COPD Flashcards
In an obstructive airway disease, do patients struggle getting air into or out of the lungs?
- getting air out of the lungs
- patients can inhale fine, but cannot exhale properly
- airways narrow and affect small, medium and larger parts of airways
In obstructive lung diseases, the elastic tissue in the lungs is affected. Are both recoil and compliance of lung tissue reduced in asthma?
- no
- recoil (ability of lungs to return to previous size) is reduces
- compliance (stretching the lungs) is increased
What type of cells line the lumen of our airways?
1 - cuboidal epithelial cells
2 - transitional columnar epithelial cells
3 - ciliated pseudostratified columnar epithelial cells
4 - ciliated cuboidal cells
3 - ciliated pseudostratified columnar epithelial cells
Which of the following is NOT a layer of the mucosa that lines the airways?
1 - loose connective tissue
2 - goblet cells
4 - smooth muscle
5 - ciliated pseudostratified columnar epithelial cells
5 - basement membrane
4 - smooth muscle
Which of the following is NOT a layer of the submucosa that lines the airways?
1 - connective tissue
2 - smooth muscle
3 - bronchial mucinous glands
4 - basement membrane
4 - basement membrane
In the lining of the lumen, do goblet cells or bronchial mucinous glands secrete the majority of mucus in the lungs?
- bronchial mucinous glands
In obstructive lung disease we can see hyperinflation and trapping of air. Why does this occur?
1 - mucus is secreted causing mucus plugs
2 - reduced elastic recoil (snap back of lung tissue)
3 - small bronchi trap air (<2cm airways
4 - all of the above
4 - all of the above
- forced vital capacity may appear normal
What is Chronic Obstructive Pulmonary Disease (COPD)?
- obstructive lung disease
- progressive airflow obstruction
- not fully reversible
- symptoms always present
The risk of COPD increases with age, at what age does the risk generally start to increase?
1 - >16 y/o
2 - >25 y/o
3 - >35 y/o
4 - >50 y/o
3 - >35 y/o
In addition to the natural progression of COPD, what is the main cause that accentuates COPD?
1 - alpha 1 trypsin deficiency
2 - smoking
3 - asbestos
4 - occupation
5 - age >35 y/o
2 - smoking
- 90% of COPD is caused by smoking
- age >35 y/o is also a high risk factor for COPD
In spirometry, would we expect to see an increase of decrease in functional residual capacity (FRC) (remaining air in lungs at end of normal exhalation) in a patient with COPD?
- increase
- recoil = reduced (ability of lungs to snap back and exhale air)
- compliance = increased (stretching the lungs)
In spirometry, would we expect to see an increase of decrease in forced vital capacity (FVC) (air that can forcefully expired following maximum inhalation) in a patient with COPD?
- small reduction
- recoil is reduced so patient has to work harder to exhale air
In spirometry, would we expect to see an increase of decrease in forced expiratory volume in 1 second (FEC1) (air that can forcefully expired in 1 second following maximum inhalation) in a patient with COPD?
- significantly reduced
- airways are narrowed
In patients with asthma the FVC and FEV1 are reduced. What is the ratio that is diagnostic in patients with COPD?
1 - FVC/FEV1 <90%
2 - FVC/FEV1 <80%
3 - FVC/FEV1 <70%
4 - FVC/FEV1 <60%
3 - FVC/FEV1 <70%
In patients with COPD is the total lung capacity increased or decreased?
- increased
- lungs can become hyper inflated
FEV1 is decreased in obstructive lung disease, but typically in COPD how much does FEV1 generally decline each year in COPD patients?
1 - 10ml/year
2 - 30ml/year
3 - 100ml/year
4 - 1000ml/year
2 - 30ml/year
What % of the UK is diagnosed with COPD?
1 - 2%
2 - 12%
3 - 20%
4 - 50%
1 - 2%
How many deaths in the UK are caused by COPD?
1 - 300
2 - 3000
3 - 30,000
4 - 300,000
3 - 30,000
How many GP appointments and acute hospital (H) admissions are due to COPD?
1 - GP = 1000 and H = 12.5%
2 - GP = 1.4 million and H = 55%
3 - GP = 100,000 and H = 12.5%
4 - GP = 1.4 million and H = 12.5%
4 - GP = 1.4 million and H = 12.5%
What is the formula for calculating pack years?
- (no. cigs per day x years) / 20
- divide by 20 as packs contain 20 cigarettes
- e.g 10 cigs for 10 years = (10x10)/20 = 5 pack years
Why are pack years calculated in COPD?
1 - can increase Q-risk
2 - can interfere with medication
3 - linked with occupation
4 - main risk factor for COPD
4 - main risk factor for COPD
- ⬆️ pack years = ⬆️ risk of COPD
- any smoking, including passive smoke can also increase COPD risk
In patients who smoke, what % go on to develop COPD?
1 - 1-2%
2 - 5-10%
3 - 15-25%
4 - >45%
3 - aprox 15-25%
Why is the inverse care law important in COPD?
- ⬇️ socio-economic = ⬆️ risk of COPD
The global initiative for COPD (GOLD) defines the severity of COPD. Which of the following is NOT part of this severity scale?
1 - Mild = FEV1 >95%
2 - Moderate = FEV1 50-79%
3 - Severe = FEV1 30-49%
4 - Very Severe = <30%
1 - Mild = FEV1 >95%
- mild is an FEV1 <80%
What is trypsin?
1 - enzyme that degrades proteins
2 - enzyme in coagulation cascade
3 - enzyme involved in bile synthesis
4 - enzyme involved in glycolysis
1 - enzyme that degrades proteins
What is alpha-1 antitrypsin?
1 - inhibits cytokines
2 - protease inhibitor
3 - inhibits scarring in the lungs
4 - HMG-CoA synthesis inhibitor
2 - protease inhibitor
- inhibits elastase in lungs following pathogen death
- elastin cannot be broken down
- COPD lungs lose elastin recoil
Why does alpha-1 antitrypsin deficiency cause COPD?
1 - reduces compliance of lungs
2 - increases compliance of lungs
3 - increases elastic recoil
4 - reduces elastic recoil
4 - reduces elastic recoil
- elastase in lungs can kill pathogens, BUT also degrades elastin
- alpha-1 antitrypsin inhibits elastate
- no alpha-1 antitrypsin means elastase degrade elastin in lungs
- causes air retention and inability to exhale
Which of the following forms of COPD can be caused by alpha-1 antitrypsin deficiency?
1 - causes emphysema (damaged alveoli)
2 - chronic bronchitis (damaged bronchi, main airways)
3 - bronchieltasis (smaller airways)
4 - all of the above
4 - all of the above
What is chronic bronchitis as a form of COPD?
1 - inflammation of upper airways
2 - inflammation of alveoli
3 - inflammation of bronchi
4 - all of the above
3 - inflammation of bronchi
- affects upper bronchi
- hyperplasia of goblet cells and increased mucus production - increased mucus plugs
- ⬆️ risk of infection