Infantile respiratory distress syndrome, (aka hyaline membrane disease)
Clinical course: Usually within 30 minutes of delivery, ↑d difficulty in respiration is observed and within a few hours significant and progressive cyanosis is evident.
Respiratory Syncitial Virus
* illness begins with upper respiratory tract symptoms
* progress rapidly over 1-2 days
* diffuse small airway disease
* cough, wheezing and rales, low-grade fever (< 101°F), and not feeding well. "
* Recurrent/Persistent lung infection:
"Wheeze, cough, Tightness.
* Initial- cough, wheeze, SOB. Hallmark is wheeze. But tightness and SOB in severe disease. All that wheezes is not asthma, but 90% of the time it is (not during aspiration of foreign bodies)
• Cough esp at night, wheezing post physical activity or exposure to allergens, breathing probs seasonal, colds >10 days, relief w/ medication"
"Obstructive SAH Syndrome (OSHAS)
Recurrent episodes of complete or partial upper airway collapse during sleep
-EEG arousal (often but usually AI<AHI), frequent arousals.
- Excessive Daytime Sleepiness not better explained by other factors . CX: Lost memory, mood changes, CV, DM issues, like they are drunk. Snoring, excessive sleepiness.
Excessive Daytime Sleepiness (EDS)
- Sleepiness vs Fatigue
-Major cause for motor vehicle accidents (MVA)
-Hypnagogic hallucinations, sleep paralysis, cataplexy
Central Sleep Apnea
W/o daytime hypercapnia: 10 consecutive minutes of Cheyne-Stokes breathing (Cres-Decr-Apnea- Creas; peak 60 seconds). See it mostly in NREM sleep, since REM sleep has dreams which turns on some neurobehavioral responses. ≥ 5x/hour. No severity gradient. They have ↑D sensitivity to CO2 (low during awake)"
NM Disease and RF
No strenth to use muscles. ↓ed endurance, ↓ed LV and sleep apnea, and hard to eat. Repeated aspiration pnuemonia - causes stiff lungs.
Asthma Obstructive Disease. Cauing RF
Asthmatic with new attack, pneumonia. May have wheezing, chest tightness, might have localized rales. May have started steroids, and actually just getting worse/more tired. RESP FAUILRE until proven otherwise since shouldn't go to sleep. ↓ed BS and PFT b/c getting so tired, hyperinflation since work so hard.
Pleural Effusions & Respitory Failure
Can cause resp failure if LARGE AND ACUTE. Solve this by draining the fluid out. Impact of physiology is in restriction. R
Mosty asymptomatic, previously found on Cxray. IF they have symptoms, mild chest pain and SOB. Since interstitial, may hear diffuse, dry rales. Severe symptoms only in stage 4. Symptoms do NOT correlate with severity.
Only use Resp Failure in stage 4 (based on cxray). Patients may present in ANY stage 1-3.
Stage 3 will have SOB un≤the patient is very sedentary. "
"• (Lobular)/ Bronchopneumonia - This form of pneumonia tends to be seen in the extremes of life, most have fever and a productive cough.
Clinical findings: insidious onset, lower fever than in typical pneumonia. Cough is usually non-productive. There are no physical findings of consolidation.
A) Objectigy with Numeric (borg) Scale 0-10
B) hx- Exertional, nocturnal (severe) intermittent, constant (≥ 4x/day)
- Sensation of Breathlessness
- Multisymptom Complaint
- If it's at rest, you have end stage disease.
2. COUGH (Need to be able to have a high exp flow at once and good upp resp muscle function)
- Productive?, Frequency, Changes
- with or without Hemoptysis
- any time can be caused by ACEi (takes a few months for chronic coughs to disappear)
- may be the ONLY symptom in a disease
3. CHEST PAIN
- Typical or atypical
4. SOMNULENCE & FATIGUE
- Headaches, nightmares, snoring, no reserve"
"* SOB, sputum production, and chronic cough. Exercise intolerance, wheeze (sound associated with turbulence). Clubbing (can be sign of chronic hypoxia).
* SOB ignored often except upon questioning. → late diagnosis. This is why ppl with RR should have regular spirometry and imaging screening.
* Pink Puffers
• Dyspnea, cachexia, no hypoxia.
• Hyperinflation, low FEV, low ER, PO2 often above 65.
* Blue Bloaters
• Hypoxia, no work generated, more likely to be overweight.
* Black lungs/hyperinflation. CP often.
* LOW diffusion. Can see hypoxia when moderate to severe. "
"o Clinical Hallmark: In order to have CB, you must have a cough at least 4 days a week + phlegm for at least 3 months in a row for at least 2 years.
