Pulmonary Function Test Flashcards
What does gas concentration and its transfer tell us?
diffusion capacity
What do you use to find inspiratory/expiratory air flows?
spirometer
What do you use to find lung volumes?
body plethysmograph
Change in volume over elastic pressure gives you what?
static compliance
What are these things:
- Methacholine
- Histamine
- Adenosine 5-monophosphate
- Cold air / Exercise tests
provocation or challenge tests
What are these:
- Treadmill
- Stationary bicycle
- Six minute walk test
cardiopulmonary exercise testing
What are these indications of:
hyper-responsiveness, chest tightness, twitchy airways, abnormally sensitive to non-specific stimulants
asthma
What is a nonselective muscarinic agonist used to induce muscle constriction in airways?
methacholine
What values are affected by: Age Gender Race Height Sex Weight Physical Factors (altitude)
pulmonary function values
After age of 25-30 years, adults normally lose small amounts (< 20 cc ) of (blank)
forced vital capacity or FVC per year
(blank) vary between races and ethnic origins
lung volumes
Some labs will routinely reduce (blank) by 10-15 % for African Americans
FVC
(blank) is capable of determining inspiratory and expiratory volumes as a function of time. (i.e flow or volume)
spirometry
What categories of abnormalities does this belong to:
Related to static mechanics
- Changes in volumes, pressures ( compliance )
restrictive
What categories of abnormalities does this belong to:
Related to dynamic mechanics
- Changes in volume/time, airflow ( flow rates )
Obstructive
What categories of abnormalities does this belong to:
Related to defects in gas exchange, changes in arterial blood gasses
vascular
If you have diaphragmatic weakness, what will it effect?
MIP and MEP
(blank) is defined as a complete expiration following a maximal inspiration
IF done as a slow expiration maneuver then termed a slow VC or SVC.
IF a rapid expiration maneuver then a fast VC or FVC
vital capacity
Forced expiratory volume over 1 second is what?
FEV1
Decreased FEV1 and decreased Flow rate-> hallmark of (blank)
airway obstruction (asthma, emphysema)
How long do you need someone to breath out to get a good pulmonary function test?
at least 6 seconds
How should the pulmonary function test look if normal?
a peak then a linear decrease
What is this:
Also called “ body boxes “
Two basic types:
The constant volume, variable-pressure type
The flow or variable-volume apparatus
Both are used to measure thoracic gas volume or TGV and changes in airway resistance and conductance
Utilize pneumotachometers
Utilize mouth pressure transducers
Allow measurement of volume differences in “box” and in lungs ( alveolar volume )
body plethysmographs
What do you use to measure thoracic gas volume or TGV and changes in airway resistance and conductance
body plethysmograph
(blank) is defined as a complete slow (not rapid or forceful) expiration following a maximal inspiration
Slow vital capacity (VC)
(blank) is the volume of gas contained in the lungs after a maximal inspiration
total lung capacity (TLC)
(blank) is the largest volume of gas that be inspired from a resting expiratory level - subdivision of vital capacity
inspiratory capacity (IC)
(blank) is the volume of gas measured from a slow, complete expiration after a maximal inspiration – subdivision of VC
Inspiratory reserve volume (IRV)
(blank) is the Volume of gas that can be expired from a resting end-expiratory level - a subdivision of VC
Expiratory reserve volume (ERV)
(blank) is the Volume of gas remaining in lungs at the end of a tidal breath
functional residual capacity (FRC)
(blank) is the Volume of gas remaining in lungs at the end of a maximal expiration, regardless of lung volume at which exhalation was initiated
Residual volume (RV)
(blank) or DLCO measures the transfer of CO across the alveolocapillary membranes. If you have Emphysema, cystic lung disease, fibrotic lung disease, pulmonary vascular disease you will have this reduced.
Diffusion capacity. It assesses the overall integrity of the alveoli, capillary bed and the alveolocapillary membranes.
DLCO involves what?
CO, O2, Nitrogen and tracers and the single breath-hold maneuver that allows to check out diffusion capacity
If you have a restriction, what happens to your FVC, FEV1, FRC, RV, TLC?
all decrease
If you have an obstruction what happens to your FVC, FEV1, FRC, RV, TLC?
decrease, decrease, increase, increase, increase
What does your volume flow loop look like in severe obstruction lung diseases?
inspiration normal, expiration is super short
What does your volume flow loop like in fixed or extra-thoracic upper airway obstruction?
squished inspiration and squished expiration
Point is that structural and functional abnormalities of upper airway can cause differences in (blank X 3)
inspiratory or expiratory or both limitations.
(blank) - dynamic truncation (squashing) of the INSPIRATORY LIMB of flow volume loop
- During inspiration and thoracic expansion, extraluminal, atmospheric pressure and negative, subatomspheric pressure combine to limit the area of the extrathoracic upper airway
- Tracheomalacia, laryngomalacia, vocal cord dysfunction
Variable extrathoracic obstruction
(blank) is the dynamic truncation (squashing) of the EXPIRATORY LIMB of the flow volume loop.
variable intrathoracic obstruction
What does this describe:
During inspiration - intrathoracic pleural pressure is negative relative to intratracheal or airway pressure, so NO flow limitation during inspiration.
During forced expiration – intrathoracic pleural pressure positive relative to intratracheal or airway pressure, so expiratory flow limited
Tracheal lesions, intrathoracic tracheomalacia, tracheal stenosis, lymphadenopathy (lymphoma), bronchogenic cysts
variable intrathoracic obstruction
What does this describe:
results in dynamic limitation of both INSPIRATORY and EXPIRATORY LIMBS of flow volume loop
May be caused by extraluminal obstructive lesions ( bulky mediastinal adenopathy, invasive thymoma, large thyroid cancers )
Bronchial mainstem lesions - usually cancers
fixed airway obstruction
What squishes both the inspiratory and expiratory limbs of the flow volume loop?
fixed obstruction
What squishes just the inspiratory limb of the flow volume loop?
variable extrathoracic
What squishes just the expiratory limb of the flow volume loop?
variable intrathoracic
If you have reduced FEV1/FVC ratio, reduced expiratory volume and reduced flow rates, AND bronchodilators increases your FEV1 and your FEF towards normal then what do you have?
asthma
If you have a proportional reduction in both FVC and FEV1, with a normal FEV1/FVC ratio (>70%). The flow volume loop will indicate the reduced volumes.
restrictive lung disease (like pulmonary fibrosis)
cardiomegaly -> suggestive of right ventricle and enlargement of main pulmonary arteries, reduced diffusion capacity, an alveolar capillary membrane is compromised (6 min walk will discern this)
hypoxemia (diffusion defects)
When that alveolar-capillary membrane is compromised what will occur?
Fluid – pulmonary edema
Diffuse pneumonitis
Fibrosis
Bronchoalveolar destruction – emphysema
Destruction or remodeling of arteriolar and capillary beds – In PAH, it is the alveolocapillary membrane > than capillary blood volume that is reduced
Diffusion of gas across those membranes impaired, resulting in hypoxemia
hypoxemia
6 min walk has prognostic abilities with (blank)
pulmonary hypertension
Thus, conditions that affect or disrupt these lung structures will impair or reduce the (blank)
DLCO (diffusion)
What do these conditions create? Emphysema, cystic lung disease, fibrotic lung disease, pulmonary vascular disease
decreased diffusion capacity
What is this:
Often time and distance recorded
Assesses oxygen degree of desaturation with ambulation
Has diagnostic, prognostic and therapeutic implications in COPD, interstitial lung disease, pulmonary hypertension, cardiomyopathies
six minute walk test
What is this:
Captures VO2, VCO2, Vd/Vt, end-tidal CO2
Again has diagnostic, prognostic and therapeutic implications
Cardiopulmonary stress testing
