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Pulm > Pulm Dx and Therapeutic Skills - Exam 1 > Flashcards

Pulm Dx and Therapeutic Skills - Exam 1 Flashcards

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1
Q

When percussing why would the lungs sound dull?

A

consolidation, pleural effusion, tumors or could be the liver

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2
Q

When percussing the lungs why would they sound hyperresonant?

A

air, emphysema, asthma or pneumothorax

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3
Q

Which PFTs measure against predicted values?

A

spirometry and plethysmography

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4
Q

What are the 5 indications of PFTs?

A

● Evaluate patients with respiratory symptoms or rib fracture
● Assess progression of previously diagnosed lung disease
● Monitor the efficacy of treatment
● Evaluate patients preoperatively
● Monitor for potentially toxic side effects of certain drugs

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5
Q

What are some limitations to PFTs?

A

patient must cooperate and be able to follow directions

kids usually 5 and older

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6
Q

______ is the volume of air inspired or expired with each normal breath at rest

A

tidal volume

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7
Q

______ is the maximum volume of air
that can be inspired over and above the tidal volume

A

inspiratory reserve volume

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8
Q

______ is the volume of air that can
be expired after the expiration of the tidal volume

A

expiratory reserve volume

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9
Q

______ is the volume of air that remains in the lungs after maximal exhalation

A

residual volume

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10
Q

Draw the PFT chart with volumes

A
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11
Q

What is this called? What is its function?

A

spirometry

Non-invasive assessment of maximum
inspiratory and expiratory volume as
well as maximal expiratory effort
- can be done pre and post bronchodilator

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12
Q

What are the pt directions for how to use a spirometry?

A
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13
Q

When is a spirometry indicated?

A

diagnostic and monitoring of lung and neuromuscular diseases that affect
breathing

prevention of post-surgical/traumatic pulmonary complications

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14
Q

When is spirometry contraindicated?

A

○ recent (<6wks) since abdominal, intracranial, or eye surgery or a
pneumothorax
○ thoracic, abdominal and cerebral aneurysms
○ unstable angina or a recent MI
○ acute severe asthma, acute respiratory distress, active TB

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15
Q

_______ the greatest volume of air that can be expelled from the lungs after
taking the deepest possible breath

A

vital capacity

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16
Q

______ the maximal speed at which air can be exhaled with force

A

peak expiratory flow rate

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17
Q

What is the gold standard for PFT? What does it measure? When is it indicated?

A

Plethysmography

Measures the total volume of air held in the lungs

Indicated if decreased FVC on
spirometry

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18
Q

What is this?

A

Plethysmography

air tight chamber with various transducers that measure pressures in the airway and within the box

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19
Q

What is the difference between obstructive and restrictive lung disease?

A

Obstructive - difficulty exhaling air from the lungs

○ Restrictive - difficulty expanding the lungs during inhalation

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20
Q

**What is the cutoff that determines responsiveness to bronchodilators for adults? for kids?

A
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21
Q

What does the green graph indicate? red? blue?

A

green: normal PFT

blue: restrictive

red: obstructive

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22
Q

How much air is in the reserve volume? How much air does the normal lung hold?

A

reserve: 2 liters

normal: 6 liters

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23
Q

**Draw the flowchart that is used to interpret PFTs

A
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24
Q

What is maximal respiratory pressures? When is it assessed?
When is it indicated?

A

part of plethysmography, forced expiration (with cheeks
bulging) through a blocked mouthpiece
after a full inhalation that measures respiratory muscle strength

