Lung testing

Question 1

if you increase resistance what disease could occur

Answer 1

obstructive

Question 2

if you decrease compliance what disease could occur

Answer 2

restrictive

Question 3

describe for a peak flow meter is and what is a normal value

Answer 3

rapid exhaled puff from a full inspiration, measures peak expiratory flow rate (PEFR) -
500-600l/min

Question 4

why is a peak flow meter good for an obstructive disease

Answer 4

reproducible

expiration

Question 5

what does a nebuliser do and what are the two types

Answer 5

convert solution of drug into fine spray
Brown- preventer e.g. corticosteroids -anti-inflammatory
Blue-reliever - bronchodilator e.g. salbutamol

Question 6

vitalograph how does it work

Answer 6

sustained fced expiration from a full inspiration 
measure 
FVC 
FEV1- first second 
normal range of ratio is 75-85%

Question 7

If FEV1/FVC<0.75 what disease is this indicative of

Answer 7

obstructive

Question 8

compliance

Answer 8

expandability of the lungs

Question 9

resistance

Answer 9

ease at which gas flows

Question 10

In an obstructive disease such as asthma what would you see with the FVC,FEV1 and the ratio

Answer 10

FVC would stay more or less the same - takes longer but more effort to get out , same capacity of the lungs
FEV1 would decrease
FEV1/FVC ratio would decrease

Question 11

In a restrictive disease such as pulmonary fibrosis what would you see with the FVC,FEV1 and the ratio

Answer 11

FVC would decrease as lungs cannot expand normally ( can’t create negative pressure )
FEV1 would also decrease
FEV1/FVC would either stay the same or increase

Question 12

what do lung functions vary with

Answer 12

height, age , gender

Question 13

Tidal volume ( Vt )

Answer 13

normal inspiration and expiration

Question 14

IRV- inspiratory reserve volume

Answer 14

amount of extra air inhaled above tidal volume

Question 15

ERV- expiratory reserve volume

Answer 15

extra air exhaled - force

Question 16

RV - residual volume

Answer 16

air that remains in the lungs after fully exhale

Question 17

TLC - total lung capacity

Answer 17

volume of air the lungs - max in

Question 18

VC - vital capacity

Answer 18

max air that is expelled after inhalation

Question 19

FVC - ( not forced vital capacity like In spirometry) functional residual capacity

Answer 19

vol of air in lungs after passive exhalation

capacities are sum of 2 or more volumes

Question 20

how does fibrosis appear on X-ray

Answer 20

widely distributed throughout the lung fields - course or fine appearance

Question 21

Inspiration is limited more by what type of disease

Answer 21

restrictive

Question 22

does hyperinflation limit IRV

Answer 22

yes

also raises FRC and RV

Question 23

In COPD what is destroyed

Answer 23

alveolar destruction and elastin broken down

Question 24

what can you use to measure function residual capacity/residual volume

Answer 24

helium dilution and body plethysmography ( deep breath in and out measure Interhtoraic pressure)

Question 25

why and when is a wheeze normally heard

Answer 25

lower airway obstruction, normally on expiration at level of bronchioles increasing resistance - inflammation of or smooth muscle spasms , inside the thoracic cavity Greater effort only increase Pip compressing small intrrathoracic airways further limiting air flow o expiration on inspiration there Is a negative Pip so bronchioles increase in diameter high pitched whistle like sound - deep and low pitched rumbling - hear breaths better than stridor

Question 26

why and when is a stridor normally heard

Answer 26

upper airway obstruction heard on inspiration at level of larynx/trachea - tumours, croup or foreign body outside thoracic cavity on inspiration more negative pressure in thorax further narrows the obstructed part of the airway - on expiration the positive pressure increases the diameter continuous high pitched crowing sound

Question 27

crackles what are they

Answer 27

alveolar rales fine and short and high pitched - caused by air passing through fluid puss or mucus - bases of lung lobes on inspiration course crackles - low pitch and moist - bronchitis Fien - fibrosis - hair rubbing on ear

Question 28

pleural rub

Answer 28

movement of inflamed pleural surfaces against one another during chest wall movement harsh grating like creaking TB and pneumonia lower anterior lung during both in and out

Question 29

in an obstructive disease both RV and TLC increasing by about 20% what happens with a restrictive disease

Answer 29

both decrease by about 20%

Question 30

in diffusion capacity DLCO/TLCO used CO to measure perfusion what does a decreased DLCO mean

Answer 30

obstructive ,pulmonary vascular os anemic disease

Question 31

what does an increased diffusion capacity for for carbon monoxide indicate( extend to which oxygen passes from the air sacs into the blood)

Answer 31

pulmonary haemorrhage or left right shunt

Question 32

what 3 things do flow volume loops allow movements of

Answer 32

upper airway obstruction - stridor or unexplained dyspnoea variable extra thoracic obstruction ( above sternal notch) - vocal paralysis Variable intrathoracic obstruction ( below sternal notch) chronic inflammatory disorders

Question 33

what is a bronchodilator response

Answer 33

degree to which FEV1 improves with inhaled bronchodilator indication of reversible airflow obstruction significant. if FEV1 increases by 12%

Question 34

FEV1 and is reduced in what

Answer 34

(forced expiratory volume in 1 second) = max. volume of air exhaled in 1 second. Reduced w/ obstruction and restriction

Question 35

FVC

Answer 35

FVC (forced vital capacity) = total volume exhaled after full inhalation. Reduced w/ restriction.

Question 36

what test is good for asthma control and a test for obstructive disease

Answer 36

peak flow meter

Question 37

how are restrictive and obstructive diseases impacted respectively

Answer 37

obstructive increases resistance | restrictive decreases compliance

Question 38

how to determine the difference between asthma and COPD

Answer 38

Test for reversibility, give bronchodilator (salbutamol) obstruction reversed in asthma but not COPD

Question 39

normal tidal volume

Answer 39

500ml

Question 40

normal inspriaotry reserve volume

Answer 40

2.5L

Question 41

normal expiratory reserve volume

Answer 41

1.5L

Question 42

normal residual volume

Answer 42

1.5L

Question 43

total lung capacity

Answer 43

6L

Question 44

when does surfactant production markedly increase

Answer 44

after 34 weeks

Question 45

what hormones stimulate surfactant production

Answer 45

Cortisol (most important by far) Thyroxine Prolactin

Question 46

if a premature baby is born under 32 weeks do you give them corticosteroids

Answer 46

yes to combat affects of surfactant

Question 47

in addition to surfactant what also helps to keep airways open in normal respiration

Answer 47

cartilage

Question 48

Pulmonary shunt: ventilation is cut off in the lung so blood gets no oxygen so V/Q ration = 0 Dead space = blood supply to alveoli are cut off so V/Q ration is high true or false

Answer 48

true