Asthma

Question 1

Asthma Patho

Answer 1

Characterized by increased responsiveness of the trachea and bronchi to various stimuli and manifested by widespread narrowing of the airways; hypertrophy of smooth muscle, mucosal Edema and hyperemia, thickening of epithelial basement membrane, hypertrophy of mucous membranes, acute information, including of airway by thick viscus mucus

Question 2

Most important allergens

Answer 2

*indoors 
Dust mites
Pets
Cockroaches
Indoor molds
Exercise
Cigarette smoke

Question 3

Signs and symptoms of asthma

Answer 3

• pulsus paradoxus > 12 mmHg
• hyperresonance
• ominous signs include fatigue, absent breath sounds, paradoxical chest or abdominal movement, inability to maintain recumbency, cyanosis
  Respiratory distress at rest
  Difficulty speaking in sentences
  Diaphoresis
  Use of accessory muscles
  Respiratory rate greater than 28
  Pulse greater than 110
  Call
  Chest tightness

Question 4

Lab and Diagnostics for asthma

Answer 4

Slight WBC elevation with eosinophilia
PFT abnormal
Hospitalization if FEV1 < 30% after treatment or peak flow < 60
* initially respiratory alkalosis with mild hypoxemia
CXR shows hyperinflation

Question 5

Stepwise approach for managing asthma in adults

Step one

Answer 5

SABA

Question 6

Step wise approach for managing asthma and adults

Step 2

Answer 6

Low dose ICS

Question 7

Stepwise approach to managing asthma and adults

Step 3

Answer 7

Low dose ICS + LABA

Question 8

Stepwise approach for managing asthma in Adults

Step 4

Answer 8

Medium dose ICS + LABA

Question 9

Stepwise approach for managing asthma and adults

Step 5

Answer 9

High dose ICS + LABA

Question 10

Stepwise approach for managing asthma in adults

Step 6

Answer 10

High dose ICS + LABA + oral corticosteroid

Question 11

Inpatient management of asthma

Answer 11

Supplemental oxygen
Inhaled  SABA
Inhaled anticholinergics 
Systemic glucosteroids 
Magnesium sulfate single dowse 2g over 20 min if not responding to above 
Anaphylaxis - epi

Question 12

Epinephrine dose for anaphylaxis

Answer 12

0.3-0.5mg SQ

Question 13

SABA

Answer 13

Albuterol ( proventil)

Levalbuterol ( xopenex)

Question 14

Low dose ICS

Answer 14

Budesonide ( pulmicort)
Fluticasone ( flovent HFA)
Triamcinolone (Azmacort)

Question 15

LABA

Answer 15

Salmeterol ( Serevent)

Formoterol ( perforomist)

Question 16

Combination preparations

Answer 16

Fluticasone + Salmeterol = Advair
Formoterol + budesonide = symbicort

Low dose ICS + LABA

Question 17

Status asthmaticus

Answer 17

Term used to describe severe, acute asthma presenting in an unremitting, poorly responsive, life-threatening manner; clinical findings are not reliable indicators of the severity of asthma

Question 18

Management of status asthmaticus

Answer 18

Oxygen
D51/2NS
Inhalation/ parent wrap sympathomimetics
IV methylprednisolone 60-125 mg or hydrocortisone 300mg IV immediately 
Consider atrovent 
Monitor pulse ox 
Abg q10-20 minutes 
Intubate