COPD

Question 1

describe the effects of smoking

Answer 1

• Cilial motility is reduced – the smoking damages/destroys the cilia
• Airway inflammation
o Neutrophilic inflammation (not steroid responsive)
• Mucus hypertrophy and hypertrophy of Goblet cells
o Chronic cough of chronic bronchitis in smokers
• Increased protease activity, anti-proteases inhibited. Thought of as an imbalance
o These proteases are released from inflammatory cells located in the lungs
• Oxidative stress
o Free radicals. Although anti-oxdiants don’t make better
• Squamous metaplasia → higher risk of lung cancer
o Since toxins are absorbed you are at risk of cancer elsewhere
• Patients are at risk of increased infections, especiallyin their lungs

Question 2

define chronic bronchitis

Answer 2

production of sputum on most days for at least three months of 2 successive years

Question 3

define emphysema

Answer 3

abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles with destruction of the alveolar walls

Question 4

how would you define hyper-inflation on a CXR?

Answer 4

If you see 6 anterior ribs or 9 posterior this would give a clinical diagnosis of hyper-inflation

Question 5

who might you suspect COPD in?

Answer 5

people aged over 35, smokers/ex-smokers who have: exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis, wheeze

Question 6

what type of respiratory failure will a pink puffer have?

Answer 6

type 1 - low oxygen, normal CO2

Question 7

what type of respiratory failure will a blue bloater have ?

Answer 7

type 2 - low oxygen, high CO2

Question 8

define moderate COPD by FEV1/FVC %

Answer 8

50-79%

Question 9

Define severe COPD by FEV1/FVC %

Answer 9

30-49%

Question 10

how would you treat an exacerbation of COPD?

Answer 10

ONAP

Oxygen, nebulizer (salbutamol, ipatropium bromide), antibiotic, prednisolone

Question 11

what range would you aim to have your oxygen saturations within in a patient with COPD?

Answer 11

88-92%

Question 12

what is the normal anion gap?

Answer 12

8-16

Question 13

what does a raised anion gap suggest?

Answer 13

accumulation of organic acids or impaired excretion of H+.

Question 14

give some causes of a raised anion gap acidosis

Answer 14

Lactate - lactic acidosis
Toxins e.g. salicylate
Ketones - DKA
Renal failure

Question 15

what cause a normal anion gap acidosis

give some examples of conditions causing this

Answer 15

loss of HCO3 from extra-cellular fluid

renal tubular acidosis, diarrhoea, carbonic anhydrase inhibitors, ureteric division

Question 16

what features would you see on an x-ray of someone with COPD

Answer 16

low and flattened diaphragm due to over-inflation
bullae
pruned blood vessels with large proximal vessels and relatively little blood visible in peripheral lungs
heart will look long and thin . It normally sit just above the diaphragm - look for a gap between