NBME 23 Ipratropium (NBME Answers)

NBME 23 Answers

nbme23/Block 4/Question#23 (reveal difficulty score)
A 74-year-old woman comes to the physician ...
Ipratropium 🔍 / 📺 / 🌳 / 📖
tags:

+2 upvote downvote
submitted by ∗skonys(58)

get full access to all content ⋅ pick a username

Any idea why it isn't Acetylcysteine? It's literally given as a mucolytic to COPD (and CF patients)

get full access to all content ⋅ pick a username

weirdmed51 Let him breathe first and think of imaginary cough later ( isn’t even mentioned )! +

weirdmed51 Her* +

+1 upvote downvote
submitted by ∗sne(59)

get full access to all content ⋅ pick a username

Acute asthma exacerbation 1. Albuterol 2. Corticosteroids 3. Ipratropium

get full access to all content ⋅ pick a username

youssefa I guess they described a COPD exacerbation here since she's a smoker and Xray showed a wide AP diameter. Either ways Ipratropium would make the best answer since its used in both cases. +5

+0 upvote downvote
submitted by ∗yotsubato(1208)

get full access to all content ⋅ pick a username

Arent we NOT supposed to use ipratropium in old people?

get full access to all content ⋅ pick a username

amirmullick3 Who said not to use it in old people? Remember "I pray that tio can breathe soon" and tio is an old uncle in spanish but its also the other drug, tiotrropium. +4

drdoom discussion of anticholinergics & elderly also discussed at some length (but different context) here: https://www.nbmeanswers.com/exam/nbme22/1288 +1

guillo12 Ipratropium does not penetrate the blood-brain barrier, so I think this is why it can be given to old people. https://www.rxlist.com/duoneb-drug.htm#clinpharm +6

+0 upvote downvote
submitted by ∗krewfoo99(115)

get full access to all content ⋅ pick a username

Anyone know why heart sounds would be distant in COPD exacerbation?

get full access to all content ⋅ pick a username

marat Cause lungs are overextended +6

marat overexpanded +5

+0 upvote downvote
submitted by ∗abhishek021196(119)

get full access to all content ⋅ pick a username

I-PRA-tropium, tiotropium Use - COPD, asthma (“I pray I can breathe soon!”).

Muscarinic antagonists competitively block muscarinic receptors, preventing bronchoconstriction. Tiotropium is long acting.

get full access to all content ⋅ pick a username

-1 upvote downvote
submitted by ∗krewfoo99(115)

get full access to all content ⋅ pick a username

Anyone know why heart sounds would be distant in COPD exacerbation?

get full access to all content ⋅ pick a username

yng Patient is usually obese (blue bloater) --> diaphragm movement is limited --> can't take deep breaths, and in extreme cases, the chest size increased and causing distant heart sound. +2

Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled ‘D’ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled ‘C’ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...