2025 – PAGE 433 – PULMONOLOGY

(DOUBLE TAKE) ASCARIS LUMBRICOIDES

Look for a history of travel to a tropical climate or immigrant status if Ascaris lumbricoides is suspected. Patients will have abdominal discomfort and pain. They can also have pancreatitis as well as INTESTINAL OBSTRUCTION. Can also have RESPIRATORY symptoms including a bronchitis that appears as SHIFTING INFILTRATES on serial chest X-rays and is associated with EOSINOPHILIA. Diagnose by examining stool for worms or barrel-shaped eggs. Treat with ALBENDAZOLE or PYRANTEL PAMOATE.

NOTE: Loffler Syndrome is the buildup of pulmonary eosinophils in the lungs due to a parasitic infection. This is also called chronic eosinophilic pneumonia. As mentioned, look for SHIFTING INFILTRATES on serial chest X-rays.

IMAGE: www.pbrlinks.com/ASCARIS1

MNEMONIC: A SCARE-E bunch of earthworm-like, BENDY creatures CLOGGED UP a BARREL.

• Key: Ascaris, eosinophilia, albendazole, intestinal obstruction, and barrel-shaped eggs.

MNEMONIC: Imagine A SCARE-E PYRATE (pyrantel pamoate) playing A NEW PIANO (pneumonia) on his ship. As the waves get rough, the NEW PIANO starts to SHIFT all over the deck (shifting infiltrates).

MISCELLANEOUS PULMONARY DEFINITIONS AND CONDITIONS

VOCAL FREMITUS

Increased vocal fremitus (VF) indicates the presence of pneumonia or a consolidation. It’s noted when you are able to feel vibrations at a particular area on a patient’s chest. Decreased VF indicates the presence of a pleural effusion or pneumothorax. Breath sounds are said to be “bronchial” over a consolidation, and decreased over an effusion.

MNEMONIC: Try to think of it this way, but note that this is physiologically WRONG. If that bothers you, skip this mnemonic. Each lung is like a sponge. If part of it is filled with a little bit of gunk (pneumonia/consolidation), there are still airspaces that allow sound to get in. Now, suppose you put a sponge into a glass of water. There would no longer be any space for sound to travel through (effusion). So, vocal fremitus is absent. Also, instead of knowing that a pneumothorax is a space filled with air, imagine it’s a VACUUM that’s devoid of air/matter. So sound, and vocal fremitus, cannot exist in such a space.

COR PULMONALE

Cor pulmonale is also known as right heart failure and is caused by pulmonary hypertension, which is often due to an obstructive airway process. The right-sided heart failure can only be reversed (at least a little) if the etiology of the obstructive pulmonary process is diagnosed and treated. Signs of cor pulmonale may include lower extremity edema, hepatomegaly, clubbing, or a gallop on the cardiovascular exam.

PEARL: If a child is noted to have large tonsils or adenoids with a lung or heart issue, think about possible obstructive sleep apnea (OSA) since it can lead to pulmonary hypertension and right-sided heart failure.

TACHYPNEA

Tachypnea may be the only indication on exam that a patient has a metabolic acidosis.