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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
When you hear a wheeze it does not always mean asthma, so what are some other causes?
congestive heart failure, bronchitis, pulmonary embolism, upper airway obstruction
26
Asthmatics have higher levels of what than normal?
eNO (exhaled nitric oxide)
27
Successful management of asthma relies on what 4 components?
routine monitoring of symptoms and lung function, controlling trigger factors, pharmacologic therapy, patient education
28
Intermittent asthma
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
29
Side effects beta agonists
tremors, palpitations, anxiety, coronary vasospasm, tachycardia, hyperglycemia, hypokalemia
30
Chronic use of SABA have been shown to increase what?
mortality
31
LABA have been shown to cause what?
severe exacerbations and increase mortality
32
What is the best treatement for exercise induced asthma
albuterol 10 mins prior to exercise, mast cell stabilizing agent 10-20 minutes prior to exercise (Cromolyn)
33
Other drugs used in exercise induced asthma
LABA, steroids, antileukotriene agents (in allergies), and Cromoglycates
34
What do cromoglycates do?
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
35
Mild persistent asthma
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
36
In mild persistent asthma it is appropriate to begin what type of drugs?
maintenance drugs (anti inflammatory meds)
37
Side effects of inhaled steroids
thrush, hoarseness/sore throat, pituitary adrenal axis suppression (kids), dec skin thickness/bone thickness, retardation of growth, inc. risk for glaucoma
38
Leukotrienes are potent mediators in allergic asthma because of what
potent bronchoconstriction, mucus hypersecretion, airway edema, eosinophil chemoattraction
39
what is an example of a leukotriene
Montelukast (singular) take once daily
40
LABA example
Salmeterold (serevent) and Formoterol , given once or twice a day
41
LABAs need to be taken with what?
steroids
42
Moderate persistent asthma
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
43
Treatment of moderate persistent asthma
medium dose inhaled steroids, LABA, leukotrienes, Theophylline (may be helpful in night symptoms), oral beta agonists
44
Severe persistent asthma
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
45
Anti IgE therapy
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
46
For status asthmaticus the decision for hospitalization should be made in how many hours?
4-6 hours
47
When does a person with status asthmaticus need to be admitted to the ICU
use of accessory muscles, fatigue, peak flow under 150L/min, normal or elevated pCO2, inc. in SOB
48
What is bronchial thermoplasty
applying heat in the form of radiofrequency waves during bronchoscopy
49
What requirements do you need to be eligible for bronchial thermoplasty
FEV1> 50%, continuous use of oral steroids, no life threatening exacerbations
50
COPD is what?
airflow obstruction is a result of both small airways disease and destruction of lung parenchyma
51
Chronic bronchitis is known as what
blue bloater, full of secretions, retains water
52
Emphysema is known as what
pink puffer, destroys lung unit
53
What percent of patients has COPD
5%
54
What is cor pulmonale
so much lung destruction which cares elevation in BP making blood harder to push through so eventually the R. ventricle will fail.
55
Chronic bronchitis symptoms
chronic cough in 3 months in each of 2 consecutive years
56
Emphysema symptoms
abnormal permanent destruction of air spaces distal to the terminal bronchioles with destruction of their walls
57
What is the major causing factor in COPD
smoking
58
what are some other cause of COPD
alpha 1 antitrypsin deficiency (emphysema), airway hyperresponsiveness, lung growth, exposures
59
Classic triad of COPD
cough, SOB, sputum production
60
Clinical features of COPD
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
What are the inflammatory cells in COPD
neutrophils, CD8, T-lymphocytes, macrophages
62
In COPD the pulmonary vasculature develops chronic changes like what?
endothelial cell dysfunction, intimal thickening, inc SM, inc inflammatory cells, vasoconstriction
63
Normal alpha 1 antitrypsin deficiency is what?
mm phenotype, zz is the worse
64
Stage 1 COPD
at risk mild, chronic cough and sputum production, may last for years
65
Stage 2 COPD
moderate, SOB begins to interfere with daily activites
66
Stage 3 COPD
SOB with most activities
67
what is the hallmark symptom of COPD
SOB
68
Physical diagnosis of COPD
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
Gold 1 standard
mild disease, >80% of predicted
70
Gold 2 standard
moderate disease, 50-79% of predicted
71
Gold 3 standard
severe disease, <50% of predicted
72
Gold 4 standard
very severe disease, <30% of predicted
73
Asthma usually releases what?
eosinophils and CD4 lymphocytes
74
COPD usually releases what?
neutrophils, macrophages, and CD8 lymphocytes
75
Contraindications to nicotine replacement
unstable coronary disease, peptic ulcer disease, recent stroke
76
Chantix is what
tricks brains into thinking you have nicotine in your body when you dont
77
What is the main treatment for COPD
bronchodilators
78
what do bronchodilators do in COPD
improve emptying of lungs, reduce hyperinflation, improve exercise
79
Anticholinergics in COPD use
blockage of acetylcholine on the M3 receptor (ipatropium)
80
Spriva
anticholinergic, and LABA, DPI, lessens frequency of exacerbations
81
Inhaled steroids in COPD should not be used if what?
only there is a documented spirometric improvement o FEV1 <50% and repeated excerbations require their use
82
What type of patient tends to improve better with steroids
Chronic bronchitis
83
What do PDE 4 inhibitors do?
dec. inflammation, and enhances SM relaxation, not used much
84
Pneumonia vaccine in COPD patient <65 yo is what?
