1
Q
what makes up COPD?
A
chronic bronchitis and emphysema
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2
Q
COPD definition
A
common, preventable airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses
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3
Q
chronic bronchitis
A
productive cough for 3 months in each of two consecutive years
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4
Q
emphysema
A
permanent enlargement of the air spaces distal to terminal bronchioles that is accompanies by destruction of the airspace walls
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5
Q
why does emphysema cause loss of elastic recoil?
A
destruction of alveolar walls
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6
Q
what parts of the respiratory system does emphysema effect?
A
terminal bronchioles, alveolar ducts, and alveoli
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7
Q
what parts of the respiratory system does chronic bronchitis effect?
A
trachea and bronchi
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8
Q
1 cause of COPD
A
smoking
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9
Q
risk factors for COPD
A
smoking
occupational exposure
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10
Q
pack years
A
ppd x years smoked
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11
Q
who should be screened for lung cancer?
A
adults 50-80 who have a 20 pack year history and currently smoke or quit within the past 15 years
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12
Q
how is lung cancer screening performed?
A
low dose CT
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13
Q
abnormalities in the airway in COPD patients
A
- chronic inflammation
- increased goblet cells and mucus production
- narrowing of airways and collapse
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14
Q
centrilobular emphysema
A
upper part of acinus damages
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15
Q
Panacinar emphysema
A
entire acinus is damages
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16
Q
periseptal emphysema
A
lower part of acinusis damaged
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17
Q
symptoms of COPD
A
- dyspnea
- chronic cough
- sputum production
- wheezing and chest tightness
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18
Q
PE of COPD
A
- increased resonance to percussion
- decreased breath sounds
- yellow stains on fingers
- chronic hoarseness of voice
- barrel chest
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19
Q
PE findings for emphysema
A
- pink complexion
- thin build with barrel chest
- cough is rare
- no peripheral edema
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20
Q
PE findings for chronic bronchitis
A
- cyanotic complexion
- peripheral edema
- stocky build
- primary complaint of productive cough
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21
Q
comorbid conditions associated with COPD
A
- lung cancer
- bronchiectasis
- sleep apnea
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22
Q
universal screening for COPD
A
none
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23
Q
cornerstone of diagnosis for COPD
A
spirometry
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24
Q
how to determine difference between COPD and Asthma on PFT
A
asthma is reversible and COPD is not
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25
Q
interpretation of PFT for COPD diagnosis
A
- FEV1 less than 80%
- FEV1/FVC less than 70%
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26
Q
Diffusing Capacity (DLCO)
A
measures the ability of the lungs to transfer gas form inhaled air to the RBCs in pulmonary capillaries
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27
Q
use for a CXR in COPD
A
- evaluates for comorbidities
- identifies complications
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28
Q
t/f CXR is necessary for routine diagnosis of COPD
A
false
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29
Q
CXR of COPD
A
- hyperinflation of lungs
- flat diaphragm
- narrow heart shadow
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30
Q
CT has a greater sensitivity and specificity for …
A
emphysema
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31
Q
pulse ox for person with mild COPD
A
over 90%
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32
Q
pulse ox % that needs supplemental O2
A
less than 90%
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33
Q
pulse ox % that medicare will cover supplemental O2
A
less than 88%
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34
Q
What does ABG measure?
A
pH
PaO2
PaCO2
HCO3
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35
Q
when do you do an ABG?
A
- FEV1 less than 50% predicted
- low O2 sat
- decreased level of consciousness
- severe COPD exacerbation
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36
Q
ABG of mild COPD
A
- low pO2
- normal pCO2
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37
Q
ABG of moderate to severe COPD
A
- low pO2
- high pCO2
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38
Q
COPD Assessment Test (CAT)
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39
Q
mMRC Breathlessness Scale
A
5 question questionnaire that measures limitation based on scale of 0-4
40
Q
GOLD categories
A
- 1: 80 or higher
- 2: 50-79
- 3: 30-49
- 4: less than 30
41
Q
category A COPD
A
- 0-1 exacerbations not needing hospitalizations
- mMRC 0-1
- CAT less than 10
42
Q
category B COPD
A
- 0-1 exacerbations not needing hospitalization
- mMRC over 2
- CAT over 10
43
Q
category C COPD
A
- 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
- mMRC 0-1
- CAT less than 10
44
Q
category D COPD
A
- 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
- mMRC over 2
- CAT over 10
45
Q
non-pharm treatment for COPD
A
- smoking cessation
- vaccinations
- oxygen therapy
- pulm rehabilitation
46
Q
pharm treatment for smoking cessation
A
- wellbutrin
- chantix
- nicotine replacement
47
Q
when is a patient recommended to get pneumonia vaccines?
A
- all patients 19-64 with comorbidities
- everyone over 65
48
Q
what pneumonia vaccine should be administered?
A
- PVC15 + PPSV23 one year later
- one dose of PVC20
49
Q
patient education for COPD
A
- proper inhaler technique
- self management
- pulm rehab
- O2 therapy
50
Q
management for category A COPD
A
intermittent use of SABA
51
Q
if the SABA is not controlling the COPD in category A, what can be added?
A
LABA
52
Q
onset of action of SABA
A
5 minutes
53
Q
duration of action of SABA
A
4-6 hours
54
Q
SABA SE
A
tachycardia, shakiness, nervousness, dizziness
55
Q
anticholinergic SABA SE
A
- dry mouth
- glaucoma
- urinary retention
56
Q
management of category B COPD
A
LABA or LAMA
57
Q
category B management additives
A
- SABA rescue inhaler for LAMA patients
- SAMA for LABA patients
58
Q
LABA onset of action
A
5 minutes
59
Q
LABA duration of action
A
12-24 hours
60
Q
category C COPD management
A
LAMA
61
Q
category C COPD management additives
A
add LABA and/or inhaled glucocorticoid
62
Q
category D COPD management
A
LABA-LAMA
63
Q
category D COPD management additives
A
LABA-LAMA-inhaled corticosteroid
64
Q
in what patient population of COPD do you use ICS as maintenance therapy?
A
category C and D with frequent exacerbations
65
Q
SE of ICS
A
- thrush
- sore throat
- glaucoma
- osteoporosis
66
Q
COPD exacerbation
A
acute worsening of respiratory symptoms that results in additional therapy
67
Q
cardinal symptoms of COPD exacerbations
A
- increased dyspnea
- increased sputum production
- increased cough or wheeze
68
Q
risk factors for COPD exacerbation
A
- age
- chronic mucus and productive cough
- duration of COPD
- antibiotic use
- comorbid conditions
- respiratory infections!!!
69
Q
mild COPD exacerbation
A
controlled by increased dose of regular medication
70
Q
moderate COPD exacerbation
A
requires treatment with systemic corticosteroids or antibiotics
71
Q
Severe COPD exacerbation
A
requires ER evaluation and/or hospitalization
72
Q
….% of COPD exacerbations can be managed outpatient
A
80
73
Q
when to hospitalize for COPD exacerbation
A
- inadequate response to outpatient therapy
- new onset of cyanosis, peripheral edema, and altered mental status
- serious coborbidities
74
Q
home management of COPD exacerbations
A
- intense bronchodilator therapy
- nebulizer therapy
- oral glucocorticoids
- abx for productive cough
75
Q
what antibiotics are prescribed for COPD exacerbations?
A
zithromax or doxy
76
Q
hospital management for COPD exacerbation
A
- supplemental oxygen
- SABA+ICS+short acting anticholinergic
- smoking cessation
- treat inf
- pulmonary rehab
77
Q
Alpha-1-antitrypsin deficiency
A
deficiency that leads to imbalance between neutrophil elastase in lung and AAT
78
Q
AAT
A
protects against degradation of elastin
79
Q
presentation of alpha 1 antitrypsin deficiency
A
- early onset emphysema
- dyspnea, cough, wheezing, phlegm production
- bronchodilator responsiveness
80
Q
risk factors for AAT related emphysema
A
- smoking
- occupational exposure
- asthma
81
Q
why can AAT deficiency lead to liver disease?
A
toxic accumulation of unsecreted AAT protein
82
Q
organic manifestations of AAT deficiency
A
- panniculitis
- IBD
- glomerulonephritis
83
Q
who do you suspect of AAT deficiency?
A
- emphysema in a young individual
- emphysema in a nonsmoker
- changes in the base of the lungs on CXR
- family history of emphysema
84
Q
diagnostic testing of AAT deficiency
A
serum AAT levels below 11
85
Q
Treatment of AAT deficiency
A
- avoid smoking
- bronchodilators
- supplemental O2
86
Q
bronchiectasis
A
permanent abnormal dilation and destruction of the bronchial walls of the large airways
87
Q
diagnosis of bronchiectasis
A
clinical: chronic daily cough with copious sputum and crackles on auscultation
88
Q
what would you see on CT of bronchiectasis?
A
bronchial wall thickening and dilated airways
89
Q
treatment of bronchiectasis
A
- Antibiotics
- Bronchodilators
- Chest physiotherapy to break up mucus
- Treatment of primary condition
90
Q
obstructive sleep apnea
A
recurrent collapse of pharyngeal airway during sleep leading to reduces airflow and intermittent disturbances in gas exchange
91
Q
risk factors of obstructive sleep apnea
A
- obesity
- male
- smoking
92
Q
cardinal features of obstructive sleep apnea
A
- apnea
- daytime somnolence
- signs of disturbed sleep
93
Q
Diagnosis of obstructive sleep apnea
A
polysomnography
94
Q
diagnostic criteria for obstructive sleep apnea
A
-5 or more obstructive respiratory event per hour + one for more associated symptom
95
Q
complications of obstructive sleep apnea
A
- daytime sleepiness
- cardio problems
- metabolic syndrome
96
Q
treatment of obstructive sleep apnea
A
- CPAP
- weight loss
- surgery
97
Q
CPAP
A
delivers fixed level of positive airway pressure and splints open airway
