Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

LMCC Part II > COPD > Flashcards

COPD Flashcards

1
Q

ddx for COPD

A 
COPD
chronic bronchitis
emphysema
asthma
bronchiectasis
central airway obstruction 
--bronchogenic or metastatic cancer or LAD
TB
obliterative bronchiolitis
diffuse panbronchiolitis 
heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what history suggests COPD

A

10+ year smoking history or significant second hand smoke

exertional dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the diagnostic criteria for COPD

A

on spirometry–>
FEV1/FVC less than 0.70

INcomplete reversal post bronchodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does emphysema present

A

“pink puffer”
muscle wasting
weight loss
hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how does spirometry distinguish between COPD and asthma

A

both have FEV1/FVC less than 0.70 but asthma has improvement with bronchodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do you see on CT for bronchiectasis

A

bronchial wall thickening and bronchial dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what might you see on CXR in TB

A

upper lung zone scarring and/or calcified granulomata

*this is in a patient with persistent cough and constitutional symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how does chronic bronchitis present

A

“blue bloaters”

CO2 retention, increased AP diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what common meds worsen COPD

A

ASA/NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some red flags in asthma

A

rescue inhaler more than 3x per week

nocturnal symptoms

symptoms of cor pulmonale

indicators of severe/worsening COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are 5 indicators of severe or worsening COPD

A

home O2

steroids

mobility assistance

obesity

4 or more episodes per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are signs of respiratory distress

A 
fragmented speech
pursed lip breathing 
nasal flaring
tracheal tug
accessory muscle use 
intercostal indrawing
paradoxical abdominal movements
tripoding
reduced breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what signs would you look for specifically on peripheral exam for COPD/obstructive lung disease

A

peripheral or central cyanosis

clubbing

smokers fingers

eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what qualifies as “barrel chest”

A

AP/lateral diameter ratio above 0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is hoovers sign

A

inward movement of the lower ribcage during inspiration instead of outward like normal

implies a flat, but functioning, diaphragm which is associated with COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what should you examine on palpation in the exam for COPD/obstructive lung disease

A 
chest expansion
hoovers sign
tracheal deviation
tactile fremitus 
subxiphoid cardiac impulse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what should you examine on percussion in the exam for COPD/obstructive lung disease

A

expect hyperresonance or loss of cardiac dullness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what qualifies as increased forced expiratory time

A

FET longer than 9 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what would you expect on auscultation for COPD/obstructive lung disease

A

soft breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what would you expect to see on CBC-D in COPD/obstructive lung disease

A

increased hematocrit to compensate for deceased PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in addition to CBC-D, what other blood test should be done in COPD and why

A

ABG

PaO2 for treatment assessment

PaCO2 to assess for CO2 retention and need for NIPPV during acute exacerbation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what blood work might you order in COPD/obstructive lung disease

A

CBC-D

ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what radiology might you order in COPD/obstructive lung disease

A

CXR
Echo–if s/s of RV dysfunction and PHTN
ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what special tests might you order in COPD/obstructive lung disease

A

spirometry/PFTs

allergy testing
BMD
sputum induction
methacholine challenge (asthma) if normal spirometry and asthma suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is the appropriate O2 target in CO2 retainers/COPD/obstructive lung disease
88-92%
26
how to manage an emergent COPDE
ABCs supplement O2 if below 88% consider BiPAP in COPD if no need for intubation and have moderate hypercapnia/acidosis intubate if--> respiratory failure, fatigue, unable to maintain adequate oxygenation inhaled medications, systemic corticosteroids, antibiotics in infectious cases
27
which COPD patients should be referred to pulmonary rehab
those with moderate to severe disease
28
what type of approach is best with pharmacological management for COPD
stepwise and use lowest step that achieves optimal control based on the patients severity of COPD develop an exacerbation plan with the patient for pharmacologic therapies including short acting bronchodilators, oral corticosteroids and antibiotics
29
describe COPD
persistent airflow limitation that is typically progressive, not fully reversible, and associated with an abnormal inflammatory response of the lungs to noxious particles or gasses i.e to cigarette smoke
30
what are the two most common conditions that contribute to COPD
emphysema (destruction of alveoli) chronic bronchitis (inflammation of bronchioles)
31
what is an AECOPD
increase in dysnpea, cough and/or sputum that is beyond normal day to day variation may be acute in onset but can also have more indolent course and result in change in regular mediation mortality risk increases as the number of exacerbations increases
32
what confirms the diagnosis of COPD
spirometry showing airflow limitation
33
in which patients should you consider a COPD diagnosis
a patient 40 or older who has 1. respiratory symptoms including dyspnea (progressive, persistent, worse with exercise), chronic cough, and increased sputum production AND 2. one of the following: - history of exposure to cigarette smoke - history of environmental/occupational exposure to smoke, dust or gas/fumes - frequent respiratory infections or - family history COPD
34
what other two diagnoses should you consider in COPD
asthma (stared in childhood) or asthma-COPD overlap syndrome (ACOS)
35
what is the natural course of COPD
slowly progressive over years even with treatment
36
how does CXR vary between asthma and COPD
usually normal in asthma in COPD shows hyperinflation and other COPD changes
37
is a CXR helpful in diagnosing COPD
no. .. may suggest but still need spirometry | * may be useful and should be documented if there are concerns about other significant comorbidities
38
define mild COPD
FEV1 80 or above breathlessness on moderate exertion, recurrent chest infections, little or no effect on daily activities
39
define moderate COPD
FEV1 50-79 increased dyspnea breathlessness walking 100m on level ground increasing limitation of daily activities cough and sputum production exacerbations requiring corticosteroids and/or antibiotics
40
define severe COPD
FEV1 30-49 dyspnea on minimal exertion daily activities severely curtailed expiring regular sputum production chronic cough
41
define very severe COPD
FEV1 less than 30
42
what are the therapeutic goals for COPD management
1. alleviate breathlessness and other respiratory symptoms that affect daily activities 2. prevent and reduce the frequency and severity of acute exacerbations 3. minimize disease progression and reduce the risk of morbidity/mortality 4. optimally manage comorbidities to reduce exacerbations and COPD symptoms related to them
43
lifestyle treatments for COPD
1. smoking cessation (even in long term smokers) --> this is the main cause of COPD and the main contributing factor for disease progression 2. physical activity --> remaining active despite SOB must remain a priority for all patients with COPD 3. pulmonary rehab 4. diet considerations--> make sure BMI stays in normal range as this limits disease progression and reduces morbidity/mortality **reduced BMI is one of the most important risk factors for COPD progression 5. air quality 6. oxygen therapy to maintain PaO2 above 60mmHG or SpO2 above 90% at rest, on exertion and during sleep 7. immunization
44
what are the benefits of smoking cessation in COPD even in long term smokers
this is the main cause of COPD and the main contributing factor for disease progression immediate benefits: improves symptom control, slows progression of disease, improves CV outcomes, reduces long term risk of lung cancer
45
what vaccines to offer
influenza and pneumococcal polysaccharide vaccine --are covered
46
what should you also address for long term planning for patients with COPD
advance care planning --initiate for all patients with diagnosis of COPD
47
what should you do for a patient who is on inhaled meds for COPD
evaluate patients inhaler technique and adherence regularly --up to 90% of patients use their device incorrectly
48
what is the goal of step 1 of COPD pharma therapy
symptom relief
49
what is the goal of step 2 of COPD pharma therapy
symptom relief and prevent exacerbations
50
what is the goal of step 3 of COPD pharma therapy
prevent exacerbations
51
what meds are used in step 1 of COPD pharma therapy
SABA or SAMA monotherapy then SAMA + SABA combination
52
what COPD meds should NOT be used concurrently
LAMA and SAMA
53
what meds are used in step 2 of COPD pharma therapy
LABA or LAMA monotherapy then LAMA + LABA combination
54
what meds are used in step 3 of COPD pharma therapy
triple therapy LAMA + LABA + inhaled corticosteroid
55
what is a way to remember that SABA/SAMA are used in step 1
step 1 is Symptom relief--S=SAMA/SABA
56
what should you prescribe for all symptomatic patients
short acting inhaled bronchodilator (SABA--short acting beta2 agonist) or short acting muscarinic antagonist (SAMA) for acute, short term relief or SOB for those with mild COPD, SAMA/SABA monotherapy is recommended SAMA may be better at preventing exacerbations and may also be better tolerated (limited evidence)
57
what is a LAMA and a LABA
long acting muscarinic antagonist long acting beta 2 agonist
58
in which patients would you move to triple therapy
FEV1 less than 50% predicted and 2 or more exacerbations in the last 12 months
59
is ICS monotherapy recommended in COPD
no
60
what is the most common cause of AECOPD
bacterial or viral infection can also be caused by PE, pneumothorax, heart failure, pleural effusion
61
how should a patient manage a severe AECOPD complicated by acute respiratory failure
MEDICAL EMERGENCY patient should seek medical treatment
62
how should most AECOPD be managed
more than 80% can be managed as outpatient
63
how long should an AECOPD persist before starting oral corticosteroid or antibiotics
no hard rule... some guidelines suggest 48 hours
64
what pharmacotherapy should be used in AECOPD
1. short acting bronchodilator--> salbutamol 2. oral corticosteroids--> prednisone 3. antibiotics
65
what dose of salbutamol in AECOPD
salbutamol 400-800 mcg (4-8 puffs) delivered via metered dose inhaler with a spacer OR salbutamol 2.5 mg by nebulizer administer frequently (every couple of hours) and titrate to response
66
what dose of prednisone in AECOPD
prednisone 40 mg PO for 5 days (but prednisone 50mg is usually used in canada) *oral corticosteroids shorten recovery time, improve lunch function, etc.
67
what would suggest alpha 1 antitrypsin deficiency
early onset emphysema or COPD unexplained liver disease family history
68
how should you plan for AECOPD with your patient
made a COPD flare up plan (theres a print out online)
69
name a SABA
salbutamol (ventolin) | use for acute relief, 1-2 puffs PRN
70
name a SAMA
ipratropium (atrovent) 2 actuations TID to QID
71
brand name for SAMA+SABA
combivent
72
name 2 LABAs
salmeterol | formoterol
73
name one LAMA
tiotropium
74
brand name one ICS + LABA
symbicort
75
name 2 ICS
budesonide (pulmicort) | fluticasone (flovent)
76
what antibiotic is sometimes prescribed as maintenance therapy to reduce risk of AECOPD
azithromycin 250 mg PO daily or 250 mg PO 3x/week
77
what is a NAC
mucolytic that can be adjunctive therapy for COPD
78
what causes 50% of AECOPD
viral chronchitis
79
when should you empirically start antibiotics in AECOPD
if have 2 of: increased SOB increased sputum volume increased sputum purulence --if have only 1 of those, wait for sputum gram stain, C&S
80
what antibiotic to use for simple AECOPD
amoxicillin 500mg PO TID 7-10 days
81
what antibiotic to use for complicated AECOPD
amox-clav 500 mg PO TID x7-10 days or cefuroxime
82
what is a complex AECOPD
4 or more exacerbations per year, failure of first line agents, antibiotics in previous three months, CAD, home O2, chronic steroid use

LMCC Part II (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions