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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
What is COPDThe airflow obstruction is usually progressive, not fully reversible, and does not change markedly over several months Not fully reversible is an important diagnostic marker The disease is predominantly caused by smoking
What is emphysemaA pathological process in which there is destruction of the terminal bronchioles and distal airspaces Leads to loss of alveolar surface area → Reduced ventilation
What can emphysema lead toDestruction of tissues removes ‘scaffolding’ support of small airways, which tend to collapse Leads to airflow obstruction Lung recoil reduced so lungs have higher resting expiratory level --> Hyperinflation Bullae can also burst leading to pneumothorax
What are the 2 types of emphysemaCentrilobular --> occurs primarily in the upper lobes due to loss of bronchioles Panlobular --> Involves all lung fields
What is chronic bronchitisChronic mucus hypersecretion --> frequent infections and a persistent cough This leads to increase amount of inflammation in the airways which leads to remodelling and narrowing of the airways
What are some causes of COPDVast majority in HICs due to smoking Alpha 1 antitrypsin deficiency --> young patients presenting with COPD Occupational exposure eg coal dust Pollution --> including indoor smoke pollution
What are some common symptoms of COPDCough and sputum production Followed by progressive breathlessness → dyspnoea Increasingly frequent exacerbations Breathlessness
What are some signs of COPDPursed lip breathing --> to increase pressure to keep the airways open Usage of accessory muscles Tachypnoea Wheezing/quiet breath sounds Hyperinflation
As the disease progresses what can happenCyanosis Carbon dioxide retention Right heart failure
What are some differences between Asthma and COPDSmoker or ex smoker → Almost every time in COPD but possibly in Asthma Symptoms under age of 65 → Rare in COPD and often in asthma Chronic cough → Common in COPD but not Asthma Nighttime waking with breathlessness → Common in Asthma not in COPD Significant day-day variability of symptoms → Common in Asthma not in COPD
What are some investigations you can runSpirometery Chest x-ray not diagnostic but can help High resolution CT scan can help to assess destruction in emphysema Arterial blood gases to assess respiratory failure Alpha-1 anti trypsin assay for younger patients
What is cor pulmonaleCor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale
What are some management plansSmoking cessation support Pulmonary rehabilitation Bronchodilators Diet Steroids Influenza vaccination Long term oxygen therapy in advanced disease Drugs such as : Beta-2 agonists , Antimuscarinics , Corticosteroids
What are some adverse effects of beta-2 agonistsTachycardia Tremor Anxiety Palpitations Hypokalaemia
What are some adverse effects of Anti-muscarinicsAcute glaucoma Urinary difficulty → urinary retention Atrial fibrillation Tachycardia
What are some adverse effects of corticosteroidsThin skin Bruising Diabetes / Osteoporosis Cataracts Increased weight
What are Blue bloaters and pink puffers mean?The” blue bloaters” represent those who have chronic bronchitis and the “pink puffers” represent patients with emphysema