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Chronic Obstructive Pulmonary Diseases Flashcards

1
Q

Prevalence of COPD in adults across Europe is:

A

5%-10%

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2
Q

COPD is characterized by:

A

Persistent respiratory symptoms and air flow limitations that is due to Airway and/or alveolar abnormalities usually caused by noxious gases or particles and influenced by host factors including abnormal lung development

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3
Q

COPD includes 2 diseases

A

Chronic Bronchitis and Emphysema

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4
Q

Prior to 2004, COPD included a 3rd disease which was

A

Asthma

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5
Q

Emphysema is defined by:

A

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis (no fibrosis visible to the naked eye)

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6
Q

Exclusion of obvious fibrosis from emphysema was intended to:

A

Distinguish the alveolar destruction of emphysema from interstitial pneumonia

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7
Q

Subtypes of Emphysema

A
  1. Proximal Acinar (Centrilobular Emphysema)
  2. Pan acinar
  3. Distal Acinar (Para septal Emphysema)
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8
Q

Chronic Bronchitis is defined as:

A

Chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough (ex: bronchiectasis) have been excluded. It may precede or follow development of airflow limitation

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9
Q

COPD is present only if:

A

Chronic airflow obstruction occurs. Chronic bronchitis without without chronic airflow obst. is not included in COPD

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10
Q

The predominant pathological changes of COPD are found in?

A

The Airways, but changes are also seen in lung parenchyma and vasculature

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11
Q

Airway abnormalities in COPD include:

A
  1. Chronic Inflammation
  2. Mucus Gland Hyperplasia
  3. Fibrosis
  4. Narrowing and reduction in the number of small airways
  5. Airway collapse due to loss of tethering caused by alveolar wall destruction in emphysema
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12
Q

Increased number of goblet cells and enlarged submucosal glands are seen in:

A

Chronic Bronchitis

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13
Q

Small Airway Disease mechanisms:

A

Airway inflammation
Airway Fibrosis
Luminal plugs
Increased Airway resistance

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14
Q

Parenchymal destruction mechanisms

A

Loss of alveolar attachments

Decrease of elastic recoil

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15
Q

Emphysema affects which structures?

A 
Structures distal to the terminal bronchiole, including:
Respiratory bronchiole
Alveolar Ducts
Alveolar Sacs
Alveoli
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16
Q

Acinus include

A

Respiratory bronchiole
Alveolar Ducts
Alveolar Sacs
Alveoli

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17
Q

The subtype of emphysema is determined by

A

the part of acinus that is affected by permanent dilation or destruction

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18
Q

Changes in lung parenchyma in COPD

A

Alveolar wall destruction
Loss of elasticity
Destruction of pulmonary capillary bed
Increased inflammatory cells, particularly macrophages, CD8+ and lymphocytes

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19
Q

Proximal Acinar emphysema is the abnormal dilatation or destruction of the

A

Respiratory bronchiole, which is the central part of the acinus

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20
Q

Proximal Acinar emphysema is commonly associated with

A

Cigarette smoking and coal workers pneumoconiosis

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21
Q

Panacinar Emphysema is defined as

A

Enlargement or destruction of all parts of the acinus

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22
Q

Panacinar emphysema is seen in

A

Alpha-1 Antitrypsin deficiency and smokers, and in combination with proximal emphysema and smoking

