COPD

Question 1

Is COPD reversible

Answer 1

No

Question 2

Charctoristics of emphysema (dilated airways)

Answer 2

• destruction of alveoli wall - less passes for gasses exchange

• air trapping in alveoli = low levels of oxygen and high levels of CO2

• loss of elastic recoil

Question 3

Characteristics of Bronchitis - blue bloaters

Answer 3

• inflam of bronchi
• muco cillary dysfunction = excess mucus producing = chronic cough
• hypoxia cor pulmonary
• cynosis- blue in colour

Question 4

Causes of COPD?

Answer 4

• smoking
• asthma
• fumes
• air pollution
• age
• genes - AATD

Question 5

Symptoms of emphysema?

Answer 5

• severe breathlessness
• hyperinflation
• thin appearance

Question 6

Symptoms of bronchitis

Answer 6

• hypoxia cor pumonary
• breathlessness
• respiratory failure
• cynosis
• obese
• productive cough

Question 7

Complications of COPD

Answer 7

• lung cancer
• recurrent chest infections
• anxiety
• depression
• respiratory failure

Question 8

Differential diagnosis?

Answer 8

• asthma
• TB
• cystic fibrosis
• lung cancer
• HF

Question 9

Test/investigations?

Answer 9

• spirometry
• chest x ray
• CT scan

Question 10

What vaccines should be given

Answer 10

pneumococcal + annual influenza (inactivated)

Question 11

Who should receive oxygen

Answer 11

• those with stable hypoxia OR blue bufferes

(It is not for breathlessness)

Question 12

If a patient has high levels of CO2 what should the oxygen saturation target be?

Answer 12

88- 92%

Question 13

If a patient has low/normal levels of CO2 what should the oxygen saturation target be?

Answer 13

94-98%

Question 14

Should the oxygen be at high or low conc?

Answer 14

Low concentration

Question 15

Before treatment begins ensure to - (pharmacological management)

Answer 15

Offer-

• smoking cessations
• vaccinations
• pulmonary rehabilitation
• self management plan
• optimise treatment of co-morbidities

Question 16

Inhaled therapies are for

Answer 16

Reliving breathlessness & exercise limitations

Patient must have satisfactory inhaler technique

Question 17

Step 1

Answer 17

SABA - salbutamol

OR

SABA - ipatropium

Question 18

Step 2 (for no asthmatic features or steroid need)

Answer 18

LABA - formoterol

+

LAMA - tiotropium

Question 19

Step 2 (for asthmatic features or need for steroids)

Answer 19

LABA - formoterol

+

ICS - Formoterol with budesonide (symbiont) - this is a combo of LABA + ICS

Question 20

Step 3

Answer 20

LABA + LAMA + ICS

Question 21

What options are included in add on therapy?

Answer 21

• oral corticosteroids
• theophylline
• oral mucolytic therapy (sputum)

Question 22

True or false

ICS should always be prescribed with LABA

Answer 22

True - LABA works best with ICS not alone

Question 23

Why does LABA have a prolonged relief affects

Answer 23

It is lipophilic and binds to beta 2 receptors for longer

Question 24

True or false SAMA stimulates parasympathetic aspect of ANS?

Answer 24

False they block it

SABA stimulates sympathetic system

LAMA + SAMA
Block parasympathetic CNS

Question 25

Antimicrobial prescribing in COPD

Question 26

Oral first line

Answer 26

• amoxicillin • doxycycline • clarythromycin (Doses same as pneumonia)

Question 27

Oral for alternative

Answer 27

• co-amoxiclav • co-trimoxazole (Doses same as pneumonia)

Question 28

First line IV

Answer 28

• amoxicillin • clarythromycin • co-amoxiclav • co-trimoxazole • pipracillin + tazobactam 5 day treatment (Doses same as pneumonia)

Question 29

Between emphysema and bronchitis, in which does loss of parenchymal lung texture.

Answer 29

Emphysema

Question 30

What is hypoxia cor pulmonary and symptoms

Answer 30

Right side HF • cynosis • SOB • odema

Question 31

Between emphysema and bronchitis which has a productive cough

Answer 31

Bronchitis

Question 32

After using a bronchodilator FEV1 less than ____ confirms persistent air flow obstruction

Answer 32

0.7

Question 33

Stages of Spirmoert my 1-4 according to MRC Dysphonia scoring system

Answer 33

1 - hurrying up or walking up a slight hill 2 - walks slower than people their age 3 - stops for a breath after walling 100m 4 - too dysphonic to leave the house or when getting changed

Question 34

In which patients, blue bloaters or pink puffers is oxygen used How long Concentration

Answer 34

Blue bloaters • long term • low concentration

Question 35

ADRS of oxygen at high conc

Answer 35

• drowsiness • headache • coma • respiratory arrest

Question 36

ICS management is likely to be beneficial in those with an eosinophil count of ?

Answer 36

>100

Question 37

Who can benefit from spacer devise

Answer 37

Elderly Cognitive impairment

Question 38

The brand name of the dual inhaler (formoterol and budesonide)

Answer 38

Symbicort

Question 39

The brand name of the dual inhaler (formoterol and beclometasone)

Answer 39

Fostair

Question 40

Brand name for LABA, LAMA & ICS combo

Answer 40

Trelegy epilepta

Question 41

Bran name for LABA and LAMA dua

Answer 41

Anoro ellipta

Question 42

Which class of drugs reduced inflammation

Answer 42

ICS

Question 43

Is it okay to use high conc of oxygen in UNCOMPLICATED cases of…

Answer 43

• pnumonia • PE • sepsis • anyphlaxic

Question 44

How is the amount of blood in the oxygen measured

Answer 44

• pulse oximetry test • blood sample from earlobe