COPD

Question 1

what is the development of COPD proportional to

Answer 1

the no. cigarettes smoked a day

Question 2

what is chronic bronchitis due to

Answer 2

neutrophilic inflammation

Question 3

how does chronic bronchitis present

Answer 3

recurrent or chronic cough

Question 4

is chronic bronchitis reversible

Answer 4

partially

Question 5

what is emphysema due to

Answer 5

the action of neutrophil elastase and relates to an inc in proteases and a dec in antiproteases

impairs gas exchange - breathless

Question 6

is emphysema reversible

Answer 6

NO

Question 7

CB pathological findings

Answer 7

inc numbers of mucus secreting goblet cells and mucociliary dysfunction

Question 8

what does mucus hypersecretion cause

Answer 8

productive cough

Question 9

what happens to the SM

Answer 9

spasm and hypertrophy

Question 10

what is the predominant lymphocytic infiltrate

Answer 10

CD8+ cell

Question 11

what is inflammation of the walls followed by

Answer 11

scarring and thickening - narrows the small airways, this causes a wheeze

Question 12

wheeze on expiration or inspriation

Answer 12

expiration

Question 13

what is the underlying pathology in a blue bloater

Answer 13

CB

Question 14

blue bloater

Answer 14

Decreased alveolar ventilation, low PaO2 and high PaCO2.

Cyanosed but not breathless, with wheeze and productive cough, and may go on to develop cor pulmonale.

Oxygen should be given with care.

Question 15

how does the body respond to hypoxemia

Answer 15

making more RBC - polycythaemia

Question 16

what is the definition of emphysema

Answer 16

abnormal enlargement of air spaces distal to terminal bronchioles due to loss of alveolar attachments and elastin breakdown

fewer but larger alveoli

Question 17

emphysema process

Answer 17

macrophages stimulated and secrete proteases - attracts neutrophils which secrete elastase

elastase causes loss of elastic recoil

air trapping causing an inc in end expiratory volume

Question 18

what is seen in PP

Answer 18

barrel chest
pursed lip breathing

eventually muscle wasting and weight loss

Question 19

Pink puffer

Answer 19

Increased alveolar ventilation, normal PaO2 and normal or low PCO2. Breathless but not cyanosed.

May progress to type 1 resp failure.

Question 20

what is barrel chest due to

Answer 20

use of expiratory muscles and inc end expiratory volume

Question 21

what are signs of hypercapnia

Answer 21

CO2 flap and morning headache

Question 22

what is centra acinar emphysema due to

Answer 22

smoking

Question 23

what is pan acinar emphysema due to

Answer 23

alpha 1 antitrypsin deficiency

Question 24

what does PFT show

Answer 24

low FVC and FEV1

reduced ratio and PEFR

Question 25

what is the FEV1/FVC ratio reduced to

Answer 25

<70%

Question 26

what is mild classed as

Answer 26

> 80% predicted

Question 27

moderate

Answer 27

<80% predicted

Question 28

severe

Answer 28

<50% predicted

Question 29

v severe

Answer 29

<30% predicted

Question 30

CXR

Answer 30

often normal

can show over inflation of lungs with flattened diaphragms (more than 6 ribs visible)

Question 31

management steps

Answer 31

1. SABA
2. SABA + LAMA/LABA
3. LABA + LAMA

Question 32

what is the likely microbiology of an exacerbation

Answer 32

H influenza
M catarrhalis
S pneumonia

Question 33

testing of acute exacerbation

Answer 33

sputum culture and purulence

CXR

Question 34

when to treat acute exacerbation

Answer 34

inc in sputum purulence or CXR change or pneumonia

Question 35

what antibiotics to give in acute exacerbation

Answer 35

amoxicillin

doxycycline 2nd line

Question 36

treat acute exacerbation

Answer 36

Ipratropium 
Salbutamol 
Oxygen 
Amoxicillin 
Prednisolone