Asthma and related MCQs by Dr chaitanya Joshi

Asthma lecture ppt and related multiple choice question for NHPC, Nursing, Nclex and PSC 2024

Asthma inhaler MDI device

Table of contents (toc)

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Introduction of asthma

Asthma is a Chronic inflammatory condition of airway Characterized by

• 1. airway limitation: reversible
• 
  
• 2. airway hyperresponsiveness
• 
  
• 3. inflammation of bronchi T cell mediated, eosinophilic, hypertrophy, mucus plugging

Classification of asthma

Extrinsic asthma

• Atopy (allergy)
• Positive skin prick test
• Childhood asthma a/w eczema

Intrinsic asthma

• Middle age
• No cause
• May show positive skin prick test
• External stimuli sensitization like toulene, NSAIDs,  beta blockers etc
• Etiology and precipitating factors

Clinical features of asthma

• Typical recurrent episodes with normal life in between
• Wheezing
• SOB
• Chest tightness
• Cough
• Classical diurnal pattern with symptoms worse in morning and night
• Cough and wheeze disturb sleep – nocturnal asthma

Diagnosis of asthma

• Mostly clinical diagnosis
• Symptoms improvement following bronchodilator and corticosteroid
• Diurnal variation on 3 days a week for 2 weeks on PEF diary
• PEF decrease after 6 min of exercise
• Investigations 
• PFT
• Exercise test
• Histamine or methacholine bronchial provocation test
• Corticosteroids trial
• Exhaled NO test
• Blood and sputum workup
• CXR
• Skin prick test for allergen

Management of asthma- treatment of asthma

Symptoms control for asthma

• Restore normal lifestyle
• Reduce risk of recurrent and severe attacks
• Enable normal growth and nutrition
• Family education and counselling
• Avoid under or overtreatment

Extrinsic factor control for asthma

• Pet
• Dust
• Smoke
• Medicine like NSAID, antibiotics
• Allergens
• Pollens 
• Pharmacological treatment
• Step down therapy
• Once control established, dose of corticosteroid titrated to the lowest dose 
• Decreasing dose of ICS around 25-50% every 3 months, a reasonable strategy for many

AE of asthma

• Aka acute severe asthma
• Treatment done at ER or on the way
• Bronchodilators, nebulization, high dose steroids etc.
• May even lead to death if not treated on time
• Pack year calculation

Flapping tremor

• Please refer to the slides

Fine tremor

• Please refer to the slides

Drugs used for asthma

• Please refer to the slides

Modified MRC scale of SOB

• Please refe to the slides below

COPD types

Two classical phenotypes

• Pink puffers:

• Thin, breathless and maintain a normal PaCO2 until the late stage of disease Emphysema, Compensated by hyperventilation, so ABG is normal

• Blue bloaters: 

• Hypercapnia> Early stage, Chronic bronchitis, Due to obstruction Co2 retention, may develop oedema and secondary polycythaemia

Barrel chest

Please refer to the slides

Multiple Choice Questions  related to respiratory system

• What is asthma attack?

• When the lungs is filled with water 
• When airways tighten and the lungs don’t get enough air
• When the heart beats too fast 
• When the heart and lungs are working too hard 

Ans: b (When airways tighten and the lungs don’t get enough air)

• Which of the following is not the characteristic of asthma? 
• Increase in IgG immunoglobulins 
• Airway hyperresponsiveness 
• Infiltration of eosinophils into the airways 
• Increased mucus production

Ans: a (Increase in IgG immunoglobulins)

• The immediate response of asthma involves:

• • Mast cell degranulation
• • Binding of antigen to IgE on macrophages
• • Release of cytokines
• • Activation of cholinergic nerves

Ans: a (Mast cell degranulation)

• Chronic asthma is associated with:

• • Activation of T lymphocytes
• • Reduced function of goblet cells
• • Activation of eosinophils
• • Decreased permeability of submucosal capillaries

Ans: c (Activation of eosinophils)

• Which test is NOT used during diagnosis of asthma?

• • Diffusing capacity
• • Peak expiratory flow rate
• • Bronchodilator challenge test
• • Skin prick test

Ans: a (Diffusing capacity)

• A diagnosis of severe asthma should be made after about how many months of uncontrolled asthma?

• • 1 month
• • 3-6 months
• • 6-9 months
• • More than 9 months

Ans: b (3-6 months)

• When a patient is diagnoses with severe asthma, which of the following is recommended?

• • Referral to specialist
• • Increased dosage of patient’s current medication
• • Education about risk factors and triggers such as smoking
• • Treatment of comorbidities and triggers such as smoking

Ans: a (Referral to specialist)

• Which drug is most commonly prescribed preventer therapy in asthma?

• • Beta2 adrenoreceptor agonists
• • Xanthine such as theophylline
• • Muscarinic receptor antagonists
• • Inhaled steroids

Ans: d (Inhaled steroids)

• Once a patient is diagnosed with asthma and referred to specialist, what does GINA recommend next step?

• • Referral to mental health professional
• • Increased dosage of patient’s current medication
• • Assessment of patient’s inflammatory phenotype
• • Hospitalization for intense observation

Ans: c (Assessment of patient’s inflammatory phenotype)

•  Acute management of asthma include all of the following, EXCEPT: 

• A high concentration of oxygen to achieve oxygen saturation of >90%
• Short acting beta-2- agonists 
• A slow infusion of aminophylline with monitoring blood values 
• A rapid infusion of dopamine 

Ans: d (A rapid infusion of dopamine)

Thank you!

Asthma and COPD lecture slide and Video Lecture

A doctor viewing x-ray of asthma patient

Thank you very much