3/13 Lecture (NOT DONE)

Question 1

The Nitrogen washout test is easy to do but is dependent on what?

Answer 1

how even the ventilation is happening in the lungs in general

Question 2

Sick lungs have a problem with even distribution of ________.

Answer 2

ventilation

Question 3

Flow Volume Loops

FVL show both inspiration and expiration, but we are most interested in ________ curve.

Answer 3

Maximal Peak Expiratory Force

Question 4

We will see theses or derivatives of this pulmonary function test in clinical because they are very common according to Dr. Schmidt

Answer 4

Flow Volume Loop

Question 5

Flow Volume Loop

What is maximal peak expiratory flow?

What is FVC?

Answer 5

PEF measures the speed or flow rate of air during the initial phase of a forced expiration. It gives us an idea of how fast air can be expelled from the lungs but doesn’t tell us about the total volume of air exhaled.

FVC measures the total volume of air that can be forcibly exhaled after taking a deep breath, regardless of the speed of exhalation.

Question 6

Flow Volume Loop

T/F: These loops are useful and we are typically looking at the Forced Vital Capacity

Answer 6

True

Question 7

Flow Volume Loops

Peak expiratory flow rate will be ________ if we have a lung issue

Answer 7

lower

Question 8

Flow Volume Loops

Restrictive diseases have ________ lung volumes and there is ________ elastic tissue

Answer 8

low; excess

Question 9

Flow Volume Loops

Lung volume is related to what?

Answer 9

Airway resistance

Question 10

A lung that is emptier than normal will make the small airways a lot more ________. Because the small airways are more ________, it’s easier to ________ them which limits the ________.

Answer 10

narrow; narrow; compress; expiratory flow rate

Question 11

T/F: For obstructive diseases, if we force an expiration using a lot of effort, this effort will be useful early on to get some air out of the lung, and it will come out at a normal
pace.

Answer 11

F

the air it will not come out at a normal
pace; it will be much slower

Question 12

To get air out of the lungs we rely on 2 things:

Answer 12

1. A change in pleural pressure
2. Recoil of the lung to help push air out of the lungs

Question 13

How do we know if a breath is passive or forced?

Answer 13

If P_IP is negative.

If it’s negative, this is NOT a forced breath

Question 14

What force is holding the airways open?

Answer 14

• 8 mmHg

Question 15

What areas of the respiratory tract have cartilage?

Answer 15

The upper respiratory tract and conducting zone

Question 16

The small airways ability to stay open is entirely dependent on what 2 things?

Answer 16

the pressure inside the small airway and the pressure in the environment (the pleural pressure)

Question 17

What are some things that can predispose airways to collapse?

Answer 17

• Narrow airways: increase likelihood of collapse because the walls are much closer together
• Low lung volumes
• Asthma

Question 18

More elastic tissue (springs) = ________ recoil

Answer 18

more

Question 19

T/F: Less elastic tissue = less recoil, resulting in a more compliant lung.

Answer 19

T

This is what happens with emphysema patients

Question 20

The springy tissue of the alveoli also provides ________ on the small airways, helping to keep them open.

Answer 20

traction

Question 21

In COPD, especially emphysema, there is a loss of ________ and ________, leading to difficulty in expelling air
from the lungs.

Answer 21

elastic recoil; airway traction

Question 22

Does having more “springs” or elastic tissue around the airway make it easier or harder to collapse?

Answer 22

Harder to collapse (assuming the airway diameter is
normal)

A thicker wall would be harder to compress

Question 23

The number one factor in getting air out of the lungs is having sufficient ________ in the lung tissue.Without this, it becomes hard to fully expel air and replace it with fresh air.

Answer 23

elastic recoil

Question 24

What are the 3 types of obstructions that can be seen on a Flow Volume Loop?

Answer 24

1. Fixed Obstruction (Intra or Extrathoracic)
2. Variable Intrathoracic Obstruction
3. Variable Extrathoracic Obstruction

Question 25

A good example of a fixed obstruction would be an ________.

Answer 25

endotracheal tube

Question 26

T/F: Regardless of the tube size, the inner lumen of an endotracheal tube will generally be narrower than the trachea

Answer 26

T

Question 27

If you put a smaller diameter tube (like an ETT tube) in the trachea, why would this cause increased airway resistance? What type of flow volume loop obstruction is this describing and how would it affect the appears of the flow volume loop?

