Chapter 17- Obstructive Lung Disease

Question 1

What are the clinical features of COPD?

Answer 1

Chronic progressive dyspnea

Question 2

What are the laboratory findings of COPD?

Answer 2

Decreased expiratory flow rates, hypoxia and hypercapnia in end-stage disease

Question 3

What are the clinical features of emphysema?

Answer 3

Little or no sputum, end stage cachexia

Question 4

What are the laboratory findings of emphysema?

Answer 4

Hyperinflation, increased compliance, low DLCO, rarely alpha1-antitrypsin deficiency

Question 5

What are the clinical features of chronic bronchitis?

Answer 5

Sputum, history of smoking, industrial exposure

Question 6

What are the laboratory findings of chronic bronchitis?

Answer 6

Nonspecific- rarely occurs in isolation without varying degree of emphysema

Question 7

What are the clinical features of asthma?

Answer 7

Episodic dyspnea, cough, wheezing, with or without environmental triggers

Question 8

What are the laboratory findings of asthma?

Answer 8

Airway hyperreactivity, response to bronchodilators

Question 9

What are the clinical features of bronchiectasis?

Answer 9

Usually large volume of sputum

Question 10

What are the laboratory findings of bronchiectasis?

Answer 10

Chest radiograph; dilated bronchi, thick walled, tram track shadows, obstruction with or without restriction on pulmonary function tests

Question 11

What are the clinical features of immotile cilia syndrome?

Answer 11

Situs inversus, dextrocardia, sinusitis, infertility

Question 12

What are the laboratory findings of immotile cilia syndrome?

Answer 12

Abnormal dynein in ciliated cells

Question 13

What are the laboratory findings with hypogammaglobulinemia?

Answer 13

Decrease in one or more immunoglobulins

Question 14

What are the clinical features of cystic fibrosis?

Answer 14

Sinusitis, bronchiectasis, meconium ileus, malabsorption, infertility

Question 15

What are the laboratory findings in cystic fibrosis?

Answer 15

Increased sweat chloride, mutation in CFTR chloride channel, elevated fecal fat, abnormal nasal mucosal potentail difference

Question 16

What are the three obstructive lung disorders that can make up COPD?

Answer 16

Chronic bronchitis
Emphysema
Chronic broncholitis

Question 17

What is the algorithm for emergency department treatment of acute bronchospasm? What should you do if there is an inadequate response to this treatment?

Answer 17

Oxygen, inhaled B2 agonist, consider inhaled anticholinergic and oral or IV corticosteroids

If inadequate response- inhaled anticholinergics if not given already. If bronchospams persists admit to hopsital. If respiratory failure consider aminophylline, Heliox (hellium=oxygen), IV magnesium, endotracheal intubation and mechanical ventilation

Question 18

What is the algorithm for emergency department treatment of acute bronchospasm? What should you do if there is a good response to this treatment?

Answer 18

Oxygen, inhaled B2 agonist, consider inhaled anticholinergic and oral or IV corticosteroids

Good response- discharge on inhaled B2 agonist +/- inhaled anticholinergic, corticosteroids x 5 days, arrange outpatient follow-up within 5 days

Question 19

What is the algorithm for outpatient treatment of the chronic/stable bronchospasm in asthma?

Answer 19

Inhaled PRN short acting B2-Agonist
If continued sx add ICS
If continued sx increase dose of ICS add long-acting b2-agonist
If continued sx add leukotriene antagonist
if sx continued add oral corticosteroids

Question 20

What is the algorithm for outpatient treatment of the chronic/stable bronchospasm in COPD?

Answer 20

Inhaled short acting b2-agonist and inhaled anticholinergic
If continued sx add trial of ICS
If continued sx add oral abx if chronic bronchitis is predominent component, and consider trial of theophylline
If continued sx trial of oral corticosteroids.

Question 21

What are the organ systems involved in cystic fibrosis?

Answer 21

Pulmonary
Pancrease
Genitourinary
Gastrointestinal

Question 22

What is the pulmonary involvement in cystic fibrosis?

Answer 22

Cough and sputum production
Recurrent pneumonias
Bronchial hyperreactivity
Hemoptysis
Pneumothorax
Significant digital clubbing
Cor pulmonale

Question 23

What is the upper respiratory tract involvement in cystic fibrosis?

Answer 23

Nasal polyps

Chronic sinusitis

Question 24

What is the gastrointestinal involvement in cystic fibrosis?

Answer 24

Meconium ileus in the neonate
Distal intestinal obstruction
Rectal prolapse
Hernias
Exocrine pancreatic dysfunction causing steatorrhea, malnutrition, and vitamin deficiency
Acute pancreatitis (rare)
Diabetes mellitus
Cirrhosis and portal HTN
Salivary gland inflammation
Cholelithiasis

Question 25

What is the genitourinary involvement in cystic fibrosis?

Answer 25

Azoospermia Decreased fertility rate in women Nephrolithiasis

Question 26

What are the diagnostic studies used in asthma?

Answer 26

``` Routine pulmonary function test Special pulmonary function test Methacholine or cold-air challenge Challenge with specific agents: occupational, drugs Chest radiograph Skin tests Blood tests ```

Question 27

What does routine pulmonary function test result in asthma?

Answer 27

Decreased FEV1; hyperinflation; improvement with bronchodilator

Question 28

What does the methacholine challenge or cold-air challenge result in asthma?

Answer 28

Indicates the presence of nonspecific bronchial hyperreactivity; bronchoconstriction occurs at lower doses in asthma

Question 29

When is the challenge with specific agents: occupational and drugs done for asthma?

Answer 29

Occasionally performed

Question 30

What does the chest radiograph result in asthma?

Answer 30

Fleeting infiltrates and central bronchiectasis in ABPA (allergic bronchopulmonary aspergillosis)

Question 31

What do skin tests result in asthma?

Answer 31

Demonstrate atopy; little value except prick test to Aspergillus fumigatus positive in ABPA (allergic bronchopulmonary aspergillosis)

Question 32

What do blood tests result in asthma?

Answer 32

Eosinophils and IgE are usually increased in atopy; levels may be very high in ABPA (allergic bronchopulmonary aspergillosis); Aspergillus preciptins increased in many but not all patients with ABPA

Question 33

Slowly progressive dyspnea characterized by abnormalities of airway and lung structure occuring in response to noxious inhaled substances

Answer 33

COPD

Question 34

What is the hallmark of COPD?

Answer 34

irreversible airflow inflammation

Question 35

Is there a genetic component to COPD?

Answer 35

Yes, less than 1% of COPD cases are linked to alpha-antitrypsin deficiency, a genetic disorder

Question 36

Permanent enlargement of the air spaces distal to the terminal bronchiole due to destruction of lung parenchyma in the absence of significant fibrosis

Answer 36

Emphysema

Question 37

Persistent cough resulting in sputum production for more than 3 months in each of the past 2 years

Answer 37

Chronic Bronchitis

Question 38

Is chronic bronchitis a disease of small or large airways?

Answer 38

Large airways and not lung parenchyma

Question 39

Slow progressive dyspnea first noted during exertion that progresses over years until it is evident at rest. Exercise intolerance and fatigue, weight loss, depression, anxiety, chronic cough

Answer 39

small airways disease

Question 40

What are the late stages of small airways disease?

Answer 40

Skeletal muscle wasting, accessory muscle use, pursed-lip breathing, weight loss, flattened diaphragm, TV decreases while RR increases

Question 41

What are PE findings of small airways disease?

Answer 41

hyperresonant to percussion, diminished breath sounds with rhonchi, wheezes, or faint crackles, barrel chest

Question 42

Caused by a virus that is common in infants during winter. Caused typically by RSV. Typical symptoms are wheezing and dyspnea that resolve without treatment

Answer 42

Acute bronchiolitis

Question 43

Common in Japan. Cough with purulent sputum, sinusitis, dyspnea

Answer 43

Diffuse panbronchiolitis

Question 44

Seen with connective tissue disease. Azithromycin increases FEV1

Answer 44

Bronchiolitis obliterans

Question 45

Abnormal dilation of the bronchi resulting from inflammation and permanent destructive changes in the elastic and muscular layers of the bronchial walls. Frequent in middle aged to older

Answer 45

Bronchiectasis

Question 46

Is Bronchiectasis localized or diffuse?

Answer 46

both

Question 47

S/S of bronchiectasis

Answer 47

chronic cough, FOUL SMELLING SPUTUM, SOB, abnormal chest sounds, fatigue Can see blood streaked sputum or clubbing

Question 48

What is the classic finding of bronchiectasis on radiograph?

Answer 48

tram tracks (parallel lines in peripheral lung fields)_

Question 49

How should you treat bronchiectasis?

Answer 49

``` Treat underlying problem Bacteria: broad spectrum ABX Allergic: corticosteroids Bronchodilators for symptoms Hemoptysis: angiography with embolization ```

Question 50

An autosomal recessive disorder that affects lungs, pancreas, reproductive organs

Answer 50

Cystic Fibrosis

Question 51

What is the most common lethal genetic disorder in white population?

Answer 51

Cystic Fibrosis

Question 52

What is the mutation in for CF?

Answer 52

gene that encodes for CFTR

Question 53

What are the common symptoms of CF in infants?

Answer 53

Meconium ileus or FTT with steatorrhea | Salty tasting skin

Question 54

Symptoms of CF

Answer 54

chronic cough with thick sputum, wheezing, dyspnea, pancreatic insufficiency, diabetes, azoospermia, nasal polyps, clubbing

Question 55

What does PFT show with CF?

Answer 55

hyperinflation, bronchial wall thickening, bronchiectasis

Question 56

How do you diagnose CF?

Answer 56

sweat test and genotyping

Question 57

What is the treatment of CF?

Answer 57

aggressive airway hygiene, nutritional support, ABX, bronchodilators, inhaled hypertonic saline, TOBI, anti-inflammatory agents

Question 58

Characterized by airway inflammation, hyper-reactivity, reversible airflow obstruction

Answer 58

Asthma

Question 59

What is the asthma triad?

Answer 59

wheezing, chronic episodic dyspnea, chronic cough

Question 60

What is included in the evaluation of asthma?

Answer 60

Bronchoprovocation challenge Blood tests that may reveal eosinophilia and increased IgE levels Documentation of hyperactivity and reversible airway obstruction to flow