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Pulmonology (inpt) > COPD > Flashcards

COPD Flashcards

1
Q

emphysema

A

air spaces are enlarges as a consequence of destruction of alveaolar septae

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2
Q

chronic bronchitis

A

dz w/ chronic cough that is productive of phlegm occuring on most days for 3 mnths of the year or for 2 + consectutive yers w. out a defined cuase

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3
Q

what are other causes of COPD?

A

environmental pollutants, recurrent URI, eosinophilia, bronchial hyperresponsivemenss, alpa 1 antitrypsin

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4
Q

PE of emphysematous COPD

A

dry cough and weight loss

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5
Q

PE of pt w/ advanced COPD

A

asthenia, dyspnea, pursed-lip breathing, grunting expirations

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6
Q

Chest exam

A
  • barrel chest=increased AP diameter

- percussion yields increased resonance=caused by hyperinflaion and air trapping

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7
Q

what do you hear on auscultaion?

A

decreased breath sounds, early inspriatory crackles (cuased by airway inflammation and mucus oversecreation)

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8
Q

what about wheezing in COPD

A

may not be present at rest, but can be evoked w. forced expiration or exertion

-common finding in exacerbation “continuous musical lung”

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9
Q

what do you hear in pts w. chronic bronchitis?

A

rhonchi- reflect secretions in the airways, breathing is raspy and loud

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10
Q

Laboratory testss

A

CXR,, PFT, CBC Puls ox, ABG

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11
Q

CXR

A

+/- hyperinflation- not sensitive enough to serve as a diagnostice tool

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12
Q

emphysema pathognomic?

A

parenchymal bullae or subpleural blebs

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13
Q

chronic bronchitis pathogonomic?

A

nonspecific peribronchal and pervascular markings

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14
Q

PFTS

A

-The FEV1/FVC ratio is decreased (< 0.70 or less than the lower limit of normal

**must be incompletely reversible w. inhaled bronchodilator

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15
Q

what would a CBC show?

A

polycythemia from chronic hypoxia

-think impaired gas exchange in lung parenchyma-worsens w/ exercise

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16
Q

what are 3 signs of impending respiratory failure?

A

hypercapnea, hypoxia, and respiratory acidosis

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17
Q

where is theophylline metabolized?

A

the liver

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18
Q

Stage 1

A

mild.

FEV1/FVC < 70% and FEV1 ≥ 80%, with or without symptoms

o Often minimal SOB with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal

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19
Q

stage 2

A

moderate.

FEV1/FVC < 70% and FEV1 = 50-80% predicted value, with or without symptoms
o Often moderate or severe SOB on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation

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20
Q

STage 3

A

severe. FEV1/FVC < 70% and FEV1 = 30-50% predicted value, with or without symptoms

o More severe SOB, with or without cough, sputum or dyspnea – often with repeated exacerbations which usually impact quality of life, reduced exercise capacity, fatigue

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21
Q

Stage 4

A

very severe. FEV1/FVC < 70%, FEV1 < 30% predicted value or FEV1 < 50% with chronic respiratory failure
o Appreciably impaired quality of life due to SOB – possible exacerbations which may even be life threatening at times

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22
Q

How is COPD defined by the GOLD?

A

a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases

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23
Q

what is a COPD exacerbatopm?

A

an acute event characterized by a worsening of the pts respiratory sx that is beyond normal day to day variations and leads to a change in meds

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24
Q

what are clinical features of an exacerbation?

A

increase in baseline dyspnea, cough, and or sputum production

25
Q

what are some non pulmonologic features or an COPD exacerbation?

A

mental status change, fever, maliase, fatiuge

26
Q

what must you rule out in someone that presents with a COPD ex?

A

acute respiratory failure-would need PEEP or mechanical ventialtion

27
Q

what would some present with that would need a mechanical ventilatro?

A

hypoxia, hypercaria, tachypnea, shallow pursed-lip breathing,

28
Q

what are some common PE finding in stable pt in a COPD ex?

A

decreased breath sounds, wheezing, prolonged expiratory phase

29
Q

what are some PE findings in more advanced COPD?

A

barrel-shaped chest, cyanosis, clubbing

30
Q

what are causes of COPD exacerbations?

