Wednesday, June 3, 2015

Extremely High yield COPD pinpoints for USMLE CK

Chronic Obstructive Pulmonary Disease (COPD) 1. COPD encompasses chronic bronchitis and emphysema. Predominant emphysema—decreased vascular markings, decreased DLCO(due to alveolar destruction) Chronic bronchitis—bronchovascular markings, normal DLCO Differential diagnosis based on DLCO (4116) (Acute bronchitis is a common cause of blood-tinged sputum and is mostly viral in etiology. Observation and close clinical follow-up is the best treatment strategy for new-onset blood-tinged sputum in an afebrile patient with acute bronchitis but no significant signs of more serious disease. 4566) 2. Managemeng of acute COPD exacerbation(AEOPD)(4039): 1) Oxygen (target saturation 88%-92%) The criteria for initiating long-term oxygen therapy in COPD patients(4131) 2) Inhaled bronchodilators(eg., albuterol, ipratropium) (4667) * Inhaled anti-muscarinic agents such as ipratropium are the mainstay of symptom management in COPD. The anti-cholinergic medications may be combined with short-acting beta agonists for greater symptom relief. * Inhaled steroids+long-acting beta agonists – more severe COPD 3) Systemic glucocorticoids 4) Antibiotics Indications: * Two of 3 cardinal symptoms of AECOPD (increased dyspnea, cough, and sputum production) * Moderate-to-severe COPD exacerbation * Those requiring mechanical ventilation Commonly used antibiotics: Macrolides (eg, Azithromycin) Fluoroquinolones (eg, levofloxacin, moxifloxacin) Penicillins/beta-lactamase inhibitors (eg, amoxicillin-clavulanate) Duration of therapy 3-7 days 5) NPPV for moderate-to-severe exacerbation (If no contraindication) * Initial management of AECOPD includes inhaled short-acting bronchodilators, glucocorticoids, and antibiotics. Patients with continued symptoms despite medical management should be considered for NPPV. * Indications and Contraindications (4040) 6) Tracheal intubation * if no improvement with NPPV * if NPPV is contraindicated 3. Asthma Vs. COPD (4017) 1) Inhaled corticosteroids--> Asthma Long-acting anticholinergic inhaler →COPD 2) Most effective test to differentiate asthma and COPD: Bronchodilator (albuterol) →>12% increase in FEV1(resotration of normal airflow)-->Asthma → partial resersibility-->COPD 4. Secondary pneumothorax should be suspected in COPD patients presenting with catastrophic worsening of their respiratory symptoms and is usually due to dilated alveolar blebs that rupture air into the pleural space. 5. Digital clubbing * COPD alone does not cause digital clubbing, and presence of clubbing in patients with COPD should prompt a search for occult malignancy. * Conditions commonly associated with digital clubbing (4521) 6. COPD is characterized by FEV1/FVC<0.7, decreased VC, increased total lung capacity, functional residual capacity, and residual volume
Post a Comment