Clinical Obstructive Lung Disease: COPD/Asthma/CF

Question 1

What are two major causes of obstructive airway disease?

Answer 1

Intrinsic airway narrowing (bronchospasm, edema, inflammation, or plugging) and “floppy” airways (decreased radial tethering)

Question 2

Airway resistance is inversely proportional to the __________.

Answer 2

fourth power of the radius of the airway

Question 3

Hyperinflation (as found in obstructive lung disease) increases __________ and decreases ___________.

Answer 3

FRC and RV; IRV and TV

Question 4

A flat diaphragm generates ____________ than a curved diaphragm.

Answer 4

less pressure at the same level of muscle tension

Question 5

In basic terms, asthma is _____________.

Answer 5

a chronic inflammatory disorder of the airways

Question 6

Differentiate extrinsic and intrinsic asthma.

Answer 6

Extrinsic asthma is IgE-mediated and caused by allergens, while intrinsic asthma is non-allergic and caused by epithelial injury or altered arachidonic acid metabolites.

Question 7

Asthma can be aggravated by ______ air.

Answer 7

cold

Question 8

Which kind of wheezing comes first, in an asthma attack?

Answer 8

Expiratory

Question 9

Stridor is __________.

Answer 9

inspiratory wheezing

Question 10

There are four grades of asthma severity. What are they?

Answer 10

(1) Intermittent
(2) Mild persistent
(3) Moderate persistent
(4) Severe persistent

Question 11

Vocal cord dysfunction is not an _________ process. As such, it is treated with _________.

Answer 11

inflammatory; speech therapy, botox, and anxiolytics

Question 12

COPD is defined as FEV/FVC

Answer 12

70%

Question 13

After 50 years of smoking, what percentage of people will have COPD?

Answer 13

20%

Question 14

Chronic bronchitis is defined as ______________.

Answer 14

a productive cough of at least three months’ duration over the past two years without other cause

Question 15

In emphysema, compliance increases because ________ decreases.

Answer 15

elastic tissue (which is the cause of alpha-1 anti-trypsin deficiency)

Question 16

On physical exam, those with chronic bronchitis will often have ________.

Answer 16

cough, rhonchi, and wheezing

Question 17

On physical exam, those with emphysema will often have _________.

Answer 17

decreased breath sounds on auscultation and hyper-resonance on percussion

Question 18

Those with emphysema and chronic bronchitis will often have ________ on physical exam.

Answer 18

tripodding, prolonged expiratory phase, and purse-lip breathing

Question 19

Exacerbations of COPD are treated with ___________.

Answer 19

steroids, antibiotics, and bronchodilators

Question 20

Unlike asthma, chronic bronchitis has minimal ___________.

Answer 20

reversibility

Question 21

Resistance = _____________

Answer 21

(8 x n x l) / (pi x r^4)

Question 22

Those with extreme asthma exacerbations can have ___________.

Answer 22

epithelial desquamation, mucous plugging, smooth-muscle hypertrophy, and inflammatory cell infiltration

Question 23

What is the clinical criteria for intermittent asthma?

Question 24

What is the clinical criteria for mild persistent asthma?

Answer 24

> 2x per week - 2 nightly attacks per month

Question 25

Moderate persistent asthma is characterized by __________.

Answer 25

daily symptoms with greater than one nightly attack per month

Question 26

Severe persistent asthma is characterized by ___________.

Answer 26

constant limitations of daily activity with frequent nightly symptoms

Question 27

"Blue bloaters" were historically called _________ and are characterized by ________ breathing.

Answer 27

chronic bronchitis; hypoventilatory

Question 28

"Pink puffers" were historically called ____________ and are characterized by __________ breathing.

Answer 28

emphysema; hyperventilatory

Question 29

Histologically, chronic bronchitis typically displays __________.

Answer 29

expanded cartilage layer

Question 30

Give the GOLD criteria.

Answer 30

All COPD patients have FEV/FVC 80% 2) 50% - 80% 3) 30% - 50% 4)

Question 31

What are five common mechanisms of death for those with COPD?

Answer 31

- Pulmonary embolism - RV failure - Pneumonia - Spontaneous pneumothorax - Respiratory failure

Question 32

Of the obstructive diseases, _________ has the most hyperinflation.

Answer 32

emphysema

Question 33

Bronchiectasis is ____________.

Answer 33

abnormal dilation of the proximal airways