Medicine- COPD + Pneumonia Flashcards
(43 cards)
Which two of the following conditions typically characterize the pathophysiology underpinning COPD?
a) Bronchiectasis
b) Interstitial lung disease
c) Emphysema
d) Chronic bronchitis
c) Emphysema
d) Chronic bronchitis
Which of the following are characteristic of Chronic Bronchitis?
a) Scarring of the lung parenchyma
b) Hypertrophy of mucus glands
c) Dilation of the alveoli following septal wall destruction
d) Permanent dilation of the bronchi
b) Hypertrophy of mucus glands
Which of the following symptoms/signs is atypical of a patient presenting with COPD?
a) SOB
b) Dry cough
c) Hyperinflated chest
d) Fatigue
b) Dry cough
What is ‘COPD’
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term referring to the obstructive airways disease of Chronic Bronchitis and Emphysema
Define chronic bronchitis?
Chronic bronchitis is defined as a daily productive cough for 3 months of the year, over two consecutive years. It is characterised by hypertrophy and hyperplasia of the mucus glands within the bronchial tree. Bronchial wall inflammation and mucosal oedema are also typically observed.
Define emphysema?
Emphysema is a disease of the terminal airways characterised by destruction of alveolar septal walls leading to dilation of the alveoli. The net result is air trapping.
Symptoms of COPD
Typical symptoms of COPD include
- Daily productive cough
- Persistent and progressive breathlessness
- Chest tightness
- Fatigue
Typical signs associated with COPD include
- Cyanosis
- Expiratory wheeze
- Frequent respiratory tract infections
- Pursed lip breathing
- Accessary muscle use to breathe
- Ankle swelling
When taking a history from a suspected COPD patient you have to screen the patient for risk factors.
What are they?
- Extensive history of cigarette smoking
- Chronic exposure to pollutants at work
- Alpha 1 Antitrypsin Deficiency
What is a classic presentation of a COPD patient?
A classic presentation of a patient with COPD would be that of a smoker, presenting with progressive symptoms of breathlessness and a productive cough. The symptom of breathlessness is often worse on exertion.
They may also report having recurrent respiratory infections.
Epidemiology of COPD?
- COPD tends to middle-aged adults and older.
- Those with a significant smoking history are at a much greater risk of developing COPD.
- Those with Alpha 1 Antitrypsin Deficiency.
Ix for COPD?
Spirometry
Lung function test
CHest X ray
A1AT levels
What would spirometry show on a COPD patient?
COPD would show an obstructive pattern of disease (FEV1/FVC ratio of < 0.7). In order to distinguish COPD from Asthma, you would test for reversibility, whereby the patient then uses a Salbutamol inhaler and spirometry is retested. In COPD, no significant change is observed, however in the case of Asthma, the condition is reversible
What would lung function test show on a COPD patient?
shows airflow limitation with increasing disease severity and symptoms. The severity of a patient’s COPD can be staged using their FEV1 value (see table RIGHT)
What does Chest X ray show on COPD patient?
COPD patients may have hyperinflated lungs
What does A1AT levels in COPD patients?
if low, may explain the cause of the patient’s COPD
Differentials for COPD
and how to differentiate them?
Asthma – the main differential to consider, however there are a number of factors that distinguish one condition from the other (summarised in the table RIGHT)
Heart failure – in a patient with HF, would expect SOB and ankle swelling, however also likely to report orthopnea, paroxysmal nocturnal dyspnea and may have basal crackles on auscultation
Bronchiectasis – would expect chronic production of large quantities of sputum. On examination, a patient with bronchiectasis may have coarse crackles and digital clubbing. Investigate with CT and CXR.
What are the different stages of COPD in relation ot FEV1
Difference in COPD and Asthma?
What is management for COPD patients?
Smoking cessation first
What are findings of COPD in a clinical examination?
- General inspection – older patients, may be on oxygen therapy, may have inhalers at the bedside, may have a sputum pot.
- Inspection of the hands – tar staining of the fingers. Flapping tremor due to CO2 retention. Fine tremor may indicate salbutamol use.
- Palpation of pulse – pulsus paradoxus (whereby the wave volume decreases with inspiration).
- Inspection of the chest – may observe a ‘barrel chest’ due to hyperinflation.
- Auscultation of the chest – expiratory wheeze
37 year old Mrs Jones presents to her GP with shortness of breath and a productive cough. The symptoms have worsened over the last few months, initially only present with exercise but now more frequent. Symptoms no worse at night. On taking her history, the GP finds: she has a 32 pack year smoking history and her mother had A1AT deficiency leading to liver cirrhosis. No other findings were noted.
Having considered other possible differentials (such as Asthma), the GP suspects a diagnosis of COPD. Which of the following points support the GP’s suspicion?
a) Symptoms no worse at night
b) Age 37 years old
c) Female
d) 32 pack year smoking history
e) Family history of A1AT
a) Symptoms no worse at night
b) Age 37 years old
d) 32 pack year smoking history
e) Family history of A1A
Mrs Jones then undergoes spirometry testing with reversibility. She is found to have an FEV1 reading of 54% predicted and an FVC reading of 84% predicted giving an obstructive pattern of respiratory disease. No significant change was observed with Salbutamol use. Given that COPD is the correct diagnosis, which of the following classifications is correct?
a) Stage 1 - Mild
b) Stage 2 - Moderate
c) Stage 3 - Severe
d) Stage 4 – Very severe
b) Stage 2 - Moderate
Mrs Jones is given the appropriate advice regarding initial management of COPD (i.e. smoking cessation etc). The GP then suggests starting inhaled therapies. Which of the following options is the most suitable inhaler therapy to start (on top of a Salbutamol PRN)?
a) LABA
b) Inhaled Corticosteroid
c) Theophylline
d) LABA and LAMA
d) LABA and LAMA
What is the underlying pathophysiology of pneumonia?
a) Inflammation of the lung tissue due to infection
b) Obstruction of the airways
c) Inadequate blood supply (and thus perfusion) to the lung parenchyma
a) Inflammation of the lung tissue due to infection
