Pulmonary

Question 1

Define Chronic Bronchitis

Answer 1

clinically as chronic cough, productive of at least two tablespoons of sputum, for 3 months in each of 2 successive years, in a patient in whom other causes of chronic productive cough have been excluded.

Question 2

Emphysema

Answer 2

pathological condition of permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.

Question 3

Asthma

Answer 3

airflow limitiation is REVERSIBLE, although you can develop airflow limitation.

Question 4

Risk Factors for COPD

Answer 4

Smoking - 15-20% of smokers develop obstruction, smoking = accelerated lung age, decline of 80-100ml per year instead of usual 20-30ml year in non smokers
x1-antitrypsin def - sig lung disease usually only in smokers, panaciar emphysema, bronchietasis, cirrhosis, panniculitis.. Air polution. Occupational exposures - dust, gold miners, farmers, grain handlers, cement workders cotton workers.

Question 5

clinical presentation of copd

Answer 5

insidious process, dyspnea develops when FEV is <60%,

Question 6

etiology of dsypnea

Answer 6

multifactorial

expiratory airflow obstruction with air trapping

hyperinflation that produces abnormalities in chest wall and resp muscle fx.

Mucus hypersecretion

Bronchoconstriction

Maldistribution of ventilation causeses frequence dependence and abnormalities in gas exchange

Deconditioning

Nutritional decline and wt.loss

Question 7

Important symptoms of copd

Answer 7

dsypnea
chronic cough
sputum production
chest tightness
wheezing (occasionally)
Hx of exacerbations - req antibx or hospitalization
Pay attention to wt loss, recurrent hemoptysis, horseness - this should be tested for malignancy.

Question 8

Grading severity of COPD

Answer 8

Severity Post bronchodilator FEV
COPD FEV/FVC Ratio %Predicted

Mild ———-80
Moderate———””——————–50-80
Severe ———–”” ——————-30-50
Very Severe —– “” ——————-<30

Question 9

copd physical exam

Answer 9

wheezing, hyperinflation (BSC), pursed lip breathing, accessory muscle use. Hoover’s sign - inward movement of the lower costal margin. Peripheral edema from cor pulmonale

Question 10

Hoover’s sign

Answer 10

inward movement of the lower costal margin - COPD pts

Question 11

is clubbing part of physical finding with copd

Answer 11

nope - look for other cause as indicated

Question 12

diagnosing copd

Answer 12

spirometry and pft’s

Question 13

BODE index

Answer 13

Body mass index
FEV1
dyspnea graded - scale
Exercise intol - 6 minute walk test
highest score is 10, lower score = lower risk of death

Question 14

Spirometry - both pre and post bronchodilator

Answer 14

Useful to make the dx, able to grade disease, Significant response from BD is increase by >12% and 200ml FEV and is more suggestive of reactive airway disease.

Question 15

Lung volumes - by body plethsmography, helium dilution, nitrogen washout

Answer 15

useful to detect air trapping - evaluate residual volume and hyperinflation, elevated total lung capacity

Question 16

DLCO

Answer 16

tends to be low in emphysema, less severely decreased with chronic bronchitis

Question 17

ABG’s

Answer 17

performed to assess resting hypoemia and detect hypercapnia

Question 18

oxygen evaluation

Answer 18

to detect oxyhemoglobin desat with exercise. 6 minute walk test provides assessment of resting and exertional needs, quantifies dist pt can walk.