1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.2. Report new knowledge
1.2.1. mechanism of wheezing
1.2.1.1. high pitch sound which is a consequence of vibration due to obstruction caused by bronchoconstruction and hyper mucus secretion, mainly related to respiratory problems
1.2.1.1.1. two types: localized and diffused
1.2.2. mechanism of asthma
1.2.2.1. hetrogenous syndrome characterized by airway obstruction and hyper responsiveness, triggered by allergen which leads to inflammation of the airway
1.2.2.1.1. two phases: early phase (bronchoconstruction, mucus hyper secretion and epithelial damage) mediated by IgE (vegus innervation). the chronic phase which is mediated by IL-2,IL-3 and many other mediators (by mast cell granulation)
1.2.3. medications and allergies that cause these symptoms
1.2.3.1. NSAID and ACE inhibitors can induce asthma also beta-blockers.
1.2.4. how could tolerance happen to allergen
1.2.4.1. allergen-immuno therapy: given a small doses of the allergen at the beginning will have immune reaction but later the patient will have tolerance (LOOK FOR THE NAME OF THE TECHNIQUE)
1.2.4.2. not exposing to the allergen for a period may lead to develop tolerance
1.2.5. eczema and its relation to asthma
1.2.5.1. relation to allergy also
1.2.5.1.1. cow's milk allergy
1.2.5.1.2. children of parents who are asthmatic or allergic to some types of food are more susceptible to get asthma (2.5-5%)
1.2.5.2. atopic syndrome can present with these symptoms
1.2.5.3. skin test can be performed to detect the allergen
1.2.5.4. children usually develop food allergy then they will have asthma
1.2.5.5. TCNP protein which will be released by the skin to the blood will reach the lung and cause these symptoms
1.3. 40 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. Atopic asthma
2.2. Mechanism
2.2.1. genetic predeposition
2.2.2. environmental exposure to allergen
2.2.3. Eczema
2.2.4. type 1 hypersenstivity (IgE mediator)
2.2.5. previous eczema and cow milk allergy
2.3. Presentation
2.3.1. intermittent dry cough with sputum sometimes
2.3.1.1. at night
2.3.1.2. after exercise
2.3.2. wheezing
2.3.3. runny nose
2.3.4. shortness of breath
2.4. Supporting data
2.4.1. oximetry test was 94
2.4.2. respiratory rate is 30
2.4.3. wheezing during expiration
2.4.4. family history of asthma
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complain
3.1.1.1. coughing the whole night, the symptoms was less that's why she didn't came before, no heamoptosis but there are sputum sometimes and the cough usually dry, runny nose, no fever, shortness of breath and wheezing
3.1.2. Previous medical / surgical history
3.1.2.1. No previous medical condition
3.1.2.2. normal delivery and development
3.1.3. Drug history / allergy
3.1.3.1. inhalers (Sulbtamol)
3.1.4. Family history
3.1.4.1. mother is atopic asthmatic
3.1.4.2. father is asthmatic
3.1.4.3. old brother used to have asthma ( symptoms free now), HE HAS ECZEMA, HE has exercise induced asthma, was treated
3.1.5. Social / occupational history
3.1.5.1. was doing regular activity but with limitation
3.1.5.2. father is a smoker (20 cig/day), mother quieted smoking ( she was a smoker during the pregnancy)
3.1.5.3. NO pets in the house
3.1.5.4. breast fed for 6 months only
3.1.5.5. live in a villa
3.1.5.6. middle class family
3.1.5.7. regular islamic family
3.1.5.8. the mother is a teacher and the father is a builder
3.1.5.9. taking care well to their child
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. Normal vital signs except for the respiratory rate
3.1.7.1.1. respiratory rate was 30/min
3.1.7.2. wheezing is heard during expiration
3.1.7.3. Ht. 104 cm and Wt.16 kg
3.1.8. tests results
3.1.8.1. oximetry test was 94
3.1.8.2. spirometry test NO clear data