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C. Year 3 MLA Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

In an obstructive airway disease, do patients struggle getting air into or out of the lungs?

A
  • getting air out of the lungs
  • patients can inhale fine, but cannot exhale properly
  • airways narrow and affect small, medium and larger parts of airways
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2
Q

In obstructive lung disease we can see hyperinflation and trapping of air. Why does this occur?

1 - mucus is secreted causing mucus plugs
2 - reduced elastic recoil (snap back of lung tissue)
3 - small bronchi trap air (<2cm airways
4 - all of the above

A

4 - all of the above

  • forced vital capacity may appear normal
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3
Q

What type of hypersensitivity is asthma?

1 - type I hypersensitivity
2 - type II hypersensitivity
3 - type III hypersensitivity
4 - type IV hypersensitivity

A

1 - type I hypersensitivity
- hyper responsive to stimuli

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4
Q

Is asthma reversible or permanent?

A
  • reversible
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5
Q

What is atopy?

A
  • genetic susceptibility
  • susceptible to allergic reactions
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6
Q

Which of the following are common symptoms of asthma?

1 - wheezing
2 - breathlessness
3 - cough
4 - chest tightness
5 - all of the above

A

5 - all of the above

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7
Q

Do patients with asthma always have symptoms?

A
  • no
  • can have acute attacks or be normal
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8
Q

The common symptoms of asthma are wheezing, breathlessness, cough and chest tightness. According to the British Thoracic Society (SIGN) how many of these symptoms does a patient have to have to be diagnosed with asthma?

1 - all 4
2 - >3
3 - >2
1 - >1

A

1 - >1

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9
Q

Roughly how many people a year die due to asthma?

1 - >100
2 - >50
3 - >10
4 - 3-5

A

4 - 3-5
- poor asthma management and education

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10
Q

Is asthma more common in adults of children?

A
  • children
  • more likely to develop allergies
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11
Q

What is the prevalence of asthma in UK adults (A) and children (C)?

1 - A - 30% and C - 40%
2 - A - 40% and C - 30%
3 - A - 20% and C - 8%
4 - A - 8% and C - 20%

A

4 - A - 8% and C - 20%

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12
Q

In patients with atopy (genetic susceptibility) what antibody do they produce a lot of that triggers the hypersensitivity?

1 - IgE
2 - IgA
3 - IgM
4 - IgD

A

1 - IgE

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13
Q

What is skin prick testing?

A
  • patients will receive small prick on arm
  • then exposed to multiple common allergans
  • positive test = raised skin
  • IgE can then be measured in blood if positive
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14
Q

Patients with atopy and asthma have polygenic inheritance, what does that mean?

A
  • multiple genes cause traits - traits may be asthma or allergies
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15
Q

What is Dermatophagoides pteronyssinus more commonly known as?

1 - pollutants
2 - hayfever
3 - dust mite
4 - exercise induced irritation

A

3 - dust mite

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16
Q

Generally what are the 2 common things that need to occur for someone to have an asthma attack?

1 - sensitisation of atopic patient
2 - inhalation of allergen
3 - individual to be <16 y/o
4 - individual to be sick

A

1 - sensitisation of atopic patient
2 - inhalation of allergen

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17
Q

Asthma can be divided into a 2 stage process, how long does each phase last?

A

1 - phase 1 = 20 minutes

  • IgE binds to mast cells and degranulate.

2 - phase 2 = 6-12 hours

  • T cells, mast, basoinophil and esionphils cells all migrate to lungs and induce bronchoconstriction and inflammation
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18
Q

Which lymphocytes regulate the initial inflammatory response in asthma?

1 - cytoxic T cells (CD8)
2 - macrophages
3 - T helper cells (CD4)
4 - neutrophils

A

3 - T helper cells (CD4)
- antigen presenting cell presents allergen to T helper cells

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19
Q

Once mast cells have been coated by IgE antibodies, which of the following do the mast cells then secrete through degranulation?

1 - leukotrienes
2 - prostaglandins
3 - histamines
4 - all of the above

A

4 - all of the above

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20
Q

Although histamines are one of the key compounds released from mast cells during an asthma attack, why do anti-histamines not work in asthma?

1 - not strong enough
2 - different histamine receptors
3 - other inflammatory mediators involved (prostaglandins + leukotrienes)
4 - all of the above

A

3 - other inflammatory mediators involved (prostaglandins + leukotrienes)

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21
Q

In an asthma attack what effects do histamines, leukotrienes and prostaglandins cause in the lungs?

