Pulmonary Flashcards
Methacholine/Bronchial Challenge Test
FEV1 falls by 20%
High NPV
Bronchodilator Challenge in Asthma
increase of 12% and at least 200 mL.
Allergic bronchopulmonary aspergillosis
severe asthma
elevated IgE
positive skin tests for Aspergillus
α1-antitrypsin testing in COPD
when diagnosed under 45 years of age
Bronchiectasis Diagnosis
airway diameter greater than that of its accompanying vessel, and lack of distal airway tapering.
Break down of ILD/DPLD
- smoking related
- steroid responsive
- connective tissue related
- exposure related
Smoking Related ILD/DPLD
1) DIP: Desquamative Interstitial Pneumonia
2) RBLD: Respitoray Bronchiolitis ILD
3) PLCH: Pulmonary Langershans Cell Histiocytosis
4) Idiopathic pulmonary fibrosis
Connective Tissue ILD/DPLD
RA and systemic sclerosis are most common
Steroid Responsive ILD
sarcoidosis
organizing PNA
eosinophilia PNA
hypersensitivity PNA
Organizing Pneumonia
peripheral sparing on CT
often follows acute infection, radiation exposure, or autoimmune disease
called cryptogenic if no cause is found
Treatment of Sarcoidosis Lung Disease
depends on the stage, earlier stages can be managed with observation and may spontaneously resolve
prednisone for more severe stages
Time Frame for Asbestos Related Disease
15-35 years
Risk Factors for Asbestos Related Disease
mine works, construction, naval shipyards, automotive
Asbestos Lung Disease Imaging Findings
Pleural Plaques or calcifications
Risk Factors for Silicosis
concrete, tile, and masonry
What to consider with worsening silicosis
TB
Lights Criteria
Pleural to serum protein >.5
Pleural to serum LDH >.6
LDH>2/3 ULN
Pleural Fluid Cholesterol
> 55 consistent with exudative
pH and Pleural fluid
less than 7.2 = complicated pleural effusion
Pleural Fluid amylase evaluates for
esophageal rupture, pancreatitis
Pleural Fluid triglycerides evaluates for
chylothorax
Causes of Chylothorax
Malignancy (lymphoma)
TB
Surgery/Disruption of Thoracic Duct
How to Diagnose TB in Pleural Effusion
Adenosine deaminase (ADA)
Definition of Parapneumonic Effusion
effusion associated with a pneumonia
Prevention of Primary Pneumothoraxes versus prevention of secondary
Primary- Smoking cessation
Secondary- Pleurodesis
Complication Parapneumonic effusion
pH less than 7.2 and glucose less than 60 mg/dL
Definition of Pulmonary Hypertension
pulmonary artery pressure of 25 mm Hg or greater
Pulmonary Hypertension Class One
pulmonary artery hypertension
Pulmonary Hypertension Class Two
left sided heart disease
Pulmonary Hypertension Class Three
lung diseases and/or hypoxia
Pulmonary Hypertension Class Four
chronic thromboembolic pulm HTN
Pulmonary Hypertension Class Five
unclear or multifactorial
Pulmonary Hypertension Exam Findings
prominent –> split S2
prominent jugular venous a wave
parasternal heave
Nitric Oxide Testing in Class 1 Pulm HTN
done to see if benefit with CCB
Bosentan is for
Group 1 Pulm HTN
Pirfenidone is for
idiopathic pulm fibrosis
Pulmonary Nodule Size
Less than 3cm
Solid Pulmonary Nodule Management less than 8mm
- calculate risk
- f/u CT
Solid Pulmonary Nodule Management more than 8mm
- calculate risk
- PET scan
Types of NSCLC
adenocarcinoma, squamous cell carcinoma, and large cell carcinoma
Mesothelioma
pleural thickening or exudative pleural effusion
poor prognosis, survival 6-8 months
Masses in Anterior Mediastinum
thymoma
teratoma/germ cell tumor
“terrible” lymphoma
thyroid
Most common presentation of thymic lesion in adults
paraneoplastic syndrome such as myasthenia gravis
Masses in Middle Mediastinum
tend to be lymphadenopathy
Masses in Posterior Mediastinum
neurogenic tumors
Apnea-hypopnea index in OSA
5-15 is mild
Definition of Central Apnea in Adults
the absence of respiratory effort associated with loss of airflow for at least 10 seconds.
Risk Factors for Central Apnea in Adults
HF, A fib
Sleep-related hypoventilation syndromes
by impaired gas exchange during wakefulness that is further compromised with sleep
decrease in oxygen saturations
Obesity Hypoventilation Syndrome
- diagnosed by hypercapnia, defined as a Pco2 greater than 45 mm Hg
- caused by combination of the mechanical load on the respiratory pump and blunting of the chemoreflex (ventilatory response to carbon dioxide)
What sleep disorder do you use bilevel ventilation for
obesity hypoventilation syndrome
neuromuscular disorders
Ethylene Glycol
- antifreeze
- crystals in renal tubules –> renal damage
Methanol
- wood alcohol
- lead to retinal damage and blindness
Treatment for cyanide poisoning
Hydroxocobalamin
Medication that can treat benzodiazepine overdose
flumazenil
Cyanide Poisoning
can be from vinyl burning in house fires
Blau Syndrome
sarcoidosis
arthritis, uveitis, and rash
Lofgren Syndrome
sarcoidosis
bilateral hilar LAD, erythema nodosum + polyarthritis/athralgia
Prevention of High Altitude Pulmonary Edema
nifedipine, sildenafil
Prevention of High Altitude Cerebral Edema
dexamethasone
