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RESP > Investigations > Flashcards

Investigations Flashcards

1
Q

First line (gold standard) investigation for a PE?

A

CTPA

Note if this cannot be carried out then offer therapeutic anticoagulation in the interim ( Riveroxaban 1st line or LMWH of 1st line is not suitable )

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2
Q

How would you investigate cor pulmonale ?

A

CXR

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3
Q

Explain what a D-dimer is and What are the indications for a D- dimer?

A

D- dimer is a protein that is made and released into the blood in response to a blood clot so the test is looking at whether or not a patient has a clotting disorder.

  1. PE
  2. DVT
  3. DIC (Disseminated intravascular coagulation)
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4
Q

Explain how type 1 and type 2 respiratory failure is categorised.

A

T1RF- (Hypercapnic resp failure)
Low oxygen and normal or low carbon dioxide

T2RF- (Hypoxemic resp failure)
Low oxygen and high carbon dioxide levels in the blood

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5
Q

When would a VQ scan be indicated ?

A

To assess the likelihood of a PE if contrast or radiation exposure is contraindicated.

contraindications include:

  • Pregnancy
  • Severe renal disease/ impairment
  • Anaphylaxis to contrast
  • Those on metformin (needs to be stopped before the CT and held for 48 hrs after)
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6
Q

What is a sweat test used for?

A

It looks at the amount of chloride in sweat and is indicated in diagnosing CF.

(The skin is soaked in pilocarpine and an electrode is placed on the skin for 5 mins. sweat is collected on both arms. A concentration of >60 mol/L = CF and <40 = unlikely )

note:
it can also be used to diagnose bronchiolitis

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7
Q

What is the most reliable test to diagnose whooping cough (pertussis)?

A

–> If the cough is of 2 weeks’ duration or less, culture of a nasopharyngeal aspirate or nasopharyngeal/pernasal swabs is recommended for people of all ages.

–>Real-time PCR testing of nasopharyngeal or throat swabs if <3 weeks cough in all age groups

–> If the cough is of more than 2 weeks’ duration, anti-pertussis toxin immunoglobulin G (IgG) serology may be employed in people aged over 17 years. Anti-pertussis toxin IgG detection in oral fluid can be used in children aged 5 to 16 years.

in summary….. A culture of a nasopharyngeal swab from the anterior nasopharynx

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8
Q

Which type of malaria is deadly

A

Falciparum malaria

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9
Q

With a young patient (<45) presenting with COPD (Emphysema) what is the most common cause?

A

A1AT (Alpha-1 antitrypsin deficiency-)deficiency (levels of <18mmol/L = deficiency)

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10
Q

What radiological findings may be found in a patient with A1AT deficiency ?

A
  1. Bullae (fluid filled sac) at the lung bases

2. Emphysematous changes (Alveolar destruction)

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11
Q

What signs may be found on CXR in pulmonary TB? (3 things)

A
  1. Caseating cavitation (mainly in upper lobes)
  2. Mediastinal or hilar lymphadenopathy,
  3. Pleural effusions
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12
Q

What kind of conditions does a PCR test diagnose? and what types of symptoms do these conditions have?

A

Upper respiratory conditions

Sx:

  • Cough
  • Runny nose
  • Sneezing
  • Throat pain
  • Fever
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13
Q

What is bronchoscopy and when is it indicated? (4 things)

A
  1. Bronchoscopy is a procedure that helps HCP look directly into the airways

Indication:

  • Lung cancer
  • Frank haemoptysis (>100ml)
  • Suspected mycobacterial disease (e.g TB)
  • Refractory consolidation
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14
Q

What does a positive FeNO test indicate?

A

Eosinophillic inflammation. A positive test indicates an asthma diagnosis but is not conclusive

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15
Q

Why might a V/Q scan be done over a CTPA in young women?

A

Because a VQ scan has less radiation

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16
Q

Explain what you are looking for in the ABCDE approach to X-rays.

A

A - airway: trachea, carina, bronchi and hilum

B- Breathing: lungs filled with air? , pleural space

C- Cardiac: heart size, and heart boarders

D- Diaphragm: shape, costophrenic angles

E Everything else: Bones, tubes, pacemakers etc

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17
Q

What findings might you find on an X-ray of someone with HF? (5 things)

A
  1. Blunt costophrenic angles
  2. Cardiomegaly
  3. Pleural effusion
  4. Kerley B lines (lower lobes)
  5. Venous congestion/ interstitial oedema
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18
Q

What X-ray findings might you find in someone with pulmonary oedema? (3 things)

A
  1. Cardiomegaly
  2. Stag antler sign (larger hilum)
  3. Bilateral changes
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19
Q

What X-ray findings might be seen in a ptx with a pneumothorax ? (4 things)

A
  1. Increased pleural space (linear shadow of the visceral pleura – indicating a collapsed lung)
  2. No lung markings
  3. Shifted mediastinum (esp. in tension pneumothorax)
  4. Absent lung airways/ vessels
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20
Q

What condition would present with honeycombing in the lungs?

A

Bronchiectasis

21
Q

What are typical findings on V/Q scan that would indicate a PE?

A

Normal ventilation with bilateral perfusion defects

22
Q

Explain needle decompression (needle thoracotomy) and when it would be used.

A

This is the insertion of a needle into the pleural space and is used to decompress a tension pneumothorax.

