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20 Cards in this Set

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Utility of bronchoscopy
Mainly used for biopsy and BAL.

Sarcoidosis (remember ddx of noncaseating granuloma)
Infections/PCP
ILD
Utility of CT/HRCT
ILD
Bronchiectasis
emphysema
UIP will have characteristic finding

CT showing >1 cm mediastinal nodes are suspicious for cancer
utility of sprial ct
Pulmonary embolism
Cancer
Utility of open lung biopsy
Pulmonary fribrosis (IPF)
DDx- hypersensitivity pneumonitis, BOOP, LAM
Utility of MRI
tumor invasion to diaphragm or chest wall (apices)
Superior sulcus
Brachial plexus
Vascular/tumor differentiation
Mass lesion of pleura
Paraspinal masses
Utility of PET
Tissue glucose uptake and measure of metabolic activity
Compete with blood glucose
False positive-
fungal, mycobacterial, sarcoidosis
False negative-
bronchoalveolar cancer, lesions less than 1 cm, elevated plasma glucose
Used to evaluate discrete mass > 1cm with pretest probability of low to mod
PFT in emphysema
RV increased (TLC).
Decreased VC.
FEV1 reduced.
FVC normal.
FEV1/FVC ratio decreased.
DLCO variable
Concave flow loop with prolonged expiration.
PFT in restrictive disease
TLC decreased
FEV1 reduced.
FVC reduced.
FEV1/FVC normal or increased.
PFT in restrictive and obstuctive
RV normal
TLC normal
DLCO decreased
example- pulmonary fibrosis and emphysema.
Fixed obstruction on PFT
Compressive tumors.
Tracheal stenosis (prolonged intubation)
Dynamic obstruction on PFT
extrathoracic- tracheomalacia and vocal cord paralysis (inspiatory problem)
intrathoracic- endobronchial tumor, foreign body (expiratory problem)
Response to B2 agonist on PFT.
FEV1 or FVC by 12% and 200ml.
Hold B2 agonist 6-8 hours and theophylline 12-24 hours before test.
Decrease in DLCO
lung surgery
emphysema
ILD
anemia will reduce DLCO and should be corrected for.
pulmonary hypertension
Increase in DLCO
Think increase in blood flow.
pulmonary edema
alveolar hemorrhage
polycythemia
***asthma (normal or increaed)
Methacholine challenge test
20% fall in FEV1.
Preop evaluation from pulmonary standpoint.
Use when surgery is in proximity to diaphragm, there is underlying mod to severe lung disease, pneumonectomy.
ABG- look for elevated PCO2
PFT- look for FEV1 < 1 lit
Preop hypoxemia and CO2 retention is bad sign.
Predicted post op FEV1 of <40% is high risk (or preop FEV1 <80%)
Use qunatitative lung scan to see how much lung is actually participating in respiration.
PFT in chronic bronchitis
concave flow volume
TLC normal or increased
VC normal or decreased
DLCO normal or decreased
PFT in asthma
concave flow volume
TLC normal or increased
VC normal or decreased
DLCO normal or increased
Response to bronchodilator.
PFT in ILD
Mild reduction in expiratory flows.
Straight or convex curve.
Proportional reduction in all lung volumes.
DLCO decreased.
Restrictive pattern.
Interpreting PFT
1. look at curve
2. look at number (>80 %)
look at TLC, FEV1, FVC, FEV1/FVC ratio
3. DLCO
(proportionate or not?)
not- think intrathoracic
yes- think extrathoracic
4. Revesibility- asthma