Pulmonary NCCPA outline Latest

Pulmonary (NCCPA outline) (Latest / Answers 100% Correct

• What is the best and most objective way to assess asthma exacerbation severity and patient

response in the ED?

Answer: Peak Expiratory Flow Rate

• What is the most common organism isolated on respiratory cultures in bacterial tracheitis?

Answer: Staph Aureus

• An O2 saturation of 90% corresponds to

Answer: RESPIRATORY DISTRESS

• Management for Intermittent Asthma

Answer: Inhaled SABA as needed

• Management for Mild Persistent Asthma

Answer: Inhaled SABA as needed + LOW DOSE ICS

• Management for Moderate Persistent Asthma

Answer:

• Low ICS + LABA OR
• Increased ICS dose OR
• Add LTRA

• Management for Severe Persistent Asthma

Answer: High dose ICS + LABA

+/- Omalizumab (Anti-IgE drug)

• IV magnesium can be useful in pts with asthma because it is...

Answer: a bronchodilator

9. 1st line treatment of acute asthmas: SABA

• albuterol, levalbuterol, terbutaline, epinephrine. MOA

Answer: bronchodialtors

• Besides Beta agonists, what else can be given in addition for acute asthma exacerbations?

Answer:

• *Anticholinergics (Atrovent)*: central bronchodilator; has a synergist response when added

to albuterol. Helpful in 1st hour.

• Corticosteroids (Prednisone): all but the mildest exacerbations should be dis- charged on a 1 / 2

short course of steroids unless CI.

• How do you manage long term, chronic asthma?

Answer:

• Maintenance includes

*Inhaled Corticosteroids (ICS)*: *TOC for longterm persistent asthma*

• LABAs: prophylaxis esp for nighttime; step down from LABA is recc after relief of

symptoms >3months.

3. Mast Cell Modifiers: best for cold air, exercise (Cromolyn, Nedocromil)

• Leukotriene Modifiers/ Receptor agonists (LTRAs): useful for asthmatics with allergic

rhinitis, aspirin induced asthma.

• Chronic Bronchitis ABG

Answer: Respiratory A*C*IDOSIS

C= chronic bronchtis

• Emphysema ABG

Answer: Respiratory Alkalosis

• How do you manage COPD

Answer:

1. SMOKING CESSATION

• Bronchodilators
• *Anticholinergic inhalers (ipratropium and tiotropium)*; preferred over beta agonists in COPD
• SABAs; for short term relief
• Theophylline (refractory)

• *Steroids for exacerbation*

4. *Supplemental O2* when sat is <88%; cor pulmonate, or PaO2 <55 OTHER:

Exercise Antibiotics when sic Vaccinations (pneumovax, flu) Pulm Rehab Surgery

• - Patient with a history of repeated respiratory tract infections
• Complaining of a cough with large amounts of mucopurulent, *foul-smelling sputum*
• PE will show crackles and wheezing on lung auscultation
• CXR will show dilated and thickened airways ("tram-tracks")
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