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Semester 5 PMCP Exam 2 > COPD - Aoki > Flashcards

COPD - Aoki Flashcards

1
Q

Obstructive lung disease - what is happening

A

air trapping

work of breathing is increased and you will likely end up trapping air because not all of it will come out

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2
Q

Airway diseases

A 
Upper airways
Asthma
COPD
Chronic Bronchitis
Broneictasis
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3
Q

Obstructive lung disease - categorized in what two ways

A

Reversible

Irreversible

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4
Q

Asthma is rev or irrev

A

rev

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5
Q

COPD is rev or irrev

A

irrev

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6
Q

Problem with airway - clinical presentation

A

cough - prod or non
Dyspnea
Dec ex capacity

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7
Q

How do we evaluate flow

A

Spirometry
Gold standard for obstruction
Capture volume being exhaled

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8
Q

PFT = what

A

pulmonary function test

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9
Q

What does PFT tell you

A

Spirometry
Then lung volumes - the size - changes in pressure
Then diffusing capacity - how good gas exchange is

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10
Q

FEV1 means

A

amount of air that comes out in the first second of forced expiration

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11
Q

FVC means

A

total amount of air your patient exhales

Forced vital capacity

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12
Q

What will a patient with obstruction show on the PFT lab report

A

the amount that comes out in first second is less than total exhaled
FEV1:FVC ratio is decreased!

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13
Q

PEF means

A

peak expiratory flow

when doing forced expiration what is the highest peak - often used for asthma management

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14
Q

If obstruction what happens to volume-time curve

A

It takes them longer to exhale

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15
Q

Normally we should finish exhalation in how many seconds

A

6

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16
Q

How do you determine if there is obstruction to air flow - what is the ratio

A

Yes obstruction if ratio is less than 5th percentile (less than 70%)
No if greater than 5th percentile

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17
Q

How do you know how severe the obstruction is

A

Look at FEV1 - magic number is 50%

If below 50% you are saying that there is severe obstruction

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18
Q

If they have an abnormal FEV1/FVC ratio - what is the next step

A

Want to determine if it is reversible or not

Try Inhaled Bronchodilator - and see if there is a response

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19
Q

Flow - volume loop looks like what in a normal/healthy person

A

upside down ice cream cone!

Should be smooth!

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20
Q

Flow - volume curve - what is the top? and the bottom?

A 
Top = exhalation
Bottom = inhalation
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21
Q

Flow - volume curve - what is typical of someone with obstruction

A

Concave exhalation - sometimes they may not even reach 0 line
Asthma and COPD - the concave is common

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22
Q

Upper airway obstruction - what do you see on flow - volume loop

A

Flattening of inspiratory portion - someone ate the ice cream!

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23
Q

How is upper airway obstruction tx - what is happening

A

speech therapy

when they take breath in, they have vocal cord dysfunction - closing on inspiration

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24
Q

Intrathoracic airway - asthma - define

A

Inflammatory disease of the airways with episodic and reversible airflow obstruction

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25
Q

Asthma - characterized by whay

A

increased airway reactivity to various stimuli

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26
Q

Epidemiology with asthma

A

present at different ages - including late adulthood!

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27
Q

Prevalence of asthma

A

5-7% of total population

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28
Q

Clinical presentation of asthma

A

Wheezing (narrowing)
Cough - prod or non (defensive mechanism)
Dyspnea

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29
Q

Precipitating factors - asthma

A 
allergens
viral infection
occupational exposure
dust, fumes
tobacco 
exercise
gastro reflux
post nasal drip
medications that induce BC
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30
Q

Pathophysiology - asthma

A
  • inflammatory process
    1 airway hyperactivity with bronchospasm - BC
    2 inflammation of bronchial mucosal
    3 increased mucous production - secretions
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31
Q

Treatment medication - asthma

A

Bronchodilators - beta agonists (albuterol)
Antiinflammatories
- Steroids
Antileukotriens

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32
Q

What receptor on airway smooth muscle

A

beta 2

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33
Q

What if symptoms persist with asthma

A

add an inhaled steroid!

