Deck 23: Obstructive Lung Disease: Copd, Asthma, and Related Diseases

Question 1

Which of the following is NOT typically found in a patient with COPD?

A)airway inflammation
B)at least partially reversible airway obstruction
C)progressive airway obstruction
D)restrictive disease

Answer 1

D

Question 2

Which form of COPD is most common?

A)chronic bronchitis
B)emphysema

Answer 2

A

Question 3

A patient is experiencing an exacerbation of COPD. He is 65 years old, fairly 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?

A)intrapulmonary percussive ventilation
B)intubation and mechanical ventilation
C)nasal CPAP
D)noninvasive ventilation

Answer 3

D

Question 4

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

A)antibiotics
B) $\beta$ ₂-agonists
C)corticosteroids
D)methylxanthines

Question 5

Emphysema is defined as:

A)chronic productive cough
B)conducting airway enlargement
C)destruction of alveolar walls without fibrosis
D)hemoptysis associated with productive cough and alveolar-capillary membrane destruction

Question 6

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

A)airway enlargement
B)chronic productive cough
C)dyspnea on exertion
D)hemoptysis

Question 7

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

A)first
B)second
C)third
D)fourth

Question 8

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

A)bilateral wheezing
B)changes in mental status
C)dyspnea on exertion
D)excessive sputum production

Question 9

What percentage of all cases of COPD is caused by an $\alpha$ ₁-antitrypsin deficiency?

A)2% to 3%
B)10% to 15%
C)25% to 40%
D)50% to 75%

Question 10

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

A)antibiotics
B) $\beta$ ₂-agonists
C)corticosteroids
D)methylxanthines

Question 11

Approximately how many Americans are affected by COPD?

A)4 million
B)8 million
C)16 million
D)32 million

Question 12

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

A)air pollution
B) $\alpha$ ₁-antitrypsin deficiency
C)cigarette smoking
D)second hand smoke

Question 13

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

A)$12 billion
B)$24 billion
C)$32 billion
D)$46 billion

Question 14

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

A)large
B)medium
C)small

Question 15

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

A)accessory muscle usage
B)frequent coughing
C)shortness of breath
D)wheezing

Question 16

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

A)accelerates recovery as noted in FEV₁
B)causes pulmonary edema due to retention of water
C)causes severe immunosuppression and worsens outcomes
D)has been shown to have no affect

Question 17

What is the critical $\alpha$ ₁-antitrypsin level below which lung elastin is attacked and broken down?

A)60 mg/dl
B)80 mg/dl
C)100 mg/dl
D)150 mg/dl

Question 18

Approximately how many individuals died of COPD in the United States in 2000?

A)120,000
B)210,000
C)550,000
D)1,000,000

Question 19

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

A)improves exercise tolerance
B)improves FEV₁
C)improves lung function
D)improves survival

Question 20

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?

A)daily phlegm production
B)diminished vascularity on the chest radiograph
C)low diffusion capacity
D)normalization of the FEV₁ after use of a bronchodilator

Question 21

What causes the degranulation of mast cells in asthma patients?

A)antigens attaching to IgE molecules on the mast cell surface
B)antigens attaching to proteins receptors on mast cell surface
C)irritant receptors on the mast cells are stimulated by antigens
D)infectious particles attacking the mast cells

Question 22

Which of the following problems is associated with intravenous augmentation of synthetic $\alpha$ ₁-antitrypsin for the patient with genetic emphysema?

A)bronchospasm
B)expense
C)headache
D)nausea

Question 23

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe is the asthma attack? pH 7.35, PaO₂ 58 mm Hg, PaCO₂ 46 mm Hg, HCO₃^- 18 mEq/L, SaO₂ 89%

A)mild
B)moderate
C)severe

Question 24

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

A)corticosteroids
B)fast-acting $\beta$ ₂-agonists
C)long-acting $\beta$ ₂-agonists
D)nonsteroidal antiinflammatory drugs

Question 25

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

A)acetylcysteine
B)leukotriene inhibitors
C)methacholine
D)methylprednisolone

Question 26

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

A)adult respiratory distress syndrome
B)COPD
C)pneumoconiosis
D)pulmonary fibrosis

Question 27

Which of the following pulmonary function improvements have been associated with lung volume-reduction surgery (LVRS) in patients with emphysema?
I)improved exercise endurance
II)improved FEV₁
III)improved quality of life
IV)improved survival

A)I, III, and IV
B)II and IV
C)III only
D)I, II, III, and IV

Question 28

What may be the drug of choice for managing atopic asthma in children?

A)albuterol
B)cromolyn
C)salmeterol
D)theophylline

Question 29

What finding of the arterial blood gas suggests a more severe attack of asthma and impending respiratory failure?

A) $\mathrm { PCO } _ { 2 } \quad 32 \mathrm {~mm} \mathrm { Hg }$
B) $\mathrm { PaCO } _ { 2 } \quad 42 \mathrm {~mm} \mathrm { Hg }$
C) $\mathrm { pH } \quad 7.5$
D) $\mathrm { PO } _ { 2 } \quad 59 \mathrm {~mm} \mathrm { Hg }$

Question 30

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

A)bronchodilators
B)corticosteroids
C)mechanical ventilation
D)oxygen

Question 31

What classification of drug would the leukotriene inhibitors fall under?

A)antiinflammatory
B)corticosteroid
C)long-acting bronchodilator
D)short-acting bronchodilator

Question 32

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

A)bronchospasm
B)frequent cough
C)nausea
D)oral candidiasis

Question 33

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

A)arterial blood gases
B)degree of pulmonary shunt
C)DLCO
D)peak expiratory flow

Question 34

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

A)Patient should lie down and try to relax.
B)Patient should probably seek medical attention now.
C)Patient should retry the PEFR maneuver.
D)Patient should take his or her controller medications.

Question 35

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

A)arterial blood gases
B)bronchoprovocation testing with pulmonary function tests
C)chest radiograph
D)ventilation-perfusion ratio ( $\dot { V } / \dot { Q }$ ) scans

Question 36

Which of the following statements are true about the incidence of asthma?
I .The prevalence has increased significantly over the past 20 years in the United States.
II.The mortality has remained the same over the past 20 years in the United States.

A)I only
B)II only
C)I and II

Question 37

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

A)arterial blood gas
B)chest radiograph
C)spirometry
D) $\dot { V } / \dot { Q }$ scan

Question 38

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

A)50 ml
B)200 ml
C)350 ml
D)500 ml

Question 39

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

A)hyperactivity of the airways
B)hyperinflation of the lung parenchyma
C)inflammation of the airways
D)mucus plugging of the airways

Question 40

Which of the following symptoms is NOT a classic symptom of asthma?

A)cough
B)shortness of breath
C)chest tightness
D)chest pain

Question 41

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

A)long distance cycling
B)running cross country
C)skiing and snowboarding
D)swimming indoors

Question 42

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

A)albuterol
B)ipratropium bromide
C)salmeterol
D)terbutaline

Question 43

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

A)albuterol
B)cromalyn
C)ipratropium bromide
D)theophylline

Question 44

Identify the hallmark symptom of bronchiectasis.

A)evidence of cystic spaces and tram tracks on the chest radiograph
B)hemoptysis
C)large amounts of purulent sputum
D)variable dyspnea

Question 45

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

A) $\beta$ ₂-agonists
B)corticosteroids
C)methylxanthines
D)oxygen

Question 46

What $\beta$ ₂-agonist is associated with 12 to 24 hours of bronchodilation?

A)albuterol
B)metaproterenol
C)salmeterol
D)terbutaline

Question 47

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

A)add or increase the dose of anticholinergic
B)add or increase the dose of antiinflammatory
C)add or increase the dose of magnesium sulfite
D)increase dose of $\beta$ ₂-agonists

Question 48

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

A)antibiotic therapy
B)anticholinergic therapy
C)environmental control
D)immunotherapy

Question 49

Which medication is an anticholinergic bronchodilator?

A)ipratropium bromide
B)pirbuterol
C)salmeterol
D)terbutaline

Question 50

Which of the following statements are TRUE about the use of bronchodilators in the treatment of asthma?
i. $\beta$ ₂-Agonists are the drug of choice in exercise-induced asthma.
II. $\beta$ ₂-Agonists do not prevent the late-onset asthma response.

A)I
B)II
C)I and II

Question 51

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

A)cigarette smoking
B)heart failure
C)hepatic disease
D)viral infections

Question 52

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

A) $\alpha$ ₁-antitrypsin deficiency
B)IgE abnormality
C)nitric oxide deficiency
D)toluene diisocyanate

Question 53

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

A)antibiotics
B)bronchodilators
C)incentive spirometry
D)oxygen

Question 54

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

A)regular antibiotic therapy
B)regular anticholinergic therapy
C)environmental control
D)regular immunotherapy

Question 55

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

A)anticholinergic
B)antiinflammatory
C) $\beta$ ₂-agonists
D)corticosteroid

Question 56

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

A)aspiration of gastric acid at night
B)supine position
C)variation in acetylcholine secretion at night
D)variation in the secretion of insulin at night

Question 57

Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?
I)allow peak inspiratory pressures to go as high as required
II)permissive hypercapnia
III)prolonged inspiratory time
IV)small tidal volumes

A)I, II, and III
B)II and IV
C)III only
D)I, II, III, and IV