WBR1055: Difference between revisions

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|QuestionAuthor={{AK}}
|QuestionAuthor={{AK}}
|ExamType=USMLE Step 3
|ExamType=USMLE Step 3
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|SubCategory=Respiratory
|MainCategory=Community Medical Health Center
|MainCategory=Community Medical Health Center
|SubCategory=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=D: Change hypertension medication
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 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.<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>
|AnswerA=Add betamethasone inhaler
|AnswerA=Add betamethasone inhaler
|AnswerAExp=Incorrect.
|AnswerAExp=Incorrect.
Line 14: Line 34:
|AnswerE=Increase albuterol dose
|AnswerE=Increase albuterol dose
|AnswerEExp=Incorrect
|AnswerEExp=Incorrect
|EducationalObjectives=D: Change hypertension medication
|EducationalObjectives=Beta blockers antihypertensives  are not used in patients with bronchspastic diseases in general, and other alternatives should be used in the management of hypertension.
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 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.<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>
|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

Revision as of 20:02, 16 March 2014
Author [[PageAuthor::Abdurahman Khalil, M.D. [1]]]
Exam Type ExamType::USMLE Step 3
Main Category MainCategory::Community Medical Health Center
Sub Category SubCategory::Respiratory
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::D: Change hypertension medication

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 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.[1]
Educational Objective: Beta blockers antihypertensives are not used in patients with bronchspastic diseases in general, and other alternatives should be used in the management of hypertension.
References: [1]]]

Approved Approved::No
Keyword WBRKeyword::Asthma, WBRKeyword::Hypertension, WBRKeyword::Beta-blocker, WBRKeyword::Bronchodilator
Linked Question Linked::
Order in Linked Questions LinkedOrder::
  1. ↑ 1.0 1.1 "LOPRESSOR (METOPROLOL TARTRATE) TABLET [VALIDUS PHARMACEUTICALS LLC]".
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