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ARDS
Etiology Lung injury ↓Surfactant Leaky alveoli → Fluid in lungs Causes Sepsis Aspiration Lung contusion Near-drowning Burns Pancreatitis Transfusion lung injury (TRALI) → <6h following transfusion Presentation Phase 1 Acute injury Normal exam Respiratory alkalosis Phase 2 6-48h Hyperventilation → ↓CO2 ↑ A-a gradient Phase 3 Dyspnea ↑RR Respiratory failure ↓...
Read moreObstructive Sleep Apnea
Etiology Obesity Presentation Daytime somnolence Loud snoring Headache Impaired memory/judgement Depression Hypertension Arrhythmias ED Bull neck Diagnosis Most accurate → Polysomnography → Multiple apnea episodes Arrhythmias ↑RBC Treatment Weight loss Avoid alcohol CPAP Uvuloplatopharyngoplasty Avoid sedatives Oral appliance → Keep tongue out
Read morePulmonary Hypertension
Definition → Pulmonary pressure >25/8 mmHg Etiology Idiopathic COPD Fibrosis PE Hypoxia ⇒ Pulmonary vasoconstriction Presentation Dyspnea on exertion Fatigue Syncope Chest pain Wide splitting S2 S4 Right sided CHF Edema Ascites JVD Diagnosis Best initial → Echo, CXR, CT Proximal artery dilation Distal vessel narrowing (pruning) Most accurate → Swan-Ganz...
Read morePulmonary Embolism
Etiology Clot (DVT) 70% → Leg veins 30% → Pelvic vein Virchow Triad Stasis Immobility Joint replacement CHF Obesity ↑ Central venous pressure Endothelial injury Trauma Surgery Fracture Thrombophilia Pregnancy Smoking OCP Coagulation disorders Factor V Leiden Protein C/S deficiency Antiphospholipid syndrome Malignancy Severe burns Amniotic fluid → Postpartum Fat →...
Read moreSarcoidosis
Etiology Idiopathic Presentation Young Black Woman with hilar adenopathy Northern European Fever, cough, malaise, weight loss Lung SOB on exertion Fine rales NO wheezing Erythema nodosum Lymphadenopathy Arthritis Parotid enlarged CNS Facial palsy Other Heart Heart block Restrictive CMP Eye Uveitis Iritis Löfgren Syndrome Arthritis Erythema nodosum Bilateral hilar...
Read moreInterstitial Lung Disease (DPLD)
Interstitial Lung Disease (Diffuse Parenchymal Lung Diseases) Etiology Idiopathic Interstitial pulmonary fibrosis Radiation PaO2 Ventilator Drugs Bleomycin Busulfan Amiodarone Methylsergide Nitrofurantoin Cyclophosphamide Pneumoconiosis History Imaging Notes Asbestosis Shipyard worker Pipe fitting Insulators Tile/brake lining Demolition Lung bases Linear opacities Fibrosis Calcified pleural plaque Alveolar septum Ferruginous bodies Present 15-20y...
Read moreSolitary Pulmonary Nodule
Etiology High probability Malignant >40y Enlarging Smoker Spiculated border >2 cm Atelectasis Adenopathy Sparse eccentric calcification Abnormal PET scan Intermediate probability Age 30-40y 1-2 cm Low probability Malignant <30y No size change Nonsmoker Smooth border <1 cm Normal lung No adenopathy Dense central calcification (Popcorn) Normal PET scan Presentation...
Read moreTuberculosis (TB)
Etiology Previous BCG has no effect on management Risk factors Recent immigrant (5y) Homeless Prisoners HIV Heath care worker Close contact with TB Steroid use Hematologic malignancy Alcoholic Diabetes Presentation Risk factor + >3w of Fever Cough Sputum Fatigue Weight loss Hemoptysis Night sweats Lymphadenopathy FUO Ghon Complex Cavitary...
Read morePneumonia
Community-Acquired Pneumonia Pneumonia before or <48h after admission Etiology Most common → Strep pneumoniae → Can cause in anybody COPD → H. influenza Recent viral influenza → S. aureus Alcoholism/Diabetes → Klebsiella Poor dentition/Aspiration → Anaerobes Young and healthy → Mycoplasma Hoarseness → Chlamidophylia pneumoniae Contaminated water/AC → Legionella Legionnaire’s Disease...
Read moreCystic Fibrosis
Etiology Autosomal Recessive CFTR gene (Chromosome 7) Thick mucus Presentation <1y → Meconium ileus, Cough, Wheezing, Recurrent URI >1y → Pancreatic insufficiency → FTT Young adult Respiratory Chronic sinopulmonary disease Chronic lung disease Cough, sputum, hemoptysis, bronchiectasis, wheezing, dyspnea Recurrent infection Sinus pain Polyps GI History of Meconium ileus Pancreatic...
Read moreEosinophilic Pulmonary Syndromes
Eosinophilic Pulmonary Syndromes General Dyspnea, cough, blood-tinged sputum, fever Peripheral eosinophilia Pulmonary infiltrates Treat underlying cause Corticosteroids may help Allergic Bronchopulmonary Aspergillosis (ABPA) Etiology Fungal antigens in bronchial tree Only in asthma patients History of atopic disorders Presentation Asthma history Atopy history Recurrent episodes of brown-flecked sputum + Transient...
Read moreBronchiectasis
Etiology Permanent anatomic abnormality → Dilated bronchi Most common cause → Cystic fibrosis (50%) Infection → TB, Pneumonia, Abscess Hypogammaglobulinemia, Immune deficiency Foreign body Tumor ABPA Collagen-Vascular disease RA Presentation Key → Recurrent episodes of high volume purulent sputum Hemoptysis Dyspnea Wheezing Weight loss Anemia of chronic disease Crackles NO clubbing...
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