Module 3- COPD/TB

Question 1

COPD

Answer 1

Common, treatable, preventable
clinical syndrome of chronic respiratory symptoms, structural pulmonary abnormalities, impaired lung function arising from multiple causes that result in airflow limitation that is not fully reversible

Question 2

Causes of COPD

Answer 2

Smoking and biomass fuel cooking
hereditary factors- alpha I antiprotease

Question 3

Symptoms and Sign of COPD

Answer 3

normally 5th or 6th decade of life
excessive cough, sputum productive and shortness of breath
if dx early absence of smoking will reduce decline in lung function
Dyspnea is mild on exertion at the start but in severe disease dyspnea occur at rest
Pink puffers vs blue bloaters

Question 4

Exacerbations of COPD

Answer 4

commonly precipitated by infection or environmental factors

Question 5

Prevention of COPD

Answer 5

preventable through elimination of longterm exposure to tobacco, products of combustion of biomass fuels, and other inhaled toxins

Question 6

High Risk indicators of COPD

Answer 6

FEV1 less than 50% of predicted
two or more exacerbations within pervious year
one or more hospitalizations for COPD exacerbations in the pervious year

Question 7

Smoking cession

Answer 7

single most important intervention

Question 8

Oxygen Therpay

Answer 8

for resting hypoxemia- PaC02 < 56mm hg
include longer survival, reduced hospitalizations and better quality of life

Question 9

inhaled bronchodilators

Answer 9

do not alter decline in lung function
SAMA 1st line due to longer duration of action
SABA offer more rapid onset but more side effects
does not improve dyspnea
LAMA- 1st line in mild disease- more severe LAMA/LABA initated

Question 10

Corticosteroids

Answer 10

ICS- not first line but can be added to LABA
if stable for 2 years remove ICS
No oral steroid unless acute exacerbation present

Question 11

Theophylline

Answer 11

4th line defense- improves dyspnea, exercise and pulmonary function, benefits are from bronchodilation, anti-inflammatory properties and extra-pulmonary effects
toxicity concerns
Last resort

Question 12

Antibiotics of COPD

Answer 12

Treat acute exacerbation, to treat acute bronchitis and prevent acute exacerbation of chronic bronchitis
Increased sputum will benefit from abx

Question 13

Abx choices for COPD

Answer 13

Treat pseudomonas aeruginosa
doxy, trimethoprim, cephalosporin, macrolide, fluoroquinolone, augmentin
3-5 days

Question 14

Pulmonary rehabilitation

Answer 14

graded aerobic physical exercise programs

Question 15

phosphodiesterase 4 inhibitor

Answer 15

Rofumilast- reduce exacerbation frequently

Question 16

Procedures for COPD

Answer 16

lung transplant
lung volume reduction surgery
bullectomy

Question 17

When to refer for COPD

Answer 17

COPD before age 40, frequent excerbautions, severe or rapid disease, need for long-term o2, disproportionate symptoms, onset of comorbid illness

Question 18

When to admit for COPD

Answer 18

severe symptoms, acute hypoxemia/hypercapnia/peripheral edema/change in mental status

Question 19

Pulmonary tuberculosis

Answer 19

causes by M. tuberculosis
Transmitted by inhaled airborne droplet nuclei containing viable organisms

Question 20

Risk Factors of TB

Answer 20

disadvantage populations
malnourished, homeless, overcrowded and substandard housing, HIV

Question 21

Primary TB

Answer 21

clinically and radiographically silent, most people with intact T cell medicated responses limit multiplication and spread but doesn’t eradicated disease but lies dormant

Question 22

Latent TB infection

Answer 22

do not have an active disease and cannot transmit the organism to others, but reactivation of disease may occur if immune defense are impaired

Question 23

Active TB

Answer 23

5-15% of individuals with latent TB who are not give preventive therapy,

Question 24

Drug resistant TB

Answer 24

resistant to one of the first line drugs, either isoniazid or rifampin

Question 25

Multidrug resistant TB

Answer 25

resistant to both isoniazid and rifampin and possibly other agents

Question 26

Extensively drug resistant TB

Answer 26

resistant to isoniazid, rifampin, fluoroquinolone and either aminoglucoside or capreomycin or both

Question 27

Signs and Symptoms of TB

Answer 27

slowly progressive constitutional symptoms- malaise, anorexia, weight loss, fever, and night sweats. Chronic cough most common- dry at first but becomes productive of purulent sputum,

Question 28

Lab Findings of TB

Answer 28

Cx- from 3 consecutive morning sputum, acid fast staining of sputum smear,
Nucleic acid amplification- detects & identifies resistance markers- allows for early isolation/treatment

Question 29

Imaging for TB

Answer 29

pulmonary TB can not be distinguish btw primary and latent

Question 30

Test for latent TB

Answer 30

Tuberculin skin test- transverse width in mm of induration measured in 48-72 hours
Interferon gamma release assays- no more sensitive that skin test

Question 31

Treatment of Latent TB- 1 medication

Answer 31

Isoniazid- 9 month oral regimen preferable to 6 months, daily dose of 300mg or 2xWkly dose of 15mg/kg
supplement of B6 for high risk patient for neuropathy

Question 32

Treatment for Latent TB 2 Medicaitons

Answer 32

Isoniazid/Rifampin- 3 month regimen daily (300/600)
Isoniazid/Rifampin- 3 month once weekly (15mg/kg & 15-30 mg/kg)

Question 33

Tx for latent TB if intolerable to Isoniazid

Answer 33

Rifampin- 4 months daily at 400mg

Question 34

Tx of HIV positive pt

Answer 34

Refer to HIV spec, need to be treated for 12 months

Question 35

COPD Treatment

Answer 35

Bronchodilator- LABA/LAMA- LAMA- LAMA/LABA or ICS/LABA

Question 36

Dyspnea with COPD

Answer 36

LABA or LAMA
then- LABA and LAMA or LABA and ICS then
LABA + LAMA + ICS
Consider switching inhaler device or investigate other causes

Question 37

exacerbation w/COPD

Answer 37

LABA or LAMA then
LABA +LAMA or LABA + ICS then
LABA + LAMA + ICS then
Roflumilast or Zithromax- former smokers

Question 38

SABA (short acting beta2 agonists

Answer 38

Fenoterol, Levalbuterol, Salbutamol, Terbutaline

Question 39

LABA (Long acting Beta2 agonists)

Answer 39

Arformoterol, Formoterol, Indacaterol, olodaterol, salmeterol

Question 40

SAMA (short acting anticholinergics)

Answer 40

Ipratropium bromide, oxitropium bromide

Question 41

LAMA (long acting anticholinergics)

Answer 41

Aclidinium Bromide, Glycopyrronium bromide, Tiotropium, Umeclidnium, glycopyrrolate, revefenacin

Question 42

Combination SABA and SAMA

Answer 42

Fentoterol/ipratropium
salbutamol/ipratropium