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Block 2 > Clin Lab: Pulm Testing > Flashcards

Clin Lab: Pulm Testing Flashcards

1
Q

What are PFT?

A

series of measurements related to lung volumes, rate of airflow, & gas exchange

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2
Q

Indications of PFT

A
  • symptoms of lung dz/dx of lung dz
  • screening
  • assess tx efficacy
    -pre-op evaluation of lung function
  • monitoring for med SE
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3
Q

Contraindications for PFT.

A
  • active or recent resp infx
  • recent surgery
  • recent or current heart issues
  • known aneurysms in chest, abdomen, brain
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4
Q

Tidal volume (TV)

A

total volume of air inhaled/exhaled in one normal breath

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5
Q

Minute volume

A

tidal volume x # breaths/minute

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6
Q

IRV

A

volume that can be forcefully inhaled after normal tidal inspiration

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7
Q

IC

A

TV + IRV

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8
Q

ERV

A

volume that can be forcefully exhaled after normal tidal expiration

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9
Q

RV

A

volume of air left in lungs after all possible air exhaled

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10
Q

FRC

A

ERV + RV

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11
Q

Slow vital capacity

A

VC measured w/ slower, prolonged exhale

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12
Q

VC

A

total volume of air that can be exhaled after a maximum inspiration

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13
Q

Forced vital capacity

A

VC measured w/ forceful exhalation

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14
Q

TLC

A

VC + RV

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15
Q

List the 3 Forced vital capacities & describe?

A
  • forced expiratory volume/time (FEV1, FEV2 etc): volume exhaled forcefully during a particular time period
  • forced expiratory flow (FEF): rate of flow during FEV25% & FEV75%)
  • Peak expiratory flow rate (PFER): maximum rate of flow during forceful exhalation
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16
Q

Types of pulmonary disorders

A

Obstructive, Restrictive, Pulmonary vasculature, breathing mechanics, neurologic control

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17
Q

Obstructive disorders are issues with

A

the airway & air flow issues

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18
Q

examples of fixed obstruction in upper airways

A

masses, mucus plug

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19
Q

Examples of variable Extrathoracic obstructions

A
  • sleep apnea
  • vocal cord issues
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20
Q

Examples of variable intrathoracic obstruction

A
  • COPD
  • asthma
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21
Q

Two categories of cause for restrictive pulm disorders

A
  • loss of compliance/elasticity
  • anatomical restrictions
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22
Q

Pulm disorders: pulm vasculature causes

A
  • chronic PE
  • chronic PHTN
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23
Q

Pulm disorders: breathing mechanics causes

A
  • diaphragm/intercostals
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24
Q

Pulm disorders: Neurological control causes

A
  • muscular dystrophy
  • stroke
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25
Q

Measurements on specialized PFTs

A
  • ABG
  • Exercise oximetry “road test”
  • 6-min walk test
  • Peak flow
  • Max inspiratory & expiratory pressure
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26
Q

What percentage of O2 will qualify a patient for home O2?

A

<88%

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27
Q

Spirometry procedure

A
  • TV measured 3-5 times
  • Forced exhalation for >6 secs measured 3 times
  • Bronchodilator challenge (if done)
    (BD inhaled; forced exhalations repeated to assess change
    Usually, albuterol)
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28
Q

What other special test can be done? (spirometry slide)

A
  • used when we suspect asthma*
  • bronchoprovocation (methacoline/allergen,exercise)
  • exercise testing
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29
Q

Results are based on predicted values for…

A

age, height, race, gender

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30
Q

On flow-volume loop, above the x-axis is…

A

exhalation

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31
Q

On flow-volume loop, below the x-axis is…

A

inhalation

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32
Q

What two things are being compared to the normal flow-volume loop?

A

shape & peak expiratory flow

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33
Q

What two things are being observed on the volume/time curve?

A
  • where is the plateau?
  • how long did it take to reach it?
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34
Q

Draw the spirometry volume/time chart

A

DONE

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35
Q

Draw flow-volume loops

A

DONE

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36
Q

GOLD criteria has a FEV1/FVC ratio of? Who is it used for?

A

70%

  • middle-aged pts to assess COPD severity
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37
Q

ATS criteria has a FEV1/FVC ratio of? Who is it used for?

A

> 85%

  • > 18yo
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38
Q

Low FEV1/FVC ratio & normal FVC is indicative of what?

A

Obstructive lung dz

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39
Q

How do you assess a bronchodilator test for obstructive lung dz?

A
  • Ratio has >12% incr and FVC has >200 mL increase–> asthma (reversible)
  • only one of the above criteria met–> COPD or bronchiectasis (irreversible)
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40
Q

Low FEV1/FVC ratio & low FVC is indicative of what?

A

Mixed disorder

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41
Q

How do you assess a bronchodilator test for a mixed disorder?

A
  • FVC increases to >LLN–> obstruction w/ air trapping (emphysema)
  • FVC does not increase to >LLN
    mixed disorder
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42
Q

Possible methods for lung measurents.

A
  • helium
  • N2 washout
  • body plethysmography
  • radiographic measurements
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43
Q

When looking at lung volumes, what will restrictive patterns show.

A

low TLC confirms (the entire box is smaller)

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44
Q

What is DLCO?

A

measures capacity of diffusion across the alveolar-capillary membrane

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45
Q

Should CO normally be present in air/blood

A

No, & it has a very high affinity for Hgb

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46
Q

Causes for decreased DLCO

A
  • interstitial lung dz
  • emphysema
  • PHTN
  • Anemia
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47
Q

Causes for normal DLCO

A
  • NM disorders affection resp system
  • chronic bronchitis
  • asthma
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48
Q

Study Slide 35 (full chart) 10 mins

A

DONE

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49
Q

What is A1AT?

A

inactivates enzyme that breaks down collagen

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50
Q

Deficiency of AAT leads to…

A
  • early onset emphysema
  • childhood cirrhosis
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51
Q

What is CF?

A

genetic disorder causing impaired Cl- transporter in cell membranes resulting in thick mucous

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52
Q

What test can be done to check for CF?

A

Cl- sweat test

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53
Q

Results of Cl- sweat test

A
  • 29 or less –> CF unlikely
  • 60 or high –> CF likely
  • 30 to 59 –> inconclusive - repeat test & monitor
54
Q

What does ACE stand for & what does it do?

A
  • Angiotensin converting enzyme
  • Angiotensin I (from liver)–> to angiotensin II (stimulates aldosterone [Na+ out of urine back into bloodstream] release)–> increases BP
55
Q

Indications for ACE levels

A
  • Sarcoidosis (elevated ACE)
56
Q

Dx testing for A1AT & ACE

A

serum level measured

57
Q

What does ANCA stand for & what do they do?

A
  • Antineutrophil cytoplasmic antibodies
  • attach WBC antigens causing inflammation & destruction of BVs w/ resultant lung damage
58
Q

Hemoptysis w/ ANCA would be…

A
  • Pneumonia
  • Autoimmune dz
  • Cancer
  • TB
59
Q

ANCA can have what vasculitides affect the lungs?

A
  • granulomatosis w polyangiitis (GPA)
  • Eosinophilic granulomatosis w/ polyangiitis (EGPA)
  • Microscopic polyangiitis
60
Q

Dx test for ANCA

A

Biopsy
- staining done for ANCA antibodies

61
Q

Common resp pathogens: viruses

A

flu, paraflu, RSV, coronavirus, metapneumovirus

62
Q

Common resp pathogens: bacteria

A

Bordetella pertussis, strep pneumo, s. aureus, mycoplasma, Legionella, Klebsiella, H. flu

63
Q

Less common resp pathogens: bacteria

A

mycobacterium TB

64
Q

Less common resp pathogens: fungi

A

histoplasmosis, aspergillus, pneumocystis

65
Q

Hallmark symptoms that make you think Legionella.

