Clin Lab Med Condensed Flashcards
Bilateral pain/swelling
Raynaud
Malar/Discoid rash
Mouth ulcers
Anti-ds DNA
Anti-Smith
Lupus
Spares DIPS
Joint pain only (no musc)
Anti-CCP
Rheumatoid Arthritis (RA)
Sicca complex
Cavities-dental
Diffuse muscle AND joint pain
Anti-Ro
Anti-La
Sjogren Syndrome
Tighten/thick skin
Difficulty swallowing
Raynaud
Telangiectasias
ACA
Anti-Scl-70
Systemic Sclerosis
Acute proximal pain
Difficulty w/ADLs
DROM
Rapid imp w/ Low dose steroids
Polymyalgia Rheumatica (PMR)
Ongoing low back pain Plantas fasciitis "Bamboo spine" "Sacroilitis" Exercise helps
HLA-b 27
Ankylosing Spondylitis
Fever
Prime rib and cocktails
MSU crystals
Negatively birefringent
Needle shaped
Gout
Chondrocalcinosis on Xray
CPPD crystals
Positively birefringent
Rhomboid shaped
Pseudogout
Anti CCP
Rhemuatoid Arthritis
Anti-ds DNA
Anti-Smith
Lupus
Anti Ro
Anti La
Sjogren syndrome
ACA
Anti-Scl-70
Systemic sclerosis
ACA
Systemic sclerosis
Anti-Scl-70
Systemic sclerosis
ESR/CRP
Polymyalgia Rheumatica
HLA-b 27
Ankylosing Spondylosis
Neg,needle
Gout
Positive,rhomboid
Pseudogout
Hyperlucency
Flattened diaphragm
Barrel chest
CXR
COPD
Tall pts in 20s
Bleb on CXR
Pneumothorax (PNX): lung collapse
Hyperlucency and absence of vascular markings
Darkness often in upper lobe
Pneumothorax (PNX): lung collapse
will see tiny collapsed lung in middle
In what condition is it helpful to get an Expiratory CXR?
Pneumothorax (PNX): lung collapse
Crackly, “rice crispy” sound with palpation
Popping bubble wrap
Acute CP that radiates
Pneumomediastinum (air leaks into mediast)
Young adult male population
Pneumomediastinum (air leaks into mediast)
Most common cause of Pneumoperitoneum (leakage of air into peritoneal cavity)
Disruption of wall of a hollow viscus organ
Pleural Effusion
Abnormal fluid OUTSIDE of the lung pushing on the lung
CXR shows abnormal white gathering outside of the black/lucent lung
Along the periphery
Effusion
Infiltrate
Sponge
Fluid has infiltrated INTO the lung
White inside the lung
Infiltrate
Usually infectious
CHF
Kerley B lines
Interstital edema
“Butterfly” or “batwing” pattern
CHF
Air bronchograms
Air filled bronchi (black) pass through fluid filled area (white)
CHF
PNA
Atelectasis
Atelectasis
Collapse or incomplete expansion of Parenchyma/Alveoli
Structural shifts of trachea, heart, filum, fissures
Overinflation of unaffected side of lung
Atelectasis
Abscess on CXR
Fluid filled
Mediastinal widening
Traumatic aortic injury Vascular anomaly Pulmonary mass Mediast lymphadenopathy Enlarged pulm artery Thymus
SOB, Cystic Fibrosis hx
Wheezing
Productive cough
Access Muscle usage
Hyperlucency
Flat diaphragm
Barrel chest
COPD
Large bullae (black circles) on CXR
Emphysema and Fibrosis
Acute SOB
CP- pleuritic
Primary cause: BLEB (Tall 20YO)
PNX
CT is definitive for
PNX
CT is gold standard for
Pneumomediastinum
Young adult male
CP—> radiating
Pneumomediastinum
Dark lines following muscle and tissue planes
“rice-crispy” sound w/palpation
Popping bubble wrap
SubQ emphysema
Subdiaphragmatic air
Recent surgery Trauma Ulcer CA Inflamm bowel dz Acute onset abdominal pain--> radiate to shoulders
Pneumoperitoneum
radiolucent BELOW the diaphragm across the abdomen
Most comm cause: disruption of wall of hollow viscus organ
Infiltrate
Cough, FEVER, SOB, SOB, CP
Usually INFECTIOUS
Are air bronchograms seen w effusion?
NO
bc there is NOT fluid in the lung with effusion, and air bronchograms are only seen when air is passing through fluid filled areas
Atelectasis
COLLAPSE OF PARENCHYMA/alveoli
Diff b/w PNX and Atelectasis
PNX: collapse of Lung
Atelectasis: collapse of Parenchyma/Alveoli
Signs of Atelectasis
One side diaphragm is elevated
Crowding of pulmonary vessels
Shift of trachea, heart, hilum, fissures
Most common cause of Atelectasis
Bronchial obstruction:
Neoplasm (CA)
Mucus plug
FB aspiration
CA
weight loss smoking hx fatigue, cough Hemoptysis* CP
Characteristic of Malignant nodules
Large >15 mm
Irregular
Inhomogenous density
Spiculated margins
Smooth, well defined, homogenous, +Calcifications
Benign nodules
Arterial Blood Gas detects/monitors
Oxygenation
Ventilation
Acid-base balance
What to consider with ABG
Allen test prior to check for collateral circulation
Draw from Radial artery
Results: 5-15 min
Respiratory Acidosis
Retaining too much CO2 (hypoventilation)
Causes of Respiratory Acidosis
COPD Neuromusc dz: Guillian Barre, Myasthenia gravis Chest wall dysfx Drugs: opoids, benzos CNS event, trauma
Respiratory Alkalosis
Blowing off too much CO2
Causes of Respiratory Alkalosis
Anxiety, fear, pain Sepsis ASA intoxication Hypoxemia Altitude
Anion Gap
Na - (Cl + bicarb)
Normal Anion Gap
8-12
Anion gap measures
Anions that can’t be measured on BMP- albumin, phosphate, sulfates, etc
Elevated Anion Gap =
MUDPILES Methanol Uremia DKA Propylene glycol Iron/Isoniazid Lactate Ethylene glycol Salicylate/starved
Non Anion Gap
Bicarb loss d/t: Diarrhea Pancreatic drainage GI fistula Renal tubular acidosis
Metabolic Acidosis
Elevated anion gap: MUDPILES
MUDPILES
metabolic acidosis
Methanol Uremia DKA Propylene glycol Iron/isoniazid Lactate Ethylene glyc Salicylate/starve
Metabolic Alkalosis, what should we check next?
TOO BASIC
Urine Chloride (Cl)
If Urine Cl is <20
(metabolic alkalosis)
RESPONSIVE
GI loss (vomiting, NG suction) Diuretics
If Urine Cl is >20
(metabolic alkalosis)
UNRESPONSIVE
Hyper-Aldo
Cushing
Renin secreting tumor
K depletion
Example of PRIMARY Metabolic Acidosis
Acidic, problem is d/t LOW BICARB
Compensatory Respiratory Alkalosis (lungs blowing off CO2 to try to compensate for the acidosis)
