Asthma USMLE Step 2 CK and Step3

ismailalmokyad's version from 2016-05-23 06:01


Question Answer
what is the presentation of asthma wheezing, acute onset of SOB, cough, and chest tightness. sputum is common but fever is not
what are common association found in patient with asthma1- symptom worse at night. 2- nasal polyps. 3- senstivity to aspirin. 4- atopic dermatitis. 5- increase length of expiratory phase. 6- increase use of accessory resp muscles.
what are the most common causes of asthma exacerbations of symptom 1- allergens(pollen, dust mites, cat dender)2 infection3 cold air.4emotion stress or exercise.5 catamenial ( related to menses).6 aspirin , NASID, BB , histmaine and nebulized medications. 7 smoking. 8 GERD
how does NSAID increases symptom of asthma?by increasing productions of leukotrine
what is allergic pneumonitis healthy patient with symptom of asthma after exposure to new enviroments (animal or plants ) it can progress to pulmonary HTN or scaring .
what is the ttt of allergic pnumonitis stop exposure and give oral steroid
what is variant asthma it is asthma with cough as the only symptom
what is the best initial test for asthma exacerbation ?peak expiratory flow(PEF) or ABG. PEF used by patient to determine function
why we do xry on asthmatic patient usually its NL or hyperinflation but we do it to exclude 1 pneumonia as cause of exacerbation 2 to exclude other causes as pneumothorax or CHF in cases that are not clear.
what is the most accurate test for asthma when the patient is symptomatic ?PFT. spirometry will show a decrease in the ration of forced espiratory volume in 1 sec to force vital capacity (FEV1/FVC) . note the FEV1 decrease more than the FVC thats why the ratio decreases.
what is the most accurate test for asthma when the patient is asymptomatic ?20% decrease in FEV1 with the use of methacholine or histamine
what are the changes of PFT in asthmatic patient 1 decrease in FEV1 and decrease in FVC but with increase of the ratio. 2 increase in FEV1 of more than 12% and 200 ml with the use of albuterol ( if symptomatic) 3 decrease in FEV1 of more than 20% with the use of methacholine or histamine . 4 increase in the diffusion capacity of the lung for carbon monoxide ( DLCO). note PFTs are normal between exacerbations.
what are the additional testing options of asthmatic patients 1- CBC(may show an increase eosinophil count) 2- skin testing (used to identify allergens) 3 - increase level of IgE (first it suggest allergic etiology and it help guide therapy such as the use of anti IgE medication Omalizumab, it also associated with allergic bronchopulmonary asperigillosis )
what is the treatment options for asthma 1- inhaled short acting beta agonist(SABA) eg albuterol, pirbuterol, levalbuterol. 2- low does inhaled corticosteroid(ICS) eg beclomethasone, budesonide, flunisolide, fluticasone, mometasone,triamcinolone. 3- long acting beta agonist(LABA) eg salmeterol or formoterol. 4- omalizumab for asthmatic patient with high IgE. 5-oral corticosteroids eg prednisone. 6- cromolyn and nedocromil to inhibits mast cell 7- theophylline 8-leukotriene modifiers ad montelukast, zafirleukast or zileuton (best for atopic patient)
what is the most common adverse effect of inhaled steroid dysphonia and oral candidiasis
what is a special S/E for zafirleukast it is hepatotoxic and has been associated with churg-stauss syndrome
what is the S/E of oral corticosteroid osteoprosis, cataracts, adrenal suppression and fat redistribution, hyperlipidemia, hyperglycemia, acne, hirsutism, thinning of skin , stria , easy bruising
what vaccine should be given to all asthmatic patient influenza and pneumococcal
what is the most important c/p of asthma exacerbation increase in RR, decrease in PEF , hypoxia, resp acidosis, possible absence of wheezing ( no air movements)
how to quantify asthma exacerbation by decrease in PEF or ABG with A-a gradient (Note PEF is approximation of the FVC and the value is based on height and age not weight ) the PEF assessment on exacerbation by seeing how much difference there is from the patient usual PEF when the patient is stable
what is the treatment of asthma exacerbation O2 , albuterol, and steroid. note steroid need 4-6 hours to work so give it right away. note ipratropium should be used but doesnt work as rapid as albuterol. note magnesium is not effective as albuterol or steroid but it help
what is the role of magnesium in asthma exacerbation it relieve bronchospasm but it only used in patient not responding to several rounds of albuterol while waiting for steroid to take effect
when we intubate asthmatic patient and put him/her in ICUwhen he is in exacerbation and not responding to o2 , albuterol, and steroid or if he/she developed resp acidosis (increase pco2)
what is the types of asthma and what is the treatment for each type 1- mild intermittent, 2 or less daytime epi/week, 2 or less night time epi /month, EFV1 > 80% the ttt is SABA. 2- mild persistent asthma = 3-6 day time epi/week, 3-4 night time epi/month , FEV1 > 80% ttt is SABA + low cortico +/- monteleukast and cromolyn. 3- moderate persistant asthma = every day epi , more than one night epi /week, FEV1 60-80%. ttt is SABA + low to mediam does cortico +/- LABA, montleukast, theophylline. 4- sever persistant asthma= every day time epi, frequent night epi, FEV1 < 60%. ttt is SABA + LABA+ high does steroid and maybe oral steroid.
why we dont use epinephrine in asthma exacerbation epinephrine injections are no more effective than albuterol and have more adverse systematic effects. epinephrine only used as drug of last resort