Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory > Chronic Obstructive Pulmonary Disorder (COPD) > Flashcards

Chronic Obstructive Pulmonary Disorder (COPD) Flashcards

1
Q

Define COPD

A

Chronic, slowly progressive airflow obstruction with little to no reversibility or variability due to lung tissue damage, heavily associated with smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of COPD?

A

Smoking

Alpha 1 Antitrypsin Deficiency

Jobs involving dust, vapours, fumes

Air pollution

Chronic asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the presentation of COPD

A

Dyspnoea/Orthopnoea

  • Progressive and persistent

Cough

  • Clear sputum, persistent

Chest Tightness

Wheeze

Reduced chest expansion

Recurrent chest infection

Hyperinflated chest

Coraco-sternal distance <3cm

Resonant or hyper-resonant

Cyanosis

Tachypnoea

Use of accessory muscles

  • SCM, intercostals, abdominal muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What tests are used in the investigation/diagnosis of COPD?

A

ECG

  • Extended P waves due to atrial strain right sided heart failure

Sputum Culture

  • Infective causes of exacerbation

ABG

  • Evidence of type 2 respiratory distress
  • Acidosis

CXR

  • Hyperinflated chest (flattened hemidiaphragm, thin heart and increased number of visible anterior ribs)
  • Bullae

Alpha 1 Antitrypsin Test

FBC

  • Polycythaemia

Pulmonary Function Tests/Spirometry

  • Obstructive pattern

Transfer factor for CO

  • Decreased in COPD, can give an indication about the severity of the disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pharmacological management of stable COPD?

A

Short Acting Beta 2 Agonist (SABA)

Short Acting Muscarinic Antagonist (SAMA)

Long Acting Beta 2 Agonist (LABA)

Long Acting Muscarinic Antagonists (LAMA)

Inhaled Corticosteroids (ICS)

Long term oxygen therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give an example of a SABA

A

Salbutamol

Terbutaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give an example of a SAMA

A

Ipatropium bromide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give an example of an ICS

A

Beclometasone dipropionate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give an example of a LAMA

A

Tiotropium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give an example of a LABA

A

Salmetorol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give an example of a LTRA

A

Montelukast

Theophylline

Aminothylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of acute exacerbation of COPD? (emergency treatment)

A

High flow oxygen

Salbutamol nebulised 5mg/4h

IV 200mg Hydrocortisone

Intubation and ventillation in severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the non-pharmacological managemet of COPD?

A

Smoking cessation

Pulmonary rehabilitation

  • Recomended early in diagnosis when patients begin to feel breathless

Vaccinations

  • Annual influenza
  • Once off pneumococcal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are complications of long-term steroid use?

A

Immunosuppression

Bruising

>Abdominal fat

HTN

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is alpha-1-antitrypsin deficiency?

A

Lack of a1-antitrypsin, an enzyme made in the liver, that controls the breakdown of other enzymes in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What mode of inheritence is alpha-1-antitrypsin deficiency?

A

Autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is alpha-1-antitrypsin deficiency managed?

A

Smoking cessation

Supportive

  • Bronchodilators
  • Physiotherapy

IV alpha1-antitrypsin protein concentrates

Surgery

  • Lung volume reduction surgery
  • Lung transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a complication of alpha-1-antitrypsin deficiency?

A

Hepatocellular carcinoma

19
Q

Why does COPD cause secondary polycythemia?

A

Secondary polycythemia most often develops as a response to chronic hypoxemia, which triggers increased production of erythopoietin by the kidneys

20
Q

What is the diagnostic test for COPD?

A

Spirometry, showing an obstructive pattern with little to no reversibility

21
Q

What organisms cause infective exacerbations of COPD?

A

Haemophilus influenzae

Streptococcus pneumoniae

Moraxella Catarrhalis

Rhinovirus

22
Q

What is the most common organism causing infective exacerbations of COPD?

A

Haemophilus influenzae

23
Q

Give features that suggest a patient’s COPD would be steroid responsive

A

Previous diagnosis of asthma or atopy

>Eosinophil

Variation of FEV1

Variation of peak expiratory flow

24
Q

Describe the COPD management ladder in steroid responsive patients

A

SABA/SAMA, stays throughout ladder

LABA and ICS

LABA, LAMA, ICS triple therapy

Specialist referral

25
Q

Describe the COPD management ladder in a non steroid responsive patient

A

SABA/SAMA stays throughout ladder

LABA + LAMA

LABA LAMA + ICS triple therapy 3 month trial and reverted back if it does not work

Specialist referral

26
Q

When should long term oxygen therapy be offered?

A

If ABG show PaO2 < 7.3kpa on two occassions measured 3 weeks apart

Or to those with a pO2 of 7.3 - 8 kPa and one of the following

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary hypertension
27
Q

What interventions improve survival in COPD?

A

Smoking cessation

Long term oxygen therapy

28
Q

What antibiotic is used for infection prophylaxis in COPD?

A

Azithromycin

Doxyclycline if long QT syndrome

29
Q

What has to be monitored with azithromycin use?

A

ECG

  • Can cause long QT syndrome

LFTs

30
Q

What factors would prompt the assessment of a patient for long term oxygen therapy?

A

FEV1 <30-49%

Cyanosis

Polycythaemia

Peripheral oedema

>JVP

O2 <92% on room air

Do not offer LTOT to people who continue to smoke despite being offered smoking cessation advice and treatment, and referral to specialist stop smoking services

31
Q

What feature of COPD can mimic a pneumothorax?

A

Large bullae

32
Q

What should be given in patients with frequent exacerbations of COPD?

A

Home supply of prednisolone and azithromycin

33
Q

What is a complication of oxygen administration in COPD patients?

A

Over administration of oxygen

These patients lose their hypoxic drive for respiration, therefore retain CO2 and subsequently hypoventilate leading to respiratory arrest/type 2 respiratory failure

34
Q

What is the O2 sat goals in COPD patients?

A

88-92% target until blood gases available

94-98% if CO2 is normal on ABG

35
Q

Describe an obstructive spriometry pattern

A

decreased FEV1

normal/decreased FVC

decreased FEV1/FVC

36
Q

What is FEV1?

A

Forced expiratory volume

The amount of air a person can forcefully exhale in one second

37
Q

What is FVC?

A

Forced vital capacity

The amout of air a person can forcefully exhale after taking a deep breath

38
Q

What is the FVC/FEV1 ratio in COPD?

A

Less than 0.7

Meaning that being able to blow air out is limited by the damage to their airways causing airway obstruction

39
Q

What should be offered to pregant woman who smoke?

A

Nicotine replacement therapy should be offered, varenicline and bupropion are contraindicated

40
Q

What is stage 1/mild airflow obstruction?

A

FEV1 over 80% of predicted

41
Q

What is stage 2/moderate airway obstruction?

A

FEV1 50-79% of predicted

42
Q

What is stage 3/severe airway obstruction?

A

FEV1 30-49% of predicted

43
Q

What is stage 4/very severe airway obstruction?

A

FEV1 less than 30% of predicted

44
Q

What oxygen should be used to treat any critically ill patient?

A

High flow/15l via non re-breather mask EVEN IN CO2 RETAINERS/COPD

Respiratory (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions