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Respiratory Therapy > Basics of Pulmonary Diagnostic Tests > Flashcards

Basics of Pulmonary Diagnostic Tests Flashcards

1
Q

Pumonary Function Tests can measure what

A

Flows

Volumes

Resistance

Compliance

Diffusion capabilities

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2
Q

Indication of PFT

A
  • To identify and quantify changes in pulmonary function
    • Most common purpose of PFT and will help to differentiate between cardiac and resp source
  • Evaluate need and effectiveness of therapy
  • ​Epidemiologic Surveillance
  • Assess for postoperative pulmonary complications
  • Determine pulmonary disability
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3
Q

3 Categoires of Pulmonary Function Tests

A

Measuring dynamic flow rates of gases through the airways

Lung volumes and capacities

Ability of the lungs to diffuse gases

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4
Q

Contraindication to PFT

A

Chest or Abdominal Pain

Recent Surgery of Thorax or Abdomen

Aneurysms

Recent Vascular surgery

Unstable cardiovascular status (myocardial infarction or pulmonary embolus)

Hemoptysis (coughing up blood) of unknown origin

Oral or facial pain exacerbated by a mouthpiece

Presence of acute disease that will interfere wil test

Pneumothorax

Recent eye surgery

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5
Q

Why Should a PFT not be done when there is chest or abdominal pain

A

This is due to the high pressure that are generated in the thorax

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6
Q

How Long After a Thorax or Abdomen Surgery can you do a PFT

A

4-6 weeks

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7
Q

ATS PFT Indications

Monitoring

A

Assess therapeutic intervention

Describe the course of the disease that affect lug function

Monitor people that are exposed injurious agents

Monitor for adverse reactions to drugs with known pulmonary toxicity

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8
Q

ATS PFT Indications

Public Health

A

Epidemiological Surveys

Derivation of reference equations

Clinical research

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9
Q

ATS PFT Indications

Disability/Impairment Evaluation

A

Assess patient as part of rehabilitation programme

Asses risks as part of insurance evaluation

Assess individuals for legal reasons

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10
Q

ATS PFT Indications

Diagnostic

A

Evaluate symptoms, signs, and abnormal lab tests

Measure effect of disease on pulmonary function

Screen individuals at risk of having pulmonary diseases

Assess pre-operative risk

Assess prognosis

Assess health status before beginning strenuous physical activity programmes

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11
Q

What is the Primary Problem in Obstructive Diseases

A

The primary problem is an increase airway resistance (Raw), which is the difference in pressure between the ends of the airway divided by the flow rate of gas moving through the airway

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12
Q

What is the Primary Problem in Restrictive Diseases

A

The primary problem is a decrease in lung and thoracic compliance and lung volumes

Restrictive lung disease affects the patient where they are unable to fill their lungs on inhalation, as the lungs are restricted from fully expanding resulting in a decrease in volume

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13
Q

Types of Obtructive Diseases

A

CBABE

Cystic Fibrosis

Brochietasis

Asthma

Bronchitis

Emphysema

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14
Q

What type of relationship does compliance and volume have

A

Compliance is the volume of gas per amount of inspiratory effort measured through the amount of pressure created in the lungs or pleural space when inspiratory muscle contract

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15
Q

What are the 2 type of PFT equitment

A
  • Those that measure volume
    • Volume and flow measuring devices are spirometers
  • Those that measure flow
    • Flow measuring devices are pneumotachometers

Both types of instruments simultaneously measure time, and compute various volumes and flow rates

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16
Q

Capacity

A

The range or limit of how much a device can measure

Most instruments are designed with capacities to measure volumes and flow rates of all adults.

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17
Q

Accuracy

A

Closeness of agreement between the results of a measurement and the true value

Ex. Calibration with a 3L syringe. If the calibration consistently comes in at it can be said to be accurate

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18
Q

Repeatability

A

Closeness of agreement between the results of successive measurements carried out with the same conditions

Same method, same observer, same instrument, same location, same condition of use, and repeated over a short space of time.

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19
Q

Error

A

No measuring instrument is perfect, and there usually is an arithmetic difference between reference values and measured values and this difference is known as error

Accuracy and error are opposing terms; the greater the accuracy, the smaller is the error.

Accuracy and error are commonly expressed as percentages, with their sum always equaling 100%.

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20
Q

Resolution

A

Smallest detectable measurement

Instruments with high resolution can measure the smallest volumes, flows, and times.

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21
Q

Reproducibility

A

How close the results are from successful measures of the same item under channged conditions

Ex. Checking calibration under slow, medium, and fast flow rates

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22
Q

Precision

A

How often we get the same value on a measure

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23
Q

Linearity

A

Linearity refers to the accuracy of the instrument over its entire range of measurement, or its capacity.

Some devices may accurately measure large volumes or high flow rates but may be less accurate when measuring small volumes or low flow rates.

