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Internal Medicine- Chest > Bronchial Asthma > Flashcards

Bronchial Asthma Flashcards

1
Q

What is Bronchial Asthma?

A

Chronic inflammation
Ccc by bronchial hyper reactivity
And reversibility
With or without ttt

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2
Q

What are the types of bronchial asthma?

A

Atopic or allergic
Non allergic
Bronchospasm

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3
Q

How to confirm atopic asthma ?

A

Skin pin prick test

Immediate wheal and increase in serum IgE

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4
Q

What is an indicative sign of atopic asthma ?

A

Positive family history

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5
Q

What type is atopic asthma ?

A

Localized type 1

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6
Q

What is the onset of asthma ?

A

Childhood

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7
Q

What is the most common chronic disease in childhood ?

A

Bronchial asthma

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8
Q

What sex is more predisposed to asthma ?

A

Boys

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9
Q

What are the other signs or commodities that indicate atopic asthma ?

A

IgE
Allergic rhinitis
Eczema

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10
Q

What trigger atopic asthma ?

A

Environmental allergens
Dust
Pollen grains
Fungi
Pets

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11
Q

What triggers non allergic asthma ?

A

Respiratory viral infection with vagal overtime

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12
Q

What triggers bronchospasm ?

A

Drugs as aspirin, beta blockers and ACE
Occupational fumes metal dust animals
Exercise gerd stress smoking sinusitis and obesity

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13
Q

What is the sign of severity of asthma ?

A

Silent chest

Asthma without wheezes

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14
Q

What are the symptoms of asthma ?

A

Night or early morning episodes

•Dyspnea
•wheezes
•coughing thick pellets
•Chest tightness

•anxiety
•Sweating

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15
Q

Most important trigger in atopic asthma ?

A

Fungi

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16
Q

When do signs of asthma appear ?

A

During attacks

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17
Q

What are the signs of asthma ?

A

c- Signs:

1- G

a- Pulse = Pulsus Paradoxus or Arrhythmias

b- Head & Neck
1- Congested pulsating neck veins with Kussmaul’s sign

2- Tachypnea + Working accessory ms

  1. LL edema

2- L

I: Symmetrical, equal movement & increased A-P diameter, Hyper-inflation

P: Trachea (Centralized), TVF (Equal)

P: Bilateral hyper-resonance + Encroaching on heart & liver

A:
a- Breath S.: Type: Harsh vesicular (Prolonged expiration) + decreased Air entry Bilaterally

b- Additional S: Coarse crepitations + Rhonchi

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18
Q

What are the complications of bronchial Asthma ?

A

Lung collapse, pneumothorax, pneumonia and respiratory failure type 2

Corpulmonale

Decreased work capacity

Asthmatic bronchitis

Allergic broncho pulmonary aspergillosis

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19
Q

What is asthmatic bronchitis ?

A

Increase in amount of sputum and poor response to treatment

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20
Q

What is ABPA?

A

Type 1 HS to Aspergillus Fumigatus antigens leading to increase in IgE

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21
Q

What is the Clinical picture of ABPA?

A

Fever
Chest pain
Worsening of asthma

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22
Q

What are the investigations of ABPA?

A

Hyperesinophilia (more than 1500 mm3)

Increase total and specific IgE

Positive skin prick test for aspergillus

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23
Q

What is the ttt of ABPA?

A

Oral prednisone and itraconazole are 200mg 2x/day for 2 mins

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24
Q

What is reversibility test (when is it positive) and in this case what does this indicate?

A

Post bronchodilator increase of FEV1 by 12% or 200ml

If positive = bronchial asthma

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25
Q

What are the investigations of Asthma ?

A

Immunological
Increase in esinophils
Increase in serum IgE total and specific
Skin test

ABG
ABG: Hypoxia and Hypercapnia

Radiology
Radiology: Same as blue bloater

Spirometery
DLco: not impaired
TLC inc
Dec FEV1
Dec FVC
PEFR sec

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26
Q

Nebulized Oz dosage for acute severe asthma

A

60%

As needed

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27
Q

Salbutamol dosage for acute severe asthma

A

5 mg repeated every 20 mins if needed, max is 3 x

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28
Q

IV Methyl prednisolone dosage for acute severe asthma

A

60 mg

Repeated every 6 hrs in the 1st day then oral for 10 - 14 days after

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29
Q

Salbutamol dosage if failed initially in acute severe asthma

A

10 mg could be repeated every 1 hr

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30
Q

Investigations for hospitalized Status Asmathicus or imminent asthma

A

PEFR + Pulse oximetry + CXR

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31
Q

Ipratropium bromide route of administration in acute severe asthma
And what is it

A

SAMA TO
Nebulized 02

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32
Q

If ipratropium bromide fails ?

