Pulmonary Flashcards
DIAGNOSIS-WHEEZING, SHORTNESS OF BREATH, COUGH, CHEST TIGHTNESS
P.ASS.- WORSE AT NIGHT, NASAL POLYPS (SENSITIVE TO ASPIRIN), ECZEMA OR DERMATITIS,INCREASED FEV
INTIAL TEST- SYMPTOMATIC
ACC. TEST-
INITIAL TEST-ASYMPTOMATIC
INTIAL TREAT- 1 OF 6 POSSIBLE (ALWAYS STEPWISE)
INTIAL TREAT- 2 OF 6 POSSIBLE (ALWAYS STEPWISE)
INITIAL TREAT- 3 OF 6 POSSIBLE (ALWAYS STEPWISE)
INITIAL TREAT- 4 OF 6 POSSIBLE (ALWAYS STEPWISE)
INITIAL TREAT- 5 OF 6 POSSIBLE (ALWAYS STEPWISE) MAYBE SKIPED
INITIAL TREAT- 6 OF 6 POSSIBLE (ALWAYS STEPWISE)
ASTHMA
ASTHMA
ER:PEAK EXPIRATORY FLOW (PEF) OR ARTERIAL BLOOD GAS (ABG) AND CXR (EXCLUDES: PNEUMONIA,PNEUMOTHORAX, CHF)
PFT- DECREASED FORCED EXPIRATORY VOLUME IN 1 SEC (FEV 1):FORCED VITAL CAPACITY (FVC) OR INCREASE FEV1 12%/200ML WITH ALBUTEROL
20% DECREASE IN FEV1 WITH METHACHOLINE OR HISTAMINE (METHACHOLINE CHALLENGE TEST)
SHORT ACTING BETA AGONIST (SABA)-ALBUTEROL, PIROBUTEROL, LEVALBUTEROL
ADD: LONG ACTION CONTROL AGENT (LACA)- LOW-DOSE INH. C.STERIODS (ICS), CROMOLYN NEDOCROMIL (MAST CELL INH), LT MOD.(e.g. MONTELUKAST)
ADD: LABA AND SABA OR INCREASE ICS DOSE
MAX DOSE: ICS + SABA AND LABA
ADD: OMALIZUMAB IF IGE IS INCREASED
ADD: ORAL PREDNISONE
TIP- ROPD=ASTHMA (REVERSABLE FORM OF COPD)? TURE OR TRUE
TIP-ROPD ETIOLOGY?
TIP- LESS USED ASHTMA OR CO- TESTED
TIP- INH. STERIOD SIDE EFFECTS-
TIP- ZAFIRLEUKAST SIDE EFFECTS-
TIP- ZILEUTON BEST FOR WHAT TYPE OF ASTHMA?
TIP- NAME TWO LABA’S
TIP- SIDE EFFECTS OF ORAL C.STEROIDS
TIP- OTHER DRUG THAT MAYBE USED IN ROPD BUT NOT CLEAR ONLY FOR COPD
TIP- ALWAYS PNEUMO VACCINE IN ASTHMA PT.? TRUE OR FALSE
TRUE
ATOPIC: ALLERGIC RHINITIS, INFECTION/COLD AIR, STRESS OR EXERCISE, CATAMENIAL, TAB AND PHARM, GERD OR OBESTIY MAINLY UNKOWN
INCREASE DLCO, CBC=EOSINOPHILIA,SKIN TEST, IGE=ALLERGY ETIOLOGY(GUILD TO OMALIZUMAB OR ASPERGILLOSIS)
DYSPHONIA AND ORAL CANDIDIASIS
HEPATOTOXIC AND P.ASS. CHURG-STRAUSS SYNDROME
ATOPIC
SALMETEROL OR FORMOTEROL
OSTEOPOROSIS, CATARACTS, ADRENA SUPPRESSION, CUSHING SYNDROME
ANTICHOLINERGICS
TRUE
INITIAL TEST: ACUTE ASTHMA EXACERBATION:
INITIAL TREAT: ACUTE ASTHMA EXACERBATION-
RESPIRATORY RATE= SEVERITY, PEF (APPX. FVC) AND ABG (A-a GRDIENT INCREASE), CXR (EXLUSION)
OXYGEN, ALBUTEROL, BOLUS OF STEROIDS (ONSET:4-6 HRS)»OTHERS:IPRATROPIUM> EPINEPHRINE>MAGNESIUM NO RESP:INTUBATION
DIAGNOSIS-SHORTNESS OF BREATH, COUGH, SPUTUM, BARREL CHEST, MUSCLE WASTING/CACHEXIA
INITIAL TEST-
ACC. TEST-
P.ASS.-
INTIAL TREAT-
COPD
CXR(FLATTENED DIAPHRAGMS)
PFT: DECREASED FEV1:FVC RATIO (UNDER 70%) INCREASED TLC, DECREASE DLCO(NOT IN BRONCHITIS)
RES. ACIDOSIS, INCREASED HEMATOCRIT (CHRONIC HYPOXIA) EKG: R. HEART HYPERT., AFIB ECHO: PULMONARY HYPERTENSION, HYPTERTROPHY
QUIT SMOKING, O2 (PO2 <88% 60&90 W/COMP.), SYMPTOMS: SABA+ANTICHOLINERGICS, STEROIDS, LABA, P. REHAB. AND TRANSPLANT
TIP- ETIOLOGY AND DIFF FROM ASTHMA IN COPD?
