Practice Questions Flashcards
Which of the following best describes asthma?
A. intermittent airway inflammation with occasional bronchospasm
B. a disease of bronchospasm that leads to airway inflammation
C. chronic airway inflammation with superimposed bronchospasm
D. relatively fixed airway constriction
C. chronic airway inflammation with superimposed bronchospasm
The patient you are evaluating is having a severe asthma flare. You have assessed that his condition is appropriate for office treatment. You expect to find the following on physical examination: A. tripod posture B. inspiratory crackles C. increased vocal fremitus D. hyperresonance on thoracic percussion
D. hyperresonance on thoracic percussion
A 44-year-old man has a long-standing history of moderate persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair) via metered-dose inhaler, one puff twice a day, and the use of albuterol 1 to 2 times a week as needed for wheezing. Three days ago, he developed a sore throat, clear nasal discharge, body aches, and a dry cough. In the past 24 hours, he has had intermittent wheezing that necessitated the use of albuterol, two puffs every 3 hours, which produced partial relief. Your next most appropriate action is to obtain a:
A. chest radiograph.
B. measurement of oxygen saturation (SaO2).
C. spirometry measurement.
D. sputum smear for white blood cells (WBCs).
C. spirometry measurement.
You examine Jane, a 24-year-old woman who has an acute asthma flare following a 3-day history of upper respiratory tract symptoms (clear nasal discharge, dry cough, no fever). She has a history of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home, her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 second (FEV1) is 65% of predicted. Her medication regimen should be adjusted to include: A. theophylline. B. salmeterol (Serevent). C. prednisone. D. montelukast (Singulair).
You also prescribe: A. amoxicillin. B. azithromycin. C. levofloxacin. D. no antimicrobial therapy.
C. prednisone.
D. no antimicrobial therapy.
Peak expiratory flow meters:
A. should only be used in the presence of a medical professional.
B. provide a convenient method to check lung function at home.
C. are as accurate as spirometry.
D. should not be used more than once daily.
B. provide a convenient method to check lung function at home.
Which of the following is most likely to appear on a chest radiograph of a person during an acute severe asthma attack? A. hyperinflation B. atelectasis C. consolidation D. Kerley B signs
A. hyperinflation
A 36-year-old man with asthma also needs antihypertensive therapy. Which of the following products should you avoid prescribing? A. hydrochlorothiazide B. propranolol C. amlodipine D. enalapril
B. propranolol
Which of the following is inconsistent with the presentation of asthma that is not well controlled?
A. a troublesome nocturnal cough at least 2 nights per week
B. need for albuterol to relieve shortness of breath at least twice a week
C. morning sputum production
D. two or more exacerbations/year requiring oral corticosteroids
C. morning sputum production
The cornerstone of moderate persistent asthma drug therapy is the use of: A. oral theophylline. B. mast cell stabilizers. C. short-acting beta2 agonists (SABA). D. inhaled corticosteroids.
D. inhaled corticosteroids.
Sharon is a 29-year-old woman with moderate persistent asthma. She is not using prescribed inhaled corticosteroids, but is using albuterol PRN to relieve her cough and wheeze with reported satisfactory clinical effect. Currently she uses about two albuterol metered-dose inhalers per month and is requesting a prescription refill. You consider that:
A. her asthma is well controlled and albuterol use can continue.
B. excessive albuterol use is a risk factor for asthma death.
C. her asthma is not well controlled and salmeterol (Serevent) should be added to relieve bronchospasm and reduce her albuterol use.
D. her asthma has better control with albuterol than inhaled corticosteroids.
B. excessive albuterol use is a risk factor for asthma death.
In the treatment of asthma, leukotriene receptor antagonists should be used as:
A. controllers to prevent bronchospasm.
B. controllers to inhibit inflammatory responses.
C. relievers to treat acute bronchospasm.
D. relievers to treat bronchospasm and inflammation.
B. controllers to inhibit inflammatory responses.
According to the National Asthma Education and Prevention Program Expert Panel Report-3 (NAEPP EPR-3) guidelines, which of the following is not a risk for asthma death?
A. hospitalization or an emergency department visit for asthma in the past month
B. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids
C. difficulty perceiving airflow obstruction or its severity
D. rural residence
D. rural residence
An 18-year-old high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate action is to: A. write the note because gym class participation could trigger asthma symptoms. B. excuse him from outdoor activities only to avoid pollen exposure. C. assess his level of asthma control and make changes in his treatment plan if needed so he can participate. D. write a note excusing him from gym until his follow-up exam in 2 months.
