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Study notes - Respiratory > *Resp. miscellaneous 2 > Flashcards

*Resp. miscellaneous 2 Flashcards

1
Q

What are the 3 main categories of pulmonary function tests?

A

Effort dependent tests
Effort independent tests
Gas diffusion tests

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2
Q

What are 2 effort dependent pulmonary function tests?

A

Peak Expiratory Flow (peak flow metre)
Spirometry (forced expiatory volumes)
*these are the most important in clinical practice

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3
Q

what does the flow rate =

A

Volume / time

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4
Q

What are 5 effort independent tests?

A 
Relaxed vital capacity (spirometry)
Helium/ N2 washout stati lung volumes
Whole body plethysmography
Impulse oscillometry
Exhaled breath nitric oxide
*these are the most important in clinical practice
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5
Q

What are 3 gas diffusion tests?

A

CO transfer tests
Arterial blood gases (resting)
SaO2 during exercise
*these are the most important in clinical practice

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6
Q

What is the name for the following ratio:

FEV1/FVC?

A

Forced expiratory ratio (FER)

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7
Q

What does RVC stand for?

A

Relaxed vital capacity

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8
Q

What is the difference between static and dynamic lung volumes?

A 
Static = not concerned with rate at which they are inspirited or exhaled
Dynamic = dependent on the rate (FVC)
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9
Q

How many times do the airways divide?

A

23 times

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10
Q

In terms of spirometry, where is air trapping suggested?

A

When there is a major difference between the relaxed vital capacity and the forced vital capacity

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11
Q

Do people with asthma or COPD normally have a full forced vital capacity?

A

FVC is normally preserved in asthmatics although it is normally lowered in COPD (due to remodelling)

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12
Q

Is the reduced FVC in COPD patients usually proportionate to the reduced FEV1?

A

No meaning the ratio is still lowered where as in restrictive conditions both are reduced proportionally meaning the ratio is usually normal

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13
Q

if you plot the expiatory flow rate against the forced expiatory volume (from TLC to RV), what is the shape for:

  • normal?
  • volume dependent airway closure e.g. asthma, chronic bronchitis
  • pressure dependent airway closure e.g. emphysema
A 
Normal = comes to a peak and decreases 
Volume = comes to less f a peak and decreases in a curve instead of a straight line
Pressure = comes to a much lesser peak and decreases suddenly
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14
Q

What test produces the flow-volume curve?

A

Spirometry (have to take gradients from some line)

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15
Q

What values can be extracted from the flow-volume curve?

A

Peak expiatory flow rate (PEFR)

Forced expiatory flow rate (FEFR) at a % of FVC

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16
Q

What are the units of the peak expiatory flow rate?

A

L/min

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17
Q

Apart from spirometry, what other instrument can be used to measure the peak flow rate?

A

Simple linear peak flow meter

18
Q

What is the peak expiatory flow rate?

A

The person’s maximum speed of expiration

19
Q

PEFR in obstructive disease?

Restrictive?

A

Decreased

Normal

20
Q

FEV1 in patients with obstructive disease?

Restrictive?

A

Decreased

Decreased

21
Q

FVC in patients with obstructive disease?

Restrictive?

A

Normal in asthmatic and decreased with COPD

Decreased

22
Q

FEV1/FVC ratio in obstructive?

Restrictive?

A

Less than 75%

Greater than 75%

23
Q

Fev1 response to B2-agonist in asthmatics?
COPD?
Restrictive?

A

greater than 15%
less than 15%
No response

24
Q

3 main types of triggers used in bronchial challenge testing?

A

Exercise
Metacholine/ histamine/ mannitol
Allergens/ chemicals

25
Q

What is a reaction of the airways to metacholine/ histamine/ mannitol a marker of?
What is measured during this?

A

Airway hyper-responsiveness marker

Concentration to produce 20% decrease in FEV1

26
Q

Why do asthmatic patients not get wheezy in general until after exercise?

A

Adrenaline causing bronchodilation

27
Q

What is cardiopulmonary exercise testing used to differentiate between?
What does it involve?

A

To differentiate between cardiac and respiratory dyspnoea

Measuring heart rate, oxygen uptake and ventilatory rate during exercise

28
Q

What happens to SaO2 during exercise in interstitial lung disease?

A

It drops (used to monitor treatment response)

29
Q

What happens to the functional residual capacity in COPD?

A

It increases in expense of Inspiratory capacity

30
Q

What does CO diffuse across?

A

Alveolar capillary barrier

31
Q

What is the total lung transfer for CO (TLCO)/ (interchangeable with DLCO)?

A

The total lung transfer for CO (corrected for alveolar volume (KCO)) - very sensitive measure of gas diffusion = implies integrity of alveolar-arterial vascular bed (anythings that impairs the bed will give a reduction in TLCO)

32
Q

What can reduce TLCO? (6)

A 
Anaemia
Emphysema
interstitial lung disease
Pulmonary oedema
PE
bronchiecstasis
33
Q

How is airway resistance measured?

A

Either by whole body plethysmography or more commonly/ easily with impulse oscillometry

34
Q

What does impulse oscillometry measure?

A

Airway resistance during quiet tidal beathing at different resonant frequencies to give total resistance and central resistance and hence peripheral airway resistance

35
Q

When is impulse oscilometry particularly useful?

A

In patients (i.e. kids) where it is easier to breathe at tidal volume than doing forced expiatory manoeuvre

36
Q

what is exhaled breath condensate?

A

Exhaled breath nitric oxide measured at a flow of 50ml/s

37
Q

What does is exhaled breath condensate a non invasive marker of?

A

Eosinophilic airway inflammation in asthma

38
Q

Why is exhaled breath condensate not useful in COPD?

A

NO suppressed by smoking

39
Q

What does high levels of exhaled NO (>35ppb) reflect?

A

Uncontrolled asthmatic inflamation

40
Q

What 2 tests are used to assess asthmatic inflammation especially when spirometry is normal?

A

Bronchial challenge

Exhaled breath condensate

Study notes - Respiratory (29 decks)

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