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Respiratory care > PFT > Flashcards

PFT Flashcards

1
Q
A

Restrictive pattern

  • low volume and normal flow
  • Reduced FVC
  • Normal FEV1/FVC ratio
  • obesity, Pulmonary fibrosis, interstitial lung disease, muscular dystrophy, scoliosis, sarcoidosis, pulmonary embolus
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2
Q
A

small airway obstruction

  • Low flow, FVC normal or low
  • Asthma exacerbation
  • emphysema
  • chronic bronchitis
  • Bronchodilators, corticosteriods
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3
Q
A

fixed large airway obstruction

  • Reduced flows on insp and exp
  • tracheostenosis
  • reduced vols and flows
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4
Q
A

Variable intrathoracic large airway obstruction

  • Expiratory curve flattened
  • flows and volumes are impacted on exhalation only
  • inside thorax
    • tracheal CA
    • tracheal malacia(soft trachea)
    • tumor
    • tx: surgical intervention
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5
Q
A

Variable extrathoracic large airway obstruction

  • Inspiratory curve flattened- reduced flow and volume
  • outside of thorax
    • laryngeal CA
    • vocal cord dysfunction - speech therapy
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6
Q

When performing spirometry it is important that values are reported at?

A

BTPS

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7
Q

GOLD Standard

Stage 0

A

At-risk- symptoms present, Normal spirometry

Avoid risk factors

Get influenza vaccine

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8
Q

GOLD Standard

Stage 1

A
  • mild
  • FEV1/FVC <70%
  • FEV1 > or equal 80%
  • Add short acting Bronchodilator PRN
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9
Q

GOLD Standard

Stage 2A

A
  • Moderate
  • FEV1/FVC <70%
  • 50%<= FEV1<=80%
  • Add LABA and rehab
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10
Q

GOLD Standard

Stage 2B

A
  • Moderate
  • FEV1/FVC <70%
  • 30%<=FEV1<=50%
  • Add inhaled steroids if repeated exacerbations
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11
Q

GOLD Standard

Stage 3

A
  • FEV1/FVC <70%
  • FEV1<=30% or PaO2<60 or right heart failure
  • Add long term O2 if chronic resp failure, ? surgical rx
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12
Q

Nitrogen washout

A
  • Measures FRC by measuring volume of N2 in lungs at end exhalation
  • open circuit- no rebeathing
  • only measures gas with communication airways (Not trapped gas)
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13
Q

Helium dilution

A
  • Closed circuit (rebreathing)
  • pt. FRC is mixed with a second separate gas with know volume and %
    • 10% He (or other inert gas)
    • 21% O2
    • 69% N2
  • gas is rebreathed until helium diluted to equilibrium
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14
Q

DLCO

A
  • used to assess diffusion of CO across alveolar membrane
  • pt exhales to RV, then maximally inhales gas mixure
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15
Q

What effects DLCO results?

A
  • Direct relationship
    • surface area of ACM
    • capillary blood vol
    • lung volume active in gas exchange
    • amount of Hb
  • Inversely
    • thickness of ACM
    • carboxyhemoglobin level (smoker)
    • alveolar O2 tension (PAO2)
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16
Q

What causes decreased DLCO?

A
  • interstital lung disease (restrictive fibrosis)
  • emphysema
  • Pulmonary vascular disease (vasculitis, Pulm HTN)
  • pneumonia
  • sarcoidosis
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17
Q

What could cause increased DLCO?

A
  • increased VA
  • polycythemia
  • exercise
  • normal or high with asthma
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18
Q

FENO

A
  • Fractional exhaled nitric oxide
  • evaluates eosinophilic airway inflammation
  • increased value: asthma not in control or COPD exacerbation (nonmed compliance)
  • Decreased value: CF and smokers
  • Normal adult: 15-25 ppb
  • Normal child: 5-22 ppb
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19
Q

Bronchoprovocation study

A
  • Determination of airway hyper-reactivity
  • Precations
    • Resuscitation equipment on hand
    • MD immediately available
    • Meds to reverse the provocation agent
  • A positive test is when a 20 DECREASE in FEV1 is observed
20
Q

What values show Obstruction in spirometry?

A
  • Low FEV1/FVC defines the presence of obstruction
  • FEV1 determines the severity
21
Q

What values show restriction on spirometry?

A
  • Low FVC with normal or high FEV1/FVC suggests restrictive lung disease
  • Measurement of TLC used to confirm restriction and grade severity
22
Q

The predicted FVC value for African American is?

A

10-15% less than that for caucasions

23
Q

what spirometry parameter would you recommend to assist a patient with asthma in monitoring their day to day symptoms?

A

PEF

24
Q

What is the proper method to minimize cross contamination between patients performing tests that only require exhalation into the apparatus?

A
  • Change only those elements through which rebreathing occurs
  • Place a disposable bacterial filter between the patient and breathing circuit
25
Q

What do you do every time before you perform spirometry?

A

Calibrate the device

26
Q

ATS standards

A

Free from

  • hesitation(slow start)
  • cough
  • Early termination ( lasts at least 6 seconds)
  • a Valsalva maneuver (glottis closure)
  • leak

Must be reproducible

  • two best FVC are within 50 ml of each other
  • two best FEV1 are within 150ml of each other
27
Q

Vt

A

Volume inspired with a normal breath

28
Q

MVV

A

Maximal voluntary ventilation

The greatest amount of air you can breathe in 12 to 15 seconds

29
Q

TLC

A

argest amount of air the lungs can hold

30
Q

PEFR or PEF

A

Fastest flow generated at the very beginning of forced exhalation

large airways

Can be used to help an asthmatic monitor their daily symptoms

31
Q

DLCO

A

Millimeters of gas the lung can transfer to the blood

32
Q

VC

A

Amount of air you can exhale after a maximum inspiration

IRV+ Vt+ ERV

33
Q

FEV1/FVC

A
  • Ratio of volume exhaled in 1 second to the total volume exhaled
  • Ratio >70% = obstruction
  • a reduced FVC with normal ratio suggests restriction
34
Q

IC

A

Amount of air you can inhale after a normal expiration

IRV+Vt

35
Q

IRV

A

Amount of air you can inhale after a normal inspiration

36
Q

RV

A

Air left in the lungs after a maximum exhalation

37
Q

FRC

A

Air left in the lungs after a normal exhalation

ERV+RV

38
Q

FVC

A

Amount of air you can forcefully exhale after a maximum inhalation

Reduced in restrictive lung disease (because they, in general, have reduced volumes)

39
Q

FEF25-75%

A

Average expiratory flow during the middle part of forced expiration

40
Q

FEV1

A

Volume of air you can forcefully exhale in 1 second

  • Reduced in obstructive disease
  • Normal in Restrictive
41
Q

ERV

A

Amount of air you can exhale after a normal exhalation

42
Q

in addition to calibration with a 3-L syringe, what method should be used to validate the spirometer performance and accuracy of software computations?

A

testing with biologic controls

43
Q

when performing bedside spirometry, you observe an S-shaped plotted FVC-versus-time curve on the display. What most likely caused this?

A

failure to achieve a rapid start exhalation

44
Q

What is a positive test in a methacholine challenge/bronchoprovocation study?

A

a 20% decrease in the FEV1

45
Q

What is a normal respiratory quotient value?

A

.8

46
Q

What is a positive bronchodilator reversal on a PFT?

A
  • 12% increase on FEV1

AND

  • 200mL increase on FEV1 or FVC

Respiratory care (12 decks)

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