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What are the four separate volumes the lungs are divided into for PFT? Lung Volumes, Lung Capacities, Lung Volumes Obstructive, Lung Volumes Restrictive
What are the Lung Volumes? Vt, IRV, ERV, and RV
What is TV? Tidal Volume: volume of gas that normally moves into and out of lungs in one quiet breath.
IRV Inspiratory Reserve Volume: volume of air that can be forcefully inspired after a normal TV (Vt)
ERV Expiratory Reserve Volume: volume of air that can be forcefully exhaled after a normal TV (Vt).
RV Residual Volume: Amount of air remaining in lungs after forced exhalation.
What are the Lung Capacities? TLC, IC, FRC, VC, RV/TLC Ratio
TLC Total Lung Capacity: Max. amt of air that lungs can accommodate.
IC Inspiratory Capacity: Volume of air that can be inhaled after a normal exhalation.
FRC Functional Residual Capacity: Lung Volume at rest after normal exhalation.
VC Vital Capacity: Volume of air that can be exhaled after a max. inspiration.
RV / TLC .Ratio Residual Volume / Total Lung Capacity Ratio: Percentage of TLC occupied by RV.
What happens to lung volumes in Obstructive Diseases? VT= N or ↑ IRV=N or ↓ ERV=N or ↓ RV=↑
What happens to lung capacities in Obstructive Diseases? VC=↓ IC=N or ↓ RV/TLC%=N or ↑ FRC=↑ TLC=N or ↑
Lung Volume and Capacity Characteristics of Obstructive Diseases? Inflammation & swelling of peripheral airways, Excessive mucus, Bronchial airway obstruction, destruction/weakening of distal airways, smooth muscle constriction of airways
What happens to lung volumes and capacities in Restrictive Diseases? All are decreased except RV/TLC% is Normal
Lung Volume and Capacity Characteristics of Restrictive Diseases? Lung compression, atelectasis, consolidation (WBC's), calcification, fibrosis, tumors, and cavitations (lung abscess).
FEVt Forced Expiratory Volume Timed: Max volume of gas that's exhaled over specific time. FEV1 is most common
FEV1/FVC Ratio or FEV1% Forced Expiratory Volume 1sec / Forced Vital Capacity Ratio: Compares amt of air exhaled in 1 sec to total amt exhaled during FVC.
FEF25%-75% Forced Expiratory Flow 25%-75%: average flow during middle 50% of FVC: Evaluates SMALL airways.
FEF200-1200 Forced Expiratory Flow 200-1200: measures average flow between 200ml-1200ml of FVC: Evaluates LARGE airways. Normal = 8L/sec or 480L/min
PEFR Peak Expiratory Flow Rate (aka PFR): measures max flow during FVC. Evaluates LARGE airways. Use with Peak flow meter. Normal = 10L/sec or 600L/min
MVV Maximum Voluntary Ventilation: Measures largest volume of gas breathed voluntarily in and out of lungs in 1 minute.
FET Forced Expiratory Time: Measures the time to exhale forcefully thru mouth from TLC; helps RT to screen effectiveness of Bronchodilator
What is the Flow Volume Loop? Graph with flow rate measurements; Upper half is Max forced expiration, Lower half is max forced inspiration.
What happens to Flow Volume Loop in Obstructive conditions? Will produce a flow volume loop with "scooped out" appearance on upper half
What happens to Flow Volume Loop in Restrictive conditions? Will produce a flow volume loop that is a "small version" of normal loop
What are the PFT expiratory findings in Obstructive disease? FVC ↓, FEVt ↓, FEF25-75 ↓, FEF200-1200 ↓, PEFR ↓, MVV ↓, FEF50 ↓, FEV1% ↓ (so ALL decreased)
(PFT) Expiratory Findings Characteristics in Obstructive? Chronic inflammation/swelling of peripheral airways, Excessive mucus, tumor in bronchus, destruction/weakening of distal airways, and smooth muscle constriction
What are the PFT expiratory findings in Restrictive disease? FVC ↓, FEVt N or ↓, FEF25-75 N or ↓, FEF200-1200 N, PEFR N, MVV N or ↓, FEF50 N, FEV1% N or ↑ (so all normal or decreased except FEV N or ↑
(PFT) Expiratory Findings Characteristics in Restrictive? Atelectasis, Consolidation, and ↑ AC Membrane thickness
Why use Radiographs? Diagnosing Lung disorders, extent and location of disease, and evaluating subsequent progress of disease
Fundamentals of Radiology 1) ability to penetrate matter depends on the density 2) dense objects absorb more & are white to light 3) less dense objects do not absorb x-rays & are dark to black
PA upright position PosteroAnterior (PA): taken on full inspiration; x-ray cassette in front of pt
Lateral positions Right lung & heart, cassette on right side. Left lung & heart, cassette on left side. If neither specified, taken on left.
Upright positions PA=posteroanterior and Lateral, left or right
Supine positions AP=Anteroposterior and Lateral Decubitus
AP Supine position Anteroposterior (AP): only if immobile; x-ray cassette is behind pt
Lateral Decubutus Diagnosis: Fluid in pleural space (pleural effusion) which is gravity dependent
Sequence of Exam? 1) Mediastinum 2) Lung Perenchyma 3) Pleura 4)Diaphragm 5)Gastric air bubble 6) Bony Thorax AND 7)extrathoracic soft tissue
Parts of mediastinum Trachea, carina, major bronchi, heart, hilar region, and major blood vessels (aortic arch & SVC)
Trachea on X-ray Translucent (darker) column overlying the vertebral column
Carina on X-ray The trachea goes into the rt and lft bronchus
Heart on X-ray Right: upper bulge is SVC/lower bulge is right atrium. Left: superior bulge is aorta, middle bulge is main pulm art, and inferior bulge is left ventricle.
