B2.058 Big Case Jackie Wright

Question 1

what can be seen on a chest x-ray of a COPD patient?

Answer 1

enlarged lungs
“small” heart
flattened diaphragm

Question 2

what is spirometry?

Answer 2

measures the volume of air exhaled at specific time points during a forceful and complete exhalation after a maximal inhalation

Question 3

FVC

Answer 3

forced vital capacity

total exhaled volume

Question 4

FEV1

Answer 4

volume exhaled in the first second

Question 5

what is a normal vs COPD value of FEV1/FVC?

Answer 5

normal - 80%

COPD - 60%

Question 6

what is GOLD staging?

Answer 6

global initiative for chronic obstructive lung disease

severity staging system based on airflow limitations

Question 7

outline the 4 GOLD stages

Answer 7

1: mild, FEV1>80% of normal
2: moderate, FEV = 50-79% normal
3: severe, FEV1 = 30-49% normal
4: very severe, FEV1 <30% of normal or <50% of normal w presence of chronic respiratory failure present

Question 8

what is a criticism of GOLD staging?

Answer 8

may be insensitive in early stages

Question 9

define chronic bronchitis

Answer 9

bronchial wall thickening may be seen in addition to enlarged vessels
repeated inflammation can lead to scarring with bronchovascular irregularity and fibrosis

Question 10

define emphysema

Answer 10

alveolar septal destruction and airspace enlargement

Question 11

where is centrilobular emphysema found?

Answer 11

upper lobes

Question 12

where is panlobular emphysema found?

Answer 12

lower lobes

Question 13

what are 5 types of obstructive pulmonary disease and what anatomic sites so they affect?

Answer 13

chronic bronchitis- bronchus
bronchiectasis- bronchus
asthma- bronchus
emphysema- acinus
small airway disease/ bronchiolitis - bronchiole

Question 14

what are major pathologic changes and associated signs/symptoms in chronic bronchitis?

Answer 14

mucous gland hypertrophy and hyperplasia, hypersecretion

cough, sputum production

Question 15

what are major pathologic changes and associated signs/symptoms in bronchiectasis?

Answer 15

airway dilation and scarring

cough, purulent sputum, fever

Question 16

what are major pathologic changes and associated signs/symptoms in asthma?

Answer 16

smooth muscle hypertrophy and hyperplasia, excessive mucous, inflammation
episodic wheezing, coughing, dyspnea

Question 17

what are major pathologic changes and associated signs/symptoms in emphysema?

Answer 17

air space enlargement, wall destruction

dyspnea

Question 18

what are major pathologic changes and associated signs/symptoms in bronchiolitis?

Answer 18

inflammatory scarring, partial obliteration of bronchioles

cough, dyspnea

Question 19

what are some ways to distinguish bronchitis from emphysema?

Answer 19

age: 40-45 B, 50-75 E
dyspnea: mild B, severe E
cough: early, copious sputum B, late, scanty sputum E
infections: common B, occasional E
cor pulmonale: common B, rare/terminal E
chest x-ray: prom vessels, large heart B, hyperinflation, small heart E
appearance: blue bloater B, pink puffer E

Question 20

what are some causes of COPD?

Answer 20

smoking, industrial exposure, cystic fibrosis, alpha-1-antitrypsin deficiency, vasculitides, connective tissue disorders, IV drug uses, immune deficiency syndromes

Question 21

how do you treat COPD?

Answer 21

try to stabilize disease
goals: decrease symptoms,, decrease exacerbations, improve function
regular treatment with a long acting bronchodilator, based on symptom relief
short acting bronchodilator available for symptom control as needed
smoking cessation, exercise, vaccines

Question 22

what are some features of exacerbation of COPD?

Answer 22

dyspnea
cough
sputum production
wheezing
distant breath sounds
tachypnea
tachycardia
use of accessory muscles
brief, fragmented speech
inability to lay supine
agitation

Question 23

how would you work up a patient with an exacerbation of COPD?

Answer 23

assess Osat w pulse oximetry
obtain ABG and PaCO2
DO NOT assess spirometry in acute severe COPD exacerbations
obtain chest x-ray
obtain CBC, electrolytes, BUN, and creatinine
test for flu
get ECG