asthma

A 48-year-old woman presents to her GP with a 3-month history of increasing fatigue, exertional dyspnoea, and a persistent cough productive of small amounts of mucus. She mentions a history of recurrent 'sinus infections' over the past year, often treated with antibiotics. She has recently felt lightheaded on standing. On examination, her blood pressure is 95/60 mmHg, pulse 88 bpm, respiratory rate 20 breaths/min, and oxygen saturation 96% on room air. Chest auscultation reveals diffuse expiratory wheezes. Blood tests performed last week show haemoglobin 85 g/L (reference range 120-150), MCV 72 fL (reference range 80-100), and normal white cell count and platelet count. Spirometry performed concurrently shows an FEV1/FVC ratio of 0.65 (predicted >0.70) with partial reversibility after bronchodilator. Considering the clinical presentation and investigations, what is the most appropriate next step in management?

A 7-year-old boy with a history of asthma presents to the clinic with increased wheezing and shortness of breath over the past week. He has been using his salbutamol inhaler more frequently, but his symptoms persist. His mother reports that he has been waking up at night due to coughing. What is the most appropriate next step in managing this child's asthma?

A 7-year-old boy is brought to the emergency department by his parents due to sudden onset wheezing and difficulty breathing. He has a history of asthma, for which he uses a salbutamol inhaler as needed. His parents report that he had a cold over the past few days, and today he started wheezing and became short of breath. On examination, he is in moderate respiratory distress, with a respiratory rate of 30 breaths per minute, oxygen saturation of 92% on room air, and widespread wheezing on auscultation. What is the most appropriate initial management step for this child?

A 10-year-old boy presents to his GP with a chronic, intensely itchy rash affecting the flexural areas of his elbows and knees, as well as his neck. His parents report that he has had this condition on and off since infancy, with periods of remission and exacerbation. He also has a history of allergic rhinitis and asthma. On examination, the skin in the affected areas is dry, lichenified, and excoriated. There are also scattered papules and plaques. The patient reports significant sleep disturbance due to the itch. Topical corticosteroids have provided temporary relief in the past, but the rash flares up again soon after stopping treatment. Which of the following is the MOST appropriate next step in managing this patient's atopic dermatitis?

A 3-year-old child presents to the clinic with a history of recurrent wheezing episodes, especially during viral infections. What is the most common cause of wheezing in children under 5 years of age?

A 4-year-old child presents with a history of recurrent wheezing and cough, particularly at night and with exercise. What is the most appropriate long-term management strategy?

A 45-year-old woman presents to her general practitioner with a 3-month history of persistent cough and occasional wheezing. She has a history of asthma, which has been well-controlled with inhaled corticosteroids. She denies any recent respiratory infections or changes in her medication. On examination, her vital signs are normal, and there are scattered wheezes on auscultation. Spirometry shows a reduced FEV1/FVC ratio that improves significantly after bronchodilator administration. What is the most appropriate next step in the management of this patient?

An 8-year-old girl presents with chronic night cough and wheezing, with possible asthma. What is the minimum age for spirometry?

A 2-year-old child is brought to the emergency department by their parents due to a persistent cough, wheezing, and difficulty breathing that has worsened over the past two days. The child has a known history of eczema and multiple food allergies, including peanuts and eggs. On examination, the child appears in mild respiratory distress with nasal flaring and intercostal retractions. Auscultation of the chest reveals bilateral wheezing. The child is afebrile, with a respiratory rate of 40 breaths per minute, heart rate of 120 bpm, and oxygen saturation of 94% on room air. A chest X-ray shows hyperinflation but no focal consolidation. Which of the following is the most likely diagnosis?

A 35-year-old woman presents to the emergency department with a 3-day history of fever, chills, and a productive cough with greenish sputum. She has a history of asthma and is currently on inhaled corticosteroids. On examination, her temperature is 38.5°C, blood pressure is 120/80 mmHg, heart rate is 110 bpm, and respiratory rate is 24 breaths per minute. Auscultation of the chest reveals wheezing and crackles in the right lower lung field. A chest X-ray shows consolidation in the right lower lobe. What is the most appropriate initial antibiotic therapy for this patient, considering her asthma and current presentation?

A 4-year-old boy is brought to the clinic by his parents due to a persistent itchy rash on his arms and legs. The rash has been present for several weeks and seems to worsen at night. The child has a history of asthma and allergic rhinitis. On examination, there are erythematous, scaly patches with excoriations on the flexural surfaces of his arms and legs. What is the most likely diagnosis?

A 5-year-old child with a known history of asthma presents with acute shortness of breath and wheezing after playing outside. What is the most appropriate initial treatment?

A 6-year-old child with a history of asthma presents with increased wheezing and difficulty breathing after exposure to cold air. What is the most appropriate immediate management?

A 10-year-old boy with a history of asthma presents to the emergency department with wheezing and shortness of breath. His mother reports that he has been using his salbutamol inhaler more frequently over the past two days. On examination, he has a respiratory rate of 28 breaths per minute, and his oxygen saturation is 92% on room air. What is the most appropriate initial management step?

A 35-year-old woman presents to her GP with worsening shortness of breath, cough, and wheeze over 2 days, requiring her salbutamol reliever daily and waking her at night. Her PEF is 60% of her personal best. She is alert, speaking in sentences, RR 22, HR 95. Based on Australian guidelines, what is the most appropriate initial management step?

A 6-year-old boy is brought to the emergency department by his parents due to sudden onset wheezing and difficulty breathing. He has a history of atopic dermatitis and allergic rhinitis. His parents mention that he was playing outside when the symptoms began. On examination, he is in mild respiratory distress with a respiratory rate of 28 breaths per minute, oxygen saturation of 94% on room air, and bilateral wheezing on auscultation. There is no fever, and his heart rate is 110 bpm. Which of the following is the most likely diagnosis?

A 4-year-old boy is brought to the pediatrician by his parents due to a persistent cough and wheezing for the past two weeks. The symptoms started after he had a cold. He has no significant past medical history and is up to date with his vaccinations. On examination, he is afebrile, with mild respiratory distress and bilateral wheezing on auscultation. What is the most appropriate initial treatment?

A 5-year-old boy presents with wheezing, shortness of breath, and a history of recurrent respiratory infections. His symptoms worsen with exercise and during the night. What is the most likely diagnosis?

A 45-year-old woman presents to the emergency department with a 3-day history of fever, productive cough with greenish sputum, and pleuritic chest pain. She has a history of asthma and is currently on salbutamol and fluticasone inhalers. On examination, her temperature is 38.5°C, respiratory rate is 24 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals decreased breath sounds and crackles in the right lower lung field. A chest X-ray shows a right lower lobe consolidation. What is the most appropriate initial antibiotic therapy for this patient, considering Australian guidelines?

A 3-year-old child is brought to the general practice clinic by his parents due to recurrent episodes of wheezing and cough, particularly following viral upper respiratory tract infections. The child has had multiple similar episodes over the past year, each resolving with bronchodilator therapy. There is no history of eczema or allergic rhinitis, and the family history is unremarkable for atopic conditions. On examination, the child appears well between episodes, with normal growth parameters and no signs of respiratory distress. Auscultation of the chest reveals clear lung fields without wheezes or crackles. Which of the following is the most likely underlying condition?