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Flashcards in Pulmonary Deck (29)
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1

Stage III COPD

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

2

Stage II COPD

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

3

Tx Stage II COPD

Short acting bronchodilator PRN
One long-acting bronchodilator
rehabilitation

4

Tx Stage I COPD

short acting bronchodilator PRN

5

Stage I COPD

FEV1/FVC < 70%
FEV > or equal 80% predicted

6

COPD is confirmed with the following sx

Airflow obstruction FEV1/FVC < 70%
FEV1 < 80% predicted

7

Sx present with COPD

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

8

Pneumonia - When to hospitalize - CRB-65

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

9

How long after episode should a repeat Xray be obtained?

7-12 weeks

10

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

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

11

How long should you treat pneumonia?

5 days minimum, usually 10 days

12

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

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

13

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

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

14

Atypical pneumonia organisms

m. pneumoniea "walking pneumonia"
chlamydophila pneumoniae

15

Pneumonia - Most common CAP organism

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

16

What conditions make it important to have 2 doses of pneumonvax

immunocompromised - Lupus, RH, HIV

17

4 rules pneumonia vaccine

#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

18

Chronic illnesses that require extra pneumovax

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

19

Reasons for chest Xray with acute cough

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

20

concern with supraclavicular node

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

21

Stage III COPD - Tx

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

22

Stage IV COPD

Very severe COPD. FEV1/FVC < 70%
FEV1 < 30% predicted or < 50% plus resp failure

23

Stage IV COPD - Tx

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

24

Asthma Triad

wheezing, cough, chest tightness/SOB

25

Intermittent asthma

Sx less than 2 X week

26

Persistant asthma

always use a inhaled corticosteroid to prevent lung remodeling

27

TB skin test > or equal 5mm

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

28

TB skin test > or equal to 10mm

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

29

TP skin test > or equal to 15mm

Positive IF healthy people with low likelihood of TB