Pulm 1 quizzable

Rheumatoid Arthritis (RA):

-RLD -connective tissue disorder -Pulmonary fibrosis -often asymptomatic -can show pleural effusion, pulmonary nodules and vasculitis -50% of PFTs are normal

List the four treatment options for COPD

-SABA: short acting beta 2 agonists (albuterol) -LABA: long acting beta 2 agonists (salmeterol) -Anticholinergics: ipatropium bromide -Theophylline derivatives (not used much, narrow therapeutic window)

Which prophylactic measures would you prescribe for someone w/ FEV1/FVC ratio of 70%

-annual flu vaccination -pneumococcal vaccination

Describe Berylliosis

-chronic granulomatous disease -nodules along septal lines -Bx for dx -found in alloys, ceramics, electronic manufacturing Tx: Corticosteroids

What factors would indicate malignancy in a solitary pulmonary nodule?

-lack of calcification -chest symptoms -lesion growth -prior hx

List the contraindications for administering a PFT:

-vomiting -vertigo -acute disease -PTX -recent ab/thoracic surgery -recent eye surgery -recent MI or unstable angina -thoracic aneurysm

Name the peripherally located pulmonary tumors:

-Adenocarcinoma -Bronchioalveolar carcinoma -Large cell carcinoma

Criteria for ICU admission during asthma attack:

-Altered Mental Status -Cannot lie -FEV1 < 25% -PaO2 < 65 mmHg -PaCO2 > 40 mmHg -Respiratory fatigue

List some methods that are used to biopsy lung tissue?

-Bronchoscopy w/ endotrachial needle aspiration -CT guided biopsy -Open thoracotomy

List the three categories of OLD:

-COPD -Bronchiectasis -Asthma

List some CXR findings that indicate malignancy:

-Cavitary lesion -Lesion > 3 cm. Investigate > 8mm. -spiculated or lobulated border -nodule growth

List some symptoms of COPD

-DOE -cough -wheeze -lip pursing -tripoding -AP diameter > transverse

List the two categories of COPD

-Emphysema -Chronic bronchitis

Name the centrally located pulmonary tumors:

-Epidermoid -Small cell carcinoma (Oat cell)

Describe Caplan's Syndrome

-Immunopathic mechanism -Seropositive RA -Progressive massive fibrosis

Describe systemic lupus erythematous (SLE)

-RLD -Connective tissue disorder CXR: pleural effusion, pulm vascular disease, pulmonary hemorrhage.

Describe Progressive Systemic Sclerosis:

-RLD -ILD and Pulmonary Vascular -Fibrosis w/ some inflammation -Connective tissue disorder -Highly resistant to tx

A Patient with COPD will likely have which of the following findings on Spirometry? 1) Decreased FEV1/FVC ratio 2) Decreased FVC 3 )Increased FEV1/FVC ratio 4) Increased FVC

1

Which of the following is most consistent with an obstructive lung disease on spirometry? 1) Decreased FEV1/FVC ratio 2) Decreased FVC 3) Decreased FEV1 4) Increased FVC

1

Which treatment steps wold you take for COPD?

1) Bronchodilators 2) O2 therapy 3) Glucocorticoids (anti-inflammatories) 4) Antibx 5) Lung xplant (FEV1 < 25% or cor pulmonale)

22-year-old woman with a history of intermittent wheezing in response to exercise presents to the emergency room with shortness of breath. Her attack occurred during an aerobics class. At this point she is having obvious difficult breathing and has diffuse wheezes on pulmonary examination. 02 saturation is 95% by pulse oximetry. Q1) The most effective treatment at this point would be A. Intravenous aminophylline B. Inhaled cromolyn sodium C. Inhaled albuterol D. Intravenous hydrocortisone E. Inhaled beclomethasone

1) C

What is a normal value for Cl?

100

What is a normal value for Na?

140

Which of the following is most consistent with a restrictive lung disease on spirometry? 1) Decreased FEV1/FVC ratio 2) Decreased FVC 3) Increased FEV1/FVC ratio 4) Increased FVC

2

Which age group is most likely to get sarcoidosis?

20-40 y.o.

What is a normal value for HCO₃?

