COPD and Asthma Management Quiz

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Questions and Answers

When are oral corticosteroids most useful in COPD treatment?

  • For routine, long-term management of COPD.
  • To treat acute exacerbations in short courses. (correct)
  • As a first-line treatment at the time of diagnosis.
  • To prevent any adverse effects of COPD.

What are the primary indications for long-term oxygen therapy?

  • SaO2 below 84% or PaO2 below 50mmHg.
  • When oxygen is beneficial for short term relief
  • SaO2 below 88% or PaO2 below 55mmHg. (correct)
  • SaO2 below 90% or PaO2 below 60mmHg.

Which best defines bronchial asthma?

  • A chronic inflammatory airway syndrome. (correct)
  • A chronic noninflammatory airway syndrome.
  • A purely genetic disease.
  • A non-reversible airway obstruction.

Which category of anti-inflammatory drugs is typically required for treating asthma?

<p>Corticosteroid-type anti-inflammatory drugs. (C)</p> Signup and view all the answers

Which of the following is a significant risk factor for asthma?

<p>Respiratory infections. (B)</p> Signup and view all the answers

Which of these is most useful in diagnosing asthma?

<p>A variable functional obstructive syndrome. (D)</p> Signup and view all the answers

Which of these best represents the symptoms of an asthmatic crisis?

<p>Paroxysmal dyspnoea, wheezing and chest tightness with a non productive cough (D)</p> Signup and view all the answers

What finding is most likely during a clinical examination of an asthmatic patient?

<p>Prolonged expiration (including auscultatory) findings. (D)</p> Signup and view all the answers

What does FEV1 measure?

<p>The amount of air forcefully exhaled in 1 second. (A)</p> Signup and view all the answers

What would you expect to see on a chest X-ray of a patient with COPD?

<p>Hypertransparent lungs with normal or increased lung markings. (C)</p> Signup and view all the answers

Which of the following is a contraindication for the six-minute walk test?

<p>A patient with a blood pressure above 200/110 mmHg. (D)</p> Signup and view all the answers

What is the main purpose of a blood gas assessment in COPD?

<p>To determine the specific type of respiratory failure associated with COPD. (C)</p> Signup and view all the answers

What is a primary goal in the management of COPD?

<p>Relieving symptoms experienced by the patient. (A)</p> Signup and view all the answers

What is a common side effect of beta 2 adrenergic medications?

<p>Sinus tachycardia (fast heart rate). (D)</p> Signup and view all the answers

Which side effect is most closely associated with anticholinergic medications?

<p>A dry feeling in mouth lining. (B)</p> Signup and view all the answers

Which finding, among these options, is a sign of clinical condensation syndrome that may be associated with the diagnosis of pneumonia?

<p>Increased vocal vibration and dullness to percussion. (B)</p> Signup and view all the answers

Which of the following best describes the typical onset and presentation of atypical pneumonia?

<p>Gradual onset with moderate fever and mild chills. (B)</p> Signup and view all the answers

What is the MOST common cause of atypical pneumonia?

<p>Legionella pneumophila (D)</p> Signup and view all the answers

What is the MOST common cause of typical or community-acquired pneumonia?

<p>Streptococcus pneumoniae (D)</p> Signup and view all the answers

Which of the following is MOST characteristic of the clinical presentation of community-acquired pneumonia?

<p>An acute lower respiratory tract illness with an onset of less than 1 month. (B)</p> Signup and view all the answers

Which of these is NOT a typical symptom associated with community-acquired pneumonia?

<p>Significant weight gain. (A)</p> Signup and view all the answers

What clinical finding is NOT typically identified in a physical examination of a patient with community-acquired pneumonia?

<p>Superficial chest circulation on the affected side (D)</p> Signup and view all the answers

Which of the following is accurate regarding the diagnosis of atypical pneumonia?

<p>Clinical findings alone are usually insufficient to accurately determine the causative agent in atypical pneumonia. (C)</p> Signup and view all the answers

Which factor is considered when assessing the severity of pneumonia?

