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Master the boards: Pulmonology > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

(61 cards)

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1
Q

What is Asthma (reactive airway disease)?

A

Abnormal bronchoconstriction of the airways

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2
Q

What is the key difference between Asthma and COPD?

A

Asthma is reversible, COPD is not

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3
Q

What are common triggers of acute asthma exacerbations?

A

Allergens, infection, cold air
emotional stress, exercise, catamenial
Aspirin, BB, NSAIDs, Histamine, tobacco smoke
GERD

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4
Q

How does asthma typically present?

A

Wheezing with acute onset SOB, cough and chest tightness often with increased sputum production

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5
Q

How does Aspirin trigger asthma?

A

Blocks anti-inflammatory prostaglandins and increases pro-inflammatory leukotrienes

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6
Q

What other clinical findings are associated with asthma?

A

Symptoms worsen at night
Nasal polyps and sensitivity to aspirin
Eczema or atopic dermatitis
Increased length of expiratory phase of respiration
Increased use of accessory respiratory muscles

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7
Q

What is the best initial test to determine function in asthma?

A

Peak expiratory flow (PEF) or Arterial Blood Gas (ABG)

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8
Q

What is the most accurate test for asthma?

A

PFT: showing an obstructive patten

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9
Q

What is an obstructive PFT pattern?

A

Decreased FEV1, Decreased FVC and decreased ratio of FEV1/FVC

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10
Q

What happens to DLCO in asthma?

A

Increased

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11
Q

What change in FEV1 with albuterol is diagnostic of asthma?

A

increased FEV1>12% and 200mL with use of albuterol

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12
Q

What change in FEV1 with methacholine or histamine is diagnostic of asthma?

A

Decreased FEV1>20% with either Methacholine or histamine

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13
Q

What is the 1st step of asthma treatment?

A

Inhaled Short-acting beta agonist (SABA)
-Albuterol

or

Formoterol with low-dose inhaled corticosteroid (ICS)

as needed

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14
Q

What is the 2nd step of asthma treatment?

A

Add routine use of control agent (low-dose ICS)

Beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone and a LABA or LT modifier

LT modifers: Montelukast, Zafirlukast, Zileuton

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15
Q

What is the 3rd step of asthma treatment?

A

increase the dose of LABA/ICS

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16
Q

What is the 4th step of asthma treatment?

A

Increase ICS to maximum dose in addition to LABA + SABA

add a long-acting anti-muscarinic antagonist (LAMA)
-Umeclidinum or Tiotropium

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17
Q

What is the 5th step of asthma treatment?

A

If the patient has elevated IgE or Eosinophil count: add monoclonal Ab against Interleukin or IgE to the SABA, LABA, ICS and Montelukast

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18
Q

What is the 6th step of asthma treatment?

A

If symptoms are still not controlled an oral corticosteroid
-Prednisone

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19
Q

What are the common side effects of inhaled steroids?

A

Dysphonia (hoarseness) and Oral Candidiasis

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20
Q

What vaccines should all asthma patients receive?

A

Influenza and Pneumococcal

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21
Q

What are common adverse effects of PO Steroids?

A

osteoporosis, Cataracts
adrenal suppression/fat redistribution
Hyperlipidemia, hyperglycemia, acne, hirsutism
thinning of skin, easy bruising, striae

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22
Q

What are commonly used monoclonal antibody drugs against Interleukin?

A

Reslizumab/Mepolizumab
Benralizumab
Dupilumab

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23
Q

How do you quantify the severity of an acute asthma exacerbation?

A

Decreased Peak expiratory flow (PEF)

ABG with increased A-a gradient

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24
Q

What is the best initial treatment for an acute asthma exacerbation?

