Pulmonary Assessment (Diagnostic Testing) Flashcards
CXR:
Hyperinflation and increased vascular markings
Antero-posterior diameter increased (Barrel chest)
Flattened diaphragm
COPD
Lung markings ______ prominent in chronic bronchitis and _________ in emphysema
more prominent
decreased
No role for _______ testing to estimate risk before surgery except Intrathoracic/lung resection surgery
routine
Pulmonary evaluation prior to select surgical procedures:
________ and _______ __________
Intrathoracic
lung resection
volume of gas that moves in/out lungs during quiet breathing (6-8 mL/kg)
Tidal Volume (TV)
Normal TV is __ mL/kg
7 mL/kg
volume of gas forcibly inhaled after a tidal inhalation
Inspiratory Reserve Volume (IRV)
volume of gas remaining within lungs after complete exhalation
Residual Volume (RV)
Regarding Lung volumes and capacities:
Cannot be measured with spirometry
Provides O2 reservoir during apnea
Residual Volume (RV)
volume of gas above the residual volume where the small airways begin to close
Closing Volume (CV)
This volume increases w/ COPD
Closing volume (CV)
IRV + TV + ERV + RV
Total Lung Capacity (TLC)
The maximum amount of air expelled from the lungs after a maximum inhalation (70 mL/kg)
Vital Capacity
The largest volume of gas inspired from resting expiratory level
Changes usually parallel vital capacity
Inspiratory Capacity
Volume of gas remaining in lungs at end-expiration (35 mL/kg)
Pre-oxygenation during anesthesia induction and intubation to fill the O2 reservoir to prevent hypoxemia during apnea
Functional Residual Capacity
(T/F) Normally, FVC = Vital Capacity (VC)
True
_____ reduced in COPD when VC normal
FVC
FVC < __ mL/kg associated with increased incidence PPCs: (indicates ineffective cough)
<15 mL/kg
Forced expiratory volume of gas over a given time interval (1sec) during the FVC maneuver
Forced Expiratory Volume 1s (FEV1)
This PFT measures large and medium sized airways
FEV1
FEV1 / FVC ratio: > ___% (Normal value)
> 75%
This PFT is the least dependent on patient effort and cooperation
Forced Expiratory Flow (FEF25-75%)
Average forced expiratory flow (FEF) during middle half of the FEV maneuver
Considered a mid-flow measurement
Forced Expiratory Flow (FEF25-75%)
Repeat PFTs __ times
3x
_____ Classification important for assessing/ranking obstructive disease
gold classification
______ values are very important for assessing restrictive disease
TLC (total lung capacity)
Name the only 2 PFTs that are not extremely low in restrictive disease
FEV1/FVC
FEF 25%-75%
Name the only 2 PFTs that are extremely low in obstructive disease
FEV1/FVC
FEF 25%-75%
Name the only 2 PFTs that are extremely low in obstructive disease
FEV1/FVC
FEF 25%-75%
_______ lung disease has a normal appearing flow-volume loop, except proportional decreases in all volumes
Restrictive
“ice cream scoop” on flow volume loop
Obstructive disease
This type of airway defect causes obstruction on expiration
Variable Intrathoracic Obstruction
This type of airway defect causes obstruction on inspiration
Variable Extrathoracic Obstruction
________ is the standard method for measuring most relative lung volumes
Spirometry
Spirometry is incapable of providing information about ________ volumes of air in the lung
absolute
Two of the most common methods of obtaining information about absolute volumes are ____ ________ tests and ______ ____________
gas dilution
body plethysmography
the main factor limiting diffusion is the _________-_________ ___________
alveolar–capillary membrane
inert gas (helium) concentration measured in expired air then residual volume is calculated
Gas dilution test
measures TLV
Pressure and flow measurements are collected in an air tight booth
Body plethysmography
Criterion for resectability, who is a “Good” surgical candidate?
FEV1 > 1.5L or 40% predicted value
DLCO > 40% predicted value
TLC < 80% predicted value
Mild restrictive lung disease
TLC < 60% predicted value
moderate restrictive lung disease
TLC < 50% predicted value
Severe restrictive lung disease
TLC < 35% predicted value
very severe restrictive lung disease
TLC < 35% predicted value
very severe restrictive lung disease
3 conditions with decreased Diffusing capacity for carbon monoxide (DLCO)
ILD. Interstitial lung disease
COPD
Anemia
FEV1 & DLCO > ___% to be considered a good surgical candidate for lung resection
40%
Look at TLC for _________ disease
restrictive disease
Do not obtain spirometry routinely before surgery other than _____ _________.
lung resection
Obtain ________ for patients with COPD or asthma having high-risk surgery (thoracic, esophageal, upper abdominal, aortic)
spirometry
Consider ________ for patients with unexplained dyspnea or effort intolerance
spirometry
