B2.058 Big Case Jackie Wright Flashcards
what can be seen on a chest x-ray of a COPD patient?
enlarged lungs
“small” heart
flattened diaphragm
what is spirometry?
measures the volume of air exhaled at specific time points during a forceful and complete exhalation after a maximal inhalation
FVC
forced vital capacity
total exhaled volume
FEV1
volume exhaled in the first second
what is a normal vs COPD value of FEV1/FVC?
normal - 80%
COPD - 60%
what is GOLD staging?
global initiative for chronic obstructive lung disease
severity staging system based on airflow limitations
outline the 4 GOLD stages
1: mild, FEV1>80% of normal
2: moderate, FEV = 50-79% normal
3: severe, FEV1 = 30-49% normal
4: very severe, FEV1 <30% of normal or <50% of normal w presence of chronic respiratory failure present
what is a criticism of GOLD staging?
may be insensitive in early stages
define chronic bronchitis
bronchial wall thickening may be seen in addition to enlarged vessels
repeated inflammation can lead to scarring with bronchovascular irregularity and fibrosis
define emphysema
alveolar septal destruction and airspace enlargement
where is centrilobular emphysema found?
upper lobes
where is panlobular emphysema found?
lower lobes
what are 5 types of obstructive pulmonary disease and what anatomic sites so they affect?
chronic bronchitis- bronchus bronchiectasis- bronchus asthma- bronchus emphysema- acinus small airway disease/ bronchiolitis - bronchiole
what are major pathologic changes and associated signs/symptoms in chronic bronchitis?
mucous gland hypertrophy and hyperplasia, hypersecretion
cough, sputum production
what are major pathologic changes and associated signs/symptoms in bronchiectasis?
airway dilation and scarring
cough, purulent sputum, fever
what are major pathologic changes and associated signs/symptoms in asthma?
smooth muscle hypertrophy and hyperplasia, excessive mucous, inflammation
episodic wheezing, coughing, dyspnea
what are major pathologic changes and associated signs/symptoms in emphysema?
air space enlargement, wall destruction
dyspnea
what are major pathologic changes and associated signs/symptoms in bronchiolitis?
inflammatory scarring, partial obliteration of bronchioles
cough, dyspnea
what are some ways to distinguish bronchitis from emphysema?
age: 40-45 B, 50-75 E
dyspnea: mild B, severe E
cough: early, copious sputum B, late, scanty sputum E
infections: common B, occasional E
cor pulmonale: common B, rare/terminal E
chest x-ray: prom vessels, large heart B, hyperinflation, small heart E
appearance: blue bloater B, pink puffer E
what are some causes of COPD?
smoking, industrial exposure, cystic fibrosis, alpha-1-antitrypsin deficiency, vasculitides, connective tissue disorders, IV drug uses, immune deficiency syndromes
how do you treat COPD?
try to stabilize disease
goals: decrease symptoms,, decrease exacerbations, improve function
regular treatment with a long acting bronchodilator, based on symptom relief
short acting bronchodilator available for symptom control as needed
smoking cessation, exercise, vaccines
what are some features of exacerbation of COPD?
dyspnea cough sputum production wheezing distant breath sounds tachypnea tachycardia use of accessory muscles brief, fragmented speech inability to lay supine agitation
how would you work up a patient with an exacerbation of COPD?
assess Osat w pulse oximetry
obtain ABG and PaCO2
DO NOT assess spirometry in acute severe COPD exacerbations
obtain chest x-ray
obtain CBC, electrolytes, BUN, and creatinine
test for flu
get ECG
