[asthma] Flashcards
(88 cards)
1
Q
A
asthma is reversible (reccurent episodes)
2
Q
A
bronchial muscle contraction
mucosal swelling
increased mucus production
3
Q
A
mast cell + basophil degranulation
release of inflammatory mediators
4
Q
A
cough
wheeze
sputum production (yellow - eosinophils)
dyspnoea
5
Q
A
cold air
6
Q
A
pollution/smoking allergens NSAIDs B-blockers emotion
7
Q
A
NSAIDs
B-blockers
8
Q
A
morning
9
Q
A
house dust mites
fur
pollen
10
Q
A
Acid reflux
11
Q
A
better at weekends
12
Q
A
widespread polyphonic wheeze
13
Q
A
tachypnoea
wheeze
hyperinflated chest
hyperresonance
14
Q
A
COPD Pulmonary oedema bronchiectasis obliterative bronchiolitis airway obstruction pneumothorax PE
15
Q
A
adult onset asthma
eosinophilia
vasculitis
16
Q
A
Lungs
heart
Nerves
skin
17
Q
A
eczema
hayfever
allergies
18
Q
A
normal or slightly reduced PaO2
Reduced PaCO2
19
Q
A
hyperventilation
20
Q
A
Raised PaCO2
ITU transfer
21
Q
A
loss of respiratory drive
22
Q
A
allergic bronchopulmonary aspergillosis
23
Q
A
Aspergillus Fumigatus fungi causes allergic reaction –> bronchocontriction –> permanent damage
24
Q
A
transfer to ICU for ventilatory support
25
[asthma]: what 2 vascular disease are associated with asthma
polyarteritis nodosa
| Churg-Strauss
26
[asthma]: what test can you perform to identify allergens
Skin prick tests
27
[asthma]: asthma can disturb sleep - how should this be quantified
affected nights per week
28
[asthma]: what is the single most diagnostic Ix?
peak flow
29
[asthma]: chronic Mx: how often should patients monitor their peak flow
2 x per day
30
[asthma]: chronic Mx: management is via a step-wise process with each step being supplementary to the previous. how many steps are there?
5
31
[asthma]: chronic Mx: what drug may be used at any time as a 'rescue' drug regardless of the step that you are on?
prednisolone
32
[asthma]: chronic Mx: what drug is used in step 1 Mx?
short acting B2 agonist (salbutumol)
33
[asthma]: chronic Mx: what is the indication for moving from step 1 to step 2 (2)
night time symptoms
| more than once daily
34
[asthma]: chronic Mx: what drug is added for step 2 Mx
Inhaled corticosteroid (beclometasone)
35
[asthma]: chronic Mx: what drug is added for step 3 Mx?
Long acting B2 agonist (salmeterol)
36
[asthma]: chronic Mx: what drugs can be added for step 4 Mx?
High dose corticosteroids (beclometasone)
+
Aminophylline (theophylline)
+
leukotriene receptor antagonist (-lukast)
37
[asthma]: chronic Mx: what drug is added for step 5
prednisolone
38
[asthma]: chronic Mx: what action should be taken if a patient reaches step 5
refer to asthma clinic
39
[asthma]: chronic Mx: what drug is added for step 2 Mx
Inhaled corticosteroid (beclometasone 800ug max)
40
[asthma]: chronic Mx: what drugs can be added for step 4 Mx?
High dose corticosteroids (beclometasone 2000ug max)
+
Aminophylline (theophylline)
+
leukotriene receptor antagonist (-lukast)
41
[asthma]: chronic Mx: what drug is added for step 5
prednisolone (1/day)
42
[asthma]: chronic Mx: what 2 pieces of lifestyle advice should you give the patient?
Stop smoking
| avoid allergens
43
[asthma]: chronic Mx: what aspect of the patient-inhaler relationship should you check
check their inhaler technique
44
[asthma]: chronic Mx: how can you remember which drugs are added at each stage (5)
```
Short
Low
Long
High +++
Prednisolone
```
45
[asthma]: chronic Mx: give 4 SEs of b2 agonists (4)
tremor
tachyarrythmias
anxiety
hypokalaemia
46
[asthma]: chronic Mx: ..... muscle is rapidly relaxed by B2 agonists
smooth muscle
47
[asthma]: chronic Mx: why are corticosteroids preferably inhaled?
minimise systemic effects
48
[asthma]: chronic Mx: over what time period do corticosteroids function to reduce mucosal inflammation?
days
49
[asthma]: chronic Mx: how do corticosteroids help in asthma?
reduce mucosal inflammation
50
[asthma]: chronic Mx: why should patients rinse their mouth after use administration of corticosteroids
prevent oral candiasis
51
[asthma]: chronic Mx: how does theophylline work?
phosphodiesterase inhibiter causing smooth reduced bronchocontriction
52
[asthma]: chronic Mx: if theophylline is give IV what must you monitor
ECG - arrhythmias
53
[asthma]: chronic Mx: how doe leukotriene receptor antagonists work?
antagonise CystLT1 receptor in airways
| reduce bronchoconstriction/mucus secretion
54
[asthma]: chronic Mx: in patients with an extremely persisten allergic asthma what may be given?
Anti-IgE mAb
55
[asthma]: chronic Mx: in patients with an extremely persisten allergic asthma what may be given?
Anti-IgE mAb
56
[asthma]: Acute severe attack: give 4 signs of a severe attack (4)
tachycardia (>110)
RR >25
unable to complete sentences
PEF 33-50% of best
57
[asthma]: Acute severe attack: give 4 signs of a life-threatening attack (4)
Silent chest (very poor air movement)
Bradycardia
PEF
58
[asthma]: Acute severe attack Mx: what is the immediate Tx?
```
Salbutamol 5mg nebulised with O2
+
prednisolone 30mg PO
+
O2 if
```
59
[asthma]: Acute severe attack Mx: when is oxygen give in an acute asthma attack
if sats
60
[asthma]: Acute severe attack Mx: what o2 sat are you aiming for?
94-98%
61
[asthma]: Acute severe attack Mx: if the severe attack progresses to include features of a life -threatening attack how frequently should salbutamol be given
every 15 mins
62
[asthma]: Acute severe attack Mx: if the severe attack progresses to include features of a life -threatening attack what additional 2 drugs are given (2)
Magnesium sulfate 1.2 - 2 g IV over 20 mins
| Ipatropium 0.5mg added to nebuliser
63
[asthma]: Acute severe attack Mx: is signs improve with treatment how frequently is salbutamol given
every 4 hours
64
[asthma]: Acute severe attack Mx: is signs improve with treatment how frequently is prednisolone given
OD for 7 days
65
[asthma]: Acute severe attack Mx: when is oxygen give in an acute asthma attack
if sats are less than 92 %
66
[asthma]: Acute severe attack Mx: post attack in order to be discharged what must their peak flow be
>75% of predicted
67
[asthma]: Acute severe attack Mx: post attack in order to be discharged what criteria must the patient meet?
75% predicted
| diurnal variation
68
[asthma]: chronic Mx: how can you remember which drugs are added at each stage (5)
```
Short
Low
Long
High +theo +-lukast
Prednisolone
```
69
[asthma]: chronic Mx: in patients with an extremely persisten allergic asthma what may be given?
Anti-IgE mAb (omalizumab)
70
[asthma]: what signs may indicate that the patient is suffering from a severe attack (2)
inability to complete sentences
| PEF 33-50% of predicted
71
[asthma]: what signs may indicate that the patient is suffering from a life threatening attack (4)
silent chest
cyanosed
exhaustion
confused
72
[asthma]: what signs may indicate that the patient is suffering from a life threatening attack (4)
silent chest
cyanosed
exhaustion
confused
73
[asthma]: an ABG may show a deceptively normal PaO2 due to ..
patient hyperventilating
| repeat later
74
[asthma]: an ABG may show a deceptively normal PaO2 due to ..
patient hyperventilating
| repeat later
75
[asthma]:how is chronic asthma diagnosed
PEF shows a diurnal variation of >20% for >=3 days for 2 weeks
76
[asthma]:is asthma a obstructive or restrictive condition
obstructive
77
[asthma]:what would be seen in relation to the FEV1/FVC ratio
reduced
78
[asthma]: what signs may indicate that the patient is suffering from a life threatening attack (4)
```
silent chest
cyanosed
exhaustion
confused
PEF
```
79
[asthma]: does the residual volume increase/decrease
increase (obstructive disease)
80
[asthma]: what signs may indicate that the patient is suffering from a life threatening attack (4)
```
silent chest
cyanosed
exhaustion
confused
PEF
```
81
[asthma]: does the residual volume increase/decrease
increase (obstructive disease)
82
[asthma]: a normal PaCO2 in an acute asthma attack is worrying why?
respiratory muscle fatigue
83
[asthma]: what PaCo2 would you expect in an acute asthma attack
low
84
[asthma]: what are you checking to ensure about the PaCo2 in an acute asthma attack
it should be low - normal levels/rising indicate respiratory muscle fatigue
85
[asthma]: what can be used as prophylaxis in mild and exercise induced
cromoglicate
86
[asthma]: why do you check [theophylline] serum ?
narrow therapeutic range - toxicity
87
[asthma]: the half life of theophylline can be increased by
Cimetidine
ciprofloxacin
erythromycin
contraceptive drugs
88
[asthma]: the half life of theophylline can be decreased by
```
phenytoin
smoking
carbamazepine
barbituates
rifampicin
```
