Week 103 Wheeze 1 (COPD)

Question 0

What is COPD?

Answer 0

A chronic, slowly progressive disorder characterised by fixed or partially reversible airway obstruction and associated with an abnormal inflammatory response of the lungs and noxious particles or gases.

Question 1

Name 3 clinical features of severe COPD

Answer 1

Agitated (Low po2) or sleepy (high po2)
Smoker; lip pursing; plethoric; hyperinflated chest; bounding pulse
wheeze; oedema; cyanosis
warm hands/metabolic flap; sob
Frequent infective exacerbations; purulent sputum

Question 2

Name 3 causes of COPD

Answer 2

1. ) Smoking
2. ) Exposure to noxious particles
3. ) Genetic - Alpha -1 antitrypsin deficiency

Question 3

Is FEV1/FVC reduced or heightened in copd patients? Why?

Answer 3

Reduced

Airway obstruction prevents rapid expulsion.

Question 4

Bronchodilators act upon ______ receptors. They are receptor ____, affecting ______. They cause the dilatation of ______.

Answer 4

Beta 2 receptors
Agonists
Adrenaline
Bronchioles

Question 5

Which drugs INHIBITS bronchoconstriction?

Answer 5

Tiatropium and ipratropium. These act upon m1 and m3 receptors.

These are muscurinic receptor antagonists, otherwise known as LAMA’s and SAMA’s.

Question 6

Wgat is meant by FEv1?

Answer 6

Forced expiratory volume (1)

The volume of air expired forcefully in one second.

Question 7

What should FEV1/FVS be, as a %?

Answer 7

Approx 70%.

Question 8

Describe chronic bronchitis.

Answer 8

An inflammatory process in the walls of the bronchiles, with excess mucus production and sputum from hypertrophic glands.

Question 9

Diagnosis of bronchitis defined as?

Answer 9

Cough productive of purulent sputum for 3 months of the year for two consecutive years.

Question 10

What is emphysema?

Answer 10

Destruction of lung tissue distal to the terminal bornchioles.
Cells release proteases (elastase, matrix metalloproteases) which breakdown elastin and collagen. These overwhelm the bodies natural anti-protease, causing destruction of alveolar walls.

Question 11

Name on short acting B2 agonist.

Answer 11

Salbutamol

Terbutaline

Question 12

Name 1 long acting beta-2 agonist?

Answer 12

Salmeterol

Formeterol

Question 13

If a patient presents with COPD like symptoms, with diurnal variation and no smoking history, would your differential diagnosis change?

Answer 13

Likely to be asthma.

Question 14

A patient presents to SAU with an acute exacerbation of COPD. What investigations would you consider?

Answer 14

ABG
CXR
ECG
FBC7 Renal profile
Sputum for bacteriology/ blood cultures

Question 15

What breath sound would you hear in croup?

Answer 15

Stridor.

Question 16

If breath sounds are absent, what likely pathologies do you suspect?

Answer 16

Pleural effusion

pneumothorax

Question 17

What are the associated changes associated with chronic bronchitis?

Answer 17

loss of ciliated cells

squamous metaplasia

Question 18

How does small airways disease differ from emphysema?

Answer 18

Fibrosis

Question 19

The reduced blood flow associated with emphysema causes what?

Answer 19

Pulmonary hypertension.

Question 20

What condition associated with COPd is described as a symptom with pathological appearances?

Answer 20

Chronic bronchitis

Question 21

What condition associated with COPD is described as a structural abnormality?

Answer 21

emphysema

Question 22

Name a long acting beta 2 agonist (LABA)

Answer 22

Salmeterol

Question 23

Blocking of muscurinic 2 receptors (m2) causes _______.

Answer 23

< Acth release

Question 24

What is ipratropium?

Answer 24

Short acting muscurinic receptor antagonist.

Question 25

What’s the first line treatment for a patient with COPD?

Answer 25

Short acting beta 2 agonist.

Question 26

Which neurotransmitter is involved with bronchodilation?

Answer 26

Adrenaline

Question 27

What drug treatment can be used to break down mucus in the lung?

Answer 27

Carbocysteine

Question 28

What are the long term effects of corticosteroids?

Answer 28

osteoporosis
hypertension
diabetes m

Question 29

What is levosimendan?

Answer 29

A calcium sensitising drug, used to improve muscle function in patients with respiratory muscle weakness.

Question 30

What effect does a negative intrapleural pressure cause?

Answer 30

Inward recoil of lungs

outward recoil of chest wall

Question 31

What parts of the airway make up the conducting zone?

Answer 31

trachea
bronchi
bronchioles
terminal bronchioles

Question 32

What parts of the airway make up the transitional and respiratory zones?

Answer 32

respiratory bronchioles
alveolar ducts
alveolar sacs

Question 33

oxygen partial pressure in air is ____ mmhg

Answer 33

150

Question 34

Oxygen partial pressure in lung and blood is _____ mmhg

Answer 34

100

Question 35

Oxygen partial pressure in tissues is ____mmhg.

Answer 35

30

Question 36

What is known as the anatomical dead space?

Answer 36

Conducting airways

Question 37

What is total volume of air that enters the airway?

Answer 37

500 ml