Asthma and Respiratory Disorders Quiz

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Questions and Answers

What is pleurodesis used for?

To prevent recurrent pneumothoraces (correct)

To diagnose pleural effusion

To treat tuberculosis

To remove fluid from the pleural space

What is a significant physical exam finding in pleural effusion?

Wheezing breath sounds

Increased tactile fremitus

Wet cough

Dullness to percussion (correct)

Which of the following conditions can cause pleural effusion?

Asthma exacerbation

Liver cirrhosis

Chronic bronchitis

Left heart failure (correct)

Barotrauma leading to pneumothorax can occur due to what activity?

Rapid ascent from underwater Signup and view all the answers

Meigs syndrome is characterized by which triad?

Ovarian fibroma, ascites, right-sided pleural effusion Signup and view all the answers

What is the primary management strategy for an acute asthma attack?

Nebulized albuterol, oxygen, and IV methylprednisolone Signup and view all the answers

Which medication should be commenced for a patient with asthma who has had 2 or more episodes per week?

Inhaled corticosteroids Signup and view all the answers

What is the most common cause of bronchiectasis in western countries?

Smoking Signup and view all the answers

What does the presence of 'cups and cups of foul-smelling sputum' indicate in patients with bronchiectasis?

Bacterial infection, particularly with anaerobes Signup and view all the answers

What imaging finding is characteristic of bronchiectasis?

Cystic dilation of the airways Signup and view all the answers

Why should inhaled corticosteroids be prescribed at discharge for an asthma patient who required hospitalization?

To ensure long-term asthma management Signup and view all the answers

What misconception might students have regarding initial asthma therapy for patients with frequent episodes?

Inhaled corticosteroids should be delayed until after albuterol Signup and view all the answers

What condition is least likely to cause bronchiectasis?

Asthma Signup and view all the answers

What notable skin change is associated with cholesterol embolism following an abdominal aortic aneurysm (AAA) repair?

Violaceous lesions on the feet Signup and view all the answers

Which of the following is a characteristic found in a cholesterol embolism under polarized light?

Maltese crosses Signup and view all the answers

What is often required to diagnose pulmonary contusion after trauma?

Diagnosis of exclusion Signup and view all the answers

Which of the following descriptions is typically NOT associated with pulmonary contusion?

Severe bruising over the anterior abdomen Signup and view all the answers

In the context of a traumatic injury, what is a significant sign of flail chest?

Paradoxical breathing Signup and view all the answers

Which condition could potentially be confused with pulmonary contusion if rib fractures are present?

Myocardial contusion Signup and view all the answers

What is the primary treatment recommended for sarcoidosis presenting as lupus pernio?

Oral prednisone Signup and view all the answers

What type of lung finding can be described as ‘white-out’ in typical references, although not common on exams?

Pulmonary contusion Signup and view all the answers

What may suggest a worsening condition if a patient with pulmonary contusion receives IV saline?

Worsening of oxygen saturation Signup and view all the answers

Which condition is most commonly associated with pulmonary fibrosis in patients with rheumatoid arthritis?

Methotrexate therapy Signup and view all the answers

What is the most common ECG finding indicative of pulmonary embolism?

Sinus tachycardia Signup and view all the answers

Which of the following is the first step in managing a suspected pulmonary embolism?

Administration of heparin Signup and view all the answers

In pregnant patients suspected of having a pulmonary embolism, which diagnostic test is preferred over CT?

V/Q scan Signup and view all the answers

What is the most common cause of death from pulmonary embolism?

Ventricular fibrillation Signup and view all the answers

What acid-base disturbance is typically observed in patients with acute pulmonary embolism?

Respiratory alkalosis Signup and view all the answers

In a patient already on warfarin who develops a pulmonary embolism, what is the first step for diagnosis?

CT scan of the chest Signup and view all the answers

Which of the following is the most common cause of fever within 24 hours post-surgery?

Atelectasis Signup and view all the answers

What does the term 'atelectasis' refer to?

