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PAS 753 (Molecular Pathophysiology) > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

asthma defintion

A

chronic episodic airway disease with effective treatment but no known cure

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2
Q

what percent of people have asthma

how many office visits are asthmas related

A

7-10%

1-3%

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3
Q

what is the leading cause of hospitalization among children and teens

A

asthma

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4
Q

asthma incidence has been increasing for 30 years

two theories why

A

air pollution

increased sensitivity to allergens due to hygiene hypothesis

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5
Q

what demographic is most likely to have asthmai

A

inner city population

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6
Q

what is the pathophysiology of asthma

A

reduction in airway diameter brough about by a contraction of smooth muscle, vascular congestion, edema, and tenacious sputum

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7
Q

three results of airway inflammation

A

bronchial hyperreactivity and bronchospasm

increased secretion and viscosity

bronchial remodeling

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8
Q

four causes related to asthma that reduce airway diameter

A

bronchospasm

vascular congestion

edema

thick sputum

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9
Q

two main types of asthma

which is most common

A

allergic and idiosyncratic

allergic

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10
Q

hallmarks of allergic asthma

A

personal or family Hx of allergies

early onset

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11
Q

what differentiates allergic from idiosyncratic asthma

A

idiosyncratic has no Hx, negative allergy skin tests, normal serum IgE

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12
Q

common triggers of allergic ashtma

A

allergies

psychological

medications

infections

habits

atmospheric

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13
Q

three mediations that cause cause asthma

A

beta blockers

anaphylaxis to medication

aspirin

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14
Q

three atmospheric triggers of asthma

A

pollution

cold air

abrupt weather changes

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15
Q

clinical manifestations of asthma

A

chronic dry cough

wheezing

SOB

sleep disturbances

poor exercise tolerance

chest tightness

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16
Q

T/F “all that wheezes is not asthma, and all asthma does not wheeze”

A

true

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17
Q

three non-asthmatic causes of wheezing

A

heart disease

COPD

inhaled foreign body

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18
Q

diagnostic process for asthma

A

improvement of symptoms with bronchodilators

sensitivity to stimuli

sputum elevated IgE

high blood eosinophil counts

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19
Q

what is the long term complication of asthma

A

airway remodeling in response to chronic inflammation that can lead to decline in pulmonary function

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20
Q

three goals of asthma treatment

A

reduce inflammation

dilate terminal airways

improve airway secretions

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21
Q

what medications can be used to reduce inflammation of asthma

A

glucocorticoids or other anti-inflammatories

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22
Q

why is inhalation therapy common

A

maximizes airway dose, minimizes systemic dose to decrease side effects

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23
Q

what is the function of beta-2 agonists in asthma treatment

side effects are caused by beta 1 cross reactivity

what are the side efects

A

bronchodilation

tachycardia, hyperglycemia, HTN

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24
Q

two types of beta 2 agonists and one example of each

A

short acting (albuterol)

long acting (salmetrol)