A

pneumonia + GI symptoms

66
Q

Outpt. diagnostics for pneumonia

A
  • clinical dx (fever + productive cough)
  • testing (CXR, labs, CBC/BMP)
67
Q

ER diagnostics for pneumonia

A
  1. CXR
  2. Labs (CBC/BMP, +/- ABG, blood cultures, lactate)
68
Q

On admission from ED diagnostics for pneumo

A
  1. Urine Antigen: strep pneumo & legionella
    Blood antigen: mycoplasma pneumonia
  2. Procalcitonin: elevated w/ bacterial infx, not w/ viral
  3. sputum culture (gram stain & culture
69
Q

What is procalcitonin?

A

produced by lung parenchymal cells in response to bacterial toxins

70
Q

What is considered a good sputum culture?

A

< 10 epithelial cells & >25 polymorphonuclear cells

71
Q

Dx tesing for suspected TB

A
  • CXR
  • 3 sputum specimens, at least 8 hrs apart, at least 1 early am (acid-fast stain, NAAT, culture & sensitivities)
  • skin test or IGRA–> TB antigens in vitro
72
Q

Disorders that can cause a pleural effusion

A
  • Lung infx, lung cancer, PE
  • pancreatitis
  • HF
  • Cirrhosis
  • Nephrotic syndrome
73
Q

Two underlying for pleural effusions

A
  • capillaries leaky (infx/cancer)
  • increase rate of osmosis into tissues–> incr hydrostatic pressure or decr oncotic pressure
74
Q

Describe exudative fluid & causes.

A
  • PROs + cells
  • think infection & cancer (lung)
75
Q

Describe transudative & causes

A
  • minimal PROs + cells
  • Pancreatitis, HF, Cirrhosis, Nephrotic syndrome
76
Q

Contraindications for thoracentesis

A
  • bleeding disorder - relative
  • skin infx at site
  • low volume effusion
77
Q

Complications of thoracentesis.

A
  • pneumothorax
  • Reactive pulm edema (if >1.5L removed)
78
Q

what type of fluid analysis is done via thoracentesis?

A
  • Gram stain & culture
  • Cell count & differential
  • PRO
  • LDH
  • Glucose
  • Cytology
  • Cholesterol
79
Q

Light’s criteria: usually exudative if AT LEAST ONE of the following

A
  1. ratio of pleural fluid PRO to serum PRO is >0.5
  2. ration of pleural fluid LDH to serum LDH is >.45 (changed from 0.6)
  3. pleural fluid LDH level is > 0.6 x the normal upper limit of serum LDH
80
Q

Does the new criteria need a serum sample?

A

NO, no blood needed
- a lot of cells means a lot of cholesterol

81
Q

Imaging for PE

A
  • CTA chest
  • V/Q scan
  • Venous US or legs (DVT?)
82
Q

Labs for PE

A

D-dimer or EKG

83
Q

Note

A

Use Wells’ criteria to help us decide whether to do a d-dimer or go straight to imaging

84
Q

A D-dimer test has a cutoff that is related to what?

A
  • age
  • d-dimer tend to go up w/ age
85
Q

what is mostly commonly seen on EKG if pt. has a pulmonary embolism?

A

sinus tachycardia

86
Q

What is the more uncommon things seen on EKG in PEs?

A

S1Q3T3 pattern

87
Q

Measure of hypoxemia on ABG: Normal PaO2

88
Q

Measure of hypoxemia on ABG: Mild

89
Q

Measure of hypoxemia on ABG: Moderate

90
Q

Measure of hypoxemia on ABG: Severe

91
Q

Hypoxemia means there a problem b/t

A

the nose & alveoli
1. ventilation issue
2. gas exchange issue

92
Q

If the etiology of hypoxemia is unclear, what can help narrow the list of causes?

A

A-a gradient

93
Q

PAO2 means:

A

partial pressure of O2 in the ALVEOLI

94
Q

PaO2 means:

A

partial pressure of O2 in the blood (arteries)

95
Q

Does the A-a gradient vary w/age?

96
Q

A-a gradient calculated vs expected: normal (close to equal) is what type of issue?

