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Lab Medicine > Pulmonary Lab Med 1 > Flashcards

Pulmonary Lab Med 1 Flashcards

1
Q

once you get a PPO2 of what, will you % saturation of 90

A

60

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2
Q

What things cause a left shift of the curve?

A

decrease temp
decreased 2-3 DPG
decreased (H+)
CO

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3
Q

the higher the elevation…..

A

the less barometric pressure there is to push the oxygen on the hemoglobin

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4
Q

how long does it take for a molecule of O2 to get across the interstitial membrane

A

3/4 of a second

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5
Q

what can you do to test if the time for molecule to get across the interstitial membrane is longer?

A

exercise them

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6
Q

does alveolar hypoventilation occur in dz processes of the lung?

A

No, when something else is going on that causes elevated pCO2 and decreased PO2

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7
Q

what are some things that cause alveolar hypoventilation?

A

Drugs
CNS injury
neuromuscular weakness (myastenia gravis)
obesity

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8
Q

what should be removed before using a pulse ox?

A

remove nail polish

make sure hands arent cold

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9
Q

example of a shunt in pulmonary

A

lobar pneumonia (densely occupied part)

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10
Q

does an increase in oxygen help solve a shunt problem?

A

No because the blood is shunted anatomically

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11
Q

4 diseases that cause V/Q mismatch

A

COPD
Asthma
Pneumonia
Pulmonary emobilsm

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12
Q

what is the most common cause of hypoxia and can be corrected w/ oxygen?

A

V/Q mismatch

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13
Q

normal PaCO2

A

35-45

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14
Q

normal PaO2

A

70-80

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15
Q

Normal O2Sat

A

90-96%

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16
Q

Normal HCO3?

A

24-28

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17
Q

what regulates the PaCO2 rate?

A

alveoli

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18
Q

what regulates the HCO3 level?

A

Kidneys

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19
Q

The hydrogen ion concentration [H+] in extracellular fluid is determined by the

A

balance between the partial pressure of carbon dioxide (PCO2) and the concentration of bicarbonate [HCO3-] in the fluid.

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20
Q

how long does it take the kidneys to make a compensatory response?

A

72 hours

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21
Q

PaCO2 elevated – causes: Drug OD, COPD exacerbation with respiratory failure

A

Respiratory acidemia

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22
Q

PaCO2 low causes: sepsis, altitude, aspirin OD

A

Respiratory alkalemia

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23
Q

HCO3 low – causes lactic acidosis, ketoacidosis, renal failure, severe diarrhea

A

Metabolic acidemia

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24
Q

HCO3 high – diuretics, vomiting, ng suction, NA HCO3 ingestion

A

metabolic alkalemia

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25
Q

If pH is normal and pCO2 and HCO3 are abnormal then __________ EXISTS

A

compensation

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26
Q

pH is abnormal, and both pCO2 and HCO3 are abnormal what is hapenning?

A

two separate abnormal processes can be occurring without compensation

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27
Q

pH normal + increased pCO2 + increased HCO3

A

compensated respiratory acidosis

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28
Q

pH normal + decreased HCO3 + decreased pCO2

A

compensated metabolic acidosis

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29
Q

what’s another way to get a CO2 level besides ABGs?

A

BMP

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30
Q

pH>7.50 + pCO2<30 + normal HCO3

A

uncompensated respiratory alkalosis

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31
Q

pH>7.50 + HCO3>30 + normal pCO2

A

uncompensated metabolic alkalosis

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32
Q

respiratory causes of acidosis

A

hypoventilation

impaired gas exchange (V/P mismatch)

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33
Q

metabolic causes of acidosis

A 
Ketoacidosis (i..e diabetes)
Renal Tubular Acidosis (i.e. renal failure)
Lactic Acidosis (i.e. Decreased perfusion or severe hypoxemia)
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34
Q

what is the anion gap?

A

Na+ – (Cl- + HCO3-)

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35
Q

if the anion gap is > 12 what does that indicate?

A

anion gap acidosis

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36
Q

what does MULEPAK stand for?

A

causes of an anion gap

Methanol, Uremia, Lactic Acidosis, Ethylene Glycol, Paraldehyde, ASA, Ketoacidosis

37
Q

respiratory causes of alkalsosi

A

Hyperventilation due to hyoxemia, metabolic acidosis, neurologic

38
Q

meatbolic causes of alkalosis

A

hypokalemia
gastric suction or vomiting
hypocholemia

39
Q

with hyperchloremia is there an elevated anion gap?

A

No

40
Q

some indications for pulmonary function tests

A

SOB, exertional dyspnea, chronic cough

41
Q

what can spirometry determine

A

FEV1
FVC (forced vital capacity)
FEV1/ FVC
forced expiratory flow (FEF) in small airways

42
Q

with obstructive lung dz what will happen to the FEV1 and FVC?

A

Decreased

43
Q

with obstructie lung disease what is FEV1/ FVC below?

A

<70%

44
Q

what is used to follow severity in COPD?

A

FEV1

45
Q

Name a differential for obstructive lung dzs

A 
Asthma
COPD
bronchiectasis
bronciolitis
upper airway obstruction
46
Q

is the relationsihp between FEV1 and FVC decreased in restrictive patterns?

