Introduction Defined as expectoration for > 3 months for > 2 consecutive years Pathophysiology overproduction of mucus due to inflammation central and peripheral airways involved results in hyperplasia of bronchiolar mucus glands and fibrosis of terminal bronchioles ciliary dysfunction Causes smoking chronic irritation promotes hyperplasia of mucus glands and increases mucus production toxicity of smoke destroys ciliated epithelium and replaces with squamous cells which ultimately reduces mucus clearance cystic fibrosis loss of CFTR function results in increased viscosity of mucus and decreased mucus clearance Presentation Symptoms dyspnea productive cough Physical exam wheezing and crackles on auscultation prolonged expiration classic pursed lip breathing "blue bloater" (end-stage) chronic alveolar hypoxia leads to pulmonary hypertension edematous due to right heart failure (end-stage) cyanosis of skin Evaluation Labs ABG during exacerbation shows hypoxemia and may show acute respiratory acidosis hypoxemia can stimulate increased erythropoetin production by the kidneys can see polycythemia with prolonged hypoxemia chronic respiratory acidosis Chest radiograph cardiomegaly (horizontally oriented) increased bronchial markings (due to mucus) Clinical diagnosis confirmed by lung biopsy (rarely indicated) ↑ Reid index gland layer > 50% of total diameter of bronchial wall bronchial wall measured from the surface epithelium to the beginning (but not including) the cartilaginous rings patch squamous metaplasia neutrophil infiltration Pulmonary function tests hallmark is obstruction ↓ FEV / FVC similar to emphysema ↑ TLC (less than emphysema) Treatment Conservative smoking cessation home oxygen Pharmacological bronchodilators and inhaled steroids for long-term maintenance systemic steroids and antibiotics for acute exacerbations roflumilast for severe disease Complications Pulmonary hypertension chronic alveolar hypoxia results in pulmonary vasoconstriction right side ventricular hypertrophy and failure (cor pulmonale) distended neck veins hepatomegaly
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.PL.15.138) A 70-year-old male with a 10-year history of COPD visits his pulmonologist for a checkup. Physical examination reveals cyanosis, digital clubbing, and bilateral lung wheezes are heard upon auscultation. The patient has a cough productive of thick yellow sputum. Which of the following findings is most likely present in this patient? QID: 100941 Type & Select Correct Answer 1 Decreased arterial carbon dioxide content 4% (4/102) 2 Increased pulmonary arterial resistance 70% (71/102) 3 Increased pH of the arterial blood 16% (16/102) 4 Increased cerebral vascular resistance 4% (4/102) 5 Increased right ventricle compliance 7% (7/102) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.PL.13.46) A 65-year-old male presents to your office complaining of worsening shortness of breath. He has experienced shortness of breath on and off for several years, but is noticing that it is increasingly more difficult. Upon examination, you note wheezing and cyanosis. You conduct pulmonary function tests, and find that the patient's FEV1/FVC ratio is markedly decreased. What is the most likely additional finding in this patient? QID: 100849 Type & Select Correct Answer 1 Decreased serum bicarbonate 5% (9/165) 2 Increased erythropoietin 66% (109/165) 3 Nasal polyps 5% (9/165) 4 Increased IgE 14% (23/165) 5 Pleural effusion 8% (13/165) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.PL.13.133) A 65-year-old male presents to the emergency department from his home complaining of dyspnea. He is alert and oriented. The following arterial blood gas readings are drawn: pH: 7.33 (Normal: 7.35-7.45), pCO2: 70 mmHg (Normal: 35-45 mmHg), HCO3 33 (Normal: 21-26 mEq/L) Which of the following is most likely to have produced this patient’s condition? QID: 100936 Type & Select Correct Answer 1 Panic attack 5% (4/78) 2 Mechanical ventilation 4% (3/78) 3 Diabetic ketoacidosis 12% (9/78) 4 Pulmonary embolus 17% (13/78) 5 Chronic obstructive bronchitis 62% (48/78) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (M1.PL.13.84) A 45-year-old man presents with a chronic productive cough that he has had for the past few years. He admits to having smoked 1 pack of cigarettes a day for the past 25 years. A chest radiograph reveals an enlarged heart. The patient's pulmonary function tests would be similar to that seen in a patient with: QID: 100887 Type & Select Correct Answer 1 Asymptomatic asthma 0% (0/69) 2 Silicosis 4% (3/69) 3 Emphysema 86% (59/69) 4 Coal worker's pneumonitis 9% (6/69) 5 Prior lung radiation 0% (0/69) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (M1.PL.13.65) A 68-year-old male smoker dies suddenly in a car accident. He had smoked 2 packs per day for 40 years. His past medical history is notable for a frequent, very productive cough, recurrent respiratory infections and occasional wheezing. He had no other medical problems. At autopsy, which of the following is most likely to be found in this patient? QID: 100868 Type & Select Correct Answer 1 Interstitial fibrosis of the lung 3% (2/58) 2 Pleural plaques 0% (0/58) 3 Increased number and activity of goblet cells 93% (54/58) 4 Ferruginous bodies 0% (0/58) 5 Mucous gland atrophy 3% (2/58) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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