Lecture 3/4 (Pulm)-Exam 2 Flashcards

Question

All Interstitial lung diseases can cause what?

Answer 1

All Interstitial lung diseases can cause fibrosis - scarring that causes stiffness of the lungs with progressive shortness of breath.

Answer 2

**Progressively worsening exertional dyspnea (most common complaint)** ⭐️ ⭐️ ⭐️ ⭐️ * Gas exchange is impaired due to ventilation/perfusion mismatching, R-to-L shunt, & decreased diffusion across abnormal interstitium * Work of breathing markedly increased because of decreased lung compliance

Answer 3

* Chronic nonproductive cough (second most common) * Crackles or rales heard on auscultation

Answer 4

Decreased FEV1, FVC, TLC, and residual volume. * The FEV1/FVC ratio is normal. * Thus, if ratio of FEV1/FVC is normal in a person with a decreased FVC – restrictive lung pattern – they can not breathe in as deeply as normal * In restrictive, both FEV1 and FVC are decreased, decline in FVC is more than FEV1 resulting in higher than 80% FEV1/FVC – so normal is restrictive, not obstructive. ## Footnote * FVC – amount of air that can be forcibly exhaled from your lungs after taking deep breath * TLC – maximum volume of air the lungs can hold * FEV1 – measure the progression of lung conditions such as chronic obstructive pulmonary disease or asthma, stands for forced expiratory volume, which is the air you can exhale in 1 second, low score means a breathing obstruction * FEV1/FVC represents the percentage of your lung capacity you can expel in one second. The higher the score, the larger your lung capacity and the healthier your lungs.

Answer 5

* Geared to cause, if known * Lung transplant is one viable therapeutic option * Antifibrotic therapy medications (pirfenidone) can slow decline of lung function * Physical therapy and supplemental oxygen->Can improve exercise tolerance and reduce chance of developing pulmonary hypertension

Answer 6

* Corticosteroids * In patients who cannot tolerate corticosteroids or whose symptoms progress despite steroid treatment, options such as cyclophosphamide, azathioprine can be given in addition

Answer 7

* Average age at presentation is 50-year-old, male smokers * Risk factors: Exposure to smoke, metal dust, farming dust, & hairdressing chemicals * Numerous causes – inhalation of toxins, infection, chronic inflammation – anything that damages lung tissue may lead to fibrosis * Idiopathic type is the most common interstitial lung disease (scar tissue within the lungs)

Answer 8

dyspnea, non-productive cough, unintended weight loss, fatigue, clubbing of digits

Answer 9

Genetic predisposition suspected * SFTPC, SFTPA2, TERT and TERC gene mutations * Sporadic IPF, in absence of telomerase mutations, is often associated with telomere shortening.

Answer 10

pul fibrosis

Answer 11

* **S** Silicosis, Sarcoidosis * **C** Coal miner’s pneumoconiosis – black lung * **A** Allergic alveolitis, aspergillosis * **T** Tuberculosis * **O** Other – drugs, berylliosis, eosinophilic granuloma

Answer 12

* R Rheumatoid arthritis * A Asbestosis * S Scleroderma * H Idiopathic Pulmonary Fibrosis * O Other – drugs, radiation

Answer 13

Pulmonary fibrosis causes reticular (net-like) shadowing of the lung peripheries which is typically more prominent towards the lung bases

Answer 14

* Characterized by recurrent pulmonary hemorrhage (cough) * May be life threatening * Not associated with renal disease

Answer 15

* Rate autoimmune disorder that causes immune system to attack tissues in the lungs and kidneys * Relapsing pulmonary hemorrhage, anemia, & renal failure * Adult males most affected

Answer 16

* Inflammatory granulomatous disease of unknown etiology. Immune reaction to a trigger such as an infection or chemicals, alteration to the immune response after exposure to an environment, occupational, or infectious agents * Immunological disorder that results in lots of small nodules throughout the body

Answer 17

The hallmark of the disease is non-caseating granulomas usually affecting the lungs (up to 90% of patients), however, any organ can be affected (except GI, that is rare) Complications of advanced disease: * Interstitial lung disease * Pulmonary hypertension * Venous thromboembolic disease ## Footnote Everyone with sarcoidosis will eventually have pulmonary involvement.

Answer 18

## Footnote * May occur anywhere on body * May become calcified with time * Not cancer

Answer 19

granulomas

Answer 20

* May be asymptomatic * Sarcoidosis will NOT cause hemoptysis * Exertional dyspnea * Cough – dry, non-productive * May have chest pain, arrhythmias, restrictive cardiomyopathy

Answer 21

Skin Findings in Sarcoidosis * Left side: Erythema Nodosum (painful nodules on the lower legs) * Right side: Infiltrated, hyperpigmented, & slightly erythematous coalescent papules & plaques on upper arm.

Answer 22

* Staged according to extent of lung involvement * CT scan/ultrasound guided biopsy/fine-needle aspiration of mediastinal lymph nodes

Answer 23

* High Ca2+ caused by dysreg calcium metabolism * High ACE from t cells-> corrlates with total granuloma load and can be used for monitoring txt and disease progression * **Amyloid A serum marker** ⭐️

Answer 24

* Typically reveals restrictive pattern (reduced vital/total lung capacity) * Endobronchial sarcoid may lead to impairment of airflow, obstructive pattern

Answer 25

* Most sen test for intersitial lung disease-lost of diffusion capacity of the lungs for CO2 * Measure of how well oxygen and carbon dioxide are diffused between the lungs and the blood

Answer 26

Requires both compatible clinical features and pathologic findings * Sarcoidosis remains elusive, diagnosis can not be made with 100% certainty * Diagnosis can be made with reasonable certainty based on history and physical features along with laboratory and pathologic findings

Answer 27

* Patient may undergo a biopsy revealing a noncaseating granuloma in either a pulmonary or an extrapulmonary organ * If clinical presentation is consistent with sarcoidosis and there is no alternative cause for the granulomas that is identified, then sarcoidosis is felt to be the cause.

Answer 28

* Ground glass opacification * Mosaic attenuation pattern * Thickening of the bronchovascular bundles and bronchial wall * Parenchymal nodules, cysts, cavities

Answer 29

* Chronic ~ 30% * Fatal in < 5% (pulmonary fibrosis) * Prognosis worse if extrapulmonary sarcoidosis exists * Vast majority will go into sustained remission with treatment * Major morbidity & mortality related to progressive respiratory dysfunction in association with severe ILD

Answer 30

Eye involvement (including blindness) is most common extrapulmonary complication -> so refer for routine exam exams **(chronic macular edema and persistent ocular inflammation)**

Answer 31

Multiorgan disease or disease too extensive for topical therapy * Systemic therapy recommended * Glucocorticoids (prednisone) remains drug of choice for this disease

Answer 32

* Systemic therapies are usually immunosuppressive, including glucocorticoids, cytotoxic, or biologics * Antimalarial drug hydroxychloroquine are effective for skin than pulmonary disease * Minocycline may be used for cutaneous sarcoidosis

Answer 33

* Pulmonary or extrapulmonary disease, cytotoxic agents such as methotrexate has been used with success * Biologic anti-TNF agents have been success to improve lung function such as Infliximab

Answer 34

Chronic intrapulmonary disease Detailed workplace & work history * Specific contaminants * Availability & use of protective devices * Ventilation * Do coworkers have similar complaints? * Ask about every job; short-term exposures may be significant

Answer 35

* CXR is useful in detecting and monitoring the pulmonary response to mineral dusts, certain metals and organic dusts. * Measurement in change of force expiratory volume in 1 (one) second before and after a working shift can be used to detect an acute bronchoconstrictive response

