COPD TCD

Question 1

How to differentiate between COPD and Asthma

Answer 1

Asthma is reversible

by 15% at least, COPD is not

Question 2

What is an example of a genetic susceptibility to COPD?

Answer 2

alpha1-anti-typsin deficiency

Question 3

Histological changes in the lungs in COPD

Answer 3

Goblet cell hyperplasia, airway narrowing, avolar destruction

Question 4

Symptoms of COPD

Answer 4

Exertional breathlessness
Chronic cough
Regular sputum production
winter exasibation

Question 5

COPD physical signs

Answer 5

Tar staining 
Central cyanosis 
tachypnoea
Chest hyper expansion 
Reduced lateral expansion and increased vertical expansion 
paradoxical lower chest movement 
reduced breath sounds 
wheeze 
palpable liver edge

Question 6

Airway obstruction diagnostic of COPD?

Answer 6

FEV1/FVC less than 0.7

Question 7

Obstructive vs restrictive lung disease

Answer 7

obstruction: FEV1 falls, FVC is the same or reduced slightly. RV increases

In restrictive, FEV1 and FVC fall the same amounts

Question 8

What are the gold stages of COPD?

Answer 8

Gold stage one FEV1 greater than 80
Gold stage two FEV1 50 to 79
Gold stage three 30 to 49
Gold stage four less than 30 predicted

Question 9

CT scan of COPD

Answer 9

‘holes’ or bullae from aveolar destruction.

Question 10

Type 1 respiratory failure

Answer 10

Just decreased PaO2, everything else normal

Question 11

Type 2 respiratory failure

Answer 11

Decreased pH
Decreased PaO2
Increased PaCO2
Increased HCO3

Question 12

What sided heart failure do you get in COPD?

Answer 12

Right ventricular failure

Question 13

Cor pulmonale flow chart

Answer 13

Hypoxia 
Pulmonary arterial vasoconstriction 
Increased pulmonary artery pressure 
Right ventricular hypertrophy 
Right ventricular failure

Question 14

Examples of LABA

Answer 14

salmeterol and eformoterol

Question 15

Example of anti muscarinic

Answer 15

Ipatropium

Question 16

What vaccinations are available for COPD

Answer 16

Influenza and pneumococcal

Question 17

Treatment algorithm for COPd

Answer 17

SABA
if still bad add LABA or anti-muscarinic
Then add inhaled corticosteroid
Then add anti muscarinic or LABA

Question 18

What is the commonest cause of exacerbations of COPD?

Answer 18

H inflenzae if virus, only about half are bacterial

Question 19

treatment of COPD exacerbation

Answer 19

sats no more than 92%
High dose SABA nebs
High dose corticosteroids, usually 40mg day prednisolone for seven days
only antibiotics if purulent sputum

Question 20

If patient has resp acidosis after initial treatment for exacerbation

Answer 20

Intravenous bronchodilator (salbutamol or theophylline)
consider urgent care
Non invasive ventilation

Question 21

What are the clinical features of hypercapnia?

Answer 21

Dilated pupils 
 Bounding pules 
Hand flap 
Myoclonus 
Confusion 
Drowsiness 
Coma

Question 22

what is p pulmonale?

Answer 22

Right atrial enlargement shown in ECG by a peaked p wave in lead II of greater than 2.5mm. Can be caused by cor pulmonale which can lead to right sided heart failure