finalquiz.pft Flashcards
1
Q
How do we measure indirect volumes?
A
Performing a SVC maneuver
2
Q
respirometers measure _______ & reports the results in ________
A
flow
volume
3
Q
Peak flow meters measures flow & reports in _______.
A
Flow
4
Q
Name the 5 purposes for PFT testing?
A
Identification (detect disease) quantification (evaluate need) Epidemiological (identifies pulmonary abnormalities from environment or occupational risk screening Post Op Risk Pulmonary disability Therapeutic Effectiveness
5
Q
Name 5 volumes that can be measured directly?
A
Vt, IRV, ERV, IC, VC
6
Q
T or F: Tidal volume has great variation & may abnormal readings are always indicative of disease.
A
False, Vt is not indactative of disease due to great variance
7
Q
What is an average Vt?
A
500 - 700 mL
8
Q
This value is part of normal breathing, is consistent at resting, you would exhale maximally to obtain reading of this expiratory level?
A
ERV
9
Q
If you tell a patient to take a maximal inspiration followed by a maximal exhalation without force you would be looking to get what type of measurement?
A
SVC
10
Q
The SVC will provide important volumes used to determine ________ disease.
A
Restrictive disease
11
Q
Maximum volume of air inspired following normal inspiration but is not clinically significant, obtained from SVC
A
IRV
12
Q
A normal exhalation, when you inhale maximally is describing:
A
IC
13
Q
T or F: there is great variation with IC
A
True
14
Q
This value can be measured on inspiration or expiration?
A
VC
15
Q
Name 5 things that can be provided with a VC maneuver
A
VT, IRV, ERV, IC, VC
16
Q
This evaluates lungs ability to move large volumes quickly?
A
Pulmonary Mechanics
17
Q
The FVC will provide important flow rates used to determine ________ disease>
A
Obstructive
18
Q
Pulmonary Mechanics uses _____ maneuver to obtain results.
A
FVC maneuver
19
Q
When an FVC is performed your exhalation needs to last longer than ______ seconds. If it cannot be completed in ______ seconds this indicates obstruction.
A
6 seconds, 3 seconds
20
Q
FVC should equal _______.
A
SVC
21
Q
FVC can measure what 5 items?
A
FVC, FEV1, PEFR, FEF 200-1200, FEF25-75
22
Q
This measurement is sometimes used to evaluate asthmatic patients pre & post bronchodilation, is seen on flow volume graph as the highest point.
A
PEFR
23
Q
What is a normal value for PEFR?
A
600 l/min
24
Q
T or F: PEFR may appear normal in abnormal patients & is also effort dependent?
A
True
25
Decreased values in this measurement is associated with large airway obstruction?
Forced expiratory flow 200-1200
26
_______ is the best indicator of obstructive disease.
FEV1
27
T or F: Largest FEV1 is not always largest FVC
True
28
This measurement is associated with small airway obstruction?
Small airway obstruction
29
This value is the FEV for a given interval expressed as a % of a FVC
FEV/FVC ratio
30
A decreased ratio of FEV1/FVC is indicative of _______ disease.
Obstructive disease
31
A ratio of less than ______ % is indicative of obstructive disease.
70%
32
A ratio of greater than 70% is indicative of _______ or ______ lungs
Normal or restrictive
33
The flow volume loop measures _________ and _______ rates of FVC
Flow Volume Loop
34
Flow per time is measured on the ______ axis & volume is measured on the ________ axis on a flow volume curve.
Flow per time is measured on vertical axis & volume is measured on horizontal axis.
35
___________ is measured on top part of line & _________ is measured below the base line.
expiration;
| inspiration
36
If you have a flow volume loop that is scooped out this may represent _______ disease; if you see a skinny and tall loop you may have ________ disease.
Obstructive
| Restrictive
37
Fixed obstruction causes:
A. Decrease in inspiratory flow rates only
B. Decrease in expiratory flow rates only
C. Normal flow rates when measured directly
D. Equal decreases in both expiratory & inspiratory flow rates.
D. Equal decreases in both expiratory & inspiratory flow rates
38
If you have a flattened flow volume loop on the expiration side this would indicate what type of obstruction?
Intrathoracic variable large airway obstruction or fixed large airway obstruction
39
If you see a relatively normal expiratory flow curve but a small volume, flattened curve on inspiration you probably have what type of obstruction?
Extrathoracic variable large airway obstruction
40
If you have a flow volume loop that looks flattened & smaller on both inspiration & expiration you probably have?
Fixed large airway obstruction
41
When you are testing for reversibility of an obstructive pattern you would need to see an increase of more than _______% following application of bronchodilator.
15%
42
When a PFT test is performed how long should a patient refrain from using their bronchodilator before testing occurs?
8 hours prior to testing
43
What test is used to look for a reactive airway? It is called _________ or __________
Bronchial provocation or methacholine challenge
44
What value should be seen in order to see a positive result in the methacholine challenge?
It is a 20% decrease in FEV1
45
When given this test you would instruct the patient to breathe in & out as fast as possible until told to stop; normally performed in 12-15 seconds often in a panting maneuver?
Maximum voluntary ventilation
46
What type of measurements is gold standard for diagnosing restrictive condition?
Lung Volume
47
If you needed to obtain a height on a person who is a double amputee how would you find it?
Measure finger to finger to approximate weight
48
PD20% represents:
A 20% decrease in FEV1
49
This measurement can gives us a picture of a patients muscular mechanics?
Max Voluntary ventilation
50
What method of drug administration is used to administer the methacholine challenge?
Nebulizer or dosimeter
51
The largest volume & rate that can be breathed per minute by voluntary effort is _____________.
Maximum voluntary ventilation
52
The predicted values for evaluation of PFT is based on what 3 factors?
Age, height, sex
53
If you test positive on the PD20% which means you have a decrease of 20% in your fev1 you probably have ___________ airways.
Reactive airways
54
Pulmonary mechanics is looking at ________ of a person.
Airflow
55
What are some reasons a person may have poor or decreased MVV measurements? 5 reasons
```
Obstructive disease
Airway resistance
muscle weakness
decreased compliance
poor patient effort
```
56
The MVV measures the amount of air moved within _________ seconds.
12-15 seconds
57
Name 3 things measured in PFT tests.
Lung volumes/capacities
Flow rates
Gas diffusion
58
What is the scale used to interpret normal vs abnormal results? Measured in percentages
80-100% = normal pft
60-79% of predicted = mild disorder
40-59% of predicted = moderate disorder
40% of predicted = severe disorder
59
If you have a patient with these values how would you diagnose him/her?
56 year old female
FVC = predicted (5.10); Observed (3.30); % predicted = 64.7%
FEV1 = Predicted (3.83); Observed (3.18); % predicted = 83%
FEV1/FVC % = Predicted 75%; Observed 96%
Volume (FVC) decreased 65% of predicted
FEV1 are normal (83% of predicted)
Since the FEV1 is normal no obstructive problem is identified but since FVC volume is decreased the patient appears to have a mild restrictive problem
DX: Mild Restrictive only
60
```
How would you diagnose this patient?
48 year old man:
FVC = 81.9% of predicted
FEV1= 44.6% of predicted
FEV1/FVC % = 41%
```
```
Volume (FVC) is normal when above 80% which would indicate no restrictive problem
The flows (FEV1) are decreased 44% of predicted so there appears to be a moderate obstructive problem
```
DX: Moderate obstructive only
61
If a patient is testing for an obstructive condition what is the next study that should be done?
Post bronchodilator study to see if obstruction is reversible
62
T or F: RV can be measured directly.
False; RV cannot be directly measured
63
In order to obtain a measurement for FRC & TLC you also must measure ________
RV
64
Name 3 tests or ways you can measure FRC?
Helium dilution
Nitrogen Washout
Body Plethysmography
65
The nitrogen washout method or N2 is a open/closed method of obtaining FRC?
Open Method
66
How is FRC measured with the Nitrogen Washout method, explain the process & what other gases if any may be used.
FRC is washed out of the lung by having the patient inspire 100% O2; The washout FRC goes into a colleting spirometer & is measured to calculate the FRC
67
A N2 washout of ________ minutes indicates normal lungs whereas a time that is greater than ________ indicates poor distribution.
2-3 minutes = normal
| > 7 minutes = poor distribution
68
If you have a leak in your system during the N2 or nitrogen washout test what happens to your FRC?
FRC is artificially raised
69
```
When performing the ___________ test for measuring FRC you are looking at the distribution of air trapping in the lungs.