A

Oxygen + Inhaled SABA + Steroid Bolus
-Albuterol is best

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25
When do you intubate in an acute asthma exacerbation?
No response to oxygen/albuterol/steroids or if respiratory acidosis develops (increased pCO2)
26
What is COPD?
Shortness of breath due to lung destruction which leads to decreased elastic recoil of the lung
27
What is shown on PFTs in COPD?
Obstructive pattern -decreased FEV1 and FVC -Decreased FEV1/FVC ratio
28
What is the most common cause of COPD?
Tobacco smoking: leads to destruction of elastin fibers
29
What is the most likely cause of COPD in a young patient who does not smoke?
Alpha-1 antitrypsin deficiency
30
What are common symptoms of COPD?
SOB worse with exertion Intermittent exacerbations of cough, sputum and SOB -often triggered by infection Barrel chest: from increased air trapping Muscle wasting and Cachexia
31
What is the best initial test for COPD?
CXR: showing increased AP diameter, air trapping and flattened diaphragms
32
What is the most accurate test for COPD?
PFT showing obstructive pattern
33
What happens to the DLCO in COPD?
it is decreased in Emphysema subtype
34
What does Plethysmography show in COPD?
Increased Residual Volume
35
What can a CBC show in COPD?
Elevated Hematocrit as a response to hypoxia
36
What can an EKG show in COPD?
RA and RV Hypertrophy,A-fib and multifocal atrial tachycardia
37
What can an Echo show in COPD?
RA and RV Hypertrophy, Pulmonary Hypertension
38
What is seen on ABG during an acute COPD exacerbation?
Increased pCO2 and Hypoxia
39
What treatments for COPD improve mortality and delay progression of disease?
Smoking Cessation Oxygen Influenza and Pneumococcal vaccines
40
What treatments for COPD improve symptoms but not mortality or progression?
SABA LABA Anticholinergics Steroids Pulmonary rehabilitation Roflumilast Theophylline Lung volume reduction surgery
41
How do you treat and acute exacerbation of COPD?
Bronchodilators + Corticosteroids + Abx
42
What is the only Anticholinergic used for an acute COPD exacerbation?
Ipratropium
43
What pathogens should Abx cover in a COPD exacerbation?
S. Pneumoniae, H. Influenzae, Moraxella Catarrhalis
44
What are commonly used Abx for a COPD exacerbation?
Macrolides Cephalosporins Augementin Quinolones Doxycycline TMP-SMX
45
What macrolide Drugs are commonly used during a COPD exacerbation?
Azithromycin and Clarithromycin
46
What Cephalosporin drugs are commonly used during a COPD exacerbation?
Cefuroxime, Cefixime, Cefaclor, Ceftibuten
47
What Quinolone drugs are commonly used during a COPD exacerbation?
Levofloxacin, Moxifloxacin, Gemifloxacin
48
What is considered mild sleep apnea?
5-15 episodes per hour
49
What is considered moderate sleep apnea?
15-30 episodes per hour
50
What is considered severe sleep apnea?
>30 episodes per hour
51
What causes Obstructive Sleep Apnea (OSA)?
caused by narrowing or closure of the throat
52
What causes Central Sleep Apnea (CSA)?
caused by a change in breathing control and rhythm
53
What are common presentations of Obstructive sleep apnea (OSA)?
daytime somnolence, hx of loud snoring Headache, daytime sleepiness, Impaired memory/judgement Depression, HTN, Erectile Dysfunction, "Bull-Neck"
54
How do you treat Obstructive sleep apnea?
Weight loss Avoid Alcohol and sedatives Oral appliances to keep tongue out of the way CPAP Surgical widening of the airway if all else fails -uvulopalatopharyngoplasty
55
What is a unique feature of Central Sleep Apnea (CSA)?
lack of abdominal or thoracic movement during pauses in breathing
56
How do you treat central sleep apnea (CSA)?
CPAP
57
What diminishes the respiratory drive in Central Sleep Apnea (CSA)?
stroke, heart failure or opiates
58
What is the most accurate test to diagnose Sleep Apnea?
Polysomnography: showing >5 apnea/hypoapnea episodes per hour no daytime hypoventilation present
59
How does Obesity Hypoventilation Syndrome present?
Sleep apnea with dyspnea in the daytime and daytime hypercapnia
60
How is Obesity Hypoventilation Syndrome diagnoses?
Increased Serum Bicarbonate with normal A-a gradient on ABG PFT showing restrictive pattern
61
How do you treat Obesity Hypoventilation Syndrome?
BiPAP acutely and refer for bariatric surgery

Master the boards: Pulmonology (12 decks)

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