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C. Year 3 MLA Respiratory > COPD > Flashcards

COPD Flashcards

1
Q

In an obstructive airway disease, do patients struggle getting air into or out of the lungs?

A
  • getting air out of the lungs
  • patients can inhale fine, but cannot exhale properly
  • airways narrow and affect small, medium and larger parts of airways
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2
Q

In obstructive lung diseases, the elastic tissue in the lungs is affected. Are both recoil and compliance of lung tissue reduced in asthma?

A
  • no
  • recoil (ability of lungs to return to previous size) is reduces
  • compliance (stretching the lungs) is increased
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3
Q

What type of cells line the lumen of our airways?

1 - cuboidal epithelial cells
2 - transitional columnar epithelial cells
3 - ciliated pseudostratified columnar epithelial cells
4 - ciliated cuboidal cells

A

3 - ciliated pseudostratified columnar epithelial cells

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4
Q

Which of the following is NOT a layer of the mucosa that lines the airways?

1 - loose connective tissue
2 - goblet cells
4 - smooth muscle
5 - ciliated pseudostratified columnar epithelial cells
5 - basement membrane

A

4 - smooth muscle

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5
Q

Which of the following is NOT a layer of the submucosa that lines the airways?

1 - connective tissue
2 - smooth muscle
3 - bronchial mucinous glands
4 - basement membrane

A

4 - basement membrane

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6
Q

In the lining of the lumen, do goblet cells or bronchial mucinous glands secrete the majority of mucus in the lungs?

A
  • bronchial mucinous glands
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7
Q

In obstructive lung disease we can see hyperinflation and trapping of air. Why does this occur?

1 - mucus is secreted causing mucus plugs
2 - reduced elastic recoil (snap back of lung tissue)
3 - small bronchi trap air (<2cm airways
4 - all of the above

A

4 - all of the above

  • forced vital capacity may appear normal
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8
Q

What is Chronic Obstructive Pulmonary Disease (COPD)?

A
  • obstructive lung disease
  • progressive airflow obstruction
  • not fully reversible
  • symptoms always present
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9
Q

The risk of COPD increases with age, at what age does the risk generally start to increase?

1 - >16 y/o
2 - >25 y/o
3 - >35 y/o
4 - >50 y/o

A

3 - >35 y/o

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10
Q

In addition to the natural progression of COPD, what is the main cause that accentuates COPD?

1 - alpha 1 trypsin deficiency
2 - smoking
3 - asbestos
4 - occupation
5 - age >35 y/o

A

2 - smoking
- 90% of COPD is caused by smoking

  • age >35 y/o is also a high risk factor for COPD
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11
Q

In spirometry, would we expect to see an increase of decrease in functional residual capacity (FRC) (remaining air in lungs at end of normal exhalation) in a patient with COPD?

A
  • increase
  • recoil = reduced (ability of lungs to snap back and exhale air)
  • compliance = increased (stretching the lungs)
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12
Q

In spirometry, would we expect to see an increase of decrease in forced vital capacity (FVC) (air that can forcefully expired following maximum inhalation) in a patient with COPD?

A
  • small reduction
  • recoil is reduced so patient has to work harder to exhale air
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13
Q

In spirometry, would we expect to see an increase of decrease in forced expiratory volume in 1 second (FEC1) (air that can forcefully expired in 1 second following maximum inhalation) in a patient with COPD?

A
  • significantly reduced
  • airways are narrowed
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14
Q

In patients with asthma the FVC and FEV1 are reduced. What is the ratio that is diagnostic in patients with COPD?

1 - FVC/FEV1 <90%
2 - FVC/FEV1 <80%
3 - FVC/FEV1 <70%
4 - FVC/FEV1 <60%

A

3 - FVC/FEV1 <70%

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15
Q

In patients with COPD is the total lung capacity increased or decreased?

A
  • increased
  • lungs can become hyper inflated
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16
Q

FEV1 is decreased in obstructive lung disease, but typically in COPD how much does FEV1 generally decline each year in COPD patients?

1 - 10ml/year
2 - 30ml/year
3 - 100ml/year
4 - 1000ml/year

A

2 - 30ml/year

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17
Q

What % of the UK is diagnosed with COPD?

