COPD Flashcards

1
Q

What are the causes of COPD not causes by direct smoking?

A
  • Chronic Asthma
  • Passive smoking
  • Maternal smoking
  • Air Pollution
  • Occupation
  • Alpha 1- anti trypsin deficiency
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2
Q

What does Alpha-1 antitrypsin do?

A

Neutralises enzymes released by neutophils

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3
Q

How many variants of of the gene for alpha 1- antitrypsin are there?

A

75

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4
Q

What is the normal genotype fo A1-antitrypsin?

A

PiMM-(86%)

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5
Q

What is the troublesome genotype fo A1-antitrypsin?

A

PiZZ -(0.03%)

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6
Q

What would be there differential diagnosis for a 40y/o smoker with cough and breathless on exertion?

A
COPD
Asthma
Lung Cancer
Left Ventricular Failure
Fibrosing alveolitis
Bronchiectasis
Rare: TB,Recurrent pulmonary emboli
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7
Q

How does COPD obstruct the airways?

A
  • Inflammation
  • Over production mucus
  • Loss of elasticity and disrupted alveolar attachments
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8
Q

How many deaths arise from COPD a year?

A

30,000

6th most common cause of death

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9
Q

How many men die from COPD?

A

15,700

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10
Q

How many women die from COPD?

A

14,300

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11
Q

How do symptoms progress IN COPD?

A

Insidious, gradually worsening over the years!

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12
Q

What are the main symptoms of COPD?

A
  • Breathlessness
  • Cough & Sputum
  • Wheeze
  • Weight loss
  • Peripheral oedema
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13
Q

Describe the Breathlessness onset by COPD

A
  • Gradual

- Little variation

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14
Q

Describe the cough onset by COPD

A
  • Long history of “Smokers cough”
  • Clear Mucoid sputum
  • Early morning and winter months
  • 94% resolution if smoking stops
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15
Q

What would you suspect if haemoptysis:

A
  • Lung Cancer
  • TB
  • Bronchiectasis
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16
Q

Describe the wheeze onset by COPD

A

Typically on exertion

17
Q

Describe the weight loss onset by COPD

A

Indicates severe disease

18
Q

Describe what causes peripheral oedema onset by COPD

A

-Cor pulmonale
-Severe disease
Respiratory failure

19
Q

What is cor pulmonale?

A

Right heart failure due to secondary respiratory failure

20
Q

What are the signs of COPD?

A

Breathlesss walking into clinic
Pursed lip breathing
Cyanosis
CO2 Flap

21
Q

What signs of COPD could be seen during chest exam?

A
  • Hyperexpasnsion chest
  • Decrease in expansion
  • Laryngeal descent
  • Paradoxical mvmt of ribs and abdomen
  • Cardiac dullness to percussion
  • Decrease in breathe sounds
  • Prolonged expriation and wheeze
  • palpable liver
22
Q

What is paradoxical breathing?

A

Paradoxical breathing is a condition when your chest moves inward during inhalation instead of moving outward

23
Q

How is COPD graded?

A

FEV1 less than 80% of FVC

24
Q

What are some essntial investigations for diagnosising COPD?

A

-Full pulmonary function testing
-Lung volume
-Carbon monoxide
gas transfer

25
Does asthma have reduced gas transfer?
NO
26
What is the minimum response bronchodilator reversibility ?
-Baseline , 15 minutes post neb 2.5-5mg subutamol
27
When is there a significant chance of reversibility?
Delta FEV1 greater than 200ml and delta FEV1 greater than 15% baseline
28
When response to bronchodilator/steroid is insignificant what does this suggest?
COPD
29
What are some clincal features found in a chest radiograph
- Hyperinflated lung fields (Greater than 10 posterior ribs seen) - Flattened diaphragm - Luncent lung fields - Bullae
30
Define type 1 respiratory failure
Low PO2
31
Define type 2 respiratory failure
Low PO2 | High PCO2
32
What would be shown on an ECG with a person with
- Right axis deviation - P pulmonale - T wave inversion v1-v4
33
What microorgansims cause increased sputum
s Pnemoniae H influenza M catarrahlis
34
What helps treatment of COPD?
- Neb Bronchodilator (beta 2 & anti muscarinic) - 02 - Oral/IV corticosteroids - Antibiotic - Diuretic iv amniophylline - respiratory stimulant - NIV( non invasive ventilation)