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D118 Pulmo and Cardiac, Fitzgerald (New).
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D118 Pulmo and Cardiac, Fitzgerald (New).
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D118 Pulmo and Cardiac, Fitzgerald(New)
c. chronic airway inflammation with superimposed bronchospasm - which of the
following best describes asthma?
a. intermitten 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
d. hyperresonance on thoracic percussion - the patient you are evaluating is having a
severe asthma flare. You have assessed that his condition is appropriate for office tx.
You expect to find the following on physical examination:
a. tripod posture
b. inspiratory crackles
c. increased vocal fremitus
d. hyperresonance on thoracic percussion
c. spirometry measurement - a 44 y/o man has a long-standing hx of moderate
persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair)
via metered-dose inhaler, one puff bid, nad the use of albuterol 1-2 times a week prn for
wheezing. Three days ago, he developed a sorethroat, clear nasal discharge, body
aches, and a dry cough. In the past 24 hrs, he has had intermittent wheezing that
necessitated the use of albuterol, two puffs every 3 hrs, which produced partial relief.
Your next most appropriate action is to obtain a:
a. chest x-ray
b. measurement of oxygen saturation (SaO2)
c. spirometry measurement
d. sputum smear for WBCs
c. prednisone - You examine Jane, a 24 y/o female who has an acute asthma flare
following a 3 day hx of UPR sxs (clear nasal discharge, dry cough, no fever). She has a
hx 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 sec (FEV1) is 65% of
predicted. Her medication regime should be adjusted to include:
a. theophylline
b. salmeterol (Serevent)
c. prednisone
d. montelukast (Singulair)
a. hyperinflation - which of the following is most likely to appear on a chest x-ray of a
person during an acute severe asthma attack?
,a. hyperinflation
b. atelectasis
c. consolidation
d. Kerley B signs
b. propranolol (beta-blocker) - a 36- y/o male with asthma also need antihypertensive
therapy. Which of the following products should you try to avoid?
a. hydrochlorothiazide (thiazide)
b. propranolol (beta-blocker)
c. amlodipine (calcium channel blocker)
d. enalapril (ACEi)
d. inhaled corticosteroids - the cornerstone of moderate persistent asthma drug therapy
is the use of:
a. oral theophylline
b. mast cell stabilizers
c. short-acting beta2 agonist (SABA)
d. inhaled corticosteroids
b. excessive albuterol use is a risk factor for asthma death - Shirley is a 29 y/o 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 2 albuterol metered-dose inhalers per month and is
requesting a prescription refill. You consider:
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 should be added to relieve
bronchospasm and reduce her albuterol use
d. her asthma has better control with albuterol than inhaled corticosteroids
b. a taper is not needed if the prednisone regimen is for 7 days or less - you see a 34
y/o male 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. within 2-8 days - after inhaled corticosteroid is initiated, improvement in control is
usually seen:
a. on the first day
b. within 2-8 days
c. in about 3-4 weeks
d. in about 1-2 months
,c. assess his level of asthma control and make changes in his tx plan if needed so he
can participate - an 18 y/o 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 sxs
b. excuse him from outdoor activities only to avoid pollen exposure
c. assess his level of asthma control and make changes in his tx plan if needed so he
can participate
d. write a note excusing him from gym until his f/u exam in 2 months
a. the potential but small risk of delayed growth with ICS is well balanced by their
effectivness - 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
effectivness
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. oral candidiasis - a potential adverse effect from ICS is:
a. oral candidiasis
b. tachycardia
c. gastrointestinal upset
d. insomnia
c. congested cough that is worse during the day - clinical findings characteristic of
asthma include all of the following except:
a. recurrent spasmodic cough that is worse at night
b. recurrent SOB and chest tightness with exercise
c. congested cough that is worse during the day
d. wheezing with and without associated respiratory infections
d. smooth muscle relaxation - 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
b. use of LABAs is associated with a small increase in risk of asthma death. - regarding
the use of long-acting beta2 agonists, 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
, c. the oral route is preferred over parenteral therapy - which of the following is TRUE
regarding the use of systemic corticosteroids in the tx 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 tx an asthma flare should not exceed the equivalent of prednisone
40mg daily
c. inhibition of muscarinic cholinergic receptors - which of the following is the therapeutic
objective of using inhaled Ipratropium bromide?
a. as an intiinflammatory
b. an increase in vagal tone in the airway
c. inhibition of muscarinic cholinergic receptors
d. an increase in salivary and mucous secreation
d. should be added to therapy only when ICS use does not provide adequate asthma
control - compared with short acting beta2 agonists, long acting beta2 agonist:
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
a. monitoring asthma - a peak flow meter is used for
a. monitoring asthma
b. diagnosing asthma
c. at least three months - The NAEPP EPR 3 guidelines recommend achieving and
maintaing controll for how long before trying to step down?
a. one month
b. two months
c. at least three months
d. six months
increased risk of death in certain patient grps and should not be used without an ICS in
asthma - LABA received a black box warning from the FDA due to an
c. reduction of airway inflammation - what is the desired therapeutic action of inhaled
corticosteroids when used to tx COPD?
a. reversal of fixed airway obstruction
b. improvement of central respiratory drive
c. reduction of airway inflammation
d. mucolytic activity
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