To determine linearity, accuracy and precision are calculated at different points over the range (capacity) of the device.

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24
Q

Output

A

Output includes the specific measurements made or computed by the instrument.

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25
Q

Sensitivity and specificity

A

Some tests are extremely sensitive,and apparently healthy individuals may have an abnormal test result.

However, some tests are not sensitive; individuals must be extremely sick to have an abnormal test result.

Most tests of pulmonary function are not specific because several different diseases may cause the test result to be abnormal.

This limitation of many pulmonary function tests explains why these tests identify a pattern of impairment rather than diagnose specific diseases.

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26
Q

Validity

A

Validity of the test relates to its meaningfulness or the ability to measure what it is intended to measure.

When performing pulmonary function testing, strictly following testing procedures, ensuring patient effort and performance, and ensuring equipment accuracy and calibration establish test validity.

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27
Q

Reliability

A

A reliable test will produce consistent test results with minimal variation

In order to check the reliability of a test you need to perform the test more than once

Ensuring test validity and reliability is the most important role of the RT.

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28
Q

Volume and Flow Monitors

A
  • The term spirometer is a generic term for all volume-measuring and flow-measuring devices
    • Spirometers includes water-sealed, bellows, and dry rolling seal types
      • A water seal spirometry is more precise than a pneumotachograph
  • As these devices collect gas they will expand, the magnitude to which the device expands if the measured volumes and the speed of expansion is the flow rate
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29
Q

Flow Measuring Devices

A
  • Thermal (hot-wire) anemometer
    • Measure flow based on temperature drop
    • Many vents use this
  • Turbine flowmeter
  • Pneumotachographs
    • This is what we will use in PFTs
    • Pressure differential
    • Ultrasonic
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30
Q

Pneumotachometers

A
  • Flow-measuring devices are commonly called pneumotachometers
  • The Fleisch-type pneumotachometer measures the change in pressure as gas flows through it.
  • Thermistors or mass flowmeters measure flow through the change in temperature created through gas flowing through it
  • Tubinometer uses rotation of a fan/blade similar to a windmill
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31
Q

Pressure Differential Pneumotachograph

A

Resistance= (Delta Pressure)/ Flow

The gas flow thru these devices is proportional to the pressure drop across a known resistance

The resistance can be brass capillary tubes, ceramic with parallel channels, or fine mesh screen

Often heated to reduce condensation

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32
Q

Hazards/Complications of Spirometry

A

pneumothorax;

increased intracranial pressure;

syncope, dizziness, light-headedness;

chest pain;

paroxysmal coughing;

contraction of nosocomial infections;

oxygen desaturation due to interruption of oxygen therapy;

bronchospasm

33
Q

Patient Position

A
  • It should be reported on whether the patient is sitting or standing during the test
    • Both positions are allowed but it must be reported so that if testing is performed over long periods of time the same position can be used
  • Sitting is preferable for safety as there is less of a chance of failing due to syncope
    • The chair should have arms and no wheels
    • If a wheelchair is used then make sure the wheels are locked
  • If the patient is standing then there should be a chair close by
34
Q

What Position is Preferred for Obese Patients

A

Standing may be preferred for obese patient as larger volumes and flows can be achieved

35
Q

Patient Details

A
  • Should record age, gender, race, height and weight for reference calculation
  • For patients with deformities (ie. Kyphoscoliosis) the span from middle fingertip to middle fingertip is used as an estimate of height
  • The use of knee height to predict height can also be used for handicapped people where arm span may be difficult to measure
36
Q

Gas diffusion testing may be helpful in diagnosis diseases such as

A

Goodpasture’s Syndrome.

37
Q

Medications and Testing

A
  • Should record medications especially cardiac and respiratory medications including the type (oral and inhaled), dose, and when they were last taken
  • When the test is to determine underlying lung function bronchodilators should be avoided whereas if the purpose of the test is to determine effectiveness of therapy then bronchodilators should be taken as normal
38
Q

Subject Preparation

A
  • Activities to avoid before testing
    • Smoking within 1 hour of testing
    • Consuming alcohol within 4hrs of testing
    • Vigorous exercise within 30 mins of testing
    • Wearing clothing that substantially restricts full chest and abdominal expansion
    • Eating a large meal within 2hrs of testing
  • It should be recorded on the report if any of these factors are a concern
  • Subjects should be as relaxed as possible before and during the tests.
  • Dentures should normally be left in place; if they are loose, they may interfere with performance and are, therefore, best removed.
39
Q

What Needs to Be Recorded for Every Test

A

Temperature, Barometric Pressure, Relative Humidity and time of day are important to record

Temperature is an important variable in most pulmonary function tests and is often measured directly by the instrument.

This is usually captured during the calibration procedure

40
Q

Repeat Testing

A

Ideally, when patients return for repeat testing (e.g. at a clinic), the equipment and the operator should be the same, and the time of day should be within 2 h of previous test times.

41
Q

What Are Some Charateristic to Remeber About Testing Order

A

The measurement of carbon monoxide diffusing capacity of the lung (DL,CO) immediately after a nitrogen washout measurement of the total lung capacity (TLC) will be affected by the increased oxygen content in the lungs, unless enough time has passed to allow the oxygen concentration to return to normal.

Tidal breathing manoeuvres may be disturbed by a recently performed maximal forced expiratory manoeuvre.

Bronchodilator administration may affect static lung volumes, reducing hyperinflation by up to 0.5 L

While bronchodilators do not seem to affect diffusing capacity when measured by the Jones–Meade method, they may allow ,10% of patients to obtain a measurement of diffusing capacity that was not possible pre-bronchodilator

42
Q

Possible Order of Test for PFT

A
  • Dynamic studies
    • Spirometry
    • Flow Volume Loop
    • PEF Static Lung Volume
  • Inhalation of Bronchodilator
  • Diffusion Capacity
  • Repeat Dynamic Studies if Bronchodilators Used
43
Q

Why Should Standard Precautions Be Used

A

Standard precautions should be applied because of the potential exposure to saliva, mucus, or blood, which can harbor potentially hazardous microorganisms.

44
Q

Transmission can be via direct contact

A
  • There is potential for transmission of upper respiratory diseases, enteric infections and blood-borne infections through direct contact.
    • Although hepatitis and HIV contagion are unlikely via saliva, transmission becomes a possibility with open sores on the oral mucosa or bleeding gums.
  • The most likely surfaces for contact are mouthpieces and the immediate proximal surfaces of valves or tubing.
  • Mouthpieces or pneumotachometers
    • Saliva, oral mucosa, bleeding gums
  • Use disposable filters (mouthpieces) and nose clips where possible
45
Q

Transmission can be via indirect contact

A

Aerosol and droplet

There is potential for transmission of tuberculosis (TB), various viral infections, opportunistic infections and nosocomial pneumonia through aerosol droplets.

The most likely surfaces for possible contamination by this route are mouthpieces, proximal valves and tubing.

46
Q

Cleaning the Devices

A

Although it is unnecessary to clean the interior surfaces of the testing instruments routinely between patients,the mouthpiece, nose clips, tubing, and any parts of the instrument that come into direct contact with a patient should be disposed, sterilized, or disinfected between patients.

Any equipment surface showing visible condensation from exhaled air should be discarded, disinfected, or sterilized before reuse.

47
Q

What is the most important function of the lungs

A

Gas Exchange

48
Q

Gas Exchange is Dependant Upon

A

Diaphragm and thoracic muscles ability to expand thorax and create a sub-atmospheric pressure

Unobstructed airway for gas flow

Ability for O2 and CO2 to diffuse through the AC membrane

Cardiovascular system to circulate oxygenated blood

49
Q

How Long After a C-Section Can You Do a PFT

A

6-8 Weeks

50
Q

What is an Absolute Contra-Indication for a PFT

A

Myocardial Infarction within 1 month

51
Q

How Long After a Pneumothorax Can Someone do a PFT

A

2 weeks post treatment

52
Q

How Long After Eye Surgery Can Someone Do a PFT

A

Lasik (1 month)

Cataract (1-2 months)

This is because the change in ocular pressure may be harmful to the eye

53
Q

Respiratory Infection and PFT

A
  • Active TB
  • Respiratory infection
    • Airway inflammation can affect results
54
Q

What Happends if a patient has smoked or eaten a large meal before a PFT

A

Will interfere will forced vital capacity

55
Q

Obstructive Lung Diseases and Airflow

A
  • Obstructive lung diseases conditions make it difficult to exhale air
    • SOB occurs from the narrowing of the airways in the lungs causing a decrease in flow rates
56
Q

Radius of Airway and Expiration

A
  • As the radius of airways will normally lessen slightly during expiration flow rates are usually measured during expiration
57
Q

Poiseuille’s Law

A
  • It is important to note that according to Poiseuille’s Law a small decrease the radius of the airway will lead to a large increase in airway resistance
    • Airway resistance can be reduced through contraction of the bronchial and bronchiolar muscles (bronchospasm), excessive secretions, swelling, tumors, collapse of bronchioles, etc.
58
Q

What are We Mesuring When We Measure Flow Rates

A
  • Through measuring flow rates, pulmonary function tests can be used to measure resistance and estimate the size of airways and indicate the presence of obstructive diseases
59
Q

What May Cause a Reduced Lung Compliance

A
  • Alveolar inflammation (pneumonia), swelling (pulmonary edema), scarring (pulmonary fibrosis)
  • A reduced thoracic compliance: thoracic wall abnormalities (kyphoscoliosis), exogenous pressure exerted on the thoracic cavity (ascites or pregnancy)
  • Neuromuscular disease as the patient is unable to generate enough sub atmospheric pressure to take a full deep breath
60
Q

