Asthma

Chapter 29 Asthma





Clinical Case Problem 1: A 22-Year-Old Man with a Chronic Cough


A 22-year-old man presents to your office for assessment of a chronic cough. He has just moved to your city and will be attending the university there. He has moved into an apartment in the basement of a house.


As soon as he moved in, he began to notice a chronic, nonproductive cough associated with shortness of breath. He has never had these symptoms before, and he has no known allergies. When he leaves for school for the day, the symptoms disappear. The symptoms are definitely worse at night.


His landlady has three cats. He did not think he was allergic to cats, but now he thinks that might be the problem.


On examination, his respiratory rate is 16 breaths/minute and regular. He is in no distress at the present time. There are a few expiratory rhonchi heard in all lobes. His blood pressure is 120/70   mm Hg, and his pulse is 72 beats/minute and regular.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?







2. In children, which of the following statements is (are) true?







3. Which of the following is (are) included in the working definition of asthma?








4. Which of the following statements regarding incidence and mortality of asthma is (are) false?







5. Asthma, from a pathophysiologic basis, is primarily







6. Following antigenic stimulation of the bronchial airway, which cell is most responsible for the beginning of the airway’s response?







7. What substance(s) released by the cell is (are) most responsible for the beginning of the airway’s response?







8. The parameter most useful in evaluating a patient with asthma is







9. The main classification classes for asthma as provided by the Expert Panel Report 3 (2007) from the National Heart, Lung, and Blood Institute include







10. The reversible airflow obstruction seen in asthma results from which of the following?







11. Which of the following is (are) a clinical hallmark(s) of asthma?







12. Which of the following is (are) associated with an increase in asthma incidence?








Clinical Case Problem 2: A 24-Year-Old Runner with Wheezing and Shortness of Breath


A 24-year-old otherwise healthy cross-country runner reports wheezing and shortness of breath only when she is exercising, especially in the cold air. These symptoms are getting worse.



13. Which of the following statements regarding exercise-induced bronchospasm (EIB) is false?







14. Which of the following is the agent of choice for the treatment of acute symptoms in these circumstances?







15. What is the mechanism of action of the agent of choice in question 14?







16. What is the pre-exercise preventive treatment of choice for EIB?







17. Nonpharmacologic means of reducing EIB include all of the following except







18. For a patient with EIB who has frequent symptoms despite nonpharmacologic treatment modalities and a beta2 agonist for acute symptoms, choose the list of long-term medications for better control in the correct order of efficacy (most effective to least effective).







19. Vocal cord dysfunction can masquerade as EIB or asthma. Characteristics of vocal cord dysfunction include all of the following except







20. What is the chief characteristic of exercise-induced hyperventilation?








Clinical Case Problem 3: A 30-Year-Old New Patient with Chronic Asthma


Mr. Smith is a 30-year-old accountant who has noticed that his asthma, which he has had since he was a young child, has gotten worse. He has recently moved from a rural area to the urban area where you practice.



21. Which of the following stepped care classifications used to guide pharmacotherapy in asthma require(s) environmental control as the necessary first step for his treatment?







22. All except which of the following are characteristics of mild persistent asthma?







23. Which of the following most accurately describes the preferred pharmacologic treatment of moderate persistent asthma in adults?







24. All except which of the following are characteristics of severe persistent asthma?







25. Pharmacotherapy of severe persistent asthma includes







26. In a patient whose PEF rate is less than 50% of personal best, suggesting a severe exacerbation, the initial home treatment includes which of the following?







27. Which of the following pulmonary function tests is the most useful for diagnosis of asthma?


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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Asthma

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