COPD

Question 1

Anatomically/histologically permanent and destructive enlargement of airspaces distal to the terminal bronchioles WITHOUT obvious fibrosis yet with loss of normal architecture

Answer 1

Emphysema

Question 2

Productive cough not attributable to other causes on most days for

at least 3 MONTHS over 2 CONSECUTIVE YEARS

Answer 2

Chronic Bronchitis

Question 3

Affected in small airway disease

Answer 3

Small bronchioles are narrowed

Question 4

Major site of increased resistance in most individuals with COPD

Answer 4

Small airways

Question 5

Emphysema pathologic types

Answer 5

Centriacinar: respiratory bronchioles
Panacinar: large spaces

Question 6

Emphysema more frequent with cigarette smoking

Answer 6

Centriacinar

Question 7

Prominent locations of centriacinar emphysema

Answer 7

Upper lobes

Superior segments of lower lobes

Question 8

Emphysema usually observed a1AT deficiency

Answer 8

Panacinar

Question 9

Predilection of panacinar emphysema

Answer 9

Lower lobes

Question 10

Most typical finding in COPD

Answer 10

Persistent reduction in forced expiratory flow rates

Question 11

Found late in the course of COPD

Answer 11

(+) air trapping and hyperinflation

Question 12

May cause severe pulmonary hypertension causing cor pulmonale and RV failure

Answer 12

Decreased FEV1 (<25% of predicted + chronic hypoxemia PaO2 <55mmHg)

Question 13

Cause of reduction of PaO2 in COPD

Answer 13

VQ mismatch

Question 14

Risk factor for mortality from chronic bronchitis and emphysema

Answer 14

Cigarette smoking

Question 15

Risk factor for COPD and a significant predictor of subsequent decline in pulmonary function

Answer 15

AHR

Question 16

PROVEN genetic factor for COPD

Answer 16

Severe a1 antitrypsin (a1AT) deficiency

Question 17

3 MC complaints in COPD

Answer 17

cough
sputum production
exertional dyspnea

Question 18

“Pink puffers”

Answer 18

Predominantly emphysema

Question 19

“Blue bloaters”

Answer 19

Predominantly chronic bronchitis

Question 20

Independent poor prognostic factor in COPD

Answer 20

Wasting

Question 21

Paradoxical inward movement of the rib cage with inspiration

Answer 21

Hoover’s sign

Question 22

RV failure signs

Answer 22

Inc JVP
RV heave or S3
Hepatic congestion
Ascites
Peripheral edema

Question 23

Gold standard for COPD diagnosis

Answer 23

Pulmonary function testing

Question 24

Hallmark of COPD

Answer 24

airflow obstruction

PFT with Decreased FEV1 and FEV1/FVC

Question 25

Confirms presence of airflow obstruction

Answer 25

FEV1/FVC ratio <70%
+
postbronchodilator FEV1 <80% predicted

Question 26

Decreased DLCO

Answer 26

Emphysema (due to parenchymal destruction characteristic of the disease)

Question 27

Most important sign of severe exacerbation in patients with very severe COPD

Answer 27

Mental status changes

Question 28

Only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in COPD

Answer 28

O2 therapy

Question 29

Bacteria frequently implicated in exacerbations

Answer 29

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis