Respiratory Disorders Study Guide

Comprehensive practice questions covering asthma, COPD, tuberculosis, community-acquired pneumonia, acute bronchitis, and lung cancer based on lecture notes.

What is the core concept of asthma beyond being a simple bronchospasm?

Asthma is primarily a chronic inflammatory airway disease with superimposed bronchospasm.

What is the preferred diagnostic test for asthma and what finding supports the diagnosis?

Spirometry is the preferred test; diagnosis is supported by an increase in $FEV_1 \geq 12\%$ after a short-acting beta2-agonist.

What is the clinical role of peak expiratory flow meters in asthma management?

They are useful for monitoring asthma at home and detecting worsening control, but they are not preferred for initial diagnosis.

What physical exam findings are common during an asthma exacerbation?

Wheezing, hyperresonance to percussion, prolonged expiratory phase, decreased tactile fremitus, low diaphragms, and increased anterior-posterior diameter.

What are the clinical criteria for Intermittent Asthma severity classification?

Symptoms $\leq 2$ days per week, nighttime awakenings $\leq 2$ times per month, SABA use $\leq 2$ days per week, and $FEV_1 > 80\%$ predicted.

What characterizes Severe Persistent Asthma in terms of symptoms and lung function?

Symptoms occur throughout the day, nighttime awakenings often 7 times per week, several SABA uses per day, and $FEV_1 < 60\%$ predicted.

What is the criteria for 'Well-Controlled' asthma regarding SABA use and nighttime awakenings?

SABA use $\leq 2$ days per week and nighttime awakenings $\leq 2$ times per month.

According to the stepwise approach, what is the preferred treatment for Step 2 Mild Persistent Asthma?

Low-dose inhaled corticosteroid (ICS).

What is the preferred treatment combination for Step 3 Moderate Persistent Asthma?

Low-dose ICS plus a Long-Acting Beta2-Agonist (LABA) or medium-dose ICS.

What is the mechanism of action for Short-Acting Beta2-Agonists (SABA)?

They stimulate beta2 receptors to relax bronchial smooth muscle, causing bronchodilation.

What is a major safety warning regarding the use of Long-Acting Beta2-Agonists (LABAs) in asthma?

LABAs should never be used as monotherapy; they must be used in combination with inhaled corticosteroids.

How can patients prevent local side effects like oral candidiasis when using Inhaled Corticosteroids (ICS)?

Rinse the mouth after use and use a spacer with a metered-dose inhaler.

What is the mechanism of Omalizumab (Xolair) in treating allergic asthma?

It is a monoclonal antibody against $IgE$.

Which specific factor was listed in the text as NOT a risk factor for death from asthma?

Rural residence.

What objective diagnostic finding confirms persistent airflow obstruction in COPD?

A post-bronchodilator $FEV_1/FVC \leq 0.70$.

Define the $FEV_1$ range for GOLD 3: Severe COPD.

$30\text{--}49\%$ predicted.

What is the most important nonpharmacologic intervention for patients with COPD?

Smoking cessation, as it slows disease progression and improves outcomes.

What are the indications for long-term oxygen therapy in COPD regarding sea-level measurements?

$PaO_2 \leq 55\,mm\,Hg$ or $SaO_2 \leq 88\%$, or $PaO_2$ between $55\text{--}59\,mm\,Hg$ with signs of pulmonary hypertension, right heart failure, or polycythemia.

What are the clinical characteristics of Roflumilast used in COPD therapy?

It is a phosphodiesterase-4 inhibitor used for severe COPD associated with chronic bronchitis and exacerbations; it is not a bronchodilator.

What organism causes Tuberculosis (TB) and how is it transmitted?

Mycobacterium tuberculosis; transmitted via airborne droplet nuclei.

In which patient group is a Tuberculin Skin Test (TST) induration of $\geq 5\,mm$ considered positive?

HIV-infected persons, recent contacts of TB cases, persons with fibrotic chest x-ray findings, organ transplant patients, and other immunosuppressed patients.

What induration size is considered a positive TST for a person with no known TB risk factors?

$\geq 15\,mm$.

What defines Community-Acquired Pneumonia (CAP)?

Pneumonia beginning in a person who lives in the community, has not recently been hospitalized, and does not reside in a long-term care facility.

What physical findings suggest lung consolidation in a CAP patient?

Increased tactile fremitus, dullness to percussion, bronchial breath sounds, egophony, and crackles.

What are the most common and most fatal pathogens in CAP?

Streptococcus pneumoniae is the most common cause and the most common cause of fatal CAP.

How is Legionella transmitted to humans?

Through inhalation of aerosolized contaminated water from sources like air conditioning systems; it is not spread person-to-person.

What are the components of the CURB-65 severity score for pneumonia?

Confusion, Uremia ($BUN > 19\,mg/dL$), Respiratory rate ($\geq 30/min$), Blood pressure (low systolic or diastolic), and Age ($\geq 65$ years).

What is the recommended outpatient antibiotic for a healthy adult with CAP and no recent antimicrobial use?

Azithromycin.

What was identified as the exception among risk factors for Drug-Resistant S. pneumoniae (DRSP)?

Use of inhaled corticosteroids.

What percentage of acute bronchitis cases are viral and what is the typical cough duration?

Approximately $90\%$ are viral, and the cough can typically last up to 3 weeks.

What is the ranking of lung cancer as a cause of cancer-related death in men and women?

It ranks number 1.

What are the ACCP guidelines for annual lung cancer screening with CT?

Patients aged 55–74 years with a smoking history of at least 30 pack-years.

What clinical symptom in lung cancer patients typically suggests recurrent laryngeal nerve involvement rather than the primary tumor itself?

Hoarseness.