Learn vocabulary, terms, and more with flashcards, games, and other study tools. From the chief complaint, the differential diagnosis is broad. Questions and Answers . Optimal management should also include counseling the patient/family about asthma care and the side effects of medication. Microsoft® PowerPoint® Viewer, included in this software, is a product of Asthma is a chronic inflammatory disease of the respiratory system characterized by bronchial hyperresponsiveness, episodic exacerbations (asthma attacks), and reversible airflow obstruction. HEENT/neck examination shows grade II arteriovenous nicking on funduscopic examination. Abdominal examination shows a gravid uterus with a fundal height of 37 cm. (M1.PL.15.75) A 16-year-old boy with a history of severe, persistent asthma presents to the emergency department with severe shortness of breath and cough. These also appear at the end of the practice cases. The diagnostic workup should also include arterial blood gas analysis to assess acidosis, bacterial blood culture to identify the organism before administering empiric antibiotics, and serum electrolyte measurements (ie, potassium) to assess the severity of dehydration. Estimated fetal weight is 2700 g (6 lb). Severe persistent asthma is defined as having either continuous daytime symptoms or frequent nighttime symptoms. 1 Asthma Maintenance | Alabama Pharmacy Association | www.aparx.org Multiple Choice Assessment Questions . Immunology. All rights reserved. Asthma is common and should be evaluated. With the availability of effective treatment for rheumatoid arthritis and concerns about opioid addiction, narcotic analgesics should have a limited role in treatment. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows it. Portions of Step 2 CS practice materials reproduced with permission This is a practice mode. acute attack except: Asthma Exam (Practice Mode) By Rnpedia.Com, Asthma Conf 09: Performing Spirometry And Spirometry Interpretation. The patient had an acute onset of right-sided chest pain 10 minutes before the ambulance arrived. Once the serum glucose result is obtained, starting IV insulin to treat the hyperglycemia is critical. In this case, a 65-year-old woman comes to the emergency department because of chest pain. Examples of poor management would include failure to order a physical examination, failure to administer a bronchodilator, and failure to address the patient’s oxygen status. World's Hardest Science Quiz You'll Ever Take! You must uninstall all previous copies of the application before attempting to download and reinstall. The characteristic physical signs of asthma include: loud prolonged polyphonic … (M1.PL.13.91) A 12-year-old female presents to her pediatrician with an asthma exacerbation. and the National Board of Medical Examiners. In this acute presentation, timing is important. Click here to check on the status of your test center. In this case, a 65-year-old man is brought to the emergency department by ambulance because of acute chest pain and respiratory distress. Please note that reviewing the sample questions … The mother says that the wheezing seems to get worse after the patient plays outside but resolves shortly after he comes inside. Genital examination reveals an edematous vulva. Skin examination reveals poor turgor. Studies demonstrated that patients presenting to EDs for … She developed generalized aches and morning joint stiffness during the past 8 weeks and, more recently, pain and intermittent swelling of both wrists, and of the proximal metacarpophalangeal joints, as well as bilateral knee swelling. Neurologic/psychiatric examination shows that the patient is lethargic but oriented. The comprehensive history, however, narrows the differential. Examples of poor management would include failure to order any physical examination; failure to order a serum glucose test; failure to order a blood culture to determine the cause of the infection or failure to order a blood culture before administering empiric antibiotics; failure to treat with IV fluids, antibiotics, and insulin; or failure to monitor the patient after treatment. The patient is experiencing sharp, left-sided chest pain that radiates to her left jaw and to her back. FREE USMLE Practice Questions. USMLE Tasks/Competencies Outline. Laboratory studies reveal a creatinine of 3.0 mg/dL and a potassium level of 5.1 mg/dL. • Review the links below, which provide feedback on diagnostic and management steps for the sample Step 3 Computer-Based Case Simulations. It would be suboptimal to order unnecessary tests or procedures that would serve no clear diagnostic or therapeutic purpose even if those actions are low-risk. Take the quiz … Examples of poor management would include failure to order any physical examination or failure to treat rheumatoid arthritis. It would be suboptimal to order anything unnecessary that would waste time, even if the test or procedure were not invasive or risky (eg, lung scan). Unfortunately he is the 10th patient in 2 days who has required similar … Serum creatinine or urea nitrogen measurements (basic metabolic profile or complete metabolic profile) to assess kidney function are indicated. An optimal, efficient approach to diagnosis would include performing an appropriate physical examination (including extremities/spine, chest/lung, cardiovascular, abdominal, skin, HEENT/neck, and lymph node examinations). An NSAID or corticosteroid relieves pain and decreases inflammation essential to provide interim symptom relief while the selected DMARD takes effect. There is marked vasospasm on funduscopic examination with normal disc margins and a minor tongue laceration. Examples of invasive and noninvasive actions that would subject the patient to unnecessary discomfort or risk or would add no useful information to that available through safer or less invasive means include: In this case, a 25-year-old woman at 38 weeks’ gestation comes to the emergency department after suffering a seizure with loss of consciousness about 10 minutes earlier. As a nursing student, you must be familiar with asthma along with how to care for a patient experiencing this disease. This presentation is a common side effect of which of the following pharmacologic agents used in the treatment of asthma? In what age group is the asthma incidence rate the highest? The patient is gravida 1, para 0, and has been receiving routine prenatal care. Anti-asthma medications include quick relief and long-term medications. These signs and symptoms are highly suggestive of a chronic systemic inflammatory process. a. The characteristic feature of persistent asthma … The diagnostic workup should also include a urinalysis and blood tests for the following: serum creatinine or urea nitrogen (basic metabolic profile or comprehensive metabolic profile) to assess kidney function; electrolytes to check sodium and potassium levels; liver enzymes; and platelet count to diagnose HELLP syndrome. USMLE ENDPOINT ONLINE COURSE: • Comprehensive explanation for high yield topics and Question banks in USMLE step 1. From the chief complaints, the differential diagnosis is broad and includes the many causes of acutely altered mental status. Manual, Copyright © 2002 by the ECFMG. are prohibited without permission from the copyright holders. In this case simulation, when NSAID or corticosteroid treatment is initiated, the patient regularly reports both joint and systemic improvements. Monitoring the patient’s respiratory status by ordering a chest/lung examination after treatment is also important. If you have questions or issues, check out the Frequently Asked Questions: Practice Materials. To prevent deformity and loss of joint function, the patient would be advised to exercise appropriately. 2. • Read the Primum CCS FAQs (PDF) to learn more about the Primum experience. USMLE Content Outline A 56-year-old African American female with a history of asthma is diagnosed with hypertension. Stabilizing the patient with intravenous (IV) magnesium sulfate to prevent another seizure, plus an IV optimal antihypertensive (hydralazine or beta blockers) to reduce blood pressure, is important. Bronchial Asthma 3. The absence of fever, chills, cough, or pleural rub suggests that the problem is not an infectious pulmonary process. Therefore, it is not feasible to list every action that might affect an examinee's score. All rights reserved. 10 item question in Asthma. The fetal heart rate should be watched until delivery by ordering a fetal monitor. The patient appears drowsy, lethargic, and acutely ill. The CCS database contains thousands of possible tests and treatments. The pregnancy has been uncomplicated so far. HEENT/neck examination shows dry mucous membranes. Once the ascending aortic dissection is discovered and aortic root involvement confirmed, optimal treatment should include open heart surgery, endovascular aortic aneurysm repair (EVAR), thoracotomy or cardiothoracic surgery, or general surgery consult. Or, a referral would be made for physical or occupational therapy. Other examples of treatments that would waste time, subject the patient to unnecessary discomfort or risk, and add no real benefit to this patient include: In this case, a 32-year-old woman comes to the office because of knee pain and swelling. Primum® Computer-based Case Simulation Software Version Download Step 3 tutorial and practice items, including