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Pulmonary > Obstructive Lung Disorders > Flashcards

Obstructive Lung Disorders Flashcards

1
Q

Atelectasis will cause

A

a V/Q mismatch

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2
Q

What is the presentation of atelectasis?

A

Typically asymptomatic, but may have SOB, cough, fever, or elevated WBC

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3
Q

In obstructive lung disease the problem is with getting air

A

out of the lung

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4
Q

What are the PFT findings in obstructive lung diseases?

A

Decreased FEV1 (< 0.8)
FEV1/FVC = lowered with obstructive patterns

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5
Q

In restrictive lung disease the problem is with getting air

A

in

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6
Q

Chronic obstructive pulmonary disease (COPD) includes

A

Emphysema and Chronic Bronchitis

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7
Q

Will expiration be prolonged in obstructive lung disease?

A

Yes, very prolonged expiratory phase

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8
Q

What causes the obstruction in chronic bronchitis?

A

Obstructive airflow secondary to thick mucus, not as structural of a process as emphysema

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9
Q

What is the presentation of chronic bronchitis?

A

Dyspnea (worse with exertion)
Decreased FEV1/FVC
Flare will lead to decreased alveolar lumen

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10
Q

What complications are associated with chronic bronchitis?

A

Pneumonia distal to obstruction
Hypoxemia
Hypercapnia
VQ mismatch

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11
Q

What is bronchiectasis most commonly due to?

A

Cystic Fibrosis
Aspiration
Immunodeficiencies
Connective tissue disorder

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12
Q

What is the common presentation of bronchiectasis?

A

Productive cough
Foul smelling sputum, purulent
Hemoptysis

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13
Q

What are the components of the atopic triad?

A

Atopic Dermatitis (Eczema)
Allergic Rhinitis (hay fever)
Asthma

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14
Q

During asthma exacerbation, the patient will have increased lung volumes leading to what complications?

A

Muscular fatigue
Respiratory failure
Pulses paradoxus from intrathoracic pressure

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15
Q

What are the complications of asthma?

A

Repetitive cellular damage leading to fibrosis

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16
Q

What gene is impacted in cystic fibrosis?

A

CFTR protein on chromosome 7

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17
Q

CFTR is a chloride transportation protein of the exocrine glands so alteration in this protein will cause what effects?

A
  • Change in water concentration/movement
  • Thickening of the secretions (dehydration)
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18
Q

What lung conditions do you likely hear crackles (rales) on exam?

A

Bronchiectasis
Bronchitis
Pneumonia
Fibrosis
CHF

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19
Q

What lung conditions do you likely hear wheeze on exam?

A

Asthma
COPD
And other causes of airway obstruction

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20
Q

When rhonchi are heard on exam what does that suggest?

A

Suggest secretions in the large airways

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21
Q

What is the etiology behind extrinsic (allergic) asthma?

A

Allergic response to environmental or animal allergens

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22
Q

What is the etiology behind intrinsic (non-allergic) asthma?

A

Occupational/pollution
Cold/humidity
Stress
Medications (ASA or NSAIDs)
Exercise

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23
Q

Is it possible for a patient to have both extrinsic and intrinsic etiology of asthma?

A

Yes

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24
Q

What are the risk factors associated with asthma?

A

Atopy
Environmental/occupational exposures
Childhood asthma or symptoms
Family history

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25
Q

What are the signs of asthma?

A

Expiratory wheezes
Diminished breath sounds
Accessory muscle use
Tripoding (severe exacerbation)

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26
Q

What is part of the work-up/diagnosis for asthma?

A

Clinical findings and HISTORY
PFT’s
Bronchoprovocation testing (methacholine, mannitol, exercise or dry air)

27
Q

What medication class do all asthma patients receive?

A

SABA as needed (albuterol)

28
Q

What is the management for step 1 asthma?

A

All ages: SABA as needed
< 4 years old: sick plan with few days of ICS due to association with URI’s

29
Q

What is the management for step 2, mild persistent asthma?

A

All ages: Continue SABA as needed
Children (up to 11): daily low dose ICS or Montelukast
> 12 years: Daily low dose ICS, or daily combination inhaler (can also alternatively use Montelukast)

30
Q

What is the management for step 3, moderate persistent asthma?

A

All ages: continue SABA as needed

< 4: Daily combo inhaler (low dose ICS with LABA), daily montelukast, or medium dose ICS

> 4: Daily combination inhaler PLUS as needed Symbicort, or daily medium dose ICS, or low dose ICS plus Montelukast

31
Q

What is the management for step 4, severe asthma?

A

Daily combination inhaler (medium dose ICS with LABA) or daily medium dose ICS with Montelukast

32
Q

What is the management for step 5, severe persistent asthma?

