Pulmonary Diagnostic Tests and Procedures Flashcards by Tahlia Wasserman

what are the 4 types of chest imaging that can be done?

chest radiograph

computed tomography (CT)

magnetic resonance imaging (MRI)

ventilation and perfusion scans

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what is a chest radiograph?

diagnostic test to determine anatomic abnormalities and pathological processes

air is dark, bone is white

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what does white hilum on a chest radiograph indicate?

increased vascularity of the pulmonary arteries

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what is the decubitus view used for?

to confirm the presence of an air-fluid level in the lungs or a small pleural effusion (taken to rule out a pleural effusion)

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what is the lordotic view used for?

to visualize the apcial or middle (R middle or L lingular segments) region of the lungs or specifically to screen for pulmonary tuberculosis

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what is the oblique view used for?

to detect pleural thickening, to evaluate the Carina, or to visualize the heart and great vessels

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what is the AP view used for?

taken at the pt’s bedside in supine (abdominal contents tend to raise the diaphragm) or in semirecumbent

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what should the hemidiaphragms look like in a chest radiograph?

smooth and rounded

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if the hemidiaphragms are flat, what is this indicative of?

obstructive disease

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what is the hila?

the root of the lungs (pulmonary blood vessels, bronchi, and group of lymph nodes)

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what is a silhouette sign?

when the lines of demarcation bw 2 structures is partially or completely obliterated (can’t see it)

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what is computed tomography (CT)?

digital chest radiography involves in narrow beam of x-rays moving across the field of examination

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CT scans are primarily used for dx of what two things?

tumors and calcification/nodules

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what does CT with contrast enhancement help visualize?

vasculature and lung perfusion

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what is the gold standard test for ruling out a PE? (KNOW THIS)

positron CT (helical CT)

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what are the advantages of CT?

much more sensitive

evaluates lung, heart, mediastenum, pleura, chest wall, upper abdomen

localized disease

guidance of interventional procedures

can detect occult pneumothorax or effusions

evaluates chest tube placement

can contribute new info

may detect unsuspected abnormalities

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what are the disadvantages of CT?

risk of transporting a pt out of the ICU

significant increased radiation

risks of IV contrasts if given

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what is pulmonary arteriography?

x-ray w/contrast dye injected into the blood vessels to look for obstructions

used to be the gold standard for PE but is too invasive and so now CT is more widely used

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what is magnetic resonance imaging (MRI)?

magnetic field, radio waves and a computer to produce detailed pics of the structures w/in the chest

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MRI is primarily indicated for evaluating what?

chest wall processes that may involve bone, muscles fat, or pleura

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what are ventilation and perfusion scans?

2 nuclear scan tests used to measure ventilation and perfusion

measures blood flow and air flow

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what is the perfusion scan?

radioactive albumin injected into the vein and scans the pt’s lungs as blood flow through them to detect the location of an emboli

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what does a decreased uptake of the radioisotope in a perfusion scan indicate?

a problem with blood flow, including occlusion of the pulmonary arteries (pulmonary embolism)

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what is the ventilation scan

radioactive gas is inhaled and scans the lungs to measure air flow

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what does a decreased uptake of the radioisotope in a ventilation scan indicate?

reduced breathing and ventilation ability or airway obstruction (pneurmonia or COPD)

what does a bronchoscopy allow us to see?

normal and variant anatomy and gross pathological changes in the bronchial wall and lumen

what can a bronchoscopy be used for?

tissue biopsy, secretion sampling/removal direct visualization of the bronchial tree infection

PTFs provide clinicians with what 3 pieces of info?

integrity of airways fxn of respiratory musculature condition of lung tissue

what do PFTs measure?

lung volumes and capacities gas flow rates gas diffusion flow-volume loop

what does the diffusing capacity of the lungs for CO look at?

the integrity of the membrane and ability of gas to perfuse

what is forced vital capacity?

max volume exhaled as quick as possible

what is FEV1?

what is forced expiratory volume in 1 sec

what does FEV1 of >2L mean?

little/no obstruction

what does FEV1 of 1-2L mean?

mild to moderate obstruction

what does FEV1 of <1L mean?

severe obstruction

what is a normal FEV1/FVC ratio? (KNOW THIS)

75%

FEV1/FVC ratio of >80-90% indicates what? (KNOW THIS)

restrictive disease

FEV1/FVC ratio of <75% indicates what? (KNOW THIS)

obstructive disease

FEV1/FVC ratio of <60% indicates what? (KNOW THIS)

severe obstructive disease

do ppl with large lung volumes and decreased FVC have obstructive or restrictive disease?

obstructive

do ppl with small lung volumes and possibly low FVC have obstructive or restrictive disease?

restrictive

what gas flow rate identifies small airway disease? (KNOW THIS)

forced midexpiratory flow

what is forced midexpiratory flow?

the volume of air exhaled over the middle half of the FVC, divided by the time required to exhale it normally 4L/sec

what is forced expiratory flow?

the average expiratory flow during early phase exhalation normally >5L/sec (300 L/min)

what is max voluntary ventilation?

the max volume of gas a patient can move for 1 minute 160-180 L/min normal values can vary 25-30%

what is peak expiratory flow?

