Mechanism, presentation, workup, treatment

Breakdown by system
PULMONARY
Obesity hypoventilation syndrome
 Presentation: fatigue, dyspnea, difficulty concentrating, hypoventilation (PaCO2>45)
 Mechanism: increased CO2 due to increased mass and SA, sleep disordered breathing,
normal Aa gradient
COPD
 Mechanism: air trapping, hyperinflation
 Presentation: breathe at higher FRC
Asthma
 Presentation: cough, SOB, wheeze, inhale dust mites, mold, pollen
 Mechanism: airway inflamm, bronchial hyperreactivity
 Workup: methacholine challenge
 Treatment: bronchodilator (ICS, albuterol)
Pulmonary arterial hypertension
 Mechanism: BMPR2 mutation have predisposition for dysfunctional endothelial and
smooth muscle cell proliferation, endothelin (vasoconstrictor) production increases,
induces smooth muscle cell prolif, intimal thickening and fibrosis (injury to pulm
arterioles)increased pressure in pulm circulationRV hypertrophy
 Presentation: dyspnea, fatigue, cyanosis, Raynaud/CREST
 Workup: S2 heart sound, RAD on EKG
 Treatment: Bosentan- endothelin antagonist
Emphysema
 Presentation: alpha-1 antitrypsin deficiency (has emphysema but never smoked), at risk
for liver cirrhosis
 Mechanism: centriacinar (neutrophils and macrophages release elastase), panacinar
(alpha-1 antitrypsin deficiency)
Pulmonary embolism
 Presentation: travel! sudden onset SOB/dyspnea and chest pain, immobilization and
recent surgery, calf swelling, hypoxemia and respiratory alkalosis (hypocapnia) due to
hyperventilation
 Mechanism: caused by DVT in lower extrem that embolizes to pulm vasculature,
blockage of pulm circulation results in V/Q mismatch, alveoli can’t oxygenate blood bc
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