Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiopulmonary Diagnostic (PFTs) > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Specialized test are often standard test performed under special conditions to evauate

A

response to a condition or medication

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

Specialized test can be used in pts who have:

A
  • Normal PFTs but have respiratory symptoms
  • uncertain results of bronchodilator testing
  • used to identify and characterized hyperresponsiveness in airway
  • Assess changes of hyperactivity or assess severity of symptoms
  • For those at risk of environmental or occupational exposure to antigens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Bronchoprovaction challenge aka Bronchial challenge used for?

A

To identify and characterize hyperresponsive in the airways

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

The less gas it takes to evoke a negative response,

A

the more hyperreactive the airway is

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

With this test we provoke bronchospasm in the airways

A

Bronchial challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Direct stimulus include:(4)

A
  • Methacholine
  • Histamine
  • Prostagladins
  • Leukotrienes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indirect Stimulus includes (5)

A
  • Mannitol
  • Adenosine
  • Exercise
  • Eucapnic voluntary hyperventilation beta blockers
  • Hypertonic saline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Direct stimulus work directly on the

A

parasympathetic muscle to cause bronchospam

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

Indirectly stimulus causes ___________________ via intermediary cells

A

bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

____________________ and ______________ are chemicals that increase parasympathetic response in bronchial smooth muscle

A

Methocholine and Histamine

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

What uses cold air or room temp gases and causes heat and water loss from the airway?

A

Eucapnic Voluntary Hyperventilation

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

Methacholine is inhaled by the pt, along with increasing doses from

A

0.016 mg/ml to 16 mg/ml, prepaired in two to four fold dilutions

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

Methacholine is used in pts who cannot

A

tolerate repeated spirometry testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is it considered a positive result in Metha Challenge?

A

When FEV1 is reduced by 20%
(PC20 or proactive concentration)

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

Metha challenge test is considered negative if the

A

dose reaches 16 mg/ml w/o 20% reduction in FEV1

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

_____ pts will experience a change in airway w/ increasing concentrations?

A

ALL

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

A healthy subject will not

A

display a decrease of 20% or more in FEV1

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

What disease process usually drops 20% w/ dose as low as 8 mg/ml or less during metha challenge and why?

A

Asthma b/c they have very sensitive airways

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

What other disease process may usually drop during Metha challenge (3)

A
  • COPD
  • CF
  • Bronchitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the test criteria for Methacholine challenge?

A

Pts must be ASYMPTOMATIC
- no coughing or wheezing
- no recent upper or lower respiratory infections
- baseline FEV1 should be normal or at least > 60% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some contraindications of the Metha challenge?

A
  • Myocardial infarction in last 3 months
  • Stroke
  • Aortic aneurism
  • Uncontrolled HTN
  • FEV1 < 50% predicted or <1.0L b/c risk that the challenge may leave the individual w/ compromised lung function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How long should SABAs be withheld?

A

8hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How long should LABA’s be withheld

A

48hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Beta agonist (range)

A

12-24hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Anticholinergics

A

24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Theophyline (range)

A

12- 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Extended Theophyline

A

48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antihistimines

A

72 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the 2 methods of delivery for Metha challenge?

A
  • 5-breath dosimeter (most common)
  • 2 min Tidal breathing method
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

For a 5 breath dosimeter method the delivered dose of the methacholine is standardized by using a fixed

A

number of 5 breaths for each

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

For the 2 minute method, the delivered dose is standardized by using a

A

fixed length of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 2 dosing methods?

A
  • Quadrupling method (4x)
  • Doubling method (2x)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

The highest dose for either test is

A

16 mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Methacholine is administered sequentially in increasing concentration ranging from

A

0.016 to 16 mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Methacholine is given via

A

neb starting with the lowest (most diluted) concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Doismeter (most common) is delivered in

A

5 breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Methacholine is prepared in

A

5 concentration each dose is 4x larger than the previous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Can doismeter be prepared and advance?

A

Yes, must be stored in fridge. Must be room temperture at the time of use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Why is doismeter preferred?

