Post on 06-Apr-2018
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MARY HAZEL TE
Post Graduate Intern
12-11-11
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yDIVIDED INTO:
y
NASOPHARYNXy OROPHARYNX
y LARYNGOPHARYNX
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y NASAL PHARYNXy Lies above the soft palate
y posterior portion of the nasal cavity.
y pharyngeal isthmus: the softpalate, the palatopharyngealarches, and the posterior wall of thepharynx.
y ORAL PHARYNXy Superior: soft palate
y Anterior: oral cavityy faucial (oropharyngeal)
isthmusLateral: palatoglossalarches
y Inferior: tongue epiglottis
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y LARYNGEAL PHARYNXy superior border: epiglottis
y inferior border: cricoid cartilage
y
Posterior:arytenoid and cricoidcartilages
y Behind the opening into the larynx
y Lateral wall: thyroid cartilage and
thyrohyoid membrane
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y The true vocal cord is labeled as vocal fold, and the
false vocal cord (a mucosal fold) is labeled as
vestibular fold.
Vestibular fold fixed fold on
each side of the larynx
Vocal fold mobile fold on
each side of the larynx
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y 2 months PTC
y (+) tenderness Left upper breast
y (-) fever
y 1 month PTC
y (+) persistence tenderness Left upper breast
y Consult was done with a private physician
y
Biopsy was done ductal carcinoma
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y (+) PTB (1989) 6 months treatment
y (-) Hypertension
y (-) Diabetes mellitus
y (-) Bronchial Asthma
y (-)Food and Drug Allergies
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y (+) Breast CA sibling
y (-) Hypertension
y (-) Diabetes Mellitus
y (-)Bronchial Asthma
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y Nonsmoker
y Non alcoholic beverage drinker
y Nurse
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yAmbulatory, consious, coherent, not in
cardiopulmonary distress
Vital Signs:
BP: 110/70CR: 78
RR: 20
T: 36.7 C
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yAnicteric sclerae, pinkish conjunctiva
y No cervical lymphadenopathies
y Symmetrical Chest Expansion, Clear breath sounds,
adynamic precordium, normal cardiac rate andryhthm
y Soft, non tender abdomen, (-) goldflamms sign
y Grossly normal extremities
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Invasive ductal carcinoma,
moderately differentiated, LeftPTB 4
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y CBC
y WBC: 19.9
y Neutrophil 97
y Segmenter 95
y Stab 2
y Lymphocyte 3
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y Pulmonary tuberculosis, upper lobes, with cavity formationsand bronchiectatic and cicatricial changes
y Pulmonary nodules, right upper and lower lobes. Granulomaformation primarily considered. Neoplastic process not ruled
out.
y Aspergilloma formation, left upper lobe, considered.
y Anterior carinal and left axillary lymphadenopathies
y Thoracolumbar hypertrophic degenerative osteoarthropathy
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yANATOMY CHEST
major fissure (oblique) is
an important anatomic
landmark in the
interpretation of chestradiographs and computed
tomographic (CT) scans.
RIGHT : upper and middle
lobe
LEFT: upper and lower
lobe
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major fissures as lucent bands of relative
hypovascularity
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At the level of T3
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y Lung Abscess
y Necrosis of the pulmonary tissue and formation of
cavities containing necrotic debris or fluid caused
microbial infection
y Manifestation: fever, cough with sputum production,
night sweats, anorexia and weight loss, may develop
hemoptysis
y Chest Radiographic appearance:
y Irregularly shaped cavity with an air fluid level
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y LUNG ABSCESSy Chest Radiographic
appearance:y Irregularly shaped cavity
with an air fluid level
y CTy Abscess often is a
rounded radiolucent lesion
with a thick wall and an ill-defined irregular margin
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y Neoplasm
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y ASPERGILLOMA
y Aspergillus species
y mode of transmission: inhalation
y a saprophytic growth of Aspergillus that colonizes inthe pulmonary cavities and is usually located in theupper lobes
y Preexisting cavities, cysts, and other air - containingspaces superinfection.
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y Manifestations:
y Manifests as an asymptomatic radiographic
abnormality
y 40-60% - hemoptysis
y Less commonly: cough and fever
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y The characteristic appearance:
y Early stage:
y irregular sponge-like network filling the cavity,
y Later stage:
y one or more rounded masses within a round or ovoid
cavity
y the mass is demarcated on one aspect from the wall of the
cavity by a crescent - shaped collection of air.y In some patients, the mycelial ball moves when the patient
shifts position.
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y Treatment
y Given when patient becomes symptomatic
y Surgical resection
y Oral itraconazole
y CT guided, intracavitary treatment with amphotericin
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THANK YOU