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aa Step 2CK: Internal & Peds > Pulmonary- Obstructive Disease > Flashcards

Pulmonary- Obstructive Disease Flashcards

1
Q

Describe the difference between obstructive and restrictive pulmonary disease on pulmonary function test?

A

Obstructive: FEV1/FVC is less than normal (<75-80)

Restrictive: FEV1/FVC in often normal.

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2
Q

What is COPD?

A

Progressive inflammatory lung disease leading to lung destruction and decrease elastic recoil that causes air flow obstruction. Encompasses chronic bronchitis and emphysema.

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3
Q

what are the characteristics of chronic bronchitis vs emphysema?

A

Chronic bronchitis: inflammation of the bronchi and bronchioles

Emphysema: destruction of the alveoli and poor gas exchange.

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4
Q

Signs and symptoms of COPD?

A 
Dinished breath sounds
Rhonchi
Wheezing
Increased total lung capacity
Barrel Chest
Muscle wasting

CXR:
Hyper-inflated Hyperlucent lungs
Elongated and narrow mediastinum
Flattened diaphragms

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5
Q

How is COPD diagnosed?

A

BIT: chest Xray.

Most accurate: Pulmonary function test or spirometry. Severity graded by the GOLD criteria.

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6
Q

What is the GOLD criteria?

A 
0-1 Exacerbations/yr without hospitalization:
GOLD 1 (Class I)	Mild  ≥ 80% FEV1
GOLD 2 (Class II)	Moderate :50% ≤ FEV1 < 80%
2+ exacerbations/yr or 1+ with hospitalization:
GOLD 3 (Class III)	Severe : 30% ≤ FEV1 < 50%
GOLD 4 (Class IV)	Very severe: < 30%
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7
Q

Tx COPD

A

Symptomatic: SABA; LABA w/ inhaled steroids; LAMAs
Not responding: theophylline and roflumilast

Chronic hypoxia: ambulatory oxygen
O2 imporves mortality

Avoid: beta blokers

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8
Q

Tx COPD exacerbation

A 
Inhaled Bronchodilators 
Inhaled anticholinergics (ipratropium)
Steroid Burst
Antibiotics 
Repiratory support
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9
Q

What is the concern with over-oxygenating COPDers?

A

If they are CO2 retainers their respiratory drive can be inhibited. Over oxygenation further compromises ventilation and precipitates hypercarbic respiratory failure. Only use enough to raise pO2 above 90%

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10
Q

What are the fibers that are damaged in COPD?

A

Elastin fibers. Passive recoil allows for exhalation.

Tobacco destroys these fibers. Ina young non smoker. alpha 1-antitrypsin deficiency can also destroy these fibers.

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11
Q

What antibiotics should be considered in acute exacerbation of COPD?

A

Coverage for: S. pneumoniea, H. flu, Moraxella catarrhalis.

Macrolides, Cephalosporins, Quinolones
Amoxi/clavulanic acid.

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12
Q

What LABAs can be used in COPD?

A 
Salmeterol
Formoterol
Arformoterol
Indacaterol
Vilanterol
Olodaterol
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13
Q

What LAMAs can be used in COPD?

A 
Tiotropium
Ipretopium 
Umeclidinium
Aclidinium 
Glycopyrrolate
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14
Q

Signs and symptoms of asthma

A
  • Chronic Wheezing
  • Eczema or atopic dermatitis
  • Family history of asthma, allergies, or eczema
  • Nasal Polyps and sensitivity to aspirin
  • Increased expiratory phase
  • Increased work of breathing (RR best indicator of severity)
  • Worse at night

Can present as a solitary cough

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15
Q

Define Asthma

A

reactive airway disease that causes abnormal bronchoconstriction of the airways. reversible obstructive lung disease (unlike COPD which is irreversible)

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16
Q

What are the diagnostic test for asthma

A

BIT during exacerbation: Peak expiratory flow or ABG
Most accurate: PFTs with albuterol or methacholine (normal between exacerbations)

CBC: eosinophilia, increased IgE.
Skin: allergen test

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17
Q

Medication challenged PFTs in asthma

A

(symptomatic patients) Albuterol: FEV1 increased >12%

(asymptomatic patients) Methacholine/ Histamine: FEV1 decreased >20%

18
Q

Stepwise Tx of Asthma

A
  1. SABA
  2. Low dose Inhaled corticosteroid (ICS)
    Alt: Cromolyn; Theo; LTRA
  3. Low ICS & LABA or Medium ICS
    Alt: Cromolyn; Theo; LTRA
  4. Med-Max ICS+ LABA; Alt:+ LAMA
  5. Monoclonal IL or IgE antibody
  6. Uncontrolled: oral corticosteroid (last resort)

