COPD

Question 1

Because COPD is a systemic disease, what are 6 other systemic manifestations?

Answer 1

IHD, cardiac failure, osteoporosis, metabolic syndrome, anemia, and depression

Question 2

Describe grade 1-5 of the dyspnea scale and how many points each grade gets?

Answer 2

Grade 1: only lose breath during strenuous exercise
Grade 2: get short of breath hurrying on level ground or up a slight hill
Grade 3: walk slower than most people and need to stop because loses breath (1point)
Grade 4: stop after about 100 yards or a few minutes for breath (2 points)
Grade 5: too breathless to leave the house or even dress (3 points)

Question 3

What is the system called that we use to predict COPD survivability?

Answer 3

BODE system
BMI
Airway obstruction
Dyspnea scale
Exercise capacity with 6 minute walk

Question 4

What is the BMI part of it?

Answer 4

If you are over 21 you do not get a point

If you are equal to or under 21 you get a point

Question 5

What is the airway obstruction part of it?

Answer 5

Measuring FEV1. 
If its equal to or over 65% no points
50-64, 1 point
36-49, 2 points
Less than or equal to 35, 3 points

Question 6

What is the 6 minute walk test part of it?

Answer 6

350 meters or over, no points
250-349, 1 point
150 - 249, 2 points
Less than 149, 3 points

Question 7

The scale is based on a 4 year survival of COPD, so what total numbers equal what survival percentages?

Answer 7

0-2, 80%
3-4, 67%
5-6, 57%
7-10, 18%

Question 8

What are the 4 reasons for dyspnea in COPD?

Answer 8

Increased dead space leading to increased CO2
Messed up V/Q ratio leading to hypoxemia
Airflow obstruction
Reduced mechanical advantage of the diaphragm

Question 9

What is the Hoover sign referring to?

Answer 9

The diaphragm and lower ribs being sucked in while inhaling instead of expanding.

Question 10

What are the two differential diagnosis for COPD he wants us to know?

Answer 10

Asthma and left ventricular failure

Question 11

What are two similarities between COPD and asthma?

Answer 11

Weather can make it worse

Exam findings of cough, wheeze and prolonged expiratory phase

Question 12

What are 4 differences about asthma that wouldn’t usually be identified with COPD?

Answer 12

It can be reversed almost completely
Seasonal component
Younger onset
ENT allergic component to it

Question 13

What are the 3 similarities between left ventricular failure and COPD?

Answer 13

Dyspnea
Orthopnea
And exam showing cough and wheeze

Question 14

3 differences unique to left ventricular heart failure?

Answer 14

PND
History of heart disease
And the exam shows heart problems

Question 15

What is the suffix for SAMA and LAMA?

Answer 15

IUM

Question 16

Suffix for short SABA?

Answer 16

Ol

Question 17

Suffix for LABA?

Answer 17

Terol

Question 18

Two suffixes for ICS?

Answer 18

Asone and ide

Question 19

What is a Respimat inhaler?

Answer 19

Propellant free liquid inhaler that creates a cloud

Question 20

What 4 other medicine groups are we using for COPD?

Answer 20

Antibiotics, oral corticosteroids, methyxanthines and PDE inhibitors

Question 21

How do we classify milder and younger patients, what is the antibiotic of choice, and what other families of antibiotics do we use?

Answer 21

Milder means FEV1 greater than 50 and less than 65 years old.
Doxycycline
Cephalosporins and macrolide
S

Question 22

What two families of antibiotics do we use for sicker and older patients?

Answer 22

Amoxicillin-clavulunate

Fluoros

Question 23

What is the most common steroid prescribed and what is the cited dose?

Answer 23

Prednisone

1 mg/kg

Question 24

What is the first indication for supplemental O2?

Answer 24

PaO2 less than 56 or SpO2 less than 89 measured twice over a 3 week period.

Question 25

What is the second indication for supplemental oxygen?

Answer 25

PaO2 less than 60 and SpO2 less than 90 and evidence of: PHTN, CHF, or HCT over 55

Question 26

What level of disease is GOLD 1 and what is treatment?

Answer 26

Mild COPD

Give either SABA or SAMA

Question 27

What is GOLD 2 level disease and treatment?

Answer 27

Moderate COPD

LABA or LAMA

Question 28

What is GOLD 3 level disease and treatment?

Answer 28

Severe COPD

ICS and LABA or ICS and LAMA

Question 29

What is Gold 4 level of disease and treatment?

Answer 29

Very severe COPD

ICS and LABA or ICS and LAMA or ICS and LABA and LAMA and oxygen therapy is needed

Question 30

If patient symptoms are still not under control in GOLD 3 and GOLD 4, what can we also prescribe?

Answer 30

Roflumilast or theophylline

Question 31

What is a good program for these COPD patients and what are two vaccinations they need big time?

Answer 31

Pulmonary rehab program.

Flu and pneumococcal

Question 32

What are we thinking with younger patient with COPD?

Answer 32

Alpha 1 antitrypsin deficiency

Question 33

Top 3 patients with COPD?

Answer 33

Smokers, former smokers and a1at

Question 34

All patients with unexplained dyspnea should be evaluated for what?

Answer 34

A1at deficiency

Question 35

Treatment for COPD is largely based on what?

Answer 35

PFTS

Question 36

What do we never use alone for treatment of COPD?

Answer 36

ICS

Question 37

Besides left heart failure, what are 5 differentials for COPD?

Answer 37

Asthma, bronchiectasis, alpha 1 antitrypsin deficency, CF, and bronchiolitis

Question 38

Most common cause of COPD?

Answer 38

Smoking

Question 39

What combo of medicine is especially useful in patients with COPD?

Answer 39

Anticholinergic and SABA

Question 40

What are the three top pathogens causing COPD exacerbation?

Answer 40

H influenza, strep pneumonia, and moraxella catarrhalis