1S_1_PHYSICAL DIAGNOSIS OF RESPIRATORY SYSTEM (PART 3)

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Usual tests look for:

1. S____

2. F____

3. M____ status

4. P____s (reasons for sickness)

1. Structure

2. Function

3. Metabolic status

4. Pathogens (reasons for sickness)

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Most commonly done diagnostic x ray

CHEST X-RAY/RADIOGRAPH

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Employs ionizing radiation

CHEST X-RAY/RADIOGRAPH

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Air appears as black

CHEST X-RAY/RADIOGRAPH

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Tissues, fluid appear as white depending on density

CHEST X-RAY/RADIOGRAPH

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM: CHEST X-RAY/RADIOGRAPH:

Can show:

1. C____ outline

2. L____

3. B____ vessels

4. B____

1. Cardiac outline

2. Lungs

3. Blood vessels

4. Bones

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS:

1. U____

2. C____ t____y

3. M____ R____ I____

4. P____ E____ion T____hy

5. Pu____y An____

1. Ultrasound

2. Computed tomography

3. Magnetic Resonance Imaging

4. Positron Emission Tomography

5. Pulmonary Angiogram

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS: sound waves

Ultrasound

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS: ionizing radiation

Computed tomography

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS: magnetic field & radiowaves; more specific than CT scan

Magnetic Resonance Imaging

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS: radioactive tracers

Positron Emission Tomography

COMMON DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

OTHER IMAGING TESTS: contrast dye

Pulmonary Angiogram

Non-invasive tests

PULMONARY FUNCTION TESTS

PULMONARY FUNCTION TESTS: Measures:

1. lung v____ and c____

2. a____, r____ of flow

3. g____ exchange 

1. lung volumes and capacities

2. airflow, rates of flow

3. gas exchange

PULMONARY FUNCTION TESTS: Measurement of the pattern of air movement into and out of the lungs during controlled ventilatory maneuvers

SPIROMETRY

PULMONARY FUNCTION TESTS: Often done as a maximal expiratory maneuver – tiring when done

SPIROMETRY

PULMONARY FUNCTION TESTS: Simple, office-based

SPIROMETRY

PULMONARY FUNCTION TESTS: Measures flow, volumes

SPIROMETRY

PULMONARY FUNCTION TESTS: Volume vs. Time

SPIROMETRY

PULMONARY FUNCTION TESTS: SPIROMETRY: INDICATIONS:

1. Detect d___

2. Evaluate e___ and monitor c___ of disease

3. Evaluate t___t

4. Measure e___ of e___

5. Assess r___ for s___al procedures

1. Detect disease

2. Evaluate extent and monitor course of disease

3. Evaluate treatment

4. Measure effects of exposures

5. Assess risk for surgical procedures 

PULMONARY FUNCTION TESTS: SPIROMETRY:

can determine:

1. Forced e____ v____ in ____ second (FEV1)

2. F____ v____ l c____ y (FVC)

3. F____ 1/F____

4. F____ e____ f____ w ____ %-____ % (FEF____ -____ )

1. Forced expiratory volume in one second (FEV1)

2. Forced vital capacity (FVC)

3. FEV1/FVC

4. Forced expiratory flow 25%-75% (FEF25-75)

PULMONARY FUNCTION TESTS: SPIROMETRY:

is the volume of air that is exhaled during the first second of VC

Forced expiratory volume in one second (FEV1)

PULMONARY FUNCTION TESTS: SPIROMETRY:

is highly dependent upon the amount of force used by the patient in early expiration at volumes near the TLC. Thus, it may be necessary to coach the patient to achieve the patient’s maximum expiratory effort.

Forced vital capacity (FVC)

PULMONARY FUNCTION TESTS: SPIROMETRY:

Reflects the airflow in the large airways

FEV1/FVC

PULMONARY FUNCTION TESTS: SPIROMETRY:

Volume exhaled over the middle half of the GVC, divided by the time required to exhale it

Forced expiratory flow 25%-75% (FEF25-75)

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY

1. T____ Pump/L____ R____e Defect

2. A____ O____e Defect

1. Thoracic Pump/Lungs Restrictive Defect

2. Airways Obstructive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY: ↓ lung volume

Thoracic Pump/Lungs Restrictive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY: ↓ airflow

Airways Obstructive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

FVC: ALWAYS low

Thoracic Pump/Lungs Restrictive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

FVC: USUALLY normal

Airways Obstructive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

FEV1 & FEV1/FVC: USUALLY normal

Thoracic Pump/Lungs Restrictive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

FEV1 & FEV1/FVC: ALWAYS low

Airways Obstructive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

Cannot expand

Thoracic Pump/Lungs Restrictive Defect

PATTERNS OF VENTILATORY DYSFUNCTION SEEN ON SPIROMETRY:

Problem in entrance or exit of air

Airways Obstructive Defect

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FVC: OBSTRUCTIVE

Normal or ↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FVC: RESTRICTIVE

↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV1: OBSTRUCTIVE

↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV1: RESTRICTIVE

↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV25-75: OBSTRUCTIVE

↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV25-75: RESTRICTIVE

NORMAL OR ↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV1/FVC: OBSTRUCTIVE

↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: FEV1/FVC: RESTRICTIVE

↑

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: TLC: OBSTRUCTIVE

Normal or ↓

SPIROMETRY INTERPRETATION: OBSTRUCTIVE OR RESTRICTIVE:

PARAMETER: TLC: RESTRICTIVE

↓

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

1. P___ F___ METER

2. A___L B___ GAS

3. P___ O___Y

4. C___ B___ ANALYSIS

5. C___Y E___ TEST

1. PEAK FLOW METER

2. ARTERIAL BLOOD GAS

3. PULSE OXIMETRY

4. CHEMICAL BREATH ANALYSIS

5. CARDIOPULMONARY EXERCISE TEST

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Measures peak expiratory flow rate

PEAK FLOW METER

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Blood is extracted from the artery

ARTERIAL BLOOD GAS

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

painful procedure (directly punctures the artery to extract blood; differs from venous)

ARTERIAL BLOOD GAS

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

ARTERIAL BLOOD GAS: measures:

1. ___2 & ___2 levels

2. ___of blood 

3. N___ 

1. O2 & CO2 levels

2. pH of blood

3. NaHCO3 

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

ARTERIAL BLOOD GAS: measures: pH blood normal

7.35-7.45

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

ARTERIAL BLOOD GAS: measures: renal function

NaHCO3 (Sodium Bicarbonate)

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

ARTERIAL BLOOD GAS: measures: Sodium Bicarbonate

NaHCO3

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Measures O2 levels by detecting changes of light absorption in the hemoglobin

PULSE OXIMETRY

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Unreliable but handy

PULSE OXIMETRY

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Affected by vasoconstriction/vasodilation, BP and blood flow

PULSE OXIMETRY

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Measures volatile organic compounds in exhaled breath 

CHEMICAL BREATH ANALYSIS

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

may serve as biomarkers for lung cancers, asthma, COPD, diabetes, bacterial growth, alcohol ingestion 

CHEMICAL BREATH ANALYSIS

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

Measures cardiac and pulmonary performance during exercise and rest

CARDIOPULMONARY EXERCISE TEST

DIAGNOSTIC MODALITIES FOR THE RESPIRATORY SYSTEM:

CARDIOPULMONARY EXERCISE TEST: gives info on:

1. H____ r____

2. B____

3. E____

4. ____ 2 consumption

1. Heart rate

2. BP

3. ECG

4. O2 consumption