Asthma

Question 1

Recurrent resp infections always represent a serious underlying pathology

Answer 1

F
The child may have :
-a simply managed cause for their symptom (viral resp infection)
-or there is evidence of a more serious underlying pathology (immune dysfunction)

Question 2

hx is enough To assess the severity and dg the cause of the sympt

Answer 2

F
Hx
PE
Appropriate investigation

Question 3

To diagnose asthma at least one of the following criteria has to be present:

Answer 3

*RECURRENT** episodes of
Wheezing
Shortness of breath
Coughing
Chest tightness

Question 4

Asthma symptoms get better at night

Answer 4

F
They worsen at night and in response to exercise and cold weather (september to April) (automn and winter)

Question 5

Asthma is the most common chronic dz in children

Answer 5

T
It is a common and non communicable dz of the lungs affecting both children and adults

Question 6

Asthma is characterized by chronic airway infection of large airways

Answer 6

F
Of small airways

Question 7

When is the usual onset of asthma (childhood or adulthood)

Answer 7

Childhood

Question 8

Genetic is the main cause of asthma

Answer 8

F
Environmental factors are the main cause of asthma

Question 9

How is the incidence of asthma changing

Answer 9

It is increasing due to increase in exposure to environmental allergens and irritants

Question 10

RF for developing asthma

Answer 10

-genetic
-allergy or atopy
-urbanization is associated with increased risk of asthma
-GI reflux dz
-events in early life that affect development of lungs (low birth wt, premature)
-obesity

Question 11

Environmental factors ( indoor and outdoor air pollution, house dust mites, chemicals, pets and danders) are the only cause of asthma

Answer 11

F
Also genetics

Question 12

1) Recurrent viral colds

Question 13

The common cold is caused by viruses that infect the nose, throat and sinuses
And it is more common in fall and winter

Answer 13

T

Question 14

Young children can get as many as 3 colds each year

Answer 14

F
8 to 10

Question 15

How much is the duration of symps in common cold

Answer 15

8 days ( 1 week)
But may extend beyond 2 weeks

Question 16

What are the symps of common cold

Answer 16

-fever
-sore throat
-cough
-rhinorrhea
-nasal congestion

Question 17

Isolated viral colds always do require further evaluation

Answer 17

F
They require further evaluation in case of :
-frequency is >15 times per year
-duration is >15d per episode

Question 18

2) chronic rhinitis

Question 19

Define chronic rhinitis

Answer 19

Chronic inflammation of the nasal mucosa that results in symptoms:
-congestion
-nasal discharge
-sneezing
For at least 30mins daily for 2 or more months

Question 20

The cause of chronic rhinitis is always allergic

Answer 20

F
Allergic or non allergic

Question 21

The pathophysiology of asthma involves both:
-airway inflammation of the bronchi and bronchioles
-intermittent airway obstruction due to contraction of smooth muscle—> bronchial hyper responsiveness

Answer 21

T

Question 22

What are the signs of asthma

Answer 22

-breathlessness (dyspnea) (shortness of breath)
-wheezing when exhaled
-chest tightness or pain
-cough that worsen at night
Productive or dry cough (usually chronic)

Question 23

Wheezing upon exhalation is not a common sign of asthma in children

Answer 23

F
It is a common sign of asthma

Question 24

Pts have stable asthma for weeks or months and suddenly develop an episode of acute asthma
Often the symptoms are triggered by certian factors, list them:

Answer 24

Triggering factors are:
-viral upper resp infection: URTI
-Exercise
-cold
-tobacco exposure
-psychological stress: alters the IS and inc in airway inflammatory response to allergens
-Emotional upset
-home factors :dust, animals, dander, chemical, perfumes, Pets, Aero allergin

Question 25

Personal or family hx of other atopic condition is present in asthmatic person

Answer 25

T

Question 26

Asthmatics respond well to -Betta blockers (propranolol) -ACE inh -Aspirin -NSAIDS

Answer 26

F These makes asthma worse !! They respond well to bronchodilators

Question 27

Conditions occur more frequently with asthma

Answer 27

-GERD -atopic dermatitis (eczema; urticaria) -obstructive sleep apnea -rhino sinusitis

Question 28

Suspect asthma in any child who has: **persistent productive cough** and **hx of episodes of wheezy chest**

Answer 28

T Associated with -Fam hx -Allergic hx -Triggering factor -psychological stress

Question 29

What is the tool used to dg asthma

Answer 29

Spirometry is the recommended test to confirm the dg of asthma

Question 30

In spirometry pt should take deep breath and exhale forcefully, where it measures the amount of airflow to breath in and out and the rate of flow

Answer 30

T

Question 31

Spirometry indicates only dg of asthma

Answer 31

F It is used for **dg** and **assessment of severity** of asthma

Question 32

What is the gold standard method to dg asthma

Answer 32

Spirometry

Question 33

At what age is spirometry perfomed

Answer 33

From age 5 and above

Question 34

Spirometry is performed only before bronchodilators

Answer 34

F Before and after in order to assess the reversibility Bcs spirometry demonstrates reversible airflow obstruction

Question 35

List the values of FEV1( it represent the percentage of the lung capacity that one can expel in second)

Answer 35

FEV1 (>80%) N FEV1 65-79% mild obstruction FEV1 50- 65% moderate obstruction FEV1 <50% severe obstruction

Question 36

How much should the FEV1 improve for dg of asthma

Answer 36

It should improve by > than 12% and increase by at least **200ml** following administration of bronchodilators

Question 37

Caffeine is a bronchoconstrictor

Answer 37

F It is a bronchodilator thus it intervenes with the result of spirometer

Question 38

In a child <5 y we cant do spirometer How to dg the child

Answer 38

Dg steps are same as before A trial of asthma med may help to establish dg—> reversal symps after administration of albuterol

Question 39

Differential diagnosis

Question 40

1) immuno deficiency disorder

Question 41

The resp system is the organ system most commonly involved in immunodeficiency disorder

Answer 41

T

Question 42

What are the clinical manifestations to suspect an immune defect

Answer 42

-unusual severity -atypical presentation -unresponsive to typical tx -recurrent

Question 43

We should suspect immunodeficiency when we have:

Answer 43

- >= 8 new **ear infection** within 1y - >= 2 serious **sinus infection** or **pneumonia** within one year - >= 2 **sepsis or meningitis** - >= 2months of **Abx** with little effect - need IV Abx or hospital to tx infection - FTT - Resistant superficial or oral candiasis - recurrent tissue or organ abcess - infection with opportunistic organisms - Fam hx

Question 44

Cellular immuno deficiencies are the most common

Answer 44

F Defects in humoral immunity (50%) Humoral and cellular (20-30%) Phagocyte defect (18%) Complement defect (<2%)

Question 45

2) chronic post infective cough What is chronic cough

Answer 45

Cough that appeared with acute infection Normally cough should subside within 2-6m

Question 46

Most common bacterias associated with chronic cough

Answer 46

Bordetella M. Pneumonia

Question 47

The post infective cough results from **bronchial hyper activity** and **impaired mucociliary clearance** that follow and inflammation that occurs with these infections

Answer 47

T

Question 48

3) inhaled foreign body It should be suspected in any child who develops persistent dry cough

Answer 48

F **persistent productive cough** particularly after Hx of chocking

Question 49

What does the severe inflammation in the bronchial mucosa due to foreign body lead

Answer 49

Obstruction of airways followed by distal infection

Question 50

Airway damage is resolved after removal of FB

Answer 50

F There may be persistent -localised airway damage -abnormal lung ft -cough

Question 51

4) disorders of celia ft Primary celiary dyskinesia is an auto dominant

Answer 51

F Auto R dz (males and females are equally affected)

Question 52

Primary ciliary dyskinesia have abnormal mucociliary clearance

Answer 52

T

Question 53

Clinical manifestations of ciliary dysfunction in newbons

Answer 53

-nasal obstruction -mucopurulent discharge -pneumonia -tachypnea

Question 54

Clinical manifestations of ciliary dysfunction in older children

Answer 54

- PERSISTENT PRODUCTIVE COUGH - atypical asthma - severe GER - bronchiectasis - chronic purulent rhinitis - sinusitis - chronic secretory OM with effusion and deafness