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RC Test 2 > B4.037 Evaluating Pulmonary Function Tests > Flashcards

B4.037 Evaluating Pulmonary Function Tests Flashcards

1
Q

what are some indications for pulmonary function testing

A 
screening
evaluation of a respiratory symptom or sign
grading severity of disease
following progression of disease
monitoring response to therapy
monitoring occupational, drug or radiation toxicity
predicting prognosis
predicting post-operative pulmonary risk
assessing disability/impairment
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2
Q

what is the basic function of spirometry

A

measures how fast and how much air you breathe out

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3
Q

what are the 3 ATS acceptability criteria for FVC

A

good start of test
smooth continuous curve
satisfactory exhalation

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4
Q

what is the optimal amount of exhalation

A

10 s

minimum of 6 s

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5
Q

what are the ATS reproducibility criteria?

A

after 3 acceptable maneuvers, if the 2 largest FEV1 are within 150 mL and the 2 largest FVC are within 150 mL, the session is complete

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6
Q

if you can’t meet the reproducibility criteria, what should you do?

A

continue until both criteria are met OR
a total of 8 trials OR
the subject cannot or should not continue

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7
Q

what should be features of the final spirometry report

A

FEV1 and FVC should be the largest from any acceptable trial (not necessarily the same)
“best test” curve should come from the trial with the largest sum of FEV1 and FVC

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8
Q

hesitating start

A

small peak in the middle of initial upward trend

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9
Q

submaximal effort

A

less steep and less tall curve

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10
Q

rainbow curve

A

less steep and less tall curve, slightly more rounded out than submaximal effort
normal in young, non-smoking females

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11
Q

early termination

A

sudden vertical drop in downward trend

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12
Q

coughing

A

sharp spikes in trend line

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13
Q

subject briefly stopped exhaling

A

flow momentarily hits zero and then goes back to where it should be

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14
Q

“knee”

A

downward trend initially flat-ish and then gets steeper

normal in young, non-smokers

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15
Q

low TLC

A

restrictive process

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16
Q

low FEV1/FVC

A

obstructive process

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17
Q

what is the gas dilution method used for

A

measurement of lung volume

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18
Q

how is the gas dilution method done

A

nitrogen washout and helium dilution

takes advantage of inert, poorly soluble gas of known concentration

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19
Q

downsides of gas dilution method

A

unable to measure gas in poor communication with airways

cannot be immediately repeated

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20
Q

what is plethysmography used for

A

measurement of lung volume

21
Q

what does the lung volume measured by plethysmography/gas dilution correspond to?

A

FRC; end expiration point on the spirogram
so
TLC = FRC + IC

22
Q

normal predicted range of FEV1, as % of predicted

A

80-120%

23
Q

normal predicted range of FVC, as % of predicted

A

80-120%

24
Q

normal predicted range of FEV1/FVC, as % of predicted

A

+/- 0.05 of predicted ratio

25
Q

normal predicted range of TLC, as % of predicted

A

80-120%

26
Q

normal predicted range of FRC, as % of predicted

A

75-120%

27
Q

normal predicted range of RV, as % of predicted

A

75-120%

28
Q

normal predicted range of DLCO, as % of predicted

A

75-120%

29
Q

what is an obstructive pulmonary defect

A

disproportionate reduction of max airflow from the lung with respect to the FVC that can be displaced from the lung
indicates EXPIRATORY airflow limitation

30
Q

cutoff for chronic obstructive lung disease FEV1/FVC

A

< 0.7

31
Q

causes of obstructive pulmonary defect

A 
asthma
COPD
bronchiectasis
obliterative bronchiolitis
lymphangioleiomyomatosis (LAM)
diffuse panbronchiolitis
32
Q

what is a restrictive pulmonary defect

A

characterizes by a reduction in TLC below the 5th percentile of normal distribution
possible indictor when FVC is reduced by FEV1/FVC is normal or increased

33
Q

what is a pseudorestriction

A

reduced FVC
normal FEV1/FVC
normal TLC

34
Q

what are some causes of restrictive defects within the lungs

A 
resection
atelectasis
stiff lung
CHF
thickened pleura
tumor
35
Q

what are some causes of restrictive defects within the pleural cavity

A

effusion
enlarged heart
tumor

36
Q

what are some causes of restrictive defects within the chest wall

A 
scleroderma
ascites
pregnancy
obesity
kyphoscoliosis
splinting due to back pain
37
Q

what are some causes of restrictive defects within the muscle

A

neuromuscular disease
old polio
paralyzed diaphragm

38
Q

what is a bronchodilator response

A

when flow volume loops improve after administration of a bronchodilator
>12% and 200 mL increase in FEV1 or FVC

39
Q

extrathoracic airway obstruction

A

above suprasternal notch

40
Q

intrathoracic airway obstruction

A

between suprasternal notch and carina

41
Q

variable airway obstruction

A

lesion narrow and decreases flow excessively during one phase of respiration

42
Q

fixed airway obstruction

A

narrowing causes decreased flow equally during both phases of respiration

43
Q

variable extrathoracic lesions

A

vocal chord paralysis or dysfunction
tracheomalacia
goiter

44
Q

variable intrathoracic lesions

A

tracheomalacia
malignant tracheal lesions
tracheal stricture

45
Q

fixed lesions

A

tracheal stenosis
vocal chord paralysis
vocal chord malignancy

46
Q

what is the DLCO

A

single breath carbon monoxide diffusing capacity

normal = 30 mL CO/min/mmHg

47
Q

how is DLCO measured

A

from RV, inhale low concentration CO plus inert/insoluble gas to TLC
10 second breath hold then exhale completely
exhaled gas analyzed for CO to calculate DLCO

48
Q

what are some reasons for a decreased DLCO

A 
Valsalva maneuver
pulmonary resection
emphysema
insterstitial lung disease
pulmonary vascular disease
pregnancy
CO
smoking
anemia

RC Test 2 (17 decks)

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