COPD

Question 1

Is COPD reversible

Answer 1

No

Question 2

Charctoristics of emphysema (dilated airways)

Answer 2

• destruction of alveoli wall - less passes for gasses exchange

• air trapping in alveoli = low levels of oxygen and high levels of CO2

Question 3

Characteristics of Bronchitis - blue bloaters

Answer 3

• inflam of bronchi
• muco cillary dysfunction = excess mucus producing = chronic cough
• hypoxia
• cynosis- blue in colour

Question 4

Causes of COPD?

Answer 4

• smoking
• asthma
• fumes
• air pollution
• age
• genes - AATD

Question 5

Symptoms of emphysema?

Answer 5

• severe breathlessness
• hyperinflation
• thin appearance

Question 6

Symptoms of bronchitis

Answer 6

• hypoxia cor pumonary
• breathlessness
• respiratory failure
• cynosis
• obese

Question 7

Complications of COPD

Answer 7

• lung cancer
• recurrent chest infections
• anxiety
• depression
• respiratory failure

Question 8

Differential diagnosis?

Answer 8

• asthma
• TB
• cystic fibrosis
• lung cancer
• HF

Question 9

Test/investigations?

Answer 9

• spirometry
• chest x ray
• CT scan

Question 10

What vaccines should be given

Answer 10

pneumococcal + annual influenza (inactivated)

Question 11

What vaccines should be given

Answer 11

pneumococcal + annual influenza (inactivated)

Question 12

Who should receive oxygen

Answer 12

• those with stable hypoxia OR blue bufferes

Question 13

If a patient has high levels of CO2 what should the oxygen saturation target be?

Answer 13

88- 92%

Question 14

If a patient has low/normal levels of CO2 what should the oxygen saturation target be?

Answer 14

94-98%

Question 15

Should the oxygen be at high or low conc?

Answer 15

Low concentration

Question 16

Before treatment begins ensure to

Answer 16

Offer-

• smoking cessations
• vaccinations
• pulmonary rehabilitation
• self management plan
• optimise treatment of co-morbidities

Question 17

Inhaled therapies are for

Answer 17

Reliving breathlessness & exercise limitations

Patient must have satisfactory inhaler technique

Question 18

Step 1

Answer 18

SABA - salbutamol

OR

SABA - ipatropium

Question 19

Step 2 (for no asthmatic features or steroid need)

Answer 19

LABA - formoterol

+

LAMA - tiotropium

Question 20

Step 2 (for asthmatic features or need for steroids)

Answer 20

LABA - formoterol

+

ICS - Formoterol with budesonide (symbiont) - this is a combo of LABA + ICS

Question 21

Step 3

Answer 21

LABA + LAMA + ICS

Question 22

What options are included in add on therapy?

Answer 22

• oral corticosteroids
• theophylline
• oral mucolytic therapy (sputum)

Question 23

True or false

ICS should always be prescribed with LABA

Answer 23

True - LABA works best with ICS not alone

Question 24

Why does LABA have a prolonged relief affects

Answer 24

It is lipophilic and binds to beta 2 receptors for longer

Question 25

True or false SAMA stimulates parasympathetic aspect of ANS?

Answer 25

False they block it

SABA stimulates sympathetic system

Question 26

Antimicrobial prescribing in COPD

Question 27

Oral first line

Answer 27

• amoxicillin
• doxycycline
• clarythromycin

(Doses same as pneumonia)

Question 28

Oral for alternative or high risk

Answer 28

• co-amoxiclav
• co-trimoxazole

(Doses same as pneumonia)

Question 29

First line IV

Answer 29

• amoxicillin
• clarythromycin
• co-amoxiclav
• co-trimoxazole
• pipracillin + tazobactam

5 day treatment

(Doses same as pneumonia)