Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y1 - Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

A chronic inflammatory disease of the large and small airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three main factors in asthma?

A

Reversible airflow obstruction
Airway inflammation
Airway hyper-responsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens in airway remodelling?

A

Basement membrane thickens
Submucosa undergoes collagen deposition
Smooth muscle hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most important type of cell that is involved in asthma?

A

Eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma is Th1 mediated, true or false?

A

False - Th2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What cells cause inflammation in asthma?

A

Mast cells
Eosinophils
Dendritic cells
Lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some triggers of asthma?

A 
Allergens (animals, dust, pollens, fungi)
Exercise
Viral infection
Smoke
Chemicals
Drugs (NSAIDs, beta blockers)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the PEFR for moderate, severe and life-threatening asthma?

A

Moderate: 75-50%
Severe: 50-33%
Life-threatening: <33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are risk factors for asthma?

A

Family history of asthma or eczema
Exposure to allergens (dust lites, pets, tobacco smoke)
Recent upper respiratory tract infection
Workplace sensitisers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of asthma?

A 
Episodic attacks of breathlessness
Non-productive cough (can be nocturnal)
Chest tightness
Wheeze
Can be precipitated by triggers
Worse at night and early morning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs of asthma?

A

Poor air entry
Expiratory wheeze
Nasal polyposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are investigations for asthma?

A 
PEFR
FEV1/FVC ratio
ABGs
Bloods - high eosinophils
Trial salbutamol
Challenge test - provocation testing for bronchospasm (exercise, histamine, methacholine, mannitol)
Immunoassay for specific IgE
Skin prick test
Fractional exhaled nitric oxide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the following investigations show in asthma?
FEV1/FVC ratio
PEFR

A

FEV1/FVC ratio: <80% of predicted
PEFR decreased compared to normal for height and sex
Diurnal variability - lower in morning than afternoon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the common examples of ICS used for asthma maintenance?

A

Beclometasone
Butesonide
Fluticasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some side affects of ICS?

A

Oral candidiasis
Stunted growth in children
Dysphonia (hoarse and weak voice)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the common examples of SABAs used for asthma relief?

A

Salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a side effect of SABAs?

A

Fine tremor
Tachycardia
Cardiac dysrhythmia
Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the common examples of LABA used for asthma maintenance?

A

Salmeterol

Formoterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the common LTRA?

A

Montelukast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an acute exacerbation of asthma?

A

An acute or subacute episode of progressive worsening of asthma symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some triggers of an acute asthma attack?

A

Respiratory viruses
Allergen
Irritant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are risk factors for an acute asthma attack?

A 
Previous near-fatal asthma - requiring ventilation or respiratory acidosis
Previous admission for asthma
Requiring 3 or more classes of asthma medication
Heavy use of SABA
Inadequate use of ICS
Incorrect inhaler technique
Smoker
Poor air quality
GORD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the symptoms of an acute asthma attack?

A 
History of asthma
Bouts of dyspnoea and chest discomfort
Nocturnal cough
Wheeze
Clear sputum if any and no haemoptysis
24
Q

What are the signs of an acute asthma attack?

A

Short of breath at rest
Tachypnoea
Tachycardia
Diminished breath sounds

25
Q

What investigations are done for an acute asthma attack?

A

Pulse oximetry
Peak flow
ABGs
ECG and CXR to exclude

26
Q

What are the next treatments for an acute asthma attack after initial treatment?

A

Continue O2 at lower dose
Oral steroids
Nebulised salbutamol
Monitor peak flow and oxygen saturations

27
Q

What does airway hyper-responsiveness mean?

A

The airway becomes twitchy and sensitive to stimuli that are breathed in
Can be either allergic or non-allergic

28
Q

What causes the brief symptoms in asthma?

A

Bronchoconstriction

29
Q

What does chronic airway inflammation cause in asthma?

A

Exacerbations

Airway hyper-responsiveness

30
Q

What does airway remodelling lead to?

A

Fixed airway obstruction - irreversible

31
Q

What are the clinical features of allergic asthma?

A

Childhood onset

Atopic triad: asthma, eczema, rhinitis

32
Q

What are the specific treatments for allergic asthma?

A

Montelukast
Antihistamines
Allergen avoidance
Omalizumab (monoclonal antibody to IgE)

33
Q

What are the clinical features of eosinophilic asthma?

A 
Eosinophils >0.15
4+ exacerbations in the previous year
Usually adult onset
F>M
More steroid resistant
34
Q

What is the specific treatment for eosinophilic asthma?

A

Prednisolone
Mepolizumab or benralizumab (anti-Il-5)
Anti-allergen not effective

35
Q

What investigations are done in all suspected asthma?

A

Spirometry - FEV1/FVC, PEFR

Trial salbutamol

36
Q

What investigations can be done if intermediate suspicion of asthma?

A 
Spirometry
Bronchodilator reversibility
PEF charting
Challenge tests
FeNO
Blood eosinophils
Skin prick test
IgE
37
Q

What is the treatment for asthma?

A
  1. Low dose ICS + SABA as required
  2. ICS + LABA + SABA as required
  3. if no response to LABA - stop LABA, increase ICS. If inadequate response to LABA - continue LABA, increase ICS. Consider trial of LRTA, theophylline, LAMA
  4. Increase ICS to high dose. Consider addition of 4th drug. Refer to specialist care
38
Q

Can SABAs be given on their own?

A

No - always ICS

39
Q

When should you move to the next step in asthma management?

A

If needing to use SABA 3x week or more

40
Q

When should you consider decreasing maintenance therapy?

A

If controlled with current medication for at least 3 months

Only consider stopping ICS completely for people using low dose ICS alone and are symptom free

41
Q

When should you refer someone with asthma to secondary care?

A

Diagnosis unclear
Suspected occupational asthma (symptoms better when not at work, adult onset, high risk occupations)
Severe/life threatening asthma attack
Red flags

42
Q

What features in ‘asthma’ are red flags?

A

Prominent systemic features (myalgia, fever, weight loss)
Unexpected clinical findings (crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor)
Persistent non-variable breathlessness
Chronic sputum production
Unexplained restrictive spirometry
CXR shadowing
Marked blood eosinophilia

43
Q

What is the action of ICS?

A

Anti-inflammatory
Decrease immunological response
No bronchodilator effect

44
Q

What is the action of SABAs in asthma?

A

Airway smooth muscle relaxation
Increase mucus clearance
Decrease mediator release from mast cells and monocytes

45
Q

When is montelukast useful?

A

Allergic phenotypes

Exercise induced asthma

46
Q

What are the side effects of montelukast?

A

Nightmares

47
Q

What is he action of montelukast?

A

Bronchodilator
Smooth muscle relaxation
Decrease in mucus secretion and oedema

48
Q

What is the example of LAMAs used most commonly in asthma?

A

Tiotropium

49
Q

When is tiotropium useful in asthma?

A

To reduce exacerbations in severe patients

Breathless patients without allergy or inflammation

50
Q

What is the action of theophylline?

A

Unclear
Relaxation of smooth muscle
Anti-inflammatory

51
Q

What are the downsides of theophylline?

A

Doesn’t work in smokers

Side effect: nausea

52
Q

When is theophylline used?

A

If nothing else works

53
Q

What is a moderate severity asthma attack?

A

Increasing symptoms
PEF >50-75%
No features of severe

54
Q

What is a severe asthma attack?

A 
Any one of:
PEF 33-50%
Resp rate >25
Heart rate >110
Inability to complete sentences in one breath
55
Q

What is a life-threatening asthma attack?

A 
Any one of:
Altered conscious level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest
Poor respiratory effort
PEF <33%
SpO2 <92
PaO2 <8
'Normal' PaCO2
56
Q

What is the treatment for an acute asthma attack?

A

Oxygen - high dose by mask, maintain 94-98% sats
Salbutamol nebuliser with O2
Ipratropium bromide nebuliser
Steroids - increase ICS
Single dose magnesium sulphate for severe or poor response to salbutamol

57
Q

Which signs in an asthma attack require referral to intensive care?

A

Deteriorating PEF
Persisting or worsening hypoxia
Hypercapnia
ABGs showing decreased pH or increased H+
Exhaustion, feeble respiration
Drowsiness, confusion, altered conscious state
Respiratory arrest

Y1 - Respiratory (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions