NGR6172 Respiratory Drugs_ Unit 5 (Part 1) Exam Questions With Correct Answers

DIAGNOSIS OF ASTHMA AND COPD □ What is atopy? - Answer - An allergy, involving an inherited immunoglobulin of the IgE type that predisposes a person to certain allergic responses. - Atopic individuals often have asthma, atopic dermatitis (eczema) and allergic rhinitis DIAGNOSIS OF ASTHMA AND COPD □ What other conditions often go along with asthma? - Answer - Allergic rhinitis - allergic conjunctivitis - eczema and nasal polyps * Some may have sensitivity to NSAIDs DIAGNOSIS OF ASTHMA AND COPD □ What are the three principle triggers for asthma? - Answer 1) Allergens and environmental factors 2) upper respiratory infections (URI) 3) psychological factors such as stress DIAGNOSIS OF ASTHMA AND COPD □ What are some of the common triggers of asthma? - Answer - Tobacco smoke - wood smoke - household sprays - viruses - dust mites - other allergens DIAGNOSIS OF ASTHMA AND COPD □ What component of speech should be documented in a patient that presents with an asthma exacerbation? - Answer Inability to speak in full sentences DIAGNOSIS OF ASTHMA AND COPD □ What part of the history is important to note in a patient with asthma? - Answer "How often have they had to use their bronchodilator?" "Have they ever been hospitalized for asthma and if so have they been intubated?" DIAGNOSIS OF ASTHMA AND COPD □ Is wheezing a reliable indicator of asthma severity? - Answer No. It may be absent in between acute attacks and unable to be heard because of diminished air flow DIAGNOSIS OF ASTHMA AND COPD □ What is the "silent chest?" - Answer Severely reduced air flow during an asthma exacerbation DIAGNOSIS OF ASTHMA AND COPD □ Patients with asthma often have a cough that worsens during the (day and night)? - Answer Night DIAGNOSIS OF ASTHMA AND COPD □ Why is bronchoconstriction worse at night in patients with asthma? - Answer Circadian rhythms occur with increased bronchoconstriction at 2-3 am due to the release of histamine DIAGNOSIS OF ASTHMA AND COPD □ What is "cough variant asthma?" - Answer Asthma that presents with coughing without wheezing DIAGNOSIS OF ASTHMA AND COPD □ Which percussion note would be found in a patient with asthma? - Answer Hyperresonance DIAGNOSIS OF ASTHMA AND COPD □ What is a "vesicular" breath sound? - Answer Vesicular breaths have a longer inspiratory phase and are heard throughout the lung periphery DIAGNOSIS OF ASTHMA AND COPD □ Which phase of respiration would be longer in patients with asthma? - Answer Expiration DIAGNOSIS OF ASTHMA AND COPD □ By measuring lung function (FEV1), forced expiratory volume by spirometry less than 80% predicted with a 12-15% improvement of FEV1 after bronchodilation confirms the diagnosis of ________? - Answer Asthma DIAGNOSIS OF ASTHMA AND COPD □ What is "provocative testing" to rule out asthma? - Answer - Methacholine challenge will cause bronchoconstriction and is often performed by pulmonologists to diagnosis asthma. - Resuscitation equipment must be available. A 20% fall in FEV1 confirms the diagnosis of asthma DIAGNOSIS OF ASTHMA AND COPD □ What would the chest X-ray (CXR) look like in a patient with chronic asthma? - Answer Hyperinflation, thickening of the bronchial wall and diminished peripheral lung vascular shadows DIAGNOSIS OF ASTHMA AND COPD □ Asthma "mimickers" or differentials for asthma include: - Answer Gastroesophageal reflux disease (GERD) and vocal cord dysfunction DIAGNOSIS OF ASTHMA AND COPD □ How is vocal cord dysfunction diagnosed and treated? - Answer Pulmonary function tests (PTFs) demonstrate variations in the pattern. Treatment consists of speech therapy to relax the vocal cords DIAGNOSIS OF ASTHMA AND COPD □ What can occur with asthma symptoms in pregnancy? - Answer 1/3 get better, 1/3 get worse, and 1/3 remain the same DIAGNOSIS OF ASTHMA AND COPD □ Can pregnant women use anti-asthma medications? - Answer Yes....breathing is important to the development of the fetus DIAGNOSIS OF ASTHMA AND COPD □ How is asthma diagnosed in young children? - Answer History and physical exam DIAGNOSIS OF ASTHMA AND COPD □ Can children articulate being short of breath? - Answer Not very well. "My chest hurts, the air is thick or more commonly, I feel fine" are sometimes phrases heard in children having difficulty breathing. DIAGNOSIS OF ASTHMA AND COPD □ Can children grow out of asthma? - Answer Yes DIAGNOSIS OF ASTHMA AND COPD □ What it the Asthma Prediction Inventory (API)? - Answer A guide to determining which small children will likely have asthma in later years. DIAGNOSIS OF ASTHMA AND COPD □ Why is the API important? - Answer It distinguishes chronic disease and can lead to better care DIAGNOSIS OF ASTHMA AND COPD □ If children have had more than 4 wheezing episodes, according to the API, they have a higher risk of having life-long or persistent asthma. They can also be at risk if they have one major or one minor criteria. Major criteria include: - Answer - Parent with asthma - Physician diagnosis of atopic dermatitis (often called eczema) - Evidence of sensitization to allergens in the air (i.e., positive skin tests or blood tests to allergens such as trees, grasses, weeds, molds, or dust mites) DIAGNOSIS OF ASTHMA AND COPD □ The minor criteria that are listed in the API that indicate increased risk of persistent or life-long asthma include: - Answer - Evidence of food allergies - 4 percent or more blood eosinophilia (Increased numbers of white blood cells called eosinophils are made by the body to fight off allergic disease. They can collect in tissues and cause damage to the airways of the lung.) - Wheezing apart from colds DIAGNOSIS OF ASTHMA AND COPD □ At what age would you expect a child to be able to perform spirometry to diagnosis asthma? - Answer Some 5-6 year olds are able to perform spirometry properly DIAGNOSIS OF ASTHMA AND COPD □ Does asthma run in families? - Answer Yes DIAGNOSIS OF ASTHMA AND COPD □ How is asthma classified? - Answer Intermittent or persistent (mild, moderate, or severe persistent) □ A patient that has symptoms once every month or only when they contract a upper respiratory infection (URI) would be classified as___________? - Answer Intermittent and require only a PRN bronchodilator DIAGNOSIS OF ASTHMA AND COPD □ A patient that has asthma symptoms 2 times a week would be classified as___________? - Answer Intermittent DIAGNOSIS OF ASTHMA AND COPD □ A patient that has asthma symptoms 3 times a week would be classified as___________? - Answer Persistent DIAGNOSIS OF ASTHMA AND COPD □ A patient that has daily asthma symptoms would be classified as: - Answer Moderate or Severe Persistent DIAGNOSIS OF ASTHMA AND COPD □ A patient that has nighttime awakenings with cough and chest tightness three times a month would be classified as having mild (intermittent or persistent) asthma? Would an inhaled corticosteroid (ICS) be recommended in this patient? - Answer - Persistent. - Yes this patient would benefit from an ICS. DIAGNOSIS OF ASTHMA AND COPD □ A patient that has nighttime awakenings with cough and chest tightness two times a month would be classified as having mild (intermittent or persistent) asthma? Would an ICS be recommended in this patient? - Answer Mild Intermittent. ICS are not usually needed unless there is an exacerbation DIAGNOSIS OF ASTHMA AND COPD □ At what stage in the classification of asthma would an ICS be needed? - Answer Persistent DIAGNOSIS OF ASTHMA AND COPD □ At what stage would a long acting beta 2 agonist (LABA) be added to an ICS? - Answer Moderate persistent DIAGNOSIS OF ASTHMA AND COPD □ What stages of asthma require a short acting beta 2 agonist (SABA)? - Answer Patients regardless of their stage should have a SABA available DIAGNOSIS OF ASTHMA AND COPD □ When is skin testing recommended? - Answer When asthma is persistent - to find out about sensitivities to allergens and to optimize treatment and preventive measures DIAGNOSIS OF ASTHMA AND COPD □ Patients with asthma are asked to monitor ________ because if the value is less than 80% of their personal best, more frequent monitoring and changes in medical therapy should be done. - Answer Peak expiratory flow rates (PEF) DIAGNOSIS OF ASTHMA AND COPD