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Pulmonology - ABIM

COPD

QuestionAnswer
Definition of COPD FEV1/FVC <70%
How do you monitor COPD? Annual spirometry, do not need full lung volumes with PFTs
What vaccinations should you give for COPD? Annual flu, pneumococcal 23 once < 65, once > 65
Name the categories of COPD with the corresponding FEV1 >80% – mild GOLD 1, 50 to 80% – moderate GOLD 2, 30 to 50% - severe GOLD 3, < 30% very severe GOLD 4
What is the treatment for COPD if FEV1 > 80%? albuterol and ipratropium
What is the treatment for COPD if FEV1 50 to 80%? Albuterol and tiotropium
When should you start and inhaled steroid for patients with COPD? When FEV1 is between 30 and 50%
When should you start a phosphodiesterase inhibitor in a COPD patient? Start roflumilast FEV1 is between 30 and 50% and you want to decrease hospitalizations.
When should patients go to pulmonary rehab? When FEV1 is between 30 and 50%
When should patients start oxygen? FEV1 <30%
What are the indications for starting oxygen in a COPD patient? 1. Oxygen saturation less than 88%, 2. Hematocrit >55, 3. Arterial oxygen less than 55 on ABG, 4. Arterial oxygen less than 60 if patient has cor pulmonale
What should you do if patient has an oxygen saturation of 92 or below on room air? Do an ABG
When should you consider a lung volume reduction surgery for your patient? 1. The patient has upper lobe emphysema, 2. The patient has decreased exercise capacity. The work up for it includes a chest CT and full PFTs.
When should lung transplant be considered in a patient with COPD? When FEV1 <20% or DLCO <20%, PCO2 >50 with pulmonary hypertension or cor pumonale despite oxygen treatment
What are the absolute contraindications to lung transplant? 1. Cancer in the last two years, 2. Recent smoking, 3. Drugs or alcohol, 4. no social support, 5. hepatitis B or C with liver damage, 6. Severe psychiatric illness, 7. Medication noncompliance.
What are the relative contraindications to lung transplant? 1. Age greater than 65, 2. Multiple comorbidities
How can you tell a patient is having a COPD exacerbation? Increased sputum in volume, change in color of sputum, increased shortness of breath
How should you treat COPD exacerbation? Albuterol plus ipratropium plus oral prednisone (40×5 days), Antibiotics for 5 to 10 days
Created by: christinapham