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Pulmonary > COPD/Emphysema (Headley) > Flashcards

COPD/Emphysema (Headley) Flashcards

1
Q

What is a disease state that is characterized by reversible airway obstruction?
Irreversible?

A

asthma

COPD

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2
Q

What changes are happening in the airways and the lung parenchyma in COPD?

A

airways: inflammation, fibrosis, luminal plugs (secretions)
parenchyma: loss of alveolar attachments and decreased elastic recoil

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3
Q

COPD mortality is higher in (men or women)

A

women

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4
Q

What are the causes of COPD?

A

smoking > occupational dust and chemicals, air pollution

poorly controlled asthma can also cause it

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5
Q

FEV1 of ____% of normal is assc with exertional dyspnea

____% of normal is assc with disability

A

40 -60%

<30%

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6
Q

Smokers with a mean ____ pack yeat Hx develop COPD

A

20

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7
Q

At what age do pts with COPD develop URT symptoms (cough and sputum)?

A

40s

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8
Q

At what age does dyspnea develop?

A

50s or 60s

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9
Q

What is required to make the diagnosis of COPD?

A

spirometry with FEV1/FVC ratio < 0.7 and no improvement in post-bronchodilator therapy FEV1 >15% and > 200 ml

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10
Q

What are the symptoms and risk factors for COPD?

A

symptoms: Cough, sputum, dyspnea (exertional then at rest)

RF: smoking, occupation, indoor/outdoor pollution (mostly developing/3rd world countries)

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11
Q

What is the clinical definition of chronic bronchitis?

A

production of sputum for 3 months in 2 consecutive years

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12
Q

What are clinical findings assc with airway obstruction with COPD

A
  • Wheezing (due to obst)

- prolonged forced expiration (due to obst)

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13
Q

What are clinical findings assc with hyperinflation with COPD?

A
  • barrel chest
  • pursed lip breathing
  • low diaphragm position
  • distant heart and breath sounds
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14
Q

What are clinical findings assc with impairment of the mechanics of breathing with COPD?

A
  • use of accessory muscles when breathing
  • retractions (in drawings of lower intercostal interspaces)
  • chest/abdominal wall paradoxical movements
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15
Q

What CV signs can be seen with advanced COPD?

A

cor pulmonale

hyperinflation puts pressure on RA –> Right heart failure
-JVD, hepatomegaly, peripheral edema

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16
Q

How are asthma and COPD spirometry results different?

A

low FEV1/FVC in asthmatics will correct with bronchodilator and it will not in pts with COPD

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17
Q

What makes a pt with COPD “high risk” to have progressive decline in disease? *sorry for the terrible wording

A

2 or more exacerbations within the past year

FEV1 < 50% of predicted value

18
Q

WHat is the defn of an exacerbation of COPD?

A

worsening of respiratory symptoms (dyspnea) that requires a change in medication

19
Q

When should a pt be screened for alpha-1 anti-trypsin deficiency?

A

person in 30 or 40s develop COPD and have a strong family Hx of COPD

20
Q

On what chromosome is the alpha-1 anti-trypsin gene found?

A

14

21
Q

Who are the pink puffers and blue bloaters? Why are they called that?

A

2 sides of the COPD spectrum:

pink puffers = emphysema prominent COPD
-pink = near normal gas values, thin, intense dyspnea

blue bloaters = chronic bronchitis prominent COPD
-blue = hypoxemic and hypercapnic, obese, CHF, edema, mild dyspnea

22
Q

What is the cause of the hypoxemia and hypercapnia in chronic bronchitis?

A

V/Q mismatch

23
Q

Are blue bloaters hypo or hyperventilated? Why?

A

Hypoventilated:

alterations in CNS centers allows for decreased work of breaking (dec RR) but it comes at a cost of inc CO2 levels

24
Q

What are the long term consequences of blue bloaters’ hypoventialtion?

A

chronic hypoxemia –>

  • polycythemia (elevated Hct)
  • Pulmonary HTN
  • cor pulmonale
25
Q

What is the cause of the hypoxemia in emphysema?

A

V/Q imbalance and diffusion abnormalities from alveolar destruction

26
Q

Are pink puffers hypo or hyperventilated? Why?

A

hyperventialted:

they maintain thier PCO2 levels in the normal rage but it comes at the cost of high work of breathing

27
Q

T or F: In emphysema O2 saturation is preserved

A

True (by inc MV)

28
Q

COPD pts are at an increased risk to develop…

A 
MI, angina
osteoporosis
respiratory infections
depression
DM
lung cancer
29
Q

What are the different inflammatory cell mediators in Asthma and COPD?

A

Asthma: CD4 and eosinophils

COPD: CD8, macrophages, neutrophils

30
Q

What does an icreased Reid Index indicate? What does this index measure?

A

chronic broncitis

bronchial gland depth as a fraction of total bronchial wall thickness

31
Q

Describe the cellular changes in the central airways (cartilaginous) of COPD/chronic bronchitis

A 
bronchial gland hypertrophy
goblet cell metaplasia
squamous metaplasia of epithelium (loss of cillia and function)
fibrosis 
infiltration by CD8 and neutrophils
32
Q

What are the differences between centrolobular and panlobular emphysema?

A

centrolobular: dilation and destruction of the respiratpry bronchioles
- upper lobe predominance
- assc with smoking

panlobular: dilation and destruction of the entire acinus
- lower lobe predominance
- assc with alphs 1 anti-trypsin def

33
Q

What are bullae?

A

emphysematous spaces > 1 cm in diameter

34
Q

What is the pathophys of emphysema?

A

loss of alveolar attatchments –> small airway collapse during expiration
V/Q mismatch

35
Q

What are the 3 irreversible changes that limit airflow in COPD?

A
  1. fibrosis and narrowing of airways
  2. loss of elastic recoil
  3. destruction of alveolar attachments
36
Q

What are the 3 reversible changes that limit airflow in COPD?

A
  1. accumulation of inflammatory cells, mucus, and plasma exudate in bronchi
  2. smooth muscle contraction
  3. dynamic hyperinflation at rest and worsening at exercise –> muscles at at mechanical disadvange and have to work harder to breathe
37
Q

How does COPD manifest on CXR

A

flattened diaphragm
hyper-inflated lungs
tear drop heart
increased vascular markingss

38
Q

Describe the PFTs for pure emphysema ?

A
  • increased TLC and RV
  • increased compliance
  • decreased VC
  • decreased elastic recoil
  • dec DLCO
39
Q

What are the etiologies of COPD exacerbations?

A

bacterial infection, virus, unidentified

40
Q

For Tx/management of COPD see sweatmen’s shit

A

im feeling lazy

Pulmonary (31 decks)

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