Pulmonary Function Tests Lecture Powerpoint Flashcards

1
Q

2 functions of the sinuses and how do we learn to breath first?

A
  • Lighten the weight of the head
  • Moisten and filter air

-through the nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Because of the respiratory system’s ability to filter upon inspiration, most pneumonias are the result of…

A

….reflux and aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Further down in the respiratory tract, we see more smooth muscle and less cartilage tissue making it….

A

…more capable of partial collapse or complete collapse in disease states (this increases residual volume in the lungs as everything distal to the collapse is affected)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Functions of PFT’s (3)

A
  • add to diagnosis of disease (pulmonary and cardiac)
  • monitor progression of disease and effectiveness of treatment
  • aid in pre op assessment of certain patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Different components of PFTs (8)

A
  • spirometry
  • flow volume loop
  • bronchodilator response
  • lung volumes
  • diffusion capacity (DLCO)
  • bronchoprovocation testing
  • max respiratory pressures
  • simple and complex cardiopulmonary exercise testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

6 min walk test

A

Test to evaluate physical function or assess therapeutic response in COPD and pulmonary fibrosis patients, considered positive if oxygen saturation falls by >4% ending below 93% after 6 minutes of walking and indicates need for confirmatory ABG’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for PFTs (6)

A
  • Signs and symptoms of pulmonary distress
  • screening at risk population (smokers current or former >45 years of age)
  • monitoring drug toxicity
  • abnormal study such as CXR or EKG
  • environmental exposure monitoring
  • preoperative assessment and risk stratification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PFT’s are beneficial but…

A

….they only support or exclude a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Steps to performance of an FVC maneuver in spirometry

A
  • Prep patient (results are VERY effort dependent)
  • cover nose with clip
  • elevate chin slightly and extend neck slightly
  • put mouthpiece in mouth after inhaling and then exhale hard and fast as possible
  • need to avoid coughing, variable flow, or early termination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spirometry’s goal is to measure ____, it cannot (directly) measure ____

A

Vital capacity, residual volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Body plethysmography

A

Used to measure total lung capacity by placing patient in a small airtight room while taking measurements to determine residual volume and total lung capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Flow (flow volume loop) definition

A

Volume of a substance moved thru a structure or space over a period of time in L/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Flow volume loop, what is it sometimes referred to as?

A
  • A measurement of flow during pulmonary function testing that should have a rounded inhalation and a sharp spike in expiration (this height should represent 90% of what can be exhaled) followed by continuous drop straight line
  • also referred to as a spirogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Volume time loop

A

A measurement of flow during pulmonary function testing that determines FEV1 and should have 90% of the volume (in L) released in the first second before quickly tapering off to a flat line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lung properties that affect spirometry (2)

A
  • mechanical properties (compliance and elastic recoil)

- resistive properties (affected by airway diameter predominantly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

% predicted in spirometry

A

What a patient performed based on what is predicted based on age, gender, height, weight, ethnicity to determine some fraction value which is then interpreted (low % is worse for the patient)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Spirometry % FVC predicted value interpretation

A

80-120% normal
70-79% mild reduction
50-69% moderate reduction
<50% severe reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Spirometry % FEV1 predicted value interpretation

A

> 75% normal
60-75% mild obstruction
50-59% moderate obstruction
<49% severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Spirometry % FEF 25-75% predicted value interpretation

A

> 60% normal
40-60% mild
20-40% moderate
<10% severe

20
Q

Obstructive disease pattern loss with spirometry % predicted values

A
  • FEF 25-75 decreased
  • FEV1 decreased
  • FVC normal to decreased in late stage (last thing to go)
  • FEV1/FVC <70% predicted
21
Q

Obstructive lung disease list (5)

A
  • asthma (reversible obstructive dz)
  • COPD (chronic bronchitis and emphysema)
  • bronchiectasis
  • bronchiolitis
  • upper airway obstruction
22
Q

Restrictive disease pattern loss with spirometry % predicted values

A
  • TLC decreased
  • FVC decreased
  • Normal or increased FEV1/FVC ratio
23
Q

Restrictive lung disease list (4)

A
  • Parenchymal disease (interstitial lung disease)
  • pleural disease
  • chest wall disease
  • neuromuscular disease
24
Q

Scooped out vs witch’s hat on volume/flow diagram

A

Scooped out is characteristic of obstructive disease, witch’s hat is characteristic of restrictive disease

