COPD

Question 1

normal FEV1/FVC ratio

Answer 1

• 70%

Question 2

what conditions are included in COPD

Answer 2

• chronic bronchitis

- emphysema

Question 3

where in the US do we see higher incidence of COPD

what is it correlated with

Answer 3

• tobacco belt

- lower SES classes

Question 4

risk factors for COPD

Answer 4

• cigarette smoking
• passive smoking
• biomass fuels
• hyper-responsive airways
• occupational factors

Question 5

genetic cause of emphysema

Answer 5

• alpha1 antitrypsin deficiency

Question 6

pathogenesis of emphysema

Answer 6

• elastase (degrades elastin) and alpha-1 antitrypsin inactivation
• involves innate and adaptive immunity

Question 7

vicious circle hypothesis

Answer 7

• initiating factors (smoking or childhood disease) + genetic predisposition

Question 8

result of pathogenesis of COPD

Answer 8

• small airway remodeling (fibrosis)
• alveolar wall destruction (emphysema)
• mucus hypersecretion

Question 9

mechanisms of physiologic obstruction

Answer 9

• filling of lumen with mucus in chronic bronchitis
• wall thickening/airway fibrosis in chronic bronchitis
• loss of tethering in emphysema

Question 10

emphysema leads to loss of _________ and results in _________

Answer 10

• loss of elastic recoil

- results in airway collapse

Question 11

symptoms of COPD

Answer 11

• shortness of breath
• cough
• wheezing
• fatigue
• weakenss

Question 12

symptoms of COPD late in illness

Answer 12

• morning headaches

- lower leg swelling due to cor pulmonale

Question 13

signs of COPD

Answer 13

• barrel chest
• accessory muscles
• wheezing
• tripod
• decreased breath sounds
• lower extremity edema

Question 14

spirometry of COPD

Answer 14

• reduced FEV1/FVC ratio below 70%

Question 15

FEV1/FVC lower limits of normal declines with

Answer 15

• age

Question 16

FRC in emphysema

Answer 16

• increased FRC

Question 17

RV in emphysema

Answer 17

• increased RV

Question 18

TLC in emphysema

Answer 18

• increased TLC

Question 19

chest x ray features in COPD

Answer 19

• low, flattened diaphragm
• air trapping
• increased A-P diameter

Question 20

effect of exercise on hyperinflation

Answer 20

• gas trapping will get worse when you exercise

- inspiratory capacity will get smaller

Question 21

symptoms with COPD correlate with

Answer 21

• inspiratory capacity

Question 22

classic ABG levels for COPD

Answer 22

• 60 pCO2

- 60 pO2

Question 23

V/Q of COPD

Answer 23

• V/Q mismatching

Question 24

complication of chronic hypoxemia associated with COPD

Answer 24

• cor pulmonale

Question 25

treatment of COPD

Answer 25

• smoking cessation

Question 26

how do you start treatment of COPD

then if it gets worse

and worse

and worse

and even worse

Answer 26

• avoid risk factors and vaccinate
• add short acting bronchodilator
• add long acting bronchodilator + rehab
• add inhaled corticosteroid
• add O2 and consider surgery

Question 27

surgery for COPD

Answer 27

• transplant

- lung volume reduction surgery

Question 28

noninvasive ventilation for COPD

Answer 28

• CPAP

- BiPAP

Question 29

if someone develops emphysema in the base of their lung, think

Answer 29

• alpha-1 antitrypsin deficiency

Question 30

three things that reduce mortality in COPD

Answer 30

• discontinue smoking
• oxygen
• lung volume reduction surgery in the right patient

Question 31

what is the number 1 cause of antibiotic abuse in the US

Answer 31

• acute bronchitis

Question 32

symptoms of acute bronchitis

Answer 32

• sudden onset of cough, greater than 5 days
• no fever, tachycardia, tachypnea
• possible chest soreness

Question 33

mean duration of acute bronchitis

Answer 33

• 18 days

Question 34

most common cause of acute bronchitis

Answer 34

• viral

Question 35

what is a normal FEV1

Answer 35

• above 80%

Question 36

helium dilution is not a good test for what condition

Answer 36

• COPD

Question 37

patients with what kind of emphysema will we use lung reduction volume surgery?

Answer 37

• apical emphysema