Test II Flashcards
_________________ is a procedure in which excess fluid accumulation (pleural effusion) is aspirated through a needle inserted through the chest wall.
Thoracentesis
A _______________ entails passing a forceps or needle through a bronchoscope to obtain a specimen.
Transbronchial lung biopsy
A lung sample can be obtained by means of what?
- Transbronchial needle biopsy
- Open-lung biopsy
- Expectoration
- Tracheal suction
- Bronchoscopy
Diagnostic thoracentesis may be performed to identify the cause of a _____________.
Pleural effusion
Neutrophils make up about _______ of the total number of WBCs.
60-70%
What are the smallest of the formed elements in the blood?
Platelets, thrombocytes
What is the normal platelet count?
150,000 - 350,000/mm3
A platelet count of less than 20,000/mm3 is associated with _________________.
Spontaneous bleeding, prolonged bleeding time and poor clot retraction
What is the normal value of glucose?
70-110 mg/dL
Increased lymphocytes are typically seen in _______________________.
Viral infections
Lymphocytes are divided into what two categories?
- B cells
- T cells
Increased basophils are primarily associated with what?
Certain myeloproliferative disorders
________________ are the second order of cells to arrive at an inflammation site, usually appearing 5 hours or more after the injury.
Monocytes
Early (immature) forms of neutrophils are nonsegmented and called ___________.
“Band” forms
Gram staining is used for what?
To classify bacteria into gram-negative or gram-positive organisms
What is performed to determine the presence of acid-fast bacilli?
Acid-fast smear and culture
____________ are commonly performed to evaluate allergic reactions or exposure to tuberculosis bacilli or fungi.
Skin tests
A negative skin test may also be seen in patients with a depression of cell-mediated immunity, such as that which develops in ____________.
HIV infections
________________ includes the insertion of a scope though a small incision in the suprasternal notch.
Mediastinoscopy
What gram-positive organism makes up 80% of all bacterial pneumonias?
Streptococcus
What bronchoscopic technique involves injecting a small amount (30mL) of sterile saline through the bronchoscope then withdrawing the fluid for examination of cells?
Bronchoalveolar lavage (BAL)
What is performed to prevent the recurrence of a pneumothorax or pleural effusion?
Pleurodesis
What are the major functions of the WBCs?
- Fight against infection
- Defend the body by phagocytosis against foreign substances
- Produce antibodies in the immune response
The fluid in the lung cavity is classified as either:
Exudate or transudate
What is the normal value for Potassium (K+)?
3.8-5.0 mEq/L
What is the normal value for Calcium (Ca++)?
4.5-5.4 mEq/L
What is the normal value for Sodium (Na+)?
136-142 mEq/L
A deficiency of platelets leads to what?
Prolonged bleed time and impaired clot retention
A low platelet count (thrombocytopenia) is associated with what?
- Massive blood transfusion
- Pneumonia
- Cancer chemotherapy
- Infection
- Allergic reactions
- Toxic effects to certain drugs
A high platelet count (thrombocythemia) is associated with what?
- Cancer
- Trauma
- Asphyxiation
- Rheumatoid arthritis
- Iron deficiency
- Acute infections
- Heart disease
- TB
- Polycythemia vera
What is the normal value for Bilirubin?
0.1-1.2 mg/dL
Increases are associated with:
- Massive hemolysis
- Hepatitis
What is the normal value for Blood urea nitrogen (BUN)?
8-18 mg/dL
Increases are associated with acute or chronic renal failure
What is the normal value for Serum creatinine?
0.6-1.2 mg/dL
Increases are associated with renal failure
What are the first WBCs to arrive at the site infection or inflammation, usually appearing within 90 minutes of the injury?
Neutrophils
B cells may up _______% of the total lymphocytes.
10-30
T cells account for ______% of the total lymphocytes.
70-90
Where are B cells formed?
Bone marrow
T cells are divided into what four categories?
