ASTHMA

Question 1

hypersensitivity reaction in asthma

Answer 1

Type 1

Question 2

name 3 type 1 hypersensitivity reactions

Answer 2

eczema
asthma
hayfever

Question 3

auscultation in asthma?

Answer 3

widespread polyphonic wheeze

Question 4

asthma investigations

Answer 4

• Spirometry
• FeNO
• CXR
• Peak flow variability
• direct bronchial challenge test

Question 5

how does FeNO test work?

Answer 5

iNOS levels tend to rise in inflammatory cells, particular eosinophils and levels correlate with levels of inflammation

Question 6

what is a type 1 hypersensitivity reaction?

Answer 6

Antigen reacts with IgE bound to mast cells

Question 7

what is samters triad

Answer 7

• aspirin hypersensitivity
• nasal polyps
• asthma

Question 8

side effects of inhaled ICS

Answer 8

oral candidiasis

stunted growth in children

Question 9

name a leukotriene receptor antagonist

Answer 9

oral montelukast

Question 10

mechanism of theophylline

Answer 10

relaxes bronchial smooth muscle

Question 11

example of LABA

Answer 11

salmeterol

Question 12

follow up requried for patients with asthma (4)

Answer 12

annual flu jab
yearly asthma review
advise exercise
avoid smoking

Question 13

first line treatment for all partients with asthma

Answer 13

SABA + low dose ICS

Question 14

when to introduce further treatment in for asthmatics?

Answer 14

when SABA used more than/equal to 3 times a week

Question 15

2 examples of low dose ICS

Answer 15

• Beclomethasone dipropionate

- Fluticasone propionate

Question 16

signs and symptoms of acute severe asthma attack

Answer 16

worsening dyspnoea, wheeze, cough, not responding to salbutamol

• use of accessory muscles
• tachypnoea
• symmetrical expiratory wheeze
• reduced air entry

Question 17

PEFR for moderate, severe & life threatening asthma attack

Answer 17

Moderate: 50-75%
Severe: 33-50%
Life threatening: < 33%

Question 18

speech for moderate, severe & life threatening asthma attack

Answer 18

moderate: normal speech

severe : incomplete sentences

life threatening: silent chest

Question 19

respiratory rate for moderate, severe & life threatening asthma attack

Answer 19

moderate: < 25/min
severe: > 25/min

life threatening: feeble resp effort

Question 20

heart rate for moderate, severe & life threatening asthma attack

Answer 20

moderate: < 110/min
severe: > 110/min

life threatening: bradycardia

Question 21

oxygen saturations in life threatening asthma?

Answer 21

< 92%

Question 22

what does normal PCO2 indicate in asthma attack and what is this a criteria for

Answer 22

normal PCO2 indicates exhaustion which is a feature of life threatening asthma attack & warrants ICU referral

Question 23

when to discharge a patient who was admitted for asthma attack?

Answer 23

PEFR > 75% & patient has not required nebulised salbutamol or oxygen for 12-24 hours

Question 24

which electrolyte should be monitored in asthma attack & why

Answer 24

Potassium

because salbutamol causes K+ to be absorbed from blood into cells

Question 25

when is a specialist referral for improved control of asthma required?

Answer 25

patient has more than or equal to 2 attacks in 12 months

Question 26

management fo Acute asthma attack?

Answer 26

``` Oxyegn Salbutamol nebulised Hydrocortisone IV Ipratropium bromide Theophylline Magnesium sulfate Escalate care ```

Question 27

NIV for type 2 resp failure

Answer 27

BiPAP

Question 28

indications for CPAP? (3)

Answer 28

- acute pulmonary oedema - congestive heart failure - obstructive sleep apnoea