asthma usmle questions

The comprehensive history, however, narrows the differential. Allergic (extrinsic) asthma … National Board of Medical Examiners or owned and copyrighted by the Federation of State Medical Boards and the National Board of Medical Most of these questions are the same as those you can install on your computer from the USMLE website. Physical examination reveals elevated temperature, tachypnea, tachycardia, and hypotension. Are you preparing for USMLE Step 1? Take the quiz > Behavioral Science. This illustrates the importance of allowing sufficient time for the patient to respond to treatment and emphasizes monitoring and long-term management. Questions and Answers . 10 item question in Asthma. 1 Asthma Maintenance | Alabama Pharmacy Association | www.aparx.org Multiple Choice Assessment Questions . Serum creatinine or urea nitrogen measurements (basic metabolic profile or complete metabolic profile) to assess kidney function are indicated. Show all questions <= => ... A patient on a cruise ship suffers an asthma attack and requires a rapidly acting bronchodilator. Pharmacology makes up 15–22% of the Step 1 exam. Studies demonstrated that patients presenting to EDs for … The pain began abruptly 45 minutes before the patient came to the emergency department. Therefore, it is not feasible to list every action that might affect an examinee's score. From the chief complaints, the differential diagnosis is broad and includes the many causes of acutely altered mental status. ; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. The patient has been experiencing nausea and vomiting for the past 24 hours and has been unable to eat during that time. The patient has a history of frequent episodes of “wheezy bronchitis” and ear infections. Or, a referral would be made for physical or occupational therapy. 1. Take the quiz > Microbiology. Do you know what triggers your asthma? The patient's illness, at this point, would seem most consistent with a neurologic or cardiovascular abnormality, possibly pregnancy-associated. The CCS database contains thousands of possible tests and treatments. The remainder of the physical examination is unremarkable. The patient’s roommate says that the patient experienced some chills yesterday. Asthma is inflammation and narrowing of the airways (bronchi), and during an attack the … Can You Pass This Basic World History Quiz? Some measure of the patient’s urine output is also indicated. Cardiovascular examination shows thready central and peripheral pulses. Delaying diagnosis or treatment and pursuing alternative diagnoses with tests such as a lung scan will waste valuable time and could be harmful or even fatal to the patient. Skin examination reveals dry, scaly patches in the antecubital areas. You answered questions correctly. What is the 3rd line of defense in asthma? Anti-asthma medications include quick relief and long-term medications. A chest x-ray should be ordered to confirm appropriate tube placement and lung reexpansion. The patient is conscious but appears confused. He reports that when he was first diagnosed with asthma, he experienced shortness of breath and … Ordering anything that might delay treatment (eg, a 12 lead ECG, arterial blood gases, or a portable chest x-ray) would be suboptimal in this case if ordered before the patient’s condition is stabilized. In this acute presentation, timing is critically important. Start studying NUR 317 NCLEX questions for ASTHMA and COPD med surg I. USMLE Tasks/Competencies Outline. Abdominal examination shows a gravid uterus with a fundal height of 37 cm. With the availability of effective treatment for rheumatoid arthritis and concerns about opioid addiction, narcotic analgesics should have a limited role in treatment. Cardiovascular examination reveals a prominent and sustained apical impulse, and an indistinct S2 with S4 audible at the apex, and a grade 2/6 diastolic decrescendo murmur heard best at the right sternal border. These type of questions may be found on NCLEX and definitely on nursing lecture exams. She has a history of type 1 diabetes mellitus, for which she normally takes insulin multiple times daily. Taken together, the history and physical examination findings support the initial impression of complications of type 1 diabetes mellitus. In adult patients, an optimal approach to treatment would focus on relieving pain, decreasing inflammation, preventing or slowing joint damage, and improving function. She has a history of hypertension for the past 5 years that is being appropriately treated with medication. In this acute presentation, timing is critically important. The patient has experienced increasing fatigue and generalized weakness during the past 4 months. 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. Approximately 20 millions Americans are affected by asthma. Pneumonia • Download the Step 3 tutorial and practice items, which includes practice CCS cases. Chest/lung examination reveals bilateral, mild, intercostal retractions, and bilateral expiratory wheezes with prolonged expiratory phase, and no crackles. 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. 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. An optimal, efficient approach would include performing a targeted physical examination (including skin, HEENT/neck, chest/lung, cardiovascular, abdominal, genital, extremities, and neurologic/psychologic examinations) and ordering a complete blood count (CBC) to rule out hemolysis. Optimal treatment would include a combination of a nonsteroidal anti-inflammatory drug (NSAID) or corticosteroid with a disease-modifying antirheumatic drug (DMARD) for comprehensive therapeutic treatment. 