pediatric asthma

Question 1

asthma is characterized by _____responsiveness and airway obstruction

Answer 1

hyperresponsiveness

Question 2

wheezing assc’d with LRTI, no wheezing after age 3

Answer 2

transient wheezing

Question 3

wheezing assc’d with incr airway reativity, incr incidence of RSV infxn, persistent wheezing after age 3

Answer 3

nonatopic wheezing

Question 4

those w/ elevated IgE levels, profound lung deficits, most likely to develop persistent asthma

Answer 4

atopic wheezers

Question 5

what to expect in acute exacerbation of asthma?

Answer 5

incr AP diameter, pulsus paradoxus, nasal flaring, palpable liver & spleen

Question 6

what are some signs of atopy in acute exacerbation?

Answer 6

atopic dermatitis, allergic rhinitis

Question 7

how to tx acute exaceration of asthma?

Answer 7

albuterol + ipratropium bromide

Question 8

spirtometry is only useful in children age____

Answer 8

5 and older

Question 9

when to do a CXR if you suspect asthma

Answer 9

need a baseline CXR

Question 10

what sort of changes will you see on CXR?

Answer 10

hyperinflation, bronchial thickening, atelactasis, pneumothorax

Question 11

DDX for asthma: adolescent,s no response to asthma meds, flat inspiratory loop on PFT, adduction of vocal cords with inspiration

Answer 11

vocal cord dysfxn

Question 12

DDX for asthma: incr with stress, absent during sleep, brassy in quality

Answer 12

psychogenic cough

Question 13

what are major risk factors for asthma (3)

Answer 13

1. parental h/o asthma
2. atopic dermatitis
3. sensitization to aeroallergen

Question 14

categories of asthma severity (4)

Answer 14

1. intermittent
2. mild persistent
3. moderate persistent
4. severe persistent

Question 15

what category: less than 2 days per week with sx, never sx at night

Answer 15

intermittent category

Question 16

how to tx intermittent asthma?

Answer 16

short acting beta agonists as needed

Question 17

how should patients with persistent sx be tx’d?

Answer 17

all patients with persistent sx should be started on long term controller meds (inhaled corticosteroid)

Question 18

how long does the full effect of inhaled corticosteroids take?

Answer 18

4 weeks

Question 19

if you have a moderate to persistent asthmatic that is poorly controlled, then how to tx?

Answer 19

long acting beta 2 agonists

Question 20

how should long acting beta agonists NOT be used?

Answer 20

do NOT use as monotherapy, do NOT use for acute exacerbations

Question 21

what to use in acute moderate/severe exacerbations in emergency care setting?

Answer 21

can add ipratropium bromide to short acting beta 2 agonist

Question 22

in what sort of setting is ipratropium bromide used?

Answer 22

urgent care, ED (NOT outpatient or inpatient)

Question 23

how often to assess spirometry?

Answer 23

initially, then every 1-2 yrs