Deck 29: Neuromuscular and Other Diseases of the Chest Wall

Question 1

Which of the following would not be considered a common pulmonary consequence of neuromuscular disease?

A)sleep apnea
B)aspiration
C)cor pulmonale
D)pneumothorax

Answer 1

D

Question 2

The rapid, shallow breathing pattern seen in patients with neuromuscular disease is generally due to which of the following mechanisms?

A)continued progression of respiratory muscle weakness
B)increased lung compliance
C)increased chest wall compliance
D)frequent respiratory infections

Answer 2

D

Question 3

What is the mortality rate for Guillain-Barré syndrome?

A)0%
B)low, less than 10%
C)moderate, 40% to 60 %
D)high, greater than 80%

Answer 3

B

Question 4

What respiratory dysfunction is commonly seen in myotonic dystrophy?

A)sleep-related disorders
B)pulmonary fibrosis
C)obstructive pulmonary disease
D)pulmonary edema

Question 5

Respiratory muscle weakness is associated with all of the following abnormalities except:

A)pulmonary embolism
B)ventilatory insufficiency
C)hypoxemia
D)Atelectasis

Question 6

A decrease in forced expiratory volume in 1 second (FEV₁) and vital capacity (VC) of greater than 20% when a patient moves from the seated to the supine position is suggestive of which of the following?

A)diaphragmatic muscle weakness
B)scalene muscle weakness
C)brainstem injury
D)internal intercostal weakness

Question 7

What is the most common peripheral neuropathy causing respiratory insufficiency?

A)Lambert-Eaton syndrome
B)amyotrophic lateral sclerosis
C)Guillain-Barré syndrome
D)myasthenia gravis

Question 8

By what age do most patients with Duchenne's muscular dystrophy die?

A)10 years
B)20 years
C)35 years
D)50 years

Question 9

Peripheral nerve disorders that cause respiratory muscle dysfunction can be caused by all of the following except:

A)inflammatory processes
B)vascular disorders
C)metabolic imbalances
D)fluid imbalances

Question 10

All of the following clinical conditions precipitate respiratory failure rapidly in patients with significant neuromuscular weakness except:

A)pulmonary edema
B)pneumonia
C)mucus plugging
D)pulmonary fibrosis

Question 11

Disorders of the neuromuscular junction include all of the following except:

A)Lambert-Eaton syndrome
B)myasthenia gravis
C)dermatomyositis
D)tetanus, botulism

Question 12

Patients with poor inspiratory muscle function might show significant orthopnea and prefer to sleep in a prone position.

Question 13

In what group of patients is myasthenia gravis most common?

A)older males
B)younger males
C)younger females
D)older females

Question 14

In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting respiratory muscle weakness?

A)TLC and VC
B)PI_max and PE_max
C)VC and expired volume per unit time (V_E)
D)VC and tidal volume (V_T)

Question 15

Nerve conduction studies are most helpful in the clinical diagnosis of which of the following?

A)myasthenia gravis
B)Lambert-Eaton syndrome
C)myotonic dystrophy
D)amyotrophic lateral sclerosis

Question 16

Lambert-Eaton syndrome is characterized by which of the following?

A)It affects mainly the limbs and eyes.
B)Patients have a mean age of 40 years.
C)Large-cell carcinoma is most common.
D)It is commonly associated with small-cell lung cancer.

Question 17

Pulmonary function testing in patients with neuromuscular weakness would show normal values for which of the following?

A)diffusing capacity of the lungs (DLCO)
B)vital capacity
C)forced expiratory volume in 1 second
D)total lung capacity

Question 18

Expiratory muscle weakness is accompanied by a poor cough and secretion clearance.

Question 19

What finding is associated with Duchenne's muscular dystrophy?

A)Lordosis
B)Drooping eyelids
C)Pedal edema
D)Hepatomegaly

Question 20

Patients with respiratory muscle weakness due to neuromuscular disease may initially report with the following symptoms except:

A)exertional dyspnea
B)fatigue
C)oliguria
D)orthopnea

Question 21

What percentage of amyotrophic lateral sclerosis patients die within 5 years of diagnosis?

A)10%
B)25%
C)50%
D)80%

Question 22

Which of the following is often preceded by a history of upper respiratory or flu-like symptoms?

A)myotonic dystrophy
B)polymyositis
C)Guillain-Barré syndrome
D)amyotrophic lateral sclerosis

Question 23

Cobb angles are used to measure the severity in which disorder of the thoracic cage?

A)ankylosing spondylitis
B)flail chest
C)scoliosis
D)pectus excavatum

Question 24

How is diaphragmatic paralysis most often diagnosed?

A)chest radiography
B)pulmonary function testing
C)arterial blood gases
D)physical examination

Question 25

What is the hallmark finding of diaphragm paralysis?

A)rapid and shallow breathing
B)weak cough
C)abdominal paradox
D)retractions

Question 26

What is the approximate mean age of onset for amyotrophic lateral sclerosis?

A)26 years
B)36 years
C)46 years
D)56 years

Question 27

What alteration in respiration is typically associated with stroke involving the cerebral cortex?

A)severe hypoxemia
B)respiratory acidosis
C)mild hyperventilation
D)sleep apnea

Question 28

At what level do the nerves that innervate the diaphragm exit the spine?

A)C1-3
B)C3-5
C)C6-7
D)T1-3

Question 29

All of the following criteria for weaning a patient with Guillain-Barré syndrome from mechanical ventilation have shown to be predictive of weaning success except:

A)VC greater than 18 ml/kg
B)transdiaphragmatic pressures greater than 31 cm H₂O
C)PI_max greater than 30 cm H₂O
D)cardiac output above 2.0 L/min

Question 30

What treatment strategies have improved the outcome in Guillain-Barré syndrome?

A)plasmapheresis
B)corticosteroids
C)radiation therapy
D)antibiotics

Question 31

Which of the following is NOT a pulmonary complication frequently associated with flail chest?

A)pneumothorax
B)hemothorax
C)pulmonary contusion
D)aspiration pneumonia

Question 32

What percentage of patients with Guillain-Barré syndrome has respiratory muscle compromise?

A)10%
B)33%
C)60%
D)100%