Pulmonary function testing

You look at the chart and you can tell if you have the lab numbers to meet the listings.

And so to get into that a little bit more specifically, I think the most common one that I see is the FEV1 or spirometry testing.

So essentially it's the breath test.

You go in, you blow, and they measure how much forced air you can exhale.

So we establish the diagnosis, which can be established multiple ways.

Sometimes it's based on symptoms that you provide to the doctor, but usually it's going to be based on some level of objective testing.

It may not be the full spirometry testing that we have with – a full COPD case.

There are other breathing-based tests that they can use.

So remember, before you start a person on amiodarone, it's probably helpful to get PFT.

It's like baseline, um, periodic PFTs, LFTs, and, uh, and TFTs, right? And then, uh, what if they give you a question about a patient and they tell you that this patient, um, is started on a class I antiarrhythmic, you know, for some class Ia antiarrhythmic for some kind of arrhythmia, right? And then, uh, you're told, uh, prior to initiating pharmacotherapy, which of the following is the most appropriate next step in management? Well, remember, um, uh, class Ia antiarrhythmics, right? They, uh, the-these are, uh, drugs like, uh, quinidine, right? Um, these are drugs like quinidine, right? I know you may be like, "There's no way they test these things on exams." No, they definitely do test them on exams.

And the thing is, they're sodium channel blockers, right? So they're gonna basically slow down depolarization of, uh, of your cardiac myocytes, right? So the thing is, if you slow down depolarization, um, you can certainly get into trouble with, uh, prolonging the QT interval, right? Prolonging the QT interval, right? Prolonging the QT interval.

So you should get a baseline EKG before you start these drugs, right? Monitor these people's QT interval.

Almost no myelosuppression, right? In fact, again, our friends at the NBMEs, they know that many of you have memorized that bleomycin causes pulmonary fibrosis, right? So what is the way they will go about this exact same question these days on the USMLE exams? They'll say prior to initiating therapy, right? Or they'll say which of the following is the most appropriate next step in management.

Uh, go ahead and get PFTs.

Go ahead and get PFTs.

Go ahead and get pulmonary function testing, right? And again, try to limit the cumulative dose because again, as I've said-- I said this in the previous podcast, many of these chemotherapeutic drugs, the way they cause issues for people is the accumulative dose.

The cumulative dose over time is what causes problems.

[laughs] 'Cause, you know, sometimes the patients will come to our specialty clinic and report that they failed everything, all biologics.

They're like, "None of them worked." And you can't find PFTs anywhere.

You can't find PROs.

You can't find labs.