NBME 23 Answers : Block 4 : #23 = A 74-year-old woman comes to the physician because ...

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NBME 23 Answers

nbme23/Block 4/Question#23

A 74-year-old woman comes to the physician because ...

Ipratropium

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submitted by yotsubato(520),

Arent we NOT supposed to use ipratropium in old people?

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. +1

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

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 +1

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submitted by sne(22),

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

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. +1

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submitted by krewfoo99(40),

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

marat Cause lungs are overextended +2

marat overexpanded +1

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submitted by krewfoo99(40),

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

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. +

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submitted by abhishek021196(3),

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.