Difference between revisions of "Pulmonology"
Jump to navigation
Jump to search
| (23 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
| + | =Missed Concepts= | ||
| + | *'''Bronchiectasis''' presents as frequent infections, cough with copious purulent sputum, and hemoptysis ('''most common cause overall'''). | ||
| + | *Get a speech and swallow eval in patients with evidence of aspiration pneumonia (sour taste in mouth, pulmonary consolidation surrounding an abscess with an air-fluid level). | ||
| + | *Chest PT and suctioning are used for post-op atelectasis. In patients with wheezing in the early post-operative period, think bronchospasm and consider scheduled nebulized bronchodilators. | ||
| + | *Reintubate early in a patient who develops laryngeal edema with impending respiratory failure. | ||
| + | *Chronic cough differential includes: '''foreign body''' (especially in a child) | ||
| + | *Croup/Laryngotracheobronchitis (parainfluenza) is a '''clinical''' diagnosis. '''Xray might show a steeple sign, but is not required to make the diagnosis.''' | ||
| + | *Polymyositis can be complicated by '''ILD''' | ||
| + | |||
=Obstructive Lung Disease= | =Obstructive Lung Disease= | ||
| − | + | ==[[Asthma]]== | |
| − | + | ||
| − | *COPD | + | ==[[Bronchiectasis]]== |
| + | ==[[COPD]]== | ||
| + | *COPD exacerbations with 2 of the following merit antibiotics: '''increased sputum purulence, increased sputum volume, increased dyspnea.''' | ||
| + | |||
=Restrictive Lung Disease= | =Restrictive Lung Disease= | ||
*Interstitial Lung Disease | *Interstitial Lung Disease | ||
| Line 10: | Line 22: | ||
*Eosinophilic Pulmonary Syndromes | *Eosinophilic Pulmonary Syndromes | ||
=Acute Respiratory Failure= | =Acute Respiratory Failure= | ||
| − | + | ==[[Hypoxemia]]== | |
| − | * | + | ==ARDS== |
| + | |||
| + | =Pulmonary Vascular Disease= | ||
| + | ==[[Pulmonary Hypertension]]/Cor Pulmonale== | ||
| + | ==[[Pulmonary Embolism]]== | ||
| + | *H&P: Acute onset dyspnea, hypoxia, tachycardia, chest pain. | ||
| + | *Dx: PERC criteria. Wells PE criteria. Sinus tach most common finding. Hypoxia. Pulmonary hypertension. CTA PE protocol is diagnostic. D-dimer can rule out if negative and pre-test probability is low. Initially shows respiratory alkalosis. | ||
| + | *Tx: | ||
| − | = | + | =Solitary Pulmonary Nodules= |
| − | * | + | *H&P: |
| − | * | + | *Dx: Start LD CT screening in smokers at age '''50'''. |
| + | *Tx: | ||
| + | |||
| + | =Sarcoidosis= | ||
| + | *H&P: Usually presents in young adults. Fever, cough, malaise, fatigue, weight loss, dyspnea, knee/ankle arthritis, '''hepatomegaly, Bells palsy''' | ||
| + | *Dx: '''GRUELING mnemonic''' (Granulomas, Rheumatoid arthritis, Uveitis, Erythema nodosum, Lymphadenitis, Interstitial fibrosis, Negative PPD, Gammaglobulinemia). CXR is best screening test, 90% have bilateral hilar or mediastinal adenopathy. CBC can show decreases in any of the cell lines. LFTs show elevated Alk phos. '''Mixed obstructive and restrictive pattern on PFTs'''. Ddx includes TB, lymphoma, fungal infection, idiopathic pulmonary fibrosis, HIV, berylliosis. | ||
| + | *Tx: Steroids for flares. Methotrexate for maintenance. | ||
| − | |||
| − | |||
| − | |||
=Pleural Disease= | =Pleural Disease= | ||
| − | + | ==[[Pleural Effusion]]== | |
| − | + | ==[[Pneumothorax]]== | |
| + | |||
=Pulmonary Sleep Disorders= | =Pulmonary Sleep Disorders= | ||
| − | + | ==[[Obstructive Sleep Apnea]]== | |
| − | + | ==[[Obesity Hypoventilation Syndrome]]== | |
Latest revision as of 19:55, 16 January 2023
Missed Concepts
- Bronchiectasis presents as frequent infections, cough with copious purulent sputum, and hemoptysis (most common cause overall).
- Get a speech and swallow eval in patients with evidence of aspiration pneumonia (sour taste in mouth, pulmonary consolidation surrounding an abscess with an air-fluid level).
- Chest PT and suctioning are used for post-op atelectasis. In patients with wheezing in the early post-operative period, think bronchospasm and consider scheduled nebulized bronchodilators.
- Reintubate early in a patient who develops laryngeal edema with impending respiratory failure.
- Chronic cough differential includes: foreign body (especially in a child)
- Croup/Laryngotracheobronchitis (parainfluenza) is a clinical diagnosis. Xray might show a steeple sign, but is not required to make the diagnosis.
- Polymyositis can be complicated by ILD
Obstructive Lung Disease
Asthma
Bronchiectasis
COPD
- COPD exacerbations with 2 of the following merit antibiotics: increased sputum purulence, increased sputum volume, increased dyspnea.
Restrictive Lung Disease
- Interstitial Lung Disease
- Systemic Sarcoidosis
- Hypersensitivity Pneumonitis
- Pneumoconiosis
- Eosinophilic Pulmonary Syndromes
Acute Respiratory Failure
Hypoxemia
ARDS
Pulmonary Vascular Disease
Pulmonary Hypertension/Cor Pulmonale
Pulmonary Embolism
- H&P: Acute onset dyspnea, hypoxia, tachycardia, chest pain.
- Dx: PERC criteria. Wells PE criteria. Sinus tach most common finding. Hypoxia. Pulmonary hypertension. CTA PE protocol is diagnostic. D-dimer can rule out if negative and pre-test probability is low. Initially shows respiratory alkalosis.
- Tx:
Solitary Pulmonary Nodules
- H&P:
- Dx: Start LD CT screening in smokers at age 50.
- Tx:
Sarcoidosis
- H&P: Usually presents in young adults. Fever, cough, malaise, fatigue, weight loss, dyspnea, knee/ankle arthritis, hepatomegaly, Bells palsy
- Dx: GRUELING mnemonic (Granulomas, Rheumatoid arthritis, Uveitis, Erythema nodosum, Lymphadenitis, Interstitial fibrosis, Negative PPD, Gammaglobulinemia). CXR is best screening test, 90% have bilateral hilar or mediastinal adenopathy. CBC can show decreases in any of the cell lines. LFTs show elevated Alk phos. Mixed obstructive and restrictive pattern on PFTs. Ddx includes TB, lymphoma, fungal infection, idiopathic pulmonary fibrosis, HIV, berylliosis.
- Tx: Steroids for flares. Methotrexate for maintenance.