Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CPR II Exam 2 > Clinical Approach to Asthma/COPD and pHTN/PE/OSA/ILD > Flashcards

Clinical Approach to Asthma/COPD and pHTN/PE/OSA/ILD Flashcards

(45 cards)

Start Studying
1
Q

What is the largest epidemiological risk factor In Utero for the development of Asthma?

A

PREMATURITY

  • has a 4x increased risk
  • also ethnicity, low socioeconomic status, stress, and C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are common Postnatal risk factors for the development of Asthma? (A/I/AP/Abx/A/O)

A
  • levels of endotoxins/allergens in home (DUST MITES)
  • viral and bacterial infections (RSV/adenovirus) that generate vigorous inflammation (unbalanced immunity)
  • also air pollution, Abx use, Acetaminophen exposure, obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Asthma diagnosis with Spirometry

A
  • diagnosis can be difficult! –> Normal spirometry does NOT EXCLUDE the disease
    • treat pt. if you think they have asthma
  • spirometry in symptomatic asthma often associated with FEV1 < 80% and FEV1/FVC < 75%
  • helps to see REVERSIBILITY of airway OBSTRUCTION like 12% improvement in FEV1 over baseline and total improvement of at least 200mL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Intermittent Asthma

What is the Rule of 2’s?

A
  • symptoms < 2x/week
  • nighttime awakenings < 2x/month
  • SABA use < 2x/week

lung function > 80%, use Step 1 therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mild Persistent Asthma

When do pts have symptoms, nighttime awakenings, and asthma exacerbations?

A

Symptoms: > 2/week but not daily

NA: 1-2/month (0-4) and 3-4/month (5-12+)

AE: 2 exacerbations in 6 months or wheezing 4x year lasting > 1 day AND risk factors for persistent asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Moderate Persistent Asthma

When do pts have symptoms, nighttime awakenings, and when is SABA used for symptom control?

A

Symptoms: daily

NA: 3-4/month (0-4) and 1/week but not nightly (5-12+)

SABA use daily (asthma causes some interference with daily activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Severe Persistent Asthma

When do pts have symptoms, nighttime awakenings, and when is SABA used for symptom control?

A

Symptoms: throughout the day

NA: 1/week (0-4) and often 7/week (5-12+)

SABA use several times a day (asthma causes extremely limited normal activity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asthma Treatment and Management

A
  • want personalized, pt.-centered approach with individualized written asthma action plan
    • fosters CO-MANAGEMENT (best quality of life)
    • show appropriate medication use!

**want to provide best quality of life through minimizing disease symptoms and abolishing exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for each step of Asthma treatment:

Intermittent Asthma
Step 1

Persistent Asthma
Step 2
Step 3
Step 4
Step 5
Step 6
A
  1. SABA as needed
  2. low-dose ICS (inhaled corticosteroid)
  3. low-dose ICS + LABA (or medium-dose ICS)
  4. medium-dose ICS + LABA
  5. high-dose ICS + LABA (and omalizumab for allergies)
  6. high-dose ICS + LABA + oral corticosteroid (and omalizumab for allergies)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common complication of Asthma and how is it treated?

A

ASTHMA EXACERBATION = acute worsening of symptoms

  • often triggered by benign viral infections, allergies
  • want to prevent this from happening

Tx: bronchodilators, systemic glucocorticoids, oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is one of the most studied preventative measures for Asthma?

What are other ways to prevent asthma?

A

BREASTFEEDING –> microbiome transfer still occurs

  • also avoid tobacco smoke, reduce obesity (eat balanced diet), get vaccinations

early exposure to microorganisms dec. risk of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is COPD and who does it commonly affect?

What are its biggest risk factors for development?

A
  • persistent airflow limitation that is usually progressive with enhanced chronic inflammatory response in airways and lungs (airflow limitation is largely IRREVERSIBLE)
  • mortality rates higher in men with strong associations to poverty

RF: smoking/tobacco exposure (MC), history of TB (more of a worldwide problem)
- first-degree relatives have 3x risk of development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is COPD diagnosed and what are the 4 Gold classifications of COPD?

How should each Gold stage be managed?

A

Dx: FEV1/FVC < 0.7 (MUST HAVE)
- pts with low FEV1 and < 12% reversibility

Gold 1 = mild (FEV1 > 80% predicted)
- educate and manage risk
Gold 2 = moderate (50% < FEV1 < 80% predicted)
- consider rehabilitation
Gold 3 = severe (30% < FEV1 < 50% predicted)
- rehabilitation (possible lung reduction/transplant)
Gold 4 = very severe (FEV1 < 30% predicted)
- lung reduction/transplant (possible rehabilitation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two goals of COPD treatment?

