Pulm: COPD

Question 1

This condition is characterized by persistent respiratory sxs and airflow limitation

Answer 1

COPD

Question 2

Small airway disease in COPD is characterized by what two pathyphysiologic responses?

Answer 2

airway inflammation and remodeling

Question 3

Parenchymal destruction in COPD is characterized by what two pathophysiologic responses?

Answer 3

loss of alveolar attachments

decreased elastic recoil

Question 4

Chronic bronchitis is characterized by presence of productive cough for…

Answer 4

at least 3 months in two consecutive years

Question 5

This is the destruction of gas-exchanging surfaces of the lung (alveoli)…

Answer 5

emphysema

Question 6

The following systemic effects are indicative of what pulm. disorder?

hypoxemia, hypercapnea
respiratory acidosis
cyanosis
cor pulmonale
weight gain/loss

Answer 6

COPD

Question 7

A patient presents with the following:

5th or 6th decade of life

DOE

Chronic cough

Sputum production

Recurrent lower respiratory infx

What is this concerning for?

Answer 7

COPD

Question 8

What is a major risk factor for COPD?

Answer 8

tobacco smoke

Question 9

What are the three “host factors” that contribute risk for COPD?

Answer 9

Alpha-1 antitrypsin deficiency

asthma

hx childhood respiratory infx

Question 10

Smoking stimulates elastase enzymes in the lungs. What two actions do elastases undergo?

Answer 10

degenerate elastin

release oxygen radicals from WBCs

Question 11

This disorder that accounts for < 1% of COPD has the following characteristics:

• causes premature emphysema
• causes overstimulation of proteases due to deficiency
• lung destruction accelerated with this disease and smoking

Answer 11

alpha-1 antitrypsin deficiency

Question 12

What are the three hallmark sxs of COPD?

Answer 12

Dyspnea
Chronic Cough
Sputum production

Question 13

What can be found on physical exam of a patient with COPD? (4)

Answer 13

use of accessory mm, tripoding

pursed lip breathing

cor pulmonale

digital clubbing

Question 14

Why does pursed lip breathing help in COPD?

Answer 14

prevents early bronchial collapse by increasing bronchial pressure

Question 15

What is the most common cause of cor pulmonale? (RHF)

Answer 15

COPD

Question 16

Patient presents with COPD and the following:

S3 gallop
RVH
Hepatomegaly
Peripheral Edema

What should you be suspicious for?

Answer 16

cor pulmonale

Question 17

A COPD patient arrives to the clinic with the following:

increased dyspnea

increased cough frequency/severity

increased/purulent sputum

What might be going on?

Answer 17

acute exacerbation of COPD

Question 18

What diagnostic is required to establish a COPD diagnosis?

Answer 18

Spirometry

Question 19

In addition to spirometry, what labs/diagnostics/imaging may be helpful? (5)

Answer 19

pulse ox

ABGs

CBC, BNP, cardiac enzymes, CMP, AAT

sputum culture

CXR/HRCT

Question 20

What test is used to diagnose and determine severity of COPD?

Answer 20

spirometry

Question 21

A post-bronchodilator FEV-1/FVC ratio of _______ confirms an obstructive pattern?

Answer 21

< 0.7

Question 22

Which GOLD class?

FEV-1 80+% of predicted

Answer 22

mild, class I

Question 23

Which GOLD class?

FEV-1 50-80% of predicted

Answer 23

Moderate, Class II

Question 24

Which GOLD class?

FEV-1 30-49% of predicted

Answer 24

Severe, Class III

Question 25

Which GOLD class? FEV-1 < 30% of predicted

Answer 25

Very Severe, IV

Question 26

What diagnostic should be ordered in the following conditions? FEV-1 < 50 SpO2 < 92 Depressed LOC Acute Exacerbation

Answer 26

ABGs

Question 27

What diagnostic should be ordered in a patient in the following conditions? pt. < 45yo non-smoker FHx of emphysema

Answer 27

AAT

Question 28

Is a CBC usually altered in COPD?

Answer 28

no, usually normal

Question 29

What CXR finding is pathognomonic for emphysema?

Answer 29

blebs or bullae

Question 30

What three signs on CXR indicate air trapping in COPD?

Answer 30

Increased AP diameter Hyperinflation and hyperlucency flattened diaphragms

Question 31

What may be present on CXR in chronic bronchitis?

Answer 31

perivascular/peribronchial markings

Question 32

What imaging modality can be considered when the following are present? pneumonia, PTX, large bullae PE Considering lung resection

Answer 32

CT Chest

Question 33

What intervention is key to preventing COPD progression?

Answer 33

smoking cessation

Question 34

3 minutes of counselling can increase smoking quit rate by___

Answer 34

5-10%

Question 35

What vaccines should be considered for COPD?

Answer 35

influenza pneumococcal

Question 36

O2 administration for ________ daily is shown to increase survival in patients with SpO2 of...

Answer 36

15+ hours daily SpO2 < 88, PaO2 < 56

Question 37

Grade A COPD is treated with...

Answer 37

SABA PRN

Question 38

Grade B COPD is treated with...

Answer 38

SABA + LAMA or LABA

Question 39

Grade C COPD is treated with...

Answer 39

SABA + LAMA

Question 40

Grade D COPD is treated with...

Answer 40

SABA + LAMA or LABA-LAMA

Question 41

What is the normal SABA (albuterol) dose?

Answer 41

2 puffs q 4-6 hours PRN

Question 42

Salmeterol and formoterol are...

Answer 42

LABA

Question 43

Ipratropium is a...

Answer 43

short acting anticholinergic

Question 44

Tiotropium and umeclidinium are what class of drug?

Answer 44

Long acting anticholinergics

Question 45

Fluticasone-salmeterol Budesonide-formoterol These are examples of...

Answer 45

LABA-ICS

Question 46

for whom is antiprotease therapy indicated?

Answer 46

AAT deficiency

Question 47

What are the two most common triggers for an acute exacerbation of COPD?

Answer 47

viral respiratory illness and pollution

Question 48

How is an acute COPD exacerbation managed in an outpatient setting?

Answer 48

Increase SABA Prednisone 40mg QD x 5 days

Question 49

What can be added for moderate to severe exacerbations of COPD?

Answer 49

abx x 5-7 days