Pulmonary Flashcards by lionel varela

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

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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TIP- ABPA
TIP-ABPA IS WHAT?
P.ASS.- ASTHMA, ATOPIC DISEASE

ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS

REACTION TO FUNGAL ANTIGENTS THAT COLONIZE THE BRONCHIAL TREE

ABPA

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TIP- HEMOPTYSIS AND WHAT LUNG DISEASES?******

ABPA, BRONCHIECTASIS, COPD, CANCER, TB,PNEUMONIA

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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-

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

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DIAGNOSIS- FEVER,COUGH,DYSPNEA,(DULLNESS TO PERCUSSION/EFFUSION),TACHYPNEA

PNEUMONIA

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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

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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

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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

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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

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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)

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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

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) 1. 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