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Internal Medicine- Chest > Bronchial Asthma > Flashcards

Bronchial Asthma Flashcards

1
Q

What is Bronchial Asthma?

A

Chronic inflammation
Ccc by bronchial hyper reactivity
And reversibility
With or without ttt

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2
Q

What are the types of bronchial asthma?

A

Atopic or allergic
Non allergic
Bronchospasm

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3
Q

How to confirm atopic asthma ?

A

Skin pin prick test

Immediate wheal and increase in serum IgE

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4
Q

What is an indicative sign of atopic asthma ?

A

Positive family history

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5
Q

What type is atopic asthma ?

A

Localized type 1

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6
Q

What is the onset of asthma ?

A

Childhood

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7
Q

What is the most common chronic disease in childhood ?

A

Bronchial asthma

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8
Q

What sex is more predisposed to asthma ?

A

Boys

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9
Q

What are the other signs or commodities that indicate atopic asthma ?

A

IgE
Allergic rhinitis
Eczema

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10
Q

What trigger atopic asthma ?

A

Environmental allergens
Dust
Pollen grains
Fungi
Pets

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11
Q

What triggers non allergic asthma ?

A

Respiratory viral infection with vagal overtime

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12
Q

What triggers bronchospasm ?

A

Drugs as aspirin, beta blockers and ACE
Occupational fumes metal dust animals
Exercise gerd stress smoking sinusitis and obesity

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13
Q

What is the sign of severity of asthma ?

A

Silent chest

Asthma without wheezes

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14
Q

What are the symptoms of asthma ?

A

Night or early morning episodes

•Dyspnea
•wheezes
•coughing thick pellets
•Chest tightness

•anxiety
•Sweating

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15
Q

Most important trigger in atopic asthma ?

A

Fungi

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16
Q

When do signs of asthma appear ?

A

During attacks

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17
Q

What are the signs of asthma ?

A

c- Signs:

1- G

a- Pulse = Pulsus Paradoxus or Arrhythmias

b- Head & Neck
1- Congested pulsating neck veins with Kussmaul’s sign

2- Tachypnea + Working accessory ms

  1. LL edema

2- L

I: Symmetrical, equal movement & increased A-P diameter, Hyper-inflation

P: Trachea (Centralized), TVF (Equal)

P: Bilateral hyper-resonance + Encroaching on heart & liver

A:
a- Breath S.: Type: Harsh vesicular (Prolonged expiration) + decreased Air entry Bilaterally

b- Additional S: Coarse crepitations + Rhonchi

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18
Q

What are the complications of bronchial Asthma ?

A

Lung collapse, pneumothorax, pneumonia and respiratory failure type 2

Corpulmonale

Decreased work capacity

Asthmatic bronchitis

Allergic broncho pulmonary aspergillosis

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19
Q

What is asthmatic bronchitis ?

A

Increase in amount of sputum and poor response to treatment

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20
Q

What is ABPA?

A

Type 1 HS to Aspergillus Fumigatus antigens leading to increase in IgE

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21
Q

What is the Clinical picture of ABPA?

A

Fever
Chest pain
Worsening of asthma

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22
Q

What are the investigations of ABPA?

A

Hyperesinophilia (more than 1500 mm3)

Increase total and specific IgE

Positive skin prick test for aspergillus

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23
Q

What is the ttt of ABPA?

A

Oral prednisone and itraconazole are 200mg 2x/day for 2 mins

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24
Q

What is reversibility test (when is it positive) and in this case what does this indicate?

