Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology > COPD > Flashcards

COPD Flashcards

1
Q

COPD definition

A

Disease state characterized by airflow
limitation that is not fully reversible but
progressive with an abnormal inflammatory
response of the lung to noxious particles or
gases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

COPD is comprised of

A

Chronic bronchitis + emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

difference between bronchitis and emphysema

A

Bronchitis is inflammation of large airways
emphysema is inflammation of alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference between COPD and asthma

A

COPD- Onset in mid-life
Symptoms slowly
progressive
Long smoking history
Largely irreversible
airflow limitations

Asthma- Onset early in life,
family history of
asthma
Symptoms vary from
day to day
Symptoms at
night/early morning
Allergy, rhinitis,
eczema also present
Largely reversible
airflow limitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors of COPD main two categories

A

Host factors
Environmental factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Host factors that affects COPD

A

Genes- alpha 1 antitrypsin deficiency
Gender- female smokers at higher risk
Lung growth- childhood infections, maternal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Environmental factors that affect COPD

A

o Tobacco smoke
o Occupational dust- wood dust
o Pollution
o Infections
o Socioeconomic status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathophysiology of COPD - central airways

A

mucus hypersecretion,
ciliary dysfunction → chronic cough, sputum
production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathophysiology of COPD - peripheral airways

A

Airway remodelling, scar
tissue formation → fixed airway limitation,dynamic hyperinflation → low FEV1, high TLC,
rhonchi, barrel chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathophysiology of COPD - parenchyma

A

emphysema → loss of elastic
recoil, impaired gas exchange → low DLCO,
hypoxaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathophysiology of COPD - vasculature

A

hypoxia →pulmonary
vasoconstriction → pulmonary hypertension
→ right ventricular hypertrophy (RAD< R in
V1, RBBB) → Right ventricular failure
(oedema, raised JVP, hepatomegaly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hx in COPD

A

–
* chronic cough (intermittent or daily-cough
and sputum production for >3months,>2
years),
* chronic sputum production,
* breathlessness (progressive and
exertional),
* wheeze
* minimal day to day variation,
* worsening of symptoms with infections
* exposure to risk factors (smoking,
occupational dusts, smoke from home
cooking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Physical signs of COPD

A
  • usually late,
  • thin wasted person,
  • hyperinflation of chest, barrel shaped
    chest, reduced cardiac dullness, liver
    pushed down
  • Prolong expiration, B/L rhonchi on
    auscultation,
  • cyanosis and polycythaemia,
  • oedema
  • cor-pulmonale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Two clinical presentations of COPD

A

Blue bloaters
Pink puffers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Blue bloaters Sx

A

Chronic, productive cough
Purulent sputum
Hemoptysis
Mild dyspnea (initially)
Cyanosis
Peripheral edema
Crackles, Wheezes
Prolonged expiration
Obese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pink puffers Sx

A

Dyspnea
Minimal cough
Increased minute ventilation
Pink skin, Pursed lip breathing
Accessory muscle use
cachexia
Hyperinflationm Barrel chest
Decreased breath sounds
Tachypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complications of blue bloaters

A

Secondary polycythemia vera due to hypoxemia
Pulmonary HTN due to reactive vasoconstriction from hypoxemia
Cor pulmonale from chronic pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications of Pink puffers

A

Pneumothorax due to bullae
Weight loss due to work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

FEV1/FVC ratio of COPD

A

<70% ( Obstructive disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

FEV1 level in COPD

A

<80% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

TLC, FRC, RV

A

Increased

22
Q

DLCO levels in COPD

A

Reduced

23
Q

DDs of COPD

A
  • Long standing breathlessness –
    1. chronic persistent asthma, chronic
    heart failure
  • Chronic cough – bronchiectasis,
    tuberculosi
24
Q

Management of COPD

A
  • Diagnose, assess, monitor
  • Reduce risk factors
  • Manage stable COPD
  • Management of exacerbation
    o Controlled oxygen through mask
    o Nebulized bronchodilators (salbutamol,
    ipratropium
    o Antibiotics
    o Oral prednisolone – 40 mg/day
25
Q

Pulmonary rehabilitation

A

Education and
training program to help patient to live an
active life within the limitation of symptoms

26
Q

Pulmonary rehabilitation

A
  • Stopping smoking
  • Controlling breathlessness
    o Breathing control
    o Pursed lip breathing
    o Correct posture
  • Stopping smoking
  • Controlling breathlessness
    o Breathing control
    o Pursed lip breathing
    o Correct posture
27
Q

