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724: Medical Lectures > Chronic Obstructive Pulmonary Disease > Flashcards

Chronic Obstructive Pulmonary Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What can be defined as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema

A

Chronic Obstructive Pulmonary Disease

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2
Q

Is airflow obstruction associated with COPD progressive

A

yes

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3
Q

What is airflow obstruction associated with?

A

airway hyperactivity

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4
Q

How many Americans have been diagnosed with COPD?

A

14 million (an equal number are believed to be undiagnosed)

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5
Q

COPD and asthma are the ___ leading cause of death in the US, with over _____ deaths annually

A

4th

12,000

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6
Q

The death rate from COPD is increasing rapidly, especially among what patient population?

A

elderly men

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7
Q

Most patients with COPD have features of what 2 diseases?

A

emphysema and chronic bronchitis

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8
Q

What can be defined as a clinical diagnosis defined by excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years?

A

chronic bronchitis

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9
Q

What can be defined as a pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis?

A

emphysema

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10
Q

What is the most significant cause of COPD?

A

cigarette smoking

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11
Q

__% of COPD patients have siginificant exposure to tobacco smoke. The remaining __% have a combination of exposures to environmental tobacco smoke, occupational dusts and chemicals, and indoor air pollution from biomass fuel used for cooking and heating in poorly ventilated buildings

A

80

20

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12
Q

What are a few other causes of COPD?

A
  • outdoor air pollution
  • airway infection
  • familial factors
  • allergy
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13
Q

What hereditary factor is implicated in chronic bronchitis?

A

A deficiency of alpha-1-antiprotease [alpha-1-antitrypsin]

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14
Q

What are 2 important risks for COPD?

A

Atopy and the tendency for bronchioconstriction to develop in response to nonspecific airway stimulation

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15
Q

What does the pathogenesis of emphysema involve?

A

Excessive lysis of elastin and other structural proteins in the lung matrix by elastase and other proteases derived from lung neutrophils, macrophages, and mononuclear cells

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16
Q

Patients with COPD characteristically present in which decade of life?

A

the 5th or 6th

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17
Q

What are 3 characteristic symptoms that these patients complain of?

A
  • excessive cough
  • sputum production
  • shortness of breath
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18
Q

Symptoms of COPD have typically been present for how long?

A

10 years or more

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19
Q

What symptoms is noted initially only on heavy exertion, with mild activity as the condition progresses, and quite possibly at rest in advanced stages?

A

dyspnea

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20
Q

As this disease progresses, what are the 2 symptom patterns that tend to emerge?

A
  • pink puffers

- blue bloaters

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21
Q

What is the major complaint among pink puffers?

A

Dyspnea, often severe, usually presenting after age 50

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22
Q

What symptoms are rare in pink puffers?

A

Cough, with scant clear mucoid sputum

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23
Q

Describe the appearance of pink puffers

A

They are thin, with recent weight loss and appear uncomfortable, with evident use of accessory muscles of respiration.

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24
Q

When examining chest sounds in pink puffers what will you hear?

A

Typically nothing, chest is very quiet without adventitious sounds

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25
Q

What do pink puffer chest radiographs reveal?

A

Hyperinflation with fattened diaphragms

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26
Q

What is the major complaint among blue bloaters?

A

Chronic cough, productive mucopurulent sputum, with frequent exacerbations due to chest infections

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27
Q

Blue bloaters are typically around the ages of __ to __

A

30-40

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28
Q

Describe the appearance of blue bloaters

A

They are typically overweight and cyanotic, but seem comfortable at rest

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29
Q

What is also common in blue bloaters?

A

peripheral edema

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30
Q

When examining chest sounds in blue bloaters what will you hear?

A

Noisy chest, with rhonchi invariably present, wheezes are also common

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31
Q

Blue bloaters typically have _____ hemoglobin, ______ PaO2, and ______ PaCO2

A

elevated

reduced

elevated

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32
Q

What do blue bloater chest radiographs reveal?

A

Increased interstitial markings (“dirty lungs”), especially at the bases, with non-flattened diaphragm

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33
Q

Which pattern of COPD is associated with obstructive sleep apnea?

A

blue bloaters

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34
Q

During exercise minute ventilation is _____ in pink puffers and ____ in blue bloaters

A

increased

decreased

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35
Q

What 4 diseases characterize the late stages of COPD?

A
  • pneumonia
  • pulmonary hypertension
  • cor pulmonale
  • chronic respiratory failure
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36
Q

What is the hallmark of COPD?

