Module Overview & Exam Review
High-yield Pulmonary Diagnostics I review built from the RESC 2340 fill-in guide: spirometry, lung volumes, DLCO, bronchoprovocation, CPX, bronchoscopy, and sleep studies.
Pulmonary Diagnostics I
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Spirometry Setup and ATS
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PFT machine is calibrated daily with a syringe.
Before spirometry/post-bronchodilator testing, the patient should avoid taking a when ordered.
During the forced vital capacity maneuver, the patient is .
Patient information used for predicted values includes age, , , , and smoking history.
ATS-quality spirometry requires acceptable efforts and reproducibility.
The course source phrases this as repeat until 3 efforts meet acceptability and reproducibility criteria.
Minimum exhalation time: healthy adults/patients >=10 years seconds; children <=10 years seconds.
You have attempts to get good spirometry tests.
LLN to ULN means .
Less than LLN means ; greater than ULN means .
FVC percent predicted grading: >80% , 66-79% , 50-65% , <50% .
The handout visual appears to show 66-69%, but the course source table gives 66-79%.
FEV1 is the best spirometry value to grade severity.
FEV1/FVC is low in patients; >100% or >ULN suggests ; <70% suggests disease.
FEV1/FVC ratio guide: about is normal in adults; can be healthy in older patients.
FEF25%-75% evaluates flow in the airways.
PEFR means .
Reversibility math
Post-Bronchodilator and MVV
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Pre/post bronchodilator testing determines of airway obstruction.
A post-bronchodilator study can assess need for additional meds and diagnose .
ATS protocol in the source uses puffs by MDI.
Recommended wait before post-spirometry is .
Significant reversibility is FEV1 or FVC increase of > and mL.
Percent change formula: .
MVV is performed for seconds at breaths per minute.
TLC, RV, FRC
Lung Volumes and Patterns
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Lung volume equipment: spirometer, He analyzer, N2 analyzer, and .
Body plethysmography is based on law.
Body plethysmography computes and is used to compute .
Body plethysmography is the quickest and most accurate method for determining .
Body box panting frequency is bpm.
Restriction by TLC: TLC <LLN but >=70% , TLC <70% but >=60% , TLC <59% .
FRC >ULN with TLC normal means ; FRC and TLC >ULN means .
Pattern snapshot: restriction causes ; obstruction with air trapping causes .
Key formulas: RV = ; TLC = or .
Gas studies
N2 Washout, He Dilution, and DLCO
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N2 washout uses % O2, with risk for depression of hypoxic drive in CO2 retainers.
N2 washout lasts up to minutes or until exhaled N2 is <%.
Helium dilution uses a known volume with % He.
Helium dilution requires a absorber, usually .
Before DLCO, the patient should not the day of the test to reduce levels in blood.
Before DLCO, the patient should be off supplemental O2 for .
DLCO maneuver: exhale to , inhale rapidly to , hold seconds.
DLCO requires a minimum of tests; wait minutes between trials.
DLCO severity: LLN-ULN , 60%-LLN , 40-60% , <40% .
Challenge tests
Bronchoprovocation and CPX
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Methacholine challenge repeats spirometry looking for a significant decrease in .
Methacholine begins after verifying post-diluent did not drop by >=10%.
Do not perform methacholine challenge in patients or if severe obstruction is present.
Methacholine is indicated when history/symptoms suggest but PFTs are inconclusive.
FEV1 must be at least predicted to start methacholine.
If FEV1 drops % from baseline after NaCl/saline, the test is and .
If FEV1 drops from baseline after methacholine dose, the test is and .
EIA/EIB prep: avoid heavy exercise hours prior; baseline FEV1 at least predicted.
EIA/EIB exercise target is of predicted max HR for minutes.
EIA/EIB positive response is sustained FEV1 decrease of .
CPX assesses/measures , , and during exercise.
CPX contraindications include limiting neuro/neuromuscular or orthopedic disorders, PaO2 <, PaCO2 > on room air.
CPX gas analyzers measure exhaled , , and .
CPX prep: comfortable clothing, no smoking hours prior, and no the day of the test.
Indications and hazards
Bronchoscopy
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Therapeutic bronchoscopy: removal of , aspiration/removal of thick , localized , and selective such as BAL.
Diagnostic bronchoscopy: suspicion of carcinoma, symptoms, hemoptysis, and positive sputum findings.
Relative contraindications include inability to cooperate, tracheal obstruction, uncontrolled , instability, and moderate-severe .
Absolute contraindications: no signed , no experienced , no emergency , inability to adequately .
and account for most deaths associated with bronchoscopy.
Most common route is ; mouth route requires a .
During bronchoscopy, monitor for topical anesthesia toxicity, , and cardiac .
Know the table
Sleep Studies and PAP
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PSG is the overnight study for definitive diagnosis of .
OSA has effort but no due to upper airway obstruction; CSA is no signal for respiratory effort.
PSG equipment/signals include EEG, EOG, chin EMG, ECG, airflow, ventilatory effort, and .
Overnight pulse oximetry checks effectiveness of and may trigger a study if desaturations persist.
HST is used to diagnose with a portable device about the size of a .
Actigraphy monitors rest/activity cycles by of a limb for a week or more.
MSLT helps diagnose and ; it uses naps with -hour breaks.
MSLT nap trial ends if the patient does not fall asleep within minutes.
MWT measures how a patient is; it uses sleep trials with -hour breaks.
MWT trial ends if the patient does not fall asleep within minutes.
AHI ratings: <5 , 5-15 , 15-30 , >30 .
CPAP is first-line for ; BiPAP uses separate pressures for and .
Auto-CPAP adjusts based on monitoring of , , and .
For PAP therapy, patient and are key to successful treatment.