pulmonology Flashcards
Lung volumes? (4)
Tidal volume: normal in/ex 500mL
Inspiratory reserve volume max in beside TV 3000mL
Expiratory reserve volume: max ex beside TV 1200mL
Residual volume: gas left in lungs after ex 1200mL
Lung capasities
Inspiratory capacity: tidal + IRV 3500ml
Functional residual capacity: ERV+RV 2400ml
Vital capacity: all air max in/ex 4700ml
Total lung capacity: 5700ml
what two parameters are measured in a spirometry?
tidal volume and air flow
what is FEV1 and FEC
FEV1: forced expiration air the first second
FEC is the total expired air during the test
what % during spirometry decides the lund capacity?
FEV1/FVC = should be > 70%
FEV1/FCV < 70% indicates
obstructive lung disease
Decreased PEFR indicates ( peak expiratory flow rate)
Bronchi/tracheal obstruction
decreased FEF 25% indicates
middle airway obstruction
decreased FEF 50% and 75% indicates
peripheral airway narrowing (smaller bronchi)
what is the limitations of the spirometry test?
only measures volume that can move so not RV - use body plethysmography for this
CO pulmonary test CI?
recent surgery
AMI
retinal displacement
pneumothorax
bronchodilator reversibility test
to diagnose asthma or differentiate between COPD and asthma
steps of bronchodilator revertability testing
- spirometry
- 400mcg salbutamol
- wait 15 min
- new spirometry
results of a bronchodilator reverasbility test?
if FEV1 > 200 ml post bronchodilator then it is asthma
when do we use a Bronchial provocation test?
if suspected asthma with a normal spirometry test
what do we give in a bronchial provocation test?
Methacholin mostly (or histamin, adenosin, bradykinin)
results of a bronchial provocation test?
if FEV1 decreases with > 20% most likely asthma
contraindications of bronchial provocation test?
Severe airway obstruction
FEV1 < 1L
Recent MI
Severe HT
Aortic aneurysm
what is measured during an ergo spirometry?
VO2 max (oxygen utilization)
CO2 production rate
minute ventilation
lung volumes
absolute CI of ergo spirometry?
coronary insufficiency
uncontrolled arrhythmia
Decompensated HF
Acute pulmonary edema
Valvular stenosis
Spo2 < 85%
ARF
Untreated thyrotoxicosis
In vitro allergy tests?
Tryptase in serum
Allergen-specific IgE
Toral IgE
In vivo allergy testing
skin prick test
skin scratch test
intradermal test
when is a in vivo allergy test positiv?
skin prick test: when wheal is > 3mm
types of sleep apnea
cental and obstructive
standardized screening questions
STOP BANG
diagnosis criteria of sleep apnea
Daytime fatigue + more then two of:
- Loud snoring
- Witnessed choking, gasping, apnea during sleep
- Diagnosis of HT
indications of ABG?
Gas exchange abnormalities
Acute resp failure
Cardiovascular diseases
Exercise test
Sleep disorders
Acid/base abnormalities
Emergency settings
Allen test before ABG
The Allen test is used to assess collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in either the radial or the ulnar artery.
TB skin test
tuberculin injected under skin - 48-72h reaction means previously infected
TB speciment test?
Bronchoalveolar lavage
sputum
Aspirates from nasopharynx, endotracheal
latent TB treatment
Izoniazide for 9 months
TB treatment
RIPE
Rifampicin
Izoniazine
Pyrazinamide
Ethambutol
TB stain?
