Clinical Features of COPD

Question 1

What organ is responsible for the production of AAT

Answer 1

Liver

Question 2

What is the function of AAT

Answer 2

Limits damage caused by activated neutrophils releasing elastase in response to infection or cigarette smoke

Question 3

Initial presentation (8)

Answer 3

SOB
Recurrent chest infections
Ongoing cough
Wheeze
Productive cough
Weight loss
Fatigue
Ankle swelling (if causing heart failure)

Question 4

Clinical features on examination (8)

Answer 4

Cyanosis
Raised JVP
Cachexia (weakness and wasting of body)
Hyperinflated lungs
Pursed lip breathing
Use of accessory muscles
Wheeze
Peripheral oedema

Question 5

Diagnosis (5)

Answer 5

>35 years old
Risk factor (smoking or occupation)
Presence of typical symptoms
Absence of clinical features of asthma
Airflow obstruction confirmed by post-bronchodilator spirometry

Question 6

Stage 1 Spirometry

Answer 6

FEV1 80%

Question 7

Stage 2 Spirometry

Answer 7

FEV1 50-79%

Question 8

Stage 3 Spirometry

Answer 8

FEV1 30-49%

Question 9

Stage 4 Spirometry

Answer 9

FEV1 less than 30%

Question 10

How can you measure hyperinflation

Answer 10

Residual volume/Total lung capacity >30%

Question 11

Radiology features (5)

Answer 11

Signet ring sign
Honeycombing
Traction bronchieactasis
Lung cysts
Centrilobular emphysema

Question 12

Treatment for secondary care

Answer 12

Oxygen
Nebulised bronchodilator
B2 and antimuscarinic 
Oral/IV corticosteroid
Aminophylline

Question 13

Mechanism of B2 agonist

Answer 13

Relaxation of lung smooth muscle

Question 14

Mechanism of antimuscarinic

Answer 14

Inhibition of mucocilary secretion to dilate airways

Question 15

Type 1 Respiratory failure

Answer 15

Hypoxemic low PO2

Question 16

Type 2 Respiratory failure

Answer 16

Hypoxemic low PO2 and high CO2 (Hypercapnic)

Question 17

Hypoxia with normal PO2 is

Answer 17

always lung parenchymal disease

Question 18

Hypoxia with elevated PCO2 could be

Answer 18

primary hypoventilation or could be severe parenchymal disease

Question 19

What is Cor Pulmonale

Answer 19

enlargement of the right side of the lungs

Question 20

Symptoms of Cor Pulmonale

Answer 20

Tachycardia
Oedema
Congested liver

Question 21

ECG features of Cor pulmonale

Answer 21

Right axis deviation, P pulmonlae, T wave inversion V1-V4

Question 22

Echo features of Cor Pulmonale

Answer 22

Pulmonary hypertension

Tricupsid regurgitation

Question 23

Secondary Polycythaemia

Answer 23

Elevated levels of erythpoietin production by the kidneys which leads to elevated levels of Hb and RBC which increased the haematocrit and viscosity of the blood