Lung collapse or collapse of alveoli Signup and view all the answers

In cystic fibrosis (CF), what is the more accurate diagnostic test compared to genotyping?

Sweat chloride test Signup and view all the answers

What condition can male patients with cystic fibrosis have that affects their fertility?

Congenital bilateral absence of vas deferens (CBAVD) Signup and view all the answers

What is the chance that a phenotypically normal sibling of a cystic fibrosis patient is a carrier of the disease?

2/3 Signup and view all the answers

Which of the following CF medications aids with structural folding and localization of CFTR to the cell membrane?

Ivacaftor Signup and view all the answers

What is the function of dornase-alfa in cystic fibrosis treatment?

Softens mucus Signup and view all the answers

Which of these statements about cystic fibrosis is true?

Many mutations in the CFTR gene can cause the disease. Signup and view all the answers

What is the significance of early-onset emphysema and cirrhosis in a patient who smokes or consumes alcohol?

They rule out alpha-1 antitrypsin deficiency. Signup and view all the answers

Which type of asthma primarily presents with a dry cough without breathing difficulties?

Cough-variant asthma Signup and view all the answers

What is the mechanism behind aspirin-induced asthma?

Inhibition of cyclooxygenase leading to bronchoconstriction Signup and view all the answers

What does the term 'increased expiratory phase' indicate?

Obstructive pathology affecting exhalation Signup and view all the answers

What occurs acutely during an asthma attack in terms of blood gas levels?

Decreased CO2, increased pH, unchanged bicarbonate Signup and view all the answers

What is a key characteristic of patients with Samter triad?

Nasal polyps, aspirin allergy, and asthma Signup and view all the answers

Why is bicarbonate unchanged during an acute asthma attack?

It takes the kidneys time to adjust. Signup and view all the answers

In chronic obstructive pulmonary disease (COPD), what happens to CO2 levels?

CO2 levels rise due to hypoxic vasoconstriction. Signup and view all the answers

Study Notes

Asthma

USMLE questions may include smokers or alcohol drinkers. Early-onset emphysema and cirrhosis are increased risks with smoking/alcohol use. Typically, COPD takes 20+ years of smoking to develop.
Bronchospasm can be idiopathic, hereditary, or triggered by allergens or cold air.
Cough-variant asthma is a presentation where the patient only has a dry cough, with no other breathing problems. These coughs are often worse in winter.
Asthma can be part of a larger constellation of atopic symptoms, such as seasonal allergies, conjunctivitis, or eczema.
Aspirin-induced asthma involves inhibition of COX by aspirin, leading to an increase in leukotrienes and bronchoconstriction. The Samter triad includes aspirin allergy, asthma, and nasal polyps.
Increased expiratory phase is a descriptor not specific to asthma, but common in obstructive lung diseases. Exhaling takes longer with asthma (↓ FEV1).
Respiratory alkalosis during an acute asthma attack is characterized by decreased CO2 and increased pH; Bicarbonate remains stable initially.
Type I respiratory failure, or acute asthma attacks, present with decreased CO2, and increased pH. Low pH and CO2 are followed by a return to normal as the patient tires. The patient will then transition to type II respiratory failure (hypoventilation): increased CO2, and decreased O2.
Spirometric testing (the primary initial diagnostic test) shows a concave expiratory portion of the curve.
Methacholine challenges can be performed for diagnosis. These agonists trigger bronchoconstriction and can be used between acute episodes.
Outpatient asthma management often includes beta2-agonists (albuterol) for acute attacks, followed by increasing ICS dose, LABA (salmeterol) if necessary, and other medications for continued episodes or poor response. Oral prednisone is a last resort for outpatient management.
Inhaled corticosteroids are critical for long-term management

Bronchiectasis

Bronchiectasis is most common worldwide due to TB, and in western countries, CF. It often presents with increased amounts of foul-smelling sputum.
Common in smokers.
Bronchiectasis can be a consideration in a child with right middle lobe syndrome and scant white sputum.
Clubbing of the fingernails is a possible characteristic.

