PE (Pulmonary Circulation)Definition | Etiology Arises from thrombi in the systemic venous circulation of the right side of the heart, or from tumors in the venous circulation. | Where do more than 90% of pulmonary emboli originate from? DVT in lower extremities | Virchow's Triad (risk factors) Venous stasis + endothelial injury + hypercoagulable state (pregnancy, cancer, estrogen OCP, nephrotic syndrome) | Clinical features Tachycardia + tachypnea | Gold standard diagnostic test Spiral CT | Treatment Anticoagulation (heparin, Lovenox, warfarin) for at least 3 months |
Buzzwords: Dyspnea after surgery, travel (airplane), LE Fx. May have c/o calf pain also. Lung scan with perfusion defects, venous stasis + vessel wall injury + hypercoagulability PneumoconiosesDefinition Chronic fibrotic lung diseases caused by inhalation of coal dust or various inert/inorganic/silicate dusts | Clinically important pneumoconioses Coal workers' pneumoconiosis, silicosis, and asbestosis | Clinical Features Often asymptomatic, can have dyspnea, inspiratory crackles, clubbing, and cyanosis | Lab Findings PGTs show restrictive dysfunction and reduced diffusing capacity. CXR variable. | Treatment Supportive (no effective tx available): O2, vaccines, rehab |
Foreign Body AspirationDefinition Aspiration of gastric contents, inert material, toxic material, or poorly-chewed food. Know Heimlich maneuver! | Clinical Features Chocking, coughing, unexplained wheezing or hemoptysis | Possible Sequelae Asphyxia, PNA (aspiration pneumonia), | What is one of the most common causes of ARDS? Acute gastric aspiration | Lab Studies Expiratory radiography may show regional hyperinflation caused by a check valve effect | Treatment Bronchoscopy for diagnosis and removal/treatment. Cultures should be obtained if post-obstructive PNA suspected |
| | Pulmonary HTN (Pulmonary Circulation)Definition Present when the pulmonary arterial pressure rises to a level inappropriate for a given cardiac output; self-perpetuation once present | Primary (idiopathic) pulmonary HTN Rare + fatal | Secondary pulmonary HTN Many causes that develop as a result from obliteration and obstruction of the pulmonary arterial tree | Hypoxia Most important/potent stimulus of pulmonary arterial vasoconstriction (others are acidosis and veno-occlusive diseases) | Clinical features Dyspnea, angina-like pain, weakness, fatigue, edema, ascites, cyanosis, syncope | Signs on physical exam Narrow splitting and accentuation of the 2nd heart sound, systolic ejection click | Treatment Chronic oral anticoagulants, CCB to lower systemic arterial pressure, and prostacyclin (a potent pulmonary vasodilator), and heart-lung transplant |
ARDS (Acute adult respiratory distress syndrome)Definition Increased permeability of the alveolar capillary membranes --> leads to pulmonary edema and widespread inflammation | 3 Clinical Settings that account for 75% of ARDS cases Sepsis syndrome + severe multiple trauma + aspiration of gastric contents | Clinical Features Rapid onset of dyspnea 12-24 hrs after the precipitating event, PE shows tachycardia, frothy pink/red sputum, diffuse crackles. Many pts are cyanotic with increasingly severe hypoxemia that is refractory to administered O2 | Lab Findings CXR shows peripheral infiltrates with air bronchograms, spares costophrenic angle, can get multi-organ failure | Treatment Treat underlying precipitating problems, supportive care (O2, PEEP), high mortality rate. 33% of deaths occur within 3 days of ARDS sx onset |
| | SarcoidosisDefinition Multiorgan disease involving abnormal collections of inflammatory cells (granulomas), most often in the lungs | Classic Patient Higher incidence in North American black women, and northern European whites | Clinical features Respiratory sx (cough, dyspnea of insidious onset, chest discomfort) | Other extrapulmonary signs/sx Malaise, fever, erythema nodosum or enlargement of parotid glands/lymph nodes/spleen/liver | Lab Findings ACE levels elevated, CXR shows bilateral hilar and right paratracheal adenopajhty and bilateral diffuse reticular infiltrates | How to confirm diagnosis Transbronchial biopsy of the lung or fine-needle node biopsy --> will show non-caseating granulomas | Treatment Corticosteroids at maintenance doses |
Idiopathic Fibrosing Interstitial PneumoniaGeneral Most common dx among pts with interstitial lung disease. | Three histopathologic patterns w/ different natural histories and treatments Usual interstitial PNA, respiratory bronchiolitis-associated interstitial lung disease, and acute interstitial pneumonitis | Clinical Features Insidious dry cough, exertional dyspnea, constitutional sx. Exam might show clubbing and inspiratory crackles. | Lab Findings CXR shows fibrosis, CT shows fibrosis + pleural honeycombing, PFTs show restrictive pattern (decreased lung volume with a normal to increased FEV1/FVC ratio) | Treatment Controversial--none has been showed to improve survival or QOL |
Hyaline Membrane DiseaseDefinition Developmental insufficiency of surfactant production and structural insufficiency in lungs. Most common cause of respiratory disease in preterm infant | Etiology Deficiency of surfactant | Clinical Features Signs of respiratory distress | Lab Findings CXR shows air bronchograms, diffuse bilateral atelectasis causing a ground glass appearance, doming of the diaphragm | Treatment Synchronized intermittent mandatory ventilation. (Can also give exogenous surfactant in delivery room for prophylaxis) |
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