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Y2 - Resp > Lecture 15 - Pulmonary Function Test > Flashcards

Lecture 15 - Pulmonary Function Test Flashcards

1
Q

What do pulmonary function tests measure?

A

Lung volumes
Rate of airflow
Gas exchange

Severity and progression of lung disease

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2
Q

What health and safety measures are done before spirometry and peak flow?

A

If gonna cough stay on mouthpiece
Hand hygiene
Peak flows to be wiped using alcohol wipes, dispose of mouthpiece

Don’t volunteer if you have contraindications to spirometry

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3
Q

What are some contraindications to spirometry?

A

Eye surgery (due to inc pressure in eyes)

Surgery’s
Lung disease
Ear infection
Cardiovascular disease
Aneurysms
Acute, nausea, vomitting and diarrhoea
Infection control issues
Confused pasties

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4
Q

What is peak expiratory flow and hows it done?

A

Patient blows into the mouth piece as hard as they can after taking a deep breath

Then a value for FEV1 is measured

Then work out FEV1:FVC ratio

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5
Q

What is the normal value for FEV1:FVC?

A

FEV1:FVC > 0.8

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6
Q

What is the definition of peak expiratory flow?

A

Max airflow rate attained during forced expiration

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7
Q

What is the point of spirometry/what does it do?

A

Used to measure lung volumes

Calculates airflow as volumes are measured overtime

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8
Q

What is tidal volume?

A

The amount of air moving in and out of our lungs at rest

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9
Q

What is inspiratory reserve volume

A

The additional amount to fair that can be inhaled after a normal inspiration

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10
Q

What is expiratory reserve volume?

A

The additional amount of air that can be exhaled after the normal expiration

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11
Q

What is residual volume?

A

The amount of air that remains in the lungs after maximum forceful expiration

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12
Q

What is inspiratory capacity?

A

The total volume of air that can be inspired following a normal expiration

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13
Q

What is functional residual capacity?

A

The volume of air present in the lungs of passive expiration

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14
Q

What is vital capacity?

A

The maximum volume of air that can be moved into or out of the lungs in one breath

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15
Q

What values are added together to measure vital capacity?

A

VC = IRV + TV + ERV

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16
Q

What is total lung capacity?

A

Volume of air contained lungs at end of a maximal inspiration

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17
Q

What are the 2 clinically relevant values that can be measured in spirometry?

A

FEV1 (forced expiratory volume in 1 second)

FVC (forced vital capacity)

From this the FEV1/FVC

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18
Q

What is FEV1 (forced expiratory volume in 1 second)?

A

The maximum volume of air that can be forcefully expired within 1 second after maximal inspiration

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19
Q

What condition is FEV1 reduced in?

A

COPD

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20
Q

What is Forced Vital capacity?

A

The total amount of air exhaled after maximal inspiration during entire FEV test

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21
Q

What does FEV1/FVC ratio actually mean?

A

The proportion of patients FVC that they can expire in the first second of forced expiration

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22
Q

What value of FEV1:FVC ratio indicates obstructive disease?

A

FEV1/FVC < 0.7

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23
Q

What are the 2 graphs that can be produced form spirometry?

A

Volume-time plot
Flow-volume loop

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24
Q

How can you determine FEV1 from a volume time plot?

A

See what volume is achieved at 1s on the plot

(1s on x axis, go up to curve, then read across to Y to find the volume)

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25
Q

How do you determine Forced Vital Capacity (FVC) from a volume-time plot?

A

The volume at which the curve plateaus

26
Q

How can you estimate peak expiratory flow rate from a volume time plot?

A

Draw a tangent and work at the initial gradient of the curve

27
Q

Look at the last slide,

Look at the volume-time plot and label:

What is the FEV1:FVC ratio?

A

1 = FEV1 (4L)
2 = FVC (5L)
3 = Peak Expiratory Flow Rate (estimated)

4/5 = 0.8

FEV1:FVC =0.8

28
Q

What is flow rate and what is its units?

A

The movement of a volume of air in a certain time

L/s

29
Q

What is Total Lung Capacity?

A

Vol of air present in lungs as you transition from max inspiration to expiration

vol of air at end of maximum inspiration (includes residual volume)

30
Q

What is residual volume?

A

The volume of air left in the lungs after the maximum exhalation

31
Q

What is a key thing to remeber when plotting a flow-volume loop plot when doing the x axis?

A

0L starts at the right and the volume increases as you approach the Y axis

32
Q

In terms of a flow volume loop, which part represents expiration?
Which part represents inspiration?

A

Expiration = above x axis

Inspiration = below x axis

33
Q

How can Peak Expiratory Flow Rate be determined from a flow-volume loop?

A

PEFR is the highest point the curve reaches

34
Q

How can Residual Volume be determined from a flow-volume loop?

