Exam 2 Pulmonary

Question 1

Indications for PFT, Spirometry, DLCO

Answer 1

1. airway fx
2. lung volume
3. diffusion capacity

Question 2

indications for ABG, DLCO, ventilation perfusion scan

Answer 2

gas exchange

Question 3

PFT/Spirometry Goal

Answer 3

Ultimately two FEV1’s and FVC’s within 200ml and 5% of each other

Question 4

pft/ spirometry technique

Answer 4

Sit up straight
Seal nares
Fully seal mouthpiece
Maximal inspiration without coughing or hesitation
Blast out expiration “forced” a minimum of 6 seconds up to 15 seconds
Repeated until three acceptable flow volume loops obtained
Never allow more than 8 blows (risk of passing out, blowing off all CO2)

Question 5

Forced vital capacity aka FVC

Answer 5

total amount of air expelled in 6 sec

reflects how well pt took deep breath in and out

Question 6

Healthy FEV1

Answer 6

70-80% first second

Question 7

forced expiratory volume 1 sec (FEV1)

Answer 7

assess airway obstruction

Question 8

what age does FEV1 decline

Answer 8

30-35 ml/yr in healthy non smokers

Question 9

what helps calculate predicted values for pft

Answer 9

ht
age
gender
face

Question 10

restriction pattern on pft

Answer 10

sharp peaked appearance
prevents full lung expansion

decreased FVC with normal or above FEV1/FVC ratio

Question 11

restriction pattern FEV1/FVC ratio

Answer 11

FEV1/FVC ratio > 70%

Question 12

diseases with restriction on pft

Answer 12

Parenchymal lung disease/chest wall disease

IPF/ILD, Kyphoscoliosis, polio, ALS, morbid Obesity (anything that effects chest wall)

Question 13

obstruction pattern on pft

Answer 13

scoop appearance

Airflow reduced airways narrow, air trapping
FEV1↓ ** ↓ FEV1/FVC ratio <70%

dt narrowing of airways, dt air trapping

Question 14

diseases with obstruction on pft

Answer 14

copd

asthma

Question 15

Quantify Severity of Illness

Spirometry: FEV1 % Predicted Gold guidelines

Answer 15

GOLD 1: Mild >/= 80%

GOLD 2: Moderate 50-79%

GOLD 3: Severe 30-49%

GOLD 4: Very Severe < 30%

Question 16

post bronchodilator - pft

what is considered reversible flow

Answer 16

15% or more and 200ml increase in FEV1 or FVC

Question 17

diffusion capacity Is done why

Answer 17

Done to assess ability of gas (oxygen) to cross membrane (alveoli) into the blood stream

Question 18

Decreased diffusion reported as DLCO in (examples)

Answer 18

COPD
ILD/Pulmonary fibrosis 
Obesity Hypoventilation Syndrome
Severe Emphysema
Interstitial Pneumonitis
Sarcoidosis

Question 19

when does diffusion capacity begin to correlate with need for o2 at night typically

Answer 19

when diffusion capacity starts to reach 40-50

will need overnight pox to assess o2 need at night

Question 20

O2 testing and qualifying with ABG or room air test

Answer 20

PO2<55% or SAO2 88% or below

Question 21

o2 testing and qualifications with pt with chf/cor pulmonale with documented edema

Answer 21

PO2 55% or below or SAO2 89% or below (1% difference from norm)

Question 22

continuous nocturnal pox recording that qualifies o2 need

Answer 22

Total of 5 minutes or more NON CONSECUTIVE with pox 88% or below or 89% or below for CHF as above.

Question 23

respiratory failure - 2 types

Answer 23

type 1 hypoxic

type 2 hypercapnic

Question 24

type 1 hypoxic RF

Answer 24

PaO2 < 60 (might not have ABG)
PCO2 normal
Disorder of oxygenation

Question 25

type 2 hypercapnic HF

Answer 25

PaCO2 > 50
When we know pt has chronically elvated CO2, they can be considered mixed or just hypercapnic
PaO2 < 60 or has been corrected and PCO2 remains elevated

Question 26

Oxygen content is dependent on what

Answer 26

hgb concentration and hgb/o2 saturation

Question 27

pox is what

Answer 27

estimate of percentage of oxygenated hgb in blood in infra-red spectra

+/- 3 accuracy

Question 28

pao2 defines

Answer 28

measures oxygen tension not content

part of abg

Question 29

pco2 is measurement of what

Answer 29

ventilation, what we exhale off when breathing

Question 30

6 minute o2 test, respiratory problem

Answer 30

Drop of 5% or more in oxygen saturation

Question 31

6 min o2 test, excessive HR response with no fall in o2 level indicates

Answer 31

deconditioning

cardiac problem

Question 32

ph value

Answer 32

7.35-7.45

Question 33

pco2

Answer 33

35-45

Question 34

po2

Answer 34

70-100

Question 35

hco3

Answer 35

23-38

Question 36

increased pco2

Answer 36

alkaline condition

Question 37

decreased pco2

Answer 37

acidic condition

Question 38

po2 value means

Answer 38

oxygen tension

Question 39

hco3 increase

Answer 39

alkaline

Question 40

hco3 decrease

Answer 40

acidic