24 (22-26)

What is a normal value for anion gap?

3-11 mEq/L

Pt has chest tightness, cough 1 wk after finishing chest radition therapy:

Radiation pneumonia

Predict PFT results:

Ans: normal Look at the % pred: FEV1/FEV ratio is greater than 80% so this is NOT obstructive (it is either normal or restrictive). FVC is greater than 80% so this is NOT restrictive. It is normal

What is a normal value for PaCO2?

40 (35-45)

What value is associated w/ a moderate reduction in FVC?

50-69%

What is a normal value for blood pH?

7.4 (7.35-7.45)

What is normal value for PaO₂?

80-100 mmHg

What does Forced Vital Capacity refer to?

A. Measurement of rate of transfer of gas from the alveolus to the capillary B. Measurement of the volume of airflow expired with the patient breathing as hard and as fast as possible C. Total volume of gas within the lungs after a maximal inspiration D. Volume of gas remaining within the lungs after a maximal expiration Ans: B

What FEV1% is associated w/ resting dyspnea?

< 25%

What FEV1% is associated w/ DOE?

< 40%

What value is associated w/ Severe reduction in FVC?

< 50%

What FEV1/FVC value is indicative of COPD?

< 70%

Which age group is most likely to get interstitial lung disease?

> 60 y.o.

What size lesion should warrant further investigation?

> 8 mm

What is a normal value for FVC?

> 80%

What is the normal value for FEV1/FVC ratio?

> 80%

What is a normal value for O₂ sat?

> 92-100%

A 70-year-oldwhite man with advanced COPD presents to you in the ER with pneumonia and an exacerbation of COPD. He is awake and alert, with acceptable work of breathing, and a ABG reveals a pH of 7.30, a PCO2 of 65 mm Hg, and a PO2 of 48 mm Hg. He is visiting relatives, and his private physician near his hometown 300 miles away tells you he has advanced disease and should not be intubated. He and his family state that they wish mechanical ventilation if it has a chance of helping him. Aggressive bronchodilator therapy and antibiotics are initiated. Which of the following is the most appropriate therapeutic plan? A. Begin oxygen at 1 liter per minute by nasal cannula B. Write a :Do not Intubate" order on the chart C. Intubate the patient D. Begin oxygen 40% by face mask E. Administer sodium bicarbonate

A

Which of the following treatment modalities is only minimally effective in the management of emphysema? A. Corticosteroids B. Smoking cessation C. Diuretics if cor pulmonale present D. Oxygen supplement if partial pressure of oxygen > 55 mm Hg at rest, exercise, or nocturnally E. Pulmonary rehabilitation

A

Which of the following would be the most reasonable next step in the assessment of the patient described above? A. Measurement of alpha 1 anti-trypsin levels B. Measurement of sweat chloride concentration C. High-resolution CT scan D. Exercise stress test E. Echocardiogram

A

Non-smoker w/ prior hx of penetrating chest trauma presents clubbing and signs of hypertrophic pulmonary osteoarthropathy, and small peripheral mass on CXR. Dx?

Adenocarcinoma Tx: surgery?

Inhaled particle 1 µm. Where will it wind up?

Alveoli < 2 µm

A 6-year-old boy who had a mild respiratory tract infection for 2 days awakens in the middle of the night with shortness of breath and difficulty breathing, and his parents bring him to the emergency room. His respiratory rate is 36/min and his heart rate is 150/min. he has a prolonged expiratory phase when breathing. He is afebrile. Lung auscultation reveals high-pitched, squeaky, musical breath sounds in all lung fields during inspiration and expiration. Which of the following is the most likely diagnosis? A. Epiglottitis B. Asthma C. Croup D. Tonsillitis E. Pneumonia

Answer B The answer is b.(Fauci, 14/e, pp 1422-1423) Asthma is an airway disease characterized by a hyperreactive tracheobronchial tree that manifests physiologically as narrowing of the airway passages, The classic triad of symptoms is dyspnea, cough, and wheezing. Attacks are usually episodic and nocturnal and often follow exposure to specific allergens, exertion, viral infection, or emotional excitement. Wheezing is described as "whistling" and is typically heard in both inspiration and expiration. The expiratory phase becomes prolonged and the patient develops tachypnea, tachycardia, and mild systolic hypertension. Accessory muscles of respiration(sternocleidomastoid and intercostals) may be used to improve breathing. If the asthma attack is severe, the patient will develop a pulsus paradoxus(an inspiratory drop in systolic blood pressure of more than 10 mm Hg). Patients with epiglottitis present with fever, drooling, and dysphagia; lung examination will be normal. Children with croup pr laryngotracheobronchitis present with labored breathing and stridor, and use accessory muscles to assist breathing.

