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Clin Med 1 - Exam 2 > Chronic Obstructive/Infiltrative Lung Diseases > Flashcards

Chronic Obstructive/Infiltrative Lung Diseases Flashcards

1
Q

Name some non-lung disorders caused by cystic fibrosis in adults

A

Aspermia

Pancreatic exocrine insufficiency

Chronic sinusitis

Nasal polyps

Bone disease

Hepatobiliary disease

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2
Q

Describe how the GOLD assessment tool guides treatment in COPD

A

Based on exacerbation history per year

2 or more moderate exacerbation OR any hospitalization = LAMA (tiotropium) + LABA (salmeterol, formoterol)

0-1 moderate exacerbations WITHOUT hospitalization = Bronchodilator (just tiotropium) OR LAMA + LABA
Determination made based on breathlessness questionnaire

ALL COPD patient get albuterol for PRN

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3
Q

Physical signs in asbestosis

A

Fine-end expiratory rales

Digital clubbing

Cor pulmonale (late disease)

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4
Q

Increased levels of ACE would be seen in these four chronic diffuse infiltrative lung diseases

A

Beryliosis

Asbestosis

Silicosis

Sarcoidosis

(ACE increased in BASS)

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5
Q

Apart from antibiotics/antivirals, what three things are used to treat an exacerbation of COPD?

A

Supplemental oxygen 88-92%

SABA (albuterol/levalbuterol) with or without ipratropium

Systemic steroids for up to two weeks

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6
Q

This chronic diffuse infiltrative lung disease is associated with increased collagen in the extra-cellular matrix

A

Idiopathic pulmonary fibrosis

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7
Q

This chronic diffuse infiltrative lung disease is associated with the bite of the wolf

A

Sarcoidosis

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8
Q

This chronic diffuse infiltrative lung disease will show bilateral hilar lymphadenopathy on chest x-ray

A

Sarcoidosis

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9
Q

Which pneumoconiosis can be most acute and show symptoms within 4-8 hours of exposure?

A

Hypersensitivity pneumonitis (includes farmer’s lung)

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10
Q

Most common cause of bullous lung disease

A

Smoking

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11
Q

Patients with this pneumoconiosis would have pleural plaques on their chest x-ray

A

Asbestosis

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12
Q

How is a cystic fibrosis newborn screening confirmed?

A

Sweat chloride test

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13
Q

Which chronic diffuse infiltrative lung disease shows bilateral reticular or reticularnodal infiltrates on chest x-ray

A

Malignant diffuse infiltrative lung disease

(Pulmonary lymphangitic carcinomatosis)

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14
Q

Name three cancer medications that cause chronic diffuse infiltrative lung diseases

A

Bleomycin

Cyclophosphamide

Methotrexate

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15
Q

Which antibiotics are best for treatment of COPD exacerbations?

A

Macrolides (azithromycin)

Ciprofloxacin (fluroquinolone)

2nd/3rd gen cephalosporins

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16
Q

How to diagnose chronic diffuse infiltrative lung disease caused by illicit drugs?

A

Biopsy is needed to confirm

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17
Q

This chronic diffuse infiltrative lung disease is three times more common in blacks

A

Sarcoidosis

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18
Q

Average age for bronchiectasis

A

60+

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19
Q

How long after initiation of amiodarone could a chronic diffuse infiltrative lung disease show up?

A

Two months to two years

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20
Q

This obstructive lung condition is triggered by infection and impaired drainage (usually cystic fibrosis)

A

Bronchiectasis

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21
Q

Which pneumoconiosis is least likely to lead to fibrosis?

A

Hypersensitivity pneumonitis (includes farmer’s lung)

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22
Q

How many COPD cases are due to smoking?

A

80-90%

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23
Q

Which pneumoconiosis is associated with egg-shells on chest x-ray?

A

Silicosis

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24
Q

Describe process of bullous lung disease

A

Alveoli distend and leak air

Big bullae forms

Bullae presses on functional lung tissue like a mass would

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25
Q

Physical exam sign for bronchiectasis

A

Inspiratory rales

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26
Q

Which two obstructive lung diseases might show bullae on CT?

