Podcast
Questions and Answers
Which of the following physical exam findings is MOST suggestive of emphysema?
Which of the following physical exam findings is MOST suggestive of emphysema?
- Increased anterior-posterior (AP) diameter
- Distant heart sounds
- Pursed-lip breathing
- All of the above (correct)
A patient with a long history of progressive dyspnea and a nonproductive cough is described as a 'pink puffer.' Which of the following conditions is MOST likely?
A patient with a long history of progressive dyspnea and a nonproductive cough is described as a 'pink puffer.' Which of the following conditions is MOST likely?
- Pneumonia
- Emphysema (correct)
- Asthma
- Chronic Bronchitis
Which of the following radiographic findings is MOST characteristic of advanced emphysema?
Which of the following radiographic findings is MOST characteristic of advanced emphysema?
- Enlarged cardiac silhouette
- Increased bronchovascular markings
- Pleural effusion
- Flattened hemidiaphragms (correct)
A patient presents with a chronic productive cough for most days of the week, lasting for at least 3 months each year for the past 2 years. Pulmonary function tests are within normal limits. Which condition BEST explains these findings?
A patient presents with a chronic productive cough for most days of the week, lasting for at least 3 months each year for the past 2 years. Pulmonary function tests are within normal limits. Which condition BEST explains these findings?
Which of the following pathophysiological mechanisms BEST differentiates emphysema from chronic bronchitis?
Which of the following pathophysiological mechanisms BEST differentiates emphysema from chronic bronchitis?
Which of the following best describes the primary physiological abnormality in obstructive lung disease?
Which of the following best describes the primary physiological abnormality in obstructive lung disease?
A patient presents with a long history of cigarette smoking and symptoms consistent with both emphysema and chronic bronchitis. Which of the following terms is most appropriate to describe this patient's condition?
A patient presents with a long history of cigarette smoking and symptoms consistent with both emphysema and chronic bronchitis. Which of the following terms is most appropriate to describe this patient's condition?
Regarding COPD mortality in the United States, which statement is most accurate based on the information provided?
Regarding COPD mortality in the United States, which statement is most accurate based on the information provided?
Which of the following is NOT typically associated with a higher prevalence of COPD?
Which of the following is NOT typically associated with a higher prevalence of COPD?
What is the approximate number of people living with COPD in the USA, based on data presented in the lecture?
What is the approximate number of people living with COPD in the USA, based on data presented in the lecture?
Among the ten leading causes of death in the United States, how does COPD uniquely stand out?
Among the ten leading causes of death in the United States, how does COPD uniquely stand out?
A researcher is investigating the impact of environmental factors on COPD development. Which of the following study designs would provide the least biased estimate of the true causal effect of long-term exposure to particulate matter (PM2.5) on COPD incidence, assuming all are equally feasible and ethical?
A researcher is investigating the impact of environmental factors on COPD development. Which of the following study designs would provide the least biased estimate of the true causal effect of long-term exposure to particulate matter (PM2.5) on COPD incidence, assuming all are equally feasible and ethical?
In a hypothetical scenario, a new genetic variant is discovered that confers complete protection against COPD, even in individuals with a severe smoking history. Assuming a 50% penetrance of this gene in the population and a hypothetical scenario where all smokers have the same smoking history, what would be the approximate decrease in COPD-related mortality if this gene were universally introduced?
In a hypothetical scenario, a new genetic variant is discovered that confers complete protection against COPD, even in individuals with a severe smoking history. Assuming a 50% penetrance of this gene in the population and a hypothetical scenario where all smokers have the same smoking history, what would be the approximate decrease in COPD-related mortality if this gene were universally introduced?
Which of the following is an established risk factor for COPD?
Which of the following is an established risk factor for COPD?
A patient presents with chronic cough, excess sputum production, and dyspnea. Physical exam reveals tachypnea and prolonged expiratory phase. Which condition is MOST likely?
A patient presents with chronic cough, excess sputum production, and dyspnea. Physical exam reveals tachypnea and prolonged expiratory phase. Which condition is MOST likely?
A patient with chronic bronchitis is likely to exhibit which of the following early signs due to a relatively undamaged pulmonary capillary bed?
A patient with chronic bronchitis is likely to exhibit which of the following early signs due to a relatively undamaged pulmonary capillary bed?
What is the primary anatomical characteristic of emphysema?
What is the primary anatomical characteristic of emphysema?
Which historical presentation is most indicative of chronic bronchitis?
Which historical presentation is most indicative of chronic bronchitis?
A patient with advanced chronic bronchitis is showing signs of altered mental status. What is the most likely cause of this?
A patient with advanced chronic bronchitis is showing signs of altered mental status. What is the most likely cause of this?
A patient with emphysema has decreased ability to oxygenate blood due to destruction of alveolar septae and pulmonary capillary bed. This leads to an increase in:
A patient with emphysema has decreased ability to oxygenate blood due to destruction of alveolar septae and pulmonary capillary bed. This leads to an increase in:
Which of the following physical exam finding is LEAST likely to be observed in a patient with COPD?