Answer 36

* Most common presenting complaint—developmentof progressive SOB, initially felt only with exertion, worsens as inflammatory process progresses. * Nonproductive, dry cough & fatigue * If ILD is from a rheumatic source, a common complaint may be pleuritic chest pain. * If pneumonia is present cough is a major complaint

Answer 37

Inflammation commonly leading to fibrosis of lungs caused by inhalation of dust in various occupations * Most common asbestos, silicosis, coal miners' pneumoconiosis

Answer 38

* Chest pain * Cough with little or no expectoration * Dyspnea * Reduced thoracic excursion * Possible cyanosis * Fatigue after slight exertion * Degree of disability depends on types of particles inhaled, as well as exposure level

Answer 39

* Range of respiratory diseases resulting from asbestos exposure * **Key diagnostic feature – “pleural plaques” – areas of hyalinized collagen seen on x-ray**

Answer 40

* Construction trades-pipefitting, boiler making * Manufacturing of safety garments, filler for plastic material & friction materials (brake & clutch linings) * Many houses / offices still contain building materials with asbestos, particularly insulation, so care must be taken when doing remodeling or reconstruction

Answer 41

* Asbestosis disease burden is directly related to intensity and duration of exposure * Usually develops at least 10 years post exposure

Answer 42

* Irregular or linear opacities that usually are first noted in the 0 lower lung fields are the chest radiographic hallmark of asbestosis. * Indistinct heart border or a “ground-glass” appearance in the lung fields may be seen.

Answer 43

* Fibrosis – 10 - 30 years * Cancer – increased risk, typically at least 15-20 years post exposure * Usually aren’t dx with asbestosis until cancer symptoms appear * Bronchogenic carcinoma is more likely than mesothelioma

Answer 44

Pleural plaques-asbestosis

Answer 45

* Gross lesion typical for pneumoconiosis, & asbestos in particular * Seen here on pleural side of diaphragmatic leaves are several tan-white pleural plaques.

Answer 46

* **Pulmonary function testing in asbestos reveals a restrictive pattern with a decrease in both lung volumes and diffusing capability** * Evidence of mild airflow obstruction

Answer 47

* **Etiology – oldest known occupational pulmonary hazard, exposure to free silica – mining, stone cutting** * **Acute silicosis can occur after any heavy exposure, no matter the brevity (ONE TIME ONLY)** * Simple silicosis results from long term exposure

Answer 48

* **Characteristic chest CT pattern “crazy paving”** * Crazy Paving is a scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines

Answer 49

Calcified lymph nodes – “eggshell” appearance and small round opacities in the upper lung fields

Answer 50

Progresses to Massive Fibrosis

Answer 51

* Longer-term, less intense exposures associated with **upper lobe fibrosis & hilar adenopathy** > 15 years after exposure * **Fibrosisis nodular & may lead to pulmonary restriction on a pulmonary function test & airflow obstruction** * Degree of exposure to silica & length of exposure determine amount of silicotic nodule formation & degree of restrictive lung disease

Answer 52

* Associate with higher-than-normal risk for TB (2- to 30- fold more often than coworkers without silicosis) & patients with chronic silicosis & positive PPD warrant anti-tuberculosis treatment * Silicosis increases risk for lung CA only about 2-fold (risk is increased when combined with exposure to tobacco smoke, diesel exhaust, or radon gas)

Answer 53

* No cure * No reversal * Aim to manage symptoms, slow progression and treat infections aggressively * May need cough suppressant, supplemental O2, bronchodilators

Answer 54

* **Spirometry** is indicated to monitor for occupational risks associated with coal mining * **Glucocorticoids** not recommended

Answer 55

* **Pneumonitis – generalized lung inflammation** * Due to foreign chemicals, molds, dusts, foreign proteins * Response to inhaled antigens that are small enough to deposit in distal airways and alveoli

