TCD questions - Asthma

Question 1

A 45-year-old man comes in wheezing and short of breath. On examination you can hear breath sounds in his left lung, but you cannot hear any breath sounds in his right lung. What is the most likely diagnosis?

1. Foreign body aspiration.
2. Pneumothorax.
3. Asthma.
4. Left ventricular heart failure.

Answer 1

Answer: foreign body aspiration (unilateral silent chest and wheeze). Pneumothorax wouldn’t cause a wheeze, ventricular heart failure is not unilateral, and a silent chest in not common in asthma

Question 2

Which one of the following is a feature of acute severe asthma?

1. Peak flow of 75% predicted.
2. Respiratory rate >15 per minute.
3. Peak flow of 33-50% of best or predicted.
4. Pyrexia >38.5, productive cough.
5. Talking in full sentences.

Answer 2

Answer: peak flow 33-50% of predicted.

Respiratory rate >25per minute, heart rate >110bpm, inability to complete sentences

Question 3

Interpret this arterial blood gas measure in someone having an asthma attack
Sample on admission (15L of Oxygen)
pH 	        7.45 (7.35-7.45)
PCO2 	4.0 (4.5-6.0)
PO2 	19.3 (10.0-15.0)
HCO3 	25 (22-26)

Answer 3

Answer: no hypoxia, the pH is just within normal limits, but the patient is likely to develop respiratory alkalosis. It is important that the ABG is repeated to ensure Freda does not deteriorate further. The low CO2 indicates hyperventilation from her increased respiratory rate and we would expect higher PO2 levels for a patient on full flow oxygen. This patient needs to be monitored closely with a low threshold for management escalation.

Question 4

A 22-year-old man is about to go home from hospital after a severe exacerbation of his asthma. He is feeling much better on his inhaled corticosteroid, salbutamol, and oral corticosteroids which were prescribed two days ago on the day of his admission. Which one of the following should you do before discharging him?

1. Stop the oral corticosteroids before discharge.
2. Check his inhaler technique and inform his GP of the recent admission.
3. Arrange a home nebuliser.
4. Arrange an outpatient appointment in six months.

Answer 4

Answer: Check his inhaler technique and inform his GP of the recent admission. Follow up should be within two working days, inhaler technique should be checked, and the patient should be issued with a peak flow meter and a written asthma management plan. These measures have been shown to reduce readmission rate

Question 5

A 26-year-old woman has been diagnosed with asthma after being admitted with worsening dyspnoea, wheeze and nocturnal cough. On the ward round, she is told she will commence on salbutamol therapy.
After the ward round, you are asked to prescribe the salbutamol and provide her with information about the new treatment and longer-term management of asthma.
Select the most appropriate information option that should be communicated to the patient from the list provided.
□ It will be several weeks before she gets any benefit from salbutamol.
□ If her asthma symptoms are not controlled, she should take her salbutamol hourly.
□ Bradycardia is a known side-effect.
□ It works by reducing the inflammation and mucus in the airways.
□ She will need to carefully monitor her peak expiratory flow rates using a flowmeter.

Answer 5

Answer: she will need to carefully monitor her peak expiratory flow rates using a flowmeter.

Inhaled salbutamol brings about rapid but short-lived bronchodilation and relief of asthma symptoms.

If asthma symptoms not controlled, she should seek medical review- and avoid another admission.

Salbutamol is not selective for B1-adrenoceptors meaning tachycardia and tremor are known side-effects

Salbutamol provides symptomatic relief in asthma by causing bronchodilation, it has no effect on airway inflammatory exudates of mucus secretion.