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CPR M2T1E4 > #28 Wheezing, Dyspnea, and Pulmonary Function Testing > Flashcards

#28 Wheezing, Dyspnea, and Pulmonary Function Testing Flashcards

1
Q

Patient has a 13% drop in FEV within 30 minutes of exercise. Dx?

A

Exercise induced bronchospasm

Positive test require 10% drop in FEV from baseline within 30 minutes of exercise

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2
Q

How would you treat EIB?

A

1 - SABA 15 minutes before exercise

2- if SABA is not enough: 2a - Daily administration of an inhaled corticosteroid (ICS) [No LABA]

2b - Daily leukotriend receptor antagonist

or

2c - Mast cell stabilizing agent (rarely used)

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3
Q

Identify.

A

Vocal Cord Dysfunction

Note flattening on bottom

Wheezing louder over the neck

PFT is normal

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4
Q

Identify

A

Obstructive Flow-Volume Loop

Note steep peak and rounded bottom

Problem in exhalation

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5
Q

Identify

A

Restrictive Flow-Volume Loop

+ decreased DLCO = Intrinsic restrictive disease

or

+ normal DLCO = Extrinsic restrictive disease

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6
Q

Identify

A

Variable Intrathoracic

Note: Flat top

Upper airway obstruction inside chest

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7
Q

COPD + Hyperinflation + Air Trapping + Decreased DLCO

A

Emphysema

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8
Q

Bronchodilator Response +/- hyperinflation +/- air trapping + increased (or normal) DLCO

A

Asthma

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9
Q

Restrictive pattern + Decreased DLCO

A

Intrinsic Restrictive Lung Disease

IPF

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10
Q

Restrictive Pattern + normal DLCO

A

Extrinsic restrictive lung disease

Scoliosis

Myasthenia Gravis

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11
Q

Obstructive Pattern + Decreased TLC

A

Mixed disease

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12
Q

WHO classifies pulmonary hypertension into 5 groups. Your patient has portal hypertension. What group would he be classified as?

A

Group 1: Pulmonary Arterial Hypertension

Idiopathic

Also: HIV infection

Drug or toxin induced

Congenital Heart Disease

Connective Tissue Disease

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13
Q

WHO classifies pulmonary hypertension into 5 groups. Your patient has systolic dysfuncion. What group would he be classified as?

A

Group 2: Pulmonary Hypertension owing to Left Heart Disease

Also: diastolic dysfunction

Valvular heart

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14
Q

WHO classifies pulmonary hypertension into 5 groups. Your patient has COPD. What group would he be classified as?

A

Group 3: Pulmonary hypertension owing to lung diseases or hypoxemias

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15
Q

WHO classifies pulmonary hypertension into 5 groups. Your patient has sarcoidosis. What group would he be classified as?

A

Group 5: Pulmonary hypertension with unclear multifactorial mechanisms

Hematologic disorders

Systemic disorders

Metabolic disorders

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16
Q

WHO classifies pulmonary hypertension into 5 groups. What is group 4?

A

Group 4: Chronic Thomboembollic Pulmonary hypertension

17
Q

Your patient has a right sided cardiac cath and was diagnosed with pulmonary arterial hypertension. What was the patient’s PAP (pulmonary arterial pressure)? PCWP (pulmonary capillary wedge pressure)?

A

PAP >= 25 mmHg

Normal PCWP (less than 15 mmHg)

18
Q

There are 6 steps to interpreting pulmonary function tests (PFT). Can you list them?

A
  1. FEV1/FVC ratio
  2. Gold criteria
  3. Broncodilator response
  4. TLC (hyperinflation vs. restrictive)
  5. RV/TLC
  6. DLCO
19
Q

PFTs are determined by what criteria?

A

Sex, age, height and race

NOT WEIGHT

20
Q

Complete PFTs include what 4 assessments?

A

Spirometry

Lung Volume

DLCO

ABGs

21
Q

Step 1. FEV1/FVC Ratio

less than 70%?

greater than 70%

A

less than 70%? = COPD

greater than 70% = normal or restrictive

22
Q

Step 2: Gold criteria

What are the 5 GOLD stages and their FEV1s?

A

Mild Stage 1: FEV1 80 - 100%

Moderate Stage 2: FEV1 50 - 79.9%

Severe Stage 3: FEV1 30 - 49.9%

Very Severe Stage 4: FEV1 less than 30%

or FEV1 less than 50% with right sided heart failure

23
Q

Step 3 Bronchodilator response (hyperactive airways)

Criteria?

A

Significant Response is >= 12% increase and an absolute improvement of at lease 200 ml after inhaling a beta agonist in the FEV1 or FVC

24
Q

Step 4 TLC

Criteria?

A

Normal 80 - 120%

Hyperinflation > 120%

Restrictive less than 80%

Mild (70-80)

Moderate (60-70)

Moderately severe (under 60)

25
Q

Step 5 RV/TLC ratio

Criteria?

A

Normal: less than 40% or less than predicted

Air trapping: > 40%

26
Q

Step 6: DLCO (Diffusion Capacity of the Lung for Carbon Monoxide)

Criteria?

A

Normal: 80 - 120%

If it is an Obstructive disease:

Decreased in emphysema

Normal in chronic bronchitis

Normal or increased in asthma

If it is in Restrictive disease:

decreased in intrinsic restrictive disease

increased in extrinsic restrictive disease

CPR M2T1E4 (15 decks)

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