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Clin Med II > Asthma > Flashcards

Asthma Flashcards

1
Q

what are clues of asthma?

A

episodic
night time symptoms
abates spontaneously

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2
Q

what are common clear triggers for asthma?

A

dust, fumes, perfumes, cold air, cockroach, exercise

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3
Q

what is the DDx of night time cough?

A

asthma
CHF
GERD

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4
Q

what does aspirin rarely cause?

A

explosive asthma

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5
Q

at what age are most ppl diagnosed with asthma?

A

age of 7 (75% of the time)

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6
Q

what is methacholine challenge testing?

A

produces asthma attacks which rules out asthma

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7
Q

what can cause tracheal stenosis?

A

prolonged mechanical ventilation

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8
Q

when are we operating under negative pressure?

A

inhale

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9
Q

when are we operating under positive pressure?

A

exhale

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10
Q

in variable intrathoracic obstruction, when is the greatest deficit?

A

exhalation

obstruction below the thoracic inlet

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11
Q

in variable extrathoracic obstruction, when is the greatest deficit?

A

inhalation

obstruction above the thoracic inlet

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12
Q

what is the MCC of wheezing?

A

allergic rhinitis with post nasal drip

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13
Q

what is another common cause of wheezing?

A

GERD

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14
Q

what will you typically hear with ILD/pulmonary fibrosis?

A

fine crackles on inspiration

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15
Q

young hystrionic female who wheezes has what?

A

vocal cord dysfunction syndrome

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16
Q

what is a positive bronchodilator response?

A

12% or greater

increase of at least 200cc in FVC or FEV1

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17
Q

when would you use a peak expiratory flow monitor?

A 
occupational asthma (look for difference b/w work and home)
scary asthma (don't have dyspnea so they can't tell when they are in trouble)-monitoring at home
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18
Q

what does exhaled nitric oxide tell you?

A

NO is a by product of an asthma related reaction and increased amounts indicates asthma

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19
Q

what labs do you order for asthma pts?

A

IgE, allergy testing (RAST panel), CBC (eosinophils)

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20
Q

what might you see on CXR with asthma pt?

A

normal

-used to exclude another problem

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21
Q

how would atelectasis appear on CXR?

A

white

22
Q

what defines severe respiratory failure?

A

High respiratory rate combined with acidosis and normal pCO2

23
Q

why are paralytics helpful?

A

ventilator can take complete control and less energy is going to the diaphragm to try to breathe

24
Q

what can steroids plus paralytics cause?

A

critical illness polyneuropathy and myopathy

25
Q

what is involved in vent management?

A

anything to prolong the expiratory time to decrease autopeep and subsequent barotrauma and improve hemodynamics

26
Q

what is autoPEEP?

A

baseline volume of air needed to be maintained in order to allow continuous airway access

27
Q

what is the underlying component of all COPD theray?

A

bronchodilate to allow air to get out of the lungs

28
Q

what is the role of heliox?

A

prevents air turbulence in the vented pt

29
Q

what is the role of nebulized heparin?

A

great anti-inflammatory

30
Q

what is the overall approach to asthma txment?

A

monitor lung function serially
controlling triggers
meds

31
Q

what are the goals of asthma therapy?

A
  1. symptom free

2. use SABA < 2x per month

32
Q

what is a common asthma trigger?

A

cleaning products

33
Q

who should avoid non selective beta blockers?

A

asthma pts

34
Q

what do sulfites do?

A

can be an asthma trigger

35
Q

what is the step up/step down approach?

A

step up to get control

then once controlled, step down to get minimal amount of drug necessary to control sxs

36
Q

what is the txment approach for mild persistent asthma?

A

low dose ICS (1st choice) OR leukotriene antagonist or theophylline

37
Q

what is the txment approach for moderate persistent asthma?

A

low dose ICS/LABA (shown to do better) or medium dose ICS

38
Q

what is the main pathophysiology of asthma?

A

small airways and inflammation

39
Q

who has an increased risk of pneumonia?

A

ICS use in COPD pts

-not first line therapy for COPD pts b/c of this

40
Q

what is the txment approach for severe persistent asthma?

A

high dose ICS/LABA, IgE to see if may benefit from omalizumab (xolair) infusions, daily or qod oral steroids, leukotriene antagonist

41
Q

what are -MAB drugs?

A

mono clonal antibodies

42
Q

what are less studied, but useful drugs for severe asthma?

A

methotrexate, cyclosporine, new meds against IL-5
clarithromycin, azithromycin
bronchial thermoplasty

43
Q

when do you need to get a contrast CT/

A

only when you want to visual mediastinum

44
Q

what is ABPA?

A

allergic bronchopulmonary aspergillosis

45
Q

how do you treat ABPA?

A

high dose steroids with long taper and anti-fungal (itraconazole 1st choice)

46
Q

what do p and c-ANCA characterize?

A

small vessel vasculitis

47
Q

what is Churg-Strauss dz?

A

can occur in steroid dependent asthmatic

can occur when leukotriene antagonist as added to regimen

48
Q

how will atelectasis look on xray?

A

wedge toward anterior

49
Q

cardiac asthma you should think

A

mitral stenosis

50
Q

what are classic findings of mitral stenosis

A

straight left heart border

large left atrium

Clin Med II (23 decks)

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