Introduction to radiology, pulm med, lab, and pulm dx procedures

Question 1

Describe the mechanics of inhalation

Answer 1

intercostal muscles and diaphragm contract, lungs expand, air is drawn in.

Question 2

Describe the mechanics of exhalation

Answer 2

a passive process, depends upon elastic recoil of lungs

Question 3

CXR reading method

Answer 3

1. Label-identify pt’s name, age, sex
2. Orientation-identify R vs. L
3. Technique-penetration, rotation, inspiration
4. Interpretation

Question 4

Technique: Proper penetration

Answer 4

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

Question 5

Technique: Rotation

Answer 5

Make sure clavicular heads are equal distance from the spinous processes of the vertebral bodies

Question 6

Technique: Inspiration

Answer 6

Should be able to count 8-10 posterior ribs

CXR should be shot in full inspiration

Question 7

Intepretation of CXR

Answer 7

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

Question 8

Densities and their appearance on CXR

Answer 8

Lead-most dense, appears radiopaque (white)
Mineral
Soft tissues
Fluid
Fat
Air-least dense, radiolucent (appears black)

Question 9

What is silhouette sign

Answer 9

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)

Question 10

What does a loss of the costophrenic angle indicate?

Answer 10

Pleural effusion

Question 11

What do Kerley B lines indicate

Answer 11

CHF

They are short horizontal lines found in the lower lateral lungs

Question 12

What does a D-dimer test measure?

Answer 12

Measure of a fibrin-degradation product released by a clot during fibrinolysis via a blood test

Question 13

When are possible circumstances when a D-Dimer test is indicated?

Answer 13

• Suspect PE or DVT

- May be used as a screening tool before doing imaging for pts with low-moderate clinical probability for PE

Question 14

What does it mean if the d-dimer test shows elevation?

Answer 14

• Elevated with PE, DVT
• However, false positives with inflammation, cancer, pregnancy, advanced age, trauma since the test isn’t very specific (50%)

Question 15

How do you interpret a d-dimer test? What is your next step?

Answer 15

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

Question 16

When do you skip the d-dimer? What do you do instead?

Answer 16

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

Question 17

What is the purpose of a sputum culture? How will this information impact the tx plan?

Answer 17

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)

Question 18

What is a cardiopulmonary stress test?

*Note: Didn’t see any notes about this; this information is from other online sources

Answer 18

• 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)

Question 19

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.

Answer 19

-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

Question 20

What are common signs and symptoms of asthma?

Answer 20

Symp=wheezing, cough, dyspnea, & chest tightness

Signs=wheezing, prolonged expiration from blockage, & hypoxia

Question 21

common signs and symptoms of COPD

Answer 21

oSymptoms=sob, wheezing, cough w/ sputum

oSigns=wheeze, rhonci, prolonged expiration, & hypoxia

Question 22

What is a basic definition of pneumonia and the common signs/symptoms?

Answer 22

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

Question 23

Typical symptoms/signs of pe?

Answer 23

oSymptoms=dyspnea, cp, & hemoptysis

oSigns=tachypnea, hypoxia, potential pleural rub

Question 24

Common etiology and symptoms of cancer/malignancy?

Answer 24

oSymptoms=dyspnea, chronic cough, hemoptysis, cp, unexplained weight loss
oNonspecific signs
oUsually from smoking, radon, or asbestos