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Flashcards in Pulmonary - CLS and HB Deck (47):
1

Spirometry is helpful in distinguishing between what three states?

normal, obstructive lung dz, restrictive lung dz

2

What are four variables in lung capacity?

Height (taller =more), race (caucasian > asian; least important), age, gender

3

The _____ is the amount of air which can be forcibly exhaled from the lungs after taking maximal inhalation

FVC

4

The _____ is the maximal amount of air you can forcefully exhale in 1 second and is used for marker for degree of obstruction

FEV1

5

What are four obstructive lung conditions?

asthma, COPD, bronchiestasis, cystic fibrosis

6

What are five restrictive lung conditions?

pulmonary fibrosis, scoliosis, diaphragmatic disorder (happens in pregnancy), neuromuscular disease, obesity

7

An FEV1/FVC value of <70% would indicate a?

obstruction

8

An FEV1/FVC value of 80% or above would indicate?

nothing, this is normal

9

An FVC value below 80% would indicate what?

restrictive

10

A patient presents with an FEV1/FVC value of 85% and a FVC value of 60%. Which of the following would NOT be a likely cause of breathing issues?
a) scoliosis
b) pulmonary fibrosis
c) neuromuscular disease
d) bronchiestasis
e) obesity

D - bronchiestasis is OBSTRUCTIVE. These values point to a restrictive disease.

11

An obstructive pattern would yield what changes in the following: a) FEV1/FVC? b) FEV1? c) FVC?

FEV1/FVC less than 70%, FEV1 <80%, FVC normal or reduced

12

Describe the FEV1 levels that would indicate a) mild, b) moderate, c) severe, and d) very severe obstruction

a) mild is >80%, b) 50-80%, c) 30-50%, d) <30%

13

A restrictive pattern would yield what changes in the following: a) FEV1/FVC, b) FEV1, c) FVC

a) FEV1/FVC normal or greater than 70%, b) FEV1 normal, c) FVC <80%

14

What parameters would indicate a bronchodilator response in a spirometry test?

After bronchodilator, 12% increase + 200 mL improvement in either FEV1 or FVC

15

True/False: Lung capacities can be directly measured

FALSE, lung volumes can be directly measured. lung capacities are inferred from lung volumes.

16

________ is the volume of air during normal, resting breathing

Tidal volume

17

______ is the maximal amount of additional air that can be expired from the lungs after normal expiration

ERV (expiratory reserve volume)

18

___ is the maximal amount of additional air that can be INSPIRED from the lungs after normal inspiration

IRV (inspiratory reserve volume)

19

___ is the amount of air left in the lungs after maximal exhalation

RV (residual volume)

20

_______ is the maximum amount of air that can fill the lungs

total lung capacity

21

________ is the maximum amount of air exhaled after a mass inhalation

vital capacity

22

________ is the amount of air in the lungs at the end of passive expiration

functional residual capacity

23

_______ is the amount of air that can be inhaled after end of normal expiration

inspiratory capacity

24

Residual volume cannot be measured by spirometry. What are the three available methods to measure residual volume?

body plethysmography, helium dilution, nitrogen washout

25

Describe body plethysmography testing.

Patient sits in chamber with nose clips shutting nostrils. Breathes/pants against a mouthpiece both open and closed. Mouth pressure is measured - mouth P = alveolar P

26

Describe the O2 movement from alveoli to capillaries

alveolus, epithelial cells, basement membrane, endothelial cells, capillary

27

How is diffusion capacity tested?

Pt takes in breath and holds breath in maximal inspiration for 10 seconds, then exhales. 1st liter of exhaled gas discarded as dead space. 2nd liter of exhaled gas is analyzed for CO concentration

28

________ is the volume that diffuses across the capillary membrane

diffusion capacity (DLCO)

29

What four diseases may be indicated by a decreased diffusion capacity (DLCO)?

COPD, interstitial lung dz, pulmonary embolism, anemia

30

Describe how to interpret PFTs (stepwise)

First, look at FEV1/FVC ratio to determine if obstructive. If obstructive, look at FEV1 to gauge severity. If normal, then look at TLC and DLCO to determine if restrictive.

31

______ is the number one avoidable cause of death

smoking

32

Up to _____ of long-term smokers will die of a smoking caused disease

50%

33

Out of the 7000+ chemicals in tobacco smoke, how many are known to be harmful and how many cause cancer?

250, 69

34

What percent of smokers want to quit and what percent try to quiet each year

70, 44

35

____ of US adults use tobacco

20.8%

36

In which groups is prevalence of smoking high?

low SES, low education, some minority popns, those with psych disorders

37

A typical puff of cigarette smoke has ___ CO by volume

5%

38

Why can smoking lead to headache, fatigue, dizziness, and breathlessness, in addition to increased risk of blood clots?

Hemoglobin preferentially binds CO over O2 so less Hgb is available to transport O2.

39

What is the half-life of carboxyhemoglobin (%COHb) and how long should one wait after last cigarette to use CO monitor?

4-6 hours, 10 minutes

40

What are the stages of change?

Precontemplation, contemplation, preparation, action, maintenance, lapse/relapse

41

Treatment options for smoking include medication, aversion therapy, and supportive behavioral therapy. What are four medications used and how do they work?

Nicotine replacement [reduce cravings and withdrawal], Wellbutrin [same], Chantix [blocks nicotine receptors so smoking less rewarding]

42

What is the most effective option for quitting smoking?

Medication and intense counseling (8+ sessions)

43

What is the most common cause of hypoxemia?

V/Q mismatch

44

If a patient is acidotic, has a low PO2 and a high PCO2, but has a normal A-a gradient, what is the cause of their hypoxemia?

not ventilating enough

45

Why does pulmonary fibrosis lead to diffusion impairment?

Collagen and fibrous tissue in alveolar walls build up so the thickness between capillaries and alveoli is increased impairing diffusion

46

How does emphysema cause V/Q mismatch?

capillaries and alveoli are destroyed so lungs are being ventilated but not perfused

47

Only _____ results in high A-a gradient on 100% oxygen

shunting