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105 Cards in this Set
- Front
- Back
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Sarcoidosis -
What is it |
Systemic dis.
unknown etiology noncaseating granulomas In US - MC in Black females 30's-40's |
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Sarcoidosis -
Hx/PE |
Fever
cough malaise arthritis - knees, ankles wt. loss dyspnea GRUELING Granulomas noncaseating RA Uveitis Erythema nodosum Lymphadenopathy Interstitial fibrosis Negative TB test Gammaglobulinemia MC - lung can also involve - neurologic eye myocardial rheumatologic GI skin acute presentations - • lofgren's syndrome - hilar adenopathy arthritis erythema nodosum • heerfordt-waldenstrom syn - uveitis parotid enlargement facial palsy fever |
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Sarcoidosis -
Dx |
Definitive Dx - Bx
CXR transbronchial or video- assisted thoracoscopic Bx PFTs - normal or restrictive inc. serum ACE hypercalcemia hypercalciuria lymphopenia inc. alk phos - if liver involved Kveim skin test skin anergy |
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Sarcoidosis -
Tx |
All pts. - ophthalmologic exam
if organ impairment - trial steroids steroids a must if - CNS uveitis hypercalcemia 80% - become stable or spontaneously resolve 20% - dev. progressive disease |
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Cystic Fibrosis -
What is it |
AR
mutation in CFTR gene on chromosome 7 => def. in chloride channel disease of exocrine glands - mainly respiratory & GI MC severe genetic disease of whites in US |
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Cystic Fibrosis -
Hx/PE |
Hx -
■ respiratory - recurrent pulm infections Pseudomonas S. aureus bronchiectasis hemoptysis chronic sinusitis cough dyspnea cyanosis digital clubbing ■ GI - meconium ileus malabsorption syn greasy stools flatulence pancreatitis rectal prolapse esoph varices biliary cirrhosis ■ abnorm glucose tolerance DM Type 2 salty-taste sweat unexplained hyponatremia infertility - males PE - cough rhonchi rales hyperresonance to percussion nasal polyps growth retardation digital clubbing |
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Cystic Fibrosis -
Dx |
Sweat chloride test -
> 60 mEq/L if < 20 y/o > 80 mEq/L if adult genetic testing |
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Cystic Fibrosis -
Tx |
Chest physical therapy
bronchodilators anti-inflammatory agents ABx DNase pancreatic enzymes vit D,A,K,E if severe - lung transplant pancreas transplant |
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COPD -
What is it |
Chronic progressive dis.
dec. lung function airflow obstruction generally due to - chronic bronchitis or emphysema 4th MCC of death in US chronic bronchitis - prod. cough for at least 3 mos. a yr for 2 consec. yrs emphysema - pathologically defined terminal airway destruction smoking - centrilobular A1-antitrypsin def. - inherited, panlobular most pts. have parts of both nearly all are smokers |
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COPD -
Hx/PE |
Sxs often minimal or
nonspecific until advanced (lost > 50% of lung function) barrel chest use of accessory chest mus JVD end-expiratory wheezing muffled breath sounds emphysema - "pink puffer" dyspnea pursed lips minimal cough dec. breath sounds late hypercarbia/hypoxia less reactive airways bet. exacerbations chronic bronchitis - "blue bloater" prod. cough cyanotic but mild dyspnea periph edema rhonchi early hypercarbia/hypoxia |
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COPD -
Dx |
■ PFTs - diag. test of choice
FEV1 - best predictor of survival (after bronchodilator) ■ bronchitis - inc. pulmonary markings normal DLCO ■ emphysema - small heart size inc. in retrosternal space dec. DLCO ■ CXR - dec. markings hyperinflated lungs flat diaphragm thin-appearing heart & mediastinum pathognomonic of emphysema - parenchymal bullae subpleural blebs ■ PFTs - FEV1/FVC < 80% ■ ABGs - pts. have baseline inc. PCO2 in acute exacerbation - rising inc. PCO2 ■ BC ■ gram stain & sputum Cx - if febrile or prod. cough |
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COPD -
