Deck 32: Neuromuscular and Other Diseases of the Chest Wall

Question 1

Which of the following is not a clinical condition that precipitates respiratory failure rapidly in patients with significant neuromuscular weakness?

A) Pulmonary edema
B) Pneumonia
C) Mucus plugging
D) Pulmonary fibrosis

Answer 1

D
Explanation: Pulmonary edema, pneumonia, and mucus plugging are examples of clinical conditions that can precipitate respiratory failure rapidly in patients with significant neuromuscular weakness.

Question 2

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

Answer 2

C
Explanation: The degree of scoliosis is measured by the Cobb angle.

Question 3

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 3

D
Explanation: The pulmonary consequences of neuromuscular disease can include the following: hyperventilation or hypoventilation, sleep apnea, aspiration, atelectasis with resulting hypoxemia, pulmonary hypertension, and cor pulmonale.

Question 4

Disorders of the neuromuscular junction include which of the following?
1) Lambert-Eaton syndrome
2) Myasthenia gravis
3) Dermatomyositis
4) Tetanus, botulism

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2, 3, and 4 only

Question 5

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 6

What respiratory dysfunction is commonly seen in myotonic dystrophy?

A) Sleep-related disorders
B) Pulmonary fibrosis
C) Obstructive pulmonary disease
D) Pulmonary edema

Question 7

What finding is associated with Duchenne muscular dystrophy?

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

Question 8

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 9

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 10

In myasthenia gravis, which two pulmonary function values are the most sensitive in detecting respiratory muscle weakness?
1) TLC and VC
2) PImax and PEmax
3) VC and expired volume per unit time (V_E)
4) VC and tidal volume (V_T)

A)1 and 4 only
B)1 and 2 only
C)3 and 4 only
D)2 and 3 only

Question 11

To effectively document and assess the need for endotracheal intubation in a patient with neuromuscular disease, which of the following would be most appropriate?

A) Spirometry every 4 to 6 hr
B) Chest x-ray every shift
C) Polysomnograpy testing
D) Monitoring SpO₂ with pulse oximeter

Question 12

Respiratory muscle weakness is associated with which of the following abnormalities?
1) Pulmonary embolism
2) Ventilatory insufficiency
3) Hypoxemia
4) Atelectasis

A)4 only
B)2, 3, and 4 only
C)1 and 3 only
D)1, 3, and 4 only

Question 13

Patients with respiratory muscle weakness due to neuromuscular disease may initially report with which of the following symptoms?
1) Exertional dyspnea
2) Fatigue
3) Oliguria
4) Orthopnea

A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2 and 4 only

Question 14

In what group of patients is myasthenia gravis most common?

A) Older males
B) Younger males
C) Younger females
D) Older females

Question 15

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 16

Which of the following is a clinical condition that typically does not precipitate rapid respiratory failure in patients with significant neuromuscular weakness?

A) Pulmonary edema
B) Pneumonia
C) Mucous plugging
D) 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

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

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

Question 19

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 20

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%

Question 21

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 22

Which of the following is often preceded by a history of upper respiratory or flulike symptoms?

A) Myotonic dystrophy
B) Polymyositis
C) Guillain-Barré syndrome
D) Amyotrophic lateral sclerosis

Question 23

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

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

Question 24

Which of the following criteria for weaning a patient with Guillain-Barré syndrome from mechanical ventilation have shown to be predictive of weaning success?
1) VC greater than 18 ml/kg
2) Transdiaphragmatic pressures greater than 31 cm H₂O
3) PImax greater than 30 cm H₂O
4) Cardiac output above 2.0 L/min

A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Question 25

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 26

How is diaphragmatic paralysis most often diagnosed?

A) Chest radiography
B) Pulmonary function testing
C) Arterial blood gases
D) Physical examination

Question 27

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

A) Plasmapheresis
B) Corticosteroids
C) Radiation therapy
D) Antibiotics

Question 28

What is the hallmark finding of diaphragm paralysis?

A) Rapid and shallow breathing
B) Weak cough
C) Abdominal paradox
D) Retractions

Question 29

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

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