Respirology

Question 1

What physiologic changes of aging occur in the respiratory system?

Answer 1

Decreased size of airways
Reduced chest wall compliance
Sarcopenia causes intercostal muscle atrophy
A-a gradient increases
PaO2 decreases with age
Decline in FEV1 and FVC
Increase in FRC and RV

Question 2

What are antibiotic options for PNA?

Answer 2

Health outpatient
- Amoxicillin
- Doxycycline
Outpatient with comorbidities
- Clavulin or cefuroxime plus macrolide
- Levofloxacin/moxifloxacin
Inpatient
- Ceftriaxone + azithromycin

Question 3

What are recommendations to lower risk of PNA in COPD patient?

Answer 3

1. PNA vaccine
2. Flu shot
3. Smoking cessation

Question 4

When managing dyspnea in advanced COPD what would you use pharm wise? What should you monitor?

Answer 4

Low dose oral opioid
ex. Morphine 5 mg q4hr + 2.5 mg q2h breakthrough PRN
Monitor:
Response
Respiratory rate
Sedation
Constipation

Question 5

What are non-dyspnea symptoms in advanced COPD?

Answer 5

Anorexia
Fatigue
Cough
Pain
Anxiety
Depression

Question 6

What are 3 non-pharm options for dyspnea in severe COPD on oxygen?

Answer 6

1. Respiratory rehabilitation
2. Breath control methods
3. Nutritional support
4. Positioning
5. Walking aid
6. Relaxation techniques

Question 7

What are 4 treatment options in OSA?

Answer 7

1. Lifestyle - weight loss, exercise, min alcohol, sleep position
2. Oral appliance
3. Positive airway pressure - CPAP
4. Surgery - tonsillectomy

Question 8

What are outcomes to look for with OSA treatment?

Answer 8

Decrease AHI (apnea hypopnea index)
Decrease Epworth Sleepiness scale
Improve QOL
Decrease risk of stroke
Dec blood pressure

Question 9

What are complications of untreated OSA?

Answer 9

Cognitive impairment
Day time sleepiness
HTN
CVA, MI, mortality
Depression