COPD

Question 1

Characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases

Answer 1

COPD

Question 2

Persistent respiratory symptoms and airflow limitations that is NOT fully reversible

Answer 2

Chronic Obstructive Pulmonary Disease (COPD)

Question 3

Major physiologic change in COPD

Answer 3

airflow limitation

Question 4

3 MC symptoms in COPD

Answer 4

cough
sputum production
exertional dyspnea

Question 5

A PROVEN GENETIC RISK FACTOR for COPD

Answer 5

α1AT deficiency

Question 6

Associated with MARKEDLY REDUCED Α1AT LEVEL

Answer 6

Z allele

Question 7

Individuals with two Z alleles or one Z and one null allele and the MC form of severe α1AT deficiency

Answer 7

PiZ

Question 8

Changes in LARGE AIRWAYS will give rise to

Answer 8

cough and sputum

Question 9

Changes in small airways ≤2 mm and alveoli

Answer 9

physiologic alterations

Question 10

Reduction of this can↑ surface tension at the air-tissue interface –> airway narrowing or collapse

Answer 10

Surfactant

Question 11

Cells that will undergo biological pathways of PROTEASE-ANTIPROTEASE IMBALANCE  ECM DESTRUCTION

Answer 11

Macrophages

Question 12

Cells that will undergo biological pathways of OXIDANT/ANTIOXIDANT IMBALANCE –> CHRONIC INFLAMMATION

Answer 12

Neutrophils

Question 13

Cells that will undergo biological pathways of APOPTOSIS –> CELL DEATH

Answer 13

Epithelial Cells

Question 14

Cells that will undergo biological pathways of LUNG REPAIR –> INEFFECTIVE REPAIR

Answer 14

Lymphocytes

Question 15

Paradoxical inward movement of the rib cage with inspiration and a result of chronic hyperinflation

Answer 15

Hoover sign

Question 16

Hallmark of COPD

Answer 16

airflow obstruction

Question 17

Radiographic findings in COPD

EMPHYSEMA

Answer 17

obvious bullae
paucity of parenchymal markings
hyperlucency

Question 18

The current definitive test for establishing the presence or absence of emphysema, the pattern of emphysema, and the presence of significant disease involving medium and large airways

Answer 18

Chest computed tomography (CT) scan

Question 19

The STRONGEST SINGLE PREDICTOR OF EXACERBATIONS

Answer 19

history of a previous exacerbation

Question 20

Pink puffers

Answer 20

emphysema

thin, non-cyanotic, prominent use of accessory muscles

Question 21

Blue bloaters

Answer 21

chronic bronchitis

heavy and cyanotic

Question 22

Signs of hyperinflation

Answer 22

barrel chest

hyperresonance on percussion

Question 23

Severe cases - signs of cor pulmonale

Answer 23

bipedal edema

ascites

Question 24

Spirometry

Answer 24

FEV1/FVC <0.70
REDUCED FEV1, FEC1/FVC
INCREASED TLC, FRC and RV (d.t. air trapping)

Question 25

GOLD 1 FEV1 > 80% predicted

Answer 25

MILD chronic cough and sputum production patient unaware that lung function is abnormal

Question 26

GOLD 2 FEV1 50 - <80% predicted

Answer 26

MODERATE chronic cough and sputum production SOB on exertion patients seek medical attention

Question 27

GOLD 3 FEV 1 30 - <50 % predicted

Answer 27

SEVERE greater SOB reduced exercise capacity fatigue repeated exacerbations

Question 28

GOLD 4 FEV 1 < 30 % predicted

Answer 28

VERY SEVERE signs and symptoms of respiratory failure (PaO2 <60 mmHg +/- PaCO2 > 50 mmHg) cor pulmonale

Question 29

Most prominent in the UPPER lobes and SUPERIOR segments of lower lobes most frequently associated with CIGARETTE SMOKING

Answer 29

Centriacinar emphysema

Question 30

Abnormally large air spaces evenly distributed within and across acinar units α1AT deficiency has a predilection for the LOWER lobes

Answer 30

Panacinar emphysema

Question 31

abnormally large air spaces evenly distributed w/n and across acinar unit significant airway inflammation and w/ centrilobular emphysema

Answer 31

Paraseptal emphysema

Question 32

Clinically defined condition with chronic cough and phlegm

Answer 32

CHRONIC BRONCHITIS

Question 33

Major site of ↑ resistance

Answer 33

SMALL AIRWAYS

Question 34

Characteristic of COPD

Answer 34

Non-uniform ventilation and V/Q mismatching

Question 35

The current DEFINITIVE TEST for establishing the presence or absence of emphysema

Answer 35

computed tomography (CT) scan

Question 36

3 INTERVENTIONS WHICH IMPROVE SURVIVAL OF PATIENTS W/ COPD

Answer 36

smoking cessation oxygen therapy in chronically hypoxemic patients lung volume reduction surgery in selected patients with emphysema

Question 37

PHARMACOLOGIC APPROACHES FOR SUCCESSFUL SMOKING CESSATION:

Answer 37

* bupropion * nicotine replacement therapy available as gum, transdermal patch, lozenge, inhaler, and nasal spray * Varenicline - a nicotinic acid receptor agonist/antagonist

Question 38

Used for symptomatic benefit in patients with COPD

Answer 38

Bronchodilators inhaled route – preferred

Question 39

improves symptoms and produces acute improvement in FEV1

Answer 39

Ipratropium bromide

Question 40

Beta Agonists

Answer 40

SABA – ease symptoms w/ acute improvement in lung function LABA – symptomatic benefit and reduce exacerbations tremor and tachycardia – main side effects

Question 41

Inhaled Glucocorticoids

Answer 41

reduce exacerbations S.E. oropharyngeal candidiasis, pneumonia and loss of bone density

Question 42

Reduce exacerbation frequency in patients w/ severe COPD, chronic bronchitis and prior history of exacerbations

Answer 42

Roflumilast

Question 43

The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in patients with COPD

Answer 43

Supplemental Oxygen