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Paige: Pulm Module! > Obstructive d/o > Flashcards

Obstructive d/o Flashcards

1
Q

What is the pathophys of asthma?

A

obstructive airflow, hyperreactivity, and inflammation

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2
Q

What causes asthma?

A

allergens, cold air, exercise, drugs, URI, etc.

often there is a trigger, often genetic predisposition

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3
Q

When do people get diagnosed with asthma?

A

Can be at any age, but most commonly before 18y

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4
Q

What is the atopic triad?

A

asthma, allergies, eczema

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5
Q

What are the common symptoms of asthma?

A

Cough, tight chest, dyspnea, use of accessory muscles

wheezing

pulsus paradoxus

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6
Q

How will you diagnose asthma?

A

decreased FEV1/FVC ratio

Reversible (10% increase after bronchodilators like B agonists)

Can be induced by Ach agonists like methyl choline

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7
Q

What will ABG show in asthma?

A

respiratory alkalosis

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8
Q

Suppore you suspect asthma, but PFTs are normal every time the pt sees you. What test can you give to induce sx?

A

Methacholine challenge

Give methacholine, and see if FEV1 decreases by 20% or more.

if it doesn’t, it’s unlikely asthma

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9
Q

What is Stage 1 asthma?

A

attacks:

< 2 times / wk during day

< 2 times / mo during night

FEV1 is 80%

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10
Q

What is stage 2 asthma?

A

attacks:

< 1 times / day during day

< 1 times / wk during night

FEV1 is 80%

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11
Q

What is stage 3 asthma?

A

attacks:

> 1 times / d during day

> 1 times / wk during night

FEV1 is 60-80%

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12
Q

What is stage 4 asthma?

A

attacks:

> 1 times / d during day

Frequent during night

FEV1 is < 60%

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13
Q

How do you best assess severity of asthma?

A

Peak Expiratory Flow Rate (PEFR)

Best for baseline and monitoring

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14
Q

How do you treat asthma?

a) Intermittent (1)
b) Mild persistant (2)
c) Moderate Persistant (3)
d) Severe persistant (4)

A

a) short acting beta agonist
b) short acting beta agonist + inhaled corticosteroid
c) short acting beta agonist + inhaled corticosteroids + long acting beta agonist
d) short acting beta agonist + HD inhaled corticosteroid + long acting beta agonist

consider PO steroids

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15
Q

How do you treat exercise induced asthma?

A

stabilizers (cromolyn, nedocromyl)

albuterol [ventolin hfa] 5 min before exercise

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16
Q

(just to reiterate)

How do you treat asthma attack?

How do you treat asthma long term?

A

attack: DOC is SABA, MC albuterol

  • also anticholinergics, MC ipratroprium, but less effective

long term: DOC is inhaled corticosteroids, MC fluticasone

  • also LABA, esp for night sx, MC salmeterol or formoterol
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17
Q

For asthma, what is an alternative to ICS in mild persistant asthma?

A

leukotriene receptor antagonists and inhibitors like zafirlukast

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18
Q

What drug is given to patients with uncontrolled asthma in adjunct to ICS?

A

long acting inhaled anticholinergic like tiotroprium

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19
Q

What is DOC for severe persistant asthma that is triggered by allergies?

A

Omalizumab (anti-igE drug)

20
Q

At what level of asthma should you consider hospitalization?

A

Moderate to severe

21
Q

What is COPD in general?

A

progressive, irreversible airway obstruction due to

a) loss of elastic recoil
b) increased airway resistance

includes emphysema and chronic bronchitis (usually coexist)

22
Q

What is emphysema (pathyphys)?

A

destroyed alveoli that are big and floppy

caused by chronic inflammation, a decrease of protective enzymes/increase of destructive enzymes, leading to alveolar destruction

usually steady decline

23
Q

What is chronic bronchitis (pathophys)?

A

airways clog with mucus

“mucociliary escalator” destroyed and patients are prone to infection

usually episodic

24
Q

What causes COPD (emphysema and chronic bronchitis)?

A

Smoking!

Also recurrent URIs, other pollutants

Rarely, alpha antitrypsin deficiency

25
Who gets COPD?
Typically age 55+ | (if \<40y consider genetic cause)
26
What are the signs and symptoms of emphysema?
**Exertional dyspnea** and hyperventilation Non-productive cough dec or absent breath sounds, dec fremitus NO peripheral edema Pt often thin with weight loss Barrel chest Tripod position with **pursed lip**
27
What are the signs and symptoms of chronic bronchitis?
Mild dyspnea **productive cough** **ronchi, crackles** and **wheezing** peripheral **edema** overweight with **cyanosis** loud, raspy breaths
28
How do you diagnose COPD? (What diagnostic factor is the same between both emphysema and chronic bronchitis?)
**Spirometry is gold standard.** DECREASED FEV1 so **decreased** FEV1/FVC ratio Non-reversible DLCO **decreased**
29
What will ABG labs look like for a) emphysema b) chronic bronchitis
a) respiratory alkalosis b) respiratory acidosis w/ inc Hct and RBC
30
Which COPD disorder has the most severe v/q mismatch?
Chronic bronchitis, w/ severe hypoxemia and hypercapnia
31
Why would you order a CXR/CT scan in COPD?
to help diagnose emphysema and to assess extent of damage
32
What will you see in CXR/CT of a) emphysema b) chronic bronchitis
**Emphysema:** hyperinflation of lungs, flat diaphragm, *droopy* heart, increasing markings **bullae or subpleural blebs** (pathognomonic) **Chronic bronchitis:** hyperinflation of lungs **without** flat diaphragms, *enlarged* R heart border, increased markings
33
How do you treat COPD?
Similar to asthma. **1. Smoking cessation** 2. Anticholinergic inhalers is **DOC** (ipratroprium; tiotropium) 3. ST bronchodilators for acute exacerbations (b2 agonist drugs like albuterol; salmeterol) Frequenty, oral abx for chronic bronchitis Other: O2, aerobic exercise, steroids (with caution), alpha1 antitrypsin replacement therapy, vaccinations
34
What is bronchiectasis?
permanent dilation of airways; destruction of bronchiole walls airways are easily collapsable & mucus clearance impaired
35
What causes bronchiectasis?
chronic bronchial injury due to infection or inflammation MC with cystic fibrosis
36
What are the signs and sx of bronchiectasis?
Foul, purulent sputum w/ chronic cough pleuritic chest pain, dyspnea **hemoptosis** recurrent pneumonia local chest **crackles** (at bases), also wheezing, rhonchi **clubbing** of fingers
37
What is the diagnostic test of choice for bronchiectasis? What will you see?
**Chest CT - dilated, tortuous airways** **"tram track"** appearance (wall thickening), plugs, consolidations Signet Ring sign (pulm artery coupled with dilated bronchus)
38
What will you see on PFT for bronchiectasis? On CXR?
PFT: obstructive pattern so dec ratio CXR: very similar to CT scan with **basal cystic spaces** (small cysts @ lung bases), atelectasis, honeycombing
39
What are the 3 most common pathogens seen in bronchiectasis?
pseudomonas (MC with CF) mycobacterium avium complex (MAC) aspergillus
40
How do you treat bronchiectasis?
Abx: amox, augmentin, Bactrim, ciprofloxacin (empiric) FQs, cephalosporins (pseudomonas coverage) Bronchodilators Chest physiotherapy If severe: lung transplant
41
What is cystic fibrosis?
increased mucus and problem with chloride transport
42
What causes CF?
autosomal recessive disease
43
Who gets CF more often?
Caucasians, northern Europeans
44
In whom should you suspect CF?
someone with a hx of chronic lung dz, pancreatitis, and infertility
45
What are the clinical manifestations of CF?
GI: **meconium ileus** at birth (failure to pass 1st stool); **foul steatorrhea** due to decreased fat absorption Pulm: **recurrent resp infections**, **prod cough**, dyspnea, chest pain, wheezing, **chronic sinusitis** Other: failure to thrive
46
How do you diagnose CF?
**Chloride sweat test** on 2 different days DNA testing for CFTR gene PFT obstructive (prob irreversible) **CXR** - **hyperinflation**, **bronchiectasis,** mucus plugging, increased interstitial markings, small/round peripheral opacities, atelectasis, blah blah blah
47
Tx of CF?
1. mucolytics (pulmozyme or dornase) 2. bronchodilators 3. chest percussion 4. abx Others: pancreatic enzyme replacement, dietary supps, lung transplant

Paige: Pulm Module! (7 decks)

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