Chapter 70: Chronic Obstructive Pulmonary Disease

Question 1

COPD definition encompasses of

Answer 1

• Chronic bronchitis
• Emphysema
• Bronchiectasis
• Asthma

Question 2

True or False

Men are at high risk of developing COPD?

Answer 2

False

Question 3

Major risk factor for developing COPD

Answer 3

Smoking

Question 4

What is the pathophysiology of COPD?

Answer 4

Mucus-secreting cells replace cells that normally secrete surfactant and protease inhibitors

Question 5

The central element of chronic lower airway obstruction is?

Answer 5

Impedance to expiratory airflow due to increased resistance or decreased caliber of the small bronchi and bronchioles

Question 6

What are the classifications of COPD severity?

Answer 6

Mild COPD - FEV1 ≥80% predicted
Moderate COPD - FEV1 between 50% and 79% predicted
Severe COPD - FEV1 between 30% and 49% predicted
Very severe COPD - FEV1 <30% predicted

Question 7

What are the hallmark symptoms of COPD?

Answer 7

Chronic and progressive dyspnea, cough, and sputum production

Question 8

COPD that is expansion of the thorax, impeded diaphragmatic motion, and global diminution of breath sounds

Answer 8

Empysema

Question 9

At what level of FEV1 will COPD has hypoxemia and hypercapnia?

Answer 9

FEV1 falls below 1L

Question 10

Best way to diagnose COPD?

Answer 10

Spirometry with a postbronchodilator FEV1 to forced vital capacity ratio of <0.7

Question 11

Chest xray showed hyperaeration, seen as increased anteroposterior chest diameter, flattened diaphragms, increased parenchymal lucency, and attenuation of pulmonary arterial vascular shadows. What COPD is this?

Answer 11

Empysema

Question 12

Chest xray show normal. What COPD is this?

Answer 12

Chronic bronchitis

Question 13

Used to distinguish COPD to acute heart failure?

Answer 13

B-type natriuretic peptide

Question 14

Treatment for COPD

Answer 14

• Oxygen
• Pharmacotherapy, measures to decrease mucus secretion
• Smoking cessation
• Pulmonary rehabilitation.

Question 15

Goal of oxygenation in COPD patient?

Answer 15

Partial pressure of arterial oxygen (Pao2) to ≥60 mm Hg or the arterial oxygen saturation (Sao2) to ≥90% at rest.

Question 16

A most preferred group of medication for COPD

Answer 16

LABA

Question 17

Bronchodilators often improve FEV1 by how many percent?

Answer 17

10%

Question 18

Medications that are best for patients at high risk of exacerbation of COPD

Answer 18

Combination inhalers with long-acting β2-agonists plus cor- ticosteroids

Question 19

Other medications that decrease the exacerbation of COPD

Answer 19

• Simvastatin

- Azithromycin (elder and mild)

Question 20

Key to dampen acute infection in COPD patient

Answer 20

Vaccination

Question 21

Important triggers for exacerbations of COPD

Answer 21

• Infection
• Hypoxia
• Cold weather
• B-blocker
• Opioids or sedative-hypnotics

Question 22

Acute exacerbations of COPD are primarily due to

Answer 22

Ventilation–perfusion mismatch

Question 23

Acute exacerbations of Asthma are primarily due to

Answer 23

Expiratory airflow limitation

Question 24

The most life-threatening feature of an acute exacerbation is

Answer 24

Hypoxemia

Question 25

The best tool in acute

evaluation for assessing oxygenation, ventilation, and acid-base disturbances

Answer 25

ABG

Question 26

What is the changes in ABG in acute respiratory acidoses in COPD patient?

Answer 26

Serum bicarbonate rises by 1 mEq/L for each 10-mm Hg increase in Pco2, and the pH will change by 0.008 × (40 – Pco2)

Question 27

What is the changes in ABG in chronic respiratory acidoses in COPD patient?

Answer 27

Serum bicarbonate rises by 3.5 mEq/L for each 10-mm Hg increase in Pco2, and the pH will change by 0.03 × (40 – Pco2)

Question 28

True or False

Administer oxygen to achieve a Pao2 of 60 to 70 mm Hg or an Sao2 between 88% and 92%

Answer 28

True

Administer oxygen to achieve a Pao2 of 60 to 70 mm Hg or an Sao2 between 88% and 92%

Question 29

First-line therapies in the management of acute, severe COPD

Answer 29

SABA

Question 30

An anticholinergic drug that is the agent of choice for COPD

Answer 30

Ipratropium bromide given as a single dose by metered-dose inhaler with a spacer or as an inhalant solution by nebulization (0.5 milligram or 2.5 mL of the 0.02% inhalant solution)

Question 31

The most common pathogen of pneumonia in COPD

Answer 31

• Streptococcus pneumonia
• Haemophilus influenzae
• Moraxella catarrhalis

Question 32

The goals of assisted mechanical ventilation in COPD pateint are what?

Answer 32

The goals of assisted mechanical ventilation are to rest ventilatory muscles and to restore adequate gas exchange

Question 33

When to use assisted mechanical ventilation in COPD patient?

Answer 33

• Respiratory muscle fatigue
• Worsening respiratory acidosis
• Deterioating mental status
• Refractory hypoxemia