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34
Q

what is the gold standard in patients with persistent asthma

A

inhaled steroid

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35
Q

What might suffice in those with intermittent asthma

A

beta agonist BD

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36
Q

Idea of spacer on inhaler

A

allows for space between mouth so this allows for better delivery - less turbulence this way so that don’t lose medication

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37
Q

Inhaler vs. Nebulizer

A

More just about technique - the effectiveness is the same for both

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38
Q

Asthma exacerbation - define

A

Acute or subacute episodes of progressively worsening SOB, coughing, wheezing, and chest tightness or any combination thereof

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39
Q

What to do with asthma exacerbation

A

use steroids

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40
Q

Status Asthmaticus - define

A

Acute severe asthma attack that does not respond to usual use of inhaled BDs

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41
Q

Status Asthmaticus - associated with what

A

sx of potential respiratory failure

Life threatening and require immediate medical attention

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42
Q

COPD - what percent of US population

A

6.3%

RISK FACTOR - SMOKING

43
Q

Pop with higher COPD prevalence

A 
65-74 yrs
Non hispanic whites
Women
Low income
Current or former smoker
44
Q

Risk factors COPD

A 
Smoke
Occupational dust, chemicals
Environmental smoke
Air pollution
Genes
Infections
SES
Aging
45
Q

Mechanism of COPD - impacts what

A

Small airway AND parenchymal destruction

46
Q

COPD - small airway disease - what is happening

A

airway inflammation
airway fibrosis, luminal plugs
Inc airway resistance

47
Q

COPD - parenchymal destruction - what is happening

A

loss of alveolar attachments

dec of elastic recoil

48
Q

Chronic bronchitis - define

A

Cough that occurs every day with sputum production that lasts at least 3 months - two yrs in a row! Plus SOB

49
Q

Chronic bronchitis - rev or irrev

A

irrev - remodeling is irreversible

50
Q

Emphysema -

A

parenchymal destruction
abnormal and permanent enlargement of airspaces
End up trapping air

51
Q

Clinical presentation - emphysema?

A

avg onset over 60
productive cough
dyspnea

52
Q

Clinical presentation - emphysema - later in the disease

A

Use of accessory mm to breath
Inc AP diameter
R heart failure may develop
Weight loss

53
Q

Why have hard time breathing in supine with resp. disease

A

Depend largely on diaphragm and normally intraabdominal pressure is higher than intrathoracic but when in supine intraabdominal pressure pushes diaphragm so we are stretching it - so it is not in the optimal place to be contracted

54
Q

Clincial presentation chronic bronchitis

A

Chronic cough with sputum
Cyanosis
Polycythemia - inc hgb content

55
Q

COPD is a spectrum of disease T or F

A

TRUE

56
Q

COPD includes what

A

chronic bronchitis and emphysema

57
Q

COPD - how will your pt present clinically

A 
Accessory mm to breathe
Inc AP diameter
Pursed lip breathing
Prolonged exp phase
Tripod position
Distant breath sounds
58
Q

COPD - comorbidities

A 
cardiovascular disease
osteoporosis
resp infection
anx and dep
diabetes
lung cancer
bronchiectasis
59
Q

Stable COPD - goals of therapy

A

Reduce symptoms

Reduce risk

60
Q

Stable COPD - goals of therapy - how do we reduce symptoms

A

Relieve symptoms
Improve ex tolerance
Improve health status

61
Q

Stable COPD - goals of therapy - how do we reduce risk

A

prevent disease progression
prevent and treat exacerbations
reduce mortality

62
Q

Single most important intervention to prevent disease and slow progression of disease

A 
Tobacco smoking cessation
Counseling
Nicotine replacement therapy
Bupropion
Varenicline
63
Q

Lung function, aging, and smoking graph

A

With smoking - your lung function goes downhill earlier and faster than the rest of your body
With cessation - will slow down the decline! no matter when you quit it will slow down

64
Q

Pharmacotherapy in COPD

A

Not to treat but moreso used to dec symptoms and complications and improve functional status

65
Q

Long acting BDs usually last how long

A

12-24 hrs

66
Q

Inhaled corticosteroid use for COPD

A

only in advanced, extreme cases

Stage 3 or 4 with significant sx or recurrent exacerbations

67
Q

Which stage of COPD are we adding therapy in

A

Stage 2 (moderate)

