Egan's 11ed Ch 25 Unit 2 Exam

Emphysema is defined as:

Destruction of alveolar walls without fibrosis

What step must be taken to gain control of asthma in a patient that is experiencing frequent emergency department visits?

Environmental control

Which of the following problems is associated with intravenous augmentation of synthetic alpha 1 -antitrypsin for the patient with genetic emphysema?

Expense

What is the approximate cost of COPD to the U.S. health system?

$50 billion

Which of the following statements are true about the incidence of asthma? 1. The prevalence has increased significantly over the past 20 years in the United States. 2. The mortality has remained the same over the past 20 years in the United States. 3. Researchers have determined the causes of asthma and are working on a vaccine. 4. Diagnosis of asthma is done in a physician's office following an extensive clinical assessment.

1 only

Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema? 1. Improved exercise endurance 2. Improved FEV 1 3. Improved quality-of-life 4. Improved survival

1, 3 and 4 only

Which of the following procedures would you recommend to further assess Mr. Jones' condition? 1. Pre-post PFT 2. Exercise testing 3. Chest x-ray 4. Room air ABG

1, 3, and 4 only

Which of the following are typically found in a patient with COPD? 1. Airway inflammation 2. Partially reversible airway obstruction 3. Progressive airway obstruction 4. Restrictive disease

1,2 and 3

Approximately how many individuals died of COPD in the United States in 2008?

145,000

1. Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus? 1. Allow peak inspiratory pressures to go as high as required. 2. Permissive hypercapnia. 3. Prolonged inspiratory time. 4. Small tidal volumes.

2 and 4 only

What percentage of all cases of COPD is caused by alpha1-antitrypsin deficiency?

2% to 3%

The mechanisms of airway obstruction in COPD include which of the following? 1. Airway remodeling 2. Inflammation and obstruction of small airway 3. Loss of elasticity 4. Active bronchospasm

2, 3, and 4 only

How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease?

200 ml

Approximately how many Americans are affected by COPD?

24 million

Which of the following signs associated with COPD is considered a late manifestation?

Accessory muscle usage

Your patient has bronchiectasis. Which of the following therapies is most needed?

Antibiotics

What causes the degranulation of mast cells in asthma patients?

Antigens attaching to IgE molecules on the mast cell surface

What classification of drug would the leukotriene inhibitors fall under?

Antiinflammatory

Identify the drug whose regular use in the treatment of asthma may worsen control or even increase the risk of death by asthma.

Beta-2 agonists

Which of the following medications is indicated for regular use in patients with stable COPD?

Beta-2 agonists

What test is most useful for the diagnosis of asthma in the symptom-free patient?

Bronchoprovocation testing with pulmonary function tests

What lung disease is the most common current indication for lung transplantation?

COPD

Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient?

Changes in mental status

Which of the following symptoms is not a typical symptom of asthma?

Chest pain

Mr. Jones is a 63 y/o Caucasian man who worked as a toll collector for 28 years. He is 5'5 tall and weighs 74 kg. He admits to smoking 2.5 packs of cigarettes per day for the last 30 years; he has tried to quit unsuccessfully on several occasions. He was seen in the pulmonary clinic complaining of shortness of breath at rest and a productive cough with clear to white sputum in the morning that have been persistent for several years. Mr. Jones admits to having had a low grade fever in the last couple of weeks. His family history is positive for lung disease. What medical problems are suggested by Mr. Jones' medical history?

Chronic bronchitis

Which complaint is most closely associated with the diagnosis of chronic bronchitis?

Chronic productive cough

What is the leading risk factor for the development of COPD?

Cigarette smoking

Which factor is associated with a decrease in the plasma levels of theophylline in an asthmatic patient?

Cigarette smoking

What medication is currently the most effective for the treatment of asthma?

Corticosteroids

What treatment strategy is most controversial for a patient with asthma?

Immunotherapy

What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD?

Improves exercise tolerance.

What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease?

Inflammation of the airways

Which of the following asthma medications is not typically administered during pregnancy?

Ipatropium Bromide

Which bronchodilator is commonly used in the hospital management of acute asthma exacerbation but is not considered the first-line bronchodilator?

Ipratropium bromide

Which medication is an anticholinergic bronchodilator?

Ipratropium bromide

During an acute exacerbation of COPD, what is the role of IV methylprednisolone?

It accelerates recovery as noted in FEV1.

Identify the hallmark symptom of bronchiectasis.

Large amounts of purulent sputum

Which of the following medications is generally only used if the patient still has debilitating symptoms from stable COPD, despite inhaled bronchodilator therapy?

Methylxanthines

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe was the asthma attack? pH 7.35, PaO2 58 mm Hg, PaCO2 46 mm Hg, HCO3- 18 mEq/L, SaO2 89%

Moderate

Which of the following side effects is associated with the use of inhaled corticosteroids?

Oral candidiasis

What treatment for patients with COPD has been shown to improve long-term survival?

Oxygen

An asthma patient's best effort produces a PEFR of 55% of personal best. What is indicated at this time?

Patient should probably seek medical attention now.

It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma?

Reversal of the FEV1 after use of a bronchodilator

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe was the asthma attack? pH 7.35 PaO2 58 mm Hg PaCO2 46 mm Hg HCO3− 18 mEq/L SaO2 89%

Severe

Of the following common causes of asthma, which of the following is the least likely to cause exercise-induced asthma?

Skiing and Snowboarding

Which airways are most susceptible to airway obstruction in patients with COPD?

Small

Which of the following tests is recommended as part of the initial assessment of asthma?

Spirometry

Where does COPD rank among the leading causes of death in the United States?

Third

Which of the following has been identified as the most common cause of occupational asthma?

Toluene diisocyanate

You are called to the ER to assess a 25-year-old female patient in status asthmaticus. Her PEFR results of pre- and post-bronchodilator therapy are given below: Pre-bronchodilator....Post-bronchodilator 1st attempt 216....334 2nd attempt 224....330 3rd attempt 210....340 You should suggest to the ER physician to:

continue current therapy.

Bronchiectasis characterized by progressive, distal enlargement of the airways, resulting in sac-like dilatations is classified as:

cystic bronchiectasis