A. Nitrogen Washout
B. He Dilution
C. Body Plethysmography
D. Calibration
```
A. Nitrogen Washout
70
T or F: When you are calibrating a gas analyzer which is used to confirm standards of PFT testing you must calibrate analyzers on same gas that is used in the test?
True
71
This is the resting volume left in the lungs when you do not inhale or exhale; it can be the volume left after a quiet exhale
FRC
72
T or F: Weight never affects a predicted value in PFT testing
True
73
T or F: Lung size may change if a patient is profoundly obese due to the restrictive area left in the cavity.
False
74
What is normal value for FEV1/FVC?
Our value is 72%
75
T or F: The FEF 200-1200 is a vital component of the PFT testing for us to measure flow and thus obstruction.
False, Peak flow will tell us same thing so don't really need; it is an indicator for large airways
76
What measurement may be good for classification for pulmonary and/or occupational purposes?
FVC
77
During PFT testing what is the maximum parameter or time that can be measured during exhalation.
15 seconds
78
When performing PFT testing for SVC & VC the tests should start within _______ ml of each other.
.2mL
79
If you increase FRC what will happen to the alveoli in the lungs?
The alveoli will stay open longer period of time so the IC & Vt will lower
80
T or F: The values of RV & FRC cannot be manipulated or changed in lungs.
False, RV & FRC can be raised in certain lungs
81
What type of maneuver can be done to improve oxygenation?
Peep maneuver
82
What flow level must be met in order for an MDI to work effectively?
60 lpm
83
Name the 6 characteristics or principles that must be applied to flow or volume equipment.
```
Capacity
Accuracy
Error
Linearity
Output
```
84
Name 3 examples of volume measuring devices.
1. Water sealed spirometers/stead wells that measure volume & time (Stead Wells, Water Sealed Collins)
2. Dry Rolling Seal (pistons with rolling diaphragm)
3. Bellows spirometer
85
Flow measuring devices are known as _______.
Pneumotachometers
86
Name 5 types of pneumotachometers or flow measuring devices.
Turbine device - Wright Respirometer (turbinometers);
Fleisch which measures pressure differential or resistance
Thermal- flow cooled
ultra sonic-signal disrupted by change
Peak Flow Meters
87
What is the formula to find Vt if you have I time & flow?
Vt= Flow X I time
88
T or F: Flow can be converted to volume when using some flow measuring equipment
True
89
What is a normal value on the Peak Flow Meter
600 lpm
90
When using _________ to measure flow repeatability is more important than accuracy and its reproducibility should be within 0.67 l/sec or 40 lpm
Peak Flow Meters
91
What do you call a principle of pulmonary function testing in which the accuracy of the measurement exists over its entire range of measurement?
linearity
92
A principle of PFT equipment that represents how much the equipment can measure?
Capacity
93
Reliability of PFT equipment is called ______.
Precision
94
The specific measurement made is called _____.
Output
95
If you have only spirometry values to analyze as you do not have a complete PFT test but the FVC = SVC but you notice the values are low this would imply what type of condition?
Restrictive
96
This is the gold standard of identifying obstructive conditions?
FEV1 values
97
Name 2 types of problems you may experience when measuring for FRC?
Patient problem
| Leaks or problem with equipment
98
When measuring for FRC this type of test is done when the patient is panting against an open & closed shutter?
Body Box
99
What must occur to obtain a valid measurement of FRC for helium or Nitrogen testing?
Equilibration
100
When performing Plethysmography what gas law is used to determine total thoracic gas volume
Boyles Law
101
Intrapulmonary volume is abbreviated as
VTG or TGV
102
T or F: In normal patients VTG = FRC
True
103
When using body box because air flow is not possible against a closed shutter mouth airway pressure = ___________.
Alveolar pressure change
104
When using the body box or plethysmography a graph is created which shows ________ & ________ changes?
Pressure & Time changes
105
T or F: When utilizing the plethysmograph the cabin the patients sits in must be pressurized & internal pressure is monitored & compared to external atm pressure
True
106
What is Boyles Law?
P1V1=P2V2
107
HE dilution for measuring FRC is considered an open or closed system?
Closed Method
108
T or F: After equilibrium occurs the changed level of O2 is used to determine FRC once He is diluted & equilibrium occurs.
