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PC1-Exam 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is classified as mild intermittent asthma severity?

A

Symptoms occur less than or equal to to two days per week or less than 2 nights per month. Exacerbations are brief.

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2
Q

What is classified as mild persistent asthma severity?

A

Symptoms occurring more than two times per week but less than one time per day. Or occurs less than two nights per month.

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3
Q

What is the classification for moderate persistent asthma severity?

A

Daily symptoms OR more than 3 to 4 nights per month.

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4
Q

What is the classification for severe persistent asthma?

A

Continual symptoms or frequent nighttime symptoms greater than 1 night per month

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5
Q

What is important to know about long acting beta agonist?

A

Long acting beta agonist can increase asthma related death and should never be used alone in the management of asthma.

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6
Q

Long acting beta agonist should only be used with what medication?

A

Long acting beta agonist should only be used with a concurrent long acting steroid.

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7
Q

Once asthma is controlled, how long should a provider wait to titrate down to the minimum dose for asthma regimen?

A

At least three months.

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8
Q

Name some medications are short acting bronchodilator’s a.k.a. SABAs ?

A

Albuterol, Ventolin, pro air, levalbuterol, Xopenex

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9
Q

Name some medication that are inhaled corticosteroid

A

Budesonide/Pulmicort, Ciclesonide,

Fluticasone propionate/Flovent HFA.

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10
Q

Name combination asthma med inhaled corticosteroids/long acting bronchodilator

A

Fluticasone – salmeterol/Advair, Mometasone-formoterol/dulera, fluticasone-vilanterol/breo, Budesonide-formoterol/symbicort 

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11
Q

Name some leukotriene blockers

A

Montelukast/singulair, zafirlukast/accolate, zileuton/zyflo 

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12
Q

Name some monoclonal antibodies anti-asthma medications

A

Omalizumab/xolair, mepolizumab/Nucala, reslizumab/cinqair, dupilumav/dupixent, 

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13
Q

Name a long acting bronchodilator

A

Salmeterol (serevent diskus) 

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14
Q

Name a long acting anticholinergic medication

A

Tiotropium (spiriva) 

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15
Q

Name a long acting anticholinergic medication for asthma

A

Tiotropium (spiriva)

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16
Q

Name a xanthine medication

A

Theophylline 

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17
Q

Name some oral systemic steroids for asthma

A

Methylprednisolone, prednisolone, prednisone

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18
Q

If you were exposed to Covid what is the CDC recommendation?

A

Quarantine for five days. The first date of your exposure is considered de zero.

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19
Q

What is the CDC recommendation after COVID-19 exposure, when it comes to getting tested?

A

Even if you don’t develop symptoms, get tested at least five days after your last had contact with someone with COVID-19.

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20
Q

After COVID-19 exposure, how many days should you watch for symptoms after your last contact with Covid exposure ?

A

10 days 

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21
Q

If you were exposed to Covid and are up-to-date on COVID-19 vaccination what is the quarantine recommendation?

A

No quarantine. You do not need to stay home unless you develop symptoms.
Even if you don’t develop symptoms get tested at least five days after your last contact with Covid

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22
Q

What are the quarantine and isolation recommendations for people who have been exposed to COVID-19 but had confirmed COVID-19 within the past 90 days?

A

No quarantine unless symptoms are present. Watch for symptoms until 10 days after last exposure.

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23
Q

The first day of symptoms or a positive virus test is what day of illness?

A

Day 0

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24
Q

If you have tested positive for Covid 19 or have symptoms regardless of vaccination status, what is the isolation requirement?

A

Isolate For at least five days

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25
Q

What is the condition of isolation after five days if you had symptoms of COVID 19?

A

End isolation after five days if you are fever free for 24 hours (meaning without use a fever reducing medication) and your symptoms are improving

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26
Q

If a patient is very sick from COVID-19 or has a weekend immune system how long should they isolate for?

A

They should isolate for 10 days.

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27
Q

Who does not need a quarantine? List 2

A

If you are up to date with your COVID 19 vaccines

Yeah confirm COVID-19 within the past 90 days with no current symptoms.

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28
Q

If you test positive and I are at home living with others that are not positive you should do what?

A

Wear a well fitted mask when you need to be around other people. Avoid contact with members of household and pets. Don’t share personal household items like cups, towels and utensils. Use separate bathroom if possible. Stay in a separate room from others.

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29
Q

If you have COVID-19 what is the recommendation for isolation quarantine and going out in public?

A

Isolate/quarantine for five days and wear a mask for five additional days in public places.

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30
Q

To assess control of asthma management you should assess for what?

A

Check adherence, inhaler technique, environmental factors, and comorbid conditions.

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31
Q

0-4yrs: What is an indication that there is a step up management needed in asthma?

A

Increasing use of a short acting beta agonist (SABA) that consists of use more than two times in a week for symptom relief indicated inadequate control

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32
Q

0-4yrs: If you need to step up in asthma management, you should reassess in how many weeks?

A

Reassess in 4-6 weeks

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33
Q

0-4yrs: If you need to step down in asthma management due to improving in condition, you should wait how many months?

A

If asthma is well-controlled for three consecutive months you should step down in management if possible

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34
Q

0-4yrs: Step three for children ages 0 to 4 years and asthma management includes a medium dose of an inhaled corticosteroid and a PRN Saba,
What else is important to do at the stage?

A

Consult asthma specialist

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35
Q

For ages 0 to 4 years old: What is an alternative first step to management and asthma?

A

Instead of the low-dose inhaled corticosteroid and PRN Saba. The patient can be put on a daily montelukast or cromolyn and use a Saba PRN

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36
Q

For children and adults ages 5 and up: if a step up approach is needed for the management of asthma how long should you reassess after changing?

A

If step up as needed, reassess and 2 to 6 weeks.

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37
Q

For ages 5 and up when should you consider consult with asthma patient? 

A

When they are on a daily and PRN combination of an inhaled corticosteroid and a LABA 

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38
Q

Ages 5+ and up, step 3-4 three in asthma management, the preferred o medication option is what?

A

In steps three and four, the preferred option includes the use of inhaled corticosteroid– formoterol (referred to as “single maintenance and reliever therapy” or “smart” ) 1-2 puffs as needed up to a maximum dose of total daily maintenance (rescue dose in adults-12, pedi 5-11 is 8 doses) 

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39
Q

What is the basic management and asthma as far as medications goes? List in order:

A
  1. Prn saba
  2. Inhaled corticosteroids
  3. LABA/ICS
  4. LAMA
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40
Q

Omalizumab asthma biological should be considered in which step of asthma management in ages 5-11?

A

Step 5&6 (last steps of management)

This is the only FDA approved asthma biological for this age group

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41
Q

Inhaled corticosteroids drugs end in what?

A

“One”

Example beclomethasone or fluticasone

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42
Q

LABAs end in what?

Long acting beta agonists

A

They end in “ol”
Salmeterol
Formeterol 

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43
Q

LAMAs end in what?

Long acting muscarinic antagonist 

A

End in “ium”

Tiotropium

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44
Q

In all patients older than five years old what should be done to determine airway obstruction is at least partially reversible?

A

Spirometry

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45
Q

What should you assess at each visit for asthma management?

A

Asthma control, proper medication technique, written action plan, patient adherence, patient concern

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46
Q

Which influenza vaccine is recommended for all patients order than six months of age that have asthma?

A

The inactivated influenza quadrivalent vaccine (iiv4) 

Live attenuated is contraindicated in these patients

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47
Q

For LABAs, daily use of salmeterol should not exceed how much mcg? 
Remember these should always be given with an ICS

A

Should not exceed 100mcg

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48
Q

For LABAs, daily use of formoterol should generally not exceed how many mcg?
Remember these should always be given with an ICS

A

24 mcg

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49
Q

List 4 risk factors for COPD

A

Host factors, tobacco, occupation, indoor/outdoor pollution

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50
Q

What are the three common symptoms associated with COPD?

A

Shortness of breath, chronic cough, and sputum

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51
Q

What is required to diagnose COPD?

What lung test

A

Spirometry

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52
Q

List two factors related to a family history of COPD and or childhood factors Associated with COPD

A

Low birthweight and childhood respiratory infections

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53
Q

Other causes for chronic cough, intrathoracic. List some diseases associated

A

Asthma, lung cancer, tuberculosis, bronchiectasis, left heart failure, cystic fibrosis

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54
Q

list other causes for a chronic cough, that are extrathoracic.

A

Chronic allergic Granados, postnasal drip syndrome, gastroesophageal reflux disease, medication (Such as ACE inhibitors -lisinopril)

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55
Q

When doing bronchodilation spirometry, how many minutes after admin of a saba should the FEV1 be measured?

A

10 to 15 minutes

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56
Q

Spirometry measurements are evaluated by comparison of the results with appropriate reference values based on what four things?

A

Based on age, height, sex and race

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57
Q

I only get breathless with strenuous exercise,

Has a modified MRC score of one on the dyspnea scale?

A

Grade 0

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58
Q

I get short of breath when hurrying up on the level or walking up a slight hill, has a modified MRC score on the dyspnea scale?

A

Grade 1

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59
Q

I walk slower than people of the same age on the level because of breathlessness or I have to stop for breath from walking on my own pace on the level.

Has a modified MRC score of one on the dyspnea scale?

A

Grade 2

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60
Q

I stop for breath after walking about 100 m or after a few minutes on the level.
 Has a modified MRC score of one on the dyspnea scale?

A

Grade 3

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61
Q

I am too breathless to leave the house or I am breathless when dressing or undressing.
 Has a modified MRC score of one on the dyspnea scale?

A

Grade 4

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62
Q

An FEV1 that is greater than or equal to 80% is considered what? 

A

Normal

63
Q

And FEV1 from 65 to 79% is considered what?

A

Mild obstruction

64
Q

An FEV1 from 50 to 64% means what?

A

Moderate obstruction

65
Q

And FEV1 less than 50% is considered what?

A

Severe obstruction

66
Q

What are the five A’s is associated with helping a patient to quit smoking?

A

Ask, advice, access, assist, arrange

67
Q

The 23 Valent pneumococcal polysaccharide vaccine PPSV 23 has been shown to reduce the incidence of community acquired pneumonia in COPD patients aged ___ with an FEV1 of _____ predicted and in those with comorbidities. This is evidence B grade. 

A

Less than 65 and and FEV1 less than 40% predicted

68
Q

In the general population of adults aged ____ The 13 Valent conjugated pneumococcal vaccine PCV 13 has demonstrated significant efficacy and reducing bacteremia and serious invasive pneumococcal disease.evidence B

A

65 and older

69
Q

The CDC recommends what vaccination to protect against pertussis for adults with COPD who were not vaccinated in adolescence.evidence b

A

Tdap (dTap/dTPa)

70
Q

The CDC recommends the zoster vaccine to protect against shingles for adults aged ___ with COPD ? Evidence b

A

Older than 50 years

71
Q

What type of therapy improves lung function, symptoms and health status, and reduces exacerbations of COPD compared to a LABA/ICS, LABA/LAMA, or LAMA monotherapy . Evidence A

A

Triple inhale therapy of a LABA/LAMA /ICS

72
Q

Treatment with azithromycin for COPD is associated with an increased risk of what, and what impairment may they suffer? evidence A

A

Increased incidence of bacterial resistance and hearing test impairment

73
Q

Long-term azithromycin erythromycin therapy reduces exacerbations over one year. Is this true or false

A

True and it is evidence A 

74
Q

List three factors to consider when initiating Inhaled corticosteroid treatment for COPD

A

History of hospitalizations for exacerbation of COPD.

More than two moderate exacerbations of COPD per year.

Blood eosinophils more than 300 cells/ul

History of, or concomitant asthma

75
Q

What are factors to consider against the use of initiating Inhaled corticosteroid treatment in pts with COPD
list 3

A

Repeated pneumonia events

Blood Eosinophils less than 100 cells/ul 

History of mycobacterial infection

76
Q

What should be assessed before conducting at the current therapy is insufficient for management of COPD?

A

Inhaler technique and adherence to therapy

77
Q

IV Alpha-1 antitrypsin augmentation therapy in patients with COPD can have what effect? 

A

It may slow down the progression of emphysema. Evidence B. 

78
Q

What effect can vasodilators have on COPD patients?

A

Vasodilators do not improve outcomes and may worsen oxygenation. Evidence B 

79
Q

What is important to know about oxygen therapy in patients with COPD?

List 2, think of copd severe pts and stable/moderate pts. Both are evidence A

A

Long-term administration of oxygen increases survival in patients with severe chronic resting Arterial hypoxemia.

In patients with stable COPD and moderate resting or exercise induced Arterial desaturation , long-term oxygen use does not lengthen time to death or first hospitalization or provide sustained benefit. 

80
Q

What are the two goals for treatment of stable COPD? 

A

Reduce symptoms (relieve symptoms, improve exercise tolerance, improve health status )  and reduce risk (prevent disease progression, prevent and treat exacerbations, reduce mortality) 

81
Q

What are some of the first line from a coat therapies for tobacco dependence? List at least three

A

Varenicline, Bupropion sustained release, Nicotine (gum, inhaler, nasal spray, patch)

82
Q

What medication is not recommended for COPD?

A

Theophylline 

83
Q

If a patient has 0-1 moderate exacerbations not leading to hospital admission and has a COPD assessment score of less than 10 and a mMRC score of 0-1 , what medication should they be started on?

A

A bronchodilator (albuterol) 

84
Q

 If a patient has 0-1 moderate exacerbations not leading to hospital admission and has a COPD assessment score of more than 10 and a mMRC score of more than 2, what medication should they be started on?

A

A long acting bronchodilator such as a LAMA or LABA

85
Q

If a patient has more than two exacerbations or more than one exacerbation that leads to hospitalization, and has a MMRC score from 0 to 1 with a COPD assessment score less than 10 what medication should they be given?

A

LAMA 

86
Q

If a patient has more than two exacerbations with one or more leading to hospitalization and a mMRC score greater than two and a COPD assessment score greater than 10 what should the patient be on? 

A

LAMA or LAMA + LABA or ICS +LABA 

87
Q

Arterial hypoxemia is defined as a PaO2 of what or a SaO2 of what?

A

PaO2 less than 55 or a SaO2 less than 88%

88
Q

The goal when prescribing supplemental oxygen to COPD pts is to Keep the SaO2 greater than what?

A

Greater than 90%

89
Q

When prescribing supplemental oxygen to COPD patients when should you reassess if the oxygen is still indicated?

A

60 to 90 days

90
Q

When considering pneumonia as a possible differential for COPD exacerbation what should be done? List three diagnostics

A

Chest x-ray, assessment of C-reactive protein and procalcitonin

91
Q

What is the recommended initial bronchodilator for treatment of acute exacerbation COPD?

A

Short acting inhale beta agonist with or without short acting anti-cholinergics.

92
Q

Systemic corticosteroids can improve lung function, oxygenation and shorten recovery time and hospitalization duration. Duration should be no more than how many days? Evidence A

A

5 to 7 days

93
Q

Anabiotic’s for indicated in the management of COPD can shorten recovery time, reduce risk of early relapse, avoid treatment failure, and hospitalized duration. Duration therapy should be no more than how many days? Evidence B

A

Duration therapy should be no more than 5 to 7 days

94
Q

What should be the first method of ventilation use in COPD patients with acute respiratory failure with no absolute contraindication because it improves gas exchange, reduces work of breathing, and the need for intubation, decrease his hospitalization duration improve survival. Evidence A

A

Noninvasive mechanical ventilation

95
Q

What are some medications for noninvasive mechanical ventilation? For COPD patients, At least one of the following have to be present.

A

Respiratory acidosis (PH less than 7.35, PaCO2 more than 45)

Severe dyspnea with clinical signs suggestive of respiratory muscle fatigue, increased work of breathing or both, accessory muscle use, paradoxical motion of the abdomen, or retraction of the intercostal spaces.

