Podcast
Questions and Answers
A patient presents with a decade-long chronic cough and increasing dyspnea upon exertion over the last two years. Their cough produces small amounts of clear mucus. They have a 70 pack-year smoking history, but quit two years ago. Examination reveals a blood pressure of 160/85, a heart rate of 96 bpm, and a respiratory rate of 20. Auscultation reveals coarse breath sounds and end-expiratory wheezes. Which diagnostic study is MOST appropriate first step for this patient?
A patient presents with a decade-long chronic cough and increasing dyspnea upon exertion over the last two years. Their cough produces small amounts of clear mucus. They have a 70 pack-year smoking history, but quit two years ago. Examination reveals a blood pressure of 160/85, a heart rate of 96 bpm, and a respiratory rate of 20. Auscultation reveals coarse breath sounds and end-expiratory wheezes. Which diagnostic study is MOST appropriate first step for this patient?
- Spirometry (correct)
- CXR (AP and lateral)
- Spiral Chest CT scan
- V/Q scan
Which of the following is LEAST likely to be an indication for performing pulmonary function tests (PFTs)?
Which of the following is LEAST likely to be an indication for performing pulmonary function tests (PFTs)?
- Detecting the presence of pulmonary disease
- Determining the etiology of a newly discovered lung mass (correct)
- Assessing the severity or progression of existing lung disease
- Risk stratification of patients prior to surgical procedures
Which condition is a contraindication for performing spirometry due to the risk of exacerbating the patient's condition?
Which condition is a contraindication for performing spirometry due to the risk of exacerbating the patient's condition?
- Controlled hypertension
- Remote history of deep vein thrombosis
- Stable asthma
- Recent eye surgery (correct)
What is the MOST common sequence of pulmonary function tests performed to evaluate a patient's respiratory status?
What is the MOST common sequence of pulmonary function tests performed to evaluate a patient's respiratory status?
Which of the following pulmonary parameters CANNOT be directly measured by spirometry?
Which of the following pulmonary parameters CANNOT be directly measured by spirometry?
In the context of spirometry interpretation, an FEV1/FVC ratio above 80% of the predicted value typically suggests what?
In the context of spirometry interpretation, an FEV1/FVC ratio above 80% of the predicted value typically suggests what?
A patient's spirometry results show a significantly reduced FVC with a normal FEV1/FVC ratio. Which of the following underlying conditions is MOST consistent with these findings?
A patient's spirometry results show a significantly reduced FVC with a normal FEV1/FVC ratio. Which of the following underlying conditions is MOST consistent with these findings?
Following administration of a bronchodilator, a patient demonstrates a 15% improvement in FEV1 and a 12% improvement in FVC from baseline. However, their symptoms persist. Which of the following interpretations is MOST accurate?
Following administration of a bronchodilator, a patient demonstrates a 15% improvement in FEV1 and a 12% improvement in FVC from baseline. However, their symptoms persist. Which of the following interpretations is MOST accurate?
Which lung volume represents the amount of air inhaled or exhaled during a typical breath at rest?
Which lung volume represents the amount of air inhaled or exhaled during a typical breath at rest?
Forced Vital Capacity (FVC) is best described as the:
Forced Vital Capacity (FVC) is best described as the:
Inspiratory Capacity (IC) is calculated as the sum of which two lung volumes?
Inspiratory Capacity (IC) is calculated as the sum of which two lung volumes?
The FEV1/FVC ratio is a clinically significant value in spirometry. What physiological parameter does this ratio primarily reflect?
The FEV1/FVC ratio is a clinically significant value in spirometry. What physiological parameter does this ratio primarily reflect?
Functional Residual Capacity (FRC) and Residual Volume (RV) both describe air remaining in the lungs. What is the key distinction between these two measurements?
Functional Residual Capacity (FRC) and Residual Volume (RV) both describe air remaining in the lungs. What is the key distinction between these two measurements?
FEF25-75% assesses airflow during which portion of the Forced Vital Capacity (FVC) maneuver?
FEF25-75% assesses airflow during which portion of the Forced Vital Capacity (FVC) maneuver?
Vital Capacity (VC) and Total Lung Capacity (TLC) both represent maximal lung volumes. However, Vital Capacity is uniquely defined as the:
Vital Capacity (VC) and Total Lung Capacity (TLC) both represent maximal lung volumes. However, Vital Capacity is uniquely defined as the:
Forced Vital Capacity (FVC) and Vital Capacity (VC) both measure the total exhaled volume after maximal inhalation. What is the primary methodological distinction between these two measurements?
Forced Vital Capacity (FVC) and Vital Capacity (VC) both measure the total exhaled volume after maximal inhalation. What is the primary methodological distinction between these two measurements?
Which lung volume is MOST directly affected by a condition that impairs the ability to fully expand the chest wall, such as severe kyphoscoliosis?
Which lung volume is MOST directly affected by a condition that impairs the ability to fully expand the chest wall, such as severe kyphoscoliosis?
A patient with advanced emphysema struggles to initiate exhalation. Which of the following values would be MOST indicative of this?
A patient with advanced emphysema struggles to initiate exhalation. Which of the following values would be MOST indicative of this?
If a patient has a decreased FEV1, and their FVC remains normal, which calculation would be MOST helpful in assessing if they have an obstructive lung disease?
If a patient has a decreased FEV1, and their FVC remains normal, which calculation would be MOST helpful in assessing if they have an obstructive lung disease?
A scientist discovers a new drug that selectively enhances the contraction of expiratory muscles without affecting inspiratory muscles. Which of the following pulmonary function parameters would be MOST affected?
A scientist discovers a new drug that selectively enhances the contraction of expiratory muscles without affecting inspiratory muscles. Which of the following pulmonary function parameters would be MOST affected?
In a patient with a restrictive lung disease, such as pulmonary fibrosis, which of the following changes in lung volumes and capacities is MOST likely?
In a patient with a restrictive lung disease, such as pulmonary fibrosis, which of the following changes in lung volumes and capacities is MOST likely?
A patient presents with a significantly reduced FEV1 but a normal FVC. Which of the following follow-up tests would BEST help determine the cause of this result?
A patient presents with a significantly reduced FEV1 but a normal FVC. Which of the following follow-up tests would BEST help determine the cause of this result?
Which of the following scenarios would MOST directly lead to an increase in a patient's Functional Residual Capacity (FRC)?
Which of the following scenarios would MOST directly lead to an increase in a patient's Functional Residual Capacity (FRC)?
A researcher is studying a novel drug that aims to simultaneously increase both FEV1 and FVC in patients with chronic bronchitis. Which specific mechanism of action would be MOST likely to achieve this outcome?
A researcher is studying a novel drug that aims to simultaneously increase both FEV1 and FVC in patients with chronic bronchitis. Which specific mechanism of action would be MOST likely to achieve this outcome?
A patient presents with a chronic cough productive of scant clear mucus, dyspnea on exertion, and a 70 pack-year smoking history. Auscultation reveals coarse breath sounds and end-expiratory wheezes. What is the MOST likely underlying mechanism causing the end-expiratory wheezes?
A patient presents with a chronic cough productive of scant clear mucus, dyspnea on exertion, and a 70 pack-year smoking history. Auscultation reveals coarse breath sounds and end-expiratory wheezes. What is the MOST likely underlying mechanism causing the end-expiratory wheezes?
Which scenario would be an ABSOLUTE contraindication to performing spirometry?
Which scenario would be an ABSOLUTE contraindication to performing spirometry?
Following spirometry, a patient's FEV1/FVC ratio is calculated to be 65%. What does this suggest, and what additional measurement would BEST help classify the specific type of ventilatory defect?
Following spirometry, a patient's FEV1/FVC ratio is calculated to be 65%. What does this suggest, and what additional measurement would BEST help classify the specific type of ventilatory defect?
A patient with suspected interstitial lung disease undergoes spirometry. Which pattern of results would be MOST consistent with this diagnosis?
A patient with suspected interstitial lung disease undergoes spirometry. Which pattern of results would be MOST consistent with this diagnosis?
A patient with known COPD undergoes spirometry before and after bronchodilator administration. Which change in FEV1 would be considered a 'significant' bronchodilator response according to standardized criteria?
A patient with known COPD undergoes spirometry before and after bronchodilator administration. Which change in FEV1 would be considered a 'significant' bronchodilator response according to standardized criteria?
Which of the following is the MOST direct physiological interpretation of a reduced DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)?
Which of the following is the MOST direct physiological interpretation of a reduced DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)?
A researcher hypothesizes that long-term exposure to particulate matter causes a disproportionate reduction in mid-expiratory flow rates. Which spirometric value would be MOST sensitive in detecting this specific effect?
A researcher hypothesizes that long-term exposure to particulate matter causes a disproportionate reduction in mid-expiratory flow rates. Which spirometric value would be MOST sensitive in detecting this specific effect?
A patient with severe emphysema undergoes pulmonary function testing. Which of the following spirometric patterns, combined with lung volume measurements, would be MOST consistent with advanced emphysema?
A patient with severe emphysema undergoes pulmonary function testing. Which of the following spirometric patterns, combined with lung volume measurements, would be MOST consistent with advanced emphysema?
