Respiratory

Question 1

Please list Clinical Findings in an Asthma or COPD Flare

Answer 1

1. Hyperresonance on Thoracic percussion
2. Decreased tactile fremitus wheeze (Exp first, insp later)
3. Prolonged Expiratory phase of forced exhalation
4. Low diaphragm
5. Increased AP diameter
6. Reduction in Forced Expiratory Volume (FEV) at 1 second or peak expiratory flow rate.

Question 2

Goal of asthma is to use a Short acting beta agonist no more than x/ week

Answer 2

2

Question 3

List two types of asthma severity, and the corresponding classifications

Answer 3

Persistent v. Intermittent
Mild Moderate Severe
Well controlled, not well controlled, very poorly controlled

Question 4

Two types of asthma therapies:

Answer 4

Relievers

Controllers

Question 5

Relievers consist of

Answer 5

Short acting beta2 agonists (SABAS)
Short acting muscarinic agents (SAMAS)
Oral Corticosteroids (OCS)

Question 6

Name 3 SABAS

Answer 6

Proventil/Ventolin/ProAir, Levalbuetrol (Xopenex) and Pirbuterol (Maxair)

Question 7

SABA MOA

Answer 7

Bind beta2 adrenergic receptor, causing smooth muscle dilation and bronchodilation

Question 8

Name 1 SAMA and its MOA

Answer 8

Ipratroprium bromide. Anticholinergic indicated for treatment of moderate or severe asthma exacerbations to provide additional bronchodilation to albuterol. Inhibits muscarinic cholinergic receptors, reducing vagal tone in the airway, decreaseing mucus secretion, and blocking reflex bronchoconstriction.

Question 9

Duration of OCS

Answer 9

7-10 days.

Question 10

Name 4 Asthma controllers

Answer 10

Inhaled Corticosteroids (ICS)
Leukotriene modifiers/leukotriene receptor agonist (LTM/LTRA)
Inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA).

Question 11

What is the preferred controller of all levels of persistent asthma?

Answer 11

ICS (examples are fluticasone, mometasone, and budesonide).

Question 12

After starting an ICS, when should one observe improvement in asthma control?

Answer 12

2-8 days

Question 13

3 ICS adverse effects, and one for children

Answer 13

Hoarseness, oral candidiasis, sore throat,

Question 14

Instructions for ICS use

Answer 14

Rinse mouth s/p ICS.