pulmonary infections & PFTs

Question 1

what is the “common cold”?

Answer 1

URI : often from rhinovirus or other virus

symptoms: clear to purulent nasal discharge, sore throat, cough, no fever or eosinophilia

Question 2

when does the “common cold” often resolve? stages of symptoms resolving?

Answer 2

most symptoms in 4-10 days, pulmonary symptoms (cough) lasting longer, up to 3 months (post-viral cough syndrome)

Question 3

what is important to distinguish with a cough?

Answer 3

source: upper (drainage from sinus/throat) or lower (lung infection) ?

Question 4

txt for common cold

Answer 4

humidifier, hydrate, mabye: decongestants/anti-histamines, cough suppressants

Question 5

define bronchitis

Answer 5

cough caused by any kind of lung infection (usually viral)- not in lung tissue but in bronchi (tubes from trachea into lung)

Question 6

what is the most common cause of hemoptysis?

Answer 6

bronchitis

Question 7

when would you use abx for bronchitis?

Answer 7

if it is AECB (acute exacerbated chronic bronchitis)

Question 8

what is…. usually follows viral bronchitis, no-longer infectious but inflamed, reactive lungs, lasting 6+ wks.

Answer 8

post-viral cough syndrome

Question 9

txt for postviral cough syndrome

Answer 9

“tincture of time”

Question 10

obstruction will likely cause ___ expiration

Answer 10

prolonged

Question 11

wheezing occurs during _____ unless…

Answer 11

expiration (narrowed airways), unless very severe- then will occur in inspirations as well

Question 12

sounds like asthma in a kid too young to have it (<2yo) …

Answer 12

RSV bronchiolitis

Question 13

what is the “cough of 100 days”

Answer 13

pertussis in adults .. usually no “whooping” sound

Question 14

preventions and txt for pertussis

Answer 14

prevention- Dtap and Tdap vaccines

txt: macrolide abx (“-mycin”)
- txt early but expect it to linger

Question 15

paroxysmal (sudden) cough with post-tussive emesis

Answer 15

pertussis/ whooping cough

Question 16

influenza is caused by …

Answer 16

influenza virus - type A & B (rarely C)

Question 17

hallmark symptoms of influenza

Answer 17

HA, myalgia, fever, malaise

Question 18

Dx of the flu is based on …

Answer 18

clinical criteria

Question 19

CDC reccomends ___ not be used for the flu b/c or _____. instead only Rx ____

Answer 19

amantidine and rimantidine (anti-virals) b/c of resistance

Rx: neuraminidase inhib (tamiflu or relenza) - decrease severity and duration

Question 20

anti-virals for the flu have little efficacy after ____

Answer 20

48 hours

Question 21

what is the presentation of pneumonia? Dx?

Answer 21

flu symptoms with purulent, chunky cough

chest Xray to Dx (fluid in alveoli)

Question 22

who gets anti-virals for flu?

Answer 22

everyone whose not young and healthy

Question 23

whats significant about the 2009 H1N1 swine flu?

Answer 23

hit young people because old people (born before 1957) already had it and had immunity

Question 24

____ has led to the nomenclature of H#N# for flu

Answer 24

antigenic shift (H and N each refer to different antigenic molecules on the surface of the virus)

Question 25

______ can make vaccines less effective, while ____ pandemic viruses arise from _______

Answer 25

yearly antigenic drift

antigenic shift

Question 26

antigenic drift vs shift

Answer 26

drift: changes of existing Hs and Ns
shift: surface H and N proteins are not Modified by replaced

Question 27

flu history: pandemics

Answer 27

1918 spanish flu, 1957 asian flu, 1958 hong kong flu

Question 28

is the next flu pandemic coming?

Answer 28

variants are ALWAYs on the horizon and can cause a pandemic

Question 29

____ viruses on humans are very lethal. why?

Answer 29

avian : virus binds (sialic acid binding specifically) in lower respiratory area- lungs hit hard

Question 30

what is the definition of disability?

Answer 30

for PFTs: objective measure of how bad a disease is

Question 31

PFTs are measured in …

Answer 31

vol/time (liters/sec)

Question 32

PFT: obstructive defect is defined by …

Answer 32

capacity is normal but it takes longer to get there- airways are narrowed. shifts graph left

Question 33

PFT: restrictive defect is defined by …

Answer 33

decreased total lung capacity- lungs overexpanded so you cant get air in. shifts graph right (small, normal shape)

Question 34

FEV1 low, FVC normal, ratio (FEV1/FVC) dec.

Answer 34

obstructive disease

Question 35

FEV1 low, ratio (FEV1/FVC) normal or high

Answer 35

restrictive disease

Question 36

% predicted value -what is it used for and what are the three levels?

Answer 36

obstructive disease: determines severity
FEV1 as percent predicted value (for avg healthy person)
<50% severe
50-70% moderate
>70% mild

Question 37

4 components of PFT testing

Answer 37

Static lung volumes
Flow rates
Bronchodilator reversibility
Bronchial challenges (e.g. cold air, occupational chemicals)

Question 38

tidal volume

Answer 38

about 500 mL, is the amount of air inspired during normal, relaxed breathing

Question 39

inspiratory reserve volume (IRV)

Answer 39

about 3,100 mL, is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume.

Question 40

expiratory reserve volume (ERV)

Answer 40

about 1,200 mL, is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume.

Question 41

reisdual volume

Answer 41

about 1,200 mL, is the volume of air still remaining in the lungs after the expiratory reserve volume is exhaled.

Question 42

vital capacity

Answer 42

is the total amount of air that can be expired after fully inhaling

Question 43

functional residual capacity (FRV)

Answer 43

is the amount of air remaining in the lungs after a normal expiration

Question 44

forced vital capacity (FVC)

Answer 44

Maximum amount of air that can be rapidly and forcefully exhaled from the lungs after full inspiration

Question 45

normal spirogram shows…

Answer 45

graph: expired vol. vs time
95% VC exhaled in 1st 3 seconds
-FEV1, FEF, FVC

Question 46

total volume most humans can hold

Answer 46

about 7L

Question 47

FEV1

Answer 47

forced capacity that comes out in the first second

Question 48

FEF 25-75

Answer 48

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

Question 49

___ is reduced in both obstructive and restrictive diseases, its the ___ that differentiates them

Answer 49

FEV1, ratio with FVC

Question 50

PFTs are ___ dependent

Answer 50

operator

Question 51

the most basic and useful lung function test

Answer 51

FEV1 - shows if theres obstruction and quantifies severity

Question 52

bronchial provocation

Answer 52

In asthma the demonstration of bronchial hyperresponsiveness to one of several constrictors challenges can be useful in establishing a diagnosis

Question 53

obstructive lung disease : what is decreased?

Answer 53

decreased: flow rates, volume, elastic recoil pressure (emphysema)
The flow volume loop acquires a scooped-out appearance
-narrow airways and parenchymal lung changes

Question 54

restrictive lung disease : what is decreased? what does the graph look like?

Answer 54

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

Question 55

etiology of restrictive vs obstructive lung disease

Answer 55

obstructive: asthma and COPD (exhaling disorder)
restrictive: pulmonary fibrosis, neuromusc disorders, chest wall disorders ,etc. (inhaling disorder)

Question 56

common symptoms for both obstructive and restrictive lung disease (4)

Answer 56

SOB, tachypnea, cough, anxiety

Question 57

those who apparently change position when trying to breath better likely have ____

Answer 57

restrictive disease