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Cardiopulmonary I > Pulmonary Outcome Measures & Diagnostics > Flashcards

Pulmonary Outcome Measures & Diagnostics Flashcards

1
Q

what is the modified MRC dyspnea scale used for?

A

measure degree of breathlessness in patients with a pulmonary diagnosis or have primary functional limitations from shortness of breath

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2
Q

the modified MRC dyspnea scale is used more for ______ and not as useful for ______

A

exertion dyspnea –> SOB with exertion
dyspnea at rest –> SOB at rest

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3
Q

your patient is experiencing stage 4 heart failure and is complaining most of SOB. does the dyspnea scale apply to this patient?

A

yes, even though they are a CV pt - their primary functional limitation is SOB

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4
Q

Modified MRC dyspnea scale grades:
– 0
– 1
– 2
– 3
– 4

A

– breathless only w/ strenuous exercise
– SOB w/ hurrying or walking up slight hill
– walk slower than equivalent aged people because of breathlessness or stop for breath when walking self-paced
– stop for breath after walking 100 m or after a few minutes
– too breathless to leave the house or breathless when dressing/undressing

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5
Q

who is the BORG dyspnea scale mostly used for?

A

pts with resting dyspnea - but can use with exertional dyspnea

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6
Q

how should you deliver the BORG dyspnea scale to your patient to differentiate between RPE scale?

A

“how hard is your breathing right now on a scale of 0-10?”

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7
Q

where does the VT2 fall on the BORG scale?
where should you keep your pts at on the BORG scale?

A

5-7
4-6 (with pathology)

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8
Q

6 minute walk test w/ pt with COPD:
– avg distance:
– distance predictive of hospitalization or mortality
– MCID

A

– 380 m
– < 200 m
– 54 m (same as HF)

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9
Q

Gait speed cutoff scores w/ pt with COPD:
– slow =
– normal =
– MCID in pulmonary rehab:

A

– < 0.8 m/s
– >/= 0.8 m/s
– 0.08 - 0.11 m/s

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10
Q

what is the ST. George’s Respiratory Questionnaire? (SGRQ)

A

instrument designed to measure impact on overall health, daily life, and perceived well-being in patients with obstructive airway disease

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11
Q

SGRQ combines ____ and _____ of symptoms with activities that are limited by breathlessness

A

frequency and severity

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12
Q

SGRQ:
– scored out of:
– high score =
– MCID:

A

– 100
– more limitations
– 4 for minimal improvement, 8 mod improvement, 12 high improvement

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13
Q

what does a chest x ray show?

A

air [black]
fat, fluid, bone and other tissue [variations of gray to white]

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14
Q

views of chest x ray:

A

anterior-posterior [frontal plane]
lateral [sagittal plane]

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15
Q

chest x ray is the first line of imaging for:

A

any respiratory distress
suspicion for pulmonary pathology
post line or device placement
post intubation or extubation

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16
Q

what is the costophrenic angle?
– sharp angle of ____ deg

A

junction of the costal and diaphragmatic pleural surfaces
– 30 deg (made of diaphragm and edge of rib cage)

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17
Q

what is a CT used to identify?
– more or less detailed?

A

structural defects of the lungs or pulmonary vasculature
– more detailed than chest X ray

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18
Q

indications for CT:

A

lung cancer
ARDS/COVID
any bleeding
structural details

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19
Q

what is a CTA? (CT angiogram)

A

radiopaque IV contrast injected prior to CT scan
shows vascular abnormalities or perfusion deficits

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20
Q

CTA is the first line of imaging used to diagnose:

A

pulmonary embolism

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21
Q

indications for CTA:

A

PE
ARDS
IPF
vascular obstruction
filling defects
impairments in flow rate

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22
Q

what is a PET scan?

A

nuclear imaging that can detect glucose uptake, blood flow, and pulmonary metabolism

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23
Q

used to assess for _______ most often

A

lung tumor metastasis in the thoracic cavity

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24
Q

cons of PET scan:

A

not as accessible as other scans
expensive
requires equipment

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25
Q

what does a pulmonary MRI evaluate?

A

pulmonary anatomy
thoracic cavity structures
pulmonary blood flow

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26
Q

MRI is similar diagnostic accuracy as ______ but ___(less/more)___ expensive and (less/more) available?

A

PET imaging
less
more

27
Q

what is MRA? (Magnetic resonance angiogram)

A

MRI imaging with IV contrast to evaluate vasculature specifically

28
Q

indications for MRI:

A

any conditions involving bone, muscle, fat of thoracic cavity
pre-op for surgical guidance
lung cancer

29
Q

ventilation =
perfusion =

A

air in the lungs
blood in the lungs

30
Q

primary indication for ventilation/perfusion (V/Q) scan:
secondary:

A

– PE
– IPF/ARDS

31
Q

ventilation/perfusion (V/Q) scan:
– how do you measure ventilation?
– how do you measure perfusion?

A

– Xenon gas inhaled and pt holds their breath. V scans over lung fields and can see Xenon gas
– radioactive IV contrast injected. Q scans over the lung fields can see where blood is perfusing

32
Q

ventilation/perfusion (V/Q) scan:
– scans occur ______ and results with ratio of ___ to ____
– both V and Q are greater in lung ____ than ____ normally

A

– simultaneously ; V to Q
– bases than apex

33
Q

on a VQ scan:
– perfusion defect with normal ventilation suggests:
– ventilation defect with normal perfusion suggests:

A

– PE
– alveolar fibrosis/destruction or airway obstruction

34
Q

what is a bronchoscopy?
– how is it performed?

A

fiber optic evaluation of the lower respiratory tract, usually just trachea/bronchi/segmental bronchi
– flexible optic scope inserted through nose or mouth to show airways

35
Q

indications for bronchoscopy:

A

visualizing bronchial structures
foreign object removal or biopsy
clearing out of secretions
taking cultures of secretions for infection identification

36
Q

indications for testing arterial blood gas (ABGs) in pulmonary patient:

A

respiratory failure/distress
altered mental status
to determine O2 delivery device or make changes to mechanical ventilation

37
Q

what information does a pulmonary function test (PFT) tell us?

A

airway integrity
respiratory musculature function
condition of lung tissues

38
Q

PFTs allow for ____ and ____ of pulmonary disease

A

diagnosis and clarification

39
Q

PFTs classifies as:

A

restrictive, obstructive, or mixed etiology

40
Q

what are the 3 types of PFTs?

A
  1. lung volumes [volume]
  2. spirometry [speed]
    – measures speed at which air is exhaled
  3. diffusing capacity [gas diffusion]
    – measures how well gas diffuses
41
Q

where is a PFT performed?

A

outpatient pulmonologists office - not in acute care/inpatient

42
Q

body plethysmograph is a closed contained system. is it more or less accurate than other spirometry methods?

A

more accurate - since it is a closed system (think phone booth)

43
Q

forced vital capacity of PFT:
– what is it measuring?
– units?
– most dependent on:
– reduced in _____ and ____ disease

A

– max volume of air exhaled as forcefully and as quickly as possible
– liters
– amount of force (strength) used in early exhalation when the lung is the most expanded
– restrictive and obstructive

44
Q

forced expiratory volume in 1 second (FEV1) of PFT:
– what is it measuring?
– reflective of:
– the lower the FEV1%, the more ____
– progressive _____ linear to worsening of disease

A

– max volume of air exhaled in the first second of max exhalation
– airflow in large airways
– obstructive the disease process (harder to get air out fast)
– decline

45
Q

FEV1/FVC ratio (%) of PFT:
– what is it measuring?
– the lower the FEV1/FVC ratio %, the more _____
– abnormal value:

A

– calculation that measures the proportion of FVC that can be exhaled in the first second of forced exhalation
– severe the obstructive diesease
– < 70%

46
Q

diffusing capacity of the lung (DLCO) of PFT:
– measures:
– what is it?
– expressed as:

A

– how well gas diffuses across the alveolar-capillary membrane
– amount of gas entering pulmonary blood flow per unit of time (how much of the air inhaled is actually getting in the blood)
– % of gas diffusing into blood

47
Q

FVC & TLC are decreased in __(restrictive/obstructive)__ lung disease

A

restrictive

48
Q

FEV1 and FEV1/FVC are decreased in __(restrictive/obstructive)___ lung disease

A

obstructive

49
Q

what two values are used to diagnose obstructive disease?

A

FEV1
FEV1/FVC ratio

50
Q

restrictive disease = ____ vital capacity and total lung capacity

obstructive disease = ____ vital capacity and total lung capacity

A

decreased

increased

51
Q

what are the biggest limitations to functional endurance with RESTRICTIVE disease?

what are the biggest limitations for functional endurance with OBSTRUCTIVE disease?

A

dec. IRV and ERV

inc. ERV and residual volume (RV)

52
Q

what are some common restrictive disorders?

A

interstitial lung diseases
IPF
PNA
ARDS
NMD

53
Q

what are some common obstructive disorders?

A

COPD
emphysema
CF

54
Q

what are some common reactive airway disorders?
– reversible or not?

A

asthma
– can be reversible

55
Q

PFT pattern for restrictive disorders to diagnose:

A

proportionally dec. FEV1 and FVC
FEV1/FVC ratio = near normal

56
Q

PFT pattern for obstructive disorders to diagnose:

A

FEV1 < 60%
FEV1/FVC ratio < 70%

57
Q

PFT pattern for reactive airway disorder to diagnose:

A

dec. of FEV1 by 10-20% with activity or trigger

58
Q

GOLD staging for COPD:
– used to:
– guides:
– predictive of:
– values can worsen from baseline if ____ occurs

A

– stratify severity of disease
– treatment
– functional activity tolerance
– exacerbation

59
Q

GOLD staging for COPD:
Normal =

A

FEV1/FVC: 80%
FEV1: 100%

60
Q

GOLD staging for COPD:
– Stage I
– Stage II
– Stage III
– Stage IV

A

– Mild ; FEV1/FVC < 70% ; FEV1 >80%
– Mod ; FEV1/FVC < 70% ; FEV1 50-80%
– Severe ; FEV1/FVC < 70% ; FEV1 30-50%
– Very severe ; FEV1/FVC < 70% ; FEV1 < 30%

61
Q

what does diffusing capacity of the lung (DLCO) measure?
– NOT a measure of:

A

integrity of the functional lung unit (respiration/oxygenation)
– any pulmonary mechanics (ventilation)

62
Q

abnormal DLCO is caused by: (3)

A

– dec. Hgb to carry O2
– inc. thickness of alveolar-capillary membrane
– dec. surface area available for gas exchange (main factor)

63
Q

severity of DLCO reductions:
– normal:
– mild dec.:
– mod dec:
– severe dec.

A

– > 75%
– 60-74%
– 40-59%
– < 40%

Cardiopulmonary I (25 decks)

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