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A. MLA Map Paediatrics > Asthma > Flashcards

Asthma Flashcards

1
Q

In an obstructive airway disease, do patients struggle getting air into or out of the lungs?

A
  • getting air out of the lungs is obstructed
  • patients can inhale fine, but cannot exhale properly causing expiratory wheeze
  • airways narrow and affect small, medium and larger parts of airways
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2
Q

In obstructive lung disease we can see hyperinflation and trapping of air. Why does this occur?

1 - mucus is secreted causing mucus plugs
2 - reduced elastic recoil (snap back of lung tissue forcing air out of lungs)
3 - small bronchi trap air (<2cm airways
4 - all of the above

A

4 - all of the above

  • forced vital capacity may appear normal
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3
Q

Which of the following are common symptoms of asthma?

1 - wheezing
2 - breathlessness
3 - cough
4 - chest tightness
5 - all of the above

A

5 - all of the above

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4
Q

The common symptoms of asthma are wheezing, breathlessness, cough and chest tightness. According to the British Thoracic Society (SIGN) how many of these symptoms does a patient have to have to be diagnosed with asthma?

1 - all 4
2 - >3
3 - >2
1 - >1

A

1 - >1

Diagnosis is made using peak flow

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5
Q

Roughly how many people a year die due to asthma?

1 - >100
2 - >50
3 - >10
4 - 3-5

A

4 - 3-5
- poor asthma management and education

More common in children

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6
Q

What is the prevalence of asthma in UK adults (A) and children (C)?

1 - A - 30% and C - 40%
2 - A - 40% and C - 30%
3 - A - 20% and C - 8%
4 - A - 8% and C - 20%

A

4 - A - 8% and C - 20%

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7
Q

What type of hypersensitivity is asthma?

1 - type I hypersensitivity
2 - type II hypersensitivity
3 - type III hypersensitivity
4 - type IV hypersensitivity

A

1 - type I hypersensitivity
- hyper responsive to stimuli
- causes IgE to be produced

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8
Q

What is skin prick testing?

A
  • patients will receive small prick on arm
  • then exposed to multiple common allergans
  • positive test = raised skin
  • IgE can then be measured in blood if positive
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9
Q

Generally what are the 2 common things that need to occur for someone to have an asthma attack?

1 - sensitisation of atopic patient
2 - inhalation of allergen
3 - individual to be <16 y/o
4 - individual to be sick

A

1 - sensitisation of atopic patient
2 - inhalation of allergen

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10
Q

Asthma can be divided into a 2 stage process, how long does each phase last?

A

1 - phase 1 = 20 minutes

  • IgE binds to mast cells and degranulate.

2 - phase 2 = 6-12 hours

  • T cells, mast, basoinophil and esionphils cells all migrate to lungs and induce bronchoconstriction and inflammation
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11
Q

Which lymphocytes regulate the initial inflammatory response in asthma?

1 - cytoxic T cells (CD8)
2 - macrophages
3 - T helper cells (CD4)
4 - neutrophils

A

3 - T helper cells (CD4)
- antigen presenting cell presents allergen to T helper cells

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12
Q

Once mast cells have been coated by IgE antibodies, which of the following do the mast cells then secrete through degranulation?

1 - leukotrienes
2 - prostaglandins
3 - histamines
4 - all of the above

A

4 - all of the above

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13
Q

Although histamines are one of the key compounds released from mast cells during an asthma attack, why do anti-histamines not work in asthma?

1 - not strong enough
2 - different histamine receptors
3 - other inflammatory mediators involved (prostaglandins + leukotrienes)
4 - all of the above

A

3 - other inflammatory mediators involved (prostaglandins + leukotrienes)

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14
Q

In an asthma attack what effects do histamines, leukotrienes and prostaglandins cause in the lungs?

1 - bronchospasm
2 - increased mucus production
3 - bronchoconstriction
4 - inflammation, damage and increased endothelium permeability
5 - all of the above

A

5 - all of the above

  • treatments for asthma target histamines, leukotrienes and prostaglandins
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15
Q

In a late phase and chronic asthma what happens to goblet cells?

1 - atrophy in number and increase risk of infection
2 - hypertrophy and impair mucus production
3 - hyperplasia and increase mucus production
4 - dysplasia and increased risk of malignancy

A

3 - hyperplasia and increase mucus production

  • increases risk of plugging and blocking of airways
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16
Q

In a late phase and chronic asthma attack what happens to smooth muscle cells?

1 - atrophy
2 - hypertrophy
3 - hypertrophy and hyperplasia
4 - atrophy and hyperplasia

A

3 - hypertrophy and hyperplasia

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17
Q

What causes smooth muscles to contract during a late phase asthma attack?

1 - cytokines
2 - histamine
3 - leukotrience
4 - RAAS

A

1 - cytokines

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18
Q

What is polyphonic wheezing?

A
  • lots of different whistling/wheezing sounds - caused by different size airways
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19
Q

Although asthma is generally reversible, what can happen if not managed and asthma becomes chronic?

1 - remodelling of airways due to chronic inflammation
2 - collagen deposition
3 - fibrotic tissue replaces parenchymal tissue
4 - fixed narrowing
5 - all of the above

A

5 - all of the above

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20
Q

Are eosinophils or neutrophils in asthma attacks generally associated with acute asthma?

A
  • eosinophils
  • raised in a WBC when doing bloods
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21
Q

Are eosinophils or neutrophils in asthma attacks generally associated with chronic asthma?

A
  • chronic
  • inflammation and steroid dependent asthma
  • just like in COPD
  • WCC is a marker of chronic asthma
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22
Q

Which 2 of the following medications have been linked with asthma attacks?

1 - aspirin (NSAIDS)
2 - ACE-I
3 - glucocorticoids
4 - B-blockers

A

1 - aspirin (NSAIDS)
- linked with abnormal COX-2 that induces asthma attack

4 - B-blockers
- cause narrowing of airways

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23
Q

Which of the following are basic physiological, non disease specific aspects that may cause asthma?

1 - pregnancy
2 - premenstrual (pre period)
3 - exercise
4 - all of the above

A

4 - all of the above

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24
Q

What is diurnal variability?

1 - asthma only occurs at a specific time in the day
2 - PEF changes throughout the day
3 - PEF is always lower in the evening as we are tired
4 - PEF reducing that triggers asthma attack

PEF = peak expiratory flow (this is the gold standard for diagnosing patients)

A

2 - PEF changes throughout the day

  • > 20% variation is a diagnosis of diurnal variability
  • asthma diagnosis =
    1 - <20% diurnal variation
    2 - >3d/week
    3 - >2 weeks
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25
Q

Typically when is PEF at its lowest?

1 - morning
2 - afternoon
3 - evening
4 - always low

A

1 - morning

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26
Q

During an acute exacerbation of asthma, does respiratory rate increase or decrease?

A
  • respiratory rate increases
  • body attempts to O2
  • tachypnoea (abnormal rapid breathing)
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27
Q

During an acute exacerbation of asthma, what happens to the heart rate?

A
  • ⬆️ heart rate - tachycardia
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28
Q

Patients with asthma experience acid -reflux. What % of asthma patients experience acid-reflux?

1 - 4-6%
2 - 8-12%
3 - 25-35%
4 - 40-60%

A

4 - 40-60%
- treat reflux and spirometry will improve

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29
Q

In severe asthma, what can happen to the colour of finger tips and skin?

A
  • cyanosis - blue skin
30
Q

Normal respiratory rate is between 12-16 breaths/minute. What respiratory rate can we expect to see in an asthma attack?

1 - >12
2 - >15
3 - >20
4 - >30

A

3 - >20

31
Q

What is a silent chest?

A
  • no sound heard from chest
  • associated with bradycardia
  • RED FLAG
  • VERY dangerous
32
Q

What are the 2 main scans that will be performed on the chest if a patient is suspected with asthma?

1 - X-ray
2 - MRI
3 - PET-scan
4 - CT

A

1 - X-ray
4 - CT

  • high sensitivity CT and gold standard for diagnosing asthma
33
Q

In spirometry, would we expect the residual volume (RV) (amount of air remaining in lungs when we forcefully exhale) to increase or decrease in asthma?

A
  • increase
  • recoil = reduced (ability of lungs to snap back and exhale air)
  • compliance = increased (stretching the lungs)
34
Q

If we suspect a patient has allergic asthma, we can perform a Fractional Exhaled Nitric Oxide (FENO) test. What cell is predominantly responsible for producing NO in allergic asthma that is detected by the FENO test?

1 - basophils
2 - eosinophils
3 - lymphocytes
4 - macrophages

A

2 - eosinophils

In healthy lungs the level of NO will be low.

A FENO >40 ppb is positive in adults

35
Q

If we suspect a patient has allergic asthma, we can perform a Fractional Exhaled Nitric Oxide (FENO) test. In children aged 5-16 y/o FENO is not routinely performed unless:

1 - patient asks for it
2 - only if in secondary care
3 - if spirometry results are normal but asthma still suspected
4 - if patient has >3 allergies confirmed

A

3 - if spirometry results are normal but asthma still suspected

> 35 is positive in 5-16 y/o children

36
Q

To determine if the asthma is reversible, the FEV1 must improve by >12% with at least an increase of 200ml (just 12% in children is required). What may patients be given that can be affective <20 minutes?

1 - Salbutamol
2 - Salmeterol
3 - Ipratropium bromide
4 - Theophylline

A

1 - Salbutamol

  • Salbutamol = SABA
  • Salmeterol = LABA
  • Ipratropium bromide = muscarinic antagonist
  • Theophylline = Phosphodiesterase inhibitors (xanthine derivatives)
37
Q

In patients with asthma, would DLCO/TLCO be low or normal?

A
  • normal as interstium and alveoli are not generally affected
  • if air reaches alveoli it will perfuse
  • ventilation is low though
38
Q

Asthma is a chronic inflammatory obstructive respiratory condition that causes narrowing of the lungs and difficult breathing. Which of the following can cause an asthma exacerbation?

1 - allergies
2 - air pollution
3 - airborne irritants
4 - respiratory infections
5 - exercise or physical activity
6 - weather and air temperature
7 - strong emotions
8 - medication
9 - all of the above

A

9 - all of the above

39
Q

In obstructive lung diseases, the elastic tissue in the lungs is affected. Are both recoil and compliance of lung tissue reduced in asthma?

A
  • no
  • recoil (ability of lungs to return to previous size) is reduces
  • compliance (stretching the lungs) is increased
40
Q

Which of the following is not a layer of the lumen in the respiratory airways?

1 - smooth muscle
2 - lamina propria
3 - epithelial cells
4 - endothelium cells

A

4 - endothelium cells
- present in blood vessels

41
Q

Once an allergen is presented to a T helper cell by an antigen presenting cell (APC), the T cell become active and secretes which 2 cytokines?

1 - IL-1
2 - IL-4
3 - IL-5
4 - TNF-a

A

2 - IL-4
3 - IL-5

42
Q

Activation of the T helper cells leads to production of IL-4 and IL-5. IL-4 then results in the production of which antibody by B cells?

1 - IgE
2 - IgA
3 - IgM
4 - IgD

A

1 - IgE

  • IgE then coats mast cells
  • basophils and eosinophils also involved
43
Q

Activation of the T helper cells leads to production of IL-4 and IL-5. IL-5 then results in the activation of which immune cell that then produces more cytokines and leukotrienes?

1 - macrophages
2 - dendritic cells
3 - cytotoxic T cells
4 - eosinophils

A

4 - eosinophils

44
Q

In spirometry, would we expect to see an increase of decrease in functional residual capacity (FRC) (remaining air in lungs at end of normal exhalation) in a patient with asthma?

A
  • increase
  • recoil = reduced (ability of lungs to snap back and exhale air)
  • compliance = increased (stretching the lungs)
45
Q

In spirometry, would we expect to see an increase of decrease in forced vital capacity (FVC) (air that can forcefully expired following maximum inhalation) in a patient with asthma?

A
  • small reduction
  • recoil is reduced so patient has to work harder to exhale air
46
Q

In spirometry, would we expect to see an increase of decrease in forced expiratory volume in 1 second (FEC1) (air that can forcefully expired in 1 second following maximum inhalation) in a patient with asthma?

A
  • significantly reduced
  • airways are narrowed
47
Q

In patients with asthma the FVC and FEV1 are reduced. What is the ratio that is diagnostic in patients with asthma?

1 - FVC/FEV1 <90%
2 - FVC/FEV1 <80%
3 - FVC/FEV1 <70%
4 - FVC/FEV1 <60%

A

3 - FVC/FEV1 <70%

48
Q

In patients with asthma is the total lung capacity increased or decreased?

A
  • increased
  • lungs can become hyper inflated
49
Q

In a patient presenting with an asthma attack, would we see in an ABG, an increased or decreased PaO2 and PaCO2?

A
  • PaO2 = normal or small reduction
  • PaCO2 = reduced due to hyperventilation
50
Q

In a patient presenting with an asthma attack, we might see a reduced PaCO2. If this is increasing, is this dangerous?

A
  • yes
  • sign of respiratory failure and near fatal
51
Q

In a patient presenting with asthmatic symptoms such as wheeze, cough, dyspnoea (SOB) and sputum, which of the following is an unlikely differential?

1 - PE
2 - COPD
3 - Pulmonary oedema
4 - Pneumothorax
5 - foreign body obstruction
6 - malignancy

A

6 - malignancy

  • could occur but unlikely to present acutely
52
Q

Which of the following are are lifestyle advice that patients with COPD and asthma should receive?

1 - smoking cessation
2 - ⬆️ activity
3 - improved nutrition
4 - all of the above

A

4 - all of the above

53
Q

When diagnosing a patient with asthma, they are prescribed a reliever for their symptoms as PRN. What is typically the first line reliever?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

1 - salbutamol (SABA)

  • only used to relieve acute symptoms
  • if using >1/month they should come to GP to have their asthma assessed
54
Q

When diagnosing a patient with asthma, they can be prescribed a preventer. Which of the following is a preventer?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

4 - prednisolone (glucocorticoid)

  • low dose of inhaled corticosteroids
  • typically BD on lowest dose

Preventer given in patients:
- using SABA >3/week
- asthma symptoms >3/week and/or woken by asthma symptoms

55
Q

If a patient does not respond to the initial treatment of glucocorticoid as a preventer, it is best to combine the glucocorticoid with another medication. What medication should be combined with prednisolone?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - montelukast (leukotriene receptor antagonist)

A

4 - montelukast (leukotriene receptor antagonist)

Leukotriene receptor antagonists (LTRAs) treat asthma and allergic rhinitis by blocking the activation of cysteinyl leukotriene (CysLT) receptors.

This prevents the inflammatory cascade that causes asthma and allergic rhinitis symptoms. LTRAs can also cause bronchodilation

56
Q

If a patient does not respond to the initial treatment of glucocorticoid and a leukotriene receptor antagonist, what medication should be added to this patients medication?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - montelukast (leukotriene receptor antagonist)

A

2 - salmeterol (LABA)

A long acting beta agonist

57
Q

If a patients asthma remains uncontrolled using the following:
- inhaled glucocorticoid
- leukotriene receptor antagonist
- LABA

What would be the next step in the management plan for this patient?

1 - increase salbutamol (SABA)
2 - increase salmeterol (LABA)
3 - tiotropium (LAMA)
4 - maintenance and reliever therapy (MART)

A

4 - maintenance and reliever therapy (MART)

  • combined ICS and LABA
    of MART doesnt work we can consider adding in a LAMA
58
Q

If the Maintenance and Reliever Therapy does not work, we can potentially add theophylline. Is anyone able to prescribe this medication?