TIP- REVERSIBILITY OF COPD
TIP- TRUE OR FALSE: NOT ALL COPD ARE ASSOCIATED WITH INCREASED PCO2 AND HYPOXIA
ALHPA1 AT DEF./TABACCO (DESTROYS ELASTIN MAKES LUNG LOOSE), TOTAL LUNG CAPACITY IS INCREASED IN COPD
12% INCREASE AND 200ML FEV1 TO ALBUTAROL ( 50% OF COPD WILL HAVE SOME DEGREE OF RESPONSE)
TRUE
DIAGNOSIS- INCREASED SHORTNESS OF BREATH, (LIKE ACUTE ASTHMA EXACERBATION), FEVER
INITIAL TREAT-
COPD-AECB ACUTE EXACERBATION CHRONIC BRONCHITIS(AECB)
LABA+ICS + ANTIBIOTICS (FIRST:MACROLIDES+CEPHALOSPORIN>QUINOLONES>AMOX/CLAV SEC.:DOXY>TMP-SMX
TIP- O2 TREATMENT CRITERIA IN COPD (O2 US IS PORPORTIONAL TO DECREASED MORTALITY)
TIP- HYPOXIC DRIVE (HOW TO MANAGE O2 FLOW)
PO2 <60 AND SAT 90%
SLOW: 21%+1L=25%+1L=29%…etc (ONLY NON-REBREATHER=100%) TILL ABOVE 90% SAT
DIAGNOSIS- PURULENT SPUTUM PRODUCTION, DYSPNEA, WHEEZING: WEIGHT LOSS, ANEMIA, RALES,CLUBBING OF FINGERS, DYSKINETIC CILIA SX
INITIAL TEST-
ACC. TEST-
INTIAL TREAT-
BRONCHIECTASIS
CXR (THICK DIALATED BRONCHI “TRAM-TRACK”) AND SPUTUM CULTURE IF INFECTION IS SUSPECTED
HD-CT SCAN
CUPPING AND CLAPPING (CHEST PHYISIOTHERAPY), TREAT INFEC (MAYBE M.AVIUM)+ INH ANTIBIO WORK BEST+ ROTATE ANTIBIO LAST: SURGICAL RESECTION
TIP- BRONCHIECTASIS=WEAK LARGE BRONCHI DILATION? TRUE OR FALSE
TIP- ETIOLOGY OF BRONCHIECTASIS
1 CYSTIC FIBROSIS (50% OF TIME), OTHER:INFECTION(TB,PNEUMONIA, ABSCESS) IMMUNE DEF., FOREIGHN BODY OR TUMORS, ABPA, RA (COLLAGEN)
TRUE
DIAGNOSIS-ASTHMATIC, BROWN-FLECKED SPUTUM, AND TRANSIENT INFILTRATES ON CXR
INITIAL TEST-
INITIAL TREAT-
ABPA
PERIPHERAL EOSINOPHILIA, SKIN TEST TO ASPERGILLUS ANTIGENS, ASPERGILLUS ANTIBODIES,IGE,CXR/CT
PREDNISONE (IF SEVERE), INH STEROIDS ARE NOT EFFECTIVE IN ABPA, ITRACONAZOLE ORALLY FOR RECURRENT
TIP- ABPA
TIP-ABPA IS WHAT?
P.ASS.- ASTHMA, ATOPIC DISEASE
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
REACTION TO FUNGAL ANTIGENTS THAT COLONIZE THE BRONCHIAL TREE
ABPA
TIP- HEMOPTYSIS AND WHAT LUNG DISEASES?******
ABPA, BRONCHIECTASIS, COPD, CANCER, TB,PNEUMONIA
DIAGNOSIS- YOUNG ADULT (33% ADULTS),CHRONIC LUNG DISEASE:BRONCHIECTASIS..etc AND INFECTIONS (SINUS PAIN AND POLYPS)
P.ASS.-
INITIAL TEST:
TIP- OTHER TESTS?
INITIAL TREAT-
CF
GI:MECONIUM ILEUS,PANCREATIC INS./MALABS, RECUR PANCREATITIS, OBSTRUCT, BILL CIRROSIS GU:
INFERTITLIY (M&W),AZOOSPERMIA, (NO VAS DEFERENS)
INCREASED SWEAT CHLORIDE TEST(PILOCARPINE HELP PRODUCE SWEAT (60MEQ/L MULTIPAL TESTS)
CXR/CT MIGHT SHOW P.ASS. BRONCHIECTASIS, PNEUMOTHORAX, SCARRING ATELECTASIS PFT (MIXED)HYPERINFLATION, ABG, CULTURE
ANTIBIOTICS, INH. RECOMBINANT HUMAN DEOXYRIBONUCLEASE(RHDNASE), BRONCHODILATORS,VACC, LUNG TRANSPLANT
TIP- NUETROPHILS IN CF DUMP DNA INTO AIRWAY
DIAGNOSIS- FEVER,COUGH,DYSPNEA,(DULLNESS TO PERCUSSION/EFFUSION),TACHYPNEA
PNEUMONIA
P.ASS- COPD
P.ASS-RECENT VIRAL INFECTION(INFLUENZA)
P.ASS- ALCOHOLISM, DIABETES (HEMOPTYSIS “CURRANT JELLY” SPUTUM)
P.ASS-A POOR DENTITION, ASPIRATION (FOUL-SMELLING “ROTTEN EGGS” SPUTUM)
HAEMOPHILUS INFLUENZAE
S. AUREUS
KLEBSIELLA
ANAEROBES
P.ASS-YOUNG, HEALTHY PATIENTS (DRY COUGH,BULLOUS MYRINGITIS)
P.ASS-HOARSENESS
P.ASS-CONTAMINATED WATER SOURCES, AIR CONDITIONING, VENT SYS. (GI SYM.:ABD PAIN, DIARRHEA OR CNS:HEADACHE, CONFUSION)
P.ASS-BIRDS
MYCOPLASMA PNEUMONIAE
CHLAMYDOPHILA PNEUMONIAE
LEGIONELLA
CHLAMYDIA PSITTACI
P.ASS-ANIMALS AT THE TIME OF GIVING BIRTH, VET, FARMERS
P.ASS- AIDS <200 CD4 CELLS
TIP- CHEST PAIN FROM PNEUMONIA CHANGES WITH RESPIRATION
COXIELLA BURNETII
PNEUMOCYSTIS
TRUE
TIP- PNEUMONIA VS BRONCHITIS
TIP- ACUTE BRONCHITIS ETIOLOGY
TIP- CHRONIC BRONCHITIS CRITERIA
P.ASS- DRY OR NON-PRODUCTIVE COUGH (BECAUSE THEY STAY IN THE INTERSTITIAL SPACE/ ALVEOLI EMPTY)
PNEUM-DYSPNEA, HIGH FEVER AND ABNOR. CXR; BRONCHITIS-DYPNEA, FEVER AND NORM CXR (COUGH MAYBE PRODUCTIVE OR NOT IN ACUTE FORM)
90% VIRAL AND 10% BACTERIAL
IRRITANT TO LARGE-MED BRONCHI, 3 CONSECUTIVE MONTHS EACH YEAR FOR TWO YEARS
MYCOPLASMA,VIRUSES, COXIELLA,PNEUMOCCTIS, CHLAMYDIA
INITIAL TEST- STEP 0 OF 2 PNEUMONIA
INITIAL TEST- STEP 1 OF 2 PNEUMONIA TYPICAL AND ATYPICAL
INITIAL TEST- STEP 2 OF 2 PNEUMONIA TYPICAL
INITIAL TEST- STEP 2 OF 2 PNEUMONIA ATYPICAL
SEVERITY OF DISEASE
CXR- LOBE CONSILIDATION IN TYPICAL; NONTYPICAL HIDE INTERSTITIAL SPACE (SCATTERED AIR SPACES)
SPUTUM GRAM STAIN FOR TYPICAL;
NONTYPICAL HIDE (LEUKOCYTOSIS,BLOOD CULTURES,THORACENTESIS/EMPYEMA:PLEURAL EFFUSION (LDH >60%,PROT.>50%,WBC1000/MICROL OR Ph<7.2)
TIP- IF TESTS AND TREAT FAIL IN PNEUMONIA DO A?
BROCHOSCOPY
INITIAL TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO MYCOPLASMA PNEUMONIA
INITIAL- TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO CHLAMYDOPHILA
INITIAL TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO LEGIONELLA
PCR, COLD AGGLUTINS,SEROLOGY, SPECIAL CULTURE MEDIA
RISING SEROLOGIC TITERS
URINE ANTIGEN, CULTURE ON CHARCOAL YEAST EXTRACT
INITIAL TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO CHLAMYDIA PSITTACI
INITIAL TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO COXIELLA BURNETII
INITIAL TEST- STETP 2 OF 2 PNEUMONIA ATYPICAL HX LEADS TO PCP
RISING SEROLOGIC TITERS
RISING SEROLOGIC TITERS
BRONCHOALVEOLAR LAVAGE (BAL)
TIP- ITS NOT NESSESARY TO CONFIRM WHAT TWO PNEUMONIA
TIP- TREATMENT OF PNEUMONIA IS DRIVEN BY SEVERITY
INITIAL TREAT- STEP 1 OF 2: PNEUMONIA HOSPITALIZATION
TIP- HOSPITALIZATION PNEUMONIA
INITIAL TREAT- STEP 2 OF 2 OUT PATIENT PNEUMONIA NO ANTIBIOTICS IN PAST 3 MONTHS + MILD SYMPTOMS
INITIAL TREAT- STEP 2 OF 2 OUT PATIENT PNEUMONIA ANTIBIOTICS IN PAST 3 MONTHS + COMORBIDITIS
MYCOPLASMA OR CHLAMYDOPHIA (JUST TREAT)
TRUE
BP(SYS30/MIN OR PO2250MG;PULSE>125;CONFUSION, TEMP104C AGE 65
=CURB65
MACROLIDE OR DOXYCYCLINE
FLUOROQUINOLONE
INITIAL TREAT- IN PATIENT PNEUMONIA
INITIAL TREAT- IN PATIENT PNEUMONIA WITH LARGE EFFUSION(PH
FLUOROQUINOLONE
TREAT LIKE ABCESS MUST PLACE CHEST TUBE FOR SUCTION TO DRAIN!
EX:PH60%,PROTEIN >50% (EXUDATE IS CAUSED BY INFECTION AND CANCER)
65+,DISEASE:HEART,LUNG, LIVER,HEMETOLOGIC, ANAPLASTIC ANEMIA,IMMUNOSUPPRESSION:DM,ALC.,C.STEROIDS,AIDS/HIV,CSFLEAK OR COCHLEAR
DIAGNOSIS- CHEST PAIN, DYSPNEA, FEVER: AFER 48HRS ADMISSION TO HOSPITAL
INTIAL TREAT-
HAP
NOT MACROLIDS; GRAM NEGATIVE: ANTIPSEUDOMONAS- CEPHALOSPORIN/PENICILLIN(W/B-ASE) OR CARBAPENEMS
DIAGNOSIS- PATIENT OF VENTILATOR: FEVER, NEW INFILTRATE ON CXR, PURULENT SECRETIONS (FROM ET TUBE)
INITIAL TEST-
INITIAL TREAT-
VAP
LEAST ACC. TO MOST ACC. FOR VAP= TRACHEAL ASPIRATE, BAL,PROTECTED BRUSH SPECIMEN BAL, VIDEO ASSISTED THORACOSCOPY(VAT) VERY INVASIVE
COMBINE 3 DRUGS:ANTIPSEUDOMONAL BETA-LACTAM+AMINOGLY OR FLUOROQ.+MRSA DRUG (E.G. VANC.)
TIP- IMIPENEM SIDE EFFECTS
SEIZURES & KIDNEY FAILURE
DIAGNOSIS- BRONCHOASPIRATION, LARG-VOLUME SPUTUM THAT IS FOUL SMELLING
INTIAL TEST-
ACC. TEST-
INITIAL TREAT-
LUNG ABSCESS
CXR
CT; ETIOLOGY: BIOPSY
CLINDAMYCIN OR PENICILLIN
TIP- LOOK FOR STROKE;NO GAG REFLEX;INTOXICATION; ENDOTRACHEAL INTUBATION
LUNG ABSCESS UPPER LOBE WHILE LYING FLAT
DIAGNOSIS-HIV “+” CD4 CELL <200; DYSPNEA ON EXCERTION, DRY COUGH AND FEVER
INITIAL TEST- PCP
ACC. TEST- PCP
INITIAL TREAT- PCP
PCP OR P. JIROVECI PNEUMONIA
CXR (BILATERAL INTERSTITIAL INFILTRATES)
ABG(HYPOXIA A-a GRADIENT), LDH ELEVATED, SPUTUM STAIN IF NEGATIVE:BRONCHOSCOPY
BRONCHOALVEOLAR LAVAGE (BAL)
TMP/SMX (ALSO FOR PROPHYLAX)+ STEROIDS IN SEVER CASES (PO235) ATOVOQUONE IN MILD PCP
TIP- LDH IS ALWAYS HIGH IN PCP TIP- ALTERNATIVE TO TMP/SMX IN PCP TIP- TMP/SMX SIDE EFFECTS? TIP-PRIMAQUINE IS CONTRAINDICATED IN? TIP- PROPHYLAX PCP TIP- HIV "+" CD4
TRUE CLINDAMYCIN AND PRIMAQUINE OR PENTAMIDINE RASH AND BONE MARROW SUPPRESSION G6PD TMP/SMX OR ATOVAQUONE OR DAPSONE AZITHROMYCIN
DIAGNOSIS-IMIGRANT, PRISONER, HIV, HEALTHCARE, EXPOSED, STEROID, HEME, IMM DEP + FEVER NIGHT SWEATS, WEIGH LOSS, HEMOPTYSIS
INITIAL TEST-
ACC. TEST-
INITIAL TREAT-1-2
TB
CXR, SPUTUM STAIN & CULTURE FOR ACID FAST RUN 3 TIMES
PLEURAL BIOPSY
SMEAR “+” TB= 4 DRUGS: RIFAMPIN, ISONIAZID, PYRRAZINAMIDE, ETHAMBUTOL (FIRST 2 MONTHS) THEN RIFAMPIN AND ISONIAZID (4 MONTHS)
SMEAR “+” AND KNOWN SENSITIVE TB= 3 DRUGS: RIP NO ETHAMBUTOL
TIP- PREGNANT TB DO NOT USE PYRAZINAMIDE OR STREPTOMYCIN
TIP- WHEN TP TREATMENT EXTENDS FROM 6 TO 9 MONTHS
TIP- SIDE EFFECTS OF TB DRUGS?
TIP-RIFAMPIN/ISONIAZID/PYRAZINAMIDE/EHTAMBUTOL-TOX AND MANAGEMENT
TRUE
OSTEOMYELITIS, MILIARY TB, MENINGITIS, PREGNANCY OR PYRAZINAMIDE NOT USED
ALL HEPATOTOXIC (STOP ONLY IF ALT/AST >3 TO 5 TIMES NORMAL)
R-RED COLOR-NON/I-NEUROPATHY-PYRIDOXINE/P-HYPERURICEMIA-NONE/E-OPTIC NEURITIS,COLOR VISION-DECREASE DOSE RENAL F.
TIP- STERIODS IN TB + SUSPECTED PERICARDITIS
TIP- PPD TEST IS “+” ? 3 CATEGORY POSITIVE
TIP- PPD TWO STAGE?
TIP- OTHER TEST LIKE PPD?
TIP- LATENT TB = PPD “+” WHAT NEXT?
