AFP Journal Review March 1, 2010. Lianne Beck, MD Assistant Professor Emory Family & Preventive Medicine. Articles. Management of COPD Exacerbations Adverse Effects of Antipsychotic Medications Common Tongue Conditions in Primary Care Urine Drug Screening: A Valuable Office Procedure.
Lianne Beck, MD
Emory Family & Preventive Medicine
102 % increase in COPD-related mortality from 1970 to 2002 (21.4 to 43.3 deaths per 100,000 persons).
EXPOSURE TO RISK
50% < FEV1< 80%
FEV1 / FVC <70%
30%< FEV1 <50%GOLD Guidelines: Classifications
of risk factors,
At RiskStage 0
+/- Chronic cough,
FEV1 / FVC <70%
+/- Chronic cough,
+/- Chronic cough, sputum,
Add regular treatment with one or more LABD
+/- Chronic Cough, sputum,
Add ICS if repeated exacerbations
Chronic respiratory failure or cor pulmonale
FEV1 / FVC <70%
Add long term oxygen
Consider surgical tx
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: NHLBI/WHO Workshop Report. Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health;Updated 2003. NIH publication 2701A.
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1. A 55-year-old man with a history of stable chronic obstructive pulmonary disease (COPD) has reduced exercise tolerance and increased cough and tenacity of sputum. A COPD exacerbation is suspected. Which one of the following tests should be performed? (check one)
A. Chest radiography.
B. Pulse oximetry.
C. Arterial blood gas measurement.
D. Brain natriuretic peptide measurement.
2. Although the patient in the previous question does not have severe respiratory distress, referral to the emergency department for evaluation is being considered. Which of the following factors increase the risk of a severe COPD exacerbation? (check all that apply)
A. Altered mental status.
B. Underutilization of home oxygen therapy.
C. Body mass index greater than 30 kg per m2.
D. At least three exacerbations in the previous 12 months.
3. Which one of the following statements about selection of an antipsychotic medication is correct? (check one)
A. There is little difference in effectiveness between first-generation antipsychotics (FGAs) and most second-generation antipsychotics (SGAs).
B. Adverse effects are similar and, therefore, are not important to consider.
C. SGAs are consistently more effective than FGAs.
D. Agents with greater potency against dopamine D2 neuroreceptors are generally preferred.
4. Which one of the following statements about cardiac arrhythmia associated with antipsychotic use is correct? (check one)
A. It is generally mild and transient.
B. Sudden cardiac death is approximately twice as common in patients taking antipsychotics as in the general population.
C. It is more common with high-potency FGAs.
D. It is less common with ziprasidone (Geodon) than with other SGAs.
5. Which of the following statements about adverse effects of antipsychotic medications are correct? (check all that apply)
A. Patients may become tolerant of sedative effects.
B. Weight gain is dose dependent.
C. Anticholinergic effects are more common with clozapine (Clozaril) than with other SGAs.
D. Tardive dyskinesia is easily and quickly reversible.
6. A patient presents with a smooth, glossy tongue that is associated with pain and burning. Which one of the following is the best strategy to diagnose the likely associated condition? (check one)
B. Nutritional assessment.
C. Testing for human immunodeficiency virus infection.
D. Close observation.
7. Which one of the following statements about symptomatic geographic tongue is correct? (check one)
A. Daily debridement with a tongue scraper is recommended.
B. The condition is associated with diabetes.
C. Topical steroid gels and antihistamine mouth rinses can alleviate discomfort.
D. Treatment should be directed at the underlying disorder.
8. Which one of the following approaches is most effective in infants with tongue-tie (ankyloglossia) and breastfeeding problems? (check one)
A. Advise the mother to stop breastfeeding.
B. Provide education and lactation support alone, because surgery is rarely effective.
C. Consider frenulectomy.
D. Inform the mother that tongue-tie rarely causes feeding problems.
9. Which one of the following is the preferred initial test for urine drug screening? (check one)
B. Polymerase chain reaction.
C. High-performance liquid chromatography.
D. Rapid, office-based enzyme-linked immunosorbent assay.
10. Which one of the following drugs can cause a false-positive test result when screening for tetrahydrocannabinol (THC)? (check one)
B. Sertraline (Zoloft).
C. Desipramine (Norpramin).
D. Bupropion (Wellbutrin).
11. Which of the following are among the most commonly tested for substances during urine drug screenings? (check all that apply)
A. Fentanyl (Duragesic).
C. Phencyclidine (PCP).