Asthma

Question 1

Most pts with asthma are allergic to

Answer 1

house dust mite

Dermatophagoides pteronyssinus

Question 2

Age of presentation of asthma

Answer 2

any age

Question 3

Peak age of presentation of asthma

Answer 3

3 years

Question 4

Drugs that can trigger asthma

Answer 4

aspirin

beta blockers

Question 5

Allergic rhinitis is present in _________ % of atopic patients

Answer 5

80

Question 6

Intrinsic asthma

Answer 6

non atopic
adult onset
aspirin sensitivity
nasal polyps

Question 7

When to suspect occupational asthma?

Answer 7

When symptoms improve during weekends

Question 8

Characteristic pathological finding in BA?

Answer 8

Thickening of subepithelial basement membrane

Question 9

Causes of subepithelial basement membrane thickening in bronchioles?

Answer 9

Asthma

Eosinophilic bronchitis

Question 10

Inflammatory changes are predominant in which airway in asthma

Answer 10

cartilaginous(bronchi)

Question 11

beta blockers and asthma

Answer 11

avoid all beta blockers

selective and topical too

Question 12

EIA clinical presentation

Answer 12

begins after exercise has ended, and recovers spontaneously within about 30 minutes

Question 13

Hormonal factors associated with asthma

Answer 13

Thyrotoxicosis and hypothyroidism can both worsen athma

low progesterone can worsen asthma

Question 14

GERD and asthma

Answer 14

common in asthmatic patients as it is increased by bronchodilators

Question 15

ventilatory failure in asthma

Answer 15

Very uncommon

Question 16

prodromal symptoms before asthma attack

Answer 16

itching of chin
discomfort between scapula
impending doom

Question 17

Reversibility

Answer 17

> 12% and 200-mL increase in FEV1 15 minutes after an inhaled short-acting 2-agonist or in some patients by a 2 to 4 week trial of oral corticosteroids

Question 18

role of allergen challenge in asthma

Answer 18

occupational asthma

Question 19

methacholine or histamine challenge

Answer 19

reduction of FEV1 by 20%

Question 20

role of methacholine challenge test

Answer 20

DD of chronic cough

Normal PFT

Question 21

Shadowing in x ray in asthma patients

Answer 21

pneumonia

eosinophilic infiltrates in patients with bronchopulmonary aspergillosis

Question 22

Difference between cardiac asthma and BA

Answer 22

basal crackles in cardiac asthma

Question 23

causes of wheeze

Answer 23

foreign body obstruction
BA
cardiac asthma
eosinophilic pneumonia
churg strauss 
PAN

Question 24

Difference between COPD and asthma

Answer 24

symptoms show less variability
never completely remit
show much less (or no) reversibility to bronchodilators

Question 25

Duration of action of SABA

Answer 25

3-6 hours

Question 26

SABAs

Answer 26

albuterol | terbutaline

Question 27

LABAs

Answer 27

salmeterol | formoterol

Question 28

duration of action of LABAs

Answer 28

12 hours

Question 29

Most common adverse effect of beta agonists

Answer 29

muscle tremor | palpitations

Question 30

Muscle tremor and palpitation due to beta agonists are commonly seen in

Answer 30

elderly

Question 31

tolerance to beta agonist therapy

Answer 31

rapid in mast cells | no tolerance for airway dilatation

Question 32

anticholinergic therapy in acute severe asthma

Answer 32

used only after beta agonists as they have a slower onset of action

Question 33

Most common adverse effect of anticholinergic therapy

Answer 33

dry mouth

Question 34

adverse effect of anticholinergic therapy in elderly patients

Answer 34

urinary retention | glaucoma

Question 35

anti inflammatory action of theophylline is due to

Answer 35

activation of histone deacytelase 2

Question 36

MOA of theophylline

Answer 36

Phosphodiesterase inhibitor

Question 37

role of aminophylline in asthma

Answer 37

severe exacerbations that are refractory to SABAs

Question 38

Most common side effects of theophylline

Answer 38

Nausea vomiting headache

Question 39

adverse effects of theophylline occur at plasma concentrations above

Answer 39

10mg/L

Question 40

adverse effects of theophylline

Answer 40

``` nausea,vomiting headache diuresis palpitations arrythmias seizures ```

Question 41

arrythmias and seizures due to theophylline is the result of

Answer 41

adenosine A1 receptor antagonism

Question 42

side effects of ICS

Answer 42

hoarsness | oral candidiasis

Question 43

how to prevent local side effects of ICS

Answer 43

use of large spacer

Question 44

OCS Rx in asthma

Answer 44

prednisone or prednisolone 35-40mg od for 5 to 10 days | no tapering needed

Question 45

key side effect of intramuscular triamcinolone in asthma

Answer 45

proximal myopathy

Question 46

steroid side effects

Answer 46

``` osteoporosis hypertension diabetes easy bruising GI ulceration cataract truncal obesity depression proximal myopathy ```

Question 47

cromones

Answer 47

cromolyn sodium | nedocromil

Question 48

role of cromones in asthma

Answer 48

trigger induced asthma like EIA,SO2,

Question 49

Frequency of omalizumab injection

Answer 49

every 2-4 weeks

Question 50

Use of reliever medication more than ________ times/week indicates need for controller therapy

Answer 50

3

Question 51

marker of impending respiratory failure in Acute severe asthma

Answer 51

normal or raised PCO2

Question 52

O2 sat target in Acute severe asthma

Answer 52

>90%

Question 53

Indication for intubation in acute severe asthma

Answer 53

impending respiratory failure

Question 54

Causes of refractory asthma

Answer 54

``` non compliance chlamydia/mycoplasma beta blockers,aspirin hypo/hyperthyroidism premenstrual worsening rhinosinusitis ```

Question 55

OCS of choice in pregnant patients

Answer 55

prednisone | as it is not converted to prednisolone by fetal liver

Question 56

safe antiasthmatic medications

Answer 56

SABA ICS Theophylline