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Clin Med- P > COPD > Flashcards

COPD Flashcards

1
Q

epidemiology of COPD: _____ of longterm smokers with well COPD, ____ of smokers will die from a smoking-related cause

A

25%, 50%

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2
Q

Worldwide, COPD is expected to move up from being ____ leading cause of ______ lost in 1990 to ____ in 2020

A

12th , disability-adjusted life-years (DALYs)

5th

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3
Q

while ____ is the leading cause of COPD,

_______ is important cause of COPD, especially in the absence of smoking

A

smoking,

Alpha 1 anti-trypsin deficiency

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4
Q

onset of COPD (decade of life?)

A

5th-6th

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5
Q

4 risk factors for COPD that are unchangable

A

genes, infections, socio-economic status, AGE

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6
Q

“GOLD” definition of COPD

A

conditions of chronic bronchitis, emphysema and chronic asthma
“a preventable, treatable disease
-airflow limitation (progressive)
-enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.”

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7
Q

COPD is considered _____ b/c its chronic

A

irreversible

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8
Q

emphysema, Chronic bronchitis, asthma… which has most reversibility, most sputum, most alveolar damage?

A

reversible: asthma
sputum: chronic bronchitis
alveolar damage: emphysema

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9
Q

emphysema, chronic bronchitis, asthma… which has no reversibility?

A

emphysema

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10
Q

onset late in life, smoking history and symptoms slowly progressive…

A

COPD

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11
Q

onset early in life, symptoms vary and worse at night/morning, family history of disease…

A

Asthma

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12
Q

what are elastases?

A

enzymes that breakdown elastic connective tissue that is there to support terminal bronchioles and alveoli - this breakdown leads to airway collapse

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13
Q

______ and _______ leads to elastase increase

A

smoking and longterm irritation

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14
Q

Alpha1- Antitrypsin deficiency

A

this is a proteolytic enzyme- deficiency leads to imbalance of elastase activity- can lead to emphysema

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15
Q

patients with COPD symptoms who are young/non-smokers.. think …

A

Alpha1-antitrypsin deficiency

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16
Q

loss of elasticity in the lung leads to …

A

small airways collapse and air is “trapped” due to premature small airway closure during expiration

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17
Q

emphysema: no symptoms until ___ of lung is damaged

A

1/3

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18
Q

_____ and ______of emphysema can be seen on ___ by not ___

A

bullae and cavities

CT, not Xray

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19
Q

different between Chronic bronchitis and emphysema in regards to where in the bronchiole/alveoli they are influencing. both involve what airway wall changes

A

emphysema- distal to terminal bronchioles (loss of alveolar surface area
chronic bronchitis- proximal to alveoli (no alveolar loss)
-both: airway wall thickening

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20
Q

Dx of COPD is based on ____

A

history! (smoker?, occupational exposure? age?, etc. )

and PFT!

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21
Q

6 signs of COPD on PE : inspection (most show up in later stages)

A

barrel chest, pursed lips, cough, dyspnea, use of accessory muscles, clubbing/nicotine stains

22
Q

barrel chest is more common in emphysema or chronic bronchitis?

A

emphysema

23
Q

pursed lips are a sign of …

A

PEEP : positive end expiratory pressure

24
Q

palpation/percussion findings of PE for COPD (4)

A

hyper-resonance
distance heart sounds (long AP diamter - barrel chest),
expiratory>inspiratory,
possible crackles, wheezing, rhonci

25
Q

____ demonstrates degree of obstruction for COPD

A

spirometry

*COPD severity is assessed using the postdilator lung function (FEV1/FVC ratio before and after inhaled bronchodilator)

26
Q

ratio of FEV1/FVC < ____ indicates obstruction

A

0.7

27
Q

COPD: mild, moderate, severe stages based on FEV1 percent predictive value

A

mild: >80%
moderate: 50%-80%
severe: 30%-50%

28
Q

COPD: Dx w/ ____ , level severity with _____

A

PFT, ABGs

29
Q

4 things to do for evaluation of person with confirmed moderate COPD

A

glucocorticoid reversibility testing, chest Xray, ABGs, anti-trypsin screen (if not usual population)

30
Q

two types of COPD

A

A. pink puffer - mainly emphysema

B. blue bloater - mainly chronic bronchitis

31
Q

pink puffer

A

Pink Puffer:- O2 stays up, breath fast and shallow (puffing) - skinny b/c putting so much metabolic effort into breathing
Hypertrophy of accessory breathing muscles
( lung compliance inc.)
Thin
Pink (polycythemia)
Pursed lips

32
Q

blue bloater

A 
coughing up mucus
Overweight
Perioral/digital cyanosis
Digital clubbing
younger
33
Q

steroids better for chronic bronchitis or emphysema?

A

chronic bronchitis

34
Q

what is chronic bronchitis and where does it come from?

A

Classic definition:
presence of cough/sputum production for most days for at least 3 consecutive months during 2 consecutive years.
Results from prolonged exposure to irritants including cigarettes and allergens, pollutants, and recurrent infections.
Have inflammatory changes in bronchial mucosa and increase in the number and size of mucus glands

35
Q

fibrosis inflammation and mucus comes from…

A

chronic bronchitis

36
Q

emphysema

A

enlargement of airspaces distal to terminal bronchioles
destruction of alveolar walls
results in: inc. CO2, pulm. HTN, inc. effort, polycythemia, cor pulmonale

37
Q

Single most effective (and cost effective) intervention to reduce the risk of developing COPD and stop its progression

A

stop smoking

38
Q

the five As to help someone stop smoking

A

The Five A’s
ASK about tobacco use
ADVISE clear, nonjudgmental personalized
ASSESS readiness to quit
ASSIST with a plan (materials, resources, Rx, referral)
ARRANGE for follow-up, Don’t give up on your patients if they relapse

39
Q

pharmacotherapy for COPD is used to do….

A

pharmacotherapy is used to decrease symptoms, reduce the frequency and severity of exacerbations,

40
Q

the only therapy that impacts the natural history of COPD

A

O2 therapy

41
Q

_______ medications are central to the symptomatic management of COPD.

A

bronchodilators

42
Q

inhaled anti-cholinergics and COPD?

A

be careful, one study showed theyre associated with increased risk of cardiovascular death, MI, or stroke among patients with COPD.”

43
Q

PDE-4 inhibitors may reduce ___ by ___% for COPD

A

May reduce exacerbation rate, by ~15-20%. but there are toxic ADRs- tacchyarrythmia, nausea/vomit, seizures

44
Q

ICS for stable COPD:

A

regular txt w/ ICS does not modify the longterm decline in FEV1
-only helpful for some symptomatic pts

45
Q

An inhaled corticosteroid combined with a ______is more effective in treating COPD symptoms than either alone

A

long-acting beta2-agonist

46
Q

LVRS- lung volume reduction surgery for COPD

A

is pallative, improves elastic recoil and diaphragm expansion
for emphysema- predominant COPD

47
Q

acute exacerbation of chronic bronchitis/COPD (AECB)

A

Increase in dyspnea, sputum purulence or sputum volume

  • fever
  • 20-50% du to viral infections
48
Q

AECB should be treated with:

A

Abx

49
Q

morning headache can be a sign of …

A

inc. CO2 (hypercapnea)- COPD

50
Q

for COPD, expiration is ____ than inspiration

A

longer

Clin Med- P (124 decks)

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