A

Add IV MgSO4

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33
Q

If MgSO4 fails ?

A

Add IV Salbutamol

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34
Q

If salbutamol fails ?

A

Add IV Theophylline

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35
Q

acute severe asthma may need ?

A

May need ICU & Correction of Acidosis or Hypokalemia if occurred

36
Q

Cortisone inhaler of budenoside dosages

A

Low dose < 400 ug
Medium 400 - 800 ug
High dose > 800 ug

37
Q

There are 10 steps to follow in cases of

A

Status Asmathicus/severe asthma
Imminent asthma

38
Q

List the 10 steps to follow

A

TTT plan of Acute severe asthma (Status asthmaticus) & Imminent asthma

1- Nebulized Oz (60 %) as needed
2- Salbutamol 5 mg repeated every 20 mins if needed max is 3 x
3- If failed IV Methyl prednisolone 60 mg (repeated every 6 hrs in the 1st day then oral for 10 - 14 days after)
4 If failed give Salbutamol again 10 mg could be repeated every 1 hr
5- If failed → Hospitalization
→ PEFR + Pulse oximetry + CXR
6- Ipratropium bromide on nebulized 02
7- If failed add IV MgSO4
8- → If Failed add IV Salbutamol
9- → if Failed add IV Theophylline
10- May need ICU & Correction of Acidosis or Hypokalemia if occurred

39
Q

What are the criteria’s to assess in asthma exacerbation?

A

Talking
Posture Dyspnea
Respiratory Rate
Pulse
Rate volume
SO2
Wheezes

40
Q

I hate should not be used to assess severity of exacerbations?

A

RR as they are usually very low

41
Q

What is Pulsus Pardoxus?

A

Inspiring obliterates pulse

42
Q

Why does silent chest occur?

A

Due to severe bronchospasm

43
Q

What is the criteria of mild exacerbation?

A

Can say sentences
Can lie flat
RR 18-25
Pulse Normal
Rate Volume Normal
SO2 above 95%
Wheezes end expiratory

44
Q

What is the criteria of moderate exacerbation?

A

Talking increase Dyspnea
Can only sit with working accessory muscles
RR 25-30
Pulse 100-120
Rate Volume PP 10-20
SO2 above 91-95%
Wheezes expiratory

45
Q

What is the criteria of severe asthmatic exacerbation?

A

Can say words only
Tripod position with working accessory muscles
RR more than 30
Pulse more than120
Rate Volume PP 20-40
SO2 above less than 91
Wheezes expiratory and inspiratory

46
Q

What is the criteria of imminent respiratory failure ?

A

Drowsy
Dec in RR
Dec in HR
Heavy sweating

47
Q

What are the 2 types of TTT of BA and what are the names of guidelines ?

A

Pt education
Medical according to Gina 2021

48
Q

What should be taught to patients regarding asthma ?

A

Diet
Exercise
Avoid triggers
Weight control
Domicilkiary follow up of PEFR

49
Q

According to GINA 2021, steps are, when to step up, when to step down

A

Stepwise
2-6w before step up
If controlled for 3m step down

50
Q

What is the difference between track 1 and 2?

A

Track 1= high risk of exacerbation (hospitalized once per year)

Track 2= low risk of exacerbation

51
Q

Track 1 meds

A

Reliever: LICS + formetrol as needed

Step 1 and 2: LICS + Formetrol as needed

Step 3: LICS + Formetrol regularly

Step 4: MICS + Formetrol regularly

Step 5: LICS + Formetrol regularly with or without oral agents

52
Q

Track 2 Meds

A

Reliever: SABA as needed

Step 1: LICS as needed

Step 2: LICS regular

Step 3: LICS + LABA regularly

Step 4: MICS + LABA regularly

Step 5: HICS + LABA regularly with or without oral agents

53
Q

What is formetrol?

A

Mix of SABA and LABA that starts in 2m and lasts 12h

54
Q

What are the relievers of asthma ?

A

LICS and formetrol
SABA oral and inhaled
Theophyline
SAMA

55
Q

What are the controllers of asthma ?

