Asthma

Question 1

What is asthma

Answer 1

chronic inflammatory condition of the airways that causes episodic exacerbations of bronchoconstriction.
Reversible airway obstruction that typically responds to bronchodilators such as salbutamol

Question 2

Presentation indicting asthma

Answer 2

Episodic symptoms
Diurnal variability. Typically worse at night.
Dry cough with wheeze and shortness of breath
A history of other atopic conditions such as eczema, hayfever and food allergies
Family history
Bilateral widespread “polyphonic” wheeze heard by a healthcare professional

Question 3

Diagnostic test for asthma

Answer 3

Fractional exhaled nitric oxide
Spirometry with bronchodilator reversibility

Question 4

NICE management for asthma

Answer 4

NICE guidelines state that the mainstay of asthma management is as follows:
1st line: SABA
2nd line: Add low-dose ICS (SABA + ICS)
3rd line: Trial additional LTRA for 4-8 weeks (SABA + ICS + LTRA)
4th line: If LTRA does not control, stop LTRA and start LABA (SABA + ICS + LABA)

Question 5

Staging of COPD

Answer 5

FEV1/FVC <0.7 with reduced FEV1 and reduced FVC indicates an obstructive picture;
FEV1/FVC >0.7 with reduced FEV1 and reduced FVC indicates a restrictive picture

Question 6

Seizures + effects

Answer 6

Seizures in the temporal lobe tend to cause memory phenomena like deja vu, as well
as hallucinations of smell or taste (uncal involvement) or sound (auditory cortex).
They may also experience automatisms such as lip-smacking, chewing or fiddling
- Seizures in the frontal lobe tend to cause motor features such as the Jacksonian
march where the seizure ‘marches’ up or down the motor homunculus starting in face
or thumb
- Seizures in the parietal lobe tend to cause sensory disturbances such as tingling,
numbness or pain
- Seizures in the occipital lobe tend to cause visual disturbances such as spots, lines
or flashes

Question 7

Dementia

Answer 7

Vascular dementia is characterised by a stepwise deterioration. There will be periods of stable symptoms followed by a sudden increase in severity. Usually caused by multiple small infarcts

Amnesia usually affects short-term memory and does not cause a change in behaviour or cognition.

Alzheimer’s will cause a steadier decline in symptoms and an MRI may show atrophy
of the brain.

Dementia with Lewy bodies will lead to memory loss with Parkinsonian symptoms as well - e.g. tremors, rigidity and bradykinesia. The difference between this and Parkinson’s is that dementia is the presenting issue rather than Parkinson’s.

Frontotemporal dementia is progressive dementia more common in those under 65. Will have atrophy of the frontal and temporal lobes and present with behavioural issues, progressive aphasia (slow, difficult speech) and semantic dementia (issues
with understanding).

Question 8

A 62 year old man came into an orthopaedic clinic, he suffers from carpal tunnel
syndrome, he has tried splinting and steroid injections. You are now discussing surgical
options, what is cut to release pressure on the median nerve?

Answer 8

Transverse carpal ligament

Question 9

Risk factors for empyema

Answer 9

pneumonia, chest surgery, chest abscesses

purulent fluid in the pleural space

Question 10

Management of Addisonian crisis

Answer 10

involves obtaining IV access and giving hydrocortisone 100mg stat dose
and if features of haemodynamic compromise are present commence volume replacement
with 0.9% sodium chloride if shocked.