28- COPD

Question 1

orthopnea

Answer 1

Dyspnea which occurs when lying flat, forcing the person to have to sleep propped up in bed or sitting in a chair. It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing

Question 2

Paroxysmal nocturnal dyspnea (PND)

Answer 2

Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing

associated with CHF- after several hours of sleep

Question 3

acute vs chronic bronchitis timing

Answer 3

acute: 1-3 weeks
chronic: productive cough for at least three months for the past two years

Question 4

most likely Differential of Shortness of Breath in Middle-Aged Man Who Smokes

Answer 4

acute bronchitis
asthma
COPD
lung cancer

Question 5

Classic Findings on Physical Exam for COPD

Answer 5

Increased anteroposterior (AP) diameter of the chest
Decreased diaphragmatic excursion
Wheezing (often end-expiratory)
Prolonged expiratory phase

Question 6

laryngeal height with COPD

Answer 6

decreased- less than 4 cm

Question 7

gold standard for diagnosing COPD

Answer 7

Pulmonary function testing (PFT)

FEV1/FVC ratio less than the 5th percentile, or less than 70%

Question 8

stress echocardiogram (C) can confirm

Answer 8

cardiac ischemia

Question 9

tests to confirm PE

Answer 9

pulmonary angiogram and chest CT

Question 10

percentages of severity of COPD

Answer 10

mild >80%
moderate: 50-79
severe 30-49
very severe <30%

Question 11

COPD vs asthma

Answer 11

COPD: irreversible (rather than reversible)
mid life (rather than early life onset)
slowly progress (rather than vary)
during exertion (as opposed to night, or early morn)
smoking influence
not related to allergies, rhinits, eczema

Question 12

immuno cells with asthma

Answer 12

Mast cells, T helper cells, and eosinophils

Question 13

immuno cells with COPD

Answer 13

Macrophages, T killer cells, and neutrophils

Question 14

is FVC increased, decreased, or same in asthma and COPD

Answer 14

same or decreased in COPD

decreased in asthma

Question 15

when do COPD symptoms begin?

Answer 15

moderate COPD

Question 16

Therapy for Mild Symptomatic COPD

Answer 16

albuterol prn, or other bronchodilators (LABAs, SABAs, inahled anticholintergics, oral methylxanthines)

Question 17

when is prednisone given in COPD?

Answer 17

acute exacerbation

Question 18

will lung function improve after 1 year of smoking cessation?

Answer 18

yes!

Question 19

how is reversibility defined in spirometry

Answer 19

defined as an increase in FEV1 ≥ 12% after bronchodilator treatment,

Question 20

therapy for moderate COPD

Answer 20

inhaled anticholinergics (ipratroprium or tiotroprium) alone or in combination with short-acting beta agonists may be utilized.

Question 21

therapy for severe COPD

Answer 21

inhaled glucocorticosteroids be added to bronchodilator treatment (LABA)

Question 22

COPD exacerbation presentation

Answer 22

Difficulty catching his or her breath
Chest tightness
Fever
Increased coughing or
A change in the cough (more productive, more mucus expelled)

Question 23

A patient should seek emergency medical care if the usual medications are not working and he or she find

Answer 23

It is unusually hard to walk or talk (such as difficulty completing a sentence)
The heart is beating very fast or irregularly
Lips or fingernails are gray or blue, or
Breathing is fast and hard, even when medication is being used

Question 24

Antibiotics should be given to:

Answer 24

Patients with exacerbations of COPD with the following three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence

Patients with exacerbations of COPD with two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms

Patients with a severe exacerbation of COPD that requires mechanical ventilation (invasive or noninvasive).

Question 25

how does COPD cause heart failure

Answer 25

1. chronic hypoxia
2. pulmonary vasoconstriction
3. increases blood pressure in the pulmonary vessels.
4. permanent damage to the vessel walls and leads to irreversible hypertension
5. Right HF -pump cant resist pressure
6. leads to an increase in preload: peripheral edema and increased jugular venous distention.

Question 26

management of resp acidosis

Answer 26

mechanical ventilation