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Internal Medicine > 5) Pulmonary (Part 1) > Flashcards

5) Pulmonary (Part 1) Flashcards

1
Q

3 most important measures in Spirometry

A
  • FVC
  • FEV1
  • FEV1/FVC ratio
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2
Q

Spirometry normal values vs. COPD

A
  • Normal is 80%

- The diagnosis of COPD is an FEV1/FVC ratio less than 70%

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3
Q

The greatest value of the flow-volume loop is to assess for

A
  • Upper airway obstruction (for example, a laryngeal cancer)
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4
Q

DLCO

A
  • Measure of the ability of the lungs to transfer gas
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5
Q

Diffusion in the lungs is most efficient when

A
  • Surface area for gas transfer is high and the blood is readily & able to accept the gas being transferred
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6
Q

Decreased DLCO seen in

A
  • COPD
  • Infiltrative lung disease
  • Pulmonary HTN
  • PE
  • Sarcoidosis
  • Scleroderma
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7
Q

Normal DLCO seen in

A
  • Asthma
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8
Q

Examples of obstructive pulmonary diseases

A
  • Asthma
  • COPD
  • Cystic fibrosis
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9
Q

Examples of restrictive pulmonary diseases

A
  • Idiopathic pulmonary fibrosis
  • Pneumoconiosis
  • Coal worker’s pneumoconiosis
  • Silicosis
  • Asbestosis
  • Sarcoidosis
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10
Q

Asthma

A
  • Reversible airway obstruction, airway inflammation, and increased airway responsiveness to various stimuli
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11
Q

Asthma symptoms

A
  • Wheezing
  • Chest tightness
  • Dyspnea
  • Cough (range from mild to severe)
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12
Q

Asthma physical exam findings

A
  • Tachypnea

- Wheezing

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13
Q

Asthmatic spirometry findings

A
  • Decreased FEV1/FVC ratio
  • Obstruction will typically improve with a bronchodilator (significant bronchodilator response)
  • Normal DLCO
  • If FEV1/FVC ratio is normal, order a methacholine challenge test/ bronchoprovocation test
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14
Q

Asthma medication classes

A
  • Short acting inhaled beta agonists (SABA)
  • Inhaled corticosteroids (ICS)
  • Long acting inhaled beta agonists (LABA)
  • Combination inhaled corticosteroids and long term beta agonists
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15
Q

Short acting inhaled beta agonists (SABA)

A
  • Albuterol

- levalbuterol (Xopenex)

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16
Q

Inhaled corticosteroids (ICS)

A
  • flunisolide (Aerospan)
  • ciclesonide (Alvesco)
  • fluticasone furoate (Arnuity Ellipta)
  • mometasone furoate (Asmanex)
  • fluticasone propionate (Flovent)
  • budesonide (Pulmicort)
  • beclomethasone dipropionate (Qvar)
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17
Q

Long acting inhaled beta agonists (LABA)

A
  • formoterol (Foradil)

- salmeterol (Serevent)

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18
Q

Combination inhaled corticosteroids and long term beta agonists

A
  • fluticasone propionate
  • salmeterol (Advair)
  • mometasone furoate
  • formoterol fumarate (Dulera)
  • budesonide
  • formoterol fumarate dihydrate (Symbicort)
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19
Q

Never prescribe a long-acting beta agonist without an inhaled corticosteroid

A
  • Has been associated with increased mortality
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20
Q

Most important cause of COPD

A
  • Smoking
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21
Q

COPD symptoms

A
  • Progressive shortness of breath with exertion
  • Chronic cough
  • Sputum prodction
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22
Q

COPD physical exam findings

A
  • Increased AP diameter

- Scattered wheezes

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23
Q

COPD CXR findings

A
  • Flattened diaphragms
  • Hyperinflated lungs
  • Increased AP diameter (on lateral CXR)
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24
Q

COPD Dx

A
  • Requires spirometry
  • Post-bronchodilator FEV1/forced vital capacity <0.7 (confirms the presence of airflow limitation that is not fully reversible)
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25
Q

American Thoracic Society COPD staging

A
  • Mild disease: FEV1/FVC <70%, FEV1 >80% predicted
  • Moderate disease: FEV1/FVC <70%, FEV1 50-80% predicted
  • Severe disease: FEV1/FVC <70%, FEV1 30 to 50% predicted
  • Very severe disease: FEV1/FVC <70%, FEV1 <30% predicted
26
Q

COPD treatment

A
  • Smoking cessation

- Long-term oxygen therapy improves survival, exercise, sleep and cognitive performance

27
Q

COPD long term oxygen therapy indications

A
  • PaO2 <55mgHg (per ABG) or cor pulmonale, Pulmonary HTN present.
  • Goal: to maintain O2 saturation >90% during rest, sleep and exertion
28
Q

COPD medications

A
  • Short Acting βeta 2 Adrenoceptor-Agonists (SABA)
  • Long Acting βeta 2 Adrenoceptor-Agonists (LABA)
  • Short Acting Muscarinic Antagonist (SAMA)
  • Long Acting Muscarinic Antagonist (LAMA)
  • Inhaled Corticosteroid (ICS)*
  • Combination SAMA + SABA
  • Combination LABA + LAMA
  • Combination ICS + LABA
  • Phosphodiesterase Inhibitors
29
Q

Short Acting βeta 2 Adrenoceptor-Agonists (SABA)

A
  • Albuterol
  • Metaproterenol
  • Terbutalin
  • Isoetharine
  • Levalbuterol
  • <6 h effect on lung function
30
Q

