Respiratory Quiz Qs Flashcards
A 42 year old woman with a history of asthma has an attack and is brought to the ED for evaluation and treatment. She is wheezing and is short of breath. What is the most likely pathophysiology of this condition?
Bronchodilation
Increased secretion of mucus
Inflammation of the bronchial serosa
Relaxation of bronchial smooth muscle
B
One effect that theophylline, nitroglycerin, isoproterenol, and histamine have in common is
Direct stimulation of cardiac contractile force Tachycardia Bronchodilation Postural hypotension Throbbing headache
B Tachycardia
Theophylline does not ordinarily cause headache or postural hypotension. Nitroglycerin does not cause direct cardiac stimulation but does evoke a compensatory sympathetic reflex. Histamine does not cause bronchodilation.
The answer is B.
A 23-year-old woman is using an albuterol inhaler for frequent acute episodes of asthma and complains of symptoms that she ascribes to the albuterol. Which of the following is not a recognized action of albuterol?
Diuretic effect Positive inotropic effect Skeletal muscle tremor Smooth muscle relaxation Tachycardia
A Diuretic effect
Albuterol is a β2-selective receptor agonist, but in moderate to high doses it induces β 1 cardiac effects as well as β2-mediated smooth and skeletal muscle effects. It does not cause diuresis.
The answer is A.
A 10-year-old child has severe asthma and was hospitalized 5 times between the ages of 7 and 9. He is now receiving outpatient medications that have greatly reduced the frequency of severe attacks. Which of the following is most likely to have adverse effects when used daily over long periods for severe asthma?
Albuterol by aerosol Beclomethasone by aerosol Cromolyn by inhaler Prednisone by mouth Theophylline in long-acting oral form
D Prednisone by mouth
If oral corticosteroids must be used, alternate-day therapy is preferred because it interferes less with normal growth in children.
The answer is D.
A 16-year-old patient is in the emergency department receiving nasal oxygen. She has a heart rate of 125 bpm, a respiratory rate of 40 breaths/ min, and a peak expiratory flow < 50% of the predicted value. Wheezing and rales are audible without a stethoscope.
Which of the following drugs does not have a direct bronchodilator effect? Epinephrine Terbutaline Prednisone Theophylline Ipratropium
C Prednisone
Although extremely important in severe chronic asthma and status asthmaticus, corticosteroids do not have a demonstrable direct bronchodilator action.
The answer is C.
A 16-year-old patient is in the emergency department receiving nasal oxygen. She has a heart rate of 125 bpm, a respiratory rate of 40 breaths/ min, and a peak expiratory flow < 50% of the predicted value. Wheezing and rales are audible without a stethoscope.
After successful treatment of the acute attack, the patient was referred to the outpatient clinic for follow-up treatment for asthma. Which of the following is not an established prophylactic strategy for asthma?
Avoidance of antigen exposure Blockade of histamine receptors Blockade of leukotriene receptors IgE antibody blockade Inhibition of phospholipase A2
B Blockade of histamine receptors
Histamine does not appear to play a significant role in asthma, and antihistaminic drugs, even in high doses, are of little or no value. Antigen avoidance is well established. Blockade of leukotriene receptors with montelukast; inhibition of phospholipase with corticosteroids; and inhibition of mediator release with the IgE antibody are also useful.
The answer is B.
Mr Green is a 60-year-old former smoker with cardiac disease and severe chronic obstructive pulmonary disease (COPD) associated with frequent episodes of bronchospasm. Which of the following is a bronchodilator useful in COPD and least likely to cause cardiac arrhythmia?
Aminophylline (B) Cromolyn (C) Epinephrine (D) Ipratropium (E) Metaproterenol (F) Metoprolol
D Ipratropium
Ipratropium is the bronchodilator that is most likely to be useful in COPD without causing arrhythmias. Tiotropium is similar.
The answer is D.
A 22-year-old man is brought to the emergency department after suffering seizures resulting from an overdose of a drug he has been taking. His friends state that he took the drug orally and sometimes had insomnia after taking it. Which of the following is a direct bronchodilator that is most often used in asthma by the oral route and is capable of causing insomnia and seizures?
Cromolyn (B) Epinephrine (C) Ipratropium (D) Metoprolol (E) Prednisone (F) Salmeterol (G) Theophylline
G Theophylline
Theophylline is a bronchodilator that is active by the oral route. It causes insomnia in therapeutic doses and seizures in overdosage.
The answer is G
Which of the following in its parenteral form is life-saving in severe status asthmaticus and acts, at least in part, by inhibiting phospholipase A2?
(A) Aminophylline (B) Cromolyn (C) Epinephrine (D) Ipratropium (E) Metaproterenol (F) Metoprolol (G) Prednisone
G Prednisone
Parenteral corticosteroids such as prednisolone (the active metabolite of prednisone) are lifesaving in status asthmaticus. They probably act by reducing production of leukotrienes (see Chapter 18 ).
The answer is G.
Which of the following has a slow onset but long duration of action and is always used in combination with a corticosteroid by inhalation?
(A) Aminophylline (B) Cromolyn (C) Epinephrine (D) Ipratropium (E) Metaproterenol (F) Metoprolol (G) Prednisone/ prednisolone (H) Salmeterol
H Salmeterol
Salmeterol is a β2-selective agonist that has a slow onset and long duration of action. Used alone, it increases asthma mortality, but in combination with inhaled corticosteroids it improves asthma control.
The answer is H.
Oral medications are popular for the treatment of asthma in children because young children may have difficulty with the proper use of aerosol inhalers. Which of the following is an orally active inhibitor of leukotriene receptors?
(A) Albuterol (B) Aminophylline (C) Ipratropium (D) Montelukast (E) Zileuton
D Montelukast
Zileuton is an inhibitor of the lipoxygenase enzyme involved in the synthesis of leukotrienes .
Montelukast and zafirlukast are leukotriene antagonists at the leukotriene receptor.
The answer is D.
A 6-year-old boy returns home from his last day of school before thanksgiving break. Over the break, he develops a cough, stuffy nose, headache, and fever. His mother administers a cough syrup containing guaifenesin. Which of the following effects is likely caused by guaifenesin?
A) Cough becomes more productive B) Cough stops altogether C) Fever diminishes D) Headache resolves E) Headache worsens
A) Cough becomes more productive
A 17-year-old female with cystic fibrosis began taking a new medication to help loosen the mucus in her respiratory tract. The patient has not been adherent to her regimen of this drug, complaining that its smell makes her sick. Which is the most likely drug?
A) Acetylcysteine B) Bromhexine C) Calfactant D) Dornase alfa E) Guaifenesin
A) Acetylcysteine
A 75-year-old man with a 40-pack-year history of smoking and known chronic obstructive pulmonary disease complains of intermittent cough. Physical examination reveals wheezing, which is suggestive of bronchospasm. Which of the following is the most appropriate treatment for this patient?
Ipratropium aerosol Mecamylamine Nicotine Oxygen Scopolamine
A) Ipratropium aerosol
A 5-year-old boy is brought to the clinic by his parents who say that he often has trouble catching his breath when he has been playing hard outside. He is allergic to peanuts. At the moment, he is breathing fine. Which of the following drugs would dilate his bronchioles in an acute asthma attack?
Albuterol Methacholine Neostigmine Nicotine Pilocarpine
A) Albuterol