A 62-year-old female presents with progressive shortness of breath over the past year. Pulmonary function test (PFT) results show:
• FVC: 3.8 L (60% predicted)
• FEV1: 2.9 L (76% predicted)
• FEV1/FVC: 82%
Which of the following best describes the patient's pulmonary pattern?
A 62-year-old female presents with progressive shortness of breath over the past year. Pulmonary function test (PFT) results show: • FVC: 3.8 L (60% predicted) • FEV1: 2.9 L (76% predicted) • FEV1/FVC: 82% Which of the following best describes the patient's pulmonary pattern?
A 55-year-old male with a recent diagnosis of unstable angina presents for spirometry testing. Which of the following represents the primary reason spirometry is contraindicated in this patient?
A 55-year-old male with a recent diagnosis of unstable angina presents for spirometry testing. Which of the following represents the primary reason spirometry is contraindicated in this patient?
A PFT report shows the following results:
• FVC: 4.5 L (70% predicted)
• FEV1: 2.3 L (48% predicted)
• FEV1/FVC: 51%
According to the American Thoracic Society guidelines, how would this patient's COPD severity be classified?
A PFT report shows the following results: • FVC: 4.5 L (70% predicted) • FEV1: 2.3 L (48% predicted) • FEV1/FVC: 51% According to the American Thoracic Society guidelines, how would this patient's COPD severity be classified?
Which of the following conditions is least likely to present with a decreased DLCO?
Which of the following conditions is least likely to present with a decreased DLCO?
Which of the following lung volumes or capacities cannot be directly measured using spirometry?
Which of the following lung volumes or capacities cannot be directly measured using spirometry?
A 34-year-old woman undergoes a methacholine challenge test. Her FEV1 decreases by 22% after exposure. What is the most likely diagnosis?
A 34-year-old woman undergoes a methacholine challenge test. Her FEV1 decreases by 22% after exposure. What is the most likely diagnosis?
A 45-year-old male presents with progressive dyspnea and a non-productive cough. PFT results show:
• FVC: 3.2 L (70% predicted)
• FEV1: 2.8 L (82% predicted)
• FEV1/FVC: 88%
• DLCO: 52% of predicted
Which of the following is the most likely diagnosis?
A 45-year-old male presents with progressive dyspnea and a non-productive cough. PFT results show: • FVC: 3.2 L (70% predicted) • FEV1: 2.8 L (82% predicted) • FEV1/FVC: 88% • DLCO: 52% of predicted Which of the following is the most likely diagnosis?
A 28-year-old female presents with episodic wheezing and shortness of breath. Spirometry shows:
• Pre-bronchodilator FEV1: 2.1 L (70% predicted)
• Post-bronchodilator FEV1: 2.8 L (93% predicted)
Which of the following best describes this pattern?
A 28-year-old female presents with episodic wheezing and shortness of breath. Spirometry shows: • Pre-bronchodilator FEV1: 2.1 L (70% predicted) • Post-bronchodilator FEV1: 2.8 L (93% predicted) Which of the following best describes this pattern?
A 52-year-old male smoker presents with a chronic cough. PFT results:
• FVC: 4.1 L (75% predicted)
• FEV1: 2.5 L (62% predicted)
• FEV1/FVC: 61%
How should this pattern be classified?
A 52-year-old male smoker presents with a chronic cough. PFT results: • FVC: 4.1 L (75% predicted) • FEV1: 2.5 L (62% predicted) • FEV1/FVC: 61% How should this pattern be classified?
Which of the following patterns is most likely associated with an obstructive lung disease?
Which of the following patterns is most likely associated with an obstructive lung disease?
Which of the following diseases is most likely to present with a normal or increased DLCO?
Which of the following diseases is most likely to present with a normal or increased DLCO?
A 40-year-old male with a history of chronic bronchitis undergoes spirometry with bronchodilator testing. His post-bronchodilator FEV1 improves by 10% and 180 mL. What is the clinical significance of this result?
A 40-year-old male with a history of chronic bronchitis undergoes spirometry with bronchodilator testing. His post-bronchodilator FEV1 improves by 10% and 180 mL. What is the clinical significance of this result?
A patient presents with the following PFT results:
• FVC: 4.2 L (65% predicted)
• FEV1: 2.2 L (50% predicted)
• FEV1/FVC: 72%
• DLCO: 40% predicted
Which pattern is most likely?
A patient presents with the following PFT results: • FVC: 4.2 L (65% predicted) • FEV1: 2.2 L (50% predicted) • FEV1/FVC: 72% • DLCO: 40% predicted Which pattern is most likely?