Long Acting βeta 2 Adrenoceptor-Agonists (LABA)
Salmeterol, formoterol, olodaterol, vilanterol, = long acting (>12 h) effect on lung
Indaceteraol = ultra long acting

A
  • Salmeterol
  • Formoterol
  • Olodaterol
  • Vilanterol
  • > 12 h effect on lung
  • Indaceteraol = ultra long acting
31
Q

Short Acting Muscarinic Antagonist (SAMA)

A
  • Ipratropium (4x /day)
32
Q

Long Acting Muscarinic Antagonist (LAMA)

A
  • Tiotropium
  • Clidinium
  • Umeclidinium
  • Glycopyrronium
33
Q

Inhaled Corticosteroid (ICS)

A
  • Beclomethasone
  • Budesonide
  • Triamcinolone
  • Fluticasone
  • Flunisolide
34
Q

Combination SAMA + SABA

A
  • Albuterol/ipratropium
35
Q

Combination LABA + LAMA

A
  • Vilanterol/umeclidinium
  • Olodaterol/tiotropium
  • Idacaterol/glycopyrronium
  • Formoterol/glycopyrrolate
  • Formoterol/aclidinium
36
Q

Combination ICS + LABA

A
  • Fluticasone propionate/salmeterol
  • Mometasone furoate/formoterol fumarate
  • Budesonide/formoterol fumarate dihydrate
  • Fluticasone furoate/vilanterol
37
Q

COPD medications for refractory disease

A
  • Phosphodiesterase inhibitors

- Rofluminast

38
Q

Cystic fibrosis (CF) prevalence

A
  • Most common genetically inherited autosomal recessive disease in Caucasians
39
Q

CF leads to

A
  • Multi-system organ dysfunction

- Majority of morbidity and mortality related to respiratory and gastrointestinal (GI) systems

40
Q

CF pathophysiology involving the lungs includes

A
  • Vicious cycle of infection
  • Inflammation
  • Bronchiectasis
41
Q

CF diagnosis/clinical course

A
  • Diagnosed with a chloride sweat test

- Clinical course includes acute exacerbations and eventual respiratory failure

42
Q

Idiopathic pulmonary fibrosis SXS/clinical manifestations

A
  • Progressive dyspnea

- Chronic cough

43
Q

IPF diagnostic studies

A
  • CXR, PFTs (restrictive pattern), High Resolution CT

- Bronchoscopy: transbronchial biopsy, bronchoalveolar lavage

44
Q

IPF Tx

A
  • Corticosteroids
  • Azathioprine (Imuran)
  • Mycophenolate (CellCept)
  • O2
  • Pulmonary Rehab
45
Q

Pneumoconiosis

A
  • Occupational lung disease

- Caused by the inhalation of dust

46
Q

Types of pneumoconiosis

A
  • Coalworker’s pneumoconiosis (aka “black lung”) – coal dust
  • Asbestosis – asbestos dust
  • Silicosis – silica dust
  • Berylliosis – beryllium dust
47
Q

Pneumoconiosis SXS

A
  • Progressive dyspnea

- Chronic cough

48
Q

Pneumoconiosis Tx

A
  • D/c offending agent
  • Corticosteroids
  • O2
  • Pulmonary rehab
49
Q

Pneumoconiosis diagnostic studies

A
  • CXR, PFTs (restrictive pattern), High Resolution CT

- Bronchoscopy: transbronchial biopsy, bronchoalveolar lavage

50
Q

Sarcoidosis clinical presentation case (50 y/o male example)

A
  • Chronic fatigue, nonproductive cough, dyspnea, anorexia, weight loss, blurred vision, and arthralgias
  • Tells you his “liver tests” have been abnormal
  • Skin findings: reddish-purple, hard (indurated), painful nodules
51
Q

Sarcoidosis CXR findings

A
  • Bilateral hilar lymphadenopathy
52
Q

Sarcoidosis significant lab findings

A
  • AST/ALT, alkaline phosphatase mildly elevated
  • Calcium is elevated
  • PFTs reveal decreased DLCO and FVC
  • ACE level may be elevate
53
Q

Sarcoidosis biopsy

A
  • Diagnostic

- Non-caseating granulomas

54
Q

Sarcoidosis Tx

A
  • First line = corticosteroids
55
Q

CXR in acute respiratory distress syndrome (ARDS) shows

A
  • B/l pulmonary infiltrates
56
Q

ARDS Tx

A
  • Requires special expertise with mechanical ventilation and management of critical illness
  • Tx of underlying condition is essential
  • Supportive care: Appropriate ventilator and fluid management
57
Q

Risk factors for Obstructive Sleep Apnea (OSA)

A
  • Obesity
  • Increased neck diameter (>17cm in men >16cm in women)
  • Abnormal upper airway abnormalities
58
Q

Abnormal upper airway abnormalities that increase risk for OSA

A
  • Macroglossia
  • Long soft palate and uvula
  • Enlarged tonsils
  • Micrognathia
  • Narrow oropharynx
59
Q

Clinical manifestations of OSA

A
  • Morning headaches
  • Recurrent awakenings
  • Daytime somnolence affecting daily activities (including driving)
  • Sleeping partner reporting snoring, periods of apnea, gasping for air
  • HTN
60
Q

Manifestations of extreme cases of OSA

A
  • Hypoxemia and pulmonary vasoconstriction –> pulmonary hypertension and right ventricular failure
61
Q

Sleep Apnea

A
  • Diagnosis = sleep study (Polysomnography)

- Treatment = CPAP machine (most effective)

Internal Medicine (14 decks)

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