Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
23 Cards in this Set
- Front
- Back
|
What can alter DLCO |
Clinical e/o that recruit blood to the alveoli (shunt, asthma, erythrocytosis, alveolar hemorrhage) can increase DLCO Conditions that decrease area available for diffusion or permeability across the alvoelar-capillary membrane can reduce DLCO |
|
|
How does CO poisioning affect SaO2? |
IT does not - get a coox to measure oxyhemoglobin |
|
|
What are RFs for allergic asthma? |
Exposure to smoke as a child, maternal smoking while pregnant, personal hx of allergies - Reduced RFs in patients exposed to microbial diversity - protects against asthma by shifting Th cells to a Th1 instead of Th2 predominant phenotype - Avoid environmental tobacco spoke - Breast feeding |
|
|
What is the pathophysiology of asthma? |
- Epithelial cell damage, smooth muscle hypertrophy, airway fibrosis and remodeling in some patients - In allergic asthma, exposure to airway allergrens following sensitization causes mast cell degranulation and initiation of an inflammatory cascade - In nonallergic asthma, viral or bacterial exposures, or direct exposure to noxious chemicals cause initiation of inflammation |
|
|
What is the pathophysiology of allergic asthma? |
Allergen --> mast cell activation --> Th2 response, release of histamine and interleukins. THis is modulated by Tregulatory cells - Chronic exposure results in airway remodeling, structural changes such as mucous cell hyperpleasia, subepithelial thickening, smooth muscle hyperplasia, connective tissue deposition and airway fibrosis |
|
|
How is asthma diagnosed? |
PFTs - but can be normal between exacerbations Methacholine challenge and improvement w/ bronchodilator of at least 12% Inhaled nitric oxide - elevated in patients with asthma Elevated serum eosinophils |
|
|
What are the different asthma syndromes? |
Allergic asthma Cough variant asthma Exercise induced bronchospasm - inspiration of cool, dry air causes drying of airway surfaces which causes bronchoconstriction, when airway drying is reversed there is a rebound effect w/ recruitment and infiltration of inflammatory cells which causes asthma Occupational asthma |
|
|
What is the treatment of exercised induced bronchospasm? |
Albuterol PRN Steroids Leukotriene antagonists Nasal breathing, covering the nose and mouth during exercise in cold environments |
|
|
What are common causes of occupational asthma |
Farmers, hairdressers, farmers - Can dx with serial peak flows during the day |
|
|
What is aspirin sensitive asthma? |
Asthma worsened by exposure to NSAIDs - COX inhibition thus increasing leukotriene synthesis - Triad of asthma, aspirin sensitivity and hyperplastic eosinophilic sinusitis w/ nasal polyps - Can perform aspirin desensitization |
|
|
What is RADs? |
Development of respiratory symptoms in minutes to hours of a single inhalation of a high concentration of an irritant - inhalation of storng fumes, particulates, chemical irritants - Treat like asthma |
|
|
How is ABPA diagnosed? |
- Difficult ot control asthma - Impaired mucociliary clearance w/ mucous plugging - Bronchiectasis from persistent inflammation - Weight loss - Diagnosed by positive skin testing to aspergillus antigens, high IgE titers to aspergillus, peripheral eosinophilia - Radiographic e/o bronchiectasis - Treat w/ systemic steroids, inhaled steroids and anti-IgE therapy (omalizumab) can help in selected patietns |
|
|
What is vocal cord dysfunction and how is it treated? |
Symptoms: mid chest tightness w/ exposures of stress; difficutly w/ inhalation, only partial response to bronchodilators - During ispiration there is paradoxical adduction of vocal cords - laryngoscopy is gold standard for dix - Spirometry: flat inspiratory limb on flow-volume loops. Speech therapy, training exercises to control laryngeal area and maintain airflow, treatmetn of GERD |
|
|
What conditions exacerbate asthma control? |
GERD, vocal cord dysfunction, obesity, OSA, depression |
|
|
What do anticholinergic medciations do? |
Dilate bronchial smooth muscle by decreasing constrictive cholinergic tone in the airways, less effective than beta-2 agonists, |
|
|
How is asthma treated? |
- Symptoms > twice per week or once per night, inhaled steroids - Then step p to LABA , when taken together LABAs potential anti-inflammatory effects of sterodis, but can cause anxiety/tremor/HA - Can add on leukotriene inhibitors to the inahled steroid step, esp useful in EIB and aspirin induced asthma - Can also try long acting antichilinergic agents - results only in modest sustained bronchodilation |
|
|
What is omalizumb? What is bronchial thermoplasty? |
Humanized monoclonal antibody against IgE, q2-4 weeks, to treat pts with moderate to severe asthma with IgE levels between 30-700 - bronchoscopically intoduced catheter is used to apply thermal energy to conducting airways 3mm or greater in diameter, w/ goal of reducing smooth muscle thickening. 3 sessions 3 weeks apart in 3 different parts of the lung. PFTs remain the same, but can note improvement in symptoms, decreased ED visits and improvemet in severity of exacerbation |
|
|
How is asthma treated in pregnancy? |
Lack of asthma control increases risks for preeclampsia and preterm labor for mothers and low birth weight, s,all gestational size and pre-term delivery - Continue to use inhaled steroids and LTRAs |
|
|
What is the role of steroids in COPD exacerbation? |
They reduce recovery time, improve lung function and arteria hypoxemia, dcecrease risk of early relapse, decrease treatment failure and length of hospital stay - There has been no established optimal dose, a frequently used regimen is prednisone 40mg x5d |
|
|
What diseases cause bronchiectasis in the upper lobes? middl3e lobes? |
Upper: CF, ABPA, congenital, CTD Midlung: NTM such as MAC Lower: chronic recurrent aspiration, end stage fibrotic disease, recurrent infections a/w immunodeficiency |
|
|
What is the treatmetn of bronchiectasis? |
Treat underlying cuase Inhaled hyperteonic saline in conjunction w/ chest PT Mucolytic agents such as NAC can reduce viscocity and liquefy sputum secretions Dornase alpha - enzyme that cleaves DNA in sputum from degenerating neutrophils and reduces sputum viscosity is beneficial to CF related rbonchiectasis but not in patients w/ bronchiectasis from other causes - No long term data supporting the use of bronchodilators - Short term steroids may be beneficial - In patients w/ flare, rule out NTM before exposing to chronic macrolide therapy - Pulmonary rehab |
|
|
How are exacerbations treated? |
Present w/ increased sputum volume, visocosity, purulence, increased cough, wheezing, SOB and hemoptysis - Abx tailored to cx |
|
|
How is CF diagnosed? |
Sweat testing Nasal potential difference Genetic CFTR mutations - burkholderia cepacia is strongly suggestive of CF - A/w DM, infertility, pancreatitis, liver disease (fatty infiltration --> cirrhosis and portal HTN, and intrahepatic cholestasis), osteoporosis |
