Family Nurse Practitioner (FNP) > Respiratory > Flashcards

Respiratory Flashcards

Assess and manage acute and chronic respiratory conditions in patients of all ages. (79 cards)

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1
Q

What are the key characteristics of asthma?

A
  • Bronchial hyperresponsiveness
  • Chronic airway inflammation
  • Airway constriction in response to triggers

Triggers include mites, molds, furry animals, pollens, cold air, and exercise.

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2
Q

Which symptoms are commonly associated with asthma?

A
  • Dyspnea
  • Cough (often worse at night)
  • Chest tightness
  • Wheezing
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3
Q

What are severe symptoms of asthma?

A
  • Tachypnea
  • Tachycardia
  • Prolonged expiratory phase
  • Poor air movement or a ‘quiet’ chest
  • Tripod breathing
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4
Q

What does spirometry measure?

A

Spirometry measures a person’s forced expiratory volume and their forced vital capacity.

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5
Q

What spirometry result indicates airflow obstruction in asthma?

A

Reduced FEV1/FVC ratio of <0.7

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6
Q

What spirometry change after bronchodilator administration is suggestive of asthma?

A

An increase of the FEV1 or FVC of >10%

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7
Q

Fill in the blank:

In asthma classification, Step 1 includes daytime symptoms ______ days/week.

A

≤2

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8
Q

What are the treatment options for Step 1 asthma?

A
  • PRN low-dose ICS-formoterol
  • PRN low-dose ICS-SABA
  • PRN SABA
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9
Q

What are the recommended treatment options for Step 2 asthma?

A
  • PRN low-dose ICS-formoterol
  • Maintenance with low-dose ICS + reliever with PRN ICS-SABA or PRN SABA
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10
Q

What are the recommended treatment options for Step 3 asthma?

A
  • Maintenance AND reliever therapy with low-dose ICS-formoterol
  • Maintenance with low-dose ICS-LABA + reliever with PRN ICS-SABA or PRN SABA
  • Maintenance with low-dose ICS + LAMA or LTRA + reliever with PRN ICS-SABA or PRN SABA
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11
Q

What are the recommended treatment options for Step 4 asthma?

A
  • Maintenance AND reliever therapy with medium-dose ICS-formoterol
  • Maintenance with medium-dose ICS-LABA + reliever with PRN ICS-SABA or PRN SABA
  • Maintenance with medium-dose ICS + LAMA or LTRA + reliever with PRN ICS-SABA or PRN SABA
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12
Q

What are risk factors for asthma exacerbations?

A
  • Insufficient asthma symptom control
  • History of asthma exacerbations
  • Smoker
  • Allergen exposure
  • Previous intubation or ICU admission
  • Low FEV1
  • Obesity
  • Food allergy
  • Chronic rhinosinusitis
  • Poor compliance or inhaler technique
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13
Q

True or False:

Asthma treatment should be stepped down if well controlled for 3 to 6 months.

A

True

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14
Q

What are the common symptoms of pediatric asthma?

A
  • Cough
  • Wheeze
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15
Q

What spirometry result indicates airflow obstruction in pediatric asthma?

A

FEV1/FVC <0.85

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16
Q

What are the treatment options for Step 1 pediatric asthma?

A
  • SABA PRN
  • Low-dose ICS whenever SABA is used
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17
Q

What are the treatment options for Step 2 pediatric asthma?

A
  • Daily low-dose ICS, with SABA PRN
  • Daily low-dose ICS, with a low-dose ICS anytime a SABA is used
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18
Q

What are the treatment options for Step 3 pediatric asthma?

A
  • Daily low-dose ICS-formoterol as reliever and maintenance therapy
  • Daily low-dose ICS-LABA, with SABA PRN
  • Daily medium-dose ICS, with SABA PRN
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19
Q

What are the treatment options for Step 4 pediatric asthma?

A
  • Daily medium-dose ICS-formoterol as reliever and maintenance therapy
  • Daily medium-dose ICS-LABA, with SABA PRN
  • Daily high-dose ICS, with SABA PRN
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20
Q

What are the classic symptoms of COPD?

A
  • Dyspnea
  • Chronic productive cough
  • Sputum production
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21
Q

What is the main risk factor for COPD?

A

Cigarette smoking

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22
Q

What spirometry result confirms a COPD diagnosis?

A

FEV1/FVC ratio less than 0.7 that is irreversible with a bronchodilator

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23
Q

What are the treatment options for Group A COPD patients?

A
  • LAMA, plus PRN SABA
  • LABA, plus PRN SAMA-SABA, or SABA
  • PRN SAMA-SABA, or SABA
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24
Q

What is the recommended treatment for Group B COPD patients?

A

LAMA-LABA dual bronchodilator therapy, plus PRN SABA

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25
What is the recommended treatment for **Group E COPD patients** with high peripheral eosinophil levels?
ICS-LAMA-LABA, plus PRN SABA
26
What are **symptoms** of an asthma exacerbation?
* Wheezing * Cough * Chest tightness * Shortness of breath
27
What is the **initial treatment** for an asthma exacerbation?
Prompt initiation of a SABA
28
What is the **typical outpatient burst dose** of oral glucocorticoids for asthma exacerbation?
Prednisone 40mg to 60mg a day for 5 to 7 days
29
What are **symptoms** of a COPD exacerbation?
* Increase in dyspnea * Cough * Sputum production
30
What is the **initial treatment** for a COPD exacerbation?
Prompt initiation of SABA or SABA-SAMA combination
31
What is the **most common cause** of bronchiolitis in children?
Respiratory syncytial virus | (RSV)
32
What is the **treatment** for mild croup?
Single dose of dexamethasone or prednisolone
33
What is the **genetic cause** of cystic fibrosis?
Mutations in the CFTR gene
34
What is the **most important diagnostic test** for cystic fibrosis?
Elevated sweat chloride test of ≥60 mmol/L. ## Footnote A sweat chloride test of 30 to 59 should have repeat testing with sweat chloride testing and CFTR sequencing.
35
Which **pathogen** is a risk factor for decreased lung function and survival in cystic fibrosis patients?
Pseudomonas aeruginosa ## Footnote At the first positive test of Pseudomonas aeruginosa, the patient is started on chronic azithromycin.
36
# Fill in the blanks: Community-acquired pneumonia is an acute infection of the \_\_\_\_\_\_ \_\_\_\_\_\_.
pulmonary parenchyma ## Footnote It is acquired in the community and can vary in presentation and severity.
37
List **two common pathogens** responsible for community-acquired pneumonia.
* Streptococcus pneumoniae * Respiratory viruses
38
What **physical exam finding** indicates consolidation in community-acquired pneumonia?
Increase in fremitus | (chest vibration) ## Footnote Vowel 'e' sounds like nasal-y 'a' (as in 'say') also indicates consolidation.
39
What is the **first-line treatment** for low-risk adult patients with community-acquired pneumonia?
Amoxicillin (1g orally 3 times a day, for at least 5 days), plus either a macrolide or doxycycline. ## Footnote Monotherapy with amoxicillin is also an option according to ATS/IDSA guidelines.
40
# True or False: X-rays are required to diagnose mild community-acquired pneumonia in pediatric patients managed outpatient.
False ## Footnote X-rays are not required for mild CAP in pediatric patients managed outpatient.
41
Which **organism** causes tuberculosis?
Mycobacterium tuberculosis
42
What are the **symptoms** of reactivation or post-primary tuberculosis?
* Cough * Weight loss * Fatigue * Chest pain * Dyspnea * Hemoptysis * Fever * Night sweats
43
# Fill in the blank: In tuberculosis, induration of \_\_\_\_\_\_ is considered positive in patients with HIV infection.
≥5mm ## Footnote This also applies to recent close contacts of active TB cases, patients with chest x-ray consistent with prior TB, and immunosuppressed patients.
44
What is the **initial treatment regimen** for adults with tuberculosis without HIV?
Isoniazid, rifampin, ethambutol, and pyrazinamide for 8 weeks, then isoniazid and rifampin for 18 weeks.
45
What **treatment** is indicated for COVID-19 patients ≥65 years, regardless of vaccine status?
Nirmatrelvir-ritonavir (Paxlovid) within 5 days of symptom onset.
46
Which patients should be **prioritized** for Paxlovid treatment in COVID-19?
Severely immunocompromised patients who are un-vaccinated and have never been infected with COVID-19, or elderly with multiple comorbidities.
47
What is the **recommended treatment** for adults with seasonal influenza?
Oseltamivir 75mg orally, twice a day, for 5 days.
48
# Select the correct answer: Which condition requires inpatient treatment for community-acquired pneumonia? A. Mild fever B. Septic shock C. Mild cough D. Nasal congestion
B. Septic shock ## Footnote Other indications include respiratory failure, inability to maintain oral intake, and oxygen saturation <92% on room air.
49
What is the **step up/step down approach** in asthma treatment?
If asthma is poorly controlled, step up therapy and if asthma is well controlled for 3 to 6 months, step down therapy.
50
What defines **well-controlled asthma**?
Symptoms of asthma occurring no more than twice a week, no night time awakenings due to asthma symptoms, and no activity limitation due to asthma symptoms.
