the basic
what are the 3 different type of asthma responses?
how are they different?
BONUS: what are the important times intervals in exercise induced
Extrinsic asthma response =episodes are triggered by IgE related reaction to external stimuli (atopic response)
Intrinsic asthma response = episodes are triggered by non-IgE related (non-Immune) stimuli- usually irritant induced or due to viral respiratory tract infection
Timing of symptoms is significant in relation to exercise initiation and cessation. –bronchoconstriction beings 3-5 minutes after exercise and peaks
at about 15 minutes then resolves within 45 -60 minutes
what are the chronic complications of COPD
Bonus: Clubbing of the digits is common in _____________. It is uncommon in _________ & It is a late finding that usually indicates advanced________
Pulmonary HTN and subsequent Cor pulmonate (Right heart failure) caused by HYPOXIC PULMONARY VASOCONSTRICTION (HPVC)
Secondary polycythemia
Bonus: idiopathic pulmonary fibrosis/sarcoidosis/ disease
name the viruses and bacteria that can cause Bronchitis
highest incidence in the late _____ and _______
• Most frequently due to viral infection but can be caused by bacteria:
Viruses
• Influenza
• Parainfluenza
• Coronavirus type 1 and 3
• Rhinovirus
• RSV
Bacteria
• Bordetella pertussis-causes prolonged cough
• Mycoplasma pneumonia
• Chlamydia pneumoniae
three pillars of CAP prevention
• Smoking cessation
• Influenza vaccination for all patients
• Pneumococcal vaccination
• At-risk patients: >65, immunocompromised, chronic disease (DM, lung, heart, liver, renal)
• Immunization: Pneumococcal 20-valent Conjugate Vaccine (Prevnar 20)
what are the different symptoms for central or more advanced compared to regional or mediastinal spread symptoms?
where will lung cancer metastasize
• Central or More Advanced
– Cough
– Hemoptysis
– Post-obstructive pneumonia
– Chest pain
• Regional or Mediastinal Spread
– Dyspnea
– Chest wall pain
– Brachial Plexus signs
– Facial swelling
– Hoarseness
• Metastatic
– Brain, adrenal, bone, liver
1) what is maintenance treatment for asthma
2) when is IV mg used
3) "Goal in emergency room setting/ initial presentation is to decide disposition
within __ hours of presentation and after ___ hrs of initial management.
1) beta agonist combined with low dose corticosteroids as the rescue inhaler (ICS-formoterol).
2) pts who are refractory to pharmacologic management for exacerbations
3) 4 and 1-3
what are the ILD stages
what are the 3 types of ILD
Mild- meaning you have 5+ years with appropriate treatment
Moderate- meaning you have 3-5+ years with appropriate treatment
Severe- meaning you have 3+ years with appropriate treatment
Advanced- meaning you have < 3 years with appropriate treatment
IPF/Sarcoidosis/ Pneumoconiosis
1)treatment for bronchitis if someone has COVID 19
2)treatment for bronchitis if someone haspertussis
3 CAP is the ____most common cause of hospitalization and the ______ common infectious
cause of death
4) what is the highest comorbidity risk for CAP
1) Nirmatrelvir/ritonavir (Paxlovid)
2) macrolide (azithromycin) if ≤ 3 weeks symptoms
in average person or ≤ 6 weeks in pregnant patient
3) second / most
4) COPD
how do treatments for Aspiration Pneumonitis and Pneumonia differ
what 2 disorders have osteomyelitis?
Pneumonitis: Supportive
Pneumonia: supportive + antibiotics
• Oral: Amoxicillin-clavulanate
• IV: Ampicillin-sulbactam
blastomycosis and coccidioidomycosis
1) what is ARDS
2) what is the pathogenesis
3) what are Pathophysiologic effects (simple:impaired gas exchange and decreased lung compliance.)
1) Acute restrictive hypoxic respiratory failure which develops as a syndrome to adverse clinical condition
2) Alveolar injury→diffuse alveolar damage→inflammatory mediators→neutrophil recruitment
3)Leakage of proteins from vascular space→
resulting in fluid shifts into interstitial space →
with net effect of interstitial edema (pulmonary edema) ALSO loss of functioning surfactant→ which makes lungs more susceptible to collapse
what is the main difference in the Patho/Etiology between Emphysema and chronic bronchitis
CB: Increased mucus gland activity of bronchi & Injury related defect in bronchial cilia and thus decreased mucocilliary clearance
Emphysema: alveolar tissue destruction and impaired function of alveolar capillary membrane. abnormal destruction of alveolar proteins elastin and collagen.
what are the BIG clinical manifestations, imaging requirements, and treatments for sarcoidosis
KEY WORDS: Non-caseating granuloma, Asteroid bodies, AND Schaumann bodies
clinical manifestations :interstitial lung disease & erythema nodosum
imaging: bilateral hilar lymphadenopathy and interstitial lung infiltrates
Lab Findings: Decreased TLC, decreased DLCO, increased ESR,Elevated Serum ACE, Hypercalcemia, Leukopenia, Eosinophilia, Hypercalciuria
Treatment: steroids or immunosuppressant cytotoxic drugs (methotrexate or infliximab)
what does Atypical refer to in CAP?
what is the actual in the pathophysiology of pneumonia?
atypical" refers to the intrinsic resistance of these
organisms to beta-lactams and their inability to be visualized on Gram stain or cultured using traditional techniques
typical: infection of alveoli --> fill with fluid or puss
Atypical: infection --> inflammation of the walls of alveoli
what are the 4 different types of Aspergillus infections, their presentations, requirements for diagnosis, and treatment
Allergic bronchopulmonary aspergillosis (ABPA) – non life threatening = wheezing, cough, SOB, fever, mucus plug [oral corticosteroids]
Aspergilloma = hemoptysis (biopsy) [surgery]
Chronic necrotizing pulmonary aspergillosis: unresponsive to antibiotics, include fever, cough, night sweats and weight loss (+IgG serology)[voriconazole or itraconazole]
Invasive aspergillosis: Fever, cough, dyspnea, pleuritic chest pain and sometimes hemoptysis in
patients with prolonged neutropenia or immunosuppression(Galactomannan antigen testing)[voricanozole]
what is “The Berlin Definition”
1. Timing- worsening respiratory symptoms occurs within 1 week of a known clinical adverse event
2. Chest Imaging -Bilateral diffuse opacities /alveolar infiltrates indicating pulmonary edema
3. Pulmonary edema cannot be fully explained by heart failure or fluid overload.
4. Severity of oxygenation deficit- PaO2/FiO2 ratio less than 300. (determined with PEEP of 5)
• Mild ARDS= PaO2/FiO2: 300-200
• Moderate ARDS= PaO2/FiO2: 200-100
• Severe ARDS= PaO2/FiO2: <100
1) what are the signs for the two different types of COPD
2) what is hypoxemia criteria for continuous home O2
1a) Emphysema: accessory muscles and lack of cyanosis.// Pink Puffer (huffing and puffing)
1b)Chronic Bronchitis: Chronic productive cough/ rhonchi & cyanosis/ Blue Bloater/ increased JVD and peripheral edema.
2) • PaO2<55
• PaO2 55-59 plus either polycythemia or signs of cor pulmonale
fill in the blank
Etiology and Epidemiology: Inhalation of _____ dust particles,
including:
1. Carbon dust( _______)
2. Coal dust ( _______)
3. Silica dust (_______)
4. Asbestos (________)
extra: what is Caplan's syndrome
inorganic
Anthracosis
Coal worker
Silicosis
Asbestosis
Necrobiotic rheumatoid nodules in lung
periphery in RA patients.
what are the typical bacteria and how to they look when they are stained?
what are important clinical features of each
streptococcus pneumonia (G+cocci in pairs) 75% of CAP cases
haemophilus influenza (G- coccobacilli) after URI and COPD
staphylococcus aureus (g+cocci cluster) MRSA, after flu, cavitary
klebsiella pneumoniae (G- rod) ethanol abuse
pseudomonas aeruginosa (G- rod) bronchiectasis (cystic fibrosis)
mortadella catarrhalis (G- diplococcus) COPD exacerbation
what are risk factors for each etiology in pneumothorax
– Spontaneous
– Secondary
– Iatrogenic
what would you see on CXR
• Primary/Spontaneous
– Tall/thin body habitus
– Smoker
– Personal history
– Younger patient
• Secondary
– Emphysema
– Asthma
– Lung disease
• Traumatic
– Iatrogenic
– Barotrauma
– Upright – see it superiorly
– Laying down – deep sulcus sign
what is Virchow’s Triad?
what are the big signs and symptoms of PE
1)Venous Stasis, Vascular Injury, Hypercoagulability
2) Tachypnea 70%, Dyspnea 73%, Pleuritic Chest Pain 66%
1)what are the pharmacologic maintenance therapy for low risk exacerbation and high risk for exacerbation
2)what is management for acute COPD exacerbation
talk about GOLD grades and severity of airflow obstruction in COPD
1a) low risk: LABA or LAMA
1b) high risk: LAMA or LAMA/LABA // Add ICS if hospitalized for exacerbation or if elevated eosinophil count ( >300/microL) // if still not correcting add PDE4 inhibitors (roscumilast)
2) 1st ipratropium (short acting anticholinergic) and albuterol (SABA) //2nd systemic corticosteroids prednisone or methylprednisolone //3rd mechanical ventilation //4th antibiotics
what are Pt's w/ asbestosis at an increased risk for developing
what are Pt's w/ BERYLLIOSIS at an increased risk for developing and what is the treatment
bronchogenic carcinoma and MALIGNANT MESOTHELIOMA OF THE PLEURA
cancer and core pulmonate // chronic steroids
name non-opportunistic and opportunistic fungal infections
note (talk about the pneumonia severity index (PSI), CURB 65 score, and minor & major criteria for ward or ICU)
Non-opportunistic
• Histoplasma capsulatum causing histoplasmosis.
• Coccidioides immitis causing coccidioidomycosis.
• Blastomyces dermatitidis causing blastomycosis.
• Paracoccidioides brasiliensis causing paracoccidioidomycosis
Opportunistic (in immunocompromised patients)
• Candida spp. causing candidiasis.
• Aspergillus spp. causing aspergillosis.
• Mucor spp. causing mucormycosis.
• Cryptococcus neoformans causing cryptococcosis.
• Pneumocystis jirovecii
what are common transudate and exudate disorders
• Transudates
– CHF
– Cirrhosis
– Renal failure
• Exudates
– Infection
– Malignancy
– Empyema
– Hemothorax
look at the SS question
culotta's question