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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{AK}} | |QuestionAuthor= {{AK}} | ||
|ExamType=USMLE Step 3 | |ExamType=USMLE Step 3 | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, Respiratory | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|MainCategory=Primary Care Office | |MainCategory=Community Medical Health Center, Primary Care Office | ||
|SubCategory=Allergy/Immunology, Respiratory | |SubCategory=Allergy/Immunology, Cardiovascular, 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= | |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. | |||
|AnswerA=Add betamethasone inhaler | |AnswerA=Add betamethasone inhaler | ||
|AnswerAExp=Incorrect. | |AnswerAExp=Incorrect. | ||
|AnswerB=Add salmeterol | |AnswerB=Add salmeterol | ||
|AnswerBExp=Incorrect. | |AnswerBExp=Incorrect. | ||
| Line 32: | Line 34: | ||
|AnswerE=Increase albuterol dose | |AnswerE=Increase albuterol dose | ||
|AnswerEExp=Incorrect | |AnswerEExp=Incorrect | ||
|EducationalObjectives= | |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. | ||
Beta blockers | |References=Lopressor FDA label<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 | ||
}} | }} | ||
Latest revision as of 02:28, 28 October 2020
| Author | [[PageAuthor::Abdurahman Khalil, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Community Medical Health Center, MainCategory::Primary Care Office |
| Sub Category | SubCategory::Allergy/Immunology, SubCategory::Cardiovascular, 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. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Asthma, WBRKeyword::Hypertension, WBRKeyword::Beta-blocker, WBRKeyword::Bronchodilator |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |