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PULMONOLOGY > COPD > Flashcards

COPD Flashcards

1
Q

What is ventilation?

A

The process of oxygen entering the alveoli and carbon dioxide exiting to the atmosphere.

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2
Q

What is the key function of the respiratory system?

A

Ventilation, the process where oxygen enters alveoli and CO2 exits to the atmosphere.

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3
Q

What is alveolar oxygenation?

A

The entry of oxygen into the alveoli.

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4
Q

What must occur for proper ventilation?

A

Unobstructed airflow and a functional thoracic pump to expand alveoli.

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5
Q

What is tidal volume (TV)?

A

The volume of air that enters and exits the lungs in normal, quiet respiration.

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6
Q

What is inspiratory reserve volume (IRV)?

A

The volume of air inhaled beyond the tidal volume.

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7
Q

What is expiratory reserve volume (ERV)?

A

The volume of air exhaled beyond the tidal volume.

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8
Q

What is residual volume (RV)?

A

The air remaining in the lungs after a forceful exhalation.

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9
Q

What is inspiratory capacity (IC)?

A

The sum of tidal volume (TV) and inspiratory reserve volume (IRV).

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10
Q

What does functional residual capacity (FRC) consist of?

A

Residual volume (RV) plus expiratory reserve volume (ERV).

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11
Q

What is total lung capacity (TLC)?

A

The total of all lung volumes and capacities.

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12
Q

What does spirometry measure?

A

It measures lung volumes and capacities, including residual volume indirectly.

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13
Q

What are the functions of the respiratory system?

A

Gas exchange, acid-base balance, immune defense, and blood pH regulation, among others.

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14
Q

What is the thoracic pump?

A

Structures that expand alveoli and help in ventilation.

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15
Q

What are the two patterns of ventilatory dysfunction?

A

Obstructive and restrictive ventilatory disorders.

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16
Q

What are the main types of obstructive lung disease?

A

Chronic Obstructive Pulmonary Disease (COPD) and asthma.

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17
Q

How does COPD differ from asthma?

A

COPD has different management and pathophysiology but both are obstructive disorders.

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18
Q

What is a restrictive lung defect?

A

A defect where lung volume is restricted due to issues in expanding alveoli, unlike airflow issues in obstructive defects.

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19
Q

What is the mnemonic PAINT used for?

A

It helps remember structures involved in ventilation: Pleura, Alveoli, Interstitium, Neuromuscular, Thoracic cage.

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20
Q

What happens to residual volume in obstructive defects?

A

Residual volume increases due to airflow obstruction.

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21
Q

What happens to residual volume in restrictive defects?

A

Residual volume decreases along with other lung volumes.

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22
Q

What is the most likely diagnosis for a 55-year-old with shortness of breath, wheezing, and distant breath sounds?

A

Chronic Obstructive Pulmonary Disease (COPD).

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23
Q

What are common symptoms of asthma?

A

Cough, dyspnea, family history of allergies, wheeze, and distant breath sounds.

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24
Q

How does heart failure differ from COPD in symptoms?

A

Heart failure includes cardiac symptoms like dyspnea at night, orthopnea, murmurs, and irregular heartbeats.

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25
Q

What are key symptoms of pulmonary tuberculosis (PTB)?

A

Chronic cough lasting over two weeks, fever, weight loss, dyspnea, and crackles or rhonchi.

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26
Q

Why is residual volume (RV) important?

A

It prevents alveoli from collapsing completely, making it easier to inflate the lungs.

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27
Q

How is alveolar gas exchange affected by interstitial lung disease?

A

Fibrosis around alveoli in interstitial lung disease hinders gas exchange, causing restrictive defects.

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28
Q

What are the two ingredients for proper ventilation?

A

A functional thoracic pump and an unobstructed airway conduit.

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29
Q

Why is exhalation more affected in obstructive diseases?

A

Exhalation relies more on lung recoil and compliance, which are reduced in obstructive diseases.

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30
Q

What clinical types of COPD are there?

A

Chronic bronchitis and emphysema.

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31
Q

How does exposure to noxious gases contribute to COPD?

A

It damages the airway, leading to inflammation and obstruction, key in COPD development.

