gesemaxu's version from 2016-12-10 10:34

Section 1

Question Answer
What type of hypersensitivity rxn for extrinsic asthma?Type I
First encouter w allergen...CD4 TH2s release IL4 (IgE class switching) and IL5 (activate eosinophils)
Inhaled antigens do what in asthma?Cross-link IgE antibodies on mast cells on mucosal surfaces
What does Leukotrienes CDE4 do? Ach?Prolonged bronchoconstriction; airway muscle contraction
Late-phase reaction (4-8 hours later) after antigen exposure- ________ is produced (which is chemotactic for eosinophils), and eosinophils release _______ and _____ which damages epithelial cells and produces airway constrictionEotaxin; BMP; Cationic protein
Direct bronchoconstrictor to assess airway closure-- used to guage airway hyperresponsiveness. Figure out the concentration necessary to decrease FEV1 by 20%, this concentration is lower in asthmaticsMethacholine
Categories of severity of asthma (4)1. Intermittent, 2. Mild (persistent), 3. Moderate (persistent), 4. Severe (persistent)
Severity classification of asthma is followed by __________control
Do not use ______ until a patient has failed moderate-high doese of inhaled corticosteroidsLong acting beta agonists
________ can be added in replacement of LABA if it fails and asthma is still uncontrolledTiotropium bromide
IgE inhibior which may cause anaphylaxis, cancer, and CADOmalizumab
Used in the ED when albuterol is maximized and patient is still symptomaticIpratropium bromide
T/F bacteria typically trigger an asthma attackFalse
T/F rhinovirus will commonly trigger an asthma attackTrue
Is humid or dry air a trigger for asthma?DRY air (cold air, too) are triggers for asthma

Section 2

Question Answer
_________ often leads to asthma, from damaged skin cells releasing _________ into the blood stream, which induces an inflammatory response after reaching the lungsEczema; TSLP (thymic stromal lymphoprotein)
Induces the release of Tcell attracting chemokines from monocytes and enhances dendritic cell maturation; promotes a TH2 response-->promotes repeated inflammation w specific antigen in the airwaysTSLP (thymic stromal lymphoprotein)
Type of asthma w later onset, nasal polyps, aspirin sensitive, unknown mechanismIntrinsic asthma
LAck of infections in early childhood preserves TH2 cell bias, where exposure to infections sends T-cells down the TH1 cell pathHygene hypothesis
What initiates bronchoconstriction in response to allergens and other stimuli like exercise and hyperventilation (and fog); acivated by IgEMast Cells
Drugs to avoid in asthmatics?1. beta blockers, 2. ACEI, 3. Aspirin
Pathogenesis of exercise induced asthmahyperventilation increases osmolality in airway lining fluid, which triggers mast cell mediator release, leading to bronchoconstriction
Increasing chest tightness, wheezing, dyspnea not relieved by inhaler. So breathless they can't complete sentencesAcute severe asthma
Refractory acute severe asthma treatmentOral aminophylline
2 main mechanisms of refractory asthma1. persistent symptoms and poor lung function, 2. reasonable lung function but severe exacerbations
Most common type of nasal polyp?Allergic polyp, seen in adults w IgE mediated allergies