Air pollution, tobacco smoke and vaping — formative SAQs

SAQ 1 (10 marks)

Parents of a 3-year-old with recurrent wheeze say they only smoke outside and in the car. The child is currently well. [3]

1. List four paediatric health outcomes linked to second-hand smoke exposure. (2) [3] [4]
2. Explain third-hand smoke in one sentence and why toddlers are vulnerable. (2) [1]
3. Outline your counselling and management plan for the next month, including what you will not claim. (6) [1] [4]

Model answer

Outcomes: lower respiratory illness, worse asthma control/exacerbations, otitis media, reduced lung growth trajectories, and SIDS-associated risk pathways (any four). [3] [4]

Third-hand smoke is residual tobacco contamination on surfaces, dust and fabrics that can re-emit or be mouthed; toddlers’ floor play and hand-to-mouth behaviour increase dose. [1]

Plan: non-judgemental history of all products and places; negotiate fully smoke-free home and car; explain outdoor-only smoking is incomplete; offer adult cessation referral/quitline; optimise asthma plan naming smoke as a trigger; follow-up. Do not claim e-cigarettes or scented candles make indoor smoking safe, and do not shame so hard that disclosure stops. [1] [4]

SAQ 2 (10 marks)

A 16-year-old daily vaper presents with progressive dyspnoea and vomiting after using informal cartridges. Oxygen saturation is 90% in air. [8]

1. What acute syndrome must you consider and what is the first management priority? (3) [8]
2. Why is “it is only water vapour” incorrect for adolescent e-cigarette use? (3) [6]
3. How would your preventive counselling differ for this adolescent versus a parent who smokes around a toddler? (4) [1]

Model answer

Consider EVALI (e-cigarette or vaping product use–associated lung injury) after excluding infection; priority is ABCDE supportive care and oxygen, with specialist involvement and product cessation. [8]

E-cigarette aerosols can deliver nicotine at dependence-forming doses plus other toxicants (carbonyls, metals, flavourants); cardiopulmonary harm is documented and youth initiation is a public-health harm, not harmless steam. [6]

Adolescent: confidential dependence assessment, dual-use screen, behavioural support, follow-up, school/safety context. Parent of toddler: focus on protecting the child’s air (home/car), third-hand residues, adult cessation referral, asthma/infection framing — still non-judgemental but different primary goal (protect dependant child versus treat user dependence). [1]