Copd

Front 1

What is the definition of COPD?

Back 1

airflow limitation that is not fully reversible, usually progressive, associated with an abnormal inflammatory responseto noxious particles or gases

Front 2

A 48 y.o. female in for the 1st time with a 3 month history of cough. No prior cough episodes. It is generally worse in the mornings, but occurs throughout the day and at times productive. She has a 15 pack year history of cigarette smoking and takes no medication. Based on the info given, at this point what is the most likely diagnosis?
A. Asthma
B. Emphysema
C. Chronic Cough
D. Chronic Bronchitis
E. Cough Variant Asthma

Back 2

C: Chronic Cough

Front 3

Define acute, sub-acute, and chronic cough

Back 3

Acute Cough < 3 weeks
Subacute Cough 3 - 8 weeks
Chronic Cough ≥ 8 weeks

Front 4

Define chronic bronchitis

Back 4

the presence of chronic productive cough for 3 months in each of 2 successive years

Front 5

Define emphysema

Back 5

abnormal permanent enlargement of airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.

Front 6

Define asthma

Back 6

Chronic inflammatory disease of the airways with bronchial hyper-responsiveness, reversible airway obstruction, and recurrent respiratory symptoms.

Front 7

In a patient with COPD, you would expect to find all of the following on a trans-bronchial biopsy except:
Macrophages
Loss of ciliary fimbrae
Mast cells
proteases
Goblet cells

Back 7

Mast cells, they are present in allergic type responses like asthma

Front 8

Chronic bronchial inflammation is caused by

Back 8

inflammatory cells (macrophages, neutrophils and CD8 cytotoxic T cells) in response to noxious stimuli
release of enzymes (proteases) which cause destruction in the airways and alveolar walls and mucus production by goblet cells

Front 9

Ciliary damage is caused by:

Back 9

the noxious stimuli (tobacco, occupational dusts and chemicals, and air pollution)

Front 10

How many % of smokers develop COPD? Why?

Back 10

15%
The inflammatory response to noxious stimuli may be genetically pre-determined...

Front 11

COPD risk is related to what?

Back 11

the total burden of inhaled particles, and possible genetic α-1-antitrypsin defieciency and
imbalance of antiproteases

Front 12

4 Components to the Overall Treatment of COPD?

Back 12

1st Component: Assess for Disease

2nd Component: Reduce Risk Factors

3rd Component: Manage and Monitor Stable COPD

4th Component: Manage Exacerbations

Front 13

What is the normal progression of COPD symptoms?

Back 13

Cough usually is the first symptom → followed by sputum production → shortness of breath.

Front 14

What are the key indicators for considering COPD diagnosis?

Back 14

Chronic cough, dyspnea, sputum production, exposure

Front 15

After following her for several years, you suspect that this patient may have COPD. She continues to smoke (now ~20yrs). On exam you find diffuse rhonchi, otherwise its normal. The best way to diagnose if she has COPD is by:
CXR
CBC to check for erythrocytosis
Clinically, by history of longstanding tobacco exposure, chronic prod cough and dyspnea
Spirometry
ABG

Back 15

Spirometry to determine exact amount of lung function

Front 16

What is the GOLD STANDARD for COPD diagnosis?

Back 16

Spirometry performed before and after bronchodilator exposure... without reversibility

Front 17

FVC = ?

Back 17

volume of air forcibly exhaled from the point of maximal inspiration

Front 18

FEV1 =

Back 18

volume of air exhaled during the first second

Front 19

What is considered reversability when after bronchodialator spirometry improves?

Back 19

Significant Reversibility is defined by ≥ 12% increase in FEV1 after bronchodilator

Front 20

FEV1/FVC is obstructive lung defect when what value is achieved?

Back 20

70%

Front 21

If FEV1 decreases ≥ 20% after methacholine provocation this indicates what?

Back 21

asthma

Front 22

All of the following are indications for an ABG in the evaluation of COPD except:
Postbronchodilator FEV1 < 50%
Hb/Hct >18/52 in ♂ and Hb/Hct >17/47 in ♀
Platelet count > 600,000
Signs of Right Heart Failure
Prolonged hypoxemia

Back 22

platelet count

Front 23

When are ABG's indicated?

Back 23

Used in most cases to determine if a patient requires home oxygen...
Post-bronchodilator FEV1 < 50%
Signs of respiratory failure (PO2<60 or PCO2>50) or Right Heart Failure
Prolonged Hypoxemia during hospitalization

Front 24

When is Complete Blood Count (CBC) indicated?

Back 24

Identify erythrocytosis/polycythemia from chronic hypoxemia and done in patients being considered for O2 supplementation

Front 25

What is BNP and what is it used for?

Back 25

Brain natriuretic peptide To help diagnose the presence and severity of heart failure

Front 26

COPD severity is based on what?

Back 26

post bronchodialator FEV1...80%. 50%. 30%.

Front 27

Which of the following routes has shown to be the most superior way to achieve smoking cessation:
Nicotine patch
Nicotine gum
Nicotine lozenge plus bupropione
Nicotine nasal spray plus bupropione and counseling program
Counseling program

Back 27

Nicotine nasal spray plus bupropione and counseling program

Front 28

Only 2 interventions have been shown to decrease mortality in COPD... what are they?

Back 28

smoking cessation and long term O2 supplementation

Front 29

INhaled steroids are appropriate for what stage COPD?

Back 29

3-4

Front 30

At what spo2 is long term home O2 introduced to COPD patients

Back 30

88%

Front 31

what is most common cause of COPD exascerbations?

Back 31

Infection of the tracheo-bronchial tree?

Front 32

What are the three cardinal signs of COPD exascerbation?

Back 32

increase SOB, increase sputum, change in sputum color...