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Clinical Medicine 2 > Exam 2: COPD > Flashcards

Exam 2: COPD Flashcards

1
Q

What are the two former terms for COPD?

A

Emphysema and chronic bronchitis

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2
Q

What is emphysema?

A

A pathological term describing the Destruction of the gas-exchanging surfaces of the lung

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3
Q

What is chronic bronchitis?

A

Presence of cough and sputum production for at least 3 months in each of two consecutive years

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4
Q

A 60 year old patient presents with DOE, chronic cough, and sputum production. What are you concerned about?

A

COPD

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5
Q

What are the risk factors for COPD?

A

Tobacco smoke, genetic factors, and occupational dusts

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6
Q

What are the 3 genetic conditions that increase risk for COPD?

A

Alpha 1 antitrypsin deficiency, asthma, and respiratory infections in childhood

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7
Q

Why does pursed lip breathing occur in COPD?

A
  • Ordinary breathing allows for early bronchial collapse on exhalation
  • Pursed lip breathing achieves resistance to outflow at the lips raising intrabronchial pressure keeping the bronchi open
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8
Q

What is Cor Pulmonale?

A

Altered structure and/or impaired function of the right ventricle that results from pulmonary HTN associated diseased of the lung (COPD), vasculature, upper airway, or chest wall

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9
Q

What is the most common cause of Cor pulmonale?

A

COPD

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10
Q

What is an acute exacerbation of COPD?

A

An acute change in the patients baseline dyspnea, cough, or sputum that is beyond normal variability and sufficient to warrant a change in therapy

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11
Q

What test is required to establish a diagnosis of COPD?

A

Spirometry

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12
Q

What is a normal FVC?

A

80-120%

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13
Q

What is a normal FEV1?

A

80-120%

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14
Q

A post bronchodilator FEV1/FVC ratio of *** confirms an obstructive pattern.

A

<0.7

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15
Q

COPD patients may have increased ** and decreased **.

A

TLC

Diffusing capacity of CO (DLCO)

***DLCO is decreased as emphysema increases

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16
Q

What is gold class 1?

A

Mild COPD with FEV1> 80%

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17
Q

What is gold class II?

A

Moderate COPD with 50% < FEV1<80%

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18
Q

What is gold class III?

A

Severe COPD with 30%< FEV1< 50%

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19
Q

What is gold class IV?

A

Very severe COPD with FEV1< 30%

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20
Q

What happens to FEV1 in obstructive disorders?

A

It is reduced

21
Q

What happens to FVC in obstructive disorders? Restrictive?

A

Obstructive: normal
Restrictive: reduced

22
Q

When should you consider ABGs for COPD?

A

If FEV1 <50%m SPO2 <92%, depressed LOC, or acute exacerbation of COPD

23
Q

What labs should you order for COPD?

A

CBC (usually normal), BNP (evaluate suspected HF), metabolic panel, and Alpha 1 antitrypsin

24
Q

What CXR signs are consistent with COPD?

A

-Signs of air trapping such as increased AP diameter, hyperinflation and hyperlucency, and flattened diaphragms

25
Q

What CXR findings are pathognomonic for emphysema?

A

Blebs or bullae

26
Q

What is the best predictor of having frequent COPD exacerbations (more than 2 per year)?

A

A history of earlier treated events

27
Q

If a patient has had 0-1 exacerbations in the last 12 months, what is their risk of developing frequent exacerbations and risk of death?

A

Low risk

28
Q

If a patient has had 2 or more exacerbations OR 1 hospitalization for COPD in the last 12 months, what is their risk of developing frequent exacerbations and risk of death?

A

High risk

29
Q

How can supplemental oxygen affect patients with COPD and hypoxia?

A

Long term administration (>15 hours per day) is shown to increase survival in patients with severe resting hypoxemia

30
Q

What is the recommended treatment for Grade A COPD?

A

A Short acting bronchodilator (SABA, SAMA, or combo) PRN

31
Q

What is the recommended treatment for grade B COPD?

A

LAMA or LABA

32
Q

What is the recommended treatment for Grade C COPD?

A

LAMA

33
Q

What is the recommended treatment for grade D COPD?

A

LAMA

OR if severe breathlessness LABA-LAMA

34
Q

What should grade B-D also have available for symptom control PRN?

A

A SABA

35
Q

What are the two kinds of bronchodilators used?

A

Inhaled B2 agonists and anticholinergics

36
Q

Albuterol is an example of what kind of drug?

A

SABA, dose 2 puffs q 4-6 hours

37
Q

Salmeterol and formoterol are examples of what kinds of drugs?

A

LABA, dosing q 12 hours

38
Q

What are the effects of Bronchodilators?

A

Bronchodilator, mucociliary clearance, diaphragmatic action, and cardiac contracility

39
Q

What are the side effects of B2 agonists?

A

Palpitations, tachycardia, insomnia, and tremors

40
Q

Ipratropium is an example of what kind of drug?

A

Short actin anticholinergic , dosed 2 puffs BID-QID

41
Q

Tiotropium is an example of what kind of drug?

A

Long acting anticholinergic

42
Q

What are the effects of anticholinergics?

Side effects?

A

Reduces air trapping, less cardiac stimulatory effect than B2 agonists.

Side effects:
Dry mouth, metallic taste, HA, and cough.

43
Q

ICS are often used with alone or in conjunction with what?

A

LABA or LABA-LAMA

44
Q

What kind of drug is advair?

A

LABA-ICS

45
Q

What are the side effects of ICS?

A

Thrush and bruising

46
Q

What is the treatment of patients with COPD and alpha 1 antitrypsin deficiency?

A

Antiprotease therapy, weekly infusions

47
Q

What are the two common triggers for COPD exacerbation?

A

Respiratory illness and pollution

48
Q

What are the two most common viruses that can respiratory illness and COPD exacerbation?

A

Influenza and rhinovirus

49
Q

What is the outpatient management of COPD exacerbation?

A
  • Increase in frequency of SABA
  • PREDNISONE 40mg x5 days
  • Abx x 5-7 days
  • Possible hospitalization

Clinical Medicine 2 (22 decks)

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