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65 Cards in this Set
- Front
- Back
symptom of allergic rhinitis is seasonal nasal stuffiness and sneezing
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True
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A nasal smear of eosinophils is useful adjunctive test for diagnosing allergic rhinitis
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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
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Nocturnal cough in a child is commonly due to bronchial asthma
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True
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Frontal sinusitis is common in young children
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False
frontal sinuses are not developed until 10 years old |
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Hemophilus influenzae in a common cause of acute sinusitis in children
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True
Streptococcus pneumoniae is more common in adults |
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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?
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Taken 10-14 days
Bactrim and Zithromax also work |
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the most common cause of acute maxillary sinusitis is allergic rhinitis
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False
Viral cause of rhinitis with blockage of the sinus ostia |
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the most common complication of recurrent otitis media is sensorineural hearing loss
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False
Conductive hearing loss |
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Ear popping is commonly associated with serous otitis media
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True
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thrombocytopenia is the most common cause of epistaxis
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False
nose-picking |
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Allergic shiners are due to stasis of venous blood secondary to nasal stuffiness
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True
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In conduction hearing loss, Weber test lateralizes to the affected ear and air conduction is longer than bone conduction
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False
bone conduction is longer than air conduction |
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In sensorineural hearing loss, Weber test lateralizes to the affected ear and air conduction is longer than bone conduction
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False
lateralizes to the normal ear and air conduction is longer than bone conduction in both ears |
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An increased AP diameter in bronchial asthma is due to an increase in TLC secondary to an increase in residual volume
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True
total lung capacity is increased due to air trapping, which increases the residual volume |
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Acute respiratory acidosis is the usual clinical presentation of a bronchial asthmatic attack.
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False
acute respiratory alkalosis is the usual ABG Respiratory acidosis is an indication for intubation and hospitalization |
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Tender anterior cervical lymph nodes can be seen in postnasal discharge for sinus infections
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True
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In bilateral otitis media, the Weber test does not lateralize
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True
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A higher than normal serum alkaline phosphatase level in a child with external evidence of bruising is usually secondary to liver trauma
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False
suspect bone fracture repair with increased osteoblastic activity |
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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
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True
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Charcot Leyden crystals are derived from mast cells
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False
crystalline material from eosinophils |
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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
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True this is an obstructive pattern
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Parents can decline to have their child questioned by DHS
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False
if there is suspicion parents are legally obligated to allow questioning |
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The primary effector cell in type I hypersensitivity reactions is the eosinophil
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False
Mast cells Eosinophils are present due to eosinophil chemotatic factor released by mast cells |
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Mast cell release from prostaglandins and leukotrienes is part of the acute early phase reaction of mast cells
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False
they are synthesized and released after the release of the primary mediators |
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Metered dose inhalers utilize short acting beta agonists, like albuterol, are the mainstay of therapy for mild bronchial asthma
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True
they are bronchodilators |
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Inhaled corticosteroids are used for moderate to severe bronchial asthma and primarily block the synthesis of leukotrienes
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False
by inhibiting phopholipase A2, they block the synthesis of both prostaglandins and the leukotrienes |
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Cromolyn sodium is a mast cell stabilizer
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True
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Aminophylline blocks phosphodiesterase, hence cAMP levels are high in bronchial smooth muscle
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True
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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
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False
Ipratropium is an anticholinergic |
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Medications for asthma are divided into two groups:
long term control medications quick relief medications |
True
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Pseudoephedrine is primarily used as a bronchodilator in asthmatics
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False: it is a nasal decongestant that helps drain the Eustachian tube and prevent ear infections
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Guaifenesin is an expectorant and cough suppressing agent
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False
is not a cough suppressant Dextromethorphan is the suppressant |
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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
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True
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Peak flow meters are useful in monitoring asthmatics at home, since they provide a rough estimate of the forced vital capacity
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True
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Eczema in infants is most commonly located in the flexor creases
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False
cheeks, trunk, extensor surfaces after 3 years it moves to the flexor creases |
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The lung compliance is usually increased in asthmatics
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False
decreased owing to an excess of water in the interstitial tissue of the lungs. This produces a mild restrictive pattern |
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The most common cause of an asthma attack is exposure to allergens
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True
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bronchial asthma is the most common cause of irreversible small airway damage
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False
it is most commonly a reversible type of airway disease Chronic bronchitis in smokers is an irreversible small airway disease |
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The respiratory bronchiole and alveolar ducts are the most common site for small airway disease
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False
Terminal non-respiratory bronchiole |
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Laminar airflow begins in the terminal bronchioles
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True due to parallel branching of the airways
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the most common cause of nocturnal cough in adults is gastroesophageal reflux disease
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True
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Expiratory wheezing is a sign of upper airway obstruction
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false
small airway obstruction, inspiratory stridor indicates upper airway obstruction |
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Functional residual capacity is the total amount of air in the lungs at the end of a normal expiration (end of tidal volume)
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True
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Expiratory wheezing is sign of upper airway obstruction
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False
small airway obstruction inspirtatory stridor indicates upper airway obstruction |
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Expiratory reserve volume is the total amount of air in the lungs at the end of a normal expiration
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True
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Subtracting the expiratory reserve volume from the functional residual capacity calculates the residual volume
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True
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In bronchial asthma, the DLco is often decreased owing to air trapping and its effect on increasing the cross sectional area of the lungs
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False
DLco is increased in bronchial asthma |
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Removing an entire lung increases the DL co
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False
removing a lung decreases the total cross sectional area of the lung that CO has to diffuse in hence, decreasing the DLco |
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Allergic conjunctivitis is usually seasonal
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True
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Hypertrophied tonsils and adenoids are most often cause of repeated infections
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True
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Recurrent periumbilical pain it usually has a pathological origin
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False
most often is related to stress and anxiety |
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type I hypersensitivity is IgE mediated activation of mast cells
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True
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define bronchial asthma
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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 |
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what is a type I hypersensitivity
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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
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what are the sympathomimetic bronchodilators used in the treatment of asthma
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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 |
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Long acting beta-agonist
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Salmeterol
slower onset the fast acting B-agonist longer half-life |
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How do inhaled corticosteriods treat asthma
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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 |
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Fluticasone/Salmeterol
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combination of beta agonist drugs with inhaled corticosteroids
not used for acute symptoms |
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Systemic corticosteroids
Predinsone, Prednisolone |
indicated when all of the other conventional agents have failed to relieve symptoms
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what is Cromolyn
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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 |
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Aminophylline, theophylline
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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 |
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Ipratropium
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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
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Pseudoephedrine
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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
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Nasal steroid preparations
Flonase, Nasonex, RhinocortAQ |
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
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Accolate
Singular |
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 |