Asthma management Flashcards
Jake is 12 months old and is prescribed a reliever for intermittent episodes of asthma that require hospitalization at times. What is the MOST APPROPRIATE method of delivering the above medication to Jake?
Question 1Select one:
a.
Aerosol with spacer and mask
b.
Breath-activated aerosol inhaler
c.
Pump / nebuliser with mask
d.
Breath-activated dry powder inhaler
Feedback
Aerosol with spacer and mask
Nebuliser if severely ill/not tolerating spacer
The mother of Erica aged 3 years brings him to see you because in the last 6 weeks she wakes coughing and wheezing 2-3 times a week. She has had three acute episodes of wheezing responding to bronchodilators. She also wheezes when excited or active and suffers from atopic eczema. You make a diagnosis of asthma. What would be the most appropriate medication to prescribe for him as a daily inhaler?
Question 2Select one:
a.
Ipratropium
b.
Fluticasone
c.
Salbutamol
d.
Salmeterol
Fluticasone
Interval symptoms require inhaled steroids
A mother of a 6 year old boy with chronic asthma wishes to discuss his inhaler device with you. He dislikes taking his spacer to school to use with fitness and sports and would like to try a dry powder inhaler. WHICH ONE of the following is the MOST IMPORTANT advantage of a spacer over a dry powder inhaler at this age? A spacer is:
Question 3Select one:
a.
More environment-friendly
b.
Less embarrassing to use
c.
More effective in an attack
d.
More effective before sport
More effective in an attack
Dry powder inhaler require substantial inspiratory effort and flow
An 8 year old boy presents to ED with an acute severe episode of breathlessness. He is staying with relatives who are unsure of his past history. On examination he is alert and anxious with significant accessory muscle use, speech limited to 1-2 words, markedly reduced air entry and soft, scattered wheeze on auscultation. His oxygen saturation is 89% on room air. What is your first step in his management?
Question 4Select one:
a.
Oral prednisone stat
b.
Liberal mask oxygen
c.
Salbutamol via spacer
d.
ABC of resuscitation
ABC of resuscitation
could be inhaled foreign body, pnemothorax. they don’t know he has asthm
Cara, a 14 year old girl maintained on inhaled budesonide via turbuhaler (dry powder inhaler) 800 mcg/day has had worsening asthma since starting high school at the beginning of the year. She has frequent sleep disturbance, and intolerance of normal PE and activity at school. She has required several recent courses of prednisone. Which of the following is THE MOST LIKELY reason for her worsening indicators of asthma control?
Question 5Select one:
a.
Misuses inhaler device
b.
Overuse of salbutamol
c.
Not taking budesonide
d.
Expectations too high
Not taking budesonide
Non-adherence most common
A 6-year-old boy requires fluticasone 1000 µg daily for treatment of severe chronic asthma. WHICH ONE of the following is the MOST APPROPRIATE method of delivering this drug to him?
Question 6Select one:
a.
Nebuliser using a T-piece
b.
Spacer and mask
c.
Dry powder inhaler
d.
Spacer without mask
Spacer without mask
only need mask if 2-3 years old or nose-breathers
The mother of a child of four years old asks your advice about the inhaled medication you prescribed. She is unsure about how to give beclomethasone (inhaled steroid) 100 µg 2 puffs twice daily via the spacer. What is current best practice about delivering the doses in terms of number of puffs of inhaler given into the chamber before breathing?
Question 7Select one:
a.
Three puffs
b.
Two puffs
c.
One puff
d.
Four puffs
One puff
more than one puff = particles collide, too big and fall to bottom
A 4-year-old boy, James has asthma. James’ mother recalls that over the last month, James has had some wheeze on exertion most days and he wakes with coughing 2-3 times per week. He has had 2 attacks of asthma in the last 6 months. What is the most appropriate initial management for James’ asthma?
Question 8Select one:
a.
Oral theophylline 125 mg twice a day
b.
Oral salbutamol 4 mg four times a day
c.
Inhaled fluticasone 50 µg twice a day
d.
Inhaled fluticasone 250 µg twice a day
Inhaled fluticasone 50 µg twice a day
high dose can affect height velocity and adrenal function
A 4-year-old boy, James has asthma requiring inhaled steroids. WHICH ONE of the following would be the MOST APPROPRIATE way to deliver the medication to James?
Question 9Select one:
a.
Dry powdered inhaler
b.
Spacer without mask
c.
Spacer with mask
d.
Breath-activated inhaler
Spacer without mask
WHICH ONE of the following BEST DESCRIBES the preparation required for a spacer. The spacer should be:
Question 10Select one:
a.
Washed in dishwashing liquid and water and hand dried
b.
Washed in pure dishwashing liquid, rinsed and air dried
c.
Washed and hot-air dried in the dishwasher
d.
Washed in dishwashing liquid and water, not rinsed, and air dried
Washed in dishwashing liquid and water, not rinsed, and air dried
hand dishwashing liquid coats the inside and stops deposition of meds
The mother of Jake, aged 12 months, brings him to see you because he has had 3 acute episodes of wheezing, responding to bronchodilators, but no interval symptoms with exercise or at night. He also gets eczema. You diagnose asthma. What is the MOST APPROPRIATE initial treatment for Jake’s asthma?
Question 11Select one:
a.
Inhaled corticosteroids twice daily
b.
Short-acting reliever as required
c.
Short-acting reliever twice daily
d.
Long-acting reliever twice daily
Short-acting reliever as required
No interval symptoms between attacks
