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Flashcards in Pulmonology Deck (28)
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1

4 types of CT scans

1. cCT (conventional)
2. HRCT (high-resolution)
3. hCT (helical): single-section and multidetector (MDCT)
4. electron beam

2

used to see anatomy, but not great for lungs

conventional CT

3

used when dz is suspected by H&P, but CXR is either normal or only slightly abnormal (ILD, emphysema (from a1-antitrypsin deficiency), bronchiectasis, lymphangitic spread of malignancy)

HRCT (high-resolution)

4

first place to start when you suspect ILD or BRONCHIECTASIS

HRCT (high-resolution)

5

does hCT (helical): single-section use IV CONTRAST?

yes

6

best method for performing CT-pulmonary angiography, and why

- multidetector (MDCT)
- see subsegmental emboli better than single-section

7

3 advantages of multidetector (MDCT)

1. scan large sections on single breath
2. collecting images of specific blood vessels
3. "high resolution"

8

CT buzzwords:

- diagnose ILD or bronchiectasis

HRCT (high-resolution)

9

CT buzzwords:

- w/u solitary pulmonary nodule

hCT or HRCT

10

CT buzzwords:

- diagnose PE

CTPA (which can be done by MDCT)

11

when is MRI useful when evaluating pulmonary disease?

- evaluating tumors near adjacent blood vessels or nerves
- for determining what is TUMOR and what is NOT

12

- ATYPICAL clinical features and NON-diagnostic HRCT
- need to exclude neoplastic and infectious causes of an interstitial pattern
- what test should be done?

lung biopsy

13

when should a lung bx be done?

- ILD
- lymphangitic spread of cancer
- eosinophilic PNA
- vasculitis
- certain infections

14

is NO LONGER routinely used in evaluating ILDs

lung bx

15

when is lung bx used in evaluating ILDs?

atypical cases when HRCT is NOT diagnostic

16

findings in bronchoalveolar lavage:

- normal findings


- < 1% neutrophils
- < 16% lymphocytes
- no eosinophils

17

findings in bronchoalveolar lavage:

- IPF
- collagen vascular disease
- asbestosis
- suppurative infections
- granulomatosis w/ polyangiitis
- ARDS

increased neutrophils

18

findings in bronchoalveolar lavage:

- hypersensitivity pneumonitis
- sarcoidosis

increased lymphocytes

19

findings in bronchoalveolar lavage:

- acute and chronic eosinophilic PNA
- some ARDS
- Churg-Strauss
- Loffler syndrome
- tropical eosinophilia
- parasite infection (esp. ascariasis)
- TB
- collagen vascular disease
- malignancy
- drug reactions

increased eosinophils

20

- 95% sensitive for PJP in AIDS pts
- CMV PNA (inclusion bodies)
- disseminated TB
- fungal infection
- diagnosing PNA in ARDS pts

diagnosis of specific types of PNAs

21

findings in bronchoalveolar lavage:

- alveolar proteinosis

- turbid
- PAS-positive material

22

findings in bronchoalveolar lavage:

- Langerhans cell histiocytosis

Langerhans cells

23

findings in bronchoalveolar lavage:

- diffuse alveolar hemorrhage

- bloody
- large amount of hemosiderin in alveolar macrophages

24

findings in bronchoalveolar lavage:

- cytotoxic lung injury

hyperplastic and atypical type 2 pneumocytes

25

findings in bronchoalveolar lavage:

- amiodarone-induced disease

"foamy" changes w/ lamellar inclusions

26

- gold standard for PE
- RARELY REQUIRED anymore

pulmonary angiogram

27

partial pressure O2 =

FiO2 x Pb

(fraction of inspired oxygen)
(atmospheric pressure)

28

ALVEOLAR GAS EQUATION

PAO2 = [(Pb - PH2O) x FiO2] - [PaCO2/0.8]