Pulm #6 Flashcards
MC etiology for emphysema
-Smoking
What is emphysema?
-Permanent enlargement of the terminal airspaces with no obvious fibrosis
Pathophysiology of Emphysema
- Alveolar capillary destruction and alveolar wall destruction
- Loss of elastic recoil
- Increased compliance leads to airway destruction
_____ involvement is most commonly seen with smoking
Centrilobar (proximal acinar)
–Not the entire acini as in alpha-1-antitrypsin deficiency
Symptoms and PE findings of emphysema
- Dyspnea
- Chronic cough (with or without sputum)
- Hyperinflation: decreased breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion, wheezing.
- Non-cyanotic: pink puffers
- Pursed-lip expiration and sitting forward to improve breathing
Gold standard diagnostic to diagnose emphysema
- PFT (obstructive pattern)
- Decreased DLCO (diffusing capacity of lungs for carbon dioxide)
Another diagnostic that can be done for emphysema?
-CXR: flattened diaphragms, increased AP diameter, decreased vascular markings, bullae
Treatment for emphysema
- Low risk of exacerbation: SABA or SAMA as needed
- More symptomatic, low risk: LAMA (Tiotropium) vs LABA (Salmeterol)
- Minimal symptomatic on day to day basis: LAMA + LABA
- Higher symptom burden: LABA + LABA + glucocorticoid
Which is more efficacious, LAMA or LABA?
LAMA
-Tiotropium
Symptoms of Superior Vena Cava Syndrome
- face and/or neck swelling
- Facial plethora
- headache
- Dilated and prominent neck and chest veins
MC etiology of superior vena cava syndrome
- Small cell bronchogenic carcinoma
- Hodgkin lymphoma
Treatment for superior vena cava syndrome
- Supportive
- elevation of the head
- Endovascular management
What is the best diagnostic for superior vena cava syndrome?
CT scan can show degree of obstruction
What is Lambert-Eaton Myasthenic Syndrome
-Antibodies against presynaptic voltage-gated calcium channels prevent Acetylcholine release, leading to muscle weakness
Lambert-Eaton Myasthenic Syndrome
-MC associated with small cell lung cancer
Symptoms for Lambert-Eaton Myasthenic Syndrome
- proximal muscle weakness that improves with repeated muscle use
- Autonomic symptoms: dry mouth, postural hypotension, ED
- Hyporeflexia, No muscle atrophy
Diagnostics for Lambert-Eaton Syndrome
- Voltage-gated calcium channel antibody assay
- Electrophysiology
- CT scan to assess for malignancy
Treatment for Lambert Eaton Syndrome
- Treat underlying malignancy
- Pyridostigmine
- Second line: Plasmapheresis, IVIG, oral immunosuppressants
MC foreign body ingested by children
Peanuts
Main cause of death in a foreign body aspiration in a child
Hypoxic-ischemic brain injury and less commonly, pulmonary hemorrhage
Why are foreign bodies MC on the right side?
Due to wider, more vertical and shorter right mainstem bronchus
Symptoms of foreign body aspiration
- Sudden onset of choking, cough, and dyspnea
- Wheezing or asymmetric breath sounds, may be normal
Definitive diagnostic for foreign body aspiration
Rigid bronchoscopy: therapeutic as well because object can be removed
-Flexible may be used in diagnostic cases when location of FB is unclear
Treatment for foreign body aspiration
-Removal of foreign body via rigid bronchoscopy
What is the difference between Tietze Syndrome and Costochondritis?
- In Tietze Syndrome, there is pleuritic chest pain, reproducible point chest wall tenderness WITH palpable edema.
- In Costochondritis, there is no palpable edema.
Both are diagnoses of exclusion, imaging is normal, and are treated with NSAIDs.