A

Bullous lung disease

Alpha-1 antitrypsin deficiency

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27
Q

How many years of exposure are needed before there is a risk of developing coal worker’s pneumoconiosis?

A

10+ years

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28
Q

True or false. Corticosteroids are useful in treatment of nitrofurantoin induced infiltrative lung disease

A

False.

Symptoms resolve within four days of stopping med

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29
Q

History is important in diagnosing chronic diffuse infiltrative lung diseases because they are commonly caused by these two things

A

Occupation/exposures

Drugs (medications and illicit)

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30
Q

What is the average age of sarcoidosis onset?

A

50+

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31
Q

Name two non-cancer medications that cause diffuse infiltrative lung disease

A

Nitrofurantoin (Macrobid)

Amiodarone

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32
Q

Name the illicit drugs that can cause chronic diffuse infiltrative lung disease

A

Amphetamines or narcotics with TALC

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33
Q

Is a CT scan necessary for COPD diagnosis?

A

No, mostly used if there are complications like pneumonia or pneumothorax

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34
Q

When should antivirals be used in treatment of COPD exacerbation?

A

If influenza or covid are causing exacerbation.

Must be used EARLY to be effective.

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35
Q

Name the three structural changes in bronchi in chronic bronchitis

A

Inflammation

Metaplasia

Gland enlargement

36
Q

In farmer’s lung, which bacteria causes a hypersensitivity reaction?

A

Actinomyces - found in hay mold

37
Q

Are chronic diffuse infiltrative lung diseases more obstructive, restrictive, or a mix of both?

A

Restrictive

38
Q

In anti-GBM antibody lung disease (Goodpasture’s) which other organ may be affected?

A

Kidneys

39
Q

How is beryliosis diagnosed?

A

BeLPT blood draw (berylium levels in blood)

40
Q

Three treatments for cystic fibrosis

A

Manage infections (chronic azithromycin)

Inhaled DNase (mucolytic)

Inhaled hypertonic saline (draw H2O into airway)

41
Q

COPD most common symptoms

A

Shortness of breath

Chronic cough

42
Q

Which four vaccinations are helpful supportive treatment in COPD patients?

A

Influenza

Pneumococcal

COVID

RSV

43
Q

True or false. Supplemental oxygen use as needed improves survival rates in COPD.

A

False.

Long-term oxygen only improves survival rate if used 24/7

44
Q

Best imaging type for bronchiolitis obliterans

A

High res CT

45
Q

This pneumoconiosis may develop into PMF (progressive massive fibrosis)

A

Coal worker’s pneumoconiosis

PMF = black lung

46
Q

Name three genetic obstructive lung diseases

A

Alpha-1 antitrypsin deficiency

Cystic fibrosis

Primary Ciliary Dyskinesia

47
Q

Which pneumoconiosis shows up 20 to 30 years after initial exposure?

A

Absestosis

48
Q

Treatment for anti-GBM antibody lung disease (Goodpasture’s)

A

Plasmapheresis (take plasma out and remove antibodies)

49
Q

Which lung disorder is known as “super emphysema”

A

Bullous lung disease

50
Q

What is the goal level for SaO2 maintenance in COPD?

A

> 90%

51
Q

This chronic diffuse infiltrative lung disease is associated with clubbing of digits and will show honeycombing on high resolution CT scans

A

Idiopathic pulmonary fibrosis

52
Q

What test is needed for diagnosis of primary ciliary dyskinesia?

A

Biopsy - to look at cilia

53
Q

In newborns with cystic fibrosis, you might see this unique sign

A

Meconium ileus

54
Q

Explain the staging of COPD diagnosis/classification

A

In all stages FEV1/FVC ration <0.7

Stages based on FEV1 %

Stage 1: 80-100%
Stage 2: 50-80%
Stage 3: 30-50%
Stage 4: 0-30%

55
Q

Which obstructive lung condition is described as “pan-acinar”?

A

Alpha-1 antitrypsin deficiency

Pan-acinar = affects all terminal airways

56
Q

Half of patients with this obstructive lung disease have their organs on the wrong side (situs inversus)

A

Primary ciliary dyskinesia

57
Q

This chronic diffuse infiltrative lung disease mimics pneumonia but the patient does not improve with antibiotics

A

BOOP

Bronchiolitis obliterans organizing pneumonia

58
Q

When should antibiotics be considered in the treatment of a COPD exacerbation?

A

If increased dyspnea/sputum/purulence or any of the following risk factors:

  • Age 65+
  • FEV1 <50%
  • On continuous supplemental O2
  • CHF/CAD
59
Q

How long must a patient have had a productive cough in order to classify as chronic bronchitis?

A

At least 3 months for two years in a row

60
Q

Explain alveolar changes in emphysema

A

Walls of parenchyma (functional unit of alveoli) break down (due to things like smoking).
Alveoli turns into one big chamber, rather than lots of small rooms.
Air circulates inside alveoli but can’t get out.

61
Q

Two diagnostic methods for alpha-1 antitrypsin deficiency

A

CT = basilar bullae (bubbles at lung base)

Serum AAT levels

(also genetic testing)

62
Q

This pneumoconiosis is associated with at least five years exposure to sandblasting, stone work or foundry work

A

Silicosis

63
Q

What would you expect to see on spirometry in COPD?

A

Reduced FEV1/FVC ratio (obstructive)

Increased residual volume

Increased total lung capacity

64
Q

Which chronic diffuse infiltrative lung disease, of known etiology, has the symptoms that progress most quickly?

A

Malignant diffuse infiltrative lung disease

(Pulmonary lymphangitic carcinomatosis)

65
Q

At what O2 levels should supplemental oxygen be ordered in COPD patients?

A

PaO2 <55

SaO2 <88%

66
Q

Which condition shows tram-track signs and ring shadows

A

Bronchiectasis

67
Q

What is the most common chronic diffuse infiltrative lung disease?

A

Idiopathic pulmonary fibrosis

68
Q

Between what ages is COPD most common?

A

40-79

69
Q

Most common symptom in anti-GBM antibody lung disease (Goodpasture’s)

A

Gross hematuria

(also some hemoptysis)

70
Q

True or false. Patients with bronchiolitis obliterans will have relief with bronchodilators.

A

False.

Can’t dilate scar tissue

71
Q

Cystic fibrosis patients have a genetic defect that leads to this …

A

Chloride channels don’t work

Leads to dry sputum

Mucus plugs airways

Causes secondary bacterial infections, persistent inflammation, bronchiectasis

72
Q

What would be seen on chest x-ray for a patient with bronchiectasis?

A

Thickened bronchial walls - tram-track sign

Ring shadows

73
Q

Definition of chronic obstructive pulmonary disease

A

Lung condition characterized by chronic dyspnea, cough, and exacerbations

74
Q

Which occupation is beryliosis associated with?

A

Metal/electronics manufacturing

75
Q

This pneumoconiosis shows hilar lymph node calcification and central nodular opacities on CT

A

Silicosis

76
Q

This obstructive lung disease may be seen in patients with a history of chronic respiratory infections, such as RSV, as a child

A

Bronchiolitis obliterans

77
Q

In alpha-1 antitrypsin deficiency what other organ (apart from lungs) might show damage?

A

Liver

(hepatitis, cirrohsis, hepatocellular carcinoma)

78
Q

Average age of onset for alpha-1 antitrypsin deficiency symtpoms

A

45-50

35-40 in smokers

79
Q

Best diagnostic test for anti-GBM antibody lung disease (Goodpasture’s)

A

Serology - need to find anti-GBM antibodies in the blood

80
Q

Why do patients with COPD get recurrent lower respiratory tract infections?

A

Metaplasia of cells lining airway = loss of cilia = less expulsion of bacteria/viruses = more infections

81
Q

Why do patients with COPD have chronic coughs?

A

Lack of cilia due to metaplasia makes it harder for them to expel mucus, especially in chronic bronchitis

82
Q

What might you see on chest x-ray in COPD?

A

Hyperinflation of lungs, flat diaphragm

83
Q

Primary ciliary dyskinesia symptoms

A

Otitis media

Daily productive cough since birth

84
Q

Treatment for sarcoidosis

A

Glucocorticoids

85
Q

The biggest thing you can do do help COPD patients (will help the most) is …

A

Smoking cessation

Clin Med 1 - Exam 2 (5 decks)

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