Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is infrequent intermittent asthma?

A

> 6 weeks between flares, no sx between flares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is frequent intermittent asthma?

A

<6 weeks between flares but no sx between flares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is persistent MILD asthma?

A

At least one of:

  • daytime symptoms >1x weekly, <1x daily
  • night-time symptoms >2x monthly but not weekly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is persistent MODERATE asthma

A

Any of

  • daytime sx daily
  • night time sx >1x week
  • some restriction to activity/sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is persistent SEVERE asthma

A 
Any of
-continual daytime sx
- frequent night time sx
-frequent flares
sx restrict activity or sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you treat a 1-2y o child with intermittent asthma or viral induced wheeze?

A

Salbutamol/SABA only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you treat a 1-2 yo with persistent asthma/ multi trigger wheeze?

A

Sodium cromoglycate 10mg 3x daily and review in 2-4wks.

if wheezing is disrupting sleep/play consider low dose ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you treat a 2-5 yo with infrequent intermittent asthma/ viral induced wheeze?

A

Salbutamol only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you treat a 2-5 yo with frequent intermittent asthma or mild persistent asthma.

A

Montelukast 4mg daily and review in 2-4 weeks

If no response trial low dose ICS and review in 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you treat a 2-5 yo with moderate-severe persistent asthma or moderate-severe multi-trigger wheeze

A

Consider regular treatment with a low dose ICS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain a stepped approach to adjusting asthma treatment in children <5yrs

A
  1. All children need a SABA and regular review
  2. Some children need a preventer: ICS/Montelukast/Cromone
  3. A few children will need high dose ICS or low dose ICS + montelukast or ICS/LABA combination
  4. Referral to paediatrician
    (If improved after 3 months then step down)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain a stepped approach to adjusting asthma treatment in children >5 years

A
  1. Salbutamol
  2. ICS or montelukast
  3. ICS/LABA, if >12yrs SMART (reliever + preventer) therapy could be considered
  4. Increase the steroid/ montelukast dose
  5. Consider alternative therapy/ referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is special about fluticasone ultra fine

A

Its dose is twice as potent!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What effect do ICS have on growth?

A

reduce adult height by 0.7% or about 1cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A 3 year old boy is commenced on a LABA on discharge from hospital as monotherapy. What are the problems with this?

A
  1. can develop a paradoxical bronchospasm - using in combination with a ICS prevents this
  2. They should not be used in under 4’s
  3. Should not be used when patient is unstable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain acute management in ED of a 5 year old with mild/mod asthma

A

salbutamol 6puffs Q20min x 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Explain acute management of a 12 y o with mod/severe asthma SpO2 90%

A

Salbutamol via spacer/ nebuliser salbutamol 2x5mg + O2 therapy + prednisolone + ipatropium 20minutely

18
Q

Explain acute management of a 12 y o with severe asthma not responding to initial treatment

A

Add magnesium sulphate 0.1-0.2mmol/kg and infuse over 20 mins
Consider ICU referral for IV salbutamol and NIV

19
Q

What happens to smooth muscle in asthma?

A

hyperplasia of the smooth muscle of the bronchial and bronchiolar wall

20
Q

Describe the pathophysiology of airway obstruction in asthma.

A
  • smooth muscle hyperplasia
  • thick tenacious mucous plug
  • thickened basement membrane
  • mucosal oedema (abnormal mucociliary clearance)
  • eosinophilia of the submucosa and secretions
  • increased mast cells in smooth muscle
21
Q

Mucosal oedema, bronchospasm and mucous plugging cause…

A

airflow obstruction, which in turn caues

  • increased resistance to airflow
  • decreased ability to expell air
  • hyperinflation
22
Q

Describe uneven ventilation-perfusion relationships in asthma

A

non-uniform changes throughout the tracheobronchiolar tree lead to

  • uneven distribution of inspired air
  • uneven circulation to the alveloi
23
Q

describe the primary cause of the pathophysiological changes seen in asthma

A

Inflammation:

  • recruitment of leukocytes to airways - release inflammatory substances
  • chronic activation of mast cells, dendritic cells, eosinophils and lympocytes secondary to Th 2 cytokine-mediated events
  • inate immune response by toll-like receptors and Th17 cells
  • impaired production of natural airway defense mediators such as lipoxins, resolvins and protectins (all important in the resolution of airway inflammation)
24
Q

What is the effect of recurrent episodes of inflammation?

A

Progressive structural and functional changes in the airway epithelium, musculature and connective tissues

25
Q

DDx for asthma in a patient presenting with cough

A
  • Pertussis
  • CF
  • Airway abnormalities
  • Protracted bacterial bronchitis in young children
  • Habit cough syndrome
26
Q

DDx for asthma in a patient presenting with wheeze

A
  • Upper airway dysfunction
  • Inhaled foreign body
  • Tracheomalacia
27
Q

DDx for asthma in a patient presenting with difficulty breathing

A

Hyperventilation
Anxiety
Breathlessness on exertion due to poor cardiopulmonary fitness

28
Q

Why would recurrence of overt asthma occur after years of being symptom free?

A

Airway inflammation may persist in the abscence of symptoms along with persistent airway obstruction

29
Q

What increases the likelyhood of a dx of asthma?

A
  1. More than one of…
    - wheeze
    - breathlessness
    - chest tightness
    - cough
  2. Particularly if
    - worse at night
    - provoked by exercise, cold air, allergen exposure, irritants, viral infections, stress and aspirin
    - recurrent or seasonal
  3. PMHx/FHx atopy
  4. O/E wheeze
  5. Spirometry changes
  6. Blood eosinophilia or raised exhaled nitric oxide
  7. Bronchial hyper-responsiveness on challenge testing at appropriate age
  8. Positive response to bronchodilator
30
Q

Describe changes seen on spirometry in asthma.

A

Obstructive pattern:

  • concave expiratory loop
  • FEV1 reduced
  • FEV1/FVC reduced

(Normal does not exclude asthma)

31
Q

What effect do bronchodilators have in spirometry

A

FEV1 increases at least 12 percent from baseline

32
Q

What changes do you see in FeNO in asthma and why?

A

Expired FeNO is higher in asthma because of eosinophillic inflammation.

33
Q

Can you diagnose Asthma with FeNO testing

A

No, supportive only

34
Q

What other disease cause high expired FeNO

A

eosinophillic bronchitis, atopy, allergic rhinitis, eczema

35
Q

Describe 3 other tests used in the dianosis of asthma, aside from spirometry and FeNO

A
  1. Direct challenge test: inhalation of increasing concentrations of histamine or methacholine causes a fall in FEV1 of >20%
  2. Indirect challenge test: negative response to exercise - can be useful in excluding asthma
  3. Peak expiratory Flow monitoring
    - serial measures of peak flow. not reliable in ruling asthma in or out.
36
Q

What percentage of children age 1-4 will be symptom free by school age?

A

50%

37
Q

How severe is this childs asthma - mod/severe/life-threatening?
How would you treat them?

SpO2 <92%
+exhausted/agitated/alt consciousness
+cyanotic/ silent chest

A

life threatening

  • O2
  • continuous nebs 2.5-5mg -salbutamol
  • ipatropium bromide 0.25mg via neb
  • IV hydrocort 4mg/kg
38
Q

How severe is this childs asthma - mod/severe/life-threatening? How would you treat them?

Able to talk
SpO2>92%
FEV1 >50% predicted

A

Moderate.

6-12puffs of salbutamol 20minutely
if age >5 give pred 1-2mg/kg

39
Q

How severe is this childs asthma - mod/severe/life-threatening? How would you treat them?

SpO2 <92%
Too breathless to talk
Obvious accessory muscle use
FEV1 33-50% predicted

A

Severe

O2
6-12 puffs salbutamol x 3 in an hour or nebs with oxygen
Pred 1-2mg/kg

40
Q

Describe well controlled asthma.

A

-Sx <2 days/wk
-Night waking <1/month
- doesnt interfer with activity
- ventolin <2 days/wk
FEV1 >80%

41
Q

Describe poorly controlled asthma

A

-Sx>2days/wk
-night waking >2/month
-interfers with activity a bit
-SABA >2days/wk
FEV1 60-80% predicted

42
Q

Describe very poorly controlled asthma

A

-Sx throught the day
- night awakiening >2x/week
-extremely limited activity
-SABA several x daily
FEV1 <60% predicted

Respiratory (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions