Clinical COPD

Question 1

Which patient? cough is rare

Answer 1

pink puffer

Question 2

Age for COPD

Answer 2

50s and 60s

Question 3

which patient? weight loss

Answer 3

pink puffer

Question 4

What scale for severity of Dyspnea of COPD are we using

Answer 4

Medical Research Scale (MRS)

Question 5

Breathlessness while hurry on ground level or walking up a slight hill

Answer 5

Grade 2

Question 6

What is the hallmark of COPD

Answer 6

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

Question 7

the 2 symptom patterns

Answer 7

• pink puffers

- blue bloaters

Question 8

Needs to stop after 100 yards or a few minutes on level ground

Answer 8

Grade 4

Question 9

single most important intervention in smokers with COPD?

Answer 9

encourage smoking cessation

Question 10

Gold 2

Answer 10

FEV1 between 49 and 80 . . . . moderate

Question 11

too breathless to leave the house or while undressing

Answer 11

Grade 5

Question 12

Gold 1

Answer 12

FEV1 > 79 . . . mild

Question 13

Which patient? increased interstitial markings (“dirty lungs”) especially at the bases and diaphragms are not flattened

Answer 13

blue bloater

Question 14

Breathlessness only with strenuous exercise

Answer 14

Grade 1

Question 15

Which patient? hyperinflation with flattened diaphragms

Answer 15

pink puffer

Question 16

which patient? overweight

Answer 16

blue bloater

Question 17

What is a fourth line agent in patients who do not achieve adequate symptom control with inhaled anticholinergic, beta 2 agonist, and corticosteroids

Answer 17

Theophilline

Question 18

Which patient? Major complaint is dyspnea

Answer 18

pink puffer

Question 19

What is required to make a diagnosis of COPD

Answer 19

spirometry

Question 20

Patients present with

Answer 20

• excessive cough
• sputum production
• shortness of breath

Question 21

which patient? late 30s and 40s

Answer 21

blue bloater

Question 22

Which patient?

Major complaint is chronic cough,production of mucopurulent sputum with frequent exacerbations due to chest infection

Answer 22

blue bloater

Question 23

What is the overall goal when giving Roflumilast

Answer 23

reduce the risk of COPD exacerbations in patients with a history of frequent COPD exacerbations (at least 2 per year or one requiring hospitalization)

Question 24

Breathlessness walking less than a mile or less than 15 minutes and slower than people their same age

Answer 24

Grade 3

Question 25

which patient? scant and clear mucoid sputum

Answer 25

pink puffer

Question 26

What is clearly the most important cause of COPD in North America and Western Europe?

Answer 26

Smoking

Question 27

Should oxygen therapy be withheld for fear of worsening respiratory acidemia?

Answer 27

NO; hypoxemia is more detrimental than hypercapnia

Question 28

Patients with a COPD exacerbation associated with increased sputum purulence accompanied by dyspnea or an increase in the quantitiy of sputum are thought to benefit most from what?

Answer 28

antibiotic therapy

Question 29

Describe the GOLD standard of classification for COPD

Answer 29

evaluation of severity based on FEV1/FVC AFTER bronchodilators

Question 30

Which patient? chest is noisy chest is quiet

Answer 30

blue bloater pink puffer

Question 31

What characterizes the late stage of COPD

Answer 31

- pneumonia - pulmonary HTN - cor pulmonale - chronic respiratory failure

Question 32

What is generally preferred to the short-acting beta-2 agonist as a first line agent? and why?

Answer 32

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

Question 33

Which patient has elevated Hb?

Answer 33

blue bloater

Question 34

PDE-4 inhibitor that decreases inflammation and my promote airway smooth muscle relaxation

Answer 34

Roflumilast

Question 35

Which patient? age 50

Answer 35

pink puffer

Question 36

What given to patients with resting hypoxemia is the only therapy with evidence of improvement in the natural history of COPD

Answer 36

Oxygen therapy

Question 37

Do bronchodilaters alter lung decline?

Answer 37

No . . they improve symptoms though

Question 38

is there any advantage of scheduled use of short acting beta 2 agonist compared with as needed administration?

Answer 38

No

Question 39

Do COPD patients benefit from corticosteroids?

Answer 39

there may be a subset of steroid responsive COPD patients more likely to benefit from long-term oral or inhaled corticosteroids

Question 40

Gold 4

Answer 40

FEV1 lower than 30 . . . very severe

Question 41

Gold 3

Answer 41

FEV1 between 29 and 50 . . . severe