Miscellaneous Flashcards
Bronchogenic Cyst
Cyst located adjacent to the trachea- usually at the level of the carina.
- Develops due to lung and foregut development anomalies
- Found incidentally on CT usually with
— Near large airway (trachea, main carina)
— Homogenous
— Water HU (0-15)
Symptoms:
- Usually Asx
- Can result in airway compromise
- Issues with swallowing
- Can also become infected
Management:
- Resection
- Observation
Can be associated with other abnormalities
- Bronchopulmonary sequestration
Pericardial Cyst
Located in the Right Costophrenic angle (majority) others in the left CPA
- Can be cause of trauma however usually congenital
- Usually found incidentally as they are symptomatic.
- Can be found due to compression sx- dizziness, cough, syncope- can cause Right ventricular outflow tract obstruction
- DDX: Malignancy, teratoma, other cyst (thymic, bronchogenic)
—- Differentiate with CT
——- homogenous fluid <20 HU
——- Very rarely septations etc.
Tx: None- observation
EGPA Diagnostic Criteria
4/6 required:
- asthma
- Parasinus disease
- Eosinophilia > 10%
- pulmonary nodules- migratory
- biopsy proven eosinophils
- polyneuropathy/mono-neuropathy
Thoracic Endometrial Syndrome
Catamenial PTX
Catamenial hemothorax
Catmenial hemoptysis
Catmenial lung/pleural nodules
- At time of menses when you see symptoms. 24-48hours after starts
- Pleural based nodules/diaphragmatic implants can cause any of the above.
Favors right side
Diagnosis: with VATS - biopsy
Treatment: hormonal therapy
Causes of pulmonary granulomatous disease
Aspiration
Autoimmune
— crohns, PBC
Drugs
Environmental: pneumonicosis, beryillious, and HP
Infections: fungal/MAC
Sarcoid like reactions: sarcoid, neoplasm, immunodeficiencies
Granulomatous lymphocytic ILD
ILD seen in Immunodeficiencies
Charactertized by cough, dyspnea
HRCT: bronchiolitis, GGO, and LAD
Biopsy (to diagnose)
- Granulomas
- LIP
- Follicular bronchiolitis
Treatment:
- Steroids
- IVIG
- RTX/immunosuppression
Kartager Syndrome (PCD)
Impaired ciliary function
Genetic- lots. of polymorphisms however most common:
—- DNAH5
—- DNALI
SX:
- Situs inversus
- infertility
- sinus infections
- Otitis media
- Pneumonia
- bronchiectasis
Dx:
- Nasal Nitric oxide test
- Confirm with electronicrograph of cilia (nasal)
Management:
- mucociliary clearance - hypertonic saline
- monitor for pulmonary infections and function
Genetics for PAH
- BMPR2 (PAH)
—- variable penetrance - ALK Gene
—- HHT and PH - PVOD
—– EIF2AK4
Risk of Bronchial artery embolization
Transverse myelitis - due to missed target and getting the spinal artery
Chest pain
Dysphagia
bleeding - bronchial venous system circulation rather than pulmonary artery system
Monier kuhn
Presents in third decade of life
Dilation of the main airways - trachea, left right main stem
—- Trachea >3cm or larger than the vertebrate
- normal distal airways
Dilation due to loss of elastic fibers on the major airways and thinning of the smooth muscle
Causes impairment in airway clearance -> results in recurrent infections and bronchiectasis.
Can also result in airway diverticuli
Rare disease that can cause emphysema and bronchiectasis in non-smokers
Treatment: Airway clearance and antibiotics for infection
Alpha Antitrypsin
Can cause bronchiectasis and emphysema
Alpha anti trypsin level <57
if >80 unlikely to cause any disease
Amiodarone Induced Toxicity
Present with fevers (low grade), chills, weight loss, dyspnea in someone with amiodarone dose of 400mg/day and on it for 2months
MOA:
- Immunologic
- Cytotoxic
CT:
- Pneumonitis
- Nodules
- Pleural effusion
Bronch:
- lipid laden Foamy Macrophages (if not present likely not amiodarone toxicity)
Treatment:
- Stop amiodarone
- Steroids for 4-12 months (long taper because long half life of amiodarone)
Dabigatran
- MOA
- Reversal agent
- clearance
Thrombin inhibitor
Reversal Agent: Idarucizumab
Clearance: Kidneys - excreted unchanged. Therefore have to consider renal function in Actions
Risk for post intubation stridor
traumatic intubation
intubation >6days
large tube
female
reintubation after self extubation
If fail cuff leak test- given 20mg steroids and extubate within 4 hours. No need to recheck
cuff leak tes- not neccessary but does reduce rates of reintubation, post ext ubation stridor but will delay extubation
Nintedadib MOA
Potent inhibitor of PDGF, FGF, and VEGF
Neuromuscular weakness on Lung function tests
Decrease in 20% on FVC for upright vs supine
If diaphragm weakness present- start with US of diaphragm vs SNIF test. SNIF test relies on paradoxical movement compared to the other
US: thickening of the diaphragm with inspiration. if no thickening - then weakness or paralysis
Pre-operative OSA detection
stop bang positive at 3 or greater
MILD OSA with or without comorbid conditions: HF, stroke, dm, renal disease, CAD—- NO INCREASED OPERATIVE RISK
SEVERE OSA WITH COMORBID CONDITIONS: INCREASED RISK OF POOR CV OUTCOMES
SEVERE OSA WITHOUT COMORBID- NO INCREASED RISK OF CV OUTCOMES
OHS: INCREASED RISK- SCREEN - RECOMMEND DELAYING SURGERY TO TITRATE CPAP
