Diagnostic Testing

Question 1

Chest xray (CXR)

Answer 1

Standard for looking at anatomy of chest

Most common views = PA, Lateral
Static view
Should be able to see all 12 ribs
Purpose - looking for abnormalities, tracking progress

Question 2

Mediastinum

Answer 2

A little wider than thoracic spine, where the heart is

Super wide could indicate aneurism

Question 3

Alveolar pattern

Answer 3

Look fluffy with present changes in distal airways

Pulm edema or pneumonia is more fluffy in appearance

Question 4

Bones and soft tissue CXR

Answer 4

Size, shape, symmetry

Width of IC spacing

Question 5

Hemidiaphragms CXR

Answer 5

R v L differences

Question 6

Costophrenic angle

Answer 6

Angle
Symmetry

Lat 10th rib to xypho-sternum

***Changes throughout breathing cycle

Question 7

Mediastinum and Hila CXR

Answer 7

Width
Vasculature
Masses

Question 8

Lung fields CXR

Answer 8

Density
Alveolar patterns
Interstitium

Question 9

Pleura CXR

Answer 9

Should not normally be able to see

Question 10

Heart CXR

Answer 10

Shape

Position

Question 11

COPD or emphysema CXR

Answer 11

Widened IC spaces
Flattened hemi-diaphragms
Squared-off costophrenic angles
Rib angles approaching 90-degrees

Question 12

CT scans

Answer 12

With contrast…

Done to show tissues with increased density proportionally to their vascularity

Used to look for pulmonary nodules

Question 13

MRI

Answer 13

Magnetic field and radio waves to get the images
Looks at concentration of protons
Good for soft tissue or lymph nodes
Costly, but better to see soft tissue compared to CT scans

Question 14

Pulmonary angiogram

Answer 14

Xrays to see where dye is going
Catheter through a vein moving towards heart chambers where dye is injected
You can see blockages

Question 15

Bronchoscopy

Answer 15

Direct visualization of the bronchial trees through a scope

Infections
Malignancy
Biopsy
Clear secretions

Question 16

V/Q scan

Answer 16

Inhale radioisotope
Inject radioisotope
Examine by xray… how areas of lung are being ventilated and perfused

Question 17

Poor ventilation

Answer 17

May be airway obstruction

Question 18

Poor perfusion

Answer 18

May be pulmonary embolism

Question 19

Cytology

Answer 19

Looking at cells from area of body under a microscope

Can be done to determine what cells look like and to see infections

Question 20

Hematology

Answer 20

WBC, RBC, platelets, Hb, Hematocrit

PTT - Partial Thromboplastin time (reflective of Heparin)
PT - Prothrombin time
INR - International Normalized Ratio

Question 21

Low PCO2

Answer 21

Alveolar HYPERventilation

Question 22

High PCO2

Answer 22

Alveolar HYPOventilation

Question 23

PCO2 > 50

Answer 23

Respiratory failure
Extent of failure is determined by accompanying change in pH

More stable pH in CHRONIC condition
Kidneys hold onto bicarbonate to balance the body environment
Failure of pulmonary system to meet metabolic demands of the body

Question 24

Combined metabolic and respiratory?

Answer 24

Metabolic can be combined
You can have both metabolic and respiratory situation
CANNOT have combined respiratory

Question 25

Primary respiratory acute v chronic

Answer 25

If HCO3- is normal, there is NO compensation and is probably more acute If HCO3- is abnormal, there IS compensation and is probably chronic Can also look at difference between PCO2 and pH Acute = change of 10 accompanied by 0.08 pH shift Chronic = change of 10 accompanied by 0.03 pH shift

Question 26

Base excess

Answer 26

Provides information about the non-respiratory component of pH Determined by comparison of expected pH to reported pH So if it is balanced and health, BE is 0

Question 27

If acidotic...

Answer 27

Any aerobic activity will further lower the pH

Question 28

Xray shades

Answer 28

Dark - rays go through body without being absorbed Lighter - more rays are absorbed Air - Dark, radioluscent Fat - Dark gray Muscle/other tissue - Lighter gray Bone - White, radio opaque