Flu and pneumococcal vaccines always

19
Q

Side effects of inhaled steroids

A

Dysphonia

Oral Candidiasis

20
Q

LTRA drugs

A

Leukotriene Modifiers:
Montelukast
Zafirlukast (adr: hepatotoxic; churg strauss)
Zileuton (best for atopic)

21
Q

ICS drugs

A 
Beclomethasone
Budesonide
Flunisolide
Fluticasone
Mometasone
Triamcinolone
22
Q

SABA drugs

A

Albuterol
Pirbuterol
levalbuterol

23
Q

Monoclonal Antibodies Asthma drugs

A 
Anti-IL: 
reslizumab
mepolizumab
benralizuman
dupilumab

Anti-IgE:
Omalizumab

24
Q

Treatment of acute asthma exacerbation

A

BITx: O2 + Inhaled SABA + Bolus steroids
Albuterol
No response: Intubate

Never use LABA, LTRA, Monoclonals, or Theo in excacerbation

25
Q

What is the concern with the use of LABA in the treatment of asthma?

A

LABAs are not to be used as a solo agent due increased risk of death.
Do not add if well controlled and remove if possible once control is achieved.

26
Q

What is a common cause of wheezing in children under the age of 2?

A

Reactive airways disease due to viral infection, commonly RSV.

27
Q

What should you think if a patient with acute asthma stops hyperventilating, wheezing, or has a normal CO2 level?

A

In severe asthma wheezing stops when loss of air movement which normalizes rate and pCO2. Patients are probably crashing.

Immediate ABG
Intubate (fatigue alone is reason to intubate)

28
Q

Define Sleep Apnea

A

Obstructive (OSA): caused by narrowing/ closure of throat
Central (CSA): change in breathing control and rhythm.

Mild: 5-15 episodes/ hr
Moderate: 15-30 episodes/hr
Severe: >30 episodes/ hr

29
Q

Signs and symptoms of OSA:

A 
Daytime somnolence
Hx of Loud snoring
Headaches
Impaired memory and judgement
Depressiion
Hypertension
ED
"bull neck"
30
Q

Tx OSA

A

weight loss
avoidance of alcohol and sedatives
oral appliances that keep the tongue out of the way
CPAP
Surgery (uvulopalatopharyngoplasty)- widen airway

31
Q

Distinguish CSA from OSA

A

CSA presents with similar symptoms.
Respiratory drive is repetitively diminished from stoke, heart failure or plates.
Unique: lack of abd or thoracic movement during pauses in breathing.

Tx: CPAP

32
Q

Diagnostic test sleep apnea

A

Most accurate: polysomnography (sleep study)

Shows hypopnea episodes during sleep, no daytime hypoventilation.

33
Q

Define Bronchiectasis

A

chronic dilation of large bronchi. permanent anatomic abnormality that cannot be reversed or cured.

34
Q

Causes of bronchiectasis

A 
CF (most common-50% cases)
Infection (TB, pneumonia, abscess)
Foreign body or tumor
ABPA
Collagen- vascular disease (e.g., RA)
Panhypogammaglobulinemia and immune deficiency
35
Q

Signs and symptoms of bronchiectasis

A
  • Recurrent high volume purulent sputum production (key to diagnosis)
  • Possible hemoptysis
  • Dyspnea/ wheezinf
  • weight loss
  • anemia of chronic disease
  • crackles
  • clubbing
  • Dyskinetic Cilia Syndrome
36
Q

Diagnostic tests for bronchiectasis

A

BIT: chest Xray (dilated thickened bronchi; “tram track” thickening of bronchi

Most accurate: High resolution CT

37
Q

S&S obstructive sleep apnea

A
  • Daytime somnolence
  • Nonrestorative sleep w/ frequent awakenings
  • Morning Headaches
  • Affective & Cognitive symptoms
  • Eretile Dysfunction
  • Systemic Hypertension
  • Pulmonary hypertension & RHF
38
Q

Mechanism of OSA and polycythemia

A

Short periods of hypopnea–> hypoxia –> renal response–> ↑ EPO –> polycythemia

39
Q

Evaluation of drowsy drivers

A

Evaluate high risk behaviors: sedation, alcohol, night/ rotating shift work

Sleep disorder: OSA increases risk for MVC 2-3x. Polysomnography

40
Q

Cardinal symptoms acute COPD excacerbation

A

↑ dyspnea
↑cough (frequency or severity)
sputum production (change color or volume)

aa Step 2CK: Internal & Peds (71 decks)

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