COPD

Question 1

What three symptoms defined by Chronic Obstructive Pulmonary Disease (COPD)?

Answer 1

Breathlessness, productive cough, and bronchochitis.

Question 2

Which two clinical conditions are associated with COPD?

Answer 2

Chronic bronchitis (due to mucous hypersecretion) and emphysema (due to parenchymal damage).

Question 3

According to the source material, what are the three primary descriptors of COPD symptoms?

Answer 3

Irreversible, progressive, and persistent.

Question 4

Pathophysiology: Define chronic bronchitis.

Answer 4

Inflammation of the bronchi characterized by coughing, mucous hypersecretions, and shortness of breath (SOB).

Question 5

Pathophysiology: Define emphysema.

Answer 5

Loss of elasticity in the alveoli resulting in reduced gaseous exchange.

Question 6

What are the physiological consequences of emphysema in terms of blood gases?

Answer 6

Low $O_2$ saturation and elevated $CO_2$ concentrations.

Question 7

What are the two main external causes of COPD identified in the text?

Answer 7

Tobacco smoke and inhalation of toxic particles.

Question 8

A mutation in the $SERPINA1$ gene leads to which specific deficiency?

Answer 8

Alpha-1 antitrypsin deficiency.

Question 9

How does alpha-1 antitrypsin deficiency contribute to COPD pathophysiology?

Answer 9

It leads to increased protease expression.

Question 10

List the modifiable risk factors for COPD.

Answer 10

1. Low socioeconomic status (poor housing, overcrowding, poverty); 2. Poor nutrition (Low BMI); 3. Smoking (increases oxidative stress and ROS).

Question 11

List the non-modifiable risk factors for COPD.

Answer 11

1. Alpha-1 antitrypsin deficiency; 2. Increasing age; 3. Gestational problems impacting lung development; 4. Low birth weight; 5. History of tuberculosis.

Question 12

What tool is specifically used to measure persistent breathlessness in COPD?

Answer 12

The mMRC dyspnea score.

Question 13

In COPD, what does green and purulent sputum typically indicate?

Answer 13

Infection.

Question 14

What assessment tool is used to test the quality of life in COPD patients?

Answer 14

The COPD Assessment Test (CAT).

Question 15

List the ‘red flags’ associated with COPD that require urgent attention.

Answer 15

1. Use of accessory muscles; 2. Weight loss; 3. Orthopnoea (waking up at night breathless); 4. Peripheral oedema; 5. Chest pain; 6. Haemoptysis.

Question 16

What is the minimum age and primary risk factor required for a COPD diagnosis?

Answer 16

35 years old or more with a present or past smoking history.

Question 17

Aside from age and risk factors, what symptoms (one of which must be present) are used for COPD diagnosis?

Answer 17

1. Exertional breathlessness; 2. Regular production of sputum; 3. Chronic cough; 4. Frequent bronchitis; 5. Wheeze.

Question 18

Spirometry: Define the physiological characteristic of ‘obstruction.’

Answer 18

Loss of flow greater than proportional loss of volume.

Question 19

Spirometry: Define the physiological characteristic of ‘restriction.’

Answer 19

Loss of volume greater than proportional loss of volume.

Question 20

What specific spirometry ratio and reversibility status defines COPD?

Answer 20

$FEV_1/FVC$ less than 0.7 with no reversibility in $FEV_1$ after taking a SABA.

Question 21

Classify COPD severity: GOLD 1 (Mild).

Answer 21

$FEV_1 \ge 80\%$

Question 22

Classify COPD severity: GOLD 2 (Moderate).

Answer 22

$50\% \le FEV_1 < 80\%$

Question 23

Classify COPD severity: GOLD 3 (Severe).

Answer 23

$30\% \le FEV_1 < 50\%$

Question 24

Classify COPD severity: GOLD 4 (Very Severe).

Answer 24

$FEV_1 < 30\%$

Question 25

What must a patient bring with them to a spirometry appointment?

Answer 25

Their Short-Acting Beta Agonist (SABA).

Question 26

Why is 'maximum effort' required from the patient during spirometry?

Answer 26

To avoid underestimating lung function and to reach a plateau for expiratory effort.

Question 27

True or False: Patients must stop their existing therapy before undergoing spirometry.

Answer 27

False (patients on existing therapy don't need to stop taking them beforehand).

Question 28

List the eight tests patients should undergo when referred for spirometry.

Answer 28

1. Chest X-ray; 2. CT thorax; 3. Full blood count; 4. BMI; 5. PEFR; 6. Serum alpha-1 antitrypsin; 7. ECG; 8. Sputum culture.

Question 29

What are the two primary principles of COPD treatment?

Answer 29

1. Reduce symptoms (reliever inhalers, quality of life, exercise capacity); 2. Reduce risk (prevent progressions, exacerbations, and mortality).

Question 30

What information should be updated at every consultation regarding a patient's smoking status?

Answer 30

Smoking history and pack-year history.

Question 31

What is the common side effect of Nicotine Replacement Therapy (NRT)?

Answer 31

Nightmares.

Question 32

NRT Pharmacokinetics: Where is nicotine gum absorbed and when is its peak concentration?

Answer 32

Absorbed through the buccal mucosa, reaching peak concentration after 30 minutes.

Question 33

How is a nicotine lozenge absorbed into the body?

Answer 33

Through the nasal passage.

Question 34

Compare the onset of action for nicotine nasal spray versus nicotine oral spray.

Answer 34

Nasal spray takes 10–15 minutes, while oral spray takes 10 minutes.

Question 35

Which NRT format is recommended for patients who experience strong morning cravings?

Answer 35

24-hour patches.

Question 36

Which three vaccines are recommended for non-pharmacological management of COPD?

Answer 36

1. Influenza vaccine; 2. Pneumococcal vaccine; 3. COVID vaccine.

Question 37

What is the referral criterion for pulmonary rehabilitation in COPD patients?

Answer 37

An mMRC score of 3 or above.

Question 38

List the contraindications for pulmonary rehabilitation.

Answer 38

Unstable Angina (UA) or a recent Myocardial Infarction (MI).

Question 39

Provide an example and the active ingredient for the SABA class.

Answer 39

Ventolin Evohaler (Salbutamol).

Question 40

Provide an example and active ingredient for the LAMA class.

Answer 40

Tiotropium or glycopyrronium.

Question 41

Which mucolytic is noted for being cost-effective with a low tablet burden?

Answer 41

Acetylcysteine.

Question 42

When should mucolytics be initiated in COPD patients?

Answer 42

Only in patients with chronic sputum despite maximum therapy.

Question 43

Line 1 Treatment: Drug class and example.

Answer 43

SABA (e.g., Ventolin) or SAMA.

Question 44

Line 2 Treatment (With Asthma Features): Drug classes and example.

Answer 44

LABA + ICS (e.g., Fostair containing Beclometasone + Formoterol).

Question 45

Why is an Inhaled Corticosteroid (ICS) specifically added to Line 2 therapy for certain patients?

Answer 45

Because eosinophilic or asthma-related inflammation is present.

Question 46

Line 2 Treatment (No Asthma Features): Drug classes and example.

Answer 46

LABA + LAMA (e.g., Ultibro containing Glycopyrronium + Indacaterol).

Question 47

List the four criteria for stepping up to Line 3 (Triple Therapy).

Answer 47

1. Day to day symptoms affecting QoL; 2. One severe exacerbation in 12 months; 3. Two moderate exacerbations in 12 months; 4. Exacerbation leading to hospital admission.

Question 48

Triple Therapy: Drug classes, example, and active ingredients.

Answer 48

LABA + LAMA + ICS (e.g., Trimbow containing Glycopyrronium + Beclometasone + Formoterol).

Question 49

What is the protocol if Triple Therapy shows no improvement after a trial?

Answer 49

Trial for 3 months, and if no improvement, revert back to LABA + LAMA.

Question 50

What is the specific dosing regimen for Azithromycin to prevent respiratory tract infections (RTIs)?

Answer 50

250mg three times a week.

Question 51

Under what four conditions is Azithromycin offered to a COPD patient?

Answer 51

1. Non-smoker; 2. Optimized on pharmacological and non-therapeutic treatments; 3. Pulmonary rehabilitation completed; 4. Three or more exacerbations per year.

Question 52

What clinical evaluations must be performed before initiating Azithromycin?

Answer 52

1. Sputum culture and sensitivity; 2. CT scan (rule out bronchiectasis/malignancy); 3. ECGs; 4. LFTs.

Question 53

Arterial Blood Gases: At what level of $O_2$ is respiratory failure defined?

Answer 53

$O_2 < 8\text{ kPa}$.

Question 54

Define Type 1 Respiratory Failure.

Answer 54

Low $O_2$ but normal $CO_2$.

Question 55

Define Type 2 Respiratory Failure (Hypercapnia).

Answer 55

Low $O_2$ and raised $CO_2$.

Question 56

What is the target $O_2$ saturation range for patients with hypercapnia?

Answer 56

$88\%-92\%$.

Question 57

Why is it dangerous to give high levels of oxygen to a hypercapnic patient?

Answer 57

If they cannot clear out $CO_2$, it can be fatal.

Question 58

What are the common complications of COPD?

Answer 58

Cor Pulmonale (right-sided cardiac hypertrophy), anxiety, and depression.

Question 59

What are the clinical signs of acute COPD?

Answer 59

Worsening SOB, increasing purulent sputum, and fever with day-to-day variation.

Question 60

What is the target $O_2$ saturation for an acute COPD patient without hypercapnia?

Answer 60

$94-98\%$.

Question 61

Acute COPD: Steroid treatment regimen.

Answer 61

Prednisolone 5mg tablets: 30mg a day as a single dose for 5 days.

Question 62

Acute COPD: Antibiotic treatment options and duration.

Answer 62

Amoxicillin 500mg TDS or Doxycycline (200mg STAT, then 100mg daily) for 5 days.

Question 63

Define Bronchiectasis.

Answer 63

Persistent and progressive chronic respiratory disease causing irreversible permanent dilation of the bronchi due to loss of elasticity.

Question 64

What are the primary causes of Bronchiectasis?

Answer 64

Inflammation, damage to airways, and accumulation of mucous.

Question 65

List the symptoms of Bronchiectasis.

Answer 65

1. Daily expectoration of high volume of sputum for over 8 weeks; 2. Breathlessness; 3. Fever; 4. Reduced exercise tolerance.

Question 66

Which specific bacterium in a sputum culture is associated with Bronchiectasis diagnosis?

Answer 66

Pseudomonas aeruginosa.

Question 67

How is Bronchiectasis diagnosed?

Answer 67

Spirometry, CXR, sputum culture, and oxygen levels.