Pulmonary Review
From Iusmicm
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==Introduction== | ==Introduction== | ||
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==Approach to Shortness of Breath== | ==Approach to Shortness of Breath== | ||
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==History and Physical Exam== | ==History and Physical Exam== | ||
| + | Know the key details of the pulmonary history and | ||
| + | physical exam | ||
| + | • Interpret basic acid-base disorders | ||
| + | • Diagnose pneumothorax, pleural effusion, and | ||
| + | atelectasis on exam or xray (know what to look for!) | ||
| + | • Know how to treat a pneumothorax, atelectasis | ||
| + | secondary to mucus plug, and pleural effusion | ||
| + | • Know basic bronchoscopic indications | ||
| + | • Know the objective findings in vocal cord dysfunction | ||
| + | syndrome | ||
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==Pulm Function Testing== | ==Pulm Function Testing== | ||
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==Peds Pulmonary== | ==Peds Pulmonary== | ||
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==Pneumonia== | ==Pneumonia== | ||
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===Definitions=== | ===Definitions=== | ||
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===Concepts=== | ===Concepts=== | ||
*Time of onset informs the likely causative agent: | *Time of onset informs the likely causative agent: | ||
| Line 31: | Line 52: | ||
***Respiratory viral titers | ***Respiratory viral titers | ||
**Thoracentesis | **Thoracentesis | ||
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==Pulmonary Hypertension== | ==Pulmonary Hypertension== | ||
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==Pulmonary Embolism== | ==Pulmonary Embolism== | ||
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==Obstructive Airways Diseases== | ==Obstructive Airways Diseases== | ||
| + | Know the components of COPD (asthma, | ||
| + | chronic bronchitis, emphysema) and their | ||
| + | defining characteristics including: | ||
| + | – Basic pathophysiology | ||
| + | – Symptomatology | ||
| + | – Diagnostic studies | ||
| + | – Classifications (asthma & emphysema) | ||
| + | – Treatment strategies (asthma & emphysema) | ||
| + | – Factors indicating poor prognosis (emphysema) | ||
| + | – Management goals (asthma) | ||
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==The Pleura & Neurologic Disorders== | ==The Pleura & Neurologic Disorders== | ||
| + | • Recall the anatomy and physiology of the | ||
| + | normal pleural space | ||
| + | • List the signs and symptoms of pleural | ||
| + | effusion and pneumothorax | ||
| + | • Identify pathophysiologic causes of an | ||
| + | effusion or pneumothorax | ||
| + | • Differentiate a transudative from an exudative | ||
| + | effusion | ||
| + | • Identify the characteristics of pleural fluid | ||
| + | analysis in common pleural diseases | ||
| + | • Identify the pulmonary function | ||
| + | abnormalities associated with | ||
| + | neuromuscular weakness | ||
| + | • List those neuromuscular diseases | ||
| + | associated with respiratory failure | ||
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==Interstitial Lung Disease and SPNs== | ==Interstitial Lung Disease and SPNs== | ||
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==Treatment of Respiratory Failure== | ==Treatment of Respiratory Failure== | ||
| + | • Be able to calculate the A-a gradient given an ABG and | ||
| + | FiO2 | ||
| + | • Define Shunt & V/Q Mismatch (increased and decreased) | ||
| + | • Know what influences the Oxygen dissociation curve to the | ||
| + | right and left | ||
| + | • Learn the types and FiO2’s of various supplemental | ||
| + | oxygen devices | ||
| + | • Understand the types and indications for Non-invasive | ||
| + | positive pressure ventilation | ||
| + | • Understand the procedure of endotracheal intubation and | ||
| + | indications for mechanical ventilation | ||
| + | • Learn basic mechanical ventilation (not covered on exam) | ||
| + | • Review for the Pulmonary Exam | ||
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==Pulmonary & Critical Care Case Conference== | ==Pulmonary & Critical Care Case Conference== | ||
| + | • Introduce you to “real-world” clinical medicine | ||
| + | through actual case studies | ||
| + | • INSPIRE you to know your stuff! | ||
| + | • Reassure you that hard work now will pay off in | ||
| + | the years to come (the light at the end of the | ||
| + | tunnel is not a freight train!) | ||
| + | • Have fun | ||
| + | • Think | ||
| + | • Pay attention | ||
| + | • Cases not on exam | ||
Revision as of 16:35, 5 March 2012
Introduction
Approach to Shortness of Breath
History and Physical Exam
Know the key details of the pulmonary history and physical exam • Interpret basic acid-base disorders • Diagnose pneumothorax, pleural effusion, and atelectasis on exam or xray (know what to look for!) • Know how to treat a pneumothorax, atelectasis secondary to mucus plug, and pleural effusion • Know basic bronchoscopic indications • Know the objective findings in vocal cord dysfunction syndrome
Pulm Function Testing
Peds Pulmonary
Pneumonia
Definitions
Concepts
- Time of onset informs the likely causative agent:
- 0-2 days: bacterial
- 0-2 days: mycoplasma, viral, legionella, pneumocystis, fungal
- chronic: anaerobic, mycobacterial, fungal, nocardia, actinomycosis
- Distribution informs the likely causative agent:
- Lobar: bacterial, anaerobes
- Diffuse: viral, pneumocystis, mycoplasma, fungal
- Nodular / cavitary: mycobacterial, fungal, anaerobes
Details
- Workup for the pt with pneumonia:
- H&P
- CBC, electrolytes, glucose, BUN / Cr, LFTs
- ABG, puls oximetry
- Chest radiograph
- Sputum gram stain, sputum culture (2 days)
- Blood culture x2 (hospitalized pts, only)
- Legionella
- Fungi
- Mycoplasma
- Respiratory viral titers
- Thoracentesis
Pulmonary Hypertension
Pulmonary Embolism
Obstructive Airways Diseases
Know the components of COPD (asthma, chronic bronchitis, emphysema) and their defining characteristics including: – Basic pathophysiology – Symptomatology – Diagnostic studies – Classifications (asthma & emphysema) – Treatment strategies (asthma & emphysema) – Factors indicating poor prognosis (emphysema) – Management goals (asthma)
The Pleura & Neurologic Disorders
• Recall the anatomy and physiology of the normal pleural space • List the signs and symptoms of pleural effusion and pneumothorax • Identify pathophysiologic causes of an effusion or pneumothorax • Differentiate a transudative from an exudative effusion • Identify the characteristics of pleural fluid analysis in common pleural diseases • Identify the pulmonary function abnormalities associated with neuromuscular weakness • List those neuromuscular diseases associated with respiratory failure
Interstitial Lung Disease and SPNs
Treatment of Respiratory Failure
• Be able to calculate the A-a gradient given an ABG and FiO2 • Define Shunt & V/Q Mismatch (increased and decreased) • Know what influences the Oxygen dissociation curve to the right and left • Learn the types and FiO2’s of various supplemental oxygen devices • Understand the types and indications for Non-invasive positive pressure ventilation • Understand the procedure of endotracheal intubation and indications for mechanical ventilation • Learn basic mechanical ventilation (not covered on exam) • Review for the Pulmonary Exam
Pulmonary & Critical Care Case Conference
• Introduce you to “real-world” clinical medicine through actual case studies • INSPIRE you to know your stuff! • Reassure you that hard work now will pay off in the years to come (the light at the end of the tunnel is not a freight train!) • Have fun • Think • Pay attention • Cases not on exam
