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RESP II Exam 2 > Obstructive Lung Disease CIS I > Flashcards

Obstructive Lung Disease CIS I Flashcards

1
Q

40yo M, dyspnea, cough, wheezing last 2-3 yrs, father cirrhosis, 20py tobacco, decreased breath sounds, hyperinflation, clubbing of digits, flattened diaphragms, FEV1 36% predicted, no improvement bronchodilator

A

obstructive

  • emphysema
  • imbalance of neutrophil elastase
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2
Q

sweat testing confirms diagnosis

A

cystic fibrosis

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3
Q

purified protein derivative skin testing

A

tuberculosis

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4
Q

sputum cytology

A

confirmation of cancer

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5
Q

acid fast sputum stain

A

tuberculosis

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6
Q

alpha 1 antitrypsin deficiency

A

risk factor for COPD

protects lungs against neutrophil elastase

patient susceptible to smoking
-age 30s or 40s COPD

often fam Hx of cirrhosis

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7
Q

19yo M, acute resp distress, productive cough, sinusitis, meconium ileus at birth, wheezing, rhonchi, clubbing of fingers

A

hyperinflated lung fields

cystic fibrosis

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8
Q

cystic fibrosis

A

malabsorption of fat soluble vits
-ADEK

sterile males

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9
Q

non-caseating granulomas

A

sarcoidosis

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10
Q

cystic fibrosis genetic

A

autosomal recessive

half siblings will be gene carriers

1/4 have disease

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11
Q

cystic fibrosis prognosis

A

lung disease to death 90% patients

survival 37 years median

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12
Q

lung manifestations in CF

A

cough, SOB, poor exercise tolerance, fatigue, sleep decline, daily productive cough

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13
Q

infection in CF

A

pseudomonas aeruginosa and staph aureus (MRSA)

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14
Q

malabsorption of vitamins

A

bulky foul smelling stools and flatulence

in CF

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15
Q

sweat glands in CF

A

elevation of Na and Cl

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16
Q

pancreas in CF

A

1/3 - diabetes by age 30

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17
Q

MSK in CF

A

decreased bone density

decreased absorption of Vit D

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18
Q

Dx of CF

A

screening immunoreactive trypsinogen
-marker of pancreatic injury

if positive - to genetic mutation analysis

Dx confirmation - sweat testing
-pilocarpine iontophoresis

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19
Q

PFT in CF

A

obstructive

20
Q

CXR in CF

A

hyperinflation

bronchiectasis

21
Q

dornase alfa

A

recombinant rhDNase

breaks down DNA in mucus

thins mucus in lungs

22
Q

ibuprofen in CF

A

high dose continually

-slower decline in lung function

23
Q

55yo M, COPD, SOB, dyspnea, decrease exercise tolerance, 40py tobacco, inhaled steroids, salmeterol, tiotropium, hyperinflated lungs, flattened diaphragm

A

bleb - emphysema - nonfunctional area of lung

decreased FEV1/FVC

24
Q

increased FEV1/FVC

A

restrictive lung diseases

25
Q

COPD

A

progressive, irreversible

onset 20-30 yr after smoking

4th leading cause of mortality in US

leading cause COPD

smokers decrease 40ml/yr per year in FEV1

pregnancy - impaired lung size

26
Q

mechanics in COPD

A

lose elastic recoil in lungs
-dependent on elastic fibers in parenchyma and surface tension in alveolar air-liquid interface

especially in small airways - less than 2mm

increased airway resistance

27
Q

COPD history

A

SOB over months to years

Hx of acute bronchitis

history of chronic cough

sputum production

wheezing, rhonchi

distant heart sounds

barrel chest

accessory muscle use

28
Q

mild COPD

A

FEV1/FVC < 70

AND FEV1 > 80% expected

29
Q

moderate COPD

A

FEV1/FVC < 70

AND 50-80% FEV1

30
Q

severe COPD

A

FEV1/FVC < 70

AND 30-50% FEV1

31
Q

very severe COPD

A

FEV1/FVC < 70

AND < 30% FEV1

or FEV1 < 50% of predicted plus chronic resp failure

32
Q

CXR COPD

A

hyperinflation
flat diaphragm
increased retrosternal space
bullae

normal in mild to moderate COPD

33
Q

emphysema

A

enlargement of air spaces distal to terminal broncvhioles with destruction of alveolar walls

34
Q

centriacinar

A

resp bronchioles distal to terminal bronchiole
-occurs with smoking

emphysema

35
Q

panacinar

A

alveolar ducts, alveoli, coalescence and bullae formation

emphysema

alpha1 antitrypsin deficiency**

occurs with smoking

36
Q

most severe COPD

A

combo of centriacinar and panacinar emphysema

37
Q

chronic bronchitis

A

enlarged mucous glands

-cough and increased mucous production

38
Q

45yo F Hx asthma, daily cough, increased dyspnea, wakes up 2 or 3 nights / week

medium dose inhaled steroids and albuterol PRN

RR 16, P 80, b/l expiratory wheezing

A

mild persistent asthma

change Tx - add long acting beta2 agonist inhaler

39
Q

intermittent asthma

A

less than 2 days /week or 2 nights / month

40
Q

mild persistent asthma

A

more than 2 days/week
but < 1 /day

or > 2 nights / month

41
Q

moderate persistent asthma

A

daily or 1 / night

42
Q

severe persistent asthma

A

Sx continual during day or frequent at night

43
Q

Tx intermittent asthma

A

beta2 agonist PRN

44
Q

Tx mild persistent asthma

A

beta2 agonist PRN

inhale corticosteroid

alternate - mast-cell stabilizer, leukotriene-receptor antagonist, theophylline

45
Q

Tx of moderate persistant asthma

A

beta2 agonist PRN

low to medium dose inhaled corticosteroid

long-acting beta2 agonist

alternate - increased medium dose corticosteroids OR low-medium dosed corticosteroid and either leukotriene-receptor antagonist or theophylline

46
Q

Tx severe persistant asthma

A

beta2 agonist PRN

high dose inhaled corticosteroid and long acting beta2 agonist

2mg/kg/day prednisone - not exceed 60mg/day

RESP II Exam 2 (23 decks)

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