Hilar Region on X-ray Left hilum is 2cm higher than right
Lung Parenchyma X-ray Absence of vascular markings = Pneumothorax, pneumonectomy, overexposed x-ray. Excessive vascular markings = fibrosis, interstitial/alveolar edema, lung compression, underexposed x-ray
Pleura on X-ray Peripheral = thickening, fluid, air, and lesions; Costophrenic angles = blunted = pleural effusion
Diaphragm on X-ray Both hemi's domed shape, right is 2cm higher than left (6th rib), if flattened, means pneumothorax
Elevated Hemi? Excess gas, collapse of middle or lower lung lobe, pulmonary infection, phrenic nerve damage, spinal curvature.
Gastric Air Bubble Under left hemidiaphragm
Contents of Bony Thorax ribs, vertebrae, clavicles, sternum & scapulae. If intercostal too close = loss of muscles, intercostal space too far apart = COPD
Extrathoracic soft tissue Tissue surrounding chest; Emphysema if air present.
Factors that PUSH or PULL anatomic structures? Atelectasis, fibrosis, pneumonectomy, pneumothorax. distented gastric air bubble, neoplasm, fluid. gas, tumors, or mass outside the lung in the mediastinum.
Mediastinum: PULLED to normal side (away from problem)? pulmonary atelectasis, pulmonary fibrosis, or pneumoectomy
Mediastinum: PUSHED to normal side (away from problem)? fluid, gas (pneumothorax), neck or thyroid tumors, large mediastinal mass.
Hemi shifted: PULLED UP atelectasis or fibrosis
Hemi shifted: PUSHED DOWN pneumothorax
Hemi shifted: PUSHED UP distended gastric bubble
Horizontal fissure: Being PULLED down? Right middle lobe or right lower lobe atelectasis
Horizontal fissure: Being PUSHED down? neoplasm (outside lung)
If lung shifted: Causes to be PULLED to abnormal side (toward problem)? lung collapse, atelectasis, fibrosis (inside lung)
If lung shifted: Causes to be PUSHED to normal side (away from problem)? Tension pneumothorax, hemothorax
Radiolucent Dark pattern (air); normal for lungs
Radiodense White pattern, solid or fluid; Diagnosis: normal for bones and organs
Infiltrate Any ill defied white area; Diagnosis: atelectasis
Consolidation Solid white area; Pneumonia / pleural effusion
Hyperflucency extra pulmonary air. Diagnosis: COPD, Asthma attach, Pneumothorax
Vascular markings lymphatics, vessels, tissue; ↑ with CHF and none if pneumothorax
Diffuse spread throughout; Diagnosis: atelectasis / pneumonia consolidation
Opaque fluid or solid.
Bilateral on both sides
Unilateral on one side
Fluffy Infiltrates Diffuse whiteness; pulmonary edema
Butterfly/batwing pattern Infiltrate butterfly shaped; Diagnosis: pulmonary edema
Patchy infiltrates scattered densities; Diagnosis: atelectasis
platelike infiltrates thin-layered densities; Diagnosis: atelectasis
Ground glass appearance Reticulogranular. Diagnosis: ARDS / IRDS
Air Bronchogram Pneumonia
Peripheral wedge-shaped infiltrate Pulmonary Embolism
Concave superior border Diagnosis: pleural effusion
basilar infiltrates with menisus Diagnosis: pleural effusion
CT Scan Computed Tomography Scan; transverse cross sectional images
PET Scan Positron Emission Tomography; shows metabolic activity of tissues or organs by giving off "hot spots". Diagnosis: cancerous lesions
MRI Magnetic Resonance Imaging; transverse, sagittal, or coronal cross sectional images
Pulmonary Angiography useful in identifying pulmonary emboli or arteriovenous malformations
V/Q Scan Ventilation/Perfusion Scan; Diagnosis: pulmonary embolism
Fluroscopy motion pictures of the chest used only in select cases (because emits large doses of x-rays)
Bronchography x-ray of tracheobronchial tree. Diagnosis: bronchogenic carcinoma AND/or bronchiectasis
Air Cyst thin-walled radiolucent (dark) area surrounded by normal lung tissue
Bleb Superficial air cyst, protruding into the pleura; aka bullae
bullae large, thin-walled radiolucent (dark) area. aka bleb
Cavity Radiolucent (dark) area surrounded by dense (white) tissue. Diagnosis: hallmark of a lung abscess
consolidation Solid white area. Diagnosis: Pneumonia / Pleural Effusion
Homogeneous density Uniformly dense (white). Diagnosis: solid tumors, fluid containing cavity, or fluid in pleural space.
honeycombing (honeycomb pattern) Reticulogranular: Diagnosis: Pneumoconiosis, ARDS, IRDS
Infiltrate any ill defined white pattern. Diagnosis: atelectasis
Interstitial density density caused by interstitial thickening
lesion Alteration of tissue or loss of function of a part
Opaque Fluid or solid. Diagnosis: consolidation
Pleural density radiodensity (white) caused by fluid, tumor, inflammation, or scarring
Pulmonary Mass Lung lesion>/= 6 cm. Dense (white) tissue; pulmonary tumor
Pulmonary nodule Lung lesion < 6 cm.
Translucent (translucency) Permits x-ray light to pass thru; usually darker areas of x-ray
Created by: Beccaboop