COPD and Bronchiectasis

Question 1

preventable and treatable disease, is characterized by persistent respiratory symptoms and airflow limittaion that is due to airway and/or alveolar abnormalities caused by significant exposure to noxiuos particles or gases

Answer 1

COPD

Question 2

Most common respiratory symptoms of COPD

Answer 2

Dyspnea
cough
sputum production

Question 3

Most important risk factor in COPD

Answer 3

Cigarette smoke

Question 4

key cell playes in COPD

Answer 4

Neutrophils, macrophages and CD8

Question 5

Pathogenesis of COPD

Answer 5

Plasma leakage, sensory nerve impairment, smooth muscle constriction

Question 6

____is already present in the early stages of COPD

Answer 6

Inflammation

Question 7

Gold stage 0

Answer 7

asymptomatic but smoking individual

Question 8

Airway inflammation is characterized by

Answer 8

Increased numbers of neutrophils, macrophages and CD8 lymphocytes

Question 9

Effect of COPD in bronchus

Answer 9

Wall thickening and inflmmation -> mucus gland hypertrophy -> increased secretions -> phlegm

Question 10

Effect of COPD in bronchiole

Answer 10

Wall thickening->inflam_>repair->remodeling->loss of alveolar attachment

Question 11

Effect of COPD in alveoli

Answer 11

Wall thinning ->inflammation ->elastolysis coalescence ->decreased elasticity

Question 12

In asthma the basement membrane

Answer 12

Thicken because smooth muscles are hyper reacting

Question 13

Mediators in asthma

Answer 13

IL-4 IL5

LTD4, histamine, ROS

Question 14

Mediators in COPD

Answer 14

IL-8 and TNF alpha

LTB4, ROS

Question 15

Effects in asthma are in the___

Answer 15

All airways

Question 16

Effects in COPD are in the _____

Answer 16

Peripheral airways

Question 17

Mechanisms underlying airflow imitation in COPD

Answer 17

Small airway disease

PArenchymal destruction

Question 18

Cause of airflow limitation

Answer 18

Irreversible, Fibrosis and narrowing of airways

Loss of elastic recoil due to alveolar destruction

Question 19

Primary site of airflow limitation:

Answer 19

Peripheral airways (bronchi and nronchioles <2mm)

Question 20

PFT results in COPD

Answer 20

FRC increases
RV increases to detriment of inspiratory capacity decreases
TLC and TV stays the same

Question 21

Pathophysiological Changes in COPD

Answer 21

Mucus hypersecretion
Ciliary dysfunction
Airflow limitation
Pulmonary hyperinflation
Gas exchange abnormalities
Pulmonary hypertension
cor pulmonale - leads to death

Question 22

total volume of air expired after a full inspiration

Answer 22

Fore vital capcity

Question 23

volume of air expired in the first second during maximal respiratory effort

Answer 23

FEV1

Question 24

Goal of COPD Assessment

Answer 24

To determine level of airflow limitation, its impact to patient’s health status and the risk of future events to eventually guide therapy

Question 25

Classification of severity of airflow limitation in COPD:

Answer 25

GOLD 1: mild FEV1/FV <0.70 GOLD 2: Moderate; 50%

Question 26

Tools for assessment in COPD

Answer 26

mMRC breathlessness scale COPD assessment Test (CAT) Clinical COPD questionnaire

Question 27

Modified MRC Questionnaire

Answer 27

Assesses patient's level of breathlessness or dyspnea at various activities

Question 28

COPD Assessment Test

Answer 28

8 item questionnaire Scoring system : 0 to 40 If score is at least 10-more = symptomatic

Question 29

Assess Risk of exacerbation

Answer 29

Ask history: >2 in the past year FEV1 postBD <50% predicted >1 hospitalization for COPD in the past year

Question 30

Performed when COPD develops in patient of caucasian descent >45 years or with a strong family history COPD

Answer 30

Alpha-1 Antitrypsin Deficient Screening

Question 31

Characterized by persistent airflow limitation with several features usually associated with asthma and COPD

Answer 31

Asthma-COPD Overlap syndrome

Question 32

How to manage ACOS

Answer 32

treat asthma first, then COPD

Question 33

Goals of therapy in COPD

Answer 33

Reduce symptoms Reduce risk Avoidance of risk factors through:

