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Cardiopulmonary Diagnostic (PFTs) > Quiz 2 Ch. 3 and 4 > Flashcards

Quiz 2 Ch. 3 and 4 Flashcards

1
Q

When measuring lung volumes, the ultimate goal is to get the

A

TLC

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2
Q

What does an increased RV/TLC ratio indicate

A

Hyperinflantion or Air-trapping, severe air-trapping

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3
Q

Which of the following cannot be measured directly
FRC
IC
TLC
RV

A

RV

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4
Q

Helium dilution uses a ________- circuit

A

closed

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5
Q

List some things you’ll need to perform helium dilution test

A
  • Closed circuit
  • Source of o2
  • Helium analyzer
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6
Q

Body box is based on who’s law?

A

Boyle’s

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7
Q

An increase in the slope of phase 3 indicates…….

A

Uneven distribution

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8
Q

The N2 concentration is plotted against the exhaled volume and divides into how many phases of exhalation

A

4

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9
Q

An increased RV and TLC indicates

A

hyperinflantion

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10
Q

An increased RV w/ a normal TLC indicates

A

airtrapping

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11
Q

During a nitrogen washout test, what should you expect if you notice a sudden spike or increased in the fall of N2

A

You have a leak

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12
Q

How long should you wait before restarting a n. washout test ?

A

15 minutes

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13
Q

What are the three ways to indirectly measure RV

A
  • Helium dilution
  • Nitrogen washout
  • Body box
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14
Q

What 2 things does the body box measure?

A
  • FRC
  • Thoracic gas volume
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15
Q

TLC is the volume of gas…

A

remaining in the lungs after a maximal inspiration

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16
Q

______________ __________ is the amount of gas remaining in the lungs at the end of a maximal expiration

A

Residual volume

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17
Q

The ___________ of gas remaining in the lungs at the _____ of a _________ breath describes?

A

volume;
end;
normal;
Functional Residual Capacity (FRC)

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18
Q

FRC=

A

ERV+ RV

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19
Q

How do we measure RV?

A

RV cannot be measured directly

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20
Q

What 2 test can be done with single and multi breaths?

A

He dilution
N2 washout

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21
Q

What does HE measure? (2)

A
  • FRC
  • Estimate lung volumes
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22
Q

The helium is diluted until?

A

Equilibrium is complete

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23
Q

HE dilution is used to measure……

A

RV but it may underestimate lung volumes (especially pts w/ poorly ventilated lungs)

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24
Q

Nitrogen washout uses a

A

open circuit

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25
Q

Pneumatchometer measures the…

A

flow of gas during breathing

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26
Q

If there is a sudden spike or increase in the fall of N2, then you….

A

have a leak

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27
Q

If you have a leak

A

you need to retest

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28
Q

Retest for N2 must wait

A

at least 15 minutes

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29
Q

For healthy lungs, test can take

A

3-4 minutes

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30
Q

what are the 2 types of Body box

A
  • constant volume (pressure type)
  • flow-based
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31
Q

Which test is the most accurate HE dilution, N2 washout, or Bodybox?

A

Body box

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32
Q

Changes in alveolar pressure is measured where?

A

At the mouth when the shutter is closed

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33
Q

Body box will usually give a ________ FRC than dilution or n2 washout

A

higher

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34
Q

Closed-circuit HE dilution is calculated as part of the…..
and measures

A

DLCO;
TLC

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35
Q

HE underestimates

A

lung volumes especially in sick pts

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36
Q

How do you perform a HE dilution?

A

The pt exhales to the RV, then inhales to the IC and holds that breath for 10 seconds, then is instructed to exhale back to RV

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37
Q

________-circuit N2 washout is plotted against the _________ and divied into 4 phases

A

open;
volume

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38
Q

How do you perform a N2 washout

A

Pt exhales to RV and then inhales 100% o2 to reach a maximum inspiration. Pt then slowly exhales again to reserve SVC

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39
Q

How many phases of exhalation are there?

A

4

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40
Q

Phase 1:

A

upper airway gas from anatomic dead space consisting of 100% o2

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41
Q

Phase 2:

A

Mixture of O2 and dead space where the concentrations of O2 and N2 changes abrulty

42
Q

What 2 phases contain dead space gas and is not used to assess distribution

A

1 and 2

43
Q

Phase 3:

A

Plateau caused by exhalation of alveolar gas, slow and uneven change in O2 and N2— last 30% of VC (even distribution

44
Q

An increase in the slope in Phase 3 indicates?

A

An uneven distrubution

45
Q

Phase 4:

A

Abrupt increase in N2 until RV is reached (closing volumes)

46
Q

Closing Volumes at which the expiratory flow becomes severely reduced or stop. Which phase is this?

A

Phase 4

47
Q

When airway closure begins, Phase 4….

A

begins and closing volumes are measured

48
Q

Closing capacity is determined by measuring closing volumes (2)

A
  • Healthy closing capacity is 30% of TLC
  • Increased values = closing early (small airway issue)
49
Q

In what order should you measure volumes?

A

1.FRC
2. RV
3. TLC

50
Q

DLCO measures the diffusion of CO monoxide across

A

the capillary membrane

51
Q

What are the normal values for DLCO

A

greater than or equal to 80%

52
Q

why do we use CO instead of O2 in DLCO test?

A

CO adheres to Hemoglobin (HB) approximately 210 times more readily

53
Q

If there is a significant decrease of CO in exhale sample, what does that indicate?

A

Good gas exchange (Diffused 80% or more)

54
Q

If measurements are the same or similar what does that mean?

A

Gas exchange is limited
(Diffused less than 80%)

55
Q

What are the 3 types of DLCO

A
  • Single breath (most commonly used)
  • Rebreathing (research)
  • Intrabreath (excersing)
56
Q

Causes of low DLCO; anything that hinders your body’s ability to deliver enough o2 to your blood stream, such as:

A
  • COPD exacerbation
  • Asthma
  • PNA
  • Chronic bronchitis
  • Pulmonary edema
  • Airway obstruction
  • OSA
  • Pulmonary embolism
  • Radiation
57
Q

CarboxyHB is a stable complex of CO that forms in

A

RBC when CO is inhaled

58
Q

COHB greater than 50% are

A

potentially fatal

59
Q

Why do you think if your pt is a heavy smoker or smokes just before the test will affect the test?

A
  • increased COHB
  • The amount of time to diffuse the increase in CO will take longer than predicated 10 seconds (indicates poor gas exchange) DLCO% is decreased
60
Q

How does a pt perform DLCO test

A

Pt breathes normal Vt to establish a baseline, then exhale to RV, then inhales to maximum IRV and holds for 10 seconds

61
Q

If you have a leak while doing the DLCO your percentage will be

A

increased

62
Q

Who’s method measures breath hold for 0.3 of the inspiratory time to the midpoint of the alveolar sample

A

Jones method

63
Q

Do not use pt’s actual weight for DLCO. What should we use instead?

A

IBW

64
Q

All DLCO volumes must be corrected to STPD

A

standard temp 0
stand pressure 760 mmHg absolute
dry (no h2o)

65
Q

The average __ best test are acceptable in DLCO

A

2

66
Q

There is a maximum of __ test trys for DLCO

A

5

67
Q

An elevated DLCO is usually associated w

A

circumstances in which there is an increase in HB—-binding sites for CO uptake

68
Q

If DLCO is low, what disease process is it?

A

Empheysema

69
Q

If DLCO is normal what disease(s) is it

A

CBAB
(W/o E)

70
Q

If pt has a restrictive disease process, we would look to the DLCO to determine if the restrcition is _____________ or _______________

A
  • interstitial (happening in the lungs)
  • extrastriatal ( happening outside of the lungs)
71
Q

If the DLCO is normal, where is happening at?

A

it is outside of the lungs

72
Q

If the DLCO is decreased it is happening

A

inside of the lungs

73
Q

What is the normal value for DLCO

A

greater than or equal to 80%

74
Q

Every DLCO test uses

A

CO

75
Q

If there is a significant decrease of CO in exhale sample, what does that indicate?

A

Good gas exchange
(Diffused 80% or more)

76
Q

If measurements are the same or similar that indicates

A

Gas exchange is limited
(Diffused less than 80%)

77
Q

DLCO SB is good for everything EXCEPT ….

A

exercising

78
Q

Why would DLCO be increased during exercise?

A

Increased temp, ventilation and blood flow

79
Q

T or F A decreased FRC, RV, and TLC indicates a restrictive disorder

A

True

80
Q

If TLC is decreased what should you expect

A

Restriction

81
Q

If TLC is increased what should you expect?

A

obstruction

82
Q

An increased RV indicates which of the following?

A

To much air in the lungs

83
Q

You have acceptable body plethysmography results if…

A
  • no drift or artifacts (no coughing, leaks)
  • Calibration
  • Acceptable and replicable
  • Frequency 0.5 and 1 hrz
  • 3 within acceptable parameters
  • FRC within 5%
84
Q

A healthy closing capacity is roughly what percentage of TLC

A

30%

85
Q

Why do we choose CO instead of O2 for DLCO testing?

A

CO has a 210 greater affinity to bind to hemoglobin than O2

86
Q

If your pt has an obstructive disease, what would we look to next to determine the severity of gas exchange

A

DLCO

87
Q

If DLCO is normal for an obstructive pt what is it usually related to?

A

CBAB
CF, Bronchietasis, Bronchitis, Asthma
Everything except Emphsyema

88
Q

If the DLCO is normal in the presence of restriction, what does this mean?

A

Lung function is normal and the restriction is related to something outside of the lung

89
Q

If your pt has a restrictive disease, what does the DLCO help determine?

A

Extrastial or Interstitial

90
Q

Defining a decreased DLCO in pts w/ mixed defect can be difficult. What do we rely on to help come up with the possible diagnosis?

A
  • Pt history
  • work environment
  • medical data
91
Q

Normal HB for Men and women

A

Men: 13.5 to 17.5
Women: 12.0 to 15.5

92
Q

What reduces DLCO?

A

Low HB

93
Q

The machine uses ______ of HB for males and ____ for females and children

A

14.6%;
13.4%

94
Q

Tracer gas is used to estimate

A

TLC

95
Q

__________ ___________ is used to calculate alveolar pressure and measures the dco

A

Driving pressure

96
Q

When DLCO is decreased or low (80%) what could that indicate?

A
  • poor gas exchange
  • It could be restrictive or obstructive
97
Q

If the pt has an obstruction disease process, we would look at the DLCO to determine the…..

A

severity of the gas exchange and rule out emphysema

98
Q

If the DLCO is low (<80%), then the obstruction is….

A

emphysema related

99
Q

If the DLCO is normal (80 to 100%), it is usually related to…

A

CF, Bronchitis, Bronchitasis or Asthma

100
Q

If you pt has a restrictive disease process we would look to the DLCO to determine if the restriction is ___________ or ____________

A

interstitial or extrastitial

101
Q

If DLCO is decreased in the presence of a restriction what does this mean?

A

its caused interstitially

102
Q

If the DLCO is normal in the presence of restriction, what does that mean?

A

The pt has normal lung function and the restriction is related to something outside the lungs

Cardiopulmonary Diagnostic (PFTs) (6 decks)

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