Exam II studying Flashcards by Morgan Evans

Which protein protects the lungs from neutrophil elastase destruction?
A) Hemoglobin
B) Alpha-1 antitrypsin (AAT)
C) Surfactant
D) Fibrinogen

B) Alpha-1 antitrypsin (AAT)

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What is a hallmark spirometry finding in COPD?
A) FEV1/FVC <70% post-bronchodilator
B) FEV1/FVC >80%
C) Reversible airway obstruction
D) Decreased FEV1 but normal FVC

A) FEV1/FVC <70% post-bronchodilator

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What is the recommended threshold for oxygen therapy for COPD patients?
A) SpO2 <92%
B) SpO2 <90%
C) PaO2 <55 mmHg or SpO2 <88%
D) PaO2 <70 mmHg

C) PaO2 <55 mmHg or SpO2 <88%

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A patient with COPD is classified as GOLD 3. What is their FEV1 range?
A) ≥80%
B) 50-80%
C) 30-50%
D) ≤30%

C) 30-50%

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Which vaccine should be given to a COPD patient aged 40 years old?
A) Pneumovax 23
B) PCV-15, PCV-20, or PCV-21
C) RSV vaccine
D) Hepatitis B vaccine

B) PCV-15, PCV-20, or PCV-21

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A COPD patient with CAT <10 and mMRC ≤1 falls into which treatment group?
A) Group A
B) Group B
C) Group E
D) Group D

A) Group A

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Which medication is appropriate for a Group A COPD patient?
A) LABA only
B) ICS + LABA
C) Bronchodilator (SABA, SAMA, LAMA, or LABA)
D) Triple therapy (LABA + LAMA + ICS)

C) Bronchodilator (SABA, SAMA, LAMA, or LABA)

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A COPD patient in Group E requires which therapy?
A) SABA only
B) LABA + LAMA + SABA
C) ICS + LABA monotherapy
D) Mucolytics only

B) LABA + LAMA + SABA

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Which bronchodilator is a short-acting muscarinic antagonist (SAMA)?
A) Albuterol
B) Levalbuterol
C) Ipratropium
D) Salmeterol

C) Ipratropium

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Which long-acting beta-agonist (LABA) is available as a nebulizer solution?
A) Salmeterol
B) Formoterol
C) Olodaterol
D) Umeclidinium

B) Formoterol (Performist)
[also Arformoterol (Brovana)]

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Which COPD treatment requires swish and spit counseling due to thrush risk?
A) Tiotropium
B) Fluticasone-containing inhalers
C) Albuterol
D) Roflumilast

B) Fluticasone-containing inhalers
[Advair; Trelegy]

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When should ICS be added to COPD therapy?
A) As monotherapy
B) When eosinophils are ≥100 and exacerbations persist
C) For all COPD patients
D) Only for GOLD 1

B) When eosinophils are ≥100 and exacerbations persist

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What is the recommended treatment for a patient failing triple therapy with eosinophils <100?
A) Increase ICS dose
B) Add Roflumilast or Azithromycin
C) Add Theophylline
D) Use SABA only

B) Add Roflumilast or Azithromycin

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Which antibiotic is used for an uncomplicated COPD exacerbation?
A) TMP-SMX
B) Azithromycin
C) Levofloxacin
D) Amoxicillin

B) Azithromycin

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Which oral corticosteroid regimen is recommended for COPD exacerbations?
A) Prednisone 20 mg BID for 7 days
B) Prednisone 40 mg QD for 5 days
C) Methylprednisolone 10 mg QD for 10 days
D) Prednisone 60 mg BID for 3 days

B) Prednisone 40 mg QD for 5 days

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What defines a moderate COPD exacerbation?
A) Change in one baseline symptom
B) Change in two baseline symptoms
C) Increased sputum volume only
D) No need for bronchodilator therapy

B) Change in two baseline symptoms

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A COPD patient with >4 exacerbations per year and multiple comorbidities is best treated with:
A) Azithromycin or Augmentin
B) Amoxicillin
C) Levofloxacin
D) Ceftriaxone

A) Azithromycin or Augmentin

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What is a potential side effect of Roflumilast?
A) Hyperglycemia
B) Neuropsychiatric effects
C) Bradycardia
D) Hypotension

B) Neuropsychiatric effects

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What is a key administration counseling point for Spiriva Respimat?
A) Expiration is 6 weeks after opening
B) It must be shaken before use
C) Use the TOP (Turn, Open, Press) technique
D) It should be used as needed

C) Use the TOP (Turn, Open, Press) technique

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A COPD patient using Trelegy has eosinophils >300 but is failing therapy. What is the next step?
A) Add Roflumilast
B) Add Dupilumab
C) Stop all inhalers
D) Increase LABA dose

B) Add Dupilumab

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Which of the following is the primary inflammatory cell type involved in COPD?
A) Eosinophils
B) Neutrophils
C) Basophils
D) Mast cells

B) Neutrophils

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A 45-year-old smoker presents with chronic productive cough for 4 months in each of the past 2 years. What is the most likely diagnosis?
A) Asthma
B) Chronic bronchitis
C) Emphysema
D) Bronchiolitis

B) Chronic bronchitis

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According to GOLD guidelines for COPD, a patient with an FEV1/FVC of 0.4 falls under which category?
A) GOLD 1
B) GOLD 2
C) GOLD 3
D) GOLD 4

C) GOLD 3

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What is the preferred initial therapy for a Group B COPD patient?
A) SABA only
B) ICS + LABA
C) LABA or LAMA
D) ICS monotherapy

C) LABA or LAMA

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What is the primary mechanism of action of Theophylline? A) Beta-2 agonist B) Phosphodiesterase inhibition C) Muscarinic receptor blockade D) Neuraminidase inhibition

B) Phosphodiesterase inhibition

Which antibiotic is recommended for a complicated COPD exacerbation? A) Amoxicillin B) Azithromycin; Augmentin C) Levofloxacin; Augmentin D) Doxycycline

C) Levofloxacin; Augmentin

A 60-year-old COPD patient has had 2 moderate exacerbations in the past year but no hospitalizations. Their CAT score is 12. Which GOLD group do they fall into? A) Group A B) Group B C) Group E D) Group C

C) Group E

Which of the following drugs is a long-acting muscarinic antagonist (LAMA)? A) Salmeterol B) Albuterol C) Tiotropium D) Formote rol

C) Tiotropium

Which of the following is true about Symbicort? A) It contains fluticasone and salmeterol B) It is used as both maintenance and reliever therapy in asthma C) It is a combination of ICS + LAMA D) It can be used as monotherapy for COPD

B) It is used as both maintenance and reliever therapy in asthma

What is the max dosing for Symbicort for chronic asthma?

1) Maintenance: 1-2 inhalations BID or QD 2) Max MART: Adults: 12 inhalations/day 12-17yo: 11 inhalations/day 4-11yo: 8 inhalations/day 3) Low to Med: Budesonide 80mcg/formoterol -Med to High: Budesonide 160/formoterol

Mometasone furoate DPI (Asmanex): How do you dose this for chronic asthma?

Low: 110-220 Med: 220-440 High: 440

A 12-year-old patient presents with nighttime awakenings twice a week due to asthma symptoms. According to GINA guidelines, what step should they be placed in? A) Step 1 B) Step 2 C) Step 3 D) Step 4

C) Step 3

What is not to be used as monotherapy for long term control of asthma bc of an increased risk of death?

Long-acting (LABA) – dosed twice daily: Salmeterol (Serevent) Formoterol (Foradil, Performist)

What is the maximum number of inhalations per day for Symbicort in a patient using it for maintenance and acute relief? A) 6 B) 8 C) 12 D) 16

C) 12

A patient with exercise-induced asthma is best treated with: A) ICS monotherapy B) LABA monotherapy C) PRN SABA before exercise D) Montelukast only

C) PRN SABA before exercise

How do nonselective beta-blockers worsen asthma? A) They increase mucus production B) They block beta-2 receptors, causing bronchoconstriction C) They stimulate histamine release D) They reduce airway inflammation

B) They block beta-2 receptors, causing bronchoconstriction

A 5-year-old patient with asthma requires a step-up in therapy. What is the next best option? A) ICS + LABA B) Montelukast C) Oral corticosteroids D) High-dose ICS

B) Montelukast

Which of the following is an appropriate counseling point for ICS inhalers? A) Shake the inhaler before use B) Rinse mouth after each use C) Use it only when symptomatic D) It should always be used with a spacer

B) Rinse mouth after each use

Which drug is a leukotriene receptor antagonist (LTRA)? A) Montelukast B) Roflumilast C) Tiotropium D) Salmeterol

A) Montelukast

A patient taking Montelukast should be monitored for: A) Weight gain B) Neuropsychiatric effects C) QT prolongation D) Hyperglycemia

B) Neuropsychiatric effects

What is the preferred antibiotic for a healthy outpatient with community-acquired pneumonia (CAP)? A) Amoxicillin 1g TID B) Levofloxacin C) Vancomycin D) Cefepime

A) Amoxicillin 1g TID

A 67-year-old patient presents with CURB-65 score of 2 and minor CAP criteria. What is the appropriate treatment setting? A) Outpatient B) ICU C) Non-ICU inpatient D) Observation only

