Bronchial Asthma Flashcards
Most accurate diagnostic test for asthma […]
Spirometry (pulmonary function test)
If patient is highly suspicious of asthma but spirometry was normal, we do […] test
Methacholine challenge
Drop FEV1 >20%
Best initial test in acute exacerbation of asthma […]
Peak Expiratory Flow
Pregnant lady present with cough of white sputum increased in severity and she developed SOB. She is allergic to dust, mites, and pollens. What is the most important investigation?
A. ABG
B. Skin allergy test
C. Spirometry
D. PDD
Spirometry
“New diagnosis”
Signs of severe asthma:
PEF: […]
SpO2: […]
RR: >30
HR: >120
PEF: <60
SpO2: <91%
PEFT […] and silent chest are indication of life-threatening asthma requiring intubation
PEFT <33%
Patient comes with asthma exacerbation, personal PFT was 300 and now 200. HR 100, what os indication of his asthma severity?
A. Cant complete a sentence in one breath
B. Pulse 70
C. SpO2 94%
D. PFR 65%
A. Cant complete a sentence in one breath
Patient work in wood factory complaining of chest tightness and cough at work, those symptoms resolve during weekend. What to do ?
A. Skin brick test
B. Specific IgE
C. Peak flow rate at home and work
C. Peak flow rate at home and work
Asthma provoked by allergen?
Asthma management steps:
Step1:
Step2:
Step3:
Step4:
Step5 (exacerbation):
1: SABA
#2: + ICS
#3: + LABA or 🔺ICS dose
#4: + LT “Montelukast”
#5: oral steroid
SABA should be accompanied by ICS or to use Symbicort (Formoterol + Budesonide)
💡before upgrading observe how pt use inhaler
SABA side effects:
- HypoKalemia
- tremor
- palpitation
LABA side effects:
Increase risk of exacerbation if not with ICS “Symbicort”
ICS side effects:
- oral thrush (candidiasis)
- Dysphonia
Medication contraindicated in asthma with
- HTN […]
- Tocolytic agent […]
- Depression […]
- SVT […]
- analgesic […]
- ß-blocker
- Carboprost
- Bupropion
- Adenosine
- NSAIDs
ABG in acute asthmatic exacerbation shows which acid-base imbalance ?
Respiratory Alkalosis
Washing out CO2 with tachypnea & hyperventilation
Indications of Intubation in acute asthma:
- Normal/🔺 Pco2 (=resp muscle fatigued)
- PEFR <30%
Asthmatic patient on SABA+ICS, still have recurrent attacks. In clinic he received bronchodilator, PEFR increase from 60 to 90. What is your next step ?
A. Increase steroid dose
B. Add LABA
C. Add Montelukast
D. Observe how to use inhaler
D. Observe how to use inhaler
Asthmatic patient on SABA. Uncontrolled, what to add ?
A. ICS/formoterol
B. ICS/anticholinergic
C. ICS/albuterol
D. Montelukast
A. ICS/formoterol
K/C Asthma on ICS and SABA still not controlled, what to add now?
A. Theophylline
B. Azithromycin
C. LABA
D. LAMA
C. LABA
SABA » + ICS » + LABA » + LT-i
K/C asthma on SABA + LABA + ICS. Still uncontrolled. What to add?
A. Low dose oral prednisolone
B. Leukotriene inhibitor
C. Medium-release theophylline
D. Inhaled ipratropium
B. Leukotriene inhibitor
SABA » + ICS » + LABA » + LT-i
Leukotriene receptor antagonist is the mechanism of action of:
A. Montelukast
B. Omalizumab
C. Salbutamol
Montelukast
Which medication decrease the inflammation in asthma?
A. Beclomethasone dipropionate
B. Mintelukast
C. Salbutamol
D. Theophylline
A. Beclomethasone dipropionate
About Excercise-induced asthma
You give Salbutamol […]-exercise
Pre
Which medication can exacerbate asthma?
A. ACEI
B. Selective ß-blocker
C. NSAIDs
D. Statins
C. NSAIDs
NSAID-exacerbated respiratory disease:
Asthma + nasal polyps & chronic sinusitis
K/C asthma on SABA+LABA+ICS high dose. Uncontrolled. Patient uses aspirin and ibuprofen daily for her migraine. What is the most appropriate initial management?
Discontinue Aspirin & Ibuprofen and start Montelukast
Anxiety + Asthma
Avoid
❌ ß-blockers
❌ Bupropion
Asthma + pregnant
Using SABA per needed, what to take and what to stop?
Continue same management
Asthma + pregnant
Which tocolytic is contraindicated?
Carboprost
Asthma + HTN
“Avoid”
ß-blockers (Propranolol)
Which medication associated with oral candidiasis?
A. Aspirin
B. Decongestants
C. Epinephrine
D. Inhaled corticosteroids
ICS
Use spacer or rinse mouth after use
Which medication may cause hypokalemia?
A. Digoxin
B. ACEI
C. Salbutomol
D. Ranitidine
Salbutamol
Stimulate pancreas to secrete insulin = 🔻K = arrhythmias
Severe asthma, pt cant complete a sentence, inspiratory and expiratory wheeze, High CO2 and Low O2. How you will manage?
A. Mg sulfate
B. IV theophylline
C. Intubate with mech ventilation
D. High flow Oxygen
Intubate
- High CO2 = resp muscle fatiguability cannot washout CO2 !!
Young female came to the clinic complaining of episodes of SOB, wheeze and cough for the last 6 months no certain provoker. She says these episodes comes suddenly and resolve suddenly. She used ventolin but improved slightly. O/E she has EBAE with no wheezing. No allergy no family history of allergy. All test were normal and spirometry is normal.
What is the diagnosis?
A. Foreign body
B. Vocal cord dysfunction
C. Asthma
B. Vocal cord dysfunction
🗝️ keys:
-She used ventolin but improved slightly
-O/E she has EBAE with no wheezing
-spirometry is normal
20 YO 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. Modify ICS to medium dose
B. Refer to otolaryngology evaluation
C. Add Montelukast
B. Refer to otolaryngology evaluation
🗝️ stridor !!
No stridor in asthma
Ddx of asthma:
Asthma + Nephritis + 🔺Eos
Churg-Strauss
Eosinophilic Granulomatosis with PolyAngitis
Ddx of asthma:
Long term smoker, photographic negative pulmonary edema on CXR
Chronic Eosinophilic pneumonia
Ddx of asthma:
🔺 Eos, 🔺IgE, +ve skin test for Aspirgillus
Allergic BronchoPulmonary Aspergillosis
ABPA
