Respiratory Exam 4 Flashcards
preferred study for PE and pulmonary nodules
Spiral (Helical ) CT
Iv contrat for?
vasculature
oral contrast for?
GI or esophageal
how long is the dye allergic reaction delayed?
2-6 hrs
Air Bronchograms
bronchi become visible due to increased opacity of surrounding lung
Bronchiectasis CT finding?
abnormal dilation of bronchial tree
lack of tapering of the bronchi
PE CT finding?
90 % sensitive for PE
well defined hypotenuse area in the pulmonary artery
GG opacities CT finding?
lower density opacities rather than thick opacities
low density lung opacity not sufficient to obscure pulm. vessels
Permanent enlargement of the air spaces DISTAL to the bronchioles
destruction of alveolar septum/wall
Emphysema
Size of pulmonary nodules ?
<3 cm
malignant pulmonary nodules?
speculated
multiple
changing in size
Benign Pulmonayr nodule?
unchnaged small calcified smooth solitary
Septated nodules?
suspect primary lung malignancy
Circumscribed nodules?
suspect lung mets
Halo sign?
surrounded by ground glass - suspect malignancy
how big should the heart be?
half the width of the chest cavity
Left heart border (left ventricle)? Silhouettes and there adjacent structures
Lingula
Right heart border (right atrium) Silhouettes and there adjacent structures
Right middle lobe
Left hemidiaphragm? Silhouettes and there adjacent structures
left lower lobe
Right hemidiaphragm? Silhouettes and there adjacent structures
right lower lobe
Aortic knuckle ? Silhouettes and there adjacent structures
left upper lobe/middle mediastinum
Descending aorta? Silhouettes and there adjacent structures
left lower lobe
Right paratracheal stripe? Silhouettes and there adjacent structures
right upper lobe / anterior mediastinum
Paraspinal lines ? Silhouettes and there adjacent structures
medial lung / posterior mediastinum
pathology of atelectasis?
Volume loss of some portion of the lung
Shows linear, curvilinear or wedge shaped opacities
More diffuse in presentation
Compensatory hyperinflation of adjacent lobes
CFTR gene is expressed in:
epithelial cells in a variety of organs including
the lung, sinuses, pancreas, sweat gland, intestine, liver, and vas deferens
CF is the most common inherited life-shortening disease of __________ in the US
caucasions
CF lung disease is characterized by:
mucociliary clearance
chronic polymicrobial infection of the airways
exaggerated inflammatory response
Sweat Chloride Test indication?
To diagnose CF:
Recurrent respiratory infections
Late passage of meconium stool
Failure to thrive - not progressing like they should
Chronic cough
Malabsorption syndromes - greasy fatty smelly stools
Pathophysiology of CF?
Abnl mutation in the CFTR (CF transmembrane conductance regulator gene)
Gene encodes a synthesis of a protein that serves as a channel through which chloride enters and leaves the cells.
Sweat near the base of the gland has a high sodium and chloride concentration ( deposits at base)
In patients with CF transport does not occur.
during the CF sweat chloride test… Sweating is induced by mild electrical current called?
(pilocarpine iontophoresis
Sodium and chloride content of sweat is measured
During the CF sweat chloride test the + electrode is ? current flow 5-12 min
pilocarpine hydrochloride
During the CF sweat chloride test the - electrode is ? current flow 5-12 min
bicarbonate solution
During the CF sweat chloride test the aper discs are placed on the arm and covered with ________ for air tight seal for one hour
paraffin
Normal SCT results ?
Normal: <50 meq/L
Equivocal SCT results?
Equivocal: -60 meq/L
Abnormal SCT results?
Abnormal: >60 meq/L
Interferring factors with swat chloride test?
Not reliable within the first few weeks of life
Not reliable for pubertal adolescents
Dehydration can reduce volume of sweat
don’t do test after a marathon
Cold room can reduce sweating
because we sweat in hot environments
Most common mutation in the CFTR gene? and what chromosome?
Delta AF508
chromosome 7
Procedures for CFTR mutation analysis ?
Serum
Chorionic villus sampling
Amniocentesis - cells
Uses PCR to amplify the locus for the mutation
Mutation and chromosome for Alpha-1 Antitrypsin?
autosomal recessive disease caused by mutations in the SERPINA1 gene on chromosome 14, which encodes the protease inhibitor alpha-1 antitrypsin (AAT)
where do you see Alpha-1 Antitrypsin deficiency ?
emphysema and COPD
Pathophysiology of Alpha-1 Antitrypsin?
AAT inactivates endoproteases that can breakdown elastic fibers and collagen in the lungs
A deficiency causes a build-up of those endoproteases
Testing for the ____ and __ alleles
S, Z
Normal AAT?
85-213 mg/dL or 0.85-2.13 g/L (SI Units)
Gold standard for PE
CT
D-dimer is a __________________ product made through the lysis of fibrin when plasmin acts on the fibrin polymer clot
fibrin degradition
what can give you a false positive for D-Dimer?
inflammation and pregnancy, being old, having CA
D-Dimer is very sensitive but not specific? T or F
T
D-Dimer normal result?
<0.4 mcg/ml
When will we have a increased D-Dimer?
DVT
PE
what detects and monitors the course of sarcoidosis as well as other granulomatous disease (Differentiate between active and dormant sarcoid disease
)
Angiotensin converting enzyme (ACE)
where does ACE come from and what does it activate?
comes from the lungs(Found in pulmonary epithelial cells) and it turns Angiotension 1 into Angiotension 2
__________ ACE levels are found in sarcoidosis pts.
elevated
ACE test has somewhat low sensitivity and specificity. T or F
T
Elevated levels of ACE are reported in ___ of patients with acute disease and only ___ of patients with chronic disease.
60%
20%
Normal ACE result?
<40 units/L
When will we see an increase in ACE levels?
Sarcoidosis (more severe= higher level)
Gaucher disease - sphingolipids are not broken down correctly and distributed all over the body TB Leprosy Alcoholic cirrhosis Hodgkin disease amyloidosis
Interfering factors of ACE?
False decreased levels:
Hemolysis - cause decrease levels
Drugs
ACE inhibitors (duh)