What are two nonpharmalogic treatment options for COPD patients?

A

Goal: reduce symptoms and reduce risk

  1. Pulmonary Rehabilitation (individually tailored)
    • improve physical activity and daily living
  2. Lung Volume reduction surgery/transplant
    • evidence-based intervention to improve quality life
    • usually for patients with severe disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 main pharmalogical treatments for COPD? (B/C/O)

A
  1. Bronchodilators = MAINSTAY (address breathlessness)
    • prefer LONG-ACTING (inc. lung function, exercise)
    • LAMA + LABA = 2x lung function ONLY
  2. Inhaled Corticosteroids (high risk of exacerbations)
    • improve lung function, dec. breathlessness
  3. OXYGEN (15 hrs/day if SaO2 < 88%)
    • REDUCED MORTALITY
    • B/ICS are only for SYMPTOM reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the ABCD groups for COPD?

What treatment should each group be given?

A

A - mMRC 0-1, CAT < 10, 0-1 exacerbations (no hospital)
Tx: SABA

B - mMRC > 2, CAT > 10, 0-1 exacerbations (no hospital)
Tx: long acting bronchodilator (LABA/LAMA)

C - mMRC 0-1, CAT < 10, 2+ exacerbations (1 hospital)
Tx: LAMA

D - mMRC > 2, CAT > 10, 2+ exacerbations (1 hospital)
Tx: LAMA or LAMA + LABA or ICS + LABA

groups B-D should also receive Pulmonary Rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

COPD Treatment (OC/Abx/O) and Prevention for Acute Exacerbations (V/LABA/ICS)

A

Treatment: ORAL CORTICOSTEROIDS (mainstay), oral antibiotics (if inc. sputum purulence), oxygen if needed (noninvasive mechanical ventilation if respiratory acidosis)

Prevention: flu vaccine, pneumococcal vaccine, long-acting bronchodilator and ICS (each reduces risk by 25%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Pulmonary Hypertension and what is it importance?

What are its symptoms? (DOE/F/PCP/HF)

A
  • mean pulmonary artery pressure (PAP) > 20 mmHg
  • importance: inc. mortality if left untreated and onset can be insidious/overlooked (vague symptoms or co-morbid conditions)

Symptoms: dyspnea (exertion), fatigue, pleuritic chest pain, signs of right-sided heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can Pulmonary Hypertension be diagnosed?

What is the Swan-Ganz Catheter?

Study These Flashcards
A

Transthoracic Echocardiogram (TTE) is the MOST COMMON way to diagnose pulmonary hypertension

  • can look at RV and LV chamber size
  • estimates PASP indirectly
  • can also use electrocardiogram (right ventricular hypertropy), labs (inc. BNP), and cardiac catheterization (Swan-Ganz catheter)

SGC: catheter placed into pulmonary arteries with balloon that can be inflated/deflated

20
Q

How is Pulmonary Hypertension treated?

What are 4 medications that can be used to treat Pulmonary Hypertension? (PA/PDI/EA/CCBs)

Study These Flashcards
A

Tx: treat underlying causes and use symptom-based treatments
- graded exercise, supplemental oxygen, diruetics

Meds: Prostacyclin agonist (vasodilation), Phosphodiesterase inhibitors (dec. NO breakdown = vasodilation), Endothelium antagonists (block vasoconstriction), CCBs (least prescribed)

  • PD inhibitor = Tadalafil
  • Endothelium antagonists = ambrisentan
21
Q

What is Virchow’s Triad and what condition does it relate to?

Study These Flashcards
A

Hypercoagulability, Venous Stasis, Endothelial Injury

  • related to venous thromboembolisms
22
Q

What do Proteins C/S and Antithrombin III block in the coagulation pathway?

Study These Flashcards
A

Proteins C/S - blocks factor VIII and V to inhibit cascade

ATIII - blocks factor II and X

23
Q

What state do Protein C/S deficiency, Antithrombin III deficiency, and Factor V Leiden mutation cause?

Study These Flashcards
A
  • all 3 lead to hypercoagulable states

PC/SD - ineffective regulation of VIIIa/Va
ATIIID - ineffective regulation of Xa and IIa (thrombin)
FVLM - mutation of Factor V preventing protein C bind

24
Q

How is Pulmonary Embolism diagnosed? (WC/L)

What imaging is used to visualize PE?

