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Old DOOS > Respiratory 3 > Flashcards

Respiratory 3 Flashcards

1
Q

reversible airflow obstruction, different phenotypes, inflammation prominent

A

asthma

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2
Q

permanent, enlargement/destruction of the respiratory bronchioles

A

Emphysema/ COPD

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3
Q

Enlarged airways from chronic infection or abnormal cilia function–CF

A

Bronchiectasis

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4
Q

sputum production 3 months/year for 2 years

A

Chronic Bronchitis

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5
Q

In an obstructive defect, what decreases more FEV1 or FVC?

A

FEV1

ratio of FEV1/ FVC is decreased

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6
Q

What must FEV1/FVC be decreased to for an obstructive lung dz?

A

70%

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7
Q

Is COPD preventable?

A

Yes, and treatable!

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8
Q

If spirometery is FEV1 >80% what severity is COPD?

A

Mild

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9
Q

50%<80% indicates what severity of COPD

A

moderate

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10
Q

30%< ____<50% indicates what severity of COPD

A

severe

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11
Q

what is very severe COPD

A

<30% FEV1 predicted value

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12
Q

what is a rare inherited deficiency that causes emphysema due to homozygous genetic mutation.

A

alpha-1 protease inhibitor deficiency

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13
Q

what does cigarette smoking cause?

A

oxidative stress which leads to inflammation
epithelial permeability
injury

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14
Q

what does mucociliary dysfunction lead to?

A

Mucus hypersecretion
reduced mucociliary transport
mucosal damage

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15
Q

what cells increase in COPD and destroy things?

A 
CD8+ T lymphocytes
Monocytes/ macrophages
Neutrophils
Mast cells 
inflammatory mediators
proteases
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16
Q

what structural changes happen w/ COPD

A 
globlet cell hyperplasia/ metaplasia
mucous gland hypertrophy
increased smooth muscle mass
airway fibrosis
alveolar dystruction
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17
Q

what are systemic components of COPD?

A 
Poor nutritional status
Reduced BMI
impaired skeletal muscle
weakness
wasting
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18
Q

what airflow limitations are there with COPD?

A

loss of alveolar attachments
loss of elastic recoil
increased smooth muscle contraction

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19
Q

does a skinny or fat COPD patient do better?

A

Fat

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20
Q

Will the liver be palpable with COPD?

A

Yes, due to hyperinflation

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21
Q

what will the thorax sound like to percussion with COPD?

A

Hyperresonance

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22
Q

where will wheezing be heard on COPD?

A

Forced expiration

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23
Q

Where are heart sounds best heard on COPD patient?

A

over xiphoid area

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24
Q

Is an ABG helpful with COPD?

A

Doesn’t help with diagnosis or prognosis

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25
Q

what causes polycythemia is patients with COPD?

A

low oxygen content

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26
Q

why may there be an elevated serum bicarbonate with COPD?

A

secondary to CO2 retention

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27
Q

what is a normal FEV1?

A

3.2-3.5 (a galloon)

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28
Q

what COPD drug may stimulate respiratory center, improve muscle function. (not used often)

A

Theophylline

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29
Q

what is the most important thing for COPD tx?

A

smoking cessation

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30
Q

apart from quitting smoking, what is the only therapy that helps reduce mortality with COPD?

A

oxygen therapy

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31
Q

If a pulse ox is less than what do they qualify for oxygen?

A

88%

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32
Q

what do all patients w/ COPD need?

A

influenza shot

SABA PRN

33
Q

when do COPD patients need regular tx with one or more LABA PRN and rehab?

A

Moderate COPD FEV1 is b/w 50 and 80% predicted

34
Q

when do you add inhaled glucocorticosteroids for COPD?

A

Severe, FEV1 is between 30-50% predicted

35
Q

When do you add long term oxygen or consider surgical options for COPD?

A

FEV <50% predicted with chronic respiratory failure

36
Q

does response to bronchodilator during spirometry challenge predict whether or not a patient will benefit from long term use?

A

No

37
Q

what do anticholinergics do?

A

“toners” prevent the airway from closing

38
Q

what is the onset of effect of albuterol?

A

1-3 minutes

39
Q

what is the duration of action of albuterol?

A

4-6 hours

40
Q

what drug inhibits acetylcholine interaction with M3 receptors- decrease smooth muscle tone

A

Ipratropium

41
Q

Onset of action of ipratropium

A

60-90 minutes

42
Q

AN MDI with spacer is just as effective as what?

