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COPD Flashcards

1
Q

What is pink puffer ?

A

Emphysema

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2
Q

What is blue bloater?

A

Chronic Bronchitis

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3
Q

What are the differential diagnoses of hemoptisis and the most common?

A
  1. Bleeding disorder
  2. mitral Stenosis
  3. Heart failure
  4. Bronchitis (MC)
  5. Bronchiactesis
  6. Pneumonia
  7. Pulmonary TB
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4
Q

Compare acute and chronic bronchitis

A

Cough: dry then productive vs productive

Duration: less than 3w vs at least 3w for consecutive years

Etiology: viral vs smoking

Patient: less than 5 vs male adult

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5
Q

What are the stages of bronchitis?

A

-chronic simple bronchitis: hypertrophy of mucus glands leading to white mucoid discharge
- Chronic mucopurulent bronchitis: 2ndry bacterial infection (strept pn or H influenza) leading to yellow sputum
- Chronic obstructive bronchitis: mucus plugs and fibrosis leading to blue bloater

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6
Q

What is emphysema?

A

Abnormal permanent dilation of spaces distal to terminal bronchioles leading to loss of elastic recoil

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7
Q

What is the inheritance of alpha 1 antitrypsin deficiency

A

AR

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8
Q

What are the types of emphysema ?

A

True: congenital (alpha 1) or acquired (smoking)

False: senility and compensatory

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9
Q

Compare alpha 1 antitrypsin def and smoking on their effect on the lung

A

Alpha 1: pan acinar lower
Smoking: centri acinar upper

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10
Q

Compare pink puffer and chronic bronchitis (without examination)

A

Age: 50s vs 40s

Symptom: more severe Dyspnea than cough more severe cough than dyspnea

Complication:
• pneumothorax or Bullae
• exaccerbations/ 2ndry polycythemia/ corpulmonale

Prognosis good vs bas

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11
Q

Compare between pink puffer and blue bloater regarding examination:

A

General examination:

•Flushed and working accessory muscles
• weight loss
• tripod position
• pursed lip breathing

• central cyanosis
• weight gain
• peripheral edema
• pulmonary htn

Local examination:

Inspection: increased AP normal AP
Percussion: hyperresosanance vs normal
Ausculation: decreased sound vs harsh vesicular

No Ronchi vs ronchi

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12
Q

Compare pink puffer and blue bloater regarding investigations:

A

CXR: • decreased bronchivascular marking, jet black lungs, ribbon shaped heart, low flat diaphragm and horizontal ribs

• increased bronchovacular marking, normal sized lungs with or without right ventricular hypertrophy

ABG:

Hypoxia and normocapnia/hypocapnia
Hypoxia and hypercapnia

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13
Q

Compare pink puffer and blue bloater regarding investigations:

A

CXR: • decreased bronchivascular marking, jet black lungs, ribbon shaped heart, low flat diaphragm and horizontal ribs

• increased bronchovacular marking, normal sized lungs with or without right ventricular hypertrophy

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14
Q

What is COPD and its RF?

A

Chronic Obstructive Lung disease
1- Def: Umbrella term used to describe diseases that are cc by chronic progressive partially reversible
airway obstruction
2- R.F.: Smoking (Pack year 20 or more)

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15
Q

Give 3 examples of COPD

A

Refractory asthma
Emphysema
Chronic bronchitis

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16
Q

Describe the Clinical picture of a COPD patient

A

a- TOP: Old Heavy smoker

b- Symp.: Blue bloater or Pink puffer
Dyspnea

c- Signs:

1- G

a- Pulse = Pulsus Paradoxus or Arrhythmias

b- Head & Neck
1- Congested pulsating neck veins with Kussmaul’s sign

2- Tachypnea + Working accessory ms

  1. LL edema

2- L

I: Symmetrical, equal movement & increased A-P diameter, Hyper-inflation

P: Trachea (Centralized), TVF (Equal)

P: Bilateral hyper-resonance + Encroaching on heart & liver

A:
a- Breath S.: Type: Harsh vesicular (Prolonged expiration) + decreased Air entry Bilaterally

b- Additional S: Coarse crepitations + Rhonchi

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17
Q

What are the differential diagnosis of dyspnea?

A
  1. Anaphylaxis
  2. Cardiac Tamponade
  3. Mycardial Infarction
  4. Foreign body Inhalation
  5. Bronchial Asthma
  6. AECOPD
  7. Pneumothorax
    8.Pulmonary embolism
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18
Q

What are the investigations of COPD?

A

4- Invest.:

A- LAB.:

1- Sputum culture (Exacerbation)/ dec AT, 2ry Polycythemia

2- ABG = dec POz ‡ inc PCOz (Blue bloater) or Normal PCO2 (Pink puffer)

3- DLco = Impaired (Pink puffer)

B- RAD.: Blue bloater + Pink puffer

C- INST.: Spirometry
Obstructive Hypoventilation pattern inc TLC, dec FVC, dec FEV1

Post Broncho-dilator Ratio of FEVI/FVC < 0.7

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19
Q

What are the complications of COPD?

A

Complications

1- Acute exacerbation (airway inflammation)

2- Lung
(Pnthx, Bronchiectasis, Pneumonia, Cancer & Resp. F )

3- Heart failure

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20
Q

COPD types

A

Type A emphysema
Type B Chronic bronchitis

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21
Q

What is the hallmark picture of COPD?

A

Dyspnea

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22
Q

What are the arrhythmias of COPD and the most common ones ?

A

Multiracial Atrial Tachycardia (mc)
Atrial fibrillation

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23
Q

What feature is not a feature of COPD and what does its presence indicate?

A

Clubbing

Bronchiactesis or Cancer

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24
Q

Explain the etiology of LL edema in COPD

A

Corpulmonale
Decrease in cop
Increase in Raas
Decrease O2 so increase in permeability
Increased CO2 leading to acidosis and increase in NaHCO3 reabsorption

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25
How are acute exacerbations classified in COPD ?
Based on the presence of cardinal features Increased Dyspnea Increased sputum Increased purulence Mild Moderate Severe
26
What type of RF does a COPD patient experience State it’s ABG
Type 2 O2 below 60 CO2 above 50
27
What does GOLD stand for (w menha t3rf its use)
Global Initiative for Lung Disease
28
What are the 3 corner stones of GOLD
Risk of Annual Exacerbations Dyspnea Grades Spirometry grades
29
Post bronchodilator test in COPD Fev1/fvc is
Less than 0.7
30
List Gold levels
Gold 1 at least 80 Gold 2 80-50 Gold 3 50-30 Gold 4 less than 30
31
Dyspnea severity is measured by
Mmrc scale
32
COPD A Grade ttt and Diagnosis
- 0 or 1 Dyspnea severity AND - no or 1 without hospitalization SABA as needed
33
What is the most common cause of AECOPD ? And percentage and etiology stating the Mac
Infection 75% Rhinovirus Mc Strept pneumoniae H influenza
34
COPD grade B diagnosis and ttt
- 2,3 or 4Dyspnea severity AND - no or 1 without hospitalization LABA AND LAMA ON REGULAR BASIS
35
C + D =
E
36
What is C grade diagnosis?
- 0 or 1 Dyspnea severity AND - 2 or more and must require hospitalization
37
What is D grade diagnosis?
- 2,3 or 4 Dyspnea severity AND - 2 or more and must require hospitalization
38
What is grade E ttt?
If esinophils are at least 300 cell per microliter add ICS on regular basis
39
What are the vaccinations that COPD patients can benefit from ?
Pcv 13 Influenza
40
When should pulmonary rehabilitation start?
Grade B
41
What is the advantage of Venturi mask ?
Improves quality of life
42
When to start Venturi mask ?
PO2 55 or less Or PO2 less than 60 with PTH
43
What is Venturi mask ?
Long term low flow oxygen therapy
44
What are the lines of TTT of COPD?
*Community* 1. Patient education (smoking cessation, respiratory muscle exercise and vaccination) *Pulomonolgy* 2. Pulmonary rehabilitation 3. Venturi mask *Internist* 4. Symptomatic treatment of cough 5. Group ttt as needed *Surgical* 6. Surgical intervention
45
All grades of COPD require dual therapy of bronchodilators except
A
46
What surgical interventions can COPD benefit from ?
Bullectomy Lung volume reduction Transplantation
47
Describe how to treat a cough.
Dry: Codiene 10ml max 4 times a day Productive: Productive Mucolytic (N acetyl cysteine) 200mg max 3 times a day Expectorant (Guaifenesin) 200mg max 12 times a day
48
In COPD which route is it choice ?
Inhalation
49
Most important factor to stop progression of COPD
Smoking cessation
50
List bronchodilators you could use
B2 agonist M3 antagonists Methylxanthines (as theophylines pde 3 and 4 inhibitors)
51
Which type of bronchodilators are used for maintenance and control ?
Long acting bronchodilators
52
Long acting anti M3 or Long acting b2 agonists Which are superior to which in exacerbations?
LAMA
53
Which are more superior in controlling Dyspnea ? B2 agonist ICS M3 antagonist
B2 agonist ICS
54
Which are more superior in controlling clinical picture ? B2 agonist ICS M3 antagonist
B2 agonists ICS
55
What musnt be used for long term COPD treatment (we can use them fel exacerbation 3ady) and why
ICS and steroids Percipitate pneumonia
56
What should only be used in case there are no long acting bronchodilators (considered the last resort)?
Theophyline
57
What should only be used in case there are no long acting bronchodilators (considered the last resort)?
Theophyline
58
What is better to start with And except in
Long acting inhalers mild occasional dyspnea
59
In AECOPD What should we use IV or oral
Both are of the same efficacy Only use iv if patient is unable to swallow
60
Explain the etiology AECOPD
a- Etio.: 1- Infections 2- Exposure to pollution, Allergens, Chemicals & Cold weather 3- Pt. non-compliance 4- Heart failure, P. Embolism, Arrhythmias
61
Explain C/P of AECOPD
b- C/P: Cardinal Features (inc Dyspnea, inc Sputum Amount, inc Sputum Purulence) Other Features (Fever, Upper Resp. Tract infection, inc HR, R.R., Wheezes, Cough) (Cyanosis & LL edema)
62
Explain TTT of AECOPD
c- TT: 1- Mild (inc Dose of TTT) 2- Moderate (Add Oral Steroids ‡ ABs) 3- Severe (Needs Hospitalization up to CU)
63
What is the most common infection in AECOPD?
Street pneumoniae

Internal Medicine- Chest (7 decks)

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