Asthma

Question 1

asthma

Answer 1

reversible, often intermittent, obstructive disease or the small airways

Question 2

pathophysiology of asthma

Answer 2

airway inflammation, airway hyperactivity, bronchoconstriction

Question 3

what type of hypersensitivity reaction is asthma

Answer 3

type 1 hypersensitivity rxn

Question 4

RF for asthma

Answer 4

atopy strongest risk factor
FHx
pollution
obesity
environmental tobacco smoke
male

Question 5

sx asthma

Answer 5

episodic dyspnea
wheezing
cough (especially at night)
may have chest tightness or fatigue

Question 6

PE for asthma

Answer 6

wheezing and/or prolonged expiratory phase during normal breathing due to presence of airflow obstruction, hyper resonance to percussion, decreased breath sounds, tachycardia, tachypnea, use of accessory muscles

Question 7

when is wheezing most prominent in asthma

Answer 7

during expiration

Question 8

severe asthma and status asthmaticus

Answer 8

inability to speak ion full sentences, “tripod” positioning, silent chest, altered mental status, pulses paradoxes (inspiratory BP drop > 10

Question 9

what is the best and most objective way to assess acute exacerbation severity and patient response to tx in asthma

Answer 9

peak expiratory flow rate

Question 10

what percent for peak expiroatry flow rate indicates tx response in asthma

Answer 10

PEFR > 15%

Question 11

what PEFR value indicates respiratory distress in asthma

Answer 11

PEFR < 200 L/min

Question 12

what might ABG show during mild exacerbation

Answer 12

respiratory alkalosis from tachypnea

Question 13

what indicates need for mechanical ventilation in asthma

Answer 13

pseudo normalization of the PaCO2 or the combination of an increased PaCO2 and respiratory acidosis may indicate impending respiratory failure

Question 14

are chest radiographs helpful in the diagnosis of asthma

Answer 14

no

Question 15

airflow obstruction in asthma

Answer 15

decreased FEV1
Decreased FEV1/FVC <0.7
increased lung volumes due to hyperinflation: increased residual volume (RV), total lung capacity (TLC), and RV/TLC

Question 16

significant reversibility in asthma

Answer 16

increase in 12% or more and 200 mL in FEV1 or FVC after inhaling a short-acting bronchodilator

Question 17

what test can you do for asthma when asthma is suspected but baseline spirometry is normal or non diagnostic

Answer 17

bronchial provocation with Methacholine or Histamine

Question 18

what will bronchial provocation testing show for asthma

Answer 18

a decrease in FEV1 20% or greater after exposure to methacholine

Question 19

intermittent asthma

Answer 19

sx 2 or fewer times per week
2 or fewer awakenings due to sx per month
use of SABA two or fewer times per week
no interference with normal activity

Question 20

tx for intermittent asthma

Answer 20

short-acting beta-agonist as needed

Question 21

mild persistent asthma

Answer 21

sx > 2 times per week (but not daily)
3-4 episodes of night awakenings due to sx per month
use of SABA more than 2 times per week (but not daily and not more than once per day)
minor limitations to daily activity

Question 22

tx for mild persistent asthma

Answer 22

low dose inhaled corticosteroids
short acting beta agonist as needed

Question 23

moderate persistent asthma

Answer 23

sx daily
night awakenings due to sx at least once per week (but not nightly)
use of SABA on daily basis
some limitations in daily activity

Question 24

tx moderate persistent asthma

Answer 24

low dose inhaled corticosteroids plus long acting beta agonist or a medium dose inhaled corticosteroid plus a long acting beta agonist
short acting beta agonist as needed

Question 25

severe persistant asthma

Answer 25

sx daily night awakenings every night use of SABA multiple times per day extreme limitations in daily activity

Question 26

tx severe persistent asthma

Answer 26

medium or high dose inhaled corticosteroid and a long-acting beta agonist plus LAMA and oral system corticosteroids

Question 27

short acting beta agonists

Answer 27

albuterol levalbuterol Terbutaline Epinephrine

Question 28

ADE short acting beta agonists

Answer 28

tachycardia arrhythmias muscle tremors CNS stimulation hypokalemia

Question 29

anticholinergics (SAMA/LAMA)

Answer 29

Ipratropium Aclidinium Glycopyrrolate Revefenacin Tiotropium Umeclidinium

Question 30

anticholinergics ADE

Answer 30

thirst blurred vision (pupil dilation) dry mouth urinary retention dysphagia glaucoma BPH

Question 31

corticosteroids

Answer 31

Prednisone Methylprednisolone Prednisolone

Question 32

ADE corticosteroids

Answer 32

immunosuppression catabolic hyperglycemia fluid retention osteoporosis growth delays

Question 33

inhaled corticosteroids

Answer 33

beclomethasone Flunisolide Triamcinolone

Question 34

ADE inhaled corticosteroids

Answer 34

oral candidiasis dysphonia

Question 35

long acting beta agonists

Answer 35

Salmeterol ICS/LABA: Budesonide/Formoterol, Fluticasone/Salmeterol

Question 36

mast cell modifiers

Answer 36

Cromolyn Nedocromil minimal side effects

Question 37

Leukotriene modifiers/receptor antagonists

Answer 37

Montelukast Zafirlukast Zileuton minimal side effects

Question 38

ADE Theophylline

Answer 38

nervousness N/V Anorexia HA Narrow TI: toxicity causes arrhythmias and seizures

Question 39

acute bronchitis

Answer 39

self-limited lower respiratory tract infection causing inflammation of the large airways

Question 40

most common cause of acute bronchitis

Answer 40

respiratory virus - Influenza A and B, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, rhinovirus

Question 41

bacterial causes of acute bronchitis

Answer 41

s pneumonia h influenza m catarrhalis mycoplasma pneumoniae chalmydia pneumoniae bordetella pertussis

Question 42

when does acute bronchitis commonly occur

Answer 42

during winter months

Question 43

sx acute bronchitis

Answer 43

cough is hallmark - acute and persistent (1-3 weeks); initially nonproductive but later a productive cough with sputum may develop. presence of sputum is nonspecific. URI sx - runny nose, sore throat, low grade fever, malaise, sore throat, HA, myalgias, fever --- fever is rare in acute bronchitis wheezing or mild dyspnea

Question 44

PE for acute bronchitis

Answer 44

often normal but both wheezing and honcho may be auscultated on PE honcho usually clear with coughing

Question 45

dx acute bronchitis

Answer 45

clinical - acute onset of persistent cough (1-3 weeks) + no findings suggestive of pneumonia (fever, tachypnea, rales, hypoxia, or signs of parenchymal consolidation, such as dullness to percussion, decreased or bronchial breath sounds, rales, ego phony)

Question 46

chest radiographs for acute bronchitis

Answer 46

not needed - usually normal or nonspecific. indicated when acute bronchitis cannot be distinguished from pneumonia

Question 47

tx acute bronchitis

Answer 47

self limited

Question 48

tx for cough in bronchitis

Answer 48

guaifenasin dextromethorphan benzonatate codeine

Question 49

FEV1 and FCV for intermittent asthma

Answer 49

FEV1 > 80% of predicted normal FEV1/FVC

Question 50

FEV1 and FVC in mild persistent asthma

Answer 50

FEV1 > 80% predicted normal FEV1/FVC

Question 51

FEV1 and FVC in moderate persistent asthma

Answer 51

FEV1 60-80% predicted FEV1/FVC reduced by < 5%

Question 52

FEV1 and FVC in severe persistent asthma

Answer 52

FEV1 < 60 FEV1/FVC reduced by > 5%