Diagnosis Flashcards
What is diagnosis based on?
Typical clinical features supported by spirometry
Can you treat the patient with a SABA before investigations begin?
Yes
When would you suspect COPD based on symptoms?
> 35yrs with a risk factor and one of the following:
• SOB
• Chronic cough
• Regular sputum production
• Frequent lower respiratory tract infections
• Wheeze
What are the other symptoms associated with COPD?
- Winter exacerbations
- Weight loss, anorexia and fatigue
- Waking at night with breathlessness
- Ankle oedema
- Reduced exercise tolerance
What would you look for on examination?
Hands:
• Tar-staining of fingers
Face:
• Central cyanosis (if hypoxic or polycythaemia)
Chest: • Tachypnoea • Hyper-inflated chest (barrel-shape) • Use of accessory muscles • Reduced lateral and increased vertical chest expansion • Paradoxical lower chest motion • Reduces breath sounds • Polyphonic expiratory wheeze • Palpable liver edge
What spirometry results would show a restrictive lung disease?
FEV1 <80% predicted
FVC <80% predicted
FEV1/FVC >70% normal
What do normal spirometry results show?
FEV1 >80% predicted
FVC >80% predicted
FEV1/FVC 75-80%
What spirometry results would show a obstructive lung disease?
FEV1 <80% predicted
FVC normal or low
FEV1/FVC <70% normal
What is GOLD stage 1?
FEV1 ≥ 80% of predicted value
What is GOLD stage 2?
FEV1 > 50-79% of predicted value
What is GOLD stage 3?
FEV1 < 30-49% of predicted value
What is GOLD stage 4?
FEV1 ≤30% of predicted value or FEV1 <50% with respiratory failure
What are the signs of cor pulmonale?
- Peripheral oedema
- Raised JVP
- Systolic parasternal heave
- A loud pulmonary second heart sound
- Hepatomegaly
What is cor pulomale?
Hypoxia -> pulmonary artery constriction -> increased pulmonary artery pressure -> RV hypertrophy -> RV failure
What other investigations would you order for COPD?
- CXR
- FBC
