CMN 568 Module 3 200 Questions and Correct Answers (Verified Answers) 2024 New Update
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Course
CMN 568
Institution
CMN 568
CMN 568 Module 3 200 Questions and Correct Answers (Verified Answers) 2024 New Update
What combination of drugs is not recommended in COPD patients? - Answer LABA+ICS combo
For which population is an annual low-dose CT recommended for lung cancer prevention? - Answer people who have COPD due...
CMN 568 Module 3 200 Questions and
Correct Answers (Verified Answers) 2024
New Update
What combination of drugs is not recommended in COPD patients? - Answer ✔
LABA+ICS combo
For which population is an annual low-dose CT recommended for lung cancer
prevention? - Answer ✔ people who have COPD due to smoking
Spirometry during covid outbreaks - Answer ✔ spirometry should be reserved for
patients requiring urgent or essential tests for the diagnosis of COPD, and/or to assess
lung function status for interventional procedures or surgery
Drugs to aid in smoking cessation - Answer ✔ bupropion, varenicline, cysteine
Theophylline considerations in COPD - Answer ✔ - 4th line therapy
- improves Hgb saturations during sleep in COPD and sleep-disordered breathing
patients
- causes bronchodilation and anti-inflammatory properties
- toxicity is a concern, as it has a low therapeutic window, monitor levels
Antibiotic therapy in COPD patients - Answer ✔ - COPD patients with increased sputum
purulence accompanied by dyspnea or increase in sputum quantity are thought to
benefit most from abx therapy
- can use Doxy, Bactrim, cephs, etc (long list)
Abx for COPD patients with frequent exacerbations despite optimal therapy - Answer ✔
azithromycin daily or 3x/week and moxifloxacin x 5days
What population is at risk for TB? - Answer ✔ - foreign born minorities
- lower socioeconomic classes
- crowded housing
- HIV
- multi-drug resistant
- health care workers
Pathophysiological process that occurs in 2-8 weeks after TB exposure/infection -
Answer ✔ - macrophages ingest and surround tubercle bacilli
- cells form a barrier shell/ granuloma to keep bacilli contained and under control (LTBI)
,- if immune system cant keep the tubercle under control, the bacilli multiply rapidly in
body (TB Disease)
When can LTBI be detected? - Answer ✔ 2-8 weeks after infection via TST or IGRA
what confirms TB diagnosis? - Answer ✔ Positive M. tb culture
what is MDR TB? - Answer ✔ - multidrug resistant TB
- caused by bacteria resistant to best TB drugs (isoniazid and rifampin)
what is XDR TB? - Answer ✔ - extensively drug-resistant TB
- caused by organisms resistant to isoniazid, rifampin, and fluoroquinolones, and >1 of
the 3 injectable second-line drugs
when should reading of TST be done? - Answer ✔ 48-72hr after test
how to administer TST - Answer ✔ - inject 0.1mL of PPD (5 tuberculin units) into
forearm between skin layers
- produce raised wheal 6-10mm in diameter
how to read TST - Answer ✔ - done by trained HCW 48-72hr after injection
- palpate injection site
- measure diameter of induration NOT redness
- record size of induration in millimeters; record "0" if no induration found
>5mm induration TST is classified as a positive test in who? - Answer ✔ - HIV infected
people
- recent contacts of infectious TB
- people with fibrotic changes on CXR
- patient with organ transplants and other immunosuppressed patients
>10mm induration TST is classified as a positive test in who? - Answer ✔ - recent
arrivals from high-prevalence countries
- IV drug users
- residents and employees of high-risk congregate settings
- people with conditions that increase risk for progressing to TB
- children < 5yr, or children exposed to high-risk adults
>15mm induration TST is classified as a positive test in who? - Answer ✔ - people with
no known risk factors for TB
how does IGRA test for TB - Answer ✔ by measuring the immune response in the
blood; may be used in place of but not in addition to TST
what tests are IGRA TB tests? - Answer ✔ - QFT gold in-tube
, - T.Spot TB test
what patient is the IGRA TB test preferred in? - Answer ✔ those who may not return to
have their TST test read and who have just received BCG vaccination
interpretation of TB results in BCG vaccinated person - Answer ✔ - TST or IGRA are not
contraindicated for BCG vaccinated people
- results are used to support or exclude diagnosis of infection
- in BCG vaccinated, interpret TST with same criteria used for non-BCG vaccinated
- booster phenomenon may occur in BCG vaccinated people
what is the standard CXR view to assess for TB? - Answer ✔ posterior-anterior view
how to collect a sputum culture to assess for TB - Answer ✔ - collect at least 3
specimens at 8-24hr intervals
- at least 1 specimen has to be first thing in the AM
- collection methods include coughing, bronch, sputum induction, gastric aspiration
- culture monthly until conversion, must have 2 consecutive negative cultures
gold standard for diagnosing TB - Answer ✔ culture
who is a candidate for LTBI therapy? - Answer ✔ - high risk people with IGRA or TST
reaction of 5mm or 10mm
- people with conditions that increase risk for TB (DM, RF, silicosis, gastrectomy,
cancer, emaciation, kids <5)
- low risk people with positive IGRA or TST reaction > 15mm
who should be treated for LTBI (even with a negative test) if they were in close contact
with an infectious TB carrier? - Answer ✔ - children <5
- immunosuppressed people
- others at risk for rapid progression to TB
retest in 8-1 weeks after last exposure
LTBI treatment regimen: INH - Answer ✔ 9 month regimen: 270 doses within 12 month
period
LTBI treatment regimen: INH + rifapentine - Answer ✔ INH and RPT given in 12 once-
weekly doses under DOT
LTBI treatment regimen: RIF - Answer ✔ - alternative to INH
- 4 months daily rifampin (120 doses within 6mo)
- should not be used in HIV + patient taking ART
adverse reactions to INH - Answer ✔ - peripheral neuropathy (give vit. B6 for this)
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