Pulmonary Function Tests and Clinical Approaches

Question 1

What lung test is used to determine if there is obstruction?

Answer 1

Spirometry

Question 2

What lung test is used to determine if there is restriction?

Answer 2

Helium dilution

Body plethysmography

Question 3

What lung test is used to determine if there is a diffusion defect?

Answer 3

CO diffusion test

Question 4

What do pre and post mean on a PFT?

Answer 4

Pre = before bronchodilator administration

Post = after bronchodilator administration

Question 5

What is the primary value for determining obstruction?

Answer 5

FEV1/FVC ratio

If less than 0.70, there is evidence of obstruction

Question 6

What is the appearance of the flow volume loop when there is small airway obstruction?

Answer 6

Scooping of the expiratory portion of the loop

Question 7

How could you test for reversible obstruction? What are the criteria for reversibility?

Answer 7

Administer a bronchodilator, then measure another flow volume loop

Need 200ccs and 12% improvement in FEV1 to classify as reversible

Question 8

If the PFT is normal initially, how could you induce obstruction and indicate hyperreactivity?

Answer 8

Methacholine challenge test

Question 9

What are the common obstructive diseases (lower airway)?

Answer 9

Asthma
Emphysema
Chronic Bronchitis
Bronchiectasis

Question 10

Describe the basic pathology behind small airway diseases. How is the airflow affected over the course of expiration?

Answer 10

The obstruction worsens as lung volume decreases

There is gradually decreasing airflow as the lung volume gets smaller due to less tethering of the bronchioles

Question 11

Describe the flow volume loop appearance of Upper Airway Obstruction

Answer 11

May be fixed or variable
Fixed - both the expiratory and inspiratory loops have a flattened appearance

Variable - either the expiratory or inspiratory loop is flattened, but not both

Question 12

Which loop is flattened in an extrathoracic upper airway obstruction?

Answer 12

Inspiratory loop is flattened

Question 13

Which loop is flattened in an intrathoracic upper airway obstruction?

Answer 13

Expiratory loop is flattened

Question 14

What intrinsic lung property determines the total lung capacity?

Answer 14

The lung elastic recoil

Question 15

At what lung volume are the lung’s and chest wall’s elastic recoils balanced?

Answer 15

FRC

Question 16

What is the primary problem in restrictive lung disease?

Answer 16

TLC is low

Question 17

What are the 3 main categories of restrictive lung diseases?

Answer 17

Interstitial lung disease
Chest wall disease
Neuromuscular disease

Question 18

List the potential causes of Interstitial Lung Disease

Answer 18

Sarcoid
Hypersensitivity pneumonitis
IPF
Tuberculosis
Fungal
Aspiration/Asbestosis
Connective Tissue Disorder/Cancer
Eosinophilic granuloma
Drugs (amiodarone, bleomycin)

Question 19

What is a normal DLco? What is the equation to calculate it (uncorrected)?

Answer 19

DLco is normally 25mL/min/mmHg

DLco = [CO]inhaled = [CO]exhaled

Question 20

What is the DLco equation corrected for hemoglobin?

Answer 20

DLco corrected = DLco x (15/Hbg)

Question 21

What conditions may cause a reduced DLco?

Answer 21

Loss of alveoli (emphysema and ILD)
Loss of capillaries (Pulm HTN)
Anemia

Question 22

When DLco is low but spirometry and lung volumes are normal, you should suspect…

Answer 22

Pulmonary HTN

Question 23

The volume of the lungs may appear very different on CXR in certain diseases. When would the lungs appear big? Small?

Answer 23

Obstructive diseases have large lungs and flat diaphragms

Restrictive diseases have small lungs and domed diaphragms

Question 24

What is the primary pathological problem in asthma?

Answer 24

Smooth muscle hypertrophy due to inflammation

It is reversible and intermittent obstruction

Question 25

What does "persistent" mean in asthma classification?

Answer 25

The patient needs persistent treatment for their asthma

Question 26

What are the two kinds of treatments used for asthma?

Answer 26

``` "Relievers" Emergency bronchodilators (albuterol, B2 agonist) ``` "Controllers" Regularly used anti-inflammatories

Question 27

What is the first line asthma controller? What might you add if that is inadequate?

Answer 27

Inhaled corticosteroid May add a long acting beta agonist if needed

Question 28

What is a common side effect on inhaled corticosteroids for asthma? How can this be avoided?

Answer 28

Thrush (oral-pharyngeal deposition of the medicine) Use a spacer to prevent thrush

Question 29

What 4 symptoms may people with asthma present with (in any combination)?

Answer 29

SOB Wheezing Chest tightness Cough

Question 30

What is cough variant asthma?

Answer 30

Asthma presenting only with a cough

Question 31

What is exercise induced asthma? How does it occur?

Answer 31

Asthma presenting after exercise. Increased ventilation during exercise leads to lots of beta agonist flowing in your blood, dilating the airways. However, the person may feel worse after stopping exercise due to dry mucus membranes and mast cell degranulation

Question 32

What is RADS?

Answer 32

Reactive Airways Dysfunction Syndrome Asthma that occurs after a single large exposure to an irritating agent

Question 33

What is Samter's Triad?

Answer 33

Asthma Aspirin sensitivity Nasal polyps People who take NSAIDs (aspirin) may develop asthma

Question 34

What is ABPA?

Answer 34

Allergic Bronchopulmonary Aspergillosis Hyperinflammatory response leading to reaction in the airways, causing asthma

Question 35

What are the two diseases considered COPD?

Answer 35

Emphysema | Chronic Bronchitis

Question 36

Describe Pink Puffers and the disease associated with it

Answer 36

Emphysema | Patient is pink and skinny. Normal pO2 and pCO2. They have increased work of breathing so they are thin (cachectic)

Question 37

Describe Blue Bloaters and the disease associated with it

Answer 37

Chronic Bronchitis Patient is edematous and cyanotic. Accepts a low pO2 (hypoxia), leading to hypoxic pulmonary vasoconstriction. Less tachypnea. Lots of mucus production

Question 38

What are the treatments of COPD?

Answer 38

Smoking cessation Medications - short and long acting bronchodilators (B agonists or anti-cholinergics) Long Term O2 therapy Cardiopulmonary Rehab (Exercise) Transplant Exogenous Alpha-1-Antitrypsin

Question 39

What is the number one indication for a lung transplant?

Answer 39

Emphysema

Question 40

What is bronchiectasis?

Answer 40

Permanent abnormal dilatation of the bronchi Tons of mucus is trapped in the airways and you get permanent abnormal dilatation with bacterial colonization and inflammation

Question 41

What is the sign of bronchiectasis that may be seen on CT?

Answer 41

Signet ring appearance | Airway is bigger in diameter than the corresponding blood vessel

Question 42

What is pneumoconiosis?

Answer 42

Buildup of dust particles in the lung and the tissue's response Causes restrictive lung disease

Question 43

What are some physical exam findings of interstitial lung disease?

Answer 43

Crackles Small lungs Clubbing of fingernails

Question 44

What is sarcoidosis?

Answer 44

Nonspecific tissue reaction with noncaseating granulomas in the lungs and other areas of body. See lymphadenopathy (hilar) and interstitial lung disease

Question 45

Where in the lung does sarcoidosis have its primary effect?

Answer 45

Upper lobes

Question 46

Where in the lung does idiopathic pulmonary fibrosis have its primary effects?

Answer 46

Lower lobes and periphery | See an extra whiteness around the base of the lungs on CT (fibrosis)

Question 47

What is the end stage appearance of IPF?

Answer 47

Honeycomb lung