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Week 8 - Respiratory > CBL - COPD > Flashcards

CBL - COPD Flashcards

1
Q

Describe the type of patient and their presentation that would make you consider a diagnosis of COPD [7]

A
  • people who are >35yrs, smokers or ex-smokers with the following symptoms:
    1. exertional breathlessness
    2. chronic cough
    3. regular sputum production
    4. frequent winter “bronchitis”
    5. wheeze
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2
Q

How do you calculate smoking pack years? [1]

A

1 pack year = 20 cigarettes/day for 1 year

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3
Q

What features would you see in a full lung function test in a patient with COPD? [3]

A
  1. elevated (↑) TLC (total lung capacity) indicating hyperinflation (i.e. TLC >120% predicted)
  2. raised (↑) RV and RV/TLC ratio indicating airtrapping
  3. reduced (↓) transfer factor due to emphysema
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4
Q

What features would you see on CXR in a patient with COPD? [5]

A
  1. overinflation
  2. low and flattened diaphragms
  3. bullae
  4. pruned blood vessels with large proximal vessels
  5. relatively little blood visible in peripheral lungs
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5
Q

Define bullae [1]

A

thin-walled air-filled space within the lung, typically arising in emphysema

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6
Q

What are you looking for in a FBC when investigating a patient with suspected COPD? [2]

A

look for polycythaemia (raised Hb and PCV) if has chronic hypoxemia

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7
Q

When would you suspect the cause of COPD being due to alpha-1 antitrypsin deficiency? [3]

A
  1. early onset
  2. miminal smoking history
  3. family history
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8
Q

What are the common pathogens that can be found in a sputum sample in a patient with COPD? [2]

A
  1. haemophilus influenzae
  2. streptococcus pneumoniae
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9
Q

What is type 1 respiratory failure? [1]

A
  • Hypoxic without hypercapnia and with an arterial partial pressure of oxygen (PaO2) of <8 kPa (<60 mmHg)
    • i.e. low oxygen (↓O2) and normal or low carbon dioxide (-/↓ CO2)
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10
Q

What is type 2 respiratory failure? [1]

A
  • Hypercapnia and hypoxia with an arterial partial pressure of carbon dioxide (PaCO2) of >6.5 kPa (>50 mmHg)
    • i.e. low oxygen (↓O2) and high carbon dioxide (↑CO2)
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11
Q

Define COPD [1]

A

term used to cover a group of clinical syndromes (chronic bronchitis and emphysema) associated with airflow obstruction and destruction of the lung parenchyma

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12
Q

Define chronic bronchitis [1]

A

the production of sputum on most days for at least 3 months in at least 2 years (when other causes of chronic cough have been excluded)

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13
Q

Define emphysema [1]

A

abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles

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14
Q

Describe the pathological changes associated with COPD [5]

A

inflammatory changes initiated by exposure to noxious particles or gases underlies most of the pathological lesions

  1. larger airways > 4mm in diameter
  2. hypersecretion of mucus
  3. hyperplasia of mucus glands in larger airways
  4. chronic inflammatory infiltrate - T lymphocytes (CD8), macrophages, neutrophils
  5. scarring and thickening of airways
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15
Q

Describe the features of small airways disease [4]

A
  1. early process in the development of COPD
  2. airways 2 - 3 mm in diameter, “ bronchiolitis”
  3. goblet cell hyperplasia
  4. narrowing of the bronchioles due to mucus plugging, inflammation and fibrosis
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16
Q

What inhaled therapies are given for breathlessness and exercise limitation in a patient with COPD? [2]

A
  1. short-acting beta agonist (SABA) or
  2. short-acting muscarinic antagonist (SAMA) as required
17
Q

What inhaled therapies are given for exacerbations or persistent breathlessness in a patient with COPD with FEV1 ≥50%? [3]

A
  1. LABA (long-acting beta agonist)
  2. LAMA (long-acting muscarinic antagonist) & discontinue SAMA
  3. SABAs (as required)
18
Q

What inhaled therapies are given for exacerbations or persistent breathlessness in a patient with COPD with FEV1 <50%? [3]

A
  1. combination inhaler:
    • long-acting beta agonist (LABA) + inhaled corticosteroids (ICS)
  2. long-acting muscarinic antagonist (LAMA) & discontinue SAMA
  3. SABAs (as required)
19
Q

What inhaled therapies are given for persistent exacerbations or persistent breathlessness in a patient with COPD? [4]

