Pulmonary Function Tests

Question 1

Exhaled breath nitric oxide is a useful measure of…

Answer 1

eosinophilic airway inflammation in asthma

Question 2

In what condition would the following changes occur in spirometry?

a. decrease FVC
b. decrease FEV₁
c. increase RV

Answer 2

COPD

Question 3

Methacholine/Histamine/Mannitol are examples of…

Answer 3

an indirect inflammatory challenge

markers of airway hyper-responsiveness with a concentration to cause a decrease of 20% FEV₁

Question 4

In what conditions would the RV increase?

Answer 4

FVC reduction

Question 5

what levels of exhaled Nitric oxide reflect uncontrolled asthmatic inflammation?

Answer 5

>35ppb

Question 6

The total lung capacity is decreased in emphysema - true or false?

Answer 6

false

emphysema causes difficulting in getting air out and thus results in hyperinflation and an increased TLC

Question 7

Examples of effort dependent tests (2)

How are they carried out?

Answer 7

FEV

Flow rates

Carried out using spirometry

Question 8

A change in which value will occur in asthma?

FVC

FEV₁

Residual Volume

Answer 8

FEV₁

The FVC will remain the same as the total capacity is possible but takes longer. The residual volume remains the same unless there is chronic poor-control and thus airway remodelling

Question 9

When spirometry is normal, FEV₁/FVC should be <75% - true or false?

Answer 9

False

They should be greater than 75%.

Asthmatics may also produce this if they have good lung volume, good control and have been involved in activities that focus on diaphragmatic breathing

Question 10

What changes in the following parameters in spirometry would be expected in a patient with COPD

a. FVC
b. FEV₁
c. Residual Volume

Answer 10

a. there should be a decrease in FVC
b. There would be a decrease in FEV₁
c. The residual volume would increase

Question 11

Forced Expiratory Ratio

Answer 11

FEV₁/FVC

Question 12

What are the expected values of…

PEFR

FEV1

FVC

FEV1/FVC Ratio

FEV1 repsonse to ß2 agonists

…in obstructive disease?

Answer 12

PEFR - decreased

FEV₁ - decreased

FVC - Normal in Asthma

Decreased in COPD

FEV1/FVC ratio - <75%

Response to b2 agonist - >15% asthma

<15% in COPD

Question 13

Why does the FEV1 initially go up in exercise?

Answer 13

Due to the release of adrenaline.

Asthmatics then get bronchoconstriction as there is a rebound reaction

Question 14

Describe Total Lung Transfer for CO

Answer 14

CO diffusion across alveolar-capillary barrier - aka single breath diffusing capacity

Acts as a soluble gas marker with a high binding affinity for haemoglobin

It is corrected for Alveolar Volume (KCO)

Question 15

Answer 15

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Question 16

What is total lung transfer for CO corrected for?

Answer 16

Alveolar Volume

Question 17

What are the most common types of pulmonary function tests?

Answer 17

Effort dependent tests

Question 18

Which condition exhibits pressure dependent expiratory airway closure?

Answer 18

emphysema

Question 19

Forced Expiratory Manoeuvre (TLC to RV)

FEV₁

FVC

FER

RVC (relaxed vital capacity)

are all examples of…

Answer 19

Dynamic Lung Volumes

Question 20

Dynamic Lung Volumes (5)

Answer 20

Forced Expiratory Manoeuvre (TLC to RV)

FEV₁

FVC

FER

RVC (relaxed vital capacity)

Question 21

What are the potential methods of Bronchial Challenge Testing ?(3)

Answer 21

1. Exercise
2. Methacholine/Histamine/Mannitol
3. Allergens/Chemicals

Question 22

FEV₁/FVC

Answer 22

Forced Expiratory Ratio

Question 23

Where is impulse oscillometry useful?

Answer 23

In patients (i.e. kids) where it is easier to breathe at tidal volume rather than forced expiratory manoeuvre

Question 24

Test for measuring static lung volumes

Answer 24

Effort Independent Tests

Helium Dilution Test

Gas trapping in COPD

Question 25

What are the 3 types of pulmonary function tests that can be carried out?

Answer 25

1. Effort dependent tests 2. Effort independent tests 3. Gas diffusion tests

Question 26

Which conditions exhibit volume dependent expiratory airway closure?

Answer 26

asthma chronic bronchitis

Question 27

In what conditions is Total Lung Transfer for CO reduced? (6) Why?

Answer 27

Anemia Emphysema Interstitial Lung Disease Pulmonary Oedema Pulmonary Embolis Bronchiectasis Because diffusion is reduced in these conditions

Question 28

How is airway resistance measured?

Answer 28

Whole body plethysmography Impulse oscillometry

Question 29

What are the expected values of... PEFR FEV1 FVC FEV1/FVC Ratio FEV1 repsonse to ß2 agonists ...in **restrictive** disease

Answer 29

PEFR - Normal FEV1 - decreased FVC - decreased FEV1/FVC Ratio - \>75% FEV1 repsonse to ß2 agonists - No response