MLA Domain 5 · Presentation

Wheeze

13 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 5

Anaphylaxis

Any Airway/Breathing/Circulation compromise = anaphylaxis → IM adrenaline now; biphasic reaction (recurrence hours later

Asthma

Life-threatening features (silent chest, SpO2 <92%, exhaustion, normal/rising PaCO2) → ITU/anaesthetic involvement — a n

Bronchiolitis

Apnoea, grunting, marked recession, <50% feeds, sats <90%, dehydration → admit

Carcinoid syndrome

Carcinoid crisis (peri-procedure) → octreotide cover

Lower respiratory tract infection & acute bronchitis

Focal chest signs/consolidation, high CURB-65 features, or systemic sepsis → it's pneumonia → treat accordingly

recognised feature · 5

Acute exacerbation of COPD

Respiratory acidosis (pH <7.35 with high PaCO2) → NIV; falling consciousness/exhaustion → ICU

Asthma-COPD overlap

Frequent exacerbations → optimise inhaled therapy and address the eosinophilic component

Chronic obstructive pulmonary disease (COPD)

Exacerbation with type 2 respiratory failure (CO2 retention, acidosis) → controlled oxygen (88–92%) + consider NIV (BiPA

Cow milk protein allergy

Anaphylaxis (IgE); faltering growth

Transfusion reactions

STOP the transfusion immediately for any significant reaction and reassess (ABCDE); recheck the patient/unit identity

differential of the above · 3

Bronchiectasis

Massive haemoptysis → emergency (bronchial artery embolisation)

Heart failure

Acute pulmonary oedema (severe dyspnoea, pink frothy sputum, hypoxia) → sit up, oxygen, IV loop diuretic ± nitrates → cr

Pneumonia

CURB-65 high (3–5) / sepsis → hospital/ICU assessment; respiratory failure → oxygen/ventilatory support