Pulmonary Flashcards
(107 cards)
1
Q
Syndrome characterized by airflow obstruction that varies markedly
A
Asthma
2
Q
Major risk factor for asthma
A
Atopy
3
Q
80% asthmatics have?
A
Allergic rhinitis
4
Q
Genetic predisposition Atopy Airway hyperresponsiveness Gender Obesity Early viral infxns
A
Endogenous factors
5
Q
Indoor/outdoor allergens Occupational sensitizers Passive smoking Air pollution Diet Acetaminophen
A
Environmental factors
6
Q
Allergens URTI Exercise Cold air Sulfur dioxide Drugs Stress
A
Triggers
7
Q
Most common viral cause of asthma exacerbation
A
Rhinovirus
8
Q
Infxn in infancy assoc with asthma
A
Respiratory syncytial virus
9
Q
Bacterial infxn implicated in severe asthma
A
Mycoplasma & chlamydophila
10
Q
Hypothesis that lack of infxn in early childhood preserve TH2 cell at birth
A
Hygiene hypothesis
11
Q
More severe persistent asthma that has later onset, assoc with nasal polyps and may be aspirin sensitive
A
Intrinsic/ non-atopic asthma
12
Q
Most common allergen?
A
Dermatopaghoides/ dust mite
13
Q
Begins after exercise has ended, recovers spontaneously w/n 30 mins
A
Exercise induced asthma
14
Q
Worse in cold, dry climates
A
Exercise induced asthma
15
Q
Common in ice/cold sports
A
Exercise induced asthma
16
Q
Exercise induced asthma is prevented by regular tx with?
A
ICS
17
Q
Asthma in obese, difficult to control
A
> 30 kg/m2
18
Q
Food additive that trigger asthma thru release of sulfur dioxide in stomach
A
Metabisulfite
19
Q
Physiologic abnormality of asthma
A
Airway hyperresposiveness
20
Q
Which Inflammatory cells are linked to development of airway hyperresponsiveness due to release of basic proteins and oxygen-deprived free radicals?
A
Eosinophil
21
Q
Anti-inflammatory cytokines, and may be deficient in asthma
A
IL-10, IL-12
22
Q
Cytokines that mediate allergic reaction
A
IL-4, 5, 9, 13
23
Q
Pro-inflammatory cytokines
A
TNF-alpha, IL-1B
24
Q
Lung function test that demonstrate reversibility of airflow limitation
A
> 12% AND 200ml increase in FEV1 15 mins after Inhaled SABA
25
Measures the increase airway hyperresponsiveness in asthma with calculation of provocative concentration that reduces FEV1 by 20%
Metacholine or histamine challenge
26
Diagnostics for asthma
Chest Xray is normal
27
Blood test are not helpful
True
28
Skin prick test
In allergic asthma
29
Non invasive test to measure eosinophilic airway inflammation
Fractional exhaled nitric oxide (FENO)
30
B2-agonist, anticholinergics, theophylline
Relievers
31
Albuterol and terbutaline
SABA
32
Salmeterol, formoterol, indacaterol, olodaterol
LABA
33
Potential problem with any agonist given chronically
Tolerance
34
Most common side effect of B2-agonist?
Muscle tremors and palpitations
35
Urinary retention in elderly, side effect of what drug?
Ipratropium
36
Ipratropium
SAMA
37
Tiotropium, glycopyrronium
LAMA
38
Most common side effect of anticholinergics?
Dry mouth
39
Most common side effect of anticholinergics in elderly
Glaucoma and urinary retentiom
40
Drug that Inhibit phosphodiesterase
Theophylline
41
Inhibited by theophylline that Switches off activated inflammatory genes, reduce steroid insensitivity
Histone deactetylase 2 (HDAC 2)
42
Increased clearance
Rifampicin, phenobarbitone, ethanol
Smoking,
BBQ
43
Decreased clearance
```
Cimetidine, erythromycin, ciprofloxacin, allopurinol, zafirlukast
CHF
Pneumonia
Viral infxn, vaccination
Old age
```
44
Type of asthma that presents with chaotic variations with near normal lung function but precipitous
Type 2 brittle asthma
45
Most effective anti-inflammatory agents in asthma
ICS
46
First line therapy for patients with persistent asthma
ICS
47
Block cys-LT1-receptors
Antileukotrienes
48
Inhibit mast cells and sensory nerve activation, blocks exercise induced asthma
Cromones, cromolyn sodium
49
Antibody that neutralized circulating IgE without binding to cell bound IgE
Omalizumab
50
Reduced blood and tissue eosinophils
Anti-IL-5
51
Impending respiratory failure
Ph 7.4, pCO2 40. PaO2 80, HCO3 35
Rising PCO2
52
What lab test to confirm poor asthma control?
Fractional exhaled nitric oxide
53
Type of asthma with persistent pattern of variability and require OCS or continuous infusion of B2 agonists
Type 1 brittle asthma
54
Tx of type 2 brittle asthma
Epinephrine
55
Drugs safe in pregnancy
SABA, ICS, Theophylline
56
OCS of choice
Prednisone
57
Irreversible airway dilation that involves the lung in a focal pr diffuse manner
Bronchiectasis
58
Most common form of brochiectasis
Cylindrical / tubular
59
Bronchiectasis in a localized area and may cause obstruction
Focal brochiectasis
60
Widespread bronchiectatic changes throughout lungs
Diffuse bronchiectasis
61
Most common lung field in cystic fibrosis and also associated with post-radiation fibrosis?
Upper lung fields
62
What lung field is associated with chronic recurrent aspiration, end-stage fibrotic lung diseases and infections?
Lower lung fields
63
What bacteria is associated with bronchiectasis in midlung fields?
Mycobacterium avium-intracellulare complex
| Dyskinetic / immotile cilia syndrome
64
Allergic bronchopulmonary aspergillosis
Tracheobrochomegaly ( mounier-kunn syndrome)
Williams-campbell syndrome
Central airways
65
Most widely cited mechanism of infections in brochiectasis?
Vicious cycle hypothesis
66
Dilated airways arising from parenchyma distortion as a result of lung fibrosis
Traction boronchiectasis
67
Most common clinical presentation of bronchiectasis?
Persistent productive cough with thick sputum
68
Dilated airways in Xray
“Tram tracks”
69
Imaging of choice for boronchiectasis
CT scan
70
Cross sectional area of airway with diameter of 1.5. What sign?
“Signet-ring sign”
71
Inspissated secretions. What sign?
“Tree in a bud”
72
Diagnostic criteria for bronchiectasis
```
2 sputum + culture
1 BAL
1 fluid sample + on culture
Biopsy
+pleural fluid
```
73
Most common organism in nontuberculous brochiectasis?
Mycobacterium avium-intracellulare
74
Prevention of brochiectasis
Smoking cessation
75
Decline rate of FEV1 among non-CF bronchiectatic patients
50-55 ml
76
Lung disease related to cigarette smoking
COPD
77
Indication of early onset COPD
Alpha 1 antitrypsin deficiency
78
Protein gene on chromosome 4 related to COPD
Hedgehog interacting protein (HHIP) gene
79
Abnormal permanent enlargement f air spaces distal to terminal bronchi with destruction of walls
Emphysema
80
Central / proximal parts
Distal alveoli are spared
Related to cigarette smoking
Most common emphysema
Centriolobular emphysema
81
Acini are uniformly enlarged in the lower lung zones
| Related to alpha 1 antitrypsin deficiency
Panacinar (panlobular) emphysema
82
Most common symptoms of COPD
Cough
Sputum
Exertional dyspnea
83
Sign of hyperinflation
Barrel chest
84
Sitting position in bronchitis
Tripod position
85
Independent poor prognostic factor in COD
Bitemporal wasting
86
Paradoxical movement of rib cage with respiration
Hoover sign
87
What test to determine Airflow obstruction with reduction in FEV1 & FEV1 / FVC ratio
Pulmonary function test
88
Hallmark of COPD
Airflow obstruction
89
Pink puffer
Emphysema
90
Blue bloater
Chronic bronchitis
91
Persistent productive cough for >3 months in 2 consecutive years
Chronic bronchitis
92
Increased size of bronchial mucus glands
| Thickness of mucus gland layer / thickness of bronchial walls
Reid index
93
Definitive test for living subjects with COPD
CT scan
94
Most important intervention in chronic bronchitis
Smoking cessation
95
Anticholinergic that may produce acute improvement in FEV1
Ipratropium bromide
96
Tx for smoking cessation
Bupropion
Varenicline
Nicotine patch
97
Acute narrowing of bronchioles due to bronchospasm
Bronchial asthma
98
Sputum cytology in asthma
Curschmann spirals
Eosinohils
Charcot-leyden crystals
99
Twisted mucus plugs
| Results from extracted mucus plugs
Curschmann spirals
100
Eosinophil membrane protein
Charcot-leyden crystals
101
Ciliated columnar cells that is sloughed off
Areola bodies
102
Triad of asthma
Cough
Wheezing
Dyspnea
103
Stimuli that can produce constant symptoms
Respiratory virus
104
GOLD
| FEV 1/ FVC <0.7, FEV >80%
GOLD STAGE I (MILD)
105
GOLD
| FEV 1/ FVC <0.7, FEV >50% but <80%
GOLD STAGE II (MODERATE)
106
GOLD
| FEV 1/ FVC <0.7, FEV >30% but <50%
GOLD STAGE III (SEVERE)
107
GOLD
| FEV 1/ FVC <0.7, FEV <30%
GOLD STAGE IV (VERY SEVERE)
