LE4 Flashcards
- The underlying mechanism of anti-hypertensive drug-induced chronic cough (as above) is:
a. drug allergy
b. All of the above
c. None of the above
d. Sensitization of sensory nerve ending to accumulated bradykinin
d. Sensitization of sensory nerve ending to accumulated bradykinin
Anti-hypertensive drug-induced chronic cough:
This is often associated with ACE inhibitors, a class of antihypertensive drugs. ACE inhibitors can lead to the accumulation of bradykinin in the respiratory tract because they inhibit the enzyme that normally breaks it down. This accumulation can sensitize the sensory nerve endings in the respiratory tract, leading to a persistent cough.
- True or false: Edema can cause localized hypoxia
a. True
b. false
a. True
Edema, or the accumulation of fluid in tissues, can lead to localized hypoxia (a deficiency in the amount of oxygen reaching the tissues). This is because the excess fluid can interfere with the diffusion of oxygen from blood vessels to the tissues.
- To address massive hemoptysis, the treatment of choice is
a. bronchial artery embolization
b. endotracheal intubation with double lumen endotracheal tube
c. surgical resection
d. photocoagulation and cautery
a. bronchial artery embolization
This procedure is often the first-line treatment for controlling massive hemoptysis. It involves the selective catheterization of the bronchial artery and the introduction of substances to block the artery and stop the bleeding.
- The cough center in the brain is located at the:
a. Nucleus tractus solitarius
b. Afferent nerves
c. Corpus callosum
d. Pineal gland
a. Nucleus tractus solitarius
This nucleus in the medulla oblongata is a part of the brainstem that plays a crucial role in the cough reflex and other respiratory processes.
- A patient with dyspnea should also have the abdomen examined for paradoxical inward movement of the abdomen during inspiration. This abnormal abdominal finding indicates:
a. Bronchiectasis
b. Abdominal aneurysm
c. Accelerated gastrointestinal peristalsis
d. Diaphragmatic weakness
d. Diaphragmatic weakness
Paradoxical inward movement of the abdomen during inspiration is a sign of diaphragmatic weakness. Normally, the diaphragm contracts and moves downward during inspiration, causing the abdomen to move outward.
- Cyanosis present since birth with clubbing is usually due to:
a. Venous occlusion
b. Congenital heart disease with right-to-left shunting
c. Raynaud’s phenomenon
d. Peripheral arterial occlusion
b. Congenital heart disease with right-to-left shunting
Cyanosis that is present from birth and accompanied by clubbing is typically indicative of congenital heart disease where there is a right-to-left shunt, such as Tetralogy of Fallot. This shunting allows deoxygenated blood to bypass the lungs and enter the systemic circulation, leading to cyanosis.
- Supplemental oxygen should only be given to patients with dyspnea if:
a. All patients regardless of O2 saturation
b. Opioids and anxiolytics do not alleviate dyspnea
c. O2 saturation drops <95% at baseline or with activity or sleep
d. O2 saturation is ≤88% with activity or sleep
d. O2 saturation is ≤88% with activity or sleep
Supplemental oxygen is typically recommended for patients with chronic respiratory diseases who have an oxygen saturation of 88% or less either at rest, with activity, or during sleep. This is because maintaining an oxygen saturation above this level helps to prevent complications associated with chronic hypoxia.
- Infectious agents that can cause hemoptysis:
a. Staphylococcus aureus, Klebsiella pneumoniae
b. Nocardia and Aspergillus and endemic fungi
c. AOTA
d. NOTA
c. AOTA
- Hemoglobin-oxygen dissociation curve SHIFT TO THE LEFT means:
a. Greater quantities of oxygen is released at any level of tissue PO2
b. NOTA
c. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
d. AOTA
c. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia.
A leftward shift in the hemoglobin-oxygen dissociation curve indicates that hemoglobin has a higher affinity for oxygen. As a result, oxygen is less readily released to the tissues at any given partial pressure of oxygen, which can contribute to tissue hypoxia.
- Hypertensive patient complained of a chronic cough. Chest x-ray was normal. The most common causative of anti-hypertensive is:
a. diuretics
b. ACE inhibitors
c. Nitrates
d. Calcium channel blockers
b. ACE inhibitors
As mentioned earlier, ACE inhibitors are known to cause a persistent dry cough in some patients. This side effect is due to the accumulation of bradykinin in the respiratory tract, which sensitizes the cough reflex.