Tx |
■ Ipratropium -
1st line metered dose inhaler can use with B2 agonist ■ 2nd line - albuterol terbutaline metaproterenol inhaler ■ 3rd line - aminophylline oral theophylline ■ to decrease mortality - home O2 and stop smoking home O2 - if PaO2 <55 cor pulmonale - if PaO2 <59 ■ exacerbation - O2 - keep PaO2 at 60 ABx - cover H. influ & pneumococcus systemic steroids ■ vaccines - h. influ - yearly pneumococcus - every 5 yrs. |
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COPD -
Complications |
Hypoxemia with nocturnal desat
if chronic low PO2, => secondary erythropoeisis pulmonary HTN => cor pulmonale chronic vent failure - early chronic bronchitis end of emphysema chronic resp failure pneumonia bronchogenic carcinoma |
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Bronchiectasis -
What is it |
Dis. of bronchi & bronchioles
cycles of infection & inflammation => perm. remodeling, dilation of bronchi, suppuration 50% with primary ciliary dyskinesia - have Kartagener's (situs inversus sinusitis infertility) assoc. with - pulmonary infections - esp. pseudomonas, h. influ hypersensitivity reactions CF immunodef. aspiration autoimmune dis. IBS complications - massive hemoptysis amyloidosis cor pulmonale visceral abscesses |
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Bronchiectasis -
Hx/PE |
Hx-
yellow or green sputum cough dyspnea possible hemoptysis halitosis PE - rales wheezes rhonchi purulent mucus |
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Bronchiectasis -
Dx |
■ CXR -
early - normal advanced - cysts tramtracks (bronchi crowding) inc. markings honeycombing ■ high-resolution CT - best noninvasive test dilation of airway varicose constriction no airway taper ballooned cysts ■ IgM, IgA, IgG - to determine subclass def. |
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Bronchiectasis -
Tx |
• Increase drainage -
bronchodilators chest PT postural drainage • ABx - when mild Sxs or sputum inc. rotate ABxs amoxicillin TMP/SMX amoxicillin/clavulanic • IV ABx - if significant Sxs or pneumonia cover gram neg aminoglycosides quinolones ceftazidime • surgery if - localized & enough function massive hemoptysis • vaccines - h. influ - every year pneumococcus - every 5 yrs. |
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Pneumoconiosis -
What is it |
Occupational lung injury
affects pulmonary interstitium dev. after long-term, high concentration exposure to inhaled particles alveolar macrophages engulf => inflammation & fibrosis inc. risk with - level & duration of exposure |
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Pneumoconiosis -
Dx |
CXR
High-res CT - if normal CXR but suspect pneumoconiosis |
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Pneumoconiosis -
Tx |
No cure
supportive therapy O2 supplementation stop smoking alert appropriate agency |
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Asbestosis -
Where Exposed When does it present |
Manufacture of
tile or brake linings insulation construction demolition building maintenance pipes shipyards presents 15-20 yrs. after initial exposure |
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Asbestosis -
Dx |
CXR -
linear opacities at lung bases pleural plaques Bx - necessary asbestos bodies "barbell shaped" |
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Asbestosis -
Complications |
Inc. risk of mesothelioma
inc. risk of bronchogenic Ca - adenocarcinoma squamous cell Ca smoking inc. risk of bronchogenic Ca (smoking not additive with mesothelioma) |
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Coal Workers' Pneumoconiosis -
Where Exposed |
Anthracosis
Black Lung Disease work in underground coal mines worse - inc. exposure higher rank/hardness inc. silica content |
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Coal Workers' Pneumoconiosis -
Dx |
CXR -
small nodular opacities (<1cm) upper lung zones increased - IgG IgA c3 ana RF spirometry - shows restrictive dis. |
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Coal Workers' Pneumoconiosis -
Complications |
Progressive massive fibrosis
Caplan syndrome - Coal Workers' Pneumoconiosis RA rheumatoid nodules in lung periphery |
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Silicosis -
Where Exposed |
Mines or quarries -
sandblasting glass pottery silica |
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Silicosis -
Dx |
CXR -
small nodular opacities (<1cm) upper lung zones eggshell calcifications Bx spirometry - shows restrictive dis. |
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Silicosis -
Complications |
Inc. risk of TB -
need annual PPD pos. is >10 progressive massive fibrosis acute form - massive exposure => lung failure in mos. |
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Berylliosis -
Where Exposed |
Aerospace plant
nuclear plant electronics plant ceramics foundries plating dental material sites die manufacturing |
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Berylliosis -
Dx |
CXR -
diffuse infiltrates hilar adenopathy |
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Berylliosis -
Complications |
Chronic steroid Txs
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Pulmonary Edema -
What is it |
Abnormal accumulation of fluid
in extravascular space |
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Pulmonary Edema -
Hx/PE |
Hx -
dyspnea orthopnea paroxysmal nocturnal dyspnea Cheyne-Stokes breathing cough cyanosis PE - rales on inspiration musical rhonchi murmurs - if cardiogenic |
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Pulmonary Edema -
Dx |
CXR -
enlarged heart prominent pulmonary vessels Kerley B lines "bat's-wing" appearance of hilar shadows perivascular cuffing peribronchial cuffing |
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Pulmonary Edema -
Tx |
Tx underlying cause
diuretics arrhythmia management inotropes & afterload reduction in some cases |
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Pulmonary Edema -
If due to inc. capillary hydrostatic pressure, list precipitating events |
MI
mitral stenosis heart failure fluid overload |
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Pulmonary Edema -
If due to inc. capillary permeability, list precipitating events |
Sepis
radiation O2 toxicity ARDS toxins |
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Pulmonary Edema -
If due to reduced lymph drainage, list precipitating event |
Inc. central venous pressure
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Pulmonary Edema -
If due to dec. interstitial pressure, list precipitating event |
Rapid removal of
pleural effusion |
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Pulmonary Edema -
If due to dec. colloid pressure, list precipitating event |
Hypoalbuminemia
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Pneumothorax -
What is it |
Collection of air in
pleural cavity can => partial or complete lung collapse |
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Pneumothorax -
What is a Primary Spontaneous Pneumothorax |
No underlying lung dis.
rupture of subpleural apical blebs or bullae tall, thin young males |
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Pneumothorax -
What is a Secondary Spontaneous Pnemothorax |
Underlying lung dis.
rupture of bleb or bulla in pts. with - COPD TB PCP |
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Pneumothorax -
What is a Traumatic Pneumothorax |
Complication of blunt &
penetrating chest injuries |
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Pneumothorax -
What is an Iatrogenic Pneumothorax |
Thoracocentesis
subclavian line placement mech ventilation bronchoscopy |
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Pneumothorax -
What is a Tension Pneumothorax |
Lung or chest wall defect
acts like one-way valve inspiration - air into cavity expiration - air trapped life-threatening condition can => shock & death causes - penetrating trauma infection CHF mechanical vent |
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Pneumothorax -
Hx/PE |
Unilat pleuritic chest pain
dyspnea tachypnea dec. or absent breath sounds hyperresonance dec. tactile fremitus tension pneumothorax - resp distress falling O2 sat hypotension distended neck veins tracheal deviation |
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Pneumothorax -
Dx |
CXR -
visceral pleural line lung retraction from chest wall (best seen in end-expiratory films) |
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Pneumothorax -
Tx |
Small -
may reabsorb spontan O2 therapy large - chest tube placement pleurodesis tension - emergency immed needle decompression in 2nd ICS at midclavic line chest tube do not wait for CXR |
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Pulmonary Embolism -
What is it Risk Factors |
95% orig from DVTs in
deep leg veins can => pulmonary infarction RHF hypoxia risk factors - Virchow's triad: stasis endothelial injury hypercoag states |
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Pulmonary Embolism -
Hx/PE |
Hx -
MC Sx - dyspnea & tachy sudden-onset dyspnea pleuritic chest pain low-grade fever cough PE - hypoxia hypocarbia resp. alkalosis tachypnea tachy fever loud P2 prominent jugular a waves- RHF Homan's sign |
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Pulmonary Embolism -
Dx |
Suspect in hospitalized or
bedridden pt. if - dyspnea tachy normal CXR ■ ABG - resp. alkalosis PO2 < 80 ■ CXR - usu normal may show pleural effusion Hampton's hump Westermark's sign atelectasis ■ EKG - not diagnostic S1Q3T3 rt.-axis deviation RV strain pattern sinus tachy - most common sign ■ V/Q scan - 1st test ■ Helical (spiral) CT with contrast - sensitive for PE in prox. pulm arteries ■ pulm angiogram - gold standard |
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Pulmonary Embolism -
Tx |
Heparin - 5 days
warfarin - start day 1 for 6 mos. if hemodynamically unstable - thrombolytics if thrombolytics contraindicated - embolectomy pregnant - LMWH for 6 mos. ■ heparin - bolus then wt-based continuous ■ warfarin - 3-6 mos. indef. if underlying predisposition keep INR 2-3 ■ IVC filter - if anticoag contraindicated if recurrent emboli with Tx ■ DVT prophylaxis - low-dose subq heparin LMWH venodyne boots early ambulation - most effective if severe - thrombolysis |
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Acute Resp Distress Syndrome -
What is it |
Inc. permeability of
alveolar-capillary barrier => influx of fluid into alv. diffuse damage to alv. & cap endothelium causes - sepsis pneumonia aspiration infection severe trauma massive blood transfusion inhaled/ingested toxins trauma drug OD acute pancreatitis |
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Acute Resp Distress Syndrome -
Hx/PE |
Acute onset in 12-48 hrs.
progression of Sxs - ■ normal PE resp. alkalosis ■ hyperventilation hopocapnia widening A-a gradient ■ acute resp failure tachypnea dyspnea dec. lung compliance rales diffuse chest infiltrates ■ severe hypoxemia - unresponsive to therapy inc. intrapulm shunting metab & resp acidosis |
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Acute Resp Distress Syndrome -
Dx |
ABG - dec. PaO2 and
inc. or normal PaCO2 Swan-Gatz catheter - normal CO normal CWP inc. pulmonary artery pressure Acute onset of resp distress PaO2/FIO2 ratio < 200 mmHg b/l pulm infiltrates on CXR no evidence of cardiac origin (normal cap wedge P = 18 mmHg) |
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Acute Resp Distress Syndrome -
Tx |
Treat underlying d/o
mechanical support with inc. PEEP and permissive hypercapnea steroids - controversial (no standard successful Tx ■ treat underlying dis. ■ maintain adequate perfusion ■ maintain O2 at goals of - FIO2 < 0.6 PaO2 > 60 mmHg SaO2 > 90% ■ mechanical vent - low PEEP inc. inspiratory times ■ support CO - inotropes cautious fluid admin ■ steroids - no if sepsis & ARDS - inc. mortality) |
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Solitary Pulmonary Nodule -
What is it |
< 3 cm
1/3 malignant completely surrounded by lung parenchyma no assoc. atelectasis no assoc. pleural effusion usu found incidentally on CXR risk of malig. inc. with age causes - granuloma carcinoma hamartoma metastasis bronchial adenoma pneumonia • calcification - points towards benign • popcorn calcification - made by hamartoma • bull's-eye calcification - made by granuloma |
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Solitary Pulmonary Nodule -
