Respiratory Pharmacology and Asthma Management

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Questions and Answers

Which risk factor is NOT associated with early-onset emphysema and cirrhosis?

Alcohol consumption

Having a healthy diet (correct)

Smoking for 5 years

A1-antitrypsin deficiency

What does cough-variant asthma primarily present as?

Wheezing and difficulty breathing

Dry cough without significant breath issues (correct)

Chronic productive cough

Shortness of breath during exercise

What is the mechanism of aspirin-induced asthma related to COX inhibition?

Shunting of arachidonic acid down the lipoxygenase pathway (correct)

Decreased leukotriene synthesis

Activation of the phospholipase pathway

Increased prostaglandin production

Which statement regarding the expiratory phase in obstructive conditions is correct?

It has a longer duration compared to normal expiration Signup and view all the answers

How does acute asthma affect arterial blood gas values?

Decreases CO2 and increases pH Signup and view all the answers

Which of the following is part of Samter triad?

Aspirin allergy Signup and view all the answers

In COPD, what typically happens to CO2 levels?

CO2 retains due to obstruction in airways Signup and view all the answers

What is a characteristic feature of asthma patients in terms of breathing pattern?

Increased expiratory phase Signup and view all the answers

What is the initial step in diagnosing asthma during an outpatient visit?

Spirometry Signup and view all the answers

Which treatment is considered first-line for managing acute asthma attacks?

b2-agonist (albuterol) Signup and view all the answers

In a patient transitioning from type I to type II respiratory failure, which change will likely be observed?

Normalization of CO2 and pH with low O2 Signup and view all the answers

What should be avoided when considering a methacholine challenge for diagnosing asthma?

Administering during acute episodes Signup and view all the answers

If a patient with asthma experiences weekly episodes despite being on albuterol, what should be added to their treatment plan?

Inhaled corticosteroid (ICS) Signup and view all the answers

What is the expected appearance of the expiratory component of the spirometry curve in asthma?

Concave Signup and view all the answers

For a patient with a history of aspirin allergy, which medication type could be particularly effective for their asthma management?

Leukotriene blockers Signup and view all the answers

What is the last resort for outpatient management of asthma?

Oral prednisone Signup and view all the answers

What is the primary reason for avoiding the use of certain medications in pediatric patients experiencing severe asthma attacks?

Potential for Cushing syndrome Signup and view all the answers

Which medication must be initiated at the time of discharge for any asthma patient requiring hospital management for an acute episode?

Inhaled corticosteroids Signup and view all the answers

In patients with asthma experiencing two or more episodes per week, what should be included in their treatment regimen?

Inhaled corticosteroids + albuterol Signup and view all the answers

What imaging finding is characteristic of bronchiectasis?

Cystic dilation of the airways 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 characteristic feature is associated with the sputum of a patient suffering from bronchiectasis?

Foul-smelling and copious Signup and view all the answers

What common misconception might students have regarding the management of acute asthma episodes?

Inhaled corticosteroids should be given first Signup and view all the answers

In the context of asthma management, what does ectasia refer to?

Dilation of the airways Signup and view all the answers

Which medication is known to block endothelin-1 receptors?

Bosentan Signup and view all the answers

What is a key characteristic of diffuse scleroderma?

Ultra-high blood pressure due to renal involvement Signup and view all the answers

Which symptom is associated with limited scleroderma (CREST syndrome)?

Sclerodactyly Signup and view all the answers

Which explanation correctly describes Raynaud's phenomenon?

Color change of the fingers with cold weather Signup and view all the answers

What type of medications should be avoided in patients with Raynaud's phenomenon?

Alpha-1 agonists Signup and view all the answers

In patients with pulmonary hypertension, what level of endothelin-1 is typically observed?

Increased Signup and view all the answers

What is one method to reduce the recurrence of Raynaud's phenomenon?

Dress warmly in cold weather Signup and view all the answers

Which patient finding is associated with pulmonary hypertension and can indicate cor pulmonale?

Loud P2 Signup and view all the answers

What is the most common ECG finding in a patient with pulmonary embolism?

Sinus tachycardia Signup and view all the answers

What is the first step in the management of a suspected pulmonary embolism?

Heparin administration Signup and view all the answers

Which of the following risk factors is associated with pulmonary embolism?

Sedentation from trauma Signup and view all the answers

What finding on a V/Q scan indicates recurrent pulmonary emboli?

Multiple sub-segmental perfusion defects Signup and view all the answers

In a patient on warfarin who develops a pulmonary embolism, what is the initial diagnostic test they should undergo?

Spiral CT chest Signup and view all the answers

What is the acid-base imbalance associated with pulmonary embolism?

Acute respiratory alkalosis Signup and view all the answers

What is a potential complication of rheumatoid arthritis related to lung health?

Restrictive lung disease Signup and view all the answers

What treatment is primarily indicated for sarcoidosis that causes lupus pernio?

Oral prednisone Signup and view all the answers

What condition is indicated by a persistent air leak despite placement of a chest tube in a trauma patient?

Ruptured bronchus Signup and view all the answers

What imaging finding is characteristic of a diaphragmatic rupture following a motor vehicle accident?

Obscured left hemidiaphragm with NG tube in the chest Signup and view all the answers

Which condition is typically associated with low blood pressure and a pneumothorax?

Tension pneumothorax Signup and view all the answers

What patient demographic is most likely to experience a spontaneous pneumothorax?

Young, tall males Signup and view all the answers

What is the primary mechanism by which tension pneumothorax occurs?

Compression of the vena cavae Signup and view all the answers

Which physical exam finding indicates a tension pneumothorax?

Decreased breath sounds on the affected side Signup and view all the answers

What is the recommended treatment sequence for a pneumothorax?

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

What happens to the trachea in the event of a simple pneumothorax?

The trachea shifts ipsilaterally 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 for early-onset COPD.
Bronchospasm can be idiopathic, hereditary, or triggered by allergens or cold air.
One-third of asthma patients present with only a dry cough, called cough-variant asthma. This is often worse in winter.
Asthma can be part of an "atopy constellation," with symptoms including dry cough (winter), seasonal allergies/rhinitis/hives (spring), and eczema (summer).
Aspirin-induced asthma involves aspirin inhibiting COX, leading to increased leukotrienes and bronchoconstriction.
Samter triad: aspirin allergy, asthma, nasal polyps.
Increased expiratory phase isn't specific for asthma, but it indicates an obstructive pathology where exhalation takes longer (lower FEV1).
Asthma acutely causes low CO2, high pH, and unchanged bicarbonate (acute respiratory alkalosis). Even though breathing is difficult, CO2 diffuses quickly.
The combination of low CO2 and low O2 in an acute asthma attack can be type I respiratory failure. Eventually, the patient's breathing rate slows as CO2 and pH rebound to normal, but low O2 persists (transition to type II respiratory failure/hypoventilation).
Initial diagnosis step for asthma is often spirometry, observing the concave expiratory curve.
Methacholine challenge can be used to diagnose asthma by inducing bronchoconstriction. Avoid during acute episodes. Can do between episodes.
Outpatient asthma management prioritizes short-acting beta2-agonists (albuterol) for acute attacks. Chronic daily asthma requires inhaled corticosteroids (like fluticasone).
Weekly asthma episodes warrants inhaled corticosteroids in addition to short-acting beta2-agonists.

Bronchiectasis

Most common cause worldwide is TB; Western countries are more commonly affected by CF. Asthma does not cause bronchiectasis.
Presents mostly as cups of foul-smelling sputum (due to anaerobes like Bacteroides).
Right middle lobe syndrome presents with scant white sputum and a thin opacification, visible in right middle lobe on radiography. This shouldn't be dismissed.
Clubbing may be present as a finding.

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Description

Test your knowledge on respiratory diseases, particularly focusing on asthma, COPD, and emphysema. This quiz covers key concepts such as risk factors, mechanisms of action, diagnosis, and treatment strategies for managing these chronic respiratory conditions.