COPD

Question 1

most common sx of dyspnea

Answer 1

emphysema

Question 2

accessory muscle use is more common with which type of COPD

Answer 2

emphysema

Question 3

what part of respiration is prolonged with COPD

Answer 3

expiration

Question 4

4 signs of hyperinflation and which copd is it seen in

Answer 4

seen in emphysema d/t air trapping
* flattened diaphragm
* increased AP diameter
* decreased vascular markings
* bullae or blebs

Question 5

pursued lip breathing is associated with…

Answer 5

emphysema

Question 6

which type is cyanotic and has peripheral edema

Answer 6

chronic bronchitis

Question 7

which type is crackles/rales, rhonci and wheezing associated with

Answer 7

chronic bronchitis

Question 7

which type will have increased Hg, hematocrit/RBC

Answer 7

chronic bronchitis

Question 8

why is there increased Hg?

Answer 8

d/t hypoxia stimulating erythropoeisis

Question 9

V/Q findings in emphysema vs chronic bronchitis

Answer 9

• matched in emphysema d/t hyperventilation
• severe mismatch in chronic bronchitis; also hypercapnia

Question 10

what does the presence of bullae on CXR signify?

Answer 10

airspace loss

Question 11

define chronic bronchitis

Answer 11

chronic productive cough for at least 3 months a year for 2 consecutive years

Question 12

3 cardinal sx of chronic bronchitis (from PPP)

Answer 12

chronic cough
sputum production
dyspnea (on exertion)

Question 13

most common type of emphysema (found on CT)

Answer 13

centrilobar/proximal acinar

Question 14

pathophys of emphysema (5 steps)

Answer 14

1. chronic inflammation
2. less protective enzymes & more damaging ones
3. alveolar-capillary membrane destruction
4. loss of recoil & airway collapse; increased compliance
5. airway obstruction/increased air trapping

Question 15

weight loss is seen more in which one? why?

Answer 15

emphysema d/t inflammation and increased WOB

Question 16

signs that COPD is d/t AAT deficiency (3)

Answer 16

• panacinar emphysema on CT
• hepatomegaly
• cirrhosis

Question 17

ABG finding (1)

Answer 17

respiratory acidosis

Question 18

4 PFT findings indicative of COPD

Answer 18

• low FEV1
• low or normal FVC
• low FEV1/FVC ratio
• increased RV and TLC

Question 19

DLCO finding in emphysema vs chronic bronchitis

Answer 19

• emphysema will be reduced d/t membrane destruction
• somewhat normal in chronic bronchitis

Question 20

pathophys of chronic bronchitis (4 steps)

Answer 20

1. chronic inflammation
2. mucous gland hyperplasia & mucus hypersecretion
3. cilia dmaged
4. neutrophils & CD8+ T cell infiltration

Question 21

pulmonary HTN, cor pulmonale and multifocal atrial tachy. is associated with…

Answer 21

chronic bronchitis

Question 22

3 signs of acute COPD exacerbation (need at least 1 of)

Answer 22

• cough increase
• sputum increase/changes
• dyspnnea increases

Question 23

group that would benefit the MOST from pulmonary rehab

Answer 23

FEV1 under 50%

Question 24

accuracy of pulse ox decreases when SBP is under what value?

Answer 24

80

Question 25

ATS severity criteria

Answer 25

* Mild: FEV 1 70+ % * Moderate: FEV1 60-69% * Moderately severe: FEV1 50-59% * Severe: FEV1 35-49% * Very severe: FEV1 < 35%

Question 26

Sympathomimetic activation through β2 receptors in lung→ relax airway smooth muscle | this is the MOA for?

Answer 26

beta 2 adrenergic agonists

Question 27

3 other names for albuterol

Answer 27

proventil proair ventolin

Question 28

name two LABAs

Answer 28

formoterol salmeterol | used 2x a day

Question 29

name two SABAs

Answer 29

albuterol levalbuterol (lasts longer)

Question 30

* exhibits broncholytic action by reducing cholinergic influence on bronchial musculature. Blocks muscarinic ACh receptors w/o specificity→ cGMP degradation * Inhibit parasympathetic tone at smooth muscle cells

Answer 30

* SAMA * SAMA + LAMA

Question 31

what class is Tiotropium (once a day, 24hr)

Answer 31

LAMA

Question 32

what class is Ipratropium (atrovent)

Answer 32

SAMA

Question 33

between LAMA and LABA which is thought to be a little better

Answer 33

LAMA

Question 34

SE of antimuscarinics

Answer 34

dry mouth, blurred vision, difficulty swallowing, thirsy, rare urinary sx

Question 35

anti-inflammatory, Antidep., dopamine/NE-reuptake inhibitor May blunt post-cessation weight gain | what MOA is this for

Answer 35

Bupropion (oral steroid)

Question 36

C/I for bupropion

Answer 36

seizure disorder

Question 37

3 indications for NIPPV

Answer 37

resp. acidosis severe dyspnea w/ signs of resp. muscle fatigue persistent hypoxemia despite supplemental oxygen

Question 38

which medication used in frequent exacerbation, decrease airway inflammation & rates of exacerbation but has high SE burden

Answer 38

Roflumilast (PPD4 inhibitor)

Question 39

reduces sputum viscosity and elasticity improves mucociliary clearance & modulates inflammatory response can reduce frequency of exacerbation | which medication

Answer 39

N-acetylcysteine (an expectorant)

Question 40

* competitive nonselective PPD inhibitor→ raised intracellular cAMP, activates PKA, inhibits TNF-alpha & inhibits leukotriene synthesis * less inflammation & innate immunity * Increases force of diaphragmatic muscle contraction * Suppresses COL1 mRNA (codes for collagen)

Answer 40

theophylline

Question 41

2 indications for theophylline

Answer 41

* Primary maintenance for those who want PO only or having issues w/ inhaler * Additive for ICU pts not responding to beta-2 agonist

Question 42

* Requires serum monitoring to avoid toxicities (5-15 mcg/ml) * Multiple drug interactions (erythromycin, cipro, rifampin) * once titrated, serum monitored Q 12 months

Answer 42

theophylline