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Respirology Flashcards

1
Q

A-a gradient

A

150 - PCO2/0.8 - PaO2

Normal = Age/4 + 4

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2
Q

Differential Diagnosis normal A-a gradient

A 
Hypoventiliation 
- Drug intoxication
- OHS/OSA
- Neuromuscular dysfunction
- Diaphragm injury (phrenic nerve / myopathy)
- Brain bleed/stroke/tumor/meningitis
High altitude
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3
Q

Differential Diagnosis wide A-a gradient

A

1) VQ Mismatch (improves w/ 100% FiO2) - COPD, PE
2) Shunt (does not improve completely with O2) - intracardiac (PFO/ASD/VSD), intrapulmonary (AVM), physiologic (severe PNA)
3) Diffusion Abnormality - ie. ILD

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4
Q

Diagnosis of asthma

A
  1. History of variable resp symptoms that vary over time & intensity
  2. PFT: variable expiratory airflow obstruction
    a) Airflow obstruction: FEV1/FVC < LLN
    b) Variability, any of:
    - FEV1 >12% and 200 cc improvement post bronchodil OR after 4 wks anti-inflm tx OR between visits
    - Diurnal peak flow variability of >10%
    - Positive methacholine challenge test = Decrease FEV1 by 20% with <4mg/ml methacholine
    - Positive exercise challenge test = Decrease in FEV1 by >=10% and 200 cc from baseline with exercise
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5
Q

Asthma Control Criteria

A

Control implies all criteria present:
Daytime symptoms <2 days/week
Nighttime symptoms <1 per week and mild
Reliever (SABA or bud/fom) <2 doses per week
Physical activity NORMAL
NO absence from work/school
Exaggerations infrequent and mild (no steroids/ED/admission, any one = severe)
Peak flow >= 90% personal best
<10-15% peak expiratory flow diurnal variation
Sputum eos <2-3%

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6
Q

Definition Uncontrolled Asthma

A
  1. Poor symptom control defined by lack of any one of asthma control criteria
  2. Frequent exacerbations (>=2 /year) req steroids
  3. One exacerbation in past year requiring hospitalization/ICU/MV
  4. Sustained airflow limitation of FEV<80% personal best
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7
Q

Definition severe asthma

A
  1. Asthma requiring use of HIGH dose ICS + 2nd controller for previous year
  2. Requiring oral steroid for >50% of the year for control
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8
Q

Work-up for severe asthma

A 
Total IgE
Peripheral and sputum eosinophil count
FeNO where available 
Skin testing for aspergillus 
\+/- CT chest to evaluate for alternate pathology
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9
Q

Treatment algorithm asthma

A

Poorly controlled = daily ICS + prn SABA
Well controlled + risk of severe exacerbation = daily ICS or prn bud/form
Well controlled with NO risk of severe exacerbation = prn bud/form or prn SABA

  1. Low dose ICS-formoterol PRN (ie. symbicort)
  2. Low dose ICS-formoterol OD + PRN +/- add LTRA (esp if exercise/NSAID induced or allergic rhinitis)
  3. Medium dose ICS-formoterol OD + PRN +/- add LTRA
  4. High dose ICS-formoterol OD + PRN +/- add LTRA
  5. Refer for phenotypic ax +/- tiotropium, biologics, Macrolides (dec exacerbations), low dose steroids, bronchial thermoplasty

*sx control x2 mo + low risk of exacerbation = consider stepping down

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10
Q

Indications for anti-IgE (Omalozumab)

A

Serum IgE 30-700 and sensitive to 1+ perennial allergen, severe despite high dose ICS and one other controller

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11
Q

Indications for anti-IL5 (mepolizumab) or IL4/13 (dupilumab)

A

Serum eosinophils >300 and recurent exacerbation despite high dose ICS and one other controller
- Dupilumab also for those w nasal polyposis or mod/severe atopic dermatitis

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12
Q

Treatment asthma exacerbation

A 
Ventolin + Atrovent
PO or IV solumedrol/pregnisone
\+/- MgSO4
Treat reversible triggers
D/C home if PEF >70% personal best after 1 hr monitoring
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13
Q

Budesonide doses

A 
Low = 200-400
Med = 400-800
High= >800
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14
Q

Fluticasone doses

A 
Low = 100-250
Med = 250-500
High = >500
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15
Q

RADS vs occupational asthma

A

RADS = develops after single high dose exposure to vapour, gas or fumes
Occupational asthma = asthma that gets worse at work due to presence of some allergen

