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PNP III > Module 3: Respiratory Disorders > Flashcards

Module 3: Respiratory Disorders Flashcards

1
Q

The asthma updates’ most highly pediatric-relevant recommendations involve three treatment options: (1) intermittent ICS dosing with -A- for quick-relief therapy, (2) -B- and reliever therapy, and (3) -C-

A

A. as-needed short-acting b2-agonist (SABA)
B. single maintenance (SMART)
C. add-on LAMA therapy

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2
Q

In children 0 to 4 years with intermittent asthma, clinicians may now conditionally recommend a -1- course of -2- with as-needed SABA at the start of a -3- for children who have had -4- of similar wheezing or >1 episodes in the past year and who are -5-.

A
  1. short (7–10 days)
  2. daily ICS
  3. viral URI
  4. > 2 lifetime episodes
  5. asymptomatic between episodes
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3
Q

In those >11 years with -1-, clinicians and families may jointly decide to use -2- -3- instead of daily ICS with as-needed SABA.

A
  1. mild persistent asthma
  2. intermittent as-needed concomitant
  3. ICS with SABA
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4
Q

For patients >3 years with mild to moderate persistent asthma who are likely adherent with daily ICS alone, a short-term increase in the ICS dose (eg, doubling, tripling, or quadrupling the daily dose) -1-. It -2- for patients whose adherence is less certain.

A
  1. is not recommended

2. may be considered

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5
Q

SMART is treatment with -1- and a specific LABA (-2-) for both -3- therapy

A
  1. ICS
  2. formoterol
  3. daily and rescue
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6
Q

Formoterol is the LABA of choice for SMART because it has a -1- onset of action and can be used -2- daily.

A
  1. rapid

2. more than twice

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7
Q

Individuals whose asthma is uncontrolled on daily ICS-LABA maintenance therapy should receive the preferred … before moving to a higher-step level of therapy

A

SMART

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8
Q

-1- or -2- (in liquid or tablet form) reduces the -3- allergic response associated with asthma.

A
  1. Subcutaneous immunotherapy (SCIT)
  2. sublingual immunotherapy (SLIT)
  3. immunoglobulin E–mediated
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9
Q

In children ages -1- with -2-, the Expert Panel recommends -3- to predict the future development of asthma.

A
  1. 0–4 years
  2. recurrent wheezing
  3. against FeNO measurement
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10
Q

Asthma is characterized by variable and recurring symptoms of: -1-, -2-, and -3-

A
  1.  Airflow obstruction
  2.  Bronchial Hyperresponsiveness
  3.  Underlying inflammation
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11
Q 
What is the most common trigger for an asthma exacerbation in a 4 year old child?
A. Upper respiratory infection
B. Exercise
C. Cold air
D. Cigarette smoke
E. Allergic rhinitis
A

A

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12
Q

Pathophysiology of asthma is a cycle of -1-, -2- in response to triggers, -3-, and -4-

A
  1. Airway remodeling
  2. Hyperresponsiveness and inflammation
  3. Obstruction
  4. Partial recovery (compared to full recovery in healthy lungs)
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13
Q

Difficulty breathing/SOB, chronic cough, cough after exercise, chest pain, wheezing, and/or night cough

A

Symptoms of childhood asthma

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14
Q

Early phase of asthmatic response is characterized by -1- and responsive to -2-. Begins in -3- in response to a trigger and abates in -4- to 2 hours. Common triggers include animal dander, pollen, mold, dust, -5-, exercise

A
  1. Inflammation and bronchoconstriction
  2. Albuterol
  3. 10-20 min
  4. 30 min
  5. cold air
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15
Q

Late phase asthmatic response is characterised by -1-. Caused by an ongoing production of the -2-. Usually begins in -3- after initial attack, reaches a maximum in -4- and disappears within -5-

A
  1. obstruction of airflow
  2. mediators of inflammation and bronchoconstriction
  3. 4-12 hrs
  4. 6-12 hrs
  5. 12-24 hrs
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16
Q

Late phase asthmatic response: May be more severe and occur -1-. -2- are not effective for this late phase, but -3- are.

