Respiratory

Question 1

Etiology of asthma

Answer 1

airway inflammation
intermittent airflow obstruction, bronchial hyperresponsiveness
Factors: allergens, URIs, exercise, GERD, sinusitis, aspirin/NSAID, obesity, pollutants

Question 2

Presentation of asthma

Answer 2

episodic wheezing
SOB
Chest tightness
Cough 
Excess sputum production
Symptoms worse at night, smoking

Question 3

Dx workup of asthma

Answer 3

Spirometry (FEV1, FVC, FEV1/FVC) before and after short acting bronchodilator
Significant reversibility of obstruction by greater than 12% and 200mL in FEV1 or FVC

Question 4

Treatment staircase for asthma

Answer 4

1: SABA PRN
2: Low-dose ICS
3: Low-dose ICS + LABA or medium dose ICS
4: Med-dose ICS + LABA or medium dose ICS plus LTRA, Theophyline or Ziletron
5: High dose ICS + LABA and consider Omalizumab for patients with allergies
6: High dose ICS + LABA + oral corticosteroid

Question 5

Severity of asthma in pt. 12 or older

Answer 5

Intermittent: symptoms 2 days a week or less
Mild: greater than 2 days a week but not daily
Moderate: Daily
Severe: Throughout the day

Question 6

Inhaled corticosteroids: type, MOA, Indication, CI, AE

Answer 6

beclomethasone (QVAR)
fluticasone (flovent)
triamcinolone (Kenalog)
MOA: inhibit release of arachadonic acid, reduces hyperresponsiveness of airway smooth muscle
Indications: COPD, asthma, allergic rhinitis
AE: oropharyngeal candidiasis/thrush, hoarseness

Question 7

Systemic steroid use in respiratory disorders. type, MOA, Indication, CI, AE

Answer 7

Prednisone, prednisolone, methyl prednisolone
MOA: inhibit release of arachadonic acid
CI: osteoporosis
AE: long term: osteoporosis, increased appetite, glaucoma, impaired wound healing, euphoria, depression, HTN, peripheral edema

Question 8

Mast cell stabilizer: type, MOA, Indication, CI, AE

Answer 8

cromolyn, nedrocromil
MOA: inhibits mast cell degranulation and release of histamine
Indication: alt therapy for mild persistent asthma (seems to not be used much now)
AE: cough, irritation, taste

Question 9

Short acting beta agonists (SABA)

type, MOA, Indication, CI, AE

Answer 9

Albuterol, levalbuterol, pirbuterol
MOA: bronchodilation
Indications; acute asthma (rescue use only), COPD, before exercise
CI: shouldn’t have to use more than twice a week.
AE: beta2 muscle cell tremors, tachycardia, hyperglycemia, hypo(kalemia and magnesia)

Question 10

Long acting beta agonists (LABA)

type, MOA, Indication, CI, AE

Answer 10

salmeterol (serevent); Formoterol
FYI: Advair = salmeterol + fluticasone
MOA: bronchodilation
Indications: asthma, COPD
AE:  beta2 muscle cell tremors, tachycardia, hyperglycemia, hypo(kalemia and magnesia)

Question 11

Anticholinergics

Type, MOA, Indication, CI, AE

Answer 11

ipatropium (atrovent): non-selective, short
tiotropium: long acting
MOA: Block vagelly mediated constriction of airway smooth muscle and mucus secretion
Indications: COPD, asthma + COPD, asthma not toleration SABAs
AE: xerostomia, taste (Not regular antiChol AE because inhaled)

Question 12

Phosphodiesterase inhibitors

Type, MOA, Indication, CI, AE

Answer 12

Theophylline
MOA: Bronchodilator. Exact MOA not clear
Indication: Used to be mainstay of treatment for asthma, replaced by ICS and beta2 agonists
AE: seizures, fatal arrythmias, tachyC

Question 13

Leukotreine modifiers

Type, MOA, Indication, CI, AE

Answer 13

Zafirlukast
Montelukast (singulair)
Zileuton
MOA: Inhibits dif steps in the arachadonic acid inflam pathway
Indications: Asthma, not for COPD
AE: elevated serum hepatic enzymes, HA, dyspepsia

Question 14

Common organisms for CAP

Answer 14

Typical: strep pneumo (gram + cocci), H flu (gram - rod)
Atypical: mycoplasma, chlamydia, legionella
Immunocomp: pseudomonas
Viral: staph aureus

Question 15

Clinical presentation for CAP typical

Answer 15

Sudden onset of high fever
Productive cough with purulent sputum
pleuritic chest pain
Rigors
Tachycardia, tachypnea

Question 16

Clinical presentation for CAP atypical

Answer 16

Low grade fever
Dry, non productive cough
extrapulmonary sxs: myalgias, malaise, sore throat, HA, N/V/D

Question 17

Physical exam

Answer 17

signs of consolidation:

• dullness to percussion
• increased tactile fremitus
• inspiratory crackles

Question 18

Indictions for hospitalization of CAP

Answer 18

Pneumonia severity index, CURB-65

Question 19

CURB-65

Answer 19

Confusion
Urea (blood urea nitrogen)
Respiratory rate greater equal to 30
Blood pressure: sys less than 90, dia less than 60
Age: greater or equal to 65
Score 2 or great hospital
Score 3 or more assess for ICU