Pulmonary - ALL Flashcards
47% of adults have at least one of what 3 conditions?
Uncontrolled HTN
Uncontrolled high LDL
Currently smoking
What three things lead to a improved outcome for a patient?
Informed activated patient
Prepared proactive practice team
Productive interactions
What are major components of a delivery system design?
Health literacy!
Define roles/tasks
Provide clinical case management
What is the definition of the chronic care model?
An organizing framework for improving chronic illness care and an excellent tool for improving care at both the individual and population level
What are the 4 roles of the community in the chronic care model?
Mobilize community resources to meet pts needs
Encourage pts to use programs
Form partnerships with orgs to support and develop serves that fill gaps
Advocate for policies to improve pt care
Who gets screened for diabetes? What is considered positive (aka diabetic)?
Ages 40-70 who are overweight or obese HbA1c >6.5 Fasting glucose >126 Anytime glucose > 200mg/dL 2 hour glucose > 200/dL during 75g oral glucose test
Who gets screened for lung cancer? How?
Ages 55-80 who have 30pk/year history and still smoke or stopped within last 15 years
Low dose CT with contrast
What gets a breast cancer screen according to the American Cancer Society?
Women ages 40-44 choice
Women ages 45-54 - mam every year
Women 55+ have choice to do it every year
High risk (BRCA+, FDR BRCA+ and pt not tested, or >20-25% lifetime risk - MRI and mammogram every year)
Who gets screened for a colonoscopy? How? What population must start at 45? Who else may start early?
Ages 50-75
Colonoscopy
African Americans
FDR <60 with it, start 10 years before diagnosis or at 40, whichever comes first
Who gets screened for osteopososis? How?
Women >65
DEXA scan
What are the three most common causes of chronic cough in non-smokers, no ACE-I, and normal CXR?
Post-nasal drip
Asthma
GERD
If history and physical exam of cough >3 weeks do not point to one of the top three causes, what do you order?
CXR
If a person with cough >3 weeks has purulent sputum, is a smoker, or is on an ACE, what do you do?
Treat accordingly
Is dyspnea a diagnosis?
No, it is just a symptom
When does giving supplemental oxygen improve longevity in COPD?
If sat <90% or PaO2 <60
After giving someone an inhaler after an abnormal spirometry, when should they follow-up? What should you do at the follow-up?
1 month
Repeat spirometry
Should you ever use the interpretation given on a spirometry print out?
No
What is FEV1, FVC, and the FEV1/FVC ratio in obstructive disease?
FEV1 < 80%
FVC < 80%
Ratio < 70%
What is FEV1, FVC, and the FEV1/FVC ratio in restrictive disease?
FEV1 < 80%
FVC < 80%
Ratio > 70% (close to 100%)
What is FEV1, FVC, and the FEV1/FVC ratio in mixed obstructive and restrictive disease?
FEV1 < 80%
FVC < 80%
Ratio > 70% (close to 70% but still greater than)
What are the requirements for asthma during bronchodilator reversibility testing?
Increase in FEV1 >200ml AND 12% above pre-bronchodilator FEV1
What is the methacholine challenge? How is it positive
Gold standard for asthma diagnosis
>20% in FEV1 after administering methacholine
Before performing a pulmonary function test, how long should SABA, LABA, SAMA, LAMA, and caffeine/smoking be withheld for?
SABA - 6 hours LABA - 12 hours SAMA - 6 hours LAMA - 24 hours caffeine/smoking - 30 minutes
What are the 4 different types of hypoxia?
Hypoxic
Hyperemic
Circulational
Histotoxic