This test can be used for:

evaluating pulmonary nodules, distinguishing pleural thickening from pleural fluid, evaluation presence of pericradial fluid or thickening, identifying patterns in ILD, identifying intracavitary processes or detecting proximal clots in the pulmonary arteries

VQ scan

PET

MRI

CTA

Pulm angiography

Worsening of symptoms on exposure to allergen.

FH of allergic diseases

SKin tests (+) to allergens

Serum IgE may be increased

Often develop bronchospasm after a URTI and may experience worsening of symptoms on exercise or cold air exposure

(-) allergic hx

POssible increase in wheezing following viral URI or emotional stress

Previous episode of near-fatal asthma

Hospitalizations for asthma w/in the previous year

These PE findings describe what disease

Tachypnes, Tachycardia, Cyanosis, Use of accessory muscles, Pulsus paradoxus, Wheezing, prolongation o expiratory phase, hyperinflation

FVC

FEV1

FEV1:FVC

FVC, FEV1, FEV1:FVC decreased

RV & TLC increased during episodes of obstruction

reduced CO2 (hypOcarbia) & respiratory alkalosis initially

Normal or elevated CO2 is worrisome as it may demonstrated need for intubation

Albuterol (short acting)

Salmeterol (long acting-not for acute tx)

Relaxes bronchial smooth muscle (smaller airway dilation)

Rapid onset <5min

Fewer systemic SE (decreases K)

DO NOT USE

narrow therapeutic window causing cardiotoxicity

Methylprednisolone (IV)

Prednisone (PO)

require >6hr to have effect in acute asthma

Anticholinergics

(Atrovent)

Aerosolizes B2 agonist-every 20 min (3x) then every 2 hrs

Aminophylline-(no longer used in acute care)

Magnesium2-4g IV over 10-20m (inhibits Ca ch sm mm activity_

The following are indication for ________

Impending resp arrest

altered mental status

hypoxemia on mask

rising PaCO2 w/ falling pH

failure of NIPPV

aerosols have failed

Can not tolerate nebulizer tx

1:1000 subq q 20min

Group of chronic and slowly progressive respiratory disorders characterized by max expiratory flow during forced exhalation and elevated FRC

IREVERSIBLE

Destructive enlargement of airspaces distal to terminal bronchioles w/o obvious fibrosis & w/ loss of normal architecture

Decreased ability to oxygenate

Progressive dyspnea w/ late onset of nonproductive cough

Mucopurulent cough w/ 2nd infections

Progressive exercise intolerance

Cachexia & late resp failure

Thin w/ barrel chest (increase AP diameter)

Tripod position

hyperresonant chest

pursed lips

distant heart sounds

"pink puffer"

Mucus production w/ airway obstruction

undamaged pulm capillary beds early

PHTN & RHF later

Inflammatory response leading to fibrosis

Frequent & recurrent pulm infections

Alteration in mental status 2nd to hypercarbia and hypoxemia

Frequent cough & expectoration

Use of accessory muscles of respiration

Coarse rhonchi & wheezing

RHF & cyanosis

"blue bloaters"

CXR shows small heart, vertical heart

Flat hemidiaphragms

Increase in retrosternal air space (hyperinflation)

Upper lobes become hyperlucent due to trapped air

Predominantly upper lob disease

CXR shows bronchovascular markings

cardiomegaly 2nd to cor pulmonale & late biventricular failure

EKG shows Cor pulmonale:

peaked P waves in inferior leads, RAD and atrial arrythmias

Lab findings show hypxia (PO2<60mmHg)

possible hypokalemia

Polycythemia (Increase RBC mass-Hgb >15; Hct>48 (blood is sludge and could form emboli)