False; The change in He? is used to determine FRC because there is no helium in lungs normally; measurement occurs after equilibrium occurs
109
T or F: Helium is an inert gas
True
110
In order to have a valid test your extrapolated volume for flow rates should be less than _______.
Less than 5% or .150 l
111
If your FVC , SVC your patient may have what type of condition?
Obstructive
112
When you are measuring FEV1 the result is reported as __________ but is actually ________ value.
FEV1 reported as volume but is actually flow
113
This is the volume exhaled before zero time point, no more than 5% of VC is allowed.
Extrapolated value
114
T or F: The larges FEV1 will always lead to the largest FVC
FALSE; the largest FEV1 does not always = largest FVC
115
This is the average air flow during mid portion of FVC.
FEF 25-75
116
If you have a reduced value of FEF 200-1200 then you may have large or small airway obstruction.
Large airway obstruction
117
This value is located on the highest point on volume flow graph & sometimes shows normal in abnormal patients.
PEFR
118
When ______ value is decreased this is a symptom of small airway obstruction
PEF 25-75
119
If you see an increased MVV value you have an increase in __________. If you see a decrease in MVV then you have _________ condition.
Increased Raw
| Decreased = obstructive condition
120
A method of measuring FRC (RV & TLC) in which gases are measured that are in communication with obstructed airways & does not take into account all airways.
He or Nitrogen washout
121
When using the Nitrogen Washout method how do you remove the patients nitrogen?
Have them inspire 100% O2 for 2-5 minutes
122
What happens to the patients Nitrogen once it is removed?
A. It is released into atmosphere as it is inert
B. It is recycled back to lungs after exhale
C. FRC washout goes to a collecting site to be measured
D. It is converted to a liquid for proper measurement
C. FRC washout goes to a collecting site to be measured
123
```
This type of test for FRC can measure gases trapped.
A. Helium Dilution
B. Nitrogen Washout
C. Body Plethysmography
D. Both A & B
E. All of the above
```
C. Body Plethysmography
124
Besides measuring FRC another value that can be provided by use of body box includes?
Airway Resistance
125
What is the scale of Severity of Raw
2.8 to 4.5 cmH2o/L/Sec = Mild
4.5 - 8 = moderate
> 8.0 = severe
126
What is a normal resistance value?
0.6 - 2.8 cmH2O/l/Sec
127
What test is used to find airway resistance?
Body Box test
128
Compliance is found by _______ change per unit of _______ change
Volume change per unit of pressure change
129
What two parameters must be calibrated in order to determine accuracy of body box?
Pressure & Flows
130
_______ is determined by volume change per unit of pressure change?
Compliance
131
________ is determined by measuring changes in pressure vs. flow.
Airway Resistance
132
When calibrating the pressure of a body box what is used to verify pressure against?
Mercury or water manometer
133
Flows are verified with what device?
Rotameter
134
Name 3 advantages of using a body box? Name 3 disadvantages?
VTG not affected by lung ventilation
Test is quicker
Easily repeatable
Disadv: Patient may not be able to physically enter the body box, Claustrophobia, Patient may not be able to pant
135
Name 3 methods of Calibration when analyzing a gas for FRC or D1CO & quality control?
Utilize known gas value
Mechanical lung analog
Test known subjects
136
What is the name of a gas analyzer?
Clark Electrode (which is polargraphic) or galvanic fuel cell
137
What is the name of the He analyzer?
Wheatstone bridge which measures thermal conductivity
138
What is the name of the analyzer for N2?
Geisler tube ionizer
139
What is the name of the analyzer for gases of stress testing?
Mass Spectrometer
140
What analyzes for DLCO testing?
Chromatograph or infrared absorption
141
Gas analyzers are calibrated by calibrating to zero and by adding a gas::
A. Running a gas that is a mixture of the gas that the device normally measures with an inert gas
B. A gas that is free of that particular gas the device tests for
C. Removing all gas & adding liquid
D. Adding O2 only as this is a major gas we have in lungs that must be tested for.
B. A gas that is free of that particular gas the device tests
142
When measuring for airway resistance raw is calculated from two curves, what do they represent?
The first curve is produced when the shutter in the box is open and flow is plotted against box pressure which produces an S-Shaped curve.
The second curve is created after the shutter is closed that plots mouth pressure against box pressure
143
When you see an increase in Raw during exhalation this is indicative of what type of abnormality?
Obstructive airways disease such as emphysema
144
An increase in resistance is represented in what way on the s-curve?
The curve will change from a skinny narrow double line to showing a wide type on the expiration side of the graph.
145
What 3 items must be calibrated on the Body Box?
Mouth pressure transducer
Flow transducer
Cabinet pressure transducer
146
T or F: Biological testing is a common component of quality control
True
147
When measuring gas distribution on the single breath N2 elimination test two things are measured, what are they?
Evenness of distribution of inspired gas
| Closing volume/closing capacity
148
When you are using an O2 analyzer which side of equipment should be used if an aerosol is provided?
Always calibrate from dry side
149
The gold standard in calibration is to analyze where?
As close to patient as possible
150
What is the name of a pH analyzer?
Sans
151
This describes what test: Patient first exhales to RV & then inspired 100% O2; The patient then exhales this gas slowly; exhaled gas passes through a N2 analyzer (geisler tube ionizer) to record changes in N2% & the volume of gas is exhaled into a spirometer
Single breath N2 elimination
152
What are the 4 phases of the SB N2 elimination?
Phase I = Deadspace, 100% O2, no N2
Phase II= combination of deadspace & alveolar gases--N2 begins to increase
Phase III= alveolar gas; evenness of gas distribution is shown by how flat the mid-portion of the test is (poor distribution slants up more)
Phase IV: Shows the sudden rise of N2% & occurs during airway closure, called the closing volume when airway closure occurs
153
When you add the closing volume to RV you have ________ ___________.
Closing capacity
154
The sudden rise of N2% that occurs at airway closure is?
Closing volume
155
What causes closure of the airways?
Compression of lower airways
156
Name 2 other test methods besides the SBN2 elimination method used to measure gas distribution?
7 minute N2 washout test
| Ventilation scans that can also measure distribution of gases
157
```
With the onset of obstructive disease what measurement shows initially, often before symptoms experienced?
A. Spirometry
B. FEV1
C. Peak Flow
D. Closing volume
```
D. Closing volume may show up before spirometry changes in obstructive conditions
158
What happens to the value of closing volume during obstructive disease?
2 things
Closing volume is elevated
| Slope of Phase III is increased
159
```
DLCO will measure the diffusion of ___________ (gas) across the Alveolar capillary membrane.
A. Carbon Monoxide
B. CO2
C. O2
D. N2
```
A. Carbon Monoxide
160
Which gas has an affinity with Hgb that is 210x greater than O2 & diffuses rapidly into pulmonary blood?
Carbon monoxide
161
When performing a Single breath DLCO test the patient inhales a VC of gas from RV containing a known amount of?
0.3& CO, 10% He, and air
162
The DLCO test requires a breath hold of _____ seconds?
10 seconds
163
What is a normal value for DLCO and what is it measured from?
Normal DLco = 25 mL/min/mmHg in STPD
164
Name 5 factors that affect Dlco?
```
HB, HCT
Body position
Breath holding time
Lung volume
Smoking
```
165
What conditions may cause a decreased DLco value?
Pulmonary fibrosis
Sarcoidosis
Ards
Edema
166
When might you expect to see an increase in DLCO?
```
Polycythemia
Exercise
Asthma
Obesity
Intralveolar hemorrhage, left to right intracardiac shunts
```
167
If you see a reduction in DLCO you can have normal lungs if it is caused by what?
Small lungs, a pure reduction in DLCO can represent small lungs
168
When evaluating alveolar capillary membrane abnormalities which arise from decreased DLCO you must compare DLCO to _______ ______.
alveolar volume
169
A minimum of ______ procedures must be performed to meet ATS standards.
3 acceptable tests
170
When evaluating patient performance standards against ATS guidelines name some important rules to identify if you have good results (4)
No false starts
Test should not differ by more than 5%
The "best test" should be determined & used
Best test means = highest FVC & FEV1
171
What are 4 measurement principles you must evaluate?
Specificity
Sensitivity
Validity
Reliability
172
To comply with standards of infection control is it necessary to routinely clean interior?
No, you do not have to routinely clean the interior; A clean mouthpiece & tubing is required & low resistance bacteria filter
173
There is a direct/inverse relationship with volume & compliance
Direct
174
When you see a reduced diffusion capacity this implies what abnormality?
