Pulmonology Lect 3- Asthma

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Asthma Quizzes & Trivia

Asthma, bronchiectasis: both treatment, signs, symptoms, diagnostics


Questions and Answers
  • 1. 

    T/F The normal peak flow is what the patient's peak flow is when he is at his best

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    The statement is true because the normal peak flow refers to the highest flow rate of air that a person can achieve when their airways are completely open and functioning optimally. This is considered the "best" peak flow for the patient because it indicates that their lungs are functioning at their highest capacity.

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  • 2. 

    The peak flow system is broken down into zones; the green zone implies _______ control: the PEF > ____. The patient has no asthma symptoms and medications should be taken as usual.

    • A.

      Caution, 50 to 80%

    • B.

      Bad, 80%

    • C.

      Good, 80%

    • D.

      Medical alert, 50%

    Correct Answer
    C. Good, 80%
    Explanation
    The green zone in the peak flow system implies good control, with a peak expiratory flow (PEF) of 80%. This means that the patient has no asthma symptoms and should continue taking their medications as usual.

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  • 3. 

    The peak flow system is broken down into zones; the red  zone implies _______ control: the PEF  ____. The patient should use a short-acting inhaled beta-agonist, and call the provider or go to the emergency room.

    • A.

      Caution, 50-80%

    • B.

      A medical alert, < 50%

    • C.

      Good control, >80%

    Correct Answer
    B. A medical alert, < 50%
    Explanation
    The red zone in the peak flow system indicates a medical alert, which means that the patient's peak expiratory flow (PEF) is less than 50%. In this zone, the patient should use a short-acting inhaled beta-agonist and seek immediate medical attention by calling the provider or going to the emergency room. This suggests that the patient's asthma is poorly controlled and requires immediate intervention to prevent worsening symptoms or complications.

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  • 4. 

    The peak flow system is broken down into zones; the yellow zone implies _______ control: the PEF  ____. The patient should use a short-acting inhaled beta-agonist

    • A.

      Medical alert,

    • B.

      Caution, 50-80%

    • C.

      Good control, >80%

    • D.

      Caution, 60-80%

    • E.

      Caution, 30-70%

    Correct Answer
    B. Caution, 50-80%
    Explanation
    The correct answer is "caution, 50-80%". In the peak flow system, the yellow zone represents cautionary control, indicating that the patient's peak expiratory flow (PEF) is between 50-80% of their personal best. When the PEF falls within this range, it suggests that the patient's asthma is not well controlled and they may be at risk for worsening symptoms. In this situation, the patient should use a short-acting inhaled beta-agonist to relieve their symptoms and consult with their healthcare provider for further management.

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  • 5. 

    T/F A routine chest x ray on an asthmatic does not show hyperinflation and peri-bronchial "cuffing"(bilateral, peri-hilar opacificaiton)

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    remember- hyperinflation and peri-bronchial cuffing are signs of asthma on chest x ray

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  • 6. 

    Which of the following are indications for ordering an arterial blood gas (ABG)?

    • A.

      Mental status changes, signs of severe asthma, lack of improvement after 15 minutes of aggressive therapy

    • B.

      Coughing, signs of severe asthma, lack of improvement after 20 minutes of aggressive therapy

    • C.

      Mental status changes, signs of severe asthma, lack of improvement after 30 to 60 minutes of aggressive therapy

    Correct Answer
    C. Mental status changes, signs of severe asthma, lack of improvement after 30 to 60 minutes of aggressive therapy
    Explanation
    An arterial blood gas (ABG) is ordered to assess the oxygen and carbon dioxide levels in the blood, as well as the acid-base balance. In this case, mental status changes can indicate inadequate oxygenation to the brain, which may require an ABG to determine the severity. Signs of severe asthma suggest respiratory distress, which can be evaluated through an ABG. Lack of improvement after 30 to 60 minutes of aggressive therapy indicates a need to reassess the patient's condition, including their blood gas levels. Therefore, all three indications mentioned in the answer are valid reasons for ordering an ABG.

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  • 7. 

    What are the complications of asthma?

    • A.

      Exercise induced asthma, dehydration, airway infection, cor pulmonale, tussive syncope, headaches

    • B.

      Exhaustion, dehydration, airway infection, cor pulmonale, tussive syncope

    • C.

      Chronic cough, dehydration, airway infection, cor pulmonale, hemoptosis, CVA

    Correct Answer
    B. Exhaustion, dehydration, airway infection, cor pulmonale, tussive syncope
    Explanation
    The complications of asthma include exhaustion, dehydration, airway infection, cor pulmonale, and tussive syncope. Asthma can lead to exhaustion due to the constant effort required to breathe, and dehydration can occur as a result of increased respiratory rate and fluid loss through sweating. Airway infection is a common complication of asthma, as the inflamed and narrowed airways are more susceptible to infections. Cor pulmonale, a condition where the right side of the heart becomes enlarged and strained, can occur in severe cases of asthma. Tussive syncope, a condition where coughing leads to loss of consciousness, can also be a complication of asthma.

