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Internal Medicine- Chest > COPD > Flashcards

COPD Flashcards

1
Q

What is pink puffer ?

A

Emphysema

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2
Q

What is blue bloater?

A

Chronic Bronchitis

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3
Q

What are the differential diagnoses of hemoptisis and the most common?

A
  1. Bleeding disorder
  2. mitral Stenosis
  3. Heart failure
  4. Bronchitis (MC)
  5. Bronchiactesis
  6. Pneumonia
  7. Pulmonary TB
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4
Q

Compare acute and chronic bronchitis

A

Cough: dry then productive vs productive

Duration: less than 3w vs at least 3w for consecutive years

Etiology: viral vs smoking

Patient: less than 5 vs male adult

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5
Q

What are the stages of bronchitis?

A

-chronic simple bronchitis: hypertrophy of mucus glands leading to white mucoid discharge
- Chronic mucopurulent bronchitis: 2ndry bacterial infection (strept pn or H influenza) leading to yellow sputum
- Chronic obstructive bronchitis: mucus plugs and fibrosis leading to blue bloater

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6
Q

What is emphysema?

A

Abnormal permanent dilation of spaces distal to terminal bronchioles leading to loss of elastic recoil

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7
Q

What is the inheritance of alpha 1 antitrypsin deficiency

A

AR

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8
Q

What are the types of emphysema ?

A

True: congenital (alpha 1) or acquired (smoking)

False: senility and compensatory

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9
Q

Compare alpha 1 antitrypsin def and smoking on their effect on the lung

A

Alpha 1: pan acinar lower
Smoking: centri acinar upper

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10
Q

Compare pink puffer and chronic bronchitis (without examination)

A

Age: 50s vs 40s

Symptom: more severe Dyspnea than cough more severe cough than dyspnea

Complication:
• pneumothorax or Bullae
• exaccerbations/ 2ndry polycythemia/ corpulmonale

Prognosis good vs bas

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11
Q

Compare between pink puffer and blue bloater regarding examination:

A

General examination:

•Flushed and working accessory muscles
• weight loss
• tripod position
• pursed lip breathing

• central cyanosis
• weight gain
• peripheral edema
• pulmonary htn

Local examination:

Inspection: increased AP normal AP
Percussion: hyperresosanance vs normal
Ausculation: decreased sound vs harsh vesicular

No Ronchi vs ronchi

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12
Q

Compare pink puffer and blue bloater regarding investigations:

A

CXR: • decreased bronchivascular marking, jet black lungs, ribbon shaped heart, low flat diaphragm and horizontal ribs

• increased bronchovacular marking, normal sized lungs with or without right ventricular hypertrophy

ABG:

Hypoxia and normocapnia/hypocapnia
Hypoxia and hypercapnia

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13
Q

Compare pink puffer and blue bloater regarding investigations:

A

CXR: • decreased bronchivascular marking, jet black lungs, ribbon shaped heart, low flat diaphragm and horizontal ribs

• increased bronchovacular marking, normal sized lungs with or without right ventricular hypertrophy

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14
Q

What is COPD and its RF?

A

Chronic Obstructive Lung disease
1- Def: Umbrella term used to describe diseases that are cc by chronic progressive partially reversible
airway obstruction
2- R.F.: Smoking (Pack year 20 or more)

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15
Q

Give 3 examples of COPD

A

Refractory asthma
Emphysema
Chronic bronchitis

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16
Q

Describe the Clinical picture of a COPD patient

A

a- TOP: Old Heavy smoker

b- Symp.: Blue bloater or Pink puffer
Dyspnea

c- Signs:

1- G

a- Pulse = Pulsus Paradoxus or Arrhythmias

b- Head & Neck
1- Congested pulsating neck veins with Kussmaul’s sign

2- Tachypnea + Working accessory ms

  1. LL edema

2- L

I: Symmetrical, equal movement & increased A-P diameter, Hyper-inflation

P: Trachea (Centralized), TVF (Equal)

P: Bilateral hyper-resonance + Encroaching on heart & liver

A:
a- Breath S.: Type: Harsh vesicular (Prolonged expiration) + decreased Air entry Bilaterally

b- Additional S: Coarse crepitations + Rhonchi

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17
Q

What are the differential diagnosis of dyspnea?

A
  1. Anaphylaxis
  2. Cardiac Tamponade
  3. Mycardial Infarction
  4. Foreign body Inhalation
  5. Bronchial Asthma
  6. AECOPD
  7. Pneumothorax
    8.Pulmonary embolism
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18
Q

What are the investigations of COPD?

A

4- Invest.:

A- LAB.:

1- Sputum culture (Exacerbation)/ dec AT, 2ry Polycythemia

2- ABG = dec POz ‡ inc PCOz (Blue bloater) or Normal PCO2 (Pink puffer)

3- DLco = Impaired (Pink puffer)

B- RAD.: Blue bloater + Pink puffer

C- INST.: Spirometry
Obstructive Hypoventilation pattern inc TLC, dec FVC, dec FEV1

Post Broncho-dilator Ratio of FEVI/FVC < 0.7

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19
Q

What are the complications of COPD?

A

Complications

1- Acute exacerbation (airway inflammation)

2- Lung
(Pnthx, Bronchiectasis, Pneumonia, Cancer & Resp. F )

3- Heart failure

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20
Q

COPD types

A

Type A emphysema
Type B Chronic bronchitis

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21
Q

What is the hallmark picture of COPD?

A

Dyspnea

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22
Q

What are the arrhythmias of COPD and the most common ones ?

