Quiz 2

Question 1

What is AFB (acid-fast bacillus) used for?

Answer 1

sputum culture and sensitivity

TB

Question 2

What type of test is AFB?

Answer 2

Microbiology

Question 3

What type of test is AFB (COVID and flu)

Answer 3

PCR

Question 4

Examples of nuclear medicine test

Answer 4

anything that has the word SCAN

VQ - ventilation perfusion scan
Pet Scan -lung, look for glucose uptake

Question 5

Why pleural tap (thoracentesis) indications? What is sent? What kind of analysis is it?

Answer 5

Used to diagnose and therapeutic

Drain fluid, send for cytology and culture

or drain fluid for a decrease chest pain or SOB

Question 6

Lights criteria for transudative and exudative

Answer 6

Transudative: imbalance of
pressure in blood vessels causes fluid to leak into pleural space – heart
failure/cirrhosis.

Exudative: injury of inflammation of the pleura causing fluid to leak – pneumonia/cancer/kidney disease/autoimmune disease

Question 7

What information is included in an ABG?

When is it indicated?

Answer 7

pH,
CO2 - Carbon dioxide
PO2 - partial oxygen pressure
HCO3 - Bicarbonate

indicated in an inpatient setting, respiratory distress,
concerns about hypercarbia

Question 8

When would you order PFT?

Answer 8

Diagnosis COPD, asthma, pulmonary fibrosis
gives good information on restrictive vs obstructive lung disease –
risk stratification (the degree of risk)

Question 9

How is a PFT performed?

Answer 9

Always before and after bronchodilator to check response to therapy

Question 10

What does Polysomnography diagnose

Answer 10

Sleep apnea

Question 11

What TB Skin test mean

Answer 11

Exposure
Rules out TB cannot rule it in

Sensitivity 59-100
Specificity 95-100

Question 12

CTA chest can look for?

Answer 12

PE or aneurysm –
Timing of the bolus is different
for each one,

if concerned for PE, must do PE protocol.

Aneurysm, then
Aneurysm protocol.

Question 13

What is risk factor of aneurysm?

Answer 13

age, smoking, HTN, family history, bicuspid aortic valve,
previous cardiac surgery

Question 14

What is risk factor of PE?

Answer 14

exogenous estrogen, history of blood clots, active cancer, recent surgery/immobilization

Question 15

D-dimer

Answer 15

protein that is made when a blood clot dissolves – (used to be called fibrin degradation products).
NOT SPECIFIC
Specificity 61-64%
Sensitivity – 97%

Question 16

Indication for Bronchoscopy

Answer 16

uses a bronchoscopy, goes down the mouth or nose into the airways: mucus plug, need a good sputum sample (atypical pneumonia)

Question 17

Laryngoscopy

Answer 17

back of the throat

Question 18

Thorascopy

Answer 18

VATS, lung reduction, esophagus and esophagectomy

Question 19

Mediastinoscopy

Answer 19

looks at the space between the lungs

Question 20

GOLD standard for COPD?

Answer 20

Spirometry

Question 21

Alpha 1 Antitrypsin

Answer 21

should be drawn on all patients with COPD diagnosis, check for genetic predispositions

Question 22

Asymptomatic hypertension – what is the most important/first action?

Answer 22

THE ANSWER IS NEVER REFERRAL

Repeat test and get a good H & P
Make medication recommendations

Question 23

What tests would you eventually order for cardiac issues (hypertension)?

Answer 23

Looking for end organ disease or risks factors

Risk stratification for coronary artery
disease, sex, risk factors, family history, smoking – CMP, UA, EKG

Question 24

What is included in lipid panel?

Answer 24

LDL
HDL
triglycerides
total cholesterol

Question 25

When do you order Troponin?

Answer 25

When doing ASC (cardiac damage) rule out

Question 26

When do you order BNP?

Answer 26

concerned about heart failure

Question 27

When to order a nuclear stress test (what kind)?

