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PANRE PULM > Obstructive Disorders > Flashcards

Obstructive Disorders Flashcards

1
Q 
Affects large bronchi
Permanent dilation
Destruction bronchial walls
LOTS of SPUTUM - often green/yellow
Chronic cough, hemoptysis, clubbing
A

Bronchiectasis

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2
Q

Etiology (Bronchiectasis)

A

Idiopathic - majority
Genetic:
1) CF (MC overall)
2) IgG deficiency (recurrent sinopulmonary infxn in childhood)
Acquired - recurrent PNA, bact infx (Staph, Kleb, Bordetella), AIDS, TB, IBD (UC>Crohns)

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3
Q

Dx (Bronchiectasis)

A 
CXR (honeycomb/popcorning)
Chest CT (dilated bronchi/thickened walls)
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4
Q

Tx (Bronchiectasis)

A

Underlying cause
Abx for infx (macrolides)
Inhaled bronchodilators (ICS, SABA, LABA)
Chest PT

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5
Q 
Asthma
C
H
E
R
I
A 
Chronic
Hyper-responsive
Episodic
Reversible
Inflammatory
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6
Q

RF’s (Asthma)

A 
URI
Exercise
Atopy
Occupation
Environment 
Drugs
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7
Q

Atopy triad

A

ASA
Asthma
Polyps

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8
Q

4 classifications (Asthma)

A

Intermittent
Mild persistent
Moderate persistent
Severe persistent

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9
Q 
Dx eval (Asthma)
Step 1 eval
A

Spirometer
Before & after SABA
Shows reduced FEV1/FVC ratio
Shows reversibility p SABA

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10
Q 
Dx eval (Asthma)
Step 2 eval
A

Bronchoprovocation (methacholine challenge)

If spirometry not diagnostic, but high clin susp

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11
Q

Tx (Asthma)

Step 1: rescue med

A

Inhaled SABA (albuterol)

Special rescue: Inhaled Anticholinergics (ipratropium)
Systemic corticosteroids (pred, methylpred)
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12
Q

Tx (Asthma)

Step 2: maintenance

A

Inhaled corticosteroid (ICS)
Takes 1 - 2 wks max effectiveness
Rinse & spit
Beclomethasone, budesonide, fluticasone, triamcinalone

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13
Q

Tx (Asthma)

Step 3: Add-on maintenance

A 
Inhaled LABA (black box warning alone)
     Salmeterol, formoterol
LABA + steroid
     Advair, Symbicort
Leukotriene modifiers (for allergen-related)
     Montelukast
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14
Q

Tx (Asthma):

Last lines

A 
Anti-IgE
Immunotherapy
Inhaled mast cell stimulators
     cromolyn - poor efficacy
Phosphodiesterase inhibitor
     theophylline - poor toxicity
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15
Q

Combination of:
1) Chronic bronchitis: inc secretions & cough
2) Emphysema: destruction alveolar-capillary membrane (dec gas exchange)
progressive, gradual decline in FEV1
mucus plugging, airway narrowing

A

COPD

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16
Q

Signs/Sxs:
Chronic bronchitis =
Emphysema =

A

= “Blue bloater”, chronic cough (smoker’s), purulent sputum, inc pulm infx, wheeze
= “Pink puffer”, DOE, ? cough, scant/clear sputum
hemoptysis, cyanosis, edema, crackles

17
Q

PE Findings (COPD):
Early =
Late =

A

= prolonged exp, wheeze on forced exp

= inc AP chest, dec tactile fremitus, hyper-resonance, dec BS

18
Q

Main Dx strategy (COPD)

A

Spirometry

FEV1/FVC ratio < 0.7 (doesn’t respond to tx)

19
Q

Other Dx (COPD)

A

CXR - RVH, CM

CT - Shows hyperinflation & parenchymal BULLAE & BLEBS

20
Q

COPD staging

A

Stage 1 - 4

Mild, mod, severe, very severe

21
Q

Stage 1 (mild COPD)

A

Chronic cough & sputum; some SOB

FEV1 > 80%

22
Q

Stage 2 (mod COPD)

A

Chronic cough & sputum; SOB may limit exertion

FEV1 50-80%

23
Q

Stage 3 (severe COPD)

A

Progressive airway limitation; signs / sxs worse c freq exacerbations
FEV1 30-50%

24
Q

Stage 4 (very severe COPD)

A

Hypercapnea, hypoxia c severe recurrent exacerbations req home O2; affect QOL
FEV1 < 30% or < 50% c chronic resp fail

25
Q

Tx COPD

A

Education: smoking cessation
Vaccines: Pneumo & Flu
Pulm rehab
Meds

26
Q

Mainstay med tx (COPD)

A

Bronchodilators

1) Short-acting inhaled rescue: combo SABA + Anticholinergic (combivent = albut + ipratrop)
2) Long-acting inhaled maint: Anticholinergics (tiotropium/spiriva) or LABA (salmeterol) + ICS

27
Q

Special Tx reserved for Stage 3 & 4

A

Inhaled corticosteroids (ICS)

??? Theophylline (older, inc toxicity profile)

New: Roflumilast

28
Q

Autosomal recessive, Caucasian
Chloride transport dysfxn
Multisystem - most exocrine glands produce abnml thick mucus secretions that obstructs glands/ ducts

A

Cystic Fibrosis (CF)

29
Q

Sinopulmonary manifestations (CF)

A 
Sinusitis
Nasal polyposis
Mult recurring lung infx become chronic (Bronchitis, PNA, Bronchiectasis)
? Pseudomonas
Wheezing, chronic cough
30
Q

Extrapulmonary manifestations (CF)

A 
MECONIUM ILEUS
Pancreatitis / insufficiency
Steatorrhea - fatty stools
Infertility (M > F); bilat absence vas deferens
FTT, bone issues
Clubbing
Anemia, hypernatremia, hypoproteinemia
31
Q

Dx (CF)

A

Eval: Newborn screening (many false +)
Screening: Sweat test (> 90% sens); nml doesn’t r/o CF
Confirmation: CFTR mutation analysis for nml or borderline sweat test

32
Q

Tx (CF)

A

Multidisciplinary
Clear/reduce secretions, chest PT, tx infxn
Nutrition, pancreatic enzyme replacement
Genetic counseling…

PANRE PULM (6 decks)

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