68
Q

Systemic steroids for COPD

A

Only for exacerbations - NOT using it daily

69
Q

Oxygen therapy - COPD

A

Use of ox therapy intermittent - no impact on mortality

Continuous - does have impact

70
Q

Vaccines imporant for COPD

A

Infleunza

Pneumococcal

71
Q

Pulm Rehab - COPD - when indicated

A

Indicated in COPD pts with dyspnea on exertion GOLD for stage 2-4

72
Q

Pulm rehab - COPD - what does it do

A 
improves exercise capacity
dec dyspnea
improve QOL
dec health care utilization
benefits last up to 18 months
73
Q

COPD acute exacerbation - define

A

an acute worsening of the patients respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication

74
Q

Consequences of COPD exacerbations

A 
neg impact on QOL
impacts sx and lung function
accelerates lung function decline
inc mortality 
inc costs
75
Q

COPD exacerbation - assessment - what do you need to determine first

A

baseline level of respiratory functioning

76
Q

COPD exacerbation - assessment - what are the signs of a severe exacerbation

A 
mental status changes
speaks only with single words
silent chest
hemodynamic instability
labored breathing
77
Q

What do you wnat to evaluate for - COPD exacerbation - assessment -

A

possible concurrent conditions like pneumonia, pleural effusion, pneumothorax, CHF

78
Q

Use of non-invasive ventilation - COPD

A

Improves resp acidosis
Dec RR, dyspnea
Dec need for intubation

79
Q

Restrictive pathologies involve what

A

the layers around the lungs - onion

Limits amount of air you can contain - reflected on total lung capacity

80
Q

First layer around lungs

A

visceral pleura
parietal pleura
in between the two you have pleural space

81
Q

Diaphragmatic dx can present like

A

restrictive dysfunction

82
Q

When would you not want to request lung function or spirometry

A

when patient is acutely ill

83
Q

Restrictive process - can be due to

A 
NM - myesthenia, GB, SBI
Skeletal - kyphosis, scoliosis
Diaphragm paralysis
Pleural disease - effusion, pneumothorax
Parenchymal disease - atelectasis, post surgical, interstitial lung disease, pulm edema
84
Q

Restrictive can be in the __- or ___

A

Pulmonary (in the lungs) or in the layers (extrapulmonary)

85
Q

Restrictive - Total lung capacity - what is standard

A

if you are 80-100% of your reference, you are good

Restriction less than 80%

86
Q

Restrictive - how to decide if in the lungs or the layers

A

look at gas exchange
If normal - think layers
If abnormal - think lungs

87
Q

Circulation - just pulmonary vasculature - can they be normal on physical exam with sounds

A

YES - you might hear nothing but they are short of breath and turning blue

88
Q

Most common cause for pulmonar circulation issue

A

Pulmonary vascular diseases - DVT!

89
Q

Imaging for PE

A

CT!

90
Q

Is ambulation contraindication with DVT

A

no

91
Q

Pulm hypertension can result from

A

clots

92
Q

Groups for pulm htn

A

1 pulmonary arterial hptn
2 LEFT HEART DISEASE
3 chronic hypoxemia
4 thromboembolic

93
Q

tx for pulm hptn

A

treat the underlying cause

94
Q

Can people with COPD and/or restrictive dsyfunction develop pulm hptn

A

yes

95
Q

who qualifies for VDs with pulm htpn

A

only group 1

pulmonary arterial hptn

96
Q

Resp failure - define

A

inability of the respiratory system to meet the metabolic demands of the body

97
Q

Resp failure can be ___ or ___

A

acute or chronic

Early rehab is critical

98
Q

Types of resp. failure

A

1 oxigenatory

2 ventilatory

99
Q

Resp failure - oxigenatory

A

gas exchange is impaired

acute vs. chronic - based on oxygen saturation

100
Q

Resp failure - ventilatory

A

you are not moving air - acute vs. chronic based on ABG and blood bicarbonate level

101
Q

Resp failure - what do you want to look at

A

ABG

102
Q

Clinical presentation - acute resp failure

A 
progressive dyspnea
use of accessory mm
paradoxical breathing
tachypnea, tachycardia, nasal flaring
Cyanosis
agitation/lethargic
103
Q

normalization of blood gas in someone who is in acute respiratory failure is

A

BAD sign

Semester 5 PMCP Exam 2 (6 decks)

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