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Kumar and Clark's > Respiratory Disease > Flashcards

Respiratory Disease Flashcards

1
Q

What is COPD?

A

A disease characterised by airflow limitation that is not completely reversible

The airflow limitation is both progressive and associated w/ abnormal inflammatory response of the lungs to noxious particles or gases

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2
Q

COPD is an overarching diagnosis that brings together a variety of clinical syndromes associated w/ airflow limitation and destruction of lung parenchyma;

List them.

A

Emphysema

Small airway disease

Chronic bronchitis

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3
Q

Airflow limitation and destruction of lung parenchyma results in what 4 defining disease characterises in COPD?

A

Hyperinflation of lungs

Ventilation/perfusion mismatch

Increased work of breathing

breathlessness

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4
Q

What % of smoker develop COPD?

A

10-20%

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5
Q

COPD is caused by what?

A

Long-term exposure to toxic particles and gases

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6
Q

What is the general overview of the pathophysiology seen in COPD?

A

Airway inflammation

+

Structural changes

w/in

Airways and lung parenchyma

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7
Q

Describe the structural changes that occur in COPD

A

Increase in the number of goblet cells (mucus-producing) in bronchial mucosa - mailed to chronic bronchitis

Acute + Chronic inflammation leading to fibrosis of small airways

Destruction of alveolar walls relating in emphysema

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8
Q

Describe the 5 pathological changes seen in the airway of COPD pts?

A

Infiltration w/ neutrophils and CD8+ lymphocytes

Squamous metaplasia

Mucus gland hyperplasia

Loss of interstitial support

Increased epithelial mucous cells

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9
Q

What is emphysema?

A

Abnormal and permanent enlargement of air spaces distal to the the terminal bronchiole accompanied by the destruction of their walls

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10
Q

What are the 2 classifications of emphysema? (according to distribution)

A

Centr-acinar emphysema

Pan-acinar emphysema

Irregular emphysema

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11
Q

What is centri-acinar emphysema?

A

Distension and damage of the lung tissue is concentrated around the bronchioles

The distal alveolar ducts and alveoli tend to be well preserved

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12
Q

Which for of emphysema is extremely common?

A

Centri-acinar emphysema

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13
Q

Pan-acinar emphysema is what?

A

Associated w/ α1-antitrypsin deficiency

Distension and destruction affect the whole acinus (a region of the lung supplied w/ air from the terminal bronchioles)

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14
Q

What happens in severe cases of Pan-acinar emphysema?

A

The lung becomes a collection of bullae (an abnormal air filled cavity in the lung)

+

Severe airflow limitation and mismatch occur

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15
Q

What happens in irregular emphysema?

A

Scarring and damage that affects the lung parenchyma patchily - independent of acinar structure

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16
Q

Emphysema leads to what kind of airflow limitation?

A

Expiratory airflow limitation

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17
Q

Why does emphysema leads to expiratory airflow limitation and air trapping? (3 reasons)

A

There is loss of of lung elastic recoil which causes an inc in the TLC

Premature closure of airways limits expiratory airflow

The loss if alveoli dec capacity for gas transfer

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18
Q

What are the 3 things that contribute to the pathogenesis of COPD?

A

Cigarette smoking

Infections

Alpha1-antitrypsin deficiency

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19
Q

How does cigarette smoking contribute to developing emphysema?

A

Increases the number of neutrophil granulocytes which release proteases and elastase

Imbalance between protease and antiprotenase activity is a causative factor in the development of emphysema.

20
Q

How does cigarette smoke affect the mucous glands in the larger airways?

A

Persistent irritation from smoke inhalation causes them to hypertrophy

21
Q

Smoke has an adverse affect on surfactant which favours what of the lungs?

A

Over distention of the lungs

22
Q

What common cause acute exacerbations of COPD?

A

Respiratory infections

23
Q

How do address infective exacerbations of COPD treatment and prophylaxis wise?

A

Prompt use of antibiotics

Routine vaccinations faint influenza + pneumococci

24
Q

What is Alpha1-antitrypsin?

A

It is a proteinase inhibitor

Produced in the liver

secreted into the blood and diffused into the lung

In the lung it inhibits proteolytic (breaks proteins na peptides into amino peptides) enzymes such as neutrophil elastase

25
Q

What are neutrophil capable of doing to the alveolar wall connective tissue?

A

Destroying them

26
Q

In α1-antitrypsin deficiency where doe the proteinase inhibitors accumulate? This leads to what?

A

Accumulates in the liver

leading to a deficiency in the lung

27
Q

What are the 3 main phenotypes of α1-antitrypsin deficiency?

A

MM (Normal)

MZ (Heterozygous deficiency) 2% of emphysema in UK

ZZ (Homozygous deficiency)

28
Q

In addition to emphysema what else can α1-antitrypsin deficiency cause?

A

Liver disease

29
Q

Describe 4 predominant the symptoms of COPD

A

Breathlessness

Wheeze

Productive w/ white or clear sputum

Prone to LRTIs

30
Q

What are the various systemic manifestations of COPD? (6)

A

HTN

Osteoporosis

Depression

Weight loss

Cachexia

R-HF

31
Q

Describe the various signs present in COPD pts (1) and what signs appear in severe cases (8)

A

May be an absence of signs

Quite wheeze present throughout the chest

However in severe disease:

Tachypnoeic

Prolonged expiration

Use of accessory muscles of respiration

Pursing the lips on expiration

reduction in cricosternal distance

Poor chest expansion

Hyperinflated lungs

Loss of normal cardiac and liver dullness

32
Q

List some possible complications in terminal events of COPD?

A

HF

Oedema

33
Q

Hypercapnia pts can what which signs? (3)

A

Peripheral vasodilation

Bounding pulse

Coarse flapping tremor

Confusion

Drowsiness

34
Q

What is the diagnosis of COPD typically based on?

A

Usually clinical:

Hx of;

Breathlessness

+

Sputum production

+

Chronic smoking

35
Q

What 2 condiments can a barrel shaped chest?

A

COPD (due to emphysema)

Osteoporosis of the spine (typically seen in older men)

36
Q

The degree of breathlessness is recorded using what in COPD?

A

Medical Research Council (MRC) dyspnea score

37
Q

What is the COPD Assessment Test (CAT)?

A

A pt scored symptom tool that measures the impact of the disease on the individual’s health and wellbeing

38
Q

Which investigations are performed in COPD? (9)

A

Lung function tests

CXR

HRCT scans

Haemoglobin levels and packed cell volume

Blood gases

Sputum culture

ECG

Echo

α 1-Antitrypsin

39
Q

What is the purpose of doing Lung function tests in COPD?

What results would you see?

A

To see evidence of airflow limitation

FEV1:FVC ratio is reduced

+

PEFR is low.

40
Q

A change in FEV1 of <15% in COPD pts ca mean what?

A

the airflow limitation is partly reversible

40
Q

A change in FEV1 of <15% in COPD pts ca mean what?

A

the airflow limitation is partly reversible

41
Q

What happens to the lung volume in COPD pts?

A

Can be normal or increased

42
Q

What are the classic features of COPD on CXR? (3)

A

Hyperinflated lungs w/ low flattened diaphragms

Large bullae (sometimes)

Blood vessels look ‘pruned’:
large proximal vessels and relatively little blood visible in the peripheral lung fields.

43
Q

When would you order a HRCT in COPD pts?

A

When a CXR appears normal

44
Q

What happens to the Haemoglobin level and packed cell volume in COPD pts?

A

can be elevated as a result of persistent hypoxaemia

classified as secondary polycythaemia

44
Q

What happens to the Haemoglobin level and packed cell volume in COPD pts?

A

can be elevated as a result of persistent hypoxaemia

classified as secondary polycythaemia

45
Q

Why would you need to check for blood gases in COPD?

A

To check for respiratory failure

Kumar and Clark's (4 decks)

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