MKSAP
MKSAP
MKSAP
Heliox(inhaledhelium)usedforobstruction(espw/asthma)
NebulizedNacetylcysteineforchronicbronchitis/bronchiectasis
Noninvasive+pressureintubationsfor24hrafterextubation,theforre
intubation
DLCOisoftenlowinanemic(needcorrectedDLCO)&pulmonaryvascular
dzwithregularlungvolumes;pulmonaryhemorrhagecauseshighDLCO
andiftestredonethelowDLCO
6minwalktest:walkasfastastheycanmeasuremaxdistance);tracks
functionalcapacity;isaprognosticindicatortoassessresponsetotherapy
orneedforlungtransplantation
PulseOxaccuratew/I23%areFalselylowinperipheralvasoonstriction,
cardiacarrthmias,excessambientlight;carboxyHgbfalselyhigh;
limitation:partialpressuremaywellbelownormalbeforesaturationfall;
doesnotgiveyouadequacyofventilation;cannotmeasureFRC/RV/TLC
ChestXray:pneumothorax,pleuraleffusion,pneumonia,HF,catheter/
intubation,serialfollowingprogression;
NeedCTforinterstiallungdz,bronchiectasis,pulnodules,cancerspread,
PE,LAD,aspirate/biopsy;PETCTgiveFDGlucosestagelungcancer,if
nodulecancerous(doesnotexcludecancerbutmakeslesslikely);COPD
exacerbationptsgetXraytoruleoutpneumonia
Upperlobepreference:sarcoidosis&silicosis,Langerhanscellhistiocytosis,
CF,2TB
Lowerlobepreference:idiopathicpulfibrosis,asbestosis,cryptogenic
organizingpneumonia,ILDmimicofHF
ContrastenhancedCT:differentiateBVfromlargeLN,metastasestoliver,
canalsoevalPE,aorticdissection;1CT=40Xray(socaninducecancer)
Persistentneuropsychiatricimpairmentaffectupto75%pta/wage,
glycemiccontrol&mechanicalventilation(ptw/sepsisorARDS)
FPPETscan:infection(TB,fungal),sarcoidosis;FNPET:variantsof
adenocarcinoma,carcinoidtumor;notusefulfornodules<1cm;
PETCThashigherspecificity/sensitivity;usedforcancerstaging;stillneed
biopsy
Bronchoscopyusefulfor:sarcoidosis,silicosis,HYpneumonitis,
Bronchoalveolarlavage90%MACisnrml;LYM,EOS,NEUisabnrml;
proceducercancauserespdep/arrestduetoanesthesia,orpneumothorax;
helpsw/mucusclearance,removingforeignbody,stentingairway
7090ptw/asthmahaveallergiesconfirmedw/skintesting;mediatorsdo
shorttermwhilecytokinesmediatelongterm;pxw/episodiccough,
dyspnea,chesttightening;worseatnight/earlymorning(1/mo);
AsthmaDifferential:COPD,vocalcorddysfunction(wheezingfromupper
airway,youngeragemonophonicwheezing),mechanicalobstruct,CF
(clubbingofdigits),HF(loweredema&bilateralinscrackles),
bronchiectasis,ABPA
RhinoisupperairwaywhileRSVislowerairway
Chroniccough=coughvariantasthama
Somepeoplew/asthmahaveGERD(needtohaverelationshipw/2Sxthen
treatingitwillprovebeneficial,otherwiseno)
ABPAcommoninptw/asthma/CF;causebrochiectosis,fibrosis;screenby
measuringIgElevels;Atb/skintest;txwithsystemicsteroids
Aspirinsensitivity=nasalpolyp+asthma(Samtertriadinadultoften)
FEV1<50orderpulmonaryrehabilitationprogram(havetowalk,noMI);
greatforCOPD,ILD,CF
Areainemphysema;