Just the basics Mam
Is this a good test?
All the living things
ITS SNOT JUST SNOT
What does this mean?
100
Name the 2 most common symptoms of vasomotor rhinitis.
What is Runny nose "RUNNERS"
and Stuffy nose "BLOCKERS"
Other symptoms include:
Postnasal drip
Sneezing
Diminished sense of smell
100
What information must we confirm is accurate each time we perform spirometry? And why does it matter?
Age
Height
Weight
Race
They are all factors that influence lung function.
100
I am made of living organisms or their components and target specific parts of the immune system that contribute to chronic inflammatory diseases.
What are biologics
100
I can cause nasal congestion and loss of smell.
What are nasal polyps
100
What is this phenomenon called?
What is Dermatographia
200
Why are the peak flows so different?
What is INCOMPLETE (or submaximal) INHALATION
Can see as difference in the peak flow between efforts with generally similar shaped curves. This is a frequent problem
Will decrease FVC and could cause falsely restrictive pattern.
Solution: Coach the subject to FILL THEIR LUNGS, taking the deepest possible breath.
200
I block IgE, and am especially helpful for patients with chronic urticaria
What is Xolair
200
Name 3 biologics
Xolair
Dupixent
Nucala
Tezspire
200
Any noted issue here? How would you troubleshoot these results?
#2 IDT negative
*Manual error in entry
*IDT placed too small
*IDT read too late
*Elder patients and some others with skin conditions may limit skin reactivity.
==> Consider immunocap testing if clinically indicated.
300
What type of medications do we avoid before spirometry and why?
We avoid short acting and long acting beta-2 agonists as they cause bronchodilation and can affect test results.
300
What error in testing is shown here
Cough
Significant coughing may cause a falsely reduced FVC. In any case, because the FEV1 /FVC ratio may be inaccurate, the maneuver is unacceptable.
Solution: Coughing is difficult to manage. Offering a drink of water before the maneuver may help.
300
I am often used if there is elevation of eosinophils. I block the production of eosinophils through blocking Interleukin 5 (IL-5)
What is Nucala
300
What are three indications for biologic therapy
Asthma
Nasal polyps
Atopic Dermatitis
EoE
300
What pattern are you seeing here (eg. normal, restrictive, obstructive). Describe expected FVC, FEV1 and FEV1/FVC
What is restriction.
The FVC and FEV1 would both be low
The ratio would be NORMAL.
This is not a pattern consistent with asthma.
400
Patient is having large local reactions in July. This is is vial formulation. What are your thoughts?
*Ensure pt is taking antihistamine day of shot. Can double up if needed.
*Are they eating a lot of cross reactive foods?
*Considering separating grasses into 2 vials.
400
What is wrong with this patients technique?
What is a POOR INITIAL BLAST
The peak on the curve is REDUCED, indicating insufficient subject effort — the weaker the blast, the lower the peak (PEF).
Test Result Implications: A curve with low peak flow will have falsely reduced FEV1 and FEV1 /FVC ratio that may be misinterpreted as “obstructive impairment”
Solution: Coach the subject to blast the air out HARDER.
400
I am a fully-human monoclonal antibody that works by blocking interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins from attaching to cell receptors
What is Dupixent
400
Patient is on maintenance. Notes their perennial (year round) symptoms are better, but still having problems in the spring. Vial A: T G W M
What would you recommend?
Separate molds into 2nd vial given proteolytic nature of the molds.
400
Patient is currently on albuterol as needed. How do you advise they proceed based off this test?
Their obstruction improved with albuterol, which means patient could have better control of their asthma. They should be on a MAINTENANCE INHALER (ICS or ICS/LABA).
500
What are the 4 most common molds?
Alternaria
Aspergillus
Cladosporium
Penicillium
500
What is wrong with this patients technique?
What is HESITATION.
The peak flow is shifted to the RIGHT. Can falsely ELEVATE the FEV1
Solution: Coach the subject to blast FASTER or IMMEDIATELY
500
I am the king of biologics. I block the tippy top of the inflammatory cascade, blocking TLSP (thymic stromal lymphopoietin), and I am approved for severe asthma.
What is Tezpire