COPD Flashcards

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1
Q

Signs and symptoms of COPD

A

CO retention flap
Tripod stance
Reduced pO2
Bounding pulse - co2 retention
Bruising from steroid use
Crackles

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2
Q

What heart condition do you need to look for in COPD

A

Cor pulmonale - where pulmonary hypertension results in right sided heart failure

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3
Q

Signs of cor pulmonale

A

Raised JVP
Hepatomegaly
Parasternal heave
Loud pulmonary second heart sound

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4
Q

What is FEV1 vs FVC

A

FEV1 - exhalation in 1 second
FVC - how much you can exhale totally after inhalation

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5
Q

Normal FEV1 and normal FVC

A

Over 80 percent

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6
Q

Normal FEV1 to FVC ratio

A

Over 70 percent

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7
Q

How can you compare obstructive vs restrictive lung diseases?

A

The FEV1 to FVC ratio would be normal in restrictive disease, as both are reduced individually.

In obstructive, the ratio would be reduced because FVC is normal/only slightly reduced.

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8
Q

Asthma vs COPD FEV1 to FVC

A

Asthma - reversible
COPD - not reversible, ratio under 70 percent

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9
Q

How do you classify COPD

A

Mild - FEV1 over 80
Moderate - FEV1 - 50-80
Severe - 30-50
Very severe - under 30

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10
Q

In COPD, what x ray changes do you see and why?

A

Hyperexpansion - look for whether the diaphragm looks flat, and if the diaphragm is being intersected by ribs 5-7 of the anterior (curved) ribs.

The lower border of the heart may be seen as floating

Bullae - black spaces

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11
Q

Management of COPD

A
  1. SABA or SAMA
  2. LABA and LAMA or LABA and ICS
  3. LABA, LAMA, ICS
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12
Q

What is SAMA

A

short acting muscarinic antagonist - e.g. ipratropium bromide

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13
Q

Give an example of a LABA ICS combo

A

Symbicort - formoterol plus budesonide

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14
Q

Give examples of non-inhaled therapies

A

Mucolytic such as carbocysteine
Theophylline

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15
Q

Give examples of non pharmacological management of COPD

A

Smoking cessation
Pulmonary rehab
Pneumococcal/influenza vaccines
Lung transplant

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16
Q

Give examples of oxygen therapy in end stage COPD

A

Long term oxygen therapy = LTOT
Ambulatory home oxygen therapy - if only hypoxemic on extertion

17
Q

When would you prescribe LTOT

A

If the pO2 was below 7.3 kPa (55mmHg, normal range is 75-100mmHg)
or below 8 with pulmonary HTN, pulmonary oedema or secondary polycythemia

18
Q

When would you prescribe ambulatory home oxygen therapy?

A

If hypoxemic on exertion only

19
Q

How much oxygen can be delivered via a nasal cannula

A

up to 2 L

20
Q

What is the oxygen delivery system between a nasal cannula and a venturi face mask and how much can it deliver?

A

Hudson normal face mask - 6 L

21
Q

What are the venturi mask colours

A

Bullies - Blue - 2-4 L
Want - White - 4-6L
Your - Yellow - 8-10 L (not 6)
Ripe - Red - 10-12 L
Grapes - 12 - 15 L

22
Q

How do you manage acute COPD exacerbation

A

Oxygen
Nebulised salbutamol 2.5mg/4 hours
Steroids - 30mg prednisolone or 200mg hydrocortisone
Antibiotics
Chest physio
BiPAP if hypercapnic acidosis and not responding to mx in 1 hr
IV aminophylline
ITU

23
Q

When do you consider ITU in someone with COPD

A

If pH is below 7.26

24
Q
A