Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory II - Exam 2 > Obstructive CIS - SRS > Flashcards

Obstructive CIS - SRS Flashcards

1
Q
  • 40 yo male presents with gradual onset of dyspnea, cough, and wheezing over the last 2-3 years.
  • Family History is remarkable for a father deceased at age 53 with cirrhosis.
  • Social History: 20 pack year history of tobacco use
  • Physical Examination: decreased breath sounds to auscultation, lungs are hyperinflated by percussion, peripheral cyanosis and clubbing of the digits
  • Pulmonary Function Testing
  • FEV1 1.06 L 36% of predicted
  • FEV1/FVC 38%
  • No significant improvement with bronchodilator treatment

What disorder does this patient have?

What is causing the damage?

A

Alpha-1 Antitrypsin deficiency

Neutrophil elastase causes the damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • 19 year old male presents to the emergency room in acute respiratory distress. He has had a productive cough for several days
  • Past Medical History: Frequent bouts of sinusitis, hospital admission 2 years ago with pneumonia, and meconium ileus at birth
  • Physical Examination: Oxygen Saturation 93% on 2L NC, nostril flaring, subcostal retractions, wheezes, rhonchi, and clubbing of the fingers

Diagnosis?

A

Cystic Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What organs are most commonly affected by CF?

A
  1. lungs,
  2. pancreas,
  3. intestines,
  4. liver,
  5. sweat gland,
  6. sinuses,
  7. vas deferens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes death in 90% of CF patients?

A

Lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CF clinical manifestations include cough,dyspnea, decreased exercise tolerance, fatigue, and increased sputum production. There is a steep decline in lung function ad adolescence and a daily productive cough arise.

What are three likely pathogens that tend to infect CF patients?

A
  1. Pseudomonas Aeruginosa
  2. S. Aureus
  3. MRSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the pancreatic manifestations of CF?

A

•Exocrine pancreatic insufficiency can lead to impaired growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does pancreatic insufficiency lead to impaired growth?

A

Malabsorption

  • Signs of malabsorption include bulky, foul smelling stools and flatulence.
  • Malabsorption of fat soluble vitamins occur.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What organs will be enlarged in CF? What can you see arise as a consequence of this?

A
  1. Hepatomegaly
    • Portal HTN leading to esophageal/gastric varices and hematemesis
  2. splenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is frequently absent in CF males?

A

Vas Deferens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does CF do to the endocrine pancreas?

A

1/3 of patients have DM by age 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some “other” clinical manifestations of CF?

A
  1. Electrolyte abnormalities
    • vomiting/nausea
    • anorexia
    • seizures
  2. Decreased absorption of Vit. D, leading to diminished bone density
  3. Kidney - nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5% of CF diagnoses are made after the age of 18. Apart from genetic mutation analysis and sweat testing, what is another screening method that we use to detect patients with this?

A

Screening with immunoreactive trypsinogen, a marker of pancreatic injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CF exhibits what kind of pattern on PFT?

A

Obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What will the key findings be on a chest x-ray in CF?

A
  • Hyperinflation
  • Bronchiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main oral antibiotics used in CF?

A

Azithromycin - Mon, Wed, Fri

Trimethoprim/sulfamethoxazole - PO 6-8 hours

Ciprofloxacin - bidaily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the key IV antibiotics for CF patients?

A
  1. Aztreonam
  2. Cefepime
  3. Ceftazidime
  4. ciprofloxacin
  5. Meropenem
  6. Piperacillin/tazobactam
  7. tobramycin
  8. vancomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Inhaled antibiotics for CF include what drugs?

A

Tobramycin

Aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Other than the CF antibiotics, what drug treatments are useful for these patients?

7

A
  1. Pancreatic enzymes
  2. Vitamin supplementation
  3. bronchodilators
  4. hypertonic saline inhalation
  5. dornase alfa (rhDNase)
  6. Ibuprofin
  7. O2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are three procedures/techniques useful in treating CF patients?

A

Lung transplant

Chest percussion

Postural Drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • 55 year old male with a history of chronic obstructive pulmonary disease complains of increased shortness of breath, dyspnea with minimal exertion, and decreased exercise tolerance.
  • Past Medical History : Multiple hospital admissions for COPD exacerbations, intubated last admit
  • Social History: 40 pack year history of tobacco use
  • Medications: maximal doses of inhaled steroid, salmeterol, and tiotropium. He frequently has been treated with oral antibiotics and oral steroids.

What pulmonary function test is most likely in this patient?

A) Decreased FEV1/FVC

B) Decreased functional residual capacity

C) Decreased total lung capacity

D) Increased FEV1

E) Increased FEV1/FVC

A

Decreased FEV1/FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What reduction in FEV1 do smokers experience per year?

A

40mL/year after age 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

COPD is a progressive, mostly irreversible airflow obstruction that comes on 20-30 years after exposure. What is the leading exposure?

A

Cigarette smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the site of obstruction in COPD?

A

Distal airways smaller than 2 mm diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are six history items you might expect from a COPD patient?

A
  • Current or past cigarette use
  • Dyspnea with slow progression
  • History of acute bronchitis
  • History of a chronic cough
  • Sputum production
  • Wheezing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are 15 physical findings you are likely to encounter in a COPD patient?

A
  1. •Barrel Chest
  2. •Prolonged expiratory phase
  3. •Accessory muscle use
  4. •Low Diaphragm
  5. •Distant Heart Sounds
  6. •Diminished Breath Sounds
  7. •Rhonchi
  8. •Wheezing
  9. •Cyanosis
  10. •Pedal Edema
  11. •Distended Jugular Veins
  12. •Hepatic congestion
  13. •Cachexia
  14. •“Blue Bloaters”
  15. •“Pink Puffers”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

COPD severity is categorized from I (mild) to IV (very severe). In each case the FEV1/FVC is < 70%. The categorization is based on FEV1 vs normal. What are the tiers?

A

I (mild): FEV1 >= 80% of predicted

II (Moderate): 50% <= FEV1 < 80% of predicted

III (Severe): 30% <= FEV1 < 50% of predicted

IV (Very Severe): < 30% of predicted or FEV1 < 50% of predicted plus chronic respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the chest x-ray findings in COPD? 5

A
  1. •Hyperinflation
  2. •Flattened Diaphragms
  3. •Increased restrosternal space
  4. •Bullae
  5. •Can be normal in mild to moderate COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What other options should you include in the COPD patients differential? 3

A
  • Asthma
  • Bronchiectasis
  • Bronchiolitis obliterans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Emphysema is enlargement of the airspaces distal to the terminal bronchiole with destruction of the alveolar wall. What are the two major types?

A

Centriacinar

Panacinar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does centriacinar emphysema effect? What is this type of emphysema common to?

A

Respiratory bronchioles distal to terminal bronchiole. (remainder of acinus spared)

Occurs with smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does panacinar emphysema impact?

What can be formed in this condition?

What are some things that lead to this?

A
  1. Alveolar ducts
  2. adjacent alveoli
  • Coalesce and form bullae
  • Common in alpha 1 antitrypsin deficiency, and occurs in smoking.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most severe COPD patients have which type of emphysema?

A

A combination of centriacinar and panacinar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the histological changes in chronic bronchitis?

A

Bronchial mucous gland enlargement and hyperplasia of epithelial goblet cells. (causes cough and further mucous production)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q
  • 45 year old female with a history of asthma complains of a daily cough and increased dyspnea. She now wakes up 2 or 3 nights a week with symptoms. Her current medicine is a medium dose inhaled steroid and albuterol inhaler as needed.
  • Physical Examination: Pulse 80, Respiratory Rate 16 Lung examination is remarkable for bilateral expiratory wheezing.
  • How would you categorize this patient’s asthma?
A

Moderate persistant asthma patient has daily symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q
  • 45 year old female with a history of asthma complains of a daily cough and increased dyspnea. She now wakes up 2 or 3 nights a week with symptoms. Her current medicine is a medium dose inhaled steroid and albuterol inhaler as needed.
  • Physical Examination: Pulse 80, Respiratory Rate 16 Lung examination is remarkable for bilateral expiratory wheezing.