max flow that occurs at any point in the time during the FVC normally 9-10 L/sec

decreased peak flow reflects what?

nonspecific mechanical problems

what are bronchodilators?

beta-2 agonists that target the smooth muscles in the bronchioles of the lung inhibits the effects of the parasympathetic NS causes bronchiole dilation

normally, would bronchodilators make a difference in PFTs?

if bronchodilators make a positive difference in PFTs b4 and after use, is the change reversible?

yes

a __% change in PFTs after bronchodilators in at least 2 of the following would indicate a reversible airway obstruction : FEV1, FVC, or FEV25-75

12%

what is the diffusing capacity of the lung (DL)

measures the integrity of the functional unit (alveoli and pulmonary blood in the capillary)

what is the diffusing capacity of the lungs for carbon monoxide (DLCO)?

measures the amount of gas entering the pulmonary blood flow per unit of time using CO as the gas bc of its high affinity for Hgb

what should normal diffusing capacity be?

20-30 mL/min/mmHg

what are the 3 key factors for abnormal DLCO testing?

1) hemoglobin - decreased quantity per unit of blood 2) alveolar-capillary membrane - increased thickness of the membrane 3) surface area - decreased functional surface area available for diffusion

what would a false test result in DLCO testing mean?

there is not enough hemoglobin

what are the steps for interpreting PTFs?

1) look at the FEV1% (if <70%=obstruction) 2) determine severity of obstruction (>2=little/no obstruction, 1-2=mild to moderate obstruction, <1=severe obstruction) 3) determine if the obstruction is fixed or reversible 4) determine if restrictive disease is present 5) determine what kind of restrictive disease is present (reduced DCLO) 6) determine severity of ossification

when the entire flow volume loop shift to the R, is this indicative of restrictive or obstructive disease?

restrictive

what can ABGs tell us?

acid-base balance, ventilation, and oxygenation

do acids or bases give up H+ ions?

acids

do acids or bases take up H+ ions?

bases

what does pH give us insights into?

respiratory or metabolic

if pH is <7.35 what is this indicative of?

acidosis

if pH is >7.45 what is this indicative of?

alkalosis

what is normal PaCO2?

what is normal PO2?

what is normal HCO3?

what is normal oxygen saturation?

97%

does hyperventilation lead to respiratory acidosis or alkalosis?

respiratory alkalosis

does hypoventilation lead to respiratory acidosis or alkalosis?

respiratory acidosis

does decreased PaCo2 indicate respiratory acidosis or alkalosis?

respiratory alkalosis

does increased PaCo2 indicate respiratory acidosis or alkalosis?

respiratory acidosis

does hyperventilation cause a drop or spike in pH?

drop in pH?? should be a spike??

does hypoventilation cause a drop or spike in pH?

spike in pH?? should be a drop??

what ABG is a direct reflection of the adequacy of alveolar ventilation?

PaCo2

what is normal alveolar ventilation?

40 mmHg

what does PaCo2 of <40 indicate?

hyperventilation

what does PaCo2 of >40 indicate?

hypoventilation

what does PaCo2 of >50 indicate?

ventilatory failure

do the lungs or kidneys regulate blood acids?

lungs

do lungs or kidneys regulate blood bases?

kidneys

high PaCo2 and low HCO3 is associated with high or low pH?

low pH

high HCO3 and low PaCo2 is associated with high or low pH?

high pH

what does PaO2 bw 60-80 indicate?

mild hypoxemia

what does PaO2 bw 40-60 indicate?

moderate hypoxemia

what does PaO2 40 indicate?

severe hypoxemia

what is the difference bw SaO2 and SpO2?

SaO2 measures O2 through an arterial blood gas sample SpO2 measure O2 through pulse ox

what does the acronym ROME mean?

respiratory opposite (pH and Co2 go in opposite directions) metabolic equal (pH and HCO3 go in the same direction)

if pH is high and PCo2 is low, is this respiratory/metabolic, alkalosis/acidosis?

respiratory alkalosis

if the pH is low and PaCo2 is high, is this respiratory/metabolic, alkalosis/acidosis?

respiratory acidosis

is PaCo2 the respiratory or metabolic component?

respiratory

is HCO3 the respiratory or metabolic component?

metabolic

if the pH is high and HCO3 is high, is this respiratory/metabolic, alkalosis/acidosis?

metabolic alkalosis

if the pH is low and HCO3 is low, is this respiratory/metabolic, alkalosis/acidosis?

metabolic acidosis

what is the direct measure of O2 saturation through arterial blood sampling?

PaO2

what does pulse ox measure?

SpO2

what are the typical hemotological tests?

ABGs, electrolyte analysis, complete blood counts, and coagulation studies

what is anemia?

low hemoglobin, low RBCs, and low hematocrit

what is polycythemia?

increased hemoglobin, RBC, or hematocrit

what is leukocytosis?

increased WBCs

what is leukopenia?

decreased WBCs

how does a patient with low RBCs and Hgb present?

cyanotic, decreased muscle power, decreased endurance, and increased HR

what is the risk of decreased platelets?

bleeding

what is the risk of increased platelets?

clotting