Clinical questions - Pulmonology Flashcards
Exudative pleural fluid: Specific gravity Protein content Cellularity Causes
Specific gravity > 1.020 - “lots of stuff in the fluid”
High protein content
Highly cellular
Causes: Infection Inflammatory Cancer Lymphatic obstruction
Transudative pleural fluid: Specific gravity Protein content Cellularity Causes
Specific gravity less than 1.020
Low protein
Hypocellular
Causes:
sodium retention
increased hydrostatic pressure - forces fluid into extravascular space
Low oncotic pressure - doesn’t pull fluid back into vascular space
Presentation, risk factors, dx and treatment for OSA
Snoring, daytime sleepiness, poor concentration, restless sleep, am headaches
Risk: obesity, male, over 50 yo, upper airway abnormalities, tobacco use, nasal congestion
Dx: polysomnography
Tx: Behavior mod - wt loss, no back sleeping, no alcohol before bed CPAP oral devices surgery
COPD Severity grading and appropriate treatment for each
All - tobacco cessation
Gold 1: mild
FEV1 > 80% predicted
SABA prn
Gold 2: Moderate
FEV1 50-80% predicted
add LABA to SABA pro
Gold3: Severe
FEV1 30-50% of predicted
add ICS to LABA and prn SABA
Gold 4: Very severe
FEV1 less than 30% of predicted
add theophylline or PDE4-i roflumulast, home O2 to ICS, LABA, and prn SABA
Acute respiratory distress syndrome - pathophys, presentation, treatment
acute diffuse inflammation of lungs causes increased vascular permeability leading to loss of lung function
Within a few days of inciting event, MC sepsis
Tx:
Admit to ICU
Treat underlying disease
Mechanically ventilate with LOW tidal volumes to minimize injury to lungs and PEEP
Conservative fluid management to reduce pulmonary edema - goal CVP 4-6 mmHg
-augment furosemide or albumin
Prone positioning to increase O2 (doesn’t increase survival)
Minimize O2 consumption - tx fevers, minimize anxiety/pain with sedatives and analgesics, limit respiratory muscle use with paralytics - especially asynchronous breathing
Transfuse only if Hgb less than 7 - transfusions increase risk of death
Management of lung nodules
if less than 8 mm - serial CT scan and monitoring for growth
>8 mm or growth get biopsy
Management of pulmonary sarcoidosis
if asymptomatic - no medications
Monitor for respiratory symptoms
-Prednisone 4-6 weeks
-ICS in stage 1-2 with mild symptoms
Management of idiopathic pulmonary hypertension
Use furosemide, diltiazem and supplemental O2
Needs long term a/c with warfarin due to increased risk of intrapulmonary thrombosis and thromboembolism
Influenza treatment
within 48 hr of onset can use antivirals or if severe symptoms
Supportive care otherwise
Treatment of pulmonary histoplasmosis
mild/moderate - itraconazole
Severe - amphotericin B
Treatment of pulmonary blastomycosis
mild/moderate - itraconazole
Severe - amphotericin B
Treatment of pulmonary coccidioidomycosis
fluconazole, ketoconazole, or itraconazole
