pulmonary diagnostic testing

Question 1

____ are the predominant diagnostic tests used to determine anatomic abnormalities and pathology in the chest cavity.

air=dark, bone=white;
fat, water and tissue are also visible.

Answer 1

chest radiographs

Question 2

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.

Answer 2

posterioanterior
left lateral

supine/ recumbent for AP views usually&raquo_space;poor inspiratory effort

Question 3

chest radiographss are to be assessed systemically.the first 4 steps are:
-assess technical quality (position/pt movement)
-evaluate location of lines and leads
-assess CV status
-check for abnormal parenchymal opacity

what are the other 3?

Answer 3

check for evidence of barotrauma
look for pleural effusion
compare to prior studies

Question 4

when observing bones and soft tissue via chest radiographs, what exactly are we looking for?

Answer 4

-rotated position?
-thorax: size, shape, symmetry
tracheal shadow

-soft tissue: might expect summation (blending) effect
-hemidiaphragms: normal=rounded + smooth
-heart and great vessels

Question 5

when normal lines of demarcation between structures are partially/fully obliterated, we are left with

Answer 5

silhouette sign

Question 6

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..

Answer 6

tumors; x-rays

Question 7

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.

Answer 7

pulmonary embolisims; ventilation and perfusion scans (V/Q scan)

Question 8

an abnormality in the chest wall such as a mass or nodule, might indicate a need for further imaging-specificallly this :

Answer 8

an MRI

Question 9

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 ____ .

Answer 9

bronchography; bronchial tree

Question 10

T/F Bronchography is indicated for assessing areas of infection and clearing viscous secretions?

Answer 10

false. this applies to fiberoptic bronchoscopy.

Question 10

total lung capacity is the sum of what 2 measures?

Answer 10

vital capacity and residual volume

Question 10

Body plethysmographs (gold standard) and spirograms can be used to test lung ___ and __

Answer 10

volume and capacity

Question 11

spirometry involves a maximal inhale follwed by a max exhale and can give us 4 important values. what are they/ what do they mean?

Answer 11

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)

Question 12

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.

Answer 12

true

Question 13

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)

Answer 13

distance, blood flow and breathing ability

Question 14

Describe the scenario represented by this PFT graph

Answer 14

normal ventilation

Question 15

Describe the scenario represented by this PFT graph

Answer 15

obstructive pathology

Question 16

Describe the scenario represented by this PFT graph

Answer 16

restrictive pathology

Question 17

Describe the scenario represented by this PFT graph

Answer 17

mechanical ventilation

Question 18

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

Answer 18

their baseline or demographic matched norms

Question 19

what are the arterial blood gas analysis norms (according to this class)
pH, PCO2, PO2, HCO3-, O2sat

Answer 19

pH:7.4
PCO2:40
PO2/O2sat :97
HCO3-:24

Question 20

how does PaCO2 dictate our interpretation of alveolar ventilation?

severity and nature determined by pH and arterial CO2, venous too!

Answer 20

hyperventilation< PaCO2@40mmHg < hypoventilation

PaCO2>50mmHg:ventilatory failure

Question 21

how do bicarbonate and carbon dioxide interact with pH? which relates to metabolic vs ventilatory acidosis/alkylosis?

Answer 21

more HCO3= higher pH (basic)
more CO2=lower pH (acidic)

HCO3- in kidneys (metabolic)
CO2- in alveoli (ventilatory)

Question 22

provide the ranges for a pt who is mild, moderately and severely hypoxemic.

Answer 22

40 mmHg = severe
40-60 mmHg mod
60-80 mmHg= mild

Question 23

T/F: ABGs are usually consistent over time, even with changes in ventilator support.

Answer 23

false. they are very time sensitive and should be reassessed with any change in modes/support.

Question 24

pause to review the ABG decision tree

Answer 24

Question 25

why might a phycisian choose to run a cytological test vs a hemotological one?

Answer 25

hemotologic (ABGs, elextrolyte analysis, CBCs, coagulation studies) are used to detect cP disease while cytological tests ID disease-causing microorganisms

Question 26

how well do you remember how to interpret INRs?

hint: normal ~1.0

Answer 26

INR >1 : hemorrhage risk
INR <1: clot risk

treatment may aim to manipulate this.