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Pulmonology > COPD > Flashcards

COPD Flashcards

1
Q

What is the main cause/risk factor for COPD?

A

smoking

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2
Q

Which is the only leading cause of death that is increasing in prevalence?

A

COPD

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3
Q

Which diseases is only partially reversible: COPD or asthma?

A

CoPD

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4
Q

What are the 3 mechanisms of COPD that lead to airflow obstruction?

A
  1. loss of tethering
  2. small airway remodeling
  3. increased mucus secretion
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5
Q

Which alpha-1 antitrypsin deficiency is linked with COPD: PiZZ, PiMZ alone, PiSZ?

A

PiZZ - linked

PiMZ - requires smoking as well

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6
Q

What is the normal alpha 1 antitrypsin phenotype?

A

PiMM

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7
Q

Who should get screened for AIATD?

A

ALL patients diagnosed with COPD (1% of them will have it)

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8
Q

In addition to COPD, what 2 conditions are associated with AIATD?

A

cirrhosis and lung cancer

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9
Q

Is COPD a neutrophilic or eosinophilic disease?

A

neutrophilic

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10
Q

Is COPD driven by a TH2 response or a macrophage response?

A

alveolar macrophage

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11
Q

What do neutrophils release to cause damage in COPD?

A

elastase
cathepsins
MMPs

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12
Q

what are the 3 hallmarks of tissue damage in COPD?

A
  1. obstructive bronchiolitis
  2. emphysema
  3. mucus hypersecretion
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13
Q

Are CD8+ cells common to asthma or COPD?

A

COPD

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14
Q

is LTB4 associated with asthma or COPD? which cells release it?

A

COPD, macrophages

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15
Q

Which IL attracts neutrophils in COPD?

A

IL 8

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16
Q

What defines chronic bronchitis?

A

Chronic bronchitis is a set of symptoms defined as the presence of a productive cough for three months in each of two successive years (that does not have another explanation)

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17
Q

What finding is associated with worse outcomes in COPD?

A

CD8+ elevation

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18
Q

What effect does CD8+ inflammation in COPD have on the course of the disease?

A

worsens it by increasing susceptibility to infection

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19
Q

Is basement membrane thickening found in asthma or COPD?

A

asthma

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20
Q

Is smooth muscle hypertrophy found in asthma or COPD?

A

asthma

21
Q

Is mucus gland hyperplasia seen in asthma or COPD?

A

both

22
Q

Inflammatory exudate in the lumen, disrupted alveolar attachments, and thickened walls with inflammatory cells in small airways are indicative of which pathologic change in COPD?

A

peribronchial fibrosis

23
Q

On CXR, what are two findings associated with COPD?

A

barrel chesting, flattened diaphragm, and retrosternal clear space

24
Q

What is the cause of decreased FEV1 in COPD?

A

PEl is reduced by emphysema and resistance is increased by peribronchial fibrosis and mucus plugging

25
Q

Among what group is COPD frequently misdiagnosed?

A

women

26
Q

FEV1 and quality of life correlated well in COPD, true or false

A

false.

27
Q

FEV1 and exercise capacity correlate well in COPD, true or false?

A

false

28
Q

In COPD, is inspiratory capacity increased or lowered on exercise? why?

A

decreased, due to increased end expiratory lung capacity/FRC from dynamic hyperinflation

29
Q

What effect does a lower IC have on ventilation in COPD?

A

increased minute ventilation occurs with a small tidal volume, leading to decreased alveolar ventilation and dyspnea on exertion .

All caused by dynamic hyperinflation

30
Q

In spirometry, what is the minimum requirement for grading COPD on the GOLD standards?

A

FEV1/FVC < 70%

31
Q

What grade is considered significant in the mMRC grading of COPD?

A

grade 2 (slower walking than age or have to stop for breath when walking on level)

32
Q

In the COPD assessment test (CAT), what is the cut off for significant COPD?

A

> 10

33
Q

Why are COPD flare ups (i.e. from infection) a problem?

A

COPD has ups and downs in lung function that are typically defined by episodes, and irreversible.

34
Q

What is the D group in COPD severity?

A

lots of symptoms/flare ups and hospitalizations

35
Q

What is the C group in COPD severity?

A

not a lot of symtpoms, but frequent hospitalizations

36
Q

What is the B group in COPD severity?

A

lots of symptoms and few hospitalizations. common to have a lot of comorbidities

37
Q

What is the least severe group in COPD?

A

A

38
Q

What is the number one treatment for COPD?

A

bronchodilators (LAMA or LABA)

39
Q

If bronchodilators are not sufficient to manage COPD, what do you do?

A

add inhaled corticosteroids (i.e. its the OPPOSITE from asthma)

40
Q

What is an important part of the management cycle of COPD?

A

patients need to increase physical activity to see if the meds are doing anything

41
Q

What is the 1 year mortality following a COPD exacerbation?

A

20%

42
Q

Oxygen, inhaled bronchodilators, systemic CS, antibiotics and ventilatory support are all part of what management in COPD?

A

exacerbation

43
Q

what group of cells is commonly affected in both the COPD and asthma processes?

A

epithelial cells

44
Q

How is COPD diagnosed?

A

FEV1/FVC < .70 and nonreversible

45
Q

What can cause hypoxemia in a COPD exacerbation?

A

V/Q mismatch and diffusion limitation

46
Q

A 53 year-old woman with a 40 pack-year history of smoking presents with dyspnea and wheeze. The most likely finding on her PFTs are:

a) Decreased FEV1, decreased FVC and increased FEV1/FVC
b) Normal values for FEV1 and FVC after albuterol
c) Decreased FEV1 and a normal FVC
d) Increased diffusing capacity

A

c - decreased FEV1 and NORMAL FVC. most likely CoPD.

might also have a decreased DLCO in setting of emphysema

47
Q

Which of the following best characterizes lung inflammation in COPD?

a) neutrophils, macrophages and CD8 lymphocytes
b) eosinophils and TH2 lymphocytes
c) non caseating granulomas
d) fibroblastic foci

A

a - CoPD ***

b- asthma

c - sarcoid

d - IPF

48
Q

Which of the following is true regarding smoking-related COPD?

a) it is not a bronchodilator responsive disease
b) the majority of smokers develop COPD
c) it is invariable progressive after smoking cessation
d) it causes hypoxemia by v/q mismatch (low v/q) and diffusion limitation

A

d - the two mechanisms for hypoxemia in COPD are low V/q and diffusion limitation

a- can be somewhat responsive, depending on the person, but not fully reversible by bronchodilators

b- not all smokers will get COPD

c - smoking cessation tends to prevent COPD

Pulmonology (35 decks)

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