- Cytotoxic cells - attack and kill foreign or infected cells
- Helper T cells - recognize foreign antigens and help activate cytotoxic T cells and plasma cells
- Inducer T cells - stimulate the production of the different T cell subsets
- Suppressor T cells - work to suppress the responses of the outer cells and provide feedback information to the system
Which WBC are large wandering cells that attack and engulf foreign antigens?
Macrophages
Which WBC represents the primary cellular defense against bacterial organisms through the process of phagocytosis?
Neutrophils
The health man has about _______ RBCs in each cubic millimeter (mm3) of blood.
5 million
The health woman has about _______ RBCs in each cubic millimeter (mm3) of blood.
4 million
What does an elevated number of monocytes suggest?
Infection and inflammation
In the healthy man, the Hct is about _______.
45 percent
In the healthy woman, the Hct is about _______.
42 percent
For both man and woman, normal MCV is ____________.
87 to 103 µm3
What entails the collection of a single sputum sample in a special container with fixative solution?
Cytology examination
What are some indications for diagnostic bronchoscopy?
- Persistent atelectasis
- Excessive bronchial secretions
- Acute smoke inhalation injuries
- Intubation damage
- Bronchiectasis
- Foreign bodies
- Hemoptysis
- Lung abscess
- Major thoracic trauma
- Stridor or localized wheezing
- Unexplained cough
- Abnormal radiographic findings
Bronchoalveolar lavage (BAL) is commonly used to diagnose what?
Pneumocystis jiroveci pneumonia
An _____________ may be performed during a bronchoscopy to help establish the stage of lung cancer and, importantly - establish if - and how — the cancer may have spread.
Endobronchial ultrasound
What test is used to inspect and perform biopsy of lymph nodes in the anterior mediastinal area?
Mediastinoscopy
Eosinophils make up about ________ of the total number of WBCs.
2 to 4%
Basophils make up about ________ of the total number of WBCs.
0.5 to 1%
Lymphocytes make up about ________ of the total number of WBCs.
20 to 25%
Monocytes make up about ________ of the total number of WBCs.
3 to 8%
Which WBC have granules that are neutral and therefore do not stain with an acid or a base dye?
Neutrophils
An increased neutrophil count is associated with:
- Bacterial infection
- Physical and emotional stress
- Tumors
- Inflammatory or traumatic disorders
- Some leukemia
- Myocardial infarction
- Burns
Normochromic anemia is commonly caused by what?
Excessive blood loss
The _______ is a measure of weight of Hb in a single RBC.
Mean Cell Hemoglobin (MCH)
What is the normal range for MCH?
27 to 32 pg/RBC
Which WBC plays an important role in the breakdown of protein material?
Eosinophils
In the healthy subject, the T4/T8 ratio is about _____.
2.0
Various clinical procedures such as bronchoscopy or the insertion of an arterial catheter are generally safe when the platelet count is no lower than _____________.
50,000/mm3
What test is performed to:
1. Diagnose bacterial infection
2. Select an antibiotic
3. Evaluate the effectiveness of antibiotic therapy?
Culture and sensitivity study
What is the turn around time for a culture and sensitivity study?
48 to 72 hours
All but the ___________ can be seen on a Gram stain.
Viral organisms
With minimal risk to the patient - and without interrupting the patient’s ventilation - the flexible fiberoptic bronchoscope allows direct visualization of the upper airways down to the third or fourth generation.
Bronchoscopy
What is considered the first line of defense in the treatment of atelectasis from retained secretions?
Routine respiratory therapy modalities at the patient’s bedside:
- CPT
- Intermittent percussive ventilation
- PD
- Deep breathing
- PEP therapy
- Coughing techniques
Clinically, therapeutic bronchoscopy is commonly used in the management of:
- Bronchiectasis
- Alveolar proteinosis (with lavage)
- Lung abscess
- Smoke inhalation
- Thermal injuries
- Lung cancer
What may be performed during a bronchoscopy to help establish the stage of lung cancer and how the cancer spread?
