Pulmonology #1 (Obstructive Diseases) Flashcards
(51 cards)
What are two risk factors for chronic obstructive pulmonary disease (COPD)?
What two conditions does this umbrella include?
Smoking***
Alpha-1-Antitrypsin Deficiency (suspect if COPD and younger than 40 years old)
Emphysema and Chronic Bronchitis
Explain emphysema pathophysiology
-Destruction of alveoli –> enlargement of terminal airspaces
-Alveolar capillary destruction + alveolar wall destructions leads to loss of surface area so oxygen exchange cannot occur as much
-Loss of elastic recoil –> airway collapse –> difficulty getting air out (expiration) –> pursed lips, tripod positioning to push air out
In emphysema, the patient likely has retained ______ because they cannot push it out.
This leads to a _____ defect. Explain this.
Retained Co2 because they cannot push it out
V/Q Mismatch: have oxygen problem, but the body compensates by decreasing CO –> less blood –> increases RR. They can still become oxygenated and have no cyanosis.
Explain the two types of emphysema and how they differ in WHO they occur in, WHAT they affect, and WHERE they affect.
Centrilobar: MC in smokers (C for cigarettes); proximal alveoli involved because smoke can’t make it distally. Upper lobes of lungs.
Panacinar: MC in alpha-1-antitrypsin deficiency (A1 sauce in pan). Entire acinus affected. Lower lobes of lungs.
Think “CP”
Symptoms of emphysema (also explain what they look like)
-Dyspnea (initially with exertion then at rest)
-Prolonged expiration
-Pursed lip and tripod position
-Chronic cough
-Hyperinflation: decreased breath sounds, increased AP diameter (barrel chest), hyper resonance to percussion, wheezing
-Non cyanotic
-Muscle wasting (cachetic), thin
Pink Puffers = non cyanotic
What is the GOLD standard diagnostic for eymphymsea and what does it show?
Pulmonary function test (PFT):
–Obstructive pattern that is not reversible
–FEV1 Decreased
–FVC Decreased
–FEV1/FVC Decreased
–DLCO Decreased
What is seen on CXR for emphysema?
What other diagnostic can help distinguish between types of emphysema?
CXR: hyperinflation, flattened diaphragm, increased AP diameter, decreased vascular markings, bullae
CT scan can help differentiate
What occurs on a bronchodilator challenge for emphysema that helps you distinguish from asthma?
Only increases FEV1/FVC ratio MILDLY. In asthma, it gives a DRAMATIC change, so you can differentiate that way.
What is chronic bronchitis defined as? What is the MCC?
Productive cough for at least 3 months out of a year for 2 consecutive years
Smoking MCC
What is the pathophysiology of chronic bronchitis?
Explain what happens to the V/Q Mismatch here. How does this lead to RHF?
-Overproduction and hyper secretion of mucus by goblet cells in response to chronic inflammation (caused by cigarette smoke)
-Mucus gland hyperplasia, goblet cell mucus production, dysfunctional cilia –> susceptible to infection
-Poor ventilation –> difficulty getting air through inflamed bronchioles –> alveolar hypoxia (not enough oxygen to lungs)–> body compensates (decreased ventilation and increased CO) –> lots of blood sent to poorly ventilated lung –> hypercapnia and respiratory acidosis –> pulmonary vascular constriction –> pulmonary hypertension –> RHF
Symptoms of chronic bronchitis?
-Dyspnea, chronic productive cough with sputum
-Crackles (rales)
-Wheezing, rhonchi
-Cyanosis (Blue Bloaters)
-RHF Symptoms: increased JVP, peripheral edema, enlarged/tender liver
What is the gold standard diagnostic for chronic bronchitis and what does it show?
PFT
–Decreased FEV1/FVC
–Decreased FEV
–Decreased FVC
–Normal DLCO (this differentiates)
Other diagnostics for chronic bronchitis?
-CXR: pulmonary HTN, increased AP diameter)
-ECG: Cor Pulmonale (RVA, RA enlargement)
-CBC: Increased Hgb and Hct due to hypoxia
-ABG: Respiratory acidosis (cannot move Co2 out)
What are the only two treatments shown to improve mortality in COPD patients?
Smoking cessation and oxygen therapy
-Smoking cessation is the SINGLE MOST important intervention
Explain why you should exercise caution if giving oxygen to a patient with COPD?
Only get oxygen between 88-92%. The body no longer responds to high levels of Co2 because it is used to it, so it responds to oxygen instead. If you give them a LOT of oxygen, the body changes the way it breathes and it can lead to acidosis.
What two vaccines are recommended in those with COPD?
Flu and Pneumo vaccines to prevent pulmonary infections
What is the treatment for COPD? Remember there are four groups
Based on GOLD Score!
-Group A (minimally symptomatic): SABA, or SABA + SAMA
-Group B (More Symptomatic): SABA + LABA/LAMA
-Group C (High Exacerbation Risk): SABA + LAMA +/ Inhaled Glucocorticoid (Fluticasone)
-Group D (High Risk): SABA + LAMA + LABA OR SABA + LABA + inhaled glucocorticoid
Name the SABA’s
Albuterol and Levalbuterol
Name the SAMA’s and give some side effects
Ipratropium
Anticholinergic side effects (dry mouth, dry eyes, etc.)
Name the LABA’s
Salmeterol, Formoterol
Name the LAMA’s and give some side effects
Tiotropium
Anticholinergic Side effects (dry mouth, dry eyes, etc.)
An ABX is given for an acute exacerbation of chronic bronchitis. What are your options?
Macrolides (Azithromycin or Clarithromycin)
What cardiac arrhythmia is associated with COPD?
Multifocal atrial tachycardia
Cystic Fibrosis is an ______________ trait that has pathophysiology of….
Autosomal recessive
Exocrine glands become clogged up due to mutation on CFTR gene –> abnormal chloride and water transport leading to thick, viscous secretions of the lungs, sinuses, etc.
