Family Medicine EOR: Pulmonology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated

Family Medicine EOR: Pulmonology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated Most common cause of asthma? Exposure to allergens (IgE mediated type I hypersensitivity) What cells appear to play a rule in the activation of the inflammatory response in asthma? TH2 cells (type of CD4 T cell) Symptoms of asthma? - Cough - Wheezing - Shortness of breath - Chest-tightness - May worsen at night Initial diagnostic test for asthma? Pulmonary function tests What establishes the presence of airflow reversibility and diagnosis of asthma? An increase in FEV1 of >12% with a minimum increase of 200 mL in FEV1 after bronchodilator use FEV1/FVC < 70%? Obstructive lung disease You suspect your patient has asthma, but they have normal spirometry results. What next? Bronchoprovocation test (methacholine challenge) Some ways for your patients to reduce exposure to factors that worsen their asthma? 1. Cover mattresses/pillows 2. Use AC to maintain humidity at <50% 3. Remove carpets 4. Limit fabric-covered items Before adding an additional medication to treat a pt's asthma, what should you do first? Make sure they are using their inhaler correctly List the classifications of asthma. 1. Intermittent 2. Mild persistent 3. Moderate persistent 4. Severe persistent Medication timeline for asthma (typically)? 1. SABA PRN (always; keep in all "steps") 2. Add low-dose ICS 3. Increase to med-dose ICS OR add LABA 4. Add a LABA OR increase to med-dose ICS 5. Increase to high-dose ICS 6. Add PO steroids Diagnosis of intermittent asthma? Sxms: <2 d/wk Nighttime awakenings: <2/month SABA use for symptom control: <2d/wk Interference with activity: None Lung function: FEV1 >80% + FEV1/FVC normal Diagnosis of mild persistent asthma? Sxms: >2 d/wk (but NOT daily) Nighttime awakenings: 3-4/month SABA use for symptom control: >2d/wk Interference with activity: Minor Lung function: FEV1 >80% predicted + FEV1/FVC usu normal Diagnosis of moderate persistent asthma? Sxms: Daily Nighttime awakenings: >1 x wk (not daily) SABA use for symptom control: Daily Interference with activity: Some Lung function: FEV1 60-80% predicted and FEV1/FVC usu normal Diagnosis of severe persistent asthma? Sxms: Throughout the day Nighttime awakenings: Often 7x wk SABA use for sxm control: Several per day Interference with activity: Very limited Lung function: FEV1 <60% predicted and FEV1/FVC reduced >5% Best way to assess asthma exacerbation severity and patient response in ED? Peak expiratory flow 3 main components to the pathophysiology of asthma? 1. Airway hyper-reactivity (IgE-mediated) 2. Bronchoconstriction (airway narrowing s/t smooth muscle constriction, mucus secretion, bronchial wall edema, airway remodeling, etc) 3. Inflammation (s/t cellular infiltration and cytokines) Define status asthmaticus? Severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. Management options for status asthmatics? 1. Oxygen 2. Bronchodilators (beta agonists, muscarinic antagonists) 3. Systemic steroids 4. Can consider magnesium sulfate 5. Can consider ketamine 6. Can consider epinephrine 7. Can consider intubation 8. Can consider Heliox as well Short acting beta agonists? - Albuterol - Levalbuterol Long acting beta agonists?