COPD - General

Question 1

Definition of COPD

Answer 1

Fixed airflow obstruction

FEV1/FVC ratio <0.7 post bronchodilator

with persistent resp sx

Question 2

How many pk years does COPD usually occur after

Answer 2

> 20

Question 3

COPD GOLD Criteria

Answer 3

FEV1 % predicated

Mild - >80%

Moderate - 50-79%

Severe - 30 - 49%

Very severe <30%, or FEV1 <50% with resp failure

Question 4

COPD:
BODE index

Answer 4

Estimates risk of hospitalization and death

BMi
Obstruction -FEV1
Dyspnoea - MRC
Exercise - 6MWT

Scored 0-10

Question 5

When to refer to Pulmonary Rehab in COPD

Answer 5

MRC 3+
or
recent hospitalisation with acute ex

Can still be smoking

Question 6

Vaccines in COPD

Answer 6

Annual flu

Covid

Pneumococcal
- 1 dose PCV20 or
- 1 dose PCV15 then PPSV23

RSV if preggo or 75-79

GOLD also suggest TDP and Zoster if >50

Question 7

Benefit of pneumococcal vaccine in COPD

Answer 7

Reduces rate of CAP and exacerbations

Question 8

Features that would suggest Cor Pulmonale in COPD

Answer 8

Peripheral edema
Raised JVP
Systolic parasternal heave
Loud pulmonary 2nd heart sound
Hepatomegaly

Question 9

When to query alpha 1 anti tryspin deficiency in COPD

Answer 9

Young pt
Early onset sx
Minimal smoking
FHx

Question 10

When should you not refer someone for pulmonary rehab

Answer 10

Unable to walk

Unstable angina or recent MI

Question 11

What is Pre-COPD

Answer 11

Sx but no airflow obstruction on spiro

Question 12

What is PRISM

Answer 12

Preserved ratio impaired spiro

FEV1 <80% predicted but FEV1/FVC ratio is >0.7 after bronchodilator

Question 13

What does BODE index tell you

Answer 13

Risk of hospitalisation and death

Question 14

Different distributions of empysema

Answer 14

Centrilobular

Panlobular

Paraseptal

Question 15

CXR features COPD

Answer 15

Hyperinflamation
Attenuation peripheral vasculature
>7 posterior ribs
bullae

Question 16

When does LTOT improve COPD survival

Answer 16

significant hypoxaemia <7.33 in STABLE COPD

Question 17

What are the 1st and 2nd cause of death in mild COPD

Answer 17

Cardiovascular disease (CAD, HTN, CCF)

2nd = lung cancer

Question 18

What’s the main cause of death in severe COPD

Answer 18

Respiratory failure

Question 19

Effect of pulmonary rehab on spirometry

Answer 19

None

Question 20

Effect of pulmonary rehab on mortality

Answer 20

None

Question 21

RV in COPD bronchial valve insertion

What’s the NHS cut off?

And what RV do ERS suggest gets benefit?

Answer 21

NHS cut off >150%

ERS says likely to get benefit >175%

Question 22

Which types of COPD patient were shown to have survival benefit from lung reduction surgery

Answer 22

heterogenous upper lobe predominant empysema
high degree of hyperinflation RV >200
low exercise capacity

Question 23

Differences in COPD if you have HIV

Answer 23

pt’s who smoke are 20-30% more likely to get COPD
Develops at earlier age
Higher symptom burden

Question 24

Which steroid inhalers should be avoided in HIV w ARVs

Answer 24

Fluticasone
Budesonides

(protease inhibitors)

Question 25

Which steroid inhalers are ok in HIV w ARVs

Answer 25

Beclomethasone Does doesn't need adjusting

Question 26

Beta blockers in COPD patients

Answer 26

Fine in theory could inhaler beta agonist inhalers, but positive effect on mortality so go for it

Question 27

How to adjust pulmonary rehab if AAA >5.5cm

Answer 27

Can still do it but not the resistance training

Question 28

When is hyperoxaemia beneficial

Answer 28

PTX Cyanide poisoning Carbon monoxide poisoning Cluster headache Sometimes in post op (but controversial)

Question 29

Breathlessness in palliative care When to give oxygen vs opiods

Answer 29

oxygen only if sats <90% or have been shown to get significant improvement in sx from oxygen

Question 30

Which patients are likely to benefit from endobronchial valves

Answer 30

Heterogenous emphysema Intact interlobar fissures

Question 31

Which patients are likely to benefit from Endobronchial coils (research setting)

Answer 31

Homogenous empyhsema Not suitable for other methods

Question 32

Who should get the pneumococcal vaccine

Answer 32

Over 65s at risk inc COPD One off Patients with chronic disease should be offered re-vaccination every 5 years

Question 33

How many strains does the pneumococcal vaccine defend against

Answer 33

23

Question 34

Most common bugs IECOPD

Answer 34

H influenzae S pneumoniae M catarrhalis

Question 35

Best predictor of future COPD exacerbations

Answer 35

Previous exacerbations

Question 36

4 phenotypes of COPD exacerbations

Answer 36

Inflammatory (eosinophilic) Pacui-inflammatory Viral Bacterial

Question 37

Best way to distinguish viral vs bacterial IECOPD

Answer 37

CRP

Question 38

What's the best predictor of survival in a ECOPD

Answer 38

pH

Question 39

Which bugs are you particularly at risk of with an FEV1 <50% in COPD

Answer 39

P aeruginosa H influenzae 6x more likely to get

Question 40

DECAF score Acute Ex COPD: What is it and what does it show

Answer 40

Dyspnoea Eosinopaenia Consolidation Acidaemia AF 0-6 score 0 mortality <1% 5 is >70%

Question 41

How many exacerbations do you need to be Group E in COPD

Answer 41

2 or 1 hospitalisation

Question 42

What breathlessness score makes you Group B COPD

Answer 42

2+

Question 43

Rx if not severely exacerbating and not too SOB ie Group A

Answer 43

SABA/bronchodilator

Question 44

Rx if SOB but not too much exacerbating (ie Group B)

Answer 44

LABA + LAMA

Question 45

Rx for SOB and exacerbating ie Group E

Answer 45

LABA+LAMA ICS only if eosinophils >0.3

Question 46

Features of asthma or EIB but not responding to steroids and normal spiro/FeNo

Answer 46

Vocal cord dysfunction

Question 47

MOA Romifluast

Answer 47

Phosphodiesterase inhibitor Stops breakdown of cAMP benra/mepo/dupilizumab as being trialled

Question 48

What's considered an adequate response to AOT

Answer 48

2 of 3 of - sats coming up to 90%+ - 10%+ increasing walking distance from baseline - improvement in BORG of at least 1 point front baseline