COPD

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USMLE Step 2 Pulmonology (2a Obstructive Lung Disease) Flashcards on COPD, created by Aaron Samide on 05/18/2016.
Aaron Samide
Flashcards by Aaron Samide, updated more than 1 year ago
Aaron Samide
Created by Aaron Samide about 8 years ago
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Resource summary

Question Answer
Diagnosis of chronic bronchitis Chronic cough productive of sputum At least 3 months/yr for 2 consecutive yrs
Pathogenesis of obstruction secondary to chronic bronchitis - Excess mucus production narrows airways - Inflammation and scarring in airways, enlargement of mucous glands, and smooth muscle hyperplasia --> obstruction
How are alveolar walls destroyed in emphysema? Relative excess in protease (elastase) activity OR Deficiency of antiprotease (α1-antitrypsin) activity
Elastase & α1-antitrypsin Elastase is released from PMNs and macrophages and digests human lung α1-antitrypsin inhibits elastase
Most common early symptom of COPD Exertional dyspnea
What type of emphysema is typically associated with smoking? Centrilobular Destruction limited to proximal acini with little change in distal
What type of emphysema is associated with α1-antitrypsin deficiency Panlobular Destruction involves both proximal and distal acini
FEV1/FVC ratio in COPD <0.7
Increased or decreased in COPD? 1. FEV1 2. TLC 3. RV 1. FEV1 decreased 2. TLC increased 3. RV increased
To diagnose airway obstruction, patient must have a _______ or ________ TLC with a _________ FEV1. Normal or increased TLD with decreased FEV1
"Pink puffers" vs. "Blue bloaters" Which is which? Pink puffers - emphysema Blue bloaters - chronic bronchitis
Expiratory time is _________ in COPD. prolonged
GOLD staging of COPD Mild - FEV1 ≤ 80% predicted Moderate - FEV1 50-80% predicted Severe - FEV1 30-50% predicted Very severe - FEV1 <30%
Vital capacity is _____ in obstructive lung disease and ______ in restrictive. low and low
COPD leads to chronic respiratory _________ with metabolic ________ as a compensation. Respiratory acidosis Metabolic alkalosis
At around age ____, FEV1 decreases ___ to ____ mL/yr, in a non-smoker. Age 35 25-30 mL/yr
How does rate of decline of FEV1 change for a smoker when he/she quits smoking? Slows to that of a nonsmoker of the same age
Respiratory symptoms should improve within ______ of quitting smoking 1 year
Criteria for long-term oxygen therapy in COPD PaO2 55mmHg OR O2 sat ≤88% either at rest or during exercise OR PaO2 55 to 59mmHg plus polycythemia or evidence of cor pulmonale
_________ has more side effects than other bronchodilators and a narrow therapeutic index, but it is occasionally used for refractory COPD Theophylline
O2 saturation goal during acute COPD exacerbation 90-93%
3 complications of COPD - Acute exacerbations - Secondary polycythemia (HCT >55% in men or >47% in women) - Pulmonary HTN and cor pulmonale
T/F: Systemic corticosteroids should be used long-term only for patients with severe COPD. False; systemic corticosteroids should NOT be used long-term for COPD patients, event if disease is severe. Their only role is in acute exacerbations.
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