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Cardiopulmonary Diagnostic (PFTs) > Final > Flashcards

Final Flashcards

1
Q

What are indications for PFT (4)

A
  • Diagnosis
  • Screening
  • Monitoring
  • Effects of medications and therapy
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2
Q

What do PFTs measure? (standard PFT)

A
  • Spirometry
  • Lung volumes
  • DLCO
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3
Q

What is the GOLD standard test for diagnosing obstructive lung diseases?

A

Spirometry

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4
Q

Lung volumes are used for diagnosing

A

restrictive lung diseases

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5
Q

DLCO is used to measure

A

gas exchange

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6
Q

PFT help classify lung diseases into 4 categories, what are they?

A
  • Obstructive (CBABE)
  • Restrictive
  • Mixed or combined lung diseases
  • Pulmonary vascular diseases
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7
Q

What are some specialized PFT

A
  • ABGS
  • 6-minute walk
  • peak flow
  • exercise oximetry
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8
Q

What is the maximal # of test on a basic PFT?

A

8

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9
Q

How should you prepare for a PFT?

A
  • No caffeine
  • No smoking
  • No large meals
  • No perfumes
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10
Q

Predicated values come from a national data base and are based on 4 demographics

A

HGAR

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11
Q

Height should be measured

A

W/o shoes

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12
Q

Weight is not an actually predicated value but should be included as it can be a variable info for Dr, in determining cause

A

something to know

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13
Q

PFT are __________ dependent

A

effort

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14
Q

Test must be ______________ and _____________

A

acceptable and replicateable

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15
Q

To get valid result that pt must be

A

coached

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16
Q

What are reasons for an invalid test (5)

A
  • not understanding
  • lack of coordination
  • poor effort
  • pain
  • coughing
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17
Q

What to do if you get invalid results? (5)

A
  • Try again
  • Reinstruct the pt
  • redemonstrate the manuver
  • Ask another RT
  • Make comments in pt report
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18
Q

If test is not replicable or within

A

Within 5% FVC, then it is not valid

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19
Q

Vital capacity can be

A

slow of forced

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20
Q

Slow vital capcity

A

measures the TOTAL VOLUME of air exhaled out of the lungs after a maximum inhalation (RELAXED)

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21
Q

Forced vital capacity

A

measures the TOTAL VOLUME of air out the lungs after a maximum inhalation (BLAST IT OUT)

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22
Q

_____ should NEVER be smaller than ____

A

SVC ;
FVC

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23
Q

What does it mean if SVC is smaller than FVC?

A

poor pt effort

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24
Q

What circumstance would you see the SVC larger?

A

obstruction

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25
Q

SVC is larger than FVC only during an obstruction (air trapping) such as (2)

A

emphysema or asthma

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26
Q

SVC the pt has

A

plenty of time to get the air out

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27
Q

FVC the pt has

A

limited time to get the air out

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28
Q

FEV1 is

A

forced expiratory volume over 1 second

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29
Q

When is FEV1 measured?

A

during FVC

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30
Q

FEV/FVC ratio defines

A

obstruction

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31
Q

FEV1 defines the

A

degree or severity of the obstruction

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32
Q

FEV/FVC ratio less than ___% predicated indicates an

A

75%
obstructive disease (CBABE)

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33
Q

FVC is normal/high (80%) you have an

A

obstruction only

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34
Q

FVC is low (<80%) you may have a

A

restrictive component (mixed)

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35
Q

FEV1 < 80% is used to determine the severity such as (5)

A
  • mild
  • moderate
  • moderately severe
  • severe
  • very severe
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36
Q

Mild

A

70-79%

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37
Q

Moderate

A

60-69%

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38
Q

Moderately severe

A

50-59%

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39
Q

Severe

A

35-49%

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40
Q

Very Severe

A

<35%

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41
Q

FEF 25%-75% reflects

A

abnormalities in the small airways

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42
Q

FEF 50% is the most accurate measure used to determine

A

pt effort

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43
Q

What is peak flow?

A

a maximal inspiration, followed by a maximal forced exhalation

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44
Q

Predicted values for peak flow are based on

A

HAG

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45
Q

Peak flow are used for

A

asthmatics

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46
Q

What is the ultimate goal for lung volumes?

A

To get the TLC

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47
Q

What is TLC

A

the volume of gas remaining in the lungs at the end of a maximal inspiration

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48
Q

What does an increased RV/ TLC ratio indicates

A

severe air trapping??

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49
Q

How do we measure Residual volume?

A

RV cannot be measured directly

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50
Q

What are the 3 methods to indirectly measure RV

A
  • Helium dilution
  • Nitrogen washout
  • Body plethysmography
51
Q

Multibreath Helium dilution needs a (4)

A
  • closed circuit
  • source of o2
  • helium analyzer
  • co2 and h2o absorbers
52
Q

The helium is diluted until

A

equilibrium is reached

53
Q

HE dilution is used to measure RV but it may……
especially in

A

underestimate lung volumes;
sick pts

54
Q

What can cause lung volumes to be overestimated?

A

leaks

55
Q

Multibreath nitrogen washout uses (4)

A
  • open circuit
  • pneumatchometer
  • nitrogen analyzer
  • 100% o2
56
Q

What is a pneumatchometer?

A

measures the flow of gases during breathing

57
Q

If there is a sudden spike or increase in the fall of N2, then you have

A

a leak

58
Q

If you have a leak you must

A

retest

59
Q

What are the 2 types of Body box

A
  • constant volume
  • flow based
60
Q

body box is based on who’s law?

A

Boyle’s

61
Q

Which one is the most accurate ?

A

Body box

62
Q

Changes in alveolar pressure is measured at the

A

mouth when the shutter is closed

63
Q

How many phases of exhalation are there?

A

4

64
Q

Phase 3 is the

A

plateau

65
Q

An increase in the slope of phase 3 means

A

uneven distribution

66
Q

When airway closure begins in phase 4 ___________ ___________ are measured

A

closing volumes

67
Q

We measure closing volumes to determine

A

closing capacity and is expressed as a % of TLC

68
Q

TLC=

A
  • IRV
  • VT
  • ERV
  • RV
69
Q

FRC=

A
  • ERV
  • RV
70
Q

IC=

A
  • IRV
  • VT
71
Q

VC=

A
  • IRV
  • VT
  • ERV
72
Q

Contraindications for PFT (4)

A
  • MI
  • Active bronchospasms
  • pneumothorax
  • cataract surgery
73
Q

If the FEV1/ FVC ratio is not available what do you look at next?

A

FVC

74
Q

High TLC and RV means

A

hyperinflantion

75
Q

High TLC and normal RV

A

Airtrapping

76
Q

How long to wait in between retesting N2 washout

A

15 mins

77
Q

How long to wait for He dilution

A

5 mins

78
Q

What gas does DLCO use? And why?

A

carbon monoxide because it binds to hb 210x more than 02

79
Q

What disease can cause DLCO to decrease

A

emphysema

80
Q

What disorder can cause DLCO to increase

A

polycythemia

81
Q

For DLCO how many test can you take

A

5 ( average 2 best test)

82
Q

If pt has a restrictive disease process we would look at the DLCO to determine if the restriction is

A

interstitial or extrastitial

83
Q

If DLCO is decreased in the presence of a restriction it usually means its cuased

A

interstitially

84
Q

If DLCO is normal in the presence of a restriction it means the pt has

A

normal lung function and the restriction is related to something outside the lungs

85
Q

Minute ventilation

A

VE= Vt x RR

86
Q

VE must be correlated w/

A

blood gases

87
Q

As body temp increases CO2 increases. What is the body’s natural response

A

take in larger volumes

88
Q

Hypoventilation
PCO2 and pH

A

PCO2 >45
pH <7.35

89
Q

Hyperventilation
PCO2 and pH

A

PCO2 <35
pH >7.45

90
Q

p100 is the pressure generated at the mouth

A

during the 1st 100 milliseconds of an inspiratory effort against an occluded airway

91
Q

Normal p100

A

1.5- 5 cm H20

92
Q

What is the bronchoprovocation challenge aka bronchial challenge?