A

the exacerbation of symptoms beyond normal day-to-day variation, often including dyspnea, an increased frequency or severity of cough, increased sputum volume or change in sputum character.

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37
Q

What can be used to provide objective information about pulmonary function?

A

spirometry

38
Q

What do pulmonary function tests reveal in the early stages of COPD?

A

evidence of abnormal closing volume and reduced midexpiratory flow rate

39
Q

Reductions in what lab values occur later on in the disease?

A

FEV1 and in the ratio of forced expiratory volume to vital capacity (FEV1% or FEV1/FVC ratio)

40
Q

What is markedly reduced in severe cases?

A

forced vital capacity (FVC)

41
Q

Lung volume measurements reveal a marked _____ in residual volume, a(n) ______ in total lung capacity, and a(n) ______ of the RV/TLC ratio.

A

increase

increase

elevation

42
Q

What does an elevated RV/TLC ratio indicate?

A

Air trapping

43
Q

What 2 blood gas abnormalities are common in late stage COPD?

A
  • hypoxemia

- respiratory acidosis

44
Q

ECG results may demonstrate what 3 things?

A
  • sinus tachycardia
  • supraventricular arrhythmias
  • ventricular irritability
45
Q

What do radiographs of patients with chronic bronchitis typically show?

A

nonspecific peribronchial and perivascular markings

46
Q

What do plain radiographs show for the diagnosis of emphysema?

A

hyperinflation with flattening of the diaphragm or peripheral arterial deficiency in about half of cases

47
Q

What imaging technique is the most sensitive and specific for the diagnosis for COPD

A

CT of the chest

48
Q

What are 5 differential diagnoses for COPD?

A
  • asthma
  • bronchiectasis
  • cystic fibrosis
  • bronchopulmonary mycosis
  • central airflow obstruction
49
Q

How is COPD distinguished from asthma?

A

Asthma is characterized by complete or near-complete reversibility of airflow obstruction

50
Q

How is bronchiectasis distinguished from COPD?

A

By recurrent pneumonia and hemoptysis, digital clubbing, and characteristic imaging abnormalities

51
Q

How is cystic fibrosis distinguished from COPD?

A

It affects children, adolescents, and young adults

52
Q

How is mechanical obstruction of the central airways distinguished from COPD?

A

by flow-volume loops

53
Q

What 5 diseases may worsen otherwise stable COPD?

A
  • acute bronchitis
  • pneumonia
  • pulmonary thromboembolism
  • atrial dysrhythmias
  • concomitant left ventricular failure
54
Q

A spontaneous ______ occurs in a small fraction of patients with emphysema

A

pneumothorax

55
Q

What may result from chronic bronchitis or may signal bronchogenic carcinoma?

A

hemoptysis

56
Q

COPD is largely preventable through what?

A

elimination of long-term exposure to tobacco smoke

57
Q

What may also help prevent COPD?

A

Vaccination against seasonal and epidemic influenza A (H1N1) and pneumococcal infection

58
Q

What are the 7 treatment ideas for ambulatory COPD patients?

A
  • smoking cessation
  • oxygen therapy
  • inhaled bronchodilators
  • corticosteroids
  • theophylline
  • antibiotics
  • pulmonary rehabilitation
59
Q

What patients are particularly likely to benefit from home oxygen therapy?

A

Hypoxemic patients with…

- pulmonary hypertension
- chronic cor pulmonale
- erythrocytosis impaired cognitive function
- exercise intolerance
- nocturnal restlessness
- morning headache
60
Q

Survival of hypoxemic patients with COPD treated with supplemental oxygen is directly proportional to what?

A

the number of hours per day oxygen is administered

61
Q

Oxygen via nasal prongs must be given for at least __ hours per day

A

15

62
Q

For most patients a flow rate of 1-3 L/min achieves a PaO2 greater than __ mm Hg

A

55

63
Q

Do bronchodilators alter the decline in lung function that is a hallmark of COPD? What do they do?

A

No, they improve symptoms, exercise tolerance, and overall health status

64
Q

What are the 2 most commonly prescribed short-acting bronchodilators?

A
  • anticholinergic ipratropium bromide

- beta-2-agonists

65
Q

What are a couple examples of anticholinergic ipratropium bromide and beta-2-agonists

A

albuterol and metaproterenol

66
Q

Which short-acting bronchodilator is typically preferred and why?

A

Ipratropium bromide because of its longer duration of action and absence of sympathomimetic side effects

67
Q

What type of short-acting bronchodilators have a more rapid onset of action, which commonly leads to greater patient satisfaction?

A

beta-2-agonists

68
Q

When should long-acting beta-2-agonists and anticholinergics be used?

A

In patients with advanced disease

69
Q

What are a few examples of long-acting beta-2-agonists ?

A
  • formoterol
  • salmeterol
  • indacaterol
  • arformoterol
70
Q

What is one example of a long-acting anticholinergic?

A

tiotropium

71
Q

Combination therapy with an inhaled corticosteroid and what reduces the frequency of exacerbations and improves self-reported functional status in COPD patients?

A

a long-acting beta-2-agonist

72
Q

What does theophylline do?

A

Improves dyspnea ratings, exercise performance, and pulmonary function in many patients with stable COPD

73
Q

What do the benefits of theophylline result from?

A
  • bronchodilation
  • anti-inflammatory properties
  • extrapulmonary effects on diaphragm strength, myocardial contractility, and kidney function
74
Q

What is a significant concern of theophylline?

A

its toxicity

75
Q

Antibiotics are prescribed to outpatients with COPD for what 3 indications?

A

1) to treat an acute exacerbation,
2) to treat acute bronchitis
3) to prevent acute exacerbations of chronic bronchitis (prophylactic antibiotics)

76
Q

What are 3 pulmonary rehabilitation exercise ideas?

A
  • Graded aerobic exercise
    Training of inspiratory muscles
  • Pursed-lip breathing
77
Q

In patients with chronic bronchitis, increased mobilization of secretions may be accomplished through the use of what?

A
  • adequate systemic hydration
  • effective cough training methods
  • the use of a hand-held flutter device and postural drainage
78
Q

What is available for replacement therapy in emphysema due to congenital deficiency?

A

Human alpha-1-antitrypsin

79
Q

Severe dyspnea in spite of optimal medical management may warrant a clinical trial of what?

A

opioids or sedative-hypnotic drugs

80
Q

What does management of a hospitalized patient with an acute exacerbation of COPD include?

A
  • supplemental oxygen (titrated to maintain SaO2 between 90% and 94% or PaO2 between 60 mm Hg and 70 mm Hg)
  • inhaled ipratropium bromide (500 mcg by nebulizer, or 36 mcg by MDI with spacer, every 4 hours as needed) plus beta-2-agonists (eg, albuterol 2.5 mg diluted with saline to a total of 3 mL by nebulizer, or MDI, 90 mcg per puff, four to eight puffs via spacer, every 1–4 hours as needed)
  • broad-spectrum antibiotics
81
Q

If progressive respiratory failure ensues what 2 things are necessary

A

tracheal intubation and mechanical ventilation

82
Q

What are 3 surgery options for patients with COPD?

A
  • Lung transplantation
  • Lung volume reduction surgery
  • Bullectomy
83
Q

What are the 8 requirements for lung transplantation?

A
  • severe lung disease
  • limited activities of daily living
  • exhaustion of medical therapy
  • ambulatory status
  • potential for pulmonary rehabilitation
  • limited life expectancy without transplantation
  • adequate function of other organ systems
  • a good social support system
84
Q

What is lung volume reduction surgery?

A

a surgical approach to relieve dyspnea and improve exercise tolerance in patients with advanced diffuse emphysema and lung hyperinflation

85
Q

What is a bullectomy?

A

An older surgical procedure for palliation of dyspnea in patients with severe bullous emphysema

86
Q

The outlook for patients with clinically significant COPD is ____.

A

poor

87
Q

What is an important predictor of survival?

A

The degree of pulmonary dysfunction at the time the patient is first seen

88
Q

The median survival of patients with FEV1 ≤ 1 L is about _ years

A

4

89
Q

When should you refer a patient for hospitalization?

A
  • COPD onset occurs before the age of 40
  • 2 or more exacerbations despite optimal treatment
  • Severe or rapidly progressive COPD
  • Symptoms disproportionate to the severity of airflow obstruction
  • Need for long-term oxygen therapy
  • Onset of comorbid illnesses (such as bronchiectasis, heart failure, or lung cancer)
90
Q

When should you admit a patient for hospitalization?

A
  • Severe symptoms or acute worsening that fails to respond to outpatient management
  • Acute or worsening hypoxemia, hypercapnia, peripheral edema, or change in mental status
  • Inadequate home care, or inability to sleep or maintain nutrition/hydration due to symptoms
  • The presence of high-risk comorbid conditions

724: Medical Lectures (42 decks)

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