Atelectasis

Atelectasis, or lung collapse, is a common cause of fever within 24 hours of surgery.
Patient pain and sedation contribute to slower, shallow breathing, and hence alveoli collapse.
Present as opacities or shadows in the lower lung fields, usually in bibasilar areas.

Obstructive Sleep Apnea (OSA)

OSA includes obstructive (due to obesity) or central (due to brain) forms.
Its primary symptom is respiratory acidosis (decreased pH, decreased bicarbonate, increased CO2)
Cor pulmonale and pulmonary hypertension can be secondary complications.
Sleep study (polysomnography) is crucial for diagnosis

Anaphylaxis

Acute dyspnea and bilateral wheezing is characteristic.
Frequently triggered by bee stings, certain foods (peanuts,), or new medications.
Signs include: tachycardia, low blood pressure, and often generalized inflammation.
Intramuscular epinephrine is the first-line treatment.
Venom immunotherapy can prevent future reactions.

Shellfish Allergy

Shellfish reactions can resemble asthma.
Reactions occur immediately after consumption of shellfish.

Cystic Fibrosis

Genetic disorder where defective CFTR protein leads to mucous accumulation.
Inspissated secretions cause obstructive lung complications.
Patients display exocrine pancreatic insufficiency and fat-soluble vitamin deficiencies (often vitamin E deficiency).
Key presentations include meconium ileus, nasal polyps, and recurrent pneumonia associated with bacterial infections, especially Pseudomonas and S. aureus
Sweat chloride testing is more reliable than genetic testing.
Male patients may present with congenital bilateral absence of the vas deferens (CBAVD).

Primary Ciliary Dyskinesia (Kartagener Syndrome)

Inherited disorder impacting cilia function, leading to recurrent infections and potential situs inversus (reversed organ placement). This diagnosis is suggested by the presence of a 'kartagener syndrome' or 'reversed organ placement' in patients with recurrent pneumonias.
Situs inversus means the organs are on the opposite side of the body.

Primary Pulmonary Hypertension (PPH)

Idiopathic disorder characterized by elevated pulmonary vascular resistance and hypertension.
High endothelin-1 levels are frequently observed.
PPH is distinguished from cor pulmonale (right sided heart failure) in that the cause of the hypertension is pulmonary versus a circulatory (systemic) origin.

Systemic Sclerosis (Scleroderma)

Autoimmune condition marked by multi-organ fibrosis and hardening.
Divided into limited (CREST) and diffuse subtypes.
Pulmonary fibrosis and hypertension are significant complications.
Treatment focuses on managing symptoms and complications.

Sarcoidosis

A granulomatous disease with non-caseating granulomas in multiple organs.
It often involves the lungs, leading to progressive lung fibrosis.
A feature of note is elevated levels of 1,25-dihydroxyvitamin D and low PTH (parathyroid hormone), due to dysregulation of the 1-alpha hydroxylase enzyme. The elevated 1,25-dihydroxyvitamin D has systemic effects including elevated serum calcium.
High suspicion for sarcoidosis if an African-American woman presents with a 6+ month cough, red shins (erythema nodosum), and low-grade fever.
Characteristic findings are often hilar lymphadenopathy on chest X-ray or CT.

Rheumatic Lung

Rheumatoid arthritis can lead to restrictive lung disease, and methotrexate, a DMARD commonly used to treat RA, may increase risk of pulmonary fibrosis.

Pulmonary Embolism (PE)

PE results from a detached thrombus (usually from a deep vein thrombosis) traveling to the lungs.
Patients commonly present with pleuritic chest pain, dyspnea, and tachycardia.
Chest CT scan is the usual method to assess for PE.
Initial treatment for PE is heparin followed by CT-imaging.

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Description

Test your knowledge on asthma, its triggers, and associated conditions like COPD and allergic responses. This quiz covers key concepts including cough-variant asthma, aspirin-induced asthma, and the physiological changes during an asthma attack. Perfect for medical students preparing for the USMLE.