TCD questions - COPD

Question 1

COPD is an obstructive lung disease predominantly caused by tobacco smoking, that shows more than 15% reversibility
□ True.
□ False.

Answer 1

Answer: false, COPD is predominantly caused by tobacco smoking, but is irreversible.

Question 2

Which of the following are clinical and pathological features of COPD? (select all 5 that apply)

1. Regular sputum production.
2. Finger clubbing.
3. Neutrophil infiltration of alveolar cells.
4. Smoker or ex-smoker.
5. Hyperinflated chest.
6. Age under 35.
7. Wheeze.
8. Night time waking with cough and wheeze.
9. Breathlessness on exertion.

Answer 2

Answer: regular sputum production, smoker or ex-smoker, hyperinflated chest, wheeze, breathlessness on exertion

Question 3

You are undertaking a medication review on one of your patients in a GP surgery. You note that the latest spirometry shows an FEV1 of 59%. The patient is already taking salbutamol prn. What other medications should be considered at this point?

• Tiotropium inhaler.
• Salmeterol inhaler.
• Regular prednisolone
• Beclomethasone inhaler.
• Seretide

Answer 3

Answer: salmeterol (LABA) and tiotropium (SAMA) inhalers.

Question 4

You are asked to review an ABG on a patient in the Emergency department who has been admitted with shortness of breath and is known to have COPD. You are told that they have a GCS of 15. The ABG shows:

FiO2 35% oxygen via venturi mask

SaO2 98%
pH 	    7.31 [7.35-7.45]
pCO2  7.8 [4.5-6 kPa]
pO2     13.6 [10-14 kPa]
HCO3  22.1 [22-26 mmol/L]
BE 	-4.5

What does the ABG show?

What would be the next best step in management?

1. Start non-invasive ventilation.
2. Give a nebuliser.
3. Call intensive care to arrange intubation and invasive ventilation.
4. Give intravenous aminophylline.
5. Reduce amount of inspired oxygen.

Answer 4

Answer: uncompensated type II respiratory failure. Note that there is an acidosis present, but the bicarbonate is normal. CO2 levels are increased due to respiratory failure.

Answer: reduce amount of inspired oxygen. The patient is alert and has borderline type II respiratory failure (uncompensated). Patients who are known to have COPD are at risk of retaining CO2. The British thoracic society oxygen guidelines recommend that target oxygen saturations should be between 88-92%. This patients’ oxygen saturations are 98%, and therefore the next most appropriate action would be to reduce the amount of inspired oxygen, and repeat the blood gas in 30 minutes.

Question 5

What of the following clinical features are typically associated with an exacerbation of COPD? (Select all that apply)

• Chest pain.
• Increased wheeze.
• Haemoptysis.
• More purulent sputum.
• Increased breathlessness.
• Decreased sputum production.

Answer 5

Answer: increased wheeze, more purulent sputum, increased breathlessness. Patient can have chest pain and haemoptysis depending on the cause of the exacerbation, but the typical features are 3-part.

Question 6

Match the drug to its mechanism of action:
Drugs: 
- Salbutamol
- Ipratropium bromide
- Theophylline
- Prednisolone
- Magnesium

Possible MOA:

• Changes nuclear transcription of cells to reduce inflammation
• Calcium channel blocker
• Anticholinergic agent
• B2 agonist
• Phosphodiesterase inhibitors

Answer 6

Answer:
Changes nuclear transcription of cells to reduce inflammation = Prednisolone

Calcium channel blocker = Magnesium

Anticholinergic agent = Ipratropium bromide

B2 agonist = Salbutamol

Phosphodiesterase inhibitors = theophylline

Question 7

What are the most common infective causes of an exacerbation of COPD? Rank your answer:

Moraxella catarrhalis, haemophilus influenzae, viruses, pseudomonas aeruginosa, streptococcus pneumoniae

Answer 7

1. Viruses
2. Haemophilus influenza
3. Streptococcus pneumoniae
4. Pseudomonas aeruginosa
5. Moraxella catarrhalis

Question 8

When is long term home oxygen therapy (LTOT) indicated in patients with COPD? (select all that apply)

1. PaCO2 > 6.0 kPa on air.
2. PaO2 < 8.0 kPa on air.
3. PaO2 < 8.0 kPa on air and evidence of core pulmonale.
4. PaO2 < 6.3 kPa on air.
5. PaO2 < 7.3kPa on air.

Answer 8

Answer: PaO2 <8.0kPa on air and evidence of cor pulmonale, PaO2 <7.3kPa on air

Question 9

You are reviewing some spirometry results for one of your COPD patients. It shows an FEV1 of 39%. What is the severity of their COPD according to the GOLD (Global initiative for chronic obstructive lung disease) classification?

□ Mild.
□ Moderate.
□ Severe.
□ Very severe

Answer 9

Answer: Severe.

Mild = >80%,
Moderate = 50-79%
Severe = 30-49%,
Very severe = <30%.