COPD

Question 1

Describe the MRC dyspnoea scale, of grades 1-5

Answer 1

1. Not troubled by breathless except on strenuous exercise
2. Short of breath when hurrying on a level or when walking up a slight hill
3. Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4. Stop for breath after walking 100 yards, or after a few minutes on level ground
5. Too breathless to leave the house, or breathless when dressing/ undressing

Question 2

Pathophysiology of bronchitis

Answer 2

• Acute inflammation of bronchial wall
• Mucous gland hyperplasia + hypertrophy -> productive cough
• Chronic inflammation + fibrosis

Question 3

Pathophysiology of emphysema

Answer 3

• Permanent enlargement of air spaces distal to terminal bronchioles
• Destruction of alveolar walls
• Loss of elastic recoil

Question 4

Difference between asthma and COPD findings on spirometry

Answer 4

Asthma spirometry findings would be better after salbutamol inhaler.

COPD spirometry findings would be the same.

Question 5

Why are people with COPD at higher risk of pneumothorax?

Answer 5

Rupture of lung bullae (form during emphysema)

Question 6

Appearance of emphysema on CXR

Answer 6

• lung hyperinflation, barrel chest
• bullae
• saber sheath trachea

Question 7

Appearance of bronchitis on CXR

Answer 7

• increased broncho-vascular markings

- cardiomegaly

Question 8

Which vaccinations should be given to COPD patients? How often?

Answer 8

Flu vaccine (yearly)

Pneumococcal vaccine (once)

Question 9

What pattern of ABG is often seen in COPD patients

Answer 9

Respiratory acidosis

PaCO2 is high

Question 10

MoA of salbutamol

Answer 10

Short acting beta2 agonist

Question 11

MoA of salmeterol

Answer 11

Long acting beta2 agonist

Question 12

MoA of budesonide

Answer 12

Corticosteroid

Question 13

MoA of tiotroprium

Answer 13

Long acting muscarinic antagonist

Question 14

MoA of ipratroprium

Answer 14

Short acting muscarinic antagonist

Question 15

What happens to MCV levels if someone is a chronic CO2 retainer

Answer 15

MCV (Hb level) increases

Leads to polycythaemia

Question 16

What encompasses the DECAF scoring system fo exacerbation of COPD

Answer 16

dyspnoea
eosinophils
consolidation
acidosis
fibrillation (AF) 

add ECG to find out DECAF score
(gives mortality score for acute exacerbation)

Question 17

What causes RV failure in cor pulmonale

Answer 17

1. Chronic hypoxia –> pulmonary artery constriction
2. Chronic hypercapnia + respiratory acidosis –> pulmonary vasoconstriction
3. Polycythaemia –> increased blood viscosity

Question 18

Why do people with chronic CO2 retention get polycythaemia

Answer 18

Chronic hypoxaemia causes increased erythropoeitin by kidneys

Question 19

Symptoms of cor pulmonale

Answer 19

• peripheral oedema
• raised JVP
• systolic parasternal heave
• angina-type chest pain
• loud 2nd heart sound (over pulmonary valve)

Question 20

What causes a raised carbon monoxide transfer factor (TLCO)

Answer 20

1. Asthma
2. Haemorrhage
3. L to R shunts
4. Polycythaemia

Question 21

What causes a low carbon monoxide transfer factor (TLCO)

Answer 21

everything else that causes lower surface area of alveoli eg COPD, fibrosis, anaemia

Question 22

Treatment for asthma attack

Answer 22

O SHIT ME

Oxygen
Salbutamol
Hydrocortisone
Ipratropium (anti-cholinergic)
Theophylline (anti-leukotriene)
Magnesium sulphate
Escalate