Diagnostic Testing

Question 1

Cytology:

Answer 1

Analysis of cells: how they form and function.

Question 2

Laboratory tests:

Answer 2

• Cytology: analysis of cells: how they form and function
• Hematology: complete blood count, WBC, RBC, platelets.
• Coagulation studies: how well id the blood clotting (partial thromboplastin time, prothrombin time)
• Arterial Blood Gas (ABG): alveolar ventilation, oxygenation, acid-base balance, disease progression.

Question 3

Arterial Blood Gas (ABG) can give information about

Answer 3

• alveolar ventilation
• oxygenation
• acid-base balance
• disease progression

Question 4

would the venous blood gas lab result be the same as arterial blood gas?

Answer 4

no

Question 5

PaCO2 > 50 =

Answer 5

respiratory failure​

• Failure of pulmonary system to meet metabolic demands of body
• Extent of failure is determined by accompanying change in pH

Question 6

Acidosis + low HCO3 =

Answer 6

primary

metabolic acidosis

Question 7

Is the problem uncompensated or compensated/compensating? Look at…

Answer 7

CO2

• UNCOMPENSATED
  
  • pH is outside the normal range
  • PaCO2 is within the normal range
• PARTIALLY COMPENSATED
  
  • Both pH and PaCO2 are outside the normal range
• COMPENSATED
  
  • ​pH is within normal range
  • PaCO2 is outside normal range

Question 8

Chronic respiratory acidosis: kidneys __________ bicarbonate

Answer 8

hold

Question 9

Corresponding increase/decrease in HCO3- which indicates that the _____________ system is compensation

Answer 9

metabolic

Question 10

Corresponding increase/decrease in PaCO2 which indicates that the _____________ system is compensation

Answer 10

respiratory

Question 11

Kidneys can compensate for chronic respiratory disorders by either holding or dumping bicarbonate. Chronic respiratory acidosis: kidneys __________ bicarbonate

Answer 11

hold

Question 12

In chronic respiratory alkalosis: kidneys will __________ bicarbonate

Answer 12

get rid of

Question 13

crime = acid
police = Bicarbonate (HCO3)
criminals = H+

Answer 13

nice

to get rid of the crime, the police hold on to criminals to be excreted by the kidneys

Question 14

What affects Forced Vital Capacity?

Answer 14

Restrictive diseases

(fibrosis, scoliosis, diaphgram can’t move, obesity, pulmonary edema…)

Question 15

Forced Expiratory Volume in 1 sec

Answer 15

• Reflects airflow in large (& medium sized) airways
• 75% - 80% of FVC should be exhaled in the first second
• If decreased = obstructive disease
• Large lungs = large FEV₁
• Large airway diameter = large FEV₁

Question 16

Measure volume and flow of air during inspiration and exhalation

Answer 16

Pulmonary Function Testing (PFT)

Question 17

Provides graphic display of inspiratory and expiratory flows and volumes

Answer 17

Flow volume loops

Question 18

Max amt of gas pt can exhale forcefully & quickly

Answer 18

Forced Vital Capacity (FVC)

Question 19

FEV1/FVC

Answer 19

• Decreased = obstructive disease
• Near normal or elevated = restrictive disease

Question 20

Normal Forced Vital Capacity

Answer 20

80%

• Mild: 60-79%
• Moderate: 51-59%
• severely impaired < 50

Question 21

Normal Forced Expiratory Volume in 1 second:

Answer 21

80%

• Mild: 60-79%
• Moderate 51-49%
• Severe < 40%

Question 22

Normal FEV1/FVC =

Answer 22

75%

• Mild 60-74%
• Moderate: 41-59%
• Severe: <40%

Question 23

What causes FVC to decrease?

Answer 23

restriction diseases, whatever restricts air into the lungs:

fibrosis, scoliosis, obesity, diaphragm can’t move.

Question 24

What causes Forced Expiratory Volume in 1 sec to decrease?

Answer 24

obstructive diseases

Question 25

* if FEV1 and FEV1/FVC = decreased (less than 75%) * RV = increased * TLC = normal or increased

Answer 25

**obstruction**

Question 26

Obstructive or restrictive?

Answer 26

**Obstructive** diseases causes **Forced Expiratory Volume in 1 sec** to decrease

Question 27

Obstructive or restrictive?