A
  • No

Need to refer to secondary care

59
Q

In asthma management, we should always considering reducing patients medications. What time period must they be stable before this is considered?

1 - 1 week
2 - 3 weeks
3 - 3 months
4 - 6 months

A

3 - 3 months

60
Q

Which of the following should be included in the annual check up with the GP about a patients asthma plan?

1 - number of exacerbations
2 - review of medication
3 - compliance to medication
4 - spirometry
5 - all of the above

A

5 - all of the above

Spirometry should be performed in all children aged >5 y/o

61
Q

If a patient with asthma had an exacerbation and attended A+E, all of the following should be done asap, EXCEPT which one?

1 - pulse oximetry
2 - chest X-ray
3 - arterial blood gas
4 - spirometry/peak flow

A

4 - spirometry/peak flow
- important but patients may not be able to do the test

62
Q

If a patient with asthma had an exacerbation and attended A+E, which 2 of the following medications should be administered at a high dose via a nebuliser?

1 - increase salbutamol (SABA)
2 - increase salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

1 - increase salbutamol (SABA)
4 - prednisolone (glucocorticoid)

  • if prednisolone via nebulised is not effective, we can give hydrocortisone via IV
63
Q

If a patient with asthma attended A+E with a severe asthma attack what mineral could be given intravenously?

1 - Ca2+
2 - vitamin D
3 - Mg2+
4 - biotin

A

3 - Mg2+

64
Q

Which of the following are the effects of magnesium that is given in severe asthma attacks?

1 - bronchodilator
2 - stabilises T cells
3 - ⬇️ inflammation
4 - all of the above

A

4 - all of the above

65
Q

Can Theophylline a phosphodiesterase inhibitors be given intravenously in acute asthma?

A
  • yes
  • acts a bronchodilator
  • phosphodiesterase inhibitors stop the degradation of cAMP and cGMP
  • results in vasodilation
66
Q

Following discharge from hospital following an acute asthma attack they are discharged. How long will they remain on the medication they are given to relieve their acute asthmatic symptoms?

1 - 6h
2 - 12h
3 - 24h
4 - 48h

A

3 - 24h

67
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients PEF1 be?

1 - 100% of best or predicted
2 - >90% of best or predicted
3 - >75% of best or predicted
4 - >50% of best or predicted

A

3 - >75% of best or predicted

68
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients diurnal variability be?

1 - <25%
2 - <15%
3 - <10%
4 - <5%

A

1 - <25%

69
Q

Prior to being discharged from hospital, which of the following must patient be checked and advised faccoridng to the British Thoracic Soceity guidelines?

1 - check inhaler technique
2 - personalised asthma plan is understood
3 - smoking cessation (support and guidance)
4 - ⬇️ oral steroid dose slowly
5 - review with doctor/nurse in 2 weeks
6 - all of the above

A

6 - all of the above

70
Q

In an acute severe presentation of asthma, what oxygen sats should we aim for?

1 - 88-92%
2 - 90-98%
3 - 94-98%

A

3 - 94-98%

71
Q

In an acute severe presentation of asthma, which 2 of the following would typically be given 1st?

1 - salbutamol
2 - prednisolone PO
3 - tiotropium (LAMA)
4 - montelukast (leukotriene receptor antagonist)

A

1 - salbutamol
- via nebuliser, but less severe cases may used inhaler with spacers

2 - prednisolone PO
- 40mg

72
Q

In an acute severe presentation of asthma, patients O2 sats should aim to be 94-98%, and be given nebulised salbutamol and oral prednisolone (40mg). However, if these do not work, which 2 of the following should be given?

1 - repeat oral prednisolone at 80mg
2 - ipratropium nebulised with Salbutamol
3 - iv MgSO4 bolus
4 - montelukast (leukotriene receptor antagonist)

A

2 - ipratropium nebulised with Salbutamol
- muscarinic antagonist

3 - iv MgSO4 bolus

Aminophylline, a broncho dilator can be given, while transferring the patient to ITU

A. MLA Map Paediatrics (61 decks)

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