9: Pulmonary (Quiz W10)

Question 1

Obstructive Dz

Answer 1

Emphysema
Chronic Bronchitis
Asthma
Bronchiectasis
CF
lung CA

Question 2

Restrictive Dz

Answer 2

ARDS
Chronic- interstitial fibrosis (eg sarcoidosis), pneumoconiosis, granulomatous
Chest wall deformities
Neuromuscular
lung CA

Question 3

Spirometry

Answer 3

in office lung eval
FVC- forced vital capacity; >80% normal
FEV1: forced expiratory volume in 1 second; >80% normal

Question 4

FEV1:FVC <0.7

Answer 4

obstructive disease

*this will diagnose COPD

Question 5

FEV1:FVC >0.7

Answer 5

restrictive disease

Question 6

DLCO

Answer 6

Diffusing capacity of gas across the lungs

Question 7

Methacholine challenge

Answer 7

evaluates bronchial hypereactivity (asthma)

if suspect asthma and spiro is normal, do this!

Question 8

FEF25-75

Answer 8

Forced expiratory flow 25-75%. More sensitive than FEV1, determines early obstructive disease.
>60% normal small airway obstruction
40-60% Mild small airway obstruction
20-40% Moderate small airway obstruction
< 10% Severe small airway obstruction

Question 9

Emphysema

Answer 9

enlargement of airspace distal to terminal bronchiole with destruction of alveolar walls
dyspnea, minimal cough, hyperinflated lung capacity, tachypnic
Ventilation > Perfusion = some areas are ventilated but not perfused thus dead space

Question 10

Chronic bronchitis

Answer 10

cough, sputum production, likely RCHF/cor pulmonale, overweight, normal resp rate
Perfusion>Ventilation= partial oxygenation of mixed venous blood

Question 11

COPD RFs

Answer 11

1 smoking

air pollution, second hand smoke, industrial pollutants
A1AT (if FHx, nonsmoker, onset 30-50 yrs)

Question 12

COPD Pathophysiology

small airway dz

Answer 12

Airway inflammation, fibrosis, epithelial hyperplasia, luminal plugs, increased airway resistance, narrowing of the terminal airways
parenchymal destruction

Question 13

COPD Pathophys

parenchymal destruction

Answer 13

Loss of alveolar attachments, decrease of elastic recoil

• -> irreversible enlargement of airspaces distal to the terminal bronchial
• -> FEV1 decline, air trapping, and hyperinflation

Question 14

COPD Centrilobar

Answer 14

heavy smokers

central acini affected, severe in upper lobes

Question 15

COPD Panacinar

Answer 15

acini uniformly enlarged, severe in lower lobes

A1AT deficiency

Question 16

COPD PEs

Answer 16

pulse ox
increased AP chest diameter
tripod, accessory muscles
Auscultation: decreased breath sounds, crackles at bases
Hyperresonant
Cyanosis, weight loss
6 minute walk test

Question 17

COPD Xray

Answer 17

usu normal

may be hyperinflation, hyperlucency

Question 18

COPD EKG changes

Answer 18

if RVH- tall P wafes, tall R waves in V1/V2

Question 19

COPD Sequalae

Answer 19

VD, Osteoporosis, Respiratory infxn, anxiety, depression, cognitive deficits, diabetes, lung cancer, bronchiectasis

Question 20

COPD Work up: Sx Questionnaire

Answer 20

COPD Assessment Test
Clinical COPD Questionnaire
mMRC Breathlessness Scale

Question 21

COPD Work up: Spirometry

Answer 21

spiro AFTER SABA to remove bronchospasm component

Question 22

COPD Work Up: Exacerbation risk

Answer 22

2+ exacerbations in last year or FEV1 <50% predicted?

Question 23

Normal (GOLD scale)

Answer 23

FEV1 >85% predicted

Question 24

Mild (GOLD 1)

Answer 24

FEV1 > 80% predicted

Question 25

Mod (GOLD 2)

Answer 25

FEV1 50-79% predicted

Question 26

Severe (GOLD 3)

Answer 26

FEV1 30-49% predicted

Question 27

Very Severe (GOLD 4)

Answer 27

FEV1 <30% predicted

Question 28

Labs/Imaging COPD

Answer 28

arterial blood gases, A1AT if new dx

CXR, Chest CT

Question 29

COPD Tx- Lifestyle

Answer 29

smoking cessation
physical activity
pneumococcal vaccine
reduce occupational exposures

Question 30

COPD TX- Naturopathic

Answer 30

bronchodilators- ephedra. belladonna, lobelia
mucolytics- lobelia, lomatia, grindelia, usnea, psha, ephedra, NAC
resp analgesic- tessalon perles
anti-ox- carotendoids, vit A, nebulized GSH

ginseng, omega3s

Question 31

COPD Tx- Rx

Answer 31

SABA (Albuterol)
LAMA (Ipratroprium)
LABA (Salmeterol)
corticosteroids- if FEV1<60%
PDE-4 inhibitors-if GOLD 3/4
oxygen therapy if <88% pulse ox

Question 32

Asthma

Answer 32

REVERSIBLE obstrxn, characterized by bronchospasm, mucosal edema, excessive viscous mucous

FEV1 >12% after albuterol

Question 33

Extrinsic asthma

Answer 33

allergic, atropic

Question 34

Intrinsic asthma

Answer 34

non-atropic

assoc with non-immunologic stimuli (cold air, emotions, exercise)

Question 35

Asthma tx

Answer 35

avoid food preservatives and salicylates (berries, dried fruit, licorice, nuts)
exercise
vit Bs, C, D, EFAs
IV Mag
Botanicals- butterbur, ginkgo, tylophora indica

Question 36

Acute asthma attack botanical formula

Answer 36

Lobelia
ephedra
capsicum

Question 37

Asthma Pharmaceuticals

Answer 37

in this order!!

1) SABA
2) inhaled steroid
3) LABA
4) Leukotriene receptor antagonist- Montelukast
5) Theophylline-prophylaxis
6) Mast cell stabilizer-prophylaxis

Question 38

Bronchiectasis Pathophys

Answer 38

mucous accumulation inflammation widening of airways deformity of airways chronic infection and blocked airways.

50% from CF

Question 39

Bronchiectasis Labs/Imaging

Answer 39

CXR followed by Chest CT- Bronchial wall thickening luminal dilation ( not seen with COPD)
Spirometry
Sputum culture
CBC and total serum antibodies

Question 40

Bronchiectasis Conventional management

Answer 40

Abx for acute/prophylaxis
physiotherapy- coughing, postural drainage, clapping
steroids

Question 41

Bronchiectasis ND Tx

Answer 41

mucous thinner- bromelain, proteolytic enzymes, NAC
nebulized hypertonic saline
physiotherapy- CH, diathermy