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32 Cards in this Set
- Front
- Back
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What is bronchoscopy?
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Bronchoscopy is the insertion of a small, thin fiberoptic scope through the nose, through the vocal cords, through the carina, and into a mid-sized brancing bronchus.
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When is bronchoscopy the most accurate diagnostic test?
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Bronchoscopy is the most accurate diagnostic test for infections such as pneumocystis ro tuberculosis. In addition, bronchoscopy is often the most accurate test for lung cancer or other mass lesion of the lung, such as abscess. This is true if they are located centrally and are too deep to be reached by a transthoracic lung biopsy.
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What is more accurate than a bronchoscopy?
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For mass lesions and infection, the only test more accurate than a bronchoscopy is an open lung biopsy.
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What is the most accurate test for a lung mass or cavity?
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The most accurate test for a lung mass or cavity is a lung biopsy. You must have tissue to diagnose cancer of obtain a specific microbiologic diagnosis.
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Describe a patient with a lung cavity?
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For a lung abscess, look for a patient described as febrile with a cough for thelast several weeks, weight loss, and possibly malodorous sputum. Lung abscess is most common in those with an increased risk of aspiration, such as alcoholics and patients after a seizure, stroke, or intubation.
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What is the most accurate test for bacterial infection of the lung?
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The most accurate test of any bacterial infection is a Gram's stain of the sputum and a sputum culture. Culture is ALWAYS the right answer to the "most accurate diagnostic test" question, if it is an infection.
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What does the case look like with infiltrates on chest x-ray?
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Answer chest X ray as the best initial test whenever there is a fever and a cough or shortness of breath.
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What is the most common etiology of interstitial infiltrates?
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Interstitial infiltrates can be caused by viral pneumonia, pneumocystis, mycoplasm, chlamydia, coxiella, and sometimes legionella.
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What is the most accurate test for interstitial infiltrates?
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It depends on the etiology:
Mycoplasma, Chlamydia, Coxiella - serology (antibody titers) Legionella - urine antigen testing, culture on specialized media PCP - bronchoalveolar lavage, increased LDH |
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What is the most common etiology of pleural effusion?
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The most common etiology of a pleural effusion is congestive heart failure or pneumonia.
Any infection can cause an effusion, although bacterial infection is the most common. Less common causes are trauma, cancer, and CT diseases such as lupus. |
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What is the most accurate test for pleural effusion?
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The most accurate test for a pleural effusion is a thoracentesis for fluid analysis. The MRI or CT is never the most accurate test for an infectious or neoplastic process. A high protein level indicates infection or cancer. A high cell count and/or low pH (<7.2) indicates an infection.
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What is the presentation of a pneumothorax?
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The patient will present as acutely short of breath with decreased breath sounds on one side, hyperresonance to percussion, an dtracheal deviation. It may be spontaneous, from a central venous catheter placed in the subclavian vein, or from ruptured bullae from pneumocystis or COPD.
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What is the next best step in management of a pneumothorax?
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After a pneumothorax is detected, the lung needs to be re-inflated. If there is a tension pneumothorax, then a needle decompression should be performed. All large pneumothoraces require the placement of a chest tube.
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What is a Flow-Volume Loop?
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Flow-volume loops are a graphical representation of inhalation and exhalation. The inhalation starts at the far right and the tracing moves down. Exhalation begins at the far left and the tracing moves up as you exhale. The loop tells not only how much you inhale/exhale, but also how fast.
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When is Flow-volume loop the right answer?
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This test is to assess various forms of obstructive and restrictive lung disease; for example, to tell the difference between COPD and interstitial lung disease. The flow-folume loop has no use in assessing infections, mass lesions, or reactive airways diesase. The flow volume loop is a graphical representation meant to uncover subtle defects in ventilation not easily represented on the numerical values of the other parts of the PFTs.
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What are PFTs?
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These are pulmonary function tests. The patient gives a maximum exhalation after a maximum inhalation. That is the FVC, or forced vital capaicty. A normal person should be able to exhale at least 80% of the air in 1 second or FEV1.
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When is a PFT the most accurate diagnostic test?
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The PFT is the most accurate test to distinguish obstructive from restrictive lung dissease in a person who is short of breath. When combined with bronchodilators or methacholine, PFTs are the most accurate test to diagnose asthma or reactive airways disease.
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What is the single most accurate test on the PFT for each pattern?
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The single most accurate part of the PFT is the FEV1/FVC ratio.
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What is ACE levels?
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Increased ACE levels are associated with sarcoidosis in 75% of patients. ACE levels are contributory to establishing the diagnosis of sarcoidosis.
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When is the answer ACE levels?
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Answer ACE levels when you are shown an African-American female patient who presents wiht cough, dyspnea, chest pain, and bilateral hilar adenopathy on chest X-ray.
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What is the most accurate diagnostic test for sarcoidosis?
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The presence of noncaseating granulomas on biopsy?
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When is Alpha-1 Antitrypsin level the answer?
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Serum alpha-1 antitrypsin (AAT) level is measured in a young nonsmoker with emphysema and liver disease. It may also be measured in a patient with a strong family history of emphysema. Low levels indicate AAT deficiency, in which the body lacks and elastase inhibitor.
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What do you see on ABGs?
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The arterial blood gas directly measures the pH, partial pressure of carbon dioxide (pCO2), and the partial pressure of oxygen (pO2). The bicarbonate level is determined based on a calculation from the pH and the pCO2. This allows you to calculate the alveolar-arterial (A-a) gradient.
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In what way is an ABG superior to a pulse oximeter?
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The sturation determined from an oximeter is ithing 1-2% of that obtained on an ABG, so we do NOT need to do an ABG for o2 saturation. An ABG allows you to know how hard someone is working in order to become oxygenated and whether there is life-threatening acidosis.
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When do you answer ABG?
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Answer ABG if there is COPD or another possibility of respiratory acidosis. Answer ABG if the question shows a case with a low serum bicarbonate and there may be a severe metabolic acidosis.
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when is Purified Protein Derivative (PPD) the answer?
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The PPD is to screen for exposure to tuberculosis (TB) and the possibility of latent infection. PPD testing is only to screen asymptomatic patients.
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What is a positive PPD?
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The test is positive based on teh situation.
1) >/= 5mm: HIV-positive, recent contact with person with active TB, patient with changes on CXR suggestive of prior TB, patients with organ transplants or other immunosuppressed patients. 2) >/= 10mm: recent immigrants from countries with high TB prevalence, injection drug users, residents/employees of hospitals, nursing homes, and homeless shelters, and patients with diabetes, renal failure, or hematological malignancies. 3) >/=15mm: persons with no risk factors for TB |
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Would you do any other tests to confirm your diagnosis other than a PPD?
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All patients with a positive PPD should get a chest X ray to exclude active disease. Positive tests are treated with isoniazid for 9 months.
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What is the impact of previous BCG vaccination?
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Previous vaccination with BCG has NO impact on these recommentadions. A test result >10mm is not to be considered a false positive because of a previous BCG.
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What is a sweat chloride test?
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Sweat chloride test is the best test (gold standard) for the diagnosis of CF.
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How is a sweat chloride test done?
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Pilocarpine is given and the amount of sodium and chloride is measured in the sweat.
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When do you answer sweat chloride test?
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Answer sweat chloride test when you are shown a patient with chronic respiratory problems such as a cough, wheezing, and shortness of breath. There will also be signs of fat malabsorption such as bulky stools and vitamin A, D, E, and K deficiency in a patient who has been unable to have children. Look for an infant with failure to thrive. Blood gas will reveal hypoxemia.
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