A

infections, exposure to pollutants, and medication nonadherence

31
Q

what are the most common cause of COPD ex?

A

viral (1/3) and bacterial (1/2)

32
Q

what is the most common viral cause

A

rhinovirus

influenza may be a RF for developing secondary bacterial PNA, MRSA!

33
Q

common bacterial pathogens?

A

H. flu, Strep pna, moraxella catarrhalis,

34
Q

what pt would be more likely to get Pseudomonas aeruginosa

A

state 3/4 COPD (FEV1 < 50% predicted value)

35
Q

what are RF for Psuedomonas aurginosa

A
  • low FEV
  • chronic use of systemic corticosteroids
  • abx use w/in the last 3 mnths
36
Q

what are some DDX of COPD ex

A

PNA, heart failure, Pulmonary embolism, heart failure, Pneumothorax

37
Q

what are factors assoicated with a positive predictablilty for a PE in pts with a COPD ex?

A

hx of venous throbmboembolism

underlying malignancy

decrease in PaCO2 of at least 5 mmgh

38
Q

diagnostic evaluation of an COPD ex

A
  • typically a clinical dx
  • PE (pulse ox)

-ABG not routinely order, but may be useful for pts with acute or actue on chronic respiratory failure
( helps with basline)

  • CXR
  • CT of thorax if suspected PE
  • CBC
  • flu, MRSA swab
  • spirometry is not recommended
39
Q

when would yoou get a sputum culture for a COPD pt

A

in pts that don’t imporve w/abx (culture w/ sensitivities)

or

pts with comorbid conditions and requrie mechanical ventilation

40
Q

what causative antigens may you find in the pts urine?

A
  • S. Pneumonia

- Legionella pneumophila

41
Q

indications for hospital admissions?

A

**in the future hospitalization may serve as a measure for risk stratification and prognostic indications

  • severe signs/sx
  • severe comorbidities
  • inadequate home support
  • older adults
42
Q

ICU admission?

A
  • noninvasive ventilation (bipap): avoid complications of intubation
  • severity

-worsening hypoxemia, respirator acidosis, or failure of noninvasive ventaion

43
Q

who needs intubations?

A

-worsening hypoxemia, respirator acidosis, or failure of noninvasive ventilation

44
Q

what does roflumilast do?

A

maintenance tx to reduce exacerbations in pts with severe COPD and chronic bronchitis

45
Q

MOA of roflumilast?

A

PDE-4 inhibition -increases intracellular adenosine monophosphate causing an overall reducton in inflammatory cells

46
Q

what are some commonly used short-acting bronchodilators that are helpful with FEV1 improvemnt

A

SABA (Beta 2): albuterol and levalbuterol

SACA (anticholinergic): ipratropium

47
Q

are long-acting bronchodilators recommended?

A

nope. no in COPD exacerbations (salmetrol)

48
Q

what is the mainstay tx for COPD exacerbaion?

A

systemic corticosteroids

49
Q

what is the GOLD recommended dosage?

A

prednisone 40 mg for 5 days

50
Q

what are the clinical outcomes of systemic corticosteroid usage?

A
  • imporved lung fxn
  • decreased recovery time
  • fewer tx failures
51
Q

when is the use of abx recommended?

A
  • dyspnea, excessive sputum, purulent sputum,

* all pts on mechanical ventalaion need an abx

52
Q

what is the preferred abx tx?

A

aminopenicillin +/- clavulanic acid, macrolies, or tetracyclines (but consider local bacterial resistance)

53
Q

what is the preferred route of abx?

A

oral, but IV can be used

54
Q

what is the recommended duration of abx tx for COPD exacerbation?

A

5-10 days

55
Q

when to know if pts is ready for discharge?

A

clinical stability- vital signs and ABG should be stable fo12 to 24 hours before discharge

SABA should not be used more than every 4 hours- and pts should be transition to LABA

56
Q

what are some interventions that can be used to reduce the freqency of COPD exacerbations?

A

stope smoking

self-management eduction, pulmonary rehab

vaccine againse flue and PNA

57
Q

what has been found to reliably slow progression of cOPD

A

stop smoking

58
Q

what does pulmonary rehabe included?

A

nutrition advice, psychological counseling, eduction, exercise training

Pulmonology (inpt) (7 decks)

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