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PFT > Lung Volumes > Flashcards

Lung Volumes Flashcards

1
Q

The volume of air that normally moves into and out of
the lungs in one “quiet” breath.

A

tidal volume

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2
Q

volume of tidal volume

A

500 ml

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3
Q

The volume of air that can be
exhaled after a normal tidal volume.

A

Expiratory Reserve Volume (ERV):

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4
Q

expiratory reserve volume

A

Normal: 1,200 mL

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5
Q

The maximum volume of air that can be inhaled after a
normal tidal volume.

A

inspiratory reserve volume

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6
Q

inspiratory reserve volume

A

normal: 3100 ml

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7
Q

The amount of air remaining in the
lung after a maximal exhalation.

A

residual volume

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8
Q

residual volume

A

1200 ml

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9
Q

Cannot be measured with simple spirometry

A

residual volume

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10
Q

Breathe normally in and out.

A

Tidal Volume (Vt):

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11
Q

• Inhale as much as you can from a normal inhalation.

A

Inspiratory Reserve Volume (IRV):

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12
Q

Exhale as much as you can from a normal exhalation..

A

Expiratory Reserve Volume (ERV):

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13
Q

Take a deep breath in, as deep as you can, and then
blow it out slowly until you can’t blow out any more.

A

Slow Vital Capacity (SVC):

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14
Q

Result of tidal breathing over a period of one minute

A

ventilation

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15
Q

Ve

A

liters of ventilation/ 1 minute

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16
Q

2 factors that determine how much ventilation occurs:

A

Frequency of breathing (f), Size of the tidal volume (VT)

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17
Q

• Used to measure all volumes and capacities except RV,
TLC, FRC

A

Direct Spirometry

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18
Q

• Involves the use of a spirometer to measure the
volumes of air moving into and out of a subject’s lungs
during breathing

A

Direct Spirometry

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19
Q

The end-expiratory volume of the three tidal breaths
that precede the VC maneuver varies by less than

A

0.1 liter

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20
Q

__ occurs during the maneuver that, in the
technologist’s opinion, interferes with the accuracy of the
test results

A

No coughing

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21
Q

Acceptability Criteria for vital capacity

A

• The end-expiratory volume of the three tidal breaths
that precede the VC maneuver varies by less than 0.1 liter
• No coughing occurs during the maneuver that, in the
technologist’s opinion, interferes with the accuracy of the
test results
• No variable effort is demonstrated by the subject during
the maneuver
• No volume loss from a leak in the system is
demonstrated
• No obstruction of the spirometer mouthpiece occurs.
(Tongue and dentures)
• Maximal expiratory and inspiratory efforts and
demonstrated

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22
Q

The largest and second largest VC values are within_____ of each other

A

0.2
liters

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23
Q
  • VC Testing must continue until:
    •
A

A total of four tests have been performed
• The patient cannot continue
• Criterium is met with the performance of
additional acceptable test maneuver

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24
Q

• Required for the determination of RV, TLC, FRC

A
  1. Indirect Spirometry
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25
Q

Most often, performed to measure FRC

A

Indirect Spirometry

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26
Q

is the most reproducible lung volume and provides
a consistent baseline for measurement

A

FRC

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27
Q

2 approaches of indirect spirometry

A

A. Gas Dilution Techniques
B. Body Plethysmograph

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28
Q

Gas Dilution Techniques
•

A

Open-Circuit Method
• Closed- Circuit Method

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29
Q

Operate on Boyle’s law except that the fractional
concentration of a known gas is used instead of its partial
pressure

A

Gas Dilution Techniques

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30
Q

Gas Dilution Techniques Operate on Boyle’s law except that the______ is used instead of its partial
pressure

A

fractional concentration of a known gas

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31
Q

• C1V1 = C2V2;

A

gas dilution tech, boyle’s law

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32
Q

produces erroneous measurements

A

System air leaks

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33
Q

Can only measure lung volumes in communication with
conducting airways

A

gas dilution

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34
Q

MUSTS in Gas Dilution Techniques

A
  1. Tight system connections
  2. Flanged mouthpiece with a good subjects seal
  3. Use of nose clip
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35
Q
  • Used to determine the anatomical deadspace in the
    lungs
A

Open- Circuit (NITROGEN WASHOUT) Method

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36
Q

This technique can only measure gas that is in
communication with the mouth.

A

Open- Circuit (NITROGEN WASHOUT) Method

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37
Q
  • Any trapped gas distal to airway obstruction will not be
    measured
A

open circuit nitrogen washout

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38
Q
  • Patient’s lungs is diluted with 100% oxygen from the FRC
    baseline
A

ocnw

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39
Q
  • As the subject breathes the oxygen, all of his or her
    exhaled gas is collected in a ______ which
    measures its volume.
A

TISSOT Spirometer

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40
Q

A _______ in the breathing circuit is used to
monitor nitrogen concentrations.

