pulm review q's

A 69 year-old male with a history of chronic lymphocytic leukemia presents to the clinic complaining of cough, dyspnea and production of copious amounts of foul smelling sputum. Physical examination reveals crackles at the lung bases. Chest x-ray shows dilated and thickened bronchi that appear as ring-like markings. Which of the following is the most likely diagnosis? A Bronchiectasis B Chronic bronchitis C Asthma D Pulmonary fibrosis

A

COPD pt comes to the office with increased dyspnea over the last few hours. Her ABG values are diminishing and she shows increased sputum purulence. pt is healthy and has not show concern for poor outcome. No known risk factors for pseudomonas. what is the suggested tx? A. Azithromycin B. IV piperacillin-tazobactam C. levofloxacin D. Augmentin

A

what is the tx for a pt with COPD who is less symptomatic and has 0-1 exacerbations per year? A. albuterol and/or ipratropium bromide B. salmeterol and/or tiotropium C. albuterol and tiotropium D. salmeterol and ICS

A pt is apart of group A GOLD - tx is SABA, SAMA or combo

A 60 year-old patient with COPD characteristic of emphysema presents with a cough and increased sputum production. The following information is noted: Temperature 100°F (37.8°C); Respiratory rate 20/min; Heart rate 88 beats/min; pH 7.44; PaO2 75 mmHg; PaCO2 40 mmHg; O2 saturation 92%. Physical examination is remarkable for increased AP diameter, diminished breath sounds without wheezes, rhonchi, or other signs of respiratory distress. Which of the following would be an appropriate treatment for this patient? tory distress. Which of the following would be an appropriate treatment for this patient? A Broad-spectrum antibiotic B Admission to the hospital C Oxygen at 6 L/min by nasal cannula D Brief course of oral theophylline

A Broad-spectrum antibiotic

what is an inpatient with mild-moderate acute asthma exacerbations treated with?

Albuterol q4h --> continuous albuterol IV Magnesium sulfate IV Steroids +/- terbutaline, ipratropium, epinephrine

A 56 year-old female with a 35 pack year smoking history presents to the clinic with shortness of breath and cough. On examination, she is thin with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sounds. Pulmonary function tests show a marked increase in total lung capacity (TLC) and a decreased FEV1. What is the most likely diagnosis for this patient? A Persistent asthma B Chronic obstructive pulmonary disease C Idiopathic fibrosing interstitial pneumonia D Sarcoidosis

B

Which of the following best describes the pathophysiology of emphysema? A. Interstitial inflammation and fibrosis B. Alveolar enlargement and loss of septa C. Mucosal edema and inflammatory response D. Excessive mucus secretion and chronic cough

B

what is the tx for a pt with COPD who is more symptomatic and has 0-1 exacerbations per year? A. albuterol and/or ipratropium bromide B. salmeterol and/or tiotropium C. albuterol and tiotropium D. salmeterol and ICS

B pt is apart of group B GOLD - tx is LABA, LAMA, SABA prn

COPD pt is admitted to the hospital with increased dyspnea and increased sputum production. pseudomonas is shown on culture. oxygen saturation is 93%. Pt is oriented only to person and time. what is the best tx? A. oxygen therapy B. IV piperacillin-tazobactam C. PO levofloxacin D. Augmentin

B (could also give IV cefepime or IV ceftazidime)

A 75 year-old man with a long history of COPD presents with acute onset of worsening dyspnea, increased productive cough, and marked agitation. While in the emergency department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg, PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate management at this point? A oxygen supplementation with a 100% non-rebreather mask B noninvasive positive pressure ventilation (NIPPV) C endotracheal intubation and mechanical ventilation D emergency tracheostomy

C

A patient with severe COPD presents to the Emergency Department with a 3 day history of increasing shortness of breath with exertion and cough productive of purulent sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most appropriate next step in his treatment? A Decrease the oxygen flow rate. B Administer oral corticosteroids. C Intubate the patient. D Administer salmeterol (Serevent)

