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D) Length of time she has been coughing
A 24-year old, otherwise healthy col-
lege student presents with c/o cough Why? This information helps you build
x 6 weeks. She has tried several OTC your ddx
cough meds with no improvement. What Acute cough < 3 weeks: bronchi-
is the most important information to con- tis, sinusitis, PND, exacerbation of
sider when building your differential diag- COPD/asthma, pneumonia, pulmonary
noses? embolism
A) Her age
B) Family hx Chronic cough (>8 weeks) GERD and
C) Ineffectiveness of OTC cough medi- Asthma are most common causes, also
cines consider infection (e.g. pertussis, atypi-
D) Length of time she has been coughing cal pneumonia), ACE inhibitors, chronic
bronchitis, bronchiectasis, lung ca)
According to the CDC, what drug class
is considered first-line treatment for per-
C) Macrolide antiobitic (e.g.
tussis?
Azithromycin, clarithromycin
A) Sulfonamide
B) Tetracycline
Sulfonamides are second-line
C) Macrolide
D) Beta-lactam
Match the antibiotics with the correct
drug class:
1. Sulfonamide
1. Sulfonamide - D.Trimethoprim-Sul-
2. Tetracycline
famethoxazole (Bactrim)
3. Macrolide
2. Tetracycline - A. Doxycycline
4. Beta-lactam
3. Macrolide - B & F, Azithromycin and
Clarithromycin
A. Doxycyline
4. Beta-lactam - C & E, PCN and
B. Azithromycin
cephalosporins
C. Penicillins
D.Trimethoprim-Sulfamethoxazole
E. Cephalosporin
F. Clarithromycin
Streptococcus pneumoniae
Mycoplasma pneuomiae (atypical
, FNP Board review questions
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pathogen)
What are the three most common bugs
Chlamydophila pneumoniae (atypical
in community-acquired pneumonia?
pathogen)
Respiratory quinolone (e.g. Lev-
What is the treatment for CAP caused by ofloxacin, moxifloxacin, gemifloxacin)
Strep pneumo? OR high-dose amoxicillin OR amoxicillin
with clavulanate
What antibiotics are avoided in CAP
caused by Strep pneumo due to high Macrolides
rates of resistance?
What is the treatment for CAP caused by
Macrolide OR doxycycline
Mycoplasma pneumoniae?
What antibiotics are avoided in CAP
Beta-lactams (ineffective)
caused by atypical pathogens?
A 38-year old mother of two teenagers
recently recovered from Mycoplasma B) No, it's not indicated
pneumonia a couple of weeks ago. She
asks if she should get the "pneumonia An otherwise healthy adult without im-
shot." She takes levothyroxine 88 mcg munocompromise or multiple comorbid
daily for hypothyroidism, but is otherwise conditions is not a "vulnerable popula-
healthy. How do you respond? tion"
A) No, it's too soon after your infection
B) No, it's not indicated The pneumonia vaccine does not pre-
C) Yes, you can get it in about a month vent mycoplasma pneumonia
D) Yes you can get it today
According to GOLD, what is required to
Spirometry (FEV1/FVC ratio < 70%)
establish the diagnosis of COPD?
A 70-year old house painter reports a
4-week history of exertional dyspnea,
chest tightness, and cough for the past
B) Angina
3 months. He has never smoked. What
C) COPD
diagnoses are included in your differen-
F) Tuberculosis
tial? Select 4.
G) Heart failure
A) Asthma
B) Angina
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C) COPD
D) GERD
E) Pneumonia
F) Tuberculosis
G) Heart Failure
How do inhaled anticholinergics work to
treat shortness of breath in COPD?
A) They cause bronchodilation in the B) They block the action of acetylcholine
lungs and prevent bronchconstriction
B) They block the action of acetylcholine
and prevent bronchoconstriction
Name a short-acting inhaled anticholin-
Ipratropium (Atrovent)
ergic:
Name a long-acting inhaled anticholiner-
Tiotropium (Spiriva)
gic:
How do inhaled betá-agonists work to
treat shortness of breath in COPD?
A) They cause bronchodilation in the A) They cause bronchodilation in the
lungs lungs
B) They block the action of acetylcholine
and prevent bronchoconstriction
What are the only 2 inhaled short-acting
Albuterol and levalbuterol
beta agonists (SABAs):
Name an inhaled long-acting beta ago-
Salmeterol (Serevent)
nists (LABAs):
Cognitive impairment, confusion, hallu-
cinations, dry mouth, blurry vision, uri-
nary retention, constipation, tachycardia,
What are the side effects associated with
acute angle glaucoma
anticholinergic medications?
"Can't see, can't pee, can't spit, can't
shit."
Name a inhaled combined short-act-
ing anticholinergic/short-acting beta ag- Ipratropium/albuterol (Combivent)
onist:
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Fluticasone/salmeterol (Advair)
Name a inhaled combined long-acting Fluticasone/vilanterol (Breo)
beta-agonist/corticosteroid Budesonide/formoterol (Symbicort)
Mometasone/frmoterol (Dulera)
Fluticasone (Flovent)
Name an inhaled steroid: Budesonide (Pulmicort)
Mometasone (Asmanex)
C, A, B, D
Put the following in the correct order for
1. Short-acting anticholinergic or SABA
COPD prescribing strategy:
PRN
THEN
A) Long-acting anticholinergic or LABA,
2. Long-acting anticholinergic or LABA,
plus rescue med
plus rescue med
B) Inhaled corticosteroid +LABA or LA
THEN
anticholinergic, plus rescue med
3. Inhaled corticosteroid +LABA or LA
C) Short-acting anticholinergic or SABA
anticholinergic, plus rescue med
PRN
THEN
D) Inhaled corticosteroid +LABA and/or
4. Inhaled corticosteroid +LABA and/or
LA anticholinergic, plus rescue med
LA anticholinergic, plus rescue med
There is good evidence in support of
oral steroids for COPD exacerbations
to shorten recovery time and improve
C) 5-day course of Prednisone 40 mg
lung function. What is the correct recom-
mended dose?
Chronic use should be avoided - asso-
ciated with an unfavorable risk-to-benefit
A) Medrol dose-pack
ratio
B) 10-day course of Prednisone 20 mg,
followed by a taper
C) 5-day course of Prednisone 40 mg
A patient with asthma symptoms dai-
ly with occasional nighttime awakenings
has
C) Moderate persistent asthma
A) Intermittent asthma
B) Mild persistent asthma
C) Moderate persistent asthma
D) Severe persistent asthma