Asthma TCD

Question 1

First step of treatment in asthma

Answer 1

Inhaled short acting beta2 agonist

Question 2

Asthma PEFR 80 predicted

Answer 2

Inhaled SABA as required

Add inhaled low dose corticosteroid up to 800ug daily

Question 3

Asthma PEFR 50-80%

Answer 3

Add LTRA, if still bad add LABA or oral theophylline

Question 4

Asthma PEFR 50-80% (2)

Answer 4

Increase inhaled corticosteroid to 2000 ug daily

Question 5

Asthma PEFR 50%

Answer 5

Add 40gm prednisolone daily

Question 6

Asthma PEFR 30% predicted

Answer 6

Hospital

Question 7

Clinical features of severe acute asthma

Answer 7

Inability to complete a sentence in one breath
Resp rate above 25
Heart rate above 110 bpm
PEFR 33-50% of predicted or best

Question 8

Clinical features of life threatening acute severe asthma

Answer 8

Silent chest, cyanosis 
Exhaustion, altered conscious level
Bradycardia or hypotension 
PEFR less than 33% of predicted or best 
PaO2 lerss that 8 kPa

Question 9

Initial treatment of acute severe asthma in hospital

Answer 9

Oxgyen for sats between 94-98 
Nebulized salbutamol 5mg 
Hydrocortisone 200mg I.V 
Antibiotics if evidence of infection 
Fluids

Question 10

Initial investigation of acute severe asthma in hospital

Answer 10

CXR to exclude pneumothorax or pneumonia
Pulse oximetry
ABG if spO2 less than 92%
PEFR before and after treatment
U&Es - steroids and salbutamol may result in hypokalaemia

Question 11

Secondary treatment if life threatening asthma doesn’t improve

Answer 11

Oxygen
Hydrocotisone 200mg every 4 hours
Nebulized B2 agnoist every 10-20 mins
Add nebulized ipratropium bromide 0.5mg 4-6 hourly
Magnesium sulphate 1.2-2g i.v over 20 mins
Inform ICU of possible admissions

Question 12

What is an ominous sign in acute severe asthma?

Answer 12

pH less than 7.35 as that means CO2 retention in tiring patient

Question 13

An increase in the FEV1 of … or more after inhalation of a short-acting bronchodilator is indicative of asthma

Answer 13

An increase in the FEV1 of 12% or more after inhalation of a short-acting bronchodilator is indicative of asthma

Question 14

Asthma treatment in pregnancy

Answer 14

Good control is extremely important, uses all inhaled drugs, pred and theo as normal

Question 15

Respiratory causes of clubbing

Answer 15

Interstitial lung disease, Ca lung, bronchiectasis

Question 16

What is Horner’s sign and what does it tell you?

Answer 16

ptosis and miosis - pancoastal tumor pressing on sympathetic chain

Question 17

Causes if raised JVP in resp exam

Answer 17

RHF, overload, massive PE, tension pneumothorax, cardiac tamponade, SVC obstruction

Question 18

Tracheal deviation

Answer 18

Away from tention pneumothorax and effusion, towards collapse and pneumonectomy

Question 19

Cause of parasternal heave in resp exam

Answer 19

Cor pulmonale

Question 20

Hyper-resonant percussion

Answer 20

air - pneumothorax and emphysematous bullae

Question 21

Dull on percussion

Answer 21

consolidation, aveolar fluid, plural thickening, neoplasm

Question 22

Stony dull percussion

Answer 22

Pleural effusion

Question 23

Vocal resonance is increased in

Answer 23

consolidation

Question 24

Vocal resonance is decreased in

Answer 24

effusion and pneumothorax

Question 25

Causes of diminished breath sounds

Answer 25

local - effusions, tumor, pneumothorax, pneumonia, collapse

Question 26

Causes o bronchial breathing

Answer 26

Consolidation, upper boarder of pleural effusion

Question 27

Cuases of polyphonic wheeze

Answer 27

asthma, COPD

Question 28

Causes of Monophonic wheeze

Answer 28

Carcinoma or foreign body

Question 29

Causes of audible rub

Answer 29

Pneumonia, PE with infacrtion

Question 30

Differentials for decreased unilateral expansion, dull percussion and reduced vocal resistance, and what change would point towards pneumonia?

Answer 30

Differentials are pleural effusion and collapse. If there were increased vocal resonance, pneumonia would be a differential