Asthma

Question 1

asthma

Answer 1

1. chronic INFLAMMATORY disorder of airways 2. intermittent OBSTRUCTION 3. airway HYPER-ACTIVITY

Question 2

is obstruction in asthma reversible?

Answer 2

often yes

Question 3

asthma risk factors

Answer 3

hx of atopic dz, FH of asthma/allergy, tobacco exposure, GERD, vocal cord dysfunction, RSV, maternal smoking

Question 4

symptoms of asthma

Answer 4

dyspnea, cough, wheezing, chest tightness

Question 5

cough in asthma is worse

Answer 5

night

Question 6

asthma worsen by

Answer 6

exercise, URI, allegens, emotion, irritants

Question 7

ACE inhibitors cause

Answer 7

chronic dry cough

Question 8

PE findings of asthma

Answer 8

expiratory wheezing, prolonged expiratory phase, tachypnea, tachycardia , pulsus paradoxus , accessory muscle use, atopic dz

Question 9

asthma initial dx

Answer 9

detailed medical hx, PE, PFT (>5years of age), methacholine challenge test (not done currently)

Question 10

PFT confirmed dx of asthma

Answer 10

> 12% improvement in FEV1 with bronchodilator

Question 11

obstructive graph in spriometry

Answer 11

concave

Question 12

peak expiratory flow meter

Answer 12

red, yellow, green zone

Question 13

when to use PEFM

Answer 13

in conjunction w.written tx plans for pt compliance on regular basis and during exacerbation

Question 14

intermittent asthma

Answer 14

all ages: sx 80%

Question 15

mild asthma

Answer 15

sx>2x/wk (not daily)
age 0-4: >2nits/mt
age >5: 3-4nits/mt
minor limitation, FEV1>80%

Question 16

moderate persistent asthma

Answer 16

daily sx,
age 0-4: 3-4 nit/mt
age >5:sx >1nite/wk
exacerbation >2/wk, affect activity, last days, FEV1 60-80%

Question 17

sever persistent asthma

Answer 17

continuous sx,
age 0-4: >1x/wk nite sx
age >5: oftern 7x/wk nite sx
limited physical activity, frequent exacerbations, FEV1<60%

Question 18

tx asthma

Answer 18

beta 2 agonists, corticosteroids, mast cell stabilizers, leukotriene modifiers (LTRA), anticholinergics, methylxanthines, immunomodulators

Question 19

tx intermittent asthma

Answer 19

SABA PRN

Question 20

tx mild persistent asthma

Answer 20

low dose ICS + SABA

Question 21

cromolyn

Answer 21

tx of mild persistent asthma (0-4 yr)

Question 22

Leukotriene receptor antagonist/cromolyn

Answer 22

tx of mild persistent asthma (5-11 yr)

Question 23

tx of moderate persistent asthma

Answer 23

refer to specialist
0-4: medium dose ICS
5-11: medium dose ICS /low dose ICS+LTRA/ long acting beta 2 agonist

Question 24

tx of sever persistent asthma

Answer 24

0-4: medium dose ICS + LABA/LTRA

5-11: medium dose ICS +LABA

Question 25

when to add oral steroids to High dose ICS + LABA

Answer 25

severe severe cases -step 6

Question 26

tx intermittent asthma adults

Answer 26

SABA (albuterol) as rescue PRN

Question 27

tx of mild asthma adult

Answer 27

low dose ICS / leukotriene inhibitor, nedocromil, theophylline

Question 28

tx of moderate persistent asthma adult

Answer 28

low dose ICS + LABA (advair) /medium dose ICS

Question 29

xolair

Answer 29

pt with allergies and step 5 asthma

Question 30

oral CS

Answer 30

asthma adult step 6 -added to high dose ICS+ LABA

Question 31

important vital sign for asthma

Answer 31

RR -tachypnea

Question 32

cbc for asthma

Answer 32

r/o infection

Question 33

peak expiratory flow

Answer 33

mild >70%-out pt
moderate 40-70%- ED
Severe < 25% -ICU

Question 34

common finding of asthma on ABG

Answer 34

respiratory alkalosis due to hyperventilation

Question 35

EKG monitoring for asthma

Answer 35

watch for hypokalemia -prolonged QT interval

Question 36

IV steroid for asthma

Answer 36

initially if PEF <50%

Question 37

abx for asthma

Answer 37

only if infection/pneumonia

Question 38

tx to exhale more CO2 for asthma if needed

Answer 38

C-PAP, BiPAP, intubation

Question 39

first line tx of asthma

Answer 39

ICS