A 60-year-old man presents to your office with an 80-pack-year history of cigarette smoking. He complains of some dyspnea on exertion. He has an asthenic body habitus and pursed-lip breathing. He has an increased anteriorposterior thickness in the thorax. Lung examination reveals decreased fremitus, hyperresonace on percussion, and diminished breath sounds. Which of the following is the most likely diagnosis? A. Bronchiectasis B. Asthma C. Emphysema D. Pleural effusion E. Pneumonia

Answer C The answer is c(Fauci, 14/e, pp 1451-1455) The increased antero-posterior thickness of the thorax indicates the presence of a "barrel chest", which in association with a smoking history and exertional dyspnea is a typical presentation of emphysema. Pursed-lip breathing is often a learned behavior that occurs with emphysema to prolong the expiratory phase of respiration and prevent sudden collapse of the small airways. Patients have an asthenic body habitus since energy expenditure is in excess of calorie intake. There is often hypertrophy of the accessory muscles of respiration. Breath sounds in emphysema are usually diminished and there is hyperresonace with percussion. Emphysema begins as a centriacinar process but eventually becomes panacinar, involving both the central and peripheral tissues.

What is a ferruginous body?

Asbestos fiber coated w/ Fe and Ca

Navy WWII vet presents post biopsy results of thickening of pleura, peritoneum, testicular tunica.

Asbestosis→malignant mesothelioma Tx: not really.

8 y.o. pt presents w/ BP that drops 15 mmHg during inspiration, tachypnic, cyanotic. Lungs hyperresonant to percussion, expiratory phase is prolonged. Coughing regularly.

Asthma Tx: EMERGENCY TX: →β2 agonist (SABA) q 20 mins x 3, then every 2 hrs until symptoms abate →Aminophylline: helps in first hour for first 5-10 mins →Magnesium: 2-4 g IV →Epinephrine Non-Emergent: -SABA (albuterol) -LABA for chronic asthma (Salmeterol) -Anticholinergics (ipatropium bromide) -Theophylline derivatives -Glucocorticoids: 6 hr onset. Methylprednisone -Cromolyn/Nedocromil Sodium

A 22-year-old female presents to the emergency department with extreme shortness of breath after jogging. No past medical history is immediately available. Vital signs are pulse 120, respiration 32, temperature 98.7 F, and blood pressure 130/84. Exam reveals a lethargic and confused patient; there are diffuse expiratory wheezes and a prolonged expiratory phase. Hyperresonance to percussion is noted. The most likely diagnosis is: A. Pneumothorax B. Bronchial asthma C. Pulmonary edema D. Pneumonia E. Bronchiolitis

B

A 35-year-old man seeks medical attention for breathlessness on exertion. He has never smoked cigarettes and has not been coughing. One sibling died of respiratory failure at 40 years of age. His three children are healthy. Physical examination reveals him to be tachypneic as he exhales through pursed lips. His chest is hyperresonant to percussion, and breath sounds are poorly heard on auscultation. Chest x-ray shows flattened diaphragms with peripheral attenuation of bronchovascular markings that is most noticeable at the lung bases Expected results of the pulmonary function testing of the man described above would include A. Increased lung elastic recoil B. Increased total lung capacity C. Reduced functional residual capacity D. Increased vital capacity E. Increased diffusing capacity

B

A 55-year-old male with a 60-pack/year history of smoking and documented COPD comes to your office with a high fever, chills, a productive cough (yellowish green sputum), and shortness of breath. On examination the patient has decreased breath sounds in the right middle lobe and right lower lobe. You suspect pneumonia. CXR confirms right middle lobe and right lower lobe pneumonia. A gram stain reveals gram-negative rods in abundance.

Based on his 60-pack/year history of smoking, the Gram stain results, and his history of chronic bronchitis, what is the most likely organism in this patient? A. Moraxella catarrhalis B. M. pneumoniae C. H. influenzae D. A or B E. A or C Ans: E

60 y.o. smoker presents w/ blood streaked sputum, coughing for last few weeks. CXR shows "tram track" parallel lines, CT shows thickened bronchial walls.

Bronchiectasis Tx: brondilators (short term and long term) -abx to treat infxn -chest PT

Pt presents w/ pneumonia-like symptoms, but pneumonia ruled out. Dx?

Bronchioalveolar carcinoma. -common variant of adenocarcinoma -arises from epithelium of distal bronchioles Tx: surgery

What is a common manifestation of asbestiosis?

Bronchogenic carcinoma Malignant mesothelioma

63 y.o. textile worker complains of chest tightness, symptoms improve when away from work.

Byssiniosis -Inhalation of cotton, yarn, etc. fibers Tx: Glucocorticoids

A 22-year-old male comes to your office for assessment of a chronic cough. He has just moved to your city and will be attending the university there. He has moved into a bachelor apartment in the basement of a house. As soon as he moved in, he began to notice a chronic, nonproductive cough associated with shortness of breath. He has never had these symptoms before, and he has no known allergies. When he leaves for school for the day, the symptoms disappear. The symptoms are definitely worse at night. His landlady has three cats. He didn't think he was allergic to cats, but now thinks that might be the case On examination, his respiratory rate is 16 breaths/min and regular. He is in no distress at the present time. There are a few expiratory rhonchi heard in all lobes. His blood pressure is 120/70 mm Hg and his pulse is 72 bpm and regular. What is the most likely diagnosis in this patient? A. Paroxysmal nocturnal cough syndrome B. Hyporesponsive airways disease C. Cough variant asthma D. Allergic bronchitis E. None of the above

C

How do you distinguish between acute and chronic CO2 retention (respiratory acidosis)? A. Respiratory rate B. Arterial oxygen saturation C. Arterial pH and venous HCO3 concentration D. Presence of bronchospasm

C

Which of the following pulmonary function tests is the most useful for the diagnosis of asthma? A. Decreased forced vital capacity (FVC) B. Increased residual volume C. Reduced FEV1/FVC D. Increased functional residual capacity E. Increased total lung capacity

C

Which of the following is NOT a characteristic pathophysiologic of asthma? A. Most common chronic disease in children and young adults B. Airway obstruction C. Reversible restrictive lung disease D. Hyperresponsiveness E. Airway inflammation

C It's a reversible OBSTRUCTIVE lung disease

47 y.o. stonecutter w/ cough, SOB, has CXR w/ small round opacities of "eggshell" appearance.

Simple Silicosis: small round opacities in upper lobes, eggshell Chronic silicosis: poorly defined nodules in upper lobes Complicated silicosis: large masses > 1 cm **Silicosis increases TB risk and Ca risk

What does a lesion ≥ 3 cm indicate

Malignancy

Pt w/ lung disease, low pancreas enzymes, and high Cl in sweat suffers from:

CF Tx: -Chest PT -aerosolized meds -abx -pancreas enzyme replacement -bilateral lung, pancreas, liver xplant needed

Pt presents w/ coughing, sputum, wheezing, periodic infxn, ↑ seratonin levels. Cxr shows endobronchial growth. Pt is flushed, cyanotic, hypotensive.

Carcinoid tumor Test: 24 hr 5-HIAA Tx: surgery

What are the two types of emphysema, and the causes?

Centrilobular: smoking Panlobular: α-1 antitrypsin deficiency

What is the first line tx for small cell carcinoma?

Chemo, perhaps w/ RXT as well.

Pt has a productive cough for 4 mos, and tends to have this at least 1x yr for the last few years. Edema, coarse rhonchi and wheezing, cyanosis. Frequent URTI. Hypercarbia and hypoxia. Accessory muscle use. CXR shows cardiomegaly w/ RVH, fibrosis, and ↑ bronchovascular markings

Chronic bronchitis Tx: -Inhalers -O2 -Pulmonary rehab

When would you prescribe oxygen therapy for someone suffering from COPD?

Chronic hypoxemia: PaO₂ < 55 mmHg -OR- Cor pulmonale -OR- pHTN present -OR- Goal to maintain o2 sat > 90%

FVC (% pred): 98% FEV1 (% pred): 96% FEV1/FVC (% pred): 98%

Normal

Pt has FVC of 88%. What is the classification?

Normal

Inhaled particle is 12 µm. Where is it most likely to wind up in the lungs?

Upper airways > 10 µm

Inhaled particle is 7 µm. Where is it most likely to wind up in lungs?

Upper tracheobrachial tree 2-10 µm

Although asthma is a heterogeneous disease, a given individual with asthma would be most likely to A. relate a personal or family history of allergic diseases B. conform to a characteristic personality type C. display a skin-test reaction to extracts of airborne allergens D. demonstrate nonspecific airway hyperirritability E. have supranormal serum immunoglobulin E

D

Causes of chronic respiratory acidosis include all of the following except: A. Restrictive lung disease B. COPD C. Severe kyphoscoliosis D. Cirrhosis of the liver E. Severe hypokalemia

D

Chronic bronchitis is defined as: A. Presence of daily nonproductive cough in a smoker B. Presence of chronic productive cough in a smoker C. Presence of productive cough for 3 months in a smoker D. Presence of a chronic productive cough for 3 months in each of two successive years in a patient in who other causes of chronic cough has been excluded.

D

In emphysema, the disease process is characterized by A. Mucus plugging of small airways B. Inflammation C. Smooth-muscle hypertrophy D. Destruction of alveolar walls E. Edema

D

In emphysema, the single most important factor in slowing the inevitable decline in forced expiratory volume in 1 second (FEV1) and improving life expectancy and quality of life is: A. The long-term use of oral or inhaled corticosteroids B. The use of continuous or nocturnal oxygen therapy C. Bronchodilator therapy with theophyllines and/or beta-agonists D. Smoking cessation E. Giving pneumococcal vaccine and yearly influenza vaccination

D

Which of the following is(are) included in the working definition of asthma A. reversible airway obstruction B. bronchial airway inflammation C. bronchial airway hyperresponsiveness to various stimuli D. all of the above

D

Which of the following most accurately describes the preferred pharmacologic treatment of moderate persistent asthma in adults? A. Inhaled sodium cromoglycate alone B. Inhaled Beta2-agonists alone C. Inhaled corticosteroids alone D. Daily-inhaled corticosteroids and long-acting, inhaled Beta2-agonists, if needed E. Inhaled sodium cromoglycate continually and intermittent inhaled Beta2-agonists

D

Which of the following pulmonary function tests is most easily carried out at home? A. FEV1/FVC ratio B. FVC C. Mid-expiratory flow rate D. Peak expiratory flow rate E. Residual volume

D

75 y.o. smoker presents w/ SOB, productive cough, T 100.5°, tripod position, barrel chest. CxR shows small, vertical heart, hyperlucent upper lobes, hyperinflation, and flat, hemidiaphragm.

Dx: Emphysema (w/ secondary infxn, as seen from temp and productive cough) Tx: lung xplant. O2 for palliation.

The goal(s) of the treatment of asthma is/are A. Prevent chronic and troublesome symptoms such as nocturnal coughing or breathlessness B. Maintain normal exercise and activity level C. Prevent recurrent exacerbations of asthma and minimize the need for Emergency Department visits or hospitalizations D. Reduce or prevent underlying airway inflammation and the series of chemical mediators that contribute to bronchospasm E. All of the above

E

Which of the following factors may precipitate an asthma attack? A. Anxiety B. Air pollution C. Exercise D. Beta-adrenergic blocking agents E. All of he above

E

Pt presents w/ clubbing, hypercalcemia, and copious sputum. Hilar mass on CXR, w/ mediastinal widening and cavitation. Dx?

Epidermoid Tx: surgery?

What is the maximal volume of air that is EXHALED from end expiration?

Expiratory Reserve Volume (ERV)

Interpret image

FEV1/FVC % is less than 80% so this is an obstructive lung disease pattern (COPD, Asthma, or Cystic Fibrosis). FEV1 will show you how severe the obstruction is. FVC is above 80% so this is NOT a restrictive process

List the spirometry results associated w/ OLD:

FEV1/FVC ratio < 80%

Which spirometry values cannot be measured? (You can't measure a FaRT)

FRC RV TLC

What is the total volume of air that can be exhaled during a maximal forced expiration effort?

FVC

What is the volume of air in the lungs at resting end-expiration?

Functional Residual Capacity (FRC)

57 y.o. sugarcane worker w/ purulent sputum, rales, fever/chills, malaise. Gets worse on Tuesdays, better over weekend. CXR shows ground glass opacification.

Hypersensitivity Pneomonitis (HP) -RLD Tx: Prednisone AKA: Farmer's lung, Pigeon Breeder's Lung, Sugarcane Lung (Bagossossis), etc.

What disease are thermoactinomycetes most associated w/?

Hypersensitivity pneumoniosis

Normal flow volume loop

Ice cream cone -It's normal to like ice cream cones

45 y.o. machinist presents w/ elevated ESR, hypoxia, late inspiratory crackles at posterior bases, pHTN, clubbing, and CXR w/ diffuse reticulonodular markings in lower lungs. HRCT shows bibasilar abnormalities and honeycombing. FEV1/FVC is 84, FEV1 = 73. No hx of smoking, lung disease. Family member died of respiratory arrest at 44.

Idiopathic Pulmonary Disease -RLD Tx: -O2 -Lung xplant -corticosteriods and immunosuppressants to decrease inflammation, -BUT- no cure. **Life expectancy < 4 yrs.

What is the maximal volume of air that can be inhaled from the resting expiratory level?

Inspiratory Capacity (IC)

What is the maximal volume of air INHALED from end inspiration?

Inspiratory Reserve Volume (IRV)

Pt has asthma symptoms < 2 days/week, night time symptoms < 2 times/month. FEV1 > 80%.

Intermittent Tx: SABA

Pt presents w/ hypoxia, non-productive cough, crackles at base of lungs, tachypnea and decreased BS. CXR shows "ground glass" look w/ some honeycombing on CT. FEV1/FVC is 85%, FEV1 is 68%. TLC, RV, VC are reduced

Interstitial Lung Disease -RLD Dx: -Labs: low ANA and RA factor if no conx tissue issues -Serum antibodies -Biopsy -Gallium scan Tx: -Treat cause -Glucocorticoids (Prednisone) **Prednisone not for IPF*** -Lung xplant

List the two types of Restrictive Pulmonary Diseases:

Interstitial Lung disease (IPD, Sarcoidosis) -RLD -Pneumoconiosis (coal workers, asbestiosis, silicosis)

30 y.o. pt presents w/ recurrent sinus infections. He and wife have been trying to have a child for 3 yrs, no luck. Heart sounds heard on right side of body.

Kartagener's Syndrome Triad: -sinus infxn -sterility -situs inversus →abnormalities of cilia make motility impossible, so mucus can't move up and out.

Male pt w/ gynecomastia presents w/ large peripheral mass on CXR, w/ cavitation.

Large cell carcinoma Tx: surgery

Pt w/ solitary pulmonary nodule measuring 5 mm. What is follow up protocol?

Low Risk pt 4-6 mm: CT 12 mos High Risk: CT 6-12 mos, 18-24

Pt w/ solitary pulmonary nodule measuring 7 mm. What is follow up protocol?

Low Risk pt 6-8mm: CT 6-12 mos, then 18-24 mos IF no change. High Risk: Ct 3-6 mos, 9-12, 24

Pt w/ solitary pulmonary nodule measuring 2 mm. What is follow up protocol?

Low Risk pt < 4mm: no f/u. High Risk pt: CT @ 12 mos.

Pt w/ solitary pulmonary nodule measuring 10 mm. What is follow up protocol?

Low risk ≥ 8 mm: CT 3, 9, 24 and/or biopsy High risk: CT 3,9, 24 and/or biopsy

ABG (What is the primary disorder)? pH: 7.25 PCO2: 40 HCO3: 18

Metabolic Acidosis

ABG (What is the primary disorder)? pH: 7.55 PCO2: 40 HCO3: 32

Metabolic alkalosis

ABG (What is the primary disorder)? pH: 7.55 PCO2: 40 HCO3: 32

Metabolic alkalosis

Restrictive lung disease flow volume loop

Middle finger -**** your restrictions

Classify pt w/ asthma symptoms 3 x week, night time symptoms 3-4 x month. FEV1 > 80%

Mild Tx: Daily long term med -Glucocorticoid (Pulmicort)

Pt has FEV1/FVC of 68, FEV is 85. What is his severity stage?

Mild disease V1/C < 70, V1 > 80

Pt has FVC of 75%. What is the classification?

Mild reduction

Interpret

Mixed obstructive/restrictive (eg COPD w/ air trapping) All of the values are less than 80%, so this is either a mixed restrictive and obstructive pattern or this can be seen in a patient with severe COPD that has air trapping.

Classify pt w/ daily asthma symptoms, night time symptoms that occur 1x week. FEV1 60-80%.

Moderate FEV1/FVC reduced 5% Tx: Glucocorticoid + long acting B agonist

Pat has V1/V of 68, FEV1= 60. Classify severity:

Moderate V1/C < 70, V1= 50-80%

Interpret spirometry: FVC (% pred): 83 % FEV1 (% pred):32% FEV1/FVC (% pred): 39%

Obstructive

Fixed large airway obstruction flow volume loop

Orange -I got an orange stuck in my throat

What do you call inflammation leading to fibrosis from inhalation of dusts?

Pneumoconiosis

What is the volume of air remaining in the lungs after a maximum exhalation?

Residual volume (RV)

ABG (What is the primary disorder)? pH: 7.31 PCO2: 50 HCO3: 25

Respiratory Acidosis

ABG (What is the primary disorder)? pH: 7.6 PCO2: 30 HCO3: 22 Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis

Respiratory Alkalosis

ABG (What is the primary disorder)? pH: 7.25 PCO2: 55 HCO3: 25

Respiratory acidosis

ABG (What is the primary disorder)? pH: 7.28 PCO2: 108 HCO3: 32

Respiratory acidosis

ABG (What is the primary disorder)? pH: 7.49 PCO2: 32 HCO3: 18

Respiratory alkalosis

ABG (What is the primary disorder)? pH: 7.6 PCO2: 28 HCO3: 25

Respiratory alkalosis

FVC (% pred): 50% FEV1 (% pred): 48% FEV1/FVC (% pred): 96%

Restrictive

Interpret image

Restrictive FEV1/FVC ratio is above 80% so this is NOT obstructive (it is either restrictive or normal); FVC is less than 80% so this is restrictive. Note that FEV1 is also decreased in restrictive patterns but the ratio (FEV1/FVC ratio) is always going to be normal in pure restrictive lung disease.

Pt complains of increasing vision loss, fever, SOB, cough. CXR reveals bilateral hilar adenopathy. ACE levels 60 %. Restrictive PFT profile. EKG shows dysrhythmia. Mild anemia

Sarcoidosis -RLD Tx: -many resolve w/o tx -corticosteroids w/ severe disease →methotrexate or azathioprine when cannot use corticosteroids -***OPTHALMOLOGIC EXAM****

Classify pt w/ continuous asthma symptoms, which also occur nightly. FEV1 < 60%

Severe FEV1 < 60% FEV1/FVC reduced > 5% Tx: SABA

Pt has V1/V of 68, FEV1= 45. Classify severity:

Severe V1/C < 70, FEV1 30-50

List some defining symptoms of Pancoast Syndrome:

Shoulder pain/numbness/weakness →Often in conjunction w/ Horner's symptoms (ptosis, miosis, anhidrosis)

Smoker presents w/ central lesion and hypernatremia, and signs of ectopic ACTH. CXR shows diffuse spreading in one lobe.

Small cell Carcinoma -Limited stage (extensive= spread beyond hemithorax/regional LN) Tx: Chemo, w/ or w/o radiation (limited), or just chemo (extensive)

What stage COPD would someone be in if FEV1 is 62%?

Stage 1: Mild (50-80%)

What stage COPD would someone be in if FEV1 is 40%?

Stage 2: Moderate (35-49%)

What stage of COPD would someone be in if FEV1 is 32%?

Stage 3: Severe (30-35%)

What stage COPD would someone be in if FEV1 is 29%?

Stage 4: Very Severe (<35%)

Pt w/ hx of asthma now has symptoms almost constantly for weeks on end. Normal tx don't respond, nor do new ones.

Status Asthmaticus -may require mechanical ventilation

What type of tumor is most associated w/ Pancoast Syndrome and/or Horner's syndrome?

Superior Sulcus Tumor (aka Pancoast Tumor) -located in apical portion of lung

What are elevated JVD, facial/arms edema, and cyanosis a sign of?

Superior Vena Cava syndrome: tumor compression of SVC, leading to Cor Pulmonale

Tx for solitary pulmonary nodule > 2 cm?

Surgical resection

Describe Paraneoplastic Syndrome:

Symptoms/issues that present secondary to tumor growth on an organ. Ex: -Cushing's (Adrenal gland→ Cortisol or Pituitary gland→ACTH) -Acanthosis nigrans -Dermatomyosis -Retinopathy -Encephalomyelitis -Myasthenic syndrome -etc.

Which spirometry values can be measured?

TV ERV IRV FVC

Interpret

This is classic asthma, you can see a significant improvement (post bronchodilator change) in the FEV1/FVC. Any % change greater than 12% after a bronchodilator is given is significant.

What is the volume of air inhaled or exhaled during each respiratory cycle?

Tidal Volume (VT)

What is the volume of air in the lungs at maximal inflation?

Total Lung Capacity (TLC)

Pt has V1/C of 68, FEV1 25%

Very severe V1/C < 70, V1 < 30%

What is the largest volume measured on complete exhalation after full inspiration?

Vital Capacity (VC)

A 70-year-old man with a history of COPD presents complaining of worsening shortness of breath for the last several days. He is coughing large amounts of yellow-colored sputum and he is receiving no relief from his B-2-agonist and ipratropium aerosolized pumps. On physical examination, the patient's respiratory rate is 40/min and his heart rate is 110/min. His blood pressure is 150/85 mm Hg. The patient is afebrile. He is using his accessory muscles of respiration to assists in breathing.

Which of the following is the most likely diagnosis? A. Acute exacerbation of COPD B. Alpha 1 antitrypsin deficiency C. Chronic bronchitis D. Exacerbation of asthma E. Pneumonia Ans: Answer A The answer is a.(Fauci, 14e, pp 1451-1455.) COPD is defined as a condition where there is chronic obstruction to airflow due to chronic bronchitis or emphysema. An exacerbation of COPD occurs when the patient develops the acute onset of marked dyspnea and tachypnea requiring use of accessory muscles that is unresponsive to medications. Alpha 1 antitrypsin deficiency should be suspected in nonsmokers who present with COPD of the lung bases in their fifties without any predisposing history, such as occupational exposure to support the diagnosis. It is rare in African Americans and Asian-Pacific islanders

A 40 year old female has had a cough that is productive of purulent sputum. On occasion, she notes spots of blood in the sputum. She has been hospitalized for pneumonia twice in the past year. She does not have dyspnea, but she has recently developed wheezing episodes. Laboratory findings include an elevated WBC count with neutrophilia and left shift. Sputum culture grew 3+ Serratia marcescens and 2+ Pseudomonas aeruginosa. A chest radiograph reveals thickened bronchi as seen on end, along with linear streaks in the right middle lobe.

You suspect this patients suffers from Bronchiectasis. What are the possible etiologies of this condition? A. Congenital Bronchiectasis, B. Post obstructive, secondary to necrotizing pneumonia (Staphylococcal or TB), C. Immunodeficiency disorders D. Immotile cilia and Kartagener's syndromes. E. All of the above Ans: E

COPD flow volume loop

miso spoon -Take a big sip of COPD