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Concepts 2 > Pulmonary Function Tests > Flashcards

Pulmonary Function Tests Flashcards

1
Q

TLC

A

Deep Inspiration: Hold 4-6 L

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2
Q

VC (vital capacity)

A

•amount exhaled AFTER maximal inspiration

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3
Q

FRC

A

functional residual capacity

Gas remaining after normal expiration

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4
Q

What cannot be measured by simple spirometry?

A

TLC, FRC, RV

(total lung capacity, functional residual capacity, and residual volume)

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5
Q

IRV

A

(inspiratory reserve volume)

Amt. inhaled above normal TV (60% TLC)

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6
Q

ERV

A

expiratory reserve volume

expiration beyond normal TV (20% TLC)

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7
Q

Lung Capcity = ____

What are the 3 different formulas?

A

Lung Capacity = The sum of 2+ volumes

Vital Capacity=IRV+TV+ERV

FRC=ERV+RV

•TLC= IRV+TV+ERV+RV

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8
Q

Spirometry = ___

A

Measurement of the speed and the amount of air that can be exhaled and inhaled. There are two types: static (for lung volumes) and dynamic (for FEV1 and flow rate).

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9
Q

The simplest test of lung function is __ and is measured by ___.

A

forced expiration

spirometry

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10
Q

Body Plethysmography test

A

patient sits in an upright chamber (looks like telephone booth) with a spirometer attached which is used to determine the flow properties of the patient

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11
Q

Cardiopulmonary stress test

A

used to evaluate dyspnea that is out of proportion to findings on static pulmonary tests (to differentiate between cardiac and pulmonary issues)

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12
Q

Diffusing Capacity of Lung for Carbon Dioxide

A

to evaluate the presence of possible parenchymal lung disease

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13
Q

When the value of the patients SaO2 is 90%, you would expect the PaO2 to be _____.

A

60 mm Hg

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14
Q

The P50 is ______.

A

the partial pressure of O2 at which Hgb is 50% saturated

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15
Q

When the SO2 = 90 what is the PO2 ?

A

60

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16
Q

When the SO2 = 83 what is the PO2 ?

A

50

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17
Q

When the SO2 = 70 what is the PO2 ?

A

40

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18
Q

When the SO2 = 50 what is the PO2 ?

A

27

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19
Q

Physiologic dead space (Vd) is the sum of ______

A

Anatomic + Alveolar Vd =Physiologic Vd

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20
Q

Anatomic dead space is characterized by _____.

A

air confined to the conducting airways.

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21
Q

Alveolar Dead Space = ____

A

•Alveoli that are ventilated but not perfused

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22
Q

Apparatus Dead Space = ____

A

Vd added by equipment

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23
Q

What is the normal value for anatomic dead space?

A

150 ml

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24
Q

What is the normal value for physiologic dead space?

A

150 ml

Becomes larger under certain disease conditions

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25
Q

Which type of dead space penetrates the gas exchange region of the lung?

A

Physiologic dead space

Anatomic dead space DOES NOT penetrate gas exchange regions of the lung

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26
Q

What parts of the respiratory tract are involved with anatomic dead space?

A

Nose, pharynx, trachea, and bronchi

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27
Q

What parts of the respiratory tract are involved with physiologic dead space?

A

Nose, pharynx, trachea, bronchi, bronchioles, alveolar duct, alveolar sac, & alveoli,

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28
Q

Which type of dead space has clinical importance?

A

Physiologic!

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29
Q

Dead space definition

Blood supply =

Ventilation =

A

Dead space = volume of air which does not take part in gas exchange, as it remains in the conducting airways or reaches alveoli, which are not perfused

Blood supply = Poor

Ventilation = Normal

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30
Q

Shunt definition

Blood supply =

Ventilation =

A

A shunt is a pathological condition, which results when the alveoli of the lungs are perfused with blood as normal, but the ventilation fails to supply the perfused region.

Blood supply = normal

Ventilation = poor

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31
Q

What are the different types of shunts?

What are the causes of a shunt?

A

Types: Anatomic and Capillary

Causes: Pneumonia and pulmonary edema, tissue trauma, atelectasis, mucus plugging, pulmonary arteriovenous fistulas etc.

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32
Q

Examples of Phsyiologic Shunts

A

Bronchial circulation

Thebesian veins

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33
Q

Examples of Intrapulmonary Shunts

A

AV malformations

ARDS

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34
Q

Examples of extrapulmonary shunts

A

Congenital heart disease

ASD/PFO

VSD

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35
Q

Causes of dead space

A

cardiovascular shock, emphysema, pulmonary embolism

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36
Q

What is the normal FEV1/FVC ratio?

A

4l/5L= 0.8 / 80%

(FEV1 = forced exhale over 1 second. Usually that normal is 4L give or take. And then the forced vital capacity is how much they can blow out completely.)

37
Q

What would the FEV1/FVC ratio be with restrictive disease?

A

> = 0.8 / 80%

38
Q

What would the FEV1/FVC ratio be with obstructive disease?

A

< 0.8 / 80%

39
Q

With an obstructive pattern, the TLC is ___

A

normal or increased

40
Q

With an restrictive pattern, the TLC is ___

A

decreased

41
Q

What is the simplest test of lung function?

A

forced expiration

measured by spirometry

42
Q

What are the lung volumes that can be measured by spirometry?

A

tidal volume

inspiratory reserve volume

expriatory reserve volume

vital capacity

43
Q

static lung volumes are AKA ____

A

absolute volumes

(they are more complicated)

44
Q

residual volume vs. FRC = ___

A

residual volume = volume remaining in the lung after forced maximal exhalation

FRC = volume of tgas in the lung after normal exhalation

CANNOT BE MEASURED BY SIMPLE SPIROMETRY

45
Q

forced exhalation is considered ____ and recommended that it is ___ in duration

A

dynamic

6 seconds

46
Q

With obstructive patterns, the expiration tends to end prematurely. Why?

A

early airway closure brought about by increased smooth muscle tone or the loss of radial traction

radial traction is what helps keep our alveoli open

radial traction lost in pts with emphysema

47
Q

With restrictive patterns, inspiration is limited by ___

A

the reduced compliance of either the lung (fibrotic) or chest wall, or weakness of your inspiratory muscles

48
Q

intrapleural pressure is __

A

theoretically always negative during inspiration

49
Q

Helium is ____

A

virtually insoluble in blood

50
Q

Measuring FRC with Helium Testing

A

after a few breaths, the helium concentrations should become the same (equilibrium).

The amount of helium that is present before and after the equilibriation phase is measured.

The helium is DILUTED by the functional residual capcity. The FRC is measured by the concentration of helium.

Not the best choice for obstructive disorders, but a good choice for normal lung function or restrictive.

51
Q

Nitrogen Washout Method

A

We have 80% nitrogen concentration in our lungs, we wash it out with our oxygen.

patient breathes into a container, that volume is measured and is how we measure the patient’s FRC with this test

52
Q

Plethysmography (telephone booth) correlates with which gas law

A

Boyle’s! P1V1 = P2V2

Christ that was a terrifying throwback to Berstein

53
Q

The damage that is done with most pulmonary diseases like COPD will show up in the ____ airways.

A

smallest

54
Q

A spirogram gives us what information?

A

the different lung volumes over time in seconds

55
Q

Flow volume loop displays our ___

A

air flow

displayed in liters per second

as it relates to lung volume in liters during your maximal inspiration from a complete exhalation as well as during a maximum expiration from a complete inspiration

56
Q

How are flow volume loops helpful?

A

Helpful in evaluation of airflow limitation on inspiration and on expiration

can help delineate on whether the pathology of a problem is intrathroacic or extrathoracic (see Connie’s slide #15 for visual)

57
Q

With upper airway problems, what will be mostly affected?

A

inspiratory flow

58
Q

With the FVC, we look at percent of predicted value which is dependent on ____.

What is the normal value

A

patient’s demographics (age, sex, race, height)

when we think about normal, the threshold is 80-120% of predicted value given the patient’s demographics (Connie said to remember this)

59
Q

Why would your total lung capacity be increased with obstructive airway disease?

A

Air trapping!

Air trapping increases the total lung volume

60
Q

Examples of obstructive lung disease

A

Asthma, COPD (emphysema, bronchitis), bronchiolitis/bronchiectasis

61
Q

Examples of restrictive diseases

A

Interstitial lung disease – Neuromuscular weakness

Pleural disease – chest wall deformities - obesity

62
Q

FVC values

A

80 – 120% =Normal

70 – 79% = Mild reduction

50 – 69% = Moderate reduction

< 50% = Severe reduction

63
Q

FEV1 values

A

> 75% Normal

60 – 75% Mild obstruction

50 – 59% Moderate obstruction

< 49% severe obstruction, < 25 add 5%, > 60 subtract 5%

64
Q

FEF25-75

A

> 79% Normal

60 – 79% Mild obstruction

40 – 59% Moderate obstruction

< 40% Severe obstruction

65
Q

TLC values

A

> 79% Normal

70 – 79% Mild restriction

60 – 69% Moderate restriction

< 60% Severe restriction

66
Q

What values would be supportive of an asthma diagnosis for spirometry?

A

Improvement in volumes by 15% after an albuterol treatment

67
Q

DLCO = ?

A

diffusing capacity of lungs for carb monoxide

68
Q

Isolated reduction of DLCO raises possibility of _____.

A

pulmonary vascular disease

69
Q

What would DLCO look like for restrictive disease?

(diffusion capacity)

A

Low diffusion capacity= Intrinsic disease (parenchymal lung disease, or increased thickness of tissue like fibrosis)

Normal diffusion capacity= Extraparenchymal causes of restriction (obesity, NM disease, chest wall limitations)

70
Q

What would DLCO look like for obstructive disease?

(diffusion capcaity)

A

Low = emphysema (due to decreased surface area)

Normal = asthma

71
Q

What is the normal PaO2 for arterial ABG

Some causes of hypoxia

A

Normal = 90-95 mmHg

  • Alveolar hypoventilation
  • Diffusion impairment
  • Shunt
  • Ventilation-perfusion inequality
  • Reduced FiO2
72
Q

The bronchial circulation sends blood to the ___ whereas the Thebesian veins send blood to the ____.

I DONT UNDERSTAND THE SIGNIFICANCE OF THIS IF ANYONE WANTS TO HELP A SISTER OUT

A

left atrium

left ventricle

73
Q

Physiologic shunts are a mechanism of ___ to ___.

A

ventilation to perfusion mismatch

74
Q

General facts about V/Q mismatch

A
  • Ventilation > perfusion at apex of lung
  • Perfusion > ventilation at base of lung
  • HOWEVER, Both ventilation and perfusion are greater at base than they are at the apex
  • Ventilation is estimated at 4 L
  • Perfusion is estimated at 5L (consider this your cardiac output)
  • Mismatch of 0.8
  • Therefore arterial oxygen is 80 – 100 mmHg
  • It’s normal to have an alveolar to arterial oxygen difference
75
Q

Oxygen Carrying Capacity

A

Based off of Henry’s Law (Hgb X 1.34)

Blood is composed in two phases: plasma and red blood cells. The fracrtional volume of blood occupied by the RBCs is called the Hematoctrit. Value is normally 40% in women and 45% in men.

Oxygen is carried in blood in two forms. 98% attached to Hgb and 2% in dissolved plasma.

76
Q

Partial pressure of oxygen in your arterial tree

(this is the formula Connie gave)

A

PaO2 = 760 -47 (0.21)

(not sure I got this one right)

77
Q

What is the normal oxygen consumption?

A

3.5 mL/kg/min

(with a 70kg patient, it would be approximately 250 ml/min)

*she said to know this one

78
Q

CO2 elevation and decreased pH cause what to the erythrocyte?

A

cause the erythrocyte to release the oxygen

(this comes from the oxyhemoglobin dissociate curve)

79
Q

Deoxygenated Hemoglobin is going to be able to carry more ___

A

CO2

80
Q

The Bohr effect describes ___

A

changes in Hgb oxygen affinity that arises from changes in the hydrogen concentration

81
Q

A rightward shift in the curve would ___

A

increase the P50 and lowers the Hemoglobin’s affinity for oxygen thus displacing the oxygen from the Hgb and releasing it to the tissues

82
Q

A leftward shift in the curve would ___

A

decreases the P50 and increases Hgb’s affinity for oxygen thus reducing its availability to the tissues

83
Q

Causes of Hypoventilation

A
  • Depression of respiratory centers (Drugs)
  • Diseases of the medulla
  • SCI
  • Neuromuscular disorders (Guillain-Barre – ALS – Duchenne – MG)
  • Thoracic abnormalities
  • Upper airway obstruction
84
Q

Causes of Diffusion Impairments

A
  • Sarcoidosis
  • asbestosis
  • Pulmonary fibrosis
  • Connective tissue disease
  • Scleroderma – SLE – Wegener’s
85
Q

If Dead space increases, ___.

A

minute ventilation (RR and/or Vt) must increase

86
Q

What is pulmonary ventilation? How is it measured?

A

The total gas flow (including dead space gas volume)

The total volume of gas per/min inspired and expired = L/min

87
Q

Alveolar Ventilation

A
  • Amount of air that reaches the gas exchange areas.
  • Vt (tidal volume) - anatomic dead space x RR
  • A change in either RR or Vt will change alveolar ventilation
  • Impairment in alveolar ventilation will increase the retention of CO2
  • An increase in Vt is more effective to increase alveolar ventilation
88
Q

Pearls of hypoventilation and hypercarbia

A
  • Hypoventilation can cause hypercarbia and hypoxemia
  • Supplemental oxygen can easily reverse hypoxemia, however it does nothing to reverse hypercarbia
  • Hypercarbia can go undetected in the patient breathing supplemental oxygen

Concepts 2 (11 decks)

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