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Pulmonary Medicine > Diagnostic Testing Pt 1 > Flashcards

Diagnostic Testing Pt 1 Flashcards

Principles of Pulm Med Chapter 3, Appendix A, and Appendix B 1. List and discuss the indications for and limitations of pulmonary function tests, bronchoscopy, and computed tomography. 2. Define the values for lung volumes and spirometry: -Tv -IC -IRV -ERV -FVC -SVC -RV -FRC -TLC -FEV1 -PEFR -FEF 3. Discuss and explain the normal range of values and interpretation of pulmonary function tests. 4. When given a clinical scenario and pulmonary function test results, determine of a

1
Q

What is a PFT?

A

Pulmonary Function Test

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2
Q

What are PFTs used for?

A
  1. Evaluation of Symptoms
  2. Determination of Disability
  3. Classification of Dz
  4. Follow up of Dz progression or response to therapy
  5. Evaluation of drugs and treatments
  6. Screening for surgical risk
  7. Epidemiologic
  8. Screening for those exposed to Pulmonary toxins
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3
Q

What do we get from PFTs?

A
  1. Flow/Volume Loops
  2. Spirometry with or without bronchodilators
  3. Lung volumes
  4. Diffusing Capacity
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4
Q

When doing PFTs, values are “predicted” as to what should be “normal” for the patient. What factors are taking into account for a “predicted” value?

A
  1. Age
  2. Sex
  3. Height
  4. Race Corrections for Blacks and Asians
  • ** Little Data for “normal” older adults >80
  • ** Common references: NHANES III, Crapo
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5
Q

What types of Disease Patterns can be detected using PFTs?

A
  1. Obstructive Ventilatory Dysfunction

2. Restrictive Ventilation Dysfunction

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6
Q

What are common Obstructive Resp. Diseases?

A
  1. Asthma
  2. COPD
  3. Bronchiectasis
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7
Q

What are common Restrictive Resp. Diseases?

A

Intrinsic Lung Diseases (Scarring of Lung Tissues)
Diaphragm/Chest Wall Dysfunction
Neuromuscular Disorders

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8
Q

What is the biggest symptom/sign that would indicate spirometry?

A

Dyspnea

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9
Q

Spirometry can be used in an outpatient clinic in order to:

A

Monitor diseases severity or effect of current therapy.

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10
Q

What values do you receive from spirometry?

A

FEV1 and FVC

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11
Q

Is this test objective?

A

No, it is based on the coaching of the Tech and the Patient’s effort

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12
Q

What would poor effort on a patient’s part cause to the curves/values coming out of the spirometry test?

A

The results can mimic certain disease processes, leading to a false assumption and clinic and potentially unnecessary testing.

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13
Q

Difference between spirometry and PFTs?

A

Spirometry is one test of PFTs

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14
Q

What are all the components of PFTs?

A
  1. Spirometry
  2. Post-Bronchodilator Spirometry
  3. Bronchoprovocation Testing (Methacholine) –asthma
  4. Lung Volumes
  5. Diffusing Capacity for Carbon Monoxide
  6. Maximal Respiratory Pressures
  7. Maximal Voluntary Ventilation
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15
Q

What is an important rule of thumb for Spirometry testing?

A

Must be completed for 10 second to be a valid test.

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16
Q

When looking at a spirometry test, what would you see in a “normal” curve?

A

Very steep slope for the first second and then tapers off

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17
Q

When looking at a spirometry test, what would you see in an “obstructive” curve?

A

Very gradual slope up over time

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18
Q

When looking at a spirometry test, what would you see in a “restrictive” curve?

A

Sharp slope up, like normal, but tapers off at a smaller volume.

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19
Q

What is PEFR (Peak Expiratory Flow Rate) most commonly used for?

A

Monitoring Asthmatic Patients

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20
Q

When looking at a spirometry flow chat, what does the curve above the axis represent?

A

Expiration

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21
Q

When looking at a spirometry flow chat, what does the curve below the axis represent?

A

Inspiration

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22
Q

If the spirometry flow curve is narrowed in on the X-axis, what are we looking at?

A

Restrictive Pulmonary Disease

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23
Q

If you see significant flattening “hockey shaped” Expiratory flow on a spirometry graph, you would assume that the patient has

A

Obstructive Pulmonary Disease

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24
Q

What factor on the PFT could indicate to the reader that the PFT was completed properly?