1 - 2%
2 - 12%
3 - 20%
4 - 50%

A

1 - 2%

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18
Q

How many deaths in the UK are caused by COPD?

1 - 300
2 - 3000
3 - 30,000
4 - 300,000

A

3 - 30,000

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19
Q

How many GP appointments and acute hospital (H) admissions are due to COPD?

1 - GP = 1000 and H = 12.5%
2 - GP = 1.4 million and H = 55%
3 - GP = 100,000 and H = 12.5%
4 - GP = 1.4 million and H = 12.5%

A

4 - GP = 1.4 million and H = 12.5%

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20
Q

What is the formula for calculating pack years?

A
  • (no. cigs per day x years) / 20
  • divide by 20 as packs contain 20 cigarettes
  • e.g 10 cigs for 10 years = (10x10)/20 = 5 pack years
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21
Q

Why are pack years calculated in COPD?

1 - can increase Q-risk
2 - can interfere with medication
3 - linked with occupation
4 - main risk factor for COPD

A

4 - main risk factor for COPD
- ⬆️ pack years = ⬆️ risk of COPD

  • any smoking, including passive smoke can also increase COPD risk
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22
Q

In patients who smoke, what % go on to develop COPD?

1 - 1-2%
2 - 5-10%
3 - 15-25%
4 - >45%

A

3 - aprox 15-25%

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23
Q

Why is the inverse care law important in COPD?

A
  • ⬇️ socio-economic = ⬆️ risk of COPD
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24
Q

The global initiative for COPD (GOLD) defines the severity of COPD. Which of the following is NOT part of this severity scale?

1 - Mild = FEV1 >95%
2 - Moderate = FEV1 50-79%
3 - Severe = FEV1 30-49%
4 - Very Severe = <30%

A

1 - Mild = FEV1 >95%
- mild is an FEV1 <80%

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25
Q

What is trypsin?

1 - enzyme that degrades proteins
2 - enzyme in coagulation cascade
3 - enzyme involved in bile synthesis
4 - enzyme involved in glycolysis

A

1 - enzyme that degrades proteins

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26
Q

What is alpha-1 antitrypsin?

1 - inhibits cytokines
2 - protease inhibitor
3 - inhibits scarring in the lungs
4 - HMG-CoA synthesis inhibitor

A

2 - protease inhibitor
- inhibits elastase in lungs following pathogen death
- elastin cannot be broken down
- COPD lungs lose elastin recoil

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27
Q

Why does alpha-1 antitrypsin deficiency cause COPD?

1 - reduces compliance of lungs
2 - increases compliance of lungs
3 - increases elastic recoil
4 - reduces elastic recoil

A

4 - reduces elastic recoil
- elastase in lungs can kill pathogens, BUT also degrades elastin
- alpha-1 antitrypsin inhibits elastate
- no alpha-1 antitrypsin means elastase degrade elastin in lungs
- causes air retention and inability to exhale

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28
Q

Which of the following forms of COPD can be caused by alpha-1 antitrypsin deficiency?

1 - causes emphysema (damaged alveoli)
2 - chronic bronchitis (damaged bronchi, main airways)
3 - bronchieltasis (smaller airways)
4 - all of the above

A

4 - all of the above

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29
Q

What is chronic bronchitis as a form of COPD?

1 - inflammation of upper airways
2 - inflammation of alveoli
3 - inflammation of bronchi
4 - all of the above

A

3 - inflammation of bronchi
- affects upper bronchi
- hyperplasia of goblet cells and increased mucus production - increased mucus plugs
- ⬆️ risk of infection

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30
Q

How long does bronchitis, which is inflammation of the airways that presents as a cough with mucus production need to present for to be defined as acute bronchitis?

1 - <1 week
2 - <2 weeks
3 - <3 weeks
4 - <4 weeks

A

3 - <3 weeks

31
Q

Chronic bronchitis as a form of COPD and typically results in a patient producing a lot of sputum. How long does this need to last for before a patient is diagnosed with chronic bronchitis?

1 - 2 day/month for 1 year
2 - 1 month for 1 year
3 - >3months for 2 years
4 - >6 months for 3 years

A

3 - >3months for 2 years

32
Q

Chronic bronchitis is a form of COPD. Which of the following symptoms can patients present with?

1 - dyspnea (SOB)
2 - cough
3 - creamy sputum
4 - symptoms gradually become worse over time
5 - all of the above

A

5 - all of the above

33
Q

Emphysema as a form of COPD. What is emphysema?

1 - damage to alveoli
2 - inflammation of alveoli
3 - inflammation of bronchi
4 - all of the above

A

1 - damage to alveoli
- distal to terminal bronchiole
- reduction in elastic properties (collagen and elastin lost)
- reduction in surface area
- interstitium becomes fibrotic and reduces perfusion

34
Q

Emphysema is a form of COPD. Which of the following symptoms can patients present with?

1 - dyspnea (SOB)
2 - cough
3 - hypoxia
4 - weight loss
5 - all of the above

A

5 - all of the above

  • patients purse their lips to help control air exhalation
35
Q

In chronic bronchitis and emphysema, do both of these have damage to the interstitium?

A
  • no
  • typically emphysema gets fibrosis of the interstitium
  • reduces O2 perfusion and increases CO2 retention
36
Q

If the interstitium is damaged or blocked in COPD, does the transfer factor for carbon monoxide (TLCO/DLCO)?

A
  • reduced
  • CO cannot diffuse
37
Q

In COPD, is there always airway remodelling?

A
  • yes
  • airway remodelling and emphysema are always present
38
Q

How can smoking increase risk of COPD?

1 - activates neutrophils in lungs
2 - elastase levels increase
3 - neutrophils cause inflammation
4 - all of the above

A

4 - all of the above
- essentially smoke irritates the lungs and causes reduced elasticity and inflammation

39
Q

What are large bullae?

1 - large mucus plugs
2 - deposits of elastase in alveoli
3 - an obstruction in the lungs
4 - alveoli sacs that have merged forming one large sac

A

4 - alveoli sacs that have merged forming one large sac

  • damaged alveolar sacs
  • small alveoli form one large sac called a bullae
40
Q

In emphysema does surface area and perfusion increase or decrease?

A
  • ⬇️ surface area
  • ⬇️ perfusion
  • can cause hypoxia and dysponea (SOB)
41
Q

In COPD there is hyperplasia of goblet cells, which increases mucus production. Which can this lead to in the lung of a patient with chronic bronchitis?

1 - ⬆️ viscous mucus
2 - ⬆️ infection as mucus acts as a medium
3 - damaged cilia
4 - fixed airway obstructions
5 - all of the above

A

5 - all of the above

42
Q

In COPD there is a reduction in elastic properties, how does this cause an increase in air trapping?

A
  • following inspiration airways collapse
  • elastic recoil of lungs forces air out, but not possible in COPD
  • air becomes trapped
43
Q

Why can trapped air and reduced elastic properties of the lungs increase work of breathing?

1 - expiration is generally passive due to elastic recoil
2 - accessory muscles need to be used to exhale causing fatigue
3 - pursed lip breathing helps, but uses lots more energy and can cause weight loss
4 - all of the above

A

4 - all of the above

44
Q

What are the most common symptoms in COPD?

A
  • breathlessness on exertion (important distinction with asthma)
  • chronic cough
  • chronic sputum production
  • winter bronchitis
  • wheeze
  • frequent infections
  • peripheral oedema (end stage COPD)
45
Q

When performing a spirometry test on a patient with COPD, would there be a >15% improvement in FEV1, and what would the FEV1/FVC ratio be?

A
  • no improvement in FEV1 as generally reversible
  • FEV1/FVC ratio is <70%
46
Q

In patients with suspected COPD due to their symptoms, but also present with significant weight loss is a red flag for what?

1 - breast cancer
2 - lung cancer
3 - haemoptysis
4 - peptic ulcers

A

2 - lung cancer

47
Q

What is haemoptysis?

A
  • coughing up blood - red flag for lung cancer
48
Q

A normal respiratory rate is around 12-16 breathes/minute. What is the respiratory rate of a patient with COPD expected to be?

