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Clin Med III - Exam 1 > 7B: Pulmonary Diagnostics > Flashcards

7B: Pulmonary Diagnostics Flashcards

1
Q

What are the standard views for a chest x-ray?

A

AP and lateral

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2
Q

How will air present on x-ray?

A

Dark

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3
Q

What does a high hemi-diaphragm suggest?

A

Large areas of atelectasis or low inflation

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4
Q

What does a flattened hemi-diaphragm suggest?

A

Overinflation

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5
Q

How do the R/L costophrenic angles differ?

A

Right cm higher than left

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6
Q

What are abnormal x-ray findings for COPD?

A

Enlarged lungs, flattened diaphragm, narrow mediastinum

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7
Q

What are abnormal x-ray findings for CF?

A

Overinflation, diffuse infection

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8
Q

What does this x-ray suggest?

A

COPD - lots of grey area

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9
Q

What does this x-ray suggest?

A

CF - white and patchy indicating fluid

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10
Q

What are abnormal x-ray findings for venous dilation?

A

Increased vascular markings

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11
Q

What are abnormal x-ray findings for pulmonary edema?

A

Central pattern of infiltrates with increased vascular margins (fluffy clouds)

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12
Q

What abnormal x-ray findings suggest infection?

A

Areas of white patches

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13
Q

What does this x-ray suggest?

A

Pulmonary edema - less air, more white space

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14
Q

What does this x-ray suggest?

A

Bronchiectasis - tree like

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15
Q

What is suggested if areas that should be dark are totally obliterated and white?

A

Consolidated pneumonia, ARDS, pneumothorax, atelectasis

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16
Q

What does this x-ray suggest?

A

Pneumonia - lower lobe completely filled with fluid

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17
Q

What does this x-ray suggest?

A

ARDS - all white and hazy, fluid everywhere

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18
Q

What does this x-ray suggest?

A

Pneumothorax - intubated and has no air in R lung

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19
Q

What does this x-ray suggest?

A

Atelectasis - no air

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20
Q

What does this x-ray suggest?

A

COVID - marble look

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21
Q

What happens to the mediastinum with pneumothorax?

A

Pushes mediastinum to contralateral side

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22
Q

What happens to the mediastinum with atelectasis?

A

Pulls mediastinum to ipsilateral side

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23
Q

What is bronchography?

A

Study of bronchial airways where you can see changes in bronchial walls and lumen - catheter is threaded down patient’s bronchi to evaluate

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24
Q

What is bronchography used for?

A

Congenital anomalies to monitor changes in progression of disease

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25
Q

What is a bronchoscopy?

A

Viewing of airways using fiberoptics, camera goes into bronchus segments - general anesthesia

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26
Q

What does a V/Q scan study?

A

Regional ventilation, gas exchange, regional perfusion

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27
Q

What is the gold standard for diagnosing PE?

A

V/Q scan

28
Q

How is a V/Q scan administered?

A

Pt breathes in xenon gas, holds their breath, then scan is taken

29
Q

What does ABG measure?

A

pH, PaCO2, PaO2, HCO2, and BE (base excess)

30
Q

What is BE?

A

Base excess - a measure of change in pH that is not related to respiration

31
Q

What does PaCO2 show?

A

Adequacy of alveolar ventilation

32
Q

What will hyperventilation cause on ABG?

A

CO2 decreased

33
Q

What will hypoventilation cause on ABG?

A

CO2 increased

34
Q

What level of CO2 is considered ventilatory failure?

A

> 55 mmHg

35
Q

What happens with ventilatory failure?

A

Acute changes in pH, loss of alertness, coma if not treated

36
Q

What four things should you consider with a ABG assessment?

A
  1. Ventilatory status - pH
  2. Relationship between pH and PaCO2
  3. Alveolar ventilation
  4. PaO2 - oxygenation status
37
Q

If there is an inverse relationship between pH and PaCO2, what is suggested?

A

Respiratory problem

38
Q

If there is not an inverse relationship between pH and PaCO2, what is suggested?

A

Metabolic problem

39
Q

What are you observing for during a clinical chest exam?

A
  • General appearance
  • Mediastinum position
  • Musculature
  • Bony thorax
  • Breathing dynamics
40
Q

Describe purulent sputum?

A

Clear, usually chronic bronchitis

41
Q

Describe blood tinged sputum

A

Red specs, TB or flu

42
Q

Describe foul smelling sputum

A

Infection, often bronchiecstasis

43
Q

Describe brassy sputum

A

Aneurysm, medical emergency

44
Q

Describe frothy sputum

A

CHF

45
Q

Describe hemoptysis sputum

A

Coughing up blood, pulmonary bleed, emergency

46
Q

Describe thick green or yellow sputum

A

Infection

47
Q

What are you assessing with rib excusion?

A

Symmetry, quality, amplitude to determine regional ventilation

48
Q

What is fremitus?

A

Vibration of voice or from secretions

49
Q

Why does hyporesonance indicate with fremitus?

A

Decreased air moving due to COPD, fluid, or lung collapse

50
Q

What does hyperresonance indicate with fremitus?

A

Echo of air moving in lung, really only caused by consolidated pneumonia

51
Q

What is mediate percussion?

A

Assess changes in lung density

52
Q

What will make a flat sound with mediate percussion?

A

Viscera

53
Q

What will make a dull sound with mediate percussion?

A

Muffled or filtered though increased density of tissue such as consolidation or tumor

54
Q

What will make a hyperresonant sound with mediate percussion?

A

Open space

55
Q

What is auscultation and what are you listening for?

A

Presence of absence of breath sounds - quality, symmetry, amplifications, relationship between inspiration and expiration, adventitia sounds

56
Q

What are rales/crackles?

A

Discontinuous sounds like short bursts of popping

57
Q

What do fine crackles at the end of inspiration indicate?

A

Sudden opening of small airways, CHF, pulmonary fibrosis, atelactasis

58
Q

What do high pitched most crackles through the breath cycle indicate?

A

Fluid

59
Q

What are wheezes?

A

Musical continuous notes, which may be heard during any phase of the breathing cycle - usually heard during expiration

60
Q

What do wheezes indicate?

A

Indicative of airway obstruction due to either mucous or bronchoconstriction - could mean lesions, mass, compression of airway, inflammation, edema, increased secreations

61
Q

What is phonation indicated for?

A

Consolidation

62
Q

What is whispering pectoriloquy?

A

Whispered words are amplified when heard through the chest wall

63
Q

What is egophony?

A

“E” comes out sounding like “A”

64
Q

What is bronchophony?

A

“99” sound is amplified

65
Q

How is phonation categorized?

A

Hypo, hyper, or normal resonsnace

Clin Med III - Exam 1 (21 decks)

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