C) Non-ICU inpatient

Which of the following is a risk factor for Pseudomonas pneumonia? A) Age >65 B) Prior hospitalization with IV antibiotics in the last 90 days C) Smoking history D) Recent travel

B) Prior hospitalization with IV antibiotics in the last 90 days

A patient with HAP and risk factors for MRSA should receive which antibiotic? A) Cefepime B) Vancomycin C) Azithromycin D) Doxycycline

B) Vancomycin

What is the primary cause of bacterial pharyngitis? A) Streptococcus pneumoniae B) Streptococcus pyogenes C) Haemophilus influenzae D) Moraxella catarrhalis

B) Streptococcus pyogenes

A patient with influenza presents 72 hours after symptom onset. What is the best treatment option? A) Oseltamivir B) Zanamivir C) Supportive care D) Baloxavir

C) Supportive care

According to GINA guidelines, what is the preferred initial treatment for a 12-year-old patient with mild asthma? A) PRN SABA B) PRN ICS-formoterol [illnesses] C) Daily ICS + PRN SABA D) Montelukast

B) PRN ICS-formoterol [illnesses]

According to GINA guidelines, what is the preferred initial treatment for a 5-year-old patient who needs step 1 asthma Tx (infreq. viral wheezing/ few or no interval Sx)? A) PRN SABA B) PRN ICS-formoterol [illnesses]+ PRN SABA C) Daily ICS + PRN SABA D) Montelukast

B) PRN ICS-formoterol [at the start of viral illnesses] + PRN SABA

According to GINA guidelines, what is the preferred initial treatment for a 5-year-old patient who needs step 2 asthma Tx (wheezing episodes req. SABA occur >/=3/yr)? A) PRN SABA B) PRN ICS-formoterol [illnesses] + PRN SABA C) Daily ICS + PRN SABA D) Daily ICS + daily LTRA or PRN ICS-formoterol [illnesses] + PRN SABA

D) Daily ICS + daily LTRA or PRN ICS-formoterol [illnesses] + PRN SABA

If an adult pt has daily asthma Sx (waking at night x1/wk or more & low lung funct), what are the track 1 and 2 options?

1) Track 1: Medium dose ICS-formoterol MART 2) Track 2: Medium/ high dose ICS-LABA PRN SABA (or ICS-SABA)

ICS-formoterol = what?

Symbicort

How does estrogen impact asthma? A) Increases bronchoconstriction B) Decreases inflammation C) Enhances beta-agonist response D) Has no effect on asthma

A) Increases bronchoconstriction

Which of the following medications can worsen asthma symptoms? A) Selective beta-1 blockers B) Nonselective beta-blockers C) Montelukast D) Tiotropium

B) Nonselective beta-blockers

A patient experiencing an acute asthma exacerbation should be treated with which corticosteroid? A) Hydrocortisone B) Prednisone C) Fluticasone D) Beclomethasone

B) Prednisone

Which of the following is NOT recommended for monotherapy in asthma? A) ICS B) LABA C) LTRA D) SABA

B) LABA

An adult patient with nighttime awakenings >1x per week and daily symptoms would be classified in which GINA step? A) Step 1 B) Step 2 C) Step 3 D) Step 4

D) Step 4

What is a major side effect of Montelukast? A) Hepatotoxicity B) QT prolongation C) Neuropsychiatric effects D) Nephrotoxicity

C) Neuropsychiatric effects

What is the preferred treatment for a Group B COPD patient? A) LABA or LAMA B) ICS + LABA C) SABA only D) ICS monotherapy

A) LABA or LAMA

A patient with COPD and eosinophils <100 who is failing LABA/LAMA therapy should be started on: A) ICS B) Roflumilast or Azithromycin C) LTRA D) Omalizumab

B) Roflumilast or Azithromycin

A COPD patient with CAT score of 8 and one moderate exacerbation falls into which GOLD group? A) A B) B C) C D) E

A) A

What is a potential side effect of Roflumilast? A) Hyperglycemia B) Neuropsychiatric effects C) Bradycardia D) Hypotension

B) Neuropsychiatric effects

Which of the following is a major cause of acute bacterial rhinosinusitis? A) Mycoplasma pneumoniae B) Moraxella catarrhalis C) Pseudomonas aeruginosa D) Staphylococcus epidermidis

B) Moraxella catarrhalis [Streptococcus pneumoniae & Haemophilus influenzae more common tho]

A 5-year-old with RSV bronchiolitis should receive which routine treatment per AAP guidelines? A) Ribavirin B) Inhaled corticosteroids C) Nebulized hypertonic saline D) Systemic corticosteroids

C) Nebulized hypertonic saline

Which neuraminidase inhibitor is not administered via inhalation? A) Zanamivir B) Oseltamivir C) Peramivir D) Baloxavir

B) Oseltamivir

Which antibiotic is preferred for a complicated COPD exacerbation? A) TMP-SMX B) Azithromycin C) Levofloxacin D) Amoxicillin

C) Levofloxacin [or Augmentin]

M1 – 3 acetylcholine antagonist is the MOA of what?