A

nitrogen analyzer

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41
Q

______ should be discontinued for a few minutes
prior to testing to avoid erroneous measurements

A

02 therapy/supplemental oxygen

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42
Q

_____ automatically measures the final nitrogen concentration
and exhaled volume, calculating the FRC, RV, and TLC

A

Computer-based pulmonary function system

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43
Q

Approximately ________ of breathing 100% 02 to
wash out N2 from the lungs

A

3-7 minutes

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44
Q
  • Test is successfully completed when the N2 levels
    decrease to become
A

less than 1.5% for at least 3
successive breaths (subjects without obstructive
disorders)

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45
Q

a different method of FRC determination is needed if

A

oxygen-induced hypoventilation is a documented
problem (as in COPD),

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46
Q

Open- Circuit (NITROGEN WASHOUT) Method

A
  1. Hypercapnia stimulates breathing
  2. Prolonged breathing of 100% oxygen may
    increase the blood oxygen level
  3. Stimulus to breath is lost
  4. Hypoventilation and acidosis
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47
Q

may result from washout of nitrogen from
poorly ventilated lung zones (obstructed areas)

A

atelectasis

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48
Q

Problems with Nitrogen Washout

A

Atelectasis may result from washout of nitrogen from
poorly ventilated lung zones (obstructed areas)
• Elimination of hypoxic drive in CO2 retainers
is possible
• Underestimates FRC due to underventilation of areas
with trapped gas

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49
Q

Criteria for ending a Nitrogen Washout Test
(Table 4-4 pg. 89, Madama)

A
  1. Exhaled nitrogen levels decrease to become <1.0% for
    subjects without obstructive disorders
  2. Prematurely discontinue: System leak, Pt. is unable to
    continue, If Tissot Spirometer used, becomes full
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50
Q

Nitrogen Washout Criteria for Acceptability

A
  1. The washout tracing/display should indicate a
    continually falling concentration of alveolar N2
  2. The test should be continued until the N2
    concentration falls to <1.5% for 3 consecutive breaths
  3. Washout times should be appropriate for the subject
    tested. Health subjects should washout N2 completely in
    3-4 minutes.
  4. The washout time should be reported. Failure to wash
    out N2 within 7 minutes should be noted.
  5. Multiple measurements should agree within 10% 6.
    Average FRC from acceptable trials should be used to
    calculate lung volumes.
  6. At least 15 minutes of room air breathing should elapse
    between repeated trials, >1 hr for patients with severe
    obstructive or bullous disease
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51
Q

A technique for measuring functional residual capacity
and residual volume and total lung capacity.

A

Closed- Circuit (HELIUM DILUTION) Method

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52
Q

It is based on the principle that if a known volume and
concentration of helium are added to a patient’s
respiratory system, the helium will be diluted in
proportion to the lung volume to which it is added.

A

Closed- Circuit (HELIUM DILUTION) Method

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53
Q

Since Helium is _____, as patients breaths the helium, it’s
volume does not decrease since it is not absorbed by the
blood

A

inert

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54
Q
  • Patient is connected to a ________ and a
    known volume and concentration of helium is added to
    the system
A

“rebreathing system”

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55
Q
  • is defined as Helium
    concentration changes of less than 0.02% over a 30
    second interval
A
  • A state of equilibrium
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56
Q
  • A state of equilibrium is defined as Helium
    concentration changes of less than
A

0.02% over a 30
second interval

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57
Q

During He dilution measurement of lung volumes,
patients breathe from a known volume and concentration
of Helium gas for a period of typically

A

4 to 7 minutes.

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58
Q

The oxygen concentration in the starting mixture is set
at _____ to ensure patients with COPD can remain
comfortable during the test

A

30%

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59
Q

-___ is situated in line with expired
breath to keep the closed-circuit CO2 level below 0.5%
and avoid discomfort and hyperventilation.

A

A carbon dioxide absorber

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60
Q

A carbon dioxide absorber is situated in line with expired
breath to keep the closed-circuit CO2 level below _____
and avoid discomfort and hyperventilation.

A

0.5%

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61
Q

is added to the system to maintain the starting
volume in the spirometer.

A

Oxygen

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62
Q

A Volume of ____ is sometimes subtracted from
the FRC to correct loss of He to the blood

A

100 ml

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63
Q

should be subtracted from the FRC

A

The dead space volume of the breathing valve and
filter

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64
Q
  1. Spirometer is filled with
    a known volume of air with added
A

oxygen of 25-30%

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65
Q
  1. A volume of He is added so that a concentration of
    approximately ____ is achieved
A

10%

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66
Q

helium dilution Criteria for Acceptability

A
  1. Spirometer tracing should indicate no leaks (detected
    by a sudden decrease in He), which would cause an
    overestimation of FRC
  2. Test is successfully completed when He readings
    change by less than 0.02% in 30 seconds or until 10
    minutes has elapsed
  3. Multiple measurements of FRC should agree within
    10%
  4. The average of acceptable multiple measurements
    should be reported
    Criteria for ending a helium dilution test Table 4-5 p. 92
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67
Q

The amount of CHANGE in air pressure and CHANGE in
volume during breathing is measured and used in the
equation

A

body plethysmography

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68
Q

The amount of _______ is measured and used in the body pleth
equation

A

CHANGE in air pressure and CHANGE in
volume during breathing

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69
Q
  • Also measures air trapped within noncommunicating
    thoracic compartments
A

body pleth

70
Q
  • To calibrate the box pressure signal, a ____ is used with the cabin door closed and the box sealed.
A

30 ml sinusoidal pump

71
Q

The _____ in and out of the sealed box
causes a change in the box pressure signal. Thus, the
pressure change can be calibrated against a known
volume

A

30 ml stroke of volume

72
Q

can be measured simultaneously
during open-shutter panting (1.5-2.5 Hz)

A

Airway Resistance (Raw) and Specific Airway
Conductance (SGaw)

73
Q
  • Airway Resistance (Raw) and Specific Airway
    Conductance (SGaw) can be measured simultaneously
    during
A

open-shutter panting (1.5-2.5 Hz)

74
Q

Most plethysmographs have___ and allow VC maneuvers to be
performed during the same testing session

A

built-in
pneumotachometers

75
Q
  • This method of measuring FRC actually measures all the
    ________; the actual
    measurement made is VTG (Volume of Thoracic gas)
A

conducting pathways including abdominal gas

76
Q
  • This method of measuring FRC actually measures all the
    conducting pathways including abdominal gas; the actual
    measurement made is
A

VTG (Volume of Thoracic gas)

77
Q
  • The most significant volumes for evaluating the effects
    of pulmonary disorders are
A

VC, FRC, RV, and TLC

78
Q

Patient is required to support cheeks with both hands
and pant with an open glottis at a rate of

A

0.5 - 1 Hz (30 -
60 breaths/min)

79
Q

Body pleth Criteria for Acceptability

A
  1. Panting maneuver shows a closed loop without drift
  2. Tracing does not go off the screen
  3. Panting is 0.5 - 1 Hz
  4. Tangents should be within 10%
  5. At least 3 FRC pleth values should agree within 5% and
    the mean reported
80
Q

• Increase FRC is considered

A

pathologic

81
Q

FRC values >120% of predicted represent

A

air trapping (Emphysematous

82
Q

FRC values _____ of predicted represent air trapping

A

> 120%

83
Q

• FRC, RV and TLC typically decreased

A

restrictive pattern

84
Q

• Usually lung volumes are decreased equally

A

restrictive pattern

85
Q

When TLC is <80% a_____ process is present

A

restrictive

86
Q

RV/ TLC is relatively normal

A

restrictive pattern

87
Q

RV/ TLC% >35% + Normal TLC

A

air trapping

88
Q

RV/ TLC% >35% + >Normal TLC

A

hyperinflation

89
Q

acute or chronic? hyperinflation

A

acute

90
Q

acute or chronic? air trapping

A

chronic

91
Q

IC volum

A

3600

92
Q

frc volume

A

2400

93
Q

vc volume

A

4800

94
Q

tlc volume

A

6000

95
Q

The total volume of the lungs can be subdivided into smaller units of volume. These units are based on

A

total lung capacity (TLC), the resting end-expiratory lung volume, and a series of specific breathing maneuvers

96
Q

A capacity is a larger unit which includes

A

two or more of the
defined lung volumes.

97
Q

The expressions _____ and _______ are both traditionally used to describe ventilation.

A

“exhaled minute ventilation”
“rninute volume”

98
Q

A consistent point of reference is needed for accurate lung volume measurement. ______ lung volume provides a reliable, stable reference level.

A

The resting end-expiratory or FRC

99
Q

a deep inspiration can trigger _______ and affect the measurement

A

bronchospasm

100
Q

to avoid the effects of bronchospasm, the maneuver should be performed as a

A

maximal expiration followed by a
maximal inspiration.