Answer 27

The smaller diameter leads to higher resistance, making it harder to get air in or out of the lungs. This obstruction affects both inspiration and expiration. This is a fixed obstruction (intra and extrathoracic). The flow-volume loop will be cut off at the top (expiration) and the bottom (inspiration) due to upper airway resistance, limiting the rate of airflow.

Question 28

What does **intra**-thoracic mean?

Answer 28

lower down or within the chest

Question 29

What does **extra**-thoracic mean?

Answer 29

above or outside the chest

Question 30

A fixed obstruction is fixed because it affects both ________ and ________ throughout the respiratory cycle.

Answer 30

inspiration and expiration

Question 31

This type of obstruction only affects expiration only, inside the chest.

Answer 31

Variable intrathoracic obstruction

Question 32

With a variable extra-thoracic obstriction, negative pressure during inspiration can cause ____________ to collapse if they are not supported properly.

Answer 32

upper airways

Question 33

With a variable intra-thoracic obstruction, during expiration, the pressure inside the chest becomes positive, which may lead to ________________ if the small airways aren’t robust, lack support, traction, or elastic recoil

Answer 33

airway collapse

Question 34

Negative pressure during inspiration can pull the ________________ together, obstructing the airway.

Answer 34

vocal cords

Question 35

With variable extra-thoracic obstruction, on expiration, the obstruction is pushed out of the way due to _________________.

Answer 35

positive airway pressure

Question 36

If a patient with a variable extra-thoracic obstruction is on a mechanical ventilator, the positive pressure from the ventilator will push the obstruction out of the way during inspiration or expirtation?

Answer 36

inspiration

Question 37

What is an example of a variable extrathoracic obstruction?

Answer 37

Paralyzed vocal cords, tracheal tumor, goiter, etc anything that obstructs airflow **outside** of the chest

Question 38

What is an example of a variable extrathoracic obstruction?

Answer 38

COPD, asthma anything that obstructs airflow **in side** of the chest

Question 39

What does FEV₁ stand for?

Answer 39

forced expiratory volume in 1 second (volume you can get out of the lungs using maximal effort in 1 second)

Question 40

What does FVC stand for?

Answer 40

a vital capacity that is being forced out from TLC

Question 41

If you are healthy, you should be able to move ________ of your ________ out of the lungs within a period of 1 second during maximal (effort) forced expiration. This is about ________ L.

Answer 41

80%; vital capacity; 3.6 L

Question 42

If you are healthy, you move < 80% of your vital capacity out of the lungs within a period of 1 second during maximal (effort) forced expiration, what does this mean?

Answer 42

Something is wrong with your lungs

Question 43

What is a normal FVC in liters?

Answer 43

4.5 L

Question 43

How long should it take to empty the lungs all the way down to RV from TLC in a normal, healthy patient?

Answer 43

8 seconds [ADD PICTURE]

Question 44

What is a normal FEV₁ in liters?

Answer 44

3.5 L

Question 45

If the FEV₁ / FVC ratio is < 70%, what lung disease does this indicate?

Answer 45

Obstructive lung disease

Question 46

If the FEV₁ / FVC ratio is > 70%, what lung disease does this indicate?

Answer 46

Normal lungs or restrictive lung disease

Question 47

A patient comes in for pulmonary function testing, what is the first test that is run and why?

Answer 47

Flow volume loop, because it is cheap and easy

Question 48

What is the partial pressure difference of nitrogen between apex and the base of the lung?

Answer 48

Trick question, there should not be a major difference

Question 49

What is the partial pressure of alveolar/lung nitrogen?

Answer 49

569 mmHg

Question 50

# Closing Capacity Test During Phase 3, expired air is primarily coming from what part of the lung?

Answer 50

base of the lung

Question 51

# Closing Capacity The base of the lung has ________, N₂ dilution compared to the top of the long

Answer 51

more

Question 52

# Closing Capacity Test As the lung move towards lower volumes, the ___________ of the lung gets emptier, we should expect more expired air to come from the ___________ of the lung

Answer 52

base ; apex

Question 53

# Closing Capacity Why isn't Phase 3 flat?

Answer 53

Initially, air is coming from the BASE of the lu ng and as Phase 3 progresses, air starts to come from the APEX of the lung. This mixture of air coming from different parts of the lung is why Phase 3 isn't flat.

Question 54

# Closing Capacity Where is air coming from in Phase 3?

Answer 54

A mixture of air from all parts of the lung Beginning of Phase 3 = air is coming from the base of the lung End of Phase 3 = air is coming from the apex of the lung

Question 55

# Closing Capacity