Chronic Obstructive Pulmonary Forums This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Aortic regurgitation
Would you do this case? 90yo patient for a hip ORIF. Dementia, CKD3, DM, COPD, prior mitral valve repair, echo from a year ago showing moderate-severe AR and moderate TR, there is a dilated RV and LV, LVEF35%, pHTN with PA pressures up to 50. I don’t have a prior echo to compare or understand progression, but I assume long-standing AR that got worse after mitral valve repair. Patient has new heart failure and hypoxia. There was a small trop bump up to 0.15 with ST depressions in the... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 3, 2021 Category: Universities & Medical Training Authors: dipriMAN Tags: Anesthesiology Source Type: forums

What is the NNT for an EM physician to have a better outcome...
Comparing physicians and PAs as solo providers in a rural... : Journal of the American Academy of PAs f the host institution were analyzed. Although minor variances in metrics were appreciated, transfers, 72-hour returns, and death rates were all similar among provider types. Results from this work do not demonstrate a clinically meaningful difference among ED metrics between physicians and PAs... journals.lww.com Just came off shift where I worked alongside an EM doc a few years out of 3 year residency. Last patient with pneumonia failing bipap wi...
Source: Student Doctor Network - July 25, 2021 Category: Universities & Medical Training Authors: Boatswain2PA Tags: Emergency Medicine Source Type: forums

Unknown Primary Head and Neck
82 yo woman who presents with a large L level Ib lymph node (4 cm, ENE, P16+/HPV-), staged as T0N3bM0. Imaging with CT neck and PET have been negative and no primary found. She has significant co-morbidities CAD, hx of PEs, COPD, etc which makes her a very poor surgical candidate. Ib node makes me think oropharynx or oral cavity primary. However, P16+/HPV- status suggests that this may be a cutaneous SCC instead? Given Ib, traditional volumes would be VERY large including entire oral... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - June 25, 2021 Category: Universities & Medical Training Authors: metview Tags: Radiation Oncology Source Type: forums

oligomet lung case
59 yo male already on 2L NC due to copd/emphysema. T2N0M1 (solitary femur neck bone met) non small cell carcinoma, PDL1 40% +, diagnosed 3/2020. Bone met was in femur neck with path fracture - had a lot of tumor removed, ortho fixation, then post op 30 Gy in 10 fractions back at diagnosis. He's now 1 year out on nivo/ipi and his only site of disease is his primary lung tumor - it went from 4 cm to 2 cm but still there. His KPS is good at around 80. I'm thinking (and med onc agrees) it's... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 10, 2021 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums

When to Check a Lipase?
So I had a case recently which has me a little puzzled. EMS brings in a dude from local homeless shelter in respiratory distress - has a history of COPD + CHF, they’ve got him on cpap and his vitals are OK, low grade fever, but clearly sick. Mentating fine, no abdominal complaints. Did the usual stuff in the ED, abx, steroids, careful IVF because of the CHF...labs (including liver stuff) only remarkable for metabolic acidosis and a white count. Notably did not get a lipase. Admitted to... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 5, 2020 Category: Universities & Medical Training Authors: The Knife & Gun Club Tags: Emergency Medicine Source Type: forums

1 week to study for NAPLEX help
So the inevitable procrastination bug hit me after school and now there is only a week left for me to study for the NAPLEX. Finally opened the RxPrep textbook but besides math, HIV, and oncology, what other sections are recommended to study? Should I just start doing practice questions? I feel pretty confident in the key disease states from school like diabetes, CVD, asthma/COPD. But are there a lot of compounding, and other random things on there? Just wondering what other people did to... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 28, 2020 Category: Universities & Medical Training Authors: MyRealNameIs Tags: Pharmacy Licensure and Exams Source Type: forums

Another Cardiac Case
I always enjoy the case presentations around here and it's been a while since I contributed, so here was a fun case 54 y/o male underwent Sternotomy for CABG/MVR/MAZE/LLAA 2 months ago after presenting with an NSTEMI. BMI 42, recent hx of Meth and Marijuana use, current everyday smoker with questionable COPD (PFTs were fine), OSA on BiPAP while at hospital (non-compliant at home), and AFib on Elliquis. Surgery went uneventfully, had a Mitral Valve Repair (simple ring), good flow in... Another Cardiac Case (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2020 Category: Universities & Medical Training Authors: sethco Tags: Anesthesiology Source Type: forums

