286 - Chronic Obstructive Pulmonary Disease

Question 1

COPD is defined by ___ respiratory symptoms and chronic ___ limitation that is not fully ___

Answer 1

persistent
airflow
reversible

Question 2

Emphysema is defined by a ___ of the lung’s ___ with air space ___

Answer 2

destruction
alveoli
enlargement

Question 3

Chronic bronchitis is defined by chronic ___ and ___

Answer 3

cough
phlegm

Question 4

In small airway disease- small ___are ___ and ___ in number

Answer 4

bronchioles
narrowed
reduced

Question 5

What is the genetic deficiency contributing to emphysema?

Answer 5

Alpha 1 antitrypsin (Alpha1AT)

Question 6

Changes in large airways lead to ___ and ___ production

Answer 6

Cough
sputum

Question 7

Changes in small airways cause ____ alterations

Answer 7

Physiological

Question 8

What does GOLD stand for?

Answer 8

Global initiative for chronic Obstructive Lung Disease

Question 9

What won’t we see in GOLD 1 and 2?

Answer 9

emphysema

Question 10

What are the 3 categories of emphysema?

Answer 10

1. Centrilobular
2. Panlobular
3. Paraseptal

Question 11

Which emphysema is most associated with smoking?

Answer 11

Centrilobular- Enlarged air spaces. Usually in the upper lobes and the upper parts of the lower lobes

Question 12

Which genetic defect is common among panlubular emphysema patients?

Answer 12

Alpha1ATD

Question 13

In COPD there is a continues decrease in ____- it is the most common finding. Also, FEV1/FVC is chronically __. Unlike asthma- ___ do not have a significant effect

Answer 13

FEV1 (Forced expiratory flow)
Low
Bronchodilators

Question 14

PaO2 is mostly normal until ___ is under __%. PaCO2 does not increase until ___ goes under ___%

Answer 14

FEV1 (Forced expiratory volume in one second)
50
FEV1
25

Question 15

Cor pulmonale and right HF start when ___ goes under ___

Answer 15

FEV1
25%

Question 16

What are the main risk factors for COPD (5)?

Answer 16

1. Cigarette smoking/passive smoking
2. Asthma
3. Infections
4. Occupational exposure
5. Air pollution

Question 17

What are the most common symptoms of CPOD? (3)

Answer 17

1. Cough
2. Phlegm
3. Exertional dyspnea

Question 18

In COPD there is a decrease in ___ and ___.
There is an increase in ___, ___, ___

Answer 18

FEV1
FEV1/FVC

TLC
FRC (Functional residual capacity)
RV

Question 19

What is FRC?

Answer 19

Functional residual capacity is the volume remaining in the lungs after a normal, passive exhalation.

Question 20

What are the characteristics of COPD severity assessment? A, B, C, D

Answer 20

A- Low symptoms, low risk
B- High symptoms, low risk
C- Low symptoms, high risk
D- High symptoms, high risk

Question 21

What is common to groups A and B?

Answer 21

0 or 1 exacerbation history without hospital admission

Question 22

What is common to groups C and D?

Answer 22

> = 2 exacerbation history, or >=1 with hospital admission

Question 23

What is the treatment for group A?

Answer 23

Bronchodilator->evaluate effect->continue, stop, or try alternative class of bronchodilator

Question 24

What is the treatment for group B?

Answer 24

LAMA or LABA

Question 25

What is the treatment for group C?

Answer 25

LAMA->further exacerbation(s)->(LAMA+LABA)or (LABA +ICS)

Question 26

What is the treatment for group D?

Answer 26

LAMA->LAMA+LABA->LABA +ICS->LAMA+LABA+ICS-> with further exacerbations-> if smoker- macrolide, or, if FEV1<50%+chronic bronchitis than roflumilast

Question 27

COPD patients should receive yearly ____ vaccine, and ___ together with ___ vaccines

Answer 27

Flu
Pneumococcal
Bordetella pertussis

Question 28

LVRS (Lung Volume Reduction Surgery) is recommended to a select group of ___ patients. The most suitable are patient with ___ lobe spread and low exertional capability after proper lung ___

Answer 28

Emphysema
Upper
rehabilitation

Question 29

The best predictor for COPD exacerbation is a former ___ and the biggest risk factor for hospital admission is a former ____

Answer 29

exacerbation
admission

Question 30

In all GOLD criteria the FEV1/FVC will be < ___

Answer 30

0.7

Question 31

Mild GOLD criteria is defined by

Answer 31

FEV1>= 80%

Question 32

Moderate GOLD criteria is defined by

Answer 32

FEV1>= 50% but <80%

Question 33

Severe GOLD criteria is defined by

Answer 33

FEV1>= 30% but <50%

Question 34

Very severe GOLD criteria is defined by

Answer 34

FEV1< 30%