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STEP Pathology > deck_5330149 > Flashcards

deck_5330149 Flashcards

1
Q

T or F. Making the air less dense helps with asthma

A

T. Add heliux (Helium and Oxygen mixture)

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2
Q

Define asthma

A

chronic inflammatory disorder of the airways, characterized by episodic, reversible bronchospasm

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3
Q

What cells play the biggest roles in asthma? Acute exacerbations?

A

mast cells, eosinophils, and T-lymphocytes ANDneutrophils in acute exacerbations

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4
Q

What is a methacolein challenge test?

A

asking a patient to inhale methacolein (a muscarinic agonist) to test airway hyperresponsive-ness

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5
Q

What are some persistent changes in airway structures seen in some asthmatics?

A

-sub-basement fibrosis-mucus hyper-secretion-injury to epithelium-smooth muscle hypertrophy -angiogenesis aka airway remodeling (can also happen in COPD)

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6
Q

T or F. Airway remodeling is not reversible

A

T. Smooth muscle contraction can be reversed but not fibrosis

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7
Q

30-50% of children with asthma will outgrow their childhood asthma in adulthood. How?

A

good management and airways grow with age

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8
Q

Overall incidence of asthma is more common in ____.

A

Women and black race!, but pediatric more in boys

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9
Q

What is extrinsic asthma?

A

triggered type 1 hypersensitivity

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10
Q

What drugs can induce asthma?

A

-Aspirin-NSAIDS

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11
Q

T or F. Leptin levels are elevated in asthmatics

A

T. Makes you obese

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12
Q

Classification of Asthma at diagnosis

A

Intermittent or Persistent

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13
Q

Classification of Asthma at follow-up

A

ControlledPartially controlledUncontrolled

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14
Q

Treatment of Intermittent Asthma

A

As needed Albuterol

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15
Q

Treatment of Mild Persistent Asthma

A

Inhaled steroids

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16
Q

Treatment of Moderate Persistent Asthma

A

Inhaled steroids + LABA

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17
Q

Treatment of Severe Persistent Asthma

A

Inhaled steroids + LABA + Leukotriene modifiers

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18
Q

LABA are associated with increased mortality

A

Use cautiously

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19
Q

Describe intrinsic asthma

A

-Triggered my respiratory infection in adulthood-Serum IgE not elevated and no family history -Skin antigen test negative

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20
Q

What is the triad for drug-induced asthma?

A

-asthma-aspirin sensitivity (flushing, angioedema, urticaria)-Nasla polyps

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21
Q

How do leukotriene affect bronchial smooth muscle?

A

contraction

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22
Q

How does aspirin cause bronchospasm?

A

Aspirin blocks the production of prostaglandins from arachidonic acid, potentiating the production of leukotrienes

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23
Q

Ho do corticosteroids help in asthma?

A

block production of phospholipid A2

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24
Q

When do asthma symptoms occur in exercise-induced bronchospasm?

A

immediately after (peaks around 5-10 minutes after)

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25
Q

What triggers exercise-induced bronchospasm?

A

cooling and mucosal drying of airways during exercise triggers mast cells to release histamine

26
Q

What are some agents used to decrease mast cell degranulation?

A

inhaled corticosteroids, chromolyn-sodium, and LABA

27
Q

T or F. A slow warm up period of exercise helps in exercise-induced bronchospasm

A

T.

28
Q

What causes nocturnal asthma?

A

decline of circulating catecholamines and cortisol

29
Q

What is needed to diagnose ABPA?

A

-poorly controlled asthma-eosinophilia-A. fumigatus positive skin test, IgG Ab-IgE > 1000ng/ml-proximal bronchiectasis-**fleeting chest infiltrates

30
Q

How is ABPA treated?

A

Prednisone (aspergillus is everywhere)

31
Q

Pathophysiology of Asthma

A

airway hyper-responsiveness, inflammation, etc.

32
Q

What is a major anaphylatoxin that mediates asthma?

A

IL-5

33
Q

How to target eosinophils in asthma?

A

steroids

34
Q

How to target mast cells in asthma?

A

cromolyn

35
Q

How to target histamine in asthma?

A

H1 blockers

36
Q

How to target leukotrienes in asthma?

A

LTRAs

37
Q

How to target IgE in asthma?

A

Omalizumab

38
Q

How to target IL-5 in asthma?

A

Mepolizumab (new)

39
Q

T or F. Asthma patients elevated parasympathetic tone

A

T.

40
Q

Difference in age of onset in asthma vs COPD

A

asthma younger

41
Q

Difference in main inflammatory cell in asthma vs COPD

A

asthma- eosinophilCOPD-neotrphil

42
Q

Relevant lymphocytes in asthma vs COPD

A

asthma- CD4COPD- CD8

43
Q

Relevant inteleukins in asthma vs COPD

A

asthma- IL-5COPD- IL-8

44
Q

Difference in main EXACERBATION cell in asthma vs COPD

A

asthma- neutrophilCOPD- eosinophil

45
Q

Asthma may be exacerbated by___

A

GERD, URI, exercise, allergens

46
Q

Ddx of asthma?

A

Viral tracheobronchitis may cause post-infectious bronchial hyper-responsiveness for up to 6 weeks

47
Q

Death from asthma is typically due to what?

A

diffuse mucus plugging of airways

48
Q

What is a Peak Flow Meter?

A

diagnostic tool for asthma (more than 20% variability = airway hyper-reactivity= diagnostic for asthma)

49
Q

When is the highest PEFR in the day?

A

4pm (and lowest at 4 am due to decline in circulating catecholamines)

50
Q

How do lung volumes in asthmatics compare to normal people?

A

hyperinflation elevated RV, FRC, RV/TLV, TLV

51
Q

What is PC20?

A

What concentration of methacholine will decreased FEV1 by 20+%

52
Q

T or F. Methacholine has a high NEGATIVE predictive value

A

T. Negative result= highly unlikely they have asthma

53
Q

What are some hormonal triggers of asthma?

A

menses, hyperthyroidism, pregnancy, stress

54
Q

What are asthma rescue medications?

A

SABA (albuterol) and SA anticholingerics (Ipratropium)

55
Q

What is a common cause of asthma bronchospasm?

A

GERD (can also cause chronic cough)

56
Q

Causes of chronic cough in non-smokers?

A

-Allergies-GERD-Asthma -ACEI cough (more rare)

57
Q

What is ‘chronic’ cough defined as?

A

8+ weeks

58
Q

What is an advantage of LEVObuterol in asthma rescue?

A

less tendency to cause tachycardia

59
Q

Sequence of asthma controllers?

A

1st- ICS2nd- LABA3rd- LTRA4th- LAMA5th- Omalizumab

60
Q

How can you differentiate between asthma and hypersensitivity pneumonitis?

A

patients with asthma will complain of SOB and wheezing and hypersensitivity pneumonitis will complain of SOB and dry cough (not an airway disease-interstitial)

STEP Pathology (80 decks)

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