Pulm Flashcards
Definitive treatment for chronic pulmonary aspiration
Layngotrachael separation
- TE from upper trachea to esophagus
- Proximal trachael is blind pouch
- Tracheostomy to mid-distal trachea
GT = will NOT prevent aspiration from reflux or salivary aspiration
Recurrent Pneumonia
2 or more episodes in 1 year
3 or more lifetime episodes with radiographic clearance
DDX:
H-type TEF
CPAM - would be shown on imaging
CGD - recurrent infections, X-linked, neutrophil oxidative burst test
CF - malabsorption, bronchiectasis (not lobar PNA), sweat test
primary ciliary dyskinesia - chronic purulent rhinitis with recurrent infections.
Hereditary Hemorrhagic Telangiectasia
Osler-Weber-Rendu syndrome
- Autosomal Dom
- Recurrent epistaxis (esp night) or other bleeding
- Vascular malformations in lungs, CNS, Liver, GI
(can lead to PULM HEMORRHAGE) - Telangiectasias on lips, oral cavity, palms, fingers, nails, soles, ears
Cystic Fibrosis
Chronic sinopulmonary disease
- normal lungs at birth then infection, inflammation, obstruction of airways leads to chronic bronchitis and bronchiectasis
- barrel chest, clubbing, nasal polyps
Pancreatic insufficiency, FTT
- no ADEK vitamins
Salt loss syndromes
Infertility
- agenesis of vas deferences or women with abnormalities in cervical mucus
Mean onset at 20 yrs
How to diagnose CF?
Sweat chloride testing
- Need to confirm if newborn screen is positive.
- NOT genetic testing.
Croup XR
Steeple sign
- loss of the normal shoulders of the subglottic airway
Lymphocytic Interstitial Pneumonitis (LIP) - who is it seen in?
Homogenous chronic ground glass opacities
Seen in HIV pts
Blastomycosis vs. Histoplasmosis vs. Coccidiodomycosis
Blasto
- central, southEAST, mid-atlantic states
- wooded sites - farmers, forestry workers, hunters, campers
- Budding yeast - single, broad based budding
- itraconazole
- disseminates to the skin
HIsto
- midwest, mississippi and ohio river valleys
- bat and bird droppings
- itraconazole
Coccidio
- southWEST- “valley fever” - deserts
- presents with erythema multiforme, erythema nodosum, lung cavities
- fluconazole
What is associated with vocal cord paralysis?
Difficult breach delivery
- vocal cord paralysis may occur due to injury of the recurrent laryngeal nerve
Vit ADEK deficiencies cause…
Night blindness is an early manifestation of vitamin A deficiency. Impaired immunity and hematopoiesis can occur in addition to the ocular changes.
Vitamin D deficiency is associated with impaired bone mineralization, which is associated with rickets in children and osteomalacia and osteoporosis in adults.
Vitamin E deficiency can cause hemolytic anemia and neurologic deficits.
Vitamin K deficiency can manifest as easy bruising and/or bleeding.
Alpha 1 antitrypsin in children
Liver disease in children and adults
Lung disease is ONLY in adulthood.
Children get liver fibrosis and cirrhosis.
Whereas pulm is in 4th and 5th decades of life.
Expected respiratory compensation for given degree of metabolic acidosis
Winter’s Formula
pCO2 = (1.5 * HCO3 + 8) +/- 2
If it’s lower, its a primary disorder
Tx of epiglottitis
Stabilize Airway - AKA 100% O2 until expert help arrives.
How to estimate CO in a pt with cardiogenic shock?
Measure mixed venous O2 saturation from an internal jugular venous catheter (central catheter)
Bc arterial oxygen content can be obtained from pulse ox.
Oxygen delivery = Arterial oxygen content × Cardiac output
Cardiac output = Stroke volume × Heart rate
Oxygen content = (1.34 × hemoglobin concentration × % oxygen saturation) + 0.003 × PO2
Oxygen consumption = Cardiac output × (arterial oxygen content - mixed venous oxygen content)
Oxygen consumption is a constant in pts who are like not moving and shit.