A large bore needle is put into the 2nd intercostal space at the mid-clavicular line of the lungs and this allows the trapped air to be released from the lungs

23
Q

In a blood gas, what would a normal Pa02 in a patient on high flow oxygen indicate?

A

This is abnormal. You would expect the patients oxygen to be above average

24
Q

What would a normal pa02 in a hypoxic asthmatic patient indicate?

A

That the patient is tiring and needs ITU Intervention immediately

25
Q

What is spirometry ?

A

A test that measures the lung function.

It does this by measuring the amount of air a patient can expel after maximum inspiration.

26
Q

What is the difference between obstructive and restrictive lung disease?

A

Obstructive:
air obstruction resulting from narrowing of bronchioles - often due to excessive contraction of the smooth muscle

Restrictive:
Restrictive lung expansion. The alveoli are often smaller

27
Q

In spirometry what is meant by VC, FVC and FEV1?

A

VC
total volume of air expelled after maximum inspiration

FVC
Total volume of air forcibly expelled in 1 breath

FEV1
Amount of air forcibly expelled in 1 second

28
Q

What are contraindications for spirometry ? (7 things)

A
  1. Recent MI in 1 month
  2. PE
  3. Recent stroke
  4. Haemoptysis
  5. Know thoracic/ cerebral or aortic aneurysms
  6. Uncontrolled HTN
  7. Abdominal/ thoracic surgery
29
Q

On spirometry what FEV1/FVC figure would indicate obstruction?

A

<0.7

Note:
FEV1- tells us if there’s obstruction (if <0.70)

FVC- tells us if there’s restriction (if <80% predicted)

30
Q

What are the FEV1 figures that would indicate the level of obstruction ?

A

FEV1 >80% = mild
FEV1 50-80%= moderate
FEV1 30-50%= severe
FEV1 <30%= v. severe

31
Q

What is the order of an asthma diagnosis?

A
  1. FeNO testing
  2. Spirometry ** (DIAGNOSTIC TEST)
  3. Bronchodilator reversibility test (can help confirm diagnosis)
  4. PEFR (support diagnosis)
32
Q

Explain what would be seen on a graph of a patient with obstructive and restrictive lung disease

A

Obstructive-
The patient can get the air out but it will take longer to do so. The spirometry graph will be more narrow rather than curved

restrictive-
The patient will not be able to get all the air out and so the graph will be flattened and lower than normal

33
Q

Explain the MRC breathlessness scale scoring (5 grades)

A

Grade 1:
No trouble except on vigorous exercise

Grade 2:
SOB when hurrying or walking up inclines

Grade 3:
Walks slower than age mates due to SOBand has to stop when walking at own pace

Grade 4:
Stops for breath after walking 100m or “few mins” of walking on a normal level

Grade 5:
Too SOB to leave the house. breathless when dressing/ undressing

34
Q

Talk through the stages of analysing spirometry. (5 steps)

A
  1. Look at if the VC or FVC is bigger. (if VC is bigger then look at FEV1 /VC and if FVC is bigger then look at FEV1/FVC ratio)
  2. Then look for evidence of obstruction. (if the ratio is <0.70 then there’s an obstruction)
  3. The go back to the FVC (restriction)
    you are looking to see if its reduced. so is it <80%
  4. Then look at FEV1 (obstruction)
    is it <80%? and grade it (do this by looking at the %pr column)
  5. Look at post bronchodilator results has the ratio (which ever one you started with) returned to normal? – if so by how many ml’s and what %??
35
Q

What would you see on microscopy of the lungs in a patient with acute severe asthma?

A

Charcot- Leyden crystals

36
Q

What is the first line test for someone you suspected to have a PE but they have a Wells score of <4 ?

A

D- dimer

37
Q

When is Rivaroxaban not appropriate to use? (6 things)

A
  1. Active bleeding
  2. Recent thrombotic events
  3. Oesophageal varices
  4. Prosthetic heart valve
  5. Recent brain or spinal injury
  6. Recent intracranial haemorrhage
38
Q

What is considered a positive FeNO test?

And what is a positive test in those ages 5-16years old?

A

A test of 40 parts per billion or more

5-16 year olds:
35ppb or more

39
Q

What is the first line diagnostic test for someone with asthma ?

A

There are more than 1 but typically:

  1. Spirometry
  2. Reversibility bronchodilator test
  3. FeNO
40
Q

What diagnostic test is most suitable in those aged 17 when investigation asthma?

A

FeNO

41
Q

What diagnostic test is most suitable in those aged 17 when investigation asthma?

A

FeNO

42
Q

What advice must you give your patient prior to having a spirometry test? (3 things)

A
  1. No Salbutamol 2 hours prior to the test
  2. No restrictive clothing
  3. If screening test stop any LABA(Foster) 12 hours before
43
Q

What test is done to confirm a diagnosis of COPD?

A

Spirometry

44
Q

What test might you do if a patient <40 years old is presenting with a COPD type picture and has never smoked or has only smoked for a short amount of time?

A

Serum Alpha 1- antitrypsin deficiency (AAT)

45
Q

What does a hyper-resonant chest suggest?

A

Too much air around your lungs or in the lung tissue itself.

46
Q

Is heart failure associated with a third heart sound?

A

Yes

47
Q

What should you do if someone has a Wells score of 4+ points?

A

Admit to hospital for a CTPA

48
Q

Treatment for PE?

A
  1. LMWH

2. Thrombolytic therapy MAY be indicated to remove the embolic material from the pulmonary arteries

RESP (5 decks)

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