A
  1. at night
  2. Bronchodilators
  3. anti-inflammatory medications, like steroids,
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17
Q 
A 3 year old child with multiple episodes of wheezing, which of the following is a major risk factor for the future development of asthma?
• A. History of bronchiolitis
• B. Atopic dermatitis
• C. History of food allergy
• D. 10% peripheral eosinophilia
• E. Uncle with asthma
A

B

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18
Q

Asthma Diagnosis (0-4): Major Criteria: -1- history of -2-; physician diagnosis of -3-; Minor Criteria: physician diagnosed -4-, wheezing unrelated to colds, -5- >3%

A
  1. parental
  2. asthma
  3. atopic dermatitis
  4. allergic rhinitis
  5. Eosinophils
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19
Q

What is considered the “gold standard” for diagnosing asthma in children 6 years and up?

A

Spirometry (PFT)

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20
Q

Major differential for asthma in the newborn/early infant

A

bronchopulmonary dysplasia

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21
Q

Top 3 differentials for asthma

A

Tracheo-bronchomalacia, GER, CF

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22
Q

Four Components of Care: 1. Assessment and Monitoring

Four major factors used for classification of Asthma

A

Age
Phenotypes
Severity
Control

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23
Q

Four Components of Care: 1. Assessment and Monitoring
Guiding Asthma Principle I: Reduce -1-
• -2- chronic and troublesome symptoms
• Minimize the need to use -3- of asthma symptoms to ≤two days/week, maintain (near) normal pulmonary function
• Maintain normal -4- levels
• Prevent -5-

A
  1. impairment
  2. Prevent
  3. SABA for relief
  4. activity
  5. reduced lung growth
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24
Q

Four Components of Care: 1. Assessment and Monitoring
Guiding Asthma Principle II: Reduce -1-
• Prevent recurrent -2-
• Provide optimal -3- or -4-
• Step-down therapy: -5- to maintain control

A
  1. Risk
  2. exacerbations
  3. pharmacotherapy with minimal
  4. no adverse effects
  5. minimum medication necessary
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25
Q

Four Components of Care: 1. Assessment and Monitoring
Guiding Asthma Principle III: Optimize -1-
• Provide initial and ongoing -2- and family
• Educate patient and family to recognize -3-
• -4- and family to identify treatment goals and achieve well-controlled asthma that allows patient to fully and safely participate in activities (eg,
physical education, recess, sports, etc)
• Maintain patient’s and family’s -5- care

A
  1. Health and Function
  2. education to patient
  3. and avoid triggers
  4. Partner with patient
  5. satisfaction with asthma
26
Q

Four Components of Care: 1. Assessment and Monitoring
Asthma severity is the -1- of the disease process and dictates which step -2-
Level of severity is determined by both -3-.

A
  1. intrinsic intensity
  2. to initiate treatment
  3. impairment and risk
27
Q

Four Components of Care: 1. Assessment and Monitoring

The stepwise approach is meant to -1- the clinical decision making required to meet -2-

A
  1. assist, not replace,

2. individual patient needs

28
Q

Four Components of Care: 1. Assessment and Monitoring
For treatment purposes, patients who had -1- oral systemic corticosteroids in the -2-, or -3- in the past year, and who have risk factors for -4- may be considered the same as patients who have -4-, even in the absence of -5- with -4-

A
  1. ≥2 exacerbations requiring
  2. past 6 months
  3. ≥4 wheezing episodes
  4. persistent asthma
  5. impairment levels consistent
29
Q

Four Components of Care: 1. Assessment and Monitoring
PFT Classificaiton of Asthma - FEV1 & FEV1/FVC:
1. >80% predicted & > 85% (80/85)
2. > 80/80
3. 60/75 - 80/80
4. <60/75

A
  1. Intermittent
  2. Mild Persistent
  3. Moderate Persistent
  4. Severe Persistent
30
Q

Four Components of Care: 1. Assessment and Monitoring
-1- is the degree to which manifestations of asthma are minimized and the goals of therapy are met (e.g., prevent symptoms/exacerbations, maintain normal lung
function and activity levels).
A guide to either -2- therapy

A
  1. Asthma control

2. maintain or adjust

31
Q

Four Components of Care: 1. Assessment and Monitoring

Asthma control classified into 3 categories:

A

well controlled, not well controlled, and poorly controlled

32
Q

Four Components of Care: 1. Assessment and Monitoring

The classification of severity or level of control is based on the -1- or -2- in which any feature occurs.

A
  1. most severe impairment

2. risk category

33
Q

Component of Care 2: Control -1- Factors and Comorbid Conditions
a. Identify -2- factors
b. Recommend measures to control
exposures to -3- that make asthma worse.
c. Identify -4- that may adversely affect asthma
management
d. -5-

A
  1. Environmental
  2. precipitating and exacerbating (ie, asthma triggers, including those in the home, school, and child care settings)
  3. allergens and pollutants/irritants
  4. comorbid medical conditions
  5. Treat comorbid conditions
34
Q

Component of Care 3: Education
Integrate education into all -1- where health professionals interact with patients.
Provide -2-
Knowledge: -3- asthma; Role of medications; Skills
-4- to control asthma
-5- in response to signs of worsening asthma

A
  1. points of care
  2. self-management education.
  3. Basic facts about
  4. Take daily actions
  5. Adjust medication
35
Q

Component of Care 3: Education
Develop a written -1- in partnership with the patient.
Take medications correctly, use appropriate type of -2- with proper technique
Identify and avoid asthma triggers
-3- of asthma control
Recognize early -4- of worsening asthma & seek medical care as appropriate
Communicate asthma information to -5- center, and other caregivers

A
  1. asthma action plan
  2. inhaler and spacer
  3. Self-monitor level
  4. signs and symptoms
  5. school, child care
36
Q

Component of Care 4: Medications

a. Select -1- devices to meet patient’s need and circumstances.
b. Periodically inspect -2- to verify appropriate type

A
  1. medication and delivery

2. medications and inhaler/spacer

37
Q

When to consult:
0-4 years and -1- or higher is required

5 years or older and -2- or higher is required

Difficulty in -3- asthma control

A
  1. Step 3 care (may consider consultation at Step 2)
  2. Step 4 care (may consider consultation at Step 3)
  3. achieving or maintaining
38
Q
  • What are Beta adrenergic agonists?
  • Beta-adrenergic agonists or Beta-agonists -1- muscle and may -2- from -3- and basophils
  • They are a class of -4- which act upon the -5-.
A
  1. relax airway smooth (bronchodilation)
  2. modulate mediator release (i.e. histamine)
  3. mast cells
  4. sympathomimetic agents
  5. beta adrenoceptors
39
Q

What is the difference between Beta-1 (β1) receptors, beta (β2) receptors and beta (β3) receptors?
• Beta-1 (β1) receptors are found in the -1- and kidneys while beta (β2) receptors are found in the -2-, liver, -3-, and skeletal muscle.
• The third type, beta (β3) receptors are found in -4-

A
  1. heart, eye,
  2. lungs, gastrointestinal tract
  3. uterus, blood vessels
  4. fat cells.
40
Q

Short acting beta (β2) agonist (SABAs) recommended in -1- asthma to be administered -2- to -3- for -4- or -5-

A
  1. mild to moderate
  2. before exposure
  3. known allergens
  4. symptom relief
  5. rescue therapy
41
Q

Inhaled beta 2 agonists delivered -1- are preferable to -2-; inhaled therapy causes fewer -3- has -4- with similar -5-, and achieves results at lower doses

A
  1. directly to airways
  2. oral agents
  3. systemic adverse effects (CV stimulation, anxiety, skeletal muscle tremor)
  4. faster action onset
  5. duration of action
42
Q

Treatment for patient under 5 with:

  1. intermittent asthma
  2. mild persistent asthma
  3. moderate persistent asthma
A
  1. SABA PRN
  2. Low-dose ICS > Cromolyn or Montelukast; consider referral
  3. Medium-dose ICS; refer
43
Q

Inhaled Corticosteroids (ICS) MOA: suppression of -1-
• Decreased synthesis and release of -2-
• Decreased infiltration and activity of -3-
• Decreased -4-
• Block -5- to allergen
• Diminishes airway reactivity to histamine, methacholine, and cold air
• May take 1-3 months to decrease -3-, decrease shedding of epithelial cells and reduce hyperplasia of epithelial goblet cells.

