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TCD Cases > COPD > Flashcards

COPD Flashcards

1
Q

What are the 3 types of lung fibrosis?

A
  1. Replacement fibrosis secondary to lung damage
  2. Focal fibrosis in response to inhaled irritants
  3. Diffuse parenchymal lung disease
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2
Q

Name 2 conditions in which diffuse parenchymal lung disease can be seen

A
  1. Idiopathic pulmonary fibrosis

2. Extrinsic allergic alveolitis

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3
Q

Name 4 connective tissue diseases that can occur in association with pulmonary fibrosis

A
  1. Rheumatoid arthritis
  2. SLE
  3. Systemic sclerosis
  4. Sjorgen’s syndrome
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4
Q

Name 3 medications that can cause lung fibrosis

A
  1. Amiodarone
  2. Nitrofurantoin
  3. Bleomycin
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5
Q

How would you calculate a smokers ‘pack years’?

A

Multiply the number of packs of cigarettes smoked per day by the number of years they have smoked.

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6
Q

What are the 3 hallmark symptoms of COPD?

A
  1. SOB
  2. Chronic Cough
  3. Sputum production
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7
Q

What is the main marker for genetic susceptibility to COPD?

A

Alpha-1 antitrypsin deficiency

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8
Q

Name 4 gene polymorphisms that confer a genetic susceptibility to the development of COPD

A
  1. Alpha-1 antitrypsin deficiency
  2. Matrix metalloproteinases
  3. TNF-alpha
  4. glutathione S transferase
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9
Q

What are the 3 main pathological changes seen within the lungs in patients with COPD?

A
  1. Goblet cell hyperplasia
  2. Airway narrowing
  3. Alveolar destruction
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10
Q

How is airway obstruction defined clinically?

A

Post- bronchodilator FEV1/FVC ratio such that FEV1/FVC is less than 0.7

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11
Q

Recall the stages of the GOLD categorisation of COPD severity

A

Stage 1 - FEV1 > 80% predicted
Stage 2 - FEV1 50-79% predicted
Stage 3 - FEV1 30-49% predicted
Stage 4 - FEV1 <30% predicted

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12
Q

Suggest 2 changes to the CXR seen in patients with COPD

A
  1. Hyperexpansion

2. Low, flat diaphragms

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13
Q

Outline the 3 broad stages of COPD pathophysiology

A
  1. Airflow obstruction
  2. Impaired gas exchange
  3. Hypoxia and hypercapnia
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14
Q

Outline the 5 stages of the pathophysiology associated with Cor Pulmonale

A
  1. Hypoxia
  2. Pulmonary arterial vasoconstriction
  3. Increased pulmonary arterial pressure
  4. Right ventricular hypertrophy
  5. Right ventricular failure
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15
Q

Name a nicotine receptor blocker

A

Varenicline

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16
Q

Name the 3 drug classes that can be used in the management of COPD

A
  1. Inhaled bronchodilators
  2. Inhaled corticosteriods
  3. Oral theophylline
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17
Q

Name 2 short acting beta-2 agonists

A
  1. Salbutamol

2. Terbutaline

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18
Q

Name 2 long acting beta-2 agonists

A
  1. Salmeterol

2. Eformoterol

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19
Q

Name 2 anti-muscarinic agents used in the treatment of COPD

A
  1. Ipratropium

2. Tiotropium

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20
Q

Name 3 inhaled corticosteroids used in the treatment of COPD

A
  1. Beclomethasone
  2. Budesonide
  3. Fluticasone
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21
Q

Name an oral theophylline

A

Aminophylline

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22
Q

Name a mucolytic used in the management of COPD

A

Carbocysteine

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23
Q

Name 2 vaccinations that should be given to patients with COPD

A
  1. Influenza

2. Pneumococcal

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24
Q

Give 6 complications associated with COPD

A
  1. Exacerbations
  2. Pneumonia
  3. Pneumothorax
  4. Right ventricular failure
  5. Peripheral neuropathy
  6. Cachexia
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25
Q

What is the most common bacterial cause of COPD exacerbation?

A

Haemophilus influenza

26
Q

Suggest 6 symptoms commonly associated with a COPD exacerbation

A
  1. Preceding Coryzal symptoms
  2. Increased breathlessness
  3. Increased cough
  4. Increased sputum
  5. Sputum purulence
  6. Ankle swelling
27
Q

Outline the 3 main types of PFTs used to assess lung function

A
  1. Spirometry
  2. Lung diffusion test
  3. Lung Plethysmography
28
Q

What is measured in each of the 3 standard PFT tests?

A
  1. Spirometry - Measures the volume of air breathed in and out
  2. Lung diffusion test - Measures the degree of oxygen transfer from the inspired air to the alveolar blood supply
  3. Lung Plethysmography - Measures the amount of air present in the lungs after exhalation
29
Q

Define Vital capacity

A

The amount of air that can be exhaled following a full inspiration

30
Q

Define FCV

A

Forced vital capacity - the maximum volume of air that you can forcibly exhale after taking the deepest breath possible

31
Q

Name 6 examples of obstructive lung disease

A
  1. COPD
  2. Asthma
  3. Chronic bronchitis
  4. Bronchiectasis
  5. Bronchiolitis
  6. Cystic fibrosis
32
Q

Suggest 7 potential causes of intrinsic restrictive lung disease

A
  1. Pneumonia
  2. Pneumoconioses
  3. ARDS
  4. Eosinophilic pneumonia
  5. TB
  6. Sarcoidosis
  7. Pulmonary fibrosis
33
Q

What is pneumoconiosis?

A

Refers to a group of lung diseases caused by the inhalation and retention of dust particles within the lungs

34
Q

What are the 4 sub-classifications of pneumoconiosis?

A
  1. Coal workers pneumoconiosis
  2. Asbestosis
  3. Silicosis
  4. Other unspecified pneumoconiosis
35
Q

Suggest 8 causes of extrinsic restrictive lung disease

A
  1. Scoliosis
  2. Obesity
  3. Obesity hypoventilation syndrome
  4. Pleural effusion
  5. Malignant tumours
  6. Ascites
  7. Pleurisy
  8. Rib fractures
36
Q

Suggest 5 causes of neurological restrictive lung disease

A
  1. Paralysis of the diaphragm
  2. Gullian-Barre syndrome
  3. Myasthenia Gravis
  4. Muscular dystrophy
  5. Amyotrophic lateral sclerosis (ALS)
37
Q

What are the 3 main features of the reversible airway obstruction associated with asthma?

A
  1. Bronchoconstriction
  2. Bronchial mucosal oedema
  3. Mucus plugging
38
Q

Define COPD

A

Lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

39
Q

What are the 3 main features of airway obstruction associated with COPD?

A
  1. Bronchoconstriction
  2. Mucosal oedema
  3. Mucosal hypersecretion
40
Q

Recall the 3 subcategories of bronchodilators that are used in the treatment of obstructive airway disease

A
  1. Sympathomimetic agents
  2. Xanthines
  3. Magnesium
41
Q

Recall 6 side effects that can be associated with the use of beta-2 agonists

A
  1. Tachycardia
  2. Arrhythmia
  3. Myocardial ischaemia
  4. Tremor
  5. Paradoxical bronchospasm
  6. Hypokalaemia
42
Q

What is the most common short acting anticholinergic drug used in the treatment of COPD?

A

Ipratropium bromide

43
Q

Classify the drug tiotropium

A

Long acting anticholinergic

44
Q

Name the 3 classical side effects associated with the use of anticholinergic drugs.

A
  1. Dry mouth
  2. Nausea
  3. Headache
45
Q

Name 2 important contra-indications for the use of anticholinergic agents

A
  1. Prostatic hyperplasia + bladder outflow obstruction

2. Glaucoma

46
Q

What is the main mechanism of action of xanthines?

A

Increased availability of cAMP thus unregulated activities of SNS to induce bronchodilitation. May also indirectly have an anti inflammatory effect via another mechanism.

47
Q

Give 5 important side effects associated with inhaled corticosteroids

A
  1. Candidiasis
  2. Hoarseness
  3. Adrenal suppression
  4. Osteoporosis
  5. Growth restriction in children
48
Q

Seretide is a combination of which 2 drugs?

A

Salmeterol and Fluticasone

49
Q

Name 4 cell types that release leukotrienes as part of the inflammatory response

A
  1. Eosinophils
  2. Mast cells
  3. Macrophages
  4. Basophils
50
Q

Name a leukotriene receptor antagonist that can be used in the treatment of COPD

A

Montelukast

51
Q

What is the proposed mechanism of action of sodium cromoglycate as an anti inflammatory in the management of COPD/asthma?

A

May inhibit degranulation of mast cells but mechanism is not fully understood

52
Q

What is Omalizumab?

A

Monoclonal antibody that binds to IgE

53
Q

Name a condition for which Omalizumab may be indicated

A

Severe persistant allergic asthma

54
Q

What is the most common mucolytic used in the treatment/ management of COPD?

A

Carbocisteine

55
Q

Suggest 6 clinical features associated with hypercapnia

A
  1. Dilated pupils
  2. Bounding pulse
  3. Hand flap
  4. Myoclonus
  5. Confusion
  6. Drowsiness
56
Q

Give 4 signs associated with COPD on CXR

A
  1. Flattened diaphragm
  2. Smaller heart size
  3. Hyperinflated lungs
  4. Horizontal rib markings
57
Q

What are the 5 most common organisms causing infective exacerbations of COPD?

A
  1. Strep Pneumonia
  2. Viruses
  3. Moraxella Catarrhalis
  4. Haemophilus influenza
  5. Pseudomonas aeruginosa
58
Q

When is long term home oxygen therapy indicated in patients with COPD?

A

PaO2 <7.3kPa on air

59
Q

What is the definition of chronic bronchitis?

A

Chronic productive cough for at least 3 months in the last 2 years

60
Q

Suggest 4 potential causes of COPD

A
  1. Smoking
  2. Alpha 1 anti-trypsin deficiency
  3. Cadmium
  4. Coal
61
Q

Which 2 medical conditions often coexist in patients with COPD?

A

Chronic bronchitis and emphysema

TCD Cases (25 decks)

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