CMN 568 FINAL EXAM QUESTIONS
WITH ALL CORRECT ANSWERS
Asthma - Diagnostic testing - Answer-Under age 5 - diagnosed based on clinical
judgement and assessment of symptoms (unable to cooperate with PFT's)
Pulmonary functions tests/spirometry
CXR not usually needed unless r/o pneumonia during exacerbation
Allergy testing may be used to ID triggers
Pulmonary Function Tests - Answer-FEV1 - Forced expiratory volume in 1 second
FVC - Forced vital capacity
FEV1/FVC ratio - compared to reference norms for age, weight, and gender
Disease reversibility is demonstrated by an increase in FEV1 after administration of
bronchodilator
3 Steps in asthma Management - Answer-1. Evaluate asthma severity
2. Initiate treatment with stepwise approach
3. Assess control and adjust treatment as needed
Classification of asthma severity - Answer-Designation is based on most severe
symptoms
Nighttime awakening is less tolerated for assessment in young children
Stepwise Approach - Answer-If patient is on step 5-6, should be seen by a pulmonogist
Asthma lifestyle modifications - Answer-No Smoking!
Pets, keep out of bedroom at the minimum
Humidity - keep indoor humidity at <50%
Keep windows closed, use air conditioner to filter air
Eliminate carpeting in bedroom if possible
Limit stuff toys, wash weekly in hot water
Encase pillows and mattress in dust-mite proof covering, wash bedding weekly in hot
water
Control indoor pests such as cockroaches
Avoid outdoor activities when pollen is high
Avoid beta blockers and sulfite containing foods (hot dogs, bologna)
Get annual flu vaccine
Theophylline - Answer-Used rarely: requires blood draws for levels and has many side
effects and drug interactions
,Peds inhaled corticosteroids - Answer-Use lowest dose possible, potentially causes
growth impairment
Asthma - Tx of acute exacerbation - Answer-SABA- repeat Q20min x 3
May need to continue SABA q3-4hrs for 24-48 hours
Continue/adjust regular control medications
Short course of oral corticosteroids
Assess adherence to medication regimen
Assess immunization status
Asthma - when to refer to hospital - Answer-Poor response to SABA after to tx 20 min
apart
Hypoxia - O2 sat <95% on RA
Marked breathlessness - inability to speak in sentences
Use of accessory muscles
Changes in alertness
PEF of <50% of personal best
Asthma - Oral corticosteroid dosing - Answer-Children - 1-2mg/kg/day
Adults - 40-60mg/day
May be given daily or BID in divided doses.
Duration 3-10 days or until symptoms resolve
Poor compliance with meds = daily
Significant side effects = BID
Don't take dose right before bed
No need to taper if less than 7 days
SABA - Answer-Short acting Beta Agonist
Albuterol
Pirbuterol
Levalbuterol
Adverse effects - well tolerated, tachycardia, angina, and tremor.
SAMA - Answer-Short acting muscarinic antagonist
Ipratropium (atrovent)
Adverse effects - dry mouth, irritation of the pharynx. May raise intraocular pressure in
glaucoma.
ICS - Answer-Inhaled corticosteroid
Beclomethasone
Budesonide
Flunisolide
Fluticasone
Mometasone
Triamcinolone acetonide
,Adverse effects - devoid of serious toxicity, most serious concern adrenal insufficiency,
common - oral candidiasis and dysphonia. Long term use can cause bone loss.
Prolonged use increase risk for cataracts and glaucoma.
LABA - Answer-Long acting beta agonist
Formoterol
Salmeterol
Adverse effects: may increase risk for severe asthma and asthma related deaths when
used as monotherapy.
LAMA - Answer-Long acting muscarinic antagonist
Tiotropium (Spiriva)
Adverse effects - dry mouth, (minimal - consitpation, urinary retention, tachycardia,
blurred vision)
LTRA - Answer-Leukotriene receptor antagonist
Montelukast - (link with neuropsychiatric effects esp. mood changes and suicidality)
Zafirlukast (AE - headache, GI disturbances, neuropsychiatric effects, churg-strauss
syndrome)
Zileuton - blocks leukotriene synthesis (Can injure the liver, neuropsychiatric effects
(depression, axiety, agitation, abnormal dreams, hallucinations, insomnia, irritability,
restlessness, and suicidality) metabolized by P450, may increase levels of theophylline,
warfarin, propranolol)
Methylxanthines - Answer-Theophylline
Produces bronchodilation by relaxing smooth muscle of the bronchi
Adverse effects - N&V, diarrhea, insomnia, restlessness, serious adverse effects
dysrhythmias and convulsions.
Drug interactions - Caffeine, tobacco and marajuana can induce metabolism. Several
agents (phenobarbitol, phenytoin, rifampin) can lower levels. Several agents
(cimetidine, fluoroquinolone abx) can increase levels.
Persons at higher risk for exposure to or infection with TB - Answer-Close contacts with
persons known or suspected to have active TB
Foreign born persons from areas where TB is common
Persons who visit TB prevalent counties
Resident and employees of high-risk congregate settings
Health care workers who serve high risk clients
Populations defined locally as having increased incidence of latant M. tuberculosis
infection or TB disease
Children exposed to adults at increased risk for infections or disease
Interpreting TST reaction - Answer-> 5mm= positive in hiv infected persons, recent
contacts with infectious TB, persons with fibrotic changes on cxr consistent with prior
TB, transpoant patients or other immunosuppresed patients.
, > 10mm = positice in recent arrivals from high risk countires, IV drug users, residents
and employees of high risk congregate settings, mycobacteriology lab personnel,
persons with conditions that increase risk for progressing to TB, children <5
> 15mm = positive in persons with no known risk factors for TB
Two step TST - Answer-Used for initial skin testing of adults to be retested periodically,
to reduce likelihood that boosted reaction will be misinterpreted as recent infection.
If first test + consider infected, if - give second test 1-3 weeks later.
If 2nd test + consider infected, if negative consider uninfected
TST - pregnant women - Answer-TST is safe and reliable for mother and fetus
throughout pregnancy
Latent TB infection (LTBI) - Answer-Special immune cells called macrophages ingest
and surround the tubercle bacilli. The cells form a barrier shell, called a granuloma, that
keeps the bacilli contained and under control (LTBI).
Granulomas may persist (LTBI), or may break down to produce TB disease
2 to 8 weeks after infection, LTBI can be detected via TST or interferon-gamma release
assay (IGRA)
The immune system is usually able to stop the multiplication of bacilli
Persons with LTBI are not infectious and do not spread organisms to others
TB Disease - Answer-In some, the granulomas break down, bacilli escape and multiply,
resulting in TB disease
Can occur soon after infection, or years later
Persons with TB disease are usually infectious and can spread bacteria to others
Positive M. tb culture confirms TB diagnosis
Sites of TB disease - Answer-Lungs (pulmonary): most common site; usually infectious
Miliary: occurs when bacilli spread to all parts of the body; rare, but fatal if untreated
Central nervous system: usually occurs as meningitis, but can occur in brain or spine
Outside the lungs (extrapulmonary): usually not infectious, unless person has
Concomitant pulmonary disease, Extrapulmonary disease in the oral cavity or larynx, or
Extrapulmonary disease with open site, especially with aerosolized fluid.
LTBI (infected) - Answer-Has a small amount of TB bacteria in his/her body that are
alive, but inactive
Cannot spread TB bacteria to others
Does not feel sick, but may become sick if the bacteria become active in his/her body
Usually has a TB skin test or TB blood test reaction indicating TB infection
Radiograph is typically normal
Sputum smears and cultures are negative
Should consider treatment for LTBI to prevent TB disease
Does not require respiratory isolation
Not a TB case
