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CVPR > Lung diseases > Flashcards

Lung diseases Flashcards

1
Q

where does Asthma obstruction occur

A

bronchi (3-4)

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2
Q

where does Asthma obstruction occur

A

bronchi (3-4)

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3
Q

Extrinsic vs Intrinsic asthma

A

extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral

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4
Q

Asthma pathophysiology

A

inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes

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5
Q

structural changes in asthma

A

SMC hypertrophy and hyperplasia
mucus hypersecrtion due to submusosal hyperplasia
angiogenesis
epithelial desquamanation

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6
Q

Lung volumes in obstructive disease

A

increase RV and FRC, but decreased IC due to high RV

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7
Q

intermittent asthma

A

less than 2 times per week and asymptomatic in between and less than 2x at night per month

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8
Q

mild persistent asthma

A

more than 2x per week or less than 1 time daily with more than 2x per night monthly

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9
Q

moderate persistent asthma

A

daily symptoms with some recovery, more than once per week at night

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10
Q

severe persistent asthma

A

continual symptoms with frequent night symptoms

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11
Q

what is well controlled asthma?

A
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12
Q

not well controlled

A

> 2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best

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13
Q

poorly controlled asthma

A

throughout day symptoms, >4 nights/wk, SABA several times a day,

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14
Q

Step ups in Asthma treatment

A

ICS before LABA, but also use omalizumab for severe and oral CS for very severe

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15
Q

LABA vs SABA

A

SABA: Albuterol is 4-6 hour duration and rapid action
LABA: salmeterol and forometerol is 12 hr sustained duration.
Should not be used along with asthma since they are not antiinflammatory!

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16
Q

Systemic Vs. Inhalted Glucocorticosteroids

A

Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition!
Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.

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17
Q

Leukotriene Modifiers

A

Oral D4 antagonists, 5-lipoxygenase inhibitor,
Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory.
attenuates exercise induced asthma

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18
Q

Omalizumab

A

Immune modulator tx for asthma. Anti-IgE

Used for severe asthma treatment given SC

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19
Q

Mepolizumab

A

immune modulator, anti IL-5

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20
Q

Atropine

A

Anticholinergic used in COPD but not asthma!
Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors.
Ipratrapium - 6 hour anticholinergic
Tiotropium: 12 hours anticholinergic

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21
Q

Tiotropium

A

long term anti-cholinergic used in >12 yo asthma patients

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22
Q

Theophylline

A

oral or IV - no longer used in asthma
Inhibits phosphodiesterase for bronchodilation and some antiinflammatory.
Not used due to narrow therapeutic window, seizures, neurologic damage and DDI

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23
Q

Cromolyn and Nedocronil

A

inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.

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24
Q

Particles >5 um are deposited

A

in pharynx and large airways

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25
Q

Particles

A

small airways;

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26
Q

Tx of COPD

A

LABA over SABA

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27
Q

Pathogenesis of Chronic Bronchitis

A

hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.

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28
Q

Pathogenesis of Emphysema

A

loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair

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29
Q

Centriacinar

A

cigarette smoking related, with central airways more inflated

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30
Q

Panacinar

A

due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.

31
Q

DLCO in emphysema vs. Chronic Bronchitis

A

emphysema has decreased but normal Bronchitis due to aveolar sparing

32
Q

Pink puffer vs Blue Bloater response to hypoxia

A

Pink: poor - hyperventilation
Blue: can tolerate

33
Q

CO in Pink puffer vs. Blue Bloater

A

Decreased CO compared to Blue Bloater

34
Q

Blood gas for Pink puffer vs blue bloater

A

pink: normal blood gas
Blue: low O2 sat

35
Q

Cor Pulmonale Pink puffer vs. blue bloater

A

more common in blue bloater, can occur with pink puffer but is end stage.

