Asthma

Question 1

Safest asthma medication to use in pregnancy

Answer 1

Inhaled corticosteroids (Advair, Dulera, Symbicort)

Question 2

True or false. Strenuous exercise should be avoided in asthmatics

Answer 2

False

Take inhaler/LTRA 5-20 minutes before exercise

Question 3

Which ethnicities most commonly suffer from asthma?

Answer 3

Puerto Rican > Black > White > Mexican

Question 4

What does FEF 25-75 measure?

Answer 4

Average forced expiratory rate during mid FVC

Question 5

Apart from spirometry, another kind of pulmonary function test which gives more detail but is rarely done is …

Answer 5

Plethysmography

Question 6

Which asthma medications are associated with cleft palate and gastroschisis birth defects if taken during pregnancy?

Answer 6

SABA (Albuterol, levalbuterol)

Question 7

Does the hyper-responsive inflammatory component of asthma relate to the mucosal or smooth muscle layer of the airway?

Answer 7

Mucosal

Constriction is the smooth muscle layer

Question 8

How many children with asthma have full remission during puberty

Answer 8

1 in 4

Question 9

True or false. Asthma can often begin after the age of 50.

Answer 9

False. If onset is after age 50, it’s probably not asthma

Question 10

A patient with asthma day symptoms 6 times a week and night symptoms once a week, with an FEV1 of 82% would get what treatment?

Answer 10

Low-dose ICS (Advair, Dulera, Symbicort)

(patient is in mild persistent class)

Question 11

True or false. Allergy testing can diagnose asthma.

Answer 11

False.

May identify triggers, but cannot diagnose

Question 12

Describe (4) potential causes of nocturnal asthma

Answer 12

Physiologic sleep changes

Bedroom/late-day allergens

GERD

Sleep apnea

(take asthma meds before bed, might help)

Question 13

Which asthma medication is associated with cleft palate, pre-eclampsia, gestational diabetes, and low birth weight complications if taken during pregnancy?

Answer 13

Oral steroids

Question 14

Asthma is commonly seen in a “march” with these two other conditions

Answer 14

Atopic dermatitis (eczema)

Seasonal allergies

Question 15

What should be given to a patient with occupational asthma?

Answer 15

Take home peak expiratory flow device for them to measure at work

Question 16

In addition to spirometry, what needs to be added to diagnose asthma?

Answer 16

Bronchodilator and repeat spirometry

Improvement = asthma

Question 17

How long should systemic steroids be used in outpatient management of asthma?

Answer 17

One to three weeks

Avoid long term use

Question 18

What is the gold standard for asthma diagnosis?

Answer 18

Methacholine/histamine challenge

Question 19

Which type of PFT is most commonly done in asthma testing?

Answer 19

Spirometry

Question 20

Theophylline is rarely used in asthma management due to …

Answer 20

Risk of seizures/arrythmias

Question 21

For patients who don’t respond to initial asthma management in the ER, what are the next two potential steps?

Answer 21

2g IV magnesium

If that fails, then mechanical ventilation (with ABGs)

Question 22

Describe initial asthma management in the ER

Answer 22

Supplemental O2
- >92% normally (>95% if pregnant)

Promptly give SABA
- add ipratropium if severe to relax lung muscles

Promptly give systemic glucocorticoids

Question 23

Patients with asthma triggered by aspirin may have this unique sign on physical exam

Answer 23

Nasal polyposis

Question 24

Asthma patients with atopic dermatitis (eczema) will have red, dry, inflamed skin on these areas of their body

Answer 24

Flexor surfaces of elbows and knees

Question 25

The two most common asthma symptoms are ...

Answer 25

Expiratory wheeze Cough (worse at night)

Question 26

A patient with asthma day symptoms once a week and night symptoms once a month, with an FEV1 of 90% would get what treatment?

Answer 26

PRN SABA (Albuterol) (patient is in intermittent class)

Question 27

In asthma would you see decreased FVC or decreased FEV1/FVC ratio on spirometry?

Answer 27

Decreased FEV1/FVC ratio (obstructive)

Question 28

Nasal polyposis is associated with which sub-type of asthma?

Answer 28

Aspirin exacerbated asthma

Question 29

Name some common environmental asthma triggers

Answer 29

Ragweed Dust Mold Exercise in cold air

Question 30

Medications to avoid in asthma management

Answer 30

Non-selective beta-blockers (propranolol) Aspirin too if they're one of those ones

Question 31

All suspected cases of asthma should be given this diagnostic test

Answer 31

PFT - pulmonary function tests

Question 32

A patient with asthma day symptoms throughout the day and night symptoms often nightly, with an FEV1 of 50% would get what treatment?

Answer 32

Med-high ICS (Advair, Dulera, Symbicort) AND LABA (Salmeterol or Formoterol) With or without oral prednisone

Question 33

Upon ER discharge after an asthma attack, which medication should be prescribed, and for how long?

Answer 33

Oral corticosteroids (prednisone) For 5-7 days

Question 34

Best management medication for asthma in patients with co-occurring allergies/atopy

Answer 34

Humanized monoclonal antibodies against IgE Xolair

Question 35

In treatment of post-nasal drip in asthmatics, what unique physical exam sign would be seen?

Answer 35

Cobble stoning of the throat

Question 36

Describe the appearance of a flow-loop pattern in asthma

Answer 36

Scooped out shape and smaller (obstructive)

Question 37

In restrictive lung diseases would you see decreased FVC or decreased FEV1/FVC ratio on spirometry?

Answer 37

Decreased FVC

Question 38

True or false. Leukotriene inhibitors are less effective than inhaled corticosteroids for treatment of inflammation

Answer 38

True

Question 39

A patient with asthma day symptoms 7 times a week and night symptoms five times a week, with an FEV1 of 72% would get what treatment?

Answer 39

Low-dose ICS (Advair, Dulera, Symbicort) AND a LABA (Salmeterol or Formoterol) OR Medium dose ICS (patient is in moderate persistent class)

Question 40

These four signs on physical exam indicate a more severe case of asthma

Answer 40

Hyper-resonance of chest Use of accessory muscles in breathing Pulsus paradoxus Quiet chest (low air flow)

Question 41

Describe the appearance of a flow-loop pattern in restrictive lung diseases

Answer 41

Normal shape, decreased size

Question 42

1 in 10 school age children, but is it more common in boys or girls in childhood and men or women as adults?

Answer 42

Boys in childhood and women in adulthood

Question 43

Name medications that commonly trigger asthma

Answer 43

Aspirin Non-selective beta-blockers

Question 44

Asthma in pregnancy usually shows up in which trimester?

Answer 44

2nd trimester