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Medical Studies 1 > 6.5 Pathophysiology of COPD > Flashcards

6.5 Pathophysiology of COPD Flashcards

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USMLE® Step 1 flashcards
1
Q

Define COPD

A
  • Preventable, treatable
  • Airflow limitation, not fully reversible
  • Usually progressive
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2
Q

Symptoms that are suggestive of COPD

A
  • Exertional breathlessness
  • Cough
  • Sputum
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3
Q

What history features could indicate increased risk of COPD?

A
  • Smoking
  • Exposure to other noxious agents
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4
Q

What is the FEV1/FVC ratio range that suggests COPD? What other condition is necessary for this?

A
  • FEV1/FVC <0.70
  • AND: bronchodilators have been given
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5
Q

What proportion of Australians over 45 have COPD?

A

1 in 20

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6
Q

What cardiovascular diagnosis is often used mistakenly instead of COPD?

A

Angina; since it commonly causes breathlessness.

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7
Q

List some childhood risk factors for COPD

A
  • Low birth weight
  • Smoking exposure
  • Famine
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8
Q

Is there a genetic component to COPD?

A

Yes; there is basically one for every disease

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9
Q

Describe how epigenetic modification leads to inflammation in COPD

A
  • Histone acetylation
  • DNA is bound more loosely
  • More transcription
  • Production of inflammatory mediators
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10
Q

Clinical features of COPD

A
  • Wheeze
  • Dyspnoea
  • Chest tightness/fullness
  • Cough (more often in mornings)
  • Sputum production
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11
Q

Common history signs of COPD

A
  • Recurrent chest infections (often in winter)
  • Tobacco
  • Occupational exposure
  • Hobbies
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12
Q

CXR signs of COPD

A

-Lungs are bigger
- Fewer lung markings visible
- Heart is pulled down
- Diaphragm is flattened

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13
Q

What does emphysema look like on a CT scan of the lungs?

A

Black holes in lungs

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14
Q

Why do people with obstructive lung diseases inhale less air?

A
  • More air is trapped in the lung
  • Less space for new air to be inhaled
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15
Q

Why are anxiety and depression common in COPD?

A

Breathlessness -> inactivity -> deconditioninng -> exercise intolerance -> disability/mortality

A vicious spiral downwards

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16
Q

Common viruses that exacerbate COPD

A
  • Rhinoviruses
  • Influenza viruses
17
Q

Common bacteria that exacerbate COPD

A
  • Haemophilus influenzaue
  • Streptococcus pneumoniae
18
Q

Effect of COPD exacerbations on mortality

A

Great increase in risk, even after first exacerbation

19
Q

Four main signs of asthma in terms of pathophysiology

A
  • Lung inflammation
  • Airway hyper-responsiveness
  • Airway remodelling
  • Mucous hypersecretion
20
Q

What happens during an asthma attack?

A
  • Smooth muscle constricts
  • More mucous is secreted
21
Q

How does the ability of cilia to clear airways change in a person with asthma?

A
  • Decreases
  • Leads to more mucus lining the airways
22
Q

Describe the airway remodelling that occurs during asthma

A
  • Subepithelial fibrosis
  • Angiogenesis
  • Smooth muscle cell hyperplasia
23
Q

Is airway remodelling more pronounced in chronic or acute asthma?

A

Chronic

24
Q

What characterises allergic asthma?

A

Raised IgE levels

25
Q

What characterises eosinophilic asthma?

A

Raised eosinophil count; greater than

26
Q

What is type 2 inflammation?

A

Inflammation mediated by Th 2 cells

27
Q

What type of asthma involves type 1 inflammation?

A

non-eosinophilic, non-allergic asthma

28
Q

Describe early phase asthma response

A
  • Typical asthma attack
  • Inhaled allergen -> mast cell degranulation
  • Reaction occurs within 10-15mins
29
Q

Describe late phase asthma reactions

A
  • Occurs 3-4 hours after initial exposure
  • Involves T cells, eosinophils, and neutrophils
  • Can have non-specific increased bronchial reactivity for up to 2 weeks
30
Q

What are two of the most common types of COPD?

A
  • Chronic bronchitis
  • Emphysema
31
Q

Describe emphysema

A
  • Loss of elasticity
  • Hyperinflation of lungs
  • Increased airspaces (instead of many small ones), decreased SA:V
32
Q

Describe COPD Pathophysiology. How does this link to exacerbation?

A
  • Inhaled irritant/toxin
  • Stimulates fibroblasts -> subendothelial fibrosis
  • Complex inflammatory pathways -> alveolar and capillary damage
  • Mucus hypersecretion in response to inflammation
  • In exacerbation, an irritant such as a bacteria or a virus simply makes this worse than normal
33
Q

What symptoms do patients present with during COPD exacerbation? Why?

A
  • Increased breathlessness (airway narrowing, increased bronchospasm)
  • Increased mucous production (goblet cell hyperplasia)
  • Increased sputum thickness (recruitment of neutrophils or, more rarely, eosinophils)
34
Q

Which is more likely to appear in older patients: COPD or asthma?

A

COPD

35
Q

When is asthma typically worse throughout the day? Is this the same for COPD?

A

Asthma: typically worse at night
COPD: consistent (although can be characterised by increased cough in the mornings)

36
Q

Which of asthma and COPD cause persistent vs variable decreases in lung function?

A

COPD: Consistent
Asthma: Variable

37
Q

Time course of asthma vs that of COPD

A

Asthma: Seasonal; no worsening
COPD: Progressive worsening

38
Q

CXR in asthma vs COPD

A

COPD: Hyperinflation
Asthma: Normal

Medical Studies 1 (90 decks)

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