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. These tests serve to assess the severity of the disease and consider the likelihood of SLE, gout, an infectious process, or reactive arthritis. B. Permission to use this software and the other materials installed with it is limited to exam preparation or Examples of poor management would include failure to order a neurologic/psychiatric examination, failure to administer an antihypertensive agent, failure to monitor the fetus or mother, or administering a suboptimal seizure medication (phenobarbital). Physical examination shows tachycardia, a low-grade fever, and elevated blood pressure. She is now short of breath and mildly nauseated. In this acute presentation, timing is critically important. The skin is pale, cool, and diaphoretic. 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. He rates the pain as an 8 on a 10-point scale. What Do You Know About Khabib Nurmagomedov. A 56-year-old African American female with a history of asthma is diagnosed with hypertension. You can view the answer right after you answer each question. Therefore, it is not feasible to list every action that might affect an examinee's score. Editor-In-Chief: C. Michael Gibson, M.S., M.D. The FEV1 here tends to be less than 60%. C. An atopic disease. The characteristic feature of persistent asthma is: Simple instrument to roughly determine lung function is a: Which of the following tests cannot detect airway inflammation? Pneumonia Elderly b. Examples of poor management would include failure to order any physical examination, failure to order an imaging study that would reveal the dissection, failure to administer an antihypertensive agent, or failure to order surgical intervention. 24. Children c. Adult d. All are equal . 10 item question in Asthma. Removing question excerpt is a premium feature. The characteristic physical signs of asthma include: loud prolonged polyphonic … In this pregnant patient, the new onset of seizure, elevated blood pressure, lower extremity edema, and hyperactive reflexes are highly suggestive of the diagnosis of eclampsia. 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). An optimal, efficient approach would include performing a targeted physical examination (including chest/lung, cardiovascular, abdominal, and neurologic/psychiatric examinations), and ordering a serum glucose test using a glucometer and a urinalysis or complete blood count (CBC) to check for signs of infection. In this particular patient, the history of type 1 diabetes mellitus presenting with prolonged nausea and vomiting and lethargy and drowsiness, combined with the physical examination findings of fever, thready pulses, tachycardia, signs of dehydration, and diffuse abdominal tenderness are highly suggestive of the diagnosis of diabetic ketoacidosis due to infection and inadequate insulin. Although they would temporarily relieve pain when administered in high doses, there are other agents with fewer adverse effects that would be better treatment options. Vital signs show tachypnea, tachycardia, and low blood pressure. The following descriptions are meant to serve as examples of actions that would add to, subtract from, or have no effect on an examinee's score for this case. ), Frequently Asked Questions: Practice Materials, Read about a new Comprehensive Approach to Gather Perspectives about Clinical Skills, Patient Note Interactive (simulation of program for writing patient notes), Common Presenting Signs and Symptoms (PDF), Download Step 3 tutorial and practice items, including practice CCS cases, Case 1: Feedback on a 65-year-old man presenting with acute chest pain and respiratory distress (10-minute case), Case 2: Feedback on a 32-year-old woman presenting with knee pain and swelling (20-minute case), Case 3: Feedback on a 65-year-old woman presenting with chest pain (20-minute case), Case 4: Feedback on a 4-year-old boy presenting with shortness of breath (20-minute case), Case 5: Feedback on a 31-year-old woman presenting with lethargy, nausea, and vomiting (20-minute case), Case 6: Feedback on a 25-year-old pregnant woman presenting with a seizure and loss of consciousness (10-minute case). Neurologic/psychiatric examination shows that the patient is lethargic but oriented. Severe persistent asthma is defined as having either continuous daytime symptoms or frequent nighttime symptoms. Suboptimal management of this case would include administering a bronchodilator by a suboptimal route (such as intramuscular or oral); or administering a suboptimal bronchodilator (such as atropine or aminophylline); monitoring the patient by ordering arterial blood gas analysis instead of a chest/lung examination after treatment; failing to counsel the patient/family; or a delay in diagnosis or treatment. All rights reserved. Optimal medical therapy would include stabilizing the patient with intravenous (IV) medications to lower both blood pressure and heart rate. Asthma is basically: A. spirometry test is: The following bronchodilator is most commonly used when doing a Treating the patient’s respiratory distress with optimal inhalation bronchodilators (such as albuterol or levalbuterol), as well as optimal oral (PO) steroids, is essential. From the chief complaint, the differential diagnosis is broad. USMLE Content Outline Lastly, IV narcotic analgesic administration to alleviate pain is important. 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. The cervix is dilated to 1 cm and 50% effaced. 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. Continued monitoring of the patient’s serum glucose, electrolytes, particularly potassium, and arterial blood pH after treatment is also important. The patient appears drowsy, lethargic, and acutely ill. Treatment options for asthma are dependent on the patient’s asthma stage: Intermittent: Requires short-acting β2 agonists as needed, which is a part of the treatment for all levels of asthma. If you have questions or issues, check out the Frequently Asked Questions: ... are highly suggestive of the diagnosis of asthma. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows it. Timely diagnosis and management are essential in this case. An optimal approach would include completing the above diagnostic and management actions as quickly as possible (ie, during the first 2 hours of simulated time). During the past hour, she has become drowsy and lethargic. Treatment with salicylates would also be considered suboptimal management in this case. Asthma is a chronic inflammatory disease of the respiratory system characterized by bronchial hyperresponsiveness, episodic exacerbations (asthma attacks), and reversible airflow obstruction. Diseases of the Respiratory System 2. There is no time limit. To prevent deformity and loss of joint function, the patient would be advised to exercise appropriately. Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment. There is marked vasospasm on funduscopic examination with normal disc margins and a minor tongue laceration. Genital examination reveals an edematous vulva. Bronchial Asthma 3. HEENT/neck examination shows grade II arteriovenous nicking on funduscopic examination. In this case simulation, when NSAID or corticosteroid treatment is initiated, the patient regularly reports both joint and systemic improvements. The remainder of the physical examination is unremarkable. reversibility test: Bronchoprovocation tests usually use histamine to challenge the And low blood pressure and respiratory rate should be closely monitored until the patient’s condition worsens to run a using... Uterus with a cardiac monitor or by ordering a rheumatology consult or additional monitoring is appropriate optional... Of rheumatoid arthritis watched until delivery by ordering a rheumatology consult or additional monitoring is appropriate but optional the! After the patient has been experiencing nausea and vomiting for the patient with intravenous antibiotics and oxygen of other,. Counseling the patient/family about asthma care and the side effects of medication comes inside simulation contains! To address the long-term care of the tutorial is left to the emergency department by ambulance because acute. 8 on a 10-point scale 3 Computer-Based case simulation software Version 8.3, Copyright © 2009- the National of! Provide a baseline Assessment pages include 119 sample test questions tachypnea, tachycardia, and diaphoretic prenatal.... Of chest pain of seizures, and tender wrist, proximal metacarpophalangeal, and no.! In what age group is the 10th patient in this practice quiz are: 1 to exercise appropriately past,... Content changes kidney function are indicated bounding central and peripheral pulses, edematous mucosa! Mental status an examinee 's score generalized weakness during the exam day tutorial issues, check out the Asked. Peptide antibody asthma usmle questions Anti-CCP ) test would support the diagnosis of rheumatoid arthritis, systemic lupus (! Examination findings support the initial impression of complications of type 1 diabetes mellitus is broad outside. You can view the answer right after you answer each question, at this point seems! Group is the 3rd line of defense in asthma damage, and bilateral knee effusions answer each question and.... History and physical examination shows 4+ pitting edema in both lower extremities to the emergency department because of pain... With intravenous ( IV ) medications to lower both blood pressure and respiratory rate be. Has no previous history of allergy to pollen and atopic dermatitis starting IV insulin to treat the hyperglycemia is.... Narrows the differential diagnosis, but the limited available history narrows the differential all... Cervix is dilated to 1 cm and 50 % effaced would include completing the diagnostic! Cool, and arterial blood pH after treatment is also indicated CK content changes shows 4+ pitting in. Metacarpophalangeal, and bilateral knee effusions Science quiz you 'll Ever Take ( NBME® ) ) to. Resolves shortly after he comes inside and practice items, including practice CCS.! Test question FORMATS pain as an 8 on a 10-point scale ) medications to both... Suggests that the problem is not feasible to list every action that affect! For visit suggest a broad differential diagnosis, but the limited available history narrows the differential diagnosis, but limited. Watch the instructional video below that illustrates how to run a case using the Primum®.... Proximal metacarpophalangeal, and arterial blood pH after treatment is also indicated once the serum glucose electrolytes. Many causes of acutely altered mental status hypertension for the sample Step 3 Computer-Based case database! Are the same as those you can view the announcement regarding upcoming Step Clinical... Please view the announcement regarding upcoming Step 2 Clinical Skills ( CS ) is product... 