A
  1. inflammation, reduce hyperresponsiveness
  2. inflammatory mediators (prostaglandins, leukotrienes)
  3. inflammatory cells (eosinophils, leukocytes)
  4. airway mucosal edema
  5. late phase reaction
44
Q

ICS Therapy:
True or False: After inhalation, the patient should rinse his/her mouth with water without swallowing to help reduce the risk of oropharyngeal candidiasis

A

True

45
Q
  • Pediatric Patients Aged 4 - 11 Years: Dosage for FLOVENT HFA
  • Recommended dosage: -1- daily, approximately -2-
A
  1. 88 mcg twice

2. 12 hours apart

46
Q

The starting dosage for QVAR Redihaler is based on -1- and -2-, including consideration of the patients’ current -3- and risk of -4-. -5- are not used with QVAR, as it may interfere with delivery.

A
  1. previous asthma therapy
  2. disease severity
  3. asthma symptom control
  4. future exacerbation
  5. Spacers
47
Q

Oral Corticosteroids
• Gain initial control of acute asthma or -1-
• May cause -2- suppression, -2- function returns rapidly
• Suppression may be prolonged with -3- short courses of oral corticosteroids per year

A
  1. severe persistent exacerbations
  2. adrenal
  3. > 4
48
Q 
Cromolyn sodium. Drug class: -1-
• Not useful for -2-
• Prevent asthma attacks with -3-
• Also used to prevent -4-
• MOA: suppresses inflammation (is not a bronchodilator). Stabilizes -5- membranes and prevents release of histamine and other mediators.
A
  1. mast cell inhibitor
  2. acute attack
  3. bronchial asthma
  4. bronchospasm (wheezing, chest tightness, trouble breathing)
  5. mast cell cytoplasmic
49
Q

[Leukotriene Receptor Antagonist (LTRA), e.g. singulair]
Effective for:
• Preventing asthmatic responses to -1—important esp. in children with unpredictable schedule of -1-
• -2- exposure and -2- rhinitis
• Additive effect with inhaled -3- and may be able to use lower -3- dose
MOA:
• Blocks/Inhibits -4- mediators
• Can decrease -5- mucous secretion, and recruitment of eosinophils and other inflammatory cells

A
  1. exercise/physical activity
  2. Allergic
  3. corticosteroid
  4. leukotrienes: inflammation synthesis
  5. inflammation, bronchoconstriction, edema,
50
Q

Anticholinergics prevent the increases in intracellular

concentration of -1- that are caused by -2- with the -3- on -4-

A
  1. cyclic guanosine monophosphate (cyclic GMP)
  2. interaction of acetylcholine
  3. muscarinic receptor
  4. bronchial smooth muscle
51
Q

Cystic Fibrosis Diagnostic studies
• -1- screening
• -2- test
• Genetic -3- mutation

A
  1. Newborn
  2. Sweat
  3. analysis for CFTR
52
Q

Newborn screening for CF
• Many newborns will have a -1- for the disease, fewer than 10 percent will -2-
•Infants diagnosed with CF through newborn screening and -3- begin are healthier

A
  1. positive newborn screen
  2. actually have it
  3. treated before symptoms
53
Q

The newborn screen for CF is a two-tier process
• The first tier is the analysis of -1- using the Guthrie card.
-This report is then sent to the -2-
•If the IRT is -3-, the second tier is diagnostic for
CF with either -4- by the State Lab or -5- at a CF center
• Positive screening with either an -3- IRT or CF
-4- needs follow up at a CF center facilitated by the -2-

