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MS-PA: Respiratory Diseases > PFT > Flashcards

PFT Flashcards

1
Q

What are the indications for PFT?

A

*PFT is is indicated for the diagnosis unexplained hypoxiema and dyspnea in at-risk patients.
*PFT can also be used for asymptomatic patients at high risk such as people on long-term amiodrone.
* PFT for prognostication of known diseases.

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2
Q

What are the three categories in which PFT can be used to classify lung diseases ?

A

1) Obstructive lung diseases such as COPD to Emphysema, Asthma, Bronchiestasis, and cystic fibrosis.
2) Restrictive lung diseases Interstitial lung diseases, chest wall pathologies, obesity and neuromuscular diseases.
3) Pulmonary vascular diseases such as pulmonary hypertension and Chronic thromboembolic diseases.

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3
Q

What are the types of interstitial lung diseases ?

A

Pulmonary fibrosis, sarcoidosis,

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4
Q

What are the common chest wall pathologies diagnosed using PFT ?

A

impact of kyphosis and scoliosis.

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5
Q

What are the neuromuscular diseases in which PFT is indicated ?

A

ALS, muscular dystrophy.

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6
Q

What are the lung functions tested in PFT ?

A

*function of large and small airways.
* Function of paranchymal structures such as alveoli and Interstitium.
* Pulmonary vasculature
* function of diaphragm and chest wall.
* Neural control of ventilation.

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7
Q

what is spirometry ?

A

It is a measure of air flow consist of flow-volume loops and lung volumes

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8
Q

What does Diffusion capacity of Carbon monoxide (DLco) Measure ?

A

It measure the integrity of alveolar capillaries.

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9
Q

what types of lung disease is diagnosed using spirometry ?

A

Obstructive lung diseases

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10
Q

What type of lung disease is diagnosed with lung volume measurements ?

A

restrictive lung disease

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11
Q

What type of lung disease is diagnosed with DLCO?

A

It diagnose pulmonary vascular disease in conjunction with other tests.

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12
Q

what is tidal volume ?

A

It is the amount of air moves in and out of the lungs during a respiratory cycle at rest. It is ~ 500 ml in men and ~400 ml in woman.

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13
Q

What is inspiratory reserve volume ?

A

It is the extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration. The normal value is between 1900- 3300 ml.

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14
Q

What is expiratory reserve volume ?

A

It is the amount of extra air exhaled above normal expiration during a force full expiration and is normally b/w 1100 ML in men and 800 ML in female.

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15
Q

What is residual volume ?

A

It is the amount of air left in the lungs after forced expiration and is normally 1 to 1.2 L

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16
Q

What is inspiratory capacity ?

A

It is the sum of the tidal volume and inspiratory reserve volume.

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17
Q

What is functional reserve capacity ?

A

It is the sum of the expiratory reserve volume and the residual volume.

18
Q

What is vital capacity ?

A

It is the sum of the tidal volume + inspiratory reserve volume and expiratory reserve volume.

19
Q

What is total lung capacity ?

A

It is the volume of air in the lungs upon the maximum effort of inspiration and in healthy adults it is closer to 6 L.

20
Q

What is Forced Vital Capacity ?

A

It is the maximum air one can forcefully exhale after maximal inhalation and it is normally 80 % of TLC or 4.8 L.

21
Q

What is forced Expiratory Volume in 1 second /FEV1 ?

A

It is the amount of air exhaled in one second after maximal inspiration and it range from 4.5 to 3.5 liters in males and from 3.25 to 2.5 liters in females.

22
Q

What is normal FEV1/ FVC ratio?

A

70% and 65% in people over the age of 65.

23
Q

what is the obstructive pattern in spirometry ?

A

FEV1= normal in very mild obstruction and decreased in moderate to severe obstruction.
FVC= normal in mild to moderate disease and decreased in sever disease.
The FEV1/FVC ratio ( Tifeneau Index) = is always <70%.

