Obstructive Lung Disease Overview
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Questions and Answers

What is primarily elevated in ACTH independent Cushing’s syndrome?

  • Aldosterone
  • CRH
  • ACTH
  • Cortisol (correct)
  • Which method provides the best indication of cortisol suppression in Cushing’s syndrome?

  • Evening salivary cortisol test
  • 1 mg dexamethasone suppression test (correct)
  • 24 hour urine collection
  • ACTH measurement
  • In Conn syndrome, which clinical presentation is commonly observed?

  • Hypertension and hypokalemia (correct)
  • Diabetes and hypernatremia
  • Hypoglycemia and hyperkalemia
  • Weight gain and hypercalcemia
  • What confirms the diagnosis of primary hyperaldosteronism?

    <p>Elevated plasma aldosterone/renin ratio</p> Signup and view all the answers

    Which test would not typically suppress aldosterone in the diagnosis of Conn syndrome?

    <p>Fludrocortisone</p> Signup and view all the answers

    What is a key feature of asthma in children?

    <p>Symptom resolution in adolescence</p> Signup and view all the answers

    Which of the following is NOT a component of asthma diagnosis?

    <p>Presence of chronic bronchitis</p> Signup and view all the answers

    What criteria can indicate the severity of asthma?

    <p>Frequency and duration of symptoms</p> Signup and view all the answers

    Which medication should be initially included in an asthma management plan?

    <p>Short-acting β2 agonists (SABA)</p> Signup and view all the answers

    What most likely triggers an exacerbation of COPD?

    <p>Irritants such as smoke or infection</p> Signup and view all the answers

    How is a significant exacerbation of asthma typically managed in an emergency setting?

    <p>Administration of oxygen and systemic steroids</p> Signup and view all the answers

    In patients with COPD, which symptom is commonly observed?

    <p>Chronic sputum production</p> Signup and view all the answers

    Which medication is used to help prevent exacerbations in asthma patients at discharge?

    <p>Inhaled corticosteroids (ICS)</p> Signup and view all the answers

    What is a contraindication to thrombolysis in a STEMI?

    <p>Previous intracranial hemorrhage</p> Signup and view all the answers

    Which of the following is NOT a sign of tissue hypoperfusion in shock?

    <p>Bradycardia</p> Signup and view all the answers

    In the management of an acute thrombotic stroke, what is the recommended daily medication after the initiation of thrombolytics?

    <p>Aspirin</p> Signup and view all the answers

    What is the proper blood pressure reduction target for managing acute hemorrhagic stroke?

    <p>SBP 140-180</p> Signup and view all the answers

    Which type of shock is characterized by inadequate blood volume?

    <p>Hypovolemic shock</p> Signup and view all the answers

    What is the first-line treatment strategy for NSTEMI?

    <p>Anticoagulation and anti-platelet therapy</p> Signup and view all the answers

    Which pathogen is considered the most common cause of pneumonia?

    <p>S.pneumoniae</p> Signup and view all the answers

    What does a CURB65 score above 2 indicate in pneumonia management?

    <p>Need for hospital admission</p> Signup and view all the answers

    In treating pneumonia in the ICU, which combination of antibiotics is typically used?

    <p>Beta-lactam and macrolide or levofloxacin</p> Signup and view all the answers

    Which chest X-ray finding is characteristic of congestive heart failure?

    <p>Interstitial edema and Kerley B lines</p> Signup and view all the answers

    Which of the following is NOT a typical indicator of delirium?

    <p>Progressive memory loss over months</p> Signup and view all the answers

    Which medication is most commonly associated with causing delirium?

    <p>Clonazepam</p> Signup and view all the answers

    What characterizes the physical examination of pneumonia according to the findings provided?

    <p>Decreased breath sounds and egophony</p> Signup and view all the answers

    What is a common sign on the chest X-ray associated with pleural effusion?

    <p>Blunted costophrenic angle</p> Signup and view all the answers

    What is the characteristic triad used for assessing cardiac tamponade?

    <p>Hypotension, muffled heart sounds, elevated JVP</p> Signup and view all the answers

    What is the primary goal of using PPI in non-variceal bleeding management?

    <p>To keep gastric pH elevated above 4</p> Signup and view all the answers

    Which statement about acute liver failure criteria is true?

    <p>Impaired synthetic function is indicated by INR &gt; 1.5</p> Signup and view all the answers

    In the management of alcoholic liver disease, which treatment is considered for moderate to severe alcoholic hepatitis?

    <p>Prednisone/prednisolone</p> Signup and view all the answers

    Which test is considered the best positive predictor for diagnosing ascites?

    <p>Fluid wave test</p> Signup and view all the answers

    What is a common complication of acute pancreatitis?

    <p>Sepsis</p> Signup and view all the answers

    Which management step is indicated for acetaminophen toxicity in acute liver failure?

    <p>N-acetylcysteine</p> Signup and view all the answers

    Which of the following represents a criterion for King's Criteria concerning acute liver failure?

    <p>Cr &gt; 300</p> Signup and view all the answers

    What is the recommended initial treatment for a patient diagnosed with acute pancreatitis?

    <p>IV hydration</p> Signup and view all the answers

    What is the purpose of administering Octreotide in variceal bleeding?

    <p>To decrease portal pressure</p> Signup and view all the answers

    Which diagnostic method is considered therapeutic for obstructive pancreatitis?

    <p>ERCP</p> Signup and view all the answers

    Which dietary management is advised for hyperlipidemia?

    <p>More fruits and vegetables</p> Signup and view all the answers

    Which laboratory finding is typically elevated in alcoholic liver disease?

    <p>GGT and ALP</p> Signup and view all the answers

    Which of the following is used for the prophylaxis of infection in patients with variceal bleeding?

    <p>Cephalosporin or fluoroquinolone</p> Signup and view all the answers

    What is the most sensitive clinical test for detecting ascites?

    <p>Shifting dullness test</p> Signup and view all the answers

    Study Notes

    Obstructive Lung Disease

    • Asthma: Characterized by chronic airway inflammation, primarily affecting children who often recover in adolescence but may relapse in adulthood.
    • Diagnosis in Kids: Symptoms include cough, sputum, wheezing, and shortness of breath (SOB) in response to triggers. Requires evidence of reversible airflow obstruction.
    • Reversible Airflow Obstruction: Assessed by a significant increase in PEFR or FEV1 post-bronchodilator or corticosteroid use, and via bronchoprovocation testing.
    • Management: Focus on patient education, severity assessment, trigger avoidance, and a medication plan including short-acting β2 agonists (SABA) and inhaled corticosteroids (ICS).
    • Exacerbations: Involve identifying and resolving triggers, use of SABA, oral steroids, and emergency interventions if necessary.

    COPD (Chronic Obstructive Pulmonary Disease)

    • Defined as a chronic, preventable, irreversible airflow limitation leading to persistent respiratory symptoms.
    • Exhibits signs of hyperinflation and barrel chest, leading to diaphragm displacement and SOB.
    • Symptoms include chronic bronchitis and an increase in exacerbations caused by infections and irritants.

    Pneumonia

    • Symptoms: Productive cough, high-grade fever, and SOB with chest X-ray showing infiltrates.
    • Vital Signs: Febrile with tachycardia and tachypnea.
    • Common Pathogens: S.pneumoniae, H.influenzae, C.pneumoniae, and atypical organisms.
    • Assessment Tool: CURB65 criteria used for hospital admission decisions.
    • Treatment Protocol: Varies from beta-lactam antibiotics combined with macrolides for non-ICU settings to beta-lactam with levofloxacin in ICU. Consider MRSA and Pseudomonas specifics for treatment.

    Chest X-Ray Interpretation

    • CHF (Congestive Heart Failure):
      • Detects enlarged cardiac silhouette, vascular redistribution, and interstitial edema.
    • Tamponade:
      • Presents with Back's Triad: hypotension, elevated JVP, and diminished heart sounds.
      • Pulsus paradoxus indicates drop in SBP during inspiration.
    • Pleural Effusion and Pneumonia:
      • Pleural edema observed as blunted costophrenic angles and pneumonia shows air bronchograms.

    Geriatrics - Delirium

    • Acute and potentially reversible cognitive disturbance often marked by inattention and fluctuating course.
    • Differential Diagnosis includes dementia and depression, with dementia lacking fluctuation.
    • Workup: Includes evaluating medications and possible triggers of delirium.

    Non-Variceal and Variceal Bleeding

    • Non-Variceal: Pantoloc for maintaining pH > 4; prevents clot degradation.
    • Variceal: Octreotide reduces portal pressure. Endoscopic interventions and antibiotics are necessary.

    Acute Liver Failure

    • Criteria: Encephalopathy with impaired synthetic function (INR > 1.5).
    • Management: Supports ABCs, prevents elevated ICP, and treats specific conditions (e.g., HSV infection, autoimmune hepatitis).

    Alcoholic Liver Disease

    • Diagnosis: Elevated AST:ALT ratios with AST dominance indicating alcoholic liver disease.
    • Management includes abstinence, nutritional support, and monitoring for variceal bleeding.

    Ascites Management

    • Diagnosis through fluid wave test as the primary indicator.
    • Management involves dietary restrictions, diuretics, and possible paracentesis.

    Acute Pancreatitis

    • Complications: Signs include necrotizing pancreatitis and possible respiratory failure.
    • Management: Focuses on supportive care, fluid resuscitation, and addressing underlying causes.

    Hyperlipidemia Management

    • Screening begins at age 40, evaluating lipid profiles and other metabolic markers.
    • Management focuses on lifestyle changes and statin therapy based on Framingham risk assessment.

    Adrenal Hormone Overproduction

    • Cushing’s syndrome: Diagnosed through screening for elevated cortisol.
    • Conn syndrome: Characterized by hypertension and hypokalemia; diagnosed via plasma aldosterone/renin ratio.

    Stroke Management

    • Acute Thrombotic Stroke: Requires ABCs, thrombolytics, and careful BP management.
    • Acute Hemorrhagic Stroke: Involves BP control and reversing anticoagulation.

    Shock Definition and Classification

    • Defined as inadequate blood flow leading to poor metabolic response in tissues.
    • Classifications include:
      • Hypovolemic: Low fluid volume.
      • Cardiogenic: Heart function impairment.
      • Obstructive: External obstruction to heart output.
      • Distributive: Volume-related issues often due to vasodilation.

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    Explore the essential aspects of obstructive lung diseases, focusing on asthma and chronic obstructive pulmonary disease (COPD). This quiz covers critical topics such as diagnosis, management strategies, and exacerbation handling in patients. Test your knowledge and understanding of respiratory health.

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