progressive hypoxemia

resp acidosis 2nd to hypercarbia

pH <7.3

PFTs show decreased FEV1 & FEV1:FVC

poor/absent reversibility w/ bronchodilators

Increased RV and normal or increase TLC

Improve dyspnea/exercise tolerance

Improve airflow

PaO2<55mmHg or SaO2<88%

PaO2 56-59mmHg w/ SaO2 <89% when Hct >55%

resting awak PaO2<60mmHg w/ SaO2<90% if hypoxic during sleep

Yearly influenza

Penumococcal w/ 23valent polysaccharide

Amantadine for unvaccinated ptsat risk by inluenza A outbreak

FEV1<25% predicted & w/ PHTN or RHF despite medical therapy

Priority given to pts w/ PaCO2 >55mmHg & progressive deterioration

Abnormal dilation of bronchi

Often result from bronchial injury due to infection

Sx: chronic purulent sputum, crackles

Dx: dilated tortuous airways on CT

Lung disease

Pancreatic enzyme insufficiency

High sweat chloride and Na levels

FVC normal or decreased

FEV1:FVC decreased markedly

RV increased (barrel chest)

TLC normal or increased

DLCO decreased in COPD; Normal in asthma

FVC decreased

FEV1:FVC normal or decreased

RV normal or increased

TLC decreased markedly

DLCO decreased

Pressure is applied over the ulnar and the radial arteries so as to occlude both of them.

Ulnar pressure is released and the color should return in 7 seconds.

This test is called?

Strep pneumoniae

H. influenzae

Morxella catarrhalis

Gm- bacilli

P. aeruginosa

Stap aureus

MRSA

Pseudomonas, Klebsiella, Moraxella, Haemophilus

(pink)

Admit the patient if

Confusion, Uremia(BUN>20), RR>30, BP<90/60, Age>65

Most common ILD

Risk factors include exposure to smoke, metal dust, farming dust & hairdressing chemicals

Late inspiratory crackles @ post lung bases

Signs of PHTN & clubbing occur late inc ourse

ESR elevated

Hypoxemia common

HRCT demonstrates bibasilar, peripheral reticular abormalities w/ focal honeycob cystic change

Restrictive patterb, reuced TLC, RV, VC DICO and normal or increased FEV1/FVC

Resting ABG may be normal or hypoxemis & resp alkalosis

No known current effective treatment

o2 supplementation

Lung transplant

Rheumatoid Arthritis

Scleroderma

SLE

Systemic granulomatous disease of unk etiology

Most common ILD in US

Highest incidence in blacks & north. europeans women>men

Multisystm inflammatory disorder commonly involving lungs

Fever, Mailaise, Dyspnea.  CXR shows bilaeral hilar adenopathy & R paratracheal lymphadenopathy.

All Sxs related to skin, eyes, peripheral nerves, liver, kidney or heart

ESR & hypercalcemia

elevates ACE

PFTS - decreased lung volume & diffusion capacity

ECG shows conduction disturbance and arrythmias

Corticosteroids when required

Opthalmalogic examination

Hypersensitivity Pneumonitis

aka Extrinsic Allergic Alveolitis

The following are examples of ________

Farmer's lung, Bagassosis, Bird Fancier's disease, Mushroom worker's disease, Pigeon breeder's lung, Duck fever, Turkey handler's disease, Lab workers _______, Epoxy resin lung

Avoidance of antigen

Prednisone fo 7-14d tapering off over 2-6 weeks

Acute or subacute dyspnea & cough.  1/3 of pts have preceding viral illness failing to improve despite atbx.

HRCT demonstrates non-segmental consolidations in a subpleural and peripheral distribution

The following are examples of ________

Antimony, Arsenic, Barium & drilling compounds, Cadmium dust, Cement dust, Chromium, Coal dust, coke oven emissions, graphite, iron dust, Mica, Rock dusts, Vanadium, phosphorous, sulfides, elemental chlorides

TTB skin test induration >5mm (+) in

Fever, loss of appetite, weight loss, night sweats, fatigue, blood streaked sputum.

CXR with apical localization

Caused by Pneumocustis Jirovecii

Sxs: dyspnea, fever, non-productive cough, hypoxemia

CXR: diffuse, bilateral, symmetrical interstitial infilatrates

Caused by the dimorphic fungus Histoplasma capsulatum.

Sxs: Fever, fatigue, weight loss, hepatosplenomegaly, and lymphadenopathy. Cough, chest pain, and dyspnea may also occur (sxs mostly limited to resp tract in HIV)