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Respiratory medicine > L6 - Pulmonary function testing > Flashcards

L6 - Pulmonary function testing Flashcards

1
Q

FEV1

A

Forced expiratory volume in 1 second

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2
Q

FVC

A

Forced vital capacity.

Total vol forcefully expired from max inspiration efforts

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3
Q

What might a low FEV1/FVC ratio indicate?

A

Obstructive pattern: Asthma, emphysema

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4
Q

What might a normal value of FEV1/FVC indicate?

A

Restrictive or a normal pattern

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5
Q

If the FEV1/FVC is normal but the FVC is low what might this show?

A

Restrictive pattern

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6
Q

Signs of lung disease

A 
Cough 
Dyspnea 
Cyanosis 
Wheezing 
Hyperinflation of lungs
Hypoxemia 
Hyperapnia
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7
Q

Dyspnea

A

Shortness of breath

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8
Q

Hypoxemia

A

Abnormally low level of oxygen in blood

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9
Q

Hypercapnia

A

Abnormally elevated level of carbon dioxide.

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10
Q

Spirometry

A

Measurement of air movement in and out of lungs during various respiratory maneuver’s

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11
Q

How might anaemia affect the lungs?

A
  • Number of haemoglobin molecules reduced.
  • Decreased ability of lung to transfer carbon monoxide to blood (experiment)
  • Lower diffusion capacity
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12
Q

Examples of conditions which decrease the surface area of the alveolar capillary membrane

A

Emphysema - breathing tubes narrowed and air sacs damaged.

Pulmonary embolism.

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13
Q

Conditions altering membrane permeability / thickness?

A

Pulmonary fibrosis

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14
Q

Why is carbon monoxide used to test diffusion capacity?

A

More soluble in blood than in lung tissue.

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15
Q

What are extraparenchymal causes of restriction? (4)

A

Impairs patients ability to fully inflate lungs:

  • Obesity
  • Neuromuscular disease
  • Chest wall deformities
  • Large pleural effusion
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16
Q

Describe quiet respiration pathophys

A
  • Diaphragm contracts.
  • Moves downwards.
  • Parietal pleura attached to diaphragm descends.
  • Movement pulls down visceral pleura.
  • Airway and alveoli expand.
  • Air sucked into lungs.
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17
Q

What occurs during expiration?

A
  • Diaphragm relaxes

- Recoil of elastic tissue in lungs expels air from alveoli and airways.

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18
Q

Describe the use of accessory muscles during forced respiration?

A
  • Neck muscles pull ribcage upwards.
  • Sternocleidomastoid elevates sternum.
  • Scalenus major and minor elevate first two ribs and sternum.
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19
Q

Which muscles pull the ribcage downwards?

A
  1. Oblique.
  2. Transverse.
  3. Rectus abdominus.
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20
Q

Which muscles fix shoulder girdle in place and pull ribcage outwards?

A

Pectoralis major.

Latissimus Dorsi.

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21
Q

Describe innervation of diaphragm?

motor and sensory supply

A

C3,4,5 keeps diaphragm alive

  1. Motor supply: via Left and right phrenic nerves.
  2. Sensory supply:
    - Central : Phrenic
    - Peripheral: Intercostal
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22
Q

Apnoea

A

Absence of breathing.

23
Q

A spinal cord injury where might cause apnoea

A

Break above C3,C4

24
Q

Intercostal muscles innervated by which distribution of motor neurones?

A

T1-T12

25
Q

Intrapulmonary pressure

A

Pressure within alveoli.

e.g. Expansion of chest and accompanying inflation of lungs will cause pressure within alveoli to fall.

26
Q

Intrapleural pressure

A

Pressure between viscera and parietal pleural layers.

Pressure in pleural space.

27
Q

How might intrapleural pressure be measured?

A

By inserting tip of needle connected to a manometer into pleural cavity.

28
Q

What can maximal respiratory pressure be used to measure?

A

Strength of inspiratory and expiratory muscles.

29
Q

Tidal volume

A
  • Amount of air inspired and expired at each breath

- at any level of activity.

30
Q

Residual volume

A

Volume of air that remains in the lungs that cannot be completely emptied.

31
Q

Functional residual capacity

A

Volume of air left in lungs at the very end of normal expiration

32
Q

What may increase airway resistance?

