Cardiopulmonary diagnostics, tests and labs values

Question 1

what is a chest X-ray?

Answer 1

Images of your heart, lungs, blood vessels, airways, and the bones of your chest & spine, fluid in or around your lungs or air surrounding a lung

Question 2

what can a chest X-ray reveal

Answer 2

Condition of your heart and lungs: detect cancer, infection, pneumothorax, pneumonia, emphysema or cystic fibrosis, pulmonary edema, congestive heart failure
Size and outline of your heart: Changes in the size and shape of your heart may indicate heart failure, pericardial effusion, or heart valve problems
Blood vessels: the aorta and pulmonary arteries and veins — are visible on X-rays, aortic aneurysms, other blood vessel problems or congenital heart disease
Calcium deposits: Detect the presence of calcium in your heart or blood vessels  indicates damage to your heart valves, coronary arteries, heart muscle or pericardium
Fractures: Rib or spine fractures

Question 3

A COPD patient will have what on their x-rays

Answer 3

X-ray will show
Increased AP - Barrel Chest
Widening intercostal spaces
Flattening of the diaphragm,
Rib angles that approach 90 degree angles

Question 4

what are the acute changes seen on a chest xray?

Answer 4

Acute changes include:
Infiltrates or increased opacity with early lung changes
Consolidated lung  alveoli and airways filled with fluid

Question 5

what are the changes on a chest x-ray

Answer 5

Chronic changes include flattened diaphragms, changes in rib angle and intercostal spaces, and interstitial thickening

Question 6

how are myocardial infractions imaged

Answer 6

imaging is used to diagnose and evaluate ischemic heart disease & myocardial infarction

thallium 201 scan or a thallium stress test

Question 7

how is ct scans used for chest diagnostics

Answer 7

-imaging by cross sections through the use of X-ray technology
-more detailed than a plain x-ray
-pulmonary: does not definitively dx, provides information for DX
heart: image of heart structures

Question 8

What does the echocardiogram assess?

Answer 8

noninvasive test- ultrasounds to assess heart function
assess cardiac structures- size of chambers, valves, wall thickness, septum, and abnormalities
asses the blood flow through the heart.

Question 9

What does a cardiac catheterization do?

Answer 9

Invasive
Passage of a catheter from brachial or femoral artery to aorta to cardiac vessels

Contrast medium with x-ray

Provides information about coronary artery blockage, cardiac anatomy & vessels, ventricular & valve function, and abnormalities

Question 10

What diagnostics does a central line: swan-ganz catheter provide

Answer 10

inserted into the right side

measures:
central venous pressure (CVP)
pulmonary artery pressure (PA)
right atrial pressure
right ventricle pressure

Question 11

how is a MRI used for diagnostic testing of the heart? when are the indicated?

Answer 11

non invasive
asses:
structure
disease of the heart
coronary arteries
aorta
pericardium
myocardium

indicated when the patients chest xray showed a mass or nodule

Question 12

what is a bronchoscopy used for

Answer 12

endoscope
view
biopsy
wash
suction
dilate
brush the interior aspect of the trachea-bronchial tree

the test is diagnostic and therapeutic

Question 13

how is fluoroscopy used foe diagnostics?

Answer 13

continuous x-ray beam that allows for observation of the movement within the body
used to examine diaphragmatic excursion

Question 14

how is a pet scan used

Answer 14

radioactive tracer injected or inhaled with images taken: areas of increased uptake indicates active processes often used to detect cancer

Question 15

what does the ventilation and perfusion scan diagnosis

Answer 15

Assesses airflow and blood flow to match the ventilation pattern of the lung to the perfusion pattern
Mismatch of V & Q indicates pulmonary ischemia, PE

Question 16

what is the ventilation

Answer 16

the amount of air in and out

Question 17

what is perfusion

Answer 17

the amount of blood flow through the lung

Question 18

what does the V/Q ratio define

Answer 18

defines the relationship between airflow and blood flow; is indicative of the gas exchange function of the lung
V/Q mismatch is the most common cause of hypoxia

Question 19

what is the normal perfusion value and what is the normal ventilation value?

Answer 19

V=normal v- 4 L air per minute
P= normal q-5 L blood per minute

Question 20

what is normal range of v/q and what is occurring if the ratio is higher or lower

Answer 20

normal V/Q ratio is 4/5 or 0.8
V/Q >0.8- poor perfusion
V/Q <0.8 poor ventilation

Question 21

what does a V/Q Mismatch demonstrate

Answer 21

V/Q mismatch demonstrates changes in the pulmonary vascular bed leading to increased pulmonary vascular resistance (vasoconstriction) > pulmonary hypertension > cor pulmonale or right sided heart failure - long term consequence

Question 22

The pulmonary system is sensitive to what?

Answer 22

pulmonary vasculature is sensitive to low oxygen and high carbon dioxide and will shunt blood for better ventilation and gas exchange

this is the mechanism of short term compensation

Question 23

what does a v/q mismatch identify?

Answer 23

regions of decreased perfusion and ventilation
identifies a pulmonary embolism
ventilation/perfusion mischamatch RLD and OLD is the most common cause of hypoxemia
Lung shunt - perfusion >ventilation
physiological dead space- ventilation >perfusion

Question 24

what normal blood volumes must v/q maintain normal for

Answer 24

pa02 and paco2
pa02= partial pressure of oxygen
paco2 partial pressure of carbon dioxide

Question 25

what are the conditions that cause a v/q mismatch

Answer 25

asthma
COPD
interstitial lung disease
cystic fibrosis
pulmonary hypertension

Question 26

what can we do to optimize chest pt and improve v/q ratio

Answer 26

postural drainage
patient positioning

Question 27

Pulmonary function testing provides information on?

Answer 27

lung volumes and capacities
flow rates
gas diffusion
gas distribution

Question 28

put is used to?

Answer 28

diagnosis disease, monitor progress with treatment and maximize medial management

Question 29

what is Fev1 one and is how is it used to diagnosis

Answer 29

the forced expiratory volume in one second
often used as a predictor of obstructive disease
Obstructive disease pts have a reduced FEV1 <60%
Restrictive disease pts typically minimally reduced or normal

Question 30

what is a stage one for the gold classification

Answer 30

mild severity

Question 31

what is a stage two for the gold classification

Answer 31

moderate severity and the fev1 is .5-.7

Question 32

what is a stage three for the gold classification

Answer 32

severe fev1 is .3-.5

Question 33

what is a stage four for the gold classification

Answer 33

very severe <.3

Question 34

what the difference between emphysema and chronic bronchitis seen on an PFT?

Answer 34

emphysema:
fev/fvc= <7%
“scooped” fev curve
Tlc INCREASED
increased compliance
DLCO decreased

bronchitis:
fev/fvc= < 70%
“scooped” fev curve
Tlc is normal
normal compliance
DLCO normal

Question 35

Diffusion capacity of carbon monoxide is measured in what units?
the single breath technique provides what information?
how does the DLCO diagnosis emphysema?

Answer 35

ml/minute/mmhg

single breath technique:
provides information regarding the exchange function of the lung

Diffusion is critical for alveolar gas exchange

one of the most sensitive tests for detecting the presence of emphysema

Diffusing capacity may be significantly reduced in emphysema <80% or greater
May not show evidence on physical exam or chest x-ray

Question 36

an electrocardiogram (EKG) is performed to

Answer 36

review the heart rate and rhythm

detect any sign of right and left ventricular enlargement

detect any evidence of myocardial ischemia

Question 37

approximately 50% of COPD patients older than 50 have

Answer 37

ischemic heart disease
hypertension
arrhythmia
heart failure

Question 38

Complete blood count norm are

Answer 38

RBC: 4-6 million cells/mm3
Hemoglobin: 12-17 g/dl
hematocrit: 36-50%
WBC: 4500-11000 cells/mcl
platelet count:150000-450000 cell/mcl

particularly important in detecting upper respiratory tract infections often seen in pulmonary disease patients