Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2.1) My Cards > 2. MTB Step 3 - COPD/Emphysema > Flashcards

2. MTB Step 3 - COPD/Emphysema Flashcards

Cards Complete Day 1: 4/30/19 * Day 2: 5/2/19 * Day 3: 5/10/19 * Day 4: 5/30/19 Day 5: 6/29/19

1
Q

PRESENTATION

What are (3) Common HPI Findings for COPD/Emphysema?

A
  1. Increased Shortness of Breath (SOB)
  2. In a Long-term Smoker
  3. With Decreased Exercise Tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MANAGEMENT

What is the ONLY way to Assess CO2 Retention in COPD/Emphysema (and therefore Critical that you perform in ALL patients presenting with Acute SOB)?

A

Arterial Blood Gas (ABG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MANAGEMENT

Acute episodes of Shortness of Breath (SOB) should be handled with which (4) Treatments?

A
  1. Albuterol (inhaled)
  2. Methylprednisolone (bolus)
  3. Ipratropium (inhaled)
  4. Oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MANAGEMENT

Acute episodes of Shortness of Breath (SOB) should receive which (3) Diagnostic Exams?

A
  1. Chest X-Ray (CXR)
  2. Arterial Blood Gas (ABG)
  3. Chest, Heart, Extremity, & Neurologic exams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MANAGEMENT

If Fever, Sputum, or new Infiltrate are present in a patient who also presents with Acute Shortness of Breath (SOB) which (2) Antibiotics should be Added, and Why?

A

add Ceftriaxone and Azithromycin for Community-Acquired Pneumonia (CAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MANAGEMENT

On CCS, why should you move the clock forward 15 - 30 minutes and Reassess AFTER giving Oxygen to a patient with COPD/Emphysema?

A

Oxygen may Worsen SOB in a patient with COPD by Eliminating Hypoxic Drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MANAGEMENT

Why should you NOT Intubate a patient with COPD solely due to CO2 Retention?

A
  • These patients often have Chronic CO2 Retention.
  • ONLY Intubate if there is a Worsening in pH i_ndicative of_ a WORSE Respiratory Acidosis.
  • Serum bicarbonate is often elevated due to metabolic alkalosis as compensation for chronic respiratory acidosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

FURTHER MANAGEMENT (IN OFFICE)

What are (5) Important Physical Findings in a patient with Chronic COPD/Emphysema?

A
  1. Barrell-shaped Chest
  2. Clubbing of Fingers
  3. Increased AP Diameter of Chest
  4. Loud P2 sound (sign of Pulmonary HTN)
  5. Edema (Decreased RV output due to Pulmonary HTN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FURTHER MANAGEMENT (IN OFFICE)

What are (3) ECG Findings in a patient with Chronic COPD?

A
  1. Right Axis Deviation (RAD)
  2. Right Ventricular Hypertrophy (RVH)
  3. Right Atrial Hypertrophy (RAH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

FURTHER MANAGEMENT (IN OFFICE)

What are (3) CXR Findings in a patient with Chronic COPD/Emphysema?

A
  1. Flattening of Diaphragm (due to hyperinflation of lungs)
  2. Elongated Heart
  3. Substernal Air Trapping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

FURTHER MANAGEMENT (IN OFFICE)

What are (2) CBC Findings in a patient with Chronic COPD/Emphysema?

A
  1. Increased Hematocrit
  2. Microcytic Reactive Erythrocytosis from Chronic Hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FURTHER MANAGEMENT (IN OFFICE)

What is (1) Chemistry Panel Finding in a patient with Chronic COPD/Emphysema?

A
  1. Increased Serum Bicarbonate due to Metabolic Compensation for Respiratory Acidosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FURTHER MANAGEMENT (IN OFFICE)

What are (2) ABG Findings in a patient with Chronic COPD/Emphysema?

A
  1. Increase in pCO2
  2. Decrease in pO2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

FURTHER MANAGEMENT (IN OFFICE)

What is meant by “being a member of the 50/50 club” in a patient with Chronic COPD/Emphysema?

A

the pCO2 is ~50 mmHg and the pO2 is also ~50 mmHg.

Example ABG for a patient with COPD:

  • pH: 7.35
  • pCO2 : 49
  • pO2 : 52
  • HCO3 : 32
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

FURTHER MANAGEMENT (IN OFFICE)

What is the Mechanism of Right Heart Enlargement in COPD/Emphysema?

A
  • Hypoxia in the lungs causes capillary constriction, in which precapillary sphincters in the lungs constrict to shunt blood away from hypoxic areas of the lung.
  • Since the hypoxia of COPD is global throughout the lung, this diffuse vasoconstriction increases pressure in the right ventricle and right atrium.
  • Over time, the result is hypertrophy of both chambers, leading to cor pulmonale, or right heart failure.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FURTHER MANAGEMENT (IN OFFICE)

What Pulmonary Function Test (PFT) Findings should you expect on the following measures in a patient with COPD/Emphysema?

  • Forced Expiratory Volume 1 (FEV1)
  • Functional Vital Capacity (FVC)
  • FEV1/FVC Ratio
  • Total Lung Capacity (TLC)
  • Residual Volume
  • DLCO
A
  • ↓ Forced Expiratory Volume 1 (FEV1)
  • ↓ Functional Vital Capacity (FVC)
  • ↓ FEV1/FVC Ratio
  • ↑ Total Lung Capacity (TLC)
  • ↑ Residual Volume
  • ↓ DLCO
17
Q

CHRONIC MEDICAL THERAPY FOR COPD

What are (5) Antimuscarinic Medications (LAMAs) used in the Treatment of Chronic COPD/Emphysema?

A
  1. Tiotropium
  2. Ipratropium
  3. Aclidinium
  4. Umeclidinium
  5. Glycopyrrolate
18
Q

CHRONIC MEDICAL THERAPY FOR COPD

What is (1) Short-Acting Beta-Agonist (SABA) used in the Treatment of Chronic COPD/Emphysema?

A

Albuterol (Inhaler)

19
Q

CHRONIC MEDICAL THERAPY FOR COPD

What are (5) Long-Acting Beta-Agonists used in the Treatment of Chronic COPD/Emphysema, but should NEVER be used alone?

A
  1. Salmeterol
  2. Formoterol
  3. Indacaterol
  4. Olodaterol
  5. Vilanterol
20
Q

CHRONIC MEDICAL THERAPY FOR COPD

What are the (2) Pneumococcal Vaccinations given to ALL patients with Chronic COPD/Emphysema and when are they given?

A

13-Polyvalent = to start

then

23-Polyvalent = 1 yr later

21
Q

CHRONIC MEDICAL THERAPY FOR COPD

What is the (1) Influenza Vaccination given to ALL patients with Chronic COPD/Emphysema?

A

Inactivated Vaccine: yearly

22
Q

CHRONIC MEDICAL THERAPY FOR COPD

What are the (2) Criteria for Long-Term Home Oxygen in patients with Chronic COPD/Emphysema?

A

pO2 < 55 mmHg

or

O2 Saturation < 88%

23
Q

CHRONIC MEDICAL THERAPY FOR COPD

What is the (1) Phosphodiesterase (PDE) Inhibitor medication given to patients with Chronic COPD/Emphysema?

A

Roflumilast

  • a PDE Inhibitor that provides a modest Anti-inflammatory effect and Relaxes smooth muscle.
  • The answer is Roflumilast ONLY when the question describes a patient who is still symptomatic despite SABAs, LABAs, LAMAs, and Inhaled Steroids.
24
Q

CHRONIC MEDICAL THERAPY FOR COPD

What is the Mechanism of Bicarbonate Increase in COPD/Emphysema?

A
  • COPD generates CO2 Retention.
  • CO2 Retention generates Respiratory Acidosis.
  • Chronic Respiratory Acidosis INCREASES new Bicarbonate generation at the Distal Tubule of the Kidney.

COPD = Bicarbonate Increase

2.1) My Cards (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions