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PANCE 2.0 > Pulmonology #1 (COPD, CF) > Flashcards

Pulmonology #1 (COPD, CF) Flashcards

1
Q

What is COPD?

A

Largely irreversible airflow obstruction due to 1) loss of elastic recoil and 2) increased airway resistance.

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2
Q

What are risk factors associated with COPD?

A

(Most important): cigarette smoking/exposure

-Alpha-1-antitrypsin deficiency
-Occupational/environment exposure
-Recurrent airway infections

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3
Q

What is the only genetic disease linked to COPD in younger patients (<40)

A

Alpha-1-antitrypsin deficiency

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4
Q

Emphysema, defined as ________, has a risk factor of _____ as being the most important

A

Permanent enlargement of the terminal airspaces

Smoking

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5
Q

Explain the pathophysiology of emphysema

A

-Chronic inflammation leads to decreased protective enzymes and increased damaging enzymes
-Alveolar capillary destruction and alveolar wall destruction
-Loss of elastic recoil and increased compliance leads to airway obstruction

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6
Q

Explain the location of emphysema in the lungs if the patient is a smoker vs alpha-1-antitrypsin deficient

A

Smoker: Centrilobar (proximal acinar)

Alpha-1: Panacinar (diffuse)

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7
Q

Symptoms and exam findings of a patient with emphysema

A

-Dyspnea (hallmark)
-Chronic cough
-Decreased breath sounds
-increased AP diameter (barrel chest)
-hyperresonance to percussion
-wheezing
-Non-cyanotic: pink puffers
-Pursed lip expiration
-Tripod positioning to improve breathing

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8
Q

What is the gold standard diagnostic for emphysema? What does it show?

A

Pulmonary function test

Decreased FEV1, decreased FEV1/FVC < 70% (obstructive pattern), decreased DLCO

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9
Q

What does a chest radiograph for a patient with emphysema show?

A

Hyperinflation

Flattened diaphragms

Increased AP diameter

Decreased vascular markings

Bullae

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10
Q

What is chronic bronchitis defined as?

A

Productive cough for at least 3 months a year for 2 consecutive years

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11
Q

MC etiology of chronic bronchitis

A

SMOKING

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12
Q

What is the pathophysiology of chronic bronchitis?

A

-Chronic inflammation leads to mucous gland hyperplasia, goblet cell mucus production, dysfunctional cilia, and infiltration of neutrophils and CD8+ cells

-This leads to increased infections

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13
Q

What are the three cardinal symptoms of chronic bronchitis?

A

-Chronic cough
-Sputum production
-Dyspnea

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14
Q

What is on physical exam in a patient with chronic bronchitis?

A

-Crackles (rales)
-Rhonchi
-Wheezing
-Signs of cor pulmonale (enlarged liver, JVD, and peripheral edema)
-Cyanosis and obesity (blue bloaters)

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15
Q

What is the gold standard diagnostic for chronic bronchitis?

A

PFT shows obstructive pattern

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16
Q

What is the ONE difference in the PFT pattern in chronic bronchitis vs emphysema?

A

In emphysema, DLCO is decreased

In chronic bronchitis, it is normal.

17
Q

What is DCLO?

A

Diffusing Capacity of the Lungs

18
Q

What is seen on ECG in a patient with chronic bronchitis?

A

Cor pulmonale (RVH, atrial enlargement, right axis deviation)

19
Q

What other labs are drawn if chronic bronchitis is suspected?

A

CBC: increased hemoglobin and hematocrit

ABG: respiratory acidosis (hypercapnia)

20
Q

Most important set in management of COPD to reduce mortality

A

Smoking cessation

21
Q

What are two GENERAL steps in management of a patient with COPD?

A

Oxygen therapy: if paO2 < 55 mmHg or saturation less than 88%

Pneumococcal vaccinations and annual influenza vaccinations

22
Q

What ABX are used for acute exacerbations of chronic bronchitis?

A

-Macrolides (Azithromycin, Clarithromycin)
-Cephalosporins
-Augmentin
-Fluoroquinolones

23
Q

What is the treatment for COPD (based on Categories A-D)

A

SABA or SAMA
Then combination of both

LAMA or LABA added to short-acting
LAMA may be better than LABA

LAMA
LAMA + LABA is better though

LAMA + LABA + inhaled glucocorticoid if persistent symptoms

24
Q

What are three indications of oxygen therapy in COPD?

A

-Cor pulmonale
-O2 saturation < 88%
-PaO2 < 55 mmHg

25
Q

What is one SABA and what are some adverse reactions?

A

Albuterol

Tachycardia, palpitations, tremors

26
Q

What is one SAMA and what are some adverse effects?

A

Ipratropium

Anticholinergic: dry mouth, thirst, blurred vision, urinary retention, difficulty swallowing

27
Q

What are some LABAs?

A

Salmeterol
Formoterol

28
Q

Name one LAMA

A

Tiotropium

29
Q

What is one adverse reaction to the inhaled glucocorticoid, fluticasone?

A

Oral candidiasis

30
Q

What gene pattern is cystic fibrosis?

A

Autosomal recessive

31
Q

Cystic fibrosis is MC in what populations?

A

Caucasians and Northern Europeans

32
Q

What’s the pathophysiology of cystic fibrosis?

A

-Mutation in CTFR gene leads to abnormal chloride and water transport across exocrine glands leading to thick, viscous secretions of the lungs, pancreas, sinuses, and GU tract

33
Q

What are some symptoms of CF?

A

-Infants: meconium ileus, failure to thrive, diarrhea

-Pulmonary: MCC of bronchiectasis

GI: malabsorption of vitamins ADEK, diarrhea, recurrent pancreatitis

-Infertility

34
Q

What is the MOST accurate diagnostic for CF?

A

Sweat chloride elevation (60 mmol/L or greater on two occasions after Pilocarpine administration)

35
Q

What does Pilocarpine do to help the sweat chloride test?

A

Induces sweating

36
Q

What is seen on a PFT in cystic fibrosis?

A

Obstructive pattern

37
Q

ABX are often needed in CF. What are some that are commonly used?

A

-macrolides (Azith, Clarith)
-Cephalosporins
-Augmentin
-Fluoroquinolones

38
Q

What are other treatment recommendations for CF?

A

-Airway clearance treatment: inhaled bronchodilators, decongestants
-Supportive: ADEK supplementation, vaccinations (Pneumo, Influenza)

PANCE 2.0 (62 decks)

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