RC206 Obstructive Lung Disease,COPD,Asthma, and related Dieases Chp 23

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

`ipratropium bromide

Which complaint is most closely associated w/the dx of Chronic Bronchitis?

a chronic productive cough

What classification of drug would the leukotriene inhibitors fall under?

antiinflammatory

Emphysema is defined as?

Destruction of alveolar walls w/out fibrosis

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

severe

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

spirometry

Of the following common causes of asthma, which is the least likely to cause EIA?

swimming indoors

Which airways are most susceptible to airway obstruction in pt.'s w/COPD

the small airways

Where does COPD rank among the leading causes of death in the U.S.?

third

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

toulene diisocyanate

Approximately how many individuals dies of COPD in the U.S. in 2008?

145,000

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

$32 billion

Which of the following statements are true about the use of bronchodilators in the treatment of asthma?

1. B2 agonists are the drug of choice in EIA 2. B2 agonists do not prevent the late onset asthma response

Which of the following procedures would you recommend to further assess Mr.Jones' condition?

1. Pre-post PFT 3. Chest x ray 4. room air ABG

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 U.S.

What percentage of all cases of COPD is caused by an A1-antitrypsin deficiency?

2-3%

Which of the following strategies is useful in the mechanical ventilation of a pt. in status asthamicus?

2. permissive hypercapnia 4. small tidal volumes

How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the pt. w/obstructive lung disease?

200ml

Approximately how many Americans are affected by COPD?

24 million

What is the critical A1-antitrypsin level below which lung elastin is attacked and broken down?

57mg/dl

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

COPD

what medical problems are suggested by Mr.Jones medical hx?

Chronic bronchitis

What does the asthma national education project(NAEP) recommend be measured at home in pt.'s w/moderate to severe asthma?

Peak Expiratory Flow

What b2 agonist is associated with a decrease in the plasma levels of theophylline in an asthmatic pt.?

Salmeterol

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

accessory muscle useage

According to the NAEP guideline, what should be considered if the pt. w/asthma requires more than 3 or 4 puffs od b2 agnoists per day

add or increase the does of antiinflammatory

What causes the degranulation of mast cells in asthma pt.'s?

antigens attaching to IgE molecules on the mast cell surface

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

b2 agonists

Which of the following medications is indicated for REGULAR use in pt.'s w/stable COPD?

b2-agonists

Which of the following signs and symptoms is most closely associated w/ respiratory failure in a COPD pt.?

changes in mental status

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

chest px

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

cigarette smoking

Which factor is associated w/a decrease in the plasma levels of theophylline in an asthmatic pt.?

cigarette smoking

You are called to the ER toa ssess a 25 y/o female pt. in asthaticus. Her PEFR results pre and post bronchodilator therapy are below; 1st pre 216 post 334 2nd pre 224 post 330 3rd pre 210 post 340 You should suggest the ER physician to:

continue current therapy

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

corticosteroids

What may be the drug of choice for managing atopic asthma in children?

cromolyn

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

cystic bronchiectasis

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

environmental control

Which of the following problems is associated w/intravenous augmentation of synthetic a1-antitrypsin for the pt. w/genetic emphysema?

expense

What is the benefit of Pulmonary rehabilitation in pt.'s w/moderate to severe COPD?

improves exercise tolerance

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

inflammation of the airways

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

ipratropium bromide

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

it accelerates recovery as noted in FEV1

Identify the hallmark symptom of bronchiectasis.

large amount of purulent sputum

After being dx w/COPD, Mr.Jones would like to know possible treatment options for his condition. You explain to Mr. Jones that all of the following interventions may be appropriate in the future except:

lung transplant

What stimulus os most commonly used in bronchoprovocation testing in the pt. suspected to have asthma?

methacholine

What medication would likely be the least often ordered during the emergency department management of an acute asthma attack?

methlyxanthines

It is not clear whether your pt. has COPD or Asthma. Which of the following characteristics is most closely associated w/the dx of Asthma?

normalization of the FEV1 after use of a bronchodilator

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

oral candidiasis

What treatment for pt.'s w/COPD has been shown to improve long term survival?

oxygen

Mr. Jones is a 63y/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 SOB at rest and a productive cough w/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 hx is positive for lung disease.

use for the following