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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
Q

what is the effect of glucocorticoids on asthma treatment

typical oral treatment

one example of inhaled glucocorticoids

A

strong anti inflammatory effect

prednisone for 5-10 days

flunisolide

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26
Q

what is the relationship of leukotrines to asthma treatment

what is one side effect of increased leukotrienes

A

modulation of inflammation

LTD4 is a powerful bronchoconstrictor

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27
Q

what produces leukotrienes

three types

A

the action of 5-lipoxygenase on arachadonic acid

LTC4, LTD4, LTE4

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28
Q

types of leukotriene blocking drugs

A

leukotriene receptor antagonists

5-lipoxygenase inhibitor

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29
Q

what is the strategy for decreasing bronchial secretions in asthma treatment

A

application of anticholinergic/antimuscarinic agents to improve air way diamter

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30
Q

three types of emergency asthma treatment

A

epinephrine subcutaneous injection

beta 2 inhalers

glucocorticoids

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31
Q

describe the use of glucocorticoid as an emergency asthma therapy

A

oral is as effective as paenteral

takes 6-12 hours

reduces hospitalization

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32
Q

define pneumonia

A

inflammation of the lungs caused by bacteria, viruses, fungus

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33
Q

risk factors for pneumonia

A

smoking, alcoholism, comorbid disease, immunosuppression

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34
Q

downsides of glucocorticoid treatment of asthma

A

can cause calcium deficiency, HTN, hyperglycemia

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35
Q

three common symptoms of pneumonia

A

productive cough

fever/chills

dyspnea

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36
Q

four less common symptoms of pneumonia

A

pleurisy, chest pain, hemoptysis, anorexia

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37
Q

diagnostic process of pneumonia

A

symptoms plus

CXR

Labs

point of care tests

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38
Q

sources of organisms that typically cause pneumonia

A

community acquired (CAP)

hospital acquired (HAP)

39
Q

what can cause CAP pneumonia

what is the most common

A

bacteria, virus, fungi

strepococcus pneumoniae (65-70%)

40
Q

gram positive sources of HAP pneumonia

A

strep and staph

41
Q

gram negative sources of HAP

A

klebsiella, pseudomonas

42
Q

treatment for CAP

A

antibiotics, hospitalization for 25%, supportive care

43
Q

treatment for HAP

A

ABx for resistant pathogens

supportive care

44
Q

common antibiotics for CAP

A

cell wall inhibitors (amoxicillin/ampicillin)

protein inhibitors (macrolides)

fluoroquinolones (nucleic acid inhibitors)

45
Q

typical cause of lobar pneumonia

A

strep

46
Q

what is the prognosis of pneumonia

A

stabilization in 3-5 days

full recovery in 4-12 weeks dependant on age

47
Q

what is the current mortality for hospital pneumonia patients

A

10%

48
Q

three potential complications of pneumonia

A

pleural empyema

lung abcess

pleural effusion

49
Q

three pathophysiology hallmarks of COPD

A

airflow obstruction

alveolar dialtion and destruction

chronic and acute airway infection

50
Q

two types of COPD

what is the difference

A

chronic bronchitis and emphysema

chronic bronchitis is has more obstruction from sputum and inflammation

emphysema has more destruction of alveoli

51
Q

T/F both chronic bronchitis and emphysema have alveolar loss and obstrution

A

true

52
Q

three typical causes of COPD

how does it rank as common cause of death

A

smoking (99%)

other debris (coal dust/silica)

genetics (cystic fibrosis)

53
Q

main symptoms of emphysema

chronic bronchitis

A

SOB with exertion and SOB at rest

chronic productive caugh with mucopurulent sputum

54
Q

how is COPD related to asthma

A

smoking damages epithelium, leading to infection, inflammtion and asthma like reactive airways

55
Q

three goals of COPD treatment

A

prevent, improve, support

56
Q

smoking cessation is only effective 15-20% of the time

why?

what can be done to help the odds

A

nicotine is highly addictive

multi-faceted programs (education, support groups, meds)

57
Q

two ways to improve COPD symptoms

A

stop smoking and control infections

improve airways with asthma medicaiton (bronchodilators, glucocorticoids, reduction in airway mucus

