Asthma Overview and Management

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Questions and Answers

What is the role of endothelin-1 in pulmonary hypertension?

It is a vasoconstrictor that is elevated in pulmonary hypertension. (correct)

It enhances nitric oxide production.

It is a vasodilator that decreases arterial pressure.

It has no significant impact on pulmonary vasculature.

Which class of medication is used to block endothelin-1 receptors?

Endothelin receptor antagonists like Bosentan (correct)

β-adrenergic agonists

Angiotensin-converting enzyme inhibitors

Calcium channel blockers

What is characteristic of limited scleroderma?

It includes widespread skin thickening and renal involvement.

It is also known as CREST syndrome. (correct)

It is marked by severe pulmonary fibrosis only.

It is synonymous with diffuse scleroderma.

Which symptom is NOT associated with sclerodactyly?

Abnormal calcium deposition in tissues Signup and view all the answers

What condition is suggested by a significant increase in blood pressure due to renal involvement?

Diffuse scleroderma Signup and view all the answers

What is a recommended strategy to reduce the recurrence of Raynaud's phenomenon?

Dress warmly in cold weather. Signup and view all the answers

Which medication should be avoided in patients with Raynaud's phenomenon?

α1 agonists Signup and view all the answers

Esophageal dysmotility related to scleroderma is often characterized by:

Decreased esophageal peristalsis and reflux Signup and view all the answers

What is the primary defect in primary ciliary dyskinesia?

Defective dynein arm function Signup and view all the answers

In a patient with situs inversus, which cardiac finding is most likely to be observed?

Cardiac sounds loudest on the right Signup and view all the answers

What characterizes the granulomas found in sarcoidosis?

Non-caseating granulomas Signup and view all the answers

What consequence might women with primary ciliary dyskinesia experience due to abnormal cilia in the fallopian tubes?

Ectopic pregnancy Signup and view all the answers

What is the role of epithelioid macrophages in sarcoidosis?

Secretion of 1a-hydroxylase Signup and view all the answers

In sarcoidosis, what happens to parathyroid hormone levels?

They are suppressed Signup and view all the answers

Which gene mutation is primarily associated with primary pulmonary hypertension (PPH)?

BMPR2 Signup and view all the answers

How does primary pulmonary hypertension differ from cor pulmonale?

PPH originates intrinsically in the lungs Signup and view all the answers

Which demographic is typically associated with sarcoidosis?

African-American women in their 20s-30s Signup and view all the answers

What imaging findings are typical for sarcoidosis?

Bihilar lymphadenopathy Signup and view all the answers

Which of the following findings would indicate cor pulmonale rather than primary pulmonary hypertension?

Right ventricular hypertrophy on ECG Signup and view all the answers

What is a likely finding in the semen of a patient with primary ciliary dyskinesia?

Decreased sperm motility Signup and view all the answers

In the context of sarcoidosis, what does high levels of 1,25-(OH)2-D3 cause?

Hypercalcemia Signup and view all the answers

Which symptom is NOT typically associated with sarcoidosis?

Chest pain Signup and view all the answers

What symptom may indicate pulmonary hypertension in a patient in their 20s to 30s?

Loud P2 or tricuspid regurgitation Signup and view all the answers

What should be chosen if a vignette suggests sarcoidosis but indicates a normal CXR?

Asthma Signup and view all the answers

What is the primary clinical significance of clubbing in patients?

It is commonly associated with bronchiectasis. Signup and view all the answers

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

Atelectasis Signup and view all the answers

What is the primary function of the sweat chloride test in cystic fibrosis diagnosis?

To evaluate the chloride ion concentration in sweat. Signup and view all the answers

In cystic fibrosis, what genetic characteristic is common among siblings?

There is a 2/3 chance a phenotypically normal sibling is a carrier. Signup and view all the answers

Which CFTR-related therapy aims at correcting channel localization and folding?

