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Internal Medicine RS > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma

A

It’s a heterogeneous disease characterized by a chronic inflammatory process associated with hyper responsiveness with history of respiratory symptoms that vary over time and air flow expiratory limitations

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2
Q

Asthma age of onset

A

At any ages

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3
Q

What are the types of cells that are involved in the asthma inflammatory response

A

T cells
Mast cells
Eosinophils
‼️macrophages are neutrophils

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4
Q

The main feature of asthma symptoms are

A

It’s a variable and reversible

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5
Q

What are the respiratory symptoms that are associated with asthma

A

Wheezing
Coughing
Breathless
Chest tightness

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6
Q

The asthma symptoms are more when

A

Early morning
At night

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7
Q

What is the pathophysiology of asthma

A

Bronchial hypersensitivity to a trigger that usually don’t effect the normal individuals ➡️bronchial narrowing ➡️smooth muscles contraction

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8
Q

Main concept of asthma

A

Hypersensitivity that causes chronic inflammation

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9
Q

The main concept for COPD

A

Chronic inflammation due to smoking 🚬
Antitrepsine imbalance

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10
Q

Asthma etiology

A

Heritable and environmental factors that cause hypersensitivity

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11
Q

What are the types of asthma

A

Intrinsic ➡️non atopic
Extrinsic ➡️atopic

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12
Q

The extrinsic asthma (atopic)

A

🔸most common form of asthma cases
🔸patients produce igE towards environmental factors
🔸associated with eczema and fever
🔸onset at young ages
🔸inhalation of an allergen that causes hypersensitivity ➡️inflammatory response ➡️bronchconstricter

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13
Q

Atopic asthma associated symptoms

A

Fever and eczema

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14
Q

The mechanism of atopic asthma

A

Environmental allergens
Inhaled by the bronchioles
Hypersensitivity to this allergen
Inflammation and bronchioconstrictor response

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15
Q

What type of immunoglobulin are produced with extrinsic asthma

A

IgE

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16
Q

Intrinsic asthma features

A

No family history
No igE elevation
Onset at adulthood
No allergies 🤧

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17
Q

The mechanism of intrinsic asthma

A

after infection
After exercise
After chemical handling
After emotional reaction
After aspirin

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18
Q

What are the drugs that could trigger the asthma

A

🔸aspirin
🔸B-blockers

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19
Q

Asthma triggers

A

Dust -pets ,molds ,cold air ,food
Drugs
Emotional and physical stress

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20
Q

The airways remodeling in asthma include

A

Hypersensitivity ➡️structural changes ➡️accumulation of deposits ➡️smooth muscle hypertrophy➡️fibrosis and narrowing

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21
Q

Out comes for several asthmatic attacks

A

Obstruction
Remolding ➡️fibrosis
Bronchospasm

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22
Q

Main symptoms of asthma

A

wheezing
Coughing
Dyspnoea
Chest tightness
🔆theses symptoms are the worst during ➡️early morning and night

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23
Q

Most common findings for asthma on physical examination

A

Wheezing

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24
Q

Most associated findings with asthma on inspection

A

🔆nasal polyps and eczema

25
Q

Diagnosis of asthma

A

History
PE
PFT
X-ray 🩻
ABG

26
Q

About what we should ask in the asthma history

A

Trigger
Family history
If it’s seasonal
If it’s associated with exercise
Worsen with any time
Associated symptoms

27
Q

What are the asthma findings on the PFT

A

Obstructive pattern
Decrease expiratory flow rate
Low FEV 1
FEV1 /FBC ratio less than 0.7

28
Q

What is the FEV1

A

Volume of air exhaled with 1 sec

29
Q

FVC

A

Volume of air exhaled with maximum forced expiration

30
Q

Normal FEV1/FVC

A

70%

31
Q

What is the atopic triad

A

Atopic asthma
Atopic dermatitis
Atopic rhinitis

32
Q

The peek expiratory flow meter

A

Maximal rate of flow that can produce during forced expiration

33
Q

What is the FEV1 ,FVC ,PEF

A

FEV1 ➡️volume of air in the 1 seconds of expiration
FVC➡️total volume of air exhaled with force expiration
PEF➡️ maximal flow rate can produced during forced expiration

34
Q

Normal peak expiratory rate

A

60

35
Q

Peak expiratory flow meter

A

🔸used in home
🔸should be done frequently
🔸normally above 60
🔸Maximal flow rates could be produced during forced expiration

36
Q

The gold standard for measuring the reversibility of air way obstructions

A

FEV 1

37
Q

When we decided that the airway obstruction in asthmatic patients is reversible

A

When the FEV1 improved 12% after giving bronchodilator

38
Q

What is the bronchoprovecation test

A

It’s a test that is done to know if the lung is hypertensive or not
Done by giving a trigger
Masseur the lung function before and after the trigger
Usually done by ➡️muscarinic drug

39
Q

X-ray asthma finding

A

Usually normal

40
Q

Signs of severe asthma

A

🔆hyperinflation ➡️diaphragm to the 8 rib
🔆mcl-ribbon shaped heart /

41
Q

Normal o2 sat

A

97.5

42
Q

Condition mimicking asthma

A

Aspirations
COPD
Cystic fibrosis

43
Q

Asthma management

A

Trigger control
Medications
Patient education

44
Q

Types of medical treatments for asthma

A

Short acting bronchodilator ➡️mild asthma ➡️once a week for 3 months ➡️inhaled bronchodilator

Combined therapy of glucocorticoid inhaled with B agonists ➡️for patients who has 3 attacks per week or awake by the asthma one night per weekend

Add on therapy ➡️adding long acting bronchodilator lABA with glucocorticoids

If the add on Therapy failed 😞 ➡️add fourth drug

45
Q

The first line drug in asthmatics patients is

A

Glucocorticoids

46
Q

What is the mechanism of glucocorticoids in asthma

A

🔸increase the response to B-agonists bronchodilator
🔸decreases formation of inflammatory mediators (prostaglandin)➡️by inhibiting the arachidonic acid

47
Q

What are the types of glucocorticoids and what are side affects of them

A

Inhaled ➡️long term treatment ➡️causes dysphonia and oropharyngeal candidate ➡️ciclosonide -budesonide

Systemic ➡️for the sever attack or chronic if the inhaled failed ➡️oral➡️DM ,hypertension , osteoporosis,gastritis

48
Q

What is the benefit of using glucocorticoids

A

🔸decrease the need for b agonists bronchodilator
🔸benefit start with one week

49
Q

B2-agonists for asthma

A

The are bronchodilators so they reverse the constriction

50
Q

Root of administration for B2 agonists

A

Inhaled by nebulizer

51
Q

Bronchodilator of choice for asthma

A

Short acting ➡️for acute attacks
Long acting ➡️prophylaxis ➡️LABA ➡️more than 12 hours ➡️formeterol ,salmeterol

52
Q

Long acting bronchodilator toxicity

A

Arrhythmia
Muscle tremors
Hypokalemia

53
Q

Drugs for asthma

A

Bronchodilator
Glucocorticoids
Leukotriene antagonist
Muscarinic antagonist
Anti igE
🔆🔆🔆🔆🔆🔆🔆🔆🔆🔆🔆🔆🔆
Nedocromil
Methylxanthines

54
Q

Leukotriene for asthma treatment

A

Prevent the action of Leukotriene
Low toxicity
Orally
Prevent exercise and aspirin bronchospasm

55
Q

Antigen igE antibody

A

Prophylactic

56
Q

Muscarinic antagonist

A

Block mascarinic receptors
Prevent vagaries discharge bronchi constructio
Ipratropium and tiotropium

57
Q

Acute sever asthma symptoms

A

Tachycardia
Tachypnea
Use of accessory muscles
Anxiety
Pulsus paradoxes ( drop in pressures while inhalation)
PEF ➡️less than 50

58
Q

When the asthma is considered life threatening

A

PEF less than 33
Hypotension and bradycardia
Silent chest with cyanosis
Confusion

59
Q

Acute asthma attacks management

A

🔆oxygen therapy ➡️nasal cannula should achieve 90 saturation
🔆steroids ➡️100 mg every 6-8 hours orally
🔆bronchodilator ➡️one hour
🔆antibiotic
🔆magnesium

Internal Medicine RS (10 decks)

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