Pulmonary

Question 1

Stage III COPD

Answer 1

FEV1/FVC < 70%
30% < FEV < 50%
Increased dyspnea, decreased exercise tol, fatigue, repeated exacerbations

Question 2

Stage II COPD

Answer 2

FEV1/FVC < 70%
50% < FEV1 < 80
dyspnea with exertion

Question 3

Tx Stage II COPD

Answer 3

Short acting bronchodilator PRN
One long-acting bronchodilator
rehabilitation

Question 4

Tx Stage I COPD

Answer 4

short acting bronchodilator PRN

Question 5

Stage I COPD

Answer 5

FEV1/FVC < 70%

FEV > or equal 80% predicted

Question 6

COPD is confirmed with the following sx

Answer 6

Airflow obstruction FEV1/FVC < 70%

FEV1 < 80% predicted

Question 7

Sx present with COPD

Answer 7

chronic cough, sputum production, dyspnea, prior exposure to cig smoke, dust, or chemicals

Question 8

Pneumonia - When to hospitalize - CRB-65

Answer 8

C = Confusion
R = RR > 30/min
B = BP < 90/60
65+ Age 65 or older

Question 9

How long after episode should a repeat Xray be obtained?

Answer 9

7-12 weeks

Question 10

Who should you order a F/U Xray after pneumonia?

Answer 10

Not needed unless over age 40 and a smoker. Purpose is to exclude underlying disease

Question 11

How long should you treat pneumonia?

Answer 11

5 days minimum, usually 10 days

Question 12

Pneumonia - Treatment if co-morbidities or abx in the last 90 days

Answer 12

suspect drug resistant strep pneumonia
Use quinalone - gemifloxacin, levofloxacin, moxifloxacin
OR - beta lactim + macrolide
OR beta lactim + docy

Question 13

Pneumonia - Treatment if otherwise healthy and no abx in the last 90 days

Answer 13

macrolide (azithromycin or clarithmycin
doxy
No NOT use quinolone
Target it ayipical organisms

Question 14

Atypical pneumonia organisms

Answer 14

m. pneumoniea “walking pneumonia”

chlamydophila pneumoniae

Question 15

Pneumonia - Most common CAP organism

Answer 15

s pneumoniae - rust colored sputum - most common cause of death from pneumonia

Question 16

What conditions make it important to have 2 doses of pneumonvax

Answer 16

immunocompromised - Lupus, RH, HIV

Question 17

4 rules pneumonia vaccine

Answer 17

#1 - Single dose age 65 all adults
#2 - Single dose in adults 19-64 with chronic illness
#3 - Highest risk 2 doses separated by 5 years
#4 - Adults who have had 1-2 doses before age 65 should have another dose at 65 as long as 5 years have passed

Question 18

Chronic illnesses that require extra pneumovax

Answer 18

CV disease, asthma, DM, liver disease, smoker, nursing home residents

Question 19

Reasons for chest Xray with acute cough

Answer 19

Abnormal VS
rales or consolidation
grather than 75 yo with cough
Fever - may not be present in the elderly

Question 20

concern with supraclavicular node

Answer 20

Always a big deal. Drains breast and chest. unilateral node = unilateral dx
Think malignancies

Question 21

Stage III COPD - Tx

Answer 21

Short acting bronchodilator PRN
Regular tx with one or more long acting bronchodilator
Rehabilitation
Inhaled glucocorticoids if significant sx

Question 22

Stage IV COPD

Answer 22

Very severe COPD. FEV1/FVC < 70%

FEV1 < 30% predicted or < 50% plus resp failure

Question 23

Stage IV COPD - Tx

Answer 23

Short acting bronchodilator PRN
Regular tx with one or more long acting bronchodilator
Rehabilitation
Inhaled glucocorticoids if significant sx
Long term O2 use
Consider surgical options

Question 24

Asthma Triad

Answer 24

wheezing, cough, chest tightness/SOB

Question 25

Intermittent asthma

Answer 25

Sx less than 2 X week

Question 26

Persistant asthma

Answer 26

always use a inhaled corticosteroid to prevent lung remodeling

Question 27

TB skin test > or equal 5mm

Answer 27

Positive IF HIV, close contact with an active case, immunosuppression

Question 28

TB skin test > or equal to 10mm

Answer 28

Positive IF dialysis, DM, malignancy, underweight, IV drug user, children < 4 yo, residents in high risk settings: jail, homeless facilities

Question 29

TP skin test > or equal to 15mm

Answer 29

Positive IF healthy people with low likelihood of TB