Ivacaftor Signup and view all the answers

What does the transepithelial nasal voltage test assess?

Nasal potential difference. Signup and view all the answers

Which of the following conditions can be associated with congenital bilateral absence of vas deferens (CBAVD)?

Cystic fibrosis Signup and view all the answers

What is the role of Dornase-alfa in the treatment of cystic fibrosis?

It acts as a nucleotidase to soften mucus. Signup and view all the answers

What indicates a possible diaphragmatic rupture in a trauma patient?

Obscured left hemidiaphragm on CXR Signup and view all the answers

Which condition is characterized by acute-onset sharp chest pain in a tall, lanky teenager?

Spontaneous pneumothorax Signup and view all the answers

What does a contralateral tracheal shift indicate in a patient?

Tension pneumothorax Signup and view all the answers

What mechanism primarily leads to the symptoms of tension pneumothorax?

Compression of the vena cavae Signup and view all the answers

What finding is expected in a physical examination of a patient with pneumothorax?

Diminished breath sounds Signup and view all the answers

What is the standard initial treatment for pneumothorax?

Needle decompression followed by chest tube Signup and view all the answers

Which of the following conditions could lead to water-soluble contrast being visualized in the mediastinum?

Ruptured bronchus Signup and view all the answers

What correlates with low blood pressure in the context of pneumothorax?

Tension pneumothorax Signup and view all the answers

What is a likely cause of low bicarbonate levels in a patient experiencing shock?

Lactic acidosis due to poor perfusion Signup and view all the answers

Which clinical presentation is more indicative of an amniotic fluid embolism rather than a pulmonary embolism?

Shortness of breath and tachycardia occurring 30 seconds to 2 minutes post-delivery Signup and view all the answers

What critical finding would suggest fat embolism in a patient with a long-bone fracture?

Petechiae on the shoulders/chest Signup and view all the answers

What is the most common presentation of a patient experiencing an air embolism after central venous line insertion?

Sudden death Signup and view all the answers

Which statement accurately describes lactic acidosis in the context of shock?

It results from tissue hypoxia leading to anaerobic metabolism. Signup and view all the answers

What event is often the precursor to developing disseminated intravascular coagulation (DIC) after childbirth?

Bleeding from catheter lines Signup and view all the answers

In the case of pulmonary embolism, which scenario would most likely lead to a diagnosis?

Sudden chest pain and dyspnea two days after surgery Signup and view all the answers

What is a characteristic diagnostic method for identifying fat embolism in pulmonary biopsy?

Oil Red O or Sudan black staining Signup and view all the answers

Study Notes

Asthma

Asthma can be idiopathic or hereditary, triggered by allergens or cold air.
A third of asthma patients only present with a dry cough (cough-variant asthma). This cough is often worse in winter.
It can be part of a broader presentation of conditions like seasonal allergies, eye/nose irritation, hives, and skin rashes.
Aspirin can induce asthma in some, via a pathway impacting leukotrienes. Aspirin allergy, asthma, and nasal polyps are indicators of this triad.
Asthma often presents with increased expiratory effort, but this is not specific.
Acutely, asthma causes decreased CO2, increased pH (respiratory alkalosis). Increased breathing rate initially leads to decrease in CO2 buildup.
The combination of CO2 and O2 levels in an acute asthma attack can be indicative of type I respiratory failure (low CO2 and high pH).
Eventually, fatigue and slowing of breathing can lead to an increase in CO2 and pH reversal (transition to type II respiratory failure, marked by high CO2 and low O2).
Intubation may be a necessary intervention.
Spirometry and methacholine challenges can help diagnose asthma.
First-line outpatient treatment is a Beta-2 agonist (albuterol).
Patients with weekly episodes often require continuous use of inhaled corticosteroids (ICS) in addition to Beta-2 agonists.