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  • 8. 

    The term ____________ is used to describe a prolonged, severe asthma attack that does not respond to treatment, and involves bronchospasm so sever that the patient is at risk for respiratory failure.

    • A.

      Cor pulmonale

    • B.

      Status asthmaticus

    • C.

      Dyspnea

    • D.

      Apnea

    • E.

      Status bronchospasmus

    Correct Answer
    B. Status asthmaticus
    Explanation
    Status asthmaticus is the correct answer because it accurately describes a prolonged, severe asthma attack that does not respond to treatment and involves severe bronchospasm. This condition is so severe that it puts the patient at risk for respiratory failure.

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  • 9. 

    What are the age groups for treatment recommendations accoring to EPR-3?

    • A.

      0-4, 5-11, 12 and older

    • B.

      0-2, 2-11, 12 and older

    • C.

      0-10, 10-15, 16 and older

    Correct Answer
    A. 0-4, 5-11, 12 and older
    Explanation
    The correct answer is 0-4, 5-11, 12 and older. This age group classification is based on the treatment recommendations provided by the EPR-3. It suggests that treatment recommendations for respiratory conditions should be tailored differently for children between the ages of 0-4, 5-11, and 12 and older. This age-based approach takes into consideration the developmental and physiological differences among these age groups, ensuring appropriate and effective treatment strategies for respiratory diseases.

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  • 10. 

    What are the three classifications of severity of asthma?

    • A.

      Mild persistent, moderate persistent, severe persistent

    • B.

      Intermittent, mild persistent, moderate persistent, severe persistent

    • C.

      Exertion persistent, mild persistent, moderate persistent, severe persistent

    Correct Answer
    B. Intermittent, mild persistent, moderate persistent, severe persistent
    Explanation
    The three classifications of severity of asthma are intermittent, mild persistent, moderate persistent, and severe persistent. These classifications are based on the frequency and severity of asthma symptoms, as well as the level of lung function impairment. Intermittent asthma is characterized by symptoms occurring less than twice a week, while mild persistent asthma involves symptoms more than twice a week but not daily. Moderate persistent asthma includes symptoms occurring daily, and severe persistent asthma is characterized by continuous symptoms that limit physical activity.

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  • 11. 

    "The likelihood of either asthma exacerbations, progressive decline in lung function, or risk of adverse effects from medicine" is defined by what term

    • A.

      Impairment

    • B.

      Risk

    • C.

      Functional limitations

    • D.

      Intensity of symptoms

    Correct Answer
    B. Risk
    Explanation
    The term "risk" is defined as the likelihood of either asthma exacerbations, progressive decline in lung function, or risk of adverse effects from medicine. It refers to the probability or chance of experiencing negative outcomes or complications related to asthma, such as worsening symptoms, decreased lung function, or side effects from medication.

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  • 12. 

    ___________ is defined as "the frequency and intensity of symptoms and functional limitations the patient is experiencing, or has recently experienced.

    • A.

      Risk

    • B.

      Intensity

    • C.

      Hypoxia

    • D.

      Agitation

    • E.

      Impairment

    Correct Answer
    B. Intensity
    Explanation
    Intensity is defined as "the frequency and intensity of symptoms and functional limitations the patient is experiencing, or has recently experienced." This means that intensity refers to the severity or strength of the symptoms and functional limitations that a patient is going through. It is a measure of how severe the patient's condition is and how much it is affecting their daily life and functioning. It is an important factor to consider in assessing and managing a patient's health and treatment plan.

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  • 13. 

    What is the treatment for persistent asthma?

    • A.

      Short- acting bronchoconstrictors

    • B.

      Daily anti-inflammatory therapy with inhaled corticosteroids

    • C.

      Short-acting bonchodilators

    • D.

      Long-acting bronchodilators only

    Correct Answer
    B. Daily anti-inflammatory therapy with inhaled corticosteroids
    Explanation
    The treatment for persistent asthma involves daily anti-inflammatory therapy with inhaled corticosteroids. This is because persistent asthma is characterized by ongoing inflammation in the airways, and inhaled corticosteroids help reduce this inflammation and prevent asthma symptoms. Short-acting bronchoconstrictors and short-acting bronchodilators provide relief during acute asthma attacks but do not address the underlying inflammation. Long-acting bronchodilators may be used in combination with inhaled corticosteroids for more severe cases, but daily anti-inflammatory therapy with inhaled corticosteroids is the mainstay of treatment for persistent asthma.

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  • 14. 

