COPD

Question 1

Usually able to maintain adeq oxygenation for longer time period
Pink puffer d/t pursed lips, skin color and thin body habitus

Answer 1

Emphysema predominant COPD

Question 2

Hypoxemia and resp acidosis common, cor pulmonale from pulm HTN
Blue bloaters d/t cyanosis and overweight

Answer 2

Chronic bronchitis predominant COPD

Question 3

Define chronic bronchitis

Answer 3

Chronic productive cough for 3 mo, during 2 consecutive years w/ no other cause

Question 4

Structural changes in chronic bronchitis

Answer 4

Mucous gland hyperplasia
Narrowing of bronchioles
Bronchial squamous metaplasia
Loss of ciliary transport

Question 5

Obstruction is inspiratory and expiratory

Answer 5

chronic bronchitis

Question 6

Pathologic enlargement of the the air spaces distal to the bronchioles d/t the destruction of the alveolar walls

Answer 6

Emphysema

Question 7

Airflow obstruction mostly during exhalation

Answer 7

Emphysema

Question 8

Not a/w sig hypoxemia

Answer 8

Emphysema

Question 9

Destruction of alveolar bed, resulting in reduced CO2 diffusing capacity
Hypercarbia

Answer 9

Emphysema

Question 10

Primarily eosinophil mediated chronic inflammatory disorder fo the airways

Answer 10

asthma

Question 11

Emphysema onset

Answer 11

Usually after age 50

Question 12

Chronic bronchitis onset

Answer 12

late 30’s-40’s

Question 13

Progressive, constant, severe dyspnea

Answer 13

Emphysema

Question 14

Intermittent, mild to moderate dyspnea

Answer 14

chronic bronchitis

Question 15

Persistent cough and sputum

Answer 15

chronic bronchitis

Question 16

Absent to mild cough and sputum

Answer 16

emphysema

Question 17

Clear, mucoid sputum

Answer 17

Emphysema

Question 18

Mucopurulent sputum

Answer 18

chronic bronchitis

Question 19

Pt presents with dyspnea, chronic cough, sputum production. Cough is usually in the morning.

Answer 19

COPD

Question 20

Dyspnea that is progressive, persistent, worse with exercise, worse with resp infxn

Answer 20

Consider COPD

Question 21

Primary cause of COPD

Answer 21

SMOKING

• stimulates elastase enzymatic activity causing degenerative changes in alveolar structures
• Causes release of cytotoxic oxygen radicals

Question 22

Causes premature emphysema

Answer 22

alpha-1 antitrypsin def

-inhibits elastase and enz, if not enough antitrypsin, they destroy lung tissue

Question 23

Exam findings of emphysema

Answer 23

Increase AP diameter
Distant breath sounds
Hyper resonant 
Pursed lip breathing 
Use of accessory muscles

Question 24

Emphysema ECG

Answer 24

sinus tachycardia
peaked P waves
Right axis deviation
RVH

Question 25

Hyperinflation (possibly with bullae) Flattening of diaphragm Enlargement of restrosternal air space CXR findings suggest:

Answer 25

Emphysema

Question 26

Cardiac enlargement Pulmonary congestion Increased lung markings CXR findings suggest:

Answer 26

Chronic bronchitis

Question 27

PFT: FVC (forced vital capacity)

Answer 27

Usually normal in COPD vs low in restrictive disease

Question 28

PFT: FEV1 (forced expiratory vol in 1 sec)

Answer 28

Decreased in COPD | reversible in asthma

Question 29

PFT: FEV1/FVC

Answer 29

decreased FEV1 w/ normal FVC suggets obstructive airway disease

Question 30

FEV1/FVC 80% predicted | W/ or w/o sx

Answer 30

Mild COPD

Question 31

FEV1/FVC <80% | Dyspnea w/ exertion, w/ or w/o cough and sputum production

Answer 31

Mod COPD

Question 32

FEV1/FVC <50% plus resp fail

Answer 32

Very severe COPD

Question 33

FEV1/FVC <50% | Increase DOE, fatigue, repeated exacerbations

Answer 33

Severe COPD

Question 34

Mainstay of COPD therapy

Answer 34

B2-agonists and anticholinergics (bronchodilators) Inhaled preferred

Question 35

Provides bronchodilation as well as reduce air trapping in lungs Well tolerated, less cardiac fx, better efficacy

Answer 35

Anitcholinergics - Short: ipatropium bromide (Atrovent) - Long: tiotropium bromide (Spiriva)

Question 36

Good bronchodilation fx, no fx on sputum/secretions

Answer 36

B2-agonists - Short: Albuterol - Long: Salmetrol, formoterol

Question 37

Inhaled for maintenance Reduce mucosal edema and inflamtn Inhibit prostaglandins Increase response to beta adreergics

Answer 37

Corticosteroids

Question 38

PDE-4 inhibitor for refractory cases

Answer 38

Anti-inflam fx | -suppresses cytokine release and inhibits lung infiltration by neutrophils and other WBCs

Question 39

Tx of alpha 1 anti-trypsin def

Answer 39

Antiprotease injections

Question 40

Indication for O2 therapy -must use at least 12 hours/d

Answer 40

pO2 less than 55 or O2 sat <88% on RA

Question 41

Why pursed lip breathing?

Answer 41

Increase resistance to air outflow, increases intrabronchial pressure to keep bronchi poen

Question 42

Macrolides

Answer 42

Azithromycin | Clarithromycin

Question 43

Flouroquinolones

Answer 43

Levofloxacin | Moxifloxacin

Question 44

Cephalosporins

Answer 44

Cefdinir | -does not cover typical pathogens