A

B/c it delivers a consistent volume of drug w/ a fixed volume of aerosol on each breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The pt takes 5 breaths of first concentration through

A

mouth w/ nose clips on (closed circuit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How should the breaths be during this test?

A

deep and slow
(RV to IRV) w/ slight breath hold at TLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When should spirometry be repeated? (Range)

A

30 to 90 seconds after each breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

After the test is completed what should be done?

A

Bronchodilator to reverse bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

If at anytime during testing FEV1 decreases by >20% then the

A

test is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What device is used for the 2 minute tidal breathing method?

A

Small volume neb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

A _________ should be used on the _____________ limb

A

filter;
expiratory

47
Q

Output needs to be

A

0.13 ml/min

48
Q

Pt rebreathes ______________ methacholine solution w/ normal relaxed breaths thru mouth w/ nose clips for 2mins

A

nebulized

49
Q

The 2 min tidal breathing method dosage starts at

A

0.031 mg/ml and increases 2x each step until the max is reached of 16.0 mg/ml

50
Q

This test method can also be prepared ahead of time and must be at room temp when used

A

something to know

51
Q

Why is a filter used on the expiratory side?

A

To prevent methacholine release in the room

52
Q

If FEV1 decreases 20% or greater it is considered a

A

positive response (pt airway is hypersensitive)

53
Q

How do you report a decrease of 20% in FEV1 after the first dose?

A

PC20 at < first dose

54
Q

How do you report no decrease after the last dose

A

PC20 >16 mg/ml

55
Q

If there is a decrease in FEV1 of 20% (PC20) at low doses of methacholine, there is a

A

high probability of asthma

56
Q

If FEV1 decrease of less than 20% at 16.0 mg/ml negative results

A

asthma is unlikely

57
Q

Pts requiring higher doses 8-16 mg/ml often do not

A

have asthma

58
Q

____________________ challange stimulates bronchoconstriction directly

A

Histamine

59
Q

Aerosolized histamine extract is similar to

A

methacholine challenge

60
Q

How is the test performed?

A
  • spirometry is performed
  • A concentration of Histamine is administered and the spirometry to get FEV1
61
Q

As long as the pt does not have a decrease in FEV1 of 20% during the Histamine challenge w/ the diluent then……

A

the test continues

62
Q

Pts breathes in ___ breaths of the 1st concentartion

A

5

63
Q

For histamine, dosing begins at

A

0.03mg/ml and doubled until reaching the max dose 10mg/ml

64
Q

What are some of the most common side effects of Histamine?

A
  • flushing
  • headache
  • sleepy
65
Q

Pt should not have these for 48 hrs b.c it can cause bronchospasms

A

Antihistamines

66
Q

What is the peak action of histamine

A

30 sec to 2 min, same as methcholine

67
Q

Exercise challenge is commonly used in pts w/ suspected

A

Exercise Induced Asthma (EIA)

68
Q

Bronchospasm usually occurs….

A

during or immediately after vigorous exercise

69
Q

What is bronchospasm usually related to during exercise?

A

Heat and water loss in the airway due to increased ventilation

70
Q

Candidates for Exercise Testing

A
  • Normal PFTs have SOB on exertion
  • Other challenge test such as methacholine or histamine were normal but pt is symptomatic
  • Evaluating therapy in a known EIA pt
  • Screening pts who may have associated risk if they are asthmatic
71
Q

Would you perform an exercise challenge on an Asymptomatic pt?

A

No b/c they have no symptoms

72
Q

How long should we wait to perform another exercise challenge? and why?

A

4hrs; Due to catecholamine release (neurotransmitters such as epinephrine and dopamine) will cause bronchoconstriction to lessen w/ additional testing

73
Q

What is needed before an exercise challenge test?

