Asthma, D Kinder DSA

Question 1

What are the 3 distinct components of asthma

Answer 1

1- recurrent airway obstruction: resolves spontaneously or with Tx
2- Airway hyper-responsiveness: exaggerated bronchoconstriction in response to stimuli with little or no effect on non-asthmatic patients
3- airway inflammation

Question 2

What cahracterizes mild asthma

Answer 2

edema and hyperemia of the mucosa plus mucosal infiltration with mast cells, eos and lymphocytes

Question 3

what characterizes moderate asthma

Answer 3

chemokines, eotaxin, RANTES, macrophage inflammatory protein 1alpha, IL8 with sm m constriction

Question 4

what characterizes severe asthma

Answer 4

hypertrophy and hyperplasia of airway glands and smooth muscle lead to severe airway thickening

Question 5

airway obstruction in asthma is a combination of what

Answer 5

constricion of sm mm
thickening of epithelium
liquids in airways

Question 6

What are triggers for asthma

Answer 6

atopy, allergy, cold air, smoking, pollution, climate changes, emotion, medications, occupational, food

Question 7

What are the asthma chemical mediators

Answer 7

ACH
histamine
leukotrienes
NO

Question 8

Describe how Ach contributes to asthma

Answer 8

released from intrapulmonary motor nn to stimulate M3 causing airway smooth mm constriction

Question 9

describe how histamine contributes to asthma

Answer 9

released from mast cells- minor role

Question 10

describe how leukotrienes and lipoxins contribute to asthma

Answer 10

derived by the lipoxygenation of AA released from target cell membrane phospholipids during cellular activation

Question 11

describe how NO contributes to asthma

Answer 11

produced by airway epithelial cells and by inflammatory cells found in the asthmatic lung. High levels found during asthma attack

Question 12

What is key in Hx that points towards asthma

Answer 12

dyspnea, cough, wheezing, anxiety
exercise induced, aspirin ingestion, extrinsic allergen induced
inability to sleep
tapid changes in temperature leading to attack

Question 13

What is Ddx for asthma

Answer 13

COPD, CHF, pneumothorax, pulmonary embolism, large airway obstruction, vocal cord dysfunction

Question 14

describe mild intermittent asthma

Answer 14

symptoms present for <2 nigh/mo

Question 15

describe mild persistent asthma

Answer 15

symptoms present for >2days/week 2nights/mo

Question 16

describe moderate persistent asthma

Answer 16

symptoms present daily or >once/night

Question 17

describe severe persistent asthma

Answer 17

Sx are continual during the day and frequent at night

Question 18

what do vital signs look like during asthma attack

Answer 18

tachypnea with RR 25-40, tachycardia and pulsus paradoxus

Question 19

what are ominous signs of sthma

Answer 19

inability to speak or drink, fatigue, drowsiness, confusion and cyanosis

Question 20

What does ABG look like in asthma

Answer 20

hypocapnea, if PaCO2 normalizes during severe attack may indicate impending respiratory failure

Question 21

what will CBC show with asthma

Answer 21

eosinophilia and elevated IgE

Question 22

What will CXR look like in asthma

Answer 22

normal, hyperinflation

sometimes severe hace have pneumothorax or pneumomediastinum

Question 23

What does EKG look like with asthma attack

Answer 23

sinus tachy, RAD sometimes with RBBB, P pulmonale, ST-T changes in severe attack

Question 24

what is Tx for intermittent asthma

Answer 24

no daily medication

short acting beta 2 agonist

Question 25

Tx for mild persistent asthma

Answer 25

short acting beta 2 agonist as needed
inhaled corticosteroid
alternate Tx with mast cell stabilizer, leukotriene R antagonist or theophylline

Question 26

What is Tx for moderate persistent asthma

Answer 26

SABA as needed
low to medium dose inhaled corticosteroid
LABA

Question 27

Tx for severe persistent asthma

Answer 27

SABA
high dose corticosteroid and LABA
if persistent 2mg/kg/day prednisone

Question 28

what gene has been traced to asthma

Answer 28

locus on chrom 17q21 for ORMDL3 which encodes ER TM proteins

Question 29

What occurs in response to the inflammatory mediators released in asthma

Answer 29

deposition of type III and V collagen below true BM

Question 30

what are the most potent contractile agonists for airway smooth m

Answer 30

LTC4 and LTD4

Question 31

what drives RR in asthma attack

Answer 31

stimulation of intrapulmonary R with subsequent effects on central resp centers

Question 32

how can asthma cause hyperventilation with low arterial PCO2

Answer 32

decrease in the ventilation to perfusion ratio

Question 33

pulse paradoxus of 15 mmHg indictes how severe of asthma attack

Answer 33

moderate

Question 34

PErcussion of thorax during asthma attck would present how

Answer 34

hyperresonance with loss of normal diaphragmatic movement

diminished tactile fremitus

Question 35

rales heard during PE of asthma patient suggest what

Answer 35

raise suspicion of alternative Dx like localized infection or heart failure

Question 36

At onset of asthma attack what type acid base may be present

Answer 36

pure respiratory alkalemia

Question 37

a normal PaCO2 in asthma patient is concern because what

Answer 37

mechanical load on resp system is greater than can be sustained by ventilatory muscles

Question 38

What blood serum [ ] could be elevated during severe asthma attcks

Answer 38

aminofransferase, lactac dehydrogenase, muscle creatinine kinase, ornitine transcarbamylase and ADH

Question 39

What is an easy way to Dx asthma

Answer 39

SOB with elevated FENO

Question 40

What is Mepolizumab

Answer 40

monoclonal Ab directed against IL5

Question 41

What is Samters triad

Answer 41

patient with asthma who takes ASA and develops chronic rhinosinusitis, nasal polyps and severe bronchial asthma