A
  1. Structures outside conducting airways (tumours) or mediastinal masses
  2. Laryngeal spasm
  3. Gastric content / blood blocking airway
  4. Relaxation of genioglossus muscle during anaesthesia causing tongue to fall backward
  5. Aspirated object
33
Q

Describe genioglossus muscle?

A
  • Fan shaped muscle.
  • Forms most of tongue mass.
  • Inserts on hyoid bone as well as inferior portion of tongue.
34
Q

Bronchomotor tone is under what type of nervous innervation

A

Parasympathetic

35
Q

Describe mediation of bronchoconstriction

A
  • Mediated by efferents from vagus to ganglia in the wall of small bronchi.
  • From which short post ganglionic fibres lead to nerve endings that release ACH to act at muscarinic receptors in bronchi smooth muscle.
36
Q

Describe stimulants of bronchoconstriction? (4)

A
  1. Cigarette smoke
  2. Histamine release from mast cells (affects parasymp), direct action on airway smooth muscle.
  3. Non-adrenergic noncholinergic fibres releasing Vasoactive intestinal polypetide.
  4. nSAIDS: notabily aspirin, and B-adrenoreceptor blocking drugs
37
Q

nSAIDS causing bronchconstriction

A
  • Aspirin

- Beta-adrenoreceptor blocking drugs

38
Q

Compliance

A

How easily lungs can be distended.

39
Q

Types of lung disease causing decreased DLCO

A
  1. Emphysema , CF
  2. Fibrosing alveoli, asbestosis
  3. Pulmonary embolism
    - pulmonary vascular disease with occlusion.
40
Q

How might we measure total lung capacity?

A

Dilution of an inert gas such as helium in an enclosed box.

Total body: plethysmograph

41
Q

Tests for gas exchange

A
  1. Pulse oximetry
    - measured by the absorbance of light by haemoglobin, used to assess hypoxaemia
  2. Blood gas analysis
42
Q

What occurs in respiratory acidosis

A

PaCO2 RISES.
pH FALLS.

Compensation: kidneys retain bicarb

43
Q

In what situations may respiratory acidosis occur?

A
  1. Lung disease
    - COPD, pneumonia, asthma, pulmonary odema
  2. MSK disorders
    - Kyphoscoliosis, chest trauma, Guillain Barre, Myasthenia Gravis
44
Q

Kyphoscoliosis

A

Abnormal curvature of the vertebral column.

45
Q

Arterial blood gas measures… (4)

A

Measures:

  1. acidity
  2. pH
  3. levels of oxygen
  4. levels carbon dioxide.
46
Q

Sign of bronchiectasis

A

Bronchiectasis - airway of lungs become abnormally widened.

Leeds to build up of excess mucus that can make the lungs more vulnerable to infection.

47
Q

A patient with chronic heart failure may have?

A
  1. Positional and exertional breathlessness.
  2. Elevated JVP
  3. peripheral oedema.
  4. Tachycardia
  5. crackles.
48
Q

A reduced lung volume may indicate

A

Restrictive problems.

- Interstitial lung disease, thoracic cage abnormalities, neuromuscular problems.

49
Q

An increase lung volume may indicate

A

Air trapping and lung overinflation, typical of COPD.

Pattern of raised RV (residual volume) and raised FRC (Functional residual capacity) with other volumes normal.

50
Q

Lung diffusion measurement

A

Measures ability of lungs to transfer gases across the alveolar capillary membrane - from lung to blood stream.

DLCO - measures what heart has to deal with, composite measure of lung vol and basement membrane abnormality

KCO - measured value. adjusted for lung volume hence demonstrates alveolar membrane pathology.

51
Q

Examples of interstitial parenchymal lung disases?

A
  1. Fibrosis
  2. Granulomastosis TB
    - inflammation of tissues including BV, primarily in resp tract
  3. Pneumoconiosis
  4. Pneumonitis (Lupus)
52
Q

Pneumoconiosus

A

Disease of lungs due to inhalation of dust.

53
Q

Pneumonitis

A

Autoimmune.

Inflammation

54
Q

Sniff test

aka Diaphragm Fluoroscopy

A

Done to evaluate function of diaphragm.

Continuous beam of X-rays to see the diaphragm move up and down on insp and exp.

Patient asked to sniff forcefully while images are acquired.

Respiratory medicine (16 decks)

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