Which of the following physical exam finding is LEAST likely to be observed in a patient with COPD?
Which of the following physical exam findings is commonly associated with chronic bronchitis, specifically the 'blue bloater' phenotype?
Which of the following physical exam findings is commonly associated with chronic bronchitis, specifically the 'blue bloater' phenotype?
Centrilobular emphysema is MOST strongly associated with which risk factor?
Centrilobular emphysema is MOST strongly associated with which risk factor?
What electrocardiogram (EKG) finding is suggestive of right atrial enlargement (RAE) in a patient with cor pulmonale?
What electrocardiogram (EKG) finding is suggestive of right atrial enlargement (RAE) in a patient with cor pulmonale?
Panlobular emphysema is typically associated with which of the following conditions?
Panlobular emphysema is typically associated with which of the following conditions?
An arterial blood gas (ABG) result from a patient with chronic bronchitis shows increased CO2 and increased HCO3. What does this indicate?
An arterial blood gas (ABG) result from a patient with chronic bronchitis shows increased CO2 and increased HCO3. What does this indicate?
A patient with COPD and a PO2 < 60 mmHg may develop secondary polycythemia. Which CBC finding would confirm this?
A patient with COPD and a PO2 < 60 mmHg may develop secondary polycythemia. Which CBC finding would confirm this?
A 75-year-old patient with a history of smoking presents with increased dyspnea. Auscultation reveals distant breath sounds and hyperresonance to percussion. A chest X-ray demonstrates hyperinflation and flattened diaphragms. Based on these findings, which of the following arterial blood gas results would be MOST expected?
A 75-year-old patient with a history of smoking presents with increased dyspnea. Auscultation reveals distant breath sounds and hyperresonance to percussion. A chest X-ray demonstrates hyperinflation and flattened diaphragms. Based on these findings, which of the following arterial blood gas results would be MOST expected?
According to the GOLD guidelines, spirometry is indicated for individuals with cardinal symptoms of COPD. Which of the following combinations represents the most indicative set of symptoms prompting spirometry?
According to the GOLD guidelines, spirometry is indicated for individuals with cardinal symptoms of COPD. Which of the following combinations represents the most indicative set of symptoms prompting spirometry?
What is the primary use of serial spirometry in the context of COPD?
What is the primary use of serial spirometry in the context of COPD?
A patient's pulmonary function test reveals a decreased FEV1/FVC ratio. Which of the following additional findings would be most consistent with a diagnosis of COPD?
A patient's pulmonary function test reveals a decreased FEV1/FVC ratio. Which of the following additional findings would be most consistent with a diagnosis of COPD?
According to the American Thoracic Society staging for COPD, what FEV1 percent predicted value defines Stage III, or severe disease?
According to the American Thoracic Society staging for COPD, what FEV1 percent predicted value defines Stage III, or severe disease?
In a healthy individual, at what age does FEV1 typically reach its peak, and what is the average rate of annual decline thereafter?
In a healthy individual, at what age does FEV1 typically reach its peak, and what is the average rate of annual decline thereafter?
At what point does a COPD patient typically experience exertional dyspnea based on their predicted FEV1?
At what point does a COPD patient typically experience exertional dyspnea based on their predicted FEV1?
Why is smoking cessation highly recommended for individuals diagnosed with COPD?
Why is smoking cessation highly recommended for individuals diagnosed with COPD?
Which of the following is the most accurate description regarding the mechanism and effect of Albuterol?
Which of the following is the most accurate description regarding the mechanism and effect of Albuterol?
A patient with COPD is prescribed both a short-acting beta-agonist and an inhaled anticholinergic. What is the primary rationale for combining these two drug classes?
A patient with COPD is prescribed both a short-acting beta-agonist and an inhaled anticholinergic. What is the primary rationale for combining these two drug classes?
Which of the following is a typical characteristic of emphysema on a chest X-ray?
Which of the following is a typical characteristic of emphysema on a chest X-ray?
A patient with suspected COPD presents with a long history of dyspnea, but a relatively recent onset of productive cough. Which condition is MOST likely?
A patient with suspected COPD presents with a long history of dyspnea, but a relatively recent onset of productive cough. Which condition is MOST likely?
Which of the following best explains why a patient with advanced emphysema might adopt a 'tripod' sitting position?
Which of the following best explains why a patient with advanced emphysema might adopt a 'tripod' sitting position?
A patient with a long history of smoking presents with symptoms of COPD. Pulmonary function tests show airflow obstruction. Which of the following additional findings would MOST strongly suggest a diagnosis of emphysema as the predominant component of their COPD?
A patient with a long history of smoking presents with symptoms of COPD. Pulmonary function tests show airflow obstruction. Which of the following additional findings would MOST strongly suggest a diagnosis of emphysema as the predominant component of their COPD?
In a patient with chronic bronchitis, increased mucus production and airway obstruction are primarily caused by which of the following pathophysiological processes?
