UWORLD PULMONARY MEDICINE

UWORLD PULMONARY MEDICINE

What are the s/s for aspiration pneumonia?
foul smelling sputum
right lower lobe
What are the risk factors for aspiration pneumonia?
1. Altered Conciousness d/t seizures, ETOH, drug OD, CVA
2. Dysphagia d.t esophageal reflux, diverticula, obstruction
3. Neuro disorder d/t advanced dementia, Parkinsonism, myasthenia gravis
4. Sedation to procedures d/t bronchoscopy, intubation, endoscopy
What is hypersensitivity pneumonitis?
alveolar inflammation d/t repeated exposure to Ag
-most commonly birds droppings or molds w/farmers
What are s/s of acute hypersensitivity penumonitis?
cough
breathlessness
fever
malaise
4-6 hours after Ag exposure
Chronic exposure to Ags with HP can cause what with the lungs?
Pulmonary fibrosis and a restrictive lung pattern on spirometry
What are typical CXR findings in HP?
ground glass opacity or “haziness” in lower lung fields
What is tx for HP?
avoidance of exposure to Ags
What is the role of systemic corticosteroids in HP?
help speed recovery from acute sxs of HP
and are critical to severe episodes
but do not slow or reverse effects –> AVOID EXPOSURE
What is a common finding in association with asthma?
GERD
What is the most common primary trigger for asthma?
GERD
What s/s should be elicited during interview in adult-onset asthma sxs?
worst after meals
worst after exercise
worse when laying down
What should be started in adult-onset asthma which worsens after meals or at night when laying down?
PO PPI
When is Inhaled Fluticasone used?
pts with persistent asthma -sxs more than twice weekly
When is inhaled albuterol used?
acute asthma attacks for immediate relief
When are oral steroids used in asthma?
severe persistent asthma
emergency tx of asthma attacks
What are pulmonary embolism findings on ECG?
Right Axis Deviation
How is intermittent asthma dx’d?
daytime sx < 2/wk B-Agonist use<2/wk nighttime awakenings < 2/month Nl FEV1 Nl FEV1/FVC no limitations of daily activity
How is Mild Persistent Asthma dx’d?
sx > 2/wk but not daily
nighttime awakenings 3-4/month
Nl PFTs
minor limitations on daily activities
How to dx Moderate Persistent Asthma?
daily sx
weekly nighttime awakenings
FEV1: 60-80% predicted value
moderate limitations on daily activities
How to dx severe persistent asthma?
sx throughout day
frequent nighttime awakenings
FEV1<60% extreme daily activity limitations
What is therapy to intermittent asthma?
beta-agonist
What is tx for mild persistent asthma?
PRN B-agonist
Inhaled Corticosteroids
What is tx for Moderate persistent asthma?
PRN B-agonist
Inhaled corticosteroids
long acting B-agonist
What is tx for severe persistent asthma?
PRN B-agonist
Inhaled corticosteroids
long-acting B-agonist
PO Corticosteroids
What is tx for pulmonary thromboembolism?
IV unfractionated Heparin
OR
subcu LWMH
*for 5-6 days*
+
PO Warfarin

then d/c Heparin when INR reaches 2-3

How is digital clubbing described on exam?
pain in wrists
thickening of distal fingers
convex nail beds
What is Hypertrophic Osteoarthropathy?
digital clubbing
sudden onset arthropathy of wrists, hands, and joints
What is Hypertrophic Pulmonary Osteoarthropathy?
clubbing and srthropathy are attributable to underlying dz: Lung CA, TB, Bronchiectasis, or emphysema
How is compliance affected in COPD?
loss of alveolar and elastic tissue increases compliance
What are the effects of barrel chest and flattening of diaphragm?
harder to decrease intra thoracic pressure during inhalation
increased work of breathing
What s/s favor obstructive lung dz?
cough, SOB, significant smoking Hx
Bilateral wheezes, respiratory distress, accessory muscles for respiration, and prolonged expiratory time
What ABG is consistent with COPD?
Respiratory acidosis
hypercapnia
hypoxia
Nl serum pH?
7.34-7.43
What is nl serum O2?
75-100
What is nl serum C02?
35-45
What is normal serum bicarb?
22-26
What are the light criteria for defining whether pulmonary effusion is exudative?
1. pe protein/serum protein > 0.5
2. pe LDH/serumLDH>0.6
3. PE LDH > 2/3 upper limit for nl serum LDH
What are common causes of PE that are exudative?
Pulmonary embolism
malignancy
infection (pneumonia/TB)
CT dz
Iatrogenic
Transudative effusions are characterized by?
few WBCs
few RBCs
Glucose near serum levels
What causes hypoxemia in pts with pneumonia?
alveolar and interstitial inflammation
areas of V/Q mismatch
increases the alveolar-arterial oxygen gradient
What is the dx test of choice for recurrent pneumonia?
Chest CT
What are causes of recurrent pneumonia involving same region of lung?
LOCAL ANATOMIC OBSTRUCTION
-bonchial compression from CA, mediastinal adenopathy, or vascular anomaly
-Intrinsic Bronchial Obstruction-bronchiectasis, retained foreing body, bronchial stenosis

RECURRENT ASPIRATION
seizures, ETOH, drugs, GERD, dysphagia, achalasia

What are some causes of recurrent pneumonia involving different regions of lung?
Sinopulmonary dz (CF, immotile cilia)
Noninfectious (vascultis, bronchiolitis obliterans w/organizaing pneumonia)
Immunodeficiency (HIV, leukemia, decreased IGs)

David from Healtheappointments

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