pulmonology

Question 1

asthma is

Answer 1

reversible hyperirritability of the tracheobronchial tree

airway inflammation and bronchoconstriction

Question 2

MC chronic childhood disease

Answer 2

asthma

Question 3

samter’s triad

Answer 3

asthma
nasal polyps
ASA/NSAID allergy

Question 4

samters triad is associated with

Answer 4

atopic dermatitis

Question 5

three main components of the pathophysiology of asthma

Answer 5

airway hyperreactivity
bronchoconstriction
inflammation

Question 6

airway hyperreactivity and asthma

Answer 6

endogenous and exogenous stimuli
early IgE mediated and later T cell-mediated
extrinsic: allergen triggers ( increased IgE)
intrinsic: nonallergic (infection, pharmacologic)

Question 7

bronchoconstriction and asthma

Answer 7

airway narrowing due to smooth muscle constriction, bronchial wall edema, thick mucus secretions.
Mucus plugs and airway remodeling lead to air trapping and obstruction: decreased expiratory airflow, increased resistance and V/Q mismatch

Question 8

inflammation and asthma

Answer 8

cellular infiltration (T lymphocytes, neutrophils, eosinophils) and their proinflammatory cytokines (leukotrienes); increase histamine release from mast cells (IgE mediated)

Question 9

classic triad for asthma

Answer 9

dyspnea
wheezing
cough (especially at night)

Question 10

physical exam of asthma

Answer 10

prolonged expiratory wheeze, hyperresonance to percussion, decreased breath sounds, tachycardia, tachypnea and use of accessory muscles

Question 11

physical exam of severe asthma and status asthmatics

Answer 11

inability to speak in full sentences, PEFR <40%, altered mental status, pulses paradoxus (inspiratory decrease of SBP >10), cyanosis, tripod position, silent chest (no air exchange), tachycardia, severe tachypnea

Question 12

Gold standard for asthma testing

Answer 12

pulmonary function test

reversible obstruction

Question 13

what test to use if pulmonary function testing is non-diagnostic

Answer 13

bronchoprovocation

methocholine challence test

Question 14

The best and most effective way to evaluate asthma exacerbation severity and patient response in ED

Answer 14

peak expiratory flow rate

response to treatment is >15% from initial attempt

Question 15

normal range for PEFR

Answer 15

400-600

Question 16

Pulse ox that is indicative of respiratory distress

Answer 16

less than 90%

Question 17

acute asthma rescue drug classes (3)

Answer 17

SABA
anticholinergics
corticosteroids

Question 18

first line treatment for acute asthma exacerbations

Answer 18

SABA effective and fastest (2-5 min)

Question 19

list of SABAs

Answer 19

albuterol
Terbutaline
Epinephrine

Question 20

SABA MOA

Answer 20

bronchodilators (especially peripherally)
decreases bronchospasm
inhibits the release of bronchospastic mediators
increases ciliary movement
decreases airway edema and resistance

Question 21

side effects of SABA

Answer 21

B1 cross reactivity: tachycardia/arrhythmias, muscle tremors, CNS stimulation

Question 22

route of administration of SABA

Answer 22

nebulizer in ED

reevaluate after 3 doses

Question 23

anticholinergic for acute asthma drug list

Answer 23

ipratropium

Question 24

MOA of anticholinergics

Answer 24

central bronchodilator (inhibits vagal-mediated bronchoconstriction) and inhibits nasal mucosal secretions. Most useful in the first hour

Question 25

side effects of anticholinergics for acute asthma

Answer 25

thirst, blurred vision, dry mouth, urinary retention, dysphagia, acute glaucoma, BPH

Question 26

list of corticosteroids for acute asthma

Answer 26

prednisone, methylprednisolone, prednisolone