A

Post bronchodilator increase of FEV1 by 12% or 200ml

If positive = bronchial asthma

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25
What are the investigations of Asthma ?
*Immunological* Increase in esinophils Increase in serum IgE total and specific Skin test *ABG* ABG: Hypoxia and Hypercapnia *Radiology* Radiology: Same as blue bloater *Spirometery* DLco: not impaired TLC inc Dec FEV1 Dec FVC PEFR sec
26
Nebulized Oz dosage for acute severe asthma
60% As needed
27
Salbutamol dosage for acute severe asthma
5 mg repeated every 20 mins if needed, max is 3 x
28
IV Methyl prednisolone dosage for acute severe asthma
60 mg Repeated every 6 hrs in the 1st day then oral for 10 - 14 days after
29
Salbutamol dosage if failed initially in acute severe asthma
10 mg could be repeated every 1 hr
30
Investigations for hospitalized Status Asmathicus or imminent asthma
PEFR + Pulse oximetry + CXR
31
Ipratropium bromide route of administration in acute severe asthma And what is it
SAMA TO Nebulized 02
32
If ipratropium bromide fails ?
Add IV MgSO4
33
If MgSO4 fails ?
Add IV Salbutamol
34
If salbutamol fails ?
Add IV Theophylline
35
acute severe asthma may need ?
May need ICU & Correction of Acidosis or Hypokalemia if occurred
36
Cortisone inhaler of budenoside dosages
Low dose < 400 ug Medium 400 - 800 ug High dose > 800 ug
37
There are 10 steps to follow in cases of
Status Asmathicus/severe asthma Imminent asthma
38
List the 10 steps to follow
TTT plan of Acute severe asthma (Status asthmaticus) & Imminent asthma 1- Nebulized Oz (60 %) as needed 2- Salbutamol 5 mg repeated every 20 mins if needed max is 3 x 3- If failed IV Methyl prednisolone 60 mg (repeated every 6 hrs in the 1st day then oral for 10 - 14 days after) 4 If failed give Salbutamol again 10 mg could be repeated every 1 hr 5- If failed → Hospitalization → PEFR + Pulse oximetry + CXR 6- Ipratropium bromide on nebulized 02 7- If failed add IV MgSO4 8- → If Failed add IV Salbutamol 9- → if Failed add IV Theophylline 10- May need ICU & Correction of Acidosis or Hypokalemia if occurred
39
What are the criteria’s to assess in asthma exacerbation?
Talking Posture Dyspnea Respiratory Rate Pulse Rate volume SO2 Wheezes
40
I hate should not be used to assess severity of exacerbations?
RR as they are usually very low
41
What is Pulsus Pardoxus?
Inspiring obliterates pulse
42
Why does silent chest occur?
Due to severe bronchospasm
43
What is the criteria of mild exacerbation?
Can say sentences Can lie flat RR 18-25 Pulse Normal Rate Volume Normal SO2 above 95% Wheezes end expiratory
44
What is the criteria of moderate exacerbation?
Talking increase Dyspnea Can only sit with working accessory muscles RR 25-30 Pulse 100-120 Rate Volume PP 10-20 SO2 above 91-95% Wheezes expiratory
45
What is the criteria of severe asthmatic exacerbation?
Can say words only Tripod position with working accessory muscles RR more than 30 Pulse more than120 Rate Volume PP 20-40 SO2 above less than 91 Wheezes expiratory and inspiratory
46
What is the criteria of imminent respiratory failure ?
Drowsy Dec in RR Dec in HR Heavy sweating
47
What are the 2 types of TTT of BA and what are the names of guidelines ?
Pt education Medical according to Gina 2021
48
What should be taught to patients regarding asthma ?
Diet Exercise Avoid triggers Weight control Domicilkiary follow up of PEFR
49
According to GINA 2021, steps are, when to step up, when to step down
Stepwise 2-6w before step up If controlled for 3m step down
50
What is the difference between track 1 and 2?
Track 1= high risk of exacerbation (hospitalized once per year) Track 2= low risk of exacerbation
51
Track 1 meds
Reliever: LICS + formetrol as needed Step 1 and 2: LICS + Formetrol as needed Step 3: LICS + Formetrol regularly Step 4: MICS + Formetrol regularly Step 5: LICS + Formetrol regularly with or without oral agents
52
Track 2 Meds
