ILD

• related: Pulmonology

ILD aka Diffuse Parenchymal Lung Disease major types:

• idiopathic interstitial pneumonia (IIP)
• Interstitial Pneumonia with Autoimmune Features (IPAF)
• connective tissue disease related (CTD-ILD)
  • scleroderma (can also have UIP)
  • RA
  • sjogren
  • myositis
• drug related
• granulomatous: sarcoidosis
• others
  • HIV
  • LAM, HX

IIP

First do HR CT scan. Types:

• UIP
  • honeycombing, LL and peripheral domina

ABPA

• related: ID, Pulmonology, aspergillosis

• patients: underlying asthma, CF
• pathogenesis: sensitization to aspergillus, intense IgE and IgG mediated immune response
• sx: recurrent exacerbations. Sx of pneumonia in asthma patient unresponsive to treatment
• dx:
  • elevated Aspergillus-specific IgE
  • elevated (eg, >417 IU/mL) t

Asthma

• related: Pulmonology

Asthma

This patient has intermittent asthma symptoms (less than daily, no waking, normal postbronchodilator FEV1).  Guidelines recommend treatment with an inhaled corticosteroid (ICS) (eg, budesonide) plus formoterol as needed.  This strategy

COPD

• related: Pulmonology, Asthma
• tag: #note

MISC

• COPD treatment
• COPD clinical trials
• pulmonary rehabilitation
• lung volume reduction surgery LVRS

Epidemiology

• 5% of the U.S. population

Pathophysiology

• airflow obstruction that's not reversible
• inflammatory condition
  • cigarette smoke/irritants activate macrophage/epithelial cells
  • neutrophil chemotactic factors released
  • proteases destroys lung parenchyma

Medicine

• Keywords:: 000 Index
• Related: Step 3, Step 1, mksap, notes

Todos

• tolearn
• MKSAP todos
  • heart murmurs

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• [[Geriatric

Lung Cancers

• related: Pulmonology, lung nodules

Syndrome of inappropriate antidiuretic hormone (SIADH) can be caused by a multitude of conditions, including tumors, drugs, and disorders of the chest and central nervous system. SIADH is associated with normovolemic hyponatremia and, in this case, is caused by small cell carcinoma (Choice D). In SIADH, the urine is concentrated but the patient is not volume depl

Lung nodules

• related: Pulmonology, lung cancers

• features:

  • Rounded opacity
  • ≤3 cm in diameter (>3 cm is considered a "mass" and malignant until proven not)
  • Surrounded by pulmonary parenchyma
  • No associated lymph node enlargement, not associated with atelectasis, hilar enlargement, pleural effusion

Solid Nodule > 8 mm

• low/moderate probability: PET scan
  • PET neg: continued

Silicosis

• related: Pulmonology
• tags: #pulmonology

Overview

• pt: mining, hydraulic fracturing, sandblasting, and foundry work
• prevention: Respiratory protection (eg, particulate respirator) is the best strategy for preventing the disease
• pathology: macrophage reaction to silica by activating fibroblasts and cause collagen production
• sx:
  • 10-30 years later after exposure
  • asymptomatic
  • dyspnea on exertion, productive cough
• dx:
  • cxr: man

MAC

• related: Tuberculosis, ID, Pulmonology
• tags: #pulmonology

Overview

• new bronchiectasis, nodules: females, no smoking hx.

  • indolent, fatigue, malaise, dry cough,
  • 2 AFB sputum
  • bronchoscopy: 1 specimen

• can also be fibrocavitary : older males, smoking hx

  • cavitation
  • can mimick TB

Mycobacterium avium complex (MAC) is a group of free-living nontuberculous mycobacteria that are ubiquitous in the environment.  Human

SvO2

• related: Cardiology, Pulmonology
• tags: #note

• mixed venous O2 saturation
• measures end O2 consumption and delivery
• must be obtained from pulmonary artery catheter or another central line device
• ScvO2 (central venous O2) useful surrogate and measured via CVC in SVC, measures venous blood from upper half of body
• normal 65-70%
• If low:
  • increased demand: hyperthemia, shiver, pain, seizure
  • decreased delivery: ane

PF ratio

• related: Pulmonology

OVERVIEW

PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure (PaO2 in mmHg) to fractional inspired oxygen (FiO2 expressed as a fraction, not a percentage)

• also known as the Horowitz index, the Carrico index, and (most conveniently) the P/F ratio
• at sea level, the normal PaO2/FiO2 ratio is ~ 400-500 mmHg (~55-65 kPa)
• MD Calc is an example of an online P/F ratio calculator – however it is quite easy to do “in yo

airway management

• related: emergency medicine, ICU, Pulmonology

FiO2 and liters

• Each liter is 4% increase
• Just remember 6L = 44%, 10L = 60%

Escalation of Oxygen Delivery

1. Simple nasal cannula: up to 6L
2. High flow nasal cannula: up to 15L
3. Face mask: up to 15L. Use this if has nasal obstruction
4. Face tent: up to 15L. Use this if claustrophobic or trauma and can't use

hepatopulmonary syndrome

• related: GI, Pulmonology
• tags: #pulmonology

Hepatopulmonary syndrome is a complication of cirrhosis caused by dilation of the pulmonary vasculature in the setting of advanced liver disease and portal hypertension. A high alveolar-arterial oxygen gradient results from functional shunting. Patients with hepatopulmonary syndrome usually have

Pneumonia

• related: Pulmonology, ID, pneumonia vaccine, legionella pneumonia
• tags: #pulmonology

Symptoms

• cough, purulent sputum, pleuritic chest pain, dyspnea, chillls, fever, night sweats, weight loss
• hemoptysis: necrotizing infections, lung abscess, TB, Gm neg pneumonia
• Elderly: less immune response. More nonrespiratory response. Confusion, weakness, lethargy, falling, decreased PO intake

Pathogenesis

• Common bugs: strep, H. flu, myco

e---

date: 2021-08-15

chest tube

• related: Pulmonology, Pleural Effusion

Indications

• empyema (pus, loculation), glucose < 40, pH < 7.0 or 0.3 lower than ABG, unimproved effusion after thoracentesis
• 14 French pigtail just as good as surgical CT

Placement

• usually 4th or 5th intercostal space

1. Collection Chamber
   • collects fluid or air
   • air travels to second cha

autoPeep

• related: Pulmonology
• tags: #pulmonology

In a mechanically ventilated patient, positive end-expiratory pressure (PEEP) can be divided into extrinsic and intrinsic components.  The extrinsic component is that provided by the ventilator; the intrinsic component is that caused by air remaining in the lungs due to incomplete expiration.  Patients with obstructive lung disease (eg, asthma, chronic obstructive pulmonary disease) are at increased risk of exc

bronchiectasis

• related: Pulmonology
• tags: #pulmonology

This patient’s presentation is suggestive of bronchiectasis.  Bronchiectasis causes permanent destruction and abnormal dilation of the conducting bronchi or airways.  Patients usually present with a chronic cough productive of mucopurulent and tenacious sputum, sometimes with dyspnea and wheezing.  There is often a past history of repeated respiratory tract infections r

pulmonary auscultations

• related: Pulmonology

Palpable vibration felt on the chest wall is known as fremitus.  Sound travels faster in solids (consolidation) than in an aerated lung, resulting in increased fremitus in pneumonia.  However, pneumonia in the presence of an obstructed bronchus would not increase the fremitus.  Th

eosinophilic pneumonia

• related: Pulmonology
• tags: #pulmonology

This patient's presentation suggests eosinophilic pneumonia, which can be further divided into acute (AEP) and chronic (CEP) eosinophilic pneumonia.  AEP typically follows a rapid course and is more common in smokers.  CEP patients are usually ==nonsmokers

acute asthma exacerbation

• related: Pulmonology
• tags: #pulmonology

This patient has an acute asthma exacerbation most likely due to a viral upper respiratory infection.  Several published treatment guidelines recommend the use of systemic corticosteroids for the following:

• All moderate to severe acute asthma exacerbations (urgent care or emergency room settings)
• Mild exacerbations (outpatient setting) that have been **unresponsive to standard

BAPE

• related: Pulmonology, asbestosis
• tags: #pulmonology

Building demolition carries a significant risk of asbestos exposure.  Benign asbestos-related pleural effusions (BAPE) are an early pleural manifestation of asbestos-related lung disease, usually occurring between 10-15 years postexposure.  They are usually small (<500 mL), often bloody, and exudative, with eosinophilic predominance (>10% of nucleated cells, frequently >50%).  BAPE may be as

Occupational Lung Disease

• related: Pulmonology
• tags: #pulmonology

When to Suspect an Occupational Lung Disease

Occupational lung disease can affect any part of the respiratory tract, including sinuses, airways, the lung parenchyma, and the surrounding pleura. As a result, signs and symptoms associated with occupational exposure include rhinitis, reactive airways disease, COPD, pleural disease, diffuse parenchymal lung disease, and malignancy. Occupational

COPD patients have proportional pulmonary hypertension

• related: Pulmonology
• tags: #pulmonology

This patient with underlying chronic obstructive pulmonary disease (COPD) has the following signs suggesting significant pulmonary hypertension:

• Hypoxemia
• Peripheral edema
• Murmur of tricuspid insufficiency
• Prominent pulmonic component of the second heart sound

Many patients with COPD have associated pulmonary hypertension (PH).  Right heart catheteriza

rhinitis medicamentosa is rebound rhinitis from medication uses

• related: ENT, Pulmonology
• tags: #note

This patient’s presentation is consistent with rhinitis medicamentosa (RM), which is most commonly due to overuse of over-the-counter nasal decongestant sprays.  The spray’s vasoconstrictive effect requires increasing amounts of the drug for symptomatic relief due to tachyphylaxis and leads to rebound vasodilation with swelling and rhinorrhea.  Patients t

Diffuse Parenchymal Lung Disease

• related: Pulmonology, ILD
• tags: #pulmonology

Diffuse parenchymal lung diseases (DPLDs) are a group of disorders based on similar clinical, radiographic, physiologic, and pathologic changes that affect the alveolar walls and often the related small airways and distal pulmonary vasculature. Like other lung diseases, these disorders present primarily with shortness of breath. Imaging studies will typically demonstrate bilater

ICS use increases pneumonia incidence in COPD patients

• related: Pulmonology
• tags: #pulmonology

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD according to airflow limitation that is not fully reversible and abnormal inflammatory response of the lungs to noxious particles.  Inhaled corticosteroids (ICS) can decrease this inflammatory response but are not recommended for stable COPD as long-acting bronchodilators have more be

pulmonary hypertension workup

• related: Pulmonology
• tags: #pulmonology

This patient has progressive dyspnea, exercise intolerance, and chronic right ventricular (RV) pressure overload seen on echocardiography (ie, RV hypertrophy, elevated pulmonary artery systolic pressure [PASP]).  This presentation is suggestive of **

COPD clinical trials

• related: COPD, Pulmonology
• tags: #pulmonology

Resting O2

• Lancet 1981
• resting O2 reduces mortality for pts with resting hypoxemia spO2<88
• LOTT trial 2016: no decrease in time to death or time to hospitalization

Uplift

• UPLIFT 2008
• tiotopium relieves dyspnea, improves lung function, quality of life, reduces exacerbation
• no significant difference in FEV1 decline or mortality

Torch

• TORCH 2007
• ICS/LABA improved

COPD treatment

• related: COPD, Pulmonology
• tags: #pulmonology

Inhalers

Nocturnal NIPPV

• Casanove, CHEST 2000
  • NIV improves quality of life, reduces CO2 retention, reduces dyspnea
  • no change in mortality or hospitalization
• Murphy 2017:
  • prolongs time to readmission or death for patients with persistent

candida infections

• related: Pulmonology, ID
• tags: #pulmonology

Lung

Bronchial tree colonization with Candida species is common in critically ill patients receiving mechanical ventilation, but primary Candida pneumonia and invasive disease are rare.  Candida pneumonia is usually not due to aspiration of oropharyngeal secretions but rather to hematogenous spread from disseminated candidiasis (eg, osteomyelitis, septic arthritis, or endocar

bronchoscopy guides

• related: Pulmonology
• tags:

Anbu scopes

• GRAY - Slim (3.8/1.2)
• GREEN - Regular (5.0/2.2)
• ORANGE - Large (5.8/2.8)

I’ve also recently learned of Boston Scientific’s disposable scopes (though they don’t put their suction channel sizes on the website but do claim the suction power is better than the aScopes). Anesthesia already uses them at Wake. If this is something else the group wants to explore, I can request a demo. In the meant

candida pneumonia

• related: Pulmonology
• tags: #pulmonology

Bronchial tree colonization with Candida species is common in critically ill patients receiving mechanical ventilation, but primary Candida pneumonia and invasive disease are rare.  Candida pneumonia is usually not due to aspiration of oropharyngeal secretions but rather to hematogenous spread from disseminated candidiasis (eg, osteomyelitis, septic arthritis, or endocarditis).  As

legionella pneumonia

• related: Pulmonology, Pneumonia
• tags: #pulmonology

This patient’s underlying risk factors (elderly age, COPD, nursing home resident), clinical presentation (confusion, high fever with bradycardia), laboratory abnormalities (hyponatremia, thrombocytopenia, elevated LFTs), and failure to respond to vancomycin and piperacillin-tazobactam are strongly s

lung volume reduction surgery LVRS

• related: COPD, Pulmonology
• tags: #pulmonology

pulmonary rehabilitation

• related: COPD, Pulmonology
• tags: #pulmonology

Population

• severe COPD, FEV1 < 50%
• moderate COPD with symptoms or exercise limited

cryoptogenic organizing pneumonia

• related: Pulmonology
• tags: #pulmonology

Organizing pneumonia is defined by histopathologic findings of patchy proliferation of granulation tissue that affects the terminal bronchiole, and alveolar ducts and spaces, and is associated with surrounding inflammation. This pattern often follows or is associated with various types of injury to the lung, including acute infection, radiation exposure, drug-induced pneumon

use sniff test to diagnose diaphragmatic paralysis

• related: Pulmonology
• tags: #pulmonology

This patient's presentation suggests unilateral diaphragmatic paralysis likely due to phrenic nerve injury during cardiac surgery.  The phrenic nerves originate from C3-C5 to innervate the diaphragm on each side.  Unilateral diaphragmatic paralysis is more common than bilateral paralysis and is usually due to the following:

• Phrenic nerve injury during cardiac surgery

aspirin exacerbated respiratory disease

• related: Pulmonology
• tags: #pulmonology

This patient’s presentation is consistent with aspirin-exacerbated respiratory disease (AERD), as summarized in the table.  AERD affects up to 20% of adult asthmatics and usually presents with the classic triad of chronic rhinosinusitis with polyposis, asthma, and aspirin (or NSAID) sensitivity.  Patients usual

cystic fibrosis

• related: Pulmonology
• tags: #pulmonology

Diagnosis

This patient's clinical presentation is suggestive of cystic fibrosis (CF).  Cystic fibrosis is generally diagnosed in infants and children, but approximately 7% of patients are diagnosed after 18 years of age.  Adult CF patients usually present with chronic respiratory problems often labeled as asthma, COPD, and recurre

segmental anatomy

• related: Pulmonology
• tags: #pulmonology

https://radiopaedia.org/cases/lobar-and-segmental-bronchial-anatomy

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Medicine

• Related: Step 1, mksap, notes

Todos

• tolearn

Organ Systems

• Allergy and Immunology
• Rheumatology
• Cardiology
• Dermatology
• Endocrine
• ENT
• GI
• Hemeonc
• ID
• MSK
• Nephrology
• Urology
• Neurology
• Pulmonology
• Podiatry

Subject Areas

• General
• Biostats
• Psychiatry
• Geriatrics
• OBGYN
• Pediatric
• [