Clinical Approach to Pulmonary Diseases

Question 1

What are the 3 categories of pulmonary causes of dyspnea?

Answer 1

• Obstruction
• Restriction
• Pulmonary HTN

Question 2

What are the main obstructive lung diseases?

Answer 2

Asthma
COPD
Bronchiectasis

Question 3

What are the main restrictive lung diseases?

Answer 3

Interstitial Lung Disease
Chest Wall
Neuromuscular

Question 4

What are the signs and symptoms of obstructive lung diseases?

Answer 4

SOB, DOE, Cough, Tightness, Poor Air Movement, Wheezing and Hyperinflation in CXR

Question 5

Is asthma a reversible disease?

Answer 5

Yes

Question 6

What are the relievers of asthma and how are they used?

Answer 6

Bronchodilators

All asthmatics get a puffer - inhaler as a beta agonist that should be used as needed

Question 7

What are the controllers of asthma and how are they used?

Answer 7

Controllers

They are anti-inflammatory medications that must be regularly used

Question 8

What are first line controllers?

Answer 8

Corticosteroids

Question 9

What are the second line controllers?

Answer 9

Long Acting beta􏰄-Agonists

􏰀Anti-Leukotrienes

Question 10

What are some SE of inhaled corticosteroids?

Answer 10

Can cause inflammation or infection in the throat - this can be managed with teeth brushing after use or a spacer that only allows small particles through

Question 11

What are SE of long acting beta agonists?

Answer 11

Long acting beta agonists on their own will increase

the risk of dying

Question 12

What is the 2nd most common cause of chronic cough?

Answer 12

Cough Variant of Asthma

Question 13

How does exercise induced asthma occur?

Answer 13

• Increased minute ventilation results in mucosal ‘dehydration’ and mast cell degranulation
• Worse in cold, dry air

Question 14

What is occupational asthma?

Answer 14

Due to inhalational trigger in work environment

Question 15

What is reactive airway dysfunction syndrome?

Answer 15

Reactive Airway Dysfunction Syndrome - patient
who was normal until one day in their life when
there asthma is triggered and they will have asthma
everyday since that exposure

Question 16

What is Samter’s Triad and what does it relate to?

Answer 16

• Asthma
• Nasal Polyposis
• ASA Sensitivity

It relates to aspirin induced asthma

Question 17

What is ABPA?

Answer 17

Allergic Bronchopulmonary Aspergillosis - hyperreactivity to aspergillus via IgE - treated with steroids

Question 18

What are the 2 main classifications of COPD and what are their symptoms?

Answer 18

􏰀- Emphysema: Permanent distention of the distal air spaces with destruction of alveolar septa
-􏰀 Chronic Bronchitis: Excessive sputum production

Question 19

What are the characteristics of emphysema?

Answer 19

Pink Puffer
􏰀- Maintains a normal pCO2
􏰀 ‘Huffs and Puffs’
􏰀 ‘Burns calories’
􏰀- Therefore, maintains a normal pO2
􏰀- Appears ‘pink’

Question 20

What are the characteristics of chronic bronchitis?

Answer 20

Blue Bloater
􏰀- “Accepts” Hypercapnea
􏰀- Less tachypneic
􏰀 Doesn’t burn calories
􏰀 Results in Hypoxia (Cyanosis)
􏰀 Hypoxic Pulmonary
- Vasoconstriction 􏰀 Edematous
􏰀 Lots of Mucous

Question 21

What are some of the medications for COPD?

Answer 21

1. Anti-cholinergics (ipratropium)

2. 􏰄Beta-agonists (albuterol,pirbuerol,levalbuterol)

Question 22

What is the recommendation for O2 use?

Answer 22

O2 proved to be beneficial for most COPD patient groups

Question 23

What is bronchiectasis?

Answer 23

A suppurative lung disease characterized by permanent abnormal dilation of the bronchi

Question 24

What is a major characteristic of bronchiecctasis?

Answer 24

Daily copious sputum production

Question 25

“Signet Ring Sign”

Answer 25

The internal diameter of the bronchus is larger than that of its accompanying vessel

Question 26

􏰀 “Tram Tracking”

Answer 26

The bronchus fails to taper in the periphery of the chest.

Question 27

What is the cycle of bronchiectasis?

Answer 27

It is the cycle of mucus stasis, infection, inflammation, and airway destruction

Question 28

What is the main cause of restrictive lung diseases?

Answer 28

Interstitial Lung Diseases

Question 29

Interstitial Lung Disease

Answer 29

Chronic, non-malignant, non-infectious inflammation and/or derangement of the alveolar walls - increased elastic recoil

Question 30

What are some examples of interstitial lung diseases?

Answer 30

``` 􏰀Sarcoid 􏰀Hypersensitivity Pneumonitis 􏰀Idiopathic Pulmonary Fibrosis/ “IIP’s” 􏰀 Tuberculosis Fungal Aspiration / Asbestosis 􏰀Connective Tissue Diseases / (Cancer) 􏰀Eosinophilic Granuloma 􏰀 Drugs - Amiodarone,Nitrofurantoin, Bleomycin ```

Question 31

What are the signs of ILD?

Answer 31

- Reduced TLC | - 􏰀 “Interstitial Markings”

Question 32

What is sarcoid?

Answer 32

􏰀Non-Specific Tissue Reaction 􏰀 | Non-Caseating Granulomata

Question 33

Who is the typical patient of sarcoid?

Answer 33

Young African American Female

Question 34

Who is the typical patient of idiopathic pulmonary fibrosis?

Answer 34

Middle Aged/Elderly Male

Question 35

What are some symptoms of IPF?

Answer 35

􏰀 Insidious DOE | 􏰀 Cough

Question 36

What are the treatments for IPF now?

Answer 36

- Previously there were no known treatments | - Now use:􏰀 Pirfenidone and Nintedanib