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Asthma pfts
def fev1/fvc, inc RV and TLC
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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
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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
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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
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Meds that can cause pulm fibrosis
amiodarone, busulfan, nitrofurantoin, bleomycin, radiation, long term high o2 conc
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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
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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
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Coal miners disease
- CXR: small nodular opacities in upper lung zones
- spirometry of restrictive dz
- progressive massive fibrosis
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Silicosis
- mines, quarries, glass, pottery
- small nodular opacities, eggshell calc
- inc risk of TB need annual TB test
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Berylliosis
- aerospace, electronics, ceramics
- diffuse infiltrates, hilar adenopathy
- chronic CST treatment
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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
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ARDS criteria
- Acute onset
- Ratio PaO2/FiO2<200
- Diffuse infiltrates
- Swan ganz pressure <18 (nml)
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Pulm htn
- dyspnea on exertion, fatigue, lethargy, sx of chf, chest pain
- Causes: L heart failure, MV disease, hypoxia
- Loud S2, often split, parasternal heave
- RVH
- Rx: O2, anticoag, vasodilators
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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
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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
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Causes of transudative pleural effusion
chf, cirrhosis, nephrotic syndrome
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