Regular features

· The following must be assessed in all patients attending hospital with suspected asthma exacerbations:
1. PEF.
2. Pulse & Respiration rate.
3. Clinical history & Speech.
4. Chest X ray.
5. Arterial Blood Gases.

· The following characteristics may identify a patient at risk of fatal or near fatal asthma:
6. Hospital admission within the last year.
7. Repeated A&E attendances.
8. Non compliance with treatment .
9. History of self discharge from hospital.
10. Requirement for 3 or more classes of asthma medication.

· The following treatments are of established value in the management of acute asthma:
11. Antibiotics.
12. Anticholinergic bronchodilators.
13. Intravenous aminophylline.
14. Intravenous Magnesium.
15. Heliox.
16. NIV.

· The Folling indicate a severe asthma excerbation:
17. PEF < 33%. 18. PaO2 < 8 kPa. 19. Normal PaCO2. 20. Respirations > 25 / min.
21. Pulse > 110/min.

· The following features excludes a severe or life threatening asthma exacerbation:
22. Normal pCO2.
23. PEF > 75%.
24. Pulse < 110/min. 25. Resps < 25/min. 26. Able to talk in full sentences. (A F A Merrison & N J Scolding) · Steroid treament should be given to patients with MS: 27. at the time of all relapses. 28. at the time of relapses and disease progression. 29. as soon as possible for significantly disabling relapses. · If steroids are given they should be given orally: 30. following intravenous steroid therapy. 31. if intravenous therapy is impracticable. 32. for disease progression. · Beta-interferon treatment is available for patients with MS who: 33. have two or more relapses in two years and are able to walk 100 metres unaided. 34. with secondary progressive disease. 35. following a single episode of optic neuritis. · Bladder problems in MS are best managed by: 36. Permanent catherisation. 37. Anticholinergics for detrusor instability. 38. Intermittent self catherisation if high residual volume. · When managing spasticity, it is worth considering the following points: 39. Baclofen may induce muscle weakness. 40. Neutropaenia is a common problem with tizanidine. 41. Selective injection of botulinum toxin may be helpful. (S I Kharkoo & W MC Rosenberg) · In the setting of an acute variceal haemorrhage: 42. An INR of 1.8 is associated with a high mortality. 43. Individuals with non-cirrhotic portal hypertension have a better prognosis than those with cirrhotic portal hypertension. 44. Grade I hepatic encephalopathy is an indication for endotracheal intubation and ventilation. 45. Therapeutic endoscopy achieves haemostasis in >90% of cases.
46. Isolated gastric varices respond better to endoscopic therapy than oesophageal varices.

· The sengstaken-Blakemore tube:
47. Has a serious complication rate of up to 35%.
48. Can be passed unaided by a single operator.
49. The oesophageal aspirate port should be spigoted.
50. The oesophageal balloon should be inf lated with 300mls of air.
51. Should be left inf lated and on traction for no more than 24 hours.

· With reference to drugs used in the management of a variceal haemorrhage
52. The main objective of pharmacotherapy is splanchnic vasodilatation.
53. Octreotide is preferable to terlipressin.
54. Antibiotics are of no value.
55. Vasopressin should be used in combination with nitrates.
56. Because of the danger of anaesthetic agents in liver disease there is a high threshold for elective endotracheal intubation and ventilation.