12/4

Question 1

Describe the steps of asthma management

• stays pretty much the same for adults and children

Answer 1

1. SABA
2. ICS (low dose)
3. LABA OR MART
4. ICS dose increase OR + montelukast
5. Specialist review

Question 2

When do you move up a step in asthma management

Answer 2

Needing SABA >3/wk OR >1/wk of waking at night

Question 3

What indicates a mild/moderate/high dose ICS

Answer 3

Mild <400 micrograms
Moderate 400-800 micrograms
High >800 micrograms

Question 4

What is MART?

Answer 4

Maintance and reliever therapy - one inhaler that replaces all else

Combo of ICS + SABA + LABA (fometerol - rather than salmeterol)

Question 5

How do you reduce someone’s ICS dose?

Answer 5

ICS by 25-50%

Question 6

Catergorise each of the following symptoms into acute/life-threatening/moderate/near-fatal asthma attack:
- can’t complete sentences
- PaCO2 >6
- normal speech
- RR >25
- O2 sats <92%
- silent chest
- PEFR <33%
- Cyanosis
- Bradycardia
- Confusion
- PEFR 33-50%

Answer 6

Moderate
- normal speech
- PEFR 50-75%

Severe
- can’t complete sentences
- PEFR 33-50%
- RR >25

Life-threatening
- PEFR <33%
- confusion
- bradycardia
- cyanosis
- silent chest
- O2 <92%

Near-fatal
- PaCO2 >6

Question 7

What should patients be started on post asthma attack?

Answer 7

40-50mg prednisolone (PO) for 5 days

Question 8

How does your acute management change for a pt with near-fatal asthma attack?

Answer 8

ITU referral

Question 9

How do you invx and manage a pt with occupational asthma?

Answer 9

serial PEFR at work and away from work

If suspected - refer to resp

Question 10

What supplies the intrinsic muscles of the hand?

Answer 10

All are ulnar except from median - LOAF of Bread

lateral two lumbricals
Opponens pollicus
Abductor pollicus bervis (B in bread = aBductor)
Flexor pollicis brevis

Question 11

Management of ectopics

bCG cut-off

Answer 11

Clinically stable and bCG <5000?

Yes = expectant management
- continually assess hCG levels
- sometimes methotrexate - if pain free and willing for followup

No = salpinectomy
- if patient becomes more unstable or hCG rises refer to surgical management too

Question 12

If an asymptomatic pt presents with abnormal HbA1c or fasting glucose what must be done?

Answer 12

Second abnormal reading to confirm before starting treatment

Question 13

How do you remember the staging of ovarian cancer?

Answer 13

1 = limited to the ovary

2 = pelvis (2 syllables)
3 = abdomen (3 syllables)
4 = metastases (4 syllables)

Question 14

What kind of lobe is associated with each of the following seizure presentations:
- Jacksonian movement (clonic movements travelling proximally)
- aura, lip smacking and clothes plucking
- visual abnormalities
- sensory abnormalities
- auditory hallucinations

Answer 14

1. Frontal lobe
2. Temporal lobe
3. Occipital lobe
4. Parietal lobe
5. temporal lobe