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clin med pulmonology > COPD and asthma > Flashcards

COPD and asthma Flashcards

1
Q

What is the most common PFT

A

spirometry

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2
Q

What kind of flow volume loop is seen with obstructive emphysema

A

scooped out curve

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3
Q

What are some extrinsic factors for asthma

A

allergic (most common)
environmental
animal

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4
Q

What are some intrinsic factors of asthma

A

occupation/pollution
cold/humidity
stress
medications (ASA or NSAIDs)
Exercise

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5
Q

What is the immune response for an extrinsic asthma attack

A

IgE mediated

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6
Q

What is the atopic triad

A

eczema (atopic dermatitis)
Asthma
Hay fever

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7
Q

What are risk factors for asthma

A

atopy
environmental/occupational exposures
childhood asthma / symptoms
Family history

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8
Q

What is used for evaluating and diagnosing asthma

A

PFT
Bronchoprovocation test

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9
Q

What are the classifications of asthma

A

intermittent
persistent (Mild, moderate, severe)

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10
Q

What are the different forms of asthma treatment

A

SABA
ICS
Leukotriene modifiers
Immunomodulators
Combos (SABA or LABA w/ ICS)

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11
Q

When are SABAs used

A

PRN

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12
Q

When are leukotriene modifiers used

A

primarily for extrinsic allergy but may help with intrinsic

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13
Q

When are immunomodulators used

A

Severe asthma and ONLY extrinsic

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14
Q

What is a sign you have to watch out for with leukotriene modifiers

A

Mood / behavioral changes
sleep changes in kids
suicidality in adults

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15
Q

How do you treat intermittent asthma

A

all ages: SABA PRN
<4 y/o: associated with URIs, use as short course at beginning of infection

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16
Q

How do you treat mild persistent asthma

A

All ages: Continue SABA PRN
<11y/o: low dose ICS or Montelukast
>12y/o: Daily ICS, Daily combo inhaler or montelukast

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17
Q

What is the risk of giving children ICS for asthma

A

risk of growth suppression with regular use

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18
Q

How do you treat moderate persistent asthma

A

All ages: SABA PRN
<4y/o: Combo inhaler, Montelukast, or medium dose ICS

> 4y/o: Daily combo inhaler and PRN, daily ICS, or low dose ICS and montelukast

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19
Q

How do you treat severe persistent asthma

A

Daily combo inhaler (medium ICS w/ LABA) or daily ICS with montelukast

*may consider omalizumab

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20
Q

What treatment may severe asthmatics need to be treated with during exacerbations

A

Oral corticosteroids
predisone
methylprednisolone
prednisolone

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21
Q

What are ways asthmatics can reduce allergen exposure

A

2nd gen antihistamines
Flonase
1st gen antihistamines PRN
Immunotherapy
Air filters
Washing face/hands after environmental exposure

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22
Q

When should patients be referred to pulmonologists

A

Difficulty diagnosing
Life threatening exacerbations
Hospitalizations
frequent oral glucocorticoids (>2/year)
Step 5 or higher
poor control

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23
Q

What population is at high risk for bronchiectasis

A

Older Women in underserved populations

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24
Q

What is occurring in bronchiectasis

A

irreversible, inflamed and easily collapsable airway that is induced by infectious insult and impaired host defense

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25
Q

What are the symptoms of bronchiectasis

A

`chronic cough (productive)
Fatigue
dyspnea
fever/chills
pleuritic chest pain

26
Q

What are the signs of bronchiectasis

A

Crackles
Wheezing
Digital clubbing

27
Q

What is pathogneumonic for bronchiectasis

A

persistent or recurrent cough with mucopurulent sputum

28
Q

What can be used to diagnose bronchiectasis

A

Labs
CXR
CT
PFT
Bronchoscopy

29
Q

How do you treat bronchiectasis

A

Treat / control recurrent infections
treat underlying disease
bronchodilators (Duoneb or SABA/Combo)
Chest physiotherapy
Surgery (severe cases)

30
Q

If a patient has a bronchiectasis exacerbation, how do you treat it

A

Antibiotics

31
Q

If someone with bronchiectasis is outpatient, how will you treat

A

Fluoroquinolone (Levofloxacin) - pseudomonas coverage

Amoxicillin or augmentin
Macrolids

32
Q

If someone has bronchiectasis is inpatient, how should they be treated

A

Ampicillin
Piperacillin/Tazobactam (Zosyn) -Pseudamonas coverage

Vanco for MRSA

33
Q

What are the types of bronchiolitis

A

Acute (most common)
Bronchiolitis obliterans (constrictive)
Proliferative
Follicular

34
Q

What causes acute bronchiolitis

A

Mycoplasma pneumonia
RSV
Influenza
Pertussis

35
Q

Which patients are most effected from acute bronchiolitis

A

Pediatric patients

36
Q

What are the causes of bronchiolitis obliterans

A

Toxic fumes (popcorn lung)
Lung transplant patients

37
Q

What causes proliferative bronchiolitis

A

Cryptogenic

38
Q

What causes follicular bronchiolitis

A

Rheumatic diseases (RA & Sjogrens)

39
Q

What are the risk factors for bronchiolitis

A

viral illness
exposure to toxic fumes
CT disorders
Rheumatologic disorders
organ transplant

40
Q

How do you diagnose bronchiolitis

A

Nasal viral panel
biopsy

41
Q

Which forms of bronchiolitis do you preform a biopsy for

A

Constrictive
proliferative
follicular

42
Q

How do you treat acute bronchiolitis

A

Supportive therapy (will peak in 3-5 days)

43
Q

how do you treat severe bronchiolitis

A

admission
respiratory support
+/- glucocorticoids
CPAP
ET tube for respiratory failure

44
Q

What is the diagnostic criteria for chronic bronchitis

A

Chronic productive cough for 3 or more months in 2 or more successive years

45
Q

How do you treat group A COPD patients

A

SABA or LABA

46
Q

How do you treat group B COPD patients

A

LABA

47
Q

How do you treat group C COPD patients

A

Add LAMA to LABA

48
Q

Which patients will get oxygen therapy with COPD

A

PaO2<55
PaO2>55 with Cor pulmonale
Hypoxia with exercise
SPO2 at or below 88%
Erythrocytosis

49
Q

What population is primarily effected by cystic fibrosis

A

Caucasian

50
Q

What is the current median of life expectancy with cystic fibrosis

A

50 years

51
Q

What type of disease os cystic fibrosis

A

Autosomal recessive
Mutation in CFTR gene

52
Q

What occurs with CF in the body

A

Thick mucus builds up in organs that contain mucus membranes
-lungs
-pancreas
-liver
-intestines
-reproductive tract

53
Q

What are some respiratory signs and symptoms of cystic fibrosis

A

persistent, productive cough
hemoptysis
apical crackles
bronchiectasis
digital clubbing

54
Q

How can you diagnose cystic fibrosis

A

Newborn screening
Genetic testing
Sweat chloride test

55
Q

What is the gold standard for diagnosing cystic fibrosis

A

Sweat chloride test

56
Q

How is the sweat choline test done

A

Sweat is produced on forearm or thigh and collected and weighed/analyzed for chloride

57
Q

What may cause a false positive on a sweat chloride test

A

Addisons disease
medium ileus
renal failure
hypothyroidism
G6PD deficiency

58
Q

What will you see on imaging with cystic fibrosis

A

Pre-bronchial cuffing
Tram lines
Recurrent infiltrates
Pulmonary blebs and bullae

59
Q

How do you treat CF

A

CFTR modulators to return part of the function of the chloride channel

60
Q

What are chronic treatments for cystic fibrosis

A

Airway clearance therapies
Prevention of infection
bronchodilators
anti-inflammatory therapy/bacterial prophylaxis

61
Q

How do you treat an acute exacerbation of CF

A

Oral glucocorticoids
respiratory support
Antivirals
Antibiotics

clin med pulmonology (12 decks)

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