A

ventilation issue

97
Q

A-a gradient calculated vs expected: elevated (calc > expected) is what type of issue?

A

gas exchange issue

98
Q

What is a bronchoscopy?

A

endoscopic procedure to visualize trachea & major bronchi

99
Q

Where can a bronchoscopy be done?

A

bedside or endoscopy suite

100
Q

unilateral wheezing: we should be concerned w/?

101
Q

What part of the anatomy can we perform a bronchoscopy?

A

central or close to the bronchus

102
Q

What part of the anatomy can we NOT perform a bronchoscopy?

A

more peripheral: beyond the bronchus (further away; deeper)

103
Q

Bronchoscopy complications

A
  • perforation or injury
  • pneumothorax
  • problems w/ anesthesia
104
Q

What special procedures can be done during a bronchoscopy?

A
  • bronchoalveolar lavage
  • Bronchial brushing
  • Biopsy
105
Q

Types of biopsies that can be done during bronchoscopy

A
  • Endotracheal or endobronchial
  • Transbronchial needle aspiration (TBNA) of lesions outside of bronchi [often ultrasound guided]
106
Q

Describe Mediastinoscopy

A

endoscopic procedure to examine mediastinum

107
Q

Mediastinoscopy indications

A

Lymph node biopsy
- lung cancer staging
- Sarcoidosis
- TB
- Lymphoma

108
Q

Mediastinoscopy complications

A
  • Pneumothorax
  • Bleeding
  • Esophageal injury
109
Q

What is the entry point for a mediastinoscopy?

A
  • sternal notch

outside tubing of the lungs but inside chest (mediastinum)

110
Q

Indication for biopsy

A

evaluation of mass or lesion

111
Q

Approach for centrally located mass or lesion

A

bronchoscopy

112
Q

Approach for peripheral mass or lesion

A

transthoracic needle aspiration (TTNA)

CT or US guided done by interventional radiology

113
Q

If you are at risk for having lung cancer what is the screening plan?

A

annual low dose CT

114
Q

What makes a person high risk for lung cancer?

A
  • 55-80yo
  • 20+ pk-yr
  • hx of smoking
  • smoker or quit < 15yo ago
  • in reasonable health
115
Q

What patients call for a more aggressive workup?

A
  • known primary cancer
  • immunocompromised
  • significant smoking history
  • FHx of cancer
  • suspicious morphology
116
Q

Describe suspicious morphology for lung nodule

A

> 8mm in size
- irregular borders
- semi-solid appearance
- upper lobes

117
Q

What criteria do providers use to assess when a patient needs to do repeat imaging?

A

Fleischer society

118
Q

NOTE

A

cancers tend to double in volume every 100-300 days

119
Q

Considerations for lung nodules

A
  • solid vs semi-solid nodules
  • Size
  • Single vs multiple
  • RFs
120
Q

What is a Pancoast tumor?

A

upper lobe of lungs put pressure on lungs/nerves & you get shoulder pain that doesn’t change w/ movement

121
Q

Other symptoms of Pancoast tumors

A

same side of face
- small pupil
- lack of sweating (Horner’s syndrome)

122
Q

Paraneoplastic syndrome

A

symptoms from secreting hormones (ADH) & ^ Ca++
- rashes
- fluid retention
- v Na+ (hyponatremia)
- ISADH

123
Q

Dx for a more concerning nodule

A
  • sputum cytology
  • bronchoalveolar lavage
  • bronchoalveolar brushings
  • transbronchial needle or transthoracic needle aspiration
  • lymph node biopsy
  • surgical biopsy
124
Q

What measurement is used to determine obstructive sleep apnea?

A

apnea/hypopnea index (AHI)

125
Q

How long must a sleep study be?

126
Q

How many events must you have to have Obstructive Sleep Apnea?

A

5 or more apnea/hypopnea events/hour

127
Q

What is mild sleep apnea?

128
Q

What is moderate sleep apnea?

129
Q

What is severe sleep apnea?

130
Q

Obstructive sleep apnea tx

131
Q

What can obstructive sleep apnea cause?

Block 2 (13 decks)

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