Respiratory

Question 1

STOP-BANG Score

Answer 1

Screening for OSA

S - SNORE - loudly enough to be through closed doors or if partner elbows you
T - TIRED - do you often feel tired, drowsy or sleepy during daytime (falling asleep during driving or while talking to someone)
O - OBSERVED - has anyone observed you stop breathing or choking/gasping during sleep
P - PRESSURE - do you have or are you being treated for high blood pressure

B - BMI > 35kg/m2
A - AGE > 50 years
N - NECK SIZE > 40cm
G - GENDER Male

LOW RISK - 0-2
INTERMEDIATE RISK - 3-4
HIGH RISK - 5-8

Question 2

Asthma definition

Answer 2

Chronic inflammatory disease

Sx include recurrent cough, wheeze, shortness of breath and chest tightness

Reversible with common triggers
- RTI
- exercise
- passive smoking
- allergies

Features that make asthma more likely
- symptoms worse at night or early morning
- night time waking
- multiple triggers - RTI, dust mites, pollen, exercise, cold air
- history of atopy (allergic rhinitis)
- relief of sx with SABA

Question 3

Wheeze vs Asthma

Answer 3

Wheeze is common in children

30% prevalence in pre-schoolers
Most kids 1-5years Will have viral induced wheeze that responds to bronchodilators but won’t go on to develop asthmA

Prevalence drops to 15% for school aged children most of whom will have asthma

Management principles for adolescents (aged > 12 years) are different to children reflecting their increased risk for poor control and severe asthma

Question 4

Asthma history questions

Answer 4

• Age at diagnosis
• Current asthma medications and asthma action plan
• Severity of flare ups
• Current sx - assess current controls
  — Night time waking / Early morning waking
  — Frequency of cough and wheeze per week
  — Any limitation on ADLs
  — Frequency use of SABA

Atopic History - allergic rhinitis and food allergies

Triggers and Environmental factors
- aeroallergens - dust, pollen, animal dander, mould
- RTIs
- Cold air
- exercise
- smoking
- change in weather - thunderstorms
- GORD
- NSAID and Beta Blockers
- Food (sulphites) cold drinks
M

Question 5

PERC and WELLS

Answer 5

WELLS
- clinical signs and symptoms of DVT - 3
- PE most likely diagnosis - 3
- Heart rate >100 - 1.5
- immobilisation for 3 days or surgery last 4 weeks - 1.5
- Previous PE or DVT - 1.5
- haemoptysis - 1
- malignancy tx within 6 months or palliative - 1

Wells > 4 = HIGH RISK - warrants imaging
Wells < 4 = LOW RISK - makes PE less likely but doesn’t rule it out - go to PERC Rule

PERC Criteria
- <50 years
- Pulse <100
- SaO2 95
- no haemoptymis
- no oestrogen use
- no surgery or trauma requiring hospitalisation last 4 weeks
- no prior VTE
- no unilateral leg swelling

If YES to all of above the PERC rule is NEGATIVE no further testing required and PE safely excluded

If PERC > 0
Then D-dimer
If D- dimer positive then CTPA