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Clin Med, Path, Pharm > test 7 > Flashcards

test 7 Flashcards

1
Q

Obstructive Lung Disease definition

A

Conditions that make it hard to exhale all the air in the lungs

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2
Q

Types of obstructive lung disease

A

Asthma, COPD (emphysema, chronic bronchitis), bronchiectasis, cystic fibrosis

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3
Q

4th leading cause of death in US

A

COPD

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4
Q

COPD triad

A

chronic bronchitis, emphysema, asthma

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5
Q

Chronic inflammation and thickening of the walls of the bronchial tubes with excess mucus

A

Chronic bronchitis

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6
Q

Abnormal, permanent enlargement of the alveoli, accompanied by destruction of their walls and without obvious fibrosis

A

Emphysema

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7
Q

What are the three main issues with COPD?

A

airway inflammation
mucociliary dysfunction
consequent airway structural changes

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8
Q

Causes of COPD other than smoking

A

environmental factors, airway hyperresponsiveness, alpha 1-antitrypsin deficiency, IVDU, HIV, GERD

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9
Q

alpha 1 antitrypsin function

A

made in liver, protects lung parenchyma from elastolytic breakdown. Deficiency causes COPD

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10
Q

Most common non-infectious pulmonary dz among HIV pts

A

COPD

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11
Q

Presence of _____ in 28% of COPD pts and increases risk of hospitalization.

A

GERD

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12
Q

Most common variable to grade severity of COPD

A

FEV1

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13
Q

What is the best single predictor of airflow obstruction?

A

Hx of >40 pack years smoking

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14
Q

COPD presentation (4)

A

DOE
Productive cough (worse in am)
Acute chest illness
Wheezing

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15
Q

What is Hoover sign?

A

Accessory muscle use

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16
Q

COPD PE: Breath sounds

A

Wheezing
Diffusely decreased breath sounds
Prolonged expiration
Coarse crackles on inspiration

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17
Q

COPD PE: Inspection, percussion

A

Hyperinflation (barrel chest)
Hyperresonant on percussion
Peripheral edema

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18
Q

Blue Bloater

A

Chronic bronchitis

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19
Q

Pink Puffer

A

Emphysema

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20
Q

Chronic bronchitis vs. emphysema PE

A

Chronic bronchitis: obese, frequent cough, R sided heart failure
Emphysema: thin w/ barrel chest, no cough, heart sounds distant

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21
Q

COPD lab findings

A

FEV1/FVC <70%
DLCO (decreased lung carbon monoxide diffusing capacity)
Increased pCO2 and HCT
Decreased pH

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22
Q

Why hematocrit is high in COPD

A

Normal amounts of oxygen can’t reach blood stream, so body adjusts by making more RBCs

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23
Q

COPD Xray findings

A

Low, flattened diaphragm
Hyperinflation
Increased AP retrosternal airspace
Narrow cardiac silhouette

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24
Q

Airflow limitation

A

Inflammation –> small airway dz and parenchymal destruction –> airflow limitation