practice CCS cases. The patient has experienced increasing fatigue and generalized weakness during the past 4 months. Examples of additional tests, treatments, or actions that could be ordered but would be neither useful nor harmful to the patient include: Examples of suboptimal or poor management would include failure to examine the chest, admission before treatment, failure to order a chest x-ray after inserting the chest tube and/or needle thoracostomy, delay in treatment to reexpand the lung, or absence of treatment. chest x-ray done to rule out: The following are helpful in determining the severity of an He reports that when he was first diagnosed with asthma, he experienced shortness of breath and … If you still experience issues after following the instructions above, please contact us. An optimal approach would include completing the above diagnostic and management actions as quickly as possible (ie, during the first hour of simulated time). An optimal, efficient diagnostic approach would include quickly performing a targeted physical examination that includes chest/lung and cardiovascular examination, cardiac monitoring, and assessing oxygen saturation by pulse oximetry. He is moaning and holding his hands over the right side of his chest. 24. Most of these questions are the same as those you can install on your computer from the USMLE website. The United States Medical Licensing Examination is a joint program of the Federation of State Medical Boards of the United States, Inc. What is the 4th line of defense in asthma? There is no time limit. Examples of invasive and noninvasive actions that would subject the patient to unnecessary discomfort or risk include: In this case, a 4-year-old boy is brought to the office because of increasing shortness of breath during the past 3 days. The diagnostic workup should also include blood tests for serum creatinine (basic metabolic profile or complete metabolic profile) to assess kidney function, electrolytes to check sodium and potassium concentrations, a complete blood count (CBC) to look for signs of anemia, serum creatine kinase or serum troponin I (cardiac enzymes) to rule out myocardial compromise, and a blood group and crossmatch. ; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. Once the headphone is confirmed to be functioning properly, the remainder of the tutorial is left to the discretion of the examinee. • Download the Step 3 tutorial and practice items, which includes practice CCS cases. Asthma is inflammation and narrowing of the airways (bronchi), and during an attack the … The patient’s illness, at this point, would seem most consistent with a coronary or aortic abnormality with associated aortic regurgitation. Register for a CBT Practice Session ». The pain is excruciating, sharp, and increases with respiration. Admitting the patient to the inpatient ward or intensive care unit, Changing the location to the outpatient office or sending the patient home, Administrative rights - Control Panel > User Accounts > Change account type, Control Panel > Appearance and Personalization >, Control Panel > Appearance and Personalization > Display >, Control Panel > Clock, Language, Region > Region and Location >, File sharing software must be disabled (e.g., uTorrent, drop box, google drive), Double click on downloaded file to extract installation file, Double click on installation file and follow prompts. In evaluating case performance, the domains of diagnosis (including physical examination and appropriate diagnostic tests), therapy, monitoring, timing, sequencing, and location are considered. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows the differential. Timely diagnosis and management are essential in this case. Diseases of the Respiratory System 2. Stabilizing the patient with optimal intravenous (IV) fluids (eg, Lactated Ringer solution or normal saline solution) to improve hydration, and treating the patient empirically with a broad-spectrum IV or intramuscular (IM) antibiotic to cover the most likely sources of infection are important. Xanthines such as aminophylline, magnesium sulfate via an IV, as well as Heliox. In this case, the sudden onset of radiating chest pain along with the bounding pulses, widened pulse pressure, aortic murmur, and long history of hypertension are highly suggestive of the diagnosis of ascending aortic dissection. When the patient was 2 years old, he was hospitalized for 1 week for similar symptoms and treated with intravenous antibiotics and oxygen. Approximately 20 millions Americans are affected by asthma. Chronic Obstructive Pulmonary Disease(COPD) 4. D. A malignant disease. 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