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Pulmonology > Obstructive Pulmonary Diseases > Flashcards

Obstructive Pulmonary Diseases Flashcards

1
Q

This condition is defined as an inflammatory disease of the airways characterized by hyperresponsiveness of the tracheobronchial tree to various stimuli (largely reversible)

A

Asthma

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2
Q

Asthma is an obstructive airway disease with what 3 components?

A

Inflammation (treat this first)
Airway hyper-responsiveness
Allergic or immunologic mediated

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3
Q

The strongest identifiable factor for someone developing asthma is what?

A

atopy

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4
Q

What are the components of the atopic triad?

A

Asthma
Eczema
Seasonal rhinitis

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5
Q

List some asthma triggers

A

Allergens (seasonal and environmental)
Infection
Exercise
Pharmacological Stimuli
Occupational Factors
Emotional Stress

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6
Q

80% of asthma cases are which type?

A

Slow-Onset Asthma

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7
Q

What is typically the first sign in asthma?

A

Cough – worse particularly at night

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8
Q

What is the standard testing used for diagnosing asthma?

A

Spirometry (Pulmonary function studies)

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9
Q

What tool is used for monitoring in asthma patients?

Patients can take home and keep track of their own flow rates (handheld devices)

A

Peak Expiratory Flow meters

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10
Q

What if you suspect patient has asthma but the PFT is normal? What test can you run?

A

Obtain a bronchial provocation test

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11
Q

What are the types of asthma?

A

Allergic (extrinsic)
Idiosyncratic (Intrinsic)
Exercise-Induced
Industrial and Occupational

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12
Q

What are the classifications in asthma?

A

Intermittent asthma
Mild persistent asthma
Moderate persistent asthma
Severe persistent asthma

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13
Q

What is the importance of classifying asthma?

A

to know where they are to guide treatment

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14
Q

Which asthma classification is described below?

Intermittent daytime symptoms occurring less than twice a week

Brief exacerbations

Nocturnal symptoms occurring less than twice a month

Asymptomatic with normal lung function between exacerbations

A

Intermittent Asthma

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15
Q

Which asthma classification is described below?

Symptoms occurring more than once a week but less than once a
day

Exacerbations affect activity or sleep

Nocturnal symptoms occurring more than twice a month

A

Mild Persistent Asthma

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16
Q

Which asthma classification is described below?

Daily symptoms

Exacerbations affect activity and sleep

Nocturnal symptoms occurring more than once a week

A

Moderate Persistent Asthma

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17
Q

Which asthma classification is described below?

Continuous symptoms

Frequent exacerbations

Frequent nocturnal asthma symptoms

Physical activities limited by asthma symptoms

A

Severe Persistent Asthma

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18
Q

These results show what classification of asthma?

FEV1 or PEF rate greater than 80% predicted with less than 20%
variability

Less than 80% = obstructive pattern

A

Intermittent Asthma

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19
Q

These results show what classification of asthma?

FEV1 or PEF rate greater than 80% predicted with variability of
20-30%

High variability

A

Mild Persistent Asthma

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20
Q

These results show what classification of asthma?

FEV1 or PEF rate 60-80% predicted with variability greater
than 30%

A

Moderate Persistent Asthma

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21
Q

These results show what classification of asthma?

FEV1 or PEF rate less than 60% predicted with variability greater
than 30%

A

Severe Persistent Asthma

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22
Q

What is the goal of treatment in asthma?

A

to gain control - only manage to make their lives as normal as
possible

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23
Q

All of the levels will have what type of medication/treatment?

A

albuterol inhaler for rescue

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24
Q

How often should you review asthma treatment?

A

every 1-6 months

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25
Q

General exacerbation Disposition in asthma: when can you discharge an asthma patient home? What factors must be met generally?

A

Discharge home if FEV1>70% and symptoms minimal or absent – monitor first to ensure stability (if less than 70, admit patient)

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26
Q

A patient being discharged from the hospital after asthma exacerbation should go home with what?

A

steroid prescription 3-10 days
short acting bronchodilator scheduled dosing 24-48 hours
increase oral corticosteroid dose
follow up and action plan instructions

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27
Q

What is a late sign in asthma that is worrisome?

A

cyanosis

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28
Q

Patient’s taking their meds but still have wheezing, an exacerbation – we call it what?

A

Asthma Attack

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29
Q

What are the initial treatment/goals of an Asthma Attack?

A

Maintain the airway at all times
Maintain SaO2 >90% - Give supplemental O2
Intubate if respiratory failure - Be prepared to intubate at any moment

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30
Q

What medication class is contraindicated in an asthma attack?

A

NSAIDs

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31
Q

Severe bronchospasm that does not respond to aggressive therapies within 30-60 minutes

A

Status Asthmaticus

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32
Q

What is the most concerning complication of an asthma attack?

