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internal med eor > COPD > Flashcards

COPD Flashcards

1
Q

what makes up COPD?

A

chronic bronchitis and emphysema

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2
Q

COPD definition

A

common, preventable airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses

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3
Q

chronic bronchitis

A

productive cough for 3 months in each of two consecutive years

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4
Q

emphysema

A

permanent enlargement of the air spaces distal to terminal bronchioles that is accompanies by destruction of the airspace walls

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5
Q

why does emphysema cause loss of elastic recoil?

A

destruction of alveolar walls

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6
Q

what parts of the respiratory system does emphysema effect?

A

terminal bronchioles, alveolar ducts, and alveoli

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7
Q

what parts of the respiratory system does chronic bronchitis effect?

A

trachea and bronchi

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8
Q

1 cause of COPD

A

smoking

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9
Q

risk factors for COPD

A

smoking
occupational exposure

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10
Q

pack years

A

ppd x years smoked

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11
Q

who should be screened for lung cancer?

A

adults 50-80 who have a 20 pack year history and currently smoke or quit within the past 15 years

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12
Q

how is lung cancer screening performed?

A

low dose CT

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13
Q

abnormalities in the airway in COPD patients

A
  • chronic inflammation
  • increased goblet cells and mucus production
  • narrowing of airways and collapse
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14
Q

centrilobular emphysema

A

upper part of acinus damages

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15
Q

Panacinar emphysema

A

entire acinus is damages

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16
Q

periseptal emphysema

A

lower part of acinusis damaged

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17
Q

symptoms of COPD

A
  • dyspnea
  • chronic cough
  • sputum production
  • wheezing and chest tightness
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18
Q

PE of COPD

A
  • increased resonance to percussion
  • decreased breath sounds
  • yellow stains on fingers
  • chronic hoarseness of voice
  • barrel chest
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19
Q

PE findings for emphysema

A
  • pink complexion
  • thin build with barrel chest
  • cough is rare
  • no peripheral edema
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20
Q

PE findings for chronic bronchitis

A
  • cyanotic complexion
  • peripheral edema
  • stocky build
  • primary complaint of productive cough
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21
Q

comorbid conditions associated with COPD

A
  • lung cancer
  • bronchiectasis
  • sleep apnea
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22
Q

universal screening for COPD

A

none

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23
Q

cornerstone of diagnosis for COPD

A

spirometry

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24
Q

how to determine difference between COPD and Asthma on PFT

A

asthma is reversible and COPD is not

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25
Q

interpretation of PFT for COPD diagnosis

A
  • FEV1 less than 80%
  • FEV1/FVC less than 70%
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26
Q

Diffusing Capacity (DLCO)

A

measures the ability of the lungs to transfer gas form inhaled air to the RBCs in pulmonary capillaries

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27
Q

use for a CXR in COPD

A
  • evaluates for comorbidities
  • identifies complications
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28
Q

t/f CXR is necessary for routine diagnosis of COPD

A

false

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29
Q

CXR of COPD

A
  • hyperinflation of lungs
  • flat diaphragm
  • narrow heart shadow
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30
Q

CT has a greater sensitivity and specificity for …

A

emphysema

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31
Q

pulse ox for person with mild COPD

A

over 90%

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32
Q

pulse ox % that needs supplemental O2

A

less than 90%

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33
Q

pulse ox % that medicare will cover supplemental O2

A

less than 88%

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34
Q

What does ABG measure?

A

pH
PaO2
PaCO2
HCO3

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35
Q

when do you do an ABG?

A
  • FEV1 less than 50% predicted
  • low O2 sat
  • decreased level of consciousness
  • severe COPD exacerbation
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36
Q

ABG of mild COPD

A
  • low pO2
  • normal pCO2
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37
Q

ABG of moderate to severe COPD

A
  • low pO2
  • high pCO2
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38
Q

COPD Assessment Test (CAT)

A

eight question questionnaire that assessed the impact of COPD on health status

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39
Q

mMRC Breathlessness Scale

A

5 question questionnaire that measures limitation based on scale of 0-4

40
Q

GOLD categories

A
  • 1: 80 or higher
  • 2: 50-79
  • 3: 30-49
  • 4: less than 30
41
Q

category A COPD

A
  • 0-1 exacerbations not needing hospitalizations
  • mMRC 0-1
  • CAT less than 10
42
Q

category B COPD

A
  • 0-1 exacerbations not needing hospitalization
  • mMRC over 2
  • CAT over 10
43
Q

category C COPD

A
  • 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
  • mMRC 0-1
  • CAT less than 10
44
Q

category D COPD

A
  • 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
  • mMRC over 2
  • CAT over 10
45
Q

non-pharm treatment for COPD

A
  • smoking cessation
  • vaccinations
  • oxygen therapy
  • pulm rehabilitation
46
Q

pharm treatment for smoking cessation

A
  • wellbutrin
  • chantix
  • nicotine replacement
47
Q

when is a patient recommended to get pneumonia vaccines?

A
  • all patients 19-64 with comorbidities
  • everyone over 65
48
Q

what pneumonia vaccine should be administered?

A
  • PVC15 + PPSV23 one year later
  • one dose of PVC20
49
Q

patient education for COPD

A
  • proper inhaler technique
  • self management
  • pulm rehab
  • O2 therapy
50
Q

management for category A COPD

A

intermittent use of SABA

51
Q

if the SABA is not controlling the COPD in category A, what can be added?

A

LABA

52
Q

onset of action of SABA

A

5 minutes

53
Q

duration of action of SABA

A

4-6 hours

54
Q

SABA SE

A

tachycardia, shakiness, nervousness, dizziness

55
Q

anticholinergic SABA SE

A
  • dry mouth
  • glaucoma
  • urinary retention
56
Q

management of category B COPD

A

LABA or LAMA

57
Q

category B management additives

A
  • SABA rescue inhaler for LAMA patients
  • SAMA for LABA patients
58
Q

LABA onset of action

A

5 minutes

59
Q

LABA duration of action

A

12-24 hours

60
Q

category C COPD management

A

LAMA

61
Q

category C COPD management additives

A

add LABA and/or inhaled glucocorticoid

62
Q

category D COPD management

A

LABA-LAMA

63
Q

category D COPD management additives

A

LABA-LAMA-inhaled corticosteroid

64
Q

in what patient population of COPD do you use ICS as maintenance therapy?

A

category C and D with frequent exacerbations

65
Q

SE of ICS

A
  • thrush
  • sore throat
  • glaucoma
  • osteoporosis
66
Q

COPD exacerbation

A

acute worsening of respiratory symptoms that results in additional therapy

67
Q

cardinal symptoms of COPD exacerbations

A
  • increased dyspnea
  • increased sputum production
  • increased cough or wheeze
68
Q

risk factors for COPD exacerbation

A
  • age
  • chronic mucus and productive cough
  • duration of COPD
  • antibiotic use
  • comorbid conditions
  • respiratory infections!!!
69
Q

mild COPD exacerbation

A

controlled by increased dose of regular medication

70
Q

moderate COPD exacerbation

A

requires treatment with systemic corticosteroids or antibiotics

71
Q

Severe COPD exacerbation

A

requires ER evaluation and/or hospitalization

72
Q

….% of COPD exacerbations can be managed outpatient

A

80

73
Q

when to hospitalize for COPD exacerbation

A
  • inadequate response to outpatient therapy
  • new onset of cyanosis, peripheral edema, and altered mental status
  • serious coborbidities
74
Q

home management of COPD exacerbations

A
  • intense bronchodilator therapy
  • nebulizer therapy
  • oral glucocorticoids
  • abx for productive cough
75
Q

what antibiotics are prescribed for COPD exacerbations?

A

zithromax or doxy

76
Q

hospital management for COPD exacerbation

A
  • supplemental oxygen
  • SABA+ICS+short acting anticholinergic
  • smoking cessation
  • treat inf
  • pulmonary rehab
77
Q

Alpha-1-antitrypsin deficiency

A

deficiency that leads to imbalance between neutrophil elastase in lung and AAT

78
Q

AAT

A

protects against degradation of elastin

79
Q

presentation of alpha 1 antitrypsin deficiency

A
  • early onset emphysema
  • dyspnea, cough, wheezing, phlegm production
  • bronchodilator responsiveness
80
Q

risk factors for AAT related emphysema

A
  • smoking
  • occupational exposure
  • asthma
81
Q

why can AAT deficiency lead to liver disease?

A

toxic accumulation of unsecreted AAT protein

82
Q

organic manifestations of AAT deficiency

A
  • panniculitis
  • IBD
  • glomerulonephritis
83
Q

who do you suspect of AAT deficiency?

A
  • emphysema in a young individual
  • emphysema in a nonsmoker
  • changes in the base of the lungs on CXR
  • family history of emphysema
84
Q

diagnostic testing of AAT deficiency

A

serum AAT levels below 11

85
Q

Treatment of AAT deficiency

A
  • avoid smoking
  • bronchodilators
  • supplemental O2
86
Q

bronchiectasis

A

permanent abnormal dilation and destruction of the bronchial walls of the large airways

87
Q

diagnosis of bronchiectasis

A

clinical: chronic daily cough with copious sputum and crackles on auscultation

88
Q

what would you see on CT of bronchiectasis?

A

bronchial wall thickening and dilated airways

89
Q

treatment of bronchiectasis

A
  • Antibiotics
  • Bronchodilators
  • Chest physiotherapy to break up mucus
  • Treatment of primary condition
90
Q

obstructive sleep apnea

A

recurrent collapse of pharyngeal airway during sleep leading to reduces airflow and intermittent disturbances in gas exchange

91
Q

risk factors of obstructive sleep apnea

A
  • obesity
  • male
  • smoking
92
Q

cardinal features of obstructive sleep apnea

A
  • apnea
  • daytime somnolence
  • signs of disturbed sleep
93
Q

Diagnosis of obstructive sleep apnea

A

polysomnography

94
Q

diagnostic criteria for obstructive sleep apnea

A

-5 or more obstructive respiratory event per hour + one for more associated symptom

95
Q

complications of obstructive sleep apnea

A
  • daytime sleepiness
  • cardio problems
  • metabolic syndrome
96
Q

treatment of obstructive sleep apnea

A
  • CPAP
  • weight loss
  • surgery
97
Q

CPAP

A

delivers fixed level of positive airway pressure and splints open airway

internal med eor (16 decks)

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