Pulmonary Assessment (Diagnostic Testing)

Question 1

CXR:

Hyperinflation and increased vascular markings

Antero-posterior diameter increased (Barrel chest)

Flattened diaphragm

Answer 1

COPD

Question 2

Lung markings ______ prominent in chronic bronchitis and _________ in emphysema

Answer 2

more prominent

decreased

Question 3

No role for _______ testing to estimate risk before surgery except Intrathoracic/lung resection surgery

Answer 3

routine

Question 4

Pulmonary evaluation prior to select surgical procedures:

________ and _______ __________

Answer 4

Intrathoracic

lung resection

Question 5

volume of gas that moves in/out lungs during quiet breathing (6-8 mL/kg)

Answer 5

Tidal Volume (TV)

Question 6

Normal TV is __ mL/kg

Answer 6

7 mL/kg

Question 7

volume of gas forcibly inhaled after a tidal inhalation

Answer 7

Inspiratory Reserve Volume (IRV)

Question 8

volume of gas remaining within lungs after complete exhalation

Answer 8

Residual Volume (RV)

Question 9

Regarding Lung volumes and capacities:

Cannot be measured with spirometry
Provides O2 reservoir during apnea

Answer 9

Residual Volume (RV)

Question 10

volume of gas above the residual volume where the small airways begin to close

Answer 10

Closing Volume (CV)

Question 11

This volume increases w/ COPD

Answer 11

Closing volume (CV)

Question 12

IRV + TV + ERV + RV

Answer 12

Total Lung Capacity (TLC)

Question 13

The maximum amount of air expelled from the lungs after a maximum inhalation (70 mL/kg)

Answer 13

Vital Capacity

Question 14

The largest volume of gas inspired from resting expiratory level

Changes usually parallel vital capacity

Answer 14

Inspiratory Capacity

Question 15

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

Answer 15

Functional Residual Capacity

Question 16

(T/F) Normally, FVC = Vital Capacity (VC)

Answer 16

True

Question 17

_____ reduced in COPD when VC normal

Answer 17

FVC

Question 18

FVC < __ mL/kg associated with increased incidence PPCs: (indicates ineffective cough)

Answer 18

<15 mL/kg

Question 19

Forced expiratory volume of gas over a given time interval (1sec) during the FVC maneuver

Answer 19

Forced Expiratory Volume 1s (FEV1)

Question 20

This PFT measures large and medium sized airways

Answer 20

FEV1

Question 21

FEV1 / FVC ratio: > ___% (Normal value)

Answer 21

> 75%

Question 22

This PFT is the least dependent on patient effort and cooperation

Answer 22

Forced Expiratory Flow (FEF25-75%)

Question 23

Average forced expiratory flow (FEF) during middle half of the FEV maneuver

Considered a mid-flow measurement

Answer 23

Forced Expiratory Flow (FEF25-75%)

Question 24

Repeat PFTs __ times

Answer 24

3x

Question 25

_____ Classification important for assessing/ranking obstructive disease

Answer 25

gold classification

Question 26

______ values are very important for assessing restrictive disease

Answer 26

TLC (total lung capacity)

Question 27

Name the only 2 PFTs that are not extremely low in restrictive disease

Answer 27

FEV1/FVC

FEF 25%-75%

Question 28

Name the only 2 PFTs that are extremely low in obstructive disease

Answer 28

FEV1/FVC

FEF 25%-75%

Question 29

Name the only 2 PFTs that are extremely low in obstructive disease

Answer 29

FEV1/FVC

FEF 25%-75%

Question 30

_______ lung disease has a normal appearing flow-volume loop, except proportional decreases in all volumes

Answer 30

Restrictive

Question 31

“ice cream scoop” on flow volume loop

Answer 31

Obstructive disease

Question 32

This type of airway defect causes obstruction on expiration

Answer 32

Variable Intrathoracic Obstruction

Question 33

This type of airway defect causes obstruction on inspiration

Answer 33

Variable Extrathoracic Obstruction

Question 34

________ is the standard method for measuring most relative lung volumes

Answer 34

Spirometry

Question 35

Spirometry is incapable of providing information about ________ volumes of air in the lung

Answer 35

absolute

Question 36

Two of the most common methods of obtaining information about absolute volumes are ____ ________ tests and ______ ____________

Answer 36

gas dilution

body plethysmography

Question 37

the main factor limiting diffusion is the _________-_________ ___________

Answer 37

alveolar–capillary membrane

Question 38

inert gas (helium) concentration measured in expired air then residual volume is calculated

Answer 38

Gas dilution test

Question 39

measures TLV

Pressure and flow measurements are collected in an air tight booth

Answer 39

Body plethysmography

Question 40

Criterion for resectability, who is a “Good” surgical candidate?

Answer 40

FEV1 > 1.5L or 40% predicted value

DLCO > 40% predicted value

Question 41

TLC < 80% predicted value

Answer 41

Mild restrictive lung disease

Question 42

TLC < 60% predicted value

Answer 42

moderate restrictive lung disease

Question 43

TLC < 50% predicted value

Answer 43

Severe restrictive lung disease

Question 44

TLC < 35% predicted value

Answer 44

very severe restrictive lung disease

Question 45

TLC < 35% predicted value

Answer 45

very severe restrictive lung disease

Question 46

3 conditions with decreased Diffusing capacity for carbon monoxide (DLCO)

Answer 46

ILD. Interstitial lung disease

COPD

Anemia

Question 47

FEV1 & DLCO > ___% to be considered a good surgical candidate for lung resection

Answer 47

40%

Question 48

Look at TLC for _________ disease

Answer 48

restrictive disease

Question 49

Do not obtain spirometry routinely before surgery other than _____ _________.

Answer 49

lung resection

Question 50

Obtain ________ for patients with COPD or asthma having high-risk surgery (thoracic, esophageal, upper abdominal, aortic)

Answer 50

spirometry

Question 51

Consider ________ for patients with unexplained dyspnea or effort intolerance

Answer 51

spirometry