Pulmonary Flashcards
Bilateral Hilar Lymphadenopathy Increased ESR and ACE Maculopapular Rash Non-Caseating Distal Granulomas with Ground Glass on CT Panda Sign
Sarcoidosis: Idiopathic increase in CD4 and decrease CD8. Presents like TB with SOB but skin is the second most commonly affected site
Panda Sign on Brain CT is pathopneumonic
Clubbing of Fingers & Toes
Decreased Perfusion:
Lung Cancer (NOT COPD!! if a COPD pt has clubbing, look
for another cause)
Cystic Fibrosis
Endocardidtis (specifically left sided)
Cyantotic Congenital Heart Diseases
Rx for mild persistent Asthma
Inhaled Steroids is the backbone of Rx for persistent asthma.
Budesonide (Pulmocort)
Triamsinolone (Asthmacort)
Albuterol is an add on for all stages but intermittent Asthma
Differentiates Dyspnea due to Respiratory Causes from that due to Cardiac Causes
BNP
If elevated, look to heart failure/pulmonary edema as opposed to a respiratory cause for shortness of breath.
Normal BNP is age dependent, higher in elderly. If BNP is normal, we exclude heart failure for SOB cause.
Long term risk of steroid use
Osteoporosis
MAIN Risk of discontinuing Steroids abruptly
Adrenal Insufficiency even to emergency
ARDS Sxs Rx & Causes
Use low tidal volumes with positive pressure PEEP to oxygenate
Opacification of both lung fields
Trauma Sepsis & Trauma leading etiology but transfusion can do it.
Multiple organ failure, esp kidney
Most common organism causing community acquired pneumonia in children under 5
1 = RSV in under 5s
VIRUSES!
Prolonged Expiration & FEV1 should make you think:
Asthma & COPD
placement for a needle aspiration in tension pneumo
2nd ICS mid-clavicular line
Rx for pneumocysistis Jerovecci
Bactrim DS
Unilateral Apical/Supraclavicular Mass, think:
Lung Cancer specifically Squamous Cell
Metastisizes to regional lymph nodes and causes pleural effusion
Exudative vs Transudative Pleural Effusion
Exudative: fluid moves from peritoneal to pleural space
High protein content. TB & Lung Cancer, INFLAMMATION of lung tissue.
Transudative: Occurs in the Absence of pleural disease, low protein, heart failure, low serum protein, hypothyroid, pulmonary embolism CHF, Nephrotic Syndrome
Use Amantidine for
Parkinsons but no longer for Flu due to resistance. Replaced by Tamiflu.
When used for Parkinsons it’s called Mimantidine
Diagnosed with Guillion Barre, get tested for:
HIV
Kerly B Lines are seen in
Pleural Effusion
Think either CHF or Fluid Overload if you have an IV in.
TB Drug with Vision Loss effect:
Ethambutol
E for Eye
Causes scotoma - loss of red/green vision and decreased acuity
PopCorn Lesion of the lung
Lung Haratoma
Haratomas are benign neoplasms and grow in various tissues. Usually made of connective tissue or adipose, They’re just extra tissue and are only problematic when they press on things.
Lung haratomas are the most common sort and are white and look popcorn shaped.
Panda Sign on MRI
Sarcoidosis
Pleural Fluid Contents in Bacterial Pneumonia
High Protein - we’re third spacing fluid in the
lobes, likely holes drilled by bugs
High LDH - as compared with serum.
LDH ratio over 0.6 is EXUDATIVE
meaning its from Inflammation
i.e. from INFECTION
LDH ratio under 0.6 is
TRANSUDATIVE i.e. from low
serum protein and 3rd spacing
NO Infection
High Specific Gravity means there’s lots of stuff
in it - as in bacteria…
TB usually appears where in the lung?
Apices
Night Sweats/ Fever/ Cough, Wt. Loss
Increased Tactile Fremitus vs Decreased
Increased vibration on touch 99 with DULNESS TO PERCUSSION indicates consolidation (as do increases in all special pneumo tests). This indicates Consolidation
DEcreases in vibration and pitch/intensity on special testing and DULLNESS TO PERCUSSION indicate Fluid in the lung, think
Effusion, like a sponge dampening the sound and vibration.
Asthma would also be decreased but percussion would increase as the lung would be full of air, like a drum. Anything in there but air reduces percussion. Since normally there’s a nice balance of moist tissue and air, normal is not drum-like.
TB vs Sarcoidosis
TB: Uni or BiLateral Caseating Granuloma
Apical Cavitations before hilar
Bacterial, Airborne
Cavity formation in the lung tissue
No particular ethnicity
Chronic cough, may be bloody
Fever, Malaise
NIGHTSWEATS + WEIGHT LOSS
Rx is INRE Abx regimen
Isoniazid
N
Rifampin
E... has eye side effect
PPD + for TB is 15mm or 5mm for HIV+
Sarcoidosis: BiLateral NON-Caseating Hilar
Granuloma
AutoImmune
No Cavities but Lymph Node Granuloma
SOB more than cough
cough is mild +unproductive
low fever malaise
African American prevalence
Rx is corticos
Female, African American + Short of Breath, maybe a mild cough… Hilar/peritracheal lymphadenopathy and increased Ace levels
think:
Sarcoidosis
