COPD

Question 1

COPD triple therapy

Answer 1

LAMA
LABA
ICS

Question 2

Indication of ICS

Answer 2

> 300 eosinophil

Question 3

X ray finding of emphysema

Answer 3

Hyperinflation
Flattening of diaphragm
lung look more black
Pulmonary vasculature decreased
Tubular heart

Question 4

HRCT of emphysema

Answer 4

Bullae +

Question 5

Mc complication of emphysema

Answer 5

Cor pulmonale

Question 6

Rupture of bullae in known cigarette smoker emphysema develop

Answer 6

Spontaneous pneumothorax

Question 7

X ray of chronic bronchitis

Answer 7

increase bronchovascular marking
dirty look

Question 8

Tall , Thin smoker . decrease exercise intolerance , breathlessness
- Tachypnoea
- Accessory Muscle Working excessively ( sternocleidomastoid )
- Sitting in tripod position
- Barrel shaped chest ( AP > Transverse )
- liver may not palpable
- CYNOSIS ABSENT
- Cachexia
- BITEMPORAL MUSCLE WASTING
- Diffuse loss of sc fat
- HOOVER SIGN : Paradoxical inward movement of ribcage
PINK PUFFERS

Answer 8

Emphysema

Question 9

Ix of emphysema

Answer 9

1.Spirometry : FEV1/FVC < 0.7
- RC , TLC , FRC increased
2.HRCT : Bulla
3.X ray - Hyperinflation
4.DLCO decrease
5.ABG : pO2 & pCO2 reduced
Type 1 RS failure

Question 10

Tx of emphysema

Answer 10

1.Nicotine deaddiction
- Nicotine buccal spray
- Varenicline ( alfa4 beta2 partial agonist of nicotine receptor )
- Bupropion
2. Video assisted thoracoscopic Sx : Bullectomy
3. Low flow O2
4. stop smoking
5. TOC : Lung Transplantation

Question 11

Mcc Ix of lung transplantation

Answer 11

Idiopathic Pulmonary Fibrosis

Question 12

Fat / obese smoker
- cough
- bronchorrhea
- Halitosis
- hemoptysis -+
-CLUBBING ABSENT (+ if lung cancer )
- inspiratory & expiratory ronchi
- BLUE BLOATERS

Answer 12

Chronic Bronchitis

Question 13

Ix of Chronic Bronchitis

Answer 13

1.Spirometry : FEV1/FVC < 0.7
not increase after give salbutamol
2.CXR : increased bronchovascular marking / dirty lung
3. IOC : HRCT
4. DLCO : Normal
5. ABG : pO2 reduced , pO2 elevated
Type 2 RS failure

Question 14

Tx of Chronic Bronchitis

Answer 14

1. AB with mucolytic
2. LAMA : Tiotropium
3. LABA
4. ICS
5. Mainstay of Tx : ;ow flow O2
   Nasal cannula 1L / min
   Ix : SpO2 < 88% at rest
   SpO2 < 89 % if PAH present

Question 15

Indication to start NIV for COPD

Answer 15

FEV1 =< 30-50%
pH < 7.35
pCO2 > 45 mmHg
SpO2 < 90 %

Question 16

Use of NIV

Answer 16

Bilateral pneumonia
Acute Pulmonary Edema
Myasthenia gravis Crisis
Weaning from ventilator

Question 17

Contraindication of NIV

Answer 17

Unresponsive pt
Inability to protect airway
Bulbur palsy
Facial trauma / Facial Sx
Apneic episode
Hemodynamic instability
MI / GI bleeding / unstable angina

Question 18

GOLD for COPD

Answer 18

MILD 1 : > 80% FEV1
MODERATE 2 : 50-79%
SEVER 3 : 30-49%
VERY SEVERE 4 : < 30%

Question 19

All COPD tested for

Answer 19

alfa 1 AT deficiency
chromosome 14
SERPINA1 locus present
M allele : normal
S allele : less elastase
Z allele : severe

Pi mc & severe form of alfa 1 AT deficiency

Question 20

Pack year

Answer 20

no. of cigarettes smoke per day / 20 * years of smoking

Question 21

BODE index

Answer 21

predict mortality in COPD

BMI
Airway Obstruction : FEV1
Dyspnoea : mMRC grading
Exercise capacity : 6 min walk test