FD in PULMONOLOGY

Question 1

Boyles law ?

Answer 1

air( gas) pressure is inversely proportional to air volume

P1P2= V2V2

Question 2

Primary principle of ventilation

Answer 2

Air moves down a pressure gradient (from an area of high pressure to low pressure)

Question 3

What is the atmospheric pressure and intra pulmonary pressure

Answer 3

760mmHg

Question 4

Muscles used for breathing

Answer 4

Intercostal muscles(main) 
Diaphragm(main )
Accessory muscles - sternocloidomastoid muscle , Scalene muscle

Question 5

What happens in inspiration

Answer 5

The volume of the lungs increase due to the constriction of the 2 muscles ( diaphragm and intercostal muscles )
During inspiration , the diaphragm contracts and moves down and it will allow the intrapulmonary volume to increase which will cause the intra pulmonary pressure to decrease (759mmHg, difference is -1mmHg) below the atmospheric pressure so because of the rule of gases , the air will flow into the lungs down its pressure gradient

Question 6

What happens in expiration ?

Answer 6

The diaphragm and the intercostal muscles relaxes and the diaphragm will move back up to its original place which will cause the intra pulmonary volume to decrease and intra pulmonary pressure to increase (761mmHg) difference is (+1)
Following the rule of gases So gases ( air) will move outside the lungs into the air outside down the pressure gradient

Question 7

4 Lara nasal sinuses are

Answer 7

Frontal
Sphenoid
Ethmoid
Maxillary

Question 8

methods of functional diagnostics of pulmonary diseases

Answer 8

Spirometry 
Bronchial provocation test 
Pneumotachography 
Peak flow metry 
Flow volume curve of forced expiration 
Body plethysmography

Question 9

2. In spirometry FVC - is

Answer 9

The total amount of air that can forcibly be blown out after full inspiration

Question 10

Purpose of PFT

Answer 10

1) Diagnosis of symptomatic disease
2) used to screen for early asymptomatic disease in high risk people e.g people with prolonged exposure to amiodarone
3) Used in people with occupational exposure or environmental exposure
4) To prognose known disease
5) Used to estimate surgical risk
6) Used to monitor response to treatment

Question 11

Obstructive lung diseases are

Answer 11

Chronic bronchitis 
Bronchial asthma 
Cystic fibrosis 
Bronchiectasis
Emphysema

Question 12

Types of PFT

Answer 12

Spirometry 
Lung volumes 
DLCo
Peak flow metry 
Arterial blood gas 
Exercise oximetry 
Maximum inspiratory and expiration pressures

Question 13

Tidal volume is ?

Answer 13

the amount of air that moves in or out of the lungs with each respiratory cycle.

Volume of air inspired and expired during quiet normal breathing

Question 14

Expiratory reserve volume

Inspiratory reserve volume

Answer 14

Inspiratory reserve volume – volume which can be inhaled additionally
after normal inspiration
3. Expiratory reserve volume – volume which can be exhaled additionally
after normal expiration

Question 15

Residual volume –

Answer 15

volume remaining in the lungs after maximal expiration

Question 16

Lung volumes are ?

Answer 16

Tidal volume
Inspiratory reserve volume
Expiratory reserve volume
Residual volume

Question 17

Lung capacities

Answer 17

Inspiratory Capacity - sum of tidal volume + inspiratory reserve volume

Functional reserve ( residual ) capacity - sum of expiratory reserve volume + residual volume

Vital capacity - Tidal volume + inspiratory and expiratory reserve volumes

Total capacity- sum of tidal volume + inspiratory and expiratory reserve volume + residual volume
volume filling the lung after maximal inspiration

Question 18

What is spirometry ?

Answer 18

A technique used to measure air flow , spread of airflow and some lung (air) volumes

Question 19

Vital capacity is known as forced vital capacity if it is performed as quickly as possible

Answer 19

True

Question 20

FEV1 is

Answer 20

Volume of air forcefully exhaled in 1 seconds after maximal inspiration

Question 21

PEAK expiratory flow rate ( PEFr) is

Answer 21

Maximum slope of curve

Question 22

What is a flow volume loop ?

Answer 22

A graph of airflow as a function of volume

Question 23

Spirometry display 2 graphs which are

Answer 23

a volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the X-axis

a flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total volume inspired or expired on the X-axis

Question 24

What is pneumotachometry ?

