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Week 8 - Respiratory > CBL - COPD > Flashcards

CBL - COPD Flashcards

1
Q

Describe the type of patient and their presentation that would make you consider a diagnosis of COPD [7]

A
  • people who are >35yrs, smokers or ex-smokers with the following symptoms:
    1. exertional breathlessness
    2. chronic cough
    3. regular sputum production
    4. frequent winter “bronchitis”
    5. wheeze
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2
Q

How do you calculate smoking pack years? [1]

A

1 pack year = 20 cigarettes/day for 1 year

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3
Q

What features would you see in a full lung function test in a patient with COPD? [3]

A
  1. elevated (↑) TLC (total lung capacity) indicating hyperinflation (i.e. TLC >120% predicted)
  2. raised (↑) RV and RV/TLC ratio indicating airtrapping
  3. reduced (↓) transfer factor due to emphysema
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4
Q

What features would you see on CXR in a patient with COPD? [5]

A
  1. overinflation
  2. low and flattened diaphragms
  3. bullae
  4. pruned blood vessels with large proximal vessels
  5. relatively little blood visible in peripheral lungs
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5
Q

Define bullae [1]

A

thin-walled air-filled space within the lung, typically arising in emphysema

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6
Q

What are you looking for in a FBC when investigating a patient with suspected COPD? [2]

A

look for polycythaemia (raised Hb and PCV) if has chronic hypoxemia

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7
Q

When would you suspect the cause of COPD being due to alpha-1 antitrypsin deficiency? [3]

A
  1. early onset
  2. miminal smoking history
  3. family history
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8
Q

What are the common pathogens that can be found in a sputum sample in a patient with COPD? [2]

A
  1. haemophilus influenzae
  2. streptococcus pneumoniae
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9
Q

What is type 1 respiratory failure? [1]

A
  • Hypoxic without hypercapnia and with an arterial partial pressure of oxygen (PaO2) of <8 kPa (<60 mmHg)
    • i.e. low oxygen (↓O2) and normal or low carbon dioxide (-/↓ CO2)
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10
Q

What is type 2 respiratory failure? [1]

A
  • Hypercapnia and hypoxia with an arterial partial pressure of carbon dioxide (PaCO2) of >6.5 kPa (>50 mmHg)
    • i.e. low oxygen (↓O2) and high carbon dioxide (↑CO2)
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11
Q

Define COPD [1]

A

term used to cover a group of clinical syndromes (chronic bronchitis and emphysema) associated with airflow obstruction and destruction of the lung parenchyma

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12
Q

Define chronic bronchitis [1]

A

the production of sputum on most days for at least 3 months in at least 2 years (when other causes of chronic cough have been excluded)

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13
Q

Define emphysema [1]

A

abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles

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14
Q

Describe the pathological changes associated with COPD [5]

A

inflammatory changes initiated by exposure to noxious particles or gases underlies most of the pathological lesions

  1. larger airways > 4mm in diameter
  2. hypersecretion of mucus
  3. hyperplasia of mucus glands in larger airways
  4. chronic inflammatory infiltrate - T lymphocytes (CD8), macrophages, neutrophils
  5. scarring and thickening of airways
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15
Q

Describe the features of small airways disease [4]

A
  1. early process in the development of COPD
  2. airways 2 - 3 mm in diameter, “ bronchiolitis”
  3. goblet cell hyperplasia
  4. narrowing of the bronchioles due to mucus plugging, inflammation and fibrosis
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16
Q

What inhaled therapies are given for breathlessness and exercise limitation in a patient with COPD? [2]

A
  1. short-acting beta agonist (SABA) or
  2. short-acting muscarinic antagonist (SAMA) as required
17
Q

What inhaled therapies are given for exacerbations or persistent breathlessness in a patient with COPD with FEV1 ≥50%? [3]

A
  1. LABA (long-acting beta agonist)
  2. LAMA (long-acting muscarinic antagonist) & discontinue SAMA
  3. SABAs (as required)
18
Q

What inhaled therapies are given for exacerbations or persistent breathlessness in a patient with COPD with FEV1 <50%? [3]

A
  1. combination inhaler:
    • long-acting beta agonist (LABA) + inhaled corticosteroids (ICS)
  2. long-acting muscarinic antagonist (LAMA) & discontinue SAMA
  3. SABAs (as required)
19
Q