Zeil Neelsen staining (red microbes)
TB culture
Blood agar, chocolat agar and charcoal yeast, Lowenstein-Jensen
1-2 days to culture
1-2 days for susceptibility test
Pleural effusion Transudate vs Exudate
Transudate is hyper filtrated < 0.5 protein
Exudate is concentrated > 0.5 protein
physical examination of pleural effusion signs
Reduced chest expansion
Dull percussion
Quiet breathing sounds
Friction rub may be heard in inflammation
CXR in pleural effusion
PA view can detect only if over 200ml
LL view can detect > 50ml
DDx of pleural effusion
TB
Pneumonia
PE
malignancy
Rheumatoid arthritis
Hemothorax
what type of pulmonary effusion is most common in congestive HF, liver cirrhosis and hypoalbuminemia
Transudate
hemoptysis DDx
bronchial tumor
pneumonia
PE
Bronchiectasis
TB
Vasculitis
forging body
DDx of acute dyspnea
PTX
PE
AMI
Airway disease (COPD and Asthma exacerbation)
Metabolic acidosis
Hyperventilation syndrom
DDx of chronic dyspnea
Asthma
COPD
Parenchymal diseases (IPF, sarcoidosis, lymphagenitis, carcinomatosis)
Chest wall deformity
Myasthenia gravis
Anemia
Hypoxia
DDX of chest pain in pulmo disease
AMI
Pulmonary infarction
PE
pneumonia
PTX
Pericarditis
Autoimmune diseases
Fractured ribs
define chronic bronchitis
productive cough for at least 3 months each year for 2 years
define emphysema
permanent dilation of airspaces distal to terminal bronchioles caused by destruction of alveolar walls and pulmonary capillaries req. for gas exchange
exogenous causes of COPD
smoking
pollution
endogenous causes of COPD
a1-trypsin deficiency
developmental abnormalities
recurrent infections (Pneumonia, TB)
Premature
Primary ciliary dyskinesia
Ab deficiency (IgA)
Reid index
Ratio of the thickness of submucosal mucus secreting glands to the thickness between the epithelium and cartilage in the bronchial tree (whole wall)
If > 0.5 then chronic bronchitis
physiological processes involved in chronic bronchitis
- Increased neutrophils, macrophages and CD8+ cells
- overproduction of growth factor causing fibrosis, narrowing and emphysema
- Goblet cell proliferation and mucus hypersecretion
- impaired ciliary function
- SMC hyperplasia of small airways and capillary’s causing HT
explain the specific process og the emphysema in COPD
inactivation of protease inhibitors (a1-trypsin) causes increased proteases and elastase activity, loss of elastic tissue and lung parenchyma and loss of elastic recoil hence large spaces
two clinical appearances of COPD
pink puffers: emphysema
Blue bloaters: Chronic bronchitis
GOLD classification of COPD
1: MILD - FEV1 > 80%
2: MODERATE - FEV1 50-80%
3: SEVERE - FEV1 30-50%
4: VERY SEVERE - FEV1 < 30%
classification of emphysema?
Centriacinar (in the resp bronchiole)
Panacinar: (whole alveoli space)
Giant Bullous emphysema
Senile emphysema (airspace dilatation without alveolar wall destruction)
spirometry finding in COPD
Scooped curved during expiration
RV and TLC are abnormally high due to increased lung compliance and decreased recoil (air trapping)
3 pharmacological treatments if COPD
- bronchodilators
- Inhaled CS
- PDE4 inhibitors
SABA?
Salbutamol, fenoterol
LABA
Salmeterol, formeterol
SAMA
ipratropium bromide
LAMA
tiotropium bromide
inhaled CS?
budesonide
fluticasone
beclomethasone
PDE4 inhibitor
roflumilast
what is MRC?
What is it used in?
Modified medical research council dyspnea scale
Used in deciding pharmacological treatment of COPD
medication in severe refractory COPD
theophylline (adenosin receptor blocker and nonspecific PDE inhibitor)
when to give long term oxygen therapy in COPD
PaO2 < 55 mmHg
Sao2 < 88% at rest
target O2 saturation in COPD
90-93%
most common cause of AECOPD
rhinovirus
parainfluenza virus
RSV
Influenza
adenovirus
name bacteria causing AECOPD
hemophilus influenza
Maroxella
Strep. pneumonia
what drug can cause AECOPD
B-blockers
diagnosis of AECOPD
clinical presentation
imaging and other tests can be taken to find the cause
treatment of AECOPD
NIPPV with BiPAP
invasive mechanical ventilation in case of resp failure or shock
antibiotics
CS
Bronchodilators
define asthma
Chronic resp disease with bronchial hypersensitivity and episodic attacks
asthma pathophysiology
overproduction of Th2 cells causes overproduction of cytokines and activation of eosinophils inducing cellular response
How can aspirin induce asthma?
COX-1 inhibition - decreased PGE2 - Increased leukotrienes and inflammation and result in submucosal edema
lung sound on asculation in asthma?
hyperresonance
end expiratory wheezels
long expiration
spirometry asthma signs?
Decreased FEV1
decreased FEV1/FVC ratio
Mast cell stabilizers
cromolyn
Anti-IgE antibodies drug
omalizumab
treatment of Asthma
it depends on symptom frequency and the treatment is based on ICS+formeterol, then you up the dose depending on severity
step 5 treatment of asthma (Severe)
in severe cases you add a LAMA + Anti-IgE + high dose ICS and refer to phenotyping
what is acute ex. of asthma?
worsening of symptoms with change in baselin lung function
define status asthmatics
severe exacerbations of astma refractory to acute treatment
what are signs if resp failure in asthma exacerbation?
high PCO2 with normal pH and resp muscle fatigue
treatment of acute exacerbations asthma
ASTHMA
Albuterol (SABA)
Steroids
Humidified O2
Magnesium
Anticholinergics (SAMA)
Benefits of inhalers VS oral drugs?
inhalers:
- Rapid onset
- Smaller dose
- Better tolerance
- BUT more expensive
types of inhalers
Meter dose inhaler (MDI)
Spacer
Dry powder inhaler
Nebulizer
causes of community acquired pneumonia
Strep. pneumonia
Mycoplasma pneumonia
chlamydia pneumonia
Hemophilus influenza
klebsiella pneumonia
Acinetobacter
S. viridians from aspiration
how is the cough during pneumonia?
Productive purulent (yellow)
Auscultation findings during pneumonia?
Fine crepitation’s and crackles during first 2 weeks
Bronchial breath sounds
Decreased breathing sounds
How to decide treatment of pneumonia?
PORT classification
what are the PORT classes and their treatment?
PORT I: at home AB per os (amoxicillin-clavulonic acid)
PORT II-III: at home AB per os some req. late hospitalization
PORT III-IV: iv AB combo + hospital (amoxicillin-clav + Macrolide)
PORT IV-V: iv AB combo + resp IC (amoxicillin-clav + Macrolide)
what is nosocomial pneumonia?
hospital aq. with onset > 48h after admission
causes of nosocomial pneumonia
Enterobacter
pseudomonas
Acinetobacter
Hemophilus
Fusobactam
Bacteroids
nosocomial pneumonia treatment
rec. prolonged IV treatment with typically used amoxiclav, ceftriaxone, piperacillin-tazobactam, carbapenem
also consider MRSA coverage
define lung abscess
localized collection of puss and necrosis within lung parenchyma caused by microbial infection
- Primary: in normal lung parenchyma
- Secondary: immunocompromised patients
etiology of lung abscess
Bacterial: Fusobacterium, Prevotella, Bacteroids, Viridans, aureus
Fungal: Aspergillus, cryptococcus, histoplasma
Parasite: Entamoeba, paragonimus
symptoms of lung abscess
fever
cough with production of foul smell
pleuritic pain
fatigue
hemoptysis
anorexia
night sweats
immediate treatment of lung abscess?
dont wait for culture
start empiric AB asap with anaerobic coverage (ampicillin/carbapenems)
what is empyema
accumulation of puss in pleural cavity
etiology of empyema
pneumonia
infected hemothorax
ruptured abscess
esophageal tear
thoracic trauma
classification of empyema
Stage 1: exudative
Stage 2: fibropurulent
Stage 3: Organized
what AB is not used in empyema
aminoglycosides due to pore pleural bioavailability
empyema treatment AB?
2nd/3rd gen. cephalosporins + metronidazole or clindamycin
first line ab in TB
RIPE
Rifampin 6m
Isoniazid 6m
pyrazinamide 2m
Ethambutol 2m
ab in drug resistante TB
aminoglycosides
fluoroquinolones
cycloserine
para-aminosalicylic acid
two lung cancer types
Small cell lung cancer (only 1 type) 20%
Non-small cell lung cancer (many subtypes) 80%
cell type in SCLC
Neuroendocrine
Anaplastic
cell type in NSCLC
Squamous epithelium 45%
Adenocarcinoma 20%
Large cell carcinoma 15%
cell type of origin in SCLC
Kulschitzky cells
treatment of SCLC
Chemo + radio
treatment of NSCLC
dependent on the stage of the disease
I-IIIa surgery
IIIb-IV chemo + radio
steps in diagnosis lung cancer
- smoking
- symptomes
- chest x-ray
- CT
- histology (sputum cytology + bronchoscopy)
how often is NSCLC operable?
10-20% of cases
what is the cure rate in NSCLC
30% cured
70% relapse
what is the cure rate in SCLC
10% cured
90% relaps
can SCLC be surgically removed?
no, only radio+chemo
pleural tumor?
mesothelioma, very rare, might also be seen in pericardium and peritoneum. 1 year survival
cause of mesothelioma?
in majority of cases there has been exposure to asbestos
Dx of pleural cancer?
pleurocentesis
CXR and CT
Laparoscopy - biopsy
treatment of mesothelioma?
radio + chemo
surgery (pleurectomy) of it causes severe lung dysfunction
symptoms of SCLC
constitutional symptoms (weight loss, fever, weakness)
SVC syndrom
Hoarseness (r. laryngeal n. palsy)
dyspnea (phrenic n. palsy)
Dullness percussion
dysphagia (esophageal compression)
treatment of SCLC
- surgery NOT recommended
- stage I-III cisplatin/carboplatin 6 cycles + radio after 3rd cycle
- stage IV 4-6 cycles + 4 cycles of topotecan + cyclophosphamide-vincristin
paraneoplastic syndrom in SCLC
1.cachexia
2. thrombocytosis DIC
3. hypercoagulation
4. dermatomyositis
5. acanthosis nigricans
6. Cushing’s
7. SIAD
8. Peripheral neuropathy
Lambert-Eton syndrom
classification of pneumothorax
- Spontaneous (primary/secondary/recurrent)
- Traumatic PTX
- Tenson PTX
Define tension PTX
one way air entry (like a valve) air enters upon inspiration but can’t exit during expiration causing pressure build up
treatment of tension PTX
Resp support and treat dyspnea FIRST
then decompression
Cell type origin in NSCLC SCC
metaplasia of squamous cells
Cell type of origin in NSCLC ADC
Pneumocyte II cells
define idiopathic pulmonary fibrosis
irreversible fibrosis and impaired pulmonary function. the most common ILD
clinical presentation of IPF
progressive dyspnea (first at exertion then also at rest)
non-productive cough
crackles (later on wheezing)
dyspnea
fatigue
cyanosis
clubbing
histopathology in IPF
Honeycomb appearance
Ground glass opacification with superimposed reticular abnormalities
Bibasal subpleural distribution
REMEMBER: other causes must be excluded for this to be IPF
IPF treatment
stop smoking
transplant
supportive O2 therapy
antifibrotic agents (pirfenidone + nintedanib)
define sarcoidosis
systemic condition characterized by non-caseating granulomatous inflammation in lungs and lymph
Pathophysiology of sarcoidosis
a) T and B cell dysfunction
b) immune hyperactivity and inflammation
c) granuloma formation
d) fibrosis and damage of organ tissue
e) calcium dysregulation (due to hyper ph.)
what is a granuloma composed of?
Epithelioid cells and macrophages in the center
Lymphocytes and fibroblasts around
acute sarcoidosis symptoms
- sudden
- fever, malaise, weight loss
- dyspnea, cough, chest pain
- arthritis, anterior uveitis, erythema nodosum
Cronic sarcoidosis symptoms
- lupus pernio
- lymphadenopathy
- bilateral hilar lymphadenopathy
- dyspnea + cough
- hepatomegaly/splenomegaly
- scar sarcoidosis
- symmetrical arthritis
- myalgia
- cystic bone lesion of distal phalanges
sarcoidosis treatment
1st line: glucocorticoids
2nd line: immunosuppressants (methotrexate)
Anti-malarian drugs
Lung transplant
prognosis of sarcoidosis?
70% have spontaneous remission
but increased calcium is ass. with poor prognosis
define pulmonary HT
mean arterial pressure > 20 mmHg
subtypes of pulmonary HT
precapillary HT
postcapillary HT
pulmonary arterial HT
Etiology of PHT
Divided into groups
G1 Pulmonary arterial HT
G2 LHF
G3 Chronic lung disease
G4 Pulmonary arterial obstruction
G5 Unclear multifactorial
diagnosing PHT
Trans thoracic echo and look for
- tricuspid regurgitation velocity
- RV pressure overload
- RV failure
- Underfilled left heart
-
vasodilators in pulmonary HT
Calcium channel blockers: First-line pulmonary vasodilator
define resp failure
acute or chronic inability of the respiratory system to maintane adequate gas exchange
types of resp failure
Type 1: Hypoxic SpO2 < 60 mmHg
Type 2: Hypercapnic PaCO2 > 50 mmHg
causes of resp failure
- impaired ventilation
- Airway obstruction
- impaired gass exchange
- VQ missmatch
how to increase ventilation on oxygen support?
Increase RF or tidal volume
how to increase oxygenation on resp support
increase FiO2 and increase PEEP
Sleep apnea breathing events
apnea (complete stop for > 10 sec)
Hypoapnea (reduced airflow by > 30% for > 10 sec
Respiratory effort-related arousal (wake up due to increased resp effort)
cause of obstructivee sleep apnea
collapse of pharyngeal muscle during sleep causing obstruction
pathophysiology of sleep apnea (Obstructive)
apnea - decreased SpO2 - increased pCO2 - hypoxic pulmonary vasoconstriction - PHT - increase sympathetic activity and secondary HT
treatment of obstructive sleep apnea
- PAP (CPAP/BiPAP)
- oral appliances (devices worn during sleep to keep mandible in place)
- Upper airway modifications (surgery if ex surgical dilation, uvuloplasty)
pulmonary embolism etiology?
DVT
Fat embolism
Air embolism
amniotic fluid embolism
Bacterial embolism
tumor
Vichows triad
endothelial damage
venous stasis
hypercoagulability
most common site of DVT
iliac vein
Wells score on PE
midl risk: < 2
moderate risk: 2-6
high risk: > 6
imaging in PE
CT angiography
Echo
VQ scan
hemodynamically stable vs unstable?
systolic blood pressure < 90 unstable
systolic blood pressure > 90 stable
when is PE excluded?
Wells score < 4
Negative D dimer
Hemodynamically stable
thrombolytic therapy?
tPA Alteplase (most used) and streptokinase/urokinase infusion for 24h
Anticoagulants PE
Heparin IV 5000 units bolus + 1000-2000 units/hour infusion
Warfarin for 3w to 6 months
recurrence of PE
without anticoagulants recurrence is 10% within first year
normal O2 demand
4L/min/kg
normal O2 values
PaO2 90-100mmHg
SatO2 > 95%
O2 supplement method?
Nasal cannula
Simple face mask
Venturi mask
non-reservoir
two classes og pulmonary edema?
cardiologic cause
non-cardiologic cause (pulmonary vs Non-pulmonary)
imaging findings in the two types of pulmonary edema
Cardiogenic: Central edema, pleural effusion, enlarged heart
Non-cardiogenic: Patchy and peripheral edema, consolidations
what is the gold standard to determine cause of pulmonary edema?
Pulmonary artery catheterization
diuretics in pulmonary edema?
furosamide
drug do reduce PCWP and cardiac filling pressure
Nesiritide
define bronchiectasis
irreversible abnormal dilation in the bronchial tree caused by cycles of inflammation leding to mucous plugging and airway destruction
etiology of bronchiectasis
disorders causing mucous plug or inflammation, bronchial narrowing
Cystic fibrosis
AR disorder of defect cystic fibrosis transmembrane conductance regulator protein (CFTR) Cl channel doesn’t work
what happens to mucous layers in organs when CF
normally Cl goes out of the cell and in the mucous it attrachs H2O keeping the mucous nice and thin. Not happening in CF and mucous gets hard and sticky
cause of CF
mutation on ch 7 at the Delta F508 gene causing absence of phenylalanin and missfolding of the CFTR protein
what happens in sweat glands in CF
here there is no REABSORPTION of Cl causing more NaCl to be excreted through the sweat
GI complication of CF
pancreatitis
cholelithiasis
meconium ileus baby
exocrine pancreas dysfunction
CF related DM
intestinal obstruction
rectal prolaps
Pulmonary complication of CF
COPD
Chronic sinusitis
recurrent chronic cough
airway obstruction
barrel chest
hemoptysis
chronic resp insufficiency
urinary complication of CF
frequent stones
frequent UTI
musculoskeletal complication of CF
frequent fractures
kyphoscoliosis
pharmacological treatment of cystic fibrosis
High dose ibuprofen
CS
SABA LAMA
N-acetylcystein
Mucolytics
define a1-trypsin deficiency
accumulation of a defect a1T protein due to mutation in SERPINA1 gene
what is the normal function of a1-anti trypsin
protect cells against degradation by neutrophil elastase
effect on liver in a1-anti trypsin deficiency
accumulation of the protein
hepatocyte destruction
cirrhosis
hepatitis
effect on lungs in in a1-anti trypsin deficiency
uninhibited neutrophil elastase activity
destruction of parenchyma and pancellular emphysema
diagnosis of a1-anti trypsin deficiency
Serum low levels
electrophoresis no peak
CXR
Chest CT
Liver biopsy: spherical inclusion bodies
treatment in in a1-anti trypsin deficiency
treat symptoms
replacement if severe
liver transplant
hypersensitivity pneumonitis
HS reaction following exposure to allergen ass. with interstitial lung disease
type of HS in hypersensitivity pneumonitis
mix of type III and type IV
most common source of allergen in hypersensitivity pneumonitis
actinomycete spores
hypersensitivity pneumonitis stages
acute 4-8h
subacute weeks-months
chronic months and after
hypersensitivity pneumonitis Dx
positive serology IgG and IgA or IgM
CXR
BAL (lymphocyte predominance
Lung Biopsy
Eosinophilic pulmonary disease (loefflers)
accumulation of eosinophils in the lung due to certain infections or allergic reactions to drugs. Mild and passing symptoms
diseases than can lead to need of lung transplant
- COPD
- Idiopathic pulmonary fibrosis
- genetic disorders such as CF a1 deficiency
- sarcoidosis
- IPAH
- lymphangio leio myomatosisi
absolute contraindications of lung transplant
Malignancy the last 2y
Chronic advanced illness (heart, renal, liver)
Uncontrolled or untreatable pulmonary or ex. pulmonary infection
Poor cardiac function
Acute medical conditions (sepsis, MI, Liver failure)
Uncontrolled bleeding
HIV
Psychiatric problems
BMI > 35
Active alcohol, tobacco or substance use
smoking cessation model
5A’s
Ask
Advise
Assess
Assist
Arrange
Nicotin replacement
patches
chewing gum
sublingual tablets
nasal spray/inhalers
Non-nicotine replacement
Bupropion: antidepressant reduce smoking desire
Varenicline: nAchR agonist releaving withdrawal
what is a invasive ventilation
where we create a airway aith a tube
typesk of masks
full face mask
total face mask
nasal mask
nasal pillows
mouth piece
helmet
complication of NI ventilation
air leaks
aspiration pneumonia
ventilation ass- lung injury (barotrauma)
severe gastric distension
skin irritation
mucus plugging
mucosal dryness
nasal bridge ulcerations
what is Fi O2
What is the value of air breathing in?
The amount of oxygen deliveres
In air 21%
in ventilation what do to with a person with hypoxemic resp failure?
increase FiO2 or increase mean airway pressure to open collapsed alveoli
in ventilation what do we to with a person with hypercapnic resp failure
increase tidal volume or minute ventilation
types of NI ventilation
CPAP
BiPAP
Define CPAP
continuous positive pressure flow during breath cycle
used in hypoxemic resp failure
function of pleura
regulate pressure inside and outside the lungs and no friction with chest wall
fluid in pleural space
8-10ml
what is in the pleural fluid
electrolytes
albumin
macrophages
glucose
mesothelial cells
lymphocytes
chest deformities
Barrel chest
Pectus Excavatum (funnel chest) (sternum inwards)
Pectus Carinatum (pigeon chest) (sternum outwards)
Kyphoscoliosis
what does the pneumocytes do`
type I: lines alveoli
type II: produce surfactant
how thick is alveoli
0.1-0.2mm in diameter
vesicular breathing sound
soft, quiet
Long in/short out
Bronchovesicular breathing sounds
intermediate loud
same in and out
Bronchial breathing sounds
loud
short in/long out
Tracheal breathing sounds
very loud
same in and out
what location is a stridor coming from?
from the trachea and must not be mistaken for lung sound
diseases with hypre resonance lung sound
asthma
COPD
Pneumothorax
contraindication of chest X-ray
pregnancy
X-ray views
anteroposterior (AP)
posteroanterior (PA)
lateral (LL)
when to do a HRCT in lung diseases
very thin slides so used if parenchymal lung disease ex. interstitial lung disease involving the acini
size of slice in a HRCT
1-2mm
What is the main indication for ventilation perfusion scintigraphy?
A ventilation and perfusion scan is most often done to detect an acute pulmonary embolus (blood clot in the lungs). It is also used to: Detect abnormal circulation (shunts) in the blood vessels of the lungs (pulmonary vessels) Detect abnormal circulation from multiple old blood clots (chronic thromboembolic disease)
what is used on PET CT
18-flyorodeoxyglucose
false positives in PET CT
inflammation
metformin use
active brown adipose tissue
high physiological uptake in the brain
causes of non-productive cough
ACEI
Emphysema
Cardiac disease
Pulmonary fibrosis
chough acute vs chronic
less then 3w is acute
more then 8w is chronic
