CLIPP 13 - Asthma

Question 1

DDX chronic cough (11)

Answer 1

• environmental irritant
• allergies
• asthma
• URI
• croup
• foreign body
• GERD
• habitual
• sinusitis
• pneumonia
• tracheitis

Question 2

TB (epidemiology, risk factors, diagnosis)

Answer 2

• urban/low-income
• foreign-born
• TST

Question 3

Asthma risk factors (3)

Answer 3

• male, African-American, low SES

Question 4

Types of cough/causes (8)

Answer 4

• dry (environmental irritant, asthma, fungal infection)
• wet/productive (lower respiratory infection)
• barking (croup, subglottic disease, foreign body)
• brassy/honking (habitual, tracheitis)
• paroxysmal (pertussis, chlamydia, mycoplasma, foreign body)
• worse at night (asthma, sinusitis)
• disappears at night (habitual)
• associated with gagging or choking (GERD)

Question 5

Asthma diagnosis criteria(3)

Answer 5

• symptoms of recurrent airway obstruction
• obstruction is at least partially reversible
• exclusion of other causes of obstruction

Question 6

Asthma severity classification symptoms (5)

Answer 6

• daytime symptoms
• nighttime awakenings
• interference with activity
• PFTs
• SABA use

Question 7

Asthma management

Answer 7

• intermittent: SABA (albuterol)

- persistent: inhaled corticosteroid (beclomethasone, fluticasone, budesonide)

Question 8

Pertinent ROS findings (6)

Answer 8

• change in voice (laryngeal irritation)
• chest pain (GI, CHF)
• choking event (aspiration)
• fever (pneumonia, sinusitis)
• headaches (sinusitis)
• sore throat (allerigies, sinusitis)

Question 9

Lung exam findings (8)

Answer 9

• tracheal deviation (mediastinal mass, pneumothorax, foreign body aspiration)
• retractions (Asthma, bronchiolitis, foreign body obstruction)
• accessory muscle use (respiratory distress)
• hyperinflation (Air trapping)
• increased I:E (obstruction)
• hyperresonance/dullness to percussion (air trapping/consolidation)
• egophony (consolidation)
• wheezing

Question 10

Breath sound descriptions (4)

Answer 10

• wheezing: airflow through narrowed airways producing sounds generally heard during expiration
• rhonchi: low-pitched sounds during inspiration or expiration due to mucus/secretions in airway
• crackles: fine or coarse discontinuous inspiratory sounds
• stridor: high-pitched inspiratory noise due to partial obstruction of extrathoracic airways