Asthma

Question 1

what are clues of asthma?

Answer 1

episodic
night time symptoms
abates spontaneously

Question 2

what are common clear triggers for asthma?

Answer 2

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

Question 3

what is the DDx of night time cough?

Answer 3

asthma
CHF
GERD

Question 4

what does aspirin rarely cause?

Answer 4

explosive asthma

Question 5

at what age are most ppl diagnosed with asthma?

Answer 5

age of 7 (75% of the time)

Question 6

what is methacholine challenge testing?

Answer 6

produces asthma attacks which rules out asthma

Question 7

what can cause tracheal stenosis?

Answer 7

prolonged mechanical ventilation

Question 8

when are we operating under negative pressure?

Answer 8

inhale

Question 9

when are we operating under positive pressure?

Answer 9

exhale

Question 10

in variable intrathoracic obstruction, when is the greatest deficit?

Answer 10

exhalation

obstruction below the thoracic inlet

Question 11

in variable extrathoracic obstruction, when is the greatest deficit?

Answer 11

inhalation

obstruction above the thoracic inlet

Question 12

what is the MCC of wheezing?

Answer 12

allergic rhinitis with post nasal drip

Question 13

what is another common cause of wheezing?

Answer 13

GERD

Question 14

what will you typically hear with ILD/pulmonary fibrosis?

Answer 14

fine crackles on inspiration

Question 15

young hystrionic female who wheezes has what?

Answer 15

vocal cord dysfunction syndrome

Question 16

what is a positive bronchodilator response?

Answer 16

12% or greater

increase of at least 200cc in FVC or FEV1

Question 17

when would you use a peak expiratory flow monitor?

Answer 17

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

Question 18

what does exhaled nitric oxide tell you?

Answer 18

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

Question 19

what labs do you order for asthma pts?

Answer 19

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

Question 20

what might you see on CXR with asthma pt?

Answer 20

normal

-used to exclude another problem

Question 21

how would atelectasis appear on CXR?

Answer 21

white

Question 22

what defines severe respiratory failure?

Answer 22

High respiratory rate combined with acidosis and normal pCO2

Question 23

why are paralytics helpful?

Answer 23

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

Question 24

what can steroids plus paralytics cause?

Answer 24

critical illness polyneuropathy and myopathy

Question 25

what is involved in vent management?

Answer 25

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

Question 26

what is autoPEEP?

Answer 26

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

Question 27

what is the underlying component of all COPD theray?

Answer 27

bronchodilate to allow air to get out of the lungs

Question 28

what is the role of heliox?

Answer 28

prevents air turbulence in the vented pt

Question 29

what is the role of nebulized heparin?

Answer 29

great anti-inflammatory

Question 30

what is the overall approach to asthma txment?

Answer 30

monitor lung function serially controlling triggers meds

Question 31

what are the goals of asthma therapy?

Answer 31

1. symptom free | 2. use SABA < 2x per month

Question 32

what is a common asthma trigger?

Answer 32

cleaning products

Question 33

who should avoid non selective beta blockers?

Answer 33

asthma pts

Question 34

what do sulfites do?

Answer 34

can be an asthma trigger

Question 35

what is the step up/step down approach?

Answer 35

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

Question 36

what is the txment approach for mild persistent asthma?

Answer 36

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

Question 37

what is the txment approach for moderate persistent asthma?

Answer 37

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

Question 38

what is the main pathophysiology of asthma?

Answer 38

small airways and inflammation

Question 39

who has an increased risk of pneumonia?

Answer 39

ICS use in COPD pts | -not first line therapy for COPD pts b/c of this

Question 40

what is the txment approach for severe persistent asthma?

Answer 40

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

Question 41

what are -MAB drugs?

Answer 41

mono clonal antibodies

Question 42

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

Answer 42

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

Question 43

when do you need to get a contrast CT/

Answer 43

only when you want to visual mediastinum

Question 44

what is ABPA?

Answer 44

allergic bronchopulmonary aspergillosis

Question 45

how do you treat ABPA?

Answer 45

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

Question 46

what do p and c-ANCA characterize?

Answer 46

small vessel vasculitis

Question 47

what is Churg-Strauss dz?

Answer 47

can occur in steroid dependent asthmatic | can occur when leukotriene antagonist as added to regimen

Question 48

how will atelectasis look on xray?

Answer 48

wedge toward anterior

Question 49

cardiac asthma you should think

Answer 49

mitral stenosis

Question 50

what are classic findings of mitral stenosis

Answer 50

straight left heart border | large left atrium