36
Q

Gold rating of COPD

A

Mild Ratio is 80

Mod ratio is 70 with FEV

37
Q

Tx of COPD

A

smoking cessation, increase physical activity, overall health preseveration.
GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA
Gold 3-4 with high risk and low-high symptoms: ICS with LABA

38
Q

Bronchiectasis:

A

abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection.
Due to frequent bacterial infection in recurrent Px, CF,
Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation.
Airways are dialted but collapsed.
tx: airway clearance, Antibiotic

39
Q

Extrinsic vs Intrinsic asthma

A

extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral

40
Q

Asthma pathophysiology

A

inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes

41
Q

structural changes in asthma

A

SMC hypertrophy and hyperplasia
mucus hypersecrtion due to submusosal hyperplasia
angiogenesis
epithelial desquamanation

42
Q

Lung volumes in obstructive disease

A

increase RV and FRC, but decreased IC due to high RV

43
Q

intermittent asthma

A

less than 2 times per week and asymptomatic in between and less than 2x at night per month

44
Q

mild persistent asthma

A

more than 2x per week or less than 1 time daily with more than 2x per night monthly

45
Q

moderate persistent asthma

A

daily symptoms with some recovery, more than once per week at night

46
Q

severe persistent asthma

A

continual symptoms with frequent night symptoms

47
Q

what is well controlled asthma?

A

Given

48
Q

not well controlled

A

> 2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best

49
Q

poorly controlled asthma

A

throughout day symptoms, >4 nights/wk, SABA several times a day,

50
Q

Step ups in Asthma treatment

A

ICS before LABA, but also use omalizumab for severe and oral CS for very severe

51
Q

LABA vs SABA

A

SABA: Albuterol is 4-6 hour duration and rapid action
LABA: salmeterol and forometerol is 12 hr sustained duration.
Should not be used along with asthma since they are not antiinflammatory!

52
Q

Systemic Vs. Inhalted Glucocorticosteroids

A

Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition!
Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.

53
Q

Leukotriene Modifiers

A

Oral D4 antagonists, 5-lipoxygenase inhibitor,
Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory.
attenuates exercise induced asthma

54
Q

Omalizumab

A

Immune modulator tx for asthma. Anti-IgE

Used for severe asthma treatment given SC

55
Q

Mepolizumab

A

immune modulator, anti IL-5

56
Q

Atropine

A

Anticholinergic used in COPD but not asthma!
Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors.
Ipratrapium - 6 hour anticholinergic
Tiotropium: 12 hours anticholinergic

57
Q

Tiotropium

A

long term anti-cholinergic used in >12 yo asthma patients

58
Q

Theophylline

A

oral or IV - no longer used in asthma
Inhibits phosphodiesterase for bronchodilation and some antiinflammatory.
Not used due to narrow therapeutic window, seizures, neurologic damage and DDI

59
Q

Cromolyn and Nedocronil

A

inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.

60
Q

Particles >5 um are deposited

A

in pharynx and large airways

61
Q

Particles

A

small airways;

62
Q

Tx of COPD

A

LABA over SABA

63
Q

Pathogenesis of Chronic Bronchitis

A

hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.

64
Q

Pathogenesis of Emphysema

A

loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair

65
Q

Centriacinar

A

cigarette smoking related, with central airways more inflated

66
Q

Panacinar

A

due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.

67
Q

DLCO in emphysema vs. Chronic Bronchitis

A

emphysema has decreased but normal Bronchitis due to aveolar sparing

68
Q

Pink puffer vs Blue Bloater response to hypoxia

A

Pink: poor - hyperventilation
Blue: can tolerate

69
Q

CO in Pink puffer vs. Blue Bloater

A

Decreased CO compared to Blue Bloater

70
Q

Blood gas for Pink puffer vs blue bloater

A

pink: normal blood gas
Blue: low O2 sat

71
Q

Cor Pulmonale Pink puffer vs. blue bloater

A

more common in blue bloater, can occur with pink puffer but is end stage.

72
Q

Gold rating of COPD

A

Mild Ratio is 80

Mod ratio is 70 with FEV

73
Q

Tx of COPD

A

smoking cessation, increase physical activity, overall health preseveration.
GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA
Gold 3-4 with high risk and low-high symptoms: ICS with LABA

74
Q

Bronchiectasis:

A

abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection.
Due to frequent bacterial infection in recurrent Px, CF,
Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation.
Airways are dialted but collapsed.
tx: airway clearance, Antibiotic

CVPR (12 decks)

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