2020–2021 BCSC Basic and Clinical Science Course™
1 Update on General Medicine
Chapter 7: Pulmonary Diseases
Evaluation
Although all patients with respiratory problems should be under the care of a capable internist or pulmonologist, ophthalmologists and other physicians should be aware of the key components in the diagnosis and evaluation of patients with pulmonary diseases. The following should be considered:
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Symptoms: Dyspnea, orthopnea, chronic cough, and chronic sputum production.
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History: Occupational exposure to various toxins and irritants, family history, cigarette use.
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Signs: Audible wheezing, cyanosis, finger clubbing, forced expiratory time greater than 4 seconds, increased anteroposterior diameter of the chest.
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Laboratory studies: Elevated hematocrit level and hypoxia or hypercapnia on arterial blood gas measurement.
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Chest radiography: Parenchymal disease, hyperinflation, diaphragmatic flattening, increased retrosternal lucency, and pleural abnormalities.
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Computed tomography of the chest: Can detect many abnormalities not seen on chest radiographs, such as small areas of adenopathy, pulmonary embolus, small nodules, infiltrative lung disease, and bronchiectasis.
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Bronchoscopy, transbronchial biopsy, and bronchial lavage: Used to obtain culture material, cytology material, and pathologic specimens for analysis.
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Pulmonary function tests: Measure the mechanical and gas exchange functions of the lungs. The forced expiratory volume over 1 second (FEV1) represents the volume exhaled in the first second of exhalation; the forced vital capacity (FVC) represents the total volume that the patient can exhale. Both parameters and their serial rate of decline in a patient are objective measures of lung function as well as predictors of comorbidity and mortality from lung cancer and cardiovascular disease. An FEV1/FVC ratio less than 70% of predicted reference values suggests obstructive disease; total lung capacity less than 70% of predicted values suggests restrictive disease.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.