Answer 56

* Fever, chills, malaise, cough, chest tightness, dyspnea, rash, headaches * Resolves in 12 hours to several days after cessation of exposure

Answer 57

* Productive cough, dyspnea, fatigue, anorexia, weight loss, pleurisy, mild hypoxemia * Lesser severity, longer duration * Resolves weeks after cessation of exposure

Answer 58

* Insidious onset cough, progressive dyspnea, fatigue, weight loss, clubbing, tachypnea, respiratory distress * Emphysematous component * May be irreversible component, even if antigen removed

Answer 59

On open **lung biopsy, granulomatous formation** like sarcoidosis may make differentiation impossible unless tissue levels of beryllium are measured * Finding evidence of a specific cell-mediated immune response (i.e., delayed hypersensitivity) to beryllium

Answer 60

* **Acute chemical pneumonitis due to toxic gases (Nitrogen Dioxide)** released from fermenting silage into atmosphere inside silo * **Farmers & grain elevator operators are at risk** * Symptoms are those of **cigarette smokers- cough, mucus production, wheezing & airway obstruction**

Answer 61

* Mainstay of treatment is antigen avoidance * Exposure history must be obtained to attempt to identify the potential offending antigen and to identify the location where a patient is exposed

Answer 62

Subacute * Role for glucocorticoid therapy – symptomatic disease, 10% decrease in lung capacity * Prednisone therapy over a duration of 1-2 weeks, followed by a taper over next 2-6 weeks Chronic * Similar trial of corticosteroids although fibrotic disease may be irreversible * With extensive fibrosis, lung transplantation may be necessary

Answer 63

* **Symptoms: Fever, cough, dyspnea following XRT to chest/breast** * Leukocytosis and elevated erythrocyte sedimentation rate (ESR) are common * Chest radiograph usually shows alveolar or nodular opacity limited to the irradiated area * PFT will show reduced lung volumes, lung compliance.

Answer 64

* ASA, cough suppression, and bed rest * Corticosteroid therapy not proven to be effective * If given, prednisone is usually used for one-week, higher doses for more critically sick followed by a taper

Answer 65

As a result of the inflammation that occurs from the initial insult * More blood clots develop * Endothelium becomes leaky Pneumonocytes get injured and die * Type I – leads to less gas exchange * Type II – less surfactant which reduces the surface tension that keeps the alveoli open

Answer 66

Dead cells and protein-rich fluid will build up and forms a hyaline membrane which makes gas exchange more difficult

Answer 67

* Causes increase risks of pneumothorax, reductions in lung compliance, and increased pulmonary dead space * Sometimes a lung biopsy is obtained for evidence of pulmonary fibrosis->Increased mortality risk if present

Answer 68

* Extensive bilateral alveolar infiltrates * Air bronchograms (arrows) * Looks similar to pulmonary edema, heart size looks normal * Pleural effusions not typical, but can occur and very common in patients with acute pancreatitis (as here)

Answer 69

Typical images of chest X-ray radiograph. The portable chest X-ray radiographs of a patient with ARDS resulted from pneumonia. * a The baseline image within 24 h of patient admission, demonstrating bilateral infiltrates. * b,c 5 and 9 days after the admission, showing the progression of the infiltration

Answer 70

* One of the most common chronic diseases globally * Affects approximately 300 million people worldwide, approximately 250,000 deaths annually. * Previously on the rise in affluent countries for the last 30 years, now has stabilized. * 10-12% of adults, 15% of children are affected.