How would you approach this case?
Love seeing the discussions you geniuses have about cases. So here is one I did a few weeks back. 55y 152kg M scheduled for Maxillectomy, Parotidectomy, neck dissection, and radial arm free flap. PMH: sub orbital SCC, IDDM (A1c 9.9), NAFLD s/p OLT about 7 years ago, moderate cervical stenosis on MRI, OSA (not on CPAP), HTN on beta blocker, HLD. No documented CAD, COPD, or CVA history. No known airway involvement by tumor, but physical exam shows Mallampati 4 PSH:OLT, Carpal tunnel, MOHS... How would you approach this case? (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2020 Category: Universities & Medical Training Authors: thetoddJR Tags: Anesthesiology Source Type: forums

Severe pHTN for bilateral debridement @ Surgicenter : (
Hey everyone, Interesting case coming up I thought I’d solicit some ideas on. 57 yo F with history of primary pHTN, COPD, OSA non-compliant with CPAP (nocturnal nasal cannula 2L instead), CABG in 2001, DES 4 mo. ago to SVG-RCA. LIMA-LAD patent, otherwise just luminal irregularities and lesions <40%. Scheduled for bilateral venous stasis ulcer debridement at the surgicenter. No angina. Can “just about” lay flat. But minimal exercise tolerance due to SOB. Sees pHTN specialist who says... Severe pHTN for bilateral debridement @ Surgicenter : ( (Source: Student Doctor Network)
Source: Student Doctor Network - June 26, 2020 Category: Universities & Medical Training Authors: ISoNitrous Tags: Anesthesiology Source Type: forums

Med school apologizes to students "triggered" by a test question
Indiana University Professor Apologizes for Triggering Medical Students With 'I Can't Breathe' Exam Question "We understand that the context in which this phrase was used resulted in a very painful trigger for many of you." reason.com It's absolutely absurd to me that students can complain about this, and even worse that schools pander to it and issue apologies when they did nothing wrong. I'm not sure how you can expect to be a doctor and handle stressful situations if you are so "triggered" by a TEST QUESTION. A...
Source: Student Doctor Network - June 19, 2020 Category: Universities & Medical Training Authors: underthesun Tags: Medical Students - MD Source Type: forums

Article about med school posted online
Indiana University Professor Apologizes for Triggering Medical Students With 'I Can't Breathe' Exam Question "We understand that the context in which this phrase was used resulted in a very painful trigger for many of you." reason.com It's absolutely absurd to me that students can complain about this, and even worse that schools pander to it and issue apologies when they did nothing wrong. I'm not sure how you can expect to be a doctor and handle stressful situations if you are so "triggered" by a TEST QUESTION. ...
Source: Student Doctor Network - June 19, 2020 Category: Universities & Medical Training Authors: underthesun Tags: Medical Students - MD Source Type: forums

Back to normal
Not what you think. But I haven’t been present on this forum for a few months, so I thought I would post a case. 69yo morbidly obese ( BMI 48) female with severe COPD for a shoulder surgery, RCR. A little more history reveals chronic paroxysmal A fib with PSVT/RVR yada yada yada PFT’s show <10% improvement with bronchodilators and nothing that stands out. Pulm med note states, pt requires 3LMP O2 continuous. Requires up to 6lpm with minimal activity. Crank the canister wide open if she... Back to normal (Source: Student Doctor Network)
Source: Student Doctor Network - June 12, 2020 Category: Universities & Medical Training Authors: Noyac Tags: Anesthesiology Source Type: forums

UWorld Q 7601 Respiratory physiology
Pt evaluated for worsening SOB on exertion, 40-pack-year smoking hit. Lung are hyperresonant on percussion and there is diffuse wheezing on auscultation. CXR reveals a flattened diaphragm with a narrow mediastinum, there are decreased bronchovascular markings in the peripheral lung region. Why this is COPD? how to tell it is not restrictive lung diseases ? (Source: Student Doctor Network)
Source: Student Doctor Network - May 26, 2020 Category: Universities & Medical Training Authors: maggiesilverchow Tags: Step I Source Type: forums

Minimum duration 15 mg iso bupiv with epi
Oral board type case: Knee removal of antibiotic spacer, placement of new implant. Obese, COPD/asthma, MH susceptible, on Coumadin (held) INR 1.2. Prefer to do spinal MAC, AWARE I COULD do CSE but seems like a pain in her and INR 1.2. So... a big boy dose of iso bupiv 12-15 mg with epi and narcotic should be VERY likely to last 4 hours, yes? (Haven’t used tetracaine in 20 years) (Source: Student Doctor Network)
Source: Student Doctor Network - May 14, 2020 Category: Universities & Medical Training Authors: caligas Tags: Anesthesiology Source Type: forums

Prognostic scores to improve care in the individual COPD patient
(Source: BMJ Comments)
Source: BMJ Comments - March 19, 2020 Category: General Medicine Source Type: forums