COPD

Question 1

Major physiologic change in COPD. (Harrison’s 19th edition, pp 1700)

Answer 1

Airflow limitation

Question 2

Centriacinar or Panacinar?

Most frequently associated with cigarette smoking. (Harrison’s 19th edition, pp 1701)

Answer 2

Centriacinar

Question 3

Centriacinar or Panacinar?

Predilection for the lower lobes. (Harrison’s 19th edition, pp 1701)

Answer 3

Panacinar

Question 4

Centriacinar or Panacinar?
Characterized by enlarged air spaces found (initially) in association with respiratory bronchioles. (Harrison’s 19th edition, pp 1701)

Answer 4

Centriacinar

Question 5

Centriacinar or Panacinar?

Focal. (Harrison’s 19th edition, pp 1701)

Answer 5

Centriacinar

Question 6

Centriacinar or Panacinar?
Refers to abnormally large airspaces evenly distributed within and across acinar units. (Harrison’s 19th edition, pp 1701)

Answer 6

Panacinar

Question 7

Centriacinar or Panacinar?

Prominent in the upper lobes and superior segments of lower lobes. (Harrison’s 19th edition, pp 1701)

Answer 7

Centriacinar

Question 8

Centriacinar or Panacinar?

Observed in patients with a1AT deficiency. (Harrison’s 19th edition, pp 1701)

Answer 8

Panacinar

Question 9

Panacinar emphysema. (Harrison’s 19th edition, pp 1701)

Answer 9

Refers to abnormally large airspaces evenly distributed within and across acinar units
Observed in patients with a1AT deficiency
Predilection for the lower lobes

Question 10

Centriacinar emphysema. (Harrison’s 19th edition, pp 1701)

Answer 10

Most frequently associated with cigarette smoking
Characterized by enlarged air spaces found (initially) in association with respiratory bronchioles
Focal
Prominent in the upper lobes and superior segments of lower lobes

Question 11

GOLD stage II. (Harrison’s 19th edition, pp 1704)

Answer 11

Moderate

FEV1/FVC < 0.7 and FEV1 >/= 50% but <80% predicted

Question 12

GOLD stage IV. (Harrison’s 19th edition, pp 1704)

Answer 12

Very severe

FEV1/FVC < 0.7 and FEV1 < 30% predicted

Question 13

GOLD stage I. (Harrison’s 19th edition, pp 1704)

Answer 13

Mild

FEV1/FVC < 0.7 and FEV1 >/= 80% predicted

Question 14

GOLD stage III. (Harrison’s 19th edition, pp 1704)

Answer 14

Severe

FEV1/FVC < 0.7 and FEV1 >/= 30% but <50% predicted

Question 15

Recommended treatment for Combined assessment of GOLD class A. (GOLD Guidelines)

Answer 15

SA anticholinergic prn or SA beta-2 agonist prn

Question 16

Recommended treatment for Combined assessment of GOLD class B. (GOLD Guidelines)

Answer 16

LA anticholinergic or LA beta-2 agonist

Question 17

Recommended treatment for Combined assessment of GOLD class C. (GOLD Guidelines)

Answer 17

ICS +

LA beta-2 agonist or LA anticholinergic

Question 18

Recommended treatment for Combined assessment of GOLD class D. (GOLD Guidelines)

Answer 18

ICS +

LA beta-2 agonist and/or LA anticholinergic

Question 19

Most highly significant predictor of FEV1 in COPD. (Harrison’s 19th edition, pp 1702)

Answer 19

Pack-years of cigarrete smoking

Question 20

Only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in patients with COPD. (Harrison’s 19th edition, pp 1706)

Answer 20

Supplemental oxygen

Question 21

Treatment of COPD that has been demonstrated to improve health-related quality of life, dyspnea and exercise capacity, and reduce rates of hospitalization over a 6-12 month period. (Harrison’s 19th edition, pp 1706)

Answer 21

Pulmonary rehabilation

Question 22

The major site of increased resistance in individuals with COPD. (Harrison’s 19th edition, pp 1701)

Answer 22

Small airways < or = 2mm diameter

Question 23

The definitive test to diagnose emphysema. (Harrison’s 19th edition, pp 1705)

Answer 23

CT scan

Question 24

Most typical finding in COPD. (Harrison’s 19th edition, pp 1701)

Answer 24

Persistent reduction in forced expiratory flow rates

Question 25

In COPD, inhaled bronchodilators will produce improvement of up to how many percent? (Harrison’s 19th edition, pp 1701)

Answer 25

15%

Question 26

Pathophysiology of COPD. (Harrison’s 19th edition, pp 1701)

Answer 26

Airflow limitation/obstruction
Hyperinflation (Increases in the residual volume and the residual volume/total lung capacity ratio)
Nonuniform distribution of ventilation
Ventilation-perfusion mismatching

Question 27

Disease state characterized by airflow limitation that is not fully reversible. (Harrison’s 19th edition, pp 1700)

Answer 27

Chronic Obstructive Pulmonary Disease (COPD)

Question 28

An anatomically defined condition characterized by destruction and enlargement of the lung alveoli. (Harrison’s 19th edition, pp 1700)

Answer 28

Emphysema

Question 29

A clinically defined condition with chronic cough and phlegm. (Harrison’s 19th edition, pp 1700)

Answer 29

Chronic Bronchitis

Question 30

A condition in which small bronchioles are narrowed. (Harrison’s 19th edition, pp 1700)

Answer 30

Small airways disease

Question 31

Hallmark of COPD. (Harrison’s 19th edition, pp 1704)

Answer 31

Airflow obstruction

Question 32

In gas exchange of COPD, PaO2 usually remains near normal until FEV1 is decreased to ____ of predicted. (Harrison’s 19th edition, pp 1702)

Answer 32

~50%

Question 33

In gas exchange of COPD, elevated PaCO2 is not expected until FEV1 is ______ of predicted. (Harrison’s 19th edition, pp 1702)

Answer 33

< 25%

Question 34

Often results in mucous gland enlargement and goblet cell hyperplasia leading to cough and mucus production. (Harrison’s 19th edition, pp 1701)

Answer 34

Cigarette smoking

Question 35

Bronchi undergo __________ predisposing to carcinogenesis and disrupting mucociliary clearance. (Harrison’s 19th edition, pp 1701)

Answer 35

Squamous metaplasia

Question 36

Offers both a mortality benefit and a symptomatic benefit in certain patients with emphysema as demonstrated in the National Emphysema Treatment Trial. (Harrison’s 19th edition, pp 1706)

Answer 36

Lung Volume Reduction Surgery (LVRS)