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TCD Content > COPD > Flashcards

COPD Flashcards

1
Q

What is Clenil?

A

Inhaled corticosteroid brand name

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2
Q

What is Serevent?

A

LABA

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3
Q

What is Spiriva?

A

LAMA

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4
Q

What is Seretide?

A

Combination inhaler

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5
Q

What is Type 1 Respiratory Failure and what PaO2 indicates T1RF?

A

Type I respiratory failure is also known as hypoxaemic failure, and is defined by a PaO2 of less than 8kPa. It indicates a serious underlying pathology with the lungs such as infection, oedema or a shunt.

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6
Q

What is Type 2 Respiratory Failure and what PaCO2 indicates T2RF?

A

Type II respiratory failure is also known as ventilatory failure, results when PaCO2 is more than 7. Reduced ventilatory effort can be a result of gas trapping, such as in COPD and severe asthma, due to chest wall deformities, muscle weakness or central causes of respiratory depression.

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7
Q

Name 7 clinical features of hypercapnia.

A

Dilated pupils

Bounding pulse

Hand falp

Myoclonus

Confusion

Drowsiness

Coma

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8
Q

What ECG sign indicates cor pulmonale (right atrial enlargement)?

A

Peaked p-waves and right axis deviation

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9
Q

What are the top five most common infective causes of COPD exacerbation? List them from most to least common.

A
  1. Streptococcus pneumoniae
  2. Viruses
  3. Moraxella catarrhalis
  4. Haemophilius influenzae
  5. Pseudomonas aeruginosa
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10
Q

You are undertaking a medication review on one of your patients in a GP surgery. You note that the latest spirometry shows an FEV1 of 59%. The patient is already taking salbutamol prn. What other medications should be considered at this point?

A

Salmeterol inhaler or tiotropium inhaler

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11
Q

You are asked to review an ABG on a patient in the Emergency department who has been admitted with shortness of breath and is known to have COPD. You are told that they have a GCS of 15. The ABG shows:

FiO2 35% oxygen via venturi mask
SaO2 98%
pH 7.31
pCO2 7.8 kPa
pO2 13.6 kPa
HCO3 22.1 kPa
BE -4.5

What does the ABG show? And what would be the best next step in management?

A

Uncompensated type II respiratory failure.

Reduce the amount of inspired oxygen.

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12
Q

What is the mechanism of action of salbutamol?

A

B2 agonist

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13
Q

What is the mechanism of action of ipratropium?

A

Antimuscarinic (anticholinergic) agent

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14
Q

What is the mechanism of action of theophylline?

A

Phosphodiesterase inhibitor

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15
Q

What is the mechanism of action of prednisolone?

A

Changes nuclear transcription of cells to reduce inflammation

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16
Q

What is the mechanism of action of magnesium?

A

Calcium channel blocker

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17
Q

When is long term home oxygen therapy (LTOT) indicated in patients with COPD? (select all that apply)

A

PaO2 < 7.3kPa on air

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18
Q

You are reviewing some spirometry results for one of your COPD patients. It shows an FEV1 of 39%. What is the severity of their COPD according to the GOLD (Global initiative for chronic obstructive lung disease) classification?

A

Severe

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19
Q

Why might patients with COPD get headaches?

A

Due to CO2 retention

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20
Q

What does Grade 1 mean on the MRC Dyspnoea Scale?

A

Breathless during strenuous exercise only

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21
Q

What does Grade 2 mean on the MRC Dyspnoea Scale?

A

Breathless when hurrying or walking up a slight incline

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22
Q

What does Grade 3 mean on the MRC Dyspnoea Scale?

A

Walks slower than people of the same age due to dyspnoea, or needs to pause for breath when walking at own pace

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23
Q

What does Grade 4 mean on the MRC Dyspnoea Scale?

A

Pauses for breath after walking 100m/a few minutes on the level

24
Q

What does Grade 5 mean on the MRC Dyspnoea Scale?