Complications of COPD

A
  • recurrent exacerbations by URTI,
  • cor-pulmonale,
  • type II respiratory failure,
  • pneumothorax,
  • polycythaemia
  • systemic effects (muscle wasting, muscle
    fatigue
28
Q

MMRC dyspnea scale

A

0 - vigourous exertion
1- rapid walking / climbing uphill
2- normal speed wailking
3- 100m / few minutes of level ground walk
4- Stationary activity – dressing, undressing etc.
Can’t leave home

29
Q

CAT ( COPD assessment tool)

A

score each from 0-5 (good - 0 to
worst -5)
1. Cough
2. Sputum
3. Chest tightness
4. Dyspnoea
5. ADL
6. Sleep
7. Confidence in walking out
8. Energy

30
Q

Dx steps in COPD

A
  1. Spirometrically confirmed Dx - Post bronchodilator FEV1/FVC <70%
  2. Assessment of airflow limitation - Predicted FEV1
    GOLD 1 >= 80
    GOLD 2 50-79
    GOLD 3 30-49
    GOLD 4 <30
  3. Assessment of Sx/risk of exacerbations - table
31
Q

Assessment of Sx/ risk of exacerbations. Y axis and X axis

A

Y axis - exacerbation Hx
X axis - Sx

32
Q

Y axis

A

0 or 1 (not leading to hospital admission)
>=2 or >=1 leading to hospital admission

33
Q

X axis

A

mMRC 0-1 and CAT <10
mMRC >=2 and CAT >=10

34
Q

Group A in COPD Mx

A

mMRC 0-1 CAT <10
0-1 exacerbations and no hospital admissions

35
Q

Group B in COPD Mx

A

mMRC >=2 CAT >=10
0-1 exacerbations and no hospital admissions

36
Q

Group C in COPD Mx

A

mMRC 0-1 CAT<10
>=2 or >=1 w hospital admission

37
Q

Group D COPD Mx

A

mMRC >=2 CAT >=10

38
Q

Group B Drugs COPD

A

LAMA or LABA
persistent Sx
LAMA+LABA

38
Q

Group A Drugs in COPD

A

LAMA or LABA
evaluate the effect
Continue, stop or try alternative class or bronchodilator

39
Q

Group C drugs COPD

A

LAMA
further exacerbations
LAMA+LABA or LABA+ICS

40
Q

Group D drugs COPD

A

Start w LAMA
further exacerbations
LAMA+LABA or LABA+ICS
further worsening
LAMA+LABA+ICS
further exacerbations
Consider Roflumilast (if FEV1 <50% predicted and pt has chronic bronchitis)
OR
Consider Macrolides (in former smokers)

41
Q

When to consider LTOT for COPD

A

if PaO2 <55mmHg
Should be given at least 15h/d

42
Q

Mortality benefit in COPD

A

Cessation of smoking
Long term O2 therapy
Lung vol reduction therapy

43
Q

Indications of NIV for COPD exacerbations

A

PaCO2 >45mmHg
Persistent hypoxia despite other exacerbation measures
Clinical severe dyspnea w progression to exhaustion

44
Q

Pack years calculation

A

(No of Cig smoked per day/ 20) x No of years smoked

45
Q

Barrel chest

A

AP diameter > transverse

46
Q

How does COPD cause the right heart to fail

A

In alveoli that are not adequately oxygenated, blood supply for perfusion will not happen. BV will undergo vasoconstriction. (Coz there’s no point sending blood to these alveoli)
This causes pulm HTN ( causes RVH coz of extra pressure in RV)
RVH causes RAD ( tall wave in V1)
At some point, R heart will fail ( Ascites, Edema, increases JVP, Hepatomegaly)

47
Q

meaning behind Pink puffers

A

usually in people increasing CO2 levels stimulate the respi centre in the medulla. But in pink puffers, hypoxia stimulates the respi centre, so they are always gasping for breaths. Therefore, they are not cyanosed.

48
Q

meaning behind blue bloaters

A

they are not sensitive to hypoxia. ( Respi centre is not stimulated by hypoxia) so they are not cyanotic. Kidneys will also undergo hypoxia. Renal hypoxia will trigger RAAS. causing Sodium- water retention giving edema

49
Q

% of controlled oxygen given in COPD and the target SpO2

A

25-28%
target SpO2 - 88-92%

50
Q
A

Pulmonology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions