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Clinical Medicine II > Pulm: COPD > Flashcards

Pulm: COPD Flashcards

1
Q

This condition is characterized by persistent respiratory sxs and airflow limitation

A

COPD

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2
Q

Small airway disease in COPD is characterized by what two pathyphysiologic responses?

A

airway inflammation and remodeling

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3
Q

Parenchymal destruction in COPD is characterized by what two pathophysiologic responses?

A

loss of alveolar attachments

decreased elastic recoil

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4
Q

Chronic bronchitis is characterized by presence of productive cough for…

A

at least 3 months in two consecutive years

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5
Q

This is the destruction of gas-exchanging surfaces of the lung (alveoli)…

A

emphysema

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6
Q

The following systemic effects are indicative of what pulm. disorder?

hypoxemia, hypercapnea
respiratory acidosis
cyanosis
cor pulmonale
weight gain/loss
A

COPD

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7
Q

A patient presents with the following:

5th or 6th decade of life

DOE

Chronic cough

Sputum production

Recurrent lower respiratory infx

What is this concerning for?

A

COPD

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8
Q

What is a major risk factor for COPD?

A

tobacco smoke

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9
Q

What are the three “host factors” that contribute risk for COPD?

A

Alpha-1 antitrypsin deficiency

asthma

hx childhood respiratory infx

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10
Q

Smoking stimulates elastase enzymes in the lungs. What two actions do elastases undergo?

A

degenerate elastin

release oxygen radicals from WBCs

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11
Q

This disorder that accounts for < 1% of COPD has the following characteristics:

  • causes premature emphysema
  • causes overstimulation of proteases due to deficiency
  • lung destruction accelerated with this disease and smoking
A

alpha-1 antitrypsin deficiency

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12
Q

What are the three hallmark sxs of COPD?

A

Dyspnea
Chronic Cough
Sputum production

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13
Q

What can be found on physical exam of a patient with COPD? (4)

A

use of accessory mm, tripoding

pursed lip breathing

cor pulmonale

digital clubbing

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14
Q

Why does pursed lip breathing help in COPD?

A

prevents early bronchial collapse by increasing bronchial pressure

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15
Q

What is the most common cause of cor pulmonale? (RHF)

A

COPD

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16
Q

Patient presents with COPD and the following:

S3 gallop
RVH
Hepatomegaly
Peripheral Edema

What should you be suspicious for?

A

cor pulmonale

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17
Q

A COPD patient arrives to the clinic with the following:

increased dyspnea

increased cough frequency/severity

increased/purulent sputum

What might be going on?

A

acute exacerbation of COPD

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18
Q

What diagnostic is required to establish a COPD diagnosis?

A

Spirometry

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19
Q

In addition to spirometry, what labs/diagnostics/imaging may be helpful? (5)

A

pulse ox

ABGs

CBC, BNP, cardiac enzymes, CMP, AAT

sputum culture

CXR/HRCT

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20
Q

What test is used to diagnose and determine severity of COPD?

A

spirometry

21
Q

A post-bronchodilator FEV-1/FVC ratio of _______ confirms an obstructive pattern?

A

< 0.7

22
Q

Which GOLD class?

FEV-1 80+% of predicted

A

mild, class I

23
Q

Which GOLD class?

FEV-1 50-80% of predicted

A

Moderate, Class II

24
Q

Which GOLD class?

FEV-1 30-49% of predicted

A

Severe, Class III

25
Q

Which GOLD class?

FEV-1 < 30% of predicted

A

Very Severe, IV

26
Q

What diagnostic should be ordered in the following conditions?

FEV-1 < 50

SpO2 < 92

Depressed LOC

Acute Exacerbation

A

ABGs

27
Q

What diagnostic should be ordered in a patient in the following conditions?

pt. < 45yo
non-smoker
FHx of emphysema

A

AAT

28
Q

Is a CBC usually altered in COPD?

A

no, usually normal

29
Q

What CXR finding is pathognomonic for emphysema?

A

blebs or bullae

30
Q

What three signs on CXR indicate air trapping in COPD?

A

Increased AP diameter

Hyperinflation and hyperlucency

flattened diaphragms

31
Q

What may be present on CXR in chronic bronchitis?

A

perivascular/peribronchial markings

32
Q

What imaging modality can be considered when the following are present?

pneumonia, PTX, large bullae

PE

Considering lung resection

A

CT Chest

33
Q

What intervention is key to preventing COPD progression?

A

smoking cessation

34
Q

3 minutes of counselling can increase smoking quit rate by___

A

5-10%

35
Q

What vaccines should be considered for COPD?

A

influenza

pneumococcal

36
Q

O2 administration for ________ daily is shown to increase survival in patients with SpO2 of…

A

15+ hours daily

SpO2 < 88, PaO2 < 56

37
Q

Grade A COPD is treated with…

A

SABA PRN

38
Q

Grade B COPD is treated with…

A

SABA + LAMA or LABA

39
Q

Grade C COPD is treated with…

A

SABA + LAMA

40
Q

Grade D COPD is treated with…

A

SABA + LAMA or LABA-LAMA

41
Q

What is the normal SABA (albuterol) dose?

A

2 puffs q 4-6 hours PRN

42
Q

Salmeterol and formoterol are…

A

LABA

43
Q

Ipratropium is a…

A

short acting anticholinergic

44
Q

Tiotropium and umeclidinium are what class of drug?

A

Long acting anticholinergics

45
Q

Fluticasone-salmeterol

Budesonide-formoterol

These are examples of…

A

LABA-ICS

46
Q

for whom is antiprotease therapy indicated?

A

AAT deficiency

47
Q

What are the two most common triggers for an acute exacerbation of COPD?

A

viral respiratory illness and pollution

48
Q

How is an acute COPD exacerbation managed in an outpatient setting?

A

Increase SABA

Prednisone 40mg QD x 5 days

49
Q

What can be added for moderate to severe exacerbations of COPD?

A

abx x 5-7 days

Clinical Medicine II (31 decks)

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