Question

 

A 15-year-old white female with a history of asthma since early childhood.

He diagnosis with asthma and Contraception initiation

Question

1. Diagnosis asthma

a. Explain the Pathophysiology of asthma

b. What is the therapeutic regimen of asthma?

c. What labs can you order for this patient?give the definition and Description of the Test. At least 2 labs

d. Significance of the Test Being Ordered for this Patient

E. What medication would give to this patient et why?

2. Diagnosis: Contraception initiation

a. Explain the Pathophysiology of Contraception initiation

b. What is the therapeutic regimen of Contraception initiation?

c. What labs can you order for this patient?give the definition and Description of the Test. At least 2 labs

d. Significance of the Test Being Ordered for this Patient

E. What medication would give to this patient et why?

 

Answer 1

a)

PATHOPHYSIOLOGY OF ASTHMA

Asthma is a syndrome characterized by airflow obstruction that varies markedly , both spontaneously and with treatment.

In asthma patients, the airways are highly responsive to variety of extrinsic and intrinsic stimuli , causing airway narrowing and reducing airflow. Airway hypersensitivity will occur.

The airway inflammation is charecterised by increasing number of eosinophils , T cells and mast cells in the airway mucous, and by desquamation of the airway epithelium. Recurrent inflammation is associated with remodeling of the airway walls as a result of epithelialization ( formation of goblet cells) , subepithelial fibrosis , smooth muscle hypertrophy and proliferation of submucosal glands.

Airflow is limited by smooth muscle constriction , airway mucosal edema, and secretory accumulation. Most of these changes are reversible, but some are not. A variety of mechanisms act together with airway inflammation to promote airway hyperresponsiveness is mostly promoted by reducing the inflammation, while progressive structural changes gradually aggregate airway hyperresponsiveness.

Much remains unknown regarding the mechanism of airway inflammation. However, based on the hypothesis that the cytokines secreted by activated T cells Play a central role, airway inflammation is thought to be an inflammatory cascade producing repeated interaction of cytokines and inflammatory mediators released from eosinophils, basophils , mast cells and sometimes neutrophils , as well as from the airway structural cells such as epithelial cells and fibroblasts.

In the airway of an asthma patient, there is infiltration by inflammatory cells ( including eosinophils, T cells, mast cells , Basophils and Neutrophils ) with vasodilation.

b)

THERAPEUTIC REGIMEN OF ASTHMA

The therapeutic regimen of the Asthma include-

* Non-pharmacological

* Pharmacological

Non-pharmacological regimen of Asthma are :-

* Avoid triggers

- Use your air-conditioner :- air conditioning reduces the amount of Airborne pollens from trees , grasses and weeds that finds its way indoors.

- Decontaminate your decor

- Maintain optimal humidity

- Prevent mold spores :- clean damp areas of the bathroom, kitchen and around the house to keep mold spores from developing.

- Reduce pet dander

- Clean regularly

- Cover your nose and mouth if it's cold out.

* Stay healthy

- Get regular exercise:- regular exercise will strengthen heart and lungs, which helps relieve asthma symptoms.

- Maintain a healthy weight :- being overweight can worsen asthma symptoms, and it puts you at higher risk of other health problems.

- Control heart burn and gastroesophageal reflux disease :- the acid reflux causes heartburn may damage lung airways and worsen asthma symptoms.

c)

Lab tests

* Allergy testing :- performed by a skin test or blood test. If you are allergic to pets , dust, mold or pollen . If allergy triggers are identified, your doctor may recommend allergy shots.

* Nitric oxide test :- this test measures the amount of the gas nitric oxide in your breath. When your airways are inflamed- a sign of asthma- you may have higher than normal nitric oxide levels.

* Sputum eosinophils :- In this test, looks for eosinophils in the mixture of saliva and mucus ( sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose coloured dye.

E)

MEDICATIONS ( PHARMACOLOGICAL TREATMENT)

* Prevention of antigen-antibody reaction :- avoidance of antigen hyposensitization - possible in extrinsic asthma and if antigen can be identified.

* Neutralization of IgE ( reaginic Antibody) :- Omalizumab

* Suppression of inflammation and bronchial hyperreactivity :- corticosteroids

* Prevention of release of mediators :- mast cell stabilizers

* Antagonism of released mediators :-

- Leukotriene

- Antagonist

- Antihistamines

- PAF Antagonists

* Blockade of constrictor neurotransmitter :- anticholinergics

* Mimicking dilator neurotransmitter :- sympathomimetics

* Directly acting bronchodilatiors :- Methylxanthines