Allergic

Question 1

Definition Brochial Asthma

Answer 1

Irreversible chronic inflamatory disorder
of airways
leading to bronchoconstriction

Question 2

Asthma Predictive Index

Answer 2

• clinical imdex to define risk of asthma in young children with recurrent wheeze.

Major:

• parent asthma
• eczema
• inherent allergen sensitization

Minor:

• allergic rhinitis
• wheeze from cold
• eosinophill more than 4%
• food allergen sensitization

Question 3

Clinical picture of bronchial asthma

Answer 3

1. Symptoms
   - SOB
   - difficult breath
   - cough
   - wheezy chest
2. Sign
   - inspection: increase RR, cyanosis
   - palpitation: palpable rhonchi
   - percussion: hyper resonance
   - auscultation:
   >air entry diminash
   >BS: harsh vesicular breathing
   >wheezing
   >crepitation

Question 4

Assesment lf acute asthma exacerbation

Answer 4

• history and physical examination
• pulmonary index score (hafal jadual)
• peak expiratory flow rate
  > use device peak flow meter
• oxygen saturation/ ABG

Question 5

Diagnosis of branchial asthma

Answer 5

• history and clinical feature
• chest xray
• pulmonary function test
• lab:
  > skin testing
  > measure specific IgE
  > eliminate diet

Question 6

DD of bronchial asthma

Answer 6

1. Upper respiratory tract
   - allergic rhinitis
   - FB
   - sinusitis
2. Middle respiratory tract
   - vocal cord paralysis
   - laryngeal stenosis
   - chronic bronchitis
3. Lower respiratory tract
   - TB
   - pneumonia
   - pulmonary edema

Question 7

Treatment of bronchoal asthma

Answer 7

1. Patient & parent education
   - teach basic and medication
2. Enviroment control
   - house dust mite
   - animal contact
   - diet, drug
3. Medication
   - B2 agonist
   - inhaled corticosteroid
   - leukotriene modifiers ( montelukast)
   - theophilline
   - systemic glucocorticosteroid
4. Follow up

Question 8

Emergency Room management of acute asthma

Answer 8

1. Inhaled b2 agonist (salmeterol 0.15mg/kg)
2. O2 therapy
   - to achieve o2 saturation more 92%
3. Oral corticosteroid: Prednisone 2mg/kg
4. If severe:
   - inhaled b2 agonist + ipratropium bromide
5. If respiratory arrest: admit to ICU

Question 9

Definition of status asthmaticus

Answer 9

Acute exacerbationof asthma

that do not respond adequately to therapeutic drug and required ICU

Question 10

Factor that increase status asthmaticus

Answer 10

• previous ICU admission
• sudden respiratory distress
• poor compliance to therapy
• respiratory arrest
• hypotension, tachycardia, tachypnea
• delay systemic steroid
• delay admission to ICU

Question 11

Treatment of status asthmaticus

Answer 11

• O2 therapy
• rapid ABG, CBC, xray chest
• cardiac & respiratory monitoring
• iv fluid for rehydration
• inhale b2 agonist (every 20 min) + ipratropium bromide (every 6 hour)
• iv aminophylline 5mg/kg every 20 minute
• if no respone, give paranteral b2 agonist ( Sc terbutaline 0.01mg/kg)
• iv Mg sulphate
• iv methyl prednisolone (1-2mg/kg/dose)
• iv sodium bicarbonate
• mechanical ventilation

Question 12

Definition of anaphylaxis

Answer 12

life threatening systemic reaction 
caused by IgE mediated hypersensitivity reaction 
and characterized by
- urticaria
- acute airways obstruction
- circulatory collapse

Question 13

causes of anaphylaxis

Answer 13

1. Food
   - peanut, fish, shellfish
2. Drug
   - penicillin, insulin
3. Venom
   - honeybee
4. Vaccine
   - tetanus, influenza
5. Cold temperature

Question 14

Clinical picture of anaphylaxis

Answer 14

• happen in minute to hour
• rhinorrhea
• sneeze
• vomit
• edema of larynx & epiglotis
• bronchospasm, then hypoxia
• VD
• urticaria
• diarrhea
• urine urgency

Question 15

Treatment of anaphylaxis

Answer 15

• rapid assesment vital sign
• IM epinephrine 0.01mg/kg
• O2 100%
• IV line (large bore)
• monitor cardiac
• IV isotonic fluid 20mg/kg

-subacute:
>h1 antagonist diphenhydramine 1-2mg/kg
>corticosteroid 1mg/kg