A

Nebulizer

43
Q

is ipratropium maintence therapy?

A

Yes

44
Q

Duration of action of ipratropium?

A

4-6 hours

45
Q

___________ more efficacious than SABA when added to ipratropium for stable COPD

A

LABA

46
Q

what do LABAs do to help COPD?

A

Decrease airflow obstruction, dynamic hyperinflation
decreased frequency and severity of symptoms
improved QOL

47
Q

What is an anticholinergic with once-daily dosing, LABA. More selectively for muscarinic sub-types than ipratropium? Onset of action 30 minutes, peak 3 hours after dose

A

Tiotropium

48
Q

Anticholinergic with affinity for musacrinic receptor. Reaches steady state after 10 minutes with 1/2 life of 5-8 hours. 1 puff BID

A

Aclidinium (Tudorza)

49
Q

what must you do with a COPD patient on oral corticosteroids?

A

2 week steroid trial with documented improvement on PFTs to justify long term use

50
Q

is there any effect on inhaled steroids with preventing FEV1 decline?

A

No, but may decrease number of exacerbations

51
Q

what do inhaled steroids have an associated with?

A

Hip fractures

52
Q

what together help improve airway obstruction, decrease dyspnea, use of SABA and overall health status?

A

LABAs and inhaled corticosteroids

53
Q

Is a combination therapy an issue with COPD?

A

No, can be beneficial

54
Q

what is a pill that is taken once a day for patients with severe COPD (FEV1 <50%) and frequent exacerbations. Leads to increased intracellular cAMP

A

Phosphodiesterase-4 inhibitors

55
Q

side effects of phosphodiesterase-4 inhibitors

A

Diarrhea

weight decrease

56
Q

what can oxygen therapy help with?

A

Prevent pulmonary HTN
improve IQ scores, general alertness
Increase endurance
Reverse polycythemia

57
Q

A person who is under 65 and their FEv1 is what can get Pneumovax?

A

FEV1 <40%

58
Q

Acute event characterized by worsening of the patient’s respiratory symptoms that is beyond normal day-to day variations and leads to change in medication

A

COPD exacerbation

59
Q

best COPD mortality predictor?

A

Hospitalization last year

60
Q

when do you give someone with COPD oxygen?

A

O2 Sat less than 87%

61
Q

how long should steroids be with exacerbations of COPD

A

2 weeks

62
Q

should you use abx with COPD when they have an exacerbation?

A

Yes

63
Q

What should a person with COPD be given for when they have an exacerbation

A

Steroids PO

Antibiotics PO

64
Q

how many Liters can nasal cannula administer?

A

6 L/ min (humidify at 4 L or greater)

65
Q

per liter how much percentage oxygen increase do you get?

A

3-4 % increase

66
Q

Is an abnormal dilatation of the bronchial tree

Can be either acquired or congenital

A

Bronchiectasis

67
Q

what is bronchiectasis linked to?

A

Pertussis and measles

can occur post TB

68
Q

how much of the medication from a MDI go into the lung?

A

10% (increases with a spacer)

69
Q

what does brochiectasis cause distally?

A

Causes scarring & obstruction & mucus/ pus accumulation

70
Q

what could bronchiectasis eventually lead to?

A

right ventricular failure/ respiratory failure

71
Q

congentital causes of bronchiectasis

A

ciliary dysfunction syndromes
cystic fibrosis
primary hypogammaglobulinemia

72
Q

acquired causes of bronchiectasis in children

A

Pneumonia
TB
foreign object

73
Q

Acquired causes of bronchiectasis in adults

A

suppurative pneumonia
TB
allergic bronchopulmonary aspergillosis
bronchial tumors

74
Q

symptoms of bronchiectasis

A

chronic cough, purulent in the morning
copious discharge
fever, malaise, pleurisy
hemoptysis

75
Q

constitutional symptoms associated w/ bronchiectasis

A

weight loss

poor appetite

76
Q

best imaging for bronchiectasis

A

High resolution CT

77
Q

what may be needed for people with hemoptysis with bronchiectasis

A

Surgical resection of localized areas

78
Q

Frequently has GI sx, failure to thrive, early respiratory infections, meconium ileus
Typically develop severe bronchiectasis, upper lobe initially

A

Cystic fibrosis

79
Q

men with CF usually lack a what?

A

Vas deferenes (infertile)

Old DOOS (21 decks)

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