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Common Chronic Obstructive Pulmonary Disease (COPD) exam questions for medical finals, OSCEs and MRCP PACES


Question 1.

What is the micro-pathology of COPD?

  • Hypertrophy and hyperplasia of mucus-secreting goblet cells of bronchial tree
  • Fibrosis and thickening of bronchial walls
  • Lymphocytic infiltrate
  • Emphysema – Dilatation and destruction of lung tissue distal to terminal bronchiole leading to reduced elasticity and gas exchange surface


Question 2.

What is the basic differential diagnosis of COPD?

  • Asthma
  • Bronchiectasis
  • Lung cancer
  • In acute exacerbations:
    • Pneumothorax
    • Pneumonia
    • Pulmonary oedema
    • Large pleural effusion
    • PE


Question 3.

How would you manage an acute exacerbation of COPD?

  • ABCDE approach
    • Monitoring, iv access, bloods (consider theophylline level)
    • Early CXR and ABG
  • Oxygen
    • Titrated to maintain sats within individualised target range
      • Usually 88-92% if unsure
    • ABG to ensure not retaining CO2
  • Bronchodilators
    • Salbutamol 5mg
      • Nebulised (or inhaled via spacer – equally effective)
      • Can run back to back
    • Ipratropium 0.5mg
      • No evidence this is more effective than salbutamol but given anyway
  • Prednisolone 30mg
    •  7-14 days
  • Antibiotics
    • If febrile, sputum purulent or signs of consolidation
      • Treat as pneumonia if consolidation on CXR
      • Empirical treatment – aminopenicillin, macrolide or tetracycline – refer to local guidelines
  • IV Thephylline
    • Only if no response to bronchodilator therapy


Question 4.

What would you do to manage COPD if these medical steps fail?

  • Non-invasive ventilation (CPAP or BiPAP)
    • In patients who are still hypercapnic and hypoxic despite medical therapy
    • Has been shown to improve survival
    • Must clearly document plan for what should happen if further deterioration and ceiling of treatment
    • Contraindications
      • Confusion or agitation
        • Unless this is due to high CO2
      • Severe dementia
      • Facial burns or trauma
      • Vomiting
      • Undrained pneumothorax
      • Copious secretions
      • Haemodynamically unstable, moribund or low GCS
        • Unless in HDU
      • Upper GI surgery or obstruction
  • Can use doxapram if NIV not available or inappropriate
    • Stimulant of chemoreceptors. CI in epilepsy.
  • Invasive ventilation
    • Careful consideration regarding whether appropriate
    • Close liaison with ITU team