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Respiratory > Bronchial Asthma > Flashcards

Bronchial Asthma Flashcards

1
Q

chest tightness, dry cough, SOB, young age, History of allergy personally or in the family
History of atopy (allergic conjunctivitis, allergic rhinitis, eczema), symptoms increase at night due to high cortisol

A

Asthma

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2
Q

Smoker, SOB, productive cough, Age > 40 (if less than 40 think about alpha 1 antitrypsin deficiency)

A

COPD (chronic bronchitis and emphysema)

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3
Q

Diagnosis of asthma

A

-Spirometry
-Peak expiratory flow meter is not diagnostic (it is the best in assessment of acute
exacerbation and good measurement for F/U at home

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4
Q

in asthma findings in spirometry
(Normal FEV1 70%)

A

FEV1 low low
FVC low
FEV1/FVC ratio Low
TLC high due to air trapping
DLCO normal or high

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5
Q

in COPD findings in spirometry
(Normal FEV1 70%)

A

FEV1 low low
FVC low
FEV1/FVC ratio Low
TLC high due to air trapping
DLCO low in emphysema , normal in chronic bronchitis

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6
Q

in Restrictive findings in spirometry
(Normal FEV1 70%)
e.g Asbetosis, eosinophilic pneumonia, idiopathic pulmonary fibrosis, sarcoidosis, silicosis, GBS, MS, morbid obesity

A

FEV1 low
FVC low
FEV1/FVC NORMAL
TLC Low
DLCO low in intrapulmonary , normal in extrapulmonary

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7
Q

Patient work in wood factory came to you complaining of chest tightness and cough in work, those symptoms resolved during weekends what to do?

A

Peak flow rate at home and work

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8
Q

Pregnant lady presented with cough of white sputum then cough increased in severity and she developed SOB she is allergic to dust, mites and pollens, what is the most important investigation?

A

Spirometry

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9
Q

Patient presenting with symptoms of obstructive lung disease PFTs show decreased vital capacity and decreased FEV1/FVC ratio what is associated with this condition?

A

increased lung compliance

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10
Q

The most ACCURATE diagnostic test for asthmatic patient is

A

Pulmonary function test (spirometry)

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11
Q

Bronchiectasis , cystic fibrosis, asthma, a-antitrypsin deficiency , COPD

A

Obstructive lung diseases

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12
Q

Best initial test in an acute exacerbation of asthma in ER

A

Peak expiratory flow

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13
Q

young female came to the clinic complaining of episodes of SOB wheeze and cough for the last 6 months not related to certain provoker, she says that these episodes come suddenly and resolve suddenly , she used ventolin but improved slightly , upon physical exam she has equal air entry with no wheezing, she is not allegric to anything and no one in the her family has the same problem, all test were normal and spirometry is normal , WHAT IS THE DIAGNOSIS?

A

Vocal cord dysfunction

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14
Q

20 years old has moderate asthma for 6 months on SABA and low dose ICS he has Stridor and wheezing symptoms that are present during playing basketball in college, BEst next step?

A

Refer to otolaryngology evaluation

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15
Q

Difficult to control asthma:-
Vocal cord dysfunction:
Eosinophilic granulomatosis with polyangiitis
Chronic eosinophilic pneumonia
Allergic bronchopulmonary aspergillosis

A

Vocal cord dysfunction:- difficult to control asthma with inspiratory tracheal sounds

Eosinophilic granulomatosis with polyangiitis:-
Asthma and upper airway disease,
+ve P-ANCA,
high eosinophil level

Chronic eosinophilic pneumonia:- long-term smoker, photographic negative pulmonary edema on chest x-ray (patchy distribution of the periphery), BAL in bronchoscopy showing high eosinophil

Allergic bronchopulmonary aspergillosis:- High eosinophil and IgE, +ve skin test for aspergillus

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16
Q

Patient presented to clinic with dry cough and exertional SOB after exercise, Did spirometry and was normal , What to do?

A

Metacholine challenge test FEV1 decrease to more than 20%

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17
Q

Highly suspicious asthma and normal PFT what to do?

A

Bronchoprovocation test … AKA Methacholine challenge tests … induce bronchoconstriction
Take a baseline PFT result and give Methacholine then check the response
If FEV1 fall more than 20% –> Bronchial asthma

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18
Q

Reverse test

A

give Ventolin , FEV improved by 12%
complete improved = asthma
mild improved= COPD

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19
Q

Asthmatic patient on SABA+ inhaled steriod
he also has recurrent attacks of asthma
in clinic he received bronchodilator , peak expiratory flow rate increases from 60% to 90% , what is you next step or first thing to do?

A

Observe how to use inhaler

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20
Q

Asthma management
stage number same as drugs number

A

Step 1: start with SABA per needed
Step 2: Add ICS
Step 3: Increase dose of ICS or add LABA
Step 4: Add leukotriene antagonist (Montelukast)
Step 5 (Exacerbation):– Mainly steroid with all other lines of treatment

Please note that recent guidelines is against SABA alone Each SABA as a rescue should be accompanied by ICS or to use Symbicort as rescue (Formoterol + Budesonide)

Mg sulphate is the last choice for severe asthma before intubation
Do not forget to observe how the patient using inhaler when he is poorly controlled on it

21
Q

leukotriene receptor antagonist is the mechanism of action of which drug?

A

Montelukast

22
Q

Asthmatic patient on SABA + LABA + ICS and still uncontrolled , what will you add in the management?

A

Leukotriene inhibitor

23
Q

Asthmatic patient with 6-8 times night symptoms , she is on SABA what to add now?

A

Inhaled corticosteriods/ formoterol

24
Q

Patient know case of asthma on ICS and SABA as needed presented to the clinic with uncontrolled symptoms what to add now?

A

LABA

25
Q

Severe asthma , patient can not complete 1 sentence , inspiratory and expiratory wheeze, High CO2 and Low O2 , how will you manage?

A

Intubation and mechanical ventilation

Normal or high PCO2 in asthmatic patient is an indication for intubation!
Means that he can not wash out CO2 any more and he has respiratory
muscle fatigability

26
Q

ABG in asthmatic patients are typically showing

A

respiratory alkalosis
as patient is washing out CO2 with the tachypnea and hyperventilation

27
Q

Asthma severity assessment (MILD)
Breathlessness =
Talks in =
Alertness=
RR=
Accessory muscle use=
Wheeze=
HR=
PEF=
SaO2 (ROOM AIR)=

A

Breathlessness = While walking , can lie down
Talks in = Sentences
Alertness= May be agitated
RR= Increased
Accessory muscle use= NO
Wheeze= Moderate often End expiratory only
HR= <100
PEF= >80%
SaO2 (ROOM AIR)= >95%

28
Q

Asthma severity assessment (Moderate)
Breathlessness =
Talks in =
Alertness=
RR=
Accessory muscle use=
Wheeze=
HR=
PEF=
SaO2 (ROOM AIR)=

A

Breathlessness = While talking , prefers sitting
Talks in = Phrases
Alertness= Usually agitated
RR= increased
Accessory muscle use= Usual
Wheeze= Loud
HR= 100-120
PEF= 60-80%
SaO2 (ROOM AIR)= 91-95%

29
Q

Asthma severity assessment (Severe)
Breathlessness =
Talks in =
Alertness=
RR=
Accessory muscle use=
Wheeze=
HR=
PEF=
SaO2 (ROOM AIR)=

A

Breathlessness = While at rest, Hunched forward
Talks in = Words
Alertness= Usually agitated
RR= often >30/min
Accessory muscle use= Usually
Wheeze= Loud
HR= >120
PEF= <60%
SaO2 (ROOM AIR)= <91%

30
Q

PEFR < 33% and Silent chest Is an indication of

A

life-threatening asthma

31
Q

Patient comes with asthma exacerbation, personal PFR was 300 and now 200 , HR 100 what is indication of his asthma severity
a-pulse of 70
b-Can not complete a sentence in one breath
c-SpO2 of 94%
d- PFR of 65%

A

b

32
Q

Most important side effects of asthma medications SABA (Salbutamol):

A

-Hypokalemia
- Tremor
- Palpitation

33
Q

Most important side effects of asthma medications ICS:-

A

-Oropharyngeal candidiasis
- Dysphonia

34
Q

Most important side effects of asthma medications LABA (Salmetrol):-

A
  • Increase the risk of exacerbation if not with ICS
35
Q

Remember those drugs in relation to asthmatic patient
HTN, hyperthyroidism, anxiety
Don’t use=

A

beta blocker

36
Q

Remember those drugs in relation to asthmatic patient
Pregnant in labor
Don’t use=
Asthma medication is safe during pregnancy

A

Carboprost

37
Q

Remember those drugs in relation to asthmatic patient
Depression
Don’t use=

A

Bupropion

38
Q

Remember those drugs in relation to asthmatic patient
SVT
Don’t use=

A

adenosine

39
Q

asthma management drug is associated with oral candidiasis?

A

Inhaled corticosteroids

40
Q

An elderly man with a history of asthma, congestive heart failure and peptic ulcer
disease is admitted with bronchospasm and rapid atrial fbrillation. He received frequent
nebulizer Salbutamol and IV Digoxin, his regular medications are continued.
24 hours after admission his serum potassium is noted to be 2.8 mmol/.
Which of his medications is most likely caused his abnormality?

A

Salbutamol (hypokalemia)

41
Q

About Exercise induced asthma, management?

A

Salbutamol pre exercise

42
Q

Hypertensive patient recently diagnosed as
bronchial asthma, which medication you will
stop?
A- Propranolol
B- Amlodipine
C- Captopril
D- Perindopril

A

A- Propranolol (beta blocker)

43
Q

Which of the following medications can
exacerbates asthma?
A- ACEI
B- Selective beta blockers
C- NSAIDs
D- Statins

A

C

44
Q

Patient with social anxiety and asthmatic, how to treat?
A- Propranolol
B- Bupropion
C- Psychotherapy CBT

A

C- Psychotherapy CBT

cause a and b worsens asthma

45
Q

Which of the following decreases the infammation in asthma?
A- Beclomethasone dipropionate
B- Montelukast
C- Salmeterol
D- Theophylline

A

A- Beclomethasone dipropionate

46
Q

Pregnant women with asthma, which tocolytics is contraindicated for her?
A- Oxytocin
B- Carboprost

A

B- Carboprost

47
Q

Asthma medications in pregnant she is using SABA per nedded , what to take and what to stop?

A

Continue the same management

48
Q

Patient have anxiety for 4 years and have asthma she noticed when she use salbutamol symptoms get worse, what to give?
A- Beta blocker
B- Bupropion
C- Sertraline

A

C- Sertraline

a,b worsens asthma

49
Q

Asthmatic patient on SABA + LABA + high-dose ICS and oral steroid though she was
uncontrolled, and the asthma is persistent.
The patient uses aspirin and ibuprofen daily for her migraine.
What is the most appropriate initial management?
A- Discontinue aspirin and ibuprofen and start
Montelukast
B- Order IgE and serum eosinophils
C- Upper laryngoscopy
D- CT chest

A

Discontinue aspirin and ibuprofen and start
Montelukast

Order IgE and serum eosinophils if patient is not using NSAID and aspirin

Respiratory (3 decks)

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