A

Multiracial Atrial Tachycardia (mc)
Atrial fibrillation

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23
Q

What feature is not a feature of COPD and what does its presence indicate?

A

Clubbing

Bronchiactesis or Cancer

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24
Q

Explain the etiology of LL edema in COPD

A

Corpulmonale
Decrease in cop
Increase in Raas
Decrease O2 so increase in permeability
Increased CO2 leading to acidosis and increase in NaHCO3 reabsorption

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25
Q

How are acute exacerbations classified in COPD ?

A

Based on the presence of cardinal features

Increased Dyspnea
Increased sputum
Increased purulence

Mild
Moderate
Severe

26
Q

What type of RF does a COPD patient experience

State it’s ABG

A

Type 2

O2 below 60
CO2 above 50

27
Q

What does GOLD stand for (w menha t3rf its use)

A

Global Initiative for Lung Disease

28
Q

What are the 3 corner stones of GOLD

A

Risk of Annual Exacerbations
Dyspnea Grades

Spirometry grades

29
Q

Post bronchodilator test in COPD
Fev1/fvc is

A

Less than 0.7

30
Q

List Gold levels

A

Gold 1 at least 80
Gold 2 80-50
Gold 3 50-30
Gold 4 less than 30

31
Q

Dyspnea severity is measured by

A

Mmrc scale

32
Q

COPD A Grade ttt and Diagnosis

A
  • 0 or 1 Dyspnea severity
    AND
  • no or 1 without hospitalization

SABA as needed

33
Q

What is the most common cause of AECOPD ? And percentage and etiology stating the Mac

A

Infection 75%

Rhinovirus Mc
Strept pneumoniae
H influenza

34
Q

COPD grade B diagnosis and ttt

A
  • 2,3 or 4Dyspnea severity
    AND
  • no or 1 without hospitalization

LABA AND LAMA ON REGULAR BASIS

35
Q

C + D =

A

E

36
Q

What is C grade diagnosis?

A
  • 0 or 1 Dyspnea severity
    AND
  • 2 or more and must require hospitalization
37
Q

What is D grade diagnosis?

A
  • 2,3 or 4 Dyspnea severity
    AND
  • 2 or more and must require hospitalization
38
Q

What is grade E ttt?

A

If esinophils are at least 300 cell per microliter add ICS on regular basis

39
Q

What are the vaccinations that COPD patients can benefit from ?

A

Pcv 13
Influenza

40
Q

When should pulmonary rehabilitation start?

A

Grade B

41
Q

What is the advantage of Venturi mask ?

A

Improves quality of life

42
Q

When to start Venturi mask ?

A

PO2 55 or less
Or
PO2 less than 60 with PTH

43
Q

What is Venturi mask ?

A

Long term low flow oxygen therapy

44
Q

What are the lines of TTT of COPD?

A
  1. Patient education (smoking cessation, respiratory muscle exercise and vaccination)
  2. Pulmonary rehabilitation
  3. Venturi mask
  4. Symptomatic treatment of cough
  5. Group ttt as needed
  6. Surgical intervention
45
Q

All grades of COPD require dual therapy of bronchodilators except

A

A

46
Q

What surgical interventions can COPD benefit from ?

A

Bullectomy
Lung volume reduction
Transplantation

47
Q

Describe how to treat a cough.

A

Dry: Codiene 10ml max 4 times a day
Productive:

Productive
Mucolytic (N acetyl cysteine) 200mg max 3 times a day

Expectorant (Guaifenesin) 200mg max 12 times a day

48
Q

In COPD which route is it choice ?

A

Inhalation

49
Q

Most important factor to stop progression of COPD

A

Smoking cessation

50
Q

List bronchodilators you could use

A

B2 agonist
M3 antagonists
Methylxanthines (as theophylines pde 3 and 4 inhibitors)

51
Q

Which type of bronchodilators are used for maintenance and control ?

A

Long acting bronchodilators

52
Q

Long acting anti M3 or Long acting b2 agonists

Which are superior to which in exacerbations?

A

LAMA

53
Q

Which are more superior in controlling Dyspnea ?

B2 agonist
ICS
M3 antagonist

A

B2 agonist
ICS

54
Q

Which are more superior in controlling clinical picture ?

B2 agonist
ICS
M3 antagonist

A

B2 agonists
ICS

55
Q

What musnt be used for long term COPD treatment (we can use them fel exacerbation 3ady) and why

A

ICS and steroids

Percipitate pneumonia

56
Q

What should only be used in case there are no long acting bronchodilators (considered the last resort)?

A

Theophyline

57
Q

What should only be used in case there are no long acting bronchodilators (considered the last resort)?

A

Theophyline

58
Q

What is better to start with

And except in

A

Long acting inhalers

mild occasional dyspnea

59
Q

In AECOPD
What should we use IV or oral

A

Both are of the same efficacy
Only use iv if patient is unable to swallow

60
Q

Explain the etiology, C/P, other features and TTT of AECOPD

A

a- Etio.:
1- Infections
2- Exposure to pollution, Allergens, Chemicals & Cold weather
3- Pt. non-compliance
4- Heart failure, P. Embolism, Arrhythmias

b- C/P:

Cardinal Features (inc Dyspnea, inc Sputum Amount, inc Sputum Purulence)

Other Features
(Fever, Upper Resp. Tract infection, inc
HR, R.R., Wheezes, Cough)
(Cyanosis & LL edema)

c- TT:
1- Mild (inc Dose of TTT)
2- Moderate (Add Oral Steroids ‡ ABs)
3- Severe (Needs Hospitalization up to CU)

Internal Medicine- Chest (3 decks)

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