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Pulmonology > Obstructive Disorders > Flashcards

Obstructive Disorders Flashcards

1
Q

What are the obstructive pulmonary disorders?

A
  • asthma
  • COPD
  • bronchiectasis
  • cystic fibrosis
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2
Q

What is asthma?

A
  • airway is hyperreactive
  • happens in small airways
  • REVERSIBLE w/tx
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3
Q

RF of asthma?

A
  • atopy (hereditary)

- obesity

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4
Q

What are cx of asthma?

A

precipitants:

  • exercise/weather (cold air that cannot be warmed up enough cxing wheezing)
  • GERD (b/c the esophagus is close to the trachea so when GERD happens it irritates the trachea cxing wheezing)
  • the air (pollution, etc)
  • post nasal drip (b/c it can go into the trachea, irritating it, wheezing happens)
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5
Q

PE of asthma?

A
  • wheezing (d/t the cxs)
  • prolong expiration (can also come w/reduced breath sounds)
  • coughing
  • +/- sputum (d/t post nasal drip)
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6
Q

Labs for asthma?

A
  • PFT BEFORE and AFTER bronchodilator
  • diagnostic: FEV1/FVC is lower than 0.7 (meaning it’s obstructive)
  • using methacholine challenge/bronchial provocation but ONLY USE if FEV1 is greater than 65%
  • IgE MIGHT be elevated
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7
Q

What is methacholine challenge?

A

used to diagnose asthma:

  • normal: airways will NOT react
  • asthma: airways will constrict b/c methacholine is a muscarinic agonist and bronchodilator will help them
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8
Q

How to diagnose asthma pt as intermittent vs persistent?

A
  • intermittent: less than 2x/wk (sx, nighttime waking; use of SABA, interference of normal activities)
  • persistent: more than 2x/wk
    mild: more than 2x BUT normal FEV1/FVC
    mod: more than 2x AND FEV1 is 60% (predicted is 80%) AND REDUCED 5% FEV1/FVC
    severe: more than 2x AND FEV1 PREDICTED is 60% AND REDUCED more than 5% FEV1/FVC
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9
Q

How to tx asthma?

A

step 1 (intermittent): SABA (rescue inhaler)
step 2 (NOT intermittent): SABA + low dose ICS
step 3: SABA + LD ICS w/ LABA OR MD ICS
step 4: SABA + MD ICS w/ LABA
step 5: SABA + HD ICS w/ LABA +/- IgE tx
step 6: SABA + HD ICS w/ LABA + oral corticosteroids
ALWAYS HAVE AN ACTION PLAN GIVEN TO PT

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10
Q

What is chronic obstructive pulmonary dz?

A

obstruction to expiration

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11
Q

Cx of COPD?

A
  • SMOKERS
  • polluation (occupation)
  • hypersensative leading to chronic inflammation that could be from allergies
  • alpha 1 anti-tripsin def
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12
Q

What dz is COPD made up of?

A

emphysema and chronic bronchitis

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13
Q

What is emphysema?

A
  • the alveolar walls are collapsing
  • pink puffers
  • there is NOT much coughing +/- mucus
  • thin
  • using accessory muscles
  • NO peripheral edema
  • chest is quiet (stomach breathing)
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14
Q

What is chronic bronchitis?

A
  • there is scarring in the lungs (fibrosis)
  • blue boaters
  • there IS coughing d/t MUCUS
  • overweight
  • cyanosis and comfortable at rest
  • chest is NOISY w/ wheezes (d/t mucus)
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15
Q

What is happening in COPD?

A

smoking and pollution is cxing INFLAMMATION in the lungs -> cxing INCREASE of elactase protein –> cxing breakdown of elastic fibers
*not only smoking and pollution but if we have inflammation going on throughout the lungs, usually we have anti-triptase to help decrease and elastic fiber breakdown but those who are anti-triptase def are at higher risk of COPD

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16
Q

Why is there barrel chesting in COPD?

A

as the alveolars die d/t to lack of elastic fibers, the equilibrium between the chest and lungs are lost cxing chest to get bigger (tug of war and chest is winning) –> cxing barrel chesting and getting filled w/air

17
Q

How do you tx COPD?

A
  • STOP smoking
  • COPD w/ bronchitis –> Abx
  • bronchodilators for QOL
  • CS for exacerbations
  • gold standard
18
Q

What is the gold standard for COPD?

A 
mild: FEV1/FVC = less than 0.7
FEV1=80%
Tx: SABA & Flu vaccine
mod:FEV1/FVC = less than 0.7
FEV1 ~80/ 50%
Tx: SABA & Flu vaccine,  LABA
severe:FEV1/FVC = less than 0.7
FEV ~50/30%
Tx: SABA & Flu vaccine, LABA, Glucocorticosteroids
very severe:FEV1/FVC = less than 0.7
FEV1~30 OR ~50% w/ chronic resp failure
Tx: SABA & flu vaccine, LABA, glucocorticosteroids, O2 +/-surgery
19
Q

What is bronchiectasis?

A
  • the permanent dilation and destruction of the bronchial walls and SCARRING of the bronchial TUBES
  • there is extra mucus build up b/c the cilia is broken and can’t clear it up
20
Q

What cxs bronchiectasis?

A
  • cystic fiborsis

- whooping cough from a young age

21
Q

What is the pathophysiology of bronchiectasis?

A
  • CHRONIC inflammation of the walls d/t cystic fibrosis (genetic)
  • destruction of the cilia (genetic)
22
Q

PE of bronchiectasis?

A
  • CHRONIC coughing w/ sputum (smells bad) –> recurrent infxn
  • hemoptysis
  • wheezing
  • weight loss
  • persistent basilar crackles
  • clubbing
  • hypoxemia (mod-severe)
23
Q

Labs for bronchiectasis?

A
  • PFT: obstructive
  • Hi Res CT: dilated and THICK bronchi; tram tracks; SIGNET RINGS
  • sputum culture: H. influenza
24
Q

Tx for bronchiectasis?

A
  • Abx (infxn)
  • KEEP THE MUCUS OUT OF THE LUNGS: CHEST PHYSIOTHERAPY (percussion to drain mucus b/c cilia is broken)
  • bronchodilators
  • hydration
  • bronchoscopy
  • resection
25
Q

What is cystic fibrosis?

A
  • it is a HEREDITARY dz

- problem with the CFCTR

26
Q

What is the pathophys of CF?

A

the CFTR is not working:

skin: Cl is not reabsorbed into body (CFTR is broken) –> Na follows Cl so Na is not reabsorbed into body
lungs: Cl is not secreted –> Na is not secreted –> H20 is not secreted –> MUCUS IS THICK

27
Q

PE of CF?

A
  • able to dx w/in 1 yo
  • PANCREATITIS (d/t the defective protein)
  • INFERTILITY (messes up w/ the sperm ct in men)
  • HEMOPTYSIS
  • chronic lung dz
  • chronic coughing
  • DECREASE in exercise
  • chronic rhinosinusitis, steatorrhea (fat in feces), abdominal pain, diarrhea d/t mucus build up in body
  • clubbing
  • hyperressonance to percussion (mucus)
  • apical crackles
28
Q

Labs for CF?

A 
CXR:
-cuffing
-mucus plugging
-PFT: mixed pattern
GOLD STANDARD: SWEAT CHLORIDE TEST (must be done 2x no diff days)
29
Q

Tx for CF?

A
  • bronchodilators
  • abx (infxn)
  • CS if needed
  • CHEST PATHOPHYSIOLOGY (for mucus)

Pulmonology (7 decks)

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