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Pulmonology > 08.18 - COPD, Emphysema (Headley) - Questions > Flashcards

08.18 - COPD, Emphysema (Headley) - Questions Flashcards

1
Q

What FEV/FVC ratio corresponds to airway obstruction

A

<70%

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2
Q

What defines “irreversible” airway obstruction

A

Does not improve by >15% with bronchodilators

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3
Q

Immune cells distinct to COPD in contrast to asthma

A

CD8 T Cells; CD68+ Macrophages

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4
Q

Primary cause of COPD

A

Cigarrette smoke

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5
Q

FEV1 of ____ of predicted is associated with exertional dyspnea

A

40-60%

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6
Q

FEV1 of ____ of predicted is associated with disability

A

< 30%

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7
Q

FEV1 <30% of predicted is associated with

A

Disability

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8
Q

FEV1 < ___ = 5 year mortality 50%

A

FEV1 < 1 L

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9
Q

FEV1 < 1 L =

A

5 year mortality 50%

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10
Q

Pack years on average for COPD

A

20 pack years

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11
Q

At what age does COPD become symptomatic

A

40’s

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12
Q

When does dyspnea develop

A

50’s - 60’s

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13
Q

What is required to make Dx of COPD

A

Spirometry: Post-bronchodilator FEV1/FVC < 70%

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14
Q

T/F: COPD can include a “reversible” component

A

True

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15
Q

Sputum production in COPD

A

Tenacious, mucoid, small quantities

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16
Q

Definition of Chronic Bronchitis

A

Production of sputum for 3 months in 2 consecutive years

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17
Q

Production of sputum for 3 months in 2 consecutive years

A

Definition of Chronic Bronchitis

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18
Q

Change in sputum color suggests

A

Infectious exacerbation

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19
Q

Why quantify dyspnea in COPD?

A

Predicts QOL and survival

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20
Q

Physical exam signs of Airflow limitation

A

Wheezing; Prolonged forced expiratory time

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21
Q

Physical exam signs of Hyperinflation

A

Barrel chest; Pursed Lip; Low diaphragm; Decr intensity of hearth and breath sounds

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22
Q

Physical exam signs of Mechanical Impairment

A

Accessory muscles; In-drawing of lower intercostal interspaces; Chest/abdominal wall paradoxical movements

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23
Q

For how long must hyperinflation be present to develop barrel chest

A

7 years

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24
Q

Heart Auscultation in COPD

A

Cor Pulmonale signs: S2 split, Pulmonary or Tricuspid Regurgitation Murmur

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25
Q

DLCO in COPD

A

Reduced in Emphysema; Normal in Chronic Bronchitis and Asthma

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26
Q

If __ are destroyed, DLCO will be low

A

Alveoli

27
Q

COPD that occurs with Alpha-1 Antitrypsin is usually ___

A

Pan-Acinar

28
Q

COPD that occurs with smoking (as opposed to A1A) is usually ___

A

Central Lobular

29
Q

What screening do you perform with COPD develops in white patient under 45 or with strong family hx

A

A1A Deficiency

30
Q

Pan-Acinar COPD occurs with

A

A1A Deficiency

31
Q

Blue Bloaters are characterized by

A

Heart failure; Cyanosis at rest; Chronic respiratory failure

32
Q

Pink Puffers are characterized by

A

Pursed Lip; Little hypoxia at rest; Thin and lean forward

33
Q

Which is emphysema: Blue Bloaters or Pink Puffers

A

Pink Puffers

34
Q

Which has signs of heart failure: Blue Bloaters or Pink Puffers

A

Blue Bloaters

35
Q

Which has little or no hypoxia at rest: Blue Bloaters or Pink Puffers

A

Pink Puffers

36
Q

Which has large sputum volume: Blue Bloaters or Pink Puffers

A

Blue Bloater: Chronic Bronchitis

37
Q

Which has normal blood gas values: Blue Bloaters of Pink Puffers

A

Pink Puffers: Not hypoxic at rest but intense dyspnea

38
Q

Which has good respiratory drive: Blue Bloaters or Pink Puffers

A

Pink Puffers

39
Q

Hypoxemia and Hypercapnia in Smurfs are due to

A

V/Q imbalance

40
Q

Why hypercapnea in Smurfs?

A

Body tolerates certain amount to decrease “Work of Breathing”

41
Q

Minute Ventilation is ___ x ___

A

RR x TV

42
Q

3 long-term problems of Type B Respiratory Failure

A

Polycythemia, Pulmonary HTN, Cor Pulmonale

43
Q

Which requires home O2: Type A or B Respiratory Failure

A

Type B

44
Q

Type A are characterized by

A

Dyspnea; Tachypnea; and High Minute Ventilation

45
Q

Why are Pink Puffers “pink”?

A

Maintain O2 sat at a high minute ventilation and much dyspnea

46
Q

What signifies death is near in Type A

A

Development of hypercapnia and severe hypoxemia

47
Q

Lung inflammation leads to increased __ and __ which leads to COPD pathology

A

Oxidative stress and Proteinases

48
Q

Hypoxemia and Hypercapnea develop primarily b/c of

A

V/Q mismatch

49
Q

Clinical Definition of Chronic Bronchitis

A

Chronic or recurrent cough present on most days for a minimum of 3 months in a year and for not less than 2 consecutive years

50
Q

Pathologic Hallmark of Chronic Bronchitis

A

Incr Reid Index: Hypertrophied mucous glands greater than 1/3 of total bronchial wall thickness

51
Q

Emphysema is abnormal enlargement of air spaces distal to

A

Terminal Bronchioles

52
Q

Centrolobular Emphysema is associated with __ and primarily involves ___ lobes

A

Smoking, Upper Lobes

53
Q

Panlobular Emphysema is associated with __ and involves ___ lobes

A

A1A Def.; Lower Lobes

54
Q

In Pure Chronic Bronchitis, Flow-Volume Loops reveals

A

Airflow obstruction during expiration and inspiration

55
Q

Which of the following are normal in Pure Chronic Bronchitis: Lung Volumes, Compliance, Elastic Recoil, DLCO

A

All are normal

56
Q

In Pure Emphysema, Flow-Volume Loops reveal

A

Airflow obstruction during expiration but not inspiration

57
Q

VC and DLCO in Pure Emphysema

A

Both reduced

58
Q

Gas exchange in Pure Emphysema

A

Preserved (CO2, O2)

59
Q

T/F: COPD exacerbations can often be prevented

A

TRUE

60
Q

Preferred bronchodilators for exacerbation

A

Short-acting inhaled beta2-agonists

61
Q

Systemic Corticosteroids in exacerbations

A

Shorten recovery time, improve lung function and arterial hypoxemia

62
Q

Therapeutic effects of short term beta-2 agonists

A

3-6 hours

63
Q

Most important drug in hypoxic patients

A

Long Term O2 Therapy

Pulmonology (31 decks)

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