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Paige: Pulm Module! > Obstructive d/o > Flashcards

Obstructive d/o Flashcards

1
Q

What is the pathophys of asthma?

A

obstructive airflow, hyperreactivity, and inflammation

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2
Q

What causes asthma?

A

allergens, cold air, exercise, drugs, URI, etc.

often there is a trigger, often genetic predisposition

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3
Q

When do people get diagnosed with asthma?

A

Can be at any age, but most commonly before 18y

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4
Q

What is the atopic triad?

A

asthma, allergies, eczema

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5
Q

What are the common symptoms of asthma?

A

Cough, tight chest, dyspnea, use of accessory muscles

wheezing

pulsus paradoxus

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6
Q

How will you diagnose asthma?

A

decreased FEV1/FVC ratio

Reversible (10% increase after bronchodilators like B agonists)

Can be induced by Ach agonists like methyl choline

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7
Q

What will ABG show in asthma?

A

respiratory alkalosis

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8
Q

Suppore you suspect asthma, but PFTs are normal every time the pt sees you. What test can you give to induce sx?

A

Methacholine challenge

Give methacholine, and see if FEV1 decreases by 20% or more.

if it doesn’t, it’s unlikely asthma

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9
Q

What is Stage 1 asthma?

A

attacks:

< 2 times / wk during day

< 2 times / mo during night

FEV1 is 80%

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10
Q

What is stage 2 asthma?

A

attacks:

< 1 times / day during day

< 1 times / wk during night

FEV1 is 80%

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11
Q

What is stage 3 asthma?

A

attacks:

> 1 times / d during day

> 1 times / wk during night

FEV1 is 60-80%

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12
Q

What is stage 4 asthma?

A

attacks:

> 1 times / d during day

Frequent during night

FEV1 is < 60%

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13
Q

How do you best assess severity of asthma?

A

Peak Expiratory Flow Rate (PEFR)

Best for baseline and monitoring

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14
Q

How do you treat asthma?

a) Intermittent (1)
b) Mild persistant (2)
c) Moderate Persistant (3)
d) Severe persistant (4)

A

a) short acting beta agonist
b) short acting beta agonist + inhaled corticosteroid
c) short acting beta agonist + inhaled corticosteroids + long acting beta agonist
d) short acting beta agonist + HD inhaled corticosteroid + long acting beta agonist

consider PO steroids

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15
Q

How do you treat exercise induced asthma?

A

stabilizers (cromolyn, nedocromyl)

albuterol [ventolin hfa] 5 min before exercise

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16
Q

(just to reiterate)

How do you treat asthma attack?

How do you treat asthma long term?

A

attack: DOC is SABA, MC albuterol

  • also anticholinergics, MC ipratroprium, but less effective

long term: DOC is inhaled corticosteroids, MC fluticasone

  • also LABA, esp for night sx, MC salmeterol or formoterol
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17
Q

For asthma, what is an alternative to ICS in mild persistant asthma?

A

leukotriene receptor antagonists and inhibitors like zafirlukast

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18
Q

What drug is given to patients with uncontrolled asthma in adjunct to ICS?

A

long acting inhaled anticholinergic like tiotroprium

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19
Q

What is DOC for severe persistant asthma that is triggered by allergies?

A

Omalizumab (anti-igE drug)

20
Q

At what level of asthma should you consider hospitalization?

A

Moderate to severe

21
Q

What is COPD in general?

A

progressive, irreversible airway obstruction due to

a) loss of elastic recoil
b) increased airway resistance

includes emphysema and chronic bronchitis (usually coexist)

22
Q

What is emphysema (pathyphys)?

A

destroyed alveoli that are big and floppy

caused by chronic inflammation, a decrease of protective enzymes/increase of destructive enzymes, leading to alveolar destruction

usually steady decline

23
Q

What is chronic bronchitis (pathophys)?

A

airways clog with mucus

“mucociliary escalator” destroyed and patients are prone to infection

usually episodic

24
Q

What causes COPD (emphysema and chronic bronchitis)?

A

Smoking!

Also recurrent URIs, other pollutants

Rarely, alpha antitrypsin deficiency

25
Q

Who gets COPD?

A

Typically age 55+

(if <40y consider genetic cause)

26
Q

What are the signs and symptoms of emphysema?

A

Exertional dyspnea and hyperventilation

Non-productive cough

dec or absent breath sounds, dec fremitus

NO peripheral edema

Pt often thin with weight loss

Barrel chest

Tripod position with pursed lip

27
Q

What are the signs and symptoms of chronic bronchitis?