Which of the following findings would NOT be expected in a patient with moderate obstructive lung disease?
Which of the following findings would NOT be expected in a patient with moderate obstructive lung disease?
A 55-year-old patient with pulmonary hypertension undergoes a DLCO test. Which of the following results is expected?
A 55-year-old patient with pulmonary hypertension undergoes a DLCO test. Which of the following results is expected?
A 53-year-old male presents with progressive dyspnea. PFT results show:
• FVC: 68% predicted
• FEV1: 70% predicted
• FEV1/FVC: 85%
Which of the following is the most likely diagnosis?
A 53-year-old male presents with progressive dyspnea. PFT results show: • FVC: 68% predicted • FEV1: 70% predicted • FEV1/FVC: 85% Which of the following is the most likely diagnosis?
Which of the following is a contraindication to performing spirometry?
Which of the following is a contraindication to performing spirometry?
A 64-year-old smoker presents with chronic cough and dyspnea. PFT results show:
• FEV1/FVC: 65%
• FEV1: 55% predicted
According to the American Thoracic Society guidelines, what is the severity of this patient's COPD?
A 64-year-old smoker presents with chronic cough and dyspnea. PFT results show: • FEV1/FVC: 65% • FEV1: 55% predicted According to the American Thoracic Society guidelines, what is the severity of this patient's COPD?
Which of the following lung volumes cannot be directly measured by spirometry?
Which of the following lung volumes cannot be directly measured by spirometry?
Which of the following patterns is characteristic of obstructive lung disease?
Which of the following patterns is characteristic of obstructive lung disease?
A patient with suspected asthma undergoes a methacholine challenge test. Which of the following results would be considered positive?
A patient with suspected asthma undergoes a methacholine challenge test. Which of the following results would be considered positive?
A 50-year-old female presents with progressive shortness of breath. PFT results:
• FVC: 3.5 L (55% predicted)
• FEV1/FVC: 83%
How would you classify the severity of her restrictive lung disease?
A 50-year-old female presents with progressive shortness of breath. PFT results: • FVC: 3.5 L (55% predicted) • FEV1/FVC: 83% How would you classify the severity of her restrictive lung disease?
Which of the following conditions is associated with a decreased DLCO?
Which of the following conditions is associated with a decreased DLCO?
A patient presents with mild dyspnea. Spirometry results show:
• FVC: 81% predicted
• FEV1: 76% predicted
• FEV1/FVC: 78%
What is the most likely diagnosis?
A patient presents with mild dyspnea. Spirometry results show: • FVC: 81% predicted • FEV1: 76% predicted • FEV1/FVC: 78% What is the most likely diagnosis?
Which of the following is considered a normal FEV1/FVC ratio in adults?
Which of the following is considered a normal FEV1/FVC ratio in adults?
Which of the following flow-volume loop findings is characteristic of obstructive lung disease?
Which of the following flow-volume loop findings is characteristic of obstructive lung disease?
A 55 y/o male presents with a chronic cough for the past 10 years and progressive dyspnea with exertion for the past 2 years. The cough is productive of scant clear mucous at times. He has a 70 pack/year tobacco use history and quit smoking cigarettes approximately 2 years ago. Physical examination reveals a blood pressure of 160/85, heart rate 96 bpm, and a respiration rate of 20. On auscultation he has course breath sounds and end-expiratory wheezes throughout the lung fields. What is the best diagnostic study in this patient?
A 55 y/o male presents with a chronic cough for the past 10 years and progressive dyspnea with exertion for the past 2 years. The cough is productive of scant clear mucous at times. He has a 70 pack/year tobacco use history and quit smoking cigarettes approximately 2 years ago. Physical examination reveals a blood pressure of 160/85, heart rate 96 bpm, and a respiration rate of 20. On auscultation he has course breath sounds and end-expiratory wheezes throughout the lung fields. What is the best diagnostic study in this patient?
Forced Vital Capacity (FVC) is the volume of air forcefully expired from partial inflation (FRC) in the first second
Forced Vital Capacity (FVC) is the volume of air forcefully expired from partial inflation (FRC) in the first second
Normal people can exhale more than 75-80% of their FVC in the first second; therefore decreases in the FEV1/FVC can be used to characterize obstructive lung disease.
Normal people can exhale more than 75-80% of their FVC in the first second; therefore decreases in the FEV1/FVC can be used to characterize obstructive lung disease.
A patient's spirometry results show FEV1/FVC <70%, FEV1 >80% predicted. According to the American Thoracic Society SEVERITY COPD Staging, which is the correct classification for the patient?
A patient's spirometry results show FEV1/FVC <70%, FEV1 >80% predicted. According to the American Thoracic Society SEVERITY COPD Staging, which is the correct classification for the patient?
What does DLCO measure?
What does DLCO measure?
Significant bronchodilator response should have an increase in FEV1 of ____ % and Absolute increase of ____ ml
Significant bronchodilator response should have an increase in FEV1 of ____ % and Absolute increase of ____ ml
Flashcards
Tidal Volume (VT)
Tidal Volume (VT)
Volume of air inhaled or exhaled during each respiratory cycle.
Inspiratory Reserve Volume (IRV)
Inspiratory Reserve Volume (IRV)
The maximal volume of air inhaled from end-inspiration.
Inspiratory Capacity (IC)
Inspiratory Capacity (IC)
The maximal volume of air that can be inhaled from the resting expiratory level.
Functional Residual Capacity (FRC)
Functional Residual Capacity (FRC)
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Expiratory Reserve Volume (ERV)
Expiratory Reserve Volume (ERV)
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Residual Volume (RV)
Residual Volume (RV)
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Forced Vital Capacity (FVC)
Forced Vital Capacity (FVC)
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Forced Expiratory Volume in one second (FEV1)
Forced Expiratory Volume in one second (FEV1)
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Pulmonary Function Tests (PFTs)
Pulmonary Function Tests (PFTs)
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Contraindications for PFTs
Contraindications for PFTs
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Common PFT Order
Common PFT Order
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FEV1 (Forced Expiratory Volume in 1 second)
FEV1 (Forced Expiratory Volume in 1 second)
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FVC (Forced Vital Capacity)
FVC (Forced Vital Capacity)
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FEV1/FVC Ratio
FEV1/FVC Ratio
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FEV1/FVC Significance
FEV1/FVC Significance
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% Diffusing capacity of the Lung
% Diffusing capacity of the Lung
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Chronic Cough
Chronic Cough
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Progressive Dyspnea
Progressive Dyspnea
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Pulmonary Function Tests (PFTs) indications
Pulmonary Function Tests (PFTs) indications
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PFTs Contraindications
PFTs Contraindications
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Spirometry
Spirometry
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Obstructive lung disease
Obstructive lung disease
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Restrictive lung disease
Restrictive lung disease
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Inspiratory Reserve Volume
Inspiratory Reserve Volume
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Inspiratory Capacity
Inspiratory Capacity
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Functional Residual Capacity
Functional Residual Capacity
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FEV1
FEV1
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FEV1/FVC Ratio Significance
FEV1/FVC Ratio Significance
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Indications of Restrictive Lung Disease
Indications of Restrictive Lung Disease
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Moderate Restrictive Lung Disease
Moderate Restrictive Lung Disease
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Increased Intrathoracic Pressure
Increased Intrathoracic Pressure
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Spirometry Risk with Unstable Angina
Spirometry Risk with Unstable Angina
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Unstable Angina and Spirometry
Unstable Angina and Spirometry
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Obstructive Lung Disease Confirmation
Obstructive Lung Disease Confirmation
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Severe COPD
Severe COPD
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COPD Diagnosis
COPD Diagnosis
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Pulmonary Function
Pulmonary Function
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Risk with COPD
Risk with COPD
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Pulmonary Hygiene
Pulmonary Hygiene
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FEV1 Key Value
FEV1 Key Value
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FVC Key Value
FVC Key Value
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Lung health
Lung health
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Obstructive diagnosis
Obstructive diagnosis
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Study Notes
Clinical Presentation
- A 55-year-old male presents with a 10-year history of chronic cough and a 2-year history of progressive dyspnea with exertion.
- The cough occasionally produces scant clear mucus.
- The patient smoked for 70 pack-years and quit approximately 2 years prior.
- Physical examination indicates a blood pressure of 160/85, a heart rate of 96 bpm, and a respiration rate of 20.
- Auscultation reveals coarse breath sounds and end-expiratory wheezes throughout the lung fields.
Lung volumes
- Functional Residual Capacity (FRC) cannot be measured by spirometry, as it involves residual volume (RV).
- The closest measure to a normal lung is FVC.
Forced Vital Capacity (FVC)
- < 80% suggests restrictive lung disease.
Obstructive Pattern
- An FEV1/FVC ratio of <70% indicates obstruction.
DLCO (diffusing capacity of lung for carbon monoxide)
- Asthma typically presents with a normal Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO).
Spirometry Cases
- Case 4: Both mixed obstructive and restrictive lung disease, but not COPD.
- Case 5: Asthma is indicated by improvement on spirometry post bronchodilator.
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