24
Q

What is the restrictive pattern in spirometry ?

A

FEV1= normal or decreased
FVC= decreased similar or greater than FEV1.
FEV1/FVC ratio = either normal or increased ≥ 70%

25
Q

How to interpret spirometry results ?

A

(Obstructive disease)
First step = look at Tifeneau index if it is low
Second step= Look at FVC, if it is normal the patient has obstructive disease, if it is low the patient has obstructive or mixed disease.

( restrictive disease)
1st step= look at Tifeneau index if it is high or normal
2nd step= Look at FVC, if it is low the patient may have restrictive lung disease. if it is high or normal the patient has normal lung mechanics.

26
Q

What is the pattern of mild obstruction in flow-volume loop?

A

Mild reduction in PEFR and coving of the expiration segment of the flow- volume loop.

27
Q

What is the pattern of sever obstruction in flow-volume loop?

A

Marked reduction in PEFR and more pronounced coving of the expiratory segment.

28
Q

What is the pattern of restrictive lung disease in flow-volume loop?

A

PEFR can be normal or mild reduction. However, the FVC educed consistently which causes shrinkage of flow volume loop in all directions, there will be no coving of the expiratory segment.

29
Q

What is variable extrathroacic airway obstruction and its flow volume loop characteristics?

A

An extrathroacic airway obstruction occurs when inspiratory flow is limited more than the corresponding expiratory flow due to a dynamic narrowing of the extrathoracic airway lumen under the increasing negative intraluminal pressure of forced inspiration, which limit maximum inspiratory flow.
On flow- Volume loop it is seen as shrinkage of inspiratory limb.
example: Vocal cord paralysis.

30
Q

What is variable intrathoracic airway obstruction and its pattern on flow-volume loop ?

A

In flow- volume loop it is seen as flattening of the expiratory limb like a table.

31
Q

What is the flow volume loop presentation of fixed airway obstruction ?

A

it is shrinkage of expiratory limb and inspiratory limb of the Flow-volume loop into a table shape due to obstruction of inhalation and exhalation.

32
Q

What is the GOLD classification of post-bronchodilatory FEV1 in COPD with a Tifeneau Index <70%?

A

GOLD 1 - mild: FEV1 ≥80% predicted. GOLD 2 - moderate: 50% ≤ FEV1 <80% predicted.
GOLD 3 - severe: 30% ≤ FEV1 <50% predicted.
GOLD 4 Very severe: 30% ≤ FEV1predicted.

33
Q

what is the purpose of post bronchodilatory PFT ?

A

GOLD guidelines state that in the case of a large increase of ≥12% and ≥ 400 mL in FEV1 after bronchodilator inhalation, the possibility of COPD is low, whereas the likelihood for asthma or asthma-COPD overlap syndrome is high.
when only FVC is increased (≥12% and ≥200 mL of the baseline), it may also be considered as a sign of bronchiectasis.

34
Q

what is the volume parameter that indicate obstructive lung disease?

A

Increase in residual volume and low Tefenau index.

35
Q

what is the volume parameter that indicate restrictive lung disease?

A

Low TLC

36
Q

what is the volume parameter that indicate mixed lung disease?

A

Low Tefenau index and low TLC

37
Q

What is DLCO ?

A

It measures how much volume of carbon monoxide per min per ml of mercury across the alveolar capillary membrane.

38
Q

what is severe impairment of gas exchange based on DLCO results ?

A

< 40% predicted

39
Q

what are the conditions that decrease DLCO ?

A

Anything that decreases alveolar membrane surface area such as emphysema or anything that increase the alveolar membrane thickness such as ILD.
The other causes are PHTN, anaemia.

40
Q

what are the factors that increase DLCO ?

A

exercise , supine position, asthma, pulmonary haemorrhage, polycythemia and mild left heart failure.

MS-PA: Respiratory Diseases (15 decks)

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