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Clin Med Exam 3 PULM > Obstructive Pulmonary Diseases > Flashcards

Obstructive Pulmonary Diseases Flashcards

1
Q

3 characteristic components of Asthma

A
  1. Obstruction of Airflow
  2. Bronchial hyperreactivity
  3. Inflammation of airway
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2
Q

A disease of chronic inflammation leading to airway narrowing and increased mucus production.

Chronic inflammation is associated with bronchospasms that lead to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing.

Often reversible airflow obstruction.

A

Asthma

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3
Q

3rd leading cause of death in US

A

COPD

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4
Q

A common, preventable, treatable disease that is not reversible. It is usually progressive and associated with enhanced chronic inflammatory response in the airway and lung to noxious particles or gas.

A

COPD

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5
Q

A chronic inflammatory condition of the small airways that results in a chronic productive cough
cough must last for 3 months in each of 2 successive years
other causes of cough (bronchiectasis, malignancy etc) must be ruled out

A

Chronic Bronchitis

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6
Q

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles due to chronic inflammation.
Destruction of airspace walls but no overt fibrosis.

A

Emphysema

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7
Q

Asthma classification and diagnosis

A

Classified according to

  1. frequency of symptoms
  2. PFT (pulmonary function testing)
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8
Q

Asthmatic symptoms appear 2 or less days / week, does not interfere w daily activities.
Nighttime symptoms 2 or fewer times per month.

A

Mild / Intermittent

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9
Q

Asthmatic symptoms appear more than 2 days / week but not daily. Minor limitation.
Nighttime symptoms 3-4 times / month

A

Mild persistent

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10
Q

Asthmatic symptoms appear daily. Some limitation in daily activity.
Nighttime symptoms more than 1x / week but not nightly
Daily use of medication

A

Moderate persistent

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11
Q

Asthmatic symptoms are continuous. Extremely limited physical activities. Nighttime symptoms often every night.
Medication use several times / day

A

Severe persistent

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12
Q

FEV1 > 80% predicted

PEFR variability < 20%

A

Mild intermittent

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13
Q

FEV1 > 80% predicted

PEFR variability 20 - 30 %

A

Mild persistant

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14
Q

FEV1 > 60% , < 80%

PEFR variability > 30%

A

Moderate persistent

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15
Q

FEV 1 < 60%

PEFR variability >60%

A

Severe persistent

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16
Q

How is the diagnosis of asthma confirmed?

A

Demonstrating reversibility of airflow obstruction with use of short-acting bronchodilator.

Reversibility = improve FEV1 by 12% and 200mL

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17
Q

Using PEFR to confirmed asthma diagnosis

A

Peek Expiratory Flow Rate, to measure diurnal variability
( {highest daily PEFR - lowest daily PEFR} / {highest daily PEFR} )

Diagnosis of asthma if PEFR varies by at least 20%, for 3 days in a week over several weeks
OR
PEFR increases by at least 20% in response to treatment

18
Q

Treatment for Intermittent asthma

A

Step 1

SABA (inhaled short acting beta2 agonists) PRN

up to 3 treatments at 20 minute intervals, as needed

19
Q

Indication of inadequate control of symptoms and need to “step up”

A

use of SABA >2x / week for symptom relief

not including EIB prevention

20
Q

Treatment for persistent asthma, step 2

A

Low-dose ICS (inhaled corticosteroid)

21
Q

Tx persistant asthma, step 3

A

Low dose ICS + LABA (long-acting inhaled beta 2 agonist)

OR

Medium-dose ICS

22
Q

Tx persistant asthma, step 4

A

Medium dose ICS + LABA

23
Q

Tx persistant asthma, step 5

A

High-dose ICS + LABA

AND

allergy treatment (Omalizumab)

24
Q

Tx persistant asthma, step 6

A

High-dose ICS + LABA + Oral corticosteroid

AND

allergy treatment (omalizumab)

25
Q

Necessary components for each step of asthma treatment

A

Patient education
Environmental control
Management of comorbidities

26
Q

Special treatment considerations for steps 2-4

A

Consider subcutaneous allergen immunotherapy for patients with allergic asthma - especially children

27
Q

When to consider consultation with asthma specialist

A

Consider at step 3, definitely consult if need to step tup to 4

28
Q

Abnormal, permanent dilation of the bronchi and destruction of bronchial walls.

A

Bronchiectasis

29
Q

What can lead to bronchiectasis?

A
  1. Congenital cystic fibrosis ** half of all cases here **
  2. Recurrent inflammation and infections (TB, fungal, abscess)
  3. Tumor obstruction
30
Q

Indication of recurrent pulmonary infections and chronic, purulent, foul-smelling sputum?

A

Bronchiectasis

transmural inflammation, mucosal edema, cratering, ulceration, and neovascularization in the airways. The result is permanent abnormal dilatation and destruction of the major bronchi and bronchiole walls.

31
Q

Test of choice for bronchiectasis

A

High-resolution chest CT - reveals dilated, tortuous airways “SIGNET-RING SIGN}

32
Q

Treatment for bronchiectasis

A

10-14 days or longterm antibiotics (augmenting, bacterium, or ciproflox)

Bronchodilators

Chest physiotherapy - airway clearance

consider lung transplant

33
Q

Rule-out tests for bronchiectasis

A
  1. Sweat chloride - rule out cystic fibrosis

2. alpha 1 anti trypsin deficiency (serum)

34
Q

Signet-ring sign in chest CT classic feature of what?

A

Bronchiectasis

35
Q

Pathophysiological / clinical syndrome that includes emphysema and chronic bronchitis

A

COPD

36
Q

Condition in which the air spaces are enlarged as a consequence of destruction of alveolar space

A

Emphysema

37
Q

Disease characterized by a chronic cough that is productive of phlegm occurring on most days for
3 months of the year for 2 or more consecutive years
without an others-defined acute cause

A

Chronic bronchitis

38
Q

Causes of COPD other than smoking

A 
Environmental pollutants
Recurrent URI
Eosinophilia 
Bronchial hyper-responsiveness 
Alpha-1 Antitrypsin deficiency
39
Q

Clinical features of emphysematous COPD

A

Progressive SOB
Excessive DRY cough
Weight loss

Advanced stage:
Pursed lip breathing
Grunting expirations

40
Q

Chest examination of COPD patient

A

Hyperinflation, increased AP dimensions

Increased resonance w percussion

Decreased breath sounds
Early Inspiratory crackles
Prolonged duration of expiration

41
Q

First test for diagnosing and monitoring COPD

A

Spirometry and PFTs

FEV1 <70%, nonreversible with bronchodilator -
*for both chronic bronchitis and emphysema

42
Q

Definitive test to determine presence of emphysema

A

Chest CT

Clin Med Exam 3 PULM (3 decks)

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