101
Q

The subject should breathe on the spirometer using a

A

mouthpiece and with noseclips on

102
Q

The subject must be observed to ensure that

A

the lips are sealed, nothing obskucts the mouth, and that there are no leaks in the system.

103
Q

Three key points for VC test are

A
  1. The breathing by the subject during the maneuver should be relaxed and controlled, not forceful.
  2. The inspirations and expirations should be at a relatively constant flow rate.
  3. The subject should maintain a brief volume plateau at both the maximal expiratory level and inspiratory level.
104
Q

The most significant factor affecting test performance is

A

subject effort.

105
Q

Acceptable maneuvers
should be repeated until _______ is demonstrated

A

reproducibility

106
Q

Measureinents of VC should be made before ______ are
performed. This is recommended to help avoid possible _______
on VC measurement.

A

FVC tests
muscle-fatigue and volume-history effects

107
Q

is the volume of air that was exhaled during the VC maneuver from the FRC baseline down to the RV level

A

ERV

108
Q

. volume of air inhaled from the FRC level up to
the TLC level.

A

Inspiratory capacity (IC) is the

109
Q

Accurate measurement of _____ as a separate volume is not possible. This is because the tidal end-inspiratory level does not provide a stable baseline from which to initiate and complete the maneuver.

A

IRV

110
Q

117 the past, volume measureincnts for direct spirometry had to be made by hand from a

A

spirometry tracing

111
Q

Most often, indirect spirometry is performed to measure_____. Once it has been determined, the subject’s RV and TLC can be calculated.

A

FRC volume

112
Q

Air trapped within the lung and not in communication with conducting airways cannot experience the

A

required gas dilution.

113
Q

Subjects with ____ can have trapped, noncommunicating air within
their lungs that is not detectable by gas dilution techniques

A

obstructive or bullous disease

114
Q

t. Another potential source of a “system” leak that can affect measurement results is the subject having a

A

perforated eardrum.

115
Q

the natural volume of nitrogen
in the subject’s lungs is washed out and diluted with

A

100% oxygen

116
Q

The washout procedure must be carefully initiated with the subject breathing in 100% oxygen from the

A

FRC baseline level.

117
Q

Because prolonged breathing of 100% oxygen may have negative effects on some subjects, tests should generally not extend beyond

A

7 minutes

118
Q

. In some people with COPD, ____ can blunt the normal
blood carbon dioxide stimulus that maintains regular breathing.

A

chronic hypercapnia

119
Q

known concentration of nitrogen (CalvN2) in the lungs is considered to be approximately

A

0.75.

120
Q

CalvN2

A

known concentration of nitrogen

121
Q

If for some reason a nitrogen washout test is not acceptably completed, the test can be repeated after a delay of_______ The delay may have to be longer for
subjects who have an obstructive pulmonary disorder.

A

at least 15 minutes.

122
Q

If the test must be repeated for some reason, it should be delayed for at least _______, this allows time for any residual helium to wash
out of the lungs before the next test.

A

four minutes

123
Q

During the test, a_____ in the system helps to circulate and effectively distribute the air,

A

blower

124
Q

is used to prevent carbon dioxide retention by the subject.

A

A soda lime canister

125
Q

With this method, a large bolus of
oxygen is added to the spirometer before the start of the test.

A

oxygen-bolus method

126
Q

With this method, oxygen is added to the system continuously during the test. The rate of oxygen addition is titrated to match the rate of consumption by the subject during the test.

A

volume-stabilized method.

127
Q

for the rebreathed helium-containing volume.

A

Douglas bag-like reservoir

128
Q

has the disadvantage of requiring a correction for tissue
nitrogen contribution.

A

The open-circuit method

129
Q

also provides a generally accepted method
for assessing the distribution of ventilation

A

the nitrogen washout test

130
Q

During BP test administration, the subject is required to perform

A

an open-glottis panting maneuver at a rate of approximately one to two breaths per second.

131
Q

is closed suddenly at end-expiration just prior to an inspiration

A

The BP shutter

132
Q

Therefore, airway pressure changes at
the mouth may be assumed to reflect

A

alveolar pressure changes

133
Q

is used to create a graph of the pressure and volume changes during panting

A

An oscilloscope or video display

134
Q

A minimum of three acceptable test maneuvers must be performed because the calculation for VTG requires a____ for angle tangent from several test tracings

A

mean value

135
Q

may be estimated by using measureinents made from chest radiographs

A

Total lung capacity

136
Q

Two methods have been developed. In each, the measurements are based on
____________ that are taken at maximum subject inspiration.