1 - bronchospasm
2 - increased mucus production
3 - bronchoconstriction
4 - inflammation, damage and increased endothelium permeability
5 - all of the above

A

5 - all of the above

  • treatments for asthma target histamines, leukotrienes and prostaglandins
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22
Q

In a late phase and chronic asthma what happens to goblet cells?

1 - atrophy in number and increase risk of infection
2 - hypertrophy and impair mucus production
3 - hyperplasia and increase mucus production
4 - dysplasia and increased risk of malignancy

A

3 - hyperplasia and increase mucus production

  • increases risk of plugging and blocking of airways
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23
Q

In a late phase and chronic asthma attack what happens to smooth muscle cells?

1 - atrophy
2 - hypertrophy
3 - hypertrophy and hyperplasia
4 - atrophy and hyperplasia

A

3 - hypertrophy and hyperplasia

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24
Q

What causes smooth muscles to contract during a late phase asthma attack?

1 - cytokines
2 - histamine
3 - leukotrience
4 - RAAS

A

1 - cytokines

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25
Q

What is polyphonic wheezing?

A
  • lots of different whistling/wheezing sounds - caused by different size airways
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26
Q

Although asthma is generally reversible, what can happen if not managed and asthma becomes chronic?

1 - remodelling of airways due to chronic inflammation
2 - collagen deposition
3 - fibrotic tissue replaces parenchymal tissue
4 - fixed narrowing
5 - all of the above

A

5 - all of the above

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27
Q

Are eosinophils or neutrophils in asthma attacks generally associated with acute asthma?

A
  • eosinophils
  • raised in a WBC when doing bloods
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28
Q

Are eosinophils or neutrophils in asthma attacks generally associated with chronic asthma?

A
  • chronic
  • inflammation and steroid dependent asthma
  • just like in COPD
  • WCC is a marker of chronic asthma
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29
Q

Which 2 of the following medications have been linked with asthma attacks?

1 - aspirin (NSAIDS)
2 - ACE-I
3 - glucocorticoids
4 - B-blockers

A

1 - aspirin (NSAIDS)
- linked with abnormal COX-2 that induces asthma attack

4 - B-blockers
- cause narrowing of airways

30
Q

Which of the following are basic physiological, non disease specific aspects that may cause asthma?

1 - pregnancy
2 - premenstrual (pre period)
3 - exercise
4 - all of the above

A

4 - all of the above

31
Q

What is diurnal variability?

1 - asthma only occurs at a specific time in the day
2 - PEF changes throughout the day
3 - PEF is always lower in the evening as we are tired
4 - PEF reducing that triggers asthma attack

PEF = peak expiratory flow

A

2 - PEF changes throughout the day

  • > 20% variation is a diagnosis of diurnal variability
  • asthma diagnosis =
    1 - <20% diurnal variation
    2 - >3d/week
    3 - >2 weeks
32
Q

Typically when is PEF at its lowest?

1 - morning
2 - afternoon
3 - evening
4 - always low

A

1 - morning

33
Q

During an acute exacerbation of asthma, does respiratory rate increase or decrease?

A
  • respiratory rate increases
  • body attempts to O2
  • tachypnoea (abnormal rapid breathing)
34
Q

During an acute exacerbation of asthma, what happens to the heart rate?

A
  • ⬆️ heart rate - tachycardia
35
Q

Patients with asthma experience acid -reflux. What % of asthma patients experience acid-reflux?

1 - 4-6%
2 - 8-12%
3 - 25-35%
4 - 40-60%

A

4 - 40-60%
- treat reflux and spirometry will improve

36
Q

In severe asthma, what can happen to the colour of finger tips and skin?

A
  • cyanosis - blue skin
37
Q

Normal respiratory rate is between 12-16 breaths/minute. What respiratory rate can we expect to see in an asthma attack?

1 - >12
2 - >15
3 - >20
4 - >30

A

3 - >20

38
Q

What is a silent chest?

A
  • no sound heard from chest
  • associated with bradycardia
  • RED FLAG
  • VERY dangerous
39
Q

What are the 2 main scans that will be performed on the chest if a patient is suspected with asthma?

1 - X-ray
2 - MRI
3 - PET-scan
4 - CT

A

1 - X-ray
4 - CT

  • high sensitivity CT and gold standard for diagnosing asthma
40
Q

In spirometry, would we expect the residual volume (RV) (amount of air remaining in lungs when we forcefully exhale) to increase or decrease in asthma?

