Reapiratory

Question 1

Lung Cancer Screening

Answer 1

Annual low-dose CT (LDCT) in adults 50-80 w/ 20 pack year hx who currently smoke or who have quit within 15 years

Question 2

Signs of Respiratory Failure

Answer 2

Tachypnea, lack of wheezing, accessory muscle use, diaphoresis, exhaustion

Question 3

Causes of Tachypnea

Answer 3

Pain, fever, physical exertion, PE, hyperthyroidism

Question 4

Egophony

Answer 4

Presence of consolidation in the lungs

Will hear “bah” sounds instead of “eee”

Question 5

Whispered Pectoriloquy

Answer 5

Instruct pt to whisper “99”

Consolidation if words are clearly heard on the lower lobes

Question 6

Normal lung percussion sound

Answer 6

Resonance

Question 7

Gold standard test for Asthma and COPD

Answer 7

PFT (pre- and post-bronchodilator)

Question 8

FEV1/FVC

Answer 8

Proportion of person’s VC that the person is able to expire in 1 second

Most important for detecting airflow obstruction

Question 9

Restrictive lung diseases

Answer 9

Pulmonary fibrosis
Pleural disease
Diaphragm obstruction

Question 10

Obstructive lung disease

Answer 10

Asthma
COPD (chronic bronchitis, emphysema)
Bronchiectasis

Question 11

Asthma lung findings

Answer 11

Wheezing with prolonged expiration

Question 12

Medication triggers for asthma

Answer 12

ASA or NSAIDs
BB
ACEI
Certain eye drops

Question 13

Goal frequency of SABA use

Answer 13

< 2 days a week

Question 14

Tx for Exercise-Induced Bronchoconstriction (asthma)

Answer 14

Pre-medicate 5-20 min before exercise w/ 2 puffs of SABA

Question 15

Emergency Management of Asthma exacerbation

Answer 15

Albuterol 0.5% solution by nebulizer every 20-30 minutes up to 3 doses

Albuterol w/spacer, 4-8 puffs every 20 minutes for 8 doses

Question 16

Glucocorticoids for Asthma exacerbations

Answer 16

Pred 40-60 for 5-7 days

If it is also taking inhaled glucocorticoids, no need to taper PO dose lasting 3 weeks or less

Question 17

Peek Expiratory Flow (PEF)

Answer 17

Based on height, age, sex (HAS)

Question 18

Chronic Bronchitis

Answer 18

Coughing w/excessive mucous for 3 or more months for a minimum of 2 or more consecutive years

Question 19

“Blue bloater” vs “pink puffer”

Answer 19

Blue = chronic bronchitis (chronic hypoxia)

Pink = emphysema (adequate O2 saturation)

Question 20

COPD Diagnosis

Answer 20

Post-bronch FEV1/FVC < 0.7

Question 21

Digital clubbing

Answer 21

Not typical in COPD

Question 22

PNA initial testing

Answer 22

CBC w Diff
BUN/Cr
CXR

Question 23

PNA Tx

Answer 23

5-7 days of tx

W/o CM Doxy or Macrolide or Amoxicillin

W/ CM Fluoroquinolone or Doxy or macrolide + beta-lactam (Augmentin or Cefuroxime)

Question 24

PNA s/sx

Answer 24

Tachypnea, crackles or rales, consolidation (dullness on percussion, increased tactile fremitus, cough does not completely clear abnormal lung sounds), pleural friction rub (caused by pleurisy - pt reports sharp localized pain with deep breath/movement/cough)

Question 25

CURB-65

Answer 25

PNA assessment 0-1 treat as OP 2 short hospital stay or monitor closely

Question 26

CURB-65 Assessment Questions

Answer 26

Confusion of new onset Blood urea nitrogen > 19 RR 30 BPM or more BP < 90 systolic or < 60 diastolic Age 65

Question 27

Acute Bronchitis Symptoms

Answer 27

Cough with or w/o sputum Absence of fever or tachypnea Lasting > 5 days Absence of asthma, COPD, or other airway disease

Question 28

Acute Bronchitis Tx

Answer 28

Bronchodilator via MDI such as SAMA (ipatroprium bromide) or SABA (albuterol) Pred 40 mg x 3-5 days

Question 29

Asthma Dx

Answer 29

Airflow obstruction that is at least partially reversible Increase in FEV1 12% and > 200 ml from baseline post beta2agonist Spirometry is preferred test to diagnose Peak flow meter primarily used for monitoring

Question 30

SABA example

Answer 30

Albuterol

Question 31

SAMA

Answer 31

Ipratropium bromide

Question 32

What step is a daily inhaler added

Answer 32

Step 3 Following almost daily symptoms with nighttime awakening greater then 1 or more times a month

Question 33

LAMA example

Answer 33

Triotropium bromide (Spiriva)

Question 34

LABA example

Answer 34

Budesonide-formoterol (symbicort)

Question 35

LABA example

Answer 35

Budesonide-formoterol (symbicort)

Question 36

Asthma control questions

Answer 36

1. Daytime asthma symptoms more than 2/week? 2. Any nighttime awakening? 3. Reliever therapy for symptoms more than 2/week? 4. Any activity limitation

Question 37

Scoring asthma control

Answer 37

1-2 positive responses = partly controlled 3-4 positive responses = uncontrolled

Question 38

Asthma assessment

Answer 38

Measure FEV1 at diagnoses, after 3-6 months of controller therapy, then periodically

Question 39

Asthma and pregnancy

Answer 39

Treat as you would any non-pregnant pt

Question 40

Air trapping is seen

Answer 40

Acute Asthma flares COPD

Question 41

Tactile fremitus

Answer 41

Decreases w/ decreased tissue density Palpitations vibration from when the pt is speaking

Question 42

Asthma wheeze

Answer 42

Initially expiratory, then inspiratory

Question 43

COPD Interventions

Answer 43

Smoking cessation Advice on physical activity and Pulm rehab Influenza, pneumococcal, RSV, COVID vaccine

Question 44

COPD definition

Answer 44

Spirometry FEV1: FVC < 0.70 post bronchodilation

Question 45

GOLD Classification

Answer 45

Severity of COPD 1 mild FEV1 80 % or more 2 mod FEV1 50-80% 3 severe FEV1 30-50% 4 very severe FEV1 less than 30%

Question 46

GOLD Classification

Answer 46

Severity of COPD 1 mild FEV1 80 % or more 2 mod FEV1 50-80% 3 severe FEV1 30-50% 4 very severe FEV1 less than 30%

Question 47

Asthma diagnoses

Answer 47

Spirometry not required like with COPD

Question 48

COPD First line tx

Answer 48

LABA or LAMA W/ very occasional breathlessness SABA or SAMA

Question 49

COPD Second Line Tx

Answer 49

LAMA + LABA

Question 50

COPD w/hospitalization and greater than 2 exacerbations

Answer 50

LABA + LAMA Add ICS if blood eosinophils are great or equal to 300

Question 51

COPD exacerbation w/ antibiotics

Answer 51

5 day course

Question 52

Pertussis TX

Answer 52

First line Macrolides x5-7 days Second line Bactrim x 14 days