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Pulmonology
Obstructive/Restrictive Lung Diseases
Obstructive Asthma Bronchiectasis COPD Chronic bronchitis Emphysema Restrictive Alveolar Edema Hemorrhage Pus Interstitial Idiopathic interstitial pneumonia Inflammatory Sarcoidosis Cryptogenic organizing pneumonia Cryptogenic means idiopathic Bronchiolitis obliterans organizing pneumonia (BOOP) Inflammation of bronchioles Seen in the context of Rheumatoid arthritis Dermatomyositis Amiodarone Idiopathic pulmonary fibrosis Neuromuscular Myasthenia Phrenic nerve palsy...
Read morePleural Disease
Pleural Effusion Etiology Transudate CHF Cirrhosis Nephrotic syndrome Exudate Pneumonia → Parapneumonic effusion TB Malignancy PE Collagen vascular RA SLE Pancreatitis Trauma Presentation Dyspnea Pleuritic chest pain Cough ↓ Breath sounds Dullness to percussion Diagnosis Best initial → CXR AP → Costophrenic angle blunting Lateral Decubitus → To assess loculation...
Read moreLung Cancer
Small Cell (SCLC) Etiology Notes Histology Paraneoplastic Small Cell Smoking myc oncogene Central Undifferentiated Aggressive Metastasis → LABBs Liver Adrenal Brain Bone Kulchitsky cells Small, dark blue Neuroendocrine Chromogranin A ⨁ Cushing → ACTH SIADH → ADH → ↓Na Lambert-Eaton Peripheral neuropathy Subacute cerebellar degeneration Non-Small Cell (NSCLC) Etiology Notes...
Read moreARDS
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...
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