Exam 4 - Copd - Pcp 2011

Front 1

Define COPD

Back 1

COPD is a preventable and treatable disease with significant extrapulmonary effects that are characterized by airflow limitations that are not fully reversible.

Front 2

Define chronic bronchitis

Back 2

COPD disease that is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years - is not necessarily air flow limitation.

Front 3

Define emphysema

Back 3

COPD disease that is defined as the destruction of alveoli and is divided into 3 subgroups.

Front 4

True or false: the majority of COPD patients suffer from COPD due to occupational chemicals or air pollution.

Back 4

False - the majority of COPD patients suffer from COPD due to tobacco smoke.

Front 5

True or false: the socioeconomic status of a population is inversely proportional to their risk for COPD

Back 5

True - as the socioeconomic status decreases there is an increase in risk for COPD

Front 6

True or false: genetics, a history of airway hyper-responsiveness and BMI are risk factors for COPD

Back 6

False - BMI is not a risk factor for COPD

Front 7

Why do COPD patients develop right heart failure characterized by RV hypertrophy and pulmonary edema?

Back 7

The body attempts to match perfusion with volume because of a V Q mismatch.

Front 8

What are key indicators to COPD

Back 8

Chronic cough, chronic sputum production, and progressive persistent dyspnea

Front 9

True or false: chronic cough and sputum production typically precede airflow limitation by years

Back 9

True - chronic cough and chronic sputum production are early signs of COPD

Front 10

True or false: spirometry is required to complete a diagnosis for COPD despite presence of key symptoms.

Back 10

True - spirometry is required to establish the diagnosis

Front 11

True or false: physical exams and chest x-rays are not diagnostic measures of COPD

Back 11

True - although airway obstruction (barrel chest/low, flat diaphragm), right heart failure, and airway destruction (bullae) may be somewhat evident via these methods - there is no concrete evidence

Front 12

What are typical ABG values for PaO2 and PaCO2 in COPD patients

Back 12

PaO2 less than 60mmHg with/without
PaCO2 greater than 45mmHg

Front 13

True or false: it is not recommended for patients with COPD to receive the flu vaccine as it may exacerbate their condition

Back 13

False - the flu vaccine is in indicated for all patients especially those with COPD

Front 14

True or false: it is important for all COPD patients to receive a SABA

Back 14

True - all patients despite their stage of COPD classification should receive a SABA

Front 15

What are the recommended avoidance measures for COPD patients?

Back 15

Smoking cessation
Avoid risk factors
Influenza vaccine

Front 16

True or false: SABAs are used as maintenance therapy for all stages of COPD

Back 16

False - SABA is used as a PRN rescue drugs for all stages of COPD

Front 17

True or false: LABAs are only used for Stage III and IV COPD

Back 17

False - LABAs are used for Stage III and IV in addition to Stage II COPD.

Front 18

True or false: inhaled steroids should always be used for Stage III and IV COPD

Back 18

False - Inhaled corticosteroids should only be used if there were 3 or more exacerbations within the last 3 years

Front 19

True or false: you should only add oxygen therapy if a patient is in stage IV COPD and the patient is suffering from chronic respiratory failure

Back 19

True - chronic respiratory failure is defined as a PaO2 of less than 60mmHg with or without PaCO2 greater than 50mmHg - should consider surgical options

Front 20

What vaccines are indicated for COPD patients?

Back 20

Influenza vaccine is recommended for all COPD patients
Pneumococcal pneumonia vaccine is recommended for all patients 65 and older, but also for those less than 65 if FEV1 is less than 40% of predicted

Front 21

What are the benefits/drawbacks of inhaled corticosteroids in COPD patients

Back 21

Inhaled corticosteroids decrease the frequency of exacerbations without modifying disease progression but regular use increases the risk for pneumonia.

Front 22

True or false: if a patient is considered a CO2 retainer then it is recommended that they receive high doses of oxygen to push out the retained CO2

Back 22

False - CO2 retainers will lose their drive to breath if placed on high dose oxygen therapy

Front 23

True or false: the minimum effective pulmonary rehabilitation is 2 months for patients with Stage II, III, or IV of COPD

Back 23

True - it is recommended that patients receive at least 2 months of pulmonary rehabilitation as maintenance therapy

Front 24

Surgery is considered one of the alternatives for drug therapy, what are the surgical options for COPD patients?

Back 24

Bullectomy - removal of dead alveoli
Lung reduction surgery
Lung transplantation

Front 25

True or false: COPD is a progressive illness which requires end of life decisions

Back 25

True - end of life will happen for COPD patients so it is an important part of non-drug therapy for patients to address this part of their disease.

Front 26

What are the key examples of non-drug therapy for patients with COPD

Back 26

Pulmonary Rehab
Avoid beta blockers (risk:benefit)
Support groups
Smoking cessation
End of life decisions
Surgery

Front 27

What are the key examples of drug therapy for COPD patients?

Back 27

Drug therapy is not recommended - there is a lack of evidence for any drug therapy in relation to COPD treatment.

Front 28

True or false: acute COPD exacerbations are rare events in COPD patients

Back 28

False - acute exacerbations are common and are considered an event in the natural course of the disease characterized by a change in the patient's condition that is beyond normal day to day variation - may warrant change in medication.

Front 29

What type of exacerbation is indicated with a PEF less than 100L/min or FEV1 of less than 1L

Back 29

A PEF less than 100L/min or FEV1 less than 1L indicates severe exacerbation

Front 30

What is indicated by a PaO2 less than 60mmHg

Back 30

PaO2 less than 60mmHg indicates respiratory failure

Front 31

True or false: a patient with PaO2 less than 40mmHg and PaCO2 greater than 60mmHg despite supplemental oxygen and non-invasive ventilation suggests a life-threatening acute exacerbation.

Back 31

False - the patient also needs a pH of less than 7.25 to suggest a life-threatening episode.

Front 32

When should patients with an acute exacerbation of their COPD be admitted to a hospital?

Back 32

Cyanosis/peripheral edema
Arrhythmias
Support at home insufficient
Elderly
Co-morbidities

Front 33

True or false: Short acting bronchodilators should have their dose/frequency increased for COPD exacerbations

Back 33

True - Short acting anticholinergics should also be added if not already being taken

Front 34

True or false: during treatment of acute COPD exacerbations the short acting bronchodilators/anticholinergics should be delivered without a spacer to increase efficacy

Back 34

False - Both short acting anticholinergics and bronchodilators should be administered using a spacer OR nebulizer.

Front 35

True or false: if a patient is not responding to short acting bronchodilators then methylxanthine should be added

Back 35

True - methylxanthine should be added to the short acting bronchodilator therapy if the patient is not responding.

Front 36

Which glucocorticosteroid therapy cannot be administered to an acidotic patient suffering from an acute exacerbation?

Back 36

Nebulized budesonide

Front 37

When should glucocorticosteroid therapy be introduced as therapy for an acute COPD exacerbation?

Back 37

Prednisone 30-40mg/d for 7-10 days should be added if the patient's FEV1 is less than 50% predicted.

Front 38

True or false: antibiotics should be given to an acute COPD exacerbation patient to prevent risk of infection

Back 38

False - antibiotics should only be added if the patient is being mechanically ventilated or if there is evidence of an infection

Front 39

When should oxygen be administered to a patient with an acute COPD exacerbation?

Back 39

Supplemental oxygen should be given to maintain a PaO2 of at least 55mmHg

Front 40

True or false: patients who are admitted to a hospital for acute COPD exacerbations should be given DVT prophylaxis

Back 40

True - patients should be given DVT prophylaxis because they will most likely be bed ridden.

Front 41

Read and know these Goals of therapy for COPD

Back 41

Relieve symptoms
Prevent disease progression
Improve exercise tolerance and health status
Prevent and treat complications or exacerbations
Reduce mortality