A

Status Asthmaticus

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33
Q

Rule of thumb in asthma:

Who Needs Preventative Care? Rule of twos - list them

A

Two beta agonist canisters a year (each bottle contains 70 pumps)

Two doses of beta agonists per week

Two nocturnal awakenings per month

Two unscheduled visits to the doctor per year (3-4 scheduled visits with a doctor per year is expected for asthma – unscheduled/more visits because of flare ups is a concern)

Two prednisone bursts per year

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34
Q

List the risk factors for death from asthma

A

Asthma history

Previous severe exacerbation (ICU or intubation)

Two or more hospitalizations for asthma in the past year

Hospitalization or an ED visit for asthma in the past month (The majority of people who die from asthma have been in the ER within the
previous 30 days)

Current use of or recent withdrawal from systemic corticosteroids

Use of >2 MDI short-acting beta2 agonist canisters per month

Social history (Low socioeconomic status or inner-city residence, serious psychosocial problems)

Comorbidities (CV disease, COPD, Emphysema, etc)

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35
Q

What condition is an all inclusive and nonspecific term applied to a spectrum of disease (most patients have mixed disease)?

A

COPD

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36
Q

In the US, what disease is the most rapidly increasing health problem?

A

COPD

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37
Q

What are the two classic forms of COPD?

A

Chronic bronchitis is a clinical condition

Emphysema is a pathological entity

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38
Q

What is a major difference between COPD and asthma?

A

COPD -you have irreversible damage/changes

Asthma - has reversible components

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39
Q

Disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with abnormal inflammatory response of the lungs to inhaled noxious particles or gases (chronic smoking)

A

COPD

40
Q

What is the hallmark of COPD?

A

Expiratory flow limitation (Can bring the air in but can’t get out)

41
Q

What is the major risk factor for COPD that accounts for 80-90% of risk in US?

A

Cigarette smoking

42
Q

What is the hereditary risk factor for COPD?

A

Alpha-1-antitrypsin deficiency

43
Q

What is the autosomal recessive condition that affects mostly Northern European whites, causes lung and liver disease, and accounts for 2-3% of patients with COPD?

A

Alpha-1-antitrypsin deficiency

44
Q

What is the pathophysiology of Alpha 1 Antitrypsin Deficiency?

A

Abnormally decreased levels of protease inhibitor

45
Q

Patients with Alpha 1 Antitrypsin Deficiency are also at risk for developing this non-lung disease?

A

hepatocellular carcinoma

46
Q

List some co-morbid conditions of COPD

A

Pneumonia
Multifocal atrial tachycardia
Ventricular dysfunction (Cor pulmonale)
Pulmonary hypertension
Secondary pneumothorax
Respiratory failure
Bronchogenic lung cancer

47
Q

What are the three major categories of COPD?

A

Chronic bronchitis
Emphysema
Asthma

48
Q

What stage of COPD is described below?

Chronic cough and sputum production, some SOB

FEV1 ≥ 80% predicted

A

Stage I - Mild COPD

49
Q

What stage of COPD is described below?

Chronic cough and sputum production; SOB may limit exertion

FEV1 50-79% predicted

A

Stage II - Moderate COPD

50
Q

What stage of COPD is described below?

Involves progressive airway limitation 🡪 clinical signs and
symptoms worsen, more frequent exacerbations

FEV1 30-49% predicted

A

Stage III - Severe COPD

51
Q

What stage of COPD is described below?

Chronic respiratory failure

Hypercapnia and hypoxia with severe, recurrent exacerbations 🡪 affects quality of life and threaten survival

These are the patients will see walking around with oxygen tanks

FEV1 <30% predicted or FEV1<50% predicted PLUS chronic respiratory failure

A

Stage IV - Very severe COPD

52
Q

In early disease in COPD, what is the typical first complaint/manifestation?

A

decreased exercise tolerance

53
Q

In COPD, what is felt to be a better predictor of mortality than
spirometry?

A

exertional dyspnea

54
Q

COPD typically presents with what characteristic symptoms?

A

chronic cough (85%)
dyspnea
copious expectoration (45%)
wheeze (40%)
fatigue

55
Q

Pink Puffer

A

Emphysema

56
Q

Blue Bloater

A

Chronic Bronchitis

57
Q

Type of COPD:

Abnormal permanent enlargement of air sacs distal to terminal bronchioles, with destruction of alveolar walls and no obvious fibrosis

Degradation of lung matrix by lung proteases – released by neutrophils attracted by cigarette smoke

Decrease in elastic recoil and collapse of airways during exhalation

A

Emphysema

58
Q

Type of COPD:

Presence of chronic productive cough occurring on most days for
at least three months in each of two successive years

“smoker’s cough”

Diagnosis can only be made when ALL other causes of chronic cough
are excluded (TB, lung cancer, congestive heart failure, etc)

A

Chronic Bronchitis

59
Q

What testing should be done on all suspected patients of COPD to assess and stage disease state?

A

spirometry

60
Q

What is the main diagnostic strategy that quantifies airflow obstruction in COPD?

A

spirometry

61
Q

Why is spirometry important in COPD?

