Pulmonary Flashcards
Difference in lung compromise between smoking-induced COPD and alpha-1 antitrypsin deficiency-related COPD
- Smoking-induced centriacinar (centrilobular) emphysema➡upper lobes
- AAT deficiency panacinar emphysema➡greater destruction of lower lobes
*Chest x-ray AAT deficiency➡bilateral basilar lucency
Clues to suspect Alpha-1 antitrypsin
- COPD at a younger age (<45 years old)
- COPD with minimal or no smoking history
- Bibasilar predominant COPD
- History of unexplained liver disease
When do you use bronchoprovocation testing with methacholine?
Patients with typical asthma symptoms but normal spirometry
Recommendations for lung cancer screening
- Annual screening→low-dose CT in adults age 55 - 80 who have a 30-pack-year smoking history and currently smoke or have quit within past 15 years
- Discontinue Screening→Once a person has not smoked for 15 years or develops a health problem limiting life expectancy or ability/willingness to have curative lung surgery
Difference of the diffusion capacity of the lung for carbon monoxide between emphysema and chronic bronchitis, and why?
- Low in Emphysema→loss of alveolar capillaries
- Normal in Chronic Bronchitis
Difference between the pleural exudate of tuberculous effusion and malignancy etiology
- Tuberculous→usually lymphocytosis>70%
- Malignancy→lymphocytosis is uncommon
Most common causes of secondary digital clubbing
- Lung malignancies (intrathoracic neoplasms)
- Intrathoracic suppurative diseases (cystic fibrosis, bronchiectasis)
- Right to left cardiac shunts (cyanotic congenital heart disease)
*COPD with or without hypoxemia does not cause digital clubbing
Best initial test in acute exacerbation of asthma
- Peak expiratory flow (PEF)→approximation of the FVC
- Arterial blood gas (ABG)→↑ A-a gradient
Most accurate test for asthma in an asymptomatic patient
> 20% decrease in FEV1 with use of methacholine or histamine
*Less likely to find an ↑ in FEV1 using a SABA (albuterol)→false negative
Findings in the pulmonary function testing in asthma
- ↓ FEV1, FVC and FEV1/FVC
- ↑>12% and 200 mL in FEV1 with albuterol
- ↓>20% in FEV1 with methacholine or histamine
- ↑ Diffusion capacity of the lung for Carbon monoxide (DLCO)
When do you use anticholinergics in chronic asthma management?
If SABA, LABA and inhaled corticosteroids at maximum doses are not sufficient
*Iptratropium, Tiotropium
Typical presentation in acute asthma exacerbation in arterial blood gas. Which finding suggests the patient is getting worse?
- Hyperventilation→Respiratory alkalosis
- ↑ work of breathing→respiratory muscle fatigue→inability to maintain adequate ventilation (hyper)►normal pH and PaCO2 (normalized or elevated from respiratory alkalosis)►impending respiratory collapse
Which are the 3 most common causes of chronic cough? What is chronic cough?
- Chronic cough→lasting >8 weeks
- Upper airway cough syndrome (postnasal drip)
- Asthma
- Gastroesophageal reflux disease (GERD)
What is a solitary pulmonary nodule? What is the first step when evaluating it?
- Rounded opacity, <3cm, completely surrounded by pulmonary parenchyma, No associated with lymph node enlargement
- Determine if nodule is low, intermediate or high malignancy risk
Which is the management of high, intermediate and low malignancy risk solitary pulmonary nodule?
- High risk→surgical excision
- Intermediate risk→FDG-PET, serial CT scans or Bx depending radiographic findings
- Low risk→serial CT scans
First line inpatient non-ICU treatment for community-acquired pneumonia
- Fluoroquinolone: Respiratory→moxifloxacin, levofloxacin
- Beta-lactam + macrolide
Best initial and most accurate diagnostic test for COPD?
- Best initial: chest x-ray
- Most accurate: Pulmonary Function Test
Which sodium disturbance you may find secondary to a pulmonary pathology and why?
Hypotonic Euvolemic Hyponatremia
- Pulmonary pathology (Pneumocystis pneumonia, Ex)→ SIADH
- Infusion of normal saline - worsen hyponatremia
Kartagener syndrome screening test
Decreased nasal nitric oxide
COPD patient with acute-on-chronic respiratory acidosis
Hypoventilation→CO2 narcosis
Pulmonary variable reflected when doing inspiratory hold maneuver?
Pulmonary compliance
Inspiratory hold maneuver➡measure plateau pressure=elastic pressure + PEEP
*Elastic recoil is inverse related to lung compliance; Elastic pressure=TV/compliance. ⬇Compliance (pulmonary fibrosis)➡stiffer lungs, ⬆elastic pressure
Radiologic feature of invasive aspergillosis in the lungs
Chest CT scan: Pulmonary nodules with surrounding ground-glass opacities (“halo sign”)
Pulmonary function test results in a patient with amyotrophic lateral sclerosis (ALS)
- Restrictive pattern (normal or ⬆FEV1/FVC, ⬇VC)➡extrinsic limitation of lung expansion
- Diaphragmatic involvement (weakness)➡⬇FVC, ⬇Maximal inspiratory pressure (reflect diaphragmatic strength), DLCO normal (pulmonar parenchyma and alveoli unaffected)
Best predictors of postoperative outcomes following lung resection surgery
FEV1 and DLCO
