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Pulmonary > Clinical Obstructive Lung Disease: COPD/Asthma/CF > Flashcards

Clinical Obstructive Lung Disease: COPD/Asthma/CF Flashcards

1
Q

What are the two major causes of airflow obstruction?

A
  1. Intrinsic airway narrowing
    • Bronchospasm, plugging, inflammation/edema
  2. “Floppy” airways
    • Decreased radial tethering or decreased integrity
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2
Q

To what degree is airway resistance inversely proportional to the radius of an airway?

A

Aiway resistance is inversely proportional to the _fourth powe_r of the radius of the airway

  • Resistance changes dramatically with samll changes in diameter
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3
Q

How does airflow obstruction increase lung volumes?

A
  • Incomplete emptying of alveoli
    • Breaths begin to stack up on each other
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4
Q

What is a common CXR finding of obstructive lung disease? ( as it regards to the diaphram?)

A

Flat and rounded diaphram

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5
Q

Why is a flat and rounded diaphram problematic?

A

Diaphrams are normaly rounded, and become flatter as they go down (and you breath in).

  • If it’s already flat at the beginining of your breath, then there becomes no mech advantage to breath in so you begin to use accessory muscles
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6
Q

Asthma

  1. What is Asthma?
  2. What are common symptoms?
  3. Is asthma obstructive or restrictive?
  4. Is asthma reversible?
  5. Is the DLCO normal, elevated or decreased?
A
  1. Chronic inflammatory disorder of the airways
  2. Recureent episodes of wheezing, breathlessness, chest tightness, coughing particularly at night or during day
  3. Obstructive
  4. Reversible with treatment and/or spontaneously
  5. Normal to increased DLCO
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7
Q

What are the two types of asthma? Describe each

A
  • Extrinsic - allergic
    • Response to environmental antigens
    • IgE mediated mostly
  • Intrinsic - nonseasonal, non allergic form
    • Chronic & persistent
    • Post-viral - epithelial injury leads to bronchial narrowing
    • Altered arachidonic acid metabolites - > incr leukotrienes, decreased prostaglandins (e.g. aspirin)
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8
Q

T/F: Asthma can be exacerbated by cold air?

A

True

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9
Q

T/F: In an asthma patient you will hear inspiratory stridor on physical exam?

A
  • False - obstructive diseases have issues with expiration (wheezing) not inspiration
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10
Q

What test can you use to check for Asthma?

A

Methylcoline challege

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11
Q

T/F: Patients often use accessory muscles during an asthma attack?

A

True

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12
Q

Describe the PV curve of as acute asthma attack versus normal

A

Follows the same curve as the normal but is shifted up

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13
Q

What is the physical exam finding that differentiates Asthma from Vocal Cord Dysfunction (VCD)?

A

INSPIRATORY STRIDOR

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14
Q

What is Vocal Cord Dysfunction?

A

VCD: Inappropriate vocal cord motion results in airflow obstruction

  • Symptoms mimic asthma
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15
Q

COPD

  1. What is the broad definition, and what two diseases fall under this diagnosis?
  2. What do the FEV1/FVC ratio have to be, in COPD?
  3. What is the biggest risk factor for COPD?
A
  1. COPD is defined by fixed airflow obstruction
    • Emphysema & Chronic Bronchitis
  2. FEV1/FVC < 70%
  3. Tobacco users
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16
Q

Chronic Bronchitis

  1. What is the clinical criterion to make this diagnosis?
  2. Describe the pathophysiology of it
A
  1. Productive cough at least 3 months over the past 2 yrs w/o other cause
  2. Increased airway resisitance due to changes in airway structure
    • edema, mucus, fibrosis
    • May have overlapping features w/ asthma
17
Q

Emphysema

  1. What is Emphysema?
  2. Is compliance of the lung in emphysema more or less than normal?
    • Does this make it more or less stretchy
  3. What is the only gene that we know is a risk factor for emphysema?
A
  1. Loss of normal alveolar spaces with enlargement of distal spaces resulting in impaired gas exchange
  2. Increased compliance of the lung
    • More stretchy due to decreased elastic tissue
  3. Alpha-1-antitrypsin deficiency
    • causes a loss of balance between proteases and antiproteases
18
Q

Emphysema causes permanent ____ of the distal airspaces (acini)

A

Enlargement

19
Q

Multiple Choice

Alpha-1-antitrypsisn deficiency in emphysema patients leads to which of the following?

a) pan-acinar enlargement
b) centri-acinar enlargment

A

Answer: Pan-acinar enlargement

  • Pan acinar involves the entire acinus, typically seen in older patients and those with A1AT deficiency
  • Centri-acinar is smoking related and incolves only the respiratory bronchioles
20
Q

What does the P-V curve of an emphysema patient look like?

A

See attached - but take away point is the slope is steepened and the curve is shifted upwards

21
Q

Clinical Vignette: You have a patient with diminished breath sounds, and hyperresonance on percussion.

What does this patient have based soley on these findings?

A

Emphysema

*Note: Common exam findins in patients with both emphysema and chronic bronchitis includes

  • Prolonged expiratory phase
  • Pursed-lip breathing
22
Q

Clinical Vignette: You have a patient who has exam findings including a productive cough, rhonchi and wheezing on ausculatation.

What does this patient most likely have based only on these findings?

A

Chronic Bornchitis

*Note: Common exam findins in patients with both emphysema and chronic bronchitis includes

  • Prolonged expiratory phase
  • Pursed-lip breathing
23
Q

What are common symptoms of COPD exacerbation?

A
  • Increased cough
  • Increased wheezing
  • Worsening obstruction on PFT
  • Unchanged CXR
  • Precipitated by infxn, pollution, PE
24
Q

How does COPD lead to death?

A
  • Respiratory failure
  • Right ventricular failure
  • Pneumonia
  • Spontaneous pneumothorax
  • Pulm Embolism
25
Q

Emphysema

  1. Is there marked hyperinflation or _hypo_inflation?
  2. Are the symptoms reversible w/ bronchodialators?
  3. Is the DLCO normal, increased or decreased?
A
  1. Marked hyperinflation
  2. No reversibility to bronchodialators
  3. Decreased DLCO

Pulmonary (36 decks)

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