Smoking History, Peak Flow Blind or Deaf

Question 1

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

Based solely on this information come up with likely differentials

Answer 1

Asthma

Bronchitis

Question 2

You are the GP

An 68 year old woman has presented with productive cough, wheeze and occasional dyspnoea. She has 30 pack year smoking history

Based solely on this information come up with likely differentials

Answer 2

COPD

Question 3

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Which of the above symptoms would be good to explore first?

Answer 3

Dyspnoea

as this is the most serious

Question 4

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Take a focused HxPC

Answer 4

TOP ERA

T - duration
O - sudden / gradual
P - worse / better / same

E - cold weather
E - time of day
E - dust 
E - allergies
E - NSAIDs

A - Eczema

Question 5

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Take a focused PMHx

Answer 5

Previous episodes
Admitted to ITU
Ongoing medical problems

Question 6

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Take a focused FHx

Answer 6

FHx

• allergies
• eczema
• asthma
• respiratory problems

Question 7

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Take a focused DHx

Answer 7

Name
Dose
Frequency
Reason

Allergies to penicillin

Question 8

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You initially suspect asthma and begin to take a history. Take a focused SHx

Answer 8

Smoking

Alcohol

Question 9

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You suspect asthma and take a structured but focused Hx. On respiratory examination what would you expect to hear?

Answer 9

Wheeze

Question 10

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You suspect asthma and take a structured but focused Hx. You have completed the examination. What should you now do?
You can also do this at the end of the history.

Answer 10

Summarise

Main Concern
\+ve symptoms
-ve symproms 
AOB 
Examination findings

Question 11

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You suspect asthma and take a structured but focused Hx. You have completed the examination and summarised. Which Igx are useful to help confirm asthma

Answer 11

PEF

Spirometry

Question 12

You are the GP

An 18 year old girl has presented with cough, wheeze and occasional dyspnoea. Not coughing up and phlegm.

You have

• Hx + examination
• Summary
• Diagnosed Asthma
• About to take a PEAK FLOW reading

The patient is blind
How should you start the instructions?

Answer 12

 WIPER