Chapter 51: Pulmonary Disorders - Asthma

Question 1

increased airway responsiveness and persistent subacute inflammation are associated with polymorphism genes located on which chromosome?

Answer 1

Chromosome 5q

Question 2

Hallmarks of asthma (4)

Answer 2

1. reversible airway obstruction from bronchial smooth muscle contraction 2. vascular congestion 3. tenacious mucus 4. mucosal edema

Question 3

The following cells are involved in mucosal inflammation except:

a. mast cells

b. B lymphocytes
c. T lymhocytes

d. eosinophils

Answer 3

b. B lymphocytes

Question 4

True or False: In asthma, FEV1/FVC ratio and PEF are higher.

FEV1 - forced expiratory volume in 1 second

FVC - forced vital capacity PEF - peak expiratory flow

Answer 4

False. In asthma, FEV1/FVC ratio and PEF are lower.

Question 5

True or False: Alterations in oxygenation primarily reflect ventilation-perfusion mismatching because of uneven distribution or airway narrowing.

Answer 5

True.

Question 6

Descrbe the 4 Clinical stages of asthma in terms of:

• FEV1
• PO2
• PCO2

Answer 6

Question 7

This is the amount of air expelled from lungs over 1 minute during a forceful expiration

Answer 7

FEV1

(forced expiratory volume in 1 second)

Question 8

This is the amount of air that can be forcible exhaled after taking the deepest breath possible.

Answer 8

FVC

(forced vital capacity)

Question 9

Why is an asthmatic pregnant woman more susceptible to hypoxia and hypoxemia than a normal pregnant woman?

Answer 9

FRC is smaller, and pulmonary shunting is increased.

Question 10

Effects of pregnancy on asthma

Answer 10

1/3 improves

1/3 unchange

1/3 worsens

Question 11

Classify the severity of asthma:

• symptoms: 2 days/week
• nocturnal awakenings: once a month
• need for SABA: 2days/week
• no interference with normal activity
• normal lung function between exacerbations
• FEV1: >80%
• FEV1/FVC: normal

Answer 11

intermittent

Question 12

Classify the severity of asthma:

• symptoms: daily
• nocturnal awakenings: twice a week
• need for SABA: daily
• some limitation
• FEV1: 60-80%
• FEV1/FVC: reduced by 5%

Answer 12

moderate

Question 14

Characterize mild asthma in terms of:

• symptoms
• nocturnal awakenings
• need for SABA
• limitation
• FEV1
• FEV1/FVC

Answer 14

Question 15

Characterize severe asthma in terms of:

• symptoms
• nocturnal awakenings
• need for SABA
• limitation
• FEV1
• FEV1/FVC

Answer 15

Question 16

Intrapartum exacerbation is seen in how many percent of women with mild or moderate asthma?

Answer 16

Two studies:

• Schatz: up to 20%
• Wendel et al: 1%

Question 17

True or False.

There is an 18-fold increased exacerbation risk following vaginal delivery versus cesarean delivery.

Answer 17

False.

There is an 18-fold increased exacerbation risk following cesarean delivery versus vaginal delivery.

Question 18

Factors significantly linked to increased morbidity in asthma.

Answer 18

severe disease

poor control

Question 19

True or False.

For women with severe asthma, the rate of delivery before 37 weeks is increased twofold.

Answer 19

True

Question 20

Enumerate:

complications of status asthmaticus

Answer 20

1. muscle fatigue with repiratory arrest
2. penumothorax
3. penumomediastinum
4. acute cor pulmonale
5. cardiac arrhythmias

Question 21

True or False:

women with moderate to severe asthma, regardless of treatment, are at increased risk of pre-eclampsia.

Answer 21

True

Question 23

Which of the following is TRUE regarding fetal effects of asthma?

a. Fetal hypoxemia develops well before the alkalosis compromises maternal oxygenation.
b. the fetus is jeopardized by decreased uterine blood flow, increased maternal venous return and an alkaline-induced leftward shift of the oxyheoglobin dissociation curve.
c. fetal growth is unaffected by asthma
d. fetal response to maternal hypoxemia include: increased umbilical blood flow, systemic and pulmonary vascualr resistance and decreased cardiac output

Answer 23

A. is true

Fetal effects of asthma:

• Fetal hypoxemia develops well before the alkalosis compromises maternal oxygenation.
• the fetus is jeopardized by decreased uterine blood flow, decreased maternal venous return and an alkaline-induced leftward shift of the oxyheoglobin dissociation curve.
• c. fetal growth restriction is increases with asthma severity
• d. fetal response to maternal hypoxemia include: decreased umbilical blood flow, increased systemic and pulmonary vascular resistance and decreased cardiac output

Additional information

• monitoring fetal response is an indicator of maternal status
• use of asthma controllers poses slightly greater possibility of teratogenic/advers fetal effects (cleft lip and palate, autism). Half of patients discontinue drugs between 5-13 weeks of gestation

Question 25

Signs of potentially fatal asthma attack

Question 26

What diagnostic best measures asthma severity?

Answer 26

Sequential measurement of FEV1 or PEFR

PEFR (peak expiratory flow rate): person’s maximum speed of expiration

Question 27

Measure of FEV1 which correlates to a severe disease (hypoxia, poor response to therapy, high relapse rate)

Answer 27

FEV1 < 1L

or

FEV1 less than 20% of predicted value

Question 28

Ideal values of FEV1 and PEFR

Answer 28

FEV1 >80% of predicted

PEFR range: 380-550 L/min

Question 30

how often should women with moderate to severe asthma measure and record either FEV1 or PEFR?

Answer 30

twice daily