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Pulmonary > PATHOPHYS: PFTs > Flashcards

PATHOPHYS: PFTs Flashcards

1
Q

What are some indications for PFTs?

A
  • Symptoms (dyspnea, cough)
  • Pre-Operative Evaluation
  • Occupational exposure
  • Evaluate therapeutic response
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2
Q

What is the “lung age”?

A

way that you can “coach” patients and explain the results of PFTs

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3
Q

What are the common PFTs that are run together?

A 
Spirometry
MVV
Lung volumes
DLCO
ABG
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4
Q

What dimesions are measured with PFTs?

A

Volume
Flow
Pressure

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5
Q

What should you do when you look at a spirometry reading?

A
  • Check test quality
  • Check vital capacity
  • Look at FEV1/FVC (should be around 80%)

ON TEST

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6
Q

What factors impact vital capacity?

A

Sex
Age (negative correlation)
Height (positive correlation)
NOT WEIGHT!!!!

ON TEST

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7
Q

What is considered to be a positive post-bronchodilator response?

A

200 ccs and 12% of vital capacity
OR
15% from basal FEV1

ON TEST

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8
Q

What is MVV?

A

Maximal voluntary ventilation: gross predictor of the strength of the lung

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9
Q

What should your MMV be?

A

40 times FEV1

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10
Q

What makes up the vital capacity?

A

Tidal volume + IRV + ERV

TEST

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11
Q

What makes up the functional residual capacity?

A

Expiratory reserve volume + Residual volume

TEST

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12
Q

True or False: both restrictive and restrictive lung disorders have low FVCs.

A

TRUE

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13
Q

How do you define an obstructive ventilatory defect?

A

FEV1/FVC ratio below 70%

ON TEST

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14
Q

What lung volume cannot be measured by spirometry?

A

Residual volume

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15
Q

How do you measure TLC?

A

Spirometry + Body plethysmograph (gold standard)

ON TEST

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16
Q

What type of diseases decrease TLC?

A

Disease of thorax, inspiratory muscles, pleural diseases, and loss of functioning alveoli

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17
Q

What type of diseases decrease VC?

A
  • Chest pain (too much pain to have maximum inspiratory effort)
  • Fatigue
  • Poor effort
18
Q

What is dynamic hyperinflation?

A

People with obstructive airway diseases air-trap in the chest due to destruction of septi between alveoli which increases the residual volume! When a patient with COPD exercises, the hyperinflation gets worse (stacking of air with each inspiration).

ON TEST

19
Q

What capacity is decreased due to static hyperinflation?

A

Inspiratory capacity

20
Q

What is compliance?

A

change of volume over change in pressure

21
Q

What is the compliance of a restrictive disease?

A

LOW (takes a lot of pressure to change a little volume)

ON TEST (know curves)

22
Q

What is the compliance of an obstructive disease?

A

HIGH (takes a little pressure to make a large volume change)

ON TEST (know curves)

23
Q

A normal slow vital capacity excludes what type of disorder?

A

a restrictive disorder

24
Q

What is commonly seen in COPD patients?

A

concominant restriction

25
Q

What leads to flow velocities being higher for each given instantaneous volume?

A

elastic recoil of the lungs

ON TEST

26
Q

What are the two portions of an expiration in the flow loop?

A

Effort dependent AND a portion that is driven by elastic recoil of the lungs

27
Q

What leads to “cut off” inspiration and expiration?

A

upper airway obstruction (tracheal stenosis)

28
Q

How quickly does oxygen exchange occur in the capillary?

A

all exchange is done in the first 1/4 of the capillary transit time

29
Q

What does the lung diffusion capacity measure?

A

Functioning capillary bed in contact with ventilated alveoli

30
Q

What do things like emphysema and fibrosis do to the DLCO?

A

Decrease DLCO

31
Q

What does blood in the lungs (ex. Goodpasture’s syndrome) do to the DLCO?

A

Increase DLCO

32
Q

What is used to measure the DL of the lung?

A

carbon monoxide

33
Q

What leads to a “cut off” inspiration only?

A

Extrathoracic upper airway obstruction (vocal cord paralysis)

34
Q

What leads to a “cut off” expiration (which slightly alters inspiration)?

A

Intrathoracic upper airway obstruction (endobronchial mass)

35
Q

True or false: Diffusion has a small role in producing gas exchange abnormalities in resting conditions.

A

True!

36
Q

What two things alter DL?

A

Reduced by reductions in TLC

Altered per gram of Hb

37
Q

What are the limitations of “single breath” test of DLCO?

A

it requires inhaled VC of > 1L and 10 seconds of breath holding (which may be difficult for some patients)

38
Q

What is considered to be “normal” DLCO?

A

81-140%

39
Q

How can you differentiate between COPD and asthma?

A

DLCO is decreased in emphysema

40
Q

What else can the COPD help differentiate between (restrictive diseases)?

A

interstitial v. chest wall diseases

41
Q

Does a positive bronchoprovocation test rule in asthma?

A

NO! negative test rules it out!

42
Q

What is considered to be a positive bronchoprovocation test?

A

FEV1 decrease of 20% with a methacholine dose of 8 mg/dL

Pulmonary (34 decks)

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