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PFTs Flashcards

1
Q

What are the 5 components of the respiratory unit?

A
  • Airways
  • Alveoli
  • Interstitium
  • Capillary
  • RBCs
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2
Q

When is it appropriate to order PFTs? (5)

A
  1. Evaluation of pts with suspected respiratory disease
  2. Eval of severity of respiratory disease
  3. Preop
  4. Eval of persons at risk for pulmonary disease
  5. Assessment of therapeutic response
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3
Q

True or false: you should never order PFTs in the acute setting

A

True

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4
Q

What are the three factors of respiration that are measured with PFTs?

A

Flow
Volume
Gas exchange

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5
Q

What is the normal Tidal Volume?

A

500 mL

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6
Q

What is the functional residual capacity?

A

Residual volume + expiratory reserve

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7
Q

What is the vital capacity?

A

TLC - residual volume (total volume that you can move)

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8
Q

What is inspiratory capacity?

A

Tidal volume + inspiratory reserve (total amount of air that you can move into your lungs, not including the residual volume)

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9
Q

What is the expiratory reserve volume?

A

Difference between the end of tidal volume expiration, and residual volume

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10
Q

Which lung volume cannot be measured with an inspirometer?

A

Residual volume

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11
Q

What is the first thing to check with a PFT result?

A

Name and date

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12
Q

What does spirometry measure? Is this a static or dynamic measure?

A

Flow

Dynamic

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13
Q

What do capacities measure?

A

Volume

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14
Q

What is used to determine gas exchange?

A

Carbon monoxide

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15
Q

What is body plethysmography?

A

Static measurement of lung volumes

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16
Q

What is DLCO? What is it used to assess?

A

Diffusion capacity of the lungs for CO. Used to evaluate gas exchange capacity of the lungs

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17
Q

Can spirometry be used to definitively diagnose restrictive lung disease?

A

No, but can aid in diagnosis

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18
Q

What are the three major factors that may affect the accuracy of spirometry?

A
  • Inability to follow instructions
  • Muscular weakness
  • Poor oral seal
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19
Q

What is the reference population for PFTs based on? (4)

A

Age
Gender
Height
Race

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20
Q

What position must the patient be in to properly evaluate PFTs?

A

Seated

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21
Q

What happens to the lungs as we age?

A

Lose elasticity

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22
Q

What is FEV1?

A

Change in expiratory volume in the 1st second

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23
Q

Where is the FEV1 on a normal time-volume curve?

A

max of dV/dt

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24
Q

What is FEV25-75?

