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Internal medicine > Chronic Obstructive Pulmonary Diseases > Flashcards

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
Q

Changes in the pulmonary vasculature include

A
  1. Intimal hyperplasia
  2. smooth muscle hypertrophy/hyperplasia
    thought to be due to chronic hypoxic vasoconstriction of the small pulmonary arteries
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26
Q

Destruction of the alveoli due to emphysema can lead to

A

loss of the associated areas of the pulmonary capillary bed

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27
Q

Risk factors for COPD

A

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

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28
Q

Alpha 1 antitrypsin functions to

A

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

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29
Q

Characteristic symptoms of COPD are

A

chronic and progressive dyspnea, cough, and sputum production that can be variable from day to day

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30
Q

How is dyspnea in COPD?

A

Progressive, persistent and characteristically worse with exercise

31
Q

how is chronic cough clinically in COPD

A

Intermittent and may be unproductive

32
Q

Clinical features in addition to dyspnea, cough and sputum production

A 
Wheezing
Chest tightness
Weight loss
Respiratory infections
Skeletal muscle dysfunction
Depression
Peripheral Edema
Osteoporosis
33
Q

On examination of a COPD patient, we inspect the following:

A

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
Q

Patients with end stage COPD may adopt a position that support breathing, such position is known as

A

Tripod position

35
Q

Palpation of a COPD patient may show:

A

Decreased fremitus vocalis
Chest expansion
Reduction of cricosternal distance

36
Q

On percussion of a COPD patient, we may find:

A

Hyperresonance of the chest
Depressed diaphragm due to chest expansion
Diminished area of cardiac and liver dullness

37
Q

On auscultation of a COPD patient, the following findings may be noted:

A 
Prolonged expiration
Reduced breath sounds
The presence of wheezing
Quiet breathing
Crackle can be heard if infections exist
38
Q

Symptoms of a blue bloater (Chronic Bronchitis)

A 
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
Q

Symptoms of a Pink Puffer (Emphysema)

A 
Dyspnea
Minimal cough
Increased minute ventilation
Pink skin, Pursed-lip breathing
Accessory muscle use
Cachexia
Hyperinflation, barrel chest
Decreased breath sounds
Tachypnea
40
Q

Complications of a Blue Bloater (Chronic Bronchitis) include

A

Secondary polycythemia vera due to hypoxemia
Pulmonary hypertension due to reactive vasoconstriction from hypoxemia
Cor Pulmonale from chronic pulmonary hypertension

41
Q

Complications of a Pink Puffer (Emphysema) include

A

Pneumothorax due to bullae

Weight loss due to work of breathing

42
Q

Key indicators for considering the diagnosis of COPD

A 
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
Q

______ is required to establish diagnosis of COPD

A

Spirometry

44
Q

Spirometry parameters required to diagnose COPD

A

Post-bronchodilator FEV1/FVC ratio of <0.70

45
Q

Other investigations of COPD in addition to spirometry include

A 
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
Q

CBC in COPD is useful in detecting:

A

Anemia or Polycythemia

47
Q

Sputum examination in COPD is useful in detecting microorganisms such as:

A

Streptococcus Pneumonia
Hemophilus Influenzae
Moraxella Catarrhalis

48
Q

in emphysema, a Chest X-Ray can indicate the following:

A

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
Q

In Chronic Bronchitis, CXR abnormality could be:

A

No apparent abnormality

Maybe thickened or increased lung markings

50
Q

CT in emphysema is useful for:

A

evaluation of bullous diseases

51
Q

the GOLD classification of COPD includes:

A
  1. FEV1
  2. Clinical symptoms
  3. History of exacerbations
52
Q

Differential diagnosis of COPD

A 
Asthma
CHF
Bronchiectasis
Tuberculosis
Obstructive Bronchiolitis
Diffuse Pan bronchiolitis
53
Q

the COPD management cycle includes:

A

|—>Review: symptoms and exacerbations –> Assess: inhaler technique and adherence/ non pharmacological approaches –> Adjust dose or switch device –>|

54
Q

Assessment of COPD symptoms has 3 techniques

A

COPD Assessment Test (CAT)
Clinical COPD Questionnaire (CCQ)
mMRC Breathlessness Scale

55
Q

mMRC Grade 0 indicates:

A

SoB with strenuous exercise

56
Q

mMRC Grade 1 indicates:

A

SoB when hurrying on the level or walking up a hill

57
Q

mMRC grade 2 indicates:

A

Walking slower than people of same age on the level because of SoB / stop for breath when walking on the level

58
Q

mMRC Grade 3 indicates:

A

Stopping for breath after walking approximately 100 meters or after a few minutes on the level

59
Q

mMRC Grade 4 indicates:

A

too SoB to leave the house or too SoB when dressing/undressing

60
Q

mMRC of ___ means less breathlessness

A

0-1

61
Q

mMRC of ____ means more breathlessness

A

> 2

62
Q

Management of COPD is based on 3 principals:

A

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
Q

General management of COPD includes:

A
  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
Q

_____________ is central to the management of breathlessness

A

Bronchodilator therapy

65
Q

______ route of bronchodilators is preferred

A

Inhaled

66
Q

_________ bronchodilator class may be used for patients with mild breathlessness

A

Short acting

67
Q

__________ bronchodilator class is appropriate for moderate to severe SoB

A

Longer acting

68
Q

Oral bronchodilator therapy, such as Theophylline maybe considered in:

A

Patients who cannot use inhaled devices efficiently\

69
Q

Limits of oral bronchodilator use:

A

Side effects
Unpredictable metabolism
Drug interations
(Monitor plasma levels)

70
Q

The fixed combination of Inhaled glucocorticoids and a Long Acting B2 Agonist (LABA) works to:

A

Improves lung function
reduces the frequency and severity of exacerbations
Improves quality of life

71
Q

advantages of fixed combinations of inhaled glucocorticoids and LABA increases the risk of ____________

A

pneumonia, particularly in elderly

72
Q

LABA/Inhaled Glucocorticoids are often given with _______

A

Long Acting Muscarinic Antagonist (to prevent bronchoconstriction)

73
Q

LAMAs are used with caution in patients with _________

A

Significant heart disease or history of urinary retention

Internal medicine (7 decks)

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