COPD/Emphysema (Headley) Flashcards Preview

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Flashcards in COPD/Emphysema (Headley) Deck (40):
1

What is a disease state that is characterized by reversible airway obstruction?
Irreversible?

asthma
COPD

2

What changes are happening in the airways and the lung parenchyma in COPD?

airways: inflammation, fibrosis, luminal plugs (secretions)

parenchyma: loss of alveolar attachments and decreased elastic recoil

3

COPD mortality is higher in (men or women)

women

4

What are the causes of COPD?

smoking > occupational dust and chemicals, air pollution
(poorly controlled asthma can also cause it)

5

FEV1 of ____% of normal is assc with exertional dyspnea
____% of normal is assc with disability

40 -60%
<30%

6

Smokers with a mean ____ pack yeat Hx develop COPD

20

7

At what age do pts with COPD develop URT symptoms (cough and sputum)?

40s

8

At what age does dyspnea develop?

50s or 60s

9

What is required to make the diagnosis of COPD?

spirometry with FEV1/FVC ratio < 0.7 and no improvement in post-bronchodilator therapy FEV1 >15% and > 200 ml

10

What are the symptoms and risk factors for COPD?

symptoms: Cough, sputum, dyspnea (exertional then at rest)

RF: smoking, occupation, indoor/outdoor pollution (mostly developing/3rd world countries)

11

What is the clinical definition of chronic bronchitis?

production of sputum for 3 months in 2 consecutive years

12

What are clinical findings assc with airway obstruction with COPD

-Wheezing (due to obst)
-prolonged forced expiration (due to obst)

13

What are clinical findings assc with hyperinflation with COPD?

-barrel chest
-pursed lip breathing
-low diaphragm position
-distant heart and breath sounds

14

What are clinical findings assc with impairment of the mechanics of breathing with COPD?

-use of accessory muscles when breathing
-retractions (in drawings of lower intercostal interspaces)
-chest/abdominal wall paradoxical movements

15

What CV signs can be seen with advanced COPD?

cor pulmonale

hyperinflation puts pressure on RA --> Right heart failure
-JVD, hepatomegaly, peripheral edema

16

How are asthma and COPD spirometry results different?

low FEV1/FVC in asthmatics will correct with bronchodilator and it will not in pts with COPD

17

What makes a pt with COPD "high risk" to have progressive decline in disease? *sorry for the terrible wording

2 or more exacerbations within the past year
FEV1 < 50% of predicted value

18

WHat is the defn of an exacerbation of COPD?

worsening of respiratory symptoms (dyspnea) that requires a change in medication

19

When should a pt be screened for alpha-1 anti-trypsin deficiency?

person in 30 or 40s develop COPD and have a strong family Hx of COPD

20

On what chromosome is the alpha-1 anti-trypsin gene found?

14

21

Who are the pink puffers and blue bloaters? Why are they called that?

2 sides of the COPD spectrum:

pink puffers = emphysema prominent COPD
-pink = near normal gas values, thin, intense dyspnea

blue bloaters = chronic bronchitis prominent COPD
-blue = hypoxemic and hypercapnic, obese, CHF, edema, mild dyspnea

22

What is the cause of the hypoxemia and hypercapnia in chronic bronchitis?

V/Q mismatch

23

Are blue bloaters hypo or hyperventilated? Why?

Hypoventilated:
alterations in CNS centers allows for decreased work of breaking (dec RR) but it comes at a cost of inc CO2 levels

24

What are the long term consequences of blue bloaters' hypoventialtion?

chronic hypoxemia -->
-polycythemia (elevated Hct)
-Pulmonary HTN
-cor pulmonale

25

What is the cause of the hypoxemia in emphysema?

V/Q imbalance and diffusion abnormalities from alveolar destruction

26

Are pink puffers hypo or hyperventilated? Why?

hyperventialted:
they maintain thier PCO2 levels in the normal rage but it comes at the cost of high work of breathing

27

T or F: In emphysema O2 saturation is preserved

True (by inc MV)

28

COPD pts are at an increased risk to develop...

MI, angina
osteoporosis
respiratory infections
depression
DM
lung cancer

29

What are the different inflammatory cell mediators in Asthma and COPD?

Asthma: CD4 and eosinophils

COPD: CD8, macrophages, neutrophils

30

What does an icreased Reid Index indicate? What does this index measure?

chronic broncitis

bronchial gland depth as a fraction of total bronchial wall thickness

31

Describe the cellular changes in the central airways (cartilaginous) of COPD/chronic bronchitis

bronchial gland hypertrophy
goblet cell metaplasia
squamous metaplasia of epithelium (loss of cillia and function)
fibrosis
infiltration by CD8 and neutrophils

32

What are the differences between centrolobular and panlobular emphysema?

centrolobular: dilation and destruction of the respiratpry bronchioles
-upper lobe predominance
-assc with smoking

panlobular: dilation and destruction of the entire acinus
-lower lobe predominance
-assc with alphs 1 anti-trypsin def

33

What are bullae?

emphysematous spaces > 1 cm in diameter

34

What is the pathophys of emphysema?

loss of alveolar attatchments --> small airway collapse during expiration
V/Q mismatch

35

What are the 3 irreversible changes that limit airflow in COPD?

1. fibrosis and narrowing of airways
2. loss of elastic recoil
3. destruction of alveolar attachments

36

What are the 3 reversible changes that limit airflow in COPD?

1. accumulation of inflammatory cells, mucus, and plasma exudate in bronchi
2. smooth muscle contraction
3. dynamic hyperinflation at rest and worsening at exercise --> muscles at at mechanical disadvange and have to work harder to breathe

37

How does COPD manifest on CXR

flattened diaphragm
hyper-inflated lungs
tear drop heart
increased vascular markingss

38

Describe the PFTs for pure emphysema ?

-increased TLC and RV
-increased compliance
-decreased VC
-decreased elastic recoil
-dec DLCO

39

What are the etiologies of COPD exacerbations?

bacterial infection, virus, unidentified

40

For Tx/management of COPD see sweatmen's shit

im feeling lazy