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RESPIRATORY EXAM 1 > CLINICAL 1 > Flashcards

CLINICAL 1 Flashcards

1
Q

Mortality from asthma is highest in which demographic?

A

African Americans and Hispanics

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2
Q

What are the 3 aspects of asthma pathophysiology?

A

Smooth muscle dysfunction, airway inflammation, and airway remodeling

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3
Q

Which drugs block the production of phospholipase A2?

A

Corticosteroids

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4
Q

The monoclonal antibody to IgE is:

A

Omalizumab

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5
Q

What is the effect of airway remodeling on FEV?

A

Decrease

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6
Q

How does asthma differ from COPD w/ respect to symptomatology?

A

COPD has continuous Sx and asthma has intermittent Sx

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7
Q

T/F: Airway remodeling only occurs in moderate to severe asthma and not in mild cases

A

False! Airway remodeling occurs even in mild cases of asthma

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8
Q

Susie has symptoms of asthma 3 nights per week, her disease severity is best classified as:

A

Moderate Persistent Asthma; daily or > 1 night/week

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9
Q

Jim has Sx of asthma once per week what is his disease severity?

A

Mild intermittent; <2 nights/month

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10
Q

Jared has asthma Sx 3 nights per month, what is his disease severity?

A

Mild persistent asthma; >2 d/wk BUT 2 nights per month

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11
Q

How do you define mild intermittent asthma?

A

Asthma Sx that occur <2 nights/ month

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12
Q

How do you define mild persistent asthma?

A

Asthma Sx that occur >2/wk BUT less than 1/ day OR >2 nights/month

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13
Q

How do you define moderate persistent asthma?

A

Daily or 1 night a week

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14
Q

How do you define severe persistent asthma?

A

Frequent and continual

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15
Q

What is the most effective drug for LONG TERM CONTROL of asthma?

A

Inhaled corticosteroids

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16
Q

What is the MOA of omalizumab? What are the limitations?

A

It is a monoclonal antibody against IgE that binds at C-epsilon domain NOT Fc, limitations are COST and ANAPHYLAXIS

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17
Q

What is the effect of asthma on FEV1 over time compared to normal population?

A

The rate of decrease of FEV1 with age is steeper, everyone’s FEV1 decreases with age.

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18
Q

Which type of helper T cell underlies asthma?

A

TH2

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19
Q

What does the number of eosinophils seen in Bx tell you about the severity of asthma?

A

The number of eosinophils parallels the severity of the Dz

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20
Q

Which disease is an airway obstructive disease associated with bronchial hyperresponsiveness?

A

ASTHMA

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21
Q

What is the pathologic finding of chronic inflammation in asthma?

A

Airway remodeling

22
Q

What is at the cornerstone of Tx for asthma?

A

Corticosteroids

23
Q

What is the relationship between the number of hours an individual slept the previous night and how quickly they fall asleep?

A

The less sleep you got last night, the quicker you will fall asleep tonight

24
Q

What are the major presenting characteristics of sleep apnea (4)

A

1) Middle aged, 2) male who 3) snores and has 4) excessive daytime somnolence? Also, post-menopausal, obese, and systemic HTN

25
Q

Name 7 anatomical risk factors for sleep apnea:

A

1) Adenotonsillar hypertrophy 2) Goiter 3) TMJ disorder 4) obesity 5) Nasal polyps/Septal deviation 6) Kyphoscoliosis and 7) micrognathia

26
Q

Name 6 MEDICAL risk factors for sleep apnea:

A

1) Hypothyroidism 2) Myxedema 3) Androgen therapy 4) Amyloid deposit in throat 5) Myotonic dystrophy and 6) DOWN’S SYNDROME

27
Q

Does sleep apnea affect oxygen saturation?

A

yes and the more severe the disease the lower the O2 Sat

28
Q

What is a “Chin EMG”?

A

Measures the tonicity of the muscles near the chin, hypertonic muscles while sleeping = probably sleep apnea

29
Q

A “Pickwickian” satisfies what 3 criteria?

A

The are 1) obese and have 2) obstructive sleep apnea and 3) have decreased alveolar ventilation WHILE AWAKE

30
Q

A patient who has sleep apnea tells you he wants to take Zzquil to help him get a better night’s sleep, why is this a bad idea?

A

CNS depressants (like diphenhydramine = Zzquil) WORSEN sleep apnea

31
Q

A tongue retaining device is best for sleep apnea due to?

A

Macroglossia

32
Q

What are the 2 most effective treatments for sleep apnea?

A

CPAP and BPAP

33
Q

We spend most of our night in this stage of sleep:

A

Stage 2

34
Q

How often does REM occur? Which muscles are not paralyzed in REM?

A

Every 90 minutes; diaphragm and extraocular eye muscles

35
Q

A person who acts out their dreams has what disorder? What is a precursor to?

A

REM behavior disorder; precursor to parkinsonisms and dementia

36
Q

As a result of our normal circadian rhythms what is our body temperature relative to set point when we are sleepy? Which stage of sleep is most similar to waking life?

A

Temp is lower at bedtime; Stage 1

37
Q

What is the major COST of disturbed sleep (i.e. apnea)? What is the most frequent sleep disturbance in the elderly?

A

Accident prone behavior; frequent awakenings

38
Q

What is the 4th leading cause of death in the USA and projected to reach #3 by 2020?

A

COPD has continuous Sx and asthma has intermittent Sx

39
Q

What are the most common clinical features of COPD? (chronic bronchitis)

A

Lots of sputum, persistent cough for greater than 3 months of the past 2 years and DYSPNEA

40
Q

Why is COPD so highly underdiagnosed?

A

Because a lot of people wait until they are symptomatic to seek Tx, and at that point a lot of lung parenchyma is lost

41
Q

Which type of cell is most directly responsible for COPD?

A

NEUTROPHILS–secreting their proteases

42
Q

Why is there mucociliary dysfunction in COPD?

A

Because there is goblet cell hyperplasia leading to more mucus and simultaneous decrease in cilia

43
Q

What does Rowane say happens to BMI in COPD?

A

Decreases; keep in mind that this is true for emphysema but chronic bronchitis pts are blue BLOATERS, but if the Q just says COPD say they are thinner

44
Q

In general what do drugs for the Tx of COPD do, what can they not do?

A

They are essentially good for Sx and quality of life bu they DO NOT MODIFY the rate of decline in lung function

45
Q

What is DOC for COPD associated with chronic bronchitis?

A

Inhaled corticosteroids

46
Q

How many americans have COPD? What is the major demographic? Why?

A

20 million, mostly women because teenage girls think it’s cool to smoke

47
Q

Below what threshold FEV1/FVC ratio do people officially have COPD?

A

0.7

48
Q

What is the major risk factor for the development of COPD?

A

Cigarrette smoke

49
Q

What are 4 impedences to airflow in COPD?

A

Airway secretions, mucosal edema, decreased airway caliber from bronchospasm or collapse of airways from loss of elasticity

50
Q

What underlies acute exacerbations (decompensation) of COPD?

A

Something that worsens airflow ON TOP OF the COPD, such as infection or cancer etc.

51
Q

Which drugs can Tx the structural changes of COPD such as airway fibrosis and pulmonary HTN?

A

NONE

52
Q

What bacteria commonly infects COPD patients?

A

Haemophilus influenzae

RESPIRATORY EXAM 1 (8 decks)

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