Respiratory

Question 1

The most common causes of bronchiolitis in infant

Answer 1

RSV, Parainfluenza….

Question 2

Most common cause of Croup in child

Answer 2

Parainfluenza 75% then RSV, influenza….

Question 3

What is the inhaled treatment of choice and dose if need for a croup patient

Answer 3

Could use racemic epi but regular 1:1000 epi (L-epinephrine) 5ml nebulized is just as effective

Question 4

a coin seen on end in AP view xray suggest what location

Answer 4

Trachea

Round in the Esophagus

Question 5

Who gets mycoplasma pneumonia

Answer 5

Although mycoplasmal pneumonia is common in all age groups, it is most common in the first 2 decades of life, is rare in children younger than five years, and has the highest rate of infection in individuals aged 5-20 years.

Question 6

At what age is CF diagnosed

Answer 6

Many variants. Most babies are screened with newborn screening and most diagnosed before 2yrs
Some may not present with symptoms until 20yrs

Question 7

What is organic dust toxicity syndrome

Answer 7

Organic dust toxic syndrome is a term recently coined to describe a noninfectious, ACUTE febrile illness associated with chills, malaise, myalgia, a dry cough, dyspnea, headache and nausea which occurs after heavy organic dust exposure. EVERYONE THAT IS EXPOSED GETS IT. treat supportively

Farmer’s Lung Dx = Acute Hypersensitivity Pneumonitis which is more rare and an individual with CHRONIC allergic lung dx from repeated exposure to biologic dust. Long term parenchymal changes

Question 8

Farmer’s lung (hypersensitivity peumomonitis)

Answer 8

Farmer’s lung is a disease caused by an allergy to the mold in certain crops. Farmers are most likely to get it because it’s usually caused by breathing in dust from hay, corn, grass for animal feed, grain, tobacco, or some pesticides. Not everyone gets farmer’s lung after breathing in these things. Treat with oral steroids

Question 9

T/F Frequent respiratory infections is protective against asthma

Answer 9

True

Question 10

What are the steps used to interpret results of an in office spirometry test?

Answer 10

The first step is determining the validity of the test by seeing if patient gives a strong enough effort. Next, the determination of an obstructive or restrictive ventilatory pattern is made. If a ventilatory pattern is identified, its severity is graded.

Question 11

What number is best used to identify Obstructive Lung disease from Spirometry?

Answer 11

FEV1/ FVC ratio—The percentage of the FVC expired in one second.

Question 12

What 4 lung volumes make up TLC - total lung capacity

Answer 12

expiratory reserve volume, inspiratory reserve volume, residual volume, and tidal volume.

Question 13

For how many seconds is FVC measured

Answer 13

Up to 6 seconds

Question 14

What is used to determine if a spirometry test (spirogram) is valid?

Answer 14

at least three acceptable spirograms must be obtained. In each test, patients should exhale for at least six seconds and stop when there is no volume change for one second. The test session is finished when the difference between the two largest FVC measurements and between the two largest FEV1 measurements is within 0.2 L.

Question 15

If FVC is low, FEV1 low or normal, and absolute FEV1/FVC ratio is >0.7 what is the diagnosis?

Answer 15

restrictive ventilatory impairment may be present- due to restricted Total Lung Capacity

Question 16

What would you expect to find on spirometry in asthma

Answer 16

A reduced FEV1 and absolute FEV1/FVC ratio < .7 indicates an obstructive ventilatory pattern, and bronchodilator challenge testing is recommended to detect patients with reversible airway obstruction (e.g., asthma).

Question 17

Always look at FEV1/FVC to see if it is > or < 0.7

Answer 17

To diagnose Obstructive Dx which is always < 0.7

Question 18

Daily symptoms of asthma puts a patient into what severity classification

Answer 18

Moderate persistent (>1x/wk at night)
Severe persistent = throughout the day, almost nightly 
Mild persistent is more than 2 days per week but not daily.  (3-4 x/wk at night)

Question 19

What is the FEV1 if Mild persistent asthma

Answer 19

> 80% predicted

Question 20

is FEV1/FVC used to diagnose Obstructive lung disease or to categorize severity

Answer 20

Just to diagnose if Obstructive or Restrictive. Would be <0.7

Question 21

At what severity level should a patient be started on an inhaled steroid?

Answer 21

Mild Persistent. (Any persistent …)

Question 22

Rule of 2 categorizing asthma severity

Answer 22

More than 2 times per week or 2 nights per month moves you into “Persistent” asthma

Question 23

Can leukotriene inhibitors be used as a substitute for inhaled corticosteroids?

Answer 23

Yes in Step 2 but not recommended . They should be used in patients already receiving inhaled steroids. Also add to aspirin sensitive asthma.

Question 24

at what “step” in therapy can you begin the monoclonal ab medications

Answer 24

5 and 6

Question 25

May use Zyflo (zileuton) at step ….

Answer 25

4

Question 26

Should COPD patients receive inhaled steroids to prevent exacerbations

Answer 26

Not any more. Now just a short course in recovery from and acute exacerbation

Question 27

COPD types A and B
COPD types C and D

Answer 27

Have low, high symptom severity but both have low exacerbation risk
Have low/high symptom severity but both have high exacerbation risk

Question 28

COPD types A and B
COPD types C and D

Answer 28

Have low, high symptom severity but both have low exacerbation risk
Have low/high symptom severity but both have high exacerbation risk
C and D get inhaled corticosteroids (severe and very severe)

Question 29

what are the criteria for COPD patient to get home O2

Answer 29

Sats <88% or PO2 < 55 or <59 with evidence of cor pulmonale

Question 30

What is the goal for number of hours of use of home oxygen for COPD patients to get improved survival

Answer 30

15 hours/day

Question 31

What is the BODE Index?

Answer 31

Index used for criteria to meet before referral of a COPD patient for lung transplant. BMI, Obstruction,Dyspnea,Exercise

Question 32

What are the PERC rules

Answer 32

Age ≥50

HR ≥ 100

SaO2 on room air < 95%

Unilateral leg swelling

Hemoptysis

Recent surgery or trauma (≤4 weeks ago requiring treatment with general anesthesia)

Prior PE or DVT

Hormone use (oral contraceptives, hormone replacement, or estrogenic hormones use in males or females)

Question 33

most common cause of Pulmonary HTN

Answer 33

Left heart failure