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32
Q

Why is spirometry essential in diagnosing lung disease?

A

It evaluates airflow and volume, identifying obstructive and restrictive patterns of disease.

33
Q

Which lung volume is measured indirectly?

A

Residual Volume (RV).

34
Q

How is residual volume (RV) calculated?

A

RV = Functional Residual Capacity (FRC) - Expiratory Reserve Volume (ERV).

35
Q

What is the functional role of surfactant in the lungs?

A

Surfactant reduces surface tension in alveoli, aiding in lung expansion and preventing collapse.

36
Q

What is the definition of COPD according to GOLD?

A

COPD is a common preventable and treatable disease characterized by persistent airflow limitation that is progressive and associated with chronic inflammation in the airways and lungs due to exposure to noxious particles or gases. Exacerbations and comorbidities contribute to its overall severity.

37
Q

Which are the main risk factors for COPD?

A

Tobacco smoking,
indoor air pollution,
outdoor air pollution, and
occupational chemicals.
Exposure to biomass fuel is a common risk factor.

38
Q

What are the three main actors in the pathophysiology of COPD?

A

Neutrophils,
CD8+ T-lymphocytes, and
macrophages.

39
Q

What role do neutrophils play in COPD?

A

Neutrophils produce substances that perpetuate inflammation, causing structural damage, bronchoconstriction, edema, mucus secretion, and airflow limitation.

40
Q

What is the significance of GETomics in COPD?

A

GETomics refers to the three factors in the development of COPD: Genetics, Environment, and Time. It emphasizes the duration of exposure to risk factors.

41
Q

What is the main cause of airflow limitation and air trapping in COPD?

A

Airflow limitation and air trapping are caused by structural damage such as small airway fibrosis and emphysema.

42
Q

What are the key symptoms of COPD?

A

Dyspnea,
wheezing/rhonchi,
chronic cough,
hyperinflation, and
poor health-related quality of life.

43
Q

What is polycythemia in COPD?

A

Polycythemia is the increased production of red blood cells due to prolonged hypoxemia, leading to sluggish blood flow and hypercoagulability.

44
Q

How does chronic bronchitis present in COPD?

A

Chronic bronchitis presents with a chronic, productive cough, purulent sputum, mild dyspnea, cyanosis, peripheral edema, and crackles or wheezes.

45
Q

What is emphysema in COPD?

A

Emphysema is characterized by the destruction of gas-exchanging air spaces, leading to dyspnea, minimal cough, hyperinflation, and decreased breath sounds.

46
Q

What is the role of spirometry in diagnosing COPD?

A

Spirometry is the gold standard for diagnosing COPD, used to assess lung function and confirm the diagnosis based on an FEV1/FVC ratio of less than 0.7.

47
Q

What is the GOLD classification of COPD based on spirometry?

A

COPD severity is classified into GOLD 1 to GOLD 4 based on the FEV1 percentage of predicted values.

48
Q

What are the symptoms of an acute COPD exacerbation?

A

An acute COPD exacerbation is marked by a sudden worsening of symptoms, requiring a change in medication and leading to a decline in lung function.

49
Q

What is the prognosis for patients with advanced COPD?

A

Patients with COPD whose FEV1 is less than 25% of the predicted value are considered pulmonary disabled and near death.

50
Q

What are the main clinical types of COPD?

A

The main clinical types of COPD are chronic bronchitis and emphysema.

51
Q

How do the symptoms of chronic bronchitis differ from emphysema?

A

Chronic bronchitis presents with a productive cough and cyanosis, while emphysema presents with dyspnea, minimal cough, and a thin body type.

52
Q

What is the significance of the FEV1/FVC ratio in diagnosing COPD?

A

A ratio of less than 0.7 is indicative of COPD, confirming the diagnosis of airflow limitation.

53
Q

What is the relationship between smoking and the development of COPD?

A

Smoking is the leading cause of COPD, though not everyone who smokes develops the disease. However, all COPD patients have a history of smoking.

54
Q

What are the risk factors for the development of COPD in childhood?

A

Childhood asthma, premature birth, low birth weight, and early respiratory infections are risk factors for COPD later in life.

55
Q

How does emphysema lead to airflow obstruction?

A

In emphysema, the destruction of elastin in the alveolar walls leads to a loss of elasticity, preventing the bronchioles from collapsing during exhalation, which results in airflow obstruction.

56
Q

How does spirometry help in the assessment of COPD?

A

Spirometry helps in determining the degree of airflow obstruction, categorizing the severity of COPD, and guiding treatment decisions based on lung function.

57
Q

How does pulmonary hypertension relate to COPD?

A

Pulmonary hypertension in COPD is a result of cor pulmonale, where right-sided heart failure develops due to chronic hypoxemia and polycythemia.

58
Q

Why is the diagnosis of COPD not based solely on clinical symptoms?

A

The diagnosis of COPD requires spirometry, as clinical symptoms alone cannot confirm the diagnosis.

59
Q

What is the significance of a decreased FEV1 in COPD patients?

A

A decreased FEV1 indicates worsening airflow limitation and is a key marker in assessing COPD severity and predicting outcomes.

60
Q

Why is COPD a major health concern worldwide?

A

COPD is the third leading cause of death worldwide, responsible for millions of deaths annually, and significantly affects quality of life, particularly in low- and middle-income countries.

61
Q

How is COPD related to the Clean Air Act?

A

The Clean Air Act aims to reduce air pollution, but many regions still suffer from high levels of indoor and outdoor pollution, contributing to the prevalence of COPD.

62
Q

What is the role of the World Health Organization in COPD awareness?

A

The WHO recognizes COPD as a global health issue and works to reduce premature mortality and improve awareness through early diagnosis and treatment initiatives.

63
Q

What level should the diaphragm be at during full inspiration on an X-ray?

A

The diaphragm should be at the level of T10 during full inspiration.

64
Q

What does a hyperlucent lung field indicate on an X-ray?

A

A hyperlucent lung field suggests increased air content, which is commonly seen in COPD.

65
Q

How does the heart shadow appear on a chest X-ray in COPD patients?

A

The heart shadow appears tubular rather than the typical shape.

66
Q

What is the normal width between intercostal spaces, and how does this change in COPD?

A

Normally, there should be 1 finger breadth between intercostal spaces; in COPD, this space is widened.

67
Q

What is the retrosternal space, and how does it appear in COPD on a lateral X-ray?

A

The retrosternal space is the area between the back of the sternum and the front of the heart, usually less than 1 cm; in COPD, it is increased due to air trapping.

68
Q

What does air trapping indicate in a COPD X-ray?

A

Air trapping indicates hyperinflation of the lungs, seen as increased retrosternal space.

69
Q

What is a bulla, and how does it form in emphysema?

A

A bulla is a large air-filled space formed by the rupture and coalescence of alveoli, commonly seen as a complication in emphysema.

70
Q

What risk does a bulla pose in emphysema?

A

A bulla can rupture with increased intrathoracic pressure, allowing air to escape into the pleural space, leading to pneumothorax.

71
Q

What is seen in an X-ray of a person with pneumothorax?

A

An X-ray of pneumothorax shows pleural lung lines that lack lung markings.

72
Q

What changes are observed in the diaphragm position in COPD?

A

The diaphragm appears low-set on the right side in COPD due to hyperinflation.

73
Q

How does the shape of the heart appear in COPD compared to a normal chest X-ray?

A

In COPD, the heart shape becomes tubular rather than the normal shape.

74
Q

What does the presence of widened intercostal spaces suggest in a COPD X-ray?

A

Widened intercostal spaces suggest hyperinflation of the lungs.

75
Q

What complication can arise if a bulla ruptures?

A

Rupture of a bulla can lead to pneumothorax as air escapes into the pleural area.

76
Q

How does the retrosternal space differ in COPD on a lateral chest X-ray compared to a normal X-ray?

A

In COPD, the retrosternal space is larger than 1 cm, while in a normal X-ray it should be less than 1 cm.

77
Q

Which COPD complication is specifically associated with emphysema?

A

Bullae formation is a specific complication associated with emphysema.

78
Q

How is hyperinflation visually represented in a chest X-ray of a COPD patient?

A

Hyperinflation is represented by a low diaphragm, hyperlucent lung fields, and widened intercostal spaces.

PULMONOLOGY (4 decks)

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