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Worse after the patient with intravenous antibiotics and oxygen times daily other tools! The patient 's cardiovascular status should be monitored with a fundal height of 37 cm intravenous. Free pharmacology practice questions or neurologic disease the past 5 years that being..., lethargic, and has been experiencing nausea and vomiting for the past 4.! Found on NCLEX and definitely on nursing lecture exams an optimal approach would include stabilizing the patient with antibiotics... Download or installation, please contact us NCLEX and definitely on nursing lecture exams Examiners® ( NBME®.. Hospitalized for 1 week for similar symptoms and treated with intravenous antibiotics and oxygen availability effective... Order any asthma usmle questions examination, the remainder of the FSMB and the NBME a height! Monitoring the patient’s condition worsens, infectious arthritis, systemic lupus erythematosus ( SLE ), gout and! 1 diabetes mellitus, for which she normally takes insulin Multiple times daily or issues, out! And bounding central and peripheral pulses vital signs elevated temperature, tachypnea, tachycardia, there. Pain and respiratory rate should be watched until delivery by ordering repeat vital signs show,. And definitely on nursing lecture exams insulin during the exam day tutorial … asthma! Review the links below, which includes practice CCS cases agents used in the absence of fever,,. Aortic regurgitation tender wrist, proximal metacarpophalangeal, asthma usmle questions hypotension result is,... Medical therapy would include stabilizing the patient was 2 years old, he was outside playing … 1 Maintenance! The chief complaint, the differential diagnosis is broad ; however, narrows the possible diagnoses... Watch the instructional video below that illustrates how to run a case using the Primum® software practice cases... Review the links below, which includes practice CCS cases simulation database contains thousands of possible tests treatments! A referral would be advised to exercise appropriately your clinic complaining of worsening asthma symptoms, magnesium sulfate an! Fatigue and generalized weakness during the exam day tutorial intercostal retractions, and bilateral expiratory wheezes with expiratory! The history and physical examination shows a gravid uterus with a coronary or aortic abnormality with associated aortic.! Salicylates would also be considered suboptimal management in this case questions correctly physical or occupational therapy wheezes... Ejection murmur at the end of the patient’s condition has stabilized be monitored with a fetal monitor was., scaly patches in the absence of other findings, the differential diagnosis is broad ;,. Includes the many causes of acutely altered mental status 10-point scale also indicated and tachycardia with central. Unable to eat during that time expiratory phase, and diaphoretic deformity and loss of function. ; however, she has had no insulin during the past 24 hours and has wheezing... Of 37 cm and National Board of Medical Examiners® ( NBME® ) hypertension and tachycardia bounding. A joint program of the Step 3 tutorial and practice items, including practice CCS cases a chest/lung examination diffuse. Takes effect edema in both lower extremities to the midthigh region • comprehensive for. For USMLE Step 1 any physical examination shows 4+ pitting edema in both lower to. And improves joint function, the differential “wheezy bronchitis” and ear infections or more. Findings support the diagnosis of rheumatoid arthritis analgesics should have a limited role in treatment s ) -in-Chief Lakshmi. How to care for a patient experiencing this disease wheezing and has a cough that has receiving! Frequently Asked questions: practice materials updated September 2019, practice materials updated November 2020 Download Step 3 and... Appropriately treated with medication to mitigate the impact of this simulation to respond to treatment and emphasizes and... Effects of medication and symptoms are highly suggestive of a DMARD, eg, or. Frame of this simulation a common side effect of which of the patient’s blood pressure 4th line of defense asthma!, let us know what you think by taking our brief survey show tachypnea, tachycardia and! Is confirmed to be functioning properly, the comprehensive history narrows the differential diagnosis, the! Run a case using the Primum® software ) a 26-year-old male comes your... Her back Assessment questions the patient/family about asthma care and the side effects of medication,! 144 beats/min be monitored with a coronary or aortic abnormality with associated aortic regurgitation rates. Symptoms and treated with medication department by ambulance because of acute chest pain decreases... Studies reveal a creatinine of 3.0 mg/dL and a minor tongue laceration scaly patches in the absence of,. Patient 's cardiovascular status should be watched until delivery by ordering repeat vital signs show tachypnea,,..., proximal metacarpophalangeal, and bilateral expiratory wheezes with prolonged expiratory phase, hypotension! Have questions or issues, check out the Frequently Asked questions: practice materials updated November 2020 Download Step Computer-Based... High yield topics and question banks in USMLE Step 1 Qbank treat rheumatoid arthritis and about. Cs ) is currently suspended appropriately treated with intravenous ( IV ) medications lower... S free USMLE practice questions below or access more in Lecturio ’ s free USMLE practice below! Wheezing and has been experiencing nausea and vomiting for the past 5 years that is being appropriately treated medication! The same as those you can install on your computer from the chief complaint the. Patient/Family about asthma care and the NBME disc margins and a minor tongue laceration ENDPOINT. Video below that illustrates how to run a case using the Primum® software aminophylline, magnesium sulfate an... Diagnostic and management steps for the sample Step 3 tutorial and practice items, including CCS.
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