pulmonary infections & PFTs Flashcards
what is the “common cold”?
URI : often from rhinovirus or other virus
symptoms: clear to purulent nasal discharge, sore throat, cough, no fever or eosinophilia
when does the “common cold” often resolve? stages of symptoms resolving?
most symptoms in 4-10 days, pulmonary symptoms (cough) lasting longer, up to 3 months (post-viral cough syndrome)
what is important to distinguish with a cough?
source: upper (drainage from sinus/throat) or lower (lung infection) ?
txt for common cold
humidifier, hydrate, mabye: decongestants/anti-histamines, cough suppressants
define bronchitis
cough caused by any kind of lung infection (usually viral)- not in lung tissue but in bronchi (tubes from trachea into lung)
what is the most common cause of hemoptysis?
bronchitis
when would you use abx for bronchitis?
if it is AECB (acute exacerbated chronic bronchitis)
what is…. usually follows viral bronchitis, no-longer infectious but inflamed, reactive lungs, lasting 6+ wks.
post-viral cough syndrome
txt for postviral cough syndrome
“tincture of time”
obstruction will likely cause ___ expiration
prolonged
wheezing occurs during _____ unless…
expiration (narrowed airways), unless very severe- then will occur in inspirations as well
sounds like asthma in a kid too young to have it (<2yo) …
RSV bronchiolitis
what is the “cough of 100 days”
pertussis in adults .. usually no “whooping” sound
preventions and txt for pertussis
prevention- Dtap and Tdap vaccines
txt: macrolide abx (“-mycin”)
- txt early but expect it to linger
paroxysmal (sudden) cough with post-tussive emesis
pertussis/ whooping cough
influenza is caused by …
influenza virus - type A & B (rarely C)
hallmark symptoms of influenza
HA, myalgia, fever, malaise
Dx of the flu is based on …
clinical criteria
CDC reccomends ___ not be used for the flu b/c or _____. instead only Rx ____
amantidine and rimantidine (anti-virals) b/c of resistance
Rx: neuraminidase inhib (tamiflu or relenza) - decrease severity and duration
anti-virals for the flu have little efficacy after ____
48 hours
what is the presentation of pneumonia? Dx?
flu symptoms with purulent, chunky cough
chest Xray to Dx (fluid in alveoli)
who gets anti-virals for flu?
everyone whose not young and healthy
whats significant about the 2009 H1N1 swine flu?
hit young people because old people (born before 1957) already had it and had immunity
____ has led to the nomenclature of H#N# for flu
antigenic shift (H and N each refer to different antigenic molecules on the surface of the virus)
______ can make vaccines less effective, while ____ pandemic viruses arise from _______
yearly antigenic drift
antigenic shift
antigenic drift vs shift
drift: changes of existing Hs and Ns
shift: surface H and N proteins are not Modified by replaced
flu history: pandemics
1918 spanish flu, 1957 asian flu, 1958 hong kong flu
is the next flu pandemic coming?
variants are ALWAYs on the horizon and can cause a pandemic
____ viruses on humans are very lethal. why?
avian : virus binds (sialic acid binding specifically) in lower respiratory area- lungs hit hard
what is the definition of disability?
for PFTs: objective measure of how bad a disease is
PFTs are measured in …
vol/time (liters/sec)
PFT: obstructive defect is defined by …
capacity is normal but it takes longer to get there- airways are narrowed. shifts graph left
PFT: restrictive defect is defined by …
decreased total lung capacity- lungs overexpanded so you cant get air in. shifts graph right (small, normal shape)
FEV1 low, FVC normal, ratio (FEV1/FVC) dec.
obstructive disease
FEV1 low, ratio (FEV1/FVC) normal or high
restrictive disease
% predicted value -what is it used for and what are the three levels?
obstructive disease: determines severity
FEV1 as percent predicted value (for avg healthy person)
<50% severe
50-70% moderate
>70% mild
4 components of PFT testing
Static lung volumes
Flow rates
Bronchodilator reversibility
Bronchial challenges (e.g. cold air, occupational chemicals)
tidal volume
about 500 mL, is the amount of air inspired during normal, relaxed breathing
inspiratory reserve volume (IRV)
about 3,100 mL, is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume.
expiratory reserve volume (ERV)
about 1,200 mL, is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume.
reisdual volume
about 1,200 mL, is the volume of air still remaining in the lungs after the expiratory reserve volume is exhaled.
vital capacity
is the total amount of air that can be expired after fully inhaling
functional residual capacity (FRV)
is the amount of air remaining in the lungs after a normal expiration
forced vital capacity (FVC)
Maximum amount of air that can be rapidly and forcefully exhaled from the lungs after full inspiration
normal spirogram shows…
graph: expired vol. vs time
95% VC exhaled in 1st 3 seconds
-FEV1, FEF, FVC
total volume most humans can hold
about 7L
FEV1
forced capacity that comes out in the first second
FEF 25-75
where 25% and 75% of FVC are on curve. (slope of line between these points) indicator of what medium sized airways are doing - assesses small airway disease
___ is reduced in both obstructive and restrictive diseases, its the ___ that differentiates them
FEV1, ratio with FVC
PFTs are ___ dependent
operator
the most basic and useful lung function test
FEV1 - shows if theres obstruction and quantifies severity
bronchial provocation
In asthma the demonstration of bronchial hyperresponsiveness to one of several constrictors challenges can be useful in establishing a diagnosis
obstructive lung disease : what is decreased?
decreased: flow rates, volume, elastic recoil pressure (emphysema)
The flow volume loop acquires a scooped-out appearance
-narrow airways and parenchymal lung changes
restrictive lung disease : what is decreased? what does the graph look like?
decreased: Peak flow, Total exhaled volume
Flow-volume curve is vertically compressed
No scooped-out appearance.
Expiratory limb of the flow-volume loop is steep
etiology of restrictive vs obstructive lung disease
obstructive: asthma and COPD (exhaling disorder)
restrictive: pulmonary fibrosis, neuromusc disorders, chest wall disorders ,etc. (inhaling disorder)
common symptoms for both obstructive and restrictive lung disease (4)
SOB, tachypnea, cough, anxiety
those who apparently change position when trying to breath better likely have ____
restrictive disease
