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Respiratory 01.15 > Asthma 01.15 > Flashcards

Asthma 01.15 Flashcards

1
Q

Two year old with 1st episode wheeze at 6 months
• 5 further episodes associated with URTIs
• No other chest symptoms
Fever <38.5
•Weight gain good

A

Broncholitis - commonest acute LRTI in infancy.

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2
Q

In 2 year old:
Respiratory distress- tachypnoea
- grunting
- subcostal & intercostal recession
- tracheal tug
- nasal flaring
• Hyperinflation with palpable liver edge
• Widespread fine crepitations throughout respiratory cycle
• Often prolonged expiratory phase with wheeze
• Hypoxia
• Fever in most (

A

Broncholitis - commonest acute LRTI in infancy.

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3
Q

3 year old with:
Exercise – wheeze, cough, SOB, tight chest
• Nocturnal cough
• ‘tummy ache’
• Wheeze with URTIs
• Nasal symptoms
• Atopy – eczema, hayfever, food allergies

A

Asthma - atopic

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4
Q

Signs you would expect in child with chronic asthma untreated:

  1. Fingers?
  2. Growth chart?
  3. Skin?
  4. Chest & ribs?
  5. Face?
A 
Fingers - Clubbing
Grow chart -  Failure to thrive
Chest - Harrison sulci, barrel chest
Skin - Ezcema
Face - Allergy – shiners (from constantly rubbing eyes), nasal crease (constantly wiping / rubbing nose), salute sign
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5
Q

Which type of CD4+ T helper cell is pro-atopic and pro-asthmatic? Th1 or Th2

A

Th2

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6
Q

Once an allergen has been presented to Th2 cell by dendritic cell, Th2 cell stimulates activity of what 3 cell types, causing inflamm. response?

A
  1. Eosinophils
  2. Mast cells
  3. B cells - IgE
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7
Q

4 key symptoms of asthma

A
  1. wheeze
  2. SOB
  3. chest tightness
  4. cough
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8
Q

What would you expect on a peak flow chart over a week?

A

Diurnal variation - lowest reading in morning “morning dippers”

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9
Q

Mast cell production of histamine, prostoglandins and leukotrienes occurs within minutes and causes what physiological response & what symptom of asthma (2)

A

Bronchoconstriction

Wheeze

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10
Q

Cytokines IL 4 and IL 13 are produced within hours by mast cells, causing what cellular and what physiological probs (2)

A

Eosinophil recruitment

Mucous production

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11
Q

What stage of asthma severity is this (1-4):
80% expected,
<2 nocturnal epis. / month

A

Stage 1 - Intermittant

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12
Q

What stage of asthma severity is this (1-4):
>1/wk, but less than 1/day
FEV1 / PEF >80% expected, variability 20%-30%
Nocturnal symp >2/mo

A

Stage 2 - Mild persistant

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13
Q

What stage of asthma severity is this (1-4):
Daily attacks, affect activity
FEV1 / PEF 60-80% expected,
Nocturnal symp >1/week

A

Stage 3 - Moderate persistent

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14
Q

What stage of asthma severity is this (1-4):
Continuous attacks, limit phys activity
FEV1 / PEF <60% expected,
Nocturnal symp frequent

A

Stage 4 - Severe persistent asthma

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15
Q

This asthma treatment is a SABA (short acting beta agonist)

Increases cAMP production - relaxation of sm muscle

A

Salbutamolin (ventolin) / terbutaline also

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16
Q

Other than bronchodilation what are 2 other effects of salbutamol

A

Incr mucus clearance

Inhib inflamm cytokines

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17
Q

S/E salbutamol (3)

A

Tremor
Tachycardia
Hypokalaemia

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18
Q

Give 1 example of each of the following asthma medications:

  1. SABA
  2. Corticosteroid
  3. LABA
  4. Leukotriene receptor agonist
  5. Xanthines
A
  1. SABA - Salbutamol
  2. Corticosteroid - Beclometasone
  3. LABA - Salmeterol
  4. Leukotriene - Montelukast
  5. Xanthine - Theophylline
19
Q

Therapeutic effects of corticosteroids for asthma (3)

A
  1. Reduce immune cell numbers (eosin. T lymph etc)
  2. Red. inflammatory mediators
  3. Red. vascular permeability
20
Q

S/E corticosteroids in LONG term use (4)

A

Osteoporosis
Incr infection risk
Hyperglycaemia
Growth retard. in kids

21
Q

S/E corticosteroids in SHORT term use (2)

A

Candida oral infection

Sore throat

22
Q

Fluticasone and budesonide are what type of asthma drug

A

corticosteroids

23
Q

What must ALWAYS be used in combination with a steroid for asthma treatment

A

LABAs e.g salmeterol

24
Q

Symbicort (Red/white), Seretide (purple) and Fostair (brown) are examples of what type of inh.

