Respiratory

Question 1

Asthma diagnosis <6 years old

Answer 1

• Patient + family hx
• Exlcude other pathology if refractory to tx
• Require all 3 of the following documented during >/ 2 episodes: airflow obstruction (cough/difficulty breathing/wheeze), reversibility of airflow obstructions (improvement with SABA +/- oral steroids), no clinical evidence of alternate diagnosis.

Question 2

Asthma diagnosis >/ 6 years old

Answer 2

• Patient + family hx
• Spirometry or positive methacholine or exercise challenge test or sufficient peak exp flow variability
• Assess for signs of atopy which predicts persistent asthma

Question 3

What to discontinue before spirometry and for how long

Answer 3

ICS +/- LABA 24 hours prior

Question 4

Spirometry asthma diagnosis for children >6 years old

Answer 4

FEV1/FVC < 0.8 - 0.9 AND increase in FEV1 12% with bronchodilator

Question 5

Spirometry asthma diagnosis for adults

Answer 5

FEV1/FVC < 0.75 - 0.8 AND increase in FEV1 12% (>200ml) with bronchodilator

Question 6

PEF asthma diagnosis for children >6 years old

Answer 6

Increase >/ 20% with bronchodilator

Question 7

PEF asthma diagnosis for adults

Answer 7

Increase more than 60L/min (min 20%) with bronchodilator
Dinural variation > 8-10% measured BID

Question 8

Methacholine challenge diagnosis for asthma

Answer 8

PC20 <4mg/mL (4-16 borderline, >16 negative)

Question 9

Exercise challenge diagnosis for asthma

Answer 9

FEV1 decrease more than 10-15% post exercise

Question 10

Good asthma control - freq of daytime symptoms

Answer 10

<2 days / week

Question 11

Good asthma control - freq of nightime symptoms

Answer 11

<1 night / week and mild

Question 12

Good asthma control - symptoms with exercise

Answer 12

Normal

Question 13

Good asthma control - freq of exacerbations

Answer 13

Mild, infrequent
(Mild: increase in symptoms not req systemic steroids or hospitalisation)

Question 14

Good asthma control - freq of absence from work or school

Answer 14

None

Question 15

Good asthma control - freq of need for Ventolin

Answer 15

</2 a week

Question 16

Good asthma control - FEV1 or PEF

Answer 16

> / 90 % personal best

Question 17

Good asthma control - PEF dinural variation

Answer 17

<10-15%

Question 18

Example SABAS for asthma

Answer 18

Ventolin 100mcg 2 puffs q4-6h
Bricanyl turboinhaler (Terbutaline) 2.5mg 1-2 puffs q6h

Question 19

Example ICS and LABA for asthma

Answer 19

NO LABA MONOTHERAPY

Symbicort (budesonide/salmeterol) 2 puff BID
Advair (fluticasone/salmeterol) 1 puff BID

Question 19

Example ICS for asthma

Answer 19

Flovent (Fluticasone) 1 puff BID
Pulmicort (Budesonide) 1 puff BID

Question 20

Example LTRA for asthma

Answer 20

Singulair - montelulast

Question 21

Classifying severity of asthma exacerbation <6/yo

Answer 21

0 - 1 - 2 - 3
SaO2: >/95% - 92-94% - </91% - X
Suprasternal retraction: absent - X - present - X
Scalene contraction: absent - X - present - X
Air entry: normal - decreased bases - decreased apex and bases - minimal or absent
Wheeze: absent - exp - in - audible w/o stethoscope

Question 22

classifying severity of asthma exacerbation >6/yo

Answer 22

Mild - Moderate - Life threatening
Posture: sits, talks in phrases - hunched forward, not full sentences - decreased consciousnesss
Quantitative findings: RR 21-20, no acc muslce use, pulse 100-120, O2 90-95 - RR >30, acc muscle use, pulse >120, O2 <89% - silent chest
Management: yellow zone - urgent transfer to acute care with o2, SABA, ipratropium and reliever

Question 23

Step-up for age 6-11 in yellow asthma plan if on ics

Answer 23

Predisone 1mg/kg x 3-5 days - max 50mg OR Dexamethasone 0.15-0.6 mg/kg/d - max 10mg

Question 24

Step-up for age >/12 in yellow asthma plan if on ics and saba

Answer 24

Increase ICS 4 fold x 7-14d or prednisone 30-50mg >/ 5 days

Question 25

Asthma criteria for hospital admission

Answer 25

Unable to speak sentences
Tachypnea > 25 /min
Tachycardia >110 / bradycardia
PEF <40% predicted
Silent chest
Cyanosis
Confusion