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25
GOLD criteria for COPD
Symptoms (from mMRC or CAT), airflow obstruction (FEV1), and exacerbation hx
26
low risk with more symptoms is what category?
B
27
High risk with less symptoms is what category?
C
28
High risk with more symptoms is what category?
D
29
What is a SAMA?
short acting anticholinergic
30
Ipratrapium
SAMA
31
Atrovent
SAMA
32
Serious reactions: bronchospasm, anaphylaxis, hypokalemia
SABA + SAMA
33
Serious reactions: a-fib, hypokalemia
SABA
34
Albuterol, ventolin, proventil
SABA
35
relaxes bronchial smooth muscle and inhibits release of immediate hypersensitivity mediators from mast cells
SABA and LABA
36
Reduces need for rescue medication. 21% reduction in exacerbations.
LABA
37
Salmeterol, formoterol, serevent, foradil
LABA
38
Serious rxn: bowel obstruction, bronchospasm, glaucoma
LAMA, SAMA
39
Tiotropium
LAMA
40
Spiriva
LAMA
41
Preferred once a day agent for COPD
LAMA
42
Preg. Cat for SAMA and LAMA
SAMA: B LAMA: C
43
Adverse effects: pharyngitis, diarrhea, extremity pain
LAMA + LABA
44
Serious Rxn: asthma related death, anaphylaxis, HTN, hypokalemia, prolonged QT
LAMA + LABA
45
Umeclidium/vilanterol
LAMA + LABA
46
Anoro Ellipta
LAMA + LABA
47
Wait at least a minute before using another inhaler
LAMA + LABA
48
Serious rxns: hypokalemia, glaucoma, cataracts, death
ICS + LABA
49
Formoterol/budesonide Salmeterol/fluticasone Formoterol/mometasone
ICS + LABA
50
Symbicort, Advair, Dulera
ICS + LABA
51
Thought to reduce neutrophil and eosinophil counts in the lungs
PDE4i
52
Adverse effects: decrease in weight, GI upset, influenza, backache, dizziness, HA, insomnia
PDE4i
53
Serious rxn: suicidal thoughts
PDE4i
54
Roflumilsat
PDE4i
55
Daliresp
PDE4i
56
Not generally recommended for COPD
Theophylline
57
Serious rxn: a-fib, SJS, seizures
theophylline
58
Complications of COPD
``` Resp. infx Pulmonary HTN Increased risk of heart disease and GERD Lung cancer Depression (40% are severely affected) ```
59
What's added to convention COPD therapy to reduce frequency of common cold, which can trigger COPD exacerbations?
PPIs
60
Define chronically hypoxic
Resting O2 <90% w/ pulm htn or R heart failure
61
Vaccines for COPD pts
Pneumococcal >65 | Influenza in all COPD pts
62
Chronic COPD infxn colonization
S. pneumoniae H. influenza M. Catarrhalis
63
Severe COPD infx colonization
P. aeruginosa
64
"relievers"
SABA, anticholinergics
65
"controllers"
LABA
66
"Preventers"
ICS, LTRAs
67
Abnormal, permanent dilation/destruction of bronchi walls
Bronchiectasis
68
Important cause of lung dz in developing countries and was a common fatal condition before abx
Bronchiectasis
69
"Lady Windermere" syndrome
bronchiectasis
70
Bronchiectasis most common demographic
female, white, slender, >60 | Vit. D deficiency is common (vit D deficient with bronchiectasis means P. aeruginosa likely)
71
Causes of bronchiectasis
acquired more common: infection, airway obstruction, impaired drainage, toxic gas exposure, CF Congenital
72
Bronchiectasis: Affected bronchi show 4 things
transmural inflammation mucosal edema craters ulcers
73
Culprits of bronchiectasis infection
``` S. pneumonia S. aureus H. influenza M. tuberculosis P. aeruginosa M. avium M. catarrhalis RSV ```
74
GERD or aspiration pneumonia are what etiology of bronchiectasis?
airway obstruction
75
CF, Primary ciliary dyskinesia, and allergic bronchopulmonary aspergillosis (ABPA) are what etiology of bronchiectasis?
impaired drainage
76
Toxic gas exposure is commonly what?
chlorine, ammonia
77
Causes 1/3 of all bronchiectasis
Cystic Fibrosis
78
Causes 1/3 of bronchiectasis that is not CF
Sequela of necrotizing infxns that are not treated properly or not treated at all
79
Clinical manifestations of bronchiectasis
Dyspnea, pleuritic chest pain, wheezing, fever, weakness, weight loss
80
Bronchiectasis: PE auscultation
Crackles Rhonchi Wheezing Inspiratory squeaks
81
Bronchiectasis: PE inspection
digital clubbing cyanosis wasting weight loss
82
What confirms bronchiectasis?
high resolution CT
83
Treatment of bronchiectasis?
1. Control infection with fluoroquinolones 2. Reduce inflammation 3. Improve bronchial hygiene
84
What's used to reduce inflammation in bronchiectasis?
B2 agonists Anti-cholinergics Inhaled Corticosteroids
85
How do you improve bronchial hygiene?
Airway mucus clearance via chest percussion and postural drainage
86
What do you use to treat infx of bronchiectasis?
fluroquinolones
87
Dz of endocrine gland, mucus blocks bronchi, pancreatic ducts, and intestines
CF | aut. recessive, chromosome 7
88
Most common lethal hereditary disease in the white population
CF | median age of dx is 6-8 months, 2/3 dx by 1
89
what gene has a defect in CF?
Protein transmembrane conductance regulator (CFTR)
90
Clinical manifestations of CF
severe lung dz, pancreatic insufficiency, nasal polyposis, sinus dz, meconium ileus (obstruction), rectal prolapse, chronic diarrhea, pancreatitis, cholelithiasis, cirrhosis
91
CF PE (pulm)
rhinitis, nasal polyps, cough (worse at night), tachypnea, resp. distress, wheezes, crackles
92
CF PE (inspection, percussion)
Increased AP diameter Clubbing Cyanosis Hyperresonant chest
93
CF PE (GI)
``` Abd. distension Hepatosplenomegaly (portal htn) Rectal prolapse Dry skin (vit A deficiency) Cheilosis (vit. B deficiency) ```
94
CF PE (urogenital)
Males: undescended testicles, hydrocele, absence of vas deferens (>95% of men are sterile) Females: Severe nutritional deficiency--amenorrhea. 20% infertile
95
CF PE (other)
scoliosis, kyphosis, swelling of submandibular or parotid gland, aquagenic wrinkling of palms (AWP)
96
Effects of CF
Sinusitis, hemoptysis, pneumothroax (ruptured alveoli), pancreatic insufficiency, diabetes, cholelithiasis, weak muscles, stress incontinence, osteoporosis, infertility
97
Diagnosis of CF
positive sweat chloride test (>60 mEq/L) or positive genetic test AND 1 of the following: COPD, pancreatic insufficiency, positive family hx
98
Goals of CF treatment
maintain lung fxn, nutritional therapy, manage complications
99
What's used to control respiratory infection in CF patients?
Cipro, azithromycin, aerosolized gentamycin or tobramycin if there's resistance
100
What infections are CF patients predisposed to?
S. aureus, P. aeruginosa
101
What's used to help CF patients clear airways of mucus?
Bronchodilator before chest physiotherapy, mucolytic (dornase alfa, pulmozyme + hypertonic saline solution aerosols)
102
What nutritional therapy is given to CF patients?
Fat soluble vitamins, pancreatic enzymes, high energy, high fat diet
103
Ivacaftor (Kalydeco)
CFTR potentiator that targets defective protein in CF.
104
Repeated chest infx in young person with upper lobe bronchiectasis
Consider CF

Clin Med, Path, Pharm (12 decks)

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