A

Mild dyspnea

productive cough

ronchi, crackles and wheezing

peripheral edema

overweight with cyanosis

loud, raspy breaths

28
Q

How do you diagnose COPD?

(What diagnostic factor is the same between both emphysema and chronic bronchitis?)

A

Spirometry is gold standard.

DECREASED FEV1 so decreased FEV1/FVC ratio

Non-reversible

DLCO decreased

29
Q

What will ABG labs look like for

a) emphysema
b) chronic bronchitis

A

a) respiratory alkalosis
b) respiratory acidosis w/ inc Hct and RBC

30
Q

Which COPD disorder has the most severe v/q mismatch?

A

Chronic bronchitis, w/ severe hypoxemia and hypercapnia

31
Q

Why would you order a CXR/CT scan in COPD?

A

to help diagnose emphysema and to assess extent of damage

32
Q

What will you see in CXR/CT of

a) emphysema
b) chronic bronchitis

A

Emphysema: hyperinflation of lungs, flat diaphragm, droopy heart, increasing markings bullae or subpleural blebs (pathognomonic)

Chronic bronchitis: hyperinflation of lungs without flat diaphragms, enlarged R heart border, increased markings

33
Q

How do you treat COPD?

A

Similar to asthma.

1. Smoking cessation

  1. Anticholinergic inhalers is DOC (ipratroprium; tiotropium)
  2. ST bronchodilators for acute exacerbations (b2 agonist drugs like albuterol; salmeterol)

Frequenty, oral abx for chronic bronchitis

Other: O2, aerobic exercise, steroids (with caution), alpha1 antitrypsin replacement therapy, vaccinations

34
Q

What is bronchiectasis?

A

permanent dilation of airways; destruction of bronchiole walls

airways are easily collapsable & mucus clearance impaired

35
Q

What causes bronchiectasis?

A

chronic bronchial injury due to infection or inflammation

MC with cystic fibrosis

36
Q

What are the signs and sx of bronchiectasis?

A

Foul, purulent sputum w/ chronic cough

pleuritic chest pain, dyspnea

hemoptosis

recurrent pneumonia

local chest crackles (at bases), also wheezing, rhonchi

clubbing of fingers

37
Q

What is the diagnostic test of choice for bronchiectasis?

What will you see?

A

Chest CT - dilated, tortuous airways

“tram track” appearance (wall thickening), plugs, consolidations

Signet Ring sign (pulm artery coupled with dilated bronchus)

38
Q

What will you see on PFT for bronchiectasis?

On CXR?

A

PFT: obstructive pattern so dec ratio

CXR: very similar to CT scan with basal cystic spaces (small cysts @ lung bases), atelectasis, honeycombing

39
Q

What are the 3 most common pathogens seen in bronchiectasis?

A

pseudomonas (MC with CF)

mycobacterium avium complex (MAC)

aspergillus

40
Q

How do you treat bronchiectasis?

A

Abx: amox, augmentin, Bactrim, ciprofloxacin (empiric)

FQs, cephalosporins (pseudomonas coverage)

Bronchodilators

Chest physiotherapy

If severe: lung transplant

41
Q

What is cystic fibrosis?

A

increased mucus and problem with chloride transport

42
Q

What causes CF?

A

autosomal recessive disease

43
Q

Who gets CF more often?

A

Caucasians, northern Europeans

44
Q

In whom should you suspect CF?

A

someone with a hx of chronic lung dz, pancreatitis, and infertility

45
Q

What are the clinical manifestations of CF?

A

GI: meconium ileus at birth (failure to pass 1st stool); foul steatorrhea due to decreased fat absorption

Pulm: recurrent resp infections, prod cough, dyspnea, chest pain, wheezing, chronic sinusitis

Other: failure to thrive

46
Q

How do you diagnose CF?

A

Chloride sweat test on 2 different days

DNA testing for CFTR gene

PFT obstructive (prob irreversible)

CXR - hyperinflation, bronchiectasis, mucus plugging, increased interstitial markings, small/round peripheral opacities, atelectasis, blah blah blah

47
Q

Tx of CF?

A
  1. mucolytics (pulmozyme or dornase)
  2. bronchodilators
  3. chest percussion
  4. abx

Others: pancreatic enzyme replacement, dietary supps, lung transplant

Paige: Pulm Module! (7 decks)

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