Pulmonology Review Flashcards

These flashcards cover key concepts and diagnostic criteria relevant to pulmonology, especially focusing on asthma, pulmonary nodules, and COPD.

What is an obstructive pattern in pulmonary function tests?

FEV1/FVC < 70% predicted.

What defines a restrictive pattern in pulmonary function tests?

FEV1/FVC > 70% predicted and FVC < 80% predicted.

What pulmonary diseases have a low DLCO and an obstructive pattern?

Emphysema.

What pulmonary diseases have a normal DLCO and an obstructive pattern?

Chronic bronchitis. Asthma.

What pulmonary diseases have a high DLCO and an obstructive pattern?

Asthma.

What pulmonary diseases have a low DLCO and a restrictive pattern?

ILD, sarcoidosis, asbestosis, heart failure.

What pulmonary diseases have a normal DLCO and a restrictive pattern?

MSK deformity, neuromuscular disease.

What pulmonary diseases have a high DLCO and a restrictive pattern?

Morbid obesity.

What pulmonary diseases have a low DLCO and a normal spirometry pattern?

Anemia, PE, PHTN.

What pulmonary diseases have a high DLCO and a normal spirometry pattern?

Pulmonary hemorrhage. Polycythemia.

What do you do if you see a solitary pulmonary nodule on routine chest X-ray?

Look at previous chest X-rays. If stable lesion over 2-3 years, no further testing needed.

If this is a new nodule, get a chest CT.

You see a solitary pulmonary nodule on CXR. It is new so then you get a chest CT scan. If the features are benign, what do you do? If the features are indeterminate, what do you do? If the features are highly suspicious, what do you do?

Benign - serial CT scans. Indeterminate - biopsy or PET. Suspicious - surgical excision.

What is occupational asthma triggered by?

Workplace antigens causing inflammation (IgE dependent or independent) → broncho-constriction.

What are classic antigens associated with occupational asthma?

Animal proteins, grain carbohydrates, isocyanates, and metals.

How do you diagnose occupational asthma?

Diagnosis typically involves a thorough history, positive bronchial provocation testing, or peak expiratory flow rate variability associated with work exposure. We want to get serial PEFR at home AND at work to compare.

How do you treat occupational asthma?

Treatment usually includes avoidance of triggers (recommend change of workplace), use of bronchodilators and corticosteroids for inflammation management, desensitization (immunotherapy).

What indicates the presence of asthma based on spirometry?

FEV1/FVC < 70%.

How is reversible airway obstruction defined in asthma diagnosis?

At least 12% and 200 mL increase in FEV1 with inhaled bronchodilator (SABA) test.

What should be assessed if the methacholine bronchoprovocation test is positive?

Asthma is possible. If you have symptoms of wheezing, cough, dyspnea, chest tightness with methacholine.

Explain what group A of COPD means and how to treat this group.

Group A of COPD refers to patients with mild symptoms and a low risk of exacerbation. Treatment includes the use of short-acting bronchodilators (SAMA or SABA) as needed.

Explain what group B of COPD means and how to treat this group.

Group B of COPD refers to patients with moderate symptoms but a low risk of exacerbation. Treatment includes the use of LABA + LAMA.

Explain what group E of COPD means and how to treat this group.

Group E of COPD refers to patients with severe symptoms and high risk of exacerbations. If you have had 1+ exacerbations requiring hospitalization or 2+ exacerbations requiring outpatient systemic corticosteroids. Treatment includes LABA + LAMA ± ICS (ICS if eosinophils in blood > 300/mm³.

What BMI causes obesity hypoventilation syndrome?

BMI > or = 30 kg/m².

What is a crucial diagnostic characteristic of in obesity hypoventilation syndrome?

Awake daytime hypercapnia (PaCO2 > 45 mm Hg).

What testing is performed to confirm obesity hypoventilation syndrome?

ABG on room air. Restrictive pattern on PFTs. Polysomnography.

What can be a first-line therapy for obesity hypoventilation syndrome?

Nocturnal positive pressure ventilation. Weight loss (bariatric surgery in select cases).

What indicates the presence of morbid obesity affecting lung function?

Increased DLCO.

What does a lab value of eosinophilia suggest in COPD treatment?

Consider ICS if eosinophil count > 300/mm³.

What does assessment of dyspnea in COPD typically include?

Using validated instruments like the COPD Assessment Test.

What is the etiology of respiratory failure in obesity hypoventilation syndrome?

Hypoventilation leading to elevated CO2 levels.

What are the indications for bariatric surgery?

BMI 40+. BMI 35+ with comorbidities like DM, HTN, OSA, CV disease.