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Intro to Respiratory Medicine > 121- Exam 2 > Flashcards

121- Exam 2 Flashcards

(55 cards)

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1
Q

What is the termination criteria for CPET?

A
  1. Chest Pain/Angina
  2. Mental Confusion
  3. Lightheadedness
  4. SPO2 <80%
  5. ECG shows ischemia or Arrythmias
  6. BP= S:>250 D:>120 or Sys falls >20
  7. Chronotropic insufficiency
  8. Cant bike 40 rpm
  9. Pt Request to stop
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2
Q

Indication for CPET

A
  1. unexplained or disproportionate dyspnea
  2. Determination of prognosis
  3. Surgical Risk
  4. Disability determination
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3
Q
  1. What is Anaerobic Threshold (aka Lactate Threshold)
  2. How do you determine max HR
A
  1. When HR is at or near max. Metabolism continues with low/no O2 which produces lactic acid
  2. 220-Age= Max HR
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4
Q
  1. What happens during exercise (CPET)
  2. What does the body do in response to
A
  1. As exercise increases, metabolism increases, O2 consumption increases and CO2 production increases
  2. Lungs increase Min Ventilation and Heart increases cardiac output
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5
Q

What is the approximate Vo2 at Rest for CPET

A

3.5 ml/kg/min

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6
Q

Contraindications and when to stop the 6 minute walk test?

A

Contraindications:
1. Absolute= Unstable Angina in previous month, MI, SOB, Chest pain
2. Relative= HR >120 BP >180/>100

When to stop:
- Chest pain
- intolerable dyspnea
- leg cramps
- diaphoresis
- pale, dusky appearance

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7
Q

How to perform a 6 minute walk test and why

A
  1. Pt can use O2, cane/walker and stop/rest as needed
  2. BORG scale done before and after
  3. HR/SPO2 monitored during test
  4. RT doesn’t walk with Pt

Why: For Pulmonary Rehab to see how far Pt can walk in 6 minutes

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8
Q

What to chart for Hallway Test and why

A
  1. Resting/Walking/Stairs SPO2
  2. Distance walked or flight of stairs
  3. Amount of O2 used and Pt response
  4. Any additional comments

Why: Evaluate the need for O2 during exercise

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9
Q

How to perform an exercise desaturation test (aka Hallway Test)

A
  1. Pt rests on room air. If O2 is used, remove and wait 15-20 minutes
  2. Check SPO2
  3. Pt walks pre-measured hallway while monitoring O2
  4. If SPO2 drops <88%, give O2, Rest and Continue
  5. Chart findings
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10
Q

What is FENO
What does it tell us about

A

Exhaled Nitric Oxide Test

High FENO supports Asthma Dx

Low FENO may reduce likelihood of asthma

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11
Q

How does an Exercise challenge work?
Is it Direct/Indirect-Why?
What indicates a positive result?

A
  1. Done on a treadmill or ergometer with nose clips
  2. Get baseline spirometry
  3. 8 minute of high intensity exercise
  4. Rest
  5. Spirometry done every 5 minutes for max 30 minutes

a 10% decline= Positive

Indirect test as it doesn’t affect smooth muscles directly

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12
Q

How is a Mannitol Test performed and What is it doing to the body?

Direct/indirect-why

What is a positive result

A

Osmotic agent given to draw fluid from surface of airways via MDI. Dehydrates to induce inflammation and onset of Asthma symptoms

Indirect as it doesn’t directly affect smooth muscles

Positive if it falls 15% from baseline or 10% between doses

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13
Q

How is a methacholine test done?

Direct/Indirect-Why?

What is a positive result

A

A drug to induce asthma
1. Baseline spirometry
2. Small nebulized dose of methacholine
3. Spirometry- If FEV1 drops by 20%= Positive
4. Continue until 20% drop or 6 doses are given
5. Albuterol to reverse

Direct as it directly affects smooth muscles of airways

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14
Q

Contraindications for Bronchoprovocation tests (5)

A
  1. No Bronchodilators on day of
  2. No Caffeine
  3. No Exercise
  4. 4-6 weeks after chest infection
  5. If FEV1 <60% predicted
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15
Q

What is PEFR/PEF?
What Disease process uses the test?
What are the zones?