A

posterior-anterior and lateral chest X rays

137
Q

assumes that the lungs, in a cross sectiOn through the chest,
are basically elliptical in shape. Measurements are made on the X rays that divide the thorax into a series of five vertical segments

A

ellipsoid volume method

138
Q

The _______ is a second radiographic technique for estimating TLC. It uses to correlate the lung surface areas measured on chest X rays to TLC
measurements made by body plethysmography.

A

planimetry method, regression equations

139
Q

The planimetry surface areas can be determined by
use of a device called a

A

planimeter

140
Q

Normal values for lung volumes are related most directly differences between subjects

A

to height, age, and gender

141
Q

A useful tool in evaluating lung volume studies is the

A

residual volume/total lung capacity ratio (RV/TLC%)

142
Q

In normal, young, healthy adults,
the RV/TLCO%, ranges between

A

20% and 35%

143
Q

A value greater than 35% indicates

A

air trapping in the lungs

144
Q

is demonstrated when, in addition to the
RV/TLCU/, being greater than normal, the TLC of the subject is also significantly greater
than normal.

A

Hyperinflation of the lungs

145
Q

tend to demonstrate reductions in all lung volumes.

A

restrictive

146
Q

on the other hand, tend to demonstrate increases in only some volumes

A

Obstructive patterns,

147
Q

Space-occuppying abnormalities within the thorax

A

(c.g., pleural effusion, pneumonia, tumor)

148
Q

, loss of lung volume

A

(e.g., atelectasis, surgical excisions),

149
Q

increased lung elastic recoil

A

(e.g., interstitial fibrosis-sarcoidosis, asbestosis, and complicated silicosis)

150
Q

deformities of the chest wall

A

(e.g., severe kyphosco1iosis)

151
Q

all can produce general restrictive patterns.

A

Space-occuppying abnormalities within the thorax (c.g., pleural effusion, pneumonia, tumor), loss of lung volume (e.g., atelectasis, surgical excisions), increased lung elastic recoil (e.g., interstitial fibrosis-sarcoidosis, asbestosis, and complicated silicosis), and deformities of the chest wall (e.g., severe kyphosco1iosis)-

152
Q

, can demonstrate a greater reduction in VC than in other lung volumes.

A

weakness of the ventilatory muscles, neuromuscular disorders, and
CNS depression

153
Q

are the result of obstructive airway disorders

A

obstructive patterns

154
Q

Diseases such as chronic bronchitis and emphysema are common types of disorders producing this
pattern.

A

obstructive pattern

155
Q

Inflammatory diseases such as _____ can result in airway obstruction during
acute exacerbations but may be fully reversible.

A

asthma

156
Q

One is where increases in RV result in a proportional reduction
of VC while the TLC remains relatively constant

A

air trapping

157
Q

In the second pattern, RV increases with little or no change in VC. This causes an increase in TLC in direct proportion to the increase in RV.

A

Hyperinflation

158
Q

Ventilation must be evaluated within the context of

A

arterial blood gas (ABC) values.

159
Q

Hypoventilation, for example,
will produce

A

hypercapnia and acidosis

160
Q

will cause a subject to increase ventilation significantly

A

Diabetic ketoacidosis

161
Q

Increases in ventilation are caused by disorders or changes from

A

homeostasis

162
Q

A normal pattern of tidal breathing.

A

eupnea

163
Q

Tidal breathing at a more rapid rate than normal.

A

tachypnea

164
Q

Tidal breathing at a slower rate than normal.

A

bradypnea

165
Q

tidal breathing larger volumes than normal, faster rate of breathing

A

hyperpnea

166
Q

tidal breathing smaller volumes than normal, slower rate of breathing

A

hypopnea

167
Q

Ventilation insufficient for physiologic needs,
results in a relative hypercapnia and respiratory acidosis.

A

hypoventilation

168
Q

Ventilation in excess for physiologic needs,
results in a relative hypocapnia and respiratory alkalosis.

A

hyperventilation

169
Q

In severe thoracic/pulmonary restrictive disorders, the
work of breathing (WOB) is _____ when the subject breathes with smaller tidal volumes. As a result, in order to maintain adequate ventilation, the respiratory rate must be______ than normal.

A

less, greater

170
Q

Subjects with flow resistance caused by obstructive disorders experience ______ WOB at_____ respiratory rates. As a result of the_____ breathing rate, the tidal volume will be _____to maintain adequate overall ventilation.

A

less, slower, slower, increased

171
Q

It must be noted that increases in tidal volume and or respiratory rate can be exhibited by subjects solely as a .

A

result of breathing on the pulmonary function apparatus, eg anxiety or effects of nose clips

PFT (3 decks)

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