Pulmonary and Cardio Tests/Diagnosis Flashcards
Stress Echo-indications, positive, what should we do
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
Stress test with thallium-indication, positive, when not to use it
Indication: increases sensitivity and to see if ischemia is reversible by slow uptake of thallium
Positive: decreased uptake of thallium
Not used in LBBB
Pharmocologic stress test-indication, what is used and how does it work,
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
Holter monitoring-when is it used
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
Stress ECG-indication, what is positive, what should you do afterwards
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
Cardiac catherization with coronary angiography: when is it used
definitive test for CAD
Used when
- noninvasive tests are nondiagnostic, angina that occurs despite medical therapy, angina soon after MI, or diagnostic dilemma
- Positive stress test
- Patient is severely symptomatic and urgent diagnosis is needed
- 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
coronary angiography
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
Difference between Unstable Angina and NSTEMI
NSTEMI will have cardiac enzymes present
Test for Variant Angina
coronary angiography with ergonovine will show ST elevation
Diagnosis of renal artery stenosis
(Unrelenting hypertension with hypokalemia)
captopril-enhanced radionuclide renal scan
MRI angiography
and Spiral CT
Definitive diagnosis for COPD
PFTs
Less than 70% FEV1/FVC
Peak flow meter less than 350 L/min
Diagnosis of Asthma
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)
Tests to run for acute asthma exacerbation
Peak expiratory flow-less than 60% predicted
ABG: increased A-a gradient
Chest X-ray- rule out exacerbation etiology
Diagnosis of Bronchiectasis
High resolution CT scan-choice
PFTs-obstructive pattern
Possible bronchoscopy
Diagnosis of pleural effusion
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
Diagnosis of empyema
CXR or CT scan
Pleural fluid will have pH less than 7.2
Diagnosis of spontaneous pneumothorax
decreased breath sounds on affected side
hyperresonance over the chest
decreased tactile fremitus on affected side
CXR: Mediastinal shift toward side of pneumothorax
Diagnosis of tension pneumothorax
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
Insterstitial lung disease Diagnosis
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
Definitive diagnosis of sarcoidosis
transbronchial biopsy-noncaseating granulomas
Wegener’s graunulomatosis diagnosis
Gold standard: tissue biopsy
c-antineutrophilic cytoplasmic Abs
Asbestosis CXR findings
pleural plaques
hazy infiltrates with bilateral linear opacities
Silicosis CXR findings
Egg shell calcifications
Berylliosis diagnosis
Beryllium lymphocyte proliferation test:
Diagnosis of Goodpasture’s syndrome
Tissue biopsy
Serologic evidence of antiglomerular basement membrane Abs
Diagnosis of Idopathic pulmonary fibrosis
CXR: ground glass or honeycombed appearance
Definitive diagnosis requires open lung biopsy
Diagnosis of acute respiratory failure
ABG:
Hypoxemia: V/Q mismatch, intrapulmonary shunting, hypoventilaton
Hypercapnia: hypoventilation secondary to other causes
A-a gradient
Diagnosis of ARDS
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)
Diagnosis of graves
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
Diagnosis of primary pulmonary hypertension
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
Cor pulmonale diagnosis
CXR: enlargement of RA, RV, and pulmonary arteries
ECG: right axis deviation, Peaked P waves, RVH
ECHO: RV dilatation, normal LV size and function
Low DLCO
Emphysema-obstructive
Interstate lung disease, sarcoidosis, asbestosis, heart failure-restrictive
Anemia, PE, pulmonary hypertension-normal spirometry
Normal DLCO
Chronic bronchitis, asthma-obstructive
Musculoskeletal, neuromuscular-restrictive
Increased DLCO
Asthma-obstructive
Obesity-restrictive
Pulmonary hemorrhage, polycythemia-normal spirometry
ABG difference in copd vs CHF exacerbation
Copd=hypercapnia
CHF=hypocapnia