- To diagnose asthma using spirometry, the expected is:
a. Non-reversibility in response to bronchodilators
b. NOTA
c. Reversibility in response to bronchodilators
d. Variable response to bronchodilators
c. Reversibility in response to bronchodilators
A key feature of asthma is the reversibility of airway obstruction. In spirometry, this is demonstrated by a significant improvement in lung function (usually measured as an increase in FEV1, or forced expiratory volume in 1 second) after the administration of a bronchodilator. This reversibility helps to distinguish asthma from other respiratory conditions like chronic obstructive pulmonary disease (COPD), where the obstruction is typically not fully reversible.
- it is the leading cause of massive hemoptysis and subsequent death
a. bronchitis
b. bronchiectasis
c. tuberculosis
d. rasmussen’s aneurysm
b. bronchiectasis
While bronchiectasis and Rasmussen’s aneurysm are also causes of hemoptysis, TB is historically and globally a more common cause, especially in areas where TB is prevalent.
- A 40 year old male complained of breathing discomfort after walking 100 meters on level ground. Based on the Modified Medical Research Council Dyspnea Scale, the grade of dyspnea is:
a. 0-1
b. 2
c. 3
d. 4
c. 3
According to the Modified Medical Research Council (MMRC) Dyspnea Scale, a grade of 3 is assigned to patients who experience breathlessness after walking a short distance on level ground. In this case, the patient’s discomfort after walking 100 meters fits this description.
- A patient at the ER complaining of dyspnea, was seen with decreased breath sounds on the left lung field to the mid base, with dullness on percussion. The most likely cause of dyspnea:
a. Pleural effusion
b. emphysema
c. interstitial edema
d. none of the above
a. Pleural effusion.
Decreased breath sounds and dullness to percussion, particularly if localized to one area of the lung, are classic signs of pleural effusion, which is the accumulation of fluid in the pleural space. This can significantly impair breathing and cause dyspnea.
- Chronic cough is defined as:
a. cough that lasts more than 12 weeks
b. cough that lasts more than 2 weeks
c. cough that last between 3-8 weeks
d. cough that is more than 8 weeks
d. cough that is more than 8 weeks
Objective finding of exaggerated fall in the systolic blood pressure by more than 10mmHg during inspiration:
a. pulsus paradoxus
b. Quincke’s sign
c. orthostatic hypotension
d. pulsus alternans
a. pulsus paradoxus
Pulsus paradoxus is characterized by an exaggerated decrease in systolic blood pressure (more than 10 mmHg) during inspiration. It is often associated with conditions like cardiac tamponade, severe asthma, or pericarditis.
Cough that lasts between 3-8 weeks is commonly seen in:
a. neoplasm
b. emphysema
c. residuum of tracheobronchitis
d. post nasal drip
c. residuum of tracheobronchitis
A cough that lasts between 3-8 weeks is often categorized as a subacute cough. This duration of cough is commonly seen as a residuum (or lingering effect) of tracheobronchitis, which is an inflammation of the trachea and bronchi, often following an upper respiratory tract infection.
A male patient with shortness of breath was referred to your clinic because of BP fluctuations during inspiration. The systolic blood pressure was reported to decrease from 120-100 mmHg. The possible causes include:
a. All of the above
b. None of the above
c. Pericardial disease
d. Chronic obstructive pulmonary disease or
asthma exacerbation
a. All of the above
The described symptom of a significant decrease in systolic blood pressure during inspiration (known as pulsus paradoxus) is a hallmark of pericardial disease, particularly cardiac tamponade. It can also be seen in severe cases of asthma or COPD exacerbations, but pericardial disease is a more direct cause of this specific symptom.
Acute cough that lasts for less than 3 weeks is due to:
a. Emphysema
b. All of the above
c. Inhalation of noxious smoke or chemicals
d. Neoplasm
c. Inhalation of noxious smoke or chemicals
Acute cough, which typically lasts less than 3 weeks, is most commonly due to viral upper respiratory infections, but it can also be caused by the inhalation of irritants like noxious smoke or chemicals. Neoplasm and emphysema are more likely to cause chronic cough.
- Treatment for cough variant asthma
a. Intermittent use of inhaled beta-agonist bronchodilators
b. All of the above
c. Inhaled glucocorticoids
d. None of the above
b. All of the above
Cough variant asthma is a type of asthma where the predominant symptom is a chronic cough. Inhaled glucocorticoids are the mainstay of treatment for controlling inflammation and preventing the cough. While inhaled beta-agonists may be used for quick relief of symptoms, they are not the primary treatment.