    Asthma medications can be broken down into 2 types: _____________ medications which are taken daily to achieve and maintain control of persistent asthma and _______ medications which are taken to promote prompt reversal of acute airflow obstruction and relief of accompaning sumptoms by direct relaxation of bronchial smooth muscle

    • A.

      Quick relief, long-term control

    • B.

      Long-term control, quick-relief (rescue)

    Correct Answer
    B. Long-term control, quick-relief (rescue)
    Explanation
    Asthma medications can be categorized into two types: long-term control medications and quick-relief (rescue) medications. Long-term control medications are taken daily to achieve and maintain control of persistent asthma. They help in preventing asthma symptoms and reducing inflammation in the airways. On the other hand, quick-relief (rescue) medications are taken to provide immediate relief by relaxing the bronchial smooth muscles and reversing acute airflow obstruction. These medications are used during asthma attacks or when symptoms suddenly worsen.

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  • 15. 

    T/F Maintenance, control, and preventive medications act to attenuate airway inflammation

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Maintenance, control, and preventive medications are designed to reduce and control airway inflammation in individuals with respiratory conditions such as asthma. These medications work by reducing the inflammation in the airways, which helps to alleviate symptoms and prevent asthma attacks. By attenuating airway inflammation, these medications can help to improve breathing and overall respiratory function. Therefore, the statement that maintenance, control, and preventive medications act to attenuate airway inflammation is true.

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  • 16. 

    What therapy is reserved for acutely ill patients and those that have trouble coordinating other therapies?

    • A.

      Metered-dose inhalers

    • B.

      Helium-oxygen

    • C.

      Small volume nebulizers

    Correct Answer
    C. Small volume nebulizers
    Explanation
    Small volume nebulizers are reserved for acutely ill patients and those who have trouble coordinating other therapies. Nebulizers deliver medication in the form of a mist that is inhaled directly into the lungs, making it easier for patients who may have difficulty using other devices such as metered-dose inhalers. This therapy is particularly beneficial for patients with severe respiratory conditions or those who are unable to effectively use other inhalation devices.

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  • 17. 

    Corticosteroids, long acting bronchodilators and leukotriene antagonists are what type of pharmacologic agents for asthma

    • A.

      Long-term control medications

    • B.

      Short acting medications

    • C.

      Quick-relief medications

    Correct Answer
    A. Long-term control medications
    Explanation
    Corticosteroids, long-acting bronchodilators, and leukotriene antagonists are classified as long-term control medications for asthma. These medications are used to manage and control asthma symptoms over an extended period of time. They work by reducing inflammation, opening up the airways, and preventing the release of substances that cause inflammation and constriction of the airways. Long-term control medications are typically taken on a regular basis to maintain asthma control and prevent asthma attacks.

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  • 18. 

    ________ is/are the most potent and consistently effetive anti-inflammatory agents currently available.

    • A.

      B blockers

    • B.

      Corticosteriods

    • C.

      Bronchodilators

    • D.

      Leukotreine antagonists

    Correct Answer
    B. Corticosteriods
    Explanation
    Corticosteroids are the most potent and consistently effective anti-inflammatory agents currently available. They work by suppressing the immune system and reducing inflammation in the body. This makes them highly effective in treating a wide range of inflammatory conditions such as asthma, allergies, arthritis, and skin disorders. Corticosteroids are available in various forms including oral tablets, inhalers, creams, and injections, allowing for targeted treatment depending on the specific condition. Their effectiveness and versatility make them the preferred choice for managing inflammation in medical practice.

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  • 19. 

    Why do you need to advise your patient to rinse their mouth out after using inhaled corticosteroids?

    • A.

      Systemic side effects of cough, dysphonia, oropharyngeal candidiasis and systemic absorption

    • B.

      Local side effects of cough, dysphonia, oropharyngeal candidiasis and systemic absorption

    • C.

      Local side effects of cough, dysphagia, oropharyngeal candidiasis and systemic absorption

    Correct Answer
    B. Local side effects of cough, dysphonia, oropharyngeal candidiasis and systemic absorption
    Explanation
    After using inhaled corticosteroids, it is important to advise the patient to rinse their mouth out to prevent local side effects such as cough, dysphonia (hoarse voice), and oropharyngeal candidiasis (thrush). Inhaled corticosteroids can cause irritation and fungal infections in the mouth and throat. Additionally, rinsing the mouth helps to reduce systemic absorption of the medication, minimizing the risk of systemic side effects.

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  • 20. 

    What medication do you use for preventing exercise induced bronchospasm and to treat nocturnal symptoms?

    • A.

      Anti-intflammatory medications will treat the patient promptly in both cases

    • B.

      Beta- adrenergic agents- long acting bronchodilators- these should not replace anti-inflammatory therapy

    • C.

      Beta- adrenergic agents- long acting bronchodilators- these are safe to replace anti-inflammatory therapy

    Correct Answer
    B. Beta- adrenergic agents- long acting bronchodilators- these should not replace anti-inflammatory therapy
    Explanation
    Long-acting beta-adrenergic agents are used to prevent exercise-induced bronchospasm and treat nocturnal symptoms. However, they should not be used as a replacement for anti-inflammatory therapy. Anti-inflammatory medications are necessary to treat the underlying inflammation in the airways, while long-acting bronchodilators help to relax and open the airways. Using bronchodilators alone without anti-inflammatory therapy may provide temporary relief of symptoms but does not address the underlying inflammation. Therefore, it is important to use both types of medication for effective management of exercise-induced bronchospasm and nocturnal symptoms.

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  • 21. 

    T/F Theohylline is a beta adrenergic agent

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    The statement that Theophylline is a beta adrenergic agent is false. Theophylline is a bronchodilator medication that belongs to a class of drugs called methylxanthines. It works by relaxing the muscles in the airways and improving breathing. Beta adrenergic agents, on the other hand, are a different class of drugs that stimulate beta adrenergic receptors and are commonly used in the treatment of asthma and other respiratory conditions. Therefore, Theophylline does not fall under the category of beta adrenergic agents.

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  • 22. 

    T/F Theophylline needs to be monitored closely due to the drugs narrow toxic-to- therapeutic range (5-15micrograms/mL), individuals metabolize it differently, and the effects of many factors on the drug absorption and metabolism.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Theophylline needs to be monitored closely due to its narrow toxic-to-therapeutic range, which means that the difference between a safe and toxic dose is small. Additionally, individuals metabolize the drug differently, so monitoring is necessary to ensure that the drug is being processed effectively. Furthermore, the absorption and metabolism of the drug can be influenced by various factors, making close monitoring necessary to maintain therapeutic levels and avoid toxicity. Therefore, the statement is true.

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  • 23. 

    Why does a nebulizer work better for asthmatics than the metered dose inhaler

    • A.

      Metered Dose Inhalers are difficult to use correctly therefore the patient doesn't get an adequate dose

    • B.

      The dose delivered by nebulizer is 35-30 times greater than that of an inhaler

    • C.

      Nebulizers prevent asthma symptoms from recurring

    • D.

      The dose delivered by a nebulizer is 10-25 times greater than that of an inhaler

    Correct Answer
    B. The dose delivered by nebulizer is 35-30 times greater than that of an inhaler
    Explanation
    Nebulizers work better for asthmatics than metered dose inhalers because the dose delivered by a nebulizer is significantly higher than that of an inhaler. This means that asthmatics using a nebulizer receive a much larger amount of medication, which can provide more effective relief from asthma symptoms.

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  • 24. 

    Why would an asthmatic be irritable?

    • A.

      Thay may be hypoxic

    • B.

      They may be hypoxic or hypocapnic

    • C.

      They may be hypoxic or hypercapnic

    Correct Answer
    C. They may be hypoxic or hypercapnic
    Explanation
    Asthmatics may experience irritability due to hypoxia or hypercapnia. Hypoxia refers to a lack of oxygen in the body, which can occur during an asthma attack when the airways are constricted, making it difficult to breathe. Hypercapnia, on the other hand, is an excessive level of carbon dioxide in the bloodstream, which can also result from inadequate breathing during an asthma episode. Both conditions can lead to physiological changes in the body, such as increased heart rate and blood pressure, which can contribute to irritability.

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  • 25. 

    What is the most effective bronchodilator during asthma exacerbations?

    • A.

      Leukotrienes

    • B.

      Short-acting inhaled beta-adrenergic agonists- albuterol

    • C.

      Corticosteroids

    • D.

      Anticholinergic agents- ipratoropium MDI

    Correct Answer
    B. Short-acting inhaled beta-adrenergic agonists- albuterol
    Explanation
    Short-acting inhaled beta-adrenergic agonists, such as albuterol, are the most effective bronchodilators during asthma exacerbations. These medications work by relaxing and opening up the airways, allowing for easier breathing. They provide quick relief of symptoms and are commonly used as rescue medications during asthma attacks. Leukotrienes, corticosteroids, and anticholinergic agents may also be used in the treatment of asthma, but they are not as effective in providing immediate bronchodilation during exacerbations.

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  • 26. 

    What drug has a potential to cause long-term suppression of the hypothalamic-pituitary- adrenal axis after administration for 2 weeks or more?

    • A.

      Anticholinergic agents

    • B.

      Systemic corticosteroids

    • C.

      Beta-adrenergic agents

    • D.

      Phosphodiesterase inhibitors

    Correct Answer
    B. Systemic corticosteroids
    Explanation
    Systemic corticosteroids have the potential to cause long-term suppression of the hypothalamic-pituitary-adrenal (HPA) axis after administration for 2 weeks or more. This is because corticosteroids mimic the effects of cortisol, a hormone produced by the adrenal glands. Prolonged use of corticosteroids can inhibit the production of cortisol by the adrenal glands, leading to HPA axis suppression. This can result in adrenal insufficiency and other hormonal imbalances. Anticholinergic agents, beta-adrenergic agents, and phosphodiesterase inhibitors do not have this effect on the HPA axis.

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  • 27. 

    Osteoporosis, cataracts,redistribution of fat, edema, thinning of skin, increased blood glucose in diabetics, decreased immune function, and stunted growth in children are all a result of what medication?

    • A.

      Short acting beta agonists

    • B.

      Systemic corticosteroids

    • C.

      Phosphodiesterase inhibitors

    Correct Answer
    B. Systemic corticosteroids
    Explanation
    Systemic corticosteroids can cause a variety of side effects, including osteoporosis (weakening of the bones), cataracts (clouding of the lens in the eye), redistribution of fat (leading to a rounded face and increased fat in the abdomen), edema (fluid retention), thinning of the skin, increased blood glucose levels in diabetics, decreased immune function, and stunted growth in children. These side effects are well-documented and known to be associated with the use of systemic corticosteroids.

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  • 28. 

    What are the 3 goals of treating asthma exacerbations?

    • A.

      Reduction of the likelihood of recurrence of obstruction

    • B.

      Correction of hypocalcemia

    • C.

      Correction of hypoxemia

    • D.

      Reversal of airflow obstruction

    • E.

      Supplemental oxygen to maintain SaO2 greater than 89%

    Correct Answer(s)
    A. Reduction of the likelihood of recurrence of obstruction
    C. Correction of hypoxemia
    D. Reversal of airflow obstruction
    Explanation
    The three goals of treating asthma exacerbations are to reduce the likelihood of recurrence of obstruction, correct hypoxemia, and reverse airflow obstruction. These goals aim to improve the patient's breathing and prevent future episodes of asthma exacerbation. Correction of hypocalcemia is not mentioned as one of the goals of treating asthma exacerbations in the given options. Supplemental oxygen to maintain SaO2 greater than 89% is not listed as one of the goals, but it is a treatment approach to correct hypoxemia.

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  • 29. 

    What is the written action you should provide to your patients that is based on signs and symptoms of expiratory flow rates?

    • A.

      Asthma action plan with green-go, yellow-caution, red-stop zones-

    • B.

      Asthma go plan with green-go, orange- caution, red-stop zones

    • C.

      Asthma plan with green- stop, yellow-caution, red-go zones

    Correct Answer
    A. Asthma action plan with green-go, yellow-caution, red-stop zones-
    Explanation
    The correct answer is "Asthma action plan with green-go, yellow-caution, red-stop zones." This answer suggests that the written action to provide to patients should be an asthma action plan that includes different zones based on the signs and symptoms of expiratory flow rates. The green zone indicates that the patient's asthma is under control and they can continue with their regular medication. The yellow zone indicates caution and advises the patient to take additional medication or seek medical advice. The red zone indicates a medical emergency and advises the patient to stop their regular medication and seek immediate medical attention.

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  • 30. 

    What is a congenital or acquired disorder of the bronchi that is a pathologic, irreversible, chronic dilation of the large and medium sized bronchi and brochioles, characterized by permanent, abnormal dilation and destruction of the bronchial walls- may be caused by recurrent inflammation or infection of the airways?

    • A.

      Asthma

    • B.

      Bronchiectasis

    • C.

      COPD

    • D.

      Cystic fibrosis

    Correct Answer
    B. Bronchiectasis
    Explanation
    Bronchiectasis is a disorder of the bronchi characterized by permanent, abnormal dilation and destruction of the bronchial walls. It is a chronic and irreversible condition that can be congenital or acquired. The dilation of the bronchi is often caused by recurrent inflammation or infection of the airways. This condition is different from asthma, COPD, and cystic fibrosis, which have their own distinct characteristics and causes.

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  • 31. 

    A patient presents with a chronic cough, production of copious amounts of purulent sputum, hemoptysis, pleuritic pain, and recurrent pneumonia. What diagnosis would you consider?

    • A.

      COPD

    • B.

      Bronchiectasis

    • C.

      Asthma

    • D.

      Cystic fibrosis

    Correct Answer
    B. Bronchiectasis
    Explanation
    Based on the symptoms described, the most likely diagnosis would be bronchiectasis. Bronchiectasis is a condition characterized by the permanent dilation of the bronchi and bronchioles, leading to a chronic cough, excessive production of purulent sputum, hemoptysis (coughing up blood), pleuritic pain (chest pain that worsens with deep breaths), and recurrent pneumonia. These symptoms are consistent with the clinical presentation of bronchiectasis, making it the most appropriate diagnosis among the options provided.

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  • 32. 

    Upon physical exam you notice the patient has copious, foul-smelling, purulent sputum, persisent crackles at the lung bases, digital clubbing, weight loss, anemia, leukocytosis with a left shift. What three tests should you order on a sputum sample?

    • A.

      Culture and sensitivity

    • B.

      Gram stain

    • C.

      Test for acid fast bacteria

    • D.

      Culture without sensitivity

    • E.

      Giemesa stain

    Correct Answer(s)
    A. Culture and sensitivity
    B. Gram stain
    C. Test for acid fast bacteria
    Explanation
    The patient's presentation with copious, foul-smelling, purulent sputum, persistent crackles at the lung bases, digital clubbing, weight loss, anemia, leukocytosis with a left shift suggests a possible respiratory infection. Ordering a culture and sensitivity test on the sputum sample would help identify the specific pathogen causing the infection and determine its sensitivity to different antibiotics. Gram stain would provide information about the morphology and arrangement of bacteria present in the sputum, aiding in the initial identification of the pathogen. Additionally, testing for acid-fast bacteria would be important to rule out tuberculosis, as it is known to cause similar symptoms.

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  • 33. 

    __________ bronchiectasis results from a global disorder which predisposes and individual to chronic inflammation whereas ______________ bronchiectasis results from a focal injury such as pneumonia/

    • A.

      Localized, diffuse

    • B.

      Diffuse, localized

    • C.

      Primary, secondary

    • D.

      Focal, diffuse

    Correct Answer
    B. Diffuse, localized
    Explanation
    Diffuse bronchiectasis results from a global disorder that affects the entire lung, leading to chronic inflammation. This condition is not limited to a specific area and can affect multiple bronchi. On the other hand, localized bronchiectasis is caused by a focal injury, such as pneumonia, which affects a specific area or lobe of the lung. In this case, the bronchiectasis is confined to a localized region rather than being spread throughout the lung.

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  • 34. 

    What disease causes half of all cases of bronchiectasis?

    • A.

      COPD

    • B.

      Cystic fibrosis

    • C.

      Asthma

    • D.

      Pleuritis

    Correct Answer
    B. Cystic fibrosis
    Explanation
    Cystic fibrosis is a genetic disease that affects the lungs and other organs, causing a build-up of thick mucus. This mucus can block the airways and lead to recurrent infections, which can eventually result in bronchiectasis. Bronchiectasis is a condition characterized by the widening and scarring of the bronchial tubes, leading to a chronic cough, shortness of breath, and frequent respiratory infections. Since cystic fibrosis is a major underlying cause of bronchiectasis, it is the correct answer to the question.

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  • 35. 

    Foul smelling sputum is often due to a/an ____________ infection.

    • A.

      Aerobic

    • B.

      Anaerobic

    • C.

      Enteric

    • D.

      Viral

    • E.

      Mycobacterial

    Correct Answer
    B. Anaerobic
    Explanation
    Foul smelling sputum is often due to an anaerobic infection. Anaerobic bacteria are known to thrive in environments with little to no oxygen, such as the lungs. These bacteria produce volatile sulfur compounds, which give the sputum its foul odor. Other types of infections, such as aerobic, viral, enteric, or mycobacterial, are less likely to cause foul smelling sputum.

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  • 36. 

    What disorder of the airway is characterized by crowded bronchial markings related to fibrosis, and small cystic spaces at the base of the lungs?

    • A.

      Cystic fibrosis

    • B.

      Bronchiectasis

    • C.

      Asthma

    • D.

      COPD

    Correct Answer
    B. Bronchiectasis
    Explanation
    Bronchiectasis is a disorder of the airway that is characterized by crowded bronchial markings related to fibrosis and small cystic spaces at the base of the lungs. This condition is caused by the permanent dilation and destruction of the bronchial tubes, leading to chronic inflammation and recurrent infections. It can result from various factors such as infections, immune system disorders, or genetic conditions. The symptoms of bronchiectasis include chronic cough, excessive mucus production, shortness of breath, and recurrent respiratory infections. Treatment typically involves managing symptoms, preventing complications, and addressing underlying causes.

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  • 37. 

    T/F X ray of the chest is the diagnostic study of choice  for bronchiectasis and will reveal dilated, tortuous airways, and bronchial wall thickening due to peri-bronchial wall thickening due to peri-bronchial fibrosis.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    CT scan is the best dx test for bronchiectasis

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  • 38. 

    What is the treatment of acute exacerbations of bronchiectasis?

    • A.

      Oxygen, hydration, antibiotics, chest physiotherapy, inhaled bronchodilators

    • B.

      Corticosteroids, hydration, antibiotics, chest physiotherapy, inhaled bronchodilators

    • C.

      Oxygen, hydration, antibiotics, inhaled bronchodilators

    • D.

