Pulmonary Flashcards
Syndrome characterized by airflow obstruction that varies markedly
Asthma
Major risk factor for asthma
Atopy
80% asthmatics have?
Allergic rhinitis
Genetic predisposition Atopy Airway hyperresponsiveness Gender Obesity Early viral infxns
Endogenous factors
Indoor/outdoor allergens Occupational sensitizers Passive smoking Air pollution Diet Acetaminophen
Environmental factors
Allergens URTI Exercise Cold air Sulfur dioxide Drugs Stress
Triggers
Most common viral cause of asthma exacerbation
Rhinovirus
Infxn in infancy assoc with asthma
Respiratory syncytial virus
Bacterial infxn implicated in severe asthma
Mycoplasma & chlamydophila
Hypothesis that lack of infxn in early childhood preserve TH2 cell at birth
Hygiene hypothesis
More severe persistent asthma that has later onset, assoc with nasal polyps and may be aspirin sensitive
Intrinsic/ non-atopic asthma
Most common allergen?
Dermatopaghoides/ dust mite
Begins after exercise has ended, recovers spontaneously w/n 30 mins
Exercise induced asthma
Worse in cold, dry climates
Exercise induced asthma
Common in ice/cold sports
Exercise induced asthma
Exercise induced asthma is prevented by regular tx with?
ICS
Asthma in obese, difficult to control
> 30 kg/m2
Food additive that trigger asthma thru release of sulfur dioxide in stomach
Metabisulfite
Physiologic abnormality of asthma
Airway hyperresposiveness
Which Inflammatory cells are linked to development of airway hyperresponsiveness due to release of basic proteins and oxygen-deprived free radicals?
Eosinophil
Anti-inflammatory cytokines, and may be deficient in asthma
IL-10, IL-12
Cytokines that mediate allergic reaction
IL-4, 5, 9, 13
Pro-inflammatory cytokines
TNF-alpha, IL-1B
Lung function test that demonstrate reversibility of airflow limitation
> 12% AND 200ml increase in FEV1 15 mins after Inhaled SABA
Measures the increase airway hyperresponsiveness in asthma with calculation of provocative concentration that reduces FEV1 by 20%
Metacholine or histamine challenge
Diagnostics for asthma
Chest Xray is normal
Blood test are not helpful
True
Skin prick test
In allergic asthma
Non invasive test to measure eosinophilic airway inflammation
Fractional exhaled nitric oxide (FENO)
B2-agonist, anticholinergics, theophylline
Relievers
Albuterol and terbutaline
SABA
Salmeterol, formoterol, indacaterol, olodaterol
LABA
Potential problem with any agonist given chronically
Tolerance
Most common side effect of B2-agonist?
Muscle tremors and palpitations
Urinary retention in elderly, side effect of what drug?
Ipratropium
Ipratropium
SAMA
Tiotropium, glycopyrronium
LAMA
Most common side effect of anticholinergics?
Dry mouth
Most common side effect of anticholinergics in elderly
Glaucoma and urinary retentiom
Drug that Inhibit phosphodiesterase
Theophylline
Inhibited by theophylline that Switches off activated inflammatory genes, reduce steroid insensitivity
Histone deactetylase 2 (HDAC 2)
Increased clearance
Rifampicin, phenobarbitone, ethanol
Smoking,
BBQ
Decreased clearance
Cimetidine, erythromycin, ciprofloxacin, allopurinol, zafirlukast CHF Pneumonia Viral infxn, vaccination Old age
Type of asthma that presents with chaotic variations with near normal lung function but precipitous
Type 2 brittle asthma
Most effective anti-inflammatory agents in asthma
ICS
First line therapy for patients with persistent asthma
ICS
Block cys-LT1-receptors
Antileukotrienes
Inhibit mast cells and sensory nerve activation, blocks exercise induced asthma
Cromones, cromolyn sodium
Antibody that neutralized circulating IgE without binding to cell bound IgE
Omalizumab
Reduced blood and tissue eosinophils
Anti-IL-5
Impending respiratory failure
Ph 7.4, pCO2 40. PaO2 80, HCO3 35
Rising PCO2
What lab test to confirm poor asthma control?