- Possible causes of dyspnea in the upright position but relieved in the supine position:
a. Left atrial myxoma and hepatopulmonary syndrome
b. Pleural effusion and cardiac tamponade
c. Congestive heart failure and cardiorenal syndrome
d. Chronic bronchitis and emphysema
a. Left atrial myxoma and hepatopulmonary syndrome
This pattern of dyspnea, known as platypnea, is unusual and can be seen in conditions like left atrial myxoma (a type of heart tumor) and hepatopulmonary syndrome (a complication of liver disease). The other options listed typically cause dyspnea that worsens in the supine position.
- True or False: Clinical picture of acute hypoxia resembles acute alcohol intoxication.
a. True
b. False
a. True
Acute hypoxia can indeed resemble acute alcohol intoxication in its clinical presentation. Symptoms like confusion, disorientation, and impaired judgment are common to both conditions. This similarity can sometimes lead to misdiagnosis in emergency situations.
- Objective physical findings indicative of increased airway resistance or lung and chest wall stiffness:
a. Tripod position
b. Supraclavicular retractions and use of accessory muscles of ventilation
c. All of the above
d. None of the above
c. All of the above
Both tripod positioning and supraclavicular retractions/use of accessory muscles of ventilation are indicative of increased work of breathing, which can be due to increased airway resistance or lung and chest wall stiffness. These are compensatory mechanisms to increase the efficiency of breathing.
- Central cyanosis is caused by
a. Venous obstruction
b. Acquired sulfhemoglobinemia
c. Arterial obstruction
d. Reduced cardiac output
b. Acquired sulfhemoglobinemia
- Subjective breathing discomfort perceived during upright position but relieved during spine position is known as
a. dyspnea
b. hypoxemia
c. hypoxia
d. platypnea
d. platypnea
Platypnea refers to the unusual condition where a person experiences shortness of breath (dyspnea) in the upright position, which is relieved by lying down (supine position).
- The cyanosis of the skin and mucous membrane is due to
a. Reduced quantity of all hemoglobin
b. Reduced quantity of white blood cells
c. Reduced quantity of hematocrit
d. Increased quantity of reduced hemoglobin or of hemoglobin derivatives
d. Increased quantity of reduced hemoglobin or of hemoglobin derivatives.
Cyanosis occurs when there is an increased amount of deoxygenated (reduced) hemoglobin in the blood, which gives the blood and the skin a bluish color. It’s not directly related to the total quantity of hemoglobin, white blood cells, or hematocrit levels.
- A patient sought consultation due to recurrent shortness of breath. Lung examination showed hyperresonance on both lung fields. The most likely cause is
a. Interstitial edema
b. emphysema
c. Pleural effusion
d. Interstitial fibrosis
b. emphysema
Hyperresonance on percussion of the lung fields is a classic finding in emphysema, a type of chronic obstructive pulmonary disease (COPD). Emphysema involves the destruction of the alveoli and results in overinflated lungs, which produce the hyperresonant sound on percussion. Interstitial edema, on the other hand, would more likely produce dullness on percussion due to fluid accumulation.
- To address expectoration of blood, the first thing to do is
a. Give tranexamic acid 500mg 1 capsule every 8 hours
b. Ascertain whether bleeding is from the respiratory tract or GI tract
c. Do sputum AFB and gene X-pert
d. Use nasal packing
b. Ascertain whether bleeding is from the respiratory tract or GI tract
When a patient presents with expectoration of blood, it is crucial to first determine the source of the bleeding. This differentiation is important because the management of gastrointestinal bleeding differs significantly from that of respiratory tract bleeding.
- Treatment for chronic eosinophilic bronchitis
a. Inhaled glucocorticoids
b. Intermittent use of inhaled beta agonist bronchodilators
c. AOTA
d. NOTA
a. Inhaled glucocorticoids
Chronic eosinophilic bronchitis, which is often associated with cough, is effectively treated with inhaled glucocorticoids. These medications help reduce airway inflammation and eosinophilic infiltration in the bronchial walls.
- Hemoglobin - oxygen dissociation curve SHIFT TO THE RIGHT means:
a. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
b. None of the above
c. All of the above
d. Greater quantities of oxygen is released at any level of tissue PO2
d. Greater quantities of oxygen is released at any level of tissue PO2
A rightward shift in the hemoglobin-oxygen dissociation curve indicates that hemoglobin has a lower affinity for oxygen. As a result, oxygen is more readily released to the tissues at any given partial pressure of oxygen, which can be beneficial in conditions where tissues require more oxygen.
- True or false: Cough alone as a manifestation of asthma is common among children but not among adults:
a. True
b. False
a. True
Cough alone as a manifestation of asthma is common among children but not among adults. Cough due to asthma in the absence of wheezing, shortness of breath, and chest tightness is referred to as “cough-variant asthma.”
