Pulmonary Review

From Iusmicm

Contents 1 Introduction 2 Approach to Shortness of Breath 3 History and Physical Exam 4 Pulm Function Testing 5 Peds Pulmonary 6 Pneumonia 6.1 Definitions 6.2 Concepts 6.3 Details 7 Pulmonary Hypertension 8 Pulmonary Embolism 9 Obstructive Airways Diseases 10 The Pleura & Neurologic Disorders 11 Interstitial Lung Disease and SPNs 12 Treatment of Respiratory Failure 13 Pulmonary & Critical Care Case Conference

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