Pulmonology Flashcards
FRV1/FVC
ratio of air volume expired in 1 second to FVC.
80% is normal,
and this ratio helps us to understand whether the patient has obstructive or restrictive lung disease
80% is +/- restrictive
Total lung capacity
increased in obstructive lung disease
decreased in restrictive lung disease
Functional vital capacity (FVC)
in obstructive versus restrictive lung disease
FVC is the air volume that can be inspired and then expired
decreased in obstructive lung disease because you can’t move air out very well
decreased in restrictive lung disease because you can’t move air in very well
FEV1 in obstructive versus restrictive lung disease
decreased in obstructive as well as in restrictive lung disease
In obstructive lung disease, FEV decreases even more than FVC, so with obstructive lung disease the FEV1/FVC ratio drops more than 70%
In restrictive lung disease the FEV1/FVC ratio is normal or increased because the FEV1 and FVC decrease at a similar rate
DLCO
relative measure of ability to transfer air from pulmonary alveoli to capillary
Alveolar-arterial gradient
What’s a normal value?
When would A-a gradient be increase?
Compares O2 status of alveoli to arterial blood
Normal= 5-15 mmHg
Increased Aa gradient indicates pulmonary embolism, pulmonary edema, right-to-left shunt, higher concentration of inspired oxygen
Aa gradient equation
PAO2-PaO2
(Atmospheric air pressure x FiO2) - (PaCO2/0.8) - (PzO2)= (713nnHg) * (0.21 PaCO2/0 .8)-(PaO2)= 5-15mmHg is considered a normal A-a gradient
PAO2= alveolar O2 content PaO2= Arterial O2 content
Common cold (viral rhinitis)
inflammation of the upper airways
Causes: rhinovirus, coronavirus, adenovirus
H and P: nasal and throat irritation, sneezing, rhinorrhea, nonproductive cough
(Productive cough tends to be more indicative of PNA or bronchitis)
Treatment: supportive, rest, analgesia, hydration, NO antibiotics
Pharyngitis
Inflammation of the throat
viruses: rhinovirus, coronavirus, adenovirus
bacteria: group A beta-hemolytic streptococci (strep pyogenes)
Symptoms: sore throat, lymphadenopathy, nasal congestion
fever, HA, GI symptoms
Red and swollen pharynx
Tonsillar exudates
Pharyngitis diagnosis- Centor criteria
Add one point if: Fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough 44yo subtract a point
Cough (absence of) Exudates Nodes T (temperature) OR (plus or minus one point for age)
0-1 points= no antibiotic/no throat culture
2-3 points= throat culture/treat if positive
4-5 points= treat empirically
Treatment: self- limited
antibiotics to prevent ARF
(post-strep glomerulonephritis risk does not change with antibiotic use)
Use beta-lactam antibiotics (penicillin, amoxicillin)
What nonbacterial infections present with tonsillar exudates?
infectious mononucleosis
strep pharyngitis
Tonsillar infections
Streptococcal pharyngitis symptoms Ear pain Difficulty swallowing High fever Tonsillar exudates
Treatment: beta- lactam antibiotics (penicillin, amoxicillin)
What are the diagnostic features of peritonsillar abscess? What is the treatment?
Infection between the tonsil and pharyngeal constrictors caused by streptococcus pyogenes, staphylococcus aureus, and/or bacterioides spp.
Severe sore throat, fever, muffled “hot potato” voice
Classic diagnostic feature is obvious abscess on the tonail or deflection of the uvula to the opposite side
Other signs and symptoms include trismus (“lockjaw”) and drooling
Treatment:
Needle aspiration or I&D
Pain meds and antibiotics: amoxicillin/clavulanate, clindamycin
Viral influenza
H and P: arthralgias, myalgias, nasal congestion, nonproductive cough, high fevers, lymphadenopathy
Flu swab
Treatment: symptomatic treatment, fluid intake, zanamivir and oseltamivir which will decrease severity of symptoms
Annual flu vaccine (especially elderly patients, healthcare workers, immunocompromised, lung disease)
Sinusitis- acute
streptococcus pneumoniae
haemophilus influenzae
moraxella catarrhalis
viral infection
associated with barotrauma, allergic rhinitis, prolonged gastric tube placement, asthma and other chronic resp infection
Complications- may spread to CNS and cause meningitis
Sinusitus- chronic
usually caused by sinus obstruction and anaerobic infection
DM predisposes to mucor mycosis
Sinusitis H and P
sinus pain, purulent nasal discharge, maxillary tooth pain, sinus tenderness to palpation, illumination test (unreliable)
CT sinuses for severe sinusitis Treatment: nasal irrigation analgesics oral decongestants intranasal steroids amoxicillin- clavulanate, doxycycline, or levofloxacin
What are the complications of strep pharyngitis, and which can be prevented with antibiotics?
ARF and glomerulonephritis
ARF can be prevented
Signs of a peritonsillar abscess
deviated uvula
trouble opening mouth
muffled “hot potato” voice
look for a bulge in the back of the throat
murmurs that decrease with squatting
HOCM and MVP, because the valve leaflets are further apart with greater afterload
Acute bronchitis
trachea and bronchi
difficult to differentiate from URI in the first few weeks. Generally a clinical diagnosis because the symptoms and radiology are nonspecific. If high fever then evaluate for PNA, and consider influenza
productive cough
shortness of breath
wheezing
sputum culture in persistent cases
Rads- CXR rules out PNA, shows mild congestion
Viruses- MCC
Mycoplasma pneumoniae
Streptococcus pneumoniae
Haemophilus influenzae
Treatment- symptomatic, self- limited Abx if increased risk of bacterial infection (other lung disease, smokers, elderly) fluoroquinolones tetracycline erythromycin azithromycin
PNA
inflammation in the alveoli
- CAP
- HAP
Clinical manifestations can break down into typical and atypical
Features of typical PNA presentation
fever cough malaise purulent sputum chest pain SOB
on xray, lobar infiltrate
common organisms: streptococcus pneumoniae staphylococcus aureus haemophilus influenzae GBS
Features of atypical PNA presentation
less severe symptoms
nonproductive cough
headache fatigue
On CXR, diffuse patchy infiltrates
Common organisms:
mycoplasma pneumonia
legionella pneumophila
chlarmydophila pneumoniae