Obstructive lung disease table

Question 1

Obstructive lung disease FEV1/FVC ratio?

What about restrictive?

Answer 1

obstructed /= 0.8

Question 2

What is the disease of the airways?

Answer 2

Chronic bronchitis

Question 3

Emphysema is considered as the disease of the __________

Answer 3

parenchyma (air spaces)

Question 4

What symptoms do BOTH chronic bronchitis and emphysema present with?

Answer 4

pursed lips, tripoding, use of accessory muscles, prolonged expiratory phase

Question 5

Two types of emphysema

Answer 5

centri-acinar from smoking

pan-acinar in older pts or those with a-1-antitrypsin deficiency

Question 6

Chronic bronchitis pathology

Answer 6

hypertrophy of submucosal glands, smooth muscle and goblet cell proliferation, squamous metaplasia

(all of them increase)

Question 7

Treatment for COPD

Answer 7

1. reduced SM tone
   - inhaled beta adrenergic agonist
   - inhaled cholinergic antagonist
2. decrease airway inflammation
   - corticosteroids

treat asthma the same way too (sorta)

Question 8

what makes asthma result in bronchoconstriction?

bronchodilation?

Answer 8

bronchoconstriction?
- parasympathetic ACh stimulation

bronchodilation?

• substance P
• vasoactive peptide
• beta agonists

Question 9

Which obstructive lung disease can present with paroxysmal nocturnal dyspnea?

Answer 9

asthma:

Question 10

Bronchiectasis
- what is it/?
what causes it?

Answer 10

Abnormal dilation of proximal med bronchi due to muscular/elastic destruction from chronic inflammation

• severe pulmonary infection
• CF
• Bronchial obstruction
• Cilia defects (kartageners)
• cartilage defects

Buckets of nasty smelling sputum!

Question 11

Two presentations of cystic fibrosis

Answer 11

recurrent infxns –> bronchiectasis

Pancreatic insufficiency

Question 12

Causes of bronchiolitis

Answer 12

Kids: viral infxn (RSV, adenovirus)

Adults: non-infectious:

• toxic gases,
• autoimmune,
• transplant rejection,
• drugs

*note: dont give antibiotics

Question 13

clinical pearl of bronchiolitis

Answer 13

auscultatory hallmark of inspiratory squeak

- late opening of inflamed bronchioles

Question 14

Vocal cord dysfxn

• what is it?
• clinial pearl?

Answer 14

upper airway obstruction
inappropriate vocal cord motion

inspiratory stridor

*often coexists with asthma

Question 15

*

If pt had respiratory acidosis, how can you tell if it is acute or chronic?

Answer 15

Acute: for every 10 Torr ↑ in CO2 , pH ↓ by 0.08

Chronic: for every 1 Torr ↑ in CO2 , HCO3-!!!! ↓ by 0.04

*chronic: bicarb/kidney kicked in

Question 16

• When would you expect necrotizing granulomas?

Non necrotizing?

Answer 16

necrotizing: usually infectious: mycobacteria, fungus

Non necrotizing: infectious, sarcoid, beryllium