Pulmonary Function Tests

Question 1

measures available air

Answer 1

Forced Vital Capacity (FVC)

Question 2

Components of FVC

Answer 2

ERV +IRV + tidal volume

Question 3

Normal FVC

Answer 3

~4 Liters in 25 y/o male (declines ~ 30 ml/ year)

Question 4

Components of TLC

Answer 4

TV + IRV + ERV + RV

Question 5

3 components PFTs assess

Answer 5

Lung volumes, Lung air flow, and Lung diffusion capacity

Question 6

Obstructive lung disease characteristic

Answer 6

“air trapping” - more time spent exhaling trapped air

inspiratory:expiratory ratio= 1:4

Question 7

Device to assess expiratory function

Answer 7

Peak Expiratory Flow meter

- measures personal best

Question 8

Assessing results of flow meter

Answer 8

1.  Green “Zone”:
 80- 100% of personal best
2.  Yellow Zone 
 50- 79% of personal best 
   ( Requires Rescue Medications)
3.   Red Zone 
 < 50% of personal best 
(Rescue medications
 \+ Call  doctor)

Question 9

Normal PEF

Answer 9

500- 700L/ min= based on Age & body height or Personal Best

Question 10

Measures only air flow not volume

Answer 10

Air Flow Tests (on expiration)

Question 11

Uses of Air Flow Tests

Answer 11

Helps classify pulmonary disease severity

Used for Daily monitoring of disease (i.e. asthma)

Question 12

Measures Peak Expiratory Flow Rate(PEFR) and Forced Expiratory Volume (FEV)

Answer 12

Spirometry

- Displayed as Flow Volume loop

Question 13

Measured first milliseconds of max expiratory efforts
(extrapolated into Liters/sec)
Must establish baseline* based on age, gender, and height

Answer 13

Peak expiratory flow rate

- not based on personal best

Question 14

Measures volume of air movement
Must establish baseline Compared with “predicted” FEV1 - Based on age, gender, height

Answer 14

Forced Expiratory volume (FEV1)

Question 15

Role of FEV1

Answer 15

Categorize Pulmonary disease severity
Identifies Progression of disease
Not used for daily monitoring

Question 16

TD is a 28 y/o male with 2 weeks of worsened asthma control. TD reports using his rescue inhaler daily.
TD would like to monitor the severity of his asthma episodes.
Which of the following are most useful for TD?
FEV1 with Spirometry
FVC with Spirometry
PEFR with Peak flow meter
PEFR with Spirometry

Answer 16

PEFR with Peak flow meter

Question 17

Identifies the presence of lung damage related to diffusion

This is damage directed at the alveolar-capillary oxygen exchange

Answer 17

Lung Diffusion Capacity
(Perfusion)
- Identifies pulmonary fibrotic changes (of alveoli)

Question 18

Technique of DLCO calculated and purpose of test

Answer 18

Known amount of CO is inhaled & hold breath X 10 sec
Measure CO on expiration (compared with inspiration)
Measures degree of reduction from baseline (i.e. > 20%) - suggests significant pulmonary fibrosis
Used to Identify conditions disrupting diffusion

Question 19

Clinical Use of Pulmonary Function tests

Answer 19

Screen & diagnosis respiratory disease
Identifying the type of pulmonary disease
Evaluation of pulmonary disease severity
Monitor pulmonary function
Beneficial Response: Response to therapy
Adverse Response: Onset of pulmonary toxicity (i.e. Drugs, radiation)

Question 20

2 Types of pulmonary diseases

Answer 20

Obstructive pulmonary disease

Restrictive pulmonary disease

Question 21

FEV1/ FVC < 70% = Diagnositic

Answer 21

Obstructive

Impedance to airflow due to airway resistance

Question 22

Decreased diameter of airways (bronchials)

Answer 22

COPD and Asthma

Question 23

Reduction in elastic recoil (alveoli)

Answer 23

emphysema

Question 24

Findings of Asthma on spirometry testing

Answer 24

Normal FVC
Decreased FEV1
Decreased FEV1:FVC
Increased TLC
Increased residual volume
Normal diffusion capacity
Dynamic Hyperinflation

Question 25

Findings on COPD on spirometry testing

Answer 25

Normal FVC
Decreased FEV1
Decreased FEV1:FVC
Increased TLC
Increased residual volume
Decreased diffusion capacity (<70%)
Dynamic hyperinflation

Question 26

Lungs are restricted in amount of air they contain

Due to Reduced compliance and/or Lung size

Answer 26

Restrictive pulmonary disease

Question 27

Sources of Restrictive lung disease

Answer 27

Intrinsic or Extrinsic causes

Question 28

Intrinsic Restrictions

Answer 28

Pulmonary fibrosis
Sarcoidosis
Lung Cancer

Question 29

Extrinsic Restrictive

Answer 29

Loss of lung volume (e.g., pleural effusions= extrinsic)
Extrathoracic compression (e.g., morbid obesity= extrinsic)

Question 30

Findings on Intrinsic Restrictive on spirometry testing

Answer 30

Decreased FVC
Decreased FEV1
Increased FEV1:FVC
Decreased TLC
Decreased RV
Decreased diffusion capacity

Question 31

Findings on Extrinsic Restrictive on spirometry testing

Answer 31

Decreased FVC
Decreased FEV1
Increased FEV1:FVC
Decreased TLC
Decreased RV
Normal diffusion capacity

Question 32

RC is a 55 y/o male with cancer treated with Bleomycin (3rd cycle of chemotherapy) who complains of worsened cough and dyspnea for 4 weeks.
No fevers, no elevated WBCs; CXR = diffuse infiltrates
(+) Tobacco= None
Pulmonary function tests:
FEV1= 2.5 L (Predicted = 3.5L);FVC = 3.0 L (Predicted = 5.5L)
RV = 3.0 L (Predicted at 2.0 L); DLCO= 30% decrease (baseline)
Which of the following does this patient exhibit?
Obstructive airway disease
Restrictive airway disease (intrinsic cause)
Restrictive airway disease (extrinsic cause)

Answer 32

Restrictive airway disease (intrinsic cause)

Question 33

BT is a 22 y/o female with a chronic cough and increasing shortness of breath for the past 3 months. BT claims her symptoms improve on weekends.
Started new job at Tyson Chicken processing plant (5 mths ago)
(+) Tobacco= 7 pack year history
Pulmonary function tests:
FEV1= 2.5 L (Predicted = 4L);FVC = 5.5 L (Predicted = 6L)
RV = 2.5 L (Predicted at 2.0 L); DLCO= Normal
Which of the following does this patient exhibit?
Obstructive airway disease
Restrictive airway disease (intrinsic cause)
Restrictive airway disease (extrinsic cause)

Answer 33

Obstructive airway disease