Pulmonary Flashcards
Vocal cord dysfunction
Unlike asthma will have monophonic wheezing rather than polyphonic wheezing. Have abrupt onset and offset of symptoms. Evaluate with laryngoscopy.
Need for chest tube with parapneumonic effusion
- greater than one half of a hemithorax
- septations and areas of loculation
- pleural fluid pH less than 7.2
- glucose level less than 60 mg/dL
- positive pleural fluid Gram stain or culture
should be treated with antibiotics and pleural drainage
Chronic cough causes
Upper airway cough syndrome (d/t postnasal ggt), asthma, nonasthmatic eosinophilic bronchitis, GERD
Nonasthmatic eosinophilic bronchitis
Basically cough variant asthma without airway hyper-responsiveness
get sputum eosoinophils
treat empirically with inhaled steroids
Lung cancer, young people
Suspect carcinoid tumor in young-non-smoker with symptoms of endobronchial obstruction.
Incidentally found ground glass opacity
ddx: focal atelectasis, fibrosis, inflammation, atypical hyperplasia or slow growing invasive adenocarcinoma. Because could be cancer and slow growing need to follow for 5 years rather than the 2 for typical solid nodules.
Severe COPD adjunctive therapies
Can use PDE4 inhibitor roflumilast. Also azithromycin
ARDS tidal volume
6 ml/kg of ideal body wt. Plateau pressure should be below 30
Light’s criteria
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 * Serum LDH Upper Limit of Normal
Pulmonary AVMs, manifestations?
Dyspnea and hemoptysis are most common. BUT can also present with strokes and brain abscesses
Sarcoid and ACE level
DO NOT order it as it is not helpful in the diagnosis
pHTN treatment
those who show a positive response to vasoreactivity testing should be started on a CCB