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16
Q

Spirometry - flattened inspiratory and expiratory curve

A

Fixed upper airway obstruction - eg goitre

  • Glottic stenosis (prolonged intubation)
  • Subglottic stenosis - GPA, sarcoid, polychondritis
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17
Q

Spirometry - flattened inspiratory curve, normal expiratory curve

A

Variable extra-thoracic obstruction - ie. vocal cord paralysis

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18
Q

Spirometry - flattened expiratory curve, normal inspiratory curve

A

Variable intra-thoracic obstruction - ie. tracheomalacia

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19
Q

Spirometry- scooped expiratory curve, normal inspiratory curve

A

Obstructive lung disease (asthma, COPD, CF)

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20
Q

Spirometry - small (but normal shaped) inspiratory and expiratory curves

A

Restrictive lung disease

If curves more rounded - think neuromuscular cause

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21
Q

Restrictive PFTs with 10% VC decline supine

A 
Diaphragmatic dysfunction 
(eg post-op/CABG, mech vent, NMD eg ALS/MG) 
--> test MIP/MEP (decreased MIP = most sensitive for B/L diaphragm involvement; most specific - FVC)
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22
Q

RV/TLC > ULN

A

Gas trapping

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23
Q

TLC > ULN

TLC < ULN

A

TLC > ULN: Hyperinflation

TLC < ULN: Restriction

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24
Q

Isolated reduced DLCO with otherwise normal PFTs

A 
Anemia (eg GIB)
Pulmonary HTN
Early ILD/emphysema (don't yet have restriction)
PE
Sarcoid
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25
Q

High DLCO, otherwise normal PFTs

A

Diffuse alveolar hemorrhage
Left sided HF
Polycythemia

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26
Q

Contra-indications to PFTs

A 
Unstable cardiovascular pathology (ACS, arrhyth, HF)
Hemoptysis
Pneumothorax
Aneurysm (thoracic, abdo, cerebral)
Recent eye/lung/intra-abdominal surgery
Acute illness
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27
Q

Contra-indications to methacholine

A

Severe asthma or COPD (FEV1<50% or <1L)
Stroke, MI within last 3 months
BP >200/100
Aortic Aneurysm

Relative: Pregnancy, use of cholinesterase inhib, FEV<60% or 1.5L

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28
Q

Diagnosis COPD

A

FEV1/FVC < 0.7 or LLN with NO significant bronchodilator response

*if diagnosed, test for A1T1 if <65yo OR <20py hx

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29
Q

COPD - Severity of airflow limitation - grading

A

Mild - FEV1>=80%
Moderate - FEV1 50-79%
Severe - FEV1 30-50%
Very Severe - FEV1<30%

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30
Q

MRC scale for grading dyspnea

A 
0 - not troubled by symptoms
1- SOB with heavy exertion
2- SOB with normal exertion
3- SOB with light exertion (ie. walking 1 block)
4- SOB with basic ADLs
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31
Q

Nonpharm treatments for all patients with COPD

A
  • Smoking cessation (slows progression, improves SURVIVAL) - use varenicline +/- patch x12+ weeks asap >e-cig/ buproprion
  • Pulmonary rehab (improves QoL/exercise capacity in all) - improves SURVIVAL and exacerbation risk if within 4 wks AECOPD
  • Supplemental O2 if eligible (increase SURVIVAL in severe hypoxemic)
  • Vaccinations (pneumovax, yearly flu, TdAP pertussis is missed as teen)
  • PRN SABA
  • Palliative/Dyspnea Mx
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32
Q

Treatment for mild COPD (MRC 0-1)

A

SABA PRN –>

LAMA or LABA (Lama preferred)

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33
Q

Treatment for moderate-severe COPD (MRC >1) at low risk exacerbation (<2 exacerbations in last yr, no hospitalizations)

A

LAMA or LABA –>
LAMA + LABA –>
LAMA + LABA + ICS (low dose)
*If stable symptoms, can step back treatment

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34
Q

Treatment for moderate-severe COPD (MRC >1) at high risk exacerbation (2+ exacerbations in last yr, 1+ COPDe requiring hospitalization)

A

LAMA + LABA –>
LAMA + LABA + ICS (low dose) –>
Add on therapies to reduce exacerbation risk: Roflumilast (wt loss/diarrhea), NAC (for bronchitis), Azithromycin (R/o NTM 1st; S/E: QTC, hearing impairment) . NO theophylline
*Never step back treatment (unless started inapprop)

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35
Q

Indications for continuous oxygen in COPD

A

PaO2 <55 (SaO2<88%) or

PaO2 <60 if: Cor pulmonale, peripheral edema, Hct >56% (erythrocytosis)

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36
Q

Advanced treatments in COPD

A

Non-invasive ventilation:
- Indications: pCO2 >=52 and hx admissions for hypercapnic respiratory failure

Lung reduction surgery (increase survival** in severe predom upper lobe emphysema)

Transplant if: Bode score 7-10 + one of :

  • FEV1<25% with DLCO <20%
  • COPDe hospitalization with PCO2>50mmHg
  • pHTN or cor pulmonale despite O2
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37
Q

Treatment Dyspnea in advanced COPD

A

Oral opioids (NOT nebulized)
Neuromuscular stimulation/chest wall vibration
Walking aids
Pursed lip breathing
Continuous O2 if meets criteria (may dec dyspnea, no significant QoL improvement)

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38
Q

Diagnosis Asthma/COPD Overlap syndrome

A
  1. Dx COPD based on rf, hx, PFTs
  2. Past Hx/dx asthma with bronchodilator reversibility
  3. Spirometry: postbronchodilator fixed FEV1/FVC<0.7

*Supportive criteria: Sp Eos >3%, peripheral eos >300, documentation of bronchodilator improvement (FEV1 by 200cc or 12%)

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39
Q

Treatment Asthma/COPD overlap

A

ICS/Laba = 1st line

Add LAMA if refractory

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40
Q

Treatment of AECOPD

A 
Supplemental O2
NIVV (BIPAP) 
SABA/SAAC (eg ipratroprium) 
Steroid x5-7 days (Pred 40) 
ABX x5-7d if 2/3: inc sputum purulence/vol/dyspnea OR req NIV/MV
Re-initiate LABA/LAAC prior to D/C
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41
Q

Indications for NIV or MV in AECOPD (NIV > MV if no excessive secretions and LOC permits)

A

pH <= 7.35
pCO2 >=45
Severe dyspnea or persistent hypoxemia despite med tx

42
Q

Causes of bronchiectasis

A

CF, primary ciliary dyskinesia, Humoral immunodeficiency (dx: immunoglobulins)
Post-infectious (TB, NTM, pertussis, recurrent PNA)
Aspiration (dx: swallow study)
ABPA
A1AT deficiency
Autoimmune: RA, SLE, IBD
Congenital malformations (bronchiomalacia, lung sequestration)
Idiopathic

43
Q

Clues to CF

A 
Onset of symptoms <45
History malabsorption
Pancreatitis
History of staph, pseudomonal or NTM infxns
Male infertility
\+sweat chloride and CFTR gene testing
44
Q

Clues to A1AT

A

Emphysema/obstruction on PFTs/CT
Liver disease
Panniculitis

45
Q

Clues to primary ciliary dyskinesia

A

Recurrent URTIs and otitis media
Male infertility
Low nasal nitric oxide

46
Q

Dx and Tx of ABPA

A

History of asthma with brown casts in sputum
Eos >1000 peripherally
Total IgE

Central bronchiectasis
Infiltrates on imaging
Sensitization to aspergillus (IgE spec AB or skin prick)

Tx: pred +/- itraconazole

47
Q

Treatment non-CF bronchiectasis

A

Airway clearance techniques (breathing technique)
Mucoactive agents (hypertonic saline) *DNAse ONLY if CF
Inhaled colistin/gent if pseudomonas colonized
Azithro if recurrent exacerbations
Pulmonary rehab (if mMRC>1)
Vaccines (Flu, pneumococc, Tdap)
Supplemental O2
NIV if resp failure w/ hypercapnea w/ recurrent hospitalization
Sx/lung resection
Transplant if poor lung fcn and 1 of: massive hemoptysis, severe PH, ICU admission or resp failure req NIV

  • NO DNAse unless CF,
  • don’t offer steroid, PDE4i, or ICS routinely
48
Q

Treatment bronchiectasis exacerbation

A

Obtain sputum Cx
ABX empirically (based on past Cx) x 14 days min
If bleeding TXA +/- embolization (1st line)

49
Q

Causes of ILD

A

Idiopathic (IPF, NSIP, COP, AIP, LIP, DIP, RBILD)

CTD-related:
- SSc, DM, Sjogrens, RA, MCTD, Sarcoid

Exposure:

  • Hypersensitivity pneumonitis (organic exposure)
  • Pneumoconiosis (inorganic exposure)
  • Drugs: MTX, macrobid, amio, bleomycin, vaping
  • Radiation-induced

Others

50
Q

Diagnosis IPF

A
  1. Progressive fibrotic ILD +
  2. UIP pattern or positive histology +
  3. Other causes excluded (CTD, meds, exposures)
51
Q

Definite UIP Pattern

A
  1. Reticular changes
  2. Basal/subpleural predominant
  3. Honeycombing
  4. Absence of inconsistent features
52
Q

Inconsistent CT features of etiologies of ILD that are not IPF

A 
GGOs
Mosaic attenuation
Cysts
Micronodules or centrilobar nodules
Consolidation
53
Q

Work-up for ILD

A

CT Chest
PFTs
ANA, RF, CCP, +/- myositis panel

*If hx mould/water/bird feather exposure or mosaic attenuation/upper lobe on CT–> precipitating Abs for HP
Consider BAL or biopsy if inconsistent features

54
Q

Treatment IPF

A

Nonpharm:

  • Smoking cessation, O2 (criteria as per COPD),
  • Vaccines, Rehab

Pharm:

  • Anti-fibrotics: Nintendanib, Pirfenidone (reduce FVC decline and mortality benefit)
  • NO steroids/immunosuppression (increases mortality in chronic IPF)
  • Steroids ok for NON-IPF eg HP, CTD, D-induced
  • Dyspnea Mx (low dose opioid)
  • Cough Mx

Transplant:

  • Refer if FVC <80%, DLCO <40% despite med tx
  • Transplant if FVC <60-65%

Supportive / Transplant for Pneumoconiosis

55
Q

Treatment of acute IPF exacerbation

A

R/O infection, PE, HF
Steroids 1g/day x3 then taper + ABX

(Will see new GGO on CT)

56
Q

Treatment CTD associated ILD

A

Steroid
MMF/Aza , if fails, ritux/cyclo
+/- Antifibrotics (new evidence: Nintedanib)

57
Q

When to do diagnostic thoracentesis

  • indication to repeat
  • dx that can’t be dx by fluid
A

Suspect EXUDATIVE effusion >1cm in lateral decubitus

  • Can repeat ONCE for sensitivity for cytology
  • Mesothelioma CANNOT be dx by fluid and req pleural biopsy
58
Q

Light’s Criteria

A

Exudative if any of the following:
Pleural protein:Serum protein >0.5
Pleural LDH:Serum LDH >0.6
Pleural fluid LDH > 2/3 ULN

59
Q

JAMA - Is this pleural effusion exudative?

clue cholesterol, ldh cutoffs

A

+ LR:
High cholesterol >55mg/dL
LDH >200
Pleural cholesterol:Serum cholesterol > 0.3

-LR:
All 3 lights criteria absent

60
Q

Causes of chylothorax (Tg >1.24, chylomicrons +)

A 
Cancer (lymphoma highest likelihood) 
Trauma
Surgery
TB
LAM (young woman w/ PTX/cystic lung dz)
61
Q

Causes of eosinophilic exudative effusion

A 
Asbestos related (BAPE)
Drugs (macrobid) 
Lung CA
PE
eGPA
Parasitic infection
62
Q

Causes of low glucose in exudative effusion

A

<1mmol: RA or empyema

1-3: Cancer, SLE, TB

63
Q

Indications for chest tube insertion in parapneumonic effusion

A

Frank pus or blood
Positive gram stain or culture from pleural fluid
pH <7.2 of pleural fluid (of gluc<3.4 if pH unavail)
Effusion >50% hemithorax or is loculated

64
Q

Indications for chest tube insertion for pneumothorax

A

Spontaneous and >2cm or symptomatic –> needle aspiration and tube
Secondary (ie. COPD, CF, TB, PCP) - bc lung abN and risk of air leak

Surgery if persistent

65
Q

Extra-pulmonary Sarcoidosis - Manifestations

A

Ocular - anterior uveitis (optho)
CNS - CN palsies, HA, ataxia, weakness, LP = nonspec lymphocytic inflammation
CVS: Heart block, restrictive cardiomyopathy, pHTN rare
GI: liver/splenic lesions, cholestasis, liver failure (rare)
Blood: HyperCa/hypercalciuria, lymphopenia, thrombocytopenia
Skin: erythema nodosum, lupus pernio

66
Q

Logfren’s Syndrome - Sarcoid

A

Erythema nodosum
Arthralgias/Arthritis (migratory)
Bilateral hilar adenopathy

*High % spontaneous remission

67
Q

Heerfordt’s Syndrome - Sarcoid

A

Anterior uveitis
Parotid enlargement
Facial palsy

68
Q

Sarcoid biopsy: indication and approach

A

ALL except clear lofgren’s, Heerfordt’s, or lupus pernio

*EBUS guided LN sampling > mediastinoscopy

69
Q

Indications to treat PULMONARY sarcoid +tx options

A

-Bothersome dyspnea/cough affecting QoL
-Decreasing lung function (obstructive or restrictive)
-pHTN
*If mild - tx with ICS
If mod-sev tx with Pred 20-40 mg OD x1-3 mo then taper to 10mg/d x1 yr

  • MTX if relapse/steroid tox for QoL/preserve FVC
  • pulm rehab for fatigue
70
Q

Indications to treat extra-pulmonary sarcoid

A

CNS/Ocular/CVS disease - all require oral prednisone
Severe skin dz, hyperCa, symptomatic liver dz also tx
-Skin refractory to steroids –> infliximab

71
Q

Indications for cardiac imaging (PET or MRI) in sarcoid

A

Symptoms or abn ECG (blocks or low voltages)

72
Q

Diagnosis of OSA

A

Symptoms (choking/snoring/daytime somnolence) +
>5 apnea/hypopnea episodes on monitoring
*mild (5-15/hr), mod 15-30, severe >30

73
Q

Indications for CPAP for OSA

A

Excessive daytime somnolence or poor sleep rltd QoL
Asymptomatic with HTN, AHI>30 (severe), critical occupation

*other tx: oral appliance (mild/mod), tonsillectomy/uvulopalatopharyngoplasty (rare)

74
Q

How / Who to screen for Pulmonary Hypertension

A

TTE

  • esp in:
  • Scleroderma (yearly w/ DLCO),
  • Portal HTN undergoing transplant w/u,
  • Residual dyspnea/exercise intol s/p 3mo AC post-PE (+/-VQ to r/o CTEPH)
75
Q

Diagnosis Pulmonary Hypertension

A

Right heart cath demonstrating mean pulm artery P >20 and pulm vascular resistance >3WU on R-heart cath

other clues: isolated reduced DLCO

76
Q

Categories: Pulmonary Hypertension

A

1- PAH: Idiopathic, Drug/Toxin, CTD, HIV, schisto, portal HTN, heritable, PVOD
2- Secondary to L heart disease: systolic/diastolic dyscn, valvulopathy
3- Secondary to hypoxemia/lung dz (COPD, ILD, etc)
4- CTEPH –> thromboendarterectomy, AC
5- Unclear mechanism (MPNs, splenectomy, sarcoid, LAM)

77
Q

Screening and diagnosis of CTEPH

A 
Screening = VQ Scan
Diagnosis = CTPE
78
Q

Work-up for all PH

A 
CBC, lytes, LFTs, TSH, BNP
HIV, HBV, HCV 
ANA, ENA 
TTE
PFTs
6MWT
VQ scan - screen for CTEPH
Abdo US
\+/- sleep study
Right heart cath
79
Q

Treatment PAH

A
  • Diuretics for volume
  • Vasoreactivity to determine if CCB candidate
  • Influenza/pneumococcal vaccines
  • PDE-5 inhibitors (sildenafil. tadalafil)
  • Endothelin receptor antags (bosentan, masetentan)
  • Prostanoids
  • Pulmonary/Physical rehab
  • OCP/contraception
  • Transplant: for NYHA III/IV
80
Q

Treatment CTEPH

A

Anticoagulation +/- pulmonary endarterectomy

81
Q

Work-up chronic cough

A

1- CXR, exclude ACEi
2- Treat UACS empirically with antihistamines and oral decongestants +/- intranasal corticosteroid
3- If no response - methacholine test to dx asthma
4- if suspect GERD based on sx, empiric tx with lifestyle, PPI, H2RA, prokinetic, 24h pH monitor if persists

82
Q

Follow-up of solid lung nodules

A

If <6mm - no follow-up
If 6-8mm - repeat CT at 6-12 months
If >8 mm - repeat CT @ 3 mo or proceed to bx

83
Q

Follow-up subsolid lung nodules

A

If < 6mm - no follow-up (unless multiple, in which case rpt in 6 mo)
If >6mm - repeat CT between 3-12 months or bx

84
Q

Differential diagnosis of clubbing

A
  • Cancer: NSCLC, mesothelioma, bronchogenic
  • Purulent: Abscess, empyema, CF, bronchiect
  • Hypoxia: ILD, Cyanotic CHD or IE
  • AI: IBD
  • Graves
85
Q

Management of complicated empyema

A

1) Insert chest tube
2) Intrapleural tPA + DNAase (better than TPA or streptokinase alone)
3) If still no drainage, then VATS with decortication

86
Q

Antibiotics for purulent COPD exacerbation without pneumonia (clinically or radiographically)

A

If simple/no RFs for complications:

  • Amoxicillin
  • Doxycycline
  • Macrolide (ie. Azithro)
  • Septra
  • 2nd/3rd gen cephalosporin

If complicated:

  • Amox-Clav
  • Fluoroquinolone

Complicated, any of:

  • FEV1<50%,
  • 4+ exac/yr,
  • Home o2,
  • Chronic steroid,
  • Abx w/i 3 mo,
  • Comorbid ischemic heart dz
87
Q

Appearance of NSIP pattern on CT

A

Diffuse GGOs
Peripheral reticulations
No honeycombing

88
Q

RF for severe asthma exacerbation

A

Any 1 of:

  • Hx of previous severe exacerbation (ED/hospitalized/steroids)
  • Poorly controlled asthma per CTS
  • > 2 SABA inhalers per year
  • Current smoker
89
Q

Asthma yellow zone

A

If on nothing: take daily ICS or prn bud-form
If on prn bud/form: take it up to 8x/d
If on daily symbicort/advair/(ics or LTRA + severe asthma in past year): increase baseline x4 for 1-2 weeks OR take pred 30-50mg x5d

90
Q

Nonpharm for asthma

A
  • Confirm Dx, educate, and give action plan
  • Weight loss + exercise train
  • Avoid trigger, allergens +/- allergen immunotherapy
  • Stop smoking + Vaccinations
  • Avoid NSAIDs (and maybe BB)
  • Tx comorbidities: GERD, PND, Obesity
91
Q

Tx Vocal cord dysfcn

A
  • Education, behav mod
  • SLP
  • Treat GERD
92
Q

Causes of lymphocytic pleural effusion

A
  • Lymphoma, carcinoma
  • TB,
  • Sarcoid
  • RA
  • Yellow nail
93
Q

RF for primary spontaneous PTX

A

Smoking
Fam Hx
Marfan
Thoracic endometriosis

94
Q

Sarcoid stages

A

1 - bilateral adenopathy
2 - adenopathy w/ parenchymal lesions
3 - parenchymal lesions with NO adenopathy
4 - fibrosis

95
Q

Hemoptysis Ddx

A
  • Infection: bronchitis, TB, bronchiectasis
  • Tumor: carcinoid (young smoker w/ lung collapse), malignancy (SCLC/NSCLC)
  • CTD: Goodpasture, GPA, SLE
  • D/Toxin: Cocaine, anticoag
  • Vascular: pulm AVM, bronchial art. aneurysm, PE
96
Q

Massive Hemoptysis

-Def’n and Mx

A

~200-600cc/24hrs
Bleeding side down
IR for arterial embolization

97
Q

Rehab for Long COVID

A

If:
New/ongoing resp SOB/cough/exercise intolerance w/ functional limitations after resolution of COVID
AND
New/ongoing need for O2
OR at least 1 of:
-Persistent imaging changes
-PFT showing reduced lung vol, airflow, DLCO

98
Q

OSA driving guidelines

A

Disqualify if:

  • Sleepiness while driving,
  • Crash in past 5y from sleeping and not on/compliant to tx (>4hrs >70% nights in past 30d)
99
Q

FITNESS FOR SURGERY, FEV1 for:

  • Pneumonectomy
  • Lobectomy
  • Poor outcomes
A

Pneumonectomy - FEV1 >2L or 80% Predicted
Lobectomy - FEV1>1.5L

Poor perioperative outcomes:

  • FEV1 <60% predicted
  • DLCO ≈ Mortality
100
Q

Restriction with normal DLCO

A

Extraparenchymal lung disease (e.g. obesity, chest wall pathology, neuromuscular disease

RCE (18 decks)

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