Chronic Obstructive Pulmonary Disease

Question 1

________ is a common respiratory condition

characterized by airflow limitation

Answer 1

Chronic obstructive pulmonary disease (COPD)

Question 2

Establishing a correct diagnosis of COPD is important because….

Answer 2

appropriate management can decrease symptoms
reduce the frequency and severity of exacerbations
improve health status, improve exercise capacity, and prolong survival

Question 3

Vast majority of COPD patients will have an hx of what

Answer 3

Smoking

Question 4

_______ is a pathological term that describes some of the structural changes sometimes associated with COPD. These changes include abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis

Answer 4

Emphysema

Question 5

“Pink Puffer” is _____ predominant

Answer 5

Emphysema

Question 6

Patient presents with these issues what would you suspect?

• “Pink Puffer”
• Major complaint is dyspnea.
• over age 50
• Cough is rare, may have scant thin clear sputum
• Thin
• Uncomfortable appearing with accessory muscle use
• Chest is quiet without adventitious lung sounds

Answer 6

Emphysema

Question 7

Patient presents with these issues what would you suspect?

• Blue Bloater
• Productive cough for three months at a time within 2 years
• Major c/o is productive chronic cough with mucopurulent sputum
• Frequent exacerbations due to chest infections
• mild dyspnea
• In their 30s and 40s

Answer 7

Chronic bronchitis

Question 8

True/ False

Digital clubbing is typical in COPD

Answer 8

FALSE
Not typical

clubbing suggests other diagnoses such as lung cancer, bronchiectasis, pulmonary fibrosis

Question 9

True/ False

Mild dependent edema may be seen in the absence of right heart failure

Answer 9

True

Question 10

What can cause digital clubbing?

Answer 10

lung cancer, bronchiectasis, pulmonary fibrosis

Question 11

What test is used to evaluate COPD

Answer 11

Spirometry

Question 12

CXR for COPD might reveal what?

Answer 12

-nonspecific peribronchial and perivascular markings
(dirty lungs) seen with bronchitis predominant
-may show hyperinflation and flattening of the diaphragm in half the cases. (Emphysema)

Question 13

Can you do Arterial Blood gasses for acute exacerbations on ship?

Answer 13

No they are obtained at higher levels of care that have capability

Question 14

True/ False

Treatment is based on risk of exacerbation: COPD is largely preventable

Answer 14

True

Question 15

What are Lifestyle modifications for treating COPD

Answer 15

1) STOP SMOKING
2) Elimination of exposure to products of combustion
3) Vaccination
4) Patient Education: use of inhaler
5) Nutrition and Self-Management

Question 16

True/False

COPD is preventable, manageable and reversible

Answer 16

False

Irreversible damage is done

Question 17

What is the 4th line agent for treating COPD who do not respond to inhaled anticholinergic, beta-2 agonists, and corticosteroid therapies?

Answer 17

Theophylline

Question 18

What is commonly prescribed to COPD patients for the following?

a) Treat an acute exacerbation
b) Treat acute bronchitis
c) Prevent acute exacerbation of acute bronchitis

Answer 18

Antibiotics

Question 19

True/False

Outlook is great for patients with significant disease. =]

Answer 19

False =[

Poor outlook

Question 20

What action would you take:
If patient is stable, not in any acute distress, with normal vital signs and you suspect COPD in a patient with no previous COPD dx

Answer 20

consult with MO, referral for PFT’ s and pulmonology referral

Question 21

What action would you take:
If patient is unstable, experiencing an acute exacerbation, has any acute distress or has any concerning abnormal vital signs,

Answer 21

discuss with MO and MEDEVAC

Question 22

What action would you take:
Exacerbation is if there is SOB, dyspnea or a
lot of wheezing

Answer 22

add Oral Steroids in addition to the Albuterol

Prednisone

Question 23

MOA for what med:
Selectively stimulates beta-2 adrenergic receptors, relaxing airway
smooth muscle

Answer 23

Short Acting Beta Antagonist

Albuterol

Question 24

What is the confirmatory test for COPD

Answer 24

Spirometry