COPD

Question 1

caused by

Answer 1

smoking

Question 2

who is more likely to get it

Answer 2

men working in unskilled manual occupations

Question 3

complications

Answer 3

• cor pulmonale
• lower tract infections
• depression

Question 4

what is the overarching characteristic

Answer 4

• airflow limitation

- destruction of lung parenchyma

Question 5

associated with

Answer 5

• ischaemic heart disease
• hypertension
• diabetes
• heart failure
• cancer

Question 6

defined by

Answer 6

disease state characterised by airflow limitation that is not fully reversible

Question 7

what is most common pathological finding

Answer 7

increase number of mucus-secreting goblet cels in bronchial mucosa

Question 8

pathology in advanced stages

Answer 8

bronchi become overly inflamed and pus is seen in lumen

Question 9

what is seen microscopically

Answer 9

infiltration of the walls of the bronchi and bronchioles

Question 10

what is the predominant lymphocytic infiltrate

Answer 10

CD8

Question 11

what can happen to epithelial layer

Answer 11

can become ulcerated

Question 12

what metaplasia occurs over time

Answer 12

squamous epithelium replaces columnar cells

Question 13

when are airways affected

Answer 13

early

Question 14

what is emphysema

Answer 14

loss of elastic recoil of lung with collapse of small airways

Question 15

what is pan-acinar emphysema associated with

Answer 15

alpha-1 antitrypsin deficiency

Question 16

what does inflammation and scarring cause in small airways

Answer 16

narrowing

Question 17

what does bronchoalveolar lavage and biopsies show

Answer 17

increased numbers of neutrophil granulocytes

Question 18

what can granulocytes release

Answer 18

elastase and proteases

help produce emphysema

Question 19

what imbalance is shown

Answer 19

in protease and antiprotease

Question 20

what antiprotease is inactivated by smoking

Answer 20

alpha1- antitrypsin

Question 21

what causes mucous gland hypertrophy in larger airways

Answer 21

persistent irritation from inhalation of cigarette smoke

Question 22

where is alpha1-antitrypsin produced

Answer 22

in liver

Question 23

where is alpha1-antitrypsin secreted

Answer 23

into blood and diffuses into lung

Question 24

what dose alpha1-antitrypsin inhibit

Answer 24

neutrophil elastase

Question 25

what does neutrophil elastase destroy

Answer 25

alveolar wall connective tissue

Question 26

symptoms

Answer 26

- productive cough - clear sputum - wheeze - breathlessness - frequent infective exacerbation

Question 27

when are symptoms worsened

Answer 27

cold or damp weather

Question 28

what are some systemic effects

Answer 28

- depress - hypertension - osteoporosis - weight loss - reduce muscle mass

Question 29

what can patients develop

Answer 29

pulmonary hypertension (cor pulmonale)

Question 30

what is diagnosis

Answer 30

clinical

Question 31

what investigations can be done

Answer 31

- Lung function test - CXR - CT - blood gases - sputum exam - ECG - echo

Question 32

what is the FEV1:FVC ratio

Answer 32

reduced

Question 33

what is seen on CXR

Answer 33

- overinflation - flattened diaphragms - pruned blood vessels can be normal so would do CT

Question 34

what causes exacerbation

Answer 34

- step pneumonia | - H.influenza

Question 35

ECG shows

Answer 35

often normal in pulmonary hypertension - tall p wave - right bundle branch block - right ventricular hypertrophy

Question 36

what is the single most useful thing for treatment

Answer 36

smoking cessation

Question 37

what drugs are used

Answer 37

- beta-adrenoreceptor agonist - antimuscarinic drug - theophyllines

Question 38

example of beta agonist

Answer 38

salbutamol

Question 39

LAMA example

Answer 39

tiotropium

Question 40

SAMA example

Answer 40

ipatropium

Question 41

do theophyllines work for COPD

Answer 41

no

Question 42

PDE4 inhibitor

Answer 42

roflumilast

Question 43

how long should prednisolone be given for

Answer 43

2 weeks

Question 44

in an exacerbation what is oxygen given through

Answer 44

venturi mask initially 24%

Question 45

what is there a loss of in emphysema

Answer 45

distal lung parenchyma

Question 46

causes of centrilobar emphysema

Answer 46

- smoking | - coal dust

Question 47

where is centrilobar emphysema mostly

Answer 47

upper lobes

Question 48

where is pan lobar emphysema

Answer 48

lower lobes

Question 49

who gets pan lobar emphysema

Answer 49

alpha-1 antitrypsin