Asthma Overview for USMLE

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Questions and Answers

What is the purpose of pleurodesis in patients with recurrent pneumothoraces?

To obliterate the pleural space (correct)

To promote lung expansion

To drain fluid from the pleural space

To relieve symptoms of thoracic pain

Which of the following is a common cause of pleural effusion as per the observed patterns?

Pneumothorax

Left heart failure (correct)

Asthma exacerbation

Pulmonary embolism

In the context of barotrauma, which scenario could lead to a pneumothorax?

Experiencing high altitude without acclimatization

Descending too quickly underwater

Ascending too quickly from underwater (correct)

Diving in shallow waters

What clinical signs indicate the presence of pleural effusion?

Dullness to percussion Signup and view all the answers

Which of the following is NOT part of the triad seen in Meigs' syndrome?

Left-sided pleural effusion Signup and view all the answers

What is a key characteristic of endothelin-1 in patients with pulmonary hypertension?

It is elevated in pulmonary hypertension. Signup and view all the answers

Which factor is essential in differentiating limited and diffuse scleroderma?

Involvement of renal function. Signup and view all the answers

Which of the following best describes the clinical presentation of limited scleroderma (CREST syndrome)?

Esophageal dysmotility leading to GERD. Signup and view all the answers

Which treatment is used to block endothelin-1 receptors in pulmonary hypertension?

Bosentan. Signup and view all the answers

Which of the following describes a clinical feature of diffuse scleroderma?

Skin tightening and sclerodactyly. Signup and view all the answers

What is an appropriate recommendation 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 due to its vasoconstrictive effects?

a1 agonists. Signup and view all the answers

What does sclerodactyly manifest as in patients with scleroderma?

Tightening of the skin on the fingers. Signup and view all the answers

What is the defining feature of type I respiratory failure during an acute asthma attack?

Low levels of both CO2 and O2 Signup and view all the answers

What is the initial diagnostic step recommended for asthma?

Spirometry Signup and view all the answers

Which medication is first-line for managing acute asthma attacks?

Albuterol Signup and view all the answers

When considering long-term management for a patient with frequent asthma episodes, what medication should be added if albuterol alone is insufficient?

Inhaled corticosteroids (ICS) Signup and view all the answers

What is the expected spirometry curve appearance in a patient with asthma?

Concave Signup and view all the answers

What should NOT be used to diagnose asthma during an acute episode?

Methacholine challenge Signup and view all the answers

Which intervention is considered the last resort for outpatient asthma management?

Oral prednisone Signup and view all the answers

In patients with asthma who have a history of aspirin allergy, which medication can be particularly effective?

Leukotriene blockers Signup and view all the answers

Which of the following best describes the cause of primary ciliary dyskinesia (Kartagener syndrome)?

Abnormality of cilia function due to defective dynein arm Signup and view all the answers

What is a common respiratory symptom of a patient with situs inversus who has primary ciliary dyskinesia?

Recurrent pneumonias Signup and view all the answers

In a patient diagnosed with primary pulmonary hypertension, which genetic mutation is often implicated?

Mutations in the BMPR2 gene Signup and view all the answers

A 25-year-old woman presents with increased pulmonary vascular markings and a loud P2 on auscultation. What condition is most likely indicated?

Primary pulmonary hypertension Signup and view all the answers

Which of the following conditions would NOT be a secondary cause of pulmonary hypertension?

Primary pulmonary hypertension Signup and view all the answers

A patient with primary ciliary dyskinesia may experience complications in which reproductive process?

Ectopic pregnancy Signup and view all the answers

Which is NOT a typical clinical finding in cor pulmonale secondary to primary pulmonary hypertension?

Junctional rhythm on ECG Signup and view all the answers

Which statement is accurate regarding the differences between cystic fibrosis and primary ciliary dyskinesia related to fertility?

Primary ciliary dyskinesia has decreased motility but sperm are present. Signup and view all the answers

What is the primary characteristic of granulomas found in sarcoidosis?

Non-caseating granulomas Signup and view all the answers

Which substance is primarily secreted by epithelioid macrophages in the lungs of a sarcoidosis patient?

1,25-(OH)2-D3 Signup and view all the answers

What key laboratory finding is typically seen in patients with sarcoidosis?

Normal phosphate levels Signup and view all the answers

In a patient with sarcoidosis, which of the following is usually suppressed?