EBUS - Endobronchial Ultrasound
Which procedure is used to diagnose carcinoma, granulomatous infection and sarcoidosis?
Mediastinoscopy
After an open-lung biopsy, a chest tube is inserted for drainage and suction for how long?
7-14 days
A needle lung biopsy is contraindicated in what patients?
(6)
- Patients with lung bullae
- Cysts
- Blood coagulation disorders
- Severe hypoxia
- Pulmonary hypertension
- Cor pulmonale
Where are over two-thirds of lung tumors located?
Lung periphery
What are the advantages of the navigational bronchoscopy procedure?
- Minimally invasive
- Reaches tumors located in the periphery of lungs
- Requires less time for recovery
- Can be done on an outpatient basis
Depending on the purpose of a thoracentesis, up to how much can be withdrawn?
1500 mL
After a thoracentesis, what is the patient instructed to do?
Lie on the puncture site for an hour to allow it to heal
What are some complications of a thoracentesis?
(5)
- Pneumothorax
- Postaspiration pulmonary edema
- Infection
- Bleeding
- Organ damage
Pleurodesis is achieved by injecting any number of agents into the pleural space through a chest tube. What are the agents called?
Sclerosing agents or sclerosants
Although complications of pleurodesis are uncommon, what are some of the risks?
- Superinfection
- Bleeding
- ARDS
- Pneumothorax and respiratory failure
Talc and doxycycline can cause __________.
Fever and pain
What can quinacrine cause?
Low BP, fever and hallucinations
Bleomycin can cause ___________.
Fever, pain and nausea
Pleurodesis may fail due to what complications?
- Trapped lung, the lung is enclosed in scar or tumor tissue
- Formation of isolated pockets within pleural space
- Loss of lung flexibility
- Production of large amounts of pleural fluid
- Extensive spread of pleural cancer
- Improper positioning, blockage or kinking of chest tube
What is the most frequent laboratory hematology?
Complete Blood Count - CBC
Clinically, what are useful in assessing a patient’s overall oxygen-carrying capacity?
- Total RBCs
- Red blood cell indices
Because of granulocyte cells have distinctive multilobar nuclei, they’re often referred as ____________.
Polymorphonuclear leukocytes
What is the WBC range count?
5,000-10,000 cells per cubic millimeter of blood
Band forms almost always signify infection if elevated about ______% of the differential.
10
The volume of red blood cells in 100 mL of blood
Hematocrit
Hematocrit is also called ___________.
Packed cell volume
What is the normal hematocrit in a healthy newborn?
45-60%
What is the normal Hb value for men?
14-16g
Each RBC contains about ______ Hb molecules
280 million
What is the normal Hb value for women?
12-15g
Hb constitutes about _____ % of the RBC weight.
33
_______ is the actual size of the RBCs and is used to classify anemias.
Mean Cell Volume (MCV)
_______ is the measure of weight Hb in a single RBC.
Mean Cell Hemoglobin (MCH)
__________ is a measure of the concentration or proportion of Hb in an average (mean) RBC.
Mean Corpuscular Hemoglobin Concentration - MCHC
What is the normal MCHC ranges for men and women?
32-36%
Macrocytic (large cell anemia) is commonly caused by _________.
Folic acid and vitamin B12 deficiencies
What type of anemia is this?
Patient produces fewer RBCs, but the RBCs that are present are larger than normal
Macrocytic anemia
Where is hypochromic (decreased Hb) microcytic (small cell size) anemia commonly seen?
Patients with:
- Chronic blood loss
- Iron deficiency
- Chronic infections
- Malignancies
Eosinophils are activated by what?
Allergies and parasitic infections
The granules of basophil stain blue with a _____.
Basic dye
_____________ are short-lived, phagocytic WBCs with a half-life of about 1 day.
Monocytes
Monocytes circulate in the bloodstream, from which they move into tissues at which point they mature into long-living macrophages called what?
Histiocytes
What happens when foreign material cannot be digested by the macrophages?
Macrophages may proliferate to form a capsule that surrounds and encloses the foreign material (e.g fungal spores)
What are considered the first lines of cellular inflammatory defense?
Macrophages and monocytes
Which lymphocyte has a smooth surface?
T cells
B cells have projections
B cells, which are formed in the bone marrow, further divide into either:
Plasma cells or memory cells
Where are T cells formed?
Thymus
What subset consists mainly of cytotoxic and suppressor cells?
T8 surface antigen
What surface antigen subset makes up 60-70% of circulating T cells?
T4 surface antigen
In a patient with HIV/AIDS, the T4/T8 ratio is usually _________.
0.5 or less
Where are platelets formed?
Bone marrow and possibly in the lungs
What is the normal value for lactic dehydrogenase?
80-120 Wacker units
What is the normal value for Serum glutamic oxaloacetic transaniminase (SGOT)?
8-33 U/mL
What is the normal value for Chloride (CI-)?
95-103 mEq/L
Ch. 10
Of the seven “index conditions” monitored, what are the 5 significant use of respiratory care services?
- Acute pneumonia
- COPD exacerbation
- Postoperative infections
- VAP
- CHF/Pulmonary edema
- Myocardial infarction
Ch. 10
According to the AARC, what is the purpose of respiratory TDPs?
- Deliver individualized diagnostic and therapeutic respiratory care to patients
- Assist physician with evaluating patients’ needs and optimize the allocation of respiratory care services
- Determine the indications for respiratory therapy
- Empower respiratory therapist to use sign and symptom based algorithms
What are the indications for Oxygen Therapy protocol?
- PaO2 less than 60 on room air
- SaO2 less than 90 room air
- Acute hypoxemia suspected
- After severe trauma
- Intraoperative and postoperative state
- Acute myocardial infarction
- Low CO state
- Hypoxia suggested in sleep study or CPET
- Hb less than 8.0 g/dL
Hypoxemia that develops as a result of consolidation is caused by _____________.
Capillary shunting
What are the indications for Airway Clearance Therapy protocol?
- Restore mucocilliary blanket
- Hydrate and remove retained secretions
- Improve cough effectiveness/expectoration
- Prevent atelectasis
Hypoxemia that results from atelectasis is caused by ____________.
Partial or total capillary shunting
What are the indications for Lung Expansion Therapy protocol?
- Predisposing conditions for atelectasis
- Upper abdominal and thoracic surgery
- Surgery in patients with chronic lung disease (CLD) and CHF
- Existing pulmonary fibrosis
- Restrictive lung disorders
- Patients with excessive secretions
- Patients with chronic neuromuscular diseases
What is the primary indication for aerosolized bronchodilator therapy?
Reversible reactive airway diseases
Hypoxemia that develops as a result of an increased alveolar-capillary membrane is caused by ____________.
Alveolar-capillary diffusion block
What is the primary treatment modality used to offset the anatomic alterations of bronchospasm?
Aerosolized Medication Therapy Protocol
What is the secondary treatment modality used to offset the mild, moderate or severe clinical manifestations associated with bronchospasm?
- Oxygen Therapy Protocol
- Mechanical Ventilation Protocol
What is the primary treatment modality used to offset the anatomic alterations associated with excessive bronchial secretions?
Airway Clearance Protocol Therapy
What is the general term used to describe the inability of the respiratory system to establish and maintain adequate oxygen uptake and carbon dioxide removal from the body?
Respiratory failure (Ventilatory failure)
On the basis of the ABG values, respiratory failure is classified as what two things?
- Hypoxemic respiratory failure (type I respiratory failure)
- Hypercapnic respiratory failure (type II respiratory failure)
There a 6 basic anatomic alterations of the lungs, which in turn cause 6 different scenarios that can result in respiratory failure. What are they?
- Atelectasis
- Alveolar consolidation
- Increased alveolar-capillary membrane thickness
- Bronchospasm
- Excessive bronchial secretions
- Distal airway and alveolar thickening
What is the ABG criteria in a patient with respiratory failure?
