COPD

Question 1

Sx COPD

Answer 1

Cough, dyspnea, decreased exercise tolerance, sputum production

Question 2

Ix + results COPD

Answer 2

Spirometry (FEV1, FVC)
<70% = obstructive
Low DLCO
R/O MI, CHF, anemia, bronchiectasis, TB, bronchiolitis
If young, no smoking history or transaminitis = check alpha 1 anti-trypsin deficiency

Question 3

FEV1 severity criteria - mild, mod, severe + v severe

Answer 3

FEV1 >80% = mild
FEV1 50-79% = moderate
FEV1 30-49% = severe
FEV1 <30% = very severe

Question 4

RF COPD

Answer 4

smoking, exposure to pollutants (wildfires), severe childhood resp disease

Question 5

Screening COPD

Answer 5

Spirometry in all smokers >40 w/ persistent cough, phlegm, wheeze, recurrent URT

Question 6

Management COPD

Answer 6

Encourage smoking cessation - Wellbutrin, NRT
Vaccinations (influenza, pneumococcal)
Refer to other health professionals
RT
Pulmonary rehab
Discuss wishes for aggressive treatment interventions
Discuss understanding of illness
Discuss prognosis
Clarify wishes relating to health status
Document medical goals
Maintenance:
Mild: SABA PRN
Moderate/ severe: LAMA + LABA (Inspiolto) OR ICS + LABA (Symbicort)
Home O2 for sats >90%
Pulmonary rehab if SOB with dual therapy

Question 7

Management of asthma COPD overlap

Answer 7

ICS + LAMA +/- LAMA

Question 8

Management of COPD exacerbation inc abx for simple, complicated or pseudo risk

Answer 8

Oxygen
Pred 30-50mg 5/7 no taper
Salbutamol 2.5-5mg neb
Ipratroprium 500mcg
Abx
Simple: amox 500mg TID or doxy 100mg BID
Complicated: amox-clav 875mg BID or levofloxacin 500mg once daily
Pseudomonas risk (chronic steroids, constant purulent sputum): ciprofloxacin 750mg BID

Question 9

Causes of COPDE

Answer 9

Infection (H influenza, S pneumonia, morazella catarrhalis)
CHF
Irritants
PE
MI

Question 10

Sx PNA

Answer 10

SOB, productive cough, fever, hemoptysis, pleuritic CP, sweats

Question 11

PNA exam findings

Answer 11

dullness to percussion, crackles, reduced AE

Question 12

RF for PNA

Answer 12

elderly, smoking, asthma, lung cancer, COPD, DM, alcoholism, recent abx use, hospitalisation within 3mo

Question 13

Ix for PNA

Answer 13

CXR PA/ lateral. If in hospital: blood culture, CBC, lytes, CRP, glucose, Cr, ALT, ABG

Question 14

Prevention of PNA

Answer 14

smoking cessation, hand washing, flu + pneumococcal vaX

Question 15

What to use to assess severity of PNA

Answer 15

PNA Severity Index or CURB-65

Question 16

What are the RF for unusual pathogens

Answer 16

Hx of TB
Exposure to birds
Travel
HIV infection
Aspiration

Question 17

Complications of PNA

Answer 17

Empyema
Pneumothorax

Question 18

Abx for PNA: regular, LTC, aspiration, 3mo-5yrs, 5-18yrs

Answer 18

Amoxicillin 1g TID x 5/7
+ doxycycline 100mg BID x1/7 then 100mg OD (if in LTC or has comorbid conditions)
Aspiration: amox clav 500mg TID
3mo-5yrs: amoxicillin 80mg/kg/d divided TID
5-18yrs: amoxicillin

Question 19

When to do contact tracing for PNA

Answer 19

TB
Nursing home residents
Legionnaires disease

Question 20

When to order FU CXR after PNA

Answer 20

necrotising or extensive PNA, or if smoker, alcohol abuse, COPD, wt loss or >40 y/o

Question 21

Common pathogens causing PNA

Answer 21

Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus
Moraxella catarrhalis
Mycoplasma pneumoniae (atypical)
Chlamydia pneumoniae (atypical)

Question 22

Rx for asthma COPD overlap

Answer 22

ICS + LAMA +/- LAMA