A
  • increase
  • recoil = reduced (ability of lungs to snap back and exhale air)
  • compliance = increased (stretching the lungs)
41
Q

To determine if the asthma is reversible, the FEV1 must improve by >15%. What may patients be given that can be affective <20 minutes?

1 - Salbutamol
2 - Salmeterol
3 - Ipratropium bromide
4 - Theophylline

A

1 - Salbutamol

  • Salbutamol = SABA
  • Salmeterol = LABA
  • Ipratropium bromide = muscarinic antagonist
  • Theophylline = Phosphodiesterase inhibitors (xanthine derivatives)
42
Q

In patients with asthma, would DLCO/TLCO be low or normal?

A
  • normal as interstium and alveoli are not generally affected
  • if air reaches alveoli it will perfuse
  • ventilation is low though
43
Q

Asthma is a chronic inflammatory obstructive respiratory condition that causes narrowing of the lungs and difficult breathing. Which of the following can cause an asthma exacerbation?

1 - allergies
2 - air pollution
3 - airborne irritants
4 - respiratory infections
5 - exercise or physical activity
6 - weather and air temperature
7 - strong emotions
8 - medication
9 - all of the above

A

9 - all of the above

44
Q

In obstructive lung diseases, the elastic tissue in the lungs is affected. Are both recoil and compliance of lung tissue reduced in asthma?

A
  • no
  • recoil (ability of lungs to return to previous size) is reduces
  • compliance (stretching the lungs) is increased
45
Q

Which of the following is not a layer of the lumen in the respiratory airways?

1 - smooth muscle
2 - lamina propria
3 - epithelial cells
4 - endothelium cells

A

4 - endothelium cells
- present in blood vessels

46
Q

Once an allergen is presented to a T helper cell by an antigen presenting cell (APC), the T cell become active and secretes which 2 cytokines?

1 - IL-1
2 - IL-4
3 - IL-5
4 - TNF-a

A

2 - IL-4
3 - IL-5

47
Q

Activation of the T helper cells leads to production of IL-4 and IL-5. IL-4 then results in the production of which antibody by B cells?

1 - IgE
2 - IgA
3 - IgM
4 - IgD

A

1 - IgE

  • IgE then coats mast cells
  • basophils and eosinophils also involved
48
Q

Activation of the T helper cells leads to production of IL-4 and IL-5. IL-5 then results in the activation of which immune cell that then produces more cytokines and leukotrienes?

1 - macrophages
2 - dendritic cells
3 - cytotoxic T cells
4 - eosinophils

A

4 - eosinophils

49
Q

In spirometry, would we expect to see an increase of decrease in functional residual capacity (FRC) (remaining air in lungs at end of normal exhalation) in a patient with asthma?

A
  • increase
  • recoil = reduced (ability of lungs to snap back and exhale air)
  • compliance = increased (stretching the lungs)
50
Q

In spirometry, would we expect to see an increase of decrease in forced vital capacity (FVC) (air that can forcefully expired following maximum inhalation) in a patient with asthma?

A
  • small reduction
  • recoil is reduced so patient has to work harder to exhale air
51
Q

In spirometry, would we expect to see an increase of decrease in forced expiratory volume in 1 second (FEC1) (air that can forcefully expired in 1 second following maximum inhalation) in a patient with asthma?

A
  • significantly reduced
  • airways are narrowed
52
Q

In patients with asthma the FVC and FEV1 are reduced. What is the ratio that is diagnostic in patients with asthma?

1 - FVC/FEV1 <90%
2 - FVC/FEV1 <80%
3 - FVC/FEV1 <70%
4 - FVC/FEV1 <60%

A

3 - FVC/FEV1 <70%

53
Q

In patients with asthma is the total lung capacity increased or decreased?

A
  • increased
  • lungs can become hyper inflated
54
Q

In a patient presenting with an asthma attack, would we see in an ABG, an increased or decreased PaO2 and PaCO2?

A
  • PaO2 = normal or small reduction
  • PaCO2 = reduced due to hyperventilation
55
Q

In a patient presenting with an asthma attack, we might see a reduced PaCO2. If this is increasing, is this dangerous?

A
  • yes
  • sign of respiratory failure
56
Q

In a patient presenting with asthmatic symptoms such as wheeze, cough, dyspnoea (SOB) and sputum, which of the following is an unlikely differential?

1 - PE
2 - COPD
3 - Pulmonary oedema
4 - Pneumothorax
5 - foreign body obstruction
6 - malignancy

A

6 - malignancy

  • could occur but unlikely to present acutely
57
Q

Which of the following are are lifestyle advice that patients with COPD and asthma should receive?

1 - smoking cessation
2 - ⬆️ activity
3 - improved nutrition
4 - all of the above

A

4 - all of the above

58
Q

What is a reliever in the treatment of asthma and COPD?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

1 - salbutamol (SABA)

  • only used to relieve acute symptoms
59
Q

When consulting the stepwise guidelines to asthma management, what is generally the first treatment option?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

4 - prednisolone (glucocorticoid)
- low dose of inhaled corticosteroids

60
Q

If a patient does not respond to the initial treatment of glucocorticoid, it is best to combine the glucocorticoid with another medication. What medication should be combined with prednisolone?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - montelukast (leukotriene receptor antagonist)

A

4 - montelukast (leukotriene receptor antagonist)

61
Q

If a patient does not respond to the initial treatment of glucocorticoid and a leukotriene receptor antagonist, what medication should be added to this patients medication?

1 - salbutamol (SABA)
2 - salmeterol (LABA)
3 - tiotropium (LAMA)
4 - montelukast (leukotriene receptor antagonist)

A

2 - salmeterol (LABA)

62
Q

If a patients asthma remains uncontrolled using the following:
- inhaled glucocorticoid
- leukotriene receptor antagonist
- LABA

What would be the next step in the management plan for this patient?

1 - increase salbutamol (SABA)
2 - increase salmeterol (LABA)
3 - tiotropium (LAMA)
4 - maintenance and reliever therapy (MART)

A

4 - maintenance and reliever therapy (MART)

  • combined ICS and LABA
    of MART doesnt work we can consider adding in a LAMA
63
Q

Which of the following should be included in the annual check up with the GP about a patients asthma plan?

1 - number of exacerbations
2 - review of medication
3 - compliance to medication
4 - spirometry
5 - all of the above

A

5 - all of the above

64
Q

If a patient with asthma had an exacerbation and attended A+E, all of the following should be done asap, EXCEPT which one?

1 - pulse oximetry
2 - chest X-ray
3 - arterial blood gas
4 - spirometry/peak flow

A

4 - spirometry/peak flow
- important but patients may not be able to do the test

65
Q

If a patient with asthma had an exacerbation and attended A+E, which 2 of the following medications should be administered at a high dose via a nebuliser?

1 - increase salbutamol (SABA)
2 - increase salmeterol (LABA)
3 - tiotropium (LAMA)
4 - prednisolone (glucocorticoid)

A

1 - increase salbutamol (SABA)
4 - prednisolone (glucocorticoid)

  • if prednisolone via nebulised is not effective, we can give hydrocortisone via IV
66
Q

If a patient with asthma attended A+E with a severe asthma attack what mineral could be given intravenously?

1 - Ca2+
2 - vitamin D
3 - Mg2+
4 - biotin

A

3 - Mg2+

67
Q

Which of the following are the effects of magnesium that is given in severe asthma attacks?

1 - bronchodilator
2 - stabilises T cells
3 - ⬇️ inflammation
4 - all of the above

A

4 - all of the above

68
Q

Can Theophylline a phosphodiesterase inhibitors be given intravenously in acute asthma?

A
  • yes
  • acts a bronchodilator
  • phosphodiesterase inhibitors stop the degradation of cAMP and cGMP
  • results in vasodilation
69
Q

Following discharge from hospital following an acute asthma attack they are discharged. How long will they remain on the medication they are given to relieve their acute asthmatic symptoms?

1 - 6h
2 - 12h
3 - 24h
4 - 48h

A

3 - 24h

70
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients PEF1 be?

1 - 100% of best or predicted
2 - >90% of best or predicted
3 - >75% of best or predicted
4 - >50% of best or predicted

A

3 - >75% of best or predicted

71
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients diurnal variability be?

1 - <25%
2 - <15%
3 - <10%
4 - <5%

A

1 - <25%

72
Q

Prior to being discharged from hospital, which of the following must patient be checked and advised faccoridng to the British Thoracic Soceity guidelines?

1 - check inhaler technique
2 - personalised asthma plan is understood
3 - smoking cessation (support and guidance)
4 - ⬇️ oral steroid dose slowly
5 - review with doctor/nurse in 2 weeks
6 - all of the above

A

6 - all of the above

C. Year 3 MLA Respiratory (15 decks)

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