Hx/PE |
Often asymp
may have - chronic cough dyspnea SOB |
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Solitary Pulmonary Nodule -
Dx |
Compare serial CXRs
chest CT characteristics favoring Ca - > 45-50 y/o new lesions larger lesions no calcification irreg calcification > 2 cm irregular margins characteristics favor benign - < 35 y/o no change central/uniform calcification < 2 cm smooth margins regular margins |
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Solitary Pulmonary Nodule -
Tx |
low-risk -
< 35 y/o nonsmoker calcified nodule CXR every 3 mos. for 2 yrs. if no change in 2 yrs, can stop high-risk - > 50 y/o smoker is likely to have cancer, so open-lung Bx and remove |
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Primary Lung Cancer -
What is it Types Risk Factors |
No. 1 cause of cancer death
risk factors - smoking major cause nonsmoker- gets adenocarcinoma radon asbestos • MC - adenocarcinoma squamous cell ca • squamous cell ca - central PTHrp => hypercalcemia cavitary lesions mets by direct extension into: hilar & mediastinum • small cell ca - central grows fast early Dx doesn't improve prognosis mets early to - brain, liver, bone, adrenals SIADH ACTH Lambert-Eaton syndrome MCC of venocaval obstruction • large cell ca - peripheral early - cavitary lesions late - distant mets • adenocarcinoma - peripheral mets to same sites as small cell association with asbestos pleural effusions with high hyaluronidase levels Dx - thoracotomy with pleural Bx bronchoalveolar ca - subtype of adenocarcinoma low-grade ca find in single or multiple nodes |
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Primary Lung Cancer -
Hx/PE |
MC Sx at time of Dx - cough
hemoptysis chest pain wt loss dyspnea hoarseness - nonresectable repeated pneumonic processes crackles atelectasis paraneoplastic syn Horner's syn - if Pancoast's tumor |
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Primary Lung Cancer -
Dx |
Usu 1st noted as nodule on CXR
■ lung CT ■ sputum cytology - highest yield - squamous cell ■ bronchoscopy - best for central ■ needle aspiration Bx - peripheral nodules with pleural fluid aspirate ■ mediastinoscopy - mediastinal ■ 90% with malignant effusions - unresectable usually adenocarcinoma ■ atelectasis - central airway obstruction |
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Primary Lung Cancer -
Tx |
Nonresectable if -
wt. loss > 10% bone pain CNS Sxs superior vena cava syndrome hoarseness mediastinal adenopathy on contralateral involves: trachea esophagus pericardium chest wall small cell ca - resectable treated with chemo etoposide & platinum (VP16) surgery not indicated nonsmall cell ca - that are resectable, treated with chemo and RT or CAP (cyclophosphamide, adriamycin, platinum) effusions - tetracycline complications - RT (palliative) prognosis - squamous cell ca - best small cell ca - worst |
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Primary Lung Cancer -
Complications |
SPHERE of complications -
SVC syndrome Pancoast's tumor Horner's syndrome Endocrine (paraneoplastic) Recurrent laryngeal Sxs (hoarseness) Effusions - pleural, pericardial also - airway obstruction lung abscess chronic interstit fibrosis |
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Interstitial Lung Disease -
What is it |
Classic type of restrictive
lung disease alveolar septal thickening => fibroblast prolif, collagen deposited, pulmonary fibrosis causes - most connective tissue dis. occupational lung exposures drugs pulmonary edema pulmonary veno-occlusive dis. idiopathic |
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Interstitial Lung Disease -
Hx/PE |
Shallow, rapid breathing
dyspnea with exercise nonproductive cough cyanosis worsened by exercise rales finger clubbing |
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Interstitial Lung Disease -
Dx |
CXR -
■ reticular pattern - more pronounced at bases ■ honeycomb pattern if severe TLC low FVC low FEV1/FVC > 80% (inc.) |
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Interstitial Lung Disease -
Tx |
Supportive
steroids cytotoxic agents immunomodulatory substances |
