Asthma

Question 1

Essentials of DX for what issue
(1) Episodic or chronic symptoms of wheezing, dyspnea, or cough.
(2) Symptoms frequently worse at night or in the early morning.
(3) Prolonged expiration and diffuse wheezes on physical examination.
(4) Limitation of airflow on pulmonary function testing or positive Broncho provocation challenge.
(5) Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy.

Answer 1

Asthma

Question 2

Asthma is a common disease, affecting approximately what % of the population?

Answer 2

8–10%

Question 3

It is slightly more common in what demographics?

Answer 3

male children (younger than 14 years)
female adults

Question 4

What is a chronic disorder of the airways characterized by variable airway obstruction, airway hyperresponsiveness, and airway inflammation

Answer 4

Asthma

Question 5

What is the most common phenotype of asthma?

Answer 5

Allergic

Question 6

True/false
Allergic asthma usually begins in childhood and is associated with other allergic diseases such as eczema, allergic rhinitis, or food allergy

Answer 6

True

Question 7

What is characterized by episodic wheezing, shortness of breath, chest tightness, and cough.

Answer 7

Asthma

Question 8

During severe asthma exacerbations, airflow may be too limited to produce wheezing, and the only diagnostic clue on auscultation may be _____________.

Answer 8

globally reduced breath sounds with prolonged expiration.

Question 9

(normal/abnormal)
Arterial blood gas (ABG) measurement may be _______ during a mild asthma attack

Answer 9

normal

Question 10

Ture/False
Respiratory alkalosis and an decrease in the alveolar-arterial oxygen difference (A–a–DO2) are common

Answer 10

False
INCREASE in alveolar arterial oxygen difference

Question 11

During severe ASTHMA exacerbations,
______ develops and the PaCO2 returns to normal.

Answer 11

hypoxemia

Question 12

CXR’s on asthma usually show what

Answer 12

usually normal or show only hyperinflation

may include bronchial wall thickening and
diminished peripheral lung vascular shadows

Question 13

when is chest imaging indicated for asthma

Answer 13

pneumonia
another disorder mimicking asthma
a complication such as pneumothorax is suspected

Question 14

The combination of an increased PaCO2 and respiratory acidosis may indicate what

Answer 14

impending respiratory failure

VENTALATE THAT MOFO

Question 15

What are the five important aspects of chronic asthma management?

Answer 15

(a) Assessing asthma control and severity,
(b) Distinguishing between severe asthma and uncontrolled asthma,
(c) Personalized pharmacologic therapy for asthma,
(d) Treatment of modifiable risk factors and control of environmental factors
(e) Guided self-management education and skills training

Question 16

Most asthma medications are administered by what two routes.

Answer 16

inhalation or by oral dosing

Question 17

What is the first line therapy for asthma management?

Answer 17

Inhaled corticosteroids

Question 18

All patients who have asthma must have access to what class of medication?

Answer 18

Shot acting Beta-agonists
(SABAs)

Question 19

What are some examples of SABAs?

Answer 19

ALBUTEROL
levalbuterol
bitolterol
pirbuterol
terbutaline

Question 20

What are the mainstays of reliever or rescue therapy
for asthma patients

Answer 20

SABA’s

Question 21

Beta-agonists are divided into what sub classes

Answer 21

SABA’s- Short acting
LABA’s -Long acting

Question 22

Treatment of exacerbations:
What is the action to take if your patient has a poor reaction to a SABA, IE PEF < 50% predicted or
personal best and have symptoms of respiratory distress

Answer 22

refer to emergency room/evac

Question 23

Your pt has exacerbation with some minor changes in airway function, PEF greater than 60% of their best and minimal signs of airway dysfunction.

Is this Mild/severe?
What would be effective to use for this reaction?

Answer 23

Mild exacerbation
SABA alone may show quick response

Question 24

Severe exacerbations of asthma can be life threatening, so treatment should be started _________.

Answer 24

Immediately

Question 25

Severe Exacerbations:
Early initiation of WHAT type of therapy is paramount because asphyxia is a common cause of asthma deaths

Answer 25

oxygen therapy

Question 26

All patients with a severe exacerbation should immediately receive what?

Answer 26

Oxygen, high doses of an inhaled SABA, and systemic corticosteroids.

Question 27

________ are most effective in achieving prompt control of asthma during acute exacerbations

Answer 27

Systemic corticosteroids

Question 28

What are the examples of corticosteroids

Answer 28

prednisone
prednisolone
parenteral methylprednisolone

Question 29

Severe Exacerbations:
Supplemental oxygen should be given to maintain a SaO2 greater than __% or a PaO2 greater than __ mm Hg.

Answer 29

SaO2 >90%
PaO2 >60 mm Hg

Question 30

What is STEP 2 in the approach to the management of Asthma

Answer 30

Daily Low dose ICS
Carry SABA

Question 31

What is STEP 3 in the approach to the management of Asthma

Answer 31

Low-dose ICS- LABA

Question 32

What is STEP 4 in the approach to the management of Asthma

Answer 32

Medium dose ICS - LABA

Question 33

What is STEP 5 in the approach to the management of Asthma

Answer 33

High dose ICS - LABA

Question 34

These issues with asthma; what is the action to take
1) Atypical presentation or uncertain diagnosis of asthma, particularly if additional diagnostic testing is required (bronchoprovocation challenge, allergy skin testing, rhinoscopy, consideration of occupational exposure).
2) Complicating comorbid problems, such as rhinosinusitis, tobacco use, multiple environmental allergies, suspected allergic bronchopulmonary mycosis.
3) Occupational asthma.
4) Uncontrolled symptoms despite a moderate-dose inhaled corticosteroid and a LABA.

Answer 34

REFER

Question 35

Refer?
Patient not meeting goals of asthma therapy after 3–6 months of treatment.

Answer 35

Yes

Question 36

Can an idc manage this patient?
-Frequent asthma-related healthcare utilization.
-More than two courses of oral prednisone therapy in the past 12 months.
-Presence of social or psychological issues interfering with asthma management.

Answer 36

No refer