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Respiratory Disease > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Asthma is what type of disease?

A

reversible obstructive airway disease

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2
Q

The largest increase in asthma is for patients under what age?

A

18

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3
Q

Definition of status asthmaticus

A

asthma attack that does not respond to conventional treatment

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4
Q

Definition of extrinsic asthmaticus

A

bronchospasm occuring in an atopic patient when exposed to environmental irritants

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5
Q

Definition of intrinsic asthma

A

asthma attacks without atopy

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6
Q

Definition of occupational asthma

A

occurs when the provoking agent is in the workplace

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7
Q

Extrinsic asthma characteristics

A

strong family history, young age onset, allergies, elevated IgE levels

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8
Q

Intrinsic asthma characteristics

A

no allergy history, adult onset, often follows a respiratory illness, perennial symptoms

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9
Q

What are the classic triad of symptoms for asthma

A

chronic cough, persistent wheezing, dyspnea

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10
Q

Other symptoms of asthma besides the classic triad

A

mucus production, chest pain, hyperventilation, hemoptysis (rare)

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11
Q

Physical exam of asthma

A

high pitched musical wheeze, tachypnea, accessory muscle use, prolonged exhalation, inc AP diameter, sweaty, retractions, allergic reactions

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12
Q

Physical exam of severe asthma

A

accessory muscle use, confusion, paradoxical pulse (breath in pulse becomes diminished), tachypnea, inability to speak, wheezing, abdominal paradox, silent chest

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13
Q

Pathophysiology of asthma

A

inc. mucus production, smooth muscle contraction, airway wall thickening, inflammatory infiltrate

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14
Q

Early phase reaction of asthma

A

have bad allergies, follows inhalation of an antigen with atopic asthma, bronchospasm occurs in minutes, mast cells release mediators and cause inflammation

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15
Q

Late phase response of asthma

A

release of cytokines during or shortly after early phase, eosinophils, neutrophils, lymphocytes, and monocytes are all involved, can last for days, usually hospitalized, happens 6-10 hours later

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16
Q

What are the categories of asthma

A

intermittent, mild persistent, moderate persistent, severe persistent

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17
Q

Pitfalls of using peak expiratory flow rate

A

drop with steroid taper if respiratory muscles weaken

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18
Q

IS provides what data?

A

FEV1 and FVC

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19
Q

What is the most important spirometric value?

A

FEV1

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20
Q

FEV1 categories

A

> 80% of predicted= borderline obstruction, 60-80% of predicted=mild obstruction, 40-60% of predicted= moderate obstruction, <40% of predicted= severe obstruction

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21
Q

what is bronchoprovocation?

A

an attempt to provoke airflow obstruction in a patient with normal pulmonary function with a stimulus known to cause bronchospasm

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22
Q

What is the most commonly known stimulus in bronchoprovocation?

A

methocholine

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23
Q

What is the methocholine challenge test

A

baseline IS is measured followed by a repeat of IS with nebulized saline, 5 inhalations of low dose methocholine is given followed by IS 2 minutes later, if FEV1 remains with 20% of baseline the test is repeated with a stronger dose, the test is terminated if the FEV1 falls less than 20% of the initial FEV1

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24
Q

Other diagnostic tests in asthma

A

chest x ray, blood tests, allergy testing, exhaled nitric oxide (kids)

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25
Q

When you hear a wheeze it does not always mean asthma, so what are some other causes?

A

congestive heart failure, bronchitis, pulmonary embolism, upper airway obstruction

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26
Q

Asthmatics have higher levels of what than normal?

A

eNO (exhaled nitric oxide)

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27
Q

Successful management of asthma relies on what 4 components?

A

routine monitoring of symptoms and lung function, controlling trigger factors, pharmacologic therapy, patient education

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28
Q

Intermittent asthma

A

mildest forms, symptoms occur 2 or fewer times a week, 2 or fewer night awakenings, peak flows are in normal range, no interference with normal activity, normal PFTs, best treated with Albuterol

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29
Q

Side effects beta agonists

A

tremors, palpitations, anxiety, coronary vasospasm, tachycardia, hyperglycemia, hypokalemia

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30
Q

Chronic use of SABA have been shown to increase what?