1 - >12
2 - >16
3 - >20
4 - >30

A

3 - >20
- tachypnoea

49
Q

Which 2 of the following may cause patients with COPD to experience flapping or muscle tremors?

1 - B agonist medication
2 - CO2 retention
3 - hypoxia
4 - mucus plugs

A

1 - B agonist medication
- chronic use of B2 agonist activate B2 receptors in skeletal muscle

2 - CO2 retention

50
Q

Why might we see an increase in jugular venous pressure in patients with COPD?

1 - increased fluid retention in COPD
2 - increased pressure in the lungs
3 - B-blocker medication increase JVP
4 - cachexia causing poor venous return

A

2 - increased pressure in the lungs
- increased pressure forces blood back through pulmonary artery and into right side of the heart
- pressure in right side of heart increases
- right heart failure increases pressure that backs up to JVP via the superior vena cava

51
Q

Would patients with COPD be more likely to develop type 1 or 2 respiratory failure?

A
  • type 2 respirator failure
  • ⬇️ PaO2
  • ⬆️ PaCO2
52
Q

Breathing difficulty is associated with severity of COPD, what is the method for classifying breathlessness?

1 - MRC scale
2 - CURB-65 score
3 - mMRC
4 - Rockwood score

A

3 - mMRC
= modified Medical Research Council Scale

53
Q

Polycythaemia, which is high RBCs, can be common in patients with COPD. Why is this?

1 - COPD can cause sickle cell disease so increase RBCs to account
2 - COPD is associated with splenomegaly
3 - hypoxia degrades RBCs
4 - bone marrow increases RBCs in an attempt to increase O2 saturations

A

4 - bone marrow increases RBCs in an attempt to increase O2 saturations

  • COPD = low PaO2
  • bone marrow increases RBC production
  • attempt to increase haemoglobin and increase O2 saturation
54
Q

If cor pulmonale is suspected in patients with COPD, what are the 2 most common cardiac assessments?

1 - troponin
2 - ECG
3 - echocardiogram
4 - FBC

A

2 - ECG
3 - echocardiogram

  • right ventricle failure and hypertrophy
55
Q

What are 2 common assessments of quality of life in patients with COPD?

1 - COPD Assessment Test (CAT)
2 - CURB-65 score
3 - Rockwood score
4 - St. Georges Respiratory Questionnaire (SGRQ)

A

1 - COPD Assessment Test (CAT)
4 - St. Georges Respiratory Questionnaire (SGRQ)

56
Q

What are predominant cells in COPD?

A
  • neutrophils (N is closer to C than A in COPD and Asthma)
57
Q

Sleep apnea occurs in aprox 3-6% of patients with COPD. Which part of the airway is most commonly affected in obstructive sleep apnea?

1 - upper respiratory tract
2 - lower respiratory tract
3 - bronchi
4 - alveoli

A

1 - upper respiratory tract
- upper airways collapse

58
Q

Which of the following are common symptoms patients with obstructive sleep apnea/hyponea present with?

1 - snoring
2 - apnoeic (means without breath) episodes (>10 secs)
3 - excessive daytime sleepiness (Epworth Sleepiness Scale)
4 - nocturnal choking
5 - morning headaches
6 - unrefreshed upon waking
7 - nocturia (urinating at night)
- ⬇️ concentration, libido, memory
8 - all of the above

A

8 - all of the above

59
Q

Which of the following are common risk factors for obstructive sleep apnea/hyponea?

1 - obesity
2 - ⬆️ collar size
3 - enlarged tongue/tonsils
4 - long uvular
5 - nasal pathology
6 - down syndrome
7 - all of the above

A

7 - all of the above

60
Q

Which of the following is NOT a method for diagnosing obstructive sleep apnea/hyponea?

1 - overnight oximetry
2 - full polysomnography
3 - CURB-65 score
4 - Epworth Sleepiness Score

A

3 - CURB-65 score

61
Q

Which of the following is NOT a typical red flag for lung disease that may suggest serious lung disease such as cancer?

1 - haemoptysis (coughing up blood)
2 - persistent unexplained fever
3 - persistent unexplained night sweats
4 - weight loss
5 - persistent cough (>3 months)
6 - stridor (high pitched wheezing)

A

5 - persistent cough (>3 months)

62
Q

Is COPD reversible?

