Cps Exam 3: Pulmonary Medicine

Front 1

symptom of allergic rhinitis is seasonal nasal stuffiness and sneezing

Back 1

True

Front 2

A nasal smear of eosinophils is useful adjunctive test for diagnosing allergic rhinitis

Back 2

True in addition to examination of nasal mucosa frequently displays a pale bluish hue or pallor along with turbinate edema, although this is not a universal finding

Front 3

Nocturnal cough in a child is commonly due to bronchial asthma

Back 3

True

Front 4

Frontal sinusitis is common in young children

Back 4

False
frontal sinuses are not developed until 10 years old

Front 5

Hemophilus influenzae in a common cause of acute sinusitis in children

Back 5

True
Streptococcus pneumoniae is more common in adults

Front 6

Augmentin is commonly used in the treatment of persistent otitis media and acute sinusitis. How long is the treatment? What other agents can be used?

Back 6

Taken 10-14 days
Bactrim and Zithromax also work

Front 7

the most common cause of acute maxillary sinusitis is allergic rhinitis

Back 7

False
Viral cause of rhinitis with blockage of the sinus ostia

Front 8

the most common complication of recurrent otitis media is sensorineural hearing loss

Back 8

False
Conductive hearing loss

Front 9

Ear popping is commonly associated with serous otitis media

Back 9

True

Front 10

thrombocytopenia is the most common cause of epistaxis

Back 10

False
nose-picking

Front 11

Allergic shiners are due to stasis of venous blood secondary to nasal stuffiness

Back 11

True

Front 12

In conduction hearing loss, Weber test lateralizes to the affected ear and air conduction is longer than bone conduction

Back 12

False
bone conduction is longer than air conduction

Front 13

In sensorineural hearing loss, Weber test lateralizes to the affected ear and air conduction is longer than bone conduction

Back 13

False
lateralizes to the normal ear and air conduction is longer than bone conduction in both ears

Front 14

An increased AP diameter in bronchial asthma is due to an increase in TLC secondary to an increase in residual volume

Back 14

True
total lung capacity is increased due to air trapping, which increases the residual volume

Front 15

Acute respiratory acidosis is the usual clinical presentation of a bronchial asthmatic attack.

Back 15

False
acute respiratory alkalosis is the usual ABG
Respiratory acidosis is an indication for intubation and hospitalization

Front 16

Tender anterior cervical lymph nodes can be seen in postnasal discharge for sinus infections

Back 16

True

Front 17

In bilateral otitis media, the Weber test does not lateralize

Back 17

True

Front 18

A higher than normal serum alkaline phosphatase level in a child with external evidence of bruising is usually secondary to liver trauma

Back 18

False
suspect bone fracture repair with increased osteoblastic activity

Front 19

The Hb and Hct in children is lower than adults because they have higher phosphate levels that increase 2,3 BPG causing a right shift of the oxygen dissociation curve

Back 19

True

Front 20

Charcot Leyden crystals are derived from mast cells

Back 20

False
crystalline material from eosinophils

Front 21

A classic obstructive lung pattern is an increase in TLC, increased residual volume, decreased vital capacity, decreased FEV1 and FVC, and decrease in the ratio of FEV1/FVC

Back 21

True this is an obstructive pattern

Front 22

Parents can decline to have their child questioned by DHS

Back 22

False
if there is suspicion parents are legally obligated to allow questioning

Front 23

The primary effector cell in type I hypersensitivity reactions is the eosinophil

Back 23

False
Mast cells
Eosinophils are present due to eosinophil chemotatic factor released by mast cells

Front 24

Mast cell release from prostaglandins and leukotrienes is part of the acute early phase reaction of mast cells

Back 24

False
they are synthesized and released after the release of the primary mediators

Front 25

Metered dose inhalers utilize short acting beta agonists, like albuterol, are the mainstay of therapy for mild bronchial asthma

Back 25

True
they are bronchodilators

Front 26

Inhaled corticosteroids are used for moderate to severe bronchial asthma and primarily block the synthesis of leukotrienes

Back 26

False
by inhibiting phopholipase A2, they block the synthesis of both prostaglandins and the leukotrienes

Front 27

Cromolyn sodium is a mast cell stabilizer

Back 27

True

Front 28

Aminophylline blocks phosphodiesterase, hence cAMP levels are high in bronchial smooth muscle

Back 28

True

Front 29

Ipratropium bromide is a long acting beta agonist that antagonizes acetylcholine, hence preventing the increase of cGMP, which promotes the constriction fo bronchial smooth muscle

Back 29

False
Ipratropium is an anticholinergic

Front 30

Medications for asthma are divided into two groups:
long term control medications
quick relief medications

Back 30

True

Front 31

Pseudoephedrine is primarily used as a bronchodilator in asthmatics

Back 31

False: it is a nasal decongestant that helps drain the Eustachian tube and prevent ear infections

Front 32

Guaifenesin is an expectorant and cough suppressing agent

Back 32

False
is not a cough suppressant
Dextromethorphan is the suppressant

Front 33

Intranasal steroids sprays block the inflammatory aspect of allergic rhinitis by blocking mast cell degranulation, hence preventing early release of primary mediators and late phase reaction mediators

Back 33

True

Front 34

Peak flow meters are useful in monitoring asthmatics at home, since they provide a rough estimate of the forced vital capacity

Back 34

True

Front 35

Eczema in infants is most commonly located in the flexor creases

Back 35

False
cheeks, trunk, extensor surfaces
after 3 years it moves to the flexor creases

