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NBME 23 Answers

nbme23/Block 4/Question#23 (37.7 difficulty score)
A 74-year-old woman comes to the physician ...
IpratropiumπŸ”
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 +1 
submitted by sne(45),
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Autec ahsmat .ot ax1raebneic e2ut.rloA bl tcrrosdi3sCoe. oti Iapoptirurm

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. +3  



 +1 
submitted by abhishek021196(49),

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

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




 +0 
submitted by yotsubato(965),
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rAnte we NTO supdsope to ues itoarmippru ni lod eeo?plp

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. +2  
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 +4  



 +0 
submitted by krewfoo99(88),
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nyneoA oknw yhw ertha ondssu lwudo be ndsitta ni OCPD cabieoxn?trae

marat  Cause lungs are overextended +5  
marat  overexpanded +3  



 -1 
submitted by krewfoo99(88),
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nAenyo kown yhw haetr nssuod loduw be ntdtsia in DOPC itebacaxr?oen

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. +1