(hans) Pulmonology p147-152

Question 1

what is the etiology of asthma?

Answer 1

unknown, but thought to be associated with obesity and atopic disorder

Question 2

what are the causes for asthma exacerbation?

Answer 2

allergens, infection/cold air, emotional stress/exercise, catamenial (related to mentstrual cycle), aspirin, NSAIDs, beta blocers, histamine, GERD

Question 3

dx?

symptoms worse at night
nasal polyps and sensitivity to aspirin
eczema or atopic dermatitis
increased length of expiratory phase of respiration
increased use of accessory respiratory muscles

Answer 3

asthma

Question 4

a pt comes with and the only sx is cough, can this be asthma?

Answer 4

yes

Question 5

what is the best initial test for acute asthma exacerbation?

Answer 5

peak expiratory flow, arterial blood gas

Question 6

what is the best initial treatment for asthma?

Answer 6

always start with inhaled short-acting beta agonist

Question 7

name 3 short acting beta agonist for asthma

Answer 7

albuterol, pirbuterol, levalbuterol

Question 8

after adding short term beta agonist for asthma, your pt ‘s symptoms are still not under control, what is your best next step?

Answer 8

add low dose inhaled corticosteroids

Question 9

2 side effects of inhaled steroids?

Answer 9

dysphonia, oral candidiasis

Question 10

what is the asthma drug that is associated with Churg-Strauss and hepatotoxicity?

Answer 10

zalfirlukast

Question 11

what particular electrolyte will relieve bronchospasm?

Answer 11

magnesium

Question 12

what 2 vaccines are given to all asthma pts?

Answer 12

influenza, pneumococcal

Question 13

2 ways to quantify the severity of the asthma?

Answer 13

1. dec peak expiratory flow

2. ABG with an increased A-a gradient

Question 14

for asthma exacerbation, why would you want to get chest x-ray?

Answer 14

to see if there is any infection leading to the exacerbation (asthma pt predisposes to pneumothorax)

Question 15

what particular drug is very effective in COPD by dilating bronchi and dec secretion?

Answer 15

ipratropium, tiotropium (anticholinergic)

Question 16

what is the best initial long-term control agent?

Answer 16

low dose inhaled corticosteroids

Question 17

name the 6 low dose inhaled corticosteroids

Answer 17

beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone

Question 18

name the 3 main types of alternate long term control agents if low dose inhaled corticosteroids

Answer 18

1. cromolyn and nedocromil
2. theophylline
3. leukotriene modifiers

Question 19

what is the mech of cromolyn and nedocromil?

Answer 19

inhibits mast cell mediator

Question 20

in terms of controlling asthma symptoms, what is drug is added at last?

Answer 20

oral corticosteroids (prednisone)

Question 21

you have given short acting beta agonist and low dose inhaled corticosteroid but still symptoms are not under control, what is the next agent you can add?

Answer 21

long acting beta agonist

Question 22

you have given SABA, LABA, inhaled corticosteroid but still not working, what is the best next step?

Answer 22

maximize the dose of the ICS

Question 23

in what case can omalizumab can be added?

Answer 23

SABA, LABA and ICS are given while the pt has increased IgE level

Question 24

what is the artificial form of acetylcholine used in diagnostic testing for asthma?

Answer 24

methacholine which provoke bronchoconstriction and increase bronchial secretion