Pulmonary and Cardio Tests/Diagnosis Flashcards Preview

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Flashcards in Pulmonary and Cardio Tests/Diagnosis Deck (35):
1

Stress Echo-indications, positive, what should we do

More sensitive than stress ECG to detect ischemia, can assess LV size and function, diagnose valvular disease
can identify CAD in preexisting ECG abnormalities

Positive: wall motion abnormalities

To do: cardiac catherization

2

Stress test with thallium-indication, positive, when not to use it

Indication: increases sensitivity and to see if ischemia is reversible by slow uptake of thallium

Positive: decreased uptake of thallium

Not used in LBBB

3

Pharmocologic stress test-indication, what is used and how does it work,

indication: when a patient cannot exercise

what and how: Adenosine and dipyridamole cause coronary vasodialtion-disease arteries receive less relative blood flow
Dobutamine: increases myocardia oxygen demand by increasing HR, BP and cardiac contractility

4

Holter monitoring-when is it used

over 24-72 hours
evaluates arrhythmias, heart rate variability and assess pacemaker and implantable cardioverter-defribrillator function

Used for evaluating silent ischemia not accompanied by ECG changes

Evaluates syncope and dizziness as well

5

Stress ECG-indication, what is positive, what should you do afterwards

Indication: Coronary artery disease (Chest pain) with normal resting ECG and capable of being on a treadmill (can exercise sufficinecyt at 85% of Max HR)

Positives: ST segment depression
Heart failure or ventricular arrhythmia during exercise or hypotension

What to do: cardiac catherization

6

Cardiac catherization with coronary angiography: when is it used

definitive test for CAD

Used when
1.noninvasive tests are nondiagnostic, angina that occurs despite medical therapy, angina soon after MI, or diagnostic dilemma
2. Positive stress test
3. Patient is severely symptomatic and urgent diagnosis is needed
4. evaluation of valvular disease and to determine the need for surgical intervention

Used for concurrent rescuing by percutaneous coronary intervention or being considered for CABG

7

coronary angiography

Most accurate method of identifying presence and severity of CAD

Main purpose: identify patients with severe coronary disease to determine if revascularization is needed-with stent or balloon can be performed at same time

Coronary stenosis>70% is signficant

8

Difference between Unstable Angina and NSTEMI

NSTEMI will have cardiac enzymes present

9

Test for Variant Angina

coronary angiography with ergonovine will show ST elevation

10

Diagnosis of renal artery stenosis

(Unrelenting hypertension with hypokalemia)
captopril-enhanced radionuclide renal scan
MRI angiography
and Spiral CT

11

Definitive diagnosis for COPD

PFTs
Less than 70% FEV1/FVC

Peak flow meter less than 350 L/min

12

Diagnosis of Asthma

PFTs are required-FEV1/FVC less than .75
Increase in FEV1 or FVC by at least 12%

Bronchoprovocation test: if PFTs are non diagnostic
Increasing doses of methacholine-decrease greater than 20% of FEV1

Increased DLCO
Hypocarbia present (hypercarbia signifies respiratory failure-mechanical ventilation/intubation)

13

Tests to run for acute asthma exacerbation

Peak expiratory flow-less than 60% predicted

ABG: increased A-a gradient

Chest X-ray- rule out exacerbation etiology

14

Diagnosis of Bronchiectasis

High resolution CT scan-choice

PFTs-obstructive pattern

Possible bronchoscopy

15

Diagnosis of pleural effusion

Dullness to percussion
Decreased breath sounds over the effusion
Decreased tactile fremitus

CXR-blunting of costophrenic angle
CT scan-more reliable

Thorancetesis: etiology not obvious
Therapeutic as well
Send for four Cs: chemistry (protein/glucose), cytology, cell count, and culture

16

Diagnosis of empyema

CXR or CT scan
Pleural fluid will have pH less than 7.2

17

Diagnosis of spontaneous pneumothorax

decreased breath sounds on affected side
hyperresonance over the chest
decreased tactile fremitus on affected side

CXR: Mediastinal shift toward side of pneumothorax

18

Diagnosis of tension pneumothorax

hypotension
Distended neck veins
Shift of trachea away from side of pneumothorax on CXR
Decreased breath sounds on affected side
Hyperresonance to percussion of side of pneumothorax

19

Insterstitial lung disease Diagnosis

CXR-nonspecific
Ct scan-shows extent of fibrosis
PFTs: FEV/FVC is increased
Low DLCO
Tissue biopsy: fiberoptic bronchoscopy, transbronchial biopsy, lung biopsy, video-assisted thoracoscopic lung biopsy

20

Definitive diagnosis of sarcoidosis

transbronchial biopsy-noncaseating granulomas

21

Wegener's graunulomatosis diagnosis

Gold standard: tissue biopsy
c-antineutrophilic cytoplasmic Abs

22

Asbestosis CXR findings

pleural plaques
hazy infiltrates with bilateral linear opacities

23

Silicosis CXR findings

Egg shell calcifications

24

Berylliosis diagnosis

Beryllium lymphocyte proliferation test:

25

Diagnosis of Goodpasture's syndrome

Tissue biopsy
Serologic evidence of antiglomerular basement membrane Abs

26

Diagnosis of Idopathic pulmonary fibrosis

CXR: ground glass or honeycombed appearance
Definitive diagnosis requires open lung biopsy

27

Diagnosis of acute respiratory failure

ABG:
Hypoxemia: V/Q mismatch, intrapulmonary shunting, hypoventilaton
Hypercapnia: hypoventilation secondary to other causes

A-a gradient

28

Diagnosis of ARDS

CXR: diffuse bilateral pulmonary inflitrates

ABG: hypoxemia PaO2 less than 60
Initially respiratory alkalosis (PaCO2 less than 40) progresses to respiratory acidosis

PCWP less than 18 versus cardiogenic pulmonary edema (greater than 18)

29

Diagnosis of graves

Low TSH
T4 and free T3 levels give estimate of severity

Thyroid stimulating immunoglobulin (elevated in graves)
Thyroid peroxidase Abs (marker for graves and hashimotos)
Throid uptake scan: diffusely elevated iodine uptake

30

Diagnosis of primary pulmonary hypertension

Cardiac Catheterization establishes diagnosis
CXR shows enlarged pulmonary arteries, enlarged RV and clear lung fields
PFTs show restrictive pattern
ECG show right axis deviation and RVH

31

Cor pulmonale diagnosis

CXR: enlargement of RA, RV, and pulmonary arteries
ECG: right axis deviation, Peaked P waves, RVH
ECHO: RV dilatation, normal LV size and function

32

Low DLCO

Emphysema-obstructive

Interstate lung disease, sarcoidosis, asbestosis, heart failure-restrictive

Anemia, PE, pulmonary hypertension-normal spirometry

33

Normal DLCO

Chronic bronchitis, asthma-obstructive

Musculoskeletal, neuromuscular-restrictive

34

Increased DLCO

Asthma-obstructive

Obesity-restrictive

Pulmonary hemorrhage, polycythemia-normal spirometry

35

ABG difference in copd vs CHF exacerbation

Copd=hypercapnia
CHF=hypocapnia