Acute respiratory medications.

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A 26yr old patient is acutely short of breath with asthma. Which of the following options would be a reasonable starting treatment using Salbutamol?

4 puffs of their metered inhaler.

2.5mg of Salbutamol via a nebuliser.

12 puffs of their metered inhaler (100mic per puff) via a spacer.

4 puffs of their metered inhaler (100mic per puff) via a spacer.

Spacers deliver the drug as well as nebulisers. 4 puffs via the spacer is too low and if you are going to use a nebuliser then use a 5mg nebule.

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Which is the following statements is CORRECT in the use of steroids in acute asthma?

Give oral Prednisone 50mg or Hydrocortisone 200mg IV.

In some patients with egg allergy it can cause paradoxical bronchocostriction.

It begins to work in 4 to 6hrs.

Hydrocortisone will precipitate if given in the same IV line as Salbutamol.

Generally it is thought that steroids start to work after 2-4 hours but some say earlier.

Use IV Hydrocortisone in severe asthma.

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Which of the following is INCORRECT about Ipratropium (Atrovent)?

It is an anticholinergic agent.

It antagonises the bronchoconstrictor effects of vagal impulses.

It acts slower than salbutamol.

It can cause bradycardia.

Being an anticholinergic agent it may cause tachycardia not bradycardia.

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What is a reasonable initial antibiotic regime for a patient who has moderately severe community acquired pneumonia. They live in the tropics, is diabetic, and has a heavy ETOH use?

Augmentin IV and Azithromycin orally.

Ceftriaxone 2gms daily IV and Doxycycline orally.

Ceftriaxone 2gms daily IV and Gentamicin 5mg/kg IV.

Meropenum 500mg q8hr IV.

Apart from your usual suspects you are trying to also cover for Meliodosis (B. pseudomallei).

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What organism causes "Kangaroo flu"?

Coxiella burnetii.

Chlamydia pneumoniaa.

Strep pneumonia.

Mycoplasma pneumonia.

Chlamydia pneumonia can infect kangaroos but not commonly. Coxiella burnetii causes Q fever and this causes what is sometimes called "kangaroo flu".

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What is the main reason that Ketamine has a role in acute life threatening asthma?

It relaxes bronchial smooth muscle and decreases agitation.

It acts as a sedative.

It is anti inflammatory.

It decreases the heart rate and BP.

Ketamine is very useful in severely short of breath patients to assist them to tolerate Bipap.It also is a bronchodilator.

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If a 60yr old man presents with fever, cough and stridor at rest which of the following would be the most useful first medication to administer in the ED?

Ceftriaxone 1gm IV.

Hydrocortisone 100mg IV.

Adrenaline 4mg via nebuliser.

Adrenaline 100mic IV.

It sounds like an infective cause of acute upper airway narrowing. Antibiotics and steroids will likely play a role but nebulised adrenaline, like in a child with croup, will give rapid improvement and buy you time.

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Aminophylline intravenously is used rarely for treating acute severe asthma in Australia. Why is that?

It can cause tachyarrhythmias.

It has not been shown to add bronchodilation when patients are on maximum steroids and B Agonists.

It often causes nausea and vomiting.

All of the above.

Aminophylline relaxes smooth muscle and improves the force of respiratory muscles. However it has a small window between a therapeutic and toxic dose.

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Which of the following would fit with the therapeutic guidelines for the trreatment of moderately severe community acquired pneumonia in an adult patient who has no drug allergies?

Benzyl Penicillin 1.2gm q6hr IV + Doxycycline 100mg q12hr po.

Ceftriaxone 1gm daily IV + Doxycycline 100mg q12hr po.

Augmentin 1.2gm q8hr IV + Azithromycin 500mg daily po.

Augmentin 1.2gm q8hr IV + Doxycycline 100mg q12hr.

Using Ceftriaxone 2gm IV is advised if the patient has a not severe allergic reaction to Penicillin. Instead of Doxycycline you could have used Azithromycin or Clindamycin orally with your Benzyl Penicillin IV.

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All but one of the following were put forward as cures for Covid. Which one did I make up?

alternative-coronavirus-masks-max-siedentopf_dezeen_2364_sq_a

Drinking Indian cow urine and applying cow dung to your body.

Applying homeopathic pellets, said to contain dust of shooting stars, to patients in Steiner hospitals.

Snorting cocaine to purify the nose and not allow the virus in.

Bathing in a jelly mixture of Listerine and gelatin.

There were a large number of rubbish, misguided "cures". Donald Trump did not help with his support for unproven therapies.