Airway Disease TBL

Question 1

Radiographic emphysema

Answer 1

Upper lung lucency

Flattening of the diaphragm

Enlarge dretrosternal clear space

Question 2

Bronchiolitis prsnetation

Answer 2

Dyspnea and dry cough…need CT

Question 3

Spirometry of emphysema

When to order alpha 1 antitrypsin

Answer 3

Obstrutive, increased residual volume and decreased diffusion capcity

CAN be reversible (25%) but is not normally

Young and/or non-smokers

Also if basilar-predominant bullous changes

Question 4

COPD exacerbation

Answer 4

2 of - dyspnea, sputum quantiy, purulence

50% causded by bacteria

Question 5

What is most predictive of airway dz in any patient

Answer 5

Cough and wheezing

Question 6

Hallmark feeling in asthma

Answer 6

Chest tightness

Question 7

PND present in

Answer 7

Both asthma and heart failure

Question 8

Emphysema characterized by (pathology)

Answer 8

Loss of lung tissue and elastic fibers distal to the terminal bronchiole

Leads to loss of radial structures and therefore airwat collapse on expiration

Question 9

What causes dyspnea in emphysema

Answer 9

Loss of radial support structure means more resistance…increase resistance leads to hyperinflantion which means dyspnea due to altered mechanis

Mild resting hypoxemia due to decreased diffusion capaicty but this mild and more on exertion

Rigfht to left shunt normally absent in COPD

Question 10

ARDS

Answer 10

Parenchymal lung injury due to cyokine rlease from type 1 injury

Causes leakage AND low surfatant…this flattens the compliance curve

Hypoxemia, alveolar collapse and DECREASED static compliance

Resistance should be normal (or increased bc of fibrosis)

PEEP can imporve compliance (but not with COPD)

Question 11

What is most likely to cause hypoxemia in emphysema

Answer 11

V/Q inequality

during resting
Alveolar hypoventilation is present when arterial pCO2 is high

Diffusion limitation is more important during exercise***

Question 12

Compliances changes based on

Answer 12

Initial lung volume

Question 13

COPD prognosis and smoiking

Answer 13

FEV1 is related to both prognosis and current smoking

Smoking cessation is the ONLY way to prolong life

Question 14

Centriacinar vs. panacinar

Answer 14

Cent- begins with RB
Panacinar - RB and alveoli

Cent - upper lobe predominant because slower PMN transit so can’t wash out as easy…15-25% of smokes

Pan - basilar predominant…31-42 onset if smoker

Question 15

Biopsy of bronchial mucosa can be used to dx

Answer 15

Ciliary dyskinesia (think situs inversus)…if they have this then prbably bronchiectasis as well

Question 16

Bronchiolitis suggested by

Answer 16

Moasic attenuation or centrilobular micronodules