COPD Flashcards
In an obstructive airway disease, do patients struggle getting air into or out of the lungs?
- getting air out of the lungs is obstructed
- patients can inhale fine, but cannot exhale properly causing expiratory wheeze
- 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 COPD?
- no
- recoil (ability of lungs to return to previous size and force air out is reduced
- 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
COPD is an umbrella term. Which of the following does NOT come under the COPD umbrella?
1 - chronic asthma
2 - chronic bronchitis
3 - cystic fibrosis
4 - emphysema
3 - cystic fibrosis
COPD conditions are:
- obstructive lung diseases
- progressive airflow obstruction
- not fully reversible
- symptoms always present
All of the following are risk factors for COPD and contribute 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/pollution
5 - age >35 y/o
6 - asthma
2 - smoking
- 90% of COPD is caused by smoking
Calculate 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
How can smoking increase risk of COPD?
1 - activates neutrophils in lungs
2 - elastase levels increase
3 - neutrophils cause inflammation
4 - all of the above
4 - all of the above
- essentially smoke irritates the lungs and causes reduced elasticity and inflammation
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
What % of the UK is diagnosed with COPD?
1 - 2%
2 - 12%
3 - 20%
4 - 50%
1 - 2%
30,000 deaths/year in UK
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
Trypsin is an enzyme responsible for degrading 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
- elastase is released by neutrophils in infection to kill pathogens, BUT also degrades elastin giving lungs elastic recoil
- alpha-1 antitrypsin inhibits elastase and stops elastin damage
- low levels of alpha-1 antitrypsin mean lungs are continually damaged and lungs lose elastic recoil
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
Bronchitis, which is inflammation of the upper airway bronchi that presents as a cough with mucus production, mucus plugs and an increased risk of infection. How long does this need to present for to be defined as acute bronchitis?
1 - <1 week
2 - <2 weeks
3 - <3 weeks
4 - <4 weeks
3 - <3 weeks
Chronic = lots of sputum production for >3months of the year for 2 years
Which of the following symptoms can patients with COPD present with?
1 - dyspnea (SOB)
2 - chronic/recurrent cough
3 - creamy sputum
4 - symptoms gradually become worse over time
5 - expiratory wheeze
6 - all of the above
5 - all of the above
SOB:
- asthma = SOB all time
- COPD = SOB on exertion