Front 36

The lung compliance is usually increased in asthmatics

Back 36

False
decreased owing to an excess of water in the interstitial tissue of the lungs. This produces a mild restrictive pattern

Front 37

The most common cause of an asthma attack is exposure to allergens

Back 37

True

Front 38

bronchial asthma is the most common cause of irreversible small airway damage

Back 38

False
it is most commonly a reversible type of airway disease
Chronic bronchitis in smokers is an irreversible small airway disease

Front 39

The respiratory bronchiole and alveolar ducts are the most common site for small airway disease

Back 39

False
Terminal non-respiratory bronchiole

Front 40

Laminar airflow begins in the terminal bronchioles

Back 40

True due to parallel branching of the airways

Front 41

the most common cause of nocturnal cough in adults is gastroesophageal reflux disease

Back 41

True

Front 42

Expiratory wheezing is a sign of upper airway obstruction

Back 42

false
small airway obstruction, inspiratory stridor indicates upper airway obstruction

Front 43

Functional residual capacity is the total amount of air in the lungs at the end of a normal expiration (end of tidal volume)

Back 43

True

Front 44

Expiratory wheezing is sign of upper airway obstruction

Back 44

False
small airway obstruction
inspirtatory stridor indicates upper airway obstruction

Front 45

Expiratory reserve volume is the total amount of air in the lungs at the end of a normal expiration

Back 45

True

Front 46

Subtracting the expiratory reserve volume from the functional residual capacity calculates the residual volume

Back 46

True

Front 47

In bronchial asthma, the DLco is often decreased owing to air trapping and its effect on increasing the cross sectional area of the lungs

Back 47

False
DLco is increased in bronchial asthma

Front 48

Removing an entire lung increases the DL co

Back 48

False
removing a lung decreases the total cross sectional area of the lung that CO has to diffuse in hence, decreasing the DLco

Front 49

Allergic conjunctivitis is usually seasonal

Back 49

True

Front 50

Hypertrophied tonsils and adenoids are most often cause of repeated infections

Back 50

True

Front 51

Recurrent periumbilical pain it usually has a pathological origin

Back 51

False
most often is related to stress and anxiety

Front 52

type I hypersensitivity is IgE mediated activation of mast cells

Back 52

True

Front 53

define bronchial asthma

Back 53

reversible, small airway disease
inflammation is the key to understanding the pathophysiology of asthma and its treatment
In atopic asthma, there is a type I hypersensitivity reaction of inhaled allergens

Front 54

what is a type I hypersensitivity

Back 54

an immediate hypersensitivity reaction involving the production of IgE antibodies against an allergen with subsequent activation of mast cells/basophils and the release of chemical mediators that produce inflammatory response

Front 55

what are the sympathomimetic bronchodilators used in the treatment of asthma

Back 55

Beta agonist: albuterol, metaproterenol administered through metered dose inhalers are a mainstay of therapy
activates beta-agonist receptors on the smooth muscle cells in the airways > stimulates adenyl clyclase and production of cAMP which relaxes the smooth muscle
use for acute relief

Front 56

Long acting beta-agonist

Back 56

Salmeterol
slower onset the fast acting B-agonist
longer half-life

Front 57

How do inhaled corticosteriods treat asthma

Back 57

Fluticasone, Budesonide is preferred treatment begining with Step 2 for mild persistant with low dose and Step 3, 4, 5, low, medium, to high dose with long acting beta agonist for moderate to severe asthma
Corticosteroids inhibit phospholipase A2 and the generation of arachidonic acid metabolites

Front 58

Fluticasone/Salmeterol

Back 58

combination of beta agonist drugs with inhaled corticosteroids
not used for acute symptoms

Front 59

Systemic corticosteroids
Predinsone, Prednisolone

Back 59

indicated when all of the other conventional agents have failed to relieve symptoms

Front 60

what is Cromolyn

Back 60

virtually a nontoxic asthma controller medication that has been in use for many years.
The high safety profile of cromolyn as well as its availability as a nebulized preparation has made it an appealing option for infants and children younger than 2 years with mild asthma
It stabilizes mast cell membranes thus preventing the mediator release and also inhibits the late phase reaction

Front 61

Aminophylline, theophylline

Back 61

no longer considered a mainstay of treatment in asthma
antagonizes airway smooth muscle adenosine receptors and blocks phosphodiesterase thus keeping cAMP levels increased in smooth muscle cells

Front 62

Ipratropium

Back 62

anticholinergic that antagonizes acetycholinergic that prevents the increase of cGMP which promotes smooth muscle contraction in the airways; commonly used in the treatment of elderly patients with an asthmatic component to their COPD

Front 63

Pseudoephedrine

Back 63

a decongestant that should help drainage of the eustachian tube and sinuses and improve nasal breathing. Guaifenesin is an expectorant and also helps to relieve irritation of mucosal membranes

Front 64

Nasal steroid preparations
Flonase, Nasonex, RhinocortAQ

Back 64

attacks the inflammatory aspect of allergic rhinnitis by blocking mast cell degranulation thus preventing both early and late phase release reactions of chemical mediators that can exacerbate allergic induced asthma

Front 65

Accolate
Singular

Back 65

LT receptor antagonist that inhibits the cysteinyl LT receptor
all of these drugs have been shown to improve asthma symptoms of reducing airway edema, relaxing smooth muscle and to cause variable improvements in pulmonary function
in addition they have all been shown to significantly reduce exercise induced bronchospasm, and seasonal allergic rhinitis symptoms