MSN 621 – Respiratory Exam () Questions and
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______ usually presents in childhood and is associated with other features of atopy, such as
eczema and hayfever. - CORRECT ANSWER -asthma
Who is at highest risk for asthma? - CORRECT ANSWER -genetic predisposition, specifically a
personal or family history of atopy (propensity to allergy, usually seen as eczema, hay fever, and
asthma)
What are some triggers to asthma? - CORRECT ANSWER -Viral respiratory tract infections
Exercise
Gastroesophageal reflux disease
Chronic sinusitis
Environmental allergens
Use of aspirin, beta-blockers
Tobacco smoke
Insects, plants, chemical fumes
Obesity
Emotional factors or stress
Asthma is significantly more common in children. Up to 40% of children will have a wheeze at
some point, which, if reversible by ______, is termed asthma, regardless of lung function tests. -
CORRECT ANSWER -beta-2 agonists
Describe ages for asthma. - CORRECT ANSWER -In childhood, asthma is more common in
boys with a male to female ratio of 2:1 until puberty when the ratio becomes 1:1. After puberty,
the prevalence of asthma is greater in females, and adult-onset cases after the age of 40 years are
mostly females. Asthma prevalence is greater in extreme of ages due to airway responsiveness
and lower levels of lung function. Of all the asthma cases, about 66% are diagnosed before the
,age of 18 years. almost 50% of children with asthma have a decrease in severity or
disappearance of symptoms during early adulthood.
Describe the patho of asthma. - CORRECT ANSWER -acute, fully reversible airway
inflammation
The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen
(e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an
increase in mucus production. This leads to a significant increase in airway resistance, which is
most pronounced on expiration.
Airway obstruction occurs due to the combination of:
-Inflammatory cell infiltration.
-Mucus hypersecretion with mucus plug formation.
-Smooth muscle contraction.
These irreversible changes may become irreversible over time due to
-Basement membrane thickening, collagen deposition, and epithelial desquamation.
-Airway remodeling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.
If not corrected rapidly, asthma may become more difficult to treat, as the mucus production
prevents the inhaled medication from reaching the mucosa. The inflammation also becomes more
edematous. This process is resolved (in theory complete resolution is required in asthma, but in
practice, this is not checked or tested) with beta-2 agonists (e.g., salbutamol, salmeterol,
albuterol) and can be aided by muscarinic receptor antagonists (e.g., ipratropium bromide),
which act to reduce the inflammation and relax the bronchial musculature, as well as reducing
mucus production.
Describe the toxicokinetics in asthma. - CORRECT ANSWER -The only relevant toxicokinetics
in asthma relates to its management as the absorption and systemic side effects of the beta-2
agonists must be monitored. Typically these will be removed from the body in 2 to 4 hours if
salbutamol and albuterol, 18 to 24 hours if salmeterol, or 48 to 72 hours if clenbuterol, which is
no longer used in the management of asthma.
,The side effects of the beta-2 agonists include tachycardia, flushing, sweating, and other signs of
sympathetic system overdrive. There is also the chance of iatrogenic hypokalaemia, which must
be monitored.
Describe the history and physical of asthma. - CORRECT ANSWER -wheeze or a cough,
exacerbated by allergies, exercise, and cold
symptoms are worse at night
may give a history of other forms of atopy, such as eczema and hay fever. There may be some
mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing
spells but appear normal in the day time.
Describe the s/s of acute asthma exacerbation. - CORRECT ANSWER -During an acute
exacerbation, there may be a fine tremor in the hands due to salbutamol use, and mild
tachycardia. Patients will show some respiratory distress, often sitting forward to splint open
their airways. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening
asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of
systemic hypoxia.
Describe what a child might look like right before an asthma attack. - CORRECT ANSWER -
Children with imminent arrest may appear drowsy, unresponsive, cyanotic, and confused.
Wheezing may be absent, and bradycardia may occur, indicating severe respiratory muscle
fatigue.