58
Q

suportive strategy for COPD

A

airway support

supplemental oxygen

59
Q

what is the prognosis of lung cancer 1 and 5 year

A

1 year, 40%

5 year, 15%

60
Q

four types of lung cancer

most commin in bold

A

squamous 30%

small cell 15%

large cell 10%

adenocarcinoma 35%

61
Q

what happens histologically with smoking

A

the loss of respiratory cilia

62
Q

from a clinical perspective, what are the two types of lung cancer

A

small cell and non small cell

63
Q

why is there a clincial distinciton between small cell lung cancer and others

A

because it is very aggressive and usually not able to be excised

64
Q

what is the prognosis of small cells lung cancer with and without treatment

A

with 10-16 months

without 6-17 weeks

65
Q

what is the main cause of lung cancer

A

smoking (13x higher) or exposure to smoke (1.5-2x)

66
Q

what is the effect of smoking cessation on CVD

A

decreased risk to normal within 3-5 years

67
Q

what is the effect of smoking cessation on lung cancer risk and prognosis

A

risk of lung cancer declines but more slowly than CVD

even with cancer the prognosis is better for those who quit

68
Q

symptoms of lung cancer

A

weight loss (50-90%)

cough (60%)

hemoptysis (10-30%)

some have cest pain (20-40%)

69
Q

what percent of patients with lung cancer are symptomatic on diagnosis

A

75-90%

70
Q

diagnostic process of lung cancer

A

direct visualization with biopsy

diagnostic imaging

71
Q

three imaging studies for lung cancer and their utlitiy

A

CXR

CT (for CT biopsy)

PET (useful in looking for distant mets)

72
Q

what is the screening test for lung cancer

what are the pros and cons

A

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
Q

what often causes chest pain assocaited with lung cancer

A

mets to bone

74
Q

where do lung mets spread

A

liver, spine, and brain

75
Q

treatment for small cell lung cancer

A

combination chem with radiation

76
Q

treatment of non-small cells carcinoma

A

surgery and chemo

77
Q

what causes tuberculosis

describe the pathogens

A

infection by mycobaterium tuberculosis

slow growing acid fast aerobe

78
Q

T/F tuberculosis only effects the lungs

A

false, late stages can effect every organ

79
Q

T/F what percent of all humans have been infected with TB

A

30-40 percent

80
Q

what is the main method of TB spread

where else can it come from

A

airborne in aerosol mucus

infected cow milk

81
Q

what is required to pass TB onto someone else

what is the efficiency of transition

A

fair close prolonged contact

23%

82
Q

what is the key pathologic feature of TB

why does it form

A

caseous granuloma

because the immune system cannot eliminate TB

83
Q

what percent of patients will develop latent TB

what about progressive TB

A

90-95%

5-10%

84
Q

symptoms and infectiousness of latent TB

A

usually none with a positive skin test

no expired TB

85
Q

symptoms and infectiousness of an active (progressive) TB infection

A

systemic symptoms (fever, weight loss, cough, hemoptysis, fatigue)

TB bacilli in expired air

86
Q

prognosis of active TB

A

100% cure rate with compliance and non-drug resistance

withotut treatment 35% will die in 1 year, another 35% in five years

87
Q

miliary TB is most common in what patients

is this more or less lethal than other

A

infants, elderly, immunocompromisd adults

very lethal

88
Q

what will induce a conversion of latent to active TB

A

immunosuppresion through HIV infection, glucocorticoids, chemo, poverty

89
Q

diagnostic process for TB

A

HP

sputum culture with acid fast stain

skin test

lab test

chest xray

90
Q

treatment for sensitive TB

A

first line drugs based on sensitivity for 2-3 months

two to three drugs for additonal 4-7 months

91
Q

resistant TB treatment

A

up to 20 months of 2nd or 3rd line agents

92
Q

isoniazid and rifampin

A

first line TB drugs

93
Q

why is follow up in TB treatment so important

A

monitor compliance, clinical response, and drug toxicity

94
Q

what percent of TB are resistant to first line drugs

how does mortality from multi-resistant TB compare to untreated active TB

A

10-15% of all strains

they are similar

PAS 753 (Molecular Pathophysiology) (17 decks)

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