G Flashcards
What are the main symptoms/signs of COPD?
- Chronic productive cough
- Shortness of breath
- Fatigue
- Scattered wheezing and rhonchi
- Distant heart sounds, but no murmurs, rubs, or gallops are heard.
What is the hallmark pathophysiologic mechanism in COPD?
Irreversible progressive obstruction of expiratory airflow due to chronic bronchitis and/or emphysema.
Irreversible inflammatory widening of the alveoli, not the bronchi (bronchiectasis→ CF, primary ciliary dyskinesia, and allergic bronchopulmonary aspergillosis, RARE COPD)
GOLD classification
Based on airflow limitation in patients with FEV₁/FVC < 70%
1️⃣ GOLD 1 (Class I)
Symptoms: Mild
FEV₁: ≥ 80% of the predicted value
2️⃣ GOLD 2 (Class II) – Moderate
Symptoms: Moderate
FEV₁: 50% ≤ FEV₁ < 80%
3️⃣ GOLD 3 (Class III) – Severe
Symptoms: Severe
FEV₁: 30% ≤ FEV₁ < 50%
4️⃣ GOLD 4 (Class IV) – Very Severe
Symptoms: Very severe
FEV₁: < 30% of the predicted value
What is the pathophysiology of emphysema and chronic bronchitis?
👉 Emphysema: Chronic exposure to cigarette smoke → destroys the alveolar walls→ enlarging the airspace → collapse and cause obstruction→ air trapping and hyperinflation (flattened diaphragm on chest X-ray)
👉Chronic Bronchitis: cigarette smoke → proliferation of mucinous-secreting cells (goblet cells) and impairs ciliary function → excess mucous secretion → airflow obstruction.
Can ↓FRC (functional residual capacity) be seen in COPD?
No, FRC ↑. It is seen in restrictive lung diseases (ILD, pneumonia, pulmonary edema). More air is trapped in the lungs after expiration due to the loss of alveolar elasticity (elastic recoil)
Is ↓ compliance in COPD?
No, it is ↑. It is seen in interstitial lung diseases (e.g., pulmonary fibrosis, pneumoconioses, sarcoidosis). The destruction of the alveoli reduces elastic recoil, making them expand more easily.
How is DLCO in emphysema and in chronic bronchitis-predominant COPD? (diffusing capacity of the lungs for carbon monoxide= DLCO measures how well gases diffuse across the alveolar-capillary membrane)
👉 Emphysema: ↓ DLCO: the alveolar walls are destroyed, leading to less surface area for gas exchange.
👉 Chronic bronchitis-predominant COPD: Normal DLCO. Chronic bronchitis affects the airways, but alveolar structure remains intact.
What are the three most common causes of chronic cough (>8 weeks)
1️⃣ Upper-airway cough syndrome (postnasal drip)
2️⃣ Asthma
3️⃣ GERD (gastroesophageal reflux disease)
A trial of an antihistamine*.
FEV₁/FVC but significant improvement with bronchodilators suggest?
Asthma ( ≥12% increase in FEV1 or FVC after bronchodilator).
In COPD, the obstruction is irreversible or shows minimal improvement with bronchodilators.
If PFT does not yield a definitive diagnosis for asthma, what test can be performed?
A bronchoprovocation test can be performed. Nonallergic stimuli (e.g., methacholine, histamine) or indirect stimuli (e.g., exercise, hyperventilation) to trigger bronchoconstriction
When is oral corticosteroid therapy recommended in asthma?
Oral corticosteroids are reserved for managing severe, treatment-refractory asthma (not respond to standard treatment (ICS + long-acting β₂ agonists).
When is a CT scan of the chest recommended in a patient with a history of cough?
to detect malignancies (e.g., hemoptysis), lung consolidations (e.g., tuberculosis), bronchiectasis, and pneumonia.
What do dullness to percussion, decreased breath sounds, and decreased tactile fremitus suggest?
Pleural effusion.
Hyperresonance: emphysema, pneumothorax
What are the diagnostic features of pleural effusion seen on chest X-ray?
1️⃣ Unilateral blunting of the costophrenic angle
2️⃣ Homogeneous density with a meniscus-shaped margin (meniscus sign)
3️⃣ Large effusion → Can cause complete opacification of the lung, mediastinal shift, tracheal deviation away from the effusion (suggests a space-occupying lesion)
What is the deep sulcus sign, and how does it appear?
The deep sulcus sign is a radiographic finding seen in pneumothorax. It shows an abnormally deep and radiolucent (dark) costophrenic angle on the affected side.
What does a positive air bronchogram indicate in a patient with dyspnea and a history of cough?
A positive air bronchogram suggests lobar pneumonia or alveolar edema (when air-filled bronchi become visible within fluid-filled or consolidated lung tissue)
In which conditions are ground-glass opacities (vidrio esmerilado) in the lungs most frequently seen? (better detected on CT scan)
1️⃣ Infections (e.g., Pneumocystis pneumonia)
2️⃣ Interstitial lung diseases (e.g., pulmonary fibrosis)
3️⃣ Acute alveolar diseases (e.g., pulmonary edema)
When are atelectasis more easily seen?
1️⃣ Obstructive → Caused by airway blockage (e.g., tumor, foreign body ).
2️⃣ Nonobstructive → Caused by external lung compression (e.g., pleural effusion, pneumothorax, surfactant deficiency).
3️⃣ Postoperative → Occurs within 72 hours of surgery due to shallow breathing and mucus plugging.
4️⃣ Rounded → Seen in chronic lung conditions (e.g., asbestosis, fibrosis).
What does elevation of the diaphragm on chest X-ray indicate in a patient with dyspnea?
Atelectasis → Due to lung volume loss, causing the diaphragm to move upward.
Or Phrenic nerve paralysis.
What is the next step in managing a mechanically ventilated patient with suspected pneumothorax (decreased breath sounds, increased airway pressure, respiratory alkalosis, and deep sulcus sign on chest X-ray)? Insertion of a chest tube, Increase the PEEP, Needle decompression, Close observation?
Insertion of a chest tube into the 4th–5th intercostal space between the anterior and midaxillary line (safe triangle) is the most appropriate next step for treating pneumothorax in a mechanically ventilated patient.
High ventilatory pressure can damage the lung tissue. Close observation would be the most appropriate next step in the management of asymptomatic patients with a small primary spontaneous pneumothorax. tension pneumothorax.
Needle decompression. tension pneumothorax (contralateral tracheal deviation, distended neck veins, cyanosis, and hemodynamic instability)
