EXAM #1: COPD

Question 1

What defining feature of COPD differentiates it from asthma?

Answer 1

Airflow obstruction is NOT fully reversible (vs. asthma)

Also, AIR-TRAPPING

Question 2

What is the primary risk factor for COPD?

Answer 2

Smoking

Question 3

What is the definition of chronic bronchitis?

Answer 3

Chronic productive cough for at least 3 months for 2 consecutive years

Question 4

What is the definition of emphysema?

Answer 4

Destruction of alveolar sacs/ lung parenchyma

Question 5

What are the clinical features of chronic bronchitis?

Answer 5

1) Productive cough
2) Cyanosis i.e. “blue boaters”

*Increased risk of infection and cor pulmonale

Question 6

What are the clinical features of emphysema?

Answer 6

1) Dyspnea with cough (minimally productive)
2) Prolonged expiration with pursed lips
3) Weight loss
4) Increased AP diameter

Question 7

In a patient with history and exam that are suspicious for COPD, what is the next step in the diagnostic work-up?

Answer 7

Spriometry

Question 8

What happens to FVC, FEV1, and TLC in COPD?

Answer 8

FVC= decreased 
FEV1= markedly decreased 
TLC= increased

Question 9

What is the FEV1/FVC ratio in COPD?

Answer 9

Decreased (less than 0.7)

Question 10

What are the tools that are used to assess the severity of COPD?

Answer 10

1) COPD Assessment Test (CAT)
2) Clinical COPD Questionnaire (CCQ)
3) mMRC Breathless Scale

Question 11

What post-bronchodilator FEV1 % indicates severe COPD?

Answer 11

Less than 50%

Question 12

Draw the flow-volume loop that you would expect to see in COPD.

Answer 12

N/A

Question 13

What are three indications of high risk in COPD?

Answer 13

1) 2+ exacerbations in last year
2) FEV1 less than 50%
3) 1+ hospitalizations

Question 14

How do you risk stratify COPD?

Answer 14

1) Assess symptoms
2) Assess risk of exacerbations

*Categorize based off of these findings into A, B, C, and D

Question 15

What is the single most important intervention in COPD?

Answer 15

Smoking cessation

Question 16

What is the first line treatment for COPD?

Answer 16

Bronchodilators

Question 17

When are inhaled corticosteroids recommended in COPD?

Answer 17

1) Severe COPD (III or IV/ C or D)
2) Patient with recurrent exacerbations
3) Patient has a reversible element to COPD (asthmatic component)

Question 18

What class of drug is Roflumilast?

Answer 18

PDE-4 inhibitor

Question 19

What is the first line therapy for a COPD Class A?

Answer 19

SAMA PRN or SABA PRN

Question 20

What is the first line therapy for a COPD Class B?

Answer 20

LAMA or LABA

Question 21

What is the first line therapy for a COPD Class C?

Answer 21

ICS + LABA or LAMA

Question 22

What is the first line therapy for a COPD Class D?

Answer 22

ICS + LABA and/or LAMA

Question 23

Are routine systemic steroids recommended in the management of COPD?

Answer 23

NO–associated with increased morbidity and mortality

Question 24

When is home oxygen therapy recommended in the setting of COPD?

Answer 24

1) PaO2 less than 55 mmHg on room air

2) SpO2 less than or equal to 88% with exertion

Question 25

What are the clinical signs of a severe COPD exacerbation?

Answer 25

1) AMS 2) Single word sentances 3) Silent chest 4) Hemodynamic instability 5) Laborded/ paradoxial breathing

Question 26

What are the standard tests to order in the setting of an acute COPD exacerbation?

Answer 26

1) ABG 2) CXR 3) Pulse oximetry 4) EKG 5) CBC, Chem 7 (BMP)

Question 27

How is a mild COPD exacerbation managed?

Answer 27

1) Systemic steroids 2) Increased SABA 3) Add abx if purulent sputum

Question 28

What patients require inpatient management of COPD?

Answer 28

1) Failure of outpatient mgmt 2) Dyspnea at rest 3) Tachypnea 4) Accessory muscle use at rest 5) Tachycardia 6) Hypoxemia

Question 29

What is the average number of intercostal spaces that should be visible on CXR? What indicates hyperinflation?

Answer 29

``` Normal= 8-9 Hyperinflation= 10+ ```

Question 30

Why don't you want to over-oxygenate a patient with COPD?

Answer 30

Exacerbation of V/Q mismatch *Relieve hypoxic vasoconstriction and shift blood to poorly ventilated region of the lung*