Answer 71

* Mild at onset, usually does not progress to severe * Severe asthma usually severe at onset

Answer 72

Endogenous * Genetic predisposition = Both parents have asthma will give the child 50% chance * Atopy * Airway hyperresponsiveness * Gender * Ethnicity * Obesity * Early viral infections

Answer 73

DUST is NUMBER ONE TRIGGER * Indoor allergens dust * Outdoor allergens * Occupational sensitizers * Passive smoking * Respiratoryinfections * Air pollution * Diet * Dampness and mold exposure * Acetaminophen or ASA * Exercise * Cold Air * Toxic fumes (paint)

Answer 74

Allergic/Endogenous Asthma * In response to allergen exposure * Will usually have Hx of urticaria or eczema * Skin tests are allergen + Idiosyncratic asthma (infection) * Typically develops after a URI * Usually is worse with exercise or cold air (rarely stress)

Answer 75

Toxin related * Cocaine or Aspirin (leukotriene synthesis leads to bronchiole constriction) Cough Variant * Only presents as chronic cough

Answer 76

* Airway inflammation and airway structural changes accompanied by varying degrees of symptoms that can be influenced by exposure to triggers that can cause acute deterioration as well as chronic symptoms are believed to play fundamental role in airway hyperresponsiveness * Mast cells and eosinophils * Mucus from hypertrophied bronchial submucosal glands, bronchoconstriction, and dehydration contribute to the formation of mucus plugs that can block airways

Answer 77

* Can develop at any age * Common in childhood, many children experience a remission of asthma symptoms around puberty, with potential recurrence years later. * Adolescents and adults who present with “new” asthma symptoms may have a history of childhood asthma or asthma symptoms

Answer 78

Widespread, high-pitched, musical wheezes * Most heard on expiration; can occur during inspiration Multiple different pitches, or “polyphonic” * Differs from the monophasic wheezing of a local bronchial narrowing, aspirated foreign body or bronchogenic CA

Answer 79

* Tachypnea * Tachycardia * Prolonged expiratory phase of respirations (decreased I:E ration) * Poor air movement, “quiet” chest * Tripoding position * Use of accessory muscles * Pulsus paradoxus (greater than 12 mmHg fall in SBP during inspiration) * Hyperinflation on CXR from air trapping in alveoli

Answer 80

* Presence or absence of wheezing is a poor predictor of the severity of airflow obstruction!

Answer 81

Atopic dermatitis-asthma is associated to this

Answer 82

* Definition: classic presentation of intermittent cough, wheeze, and shortness of breath brought on by triggers and relieved by bronchodilating medications. * “Classic” signs: intermittent dyspnea, cough, and wheezing-> Always consider cough variant asthma * Can be difficult to distinguish asthma from other respiratory diseases since nonspecific and overlap

Answer 83

Definitive diagnosis requires history or presence of respiratory symptoms consistent with asthma, combined with the demonstration of variable expiratory airflow obstruction.

Answer 84

* Tests of airflow limitation are critical tools in the diagnosis of asthma

Answer 85

* Determine if baseline airflow limitation (obstruction) is present * Assess reversibility of the obstruction * Characterize the severity of airflow limitation

Answer 86

* reduced FEV1 and FVC ratio * residual volume (RV) and total lung capacity (TLC) increased during episodes of obstruction (can’t exhale)

Answer 87

Assess reversibility of the obstruction * Repeat spirometry after administration of a bronchodilator * Reduction of FEV1 to < 25% predicted or < .75 L after administration of a bronchodilator indicates severe disease Characterize the severity of airflow limitation * Based on FEV1 as a percentage of the normal predicted value

Answer 88

Bronchodilator response = ([Post-bronchodilator value – Prebronchodilator value] x 100)/Predicted value, where "value" is either FEV1 or FVC. **An increase of >10 percent is considered significant.**

Answer 89

* Inadequate inhalation of the bronchodilator due to problems using the metered-dose inhaler correctly * Recent use of a quick-acting bronchodilator or other anti-asthmatic medications (eg, long-acting bronchodilators), resulting in near-maximal bronchodilation prior to testing * Minimal airflow obstruction at the time of testing (FEV1 already close to 100 percent) * In some patients with asthma, the presence of irreversible airways obstruction due to chronic airways inflammation or scarring * Treatment with controller medications (eg, inhaled glucocorticoid or leukotriene receptor antagonist) that were not withheld prior to testing * Uncooperative patients leading to subjective test

Answer 90

Bronchoprovocation Testing

Answer 91

Asthma is one of the important causes of unexplained chronic cough; however, in the absence of bronchial hyperresponsiveness, a diagnosis other than asthma should be considered.

Answer 92

* (**Methacholine**, inhaled mannitol, exercise, or hyperventilation of dry air) * People with asthma are more sensitive (hyperresponsive) to such stimuli than those without asthma. * In addition, the percent improvement when bronchodilator is administered after bronchoconstriction may predict someone who is prone to exacerbations

Answer 93

* Spirometry performed to establish baseline * Methacholine is administered sequentially in increasing concentrations prepared in two to four-fold dilutions. * Methacholine is given via nebulization starting with the lowest (most diluted) concentration. * FEV1 gets measured at 30, then 90 seconds post aerosol inhalation.

Answer 94

* Measures a brief, forceful exhalation * Usually used to monitor patients with a known diagnosis of asthma or to assess the role of a particular occupational exposure or trigger.

Answer 95

* Daily evaluation with a peak flow meter is an important component of optimal asthma management * Warns of changes in disease states and allows for adjustments daily as needed * Changes in peak flow will occur prior to clinical symptoms

Answer 96

Blood tests cannot determine the presence or absence of asthma or gauge severity * CBC with diff to screen for eosinophilia * Eosinophil percentage >15% or counts >1500 eosinophils/microL may be due to allergic asthma

Answer 97

Hyperinflation

Answer 98

* Goal to optimize control of asthma symptoms and reduce the risk of exacerbations, while minimizing medication adverse effects. * A person with well-controlled asthma should be able to work, go to school, play, and sports without limitation due to breathing. * Avoid drying agents and stay hydrated (reduces mucus plug rates)

Answer 99

* Patient education * Control of asthma triggers * Monitoring for changes in symptoms or lung function * Pharmacologic therapy

Answer 100

Glucocorticoids (IV or PO, same time onset) * Steroids in acute asthma requires 6 hours or more to have an effect * Prednisone, Prednisolone, Triamcinolone, Methylprednisolone, Dexamethasone * Very large doses of glucocorticoids have no advantage over more conventional doses

Answer 101

Inhaled corticosteroid (ICS) * Adjunct to chronic therapy, have low yield of benefit in acute attacks * Fluticasone (Flovent HFA, Arnuity Ellipta, others) * Budesonide (Pulmicort Flexhaler) Cromolyn * Mast cell stabilizing agents, not really used in acute treatment of attack

Answer 102

Leukotrienes are chemicals that are released when in contact with something you are allergic to - the chemicals cause classic allergy symptoms including those found in asthma * LTRA’s block this pathway and lessen symptoms of asthma * Montelukast (Singulair®). * Zafirlukast (Accolate

Answer 103

If use of SABA greater than 2 days a week for symptom relief, there is evidence to step up treatment Sometimes an additional step is added between 4 and 5 which includes a daily medium to high dose ICS-LABA-LAMA + SABA * LAMA- long acting muscarinic antangonist

Answer 104

* Anticholinergic drugs are used in asthma patients to relax and enlarge the airway, which makes breathing easier. * Acetylcholine is the predominant parasympathetic neurotransmitter in the airways and plays a key role in the pathophysiology of obstructive airway diseases, such as asthma, through bronchial smooth muscle contraction and mucus secretion * Anticholinergics are used along with short-acting beta2-agonists to treat severe asthma attacks or status asthmaticu

Answer 105

Under slide: * Blue bloater- hypoxic, cardiac sequalae, cor-pulmonale ->Cor pulmonale This occurs when low oxygen levels due to COPD cause a rise in blood pressure in the arteries of the lungs, a condition known as pulmonary hypertension. This increase in pressure places excess strain on the heart’s right ventricle as it works to pump blood through the lungs. As a result, the heart muscle weakens and right-sided heart failure can occur. * Pink puffer- short shallow breath- redness of cheeks

Answer 106

Representative spirograms (upper panel) and expiratory flow- volume curves (lower panel) for normal (A), obstructive (B), and restrictive (C) patterns.

