Pulmonary Outcome Measures & Diagnostics

Question 1

what is the dyspnea scale used for?

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

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

Question 4

** add in dyspnea scale ratings **

Question 5

who is the BORG dyspnea scale mostly used for?

Answer 5

pts with resting dyspnea - but can use with exertional dyspnea

Question 6

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

Answer 6

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

Question 7

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

Answer 7

5-7
4-6

Question 8

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

Answer 8

– 380 m
– < 200 m
– 54 m (same as HF)

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

frequency and severity

Question 12

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

Answer 12

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

Question 13

what does a chest x ray show?

Answer 13

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

Question 14

views of chest x ray:

Answer 14

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

Question 15

indication for use of chest x ray:

Answer 15

first line of imaging for:
any respiratory distress
suspicion for pulmonary pathology
post line or device placement
post intubation or extubation

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

indications for CT:

Answer 18

lung cancer
ARDS/COVID
any bleeding
structural details

Question 19

what is a CTA? (CT angiogram)

Answer 19

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

Question 20

CTA is the first line of imaging used to diagnose:

Answer 20

pulmonary embolism

Question 21

indications for CTA:

Answer 21

PE
ARDS
IPF
vascular obstruction
filling defects
impairments in flow rate

Question 22

what is a PET scan?

Answer 22

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

Question 23

used to assess for _______ most often

Answer 23

lung tumor metastasis in the thoracic cavity

Question 24

cons of PET scan:

Answer 24

not as accessible as other scans
expensive
requires equipment

Question 25

what does a pulmonary MRI evaluate?

Answer 25

pulmonary anatomy
thoracic cavity structures
pulmonary blood flow

Question 26

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

Answer 26

PET imaging
less
more

Question 27

what is MRA? (Magnetic resonance angiogram)

Answer 27

MRI imaging with IV contrast to evaluate vasculature specifically

Question 28

indications for MRI:

Answer 28

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

Question 29

ventilation =
perfusion =

Answer 29

air in the lungs
blood in the lungs

Question 30

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

Answer 30

– PE
– IPF/ARDS

Question 31

ventilation/perfusion (V/Q) scan:
– measures ventilation:
– measures perfusion:

Answer 31

– 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

Question 32

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

Answer 32

– simultaneously ; V to Q
– bases than apex

Question 33

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

Answer 33

– PE
– alveolar fibrosis/destruction or airway obstruction

Question 34

what is a bronchoscopy?
– how is it performed?

Answer 34

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

Question 35

indications for bronchoscopy:

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

airway integrity
respiratory musculature function
condition of lung tissues

Question 38

PFTs allow for ____ and ____ of pulmonary disease

Answer 38

diagnosis and clarification

Question 39

PFTs classifies as:

Answer 39

restrictive, obstructive, or mixed etiology

Question 40

what are the 3 types of PFTs?

Answer 40

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

Question 41

where is a PFT performed?

Answer 41

outpatient pulmonologists office - not in acute care/inpatient

Question 42

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

Answer 42

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

Question 43

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

Answer 43

– 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

Question 44

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

Answer 44

– 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

Question 45

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

Answer 45

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

Question 46

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

Answer 46

– 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

Question 47

FVC = (inc/dec) restrictive disease = (inc/dec) obstructive disease

FEV1 =

Answer 47

** slide 28 **

Question 48

what two values are used to diagnose obstructive disease?

Answer 48

FEV1 &
FEV1/FVC ratio

Question 49

restrictive disease = ____ vital capacity and total lung capacity

obstructive disease = ____ vital capacity and total lung capacity

Answer 49

decreased

increased

Question 50

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

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

Answer 50

dec. IRV and ERV

inc. ERV and residual volume (RV)

Question 51

what are some common restrictive disorders?

Answer 51

interstitial lung diseases
IPF
PNA
ARDS
NMD

Question 52

what are some common obstructive disorders?

Answer 52

COPD
emphysema
CF

Question 53

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

Answer 53

asthma
– can be reversible

Question 54

PFT pattern for restrictive disorders to diagnose:

Answer 54

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

Question 55

PFT pattern for obstructive disorders to diagnose:

Answer 55

FEV1 < 60%
FEV1/FVC ratio < 70%

Question 56

PFT pattern for reactive airway disorder to diagnose:

Answer 56

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

Question 57

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

Answer 57

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

Question 58

** stages for COPD ***

Answer 58

slide 32

Question 59

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

Answer 59

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

Question 60

abnormal DLCO is caused by: (3)

Answer 60

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

Question 61

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