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WorksheetsSIMULATION EXAM ANDREWS/KESHVARA
Total questions: 81
Worksheet time: 6hrs 41mins
Which of the following should NOT be used as a monotherapy to treat asthma?
LAMA
LABA
SABA
Which of the following causes B cell isotype switching that results in IgE production?
IL-4
IL-5
IL-9
IL-13
Which of the following is responsible for eosinophilia in asthma?
IL-4
IL-5
IL-9
Which of the following is classified as LABA?
Albuterol
Terbutaline
Levalbuterol
Olodaterol
Which of the following has the longest duration of action?
Advair
Symbicort
Dulera
Breo Ellipta
Which of the following has the longest duration of action?
Ipratropium bromide
Aclidinium
Tiotropium
Glycopyrrolate
Which of the following inhibits the production of leukotrienes?
Roflumilast
Zyleuton
Montelukast
Which of the following is/are a leukotriene receptor antagonist(s)? [select all that apply]
Zyleuton
Montelukast
Zafirlukast
Roflumilast
Unlike in asthma, the inflammation in COPD mainly involves [select all that apply]
Mast cells
Helper T2 cells
Macrophages
Cytotoxic T cells
Which of the following is an antibody that binds to IL-5 receptor?
Omalizumab
Benralizumab
Reslizumab
Mepolizumab
Which of the following blocks the functions of both IL-4 and IL-13 receptors?
Dupilumab
Mepolizumab
Omalizumab
Benralizumab
Which of the following is/are the findings in atopy? Select all that apply
Increased IgE titer
Increased cyctotoxic T-cell count
Increased Th2 count
Eosinophilia
Increased Th1 count
Which of the following is/are characteristics of COPD that differentiate it from Asthma? Select all that apply
Hyperresponsive airways
IgE mediated inflammation
Presence of neutrophils and cytotoxic T cells
Inflammation damage to alveolar walls and lung parenchyma
Inflammation resistant to corticosteroid treatment
What are the beneficial effects of Beta 2 Agonists? Select all that apply
Increase in ciliary activity
Decreased plasma exudation
Mast cell stabilization
Reduced adhesion of bacteria to epithelium
Bronchodilation
What shows the yellow spot?
Increases GCC and decreases MCC, decreasing resistance to metabolism.
Increases GCC and decreases MCC, increasing resistance to metabolism.
It is required for glucocorticoid activity
It is converted to a hydroxy group during activation
It is converted to an ester during activation.
Which represents the most potent GCC?
What letter show an increase in GCC and MCC
A
B
C
D
What letter shows an increase in GCC activity only?
A
B
C
D
What letter represents suppression of MCC activity?
A
B
C
D
It increases both GCC and MCC
It increases GCC activity
It is removed during activation of this prodrug
Which of the following are effects of Glucocorticoids? Select all that apply
Loss of muscle mass
Gluconeogenesis
Decreased fibroblasts and collagen
Decreased osteoblasts
Redistribution of fat from limbs to trunk and face
Which of the following are the effects caused by Beta 2 Agonist Inhalers? Select all that apply
Bradycardia
Tachycardia
Somnolence
Nervousness
Muscle Tremors
LABA is often used alone in?
Asthma
COPD
Both ASTHMA and COPD patients
Which of the following is the function of PDE?
conversion of ATP to cAMP
conversion of cAMP to AMP
conversion of adenosine to AMP
Which of the following is the consequence of inhibiting PDE?
Decrease intracellular cAMP levels
Increase in intracellular cAMP levels
Roflumilast has an indicated use in which patients?
Asthma
COPD
Both Asthma and COPD
Arachidonic acid is derived from
Cholesterol
Membrane phospholipids
Which of the following is the most potent LT as far as bronchoconstriction goes?
LTC4
LTD4
LTE4
Which LT blocker has a shorter half life and a greater propensity to cause drug drug interactions?