SAMAs (Ipratropium (Atrovent))

True or false: both ICS monotherapy and ICS/LABA therapy are not appropriate for COPD

True

What is a common SABA/ SAMA COPD combination inhaler?

Albuterol sulfate; ipratropium bromide (Duoneb or Combivent Respimate)

What are 4 LABA/ LAMA COPD combination inhalers?

1) Umeclidium bromide; vilanterol trifenetate 2) Tiotropium bromide; olodaterol hydrochloride 3) Glycopyrrolate; indacaterol maleate 4) Glycopyrrolate; formoterol maleate

What is a triple combination inhaler for COPD?

Fluticasone furoate; umeclidinium bromide; vilanterol trifenatate (aka Trelegy Ellipta)

How do you differentiate the 3 types of acute COPD exacerbations?

Mild = 1 cardinal Sx, moderate = 2, severe = 3

Repair during what disease involves replacement of injured tissue by parenchymal cells of the same type and replacement by connective tissue and its maturation into scar tissue?

Asthma

A patient with nighttime awakenings twice per week and daily symptoms is classified in which GINA step? A) Step 1 B) Step 2 C) Step 3 D) Step 4

D) Step 4

Which of the following corticosteroids is appropriate for acute asthma exacerbations? A) Fluticasone B) Beclomethasone C) Prednisone D) Budesonide

C) Prednisone

How should albuterol nebulization be administered in an acute exacerbation? A) Once every 8 hours B) Every 20 minutes for 3 doses, then as needed C) Once per day D) As a continuous infusion for 24 hours

B) Every 20 minutes for 3 doses, then as needed

A COPD patient with eosinophils >300 is failing triple therapy (LABA + LAMA + ICS). What is the next step? A) Add Roflumilast B) Add Dupilumab C) Stop all inhalers D) Increase ICS dose

B) Add Dupilumab

Which antibiotic is preferred for a complicated COPD exacerbation? A) TMP-SMX B) Azithromycin C) Levofloxacin D) Amoxicillin

C) Levofloxacin (more importantly though Augmentin and Levaquin are preferred)

A patient with flu and pneumonia requiring antiviral treatment beyond 48 hours of symptom onset should receive: A) Oseltamivir B) Baloxavir C) Supportive care D) High-dose amoxicillin

A) Oseltamivir

What do the Advair Diskus and Trelegy have in common? (hint: counseling point)

You need to rinse your mouth out after

Which drug has a black box warning for increased risk of death when used as monotherapy in asthma? A) Salmeterol B) Budesonide C) Tiotropium D) Montelukast

A) Salmeterol [also Formoterol (Foradil, Performist)]

Which antibiotic is most appropriate for treating an inpatient with severe CAP who has a risk factor for MRSA? A) Azithromycin B) Vancomycin C) Amoxicillin D) Doxycycline

B) Vancomycin [also Linezolid]

How long do you treat kids for ABRS?

10-14 days

What is the primary treatment for severe persistent asthma in adults? A) Low-dose ICS B) Medium-dose ICS/LABA C) High-dose ICS/LABA with possible addition of biologics D) SABA PRN

C) High-dose ICS/LABA with possible addition of biologics

Before the first use or after 7 days of inactivity, what should you do with an MDI inhaler? A) Shake vigorously B) Prime the inhaler with two test sprays C) Discard it D) Clean it with alcohol

B) Prime the inhaler with two test sprays

Which biologic is an IL-4 receptor antagonist used in the treatment of moderate to severe asthma? A) Omalizumab B) Dupilumab C) Benralizumab D) Mepolizumab

B) Dupilumab

What is the mechanism of action of tiotropium? A) Beta-2 agonist B) Muscarinic receptor antagonist C) Leukotriene receptor antagonist D) Phosphodiesterase inhibitor

B) Muscarinic receptor antagonist

Which of the following is a long-term macrolide antibiotic used in COPD management to reduce exacerbations? A) Clarithromycin B) Erythromycin C) Azithromycin D) Roxithromycin

C) Azithromycin

Which guideline is primarily used for asthma management? A) GOLD B) IDSA C) GINA D) AAP

C) GINA

Which guideline is used for the management of COPD? A) GINA B) GOLD C) IDSA D) AAP

B) GOLD

In the Tx of bacterial pharyngitis in patients with a type I penicillin allergy, which antibiotic is preferred? A) Amoxicillin B) Azithromycin C) Cephalexin D) Clindamycin

B) Azithromycin (and Tx for 5 days instead of 10)