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Pulm > Lecture 1: Diagnostic & Therapeutic Skills > Flashcards

Lecture 1: Diagnostic & Therapeutic Skills Flashcards

1
Q

At what age is PFT indicated?

A

5 and older.

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2
Q

What is acrocyanosis?

A

Cyanosis of the extremities

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3
Q

What kind of condition is PFT usually tested in?

A
  • Chronic lung conditions with respiratory symptoms.
  • Rib fracture

Generally not for things like pneumonia.

Can be done for things like a rib fracture, which are acute but can impair pulmonary function as a secondary complication.

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4
Q

What is a normal total lung capacity? (TLC)

A

6L

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5
Q

How are lung reserve volumes calculated?

A

IRV: Air inspired ABOVE the tidal volume.
ERV: Air exhaled BELOW the tidal volume.

Neither calculation includes tidal volume itself.

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6
Q

What is spirometry generally indicated for?

A
  • Diagnosis/monitoring of lung/neuromuscular disease.
  • Preventing post-surgical pulmonary complications.

Encourages people to take deep breath to prevent alveolar collapse.

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7
Q

What people should avoid spirometry?

A
  • Recent abdominal/intracranial/eye surgery or pneumothorax
  • Aneurysms
  • Unstable angina/recent MI
  • Acute severe asthma, acute respiratory distress, active TB

Mimics valsalva, which can open abdominal wounds or increase ICP.

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8
Q

What is a normal FEV1/FVC ratio?

A

70% or more.

Less than 0.7 generally implies COPD.

Normal implies normal or restrictive lung disease.

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9
Q

What is gold standard testing for PFTs? Indication?

A

Plethysmography

Decreased FVC on spirometry.

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10
Q

Why is plethysmography used?

A

Measures TLC because the chamber is enclosed and the residual lung volume can be measured as well.

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11
Q

Define obstructive vs restrictive lung disease.

A
  • Obstructive: Difficulty EXHALING air.
  • Restrictive: Difficulty INHALING air.
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12
Q

For an adult, what increases imply a positive response to bronchodilator therapy? Child?

A
  • Increases in FEV1 > 12%
  • Increases in FVC > 0.2L

Both must be present.

5-18: Does not require FVC change.

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13
Q

How do flow volume loops differ between obstructive and restrictive lung disease?

A
  • Obstructive: expiration flow rate should be LOW. Inspiration is partially impaired.
  • Restrictive: Inspiration flow rate should be LOW. Expiration is partially impaired. Impaired TLC.
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14
Q

What factor is restrictive lung disease graded by?

A

TLC

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15
Q

What factor is obstructive lung disease graded by?

A

FEV1

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16
Q

How is diffusing capacity measured? (DLco)

A

Inhalation of carbon monoxide and tracer. Amount exhaled = did not diffuse.

Example: 15% exhaled = 85% diffusing capacity.

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17
Q

What is the most sensitive PFT?

A

DLco

18
Q

What is considered a passing 6MWT?

A

Flat surface walking for 6 minutes at 95%+ pulse ox with 1200-2300 ft walked.

19
Q

What is peak flow used for?

A

Monitoring asthmatic’s peak expiratory flow rate to determine asthma control.

Non-invasive, simple, at home.

20
Q

Why is ETCO2 preferred over O2 sats?

A

ETCO2 will rise almost 1 minute prior to O2 drop, which can signal hypoxia sooner.

21
Q

What are the 4 phases of a CO2 waveform?

A
  1. Dead space ventilation
  2. Ascending phase (exhalation)
  3. Alveolar phase (uniform exhalation)
  4. Inspiration (inhaling)
22
Q

What does elevated ETCO2 imply?

A

Hypercapnia.

Implies hypoventilation.

23
Q

How is an asthmatic’s CO2 waveform altered?

A

Rounded part in ascending phase and an upward sloping alveolar plateau.

Shark-fin deformity

24
Q

When are sputum cultures indicated for pneumonia?

A
  • IP admission for pneumonia
  • OP failure of empiric ABX for pneumonia
25
Q

What is the primary disadvantage of CT scanning?

A

Radiation exposure is much higher with a CT than with a single XR.

mSv

Example: CXR: 0.1 mSv (10 days of natural radiation)
CT Chest: 7 mSv (2 years of natural radiation)

26
Q

What food allergy should be checked prior to contrast injection?

A

Seafood/shellfish because iodine is often a contrast agent.

27
Q

What is the difference between a CTA and a CT Chest with contrast?

A

CTA only highlights vascular structures.

CT Chest with contrast will show both tissue and vascular structures.

28
Q

When is a VQ scan indicated?

A

R/o PE when CT is contraindicated.

AKA CT is PREFERRED first-line test.

It is not more sensitive. It is primarily in pregnant patients.

29
Q

What exactly does a VQ scan measure?

A

Detects poor blood flow in pulmonary vasculature (perfusion) and uneven air distribution (ventilation).

30
Q

Describe the VQ scan procedure.

A
  1. Inhalation of radioactive material to image airflow in lungs. (ventilation)
  2. Injection of radioactive material to assess vasculature. (perfusion)
31
Q

What would a VQ scan look like for a suspected PE?

A
32
Q

What is the main pitfall of a VQ scan?

A

Unable to identify a blood clot. It simply reveals that blood flow is impaired in general.

33
Q

Describe the 3 types of abnormal VQ scans.

A
  1. Abnormal ventilation, normal perfusion: COPD or asthma.
  2. Normal ventilation, abnormal perfusion: PE.
  3. Abnormal ventilation, abnormal perfusion: Any of above + pneumonia.
34
Q

What are the biggest risks with a VQ scan?

A
  • Radioactive breastmilk for 24 hours.
  • Allergic reaction: MC urticaria
35
Q

What is the definitive/gold standard test for acute PE?

A

Pulmonary angiography.

Invasive test, not indicated first-line.

36
Q

What does a negative pulmonary angiography indicate?

A

Excludes clinically relevant PEs.

37
Q

When is pulmonary angiography indicated over CTA?

A
  • Nondiagnostic CTA.
  • Gold standard for PE.

Otherwise, CTA is preferred.

38
Q

What are the two types of bronchoscopes and the differences?

A
  • Flexible: MC, using procedural sedation.
  • Rigid: using general anesthesia
39
Q

When is bronchoscopy indicated?

A
  • Evaluation and removal of airway foreign bodies
  • Diagnosing and staging bronchogenic carcinoma
  • Hemoptysis
  • Pulmonary infections
  • Transbronchial lung biopsy
  • Bronchoalveolar lavage
40
Q

What is the main contraindication to bronchoscopy?

A

Severe bronchospasms or bleeding diathesis.

Diathesis = tendency to suffer from a medical condition.

Pulm (12 decks)

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