A

Too breathless to leave the house, or breathless when dressing

25
Q

Apart from the lungs, what other organ can alpha-1 antitrypsin deficiency affect?

A

Liver disease

26
Q

What features of asthma differentiate it from COPD?

A

Diurnal variation in symptoms and peak flow

History of atopy

Eosinophilia (in blood and sputum)

Lung function tests demonstrating bronchodilator reversibility

27
Q

What features of bronchiectasis differentiate it from COPD?

A

Expectorate larger volumes of sputum

More frequent LRT infections (often starting in childhood)

High-resolution chest CT showing bronchial dilation

28
Q

What features of congestive cardiac failure differentiate it from COPD?

A

Orthopnea

PND

History of cardiovascular disease

Fine basal inspiratory crepitations

Bloods showing elevated BNP

Echocardiogram showing reduced ejection fraction

29
Q

What features of lung cancer differentiate it from COPD?

A

Weight loss

Haemoptysis

Chest x-ray and bronchoscopy showing the presence of tumour

30
Q

What features of tuberculosis differentiate it from COPD?

A

Drenching night sweats

Weight loss

Positive sputum culture and microscopy

31
Q

What FEV1/FVC do you see in COPD?

A

<70%

32
Q

What FEV1 indicates mild COPD?

A

> 80% of predicted

33
Q

What FEV1 indicates moderate COPD?

A

50-79% of predicted

34
Q

What FEV1 indicates severe COPD?

A

30-49% of predicted

35
Q

What FEV1 indicates very severe COPD?

A

<30% of predicted?

36
Q

What PaCO2 and bicarbonate levels would indicate that a patient is a “CO2-retainer”?

A

PaCO2 >6 and bicarbonate >30

37
Q

What classes as a hyper-inflated chest on an X-ray?

A

> 6 anterior ribs or >10 posterior ribs visible in the mid-clavicular line

38
Q

Describe the conservative management of COPD

A

Smoking cessation

Pulmonary rehabilitation

Annual influenza vaccine

One-off pneumococcal vaccine

Personalised self-management plan

39
Q

Other than cessation advice, what other treatments can be given to help a patient stop smoking?

A

Nicotine replacement

Anti-depressants

Nicotine receptor blockers

40
Q

Name an anti-depressant used to help patients with smoking cessation

A

Bupropion

41
Q

Name a nicotine receptor blocker used to help patients with smoking cessation

A

Varenicline

42
Q

Name two SABAs

A

Salbutamol and terbutaline

43
Q

Name two LABAs

A

Salmetarol and eformoterol

44
Q

Name two antimuscarinics

A

Ipratropium and tiotropium

45
Q

Name three inhaled corticosteroids

A

Beclomethasone

Budesonide

Fluticasone

46
Q

Name an oral theophylline

A

Aminophylline

47
Q

Name a mucolytic

A

Carbocysteine

48
Q

Name the three types of inhalers

A

Breath-activated

Dry powder

Metered dose

49
Q

Describe the treatment of COPD when newly diagnosed

A

Give anti-smoking advice/ treatment

Choose correct inhaler device and short SABA

50
Q

What should you do if the patient is still breathless on their SABA?

A

Add LABA or anti-muscarinic

51
Q

What should you do if the FEV1/FVC <50% or the patient is getting frequent exacerbations?

A

Add an inhaled corticosteroid

52
Q

Should you do if the patient is still breathless despite being on SABA, LABA, and antimuscarinic?

A

Consider pulmonary rehabilition, high dose bronchodilators (e.g. multidose SABAs or nebuliser), and theophylline

53
Q

What is QVAR?

A

Inhaled corticosteroid brand name

54
Q

What is plumicort?

A

Inhaled corticosteroid brand name

55
Q

What is flixotide?

A

Inhaled corticosteroid brand name

56
Q

What is Symbicort?

A

Combination inhaler

57
Q

What is Fostair?

A

Combination inhaler

TCD Content (6 decks)

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