copd

Question 1

What does COPD stand for?

Answer 1

Chronic Obstructive Pulmonary Disease

Question 2

What are the two main conditions that comprise COPD?

Answer 2

• Emphysema
• Chronic bronchitis

Question 3

Define chronic bronchitis.

Answer 3

A condition characterized by excessive mucous secretion from the bronchial tree, with productive cough every day for at least 3 months of the year for at least 2 successive years.

Question 4

What is the Reid index in chronic bronchitis?

Answer 4

The ratio of mucus glands to wall thickness; normal is 40%, but in COPD, it can be up to 70%.

Question 5

Define emphysema.

Answer 5

A pathologic term indicating enlargement of the air spaces distal to the terminal bronchioles due to dilatation and/or destruction of the alveolar walls.

Question 6

What is the difference between true emphysema and false emphysema?

Answer 6

True emphysema involves destruction of alveolar walls, while false emphysema involves dilatation only and usually does not cause significant respiratory dysfunction.

Question 7

What characterizes centriacinar COPD?

Answer 7

It involves the central part of the acinus and is associated with cigarette smoke and chronic bronchitis.

Question 8

What is panacinar COPD?

Answer 8

Involves all parts of the acinus uniformly and is seen in patients with alpha-1-antitrypsin deficiency.

Question 9

What is the most important risk factor for COPD?

Answer 9

Smoking

Question 10

What impact does smoking have on mucosal glands?

Answer 10

It causes mucosal gland hypertrophy with increased mucus secretion.

Question 11

What is the oxidant-antioxidant theory related to COPD?

Answer 11

Cigarettes contain many free oxygen radicals, resulting in oxidative stress to the lungs.

Question 12

What are the three extremes of the clinical spectrum of COPD?

Answer 12

• Chronic bronchitis
• Centriacinar emphysema (Type B)
• Panacinar emphysema (Type A)

Question 13

What are the characteristics of a ‘pink puffer’?

Answer 13

Patients with panacinar COPD who are usually puffing and not cyanosed.

Question 14

Describe the clinical features of a ‘blue bloater’.

Answer 14

Patients with centribular COPD who may be edematous and cyanosed.

Question 15

What are common symptoms of COPD?

Answer 15

• Chronic cough
• Dyspnea with wheezing
• Chest pain
• Manifestations of respiratory failure

Question 16

What is the significance of cor pulmonale in COPD?

Answer 16

It is a common complication due to pulmonary hypertension leading to right ventricular hypertrophy and potential heart failure.

Question 17

What does ABG stand for in the context of COPD?

Answer 17

Arterial Blood Gas

Question 18

What is a common radiological finding in panacinar COPD?

Answer 18

Bullae in lower lung zones.

Question 19

What blood gas abnormalities are seen in severe COPD?

Answer 19

• Hypercapnia
• Hypoxemia
• Elevated plasma bicarbonate

Question 20

What is the pathophysiological effect of hypoxia in COPD?

Answer 20

It leads to direct vasoconstriction of pulmonary arterioles, resulting in pulmonary hypertension.

Question 21

True or False: COPD is more common in females than males.

Answer 21

False

Question 22

What is the relationship between alpha-1 antitrypsin deficiency and COPD?

Answer 22

It is the most common genetic factor related to the development of COPD.

Question 23

What physical examination sign may indicate severe COPD?

Answer 23

Cyanosis may be present.

Question 24

Fill in the blank: Chronic bronchitis can lead to _______ emphysema.

Answer 24

centriacinar

Question 25

What is a common symptom of advanced COPD?

Answer 25

Weight loss and muscle wasting.

Question 26

What is Chronic Obstructive Pulmonary Disease (COPD)?

Answer 26

A progressive lung disease characterized by airflow limitation and includes chronic bronchitis and emphysema. ## Footnote COPD leads to breathing difficulties and is often caused by long-term exposure to irritants such as tobacco smoke.

Question 27

What are the signs of central cyanosis in COPD?

Answer 27

May be present during general examination. ## Footnote Central cyanosis indicates insufficient oxygenation of the blood.

Question 28

What can cause congestion in neck veins in COPD patients?

Answer 28

Increased intrathoracic pressure or occurrence of cor pulmonale and right-sided heart failure. ## Footnote Cor pulmonale is a condition that affects the right side of the heart due to lung disease.

Question 29

What is clubbing of fingers associated with in COPD?

Answer 29

Occurs if there is associated bronchiectasis or bronchial carcinoma. ## Footnote Clubbing is often a sign of chronic hypoxia or lung diseases.

Question 30

What can cause oedema of the lower limbs in COPD?

Answer 30

Cor pulmonale or less commonly due to salt and water retention or DVT. ## Footnote Oedema may indicate fluid retention due to heart failure.

Question 31

What are the manifestations of airway obstruction in COPD during chest examination?

Answer 31

Vesicular breath sounds with prolonged expiration, generalized wheezes (rhonchi), and crepitations. ## Footnote These signs indicate restricted airflow and possible airway inflammation.

Question 32

What does hyperinflation of the chest indicate in COPD?

Answer 32

Increased antero-posterior diameter, barrel chest, and bilateral limitation of chest expansion. ## Footnote Hyperinflation is often due to emphysema.

Question 33

What is Hoover's sign?

Answer 33

Costal margin retraction on inspiration. ## Footnote It indicates a flattening of the diaphragm and is associated with severe lung disease.

Question 34

What laboratory findings are associated with respiratory failure in COPD?

Answer 34

Decreased PO2, increased PCO2, and increased bicarbonate in arterial blood gases. ## Footnote These findings indicate hypoxemia and hypercapnia.

Question 35

What are common complications of COPD?

Answer 35

* Acute exacerbations * Acute respiratory failure * Pneumonia * Cor pulmonale * Pneumothorax * Bronchial obstruction * Erythrocytosis * Thromboembolism * Salt and fluid retention ## Footnote Complications can lead to worsening symptoms and increased morbidity.

Question 36

What is the purpose of oxygen therapy in COPD?

Answer 36

Long-term continuous administration of low flow O2 at home to manage severe hypoxia. ## Footnote Indicated when PaO2 is less than 55 mmHg or SaO2 is less than 88%.

Question 37

What are the first-line bronchodilators for COPD treatment?

Answer 37

B2 agonists such as salbutamol and terbutaline (short-acting) and salmeterol and formoterol (long-acting). ## Footnote Bronchodilators help to relax the muscles around the airways, improving airflow.

Question 38

What are indications for inhaled corticosteroids in COPD?

Answer 38

Used in acute exacerbation of COPD, especially for patients with asthmatic bronchitis not responding to bronchodilators. ## Footnote Corticosteroids reduce inflammation and swelling in the airways.

Question 39

What is the role of lung volume reduction surgery in COPD?

Answer 39

To remove diseased lung tissue to improve airflow and breathing efficiency. ## Footnote This surgical option is typically considered for severe cases.

Question 40

What is the significance of sputum culture in COPD management?

Answer 40

To detect infections, especially when purulent sputum is present. ## Footnote Identifying pathogens helps tailor antibiotic therapy.

Question 41

What can cause left-sided heart failure in COPD?

Answer 41

Associated disease affecting the left side of the heart, especially coronary heart disease. ## Footnote This can lead to volume overload and exacerbate heart failure symptoms.

Question 42

What are some signs of respiratory failure in COPD?

Answer 42

* Central cyanosis * Drowsiness and hypersomnia * Asterixis (flapping tremors) * Increased intracranial tension and papilloedema * Coma occurs terminally ## Footnote These signs indicate severe hypoxia and respiratory distress.

Question 43

Fill in the blank: The distance between the suprasternal notch and the cricoid may be reduced in COPD due to _______.

Answer 43

decrease length of extrathoracic trachea.

Question 44

True or False: Hyperresonance on percussion is a sign of normal lung function in COPD.

Answer 44

False. ## Footnote Hyperresonance indicates air trapping and hyperinflation.

Question 45

What are the common antibiotics used for treating respiratory infections?

Answer 45

Macrolides, tetracycline, quinolones, 2nd generation cephalosporins, co-trimoxazole ## Footnote Treatment duration is typically 7-10 days.

Question 46

What are mucolytics used in respiratory therapy?

Answer 46

Bromhexine hydrochloride, oral acetyl cysteine ## Footnote Mucolytics help break down mucus.

Question 47

What is the role of bronchodilators in respiratory treatment?

Answer 47

They help open the airways to improve breathing ## Footnote Commonly used in conditions like COPD.

Question 48

What is acute respiratory failure (ARF)?

Answer 48

Failure of the respiratory system to supply sufficient oxygen to the blood and body organs ## Footnote Can occur with or without adequate ventilation.

Question 49

What are the two types of acute respiratory failure?

Answer 49

Type I (hypoxemic), Type II (hypercapnic) ## Footnote Type I shows only hypoxemia; Type II shows hypoxemia and hypercapnia.

Question 50

What causes Type I acute respiratory failure?

Answer 50

Usually pulmonary causes only ## Footnote Example: pneumonia.

Question 51

What causes Type II acute respiratory failure?

Answer 51

Pulmonary causes like COPD and extrapulmonary causes like brain lesions or neuromuscular junction disease ## Footnote Type II shows hypoxemia, hypercapnia, and respiratory acidosis.

Question 52

How is acute respiratory failure diagnosed?

Answer 52

Arterial blood gases sample showing hypoxemia and/or hypercapnia with respiratory acidosis ## Footnote Diagnosis criteria: PaO2 < 60 mmHg, PaCO2 > 45 mmHg, pH < 7.35.

Question 53

What is the oxygenation index used for diagnosing ARF in patients on O2 therapy?

Answer 53

An oxygenation index < 200 ## Footnote This is a ratio of arterial O2 tension to inspired O2 fraction.

Question 54

What is the primary treatment approach for ARF?

Answer 54

Directed towards the precipitating cause and relief of life-threatening disturbances ## Footnote Includes keeping patent airways and O2 therapy.

Question 55

What are the mechanical ventilation options for COPD patients in respiratory failure?

Answer 55

Non-invasive (CPAP, BiPAP) or invasive (endotracheal intubation, tracheostomy) ## Footnote Non-invasive methods are preferred if possible.

Question 56

What factors are known to improve survival in COPD patients?

Answer 56

* Smoking cessation * Long term oxygen therapy (LTOT) * Lung volume reduction therapy ## Footnote These interventions can significantly impact patient outcomes.

Question 57

What are potential future therapeutic considerations for COPD management?

Answer 57

* Anticytokines * Alpha 1 protease inhibitor replacement * Specific antileukotrienes * New bronchodilators * Antioxidants * Gene therapy * Alveolar repair * Mucoregulators ## Footnote These approaches aim to address various aspects of COPD.

Question 58

What are some extrapulmonary comorbidities associated with COPD?

Answer 58

* Weight loss * Nutritional abnormalities * Skeletal muscle dysfunction * Osteoporosis * Bone fractures * Recurrent respiratory infections * Depression * Sleep disorders * Increased risk of angina and myocardial infarction * Increased risk of diabetes, anemia, and glaucoma ## Footnote COPD has significant systemic effects beyond the lungs.