Clinical Features of COPD

Question 1

COPD definition

Answer 1

Lung disease characterised by chronic obstruction of lung airflow

Question 2

Diseases included within COPD

Answer 2

Chronic bronchitis

Emphysema

Question 3

COPD symptoms are due to

Answer 3

Airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases

Question 4

Risk factors of COPD

Answer 4

Smoking (no.1)
Occupation
Age
Lower socioeconomic status
Asthma/airway hyper-reactivity
Childhood infection

Question 5

Is COPD more common in men or women

Answer 5

Women

Question 6

Alpha-1 antitrypsin

Answer 6

Protease inhibitor made in the liver

Question 7

Function of alpha-1 antitrypsin

Answer 7

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

Question 8

Effect of alpha-1 antitrypsin deficiency

Answer 8

Alveolar damage and emphysema

Question 9

Percentage of smokers that develop COPD

Answer 9

<50%

Question 10

Common symptoms of COPD

Answer 10

Shortness of breath
Recurrent chest infections
Ongoing cough
Sputum
Wheeze
Chest tightness

Question 11

Less common symptoms of COPD

Answer 11

Weight loss
Fatigue
Decreased exercise tolerance
Ankle swelling (heart failure)
Cor pulmonale

Question 12

Examination findings in COPD

Answer 12

Cyanosis
Raised JVP
Cachexia
Wheeze
Pursed lip breathing
Hyper-inflated chest
Use of accessory muscles
Peripheral oedema
Flapping tremor

Question 13

mMRC breathlessness scale

Answer 13

0-4, 0 being breathlessness with strenuous exercise, 4 being too breathless to leave the house

Question 14

Diagnosis criteria

Answer 14

Typical symptoms
Aged > 35
Presence of risk factor
Absence of clinical features of asthma
Airflow obstruction confirmed by spirometry

Question 15

Spirometry of stage 1 COPD

Answer 15

80%

Question 16

Spirometry of stage 2 COPD

Answer 16

50-79%

Question 17

Spirometry of stage 3 COPD

Answer 17

30-49%

Question 18

Spirometry of stage 4 COPD

Answer 18

<30%

Question 19

Spirometry demonstrates

Answer 19

Lack of reversibility

Question 20

Spirometry in restrictive disorder

Answer 20

Ratio is normal as both FEV1 and FVC reduced

Question 21

Signs on chest x-ray of COPD

Answer 21

Vascular hila
Hyperinflation
Bulla
Small heart
Flat diaphragm

Question 22

How many people are living with COPD in the UK

Answer 22

1.2 million (2% pop)

Question 23

How common is COPD out of all lung diseases

Answer 23

2nd most common

Question 24

Is the prevalence of COPD increasing or decreasing

Answer 24

Increasing

Question 25

How many people are diagnosed with COPD each year in the UK

Answer 25

115,000

Question 26

Are incidences of COPD increasing or decreasing

Answer 26

Decreasing

Question 27

Onset of COPD compared to asthma

Answer 27

In mid-life whereas asthma in early life

Question 28

Progressiveness of symptoms of COPD

Answer 28

Slowly progressive

Question 29

People with COPD usually have a history of

Answer 29

Tobacco smoking or exposure to other types of smoke

Question 30

If unsure if asthma or COPD, carry out

Answer 30

Pulmonary function tests - lung volumes and transfer factor

Question 31

Residual volume in COPD

Answer 31

Increases

Question 32

Total lung capacity in COPD

Answer 32

Increases

Question 33

RV/TLC

Answer 33

>30%

Question 34

Gas transfer in COPD

Answer 34

Reduces

Question 35

Diffusion of carbon monoxide in COPD

Answer 35

Decreases

Question 36

Carbon monoxide transfer coefficient abundance in COPD

Answer 36

Decreases

Question 37

Radiology to differentiate between COPD and asthma

Answer 37

High resolution computed tomography (HRCT)

Question 38

Differential finding in HRCT in COPD

Answer 38

Upper zone emphysema

Question 39

2 main things that differentiate COPD and asthma

Answer 39

Diurnal variability and reversibility with bronchodilators

Question 40

Management of acute exacerbations in primary care

Answer 40

Change in inhalers Oral steroids (prednisolone) Antibiotics

Question 41

Acute exacerbation in secondary care triggers

Answer 41

Viral/bacterial infection Sedative drugs Trauma

Question 42

Treatment of acute exacerbations in secondary care

Answer 42

Oxygen Nebulised bronchodilator Oral/IV corticosteroids Antibiotics

Question 43

Factors used to measure severity

Answer 43

Spirometry Nature and magnitude of symptoms History of moderate and severe exacerbations and future risk Presence of co-morbidity

Question 44

How much does NHS spend on prescribed inhalers each year

Answer 44

£10 million

Question 45

Number of deaths from COPD worldwide annually

Answer 45

3 million

Question 46

Predicated COPD related deaths worldwide annually in 2030

Answer 46

4.5 million

Question 47

Number on thing patients can do to slow progression of COPD

Answer 47

Stop smoking