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Unit 2 Clin Med II > L11 PFTs and Asthma > Flashcards

L11 PFTs and Asthma Flashcards

1
Q

FVC

A

forced vital capacity

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2
Q

FVC

A

forced vital capacity

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3
Q

FEV1

A

forced expiratory capacity in the first second of expiration

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4
Q

FEF 25-75%

A

forced expiratory flow 25-75%, the middle half of forced expiration

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5
Q

SVC

A

slow vital capacity

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6
Q

IC

A

inspiratory capacity

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7
Q

ERV

A

expiratory reserve volume

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8
Q

TLC

A

total lung capacity

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9
Q

VC

A

vital capacity

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10
Q

RV

A

residual volume

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11
Q

TV

A

tidal volume

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12
Q

IRV

A

inspiratory reserve volume

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13
Q

FRC

A

functional residual capacity

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14
Q

perform spirometry ________ because ______

A

sitting

less likelihood of syncope

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15
Q

spirometry is done at least

A

3 times

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16
Q

most useful information for obstruction on spirometry

A

FEV1

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17
Q

defines severity of obstruction, assists in differentiationg obstructive vs restrictive

A

FEV1/FVC

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18
Q

FEV1/FVC ratio indicative of obstructive pattern

A
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19
Q

curve quality control involves

A
  1. volume time curve plateaus
  2. expiration lasts >6 secs
  3. Two best efforts within .2 L
  4. Flow volume loop are free of artifact
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20
Q

TV

A

tidal volume

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21
Q

diffusion capacity has a false reduction when _______

to compensate ________

A

anemic

adjust for hemoglobin level

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22
Q

defines severity of obstruction, assists in differentiationg obstructive vs restrictive

A

FEV1/FVC

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23
Q

FEF 25-75%

A

nonspecific for small airway obstruction but may be an early indicator of disease

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24
Q

how long after administering 2-4 puffs of bronchodilator do you wait to repeat testing

A

15 minutes

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25
Q

how many rounds of bronchodilator testing are done?

A

3-8 rounds

possibly repeated during flare

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26
Q

bronchodilator may be given by

A

nebulizer

inhaler

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27
Q

methacholine is given by

A

nebulizer

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28
Q

after givign methacholine, spirometry is conducted at

A

30 seconds

90 seconds

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29
Q

a positive methacholine challenge is

A

FEV1 decreases by 20%

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30
Q

problems with methacholine challenges

A

risky, must be closely monitored

false positives

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31
Q

expiration makes a triangle

A

normal flow volume loop

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32
Q

goes up and then has a weird dip on the way back down

A

obstructive flow volume loop

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33
Q

total lung capacity =

A

residual volume + vital capacity

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34
Q

diffusion capacity measures

A

ability of lungs to transfer gas and saturate hemoglobin using CO instead of O2

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35
Q

after diagnosis, retest FEV1

A

after 3-6 months of controller treatment

periodically every 1-2 years

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36
Q

asthma

A
  1. Chronic airway inflammations
  2. Intermittent and reversible airway obstruction
  3. Bronchial hyper-responsiveness
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37
Q

obstructive disease inspiration is

A

normal

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38
Q

obstructive disease expiration is

A

limited

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39
Q

lung volumes of obstructive disease

A

high

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40
Q

airway of obstructive disease

A

narrowed

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41
Q

Normal in obstructive disease

A

VC

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42
Q

Increased in obstructive disease

A

TLC

RV

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43
Q

decreased in obstructive disease

A

FEV1

FEV1/FVC

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44
Q

lung volume in restrictive disease

A

reduced

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45
Q

Samter’s triad

A
  1. sinus disease with nasal polyps
  2. ASA sensitivity
  3. severe asthma
46
Q

inspiration and expiration in restrictive disease

A

appear normal but flow and volume are significantly reduced

47
Q

decreased in restrictive disease

A

TLC
FVC
RV
FEV1

48
Q

normal or increased in restrictive disease

A

FEV1/FVC

49
Q

normal FEV1 value

A

rules out obstruction/restriction

50
Q

indicative of obstructive disease

A

FEV1 < 80% predicted

TLC increased by 15-20%

51
Q

an alternative to FEV1, as it is more sensitive for detecting early airway obstruction

A

FEF 25-75%

52
Q

if ratio of FEV1/FVC is .7-lower limit normal

A

may have mild obstruction

refer FEV1 and FEF 25-75%

53
Q

asthma symptoms

A
  1. Coughing: nocturnal, seasonal, triggered, longer than 3 weeks
  2. Wheezing: inspiratory and expiratroy
    Chest pain/pressure, dyspnea, SOB
54
Q

step 4

A

severe persistant asthma

55
Q

medications which can trigger an asthma attack

A

beta blockers
aspirin
NSAIDS

56
Q

risk factors for asthma

A 
Atopy
ASA/NSAID intolerance
food allergies
GERD
RSV
family history
maternal smoking
obesity
57
Q

pulmonary function tests in intermittent asthma

A

Normal pulmonary function tests between exacerbations, no limits on activities

58
Q

associated signs of asthma

A 
rhinitis
sinusitis
conjunctivitis
URI
atopic dermatitis
59
Q

chest of an asthmatic

A

increased AP diameter

60
Q

samter’s triad aka

A

ASA triad

61
Q

moderate persistent asthma symptoms/SABA use

A

daily

some activity limitations

62
Q

atopic triad

A
  1. Atopic dermatitis
  2. Allergic rhinitis
  3. Asthma
63
Q

atopic march

A

atopic dermatitis → food allergy → allergic rhinitis → asthma

64
Q

moderate persistant asthma FEV1/FVC

A

reduced by 5%

65
Q

severe persistent asthma symptoms/SABA use

A

daily, throughout the day

extremely limited physical activity

66
Q

severe persistent asthma nighttime awakenings

A

0-4: more than once a week

5+: nightly

67
Q

FEV1/FVC in asthma

A

normal or decreased relative to predicted values

68
Q

reversibility with bronchodilaotr in young kids

A

> 8% in young children

69
Q

step 1

A

intermittent asthma

70
Q

step 2

A

mild persistant asthma

71
Q

step 3

A

moderate persistant asthma

72
Q

step 4

A

severe persistant asthma

73
Q

intermittent asthma nighttime awakenings

A

0-4: none

5+: less than two nights/month

74
Q

intermittent asthma symptoms/SABA use

A

less than 2 days/week

75
Q

cromolyn

A

mast cell stabilizer

76
Q

Symptoms/SABA use in mild persistent asthma

A

more than 2 days/week

77
Q

mild persistent asthma pulmonary function tests

A

Normal pulmonary function tests with minor limitation in activity

78
Q

step 5 treatment

A

High dose ICS + LABA (or LTRA in ages 0-11)

79
Q

step 6 treatment

A

High dose ICS + LABA (or LTRA in ages 0-11) + oral steroids

80
Q

moderate persistent asthma FEV1

A

60-80%
*******

81
Q

if positive for any condition of rule of 2

A

asthma is not under control

82
Q

severe persistent asthma symptoms/SABA use

A

daily, throughout the day

83
Q

well controlled asthma symptoms/SABA

A

less than 2x/week

84
Q

severe persistent asthma FEV1

A

<60%

85
Q

severe persistent asthma FEV1/FVC

A

reduced by more than 5%

86
Q

montelukast

A

leukotriene receptor antagonist

used ages 0-4

87
Q

in chilren older than 12, use _________ to assess control instead of ____________

A

3 validated questionnaires

FEV1/FVC

88
Q

benralizumab

A

monoclonal anti-IL5 receptor a antibodies

89
Q

not well controlled asthma nighttime awakenings

A

0-4: >1x/month
5-11: >2x/month
12+: 1-3x/week

90
Q

used in all stages of asthma PRN

A

SABA

91
Q

step 1 treatment

A

SABA prn

92
Q

step 2 treatment

A

Low dose ICS daily
-or-
LTRA or cromolyn

93
Q

step 3 treatment

A

Medium dose ICS
Or
Low dose ICS + LABA (or LTRA)

94
Q

Rule of 2:

A
  1. symptoms more than 2x a week
  2. awaken with asthma more than 2x a month
  3. refil rescue inhaler more than 2x a year
  4. peak flow meter measure less than 20% from baseline
95
Q

how often to follow up asthma

A

initially: every 1-3 months

then every 3-12 months depending on severity

96
Q

yellow PFER should

A

use SABA and increase meds

97
Q

well controlled asthma FEV1

A

> 80%

98
Q

well controlled asthma FEV1/FVC

A

> .8 for ages 5-11

99
Q

not well controlled asthma symtoms/SABAA

A

> 2 days/week

100
Q

not well controlled asthma FEV1

A

60-80%

101
Q

not well controlled asthma FEV1/FVC

A

75-80%

102
Q

very poory controlled asthma symptoms/SABA

A

daily

103
Q

very poory controlled asthma FEV1

A

<60%

104
Q

very poory controlled asthma FEV1/FVC

A

<75%

105
Q

signs of severe obstruction

A 
tachypnea
tachycardia
tripod positioning
accessory muscle use
pulsus paradoxus
106
Q

useful handheld on the go measurement of asthma control

A

peak flow expiratory rate (PFER)

107
Q

green: good control PFER

A

> 80%

108
Q

yellow: caution PFER

A

50-80%

109
Q

red: medical alert PFER

A

<50%

GO TO ED

110
Q

when to use a CXR for asthma

may show

A

ruling out infection or obstruction

hyperinflation

111
Q

treatment for asthma exacerbation

A
  1. O2
  2. SABA (albuterol/xopenex) +/- ipratropium bromide
  3. Systemic corticosteroids: prednisolone 1mg/kg/day
    +/- abx, respiratory monitoring, CPAP, BiPAP, intubation
112
Q

xopenex

A

saba

Unit 2 Clin Med II (7 decks)

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