Parathyroid hormone (PTH) Signup and view all the answers

What is a common demographic presentation of a patient with sarcoidosis?

African-American woman in her twenties to thirties Signup and view all the answers

What radiological finding is associated with sarcoidosis on CXR or CT scans?

Bihilar lymphadenopathy Signup and view all the answers

What symptom might be present in a sarcoidosis patient aside from respiratory symptoms?

Erythema nodosum Signup and view all the answers

What should be considered if a patient vignette suggests sarcoidosis but states a normal CXR?

Choose a diagnosis of asthma Signup and view all the answers

What mechanism does aspirin use to potentially trigger asthma symptoms?

Inhibition of COX and shunting of arachidonic acid Signup and view all the answers

Which condition is known to potentially present with a dry cough, especially worsened in winter, indicating cough-variant asthma?

Asthma Signup and view all the answers

What is the Samter triad associated with?

Aspirin allergy, asthma, and nasal polyps Signup and view all the answers

What does the term 'increased expiratory phase' indicate in obstructive lung pathology?

Difficulty exhaling air out of the lungs Signup and view all the answers

In cases of asthma, what is typically observed in arterial blood gas analysis during an acute episode?

Decreased CO2 and increased pH Signup and view all the answers

How does a1-antitrypsin deficiency impact the risk of developing emphysema and cirrhosis?

It raises the risk for early-onset emphysema and cirrhosis. Signup and view all the answers

Which symptom is characteristic of COPD as opposed to asthma regarding the onset of respiratory issues?

Usually manifests after 20+ years of smoking Signup and view all the answers

What is a common presentation of cough-variant asthma?

Dry cough without wheezing Signup and view all the answers

Study Notes

Asthma

USMLE Qs may present patients with a history of smoking or alcohol use. Early-onset emphysema and cirrhosis can be associated with these behaviors. Typically COPD requires greater than 20+ years of smoking.
Bronchospasm can be idiopathic, hereditary, or triggered by allergens or cold air.
Cough-variant asthma presents primarily with a dry cough, often worse in winter. This is present in one-third of asthma patients.
Atopy constellation can include dry cough in winter, seasonal allergies (seasonal allergic rhinitis and/or conjunctivitis), urticaria or skin rashes, and/or eczema, which can co-occur with asthma.
Aspirin-induced asthma is caused by aspirin inhibiting COX, leading to increased leukotrienes which result in bronchoconstriction.
Samter triad encompasses aspirin allergy, asthma, and nasal polyps.
Increased expiratory phase is a common term in asthma vignettes characterized by an increased time for exhalation. This is seen in obstructive lung diseases.
Acute asthma causes decreased CO₂, increased pH, and unchanged bicarbonate, leading to respiratory alkalosis. This is because CO₂ diffuses quickly.
Transition to type II respiratory failure in acute asthma may occur when CO₂ and pH rebound to normal levels despite low O₂. This signifies a transition towards hypoventilation.
Spirometry is the best initial step in diagnosing asthma in a patient experiencing acute episodes. The expiratory curve is concave in asthma.
Methacholine challenge can also diagnose asthma. This muscarinic agonist is given to trigger bronchoconstriction and symptoms. It is not given during an acute asthma attack.
Initial outpatient asthma management includes β2-agonists (like albuterol) for acute attacks, and inhaled corticosteroids for chronic, weekly or more episodes.
Management for severe asthma attacks involves nebulized albuterol, oxygen, and intravenous methylprednisolone in a hospital setting. Inhaled corticosteroids should be administered at discharge if the patient is not currently on them. A specific USMLE Q will state this.
Inhaled fluticasone may be initiated at discharge, regardless of current therapy, for hospitalised and chronic patients.

Bronchiectasis

A common cause worldwide is tuberculosis (TB), and in western countries it is cystic fibrosis (CF), and occasionally, smoking.
Presentation often involves a large volume of foul-smelling (anaerobic) sputum.
Clubbing of the fingers is not mandatory, but USMLE frequently associates it with bronchiectasis.
A 2CK Q may present a child with right middle lobe syndrome, scant white sputum, and a linear opacity, where bronchiectasis would be the answer

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Description

This quiz covers key concepts related to asthma, including types, triggers, and associations commonly tested in the USMLE. Topics include bronchospasm, cough-variant asthma, and the Samter triad. Enhance your understanding of asthma's clinical presentation and its implications for patient management.