Answer 27

uses a tracer given by IV, can be done with exercise or independently. Looks at arteries at rest and during exercise and evaluates for decreased blood flow or damage. Can be done by PET (positron emission technology) or SPECT (single-photon emission computed tomography). Exercise: treadmill test – can be done with or without echocardiogram

Question 28

When do you order Holter

Answer 28

Long term (24-48 hours) monitoring of EKG for arrhythmias

Question 29

Arterial Doppler

Answer 29

Arterial doppler for claudication, pain with walking, discoloration of extremities, nonhealing wounds, loss of hair, pain worse at night, better in AM

Question 30

Venous Doppler

Answer 30

Venous doppler for patients with unilateral leg swelling, dependent edema and concerned for DVT

Question 31

EP (electrophysiology) Studies

Answer 31

induce arrhythmias for mapping, a-fib, needs ablation

Question 32

Echocardiography

Answer 32

Transesophageal echocardiography – invasive Transthoracic echocardiography – noninvasive – external with ultrasound probe TEE may need to be done if unable to visualize due ot scarring, obesity or pneumothorax or Source of embolus

Question 33

Gold standard testing for common abdominal conditions Appendicitis

Answer 33

CT - most accurate size matters CT is gold standard for adults, ultrasound is for pediatrics.

Question 34

Gold standard testing for common abdominal conditions Diverticulitis

Answer 34

CT abdomen/pelvis with contrast (IV/PO)

Question 35

Gold standard testing for common abdominal conditions Other

Answer 35

Cholecystitis – US RUQ Ovarian Torsion – US Testicular torsion – US Hepatomegaly – US Renal Stones Non-Contrast CT Scan

Question 36

Gold Standard -Stool tests

Answer 36

C-diff – has to be liquid – think about recent antibiotics, abdominal pain/cramping, fever, leukocytosis – who is at risk - immunocompromised bv Ova/parasites – who is at risk? Think immunocompromised, recent travel to an area with high risk Stool for culture – not usually febrile and not usually leukocytosis, diarrhea

Question 37

Liver function enzymes

Answer 37

abdominal pain, jaundice, ascites, vomiting, ETOH, hepatitis

Question 38

Lipase is GOLD standard for what

Answer 38

Pancreatitis

Question 39

Risk Factors for Pancreatitis

Answer 39

gallstones, ETOH, epigastric pain, unable to eat/vomiting, can have fever – amylases less used (some still do)

Question 40

Ammonia

Answer 40

liver failure helps to risk stratify and determine the extent

Question 41

Bilirubin

Answer 41

yellow/brown urine concern for bile duct obstruction

Question 42

CMP

Answer 42

full chemistry panel with electrolytes, including calcium (not magnesium or phosphorus), liver function tests, protein, albumin and bilirubin

Question 43

HIDA (hepatobiliary iminodiacetic acid scan)

Answer 43

nuclear medicine radioactive material goes into gallbladder and small intestines – slow movement indicates blockage or obstruction – no tracer indicates acute cholecystitis – also looks at gallbladder ejection for chronic cholecystitis.

Question 44

Endoscopic retrograde cholangiopancreatography (ERCP)

Answer 44

looks at liver, gallbladder, bile duct and pancreas. X-ray and endoscopy that looks at patency of bile and pancreatic ducts.

Question 45

How to screen for colon cancer?

Answer 45

Cologuard (no risk factors), sigmoidoscopy (low risk) colonoscopy (risk)

Question 46

What age based on risk factors? Who gets what?

Answer 46

45? Family history new onset of fecal bleeding

Question 47

EGD

Answer 47

looks at the upper GI (esophagus stomach, duodenum)

Question 48

Indications to perform EGD?

Answer 48

Bleeding, dysphagia, epigastric pain, increased NSAID use, smoking, vomiting, unable to tolerate PO, “burning”

Question 49

What kind of test is CT

Answer 49

x-ray study

Question 50

How does carboxyhemoglobin work?

Answer 50

CO2 poisoning 10-20 will reveal signs of CO2 poisoning 30-50 is severe poisoning 50-80 can significantly impending death and requires hyperbaric oxygen chamber

Question 51

What can transesophageal find that a transthoracic sometimes cannot find

Answer 51

Source embolism, endocarditis, prosthetic valve dysfunction, and left atrial, appendage thrombus in atrial fibrillation