A

No, usually normal or increased

47
Q

name some restrictive lung dzs

A

pleural (cancer)
parenchymal
chest wall (broken ribs)
neuromuscular (guillan-burre, MG)

48
Q

what does a improved FEV1 after a bronchodilator indicate?

A

A reversible airflow obstruction

49
Q

what is considered improvement on FEV1 after a bronchodilator?

A

12-15% improvement

50
Q

Spirogram that Measures forced inspiratory and expiratory flow rate. Augments spirometry results.

A

Flow volume loop

51
Q

what are indications for a flow volume loop?

A

Evaluation of upper airway (stridor, unexplained dyspnea)

52
Q

how do you measure lung volumes?

A

helium

	- nitrogen washout
	- body plethsmography
53
Q

when are lung volumes indicated

A

Diagnose restrictive component

Differentiate chronic bronchitis from emphysema

54
Q

Measures ability of lungs to transport inhaled gas from alveoli to pulmonary capillaries

A

diffusing capacity

55
Q

what does diffusing capacity depend on?

A

alveolar—capillary membrane
hemoglobin concentration
cardiac output

56
Q

what can cause a decreased DLCO

A

obstructive lung dz
parenchymal dz
pulmonary vascular dz
anemia

57
Q

what can cause increased DLCO

A

asthma (or normal)
pulmonary hemorrhage
polycythemia
left to right shunt

58
Q

Indications for DLCO

A

Differentiate asthma from emphysema
Evaluation and severity of restrictive lung disease
Early stages of pulmonary hypertension
(it is expensive)

59
Q

Useful for diagnosis of asthma in the setting of normal pulmonary function tests

A

Bronchoprovocation

60
Q

common agents for bronchoprovocation

A

Methacholine, Histamine, others

61
Q

when is a bronchoprovocation considered diagnostic

A

≥20% decrease in FEV1

62
Q

with emphysema what happens with the TLC?

A

TLC is increased

63
Q

what happens with the DLCO with empysema?

A

decreased

64
Q

A 36yo WF, non-smoker, presents to your office for follow-up of ‘recurrent bronchitis.’ You suspect asthma and decide to order spirometry. Which of the following would you include in your prescription for testing?

A

if no obstruction present, perform methacholine challenge

65
Q

Exhaled Nitric Oxide is elevated in patients with ______________________________

A

eosinophilic inflammation

66
Q

what is an x-ray with smaller thorax helps to see pneumothorax better

A

Expiratory film

67
Q

what ribs do you see on an x-ray?

A

posterior

68
Q

what can shift the hilum toward the problem?

A

atelectasis
fibrosis
post pneumoectomy

69
Q

what can a shift of the hilum away indicate?

A 
pleural effusion
air trapping
tension pneumo
pneumo
tumor
70
Q

When the lung is consolidated and the bronchi contain air, the dense lung delineates the air in the bronchi

A

air bronchogram

71
Q 
Fluffy
Poorly defined
Often contain air bronchograms
ARDS, Pulmonary Edema, bacterial pneumonia
Diffuse, focal
A

Alveolar infiltrates

72
Q

streaky infiltrates
linear, nodular diffuse
associated w/ fibrosis, heart failure

A

interstitial infiltrates

73
Q

any pulmonary lesion represented in a radiograph by a sharply defined, discrete, nearly circular opacity 2-30 mm in diameter

A

Nodule

74
Q

what is larger than 3 cm seen on x-ray?

A

mass

75
Q 
Scarring of lung due to injury
Chronic aspiration
Inhalation injury
Acute Respiratory Distress Syndrome
Infection
Occupational exposures
Collagen-Vascular related
A

pulmonary fibrosis

76
Q

when do you use CT with contrast

A

concerned about something vascular

77
Q

when do you get a sputum sample

A

underlying lung dz

best if first morning sample, shouldn’t have >25 squamous cells (that indicates saliva)

78
Q

when would you use the methacholine challenge?

A

if PFTs are normal are you suspect asthma

79
Q

when is a methacholine challenge diagnostic?

A

> 20% decrease FEV1

80
Q

If you see a “sail collapsed” on a FV loop what should you suspect?

A

Obstructive pattern

81
Q

What does the FV loop look like on a restrictive pattern?

A

Decreased

82
Q

If you have a restrictive lung dz and then you get a DLCO and it is decreased what do you suspect?

A

parenchymal disease

83
Q

Is DCLO normal for chronic bronchitis or emphysema?

A

chronic bronchitis

84
Q

how do you evaluate pulmonary HTN?

A

echocardiogram + doppler

best test is cardiac catheterization with direct measurement of pulmonary arterial pressure

85
Q

Is TLC normal in emphysema or chronic bronchitis?

A

Chronic bronchitis

86
Q

lines that indicate fluid accumulation

A

Kerley B lines

87
Q

pH < 7.30 + pCO2 >50 + normal HCO3

A

uncompensated respiratory acidosis

88
Q

pH < 7.30 + HCO3<18 + normal pCO2

A

uncompensated metabolic acidosis

Lab Medicine (12 decks)

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