<p>Associated diseases (A)</p> Signup and view all the answers

According to the information, what is a factor in assessing pneumonia severity?

<p>Age (B)</p> Signup and view all the answers

What does the Pneumonia Severity Index primarily help determine?

<p>Whether patients should be treated at home or in hospital (B)</p> Signup and view all the answers

Which of the following is a component of the pneumonia severity score?

<p>Presence of an associated disease (A)</p> Signup and view all the answers

In the absence of a chest X-ray, how is a patient with pneumonia usually treated?

<p>The patient will be treated based on medical history, clinical, and biological assessment (A)</p> Signup and view all the answers

In patients with community-acquired pneumonia, is a chest X-ray considered essential?

<p>Chest X-ray is essential (C)</p> Signup and view all the answers

Which method is used to identify the pathogen responsible for community-acquired pneumonia?

<p>Sputum examination (C)</p> Signup and view all the answers

What does an elevated procalcitonin level typically indicate?

<p>Bacterial infection (D)</p> Signup and view all the answers

Which of the following is a potential complication of pneumonia?

<p>Marked physical asthenia (C)</p> Signup and view all the answers

Which of these options is NOT a cause of infectious pneumonia?

<p>Radiation (B)</p> Signup and view all the answers

Which of the following conditions can result in non-infectious pneumonia?

<p>Sarcoidosis (B)</p> Signup and view all the answers

Non-infectious pneumonia is most likely to occur in patients with which of the following conditions?

<p>Patients with collagenosis (B)</p> Signup and view all the answers

How is community-acquired pneumonia typically treated initially?

<p>With empirically administered antibiotics (B)</p> Signup and view all the answers

Which of the following is the recommended outpatient treatment for community-acquired pneumonia in patients without risk factors?

<p>Amoxicillin (A)</p> Signup and view all the answers

If a patient with community-acquired pneumonia is allergic to penicillins, which of the following antibiotics is recommended?

<p>Aztreonam + Macrolide or FQ (C)</p> Signup and view all the answers

What is the recommended treatment for pneumonia caused by the influenza A virus?

<p>Oseltamivir (D)</p> Signup and view all the answers

Which of the following is a consequence of sleep deprivation?

<p>Decreased immune response (D)</p> Signup and view all the answers

Which of these is a recommended treatment for sleep deprivation?

<p>Increasing light intensity in the bedroom before bedtime (C)</p> Signup and view all the answers

What is the first-line investigation for suspected obstructive sleep apnea?

<p>Nocturnal ventilatory polygraphy (D)</p> Signup and view all the answers

What defines obstructive sleep apnea (SASO)?

<p>Lack of airflow to nose and mouth &gt; 5 sec (A)</p> Signup and view all the answers

In obstructive sleep apnea (SASO), what is characteristic of respiratory effort?

<p>Respiratory effort of chest and abdominal muscles is present (A)</p> Signup and view all the answers

What is a key feature of hypopnea of the obstructive type?

<p>Respiratory effort of chest and abdominal muscles is present (B)</p> Signup and view all the answers

Which of the following is a type of respiratory event?

<p>Mixed sleep apnea (A)</p> Signup and view all the answers

What does the Apnoea Hypopnopnoea Index (AHI) measure?

<p>The ratio between the number of apnoea, hypopnoea and total sleep time (TST) (D)</p> Signup and view all the answers

Flashcards

Forced Vital Capacity (FVC)

The maximum amount of air that can be forcibly exhaled from the lungs after a deep breath.

6-Minute Walk Test

A test where a patient walks as far as they can in 6 minutes. It helps assess lung function and exercise tolerance.

Forced Expiratory Volume in 1 Second (FEV1)

A lung function test that measures the amount of air a person can exhale in one second.

Beta-2 Adrenergic Agonists (SABAs)

A type of medication that opens up the airways in the lungs, making breathing easier. It works mainly by relaxing the muscles in the airways.

