Respiratory Lab Questions Flashcards
*Not an official Lab questions*
What is the Tl aka FEV1/FVC in Obstructive Disease?
(Tiffeneau-Pinelli index should be ~70%)
Tl = FEV1↓↓ / FVC↓ = ↓
(Tiffeneau-Pinelli index)
*Not an official Lab questions*
What is the Tl aka FEV1/FVC in Restrictive Disease?
(Tiffeneau-Pinelli index should be ~70%)
Tl = FEV1↓ / FVC↓↓ = Normal or ↑
A 25-year-old woman has been admitted to hospital due to severe dyspnea of sudden onset. She mentions that lately she wakes up at night due to coughing. She also noticed an occasional wheezing sound during respiration. She has allergies; she has been smoking for 5 years, 5 cigarettes/day. Physical examination: diaphragm is found low by percussion, exhalation is prolonged, a bit of wheezing sound can be heard at the end.
Pulmonary function tests: FVC: 3.02 l (80%), FEV1: 1.52 l (45%).
Reversibility test with Salbutamol: FVC: 3.52 (95%) FEV1: 1.75 l (62 %)
What is the most likely diagnosis?
- TI calculated is 56%, Young Women, Mild Smoker → Not COPD
- Paroxysmal Nocturnal Dyspnea→ from physiologic respiratory depression worsening the standing issues
- Wheezing→Brinchoconstriction and/or mucus hypersecretion
- Low Diaphragm because of Obstruction
- Prolonged Exhalation, TI<70%→ Obstructive Disease
- Salbutamol ( β2 Agonist) shows FVC and FEV1 increase→Diagnosis: Asthma Bronchiale
A 67-year-old man complains of coughing. He is currently producing large amounts of yellowi-greenish sputum that is more than the amount he usually has. It is hard for him even to go to the toilet, due to his severe dyspnea. He has been treated for hypertension and hyperlipidemia for years. He weighs 100 kg. He has been smoking since the age of 14, around 30 cigarettes/day. Physical examination: his lips are markedly cyanotic; exhalation is prolonged with occasional wheezing at the end. Bronchial ronchi can be heard.
ABG: pH: 7.35; pCO2: 43 mmHg, pO2: 54 mmHg
Pulmonary function tests: FVC 2.12 l (52 %) FEV1: 0.97 l ( 32%), TLC: 5.24 l (105%), RV: 3.27 (176%), Raw: 0.87 kPa·s/l. Reversibility test with Salbutamol: FVC: 2.19 l (54%) FEV1: 1.01 l (33 %)
What type of ventilation defect is present? What is the most likely diagnosis?
Severly Low pO2, Age, Smoking, “Blue Bloater”→Obstructive Disorder
TI<70%, Raw = Rairway↑, TLC↑, RV↑→COPD
Salbutamol( β2 Agonist)-Poor Response→ Not Asthma
- pO2 < 60mmHg = Hypoximic Lung Failure
- This is Probably Chronic Bronchitis
A 55-year-old woman complains of toughening of her skin and of having fissures on her hands. She has
been avoiding climbing stairs for years due to breathlessness. Her dyspnea got much worse in the last few years. Auscultation of the lungs does not reveal any abnormality. Chest radiography shows increased opacification on both sides, mostly at the bases, above the diaphragm. The heart appears enlarged to the right, the pulmonary trunks are thicker on both sides. Pulmonary function tests: FVC: 3.01 l (64 %), FEV1:2.75 l (68%), TLCO:54 %,KLCO: 45%
ABG at rest: pH: 7.38, pCO2: 38 mmHg, pO2: 81 mmHg
ABG after 6 min of exercise: pH: 7.42; pCO2:34 mmHg, pO2: 75 mmHg ECG: signs of right ventricular strain, P pulmonale.
What type of ventilation defect is present? What additional tests should be performed? What is
the possible diagnosis?
CREST Syndrome/ Scleroderma
- TLCO- aka Diffusion Lung capacity of CO↓
- KLCO - Corrected TLCO (should be higher) ↓
- Symptoms of Hardening of Skin and Lungs
- RVH with P Pulmonale (PHTN)
- TI>70% → Restrictive Disorder, Fibrosis
- Final Diagnosis by checking Anti-centromeric and Anti-topoisomerases Autoantibodies
A 72 year old man presents at the ambulance due to severe dyspnea. He has a history of longstanding hypertension, two AMIs and coronary artery disease. At his admission he complains of progressing postural dyspnea. RR: 160/100, heart rate: 108/min, rate of respiration: 22/min. Blood gas: pH: 7,36, pCO2: 40 Hgmm, pO2: 72 Hgmm, O2 saturation (without oxygen supplementation): 88%. ECG: signs of LVH, ST elevation and significant Q waves in the anterior and lateral leads. What other diagnostic tests would you indicate? What type of disease(es) could this patient have?
Clinical: RR↑, HR↑, Tachypnea, Hypoxemia with low saturation
ECG: LVH (chronic Hypertension), ST elevation+Q
Further tests: Troponin I (for possible MI) and CK-MB (monitoring for 2nd MI)
Probable Diagnosis: STEMI → Pulmonary Edema or Congestion
A 57 year old man four days after his knee replacement surgery complains of sudden, severe dyspnea and pain on the left side of his chest.
RR: 110/70, heart rate: 120/min, respiration rate: 28/min. Physical examination finds normal heart and lung status, the right lower limb is edematous, tender, erythematic and is warm compared to the left lower limb. Blood gas: pH: 7,36, pCO2: 40 Hgmm, pO2: 72 Hgmm, O2 saturation (without oxygen supplementation): 78%. What other diagnostic tests would you indicate? What is the possible diagnosis?
Clinical: Tachypnea, Right Leg Edema, Hypoxemia with low saturation
- Further Tests to confirm DVT: D-Dimers and US of right lower limb
- Further test to confirm PE: S1Q3T3 on ECG and Angio-CT for visualisation
(also possible to see RVH and RAD in PE)
