Pulmonology

Obstructive Lung Disease

Restrictive Lung Disease

• Interstitial Lung Disease
• Systemic Sarcoidosis
• Hypersensitivity Pneumonitis
• Pneumoconiosis
• Eosinophilic Pulmonary Syndromes

Acute Respiratory Failure

Pulmonary Vascular Disease

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.
• 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

Pulmonary Sleep Disorders

Missed Concepts

• 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.