pulmonary diagnostic testing Flashcards
____ are the predominant diagnostic tests used to determine anatomic abnormalities ( fiborsis/collapse) and abnormal material (blood/exudate)
air=dark, bone=white;
fat, water and tissue are also visible.
chest radiographs
for chest radiographs, though other views can, and are, frequently observed, the standard directions are ___ (2). Also, the more upright they are for this, the better –standing preferred.
posterioanterior
left lateral
supine/ recumbent for AP views usually»_space;poor inspiratory effort
when observing bones and soft tissue via chest radiographs, what exactly are we looking for?
-rotated position?
-thorax: size, shape, symmetry
tracheal shadow
-soft tissue: might expect summation (blending) effect
-hemidiaphragms: normal=rounded + smooth
-heart and great vessels
when normal lines of demarcation between structures are partially/fully obliterated, we are left with
silhouette sign
chest CTs (computed tomography) are mainly used to distinguish ____ from calcifications or nodules. They look at more layers and structures than ____ but usually require pt transport..
tumors; x-rays
Pulmonary arteriographies are the gold standard for identifying ___. These can also be ruled out via ____However, CT scans have become more popular since they are less invasive, less time consuming, expensive and assoc w/ lower morbidity/mortality/complications.
pulmonary embolisims; ventilation and perfusion scans (V/Q scan)
perfusion deficits or an abnormality in the chest wall such as a mass or nodule, might indicate a need for further imaging-specificallly this test: ___
an MRI
normal anatomy, variant and gross pathlogical change can all be observed via ___ but fiberoptic bronchoscopy has decreased the need. It permits direct visualization of more of the ____ .
bronchography; bronchial tree
T/F Bronchography is indicated for assessing areas of infection and clearing viscous secretions?
false. this applies to fiberoptic bronchoscopy.
total lung capacity is the sum of what 2 measures?
vital capacity and residual volume
Body plethysmographs (gold standard) and spirograms can be used to test lung ___ and __
volume and capacity
spirometry involves a maximal inhale follwed by a max exhale and can give us 4 important values. what are they/ what do they mean?
FVC (max amount of air that can be inhaled/exhaled)
FEV (max exh, usually 200-1200)
FEV1/FVC (max exhale in 1s/FVC)
VC (TLC- residual vol)
T/F: Peak expiratory flow is a measure often taken for asthmatic pts and is used to compare with demographically matched norms and their own baselines.
true
Diffusion capacity of the lung (DL) and diffusion capacity for CO (DLCO) are tests that inform us of difference in partial pressures of gasses in alveoli/pulmonary blood. what are the components of the info provided ? (3)
distance, blood flow and breathing ability
Describe the scenario represented by this PFT graph
normal ventilation
Describe the scenario represented by this PFT graph
obstructive pathology
Describe the scenario represented by this PFT graph
restrictive pathology
Describe the scenario represented by this PFT graph
mechanical ventilation
when interpreting basic PFTs, note that they are typically printed in columns of predicted, observed and % of observed. The predictions are based on______.
also consider pt effort for in context
their baseline or demographic matched norms
how does PaCO2 dictate our interpretation of alveolar ventilation?
severity and nature determined by pH and arterial CO2, venous too!
hyperventilation< PaCO2@40mmHg < hypoventilation
PaCO2>50mmHg:ventilatory failure
how do bicarbonate and carbon dioxide interact with pH? which relates to metabolic vs ventilatory acidosis/alkylosis?
more HCO3= higher pH (basic)
more CO2=lower pH (acidic)
HCO3- in kidneys (metabolic)
CO2- in alveoli (ventilatory)
provide the ranges for a pt who is mild, moderately and severely hypoxemic.
40 mmHg = severe
40-60 mmHg mod
60-80 mmHg= mild
T/F: ABGs are usually consistent over time, even with changes in ventilator support.
false. they are very time sensitive and should be reassessed with any change in modes/support.
pause to review the ABG decision tree
why might a phycisian choose to run a cytological test vs a hemotological one?
hemotologic (ABGs, elextrolyte analysis, CBCs, coagulation studies) are used to detect cP disease while cytological tests ID disease-causing microorganisms
how well do you remember how to interpret INRs?
hint: normal ~1.0
INR >1 : hemorrhage risk
INR <1: clot risk
treatment may aim to manipulate this.
PET scans are often used during___
cancer dx and treatment
describe respiratory alkalosis causes and s/s
cause: alveloar hyperventilation
s/s: dizziness, tingling. numbness and early tetany
describe respiratory acidosis causes and s/s
note: presentation has early (4) /late phases (3)
alveolar hypoventilation
early: anxiety, reetleness, dyspnea, HA
late: confusion, solomnence, coma
describe metabolic alkalosis causes and s/s
causes: bicarbonate ingestion, vomiting /diuretics, steroids, adrenal dx
weakness, mental dullness, maybe early tetany
describe metabolic acidosis causes and s/s
causes: diabetic, lactic or uremic acidosis, prolonged diarrhea
secondary hyperventilation (Kaussmal breathing), nausea, lethargy > coma
