CVPR Week 5: Pulmonary function tests

Question 1

Spirometry measures?

Answer 1

lung function

• FVC
• FEV1

Question 2

FVC AKA

Answer 2

Forced vital capacity

Question 3

FVC definition

Answer 3

s defined as the amount of air that can be forcibly exhaled from the lungs after taking the deepest breath possible

Question 4

FEV1 AKA

Answer 4

Forced expiratory volume in 1 second

Question 5

FEV1 definition

Answer 5

FEV1 is the maximal amount of air you can forcefully exhale in one second

the test shows if there is airway obstruction

Question 6

Lung volume tests measure?

Answer 6

Measures lung capacity

• TLC
• RV

Question 7

TLC AKA

Answer 7

Total lung capacity

Question 8

TLC definition

Answer 8

• about 6,000 mL
• is the maximum amount of air that can fill the lungs
• (TLC = TV + IRV + ERV + RV)

Question 9

RV AKA

Answer 9

Residual volume

Question 10

RV Definition

Answer 10

the volume of air still remaining in the lungs after the most forcible expiration possible

Question 11

PFT AKA

Answer 11

Pulmonary function tests

Question 12

PFT Values

Answer 12

Question 13

In pulmonary, capacity is?

Answer 13

The sum of at least 2 volumes

Question 14

What are PFTs used for?

Answer 14

• Diagnosis and treatment of lung disease
• Evaluate disease progression or improvement during treatment
• Pre-operative evaluation
• Clinical diagnosis of dyspnea
• Evaluate impairment
• Changes due to exposures or drugs (occupational exposures or drugs like amiodarone and chemotherapies)

Question 15

Common drugs that cause pulmonary toxicity

Answer 15

• Chemotherapies
• amiodarone

Question 16

Preoperative PFTs value and indications

4 listed

Answer 16

• somewhat useful for predicting the risk of postoperative complications
• Lung function alone should not be used to deny a patient non-pulmonary surgery
• In lung resection, used to predict a post-resection FEV1 of 0.8L
• Exercise testing may also be useful

Question 17

Symptom diagnostics to help in the evaluation

5 listed

Answer 17

• Cough
• Dyspnea
• Wheezing
• Orthopnea
• Chest pain

Question 18

Lab or imaging study diagnostics to help in the evaluation

4 listed

Answer 18

• Hypoxemia
• Hypercapnia
• Polycythemia
• Abnormal CXRs

Question 19

Physical exam finding diagnostics to help in the evaluation

Answer 19

• signs of overinflation
• Wheezing
• Crackles
• Cyanosis

Question 20

Spirometry values measured

Answer 20

Often measured before and after bronchodilators

• FEV1
• FVC

Question 21

For most cases, what test values are needed to define lung disease is present and follow patients with obstructive disease

Answer 21

• FEV1
• FVC

Question 22

How to perform spirometry

8 listed

Answer 22

Question 23

The flow volume loop of spirometry

Answer 23

Question 24

How is an obstructive defect determined from PFTs?

Answer 24

• FVC is the total amount of air exhaled from total lung capacity down to residual volume
• FEV1 is the amount of air exhaled in 1 second (most people should be able to exhale 70% of their VC in 1 second)
• Expressed as FEV1/FVC ratio
• This is a difficulty in getting air out rather than in

Question 25

Air movement deficits in Obstructive lung diseases

Answer 25

Difficulty getting air "**out**"

Question 26

Air movement deficits in Restrictive lung diseases

Answer 26

Difficulty getting air "**in**"

Question 27

Ratio of what indicates airflow obstruction?

Answer 27

\<70% of FEV1/FVC

Question 28

FEV1/FVC of \<100 and \>70

Answer 28

mild

Question 29

FEV1/FVC of \<70 and \>60

Answer 29

Moderate

Question 30

FEV1/FVC of \<60 and \>50

Answer 30

Moderately severe

Question 31

FEV1/FVC of \<50 and \>35

Answer 31

Severe

Question 32

FEV1/FVC of \<35

Answer 32

Very severe

Question 33

Severity of airflow obstruction classifications

Answer 33

Question 34

Common obstructive lung defects

Answer 34

* Asthma * COPD/Chronic bronchitis * Ephysema * Bronchiectasis

Question 35

Asthma level of obstruction

Answer 35

It may be variable obstruction improving post-bronchodilator

Question 36

Asthma PFTs

Answer 36

* PFTs may be normal if patient's asthma is under control * Normal spirometry doesn't rule out the disease for this reason * Spirometry can help define the severity of the disease * Bronchodilatory response - increase in FEV1 of 12% and greater than 0.2 L suggests response * Lack of bronchodilator response does not rule out asthma or mean that bronchodilators are not useful * Lung volumes are usually not needed

Question 37

Asthma normal spirometry

Answer 37

spirometry may be normal if the patient's asthma is under control and for this reason the disease cannot be ruled out by normal spirometry

Question 38

Asthma bronchodilator response considerations

Answer 38

* increase in FEV1 of 12% and greater than 0.2 L suggests a response * Lack of a bronchodilator response does not rule out asthma or mean that bronchodilators are not useful