Obstructive Vs. Restrictive Disease

Useful Measurements

A

Obstructive: Flow Rates

Restrictive: Volumes or capacities

61
Q

Obstructive Vs. Restrictive Disease

Pathology

A

Obstructive: Increased Airway Resistance

Restrictive: Decreased lung ot thoracic compliance

62
Q

Obstructive Vs. Restrictive Disease

Breathing Phase Difficulty

A

Obstructive: Expiration

Restrictive: Inspiration

63
Q

Obstructive Vs. Restrictive Disease

Anatomy Affected

A

Obstructive: Airways

Restrictive: Lung Parenchyma, Thoracic Pump

64
Q

ATS Equitment and Accuracy

A

*According to ATS criteria equipment must have an accuracy of 3% or 0.05L with a flow rate of 0-14 L/sec and Volume of 0.5-8 L

65
Q

Thermal Flowmeters

A
  • Operates on the principle that as gas passes over a heated wire the sensor cools and changes its resistance, and the change in resistance is proportional to gas flow
    • Gas flow is calculated from the amount of power needed to maintain the temperature of the element (cooling=decreased resistance=higher gas flow)
      • Inverse relationship between gas flow and power
66
Q

Ultrasonic Pneumotachograph

A
  • Also called a Vortex Shedder! (ex. Servo-i)
  • Uses struts to create partial obstruction to gas flow and as gas flows the struts vortices are formed
  • The ultrasonic transmitter produces sound waves which are interrupted by the vortices
  • These ‘interruptions’ are counted by the receiver and are equivalent to a specific volume
67
Q

Which Patients are at most risk for infections and which patients are at most hazard

A
  • Patients with oral lesions or active respiratory infections pose the greatest potential hazard, and patients with compromised immune systems are at the greatest risk.
68
Q

Most Likely Equitment to be a source for contamination

A
  • The most likely surfaces for possible contamination by this route are mouthpieces, proximal valves and tubing.
    • Use disposable filters (mouthpieces) and nose clips where possible
69
Q

Minimum Requirements for Quality Control

A
  • Documentation of repairs or alterations to equipment-
  • Dates of computer software/hardware updates
  • Log Volume Calibration and Calibration Checks
    • Done daily with a 3L syringe
  • Flow Calibration and Checks
    • At last 3 maneuvers
    • Flow between 0.5 – 12 L/s (injection times of 0.5 – 6 sec. with 3L syringe)
70
Q

Which of the following would be considered an indication for performing a pulmonary diagnostic test?

  1. To confirm the presence of pulmonary disease
  2. To confirm the absence of pulmonary disease
  3. To quantify the impact of pulmonary diseases on lung function, if any
  4. All of the above
  5. A and C
A

All of the above

71
Q

Pulmonary function studies can assess all of the following except for

Carbon Monoxide Levels

Lung Volumes

Diffusion Capacities

Expiratory Flow Rates

A

Carbon Monoxide Levels

72
Q

You are supposed to perform a full PFT on a patient who underwent abdominal surgery two weeks ago. Is this a contraindication from performing these tests

Yes

No

A

Yes

73
Q

The hazards of pulmonary diagnostic testing includes

Bronchospasm

Fainting

Risk of infection

Increased intracranial pressure

All of the above

A

All of the above

74
Q

Repeatability is defined as

The closeness of agreement between a test result and the true value

The closeness of agreement between the results of successive tests under the same conditions

The closeness of agreement between the results of successive tests under differing conditions

None of the above

A

The closeness of agreement between the results of successive tests under the same conditions

75
Q

Which of the following activities may impair the reliability of pulmonary function testing?

Smoking within 1 hour of testing

Drinking alcohol within 4 hours of testing

Eating a large meal within 2 hours of testing

All of the above

A and B

A

All of the above

76
Q

Patient characteristics that impact lung function includes

Height

Age

Gender

All of the Above

A and B

A

All of the Above

77
Q

You would expect less than ideal PFT results from which of the following patients

Bill with mild GI upset and pain

Tim with recent jaw surgery

Betty, pregnant with twins, who suffer from incontinence

Millie with Alzheimer’s

All of the above

A

All of the above

78
Q

Ethnicity must be taken in to consideration when assessing PFT results

True

False

A

True

79
Q

You are about to test a patient who seem tired and frail. Prior to starting testing you should

Ask the patient to stand for better results

Ask the patient to sit on a chair with wheel so that he can get close to the device

Ask the patient to sit on a chair without wheel so that he is stable

Ask the patient if he would like to reschedule his tests

A

Ask the patient to sit on a chair without wheel so that he is stable

Respiratory Therapy (17 decks)

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