COPD

Question 1

defined as a disease state characterized by persistent respiratory symptoms and airflow limitation that is not fully reversible

Answer 1

COPD

Question 2

anatomically defined condition characterized by destruction of the lung alveoli with air space enlargemen

Answer 2

Emphysema

Question 3

clinically defined condition with chronic cough and phlegm

Answer 3

Chronic bronchitis

Question 4

condition in which small bronchioles are narrowed and reduced in number

Answer 4

Small airway disease

Question 5

Major physiologic change in COPD

Answer 5

Airflow limitation

Question 6

highly stable component of the extracellular matrix that is critical to the integrity of the lung.

Answer 6

Elastin

Question 7

postulated that the balance of elastin-degrading enzymes and their inhibitors determines the susceptibility of the lung to destruction resulting in air space enlargement

Answer 7

elastase:antielastase hypothesis

Question 8

Key component of COPD pathobiology

Answer 8

Oxidative stress

NRF2, SOD3

Question 9

Primary mechanisms in the development of emphysema

Answer 9

Elastin degradation and disordered repair

Question 10

Mechanism of cigarette smoke oxidant-mediated structural cell death

Answer 10

Excessive ceramide production and Rtp801 inhibition of mammalian target of rapamycin (mTOR)

Question 11

Changes in large airways cause

Answer 11

Cough and sputum production

Question 12

Changes in small airways and alveoli

Answer 12

Physiologic alterations

Question 13

GOLD Stage characterized by extensive emphysema

Answer 13

GOLD 3 and 4

Question 14

Results in mucus gland enlargement and goblet cell hyperplasia, leading to cough and mucus production that define chronic bronchitis, but these abnormalities are not related to airflow limitation

Answer 14

Cigarette smoking

Question 15

Most potent secretagogue

Answer 15

Neutrophil elastase

Question 16

Major site of increased resistance in COPD

Answer 16

Airways <2mm

Question 17

COPD cellular changes in small airways

Answer 17

Mucus-secreting cells replacing surfactant-secreting Club cells

Question 18

Destruction of gas-exchanging air spaces

Answer 18

Emphysema

Question 19

Blood cell that accumulate in respiratory bronchioles of smokers

Answer 19

Macrophages

Question 20

Emphysema pattern associated with smoking

Answer 20

Centrilobular, prominent in the upper lobes and superior segments of lower lobes

Question 21

Emphysema pattern in a1-AT deficiency

Answer 21

Panlobular, lower lobes

Question 22

Emphysema pattern distributed pleural margins with relative sparing of the lung core or central regions

Answer 22

Paraseptal

Question 23

Most typical finding in COPD

Answer 23

Persistent reduction in forced expiratory flow rates

Question 24

Arterial pO2 remains normal until FEV1 is

Answer 24

FEV1 ~50 of predicted

Question 25

Elevation of PACO2 is not ecepected until FEV1 is

Answer 25

FEV1 <25% predicted

Question 26

Pulmonary hypertension causing cor pulmonale and RV failure when FEV1 and PaO2 are?

Answer 26

FEV1 <25% predicted | Chronic hypoxemia paO2 <55mmHg

Question 27

Most highly significant predictor of FEV1

Answer 27

Pack-years of cigarette smoking

Question 28

Most common form of severe a1AT deficiency

Answer 28

PiZ, either two Z alleles or one Z and one null allele

Question 29

``` Allele associated with normal a1AT levels A. M allele B. S allele C. Z allele D. Null allele ```

Answer 29

A. M allele S: slightly reduced Z: markedly reduced Null: absence

Question 30

Three most common symptoms in COPD

Answer 30

Cough Sputum production Exertion also dyspnea

Question 31

Hoover’s sign

Answer 31

Paradoxical onward movement of the rib cage with inspiration

Question 32

Hallmark of COPD

Answer 32

Airflow obstruction

Question 33

Change in PH in: 1. Acute respiratory acidosis 2. Chronic

Answer 33

1. Acute: 0.08 units/10mmHg | 2. Chronic: 0.03 units/10mmHg

Question 34

Ventilator failure

Answer 34

PCO2 >45mmHg

Question 35

Three interventions demonstrated improve survival in COPD

Answer 35

Smoking cessation Oxygen therapy Lung volume reduction surgery

Question 36

Primary treatment for all COPD patients

Answer 36

Bronchodilators

Question 37

Preferred route of medication delivery

Answer 37

Inhaled

Question 38

Main role of ICS in COPD

Answer 38

Reduce exacerbations

Question 39

Define frequent exacerbations

Answer 39

Two or more per year

Question 40

Only pharmacological therapy demonstrated to unequivocally decrease mortality rates

Answer 40

Supplemental O2

Question 41

Eligibility for a1AT augmentation therapy

Answer 41

Serum a1AT <11uM (~50mg/dL)

Question 42

``` Recommended vaccines in COPD, except A. Influenza B. Hib C. Pneumococcal D. Bordetella pertussis ```

Answer 42

B. Hib

Question 43

Strongest single predictor of exacerbation

Answer 43

Previous exacerbation

Question 44

``` Bacteria frequently implicated in COPD, except A. S. pneumoniae B. H. influenzae C. Moraxella catarrhalis D. M. Pneumoniae ```

Answer 44

D.