Last minute revision of Pulmonology

High Yield Pulmonology contents

RhinosinusitisThick nasal mucus, a plugged nose, facial pain or pressure of a dull, constant, or aching sort over the affected sinuses. Other signs and symptoms may include fever, headaches, poor sense of smell, sore throat, and cough.
RhinitisSneezing, congestion, and runny nose (common cold)
PharyngitisTypically results in a sore throat and fever . Other symptoms may include a runny nose, cough, headache, a hoarse voice. Symptoms usually last three to five days. Complications can include sinusitis and acute otitis media
Nasopharyngitis ( common cold )include a cough, a runny nose, nasal congestion and a sore throat, sometimes accompanied by muscle ache, fatigue, headache, and loss of appetite , The cough is usually mild compared to that accompanying influenza. While a cough and a fever indicate a higher likelihood of influenza in adults, a great deal of similarity exists between these two conditions .
Nasal polypnasal congestion, sinusitis, anosmia (loss of smell), and secondary infection leading to headache .
Angiofibromaprofuse epistaxis
Nasopharyngeal carcinomaSwelling of the lymph nodes in the neck is the initial presentation in many people, Signs and symptoms related to the primary tumor include trismus, pain, otitis media, nasal regurgitation due to paresis (loss of or impaired movement) of the soft palate, hearing loss and cranial nerve palsy (paralysis).
Acute epiglottitishigh fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor; risk of airway obstruction.
Laryngeotracheobronchitis ( croup )a hoarse, “barking” cough and inspiratory stridor .
Vocal cord noduleshoarseness; resolves with resting of voice .
Laryngeal papilloma•Hoarseness or other voice changes•A lump in the neck•A sore throat or feeling that something is stuck in the throat•Persistent cough•Stridor – a high-pitched wheezing sound indicative of a narrowed or obstructed airway•Bad breath•Earache (“referred”)•Difficulty swallowing
Pneumoniafever and chills, productive cough with yellow-green (pus) or rusty (bloody) sputum, tachypnea with pleuritic chest pain, decreased breathSounds , dullness to percussion, and elevated WBC count. Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or confusion, pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum,pneumonia caused by Klebsiella may have bloody sputum often described as “currant jelly”.Bloody sputum (known as hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, and lung abscesses as well as more commonly with acute bronchitis ,Mycoplasma pneumonia may occur in association with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection.Viral pneumonia presents more commonly with wheezing than does bacterial pneumonia. Types :LobarBronchoInterstitialAspiration
Acute bronchitisexpectorating cough, shortness of breath (dyspnea), and wheezing. On occasion, chest pains, fever, and fatigue or malaise may also occur.
Lung abscessCough, fever with shivering, and night sweats are often present. Cough can be productive of foul smelling purulent mucus (≈70%) or less frequently with blood in one third of cases).Affected individuals may also complain of chest pain, shortness of breath, lethargy and other features of chronic illness.Those with a lung abscess are generally cachectic at presentation. Finger clubbing is present in one third of patients. Dental decay is common especially in alcoholics and children. 
Tuberculosisfevers and night sweats, cough with hemoptysis , and weight loss.
Chronic obstructive pulmonary diseasesChronic bronchitis
Chronic productive cough lasting at least 3 months over a minimum of 2 years;
1.Productive cough due to excessive mucus production
2.Cyanosis (‘ blue bloaters’)-Mucus plugs trap carbon dioxide; ↑ Paco2 and ↓ Pao2 .Increased risk of infection and cor pulmonale .  

Emphysema
1. Dyspnea and cough with minimal sputum
2. Prolonged expiration with pursed lips (‘pink-puffer’)
3. Weight loss
4. Increased anterior-posterior diameter of chest (‘barrel-chest,)
5. Hypoxemia (due to destruction of capillaries in the alveolar sac) and cor pulmonale are late complications
Asthmaassociated with allergic rhinitis, eczema, and a family history of atopy .
1.Dyspnea and wheezing
2.Productive cough, classically with spiral-shaped mucus plugs (Curschmann spirals) and eosinophil-derived crystals (Charcot-Leyden crystals ).
3.Severe, unrelenting attack can result in status asthmaticus and death.
Bronchiectasisl. Cough, dyspnea, and foul-smelling sputum2. Complications include hypoxemia with cor pulmonale and secondary (AA) amyloidosis.
Idiopathic pulmonary fibrosis• Age over 50 years
• Dry, non-productive cough on exertion
• Progressive exertional dyspnea (shortness of breath with exercise)
• Dry, inspiratory bibasilar “Velcro like” crackles on auscultation (a crackling sound in the lungs during inhalation similar to Velcro being torn apart slowly, heard with a stethoscope).
• Clubbing of the digits, a disfigurement of the finger tips or toes
Pneumoconiosiscough and shortness of breath
Types: Coal Silicosis Berylliosis Asbestosis
Sarcoidosisl. Dyspnea or cough (most common presenting symptom)
2.Elevated serum ACE
3.Hypercalcemia (l-alpha hydroxyla e activity of epithelioid histiocytes converts vitamin D to its active form)
Hypersensitivity pneumonitisfever, cough, and dyspnea hours after exposure; resolves with removal of the exposure
Pulmonary hypertensionsevere respiratory distress → cyanosis and RVH → death from decompensated cor pulmonale.
DVTpain or tenderness, swelling, warmth, redness or discoloration, and distention of surface veins, although about half of those with the condition have no symptoms.
Pulmonary embolismV˙/Q˙ mismatch, hypoxemia, respiratory alkalosis. Sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia. Large emboli or saddle embolus may cause sudden death.
ARDSshortness of breath, fast breathing, and a low oxygen level in the blood due to abnormal ventilation .
NRDS1.            Increasing respiratory effort after birth, tachypnea with use of accessory muscles, and grunting2.            Hypoxemia with cyanosis3.            Diffuse granularity of the lung (‘ground-glass’ appearance) on x-ray
Sleep apneaRepeated cessation of breathing > 10 seconds during sleep → disrupted sleep → daytime somnolence. Nocturnal hypoxia → systemic/pulmonary hypertension, arrhythmias (atrial fibrillation /flutter) , sudden death. Obstructive sleep apnea : Associated with obesity, loud snoringCentral sleep apnea : May be associated with Cheyne-Stokes respiration
Lung cancerscough, hemoptysis, bronchial obstruction, wheezing, pneumonic “coin” lesion on CXR or noncalcified nodule on CT.SPHERE of complications:Superior vena cava syndromePancoast tumorHorner syndrome Endocrine (paraneoplastic)Recurrent laryngeal nerve compression (hoarseness)Effusions (pleural or pericardial) TYPES :Small cell : May produce ACTH (Cushing syndrome), SIADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome) or neurons (paraneoplastic myelitis, encephalitis, subacute cerebellar degeneration).Squamous cell : hyperCalcemia (produces PTHrP).Adenocarcinoma : Associated with hypertrophic osteoarthropathy (clubbing).Large cellBronchioloalveolarcarcinoid tumor : Symptoms due to mass effect or carcinoid syndrome (flushing, diarrhea, wheezing).Metastasis 
Pancoast tumor → pancoast syndromeCompression of locoregional structures may cause array of findings:Recurrent laryngeal nerve → hoarsenessStellate ganglion → Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)Superior vena cava → SVC syndromeBrachiocephalic vein → brachiocephalic syndrome (unilateral symptoms)Brachial plexus → sensorimotor deficits
superior vena cava syndrome“facial plethora”; neck (jugular venous distention), and upper extremities (edema). Can raise intracranial pressure (if obstruction is severe) → headaches, dizziness, ↑ risk of aneurysm/ rupture of intracranial arteries.
PneumothoraxDyspnea, uneven chest expansion. Chest pain, ↓ tactile fremitus, hyperresonance, and diminished breath sounds, all on the affected side.
Mesotheliomaresult in hemorrhagic pleural effusion (exudative), pleural thickening
Pleural effusionOnce accumulated fluid is more than 300 mL, there are usually detectable clinical signs, such as decreased movement of the chest on the affected side, dullness to percussion over the fluid, diminished breath sounds on the affected side, decreased vocal resonance and fremitus (though this is an inconsistent and unreliable sign), and pleural friction rub.
Last minute revision of Pulmonology
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