Respiratory system: Restrictive diseases have all reduced volumes and capacities.

Decreased FEV1, dec FVC, FEV1/FVC normal or high. Vital capacity is max inspiration followed by max expiration. Problem in restrictive disease involves inhaling. VC is reduced in obstructive diseases, as you can max inhale but cannot max exhale. Decrease FEV1( forced expiratory volume in 1 sec). FEV1/FVC is decreased in obstructive diseases. Therefore, RV increases. TLC increases in obstructive diseases. Obstructive disease have problem with getting air out of lungs. eg. Emphysema and Chronic Bronchitis(COPD). Increase in

AP diameter of chest(barrel chest). FEV 25-75%(mid max expiratory flow) is used to differentiate obstructive and restrictive. It is reduced in pt with obstructive disease. Residual volume inc in obstructive and dec in restrictive(as all volumes dec in restrictive diseases). In diseases of alveolar capillary membrane(e.g.. Adult respiratory distress syndrome, Emphysema) dec oxygen, inc CO2 leading to acidosis. DLCO(diffusion of lung carbon monoxide) if it is dec think of Emphysema. In chronic bronchitis, alveolar membrane is intact. Simple way to measure gas exchange at alveolar capillary membrane is by Aleolararterial(A-a) O2 gradient.

Send ABGs, find value of PH, PCO2,PO2(80mmHg) Alveolar O2 @ room temp = 150-1.2(PC02) eg. pco2=40 Therefore, Alveolar O2=102 For A-a. 102-80= 18. Normal A-a is 515mmHg. Solitary Pulmonary nodule. Is a nodule less than 6cm on CXR. If greater than 6cm, it is a pulmonary mass. If nodule is found in young, non smoker and less than 6cm, repeat cxr 3 months/2yr. if no change it is a benign lesion. Types of calcification in a pulmonary nodule. PET scan is more sensitive to pick calcification in a nodule than CXR. pop-corn calcification: in Hemartomas( mixed epithelial cell tumor)

central calcification or Bull's eye: granulomas(TB) eccentric calcification: Malignacy( go for biopsy). If pt is older and smoker and you find a solitary nodule go for biopsy. Pleural Effusion: costophrenic angle is obliterated. Earliest sign in Pleural Effusion. Approx 300cc fluid is required to obliterate costophrenic angle. If you find obliterated angle on CXR, do decubitus CXR( on lying down on side of effusion). Fluid will move to dependant part of lung. Go for Thoracocentesis. More the effusion, safer is the thoracocentesis. if no fluid and you put a needle in it. it will cause pneumthorax. Look for LDH( normal 200) and pleural

proteins to classify effusions. Classify all pleural effusion based on whether they are Transudate or Exudate. Transudate caused by system diseases. Eg. Congestive Heart Failure due to inc pressure. or dec oncotic pressure(e.g., nephrosis, cirrhosis). dec LDH, dec proteins in both pleural fluid and serum. Exudate is caused by pulmonary diseases in which pleura becomes leaky like CA, TB and pulmonary embolus( transudate or exudate), pneumonia, infections. If pleural fluid becomes infectious(complicated) you need to drain effusion with chest tube to prevent scarring of the lung. Signs of complicated pleural fluid- dec ph(acidic), pus(empyema), gram stain showing polymorph, dec glucose in

fluid. e.g., para pneumonic effusion. Atelectasis: collapse of part of lung. within 24-48hrs of post-op. caused by pain medications and anaesthesia that would impair cough reflex and poor inspiration. Also due to non surgery related cases like CA, Foreign body. S/S: tachycadia, dyspnea. Tracheal deviation toward the lesion. treatment. Incentive spirometry.