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Respiratory 3 Flashcards

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1
Q

reversible airflow obstruction, different phenotypes, inflammation prominent

A

asthma

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2
Q

permanent, enlargement/destruction of the respiratory bronchioles

A

Emphysema/ COPD

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3
Q

Enlarged airways from chronic infection or abnormal cilia function–CF

A

Bronchiectasis

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4
Q

sputum production 3 months/year for 2 years

A

Chronic Bronchitis

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5
Q

In an obstructive defect, what decreases more FEV1 or FVC?

A

FEV1

ratio of FEV1/ FVC is decreased

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6
Q

What must FEV1/FVC be decreased to for an obstructive lung dz?

A

70%

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7
Q

Is COPD preventable?

A

Yes, and treatable!

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8
Q

If spirometery is FEV1 >80% what severity is COPD?

A

Mild

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9
Q

50%<80% indicates what severity of COPD

A

moderate

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10
Q

30%< ____<50% indicates what severity of COPD

A

severe

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11
Q

what is very severe COPD

A

<30% FEV1 predicted value

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12
Q

what is a rare inherited deficiency that causes emphysema due to homozygous genetic mutation.

A

alpha-1 protease inhibitor deficiency

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13
Q

what does cigarette smoking cause?

A

oxidative stress which leads to inflammation
epithelial permeability
injury

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14
Q

what does mucociliary dysfunction lead to?

A

Mucus hypersecretion
reduced mucociliary transport
mucosal damage

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15
Q

what cells increase in COPD and destroy things?

A 
CD8+ T lymphocytes
Monocytes/ macrophages
Neutrophils
Mast cells 
inflammatory mediators
proteases
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16
Q

what structural changes happen w/ COPD

A 
globlet cell hyperplasia/ metaplasia
mucous gland hypertrophy
increased smooth muscle mass
airway fibrosis
alveolar dystruction
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17
Q

what are systemic components of COPD?

A 
Poor nutritional status
Reduced BMI
impaired skeletal muscle
weakness
wasting
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18
Q

what airflow limitations are there with COPD?

A

loss of alveolar attachments
loss of elastic recoil
increased smooth muscle contraction

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19
Q

does a skinny or fat COPD patient do better?

A

Fat

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20
Q

Will the liver be palpable with COPD?

A

Yes, due to hyperinflation

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21
Q

what will the thorax sound like to percussion with COPD?

A

Hyperresonance

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22
Q

where will wheezing be heard on COPD?

A

Forced expiration

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23
Q

Where are heart sounds best heard on COPD patient?

A

over xiphoid area

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24
Q

Is an ABG helpful with COPD?

A

Doesn’t help with diagnosis or prognosis

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25
what causes polycythemia is patients with COPD?
low oxygen content
26
why may there be an elevated serum bicarbonate with COPD?
secondary to CO2 retention
27
what is a normal FEV1?
3.2-3.5 (a galloon)
28
what COPD drug may stimulate respiratory center, improve muscle function. (not used often)
Theophylline
29
what is the most important thing for COPD tx?
smoking cessation
30
apart from quitting smoking, what is the only therapy that helps reduce mortality with COPD?
oxygen therapy
31
If a pulse ox is less than what do they qualify for oxygen?
88%
32
what do all patients w/ COPD need?
influenza shot | SABA PRN
33
when do COPD patients need regular tx with one or more LABA PRN and rehab?
Moderate COPD FEV1 is b/w 50 and 80% predicted
34
when do you add inhaled glucocorticosteroids for COPD?
Severe, FEV1 is between 30-50% predicted
35
When do you add long term oxygen or consider surgical options for COPD?
FEV <50% predicted with chronic respiratory failure
36
does response to bronchodilator during spirometry challenge predict whether or not a patient will benefit from long term use?
No
37
what do anticholinergics do?
"toners" prevent the airway from closing
38
what is the onset of effect of albuterol?
1-3 minutes
39
what is the duration of action of albuterol?
4-6 hours
40
what drug inhibits acetylcholine interaction with M3 receptors- decrease smooth muscle tone
Ipratropium
41
Onset of action of ipratropium
60-90 minutes
42
AN MDI with spacer is just as effective as what?
Nebulizer
43
is ipratropium maintence therapy?
Yes
44
Duration of action of ipratropium?
4-6 hours
45
___________ more efficacious than SABA when added to ipratropium for stable COPD
LABA
46
what do LABAs do to help COPD?
Decrease airflow obstruction, dynamic hyperinflation decreased frequency and severity of symptoms improved QOL
47
What is an anticholinergic with once-daily dosing, LABA. More selectively for muscarinic sub-types than ipratropium? Onset of action 30 minutes, peak 3 hours after dose
Tiotropium
48
Anticholinergic with affinity for musacrinic receptor. Reaches steady state after 10 minutes with 1/2 life of 5-8 hours. 1 puff BID
Aclidinium (Tudorza)
49
what must you do with a COPD patient on oral corticosteroids?
2 week steroid trial with documented improvement on PFTs to justify long term use
50
is there any effect on inhaled steroids with preventing FEV1 decline?
No, but may decrease number of exacerbations
51
what do inhaled steroids have an associated with?
Hip fractures
52
what together help improve airway obstruction, decrease dyspnea, use of SABA and overall health status?
LABAs and inhaled corticosteroids
53
Is a combination therapy an issue with COPD?
No, can be beneficial
54
what is a pill that is taken once a day for patients with severe COPD (FEV1 <50%) and frequent exacerbations. Leads to increased intracellular cAMP
Phosphodiesterase-4 inhibitors
55
side effects of phosphodiesterase-4 inhibitors
Diarrhea | weight decrease
56
what can oxygen therapy help with?
Prevent pulmonary HTN improve IQ scores, general alertness Increase endurance Reverse polycythemia
57
A person who is under 65 and their FEv1 is what can get Pneumovax?
FEV1 <40%
58
Acute event characterized by worsening of the patient’s respiratory symptoms that is beyond normal day-to day variations and leads to change in medication
COPD exacerbation
59
best COPD mortality predictor?
Hospitalization last year
60
when do you give someone with COPD oxygen?
O2 Sat less than 87%
61
how long should steroids be with exacerbations of COPD
2 weeks
62
should you use abx with COPD when they have an exacerbation?
Yes
63
What should a person with COPD be given for when they have an exacerbation
Steroids PO | Antibiotics PO
64
how many Liters can nasal cannula administer?
6 L/ min (humidify at 4 L or greater)
65
per liter how much percentage oxygen increase do you get?
3-4 % increase
66
Is an abnormal dilatation of the bronchial tree | Can be either acquired or congenital
Bronchiectasis
67
what is bronchiectasis linked to?
Pertussis and measles | can occur post TB
68
how much of the medication from a MDI go into the lung?
10% (increases with a spacer)
69
what does brochiectasis cause distally?
Causes scarring & obstruction & mucus/ pus accumulation
70
what could bronchiectasis eventually lead to?
right ventricular failure/ respiratory failure
71
congentital causes of bronchiectasis
ciliary dysfunction syndromes cystic fibrosis primary hypogammaglobulinemia
72
acquired causes of bronchiectasis in children
Pneumonia TB foreign object
73
Acquired causes of bronchiectasis in adults
suppurative pneumonia TB allergic bronchopulmonary aspergillosis bronchial tumors
74
symptoms of bronchiectasis
chronic cough, purulent in the morning copious discharge fever, malaise, pleurisy hemoptysis
75
constitutional symptoms associated w/ bronchiectasis
weight loss | poor appetite
76
best imaging for bronchiectasis
High resolution CT
77
what may be needed for people with hemoptysis with bronchiectasis
Surgical resection of localized areas
78
Frequently has GI sx, failure to thrive, early respiratory infections, meconium ileus Typically develop severe bronchiectasis, upper lobe initially
Cystic fibrosis
79
men with CF usually lack a what?
Vas deferenes (infertile)

Old DOOS (21 decks)

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