COPD Management
Asthma Management
Pharmacology
Cases
EBM
100
The primary principle in management of COPD.
What is smoking cessation?
100
The definition of persistent asthma.
What is the occurrence of symptoms more than twice weekly and/or nighttime symptoms more than twice monthly?
100
The recommended length of oral corticosteroid treatment in severe asthma exacerbations.
What is 5 to 10 days?
100
19 y/o WM with moderate persistent asthma with frequent exacerbations despite appropriate therapy with albuterol, fluticasone, and salmeterol. What are the most likely complicating factors?
Improper use of inhalers and non-compliance with therapy.
100
An appropriate course of action in a patient with moderate persistent asthma who presents with inadequate symptom control on fluticasone (Flovent) 110 mcg 2 puffs twice daily.
What is the addition of tiotropium (Spiriva) or salmeterol (Serevent or Advair)? December, 2010 POEMs
200
The two interventions well-proven to prolong survival in patients with COPD.
What are smoking cessation and oxygen therapy?
200
The recommended course of action for a newly-diagnosed asthmatic currently taking carvedilol (Coreg) for heart failure.
What is switching to a cardioselective beta-blocker?
200
The maximum daily dosage of albuterol.
What is 12 puffs, or 1080 mcg?
200
A 65 year old man with chronic bronchitis develops lower extremity edema. ECG shows RVH. What is the appropriate immediate treatment at this time?
Continuous oxygen supplementation and diuresis.
200
The frequency of monitoring via spirometry with a demonstrated benefit to COPD patients.
What is none? September 2010 POEMs.
300
The three interventions that should be initiated in all stage I COPD patients without contraindications.
What are influenza vaccination, pneumococcal vaccination, and short-acting beta-agonists?
300
The indication for desensitization therapy in the management of asthma.
What is the identification of a single offending allergen?
300
Class of bronchodilators shown to increase the risk of asthma-related death.
What are beta-agonists (Both long-acting and short-acting, if overused)?
300
A 50-year old patient with emphysema is found to have NSCLC of the LUL. What is the potential benefit of partial lobectomy?
Removal of the tumor, and improved gas exchange via effective lung volume reduction surgery.
300
An adverse effect of fluticasone in COPD patients which may not be present in budesonide.
What is increased risk of pneumonia? November, 2009 POEMs.
400
Symptoms that indicate the need for antibiotic initiation in an acute exacerbation of COPD.
What are fever and grossly purulent sputum?
400
The primary indications for the use of theophylline in asthma.
What are nocturnal exacerbations and refractory disease?
400
The electrolyte abnormality associated with excessive use of beta-agonists.
What is hypokalemia?
400
A 15-year old AAM football player is experiencing cough and shortness of breath with exercise. What are appropriate pharmacotherapies?
Long-acting beta-agonist, mast cell stabilizers (Cromolyn or nedocromil), or leukotriene inhibitors (Montelukast).
400
The benefit of levalbuterol over racemic albuterol in the management of COPD and albuterol.
What is none (Probably). Some studies have shown improved efficacy, more tolerability, and lower heart rates, but the benefits have not been consistently shown.
500
The minimum amount of time that continuous oxygen supplementation should be given in chronically hypoxemic patients with cor pulmonale.
What is 15 hours?
500
The medication of choice in an asthmatic with beta-blocker-induced bronchospasm.
What is ipratropium (Atrovent)?
500
The presumptive benefits associated with second-generation inhaled steroids (Eg, fluticasone and budesonide) over the first generation.
What are improved steroid-receptor binding (Better efficacy) and enhanced first-pass hepatic clearing (Less systemic toxicity)?
500
35 y/o WM 1 PPD smoker with a strong family history of COPD, asthma, and lung cancer presents for the first time with complaints of increasing productive cough and dyspnea on exertion. Predominantly lower-lobe emphysema is shown on imaging. You suspect alpha-1 antitrypsin deficiency. What lab tests should you order, and what should you tell the patient?
Plasma alpha-antitrypsin level and liver function tests. The patient is not a candidate for any disease-specific interventions as long as he continues to smoke.
500
The recommended action for a surgical patient on oral or very high-dose inhaled corticosteroids for asthma.
What are stress doses (Eg, hydrocortisone 100mg) every 8 hours during the surgical period, with a rapid taper within 24 hours of surgery? NHLBI Asthma Guidelines
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