Obstructive Lung Disease CIS I Flashcards Preview

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Flashcards in Obstructive Lung Disease CIS I Deck (46):
1

40yo M, dyspnea, cough, wheezing last 2-3 yrs, father cirrhosis, 20py tobacco, decreased breath sounds, hyperinflation, clubbing of digits, flattened diaphragms, FEV1 36% predicted, no improvement bronchodilator

obstructive
-emphysema
-imbalance of neutrophil elastase

2

sweat testing confirms diagnosis

cystic fibrosis

3

purified protein derivative skin testing

tuberculosis

4

sputum cytology

confirmation of cancer

5

acid fast sputum stain

tuberculosis

6

alpha 1 antitrypsin deficiency

risk factor for COPD

protects lungs against neutrophil elastase

patient susceptible to smoking
-age 30s or 40s COPD

often fam Hx of cirrhosis

7

19yo M, acute resp distress, productive cough, sinusitis, meconium ileus at birth, wheezing, rhonchi, clubbing of fingers

hyperinflated lung fields

cystic fibrosis

8

cystic fibrosis

malabsorption of fat soluble vits
-ADEK

sterile males

9

non-caseating granulomas

sarcoidosis

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cystic fibrosis genetic

autosomal recessive

half siblings will be gene carriers

1/4 have disease

11

cystic fibrosis prognosis

lung disease to death 90% patients

survival 37 years median

12

lung manifestations in CF

cough, SOB, poor exercise tolerance, fatigue, sleep decline, daily productive cough

13

infection in CF

pseudomonas aeruginosa and staph aureus (MRSA)

14

malabsorption of vitamins

bulky foul smelling stools and flatulence

in CF

15

sweat glands in CF

elevation of Na and Cl

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pancreas in CF

1/3 - diabetes by age 30

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MSK in CF

decreased bone density

decreased absorption of Vit D

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Dx of CF

screening immunoreactive trypsinogen
-marker of pancreatic injury

if positive - to genetic mutation analysis

Dx confirmation - sweat testing
-pilocarpine iontophoresis

19

PFT in CF

obstructive

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CXR in CF

hyperinflation

bronchiectasis

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dornase alfa

recombinant rhDNase

breaks down DNA in mucus

thins mucus in lungs

22

ibuprofen in CF

high dose continually
-slower decline in lung function

23

55yo M, COPD, SOB, dyspnea, decrease exercise tolerance, 40py tobacco, inhaled steroids, salmeterol, tiotropium, hyperinflated lungs, flattened diaphragm

bleb - emphysema - nonfunctional area of lung

decreased FEV1/FVC

24

increased FEV1/FVC

restrictive lung diseases

25

COPD

progressive, irreversible

onset 20-30 yr after smoking

4th leading cause of mortality in US

leading cause COPD

smokers decrease 40ml/yr per year in FEV1

pregnancy - impaired lung size

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mechanics in COPD

lose elastic recoil in lungs
-dependent on elastic fibers in parenchyma and surface tension in alveolar air-liquid interface

especially in small airways - less than 2mm

increased airway resistance

27

COPD history

SOB over months to years

Hx of acute bronchitis

history of chronic cough

sputum production

wheezing, rhonchi

distant heart sounds

barrel chest

accessory muscle use

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mild COPD

FEV1/FVC < 70

AND FEV1 > 80% expected

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moderate COPD

FEV1/FVC < 70

AND 50-80% FEV1

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severe COPD

FEV1/FVC < 70

AND 30-50% FEV1

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very severe COPD

FEV1/FVC < 70

AND < 30% FEV1

or FEV1 < 50% of predicted plus chronic resp failure

32

CXR COPD

hyperinflation
flat diaphragm
increased retrosternal space
bullae

normal in mild to moderate COPD

33

emphysema

enlargement of air spaces distal to terminal broncvhioles with destruction of alveolar walls

34

centriacinar

resp bronchioles distal to terminal bronchiole
-occurs with smoking

emphysema

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panacinar

alveolar ducts, alveoli, coalescence and bullae formation

emphysema

alpha1 antitrypsin deficiency**

occurs with smoking

36

most severe COPD

combo of centriacinar and panacinar emphysema

37

chronic bronchitis

enlarged mucous glands
-cough and increased mucous production

38

45yo F Hx asthma, daily cough, increased dyspnea, wakes up 2 or 3 nights / week

medium dose inhaled steroids and albuterol PRN

RR 16, P 80, b/l expiratory wheezing

mild persistent asthma

change Tx - add long acting beta2 agonist inhaler

39

intermittent asthma

less than 2 days /week or 2 nights / month

40

mild persistent asthma

more than 2 days/week
but < 1 /day

or > 2 nights / month

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moderate persistent asthma

daily or 1 / night

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severe persistent asthma

Sx continual during day or frequent at night

43

Tx intermittent asthma

beta2 agonist PRN

44

Tx mild persistent asthma

beta2 agonist PRN

inhale corticosteroid

alternate - mast-cell stabilizer, leukotriene-receptor antagonist, theophylline

45

Tx of moderate persistant asthma

beta2 agonist PRN

low to medium dose inhaled corticosteroid

long-acting beta2 agonist

alternate - increased medium dose corticosteroids OR low-medium dosed corticosteroid and either leukotriene-receptor antagonist or theophylline

46

Tx severe persistant asthma

beta2 agonist PRN

high dose inhaled corticosteroid and long acting beta2 agonist

2mg/kg/day prednisone - not exceed 60mg/day