7B: Pulmonary Diagnostics Flashcards
What are the standard views for a chest x-ray?
AP and lateral
How will air present on x-ray?
Dark
What does a high hemi-diaphragm suggest?
Large areas of atelectasis or low inflation
What does a flattened hemi-diaphragm suggest?
Overinflation
How do the R/L costophrenic angles differ?
Right cm higher than left
What are abnormal x-ray findings for COPD?
Enlarged lungs, flattened diaphragm, narrow mediastinum
What are abnormal x-ray findings for CF?
Overinflation, diffuse infection
What does this x-ray suggest?
COPD - lots of grey area
What does this x-ray suggest?
CF - white and patchy indicating fluid
What are abnormal x-ray findings for venous dilation?
Increased vascular markings
What are abnormal x-ray findings for pulmonary edema?
Central pattern of infiltrates with increased vascular margins (fluffy clouds)
What abnormal x-ray findings suggest infection?
Areas of white patches
What does this x-ray suggest?
Pulmonary edema - less air, more white space
What does this x-ray suggest?
Bronchiectasis - tree like
What is suggested if areas that should be dark are totally obliterated and white?
Consolidated pneumonia, ARDS, pneumothorax, atelectasis
What does this x-ray suggest?
Pneumonia - lower lobe completely filled with fluid
What does this x-ray suggest?
ARDS - all white and hazy, fluid everywhere
What does this x-ray suggest?
Pneumothorax - intubated and has no air in R lung
What does this x-ray suggest?
Atelectasis - no air
What does this x-ray suggest?
COVID - marble look
What happens to the mediastinum with pneumothorax?
Pushes mediastinum to contralateral side
What happens to the mediastinum with atelectasis?
Pulls mediastinum to ipsilateral side
What is bronchography?
Study of bronchial airways where you can see changes in bronchial walls and lumen - catheter is threaded down patient’s bronchi to evaluate
What is bronchography used for?
Congenital anomalies to monitor changes in progression of disease
What is a bronchoscopy?
Viewing of airways using fiberoptics, camera goes into bronchus segments - general anesthesia
What does a V/Q scan study?
Regional ventilation, gas exchange, regional perfusion
What is the gold standard for diagnosing PE?
V/Q scan
How is a V/Q scan administered?
Pt breathes in xenon gas, holds their breath, then scan is taken
What does ABG measure?
pH, PaCO2, PaO2, HCO2, and BE (base excess)
What is BE?
Base excess - a measure of change in pH that is not related to respiration
What does PaCO2 show?
Adequacy of alveolar ventilation
What will hyperventilation cause on ABG?
CO2 decreased
What will hypoventilation cause on ABG?
CO2 increased
What level of CO2 is considered ventilatory failure?
> 55 mmHg
What happens with ventilatory failure?
Acute changes in pH, loss of alertness, coma if not treated
What four things should you consider with a ABG assessment?
- Ventilatory status - pH
- Relationship between pH and PaCO2
- Alveolar ventilation
- PaO2 - oxygenation status
If there is an inverse relationship between pH and PaCO2, what is suggested?
Respiratory problem
If there is not an inverse relationship between pH and PaCO2, what is suggested?
Metabolic problem
What are you observing for during a clinical chest exam?
- General appearance
- Mediastinum position
- Musculature
- Bony thorax
- Breathing dynamics
Describe purulent sputum?
Clear, usually chronic bronchitis
Describe blood tinged sputum
Red specs, TB or flu
Describe foul smelling sputum
Infection, often bronchiecstasis
Describe brassy sputum
Aneurysm, medical emergency
Describe frothy sputum
CHF
Describe hemoptysis sputum
Coughing up blood, pulmonary bleed, emergency
Describe thick green or yellow sputum
Infection
What are you assessing with rib excusion?
Symmetry, quality, amplitude to determine regional ventilation
What is fremitus?
Vibration of voice or from secretions
Why does hyporesonance indicate with fremitus?
Decreased air moving due to COPD, fluid, or lung collapse
What does hyperresonance indicate with fremitus?
Echo of air moving in lung, really only caused by consolidated pneumonia
What is mediate percussion?
Assess changes in lung density
What will make a flat sound with mediate percussion?
Viscera
What will make a dull sound with mediate percussion?
Muffled or filtered though increased density of tissue such as consolidation or tumor
What will make a hyperresonant sound with mediate percussion?
Open space
What is auscultation and what are you listening for?
Presence of absence of breath sounds - quality, symmetry, amplifications, relationship between inspiration and expiration, adventitia sounds
What are rales/crackles?
Discontinuous sounds like short bursts of popping
What do fine crackles at the end of inspiration indicate?
Sudden opening of small airways, CHF, pulmonary fibrosis, atelactasis
What do high pitched most crackles through the breath cycle indicate?
Fluid
What are wheezes?
Musical continuous notes, which may be heard during any phase of the breathing cycle - usually heard during expiration
What do wheezes indicate?
Indicative of airway obstruction due to either mucous or bronchoconstriction - could mean lesions, mass, compression of airway, inflammation, edema, increased secreations
What is phonation indicated for?
Consolidation
What is whispering pectoriloquy?
Whispered words are amplified when heard through the chest wall
What is egophony?
“E” comes out sounding like “A”
What is bronchophony?
“99” sound is amplified
How is phonation categorized?
Hypo, hyper, or normal resonsnace