Answer 24

It measures the flow rate of gases during breathing.

Question 25

Peak Expiratory Flow Meter?

Answer 25

It is a portable, hand-held device that does Peak flow measurement which is a procedure in which air flowing out of the lungs is measured. The measurement obtained is called the peak expiratory flow rate (PEFR), or peak expiratory flow (PEF). A peak flow meter is small and light enough to be used almost anywhere.

Question 26

Purpose of a peak flow meter ?

Answer 26

It can help to determine when you seek emergency care It can help to know if your asthma management and treatment is working ``` When to stop or add medication as directed by a doctor what triggers the asthma attack (such as exercise-induced asthma) ```

Question 27

Factors or conditions that interfere with the accuracy of peak flow measurement using peak flow meter are ?

Answer 27

``` Coughing during procedure Poor seal around the mouthpiece Using bronchodilators Using different brands of peak flow meters Blocking the mouthpiece with the tongue ```

Question 28

How do you do the peak flow meter procedure ?

Answer 28

1. Before each use, make sure the sliding pointer on the PFM is reset to the zero mark. 2. Hold the PFM by the handle. 3. Stand up straight. 4. Remove chewing gum or any food from your mouth. 5. Take a deep breath and put the mouthpiece in your mouth. Seal your lips and teeth tightly around the mouthpiece. 6. Blow out as hard and as fast as you can. Remember, a “fast blast” is better than a “slow blow.” 7. Note the number where the sliding pointer has stopped on the scale. 8. Reset the pointer to zero. 9. Repeat this routine three times. You will know you have done the technique correctly when the three readings are close together. 10.If you cough during a measurement, you should repeat it. Record the highest of the three readings on a graph or in a notebook. Do not average these numbers together. This is called “peak flow.”

Question 29

What are peak flow zones ?

Answer 29

Peak flow zones are based on the traffic light concept: red means danger, yellow means caution, and green means safe. These zones are different for each person.

Question 30

Green in the peak flow zone means

Answer 30

This is the GO zone. It is from 80 to 100 percent of your highest peak flow reading, or personal best. This is the zone you should be in every day. Measurements in this zone signal that air moves well through the large airways and that you can do the usual activities and go to sleep without trouble. You should continue to follow your asthma plan as directed by your doctor.

Question 31

What is the yellow Zone in the peak flow meter ?

Answer 31

It is the CAUTION or SLOW DOWN zone It is 50-80% of personal best Measurements in this zone are a clue that the large airways are starting to narrow. mild symptoms- coughing, feeling tired, feeling short of breath, or feeling like your chest is tightening. These symptoms may keep you from your usual activities or from sleeping well. You should notify your doctor at this time. He or she may instruct you to increase or change your medications and give you additional instructions to help prevent your symptoms from worsening.

Question 32

RED zone peak flow meter readings means

Answer 32

This is the STOP zone. The red zone is less than 50 percent of your personal best. Readings in this zone mean severe narrowing of the large airways has occurred. This is a medical emergency and you should get help right away. You may now be coughing, very short of breath, wheezing both when breathing in and out, or having retractions. You may also have problems walking and talking. You should take your reliever medication now and call your doctor.

Question 33

How to measure lung volumes ?

Answer 33

Spirometry Gas dilution test ( helium dilution and nitrogen washout ) Imaging studies

Question 34

Contraindications of spirometry

Answer 34

``` Pulmonary embolism Pregnancy Children less than 6 years Mental patients recent thoracic or abdominal surgeries Recent brain surgeries Recent eye or ear surgeries Pneumothorax Hemoptysis Stroke Recent MI or acute coronary syndrome ```

Question 35

3 things you check in spirometry ?

Answer 35

FVC , VC , MVV

Question 36

What bronchodilator is used in spirometry and dose and how long should you wait ?

Answer 36

Salbutamol 400mg , wait for 20 mins

Question 37

Another alternative drug to salbutamol in spirometry is ?

Answer 37

Ipratropium , you wait for 40 mins

Question 38

During spirometry when checking for MVV , how many seconds should you take a deep and fast breath in and out ?

Answer 38

12 secs

Question 39

During spirometry when you want to check for FVC and VC, how many secs is required to blow out air hard

Answer 39

6 secs

Question 40

Why is the interpleural pressure -4mmHg

Answer 40

Due to elasticity of lungs Surface tension Elasticity of chest wall