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Clin Med exam 3
Asthma and obstructive sleep apnea
32
Medical
Graduate
10/24/2010

Additional Medical Flashcards

 


 

Cards

Term

Recurrent episodes of coughing, +/- wheezing, breathlessness and chest tightness

 

These episodes are usually associated with widespread but variable airflow obstruction that is OFTEN reversible either spontaneously or with treatment

Definition
Asthma
Term
Produce mediators that cause allergic inflammation
Definition
Th2
Term
Produce mediators criticak to defend against infection
Definition
Th1
Term
Asthma -imbalance of Th1 and Th2
Definition
overexpression of Th2 and underexpression of Th1
Term
Two major environmental factors of asthma
Definition

1. Airborne allergens

2. Viral respitatory infections - implicated during infancy

Term
Other risk factors of asthma
Definition

tobacco smoke

air pollution

occupational exposures

diet low in antioxidants and omega3 fatty acid

Term
Asthma Bronchoconstriction caused from:
Definition

IgE dependent release of mediators from mast cells

-histamime

-tryptase

-leukotrienes

-prostaglandins

 

+++less defined=NSAIDS, cold air, exercise

Term
Pathophysiology of asthma
Definition

1. Airway edema/inflammation

2. airway hyperresponsiveness

3. airway remodeling

Term
Diagnostic tool for asthma
Definition

Spirometry: repeated measurements

-FEV1 dec

-FEV6 (sub for FVC)

-FVC (preserved or dec)

-FEV1/FVC dec

 

+++tested before and after SABD to assess reversibility

Term
Spirometry results that indicate asthma
Definition

1. FEV1>200 ml and 12% change from baseline

2. some show reversibility after 2-3 wks on ICS

 

-need follow up spiro

Term
Complete Pulmonary function tests:
Definition

Spirometry

flow loops

lung vol

airway resistance

DLCO

Term
Other diagnostics for Asthma
Definition

Complete PFTs

ABG

Sputum eosinophilia

FeNO measurements

Bronchoprovocation

Allergy testing

serologies

GERD testing

CT sinus

 

Term
Peak flow
Definition

Monitoring tool, not diagnostic for asthma

 

green (80-100%) good

yellow (50-80%) caution

Red (<50%) danger

 

Term

Methacholine is adminstered in incremental doses up to max dose of 16 mg/ml

 

20% dec in FEV1, up to 4mg/ml =positive  for bronchial hyperresponsiveness

 

Avoid performing test is FEV1 less than 65-70% at baseline

Definition
Bronchoprovocation - methacholine challenge
Term
DD of asthma in infants and children
Definition

-allergic rhinitis and sinusitis

-FB

-VCD

-Vascular ring or laryngeal webs

-laryngotracheomalacia, tracheal stenosis, bronchostenosis

-large  nodes, tumor

-viral bronchitis/brinchiolitis

-CF

-Bronchopulmonary dysplasia

-CHD

Term
DD of asthma in adults
Definition

ABOA

Eosinophilic bronchitis

Post infectious cough

GERD

PND/ Sinus disease

tumors

cardiac

VCD

In acute setting

Bronchiectasis

aspergillus (fungal)

occupational lung disease

 

 

Term

Once diagnosis is established next:

 

Definition

1. Identify percipiating factors

 

2. identify comorbid that may aggravate asthma

 

3.classify asthma severity using impairment and risk domains

 

4. assses the patients knoledge and skills for self management

Term

1. Symptoms 2x a week

2. <2nocturnal awakenings

3. use of SABA fewer than 2xa week

4. no change in activities

5. one, or no exacerbations requiring PO steroids

6. FEV1 b/w exacerbations that is normal

Definition
Mild intermittent Asthma
Term

1. Symp >2x a week

2. 3-4 nocturnal awakenings per mo

3. use of SABA > 2 x a week not daily

4. minor interference with ADLs

5. FEV1 normal (>80% predicted)

6. 2 or more exacerbations requiring PO steroids per year

Definition
Mild Persistent asthma
Term

1. Symptoms daily

2. Nocturnal awakenings more than once a wk

3. daily need for SABA

4. Some limitations in nl activities

5. FEV1 b/w 60-80% predicted

6. FEV1/FVC reduced below normal

Definition
Moderate persistent asthma
Term

1. continuous symptoms

2. nocturnal awakenings nightly

3. need for SABA multiple times daily

4. extreme limitation in activity

5.FEV1 <60% predicted

6. FEV1/FVC reduced below normal

7. 2 or more exacerbations requiring oral steroids per year

Definition
Severe Persistent Asthma
Term

Monoclonal ABX that binds to IGE

Must have ALLRGIC ASTHMA and >12 yo

 

mod-severe persistant asthma

High IGE

(+) allergy testing

SQ injection based on BMI

Steroid sparing

Definition

XOLAIR

(Omalizumab)

Term
High Risk Asthma patients
Definition

1. severe air flow obstruction

2. persistent severe airflow obstruction

3. 2 or + ED visits/yr

4. any hx of intubation or ICU

5. pt feels danger or fear of asthma

6. FEMALE, NONWHITE, nonuse of ICS

7. Smokers + drugs

8. depression, stress, low socioeco

9. attitudes about medication use

 

Term
Goals for therapy:
Definition

1. Reduce impairment

2. reduce risk

3. periodic assessments

Term
Education points for asthma patients:
Definition

1. Basic facts

2. Roles of meds and differeneces in meds

3. Patient skills

Term
Risk/complications of asthma:
Definition

1. death

2. fixed airway obstruction

3. status asthmaticus

Term
Different stages of status asthmaticus
Definition

stage 1: SaO2 no, hypervent, PO2

 

Stage 2: Hypervent Hypoxia--> close monitor IRU

 

Stage 3: PCO2 nl "false", resp muscle fatigue, hypoxia=ICU

 

Stage 4: PCO2 high, PO2 low = ICU

Term

Signs/symp:

snoring

witness apnea

EDS

insomnia

non-restorative sleep

GERD

morning headache

Definition
Obstructive Sleep Apnea
Term
No lung in breath for >/+ to 10 sec
Definition
Apnea
Term
airflow reduction + drop in O2 by at least 4%
Definition
Hypopnea
Term
Apnea Hypopnea Index (AHI)
Definition

<5/hr = normal

5-20 = mild - mod

20-40 = mod to severe

>40 = very severe

Term

Test of upper air resistence + arousal

snore + arousal

Respiratory event related arousal

>15/hr abnormal

Definition
Respiratory disturbance index
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