28 - 58 yo M with SOB

Question 1

how does paroxysmal nocturnal dyspnea differ from orthopnea?

Answer 1

• PND is relieved by sitting upright but not as quickly as orthopnea
• PND does not develop immediately upon sitting down

Question 2

acute bronchitis is a productive cough lasting for _____ weeks whereas the timeframe for chronic bronchitis is _______________________

Answer 2

• 1-3 weeks

- 3 months for past 2 years

Question 3

which inflammatory cells are found in COPD?

Answer 3

• macrophages
• T killer cells
• neutrophils

Question 4

a post-bronchodilator FEV1/FVC ratio under _____% confirms the presence of airflow limitation that is not fully reversible, and reversibility is defined as an increase in FEV1 of ____ or more after bronchodilator

Answer 4

• 70%

- 12%

Question 5

FVC is _____________ in COPD but always __________ in asthma

Answer 5

• normal or decreased

- decreased

Question 6

what is the therapy for moderate COPD (FEV1 50-80%)?

Answer 6

inhaled anticholinergics (ipratropium, tiatropium) alone or in combination with short acting beta agonists

Question 7

what is the therapy for severe COPD (FEV1 under 50%)?

Answer 7

inhaled glucocorticoids added to bronchodilators

Question 8

what is the gold standard for diagnosing COPD? what criteria confirm the diagnosis?

Answer 8

• PFTs

- FEV1/FVC less than 5th percentile or less than 0.7

Question 9

what is the most relevant side effect of long term treatment with systemic glucocorticoids in COPD?

Answer 9

steroid myopathy (muscle weakness, decreased functionality, respiratory failure)

Question 10

what is the proposed mechanism for COPD leading to heart failure?

Answer 10

• chronic hypoxia causes pulmonary vasoconstriction
• increase in BP in pulmonary vessels, which causes permanent damage to vessel walls and leads to irreversible HTN
• right heart eventually fails because it cannot sustain flow effectively against pressure
• right heart failure leads to increased preload with peripheral edema and increased JVD