Montelukast
Zafirlukast
Steroidal hormones are synthesized in?
adrenal medulla
adrenal cortex
Which of the following are the physiological effects of Cortisol? Select all that apply
Lipid redistribution
Increased gluconeogenesis
Thinning of skin
Insomnia
Increased glucose utilization by cells.
Which of the following are immune effects of Cortisol? Select all that apply
Increase in the number of circulating leukocytes
Decrease in the number of circulating leukocytes
Inhibition of leukotriene and prostaglandin production
Increases in IgE specific immune responses
Which of the following are a concern when using systemic glucocorticoids on a long term basis to treat Asthma? Select all that apply
Hyperglicemia
Weight gain
Hypotension due to mineralcorticoid activity
HPA supression
Diminished response in lungs due to tolerance
Which of the following is TRUE regarding Prednisone?
Prednisolone is a prodrug of prednisone
Prednisone is a prodrug of prednisolone
Prednisone is more potent than prednisolone
Which of the following is TRUE regarding Glucocorticoids? Select all that apply
Inhaled GCC reduce the number of eosinophils
Inhaled GCC reduce airway hyperresponsiveness over time
Inhales GCC increase the number of Beta 2 receptors within airways
Inhaled GCC becomes less effective over time due to desensitization
Which of the following GCC inhaler features are desirable? Select all that apply
greater first pass metabolism
limited tissue distribution
rapid systemic inactivation
rapid systemic absorption
high affinity for mineralcorticoid receptor
In this give structure of Fluticasone Furoate, what is the significance of the circled furoate ester?
It is removed as part of the activation of this prodrug.
It enhances the GCC activity of the drug.
It increases the first pass metabolism of the drug.
Which of the following binds to circulating IgE antibodies?
Omalizumab
Mepolizumab
Reslizumab
Mepolizumab decreases the effects of
IL-4
IL-5
IL-9
IL-13
Persistent inflammation or uncontrolled asthma will lead to? Select all that apply
Epithelial damage & loss of ciliated cells
Subepithelial fibrosis (collagen)
Myocyte hypertrophy
Angiogenesis (more edema)
Thickening of airways (decreased elasticity)
COPD is ? (Select all that apply)
Inflammation predominantly in small airways
Inflammation is chronic & minimally responsive to corticosteroids
Small airway narrowing & fibrosis (obstructive bronchiolitis)
Destruction of alveolar walls & lung parenchyma (emphysema)
Excessive mucus production (obstructive)
COPD Systemic manifestations? (Select all that apply)
Skeletal muscle wasting
Weight loss
Depression
Osteoporosis
Ischemic heart disease
COPD cellular components? Select all that apply
Cytotoxic T lymphocytes (Tc1)
Neutrophils
Macrophages
Mast cells
TH2
Which one activates B2 to lead to to Bronchodilation?
Sympathetic
Parasympathetic
Which one activates M3 to lead to to Bronchoconstriction mucus production ?
Sympathetic
Parasympathetic
Which of the following counseling points should discussed with a patient who is starting roflumilast therapy?
Do not use this medication with inhaled corticosteroids
This therapy should only be taken during periods of increased symptoms of exacerbation
A common side effect of this medication is gastrointestinal, including nausea
Take in divided doses at least twice daily
Which of the following best describes the impact of smoking cessation on the natural course of COPD?
Cessation allows recovery of the majority of excess loss of lung function.
Following cessation, the rate of loss of lung function decreases to that of a nonsmoker.
Significant increases in spirometry are evident within one year.
The risk for lung cancer is similar to life-long nonsmokers following cessation.
Conventional pharmacologic therapy for pulmonary arterial hypertension includes all of the following except:
Digoxin
Oxygen therapy
Sublingual nitroglycerin
Warfarin
Pulmonary hypertension can be defined as a mean pulmonary artery pressure of ≥____ mm Hg at rest with a pulmonary wedge pressure equal to or less than 15 mm Hg measured by right heart catheterization.
