Pulm 5 Flashcards
A 68 yo male comes in because he’s been having difficulty breathing. He has a 25 year pack history of tobacco use. On exam you notice tachypnea, tachycardia, unusually long expiration, and wheezing. What disease do you think it might be? What diagnostic test will you do to confirm your diagnosis?
COPD
Perform spirometry to determine what stage COPD he has
A 63 yo female presented to your office with dyspnea, tachypnea, long expirations, wheezing, and retractions on inspiration. She has a 30 pack year history of tobacco use. Spriometry showed that the pt’s FEV1/FVC was
Stage II (moderate) COPD Strongly recommend smoking cessation! Put the pt on a long-acting bronchodilator (B-agonist) Educate the pt about the disease and the importance of avoiding irritants such as aerosolized particles (deoderant, hairspray, insecticide, smoke)
A pt comes in with wheezing, difficulty breathing, long expirations, and accessory muscle use during inspiration. On spirometry the pt’s FEV1/FVC was
COPD
Genetic alpha-1 antitrypsin deficiency
Having her get an annual flu and PNA vaccine
Recomment augmentin therapy
A pt comes in to your office because he has had a chronic, productive cough almost every day for the past 3 months, and this is the third year this has happened to him. Today he is plethoric and has a blue tinge around his lips and on the tip of his nose. His spirometry results are FEV1/FVC
Chronic bronchitis
(Stage III COPD)
Treat with an inhaled glucocorticosteroid
Also perform an EKG to look for pulmonary HTN and/or right ventricular dysfunction/hypertrophy
A pt presents with significant difficulty breathing. He is in the tripod position and is clearly using his SCM and external intercostals to help breathe. He has been having difficulty breathing for a while and wants a definitive diagnosis. Spriometry shows FEV1/FVC
Stage IV COPD
Recommend long-term O2 therapy and surgery
A 42 yo female presents with dyspnea on exertion and a minor cough. She came in because she feels like she can’t breathe unless she leans forward with her hands on her knees and purses her lips. On exam you hear hyperresonant chest sounds. What findings do you expect to see on her CXR?
Emphysema (pink puffer)
CXR should show a flat diaphragm, a blunted costophrenic angle, irregular lung field lucency, and an enlarged retrosternal space.
What causes emphysema?
Alveolar destruction
Enlarged respiratory bronchioles, protease (elastase) to antiprotease (a-1 antitrypsin) imabalance, and destroyed vascular bed all lead to alveolar destruction which impairs gas exchange in the lungs
A pt has a persistent, purulent, productive cough, dyspnea, and nasal polyps. The mucus she is coughing up is thick and stick. What is the most likely underlying etiology causing the pt’s disease?
Cystic fibrosis
Caused by an autosomal recessive genetic disorder where the cystic fibrosis conductance regulator (CFTR) gene on chromosome 7 is mutated, resulting in ineffective sodium/chloride channels
What are 3 lab tests you can perform if you suspect a pt has CF?
Skin sweat test!!
Nasal potential difference measure
Molecular CFTR DNA mutation test
What is the main goal of treatment for CF pts?
Children: to delay p. aeroginosa infection
Adults: to suppress their p. aeroginosa infection
A pt has a persistent cough that produces excessive amounts of viscous, sticky mucus. She also has persistent wheezing and has had pneumonia 3 times in the last 2 years. You notice that she has clubbing of her fingernails. Spirometry shows an obstructive pattern, and he CXR shows hyperinflation, hilar adenopathy, and infiltrates. What is the best treatment for this pt?
CF
Pulmonary health and prevention should be accomplished via an interdisciplinary approach to treatment including inhaled tobramycin, exercise, chest physiotherapy/toilet, PEEP mask, and clearing the viscous secretions of the lower airways via an inhaled DNAase or a hypertonic saline inhalation
What bacterial infection is often deadly and carries a poor prognosis in CF pts?
Burkholderia cepacia
What causes bronchiectasis?
CFTR defect –> dehydrated mucus –> inpaired mucus clearance –> chronic infection –> chronic ifnlammation –> bronchiectasis
Bronchiectasis is dilation of the bronchi or bronchioles
The bronchi/bronchioles are obstructed by inflammation or mucus plugs
In the baby ward, you see a baby that is tachypneic, cyanotic, flaring its nostrils and is grunting. You look over its chart and see that it was born in week 27 to a diabetic mother. What is most likely causing this child’s symptoms? What diagnostic test would you perform and what results would you expect to see?
Hyaline membrane disease caused by surfactant deficiency
A CXR should show atelectasis, ground glass appeareance, air bronchograms, and low lung volumes
You have a 36 yo female who is 6 1/2 weeks pregnant. Her last child was born early via C-section and had RDS. She is worried the same thing might happen with this pregnancy. What disease are you worried the child might have? How are you going to prevent this disease?
Hyaline membrane disease
Prevent a premature birth, and if possible avoid a C-section
Prevent labor until at least week 28 so the lungs have time to fully develop
Give the mother corticosteroids 24 hours prior to deliver if the baby is going to be born between 26-28 weeks