23 valent
85
Pneumonia vaccine in COPD patient >64 yo is what?
23 valent, and 13 valent
86
Goals of O2 therapy
keep PO2 at least 60, and SaO2 at least 90%
87
Surgical therapy is helpful is what types of patients
emphysema, bullectomy (remove bulla that do not contribute in gas exchange)
88
lung volume reduction surgery is helpful with what patients
with bronchitis
89
In lung transplantation COPD patients are put where on the list?
bottom
90
Why in noninvasive positive pressure ventilation helpful in COPD
succes rate of 80-85%, inc pH, dec pCO2, improves breathlessness, dec length of hospital stay, intubation rate is reduced
91
Invasive mechanical ventilation in COPD patients is what percentage of hospital mortality
17-30%
92
Wakefullness definition
often called stage W, low voltage mixed frequency EEK rhythms and rapid eye movements and blinks
93
Sleep stage 1
low voltage, mixed frequency EEG with 3-7 Hz.
94
Sleep stage 2
background EEG that is relatively low voltage, theta waves
95
Sleep stage 3
deepest of sleep, very slow EEG activity
96
REM sleep
consists of low voltage with episodic rapid eye movements
97
Obstructive apnea is what
most common type
98
Central apnea is what
less common, associated with CHF, neuro problems, respiratory control
99
Mixed apnea is what
starts at CSA then evolves into OSA
100
Complex apnea is what
central apnea when OSA is rx with CPAP
101
Patients with severe sleep apnea have reduced what?
cerebral blood flow while awake
102
Symptoms of OSA
excessive sleepiness, snoring, apneic episodes, choking/gasping in sleep, nocturia, tiredness upon wakening
103
oral appliances success rate is what
60% success in mild to moderate apnea
104
Bronchiectasis definition
acquired disorder that is permanent abnormal dilatation and destruction of the bronchial walls
105
Classic clinical manifestations of bronchiectasis
cough, daily production of large amount of tenacious sputum lasting months to years (yellow/green)
106
What breath sound is usually heard in bronchiectasis
crackles/rhonchi
107
Induction of bronchiectasis requires what 2 factors?
infection, and impairment of drainage, airway obstruction, and or defect in immune system
108
Affected airways in bronchiectasis show what?
inflammation, mucosal edema, cratering and ulceration
109
What infections can happen in bronchiectasis
viral, mycoplasma, TB, Pertusis, mycobacterial avium complex
110
Youngs Syndrome
similar to CF, normal sweat chloride, pancreatic function, nasal potential differences
111
What is the gold standard for diagnosis of bronchiectasis
CT scan
112
What does a CT scan look like in a patient with bronchiectasis
airway dilation, lack of tapering of the airway, bronchial wall thickening, mucous plugs
113
What is the treatment of bronchiectasis
antibiotics, bronchodilators, chest PT
114
What is CF
multisystem disease affecting the digestive system, sweat glands, and the reproductive tract
115
What is the major organ that the CF affects
pancreas
116
CF patients have an abnormal transport of what?
chloride and sodium across the respiratory epithelium resulting in thick viscous airway secretions
117
CF is caused by what mutation on what chromosome
single mutation on chromosome 7
118
What has been shown as a regulated chloride channel which regulates the activity of other chloride and sodium channels
CFTR
119
CFTR malfunction leads to defective what?
CAMP dependent chloride secretion from the respiratory epithelium
120
What are the usual bacteria in CF
hemophilus influenzae, pseudomonas aeruginosa, staphylococcus aureus, and burkholderia cepacia
121
Clinical manifestations of CF
symptoms occur early in life (infancy/childhood), cough, airway hyperreactivity with wheezing, sinus disease, pancreatic disease, biliary disease, infertility, muscleskeletal disorders
122
How do you diagnose CF
sweat chloride (gold standard), molecular diagnosis
123
Radiographic findings for CF
hyperinflation, inc. interstitial marking, tram lines/ring shadows, flattening of diaphragms, cystic changes
124
What mucolytic agent is used in CF
DNAase (dornase alfa), dec viscosity of sputum by cleaving strands of DNA
125
What is the most common genetic defect in CF
F508del (90% of patients have this gene defect)

Respiratory Disease (1 decks)

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