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emergency care
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Pharmacology
100
A 14 year old who: uses her albutrol once a week, has symptoms once per week, has no limitation in daily activities, coughs two nights per month has an FEV1 of 85% predicted.
What is Intermittent asthma.
100
A clinician's ability to do this is as important as prescribing the right medicine for asthma.
What is communicate effectively with the patient? Good communication between patient and clinician helps identify patient concerns that may block adherence, makes patient teaching more effective and promotes patient self-confidence to follow the treatment plan. It may take several standard primary care visits to efficiently and effectively accomplish initial patient education. 39% believe medicines are addictive. 36% believe medicines are not safe to take over a long period. 58% believe regular use will reduce effectiveness
100
The next step in treatment at home if peak flow remains < 50% of personal best after an Albuterol treatment.
What is repeat the Albuterol immediately?
100
The treatment for intermittent asthma.
What is short acting beta agonist as needed.
100
The mechanism of action of Montelukast.
What is a leukotriene receptor antagonist?
200
A 7 year old who: uses their Albuterol once daily Has three night time awakenings per month Has no limitation in activity
What is Moderate Persistent asthma? Daily use of Albuterol puts this child into a Moderate category.
200
Daily use of this asthma medication is associated with increased mortality and diminished symptom control.
What is Albuterol?
200
The severity of an asthma exacerbation when a patient can talk in phrases.
What is a Moderate exacerbation? Severe = talk in words.
200
The treatment of choice for severe persistent asthma, step 5, in a 12 year old.
What is a high dose inhaled corticosteroid and a LABA?
200
The preferred therapy for exercise induced asthma.
What is a short acting bronchodilator/short acting beta2 agonist/albuterol or xoponex?
300
A 1year old who wakes up more than one night per week due to asthma. Has daytime symptoms twice per week Has mild limitation of activity
What is Severe persistent asthma? Waking up more than once per week due to asthma puts this child into a severe category.
300
A 14year old female with severe persistent asthma is brought to the ED in status asthmaticus by her friends late Saturday night. They admit that they ahd been partying together at a "trashcan" party". This is the most likely ingested chemical causing her difficulty breathing.
What are Sulfites? Known to trigger life threatening asthma. Found in wines and beers, condiments, trail mix, soup mixes, quacamole, shrimp and processed foods.
300
A 5 year old boy with moderate persistent asthma has hives and wheezing while eating out with his family. Symptoms are relieved with Albuterol and benedryl. This is the mechanism of his difficulty breathing 6 hours later.
What is late phase IgE-mediated allergic response. Occurs 4-12 hours after initial response.
300
This medication can be used as an alternative to low dose inhaled corticosteroids in mild persistent asthma in a 6 month old.
What is Montelukast (Cromolyn is also acceptable answer)?
300
The mechanism of action of Formeterol.
What is a long acting beta-agonist?
400
A 12 year old who wakes up two nights per week due to asthma. Has a FEV1 of 65% Has daily symptoms
What is moderate persistent? All of these put patient in moderate persistent category.
400
You assess a 9 year old female in your primary care office whom you suspect to have asthma. You assess Albuterol use, activity limitation, night time cough, and frequency of symptoms as well as perform a physical exam. What other piece of valuable information should you collect to determine if she has asthma?
What is spirometry? Office based physicians who care for asthma patients should have access to spirometry, which is useful in both diagnosis and periodic monitoring. One study reports that one-third of the children who had moderate to severe asthma were reclassified to a more severe asthma category when pulmonary function reports of FEV1 were considered in addition to symptom frequency (stout et al. 2006) Conversely, a majority of children in another study who had mild-to-moderate asthma classified by symptoms had normal FEV1(Bacharier et al. 2004).
400
This medication can be used in an emergency situation if albuterol is not available.
What is subcutaneous epinephrine or terbutaline?
400
The next step when evaluating a child with 4 year history of severe persistent asthma who went from the 50% in height to the 25%.
What is order a cortisol level?
400
You are seeing a 17 year old female with history of moderate persistent asthma for your partner. She was seen 3 months ago for a well visit and her asthma was under good control. She comes today with complaints of worsening control over the last 2-3 months. She is accompanied to clinic with her boyfriend today who reports that she has been coughing more at night and is short of breath when playing tennis. You should look for use of this medication.
What is an estrogen based birth control?
500
An 11 year old with an FEV1 of 70% predicted.
What is Moderate Persistent asthma? 60-80% is moderate < 60% is severe > 80 is intermittent to mild
500
Sensitivity to this mold is related to an increased risk of death from asthma.
What is alternaria?
500
The proper disposition of a 12 year old patient with asthma in the ED with a RR of 42 and a PaCO2 of 43.
What is admission to the PICU?
500
This treatment should be considered for a 12 year old with environmental allergies who is not well controlled on high dose inhaled steroids, oral steroids and a LABA.
What is Omalizumab (xolair) An immunomodulator that blocks the IgE antibody from binding to it's receptor site on basophils and mast cells.
500
A lipophilic side chain helps this medication attach to the plasma membrane and increases duration of it's binding.
What are long acting beta agonists?