Pulm Flashcards
CREST syndrome
CREST Assoc w/ systemic sclerosis, pulm HTN 2/2 arterial intimal hyperplasia
Survival benefit in COPD
Oxygen (O2 sat <88%, <89% if pt has Crit >55%
Pancoast tumor
Smoking, horners, superior vena cava syndrome (dx CXR), brachial plexus neuropathy
Etiology of pulmonary HTN
constriction of pulm vessels–>RVHF
SIADH causes
Lung probs (HIV PCP) NS makes it worse
Euvolemic hyponatremia sOsm<275, UOsm>100, UNa>40
Chronic cough
> 8 weeks, post nasal drip (gets better w antihistamines), asthma, GERD
Multifocal atrial tachycardia
Not a fib (no Ps in a fib), >=3 distinct P waveforms in V1
Causes=COPD exacerbation, catecholamine surge (sepsis), electrolytes
Tx underlying cause, IF PERSISTS after tx CCB
Bronchitis
Most viral, cough >5 days, may have blood-tinged sputum
Bronchiectasis
CF upper lobes, other causes lower, recurrent infections, CT dx
Ddx chronic bronchitis (=smokers, chronic cough vs infx)
Causes of hemithorax opacification on XR
- Atelectasis 2/2 Mucus plug mainstem bronchus (mediastinal shift TOWARD affected side, NO hemodynamic changes, bronchoscopy)
- Diaphragmatic hernia (partial opacity left lower, pt w trauma)
- Pleural effusion (med shift AWAY)
- PNA Multi lobular (slower onset)
- Pneumothorax (hemodynamic changes, radiolucent, med shift AWAY)
Drowning
Arrhythmia (immediate)
Cerebral edema (submersion >5 min)
ARDS (72 h, surfactant washed away by liquid, admit and monitor)
Complications of PEEP
Alveolar damage, pneumothorax, hypotension
Glucocorticoids
High PMNs
Asthma
Steps: 1=PRN alb <2/wk, <2/mo 2=+low dose ICS 3-4/mo 3=+LABA OR +Med dose ICS daily, >1/wk 4=LABA AND med dose ICS >1/day 5=high dose ICS 6=+PO steroid
Exacerbation management
Mild-moderate=O2, SABA
Severe=O2, SABA+ipratropium, PO steroid, Mg if not improved in 1h, Look for signs of resp distress high PCO2, DECREASED wheezes
GERD can make sx worse 2/2 microaspiration! (Night + postprandial sx, hoarse in the AM)
Asbestos
Bronchogenic carcinoma (cavitary mass on CXR, MC) Pleural mesothelioma (less common, pleural effusion)
Anaphylaxis
1 organ system affected + hypotension, don’t need hives!! trigger can be food or abx in PT w asthma/atopy
Give IM epi
Mediastinal masses
lymphoma can be any
Anterior=G and the 3Ts thymoma(MYASTHENIA GRAVIS), retrosternal thyroid, teratoma, germ cell tumor (bHCG sem AND nonsem, nonseminomatous +AFP)
Middle=PA TrBL pericardial cyst, aortic aneurysm, tracheal tumor, bronchogenic cyst, lymph node
Posterior=ADEME (Adele’s diva alterego this time for ME) aortic aneurysm, diaphragmatic hernia, esophageal tumor, meningocele, enteric cyst
Congenital diaphragmatic hernia
Herniated gut compresses L lung, heart sounds louder on R, don’t do anything that will put air in the GI tract! ET intubation only, then NG decompression
Increased breath sounds
Consolidation (PNA)
Ventilators
ARDS—> avoid barotrauma low tidal volume <6mL/kg (ideal body weight), low FiO2 <0.6%, PEEP can be 15-20, goal O2 sat >88%
Pneumonia
V=0, severe V/Q mismatch, R—>L intrapulmonary shunting, NO IMPROVEMENT W INC FiO2
PFTs
Obstructive: TLC ^ FEV1/FVC<80%, DLCO ^ in asthma, dec COPD
Restrictive: TLC dec, FEV1/FVC nl (both dec), DLCO dec ILD, nl restrictive chest wall dz
Causes of cor pulmonale
COPD
ILD
Pulm vascular dz
OSA
COPD exacerbation tx
O2
Neb albuterol + ipratropium (SABA + anticholinergjc)
PO steroid
+- abx
NO LABA FOR ACUTE EXACERBATION
In severe COPD, O2 can induce hypercapnea (VQ mismatch) May have sz
Chronic bronchitis vs emphysema
Chronic bronchitis—> productive cough 3 mo for 2 yrs, nl DLCO, CXR inc pulm vasc markings, flattened diaphragm
Emphysema—> dec DLCO, CXR dec pulm vasc markings, hyperinflation, a-1-antitrypsin (liver dz, panacinar, lower lobes) vs smoking (centriacinar, upper lobe)
Cavitary lung lesions
- Abscess—> usually anaerobes indolent course, SIADH, systemic sx, putrid sputum, upper lobes/posterior (dependent while lying down), alcoholic/drug user/chronic renal dz, CT air fluid levels clindamycin
- Aspergillosis—> classic triad hemoptysis, pleuritic CP, fever, immunocomp, nodules w ground glass, chronic= >3 mo, systemic sx, cav lesion apical +/- aspergilloma
- TB—> no air-fluid level, disseminated spondylitis/fx arthritis osteo
- Bronchogenic carcinoma—> asbestos
- Granulomatosis w polyangiitis—> ulcers, multiple, kidney probs
- Squamous cell—> no leukocytosis or fever, slower onset (SMALL CELL DOES NOT FORM CAV)
Solitary pulmonary nodule
Def=<3cm, round, surround nl
No change 2-3y r/o ca (ca x2 qmo-y)
+ changes—> CT
serial scans, PET/bx (central bronchoscopy periph CT guided percutaneous), or if likely malignant surg
Secondary spontaneous pneumothorax
Ruptured apical bleb, COPD, Marfans, no tracheal shift
Massive hemoptysis
> 600mL/24h or >1mL/h
Bronchoscopy (balloon tamp, cauterize), pulm arteriography (embolization), thoracotomy if can’t stop bleeding
Mild/mod can get a CT
Nonallergic rhinitis
No eye sx, no trigger
Tx intranasal antihist OR steroid
Croup
Barking cough, +-insp stridor ONLY WHEN CRYING
Steroid, racemic epi if no improvement
Ddx DROOLING=epiglottitis (Hib)
Lung + kidney
Granulomatosis w polyangiitis—> tracheal narrowing, ulceration, multiple lung nodules w cavitation, anemia, dx ANCA or bx, tx steroid + rituximab OR cyclophosphamide
Goodpasture—> basement membrane
COPD diaphragm flattening
INC wob (shortened muscle can’t contract as well during inspiration)
INC lung compliance
INC thoracic wall recoil
Aspirin-exacerbated respiratory disease
Looks like asthma sx + allergic eyes, 30m-3h after NSAID, dec PGE, inc leukotrienes, polyps
Sarcoidosis
Looks like mediastinal widening on XR, chronic granulomatous inflammation
If it’s a euvolemic patient w lung stuff literally ANY lung stuff + hyponatremia
SIADH
ARDs
O2 doesn't help Lung compliance IS LOW (fluid) PaO2/FiO2 DEC Aa gradient INC PA pressure INC
CAP
MC causes: strep pneumo, h flu, legionella, mycoplasma
CURB-65: Confusion, Urea nitrogen>20, RR>30, BP<90/60, age>65
1-2 maybe IP
3 def IP
5 ICU
Treatment:
OP —> azithro OR doxy
OP + comorbidities, IP —> +B-lactam (amox/cephalosporin) OR FQ
ICU —> Same as above but FQ + B-lactam
Lots and lots of albuterol
Can cause hypoK
PE
Acute a fib (2/2 RA strain), MC site of thrombus=proximal thigh iliac, femoral, popliteal
Bronchiolitis
RSV, babies <2mo high risk of apnea
COPD PFTs
DEC VITAL CAPACITY
Nitrofurantoin side effect
Hypersensitivity pneumonitis, 3-9 d after, +/- rash
CF
Lungs, pancreas, nasal polyps
Weaning someone off a vent
- Alert enough to breathe on their own
- Minimal vent settings (Vt 7-8, PEEP<5, FiO2<40%
- pH > 7.25
Breathing trial turn vent off for a few hrs monitor ABGs before extubating
small cell lung cancer
CHEMO
Exudative pleural effusion
Empyema (acute, PNMs), TB (indolent, lymphs, prot>4, LDH>500, pt IC), cancer (lung breast), PE (blood, low prot)
Blunt chest trauma
Hemothorax, intercostal vessels can bleed a lot, if >1,500mL blood emergency thoracotomy
Management of tension pneumothorax
NEEDLE THORACOSTOMY BEFORE ALL ELSE (only time ignore ABCs)
Non-small cell lung cancer
Brain mets, surgery
