Adult - Respiratory II Flashcards
What are the five conditions which may cause significant night sweats?
TB menopause AIDS lymphoma endocarditis
What are the signs and symptoms of TB?
majority of people are ASYMPTOMATIC if present: weight loss night sweats low grade fever cough
What is the typical cough progression in TB?
dry cough progressing to productive and sometimes blood tinged
What are the two tests definitively diagnostic for TB?
culture
CXR - small, homogenous infiltrate in upper lobes
Is TB reportable?
yes
What is INH?
the abbreviation for isoniazid
What is the medication regimen for TB?
RIPE R - Rifampin I - Isoniazid (INH) P - Pyrazinamide E - Ethambutol
When can the 4th drug in the TB regimen be dropped?
if the isolate is fully suceptible to RIF and INH
How long are the drugs given in TB?
INH and RIF for at least 6 months
pyrazinamide for 2 months
How is TB therapy monitored?
Weekly sputum smears and cultures for the first 6 weeks
Then monthly until negative cultures documented
Continued positive TB cultures after what time frame would raise the suspicion of drug resistance?
3 months
What baseline studies should be obtained prior to starting TB drug therapy?
LFTs
CBC
serum creatinine
What lab work must be monitored weekly while on INH?
LFTs
What needs to be monitored in people taking ETHAMBUTOL?
visual acuity
red-green color perception
PPD reading of 5 mm considered positive in what populations?
HIV patients
contacts of a known cause
those with typical TB presentation on CXR
PPD reading of 10 mm considered positive in what populations?
immigrants
high risk groups
health care workers
PPD reading of 15 mm considered positive in what populations?
all others
those not in any high prevalence groups
FVC
stands for -
defined -
significant in -
forced vital capacity
volume forcefully expelled after max inspiration
significant in OBSTRUCTIVE diseases
FEV1
stands for -
defined -
significant in -
forced expiratory volume in 1st second
volume expelled in 1st second of FVC maneuver
significant in OBSTRUCTIVE diseases
FEF 25-75
stands for -
defined -
significant in -
forced expiratory flow in middle 50%
max mid-expiratory airflow rate
significant in OBSTRUCTIVE diseases
PEFR
stands for -
defined -
significant in -
peak expiratory flow rate
max rate achieved in FVC maneuver
significant in OBSTRUCTIVE diseases
TLC
stands for -
defined -
significant in -
total lung capacity
volume in lungs after max inspiration
significant in RESTRICTIVE diseases
FRC
stands for -
defined -
significant in -
functional residual capacity
volume left after passive exhalation
significant in RESTRICTIVE diseases
RV
stands for -
defined -
significant in -
residual volume
volume remaining after max exhalation
significant in RESTRICTIVE diseases
What are the PFTs which reflect AIRFLOW RATE?
FVC
FEV1
FEF 25 - 75
PEFR
What are the PFTs which reflect VOLUMES?
TLC
FRC
RV
Which type of PFTs are decreased in obstructive diseases?
the airflow rate measures
Which type of PFTs are decreased in restrictive diseases?
the volume measures
What are examples of OBSTRUCTIVE diseases?
asthma
COPD
What are examples of RESTRICTIVE diseases/conditions? (6)
pneumonia pleural effusion pulmonary fibrosis lobectomy morbid obesity pregnancy
What is a pleural effusion?
a buildup of fluid between the lungs and chest cavity in the pleural space
Clear fluid in pleural effusion is called what?
transudate
Cream colored fluid in pleural effusion is called what?
exudate – contains protein
Pus found in pleural effusion is called what?
empyema
Blood in pleural effusion is called what?
hemorrhagic
What is the typical Xray finding in pleural effusion?
loss of costophrenic angle to blunting or shadows
no shark fins
What is the difference between pleural effusion and infiltrate?
pleural effusion is fluid between the lung and chest wall in the pleural space
infiltrate is a general term meaning an abnormal substance that accumulates gradually within cells or body tissues
What is atelectasis?
collapse of all or part of the lung - develops when alveoli become deflated
What is tactile fremitus?
“99” - ulnar surfaces of hands on back
increased in consolidation (pnumonia)
decreased in pleural effusion
