COPD

Question 1

Smoker, SOB, productive cough, Age > 40 (if less than 40 think about alpha 1 antitrypsin deficiency)

Answer 1

COPD

Question 2

Diagnosis of COPD

Answer 2

Spirometry

Question 3

3 things to improve survival in COPD patient?

Answer 3

1- Smoking cessation
2- Vaccination (pneumococcal , influenzas ,Covid.
3- Home oxygen therapy if indicated

Question 4

Indications for home oxygen therapy:-

Answer 4

-These numbers need to be out of exacerbation attack and repeated in 2 readings

-PaO2 < 55 or SaO2 < 88% on RA -
-PaO2 55-59 + (dependent edema, Hct > 56%, pulmonary hypertension) cor pulmonale
-Nocturnal hypoxemia

PO2
>80 = normal
60-80= Hypoxemia
<60 = Hypoxia

Question 5

Most imp.
points:-
① know the way of oxygenation
② Bronchodilators :
LAMA & LABA .
③Cover with Abx cause it’s the most imp cause of exacerbation
④ if he Takes all the metrication and Still not improved Choose Pulmonary Rehabilitation

Answer 5

.

Question 6

You are treating a 52-year-old woman with a 40-pack-year history of smoking. She reports productive cough that has been present for the last 3 to 4 months, beginning in the fall.
She remembers having the same symptoms last year in the fall, and attributed it to a “cold that she just couldn’t kick.” She does not have fevers, reports mild dyspnea when walking upstairs, and denies hemoptysis.
Which of the following is the most likely diagnosis?

Answer 6

Chronic bronchitis

Question 7

Male smoker since 3-4 years has dyspnea,
increased AP diameter of chest,
FEV1/FVC ratio is less than 0.7,
DLCO is low,
FEV1/FVC mildly improved after administration of beta agonist,
what is the likely diagnosis?

Answer 7

Emphysema (DLCO is low)

Question 8

Male, Smoker, diffuse wheezing, normal chest x-ray, what is the diagnosis?

Answer 8

COPD

Question 9

COPD on pulmonary function test?

Answer 9

Increase TLC, decrease FEV1/FEVC <0.7, decrease VC

Question 10

How to follow the progression in COPD patient?

Answer 10

Change in FEV1

Question 11

Which one of the following improve survival in
COPD patient?
A- Salbutamol
B- Smoking cessation
C- Oxygen therapy for all patient
D- Prednisone

Answer 11

B- Smoking cessation

Question 12

60-year-old male patient known case of COPD diagnosed 10 years ago, He read that oxygen improve survival in COPD patient and asking to start oxygen, what is the indication to start home oxygen in COPD patient?

Answer 12

2 readings of PaO2 < 55 in ABG done out the time of attack

Question 13

Which of these is an indication for home oxygen therapy in COPD?
A- 1 reading of Po2 < 7.8 kPa
B- 2 readings of Po2 < 7.3
C- 1 reading of Po2 < 8
D- 2 readings of Po2< 6.3

Answer 13

B- 2 readings of Po2 < 7.3

7.3 kPa = 55 mm Hg

Question 14

COPD with Cor pulmonale what is the best thing to improve survival?
A- Diuretic
B- Oxygen therapy

Answer 14

B- Oxygen therapy

Question 15

COPD patient came to clinic with bilateral lower limb edema and pulmonary hypertension. O2 sat was 86%, PO2: 8.6, PCO2: 7.5, which of the following is the appropriate management to give for the patient now?
A) Start oral furosemide
B) Start oxygen therapy
C) Prednisolone therapy

Answer 15

B) Start oxygen therapy
since 02 Sat is < 88

Question 16

COPD patient on salmeterol and albuterol, still not controlled as he needs to use albuterol more often now and he had multiple exacerbations in the last 6 months, what to give him for maintenance?

Answer 16

Tiotropium (LAMA)

Question 17

A patient presents with a COPD exacerbation.
Which drug will decrease the mucous secretion more than bronchodilation?
A- Cromolyn Sulphate
B- Ipratropium Bromide
C- Montelukast
D- Prednisone

Answer 17

B- Ipratropium Bromide (SAMA)

Question 18

Patient known case of COPD alert, has moderate respiratory distress.
Sa02 93%, ABG showed hypoxia, hypercapnia and acidosis. What is
the next step:
A- Non-invasive ventilation
B- Mechanical ventilation
C- Increase oxygen
D- Decrease oxygen

Answer 18

A- Non-invasive ventilation

Question 19

COPD and oxygen?
Your optimum target in COPD patient with Co2 retention is to keep saturation?
Non-invasive mechanical ventilation (Bipap and C-pap)?
Invasive mechanical ventilation?

Answer 19

88-92%
Non-invasive mechanical ventilation (Bipap and C-pap) = should be conscious and alert
Invasive mechanical ventilation –> if patient is comatose, altered level of
consciousness, has risk of aspiration (mouth full of secretion)

Question 20

Best way to deliver oxygen in COPD patient?

Answer 20

Venture bag

Question 21

COPD and affected conscious level, low pH?

Answer 21

B- Mechanical ventilation

Question 22

Exacerbation of COPD best management?

Answer 22

Non invasive mechanical ventilation

Question 23

COPD acute exacerbation with a mouth full of secretions?

Answer 23

Invasive Mechanical ventilation

Question 24

COPD patient with lower limb edema and
hepatosplenomegaly Right heart failure signs, what to do to confirm
diagnosis?

Answer 24

Echo

Question 25

COPD can cause right side heart failure, cor pulmonale and pulmonary HTN
Diagnosis :- Echocardiography
COPD is associated with MAT (Multifocal atrial tachycardia)
what is the Treatment?

Answer 25

antiarrhythmic and treat the underlying cause

Question 26

Patient known case of COPD complaining of SOB, palpitation, on examination there is
irregular pulse, what is the treatment?

Answer 26

Amiodarone (anti-arrhythmic)

Question 27

COPD patient developed sudden symptoms of spontaneous pneumothorax, X-ray was done and showed 2 cm pneumothorax, management?

Answer 27

Chest tube
Any 2ⁿᵈ pneumothorax . Put chest tube regardless of the size