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Clinical Medicine II > Pulm: Asthma > Flashcards

Pulm: Asthma Flashcards

1
Q

Asthma is characterized by what three pathophysiologic processes?

A
  1. chronic inflammation
  2. reversible obstruction
  3. hyperresponsiveness
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2
Q

80% of asthma sxs develop before what age?

A

5yo

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3
Q

What are two major sxs for asthma?

A

Wheezing

Nocturnal, seasonal, cough longer than 3 weeks

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4
Q

What medications can trigger asthma sxs?

A

Beta Blockers, ASA, NSAIDs

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5
Q

If an asthma Dx is known, what questions must be included on patient hx? (5)

A
  1. Medications
  2. last use of inhaler
  3. frequency of inhaler use
  4. ED visits
  5. hospitalization?
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6
Q

A patient presents with…

Increased AP diameter
Wheezing
Rhinitis sxs
Atopic dermatitis

What should you consider?

A

Asthma

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7
Q

What are 5 signs of severe obstruction in asthma?

A

tachypnea

tachycardia

Tripod

accessory muscle use

Pulsus paradoxus

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8
Q

The following is called ______ triad and is associated with _______:

Sinus dz/nasal polyps

ASA sensitivity

Severe Asthma

A

Samter’s Triad

Aspirine Exacerbated Respiratory Disease

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9
Q

The following is the _______ triad…

Atopic dermatitis
Allergic Rhinitis
Asthma

A

Atopic Triad

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10
Q

atopic dermatitis –> food allergy –> allergic rhinitis –> Asthma

This is known as…

A

Atopic march

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11
Q

The following are asthma DDx in what populations?

GERD
Allergic rhinosinusitis
URI
CF
Pertussis
FB or mass
RAD
CHD
Laryngotracheomalacia
Eosinophilic bronchitis
A

Infants and Children

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12
Q

DDx in what populations?

GERD
COPD
CHF
PE
Vocal cord dysfuntion
Obstructive sleep apnea
chronic upper airway synd.
ACE-I cough
A

Adolescent and adults

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13
Q

For what age is spirometry indicated?

A

> 5 yo

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14
Q

A patient undergoes spirometry and has the following results:

  1. FEV-1: < 80%
  2. FEV-1/FVC: normal/decreased (70-85%)
  3. Reversibility: > 12% or 8% in young children
A

Asthma

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15
Q

What step of asthma?

Sx 2 or fewer days/week

FEV-1 > 80%

Infrequent nighttime awakenings

2 or fewer days/week of SABA use

A

Step 1: Intermittent Asthma

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16
Q

What step of asthma?

Sxs 2+ days/week

3-5 nighttime awakenings

FEV-1 > 80%

Minor limitation of activity

2+ days of SABA use per week

A

Step 2: Mild persistent

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17
Q

What step of asthma?

Daily sxs

Weekly nighttime awakenings

FEV-1 60-80%

FEV-1/FVC reduced 5%

daily SABA use

A

Step 3: Moderate Persistent Asthma

18
Q

What step of asthma?

Sxs throughout the day

Nightly awakenings

FEV-1 < 60%

FEV-1/FVC reduced by 5%

Extremely limited physical activity

SABA several times per day

A

Step 4: Severe persistent asthma

19
Q

What drug is an LTRA?

A

Montelukast

20
Q

For what ages is a LTRA used?

A

0-4 yo

21
Q

What two drugs are monoclonal antibodies?

A

omalizumab

Benralizumab

22
Q

Which drug is a methylxanthine?

A

theophyline

23
Q

Who should get a SABA?

A

everyone

24
Q

Which asthma step is managed with the following?

SABA prn

Consider low dose ICS (GINA)

A

Step 1

25
Q

Which asthma step is managed with the following?

low dose ICS or LTRA/Cromolyn

A

Step 2

26
Q

Which asthma step is managed with the following?

consider specialist

medium dose ICS

OR

low dose ICS + LABA/LTRA

A

Step 3

27
Q

What is the GINA preferred tx for step 3 asthma?

A

medium dose ICS + ICS/LABA

28
Q

Which asthma step is managed with the following?

Refer to specialist

Medium dose ICS + LABA/LTRA (0-4 yo)

A

Step 4

29
Q

What is the GINA preferred tx for step 4 asthma?

A

medium/high dose ICS + LABA

30
Q

Which asthma step is managed with the following?

High dose ICS + LABA

+/- Omalizumab (12+ with allergies)
Sub LABA for LTRA (ages 0-4)

A

Step 5

31
Q

In step 5 asthma, GINA recommends what SubQ med for pts 12+ with severe eosinophilic asthma?

A

benralizumab

32
Q

Which asthma step is managed with the following?

High dose ICS + LABA + PO Steroids

+/- Omalizumab (12+ with allergies)
Sub LABA for LTRA (ages 0-4)

A

Step 6

33
Q

The Baylor Healthcare “Rules of Two” are…

Yes to these questions indicate…

A

sxs 2 x week

awaken at night 2 x month

refil inhaler 2 x yearly

peak flow < 2 x 10 (20%) from baseline?

yes = uncontrolled

34
Q

Is the following asthma profile well controlled, not well controlled, or very poorly controlled?

Sx 2 or fewer / week

Nighttime awakenings:

  • 0-11: 1 or less monthly
  • 12+: less than 2x month

FEV-1: > 80%

FEV-1/FVC: > 80%

A

Well controlled

35
Q

Is the following asthma profile well controlled, not well controlled, or very poorly controlled?

Sx 2+ days/week

Nighttime awakenings:

  • 0-4: 1+ monthly
  • 5-11: 2+ monthly
  • 12+: 1-3 x weekly

FEV-1: 60-80%

FEV-1/FVC: 75-80%

A

Not well controlled

36
Q

Is the following asthma profile well controlled, not well controlled, or very poorly controlled?

Sx daily

Nighttime awakenings:

  • 0-4: 1 x weekly
  • 5-11: 2+ weekly
  • 12+: 4+ x weekly

FEV-1: < 60%

FEV-1/FVC: < 75%

A

Very poorly controlled

37
Q

Peak flow > 80% indicates…

A

Green zone, good control

38
Q

Peak flow 50-80% indicates

A

yellow zone, caution

39
Q

A yellow zone (50-80% peak flow) should be handled by…

A

SABA and consider changes to meds

40
Q

Peak flow < 50% indicates

A

Red zone, emergency

41
Q

What two diagnostics outside of PFTs can be helpful in diagnosing asthma?

A

ABG showing respiratory alkalosis

CXR showing hyperinflation or to r/o infx/obstruction

42
Q

How is an asthma exacerbation treated?

A
  1. Oxygen
  2. SABA/SVN (albuterol or xoponex +/- ipratropium)
  3. systemic CS

f/u 1 week

Clinical Medicine II (31 decks)

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