QuestionSBA
QuestionChoice
This patient isn't having an acute asthma exacerbation nor is he at the point in the asthma treatment ladder in which oral corticosteroids would be considered (this would only be initiated by a specialist).
50327
d
Add oral prednisolone 5mg PO OD
QuestionChoice
This patient isn't having an acute asthma exacerbation therefore this option is inappropriate.
50328
e
Admit to hospital
QuestionChoice
Moderate-dose MART may be considered for patients whose asthma remains uncontrolled on low-dose MART. However, a stepwise approach is essential in asthma management, and since this patient has not yet trialed low-dose MART, moderate-dose MART would be premature at this stage.
50324
a
Moderate dose daily maintenance and reliever therapy (MART)
QuestionChoice
Montelukast, a leukotriene receptor antagonist, is not typically considered as a first-line step in asthma management. It may be added as adjunct therapy if symptoms remain uncontrolled on moderate-dose MART. However, since the patient has not yet trialed low-dose or moderate-dose MART, montelukast is not indicated at this stage. 
50325
b
Add montelukast 10 mg PO OD
QuestionChoice
The patient's symptoms of nighttime wheezing and exercise limitation, coupled with an FEV1/FVC ratio of 53%, indicate suboptimal asthma control despite adherence to his current as-needed low-dose ICS/formoterol regimen. The most appropriate next step is to initiate low-dose daily maintenance and reliever therapy (MART), which involves using a low-dose ICS/formoterol combination both as a daily maintenance inhaler and as needed for symptom relief. 
50326
c
Low dose daily maintenance and reliever therapy (MART)
QuestionComment
So essentially we're switching from AIR therapy to MART (PRN to regular)?
61180
User
subscriber
DJnR
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3648
Moving up the treatment ladder of asthma when a SABA and ICS are not working
Topic
92
General Practice
10119
Case Presentation: A 26 year old man attends his GP for a review of his asthma. He is still feeling wheezy at night and struggling to exercise. His inhaler technique is good and he is taking his medications as recommended.

**PMH** Asthma

**DH** Low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler as required

**On examination**

FEV1/FVC ratio: 53%

Question: Select the most appropriate management at this stage.

c