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CRRAB II Week 7 > PBL Case 7 > Flashcards

PBL Case 7 Flashcards

1
Q

What causes hemoptysis in the case of pneumonia?

A

Inflammatory mediators released by alveolar macrophages and newly recruited neutrophils create alveolar capillary leak –> erythrocytes can cross the alveolar-capillary membrane –> consequent hemoptysis

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2
Q

What approaches do you use to diagnose pneumonia?

A

Symptoms, CXR, sputum gram stain, sputum cultures and blood cultures.

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3
Q

What should you use to determine pneumonia treatment?

A

Gram stain and cultures (usually tetracycline or macrolide)

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4
Q

What will you see on CXR with lobar pneumonia?

A

Consolidation involving entire lobe

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5
Q

What will you see on CXR with Bronchopneumonia?

A

Patchy distribution along bronchiole

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6
Q

What will you see on CXR with Interstitial pneumonia?

A

Diffuse patchy inflammation

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7
Q

How do you evaluate COPD?

A

Using spirometry.
First without a Beta2 agonist.
Then after a Beta2 agonist.

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8
Q

What does it mean if there is a reversible component to the suspected COPD?

A

Asthma!

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9
Q

What do you see in the FEV1:FVC ratio of asthma after Beta2 agonist test?

A

FEV1:FVC increases!!

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10
Q

What do you see in the FEV1:FVC ratio of chronic bronchitis, Emphysema and Bronchiectasis after beta2 agonist test?

A

FEV1:FVC ratio doesn’t change much

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11
Q

What is the classic symptom of Chronic Bronchitis?

A

Excessive mucus production

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12
Q

What will you see on CXR with Emphysema?

A

Barrel-shaped chest with flat diaphragms

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13
Q

What are types of Bronchiectasis?

A
  • Cystic fibrosis
  • Kartagener’s syndrome
  • Allergic bronchopulmonary aspergillosis
  • Chronic NECROTIZING infection (MOST COMMON)
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14
Q

What is the normal FEV1/FVC ratio?

A

About 80%

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15
Q

What is the FEV1/FVC ratio in obstructive disease?

A

Less than 80%

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16
Q

What is the FEV1/FVC ratio in restrictive disease?

A

Greater than 80%

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17
Q

What is forced vital capacity (FVC)?

A

Volume of air that can be expired with a maximal effort after a maximal inspiration.

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18
Q

What is forced expiratory volume 1 (FEV1)?

A

Volume of gas expired during the first second

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19
Q

How does Total lung capacity (TLC) change in obstructive and restrictive lung disease?

A

Obstructive - Increases

Restrictive - Decreases ALOT

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20
Q

How does residual volume (RV) change in obstructive and restrictive lung disease?

A

Obstructive - increases ALOT

Restrictive - decreases

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21
Q

How does functional residual capacity (FRC) change in obstructive and restrictive lung disease?

A

Obstructive - increases ALOT

Restricitve - decreases

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22
Q

How does forced vital capacity (FVC) change in obstructive and restrictive lung disease?

A

Obstructive - No change or decreases

Restrictive - decreases ALOT

23
Q

What happens to FEV1 in obstructive and restrictive lung disease?

A

Obstructive - Decreases ALOT

Restrictive - Decreases

24
Q

What happens to FEV1/FVC in obstructive and restrictive lung disease?

A

Obstructive - Decreases ALOT

Restrictive - No change or increases

25
Q

What are the most diagnostic spirometry readings for Obstructive lung disease?

A

Dec. FEV1/FVC

Inc. TLC

26
Q

What are the most diagnostic spirometry readings for Restrictive lung disease?

A

Dec. FVC

Dec. TLC

27
Q

How does chronic alcoholism influence drug and treatment choice?

A

Some antibiotics cause Disulfiram like reactions!!

28
Q

What antibiotics cause Disulfiram-like reactions?

A
  • Metronidazole
  • Some Cephalosporins
  • Griseofulvin
  • Procarbazine
  • Sulfonylureas
29
Q

What is important to remember about chronic alcohol use?

A

Alcohol is a Cytochrome P450 inducer (drug interactions)

30
Q

What does smoking cause?

A

Emphysema and Chronic Bronchitis (COPD)

31
Q

What does drinking do that makes patients more likely to get pneumonia?

A

Drinking suppresses cough and makes patient more susceptible to infection.

32
Q

What are the goals of drug therapy for chronic COPD (chronic obstructive pulmonary disease)?

A

Reduce symptoms such as dyspnea, improve exercise tolerance and quality of life, and decrease complications of the disease such as acute exacerbations.

33
Q

What are the 8 main treatment strategies for COPD?

A
  1. Smoking cessation
  2. Short-acting beta2 agonists
  3. Long-acting beta2 agonists
  4. Long-acting Muscarinic Antagonists
  5. Glucocortioids
  6. Combination therapies
  7. Oxygen therapy
  8. Pulmonary Rehabilitation
34
Q

What should you remember about short acting beta-2 agonists?

A
  • Most effective acute bronchospasm therapy
  • Used for acute relief
  • Rapid onset (
35
Q

What should you remember about long acting beta-2 agonists?

A
  • Sustained bronchodilation for at least 12 hours

- Shown to improve lung function and quality of life and to lower exacerbation rates in patients with COPD

36
Q

What are two common combinations of COPD drugs?

A
  1. Short-acting beta2 agonists + Short-acting muscarinic antagonist (albuterol/ipratropium)
  2. Corticosteroid + Long-acting beta2 agonists (fluticasone/salmeterol)
37
Q

What is the significance of Oxygen therapy in COPD patients?

A

For patients with severe hypoxemia, use of long-term supplemental oxygen therapy has been shown to increase survival and quality of life. Oxygen therapy may also increase exercise capacity in patients with mild or moderate hypoxemia, but its long-term benefits in such patients are unclear.

38
Q

What classifies Stage I or Mild COPD?

A

FEV1/FVC /= 80%

39
Q

What classifies Stage II or Moderate COPD?

A

FEV1/FVC

40
Q

What classifies Stage III or Severe COPD?

A

FEV1/FVC

41
Q

What classifies Stage IV or Very Severe COPD?

A

FEV1/FVC

42
Q

What should you use to treat all stages of COPD?

A
  • Active reduction of risk factors; influenza vaccination

- Add short-acting bronchodilator as needed

43
Q

What should you use to treat Stage II - IV COPD?

A
  • Add regular treatment with one or more long-acting bronchodilators
  • Add pulmonary rehabilitation
44
Q

What should you use to treat Stage III - IV COPD?

A

-Add inhaled glucocorticoid if repeated exacerbations

45
Q

What should you use to treated Stage IV COPD?

A
  • Add long-term O2 if chronic respiratory failure.

- Consider surgical treatments

46
Q

What is Pulmonary Rehabilitation?

A

A program of exercise, education, and support to help you learn to breathe—and function—at the highest level possible. At pulmonary rehabilitation you’ll work with a team of specialists who will help you improve your physical condition.

47
Q

What should you focus on in patients with limited means who have health problems and addictions?

A

HARM REDUCTION

-Proven track record to reduce new infections, public disturbances, arrests, etc.

48
Q

What is one of the most common causes of Hemoptysis?

A

Acute or Chronic Bronchitis

49
Q

Where does blood come form in Hemoptysis caused by acute or chronic bronchitis?

A
  • Bronchial arteries which supply the airways, hilar lymph nodes, visceral pleura.
  • These vessels become leaky from inflammatory mediators (histamine-mass cells, PGE2-AA, bradykinin-hageman factor XII from the liver, LTC4, D4, E4-AA) and from endothelial damage (usually from neutrophil or infectious damage)
50
Q

What does the Infectious Diseases Society of America recommend for diagnosis of community-acquired pneumonia?

A
  1. Chest imaging (CXR or CT)
  2. Blood cultures (collected before antibiotics are started)
  3. Sputum gram stain and sputum culture (when productive cough is present)
  4. Urinary Antigen Tests (for strep. pneumo. and Legionella pneumonphilia for patients with severe CAP)
  5. Additional testing for specific pathogens based on clinical and epidemiological clues
51
Q

What population is alpha1-antitrypsin deficiency most common in?

A

Populations of Northern European ancestry –> very under diagnosed

52
Q

What three novel genetic loci have been associated with COPD susceptibility?

A
  • IREB2
  • HHIP
  • FAM13A
53
Q

What condition is Palmar Erythema seen in?

A

Liver disease

CRRAB II Week 7 (8 decks)

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