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Block 4: SD 3 Week 10 > Integration and Review of Respiratory Medicine > Flashcards

Integration and Review of Respiratory Medicine Flashcards

1
Q

Be able to reproduce this chart.

A

Reproduce chart

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2
Q

Reversibility of asthma is demonstrated by a 12-15% or 200ml increase in FEV1 from the baseline, 15 min after treatment with what?

A

inhaled short acting Beta 2 agonist

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3
Q

How will a persons FEV1 be affected if they have asthma and are given a methacholine challenge test?

A

FEV1 is reduced

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4
Q

Be able to go through the stepwise approach towards the treatment of chronic asthma.

A
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5
Q

What is bronchiecstasis?

A

Permanent dilatation of bronchi and bronchioles (diff. from emphysema)

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6
Q

A person with bronchiecstasis can have it due to what conditions?

A

destruction of cartilage, muscle and elastic tissue.

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7
Q

Bronchiectstasis can happen because of what?

A

Chronic necrotizing infections (of the bronchi and bronchioles).

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8
Q

Is bronchiecstasis a primary disease?

A

no it occurs secondary to persisting infection or obstruction.

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9
Q

How do you treat bronchiecstasis?

A

clearing aiways, chest physiotherapy, appropriate antibiotics

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10
Q

Describe etiology of bronchiecstasis.

A

chronic infection
tuberculosis,H. influenzae,andS. aureus
atypical mycobacteria

bronchial obstruction

CF

ciliary function

immunodeficiency

allergic bronchopulmonary aspergillosis (ABPA

autoimmune conditions like RA and Sjögren’s syndrome

a1- antitrypsin deficiency

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11
Q

What are the main clinical features of bronchiecstasis?

A

Cough with copius sputum
Wheezing/rhonchi
Hemoptysis
Dyspnea
clubbing

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12
Q

What are the common radiographic features of bronchiecstasis?

A

tram track sign -chest X-ray

dilated airways, signet ring sign, tree in bud sign - CT

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13
Q

What is Hoover’s sign?

A

paradoxical inward movement of the rib cage with inspiration

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14
Q

Hoover’s sign can be seen in what lung pathology?

A

bronchitis and emphysema

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15
Q

How is diaphragmatic excursion assessed?

A

by percussion

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16
Q

Is clubbing of the digits a sign of COPD?

A

no

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17
Q

A chest skiagram may show what hallmark signs in an individual with COPD?

A

increased peribronchial markings

hyperinflation

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18
Q

What may a blood test in an individual with COPD present with?

A

Arterial Blood Gas - Hypoxemia, respiratory acidosis (↑PCO2 and ↓pH) due to ventilatory failure.

Blood tests may reveal mild polycythemia secondary to the chronic hypoxia.

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19
Q

Emphysema

A

Abnormal permanent enlargement of the air spaces distal to the terminal bronchioles and destruction of their walls without any obvious fibrosis with progressive dyspnea.

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20
Q

Where is centriacinar type emphysema most commonly located?

A

upper lobes

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21
Q

Most common cause of centriacinar emphysema?

A

exposure to smoke

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22
Q

Explain the pathology behind panacinar emphysema.

A

most common presentation ofAAT deficiency

also due to a functional AAT deficiency as a result of smoking

oxidants and inflammatory reaction of smoke can destroy AAT
smoking exacerbateseffects of genetic AAT deficiency

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23
Q

Where is panacinar type of emphysema usually found? (why)

A

in the lower lobes

result of lower lobes recieving ↑ perfusion allowing more immune cells to traffic into the alveoli

24
Q

Who is paraseptal emphysema most commonly found in?

A

most commonly involves young, otherwise healthy males

25
Q

What are some complications associated with paraseptal emphysema?

A

associated with bullae
found near the pleura
increased risk for spontaneous pneumothorax

26
Q

Know some general characteristics that would allow you to make a differential diagnosis between emphysema and bronchitis?

A
27
Q

Do restricive lung disease cause reduced or increased lung compliance?

A

reduced lung compliance

28
Q

Do restrictive lung diseases cause increased or decreased elastic recoil?

A

increased elastic recoil

29
Q

Are there increased or decreased expiratory flow rates in restrictive lung diseases? (explain why)

A

increased expiratory flow rates due to increased radial traction (result of increased elastic recoil) on airway walls

30
Q

What are some clinical features of ILD’s?

A

Progressive exertion dyspnea and persistent dry cough

31
Q

What are common findings about chest X-ray of person with ILD?

A

Bibasilar Reticular pattern or Nodular opacities
Honeycomb like features
Hilar/mediastinal lymphadenopathy

32
Q

What are the signs you may see in the heart that could lead you to suspect there is some type of ILD?

A

Signs of cor-pulmonale, Loud P2

33
Q

Upon arterial blood gas analysis what may you find in a person with ILD?

A

Hypoxemia (exertional to resting)
Normal or reduced PaCO2
Respiratory alkalosis.

34
Q

On HRCT (high-res computed tomography)

A

Honeycombing, ground glass opacities

better assessment of the extent and distribution of disease

Coexisting disease is often best recognized e.g., mediastinal adenopathy, carcinoma, or emphysema

35
Q

What is pneumoconiosis?

A

ILD due to inhalation of small dust particles(coni = latin for dust)

36
Q

Pathophysiology of pneumoconiosis?

A

varied and based on the type of dust

37
Q

In terms of fibrogenicity of dust particles list from least to most of the particles we discussed.

A

coal (least), asbestos, silica, and beryllium (max)

38
Q

Small particles less than 2 microns affect what structures and how are they cleared?

A

affect alveoli (< 2 microns) phagocytosed by macrophages

39
Q

Intermediate particles that affect respiratory bronchioles ( > 2 microns but < 10 microns) are cleared by what?

A

muck-ciliary transport

40
Q

Be able to reproduce chart listing the types of pneumoconioses depending on the disease and exposure.

A

roofing and plumbing can also be listed as exposures that can cause asbestosis.

41
Q

What parts of the lungs does asbestosis affect?

A

lower lobes including the entire respiratory unit

42
Q

Describe how asbestos bodies appear and what cells they appear in

A

(Ferruginous body) golden-brown fusiform rods (due to iron and protein deposition) resemble dumbbells → made of iron! located inside macrophages

43
Q

What may be found in the diaphragm and posterolateral mid lung of someone with asbestosis?

A

calcified pleural plaques

44
Q

What part of the lungs are affected by silicosis?

A

upper lobes

45
Q

Pathology of silicosis.

A

macrophages activated by silica (quartz) release fibrogenic cytokines

46
Q

Characteristic feature upon biopsy of someone with silicosis.

A

silica particles surrounded by collagen “eggshell” calcification of hilar lymph nodes

47
Q

What are sequelae associated with silicosis?

A

may impair macrophage function , ↑ susceptibility to TB (3 fold increased risk), ↑ incidence of lung cancer

48
Q

Pathology of berylliosis. (What other condition does it resemble)

A

Non-caseating granulomas, nodular infiltrates, and enlarged
lymph nodes (resembles sarcoidosis)

49
Q

Be able to compare and contrast bronchitis obliterans with bronchiolitis obliterans organizing pneumonia.

A
50
Q

What is sarcoidosis?

A

multisystem granulomatous disease of unknown etiology that predominantly affects the lungs causing restrictive lung disease

51
Q

What are hallmarks of sarcoidosis?

A

non caseating granulomatous inflammation of multiple organs,

lupus perinea (bluish-red or violaceous nodules and plaques over the nose, cheeks and ears).

Erthyma nodosum (painful shiny nodules most commonly on shins) less specific but more common
Eye lesions: uveitis

52
Q

Is there a single diagnostic test for sarcoidosis?

A

no which makes diagnosis challenging

53
Q

Best way to go about diagnosing sarcoidosis?

A

Diagnosis is clinical and often one of exclusion

54
Q

Upon chest radiograph what are some characteristic features of saroidosis?

A

bilateral hilar lymphadenopathy, lungs involved in 90% of the cases

55
Q

Explain what are some characteristic lab features for one with sarcoidosis.

A

↑ serum ACE , hypercalcemia , ↑ 1-α-hydroxylase → hypervitaminosis D, ↑CD4:CD8 in BAL.

56
Q

What are the best ways to treat sarcoidosis pharmacologically?

A

First-line: Systemic corticosteroids - prednisone
Second line: Methotrexate

Block 4: SD 3 Week 10 (6 decks)

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