Typical exam stem
A young adult with asthma presents unable to complete sentences and has widespread wheeze. How would you assess severity and manage the attack?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
Which clinical features indicate life-threatening asthma?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Assess severity before being reassured by the wheeze
Acute asthma is assessed by symptoms, respiratory effort, oxygenation, peak expiratory flow when feasible, and evidence of exhaustion or altered consciousness. A quiet chest in a distressed patient is a dangerous sign because it may indicate critically reduced airflow rather than improvement.
- Record respiratory rate, pulse, oxygen saturation and ability to speak.
- Measure PEF when the patient can perform it safely and compare with personal best or predicted value.
- Look for accessory-muscle use, agitation, fatigue, cyanosis, hypotension and reduced consciousness.
- Consider alternative or associated diagnoses such as anaphylaxis, pneumothorax, pneumonia, pulmonary embolism and upper-airway obstruction.
Emergency treatment sequence
Give controlled oxygen when hypoxaemic and repeated rapid-acting inhaled bronchodilator therapy, adding anticholinergic bronchodilation in severe attacks. Give systemic corticosteroid treatment early. Severe or poorly responsive attacks may require intravenous magnesium and senior respiratory or critical-care input according to local protocol.
Reassess repeatedly. Improvement is shown by reduced work of breathing, better speech, improving airflow and stable oxygenation. Worsening fatigue, rising carbon dioxide, altered mental state or a silent chest suggests impending respiratory failure and requires urgent critical-care involvement.
Discharge is part of the exam answer
- Confirm sustained clinical improvement and safe bronchodilator requirements.
- Review inhaler technique and adherence.
- Ensure anti-inflammatory controller treatment is appropriate; reliance on reliever-only treatment is unsafe.
- Provide an action plan, trigger review and follow-up.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.