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5 kinds of Respiratory tests

Thoracentesis: Pleural effusion/tranfusion; Interstitial Lung Dz (ILD), Cancer, Absestosis/pneumocosis
Sputum: PNA and TB ( & mycoses)
Pharyngeal: Bordetella, RSV
Throat & Nasal: Strep, Flu and Mono

Sputum test categories, follow-up tests

TB, CA, PNA
CA: Abnormal cells, Marker ABs/enz.s
PNA: Gram stain: G+: Pneumococcus;
G-: MPP, Klebsiella, HiB, Legionnaire's, Serratia
TB: Acid-fast stain

Sputum collection

Deep cough or suction

Throat culture use & technique

Collect at tonsilar pillars. New swab for each pathogen
Lab: 2-3 days, Strep, Mono, 'Flu
Rapid Test: same day, only 70% sensitive

Nasopharyngeal culture use & technique

Insert swab thru nostril to pharynx.
BEST test for Bordatella in first 2 weeks
RSV in infants can be fatal. Check early!

Bedside thoracentesis/bronchoalveolar lavage use & technique

Bronchoalveolar lavage w/ 150 mL saline. Collect w/ bronchoscope and do Gram, cytology (CA), & fluid analysis

Exudate vs Transudate: When & How

IF pleural effusion suspected or seen on CXR:
EXUDATE--> Cancer, PNA, Trauma, Asbestos, (PE). Exudate will be milky or bloody. LDH ELEVATED at >0.6 X serum and PROTEINS elevated at >0.5 X serum
TRANSUDATE --> CHF, Cirrhosis, Nephrosis, Hypoalbuminemia, Constrictive pericarditis, PE. Transudate may be clear (ascites/edema/CHF) or cloudy, from neutrophils and cellular debris. LDH is NOT ELEVATED

PPD

Purified Protein Derivative used in Mantoux test for TB
Detects EXPOSURE, not Ix. Read induration @ 48-72 hr. If positive, order CX & begin tx w/ isoniazid &/or rifampin

Two-step PPD

Double negative needed on Mantoux.
2nd test 1-2 weeks after 1st, given in same area. Positives are usually "boosted" responses from previous Infection.

Mantoux (PPD) 5mm positive criteria

HIV+
Direct exposure to TB pt
IV user w/ UNKNOWN HIV status

Mantoux (PPD) 15 mm criteria

No risk factors

Mantoux (PPD) 10 mm criteria

HIV-neg IV user, foreigner, low socio-economic, extended care, kids <4yrs, immuno-compromised, healthcare givers

Familial COPD S/s, test & use/limitation

S/s: FamHx, cyanosis, dyspnea unaffected by albuterol, finger clubbing.
Test: Alpha-1 Antitrypsin (AAT). Protease inhibitor that protects lower airways. Collect in Red cap tube (serum)
Deficiency is familial, increases risk for COPD in 20s-30s.
Acute phase product, like ESR & CRP: may elevate during infections

Alpha 1 Antitrypsin-associated diseases

COPD is main disease. Others: Cirrhosis and Panniculitis- nodular inflammation of subcutaneous tissues.

Cystic Fibrosis (CF) test

Pilocarpine iontophoresis test- known as Sweat Chloride test"
GOLD STANDARD test; 2 tests on 2 days
Cl- ions are tested:
Normal: <40
Borderline: 40-60
Positive CF: >60. 30% Caucasians are carriers

PFT/Spirometry definition. What 3 classes of conditions does it identify?

Pulmonary Function Test. Distinguishes chronic RESTRICTIVE, chronic OBSTRUCTIVE, and PERFUSION conditions

Obstructive lung diseases

1)COPD = emphysema & chronic bronchitis;
2) Asthma

Distinguishing COPD from Asthma

1) Asthma responds to albuterol, COPD doesn't
2) Asthma is episodic, COPD is chronic.

Restrictive lung diseases

1) Chronic Interstitial Lung Disease = Sarcoidosis & Pulmonary Fibrosis;
2) Adult Respiratory Distress Syndrome [ARDS];
3) Muscular Dystrophy [MD] and Amyotrophic Lateral Sclerosis [ALS],
4) Obesity;

Pulmonary perfusion disorders

1) Pulmonary Embolism
2) Pulmonary vasculitis
3) R->L shunts [e.g., Tetralogy of Fallot]

Spirometry predictive factors

Gender, ht, wt, age, race.
Caucasians have 20% greater values
80% predicted values are used for normal

ABG stands for what? Normal values?

Arterial Blood Gas
Normals:
pH: 7.35-7.45
PaCO2: 35-45 mm Hg
PaO2: 80-95 mm Hg
HCO3: 22-26 mEq/L
O2 Sat 95-99%

TB signs & symptoms, when to test

Productive cough, hemoptysis, night sweats, weight loss; also if recent TB contact or new immigrant.

Three classes of Spirometry tests

1) Flow rates;
2) Volumes (Capacities);
3) Gas exchange

Effect of vomiting on ABGs

Towards Metabolic Alkalosis

Effect of Diarrhea on ABGs

Towards Metabolic Acidosis

Vital Capacity

IRV + TV + ERV, where:
IRV = Inspiratory reserve volume,
TV = Tidal volume
ERV = Expiratory reserve volume

TLC

VC + RV, where:
-VC = Vital capacity
-RV = Residual volume

Inspiratory capacity

TV + IRV, where
-TV = tidal volume
-IRV = Inspiratory Reserve Volume

FEF definition and how it's derived

Forced Expiratory Flow is the middle of FEV1: average forced flow rate

Effect of OBSTRUCTIVE diseases on Lung Volumes. What causes this effect?

Increases TLC, RV, & FRC, because air's trapped INSIDE, increasing all the static volumes.

Effect of RESTRICTIVE diseases on Lung Volumes. What causes this effect?

Decreases TLC, RV, FRC, because air cannot be drawn in, so static values are reduced.

FEV1 : FVC in OBSTRUCTIVE dz

FEV1 : FVC compares volume expelled in 1 sec to total expelled. DECREASED w/ obstruction

FEV1 : FVC effect of RESTRICTIVE disease

Even though both values decrease, the FEV1 : FVC ratio is normal to increased

Vital Capacity in OBSTRUCTIVE dz

REDUCED, (Larger initially). Use only a portion of capacity because of obstruction

Vital Capacity in RESTRICTIVE dz

REDUCED. Restricted filling lowers space used.

Volume/Time in OBSTRUCTIVE dz

Smaller volume/sec

Volume/Time in RESTRICTIVE dz

Unimpeded volume/sec, but ratio increased

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