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Anticholinergics

Includes medication such as ipratropium and tiotropium, which work by blocking a certain type of chemical in the body that causes the airways to become narrow.

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Methylxanthines

A group of medications used to treat COPD, but their effectiveness in improving breathing is weaker than other medications like SABAs.

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Relieving Symptoms

This is an important goal of COPD management. It focuses on reducing symptoms and making it easier for patients to breathe.

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Bronchodilator Medications (BDLAs)

Often used in combination with other medications to improve the effectiveness of treatment.

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What is bronchial asthma?

A chronic inflammatory airway syndrome with reversible airflow limitation that can vary over time. This means the narrowing of the airways can get better and worse.

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When are oral corticosteroids used in COPD?

Oral corticosteroids are used in short courses for treating exacerbations of COPD. They are not routinely given and aren't needed from diagnosis.

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When is long-term oxygen therapy indicated in COPD?

Long-term oxygen therapy is indicated for patients with COPD when their blood oxygen levels are consistently low. This usually happens when the saturation level (SaO2) is below 88% or the partial pressure of oxygen in the blood (PaO2) is below 55mmHg.

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What are some risk factors for asthma?

Risk factors for asthma include respiratory infections, exposure to allergens, and certain genetic predispositions.

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How can we diagnose asthma?

One way to diagnose asthma is by observing a significant improvement in symptoms after taking salbutamol, a bronchodilator medication. This shows that the airway narrowing is reversible.

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What are the symptoms of asthma?

The symptoms of asthma include coughing, wheezing, chest tightness, and shortness of breath. Symptoms may vary in severity and frequency.

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What is an asthmatic crisis?

An asthmatic crisis is a severe exacerbation of asthma characterized by rapid onset of severe symptoms like difficulty breathing, wheezing, chest tightness, and coughing. It's essentially a medical emergency, and urgent medical attention is required.

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What is a characteristic finding during a clinical examination of an asthmatic patient?

One characteristic finding during a clinical examination of an asthmatic patient is prolonged expiration, which is evident when listening to the lungs with a stethoscope.

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Clinical condensation syndrome

A clinical syndrome characterized by dullness, vocal vibration, crackling, and potentially tubal murmur, suggesting the presence of pneumonia.

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Atypical pneumonia

A type of pneumonia that usually presents with flu-like symptoms like moderate fever, slight chills, and a quick onset, but the general condition of the patient can be quite poor.

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Most common etiology of atypical pneumonia

Bacteria like Legionella pneumophila, Influenza A, and Influenza B are common culprits behind atypical pneumonia.

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Diagnosing pneumonia with clinical findings

Clinical signs alone, even when combined, cannot definitively diagnose pneumonia. Further investigations, like imaging or laboratory tests, are essential.

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Most common etiology of community-acquired pneumonia

"Typical pneumonia" is usually caused by bacteria like Streptococcus pneumoniae, which accounts for the majority of community-acquired pneumonia cases.

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Clinical presentation of community-acquired pneumonia

Community-acquired pneumonia is characterized by acute onset of a lower respiratory tract illness, usually within the past month, and frequently involves a dry cough progressing to a productive cough with rusty or purulent sputum.

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Common symptoms of community-acquired pneumonia

Fever above 37.7°C is a common sign of community-acquired pneumonia, but other symptoms like headaches or abdominal pain are not typical.

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Physical exam findings in community-acquired pneumonia

The physical exam of a patient with community-acquired pneumonia often reveals crackle wheezing, rapid heartbeat (tachycardia), and poor circulation (due to reduced blood flow) in the chest.

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Pneumonia Severity Index

A scoring system used to determine the severity of pneumonia in patients, helping decide whether they need hospitalization or can be treated at home.

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Pneumonia

Inflammation of the lungs caused by various microorganisms, ranging from mild to life-threatening.

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Associated disease

The presence of an underlying medical condition that increases the risk of pneumonia and can worsen its severity.

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Procalcitonin

A blood test that measures the level of procalcitonin, a protein elevated in bacterial infections, indicating the likelihood of bacterial pneumonia.

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Chest X-ray

A medical imaging technique using X-rays to visualize the lungs and detect abnormalities, such as pneumonia.

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Usual blood tests

A collection of tests measuring various blood components, used to evaluate overall health status and potentially identify markers of infection or inflammation.

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Sputum examination

An examination of sputum, the phlegm coughed up from the lungs, to identify the specific pathogen causing pneumonia.

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Pathogen identification

The identification of the specific organism causing pneumonia, crucial for targeted antibiotic therapy.

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Pneumonia in patients with collagenosis

A type of pneumonia that occurs in patients with autoimmune diseases, such as lupus or rheumatoid arthritis.

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Pneumonia in diabetic patients

A type of pneumonia that occurs in patients with diabetes.

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Pneumonia in patients with asthma

A type of pneumonia that occurs in patients with asthma.

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Pneumonia in patients with TB

A type of pneumonia that occurs in patients with tuberculosis.

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Empirical antibiotic treatment for community-acquired pneumonia

The initial treatment of community-acquired pneumonia involves using antibiotics that are effective against the most likely causes of the infection.

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Outpatient treatment of community-acquired pneumonia without risk factors

Outpatient treatment of community-acquired pneumonia without risk factors is usually done with Amoxicillin, a broad-spectrum antibiotic.

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Treatment of community-acquired pneumonia allergic to penicillin

Treatment of patients with community-acquired pneumonia allergic to penicillin involves using alternative antibiotics, such as Aztreonam combined with a Macrolide or Fluoroquinolone.

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Treatment of pneumonia due to influenza A virus infection

The recommended treatment for pneumonia caused by influenza A virus is Oseltamivir, an antiviral medication.

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Obstructive Sleep Apnea (OSA)

A condition where a person experiences repeated pauses in breathing during sleep, often accompanied by snoring and daytime sleepiness.

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Central Sleep Apnea (CSA)

A type of sleep apnea where the brain fails to send signals to the muscles that control breathing, leading to pauses in breathing.

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Hypoventilation Syndrome

A condition where breathing is shallow and slow during sleep, resulting in reduced oxygen levels in the blood.

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Apnea-Hypopnea Index (AHI)

A measurement of the number of apneas and hypopneas per hour of sleep.

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Hypopnea

A decrease in airflow by at least 30% for more than 10 seconds, with respiratory effort present.

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Apnea

A complete cessation of airflow for more than 10 seconds, with evidence of respiratory effort.

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Nocturnal Ventilatory Polygraphy

The first line of investigation in patients with suspected obstructive sleep apnea.

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Upper Airway Resistance Syndrome (UARS)

A condition where the upper airway narrows during sleep, causing snoring and breathing problems, but without complete cessation of airflow.

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Study Notes

Symptom Definition

  • A symptom is a subjective element reported by the patient.
  • A symptom is objectified by a doctor.
  • A symptom is a group of signs and symptoms that occur in a disease.
  • Symptoms include inspection, palpation, percussion, and listening.

Clinical Examination

  • The general clinical examination focuses on patient attitude and posture.
  • The patient's medical documents are also reviewed.
  • The patient's position in bed is examined.

Claude-Bernard-Horner Syndrome

  • Characterized by ptosis, myosis, and anhidrosis.

Erythema Nodosum

  • Associated with various diseases, including bronchial asthma, lung cancer, bronchiectasis, and primary tuberculosis.

Hoover Sign

  • A sign of restriction.
  • Not related to atelectasis or lung cancer.

Tympanism

  • Defined as increased loudness when percussing an area where air is under pressure.
  • This is not diminished or abolished sonority.

Increased Lung Sounds

  • Observed in pneumonia, large intrapulmonary cavities, and bronchiectasis, not lung cancer.

