Clin Med: Asthma and Chronic Obstructive Pulmonary Disease

Question 1

Where does gas exchange happen?

Answer 1

Alveoli

Question 2

Asthma is

Answer 2

bronchial wall hyperresponsiveness and airway inflammation

Question 3

two types of asthma

Answer 3

extrinsic and intrinsic

Question 4

Extrinsic asthma is

Answer 4

allergic - most common
environmental vs animal allergens

Question 5

Intrinsic asthma is

Answer 5

occupational/ pollution
cold/ humidity
stress
medications: ASA or NSAIDS
Exercise

Question 6

Extrinsic Asthma pathophysiology

Answer 6

IgE mediated

Question 7

History of _______ as a child will increase risk of developing asthma

Answer 7

Seasonal allergies with rashes as a child
Eczema

Question 8

Step 1 management (intermittent)

Answer 8

SABA
ICS at beginning of infection

Question 9

Step 2 management (Mild persistent)

Answer 9

SABA
Daily low dose ICS
alternative moteleukast

Question 10

Step 2 management (mild persistent)

Answer 10

SABA
daily ICS
alternative moteleukast

Question 11

Step 3 management (Moderate persistent)

Answer 11

SABA
daily ICS/LABA (combo)
Montelukast
or daily medium dose ICS

Question 12

Step 4-5 management (severe persistent)

Answer 12

Step 4:
SABA
medium combo (ICS/LABA)
daily medium dose moteleukast
Step 5:
daily high dose ICS with LABA
daily high dose ICS with montelukast
may consider omalizumab
steroids - prednisone

Question 13

Asthma risk reduction

Answer 13

avoid triggers
allergens - allergy meds, flonase, 1st gen antihistamines, washing face and hands
Medication management
Asthma action plan

Question 14

Bronchiectasis is

Answer 14

irreversible inflamed and easily collapsible airways
affects medium sized bronchi and bronchioles
airways become wide (dilated) causing excess mucus

Question 15

Everyday asthma

Answer 15

moderate persistent asthma

Question 16

1-2 times a week but not everyday asthma

Answer 16

mild persistent asthma

Question 17

a couple times per day everyday

Answer 17

severe asthma

Question 18

Bronchiectasis presentation

Answer 18

chronic cough*
malodorous thich, mucopurulent*
pleuritic chest pain
digital clubbing
fever/chills
SOB

Question 19

Gold standard testing for Bronchiectasis

Answer 19

CT scan

Question 20

Best testing for bronchiectasis

Answer 20

bronchoscopy
assess for obstructing lesions
sputum studies are negative
can take samples

Question 21

Treatment for bronchiectasis

Answer 21

treat and control recurrent infections
treat underlying disease
SABA and combo inhalers
duonebs (albuterol/ atrovent)
surgery (severe cases)

Question 22

Bronchiectasis exacerbation treatment

Answer 22

antibiotics
fluoroquinolones: levofloxacin (pseudomonas coverage)
amoxicillin or augmentin
macrolides: azithromycin

parental:
ampicillin
vancomycin (concern for MRSA)
zosyn (pseudomonas coverage)

Question 23

Bronchiolitis is

Answer 23

inflammation of the bronchioles

Question 24

Types of bronchiolitis

Answer 24

acute - most common - pediatric pts - RSV, in adults mycoplasma
Bronchiolitis Obliterans (Constrictive) - toxic fumes - ‘popcorn lung’
Proliferative - cryptogenic (not a bacterial infection - chemical exposure, bird exposure)
Follicular - Rheumatic diseases, HIV, hypersensitivity pneumonitis

Question 25

Bronchiolitis ssx

Answer 25

upper respiratory sxs fever wheezing tachypnea shallow respirations - rhinorrhea for kids poor appetite

Question 26

Bronchiolitis workup

Answer 26

CXR nasal viral panel PFTs biopsy

Question 27

Treatment of Acute Bronchiolitis

Answer 27

supportive therapy parent education - suctioning of the nose peaks 3-5 days

Question 28

Treatment of Severe Bronchiolitis

Answer 28

supportive care respiratory support - nasal suctioning, O2 prn Trial - bronchodilator, sometimes it doesn't work glucocorticoids CPAP for risk of resp failure intubation for resp failure

Question 29

COPD consists of

Answer 29

chronic bronchitis emphysema chronic obstructive asthma

Question 30

Blue bloaters =

Answer 30

Chronic bronchitis

Question 31

Pink puffers =

Answer 31

Emphysema

Question 32

Ssx of COPD

Answer 32

cough persistent progressive dyspnea (worse with exertion) CO2 retention (chronic bronchitis) weight loss (emphysema) tachycardia HTN barrel chest (emphysema) wheezes and crackles

Question 33

Chronic bronchitis ssx

Answer 33

chronic productive cough for 3 or more months in 2 or more successive years CO2 retention more likely to be obese cyanotic, reduced respiratory drive, hypoxic

Question 34

Emphysema ssx

Answer 34

wt loss hunched over, tripoding dyspneic with prolonged expiration permanent enlargement of alveoli - impaired gas exchange

Question 35

COPD group A treatment

Answer 35

SABA or LABA

Question 36

COPD group B treatment

Answer 36

LABA or LAMA consider SABA and LABA

Question 37

COPD group C treatment

Answer 37

add LAMA

Question 38

COPD group D

Answer 38

LAMA or LAMA and LABA or ICS and LABA

Question 39

treatment and education for COPD

Answer 39

stop smoking exercise health maintenance antibiotics +/- oral steroids for exacerbation Supplemental O2

Question 40

Cystic fibrosis is a

Answer 40

mutation in the CFTR gene (CF transmembrane conductance regulator) - channel that transports chloride

Question 41

The CFTR mutation causes

Answer 41

buildup of thick mucus in organs that contain mucus membranes

Question 42

CF gold standard testing

Answer 42

Sweat chloride testing - sweat is collected and weighed/ analyzed for chloride

Question 43

Definitive dx testing for CF is

Answer 43

genetic testing

Question 44

CF treatment

Answer 44

inhaled dnase Chest physiotherapy Percussive vests exercise prevention of infections - immunization (not live) bronchodilators anti inflammatory/ bacterial prophylaxis CFTR modulators