Fractional exhaled nitric oxide
Type of asthma with persistent pattern of variability and require OCS or continuous infusion of B2 agonists
Type 1 brittle asthma
Tx of type 2 brittle asthma
Epinephrine
Drugs safe in pregnancy
SABA, ICS, Theophylline
OCS of choice
Prednisone
Irreversible airway dilation that involves the lung in a focal pr diffuse manner
Bronchiectasis
Most common form of brochiectasis
Cylindrical / tubular
Bronchiectasis in a localized area and may cause obstruction
Focal brochiectasis
Widespread bronchiectatic changes throughout lungs
Diffuse bronchiectasis
Most common lung field in cystic fibrosis and also associated with post-radiation fibrosis?
Upper lung fields
What lung field is associated with chronic recurrent aspiration, end-stage fibrotic lung diseases and infections?
Lower lung fields
What bacteria is associated with bronchiectasis in midlung fields?
Mycobacterium avium-intracellulare complex
Dyskinetic / immotile cilia syndrome
Allergic bronchopulmonary aspergillosis
Tracheobrochomegaly ( mounier-kunn syndrome)
Williams-campbell syndrome
Central airways
Most widely cited mechanism of infections in brochiectasis?
Vicious cycle hypothesis
Dilated airways arising from parenchyma distortion as a result of lung fibrosis
Traction boronchiectasis
Most common clinical presentation of bronchiectasis?
Persistent productive cough with thick sputum
Dilated airways in Xray
“Tram tracks”
Imaging of choice for boronchiectasis
CT scan
Cross sectional area of airway with diameter of 1.5. What sign?
“Signet-ring sign”
Inspissated secretions. What sign?
“Tree in a bud”
Diagnostic criteria for bronchiectasis
2 sputum + culture 1 BAL 1 fluid sample + on culture Biopsy \+pleural fluid
Most common organism in nontuberculous brochiectasis?
Mycobacterium avium-intracellulare
Prevention of brochiectasis
Smoking cessation
Decline rate of FEV1 among non-CF bronchiectatic patients
50-55 ml
Lung disease related to cigarette smoking
COPD
Indication of early onset COPD
Alpha 1 antitrypsin deficiency
Protein gene on chromosome 4 related to COPD
Hedgehog interacting protein (HHIP) gene
Abnormal permanent enlargement f air spaces distal to terminal bronchi with destruction of walls
Emphysema
Central / proximal parts
Distal alveoli are spared
Related to cigarette smoking
Most common emphysema
Centriolobular emphysema
Acini are uniformly enlarged in the lower lung zones
Related to alpha 1 antitrypsin deficiency
Panacinar (panlobular) emphysema
Most common symptoms of COPD
Cough
Sputum
Exertional dyspnea
Sign of hyperinflation
Barrel chest
Sitting position in bronchitis
Tripod position
Independent poor prognostic factor in COD
Bitemporal wasting
Paradoxical movement of rib cage with respiration
Hoover sign
What test to determine Airflow obstruction with reduction in FEV1 & FEV1 / FVC ratio
Pulmonary function test
Hallmark of COPD
Airflow obstruction
Pink puffer
Emphysema
Blue bloater
Chronic bronchitis
Persistent productive cough for >3 months in 2 consecutive years
Chronic bronchitis
Increased size of bronchial mucus glands
Thickness of mucus gland layer / thickness of bronchial walls
Reid index
Definitive test for living subjects with COPD
CT scan
Most important intervention in chronic bronchitis
Smoking cessation
Anticholinergic that may produce acute improvement in FEV1
Ipratropium bromide
Tx for smoking cessation
Bupropion
Varenicline
Nicotine patch
Acute narrowing of bronchioles due to bronchospasm
Bronchial asthma
Sputum cytology in asthma
Curschmann spirals
Eosinohils
Charcot-leyden crystals
Twisted mucus plugs
Results from extracted mucus plugs
Curschmann spirals
Eosinophil membrane protein
Charcot-leyden crystals
Ciliated columnar cells that is sloughed off
Areola bodies
Triad of asthma
Cough
Wheezing
Dyspnea
Stimuli that can produce constant symptoms
Respiratory virus
GOLD
FEV 1/ FVC <0.7, FEV >80%
GOLD STAGE I (MILD)
GOLD
FEV 1/ FVC <0.7, FEV >50% but <80%
GOLD STAGE II (MODERATE)
GOLD
FEV 1/ FVC <0.7, FEV >30% but <50%
GOLD STAGE III (SEVERE)
GOLD
FEV 1/ FVC <0.7, FEV <30%
GOLD STAGE IV (VERY SEVERE)