COPD

Question 1

What is Clenil?

Answer 1

Inhaled corticosteroid brand name

Question 2

What is Serevent?

Answer 2

LABA

Question 3

What is Spiriva?

Answer 3

LAMA

Question 4

What is Seretide?

Answer 4

Combination inhaler

Question 5

What is Type 1 Respiratory Failure and what PaO2 indicates T1RF?

Answer 5

Type I respiratory failure is also known as hypoxaemic failure, and is defined by a PaO2 of less than 8kPa. It indicates a serious underlying pathology with the lungs such as infection, oedema or a shunt.

Question 6

What is Type 2 Respiratory Failure and what PaCO2 indicates T2RF?

Answer 6

Type II respiratory failure is also known as ventilatory failure, results when PaCO2 is more than 7. Reduced ventilatory effort can be a result of gas trapping, such as in COPD and severe asthma, due to chest wall deformities, muscle weakness or central causes of respiratory depression.

Question 7

Name 7 clinical features of hypercapnia.

Answer 7

Dilated pupils

Bounding pulse

Hand falp

Myoclonus

Confusion

Drowsiness

Coma

Question 8

What ECG sign indicates cor pulmonale (right atrial enlargement)?

Answer 8

Peaked p-waves and right axis deviation

Question 9

What are the top five most common infective causes of COPD exacerbation? List them from most to least common.

Answer 9

1. Streptococcus pneumoniae
2. Viruses
3. Moraxella catarrhalis
4. Haemophilius influenzae
5. Pseudomonas aeruginosa

Question 10

You are undertaking a medication review on one of your patients in a GP surgery. You note that the latest spirometry shows an FEV1 of 59%. The patient is already taking salbutamol prn. What other medications should be considered at this point?

Answer 10

Salmeterol inhaler or tiotropium inhaler

Question 11

You are asked to review an ABG on a patient in the Emergency department who has been admitted with shortness of breath and is known to have COPD. You are told that they have a GCS of 15. The ABG shows:

FiO2 35% oxygen via venturi mask
SaO2 98%
pH 7.31
pCO2 7.8 kPa
pO2 13.6 kPa
HCO3 22.1 kPa
BE -4.5

What does the ABG show? And what would be the best next step in management?

Answer 11

Uncompensated type II respiratory failure.

Reduce the amount of inspired oxygen.

Question 12

What is the mechanism of action of salbutamol?

Answer 12

B2 agonist

Question 13

What is the mechanism of action of ipratropium?

Answer 13

Antimuscarinic (anticholinergic) agent

Question 14

What is the mechanism of action of theophylline?

Answer 14

Phosphodiesterase inhibitor

Question 15

What is the mechanism of action of prednisolone?

Answer 15

Changes nuclear transcription of cells to reduce inflammation

Question 16

What is the mechanism of action of magnesium?

Answer 16

Calcium channel blocker

Question 17

When is long term home oxygen therapy (LTOT) indicated in patients with COPD? (select all that apply)

Answer 17

PaO2 < 7.3kPa on air

Question 18

You are reviewing some spirometry results for one of your COPD patients. It shows an FEV1 of 39%. What is the severity of their COPD according to the GOLD (Global initiative for chronic obstructive lung disease) classification?

Answer 18

Severe

Question 19

Why might patients with COPD get headaches?

Answer 19

Due to CO2 retention

Question 20

What does Grade 1 mean on the MRC Dyspnoea Scale?

Answer 20

Breathless during strenuous exercise only

Question 21

What does Grade 2 mean on the MRC Dyspnoea Scale?

Answer 21

Breathless when hurrying or walking up a slight incline

Question 22

What does Grade 3 mean on the MRC Dyspnoea Scale?

Answer 22

Walks slower than people of the same age due to dyspnoea, or needs to pause for breath when walking at own pace

Question 23

What does Grade 4 mean on the MRC Dyspnoea Scale?

Answer 23

Pauses for breath after walking 100m/a few minutes on the level

Question 24

What does Grade 5 mean on the MRC Dyspnoea Scale?

