Respiratory Medicine - asthma

Question 1

two subtypes of asthma?

Answer 1

eosinophilic and neutrophilic

Question 2

path of eosinophilic asthma?

Answer 2

• involves thickening of BM

- igE and mast cells

Question 3

is eosinophilic asthma steroid responsive?

Answer 3

yes

Question 4

is neutrophilic asthma steroid responsive?

Answer 4

no - mechanism not understood

Question 5

which cells hypertorphy in asthma?

Answer 5

goblet cells

Question 6

which type of t cells are involved in asthma?

Answer 6

Th2

Question 7

what will a peak flow diary show with asthma?

Answer 7

diurnal variation > 20%

Question 8

what procedural ix to do for asthma?

Answer 8

• peak flow diary/testing
• spirometry with reversibility test
• histamine/methacholine challenge

Question 9

what blood ix to do for asthma?

Answer 9

• FBC - increased eosinophils
• CRP - raised with inflammation
• igE RAST panel
• ABG

Question 10

what is an igE rast panel?

Answer 10

-test that looks for antibodies against specific allergens (dust, pollen, pet dander)

Question 11

what imaging to do for asthma?

Answer 11

cXRAY

Question 12

acute severe asthma - clinical findings

Answer 12

unable to complete full sentences

Question 13

acute severe asthma - PEFR?

Answer 13

33-50% of predicted best

Question 14

acute severe asthma - resp rate?

Answer 14

> 25

Question 15

acute severe asthma - HR ?

Answer 15

> 110

Question 16

acute severe asthma - ABG findings ?

Answer 16

PaO2 > 8

PaCO2 decreased

Question 17

life-threatening asthma - clinical findings?

Answer 17

feeble resp effort, cyanotic, reduced GCS

Question 18

life-threatening asthma - PEFR?

Answer 18

<33% of best predicted value

Question 19

life-threatening asthma - resp rate?

Answer 19

silent chest, imperceptible RR

Question 20

life-threatening asthma - HR and BP?

Answer 20

bradycardio and hypotension

Question 21

life-threatening asthma - ABG findings?

Answer 21

PaO2 < 8

CO2 normal

Question 22

near-fatal asthma - clinical findings?

Answer 22

unable to speak

Question 23

near-fatal asthma - ABG findings?

Answer 23

High CO2 > 4.6 + low pH (7.35)

Question 24

how many steps is there in the asthma control approach?

Answer 24

FIVE

Question 25

STEP ONE asthma treatment

Answer 25

• as needed low dose ICS-formoterol

- as needed low dose ICS-formoterol +- SABA

Question 26

what is symbocort?

Answer 26

budesonide+formoterol (steroid + LABA)

Question 27

STEP TWO ASTHMA CONTROL

Answer 27

• daily low dose ICS or as needed low dose ICS-formoterol

- as needed low dose ICS-formoterol +- SABA

Question 28

STEP THREE ASTHMA CONTROL

Answer 28

• low dose ICS + LABA

- as needed low dose ICS-formoterol +- SABA

Question 29

STEP FOUR ASTHMA CONTROL

Answer 29

• medium dose ICS-LABA

- as needed low dose ICS-formoterol +- SABA

Question 30

STEP FIVE ASTHMA CONTROL

Answer 30

• high dose ICS-LABA +/tiotropium +- biologics +- corticosteroids
• -as needed low dose ICS-formoterol +- SABA

Question 31

what is omalizumab?

Answer 31

anti-igE monoclonal antibody for severe asthma - given every four weeks

Question 32

Acute asthma excacerbation presents in emergency…. management?

Answer 32

ABCS - assess severity
Lab tests - ABG, bloods, FBC, CRP
Initial rescusc - IV access with 2 wide bore IVs, supplemental oxygen

PHARM:

1. salbutamol - nebulized
2. hydrocortisone 100 mg IV
3. add ipatropium to nebulizers
4. MgSulfate IV over 20 min
5. Consider ICU referral