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AP2 > Lecture 3/13 - Pulmonary > Flashcards

Lecture 3/13 - Pulmonary Flashcards

1
Q

In the Nitrogen washout test with sick lungs, the time it takes to get to an ________ N2 concentration of _____ will be ______

A

exhaled

2.5%

increased (more breaths to get to N2 concentration 2.5%)

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2
Q

What are we most interested in when looking at flow volume loops?

A

Maximum peak expiratory force (airflow/y-axis)

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3
Q

In Expiratory flow curves (flow volume loops) the maximal effort curve (peak expiratory flow rate) will be ______ if the lung is sick

A

decreased/lower

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4
Q

Why is peak expiratory rate decreased in restrictive diseases?

A

Less volume inhaled dt to increased scar tissue –> decreased airway diameter = INCREASED AIRWAY RESISTANCE –> decreased airflow rate

Decreased airway diameter also makes the airway easier to compress.

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5
Q

In expiratory flow curves (flow volume loops), why is the obstructive disease shape different?

A

Shape/contour of curve is dt small airway collapse from forced exhalation.

Useful early on, but exhale rate will decrease.

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6
Q

What 2 things do we rely on to get air out the lungs?

A
  1. a change in pleural pressure
  2. Recoil of the lung to push air out.
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7
Q

Equation: PA =

A

Pleural pressure + recoil pressure

PPl + PER/TP

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8
Q

Positive alveolar pressure forces air _______ the lung

A

Out of

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9
Q

The pressure gradient _______ as we get further away from the alveoli and into the respiratory system

A

Decreases

It will follow a gradient compared to the outside environment pressure

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10
Q

_________ pleural pressure holds the alveoli open

A

Negative

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11
Q

What happens to pleural pressure during forced expiration?

A

It becomes more positive

Ex) +25 mmHg

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12
Q

How do you find the Delta P in the alveoli?

A

Alveoli pressure - environment pressure

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13
Q

The conducting zones in our _____ respiratory tract are held open by ________

A

Upper

Cartilage

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14
Q

The small airways ability to stay open is dependent on what (2)?

A
  1. Positive Alveoli pressure
  2. Negative pleural pressure

Plerual pressure needs to be lower than alveolar pressure

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15
Q

Where is the potential choke point in the lower airway? Why?

A

Right before the cartilage in the conducting zone

-There’s no cartilage here for structure
-Pressure in airway has decreased (going up into the system decreases pressure from alveolar pressure)

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16
Q

If pleural pressure is equal to the pressure in the airway at the potential chokepoint site, will this cause a collapse?

A

No

Pleural pressure would need to be greater than airway pressure

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17
Q

Lower lung volumes ______ the chance of airway collapse

A

increases

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18
Q

How does obstructive diseases (emphysema) affect small airway collapse?

A

Decreased PER –> Decreased PA –> Decreases pressure airway gradient at potential chokepoint

During forced exhalation, if pleural pressure is greater than pressure in the airway at the potential choke point –> collapse

This increases the risk of having issues getting air out of lung.

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19
Q

What are things that can increase risk to small airway collapse?

A

Narrow airways
Low lung volumes
Asthma

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20
Q

What is airway traction caused by? What does it do? How is this affected w/ obstructive lung diseases? restrictive?

A

Springy tissue in alveoli that provides traction and helps keep them open

Obstructive: Less springs –> airway more narrow = prone to collapse (Less traction)

Restrictive: more springs –> less likely to collapse as long as airway diameter is normal

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21
Q

Emphysema has ______ springy tissue/recoil/traction than COPD

A

LESS

It is more difficult to exhale with emphysema than with COPD

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22
Q

What can make the upper airways more prone to collapse?

A

Damage to/loss of cartilage

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23
Q

what is the number one factor in getting air out of the lungs?

A

PER

(Pleural pressure helps but not more important than elastic recoil)

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24
Q

What is a Fixed Obstruction? What does it affect? Ex? How does this affect the flow volume loops?

A

Narrowing of the upper respiratory airway
Ex) ETT

Decreased diameter –> increased resistance
Harder to inhale or exhale

Both expiratory/inspiratory loops will be cut off at the top dt limited airflow rate from increased resistance

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25
Fixed Obstructions can be ______ or _____ thoracic. What does this mean?
Intra-thoracic: lower down or within the chest Extra-thoracic: outside or above the chest
26
What is a variable intrathoracic Obstruction? Ex? What does it affect? How does this affect the flow volume loops?
Expiration --> plerual pressure becomes positive --> airway collapse if small airways isn't robust (lack support, traction, elastic recoil) Ex) emphysema, asthma Forced expiration only (During inspiration, the obstruction is removed dt negative pleural pressure) Expiratory loop is cut off the top dt limited airflow rate during expiration
27
What is a variable extrathoracic Obstruction? Ex? What does it affect? How does this affect the flow volume loops?
Obstruction outside the chest affecting the upper airway --> negative pressure during inspiration --> upper airway collapse Ex) loss of cartilage (tracheal resection), paralyzed vocal cords Affects inspiration (during expiration, the obstruction is pushed out the way dt positive airway pressure) Inspiratory loop is cut off at the top dt limited airflow rate during inspiration
28
FEV1 =
Force expiatory volume in 1 second
29
FVC =
Forced vital capacity
30
What is the FEV1/FVC pulmonary function test? What do you want your percentage to be higher than?
Looks at FEV1/FVC ratio (fraction) to determine the health of the lungs. Graph includes: FVC (VC), TLC, RV These also help look at the health of the lung
31
What should your FEV1/FVC be? What is this mean?
80% You should be able to move 80% of your vital capacity out of your lungs in 1 second If its less, then something is wrong
32
FEV1/FVC PFT: The bottom of the y-axis starts at _________
RV or TLC (read the graph)
33
Equation: VC =
TLC - RV
34
FEV1/FVC PFT: Describe the x-axis
Time Most are read from right to left **pay attention to this axis** Some are read left to right
35
We decrease our lung volume by alot within ____ sec(s). What happens to the rest of the volume?
1 Takes longer to get out of the lung (even if healthy - about 8 seconds to get lung volume to RV)
36
FEV1/FVC PFT: what is the most common problem you'll see? How does this change the graph??
Airway obstruction Decreased amount of air volume coming out in 1 second --> the rest of air comes out slower = longer to get to RV
37
What is a normal FEV1?
3.6 L Anything below this is abnormal
38
FEV1/FVC PFT: what is the difference between this and a flow volume loop conversion?
No time axis **They have to give you the one second mark**
39
FEV1/FVC PFT: how would restrictive lung disease be displayed?
**-A normal ratio/ percentage** -Decreased FEV1 -decreased VC -overall decreased lung volume
40
FEV1/FVC PFT: how would obstructive lung disease be displayed?
**-Decreased normal ratio/ percentage** -Decreased FEV1 -decreased VC
41
What is the hallmark shape of obstructive lung disease in a expiatory flow loop?
Peak --> concave slope
42
PTF algorithm: what are the 1st & 2nd steps?
Flow volume loop --> figure FEV1/FVC ratio <70% = Obstructive Not <70% = restrictive or normal
43
PTF algorithm: what is step 3?
Helium dilution spirometry to figure out TLC & RV Increased RV = obstructive
44
PTF algorithm: what is step 4?
DLCO measurement Carbon monoxide diffusion test: measures surface area available for gas exchange in lungs
45
PTF algorithm: what is step 5?
FEV1 reversibility with bronchodilator Administer a bronchodilator --> see if condition reverses FEV1 reversibility = reactive airway problem (asthma) No change = elastic tissue problem (obstructive)
46
PFT disorder table: asthma
FEV1: decrease FVC: decrease Ratio: decrease TLC: N/increase RV: increase FRC: N/increase DLCO: N
47
PFT disorder table: COPD
FEV1: decrease FVC: N/decrease Ratio: decrease TLC: N/increase RV: increase FRC: N/increase DLCO: N/decrease
48
PFT disorder table: fibrosis
FEV1: decrease FVC: decrease Ratio: N/Increase TLC: decrease RV: decrease FRC: decrease DLCO: decrease
49
PFT disorder table: muscle weakness
FEV1: decrease FVC: decrease Ratio: N/Increase TLC: decrease RV: N/Increase FRC: N DLCO: N
50
PFT disorder table: kyphoscoliosis
FEV1: decrease FVC: decrease Ratio: N/Increase TLC: decrease RV: N/decrease FRC: decrease DLCO: N
51
FEV1/FVC PFT: restricted lung disease can mimic someone who is healthy but just ________
Small
52
What is the normal expiratory flow rate with normal breathing at FRC?
1 L/sec
53
Closing Volume/Capacity test: what does this test tell you about?
Smaller airways and their tendency to collapse Overall health of the lung
54
Closing Volume/Capacity test: what are the steps to this test?
1. Exhale to RV. 2. Inhale to TLC while breathing 100% O2. 3. Expire to RV
55
Closing Volume/Capacity test: what are we measuring?
Exhaled **nitrogen** from VC after exhaling to RV and inhaling 100% O2 Allows us to see nitrogen coming out of the patient at different time points/ different parts of the lung
56
Closing Volume/Capacity test: at RV, what are the conditions regarding the alveoli at the base and Apex of the lung? How does this affect this test?
Base: 20% full -Requires more transpulmonary pressure to fill with volume -doesn't readily accept volume Apex: 30% full -more readily accepts volume The Apex accepts air first but takes in less 100% O2 (70%) to fill alveoli -Base accept air last but takes in more (80%) -After 100% O2 Base pre-existing N2 concentration more dilute than apex.
57
AT RV, what is the PPl at the apex? base?
Apex: -2.2 mmHg Base: +4.8 mmHg
58
PIN2 =
564 mmHg
59
Closing Volume/Capacity test: how many phases are there?
4
60
Closing Volume/Capacity test: describe phase 1
Start at TLC --> expired dead space (Trachea, 2 main stems) air --> 100% O2 About 100 ml **no N2 present**
61
Closing Volume/Capacity test: describe phase 2
**transitional period** Anatomical, dead space air mixed with some of the alveolar air Increases the more we expire dt getting air from deeper parts of the lung
62
During the Fowlers test, the midpoint of transitional phase can be used to estimate__________
Anatomical dead space
63
Closing Volume/Capacity test: phase 2 is the same as what test?
Fowler PFT: transition phase
64
Closing Volume/Capacity test: describe phase 3
**Plateau phase** but it's not flat Beginning & Majority: exhaled nitrogen from the base of lung Small end: exhaled nitrogen from the Apex
65
When expiring to RV, air comes from the ________of the lung first
Base (reverse of inhaling)
66
Closing Volume/Capacity test: what causes the slope in phase 3
Transitioning from more dilute nitrogen in the base of the lung to more concentrated nitrogen in the Apex of the lung
67
Closing Volume/Capacity test: during phase 3, as we get more expired air from the Apex the slope ______
Increases
68
Closing Volume/Capacity test: describe phase 4
Abrupt change in expired, not nitrogen concentration dt small airways at the base of the lung collapsing --> increase nitrogen concentration from the air in the Apex of the lung This causes a steep shift in the slope of the line upward
69
Closing Volume/Capacity test: the point where the change from phase 3 to phase 4 is called
Closing volume/capacity point
70
Closing Volume/Capacity test: what is closing capacity?
Closing volume added to residual volume RV + closing volume = closing capacity
71
Closing Volume/Capacity test: what is closing volume?
Amount of air coming out of patients during phase 4
72
Closing Volume/Capacity test: what is closing capacity? Increase closing capacity. = _________ closing volume.
Increase
73
What does closing volume/closing capacity tell us about?
Properties of the deep, small airways
74
Closing Volume/Capacity test: what does it mean when phase 4 starts earlier? What causes this?
Small airways are collapsing at the base at an earlier volume Causes: not enough traction Small airways Thinner airways More narrow airway
75
Equation: closing capacity =
Closing volume + RV
76
Closing Volume/Capacity test: what are the benefits of this test?(3)
-Detects very small changes and tissue behavior -easy to perform -only need a N2 meter and O2 tank
77
How does close and capacity change with age?
TLC: no significant change IC: no significant change VC: small increase ERV: increases a bit RV: increases w/ age (dt loose elasticity - hard to empty the along with normal aging)
78
Closing Volume/Capacity test: in a healthy 20 yo, why is phase 4 small? What does this cause?
They have hardly any small airway collapse because they barely drop below FRC during normal breathing to actually collapse at RV Causes phase 3 to be longer
79
Closing Volume/Capacity test: in a 70 yo, why is phase 4 larger? What does this cause?
Closing capacity & closing volume are higher Small airway start to collapse before we expire to RV Less elastic tissue as function of age --> less recoil & traction --> more effort to exhale to RV --> small airway collapse Causes phase 3 to be shorter
80
Do older people have airway collapse on almost every breath. What does this cause? What age does this start?
Yes Increases their WOB Starts at 55 even with perfect health

AP2 (17 decks)

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