25
Q

Bronchodilator response spirometry

A

Test done on patients with obstructive pattern on spirometry to determine degree to which FEV1 improves with inhaled bronchodilator to document reversible airflow obstruction, significant if FEV1 increases by 12% and 200mL or greater

26
Q

Fixed upper airway obstruction pattern on flow volume loop (such as a tumor in larynx) vs variable extrathoracic obstruction vs variable intrathoracic obstruction

A
  • Rounded shape with equal expiratory (+) and inspiratory (-) values
  • Rounded shape with greater expiratory (+) and lower inspiratory (-) flow
  • Rounded shape with lower expiratory (+) and greater inspiratory (-) flow
27
Q
  • Methods for measuring lung volumes (3)

- Indications for a lung volume measurement (2)

A
  • Helium, nitrogen washout, body plethsmography

- diagnose restrictive component, differentiate between chronic bronchitis from emphysema

28
Q

Lung volume % predicted patterns (TLC and RV) in obstructive and restrictive disease

A

Obstructive: TLC>120% predicted, RV >120% predicted
Restrictive: TLC <80% predicted, RV <80% predicted

29
Q

Carbon monoxide diffusion capacity (DLCO), what does a decreased and increased value mean?

A
  • Measures the lungs diffusing capacity to transport inhaled gas from alveoli to pulmonary capillaries using a small amount of carbon monoxide
  • <80% predicted indicates obstructive lung disease or anemia, >120% predicted indicates asthma or polycythemia
30
Q

7 barriers to o2 transport in the alveoli according to walt

A
  • alveolar epithelium
  • tissue interstitum
  • capillary epithelium
  • plasma layer
  • red cell membrane
  • red cell cytoplasm
  • hemoglobin binding forces and type of hemoglobin
31
Q

Bronchoprovocation testing, what is a positive result?

A

Use of methacholine, histamine, or exercise stress test in an attempt to induce bronchospasm useful in diagnosis of asthma and diagnostic if >20% decrease in FEV1

32
Q

Obstructive pattern evaluation of FVC. FEV1, FEV1/FVC, FV loop shape, DLCO, TLC/RV, responsiveness to bronchodilator

A
  • FVC normal or decreased
  • FEV1 decreased
  • FEV1/FVC decreased <70%
  • scooped loop
  • DLCO decreased in emphysema or normal in crhonic bronchitis
  • TLC/RV increased
  • positive response to bronchodilator
33
Q

Restrictive pattern evaluation of FVC, FEV1, FEV1/FVC, FV loop shape, DLCO, TLC/RV

A
  • FVC decreased
  • FEV1 decreased or normal
  • FEV1/FVC normal
  • witch’s hat loop
  • DLCO decreased
  • TLC/RV decreased
34
Q

DLCO will be ___ in emphysema but ___ in chronic bronchitis because ____

A

Decreased, normal, chronic bronchitis affects proximal airways where gas exchange is not taking place

35
Q

Acinus

A

The anatomic unit of the lung supplied by the terminal bronchiole where gas exchange in the respiratory system occurs

36
Q

Principle of child lung function preservation

A

Need to preserve while young so it continues to have sufficient reserve when old

37
Q

The 4 volumes of the lung

A
  • Inspiratory reserve
  • tidal
  • expiratory reserve
  • residual
38
Q

The 4 capacities of the lung

A

(2 or more volumes comprise a capacity)

  • vital
  • inspiratory
  • functional residual
  • total lung
39
Q

FEV1

A

Forced expiratory volume in 1 second, a very beneficial measurement taken by spirometry

40
Q

FVC

A

Forced vital capacity, a very beneficial measurement taken by spirometry

41
Q

FEV1/FVC%

A

The forced expiratory volume in one second divided by the total forced vital capacity, should be 90% in a healthy lung, a very beneficial measurement taken by spirometry

42
Q

FEF25-75

A

Measure of forced expiratory flow during middle have of FVC, provides insight into the smaller and intermediate airways and indicates treatment being necessary as early stages of lung disease progresses before other spirometric values are decreased as well

43
Q

____ spirometry measurement is used to track severity of COPD over time

A

FEV1

44
Q

Normal lungs have ___ flow rate and ___ lung volume

Restrictive lungs have ___ flow rate and ___ lung volume

Obstructive lungs have ___ flow rate and ___ lung volume

A
  • High, high
  • High, low
  • Low, high
45
Q

Bronchoprovocation is useful in diagnosis of asthma in the setting of ____ PFTs

A

Normal