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

Obstructive Lung Disease CIS II Flashcards

1
Q

asthma components

A

1 recurrent obstruction - resolves with Tx

2 airway hyperresponsiveness

3 airway inflammation

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2
Q

asthma population

A

8% adults

boys and women

15 million outpatient visits and 2 million hospitalizations

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3
Q

mild asthma

A

edema and hyperemia of mucosa and infiltration of mucosa with mast cells, eosinos, lymphocytes

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4
Q

moderate asthma

A

chemokines eotaxin, RANTES, macro inflammatory protein I, IL8

lead to inflammation and smooth m constriction

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5
Q

severe asthma

A

hypertrophy and hyperplasia of airway glands and smooth m lead to severe airway thickening

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6
Q

airway obstruction in asthma

A

constriction of airway smooth m

thickened airway epithelium

liquids in airway

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7
Q

ACh

A

M3 - smooth m constriction in asthma

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8
Q

histamine

A

minor role in asthma

-mast cells

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9
Q

leukotrienes and lipoxins

A

lipoxygenation of arachidonic acid release from target cell membrane phospholipids during cell activation

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10
Q

nitric oxide

A

produced by airway epithelial cells and by inflammatory cells found asthmatic lung
-high levels found during asthma attacks

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11
Q

asthma Hx

A

dyspnea, cough, wheezing, anxiety

exercise induced, aspirin ingestion, allergens

cough, hoarseness, inability to sleep

rapid change in temp or humidity may lead to an attack

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12
Q

pulsus paradoxus

A

10mmHg systolic difference during inspiration

in asthmatics

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13
Q

ABG in asthma

A

mild hypocapnea

normalized - indicated resp failure

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14
Q

asthma PFT

A

obstructive

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15
Q

CBC asthma

A

eosinophilia

IgE elevation

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16
Q

CXR asthma

A

hyperinflation

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17
Q

EKG asthma

A

RBBB, P pulmonale, ST-T changes

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18
Q

P pulmonale

A

right atrial enlargement

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19
Q

omalizumab

A

monoclonal Ab for IgE

alternate Tx for hypersensitivity asthma

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20
Q

60yo M, cough, productive purulent sputum, dyspnea, hemoptysis, pleuritic chest pain, wheezing and rales, dilated airways

A

bronchiectasis

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21
Q

atelectasis

A

collapse of lung

22
Q

ARDS

A

acute resp distress syndrome

-white out of lung on CXR

23
Q

churg strauss syndrome

A

elevated eosinos

24
Q

bronchiectasis

A

abnormal permanent dilation of bronchi and bronchioles

due to repeated cycles of airway infection and inflammation

abnormal cilia, mucous clearance, rainage, and host defenses

25
Q

mycobacterium avium intracellulare

A

right middle lobe and lingula of lung

-may lead to bronchiectasis

26
Q

etiology of bronchiectasis

A

1/2 CF

1/3 infection

  • pertussis, TB, MAI
  • CF, primary ciliary dyskinesia, alpha1 antitrypsin
  • esophageal dysfunction and aspiration, COPD, aspergillosis, tumor, foreign body
  • sjogrens, rheumatoid arthritis, HIV, IgG deficiency
27
Q

chronic cough, purulent sputum, hemoptysis, pleuritic chest pain, weight loss, fatigue, wheezing and crackles

A

bronchiectasis

28
Q

Dx of bronchiectasis

A

high res CT
-bronchi visible in peripheral 1cm of lung

-internal bronchial diameter greater than diameter of accompanying bronchial artery

29
Q

CF bronchiectasis

A

upper lobe predominance

30
Q

aspiration bronchiectasis

A

lower lobes

31
Q

aspergillosis bronchiectasis

A

central bronchiectasis

32
Q

bronchiectasis PFT

A

obstruction

33
Q

electron microscopy

A

Dx of primary ciliary dyskinesia

34
Q

Tx of bronchiectasis

A

Tx of underlying conditions

antimicrobials

anti-inflammatory

surgery for localized

end stage - transplant

35
Q

63yo F worsening dyspnea, Hx COPD, no fevers/chills, moderate resp distress, trouble speaking, RR 28, pulse ox 84%
-diminished breath sounds, end expiratory wheezes

ABG pH 7.3, hypoxemia, PCO2 65

no improvement on beta2 agonist and O2 Tx

A

resp acidosis

CXR hyperinflation and flat diaphragm

36
Q

to prevent acute increase in PCO2

A

venturi mask

can tightly control the O2 administration

too much O2 can actually decrease resp drive

37
Q

venturi mask

A

dial to control FiO2 patient received

can slowly titrate O2 level up with more control than normal mask

38
Q

41yo carpenter, asthma, cough, wheezing, sx during work hours, FEV1 decrease with exposure to western red cedar, albuterol inhaler

A

occupational asthma

best way to manage
-avoid further exposure to wood dust - wear specialized respirator at work - but probably won’t

so add inhaled corticosteroids**

39
Q

35yo M dyspnea, worsening over last 8 months, SOB when not moving, 5py tobacco, quit smoking 3yr ago, no sputum fevers chills, BP 105/70, P 120, RR 28, intercostal retraction, diminished breath sounds

PFT - TLC and RV elevated, VEF1/FVC decreased

A

obstructive - severe bc 30% of predicted

most likely Dx - alpha1 antitrypsin deficiency

40
Q

65yo F productive cough, 2 spoons/day, cough 3 months, chronic cough during different seasons

A

most appropriate diagnosis

-chronic bronchitis

41
Q

chronic bronchitis

A

3 months productive cough for 2 consecutive years**

42
Q

20yo F wheezing and SOB past 3 months, worse with exercise, seasonal allergies, roommate has pet cat

A

best assess possible etiology

-serum IgE levels

43
Q

mycoplasma

A

chronic non-productive cough

cold agluttinins

44
Q

reid index

A

thickness epithelium to blood vessel

thickened = chronic bronchitis

45
Q

35yo dairy farmer, chronic cough few years, mild wheezing, decreased FEV1 and FVC, CXR normal, eosinophilia, serum thermoactinomyces vulgaris in blood work

A

most likely diagnosis

-farmers lung

46
Q

wegeners granulomatis

A

sinusitis, lung sx, hematuria

47
Q

sarcoidosis

A

hilar adenopathy, non-caseating granulomas, serum ACE level elevated

48
Q

acute farmers lung

A

resolves 12 hours to days
-fever chills, non-productive cough, chest tight, dyspnea, HA, malaise

acute resp failure with large inhalation

moldy hay or contaminated compost

49
Q

subacute farmers lung

A

chronic cough, dyspnea, anorexia, weight loss

insidious onset and may occur over weeks to months

50
Q

chronic farmers lung

A

prolonged and continuous exposure

irreversible lung damage possible

severe dyspnea at rest with exertion

RESP II Exam 2 (23 decks)

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