- PaO2 less than 60 mmHg
- CO2 greater than 50 mmHg
- A mixture of both
What are some subjective findings of respiratory failure?
- Dyspnea
- Anxiety
- Restlessness
- Rapid and shallow breathing
What are some objective findings of respiratory failure?
- Cardiac arrythmias
- Hypertension and preterminally hypotension
- Coma
- Death
The term hypoxemic respiratory failure is when the primary problem is ____________________.
Inadequate oxygenation between the alveoli and the pulmonary capillary system, which results in a decreased PaO2.
The term hypercapnic respiratory failure is when the primary problem is ____________________.
Alveolar hyperventilation, which results in an increased PaCO2, and without supplemental oxygen, a decreased PaO2.
Hypercapnic respiratory failure is commonly called what?
Ventilatory failure
What are some clinical indicators of hypoxemic respiratory failure?
- Decreased PaO2
- Increased alveolar-arterial oxygen tension gradient
- Decreased arterial oxygen tension to fractional inspired oxygen ratio (PaO2/FIO2)
What are the major pathophysiologic causes of hypoxemic respiratory failure?
- Alveolar hypoventilation
- Pulmonary shunting
- Ventilation-perfusion mismatch
- Less common: Decrease in inspired oxygen pressure
What are some common causes of alveolar hypoventilation?
- CNS depressants
- Head trauma
- Chronic obstructive pulmonary disease
- Obesity
- Sleep apnea
- NMDs
When does alveolar hypoventilation develop?
When the minute volume of alveolar ventilation is not adequate for the body’s metabolic needs
The results of alveolar hypoventilation are _______________.
- Hypoxia
- Hypercapnia
- Respiratory acidosis
- In severe cases, pulmonary hypertension with cor pulmonale
Treatment of alveolar hypoventilation primarily consists of _________________.
Ventilatory support
Define pulmonary shunting.
The portion of the cardiac output that moves from the right side to the left side of the heart without being exposed to alveolar oxygen.
Pulmonary shunting is divided into what two categories?
- Absolute shunt
- Relative shunt
Which type of shunt responds poorly to oxygen?
Absolute shunts
Absolute shunts are either classified as ____________ or _______________.
Anatomic shunt or capillary shunt
Anatomic shunts occur when ___________________.
Blood flows from the right side of the heart to the left side without coming in contact with an alveolus for gas exchange
In a healthy lung, what is the normal anatomic shunt of the cardiac output?
3 percent
What is the normal P(A-a)O2 difference?
7 to 15 mmHg
What are common abnormal causes of anatomic shunts?
- Congenital heart disease
- Intrapulmonary fistula
- Vascular lung tumors
Capillary shunts are caused by _______________.
- Alveolar collapse or atelectasis
- Alveolar fluid accumulation
- Alveolar consolidation or pneumonia
The sum of __________________ makes up the absolute (also called the true shunt)
Anatomic shunt and capillary shunt
What are some common respiratory disorders that cause airway obstruction?
- Emphysema
- Chronic bronchitis
- Asthma
- CF
Define relative shunt.
When pulmonary capillary perfusion is in excess of alveolar ventilation.
A relative shunt can be caused by ____________.
An airway obstruction, an alveolar-capillary diffusion defect or both
Under normal conditions, the overall alveolar ventilation is _________.
4 L/min
Under normal conditions, the pulmonary capillary blood flow is _________.
About 5 L/min
In an ____________ the alveolar oxygen does not come in direct contact with the shunted blood - the nonoxygenated blood completely bypasses the ventilated alveoli and mixes downstream with the oxygenated blood.
Anatomic shunt
What is the VD/VT ratio in a normal spontaneously breathing adult?
20-40%
What is the VD/VT ratio in a patient receiving mechanical ventilation?
40-60%, because of the mechanical dead space added by the ETT.
The VD/VT ratio increases with diseases that cause significant dead space, such as ____________.