51
What characterizes **chronic obstructive pulmonary disease** (COPD)?
Persistent respiratory symptoms, usually caused by significant exposure to noxious particles or gases.
52
What is an **asthma exacerbation**?
An incident of worsening symptoms and lung function, that may occur from a trigger, such as an upper respiratory infection, allergen, irritant, lack of medication compliance, or for an unknown reason.
53
How often should nebulized albuterol be administered in an asthma exacerbation?
every 20 mins, up to 3 doses in 1 hour
54
When are oral glucocorticoids indicated for asthma exacerbations?
In moderate to severe exacerbations and for those who do not completely improve with an inhaled, fast-acting, bronchodilator.
55
How often can a metered dose inhaler of albuterol be used in an asthma exacerbation?
4 to 8 puffs every 20mins, up to 3 doses in 1 hour
56
What is the **treatment** for COPD exacerbation?
* Prompt initiation of SABA or SABA-SAMA combination * Systemic glucocorticoids * Antibiotics for most patients
57
What are **risk factors** for poor outcomes in COPD exacerbation?
* Age 65 years or older * FEV1 <50% predicted * 2 or more COPD exacerbations in the past 12 months * On continuous oxygen * Comorbidities including heart failure or ischemic heart disease
58
What characterizes **community-acquired pneumonia**?
An acute infection of the pulmonary parenchyma, acquired in the community.
59
What is the **CURB-65 score** used for?
Assessing the severity of pneumonia.
60
What are the components of the CURB-65 score?
* Confusion * Urea >7mmol/L * Respiratory rate ≥30 breaths/minute * Blood pressure: SBP <90 mmHg or DBP <60 mmHg * Age ≥65 years
61
What is the recommended **pneumococcal vaccination** for adults 50 years or older?
* PCV15, followed by a dose of PPSV23 one year later * PCV20 or PCV21: additional vaccination not recommended
62
What are symptoms of **primary tuberculosis** (TB)?
* Fever * Chest pain
63
What are the treatment options for **tuberculosis**?
* Isoniazid * Rifampin * Ethambutol * Pyrazinamide
64
What is the **leading cause** of cancer-related death?
Lung cancer
65
What is the **recommended screening** for lung cancer?
Low dose CT for adults (ages 50 to 80 years) with at least a 20-pack history of smoking.
66
What is the **recommended annual screening** for adults aged 50 to 80 years with a 20-pack-year smoking history?
Annual low-dose CT scan. ## Footnote This screening is recommended for those who currently smoke or have quit within the last 15 years.
67
How is **pack history** calculated for smoking?
Multiply the number of packs of cigarettes smoked per day by the number of years smoked.
68
When should annual low-dose CT scans be **discontinued** for smokers?
Once the patient has reached 15 years smoke-free or has a limited life expectancy.
69
What are the **three steps** in the approach to **smoking cessation**?
* Ask about smoking habits * Advise to quit smoking * Offer support/treatment
70
What are the **components of treatment** for smoking cessation?
* Behavior support * Pharmacotherapy * Varenicline (Chantix) * Nicotine replacement therapy
71
What **forms of nicotine replacement therapy** are available?
* Nicotine patch (long acting) * Nicotine gum (short acting)
72
What is the **primary method** for diagnosing lung cancer?
Pathologic evaluation of either the pleural fluid or with a tissue biopsy.
73
# Fill in the blanks: Lung cancer is a leading cause of cancer-related death, and \_\_\_\_\_\_ \_\_\_\_\_\_ is most beneficial.
smoking cessation
74
What are **common presentations** of lung cancer?
* Cough with hemoptysis * Dyspnea * Weight loss
75
What is the **function** of the nose and nasal cavity in the respiratory system?
Filters, warms, and humidifies incoming air; includes mucous membranes that trap particles and pathogens.
76
What is the **role** of alveoli in the lungs?
Tiny air sacs at the end of bronchioles where gas exchange occurs; surrounded by capillaries that allow oxygen to enter the blood and carbon dioxide to exit.
77
# True or False: The diaphragm is a muscle that assists with breathing by expanding and contracting the thoracic cavity.
True ## Footnote The diaphragm contracts and flattens to increase thoracic volume, enabling inhalation.
78
# Fill in the blank: Normal oxygen saturation in arterial blood is \_\_\_\_\_\_.
95% to 100%
79
What are the **normal findings for tactile fremitus** during a respiratory exam?
Tactile fremitus felt symmetrically.
Family Nurse Practitioner (FNP)
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