- The parasite that can mimic tuberculosis common in Southeast Asia and China causing hemoptysis:
a. Loa loa
b. Diphyllobothrium latum
c. Paragonimus westermani
d. Enterobius vermicularis
c. Paragonimus westermani
Paragonimus westermani, a lung fluke, is known to cause paragonimiasis, which can present with symptoms similar to tuberculosis, including hemoptysis. It is endemic in certain parts of Southeast Asia and China.
- The hemoptysis that is cyclical that occurs with menstrual bleeding is:
a. Catamenial hemoptysis
b. Hemoptysis from Kaposi’s sarcoma
c. Aspergillosis hemoptysis
d. Pulmonary asbscess
a. Catamenial hemoptysis
Catamenial hemoptysis is a rare condition where a woman experiences lung bleeding that coincides with her menstrual cycle. It is thought to be related to endometrial tissue deposits in the lung, which respond to hormonal changes during the menstrual cycle.
- Massive hemoptysis is defined as:
a. 100-150mL blood loss at one time
b. All of the above
c. None of the above
d. Blood loss of 400mL in 24 hours
b. All of the above
Massive hemoptysis is typically defined as the expectoration of a significant amount of blood, usually around 300-600 mL within 24 hours, but the threshold can vary. A loss of 400 mL in 24 hours is commonly used as a criterion.
- Ineffective coughing leading to serious infections may be due to:
a. All of the above
b. Tracheobronchomalacia
c. IV sedation and anesthesia
d. Severe kyphoscoliosis
a. All of the above
Ineffective coughing can be due to various causes, including tracheobronchomalacia (weakening of the tracheal and bronchial walls), IV sedation and anesthesia (which can suppress cough reflex), and severe kyphoscoliosis (which can impair respiratory muscle function).
- Cyanosis of extremities from cold-induced vasospasm is:
a. High altitude hypoxia
b. Carboxyhemoglobinemia
c. Methemoglobinemia
d. Raynaud’s Phenomenon
d. Raynaud’s Phenomenon
Raynaud’s phenomenon is characterized by episodic vasospasm in the extremities, often in response to cold or stress, leading to color changes in the skin of the fingers and toes, including cyanosis.
- Poisons such as cyanide cause hypoxia that tissues are unable to use oxygen and venous blood tends to have high oxygen tension. This is called:
a. Eisenmenger’s syndrome
b. Central hypoxia
c. Shunting
d. Histotoxic hypoxia
d. Histotoxic hypoxia
Histotoxic hypoxia occurs when tissues are unable to utilize oxygen effectively. Poisons like cyanide inhibit cellular respiration, leading to high oxygen tension in venous blood because oxygen cannot be utilized by the tissues.
- Most hemoptysis is due to vessels in the:
a. None of the above
b. Bronchial arteries
c. All of the above
d. Pulmonary arteries
b. Bronchial arteries
Most cases of hemoptysis originate from the bronchial arteries, not the pulmonary arteries. The bronchial arteries have systemic pressure and can be a source of significant bleeding in conditions like bronchiectasis, lung infections, and lung cancer.
- True or false: Chronic eosinophilic bronchitis causes chronic cough with a normal chest radiograph
a. True
b. False
a. True
Chronic eosinophilic bronchitis is a common cause of chronic cough and is characterized by an eosinophilic infiltration of the bronchial walls without airway hyperresponsiveness. It typically presents with a chronic cough but with a normal chest radiograph.
- In carbon monoxide intoxication, the hemoglobin-oxygen dissociation shifts to the:
a. AOTA
b. left
c. right
d. NOTA
b. left
In carbon monoxide (CO) poisoning, the hemoglobin-oxygen dissociation curve shifts to the left. CO binds to hemoglobin with a much higher affinity than oxygen, reducing the amount of oxygen that hemoglobin can transport. This shift to the left indicates that hemoglobin holds onto the remaining oxygen more tightly, making it less available to tissues.
6 Ineffective coughing leading to serious infections may be due to:
a. severe kyphoscoliosis
b. tracheobronchomalacia
c. IV sedation and anesthesia
d. all of the above
d. all of the above
Ineffective coughing can be due to various causes, including severe kyphoscoliosis (which can impair respiratory muscle function), tracheobronchomalacia (weakening of the tracheal and bronchial walls), and IV sedation and anesthesia (which can suppress cough reflex). All these conditions can lead to an inability to effectively clear airway secretions, increasing the risk of serious infections.
