Step-Up To Medicine - Diseases Of The Pulmonary System (Quick Hits)

Front 1

What patients are most often affected by chronic bronchitis?

Back 1

Smokers

Front 2

What airways are affected in chronic bronchitis?

Back 2

Respiratory bronchioles (proximal acini)
- Upper lung

Front 3

What patients most often develop emphysema?

Back 3

Alpha-1 antitrypsin deficiency

Front 4

What airways are most affected by emphysema?

Back 4

Distal to terminal bronchioles: Proximal and distal acini
- Lung base

Front 5

What are PFT changes seen in COPD?
- FEV1/FVC
- FEV1
- TLC
- RV

Back 5

- FEV1/FVC: Decreased (< 0.75)
- FEV1: Decreased
- TLC Increased
- RV: Increased

Front 6

What is the appearance of a patient with emphysema?

Back 6

- Thin
- Leaning forward
- Barrel chest
- Tachypnic
- Distressed / accessory muscle use

Front 7

What is the appearance of a patient with chronic bronchitis?

Back 7

- Overweight
- Signs of cor pulmonale
- Normal respiratory rate
- No apparent distress

Front 8

What acid-base change is seen in COPD?

Back 8

- Chronic respiratory acidosis
- Compensatory metabolic alkalosis

Front 9

How does smoking cessation affect lung function in a person with COPD?

Back 9

RATE of decline normalizes

Front 10

What tests are used to clinically monoitor patients with COPD?

Back 10

- Serial FEV1
- Pulse oximetry
- Exercise tolerance

Front 11

What are the therapeutic interventions proven to lower mortality in patients with COPD?

Back 11

- Smoking cessation
- Home O2 therapy

Front 12

What are the pharmaceutical agents used to treat COPD?

Back 12

Bronchodilators:
- Beta-2 agonists: albuterol
- Anticholinergics: ipratropium bromide


Inhaled steroids (for acute exacerbations):
- Budesonide
- Fluticasone


Antibiotics (for acute exacerbations)

Front 13

What medication is contraindicated in acute COPD or asthma exacerbation?

Back 13

Beta-blockers

Front 14

What is the criteria for continuous or intermittent long-term O2 therapy in COPD?

Back 14

- PaO2: 55
- Pulse oximetry: < 88%
- PaO2 55-59 + polycythemia or Sx of cor pulmonale

Front 15

When during the day do O2 levels change in patients with COPD?


How is this treated?

Back 15

Night:
- Give O2, CPAP

Front 16

What is the main treatment goal for COPD patients?

Back 16

Reduce number and severity of COPD exacerbations

Front 17

What is one of the main precipitators of a COPD exacerbation?

Back 17

Pulmonary infection:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Moraxella catarrhalis
- Viral

Front 18

What is the treatment protocol for a patient who presents with a COPD exacerbation?

Back 18

- CXR
- B2-agonist + anticholinergic
- Systemic corticosteroids
- Antibiotics
- O2
- Noninvasive positive-pressure ventilation

Front 19

What are signs of an acute severe asthma attack?

Back 19

- Tachypnea
- Diaphoresis
- Wheezing
- Incomplete sentences
- Accessory muscle use
- Paradoxic abdominal and diaphram breathing

Front 20

At what age can asthma manifest?

Back 20

Any age

Front 21

What are the common causes of wheezing?


How do these cause wheezing?

Back 21

- Asthma
- CHF: Airway edema, bronchial congestion
- COPD: Inflammed, narrow airway, bronchospasm
- Cardiomyopathy: Edema around bronchi
- Lung cancer

Front 22

What diagnostic changes in PFTs are required for a Dx of asthma?

Back 22

- FEV1: Decreased
- FVC: Decreased
- FEV1/FVC: Decreased (< 0.75)


- Increase in FEV1 > 12% after albuterol
- Decrease in FEV1 > 20% after methacholine or histamine
- Increase diffusion capacity for CO

Front 23

What is a quick way to diagnose asthma in an emergent setting?

Back 23

Peak flow measurement

Front 24

What is the common ABG finding in an asthmatic patient?

Back 24

Hypocarbia

Front 25

What is a sign for intubation in a patient suffering an asthma attack?

Back 25

Normal / Increased PaCO2:
- Patient normally hyperventilates
- Indicates patient is tiring / decompensating

Front 26

What medications should be avoided in asthmatics?

Back 26

Beta-blockers

Front 27

What are side-effects of inhaled corticosteroids?

Back 27

Oropharyngeal deposition:
- Sore throat
- Oral candidiasis (thrush)
- Hoarseness

Front 28

What is the diagnostic workup for a patient undergoing an acute asthma exacerbation?


What would these tests show?

Back 28

- Peak expiratory flow: Decreased
- ABG: Increased A-a gradient
- CXR: R/o pneumonia, PTX

Front 29

What are complications of asthma?

Back 29

- Status asthmaticus (not responding to std. Rx)
- Acute respiratory failure
- PTX, atelectasis, pneumomediastinum

Front 30

What is the common description of aspirin-sensitive asthma?

Back 30

Patients with:
- Asthma
- Nasal polyps

Front 31

How do infections cause bronchiectasis?

Back 31

- Destroy and damage bronchial wall
- Interfere with ciliary action

Front 32

What is bronchiectasis?

Back 32

Permanent dilation and destruction of bronchial walls and cilia

Front 33

What is the main goal in treating bronchiectasis?

Back 33

Prevent complications:
- Pneumonia
- Hemoptysis

Front 34

What is needed to make the diagnostic differentiation between small cell and non-small cell lung cancer?

Back 34

Tissue Dx

Front 35

Which lung cancer has the lowest association wtih smoking?

Back 35

Adenocarcinoma

Front 36

How are non-small cell and small cell lung cancers staged?

Back 36

NSCLC: Primary TNM system


SCLC:
- Limited: Chest + supraclavicular nodes (no cervical, axillary)
- Extensive: Outside chest and supraclavicular nodes

Front 37

What is are the most common complications associated with local invasion of lung cancer?

Back 37

- SVC syndrome
- Horner's syndrome
- Pancoast's tumor
- Eaton-Lambert syndrome

Front 38

How does SVC syndrome present?

Back 38

- Facial fullness
- Facial and arm edema
- Dilated veins: chest, arms, face
- JVD

Front 39

What is the diagnostic workup for lung cancer?

Back 39

- CXR
- CT
- Biopsy

Front 40

What classification of lung cancer is more often detected by sputum cytology?

Back 40

Central tumors