POM1 TBL3 -pulmonology

What are the main categories of causes of acute onset dyspnea?

Acute dyspnea can stem from pulmonary, cardiac, or systemic causes.

What are the pulmonary causes of acute dyspnea?

Pneumonia, COPD or asthma exacerbation, pulmonary embolism, pneumothorax, and pleural effusion.

What are the cardiac causes of acute dyspnea?

Pulmonary edema or heart failure with fine crackles, S3 gallop, and orthopnea.

What are the systemic causes of acute dyspnea?

Anemia, anxiety, metabolic acidosis, and neuromuscular weakness such as ALS, Guillain-Barré, or Myasthenia gravis.

A chronic respiratory condition with variable airway obstruction, hyperresponsiveness, and inflammation. What disease is this?

Asthma

What are the criteria for intermittent asthma?

Symptoms ≤2 days/week, ≤2 nights/month, FEV₁ ≥80%, no activity limitation.

What are the criteria for mild persistent asthma?

Symptoms >2 days/week but not daily, 3-4 nights/month, FEV₁ ≥80%, minor limitation.

What are the criteria for moderate persistent asthma?

Daily symptoms, >1 night/week, FEV₁ 60-80%, some limitation.

What are the criteria for severe persistent asthma?

Symptoms throughout the day, often nightly, FEV₁ <60%, extreme limitation.

What are common clinical findings in asthma?

Episodic dyspnea, wheezing, chest tightness, nocturnal cough

What physical exam findings are seen in asthma?

Prolonged expiration, accessory muscle use, hyperresonance, decreased breath sounds.

A disease with persistent respiratory symptoms and irreversible airflow limitation.

What disease is this?

COPD

What are features of emphysema (pink puffer)?

exertional dyspnea, quiet lungs, thin body habitus, barrel chest

What are features of chronic bronchitis (blue bloater)?

Chronic productive cough, cyanosis, rhonchi/wheeze, overweight.

What FEV₁ value defines GOLD Stage 1 COPD?

≥80% predicted (mild).

What FEV₁ value defines GOLD Stage 2 COPD?

50-79% predicted (moderate).

What FEV₁ value defines GOLD Stage 3 COPD?

30-49% predicted (severe).

What FEV₁ value defines GOLD Stage 4 COPD?

<30% predicted (very severe).

What are late complications of COPD?

Cor pulmonale, pneumonia, chronic respiratory failure.

A life-threatening allergic reaction to drugs, food, or insects.

What is this known as?

Anaphylaxis

What are signs and symptoms of anaphylaxis?

Wheezing, bronchospasm, hypotension, urticaria, angioedema, stridor.

How is anaphylaxis diagnosed?

Clinically based on allergen exposure history.

What is first-line treatment for anaphylaxis?

IM epinephrine 0.3-0.5 mg, airway management, oxygen, IV fluids, antihistamines, corticosteroids.

What percentage of the U.S. population has asthma?

About 8%, higher in African Americans aged 15-24.

What are typical asthma symptoms?

Episodic wheezing, dyspnea, chest tightness, dry nocturnal cough.

What findings indicate asthma on diagnostics?

Decreased FEV₁/FVC with reversibility after bronchodilator or positive methacholine challenge.

What is the stepwise management for asthma?

SABA → ICS → LABA/ICS → oral steroids if severe; remove triggers.

How common is COPD in the U.S.?

About 16 million people; 3rd leading cause of death.

What physical findings suggest COPD?

Barrel chest, prolonged expiration, diminished sounds, wheezing.

What diagnostic criteria define COPD?

FEV₁/FVC < 0.70 and hyperinflation on chest X-ray.

What are key treatments for COPD?

Smoking cessation, bronchodilators, corticosteroids, oxygen therapy, vaccines, pulmonary rehab.

What is a pleural effusion?

Accumulation of excess fluid in the pleural space.

What causes transudative pleural effusions?

Heart failure, cirrhosis, nephrotic syndrome.

What causes exudative pleural effusions?

Infection, malignancy, pulmonary embolism.

What physical findings indicate a pleural effusion?

Dullness to percussion, decreased fremitus, decreased breath sounds.

How is a pleural effusion diagnosed?

Chest X-ray with meniscus sign and thoracentesis using Light's criteria.

How are pleural effusions managed?

Treat underlying cause, drain large or symptomatic effusions, pleurodesis (medical procedure that involves causing the two layers of the pleura (the membrane that covers the lungs) to stick to each other) for recurrent.

What are symptoms of acute bronchitis?

Cough (often productive), malaise, low-grade fever.

How is acute bronchitis diagnosed?

Clinically; chest X-ray usually normal.

How is acute bronchitis treated?

Supportive care, bronchodilators if wheezing.

What is bronchiectasis?

Chronic dilation of bronchi, often post-infectious or congenital (CF).

What are bronchiectasis symptoms?

Chronic purulent sputum, hemoptysis, coarse crackles, wheezing.

What imaging confirms bronchiectasis?

High-resolution CT showing bronchial dilation.

How is bronchiectasis managed?

Airway clearance, antibiotics, bronchodilators.

What are key symptoms of community-acquired pneumonia?

Fever, productive cough, pleuritic chest pain, bronchial breath sounds

What defines nosocomial pneumonia?

Onset ≥48 h after hospital admission, usually gram-negative or MRSA pathogens.

What organisms cause atypical pneumonia?

Mycoplasma, Chlamydophila, Legionella.

How does atypical pneumonia present?

Dry, nonproductive cough with diffuse infiltrates.

How is pneumonia managed?

Empiric antibiotics, oxygen therapy, fluids.

What is a pneumothorax?

Air in the pleural space leading to lung collapse.

What are the main types of pneumothorax?

Primary (spontaneous), Secondary (from disease), and Traumatic.

How does pneumothorax present?

Sudden dyspnea, pleuritic chest pain, unilateral decreased breath sounds, hyperresonance (too much air in chest cavity)

What confirms pneumothorax on imaging?

Chest X-ray showing visceral pleural line and lung collapse.

How is pneumothorax treated?

Needle decompression for tension type; chest tube for large or symptomatic cases.

What is a pulmonary embolism?

Obstruction of a pulmonary artery by a thrombus.

How common is PE in DVT patients?

Occurs in 60-70% of hospitalized patients with DVT.

What are common symptoms of PE?

Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia, hemoptysis.

What tests diagnose PE?

CTPA (pulm angiography, (gold standard)), D-dimer, V/Q scan if contrast contraindicated.

How is PE treated?

Anticoagulation (heparin → DOAC), thrombolysis for massive PE, IVC filter if anticoagulation contraindicated.