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Pulmonology > Intro to Pulmonary Diagnostics > Flashcards

Intro to Pulmonary Diagnostics Flashcards

0
Q

Pulmonary mechanics of inspiration

A

Intercostal muscles and diaphragm contract Lungs expand Air drawn in

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1
Q

What is the only artery in the body that carries deoxygenated blood?

A

Pulmonary artery

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2
Q

Pulmonary mechanics of expiration

A

Passive process Depends on elastic recoil of lungs

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3
Q

Airway obstruction.

A

Asthma Chronic bronchitis COPD Results in air trapping due to decreased expiratory flow

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4
Q

Fingernail clubbing

A

Many causes including -lung cancer -TB -Cystic Fibrosis -Endocarditis

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5
Q

CXR

A

Common indications -pneumonia -pneumothorax -CHF Noninvasive Low radiation exposure Cost: $200-350

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6
Q

Pulmonary function testing

A

Spirometry -measures volume and speed of airflow on inspiration and expiration. Used to diagnose and assess asthma, COPD, pulmonary fibrosis Noninvasive, safe

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7
Q

CT scan of the chest

A

Used to diagnose -PE -pneumonia -aortic dissection -lung cancer Much higher sensitivity than a CXR Higher radiation (100-400X) Higher cost ($1800)

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8
Q

Spiral CT

A

Continuous, rotating beam Quicker, higher resolution than conventional CT

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9
Q

Multirow CT

A

Latest generation of CT Thinner slices, improved resolution

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10
Q

CT for PE

A

CT is the preferred study to assess for PE because it is highly sensitive and non-invasive

With IV contrast

Look for filling filling defects in pulmonary arteries or branches

Will also show alternate causes of sxs

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11
Q

Ventilation/perfusion scan

A

(V/Q Scan)

Also used to asses for PE when important to reduce radiation exposure or when contrast can’t be administered (renal dz/allergy)

Ventilation: radionuclide inhaled to assess ability of air to reach all parts of lungs

Perfusion: IV radionuclide to assess blood circulation

V/Q Mismatch: where normal airflow, but impaired perfusion

Results can be normal, low probability, intermediate probability, or high probability

Low or intermediate probability cannot r/o PE

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12
Q

Pulmonary Angiography

A

Diagnose PE

Insert catheter under fluoro into pulmonary arteries and inject dye

Invasive, higher risk.

Same sensntivity as CT so has largely been replaced

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13
Q

D-Dimer

A

Fibrin degredation product released by a clot

Elevated with PE, DVT

If pt has low to moderate risk of PE and has normal D-Dimer, can r/o PE

Very sensitive (95%), but not very specific (50%)

False positives with: inflammation, cancer, pregnancy, advanced age, trauma

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14
Q

Sputum Culture

A

Used to identify specific organism causing pneumonia

May be contaminated by oral flora

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15
Q

WBC

A

Often, but not always, elevated with pneumonia

Neither sensitive nor specific

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16
Q

Bronchoscopy

A

Fiberoptic scope to view airways

Search for tumors, foreign bodies, source of hemoptysis

Obtain biopsies

Low risk

17
Q

During a PA CXR, which way does the patient stand?

A

The rays flow from posterior to anterior, with the anterior chest closest to the film.

18
Q

During a lateral CXR, which way does the patient stand?

A

With their left side up against the film.

19
Q

AP CXR

A

Usual portable technique

Heart shadow is magnefied

Often times, the patient is also supine:

DIaphragms are higher, lung volume is decreased

20
Q

Lateral decubitus CXR

A

Patient lying on side

Useful for detecting pleural effusion

21
Q

Densities

A

Lead > Mineral > Soft Tissues > Fluid > Fat > Air

Mineral–very dense, appears white

  • calcifications, bone

Soft tissues

  • muscle, mediastinal structures

Fluid

  • Heart, vessels

Fat

  • Breasts

Air

  • Lungs, gastric bubble, trachea, bronchi
22
Q

CXR Reading Method

A

Label: pt’s name, age, sex

Orientation: R vs L side

Technique: Penetration, rotation, inspiration

Interpretation

23
Q

Proper penetration

A

Should barely be able to see outline of vertebral bodies within heart shadow down to diaphragm

Bronchovascular structures should be visible

On lateral films: Vertebral bodies should darken as you move caudally because more air in lower lobes

24
Q

Rotation

A

Make sure clavicular heads are equal distance from spinous processes

Rotated film can distort appearance of heart and mediastinum

25
Q

Inspiration

A

CXR should be shot at full inspiration

Should be able to count 8-10 posterior ribs

26
Q

General things to interpret on CXR

A

Heart and great vessels

Lungs

Soft tissues

Bones

27
Q

Heart and Great Vessels

A

Cardiac silhouette normally 1/2 or less of thoracic width on PA

Check aortic knob, mediastinal width, SVC

28
Q

Lungs

(CXR Interpretation)

A

Lung fields:

  • Infiltrate, atelectasis
  • Nodules, mass
  • Pneumothorax

Vasculature

  • Hilar and pulmonary vessels
  • Peripheral vasculature–seen in lateral 1” of lung, clearer in lower fields on upright films

Costophrenic Angle

  • Pleural effusion blunts angle
  • Right diaphragm higher than left
29
Q

Soft Tissues

A
  • Breasts
  • Chest wall
  • Neck
  • Mediastinum
    • trachea should be midline
    • identify tracheal bifurcation
    • look for mediastinal widening
    • hilar mass or lymphadenopathy
30
Q

Bones

A

Look for lesions or fractures of:

clavicles

scapulae

humeri and shoulder joints

ribs

spine

31
Q

Silhouette Sign

A

If a pulmonary opacity is in contact with the heart border, then the heart border will be obscured

Commonly seen with RML and left lingular infiltrates

32
Q

CXR Findings in CHF

A

Cardiomegaly

Cephalization of pulmonary flow

Interstitial Edema-lungs whited out

Kerley B Lines

Fluid in fissures

Pulmonary Edema

Pleural Effusions-blunted costophrenic angles

33
Q

Cephalization of Pulmonary Flow

A

Normally pulmonary blood flow is more prominent in dependent areas of lung (near bases)

When congested it is also prominent toward head

34
Q

Kerley B Lines

A

Short, horizontal lines found in lower lung periphery

Seen MC’ly in CHF

35
Q

Pneumothorax

A

Lung space is black, with area where lung is pronounced and shriveled

Subtly, a pleural line can be noted where the lung has separated from cavity

36
Q

Tension Pneumothorax

A

Life-threatening

L mediastinal shift, decreased venous return (can kink aorta and vena cava)

May rapidly lead to cardiac arrest

Needs emergent needle thoracotomy

37
Q

COPD Changes

A

Diffuse hyperinflation with flattening of diaphragms

38
Q

Atelectasis

A

Collapse or incomplete expansion of part of the lung

Linear or curvilinear increased density on CXR, often associated with volume loss

May see elevated diaphragm because lung collapses on itself

39
Q

Solitary Pulmonary Nodule

A

Can be innocuous or malignant

More likely to be benign if calcified

Try to compare to previous CXR

Consider CT/biopsy to evaluate

40
Q

Pulmonary Mass

A

Well-defined opacity

Suspicious for malignancy

Pulmonology (17 decks)

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