Pulmonary embolism
Where is the PeCO2 derived?
Capnometer
What is the normal overall pulmonary ventilation-perfusion ratio?
4:5 or 0.8
The volume of gas in the conducting airways: the nose, mouth, pharynx and larynx and lower portions of the airways down to but not including the respiratory bronchioles.
Anatomic dead space
The sum of the anatomic and alveolar dead space.
Physiological dead space
The volume of anatomic dead space is approx. equal to ____________ of normal body weight.
1 mL/lb (2.2 mL/kg)
When the alveolus is ventilated but not perfused with capillary blood. What is this called?
Alveolar dead space
_______________ is used clinically to identify the primary cause of hypoxemic respiratory failure.
Alveolar-arterial oxygen tension difference
What is the normal range for P(A-a) O2?
7-15 mmHg and should not exceed 30 mmHg
P(A-a) O2 increases at _____________.
High oxygen concentrations
The normal P(A-a) O2 for an FiO2 of 1.0 is ___________________.
25-65 mmHg
What is the critical value of P(A-a) O2 on the 100% oxygen is __________.
Greater than 350 mmHg
When ___________ is the primary cause of hypoxemic respiratory failure, the P(A-a) O2 is elevated.
- V/Q mismatch
- Pulmonary shunting
- Diffusion blockade
What is the phrase used when the primary problem is alveolar hypoventilation?
Hypercapnic respiratory failure (type II)
What are the major pathophysiologic mechanisms that result in hypercapnic respiratory failure?
- Alveolar hypoventilation
- Increased dead space disease
- Severe V/Q mismatch
A condition in which the lungs are unable to meet the metabolic demands of the body in terms of CO2 removal.
Acute ventilatory failure - acute respiratory acidosis
What are the four standard criteria for mechanical ventilation?
- Apnea
- Acute ventilatory failure
- Impending ventilatory failure
- Severe refractory hypoxemia
Is apnea an indication of invasive or noninvasive mechanical ventilation?
Invasive mechanical ventilation
_________ occurs when the patient demonstrates a significant increase in the work of breathing with borderline acceptable ABG values.
Impending ventilatory failure
Severe refractory hypoxemia is seen _______________.
In cases of severe pneumonia, ILDs, ARDS
What is the primary indication for NIV?
Hypercapnic respiratory failure secondary to COPD exacerbation
What are some benefits of noninvasive ventilation?
- Avoids ET intubation
- Reduces airway trauma, risk for aspiration, nosocomial pneumonia
- Maximizes patient effort
- Decrease mortality
- Increases alveolar ventilation
- Decreases muscle fatigue
- Decreases O2 consumption
About _____% of ventilated patients need a more systemic approach to discontinuing the ventilatory support.
15-20
About _____% of patients require days or weeks to be weaned off MV.
5
What are some common used tools to assess the patient’s readiness for ventilator weaning?
- PaO2/FiO2 ratio
- P(A-a)O2
- MIP
- Airway occlusion pressure at 0.1 second
- P0.1/MIP ratio
- VC
- VEsp
- MVV
- Pressure Time Index (PTI)
- RSBI
- Cuff leak test
Term used when it can be proved the mechanical ventilation caused an acute lung injury.
VILI - Ventilator Induced Lung Injury
What are the most common forms of VALI?
- Barotrauma
- Volutrauma
What is the normal range for PaO2/PAO2 ratio?
0.75 to 0.95
What is the normal range for PaO2/FiO2 ratio?
350-450
What is the normal range for Qs/Qt?
<5
What is the normal PTI range?
0.5 to 1.2.
Criteria for successful weaning are less than 0.15-0.18
________________ is defined as the overexpansion of the alveolar structure, alveolar rupture and air leakage caused by high ventilator volumes and pressure.
Barotrauma
How is volutrauma different from barotrauma?
Alveolar rupture does not occur
Studies have suggested that ____________ is the most reliable single measurement to assess the risk for barotrauma in ventilated patients.
