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AG-ACNP – Respiratory: Questions With Solutions
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AG-ACNP – Respiratory: Questions With Solutions
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AG-ACNP – Respiratory: Questions With Solutions58 yo. M presents to ED with complaints of dry cough. CXR revealed
generalized, inflamed film throughout. What is the most likely diagnosis?
Right Ans - Pneumonitis
What drug has been known to prevent nosocomial PNA? Right Ans -
Sulcarafate (Carafate) - Mucosal Protective Agent
What is an initial finding associated with a pulmonary embolism? Right
Ans - Respiratory Alkalosis - secondary to increased RR and blowing off CO2
What is diagnostic of pulmonary HTN? Right Ans - 2D echo
Your patient is intubated on the following settings: SIMV/FiO2 .6/PEEP 5. You
notice shunting. What should your next action be? Right Ans - Increase
PEEP from 5 to 10 to recruit alveoli and increase surface area to improve
oxygenation
32 yo. M with PMH significant for mitral valve replacement now complains of
wheezing during physical activity 2-3 times/week. What should you do next?
Right Ans - Send patient for pulmonary function testing.
What is the pathology of asthma? Right Ans - Increased
responsiveness/hyperresponsiveness of the trachea and bronchi to a stimuli.
Acute inflammation
Narrowing of airways
Hypertrophy of smooth muscle
Mucosal plugging of airways
What are the hallmark signs and symptoms of asthma? Right Ans -
Respiratory distress at rest
Difficulty speaking in sentences
RR > 28
Pulsus paradoxus > 12 mmHg
What PFT value is suggestive of an obstructive disease? Right Ans -
Decreased FEV1
, Which acid-base imbalance is associated with asthma? Right Ans -
Respiratory Alkalosis with mild hypoxemia
What PFT values would indicate hospitalization of an asthmatic patient?
Right Ans - Decreased FEV1 <30% predicted OR
does not increase to at least 40% predicted after 1 hr.
Peak flow is <60 L/min initially OR does not increase to >50% predicted after
1 hr tx
What are the ominous findings associated with an asthma exacerbation?
Right Ans - Extreme fatigue
Lethargy
ABG - hypercapnea >pCO2 >45 mmHg = EMERGENCY
What is the outpatient daily management drug for asthma? Right Ans -
Inhaled Corticosteroids - Budesonide (Pulmicort)
What side effect is associated with inhaled corticosteroids? Right Ans -
Candidal infection of the oropharynx, dry mouth, and sore throat. Educate
patient to rinse mouth.
What drug is indicated for breakthrough symptoms, rescue therapy and
before exercise in the asthma patient? Right Ans - Short acting beta-2
adrenergic agonist - Albuterol (Proventil)
If symptoms persist in the asthma patient, what pharmacological
interventions are indicated? Right Ans - Increase inhaled corticosteroids or
add long acting beta-2 adrenergic agonist - Salmeterol (Serevent)
What is the indications for ipratroprium bromide (Atrovent)? Right Ans -
Secretion management. Inhaled anticholinergic
What drug is indicated in the chronic management of asthma? Right Ans -
Antileukotrienes - montelukast (Singulair)
Which drugs are associated with the BBW - Do not take during acute asthma
exacerbation? Right Ans - Long acting beta-2 agonists
Antileukotrienes
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