DHA Clinical Practice & Guidelines 5 — Questions and Answers
Question 1: A 65-year-old male with COPD has an FEV1/FVC ratio of 0.62 and FEV1 of 55% predicted. Per DHA/GOLD guidelines, what GOLD stage is this?
- GOLD 1 (Mild)
- GOLD 2 (Moderate) (Correct answer)
- GOLD 3 (Severe)
- GOLD 4 (Very Severe)
Correct answer: GOLD 2 (Moderate)
GOLD Stage 2 (Moderate COPD) is defined by FEV1/FVC <0.70 with FEV1 50–79% predicted.
Question 2: Under DHA guidelines for pain management, which WHO analgesic ladder step is appropriate for a patient with moderate cancer pain (NRS 5/10) who has failed Step 1 therapy?
- Continue Step 1 with dose escalation
- Step 2: Weak opioids (e.g., codeine or tramadol) (Correct answer)
- Step 3: Strong opioids (e.g., morphine)
- Adjuvant therapy only (e.g., corticosteroids)
Correct answer: Step 2: Weak opioids (e.g., codeine or tramadol)
The WHO analgesic ladder prescribes Step 2 weak opioids (tramadol, codeine) for moderate pain when non-opioids (Step 1) are insufficient.
Question 3: Per DHA infection control guidelines, which PPE combination is required when performing an aerosol-generating procedure (AGP) on a patient with suspected airborne infection?
- Surgical mask, gloves, and gown
- N95 respirator, gloves, gown, and eye protection (Correct answer)
- N95 respirator and gloves only
- Surgical mask, gloves, gown, and face shield
Correct answer: N95 respirator, gloves, gown, and eye protection
AGPs on suspected airborne-infection patients require N95 (or equivalent) respirator, gloves, fluid-resistant gown, and eye/face protection per DHA infection control standards.
Question 4: A child is brought to the DHA clinic with a weight-for-height Z-score of -2.8. How should this nutritional status be classified per WHO/DHA standards?
- Normal nutritional status
- Mild acute malnutrition
- Moderate acute malnutrition (Correct answer)
- Severe acute malnutrition
Correct answer: Moderate acute malnutrition
A weight-for-height Z-score between -3 and -2 (exclusive) indicates Moderate Acute Malnutrition (MAM) requiring therapeutic nutritional support.
Question 5: According to DHA guidelines, what is the target LDL-cholesterol level for a patient classified as very high cardiovascular risk (e.g., prior MI)?
- < 3.0 mmol/L (< 116 mg/dL)
- < 2.6 mmol/L (< 100 mg/dL)
- < 1.8 mmol/L (< 70 mg/dL) (Correct answer)
- < 1.4 mmol/L (< 55 mg/dL)
Correct answer: < 1.8 mmol/L (< 70 mg/dL)
For very high CV risk patients including those with prior MI, the LDL target is <1.8 mmol/L (<70 mg/dL) with ≥50% reduction from baseline per DHA/ESC guidelines.
Question 6: Under DHA clinical governance standards, a 'never event' occurs in the hospital. What is the mandatory initial reporting timeframe to the DHA?
- Within 24 hours (Correct answer)
- Within 48 hours
- Within 72 hours
- Within 7 days
Correct answer: Within 24 hours
DHA patient safety regulations require that never events and serious adverse events be reported to the DHA within 24 hours of discovery.
Question 7: A patient on warfarin presents with an INR of 7.2 and minor bleeding (gum bleeding). Per DHA anticoagulation guidelines, what is the most appropriate management?
- Administer IV vitamin K 10mg and fresh frozen plasma
- Hold warfarin, give oral vitamin K 1–2.5mg, and monitor INR (Correct answer)
- Continue warfarin at reduced dose and recheck INR in 1 week
- Administer 4-factor PCC (prothrombin complex concentrate) immediately
Correct answer: Hold warfarin, give oral vitamin K 1–2.5mg, and monitor INR
For supratherapeutic INR (>5) with minor bleeding, holding warfarin and administering low-dose oral vitamin K (1–2.5mg) is recommended, with INR recheck within 24–48 hours.
DHA Clinical Practice & Guidelines 5
A 65-year-old male with COPD has an FEV1/FVC ratio of 0.62 and FEV1 of 55% predicted.
Per DHA/GOLD guidelines, what GOLD stage is this?