TRUE
5MM: HIV, STERIOD USERS,EXPOSED,CXR CALC.,ORGAN TRANS REC, 10MM:IMMIGRANTS,PRISONER,HEALTH CARE, HEME/ONCO 15MM:NO RISK
FIRST TIME PPD TEST= 2 TESTS WITHIN 1 TO 2 WEEKS
INTERFERON GAMMA RELEASE ASSAY (IGRA)
- EXLCUDE ACTIVE TB WITH CXR 2. ISONIAZID FOR 9 MONTHS 3.ADD PYRIDOXINE
DIAGNOSIS-LUNG NODULE:<1CM, NO ADENOPATHY, DENSE, CENTRAL CAL,NORMAL PET
BENIGN
DIAGNOSIS-LUNG NODULE: >40YRS,ENLARGING,SMOKER, SPICULATED BORDER,>2CM,ATELECTASIS, ADENOPATHY, SPARSE, ECCENTRIC CAL
MALIGNANT
TIP-BIOPSY ALL ENLARGING LESIONS
INITIAL TREAT- HIGH PROBABILITY MALIGNANT NODULE
INITIAL TREAT-INTERMEDIATE PROBABILITY NODULE
TRUE
RESECT
SPUTUM CYTOLOGY: “+”=RESECT, BRONCHOSCOPY:CENTRAL TRANSTHOR NEEDLE BIOPSY:PERIPHERAL,PET, VATS
DIAGNOSIS- DYSPNEA, WORSENING ON EXERTION, FALES, P2 HEART SOUND,CLUBBING OF FINGERS
PULMONARY FIBROSIS
TIP- ETIOLOGY PULMONARY FIBROSIS
IDIOPATHIC,RADIATION,DRUGS: (BLEOMYCIN, BUSULFAN,AMIODARONE, METHYLSERGIDE, NITROFURANTIOIN, CYCLPHOS) PNEUMOCONIOSES(IFIP)
DIAGNOSIS- P.FIBROSIS,COAL EXPOSURE***
DIAGNOSIS-P.FIBROSIS, SANDBLASTING, ROCK MINING,TUNNELING*****fix’em
DIAGNOSIS-P.FIBROSIS, SHIPYARD, PIPE FITTING ,INSULATORS
DIAGNOSIS-P.FIBROSIS, COTTON EXPOSURE
DIAGNSOS-P.FIBROSIS, ELECTRONIC MANUFACTURE
DIAGNOSIS-P.FIBROSIS, MOLDY SUGAR CANE
COAL WORKERS PNEUMOCONIOSIS SILICOSIS ASBESTOSIS BYSSINOSIS BERYLLIOSIS BAGASSOSIS
INITIAL TEST- P.FIBROSIS
ACC TEST- P. FIBROSIS
TIP- ECHO ON P. FIBROSIS SHOWS?
INTIAL TREAT- P.FIBROSIS
CXR, HD-CT SCAN IS MORE ACC. THEN PFT:DECREASED EVERYTHING (RATIO IS PORPORTIONAL)
LUNG BIOPSY
P. HYPERTENSION AND RIGHT VENTRICULAR HYPERTROPHY
ONLY BERYLLIOSIS RESPONDS TO STERIODS (B.C. IT IS COMPOSED OF GRANULOMAS) OR P.ASS. INFLAMATION
DIAGNSOS- AFRICAN A. WOMEN, SHORTNESS OF BREATH,RALES, ERYTHEMA NODOSUM, LYMPHADENOPATHY
P.ASS. PAROTID GLAND ENLARGEMENT, FACIAL PALSY, HEART BLOCK, AND RESTRICTIVE CARDIOMYOPATHY,CNS INVOLVED,IRITIS AND UVEITIS
INTIAL TEST-SARCOIDOSIS
ACC. TEST- SARCOIDOSIS
INITIAL TREAT-SARCOIDOSIS
SARCOIDOSIS
SARCOIDOSIS
CXR (HILAR ADENOPATHY), ELEVATED ACE LEVEL 60%,HYPERCALCEMIA:20%, HYPERCALCURIA,PFT:RESTRICTIVE
BIOPSY:(NONCASEATING GRANULOMAS)
PREDNISONE ONLY IN SYMPTOMATIC PATIENTS
TIP- BRONCHOALVEOLAR LAVAGE SHOWS?=HELPER CELLS
DIAGNOSIS- ACUTE DYPNEA,NORMAL CXR AND CLEAR LUNGS:TACHY-PNEA-CARDIA,COUGH,HEMOPTYSIS,CHEST PAIN,FEVER,LOW BP
INITIAL TEST- PE 1 OF 2
INITIAL TEST-STEP 2 OF 2
ACC. TEST- PE
PE FROM DVT (70%) OR PELVIC VEINGS 30%
CXR(NORMAL/ATELETASIS, WDGE INFARCT,HAMPTON HUMP,WESTERMARK),EKG:SINUS TACH,ST-T WAVE CHANGE 5% RIGHT DEV. AND BLOCK ABG: HYPOXIA/RES.ALK
SPIRAL CT SCAN (CT ANGIOGRAM):CONFIRMS PE, V/Q IN PREGNANCY
ANGIOGROPHY (MAYBE FATAL IN 0.5%)
TIP- PE COMES FROM HEMOSTASIS:IMMOBILITY,SURGERY,TRAUMA,JOINT REPLACEMENT, THROMBOPHILIA(LEIDEN V)
TRUE
INITIAL TEST- PE STEP 1 OF 2
INITIAL TEST-PE STEP 2 OF 2
ACC. TEST- PE
TIP- PE EKG MOST COMMON IS ST-T WAVE CHANGES NOT S1Q3,T3
TIP- REMEMBER TO TREAT BEFORE CONFIRMING PE
TIP- NEGATIVE D- DIMER CAN ONLY EXCLUDE (SENSITIVE) BUT NOT SPECIFIC
TIP- LOWER EXTREMEDY DOPPLER (LE DOPPLER) 70% ACC. STILL TREAT THE SAME
TIP-HOLD TREAT IF; CT NEG. AND V/Q OR LE NEG.
TIP-ANGIOGRAPH IS RARE ALTHOUGH MOST ACC.
TRUE
INITIAL TREAT- PE
INITIAL TREAT- PE AND CONTRAINDICATED ANTICOAGULANTS,RECURRENT EMBOLI, RV DYSFUNCTION
INITIAL TREAT- PE + HEMODYNAMICALLY UNSTABLE(e.g. HYPOTENSION SYS BP
HEPARIN( OR FONDAPARINUX) + WARFARIN TO REACH THERAPEUTIC INR 2 TO 3
INFERIOR VENA CAVA FILTER
THROMBOLYTICS
DIRECT ACTING THROMBIN INHIBITORS (ARGATROBAN, LEPIRUDIN)
DIAGNOSIS-DYSPNEA, FATIGUE, SYNCOPE, CHEST PAIN, WIDE SPLITTING OF S2 LOUD P2 AND TRICUSPID AND PULMONARY VALVE INS
INITIAL TEST- 1/2
INITIAL TEST- 2/2
INITIAL TREAT-P. HYPERTENSION
PULMONARY HYPERTENSION
CXR AND CT (DILTATION OF PRIMARY ARTERIES: PRUNING),SWAN-GANZ,EKG:R.AXIS DEV.,
ECHO:DOPPLER ESTIMATES BP, V/Q:EXCLUDE PE, CBC SHOWS POLYCYTHEMIA FROM CHRONIC HYPOXIA
TX CAUSE, PG. ANALOGS(EPOPROSTENOL, TREPROSTINIL, ILOPROST, BERAPROST), ENDOTHELIN ANTAGONISTS:BOSENTAN, SILDENAFIL
TIP- PULMONARY BP >25/8 IS HYPERTENSION
TIP- ETIOLOGY P. HYPERTENSION=PRIMARY-IDIOPATHIC; SECONDARY: FROM CHRONIC DISEASE
DIAGNOSIS- HEADACHE, IMPAIRED MEMORY AND JUDGEMENT, DEPRESSION,HYPERTENSION, ED, BULL NECK
INITIAL TEST- OBSTRUCTIVE SLEEP APNEA
INITIAL TREAT- OBSTRUCTIVE SLEEP APNEA
TIP- SLEEP APNEA + INCREASED BICARB IS?
OBSTRUCTIVE SLEEP APNEA
POLYSOMNOGRAPHY
WEIGHT LOSS AND AVOID ALCOHOL,CPAP,UVULOPLATOPHARYNGOPLASTY, AVOID SEDATIVES, ORAL TONGUE APPLIANCE
OBESITY/HYPO-VENTILATION SYNDROME
DIAGNOSIS- CHEST PAIN, DYSPNEA, FEVER, BLOOD CULTURE “+” FOR INFECTION
P.ASS.-
P.ASS.-SEPSIS OR ASPIRATION, LUNG CONTUSION/TRAUMA,NEAR-DROWNING, BURNS OR PANCREATITIS
INITIAL TEST-
INITIAL TREAT-
ARDS
DECREASES SURFACTANT AND MAKES LUNG CELLS LEAKY AND ALVEOLI FILL WITH FLUID
ARDS
CXR(WHITE OUT), AIR BRONCHOGRAMS, PO2/FIO2