Question 34

Greatest capacity to influence the natural history of COPD

Answer 34

Smoking cessation

Question 35

Brief strategies to help the patient willing to quit smoking

Answer 35

``` ASK ADVICE ASSESS ASSIST ARRANGE ```

Question 36

Stimulate beta-2 receptors, thus relax airway smooth muscle

Answer 36

Beta-2 agonist

Question 37

Block the effect if Ach on M3 receptors and relax smooth muscle

Answer 37

Anti-cholinergics

Question 38

Exact MOA controversial; Antagonize bronchoconstriction through PDE4 inhibition in smooth muscle;

Answer 38

Methylxanthines

Question 39

Eacerbations are reduced by ______in patients with severe and very severe COPD (GOLD 3 and 4) and a history of exacerbations

Answer 39

ROFLUMILAST (PDE4) inhibitors

Question 40

Management of Group A

Answer 40

Give bronchodilator->Evaluate effect _> change if ineffective

Question 41

management of group B

Answer 41

Mandatory put in LAMA or LABA depending on patient and behavior on side effect

Question 42

management of Group C

Answer 42

LAMA, if with exacerbations, shift to LAMA +LABA Alternatively LAMA +ICS

Question 43

management of Groupd D

Answer 43

Dual therapy (LAMA+LABA) If with exacerbations, sequentially add: ICS, PDE4, Macrolide, Descalation of symptoms

Question 44

Pneumococcal polysaccharide vaccine is recommended for those who are

Answer 44

65 years old and older | Younger than 65 with FEV1 <40% predicted

Question 45

Removal of hyperinflated section

Answer 45

Lung volume Reduction Surgery

Question 46

an acute event characterized by worsening of the patient's respiratory symptoms that is beyond normal day to day variation and leads to a change in medication

Answer 46

Exacerbations

Question 47

Most common cause of COPD exacerbation

Answer 47

Viral infection

Question 48

Antonisen Criteria

Answer 48

At least two of the following cardinal symptoms: Shortness of breath Sputum purulence Increase sputum volume ``` or any one of the above plus URTI Wheeze Cough Increased PR/RR ```

Question 49

Mild Exacerbations

Answer 49

Requiring more reliever medication

Question 50

Moderate Exacerbations

Answer 50

Systained worsening symptoms (2-3 days) Need for antibiotic and or systemic CS Unscheduled hospital visits

Question 51

Severe Exacerbations

Answer 51

Require hospitallization

Question 52

Oxygen saturation

Answer 52

88-92%

Question 53

Antibiotics should be given to patients with

Answer 53

Increased dyspnea, sputum volume, and sputum purulence

Question 54

Abnormal and permanent dilatation of the medium-sized bronchi , destruction of elastic and muscular components of their walls, primarily mediated by neutrophils

Answer 54

Bronchiectasis

Question 55

Primary criteria for bronchiectasis

Answer 55

Impairment of mucociliary drainage in one or both of the lungs. - Acute or chronic infection - Anatomic airway obstruction - Congenital disease that predisposes to chronic infection

Question 56

enzyme deficiency that produce non-functional cilia

Answer 56

Alpha-1 anti trypsin deficiency

Question 57

SIte of pathology in bronchiectasis

Answer 57

Medium sized bronchi - replaced by fibrous tissue

Question 58

Causes of bronchiectasis

Answer 58

``` Post infective Mechanical obstruction Deficient immune response Inflammatory pneumonitis Congenital Excessive immune response Abnormal mucus clearance Fibrosis ```

Question 59

reed classification

Answer 59

Radiologic classification

Question 60

Reed classification (Radiologic)

Answer 60

Cylindrical Bronchiectasis -Sections of bronchi are consistently widened Varicose Bronhiectasis - There are local constrictions and there is an irregular pattern that closely mimics that of the varicose veins Saccular (Cystic) Bronchiectais - dilation increases towards the peripheral areas of the lung; honeycombing

Question 61

Predominant organism in sputum of bronhiectasis patient

Answer 61

gram negative

Question 62

Cystic fibrosis

Answer 62

Mucoviscoidosis AR disorder CFTR protein

Question 63

Cystic fibrosis Diagnosis

Answer 63

Gibson-Cooke Sweat Test -Gold standard -Forearm sweat stimulated with pilocarpine (+) >60mml/L Cl

Question 64

Clinical features of Cystic fibrosis

Answer 64

Coughing, dyspnea, and expiration of foul, voluminous secretions especially prevalent in the morning

Question 65

Signet ring sign on Chest CT

Answer 65

bronchiectasis

Question 66

Only curative treatment of bronhiectasis

Answer 66

Surgical Treatment