In a patient with chronic bronchitis, increased mucus production and airway obstruction are primarily caused by which of the following pathophysiological processes?
What is the typical age range during which the prevalence of COPD peaks?
What is the typical age range during which the prevalence of COPD peaks?
Which of the following factors is considered an established risk factor for COPD?
Which of the following factors is considered an established risk factor for COPD?
Which of the following clinical findings is LEAST likely to be observed in a patient with emphysema?
Which of the following clinical findings is LEAST likely to be observed in a patient with emphysema?
Centrilobular emphysema is most strongly associated with which of the following risk factors?
Centrilobular emphysema is most strongly associated with which of the following risk factors?
Which of the following is an established risk factor for COPD, specifically related to a genetic abnormality?
Which of the following is an established risk factor for COPD, specifically related to a genetic abnormality?
A patient’s history includes chronic cough, excess sputum production, and dyspnea. On examination you note tachypnea, prolonged expiratory phase and wheezing. Which condition is MOST likely?
A patient’s history includes chronic cough, excess sputum production, and dyspnea. On examination you note tachypnea, prolonged expiratory phase and wheezing. Which condition is MOST likely?
Which of the following is the primary anatomical characteristic of emphysema?
Which of the following is the primary anatomical characteristic of emphysema?
What is the underlying mechanism by which emphysema causes a decreased ability to oxygenate blood?
What is the underlying mechanism by which emphysema causes a decreased ability to oxygenate blood?
Which of the following is NOT classified as an obstructive lung disease?
Which of the following is NOT classified as an obstructive lung disease?
What is the primary physiological characteristic of obstructive lung diseases?
What is the primary physiological characteristic of obstructive lung diseases?
What is the primary cause of COPD according to the information provided?
What is the primary cause of COPD according to the information provided?
Which statistic BEST reflects the impact of COPD in the United States?
Which statistic BEST reflects the impact of COPD in the United States?
Approximately how many people in the United States are living with COPD?
Approximately how many people in the United States are living with COPD?
Which demographic group has a higher prevalence of COPD?
Which demographic group has a higher prevalence of COPD?
Considering all the information provided, which statement BEST encapsulates the factors contributing to COPD prevalence?
Considering all the information provided, which statement BEST encapsulates the factors contributing to COPD prevalence?
Which of the following is the MOST likely cause of altered mental status in a patient with advanced chronic bronchitis?
Which of the following is the MOST likely cause of altered mental status in a patient with advanced chronic bronchitis?
A patient with chronic bronchitis presents with lower extremity edema, cyanosis, and jugular venous distention. Which of the following conditions is the MOST likely underlying cause of these findings?
A patient with chronic bronchitis presents with lower extremity edema, cyanosis, and jugular venous distention. Which of the following conditions is the MOST likely underlying cause of these findings?
Which of the following EKG findings is MOST suggestive of right ventricular hypertrophy (RVH) in a patient with cor pulmonale?
Which of the following EKG findings is MOST suggestive of right ventricular hypertrophy (RVH) in a patient with cor pulmonale?
Arterial blood gas (ABG) results for a patient with chronic bronchitis reveal elevated levels of both CO2 and HCO3. Which of the following BEST explains this pattern?
Arterial blood gas (ABG) results for a patient with chronic bronchitis reveal elevated levels of both CO2 and HCO3. Which of the following BEST explains this pattern?
A 60-year-old male with a 40-pack-year smoking history presents with complaints of chronic cough, shortness of breath, and fatigue. His oxygen saturation is 88% on room air. A complete blood count (CBC) reveals a hemoglobin of 16.8 g/dL and a hematocrit of 52%. Which of the following BEST explains these CBC findings?
A 60-year-old male with a 40-pack-year smoking history presents with complaints of chronic cough, shortness of breath, and fatigue. His oxygen saturation is 88% on room air. A complete blood count (CBC) reveals a hemoglobin of 16.8 g/dL and a hematocrit of 52%. Which of the following BEST explains these CBC findings?
A 55-year-old patient with a known history of COPD presents to the clinic for a routine follow-up appointment. The patient reports having increased dyspnea on exertion, and the provider orders spirometry. Which of the following is the MOST appropriate indication for spirometry in this scenario?
A 55-year-old patient with a known history of COPD presents to the clinic for a routine follow-up appointment. The patient reports having increased dyspnea on exertion, and the provider orders spirometry. Which of the following is the MOST appropriate indication for spirometry in this scenario?
A patient with a long-standing history of COPD presents to the emergency department with worsening dyspnea. An arterial blood gas reveals a pH of 7.20, PaCO2 of 70 mmHg, HCO3- of 28 mEq/L, and PaO2 of 55 mmHg. Which of the following acid-base disturbances BEST describes this patient's condition?
A patient with a long-standing history of COPD presents to the emergency department with worsening dyspnea. An arterial blood gas reveals a pH of 7.20, PaCO2 of 70 mmHg, HCO3- of 28 mEq/L, and PaO2 of 55 mmHg. Which of the following acid-base disturbances BEST describes this patient's condition?
