maximal forced expiration through peak flow meter - estimates airway calibre - more effort-dependent

PaO2 6kPa little O2 too much CO2

Biochemistry Tests Flashcards by Monica Kierney

sputum examination

appearance 
clear/colourless (chronic bronchitis)
yellow-green (pulmonary infection)
red (haemoptysis)
black (smoke, coal dust)
frothy white-pink (pulmonary oedema)

sample –> laboratory -microscopy , culture, cytology

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peak expiratory flow

maximal forced expiration through peak flow meter

estimates airway calibre
more effort-dependent

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pulse oximetry

peripheral O2 sat
non invasive
less than/equal to 80% = abnormal
pneumonia less than 92% = serious sign
-check ABG for PaCO2

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pulse oximetry complication

poor perfusion
motion
excess light
skin pigmentation
nail varnish
dyshaemoglobinaemias
CO poisoning

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arterial blood gas

herparinized blood - taken from radial/ femoral artery
pH, PaO2, PaCO2 meaured
FiO2 noted

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Normal pH ABG

7.35-7.45

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ph<7.35

acidosis

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ph>7.45

alkalosis

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normal PaO2

10.5-13.5pKa

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hypoxia ccauses

ventilation/perfusion mismatch
hypoventilation
abnormal diffusion
right o left cardiac heart shunts

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severe hypoxia

PaO2 <8kPa

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normal PaCO2

4.5-6kPa

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PaCO2 <4.5kPa

hyperventilation

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PaCO2 >6.0kPa

hypoventilation

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Type 1 resp failure

too little O2
PaO2<8kPa
PaCO2<6kPa

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Type 2 resp failure

PaO2<8kPa
PaCO2>6kPa
little O2
too much CO2

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What does spirometry measure

functional lung volumes

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How are FEV1s and FVCs cmeasyred

full forced expiration in a spirometer

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when does exhalation finish

until no more breaths = exhaled

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is FEV1 or PEF more effort dependent

PEF

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what does FEV1/FVC ratio give estimate of

airflow obstruction severity

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Obstructive defect FEV1/FVC ratio

<75%

Restrictive defect FEV1/FVC

equal to > than normal

Normal FEV1/FVC ratio

75-80%

Obstructive defect examples

asthma | COPD

Restrictive defect examples

``` Lung fibrosis Sarcoidosis Pneumoconiosis Interstitial pneumonias Connective tissue diseases Pleural effusions Obesity Kyphoscoliosis Neuromuscular problems ```

what does Alveolar arterial oxygen gradient measure

difference in O2 pressure between alveolar + arterial sides

Aa gradient normal breathing range

0. 2-1.5 kPa (25 yrs) | 1. 5-3.0 kPa (75 yrs)

high Aa gradient hypoxia

O2 transfer problem

normal Aa gradient hypoxia

hypoventilation

lung capacities used to distinguish obstructive/ restrictive diseases

Total lung capacity | Residual volume

In obstructive airway disease what happens to TLC and RV

Increased

TLC and RV are reduced in

Restrictive lung diseases | Musculoskeletal abnormalities

explain gas transfer coefficient

CO diffusing capacity measures -CO uptake from single inspiration in standard time -lung volume by helium dilution

gas transfer coefficient = high

alveolar haemorrhage

gas transfer coefficient = low

emphysema

what does the flow volume loop measure

flow at various lung volumes

radiology used in chest medicine

``` chest x-ray ultrasound radio-nucleotide scans computed tomography pulmonary angiography ```

what is ultrasound used for

diagnosis + guide drainage of pleural effusions + emphysema

radionucleotide scans are used for

ventilation/perfusion scans -diagnose PE bone scans bone metastases

what is computed tomography used for

``` thorax diagnosing + staging lung cancer imaging hila, mediastinum, pleura high resolution CT -diagnose interstitial lung disease + bronchiectasis CT pulmonary angiography -PE diagnosis ```

fibreoptic bronchoscopy

local anaesthetic via nose or mouth susoected lung carcinomas slowly resolving pneumonia in immunosuppressed interstitial lung disease

pre procedure investigations fibreoptic bronchoscophy

``` FBC CXR spirometry pulse oximetry ABGs ```

bronchoalveolar lavage

at time of bronchoscopy | instil + aspirate known vl warmed, buffered 0.9% saline into distal airway

bronchoalveolar lavage diagnostic indications

suspected malignancy pneumonia immunocompromised suspected TB interstitial lung disease

bronchoalbeolar lavage complication

hypoxia transient fever transient CXR shadow

types of lung biopsy

percutaneous needle biopsy transbronchial biopsy open lung biopsy

percutaneous needle biopsy

under radiological guidance | peripheral lung + pleural lesions

transbronchial biopsy

@ bronchoscopy | diagnose diffuse lung disease

surgical procedures

rigid bronchoscopy mediastinoscopy mediastinotomy thoracoscopy

rigid bronchoscopy

widen lumen larger mucosal biopsies controls bleeding removes foreign bodies

mediastinoscopy | mediastinotomy

examination + biopsy of mediastinal lymph nodes/ lesions

thoracoscopy

examination + biopsy of pleural lesions drainage of pleural effusion talcpleurodesis