COPD and asthma

Question 1

What is the most common PFT

Answer 1

spirometry

Question 2

What kind of flow volume loop is seen with obstructive emphysema

Answer 2

scooped out curve

Question 3

What are some extrinsic factors for asthma

Answer 3

allergic (most common)
environmental
animal

Question 4

What are some intrinsic factors of asthma

Answer 4

occupation/pollution
cold/humidity
stress
medications (ASA or NSAIDs)
Exercise

Question 5

What is the immune response for an extrinsic asthma attack

Answer 5

IgE mediated

Question 6

What is the atopic triad

Answer 6

eczema (atopic dermatitis)
Asthma
Hay fever

Question 7

What are risk factors for asthma

Answer 7

atopy
environmental/occupational exposures
childhood asthma / symptoms
Family history

Question 8

What is used for evaluating and diagnosing asthma

Answer 8

PFT
Bronchoprovocation test

Question 9

What are the classifications of asthma

Answer 9

intermittent
persistent (Mild, moderate, severe)

Question 10

What are the different forms of asthma treatment

Answer 10

SABA
ICS
Leukotriene modifiers
Immunomodulators
Combos (SABA or LABA w/ ICS)

Question 11

When are SABAs used

Answer 11

PRN

Question 12

When are leukotriene modifiers used

Answer 12

primarily for extrinsic allergy but may help with intrinsic

Question 13

When are immunomodulators used

Answer 13

Severe asthma and ONLY extrinsic

Question 14

What is a sign you have to watch out for with leukotriene modifiers

Answer 14

Mood / behavioral changes
sleep changes in kids
suicidality in adults

Question 15

How do you treat intermittent asthma

Answer 15

all ages: SABA PRN
<4 y/o: associated with URIs, use as short course at beginning of infection

Question 16

How do you treat mild persistent asthma

Answer 16

All ages: Continue SABA PRN
<11y/o: low dose ICS or Montelukast
>12y/o: Daily ICS, Daily combo inhaler or montelukast

Question 17

What is the risk of giving children ICS for asthma

Answer 17

risk of growth suppression with regular use

Question 18

How do you treat moderate persistent asthma

Answer 18

All ages: SABA PRN
<4y/o: Combo inhaler, Montelukast, or medium dose ICS

> 4y/o: Daily combo inhaler and PRN, daily ICS, or low dose ICS and montelukast

Question 19

How do you treat severe persistent asthma

Answer 19

Daily combo inhaler (medium ICS w/ LABA) or daily ICS with montelukast

*may consider omalizumab

Question 20

What treatment may severe asthmatics need to be treated with during exacerbations

Answer 20

Oral corticosteroids
predisone
methylprednisolone
prednisolone

Question 21

What are ways asthmatics can reduce allergen exposure

Answer 21

2nd gen antihistamines
Flonase
1st gen antihistamines PRN
Immunotherapy
Air filters
Washing face/hands after environmental exposure

Question 22

When should patients be referred to pulmonologists

Answer 22

Difficulty diagnosing
Life threatening exacerbations
Hospitalizations
frequent oral glucocorticoids (>2/year)
Step 5 or higher
poor control

Question 23

What population is at high risk for bronchiectasis

Answer 23

Older Women in underserved populations

Question 24

What is occurring in bronchiectasis

Answer 24

irreversible, inflamed and easily collapsable airway that is induced by infectious insult and impaired host defense

Question 25

What are the symptoms of bronchiectasis

Answer 25

`chronic cough (productive) Fatigue dyspnea fever/chills pleuritic chest pain

Question 26

What are the signs of bronchiectasis

Answer 26

Crackles Wheezing Digital clubbing

Question 27

What is pathogneumonic for bronchiectasis

Answer 27

persistent or recurrent cough with mucopurulent sputum

Question 28

What can be used to diagnose bronchiectasis

Answer 28

Labs CXR CT PFT Bronchoscopy

Question 29

How do you treat bronchiectasis

Answer 29

Treat / control recurrent infections treat underlying disease bronchodilators (Duoneb or SABA/Combo) Chest physiotherapy Surgery (severe cases)

Question 30

If a patient has a bronchiectasis exacerbation, how do you treat it

Answer 30

Antibiotics

Question 31

If someone with bronchiectasis is outpatient, how will you treat

Answer 31

Fluoroquinolone (Levofloxacin) - pseudomonas coverage Amoxicillin or augmentin Macrolids

Question 32

If someone has bronchiectasis is inpatient, how should they be treated

Answer 32

Ampicillin Piperacillin/Tazobactam (Zosyn) -Pseudamonas coverage Vanco for MRSA

Question 33

What are the types of bronchiolitis

Answer 33

Acute (most common) Bronchiolitis obliterans (constrictive) Proliferative Follicular

Question 34

What causes acute bronchiolitis

Answer 34

Mycoplasma pneumonia RSV Influenza Pertussis

Question 35

Which patients are most effected from acute bronchiolitis

Answer 35

Pediatric patients

Question 36

What are the causes of bronchiolitis obliterans

Answer 36

Toxic fumes (popcorn lung) Lung transplant patients

Question 37

What causes proliferative bronchiolitis

Answer 37

Cryptogenic

Question 38

What causes follicular bronchiolitis

Answer 38

Rheumatic diseases (RA & Sjogrens)

Question 39

What are the risk factors for bronchiolitis

Answer 39

viral illness exposure to toxic fumes CT disorders Rheumatologic disorders organ transplant

Question 40

How do you diagnose bronchiolitis

Answer 40

Nasal viral panel biopsy

Question 41

Which forms of bronchiolitis do you preform a biopsy for

Answer 41

Constrictive proliferative follicular

Question 42

How do you treat acute bronchiolitis

Answer 42

Supportive therapy (will peak in 3-5 days)

Question 43

how do you treat severe bronchiolitis

Answer 43

admission respiratory support +/- glucocorticoids CPAP ET tube for respiratory failure

Question 44

What is the diagnostic criteria for chronic bronchitis

Answer 44

Chronic productive cough for 3 or more months in 2 or more successive years

Question 45

How do you treat group A COPD patients

Answer 45

SABA or LABA

Question 46

How do you treat group B COPD patients

Answer 46

LABA

Question 47

How do you treat group C COPD patients

Answer 47

Add LAMA to LABA

Question 48

Which patients will get oxygen therapy with COPD

Answer 48

PaO2<55 PaO2>55 with Cor pulmonale Hypoxia with exercise SPO2 at or below 88% Erythrocytosis

Question 49

What population is primarily effected by cystic fibrosis

Answer 49

Caucasian

Question 50

What is the current median of life expectancy with cystic fibrosis

Answer 50

50 years

Question 51

What type of disease os cystic fibrosis

Answer 51

Autosomal recessive Mutation in CFTR gene

Question 52

What occurs with CF in the body

Answer 52

Thick mucus builds up in organs that contain mucus membranes -lungs -pancreas -liver -intestines -reproductive tract

Question 53

What are some respiratory signs and symptoms of cystic fibrosis

Answer 53

persistent, productive cough hemoptysis apical crackles bronchiectasis digital clubbing

Question 54

How can you diagnose cystic fibrosis

Answer 54

Newborn screening Genetic testing Sweat chloride test

Question 55

What is the gold standard for diagnosing cystic fibrosis

Answer 55

Sweat chloride test

Question 56

How is the sweat choline test done

Answer 56

Sweat is produced on forearm or thigh and collected and weighed/analyzed for chloride

Question 57

What may cause a false positive on a sweat chloride test

Answer 57

Addisons disease medium ileus renal failure hypothyroidism G6PD deficiency

Question 58

What will you see on imaging with cystic fibrosis

Answer 58

Pre-bronchial cuffing Tram lines Recurrent infiltrates Pulmonary blebs and bullae

Question 59

How do you treat CF

Answer 59

CFTR modulators to return part of the function of the chloride channel

Question 60

What are chronic treatments for cystic fibrosis

Answer 60

Airway clearance therapies Prevention of infection bronchodilators anti-inflammatory therapy/bacterial prophylaxis

Question 61

How do you treat an acute exacerbation of CF

Answer 61

Oral glucocorticoids respiratory support Antivirals Antibiotics