A researcher aims to study the effects of chronic cough on quality of life in individuals without diagnosed respiratory conditions. What is the MOST suitable study design for this research question?
A researcher aims to study the effects of chronic cough on quality of life in individuals without diagnosed respiratory conditions. What is the MOST suitable study design for this research question?
Which of the following is the MOST important use of serial spirometry in COPD management?
Which of the following is the MOST important use of serial spirometry in COPD management?
A patient with COPD has an FEV1 that is 42% of their predicted value. According to the American Thoracic Society staging, this patient would be classified as having:
A patient with COPD has an FEV1 that is 42% of their predicted value. According to the American Thoracic Society staging, this patient would be classified as having:
A 68-year-old patient with a 40-pack-year smoking history is diagnosed with COPD. At what age did this patient's FEV1 likely reach its peak, assuming a typical natural history?
A 68-year-old patient with a 40-pack-year smoking history is diagnosed with COPD. At what age did this patient's FEV1 likely reach its peak, assuming a typical natural history?
At what point in the progression of COPD does a patient typically start to experience exertional dyspnea, based on their predicted FEV1?
At what point in the progression of COPD does a patient typically start to experience exertional dyspnea, based on their predicted FEV1?
What is the expected effect of smoking cessation on the rate of FEV1 decline in a patient newly diagnosed with COPD?
What is the expected effect of smoking cessation on the rate of FEV1 decline in a patient newly diagnosed with COPD?
Which of the following is the primary mechanism of action of Albuterol in the treatment of COPD?
Which of the following is the primary mechanism of action of Albuterol in the treatment of COPD?
A patient with COPD is prescribed both Albuterol and Ipratropium. What is the MOST likely rationale for using these two medications in combination?
A patient with COPD is prescribed both Albuterol and Ipratropium. What is the MOST likely rationale for using these two medications in combination?
Which of the following spirometry results is MOST consistent with a diagnosis of COPD, especially when considering disease progression?
Which of the following spirometry results is MOST consistent with a diagnosis of COPD, especially when considering disease progression?
Which of the following spirometry findings is NOT characteristic of COPD?
Which of the following spirometry findings is NOT characteristic of COPD?
Which of the following is the most important intervention to slow the progression of emphysema?
Which of the following is the most important intervention to slow the progression of emphysema?
Which feature is more characteristic of chronic bronchitis compared to emphysema?
Which feature is more characteristic of chronic bronchitis compared to emphysema?
Which pulmonary function test (PFT) result differentiates asthma from COPD?
Which pulmonary function test (PFT) result differentiates asthma from COPD?
Which of the following is the primary mechanism of airflow obstruction in emphysema?
Which of the following is the primary mechanism of airflow obstruction in emphysema?
Which of the following criteria defines chronic bronchitis?
Which of the following criteria defines chronic bronchitis?
Which of the following is NOT considered a probable or established risk factor for COPD?
Which of the following is NOT considered a probable or established risk factor for COPD?
Which of the following physical exam findings is more specific to emphysema compared to chronic bronchitis?
Which of the following physical exam findings is more specific to emphysema compared to chronic bronchitis?
A 22-year-old male presents with an acute asthma exacerbation. Which of the following treatments should be administered first?
A 22-year-old male presents with an acute asthma exacerbation. Which of the following treatments should be administered first?
Which pulmonary function test (PFT) result confirms the diagnosis of asthma?
Which pulmonary function test (PFT) result confirms the diagnosis of asthma?
Which of the following mechanisms is LEAST likely to contribute to airflow limitation in COPD?
Which of the following mechanisms is LEAST likely to contribute to airflow limitation in COPD?
Which of the following medications is routinely used in asthma but NOT typically used as monotherapy in COPD?
Which of the following medications is routinely used in asthma but NOT typically used as monotherapy in COPD?
Which of the following best describes the change in FEV1 in obstructive lung diseases?
Which of the following best describes the change in FEV1 in obstructive lung diseases?
Which of the following spirometry findings confirms reversible airway obstruction consistent with asthma?
Which of the following spirometry findings confirms reversible airway obstruction consistent with asthma?
Which of the following is the primary cause of airflow limitation in chronic bronchitis?
Which of the following is the primary cause of airflow limitation in chronic bronchitis?
According to GOLD guidelines, which classification corresponds to an FEV1 of 55% predicted in a patient with COPD?
According to GOLD guidelines, which classification corresponds to an FEV1 of 55% predicted in a patient with COPD?
Which of the following is NOT typically required to diagnose asthma?
Which of the following is NOT typically required to diagnose asthma?
Which of the following features is more characteristic of COPD than asthma?
Which of the following features is more characteristic of COPD than asthma?
A patient with COPD and chronic respiratory failure is prescribed long-term oxygen therapy. Which of the following PaO2 levels indicates the need for oxygen therapy according to GOLD guidelines?
A patient with COPD and chronic respiratory failure is prescribed long-term oxygen therapy. Which of the following PaO2 levels indicates the need for oxygen therapy according to GOLD guidelines?
Which of the following is a hallmark sign of an acute COPD exacerbation?
Which of the following is a hallmark sign of an acute COPD exacerbation?
Which of the following conditions is LEAST likely to present with a decreased FEV1/FVC ratio?
Which of the following conditions is LEAST likely to present with a decreased FEV1/FVC ratio?
Which of the following treatments is indicated during an acute COPD exacerbation?
Which of the following treatments is indicated during an acute COPD exacerbation?
Which of the following physical exam findings is more common in chronic bronchitis than emphysema?
Which of the following physical exam findings is more common in chronic bronchitis than emphysema?
Which of the following ABG results is most likely during an acute asthma exacerbation?
Which of the following ABG results is most likely during an acute asthma exacerbation?
Which of the following mediators plays the most significant role in bronchoconstriction during an asthma attack?
Which of the following mediators plays the most significant role in bronchoconstriction during an asthma attack?
Which of the following spirometry results confirms a diagnosis of COPD according to GOLD criteria?
Which of the following spirometry results confirms a diagnosis of COPD according to GOLD criteria?
Which of the following is NOT a common trigger for asthma exacerbations?
Which of the following is NOT a common trigger for asthma exacerbations?
Which of the following pulmonary function test (PFT) findings is characteristic of lung hyperinflation in COPD?
Which of the following pulmonary function test (PFT) findings is characteristic of lung hyperinflation in COPD?
A 45-year-old non-smoker presents with early-onset emphysema. Which of the following laboratory tests is most appropriate to evaluate for an underlying cause?
A 45-year-old non-smoker presents with early-onset emphysema. Which of the following laboratory tests is most appropriate to evaluate for an underlying cause?
Which of the following findings differentiates emphysema from asthma on pulmonary function testing?
Which of the following findings differentiates emphysema from asthma on pulmonary function testing?
In emphysema, the disease process is characterized by which of the following?
In emphysema, the disease process is characterized by which of the following?
Which of the following represents an obstructive pattern of impairment during spirometry?
Which of the following represents an obstructive pattern of impairment during spirometry?
A 54-year-old obese woman presents with the chief complaint of hemoptysis. She states that over the last day she has coughed up approximately 10 cc of blood-streaked sputum. She denies any fever, chills, chest pain, or shortness of breath. Which of the following is the most likely diagnosis?
A 54-year-old obese woman presents with the chief complaint of hemoptysis. She states that over the last day she has coughed up approximately 10 cc of blood-streaked sputum. She denies any fever, chills, chest pain, or shortness of breath. Which of the following is the most likely diagnosis?
A 59-year-old woman presents complaining of a cough productive of sputum for nearly 10 years. Her cough occurs during the day, and she produces sputum daily. Which of the following is the most likely diagnosis?
A 59-year-old woman presents complaining of a cough productive of sputum for nearly 10 years. Her cough occurs during the day, and she produces sputum daily. Which of the following is the most likely diagnosis?
A 70 y/o man with a history of COPD presents complaining of worsening shortness of breath for the last several days. Which of the following is the most likely diagnosis?
A 70 y/o man with a history of COPD presents complaining of worsening shortness of breath for the last several days. Which of the following is the most likely diagnosis?
The goal(s) of the treatment of asthma is/are
The goal(s) of the treatment of asthma is/are
A 22-year-old male comes to your office for assessment of a chronic cough. What is is the most likely diagnosis in this patient?
A 22-year-old male comes to your office for assessment of a chronic cough. What is is the most likely diagnosis in this patient?
Although asthma is a heterogeneous disease, a given individual with asthma would be most likely to
Although asthma is a heterogeneous disease, a given individual with asthma would be most likely to
A 22-year-old female presents to the emergency department with extreme shortness of breath after jogging. The most likely diagnosis is:
A 22-year-old female presents to the emergency department with extreme shortness of breath after jogging. The most likely diagnosis is:
Which of the following factors may precipitate an asthma attack?
Which of the following factors may precipitate an asthma attack?
Which of the following is(are) included in the working definition of asthma
Which of the following is(are) included in the working definition of asthma
Which of the following pulmonary function tests is the most useful for the diagnosis of asthma?
Which of the following pulmonary function tests is the most useful for the diagnosis of asthma?
In emphysema, the single most important factor in slowing the inevitable decline in forced expiratory volume in 1 second (FEV1) and improving life expectancy and quality of life is:
In emphysema, the single most important factor in slowing the inevitable decline in forced expiratory volume in 1 second (FEV1) and improving life expectancy and quality of life is:
Flashcards
Chronic Bronchitis Lung Involvement
Chronic Bronchitis Lung Involvement
Affects all lung fields, particularly the bases.
Emphysema Lung Involvement
Emphysema Lung Involvement
Affects primarily the upper lobes.
Emphysema Pathophysiology (Specific)
Emphysema Pathophysiology (Specific)
Loss of respiratory bronchioles in proximal portion of alveolus, with sparing of distal alveoli.
Chronic Bronchitis Pathophysiology
Chronic Bronchitis Pathophysiology
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Chronic Bronchitis Clinical Definition
Chronic Bronchitis Clinical Definition
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COPD prevalence peak age
COPD prevalence peak age
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Established COPD risk factors
Established COPD risk factors
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Probable COPD risk factors
Probable COPD risk factors
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Possible COPD risk factors
Possible COPD risk factors
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COPD disease processes
COPD disease processes
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Common COPD symptoms
Common COPD symptoms
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Common COPD physical exam findings
Common COPD physical exam findings
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Emphysema definition
Emphysema definition
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Obstructive Lung Disease (OLD)
Obstructive Lung Disease (OLD)
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COPD Definition
COPD Definition
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What conditions make up COPD?
What conditions make up COPD?
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OLD: Expiratory Flow
OLD: Expiratory Flow
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OLD: Functional Residual Capacity (FRC)
OLD: Functional Residual Capacity (FRC)
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Primary Cause of COPD
Primary Cause of COPD
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COPD Mortality Rank
COPD Mortality Rank
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COPD: Mortality Trends & Prevalence
COPD: Mortality Trends & Prevalence
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Chronic Bronchitis Presentation
Chronic Bronchitis Presentation
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Chronic Bronchitis - PE Findings
Chronic Bronchitis - PE Findings
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CXR Findings in Chronic Bronchitis
CXR Findings in Chronic Bronchitis
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EKG Findings in Cor Pulmonale
EKG Findings in Cor Pulmonale
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ABG in COPD
ABG in COPD
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Lab Findings in COPD
Lab Findings in COPD
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Cardinal Symptoms of COPD
Cardinal Symptoms of COPD
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Spirometry in COPD/Asthma
Spirometry in COPD/Asthma
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Role of Spirometry in COPD
Role of Spirometry in COPD
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Typical PFTs in COPD
Typical PFTs in COPD
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ATS COPD Staging
ATS COPD Staging
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COPD Natural History (FEV1)
COPD Natural History (FEV1)
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COPD and Dyspnea
COPD and Dyspnea
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COPD Treatment - Medications
COPD Treatment - Medications
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Albuterol Mechanism in COPD
Albuterol Mechanism in COPD
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Smoking Cessation Benefits in COPD
Smoking Cessation Benefits in COPD
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Conditions Included in COPD
Conditions Included in COPD
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OLD: Key Physiological Abnormality
OLD: Key Physiological Abnormality
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Usual COPD Cause
Usual COPD Cause
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COPD Mortality (US)
COPD Mortality (US)
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COPD Prevalence (USA)
COPD Prevalence (USA)
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COPD Ranking
COPD Ranking
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Emphysema (anatomical definition)
Emphysema (anatomical definition)
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Emphysema Pathophysiology
Emphysema Pathophysiology
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Centrilobular Emphysema
Centrilobular Emphysema
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Panlobular Emphysema
Panlobular Emphysema
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Tachypnea in COPD
Tachypnea in COPD
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Pursed Lip Breathing
Pursed Lip Breathing
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Barrel Chest
Barrel Chest
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Tripod Posturing
Tripod Posturing
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Emphysema Historical Presentation
Emphysema Historical Presentation
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Emphysema Physical Exam Findings
Emphysema Physical Exam Findings
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Emphysema CXR Findings
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Emphysema CXR Sensitivity
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Spirometry in COPD
Spirometry in COPD
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COPD Stage III Severity
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COPD: Stage I
COPD: Stage I
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COPD Prediction Factors
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FEV1 Decline in COPD
FEV1 Decline in COPD
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FEV1 & Exertional Dyspnea
FEV1 & Exertional Dyspnea
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Albuterol's Impact on COPD
Albuterol's Impact on COPD
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Benefits of Smoking Cessation in COPD
Benefits of Smoking Cessation in COPD
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Chronic Bronchitis Late Stage Effects
Chronic Bronchitis Late Stage Effects
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Chronic Bronchitis - Late Stage Mental Changes
Chronic Bronchitis - Late Stage Mental Changes
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Cor Pulmonale Definition
Cor Pulmonale Definition
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ABG Changes in COPD
ABG Changes in COPD
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Spirometry Purpose
Spirometry Purpose
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Spirometry Indications
Spirometry Indications
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COPD Spirometry: DLCO
COPD Spirometry: DLCO
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Emphysema & Smoking
Emphysema & Smoking
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Chronic Bronchitis Hallmark
Chronic Bronchitis Hallmark
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Asthma vs. COPD: Bronchodilators
Asthma vs. COPD: Bronchodilators
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Emphysema: Airflow Obstruction
Emphysema: Airflow Obstruction
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Chronic Bronchitis Definition
Chronic Bronchitis Definition
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COPD Risk Factors: NOT
COPD Risk Factors: NOT
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Emphysema: Physical Exam
Emphysema: Physical Exam
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Asthma Exacerbation: First Step
Asthma Exacerbation: First Step
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Asthma Diagnosis: PFTs
Asthma Diagnosis: PFTs
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COPD: Airflow Limitation – NOT
COPD: Airflow Limitation – NOT
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COPD treatment:
COPD treatment:
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FEV1 and Obstructive Disease
FEV1 and Obstructive Disease
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Asthma: Spirometry Confirmation
Asthma: Spirometry Confirmation
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Chronic Bronchitis: Obstruction
Chronic Bronchitis: Obstruction
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COPD: GOLD 3 Definition
COPD: GOLD 3 Definition
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Asthma: Diagnosis Requirements
Asthma: Diagnosis Requirements
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COPD vs. Asthma Distinctions
COPD vs. Asthma Distinctions
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COPD: Oxygen Goals
COPD: Oxygen Goals
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COPD Exacerbations
COPD Exacerbations
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Fibrosis and FEV1/FVC Ratio
Fibrosis and FEV1/FVC Ratio
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What to treat COPD with
What to treat COPD with
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Chronic Bronchitis PE
Chronic Bronchitis PE
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ABG (acute asthma exacerbation)
ABG (acute asthma exacerbation)
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Asthma Mediations
Asthma Mediations
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COPD Diagnosis (GOLD)
COPD Diagnosis (GOLD)
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Asthma triggers:
Asthma triggers:
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COPD: lung hyperinflation.
COPD: lung hyperinflation.
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Emphysema (testing): underlying cause?
Emphysema (testing): underlying cause?
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Differntiating: emphysema and asthma
Differntiating: emphysema and asthma
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Study Notes
Obstructive Lung Disease Epidemiology
- COPD represents chronic, slowly progressive respiratory disorders.
- Airflow obstruction and increased FRC from trapped gas characterize COPD.
Obstructive Lung Disease Causes
- Cigarette smoking or chronic irritant inhalation commonly lead to COPD.
- COPD encompasses chronic bronchitis, emphysema, and asthma with each case presenting a unique combination.
COPD: Mortality and Morbidity
- COPD is the 4th leading cause of death in USA, leading to 120,000 deaths annually translating to one death every 4 minutes.
- Approximately 10 million people in the USA live with COPD, equaling the population of Michigan.
Chronic Bronchitis: Definition
- Chronic bronchitis is clinically defined as a productive cough on most days for at least 3 months over 2 consecutive years.
Chronic Bronchitis: Pathophysiology
- Excessive mucus production, airway obstruction, and hyperplasia of mucus-producing glands define the pathophysiology
- Inflammation and secretions cause the obstructive component.
- Hypoxemia, pulmonary hypertension, and cor pulmonale (RV failure) develop later
Chronic Bronchitis: Findings
- Frequent cough during the day and expectoration
- Auscultation often reveals coarse rhonchi and wheezing.
- Edema and cyanosis indicate RV failure (cor pulmonale)
COPD testing: ABG's
- HCO3 levels will be found increased
- Any pH below 7.3 is an acute respiratory disfunction.
Emphysema Classification
- Classified as either Centrilobular (primarily in smokers and upper lobes) or Panlobular (typically in alpha-1-antitrypsin deficiency and all lung fields especially in bases)
- Centrilobular involves loss of respiratory bronchioles in the proximal portion of alveoli, with sparing of distal alveoli
- Panlobular involves loss of all portions of alveolus from the respiratory bronchiole to the alveoli.
Emphysema: Historical Presentation
- Long history of progressive dyspnea with late onset of nonproductive cough
- Patients may experince mucopurulent productive cough with secondary infections
- Wheezing is commonly reported
- Progressive exercise intolerance and limitation of activities
- Eventual cachexia and late respiratory failure
Emphysema: Physical Exam Findings
- Pursued lips and dependency on accessory respiratory muscles to breathe properly -- Patients are typically Thin with barrel chest
- Can adopt a tripod position to assisst breating --The chest may be hyperresonant
- Heart sounds can be very distant, hence the common nickname "pink puffers"
CXR Emphysema
- CXR can be insensitive during early stages of some diseases
- Patients can show flat hemidiaphragms
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- Increase in retrosternal air space (hyperinflation)
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- Upper lobes become hyperlucent due to destruction of lung tissue(trapped air)
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- CXR is often insensitive, with abnormalities on PFT's is disproportionate
COPD CXR
- Elevated bronchovascular markings can be observed -- Second degree level âž” Cardiomegaly also Late BV failure
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- RVH âž” Right Ventricular hypertophpy, and higher puming pressures that cause
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- Lung Tissue loss also leading to fribrosis
COPD testing: EKG Findings
- Peaked P waves in inferior leads (2, 3, & aVF) indicating Right atrial enlargement(RAE)
- RAD is possible
COPD GOLD Criteria
- GOLD 1: Mild FEV1 is greater than or equal to 80% predicted.
- GOLD 2: Moderate FEV1 is 50-79% predicted.
- GOLD 3: Severe FEV1 is 30-49% predicted.
