Obstructive Pulmonary Diseases

Question 1

——— accounts for half of the cases of bronchiectasis, clinical feature differentiating it from other causes??

Answer 1

Cystic fibrosis
Pseudomonas in the sputum;
Upper lung lobe involvement

Question 2

Reversible airway obstruction- spirometer

Answer 2

> 12% increase in FEV1 with the use of albuterol

Question 3

Methacholine challenge test is diagnostic when——?

Answer 3

To diagnose asthma especially in asymptomatic pts

20% decrease in FEV1 with the use of methacholine or histamine

Question 4

PFT In asthma
What happens to FEV1, FVC, their ratio and DLCO?
Difference with COPD?

Answer 4

Decreased FEV1(<80)and FVC with a decreased FEV1/FVC ratio(<70%);increased or normal DLCO
But in COPD, no significant change in FEV1 with albuterol; DLCO May b normal initially or decreased but can never b increased

Question 5

Obesity,, which pattern of PFT is expected? Obstructive or restrictive?

Answer 5

Restrictive with FEV1/FVC >70%

Question 6

In acute asthmatic exacerbation, a normal or elivated PaCo2 level suggests? What’s the usual ABG analysis finding?

Answer 6

It suggests an impending respiratory failure.

Usually, they’ll have resp alkalosis with low PaCo2 level

Question 7

Asthma severity classification

Answer 7

Sx frequency per week or SABA use; night time awakening

1. Intermittent- <2 days/wk; <2 per month
2. Mild persistent- >2dys not daily; 3-4 times per month
3. Moderate persistent- daily; >1per wk but not nightly
4. Severe persistent- throughout the day; 4-7 per wk

Question 8

Stepwise Rx approach to asthma

Answer 8

Step1 SABA
Step2- low dose ICS
Step3- 2+ LABA OR moderate dose ICS
step4 - moderate dose ICS , LABA
Step5- high dose ICS , LABA
Step6- 5+ systemic steroids 
Consider omalizumab for IgE positive step 5&6
SABA can b used at all steps

Question 9

Exercise induced bronchoconstriction is due to? Rx?

Rx for those who exercise daily?

Answer 9

Is due to mast cell degranulation triggered by high volume of dry cold air
SABA, mast cell stabilizers r used10-20min prior to exercise.
For daily exercise, ICS or antileukotrine agents can b used

Question 10

In a COPD pt when should alpha1 antitrypsin def b considered? Which part of the lungs is usually involved?
Dx is by measuring——?

Answer 10

Young, no smoking hx; basilar lucency with panacinar involvement (smoking is centriacinar affecting upper lungs), hx of unexplained liver disease

Dx - serum AAT level

Question 11

PFT in COPD
FEV1
FVC
VC
TLC
DLCO

Answer 11

Decreased VC, increased TLC
FEV1 is disproportionately decreased as compared to VC so the ratio is decreased
DLCO IS DECREASED esp in emphysema
No or incomplete improvement with albuterol

Question 12

COPD Rxs that delay mortality (3)

Answer 12

• Smoking cessation
• Long term supplemental oxygen(LTOT)
• influenza n pneumococcal vaccinations

Question 13

Criteria for initiating LTOT

Answer 13

• PaO2 =<55mmHg or SaO2=<88%

- in pts with corpulmonale, evidence of rt heart failure, hct >55% —> PaO2 =<59, SaO2=<89%

Question 14

Acute exacerbation of COPD Is initially managed with SABA, ICS,… if sxs continue despite medical mx… what’s next?

Answer 14

Non invasive ventilatory support which is delivered by face mask, no intubation. (CPAP or BiPAP)
It decreases mortality

Question 15

When r antibiotics indicated in AECOPD?

Answer 15

For moderate n severe exacerbation. Not for mild ones

Question 16

Clinical presentation of bronchiectasis and difference with COPD

Answer 16

Recurrent infection, copious purulent sputum, dyspnea, wheezing
- sputum pdn is more prominent in bronchiectasis than COPD; no causal relationship has been established with smoking

Question 17

A young child with cystic fibrosis and concurrent influenza developed bacterial infection; what empiric abx would b most important to administer?

Answer 17

Vancomycin!

Staphylococcus is the most common o/m in young children with cystic fibrosis esp in the setting of influenza infection.