1. Respiratory Disease – Peak Flow Clinical Skills and Simulation Team Respiratory Disease Quiz – Peak Flow Clinical Skills Formative Quiz

2. Respiratory Disease – Peak Flow Question 1 Asthma can confidently be diagnosed using a single PEFR reading Question 1 TRUE FALSE

3. Respiratory Disease – Peak Flow Question 2 What is most likely to have happened at Point A A.Patient Started Asthma Medication B.Patient Stopped Asthma Medication Question 2 A

4. Respiratory Disease – Peak Flow Question 3 Which of the following is correct regarding parameters that effect PEFR? A.Sex, Age, Weight B.Sex, Age, Height Question 3 23 Today 55 Today 64 Today

5. Respiratory Disease – Peak Flow Question 4 What is the most useful test procedure for establishing the diagnosis and severity of COPD? Question 4 PEAK EXPIRATORY FLOW RATE SPIROMETRY A A B B

6. Respiratory Disease – Peak Flow Question 5 After a patient does 3 readings on a PEFR meter the reading that is recorded on the PEFR graph is: A.The Third Reading B.The Highest Reading Question 5

7. Respiratory Disease – Peak Flow Question 6 In the patients Asthma Action Plan home monitoring of asthma using daily PEFR’s would best be correlated with: A.The patient’s best ever PEFR B.The estimated best value for the patient’s given age, sex and height Question 6

8. Respiratory Disease – Peak Flow Case Study 1 Christopher, a 45 year old, male, smoker, 1.8m tall, who has noticed increased shortness of breath on exertion in recent months. From the PEFR diary the most likely diagnosis is: A.Asthma B.COPD Question 7

9. Respiratory Disease – Peak Flow Case Study 2 Kimberly, a 22 year old, female smoker, 1.9m tall, who has noticed a persistent nocturnal cough in recent months. From the PEFR diary the most likely diagnosis is: A.Asthma B.COPD Question 8

10. Respiratory Disease – Peak Flow Case Study 2 - Continued Kimberly is diagnosed with asthma which is through to have been triggered by a kitten that she was given for her birthday. Over the next fortnight her PEFR diary is a below. What is most likely to have happened at point B on the graph A.She gave the kitten away to a friend B.She commenced inhaled corticosteroids Question 9

11. Respiratory Disease – Peak Flow Question 10 Whilst performing a PEFR the patient should be instructed to take a deep breath in through their: Question 10 Mouth Nose

12. Respiratory Disease – Peak Flow ANSWERS

13. Respiratory Disease – Peak Flow Question 1 Asthma can confidently be diagnosed using a single PEFR reading Question 1 TRUE FALSE

14. Respiratory Disease – Peak Flow Answer 1 Asthma can confidently be diagnosed using a single PEFR reading A single PEFR reading may show evidence of airway obstruction if it is below the predicted value, however the cause of the airflow obstruction would not be clear (e.g. COPD or Asthma). A peak expiratory flow diary demonstrating diurnal variability of >30% would be highly suggestive of asthma, however spirometry is now the gold standard for diagnosis. Answer 1 FALSE

15. Respiratory Disease – Peak Flow Question 2 What is most likely to have happened at Point A A.Patient Started Asthma Medication B.Patient Stopped Asthma Medication Question 2 A

16. Respiratory Disease – Peak Flow Answer 2 What is most likely to have happened at Point A Answer 2 A B B Patient Stopped Asthma Medication The diurnal variation increases in amplitude and the general mean PEFR drops indicating poorer control

17. Respiratory Disease – Peak Flow Question 3 Which of the following is correct regarding parameters that effect PEFR? A.Sex, Age, Weight B.Sex, Age, Height Question 3 23 Today 55 Today 64 Today

18. Respiratory Disease – Peak Flow Answer 3 Which of the following is correct regarding parameters that effect PEFR? Weight is not a parameter that effects PEFR Answer 3 23 Today 55 Today 64 Today B B Sex, Age and Height

19. Respiratory Disease – Peak Flow Question 4 What is the most useful test procedure for establishing the diagnosis and severity of COPD? Question 4 PEAK EXPIRATORY FLOW RATE SPIROMETRY A A B B

20. Respiratory Disease – Peak Flow Answer 4 What is the most useful test procedure for establishing the diagnosis and severity of COPD? Answer 4 SPIROMETRY Spirometry measures FEV 1 and FEV/FVC% and is the recommended Gold Standard for diagnosis and measurements of severity in COPD B B

21. Respiratory Disease – Peak Flow Question 5 After a patient does 3 readings on a PEFR meter the reading that is recorded on the PEFR graph is: A.The Third Reading B.The Highest Reading Question 5

22. Respiratory Disease – Peak Flow Answer 5 After a patient does 3 readings on a PEFR meter the reading that is recorded on the PEFR graph is: Answer 5 B B The Highest Reading

23. Respiratory Disease – Peak Flow Question 6 In the patients Asthma Action Plan home monitoring of asthma using daily PEFR’s would best be correlated with: A.The patient’s best ever PEFR B.The estimated best value for the patient’s given age, sex and height Question 6

24. Respiratory Disease – Peak Flow Answer 6 In the patients asthma action plan home monitoring of asthma using daily PEFR’s would best be correlated with: Answer 6 A A The Patients Best Ever PEFR

25. Respiratory Disease – Peak Flow Case Study 1 Christopher, a 45 year old, male, smoker, 1.8m tall, who has noticed increased shortness of breath on exertion in recent months. From the PEFR diary the most likely diagnosis is: A.Asthma B.COPD Question 7

26. Respiratory Disease – Peak Flow Case Study 1 Christopher, a 45 year old, male, smoker, 1.8m tall, who has noticed increased shortness of breath on exertion in recent months. From the PEFR diary the most likely diagnosis is: Answer 7 B B COPD General Baseline is lower than expected for his sex and height with little diurnal variation

27. Respiratory Disease – Peak Flow Case Study 2 Kimberly, a 22 year old, female smoker, 1.9m tall, who has noticed a persistent nocturnal cough in recent months. From the PEFR diary the most likely diagnosis is: A.Asthma B.COPD Question 8

28. Respiratory Disease – Peak Flow Case Study 2 Kimberly, a 22 year old, female smoker, 1.9m tall, who has noticed a persistent nocturnal cough in recent months. Answer 8 A A Asthma Asthma, note high amplitude diurnal variation with ‘morning dipping’ typical of poorly controlled asthma

29. Respiratory Disease – Peak Flow Case Study 2 - Continued Kimberly is diagnosed with asthma which is through to have been triggered by a kitten that she was given for her birthday. Over the next fortnight her PEFR diary is a below. What is most likely to have happened at point B on the graph A.She gave the kitten away to a friend B.She commenced inhaled corticosteroids Question 9

30. Respiratory Disease – Peak Flow Case Study 2 - Continued Kimberly is diagnosed with asthma which is through to have been triggered by a kitten that she was given for her birthday. Over the next fortnight her PEFR diary is a below. What is most likely to have happened at point B on the graph Answer 9 B B She commenced inhaled corticosteroids This explains the relatively rapid control of her symptoms as demonstrated by reduced amplitude of diurnal variation and increased average PEFR reading. Cat dander and saliva extract can remain in even the cleanest of homes for over a year in levels enough to provoke asthma in susceptible individuals.

31. Respiratory Disease – Peak Flow Question 10 Whilst performing a PEFR the patient should be instructed to take a deep breath in through their: Question 10 Mouth Nose

32. Respiratory Disease – Peak Flow Answer 10 Whilst performing a PEFR the patient should be instructed to take a deep breath in through their: Answer 10 Mouth Nose X Inspiration through the nose increases the ‘dead space’ in the respiratory system and hence reduces the vital capacity

33. Respiratory Disease – Peak Flow WELL DONE Please add up your marks… Score is out of 10