unexplained decrease in
VC or suspected respiratory muscle weakness

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25
____ is the most sensitive PFT. What does it assess?
Diffusing capacity (DLco) assesses the transfer of oxygen and carbon dioxide
26
Which PFT assesses oxygenation during exertion and the distance a patient can walk? What do you need to monitor for? What is considered a normal test?
6 minute walk test monitor for s/s of dyspnea and fatigue. Also need to monitor oxygen saturation at rest and while walking normal is 1300-2300 without symptoms and pulse ox above 95%
27
What does peak flow measure? When is most commonly used? What is the pt education?
Measures peak expiratory flow (PEF) rate Utilized to determine adequate control of asthma blow a "fast hard blast" versus slowly emptying your lungs
28
What should you do if your peak flow is in the green range? yellow? red?
green: all clear-> no treatment necessary yellow: caution -> implement treatment plan prescribed by PCP Red: medical alert -> contact provider and start bronchodilator therapy immediately
29
What does a pulse oximetry measure? What is normal?
○ Reading is provided as a percentage of hgb that is oxygenated ● Normal 95% or higher
30
What are some limitations of the pulse oximetry?
○ nail polish, pigmented skin ○ bright lighting ○ patient movement, improper placement ○ poor perfusion ○ CO poisoning
31
a pulse oximetry is unable to differentiate between ____ and _____
carbon monoxide (CO) and oxygen (O2)
32
What does capnography measure?
the measurement and and monitoring of the concentration of CO₂ in expiratory gases
33
What is a better representation of impending hypoxia, capnography or pulse ox?
capnography is better because CO₂ will rise 30-60 seconds before O₂ drops in respiratory depression
34
What are the 4 phases of capnography? Where does inhalation and exhalation happen? Draw the curve/graph
35
What is a normal EtCO2 level? What does it mean if it fall below that? above?
● normal EtCO₂ levels are 35-45 mmHg EtCO₂ < 35 mmHg = Hypocapnia ■ Etiologies: hypothermia, low cardiac output, pulmonary embolism, hyperventilation EtCO₂ > 45 mmHg = Hypercapnia ■ Etiologies: Malignant hyperthermia, shivering, fever, sepsis, severe hypothyroidism¹, hypoventilation
36
What does obstructive lung disease capnography look like?
Obstructive disease results in a rounded ascending phase and upward slope in the alveolar plateau
37
Name the 3 indications for capnography
● Ensuring proper ventilation during: ○ general anesthesia ○ procedural sedation ● Confirmation of proper ET tube placement and ventilator settings ● Ensuring adequacy of chest compressions in cardiac arrest
38
When would you order a sputum culture? What are some important collection instructions?
find cause of LOWER respiratory infection OR to look for abnormal cells under a microscope ○ collect before initiating antibiotics ○ prefered early morning collection ○ rinse mouth out with plain water ○ breathe deeply to stimulate coughing and expectoration ○ refrigerate the container until processing takes place ○ avoid adding saliva or nasopharyngeal secretions to the sputum sample
39
What are the 2 major types of CT scans? Which one is used most?
conventional and helical**- MC
40
What are some advantages of helical CT? What are some disadvantages?
● Faster and more anatomic coverage ● Allows for cardiac imaging ● Eliminates respiratory artifact during breathing ● Sharper, more high-definition 3D images radiation exposure: 7 mSv (standard UV exposure to 3 mSv per year)
41
What are some indications for lung CT?
● Inconclusive x-rays or abnormality on physical examination ● Assess cardiothoracic space for tumors and other lesions ○ monitor response of tumors to treatment ● Intrathoracic injury/bleeding ● Complicated infection ● Unexplained chest pain ● Obstructions ● Provide guidance for biopsies and/or aspiration of the tissue from the chest
42
What are some risks/CI/cautions with CT?
pregnancy especially in the first trimester hx of large amounts of radiation exposure
43
What are some risks/CI/cautions with contrast dye? **What is the important one to remember?
■ Allergy to contrast dye ○ Severe renal impairment - GFR < 20 mL/min ○ Hyperthyroidism or thyroid goiter - may potentiate thyrotoxic crisis ○ Pheochromocytoma - may induce hypertensive crisis **Metformin use - drug must be discontinued prior to contrast and held for 48 hours after**
44
What is the weight limit for a CT? What happens if a metal object is scanned inside the body?
450 lbs looks like a starburst
45
What common GI test can limit the effectiveness of a CT scan?
barium in esophagus from recent barium study
46
When is contrast indicated? What is contrast mostly composed of?
Indicated if assessing vascular disease or to delineate area of concern from adjacent structures iodine!!!
47
What does a CTA show?
only shows pulm vasculature
48
What is a V-Q scan show? When is it indicated?
A nuclear medicine scan that uses radioactive material to examine air flow (ventilation) and blood flow (perfusion) in the lungs. VQ scans detect poor blood flow in the pulmonary vascular and uneven air distribution diagnose or rule out a pulmonary embolism (PE) when CT is contraindicated
49
What is the procedure for a V-Q scan?
50
V-Q scan: if the ventilation scan is abnormal but the perfusion scan is normal. What does this indicate?
abnormal airways in all or part of the lung COPD or asthma
51
V-Q scan: if the perfusion scan is abnormal but the ventilation scan is normal. What does this indicate?
depends on the difference between the two scans but a PE might be present
52
V-Q scan: both the ventilation and perfusion scans are abnormal. What does this indicate?
pneuomonia, COPD or PE
53
suspect a PE in a preg pt, what imaging do you order?
V-Q scan is preferred in preg pts
54
What are some risks associated with a V-Q scan?
● Radiation is very minimal and usually out of system in a few days ● Pregnancy: radiology will use a smaller amount of radioactive dye ● Breastfeeding: mothers must discard milk for 24 hours post scan ● Mild and rare chance of allergic reaction - MC hives
55
______ dx technique is the gold standard in diagnosing acute PEs
pulmonary angiography
56
Describe the procedure for pulmonary angiography. What will a PE look like?
● A “filling defect” or abrupt cutoff of a small vessel is indicative of embolus
57
Besides a potential PE, what are 4 additional indications for pulmonary angiography?
● AV malformation of the lung ● Congenital narrowing of pulmonary vessels ● Pulmonary artery aneurysms ● Pulmonary hypertension
58
What are some risks associated with pulmonary angiography?
● Allergic reaction to contrast dye ● Kidney damage from contrast dye ● Damage to blood vessel or nerve from needle or catheter ● Injury to nerves at puncture site ● Excessive bleeding, blood clot or hematoma formation ● MI or stroke
59
What are some differences between CT angiography and pulmonary angiography?
60
_______ procedure used to directly visualize the airways and diagnose lung disease. What are the 2 types? What types of sedation do you need for both
bronchoscopy flexible- MC- procedural sedation rigid- general anesthesia
61
What are some indications for bronchoscopy?
● Evaluation and removal of airway FB’s or other obstructions ● Diagnosis and staging of bronchogenic carcinoma ● Evaluation of hemoptysis ● Diagnosis of pulmonary infections ● Transbronchial lung biopsy ● Bronchoalveolar lavage
62
What is the CI for bronchoscopy? What are some common complications? What is the rate of major complications?
● SEVERE bronchospasm or bleeding diathesis Transient hypoxemia, pneumothorax, hemorrhage less than 1%
63

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