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55 Cards in this Set
- Front
- Back
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Chronic Obstructive Pulmonary disease
COPD |
clinical and pathophysiologic syndrome that includes 2 different diseases
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2 diseases involved in COPD
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Chronic bronchitis
Emphysema |
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COPD is characterized by...
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presence of airflow obstruction
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Chronic bronchitis is...
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clinical disorder characterized by excessive production of mucus in the bronchi
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Manifestations of Chronic bronchitis
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cough and production of sputum for a minimum of 3 months per year for at least 2 consecutive years
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Signs & Symptoms of Chronic bronchitis
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-Wheezing & rhonchi heard in chest
-Age on onset 35-45 y/o -Dyspnea = mild & late -cough early with copious sputum -infections are common |
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Cor pulmonale
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(right-sided heart failure)
-enlargement of right ventricle due to high blood pressure in the lungs usually caused by chronic lung disease |
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Chronic bronchitis caused by
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-cigarette smoking
-air pollution -predisposes to recurrent infections |
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Chronic bronchitis patients are called...and why
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"Blue bloaters" due to cyanosis that occurs
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Emphysema
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abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of bronchiolar walls and the alveolar septa
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Emphysema patients referred to as
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"Pink puffers"
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Emphysema presents with
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barrel-chest, dyspnea without cough or sputum production, and cachexia
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Emphysema
(age of onset) (dyspnea - when) (cough - when) |
Age = 50-75 y/o
Dyspnea is severe and occurs early Cough occurs late and produces scant sputum |
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Most important cause of COPD
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Cigarette smoking
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COPD
Signs & Symptoms |
Daily morning cough with clear sputum
(earliest symptom) |
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COPD - Lab Findings
Polycythemia caused by... |
chronic hypoxemia
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COPD - EKG Shows...
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-Multifocal atrial tachycardia
-Atrial flutter -Atrial fibrillation -Ventricular irritability |
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COPD
Pathognomonic signs of emphysema on CXR |
-Parenchymal bullae or sub-pleural blebs
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COPD
Differential Diagnosis |
-Asthma
-Bronchiectasis -Cystic Fibrosis |
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COPD Complications
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-Pulmonary hypertension
-Cor pulmonale -Chronic respiratory failure |
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COPD pts at risk for ....
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-Pulmonary emboli
-Spontaneous pneumothorax |
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COPD
Treatment Goal |
improve functional state and to relieve symptoms
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COPD
Most important intervention |
SMOKING CESSATION
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Only drug therapy known to alter natural history of COPD
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Supplemental oxygen
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Bronchodilators offer what...
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improvement in symptoms, exercise tolerance, overall health status
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2 Most Common Bronchodilators
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-anti-cholinergic ipratropium bromide (Atrovent)
-short-acting beta-agonists (albuterol) |
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Which is preferred first-line treatment for COPD?
(which bronchodilator) |
Ipratropium bromide over a short-acting beta-agonists
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Short-acting beta-agonists can cause ....
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tachycardia, tremor, hypokalemia
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3rd line treatment of COPD
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Oral theophylline
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Goal of 3rd line treatment
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given to those who fail to achieve adequate symptom control with anti-cholinergics and beta-agonists
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What type of COPD patient benefits from antibiotic therapy
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Patient with a flare of COPD associated with dyspnea and a change in the quantity or character of sputum
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Antibiotic of choice for COPD
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Trimethoprim-sulfamethoxazole (Bactrim DS)
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Cystic fibrosis
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most common cause of severe chronic lung disease in young adults, and the most common fatal hereditary disorder of Caucasians in the U.S.
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Cystic fibrosis
what type of genetic disorder? |
Autosomal recessive disorder
-each parent must have gene for a child to be born with CF |
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Cystic Fibrosis
Caused by... |
abnormalities in a membrane chloride channel that results in altered chloride transport
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CF affects which tissues
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tissues that produce mucus secretions
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CF --
Exocrine glands produce what.. |
abnormally thick mucus that obstructs glands and ducts
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Cystic Fibrosis
Pulmonary manifestations |
-Acute & chronic bronchitis
-Bronchiectasis -Pneumonia -Atelectasis -Peri-bronchial & parenchymal scarring |
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Cystic Fibrosis
Other GI things that can occur... |
-Pancreatitis
-Biliary cirrhosis -Gallstones |
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Patients with CF are at increased risk for...
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-GI tract malignancies
-Osteopenis -Arthropathies |
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Cystic Fibrosis
Usually become symptomatic when... |
Usually within the 1st year of life
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Cystic Fibrosis
Common Signs & Symptoms |
Cough, sputum production, decreased exercise tolerance, and recurring hemoptysis
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Cystic Fibrosis
More S & S |
-Facial (sinus) pain or pressure
-Purulent nasal discharge -Steatorrhea, diarrhea, abd pain |
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Hyperinflation
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*reflection of airway obstruction*
--seen early in CF with CXR |
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What lobe of the lung do you find signs of CF?
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right upper lobe
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Gold standard test for diagnosis of CF
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Quantitative Pilocarpine Iontophoresis Sweat Test
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What is required for accurate dx of CF
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Two tests on different days are required
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Values on sweat test the lead to dx of CF
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> 60mEq/L = consistent with dx
40 to 60 mEq/L = borderline or inconclusive |
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What is common....false positives or false negatives on sweat chloride test
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False negatives = noral test does NOT exclude the dx
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Ways of treatment for CF
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-Postural drainage
-Chest percussion -Vibration techniques -Directed cough |
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Drugs for treatment
N-acetylcysteine (Mucomyst) what does it do? |
reduced viscosity of mucus and increases clearing of secretions
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2 Common pathogens present with CF
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Staph aureus and Pseudomonas aeruginose
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Nutritional recommendations for CF patients
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-liberal salting of foods
-high protein, high calorie diet -vitamin supplements |
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death in CF patients results from...
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Pulmonary complications
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Domase alfa (Pulmozyme) does what...
(inhaled aerosolized enzyme) |
Cleaves extracellular DNA in sputum and decreases mucus viscosity
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