3: COPD Diagnosis

Question 1

In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?

FEV1

Answer 1

Decreased

Question 2

In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?

FEV1/FVC Ratio

Answer 2

Decreased

Question 3

In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?

Total Lung Capacity (TLC)

Answer 3

Normal or Increased

Question 4

In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?

Residual Volume (RV)

Answer 4

Increased

Question 5

In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?

Diffusing Capacity (DLCO)

Answer 5

Normal or Decreased

Question 6

In a COPD diagnosis, what would postbronchodialtor FEV1 be?

Answer 6

≤ 80% predicted

Question 7

In a COPD diagnosis, what would postbronchodialtor FEV1/FVC ratio be?

Answer 7

< 0.70

Question 8

What diagnostic is standard for initial diagnosis of COPD?

Answer 8

CXR to see lung hyperinflation

Question 9

On a CXR, what indicates COPD?

Answer 9

• Visible bullae, decreased parenchymal markings, or hyperlucency (emphysema)
• Increased lung volumes, flattening of diaphragm
• Enlarged heart

Question 10

T/F CXR is all that is needed for COPD diagnosis.

Answer 10

False. Not stand-alone diagnostic, but can r/o other alternatives.

Question 11

CXR is seldom diagnostic for COPD without obvious _____.

Answer 11

CXR is seldom diagnostic for COPD without obvious bullous disease.

Question 12

Though not a 1st-line test, what can be used to r/o malignancy when diagnosing COPD?

Answer 12

CT

Question 13

Who qualifies for alpha-1 antitrypsin (AAT) deficiency testing?

Answer 13

• <45 yo
• Caucasian descent
• Strong family hx of COPD

Question 14

What AAT value strongly suggests deficiency?

Answer 14

15-20% below normal

Question 15

What labs would you order in COPD diagnosis?

Answer 15

• Serum chemistry
  
  • Sodium retention.
  • K+ levels lowered by diuretics, B agonsts, and theophylline.
  • Renal excretion of Ca and Mg increased by B adrenergic agonists. May be important with hypokalemia.
• CBC
  
  • Hematocrit imbalance (usually mild polycythemia).
• BNP
  
  • May not give straightforward differentiation from CHF.

Question 16

When is an ABG ordered?

Answer 16

For stable persons with FEV1 less than 50% or with right-sided heart failure (inpatient)

Question 17

Which differential dx is this?

• Early-life onset
• Positive family hx
• Allergies
• Reversible obstruction

Answer 17

Asthma

Question 18

Which differential dx is this?

• Older adults
• Basilar crackles
• Cardiomegaly
• Pulmonary edema on CXR

Answer 18

CHF

Question 19

Which differential dx is this?

• Excessive purulent sputum
• Bacterial pathogen
• Bronchial dilation and thickening on CXR

Answer 19

Bronchiectasis

Question 20

Which differential dx is this?

• All ages
• Infiltrate, nodular lesions or granuloma on CXR
• High local prevalence

Answer 20

Pulmonary TB

Question 21

In making a COPD diagnosis, what is looked for on PE?

Answer 21

1. Breathlessness test (e.g., 6-minute walk)
2. Body mass index (BMI)
3. Chest inspection and auscultation
4. Vital signs including pulse oximetry

Question 22

In making a COPD diagnosis, what is looked for on spirometry?

Answer 22

1. Baseline test
2. Postbronchodilator FEV1 (value less than 70% of predicted indicates COPD)

Question 23

What are 2 questionnaires administered for COPD?

Answer 23

1. COPD Population Screener (COPD-PS)
2. Lung Function Questionnaire (LFQ)

Question 24

How is the 6-minute walk test administered?

Answer 24

• 30 m marked every 3 meters including turnaround points
• Record time/lap before patient must stop for breath
• Monitor pulse oximetry