Pulmonary Exam #1 2012
Just a new way for me to study, hopefully it can help some others too. Facts not fully checked, learn at your own risk.
Questions and Answers
- 1.
COPD In COPD, when looking at a CAT score, what is the score that differentiating severe and not as severe?
- A.
5
- B.
10
- C.
15
- D.
20
Correct Answer
B. 10Explanation
A CAT score is used to assess the severity of symptoms in patients with COPD. A score of 10 is the threshold that differentiates between severe and not as severe COPD. This means that if a patient has a CAT score of 10 or higher, their COPD is considered severe, while a score below 10 indicates a less severe form of the disease.Rate this question:
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- 2.
COPD While the causes of emphysema and chronic bronchitis differ, their presentations are exactly the same.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
emphysema- breakdown of airway surface (think smokers cough)
chronic bronchitis - mucusy cough
Both of these condiitions fall under COPDRate this question:
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- 3.
COPD Which of the following is NOT a key pathogensis process in COPD
- A.
Airway hypersensitivity
- B.
Inflammation
- C.
Protease-Anti-protease imbalance
- D.
Oxidative stress
Correct Answer
A. Airway hypersensitivityExplanation
Airway hypersensitivity is not a key pathogenesis process in COPD. COPD is primarily caused by inflammation, protease-anti-protease imbalance, and oxidative stress. Inflammation refers to the chronic inflammation of the airways, leading to damage and narrowing of the airways. Protease-anti-protease imbalance refers to the imbalance between proteases (enzymes that break down proteins) and their inhibitors, leading to tissue destruction. Oxidative stress is the imbalance between the production of reactive oxygen species and the body's ability to detoxify them, causing damage to lung tissue. However, airway hypersensitivity, which is characterized by an exaggerated response of the airways to certain stimuli, is not considered a key process in COPD.Rate this question:
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- 4.
COPD In COPD, which protein is broken down in patient lungs?
- A.
Collagen
- B.
Mucin
- C.
Colloidin
- D.
Elastin
Correct Answer
D. ElastinExplanation
Protease, anti protease imbalance destroys elasticRate this question:
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- 5.
COPD vs. Asthama Which of the following is FALSE? (Warning trick questions)
- A.
Asthma is variable shortness of breath
- B.
COPD is associated with a sputum production
- C.
COPD is associated with CD8 T cells while Asthama is CD4 T cells
- D.
COPD and Asthma are always worsened by exercise
Correct Answer
D. COPD and Asthma are always worsened by exerciseExplanation
COPD is always worsened by excercise (more symptoms), asthama CAN be induce by excercise but not ALL people experience (cross ref w/ Dixit notes)Rate this question:
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- 6.
COPD Which of the following is NOT a diagnostic symptom of COPD?
- A.
History of smoking
- B.
Wheezing cough
- C.
Dyspnea
- D.
Chronic cough
- E.
Chronic sputum production
Correct Answer
B. Wheezing coughExplanation
Wheezing cough is not a diagnostic symptom of COPD. While wheezing can be a symptom of COPD, it is not specific to this condition and can occur in other respiratory conditions as well. Other symptoms such as history of smoking, dyspnea (shortness of breath), chronic cough, and chronic sputum production are more commonly associated with COPD and can aid in its diagnosis.Rate this question:
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- 7.
COPD A diagnosis of COPD must be confirmed by spirometry
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
COPD stands for Chronic Obstructive Pulmonary Disease, which is a progressive lung disease that causes difficulty in breathing. Spirometry is a diagnostic test used to measure lung function. It assesses the amount of air a person can inhale and exhale, as well as the speed at which they can do so. Since COPD is a specific condition with distinct symptoms, it is important to confirm the diagnosis through spirometry to differentiate it from other respiratory disorders. Therefore, the statement "A diagnosis of COPD must be confirmed by spirometry" is true.Rate this question:
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- 8.
COPD At what age should a practitioner consider COPD and performing spirometry?
- A.
After any severe exacerbation
- B.
40 years
- C.
50 years
- D.
65 years
Correct Answer
B. 40 yearsExplanation
A practitioner should consider COPD and performing spirometry at the age of 40 years. This is because COPD, a chronic lung disease, typically develops slowly over time and is more common in individuals who smoke or have a history of smoking. By the age of 40, individuals who smoke or have other risk factors may already be experiencing symptoms or have reduced lung function, making it important to consider COPD and conduct spirometry testing to assess lung function.Rate this question:
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- 9.
COPD What is the hallmark spriometry indicator of COPD?
- A.
FEV < 40%
- B.
FEV1/ FVC < 40%
- C.
FEV < 70%
- D.
FEV1/ FVC < 70%
Correct Answer
D. FEV1/ FVC < 70%Explanation
The hallmark spirometry indicator of COPD is FEV1/FVC < 70%. This means that the forced expiratory volume in one second (FEV1) is less than 70% of the forced vital capacity (FVC). This ratio indicates airflow limitation and is used to diagnose COPD.Rate this question:
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- 10.
COPD Second hand exposure to smoking is considered a risk factor for COPD
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Exposure to secondhand smoke is indeed considered a risk factor for COPD. Secondhand smoke contains harmful chemicals that can damage the lungs and lead to the development of COPD. Breathing in this smoke can cause inflammation and irritation in the airways, leading to chronic bronchitis and emphysema. Therefore, it is important to avoid secondhand smoke to reduce the risk of developing COPD.Rate this question:
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- 11.
COPD Left heart failure is a complication of COPD
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Right heart pumps blood to the lungs. COPD = more work for the right lung, leading to its failureRate this question:
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- 12.
COPD Assessment of COPD can be based on FEV alone
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
That was the old guidelines, the new ones look at:
Symptoms (based on symptom scores)
Airflow limitation (based on FEV1)
Frequency of exacerbationsRate this question:
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- 13.
COPD B2 agonists cause increases of cAMP which subsequent;y causes relaxation of bronchial smooth.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Pneumonic - I always forget how cAMP works. cAMP-ing makes me relaxed.Rate this question:
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- 14.
COPD Which is a Side effect of B2 agonist?
- A.
Hypokalemia
- B.
Hyponatremia
- C.
Hypercalcemia
- D.
Hyperlipidemia
Correct Answer
A. HypokalemiaExplanation
It "hides" the potassium in your cells (I think I heard this during her lecture)Rate this question:
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- 15.
COPD LABAs cause an increase in risk of death, when used alone in COPD.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
In ASTHMA they should not be used as monotherapy.
In COPD, they can be used as monotherapy.Rate this question:
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- 16.
COPD Formoterol is a full B2 agonist, Salmetrol is a partial B2 agonist
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Formoterol = Full
Salmeterol = SometimesRate this question:
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- 17.
COPD Which muscarinic receptor is most antagonized by Tiotropium?
- A.
M1
- B.
M2
- C.
M3
- D.
M4
Correct Answer
C. M3Explanation
Tiotropium is a muscarinic receptor antagonist commonly used in the treatment of chronic obstructive pulmonary disease (COPD). Among the muscarinic receptors (M1, M2, M3, and M4), the M3 receptor is the most antagonized by Tiotropium. By blocking M3 receptors, Tiotropium helps to relax the smooth muscles in the airways, leading to bronchodilation and improved airflow in patients with COPD.Rate this question:
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- 18.
COPD Ipratropium is short-acting anticholingeric while tiotropium is a long-acting anticholinergic
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Ipratropium and tiotropium are both anticholinergic medications used to treat COPD. However, they differ in their duration of action. Ipratropium is considered a short-acting anticholinergic, meaning it provides relief for a shorter period of time. On the other hand, tiotropium is a long-acting anticholinergic, providing sustained relief over a longer duration. Therefore, the statement that "Ipratropium is short-acting anticholinergic while tiotropium is a long-acting anticholinergic" is true.Rate this question:
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- 19.
COPD Which of the following is NOT a mechanism of bronchodialation dur to methylxanthines
- A.
Inhibition of phosphodiesterase
- B.
Increase of cAMP
- C.
Inhibit actions of leukocytes
- D.
Inhibition of release of inflammation mediators
Correct Answer
C. Inhibit actions of leukocytesExplanation
Inhibiting phosphodiesterases actually causes the increase of cAMP which both cause bronchodialation
(from Dixit) inhibition of deacytalation of DNA causes the (Smithburger) inhibition of release of inflammatory mediators
I made up the part about leukocytesRate this question:
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- 20.
COPD What is the goal trough level of Theophylline? (Not given below, why is this level importance to know?)
- A.
3-5 mcg/mL
- B.
8-15 mcg/mL
- C.
50-100 mcg/mL
- D.
100-200 mcg/mL
Correct Answer
B. 8-15 mcg/mLExplanation
Important because Theophylline has a narrow therapeutic range.Rate this question:
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- 21.
COPD Which phosphodiesterase is inhibited by roflumilast?
- A.
PDE-1
- B.
PDE-2
- C.
PDE-3
- D.
PDE-4
Correct Answer
D. PDE-4Explanation
Note - PDE inhibitors would be thought to act as a broncodialator (due to its impact on cyclic molecules; cAMP cGMP), but its action is more like an anti-inflammatoryRate this question:
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- 22.
COPD Corticoids steroid are less effectve in COPD than in asthma.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Corticosteroids are less effective in treating COPD compared to asthma. This is because the underlying mechanisms of these two conditions are different. In asthma, inflammation plays a major role, and corticosteroids are effective in reducing inflammation and controlling symptoms. However, in COPD, inflammation is not the primary cause of symptoms. Instead, it is mainly caused by damage to the airways and lungs due to smoking or long-term exposure to irritants. Corticosteroids may still be used in COPD to manage exacerbations or in combination with other medications, but their overall effectiveness is lower compared to asthma.Rate this question:
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- 23.
COPD Antibiotics are given during COPD exacerbation based on sputum volume, color, AND dyspnea. (not OR)
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
When sputum is green-colored, then ONLY concurrent presence increased volume OR dyspnea are requirements to give antibiotics.Rate this question:
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- 24.
Smoking How many cigarettes are in a pack? (I don't know if we need to memorize it, but it kept coming up in the notes)
- A.
10
- B.
15
- C.
20
- D.
30
Correct Answer
C. 20Explanation
A standard pack of cigarettes typically contains 20 cigarettes. This is a common knowledge question as it is widely known that cigarette packs usually contain 20 cigarettes.Rate this question:
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- 25.
Smoking NRT Patches dosing (starting dose) are based on which of the following?
- A.
Time to first cigarette (1hr=21mg)
- B.
Time to first cigarette (30min=21mg)
- C.
Cigarettes in a day (10=21mg)
- D.
Cigarettes in a day (20=21mg)
Correct Answer
C. Cigarettes in a day (10=21mg)Explanation
Cigarettes in a day (10=21mg)
21 mg; 4-6weeks
14 mg 4-6 weeks
7 mg 2 weeks
Note- can cause vivid dreamsRate this question:
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- 26.
Smoking NRT Gum dosing (starting dose) are based on which of the following?
- A.
Time to first cigarette (30min=6mg)
- B.
Cigarettes in a day (10=4mg)
- C.
Cigarettes in a day (10=6mg)
- D.
Cigarettes in a day (25=4mg)
Correct Answer
D. Cigarettes in a day (25=4mg)Explanation
1 piece every 1-2 hours x 6 weeks
then every 2-4 hours x 3 weeks
then every 4-8 hours x 3 weeks
max = 24 pieces/dayRate this question:
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- 27.
Smoking NRT Lozenge dosing (starting dose) are based on which of the following?
- A.
Time to first cigarette (>30 min=2mg,
- B.
Cigarettes in a day (10=4mg)
- C.
Cigarettes in a day (10=6mg)
- D.
Cigarettes in a day (25=4mg)
Correct Answer
A. Time to first cigarette (>30 min=2mg,Explanation
1 lozenge every 1-2 hours using at least 9/day for the first 6 weeks
then every 2-4 hours x 3 weeks
then every 4-8 hours x 3 weeks
max = 20 lozenges/dayRate this question:
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- 28.
Smoking When using the Nicotine nasal spray, the patient should NOT inhaled when it is sprayed into the nostril
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
When using the Nicotine nasal spray, the patient should not inhale when it is sprayed into the nostril because the purpose of the nasal spray is to deliver nicotine directly to the nasal membranes, not to the lungs. Inhaling the spray would bypass the intended route of administration and may lead to improper absorption of the nicotine. Therefore, it is important for the patient to follow the instructions and avoid inhaling the spray.Rate this question:
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- 29.
Smoking Which of the following is NOT a side effect of Bupropion?
- A.
Insomnia
- B.
Dry mouth
- C.
Vivid dreams
Correct Answer
C. Vivid dreamsExplanation
Bupropion is a medication commonly used to help people quit smoking. It works by reducing cravings and withdrawal symptoms. While insomnia and dry mouth are known side effects of Bupropion, vivid dreams are not typically associated with this medication. Therefore, vivid dreams are NOT a side effect of Bupropion.Rate this question:
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- 30.
Smoking Buproprion can be used with NRT.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Buproprion, also known as Wellbutrin or Zyban, is an antidepressant medication that has been found to be effective in helping people quit smoking. It works by reducing nicotine cravings and withdrawal symptoms. Nicotine Replacement Therapy (NRT) is another method commonly used to help individuals quit smoking, which involves using products like nicotine gum, patches, or lozenges to provide a controlled amount of nicotine. Combining buproprion with NRT has been shown to increase the chances of successfully quitting smoking, making the statement "Buproprion can be used with NRT" true.Rate this question:
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- 31.
Smoking Which of the following about Varenicline is FALSE?
- A.
There is a black box warning about "suicidal ideation"
- B.
Should NOT be used with NRTs
- C.
Contraindications: jobs reuqiring mental alertness (e.g. air traffic controllers)
- D.
Should be taken on an empty stomach
- E.
Patients can still smoke while on Varenicline (before their quit date)
Correct Answer
D. Should be taken on an empty stomachExplanation
Varenicline should not be taken on an empty stomach.Rate this question:
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- 32.
Smoking Which of the following does NOT delay weight gain? (Or at least isn't known to do so)
- A.
Varenicline (Chantix)
- B.
Nicotine gum
- C.
Nicotine lozenge
- D.
Bupropion SR (Wellbutrin SR)
Correct Answer
A. Varenicline (Chantix)Explanation
Varenicline (Chantix) is a medication used to help people quit smoking. It works by reducing the craving for nicotine and blocking the pleasurable effects of smoking. While smoking is known to delay weight gain, varenicline itself does not have this effect. Therefore, it is the correct answer to the question.Rate this question:
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- 33.
Asthma Corticosteroids have minimal drugs interactions (except for some mediated through CYP3A4) because they are minimally absorbd systemically.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Corticosteroids have minimal drug interactions because they are minimally absorbed systemically. This means that they do not interact with many other medications, except for some interactions that are mediated through the enzyme CYP3A4. Therefore, the statement "True" is correct.Rate this question:
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- 34.
Asthma When should Montelukast be taken?
- A.
Upon waking
- B.
With breakfast
- C.
With lunch
- D.
With dinner
- E.
In the evening
Correct Answer
E. In the eveningExplanation
I have this in my notes from Dr. Smith's lecture, but wasn't positive about "evening" vs. bedtime. I think "evening" was the correct choiceRate this question:
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- 35.
Asthma After how long a time period should you consider moving a "step" down in a patient's medications if their asthama has been well-controlled?
- A.
3-4 weeks
- B.
1-2 months
- C.
3 months
- D.
6 months
Correct Answer
C. 3 monthsExplanation
Dr. Smith's notes, under "Medication Adjustments" following the charts describing severity/persistence of asthmaRate this question:
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