Bronchiectasis

Most common causes worldwide and in Western countries are tuberculosis and cystic fibrosis respectively.
Patients often describe copious amounts of foul-smelling sputum.
Clubbing is frequently present.
This condition isn't related to asthma

Atelectasis

Lung collapse is the primary feature.
Post-surgery, this is a common cause of fever within 24 hours.
Bibasilar shadows seen on x-rays.
Related to slower, shallower breathing in patients on respiratory support post-surgery.
Resorptive atelectasis occurs when obstruction distally in a section of lung causes distal area collapse.
Obstruction can be due to a tumor.
Chronic respiratory acidosis (increased CO2, decreased pH) is a characteristic.

Obstructive sleep apnea (OSA)

OSA can contribute to pulmonary hypertension, leading to cor pulmonale.

Anaphylaxis

Characterized by acute dyspnea, bilateral wheezing, tachycardia, and low blood pressure.
Triggers include environmental or food allergens, insect stings and recently introduced medication.
Epinephrine is a key treatment.

Scombroid

An often misdiagnosed condition that may mimic seafood allergy;
Due to toxin produced in decaying fish;
Treatment involves antihistamine medications.

Shellfish allergy

Triggered by shellfish consumption.
Can display similar symptoms to asthma.
Not related to scombroid syndrome.

Cystic fibrosis

Autosomal recessive, caused by mutations in the CFTR gene.
Characterized by abnormal chloride channel function.
Causes thick secretions in the lungs, resulting in recurrent infections (pneumonia).
Pancreatic insufficiency is a common symptom, which leads to fat malabsorption and vitamin deficiency.
Males can present with infertility due to the absent vas deferens in congenital form.

Primary ciliary dyskinesia (Kartagener syndrome)

Autosomal recessive, a disorder of cilia function.
Characterized by situs inversus (organs reversed).
Presents with chronic respiratory infections.

Primary pulmonary hypertension (PPH)

Pulmonary hypertension originating in the lungs.
Elevated endothelin-1 levels often present.
Characterized by right-ventricle hypertrophy.

Systemic sclerosis

Autoimmune disorder causing fibrosis in various parts of the body (sclerosis).
Classified as limited or diffuse subtypes.
Limited scleroderma and CREST syndrome (Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias) are frequent presentations.
Associated with pulmonary fibrosis and hypertension.

Sarcoidosis

Idiopathic condition with non-caseating granulomas in various organs;
Often affects lungs.
Characteristic of altered vitamin D metabolism, and hypercalcemia.

Rheumatoid lung

Restrictive lung disease, is a complication of rheumatoid arthritis.
Fibrosis development can lead to problems breathing.

Pulmonary embolism

Obstruction by clots in the pulmonary arteries.
Risk factors include, recent surgery, in-situ issues, and inherited blood clotting disorders.
Characterized by acute shortness of breath, tachycardia, and hypoxia.
Possible for it to occur while on oral anticoagulation medicines.

Amniotic fluid embolism

Obstetric complication.
Related to placental separation and amniotic fluid entering the circulatory system after delivery.
Presents similar to pulmonary embolism and potentially leads to coagulopathy.

Fat embolism

Embolization of fat post-fracture;
Characterized by shortness of breath and petechiae over the body.

Air embolism

Air blockage in circulatory system via introduction via a medical procedure,
Often leads to sudden death.

Cholesterol embolism

Cholesterol plaques breaking off and lodging in the lungs (and vasculature).
Common presentation of a previously unremarked or uninvestigated abdominal aortic aneurysm.
Skin manifestations in the toes are a frequent presentation.

Pleurisy

Inflammation of lining of the lungs and the chest cavity.
Characterized with chest pain.
Can be indicative of an underlying condition like pneumonia, or malignant processes.

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Description

This quiz explores the various aspects of asthma, including its triggers, symptoms, and classifications. Learn about the implications of cough-variant asthma, the role of aspirin, and the physiological changes during an acute attack. Test your knowledge on this common respiratory condition and its management.