Persistent hypoxemia despite supplemental oxygen therapy

96
Q

When discharging a patient with COPD the follow up should take place when?

A

Less than one to four weeks for a follow up.

97
Q

After discharging from the hospital, and 12 to 16 week Follow up appointment should reassess what?

A

Measures from spirometry

98
Q

List some common risk factors for the development of lung cancer there are six

A

Age greater than 55, smoking history includes more than 30 packs per year, presence of emphysema on a CT scan, presence of airflow limitation with a FEV1/FVC ratio less than 0.7,
BMI less than 25, and family history of lung cancer

99
Q

What should you avoid for patients with COPD suspected or proven COVID-19 exist?

A

Avoid spirometry unless essential, and avoid Bronchoscopy unless essential.

100
Q

For COVID-19 therapy and COPD patient what are the recommendations pharmacologically?

A

Use the systemic steroids and remdesivir as recommended for patients with COPD

101
Q

People who cannot properly wear a mask, including children less than two years of age and people of any age or certain disabilities should isolate for how long?

A

Should isolate for 10 days

102
Q

For asymptomatic patients that test positive, day zero is what?

A

Day zero is the date their specimen was collected for the positive test

103
Q

Patients who have recovered from COVID-19 can continue to have detectable SARS – Covid2RNA in the upper respiratory specimens for up to how long?

A

After three months after illness onset

104
Q

Asymptomatic patients with close contact with someone with COVID-19 regardless of vaccination status should have how many tests and how long apart?

A

Testing is recommended immediately but not generally earlier than 24 hours after exposure and if negative should retest again in 5 to 7 days after the exposure 

105
Q

Which manufacturer for Covid-19 Vaccination can administer to ages 5 to 17?

A

Only Pfizer

106
Q

For Pfizer mRNA vaccine the second dose can be administered or given after how many weeks? For all ages

A

At least 3 to 8 weeks. Only three weeks for 5 to 11 year olds

107
Q

For the Moderno mRNA vaccine the second dose can be given after how many weeks?

A

It can be given at least 4-8weeks

108
Q

The first booster dose for both the Pfizer and Moderno mRNA vaccine can be given after how many months after the second primary dose?

A

At least five months

109
Q

Can COVID-19 vaccines be administered on the same day as other vaccines?

A

Yes

110
Q

Are Covid19 doses administered up to four days before the minimum interval considered valid?

A

Yes they are considered valid. Does is administered at anytime after the recommend interval are valid.

111
Q

The general symptoms of TB disease include what?

A

Feelings of sickness or weakness, weight loss, fever, and night sweats.

112
Q

Symptoms of TB lung disease include what?

A

Coughing, chest pain, coughing up blood.

113
Q

Describe latent TB infection

A

People with latent TB have TV germs in their bodies but they are not safe because the germs are not active. They cannot spread to others.

114
Q

A person given the to tuberculin

skin test must return within how many hours to have a train health your worker look for reaction on the arm? 

A

Within 48 to 72 hours

115
Q

A positive test for TB infection means what? 

A

Only tell that a person has been infected with the TB germ

116
Q

Bacille calmette-Guerin Is a vaccine for what disease?

A

 For tuberculosis.

117
Q

What is important to know with the Basilica calmette-Guerin vaccine? 

A

It can cause a false positive tuberculin skin test.

BCG vaccination does not completely prevent people from getting TB

118
Q

How long is the treatment for TB disease be treated?

A

6 to 12 months

119
Q

What is DOT stand for in relation to TVBdisease?

A

Direct observe therapy, it helps the patient complete treatment in the least amount of time for patients who have been diagnosed with TB disease

120
Q

What is compliance? think of balloon

A

Ability of the lungs to stretch and expand

121
Q

What is resistance? Think of a lemon seed in a straw

A

Frictional force of air way, disturbs airflow.

122
Q

What is obstructive?

 Think of no exit

A

Difficulty in the air flowing out of lungs, decrease your flow

123
Q

What is restrictive? Think of restricted entry

A

Lungs having difficulty expanding

124
Q

What is the maximum volume of air the lungs can hold?

A

Total lung capacity

125
Q

What is the volume remaining in lungs after a normal exhalation?

A

Functional residual capacity

126
Q

What is this term? it’s the amount of air remaining in lungs after maximum expiration

A

Residual volume

127
Q

What is this term? It is the total air volume normally exhaled after inhaling maximum volume 

A

Vital capacity

128
Q

What is the total air volume exhaled forcefully/quickly after inhaling maximum volume?

A

Forced vital capacity

129
Q

What is the amount of air expired during the FVC portion of the test?

A

forced expiratory volume one (FEV1)

130
Q

Increase volume with a low ratio of FEV1/FVC is Indicative of what respiratory problem?

A

COPD, obstructive respiratory problem

131
Q

Decrease volume, with a normal or increased FEV1/FVC ratio is what type of respiratory problem?

A

Most common and asthma, restrictive airway problem

132
Q

If the total lung capacity (TLC) and FEV1/FVC ratio are both decreased what does this mean?

A

Mixed restrictive and obstructive disease

133
Q

What is DLCO stand for?

A

Diffusing capacity for carbon monoxide

134
Q

What is the DLCO used for?

A

Assess gas exchange

135
Q

A decreased DLCO below 75 means what?

A

Suggest intrinsic lung disease such as pneumonia, cystic fibrosis, occupational exposure. Anything that can cause scarring in the lung

136
Q

A normal DLCO accompanied by a restrictive disease suggest what?
Normal is 75 or above.

A

Suggest a non-pulmonary cause of restriction. Two more or scoliosis – anything that compacts the lung 

137
Q

What is the normal FVC in a patient?

A

500 mL

138
Q

What is the normal amount in FEV1?

A

400

139
Q

A Reduced FVC (lung volume) with a normal/increased FEV1/FVC ratio? 

A

restrictive disease asthma 

140
Q

What other organs can get/be affected by TB disease? List 3 common ones

A

Kidney spine and brain

141
Q

What are the two categories for people high risk for developing TB disease?

A

Persons who have been recently infected with TB bacteria, and persons with no conditions that weaken the immune system

142
Q

For a traveler that anticipates possible pro life exposure people with TB, they should do what before they leave and after they come back? How many weeks after they come back?

A

They should have a TB skin test or a TB blood test Before leaving the US.

It’s a test is negative they should have a repeat test and 8 to 10 weeks after returning to the US.

143
Q

Children should be considered for BCG vaccination only if they are exposed to an adult and can’t be separated from the adult who have what?

A

From adults who are untreated or ineffectively treated for TB, the child can’t be given long-term primary preventive treatment for TB infection or have isoniazid and rifampin resistant strains of TB disease

144
Q

For children under the age of five which TB test is preferred?

A

TB skin test

145
Q

If a person is having a cough for three weeks and is spitting up with blood what should you consider as a differential?

A

Tuberculosis

146
Q

What is this term? TB disease caused by bacteria resistant to the two of the most important medicines INH and RIF

A

Multi drug resistant tuberculosis

147
Q

What is the preferred test for people who have received the BCG tuberculosis vaccine?

A

A TB blood test (quantiferon and t-spot)

148
Q

Is annual TB testing of healthcare personnel recommended?

A

No. Unless there is a known exposure on going transmission at the healthcare facility.

149
Q

What is the treatment for healthcare workers is diagnosed with latent TB?

A

Once weekly INH and rifapebtine for three months and daily rifampin for 4 months

150
Q

If a healthcare provider had a previous negative TB test when should I retest after the last known exposure?

A

8 to 10 weeks after the last known exposure

151
Q

For healthcare professionals with a documented history of a positive TB test what should they do?

A

They do not need to be retested after exposure to TB. They should receive a TV symptom screen and if they have symptoms of TB they should be evaluated for TB disease.

152
Q

If a healthcare personnel had a history of latent TB infection and have a negative test, when should they retest to confirm the results?

A

1 to 3 weeks after the first test to be considered not infected.

153
Q

Latent tuberculosis screening is what grade for USPSTF ?

A

Grade b

Screen high populations

PC1-Exam 2 (3 decks)

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