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Clin Med II test II > COPD > Flashcards

COPD Flashcards

1
Q

COPD is characterized by…

What are the two classic types (although there is much overlap)

A

progressive airflow limitation and enhanced chronic inflammatory response

  • small airway dz (blue bloaters-chron. bronchitis)
  • parenchymal destruction (pink puffers-emphysema)
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2
Q

What happens in small airway disease? What is its nickname and what is predominant?

A

airway inflammation and airway remodeling

“BLUE BLOATER” chronic bronchitis predominant

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3
Q

What happens in parenchymal destruction? What is its nickname and what is predominant?

A

loss of alveolar attachments and decreased elastic recoil

“PINK PUFFER”, emphysema predominant

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4
Q

pink puffer description

A

Emphysema-predominant, adequate oxygenation for a longer time period
“Pink Puffer” b/c of pursed-lip breathing, pink skin and thin body habitus (air comes in easily but need to recruit accessory muscles to get it out)

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5
Q

blue bloater description

A

Chronic Bronchitis-predominant
hypoxemia and respiratory acidosis more common; cor pulmonale from pulm HTN
“Blue Bloaters” due to cyanosis and overweight body habitus

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6
Q

Chronic Bronchitis definition

A

chronic productive cough for 3 months during 2 consecutive years with no other casue

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7
Q

Structural changes in chronic bronchitis

A
  • mucous gland hyperplasia->excess mucus and narrowing of bronchioles
  • bronchial squamous metaplasia
  • loss of ciliary tranport
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8
Q

What happens to the bronchial wall and what does that (primary mediator)?

A

inflammation of bronchial wall-infiltration of submucosal layer by NEUTROPHILS

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9
Q

What else is thought to play an important role in chronic bronchitis?

A

Chronic bacterial infection and hyper-reactivity are thought to play an important role

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10
Q

What kind of obstruction occurs in chronic bronchitis?

A

inspiratory and expiratory

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11
Q

What occurs due to impeded ventilation of chronic bronchitis?
How does parenchymal damage of chronic bronchitis compare to that of emphysema?

A

hypoxemia and hypercarbia

less parenchymal damage than emphysema

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12
Q

How is EMPHYSEMA characterized?

A

pathologic enlargement of the air spaces distal to the terminal bronchioles du to destruction of alveolar walls

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13
Q

What is the destructive process of emphysema?

A

not clearly understood (possibly too much elastase or too little antitrypsin activity)

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14
Q

3 structural changes in emphysema

A
  1. dramatic decline in alveolar surface area available for gas exchange
  2. decreased elastic recoil, which limits airflow
  3. loss of alveolar supporting structure
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15
Q

Emphysema: effect on capillary bed and the effect of this

A

emphysema destroys the capillary bed, resulting in reduced Co2 diffusing capacity
->hypercarbia (hypercapnia)
BUT NOT AS SIGNIFICANT HYPOXEMIA

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16
Q

When does airflow obstruction occur in emphysema?

A

airflow obstruction mostly during exhalation

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17
Q

What is asthma and what mediates it?

A

Asthma is a chronic inflammatory disorder of the airways-primarily EOSINOPHIL mediated

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18
Q

3 steps in asthma

A

airway hyper-reactivity->increased secretions, mucosal edema, constriction of bronchial smooth muscle->airway obstruction
[reversible]

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19
Q

Emphysema describe: age at sx onset, character of dyspnea, cough, sputum prod., sputum appear

A 
Emphysema onset: usually after age 50
dyspnea: progressive, constant, severe
cough: absent to mild
sputum prod: absent to mild
sputum appearance: clear, mucoid
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20
Q

Chronic bronchitis describe: age at sx onset, character of dyspnea, cough, sputum prod, sputum appearance

A 
Chronic Bronchitis onset: usually late 30s-40s
dyspnea: intermittent, mild to moderate
cough: persistent, severe
sputum production: persistent, severe
sputum appearance: mucopurulent
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21
Q

When does COPD present?

A

5th or 6th decade

22
Q

Cardinal sxs of COPD:

A

CARD SXS: dyspnea, chronic cough and sputum production

  • cough usually occurs in the morning
  • in early COPD dysp on sig exertion, but progresses to miminal exertion or rest
23
Q

Exposure to what puts you at risk for COPD?

A
  • tobacco smoke

- other inhaled irritants (occupational dusts, pollution)

24
Q

DDx for COPD

A

Asthma, Bronchiectasis, CHF, Obliterative bronchiolitis, central airway stenosis, lung cancer, TB, coccidioidomycosis, cystic fibrosis (younger pts), acute bronchitis (80-90% viral)

25
Q

Risk factors for COPD

A
  1. CIGARETTE SMOKING (#1 cause, 80% of COPD pts, most have at least 20 pack year hist)
  2. air pollution (indoor and outdoor)
  3. second hand smoke
  4. airway hyper-responsiveness
  5. Generic RF: alpha-1 antitrypsin deficiency
    (<1% of all cases, causes premature emphysema)
26
Q

How does cigarette smoking contribute to COPD?

A
  • cig smoke stimulates elastase enzymatic activity, causing degenerative changes in elastin and alveolar structures
  • causes release of cytotoxic oxygen radicals from WBCs in lung tissue
    (amt. and duration of cig smoking contribute to dz severity)
27
Q

What kind of environmental/occupational exposure will place the proletariat at risk for COPD?

A

coal miners, grain handlers, metal molders, workers exposed to dust, cooking with biomass fuels (1/3 of the world)

28
Q

Name a hereditary syndrome that results in early onset of emphysema. What is the average age of appearance?

A

Alpha 1-antitripsin deficiency (<1% of US cases of emphysema)
onset: 53 y/o nonsmokers, 40 y/o smokers (process is accelerated in smokers w/AAT def)

29
Q

What is Alpha 1-antitrypsin? What happens if it disappears?

A

AAT is a protease inhibitor which inhibits elastase and several other proteolytic enzymes
-if AAT is not present in adequate amt, elastase & other proteolytic enzymes destroy lung tissue

30
Q

COPD physical exam HEENT

A

check oral cavity closely, look for tobacco staining

31
Q

COPD physical exam neck

A

masses, JVD

32
Q

COPD physical exam chest

A

“body habitus”-look for increased AP diameter (barrel chest), use of accessory muscles, rate, effort of breathing, central cyanosis

33
Q

COPD physical exam lungs

A

decreased breath sounds, rhonchi, wheezes, crackles, prolonged exhalation (tends to be bilateral)

34
Q

COPD physical exam percussion

A

hyper-resonant

35
Q

COPD physical exam heart

A

possible gallop, RV life, PMI

36
Q

COPD physical exam abdomen

A

possible hepatomegaly, tenderness

37
Q

COPD physical exam exterior

A

cyanosis, clubbing, muscle wasting, tobacco stains on fingers, peripheral edema

38
Q

Emphysema exam findings

A 
increased AP diameter
"distant" breath sounds
hyper-resonant to percussion
possible pursed-lip breathing
using accessory muscles
39
Q

COPD CBC results

A

usually normal, may show polycythemia (increased H/H) later in chron. bronchitis, due to hypoxemia

40
Q

COPD ABG results

A

hypoxemia (not as significant in emphysema as chron bronch), hypercarbia (CO2 retention)

41
Q

COPD EKG results

A

sinus tachycardia, peaked P waves, and right axis deviation, RVH

42
Q

Should you do a sputum examination in COPD?

A

NOT usually recommended/helpful (can be colonized w/bacteria anyway)
-recommended if you’ve been treating a patient and they’re not getting better

43
Q

3 CXR findings suggestive of emphysema

A
  • hyperinflation (possibly with bullae)
  • flattening of diaphragms
  • enlargement of retrosternal air space
44
Q

CXR findings suggestive of chronic bronchitis

A
  • cardiac enlargement
  • pulmonary congestion
  • increased lung markings
45
Q

CT for COPD? sens, spec?

A

CT, esp high resolution CT has much greater sensitivity and specificity than standard chest radiography for dx of COPD, but NOT necc. for ROUTINE work-up

46
Q

name 3 pulmonary function tests (PFTs)

A

forced vital capacity (FVC)
forced expiratory volume in 1 second (FEV1)
FEV1/FVC

47
Q

Define forced vital capacity (FVC). What would you see in COPD?

A

FVC: amount of air forcefully exhaled after a maximal inspiration (varies w/height & age)
-usually normal or slightly decreased in COPD vs. low in restrictive dz

48
Q

Define FEV1? What is normal, what do you see in obstructive airway dz?

A

FEV1=forced expiratory volume in 1 sec
normal>80% of predicted
FEV1 DECREASES in obstructive airway dz
(reversible in asthma; increases w/bronchidilator)

49
Q

FEV1/FVC: normal value, abnormal meanings

A

normal FEV1/FVC: 70-80%
decreased FEV1 w/normal FVC suggests obstructive airways dz
<70% post bronchodilator

50
Q

GOLD guidelines severity of airflow limitation-1st step

A

patients must have FEV1/FVC<70% to be staged

51
Q

GOLD Stage I COPD PVTs, sxs, and tx

A

mild COPD
FEV1/FVCor= 80% predicted
with or without sxs
Tx: short-acting bronchodilator

52
Q

GOLD Stage 2 COPD PVTs, sxs and tx

A

moderate COPD
FEV1/FVC<80
DOE, w/ or w/out cough and sputum production
tx:
-short acting bronchodilator when needed
-regular tx w/one or more long-acting bronchodilators
-rehabilitation

Clin Med II test II (2 decks)

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