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?

<p>It has a longer duration compared to normal expiration (B)</p> Signup and view all the answers

How does acute asthma affect arterial blood gas values?

<p>Decreases CO2 and increases pH (B)</p> Signup and view all the answers

Which of the following is part of Samter triad?

<p>Aspirin allergy (C)</p> Signup and view all the answers

In COPD, what typically happens to CO2 levels?

<p>CO2 retains due to obstruction in airways (C)</p> Signup and view all the answers

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

<p>Increased expiratory phase (D)</p> Signup and view all the answers

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

<p>Spirometry (C)</p> Signup and view all the answers

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

<p>b2-agonist (albuterol) (B)</p> Signup and view all the answers

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

<p>Normalization of CO2 and pH with low O2 (C)</p> Signup and view all the answers

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

<p>Administering during acute episodes (A)</p> 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?

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

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

<p>Concave (A)</p> 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?

<p>Leukotriene blockers (B)</p> Signup and view all the answers

What is the last resort for outpatient management of asthma?

<p>Oral prednisone (B)</p> 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?

<p>Potential for Cushing syndrome (A)</p> 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?

<p>Inhaled corticosteroids (D)</p> 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?

<p>Inhaled corticosteroids + albuterol (A)</p> Signup and view all the answers

What imaging finding is characteristic of bronchiectasis?

<p>Cystic dilation of the airways (C)</p> Signup and view all the answers

What is the most common cause of bronchiectasis in Western countries?

<p>Smoking (C)</p> Signup and view all the answers

What characteristic feature is associated with the sputum of a patient suffering from bronchiectasis?

<p>Foul-smelling and copious (A)</p> Signup and view all the answers

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

<p>Inhaled corticosteroids should be given first (A)</p> Signup and view all the answers

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

<p>Dilation of the airways (A)</p> Signup and view all the answers

Which medication is known to block endothelin-1 receptors?

<p>Bosentan (A)</p> Signup and view all the answers

What is a key characteristic of diffuse scleroderma?

<p>Ultra-high blood pressure due to renal involvement (B)</p> Signup and view all the answers

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

<p>Sclerodactyly (B)</p> Signup and view all the answers

Which explanation correctly describes Raynaud's phenomenon?

<p>Color change of the fingers with cold weather (B)</p> Signup and view all the answers

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

<p>Alpha-1 agonists (C)</p> Signup and view all the answers

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

<p>Increased (C)</p> Signup and view all the answers

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

<p>Dress warmly in cold weather (A)</p> Signup and view all the answers

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

<p>Loud P2 (C)</p> Signup and view all the answers

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

<p>Sinus tachycardia (D)</p> Signup and view all the answers

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

<p>Heparin administration (B)</p> Signup and view all the answers

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

<p>Sedentation from trauma (B)</p> Signup and view all the answers

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

<p>Multiple sub-segmental perfusion defects (A)</p> 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?

<p>Spiral CT chest (D)</p> Signup and view all the answers

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

<p>Acute respiratory alkalosis (C)</p> Signup and view all the answers

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

<p>Restrictive lung disease (B)</p> Signup and view all the answers

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

<p>Oral prednisone (D)</p> 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?

<p>Ruptured bronchus (A)</p> Signup and view all the answers

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

<p>Obscured left hemidiaphragm with NG tube in the chest (A)</p> Signup and view all the answers

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

<p>Tension pneumothorax (C)</p> Signup and view all the answers

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

<p>Young, tall males (A)</p> Signup and view all the answers

What is the primary mechanism by which tension pneumothorax occurs?

<p>Compression of the vena cavae (D)</p> Signup and view all the answers

Which physical exam finding indicates a tension pneumothorax?

<p>Decreased breath sounds on the affected side (A)</p> Signup and view all the answers

What is the recommended treatment sequence for a pneumothorax?

<p>Needle decompression followed by tube thoracostomy (D)</p> Signup and view all the answers

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

<p>The trachea shifts ipsilaterally (D)</p> Signup and view all the answers

Flashcards

Asthma

An inflammatory airway disease marked by bronchospasm, airway hyperresponsiveness, and mucus production. It's characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night or early morning.

Cough-variant asthma

A type of asthma where the main symptom is a dry cough, particularly in winter, without obvious breathing problems. This may be the only sign of asthma in some patients.

Aspirin-induced asthma

A form of asthma triggered by aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). It's often associated with nasal polyps and sensitivity to aspirin.

Samter Triad

A clinical triad consisting of aspirin allergy, asthma (often triggered by aspirin), and nasal polyps. It's a specific form of aspirin-induced asthma.

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Atopic constellation in asthma

The principle that asthma can be part of a broader constellation of allergies. Patients may experience seasonal allergies (hay fever), skin conditions like eczema, and urticaria (hives) alongside asthma.

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Increased expiratory phase

A clinical sign of obstructive airway diseases like asthma where it takes longer to exhale completely. The expiratory phase of respiration is prolonged.

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Acute respiratory alkalosis in asthma

A decrease in carbon dioxide (CO2) levels in the blood, leading to a higher pH value. This occurs due to hyperventilation in acute asthma.

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Blood gas changes in acute asthma

A characteristic pattern of blood gas abnormalities in asthma: decreased CO2, decreased pH, and unchanged bicarbonate. This reflects the acute nature of the condition.

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Type I Respiratory Failure

A type of respiratory failure characterized by low oxygen levels and normal or slightly elevated carbon dioxide levels. This occurs in acute asthma attacks because the airways are narrowed, making it difficult to breathe in enough oxygen.

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Type II Respiratory Failure

A type of respiratory failure characterized by low oxygen levels and elevated carbon dioxide levels. This occurs when the body is no longer able to compensate for the low oxygen levels in Type I respiratory failure, leading to decreased breathing effort and a build-up of carbon dioxide.

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Spirometry

A common diagnostic test used to assess lung function by measuring airflow in and out of the lungs. In asthma, it will reveal a concave expiratory component.

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Beta-2 Agonist (Albuterol)

A medication that acts as a bronchodilator, relaxing the muscles in the airways of the lungs and opening them up, providing relief from asthma symptoms. It is often the first-line treatment for acute asthma attacks.

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Inhaled Corticosteroid (ICS)

A type of medication that can help prevent asthma attacks by reducing inflammation in the airways, often prescribed for patients with persistent or frequent asthma symptoms.

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Methacholine

A short-acting muscarinic agonist that constricts the airways. It is used in a diagnostic test called a methacholine challenge to identify asthma.

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Long-Acting Beta-2 Agonist (LABA)

A type of medication that can help prevent asthma attacks and reduce the need for inhaled corticosteroids. It acts by relaxing the muscles in the airways and preventing them from becoming inflamed.

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Steroid treatment for acute asthma attack (IV methylprednisolone)

Steroid treatment for asthma attacks. Effective in decreasing recurrence, but long-term use can cause Cushing syndrome and linear bone growth problems in children.

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Discharge medication for hospitalized asthma patient

Inhaled corticosteroids like fluticasone are essential for asthma patients who require hospitalization for an acute episode, even if they were not on them previously.

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Asthma management for frequent episodes

Any asthma patient experiencing 2 or more episodes per week requires inhaled corticosteroids (ICS) in addition to albuterol, even if they are not currently on any medications.

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Bronchiectasis

A condition characterized by permanent widening (dilation) of airways due to loss of muscle, often presenting with large amounts of foul-smelling sputum.

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Common causes of bronchiectasis

The most common cause of bronchiectasis worldwide is tuberculosis, while cystic fibrosis is more prevalent in Western countries. In USMLE scenarios, it's commonly associated with smoking.

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Sputum in bronchiectasis

Bronchiectasis often presents with a large amount of foul-smelling sputum, indicating the presence of anaerobic bacteria like Bacteroides.

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Right middle lobe syndrome

A condition where the middle lobe of the right lung is affected, often presenting with minimal white sputum and a thin linear opacity on imaging. It's often associated with bronchiectasis.

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Inhaled Corticosteroids (ICSs) in acute asthma management

Inhaled corticosteroids have no role in the immediate management of an acute asthma attack.

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Lupus Pernio

A form of sarcoidosis that causes an enlarged nose, despite the name.

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Rheumatoid Lung

A restrictive lung disease that can occur in patients with Rheumatoid Arthritis.

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S1Q3T3 on ECG

A specific ECG finding for Pulmonary Embolism that is not commonly tested on the USMLE.

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Deep Vein Thrombosis (DVT)

A significant risk factor for Pulmonary Embolisms that often presents with acute shortness of breath and tachycardia.

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Sinus Tachycardia

The most commonly tested ECG finding in Pulmonary Embolism on USMLE.

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Heparin

A drug that is the first-line treatment for Pulmonary Embolism.

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Spiral CT of the chest

This type of CT scan is used to diagnose Pulmonary Emboli after heparin administration.

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Ventricular Fibrillation

This is a common consequence of a Saddle Embolus, which is a large blood clot blocking the main pulmonary artery.

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Pulmonary hypertension

Elevated pulmonary artery pressure (PAP) without evidence of left heart disease. Due to increased resistance in the pulmonary vasculature, the right ventricle has to work harder, causing right ventricular hypertrophy.

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Primary pulmonary hypertension

A specific type of pulmonary hypertension characterized by vasoconstriction, increased vascular remodeling, and inflammation in the pulmonary arteries. This can lead to irreversible lung damage.

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Endothelin-1

A powerful vasoconstrictor that is elevated in pulmonary hypertension, regardless of the underlying cause. USMLE often focuses on its role in primary pulmonary hypertension.

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Bosentan

A medication that blocks endothelin-1 receptors. This is a high-yield treatment for pulmonary hypertension, especially primary pulmonary hypertension.

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Systemic sclerosis (Scleroderma)

An autoimmune disease characterized by fibrosis and hardening of tissues throughout the body. It can affect skin, lungs, kidneys, and other organs.

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Limited scleroderma

A subtype of systemic sclerosis characterized by CREST syndrome (Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias) without significant internal organ involvement.

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Diffuse scleroderma

A subtype of systemic sclerosis with extensive organ involvement, including the kidneys. This often leads to high blood pressure due to the kidneys' role in regulating blood pressure.

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Raynaud's phenomenon

A sign of systemic sclerosis, which is a narrowing of the blood vessels, especially in the fingers and toes. This causes pain, numbness, and color changes in the extremities, particularly in cold weather.

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Pneumothorax

A condition characterized by a collapsed lung with air in the pleural space, often due to a ruptured subapical bleb.

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Tension Pneumothorax

A buildup of pressure in the pleural space compressing the lung and shifting the mediastinum, causing a drop in venous return.

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Pneumothorax and Low BP

A pneumothorax causing a drop in blood pressure due to compromised venous return.

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Acute-onset Chest Pain in Tall Patients

A sudden and sharp chest pain often experienced by tall and lanky individuals.

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Obscured Hemidiaphragm and NG Tube in the Chest

A diagnostic finding on X-Ray that suggests a possible diaphragmatic rupture.

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Needle Decompression Followed by a Chest Tube

The immediate treatment for a pneumothorax.

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Tube Thoracostomy

A treatment for pneumothorax that is synonymous with chest tube placement.

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Hyper-resonance to Percussion, Decreased Breath Sounds, Decreased Tactile Fremitus

A finding on physical exam that indicates the presence of a pneumothorax.

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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.

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