal nerve palsy (hoarseness).
Esophageal Cancer
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Treatment Surgery, Chemotherapy, Radiation, Laser ablation (pall), Dilation with stent (pall), feeding tube (pall)
Esophageal Cancer
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Esophageal Cancer (mechanical or motor)
Mechanical
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Dysphagia with solid food only. Regurgitation. Long history of GERD. Shatzki's ring. Intermittent dysphagia but slowly progressive.
Esophageal Stricture
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Dilation with ballon (not stent)
Esophageal stricture
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Esophageal stricture (mechanical or motor)
mechanical
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Orthopenia
Upright to be comfortable
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PND
Paroxysmal nocturnal dyspnea- wake up gasping for air at night
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Sudden onset of SOB. Hemodynamic instability. Mediastinal shift or tracheal deviation. Tympanic percussion. Quite breath sounds.
Pneumothorax
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Sudden onset of SOB. Hemoptosis, Deep Vein Thrombosis (DVT), Tachycardia. Recent surgery (5-7 days ago)
Pulmonary Embolism (PE)
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How is treatment different for Pneumothorax v. PE?
Pneumothorax- chest tube/IV needle; PE- anticoagulative (Heparin and Warfarin) or Vena Cava Filter if recent surgery.
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Cough, wheeze, chest pain, history of smoking, Hemoptosis, Weight loss
Lung Cancer
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Cough, slow progressive dyspnea, dyspnea on exertion, history of smoking
COPD
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What does chest x-ray look like for the following (lung cancer, COPD, Pneumothorax, PE)
lung cancer subtle changes; COPD- darker than normal for increased air in lung; Pneumothorax- tracheal shift; PE- normal
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Resonance percussion of lungs
Normal
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Tympanic Percussion
Pneumothorax
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Hyperesonance percussion
emphysema
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Orthopenia, PND, exertion or lying down can aggravate it dyspnea may be progressive or sudden
Left Sided Heart Failure
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