OPD

Question 1

obstruction

Answer 1

worsen expiration
cause increased WOB (use accessory muscles), emptying of lungs slows (dereased FEV1)
cause v/q mismatch and hypoxemia
air trapping -> hypovent and hypercap
dyspnea and wheezing always
air trapping patho: cant fully exhale = high CO2, air trapped in alveoli = increased WOB, lungs hyperinflated, no gas exchange, chronic high co2 and low o2

Question 2

obstruction: asthma

Answer 2

chronic inflam of bronchial airways (not alveoli) causes bronchial hyperresponsiveness, constriction of airways and variable airflow obstruction that is reversible
chronic disease state with acute exacerbations

Question 3

asthma: rf

Answer 3

allergies (children), familial link, level of allergen exposure, urban residency, exercise, air pollution (indoor and outdoor), smoke/tobacco, recurrent RTI, gerd, decreased exposure to certain infectious organisms = immunologic imbalance

Question 4

asthma: phys

Answer 4

antigen exposure (trigger) -> lots of immune cells (dendritic helper T-2, mast, b lymph, neutrophils, basophils, eosinophils
airway inflam
hypersecretion of mucus, airway muscle constriction, swelling bronchial membranes
narrowing breathing passages
wheezing, cough, sob, tightness in chest

Question 5

asthma: early response

Answer 5

immediate activation, cascade release of inflam mediators occurs within minutes
vasodilation, increased capillary permeability, mucosal edema, bronchial smooth muscle contraction (bronchoconstriction), mucus secretion

Question 6

asthma: late response

Answer 6

4-8 hours after, they have already recovered
recruitment of eosinophils, neutrophils, and lymphocytes cause another release inciting same process

Question 7

asthma: responses

Answer 7

bronchoconstriction = #1 s of asthma attack
inflam -> cause seriousness of disease (long term damage if untreated, irreversible, airway remodeling with chronic asthma)

Question 8

asthma: diagnose

Answer 8

hx of allergies, recurrent wheeze, dyspnea, course/exercise intolerance
PFT: measure lung function with respect to time, gold standard, decreased EFR, decreased FEV1

Question 9

asthma: cm

Answer 9

wheeze (classic), SOA (breathless/dyspnea), cough, chest tightness
severe: accessory , distant BS, diaphoresis, dont speak, resp failure = repetitive hacking cough and no BS

Question 10

asthma: tm

Answer 10

avoid irritants, use PFM
low dose corticosteroids (exacerbations)
short acting beta agonist inhalers for mild (severe = inhaled anti inflam corticosteroids, long acting beta, leukotriene antagonists)
immunotherapy

Question 11

asthma: status asthmaticus

Answer 11

severe S
unrelenting asthma attach: silent chest, no air movement, pCO2 > 70
life threatening -> IV epinephrine (epi pen)
treat: avoid, drugs (bronchodilators, corticosteroids, o2 therapy)

Question 12

chronic bronchitis

Answer 12

hypersecretion of mucus and chronic productive cough for 3 mo and 2 yr

Question 13

chronic bronchitis: cm

Answer 13

persistant productive cough - purulent if also resp infection (freq bc mucus favorable breeding ground)
progresses: increased cough, increased congestion, increased SOA

Question 14

chronic bronchitis: diagnosis

Answer 14

hx of s, PA, chest imaging, pulmonary function test (decreased FEV1)
by time of treatment seeking, disease is progressive and pathologic changes are irreversible
smokers and vapers

Question 15

chronic bronchitis: pathophys

Answer 15

inhaled irritants = airway inflam -> infiltration with neutrophils, macrophages, lymphocytes, into bronchial walls
continual bronchial inflam -> bronchial edema, increase in number and size of goblet cell and mucus glands
thick tenacious mucus produced and cant be cleared bc impaired ciliary function: cilia damaged bc inflam/thickened secondary to edema, accumulation of inflam cells, thickened smooth muscle secondary to chronic bronchospasm (fibrosis)
initially only affects larger airways -> eventually all involved

Question 16

chronic bronchitis: late cm

Answer 16

pulm htn:
increased pulmonary artery P d/t elevated pulmonary venous P, increased pulm BF, pulm vascular obstruction, hypoxemic
S: syncope, DOE, fatigue
can cause R sided HF = cor pulmonale

Question 17

chronic bronchitis: tm

Answer 17

prevent (dont smoke - if stop before S occur, risk for bronchitis decreases considerably and looks like someone that never smoked)
irreversible -> can be halted if stop smoking
bronchodilators
expectorants/prophylactic abx, CPT, steroids (late or acute exacerbations), home o2

Question 18

emphysema

Answer 18

abn permanent enlargement of gas exchange airways, accompanied by destruction of alveolar walls
obstruction from inflam and destructive change in lung tissue
major mechanism of airflow limitation if loss of elastic recoil with collapse of airways during exp

Question 19

emphysema: defined

Answer 19

chronic, irreversible, progressive, destructive
decreased elastic recoil
abn permanent enlargement of air spaces distal to terminal bronchioles secondary destruction of alveolar (pop) walls and capillary beds -> airway remodeling
lung hyperinflation -> destruction from tissue change, not mucus production
obstruction is secondary to change in lung tissue
major mechanism of airflow limitation is less of elastic recoil, causes: smoke, air pollution, freq childhood resp infections, genetics (alpha antitrypsin enzyme deficiency)

Question 20

emphysema: cm

Answer 20

gradual increase in breathlessness, DOE
eventually SOA at rest: prolonged exp, may become oxygen dependent
wheezing, malN (increased WOB), decreased muscle mass, barrel chest (1:1), pursed lip breathing, decreased breath sounds

Question 21

emphysema: diagnose

Answer 21

PFT (FEV1 decreased)
CXR: hyperinflate
abg: resp acidosis (increased CO2, decreased pH)
alpha antitrypsin (AAT)

Question 22

emphysema: tm

Answer 22

dont smoke
bronchodilators and anti inflam agents (mainstay), o2 supplementation, breathing retraining, relaxation techniques, abx for acute infections

Question 23

chronic bronchitis v emphysema

Answer 23

chronic B: overweight and cyanotic, increased hgb, peripheral edema, ronchi and wheeze, mucus! main issue, hypoxic and cyanotic
emphysema: older and thin (decreased muscle mass, malN), severe dysp, quiet chest (and wheeze), hyperinflation with flat diaphragm, hypercarbic and dyspneic
both!: hypoxic -> decreased o2 and increased co2