C

what is the tx for a pt with COPD who less symptomatic and has >2 exacerbations per year? A. albuterol and/or ipratropium bromide B. salmeterol and/or tiotropium C. albuterol and tiotropium D. salmeterol and ICS

C pt is apart of group C GOLD - tx is LAMA and SABA prn

what is the tx for a pt with COPD who is more symptomatic and has >2 exacerbations per year? A. albuterol and/or ipratropium bromide B. salmeterol and/or tiotropium C. albuterol and tiotropium D. salmeterol and ICS

C pt is apart of group D GOLD - tx is LAMA, SABA prn

COPD pt is admitted to the hospital with increased dyspnea and increased sputum production. No bacteria is shown on culture. oxygen saturation is 93%. Pt is oriented only to person and time. what is the best tx? A. oxygen therapy B. IV piperacillin-tazobactam C. IV levofloxacin D. Augmentin

C pt is having acute exacerbation no risk for pseudomonas

COPD pt comes to the office with increased dyspnea over the last few hours. Her ABG values are diminishing and she shows increased sputum purulence. you are concerned that the pt may need to be admitted to the hospital because previous occurrences have not had the best outcomes. You suspect pseudomonas infection. what is the suggested tx? A. Azithromycin B. Cedinir C. Ciprofloxacin D. Augmentin

C (could also prescribe levofloxacin) pt has risk for poor outcome and pseudomonas

Which of the following physical exam findings is consistent with moderate emphysema? A Increased tactile fremitus B Dullness to percussion C Distant heart sounds D Deviated trachea

C Distant heart sounds (due to hyperinflation of the lungs)

a patient brought to the emergency room with acute onset of dyspnea and tachypnea. He has a long history of alcoholism and was involved in a motor vehicle accident two days ago. He is hypoxic with crackles auscultated bilaterally and frothy pink sputum. Chest radiography reveals diffuse bilateral infiltrates which spare the costophrenic angle and air bronchograms, there is no cardiomegaly or pleural effusion noted. Oxygen saturation is 70%. what is the diagnosis? A Asthma B Bronchiectasis C COPD D ARDS

D

COPD pt comes to the office with increased dyspnea over the last few hours. Her ABG values are diminishing and she shows increased sputum purulence. you are concerned that the pt may need to be admitted to the hospital because previous occurrences have not had the best outcomes. No known risk factors for pseudomonas. what is the suggested tx? A. Azithromycin B. Cedinir C. Ciprofloxacin D. Augmentin

D (could also prescribe levofloxacin or moxifloxacin) pt has risk for poor outcome but no risk for pseudomonas

a premature infant who is born at 32 weeks and after several hours develops rapid shallow respirations at 60/ min, grunting retractions, and duskiness of the skin. The chest X-ray reveals diffuse bilateral atelectasis, ground glass appearance, and air bronchograms. What is the diagnosis?

pediatric respiratory distress syndrome

what is an outpatient with mild-moderate acute asthma exacerbations treated with?

Start with albuterol x1 and monitor for improvement over 1-2 hours Try 3 back-to-back Combinebs every 20 minutes (ipratropium+albuterol) Consider steroids

An infant born at 30 weeks' gestation begins to have respiratory difficulty shortly after birth. Examination reveals rapid, shallow respirations at 80 per minute with associated intercostal retractions, nasal flaring and progressive cyanosis. Chest x-ray reveals the presence of air bronchograms and diffuse bilateral atelectasis. Which of the following is the most likely diagnosis?

pediatric respiratory distress syndrome

4. "Reversibility" is defined as an increase from baseline in FEV1/FVC, after bronchodilator administration, of A. at least 12% and at least 200 mL B. at least 12% and at least 100 mL C. at least 10% and at least 200 mL D. at least 10% and at least 100 mL

a

65-year-old male complaining of fatigue and shortness of breath with exertion. The patient reports minimal cough. On physical exam, you note a thin, barrel-chested man with decreased heart and breath sounds, pursed-lip breathing, end-expiratory wheezing, and scattered rhonchi. Chest X-ray reveals a flattened diaphragm, hyperinflation and a small, thin appearing heart. PFTs show a decreased FEV1 / FVC ratio. what is your diagnosis? A. emphysema B. chronic bronchitis C. asthma D. ARDS

a

A 17 year-old male who is trying out for the track team notes excessive coughing with chest tightness when running. Which of the following is the most appropriate preventive agent for this patient? A Albuterol inhaler (Proventil) B Inhaled corticosteroids C Aminophylline (Theo-Dur) D Ipratropium (Atrovent)

a

A 24 year-old male presents complaining of a 9 month history of increasing shortness of breath, dyspnea on exertion, and a cough productive of white sputum, mostly in the mornings. He denies orthopnea, PND, peripheral edema, fever, chills, night sweats, recent changes in weight, palpitations, chest pain, food intolerances, or other complaints. Patient has a history of recurrent lung infections. He states that his father had chronic pulmonary problems and died at age 42 from unknown lung disease. The patient denies smoking, alcohol or illicit drug use. On physical examination, the respiratory rate is 22 per minute, pulse of 98 bpm, temperature of 98.7 degrees. Pulmonary exam reveals end-expiratory wheezes bilaterally and hyperresonance to percussion. His cardiac exam is normal. Chest x- ray shows decreased lung markings. ECG is normal. Pulmonary function tests show an FEV1 63% of expected and residual capacity is 123% of expected. Which of the following is the most likely diagnosis? A Emphysema B Pulmonary fibrosis C Ventricular septal defect D Congestive heart failure

a

A 3 year-old girl is diagnosed with atopic dermatitis. Which of the following disorders is this child at risk for in the future? A Asthma B Bronchiectasis C COPD D ARDS

a

A 36-year-old male who is hospitalized because of severe injuries from a motor vehicle accident develops rapid onset of profound dyspnea. Initial chest x-ray shows a normal heart size with diffuse bilateral infiltrates. Follow-up chest xray shows confluent bilateral infiltrates that spare the costophrenic angles. Which of the following is the best clinical intervention for this patient? A Tracheal intubation with lowest level PEEP B Bilateral chest tube insertion C IV fluids D Enteral nutrition E Provide supplemental oxygen

a

A 55 year-old man with a history of chronic bronchitis presents with two days of increased dyspnea and cough with worsening purulent sputum production. He is currently using inhaled albuterol as needed. In addition to systemic corticosteroids, what pharmacologic agent is warranted at this time for treatment of this patient? A Antibiotic B Inhaled corticosteroid C Long acting beta-agonist D Theophylline

a

A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. Which of the following is the most appropriate initial treatment? A Albuterol (Proventil) inhaler B Montelukast (Singulair) C Salmeterol (Serevent) inhaler D Sustained release theophylline

a

Patients with COPD have the symptoms of chronic bronchitis and emphysema. Which of the following morphologic patterns of emphysema is typically most severe in the upper lobes? A Centriacinar emphysema B Panacinar emphysema C Distal acinar emphysema D Paraseptal emphysema

a

What is seen in pulmonary function tests in patients with bronchiectasis? A. Decreased FEV 1/FVC B. Normal FEV 1/FVC C. Increased FEV 1/FVC

a

What is the most common pathogen found in non-cystic fibrosis patients with bronchiectasis? A. Haemophilus influenza B. Pseudomonas aeruginosa C. Streptococcus pneumoniae D. Staphylococcus aureus

a

Which of the following is the major pathogenetic mechanism that causes asthma? A airway inflammation B mucus hypersecretion C dilated airways D irreversible fibrosis

a

Which type of emphysema is mostly seen in cigarette smokers? A. Centriacinar B. Panacinar C. Distal Acinar D. Paraseptal

a

1. A 48 year-old man is evaluated for a 1-year history of cough. Pulmonary function tests shows FEV1 of 75% of predicted and an FEV1/FVC of 63%. Following administration of a bronchodilator, there is no significant change in the FEV1/FVC ratio and FEV1 is 79% of predicted. Which of the following is the most likely cause of this patient's cough? A. Asthma B. COPD C. Sarcoidosis D. Idiopathic Pulmonary Fibrosis

b

1. What is the most common pathogenesis of emphysema? A. Mucus gland enlargement and goblet hyperplasia B. Destruction of lung parenchyma C. Smooth muscle hypertrophy in airways D. Genetic mutation

b

2. What FEV1/FVC ratio on spirometry indicates obstructive lung disease? A. Less than 80% B. Less than 70% C. More than 70% D. More than 80%

b

A 5 year-old male presents with a history of recurrent episodes of acute bronchitis, characterized by fever and productive cough. He has no known significant past medical history. His pulmonary examination reveals crackles in the bilateral lower lobes. The remainder of his physical examination is normal. Chest x-ray demonstrates platelike atelectasis and dilated, thickened airways in the middle and lower lungs. Which of the following is the most likely diagnosis? A Acute bronchitis B Bronchiectasis C Emphysema D Asthma

b

A 56 year-old male with a 40 pack-year smoking history presents complaining of progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted), an FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most consistent with A sarcoidosis. B chronic bronchitis. C interstitial lung disease. D congestive heart failure.

b

A 73-year-old obese female with a 20 pack year smoking history presents complaining of chronic productive cough. She states that it has been occurring over the past 3 years more frequently November through February. Which of the following pulmonary function test values would you expect to find decreased? A tidal volume B forced expiratory volume in 1 second/forced vital capacity C residual volume D total lung capacity

b

What is seen classically in chest imaging for patients with bronchiectasis? A. Honeycombing B. Tram-track and signet ring sign C. Eggshell calcifications D. Hyperinflation

b

What is the most common pathogen found in cystic fibrosis patients with bronchiectasis? A. Haemophilus influenza B. Pseudomonas aeruginosa C. Streptococcus pneumoniae D. Staphylococcus aureus

b

Which of the following is independently associated with an increased risk for all-cause mortality in patients with COPD? A Asthma B Bronchiectasis C Underweight status D Depression

b

Which of the following pathophysiological processes is associated with chronic bronchitis A Destruction of the lung parenchyma B Mucous gland enlargement and goblet cell hyperplasia C Smooth muscle hypertrophy in the large airways D Increased mucus adhesion secondary to reduction in the salt and water content of the mucus

b

You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility? A Decrease In FEV1 B Increase in FEV1 C Decrease in FVC D Increase in FVC

b

a 60-year-old female with shortness of breath of recent onset. She has a six-year history of cough and rhonchi and is on oxygen at home. Physical exam reveals a respiratory rate of 32, slightly labored breathing, and a temperature of 98.9F. Her SpO2 is 90% while receiving oxygen via nasal cannula at 2 Lpm. A. emphysema B. chronic bronchitis C. asthma D. ARDS

b

1. What is the most common cause of bronchiectasis? A. Infections B. Foreign body obstruction C. Cystic Fibrosis D. Lung abscess

c

7. What is a simple and cheap test that can be used by a patient at home to monitor asthma? A. Spirometry B. Pulse Oximetry C. Peak expiratory flow rate (PEFR) D. Six minute walk test

c

A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well controlled until 2 days ago and since yesterday she has been using her albuterol inhaler every 4-6 hours. She is normally very active, however yesterday she did not complete her 30 minutes exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment? A chest x-ray B sputum gram stain C peak flow D ventilation - perfusion scan

c

A 32-week preterm infant has an APGAR score of 9 at 5 minutes. Thirty minutes after delivery, tachypnea, retractions, and expiratory grunting are noted. Cyanosis and dyspnea appear with little response to oxygen. Physical examination reveals poor air movement bilaterally. A chest x-ray reveals air bronchograms and a fine reticular granular pattern. Which of the following conditions should be suspected? A Atelectasis B Diaphragmatic hernia C Respiratory distress syndrome D Pneumothorax

c

A 45 year-old male presents with complaints of a chronic cough productive of mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it to a "smoker's cough". He has been coughing up a lot of sputum lasting all winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination reveals a moderately obese male in no acute respiratory distress. Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. Which of the following is the most likely diagnosis? A Lung cancer B Bronchiectasis C Chronic bronchitis D Interstitial lung disease

c

A 57-year-old man is being evaluated for shortness of breath. The following spirometric data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L (predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed) 128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted These findings are consistent with which of the following? A No demonstrable abnormality B Restrictive lung disease C Obstructive lung disease D A ventilation/perfusion mismatch

c

A 67 year-old man presents complaining of gradually worsening fatigue and shortness of breath. He is a previous smoker with an 80 pack-year smoking history. He denies chest pain, night sweats, or hemoptysis. On physical examination, you note a very thin male who appears older than his stated age. Lung and heart sounds are barely audible to auscultation. Which of the following interventions is likely to alter the disease course? A Inhaled bronchodilator therapy B Inhaled steroid therapy C Home oxygen D Theophylline

c

What is the mechanism of action of salmeterol (Serevent) in the treatment of asthma? A Anti-inflammatory B Immunotherapy for specific allergens C Relaxing of bronchial smooth muscle D Reduction of leukotriene production

c

What medication would you give to a COPD patient with an acute exacerbation, who has no risk factors or risk for pseudomonas? A. Ciprofloxacin B. Levofloxacin C. Azithromycin D. Amoxicillin-clavulanate

c

Which of the following is accurate regarding the treatment of patients with COPD? A Pneumococcal vaccines are contraindicated in patients with COPD B Intravenous alpha1-antitrypsin levels should be kept at 8-10 mmol/L C Long-term oxygen therapy is recommended for patients with a partial pressure of oxygen in arterial blood <55 mm Hg or oxygen saturation <90% D Because cardiovascular disease is common in patients with COPD, beta-blockers are indicated in all patients

c

Which of the following is the most effective way for patients with persistent asthma to monitor the severity of their symptoms? A call the health care provider regularly B keep a diary of symptoms C monitor peak flow D ask a family member to monitor symptoms

c

Which of the following studies provides the best clues to the acuteness and severity of disease exacerbation? A Serum chemistry evaluation B Alpha1-antitrypsin measurement C Arterial blood gas (ABG) analysis D Sputum evaluation

c

a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes. what is the diagnosis? A. emphysema B. chronic bronchitis C. asthma D. bronchiectasis

c

3. Which of the following is NOT an obstructive lung disease? A. Emphysema B. Asthma C. Bronchiectasis D. Idiopathic pulmonary fibrosis

d

5. In which of the following diseases will DLCO be NOT be decreased? A. Chronic Bronchitis B. Emphysema C. Pulmonary Fibrosis D. Asthma

d

6. What is the volume of air remaining in the lungs after forceful expiration? A. Tidal volume B. Inspiratory Reserve Volume C. Expiratory reserve volume D. Residual volume

d

8. What is gold standard for measuring lung volumes? A. Spirometry B. Pulse Oximetry C. Peak expiratory flow rate (PEFR) D. Body plethysmography

d

A 22 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks. The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. Which of the following is the most appropriate intervention at this time? A Oral prednisone B Oral theophylline C Salmeterol inhaler D Beclomethasone inhaler

d

A 25 year-old male with a history of asthma presents complaining of increasing episodes of evening and daytime symptoms. He is on a short acting inhaled beta agonist prn. He is presently using his short acting beta agonist on a daily basis. Which of the following is the most appropriate addition to this patient's regimen? A methylxanthine oxidase inhibitor B long acting beta agonist inhaler C leukotriene inhibitor D inhaled corticosteroid

d

A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. Which of the following would be the most appropriate treatment for this patient? A Mast cell stabilizer B Long acting beta agonist C Leukotriene receptor antagonist D Low dose inhaled corticosteroid

d

A 62 year-old male presents with a history of dyspnea on exertion and chronic cough worse with arising in the mornings. He has a 40-year-pack history of cigarette use. On examination there is increased AP diameter and decreased breath sounds with a prolonged expiratory phase. Pulse oximetry reveals an oxygen saturation of 93% on room air. In addition to smoking cessation, which of the following is an appropriate intervention at this time? A. home oxygen therapy B. maintenance oral steroids C. prophylactic abx therapy D. recommend flu and pneumococcal vaccines

d

All COPD patients should receive the following EXCEPT? A. Bronchodilators B. Pneumococcal vaccination C. Annual influenza vaccination D. Inhaled corticosteroids

d

Chronic bronchitis is clinically defined as a daily productive cough for? A. 3 months for 1 year B. 2 months for 2 consecutive years C. 2 months for 1 year D. 3 months for 2 consecutive years

d

In patients with COPD, which of the following has been shown to decrease rate of malignancy and cardiovascular disease and improve survival? A bronchodilator therapy B pulmonary rehabilitation C oral glucocorticosteroids D smoking cessation

d

Which of the following is generally recognized as the most significant symptom of COPD? A Productive cough B Pulmonary hypertension C Cor pulmonale D Breathlessness

d

a 25-year-old cystic fibrosis patient complaining of chronic, frequent coughing productive of yellow and green sputum. She recently recovered from a Pseudomonas spp. pneumonia requiring hospitalization. On physical examination, you notice foul breath, purulent sputum, and hemoptysis along with a CXR demonstrating dilated and thickened airways with "plate-like" atelectasis (scarring). what is the diagnosis? A. emphysema B. chronic bronchitis C. asthma D. bronchiectasis

d

what is the tx for a pt with COPD and asthma who is more symptomatic and has >2 exacerbations per year? A. albuterol and/or ipratropium bromide B. salmeterol and/or tiotropium C. albuterol and tiotropium D. salmeterol and ICS

d pt is apart of group D GOLD w/ COPD and asthma overlap - LABA + ICS

pt with asthma comes into ur office with coughing 1 day per week which is the only time she uses her inhaler. she wakes up with nighttime dyspnea 2 times per month. She has no problem exercising or doing everyday tasks. how is this pt classified based on the asthma severity chart and what is the tx?

intermittent encourage the pt to continue using her inhaler as needed

You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed in 60% oxygen. Chest x-ray shows atelectasis with air bronchograms. Which of the following is the most likely diagnosis?

pediatric respiratory distress syndrome

pt with increased RR without accessory muscle use, becomes breathless while walking and can only talk in sentences. she has a moderate wheeze at the end of expiration. her pulse is 80 bpm. pt can lie down without issue. what is severity of this pts exacerbation?

mild

28 yr old male with asthma comes to ur office with coughing and dyspnea 3-4 days per week. he doesnt wake up often from his symptoms, and is at most 3 times per month. he uses his inhaler only 4-5 times a week but not daily. there is minor limitation with exercise. how is this pt classified based on the asthma severity chart and what is the tx?

mild daily low dose ICS and SABA OR combo SABA/ICS prn

agitated pt with increased RR with accessory muscle use, becomes breathless while chilling and tries to limit her activity. she can only talk in phrases. she has a loud wheeze throughout expiration. her pulse is 120 bpm. pt can't lie down without coughing so she prefers sitting. what is severity of this pts exacerbation?

moderate

17 yr old female with asthma comes to ur office complainign of daily coughing fits. she wakes up most nights with sx, but not every night. she uses her inhaler everyday and has can only exercise for 30 minutes without sx. how is this pt classified based on the asthma severity chart and what is the tx?

moderate daily and PRN combo low dose ICS+LABA

agitated pt with RR: 36 with paradoxical thoracoabdominal movement, becomes breathless while chilling which interferes with conversation because she cant talk. no wheeze is present. her pulse is 30 bpm. pt is unable to recline. what is severity of this pts exacerbation?

respiratory arrest imminent

agitated pt with RR: 36 with accessory muscle use, becomes breathless while chilling which interferes with conversation. she can only talk in words. she has a loud wheeze throughout inhalation and expiration. her pulse is 140 bpm. pt can't lie down without coughing and prefers to sit upright. what is severity of this pts exacerbation?

severe

21 yr old male with asthma posts up to ur office with sx all throughout the day everyday. he wakes up everynight from coughing and uses his inhaler several times a day. he cannot exercise it is so bad. how is this pt classified based on the asthma severity chart and what is the tx?

severe refer to pulm