A

Inhaled Corticosteroids
Oral corticosteroids
LABA
LAMA
Montelukast
Zileuton
Theophyline
Disodium cromoglycate
Omalizumab
Cromones

56
Q

What is omalizumab?

A

Anti IgE

57
Q

How does Theophyline work ?

A

Inhibits PDE 3 and 4
Inhibits adenodsine receptors

Leads to smooth muscle relaxation
Decreased chemotaxis of neutrophils and esinophils

58
Q

AES of Theophyline

A

Very severe Git upset and arrhythmia

59
Q

What are the mechanism of action of montelukast and uses

A

lts receptor blocker used in aspirin, exercise and smoking triggered asthma

60
Q

What is the mechanism of action of zileuton? And use

A

lts enzyme inhibitors used in aspirin, exercise and smoking triggered asthma

61
Q

Ae of lama

A

Day mouth

62
Q

Ae of laba and mc

A

Tremor mc
Palpitation
Hypokalemia

63
Q

Ae or inhaled and oral corticosteroids

A

Hoarseness of voice
Oral Candiasis

64
Q

What is the DOC of asthma

A

ICS

65
Q

Step 1 symptoms

A

Intermittent

1 daytime attack per week

66
Q

Step 2 symptoms

A

Mild persistent

2-6 daytime attacks per week

67
Q

Step 3 symptoms

A

Moderate persistent

Daytime attacks all week

68
Q

Step 4 symptoms

A

Severe persistent

All week long in addition to physical limitations

69
Q

Refractory asthma

A

Failed to respond to HICS and LABA despite optimum TTT

70
Q

List the mediators involved in airway remodeling and their origin

A

VEGF (TH2)
IL3 (Esinophils and TH2)
THF b (mast cell)

71
Q

Which phase of ventilation is most limited in asthma ?

A

Expiratory

72
Q

List the pathological features of airway remodeling

A

Neutrophil and esinophils in linen
Mucus excess
Mucus gland metaplasia
Mucus membrane swelling
Suepithial fibrosis and swelling
Smooth muscle contraction

73
Q

What are indicators of asthma ?

A

Presence more than one of 5 of those
- wheeze, Dyspnea, tightness, pellets

Late night or early morning

Varying severity

Triggers present

74
Q

What varies proportionally with severity of attack ?

A

The PEFR

75
Q

Which points the likelihood of it being asthma ?

A

Isolated cough
Chronically productive
Dizziness
Chest pain
Exercise induced dyspnea with stridor

76
Q

What are the 2 cornerstones of asthma diagnosis ?

A
  1. Evidence of variable expiratory airflow limitation
    • 1-2w daily PEFR variability through
    daily amplitude * 100/ daily mean
    • PEFR/ FEV1 significant increase after 4w of controller
  2. History of variable respiratory symptoms consistent with clinical picture
    • as before
77
Q

Normal FEV1 to FVC ratio

A

Normal more than 0.75 to 0.8
Child more than 0.9

78
Q

If case is highly consistent with asthma but nothing shows up. What to do ?

A

Repeat during attack or after withholding BD

79
Q

What are the 2 points used to assess severity of asthma regarding steps ?

A

Frequency of attacks and FEV1

80
Q

Can asthma and COPD coexist ?

A

Yes especially if above 65y

81
Q

What are asthma phenotypes ?

A

Observed combination of clinical, biological and physiological features due to genetic and environmental factors

Leading to altered
Age of onset
Presence of atopy
Lung function

Despite having similar manifestations

82
Q

Can phenotypes be further divided

A

Into endotypes based on pathophsyiological molecular mechanisms

83
Q

DD of asthma other than dyspnea (htrz3hom hena 3ady)

A

Drug induced as ace
Infiltration with esinophils
VC dysfunction

84
Q

Ciclesonide doses

A

80-160
161-320
Above 320

85
Q

Ics doses units

A

Mcg

86
Q

Budensonide

A

Less than 400
400 to 800
More than 800

87
Q

How to assess asthmatic control

A

For past 4w
- daytime symptoms above 2/w

  • night time waking above 2/w
  • Reliever needed above 2/w
  • activity limitation

Well controlled 0 maintain and find lowest suitable
Partly controlled 1-2 consider upgrading
Uncontrolled 3-4 keep upgrading till controlled

Internal Medicine- Chest (3 decks)

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