COPD

Question 1

Typical patients

Answer 1

Elderly patients, smokers.

Question 2

Pathophysiology

Answer 2

Chronic Bronchitis and Emphysema

Mucous Hypersecretion
Loss of cillia function
Small airway fibrosis

Question 3

Causes

Answer 3

Smoker
Alpha 1 Antityipsin Defficiancy
Industrial pollutants (Soot)

Question 4

Symptoms

Answer 4

Dyspnoea
Cough
Recurrent LRTI
Headache
Fatigue

Question 5

MRC Scale

Answer 5

1 - Breathless on streneous exercise
2 - Breathless when rushing/ Incline
3 - Walks slower than others of same age, must pause.
4 - Unable to walk more than 100m without couple minutes pause.
5 - Unable to leave home, Breathless when dressing.

Question 6

Examination findings

Answer 6

Tar staining
Peripheral cyanosis
CO2 Flap
Oral thrush (ICS)
Pursed lipped breathing
Barrel chest
Hyperressonance
Wheeze

Question 7

Investigations

Answer 7

PFT (Fev1:FVC < 70%)
CXR
Sputum culture
Routine bloods
ECG
ABG

Question 8

CXR Signs

Answer 8

Hyperinflation (>6 anterior ribs)
Hyperlucent
Flattened Diaphragm

Question 9

Treatment

Answer 9

Smoking Cessation
Self management plan
Regular vaccines
Drug treatment (SABA/LABA/LAMA/ICS)
Pulmonary Rehabilitation
LTOT
Surgery (Reduction/Transplant)

Question 10

Exacerbation features

Answer 10

Increased cough
Increased sputum
Change in sptum colour
Worsening breathlessness
Fever

Question 11

Complications

Answer 11

Cor Pulmonale
Secondary Polycythemia
Bronchiectasis
Osteoperosis
Anxiety
Depression

Question 12

Acute Treatment

Answer 12

A-E Assessment
Oxygen (88-92% if retainer)
Nebulised SABA and Ipatropium
30mg Oral Prednisolone 7d
CXR
IV Aminophylline
Consider NIV if type 2 Resp Failure
Consider ITU Refferal if PH<7.25