A

Daily high dose ICS with LABA

OR

Daily high dose ICS with Montelukast

Consider Omalizumab (Xolair)

33
Q

What are mechanisms of prevention in asthma?

A

Avoid triggers

Allergens (allergy medications, immunotherapy, air filters, or washing face/hands)

Medication Management

Asthma Action Plan

34
Q

What are signs of bronchioctasis?

A

Crackles
Wheezing
Digital clubbing

35
Q

What are symptoms of bronchiocstasis?

A

Chronic Cough
- Productive
- Malodorous thick, mucopurulent mucus
- Hemoptysis

Fatigue
SOB
Fever/chills
Pleuritic Chest Pain

36
Q

What is a symptom that is a common “buzz word” on exam questions associated with bronchiectasis?

A

Persistent or recurrent cough with mucopurulent sputum

37
Q

What should be included in the work-up of bronchiectasis?

A

Labs - CBC, Immunoglobulins, Sweat Chloride, Sputum smear, Alpha-1 tripsin, Rh factor

CXR

CT (gold standard)

PFTs (for prognostics)

Bronchoscopy

38
Q

What is the treatment for bronchiectasis?

A

Treat and control underlying disease/infection
Bronchodilators (Duonebs or SBA and combo’s)
Chest physiotherapy (Chest PT)
Surgery (sever cases)

39
Q

What antibiotic should be used for psuedomonas coverage in bronchiectasis?

A

Fluoroquinolone: Levofloxacin (oral)
Pipercillin/Tazobactam (Zoyn) (IV)

40
Q

What are some oral antibiotics that can be used to treat bronchiectasis?

A

Fluoroquinolones
Amoxacillin or Augmentin
Macrolides

41
Q

What is the most common cause of acute bronchiolitis in pediatric patients?

A

RSV

42
Q

What are the types of bronchiolitis?

A

Acute (most common)
Bronchiolitis Obliterans
Proliferative
Follicular Bronchiolitis

43
Q

What are the symptoms of bronchiolitis?

A

Upper respiratory symptoms
Fever
Wheezing
Tachypnea
Shallow respirations
Poor appetite

44
Q

What should be included in the work-up of bronchiolitis?

A

Clinical context and medical history
CXR
Viral panel
PFT’s
Biopsy (not for acute)

45
Q

When is endotracheal intubation indicated in severe bronchiolitis?

A

Only in respiratory failure

46
Q

What is the treatment for mild-moderate bronchiolitis?

A

Supportive therapy and parent eduction

47
Q

What is the treatment for severe bronchiolitis?

A

Admission with supportive care
Respiratory support (nasal suctioning and LFNC)
Bronchodilator
+/- Glucocorticoids
CPAP for risk of respiratory failure
Intubation for respiratory failure

48
Q

Is COPD more common in women or men?

A

Women, there are also more death in women

49
Q

What patients are most likely to be diagnosed with COPD?

A

Current or former smokers
History of asthma

50
Q

What are the risk factors associated with COPD?

A

Smoking!
Air pollutants
Genetic factors
Respiratory infections
Atopy and Asthma

51
Q

What is atopy?

A

Genetic predisposition to develop atopic triad or atopic triad symptoms (rhinitis, eczema, asthma)

52
Q

What are the signs/symptoms of COPD?

A

Cough
Persistent, progressive dyspnea
CO2 retention
Weight loss (emphysema)
Tachycardia
Hypertension
Wheeze/crackles
Prolonged expiratory phase
Barrel chest

53
Q

What CXR findings can be associated with COPD?

A

Hyperinflated lungs
Flat diaphragm

54
Q

What is the treatment for Group A COPD?

A

SABA or LABA

55
Q

What is the treatment for Group B COPD?

A

LABA

Consider SABA and LABA

56
Q

What is the treatment for Group C COPD?

A

Add LAMA

57
Q

What is the treatment for Group D COPD?

A

Most started on LAMA
Combination LAMA/LABA
LABA/ICS

58
Q

What organs are impacted in COPD due to containing mucus membranes?

A

Lungs
Pancreas
Liver
Intestines
Reproductive tract

59
Q

What are the respiratory signs/symptoms of CF?

A

Persistent, productive cough
Wheeze
Dyspnea
Hemoptysis
Apical crackles
Bronchiectasis
Barrel chest
Respiratory distress/failure
Digital clubbing

60
Q

What is the screening test for CF?

A

Newborn screen

61
Q

What is the gold standard test for CF?

A

Sweat chloride test

62
Q

What is the most definitive test in diagnosing CF?

A

Genetic testing (numerous different mutations)

63
Q

What is an indicative chloride concentration on sweat testing for diagnosing CF?

A

> /= 60 mmol/L

64
Q

What is the diet recommendation for a patient on Trikafta?

A

Require a diet high in fats to maximize absorption

Pulmonary (15 decks)

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