Answer 24

Too breathless to leave the house, or breathless when dressing

Question 25

Apart from the lungs, what other organ can alpha-1 antitrypsin deficiency affect?

Answer 25

Liver disease

Question 26

What features of asthma differentiate it from COPD?

Answer 26

Diurnal variation in symptoms and peak flow History of atopy Eosinophilia (in blood and sputum) Lung function tests demonstrating bronchodilator reversibility

Question 27

What features of bronchiectasis differentiate it from COPD?

Answer 27

Expectorate larger volumes of sputum More frequent LRT infections (often starting in childhood) High-resolution chest CT showing bronchial dilation

Question 28

What features of congestive cardiac failure differentiate it from COPD?

Answer 28

Orthopnea PND History of cardiovascular disease Fine basal inspiratory crepitations Bloods showing elevated BNP Echocardiogram showing reduced ejection fraction

Question 29

What features of lung cancer differentiate it from COPD?

Answer 29

Weight loss Haemoptysis Chest x-ray and bronchoscopy showing the presence of tumour

Question 30

What features of tuberculosis differentiate it from COPD?

Answer 30

Drenching night sweats Weight loss Positive sputum culture and microscopy

Question 31

What FEV1/FVC do you see in COPD?

Answer 31

<70%

Question 32

What FEV1 indicates mild COPD?

Answer 32

>80% of predicted

Question 33

What FEV1 indicates moderate COPD?

Answer 33

50-79% of predicted

Question 34

What FEV1 indicates severe COPD?

Answer 34

30-49% of predicted

Question 35

What FEV1 indicates very severe COPD?

Answer 35

<30% of predicted?

Question 36

What PaCO2 and bicarbonate levels would indicate that a patient is a "CO2-retainer"?

Answer 36

PaCO2 >6 and bicarbonate >30

Question 37

What classes as a hyper-inflated chest on an X-ray?

Answer 37

>6 anterior ribs or >10 posterior ribs visible in the mid-clavicular line

Question 38

Describe the conservative management of COPD

Answer 38

Smoking cessation Pulmonary rehabilitation Annual influenza vaccine One-off pneumococcal vaccine Personalised self-management plan

Question 39

Other than cessation advice, what other treatments can be given to help a patient stop smoking?

Answer 39

Nicotine replacement Anti-depressants Nicotine receptor blockers

Question 40

Name an anti-depressant used to help patients with smoking cessation

Answer 40

Bupropion

Question 41

Name a nicotine receptor blocker used to help patients with smoking cessation

Answer 41

Varenicline

Question 42

Name two SABAs

Answer 42

Salbutamol and terbutaline

Question 43

Name two LABAs

Answer 43

Salmetarol and eformoterol

Question 44

Name two antimuscarinics

Answer 44

Ipratropium and tiotropium

Question 45

Name three inhaled corticosteroids

Answer 45

Beclomethasone Budesonide Fluticasone

Question 46

Name an oral theophylline

Answer 46

Aminophylline

Question 47

Name a mucolytic

Answer 47

Carbocysteine

Question 48

Name the three types of inhalers

Answer 48

Breath-activated Dry powder Metered dose

Question 49

Describe the treatment of COPD when newly diagnosed

Answer 49

Give anti-smoking advice/ treatment Choose correct inhaler device and short SABA

Question 50

What should you do if the patient is still breathless on their SABA?

Answer 50

Add LABA or anti-muscarinic

Question 51

What should you do if the FEV1/FVC <50% or the patient is getting frequent exacerbations?

Answer 51

Add an inhaled corticosteroid

Question 52

Should you do if the patient is still breathless despite being on SABA, LABA, and antimuscarinic?

Answer 52

Consider pulmonary rehabilition, high dose bronchodilators (e.g. multidose SABAs or nebuliser), and theophylline

Question 53

What is QVAR?

Answer 53

Inhaled corticosteroid brand name

Question 54

What is plumicort?

Answer 54

Inhaled corticosteroid brand name

Question 55

What is flixotide?

Answer 55

Inhaled corticosteroid brand name

Question 56

What is Symbicort?

Answer 56

Combination inhaler

Question 57

What is Fostair?

Answer 57

Combination inhaler