Study These Flashcards
A

Wells Criteria (point-based scoring system to determine PE probability)

Labs: D-dimer serum lvls are good at RULING OUT PE if lvls are normal (SENSITIVE TEST)
- other inflammatory states can have (+) D-dimers

I: CT chest with Contrast (primary test for PE diagnosis)

  • GOLD standard (visualize vasculature/vessels)
  • also used V/Q scan (second-line study)
    • for pts. w/contrast allergy and end stage renal disease
25
What is seen on ECG of a patient with Pulmonary Embolism? (ST/RV/BB/SQT) What is seen on Echocardiogram of a patient with Pulmonary Embolism?
- Sinus Tachycardia is most common finding (44%) - RV strain: inverted T waves in leads V1-4 - incomplete/complete RBBB - S1, Q3, T3: deep S-wave in lead 1, Q-wave in lead 3, and inverted T-wave in lead 3 ECHO = D-shaped LV chamber due to RV enlargement - pathomneumonic for PE until proven otherwise
26
What are the symptoms of Unstable PE (H/RVS/ECE) and what are its 2 treatment options?
Sx: HYPOTENSION, RV strain, elevated cardiac enzymes 1. Resuscitation: ventilation (oxygen) and IVF/vasopressors 2. Thrombolytics: ensure NO contraindications **if systemic thrombolysis fails --> repeat thrombolysis, attempt catheter thrombolysis, and proceed to surgery for thrombectomy**
27
What are treatment options for Stable PE? (H/LMWH/W/DOACs)
Heparin: inhibits Factor II/X via antithrombin III - continuous drip, but quick onset/easy to stop LMW Heparin: enoxaparin - requires injection, but quick onset (SubQ) Vitamin K Antagonist: WARFARIN (blocks F 2, 7, 9, 10) - oral, cheap but requires INR check and LMWH bridge DOACs: rivaro/api/endoxaban and dabigatran - do NOT need LMWH bridge (Xa inhibitors) - oral, no labs or dietary restrictions, less bleeding - cost and reversible agents are cons
28
What are the reversal agents for LMWH, Warfarin, and DOACs used to treat Pulmonary Embolism?
LMWH: protamine sulfate Warfarin: Vitamin K, fresh frozen plasma DOACs: andexanent alpha (Xa Inhibs) and idarucizumab (Thrombin Inhib)
29
What is the common duration of treatment for pts. with Pulmonary Embolism?
**MINIMUM 3 months for all patients** - extended treatment not typically needed for pts. with provoked DVT/PE (travel, surgery, hormone therapy) - indefinite anticoagulation intended for those with underlying disease (malignancy and genetic mutations)
30
What is Obstructive Sleep Apnea (OSA), what is apnea, and how is OSA measured?
- disruption of breathing pattern while sleeping that results in excessive daytime somnolence despite adequate sleep periods and not explained by other causes = snoring, gasping for air, breathing pause apnea = red. breathing for 10 sec with drop in SpO2 > 3% - OSA measured by Apnea-Hypopnea Index (AHI) calculated by taking # of apnea episodes/hours
31
What are risk factors for OSA? (O/LT/CA/ET/ELN/M)
- OBESITY - #1 cause/predictor of OSA - large tongue - craniofacial abnormalities (retrognathia/micrognathia) - enlarged Tonsils or LNs - Male sex
32
What is the STOPBANG risk criteria for OSA?
S - snoring T - tired O - observed (has someone seen you stop breathing) P - pressure (high blood pressure) B - body mass index > 35 A - age (older than 50) N - neck size G - gender Low risk = 0-2, intermediate = 3-4, high risk = 5-8
33
How is OSA diagnosed and what are two treatment options for patients with it? (CPAP/OA)
Dx: Polysomnogram (PSG) = GOLD STANDARD - records sleep activity for 6-7 hours overnight - monitors EEG, ECG, ocular movement, airflow, O2 - generates AHI, diagnose severity of sleep apnea Tx: CPAP or Oral Appliances - CPAP - provides positive pressure ventilation - improved compliance rate with education/support - OA - thrust mandible forward (opens airway) - for mild OSA, requires adjustments, jaw pain
34
What are the 4 common characteristics of Interstitial Lung Disease? (RPFTs/DLCO/DOE/A)
1. restrictive pattern on PFTs 2. dec. DLCO 3. dyspnea on exertion 4. absence of primary infection or malignancy
35
Idiopathic Pulmonary Fibrosis Who does it affect, what are its symptoms, what does it sound like of physical exam, and what is seen on CT imaging? (BH/TB) How is it treated? (SC/S/IM/AF)
