Week 7 Flashcards
What is the classic presentation for COPD? (3 parts)
dyspena, cough, excess sputum
Name 3 late stage symptoms of COPD
Tripoding, pursed lip breathing, Increased resonance, crackles, diminished lung sounds, Cor pulmonale, Increased expiratory phase (early onset is asymptomatic)
What value on spirometry is diagnostic of COPD? FEV1 _____+ FVC/FEV Ratio _____
FEV < 80% and FVC/FEV < 0.7 post SABA (in order to demonstrate IRREVERSIBLE inflammation)
A patient with COPD has a CAT score of <10 and was hospitalized for a COPD exacerbation last month. What group is this patient in? (A,B,C,D)
Group C
What medication regimen should a group D COPD patient be on?
Multiple options : LAMA or LAMA + LABA or ICS + LABA
What are the components of the asthmatic triad?
asthma, allergies, atopy
What is the hallmark diagnostic spirometry finding for a patient with asthma?
Improved peak flow metrics post SABA + FEV < 80%
You diagnose a patient with asthma and decide they are appropriate to begin treatment at step 2. You prescribe a low dose ICS and PRN SABA. When should the patient be seen back in the office?
2-4 weeks for NEW onset asthma
How often should a known asthmatic with moderate asthma check their spirometry? What time of day should this be done?
daily in the early afternoon
A known asthmatic patient presents to the clinic complaining of shortness of breath most days with occasional nocturnal dyspnea. Their FEV1 is 85% in the office today. What step is this patient on? What do you prescribe?
Step 3; low dose ICS + LABA or med dose ICS + prn SABA (would be step 4 if their FEV was 60-80%)
A patient is seen in clinic for an asthma exacerbation. The provider administers three
nebulizer treatments with little improvement, noting a pulse oximetry reading of 90% with 2 L
of oxygen. A peak flow assessment is 70%. What is the next step in treating this patient?
a. Administer three more nebulizer treatments and reassess.
b. Admit to the hospital with specialist consultation.
c. Give epinephrine injections and monitor response.
d. Prescribe an oral corticosteroid medication.
B
Patients having an asthma exacerbation should be referred if they fail to improve after three
nebulizer treatments or three epinephrine injections, have a peak flow less than 70% and a
pulse oximetry reading less than 90% on room air. Giving more nebulizer treatments or
administering epinephrine is not indicated. The patient will most likely be given IV
corticosteroids; oral corticosteroids would be given if the patient is managed as an outpatient.
An adult develops chronic cough with episodes of wheezing and shortness of breath. The
provider performs chest radiography and other tests and rules out infection, upper respiratory,
and gastroesophageal causes. Which test will the provider order initially to evaluate the
possibility of asthma as the cause of these symptoms?
a. Allergy testing
b. Methacholine challenge test
c. Peak expiratory flow rate (PEFR)
d. Spirometry
D
Spirometry is recommended at the time of initial assessment to confirm the diagnosis of
asthma. Allergy testing is performed only if allergies are a possible trigger. The methacholine
challenge test is performed if spirometry is inconclusive. PEFR is generally used to monitor
asthma symptoms.
A patient diagnosed with asthma calls the provider to report having a peak flow measure of
75%, shortness of breath, wheezing, and cough, and tells the provider that the symptoms have
not improved significantly after a dose of albuterol. The patient uses an inhaled corticosteroid
medication twice daily. What will the provider recommend?
a. Administering two more doses of albuterol
b. Coming to the clinic for evaluation
c. Going to the emergency department (ED)
d. Taking an oral corticosteroid
A
The patient is experiencing an asthma exacerbation and should follow the asthma action plan
(AAP) which recommends three doses of albuterol before reassessing. The peak flow is above
70%, so ED admission is not indicated. The patient may be instructed to come to the clinic for
oxygen saturation and spirometry evaluation after administering the albuterol. An oral
corticosteroid may be prescribed if the patient will be treated as an outpatient after following
the AAP.
A patient recovering from a viral infection has a persistent cough 6 weeks after the infection.
What will the provider do?
a. Perform chest radiography to assess for secondary infection
b. Perform pulmonary function and asthma challenge testing
c. Prescribe a second round of azithromycin to treat the persistent infection
d. Reassure the patient that this is common after such an infection
ANS: D
Postinfection cough is common after a viral infection and may persist up to 8 weeks after the
infection; this type of cough generally needs no intervention. It is not necessary to perform
chest radiography unless secondary infection is suspected. Antibiotics are not indicated.
Unless the cough persists after 8 weeks, asthma testing is not indicated.
A nonsmoking adult with a history of cardiovascular disease reports having a chronic cough
without fever or upper airway symptoms. A chest radiograph is normal. What will the
provider consider initially as the cause of this patient’s cough?
a. ACE inhibitor medication use
b. Chronic obstructive pulmonary disease
c. Gastroesophageal reflux disease
d. Psychogenic cough
ANS: A
About 10% of patients taking ACE inhibitors will develop chronic cough. COPD, GERD, and
psychogenic causes are possible, but given this patient’s cardiovascular history, the possibility
of ACE inhibitor-induced cough should be investigated initially.
A young adult patient develops a cough persisting longer than 2 months. The provider
prescribes pulmonary function tests and a chest radiograph, which are normal. The patient
denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does
not take any medications. What will the provider evaluate next to help determine the cause of
this cough?
a. 24-hour esophageal pH monitoring
b. Methacholine challenge test
c. Sputum culture
d. Tuberculosis testing
ANS: B
Chronic cough without other symptoms may indicate asthma. If PFTs are normal, a
methacholine challenge test may be performed. 24-hour esophageal pH monitoring is
sometimes performed to evaluate for GERD, but this patient does not have abdominal
symptoms and this test is usually not performed because it is inconvenient. Sputum culture is
not indicated. TB is less likely.
