Ten-minute consult

1. A 28-year-old woman presents with a 4-month history of intermittent wheeze, nocturnal cough and chest tightness. Objective tests confirm asthma. She is not highly symptomatic and has not had an acute attack. She has never used an inhaler. What is the most appropriate initial regular strategy?

2. A 62-year-old man with a 40 pack-year smoking history reports progressive exertional breathlessness and winter bronchitis. Post-bronchodilator spirometry: FEV1 1.85 L (62% predicted), FVC 3.40 L, FEV1/FVC 0.54. What is the most appropriate interpretation?

3. A 52-year-old woman who stopped smoking 8 years ago reports two episodes of unexplained frank haemoptysis this week. She feels otherwise well. What is the most appropriate next management for suspected lung cancer? The most appropriate action is: Routine chest X-ray and review the film in 6 weeks if it is reported as normal

4. A 44-year-old man is seen face to face with fever, productive cough and focal crackles. You diagnose community-acquired pneumonia. He is orientated, respiratory rate 18 breaths per minute, blood pressure 128/78 mmHg. He can take tablets. There are no sepsis features. What is the most appropriate place-of-care plan?

5. A 31-year-old man has a 6-week history of cough, night sweats and weight loss. Chest X-ray shows apical cavitation. You suspect pulmonary tuberculosis. Sputum has been sent but culture will take weeks. What is the most appropriate notification action? The most appropriate action is: Wait for a positive culture before notifying, to avoid false public-health alerts

6. A 49-year-old woman with COPD wants to stop smoking. She is 50 years old next birthday, not pregnant, and accepts behavioural support. She prefers a nicotine-containing licensed option rather than a tablet. What is the most appropriate pharmacological offer among the following? Select TWO correct statements.

Select all that apply.

7. A 34-year-old man is stepped up from as-needed AIR to low-dose maintenance and reliever therapy (MART) with budesonide/formoterol. He asks whether he should keep his old salbutamol inhaler 'just in case'. What is the most appropriate advice? The most appropriate action is: Use salbutamol and MART together at every symptom episode to double bronchodilation

8. A 68-year-old woman with known COPD has a moderate exacerbation: more breathless, wheeze, but no features of pneumonia or respiratory failure. She can use her inhalers. What is the most appropriate oral corticosteroid course if a steroid is indicated?

9. A 3-year-old has recurrent viral wheeze and interval symptoms suggestive of asthma. He cannot perform spirometry or FeNO. What is the most appropriate diagnostic-management approach? Select TWO correct statements.

Select all that apply.

10. A 70-year-old with confirmed COPD is limited by breathlessness. MRC dyspnoea scale is 3. He has had no recent unstable cardiac event. What is the most appropriate non-pharmacological referral?