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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
Name 7 anatomical risk factors for sleep apnea:
1) Adenotonsillar hypertrophy 2) Goiter 3) TMJ disorder 4) obesity 5) Nasal polyps/Septal deviation 6) Kyphoscoliosis and 7) micrognathia
26
Name 6 MEDICAL risk factors for sleep apnea:
1) Hypothyroidism 2) Myxedema 3) Androgen therapy 4) Amyloid deposit in throat 5) Myotonic dystrophy and 6) DOWN'S SYNDROME
27
Does sleep apnea affect oxygen saturation?
yes and the more severe the disease the lower the O2 Sat
28
What is a "Chin EMG"?
Measures the tonicity of the muscles near the chin, hypertonic muscles while sleeping = probably sleep apnea
29
A "Pickwickian" satisfies what 3 criteria?
The are 1) obese and have 2) obstructive sleep apnea and 3) have decreased alveolar ventilation WHILE AWAKE
30
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?
CNS depressants (like diphenhydramine = Zzquil) WORSEN sleep apnea
31
A tongue retaining device is best for sleep apnea due to?
Macroglossia
32
What are the 2 most effective treatments for sleep apnea?
CPAP and BPAP
33
We spend most of our night in this stage of sleep:
Stage 2
34
How often does REM occur? Which muscles are not paralyzed in REM?
Every 90 minutes; diaphragm and extraocular eye muscles
35
A person who acts out their dreams has what disorder? What is a precursor to?
REM behavior disorder; precursor to parkinsonisms and dementia
36
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?
Temp is lower at bedtime; Stage 1
37
What is the major COST of disturbed sleep (i.e. apnea)? What is the most frequent sleep disturbance in the elderly?
Accident prone behavior; frequent awakenings
38
What is the 4th leading cause of death in the USA and projected to reach #3 by 2020?
COPD has continuous Sx and asthma has intermittent Sx
39
What are the most common clinical features of COPD? (chronic bronchitis)
Lots of sputum, persistent cough for greater than 3 months of the past 2 years and DYSPNEA
40
Why is COPD so highly underdiagnosed?
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
Which type of cell is most directly responsible for COPD?
NEUTROPHILS--secreting their proteases
42
Why is there mucociliary dysfunction in COPD?
Because there is goblet cell hyperplasia leading to more mucus and simultaneous decrease in cilia
43
What does Rowane say happens to BMI in COPD?
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
In general what do drugs for the Tx of COPD do, what can they not do?
They are essentially good for Sx and quality of life bu they DO NOT MODIFY the rate of decline in lung function
45
What is DOC for COPD associated with chronic bronchitis?
Inhaled corticosteroids
46
How many americans have COPD? What is the major demographic? Why?
20 million, mostly women because teenage girls think it's cool to smoke
47
Below what threshold FEV1/FVC ratio do people officially have COPD?
0.7
48
What is the major risk factor for the development of COPD?
Cigarrette smoke
49
What are 4 impedences to airflow in COPD?
Airway secretions, mucosal edema, decreased airway caliber from bronchospasm or collapse of airways from loss of elasticity
50
What underlies acute exacerbations (decompensation) of COPD?
Something that worsens airflow ON TOP OF the COPD, such as infection or cancer etc.
51
Which drugs can Tx the structural changes of COPD such as airway fibrosis and pulmonary HTN?
NONE
52
What bacteria commonly infects COPD patients?
Haemophilus influenzae

RESPIRATORY EXAM 1 (8 decks)

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