Answer 107

* The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a common, preventable, and treatable disease state characterized by persistent respiratory symptoms and airflow limitation due to airway and alveolar abnormalities usually caused by significant exposure to noxious particles or gases. * Umbrella term for chronic bronchitis and emphysema * Airflow limitation that is not fully reversible (<12% improvement after bronchodilator therapy) ## Footnote * COPD is a major cause of chronic morbidity and is the third leading cause of death worldwide and fourth leading cause of death in US. * Estimated to be present in 10% of adults over age 40

Answer 108

* Permanent & destructive enlargement of airspaces distal to terminal bronchioles without obvious fibrosis * Gradual destruction of alveolar septae & pulmonary capillary bed, leading to decreased ability to oxygenate blood (dead space)

Answer 109

**Spirometry GOLD STANDARD for diagnosis and assessment of severity** * a post-bronchodilator FEV1/FVC <0.70 confirms the presence of persistent airflow limitation (poor reversibility with bronchodilators) * Hemoptysis of unknown origin is a disqualifier for performing test

Answer 110

All smokers & former smokers 35 years of age or older * Anyone of any age with 1 or more of the “cardinal” symptoms of COPD * Chronic cough * Excess sputum production * Dyspnea on mild exertion out of proportion to age * Wheeze

Answer 111

Normal FEV1 essentially excludes COPD * Annual loss of FEV1 may range from 50-100ml per year in COPD patients

Answer 112

Alpha-1 antitrypsin deficiency (AATD) screening (is an inherited disorder that may cause lung disease and liver disease) * WHO recommends that all patients with dx of COPD should be screened, especially in areas with high AATD prevalence * Typically done in patients with COPD <45 years old, no exposures, family history of COPD, unexplained liver disease

Answer 113

* Is usually normal early * Hyperinflation: flattened diaphragm and an increase in the volume of retrosternal airspace - “Tombstones” * Hyperlucency of the lungs * Rapid tapering of vascular markings * Enlargement of central pulmonary arteries in advanced disease with PAH * Respiratory infections are primary causes pf COPD exacerbations

Answer 114

Tombstones-emphysema * Lungs are more radiolucent due to increased * Air trapping

Answer 115

Bullae with Spontaneous Pneumothorax- Emphysema * Can develop large bullae leading to pneumothorax | lose elastic tissue so cannot keep alevloi open

Answer 116

Bullous emphysema occurs when there's damage to your alveolar walls, which stretch to form large pockets of air (bullae). These air pockets can measure larger than 1 centimeter (cm). Bullae affect how your lungs work. They make it more difficult for your alveoli to exchange oxygen and carbon dioxide

Answer 117

* Not routinely used for dx; used to detect bronchiectasis (bron-chi-ec-ta-sis) or screening lung CA in patients that meet criteria * Emphysema: tissue loss, blebs * Bronchitis: airway narrowing and wall thickening * Enlargement of central pulmonary arteries in advanced disease

Answer 118

* P waves >3mm indicate cor pulmonale * Multifocal atrial tachycardia (different shapes of waves) seen in COPD

Answer 119

* estimate of pulmonary artery pressure

Answer 120

Oxygen (only when indicated!) – Goal is 88-92% * Hypoxia is a respiratory stimulus and hence you cannot just give O2 like to a non-COPD patient * **Oxygen has the greatest impact on survival**

Answer 121

* Assessment of either dyspnea using mMRC or symptoms using CAT

Answer 122

Assessment of either dyspnea using mMRC or symptoms using CAT

Answer 123

* Group A: Minimally symptomatic, low risk of future exacerbations: mMRC grade 0 to 1 or CAT score <10; 0 to 1 exacerbation per year and no prior hospitalization for exacerbation * Group B: More symptomatic, low risk of future exacerbations: mMRC grade ≥2 or CAT score ≥10; 0 to 1 exacerbation per year and no prior hospitalization for exacerbation

Answer 124

* Group C: Minimally symptomatic, high risk of future exacerbations: mMRC grade 0 to 1 or CAT score <10; ≥2 exacerbations per year or ≥1 hospitalization for exacerbation * Group D: More symptomatic, high risk of future exacerbations: mMRC grade ≥2 or CAT score ≥10; ≥2 exacerbations per year or ≥1 hospitalization for exacerbation

Answer 125

* SAMA (short-acting muscarinic antagonist)(anticholinergic) * SABA (Short-acting beta agonist) * Ipratroprium/Albuterol * LAMA * LABA

Answer 126

## Footnote * Spacer helps medicine move past your mouth and throat and get deep into the lungs * Extends amount of time it takes for the medicine to enter the lungs.

Answer 127

Decrease risk of infections and subsequent COPD exacerbations * Annual Flu * 23-valent pneumococcal polysaccharide vaccine PPSV-23 * Once before 65/once after * COVID

Answer 128

* Lung volume reduction surgery in patients with upper lobe emphysema * Bronchoscopic lung reduction in select patients with advanced emphysema * Surgical bullectomy in select patients with large bulla * Severe COPD with other criteria, consider transplant

Answer 129

* Pulmonary rehab * Long term non-invasive ventilation for severe chronic hypercapnia and history of hospitalization for acute respiratory failure * Nutrition * Palliative care

Answer 130

* Empiric antibiotic therapy is indicated for patients who are most likely to have a bacterial infection causing the exacerbation and for those who are most ill. * Empiric antibiotic treatment in patients with a moderate to severe COPD exacerbation (defined as having ≥2 of 3 cardinal symptoms: increased dyspnea, increased sputum volume/viscosity, or increased sputum purulence) or a COPD exacerbation requiring hospitalization and/or ventilatory support (either invasive or noninvasive).

Answer 131

* Bronchiectasis is a clinical syndrome characterized by abnormal dilation and distortion of the bronchial tree, resulting in chronic obstructive lung disease with clinical manifestations of chronic cough, sputum production, and recurrent chest infections. * This syndrome is typically the result of a variety of pathophysiologic processes that cause the bronchi to have weak, distorted, and easily collapsible walls, with chronic inflammation, infection, and impaired mucociliary function and mucus plugging. ## Footnote Under slide * A condition in which the lungs' airways become damaged, making it hard to clear mucus. * Bronchiectasis may result from an infection or medical condition, such as pneumonia or cystic fibrosis. Mucus builds up and breeds bacteria, causing frequent infections. * Symptoms include a daily cough that occurs over months or years and daily production of large amounts of phlegm. * Treatment may include physical therapy and medications, such as antibiotics and drugs to help loosen mucus.

Answer 132

* infectious insult * Impaired drainage, airway obstruction, or a defect in host defense

Answer 133

* Treating exacerbations * Controlling chronic infection * Reducing inflammation * Improving bronchial hygiene * Sometimes surgery

Answer 134

* Patients have high burden of bacterial pathogens and inflammation, and exacerbations are associated with increase or change to the bacterial population. * Exacerbation determined based on symptoms rather than lab

Answer 135

* Cough mn * Sputum volume and/or consistency * Sputum purulence * Breathlessness and/or exercise intolerance * Fatigue and/or malaise * Hemoptysis

Answer 136

* Focal or diffuse crackles * Sonorous wheezes/rhonchi * Mid-inspiratory squeaks * Sibilant wheezes

Lecture 3/4 (Pulm)-Exam 2 Flashcards

(250 cards)