C. assess his level of asthma control and make changes in his treatment plan if needed so he can participate.
You see a 34-year-old man with moderate persistent asthma who has a severe asthma flare and a regimen of oral prednisone is being considered. Which of the following is true?
A. A taper is needed for prednisone therapy lasting longer than 4 days.
B. A taper is not needed if the prednisone regimen is for 7 days or less.
C. A taper is not needed regardless of duration of prednisone therapy.
D. A taper is needed if the patient is taking concomitant inhaled corticosteroids.
B. A taper is not needed if the prednisone regimen is for 7 days or less.
After inhaled corticosteroid is initiated, improvement in control is usually seen: A. on the first day of use. B. within 2 to 8 days. C. in about 3 to 4 weeks. D. in about 1 to 2 months.
B. within 2 to 8 days.
Compared with albuterol, levalbuterol (Xopenex) has:
A. a different mechanism of action.
B. the ability potentially to provide greater bronchodilation with a lower dose.
C. an anti-inflammatory effect similar to that of an inhaled corticosteroid.
D. a contraindication to use in elderly patients.
B. the ability potentially to provide greater bronchodilation with a lower dose.
Which of the following is consistent with the NAEPP comment on the use of inhaled corticosteroids (ICS) for a child with asthma?
A. The potential but small risk of delayed growth with ICS is well balanced by their effectiveness.
B. ICS should be used only if leukotriene modifiers fail to control asthma.
C. Permanent growth stunting is consistently noted in children using ICS.
D. Leukotriene modifiers are equal in therapeutic effect to the use of a long-acting beta2-agonist.
A. The potential but small risk of delayed growth with ICS is well balanced by their effectiveness.
A potential adverse effect from ICS use is: A. oral candidiasis. B. tachycardia. C. gastrointestinal upset. D. insomnia.
A. oral candidiasis.
Clinical findings characteristic of asthma include all of the following except:
A. a recurrent spasmodic cough that is worse at night.
B. recurrent shortness of breath and chest tightness with exercise.
C. a congested cough that is worse during the day.
D. wheezing with and without associated respiratory infections.
C. a congested cough that is worse during the day.
Which of the following best describes the mechanism of action of short-acting beta2-agonists? A. reducer of inflammation B. inhibition of secretions C. modification of leukotrienes D. smooth muscle relaxation
D. smooth muscle relaxation
Regarding the use of long acting beta2-agonists (LABAs), which of the following is not true?
A. LABAs enhance the antiinflammatory action of corticosteroids.
B. Use of LABAs is associated with a small increase in risk of asthma death.
C. LABA use reduces the risk of asthma exacerbations.
D. LABAs can be used as monotherapy to relieve bronchospasms in asthma.
D. LABAs can be used as monotherapy to relieve bronchospasms in asthma.
Which of the following is the therapeutic objective of using inhaled ipratropium bromide?
A. as an antiinflammatory.
B. an increase in vagal tone in the airway
C. inhibition of muscarinic cholinergic receptors
D. an increase in salivary and mucous secretions
C. inhibition of muscarinic cholinergic receptors
Which of the following is true regarding the use of systemic corticosteroids in the treatment of asthma?
A. Frequent short bursts are preferred over daily inhaled corticosteroids.
B. The oral corticosteroid should be started at day 3-4 of the asthma flare for optimal effect.
C. The oral route is preferred over parenteral therapy.
D. The adult dose to treat an asthma flare should not exceed the equivalent of prednisone 40 mg daily.
C. The oral route is preferred over parenteral therapy.
Compared with SABAs, LABAs:
A. are recommended as a first-line therapy in mild intermittent asthma.
B. have a significantly different pharmacodynamic profile.
C. have a rapid onset of action across the drug class.
D. should be added to therapy only when ICS use does not provide adequate asthma control.
D. should be added to therapy only when ICS use does not provide adequate asthma control.
Which of the following statements is false regarding the use of omalizumab (Xolair)?
A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares.
B. The medication selectively binds to IgE to reduce exacerbations.
C. Labeled indication is for patients with poorly controlled asthma with frequent exacerbations.
D. Special evaluation is required prior to its use and ongoing monitoring is needed during use.
A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares.
Subcutaneous immunotherapy is recommended for use in patients:
A. with well-controlled asthma and infrequent exacerbations.
B. with allergic-based asthma.
C. with moderate persistent asthma who are intolerant of ICS.
D. with poorly-controlled asthma who fail therapy with omalizumab.
B. with allergic-based asthma.
T/F Most prescribers are well versed in the relative potency of ICS and prescribe an appropriate dose for the patient’s clinical presentation.
