1. Asthma pfts
    def fev1/fvc, inc RV and TLC
  2. Bronchiectasis
    • cycles of infection and inflamm leads to fibrosis and perm dilation of bronchi
    • chronic cough and bouts of colored sputum, assoc with CF, history of pulm inf etc
    • CXR: inc bronchvascular markings and tram lines=BIT
    • CT=MAT, dilated airways
    • dec fev1/fvc
    • rx: toilet, abx for acute infection
  3. Asthma classifications and rx
    • Mild int<2 night/month, <2 day/wk, fev1 >80
    • B2 ag
    • Mild persist: >2/wk but <1/day, >2 night/month
    • FEV1>80, low dose inhaled CST and bronchodil
    • Mod persist: daily, >1night/wk, fev1 60-80, low dose inhaled+long acting B2 agonist and short B2
    • Severe: all day all night fev1 <60, high dose inhaled cst + long acting b2
  4. Restrictive lung dz
    • dec lung compliance, dec expansion
    • inflammation or fibrosis of interlay septum
    • shallow rapid breathing, crackles, nml or inc fev1/fvc, def tlc, dec fvc
  5. Meds that can cause pulm fibrosis
    amiodarone, busulfan, nitrofurantoin, bleomycin, radiation, long term high o2 conc
  6. Systemic sarcoidosis
    • noncaseating granuloma, african american
    • fever, cough, malaise, arthritis
    • erythema nodosum
    • CXR: hilar lymphadenopathy and nodules= BIT
    • MAT: biopsy
    • inc ace, hypercalcemia, inc alk phos
    • rx: CST
  7. Asbestosis
    • shipyard, insulation, presents 15-20 yrs after exposure
    • CXR with linear opacities at lung bases and interstitial fibrosis, calcified pleural plaques
    • inc risk of mesothelioma and lung cancer esp if smoker
  8. Coal miners disease
    • CXR: small nodular opacities in upper lung zones
    • spirometry of restrictive dz
    • progressive massive fibrosis
  9. Silicosis
    • mines, quarries, glass, pottery
    • small nodular opacities, eggshell calc
    • inc risk of TB need annual TB test
  10. Berylliosis
    • aerospace, electronics, ceramics
    • diffuse infiltrates, hilar adenopathy
    • chronic CST treatment
  11. A-a gradient
    • (150-5/4(Pco2))-PaO2
    • increased A-a gradient suggests V/Q mismatch or diffusion impairment, Nml=5-10
    • if corrects with O2, V/q mismatch such as copd, asthma, interstitial lung dz
    • If doesnt correct with O2, shunt: alv collapse, pulm edema, intracardiac shunt
  12. ARDS criteria
    • Acute onset
    • Ratio PaO2/FiO2<200
    • Diffuse infiltrates
    • Swan ganz pressure <18 (nml)
  13. Pulm htn
    • dyspnea on exertion, fatigue, lethargy, sx of chf, chest pain
    • Causes: L heart failure, MV disease, hypoxia
    • Loud S2, often split, parasternal heaveĀ 
    • RVH
    • Rx: O2, anticoag, vasodilators
  14. Lung cancers
    • Small cell: smoking, PTHrp, central
    • Adenocarc: not assoc with smoking, peripheral, bronchoaveolar carc Not resectable.
    • SCC: central, smokers
    • Mets: liver, adrenals, brain, bone
    • Pancoasts tumor:at apex of lung can lead to horners
    • SVC syndrome, hoarseness
  15. Lights criteria for pleural effusions
    • An effusion is an exudate if it meets any of these criteria:
    • Pleural protein/serum protein >.5
    • Pleural LDH/Serum LDH >.6
    • Pleural fluid LDH >2/3 upper limit of normal serum ldh
    • Exudates: pneumonia, tb, malig, pe, pancreatitis
  16. Causes of transudative pleural effusion
    chf, cirrhosis, nephrotic syndrome
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