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airway diseases Flashcards

1
Q

asthma is a chronic inflam condition of the lung, characterized by

A

airway limitation/ obstruction
airway hyperresponsives
airway/ bronchi inflammation

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2
Q

what are two types of asthma

A

extrinsic and intrinsic

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3
Q

what causes extrinsic asthma or allergic asthma

A

common triggers such as dust, animal dander, pollens, fungi

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4
Q

what is extrinsic asthma associated with

A

a history of allergies
symptoms worsen with seasons
increased lvls of igE

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5
Q

tx of extrinsic asthma

A

inhaled corticosteroids
anti-histamines

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6
Q

what is intrinsic asthma

A

non-allergic asthma factors like:
stress
cold air
exercise
resp infections

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7
Q

when does intrinsic asthma start what age

A

middle age with no history of asthma

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8
Q

what is the pathogenesis of asthma

A

airway narrowing due to:
-smooth muscle contraction
-thickening of wall by inflam and cellular infiltrate
-secretions in lumen

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9
Q

how to assess SOB in asthmatic person

A

ability to complete sentences
use of acessory muscles
audible weeze or silent chest
cyanosis

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10
Q

what are shown in investigations in PFTs in asthmatic person

A

PFT: obstructive pattern
low fev , fvc, fev1/fvc ratio

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11
Q

peak expiratory flow rate in asmathic used for what

A

-used for follow up and monitoring patients
-it is gd to be used for bedside to see if pt improving
-lowest value in early morning

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12
Q

what is the normal range of pefr

A

> 400

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13
Q

what is metacholine challenge test used for

A

asymptomatic pts if PFTs are normal
metacholine

(Methacholine is a cholinergic agent that stimulates muscarinic receptors in the airway smooth muscle, causing bronchoconstriction)

Individuals with asthma or hyperresponsive airways experience a greater degree of bronchoconstriction at lower methacholine doses than non-asthmatics.

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14
Q

what are signs of life threatning asthma attack

A

silent chest
cyanosis
weak resp effort
bradycardia
hypotension
arrythmia

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15
Q

acute asthma attack management

A

oxygen (40-60%)
inhaled b2 agonist (salbutamol)
corticosteroids
add iprotromium for moderate to severe attacks

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16
Q

what are features of acute severe asthma attack

A

-inabilty to complete a sentence in one breath
-resp rate of >25 breaths/ min
-tachycardia >110
-PEFR 33-50% of predicted normal or best

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17
Q

what is the results of pft in copd patients in regards to FEV, FEV1/FVC, TLC,RV,FRC

A

FEV= decreased
FEV1/FVC= decreased <70
TLC,RV,FRC = increased (trapped air)

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18
Q

what are risk factors of copd

A

smoking
second hand smoke
alpha 1 antitrypsin deficiency
chronic asthma
infections precepitating cause of acute exacerbations

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19
Q

what will ABG show in copd

A

hypercapnia hypoxemia

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20
Q

two types in copd

A

emphysema and chronic bronchitis

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21
Q

what do pts present with in chronic bronchitis

A

chronic productive cough (sputum) at least 3 months per yr for 2 consec yrs

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22
Q

pathogenesis of chronic bronchitis what happens in the airways

A

-excess mucus production narrows the airways
-inflammation and scarring in airways + enlarged mucus glands + SM hyperplasia —->obstruction

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23
Q

on auscultaion in copd pts what do u hear

A

end - expiratory wheeze
decreased breath sounds
hyperrosance on percussion

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24
Q

signs of chronic bronchitis indicating that its a blue bloater

A

cyanosis
usually overweight
RR normal
tachycardia
signs of high co2= bounding pulse, course flapping tremor, peripheral vasodilation