A

Help determine the severity of disease to tailor treatment and predict/follow course

62
Q

What is the primary importance for treatment in COPD?

A

Smoking Cessation

63
Q

What are the treatment goals of COPD?

A

Prevent further damage

Prevent and treat acute exacerbations

Maximize current function

64
Q

Why is smoking cessation so important even in COPD patients with current damage?

A

Will halt further damage to lungs

65
Q

What is the only treatment in COPD that prolongs survival?

A

Correct hypoxia with O2 therapy

66
Q

The mainstay of drug therapy for COPD

A

Inhaled Bronchodilators

67
Q

First line treatment in COPD

A

Anticholingerics (inhaled)

68
Q

What is the most common etiology of acute exacerbations of COPD?

A

Infectious: 70-80%

69
Q

In COPD, what is the BEST intervention shown to slow disease
progression?

A

Smoking cessation

70
Q

Condition that is both restrictive and obstructive (but for our purpose we’ll consider it obstructive)

Multisystem autosomal recessive disorder that leads to abnormalities in membrane chloride channel (CFTR) 🡪 altered chloride transport and water flux across epithelial cells (affects all exocrine tissue)

A

Cystic Fibrosis

71
Q

Genetic – autosomal recessive disorder

Abnormality is CFTR

A

Cystic Fibrosis

72
Q

What is the most common cause of severe chronic lung disease in young adults?

A

Cystic Fibrosis

73
Q

What is the most common fatal hereditary disorder of whites in US?

A

Cystic Fibrosis

74
Q

What is the pathophysiology of Cystic Fibrosis?

A

Abnormal membrane chloride channels result in altered chloride and
water transport across epithelial cells

Inadequate hydration results in impaired mucociliary clearance

Exocrine glands produce abnormal amounts of mucus that obstructs glands and ducts – resulting in obstruction and tissue damage

75
Q

What extrapulmonary condition of Cystic fibrosis is virtually pathognomonic?

A

Meconium ileus

76
Q

What pathogen is associated with Cystic Fibrosis in pneumonia cases?

A

Pseudomonas

77
Q

What diagnostic method is used to diagnose cystic fibrosis?

A

Pilocarpine iontophoresis sweat test

78
Q

What is a positive result for pilocarpine iontophoresis sweat test?

A

Increase in sodium chloride (>60 meq/L) in the sweat of a patient
on two occasions

79
Q

What is important to keep in mind when interpreting a Pilocarpine iontophoresis sweat test?

A

Normal sweat test doesn’t rule out CF 🡪 CFTR mutation analysis for
patients with normal or borderline sweat chloride levels

80
Q

What is the definitive diagnostic testing for cystic fibrosis?

A

Genetic Testing

81
Q

True or false:

All states now mandate newborn screening for CF

A

True

82
Q

Congenital or acquired disorder of the large bronchi characterized by permanent, abnormal dilation and destruction of bronchial walls

Key: permanently enlarged or dilated

A

Bronchiectasis

83
Q

A complication of cystic fibrosis

(Other causes but mainly see with CF)

A

Bronchiectasis

84
Q

What is the most common cause for Bronchiectasis?

A

Cystic Fibrosis

85
Q

What is the HALLMARK sign of Bronchiectasis?

A

Chronic cough, copious foul smelling purulent sputum (“3-phase sputum”)

86
Q

What is the key to telling apart COPD from bronchiectasis?

A

imaging

87
Q

CXR finding is seen in what condition?

Show dilated and thickened bronchi that appear as “tram tracks”

Dilated bronchi with ring-like markings

A

Bronchiectasis

88
Q

What is the diagnostic study of choice in bronchiectasis?

A

CT

89
Q

breath cessation for at least 10 seconds

A

Apnea

90
Q

Airway becomes obstructed during sleep (various etiologies)

Pathologic if obstruction lasts >10 seconds and occurs >7-10x/hr (start to get concerned)

Characterized by loud snoring punctuated with episodes of silence leading to microarousals

A

Obstructive sleep apnea

91
Q

Obstructive sleep apnea is more common in which patients with?

A

Obesity

Adenotonsillar enlargement

Craniofacial dysmorphogenesis (ex: Down Syndrome and macroglossia)

92
Q

List some risk factors for obstructive sleep apnea

A

Micrognathia
Macroglossia
Obesity
Tonsillar hypertrophy
EtOH
Sedatives before going to bed
Large neck
hypothyroidism
Cigarette smoking
Common cold

93
Q

List some conditions and situations that patient’s with obstructive sleep apnea are at risk for

A

Accidents
HTN
IND
Cardiac ectopy
CVA
Cardiac arrhythmias
Severe hypoxemia during sleep
Excessive daytime sleepiness
Pulmonary hypertension
Cor pulmonale

94
Q

In suspected obstructive sleep apnea, what should be obtained?

A

a polysomnography (PSG) 🡪 “sleep study”

95
Q

What is the best treatment for obstructive sleep apnea?

A

CPAP

Pulmonology (8 decks)

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