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Clin Med pulm > Pulmonary Diagnostics > Flashcards

Pulmonary Diagnostics Flashcards

1
Q

What vaccine can interfere with a TST?

A

Bacille Calmette-Guerin (BCG for TB)

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2
Q

TST:

A

Tuberculin Skin Testing:

  • intradermal injection on forearm, evaluate at 48-72 hrs.
  • 5mm (HIV, recent TB exposure), 10 (pts with risk factors for TB, 15 (those without risk factors)
  • TB exposure has to be at least 6 weeks prior to TST
  • CXR as needed if positive
  • Non-rxn maybe due to bacterial infection, viral infection, or immunosuppressive drugs (steroids) overwhelming TB
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3
Q

What test can be performed on people w/ BCG vaccine?

A

Quantiferon Gold TB test

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4
Q

Quantiferon Gold TB test:

A
  • blood test can diagnose latent or active TB
  • Highly specific, single visit
  • stimulates T cell response
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5
Q

TB Testing AFB Smear & culture:

A
  • detects mycobacterium infections
  • Pulmonary infection: collect 3-5 sputum samples
  • can have false negative smears
  • need culture for definitive confirmation
  • slow growing days to weeks to months
  • susceptibility testing is extremely important for TB due to resistance
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6
Q

NAAT TB testing:

A
  • inconjunction with smear

- more sensitive

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7
Q

MODS

A
  • Microscopic-Observation Drug-Susceptibility
  • For TB
  • 7 days - rapid
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8
Q

Pulmonary Function Testing (PFTs)

A

-assesses respiratory function, abnormalities and disease severity

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9
Q

Indications of PFTs:

A
  • Differentiate type and severity of lung dysfunction
  • Monitor Therapy and disease progression
  • Evaluate lung function function prior to a surgical procedure
  • Determine lungs gas diffusing ability
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10
Q

Full PFTs:

A

Spirometry/ volumes/ capacities

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11
Q

Things to consider with PFTs:

A

age, hgt, wgt, gender, ethnicity, pt ability, clinical context

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12
Q

Spirometry:

A
  • measures volumes and airflow rates
  • results are compared to predicted values
  • if values are greater than 80% of predicted then its normal
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13
Q

Forced Vital capacity (FVC)

A
  • part of spirometry
  • amount exhaled after max inspiration
  • this is diminished in obstructive and restrictive diseases
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14
Q

Forced Expiratory Volume 1 Sec (FEV1)

A

-1st sec of FVC

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15
Q

FEV1/FVC ratio:

A
  • results relatively normal in restrictive disease and markedly lower in obstructive
  • 80% or greater is normal
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16
Q

Inspiratory reserve volume (IRV)

A

-volume remaining after forced exhale

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17
Q

Expiratory Reserve Volume (ERV)

A

-Max volume exhaled after normal expiration

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18
Q

Obstructive diseases show _______ volumes.

A

hyperinflated/increased

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19
Q

Restrictive diseases show all ________ volumes and capacities.

A

low

20
Q

Volumes are needed for _____

A

DLCO

-diffusing capacity of the lung

21
Q

Volume is determined by…

A

finding FRC and calculating other values based on spirometer IC and ERV

22
Q

VT-

A

tidal volume - quiet breathing

23
Q

Lung Diffusing Capacity (DLco)

A
  • measures lungs ability to exchange gasses and saturate RBCs w/ O2
  • single breath of CO and Helium measured by gas chromatograph
  • normal= little CO returned (75-120% of predicted)
  • interstitual lung dz, pneumonia, tomur, PE, emphysema
24
Q

PFTs in restrictive diseases=

A
  • FEV1=
  • FVC, low
  • FEV1/FVC=
  • TLC-RV-FRC, low
25
Q

PFTs in Obstructive diseases=

A 
FEV1, low
FVC=/low
FEV1/FVC, low
TLC=/^
RV=/^
FRC,^
26
Q

Who do you do ABGs on?

A

-sicker ventilated pts, non-ventilated pts, and pre-op

27
Q

what else do you obtain with ABG?

A

serum blood chemistry to compare values

28
Q

acidemia=

A

<7.35

29
Q

Alkalemia=

A

> 7.45

30
Q

Anion Gap [Na-(Cl+HCO3)]

A

-difference measured between anions and cations

31
Q

Anion gap uses

A
  • determining a DDx of various metabolic acidemia

- Normal= 12+/- 4 (normally HCO3 loss)

32
Q

D-dimer

A
  • tests intravascular clotting
  • Looks for plasmin activity on a fibrin clot
  • high sensitivity for amount of clot breakdown, but not any one pathology
  • Normal values= ‘none’
  • tests for DIC, DVT, PE, general fibrinolysis
  • elevated after surgery, cancer, pregnancy or sickle cell
33
Q

Alpha 1 antitrypsin (AAT)

A
  • used if you suspect familial component of emphysema which occurs early in life
  • non-specific marker for inflammation so must use with clinical workup
34
Q

Sweat Chloride Test

A
  • diagnostic for Cystic Fibrosis (>60 men/L)
  • Performed on children w/ FTT, malabsorption, early asthma, ongoing respiratory infections, presence of meconium ileus at birth.
  • screen siblings with CF
  • must have 2 positive tests
35
Q

Chest Computed Tomography (CT) scan

A

-used for- tumor, PNA, abscess, lung dz, aortic dz, bony dz, upper GI dz, mediastinal dz

36
Q

Number 1 modality to identify pulmonary embolism-

A

Spiral CT with contrast

37
Q

When is chest CT contraindicated?

A
  • instable pt
  • pregnancy
  • profound claustrophobia
  • No IV contrast w/ iodine- shellfish allergy
38
Q

Chest CT complications:

A

Acute Renal failure

  • allergic rxn
  • interaction w/ metformin precipitating acidosis or hypoglycemia
39
Q

Spiculated nodule=

A

not round or nice, stuff moving from it

= cancer

40
Q

Ventilation/Perfusion Scan (VQ)

A
  • used for diagnosis of suspected PE
  • Dx categories: negative, low probability, high probability, positive.
  • *used less than spiral test CT, but negative scan rules out a PE
41
Q

What is the gold standard test when a VQ is equivocal?

A

Pulmonary Angiography

42
Q

Pulmonary Angiography

A
  • essentially replaced by spiral chest CT
  • its more invasive
  • takes longer
  • potential for cardiac arrhythmias
43
Q

Thoracentesis

A

Needle insertion into the pleural space to remove excess fluid for treatment and diagnosis.
Done with or without ultrasound guidance.
Specimens sent for: cytology, cell count, gm stain, cultures, protein, glucose, TB, fungus.
Differentiate between transudate and exudate effusions.
Transudates: CHF, cirrhosis, nephrotic syndrome
Exudates: malignancy, infection or inflammation

44
Q

Bronchoscopy

A

Endoscopic modality to directly visualize the larynx, trachea and bronchi.
Flexible fiberoptic or rigid scope.
Diagnosis or treatment.
Rigid: removal of larger FB under GETA.
Flexible: more commonly used because of flexibility and ability to reach smaller airways.
Obtain sputum samples, biopsy lesions, assess airways, look at larynx, stop bleeding,

45
Q

Tube Thoracostomy (chest tube)

A

Remove air or fluid

Therapy for introducing sclerosing agents

46
Q

Video Assisted Thoracic Surgery (VATS)

A

Laproscopic thoracic surgery for diagnosis and treatment

47
Q

Thoracotomy

A
  • Open thoracic surgery both diagnostic and therapuetic
  • Most commonly used for lung resection due to malignancy
  • extremely painful

Clin Med pulm (11 decks)

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