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Junior - Pulm Mod 1 COPY > 2 - Pulmonary Diagnostics > Flashcards

2 - Pulmonary Diagnostics Flashcards

1
Q

What kinds of things are seen on CXR?

A 
PA and Lateral view
Looking for
-Lobar and interstitial infiltrates
-Masses and nodules
-Atelectasis and pneumothorax
-Effusion and hemothorax
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2
Q

What is the preferred radiologic study for nodule workup?

A

Computed tomography

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3
Q

How often is MRI used for pulmonary studies?

A

It is used less than CT

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4
Q

What can a perfusion/ventilation scan show?

A

Not a whole lot. It will rule out things if it is normal but it is not very specific

But they may detect pulmonary emboli

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5
Q

What is the difference between a perfusion and ventilation scan?

A

Perfusion: inject radio labeled albumin

Ventilation: inhaled radioactive gas

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6
Q

What is a PET good for diagnosing?

A

Malignant lesions

Staging of cancer

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7
Q

What good is a bronchoscopy?

A 
It allows for direct visualization of the airways. 
Allows us to: 
- collect samples
- lavage
- remove secretions
-evaluate airway
- evaluate hemoptysis
- dx some pulmonary infx
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8
Q

What types of bronchoscopies are there?

A

Rigid and flexible

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9
Q

Is a pulmonary function test an diagnostic tool?

A

No, it is good for determining the extent of impaired function not to diagnose

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10
Q

What are some pulmonary evaluations tests?

A

PFTs (pulmonary function test)

ABG (arterial blood gas)

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11
Q

What are the 2 types of spirometry?

A
  1. Pre and post bronchodilator

2. Flow volume loop

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12
Q

What are some pulmonary function tests?

A 
Spirometry
Lung volumes
DLco (diffusing capacity)
Peak flow meter
Pulse oximetry
ABGs
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13
Q

What is the purpose of PFTs? Do they require something?

A

To measure the airflow rates vs lung volume and gas exchange

Requires age, gender, height (sometimes race)

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14
Q

What are some indications for PFTs?

A
  • Assessment of type/extend of lung disfunction
  • diagnosis of dypsnea/cough causes
  • detection of early dysfunction
  • occupational surveillance
  • follow up of therapeutic response
  • preoperative assessment
  • disability evaluation
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15
Q

Are PFT ever contraindicated

A

Why yes it is, let me tell you more:

Contraindications include:

  • acute sever asthma
  • respiratory distress
  • angina
  • pneumothorax
  • ongoing hemoptysis
  • active TB
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16
Q

What is the most available and useful PFT?

A

Spirometry

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17
Q

What does spirometry do?

A

Measures the volume of air exhaled at specific time points

- requires a full inhalation followed by forceful and complete exhalation

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18
Q

What is the flow - volume loop in spirometry?

A

It is a graphic record of maximal inspiratory and expiratory maneuvers

Plotted as flow vs volume

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19
Q

Can a flow volume loop tell if a pt doesnt try hard enough?

A

The early numbers (FEV1) are effort dependent

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20
Q

What about the later numbers (25-75) of spirometry?

A

Effort independent and accurately reflect mechanical properties of lungs and resistance to airflow

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21
Q

When doing spirometry what is the FVC?

A

Forced vital capacity

Indicates the degree of lung/chest expansion

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22
Q

What will a FVC show us?

A

The total amount of air (volume) a pt can blow out as rapidly as possible after inhaling as deeply as possible.

It is a good indicator of effort

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23
Q

What is FEV1?

A

The forced expiratory volume in 1 sec

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24
Q

FEV1 measures?

A

Volume

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25
Q

What does FEV1 indicate?

A

Patency of the large airways
And
Indicates large and small airway function

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26
Q

What is the FEV1/FVC ratio?

A

It is the % of FVC that occurs in the 1st second

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27
Q

What does a low FEV1/FVC ratio tell us?

A

Indicates obstruction

28
Q

What is the other name for FEF 25-75?

A

Maximal mid-expiratory flow rate (MMEF)

29
Q

What does FEF 25-75 tell me?

A

Patency of the small airways

Measures flow

30
Q

What does obstructive lung disease feel like?

A

Reduction in air flow rates

Imagine taking a deep breath but having to exhale through a straw

FEV1/FVC ratio <80%

31
Q

What does restrictive lung disease feel like?

A

Reduction in lung volumes

Imagine trying to take a deep breath with a tight band around your chest

Reduced FVC but normal FEV1/FVC

32
Q

What are the 3 types of dysfunction indicated by spirometry?

A

Obstructive
Restrictive
Mixed

33
Q

What will obstructive flow rates look like on spirometry?

A

They will present a scooped appearance

FEF25-75 and FEV1 are reduced

34
Q

What will spirometry look like for restrictive pattern?

