Obstructive Lung Disease CIS II Flashcards Preview

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Flashcards in Obstructive Lung Disease CIS II Deck (50):
1

asthma components

1 recurrent obstruction - resolves with Tx

2 airway hyperresponsiveness

3 airway inflammation

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asthma population

8% adults

boys and women

15 million outpatient visits and 2 million hospitalizations

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mild asthma

edema and hyperemia of mucosa and infiltration of mucosa with mast cells, eosinos, lymphocytes

4

moderate asthma

chemokines eotaxin, RANTES, macro inflammatory protein I, IL8

lead to inflammation and smooth m constriction

5

severe asthma

hypertrophy and hyperplasia of airway glands and smooth m lead to severe airway thickening

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airway obstruction in asthma

constriction of airway smooth m

thickened airway epithelium

liquids in airway

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ACh

M3 - smooth m constriction in asthma

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histamine

minor role in asthma
-mast cells

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leukotrienes and lipoxins

lipoxygenation of arachidonic acid release from target cell membrane phospholipids during cell activation

10

nitric oxide

produced by airway epithelial cells and by inflammatory cells found asthmatic lung
-high levels found during asthma attacks

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asthma Hx

dyspnea, cough, wheezing, anxiety

exercise induced, aspirin ingestion, allergens

cough, hoarseness, inability to sleep

rapid change in temp or humidity may lead to an attack

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pulsus paradoxus

10mmHg systolic difference during inspiration

in asthmatics

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ABG in asthma

mild hypocapnea

normalized - indicated resp failure

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asthma PFT

obstructive

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CBC asthma

eosinophilia
IgE elevation

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CXR asthma

hyperinflation

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EKG asthma

RBBB, P pulmonale, ST-T changes

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P pulmonale

right atrial enlargement

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omalizumab

monoclonal Ab for IgE

alternate Tx for hypersensitivity asthma

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60yo M, cough, productive purulent sputum, dyspnea, hemoptysis, pleuritic chest pain, wheezing and rales, dilated airways

bronchiectasis

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atelectasis

collapse of lung

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ARDS

acute resp distress syndrome

-white out of lung on CXR

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churg strauss syndrome

elevated eosinos

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bronchiectasis

abnormal permanent dilation of bronchi and bronchioles

due to repeated cycles of airway infection and inflammation

abnormal cilia, mucous clearance, rainage, and host defenses

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mycobacterium avium intracellulare

right middle lobe and lingula of lung

-may lead to bronchiectasis

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etiology of bronchiectasis

1/2 CF

1/3 infection
-pertussis, TB, MAI
-CF, primary ciliary dyskinesia, alpha1 antitrypsin
-esophageal dysfunction and aspiration, COPD, aspergillosis, tumor, foreign body
-sjogrens, rheumatoid arthritis, HIV, IgG deficiency

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chronic cough, purulent sputum, hemoptysis, pleuritic chest pain, weight loss, fatigue, wheezing and crackles

bronchiectasis

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Dx of bronchiectasis

high res CT
-bronchi visible in peripheral 1cm of lung

-internal bronchial diameter greater than diameter of accompanying bronchial artery

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CF bronchiectasis

upper lobe predominance

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aspiration bronchiectasis

lower lobes

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aspergillosis bronchiectasis

central bronchiectasis

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bronchiectasis PFT

obstruction

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electron microscopy

Dx of primary ciliary dyskinesia

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Tx of bronchiectasis

Tx of underlying conditions

antimicrobials

anti-inflammatory

surgery for localized

end stage - transplant

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63yo F worsening dyspnea, Hx COPD, no fevers/chills, moderate resp distress, trouble speaking, RR 28, pulse ox 84%
-diminished breath sounds, end expiratory wheezes

ABG pH 7.3, hypoxemia, PCO2 65

no improvement on beta2 agonist and O2 Tx

resp acidosis

CXR hyperinflation and flat diaphragm

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to prevent acute increase in PCO2

venturi mask

can tightly control the O2 administration

too much O2 can actually decrease resp drive

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venturi mask

dial to control FiO2 patient received

can slowly titrate O2 level up with more control than normal mask

38

41yo carpenter, asthma, cough, wheezing, sx during work hours, FEV1 decrease with exposure to western red cedar, albuterol inhaler

occupational asthma

best way to manage
-avoid further exposure to wood dust - wear specialized respirator at work - but probably won't

so add inhaled corticosteroids**

39

35yo M dyspnea, worsening over last 8 months, SOB when not moving, 5py tobacco, quit smoking 3yr ago, no sputum fevers chills, BP 105/70, P 120, RR 28, intercostal retraction, diminished breath sounds

PFT - TLC and RV elevated, VEF1/FVC decreased

obstructive - severe bc 30% of predicted


most likely Dx - alpha1 antitrypsin deficiency

40

65yo F productive cough, 2 spoons/day, cough 3 months, chronic cough during different seasons

most appropriate diagnosis
-chronic bronchitis

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chronic bronchitis

3 months productive cough for 2 consecutive years**

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20yo F wheezing and SOB past 3 months, worse with exercise, seasonal allergies, roommate has pet cat

best assess possible etiology
-serum IgE levels

43

mycoplasma

chronic non-productive cough

cold agluttinins

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reid index

thickness epithelium to blood vessel

thickened = chronic bronchitis

45

35yo dairy farmer, chronic cough few years, mild wheezing, decreased FEV1 and FVC, CXR normal, eosinophilia, serum thermoactinomyces vulgaris in blood work

most likely diagnosis
-farmers lung

46

wegeners granulomatis

sinusitis, lung sx, hematuria

47

sarcoidosis

hilar adenopathy, non-caseating granulomas, serum ACE level elevated

48

acute farmers lung

resolves 12 hours to days
-fever chills, non-productive cough, chest tight, dyspnea, HA, malaise

acute resp failure with large inhalation

moldy hay or contaminated compost

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subacute farmers lung

chronic cough, dyspnea, anorexia, weight loss

insidious onset and may occur over weeks to months

50

chronic farmers lung

prolonged and continuous exposure

irreversible lung damage possible

severe dyspnea at rest with exertion