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MHD > Pulmonary Function Tests and Clinical Approaches > Flashcards

Pulmonary Function Tests and Clinical Approaches Flashcards

1
Q

What lung test is used to determine if there is obstruction?

A

Spirometry

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2
Q

What lung test is used to determine if there is restriction?

A

Helium dilution

Body plethysmography

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3
Q

What lung test is used to determine if there is a diffusion defect?

A

CO diffusion test

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4
Q

What do pre and post mean on a PFT?

A

Pre = before bronchodilator administration

Post = after bronchodilator administration

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5
Q

What is the primary value for determining obstruction?

A

FEV1/FVC ratio

If less than 0.70, there is evidence of obstruction

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6
Q

What is the appearance of the flow volume loop when there is small airway obstruction?

A

Scooping of the expiratory portion of the loop

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7
Q

How could you test for reversible obstruction? What are the criteria for reversibility?

A

Administer a bronchodilator, then measure another flow volume loop

Need 200ccs and 12% improvement in FEV1 to classify as reversible

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8
Q

If the PFT is normal initially, how could you induce obstruction and indicate hyperreactivity?

A

Methacholine challenge test

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9
Q

What are the common obstructive diseases (lower airway)?

A

Asthma
Emphysema
Chronic Bronchitis
Bronchiectasis

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10
Q

Describe the basic pathology behind small airway diseases. How is the airflow affected over the course of expiration?

A

The obstruction worsens as lung volume decreases

There is gradually decreasing airflow as the lung volume gets smaller due to less tethering of the bronchioles

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11
Q

Describe the flow volume loop appearance of Upper Airway Obstruction

A

May be fixed or variable
Fixed - both the expiratory and inspiratory loops have a flattened appearance

Variable - either the expiratory or inspiratory loop is flattened, but not both

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12
Q

Which loop is flattened in an extrathoracic upper airway obstruction?

A

Inspiratory loop is flattened

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13
Q

Which loop is flattened in an intrathoracic upper airway obstruction?

A

Expiratory loop is flattened

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14
Q

What intrinsic lung property determines the total lung capacity?

A

The lung elastic recoil

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15
Q

At what lung volume are the lung’s and chest wall’s elastic recoils balanced?

A

FRC

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16
Q

What is the primary problem in restrictive lung disease?

A

TLC is low

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17
Q

What are the 3 main categories of restrictive lung diseases?

A

Interstitial lung disease
Chest wall disease
Neuromuscular disease

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18
Q

List the potential causes of Interstitial Lung Disease

A 
Sarcoid
Hypersensitivity pneumonitis
IPF
Tuberculosis
Fungal
Aspiration/Asbestosis
Connective Tissue Disorder/Cancer
Eosinophilic granuloma
Drugs (amiodarone, bleomycin)
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19
Q

What is a normal DLco? What is the equation to calculate it (uncorrected)?

A

DLco is normally 25mL/min/mmHg

DLco = [CO]inhaled = [CO]exhaled

20
Q

What is the DLco equation corrected for hemoglobin?

A

DLco corrected = DLco x (15/Hbg)

21
Q

What conditions may cause a reduced DLco?

A

Loss of alveoli (emphysema and ILD)
Loss of capillaries (Pulm HTN)
Anemia

22
Q

When DLco is low but spirometry and lung volumes are normal, you should suspect…

A

Pulmonary HTN

23
Q

The volume of the lungs may appear very different on CXR in certain diseases. When would the lungs appear big? Small?

A

Obstructive diseases have large lungs and flat diaphragms

Restrictive diseases have small lungs and domed diaphragms

24
Q

What is the primary pathological problem in asthma?

A

Smooth muscle hypertrophy due to inflammation

It is reversible and intermittent obstruction

25
Q

What does “persistent” mean in asthma classification?

A

The patient needs persistent treatment for their asthma

26
Q

What are the two kinds of treatments used for asthma?

A 
"Relievers" 
Emergency bronchodilators (albuterol, B2 agonist)

“Controllers”
Regularly used anti-inflammatories

27
Q

What is the first line asthma controller? What might you add if that is inadequate?

A

Inhaled corticosteroid

May add a long acting beta agonist if needed

28
Q

What is a common side effect on inhaled corticosteroids for asthma? How can this be avoided?

A

Thrush (oral-pharyngeal deposition of the medicine)

Use a spacer to prevent thrush

29
Q

What 4 symptoms may people with asthma present with (in any combination)?

A

SOB
Wheezing
Chest tightness
Cough

30
Q

What is cough variant asthma?

A

Asthma presenting only with a cough

31
Q

What is exercise induced asthma? How does it occur?

A

Asthma presenting after exercise.

Increased ventilation during exercise leads to lots of beta agonist flowing in your blood, dilating the airways. However, the person may feel worse after stopping exercise due to dry mucus membranes and mast cell degranulation

32
Q

What is RADS?

A

Reactive Airways Dysfunction Syndrome

Asthma that occurs after a single large exposure to an irritating agent

33
Q

What is Samter’s Triad?

A

Asthma
Aspirin sensitivity
Nasal polyps

People who take NSAIDs (aspirin) may develop asthma

34
Q

What is ABPA?

A

Allergic Bronchopulmonary Aspergillosis

Hyperinflammatory response leading to reaction in the airways, causing asthma

35
Q

What are the two diseases considered COPD?

A

Emphysema

Chronic Bronchitis

36
Q

Describe Pink Puffers and the disease associated with it

A

Emphysema

Patient is pink and skinny. Normal pO2 and pCO2. They have increased work of breathing so they are thin (cachectic)

37
Q

Describe Blue Bloaters and the disease associated with it

A

Chronic Bronchitis
Patient is edematous and cyanotic. Accepts a low pO2 (hypoxia), leading to hypoxic pulmonary vasoconstriction. Less tachypnea. Lots of mucus production

38
Q

What are the treatments of COPD?

A

Smoking cessation

Medications - short and long acting bronchodilators (B agonists or anti-cholinergics)

Long Term O2 therapy

Cardiopulmonary Rehab (Exercise)

Transplant
Exogenous Alpha-1-Antitrypsin

39
Q

What is the number one indication for a lung transplant?

A

Emphysema

40
Q

What is bronchiectasis?

A

Permanent abnormal dilatation of the bronchi

Tons of mucus is trapped in the airways and you get permanent abnormal dilatation with bacterial colonization and inflammation

41
Q

What is the sign of bronchiectasis that may be seen on CT?

A

Signet ring appearance

Airway is bigger in diameter than the corresponding blood vessel

42
Q

What is pneumoconiosis?

A

Buildup of dust particles in the lung and the tissue’s response

Causes restrictive lung disease

43
Q

What are some physical exam findings of interstitial lung disease?

A

Crackles
Small lungs
Clubbing of fingernails

44
Q

What is sarcoidosis?

A

Nonspecific tissue reaction with noncaseating granulomas in the lungs and other areas of body.

See lymphadenopathy (hilar) and interstitial lung disease

45
Q

Where in the lung does sarcoidosis have its primary effect?

A

Upper lobes

46
Q

Where in the lung does idiopathic pulmonary fibrosis have its primary effects?

A

Lower lobes and periphery

See an extra whiteness around the base of the lungs on CT (fibrosis)

47
Q

What is the end stage appearance of IPF?

A

Honeycomb lung

MHD (57 decks)

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