COPD

Question 1

Pathophysiology of COPD? (2)

Answer 1

Chronic bronchitis with airway narrowing

destruction and enlargement of alveoli (emphysema) causing loss of elastic traction and airway collapse

Question 2

Main aetiological factors in COPD? (2)

Answer 2

Cigarette smoking

Alpha-1 antitrypsin deficiency (rare but suspect in younger patients)

Question 3

COPD symptoms? (4)

Answer 3

Chronic cough
Breathlessness
Wheeze
Regular sputum production

Question 4

Spirometry pattern of COPD?

Answer 4

Obstructive picture- reduced PEFR, FEV1:FVC ratio, reduced lung volumes

Question 5

CXR signs of COPD? (3)

Answer 5

Hyperexpansion
Increased cardiothoracic ratio secondary to cor pulmonale
Flat hemidiaphragm

Question 6

Full blood count in COPD?

Answer 6

Increased Hb and haemotocrit (due to secondary polycythaemia)

Question 7

Signs of right heart failure? (3)

Answer 7

Right ventricular heave
Ankle swelling
Raised JVP

Question 8

Autonomic effects on airways? (2)

Answer 8

Sympathetic- dilates airways

Parasympathetic (resting)- constricts airways

Question 9

First-line therapy for COPD?

Answer 9

SABA (e.g. salbutamol) or SAMA (e.g. ipratropium)

Question 10

Other inhalers used for COPD?

Answer 10

LABA e.g. salmeterol
LAMA e.g. triotropium
LABA + ICS (e.g. Seretide)

Question 11

Conservative COPD management measures?

Answer 11

Smoking cessation

Pneumoccal (one-off) and season influenza vaccines

Question 12

How is the severity of COPD graded?

Answer 12

Mild-very severe, based on FEV1

Question 13

What are the indications for long term oxygen therapy? (5)

Answer 13

Po2 on room air <7.3 kPA
or Po2 on room air between 7.3-8.0 and one of:

a) secondary polycythaemia
b) nocturnal hypoxaemia
c) peripheral oedema
d) pulmonary hypertension

Question 14

What are the features of cor pulmonale? (4)

Answer 14

Peripheral oedema
Raised JVP
Systolic parasternal heave
Loud P2 heart sound

Question 15

Still breathless despite using salbutamol PRN: management?

Answer 15

a) FEV1 greater than 50- LABA or LAMA

b) FEV1 less than 50- LABA + ICS, or LAMA

Question 16

Commonest organisms causing infective exacerbations of COPD? (4)

Answer 16

H. influenzae
Strep. pneumoniae
Moraxella
Viruses (mainly rhinovirus)

Question 17

Management of infective exacerbations? (3)

Answer 17

Antibiotics if sputum purulent/clinical signs of pneumonia
Prednisolone
Increase frequency of inhaler, consider nebs

Question 18

Patients with COPD typically have what ABG picture?

Answer 18

Compensated respiratory acidosis

Question 19

How is ABG compensation achieved in COPD patients? What effect does this have on urine?

Answer 19

Increased renal reabsorption of bicarbonate; makes the urine acidic

Question 20

Clinical manifestations of hypercapnia? (3)

Answer 20

Warm dilated peripheries
CO2 retention flap
Papilloedema