- GOLD 4: Very Severe FEV1 is less than 30% predicted.
COPD: Natural History
- Characterized by accelerated decline of FEV1 with aging
Long Term O2 therapy
- PaO2 < 55 mm Hg or SaO2 < 88%
- It reverse secondary polycthemia and
-
- May need supplement if SaO2 < 89% when HCT >55% and Cor Pulmonale/PHT
- Patients with resting awake PaO2 < 60 mmHg and and SaO2 < 90% May need supplement during exercise
Treatment
- Lung transplantation might be required and is more likely Asthma & other reversible airflow must be excluded when considering COPD
- It is important to to follow guidelines Alpha 1t âž” if have Alpha 1AT leves <11
Pharmacological treatment of COPD: Beta Agonist
- Albuterol, metaproterenol, terbutaline, isoetharine, levalbuterol are short acting.
- Salmeterol, formoterol are long acting.
- Beta-agonists are minimal effects and BP
Prophylaxis in COPD
- Amantadine for unvaccinated patients who are placed at risk
Salmeterol;
- DO NOT USE IN ACUTE EPISODE is long acting agent that can improve and produce longer lasting bronchodlation
- Has been shown to improve FEV1
- Onset action of 15 minutes and 12 hour window
Other COPD treatments
- Patients identified with α1-antitrypsin deficiency are eligible for treatment with α-Trypsin augmentation therapy.
Asthma: Incidence and Morality
- Asthma leads to 2 million ED visits/year and 500,000 hospital admissions/year.
- 5,000 deaths/year are due to asthma.
- It is 4-5% of adults have asthma
- 12-15% of school age children have asthma
- 80-90% develop symptoms by age 5 AND 50% are often free symptoms
- Most asthma deaths are preventable and often due to patient delays in seeking treatment.
Asthma: Clinical PathoPhysiology
- Increased sensitivity and responsiveness leads to inflammation that occurs in lower airways
- Airways are often hyperreactivity, reversible either spontaneous or with medications
- Wide range of severity Small and large airways are infiltrated with mast cells and eosinophils, leading to: Recurrent episodes of coughing/wheezing
- Bronchial inflammation and bronchial airway hyperresponsiveness to various stimuli
Asthma: Clinical Presentation Additional Info:
- Compare one side to the other sequentially
- Listen to the upper airway (trachea) Also if Note if may be very high pitched or or no air movement signals.
- Unilateral signals possible pneumothorax
- Wheezing = air is still being exchanged is a good thing! âž” check expiratory phase to see if obstructor is present
Asthma: Physical findings during PE
Elevated AP dimiteter is the indicator or trapping the air
PFT's in Asthma-
- PFT's to do to know; FE1/FVC, and DLCO levels to know airflow
- Patient of cooperation must-
- Most patients too sick to coorperate
- Patients in extremeis catnno coorperate in general
- reduction of FEV1 with administration indicates a severe disease is and of all things all deal with expiration (inversion)
- Should be used to know Air flow "FEV 1---IF ONLY ONE CAN BE OBTAINED"-
Asthma tests: LAB data to know
- CBC = for esoinphilia
- ABG and sputum analysis to know exasterbation
Labs with ABG
- Hpoxemai and hypo carbia indicate initially
- Can present normally or with low value
- Note taht elevated levels and normal PCO is very worrisome*âž” "Worriosme" and may result in intubation
COPD:
- The main goal is to not have problems, âž” nocuturnal sympotms and normal level
Factors that influence reaction
- Allergy factor
- Pharm agent + Beta blockers
- Sulfites Food
- Pollution from smoke
Factors that precipitate the reation
- Respiratory traact and or infection
- Weathers
- SMOke + Allergens also STRESS related
Acute = with selecited beta agent every 20-30
Treatment for all Asthma;
- Goal of Asthma treatment and therapy can be acheived when patinets have minimal;
- Intermittent Quick-acting inhaled beta-2-selective adrenergic agonist such as albuterol
- Mild persistent Daily long-term controller: low dose of corticosteroid
- Moderate persistent = Low doses of inhaled glucocorticoid plus a long-acting inhaled beta agonist or medium doses of an inhaled glucocorticoid
- Severe persistent =Medium (Step 4) or high (Step 5) doses of an inhaled glucocorticoid, in combination with a long-acting inhaled beta-agonist
Medications : Corticosteroids;
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Do not decrease frequency but rather decrease severity & REDUCE THE NEED FOR hospitalization Ameliroates systemic side effects and intended chronci usage also intended for chronci usage.
-
Systemtic- not as well for asthma but exaserbations Long is bad but has as long term: HTN, Osteoperorsis
Bronchiasis :
- 2 is inflammation and destitution for the damage that is the reason that structural is bad âž” infection/inflam
- Most for people
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Description
Test your knowledge of emphysema and chronic bronchitis with this quiz. Questions cover physical exam findings, radiographic characteristics, and underlying pathophysiology. Differentiate between these obstructive lung diseases based on key clinical and diagnostic features.
