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Heart, Lungs and Blood > Measuring and interpreting lung function tests > Flashcards

Measuring and interpreting lung function tests Flashcards

1
Q

What is the antenatal phase of lung function development and how is it affected by genetic and environmental factors?

A

The antenatal phase of lung function development is during the embryo and fetus stages, where there are 23 generations of airways and development of alveoli. Genetic and environmental factors, such as maternal smoking, maternal nutrition, placental insufficiency, prematurity (lack of surfactant and neonatal respiratory distress), and postnatal exposure to maternal smoking, infections, and allergens can affect lung function development during this phase.

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2
Q

What is the growth phase of lung function development and when does it occur?

A

The growth phase of lung function development occurs from birth to young adulthood.

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3
Q

What is the plateau phase of lung function development and when does it occur?

A

The plateau phase of lung function development occurs during young adulthood.

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4
Q

What is the decline phase of lung function development and when does it occur?

A

The decline phase of lung function development occurs during older adulthood.

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5
Q

What do basic pulmonary function tests measure?

A

Basic pulmonary function tests measure airflow, lung volumes, gas exchange, and airway reactivity.

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6
Q

What factors do lung function tests depend on?

A

Lung function tests depend on factors such as gender (F/M), age, height, weight, and ethnicity. The values obtained from these tests are compared to the predictive normal values obtained from a large cohort of individuals and expressed as a percentage.

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7
Q

What are some dynamic lung volumes that can be easily measured at the bedside or in the outpatient clinic?

A

Some dynamic lung volumes that can be easily measured at the bedside or in the outpatient clinic include peak expiratory flow (PEF), forced expiratory volume (FEV), forced vital capacity (FVC), and relaxed vital capacity (RVC).

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8
Q

What are some contraindications for dynamic lung volume measurements?

A

Some contraindications for dynamic lung volume measurements include haemoptysis, pneumothorax, severe hypertension, recent myocardial infarction, tachyarrhythmia, pulmonary embolism, aortic aneurysm, raised intraocular pressure, recent eye surgery, and recent thoracic or abdominal surgery.

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9
Q

In which respiratory conditions will PEF be reduced?

A

PEF will be reduced in obstructive airways diseases such as asthma, COPD, and bronchiectasis.

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10
Q

Is routine PEF monitoring recommended for COPD?

A

No, routine PEF monitoring is not recommended for COPD as it is a largely irreversible condition.

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11
Q

Why is diurnal peak flow monitoring important in asthma management?

A

Diurnal peak flow monitoring is important in asthma management as it can help identify triggers and assess the effectiveness of treatment.

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12
Q

What is normal diurnal variation in peak flow readings?

A

Normal diurnal variation in peak flow readings is 8%.

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13
Q

What is peak flow monitoring used for in the workplace?

A

Peak flow monitoring in the workplace is used to diagnose occupational asthma.

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14
Q

In which non-respiratory conditions may peak flow be reduced?

A

Peak flow may be reduced in diseases affecting the chest wall such as neuromuscular diseases and kyphoscoliosis, as well as diseases affecting the upper airways such as tracheal tumour and thyroid goitre.

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15
Q

What is spirometry?

A

Spirometry is a lung function test that measures the volume of air that can be exhaled during a forced expiration in one manoeuvre.

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16
Q

What is measured in spirometry?

A

Spirometry measures forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and calculates FEV1/FVC.

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17
Q

What is the normal range for FEV1/FVC ratio?

A

The normal FEV1/FVC ratio is 0.75-0.85 (75-85%) = 80%.

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18
Q

What distinguishes between obstructive and restrictive lung disease in spirometry?

A

FEV1/FVC ratio distinguishes between obstructive and restrictive lung disease.

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19
Q

What can spirometry values determine?

A

Spirometry values can determine the severity of the disease, the prognosis of the disease, and can be used to monitor response to treatment.

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20
Q

What distinguishes between obstructive and restrictive lung disease in spirometry readings?

A

The FEV1/FVC ratio. In obstructive lung disease, the ratio is < 0.7 due to narrowing of the large and medium-sized airways, resulting in reduced FEV1. In restrictive lung disease, the ratio is normal or increased due to decreased lung compliance, resulting in reduced FVC and possibly reduced FEV1.

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21
Q

What can be determined from spirometry readings?

A

The severity and prognosis of lung disease, as well as the response to treatment. In obstructive lung disease, the GOLD stage for COPD is determined based on spirometry readings.

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22
Q

What is reduced in restrictive lung disease?

A

FVC is reduced due to decreased lung compliance, resulting in less volume of air to expel. FEV1 may also be reduced to a lesser extent, but the FEV1/FVC ratio is normal or increased.

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23
Q

What is reduced in obstructive lung disease?

A

FEV1 is reduced due to narrowing of the large and medium-sized airways. The FEV1/FVC ratio is < 0.7.

24
Q

What conditions affect chest wall compliance?

A

Kyphoscoliosis, ankylosing spondylitis, diaphragmatic muscle weakness, and inspiratory muscle weakness can all affect chest wall compliance.

25
Q

What can the shape of the flow-volume loop differentiate between?

A

The shape of the flow-volume loop can differentiate between extra-thoracic and intra-thoracic obstruction.

26
Q

Why will narrowing at high lung volumes have the greatest effect on maximum expiratory flows?

A

Flow is more effort-dependent at high lung volumes.

27
Q

What is plotted against time in a flow-volume loop?

A

The volume of air inspired and expired is plotted against time.

28
Q

At what point are the airways most dilated and airway resistance minimized in a flow-volume loop?

A

At Total Lung Capacity (TLC).

29
Q

Why is the inspiratory manoeuvre in a flow-volume loop less reproducible than the expiratory part?

A

The inspiratory manoeuvre is more effort-dependent.

30
Q

What is FEV1/FVC and what values can indicate obstructive or restrictive lung diseases?

A

FEV1/FVC is the ratio of forced expiratory volume in 1 second to forced vital capacity. A ratio < 70% indicates obstructive lung disease and a normal or low ratio indicates restrictive lung disease.

31
Q

What can a normal flow-volume loop indicate?

A

A normal flow-volume loop indicates no significant airway obstruction or restriction.

32
Q

What is a low volume loop in a flow-volume loop test?

A

A low volume loop is a flow-volume loop with a reduced size due to reduced lung volumes.

33
Q

What is the flow-volume loop?

A

The flow-volume loop is a graphical representation of the volume of air expired or inspired over time, which can be used to assess lung function.

34
Q

What can the shape of the flow-volume loop indicate?

A

The shape of the flow-volume loop can differentiate between extra-thoracic and intra-thoracic obstruction.

35
Q

What is a low volume loop?

A

A low volume loop is a flow-volume loop in which the inspiratory or expiratory volumes are reduced, indicating a restrictive lung disease.

36
Q

What is concave loop pattern?

A

A concave loop pattern is when the expiratory limb of the flow-volume loop is concave, indicating an obstructive lung disease.

37
Q

What is scalloping in the flow-volume loop?

A

Scalloping in the flow-volume loop is a pattern where the expiratory flow is interrupted during the mid-portion of the exhalation, indicating variable extrathoracic obstruction such as vocal cord dysfunction.

38
Q

What is a small, but normal flow-volume loop?

A

A small, but normal flow-volume loop indicates normal lung function, but may occur in smaller individuals.

39
Q

What is upper airway obstruction?

A

Upper airway obstruction is a condition in which the airway in the upper respiratory tract is narrowed or blocked, leading to difficulty breathing.

40
Q

What are the three types of upper airway obstruction?

A

The three types of upper airway obstruction are variable extra-thoracic, variable intra-thoracic, and fixed intra-thoracic.

41
Q

What are static lung volumes?

A

Static lung volumes are the volumes of air in the lungs at different stages of breathing. These include Total Lung Capacity (TLC), Functional Residual Capacity (FRC), Residual Volume (RV), Vital Capacity (VC), and Tidal Volume (TV).

42
Q

How are static lung volumes measured?

A

Static lung volumes are measured using the helium dilution method or the whole body plethysmography method

43
Q

What is the purpose of measuring static lung volumes?

A

The purpose of measuring static lung volumes is to make an accurate diagnosis of lung disease.

44
Q

What is the Whole-body plethysmography test?

A

The Whole-body plethysmography test is a method used to measure lung volumes. It involves a large airtight body box that measures the change in pressure when the patient breathes.

45
Q

What are the normal values for static lung volumes?

A

Normal values for static lung volumes depend on the age, gender, ethnicity, height, and weight of the individual. The values are compared with values of individuals of the same characteristics and given as a percentage predicted.

46
Q

In which conditions is TLC reduced?

A

TLC is reduced in any intrapulmonary or extra-pulmonary restrictive disorder.

47
Q

In which condition is TLC increased?

A

TLC is increased in any condition that results in air trapping, such as obstructive lung disease.

48
Q

What is transfer factor for CO/Diffusing capacity?

A

Transfer factor for CO/Diffusing capacity (TLCO/DLCO) is an estimate of the amount of CO which diffuses across the alveolar-capillary membrane.

49
Q

How is transfer factor for CO measured?

A

Transfer factor for CO is measured using a single-breath method, using a very low concentration of CO as a surrogate for O2.

50
Q

What is the transfer coefficient?

A

The transfer coefficient is called KCO, and is the transfer factor per unit alveolar volume.

51
Q

How is TLCO calculated?

A

TLCO = KCO/VA, and is corrected for haemoglobin.

52
Q

What is KCO?

A

KCO measures the transfer of CO in the alveoli that are ventilated.

53
Q

What conditions can cause a reduction in TLCO?

A

TLCO is reduced by conditions that result in ventilation/perfusion mismatch, conditions that impede blood flow (such as pulmonary emboli), conditions that reduce alveolar surface area (such as emphysema), conditions that impede transport of oxygen across the capillary membrane (such as interstitial lung disease), and respiratory muscle weakness causing restriction, chest wall deformity, obesity and pneumonectomy.

54
Q

What conditions can cause an increase in TLCO?

A

TLCO is increased by increased pulmonary capillary blood volume (such as high cardiac output state, polycythaemia and pulmonary haemorrhage).

55
Q

Why may KCO be elevated in extra-thoracic restrictive conditions?

A

KCO may be elevated in extra-thoracic restrictive conditions because it measures the transfer of CO in ventilated alveoli, which have greater blood flow.

Heart, Lungs and Blood (51 decks)

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