COPD

Question 1

a chronic obstructive pulmonary disease that is generally progressive and may be accompanied by airway hyperactivity

Answer 1

chronic obstructive pulmonary disease

Question 2

when are chronic bronchitis and emphysema considered “reversible”?

Answer 2

during acute exacerbations

Question 3

what is emphysema known as?

Answer 3

pink puffer

Question 4

what is chronic bronchitis known as?

Answer 4

blue bloater

Question 5

a patient presents with minimal V/Q mismatch since both alveoli and vessels are damaged, no hypoxemia, hypercapnia, hyperventilation to compensate for CO2, and muscle wasting due to decreased cardiac output. what are they likely experiencing?

Answer 5

emphysema

Question 6

what would chest imaging show for a patient with emphysema? (3)

Answer 6

enlarged lungs
large, irregular bullae
flattened diaphragm

Question 7

a patient presents with V/Q mismatch since airways are damaged but capillaries are intact, hypoxia, cyanosis, acidosis that leads to cor pulmonale, leading to right heart failure and peripheral edema. what are they experiencing?

Answer 7

chronic bronchitis

Question 8

what would chest imaging show for a patient with chronic bronchitis? (2)

Answer 8

increased vascular markings
cardiomegaly

Question 9

what is the #1 risk factor for COPD?

Answer 9

smoking

Question 10

how would a patient present with COPD that has been present for over 10 years and today they just feel worse? (3)

Answer 10

worsening SOB, cough, and sputum

Question 11

what can COPD exacerbations lead to?

Answer 11

respiratory distress / failure

Question 12

what does a COPD exacerbation mimic?

Answer 12

asthma exacerbation

Question 13

what are most COPD exacerbations triggered by?

Answer 13

respiratory infections

Question 14

a patient presents with dyspnea worsening with exertion, digital clubbing, chronic productive cough with SOB. what are they likely experiencing?

Answer 14

COPD

Question 15

what 6 diagnostics should/can be order for a patient with suspected COPD?

Answer 15

blood gas
CBC
spirometry
chest xray
chest CT
doppler echocardiogram

Question 16

what would be seen in a blood gas for a patient with COPD?

Answer 16

normal pH (compensation)
increased CO2
increased HCO3

Question 17

what would be seen in a patient’s CBC if they have COPD?

Answer 17

increased (compensation) or normal Hb and Hct

Question 18

in a spirometry, what would the results look like in a patient with COPD?

Answer 18

TLC increased
FEV1 decreased
FVC normal, until severe
FEV1/FVC ratio decreased

Question 19

what would be seen in a PA CXR for a patient with COPD?

Answer 19

hyperinflation of lungs
flattened diaphragm
increased bronchovesicular markings
vertically oriented cardiomegaly

Question 20

what would be seen in a chest CT of a patient with emphysema? (2)

Answer 20

alveolar destruction
airspace enlargement

Question 21

what would be seen in a chest CT of a patient with bronchitis? (3)

Answer 21

bronchial wall thickening
scarring
increased bronchovesicular markings

Question 22

what would be seen in a doppler echocardiogram of a patient with COPD? (2)

Answer 22

enlarged pulmonary arteries
increased pulmonary blood pressure

Question 23

what is the oxygen therapy recommendation for COPD?

Answer 23

long-term continuous O2

Question 24

what is the first line treatment for COPD?

Answer 24

SAMA - ipratropium

Question 25

what is the second line treatment for COPD?

Answer 25

albuterol - SABA

Question 26

what are the long-acting medications that can be used for COPD? (2)

Answer 26

LABA - salmeterol LAMA - tiotropium

Question 27

what are some examples of ICS that can be used for COPD?

Answer 27

fluticasone budesonide

Question 28

if ICS cannot be used alone for COPD, how should they be used?

Answer 28

ICS + LABA

Question 29

what combination therapy reduces COPD exacerbations?

Answer 29

ICS + LABA

Question 30

what is the fourth line treatment for COPD that should only be used when symptoms are not controlled with ICS, anticholinergics, and steroids?

Answer 30

theophylline

Question 31

what is a PDI that could be used for COPD in the future?

Answer 31

roflumilast

Question 32

what treatment for COPD is indicated for acute exacerbation and prevention or refractory, frequent exacerbations?

Answer 32

antibiotics

Question 33

what antibiotics can be use prophylactically for frequent exacerbations despite optimal medical therapy? (2)

Answer 33

azithromycin moxifloxacin

Question 34

what is the first step for a COPD exacerbation?

Answer 34

supplemental O2

Question 35

what is the first diagnostic that should be done in a COPD exacerbation?

Answer 35

CXR - exclude other causes

Question 36

what is the second diagnostic after CXR to be done for COPD exacerbation?

Answer 36

LABS: CBC chemistry blood gas

Question 37

what airway medications should be given for a COPD exacerbation?

Answer 37

SABA + SAMA albuterol + ipratropium

Question 38

what steroids can be given for a COPD exacerbation?

Answer 38

prednisone methylprednisolone

Question 39

what antibiotics can be given for a COPD exacerbation?

Answer 39

azithromycin

Question 40

what are 2 surgical interventions that can be done in COPD?

Answer 40

lung volume reduction lung transplant

Question 41

when is COPD survival about 4 years?

Answer 41

FEV1 less than 1L