Asthma

Question 1

Asthma is defined by what triad?

Answer 1

Airway inflammation
Airway hyperresponsiveness
Reversible airflow obstruction

Question 2

At what age can asthma affect a patient?

Answer 2

Any age

Question 3

Asthma is characterized by what four intermittent symptoms?

Answer 3

SOB
Wheezing
Chest tightness
Cough

Question 4

What is the most common physical exam finding in patient with asthma?

Answer 4

wheezing

Question 5

Is asthmatic wheezing heard on inhalation or exhalation?

Answer 5

Both

Question 6

What test is required for diagnosis of asthma?

Answer 6

PFT’s

Question 7

How is FEV1 affected in asthma?

Answer 7

decreased

Question 8

How is the FVC affected in asthma?

Answer 8

decreased

Question 9

How is the FEV1:FVC ratio affected? What value is a positive result?

Answer 9

decreased

<0.75

Question 10

With a positive albuterol test for asthma, how does the FEV1 change?

Answer 10

Increases >12%

Question 11

With a positive methacholine or histamine challenge test for asthma, how does the FEV1 change?

Answer 11

Decrease <20%

Question 12

In the ED what test should be performed to measure the severity of a possible asthma attack?

Answer 12

Peak Flow Rate

Peak Expiratory Flow Rate

Question 13

What are the two broad types of asthma and which is more common?

Answer 13

Intrinsic and Extrinsic

Extrinsic is more common

Question 14

What immunoglobulin is excessively produced in extrinsic asthma?

Answer 14

IgE

Question 15

When should ABG’s be considered on an asthmatic patient?

Answer 15

Significant respiratory distress

Question 16

What two results may be seen on an ABG of an asthmatic patient in respiratory distress?

Answer 16

Hypocarbia

Hypoxemia

Question 17

If the PaCO2 is normal or raised in an asthmatic patient in respiratory distress, what should you think?

Answer 17

Oh shit

Respiratory failure may ensue

Question 18

What is the significance of a normal to increased PaCO2 in an asthmatic patient in respiratory distress?

Answer 18

Respiratory muscle fatigue

Severe airway obstruction

Question 19

What med should be AVOIDED in asthmatics?

Answer 19

Beta-Blockers!!!

Question 20

What two things need to happen if an asthmatic patient in respiratory distress with an increased PaCO2?

Answer 20

Hospitalize

Possible mechanical ventilation

Question 21

What is mild intermittent asthma?

Answer 21

Symptoms 2 or fewer times per week

Question 22

What is the treatment for mild intermittent asthma?

Answer 22

Nothing

Question 23

What is mild persistent asthma?

Answer 23

Symptoms 2 or more times per week but not everyday

Question 24

What is the treatment for mild persistent asthma?

Answer 24

Low dose inhaled corticosteroid

Question 25

What is moderate persistent asthma?

Answer 25

Daily symptoms | Frequent exacerbations

Question 26

What is severe persistent asthma?

Answer 26

Continual symptoms Frequent exacerbations Limited physical activity

Question 27

What is the treatment for moderate persistent asthma?

Answer 27

Daily inhaled corticosteroid (low dose) or Cromolyn/nedocromil or Methylxanthine or Antileukotriene

Question 28

What med do all asthmatic patients receive regardless of severity?

Answer 28

Short acting Beta-Agonist as needed

Question 29

For acute asthma exacerbations, what three tests need to be ordered?

Answer 29

1. PEF 2. ABG 3. Chest x-ray

Question 30

What results will be seen on a PEF, ABG, and CXR of a patient with an asthma exacerbation?

Answer 30

PEF decreased ABG increased A-a gradient Rule out pneumonia, pneumothorax

Question 31

In order to diagnose severe asthma exacerbation, what is the corresponding value of the peak expiratory flow rate?

Answer 31

<60% of predicted

Question 32

What are the top three deadly complications of asthma?

Answer 32

1. Status asthmaticus - No response to meds 2. Acute respiratory failure (d/t muscle fatigue) 3. Pneumothorax, atelectasis, pneumomediastinum

Question 33

What 3 things must be given and what 2 might be given to a patient to treat an acute asthma exacerbation?

Answer 33

1. Inhaled B-Agonist 2. Corticosteroids IV or oral 3. Supplemental Oxygen 1. Antibiotics if severe severe exacerbation or suspicion of infection 2. Intubation for patients in respiratory failure or impending failure.