NR601 Midterm Exam
What are the 3 primary physiological changes of aging? ANS: 1. Reduced physiological reserve of most
body systems, esp. cardiac, resp, renal.
2. Reduced homeostatic mechanisms that fail to adjust regulatory systems (i.e. temp control, fluid/lyte
balance, etc.).
3. Impaired immunological function (infection risk is greater, autoimmune dz's more prevalent)
What is the preferred amount of exercise for elderly? ANS: 30min/day 5 days/wk of moderate exercise.
If trying to lose wt: 60min/day.
What are PFTs? ANS: Group of tests that provide quantifiable measurement of lung function, used to dx
resp abnormalities or assess progression/resolution of lung dz.
What is FEV1? ANS: Forced Expiratory Volume in 1 second (80-120%)
What is FVC? ANS: Forced Vital Capacity (80-120%)
What is normal FEV1/FVC ratio? ANS: <0.7 (70%)
What is GOLD 1 criteria? ANS: Mild
FEV1 >/= 80% predicted
What is GOLD 2 criteria? ANS: Moderate
FEV1 50-79% predicted
,What is GOLD 3 criteria? ANS: Severe
FEV1 30-49% predicted
What is GOLD 4 criteria? ANS: Very severe
FEV1 <30% predicted
What are the signal symptoms of COPD? ANS: Dyspnea
Chronic cough w/sputum
Decreased activity tolerance
Wheezing
What are characteristics of COPD? ANS: Common, preventable, treatable.
Characterized by persistent airflow limitation.
Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs to
noxious particles/gases
Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz.
Decreased elastic recoil of alveoli.
What are risk factors for COPD? ANS: Smoking (increasing w/number of pack years)
Second hand smoke
Environmental pollution (endotoxins, coal dust, mineral dust)
,What is seen on phys exam in COPD? ANS: May be normal in early states
As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant heart
tones (b/c of hyperinflation, so S1/S2 sounds off in distance), accessory muscle use, pursed lip breathing,
increased expiratory phase, neck vein distention.
How is COPD diagnosed? ANS: Spirometry is gold standard (pre and post bronchodilator).
Irreversible airflow limitation is hallmark.
How is COPD treated? ANS: Bronchodilators: beta agonists (long/short), anticholinergics (long/short), or
combo.
What is the MOA of beta agonists? ANS: Stimulates beta-2-adrenergic receptors, increasing cyclic AMP,
resulting in relaxing airways.
What is the MOA of anticholinergics? ANS: Block the effect of acetylcholine on muscarinic type 3
receptors, resulting in bronchodilation.
Why are long-acting beta agonists prescribed for COPD? ANS: They are for moderate airflow limitation.
They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL.
What are some non pulmonary diagnoses that result in COPD-type symptoms? ANS: CHF
Hyperventilation syndrome
Panic attacks
Vocal cord dysfunction
, Obstructive sleep apnea
Aspergillosis
Chronic fatigue syndrome
What are signal symptoms of asthma? ANS: Wheezing
Shortness of breath
Cough (esp at night)
Chest tightness
What is chronic bronchitis? ANS: Daily chronic cough w/increased sputum for at least 3 consecutive
months in at least 2 consecutive years.
Usually worse on wakening.
May or may not be associated with COPD.
What is emphysema? ANS: Characterized by obstruction to airflow caused by abnormal airspace
enlargement distal to terminal bronchioles.
Chronic inflammation/remodeling, trapping air, hindering effective O2/CO2 exchange (all due to
inflammatory mediators infiltrating airways).
What are signal symptoms of ischemic heart dz? ANS: Chest pain
Chest tightness
Chest discomfort
What is ischemic heart dz? ANS: Imbalance between supply and demand for blood flow to myocardium
What are the 3 primary physiological changes of aging? ANS: 1. Reduced physiological reserve of most
body systems, esp. cardiac, resp, renal.
2. Reduced homeostatic mechanisms that fail to adjust regulatory systems (i.e. temp control, fluid/lyte
balance, etc.).
3. Impaired immunological function (infection risk is greater, autoimmune dz's more prevalent)
What is the preferred amount of exercise for elderly? ANS: 30min/day 5 days/wk of moderate exercise.
If trying to lose wt: 60min/day.
What are PFTs? ANS: Group of tests that provide quantifiable measurement of lung function, used to dx
resp abnormalities or assess progression/resolution of lung dz.
What is FEV1? ANS: Forced Expiratory Volume in 1 second (80-120%)
What is FVC? ANS: Forced Vital Capacity (80-120%)
What is normal FEV1/FVC ratio? ANS: <0.7 (70%)
What is GOLD 1 criteria? ANS: Mild
FEV1 >/= 80% predicted
What is GOLD 2 criteria? ANS: Moderate
FEV1 50-79% predicted
,What is GOLD 3 criteria? ANS: Severe
FEV1 30-49% predicted
What is GOLD 4 criteria? ANS: Very severe
FEV1 <30% predicted
What are the signal symptoms of COPD? ANS: Dyspnea
Chronic cough w/sputum
Decreased activity tolerance
Wheezing
What are characteristics of COPD? ANS: Common, preventable, treatable.
Characterized by persistent airflow limitation.
Usually progressive, associated with enhanced chronic inflammatory response in airways and lungs to
noxious particles/gases
Airway fibrosis, luminal plugs, airway inflammation, increased airway resistance, small airway dz.
Decreased elastic recoil of alveoli.
What are risk factors for COPD? ANS: Smoking (increasing w/number of pack years)
Second hand smoke
Environmental pollution (endotoxins, coal dust, mineral dust)
,What is seen on phys exam in COPD? ANS: May be normal in early states
As severity progresses: lung hyperinflation, decreased breath sounds, wheezes at bases, distant heart
tones (b/c of hyperinflation, so S1/S2 sounds off in distance), accessory muscle use, pursed lip breathing,
increased expiratory phase, neck vein distention.
How is COPD diagnosed? ANS: Spirometry is gold standard (pre and post bronchodilator).
Irreversible airflow limitation is hallmark.
How is COPD treated? ANS: Bronchodilators: beta agonists (long/short), anticholinergics (long/short), or
combo.
What is the MOA of beta agonists? ANS: Stimulates beta-2-adrenergic receptors, increasing cyclic AMP,
resulting in relaxing airways.
What is the MOA of anticholinergics? ANS: Block the effect of acetylcholine on muscarinic type 3
receptors, resulting in bronchodilation.
Why are long-acting beta agonists prescribed for COPD? ANS: They are for moderate airflow limitation.
They relieve symptoms, increase exercise tolerance, reduce number of exacerbations, improve QOL.
What are some non pulmonary diagnoses that result in COPD-type symptoms? ANS: CHF
Hyperventilation syndrome
Panic attacks
Vocal cord dysfunction
, Obstructive sleep apnea
Aspergillosis
Chronic fatigue syndrome
What are signal symptoms of asthma? ANS: Wheezing
Shortness of breath
Cough (esp at night)
Chest tightness
What is chronic bronchitis? ANS: Daily chronic cough w/increased sputum for at least 3 consecutive
months in at least 2 consecutive years.
Usually worse on wakening.
May or may not be associated with COPD.
What is emphysema? ANS: Characterized by obstruction to airflow caused by abnormal airspace
enlargement distal to terminal bronchioles.
Chronic inflammation/remodeling, trapping air, hindering effective O2/CO2 exchange (all due to
inflammatory mediators infiltrating airways).
What are signal symptoms of ischemic heart dz? ANS: Chest pain
Chest tightness
Chest discomfort
What is ischemic heart dz? ANS: Imbalance between supply and demand for blood flow to myocardium