A

The intercept on the x axis which is furthest to the right

35
Q

How can Forced Vital Capacity be determined from a flow-volume loop?

A

The volume between the 2 x interceptions

36
Q

Go the last slide and label the normal flow-volume loop:

2

A

1 = peak expiratory flow rate
2 = Residual volume
3 = Forced Vital Capacity
4 = Total Lung Capacity
5 = expiration
6 = inspiration

37
Q

How are FEV1, FVC, TLC and functional residual capacity affected with Obstructive Lung Disease?

A

FEV1 = REDUCED

FVC = normal at start but decreases with severe disease

TLC and FUnctioonal Residual capacity ((FRC) increase due to the Increased Residual Volume since the lungs cant empty as well

38
Q

How can we use spirometry to determine the difference between asthma and COPD?

A

Asthma is a reversible obstruction whereas COPD is not

FEV1:FVC ratio should be calculated (will be below 0.7 indicating obstruction)

Then give bronchodilators and should see a 12% improvement in FEV1:FVC following bronchodilators

39
Q

What percentage improvement should be seen in FEV1:FVC ratio if a patient has a reversible obstructive disorder like asthma?

A

12% improvement

40
Q

Describe how a volume-time plot of a patient with an obstructive lung disease will present (COPD):

A

The FEV1 is reduced
The max volume reached is lower (only if severe)

41
Q

Describe how a flow-volume loop of a patient with an obstructive lung disease will present (COPD):

A

The peak flow rate is reduced
The expiration as flow rate decreases is SCALLOPED
And inspiratory volume is slightly less in severe obsturciton

42
Q

Go to the last slide and draw on graphs 1 and 2 how a patient with an obstructive disease would present then check on slide 25:

A
43
Q

Go to the last slide and label the spirometry graph:

A

1 = inspiratory reserve capacity
2 = tidal volume
3 = expiratory reserve capacity
4 = residual volume
5 = inspiratory capacity
6 = functional residual capacity
7 = vital capacity
8 = total lung capacity

44
Q

What values are normally decreased in restrictive Lung disease?

A

FVC
Functional residual capacity and total lung capacity

FEV can be decreased

45
Q

What are some examples of Restricitve Lung Disease?

A

Pulmonary fibrosis
Pleural effusion
Myasthenia gravis
Kyphoscoliosis

46
Q

How does a flow-volume loop appear for a patient with restrictive lung disease?

A

The wizard hat appearance

Expiration part looks the same but is just smaller due to lungs being smaller

Inspiration section is much smaller due to struggling in inflating the lung s

47
Q

What part of breathing is mainly affected in obstructive lung disease and restrictive lung disease?

A

Obstructive = expiration

Restrictive = inspiration

48
Q

Go to the last slide and draw a how a patients plot would look with restrictive lung disease for both volume-time and flow-volume:

Check on slide 28

A
49
Q

What is DLCO?

A

Diffusing capacity carbon monoxide

50
Q

What is the purpose of doing a Diffusing Capacity Carbon Monoxide test?

A

Determines if theres a problem with the alveolar capilary membrane

It allows us to work out how much oxygen travels from alveoli to blood by measuring CO diffusion

51
Q

What conditions would DLCO be decreased?

A

Anything with alveolar inflammtion
Emphysema
Pulmonary fibrosis

52
Q

What sort of problem is indicated if theres an Abnomral DLCO but normal CXR and spirometry ?

A

Problem with vascular part of membrane

Idiopathic pulmonary arterial hypertension
Chronic thrombosis-embolism disease of lung

53
Q

Look at slide 31, what condition does this patient likely have?

A

Restrictive lung disease

FEV1:FVC > 0.7
TLC LOW
DLCO LOW

54
Q

What is an example of restricitve lung disease whihc will have a normal DLCO?

A

Kyphoscoliosis
(Lungs have gotten smaller due to shape of thorax)

Myasthenia gravis (neuromuscular)

55
Q

Go to the last slide and label the flow-volume plots in image 3

A

1 = normal
2 = early obstruction
3 = obstructive lung disease
4 = restrictive lung disease

56
Q

What is coal pneumoconiosis?

A

When dust and particles build up in the lungs leading to damage and inflammation which progresses to fibrosis (restrictive)

57
Q

What is coal pneumoconiosis?

A

When dust and particles build up in the lungs leading to damage and inflammation which progresses to fibrosis (restrictive)

58
Q

What may be some issues with technique in spirmometry?

A

Poor posture
Poor seal
Submaximal effort
Cough
Premature termination of exhalation

59
Q

What are some advantages of peak flow meters?

A

Cheap portable
Simple
Assess efficiency of medication
Can do by themselves

60
Q

What are some disadvantages of peak flow meters?

A

Relies of patient cooperation
Poor technique heavily effects it
Effor tdependant

Y2 - Resp (23 decks)

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