WBR1055: Difference between revisions

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(Created page with "{{WBRQuestion |QuestionAuthor={{AK}} |ExamType=USMLE Step 3 |MainCategory=Primary Care Office |SubCategory=Allergy/Immunology, Respiratory |MainCategory=Primary Care Office |S...")
 
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|QuestionAuthor={{AK}}
|QuestionAuthor={{AK}}
|ExamType=USMLE Step 3
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Allergy/Immunology, Respiratory
|Prompt=A 54 year old man comes to the clinic for asthma follow up, he was diagnosed with asthma 5 years ago. He is on inhaled albuterol as needed, he has persistent cough and complains of episodes of shortness of breath every other day. His history is unremarkable except for hypertension diagnosed recently and taking metoprolol for it. He is otherwise healthy, his vitals are temperature:37.2 c, heart rate:78 beat/minute, blood pressure: 134/84 and respiration rate is 16/minute. The physical examination is normal. What is the best next step in management of this patient?
|Prompt=A 54 year old man comes to the clinic for asthma follow up, he was diagnosed with asthma 5 years ago. He is on inhaled albuterol as needed, he has persistent cough and complains of episodes of shortness of breath every other day. His history is unremarkable except for hypertension diagnosed recently and taking metoprolol for it. He is otherwise healthy, his vitals are temperature:37.2 c, heart rate:78 beat/minute, blood pressure: 134/84 and respiration rate is 16/minute. The physical examination is normal. What is the best next step in management of this patient?
|Explanation=The patient has a diagnosis of asthma and put on albuterol as a treatment of mild asthma, but  during the follow up worsening of symptoms has been reported by the patient.  
|Explanation=The patient has a diagnosis of asthma and put on albuterol as a treatment of mild asthma, but  during the follow up worsening of symptoms has been reported by the patient.
|AnswerA=Add betamethasone inhaler
|AnswerA=Add betamethasone inhaler
|AnswerAExp=Incorrect.  
|AnswerAExp=Incorrect.
|AnswerB=Add salmeterol
|AnswerB=Add salmeterol
|AnswerBExp=Incorrect.
|AnswerBExp=Incorrect.
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|AnswerEExp=Incorrect
|AnswerEExp=Incorrect
|EducationalObjectives=In a presentation of worsening asthma, looking for triggers of patient symptoms in the history is essential to avoid additional treatment, cost and harm to the patient. Knowing drug interactions with asthma medications and change medication accordingly is the the best approach.  
|EducationalObjectives=In a presentation of worsening asthma, looking for triggers of patient symptoms in the history is essential to avoid additional treatment, cost and harm to the patient. Knowing drug interactions with asthma medications and change medication accordingly is the the best approach.  
Beta blockers exacerbate bronchospastic diseases and shouldn't be used in hypertensive patients with asthma as a general rule. However, metoprolol can be used in case of failure or intolerance of other antihypertensives, and the doses should be lowered with bronchdilators administered concomitantly.  
Beta blockers exacerbate bronchospastic diseases and shouldn't be used in hypertensive patients with asthma as a general rule. However, metoprolol can be used in case of failure or intolerance of other antihypertensives, and the doses should be lowered with bronchdilators administered concomitantly.
|References=<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = LOPRESSOR (METOPROLOL TARTRATE) TABLET [VALIDUS PHARMACEUTICALS LLC] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0283bc9d-6998-493a-824a-d4c85f704111 | publisher =  | date =  | accessdate = }}</ref>
|References=<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = LOPRESSOR (METOPROLOL TARTRATE) TABLET [VALIDUS PHARMACEUTICALS LLC] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0283bc9d-6998-493a-824a-d4c85f704111 | publisher =  | date =  | accessdate = }}</ref>


|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Asthma, Hypertension, Beta-blocker, Bronchodilator,  
|WBRKeyword=Asthma, Hypertension, Beta-blocker, Bronchodilator,
|Approved=No
|Approved=No
}}
}}

Revision as of 19:39, 16 March 2014

 
Author [[PageAuthor::Abdurahman Khalil, M.D. [1]]]
Exam Type ExamType::USMLE Step 3
Main Category
Sub Category
Prompt [[Prompt::A 54 year old man comes to the clinic for asthma follow up, he was diagnosed with asthma 5 years ago. He is on inhaled albuterol as needed, he has persistent cough and complains of episodes of shortness of breath every other day. His history is unremarkable except for hypertension diagnosed recently and taking metoprolol for it. He is otherwise healthy, his vitals are temperature:37.2 c, heart rate:78 beat/minute, blood pressure: 134/84 and respiration rate is 16/minute. The physical examination is normal. What is the best next step in management of this patient?]]
Answer A AnswerA::Add betamethasone inhaler
Answer A Explanation AnswerAExp::Incorrect.
Answer B AnswerB::Add salmeterol
Answer B Explanation AnswerBExp::Incorrect.
Answer C AnswerC::Prednisone
Answer C Explanation AnswerCExp::Incorrect.
Answer D AnswerD::Change hypertension medication
Answer D Explanation AnswerDExp::Correct.
Answer E AnswerE::Increase albuterol dose
Answer E Explanation AnswerEExp::Incorrect
Right Answer RightAnswer::D
Explanation [[Explanation::The patient has a diagnosis of asthma and put on albuterol as a treatment of mild asthma, but during the follow up worsening of symptoms has been reported by the patient.

Educational Objective: In a presentation of worsening asthma, looking for triggers of patient symptoms in the history is essential to avoid additional treatment, cost and harm to the patient. Knowing drug interactions with asthma medications and change medication accordingly is the the best approach. Beta blockers exacerbate bronchospastic diseases and shouldn't be used in hypertensive patients with asthma as a general rule. However, metoprolol can be used in case of failure or intolerance of other antihypertensives, and the doses should be lowered with bronchdilators administered concomitantly.
References: [1]]]

Approved Approved::No
Keyword WBRKeyword::Asthma, WBRKeyword::Hypertension, WBRKeyword::Beta-blocker, WBRKeyword::Bronchodilator
Linked Question Linked::
Order in Linked Questions LinkedOrder::
  1. "LOPRESSOR (METOPROLOL TARTRATE) TABLET [VALIDUS PHARMACEUTICALS LLC]".