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Clin Lab > Respiratory Labs > Flashcards

Respiratory Labs Flashcards

1
Q

respiratory system

A

-gas exchange:
-blood gas
-electrolytes- anion gap

-fluid analysis- pleural space

-secretion- bronchoalveolar lavage

WHY?
-infections
-asthma
-respiratory distress- not enough surfactant
-COPD
-sepsis
-lung cancer

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2
Q

major causes of respiratory disease

A

-tumors
-infections
-airway disease- shunting, (asthma and COPD)
-pulmonary vasculature disease (PE and pulmonary HTN)
-interstitial lung disease (sarcoidosis, pneumoconiosis, and many others)

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3
Q

diagram of airways-ventilation

A

-can be blocked by embolism- complete ventilation, no perfusion
-thickened alveolar-capillary barrier with impaired gas transfer (interstitial)
-thickness of membrane, temperature, distance- influence diffusion
-airway obstruction

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4
Q

modified allen test / radial artery ABG

A

-pts hand is held high while the fist is clenched and both radial and ulnar arteries are compressed
-blood will drain from hand
-then lower the hand
-open fist
-release ulnar artery but not the radial
-color should return to hand within 6s
-indicates pt ulnar artery and an intact superficial palmar arch
-if flow is not restored to hand -> you cant do an ABG on this hand -> no collateral flow

-collateral flow to fingers via ulnar and radial
-radial artery is palpated between distal radius and tendon of flexor carpi radialis

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5
Q

components of typical arterial blood gas kit

A

-arterial blood gas syringe
-protective needle
-syringe cap
-iodine and alcohol preparation swabs
-gauze
-pt label
-biohazard ice bag
-adhesive bandage

-sample goes on ice

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6
Q

femoral artery anatomy/puncture

A

-outside to inner- femoral nerve, artery, vein
-NAVEL
-femoral artery can be palpated just below midpoint of inguinal ligament
-blood draw- 90 degree angle
-catheter (snake a line)- 45 degree angle

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7
Q

blood gas

A

-Partial pressure of Oxygen
-Partial pressure of carbon dioxide
-pH

-Lungs respond within minutes ->
-ex. if you put a pt on a ventilator, the lungs respond in mins, redraw ABG can be done within mins
-Renal response takes hours/days

-Hypoxemia
-Hypercapna
-Respiratory Acidosis
-Metabolic Acidosis
-Respiratory Alkalosis
-Metabolic Alkalosis

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8
Q

effect of temperature on blood gas measurements

A

-higher temp -> lower pH
-lower temp -> higher pH
-temp affects pH
-put sample on ice

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9
Q

Reasons for ABG

A
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10
Q

causes of respiratory alkalosis

A
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11
Q

causes of metabolic alkalosis

A

-lax
-vomiting
-NG
-diuretics
-primary mineralocorticoid excess

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12
Q

major causes of metabolic acidosis

A

-DKA- tx IV insulin

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13
Q

electrolytes and anion gap

A

-Sodium
-Potassium
-Chloride
-Bicarbonate

-Anion Gap:
-Difference between major free cations and free anions.
-Used for evaluation of acidosis
-Amount of increased GAP is

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14
Q

BMP: chart

A
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15
Q

calculate anion gap

A

-Na - (Cl + HCO3)
-normal < 12

ANION GAP
-Methanol
-Uremia
-Diabetic ketoacidosis
-Propylene glycol
-Iron tablets or INH
-Lactic acidosis
-Ethylene glycol
-Salicylates

NORMAL ANION GAP
-Hyperalimentation
-Addison’s disease
-Renal tubular acidosis
-Diarrhea
-Acetazolamide
-Sprionolactone
-Saline infusion

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16
Q

thoacentesis

A

-asses:
-color
-characteristics
-odor
-exudate
-transudate

-transudative:
-low protein and LDH
-increased hydrostatic pressure or low osmotic pressure
-water/fluid (clear) in lungs
-ex. CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia

-exudative:
-high protein and LDH
-inflammation and increased capillary permeability
-ex. pneumonia, cancer, TB, viral infection, PE, autoimmune
-pus, yellow, odor, thick

17
Q

lights criteria for pleural effusions

A
18
Q

bronchalveolar lavage fluid analysis

A

-scope down trachea, bronchus -> view and obtain specimen

-Diagnostic:
-Pulmonary infections
-Acquired PNA
-Interstitial lung diseases
-Lung cancers
-Lung transplant monitoring

-Culture, WBC count, Gram Stain
-Bloody- Avelolar hemorrhage
-Cloudy- Pulmonary alveolar proteinosis
-Microscopy / Biomarkers

19
Q

PNA

A

-Community Acquired PNA
-S. pneumoniae
-Mycoplasma pneumoniae
-F. Influenzae
-Legionella
-Bordetella perstussis

-Viral PNA:
-Influenza
-COVID 19

-Ventilator Infections:
-Drug Resistant:
-K. pneumonia
-P. aeruginosa
-A. Baumanii
-MRSA

-Travel?
-TB
-Fungal

-Depressed Immunity?
-HIV- Pneumocystis or CMV

-Neutropenic- Aspergillus

20
Q

PNA- testing

A

Bacterial
Fungal
Parasitic
Viral

-Gram stain
-Sputum Culture
-Acid Fast Staining (TB)- culture/nucleic acid amplification test
-PCR assays
-KOH preps
-NAAT for viral infections
-Rapid Antigen Test for Flu

21
Q

asthma

A

-spirometry
-pulmonary function tests
-CXR
-allergy testing

22
Q

COPD

A

-Pulmonary Function Tests
-CBC
-Rule out infections
-Symptoms
-r/o Alpha-1 antitrypsin Deficiency, elastin degradation

23
Q

acute respiratory distress syndrome (ARDS)

A

-Rapid onset respiratory failure.
-Systemic inflammation, trauma, severe infection
-Significant morbidity & mortality
-Hypoxia, bilateral infiltrates, respiratory failure without cardiovascular insult or pulmonary HTN.
-Dx: Hx, CXR, CT, ABG, Echo, Cardio biomarkers,
-Tx: Oxygen, IV fluids, underlying disease
-if in preterm labor- give steroids to increase lung maturity in baby

24
Q

neonatal respiratory distress syndrome

A

-Incomplete development, preterm infants
-Deficiency in surfactant, which prevents alveolar collapse during exhalation
-Have perfusion but lack ventilation… hypoxia & respiratory acidosis.
-Steroids 48hrs before birth.
-Lamellar body count test for fetal lung maturity in amniotic fluid

25
Q

sepsis

A

-Severe physiological and biochemical response to a global infection.
-Response to infection is no longer localized.
-Systemic Inflammatory Response Syndrome (SIRS), proinflammatory cytokines cause fever, leukocytosis, activation of endothelial cell function and coagulation
-LEFT SHIFT- neutrophils (banded), leukocytosis
-Signs: Temperature >38C or <36C, WBC >12 or <4, RR>20 /min, HR>90 bpm.
-Shock hypotension and organ failure
-70 % mortality
-Lactate elevation, WBC with neutrophil elevation (left shift)

26
Q

lung cancer

A

-CXR, CT, MRI
-Tissue histological & immunohistochemical analysis
-Molecular testing, mutations direct therapy. Gene protein mutations, amplifications or rearrangments.
-Cytokeratin 19 fragments in serum may be used in prognosis.

27
Q

immunohistochemical and histochemical stains useful in diff dx of various carcinomas

A

Clin Lab (14 decks)

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