False negative tests may be caused by:
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
Heaf test
The Heaf test was previously used in the UK but has been since been discontinued. It
involved injection of PPD equivalent to 100,000 units per ml to the skin over the flexor
surface of the left forearm. It was then read 3-10 days later.
Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB.
Credit: NIAID
External Links
NICE
2016 Tuberculosis guidelines
,Question 1 of 162
A 27-year-old woman is reviewed in the asthma clinic. She currently uses salbutamol inhaler 100mcg
prn combined with beclometasone dipropionate inhaler 400mcg bd. Despite this she is having frequent
exacerbations of her asthma and recently required a course of prednisolone. What is the most
appropriate next step in management?
Add a leukotriene receptor antagonist
Add tiotropium
Add salmeterol
Start to take the salbutamol regularly, 2 puffs qds
Switch beclometasone to fluticasone
,Question 1 of 162
A 27-year-old woman is reviewed in the asthma clinic. She currently uses salbutamol inhaler 100mcg
prn combined with beclometasone dipropionate inhaler 400mcg bd. Despite this she is having frequent
exacerbations of her asthma and recently required a course of prednisolone. What is the most
appropriate next step in management?
Add a leukotriene receptor antagonist
Add tiotropium
Add salmeterol
Start to take the salbutamol regularly, 2 puffs qds
Switch beclometasone to fluticasone
The 2016 British Thoracic Society guidelines would actually recommend this is done in the form of a
combined inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) inhaler.
Discuss and give feedback
Asthma: management in adults
External links
British Thoracic Society
2016 Asthma guidelines
External media
Inhaler and Nebuliser Explanation
Oxford Medical Education - YouTube
, Question 2 of 162
Which one of the following would cause a rise in the carbon monoxide transfer factor (TLCO)?
Emphysema
Pulmonary embolism
Pulmonary hemorrhage
Pneumonia
Pulmonary fibrosis
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
Heaf test
The Heaf test was previously used in the UK but has been since been discontinued. It
involved injection of PPD equivalent to 100,000 units per ml to the skin over the flexor
surface of the left forearm. It was then read 3-10 days later.
Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB.
Credit: NIAID
External Links
NICE
2016 Tuberculosis guidelines
,Question 1 of 162
A 27-year-old woman is reviewed in the asthma clinic. She currently uses salbutamol inhaler 100mcg
prn combined with beclometasone dipropionate inhaler 400mcg bd. Despite this she is having frequent
exacerbations of her asthma and recently required a course of prednisolone. What is the most
appropriate next step in management?
Add a leukotriene receptor antagonist
Add tiotropium
Add salmeterol
Start to take the salbutamol regularly, 2 puffs qds
Switch beclometasone to fluticasone
,Question 1 of 162
A 27-year-old woman is reviewed in the asthma clinic. She currently uses salbutamol inhaler 100mcg
prn combined with beclometasone dipropionate inhaler 400mcg bd. Despite this she is having frequent
exacerbations of her asthma and recently required a course of prednisolone. What is the most
appropriate next step in management?
Add a leukotriene receptor antagonist
Add tiotropium
Add salmeterol
Start to take the salbutamol regularly, 2 puffs qds
Switch beclometasone to fluticasone
The 2016 British Thoracic Society guidelines would actually recommend this is done in the form of a
combined inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) inhaler.
Discuss and give feedback
Asthma: management in adults
External links
British Thoracic Society
2016 Asthma guidelines
External media
Inhaler and Nebuliser Explanation
Oxford Medical Education - YouTube
, Question 2 of 162
Which one of the following would cause a rise in the carbon monoxide transfer factor (TLCO)?
Emphysema
Pulmonary embolism
Pulmonary hemorrhage
Pneumonia
Pulmonary fibrosis
