COPD Patient Assessment

Question 1

Name the six general aspects of clinical presentation of COPD?

Answer 1

-dyspnea
-wheezing
-chest tightness
-fatigue
-activity limitation
-cough +/- sputum production

Question 2

What type of dyspnea is indicative of COPD?

Answer 2

-progressive over time
-worse with exercise
-persistent

Question 3

Is wheezing heard upon inspiration or expiration?

Answer 3

expiration

Question 4

Is coarse rhonchi heard upon inspiration or expiration?

Answer 4

expiration

Question 5

Is coarse rales (crackles) heard upon inspiration or expiration?

Answer 5

inspiration

Question 6

What are the physical exam findings of chronic COPD?

Answer 6

-lung hyperinflation (barrel chest)
-reduced O2 saturation
-cyanosis

Question 7

Cough and expectoration are more frequent in chronic bronchitis or emphysema?

Answer 7

chronic bronchitis

Question 8

Coarse ronchi is more common in chronic bronchitis or emphysema?

Answer 8

chronic bronchitis

Question 9

Obesity is more common in chronic bronchitis or emphysema?

Answer 9

chronic bronchitis

Question 10

Heart failure is associated with chronic bronchitis or emphysema?

Answer 10

chronic bronchitis

Question 11

Pursed lip breathing and “tripod” sitting position is more common with chronic bronchitis or emphysema?

Answer 11

emphysema

Question 12

What is the FEV1/FVC ratio that is diagnostic for COPD?

Answer 12

FEV1/FVC<0.7 (post-bronchodilator)

Question 13

What does the GOLD grade assess?

Answer 13

degree of airflow limitation

Question 14

What FEV1 value is GOLD 1?

Answer 14

> or = 80% predicted, mild limitation

Question 15

What FEV1 value is GOLD 2?

Answer 15

50-80% predicted, moderate limitation

Question 16

What FEV1 value is GOLD 3?

Answer 16

30-50% predicted, severe limitation

Question 17

What FEV1 value is GOLD 4?

Answer 17

<30% predicted, very severe

Question 18

What does mMRC assess?

Answer 18

symptoms (just dyspnea)

Question 19

What does mMRC stand for?

Answer 19

modified British Medical Research Council Questionnaire

Question 20

What does the COPD Assessment Test (CAT) assess?

Answer 20

symptoms beyond just dyspnea

Question 21

What mMRC and CAT score constitutes group A diagnosis of COPD?

Answer 21

mMRC 0-1
CAT <10

Question 22

What mMRC and CAT score constitutes group B diagnosis of COPD?

Answer 22

mMRC > or = 2
CAT > or = 10

Question 23

What constitutes a diagnosis of COPD to be group E?

Answer 23

2 or more moderate exacerbations OR
1 or more exacerbation leading to hospitalization

Question 24

What defines a COPD exacerbation?

Answer 24

-increased dyspnea and/or cough and sputum
-worsen in <14 days
-inflammation
-tachypnea and/or tachycardia

Question 25

What are the most frequent confounders of COPD?

Answer 25

-pneumonia -heart failure -pulmonary embolism

Question 26

What are the less frequent confounders of COPD?

Answer 26

-pneumothorax; pleural effusion -MI/cardiac arrhythmias

Question 27

What is the criteria for moderate COPD exacerbation?

Answer 27

-Dyspnea VAS ≥ 5 -RR ≥ 24 -HR ≥ 95 -resting O2 <92% and/or change >3% -CRP ≥ 10 mg/L -PaO2 ≤ 60 and/or PaCO2 > 45 but no acidosis on ABG

Question 28

What is the criteria for severe COPD exacerbation?

Answer 28

-same as moderate but with ABG showing new onset/worsening hypercapnia with acidosis