10
15
20
25
Which of the following is a risk associated with inhaled corticosteroid use for the treatment of COPD?
Increased mortality
Leukopenia
Osteoporosis
Pneumonia
Which of the following statements is CORRECT concerning ICS in the treatment of asthma?
Available ICS are equipotent based on a mcg to mcg comparison.
Advantages are high topical potency and low systemic activity.
Response to therapy is prompt, with resolution of symptoms within 3 to 4 days.
Therapeutic index is irrelevant to the delivery device
A patient presenting with no discomfort at rest but increased dyspnea, fatigue, and chest pain on exertion is classified in which World Health Organization functional class?
Class I
Class II
Class III
Class IV
Which of the following patients is expected to have a significant drop in oxygen saturation during a 6-minute walk test?
A 21-year-old female with uncontrolled asthma
A 65-year-old male with diffuse alveolar hemorrhage and a DLCO of 110%
A 60-year-old male with severe emphysema and a DLCO of 30%
A 50-year-old female with tracheal stenosis
Which of the following therapies is appropriate to reduce the risk for exacerbations from COPD?
Oral corticosteroids
Long-acting muscarinic antagonists
Antimicrobial agents
Inhaled corticosteroids
Which of the following counseling points is recommended for patient switching inhaled drug therapy from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI)?
Continue to use an ancillary holding chamber with the new inhaler
There is no need to exhale prior to use of the new inhaler
Use a rapid forceful inhalation effort to aerosolize the dose of the new inhaler
Rinse the new inhaler in warm water daily to ensure consistent dose delivery
Which one of the following statements is CORRECT concerning biologics in the treatment of asthma?
Omalizumab blocks release of interleukin-5
Reslizumab is administered subcutaneously.
Mepolizumab response is predicted by baseline blood eosinophil levels.
Dupilumab blocks the IL-5 receptor.
A 28-year-old woman presents to your clinic with increasing dyspnea with mild exertion for 1 year, chest tightness, and occasional ankle edema, consistent with World Health Organization Class II pulmonary arterial hypertension. The patient denies paroxysmal nocturnal dyspnea, orthopnea, wheezing, or palpitations but does report an 8-lb (3.6 kg) weight gain over the last year. The patient has no known drug allergies and is not currently taking any medications. She has previously been found unresponsive to acute vasoreactivity testing.
What is the most appropriate initial treatment for this patient?
Sildenafil 100 mg orally daily
Epoprostenol 2 ng/kg/min continuous infusion
Ambrisentan 5 mg orally daily
Amlodipine 5 mg orally daily
Which of the following pneumococcal vaccination strategies is recommended for 59-year-old patient with COPD?
PPSV 23 only (pneumococcal polysaccharide)
PCV 13 only (pneumococcal conjugate)
PPSV 23 (pneumococcal polysaccharide) now, and PCV 13 (pneumococcal conjugate) in 8 weeks
PCV 13 (pneumococcal conjugate) now, and PPSV 23 (pneumococcal polysaccharide) in one year
Which of the following estimates of cigarette smoking as a cause of COPD is most accurate?
12%
30%
55%
85%
Which of the following management strategies has been shown to reduce the progressive decline in lung function associated with COPD?
Smoking cessation
Inhaled corticosteroids
Long-acting beta agonists
Supplemental oxygen therapy
If unresponsive to acute vasoreactivity testing, the patient should not receive which class of drug therapy?
Calcium channel blockers
Endothelin antagonistsv
Phosphodiesterase inhibitors
Prostacyclin analogs
The diagnosis of “obstructive” pattern in pulmonary function testing requires one of the following:
Positive bronchodilator response
Increased FEV1/FVC ratio
Decreased FEV1/FVC ratio
Increased total lung capacity
Decreased residual volume
Epoprostenol is indicated for PAH patients in which of the following WHO functional classifications?
WHO functional class I and II
WHO functional class II and III
WHO functional class II, III, and IV
WHO functional class III and IV
Which of the following symptoms is not suggestive of pulmonary arterial hypertension?
Exertional chest pain
Syncope
Lower extremity edema
Wheezing
Which one of the following statements is CORRECT concerning the use of leukotriene modifiers in asthma management?
Evidence to support causality of suicidal thoughts and suicide with use of LTRA's is lacking.
LTRAs are more effective than LABAs as add-on to ICS therapy moderate persistent asthma.
Montelukast has increased efficacy over short-acting inhaled β2-agonists for the treatment of EIB.
Use of leukotriene modifiers is limited due to the potential for renal toxicity.
Which of the following medication classes is utilized in the treatment of an acute exacerbation of COPD?
Short-acting beta agonists
Long-acting beta agonists
Inhaled corticosteroids
Long-acting muscarinic antagonists
Which one of the following is NOT a mediator associated with airway inflammation?
Histamine
Goblet cells
Leukotrienes
Prostaglandins
Which of the following medications is associated with significant elevations in aminotransferases, requiring baseline and monthly monitoring?
Epoprostenol
Amlodipine
Sildenafil
Bosentan
Which of the following best describes the mechanism of action of Epoprostenol?
A competitive antagonist of endothelin receptors, causing vasodilation of the pulmonary vasculature
Phosphodiesterase inhibition, causing an increase in cyclic guanosine monophosphate leading to vasorelaxation
Inhibition of influx of extracellular calcium, leading to vasodilation
Direct vasodilation of pulmonary vascular beds as well as inhibition of platelet aggregation
Which of the following medications does NOT trigger asthma symptoms?
Aspirin
Naproxen
Propranolol
Penicillin
Which of the following is recommended for a patient who continues to experience symptoms of COPD despite treatment with a single long-acting bronchodilator therapy?
Add a scheduled short-acting bronchodilator agent
Add an inhaled corticosteroid
Add another long-acting bronchodilator
Add a chronic anti-inflammatory such as azithromycin
Infection, catheter obstruction, and sepsis are potentially serious complications of which of the following drugs?
Bosentan
Sildenafil
Treprostinil
Diltiazem
Which of the following has been shown to be an achievable outcome of pharmacotherapy for chronic management of COPD?
Reduced mortality
Normalization of spirometry
Reduced exacerbations
Prevention of accelerated loss of lung function
Which one of the following statements is CORRECT about the major characteristics of marketed dry powder inhalers (DPIs) used to deliver drugs to the lungs?
Drug delivery is breath-actuated, requiring minimal hand–lung coordination by the patient.
DPI's have been standardized to require the same inspiratory flow rate.
Only inhaled corticosteroids are available as a DPI.
Slow inhalation from the device is needed for optimal lung deposition of the powder.
Which one of the following is NOT a dry powder inhaler?
Diskus
Flexhaler
Respimat
Twisthaler
Which of the following agents is not used for acute vasoreactivity testing in pulmonary arterial hypertension?
Epoprostenol
Nitroglycerin
Adenosine
Nitric oxide
Women of child-bearing age with pulmonary arterial hypertension should be counseled on the risks of pregnancy. Which of the following medications is teratogenic in pregnancy?
Macitentan
Amlodipine
Epoprostenol
Diltiazem
A positive bronchodilator response is defined as:
Increase in FEV1 >500 mL
Increase in FEV1>200 mL
Increase in FEV1>12%
Increase in FEV1 >200 mL and 12%
For a patient newly diagnosed with Gold stage 1, category A COPD, which of the following pharmacotherapy strategies is recommended?
Start an inhaled corticosteroid
Start an inhaled bronchodilator
Start an oral leukotriene modifier
Start supplemental oxygen
A 37 year old female presents with the following: FEV1 76% predicted, use of albuterol (for rescue) 5-6 days/week, waking with asthma symptoms 4-5 times/month, and increased asthma symptoms during her daily walk to work and workouts. Her asthma severity would be classified as:
Intermittent
Mild
Moderate
Persistent