False
T/F Approximately 80% of the dose of an ICS is systemically absorbed.
False
T/F Leukotriene modifiers and ICS are interchangeable clinically because both groups of medications have equivalent anti-inflammatory effect.
False
T/F Little systemic absorption of mast cell stabilizers occurs with inhaled or intranasal use.
True
T/F Due to safety concerns, mast cell stabilizers are no longer available.
False
When discussing immunizations with a 67-year-old woman with chronic obstructive pulmonary disease (COPD), you advise that she:
A. receive live attenuated influenza virus vaccine.
B. avoid immunization against influenza because of the risk associated with the vaccine.
C. receive inactivated influenza virus vaccine.
D. take an antiviral for the duration of the influenza season.
C. receive inactivated influenza virus vaccine.
T/F Seasonal influenza vaccination is generally recommended for all persons over the age of 6 months.
True
T/F A 66-year-old woman is an acceptable candidate
for the high-dose inactivated influenza vaccine shot.
True
T/F Cigarette smokers should not receive the pneumococcal vaccine until 65 years of age.
False
T/F A 52-year-old immunocompetent patient with COPD who receives the pneumococcal vaccine should get revaccinated in 5 years.
False. He should receive another dose when he turns 65 plus additional doses later.
When used in treating COPD, ipratropium bromide (Atrovent) is prescribed to achieve which of the following therapeutic effects? A. increase mucociliary clearance B. reduce alveolar volume C. bronchodilation D. mucolytic action
C. bronchodilation
What is the desired therapeutic action of inhaled corticosteroids when used to treat COPD?
A. reversal of fixed airway obstruction
B. improvement of central respiratory drive
C. reduction of airway inflammation
D. mucolytic activity
C. reduction of airway inflammation
Which is most consistent with the diagnosis of COPD?
A. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use
B. dyspnea on exhalation
C. elevated diaphragms noted on x-ray
D. polycythemia noted on complete blood cell count
A. FEV1/FVC ratio equal to or less than 0.70 after properly timed SABA use
The most effective nonpharmacologic method to prevent exacerbations in patients with COPD is:
A. weight loss for those with a BMI greater than 25 kg/m2.
B. avoid exposure to children or day-care centers.
C. brisk walking for at least 5 minutes 3-5 times a day as tolerated.
D. avoid exposure to pulmonary irritants, such as cigarette smoke.
D. avoid exposure to pulmonary irritants, such as cigarette smoke.
When managing patients with COPD who continue to smoke cigarettes, a discussion on the importance of smoking cessation should occur:
A. at the initial diagnosis visit.
B. with each COPD flare.
C. once inhaled corticosteroid therapy is initiated.
D. at every office visit.
D. at every office visit.
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, which of the following medications is indicated for use in all COPD stages? A. short-acting inhaled beta2-agonist B. inhaled corticosteroid C. long-acting anticholinergic D. long-acting beta2 agonist
A. short-acting inhaled beta2-agonist
According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in stage III or severe COPD is to:
A. minimize the risk of repeated exacerbations.
B. improve cough function.
C. reverse alveolar hypertrophy.
D. help mobilize secretions.
A. minimize the risk of repeated exacerbations.
Which of the following systemic corticosteroid doses is most potent? A. methylprednisolone 8 mg B. triamcinolone 10 mg C. prednisone 15 mg D. hydrocortisone 18 mg
C. prednisone 15 mg
Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection? A. Legionella species B. Streptococcus pyogenes C. Respiratory tract viruses D. Staphylococcus aureus
C. Respiratory tract viruses
Which is the most appropriate choice of therapy in the treatment of a mild acute COPD exacerbation in a 42-year-old man?
A. A 5-day course of levofloxacin
B. A 7-day course of amoxicillin
C. A 10-day course of doxycycline
D. Antimicrobial therapy is usually not indicated.
D. Antimicrobial therapy is usually not indicated.
Which is the most appropriate statement about therapy for a severe COPD exacerbation in a 52-year-old man?
A. A 5-day course azithromycin should be prescribed.
B. A 10-day course of amoxicillin/clavulanate is advisable,
C. A 7-day course of trimethoprim-sulfamethoxazole is recommended.
D. The role of antimicrobial therapy is debated, even for severe disease.
D. The role of antimicrobial therapy is debated, even for severe disease.
