H314:1700-1707-COPD

Question 1

Describe the pathogenesis of COPD

Answer 1

Neutrophil and macrophage recruitment –> secretion of proteinase inhibitors –> ECM degradation = lung destruction

Question 2

2 areas of pathology in COPD

Answer 2

Large airway (goblet cell hyperplasia - cough/mucous)
Small Airway (major site of resistance

Question 3

Define COPD

Answer 3

Airway flow that is not fully reversible that includes emphysema (anatomical-destruction), chronic bronchitis (cox-cough and phlegm), and small airway disease.

Question 4

Hypoxemia in COPD that is difficult to correct should cause one to ….

Answer 4

Search for another cause as the shunting in COPD is usually responsive to O2

Question 5

4 risk factors for COPD

Answer 5

Cigarettes,Air pollution,occupational exposures and a1AT deficiency

Question 6

3 most common symptoms in COPD

Answer 6

Cough
Sputum Production
Exertional dyspnea

Question 7

What is the Hoover’s sign

Answer 7

Paradoxical motion of rib cage due to hyperinflation changing the AP diameter of the rib cage

Question 8

Is clubbing of the digits a sign of COPD ?

Answer 8

Nope

Question 9

GOLD criteria:

Answer 9

All stages FEV1/FVC =

Question 10

Only three treatments for COPD that have been demonstrated to influence the natural history of the disease:

Answer 10

Oxygen, smoking cessation and lung volume reduction surgery (in select patients(

Question 11

All other treatments are directed towards doing what ?

Answer 11

Decreasing frequency and severity of exacerbation a

Question 12

What therapy has been shown to increase risk of death from respiratory causes ?

Answer 12

LABAs w/o concomitant corticosteroids

Question 13

Two types of LAB2As + corticosteroid (Long acting Beta 2 Agonists)

Answer 13

Salmeterol/fluticasone (Advair)
Formoterol/mometasone (Dulera)
Formoterol+Budesonide (Symbicort)
Salmeterol (Severent)

Question 14

Anti-Ach + SABAs

Answer 14

Albuterol+ipratropium ( Combivent/DuoNeb)
Albuterol (ProAir/Ventolin)
Levalbuterol (Xopanex)

Question 15

Resting Hypoxemia definition

Question 16

2 other tx for COPD (mucolytic and enzyme replacement)

Answer 16

N-AC (Mucinex) 
IV aAT1 (requires level

Question 17

3 vaccines and 3 other non-medication therapies

Answer 17

Pneumococcal,Flu,possibly pertussis
Pulm Rehab,
LVRS not recommended for deconditioned, PA >45mmHg, CHF, DLco

Question 18

Three qualifiers of COPD exacerbation

Answer 18

Increase in sputum
Change in color of sputum
Increased dyspnea

Question 19

Define hypercarbia

Answer 19

.pCO2 of >45 mmHg

Question 20

___ weeks of glucocorticoid tx was no different than ___ weeks of tx.

Answer 20

2; 8

Question 21

GOLD guidelines for gstd tx

Answer 21

30-40 mg x 10-14d

Question 22

Contraindications for NIPPV for hypercarbic/respiratory failure patients

Answer 22

CV instability, MS prevents, inability/copious secretions, inability to fit mask.

Question 23

New Anti-ach (M3) medications

Answer 23

Tudorza (aclidinium)