PANCE Blueprint Pulmonary (10%)

Other Pulmonary Disease (PEARLS)

PANCE Blueprint Pulmonary (10%)

The NCCPA™ PANCE Pulmonary Content Blueprint other pulmonary diseases

Acute respiratory distress syndrome (ARDS)	Non-cardiogenic pulmonary edema Etiology: Sepsis, severe trauma, aspiration of gastric contents, near-drowning Presentation: Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event. Tachypnea, pink frothy sputum, crackles Diagnostic studies: Chest radiograph: air bronchograms and bilaterally fluffy infiltrate Normal BNP, pulmonary wedge pressure, left ventricle function and echocardiogram Treatment: Underlying cause and intubation positive pressure oxygen
Asthma (ReelDx)	Presentation: Most often young patients present with wheezing and dyspnea often associated with illness, exercise and allergic triggers Diagnosis and monitor with peak flow. PFT's: Greater than 12% increase in FEV1 after bronchodilator therapy FEV1 to FVC ratio < 80% (You would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount In asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio Treatment guidelines: Mild Intermittent: Less than 2 times per week or 3-night symptoms per month Step 1: Short-acting beta2 agonist (SABA) PRN Mild Persistent: More than 2 times per week or 3-4 night symptoms per month Step 2: Low-Dose inhaled corticosteroids (ICS) daily Moderate Persistent: Daily symptoms or more than 1 nightly episode per week Step 3: Low-Dose ICS + Long-acting beta2 agonist (LABA) daily Step 4: Medium-Dose ICS +LABA daily Severe Persistent: Symptoms several times per day and nightly Step 5: High-Dose ICS +LABA daily Step 6: High-Dose ICS +LABA +oral steroids daily Acute treatment: Oxygen, nebulized SABA, ipratropium bromide, and oral corticosteroids Making Sense of Forced Vital Capacity Forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath. Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test You would expect the amount of air exhaled during the first second to be the greatest amount. In asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio.
Cystic fibrosis	Etiology: Autosomal recessive mutation in the CFTR gene Abnormally thick mucus, difficulty clearing mucus Presentation: Recurrent respiratory infections (especially Pseudomonas), steatorrhea Diagnosis: Quantitative sweat chloride test CXR may reveal hyperinflation, mucus plugging, and focal atelectasis Treatment: Maintenance: Chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A, D, E, K) Acute exacerbations: Antibiotics
Foreign body aspiration	Presentation (depends on the location of obstruction) Inspiratory stridor if high in the airway Wheezing and decreased breath sounds if low in the airway Complications: Pneumonia, acute respiratory distress syndrome, asphyxia Treatment: Remove foreign body with a bronchoscope
Hyaline membrane disease	Etiology: Insufficient surfactant Population: Preterm newborn Chest radiograph: Ground glass appearance, air bronchograms, bilateral atelectasis Treatment: Ventilation and steroids
Bronchiectasis	Plate-like atelectasis seen with bronchiectasis Etiology: ½ of cases are due to cystic fibrosis Presentation: Copious foul-smelling sputum, frequent respiratory infections, chronic cough Radiograph: Dilated, thickened airways, and scattered opacities. “Tram-tracks”, CXR shows plate-like atelectasis Treatment: Chest physiotherapy and antibiotics for acute exacerbations

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