The document discusses the diagnosis and management of acute severe asthma. Key points include: - Physical exam should check pulse, respiratory rate, use of accessory muscles, and bilateral rhonchi. - Differential diagnosis to consider includes acute exacerbation of COPD, acute left ventricular failure, and pulmonary embolism. - Preferred initial treatment is salbutamol nebulization, steroids (methylprednisolone IV), and supplemental oxygen. - Other supportive therapies include inhaled beta agonists, aminophylline IV, and magnesium sulfate. Close monitoring for side effects is important.

1. SPMP ON ASTHMA Dr. S. Aswini Kumar. MD A 15 year-old boy is brought to the casuality department with severe dyspnoea V. 01. The histories suggestive of acute severe asthma are the following EXCEPT: A. Episodic wheeze B. Eczematous dermatitis C. Asthmatic medications D. B/L pitting pedal edema E. Allergic rhinitis V. 02. One should examine for the following physical signs: A. Pulse rate B. Respiratory rate C. Accessory muscles working D. Bilateral rhonchi E. All the above V. 03. All the following physical signs indicates severe asthma EXCEPT: A. Pulsus paradoxus B. Inability to speak in full sentences C. Central cyanosis D. Silent chest E. Reduced respiratory rate V. 04. The first investigation to be done on an emergency basis is: A. PEFR B. ABG C. CXR D. ECG E. BRE V. 05. Differential diagnosis to be considered before starting treatment are the following EXCEPT: A. Acute Exacerbation of COPD B. Acute LVF, C. Pneumothorax, D. Pontine Hemorrhage E. Recurrent Pulmonary Embolism V.06. The preferred mode of therapy is: A. Dexamethazone 1mg SC tid B. Deriphyllin 400mg IV bolus C. Salbutamol Nebulisation D. Frusemide 40mg IM E. Digoxin 1mg IV V. 07. Dose of nebulized salbutamol in the management of acute severe asthma is A. 25mg IV 8 hourly B. 2.5mg solution in 20min repeat q 1h-2h-4h C. 1.25mg subcutaneous bid D. 15.0 mg nebulized q 10m E. None of above V. 08. The following about use of steroids in Acute Severe Asthma are true EXCEPT: A.Indicated in all severe cases B.Potent anti inflammatory action C.No absolute contraindication D.Preferably Methyl prednisolone IV E.Inhaled steroids not useful V. 09. The following statements about Steroid administration are true EXCEPT: A.Methyl prednisolone 125mg IV B.Methyl prednisolone 40-60mg q 6h for 48h C.Steroid as MDI with spacer as effective as IV D.Prednisolone 20-40mg tid orally for 7 days E.Short term steroids always needs tapering dose V. 10. Other modalities of treatment are the following EXCEPT: A. Terbutaline 0.5mg SC q 8h B. Deriphyllin 100mg IM q8h C. Adrenaline 0.6mg IV q 8h D. Aminophyllin 500mg Iv infusion E. Ipratropium Nebulisation V. 11. Aminophyllin injection is given as 250mg in 20ml of 25% dextrose slow IV if none of the following contraindications exist: A. BP <90 B. History of seizures C. Allergy to theophyllin D. Quinolone administration E. All of the above V. 11. Dose of theophyllin should be reduced to half or stopped if theophyllin toxicity can be identified by the presence of: A. Nausea and vomiting B. Tachycardia and hypotension C. Agitation or seizures D. Concentration >20ug/ml E. All of the aboveV. 13. As supportive therapy all of the following are useful EXCEPT: A.Oxygen inhalation B.Propped up position C.Morphine injection D.IV fluids E.Nebulisation N acetylcystine V. 14. The following statements regarding use of adrenaline in ASA are true EXCEPT: A.Dose is 0.3 to 0.6ml SC B.Must be given in all patients C.Safe in children below 18 D.Unsafe in old people E.Contra indicated in CAHDV. 15. Herst method in the management of Acute Severe Asthma is the administration of: A.Adrenaline by nurse B.Aminophyllin as drip C.Salbutamol Nebulisation D.Steroid containing MDI E.Adrenaline given S/C by doctor minute by minute minim by minim V. 16. The following treatment can be used as follow up A.Budesonide rotacaps BD B.Ambroxol sodium tid C.Prednisolone 40mg od D.Salbutamol MDI SOS E.All the above V. 17. If the patient complaints of left sided chest pain, give: Diclofenac Sodium 50mg IM stratum Pethidine 50 mg IM stratum Paracetamol 150 mg IM stratum Diazepam 10 mg orally stratum Ibuprophen 400 mg orally trice daily