Obstructive Lung Disease CIS I

Question 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

Answer 1

obstructive

• emphysema
• imbalance of neutrophil elastase

Question 2

sweat testing confirms diagnosis

Answer 2

cystic fibrosis

Question 3

purified protein derivative skin testing

Answer 3

tuberculosis

Question 4

sputum cytology

Answer 4

confirmation of cancer

Question 5

acid fast sputum stain

Answer 5

tuberculosis

Question 6

alpha 1 antitrypsin deficiency

Answer 6

risk factor for COPD

protects lungs against neutrophil elastase

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

often fam Hx of cirrhosis

Question 7

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

Answer 7

hyperinflated lung fields

cystic fibrosis

Question 8

cystic fibrosis

Answer 8

malabsorption of fat soluble vits
-ADEK

sterile males

Question 9

non-caseating granulomas

Answer 9

sarcoidosis

Question 10

cystic fibrosis genetic

Answer 10

autosomal recessive

half siblings will be gene carriers

1/4 have disease

Question 11

cystic fibrosis prognosis

Answer 11

lung disease to death 90% patients

survival 37 years median

Question 12

lung manifestations in CF

Answer 12

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

Question 13

infection in CF

Answer 13

pseudomonas aeruginosa and staph aureus (MRSA)

Question 14

malabsorption of vitamins

Answer 14

bulky foul smelling stools and flatulence

in CF

Question 15

sweat glands in CF

Answer 15

elevation of Na and Cl

Question 16

pancreas in CF

Answer 16

1/3 - diabetes by age 30

Question 17

MSK in CF

Answer 17

decreased bone density

decreased absorption of Vit D

Question 18

Dx of CF

Answer 18

screening immunoreactive trypsinogen
-marker of pancreatic injury

if positive - to genetic mutation analysis

Dx confirmation - sweat testing
-pilocarpine iontophoresis

Question 19

PFT in CF

Answer 19

obstructive

Question 20

CXR in CF

Answer 20

hyperinflation

bronchiectasis

Question 21

dornase alfa

Answer 21

recombinant rhDNase

breaks down DNA in mucus

thins mucus in lungs

Question 22

ibuprofen in CF

Answer 22

high dose continually

-slower decline in lung function

Question 23

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

Answer 23

bleb - emphysema - nonfunctional area of lung

decreased FEV1/FVC

Question 24

increased FEV1/FVC

Answer 24

restrictive lung diseases

Question 25

COPD

Answer 25

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

Question 26

mechanics in COPD

Answer 26

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

Question 27

COPD history

Answer 27

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

Question 28

mild COPD

Answer 28

FEV1/FVC < 70 AND FEV1 > 80% expected

Question 29

moderate COPD

Answer 29

FEV1/FVC < 70 AND 50-80% FEV1

Question 30

severe COPD

Answer 30

FEV1/FVC < 70 AND 30-50% FEV1

Question 31

very severe COPD

Answer 31

FEV1/FVC < 70 AND < 30% FEV1 or FEV1 < 50% of predicted plus chronic resp failure

Question 32

CXR COPD

Answer 32

hyperinflation flat diaphragm increased retrosternal space bullae normal in mild to moderate COPD

Question 33

emphysema

Answer 33

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

Question 34

centriacinar

Answer 34

resp bronchioles distal to terminal bronchiole -occurs with smoking emphysema

Question 35

panacinar

Answer 35

alveolar ducts, alveoli, coalescence and bullae formation emphysema alpha1 antitrypsin deficiency** occurs with smoking

Question 36

most severe COPD

Answer 36

combo of centriacinar and panacinar emphysema

Question 37

chronic bronchitis

Answer 37

enlarged mucous glands | -cough and increased mucous production

Question 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

Answer 38

mild persistent asthma change Tx - add long acting beta2 agonist inhaler

Question 39

intermittent asthma

Answer 39

less than 2 days /week or 2 nights / month

Question 40

mild persistent asthma

Answer 40

more than 2 days/week but < 1 /day or > 2 nights / month

Question 41

moderate persistent asthma

Answer 41

daily or 1 / night

Question 42

severe persistent asthma

Answer 42

Sx continual during day or frequent at night

Question 43

Tx intermittent asthma

Answer 43

beta2 agonist PRN

Question 44

Tx mild persistent asthma

Answer 44

beta2 agonist PRN inhale corticosteroid alternate - mast-cell stabilizer, leukotriene-receptor antagonist, theophylline

Question 45

Tx of moderate persistant asthma

Answer 45

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

Question 46

Tx severe persistant asthma

Answer 46

beta2 agonist PRN high dose inhaled corticosteroid and long acting beta2 agonist 2mg/kg/day prednisone - not exceed 60mg/day