P plat - Ventilator plateau pressures
and monitoring peak airway pressures
The generally accepted lung protective strategies to avoid and treat VALI are:
Low tidal volumes, low peak and plateau pressures and permissive hypercapnia
What is characterized by a weakening and permanent enlargement of the air spaces distal to the terminal bronchioles and by destruction of the alveolar walls?
Emphysema
What are the two major types of emphysema?
Panacinar (panlobular) and Centriacinar (centrilobular)
Chronic bronchitis is defined clinically as…..
Chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded
In patients with COPD, both _______ and _______ are present.
Chronic bronchitis and emphysema
Whose definition is this?
Chronic obstructive pulmonary disease is a preventable and treatable disease state caused by airflow limitation that is not fully reversible.
The American Thoracic Society
Whose definition is this?
Chronic obstructive pulmonary disease is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is caused by airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gas
GOLD - Global Initiative for Chronic Obstructive Lung Disease
The ___________ are the primary structures that undergo change in chronic bronchitis.
Conducting airways (particularly the bronchi)
What are the major pathologic or structural changes associated with chronic bronchitis?
- Chronic inflammation and thickening of the walls of the peripheral airways
- Excessive mucous production and accumulation
- Partial or total mucous plugging of the airways
- Smooth muscle constriction of bronchial airways
- Air trapping or hyperinflation of alveoli may occur in late stages
With emphysema, the weakened distal airways tend to collapse during _______________ in response to increased ICP.
Expiration
Where is panlobular emphysema commonly found?
Lower parts of the lungs and is sometimes associated with a deficiency of the protease inhibitor alpha1-antitrypsin
Which type of emphysema is more severe?
Panlobular emphysema
In centrilobular emphysema, the pathologic issues involve the ___________.
Respiratory bronchioles in proximal (central) portion of the acinus
What is centriacinar emphysema strongly associated with?
Smoking and chronic bronchitis
It is estimated that _______ people in the US have chronic bronchitis, emphysema or both
10-15 million
COPD-related deaths claim more than _______ Americans each year
138,000
More people have chronic bronchitis than emphysema.
CB - 9.5 million
Emphysema - 4.1 million
Alpha1-antitrypsin is made in the _____________.
Liver. One of its functions is to protect the lungs from neutrophil elastase, an enzyme that can break down connective tissue
The premature development of emphysema is the hallmark of __________________________
Alpha1-antitrypsin
What is the normal level of alpha1-antitrypsin?
150-350 mg/dL when measure via radial immunodiffusion.
A spirometry test is required to confirm the diagnosis of COPD, showing the presence of a postbronchodilator FEV1/FVC of ___________.
Less than 0.70
What are three main spirometric tests used to measure the severity of airflow limitation in a patient with suspected COPD?
- FVC
- FEV1
- FEV1/FVC ratio
What are the primary goals of COPD assessment?
- Establish degree of airflow limitation
- Determine the effect of the COPD on the patient’s health status
- Ascertain the risk for future events
An mMMR greater than _____ is considered a high risk patient.
2
A CAT score less than ____ is classified as a low risk patient.
10
According to GOLD, a COPD exacerbation is defined as ______________________.
“acute worsening of respiratory symptoms that result in additional therapy”
What is the best predictor for the risk of exacerbation?
Patient’s history of exacerbations, including hospitalizations
A history of _____________ per year is considered a high risk for more exacerbations.
Two or more exacerbations
The inward movement of the lower lateral chest wall during each inspiration - indicates severe hyperinflation.
Hoover sign.
Palpation of the chest: Chronic bronchitis
Normal
Percussion of the chest: Chronic bronchitis
Normal
Percussion of the chest: Emphysema
- Hyperresonance
- Decreased diaphragmatic excursion
Auscultation of the chest: Emphysema
- Diminished breath and heart sounds
- Prolonged expirations
Peripheral edema and venous distention: CB and Emphysema
Emphysema - end stage
CB - COMMON!