-Need two years to exclude other diseases like TB, PN, etc.
- Air flow limitation NOT needed for diagnosis.
- may have wheezing due to narrowing airway
"DDX: Length, most common is Pneumonia.
Onset usually occurs within 24 hours to 3 days of the original illness or injury. At 72 hours, 85% of patients have clinically apparent ARDS. Typicall does NOT occur after 2 weeks of the event. "
- cough > 3weeks duration
- night sweats/chills
- fever and weight loss due to macrophage activation releasing cytokines such as TNFα
Night sweats, fevere, weight loss, does not respond to normal AB. Fluid, effusions, infilarates -all possible. BUT reactivateion TB is classically in the upper lobe. "
Dyspnea, SOB, Rales (velcro crackles on asucultation).
Idiopathic Pulmonary Fibrosis
"Insidious onset; several months of progressive dyspnea, cough, weight loss. If was fine a few months ago, it's NOT IPF.
- 1/3 post-viral illness"
Smoking-Related Interstitial Lung Disease
"Desquamative interstitial pneumonia (DIP)
Clinical: more symptomatic than RB or RB-ILD
Clinical: Often incidental findings in lungs of smokers.
Lymphocytic interstitial pneumonia (LIP)
• ↑ing dyspnea, cough over few years
Nonspecific interstitial pneumonia (NSIP)
Insidious onset of dyspnea, cough
Hypersensitivity Pneumonitis - (EXTRINSIC ALLERGIC ALVEOLITIS)
"Clinical symptoms are varied, but can consist of acute attacks that appear 4 to 6 hours after exposure, consisting of cough, dyspnea, fever, and leukocytosis.
Acute HP (uncommon)
• Presents after sudden massive exposure in a previously sensitivized person. Abrupt onset of fever, chills, chest tightness, malaise headache variable cough. Peaks 4-6 hours after exposure, rarely biopsied. Often presents as ARDS and histologically as DAD.
Chronic HP (common)
• Present with cough, dyspnea, weight loss
• Occurs after multiple episodes with chronic exposure to antigen, can lead to development of interstitial fibrosis and if exposure continues, progressive lung disease"
Acute interstitial pneumonia (AIP)
• Clinical: Acute severe shortness of breath, respiratory failure, patient typically on a ventilator
Latency up to 20 yrs.
Coal Workers' Pneumoconiosis (CWP)
Patients present with productive cough and resting dyspnea.
• Latency 13 -20years
Like most pneumonoconioses, asbestosis commonly presents with dyspnea and cough. Exertional dyspnea generally presents first, and once the disease progresses → dyspnea at rest."
Bronchogenic Carcinoma (BCC)
"Cough, ↑d incidence of hemoptysis, ↑d wheeze/strider. Can come in with pneumonia also.
Presenting Signs & Symptoms
-Cough, Dyspnea: 45-75%
-Chest Pain, Hemoptysis: 27-57%
-Weight loss, fatigue, distant organ symptoms, bone pain, confusion, hoarseness.
Can also have paraneoplastic syndromes: from hormonal"
NSCC- Adenocarcinoma (~30-50%)
coughs up mucus
NSCC- Squamous cell carcinoma (~30%)
"""The most important factor affecting survival is the TNM staging system. Presenting symptoms of lung cancer of any kind are frequently unspecific, and consist of cough, weight loss, chest pain, and dyspnea. ""
Can also have paraneoplastic syndromes: clubbing/hypercalcemia.
↓ed BS on side of mass "
Small cell carcinoma
"Small cell lung carcinoma is the most common lung cancer associated with ectopic hormone production.
Clinical signs and symptoms are similar to other pulmonary malignancies and consist of cough, weight loss, chest pain, and dyspnea.
Cushing's syndrome and a Cushingoid body habitus can develop with excessive ACTH secretion.
Electrolyte abnormalities such as hyponatremia can result due to SIADH.
Lambert-Eaton myasthenic syndrome, which is a disorder of muscle weakness due to auto-antibodies directed against neuronal pre-synaptic calcium channels, can also be seen as a manifestation of lung carcinoma."
"Carcinoid of the
Lung (0.8%) -Neuroendocrine"
"About 25% of patients are asymptomatic at the time of diagnosis.
Common presenting symptoms include cough, hemoptysis and recurrent obstructive pneumonias. Wheezing, chest pain and dyspnea can also occur. "
The most common presenting symptoms are chest pain, dyspnea, and recurrent idiopathic pleural effusions.