A

FEV1/FVC Ratio

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25
Q

If all the numbers in the Lung Volumes section of the PFT are reduced, what would that indicate?

A

Restrictive Disease

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26
Q

When you see a fluttering during inspiration (ups and downs), what does this indicate? What is most commonly the answer?

A

Indicative of something underlying occurring.

Sleep Apnea or Parkinson’s

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27
Q

You get a PFT back and all the numbers for Spirometry and Diffusion Capacity look normal, but then you look at the flow curve and notice a flattening on the inspiratory part of the flow. What would this indicate to you?

A

Mass on the Vocal Cords

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28
Q

After starting a patient on a bronchodilator, what is the intended effect in relation to PFT results?

A
  1. Increase in FEV1 and FVC by greater than or equal to 12%
  2. Absolute increase of about 200 cc

**Note a lack of an acute response does not mean the bronchodilator treatment is of no benefit.

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29
Q

What is a normal FEV1?

A

> 80% predicted

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30
Q

What is a normal FVC?

A

> 80% predicted

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31
Q

What is a normal FEV1/FVC?

A

> 90% predicted

>0.7

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32
Q

What FEV1 level (compared to normal) would indicate obstructive dysfunction?

A

Decreased

33
Q

What FVC level (compared to normal) would indicate obstructive dysfunction?

A

Normal or Decreased

34
Q

What FEV1 level (compared to normal) would indicate restrictive dysfunction?

A

Decreased

35
Q

What FVC level (compared to normal) would indicate restrictive dysfunction?

A

Decreased

36
Q

What FEV1/FVC level (compared to normal) would indicate restrictive dysfunction?

A

Normal

37
Q

What FEV1/FVC level (compared to normal) would indicate obstructive dysfunction?

A

Decreased

38
Q

Vital capacity can be _______ in obstructive dysfunction, although the lung volumes are ______________________.

A

Reduced;

Normal or increased

39
Q

What is the significance of doing a lung volume test? Why would we do this?

A
  1. Confirm a diagnosis of RVD based on spirometry (low TLC)
  2. Helps diagnose OVD (high RV in absence of other findings)
  3. Need to diagnose combined OVD and RVD
40
Q

What is the normal TLC level?

A

80-120% predicted

41
Q

What is the normal RV level?

A

80-120% predicted

42
Q

What TLC level (compared to normal) would indicate obstructive dysfunction?

A

Normal to increased

43
Q

What RV level (compared to normal) would indicate obstructive dysfunction?

A

Increased

44
Q

What TLC level (compared to normal) would indicate restrictive dysfunction?

A

Decreased

45
Q

What RV level (compared to normal) would indicate restrictive dysfunction?

A

Normal to decreased

46
Q

DLCO

A

Diffusing Capacity

47
Q

A patient exhales to residual volume (RV) and then rapidly inhales a gas mixture containing a small about of carbon monoxide.
After 10 seconds of breath-holding at TLC, the patient exhales and the gas is analyzed.

This test is called?

A

Diffusing Capacity (DLCO)

48
Q

What does the DLCO measure?

A

Capacity of the lung to transfer gas.

Hemoglobin in the body is supposed to be able to correct for the abnormalities caused by the DLCO test, given that the gas is exchanged into the body appropriately.

49
Q

The affinity of CO to hemoglobin is ______ than that of O2. By how much or how little?

A

Higher affinity by 200 times as much

50
Q

Because of the high affinity of CO to Hb, the DLCO test is dependent on two factors.

A
  1. Surface area and thickness of the alveolar capillary membranes
  2. Volume of the capillary bed and the hemoglobin concentration
51
Q

The high affinity of CO to Hb removes what factor from the DLCO test?

A

Cardiac Output is not a variable that matters

52
Q

What is the normal value for DLCO?

A

> 75% predicted

53
Q

What DLCO level (compared to normal) would indicate obstructive dysfunction?

A

Decreased in Emphysema,

but normal in asthma or chronic bronchitis

54
Q

What DLCO level (compared to normal) would indicate restrictive dysfunction?

A

Decreased in parenchymal disease

55
Q

In Pulmonary Vascular Disease, what value of a PFT would be indicative of this? What would the other values of the PFT represent?

A

DLCO will be decreased

FEV1, FVC, FEV1/FVC, TLV, and RV would all be normal!!

56
Q

When looking at PFTs, what is a good way to approach it?

A
  1. Look at the time curve (flow curve)
  2. Look at the Ratio
  3. Look at FEV1 and FVC to see if they are normal
57
Q

Two types of Bronchoscopies

A
  1. Fiberoptic Bronchoscopy (FOB)

2. Rigid Bronchoscopy

58
Q

Where is Rigid Bronchoscopy completed?

A

OR under anesthesia

59
Q

Where can FOB (Fiberoptic Bronchoscopy) be completed?

A

PFT lab? Conscious sedation needed for this.

60
Q

When are bronchoscopies completed?

A
  1. Lung nodule or mass
  2. Pulmonary infiltrate that has not been dx or treated by non-invasive methods, such as unresolving pneumonia or fibrotic/inflammatory changes on a CT
  3. Sample the flora inhabiting a lung abscess
  4. Look for and extract foreign bodies
  5. Examine the tracheobronchial tree
  6. Mechanical interventions for airway deformities or obstruction (Foreign Body in lungs)
61
Q

Do normal pneumonia findings indicate a bronchoscopy?

A

Nope!

62
Q

When performing a bronchoscopy, when will you use needle aspiration?

A
  1. Viral, bacterial, or fungal sampling

2. Pathology - cancer screening

63
Q

When performing a bronchoscopy, when will you use transbronchial lung biopsy?

A
  1. Viral, bacterial, or fungal sampling

2. Pathology - cancer screening, inflammatory lung diseases (fibrosis), granulomatous lung diseases (TB/Sarcoid)

64
Q

When performing a bronchoscopy, when will you use rigid bronchoscopy?

A
  1. Balloon dilation of structures

2. Placements of prostheses/stents

65
Q

What are risks/complications of doing Bronchoscopies?

A
  1. Sinusitis
  2. Vocal Cord Injury
  3. Pneumonia or bronchitis (most common infections after procedure)
  4. Bleed (common with coagulopathy)
  5. Pneumothorax (can cause lung collapse)
  6. Respiratory compromise requiring intubation
  7. Stroke
66
Q

During this test, the radiologist will observe how your diaphragm moves. You will be asked to “sniff” or quickly breathe in through your nose

A

Sniff Test

67
Q

Sniff Test is a _____ test

A

Fluoroscopy Test

68
Q

Fluoroscopy is also used to ?

A
  1. Guide transbronchial biopsies/brushes

2. Check for pneumothoraces after Transbronchial Biopsy

69
Q

During this test, a thin X-ray beam rotates around an area of the body generating a 3D image of the internal structures

A

CT Scan (Computerized Tomography)

70
Q

When do you perform a CT?

A
  1. To better define a suspected abnormality or needing further assessment
  2. Better define mediastinal processes, such as lung cancer staging, thymoma, fibrosing mediastinitis, dissecting aneurysms
  3. Determine the best site for an invasive procedure or to determine if an invasive procedure is indicated.
  4. To assess extrapulmonary structures such as the musculoskeletal system, parietal pleura, and adrenal glands.
71
Q

When would you use a CT with contrast?

A

To see/define the lymph nodes or pulmonary vasculature.

Important for cancer staging or PEs

72
Q

When would you use a CT without contrast?

A

Just adequate imaging. Most structures are visible on CT without contrast

73
Q

If there is a suspected PE, what would protocol suggest you do?

A

CT with IV contrast

74
Q

What is something important to keep in mind when using contrast?

A

Renal issues cannot tolerate contrast! Contrast passes through the kidneys!

75
Q

Whats the difference between a high resolution and a normal CT?

A

High resolution = thinner slices, better dfinition of the interstitium.

HRCTs commonly used for ILDs

76
Q

Idiopathic Pulmonary Fibrosis commonly presents on a HRCT as

A

Subpleural honeycombing

77
Q

What is a Pancoast Tumor?

A

Tumor typically located in the apex of the lung.

The growing tumor can cause compression of a brachiocephalic vein, subclavian artery, phrenic nerve, recurrent laryngeal nerve, vagus nerve, or, characteristically, compression of a sympathetic ganglion resulting in a range of symptoms known as Horner’s syndrome.

78
Q

What are risks associated with CT?

A
  1. Transport of patient and positioning
  2. Contrast-induced nephropathy
  3. Radiation!!!

CP and lots of radiation can cause Cancer (Random)

Pulmonary Medicine (14 decks)

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