ch. 15

Question 1

In asthma the bronchi are hyperactive to stimuli increasing the production of…

Answer 1

Immunoglobulin E(IgE), mast cell degranulation and inflammatory-mediators.

Question 2

Most common spirometry tests used to diagnose and manage asthma?

Answer 2

FVC(forced viral capacity) FEV1 and FEV1/ FEV%

Question 3

Reversibility or indicator of airway responsiveness to bronchodilator is defined as?

Answer 3

Increase in FEV1 and FVC of 12%

Question 4

What additional tests are used to differentiate asthma from childhood diseases?

Answer 4

Broncoprovocation challenge, chest radiograph, allergy testing, sputum, blood and urine testing.

Question 5

What test uses methacholine or mannitol inhalation to induce hyperactivity of small airways to see a reduction in FEV1

Answer 5

Broncoprovocation challenge test

Question 6

What % of reduction of FEV1 is considered positive for the broncoprovocation test?

Answer 6

20% reduction of FEV1

Question 7

Exercise tolerance tests are performed over 5 to 8 minutes and heart rate is increased to 85% of predicted. What decline % of FEV1 shows a positive response?

Answer 7

Decline of 15% of FEV1

Question 8

Exercise test is more or less sensitive to bronchial hyper responsiveness?

Answer 8

Less sensitive

Question 9

Asthma expert panel report(EPR-3) divides asthma assessment and treatment into how many ranges?

Answer 9

3: 0-4 years, 5-11 years, 12 years or older.

Question 10

Asthma is categorized into two domains, which are?

Answer 10

Impairment and risk

Question 11

Four classifications of asthma

Answer 11

Intermittent, mild persistent, moderate persistent, and severe.

Question 12

Impairment for intermittent asthma

Answer 12

Symptoms<2 days a week, 0 night time awakenings, Saba for symptoms _< 2 days a week, no interference with normal activity. 0-1 exacerbations requiring oral steroids.

Question 13

Mild persistent asthma classification

Answer 13

> 2 days/week but not daily
Nighttime awakenings 1-2 times a month.
Saba for symptoms > 2 days a week but not daily.
Interference with normal activity- minor
exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year.

Question 14

Moderate persistent asthma classification

Answer 14

Symptoms daily
Nighttime awakenings- 3-4 times a month
Saba for symptoms daily
Some limitation to normal activity
> 2 exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year.

Question 15

Sever asthma classification

Answer 15

Symptoms: throughout the day

Nighttime awakenings: > 1 time a week

Saba for symptoms: several times per day

Extremely limited activity

> 2 exacerbations in 6 months requiring oral steroids or 4 wheezing episodes per year

Question 16

Detailed history and physical is useful in

Answer 16

Differentiating asthma from other diseases.

Question 17

Decrease pharmacological therapy if asthma control improves and sustains for

Answer 17

3 months

Question 18

What is the key element for asthma home management?

Answer 18

Education

Question 19

Peak flow monitor is not as sensitive as the FEV1 to changes in?

Answer 19

Diameter of small airways.

Question 20

Used to measure how much air can move out of the airway with a blast of exhalation.

Answer 20

Peak flow meter

Question 21

Step 1 asthma

Answer 21

Saba prn

Question 22

Step 2 asthma

Answer 22

Low dose ics can use chromolyn or montelukast

Question 23

Step 3 asthma

Answer 23

Medium dose ics

Question 24

Step 4 asthma

Answer 24

Medium dose ics+ LABA or montelukast

Question 25

Step 6 asthma control

Answer 25

High dose ics+ LABA or montelukast

Oral steroids

Question 26

Managements of asthma 4 components

Answer 26

components:
(1)Assess and monitor asthma severity and control
(2)Partner with patients and families to educate them on their asthma plan of care
(3)Control environmental factors and comorbid conditions that trigger asthma exacerbation
(4)Prescribe appropriate medications for treatment of asthma
–Assess and monitor asthma severity and control

Question 27

Quick relief rescue

Answer 27

–SABAs
–3–5 minutes onset
–4–6 hours effect
–Normally not on a regular basis

Question 28

Asthma management in the hospital

Answer 28

•Poor response to therapy within the first few hours of treatment (2–4) in the ED or a repeat visit within 24 hours of discharge home from the ED

Question 29

Cystic Fibrosis

Answer 29

• Life-limiting autosomal recessive disorder

* Affects approximately 80,000 individuals worldwide

Question 30

Etiology CF

Answer 30

–Single gene defect on chromosome 7
–Carriers have few or no symptoms.
–Each child conceived from two CF carriers has a 25% chance of being affected with CF, a 50% of being a carrier

Question 31

Loss of cftr

Answer 31

have a profound impact on water and electrolyte transport across the epithelium.

Question 32

CFTR is a chloride channel expressed in the

Answer 32

Apical membrane of epithelial cells of lung, pancreas, sweat duct, reproductive, kidney, liver, sub mucosal glands

Question 33

Newborn screening tests for CF

Answer 33

IRT imunoreactive trypsinogen

Sweat chloride test- 75 mg of sweat collected over 30 mins

Question 34

A sweat chloride test of more than what Suggests CF

Answer 34

60 mmol/L on two occasions