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23
Q

in paraseptal (Distal acinar) emphysema, the ________ are predominantly affected

A

Alveolar ducts

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24
Q

When paraseptal emphysema occurs alone, the usual association is

A

Spontaneous pneumothorax in a young adult

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25
Changes in the pulmonary vasculature include
1. Intimal hyperplasia 2. smooth muscle hypertrophy/hyperplasia thought to be due to chronic hypoxic vasoconstriction of the small pulmonary arteries
26
Destruction of the alveoli due to emphysema can lead to
loss of the associated areas of the pulmonary capillary bed
27
Risk factors for COPD
Tobacco smoke (95% of cases) Occupational exposure (coal dust, silica and cadmium) Cannabis smoking Indoor air pollution: Cooking with biomass fuels Outdoor air pollution: smaller effect Recurrent childhood infections Maternal smoking Genetic: Alpha 1 antitrypsin deficiency, Airway hyper reactivity Low birth weight & lung development problems Aging populations and female gender Low socio economic status History of infections
28
Alpha 1 antitrypsin functions to
Protect the lungs from damage caused by protease enzymes such as elastase and trypsin, that can be released as a result of inflammatory response to tobacco smoke
29
Characteristic symptoms of COPD are
chronic and progressive dyspnea, cough, and sputum production that can be variable from day to day
30
How is dyspnea in COPD?
Progressive, persistent and characteristically worse with exercise
31
how is chronic cough clinically in COPD
Intermittent and may be unproductive
32
Clinical features in addition to dyspnea, cough and sputum production
``` Wheezing Chest tightness Weight loss Respiratory infections Skeletal muscle dysfunction Depression Peripheral Edema Osteoporosis ```
33
On examination of a COPD patient, we inspect the following:
Barrel shaped chest Accessory respiratory muscle participate Prolonged expiration during quiet breathing Expiration through pursed lips Paradoxical retraction of the lower airspaces during inspiration (Hoover's sign) Tripod position (supporting body with arms)
34
Patients with end stage COPD may adopt a position that support breathing, such position is known as
Tripod position
35
Palpation of a COPD patient may show:
Decreased fremitus vocalis Chest expansion Reduction of cricosternal distance
36
On percussion of a COPD patient, we may find:
Hyperresonance of the chest Depressed diaphragm due to chest expansion Diminished area of cardiac and liver dullness
37
On auscultation of a COPD patient, the following findings may be noted:
``` Prolonged expiration Reduced breath sounds The presence of wheezing Quiet breathing Crackle can be heard if infections exist ```
38
Symptoms of a blue bloater (Chronic Bronchitis)
``` Chronic productive cough Purulent sputum Hemoptysis Mild dyspnea initially Cyanosis due to hypoxemia Peripheral Edema due to cor pulmonale Crackles, wheezes Prolonged expiration Obesity ```
39
Symptoms of a Pink Puffer (Emphysema)
``` Dyspnea Minimal cough Increased minute ventilation Pink skin, Pursed-lip breathing Accessory muscle use Cachexia Hyperinflation, barrel chest Decreased breath sounds Tachypnea ```
40
Complications of a Blue Bloater (Chronic Bronchitis) include
Secondary polycythemia vera due to hypoxemia Pulmonary hypertension due to reactive vasoconstriction from hypoxemia Cor Pulmonale from chronic pulmonary hypertension
41
Complications of a Pink Puffer (Emphysema) include
Pneumothorax due to bullae | Weight loss due to work of breathing
42
Key indicators for considering the diagnosis of COPD
``` progressive persistent SoB Intermittent unproductive chronic cough Chronic sputum production Recurrent LRTI History of risk factors Family history of COPD Childhood factors (Low Birthweight/ childhood resp. inf.) ```
43
______ is required to establish diagnosis of COPD
Spirometry
44
Spirometry parameters required to diagnose COPD
Post-bronchodilator FEV1/FVC ratio of <0.70
45
Other investigations of COPD in addition to spirometry include
``` CBC Sputum Examination CXR CT High resolution CT scan Lung volume and Diffusing Capacity Oximetry and Arterial Blood Gas Alpha 1 Antitrypsin Deficiency Screening ```
46
CBC in COPD is useful in detecting:
Anemia or Polycythemia
47
Sputum examination in COPD is useful in detecting microorganisms such as:
Streptococcus Pneumonia Hemophilus Influenzae Moraxella Catarrhalis
48
in emphysema, a Chest X-Ray can indicate the following:
Marked over-inflation of the chest with flat and low diaphragm Widening of intercostal space Horizontal Rib pattern Long thin Heart shadow Decreased markings of lung peripheral vessels
49
In Chronic Bronchitis, CXR abnormality could be:
No apparent abnormality | Maybe thickened or increased lung markings
50
CT in emphysema is useful for:
evaluation of bullous diseases
51
the GOLD classification of COPD includes:
1. FEV1 2. Clinical symptoms 3. History of exacerbations
52
Differential diagnosis of COPD
``` Asthma CHF Bronchiectasis Tuberculosis Obstructive Bronchiolitis Diffuse Pan bronchiolitis ```
53
the COPD management cycle includes:
|--->Review: symptoms and exacerbations --> Assess: inhaler technique and adherence/ non pharmacological approaches --> Adjust dose or switch device -->|
54
Assessment of COPD symptoms has 3 techniques
COPD Assessment Test (CAT) Clinical COPD Questionnaire (CCQ) mMRC Breathlessness Scale
55
mMRC Grade 0 indicates:
SoB with strenuous exercise
56
mMRC Grade 1 indicates:
SoB when hurrying on the level or walking up a hill
57
mMRC grade 2 indicates:
Walking slower than people of same age on the level because of SoB / stop for breath when walking on the level
58
mMRC Grade 3 indicates:
Stopping for breath after walking approximately 100 meters or after a few minutes on the level
59
mMRC Grade 4 indicates:
too SoB to leave the house or too SoB when dressing/undressing
60
mMRC of ___ means less breathlessness
0-1
61
mMRC of ____ means more breathlessness
>2
62
Management of COPD is based on 3 principals:
Prevention of further progression of the disease Preservation and enhancement of pulmonary function capacity Avoidance of exacerbations in order to improve the quality of life
63
General management of COPD includes:
1. Smoking Cessation advice 2. Annual influenza vaccination 3. Pneumococcal vaccination 4. Covid 19 vaccination 5. Improved obesity, depression etc.. 6. Mucolytic agents are occasionally used but with limited evidence of benefit
64
_____________ is central to the management of breathlessness
Bronchodilator therapy
65
______ route of bronchodilators is preferred
Inhaled
66
_________ bronchodilator class may be used for patients with mild breathlessness
Short acting
67
__________ bronchodilator class is appropriate for moderate to severe SoB
Longer acting
68
Oral bronchodilator therapy, such as Theophylline maybe considered in:
Patients who cannot use inhaled devices efficiently\
69
Limits of oral bronchodilator use:
Side effects Unpredictable metabolism Drug interations (Monitor plasma levels)
70
The fixed combination of Inhaled glucocorticoids and a Long Acting B2 Agonist (LABA) works to:
Improves lung function reduces the frequency and severity of exacerbations Improves quality of life
71
advantages of fixed combinations of inhaled glucocorticoids and LABA increases the risk of ____________
pneumonia, particularly in elderly
72
LABA/Inhaled Glucocorticoids are often given with _______
Long Acting Muscarinic Antagonist (to prevent bronchoconstriction)
73
LAMAs are used with caution in patients with _________
Significant heart disease or history of urinary retention

Internal medicine (7 decks)

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