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27 Cards in this Set
- Front
- Back
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Which obstructive disease is reversible?
Which is not fully reversible? |
Asthma
COPD |
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COPD
Airflow limitation that is/is not fully reversible Progressive and associated with an abnormal ________ response of the lungs to noxious particles or gas |
is not
inflammatory |
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What disease is this?
Chronic productive cough for 3 months in two successive years |
Chronic bronchitis
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What is this?
Pathological term in which there is enlargement of airspaces with destruction of bronchiole walls |
Emphysema
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Patients with unremitting asthma are classified as having _____
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COPD
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Asthma:
triggered by a _______ agent. What two cell types more evident? |
sensitizing
CD4+ T lymphocytes Eosinophils |
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COPD:
triggered by a ______ agent. What 3 cell types more evident? |
CD8+ T lymphocytes
Macrophages Neutrophils |
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Clinical features of COPD:
Patients have usually smoked at least __ cigarettes a day for __ or more years Starts with chronic _____ _____ may not occur until 10-20 years later |
20
20 cough dyspnea |
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As COPD progresses...
Chronic ____ production Weight loss Morning _____ hypercapnia with hypoxemia Cor pulmonale |
sputum
headache (chronic hypoxia at night0 |
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What is the normal percent of FEV1/FVC for COPD patients?
Percent of FEV1 predicted? |
<70%
>80% |
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Physical Exam of COPD pt:
Prolonged ______ Hyperinflation Hyperresonent percussion Depressed ______ Decreased ______ sounds Wheezes |
expiration
diaphagm breath |
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End Stage COPD Sx:
Accessory muscles (sternocleidomastoid) What do they do to their lips? Cyanosis Enlarged _____ asterixis |
pursed
liver |
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What happens in COPD?
FEV1 FEV1/FVC TLC FEF 25-75 Bronchodialator response |
Decreased
Decreased Increased Decreased (flattened) Absent |
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Lateral radiograph demonstrates significantly increased anteroposterior diameter, flattening of the
_______, and an increased ________ air space. PA view - ________ lung fields. |
diaphragms
retrosternal hyperlucent |
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What is the best way to manage COPD?
What does this tx slow? |
Quit smoking!
Slows the decline in FEV1 |
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Tx of COPD:
Beta 2 agonist bronchodialators - which? Anticholinergic agents - inhaled _____ is first line therapy Which drug that you have to watch for toxicity? Inhaled corticosteroids- may slow rate of decline of ___ |
albuterol
ipratropium theophylline FEV-1 |
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For COPD you should use supplemental oxygen if their O2 sat is below __% on room air or falls below __% with exertion. Or if cor pulmonale is present
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88
85 |
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What is the classic triad of asthma symptoms?
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Persistent wheeze
Chronic cough Chronic dyspnea |
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What is it called when you have a greater than 10mmHg fall in systolic pressure during inspiration?
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Pulses paradoxus
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PEFR:
Red - less than __% of personal best Yellow - __ to __% Green - over __% |
50
50-80 80 |
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An increase in FEV-1 of more than __% is considered responsive
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12%
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What percent of predicted FEV-1 is considered borderline asthma?
Severe asthma? |
>80%
<40% |
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What drug do you use as a provocative test or an "exercise test for the lungs"?
Provacative concentration is the amount of inhaled agonist required to drop the FEV1 by __ percent fom baseline |
Methacholine
20% |
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Tx for asthma is a _____ approach.
Step 1: Start with _______ as needed. Step 2: Low dose inhaled _______ Step 3: Low dose _______ and long acting ______ Step 4: Medium dose _______ and long acting ______ Step 5: High dose ________ and long acting _______ Step 6: High dose ____ and long acting ______ and oral ________ |
stepwise
short acting beta agonist (albuterol) inhaled corticosteroid beta-agonist oral corticosteroid |
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For asthma treatment you should step down if asthma is well-controlled at least _ months
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3
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Omalizumab:
Anti-___ monoclonal antibody which binds free __ in circulation Decreases receptors on ______ How is it administered? |
IgE
basophils injected sub-Q EXPENSIVE! |
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Why do COPD patients breathe with pursed lips?
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produces pressure which helps keep airways open
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