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MHD VI: Pulm > 11.24: Clinical Obstructive lung disease > Flashcards

11.24: Clinical Obstructive lung disease Flashcards

1
Q

What are general categories of dyspnea?

A
  1. Pulmonary:
    a. Restriction
    b. Obstruction
    c. Htn.
  2. Cardiac
  3. Renal acidosis
  4. Anemia
  5. NM
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2
Q

What are the big three obstruction diseases?

A
  1. Asthma
  2. COPD
    a. Emphysema
    b. Chronic Bronchitis
  3. Bronchiectasis
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3
Q

Categories of restrictive lung disease?

A
  1. Interstitial disease
    a. Sarcoid
    b. UIP/IPF
  2. Chest wall
    3 Neuromuscular
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4
Q

Main commonality / difference between restriction and obstructive lung disease?

A

Common: SOB, DOE, cough
Difference: Path / Prog / Treatment

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5
Q

Cause of obstructive v. restrictive?

A

Obstructive: increased airway resistance
Restrictive: abnormal elastic recoil

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6
Q

CXR diff. in obs. vs. rest?

A

Obs: Larger (hyperinflated lungs)
Rest: smaller lungs

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7
Q

Exam finding obs. vs. rest.?

A

Obs: Wheezing
Rest: Crackles

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8
Q

Difference in lung function in obs. vs. rest.?

A

Obs: Decreased FEV/FVC
Rest: Decreased TLC

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9
Q

Main cause of asthma?

A
  • Primarily a disease of inflammation
  • Submucosal edema seen
  • Mucous gland hyperplasia seen
  • Smooth muscle hypertrophy
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10
Q

Main difference in presentation between asthma and other obstructive disease?

A
  • Asthma is reversible: normal 99% of Days

- COPD ptns. will have symptoms every day

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11
Q

4 cardinal symptoms to include asthma in DDx?

A

EPISODIC……..

  1. SOB/DOE
  2. Wheezing
  3. Cough
  4. Chest tightness
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12
Q

How do asthmatics perform on PFTs?

A
  1. WHEN ASYMPTOMATIC: normal performance but can try to provoke symptoms w/ methacholine challenge test
  2. WHEN SYMPTOMATIC: obstruction that gets better with bronchodilator seen
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13
Q

4 Categories assessed in classifying type of asthma?

A
  1. x per week albuterol rescue inhaler needed
  2. x per month woken up by symptoms
  3. PEFR / FEV
  4. PEFR variability: bad if this is high
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14
Q

What is PND?

A

“Paroxysmal nocturnal dyspnea”

  • Often seen in heart failure
  • Often seen in asthmatics whose symptoms are usually worse at night
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15
Q

How is PF used in medicating asthmatic?

A

“Peak flow”
- Ptn. measures when feeling health and compares to when sick
-

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16
Q

2 categories of asthma treatments?

A
  1. Relievers: emergency bronchodilators

2. Controllers: daily use anti inflammatories

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17
Q

What are the relievers?

A
  • Beta agonist usually inform of “MD” metered dose inhaler
  • Can also be in nebulizers
  • **MD Albuterol 2 puffs as needed is common rx.
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18
Q

First/second line of asthma controllers?

A

First: Daily use inhaled corticosteroids (anti inflammatory)
- Must be used daily to maintain effects
- Even when feeling well
Second:
a. Long acting B agonist
b. Anti leukotrienes

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19
Q

Side effects of inhaled corticosteroids?

A
  1. Oral/Pharyn “Thrush:” Yeast infection

* *Spacer minimizes this

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20
Q

What is thermoplasty?

A
  • Heated probe placed in airway through bronchoscopy
  • Disables smooth muscle in airway so less likely to spasm
  • Very experimental
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21
Q

When can asthma therapy be stepped down?

A
  • Has been well controlled for at least 3 mos.
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22
Q

3 main diseases to think of in person with chronic cough?

A
  1. PND: Post nasal drip
  2. GERD: Acid reflux
  3. Asthma
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23
Q

What is cough variant asthma?

A
  • SOB, wheezing, tightness are not a complaint

- Cough is only complaint

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24
Q

What is exercise induced asthma?

A
  • Increased ventilation dehydrates mucosa and leads to mast cell degranulation and bronchospasm
  • Dehydration occurs because more of moisture is pulled to hydrate increase respiratory volume
  • Worse in cold air
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25
How is exercise induced asthma different from exercise induced SOB?
- W/ asthma person is find with exercise w/ symptoms after - During exercise we have inc. catecholamines to help bronchodilator * **Treatment is albuterol pre exercise, exercise in water/humid environment
26
Impact of PND / GERD on asthma?
- Will not respond well to asthma treatment if these two not well controlled
27
Indication of occupational asthma?
Symptoms worse when on vacation
28
What is RADS?
"Reactive Airways Dysfunction Syndrome" - Never have asthma until BIG BANG environmental exposure - Most people feel fine next day, this person has asthma triggered
29
What is Churg-Strauss?
- Inflammation of small vessels: vasculitis - Presents with: 1. Asthma 2. Hyper EOS 3. Mononeuropathies: individual nerves don't work
30
What is Samter's Triad?
``` "Aspirin sensitivity" 1. Asthma 2. Nasal polyps 3. ASA sensitivity exacerbating asthma RX: antileukotrienes ```
31
What is APBA?
"Allergic Bronchopulmonary Aspergillosis" - Aspergillosis: Fungus in soil normally not problematic - Ptn. with asthma plus demonstrated reactivity to aspergillus can demonstrate this RX: steroids
32
Asthma summary?
``` EPISODIC: 1. Cough 2. Tightness 3. Weeze 4. Dyspnea Cause: Inflammation RX: inhaled corticosteroids w/ emergency bronchodilators ```
33
2 types of COPD?
1. Emphysema: permanent distention of distal airspace w. destruction of alveolar septa "Pink puffer" 2. Chronic Bronchitis: Excessive sputum production "Blue Bloater"
34
Etiology of pink puffer?
- Able to maintain normal pCO2 by huffing and puffing - Burns calories so keeps them thin - Huffing allows normal O2 to stay "pink"
35
Etiology of blue bloater?
- Accepts hypercapnia so Co2 creeps up - This is because they are not breathing as hard - Leads to less O2 in blood - Hypoxia develops leading to hypoxic vasoconstriction, cor pulmonale, and bloated appearance
36
What is hypercapnia?
Excessive CO2 in blood, typically caused by inadequate respiration
37
COPD presentation?
- Insidious onset of SOB, DOE, Cough | - There IS day to day variability but likely they will not have felt up to running after a bus for a very long time
38
PFTs in COPD?
- Obstruction without bronchodilator response - Hyperinflation; high TLC - Reduced diffusion capacity
39
COPD treatment?
1. STOP SMOKING 2. Start with short acting bronchodilators used when needed a. B agonist b. Anticholinergic 3. Add in long acting bronchodilator 4. If O2 is low while sitting still or at night give O2 - If low while walking, only use when walking
40
SE of long acting bronchodilators?
- Increased mortality | - Need to add in inhaled cortico to prevent this
41
Pathology of bronchiectasis?
- Inflammation destroying integrity of airway so when ptn. exhales / coughs airways collapse trapping more mucus leading to more inflammation - Suppurative characterized by abnormal dilation of bronchi - Cups of mucus / day coughed up
42
What does suppartive?
- Pus producing | Think "PUS backwards = SUP"
43
What is cycle of inflammation in bronchiectasis?
- Neutrophil / protease inflammation of airway making harder to fill - Inflammation destroys airways - Destruction makes mucus clearance hard - Low mucus clearance leads to bacterial colonization
44
Bacteria often involved in bronchiectasis?
1. Staph aureus 2. Pseudomonas 3. Non TB mycobacterium
45
Symptoms of bronchiectasis?
1. SOB / DOE | 2. Daily copious sputum production
46
Bronchiectasis Causes?
1. CF 2. Kartagener's: ciliary problem 3. Pneumonia 4. RA
47
CXR/CT presentation of bronchiectasis?
"Signet Ring Sign" - Internal diameter of bronchus > accompanying vessel - Normally same size "Tram Tracking" - Bronchus fails to taper in periphery of chest
48
What are "Signet Ring Sign" and "Tram Tracking" characteristic of?
Bronchiectasis, seen on cxr / ct
49
Treatment of bronchiectasis?
Break cycle of mucus formation 1. Airway therapy a. Chest percussion b. Bronchodilators c. Hypertonic saline 2. Antiinflammatory 3. Antibiotics 4. Transplant needed in CF
50
What is Lymphangioleiomyomatosis?
"LAM" | - Obstructive airway disease ONLY seen in women of childbearing age
51
What is Bronchiolitis Obliterans
- Idiopathic narrowing of airway that mirrors COPD in lack of response to bronchodilators but have never smoked, not AT1 deficiency
52
Definition of restrictive lung disease and three causes?
Low TLC 1. Interstitial lung disease: most common 2. Chest wall disease 3. NM disease
53
What is Interstitial lung disease?
- Chronic inflammatory lung disease with stuff deposited in interstitium - Increased elastic recoil
54
What are IIPs?
"Idiopathic Interstitial Pneumonia" 1. UIP/IPF 2.
55
What is UIP?
"Usual pulmonary pneumonia" - Pathologic term for Idiopathic pulmonary fibrosis - Normal alveoli, next to inflammatory, next to scared in imaging all in same biopsy - Patient will thus present with clinical syndrome of "IPF"
56
What is NSIP
"Nonspecific interstitial pneumonia" | - Expect connective tissue disorder, hypersensitivity
57
What would exam show in interstitial lung disease?
1. Small lungs 2. SOB 3. Crackles 4. Low TLC 5. Clubbing of fingers 6. CXR with interstitial markings
58
Causes of interstitial lung disease?
``` "SHIT FACED" Sarcoid Hypersensitivity pneumonitis Idiopathic pulmonary fibrosis TB Fungal Aspiration/asbestos Connective tissue disorder EOS granuloma Drugs Pneumoconioses ```
59
What is sarcoid?
- Giant cells, non caseating granulomas - Non specific tissue reaction: idiopathic - Lymphadenopathy or interstitial disease in lung - Can involve eyes, skin as well
60
What are non caseating granulomas indicative of?
Sarcoid
61
Sarcoid treatment?
Corticosteroids to everyone that has symptoms
62
Who is IPF usually seen in?
"Idiopathic pulmonary fibrosis" - Insidious DOE in Middle aged/ elderly male - Cough - Crackles - Low TLC - Lower lobe, peripheral, ILD "Reticulonodular infiltrates / lines and dots " * **Biopsy if atypical presentation
63
What is ILD?
"Reticulonodular infiltrates / lines and dots " | - Seen on CT of IPF
64
IPF prognosis?
2.5 - 5 years
65
IPF treatment?
1. Pirfenidone 2. Nintedanib * **Transplant

MHD VI: Pulm (20 decks)

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