A
  • History and physical
  • EKG
  • No bronchodilators prior to test
  • FEV1 should be no less than 65%of predicated
  • No vigorous exercise for 4hrs prior
  • No respiratory infections 3-6 weeks prior
74
Q

Workload should be at

A

80-90% of max HR for 4 to 6 mins

75
Q

During the exercise test what should be monitored? (4)

A
  • EKG
  • HR
  • BP
  • sats
76
Q

When should you monitored vitals?

A

1 to 2 mins post exercise

77
Q

When is the exercise challenge test positive?

A

Decrease of 10 to 15% of FEV1

78
Q

In a healthy pt exercise will

A

increase the FEV1.
(if it increases then pt most likely does not have EIA)

79
Q

Eucapnic Voluntary Hyperventilation Testing is similar to

A

exercise testing, b/c it provokes a bronchospasm due to heat and water loss from the airways

80
Q

EVH usually uses (2)

A
  • cold, dry gas
  • CO2 is added to prevent hyperventilation (creating a co2 narcosis)
81
Q

To perform the EVH a mixture of air is passed over a….

A

heat exchanger or cooling coil to chill air to -10 to -20 degrees Celsius

82
Q

No ___________________ prior to test b/c we are trying to

A

bronchodilators;
invoke a bronchospasm

83
Q

What is the most common test used for EVH

A

Cold air method

84
Q

During the EVH test, pt’s must rebreathe in gas w/ ______________ respirations.

A

elevated

85
Q

Pts must ventilate at 60- 85% of their

A

MVV for 4-6 minutes during the EVH test

86
Q

What is added to prevent hyperventilation during the EVH test?

A

CO2

87
Q

A decreased FEV1 of ___ % in the EVH test indicates a reactive airway (positive)

A

10%

88
Q

In a healthy person EVH will usually cause _______________ not a bronchospasm

A

bronchodilation

89
Q

Some asthmatics will experience an significant decrease FEV1 of

A

20-60%

90
Q

Exhaled Nitric Oxide (ENO) is a method used for assessing

A

airway inflammation

91
Q

ENO measures

A

inflammation in the lungs

92
Q

ENO specifically measures

A

Eosinophilic inflammation

93
Q

Increased eosinophilic is common in what disease process (2)

A
  • Asthma
  • COPD
94
Q

What causes a decrease in ENO?

A

smoking

95
Q

Before an ENO test pt’s should not (3)

A
  • smoke
  • eat
  • drink
    (for 1 hr prior)
96
Q

When should the ENO test be performed?

A

before ALL the other test

97
Q

What should be recorded before the test?

A

current meds and health status

98
Q

What can decrease inflammation?

A

Corticosteriods

99
Q

How can ENO be measured? (2)

A
  • Online
  • Offline
100
Q

Sample exhaled gas continuously at the mouth is most common. Which ENO measuring method is this?

A

Online

101
Q

This measures collected gas in an sampling device

A

Offline

102
Q

For online pt inhales thru

A

Nitric oxide scrubber.
They exhale to RV, and inspire over 2 to 3 seconds to TLC (slow, even deep breath)

103
Q

To prevent nasal no contamination….

A

nose clips is needed

104
Q

Exhaled gas with the online method, measuring should be (#)

A

0.05L/sec

105
Q

We must have at least ___ acceptable test withing ___% of each other then average them

A

2;
20%

106
Q

How long should you wait in between measurements for online?

A

30 seconds

107
Q

For offline measuring the pt inhales to

A

TLC through no scrubber or from a reservoir of no-free gas

108
Q

Where is the sample collected in the offline measurement?

A

In a ballon

109
Q

How long does analysis take for offline?

A

12 hr

110
Q

For nasal nitric oxide air is aspirated into

A

one side of the nose and out the other

111
Q

What is the normal FENO in adults and children

A

adults 10-35 ppb
children 5-25

112
Q

If levels are elevated above the norms, what does this mean?

A

Suspected eosinophilic inflammation of the airways or alveolitis

113
Q

Why do changes in Nitric oxide happen quicker than changes in PFTs?

A

It demonstrates immediate changes in airway inflammation markers

Cardiopulmonary Diagnostic (PFTs) (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions