Unit 3 Practice Questions Flashcards
A thin patient w/ a slight build present with constant difficulty breathing and clear mucus. A physical exam also indicates an increased chest anteroposterior diameter and hyperresonance on percussion. Given the most likely diagnosis, which class of medications is best suited for long-term tx?
a. Antibiotics
b. Anticholinergics
c. Antileukotrienes
d. Short-acting beta-2 adrenergic agonists
B. Anticholinergics
Diagnosis: emphysema. This is treated with ipratropium bromide; antibiotics treats complications; SABA may treat but ipratropium is preferred d/t greater efficacy and minima cardiac stimulation effects; antileukotrienes are not used in emphysema
Which of these manifestations is LEAST likely to present with the onset of asthma?
a. Plugging the airways by thick mucus
b. Hypertrophy of the mucus glands
c. Thinning of the epithelial basement membrane
d. Hypertrophy of smooth muscle
C. thinning of the epithelial basement membrane
Asthma presents as a result of increased responsiveness of the trachea and bronchi to stimuli, often leading to the thickening, not thinning, of the epithelial basement membrane. Other physical changes likely to produce from asthma include plugging of the airways by thick mucus and hypertrophy of both the mucus gland and smooth muscle.
Your patient was seen by a pulmonologist 2 months ago and diagnosed with asthma. The pulmonologist ordered a short acting beta-2 agonist for initial symptom relief. However, on today’s visit to your office, the patient states, “I don’t think this stuff is really working because I’m still short of breath.” You refer the patient back to the pulmonologist. Which of the following would you anticipate being the next step in the patient’s management following the latest national guidelines?
a. An antileukotriene
b. A long-acting beta-2 adrenergic agonist
c. A metered anticholinergic
d. An inhaled corticosteroid
d. an inhaled corticosteroid
By national guidelines for asthma management, a low-dose ICS is usually the first step for increased management after a SABA shows insufficient results in controlling symptoms. While an antileukotriene, such montelukast, may serve as alternative treatment at this
step, a low-dose ICS is considered to be the standard medication. Long-acting beta-2 agonists typically see use if tx with a low-dose ICS fails to manage symptoms, whereas metered anticholinergics are usually paired with a SABA for short-term sx relief, not longterm sx control.
Jackie, a 25-yo female, comes to the clinic experiencing respiratory distress and difficulty speaking. Her lungs are
hyperresonant and show hyperinflation on the x-ray. Which result would most strongly indicate that Jackie should be admitted to a hospital?
a. Forced expiratory volume is below 30%
b. Respiratory rate is 25 breaths/minute
c. Pulsus paradoxus of 8 mmHg
d. Pulse is 112 bpm
a. forced expiratory volume is below 30%
Which of these is NOT a common indoor trigger for asthma?
a. Cockroaches
b. Dust mites
c. Exercise
d. Termites
d. termites
Although termites may trigger asthma, they are not commonly considered to be an indoor trigger for the condition. Dust mites, pets, cockroaches, indoor molds, exercise, and cigarette smoke are all common indoor causes of asthma.
Upon examination, you notice that Alex, an obese 63yo male, has moderate dyspnea and purulent sputum. His lungs are normal upon percussion. Laboratory results reveal an increased hematocrit level. Given the most likely diagnosis, which of the following drugs would you be LEAST likely to prescribe for the patient’s condition?
a. Ipratropium bromide
b. Albuterol
c. Budesonide
d. Montelukast
d. Montelukast
A patient with dyspnea, purulent sputum, obesity, and an increased hematocrit level most likely has chronic bronchitis, which would not require the administration of montelukast. Mainstays of chronic bronchitis tx include anticholinergics such as ipratropium bromide, as well as beta-2 adrenergic agonists, such as albuterol. Budesonide and other corticosteroids may likewise see use improving lung function. Leukotriene receptor antagonists, such as montelukast, are not commonly used to treat chronic bronchitis, and would more likely see use in the management of asthma.
Which of the following medications is considered to be the mainstay of treatment for chronic obstructive pulmonary disease?
a. Budesonide
b. Ipratropium bromide
c. Salmeterol
d. Triamcinolone
b. Ipratropium bromide
A 52yo female patient comes to your practice with complaints of breathlessness and a cough accompanied by excessive phlegm. She produces a sputum sample, which appears clear upon inspection. You order a PFT; in reviewing the results, you find evidence indicating both an increased functional residual capacity and an increased total lung capacity. Which of the following respiratory disease would be the most likely diagnosis?
a. Acute bronchitis
b. Emphysema
c. Tuberulosis
d. Pneumonia
b. Emphysema
Victor, a stocky 40yo male, presents to the clinic with complaints of difficulty breathing and “endless amounts of gunk whenever he coughs.” During the visit, he coughs up a substantial amount of yellow phlegm. A blood test reveals an increased hematocrit level, and a physical exam detects lungs that are normal upon percussion. You order a pulmonary lab for the patient. Given the most likely condition, which of the following findings would you LEAST expect?
a. Increased forced expiratory volume in 1 second
b. Increased total lung capacity
c. Increased functional residual capacity
d. Increased residual volume
a. increased forced expiratory volume in 1 second
Least expect an increased FEV1 because that’s an indication of healthy lung functioning
In cases of asthma, the trachea and bronchi typically become more:
a. Thickened
b. Narrowed
c. Responsive
d. Hyperemic
c. Responsive
Asthma commonly results in the increased responsiveness of the trachea and bronchi to stimuli. Thickening of the epithelial basement
membrane and mucosal edema and hyperemia typically result in narrowing of the respiratory airways.
Winston, a 42yo male, is an HIV-positive patient whose TB skin test returns with an elevation of 5mm. After confirming a diagnosis of TB, you prescribe a traditional drug regimen. For what minimum period of time is Winston expected to continue his regimen?
a. 7 months
b. 8 months
c. 9 months
d. 10 months
c. 9 months
HIV-+ pts who test + for TB are expected to be treated for 9 months. In pts who are not immunocompromised and who test + for TB, the regimen may be tapered before 9 months, with 6 months standing as the traditional cut-off point.
All of the following would be consistent with a typical manifestation of severe asthma EXCEPT:
a. RR of 35
b. HR of 125
c. Pulsus paradoxus of 15 mmHg
d. WBC of 1800 eosinophils/mc
c. Pulses paradoxes of 15 mmHg
A pulsus paradoxus of 15 mmHg does not strongly indicate severe asthma; rather, it would more strongly indicate moderate asthma, which typically presents with pulsus paradoxis of 10-20 mmHg. A respiratory rate that exceeds 28 is a sign of asthma in older children. Furthermore, the patient’s pulse of 125 is consistent with the elevated pulse that typically occurs in severe cases of asthma. A WBC count that detects more than 1500 eosinophils/mcl may also indicate severe asthma.
The practitioner recognizes that all of these are expected pulmonary findings in the geriatric patient EXCEPT:
a. Total lung capacity decreases
b. Residual volume increases
c. Vital capacity decreases
d. The number of mucus-producing cells increases
a. total lung capacity decreases
A geriatric patient is likely to experience an unchanged, not decreased, total lung capacity (TLC). Patients in the geriatric population commonly experience an increase in residual volume alongside a decrease in vital capacity, meaning that TLC typically remains constant. Geriatric patients are likely to experience an increase in the number of mucus-producing cells
Common symptoms of COPD are:
cough
dyspnea
sputum production
Is a CXR needed to diagnose COPD?
NO. CXR may show hyperinflation, but PFTs are the standard for diagnosis. PFT may be able to diagnose prior to the presentation of symptoms.
What is the PFT result needed for diagnosis of COPD?
FEV1 < 0.7
Does every patient with asthma need a SABA?
YES
30yo patient with persistent asthma, what are the essential components of their care plan? (select all that apply)
a. Asthma action plan
b. Flu and pneumonia vaccine
c. Rescue inhaler
d. LABA
a. asthma action plan
b. four and pneumonia vaccine
c. rescue inhaler
T or F: Asthma patients and COPD pts both need rescue inhalers?
TRUE
Most common side effects of long-term inhaled steroid use?
a. Osteoporosis and GERD
b. Hypertension and diabetes
c. Hyperkalemia and diabetes
d. Bone demineralization (osteopenia) and cataracts
d. bone demineralization (osteopenia) and cataracts
A 12yo patient presents to the clinic with wheezing, SOB, a feeling of tightness in the chest. He is afebrile. Which of the following would be the best test to confirm diagnosis?
a. CBC
b. Blood cultures
c. PFT
d. Chest X-ray
c. PFT
T or F: USPSTF recommends screening with low-dose helical CT scans for lung cancer?
True
(Small vs large cell carcinoma – McPhee pg. 1622)
T or F: Women are more likely to be diagnosed with mesothelioma?
Answer: False
What are symptoms of TB?
Cough (3+ weeks), hemoptysis, chest pain, sputum production, weight loss, anorexia, fatigue