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Pulmonology > Diagnostics > Flashcards

Diagnostics Flashcards

1
Q

Bicarbonate Buffer System/Equation..

A

CO2 + H2O H2CO3 H^+ + HCO3

CO2 = acid
H2O = base
H+ = acid
HCO3 = base

H2CO3 = carbonic anhydrase

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2
Q

Respiration Goals?

A
  1. Air in/out; blood round and round.
  2. Diffusion depends on distance, surface area and pressure differences.
  3. O2 depends on diffusion, CO2 depends on ventilation.
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3
Q

3 ways the body compensates for Acid-Base Changes?

A
  1. Bicarb-Buffer System.
  2. Respiration (Lungs).
  3. Metabolic (Kidneys).
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4
Q

ABG Format and ABG Normal values?

A

pH/CO2/PaO2/HCO3

7.4/40/80-100/24

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5
Q

LUNGS —> What? aka? Speed? Control? How?

A 
What: CO2
Aka: acid
Speed: Fast
Control: involuntary and voluntary inspiration/expiration
How: MV = RR x VT
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6
Q

KIDNEYS —> What? Aka? Speed? Control? How?

A 
What: HCO3
aka: base
Speed: very slow
Control: Involuntary
How: make and manage HCO3
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7
Q

What is the 5 step ABG Interpretation Process?

A
  1. pH
  2. Primary RESPIRATORY or METABOLIC Process (look at the PCO2 and HCO3).
  3. If Respiratory…
    3Ra. Acute or Chronic?
    3Rb. pH within normal range (compensation from the kidneys).
    3M. If a metabolic process, is there respiratory compensation and is it adequate? (EpCO2)
  4. Calculate the Anion Gap (AG).
  5. Delta Gap (DG) —> if anion gap is high, what is the delta gap?
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8
Q

Superior detail (better than CXR) of internal organs and structures?

A

CT Chest

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9
Q

Air < fat < bone…

A

Air is less dense than fat and bone; so black.

Fat is more dense than air but less dense than bone; so gray.

Bone is the most dense; so white.

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10
Q

Type of CT scan that uses a step and shoot process - better for high resolution images, less radiation, slower.

A

Axial CT

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11
Q

Type of CT that is more common, faster, higher radiation dose, minimizes motion artifact?

A

Helical CT.

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12
Q

Most effective radiation dose for CT Chest?

A

Between 5-10 mSv.

Always use lowest dose radiology exam available to achieve your Dx.

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13
Q

A consistent and thorough technique for reviewing images?

A

Read from the outside in!

  • Assess type of scan.
  • Review pt H/P findings.
  • Pt. Positioning (prone, supine).
  • Review all windows (lungs, soft tissue, bone).
  • Review prior imaging.
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14
Q

Specific types of CT Chest scans?

A

Standard
High Resolution (HCRT)
CT Pulmonary Angiogram (CTA)
Low Dose CT Chest (LDCT)

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15
Q

Standard CT Chest scan?

A
  • 3-10 mm Slices or Cuts
  • Maximal inspiration
  • +/- contrast
  • Indications:
  • further eval CXR abnormality.
  • Empyema/abscess.
  • Lung cancer staging.
  • Pleural/mediastinal abnormalities.
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16
Q

High Resolution CT (HRCT)?

A
  • 0.625 mm - 1.5 mm every 10 mm
  • Highly detailed images of lung parenchyma, vessels, airways.
  • Typically w/o contrast
  • Indications:
  • abnormal PFTs w/normal CXR.
  • Diffuse interstitial changes on CXR.
  • Known ILD, need to assess progression, response to treatment.
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17
Q

Why is contrast used in CT?

A

Contrast will make organs more apparent.

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18
Q

CT Pulmonary Angiogram (CTA)?

A
  • Contrast bolus required, timing of bolus is key.
  • Allows for optimal vascular enhancement.
  • must have adequate venous access.
  • Indications:
  • concern for PE, Aortic Aneurysm, Aortic dissection.
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19
Q

Low Dose CT Chest (LDCT)?

A
  • Now approved for lung cancer screening in certain pt. Populations.
  • Specific for nodules and masses.
  • CMS guidelines for LDCT:
  • Age 55-77.
  • Asymptomatic.
  • Tobacco use Hx >30 pack years.
  • Active tobacco use or quit within past 15 years.
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20
Q

CT Chest views?

A

Coronal, Sagittal, Transverse

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21
Q

CT Chest windows?

A

Lung Windows - lung parenchyma.

Soft Tissue - mediastinum, blood vessels, muscles, heart, LN.

Bone Windows - rib cage, spine.

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22
Q

2 disorders that make up COPD?

A

Emphysema and Chronic Bronchitis

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23
Q

What do you need to diagnose Emphysema or Chronic Bronchitis as COPD?

A

Need to prove an obstruction.

On PFT, an FEV1/FVC < 70%.

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24
Q
  1. Permanent enlargement of air spaces distal to bronchioles in the alveoli.
  2. Destruction of elastin walls of alveoli.
  3. 3 Types:
    - Centriacinar/lobular.
    - Panacinar.
    - Distal acinar/paraseptal
A

EMPHYSEMA

Centriacinar/Lobular - upper lobes of lungs at proximal alveolus.
Panacinar - entire alveolus.
Distal acinar/paraseptal - distal end of alveolus near septum.

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25
Q

What does Bullae on CT mean?

A

Full extent emphysema

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26
Q
  • Dilation of the bronchioles
  • airway has larger diameter than corresponding blood vessel.
  • leads to impaired secretion clearance and recurrent infection.
  • Lower lobes, chronic aspiration, immunodeficiency, IPF.
  • Upper lobes: CF, TB, Sarcoidosis, ABPA.
  • Central: ABPA
A

Bronchiectasis

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27
Q

Airway thickening on CT Chest?

A

Cystic Bronchectasis

28
Q

Pleural Effusions

A

Fluid in the pleural space….look up a picture.

29
Q

Honeycombing on CT Chest?

A

Clusters of cystic airspace’s 3-10 mm in diameter.

30
Q

Honeycombing on CT Chest often seen in what disease?

A

IPF - interstitial pulmonary fibrosis; among other ILD’s.

31
Q

Honeycombing and Cystic Bronchiectasis

A

Honeycombing - clusters of cystic airspaces

Cystic bronchiectasis - thickening of the airways.

Look up a picture…

32
Q

GGO?

A

Ground Glass Opacities

33
Q

What are Ground Glass Opacities?

A

“Veil” like opacification.

A common, non-specific finding but assume pulmonary edema.

A DECREASE IN AIR W/O OBLITERATION OF ALVEOLI OR VASCULAR STRUCTURES.

34
Q

What diseases can cause GGO?

A

Pulmonary edema, alveolitis, interstitial pneumonitis, resolving PNA, Viral PNA, Hemorrhage, PJP, COVID-19.

35
Q

Multiple Cavitary nodules

A

can be solid or hollow w/thickening around - may be malignat or benign.

36
Q

Nodules/masses on CT Chest?

A

Masses > 3cm
Nodules < 3 cm.

May be cavitary (TB), spiculated (CA), lobulated, solid, semi-solid, ground glass.

May be calcified or non calcified.

37
Q

Respiratory Acidosis expected pH, primary abnormality and how to compensate?

A

Decreases pH, increase in pCO2, retain HCO3

38
Q

Respiratory alkalosis expected pH, primary abnormality and how to compensate?

A

Increased pH, decrease in pCO2, excrete HCO3.

39
Q

Metabolic acidosis expected pH, primary abnormality and how to compensate?

A

Decrease in pH, decrease in HCO3, blow of CO2.

40
Q

Metabolic alkalosis expected pH, primary abnormality and how to compensate?

A

Increase in pH, increase in HCO3, retain CO2.

41
Q

Followed serially by using Fleischner’s criteria?

A

Incidental Solitary Pulmonary Nodules (SPN)

*The criteria helps to determine if the pt needs serial CT scans or not - determines if nodule is benign or malignant.

42
Q

What is pH?

A

How acidic or base the blood is.

43
Q

Alkalemia =? and Acidemia =??

A

Alkalemia = elevated base or elevation in pH

Acidosis = elevated acid or decrease in pH

44
Q

How to calculate an EpCO2 for a metabolic acidosis or alkalemia to determine respiratory compensation?

A

Metabolic acidosis use Winters Formula -> EpCO2 = 1.5 *(HCO3) + 8 +/-2.

Metabolic alkalosis use the “other” formula -> EpCO2 = 0.7(HCO3) +20 +/- 5.

45
Q

Interpret an EpCO2?

A

If within calculated EpCO2 range, then you have respiratory compensation.

If PCO2 < EpCO2 = respiratory acidosis.

If PCO2 > EpCO2 = respiratory alkalosis.

46
Q

What does an elevated Anion Gap mean?

A

High Anion Gap = Metabolic Acidosis

47
Q

Why do we calculate the Delta Gap after an elevated A.G and what are we calculating?

A

To determine if the HAGMA (High AG Metabolic Acidosis) is related to AG or something else.

We are calculating the Corrected Bicarbonate = cHCO3

48
Q

Interpret the Delta Gap?

A

cHCO3 = (AG-12) + (HCO3)

cHCO3 >26 = metabolic alkalosis

cHCO3 < 26 = metabolic acidosis

49
Q

Causes of Respiratory Acidosis?

A

Hypoventilation & increased CO2 production.

50
Q

What are causes of Respiratory Alkalosis? Hint: CHAMPS

A 
C - CNS Dz.
H - Hypoxia.
A - Anxiety (hyperventilation)
M - Mechanical ventilation.
P - Pregnancy
S - Salicylates.
51
Q

Causes of a Metabolic Alkalosis?

A

Vomiting, NG suction or Diuretics

52
Q

Causes of a Metabolic Acidosis or HAGMA? Hint: MUDPILES.

A 
M - Methanol
U - Uremia
D - DKA, AKA, SKA - (Alcoholic Ketoacidosis, Starvation Ketoacidosis)
P - Paraldehyde
I - Isoniazide
L - Lactic Acidosis
E - ETOH/Ethylene Glycol
S - Salicylates
53
Q

Cause of a NON-AG Metabolic Acidosis? Hint: ABCD

A

A - Addison’s Dz.
B - Bicarbonate Loss (GI - diarrhea, RTA - renal tubular acidosis)
C - Chloride (due to dilution of bicarbonate).
D - Drugs (Diamox)

54
Q

What does a “spiculated” mass on CT Chest indicate?

A

Cancer baby.

55
Q

What does “multiple pulmonary nodules/masses” mean on CT Chest?

A

Cancer till proven otherwise.

56
Q

What is an air bronchogram on CXR and CT?

A

Bronchogram means “patent bronchial tubes surrounded by consolidated lung” OR alveolar infiltrates. #smuttsinlung.

Think: CONSOLIDATION

57
Q

What does “Tree-in-bud” pattern mean and what disease states?

A

It means NADA.

Can be seen in respiratory bronchiolitis, infection, langerhans cell histiocytosis, hypersensitivity, PNA, tumor embolization, aspiration.

58
Q

Describe a PE finding on CT chest?

A

The IV contrast will appear white within a blood vessel and the grey/dark areas within the blood vessels may indicate filling defects such as PE.

“White, white, white GRAY! = filling defect.

59
Q

Signs/Symptoms of a pt with a PE-wedge infarct found on CT Chest?

A

Painful pleuritic CP, Dyspnea, Hemoptysis, etc (other Sx of PE)

60
Q

T/F: Is CT a more accurate method than CXR for detecting PTX (Pneumothorax)?

A

True; it is the most sensitive imaging to detect small or locutated pneumothoraces.

61
Q

What does PTX on CT Chest look like?

A

An absence of lung markings and pleural lines.

Look at an image..

62
Q

PTX with mediastinal shift means?

A

Tension Pneumothorax

63
Q

Pattern of ground glass Opacities with a net of interlobular septal thickening?

A

“Crazy Paving”

64
Q

Diagnosis of “Crazy Paving” on CT Chest?

A

NONSpecific but can be seen in PJP, ILD, Sarcoidosis, ARDS, Pulmonary Hemorrhage.

65
Q

What are Alveolar Infiltrates?

A

Indicates an air space disease or alveolar disease.

Fluid displaces air.

66
Q

What does Interstitial Infiltrate look like in CXR and what does it indicate?

A

Appears as a “Lacy, reticular” pattern and indicates thickening of interstitial tissues and pleural fissures.

67
Q

What is the 5 step process in PFT interpretation?

A
  1. Is there obstruction? (FEV1/FVC ratio)
  2. Is there restriction? (FVC).
  3. If there is restriction, is it real? (TLC).
  4. If there is restriction or obstruction, why? (DLCO).
  5. If there is restriction or obstruction, how bad? (FEV1 and/or TLC).

Pulmonology (5 decks)

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