1
Q
define COPD?
A
progressive and irreversible obstructive airway disease
2
Q
which two diseases fall under the umbrella of COPD?
A
emphysema and chronic bronchitis
3
Q
is asthma part of COPD?
A
no
4
Q
is COPD progressive?
A
yes
5
Q
is COPD reversible or irrerversible?
A
irreversible
6
Q
if an enzyme is a protease, what exactly does it do?
A
proteolysis; breaks down protein
7
Q
elastase is what type of enzyme?
A
protesase
8
Q
what protein does elastase break down?
A
elastin
9
Q
which molecule counteracts elastase?
A
alpha-1-antytripsin
10
Q
what class of molecule is alpha-1-antytripsin?
A
anti-protease
11
Q
Emphysema is an imbalance between what proteins?
which protein is greater?
what effect does this have on lung tissue
A
elastase > alpha-1-antitrypsin
elastin broken down
12
Q
how does elastin broken down in emphysema change alveoli?
A
fewer, larger alveoli
13
Q
how does elastin broken down in emphysema change the passive part of exhaling?
how will this change the shape of the lungs? and shape of ribcage?
how will this look on CXR
A
lung can not recoil.
lungs stay hyperinflated,
rib cage expanded
CXR: big lungs with lots of black (air)
14
Q
which epithet is used to describe emphysema patients?
A
pink puffers
15
Q
which epithet is used to describe chronic bronchitis patients?
A
blue bloaters
16
Q
Who and why are they called pink puffers?
A
emphysema
pink - skin is pink early on, (blue in later stages).
puffers - pursed lip breathing
17
Q
Who and why are they called blue bloaters?
A
chronic bronchitis
blue skin
bloaters - fat
18
Q
someone has pure emphysema, what are the classical characteristics they will show?
- 4 in total
A
pink skin
pursed lip breathing
muscle wasting
barrel chest
19
Q
what happens to cilia in chronic bronchitis?
A
paralysed
20
Q
define chronic bronchitis?
A
mucus hypersecretion secondary to ciliary paralysis
21
Q
what is the obstruction in chronic bronchitis?
A
mucus in airways
22
Q
in chronic bronchitis how will the histology look of the goblet cells,
what is the function of the goblet cells?
A
goblet cell hypertrophy and hyperplasia
make mucus
23
Q
how exactly does smoking cause emphysema
A
smoking –>macrophage + neutrophils activated –> these make ↑elastase –> destroys alveoli (emphysema)
24
Q
what does smoking do to mucus production?
A
mucus hypersecretion
25
Risk factors for COPD
| - 5 things
```
Age
Smoking
Air pollution
Occupation exposure
A1AT deficiency – younger diagnosis
```
26
why is it that anything causing chronic inflammation of lungs can give you COPD and not just smoking?
aside from smoking what else can cause chronic lung inflammation?
- 2 things
lung inflammation --> macrophages + neutrophils activated --> these cells make proteases --> protease destroys harmful stuff & also healthy tissue.
but if chronically inflamed you will get chronic ↑ proteases --> chronic damage of healthy tissue --> COPD
```
air pollution
occupation exposure (asbestos)
```
27
Complications of COPD?
| - 5 things
```
Acute exacerbation
Cor pulmonale
Type 1 or 2 resp failure
Secondary polycythaemia
Pneumothorax
```
28
what is essentially the underlying cause of COPD
chronic inflammation of lungs
29
what is the pathway for how COPD causes cor pulmonale?
Severe COPD --> Pulmonary HTN --> R. Sided heart failure, i.e. cor pulmonale.
30
define cor pulmonale?
right sided haeart failure due to lung disease
31
how does COPD cause pulmonary HTN?
| - give step by step pathway
COPD --> hypoxia in lungs --> vasculature remodels + lose capillaries in emphysema --> pulmonary HTN
32
what effect does emphysema have on capillaries in lungs?
lose capillaries
33
define polycythaemia?
↑[RBC] in blood
34
why is there secondary polycythaemia in COPD?
compensation for chronic hypoxia
35
someone has COPD,
on auscultation what do you classically hear?
and why?
wheeze
narrowed airways (mucus filled) & fewer alveoli.
36
symptoms of COPD
| - 3 things
SOB
Productive cough
Wheeze
37
signs of COPD
-6 things
explain why you get each one?
Tachypnoea – SOB
Barrel chest – air in lungs, rib cage expanded
Hyperresonance on percussion – air in lungs
Wheeze – narrow airway
Tar staining – smoking
Peripheral cyanosis – chronic hypoxia
38
GOLD.S IX for COPD?
What is a positive result?
Spirometry and bronchodilator reversibility
FEV1/FVC < 0.70 and no reversibility post-bronchodilator is +ive result
39
what is the FEV1/FVC ratio for obstructive lung disease?
FEV1/FVC < 0.70
40
what is GOLD.S IX for COPD?
asides from the gold.S Ix what other Ix will you do for a pt suspected of COPD and what are you looking for/why do you do this?
- 3 IX
Spirometry and bronchodilator reversibility
CXR – flat diaphragm, hyperinflation and bullae.
check lung cancer
FBC – polycythaemia
BMI - weight changes in COPD
41
what does Serum A1AT look for?
when would this be indicated in a pt with COPD, what are you looking for?
alpha-1-antytripsin
| if symptoms are early onset, or no smoking history, alpha-1-antytripsin
inherited disorder
42
alpha-1-antytripsin deficiency is a non-inherited disorder.
true or false?
false
43
very young pt who has never smoked has COPD symptoms, grandfather had the same problem
what could be the cause of their COPD?
which Ix will help diagnose this?
alpha-1-antytripsin deficiency
Serum A1AT
44
a doctor does an ECG on someone with COPD, what condition is he looking for?
What features on an ECG will be +ve for this condition?
- 2 thigns
R. Sided heart failure
right BBB or right axis deviation
45
pt has acute exacerbation of COPD.
You want to check their lactate and assess what type (1 or 2) resp failure they have.
Which Ix do you use?
ABG
46
pt has acute exacerbation of COPD. you suspect an infective cause.
What Ix do you do to confirm infection and confirm the infective organism?
Sputum culture
47
What are the two common options for nicotine replacement?
varenicline
| bupropion
48
pt has COPD,
| what two vaccinations should they get?
one off pneumococcal & annual influenza
49
pt has chronic productive cough, what is the 1st line therapy?
Oral Mucolytic therapy
50
pt has COPD and is on treatment for this.
but now develops cor pulmonale, what is the additional management for this?
-2 things (name drug)
Furosemide
| long term O2 therapy
51
COPD pt cannot tolerate his inhaled medication.
What drug do you give?
class of this drug?
MOA of this drug?
Theophylline
bronchodilator
relaxes bronchial smooth muscle.
52
pt with COPD, but he is refractory to bronchodilator therapy.
which drug can help this?
Roflumilast
53
pt newly diagnosed with COPD
what is the 1st line medical MX for all patients?
1st: SABA or SAMA
54
pt newly diagnosed with COPD.
what is the most effective intervention to treat him?
stop smoking
55
pt newly diagnosed with COPD. he is asthma/steroid responsive.
his SABA and SAMA does not help.
What is the next Medical MX?
LABA + ICS
56
pt newly diagnosed with COPD. he is asthma/steroid irresponsive.
his SABA and SAMA does not help.
What is the next Medical MX?
LABA + LAMA
57
pt newly diagnosed with COPD . he is put on 1st line drug management.
What is the drug class? (2)
the drug is working, so what should his management be?
1st: SABA or SAMA
continue with SABA/SAMA
58
pt has COPD, he is asthma responsive.
SABA/SAMA is ineffective.
LABA + ICS also ineffective.
What is the next cocktails of drugs for him?
LABA + LAMA + ICS
59
define Acute Exacerbation of COPD
an acute worsening of respiratory symptoms.
60
what could trigger an acute exacerbation of COPD?
- 3 things
what do these triggers do to inflammation?
infection, air pollutants, allergens
↑inflammatory cells
61
what is the most common trigger for an acute exacerbation of COPD?
infection
62
As COPD worsens the acute exacerbations get worse
true or false?
true
63
Some exacerbations are very long and thus deteriorate lung function permanently
true or false?
true
64
all infective exacerbations are bacterial.
true or false?
false
65
why exactly does an inflammatory trigger worsen COPD symptoms
inflammatory trigger --> ↑macrophages + neutrophils --> ↑↑↑mucus, bronchoconstriction, ↑proteases --> symptoms worse
66
most common infective cause for acute exacerbation of COPD in smokers?
Haemophilus influenzae
67
most common viral cause for acute exacerbation of COPD in smokers?
Rhinovirus
68
someone has acute exacerbation of COPD.
what is the hallmark symptom to suggest an infective trigger?
↑sputum + changes colour
69
signs of acute exacerbation of COPD.
| - 5 things
```
Hypoxic
Tachypnoea
Acute confusion
New-onset peripheral oedema
New-onset cyanosis
```
70
pt has acute exacerbation of COPD.
What is the initial assessment (1st line) comprised of?
- 4 things
Vitals
GCS – confusion
Examine chest
Check ability to cope at home
71
how is acute exacerbation of COPD diagnosed?
Clinical diagnosis
72
is a sputum culture routinely done for acute exacerbation of COPD?
no
73
pt has acute exacerbation of COPD, there are sputum changes?
What is line Mx?
- 3 things
↑bronchodilator
Prednisolone 30mg 7-14 days
AB
74
pt has acute exacerbation of COPD.
which steroid is given, dose, how long?
Prednisolone 30mg 7-14
75
which AB are 1st line for acute exacerbation of COPD?
what is the mnemonic for this?
amoxicillin, clarithromycin, doxycycline
abc easy as adc
76
pt has acute exacerbation of COPD.
what features would make you admit them to hospital?
- 6 things
```
Severe breathlessness
O2 sats <90%
Acute confusion
Can’t cope at home (or living alone)
Already on LTOT
Changes on CXR
```
77
pt has acute exacerbation of COPD.
what feature is required for antibiotic prescription?
sputum changes
78
pt comes to A&E with acute exacerbation of COPD.
he is assessed and told he can go home.
which Mx is used for all of these patients who go home?
1st Line: ↑short acting bronchodilator
79
pt comes to A&E with acute exacerbation of COPD.
he is assessed and told he can go home. he is put on ↑short acting bronchodilator but says he struggles with daily activities.
what drug is now indicated?
Prednisolone
80
pt has acute exacerbation of COPD and is told he can be managed at home.
at home he struggles with daily activities because of his symptoms.
what drug is now indicated?
Prednisolone
81
pt has acute exacerbation of COPD, no sputum culture is done but he is on put AB.
when is a sputum culture done for acute exacerbation of COPD?
If AB have not worked – then send sputum culture
82
should all exacerbations be followed up.?
and is so when?
yes
after 6 weeks
83
emphysema etymology?
emphusan - puff up
84
sama stand for what?
short acting muscarinic antagonists ipratropium
85
sama example?
ipratropium
Respiratory
flashcards
Decks in class (22)
# Cards
-
COPD, acute exacerbation85
-
Asthma75
-
mesothelioma + Asbestos42
-
Pneumoconiosis33
-
Lung cancer58
-
Tuberculosis56
-
pneumonia29
-
acute bronchitis20
-
acute respiratory distress syndrome15
-
Alpha-1 antitrypsin deficiency18
-
Atelectasis6
-
Bronchiectasis21
-
chest drain17
-
Kartagener’s syndrome6
-
oxygen Masks13
-
Pleural effusion, pleurisy, pleuritic chest pain34
-
Pulmonary Embolism34
-
Superior vena cava obstruction8
-
Pulmonary fibrosis17
-
case 5 resp102
-
grey folder Q134
-
haemoptysis differentials10