A

mortality

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31
Q

LABA have been shown to cause what?

A

severe exacerbations and increase mortality

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32
Q

What is the best treatement for exercise induced asthma

A

albuterol 10 mins prior to exercise, mast cell stabilizing agent 10-20 minutes prior to exercise (Cromolyn)

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33
Q

Other drugs used in exercise induced asthma

A

LABA, steroids, antileukotriene agents (in allergies), and Cromoglycates

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34
Q

What do cromoglycates do?

A

prevent both early and late response to antigen exposure, reduce airway reactivity, cause phosphorylation of the cell membrane, inhibit opening of chloride channels, need to take for 6 weeks

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35
Q

Mild persistent asthma

A

symptoms needing treatment more than twice a week, 3-4 night awakenings, fluctuation in peak flow >20%, use of SABA more than twice a week, PFTs are normal, 2 or more exacerbations requiring oral steroids per year

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36
Q

In mild persistent asthma it is appropriate to begin what type of drugs?

A

maintenance drugs (anti inflammatory meds)

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37
Q

Side effects of inhaled steroids

A

thrush, hoarseness/sore throat, pituitary adrenal axis suppression (kids), dec skin thickness/bone thickness, retardation of growth, inc. risk for glaucoma

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38
Q

Leukotrienes are potent mediators in allergic asthma because of what

A

potent bronchoconstriction, mucus hypersecretion, airway edema, eosinophil chemoattraction

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39
Q

what is an example of a leukotriene

A

Montelukast (singular) take once daily

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40
Q

LABA example

A

Salmeterold (serevent) and Formoterol , given once or twice a day

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41
Q

LABAs need to be taken with what?

A

steroids

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42
Q

Moderate persistent asthma

A

daily symptoms, daily use of bronchodilators, night symptoms more than once a week, FEV1 60-80% of predicted, oral steroids are necessary 2 or more times a year, asthma attacks interfere with normal activities

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43
Q

Treatment of moderate persistent asthma

A

medium dose inhaled steroids, LABA, leukotrienes, Theophylline (may be helpful in night symptoms), oral beta agonists

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44
Q

Severe persistent asthma

A

symptoms of asthma throughout the day, need for SABA several times a day, night awakenings, FEV1 below 60% of predicted, extreme limits to daily activity, requires 2 or more courses of oral steroids

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45
Q

Anti IgE therapy

A

most asthmatics have inc. levels of IgE, IgE is formed to inhaled allergens and is produced by B type lymphocytes, subcutaneous injection given 2-4 weeks

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46
Q

For status asthmaticus the decision for hospitalization should be made in how many hours?

A

4-6 hours

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47
Q

When does a person with status asthmaticus need to be admitted to the ICU

A

use of accessory muscles, fatigue, peak flow under 150L/min, normal or elevated pCO2, inc. in SOB

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48
Q

What is bronchial thermoplasty

A

applying heat in the form of radiofrequency waves during bronchoscopy

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49
Q

What requirements do you need to be eligible for bronchial thermoplasty

A

FEV1> 50%, continuous use of oral steroids, no life threatening exacerbations

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50
Q

COPD is what?

A

airflow obstruction is a result of both small airways disease and destruction of lung parenchyma

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51
Q

Chronic bronchitis is known as what

A

blue bloater, full of secretions, retains water

52
Q

Emphysema is known as what

A

pink puffer, destroys lung unit

53
Q

What percent of patients has COPD

A

5%

54
Q

What is cor pulmonale

A

so much lung destruction which cares elevation in BP making blood harder to push through so eventually the R. ventricle will fail.

