Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

competency 10/11 > respi: copd > Flashcards

respi: copd Flashcards

1
Q

COPD is characterised by

A

qpersistent respiratory sx and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases
- chronic bronchitis
- emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

chronic bronchitis

A
  • consists of persistent cough + sputum production
  • for most days of 3 months in a year for at least 2 consec years
  • independent disease entity, that may occur before or after the development of airflow limitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

emphysema

A
  • abnormal permanent enlargement of the airspaces distal to terminal bronchioles
  • accompanied by destruction of their walls +/- obvious fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

risk factors for copd

A
  • tobacco smoking
  • indoor/outdoor air pollution
  • occupational exposures
  • genetic factors - severe hereditary alpha-1 antitrypsin deficiency: early onset of lung damage
  • age and sex - aging and female sex incr risk
  • lung growth and development
  • socioeconomic status: inversely related
  • asthma and airway hyper-reactivity
  • chronic bronchitis: incr freq of exacerbations
  • infections: hx of severe childhood infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

copd should be considered in any pt who has

A

dypsnea, chronic cough, sputum production, hx of exposure to risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

dyspnea that is

A

progressive over time, characteristically worse with exercise, persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

chronic cough

A

may be intermittent and may be unproductive
- recurrent wheeze
- present throughout the day, seldom nocturnal only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

GOLD 1

A

> = 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

GOLD 2

A

50-79

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GOLD 3

A

30-49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GOLD 4

A

<30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

mMRC grade 0

A

only breathless w strenuous exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mMRC grade 1

A

short of breath when hurrying on the level or walking up a slight hill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mMRC grade 2

A

walk slower than people of the same age on the level because of breathlessness, or have to stop for breath when walking on my own pace on the level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mMRC grade 3

A

stop for breath after walking about 100 meters or after a few mins on the level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

mMRC grade 4

A

too breathless to leave the house or when dressing/undressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CAT: <10

A

low impact on life
>= 10: consider regular treatment for sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CAT: >30

A

high impact on life, can barely leave house

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CAT: how many points change will suggest a clinically significant change in health status?

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Spiriva

A

tiotropium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Incruse

A

umeclidinium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Onbrez

A

indacaterol

23
Q

Relvar

A

vilanterol + fluticasone

24
Q

Seretide

A

salmeterol + fluticasone

25
Symbicort
formoterol + budesonide
26
regular treatment with ICS
incr risk of pneumonia esp in those w severe disease
27
LTRA use in copd
not tested adequately
28
simvastatin use in copd
does not prevent exacerbation in copd pt at incr risk of exacerbations and without indications for statin therapy - but observational studies suggest that statins may have pos effects on some outcomes in pts with copd who receive them for cv and metabolic indications
29
PDE4i in copd
in pt w chronic bronchitis, severe to moderate copd and a hx of exacerbation - can improve lung function and decr exacerbations
30
oral glucocorticoids use in copd
long term use has numerous side effects with no evidence of benefits
31
theophylline in copd
low dose reduce exacerbations but does not improve post-bronchodilator lung function
32
theophylline adr
- n/v, diarrhea - incr urination - incr hr, palpitations - breathlessness - insomnia - can cause seizures in toxic levels (has narrow therapeutic window)
33
initial pharmacological treatment: group A
bronchodilator: SABA or SAMA
34
initial pharmacological treatment: group B
long-acting bronchodilator: LABA or LAMA
35
initial pharmacological treatment: group C
LAMA
36
initial pharmacological treatment: group D
LABA+LAMA or ICS+LABA
37
when deciding whether or not to initiate ICS therapy, consider these factors:
- freq of exacerbations - hosp for an exacerbation - blood eosinophil count - hx of or concurrent asthma - hx of repeated pneumonia - hx of mycobacterial infection
38
azithromycin
may reduce exacerbation rate, esp in ex-smokers - 250mg/d or 500mg 3x/wk for 1 year
39
azithromycin adr
stomach cramps, diarrhea long term use, concern of ototoxicity eg. hearing impairment
40
PDE4i: roflumilast
* Reduce inflammation by inhibiting the breakdown of intracellular cyclic AMP * Reduces moderate and severe exacerbations treated with systemic steroids in patients with severe to very severe COPD * Benefits greater in patients with a prior history of hospitalisation for an acute exacerbation * Adverse effects: diarrhea, nausea, reduced appetite, weight loss, abdominal pain, sleep disturbance, headache, depression * Not registered in Singapore
41
vaccinations
influenza: all PCV13 and PPSV23: >65yo, younger pt w significant comorbid conditions incl chronic heart or lung disease covid-19: all Tdap (dTaP/dTPa): adults who were not vaccinated in adolescence to protect against pertussis (whooping cough)
42
Long-term oxygen therapy (LTOT) is indicated for stable patients who have:
* PaO2 at or below 7.3 kPa (55 mmHg) or SaO2 at or below 88%, with or without hypercapnia confirmed twice over a three week period; or * PaO2 between 7.3 kPa (55 mmHg) and 8.0 kPa (60 mmHg), or SaO2 of 88%, if there is evidence of pulmonary hypertension, peripheral edema suggesting congestive cardiac failure, or polycythemia (hematocrit > 55%). * Shown to improve survival in patients with severe resting hypoxemia
43
exacerbation of copd
an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal dayto- day variations and leads to a change in medication.”
44
exacerbations are classified as
mild, moderate, severe
45
mild exacerbation
treat w short-acting bronchodilators only
46
moderate exacerbation
treat with short-acting bronchodilators plus antibiotics and/or corticosteroids
47
severe exacerbation
pt requires hospitalisation or visits the emergency room. may be a/w acute respiratory failure
48
o2 therapy
maintain PaO2>60mmHg or SaO2 = 88-92%
49
corticosteroids
prednisolone PO 40mg OM x5d - longer courses may be a/w incr risk of pneumonia and mortality
50
role of vit d in immune modulation
All patients hospitalised for exacerbations should be assessed and investigated for severe deficiency (<10 ng/ml) and given vitamin D supplementation if required
51
methylxanthines
(theophylline) not recommended due to incr side effect profile
52
indications for antibiotics
* Patients with 3 “cardinal symptoms” (i.e., worsening dyspnea, increased sputum purulence and increased sputum volume) * Patients with 2 “cardinal symptoms” if increased sputum purulence is one of them * Severe exacerbations that require mechanical ventilation (invasive or non-invasive) * Consider other indicators of infection * Fever * Increased WBC count * CRP, procalcitonin * Changes on chest X-ray
53
most common bacteria
* Haemophilus influenzae * Streptococcus pneumoniae * Moraxella catarrhalis

competency 10/11 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions