1
Q
A medication that has a side effect of “a cough”
A
ACE-I
2
Q
Two respiratory pathogens that are known to cause “Atypical Pneumonia” are:
A
- Mycoplasma Pneumonia
* Streptococcus Pneumonia
3
Q
What does a “peak flow meter” measure
A
- EXPIRATORY flow (peak expiratory flow) - The air that flows out the patient’s lungs.
4
Q
Chest X-ray of an asthma patient will show
A
- HyperInflation
5
Q
The “GOLD STANDARD” to diagnose COPD and Asthma
A
- Spirometry/Pulmonary Function Test (FEV1 and FVC)
6
Q
- A dry cough for the 1st 5 days, then…
- Progressing to a productive, rough cough.
- Sputum maybe clear, white, yellow, or green or bloody.
- Is usually preceded by a viral infection
A
- Acute Bronchitis
7
Q
The most common forms of COPD include:
A
- Chronic Bronchitis, and…
* Emphysema
8
Q
- An FEV1/FVC ratio of 80%
The above mentioned is indicative of:
A
Mild COPD
9
Q
Treatment for Mild COPD includes
A
- Reduction of risk factors (smoking cessation)
- Flu and Pneumonia vaccines
- Short-Acting anticholinergics (Ipratroprium/Atrovent) PRN or
- Short-Acting beta-agonists (Albuterol/Proventil) PRN
10
Q
The cornerstone pharmacological therapy for ASTHMA is:
A
- Inhaled corticosteroids (ICS)
11
Q
- CHRONIC, recurrent cough, wheeze, shortness of breath and/or chest tightness
- Symptoms occurs or are “worse at night”, or with exercise, viral infections, or irritants (smoking)
- An increase in FEV1 greater than 12% from baseline, post short-acting beta2-agonist
- **The above is a diagnosis of: ***
A
- Asthma
12
Q
Populations that are at increased risk for Tuberculosis and would have a PPD or Mantoux result “Greater than or equal to 10mm” ( >10mm)
A
- Foreign born people/ Recent Immigrants
- Prisoners
- Nursing home residents
- Indigents/Homeless
- Minorities
- Healthcare providers/Migrant Farmers
- People with blood disorders or prolonged steroid therapy use
- OVERCROWDED POPULATIONS
13
Q
The goal of COPD is to:
A
- Reduce the disease progression
- Reduce symptoms and exacerbations
- Improve exercise tolerance and quality of life.
14
Q
Common sign on a chest Xray of a patient with Croup:
A
- Steeple Sign (Soft tissues of the neck and chest show subglottic narrowing)
15
Q
Coughing with excessive mucus production for at least 3 or more months for 2 consecutive years or more.
A
- Chronic Bronchitis
16
Q
Permanent alveolar damage and loss of elastic recoil, which result in chronic “hyperinflation” of the lungs
A
- Emphysema
17
Q
Rust colored sputum is often seen with
A
- Steptococcus Pneumonia
18
Q
The “GOLD STANDARD” for diagnosing Community Acquired Pneumonia is:
A
- Chest Xray
19
Q
In a healthy person, with a onset of severe cough of 2 weeks (14 days), you should suspect:
A
- Pertussis
20
Q
Difference between “Bacterial” pneumonia and “Atypical” pneumonia is:
A
- Bacterial PNA (S. Pneumoniae) = Acute Onset, “high fever and chills”, and lobar infiltrates on C-Xray
- Atypical PNA (M. Pneumonia = Gradual Onset, “low-grade fever”, interstitial or patchy (diffuse) infiltrates on C-Xray.
21
Q
The cornerstone treatment for COPD includes:
A
- Inhaled Anticholinergics (Atrovent), and/or ..
* Long-Acting Beta Agonists (Salmeterol)
22
Q
All asthma patients need a _____ PRN
A
- Short-Acting Beta2 agonist (Albuterol)
23
Q
Peak Expiratory Flow Rate (PEFR or PEF) is based on: (mnemonic HAG)
A
- Height
- Age
- Gender
24
Q
Risk factors of Pulmonary Embolisms include:
A
- Atrial Fibrillation (A-Fib)
- Pregnancy
- Estrogen therapy
- Surgery
- Long bone fractures
- Prolonged Inactivity
25
* With tactile fremitus, an abnormal finding would be considered, when _____
* Vibrations are felt stronger during palpation, in the lower lobes than the upper lobes, when the patients says "99" or "1,2,3"
26
Reduction in airflow rates is considered as
* Obstructive dysfunction (Asthma, COPD, bronchiectasis)
27
1st line treatment for community acquired pneumonia in patient with no co-morbidities
* ********* MACROLIDES **********
* Clarythromycin B.I.D x 10 days
* Azythromycin Daily x 5 days
* Erythromycin Q.I.D x 10 days
28
2nd line treatment for CAP
* Tetracyclines (Doxycycline 100mg B.I.D x 10 days)
29
Anticholingergic medications should be avoided in patients with:
* Narrow-angled Glaucoma
* BPH
* Bladder neck obstruction
30
During percussion of the lung fields, "Tympany" or "Hyperresonance" is associated with * _______, and "Dull-tone" is associated with * _____.
* Tympany = COPD
| * Dull-tone = Bacterial PNA with lobar consolidation, Pleural effusion.
31
Reduction of lung volume due to decreased lung compliance
* Restrictive Dysfunction (Pulmonary fibrosis, pleural disease, diaphragm obstruction)
32
This testing is used on immunocompromised patients testing for TB and Candida
* Anergy testing (PPD is placed in one arm and Candidas is placed in the other arm)
33
If a PPD test is greater than 10mm induration, what should be ordered?
* Chest X-ray
34
Medications that do NOT affect the inflammatory changes seen in Asthma patients include:
* Bronchodilators - bronchodilators open up air passages, but do not have anti-inflammatory components to reduce inflammatory changes seen in Asthma patients.
35
* HIV (+)
* Recent contact with infectious TB cases
* CXR with fibrotic changes consistent with previous TB disease.
* Any child who had close contact or has TB symptoms (before age 5)
* Immunocompromised patients
* *** The above mentioned will show a PPD or mantoux result of:
* Greater than or equal 5 mm (>5mm)
36
1st line treatment for SEVERE asthmatic exacerbation or respiratory distress is:
* Adrenaline Injection (Epinepherine)
37
Treatment plan for Acute Bronchitis includes:
* Fluids and Rest (1st Choice)
* Anti-tussives (Benzonatate/Tessalon)
* Muculytics/Expectorants (Guaifenesin)
* Albuterol Inhalers for wheezing
* **** NO ANTIBIOTICS*****
38
* Severe sore throat
* High Fever
* Fine sand paper rash
* **** The above mentioned are characteristics of *****
* Scarlet Fever (A group "A" streptococcal infection)
39
Streptococcus Pneumoniae is the bacterium most responsible for the highest mortality in patients with _____
* Community Acquired Pneumonia
40
* A viral infection caused by RSV that is commonly seen during the winter/spring months in infants and young children.
* Signs and Symptoms include: Fever, Inspiratory and/or Expiratory wheezing, with clear drainage
* *** The above mentioned is indicative of ****
* Bronchiolitis
41
This asthma classification includes:
* Normal FEV between exacerbations
* Symptoms are less than 2 days a week
* Use of Short acting beta-agonist (S.A.B.A) is less than 2 days a week.
* Intermittent Asthma
42
Mild Persistent asthma includes:
* FEV greater than 80%
* Symptoms are greater than/equal to 2 days a week, but not daily.
* Night time awakenings are 1 - 2 a month
* Used of S.A.B.A is greater than/equal to 2 days a week, but not daily.
* Minor limitation in normal activity
43
This classification of asthma includes:
* Symptoms throughout the day
* Nighttime awakenings > 1 time a week
* S.A.B.A usage is several times a day
* Extremely limited in normal activity
* FEV
* Severe Persistent
44
Abnormal forms of lymphocytes will occasionally show in which viral infections
* Epstein Barr Virus
45
A pathogenic bacteria found in older children and adults with cystic fibrosis
* Pseudomonas Aeruginosa
46
Medications that do NOT treat inflammation in Asthma patients include
* Theophylline - this medication controls inflammation, but does not reduce inflammation.
47
Auscultation of normal breath sounds would include:
* Vesicular breath sounds in the lower lobes, and...
| * Bronchial breath sounds in the upper lobes
48
Pulsus Paradoxus is usually associated with:
* Severe Airway Obstruction (i.e status asthmaticus, severe COPD exacerbation)
49
Treatment for Intermittent Asthma (mild intermittent asthma) includes:
* Albuterol (Ventolin) M.D.I prn
50
Treatment for Severe Persistent Asthma includes:
* High-dose ICS, plus...
* Long-acting beta2 - agonists, plus...
* Oral steroids daily
* Albuterol M.D.I prn
51
* Risk Factors for "Drug Resistant Streptococcus Pneumonia" include:
* Antimicrobial therapy within the last 3 months
* Alcoholism, liver, or renal disease
* Co-Morbidities
* Immunosuppression
* Exposure to children in daycare
52
The only treatment known to prolong life in COPD patients is:
Supplemental Oxygen
53
The treatment for TB exposure in HIV (-) patients include:
* INH 300mg/day for 9 months
54
* How does the anticholinergic drug "Ipratropium (Atrovent)",used in COPD patients, work?
* It decreases parasympathetic tone/reduces cholinergic tone, which thereby produces bronchodilation
FNP: Systems Review
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