6. Asthma

Question 1

asthma is reversibility of airflow obstruction with symptoms worse at night or in the early morning with prolonged expirations and diffuse wheezes on PE. There is a limitation of?

Answer 1

airflow on pulmonary function testing or positive methacholine challenge (broncho-provocation)

Question 2

CLinical symptoms of asthma include, cough, wheeing, chest tightness, prolonged exhalation and ?

Answer 2

shortness of breath

Question 3

Asthma causes airway walls to become inflamed and thickened and well as what of the smooth muscles?

Answer 3

tightening and proliferation

**exposure to allergens can trigger astham - Mast cells play large role

Question 4

Prolonged status asthmaticus is characterized by charcot leyden crystals (found in sputum/lavage, composed of eosinophil break down products galectin10) and is also characterized by what, which are characteristic in sputum- extrusion of mucus plugs from sub-epithelial mucous gland ducts or bronchioles?

Answer 4

Curschmann sprials

Question 5

What is a characteristic finding of chronic asthma, associated with thickening of airway wall, fibrosis, inc vascularity, inc submucosal glands, usually contributing to chronic irreversible airway obstruction?

Answer 5

Airway remodeling

Question 6

The strongest predisposing factory to asthma is atopy -exposure to inhaled allergens, as well as nonspecific precipitants such as URI, sinusitis, aspiration and?

Answer 6

exercise

Question 7

In differentiating between COPD and bronchial asthma FEV1 and FEV1/FVC ratio never returns to normal with drug therapy however in asthma what occurs?

Answer 7

FEV and the ratio most likely returns to normal!

Question 8

volume curves of COPD look like a chair while volume curves for asthma (scooped) have pre broncodilator concavity like COPD but then?

Answer 8

improves post bronchodilator (COPD does not)

Question 9

What type of dysfunction occurs in tall thin young women, usually runners which on volume curves can see a truncated inspiratory loop?

Answer 9

Vocal cord dysfunction (VCD)

*flat bottom of graph

Question 10

What is characteristic of restrictive lung disease on volume curves?

Answer 10

Decreased total volume

Question 11

What is the most common medication for quick relief of asthma?

Answer 11

B2 agonists - SABA- ALBUTERAL (or levalbuterol)

Question 12

What anticholinergic may be used for the first 24 hours of an acute attack along with albuterol?

Answer 12

ipratropium

Question 13

Long term control asthma medications include ICS and leukotriene modifiers, ICS include beclomethasone, budesonide and?

Answer 13

fluticasone (Dr Newman likes this)

Question 14

Leukotriene modifiers which are released by mast cells include montelukast and zafirlukasts -LT receptor antagonists and zileuton which is a 5-lipoxygenase inhibtor are great for managing?

Answer 14

allergies too

Question 15

The following characteristics are common of what respiratory distress?
breathlessness at rest, is silent, drowsy/confused, RR >30 per min, no wheezing, bradycardia, FEV1 <25% predicted, etc

Answer 15

Respiratory arrest imminent

Question 16

Asthma is considered what severity if there is 0-1 exacerbations requiring oral CS in one year?

Answer 16

Intermittent

Question 17

Asthma severity is classified as what if there is more than 2 exacerbations requiring oral CS in one year?

Answer 17

Persistent and

mild: symptoms 2 days per week
mod: symptoms daily
severe: symptoms throughout the day

Question 18

For intermittent asthma, use a SABA PRN. if time passes and the albuterol SABA is no longer working for the asthma, what should be added?

Answer 18

low dose ICS (step 2)
Step 3 - med dose ICS
Step 4- med dose ICS + LABA
Step 5- High dose ICS+ LABA
Step 6- high dose ICS +LABA + oral CS

Question 19

The following is characteristic of what type of asthma?
less than 2 times per week symptoms, not often awakened at night, no limitation of activity, SABA use less than 2x per week, FEV >80% predicted, asthma exacerbations 0-1 per year, tx with step 1 (SABA)

Answer 19

Intermittent asthma

Question 20

What is the initial treatment for asthma - approach at home, which is up to 2 treatments 20 mins apart of 2-6 puffs by MDI or nebulizer?

Answer 20

Inhaled SABA

Question 21

Dx of asthma in children less than 2 can be difficult, repeated wheezing episodes with no other identifiable cause, along with family hx or atopy and what i used to help in the diagnosis?

Answer 21

response to albuterol

Question 22

What type of control over asthma would the following data suggest?
symptoms less than 2 days per week, less than 1-2 nighttime awakenings per month, no interference with activity, SABA use less than 2 days per week, FEV1>80%, 0-1 asthma exacerbations per year requiring oral CS

Answer 22

Well controlled asthma

Question 23

Part of the process of diagnosis and treating asthma is education, which includes treatment goals, inhaler technique, elimination of triggers and an asthma?

Answer 23

action plan