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Exam 3 clinical > COPD > Flashcards

COPD Flashcards

1
Q

what is COPD?

A

limited airflow that isn’t fully reversible
both emphysema & chronic bronchitis (both progressive, co-exist)
PROGRESSIVE airflow limitation
abnormal inflammatory response of lungs to noxious particles / gases

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2
Q

what is the primary cause of COPD?

A

cigarette smoking

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3
Q

what are the causes of COPD?

A

tobacco smoke
air pollution
occupational exposure
a-1 antitrypsin deficiency (destroy alveolar walls)

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4
Q

what are the pathological changes of COPD?

A
  1. hypertrophy of mucus-secreting glands
  2. hyperplasia of goblet cells (psudostratified ciliated columnar)
  3. ciliary dysfunction
  4. breakdown of elastin (destruction of alveolar wall & structure)
  5. formation of larger air spaces & reduced total SA for gas exchange (bullae)
  6. vascular bed changes –> pulmonary hypertension
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5
Q

what is emphysema?

A

elastin breakdown & subsequent loss of alveolar integrity –> permanent destructive enlargement of airspaces DISTAL to terminal bronchioles

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6
Q

what is chronic bronchitis?

A

excessive mucus secretion & impaired removal of secretions (from ciliary dysfunction)

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7
Q

why does COPD lead to increased airway resistance?

A
  1. luminal obstruction of airways by mucus (slow moving, thick, ciliary dysfunction)
  2. narrowing small bronchioles - normally kept open by outward pull (radical traction) by elastin
  3. decreased elastic recoil –> reduced expiratory force –> air trap (increase residual volume)
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8
Q

what leads to hyperinflation?

A

expiratory flow limitation (decreased elastic recoil, narrowing small bronchioles, luminal obstruction)

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9
Q

what predisposes patient to hypoxia?

A

airway narrowing & destruction of lung parenchyma

especially during exercise

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10
Q

what is hypoxia from?

A

airways narrowing & pulmonary vasculature changes

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11
Q

what does progressive hypoxia causes?

A

pulmonary vasoconstriction & vascular SM thickening

with subsequent pulmonary hypertension + RH failure (cor pulmonale)

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12
Q

what is a typical history of COPD?

A

gradual onset

usually present in older people with long history of smoking

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13
Q

what are the symptoms of COPD?

A
  1. cough (usually initial)
  2. frequent morning cough (constant through progression)
  3. usually productive cough (sputum produced)
  4. SoD (dyspnoea) - usually on exertion, progress to at rest
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14
Q

physical examinations of COPD patients

A
  1. tachypnoea
  2. use of accessory muscles of respiration
  3. barrel chest
  4. hyper-resonance on percussion
  5. reduced intensity (distant) breath sounds
  6. reduced air entry (poor air movement)
  7. wheezing
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15
Q

what causes tachypnoea?

A

increase RR to compensate for hypoxia & hypoventilation

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16
Q

what are the accessory muscles of respiration?

A

SCM
scalene
pec minor

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17
Q

why use the accessory muscles of respiration?

A

difficulty moving air in & out of lungs

18
Q

how can you tell if a patient is using accessory muscles of respiration?

A

tracheal tug
intercostal recession
subcostal recession
nasal flare

19
Q

what is barrel chest?

A

increase A-P diameter of chest

20
Q

why will patient present with barrel chest?

A 
hyperinflation (decreased elastic recoil --> limited expiratory flow rate) 
air trapping (secondary to incomplete expiration)
21
Q

why will there be hyper-resonance on percussion?

A

hyperinflation & air trapping

22
Q

why will there be reduced intensity (distant) breath sounds?

A

caused by barrel chest, hyperinflation & air trapping

23
Q

why will there be reduced air entry (poor air movement)?

A

secondary to loss of lung elasticity & lung tissue breakdown

24
Q

what are late features of COPD?

A
  1. central cyanosis
  2. flapping tremors
  3. signs of RH failure
25
Q

what causes central cyanosis?

A

hypoxia due to type 2 resp failure

26
Q

what causes flapping tremors?

A

CO2 retention (hypercapnia)

27
Q

what are signs of RH failure?

A
  1. distended neck veins (raised JVP)
  2. hepatomegaly (back up of portal venous system)
  3. ankle oedema
28
Q

why will there be signs of RH failure in late feature of COPD?

A

secondary to pulmonary hypertension

29
Q

what are investigations carried out for COPD?

A

lung function tests:

spirometry (vitalograph & flow- volume)

30
Q

what will the spirometry show for a patient with COPD?

A

obstructive pattern (FEV1/FVC <70%)

31
Q

what will spirometry show after bronchodilators?

why do this?

A

limited reversibility

rule out asthma

32
Q

what will vitalograph (time-volume) show?

A

low FEV1, nearly normal FVC

33
Q

what will flow volume loops show?

A

typical obstructive pattern (low PEFR & scalloping)

34
Q

what is a feature of emphysema in terms of lung diffusion capacity?

A

decreased diffusing lung capacity for CO (DLCO)

35
Q

how do you check for lung diffusion capacity?

A

patient breathes in mixture of CO & helium after max expire
hold breath for 10 seconds then measure volume & conc to work out diffusing capacity
(CO because pCO = 0, high affinity for Hb, small amount - toxic)

36
Q

what would CXR of COPD look like?

A

hyper-inflated lungs

37
Q

what does hyper-inflated lungs lead to (on CXR)?

A

flattened diaphragm
hyperlucent lungs
increased A-P diameter of chest

38
Q

what else can CXR show aside from hyper-inflated lungs?

A

complications of COPD e.g. pneumonia & pneumothorax

39
Q

what is CXR useful for?

A

to rule out other pathologies e.g. lung cancer in patient with chronic cough

40
Q

what tests will be checked on patients aside from CXR & spirometry?

A

pulse oximetry & ABG analysis

41
Q

when would you carry out pulse oximetry & ABG analysis?

A

acutely unwell patients
to assess hypoxia & hypercapnia
CBG - home ox therapy

Exam 3 clinical (26 decks)

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