COPD

Question 1

BAL in COPD shows increased number of what cell types?

Answer 1

Neutrophils and macrophages

Question 2

Cells recruited and activated in COPD by IL-8 and Leukotriene B4

Answer 2

Neutrophils

Question 3

Cells in COPD that correlate with severity of COPD

Answer 3

Neutrophils

Question 4

3 Proteinases secreted by neutrophils in COPD

Answer 4

• Neutrophil Elastase
• Cathepsin
• Proteinase 3

Question 5

Cells in COPD activated by cigarette smoke

Answer 5

Macrophages

Question 6

CD4/CD8 shift in COPD

Answer 6

Shift toward CD8

Question 7

Substance generated from chemical reaction with cigarette smoke and macrophages or neutrophils

Answer 7

Reactive oxygen species (ROS)

Question 8

Substance that supresses inflammatory genes that is impaired in COPD

Answer 8

Histone deacetylase 2 (HDAC2)

Question 9

Components of BODE index

Answer 9

BMI, Degree of obstruction, Dyspnea, Exercise capacity

Question 10

4 Hereditary diseases that cause bullous emphysema

Answer 10

Fabry’s disease (glycosphingolipid accumulation)
Cutis Laxa (lack of elastin fibers in the ECM)
Ehlers-Danlos (defect in collagen)
Marfan’s (Fibrillin-1 formation of ECM)

Question 11

Increased cancer risk in COPD with smoking and Bullous disease.

Answer 11

Smoking = 5x more risk
Bullous = 32x more risk

Question 12

Effect of cannabis on COPD

Answer 12

Acute = bronchodilator, increase FEV1 by 150-250 ml
Chronic = goblet cell hyperplasia and loss of ciliated bronchial epithelium

Question 13

Effect of neutrophil elastase in COPD

Answer 13

degrades elastin in elastic tissue like alveoli, higher amounts in emphysema

Question 14

Inhibitor that prevents elastase from destroying lung matrix

Answer 14

Alpha-1 antitrypsin

Question 15

Treatment which decreases gene expression of pro-inflammatory cytokines in those deficient

Answer 15

Alpha-1 antitrypsin

Question 16

4 Inflammatory cytokines in pulmonary disease

Answer 16

IL-1b
IL-6
TNF-a
B cell activating factor (BAFF)

Question 17

Threshold of alpha-1 antitrypsin deficiency in which emphysema is common

Answer 17

< 11

Question 18

5 most common types of alpha-1 antitrypsin deficiency in order from least to most severe

Answer 18

MM (Normal)
SS
MZ
SZ
ZZ

Question 19

Most common respiratory diagnosis in patients with alpha-1 antitrypsin deficiency prior to the diagnosis of hereditary emphysema

Answer 19

Asthma

Question 20

7 key features of alpha-1 antitrypsin deficiency

Answer 20

• Early onset emphysema (< 45)
• Lower lobe disease
• Unexplained liver disease
• Necrotizing panniculitis
• C ANCA positive vasculitis
• Family history of COPD, bronchiectasis, panniculitis
• Unremitting asthma with airflow obstruction

Question 21

Substance that accounts for 50% of COPD in developing countries and is present in 90% of rural households

Answer 21

Biomass fuel (wood, charcoal, vegetable matter, animal dung)

Question 22

Occupational fumes that are known to cause emphysema

Answer 22

Cadmium

Question 23

Which is the worse occupational exposure, dust or fumes?

Answer 23

Dust

Question 24

Most common virus that causes COPD exacerbation

Answer 24

Rhinovirus (over 100 subtypes!)

Question 25

How does viral infection effect COPD exacerbation

Answer 25

Causes longer time to recovery

Question 26

Effects of pulmonary rehab in COPD

Answer 26

- Improves exercise capacity and health status - Reduces readmission in the year following initiation - Significant reduction in mortality

Question 27

Minimum time for pulm rehab to be effective

Answer 27

6 weeks

Question 28

Requirement for roflumilast use

Answer 28

- On max inhaler therapy - FEV1 < 50% - Chronic bronchitis subtype

Question 29

Requirement for macrolide use in copd

Answer 29

Former smoker (doesn't work in active smoking)

Question 30

Initial inhaler regimen in GOLD B

Answer 30

LABA or LAMA, combo if fails

Question 31

Initial inhaler regimen in GOLD C

Answer 31

LAMA, combo LAMA/LABA if fails

Question 32

Treatment in overlap syndrome that reduces mortality and exacerbations in COPD

Answer 32

CPAP therapy

Question 33

PA diameter and ratio of PA diameter to ascending aorta measured on CT that are markers of pulmonary vascular remodeling and thus suggest PAH

Answer 33

PA diameter > 28 mm | Ratio > 1

Question 34

Ratio found on CT that is an independent marker of severe COPD exacerbations and mortality

Answer 34

Pulmonary artery to ascending aorta ratio > 1

Question 35

4 scoring categories of FEV1 in BODE index

Answer 35

0 points = > 65% 1 point = 50-65% 2 points = 35-50% 3 points = < 35%

Question 36

4 scoring categories of 6MWT in BODE index

Answer 36

0 points = > 350 m 1 point = 250-350 m 2 points = 150-250 m 3 points = < 150 m

Question 37

4 scoring categories of mMRC in BODE index

Answer 37

0 points = 0-1 1 point = 2 2 point = 3 3 point = 4

Question 38

4 year survival BODE index 0-2

Answer 38

80%

Question 39

4 year survival BODE index 3-4

Answer 39

67%

Question 40

4 year survival BODE index 5-6

Answer 40

57%

Question 41

4 year survival BODE index 7-10

Answer 41

18%

Question 42

total number of segments for calculating post op FEV1

Answer 42

18 Right - 3 upper, 2 middle, 5 lower Left - 4 upper (lingula included), and 4 lower (no medial-basal on left)

Question 43

Formula for predicting post op DLCO or FEV1

Answer 43

preoperative value (FEV1 or DLCO) x 1 - (segments to be removed/18)

Question 44

number of feet in 400 m for shuttle walk

Answer 44

1,333 ft

Question 45

number of feet in 22 m for stair climb

Answer 45

73 ft

Question 46

number of feet in 1 flight of stairs

Answer 46

13 ft or 4 m

Question 47

Threshold for postoperative FEV1 or DLCO to suggest low risk for lung resection

Answer 47

> 60%

Question 48

Threshold for postoperative FEV1 or LDCO below which you need a CPET

Answer 48

< 30%

Question 49

Test done for lung resection risk if predicted post operative FEV1 or FVC falls between 30 and 60%

Answer 49

shuttle walk test or stair climb

Question 50

VO2 max value indicating low risk for lung resection

Answer 50

> 20 ml/kg/min or > 75%

Question 51

VO2 max value indicating moderate risk for lung resection

Answer 51

10 - 20 ml/kg/min or 35 - 75%

Question 52

VO2 max value indicating high risk for lung resection

Answer 52

< 10 ml/kg/min or < 35%

Question 53

PaO2 level on high altitude test that requires in flight oxygen

Answer 53

< 50

Question 54

2 patient's who need high altitude test for in flight oxygen

Answer 54

Sats > 95% but desate to < 84% when walking Sats 92-95% but severe exertion dyspnea

Question 55

Sat level below which oxygen is required in flight

Answer 55

92% at rest