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Pulmonology Board Review > COPD > Flashcards

COPD Flashcards

1
Q

BAL in COPD shows increased number of what cell types?

A

Neutrophils and macrophages

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2
Q

Cells recruited and activated in COPD by IL-8 and Leukotriene B4

A

Neutrophils

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3
Q

Cells in COPD that correlate with severity of COPD

A

Neutrophils

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4
Q

3 Proteinases secreted by neutrophils in COPD

A
  • Neutrophil Elastase
  • Cathepsin
  • Proteinase 3
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5
Q

Cells in COPD activated by cigarette smoke

A

Macrophages

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6
Q

CD4/CD8 shift in COPD

A

Shift toward CD8

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7
Q

Substance generated from chemical reaction with cigarette smoke and macrophages or neutrophils

A

Reactive oxygen species (ROS)

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8
Q

Substance that supresses inflammatory genes that is impaired in COPD

A

Histone deacetylase 2 (HDAC2)

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9
Q

Components of BODE index

A

BMI, Degree of obstruction, Dyspnea, Exercise capacity

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10
Q

4 Hereditary diseases that cause bullous emphysema

A

Fabry’s disease (glycosphingolipid accumulation)
Cutis Laxa (lack of elastin fibers in the ECM)
Ehlers-Danlos (defect in collagen)
Marfan’s (Fibrillin-1 formation of ECM)

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11
Q

Increased cancer risk in COPD with smoking and Bullous disease.

A 
Smoking = 5x more risk
Bullous = 32x more risk
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12
Q

Effect of cannabis on COPD

A 
Acute = bronchodilator, increase FEV1 by 150-250 ml
Chronic = goblet cell hyperplasia and loss of ciliated bronchial epithelium
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13
Q

Effect of neutrophil elastase in COPD

A

degrades elastin in elastic tissue like alveoli, higher amounts in emphysema

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14
Q

Inhibitor that prevents elastase from destroying lung matrix

A

Alpha-1 antitrypsin

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15
Q

Treatment which decreases gene expression of pro-inflammatory cytokines in those deficient

A

Alpha-1 antitrypsin

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16
Q

4 Inflammatory cytokines in pulmonary disease

A

IL-1b
IL-6
TNF-a
B cell activating factor (BAFF)

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17
Q

Threshold of alpha-1 antitrypsin deficiency in which emphysema is common

A

< 11

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18
Q

5 most common types of alpha-1 antitrypsin deficiency in order from least to most severe

A 
MM (Normal)
SS
MZ
SZ
ZZ
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19
Q

Most common respiratory diagnosis in patients with alpha-1 antitrypsin deficiency prior to the diagnosis of hereditary emphysema

A

Asthma

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20
Q

7 key features of alpha-1 antitrypsin deficiency

A
  • Early onset emphysema (< 45)
  • Lower lobe disease
  • Unexplained liver disease
  • Necrotizing panniculitis
  • C ANCA positive vasculitis
  • Family history of COPD, bronchiectasis, panniculitis
  • Unremitting asthma with airflow obstruction
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21
Q

Substance that accounts for 50% of COPD in developing countries and is present in 90% of rural households

A

Biomass fuel (wood, charcoal, vegetable matter, animal dung)

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22
Q

Occupational fumes that are known to cause emphysema

A

Cadmium

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23
Q

Which is the worse occupational exposure, dust or fumes?

A

Dust

24
Q

Most common virus that causes COPD exacerbation

A

Rhinovirus (over 100 subtypes!)

25
Q

How does viral infection effect COPD exacerbation

A

Causes longer time to recovery

26
Q

Effects of pulmonary rehab in COPD

A
  • Improves exercise capacity and health status
  • Reduces readmission in the year following initiation
  • Significant reduction in mortality
27
Q

Minimum time for pulm rehab to be effective

A

6 weeks

28
Q

Requirement for roflumilast use

A
  • On max inhaler therapy
  • FEV1 < 50%
  • Chronic bronchitis subtype
29
Q

Requirement for macrolide use in copd

A

Former smoker (doesn’t work in active smoking)

30
Q

Initial inhaler regimen in GOLD B

A

LABA or LAMA, combo if fails

31
Q

Initial inhaler regimen in GOLD C

A

LAMA, combo LAMA/LABA if fails

32
Q

Treatment in overlap syndrome that reduces mortality and exacerbations in COPD

A

CPAP therapy

33
Q

PA diameter and ratio of PA diameter to ascending aorta measured on CT that are markers of pulmonary vascular remodeling and thus suggest PAH

A

PA diameter > 28 mm

Ratio > 1

34
Q

Ratio found on CT that is an independent marker of severe COPD exacerbations and mortality

A

Pulmonary artery to ascending aorta ratio > 1

35
Q

4 scoring categories of FEV1 in BODE index

A

0 points = > 65%
1 point = 50-65%
2 points = 35-50%
3 points = < 35%

36
Q

4 scoring categories of 6MWT in BODE index

A

0 points = > 350 m
1 point = 250-350 m
2 points = 150-250 m
3 points = < 150 m

37
Q

4 scoring categories of mMRC in BODE index

A

0 points = 0-1
1 point = 2
2 point = 3
3 point = 4

38
Q

4 year survival BODE index 0-2

A

80%

39
Q

4 year survival BODE index 3-4

A

67%

40
Q

4 year survival BODE index 5-6

A

57%

41
Q

4 year survival BODE index 7-10

A

18%

42
Q

total number of segments for calculating post op FEV1

A

18
Right - 3 upper, 2 middle, 5 lower
Left - 4 upper (lingula included), and 4 lower (no medial-basal on left)

43
Q

Formula for predicting post op DLCO or FEV1

A

preoperative value (FEV1 or DLCO) x 1 - (segments to be removed/18)

44
Q

number of feet in 400 m for shuttle walk

A

1,333 ft

45
Q

number of feet in 22 m for stair climb

A

73 ft

46
Q

number of feet in 1 flight of stairs

A

13 ft or 4 m

47
Q

Threshold for postoperative FEV1 or DLCO to suggest low risk for lung resection

A

> 60%

48
Q

Threshold for postoperative FEV1 or LDCO below which you need a CPET

A

< 30%

49
Q

Test done for lung resection risk if predicted post operative FEV1 or FVC falls between 30 and 60%

A

shuttle walk test or stair climb

50
Q

VO2 max value indicating low risk for lung resection

A

> 20 ml/kg/min or > 75%

51
Q

VO2 max value indicating moderate risk for lung resection

A

10 - 20 ml/kg/min or 35 - 75%

52
Q

VO2 max value indicating high risk for lung resection

A

< 10 ml/kg/min or < 35%

53
Q

PaO2 level on high altitude test that requires in flight oxygen

A

< 50

54
Q

2 patient’s who need high altitude test for in flight oxygen

A

Sats > 95% but desate to < 84% when walking

Sats 92-95% but severe exertion dyspnea

55
Q

Sat level below which oxygen is required in flight

A

92% at rest

Pulmonology Board Review (32 decks)

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