Obstructive Lung Disease CIS II

Question 1

asthma components

Answer 1

1 recurrent obstruction - resolves with Tx

2 airway hyperresponsiveness

3 airway inflammation

Question 2

asthma population

Answer 2

8% adults

boys and women

15 million outpatient visits and 2 million hospitalizations

Question 3

mild asthma

Answer 3

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

Question 4

moderate asthma

Answer 4

chemokines eotaxin, RANTES, macro inflammatory protein I, IL8

lead to inflammation and smooth m constriction

Question 5

severe asthma

Answer 5

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

Question 6

airway obstruction in asthma

Answer 6

constriction of airway smooth m

thickened airway epithelium

liquids in airway

Question 7

ACh

Answer 7

M3 - smooth m constriction in asthma

Question 8

histamine

Answer 8

minor role in asthma

-mast cells

Question 9

leukotrienes and lipoxins

Answer 9

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

Question 10

nitric oxide

Answer 10

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

Question 11

asthma Hx

Answer 11

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

Question 12

pulsus paradoxus

Answer 12

10mmHg systolic difference during inspiration

in asthmatics

Question 13

ABG in asthma

Answer 13

mild hypocapnea

normalized - indicated resp failure

Question 14

asthma PFT

Answer 14

obstructive

Question 15

CBC asthma

Answer 15

eosinophilia

IgE elevation

Question 16

CXR asthma

Answer 16

hyperinflation

Question 17

EKG asthma

Answer 17

RBBB, P pulmonale, ST-T changes

Question 18

P pulmonale

Answer 18

right atrial enlargement

Question 19

omalizumab

Answer 19

monoclonal Ab for IgE

alternate Tx for hypersensitivity asthma

Question 20

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

Answer 20

bronchiectasis

Question 21

atelectasis

Answer 21

collapse of lung

Question 22

ARDS

Answer 22

acute resp distress syndrome

-white out of lung on CXR

Question 23

churg strauss syndrome

Answer 23

elevated eosinos

Question 24

bronchiectasis

Answer 24

abnormal permanent dilation of bronchi and bronchioles

due to repeated cycles of airway infection and inflammation

abnormal cilia, mucous clearance, rainage, and host defenses

Question 25

mycobacterium avium intracellulare

Answer 25

right middle lobe and lingula of lung -may lead to bronchiectasis

Question 26

etiology of bronchiectasis

Answer 26

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

Question 27

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

Answer 27

bronchiectasis

Question 28

Dx of bronchiectasis

Answer 28

high res CT -bronchi visible in peripheral 1cm of lung -internal bronchial diameter greater than diameter of accompanying bronchial artery

Question 29

CF bronchiectasis

Answer 29

upper lobe predominance

Question 30

aspiration bronchiectasis

Answer 30

lower lobes

Question 31

aspergillosis bronchiectasis

Answer 31

central bronchiectasis

Question 32

bronchiectasis PFT

Answer 32

obstruction

Question 33

electron microscopy

Answer 33

Dx of primary ciliary dyskinesia

Question 34

Tx of bronchiectasis

Answer 34

Tx of underlying conditions antimicrobials anti-inflammatory surgery for localized end stage - transplant

Question 35

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

Answer 35

resp acidosis CXR hyperinflation and flat diaphragm

Question 36

to prevent acute increase in PCO2

Answer 36

venturi mask can tightly control the O2 administration too much O2 can actually decrease resp drive

Question 37

venturi mask

Answer 37

dial to control FiO2 patient received can slowly titrate O2 level up with more control than normal mask

Question 38

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

Answer 38

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**

Question 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

Answer 39

obstructive - severe bc 30% of predicted most likely Dx - alpha1 antitrypsin deficiency

Question 40

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

Answer 40

most appropriate diagnosis | -chronic bronchitis

Question 41

chronic bronchitis

Answer 41

3 months productive cough for 2 consecutive years**

Question 42

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

Answer 42

best assess possible etiology | -serum IgE levels

Question 43

mycoplasma

Answer 43

chronic non-productive cough cold agluttinins

Question 44

reid index

Answer 44

thickness epithelium to blood vessel thickened = chronic bronchitis

Question 45

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

Answer 45

most likely diagnosis | -farmers lung

Question 46

wegeners granulomatis

Answer 46

sinusitis, lung sx, hematuria

Question 47

sarcoidosis

Answer 47

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

Question 48

acute farmers lung

Answer 48

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

Question 49

subacute farmers lung

Answer 49

chronic cough, dyspnea, anorexia, weight loss insidious onset and may occur over weeks to months

Question 50

chronic farmers lung

Answer 50

prolonged and continuous exposure irreversible lung damage possible severe dyspnea at rest with exertion