Corticosteroids in Respiratory Disorders — MCQs
A 3-year-old is diagnosed with severe acute asthma exacerbation. Which medication is given first?
Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?
What is the recommended treatment for oral sores caused by inhaled steroids?
Which is not an action of cortisol?
What is the most common gastrointestinal side effect of oral contraceptives?
Hydrocortisone Acetate is injected in a painful arthritic TMJ to?
Long-term steroid ingestion leads to all of the following except:
Which of the following is not typically used for the immediate treatment of acute asthma?
What is the drug of choice for most forms of interstitial lung disease?
A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?
Corticosteroids in Respiratory Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A 3-year-old is diagnosed with severe acute asthma exacerbation. Which medication is given first?
- A. Inhaled ipratropium
- B. IV corticosteroids
- C. Nebulized salbutamol (Correct Answer)
- D. IV magnesium sulfate
Explanation: ***Nebulized salbutamol*** - **Salbutamol** (albuterol) is a **short-acting beta-2 agonist (SABA)** which provides rapid bronchodilation by relaxing smooth muscles in the airways. - It is the **first-line treatment** for acute asthma exacerbations due to its quick onset of action and effectiveness in relieving bronchospasm. *Inhaled ipratropium* - **Ipratropium**, an anticholinergic, is often added to bronchodilators like salbutamol in **severe exacerbations** but is not the primary initial bronchodilator. - It works by blocking muscarinic receptors, causing **bronchodilation**, but its onset of action is slower than salbutamol. *IV corticosteroids* - **Corticosteroids** reduce airway inflammation and are crucial for preventing relapse and shortening recovery in severe asthma, but their **onset of action is delayed** (several hours). - They are typically administered after initial bronchodilation with SABAs and are not the first medication given for immediate symptom relief. *IV magnesium sulfate* - **Magnesium sulfate** is a smooth muscle relaxant that can be used in **severe, life-threatening asthma exacerbations** that are refractory to standard therapy. - It is considered a **second or third-line treatment** rather than an initial intervention for immediate bronchodilation.
Question 2: Which of the following is NOT a mechanism of action of theophylline in bronchial asthma?
- A. Adenosine receptor antagonism
- B. Increased histone deacetylation
- C. Phosphodiesterase inhibition
- D. Beta-2 receptor stimulation (Correct Answer)
Explanation: ***Beta-2 receptor stimulation*** - Theophylline is a **non-selective phosphodiesterase inhibitor** and an **adenosine receptor antagonist**, but it does not directly stimulate beta-2 receptors. - **Beta-2 receptor agonists** like salbutamol or formoterol are the medications that work by stimulating these receptors to cause bronchodilation. *Phosphodiesterase inhibition* - Theophylline inhibits **phosphodiesterase enzymes**, leading to an increase in intracellular **cAMP** levels. - This increase in **cAMP** promotes bronchodilation by relaxing airway smooth muscle. *Adenosine receptor antagonism* - Theophylline acts as an antagonist at **adenosine receptors**, particularly A1 and A2B. - Antagonism of adenosine receptors can reduce bronchoconstriction and inflammatory mediator release, contributing to its anti-asthmatic effects. *Increased histone deacetylation* - Theophylline, particularly at lower concentrations, increases the activity of **histone deacetylase (HDAC)**. - This action helps to **repress inflammatory gene expression**, which is a unique anti-inflammatory mechanism separate from its bronchodilatory effects.
Question 3: What is the recommended treatment for oral sores caused by inhaled steroids?
- A. Fusidic acid
- B. Mupirocin ointment
- C. Clotrimazole
- D. Miconazole (Correct Answer)
Explanation: ***Miconazole*** - **Miconazole** is an **antifungal medication** available in gel or oral tablet forms, effective in treating oral thrush (candidiasis), a common side effect of inhaled steroid use. - Its **broad-spectrum antifungal activity** means it targets the *Candida* species responsible for these oral sores, relieving symptoms and promoting healing. *Clotrimazole* - While **clotrimazole** is an **antifungal medication** that can be used for oral candidiasis, it is typically available as troches (lozenges) and may be less commonly prescribed for this specific condition than miconazole in some regions. - Its mechanism of action involves **inhibiting ergosterol synthesis**, disrupting the fungal cell membrane; however, **miconazole** is often favored for its ease of application and efficacy in oral candidiasis. *Fusidic acid* - **Fusidic acid** is an **antibiotic** primarily used to treat bacterial infections, particularly those caused by *Staphylococcus* species. - It has **no antifungal properties**, making it ineffective against oral sores caused by inhaled steroid-induced candidiasis. *Mupirocin ointment* - **Mupirocin** is an **antibiotic ointment** used topically to treat bacterial skin infections, such as impetigo. - It works by **inhibiting bacterial protein synthesis** and is not effective against fungal infections like oral thrush.
Question 4: Which is not an action of cortisol?
- A. Mobilization of fatty acids
- B. Increases liver and plasma proteins
- C. Stimulation of gluconeogenesis
- D. Increases the number of eosinophils (Correct Answer)
Explanation: ***Increases the number of eosinophils*** - Cortisol and other glucocorticoids actually cause a **decrease in the number of eosinophils** in circulation. - This effect is due to increased destruction of eosinophils and decreased production, contributing to their **immunosuppressive** actions. *Mobilization of fatty acids* - Cortisol plays a role in **lipid metabolism**, promoting the breakdown of fats from adipose tissue. - This leads to the **release of fatty acids** into the bloodstream for energy utilization, especially during stress or fasting. *Increases liver and plasma proteins* - Cortisol has an **anabolic effect on the liver**, promoting the synthesis of various proteins, including plasma proteins. - This contributes to maintaining protein levels in the body, although its overall effect on protein metabolism can be catabolic in muscle. *Stimulation of gluconeogenesis* - Cortisol is a major **glucocorticoid**, meaning it increases blood glucose levels. - It achieves this by stimulating the liver to produce glucose from non-carbohydrate sources like amino acids and glycerol, a process known as **gluconeogenesis**.
Question 5: What is the most common gastrointestinal side effect of oral contraceptives?
- A. Decreased appetite
- B. Weight loss
- C. Nausea (Correct Answer)
- D. Constipation
Explanation: ***Nausea*** - **Nausea** is a very common gastrointestinal side effect of oral contraceptives, especially during the initial weeks of use, due to the **estrogen component**. - This side effect often **improves over time** as the body adjusts, or can be managed by taking the pill with food or at bedtime. *Weight loss* - Oral contraceptives are **not typically associated with weight loss**; in fact, some users may experience slight weight gain, although studies show no consistent significant effect. - Changes in weight are more often due to **fluid retention** rather than true fat loss. *Decreased appetite* - **Decreased appetite** is not a common side effect of oral contraceptives; rather, some individuals might experience an increased appetite due to hormonal fluctuations. - The hormonal effects on metabolism and appetite are **varied and not consistently demonstrated** to lead to decreased appetite. *Constipation* - **Constipation** is not a frequent gastrointestinal side effect of oral contraceptives; rather, some users may experience changes in bowel habits, but **diarrhea is more commonly reported** than constipation when GI issues occur. - Hormonal contraceptives primarily affect the gut through **estrogen and progestin**, leading to various effects, but constipation is not a predominant one.
Question 6: Hydrocortisone Acetate is injected in a painful arthritic TMJ to?
- A. Lubricate the synovial joint
- B. Decrease the inflammatory response (Correct Answer)
- C. Anaesthetize the nerve supply
- D. Increase the blood supply
Explanation: ***Decrease the inflammatory response*** - **Hydrocortisone Acetate** is a **corticosteroid**, well-known for its potent anti-inflammatory properties. - Injecting it directly into an arthritic temporomandibular joint (TMJ) helps to reduce local inflammation, thereby alleviating pain and improving joint function. *Lubricate the synovial joint* - While lubrication is important for joint function, **hydrocortisone acetate** does not act as a lubricant like hyaluronic acid. - Its primary mechanism is based on immune modulation and anti-inflammatory effects, not physical lubrication. *Anaesthetize the nerve supply* - **Hydrocortisone acetate** is not a local anesthetic; it does not directly block nerve impulses to provide immediate pain relief through numbness. - Although it reduces pain, this is secondary to its anti-inflammatory action rather than direct neural blockade. *Increase the blood supply* - **Corticosteroids** generally have vasoconstrictive properties, meaning they can *decrease* blood flow rather than increasing it, especially at the site of inflammation. - Increasing blood supply is not a therapeutic goal in managing acute inflammation in an arthritic joint.
Question 7: Long-term steroid ingestion leads to all of the following except:
- A. Avascular necrosis of head of femur
- B. Growth retardation
- C. Hypoglycemia (Correct Answer)
- D. Cataract
Explanation: ***Hypoglycemia*** - Chronic steroid use primarily leads to **hyperglycemia** due to increased **gluconeogenesis** and **insulin resistance**, not hypoglycemia. - Steroids raise blood glucose levels, potentially inducing or worsening **diabetes mellitus**. *Avascular necrosis of head of femur* - Long-term steroid use is a well-established risk factor for **avascular necrosis**, particularly affecting the **femoral head**. - This occurs due to impaired blood supply to the bone, leading to its death. *Cataract* - **Posterior subcapsular cataracts** are a known ocular complication of prolonged systemic corticosteroid therapy. - The mechanism involves direct effects of steroids on lens metabolism and protein aggregation. *Growth retardation* - In children, chronic corticosteroid therapy can suppress growth, leading to **growth retardation**. - This is due to interference with **growth hormone secretion** and direct effects on bone formation.
Question 8: Which of the following is not typically used for the immediate treatment of acute asthma?
- A. Prednisolone
- B. Ipratropium bromide
- C. Salmeterol (Correct Answer)
- D. Salbutamol
Explanation: ***Salmeterol*** - **Salmeterol** is a **long-acting beta-2 agonist (LABA)**, typically used for **maintenance therapy** in asthma to prevent symptoms, not for immediate relief of an acute attack. - Its **slow onset of action** makes it unsuitable for the rapid bronchodilation required during an acute asthma exacerbation. *Prednisolone* - **Prednisolone** is an **oral corticosteroid** used in acute asthma exacerbations to reduce inflammation and prevent relapse. - While it has a delayed onset of action, it is a crucial component of immediate management to control the underlying inflammation. *Salbutamol* - **Salbutamol** is a **short-acting beta-2 agonist (SABA)**, which is the **first-line treatment** for immediate relief of acute asthma symptoms. - It acts rapidly to **bronchodilate** the airways, improving airflow within minutes. *Ipratropium bromide* - **Ipratropium bromide** is a **short-acting muscarinic antagonist (SAMA)** that can be used in conjunction with SABAs for acute severe asthma. - It provides **additional bronchodilation** by blocking acetylcholine's effects on bronchial smooth muscle.
Question 9: What is the drug of choice for most forms of interstitial lung disease?
- A. Antibiotics
- B. Bronchodilators
- C. Aspirin
- D. Corticosteroids (Correct Answer)
Explanation: ***Corticosteroids*** - **Corticosteroids** are the **drug of choice** for many forms of **interstitial lung disease (ILD)** due to their potent **anti-inflammatory** and **immunosuppressive properties**, which help reduce lung inflammation and prevent fibrosis. - They are particularly effective in inflammatory ILDs such as **sarcoidosis**, **hypersensitivity pneumonitis**, and some **connective tissue disease-associated ILDs**. *Antibiotics* - **Antibiotics** are primarily used to treat bacterial and other microbial infections and are **not effective** against the **inflammatory and fibrotic processes** characteristic of most ILDs. - They might be used if there's a **secondary bacterial infection** complicating ILD, but not as primary treatment for the ILD itself. *Bronchodilators* - **Bronchodilators** work by relaxing the muscles around the airways, making them wider and easier to breathe through, which is beneficial in conditions like **asthma** or **COPD**. - They are **not primarily used** in ILD as the main problem is **inflammation and scarring of the lung tissue**, not reversible airway constriction. *Aspirin* - **Aspirin** is an **NSAID** with **anti-inflammatory**, **anti-platelet**, and **analgesic properties**, commonly used for pain relief, fever reduction, and cardiovascular protection. - It has **no established role** in the primary treatment of **interstitial lung disease**, as its anti-inflammatory effects are typically insufficient for the severe inflammation seen in ILD.
Question 10: A patient comes with a history of asthma and sinusitis. On looking into his medical records, you notice this has been attributed to Samter’s triad. Which drug should be avoided in this patient due to its potential to exacerbate respiratory symptoms?
- A. Cotrimoxazole
- B. Co-amoxiclav
- C. Chloramphenicol
- D. Aspirin (Correct Answer)
Explanation: ***Aspirin (Correct Answer)*** - Samter's triad, or **aspirin-exacerbated respiratory disease (AERD)**, is characterized by **asthma**, **nasal polyps with chronic rhinosinusitis**, and a severe reaction to **aspirin** and other **NSAIDs**. - **Aspirin** inhibits COX-1, leading to an overproduction of **leukotrienes**, which causes bronchoconstriction and exacerbates respiratory symptoms in susceptible individuals. - This is the drug that **must be avoided** in patients with Samter's triad. *Cotrimoxazole (Incorrect)* - **Cotrimoxazole** (trimethoprim-sulfamethoxazole) is an antibiotic not directly involved in the cyclooxygenase pathway. - While allergic reactions can occur, it is **not specifically contraindicated** in Samter's triad. *Co-amoxiclav (Incorrect)* - **Co-amoxiclav** (amoxicillin/clavulanic acid) is a penicillin-class antibiotic, and its mechanism of action does not involve prostaglandin synthesis. - It does not pose a specific risk for exacerbating respiratory symptoms in patients with **Samter's triad**. *Chloramphenicol (Incorrect)* - **Chloramphenicol** is an antibiotic that inhibits bacterial protein synthesis and is not associated with the pathogenesis of Samter's triad. - It does not impact the **cyclooxygenase or lipoxygenase pathways** that are central to AERD.
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