      Oxygen, antibiotics, chest physiotherapy, inhaled bronchodilators

    Correct Answer
    A. Oxygen, hydration, antibiotics, chest physiotherapy, inhaled bronchodilators
    Explanation
    The treatment of acute exacerbations of bronchiectasis includes oxygen, hydration, antibiotics, chest physiotherapy, and inhaled bronchodilators. Oxygen therapy is necessary to provide adequate oxygenation to the patient. Hydration helps to thin the mucus and facilitate its clearance. Antibiotics are prescribed to treat any underlying infection. Chest physiotherapy helps to mobilize and clear the mucus from the airways. Inhaled bronchodilators help to open up the airways and improve breathing. This comprehensive approach aims to alleviate symptoms, improve lung function, and prevent further complications.

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  • 39. 

    What are the complications of bronchiectasis?

    • A.

      Dyspnea, cor pulmonale, secondary parietal abscesses

    • B.

      Hemoptysis, cor pulmonale, amyloidosis, secondary visceral abscesses at distant sites

    • C.

      Hemoptysis, cor pulmonale, amyloidosis, hypoxemia

    Correct Answer
    B. Hemoptysis, cor pulmonale, amyloidosis, secondary visceral abscesses at distant sites
    Explanation
    Bronchiectasis is a condition characterized by the permanent dilation of the bronchi, which can lead to various complications. Hemoptysis, the coughing up of blood, is a common complication of bronchiectasis due to the damage and inflammation of the bronchial walls. Cor pulmonale, a condition where the right side of the heart becomes enlarged and weakened, can occur as a result of chronic lung disease like bronchiectasis. Amyloidosis, the buildup of abnormal proteins in organs and tissues, can also be a complication of bronchiectasis. Lastly, secondary visceral abscesses at distant sites can occur due to the spread of infection from the bronchiectatic lungs to other organs.

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  • 40. 

    Empirical oral antibiotic therapy is reasonable in acute exacerbation of a specific bacterial pathogen cannot be isolated. What are the two reasonable choices?

    • A.

      Trimethoprim-sulfamethoxazole and a cephalosporin

    • B.

      Amoxicillin and metronidazole

    • C.

      Amoxicillin/ amoxicillin-clavulanate and trimethoprim-sulfamethoxazole

    Correct Answer
    C. Amoxicillin/ amoxicillin-clavulanate and trimethoprim-sulfamethoxazole
    Explanation
    The correct answer is amoxicillin/ amoxicillin-clavulanate and trimethoprim-sulfamethoxazole. Empirical oral antibiotic therapy is used when a specific bacterial pathogen cannot be isolated. Amoxicillin/ amoxicillin-clavulanate is a broad-spectrum antibiotic that covers a wide range of bacteria, while trimethoprim-sulfamethoxazole is effective against many common bacterial pathogens. Using both antibiotics together increases the likelihood of covering the potential pathogens causing the acute exacerbation.

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  • 41. 

    What three components characterize asthma?

    • A.

      Inflammation of the airways, overflow of airflow, bronchial hyper-reactivity

    • B.

      Inflammation of the airways, obstruction to airflow, bronchial hyper-reactivity

    • C.

      Obstruction to airflow, bronchial hyper-reactivity, mucus production

    • D.

      Chronic dilation of large and medium sized bronchi and bronchioles, destruction of the bronchial walls, recurrent inflammation or infection of the airways

    Correct Answer
    B. Inflammation of the airways, obstruction to airflow, bronchial hyper-reactivity
    Explanation
    The three components that characterize asthma are inflammation of the airways, obstruction to airflow, and bronchial hyper-reactivity. Inflammation of the airways refers to the swelling and irritation of the bronchial tubes, which can lead to symptoms such as coughing and wheezing. Obstruction to airflow occurs when the airways become narrow or blocked, making it difficult for air to move in and out of the lungs. Bronchial hyper-reactivity refers to the increased sensitivity of the airways to various triggers, causing them to constrict and further obstruct airflow.

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  • 42. 

    T/F There is a genetic predisposition to asthma?

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    There is evidence to support the existence of a genetic predisposition to asthma. Research has shown that individuals with a family history of asthma are more likely to develop the condition themselves. Studies have identified specific genes that are associated with an increased risk of asthma, suggesting a genetic component to the disease. Additionally, twin studies have demonstrated a higher concordance rate for asthma in identical twins compared to fraternal twins, further supporting the role of genetics in asthma susceptibility.

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  • 43. 

    A patient presents with episodic wheezing, difficulty breathing, chest tightness, and cough- what is a likely diagnosis based on these symptoms? hint: in some cases airflow may be too limited to produce wheezing and the only diagnostic clue on auscultation may be globally reduced breath sounds with prolonged expiration.

    • A.

      COPD

    • B.

      Bronchiectasis

    • C.

      Cystic fibrosis

    • D.

      Asthma

    • E.

      Chronic cough

    Correct Answer
    D. Asthma
    Explanation
    Based on the symptoms described, such as episodic wheezing, difficulty breathing, chest tightness, and cough, the likely diagnosis is asthma. These symptoms are characteristic of asthma, which is a chronic inflammatory disease of the airways. In some cases, the airflow may be too limited to produce wheezing, and auscultation may reveal globally reduced breath sounds with prolonged expiration. COPD, bronchiectasis, and cystic fibrosis can also present with similar symptoms, but asthma is the most likely diagnosis based on the given information.

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  • 44. 

    T/F The evaluation for asthma should include spirometry before and after the administration of a short-acting bronchodilator

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Spirometry is a pulmonary function test that measures the amount of air a person can inhale and exhale, as well as the speed at which they can exhale. It is an essential tool in the evaluation of asthma as it helps to assess lung function and diagnose the condition. Performing spirometry before and after the administration of a short-acting bronchodilator helps to determine the reversibility of airflow obstruction, which is a characteristic feature of asthma. This test can help confirm the diagnosis, assess the severity of the condition, and monitor the effectiveness of treatment. Therefore, the statement that the evaluation for asthma should include spirometry before and after the administration of a short-acting bronchodilator is true.

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  • 45. 

    Airflow obstruction is indicated by a reduced FEV1/FVC ratio (below ________ %)

    • A.

      70%

    • B.

      80%

    • C.

      90%

    • D.

      100%

    Correct Answer
    A. 70%
    Explanation
    Airflow obstruction is indicated by a reduced FEV1/FVC ratio. This ratio represents the percentage of forced expiratory volume in one second (FEV1) divided by the forced vital capacity (FVC). A reduced ratio suggests that the individual has difficulty exhaling a sufficient amount of air in the first second of forced expiration, which is characteristic of airflow obstruction. Therefore, a reduced FEV1/FVC ratio below 70% indicates airflow obstruction.

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  • 46. 

    Peak expiratory flow (PEF) meters are hand held devices designed as home monitoring tools. What is considered normal peak flow?

    • A.

      It is what the standard of care is across all aspects of asthma patients

    • B.

      It is what the patient's peak flow is when he/she is at their best

    • C.

      It ranges between green zones and yellow zones according to PEF monitoring guidelines

    • D.

      A range to determine peak flow variability

    Correct Answer
    B. It is what the patient's peak flow is when he/she is at their best
    Explanation
    The correct answer is that normal peak flow is what the patient's peak flow is when he/she is at their best. This means that the normal peak flow is the highest level of airflow that the patient is able to achieve. It serves as a baseline for comparison and helps in monitoring the patient's respiratory health.

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  • 47. 

    Give three functions of the peak expiratory flow meter (select the three that apply)

    • A.

      Provide the patient and provider with subjective measurements on which to base treatment

    • B.

      Provide the patient and provider with objective measurements on which to base treatment

    • C.

      Establish peak flow maximums

    • D.

      Quantify asthma severity

    • E.

      Establish peak flow variability

    Correct Answer(s)
    B. Provide the patient and provider with objective measurements on which to base treatment
    D. Quantify asthma severity
    E. Establish peak flow variability
    Explanation
    The peak expiratory flow meter is used to provide objective measurements to both the patient and the healthcare provider, which helps in determining the appropriate treatment for the patient. It also helps in quantifying the severity of asthma by measuring the peak flow rate. Additionally, the peak expiratory flow meter can be used to establish peak flow variability, which is an important indicator of asthma control.

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  • 48. 

    ____________ is defined as hypertrophy of the right ventricles resulting from disease of the lungs.

    • A.

      Tussive syncope

    • B.

      Cor pulmonale

    • C.

      Status asthmaticus

    • D.

      Atopy

    Correct Answer
    B. Cor pulmonale
    Explanation
    Cor pulmonale is defined as hypertrophy of the right ventricles resulting from disease of the lungs. This condition occurs when the lungs are unable to efficiently oxygenate the blood, leading to increased pressure in the pulmonary arteries and subsequent enlargement of the right ventricle. Common causes of cor pulmonale include chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and lung disorders such as emphysema or pulmonary fibrosis. The increased workload on the right ventricle can eventually lead to heart failure if left untreated.

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  • 49. 

    (T/F) Atopy is the genetic predisposition to respond to allergens

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Atopy refers to a genetic tendency to develop allergic diseases such as asthma, eczema, and hay fever. Individuals with atopy have a heightened immune response to common allergens, leading to allergic reactions. This genetic predisposition can be inherited and increases the likelihood of developing allergies when exposed to allergens. Therefore, the statement that atopy is the genetic predisposition to respond to allergens is true.

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  • 50. 

    T/F Routine chest x rays should be ordered on patients who have asthma

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    x rays are only indicated when pneumonia, other mimicking dz, and complications of asthma (pneumothorax) is suspected

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