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Internal Medicine > Pulmonary and Cardio Tests/Diagnosis > Flashcards

Pulmonary and Cardio Tests/Diagnosis Flashcards

1
Q

Stress Echo-indications, positive, what should we do

A

More sensitive than stress ECG to detect ischemia, can assess LV size and function, diagnose valvular disease
can identify CAD in preexisting ECG abnormalities

Positive: wall motion abnormalities

To do: cardiac catherization

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2
Q

Stress test with thallium-indication, positive, when not to use it

A

Indication: increases sensitivity and to see if ischemia is reversible by slow uptake of thallium

Positive: decreased uptake of thallium

Not used in LBBB

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3
Q

Pharmocologic stress test-indication, what is used and how does it work,

A

indication: when a patient cannot exercise

what and how: Adenosine and dipyridamole cause coronary vasodialtion-disease arteries receive less relative blood flow
Dobutamine: increases myocardia oxygen demand by increasing HR, BP and cardiac contractility

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4
Q

Holter monitoring-when is it used

A

over 24-72 hours
evaluates arrhythmias, heart rate variability and assess pacemaker and implantable cardioverter-defribrillator function

Used for evaluating silent ischemia not accompanied by ECG changes

Evaluates syncope and dizziness as well

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5
Q

Stress ECG-indication, what is positive, what should you do afterwards

A

Indication: Coronary artery disease (Chest pain) with normal resting ECG and capable of being on a treadmill (can exercise sufficinecyt at 85% of Max HR)

Positives: ST segment depression
Heart failure or ventricular arrhythmia during exercise or hypotension

What to do: cardiac catherization

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6
Q

Cardiac catherization with coronary angiography: when is it used

A

definitive test for CAD

Used when

  1. noninvasive tests are nondiagnostic, angina that occurs despite medical therapy, angina soon after MI, or diagnostic dilemma
  2. Positive stress test
  3. Patient is severely symptomatic and urgent diagnosis is needed
  4. evaluation of valvular disease and to determine the need for surgical intervention

Used for concurrent rescuing by percutaneous coronary intervention or being considered for CABG

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7
Q

coronary angiography

A

Most accurate method of identifying presence and severity of CAD

Main purpose: identify patients with severe coronary disease to determine if revascularization is needed-with stent or balloon can be performed at same time

Coronary stenosis>70% is signficant

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8
Q

Difference between Unstable Angina and NSTEMI

A

NSTEMI will have cardiac enzymes present

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9
Q

Test for Variant Angina

A

coronary angiography with ergonovine will show ST elevation

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10
Q

Diagnosis of renal artery stenosis

A

(Unrelenting hypertension with hypokalemia)
captopril-enhanced radionuclide renal scan
MRI angiography
and Spiral CT

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11
Q

Definitive diagnosis for COPD

A

PFTs
Less than 70% FEV1/FVC

Peak flow meter less than 350 L/min

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12
Q

Diagnosis of Asthma

A

PFTs are required-FEV1/FVC less than .75
Increase in FEV1 or FVC by at least 12%

Bronchoprovocation test: if PFTs are non diagnostic
Increasing doses of methacholine-decrease greater than 20% of FEV1

Increased DLCO
Hypocarbia present (hypercarbia signifies respiratory failure-mechanical ventilation/intubation)
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13
Q

Tests to run for acute asthma exacerbation

A

Peak expiratory flow-less than 60% predicted

ABG: increased A-a gradient

Chest X-ray- rule out exacerbation etiology

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14
Q

Diagnosis of Bronchiectasis

A

High resolution CT scan-choice

PFTs-obstructive pattern

Possible bronchoscopy

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15
Q

Diagnosis of pleural effusion

A

Dullness to percussion
Decreased breath sounds over the effusion
Decreased tactile fremitus

CXR-blunting of costophrenic angle
CT scan-more reliable

Thorancetesis: etiology not obvious
Therapeutic as well
Send for four Cs: chemistry (protein/glucose), cytology, cell count, and culture

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16
Q

Diagnosis of empyema

A

CXR or CT scan

Pleural fluid will have pH less than 7.2

17
Q

Diagnosis of spontaneous pneumothorax

A

decreased breath sounds on affected side
hyperresonance over the chest
decreased tactile fremitus on affected side

CXR: Mediastinal shift toward side of pneumothorax

18
Q

Diagnosis of tension pneumothorax

A

hypotension
Distended neck veins
Shift of trachea away from side of pneumothorax on CXR
Decreased breath sounds on affected side
Hyperresonance to percussion of side of pneumothorax

19
Q

Insterstitial lung disease Diagnosis

A 
CXR-nonspecific
Ct scan-shows extent of fibrosis
PFTs: FEV/FVC is increased 
Low DLCO
Tissue biopsy: fiberoptic bronchoscopy, transbronchial biopsy, lung biopsy, video-assisted thoracoscopic lung biopsy
20
Q

Definitive diagnosis of sarcoidosis

A

transbronchial biopsy-noncaseating granulomas

21
Q

Wegener’s graunulomatosis diagnosis

A

Gold standard: tissue biopsy

c-antineutrophilic cytoplasmic Abs

22
Q

Asbestosis CXR findings

A

pleural plaques

hazy infiltrates with bilateral linear opacities

23
Q

Silicosis CXR findings

A

Egg shell calcifications

24
Q

Berylliosis diagnosis

A

Beryllium lymphocyte proliferation test:

25
Q

Diagnosis of Goodpasture’s syndrome

A

Tissue biopsy

Serologic evidence of antiglomerular basement membrane Abs

26
Q

Diagnosis of Idopathic pulmonary fibrosis

A

CXR: ground glass or honeycombed appearance

Definitive diagnosis requires open lung biopsy

27
Q

Diagnosis of acute respiratory failure

A

ABG:
Hypoxemia: V/Q mismatch, intrapulmonary shunting, hypoventilaton
Hypercapnia: hypoventilation secondary to other causes

A-a gradient

28
Q

Diagnosis of ARDS

A

CXR: diffuse bilateral pulmonary inflitrates

ABG: hypoxemia PaO2 less than 60
Initially respiratory alkalosis (PaCO2 less than 40) progresses to respiratory acidosis

PCWP less than 18 versus cardiogenic pulmonary edema (greater than 18)

29
Q

Diagnosis of graves

A

Low TSH
T4 and free T3 levels give estimate of severity

Thyroid stimulating immunoglobulin (elevated in graves)
Thyroid peroxidase Abs (marker for graves and hashimotos)
Throid uptake scan: diffusely elevated iodine uptake

30
Q

Diagnosis of primary pulmonary hypertension

A

Cardiac Catheterization establishes diagnosis
CXR shows enlarged pulmonary arteries, enlarged RV and clear lung fields
PFTs show restrictive pattern
ECG show right axis deviation and RVH

31
Q

Cor pulmonale diagnosis

A

CXR: enlargement of RA, RV, and pulmonary arteries
ECG: right axis deviation, Peaked P waves, RVH
ECHO: RV dilatation, normal LV size and function

32
Q

Low DLCO

A

Emphysema-obstructive

Interstate lung disease, sarcoidosis, asbestosis, heart failure-restrictive

Anemia, PE, pulmonary hypertension-normal spirometry

33
Q

Normal DLCO

A

Chronic bronchitis, asthma-obstructive

Musculoskeletal, neuromuscular-restrictive

34
Q

Increased DLCO

A

Asthma-obstructive

Obesity-restrictive

Pulmonary hemorrhage, polycythemia-normal spirometry

35
Q

ABG difference in copd vs CHF exacerbation

A

Copd=hypercapnia

CHF=hypocapnia

Internal Medicine (17 decks)

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