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25
what is emphysema
permanent enlargement of air spaces distal to terminal bronchioles due to destruction of alveolar walls
26
what exactly happens in emphysema or its pathogenesis in alveolar wall destruction
elastase enzyme is released during inflamation which breaks down elastin in alveolar walls alpha 1antitrypsin inhibits elastase protect elastic recoil of lung
27
what are signs of an emphysema patient indicating pink puffer signs
thin due to increased BMR barrel chest tachypnea breathing thru pursed lips (prevent alveolar and airway collapse) pt in distress using acessory muscles
28
tx of copd
smoking cessation home o2 therapy inhaled bronchodilators
29
what can cause acute copd exacerbation
viral or bacterial infection heart failure pulmonary embolism new onset A.fib
30
what results in permanent dilation of bronchi due to recurrent infection and inflam that lead to fibrosis
bronchiectasis
31
symptoms presented in pt w bronchiectasis
chronic productive cough prulent copious yellow or green sputum dyspnea hemoptysis pleuritic chest pain----> if with infection
32
what are signs on inspection shows bronchiectasis
finger clubbing coarse inspiratory crackles wheeze
33
what are investigations to order for bronchiectasis pt
sputum culture chest x ray high resolution CT: gold standard spirometry: obstructive sweat test and CF genetic assessment---> cystic fibrosis
34
what would chest x ray show in bronchiectasis
chest x ray : shadow, thickened bronchial walls (tramline and ring shadow)
35
if pseudomans exacerbation in bronchiectasis what antibiotic would u use
ciprofloxacin dual if resistance common
36
if h.influenza exacerbation in bronchiectasis what antibiotic to use
co-amoxiclav
37
mutation in what causes cystic fibrosis
genetic mutation of CFTR on chrom 7 ( a chloride channel and regulatory protein found in epithelial cell membranes in lungs, pancreas, gi ) responsible for chloride and water transport
38
what happens in cystic fibrosis
abnormal ion transport ----> increased salt content in sweat gland secretions, alter viscosity, and tenacity of mucus.
39
what is a pneumonic to help remember features of cystic fibrosis
C.F. PANCREAS C: Chronic cough • Persistent productive cough and recurrent respiratory infections. F: Failure to thrive • Poor weight gain and growth due to malabsorption. P: Pancreatic insufficiency • Steatorrhea (fatty stools), malabsorption, and vitamin deficiencies (A, D, E, K). A: Autosomal recessive • Inheritance pattern of CF caused by mutations in the CFTR gene. N: Neonatal complications • Meconium ileus in newborns is often the first sign of CF. C: Clubbing • Digital clubbing due to chronic hypoxia. R: Recurrent respiratory infections • Colonization by organisms like Pseudomonas aeruginosa and Staphylococcus aureus. E: Electrolyte abnormalities • Salty sweat due to high chloride levels, detected by the sweat chloride test. A: Absence of vas deferens • Causes infertility in males. S: Sinusitis • Chronic sinus infections and nasal polyps.
40
what causes reccurent chest infections in pts with cystic fibrosis
decreased airway surface liquid layer--> impaired ciliary function--> retention of mucoprululent secretions--> mucus stasis and airway inflam
41
what are the infections that happen below 10 yrs and after 10 yrs on CF pts
staph aures (below 10 yrs of age) pseudomonas (after 10 yrs of age)
42
what can be seen on examination of CF patients
clubbing hyperinflated lung coarse inspiratory crackles w/wout expiratory wheeze
43
diagnosis of CF
-sweat test ---> increased chloride concentration -neonatal heel prick screening at birth (measure immunoreactive trypsinogen) -genetic testing
44
what is cessation of breathing for more than 10secs for multiple times during sleep, bcz of upper airway obstruction since muscles hypotonic
obstructive sleep apnea
45
what happens to nasal and resp effort in OSA
nasal effort reduced but resp effort maintained (thoracoabdominal movement)
46
what are risk factor of obstructive sleep apnea
obese patients BMI>30 large tongue hypothyroidism acromegaly goiter male gender post menopausal women age >40 down syndrome
47
what are nocturnal symptoms of OSA
loud snoring nocturia insomnia restless sleep gasping choking
48
how to diagnose obstructive sleep apnea
sleep study --> 10-15 apneas in 1 hr of sleep diagnostic Epworth sleepiness scale pt asked how much he sleeps in random places if more than 10 has sleep disorder
49
how to differ btwn OSA and central sleep apnea
in central sleep apnea there is no resp movement
50
causes of central sleep apnea
post-trauma heart failure cheyne-stokes breathing stroke opioids
51
what happens in tubercolosis
inhalation of aerosal droplets containing M.tubercolosis (aerobic intracellular pathogen) deposit in lungs
52
what are four outcomes that can happen if someone sneezed and has TB on the face of another
1) immediate clearance of organism no infection 2) primary disease: immediate onset of active disease 3) latent infection: infected by TB but infection is contained by immune system and pt develops cell-mediated immunity 4) reactivation disease: onset of active disease many yrs following period of latent
53
features of primary TB
-initial infection after exposure -often asymptomatic or mild flu like symptoms -upper region of lungs -formation of ghon focus: granulomatous lesion - ghon complex
54
define ghon focus and ghon complex
-ghon focus: primary lung lesion in lung tissue central areas of cessation surrounded by epitheloid and giant langerhan cells is the initial infection site in lungs when person gets TB -ghon complex: when ghon focus spreads to nearby LNs form larger infected area
55
what type of TB is where majority heal and calcify
primary TB
56
what are symptoms of active TB
fever night sweats weight loss cough : dry-purulent-hemoptysis apical areas
57
what are the most common areas for TB to form
1) lungs 2) LNs 3) Gi= ileocecal region (like crohns)
58
what does miliary TB look like
-hematogenous dissemination by presence of small, firm white nodules -mostly in lungs, LN, bones
59
diagnosis of TB in chest x ray
upper lobe patchy/nodular infiltration with cavities
60
tx of Tb
RIPE therapy Rifampin isoniazid pyrazinamide Ethambutol initial phase: those 4 for 2 months continuation phase: isoniazid and rifampin for 4 months total tx plan is 6months
61
side effects of RIPE drugs
isoniazid : allergic reactions, peripheral neuropathy, give vit b6 rifampicin: body secretions PINK pyrazinamide: hyperurecemia, gout, rash (contra in preg) ethambutol: optic neuritis hepatotoxicity: RIP
62
how is latent TB detected
by injecting TB antigen intradermaly PPD or Interferon gamma assay (IGRA) PPD is +ve depending on size of indurance not redness
63
latent TB tx
Tx is isoniazid for 9months continued

resp (4 decks)

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