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NBME 23 Answers

nbme23/Block 4/Question#23

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


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submitted by yotsubato(293),

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. +  
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 +  

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submitted by sne(16),

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. +  

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

marat  Cause lungs are overextended +  
marat  overexpanded +  

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. +