08.18 - COPD, Emphysema (Headley) - Questions Flashcards Preview

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Flashcards in 08.18 - COPD, Emphysema (Headley) - Questions Deck (63):
1

What FEV/FVC ratio corresponds to airway obstruction

<70%

2

What defines "irreversible" airway obstruction

Does not improve by >15% with bronchodilators

3

Immune cells distinct to COPD in contrast to asthma

CD8 T Cells; CD68+ Macrophages

4

Primary cause of COPD

Cigarrette smoke

5

FEV1 of ____ of predicted is associated with exertional dyspnea

40-60%

6

FEV1 of ____ of predicted is associated with disability

< 30%

7

FEV1 <30% of predicted is associated with

Disability

8

FEV1 < ___ = 5 year mortality 50%

FEV1 < 1 L

9

FEV1 < 1 L =

5 year mortality 50%

10

Pack years on average for COPD

20 pack years

11

At what age does COPD become symptomatic

40's

12

When does dyspnea develop

50's - 60's

13

What is required to make Dx of COPD

Spirometry: Post-bronchodilator FEV1/FVC < 70%

14

T/F: COPD can include a "reversible" component

True

15

Sputum production in COPD

Tenacious, mucoid, small quantities

16

Definition of Chronic Bronchitis

Production of sputum for 3 months in 2 consecutive years

17

Production of sputum for 3 months in 2 consecutive years

Definition of Chronic Bronchitis

18

Change in sputum color suggests

Infectious exacerbation

19

Why quantify dyspnea in COPD?

Predicts QOL and survival

20

Physical exam signs of Airflow limitation

Wheezing; Prolonged forced expiratory time

21

Physical exam signs of Hyperinflation

Barrel chest; Pursed Lip; Low diaphragm; Decr intensity of hearth and breath sounds

22

Physical exam signs of Mechanical Impairment

Accessory muscles; In-drawing of lower intercostal interspaces; Chest/abdominal wall paradoxical movements

23

For how long must hyperinflation be present to develop barrel chest

7 years

24

Heart Auscultation in COPD

Cor Pulmonale signs: S2 split, Pulmonary or Tricuspid Regurgitation Murmur

25

DLCO in COPD

Reduced in Emphysema; Normal in Chronic Bronchitis and Asthma

26

If __ are destroyed, DLCO will be low

Alveoli

27

COPD that occurs with Alpha-1 Antitrypsin is usually ___

Pan-Acinar

28

COPD that occurs with smoking (as opposed to A1A) is usually ___

Central Lobular

29

What screening do you perform with COPD develops in white patient under 45 or with strong family hx

A1A Deficiency

30

Pan-Acinar COPD occurs with

A1A Deficiency

31

Blue Bloaters are characterized by

Heart failure; Cyanosis at rest; Chronic respiratory failure

32

Pink Puffers are characterized by

Pursed Lip; Little hypoxia at rest; Thin and lean forward

33

Which is emphysema: Blue Bloaters or Pink Puffers

Pink Puffers

34

Which has signs of heart failure: Blue Bloaters or Pink Puffers

Blue Bloaters

35

Which has little or no hypoxia at rest: Blue Bloaters or Pink Puffers

Pink Puffers

36

Which has large sputum volume: Blue Bloaters or Pink Puffers

Blue Bloater: Chronic Bronchitis

37

Which has normal blood gas values: Blue Bloaters of Pink Puffers

Pink Puffers: Not hypoxic at rest but intense dyspnea

38

Which has good respiratory drive: Blue Bloaters or Pink Puffers

Pink Puffers

39

Hypoxemia and Hypercapnia in Smurfs are due to

V/Q imbalance

40

Why hypercapnea in Smurfs?

Body tolerates certain amount to decrease "Work of Breathing"

41

Minute Ventilation is ___ x ___

RR x TV

42

3 long-term problems of Type B Respiratory Failure

Polycythemia, Pulmonary HTN, Cor Pulmonale

43

Which requires home O2: Type A or B Respiratory Failure

Type B

44

Type A are characterized by

Dyspnea; Tachypnea; and High Minute Ventilation

45

Why are Pink Puffers "pink"?

Maintain O2 sat at a high minute ventilation and much dyspnea

46

What signifies death is near in Type A

Development of hypercapnia and severe hypoxemia

47

Lung inflammation leads to increased __ and __ which leads to COPD pathology

Oxidative stress and Proteinases

48

Hypoxemia and Hypercapnea develop primarily b/c of

V/Q mismatch

49

Clinical Definition of Chronic Bronchitis

Chronic or recurrent cough present on most days for a minimum of 3 months in a year and for not less than 2 consecutive years

50

Pathologic Hallmark of Chronic Bronchitis

Incr Reid Index: Hypertrophied mucous glands greater than 1/3 of total bronchial wall thickness

51

Emphysema is abnormal enlargement of air spaces distal to

Terminal Bronchioles

52

Centrolobular Emphysema is associated with __ and primarily involves ___ lobes

Smoking, Upper Lobes

53

Panlobular Emphysema is associated with __ and involves ___ lobes

A1A Def.; Lower Lobes

54

In Pure Chronic Bronchitis, Flow-Volume Loops reveals

Airflow obstruction during expiration and inspiration

55

Which of the following are normal in Pure Chronic Bronchitis: Lung Volumes, Compliance, Elastic Recoil, DLCO

All are normal

56

In Pure Emphysema, Flow-Volume Loops reveal

Airflow obstruction during expiration but not inspiration

57

VC and DLCO in Pure Emphysema

Both reduced

58

Gas exchange in Pure Emphysema

Preserved (CO2, O2)

59

T/F: COPD exacerbations can often be prevented

TRUE

60

Preferred bronchodilators for exacerbation

Short-acting inhaled beta2-agonists

61

Systemic Corticosteroids in exacerbations

Shorten recovery time, improve lung function and arterial hypoxemia

62

Therapeutic effects of short term beta-2 agonists

3-6 hours

63

Most important drug in hypoxic patients

Long Term O2 Therapy