Describe life threatening asthma - CORRECT ANSWER -Life-threatening asthma is a type of
asthma that does not respond to systemic steroids and beta 2 agonist nebulization. It has the
following characteristic findings on examination:
Peak expiratory flow less than 33% of personal best
Oxygen saturation less than 92%
The normal partial pressure of carbon dioxide
Silent chest
Cyanosis
Feeble respiratory effort
, Bradycardia
Arrhythmias
Hypotension
Confusion, coma
Exhaustion
Describe near-fatal asthma. - CORRECT ANSWER -In near-fatal asthma, the partial pressure of
carbon dioxide is raised, or mechanical ventilation is required with raised inflation pressures.
What is a late bedside finding of asthma? - CORRECT ANSWER -Low pulse ox reading.
Describe bedside peak flow measures with asthma. - CORRECT ANSWER -Peak flow measures
also can be used to assess asthma and should always be checked against a nomogram as well as
the individual patient's normal baseline function. The different severities of acute asthma attacks
have an associated peak flow measurement, recorded as a certain percentage of expected peak
flow.
Describe labs with asthma - CORRECT ANSWER -Urea and electrolytes (kidney function)
should be taken if the patient has a high dose or repeat salbutamol, as one of the side effects of
salbutamol is to cause potassium to shift into the intracellular space transiently, which can induce
a transient, iatrogenic hypokalaemia. Eosinophilia is common but is not specific for asthma.
Recent studies show that levels of sputum eosinophils may guide therapy. In addition, some
patients may have an elevation of serum IgE.
Describe ABGs with asthma - CORRECT ANSWER -Arterial blood gas may reveal hypoxemia
and respiratory acidosis. Studies indicate that periostin may be a marker for asthma, but its
clinical role remains unsettled.
Describe the EKG with asthma. - CORRECT ANSWER -An ECG will reveal sinus tachycardia,
which may be due to asthma, albuterol, or theophylline.
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______ usually presents in childhood and is associated with other features of atopy, such as
eczema and hayfever. - CORRECT ANSWER -asthma
Who is at highest risk for asthma? - CORRECT ANSWER -genetic predisposition, specifically a
personal or family history of atopy (propensity to allergy, usually seen as eczema, hay fever, and
asthma)
What are some triggers to asthma? - CORRECT ANSWER -Viral respiratory tract infections
Exercise
Gastroesophageal reflux disease
Chronic sinusitis
Environmental allergens
Use of aspirin, beta-blockers
Tobacco smoke
Insects, plants, chemical fumes
Obesity
Emotional factors or stress
Asthma is significantly more common in children. Up to 40% of children will have a wheeze at
some point, which, if reversible by ______, is termed asthma, regardless of lung function tests. -
CORRECT ANSWER -beta-2 agonists
Describe ages for asthma. - CORRECT ANSWER -In childhood, asthma is more common in
boys with a male to female ratio of 2:1 until puberty when the ratio becomes 1:1. After puberty,
the prevalence of asthma is greater in females, and adult-onset cases after the age of 40 years are
mostly females. Asthma prevalence is greater in extreme of ages due to airway responsiveness
and lower levels of lung function. Of all the asthma cases, about 66% are diagnosed before the
,age of 18 years. almost 50% of children with asthma have a decrease in severity or
disappearance of symptoms during early adulthood.
Describe the patho of asthma. - CORRECT ANSWER -acute, fully reversible airway
inflammation
The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen
(e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an
increase in mucus production. This leads to a significant increase in airway resistance, which is
most pronounced on expiration.
Airway obstruction occurs due to the combination of:
-Inflammatory cell infiltration.
-Mucus hypersecretion with mucus plug formation.
-Smooth muscle contraction.
These irreversible changes may become irreversible over time due to
-Basement membrane thickening, collagen deposition, and epithelial desquamation.
-Airway remodeling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.