Palpation of the chest: Emphysema
- Decreased tactile fremitus
- Decreased chest expansion
- PMI often shifts to epigastric area
Hoover sign is common in CB or emphysema?
Pink puffers! Emphysema
Patients in Group C should be given _____________.
A single LAMA.
What is the initial tx for group B patients?
LAMA or LABA
Patients in group D should be stated on ________________.
LABA + LAMA
Initially, supplemental oxygen should be administered with a target SaO2 of _________.
88-92%
Oxygen therapy is used to:
- Treat hypoxemia
- Decrease WOB
- Decrease myocardial work
Which phenotype is associated with the lowest serum concentration of alpha1- antitrypsin?
ZZ phenotype
Patients with allergic asthma usually respond well to therapy with ____________.
ICSs
What type of medication is Beclomethasone?
ICS
Brand name: QVAR
What type of medication is Tiotropium?
LAMA
Brand name: Spiriva HandiHaler
Spirivia Respimat
What is sameterol’s brand name?
Serevent Diskus (LABA)
What is CICLESONIDE’s brand name?
Inhaled Corticosteroids
Alvesco
What is FLUTICASONE’s brand name and drug class?
Inhaled Corticosteroids
- Flovent HFA
- Flovent Diskus
- Arnuity Ellipta
What is HYRDOCORTISONE’s brand name and drug class?
Oral Corticosteroids
Solu-Cortef
What is MOMETASONE’s brand name and drug class?
Inhaled Corticosteroids
Asmanex Twisthaler
Asmanex HFA
What is FLUNISOLIDE’s brand name and drug class?
Inhaled Corticosteroids
Aerospan HFA
What is Dulera?
ICS and LABA combined
Mometasone and formoterol
What is METHYLPREDNISOLONE’s brand name and drug class?
Oral Corticosteroid
- Medrol
- Solu-Medrol
What is Advair Diskus?
ICS and LABA
Fluticasone and salmeterol
What is Symbicort?
ICS and LABA
Budesonide and formoterol
What is Budesonide?
Inhaled Corticosteroid
Pulmicort Flexhaler
What are the LAMAs?
Tiotropium - Spiriva HandiHaler and Spiriva Respimat
Aclidinium - Tudorza Pressair
Umeclidinium - Incruse Ellipta
What are the Leukotriene Inhibitors?
Zafirlukast - Accolate
Montelukast - Singulair
Zileuton - Zyflo, Zyflo CR
What are the Xanthine Derivatives?
Theophylline - Theochron, Elixphyllin, Theo-24
Oxtriphylline - Choledyl SA
Aminophylline - Generic
Dyphylline - Lufyllin
What are the agents used to reduce inflammation in allergic diseases?
Anti-interleukin-5
- Mepolizumab (subc.)
- Reslizumab (IV)
Antiimmunoglobulin E (Anti-IgE)
Omalizumab - Xolair
Combined SABAs and Anticholinergic agent
Ipratropium and Albuterol - DuoNeb, Combivent Respimat
Combined LABAs and Anticholinergic agent
Umeclidinium and Vilanterol - Anora Ellipta
What classification is Albuterol?
Classification: SABA
Brand name: Proventil HFA, Ventolin HFA, ProAir HFA
What is Ipratropium classified as and what is the brand name?
Classification: SAMA
Brand name: Atrovent HFA
What are all the LABAs?
- Salmeterol: Servent Diskus
- Formoterol: Performist, Foradil Aerolizer
- Arformoterol: Brovana
- Indacater: Arcapta Neohaler
- Olodaterol: Striverdi Respimat
What is fluticasone and salmeterol?
COMBINED LABA AND ICS
Advair Diskus (250/50 mcg only)
What is budesonide and formoterol?
COMBINED LABA AND ICS
Symbicort (60/4.5 mcg only)
What is fluticasone and vilanterol?
COMBINED LABA AND ICS
Breo Ellipta
What is a phosphodiesterase-4 inhibitor?
Generic: Roflumilast
Brand name: Daliresp