Loss of pulmonary vascular bed/or parenchyma
175
This principle of equipment measurement looks at ratio of all patients & looks at positive test results.
Sensitivity
176
Deals with equipment results that are truly negative?
Specificity
177
When you have airtrapping what type of change if any will it have on your FRC & RV
both will increase from hyperinflation or obstructive conditions
178
This measurement is very good for looking at purely restrictive condition but with combined problem this value may not change at all?
TLC
179
If you have poor distribution like in the case of COPD what happens when looking at distribution of gas?
The closing volume will be different
180
During emphysema what normally happens to your DLCO value?
It will decrease due to loss of integrity of surface area; it becomes so loose it looses its ability to transfer
181
When measuring DLCO you are given a ____________ ___________ measurement but it must be converted to __________ __________.
Absolute value;
| Relative value
182
Name a restrictive condition that does not cause a decrease in DLCO?
ALS
| Neuromuscular
183
Exhaled nitric evaluates the activity of ___________ activity which is an indictor of reactive airway.
Eosonophils
184
What type of condition may cause problems with PFT testing and prevent equilibration or cause pain.
Ear infection
185
When assessing abnormal lung conditions, when you are looking at obstructive conditions you are looking at _______; with restrictive you are looking at _______.
Obstructive - flows
| restrictive- volumes
186
Normal PFT machines allow for exhalation of up to _____ seconds; Patient should have _______ seconds of exhale.
15 seconds
| 6 seconds
187
T or F: PFT tests can be used to diagnose conditions such as COPD or asthma?
False they can only show patterns such as obstruction or restriction
188
Name two things which are vital to accurate PFT tests?
Patient cooperation, good instructions from RT
189
When you measure your VC is this a direct or indirect measurement?
Direct
190
What can a FVC imply if results are abnormal?
It would be used to determine if obstructive condition present
191
In a normal lung what 2 values should match: If they do not match what could the patient have?
SVC = FVC; airway obstruction
192
When we refer to pulmonary mechanics this is speaking to ______ of air/
Flow of air; airflow
193
Two major things that can affect outcomes when measuring FRC are ______ & _________.
Obstruction or leaks
194
T or F: a restrictive disease always shows a decrease of DlCO
False, some restrictive diseases do not affect or cause a decrease in DLCO
195
What is normally given for pulmonary hypertension?
Nitrics
196
T or F: the number of patients with CF is under estimated?
True
197
T or F: it's unusual for post surgery patients to experience decreased lung volumes which mimick restrictive conditions
False
198
Name a couple of conditions causing decreased lung volumes?
```
Inflammatory diseases
Cardiac disease
Neurological neuromuscular
Pleural disease
Thoracic deformities
Fibrotic disease
```
199
These types of abnormalities are characterized by decreased compliance, decreased thoracic compliance?
Restrictive disease
200
T or F: Increased volume = decreased compliance
F; direct relationship exists
201
Name some common causes of obstruction (6)?
```
Bronchoconstriction
excessive swelling
tumors
bronchiole collapse
increased Raw & decreased flow
```
202
If you have a FEV1 value decreased or 44% of predicted how would you classify this patient with no other data?
Obstructive only, moderate
203
If you patient has an FEV1 of 81? how would they be classified?
Normal
204
When evaluating pulmonary function test analysis they are based on _________.
Predicted normal values
205
In order to meet ATS qualifications for acceptable performance standards when performing more than 1 tests they should not differ by more than ______%.
5%
206
What type of equipment may be used to validate other PFT equipment & it uses volume & time measurements.
Water Sealed Collins
207
The gold standard of rotor spirometers which measures air flow as it passes through a motor or turbine?
Wrights respirometer
208
In order to calibrate volume what do you do?
Measure against a 3.0 syringe
209
When a patient exhales to RV and then inspires 100% O2 they are probably receiving what type of test?
SB N2
210
What are some factors that may give false results when looking at DLCO? 6 total
```
Alcohol measurements will decrease DlCO
HB, HCT
Body position
Breath hold time, will increase if not held long enough
Patients lung volumes
Smoking
```
211
When performing tests for DLCO a patient who is a smoker should be instructed not to smoke _________ hrs before the testing.
24 hours
