WBR1055
| Author | [[PageAuthor::Abdurahman Khalil, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | |
| Sub Category | |
| 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::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. Educational Objective: 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 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:: |