A

Used to identify and characterize hyperresponsiveness in the airways

93
Q

The less gas it takes to evoke a negative response..

A

the more hyperreactive the airway is

94
Q

Methacholine challenge is inhaled by the pt in increasing doses

A

0.016 to 16 mg/mL and prepared in 2 to 4 fold dilutions

95
Q

The lower the dose needed to illicit a bronchospams

A

the more hyper responsive the airway is

96
Q

What is the timing for the Jones method

A

measures breath hold from 0.3 of the inspiratory time to the midpoint of the alveolar sample

97
Q

What does the maximum voluntary measure? (3)

A
  • Resistance
  • lung compliance
  • respiratory muscle strength
98
Q

What are examples of bronchoprovocation (3)

A
  • methacholine challenge
  • histamine challenge
  • exercise challenge
99
Q

Does the methacholine challenge evoke a bronchospasms indirectly or directly

A

directly
(exercise challenge evokes a bronchospasm indirectly)

100
Q

What is PC20

A

The point in which there is 20% decrease in FEV1

101
Q

What is the formula for Vt?

A

VT= MV/RR

102
Q

What is the Severghaus electrode used for?

A

PaCO2

103
Q

What does the Clark electrode used for?

A

PaO2

104
Q

What is the. Sanz electrode used for?

A

pH

105
Q

What are the 5 types of flow sensors?

A
  • Turbine
  • Pressure-differential
  • Heated wire
  • Pitot flow flow sensors
  • Ultrasonic flow sensors
106
Q

What is the most popular flow sensor

A
  • turbine (the Wright’s Respirometer)
107
Q

How many turbines does the turbine flow sensor have

A

5

108
Q

Which electrode is polarographic and needs a polarized voltage

A

Clark electrode

109
Q

The Clark electrode is good for _________ testing

A

exercise

110
Q

Define steady state

A

When HR remains constant for 1 minute

111
Q

How to determine max HR?

A

220- age

112
Q

What is VO2 max?

A

the minimum rate of oxygen consumption during incremental exercise (maximum aerobic capacity)

113
Q

Will VO2 max be higher on the treadmill or on the cycle ergometer? Why?

A

Treadmill b/c you are exerting more energy and the body is consuming more O2 that it needs

114
Q

What is the Borg scle

A

Perceived exertion (the pt perception) on how hard they feel they are working

115
Q

How often is workload increased using the borg scale?

A

every 3 minutes

116
Q

How do you increase workload on the treadmil

A

change the speed and slope of walking

117
Q

How do you increase workload on the cycle ergometer

A

Adjust the resistance of the pedals and frequency (rpms)

118
Q

Where should you instruct the pt to keep their hands during the treadmill test

A

The pt should relax w/ their hands resting on the side rails slightly above their body in front of them

119
Q

What are 3 ancillary groups for rehab

A
  • Better breathers (COPD)
  • Harmonic (COPD)
  • Quest for breath (for idiopathic CF)
120
Q

How does a pt get into pulmonary rehab

A
  • must have a referral to rehab program from dr
  • PFTs/ABG/SpO2 (must be done)
  • smoking history
  • H&P
  • current meds
  • commitment to the program
  • Transportation/ financial resources
  • negative pulmonary stress
121
Q

If spirometry values (FEV1, FVC, FEV1/FVC ratio) what would be the first value to look to determine obstruction or restrriction

A

FEV1/ FVC ratio

122
Q

If FEV1/ FVC ratio is not availble, what should you look at next?

A

FVC

123
Q

If you only have lung volumes (RV, TLC, FRC, RV/TLC ratio, etc.) where should you start to rule out obstruction or restriction

A

RV/TLC ratio

Cardiopulmonary Diagnostic (PFTs) (6 decks)

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