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Pulmonary Lab Med 1 Flashcards

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1
Q

once you get a PPO2 of what, will you % saturation of 90

A

60

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2
Q

What things cause a left shift of the curve?

A

decrease temp
decreased 2-3 DPG
decreased (H+)
CO

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3
Q

the higher the elevation…..

A

the less barometric pressure there is to push the oxygen on the hemoglobin

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4
Q

how long does it take for a molecule of O2 to get across the interstitial membrane

A

3/4 of a second

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5
Q

what can you do to test if the time for molecule to get across the interstitial membrane is longer?

A

exercise them

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6
Q

does alveolar hypoventilation occur in dz processes of the lung?

A

No, when something else is going on that causes elevated pCO2 and decreased PO2

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7
Q

what are some things that cause alveolar hypoventilation?

A

Drugs
CNS injury
neuromuscular weakness (myastenia gravis)
obesity

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8
Q

what should be removed before using a pulse ox?

A

remove nail polish

make sure hands arent cold

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9
Q

example of a shunt in pulmonary

A

lobar pneumonia (densely occupied part)

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10
Q

does an increase in oxygen help solve a shunt problem?

A

No because the blood is shunted anatomically

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11
Q

4 diseases that cause V/Q mismatch

A

COPD
Asthma
Pneumonia
Pulmonary emobilsm

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12
Q

what is the most common cause of hypoxia and can be corrected w/ oxygen?

A

V/Q mismatch

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13
Q

normal PaCO2

A

35-45

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14
Q

normal PaO2

A

70-80

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15
Q

Normal O2Sat

A

90-96%

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16
Q

Normal HCO3?

A

24-28

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17
Q

what regulates the PaCO2 rate?

A

alveoli

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18
Q

what regulates the HCO3 level?

A

Kidneys

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19
Q

The hydrogen ion concentration [H+] in extracellular fluid is determined by the

A

balance between the partial pressure of carbon dioxide (PCO2) and the concentration of bicarbonate [HCO3-] in the fluid.

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20
Q

how long does it take the kidneys to make a compensatory response?

A

72 hours

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21
Q

PaCO2 elevated – causes: Drug OD, COPD exacerbation with respiratory failure

A

Respiratory acidemia

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22
Q

PaCO2 low causes: sepsis, altitude, aspirin OD

A

Respiratory alkalemia

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23
Q

HCO3 low – causes lactic acidosis, ketoacidosis, renal failure, severe diarrhea

A

Metabolic acidemia

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24
Q

HCO3 high – diuretics, vomiting, ng suction, NA HCO3 ingestion

A

metabolic alkalemia

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25
If pH is normal and pCO2 and HCO3 are abnormal then __________ EXISTS
compensation
26
pH is abnormal, and both pCO2 and HCO3 are abnormal what is hapenning?
two separate abnormal processes can be occurring without compensation
27
pH normal + increased pCO2 + increased HCO3
compensated respiratory acidosis
28
pH normal + decreased HCO3 + decreased pCO2
compensated metabolic acidosis
29
what's another way to get a CO2 level besides ABGs?
BMP
30
pH>7.50 + pCO2<30 + normal HCO3
uncompensated respiratory alkalosis
31
pH>7.50 + HCO3>30 + normal pCO2
uncompensated metabolic alkalosis
32
respiratory causes of acidosis
hypoventilation | impaired gas exchange (V/P mismatch)
33
metabolic causes of acidosis
``` Ketoacidosis (i..e diabetes) Renal Tubular Acidosis (i.e. renal failure) Lactic Acidosis (i.e. Decreased perfusion or severe hypoxemia) ```
34
what is the anion gap?
Na+ – (Cl- + HCO3-)
35
if the anion gap is > 12 what does that indicate?
anion gap acidosis
36
what does MULEPAK stand for?
causes of an anion gap | Methanol, Uremia, Lactic Acidosis, Ethylene Glycol, Paraldehyde, ASA, Ketoacidosis
37
respiratory causes of alkalsosi
Hyperventilation due to hyoxemia, metabolic acidosis, neurologic
38
meatbolic causes of alkalosis
hypokalemia gastric suction or vomiting hypocholemia
39
with hyperchloremia is there an elevated anion gap?
No
40
some indications for pulmonary function tests
SOB, exertional dyspnea, chronic cough
41
what can spirometry determine
FEV1 FVC (forced vital capacity) FEV1/ FVC forced expiratory flow (FEF) in small airways
42
with obstructive lung dz what will happen to the FEV1 and FVC?
Decreased
43
with obstructie lung disease what is FEV1/ FVC below?
<70%
44
what is used to follow severity in COPD?
FEV1
45
Name a differential for obstructive lung dzs
``` Asthma COPD bronchiectasis bronciolitis upper airway obstruction ```
46
is the relationsihp between FEV1 and FVC decreased in restrictive patterns?
No, usually normal or increased
47
name some restrictive lung dzs
pleural (cancer) parenchymal chest wall (broken ribs) neuromuscular (guillan-burre, MG)
48
what does a improved FEV1 after a bronchodilator indicate?
A reversible airflow obstruction
49
what is considered improvement on FEV1 after a bronchodilator?
12-15% improvement
50
Spirogram that Measures forced inspiratory and expiratory flow rate. Augments spirometry results.
Flow volume loop
51
what are indications for a flow volume loop?
Evaluation of upper airway (stridor, unexplained dyspnea)
52
how do you measure lung volumes?
helium - nitrogen washout - body plethsmography
53
when are lung volumes indicated
Diagnose restrictive component | Differentiate chronic bronchitis from emphysema
54
Measures ability of lungs to transport inhaled gas from alveoli to pulmonary capillaries
diffusing capacity
55
what does diffusing capacity depend on?
alveolar—capillary membrane hemoglobin concentration cardiac output
56
what can cause a decreased DLCO
obstructive lung dz parenchymal dz pulmonary vascular dz anemia
57
what can cause increased DLCO
asthma (or normal) pulmonary hemorrhage polycythemia left to right shunt
58
Indications for DLCO
Differentiate asthma from emphysema Evaluation and severity of restrictive lung disease Early stages of pulmonary hypertension (it is expensive)
59
Useful for diagnosis of asthma in the setting of normal pulmonary function tests
Bronchoprovocation
60
common agents for bronchoprovocation
Methacholine, Histamine, others
61
when is a bronchoprovocation considered diagnostic
≥20% decrease in FEV1
62
with emphysema what happens with the TLC?
TLC is increased
63
what happens with the DLCO with empysema?
decreased
64
A 36yo WF, non-smoker, presents to your office for follow-up of ‘recurrent bronchitis.’ You suspect asthma and decide to order spirometry. Which of the following would you include in your prescription for testing?
if no obstruction present, perform methacholine challenge
65
Exhaled Nitric Oxide is elevated in patients with ______________________________
eosinophilic inflammation
66
what is an x-ray with smaller thorax helps to see pneumothorax better
Expiratory film
67
what ribs do you see on an x-ray?
posterior
68
what can shift the hilum toward the problem?
atelectasis fibrosis post pneumoectomy
69
what can a shift of the hilum away indicate?
``` pleural effusion air trapping tension pneumo pneumo tumor ```
70
When the lung is consolidated and the bronchi contain air, the dense lung delineates the air in the bronchi
air bronchogram
71
``` Fluffy Poorly defined Often contain air bronchograms ARDS, Pulmonary Edema, bacterial pneumonia Diffuse, focal ```
Alveolar infiltrates
72
streaky infiltrates linear, nodular diffuse associated w/ fibrosis, heart failure
interstitial infiltrates
73
any pulmonary lesion represented in a radiograph by a sharply defined, discrete, nearly circular opacity 2-30 mm in diameter
Nodule
74
what is larger than 3 cm seen on x-ray?
mass
75
``` Scarring of lung due to injury Chronic aspiration Inhalation injury Acute Respiratory Distress Syndrome Infection Occupational exposures Collagen-Vascular related ```
pulmonary fibrosis
76
when do you use CT with contrast
concerned about something vascular
77
when do you get a sputum sample
underlying lung dz | best if first morning sample, shouldn't have >25 squamous cells (that indicates saliva)
78
when would you use the methacholine challenge?
if PFTs are normal are you suspect asthma
79
when is a methacholine challenge diagnostic?
>20% decrease FEV1
80
If you see a "sail collapsed" on a FV loop what should you suspect?
Obstructive pattern
81
What does the FV loop look like on a restrictive pattern?
Decreased
82
If you have a restrictive lung dz and then you get a DLCO and it is decreased what do you suspect?
parenchymal disease
83
Is DCLO normal for chronic bronchitis or emphysema?
chronic bronchitis
84
how do you evaluate pulmonary HTN?
echocardiogram + doppler | best test is cardiac catheterization with direct measurement of pulmonary arterial pressure
85
Is TLC normal in emphysema or chronic bronchitis?
Chronic bronchitis
86
lines that indicate fluid accumulation
Kerley B lines
87
pH < 7.30 + pCO2 >50 + normal HCO3
uncompensated respiratory acidosis
88
pH < 7.30 + HCO3<18 + normal pCO2
uncompensated metabolic acidosis

Lab Medicine (12 decks)

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