Introduction to radiology, pulm med, lab, and pulm dx procedures Flashcards
Describe the mechanics of inhalation
intercostal muscles and diaphragm contract, lungs expand, air is drawn in.
Describe the mechanics of exhalation
a passive process, depends upon elastic recoil of lungs
CXR reading method
- Label-identify pt’s name, age, sex
- Orientation-identify R vs. L
- Technique-penetration, rotation, inspiration
- Interpretation
Technique: Proper penetration
Should be able to barely see outline of vertebral bodies within heart shadow down to diaphragm
Bronchovascular structures should be visible
Lateral View: Vertebral bodies should darken as you move caudally
Technique: Rotation
Make sure clavicular heads are equal distance from the spinous processes of the vertebral bodies
Technique: Inspiration
Should be able to count 8-10 posterior ribs
CXR should be shot in full inspiration
Intepretation of CXR
Heart and great vessels (cardiac silhouette <1/2 of thoracic width, atrial and ventricular borders, aortic knob, mediastinal width, SVC)
Lung fields (infiltrate, nodules, pneumothorax)
Vasculature (hilar and pulmonary vessels, peripheral vasculature)
Costohprenic Angle (should be a clear, angled, point; plueral effusion will blunt the angle)
Soft tissue
Bones
Densities and their appearance on CXR
Lead-most dense, appears radiopaque (white)
Mineral
Soft tissues
Fluid
Fat
Air-least dense, radiolucent (appears black)
What is silhouette sign
When the heart border is obscured d/t pukmonary opacity d/t an infiltrate
Commonly occurs in right middle lobe and left lingular infiltrates (such as pneumoniae)
What does a loss of the costophrenic angle indicate?
Pleural effusion
What do Kerley B lines indicate
CHF
They are short horizontal lines found in the lower lateral lungs
What does a D-dimer test measure?
Measure of a fibrin-degradation product released by a clot during fibrinolysis via a blood test
When are possible circumstances when a D-Dimer test is indicated?
- Suspect PE or DVT
- May be used as a screening tool before doing imaging for pts with low-moderate clinical probability for PE
What does it mean if the d-dimer test shows elevation?
- Elevated with PE, DVT
- However, false positives with inflammation, cancer, pregnancy, advanced age, trauma since the test isn’t very specific (50%)
How do you interpret a d-dimer test? What is your next step?
If the d-dimer is elevated then need to follow up with a more definitive test like a chest CT or V/Q to dx PE
When do you skip the d-dimer? What do you do instead?
For pts with a high clinical probability (via the PERC score or Wells Criteria), skip d-dimer and go straight to CT or V/Q
What is the purpose of a sputum culture? How will this information impact the tx plan?
Identify the specific organism causing pneumonia; can then choose targeted antibiotics/use more narrow spectrum (Note: can do an initial gram stain to help guide treatment since culture takes 24-48 hours)
What is a cardiopulmonary stress test?
*Note: Didn’t see any notes about this; this information is from other online sources
- A noninvasive way to measure the amount of oxygen your body is using, the amount of carbon dioxide it is producing, your breathing pattern, and electrocardiogram (EKG) while exercising (like on a stationary bike)
- Measures gas exchange as well as pulmonary and cardiac activity
- For pulmonary, can show things like if lungs are not able to take in enough air to meet the body’s demands (e.g. COPD, asthma) or inability of the body to pull oxygen from the lungs into the bloodstream (e.g. PE)
Identify risk factors for pulmonary disease and state why these factors put the patient at increased risk for developing specific pulmonary diseases and complications of disease.
-Smoking (biggest risk factor)
-Immobilization (blood settles and forms a clot in the leg), -Recent lower extremity trauma
-Cancer (associated humeral factors that may be thrombogenic)
Obesity
-Pregnancy (increased hormone levels and pressure on IVC which reduces venous return)
-OCP use
What are common signs and symptoms of asthma?
Symp=wheezing, cough, dyspnea, & chest tightness
Signs=wheezing, prolonged expiration from blockage, & hypoxia
common signs and symptoms of COPD
oSymptoms=sob, wheezing, cough w/ sputum
oSigns=wheeze, rhonci, prolonged expiration, & hypoxia
What is a basic definition of pneumonia and the common signs/symptoms?
Definition=LRI in person with symptoms of acute infection, with or without infiltrate in Cxray, resulting in abnormal lung function
oSymptoms=cogh, +/- sputum (green/yellow), fever, dyspnea, fatigue, myalgias, pleuritic cp, & fever >100.4
oSigns=hypoxia, rales, bronchial breath sounds, dullness to percussion due to consolidation/fluid accumulation, tachypnea, tachycardia, cyanosis
Typical symptoms/signs of pe?
oSymptoms=dyspnea, cp, & hemoptysis
oSigns=tachypnea, hypoxia, potential pleural rub
Common etiology and symptoms of cancer/malignancy?
oSymptoms=dyspnea, chronic cough, hemoptysis, cp, unexplained weight loss
oNonspecific signs
oUsually from smoking, radon, or asbestos