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25
what is the effect of glucocorticoids on asthma treatment typical oral treatment one example of inhaled glucocorticoids
strong anti inflammatory effect prednisone for 5-10 days flunisolide
26
what is the relationship of leukotrines to asthma treatment what is one side effect of increased leukotrienes
modulation of inflammation LTD4 is a powerful bronchoconstrictor
27
what produces leukotrienes three types
the action of 5-lipoxygenase on arachadonic acid LTC4, LTD4, LTE4
28
types of leukotriene blocking drugs
leukotriene receptor antagonists 5-lipoxygenase inhibitor
29
what is the strategy for decreasing bronchial secretions in asthma treatment
application of anticholinergic/antimuscarinic agents to improve air way diamter
30
three types of emergency asthma treatment
epinephrine subcutaneous injection beta 2 inhalers glucocorticoids
31
describe the use of glucocorticoid as an emergency asthma therapy
oral is as effective as paenteral takes 6-12 hours reduces hospitalization
32
define pneumonia
inflammation of the lungs caused by bacteria, viruses, fungus
33
risk factors for pneumonia
smoking, alcoholism, comorbid disease, immunosuppression
34
downsides of glucocorticoid treatment of asthma
can cause calcium deficiency, HTN, hyperglycemia
35
three common symptoms of pneumonia
productive cough fever/chills dyspnea
36
four less common symptoms of pneumonia
pleurisy, chest pain, hemoptysis, anorexia
37
diagnostic process of pneumonia
symptoms plus CXR Labs point of care tests
38
sources of organisms that typically cause pneumonia
community acquired (CAP) hospital acquired (HAP)
39
what can cause CAP pneumonia what is the most common
bacteria, virus, fungi strepococcus pneumoniae (65-70%)
40
gram positive sources of HAP pneumonia
strep and staph
41
gram negative sources of HAP
klebsiella, pseudomonas
42
treatment for CAP
antibiotics, hospitalization for 25%, supportive care
43
treatment for HAP
ABx for resistant pathogens supportive care
44
common antibiotics for CAP
cell wall inhibitors (amoxicillin/ampicillin) protein inhibitors (macrolides) fluoroquinolones (nucleic acid inhibitors)
45
typical cause of lobar pneumonia
strep
46
what is the prognosis of pneumonia
stabilization in 3-5 days full recovery in 4-12 weeks dependant on age
47
what is the current mortality for hospital pneumonia patients
10%
48
three potential complications of pneumonia
pleural empyema lung abcess pleural effusion
49
three pathophysiology hallmarks of COPD
airflow obstruction alveolar dialtion and destruction chronic and acute airway infection
50
two types of COPD what is the difference
chronic bronchitis and emphysema chronic bronchitis is has more obstruction from sputum and inflammation emphysema has more destruction of alveoli
51
T/F both chronic bronchitis and emphysema have alveolar loss and obstrution
true
52
three typical causes of COPD how does it rank as common cause of death
smoking (99%) other debris (coal dust/silica) genetics (cystic fibrosis)
53
main symptoms of emphysema chronic bronchitis
SOB with exertion and SOB at rest chronic productive caugh with mucopurulent sputum
54
how is COPD related to asthma
smoking damages epithelium, leading to infection, inflammtion and asthma like reactive airways
55
three goals of COPD treatment
prevent, improve, support
56
smoking cessation is only effective 15-20% of the time why? what can be done to help the odds
nicotine is highly addictive multi-faceted programs (education, support groups, meds)
57
two ways to improve COPD symptoms
stop smoking and control infections improve airways with asthma medicaiton (bronchodilators, glucocorticoids, reduction in airway mucus
58
suportive strategy for COPD
airway support supplemental oxygen
59
what is the prognosis of lung cancer 1 and 5 year
1 year, 40% 5 year, 15%
60
four types of lung cancer most commin in bold
squamous 30% small cell 15% large cell 10% **adenocarcinoma 35%**
61
what happens histologically with smoking
the loss of respiratory cilia
62
from a clinical perspective, what are the two types of lung cancer
small cell and non small cell
63
why is there a clincial distinciton between small cell lung cancer and others
because it is very aggressive and usually not able to be excised
64
what is the prognosis of small cells lung cancer with and without treatment
with 10-16 months without 6-17 weeks
65
what is the main cause of lung cancer
smoking (13x higher) or exposure to smoke (1.5-2x)
66
what is the effect of smoking cessation on CVD
decreased risk to normal within 3-5 years
67
what is the effect of smoking cessation on lung cancer risk and prognosis
risk of lung cancer declines but more slowly than CVD even with cancer the prognosis is better for those who quit
68
symptoms of lung cancer
weight loss (50-90%) cough (60%) hemoptysis (10-30%) some have cest pain (20-40%)
69
what percent of patients with lung cancer are symptomatic on diagnosis
75-90%
70
diagnostic process of lung cancer
direct visualization with biopsy diagnostic imaging
71
three imaging studies for lung cancer and their utlitiy
CXR CT (for CT biopsy) PET (useful in looking for distant mets)
72
what is the screening test for lung cancer what are the pros and cons
yearly low dose CT for 3 yeras in patients 55 or older with a 30 yr pack history pro: provides a modest increase in survival cons: costly, high false positive
73
what often causes chest pain assocaited with lung cancer
mets to bone
74
where do lung mets spread
liver, spine, and brain
75
treatment for small cell lung cancer
combination chem with radiation
76
treatment of non-small cells carcinoma
surgery and chemo
77
what causes tuberculosis describe the pathogens
infection by mycobaterium tuberculosis slow growing acid fast aerobe
78
T/F tuberculosis only effects the lungs
false, late stages can effect every organ
79
T/F what percent of all humans have been infected with TB
30-40 percent
80
what is the main method of TB spread where else can it come from
airborne in aerosol mucus infected cow milk
81
what is required to pass TB onto someone else what is the efficiency of transition
fair close prolonged contact 23%
82
what is the key pathologic feature of TB why does it form
caseous granuloma because the immune system cannot eliminate TB
83
what percent of patients will develop latent TB what about progressive TB
90-95% 5-10%
84
symptoms and infectiousness of latent TB
usually none with a positive skin test no expired TB
85
symptoms and infectiousness of an active (progressive) TB infection
systemic symptoms (fever, weight loss, cough, hemoptysis, fatigue) TB bacilli in expired air
86
prognosis of active TB
100% cure rate with compliance and non-drug resistance withotut treatment 35% will die in 1 year, another 35% in five years
87
miliary TB is most common in what patients is this more or less lethal than other
infants, elderly, immunocompromisd adults very lethal
88
what will induce a conversion of latent to active TB
immunosuppresion through HIV infection, glucocorticoids, chemo, poverty
89
diagnostic process for TB
HP sputum culture with acid fast stain skin test lab test chest xray
90
treatment for sensitive TB
first line drugs based on sensitivity for 2-3 months two to three drugs for additonal 4-7 months
91
resistant TB treatment
up to 20 months of 2nd or 3rd line agents
92
isoniazid and rifampin
first line TB drugs
93
why is follow up in TB treatment so important
monitor compliance, clinical response, and drug toxicity
94
what percent of TB are resistant to first line drugs how does mortality from multi-resistant TB compare to untreated active TB
10-15% of all strains they are similar

PAS 753 (Molecular Pathophysiology) (17 decks)

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