55
Q

Chronic bronchitis symptoms

A

chronic cough in 3 months in each of 2 consecutive years

56
Q

Emphysema symptoms

A

abnormal permanent destruction of air spaces distal to the terminal bronchioles with destruction of their walls

57
Q

What is the major causing factor in COPD

A

smoking

58
Q

what are some other cause of COPD

A

alpha 1 antitrypsin deficiency (emphysema), airway hyperresponsiveness, lung growth, exposures

59
Q

Classic triad of COPD

A

cough, SOB, sputum production

60
Q

Clinical features of COPD

A

chronic cough and sometimes wheezing in their 40s, acute chest illness may occur in their 50s, SOB usually in their 60s , chronic hypoxia, hypercapnia, AM headache, cor pulmonale, weight loss

61
Q

What are the inflammatory cells in COPD

A

neutrophils, CD8, T-lymphocytes, macrophages

62
Q

In COPD the pulmonary vasculature develops chronic changes like what?

A

endothelial cell dysfunction, intimal thickening, inc SM, inc inflammatory cells, vasoconstriction

63
Q

Normal alpha 1 antitrypsin deficiency is what?

A

mm phenotype, zz is the worse

64
Q

Stage 1 COPD

A

at risk mild, chronic cough and sputum production, may last for years

65
Q

Stage 2 COPD

A

moderate, SOB begins to interfere with daily activites

66
Q

Stage 3 COPD

A

SOB with most activities

67
Q

what is the hallmark symptom of COPD

A

SOB

68
Q

Physical diagnosis of COPD

A

central cyanosis, barrel chest, shallow rapid breathing, accessory muscle use, lower extremity edema, palpation and percussion (low diaphragms and liver), Auscultation (dec. breath sounds, wheezing, heart sounds in epigastic area)

69
Q

Gold 1 standard

A

mild disease, >80% of predicted

70
Q

Gold 2 standard

A

moderate disease, 50-79% of predicted

71
Q

Gold 3 standard

A

severe disease, <50% of predicted

72
Q

Gold 4 standard

A

very severe disease, <30% of predicted

73
Q

Asthma usually releases what?

A

eosinophils and CD4 lymphocytes

74
Q

COPD usually releases what?

A

neutrophils, macrophages, and CD8 lymphocytes

75
Q

Contraindications to nicotine replacement

A

unstable coronary disease, peptic ulcer disease, recent stroke

76
Q

Chantix is what

A

tricks brains into thinking you have nicotine in your body when you dont

77
Q

What is the main treatment for COPD

A

bronchodilators

78
Q

what do bronchodilators do in COPD

A

improve emptying of lungs, reduce hyperinflation, improve exercise

79
Q

Anticholinergics in COPD use

A

blockage of acetylcholine on the M3 receptor (ipatropium)

80
Q

Spriva

A

anticholinergic, and LABA, DPI, lessens frequency of exacerbations

81
Q

Inhaled steroids in COPD should not be used if what?

A

only there is a documented spirometric improvement o FEV1 <50% and repeated excerbations require their use

82
Q

What type of patient tends to improve better with steroids

A

Chronic bronchitis

83
Q

What do PDE 4 inhibitors do?

A

dec. inflammation, and enhances SM relaxation, not used much

84
Q

Pneumonia vaccine in COPD patient <65 yo is what?

A

23 valent

85
Q

Pneumonia vaccine in COPD patient >64 yo is what?

A

23 valent, and 13 valent

86
Q

Goals of O2 therapy

A

keep PO2 at least 60, and SaO2 at least 90%

87
Q

Surgical therapy is helpful is what types of patients

A

emphysema, bullectomy (remove bulla that do not contribute in gas exchange)

88
Q

lung volume reduction surgery is helpful with what patients

A

with bronchitis

89
Q

In lung transplantation COPD patients are put where on the list?

A

bottom

90
Q

Why in noninvasive positive pressure ventilation helpful in COPD

A

succes rate of 80-85%, inc pH, dec pCO2, improves breathlessness, dec length of hospital stay, intubation rate is reduced

91
Q

Invasive mechanical ventilation in COPD patients is what percentage of hospital mortality

A

17-30%

92
Q

Wakefullness definition

A

often called stage W, low voltage mixed frequency EEK rhythms and rapid eye movements and blinks

93
Q

Sleep stage 1

A

low voltage, mixed frequency EEG with 3-7 Hz.

94
Q

Sleep stage 2

A

background EEG that is relatively low voltage, theta waves

95
Q

Sleep stage 3

A

deepest of sleep, very slow EEG activity

96
Q

REM sleep

A

consists of low voltage with episodic rapid eye movements

97
Q

Obstructive apnea is what

A

most common type

98
Q

Central apnea is what

A

less common, associated with CHF, neuro problems, respiratory control

99
Q

Mixed apnea is what

A

starts at CSA then evolves into OSA

100
Q

Complex apnea is what

A

central apnea when OSA is rx with CPAP

101
Q

Patients with severe sleep apnea have reduced what?

A

cerebral blood flow while awake

102
Q

Symptoms of OSA

A

excessive sleepiness, snoring, apneic episodes, choking/gasping in sleep, nocturia, tiredness upon wakening

103
Q

oral appliances success rate is what

A

60% success in mild to moderate apnea

104
Q

Bronchiectasis definition

A

acquired disorder that is permanent abnormal dilatation and destruction of the bronchial walls

105
Q

Classic clinical manifestations of bronchiectasis

A

cough, daily production of large amount of tenacious sputum lasting months to years (yellow/green)

106
Q

What breath sound is usually heard in bronchiectasis

A

crackles/rhonchi

107
Q

Induction of bronchiectasis requires what 2 factors?

A

infection, and impairment of drainage, airway obstruction, and or defect in immune system

108
Q

Affected airways in bronchiectasis show what?

A

inflammation, mucosal edema, cratering and ulceration

109
Q

What infections can happen in bronchiectasis

A

viral, mycoplasma, TB, Pertusis, mycobacterial avium complex

110
Q

Youngs Syndrome

A

similar to CF, normal sweat chloride, pancreatic function, nasal potential differences

111
Q

What is the gold standard for diagnosis of bronchiectasis

A

CT scan

112
Q

What does a CT scan look like in a patient with bronchiectasis

A

airway dilation, lack of tapering of the airway, bronchial wall thickening, mucous plugs

113
Q

What is the treatment of bronchiectasis

A

antibiotics, bronchodilators, chest PT

114
Q

What is CF

A

multisystem disease affecting the digestive system, sweat glands, and the reproductive tract

115
Q

What is the major organ that the CF affects

A

pancreas

116
Q

CF patients have an abnormal transport of what?

A

chloride and sodium across the respiratory epithelium resulting in thick viscous airway secretions

117
Q

CF is caused by what mutation on what chromosome

A

single mutation on chromosome 7

118
Q

What has been shown as a regulated chloride channel which regulates the activity of other chloride and sodium channels

A

CFTR

119
Q

CFTR malfunction leads to defective what?

A

CAMP dependent chloride secretion from the respiratory epithelium

120
Q

What are the usual bacteria in CF

A

hemophilus influenzae, pseudomonas aeruginosa, staphylococcus aureus, and burkholderia cepacia

121
Q

Clinical manifestations of CF

A

symptoms occur early in life (infancy/childhood), cough, airway hyperreactivity with wheezing, sinus disease, pancreatic disease, biliary disease, infertility, muscleskeletal disorders

122
Q

How do you diagnose CF

A

sweat chloride (gold standard), molecular diagnosis

123
Q

Radiographic findings for CF

A

hyperinflation, inc. interstitial marking, tram lines/ring shadows, flattening of diaphragms, cystic changes

124
Q

What mucolytic agent is used in CF

A

DNAase (dornase alfa), dec viscosity of sputum by cleaving strands of DNA

125
Q

What is the most common genetic defect in CF

A

F508del (90% of patients have this gene defect)

Respiratory Disease (1 decks)

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