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Clinical Medicine II > Pulm: PFTs > Flashcards

Pulm: PFTs Flashcards

1
Q

What three tests make up the basic PFTs?

A

Airflow Spirometry

Lung Volumes

DLCO

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2
Q

FEF 25-75%

A

Forced Expiratory Flow 25-75%

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3
Q

SVC

A

Slow vital capacity

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4
Q

IC

A

inspiratory capacity

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5
Q

IRV

A

Inspiratory Reserve Volume

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6
Q

FRC

A

Functional Residual Capacity

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7
Q

How many times must spirometry be performed and for what reason

A

3x, it is an operator dependent test

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8
Q

In what position should spirometry be performed?

A

sitting

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9
Q

What is the test procedure for spirometry?

A
  1. relax, breath normally
  2. deep breath in
  3. Forceful exhalation of all air
  4. Deep Breath In
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10
Q

This measurement is most useful for measuring obstruction…

A

FEV1

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11
Q

This measure is the total volume of air with maximal effort

A

FVC

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12
Q

This measure defines the severity of obstruction and assists in differentiating obstructive and restrictive lung disease

A

FEV-1/ FVC Ratio

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13
Q

What measure of FEV-1/FVC is considered an obstructive pattern?

A

< 0.7

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14
Q

This measures the airflow movement during the middle half of forced expiration.

It is nonspecific for small airway obstruction, but may indicate early disease.

A

FEF 25-75%

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15
Q

If this test is positive it:

Aides in Dx
Provides Tx options
Improves Compliance

A

Bronchodilator/Reversibility testing

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16
Q

What indicates reversibility with bronchodilator testing?

A

FEV1 increased by 12% and 200ml

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17
Q

What is the protocol for bronchodilator/reversibility testing?

A
  1. Use neb or inhaler, monitor technique
  2. 2-4 puffs, hold in lungs 5-10 seconds
  3. spirometry after 15 minutes
  4. Repeat 3-8 rounds
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18
Q

What indicates a positive bronchoprovication/methacholine challenge test?

A

FEV-1 decreased by 20%

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19
Q

What is the protocol for the bronchoprovocation/methacholine challenge test?

A
  1. administer dilute methacholine solution via neb.
  2. spirometry at 30 and 90s
  3. increase concentration
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20
Q

Does bronchoprovocation need to be monitored? Methacholine is a part of what drug class that makes this so?

A

Yes

M agonist causes bronchoconstriction

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21
Q

What must be achieved when assessing the quality of the curves in spirometry? (4)

A
  1. volume-time curve plateu
  2. expiration lasting > 6s
  3. two best efforts w/in 0.2:L
  4. flow-volume loop free of artifact
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22
Q

Inspiratory flow > Expiratory flow indicates…

A

obstructive disease

23
Q

Inspiratory flow > Expiratory flow indicates…

A

restrictive lung disease

24
Q

Volume of air within the lung after maximal inhalation…

A

TLC

25
Q

Volume of air we breathe out following maximal inhalation

A

VC

26
Q

The volume of air remaining in the lungs after maximal exhalation

A

RV

27
Q

Formula for TLC…

A

TLC = VC + RV

28
Q

This test:

Measures ability of lungs to transfer gas and saturate Hb

Uses CO as surrogate for O2 transfer

A

DLCO

29
Q

What can lead to a false reduction in the DLCO?

A

anemia

30
Q

How is DLCO measured?

A

measurement of helium/CO during exhalation

31
Q

DLCO test is administered and the following result achieved:

-Little CO collected during exhalation

How should these results be interpreted?

A 
Healthy lungs
(CO exchanged for CO2 in the alveoli, so little CO remains in lungs)
32
Q

DLCO test is administered and the following result is achieved:

-higher CO levels collected during exhalation

How should these results be interpreted?

A

Diseased lungs

less CO can diffuse, so more remains in the lungs

33
Q

This PFT profile indicates obstructive or restrictive disease?

TLC: Increased
FVC: Normal
RV: Increased
FEV-1: Decreased
FEV-1/FVC: Decreased
A

Obstructive

34
Q

This PFT profile indicates obstructive or restrictive disease?

TLC: Decreased
FVC: Decreased
RV: Decreased
FEV-1: Decreased
FEV-1/FVC: Normal/Increased
A

Restrictive

35
Q

Obstructive or restrictive?

Airway narrowing –> limited airflow with expiration

Reduced airflow with high lung volumes

Normal inspiration

A

Obstructive

36
Q

Obstructive or restrictive?

Reduced lung expansion –> Reduced lung volume

Inspiration and expiration will appear normal, but flow and volume significantly reduced

A

Restrictive

37
Q

FEV-1/FVC Decreased…

A

obstructive

38
Q

FEV-1/FVC increased/normal

A

Restrictive

39
Q

The following conditions are considered obstructive or restrictive?

Asthma
Asthmatic bronchitis
bronchitis
COPD
CF
Emphysema
Upper Airway Obstruction
A

Obstructive

40
Q

The following conditions are considered obstructive or restrictive?

Pulm. Fibrosis
ILD
Thoracic deformity
pleural effusion
tumor
neuromuscular disease
obesity
A

Restrictive

41
Q

5 Steps to PFT Interpretation:

A
  1. examine flow-volume curve
  2. examine FEV-1 value
  3. Examine FEV-1/FVC ratio
  4. Examine bronchodilator response
  5. Examine DLCO
42
Q

3 things to look for on flow-volume curve…

A
  1. normal appearing?
  2. scooped out? (obstructive pattern)
  3. increased/peaked slope? (restrictive)
43
Q

On the flow-volume curve, you notice a scooped out appearance. What does this indicate?

A

Obstructive Lung Disease

44
Q

On the flow-volume curve, you notice the slope is increased with a peak appearance. What does this indicate?

A

Restrictive lung disease

45
Q

What 3 things should you look for when examining FEV-1 and lung volumes?

A
  1. Normal? r/o obstruction/restriction
  2. Decrease by 15-20% from predicted value? Obstruction
  3. TLC increased 15-20%? Obstruction
46
Q

What 3 things should be examined when looking at the FEV-1/FVC Ratio

A
  1. Ratio 70% or less? Obstructive
  2. Ratio 70%-LLN.
  3. Normal/increased? restrictive
47
Q

A normal FEV-1 and lung volumes rules out…

A

obstruction and restriction

48
Q

A decreased FEV-1 and lung volume by 15-20% of predicted value indicates…

A

obstruction

49
Q

A TLC increased by 15-20% indicates…

A

obstruction

50
Q

An FEV-1/FVC ratio 70% or less indicates…

A

obstruction

51
Q

If FEV-1/FVC ratio is between 70%-LLN, what should you consider?

A

Mild obstruction

Refer to FEV-1 and FEF 25-75% for asthma consideration

52
Q

If FEV-1/FVC is normal to increased, what should you consider?

A

restrictive disorder

53
Q

When examining bronchodilator response, the FEV-1 increased by 12%. What does this suggest?

A

hyperreactive, reversible airways

54
Q

What should you look for on DLCO?

A

normal, increased or decreased?

Clinical Medicine II (31 decks)

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