#27 Arfoosh - Pulmonary Obstructive Disease

Question 1

Your patient comes in with dyspnea, chronic cough with sputum. How will you diagnose your suspicion of COPD?

Answer 1

Spirometry is required.
FEV1/FVC less than 0.70.

If there is variance on multiple visits it may be asthma related.

Question 2

BB is classified as a GOLD 1 and has had only 1 exacerbation this year. The mMRC score was 1 and CAT was 8. How would you treat this patient?

Answer 2

Group A: Low risk, less symptoms
SAMA prn
or
SABA prn

Question 3

ER is classified as a GOLD 2 and has had only 1 exacerbation this year. The mMRC score was 3 and CAT was 12. How would you treat this patient?

Answer 3

Group B: Low risk, more symptoms
LAMA
or
LABA

Question 4

OR is classified as a GOLD 4 and has had 3 exacerbations this year. The mMRC score was 1 and CAT was 9. How would you treat this patient?

Answer 4

Group C: High risk, Less Symptoms
ICS + LABA
or
ICA + LAMA

Question 5

TR is classified as a GOLD 3 and has had 2exacerbation this year. The mMRC score was 4 and CAT was 12. How would you treat this patient?

Answer 5

Group D: High risk, more symptoms

ICS + LABA and/or LAMA

Question 6

What vaccines would you recommend to a patient with COPD?

Answer 6

Influenza vaccine

Pneumococcal Polysaccharide Vaccine

Question 7

Your patient is hospitalized for acute exacerbation of COPD. You need to manage their respiratory acidosis and severity of their dyspnea. What could you do that would also decrease mortality and the need for intubation?

Answer 7

Noninvasive ventilation (NIV)

Question 8

What assessment would you not perform during an exacerbation of COPD?

Answer 8

spirometric test

Question 9

When do inhaled corticosteroids get added to treatment?

Answer 9

Group C and D

Question 10

When would you use supplemental O2?

Answer 10

PO2 less than 55
O2 saturation less than 88%
or PO2 56-59% with one of the following
*carpulmonale
*pulmonary HTN
* HCT>56%