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29 Cards in this Set

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  • Back
presentation of CF
recurrent infections secondary to imparied cilia function and airway obstruction. chronic sinusitis, nasal poylps, lower resp infection.
pathogenesis of CF
mutant CFTR, Na absorption is increased, water absorption is increased and thick mucous becomes the problem-->predisposition for chronic infections
What is CFTR?
Cystic fibrosis transmembrane conductance regulator. This is the gene that is mutant in cystic fibrosis
physiological findings in CF
**OBSTRUCTIVE pattern**, air trapping, progressive course, decreased compliance, decreased flow rates at low lung volumes. increased dead space, decreased exercise tolerance
Is cystic fibrosis obstructive or restrictive lung disease
obstructive
clinical signs of Cystic fibrosis
chronic infection, persistent productive cough, clubbing (from hypoxia), sinus disease, chronic airway obstruction, nasal polyps
complications of CF
hemoptysis, bronchiectasis, pneumothorax, respiratory failure, cor pulmonale
What are the common pathogens seen in CF?
1) pseudomonas aeruoginosa (lower airway)
2) Staphylococcus Aureus
3) Haemophilus Influenze
4) Burkholderria Cepacia
GI problems seen in CF
Meconium ileus, recurrent distal intestinal obstrction, constipation, rectal prolapse, failure to thrive in infancy and childhood
Liver disease in CF
billiary duct obstruction-->cystic duct becomes fibrotic, billiary stasis.
Cirrhosis of the liver, Portal hypertension (end stage liver failure)
what happens to the pacrease in cystic fibrosis?
mucus plugging of pancreatic ducts. Impaired HCO3 and fluid secretion in pancrease=pancreatic damage. Impaired absorption of ADEK. chronic diarrhea. Steatorrhea=fatty stool
type 1 diabetes
diagnosis of CF
history and physical is primary
DNA analysis-CF mutations
+ sweat test, abnormal nasal transepithelial potential difference value*
Goals of treatment
Decrease clinical consequences. Direct treatment at sputum problem
pulmonary management in CF
regular visits to CF center
Airway clearance=chest PT, postural drainage, breathing exercises
mucus thinners,antibiotics, anti-inflammatory drugs, bronchodilators
nutritional needs in CF
high calorie, high protein diet. Pancreatic enzyme supplementation, Fat soluble vitamin replacement (ADEK)
epidemiology of chronic bronchitis
15 million people in US. Increased 42% since 1982. COPD is 5th leading cause of death in US
Chronic bronchitis defined
excess mucus production for at lease 3 months during at least 2 years
emphysema defined
an abnormal permanent enlargement of the air spaces accompanied by the destruction of their walls
contrast emphysema from chronic bronchitis
empysema is an air space problem, bronchitis is a mucous problem
risk factors for chronic bronchitis
smoking, infection, pollution. Main risk factor is SMOKING
pathophysiology of chronic bronchitis
OBSTRUCTIVE disease. airway resistance due to mucus, edema and bronchial narrowing. V/Q mismatch=mucous plugging, hypoxemia, airway obstruction
clinical manifestations in early stages of Chronic bronchitis
slow progressiong, minor smoking cough
late stage symptoms chronic bronchitis
hypoxemia, dyspnea on exertion--> then at rest, cyanosis, cor pulmonale, clubbing, polycythemia (elevated RBCs because of stimulation of bone marrow in hypoxia)
pink puffer
emphysema
blue bloater
chronic bronchitis
hx in chronic bronchitis
smoking, chronic cough, hyperproduction of sputum
diagnosis of Chronic bronchitis
pulmonary funtion, obstructive pattern, elevation of PCO2, decreased PO2, CBC shows elevated hematocrit, Chest x-ray, CT scan
treatment of chronic bronchitits
avoidance of respiratory irritants(tobacco primarily) smoking cessation=reduce cough and reduce sputum production
corticosteroids for COPD--short courses only
bronchodilators (B agonists=short acting and also long acting anticholinergics)
theophilline=helps with diaphram function and mucocilliary clearance, Antibiotics during exacerbation only, expectorants (not significantly helpful) cough suppressants (only short term if tired from nighttime coughing) nutritional supplementation, anti-anxiety/anti-depressants
oxygen supplementation in COPD
improves quality of life in resp failure. goal is to keep saturatin >90%