Question 39

Asthma lung volumes

Answer 39

Lung volumes are not usually needed

Question 40

COPD PFTs 3 listed

Answer 40

* A decrease in FEV1 helps define the severity of the disease along with functional status and exacerbations for prognostication * Lack of bronchodilator response does not mean that bronchodilators are of no use * Lung volumes can show hyperinflation (elevated TLC) and air trapping (elevated RV)

Question 41

Lung volumes measure

Answer 41

TLC and RV

Question 42

Lung volume testing usefulness

Answer 42

not needed as a routine test but is useful in defining restrictive lung diseases

Question 43

Increased TLC in obstruction

Answer 43

means hyperinflation and increased RV air trapping

Question 44

Lung volume testing for defining restrictive diseases 3 listed

Answer 44

* Defined as a decrease in lung volume * decreased TLC below the lower limit of normal * FVC and FEV1 are both reduced but the ratio is normal meaning difficulty getting air in and not getting air out

Question 45

Restrictive defect is defined by?

Answer 45

Based on a reduced TLC A decreased VC in the presence of a normal to increased FEV1?FVC ratio is suggestive of restriction but should also have lung volumes to confirm

Question 46

Mild restrictive disease

Answer 46

TLC = 70

Question 47

Moderate restrictive disease

Answer 47

TLC = \<70 and \>60

Question 48

Severe restrictive disease

Answer 48

TLC = \<60

Question 49

Causes of decreased TLC in restrictive lung disease

Answer 49

* Interstital lung disease/pneumoconiosis * scarring and fibrosis of alveolar septae * Loss of lung tissue * Surgical resection * Breathing mechanics * mechanical/neuromuscular disease leads to a restrictive process however the lungs themselves are normal * Obesity * restriction due to the chest wall and abdomen impinging on the thoracic space * lung parenchyma is normal

Question 50

Obesity mechanism of decreased TLC 2 listed

Answer 50

* restriction due to the chest wall and abdomen impinging on the thoracic space * lung parenchyma is normal

Question 51

Breathing mechanics mechanism of decreased TLC

Answer 51

A mechanical/neuromuscular disease leads to a restrictive process however the lungs themselves are normal

Question 52

Loss of lung tissue mechanisms of decreased TLC

Answer 52

Surgical resection

Question 53

Interstitial lung disease/pneumoconiosis mechanism of decreased TLC

Answer 53

scarring and fibrosis of alveolar septae

Question 54

DLCO AKA

Answer 54

Diffusion capacity for Carbon Monoxide

Question 55

DLCO test

Answer 55

* Assesses the amount of functional alveolar-capillary surface area or how much blood is in the lung available for gas exchange * Used to assess whether lung parenchyma is normal; particularly in restrictive processes * Decrease can be an early sign of pulmonary fibrosis or pulmonary vascular disease

Question 56

What can cause a decreased DLCO?

Answer 56

* Obstructive lung disease (emphysema: loss of alveolar surface area) * Restrictive lung disease (interstital lung disease, not usually in obesity or neuromuscular weakness) * Radiation therapy * Amiodarone Bleomycin Nitrofurantoin and other chemotherapies * Pulmonary vascular disease: PE/pHTN

Question 57

Interpretation considerations of PFTs 5 listed

Answer 57

* Interpretation should be made in light of the clinical question * No single test is diagnostic * Results can be affected by patient effort, machine reproducibility, disease state of the patient * Evaluate the quality of the test * Use of prediction equations are based on population studies and may not represent the patient being studied

Question 58

Considerations for the quality of a test 3 listed

Answer 58

* The lab should follow ATS recommendations (special training and certification for RTs to perform PFTs * Results should be reproducible * Minimum of 6 seconds exhalation time with a 2-second plateau on a volume-time curve

Question 59

Interpretation criteria 5 listed

Answer 59

Question 60

PFT study

Answer 60

normal test

Question 61

PFT Study

Answer 61

* this is obstructed * and looks like they have a bronchodilator response * FEV1/FVC = \<48 so pretty bad and there is a response to bronchodilators

Question 62

PFT Study

Answer 62

normal

Question 63

PFT Study

Answer 63

* mildly restrictive and a little DLCO * FEV1 and FVC is reduced but their ratio is normal * DLCO is corrected for anemia

Question 64

Obstructive vs Restrictive: Lung volume

Answer 64

obstructive ↑ Restrictive ↓

Question 65

Obstructive vs Restrictive: FEV1

Answer 65

Obstructive: ↓↓ Restrictive: ↓

Question 66

Obstructive vs Restrictive: FVC

Answer 66

Obstructive: ↓ Restrictive: ↓

Question 67

Obstructive vs Restrictive: FEV1/FVC

Answer 67

Obstructive: ↓ Restrictive: nml/↑

Question 68

Obstructive vs Restrictive * Lung volume * FEV1 * FVC * FEV1/FVC

Answer 68

Question 69

Case

Answer 69

Question 70

Upper airway obstruction

Answer 70

Question 71

PFT Prediction equations

Answer 71

Question 72

PFT Normal curve

Answer 72

Question 73

PFT Prediction equations Crapo

Answer 73

Question 74

Obstructive defect

Answer 74

* A disproportionate reduction of maximal airflow with respect to the maximal lung volume * FEV1 decreases more than FVC * Earliest limitation is in small airways (FEF 25-75)

Question 75

Obstructive defects treatments

Answer 75

Question 76

Bronchodilatory response

Answer 76

Question 77

Bronchodilator response

Answer 77