Acute Cough

  • Lasts less than 15 days.
  • Does not last longer than 4 weeks.
  • A symptom of newly established bronchopulmonary distress.

Pulmonary Complications of Cough

  • Respiratory complications are a result of cough.

COPD

  • A chronic, preventable, and treatable disease.
  • Characterized by a chronic inflammatory disease.
  • Causes include influenza A and B, bacterial infections, alpha-1 antitrypsin deficiency, and flour exposure.
  • Mechanisms that induce COPD in smokers include chronic inflammation, acute viral infection, acute inflammation.
  • COPD is often caused by bronchial obstruction.
  • Diagnosing COPD involves evaluating ventilatory function tests.

COPD Symptoms

  • Shortness of breath
  • Coughing up mucus
  • Headaches
  • Weight loss
  • Nocturnal dyspnea
  • Asthenia

COPD Diagnosis

  • Blood tests
  • Computerized pulmonary tomography
  • Chest X-rays, sometimes with contrast agents
  • History of smoking or exposure to harmful substances
  • Six-minute walk tests are used to evaluate physical endurance.

COPD Treatment and Management

  • Controlling symptoms and preventing complications.
  • Beta 2 adrenergic agonists (SABA), like formoterol, salmeterol, and indacaterol.
  • Inhaled corticosteroids like inhaled controller corticosteroids.

Asthma

  • Chronic inflammatory disease.
  • Risk factors include respiratory infections and inadequate hydration.
  • Symptoms such as coughing and wheezing are common.
  • Diagnosis includes evaluation of patient history, clinical examination, and imaging techniques like chest X-rays.
  • Treatment strategies include controlling symptoms and preventing exacerbations.

Pneumonia

  • Acute inflammation of the lung parenchyma.
  • Associated with pathogenic germs entering the lungs through contaminated water, air, or blood.
  • Bronchopneumonia is characterized by multiple inflammatory processes in the bronchioles and alveoli.
  • Interstitial pneumonia is an inflammation that occurs inside the interstitial tissue.
  • Non-infectious pneumonia may be caused by viruses, bacteria, or fungus.
  • Diagnosis involves assessing patient history, physical examination, and imaging (including chest X-ray).
  • Treatment varies based on cause, severity, and patient factors.
  • The duration of antibiotic treatment varies.

Tuberculosis

  • Infectious disease resulting from Mycobacterium tuberculosis bacteria.
  • Transmission occurs through aerosols produced during coughing, sneezing, or speaking.
  • Infection can occur by inhalation, ingestion, or inoculation.
  • Symptoms depend on the disease stage (latent or active).
  • Diagnosis involves investigating causative agents, performing skin tests, and using radiologic tests.
  • Treatment often entails a prolonged antibiotic regimen.
  • Treatment may include use of antibiotics and vaccination programs.

Atypical Pneumonia

  • Is characterized by initial and continued symptoms, often requiring a thorough assessment.
  • Most common etiology includes Influenza A, B, Legionella pneumophila, and Hemophilus influenza.
  • Clinical presentation is variable but typically involves respiratory symptoms like cough and shortness of breath.

Idiopathic Pulmonary Fibrosis (IPF)

  • Progressive lung disease caused by inflammation and scarring of lung tissues.
  • Diagnostic tools may include diffusion tests, but are not sufficient on their own.
  • Treatment is often supportive and involves medications.
  • Additional management may be necessary if symptoms worsen or spread.

Sleep Apnea

  • Respiratory disorder characterized by pauses in breathing or decreased airflow through the nose and mouth during sleep.
  • The causes involve structural and neuromuscular factors.
  • Diagnosis may include neurological examination, nocturnal ventilatory polygraphy, and spirometry tests.
  • Severity is determined by the apnea-hypopnea index (AHI).
  • Untreated sleep apnea can lead to severe health problems.
  • Treatment often involves lifestyle changes, CPAP, BiPAP, or APAP therapy.

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