A
  • no
  • largely irreversible
63
Q

Is type 1 or 2 respiratory failure likely in patients with COPD?

A
  • type 2 respiratory failure
  • PaO2 <50mmHg
  • PaCo2 >60mmHg
64
Q

Cor pulmonale can occur in COPD. What is Cor pulmonale?

1 - left sided heart failure
2 - hepatic failure
3 - respiratory disease causing right sided heart failure
4 - respiratory disease causing left sided heart failure

A

3 - respiratory disease causing right sided heart failure

65
Q

Which of the following are simple lifestyle advice that patients with COPD should receive?

1 - smoking cessation
2 - ⬆️ activity
3 - improved nutrition
4 - all of the above

A

4 - all of the above

66
Q

In COPD, once the following have been tried:

  • stop smoking
  • pneumococcal vaccinations
  • influenza vaccinations
  • pulmonary rehabilitation
  • optimise treatment for comorbidities

Which 2 of the following can initially be offered?

1 - Salbutamol (SABA)
2 - Salmeterol (LABA)
3 - Ipratropium (SAMA)
4 - Prednisolone (glucocorticoid)

A

1 - Salbutamol (SABA)
3 - Ipratropium (SAMA)

  • start on one of these to relieve symptoms as needed
67
Q

In COPD, if a SABA or SAMA has been tried and patients are still having symptoms, which 2 of the following could be the next step in the management for this patient?

1 - SABA +LABA
2 - LAMA and LABA
3 - LABA + ICS
4 - SABA and LAMA

A

2 - LAMA and LABA
3 - LABA + ICS

68
Q

If SABA +LABA OR LABA + ICS fails to relieve symptoms of COPD, what would be the next step in the management for this patient?

1 - SABA + LABA
2 - LAMA and LABA and ICS
3 - LABA + ICS + Phosphodiesterase inhibitors
4 - SABA + LAMA + leukotriene receptor antagonist

A

2 - LAMA and LABA and ICS

69
Q

In patients with COPD who have any of the following they should be admitted to hospital.

  • severe breathlessness.
  • unable to perform ADL
  • deteriorating general condition
  • rapid onset of symptoms.
  • acute confusion
  • impaired consciousness
  • cyanosis.
  • O2 saturation <90%

What should they be given asap?

1 - LABA
2 - oxygen
3 - air
4 - SABA

A

2 - oxygen
- O2 via a Venturi mask at 24% at 2-3 l/min OR Venturi 28% mask at a flow rate of 4 l/min OR nasal cannula at a flow rate of 1-2 l/min (if a 24% mask is not available).

  • aim for sats of 88-92%
70
Q

If patients with COPD have an acute exacerbation, which of the following are commonly performed?

1 - nebulised short acting B2 agonist
2 - systemic steroids
3 - controlled O2
4 - intravenous aminophylline
5 - non invasive ventilation
6 - antibiotics
7 - all of the above

A

7 - all of the above

71
Q

Which of the following improves survival in COPD?

1 - long term O2 therapy
2 - SABA +LABA
3 - ICS
4 - LAMA + ICS

A

1 - long term O2 therapy
- long term O2 therapy
- non invasive ventilation
- lung volume reduction therapy

72
Q

What are some basic points to consider when discharging a COPD patient?

A
  • nutrition - smoking cessation - appropriate inhaler and correct technique - pulmonary rehabilitation - palliative care - vaccinations - psychological support
73
Q

If a patient presents to hospital with an admission of COPD, all of the following should be done asap, EXCEPT which one?

1 - chest X-ray
2 - ABG
3 - spirometry
4 - ECG
5 - FBC
6 - sputum sample culture
7 - blood sample culture

A

3 - spirometry
- important, but patient is unlikely to be able to do this

74
Q

Which of the following empirical antibiotics is NOT considered in patients with a COPD exacerbation?

1 - vancomycin
2 - amoxicillin
3 - clarithyromyocin
4 - doxycycline

A

1 - vancomycin

  • antibiotic given depends on the patient

C. Year 3 MLA Respiratory (15 decks)

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