A
  1. immunoreactive trypsinogen (IRT)
  2. PCP
  3. elevated
  4. gene analysis
  5. sweat chloride testing
54
Q

PCP actions given:

  1. Elevated IRT w/o mutation
  2. Elevated IRT w/ 1 mutation
  3. Elevated IRT w/ 2+ mutations
A
  1. monitor for signs of CF: persistent diarrhea, poor weight gain, chronic cough or other respiratory problems - any of these are call for CF specialist referral
  2. Sweat chlorine test at a CF center (under 30, negative; 30-59, refer for further assessment; >60 positive Dx)
  3. Positive diagnosis, refer for CF care
55
Q

-Cystic Fibrosis Clinical findings-
Pulmonary
• Chronic lung disease, -1-, dysfunctional mucociliary transport, obstruction, chronic infections
• Chronic -2-, respiratory failure
• Progressive disease – -3-
GI/nutrition
• -4- insufficiency, rectal prolapse
• Thick, fat-laden stools, failure to thrive
• -6-, GER, A, K, E, D deficiencies
• Distal intestinal obstructive syndrome (DIOS) -blockage or bowel obstruction, seen only in people with CF

A
  1. inflammation, viscous mucus
  2. cough, sputum production
  3. respiratory failure, death
  4. Meconium ileus, pancreatic
  5. Volvulus, duodenal inflammation
56
Q 
Cystic Fibrosis Clinical findings
Hepatobiliary tract
• -1-, ascites, hematemesis
Endocrine
• Recurrent -2-
Musculoskeletal
• Vitamin -3-
Reproductive
• -4-
• -5-
A
  1. Biliary cirrhosis, jaundice
  2. pancreatitis, diabetes mellitus
  3. D deficiency – osteoporosis
  4. Delayed sexual development
  5. Male sterility
57
Q

CF inheritance pattern

A

autosomal recessive

58
Q

Cystic Fibrosis
The defective gene and its protein product cause the body to produce -1- mucus that:
• -2- and leads to life-threatening bronchiectasis
• Affects the pancreas and stops enzymes from -3-
• Impacts other organ systems affecting -4-

A
  1. unusually thick, sticky
  2. Obstructs the airway
  3. facilitating food absorption
  4. quality of life
59
Q

CF Mgmt:
• PCP manages -1- and -2- care, including immunizations
• -3- managed at a CF-accredited center with multidisciplinary team

A
  1. Anticipatory guidance
  2. routine well-child
  3. Complicated treatment regimens
60
Q

Cystic Fibrosis Management
Pulmonary
• -1- – for airway clearance
• Ivacaftor – transmembrane conductance regulator
• High-dose -3- inflammation
• -4-
GI
• Replacement of -5-
• -6- replacement
• Management of cystic fibrosis liver disease
• Distal intestinal obstruction syndrome (DIOS) management – osmotic laxatives
Endocrine
• Diabetes mellitus – management/diagnosis

A
  1. Inhaled dornase alfa
  2. ibuprofen reducing chronic
  3. Manage chronic pneumothoraces
  4. pancreatic enzymes
  5. Fat-soluble vitamin
61
Q
  1. PROTEINURIA,
  2. HYPOALBUMINEMIA, HYPERLIPIDEMIA
  3. +/- EDEMA
A

NEPHROTIC SYNDROME

  1. UA results
  2. CMP/Lipid Panel results
  3. Phy’l Exam
62
Q
  • Excessive excretion of protein in urine from increased -1-
  • Selective (albumin only) or non-selective (most serum proteins) proteinuria
  • Massive proteinuria (3-4+) or protein-creatinine ratio greater than 2-3:1
  • Edema formation from decreased -2-
  • Liver -3- – hyperlipidemia and lipiduria
  • Reduced -4- – increased reabsorption of water
A

.Nephrotic Syndrome

  1. glomerular filtration permeability
  2. plasma oncotic pressure
  3. increases protein synthesis
  4. volume stimulates ADH

PNP III (10 decks)

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