A

Peak expiratory flow rate

Asthma Pts

Green=80%+ GOOD
Yellow= 50-80% QUICK RELIEF METHODS
Red= <50% EMERGENT, GO TO ED or SEE DR

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16
Q

What is RSBI?
What is it’s normal value?
When do we use it?

A

Rapid Shallow Breathing Index Ratio

60-105 with successful vent weaning <105

Used to determine pt readiness to wean of ventilator

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17
Q

Why do we measure MIP/MEP (NIF/NEF)

A

To test muscle (diaphragm) strength

to see if vented pts are ready for unassisted ventilation

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18
Q

What 5 diseases affect the alveolar capillary membrane

A
  1. Emphysema
  2. ILD
  3. PNA
  4. Pulm. Edema
  5. ARDS
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19
Q

What is DLCO and what does it measure

A

Diffusion Capacity of Carbon Monoxide

Measures the amount of CO that moves across the alveolar capillary to determine Diffusion rate in pt’s

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20
Q

What does an increased RV (Residual Volume) or TLC (Total Lung Capacity) indicate (2)

A

Air trapping & Hyperinflation

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21
Q

What does a reduced TLC indicate

A

Restrictive Disease

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22
Q

How does Nitrogen washout, Helium Dilution & Body Plethysmography work?

What do each one tell us?

A

Nitrogen Washout= Pt Breaths 100% O2 with no rebreathing until nitrogen is ‘washed out’. Max 7 minutes or until nitrogen is <1.5%. Tells us Functional Residual Capacity

Helium Dilution= Pt breaths a Known amount of gas with known vol of Helium. Looking for equilibrium between lungs and Known Helium amount. Tells us Function Residual Capacity.

Body plethysmography (aka Body Box)= Pt pants like a dog at 30-60 bpm in box. Box measure difference in thoracic pressures and box pressures. Best Test option as it measures residual volume and air trapping

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23
Q

What are the 3 tests to measure lung volumes?

Which is most common?

Study These Flashcards
A
  1. Nitrogen Washout
  2. Helium Dilution
  3. Body plethysmography (BEST ONE)
24
Q

What are the 3 reasons we would obtain lung volumes?

Study These Flashcards
A
  1. Pts with obstruction or low FVC
  2. Pts with low FVC
  3. Pt with obstruction
25
How does restriction generally appear and what are the 3 diseases?
Not enough air in the lungs to begin with, Stiffness in the lungs, Pathological, Decrease lung volumes and capacities 1. Pulmonary Fibrosis 2. Sarcoidosis 3. Obesity
26
How does Obstruction generally appear and what are the 6 associated diseases?
Enough air in lung, but hard to get out. Inflamed and easily collapsable airways, obstruction to airflow, problems exhaling, Frequent medical visits or hospitalization, increasing residual volume 1. Asthma 2. COPD 3. Emphysema 4. Bronchitis 5. Bronchiectasis 6. Cystic Fibrosis
27
What are the 5 obstructive characteristics
1. Bronchial Secretions 2. Bronchospasms 3. Mucus plugging 4. Distal airway weakening or air trapping 5. Flow of gas reduced on forced exhale
28
Obstructive vs. restrictive 1. If FEV1/FEV are decreased, what does it indicate?
Obstructive Disorders
29
Obstructive vs. restrictive 1. If FEV% is normal or increased what does it indicate?
Restrictive disorders
30
What are the 4 common errors during a PFT?
1. Coughing especially in 1st second 2. Failure to expire to FVC "Curve with no plateau" 3. Slow Start "Curve has S shape" 4. Air leak "curve will dip down rather than rise steadily"
31
What do the 4 flow Volume lopps look like
Normal= steep increase, gradually decrease, bubble bottom Early Small Obstruction= Steep increase, gradual decrease with slight scooping, bubble bottom COPD/Obstruction= Steep increase, gradual decrease with large scooping, bubble bottom THINK: 'b' Restrictive= Steep increase, Steep decrease, narrow bubble bottom. THINK: 'R'
32
What are the 7 acceptability criteria's of the ATS for PFT?
1. No slow start 2. No cough in 1st sec 3. No early end 4. No Valsalva Maneuver 5. No Leak 6. No obstructed mouthpiece 7. No extra breaths
33
What is reproducibility criteria and how many are done for PFT?
Minimum of 3 tests that all meet acceptability criteria. No more than 8 tests to be attempted. If acceptability criteria cannot be met, note would be made indicating failure to meet reproducibility
34
What is FVC? What is FEV1? What do they indicate
Forced Vital Capacity & Forced expiratory volume in 1 second (When divided by each other= FEV%)
35
What is FEV% and what does it indicated
FVC/FEV1 When less than 70%= Obstruction When greater than 70%= No Obstruction (look at FVC >80%?) Yes= Normal Spirometry. No= Possible Restriction needing further testing
36
What is FEV1 and what does it measure
Forced Expiratory Volume in 1 second. How much air pt can get out in 1 second
37
What is FVC and what does it measure. What is important to remember about the test? How is the test done?
Forced Vital Capacity. Amount of air you can forcefully exhale after max inspiration Most common maneuver. Pt must be sitting as they may pass out Big deep breath in, Blast it out as hard as possible and as long as possible.
38
How long should a pt refrain from using these 3 inhalers before spirometry?
Short Acting bronchodilator= 4 hrs Long acting= 12 hours Ultra long action= 24 hours
39
What pt info is needed prior to spirometry (4)
1. Meds Hx 2. Smoking Hx including how long and what 3. Height, Age, Gender, Ethnicity 4. How long since last respiratory medicine
40
How is spirometry calibration Done
1. Daily 2. 3L syringe AKA super syringe 3. 3 pumps of syringe with varying flows 2-12 L/sec 4. what is pumped into machine should match. Acceptable range +/- 3.5%. varies depending on facility
41
What are the 4 things normal values are based on?
Heigh, Age, Gender, Ethnicity
42
Public Health indications look for what?(3)
1. Epidemiologic Surveys 2. Establish normal values 3. Clinical Research
43
Disability indications look for what?(2)
1. Assess level of disability from lung disease 2. Assess risk for insurance evaluation
44
Monitoring indications look for what?(3)
1. change in lung function with med administration 2. monitor adverse drug affects 3. assess effect of environmental or occupational exposure
45
Diagnostic indications look for what?(4)
1. abnormal signs, symptoms, lab results 2. How a disease is affecting pulmonary function 3. screening and preoperative risks 4. health status pre-exercise plan
46
What are the 4 indications for spirometry
1. Diagnostics 2. Monitoring 3. Disability 4. Public Health
47
What is the most common PFT test and what is it testing for?
Spirometry Testing for airflow obstruction or restriction
48
What 4 lung volumes make up the total lung capacity?
1. Inspiratory reserve Volume 2. Tidal Volume 3. Expiratory reserve volume 4. Residual volume
49
What 2 lung volume make up the functional residual capacity?
1. Expiratory reserve volume 2. Residual Volume
50
What 3 lung volumes make up the Vital Capacity?
1. Inspiratory Reserve Volume 2. Tidal Volume 3. Expiratory Reserve Volume
51
What 2 lung volumes make up the inspiratory capacity?
1. Inspiratory Reserve Volume 2. Tidal Volume
52
What are the 4 lung Capacities?
1. Inspiratory Capacity 2. Vital Capacity 3. Functional Residual Capacity 4. Total Lung Capacity
53
What are the 4 lung volumes?
1. Inspiratory Reserve Volume 2. Tidal Volume 3. Expiratory Reserve Volume 4. Residual Volume
54
FEV1/FVC Chart Break down
Greater than 70? Yes= No Obstruction= is FVC greater than 80? Yes= Normal Spirometry. No= Possible restriction further testing needed Greater than 70? No= Yes Obstruction. What severity is FEV1 Ranked (mild, mode, severe, very severe)? Is that %change >200ml & 12%+? Yes= Yes to significant response to bronchodilator No= No significant change to bronchodilator
55
GOLD COPD Chart Severity Levels?
Gold 1= Mild= 80%+ Gold 2= Moderate=50-79 Gold 3= Severe= 30-49 Gold 4= Very Severe= <30

Intro to Respiratory Medicine (10 decks)

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