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Hypersensitivity Pneumonitis -
What is it |
Type III hypersensitivity
reaction to environmental or occupational antigens acute, subacute & chronic all forms - alveolitis acute interstit inflammation lymphocytes infiltrate if long-term exposure - => granulomas & fibrosis |
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Hypersensitivity Pneumonitis -
Hx/PE |
■ Acute -
dyspnea fever shivering cough - starts 4-6 hrs after exposure ■ chronic - progressive dyspnea fine b/l rales |
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Hypersensitivity Pneumonitis -
Dx |
CXR -
■ acute: normal (10%) miliary nodular infiltrates ■ chronic: fibrosis in upper lobes |
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Hypersensitivity Pneumonitis -
Tx |
Avoid ongoing exposure
steroids cytotoxic agents immunomodulatory substances |
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Hypersensitivity Pneumonitis
Farmer's Lung - What causes it |
Spores of actinomycetes
from moldy hay |
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Hypersensitivity Pneumonitis
Bird Fancier's Lung - What causes it |
Antigens from -
feathers excreta serum |
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Hypersensitivity Pneumonitis
Mushroom Worker's Lung - What causes it |
Spores of actinomycetes
from compost |
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Hypersensitivity Pneumonitis
Malt Worker's Lung - What causes it |
Spores of Aspergillus clavatus
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Hypersensitivity Pneumonitis
Grain Handler's Lung - What causes it |
Grain weevil dust
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Hypersensitivity Pneumonitis
Bagassosis - What causes it |
Spores of actinomycetes
from sugarcane |
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Hypersensitivity Pneumonitis
Air Conditioner Lung - What causes it |
Spores of actinomycetes
from air conditioners |
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Asthma -
What is it |
Dis. of chronic airway
inflammation caused by variety of triggering stimuli => reversible bronchoconstrict inflammation, mucous plugging, smooth muscle hypertrophy • Intrinsic - nonimmunologic nonatopic cold air exercise infections emotional upset severe prognosis - less favorable • extrinsic - atopic inc. IgE positive family Hx prognosis good • respiratory infections - MC stimuli to cause exacerbations kids - RSV adults - rhinovirus • pharmacologic stimuli - aspirin tartrazine (coloring agent) B-adrenergic antag • aspirin sensitivity- nasal polyposis adults |
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Asthma -
Hx/PE |
Hx -
cough dyspnea episodic wheezing chest tightness worse at night or early a.m. h/o - freq. ER visits intubations PO steroid use PE - tachypnea tachy dec. breath sounds wheezing prolonged expiratory duration- (dec. I/E ratio) hyperresonance accessory muscle use possible pulsus paradoxus dec. O2 sat - late sign |
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Asthma -
Dx |
ABG -
mild hypoxia & resp. alkalosis PFTs spirometry CBC CXR - hyperinflation methacholine challenge |
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Asthma -
Tx |
Avoid allergens
acute - O2 bronchodilators (B agonists) ipratropium steroids to avoid intubation in severe- pos. airway pressure Heliox chronic - FEV1 peak flow ABGs bronchodilators steroids cromolyn theophylline Montelukast ASTHMA meds for exacerbations- Albuterol Steroids Theophylline Humidified O2 Magnesium Anti-leukotrienes |
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Hypoxemia -
What is it |
Dec. blood O2 content
due to alv. hypoventilation causes - right-to-left shunt hypoventilation ↑ blood velocity dec. inspired O2 tension airway obstruction V/Q mismatch diffusion impairment |
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Hypoxemia -
Hx/PE |
Dec. HbO2 sat
cyanosis tachypnea SOB pleuritic chest pain altered mental status |
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Hypoxemia -
Dx |
Pulse oximetry
CXR pulm embolism evaluation ABG calculate A-a |
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Hypoxemia -
A-a Calculation What does ↑ A-a mean |
Alveolar O2 - ABG O2
PAO2 - PaO2 [150-1.2(pCO2)] - PaO2 5-15 mmHg is normal ↑ A-a gradient - V/Q mismatch diffusion impairment ↑ in all hypoxemia except - hypoventilation low altitude |
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Hypoxemia -
Tx |
Tx underlying cause
O2 if on vent, ↑ O2 sat by - ↑ FIO2, ↑ PEEP or ↑ I/E ratio hypercapnic - ↑ minute ventilation - ↑ TV or ↑ RR |
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Pleural Effusion -
What is it |
Abnorm accumulation of
fluid in pleural cavity transudative or exudative |
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Pleural Effusion -
What is Transudative |
Intact capillaries
=> protein-poor pleural fluid causes - CHF nephrotic syn cirrhosis protein-losing enteropathy ratio of pleural prot to serum prot - < 0.5 ratio of pleural LDH to serum LDH - < 0.6 |
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Pleural Effusion -
What is Exudative |
Inflammation
=> leaky capillaries protein-rich pleural fluid causes - malig TB bact. infection viral infection PE with infarct collagen vas. dis. pancreatitis hemothorax chylothorax traumatic tap ratio of pleural prot to serum prot - > 0.5 ratio of pleural LDH to serum LDH - > 0.6 |
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Pleural Effusion -
Hx/PE |
Often asymp
dyspnea pleuritic chest pain dec. breath sounds dullness to percussion dec. tactile fremitus |
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Pleural Effusion -
Dx |
■ CXR -
blunting of costophrenic angles decubitus CXR ■ pleural fluid analysis - LDH protein gram stain CBC culture cytology ■ needle Bx - Dx TB effusion ■ definitive Dx - thoracocentesis or open Bx |
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Pleural Effusion -
Tx |
■ Transudative -
Tx underlying condition thoracocentesis if dyspneic ■ malignant - pleurodesis: if unresponsive to RT or chemo thoracocentesis pleuroperitoneal shunt pleurectomy ■ parapneumonic - if empyema - chest tube drainage ■ hemothorax - chest tube |
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Sleep Apnea -
What is it Risk Factors |
Obstructive, central, mixed
■ obstructive - recurrent episodes partial or complete closure of upper airway resp. efforts continue ■ central - episodic cessation of airflow & resp. efforts due to loss of central drive ■ mixed ■ causes - abnorm in feedback control of breathing during sleep dec. sensitivity of upper airway muscles or inspiratory muscles to stimulation anatomic abnorm ■ risk factors - male obesity sleep sedatives nasal obstruction hypothyroidism macroglossia micrognathia acromegaly |
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Sleep Apnea -
Hx/PE |
Daytime sleepiness
systemic HTN when severe - pulmonary HTN cor pulmonale impaired concentration loud snoring during sleep - gasping choking recurrent arousals |
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Sleep Apnea -
Dx |
Sleep studies
(polysomnography) |
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Sleep Apnea -
Tx |
Obstructive -
wt. loss nasal CPAP central - acetazolamide progesterone supplemental O2 early Tx essential mandibular advancement devices body repositioning surgery no alcohol, sedatives ■ kids - most cases due to tonsil/adenoid hypertrophy correct via surgery |
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Atelectasis -
What is it |
Collapse of part or all of lung
• MC seen - immediate postop period secondary to poor inspiration or no coughing • other causes - mucous plug tumor obstruction |
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Atelectasis -
Hx/PE |
• Acute -
dyspnea and hypoxemia fever tachy • chronic - may be asymp |
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Atelectasis -
Dx |
• Upper lobe -
trachea to affected side lower lobe - elevation of corresponding part of diaphragm massive - mediastinal shift |
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Atelectasis -
Tx |
• To prevent -
deep breathing and coughing incentive spirometer pulmonary toilet • bronchoscopy - removal of mucous plugs for spontaneous atelectasis |