A

This is decreased volume with preserved flow so…

Curves tend to be peaked and narrowed

35
Q

What are the obstructive diseases?

A

COPD
Asthma
Bronchiectasis
Cystic fibrosis

36
Q

What are the restrictive lung diseases?

A 
Interstitial lung disease
- pulmonary fibrosis
- sarcodisis 
Chest wall pathology
- scoliosis
- kyphosis
Obesity
Neuromuscular disase 
-ALS
- MD
37
Q

What are the 2 different abnormals that are found using flow rates of spirometry?

A

FEV1 and FVC (independently) <80%

FEV1/FVC radio <70%

38
Q

Spirometry algorithm

Is the FEV1/FVC is <70%?

A

Yes = obstruction

No = restriction or normal

39
Q

Spirometry algorithm

Obstruction, is the FVC <80% predicted?

A

Yes: mixed defect - refer

No: pure obstruction look at FEV1 and FVC

40
Q

Spirometry algorithm

Pure obstruction; is the FEV1 or FVC > 200cc or 12% with bronchodilator administration?

A

Yes: asthma component, look at FEV1 with exercise

No: fixed obstructive defect (not bronchospasm)
- classify severity

41
Q

Spirometry algorithm

Asthma component; does the FEV1 drop >15% with exercise or >20% with methacholine?

A

Yes: asthma likely

No: asthma unlikely

42
Q

Spirometry algorithm

Normal or restrictive; is the FVC < 80%

A

Yes: restrictive

No: normal

43
Q

When are lung volume measurements useful?

A

When spirometry shows a Low FVC

44
Q

What is the gold standard for lung volume testing?

A

Body plethysmography

45
Q

What is body plethysmography?

A

The measurement of air pressure and volume changes within a closed box as the patient respires

46
Q

How is body plethysmography calculated?

A

TLC using boyle’s law is the most accurate way

47
Q

How are lung volumes broken up?

A

TLC: total lung capacity
VC: vital capacity
RV: residual volume
FRC: functional residual capacity

48
Q

What is DLco?

A

A type of PFT

Diffusing Capacity: a measurement of alveolar/capillary gas transfer

49
Q

What does DLco help us do?

A

Differentiate emphysema vs chronic bronchitis in COPD patients

50
Q

What 2 things influence DLco score?

A

The alveolar surface area and pulmonary flow (why you can use it to differentiate types of COPD)

51
Q

What does an elevated DLco indicate?

A

Increased capillary flow

  • pulmonary hemorrhage
  • acute Heart Failure
  • asthma (possibly)
52
Q

What does decreased DLco mean?

A

Decreased alveolar surface area or capillary flow

  • emphysima (reduced cap flow)
  • interstitial lung disease (reduced SA)
  • pulmonary vascular disease (decreased blood flow)
53
Q

What pathologies do not effect DLco?

A

Asthma and chronic bronchitis dont affect DLco

54
Q

What is a peak flow meter??

A

A hand held device that pts can use to monitor progression or acute exacerbation

Influences treatment regiment

55
Q

What does SpO2 measure

A

hemoglobin O2 saturation

56
Q

Is SpO2 accurate?

A

No its +/- 4%

It requires normal blood pH, PCO2 and Hblevels

57
Q

When is SpO2 more inaccurate than usual?

A

Severe anemia, abnormal Hb, IV dyes

Lack of pulsitle arterial flow (BP cuff, HOTN, Hypothermia)

58
Q

What is the rule for SpO2 to PaO2 conversion?

A

40-50-60/70-80-90 rule

70% SPO2 = PaO2 40%
80% SPO2 = PaO2 50%
90% SPO2 = PaO2 60%

59
Q

Despite funciton of the lungs PFTs alone cannot assess ventilation, what else is required?

A

Ventilation is gas exchange - specifically removal of CO2 from cellular metabolism so ABG’s are also require to truly assess

60
Q

What are ABGs?

A

Direct measure of:

  • arterial oxygen
  • CO2 partial pressure
  • pH
61
Q

What does pH tell us with ABGs?

A

As arterial PCO2 increases pH decreases - drives equation Right

And vice versa

62
Q

What is the rule for pH and PCO2 fluctuations?

A

PH falls 0.1 for each 10mmHg rise in PCO2

63
Q

What is acid base compensation?

A

Kidneys and lungs attempt to balance each other with pH

They will move the pH back toward but not quite to normal

64
Q

Normal
PCO2
pH
HCO3

A

PCO2: 35-45
pH: 7.35-7.45
HCO3: 22-30

65
Q

Do you have any history of mental illness in your family?

A

I have an uncle who does yoga

Junior - Pulm Mod 1 COPY (6 decks)

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