A
  1. combination inhaler:
    • long-acting muscarinic antagonist (LAMA) +
    • long-acting beta agonist (LABA) +
    • inhaled corticosteroid (ICS)
  2. SABAs (as required)
20
Q

Give 2 examples of a SABA [2]

A

short-acting beta agonist = salbutamol, terbutaline

21
Q

Give an example of a SAMA [1]

A

short-acting muscarinic antagonist = ipratropium

22
Q

Give an example of a LABA [1]

A

long-acting beta agonist = salmeterol

23
Q

Give an example of a LAMA [1]

A

long-acting muscarinic antagonist = tiotropium

24
Q

What oral therapies can be given to patients with COPD and when are they used? [3]

A
  1. Oral corticosteroids
    • used in short courses for exacerbations of COPD
  2. Mucolytics
    • e.g. carbocysteine
    • Helps in sputum expectoration
  3. Oral theophyllines
25
Q

In an exacerbation of COPD, what SpO2 levels should you aim for to avoid patients developing hypercapnia? [1]

A

88-92%

26
Q

What are the signs of a pink puffer and what does it indicate? [5]

A
  1. high respiratory drive
  2. ↓PaO2
  3. ↓PaCO2
  4. desaturates on exercise
  5. indicates Type 1 respiratory failure
27
Q

What are the clinical features seen on examination of a pink puffer? [5]

A
  1. pursed lip breathing
  2. uses accessory muscles
  3. wheeze
  4. indrawing of intercostals
  5. tachypnoea
28
Q

What are the signs of a blue bloater and what does it indicate? [7]

A
  1. loss of central sensitivity to CO2
  2. reliance on hypoxic drive to stimulate breathing
  3. low respiratory drive
  4. ↓PaO2
  5. ↑PaCO2
  6. right heart failure (oedema)
  7. indicates Type 2 respiratory failure
29
Q

What are the clinical features seen on examination of a blue bloater? [9]

A
  1. confusion
  2. drowisness
  3. cyanosis
  4. wheeze
  5. hypoventilation
  6. warm peripheries
  7. bounding pulse
  8. flapping tremor
  9. peripheral oedema
30
Q

Define an exacerbation of COPD and what are the commonly reported symptoms of an exacerbation? [5]

A
  1. sustained worsening of the patient’s symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset.
  2. Commonly reported symptoms:
    • worsening breathlessness,
    • cough,
    • increased sputum production
    • change in sputum colour
31
Q

How do you manage an exacerbation of COPD in a hospital setting? [7]

A
  1. Assess severity:
    • symptoms
    • ABG
    • CXR
  2. Controlled oxygen therapy:
    • 24-28 % oxygen,
    • aim to maintain SpO2 88-92%
    • repeat ABGs at 1 hour
  3. Bronchodilators:
    • nebulised salbutamol 2.5-5mg
    • ipratropium bromide 0.5mg qds (and PRN)
    • consider IV aminophylline if not improving
  4. Corticosteroids:
    • prednisolone 30-40 mg od
  5. Antibiotics:
    • if signs of bacterial infection (purulent sputum, increased sputum volume, ↑WCC, ↑CRP)
  6. Non-invasive ventilation (NV):
    • for acidotic type Il respiratory failure
  7. Other:
    • consider DVT prophylaxis (LMWH),
    • monitor fluid balance and nutrition,
    • manage co-morbidities
32
Q

Define pleural effusion [1]

A

fluid in the pleural space

33
Q

What are the clinical signs of a pleural effusion? [3]

A
  1. decreased breath sounds,
  2. stony dull to percussion,
  3. decreased tactile or vocal fremitus
34
Q

What are the clinical features of a pleural effusion on CXR? [4]

A
  1. need >500ml of fluid to be present to see on CXR
  2. uniformly white appearance
  3. blunting of the costophrenic and cardiophrenic angles.
  4. a meniscus at the upper edge
35
Q

When you take a pleural aspirate, what should you send the samples for? [4]

A
  • send samples for:
    1. biochemistry,
    2. pH,
    3. cytology
    4. microbiology
36
Q

What are the 2 categories of pleural aspirate, what are the fluid protein levels of each and what are the typical causes of each type? [10]

A
  1. Exudate
    • fluid protein usually >30 g/l
    • e.g. in…
      • pneumonia,
      • malignancy,
      • TB
  2. Transudate
    • fluid protein <30 g/l (usually <20 g/l)
    • e.g. in…
      • heart failure,
      • liver failure,
      • nephrotic syndrome

Week 8 - Respiratory (14 decks)

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