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Spring 2025 - H&P Assessment > Obstructive Lung Disease (2nd Half) > Flashcards

Obstructive Lung Disease (2nd Half) Flashcards

1
Q

Gold Spirometric Criteria for COPD severity

A
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2
Q

What do you expect to see on an CXR with a severe COPD patient?

COPD Diagnosis

A

Abnormailites may be minimal even with w/severe COPD

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3
Q

What does hyperlucency in the lung periphery suggest?

COPD Diagnosis

A

Emphysema

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4
Q

What does Bullae confirm?

COPD Diagnosis

A

Emphysema

(only a small % of pts when emphysema have bullae)

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5
Q

What is multiorgan loss tissue (MOLT)? What is associated with MOLT?

COPD Diagnosis

A

phenotype of COPD, is associated with airspace enlargement, alveolar destruction,loss of bone, muscle, and fat tissues, and carries higher rates of lung cancer

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6
Q

What is Bronchitic? associated with?

COPD Diagnosis

A

phenotype is associated w/ bronchiolar narrowing and wall thickening and is usually accompanied by metabolic syndrome and cardiac disease

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7
Q

What is a alpha-1-antitrypsin deficiency?

COPD labs

A

is an inherited disorder assoc w/ COPD
low α1-antitrypsin requires lifelong replacement therapy

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8
Q

Eosinophils? high vs low levels?

COPD Labs

A

should be measured in pts with uncontrolled disease
* high eosinophils indicate the need for inhaled glucocorticoids
* low levels are assoc w/ increased risk of pneumonia

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9
Q

ABGs?

COPD Labs

A

often normal until COPD is severe.
* PaO2 doesn’t usually decrease until FEV1 is less than 50% of predicted
* PaCO2 may not increase until the FEV1 is even lower.

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10
Q

COPD treatment goals?

COPD Tx

A

designed to alleviate symptoms and slow pregression.

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11
Q

What is the first step of COPD treatment?

A

reduce exposure to smoke and pollutants.

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12
Q

How does smoking cessation affect COPD treatment?

COPD tx

A

smoking cessation can decrease dz progression and lower mortality by up to 18%.

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13
Q

What medications are used when treating COPD?

A

Long-acting inhaled mescarinic-antagonist

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14
Q

What if dyspnea persists after long-acting inh muscarinic-antagonist?

A

long-acting beta-2 agonist can be added

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15
Q

What medication is effective in pts w/ associated asthma, rhinitis,elevated eosinophils, and history of exacerbations?

A

Inhaled glucocorticoids

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16
Q

What medications are used to improve FEV1 and reduce exacerbation?

A

Inhaled treatments (in general)

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17
Q

What are other forms of COPD treatment?

A

FLU & pneumonia vaccines

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18
Q

If right heart failure or CHF has developed, what medications can you use?

A

Diuretics

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19
Q

What treatment is done for patient’s during exacerbation?

A

Abx, corticosteriods, and theophylline may be neceddary

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20
Q

What does pulmonary rehab program do for COPD pts?

A

increase exercise capacity

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21
Q

How is the risk of death decreased?

COPD treatment

A

Long-term home O2 is recommended when
* PaO2 is less than 55mmHg
* HCT greater than 55%
* if evidence of cor-pulmonale

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22
Q

Treatment for COPD table

slide 31

A
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23
Q

Treatment for COPD exacerbation - Table

slide 32

A
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24
Q

What is lung volume reduction surgery?

COPD surgical treatment

A

In pt w/severe refractory COPD and overdistended lung tissue, lung volume reduction surgery may be necessary

