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Asthma exacerbation — MCCQE Part 1 MCQ

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ModerateDyspneaAsthma exacerbationMCCQE Part 1

22-year-old university student with asthma presents with wheezing and chest tightness after cat exposure. She speaks in phrases, peak flow is 45% predicted and oxygen saturation is 91%. Which of the following is the most appropriate next step?

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Correct answer: A — Give inhaled salbutamol, ipratropium, systemic corticosteroids and oxygen, with close reassessment

Give inhaled salbutamol, ipratropium, systemic corticosteroids and oxygen, with close reassessment is best because moderate-to-severe asthma exacerbation needs bronchodilation, steroids and oxygen support. Prescribe an antibiotic without assessing severity or likely cause is suboptimal because antibiotics are not the default for all respiratory presentations; Discharge without oxygen assessment or safety-netting is suboptimal because oxygenation and work of breathing guide urgency; Request elective pulmonary function testing as the immediate step is suboptimal because spirometry is rarely the first step in an unstable acute presentation; Treat as anxiety without excluding cardiorespiratory disease is suboptimal because anxiety is a diagnosis of exclusion when objective respiratory features are present. Early systemic corticosteroids reduce relapse in significant asthma exacerbations.

Reference: CTS asthma guidance