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PANCE 2.0 > Pulmonology #2 (Bronchiectasis, Asthma, Sarcoidosis) > Flashcards

Pulmonology #2 (Bronchiectasis, Asthma, Sarcoidosis) Flashcards

1
Q

MCC of bronchiectasis in the US

A

Cystic fibrosis

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2
Q

Bronchiectasis is due to recurrent lung infections. If the patient has CF, what is the likely pathogen?

A

Pseudomonas aeruginosa

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3
Q

If bronchiectasis is NOT due to CF, what is the likely cause?

A

H. Influenzae

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4
Q

What is the pathophysiology of bronchiectasis?

A

Dilatation of the airways and impairment of the mucociliary escalator leads to repeat infections, airway obstruction, and peribronchial fibrosis

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5
Q

Symptoms of bronchiectasis

A

-persistent productive cough with thick sputum
-dyspnea
-Pleuritic chest pain
-Hemoptysis
-Crackles, wheezing, rhonchi

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6
Q

Preferred imaging of choice for bronchiectasis

A

High resolution CT scan

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7
Q

What do you see on CT scan for a patient with bronchiectasis?

A

-Thickened bronchial walls, airway dilatation, lack of tapering of the airway (tram track appearance) and signet ring sign (increased airway diameter)

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8
Q

However, the GOLD standard diagnostic for bronchiectasis is

A

PFT (obstructive pattern)

-Decreased FEV1, FEV1/FVC

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9
Q

Treatment for bronchiectasis

A

-Chest physiotherapy, mucolytics, bronchodilators
-ABX often needed: Macrolides, Cephalosporins, Augmentin, Fluoroquinolones.

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10
Q

What is asthma defined as?

A

Reversible, often intermittent obstructive disease of the small airways

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11
Q

What are the three components of the pathophysiology of asthma?

A

Airway hyperreactivity
Bronchoconstriction
Inflammation

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12
Q

Strongest risk factor for asthma

A

Atopy

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13
Q

Other risk factors for asthma

A

-Family history
-Air pollution
-Obesity
-Tobacco Smoke
-Male gender

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14
Q

What are the three components of Samter’s Triad?

A

Aspirin sensitivity, asthma, chronic rhinosinusitis

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15
Q

What are the three components of the atopic triad?

A

Asthma + Atopic Dermatitis (Eczema) + Allergic Rhinitis

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16
Q

Triggers for an asthma attack?

A

-Anxiety, stress, exercise, cold air, dry air
-Animal dander, pollen, mold, dust mites
-Increased IgE
-medications (aspirin, BB)
-GERD

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17
Q

Symptoms of asthma (there is a classic triad)

A

-Dyspnea
-Wheezing
-Cough (especially at night)

18
Q

What are other physical exam findings of a patient who is having an asthma attack?

A

-Prolonged expiration with wheezing
-hyperresonance to percussion
-tachypnea
-Tachycardia
-Use of accessory muscles

19
Q

What are some symptoms of status asthmaticus or severe asthma?

A

-AMS
-Inability to speak full sentences
-Tripod positioning
-Silent chest (no air movement)

20
Q

Gold standard in making the diagnosis of asthma

A

PFT

-Shows reversible obstruction (decreased FEV1, FEV1/FVC, increased RV and TLC)

21
Q

What other method is used to diagnose asthma, besides a PFT?

A

Bronchoprovocation: Methacholine challenge (>20% decreased on FEV1) followed by bronchodilator challenge (increase by 12% or more is expected)

22
Q

What ABG is expected in a patient with an asthma exacerbation?

A

Respiratory alkalosis (from tachypnea)

23
Q

What is the BEST and most objective way to assess asthma exacerbation severity and patient response to treatment?

A

Peak expiratory flow rate

-If > 70% predicted or improvement by 15%, patient can be discharged

24
Q

Explain what intermittent asthma is

A

Symptoms: <2 days/week
SABA use: <2x/days/week
Nighttime awakenings: <2x/month
Normal lung function
SABA as needed

25
Q

Explain what mild persistent asthma is

A

Symptoms: > 2/week but not daily
SABA use: >2/week but not >1 daily
Nighttime awakenings: 3-4/month
FEV1> 80% predicted
SABA and low dose ICS

26
Q

Explain what moderate persistent asthma is

A

Symptoms: Daily
SABA: Daily
Nighttime awakenings: >1/week but not nightly
FEV1 60-80% predicted
Low ICS + LABA or Medium ICS

27
Q

Explain what severe persistent asthma is

A

Symptoms: Throughout the day
SABA: Several times a day
Nighttime: Often, nightly
FEV1 < 60%
High dose ICS + LABA +/- Omalizumab

28
Q

When can you take a step DOWN in the asthma treatment tree?

A

If symptoms are controlled > 3 months

29
Q

Name the SABAs and some side effects

A

Levalbuterol
Epinephrine
Albuterol
Terbutaline

Tachycardia, muscle tremors, CNS stimulation

30
Q

LABAs, such as ______ and _________, are only used if symptoms are not controlled with ICS alone

A

Salmeterol

Budesonide/Formoterol

31
Q

Explain what theophylline is and when it is used

A

Bronchodilator that improves respiratory muscle endurance

Higher doses needed in smokers because smoking decrease Theophylline levels

32
Q

Risk factors for sarcoidosis

A

Females
AA
Northern Europeans

33
Q

What is the pathophysiology of sarcoidosis

A

-Exaggerated T cell response to a variety of antigens or self-antigens

34
Q

Symptoms of Sarcoidosis (there are MANY)

A

-50% are asymptomatic
-Dry, nonproductive cough, dyspnea, rales
-Erythema nodosum, lupus pernio, maculopapular rash, parotid gland enlargement
-Anterior uveitis
-Restrictive cardiomyopathy
-Arthralgias, fever, weight loss, hepatomegaly
-Cranial nerve palsies

35
Q

What is Lofgren Syndrome?

A

Triad of Erythema Nodosum + Bilateral hilar LAD + polyarthralgias with fever

36
Q

What is erythema nodosum?

A

Rash on shins

37
Q

What is lupus pernio?

A

Butterfly (malar) rash on face

38
Q

Best initial test for sarcoidosis?

A

Chest radiographs: bilateral hilar lymphadenopathy (batwing appearance)
-Ground glass appearance
-Eggshell calcifications
-Fibrosis

39
Q

On PFT for sarcoidosis, what is classic?

A

Restrictive pattern

Normal or increased FEV1/FVC
Decreased FEV1
Decreased lung volumes

40
Q

However, what is the most accurate test for sarcoidosis?

A

Tissue biopsy: noncaseating granulomas

41
Q

On labs, what is seen in sarcoidosis?

A

Increased ACE levels is hallmark

42
Q

If symptomatic sarcoidosis, what is the treatment?

A

oral corticosteroids are first-line

Methotrexate, Hydroxychloroquine are for skin lesions

PANCE 2.0 (62 decks)

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