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Questions and Answers
What type of respiratory failure occurs during an acute asthma attack?
What type of respiratory failure occurs during an acute asthma attack?
Which diagnostic tool is preferred to initiate diagnosis in a suspected asthma case?
Which diagnostic tool is preferred to initiate diagnosis in a suspected asthma case?
If a patient experiences weekly asthma episodes, what is the next step in management after starting albuterol?
If a patient experiences weekly asthma episodes, what is the next step in management after starting albuterol?
What response occurs when a patient with asthma begins to fatigue and breathing rate slows?
What response occurs when a patient with asthma begins to fatigue and breathing rate slows?
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Which medication is considered the first-line treatment for acute asthma attacks?
Which medication is considered the first-line treatment for acute asthma attacks?
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In case of inadequate control with albuterol and inhaled corticosteroids, what is the next recommended step?
In case of inadequate control with albuterol and inhaled corticosteroids, what is the next recommended step?
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Which of the following is true about methacholine testing for asthma diagnosis?
Which of the following is true about methacholine testing for asthma diagnosis?
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What treatment should be considered for an asthma patient with a history of aspirin allergy?
What treatment should be considered for an asthma patient with a history of aspirin allergy?
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What condition is indicated by a patient experiencing early-onset emphysema and cirrhosis despite relatively short smoking history?
What condition is indicated by a patient experiencing early-onset emphysema and cirrhosis despite relatively short smoking history?
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Which of the following best describes cough-variant asthma?
Which of the following best describes cough-variant asthma?
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What is the primary mechanism behind aspirin-induced asthma?
What is the primary mechanism behind aspirin-induced asthma?
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Which phrase is commonly associated with asthma and indicates prolonged exhalation?
Which phrase is commonly associated with asthma and indicates prolonged exhalation?
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In patients with acute asthma, what changes occur in arterial blood gas values?
In patients with acute asthma, what changes occur in arterial blood gas values?
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What characterizes Samter's triad?
What characterizes Samter's triad?
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What is typically unchanged during an acute asthma attack?
What is typically unchanged during an acute asthma attack?
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What is a standard clinical observation during an obstructive lung disorder like asthma?
What is a standard clinical observation during an obstructive lung disorder like asthma?
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What laboratory findings can indicate lactic acidosis due to ischemia from poor perfusion?
What laboratory findings can indicate lactic acidosis due to ischemia from poor perfusion?
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In a patient who has just given birth, what is the likely cause of sudden shortness of breath and tachycardia 30 seconds to 2 minutes after delivery?
In a patient who has just given birth, what is the likely cause of sudden shortness of breath and tachycardia 30 seconds to 2 minutes after delivery?
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What is the primary purpose of pleurodesis in patients with recurrent pneumothoraces?
What is the primary purpose of pleurodesis in patients with recurrent pneumothoraces?
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Which of the following conditions can lead to lactic acidosis?
Which of the following conditions can lead to lactic acidosis?
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What is the primary reason for avoiding systemic corticosteroids in acute asthma management?
What is the primary reason for avoiding systemic corticosteroids in acute asthma management?
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In the management of very small pneumothoraces in stable patients, what is the recommended approach?
In the management of very small pneumothoraces in stable patients, what is the recommended approach?
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Which mechanism describes how a pneumothorax might occur due to pulmonary barotrauma?
Which mechanism describes how a pneumothorax might occur due to pulmonary barotrauma?
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What condition may present with bleeding from intravenous sites following delivery of the placenta?
What condition may present with bleeding from intravenous sites following delivery of the placenta?
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What must be administered to an asthma patient upon hospital discharge if they were not previously on any inhaled corticosteroids?
What must be administered to an asthma patient upon hospital discharge if they were not previously on any inhaled corticosteroids?
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What physical exam findings are consistent with pleural effusion?
What physical exam findings are consistent with pleural effusion?
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What typical sign may indicate fat embolism in a patient with recent long-bone fracture?
What typical sign may indicate fat embolism in a patient with recent long-bone fracture?
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Which of the following describes the most common cause of bronchiectasis in Western countries?
Which of the following describes the most common cause of bronchiectasis in Western countries?
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Which condition is characterized by a triad of ovarian fibroma, ascites, and right-sided pleural effusion?
Which condition is characterized by a triad of ovarian fibroma, ascites, and right-sided pleural effusion?
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What type of sputum is typically associated with bronchiectasis?
What type of sputum is typically associated with bronchiectasis?
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What specific staining technique is used for a pulmonary biopsy to confirm fat embolism?
What specific staining technique is used for a pulmonary biopsy to confirm fat embolism?
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What is a potential fatal outcome from air embolism following the insertion of a central venous line?
What is a potential fatal outcome from air embolism following the insertion of a central venous line?
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In a case involving a child who has scant white sputum and linear opacity in the right middle lobe, which diagnosis is likely?
In a case involving a child who has scant white sputum and linear opacity in the right middle lobe, which diagnosis is likely?
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What is the role of inhaled corticosteroids in asthma management for patients with frequent episodes?
What is the role of inhaled corticosteroids in asthma management for patients with frequent episodes?
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What condition commonly leads to low bicarb levels during shock?
What condition commonly leads to low bicarb levels during shock?
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What is the typical radiological finding in bronchiectasis on a transverse CT scan?
What is the typical radiological finding in bronchiectasis on a transverse CT scan?
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Which option is NOT part of the acute management protocol for a severe asthma attack?
Which option is NOT part of the acute management protocol for a severe asthma attack?
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What is the most common ECG finding for a pulmonary embolism?
What is the most common ECG finding for a pulmonary embolism?
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Which treatment is the first step in managing a suspected pulmonary embolism?
Which treatment is the first step in managing a suspected pulmonary embolism?
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What is the most specific finding on ECG for pulmonary embolism that is not commonly found in multiple-choice questions?
What is the most specific finding on ECG for pulmonary embolism that is not commonly found in multiple-choice questions?
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What are the acid-base changes seen in pulmonary embolism?
What are the acid-base changes seen in pulmonary embolism?
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If a patient on warfarin develops a pulmonary embolism, what is the first step in management?
If a patient on warfarin develops a pulmonary embolism, what is the first step in management?
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Which condition is a restrictive lung disease caused by rheumatoid arthritis?
Which condition is a restrictive lung disease caused by rheumatoid arthritis?
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What is the primary reason to use a V/Q scan instead of a CT for diagnosing pulmonary embolism?
What is the primary reason to use a V/Q scan instead of a CT for diagnosing pulmonary embolism?
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What condition can result from a combination of rheumatoid arthritis and methotrexate treatment?
What condition can result from a combination of rheumatoid arthritis and methotrexate treatment?
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Study Notes
Asthma
- Asthma can present with bronchospasm, either idiopathic or triggered by allergens or cold air.
- A subset of asthma patients present only with a persistent cough, termed cough-variant asthma.
- Asthma can manifest alongside other allergic conditions, such as seasonal allergies, conjunctivitis, or eczema.
- Aspirin can induce asthma in individuals with sensitivity to aspirin by inhibiting COX and increasing leukotriene production. This triad is also called Samter's triad.
- During an asthma attack, expiratory phase is prolonged. Acutely, patients experiencing asthma show decreased CO2, increased pH, and unchanged bicarbonate levels. This is acute respiratory alkalosis, caused by increased breathing rate.
- Chronic bronchitis, in contrast, shows increased CO2 because of impaired CO2 diffusion in the lungs due to mucous buildup and hypoxic vasoconstriction.
- Acute asthma attacks can lead to type I respiratory failure, with decreasing respiratory rate and increase in CO2 levels. Eventually, type II respiratory failure results.
- Initial diagnostic step for patients with asthma is a spirometry test to determine expiratory curve.
- Methacholine challenge can also diagnose asthma as the allergen may constrict airways.
- Typical treatment for asthma includes beta-2 agonists (e.g., albuterol) for acute attacks and inhaled corticosteroids (e.g., fluticasone) for long-term management.
- Patients with frequent attacks (2+ per week) often require dual therapy, combining inhaled corticosteroids and beta-2 agonists.
Bronchiectasis
- Bronchiectasis is characterized by chronic dilation of the bronchial airways.
- Worldwide, Tuberculosis is a main cause of bronchiectasis. In Western Countries, cystic fibrosis is a major cause.
- The condition is often presented with excessive, foul-smelling sputum production.
- Clubbing of the fingers is a common observation in patients with bronchiectasis.
Atelectasis
- Atelectasis refers to the collapse of alveoli in the lung.
- This is a common complication following surgery, often occurring within the first 24 hours.
- Atelectasis presents as bibasilar shadows or opacities on chest X-rays with fever in the post-surgery patient.
- Obstructive atelectasis occurs distal to an obstruction.
- The most common cause of atelectasis is obstruction from tumor or foreign body.
- The onset of fever within 24 hours of surgery is a high-yield indicator for atelectasis in 2CK exams.
Obsessive Sleep Apnea (OSA)
- Characterized by periods of cessation of breathing during sleep.
- Risk factors include obesity, and age.
- Diagnosis is done through sleep studies (polysomnography).
- Chronic fatigue is often associated which leads to dysthymia or depression.
Anaphylaxis
- Acute allergic reaction, triggered by exposure to allergens.
- Presents with symptoms such as dyspnea, bilateral wheezing, tachycardia, and hypotension.
- Common causes are insect stings, medications, and foods.
- Treatment involves administration of intramuscular epinephrine and supportive care.
- Venom immunotherapy can reduce the chances of future events.
Scombroid
- This is food poisoning caused by bacteria in certain fish. The poisoning can mimic symptoms of allergic reactions, asthma, or anaphylactic shock and hence it is important for students to distinguish between Scombroid and allergic reactions.
Shellfish Allergy
- A Type I hypersensitivity (IgE-mediated) reaction to shellfish consumption.
- Symptoms include respiratory distress, and skin rashes.
- It is important to distinguish it from Scombroid.
Cystic Fibrosis
- It is also caused by mutations in the CFTR gene on chromosome 7.
- The main mutation is ΔF508 which causes abnormal CFTR protein folding.
- CFTR protein is a chloride channel which is important for secretion of mucus.
- In CF, the chloride channel is mislocalized, resulting in inspissated secretions in the lungs, digestive tract leading to pancreatic insufficiency.
- Meconium ileus; is the symptom that is seen in infants.
- Sweat test (sweat chloride > 60 mEq/L) is used for diagnosis.
- Secondary complications include nasal polyps, and recurrent pneumonias.
Primary Ciliary Dyskinesia (Kartagener Syndrome)
- The condition is often characterized by situs inversus (mirror-image organization of organs)
- Dynein arms causing impaired cilia function are the cause.
- Patients often have recurrent respiratory infections.
Primary Pulmonary Hypertension (PPH)
- This is characterized by pulmonary hypertension that is not caused by other conditions such as COPD or left heart failure.
- Mutations and dysfunction in the BMPR2 gene is the cause in most cases.
- Patients often have symptoms of dyspnea, fatigue, and edema.
- Elevated endothelin-1 levels are a characteristic feature.
- Bosentan (an endothelin receptor antagonist) is a treatment option.
Systemic Sclerosis (Scleroderma)
- An autoimmune condition characterized by fibrosis (scarring) of the skin and internal organs.
- The distinction between limited and diffuse scleroderma (CREST syndrome) subtypes is a key factor.
- Pulmonary fibrosis is a prominent feature which leads to pulmonary hypertension.
Sarcoidosis
- Characterized by the presence of non-caseating granulomas in multiple organs, notably the lungs.
- The condition can cause hypercalcemia due to inappropriate 1,25-(OH)2-D3 production.
Rheumatoid Lung
- Rheumatoid lung is a possible complication of rheumatoid arthritis.
- It's characterized by fibrosis and can lead to respiratory distress.
- Methotrexate, a medication used to treat rheumatoid arthritis, is associated with pulmonary fibrosis, as the most common cause.
Pulmonary Embolism (PE)
- This condition is due to thromboemboli that travels to the lungs obstructing pulmonary circulation.
- Risk factors include post-surgery, prolonged immobility, and certain underlying conditions.
- Sinus tachycardia is a common ECG finding, while S1Q3T3 is an atypical and non-essential pattern.
- Diagnosis is usually confirmed with spiral CT scans, and treatment typically involves heparin followed by a CT scan to assess the effect of the treatment.
Amniotic Fluid Embolism
- This is not directly initiated by a condition. It is a complication post-childbirth (rare), commonly following placental separation.
- It has an acute onset and can be fatal due to the sudden onset and the systemic inflammatory response.
Fat Embolism
- Fat emboli are a complication of fractures, particularly long bone fractures, with an acute onset.
- Common causes include trauma or long-bone fractures.
- The condition is characterized by dyspnea and petechiae or purpura( skin rash).
Air Embolism
- Air emboli enter the circulation, frequently occurring during procedures involving catheter insertion, or trauma to venous structures.
- Symptoms often involve respiratory issues and cardiovascular collapse.
Cholesterol Embolism
- This complication follows certain surgeries, especially involving the aorta and can impact the extremities of the body, producing a skin rash which is observed usually after a surgery.
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Description
Test your knowledge on asthma management, diagnosis, and treatment strategies. This quiz covers various aspects of asthma including acute attacks, medications, and diagnostic tools. Perfect for healthcare professionals and students in respiratory medicine.