What inhaled therapies are given for persistent exacerbations or persistent breathlessness in a patient with COPD? [4]

A
  1. combination inhaler:
    • long-acting muscarinic antagonist (LAMA) +
    • long-acting beta agonist (LABA) +
    • inhaled corticosteroid (ICS)
  2. SABAs (as required)
20
Q

Give 2 examples of a SABA [2]

A

short-acting beta agonist = salbutamol, terbutaline

21
Q

Give an example of a SAMA [1]

A

short-acting muscarinic antagonist = ipratropium

22
Q

Give an example of a LABA [1]

A

long-acting beta agonist = salmeterol

23
Q

Give an example of a LAMA [1]

A

long-acting muscarinic antagonist = tiotropium

24
Q

What oral therapies can be given to patients with COPD and when are they used? [3]

A
  1. Oral corticosteroids
    • used in short courses for exacerbations of COPD
  2. Mucolytics
    • e.g. carbocysteine
    • Helps in sputum expectoration
  3. Oral theophyllines
25
In an exacerbation of COPD, what SpO2 levels should you aim for to avoid patients developing hypercapnia? [1]
88-92%
26
What are the **signs** of a pink puffer and what does it indicate? [5]
1. high respiratory drive 2. ↓PaO2 3. ↓PaCO2 4. desaturates on exercise 5. indicates **Type 1** respiratory failure
27
What are the clinical features seen on examination of a pink puffer? [5]
1. pursed lip breathing 2. uses accessory muscles 3. wheeze 4. indrawing of intercostals 5. tachypnoea
28
What are the **signs** of a blue bloater and what does it indicate? [7]
1. loss of central sensitivity to CO2 2. reliance on hypoxic drive to stimulate breathing 3. low respiratory drive 4. ↓PaO2 5. ↑PaCO2 6. right heart failure (oedema) 7. indicates **Type 2** respiratory failure
29
What are the clinical features seen on examination of a blue bloater? [9]
1. confusion 2. drowisness 3. cyanosis 4. wheeze 5. hypoventilation 6. warm peripheries 7. bounding pulse 8. flapping tremor 9. peripheral oedema
30
Define an exacerbation of COPD and what are the commonly reported symptoms of an exacerbation? [5]
1. sustained worsening of the patient's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset. 2. Commonly reported symptoms: * worsening breathlessness, * cough, * increased sputum production * change in sputum colour
31
How do you manage an exacerbation of COPD in a hospital setting? [7]
1. Assess severity: * symptoms * ABG * CXR 2. Controlled oxygen therapy: * 24-28 % oxygen, * aim to maintain SpO2 88-92% * repeat ABGs at 1 hour 3. Bronchodilators: * nebulised salbutamol 2.5-5mg * ipratropium bromide 0.5mg qds (and PRN) * consider IV aminophylline if not improving 4. Corticosteroids: * prednisolone 30-40 mg od 5. Antibiotics: * if signs of bacterial infection (purulent sputum, increased sputum volume, ↑WCC, ↑CRP) 6. Non-invasive ventilation (NV): * for acidotic type Il respiratory failure 7. Other: * consider DVT prophylaxis (LMWH), * monitor fluid balance and nutrition, * manage co-morbidities
32
Define pleural effusion [1]
fluid in the pleural space
33
What are the clinical signs of a pleural effusion? [3]
1. decreased breath sounds, 2. stony dull to percussion, 3. decreased tactile or vocal fremitus
34
What are the clinical features of a pleural effusion on CXR? [4]
1. need \>500ml of fluid to be present to see on CXR 2. uniformly white appearance 3. blunting of the costophrenic and cardiophrenic angles. 4. a meniscus at the upper edge
35
When you take a pleural aspirate, what should you send the samples for? [4]
* send samples for: 1. biochemistry, 2. pH, 3. cytology 4. microbiology
36
What are the 2 categories of pleural aspirate, what are the fluid protein levels of each and what are the typical causes of each type? [10]
1. Exudate * fluid protein usually \>30 g/l * e.g. in... * pneumonia, * malignancy, * TB 2. Transudate * fluid protein \<30 g/l (usually \<20 g/l) * e.g. in... * heart failure, * liver failure, * nephrotic syndrome

Week 8 - Respiratory (14 decks)

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