If not corrected rapidly, asthma may become more difficult to treat, as the mucus production
prevents the inhaled medication from reaching the mucosa. The inflammation also becomes more
edematous. This process is resolved (in theory complete resolution is required in asthma, but in
practice, this is not checked or tested) with beta-2 agonists (e.g., salbutamol, salmeterol,
albuterol) and can be aided by muscarinic receptor antagonists (e.g., ipratropium bromide),
which act to reduce the inflammation and relax the bronchial musculature, as well as reducing
mucus production.
Describe the toxicokinetics in asthma. - CORRECT ANSWER -The only relevant toxicokinetics
in asthma relates to its management as the absorption and systemic side effects of the beta-2
agonists must be monitored. Typically these will be removed from the body in 2 to 4 hours if
salbutamol and albuterol, 18 to 24 hours if salmeterol, or 48 to 72 hours if clenbuterol, which is
no longer used in the management of asthma.
,The side effects of the beta-2 agonists include tachycardia, flushing, sweating, and other signs of
sympathetic system overdrive. There is also the chance of iatrogenic hypokalaemia, which must
be monitored.
Describe the history and physical of asthma. - CORRECT ANSWER -wheeze or a cough,
exacerbated by allergies, exercise, and cold
symptoms are worse at night
may give a history of other forms of atopy, such as eczema and hay fever. There may be some
mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing
spells but appear normal in the day time.
Describe the s/s of acute asthma exacerbation. - CORRECT ANSWER -During an acute
exacerbation, there may be a fine tremor in the hands due to salbutamol use, and mild
tachycardia. Patients will show some respiratory distress, often sitting forward to splint open
their airways. On auscultation, a bilateral, expiratory wheeze will be heard. In life-threatening
asthma, the chest may be silent, as air cannot enter or leave the lungs, and there may be signs of
systemic hypoxia.
Describe what a child might look like right before an asthma attack. - CORRECT ANSWER -
Children with imminent arrest may appear drowsy, unresponsive, cyanotic, and confused.
Wheezing may be absent, and bradycardia may occur, indicating severe respiratory muscle
fatigue.
Describe life threatening asthma - CORRECT ANSWER -Life-threatening asthma is a type of
asthma that does not respond to systemic steroids and beta 2 agonist nebulization. It has the
following characteristic findings on examination:
Peak expiratory flow less than 33% of personal best
Oxygen saturation less than 92%
The normal partial pressure of carbon dioxide
Silent chest
Cyanosis
Feeble respiratory effort
, Bradycardia
Arrhythmias
Hypotension
Confusion, coma
Exhaustion
Describe near-fatal asthma. - CORRECT ANSWER -In near-fatal asthma, the partial pressure of
carbon dioxide is raised, or mechanical ventilation is required with raised inflation pressures.
What is a late bedside finding of asthma? - CORRECT ANSWER -Low pulse ox reading.
Describe bedside peak flow measures with asthma. - CORRECT ANSWER -Peak flow measures
also can be used to assess asthma and should always be checked against a nomogram as well as
the individual patient's normal baseline function. The different severities of acute asthma attacks
have an associated peak flow measurement, recorded as a certain percentage of expected peak
flow.
Describe labs with asthma - CORRECT ANSWER -Urea and electrolytes (kidney function)
should be taken if the patient has a high dose or repeat salbutamol, as one of the side effects of
salbutamol is to cause potassium to shift into the intracellular space transiently, which can induce
a transient, iatrogenic hypokalaemia. Eosinophilia is common but is not specific for asthma.
Recent studies show that levels of sputum eosinophils may guide therapy. In addition, some
patients may have an elevation of serum IgE.
Describe ABGs with asthma - CORRECT ANSWER -Arterial blood gas may reveal hypoxemia
and respiratory acidosis. Studies indicate that periostin may be a marker for asthma, but its
clinical role remains unsettled.
Describe the EKG with asthma. - CORRECT ANSWER -An ECG will reveal sinus tachycardia,
which may be due to asthma, albuterol, or theophylline.
