Figure-1: Normal flow volume

loop.
ABC=inspiratory part of the loop
(oval);
ACD=expiratory part of the loop
(triangular);
ABCD=muscle dependent part of
the loop;
DA=effort (muscle) independent
part of the loop;
AC=vital capacity;
CD=peak expiratory flow (PEFR).
Figure 2: Normal flow volume
loop.
MEF50=maximum expiratory
flow at 50% of VC;
MIF50=maximum inspiratory
flow at 50% VC;
VC=vital capacity;
TLC=total lung capacity;
RV=residual volume
 Obstructive Airway Disease
• Extra-thoracic obstruction
• Intra-thoracic obstruction
• Fixed Large Airway obstruction
• Peripheral Airway obstruction
 Variable Extra-thoracic Obstruction

Expiratory part of the F/V-

loop is normal
Obstruction pushed
outwards by the force of
the expiration
During inspiration the
obstruction is sucked into
the trachea with partial
obstruction and flattening
of the inspiratory part of
the flow-volume loop.
Goitre, Vocal-cord palsy, Tumour
Variable Intra-thoracic obstruction
A tumour located near the
intrathoracic part of the
trachea is sucked outwards
during inspiration (Normal
morphology of the
inspiratory part)
During expiration the
tumour is pushed into the
trachea with partial
obstruction and flattening
of the expiratory part

Intra-thoracic tumour
 Fixed Large Airway Obstruction

Intra-/Extra-thoracic
Eg. Tracheal stenosis
Peripheral Airway Obstruction

COPD
Asthma
 Restrictive Airway Disease

Fibrosis, Effusion
 Ventilation - Xenon 133
V/Q Scan Perfusion – Tc99
v/q > 1
 COPD
Consolidation

V/Q < 1
PE + COPD
Bronchoscopy

Rigid bronchoscope
• Rigid bronchoscopy
– retrieving foreign objects
– Controlling massive haemoptysis (elelctrocautary)
Flexible fiberoptic bronchoscope
(up to sub-segmental bronchi)
• Procedure
– Local anaesthesia (Rigid – general anaesthesia)
– Overnight starving (6hrs)
– IM atropine 0.6mg 30 min before
– IV sedation (midazolam/diazepam)
– Topical anaesthesia (lignocaine 2% gel ) to nose,
nasopharynx,
– 2ml Lignocaine (4%) instilled on to the vocal cords
– Moniter PR, SpO2 and BP
• Complications
– Bleeding after biopsy
– Pneumothorax
– Stridor (Laryngospasm)
– Arrythmias
 Skin Prick Testing

• Not affected by bronchodilators/steroids

• Stop anti-histamines 48hrs before
• 10min >= 3mm is regarded as positive (control should be negative)
Sleep Apnoea - Polysomnography
Central
 Tb
• Mantoux test
Tb Granuloma
Tb Granuloma
Non-Tb (Sarcoidosis)
AAFB in Ziehl-Neelsen Stain
A. Non Acid-fast bacteria B. Acid-fast bacteria
Sarcoidosis
• Punched-out lytic
lesions
• Lace-like destruction
• Bone stones (acro-
osteosclerosis)
• Bone destruction
with/without
pathologic fracture
• Acro-osteolysis
• Subperiosteal
resorption resembling
hyperparathyroidism
•
Broncho-alveolar Lavage
 Indication
• Pneumonia in immuno-compromised
• Pneumonia in ventilated
• Interstitial Lung Disease
Cryptococcus neoformans
e.g: IPF