Reliever: SABA as needed Step 1: LICS as needed Step 2: LICS regular Step 3: LICS + LABA regularly Step 4: MICS + LABA regularly Step 5: HICS + LABA regularly with or without oral agents
53
What is formetrol?
Mix of SABA and LABA that starts in 2m and lasts 12h
54
What are the relievers of asthma ?
LICS and formetrol SABA Theophyline SAMA
55
What are the controllers of asthma ?
Inhaled Corticosteroids Oral corticosteroids LABA LAMA Montelukast Zileuton Theophyline Disodium cromoglycate Omalizumab Cromones
56
What is omalizumab?
Anti IgE
57
How does Theophyline work ?
Inhibits PDE 3 and 4 Inhibits adenodsine receptors Leads to smooth muscle relaxation Decreased chemotaxis of neutrophils and esinophils
58
AES of Theophyline
Very severe Git upset and arrhythmia
59
What are the mechanism of action of montelukast and uses
lts receptor blocker used in aspirin, exercise and smoking triggered asthma
60
What is the mechanism of action of zileuton? And use
lts enzyme inhibitors used in aspirin, exercise and smoking triggered asthma
61
Ae of lama
Day mouth
62
Ae of laba and mc
Tremor mc Palpitation Hypokalemia
63
Ae or inhaled and oral corticosteroids
Hoarseness of voice Oral Candiasis
64
What is the DOC of asthma
ICS
65
Step 1 symptoms
Intermittent 1 daytime attack per week
66
Step 2 symptoms
Mild persistent 2-6 daytime attacks per week
67
Step 3 symptoms
Moderate persistent Daytime attacks all week
68
Step 4 symptoms
Severe persistent All week long in addition to physical limitations
69
Refractory asthma
Failed to respond to HICS and LABA despite optimum TTT
70
List the mediators involved in airway remodeling and their origin
VEGF (TH2) IL3 (Esinophils and TH2) THF b (mast cell)
71
Which phase of ventilation is most limited in asthma ?
Expiratory
72
List the pathological features of airway remodeling
Neutrophil and esinophils in linen Mucus excess Mucus gland metaplasia Mucus membrane swelling Suepithial fibrosis and swelling Smooth muscle contraction
73
What are indicators of asthma ?
Presence more than one of 5 of those - wheeze, Dyspnea, tightness, pellets Late night or early morning Varying severity Triggers present
74
What varies proportionally with severity of attack ?
The PEFR
75
Which points decrease the likelihood of it being asthma ?
Isolated cough Chronically productive Dizziness Chest pain Exercise induced dyspnea with stridor
76
What are the 2 cornerstones of asthma diagnosis ?
1. Evidence of variable expiratory airflow limitation • 2w daily PEFR variability through (daily amplitude * 100/ daily mean) • PEFR significant increase after 4w of controller 2. History of variable respiratory symptoms consistent with clinical picture • as before
77
Normal FEV1 to FVC ratio
Normal more than 0.75 to 0.8 Child more than 0.9
78
If case is highly consistent with asthma but nothing shows up. What to do ?
Repeat during attack or after withholding BD
79
What are the 2 points used to assess severity of asthma regarding steps ?
Frequency of attacks and FEV1
80
Can asthma and COPD coexist ?
Yes especially if above 65y
81
What are asthma phenotypes ?
genetic and environmental factors Leading to altered Age of onset Presence of atopy Lung function Despite having similar manifestations
82
Can phenotypes be further divided
Into endotypes based on pathophsyiological molecular mechanisms
83
DD of asthma other than dyspnea (htrz3hom hena 3ady)
Drug induced as ace Infiltration with esinophils VC dysfunction
84
Ciclesonide doses
80-160 161-320 Above 320
85
Ics doses units
Mcg
86
Budensonide
Less than 400 400 to 800 More than 800
87
How to assess asthmatic control
For past 4w - daytime symptoms above 2/w - night time waking above 2/w - Reliever needed above 2/w - activity limitation Well controlled 0 maintain and find lowest suitable Partly controlled 1-2 consider upgrading Uncontrolled 3-4 keep upgrading till controlled

Internal Medicine- Chest (7 decks)

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