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25
# Lung volume reduction surgery What does of the removal of overdistended areas of the lung allow for?
allows for normal lung tissue to expand.
26
# Lung volume reduction surgery what is the most commonly performed via?
* median sternotomy * video-assisted thorascopic surgery (VATS)
27
Anesthesia mgmt for surgical COPD?
* DLT * avoid N2O * minimize high airway pressures
28
Is CVP a reliable guide for fluid mgmt?
CVP is unreliable b/c surgical alterations affect intrathoracic pressures.
29
Smoking & COPD are associated with what cormorbidities?
* DM * HTN * PVD * ischemic heart disease * heart failure * dysrhythmias * lung cancer
30
How is the right ventricular function assessed?
echocardiogram, along with clinical exam.
31
What should be continued until the morning of surgery?
inhalation therapy
32
What are some clinical findings that are more predictive of pulmonary complications than spirometery tests?
* Smoking * wheezing * productive cough
33
When in doubt what is a test that can be used to access lung disease?
Spirometry with FEV1
34
What are the indicatoins for pre-op pulmonary evaluation? (9)
1) hypoxemia on room air or a need for home 02 without a known cause 2) a bicarbonate >33 mEq/L or PC02 >50 mmHg w/o diagnosed pulmonary dz   3) a history of respiratory failure d/t an existing problem  4) severe SOB attributed to respiratory disease 5) planned pneumonectomy 6) difficulty assessing pulmonary function by clinical signs 7) the need to distinguish causes of respiratory compromise 8) the need to determine the response to bronchodilators 9) suspected pulmonary HTN
35
Major risk factors for development of post-operative pulmonary complications - Table ## Footnote slide 36
36
Strategies to reduce post-op complications- table ## Footnote slide 37
37
# Smoking cessation % of smokers undergo general anesthesia annually?
5-10%
38
How many weeks does it take to see the max benefit from smoking cessation?
until 8 weeks
39
What is the adverse effects of carbon monoxide?
O2 carrying capacity and of nicotine on the CV system are short-lived.
40
What is the elimination half-life of carbon monoxide?
4-6 hrs
41
After 12 hrs of smoking is stopped, what is the PaO2 and plasma level of carboxyhemoglobin?
the Pa02 at which HGB is 50% saturated with oxygen (P50) increases from 22.9 to 26.4 mmHg, and plasma levels of carboxyhemoglobin decrease from 6.5% to 1%.
42
Does short term abstinence from cigarettes help with post-op pulmonary complications?
has not been proven to decrease post-op pulmonary complications (despite favorable effects on plasma carboxyhemoglobin)
43
What does smoking interferes with what?
* normal immune function * ability to reponse to pulmonary infection following surgery
44
How long does it take for normal immune function to return after abstinence from smoking?
at least 6 weeks of abstinence
45
How long does it take for hepatic enzymes activity to return to normal?
6 weeks or longer
46
How many weeks is optimal timing of smoking cessation before surgery to reduce post-op pulmonary complications?
max benefit @ 8 weeks (6-8 weeks)
47
Whar are some nicotine replacement?
* patches * inhalers * nasal sprays * lozenges * gum
48
What medication is recommended to start 1-2 weeks before smoking is stopped?
sustained release bupropion
49
What are some disadvantages in the immediate pre-op period?
* Increase in sputum production * anxiety * irritability * nicotine withdrawal
50
What is bronchiectasis?
irreversible airway dilation, inflammation, and chronic bacterial infection
51
Bronchiectasis has high prevalence in?
in pts>60 with chronic lungs dz s/a COPD & asthma, and in women
52
Bronchiectasis Sx?
* chronic productive cough with purulent sputum * hemoptysis * clubbing * poor mucociliary activity * recurrent bacterial infection causing further inflammation * bronchial dilation * airway collapse * airflow obstruction * inabily to clear secretion
53
Can you eradicate a bacterial superinfection once established? | bronchiectasis
No, it is nearly impossible to eradicate, and daily excessive sputum production persists
54
what baseline test shoud be obtained in bronchiectasis?
baseline CXR and PFTs
55
When is a sputum culture obtained? | Bronchiectasis
for any active infection
56
What is the gold standard for bronchiectasis?
CT : shows dilated bronchi
57
What is the main treatment for bronchiectasis?
abx (depending on sputum culture) and chest physiotherapy
58
What is another alternative for treatment? | Bronchiectasis
flu vaccine, bronchodilators, corticosteriods, and O2 therapy
59
When is surgery used for bronchiectasis?
surgery is reserved for severe symptoms or recurrent complications.
60
How many people in the US are affected by Cystic Fibrosis?
30,000
61
What is the cause of cystic fibrosis?
caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR ) gene
62
What does the CFTR gene do?
produces a protein, which aids in salt and water movement in and out of cells, leads to production of abnormally thick mucus.
63
Cystic fibrosis further sx include?
* dehydrated viscous secretions * luminal obstruction * destruction & scarring of various glands and tissue
64
What can cystic fibrosis lead to?
severe organ damage
65
What does exocrine pancreatic insufficiency leads to?
malabsorption of fat & fat-soluble vitamins
66
What is the primary cause of morbidity and mortality?
chronic pulmonary infection
67
How is cystic fibrosis diagnosed?
a sweat chloride concentration greater than 60 mEq/L
68
What can DNA analysis offer for cystic fibrosis diagnosis?
identify CFTR mutation
69
What would be evidence of pancreatic exocrine insufficiency associated with cystic fibrosis?
Malabsorption with a response to pancreatic enzyme treatment
70
What would you see in a bronchoalveolar lavage that is indicative of airway inflammation?
showing high percentage of neutrophils
71
What is present in all adults that have cystic fibrosis?
COPD
72
What is the treatment for cystic fibrosis?
* Abx * chest physiotherapy * bronchodilators * pancreatic enzymes replacement * O2 therapy
73
What increases sputum clearance in cystic fibrosis?
recombinant human deoxyribonuclease
74
What is a treatment that is currently being investigated to treat cystic fibrosis?
gene therapy
75
What is primary ciliary dyskinesia?
congenital impairment of ciliary activity in respiratory tract, epithelial cells, and sperm tails and ciliated ovary ducts.
76
What does impaired ciliary activity lead to?
chronic sinusitis, recurrent respiratory infections, bronchiectasis, and infertility
77
What is kartagener syndrome?
triad of chronic sinusitis, bronchiectasis, and situs inversis (chest organ position is inversed)
78
Approx how many patients with congenitally non-functioning cilia have situs inversus?
approx 1/2 pts
79
what is isolated dextrocardia is almost always assoc with what?
congenital heart disease
80
Pre op for primary ciliary dyskinesia?
ensure active infection is treated, determine if organ inversion is present.
81
What anesthesia approach is preferred for primary ciliary dyskinesia patients?
RA is preferable to GA, to decrease post-op pulmonary complications
82
What route of airways should be avoided in primary ciliary dyskinesia?
Avoid nasal airways d/t high incidence of sinusitis.
83
What vessel is selected for CVC, in inversion of great vessels?
left IJ vein - normally the right IJ is preferred as it leads straight to the SVC
84
What should be done with EKG placement if dextrocardia is suspected?
EKG position reserved for accurate interpretation
85
What side should uterine displacement in pregnant women?
Right side. - normally Left uterine displacement is implemented to avoid vena cava syndrome
86
If DLT (double lumen tube) is needed, pulmonary inversion may indicate __ side DLT placement?
Right DLT placement - typically, L DLT preferred b/x right mainstem is shorter and right upper lobe more easily obstructed.
87
What is bronchiolitis obliterans?
epithelial inflammaion leading to bronchiolar destruction and narrowing
88
What are the risks for bronchiolitis obliterans?
viral lung infections, toxin exposures, lung transplant, stem cell transplant
89
What are the sign and symptoms of bronchiolitis obliterans?
nonspecific, including dyspnea and non-productive cough
90
How are the expected results of a PFTs of a patient with brochiolitis obliterans?
PFTs show obstructive disease, reduced FEV1 and FEV1:FVC ratio that is unresponsive to bronchodilators
91
What does a CT show in brochiolitis obliterans?
CT shows air trapping and bronchiectasis in severe cases
92
What is central airway obstruction?
includes obstruction of airflow in the tracheal and mainstem bronchi.
93
What is the % of lung cancer pts that are affected by airflow obstruction?
20-30%
94
95
What are the obstruction c/b in "central airway obstruction"?
obstruction c/b tumors, granulations, and airway thinning.
96
What can cause tracheal stenosis?
prolonged intubation
97
tracheal ischemia can progress to what?
scar formation
98
How is tracheal stenosis and ischemia minimized by?
the use of high volume, low pressure cuffs on ETTs.
99
When does tracheal stenosis become symptomatic?
lumen decreased to less than 5mm
100
# central airway obstruction When would symptoms develop after extubation? | tracheal stenosis
symptoms may not develop until weeks after extubation. | dyspnea becomes promiment, even at rest.
101
What imaging would show tracheal narrowing?
CT
102
In flow-volume loops would display flatteneing in inspiratory or expiratory curves? and why?
flattened inspiratory & expiratory curves, which is characteristic of a fixed airway obstruction.
103
Is stridor usually audible?
yes
104
When are accessory muscles usually active durign the breathing cycle? | central airway obstruction
utilized throughout all phases of breathing cycle.
105
# Treacheal stenosis What can be used to treat tracheal stenosis?
tracheal dilation
106
# Treacheal stenosis What is the most successful tx?
surgical resection and reconstruction
107
# Treacheal stenosis When would a translaryngeal intubation is necessary?
for surgical resection and reconstruction
108
When would high-frequency ventilation be helpful?
when the distal trachea is opened, and ETT inserted and attached to the anesthetic circuit.
109
How does helium gas help anesthesia of inspired gases?
Anesthesia may be facilitated by the addition of helium to the inspired gases * decreases the density of the gas mixture and may improve flow through the area of tracheal narrowing
110
How can tracheal dilation be done?
bronchoscopically using balloon dilators, surgical dilators, or laser resection. also w/ a tracheobronchial stent could be inserted.

Spring 2025 - H&P Assessment (9 decks)

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