Since this patient has moderate persistent asthma, what is the most appropriate addition to her therapy?

A) Add a long acting B2-agonist inhaler

B) Add an ipratropium metered-dose inhaler

C) Double the dose of inhaled corticosteroid

D) Start a 10-day course of a macrolide antibiotic

A

A. Add a long acting B2-agonist inhaler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Asthma is a clinical syndrome of unknown etiology with 3 distinct components. What are they?

A
  • 1) Recurrent airway obstruction that resolves spontaneously or with treatment.
  • 2) Airway hyperresponsiveness: exaggerated bronchoconstrictor response to stimuli that have little or no effect on nonasthmatic patients.
  • 3) Airway Inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What type of asthma?

“hypertrophy and hyperplasia of airway glands and smooth muscle lead to severe airway thickening”

A

Severe

38
Q

What type of asthma?

“•edema and hyperemia of the mucosa and infiltration of the mucosa with mast cells, eosinophils, and lymphocytes.”

A

Mild asthma

39
Q

What type of asthma?

“•chemokines eotaxin, RANTES, macrophage inflammatory protein 1 alpha, and interleukin 8 lead to inflammation and smooth muscle constriction”

A

Moderate asthma

40
Q

What is the airway obstruction in asthma d/t?

A

1) constriction of airway smooth muscle
2) thickening of airway epithelium
3) liquids in the airway

41
Q

What are some examples of asthma triggers?

A
  1. •Atopy
  2. Occupational
  3. •Allergy
  4. Food
  5. •Cold Air
  6. •Smoking or Smoke in the environment
  7. •Pollution
  8. •Climate Changes
  9. •Emotion
  10. •Medications
42
Q

What are five mediators of asthma?

A
  1. acetylcholine
  2. histamine
  3. leukotrienes
  4. lipoxins
  5. nitric oxide
43
Q

What are some examples of things you would hear in an asthma patients history?

A
  • Dyspnea, cough, wheezing, and anxiety
  • Exercise induced, aspirin ingestion, extrinsic(allergen induced), or intrinsic(unknown)
  • Cough, hoarseness, or inability to sleep through the night
  • Rapid changes in temperature or humidity may lead to an attack
  • occupation exposures
44
Q

What is the criteria for mild/intermittent asthma?

A

•symptoms present for 2 days/week or less, or 2 nights/month or less

45
Q

What is the criteria for mild persistent asthma?

A

•symptoms present for > 2 days/week but less than once daily, or > 2 nights/ month

46
Q

What is the criteria for moderate persistent asthma?

A

•symptoms present daily or greater than once/night

47
Q

What is the criteria for severe persistent asthma?

A

•symptoms are continual during the day and frequent at night

48
Q

Asthma patient ABG will normally indicate mild hypocapnea, If PaCO2 normalizes during a severe attack, what can this indicate?

A

Imminent respiratory failure

49
Q

What is the treatment recommendation of intermittent asthma?

A

Short acting beta 2 agonist as needed

(no daily meds)

50
Q

What is the treatment protocol for mild persistent asthma? What are three alternatives to the primary recommendation?

A
  1. Short acting beta 2 agonist as needed
  2. inhaled corticosteroid
  • alternative to corticosteroids include:
    • mast cell stabilizer
    • leukotriene-receptor antagonist
    • theophylline
51
Q

What is the treatment protocol for moderate persistent asthma?

A
  1. Short-acting beta-2 agonist as needed
  2. Low to medium dose inhaled corticosteroid
  3. Long-acting beta-2 agonist
52
Q

What is the treatment protocol for severe persistent asthma?

A
  1. Short-acting beta-2 agonist as needed
  2. High-dose inhaled corticosteroid and long-acting beta-2 agonist
  3. If symptoms persist, 2mg/kg/day of prednisone may be required, generally not to exceed 60mg/day
53
Q

What drug is this?

“monoclonal antibody in patients with moderate to severe persistent asthma who have shown reactivity to an allergen and whose symptoms are inadequately controlled by an inhaled corticosteroid.”

A

Omalizumab

54
Q
  • 60 year old male presents with a complaint of increased cough productive of purulent sputum, dyspnea, hemoptysis, pleuritic chest pain, and weight loss.
  • Physical Examination: wheezing and rales on auscultation of the lungs.
  • X-ray: see attached
  • Which of the following disorders is the most likely cause of this patient’s airway dilation?

A) Asthma

B) Atelectasis

C) Adult Respiratory Distress Syndrome

D) Bronchiectasis

E) Churg-Strauss Syndrome

A

D) Bronchiectasis

55
Q

Bronchiectasis is abnormal permanent dilatation of the bronchi and bronchioles caused by repeated cycles of airway infection and inflammation. What are the abnormalities that can lead to bronchiectasis?

A
  1. Cilia (kartagener’s)
  2. Mucous clearance
  3. mucous rheology
  4. airway drainage
  5. host defenses
56
Q

What happens to patients with bronchiectasis?

A

Develop chronic infections that lead to lung destruction

57
Q

What do half of bronchiectasis patients have?

A

CF

58
Q

What do one third of bronchiectasis etiologies include?

A

Infectious etiology - often years before onset.

59
Q

What are some examples of infectious etiologies for bronchiectasis?

A
  1. Pertussis
  2. TB
  3. MAC
60
Q

What genetic etiologies push a patient towards bronchiectasis?

A
  1. CF
  2. Kartagener’s
  3. Alpha-1-antitrypsin deficiency
61
Q

What are some immune and autoimmune etiologies for bronchiectasis?

A
  1. hypogammaglobulinemia
  2. Ig deficiencies
  3. HIV
  4. Sjogren’s
  5. RA
62
Q

What are six symptoms common to bronchiectasis?

A
  1. •Chronic cough with purulent sputum production
  2. •Dyspnea
  3. •Intermittent hemoptysis
  4. •Pleuritic chest pain
  5. •Weight loss
  6. •Fatigue
63
Q

What are two things you will see in PE of a patient with bronchiectasis?

A
  1. •Wheezing, rales
  2. Decline in Pulmonary function
  • Slow decline in pulmonary function
  • Decline more rapid if patient has Pseudomonas aeruginosa
64
Q

High resolution CT is used to make the diagnosis of bronchiectasis. What are the three important findings involved in this condition?

A
  1. •Lack of bronchial tapering
  2. •Bronchi visible in the peripheral 1 cm of the lungs
  3. •Internal bronchial diameter greater than the diameter of the accompanying bronchial artery
65
Q

Where does bronchiectasis d/t CF typically present?

A

Upper lobe

66
Q

Where does bronchiectasis from aspiration typically present?

A

Lower lobe

67
Q

Where does bronchiectasis from MAI (mycobacterium avium intracellular) typically present?

A

Right middle lobe and lingular

68
Q

What area of the lung does ABPA (allergic bronchopulmonary aspergillosis) typically cause bronchiectasis?

A

Central

69
Q

Apart from high res. CT, what other testing methods are employed for bronchiectasis patients?

A
  • PFT: demonstrates obstruction
  • Bronchoscopy: Used to detect airway abnormalities including tumors, structural deformities, and foreign bodies. Most helpful if the bronchiectasis is localized
  • Sputum cultures and bronchial alveolar lavage used to assess infectious etiologies
70
Q

What are still more tests that would be worth considering depending on the presentation of a bronchiectasis patient?

A
  • Serum Immunoglobulin levels
  • Genetic disease screening
  • Sweat chloride to diagnose cystic fibrosis
  • Electron microscopy of airway mucosal cilia to diagnose primary ciliary dyskinesia
  • Alpha 1 antitrypsin levels
  • Rheumatoid Factor for rheumatoid arthritis
  • SSA, SSB for Sjogren’s Syndrome
71
Q

Give five components/options for the treatment of bronchiectasis!