A

Forced expiratory volume in the 25-75% of the curve

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25
What part of a PFT is used to assess whether or not there is an obstruction to airflow? What value of this is characteristic of an obstruction to airflow?
FEV1/FVC | Less than the 5th percentile or a value less than 0.7
26
What value of a PFT determines the severity of an obstruction to airflow? What values indicate mild, moderate, and severe?
``` FEV1: Mild = greater than 70% Mod = 50% to 69% Severe = 35-50% Very Severe = less than 35% ```
27
What are the obstructive pathologies to airflow? (6)
- Asthma - COPD - Bronchiectasis - CF - Upper airway obstruction - Extrinsic airway narrowing - FBs
28
What happens to the flow volume loop with an obstructive disease?
Earlier outflow peak, with a sudden dropoff of flow
29
What happens to the FVC plateau on the time-volume exhaled curve with an obstructive disease? What about the FEV1?
Lower plateau, with a lower FEV1 value
30
What happens to the FVC plateau on the time-volume exhaled curve with an restrictive disease? What about the FEV1?
Lower plateau, with a lower FEV1 value
31
Sequential FVC measurements should be within what value of each other to be considered good quality?
Within 5%
32
How can you determine that quality of the breath in a PFT (time vs volume exhaled curve)?
Morphology of the graph
33
What are the characteristics of the flow-volume curve pattern with restrictive lung diseases?
Lower volumes and flow rates, but normal morphology of the curve
34
What happens to the volume vs flow curve with an obstructive disease?
Indentation of the normal curve, with a lower PEF (flow drops off more quickly than usual after peak reached)
35
What happens to the time-volume expired curve with obstructive diseases?
Slow rise, reduce volume expired, prolonged time to full expiration
36
What is the morphology of the flow-volume loop with a large lower airway obstructive disease? Why?
Inflow is normal, but expiratory flow plateau is reduced, and prolonged Expiration increases pressure inside the lungs, and puts pressure on a narrow airway
37
What is the morphology of the flow-volume loop with a fixed lower airway obstructive disease? (think concentric obstruction)
Reduced flows throughout inspiration and expiration
38
What is the indication for a bronchoprovocation test?
Evaluate airway hyperresponsiveness
39
What are the three drugs used to induce bronchospasm with a bronchoprovocation test?
Methacholine Mannitol Hypertonic saline
40
What indicated a positive bronchoprovocation test?
If FEV1 decreases by more than 20% after drug administration
41
What is the PD20 for a bronchoprovocation test?
Dose required to lower the FEV1 by 20%
42
What are the three techniques to measure lung capacities?
- Body plethysmography - Nitrogen wash out - He technique
43
What is Boyle's law? What is the simplification that is used with body plethysmography?
(V1)(P1)(T1) = (V2)(P2)(T2) T1=T2, thus (V1)(P1) = (V2)(P2)
44
What is the range of TLC that indicates a restrive lung pathology?
Less than 80% of normal
45
What is the range of TLC that indicates a hyperinflated lung pathology?
Greater than 120% of normal
46
What are some examples of the neuromuscular pathologies that can cause restrictive lung diseases?
Myasthenia gravis Guillain-barre Spinal cord injury
47
What are the skeletal abnormalities that can cause restrictive lung disease?
Kyphosis | Scoliosis
48
How do you determine the cause of a restrictive lung disease?
DLCO normal = respiratory unit it fine, and the restriction is outside the lungs. If decreases, then it is affected.
49
What can cause abnormal DLCO? (3)
- Alveolar abnormalities - Interstitial space process - Capillary/circulation probs
50
What is the MIP? A low value indicates what?
Maximum inhalation against an occluded airway Lower value indicates breathing problems are neuromuscular in origin
51
What is MEP?
Maximal exhalation against an occluded airway
52
What are the 8 steps of PFT interpretation?
1. Ensure demographics 2. FEV1/FVC 3. How severe 4. Fixed or reversible 5. Large airway obstruction 6. Intra or extrathoracic 7. Restrictive process? 8. Parenchymal disease
53
What are the PFT values that are used to determine if there is an airway obstructive present?
FEV1/FVC
54
What are the PFT values that are used to determine the severity of an obstruction?
FEV1 compared to reference
55
What are the PFT values that are used to determine if there is an airway obstruction is fixed or reversible?
Variation of FEV1 and/or FVC on prebronchodilator and post
56
Obstructive or restrictive pattern on time vs volume expired curve: Slow rise, reduced volume expired; prolonged time to full expiration
Obstructive
57
Obstructive or restrictive pattern on time vs volume expired curve: fast rise to plateau at reduced max volume
Restrictive
58
Reduced inflow but normal outflow on a volume-flow curve indicates what? Why?
Upper airway obstruction d/t lower pressures in the airways are occluding the upper airways
59
What is the treatment for paradoxical vocal cord dysfunction?
Speech pathology exercises
60
What does the volume-flow curve look like with a fixed obstruction? Why?
low plateau on both inspiration and expiration, since the obstruction does not change with inspiration or expiration
61
What does the volume-flow curve look like with neuromuscular weakness?
Lower flows and volumes throughout
62
After giving bronchodilators, the FEV1 must improve by more than what percent and increase by how many mLs to diagnose an obstructive lung disorder
12% | 200 mL

Respiratory (34 decks)

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