- affects pts older than 60 yo, M = F Sx: progressive dyspnea, dry cough, fatigue, inability to perform ADLs PE: inspiratory CRACKLES ("velcro lung") CT: bilaterally honeycombing, traction bronchiectasis Tx: supportive care (O2/rehab), steroids, immunomodulators, anti-fibrotic therapy (pirfenidone - fibroblast prolif. and nintedanib - TK inhibitor)
36
Sarcoidosis Who does it affect, what is it characterized by, what are two cutaneous manifestations (LP/EN), and what are two syndromes pts have (LS/HS)? What are Lofgren's (EN/HL/F/A) and Heerfordt's (AU/P/F/CNP) Syndromes?
- affects African American females the most, either in 2nd-3rd or 6th decade (biomodal) - characterized by NONCASEATING GRANULOMA CM: lupus pernio and erythema nodosum S: Lofgren's (EN/hilar lymphadenopathy/fever/arthritis) and Heerfordt's (ant. uveitis/parotitis/CN 7 palsy/fever)
37
Sarcoidosis What is the most common radiological finding, what are stages 0-4 of radiographic sarcoidosis, and how is it treated? (S/M/A/C)
I: most common finding is HILAR LYMPHADENOPATHY Stages: - 0 = no pulmonary involvement - 1 = Hilar LAD - 2 = Hilar LAD + infiltrates - 3 = infiltrates only - 4 = fibrosis Tx: supportive, steroids (1st line therapy), methotrexate, azathioprine, cyclophosphamide
38
Granulomatosis with Polyangiitis Who does it affect, what does it affect, what is a clinical manifestation it can cause, what lab is it positive for, and how is it treated (S/C)?
- small-vessel vasculitis affecting sinuses/lungs/kidneys in middle-aged caucasians PE: saddle nose deformity (relapsing polychondritis) Lab: c-ANCA (+) Tx: steroids and cyclophosphamide
39
Goodpasture's Syndrome Who does it affect, what does it affect, what is seen on radiology, what lab is it positive for, and how is it treated (P/S/C)
- autoimmune condition with Abs against basement membrane of alveoli and glomerular parenchyma in caucasians (usually pediatrics, or bimodal adult distrib) Radio: bilateral ground glass opacities Lab: anti-GBM (+) Tx: PLASMAPHERESIS, steroids, cyclophosphamide
40
What 3 Connective Tissue disorders are most commonly associated with ILD? (SS/RA/DP)
1. Systemic Sclerosis = MC CT disease with ILD 2. Rheumatoid Arthritis = more common in males 3. Dermatomyositis/Polymyositis - (+) for anti-synthetase Abs
41
Hypersensitivity Pneumonitis How does it present clinically, what is seen on radiographs, what is seen on histology, and how is it treated?
PE: symptoms IMPROVE when patient goes on vacation, otherwise cough, dyspnea, +/- fevers Radio: chronic forms have honeycomb patterns that SPARE the base of the lungs (unlike IPF) Histo: possible NON-caseating granulomas, PLASMA CELLS Tx: remove pt. from antigen
42
Silicosis Who does it affect, what is the difference in radiographs between long and progressive disease, and what are pts. at inc. risk of developing?
- affects miners, stone cutters, sand blasters, quarry workers Long exposure - Simple Silicosis - nodular disease and calcified hilar LN Progressive - Complicated Silicosis - large nodules (> 1cm) with extensive fibrosis - pts at inc. risk of infections, ESPECIALLY TB
43
Asbestosis Who does it affect, what is seen on radiography, and what are pts. at inc. risk of developing?
- affects construction, INSULATION, demolition, automobile workers ("needle-like") Radio: multiple nodular opacities, pleural effusion/fibrosis, blurred diaphragm/cardiac silhouette - pts. at inc. risk of mesothelioma and lung cancer (asbestos and cigarette smoke have SYNERGISTIC effect on lung cancer rates)
44
Coal Worker Pneumoconiosis Who does it affect and what is the difference between Simple and Complicated?
- affects miners who inhale coal dust (high lvls of silica) Simple: asymptomatic - Radio: small nodules (< 1cm) at APEX of lung Complicated: cough, dyspnea, sputum - Radio: large nodules (> 1cm) with patchy infiltrates at BASE, with fibrosis
45
Berylliosis Who does it affect, what is the difference between acute and chronic versions, what are pts. at inc. risk of developing, and how is it treated (S/R)?
- affects pts. in alloy or electronic device manufacturing (beryllium exposure) Acute: similar rxn to hypersensitivity pneumonitis Chronic: insidious onset, from cumulative exposure - Radio: hilar LAD, diffuse infiltrates - pts are at inc. risk of LUNG CANCER Tx: steroids, removal from beryllium environment

CPR II Exam 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions