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Clin Med 2 > COPD > Flashcards

COPD Flashcards

1
Q

Usually able to maintain adeq oxygenation for longer time period
Pink puffer d/t pursed lips, skin color and thin body habitus

A

Emphysema predominant COPD

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2
Q

Hypoxemia and resp acidosis common, cor pulmonale from pulm HTN
Blue bloaters d/t cyanosis and overweight

A

Chronic bronchitis predominant COPD

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3
Q

Define chronic bronchitis

A

Chronic productive cough for 3 mo, during 2 consecutive years w/ no other cause

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4
Q

Structural changes in chronic bronchitis

A

Mucous gland hyperplasia
Narrowing of bronchioles
Bronchial squamous metaplasia
Loss of ciliary transport

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5
Q

Obstruction is inspiratory and expiratory

A

chronic bronchitis

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6
Q

Pathologic enlargement of the the air spaces distal to the bronchioles d/t the destruction of the alveolar walls

A

Emphysema

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7
Q

Airflow obstruction mostly during exhalation

A

Emphysema

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8
Q

Not a/w sig hypoxemia

A

Emphysema

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9
Q

Destruction of alveolar bed, resulting in reduced CO2 diffusing capacity
Hypercarbia

A

Emphysema

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10
Q

Primarily eosinophil mediated chronic inflammatory disorder fo the airways

A

asthma

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11
Q

Emphysema onset

A

Usually after age 50

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12
Q

Chronic bronchitis onset

A

late 30’s-40’s

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13
Q

Progressive, constant, severe dyspnea

A

Emphysema

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14
Q

Intermittent, mild to moderate dyspnea

A

chronic bronchitis

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15
Q

Persistent cough and sputum

A

chronic bronchitis

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16
Q

Absent to mild cough and sputum

A

emphysema

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17
Q

Clear, mucoid sputum

A

Emphysema

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18
Q

Mucopurulent sputum

A

chronic bronchitis

19
Q

Pt presents with dyspnea, chronic cough, sputum production. Cough is usually in the morning.

A

COPD

20
Q

Dyspnea that is progressive, persistent, worse with exercise, worse with resp infxn

A

Consider COPD

21
Q

Primary cause of COPD

A

SMOKING

  • stimulates elastase enzymatic activity causing degenerative changes in alveolar structures
  • Causes release of cytotoxic oxygen radicals
22
Q

Causes premature emphysema

A

alpha-1 antitrypsin def

-inhibits elastase and enz, if not enough antitrypsin, they destroy lung tissue

23
Q

Exam findings of emphysema

A 
Increase AP diameter
Distant breath sounds
Hyper resonant 
Pursed lip breathing 
Use of accessory muscles
24
Q

Emphysema ECG

A

sinus tachycardia
peaked P waves
Right axis deviation
RVH

25
Q

Hyperinflation (possibly with bullae)
Flattening of diaphragm
Enlargement of restrosternal air space
CXR findings suggest:

A

Emphysema

26
Q

Cardiac enlargement
Pulmonary congestion
Increased lung markings
CXR findings suggest:

A

Chronic bronchitis

27
Q

PFT: FVC (forced vital capacity)

A

Usually normal in COPD vs low in restrictive disease

28
Q

PFT: FEV1 (forced expiratory vol in 1 sec)

A

Decreased in COPD

reversible in asthma

29
Q

PFT: FEV1/FVC

A

decreased FEV1 w/ normal FVC suggets obstructive airway disease

30
Q

FEV1/FVC 80% predicted

W/ or w/o sx

A

Mild COPD

31
Q

FEV1/FVC <80%

Dyspnea w/ exertion, w/ or w/o cough and sputum production

A

Mod COPD

32
Q

FEV1/FVC <50% plus resp fail

A

Very severe COPD

33
Q

FEV1/FVC <50%

Increase DOE, fatigue, repeated exacerbations

A

Severe COPD

34
Q

Mainstay of COPD therapy

A

B2-agonists and anticholinergics
(bronchodilators)
Inhaled preferred

35
Q

Provides bronchodilation as well as reduce air trapping in lungs
Well tolerated, less cardiac fx, better efficacy

A

Anitcholinergics

  • Short: ipatropium bromide (Atrovent)
  • Long: tiotropium bromide (Spiriva)
36
Q

Good bronchodilation fx, no fx on sputum/secretions

A

B2-agonists

  • Short: Albuterol
  • Long: Salmetrol, formoterol
37
Q

Inhaled for maintenance
Reduce mucosal edema and inflamtn
Inhibit prostaglandins
Increase response to beta adreergics

A

Corticosteroids

38
Q

PDE-4 inhibitor for refractory cases

A

Anti-inflam fx

-suppresses cytokine release and inhibits lung infiltration by neutrophils and other WBCs

39
Q

Tx of alpha 1 anti-trypsin def

A

Antiprotease injections

40
Q

Indication for O2 therapy

-must use at least 12 hours/d

A

pO2 less than 55
or
O2 sat <88% on RA

41
Q

Why pursed lip breathing?

A

Increase resistance to air outflow, increases intrabronchial pressure to keep bronchi poen

42
Q

Macrolides

A

Azithromycin

Clarithromycin

43
Q

Flouroquinolones

A

Levofloxacin

Moxifloxacin

44
Q

Cephalosporins

A

Cefdinir

-does not cover typical pathogens

Clin Med 2 (9 decks)

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