Pulmonary

Question 1

what are the 2 classic types of COPD?

Answer 1

chronic bronchitis, emphysema

Question 2

chronic bronchitis is

Answer 2

a clinical diagnosis

Question 3

emphysema is

Answer 3

a pathologic diagnosis

Question 4

the two chronic bronchitis and emphysema

Answer 4

often coexist (pure emphysema or pure chronic bronchitis is rare)

Question 5

COPD is the 4th

Answer 5

leading cause of death in the US

Question 6

4 risk factors for COPD?

Answer 6

1. tobacco smoke (indicated in 90% of COPD pts)
2. alpha1 antitrypsin def
3. environmental factors (second had smoke)
4. chronic asthma

Question 7

explain the 2 pathogenesis of chronic bronchitis

Answer 7

1. excess mucus production narrows the airways –> pts have productive cough
2. inflammation and scarring in airways, enlargement of mucous glands, and smooth muscle hyperplasia lead to obstruction

Question 8

explain the pathogenesis of emphysema

Answer 8

destruction of alveolar walls is due to relative excess in protease (elastase) activity, or relative deficiency of antiprotease (alpha 1 antitrypsin) activity in the lung

Question 9

where does elastase come from?

Answer 9

macrophages, and it digests human lungs (alpha 1 antitrypsin blocks elastase)

Question 10

how does tobacco smoking contribute to emphysema?

Answer 10

smoking increases the number of activated macrophages –> more elastase production and increases oxidative stress on the lung by free radical production

Question 11

what is FEV1?

Answer 11

the amount of air that can be forced out of the lungs in 1 second.

Question 12

what does it mean to have lower FEV1?

Answer 12

more difficulty one has breathing

Question 13

what are the values of TLC and FEV1 in airway obstructive dz?

Answer 13

inc TLC, dec FEV1

Question 14

FEV1/FVC of what value indicates airway obstruction?

Answer 14

less than 0.7

Question 15

what are the 2 interventions that are shown to lower mortality in COPD?

Answer 15

1. home oxygen therapy

2. smoking cessation

Question 16

treatments for COPD?

Answer 16

bronchodilators (beta 2 agonists, anticholinergics or both)

Question 17

treatments for acute exacerbations of COPD?

Answer 17

steroids and antibiotics

Question 18

what are the diff btw emphysema and chronic bronchitis?

Answer 18

emphysema = pink puffer

1. pts tend to be thin due to inc energy expenditure during breathing
2. when sitting, pts tend to lean forward
3. pts have a barrel chest (inc AP diameter of chest)
4. tachypnea (hyperventilation)–> resp alkalosis

chronic bronchitis (blue bloaters)

1. pts tend to be overweight and cyanotic due to chronic hypercapnia and hypoxemia
2. chronic cough/sputum production

Question 19

can steroids be used for long term treatment for COPD?

Answer 19

no, it should only be used for acute exacerbation of COPD

Question 20

2 paths associated with “thickened peritracheal stripe and splayed carina bifurcation.”

Answer 20

Lt atrium enlargement due to mitral stenosis, cancer

Question 21

transdutive

Answer 21

CHF, nephropath