PULM Flashcards
volume of air moved into or out of the lungs during quiet breathing
tidal volume
the volume of air remaining in the lungs after maximal expiration
residual volume
the volume of air that can be further exhaled at the end of normal expiration
Expiratory reserve volume
the volume of air that can be further exhaled at the end of normal inspiration
Inspiratory reserve volume
maximum volume of air that can be exhaled following maximal inspiration
vital capacity
the volume in the lungs at maximal inspiration
total lung capacity
the volume of gas in the lungs at normal tidal volume end expiration
functional residual capacity
the volume of air that has been exhaled at the end of the first second of forced expiration
FEV1
measurement of volume of air that can be expelled from a maximally inflated lung with pt breathing as hard and fast as possible
forced vital capacity
continuous, whistling, musical, high-pitched sounds heard during expiration due to narrowed obstructed airways
wheezing
–seen with obstructive lung diseases
continuous, rumbling, coarse, low-pitched sounds that clear with cough
rhonchi
–caused by secretions
discontinuous, high pitched sounds heard during inspiration
rales (crackles)
–not cleared w/ cough
–seen with pneumonia, atelectasis, bronchitis, bronchiectasis, pulm fibrosis
monophonic sound over trachea due to narrowing of larynx
stridor
MC RF for COPD
smoking and/or exposure
only genetic disease linked to COPD in younger patients <40 yo
alpha-1 antitrypsin deficiency
Dx for COPD
PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted (decreased DLCO in emphysema)
Define chronic bronchitis
productive cough for a least 3 months a year for 2 consecutive years
Factors that reduce mortality in COPD:
1- smoking cessation
2- O2 therapy
3- PCP and Flu vaccines annually
Indications of O2 therapy in COPD: (3)
paO2 <55 mmHg, O2 sat <88%, or cor pulmonale
Abx Tx for AECOPD:
macrolides (azith, clarith), cephalosporins (cefuroxime, cefixime), Augmentin, fluoroquinolones
categorizes severity of COPD based on FEV1 and FEV1/FVC ratios
GOLD criteria
Gold Criteria: Category C patients should be treated with
LAMA
Maximal COPD therapy includes:
LAMA + LABA + inhaled glucorticoid
–supportive: O2, smoking cessation, annual vaccines
–steroids and abx in AECOPD
MC cause of bronchiectasis in US
CF
Dx of CF
sweat chloride test (Cl levels >60 on 2 occasions after pilocarpine administration)
CF results due to a mutation in this receptor
CF transmembrane conductance receptor
–causes abnormal chloride and water transport across exocrine glands, resulting in thick viscous secretions of lungs, pancreas, sinuses, intestines in CF
MC organism to cause recurrent lung infections in bronchiectasis
pseudomonas aeruginosa if CF
–H flu if not related to CF
MC RFs for CF
Caucasians, Northern Europeans
Dx for bronchiectasis and classic findings
High resolution CT with thickened bronchial walls (tram track) and increased airway diameter > adjacent vessel diameter (signet ring sign)
PFTs with decreased FEV1, decreased FEV1/FVC <70% predicted
MC RF for asthma
atopy
Atopic triad
asthma
allergic rhinitis
atopic dermatitis (eczema)
Samter’s triad
asthma
chronic rhinosinusitis with polyps
sensitivity to ASA/NSAIDs
Dx for asthma
PFTs with reversible obstruction (decreased FEV1, decreased FEV1/FVC following methacholine challenge)
best and most objective way to assess severity & treatment response in asthma exacerbation
peak expiratory flow rate
Tx of moderate persistent asthma
Low ICS + LABA
–alternatives, Medium ICS or add LTRA
Tx of severe persistent asthma
High ICS + LABA +/- Omalizumab
MC RFs for sarcoidosis
Female, AA, Northern Europeans
Dx for sarcoidosis
CXR with bilateral hilar LAD
PFTs with restrictive pattern
Tissue biopsy with noncaseating granulomas
MC RF for pulmonary fibrosis
men >40 yo
Dx for pulmonary fibrosis
Chest CT with reticular honeycombing, focal ground-glass opacifications
PFTs with restrictive pattern
Tissue biopsy with honeycombing
RF for silicosis
coal mining, quarry work with granite, slate, quartz, pottery makers, sandblasting, glass and cement manufacturing
CXR with silicosis
multiple, small (<10mm) round nodular opacities in UL
*eggshell calcifications of hilar and mediastinal nodes
lung disease from inhalation of coal dust particles
coal worker’s pneumoconiosis (black lung disease)
lung disease from inhalation of silicon dioxide
silicosis
Caplan syndrome
coal worker’s pneumoconiosis + RA
Dx for coal worker’s pneumoconiosis
CXR with small nodules in ULs and hyperinflation in LLs in obstructive pattern
lung disease from inhalation of beryllium
Berylliosis
RF for Berylliosis
aerospace, electronics, ceramics, tool and dye manufacturing, jewelry making
lung disease due to cotton exposure
Byssinosis
RF for Byssinosis
employed in textile industries (flax or hemp exposure)
lung disease due to inhalation of asbestos fibers
asbestosis
RF for Asbestosis
destruction, repair, or renovation of old buildings, insulation
Dx for asbestosis
CXR with pleural plaques in LLs
PFTs with restrictive pattern
Tissue biopsy with linear asbestos bodies
MC complication of asbestosis
bronchogenic carcinoma (mesothelioma is most specific)
hypersensitivity pneumonitis from nitrogen dioxide gas exposure released from plant matter
silo filler disease