A

Combination steroid and LABA - preventer and reliever

25
Q

3 therapeutic effects of Leukotriene receptor antagonists

A
  1. Red wheeze & bronchoconstriction
  2. Reduce eosin. and basophil
  3. Red. mucus & microvasc leakage
26
Q

S/E of montelukast etc (2)

A

GI disturb

Headache

27
Q

Xanthines - therap. effect?

A

Red inflamm mediators

28
Q

SE Xanthines (very narrow therap window) (4)

A
  1. Naus & vom
  2. Tachycardia
  3. Convulsions
  4. Coma!
29
Q

Maj. interaction of Xanthines

A

Macrolides e.g clarithromycin - incr. blood levels of theophyliine

30
Q

What is Omalizumab and how does it help with asthma

A

Monocl antibody - bind to IgE prevent interact with mast cells.

31
Q

4 maj risks of steroid use in children

A
  1. Cushings
  2. Adrenal suppression
  3. Fungal in mouth
  4. Reduc. resist to chickenpox (h.zoster)
32
Q

This drug can be nebulised for severe acute asthma attacks

A

Ipratropium (anti-muscarinic)

33
Q

This dryg can be given IV for severe acute asthma attacks

A

IV magnesium sulphate

34
Q

Phosphodiesterase inhibits cAMP and therefore inhibits relaxation of sm muscle.
Which drug inhibits phosphodiesterase, thus helping sm musc relaxation?

A

Xanthines eg Theophylline

35
Q

What is FEV1

A

Forced Epired Vol in 1 sec - amount breathed out in 1 second from FULL INSPIRATION

36
Q

What is FVC

A

Forced Vital Capacity - Amount of air expired in WHOLE BREATH from FULL INSPIRATION

37
Q

What is PEFR

A

Peak Expiratory Flow Rate (L/s) = percentage figure of expected rate in a healthy individual. e.g. Mild asthma - expect PEFR >80%
In Severe it can be <60%

38
Q

Below what age are lung function tests less reliable

A

5years

39
Q

Name 2 obstructive disorders and 2 restrictive disorders

A

Obstructive: Asthma, Cystic Fibrosis, COPD
Restrictive: Severe kyphosis, pleurisy, diaphragmatic hemiparalysis

40
Q

4 clinical features used to distinguish COPD from Asthma

A
  1. COPD - chronic cough
  2. Asthma - reversibility with inhalers
  3. Smoking history - COPD
  4. Nocturnal variation - asthma
41
Q

DD for Chronic cough +/- wheeze in under 1yo (5)

A
  1. Bronchiolitis
  2. Pertussis (hooping cough) / other infection
  3. GORD
  4. Transient early wheeze
  5. Cf
    others. ..
42
Q

This virus is:
The commonest acute lower respiratory tract infection in
infancy.
• Respiratory Syncytial Virus (RSV) in 80% cases, others
adenovirus, influenza and parainfluenza virus.
• Winter months.
• Necrosis of the ciliated cells and proliferation of non-ciliated
cells.
• Bronchiolar obstruction, atelectasis and hyperinflation
• Leads to hypoxia, hypercarbia and ventilation

A

Broncheolitis

43
Q

DD for chronic cough +/- wheeze in pre-school kids <5yo (7)

A 
1. Transient early wheeze
2, Asthma
3. Infections
– Recurrent Viral URTIs
– Bacterial (pertussis or
persistent collapse
– TB
4. Inhaled foreign body
5. Passive smoking
6. Cystic fibrosis +
bronchiectasis
7. GORD
others...
44
Q 
7 yr old
Wheezy since 3 yrs with URTIs
• Infantile eczema
• Allergy reaction to egg at 14 months
• Wheezy when visits grandma who has a cat
• Treatment – bronchodilator prn
• Recently waking with cough at night
• Most likely diagnosis?
A

Asthma
Recurrent viral URTIs

others…

Respiratory 01.15 (5 decks)

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