Answer 27

**restrictive** diseases causes FVC to decrease, and TLC, RV, FRC decrease

Question 28

* TLC = decreased * RV, VC, and FRC = usually decreased

Answer 28

Restrictive

Question 29

x-rays go through body without being absorbed (dark areas) are more..

Answer 29

**radiolucent**

Question 30

x-rays thta are absorbed in lighter areas are more

Answer 30

**radiopaque**

Question 31

air in an x-ray is\_\_\_\_\_\_

Answer 31

**rediolucent**

Question 32

bone is a x-ray is white because is

Answer 32

radiopaque

Question 33

in an radiograph what is lighter (whiter) muscle or fat?

Answer 33

muscle is lighter

Question 34

* Standard for looking at anatomy of chest * Views usually described as PA, AP, Lateral

Answer 34

Chest X-ray (CXR)

Question 35

Answer 35

Question 36

Answer 36

* COPD * Barrel chest * Widened intercostal spaces * Flattened hemi-diaphragms * Squared off costophrenic angles * Rib angles approaching 90 degrees

Question 37

Answer 37

Pneumonia

Question 38

Answer 38

atelectasis partial collapse

Question 39

Answer 39

atelectasis

Question 40

Used to look for pulmonary **nodule**

Answer 40

Computed Tomography (CT Scan)

Question 41

Used primarily for soft tissue and lymph nodes

Answer 41

MRI (Magnetic Resonance Imaging)

Question 42

imaging test that uses x-rays and special dye to see inside the arteries

Answer 42

Pulmonary Angiogram

Question 43

Direct visualization of the bronchial tree through a scope

Answer 43

Bronchoscopy

Question 44

Radionuclide V/Q Scan

Answer 44

Examine by x-ray—how areas of lung are being ventilated and perfused: * Inhale radioisotope * Inject radioisotope * Poor ventilation: may be airway obstruction * Poor perfusion: may be PE

Question 45

Answer 45

Radionuclide V/Q Scan: Examine by x-ray—how areas of lung are being ventilated and perfused

Question 46

Answer 46

**Radionuclide V/Q Scan**

Question 47

True or false: **bronchoscopy** can be used to clear secretions

Answer 47

true

Question 48

Answer 48

Pulmonary Angiogram

Question 49

Answer 49

Pulmonary Angiogram

Question 50

* Catheter inserted and carefully fed into and through the right side of the heart to the pulmonary artery (leads to the lungs) * Dye injected in to the catheter once in the correct location * X-ray images are taken to see how the dye moves through the lungs’ arteries * Dye helps detect blockages to blood flow

Answer 50

Pulmonary Angiogram

Question 51

Better view of soft tissue than CT scan, but is more expensive and takes longer

Answer 51

MRI

Question 52

Amount of gas (CO, carbon monoxide) entering the pulmonary blood flow per unit time

Answer 52

DL or DLCO (diffusing capacity of the lung)

Question 53

What gas is used in DLCO or DL (diffusing capacity of the lung)?

Answer 53

**CO (carbon monoxide)** is used as it has a greater affinity for hemoglobin

Question 54

Diffusing capacity of the lungs can be reduced in three cases:

Answer 54

* Decreased hemoglobin * Increased thickness of alveolar-capillary membrane * Decreased surface area for diffusion (primary factor), (COPD).

Question 55

Which is the most important confounding factor in PFT?

Answer 55

**poor effort** from the patient, make sure pt puts maximun effort

Question 56

In PFT, if the pt's value falls outside the predicted value by more than \_\_\_\_% is considered abnormal

Answer 56

25%

Question 57

heard over the trachea, ratio?

Answer 57

tracheal sound 1:1 with gap

Question 58

Sound heard over the sternum or manubrium, ratio?

Answer 58

**Bronchial** 1:2 with gap

Question 59

Sound heard anteriorly at the 1st and 2nd ICS and posteriorly between the scapulae

Answer 59

bronchovesicular 1:1 continuous

Question 60

Heard throughout lung periphery

Answer 60

**vesicular** 3:1 continuous

Question 61

(smoking) pack years =

Answer 61

packs per day x years smoked

Question 62

70 pack years =

Answer 62

1 pack per day for 70 years or 2 pack per day for 35 years

Question 63

10 pack year

Answer 63

1 pack per day for 10 years 2 packs 5 years

Question 64

PFT measured again 5-20 minutes after bronchodilator. Normal or PURELY restrictive disease should show differences in what?

Answer 64

**no difference**