Obstructive Lung Disease

Patient should probably seek medical attention now.

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

Chronic productive cough

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

Cigarette smoking..

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

Breo Ellipta

Which medication is a once-daily combination of a beta-2 agonist and an inhaled corticosteroid?

Ipratropium bromide

Which medication is an anticholinergic bronchodilator?

1. Airway inflammation 2. Partially reversible airway obstruction 3. Progressive airway obstruction

Which of the following are typically found in a patient with COPD?

Ipratropium bromide

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

Toluene diisocyanate

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

Methylxanthines

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

Beta-2 agonists

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

Expense

Which of the following problems is associated with intravenous augmentation of synthetic alpha1-antitrypsin for the patient with genetic emphysema?

Improved exercise endurance Improved quality-of-life Improved survival

Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema?

Oral candidiasis

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

Changes in mental status

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

Accessory muscle usage

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

The prevalence has increased significantly over the past 20 years in the United States.

Which of the following statements are true about the incidence of asthma?

Permissive hypercapnia. Small tidal volumes.

Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?

Chest pain

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

Spirometry

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

Antibiotics

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

It accelerates recovery as noted in FEV1.

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

destruction of alveolar walls without fibrosis.

Emphysema is defined as:

200 ml

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

57 mg/dl or 11 µmol/L

What is the critical alpha1-antitrypsin level below which lung elastin is attacked and broken down?

Cigarette smoking

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

COPD

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

Corticosteroids

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

Methylxanthines

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

Inflammation of the airways

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

2% to 3%

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

Environmental control

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

Methacholine

What stimulus is most commonly used in bronchoprovocation testing in the patient suspected to have asthma?

Bronchoprovocation testing with pulmonary function tests

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

Oxygen

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

Immunotherapy

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

Third

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

Small

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

Ipratropium bromide

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

Improves exercise tolerance.

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

Severe

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%

Noninvasive ventilation

A patient is experiencing an exacerbation of COPD. He is 65 years old, slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.29. Which of the following therapies would be most indicated?

Add or increase the dose of antiinflammatory.

According to the National Asthma Education Project guidelines, what should be considered if the patient with asthma requires more than 3 or 4 puffs of beta-2 agonists per day?

24 million

Approximately how many Americans are affected by COPD?

145,000

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

cystic bronchiectasis.

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

Beta-2 agonists..

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

Large amounts of purulent sputum

Identify the hallmark symptom of bronchiectasis

Reversal of the FEV1 after use of a bronchodilator

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?

Skiing and snowboarding

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

2. Inflammation and obstruction of small airway 3. Loss of elasticity 4. Active bronchospasm

The mechanisms of airway obstruction in COPD include which of the following?

Salmeterol

What beta-2 agonist is associated with 12 to 24 hr of bronchodilation?

Antigens attaching to IgE molecules on the mast cell surface.

What causes the degranulation of mast cells in asthma patients?

Antiinflammatory

What classification of drug would the leukotriene inhibitors fall under?

Peak expiratory flow

What does the National Asthma Education Project recommend be measured at home in patients with moderate to severe asthma?

Aspiration of gastric acid at night

What etiologic factor is associated with the onset of nocturnal asthma?

$50 billion

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