Pulmonary Flashcards
Clinical Presentation of Asthma?
- Wheezing
- Episodic Coughing
- Intermittent Dyspnea
Diagnostic criteria for Asthma?
Reduced FEV1 to FVC ratio on Spirometry
Complications of Asthma Exaberation?
- Severe Hypoxema
- Hypercapnia
- Respiratory acidosis
Treatment for Acute Asthma Exaberation?
- Supplemental Oxygen
- Inhaled Albuterol
- Systemic Corticosteriods
- Ipratropium/Magnesium Sulfate
Maintenance Treatment for Intermittent Asthma?
Intermittent Asthma= 2 episodes a wk, 2 night episodes a month, FEV1= 80%
- Treat with Inhaled B2-agonists (albuterol)
Maintenance Treatment for Mild Persistent Asthma?
Mild Persistent = 2+ episodes a wk (not daily), 3-4 night episodes a month, FEV1= 80%
- Treat with Inhaled Albuterol + Low dose corticosteriod
Maintenance Treatment for Moderate Persistent Asthma?
Moderate Persistent = Daily symptoms, Night episodes 1x a week, FEV1= 60-80%
- Treat with Low/med dose corticosteriods, Long acting inhaled B2 agonists, Quick acting inhaled B2 agonists
Maintenance Treatment for Severe Persistent Asthma?
Severe Persistent Asthma = Symptoms throughout the day, Night symptoms multiple times a week, FEV1= < 60%
- Treat with Med/High dose corticosteriods, Long acting inhaled B2 agonists, Quick acting inhaled B2 agonists
Treatment for Asthma-exaberated Respiratory disease?
- Montelukast
- Zafirlukast
Clinical Presentation of COPD?
- “Barrel chest” (increased AP diameter)
- Diminished breath sounds
- Hyperresonance on percussion
- Prolonged expiration with “pursed lips” breathing
Diagnostic Criteria for COPD?
Pulmonary Function Tests results of:
- Decreased FEV1
- Decreased FEV1/FVC ratio
- Decreased VC
- Normal DLCO in chronic bronchitis vs decreased DLCO in emphysema
- Increased TLC, RV, FRC (from trapped air)
Chest X-Ray findings in COPD?
- Flattening of the diaphram
- Hyperlucent lungs
- Elongated, tubular shaped Heart (severe)
Complications of COPD?
- Respiratory Acidosis
- Cor pulmonale
- Spontaneous Pneuothorax
Treatment of COPD symptoms?
- Inhaled and Long Acting B2- agonists
- Inhaled anti-cholinergics (Ipratropium)
- Corticosteriods (Severe only)
Indications for supplemental oxygen in COPD?
- PaO2 < 55 mmhg
- SpO2 < 88 mmhg
or presence of Cor-pulmonale or Erythrocytosis
Treatment for Acute COPD exaberations?
- Supplemental oxygen titratedto goal(SpO2) of 88 to 92%
- Inhaled bronchodilators(e.g.albuterol,ipratropium)
- Intravenous glucocorticoids
- Antibiotics
Clinical Presentation of Lung Cancer?
- Cough
- Dyspnea
- Wheezing
- Hemoptysis
- Fatigue
- Weight loss
- Paraneoplastic syndromes
Initial test for suspected Lung Cancer?
Chest CT
Definitive Diagnostic test for Lung Cancer?
Biopsy (Endobronchial ultrasound guided biopsy)
Complications of Lung Cancer?
- Metastatic Disease
- Mass effects
- Paraneoplastic Syndrome
- Pleural Effusion
Clinical Presentation of Superior Vena Cava Syndrome and most common cause?
- Facial fullness
- Edema of neck, arms, head
- JVD
Associated with small cell lung cancer
Types of Mass effects as a result of Lung Cancer?
- Superior Vena Cava Syndrome
- Horner’s Syndrome
- Pancoast Tumor
Common sites of metastasis in Lung Cancer?
- Brain
- Bone
- Adrenal Glands
- Liver
Lung Cancer that is commonly found centrally near the hilum and how to treat it?
Small Cell Lung Cancer, Treat with Chemotherapy and Radiation
Parneoplastic Syndromes associated with Small Cell Lung Cancer?
- Cushing syndrome (ectopic ACTH secretion)
- SIADH
- Ectopic growth hormone secretion
- Peripheral neuropathy
- Subacute cerebellar degeneration
- Lambert-Eaton syndrome
- Limbic encephalitis
- Dermatomyositis
Common Peripherally located lung cancer and how to treat it?
Large Cell Lung Cancer, Treat with Surgery
Paraneoplastic syndromes associated with Large cell lung cancer?
- Gynecomastia
- Galactorrhea
Centrally locateted Lung Cancer that is heavily associated with smoking?
Squamous Cell Lung Cancer
Appears as cavitating lesions on CXR
Paraneoplastic syndromes associated with Squamous cell lung cancer?
- Hypercalcemia
- Dermatomyositis
Location of Adenocarcinoma of the lung?
Peripherally located. Associated with women and not smoking
Paraneoplastic syndromes associated with Adenocarcinoma of the lung?
- Hypertrophic osteoarthropathy(a specific form of clubbing)
- DIC
- Thrombophlebitis
- Microangiopathic hemolytic anemia
- Dermatomyositis
Etiologies of Acute Respiratory Distress Syndrome?
“AAARDDDSSS”
- Aspiration
- Acute pancreatitis
- Air orAmniotic embolism
- Radiation
- Drug overdose
- DIC
- Drowning
- Shock
- Sepsis
- Smoke inhalation
Clinical Presentation of ARDS?
- Dyspnea
- Tachypnea
- Diffuse Crackles
- Tachycardia
Increased Positive End-Expiratory Pressure in ARDS causes what?
Opening of collapsed alveoli
Target partial pressure of oxygen (PaO2) and oxygen saturation (SaO2) for patients with ARDS?
PaO2= 55-80% SaO2= 88-95%
Treatment for ARDS that is refractory to standard mechanical ventilation?
Venovenous extracorporeal membrane oxygenation (ECMO)
Etiologies of exudative Pleural Effusions?
Due to increase vessel permeability:
- Lung infections (e.g., pneumonia)
- Tuberculosis
- Cancers (e.g., lung, breast, lymphoma, mesothelioma)
- Pulmonary embolism
- Impaired pleural lymphatic drainage
Etiologies of transudative Pleural Effusions?
- Increased Hydrostatic pressure (e.g., CHF)
- Decreased Oncotic pressure (e.g., nephrosis, cirrhosis)
- Injuries to the pleural lining (e.g., central venous catheter misplacement)
Clinical Presentation of Pleural Effusion?
- Dyspnea
- Pleuritic Chest Pain
- Worsens over time
Physical Exam Findings in Pleural Effusion?
- Decreased breath sounds to auscultation
- Dullness to percussion
- Decreased fremitus
- Pleural rub
- Tracheal deviation, if large
Criteria to diagnose Exudative Pleural Effusions?
- Protein/Serum Protein Ratio > 0.5
- LDH/Serum LDH Ration > 0.6
- LDH > 2/3 of the upper normal limit of serum LDH
Treatment for Pleural Effusions?
Treat underlying condition
Treatment for Parapneumonic Pleural Effusions?
- Antibiotics
- Chest tube drainage (for complicated pneumo)
Virchow’s Triad?
- Hypercoagulability
- Stasis
- Endothelial Damage
Risk Factors for DVT? (5)
- Recent surgery(especially orthopedic surgery)
- Pregnancy (current or recent)
- Cancer
- Long-distance plane travel
- Prolonged bedrest
Clinical Presentation of DVT?
- Unilateral leg pain
- Warmth
- Swelling
Diagnostic tests for DVT?
- Compression Ultrasound
- D-Dimer
Treatment for DVTs and/or Pulmonary Embolism?
- Anticoagulation (warfarin, heparin, Factor Xa inhibitors)
Treatment for DVT when anticoagulation is contraindicated (bleeding risks)?
Inferior Vena Cava Filter
Pulmonary arterial pressure above what number indicates Pulmonary HTN?
25mmHg
Cause of Secondary Pulmonary HTN?
- Cardiac (Congential defects, Lt HF, Valvular disease)
- Recurrent Thrombotic Events
- Pulm. Disease (COPD, Sleep apnea, Interstitial Disease)
Auscultation of the heart findings in Pulm. HTN?
- Loud P2 heart sound
- Right Ventricular Heave
Diagnostic test for Pulm. HTN?
- Echocardiogram
- Right Heart Catherization (Definite)
EKG Findings in Pulm. HTN?
- Right axis deviation
- Peaked P waves (P pulmonale)
- Right ventricular hypertrophy
Treatment for Primary (Idiopathic) Pulmonary HTN?
- Calcium Channel Blockers
- Prostanoids(epoprostenol, treprostinil and iloprost)
- Endothelin receptor antagonists( ambrisentan, bosentan, macitentan)
- PDE5 inhibitors(sildenafil) (Viagra)
- Lung Transplant
Non-caseating granulomas in multiple organs but most commonly the lungs characterizes what disease?
Sarcoidosis
Clinical Manifestations of Sarcoidosis?
- Skin Findings (Erythema nodosum, Lupus pernio)
- Arthrirtis
- Cough, Dyspnea, Anthralgias
- Anterior Uveitis
- Lymphadenopathy
- Interstitial Fibrosis
Diagnostic Tests for Sarcoidosis and its Findings?
Chest X-ray
- Bilateral hilar lymphadenopathy
- Interstitial infiltrates.
Lymph node biopsy is definitive
Lab Abnormalities in Sarcoidosis?
- Increased serum ACE and gammaglobulins
- Hypercalcemia and Hypercalciuria
- Increased Vitamin D
- Elevated ALP if there is liver involvement
Most Common Cardiac Compications of Sarcoidosis?
- Heart Block (3rd or 1st)
- Ventricular Arrhythmia
Treatment of Sarcoidosis?
- Spontaneous Remission (non-progressive)
- Prednisone
- Methotrexate(Trexall)
- Infliximab(Remicade)
- Lung transplantation
Health care acquired Pneumonia occurs after?
2 days after admission
Common location of Aspiration Pneumonia?
Right Lower Lobe
Risk Factors for Aspiration Pneumonia?
- GERD
- Poor dentition
- Reduced consciousness(eg,seizures, alcoholism)
- Procedures (eg,bronchoscopy, upper endoscopy, nasogastric feeding)
- Oropharyngeal muscle fatigue(eg,myasthenic syndromes, muscular dystrophy)
Treatment for Aspiration Pneumonia?
- Oral Amoxicillin/Clavulanate
- Parenteral Ampicillin/Sulbactam
Diagnostic test for Pneumonia and its findings?
- Interstitial infiltrates
- Lobar consolidation
- Cavitation
Criteria for hospitalizing a Pneumonia Patient?
CURB 65
- C: confusion
- U: blood urea nitrogen >20 mg/dL
- R: respiratory rate >30/min
- B: blood pressure systolic <90, diastolic <60
- 65: age >65 years
Outpatient Treatment for Community-Acquired Pneumonia?
- Azithromycin
- Doxycycline
Inpatient Treatment for Community Acquired Pneumonia?
- Respiratory Flouroquinolone or
- Beta-lactam + Macrolide
Give both for patients in the ICU