A
  1. •Treat underlying condition
  2. •Specific antimicrobials
  3. •Anti-inflammatory – inhaled steroids, macrolide antibiotics
  4. •Surgery for localized or refractory disease
  5. •Transplantation for end-stage disease
72
Q

What does a venturi mask allow?

A

Gradual upward titration of O2 delivery to patient to help minimize risk of supressing respiratory drive

73
Q

•41 year old nonsmoking carpenter is referred to you for treatment of asthma. He initially described cough, wheezing, and dyspnea in the evening which was controlled with his albuterol inhaler.

He now experiences symptoms during work hours and is using his inhaler more frequently. During vacation last month, at the beach, he had no symptoms, but upon returning to his work his symptoms have returned. His exam is unremarkable. A bronchoprovocation test with western red cedar produces a 30% decrease in his FEV1

  • The best way to manage this patient’s occupational asthma is ?
  • A. Continue symptomatic treatment with his albuterol
  • B. Avoid any further exposure to wood dust
  • C. Wear a specialized respirator at work
  • D. Add inhaled corticosteroids
  • E. Daily oral corticosteroids
A

Inhaled corticosteroids

74
Q
  • 35 year old white male come to your office complaining of difficulty breathing that has been worsening over the last 8 months.
  • He states he is now short of breath even when not moving. He has a 5 pack year history of smoking and quit 3 years ago when he first noticed difficulty breathing. This has persisted until now.
  • His family history is unknown because the patient was adopted. The patient denies sputum production, fever, or chills.
  • His blood pressure is 105/70 mm Hg in his right arm, pulse is 120/min and regular, RR 29/min at rest.
  • Examination shows intercostal retraction during breathing. On auscultation of his chest there are diminished breath sounds throughout both lungs and wheezes bilaterally. The rest of his examination is unremarkable
  • TLC 115% of predicted
  • RV 110% of predicted
  • FEV1/FVC 30% or predicted
  • DLco 55% of predicted

What is the most likely diagnosis?

A

Alpha-1 antitrypsin deficiency

75
Q
  • 65 year old white female is seen with a chronic productive cough. She produces over 2 tablespoons of sputum each day and her current cough has been present for 3 months. History reveals that she had a similar episode of chronic, productive cough that lasted more than 3 months each year for the last 2 years, but at different seasons of the year.
  • The most appropriate diagnosis of this patient is:
  • A. Seasonal allergies
  • B. Emphysema
  • C. Chronic bronchitis
  • D. Asthma
  • E. Sino-bronchial syndrome
A

Chronic bronchitis

76
Q
  • 20 year old female with symptoms of wheezing and shortness of breath for the past 3 months.
  • It is worse with exercise. Her past medical history is consistent with seasonal conjunctivitis and rhinitis.
  • She moved into her college dormitory 4 months ago and noticed she became worse after the move. Her roommate has a pet cat that sleeps on her bed.
  • Which of the following would best assess the possible etiology of her condition?

•

  • A. Serum IGE level
  • B. Circulating eosinophil count
  • C. Nasal smear for eosinophils
  • D. Antibody titers for Mycoplasma pneumonia
  • E. Reid index
A

Serum IgE

Circulating Eos and nasal smear Eos not specific enough.

77
Q
  • 35 year old dairy farmer who has never smoked. He has a chronic cough for the past two years. On physical examination he is afebrile, he has a mild wheeze heard on expiration. Spirometry reveals a mild decreased FEV1, and a decreased FVC.
  • Chest x-ray is normal. Lab reveals an eosinophilia and clusters of eosinophils are noted in his sputum.
  • He has serum precipitins to Thermoactinomyces vulgaris in his blood work
  • A. Farmer’s lung
  • B. Chronic bronchitis
  • C. Bronchial asthma
  • D. Sarcoidosis
  • E. Wegner’s granulomatosis
A

Farmer’s Lung

78
Q

Apart from the occupational exposure component, what are elements of a patient’s history that would point to farmer’s lung?

A
  1. Fever
  2. Chills
  3. Nonproductive cough
  4. chest tightness
  5. dyspnea
  6. headache
  7. malaise
79
Q

How does subacute farmer’s lung manifest?

What is the timeline?

A
  1. Chronic Cough
  2. Dyspnea
  3. Anorexia
  4. Weight loss

Subacute disease is insidious in onset and may occur over weeks to months

80
Q

Chronic farmer’s lung results from prolonged and continuous exposure to the antigen. What can you see in these patients?

A
  1. Irreversible lung damage
  2. severe dyspnea at rest or with exertion
81
Q

•42 year old male with asthma since childhood. He has never smoked cigarettes but does smoke marijuana. He now has low grade fevers, a productive cough, and mild exercise induced dyspnea. He denies chest pain or hemoptysis. Six weeks ago a persistent cough had developed with sputum production. His temperature is 100.6 F, and he has expectorated thick brown cords in the phlegm. The patient was given a diagnosis of pneumonia and received a dose of azithromycin without benefit. His WBC count is 11, 200 with 35% eosinophils. His chest x-ray shows diffuse pulmonary infiltrates.

Diagnosis?

  • A. Acute asthma
  • B. Pneumococcal pneumonia
  • C. Acute bronchopulmonary aspergillosis
  • D. Tuberculosis
  • E. Wegner’s granulomatosis
A

ABPA

82
Q
  • 35 year old woman come to the ER with urticaria, SOB, and wheezing. She is stabilized with epinephrine and antihistamines. One hour prior to symptoms she had a headache and took an OTC cold medication. She ate a meal of a tuna fish sandwich on white bread with lettuce, tomato, and a diet cola. She has no known food allergies and has not had this problem prior. Her PMH is positive for perennial nasal congestion treated with a nasal steroid. She was diagnosed with asthma 5 years earlier and takes an inhaled steroid and rescue inhaler. She saw an allergist one year ago and all “prick tests” to common allergies were negative.
  • Physical exam reveals small bilateral nasal polyps, the chest is clear to auscultation now.

The most likely cause of her reaction is:

  • A. Tuna fish allergy
  • B. Scombroid poisoning
  • C. Allergy to food coloring in the diet cola
  • D. Sensitivity to ASA or NSAIDS
  • E. Aspergillosis
A

Sensitivity to ASA or NSAIDs

83
Q

What is Samter’s triad?

A

Asthma

Nasal Polyps

ASA/NSAID sensitivity

84
Q
  • 32 year old white female who is a ranch hand from Craig, CO. She presents with signs and symptoms of COPD. She has hypoxia, a prolonged expiratory phase of respiration, and a poor FEV1. She has never smoked , but does have a family history of early emphysema.
  • A. Farmer’s lung
  • B. Silo fillers lung
  • C. Alpha 1 antitrypsisn deficiency
  • D. Agammaglobulinemia
  • E. Pulmonary fibrosis
A

Alpha 1 antitrypsisn deficiency

85
Q

•23 year old female has a history of asthma. She is using an albuterol rescue inhaler about 4 times a week and wakes up once a week with symptoms.

How would you classify her asthma?

A

Mild persistent

86
Q

•42 year old nurse is evaluated because of coughing, wheezing, and shortness of breath for the past 2 months. She relates the onset of her illness to a heavy exposure during an accidental spill of glacial acetic acid at work. At the time of exposure, she experienced dyspnea, eye irritation, and nasal congestion. She now complains of frequent paroxysms of cough, chest tightness, and awakening at night with SOB. Her physical exam is normal and her spirometry only reveals a decreased FEF25-75 at 45% of predicted. This improves to 65% of predicted with inhalation of albuterol.

Which of the following is the most likely diagnosis?

  • A. Reactive airways dysfunction syndrome (RADS)
  • B. Atopic asthma
  • C. Allergic occupational asthma
  • D. Chronic bronchitis
  • E. Alpha-1-antitrypsin disease
A

•A. Reactive airways dysfunction syndrome (RADS)

87
Q

•44 year old female has progressive difficulty with breathing for several years since her hysterectomy/bilateral oophorectomy. She takes thyroid supplements for borderline thyroid function, hormone therapy, eye drops for signs of early glaucoma, and water pills for weight gain. She does not smoke. Her mother has hay fever. Physical exam reveals a slender nervous woman with wheezing noted only on forced expiration. The rest of the exam is normal, Chest x-ray is normal and her FEF25-75 is 45% of predicted.

The most likely cause of her respiratory disorder is:

  • A. Psychological dyspnea
  • B. Beta-blocker induced asthma
  • C. NSAID induced asthma
  • D. Sarcoidosis
  • E. Pulmonary artery hypertension
A

•B. Beta-blocker induced asthma - given to the patient to treat her glaucoma. Can end up causing systemic effects also

88
Q
  • 22 year old male with a 2 year history of asthma has worsening respiratory function. He has seen a couple of doctors and tried a couple of inhalers, but has not had much success in controlling his asthma exacerbations. He has had two episodes of pneumonia in the last 2 years and often suffers from episodes of coughing and wheezing. These episodes are associated with blood-tinged, greenish sputum, fever, malaise, and expectoration of brownish mucous plugs. Past medical history and review of symptoms are otherwise unremarkable. Vital signs: T 98.6, BP 120/72 mm Hg, pulse 68/min, RR 28/min.
  • Examination reveals an ill appearing male in moderate distress. Respiratory examination reveals rare inspiratory crackles in the left lung base and coarse breath sounds in both upper lung lobes. The rest of the examination is normal. A chest x-ray reveals a small amount of parenchymal infiltrates in the upper lobes, some plate-like atelectasis at the left lung base, and some branched tubular radiodensities that the radiologist describes as “gloved finger” shadows. Serum IgE levels are sent and come back as 1,500ng/mL (normal is less than 1,000 ng/mL

Which of the following is the most appropriate therapy?

  • A. Amphotericin B
  • B. Caspofungin
  • C. Fluconazole
  • D. Prednisone
  • E. Surgery
A

Prednisone was the answer here. Though he later conceded that you would likely also give fluconazole to try and eliminate the organism.

89
Q

APBA often occurs in asthmatics and CF patients from a hypersensitity reaction, and may cause fever and pulmonary infiltrates that do not respond to antibacterial therapy.What also may happen in patients with ABPA?

How does it present?

A

•ABPA may occur in conjunction with allergic fungal sinusitis, with symptoms including chronic sinusitis with purulent sinus drainage.

90
Q
  • 65 year old woman with a long-standing history of smoking quit smoking 10 years ago when she was told that she had severe emphysema. She has been treated since then with prednisone 15 mg daily, albuterol, and ipratropium inhalers, inhaled steroids, theophylline, and leukotriene inhibitors. She is also on 24 hour supplemental oxygen. She now comes to the office with increasing shortness of breath and an inability to complete the minimal activities of daily living. She is essentially bedridden now. She denies a cough, fever, chills, shakes, shortness of breath, or chest pain.
  • Her oxygen saturation is 69% on 4 liters of oxygen. Lungs have poor air movement with no wheezing. Heart is regular, rate, and rhythm. She has no pedal edema. Laboratory studies are unremarkable. Electrocardiogram is normal sinus rhythm with evidence of right sided strain. Chest x-ray shows hyperinflated lungs. PFTs indicate an FEV1 that is 18% of predicted value

Which of the following is the next appropriate step in management?

  • A. Increase the dose of prednisone
  • B. Increase the frequency of inhalers
  • C. Obtain a CT of the chest
  • D. Refer for lung transplant
  • E. Schedule an echocardiogram
A

Lung transplant

91
Q
A

Respiratory II - Exam 2 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions