Pulmonology

Question 1

The air in the lung at max expiration

Answer 1

Residual Volume (RV)

Question 2

The air in the lung that can be exhaled after normal expiration

Answer 2

Expiratory reserve volume (ERV)

Question 3

Air entering and exiting the lungs during normal expiration

Answer 3

Tidal volume (TV)

Question 4

Air in excess of tidal volume entering the lungs at full inspiration

Answer 4

Inspiratory reserve volume (IRV)

Question 5

RV + ERV: the volume of air in the lungs at the end of passive expiration

Answer 5

Functional reserve capacity

Question 6

RV + ERV + TV + IRV: The volume of the lungs at max inspiration

Answer 6

Total lung capacity (TLC)

Question 7

What are lung volume assessments useful for?

Answer 7

Evaluating restrictive lung disease, looking for evidence of hyperinflation 2/2 obstructive lung disease and interpreting DLco

Question 8

Name the components of PFTs

Answer 8

Spirometry
Lung volume measurements
Quantitation of diffusing capacity

Question 9

What are PFTs useful for?

Answer 9

Eval of pts w/ risk factors (i.e. smoking)
Eval of chronic persistent cough, wheezing, dyspnea or exertional cough/chest pain
Assess bronchodilator therapy
Eval work exposure
Assess surgical risk
Assess impairment/disability

Question 10

Use this test to screen smokers >45 yo for COPD

Answer 10

Spirometry

Question 11

This test reveals stridor over the neck or unexplained dyspnea, and is used to dx variable airway obstruction (vocal cord paralysis or dysfunction)

Answer 11

Forced inspiratory maneuvers

Question 12

Use this test when obstruction is seen on spirometry, or when asthma is suspected

Answer 12

Postbronchodilator spirometry, repeat test 10 min after bronchodilator administration

Question 13

This test may be used to diagnose interstitial lung disease

Answer 13

Lung volumes

Question 14

This test differentiates restrictive vs obstructive lung disease

Answer 14

DLco

Question 15

What test result on postbronchodilator spirometry indicates bronchodilator responsiveness?

Answer 15

FVC increase of 12% & at least 0.2 L

Question 16

Low DLco indicates what condition?

Answer 16

Emphysema

Question 17

Normal DLco indicates what?

Answer 17

Bronchitis

Question 18

Normal to high DLco indicates what?

Answer 18

Asthma

Question 19

What disease causes:
Normal/low FEV1/FVC
Normal TLC
Normal/High DLco

Answer 19

Asthma

Question 20

What disease causes:
Low FEV1/FVC
High/normal TLC
Normal/high DLco

Answer 20

COPD

Question 21

What disease causes:
Normal/low FEV1/FVC
Low TLC
Low DLco

Answer 21

Fibrotic disease

Question 22

What disease causes:
Normal FEV1/FVC
Low TLC
Normal DLco

Answer 22

Extrathoracic restriction

Question 23

What PaO2 level is considered hypoxemia?

Answer 23

PaO2 <80 (80-100 is normal)

Question 24

What is the most common cause of hypoxia?

Answer 24

Hypoxemia

Question 25

Most common cause of hypoventilation?

Answer 25

Medications

Question 26

PE, PFO and PDAs are the most common cause of this type of shunt.

Answer 26

Right to Left

Question 27

An increase in the A-a gradient in combination with low PaCO2 that does not improve with O2 supplementation is suggestive of this type of shunt?

Answer 27

Right to Left

Question 28

An increase in the A-a gradient with hypoxemia that improves with supplemental O2 suggests what?

Answer 28

V/Q (ventilation/perfusion) mismatch

Question 29

PE, asthma, COPD and pneumonia may all cause what pulmonary dysfunction?

Answer 29

V/Q (ventilation/perfusion) mismatch

Question 30

ILD or parenchymal disease show what test results?

Answer 30

Very low DLco, increased A-a gradient and improvement with supplemental O2

Question 31

Normal A-a gradient with hypoxemia that responds to supplemental O2 is suggestive of what causes?

Answer 31

High altitudes, closed space rescues, structural fires

Question 32

A patient presenting with agitation, headache, somnolence, coma and possibly seizures suggests what condition?

Answer 32

Hypoxemia

Question 33

What tests should be ordered for a patient presenting with agitation, headache, somnolence, coma and possibly seizures?

Answer 33

ABG, CXR, Pulse Ox may not be useful. Calculate A-a gradient.

Question 34

Formula A-a gradient

Answer 34

PiO2 - (PaO2 - PaCO2/8) | PiO2 = FiO2