The patient's cardiovascular status should be monitored with a cardiac monitor or by ordering repeat vital signs. Physical examination shows slight tachycardia. Boards of the United States, Inc. and the National Board of Medical Examiners, except for the following: Copyright © 2016- National Board of Medical Examiners as to the computer program test driver. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Lastly, IV narcotic analgesic administration to alleviate pain is important. Allergic (extrinsic) asthma … Suboptimal management of this case would include delay in diagnosis or treatment; administering suboptimal IV fluids (eg, hypotonic saline solutions, dextrose in water, or dextrose in Lactated Ringer solution); initial treatment with subcutaneous insulin; suboptimal IV or IM antibiotics; or neglecting to order indicated blood tests. Register for a CBT Practice Session ». The United States Medical Licensing Examination is a joint program of the … 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. An NSAID or corticosteroid relieves pain and decreases inflammation essential to provide interim symptom relief while the selected DMARD takes effect. Deep tendon reflexes are 4+ with bilateral clonus at the ankles. Severe persistent asthma is defined as having either continuous daytime symptoms or frequent nighttime symptoms. Physical examination shows tachycardia, a low-grade fever, and elevated blood pressure. Therefore, it is not feasible to list every action that might affect an examinee's score. Asthma is basically: A. HEENT/neck examination shows dry mucous membranes. Serum creatinine or urea nitrogen measurements (basic metabolic profile or complete metabolic profile) to assess kidney function are indicated. In this acute presentation, timing is critically important. Anti-asthma medications include quick relief and long-term medications. airways. USMLE Tasks/Competencies Outline. At age 18 months, the patient had pressure equalizing tubes inserted. Quiz: Which Anime Character Are You Most Like? Neurologic/psychiatric examination shows that the patient is conscious but oriented to person and place only. (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. The patient is experiencing sharp, left-sided chest pain that radiates to her left jaw and to her back. All rights reserved. 1. National Board of Medical Examiners or owned and copyrighted by the Federation of State Medical Boards and the National Board of Medical Download Step 3 tutorial and practice items, including practice CCS cases. Neurologic/psychiatric examination shows that the patient is lethargic but oriented. Physical examination shows bilateral swollen, warm, and tender wrist, proximal metacarpophalangeal, and knee joints, and bilateral knee effusions. The fetus is cephalic by palpation with a fetal heart rate of 144 beats/min. USMLE Content Outline If you have questions or issues, check out the Frequently Asked Questions: ... are highly suggestive of the diagnosis of asthma. 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. A 56-year-old African American female with a history of asthma is diagnosed with hypertension. The skin is pale, cool, and diaphoretic. 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. 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. These tests serve to assess the severity of the disease and consider the likelihood of SLE, gout, an infectious process, or reactive arthritis. • Review the links below, which provide feedback on diagnostic and management steps for the sample Step 3 Computer-Based Case Simulations. 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 patient is anxious, diaphoretic, and in severe distress from chest pain. The mother says that the wheezing seems to get worse after the patient plays outside but resolves shortly after he comes inside. She has a history of type 1 diabetes mellitus, for which she normally takes insulin multiple times daily. The patient appears pale and in marked respiratory distress. HEENT/neck examination shows pale, boggy, edematous nasal mucosa without nasal flaring. This NCLEX review will discuss asthma. Skin examination reveals dry, scaly patches in the antecubital areas. Take the quiz > Microbiology. are prohibited without permission from the copyright holders. Timely diagnosis and management are essential in this case. Chronic Obstructive Pulmonary Disease(COPD) 4. B. The patient has been experiencing nausea and vomiting for the past 24 hours and has been unable to eat during that time. Emergency oral and intravenous steroids. 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. Try 12 free pharmacology practice questions below or access more in Lecturio’s free USMLE Step 1 Qbank. Are you preparing for USMLE Step 1? (M1.PL.13.91) A 12-year-old female presents to her pediatrician with an asthma exacerbation. ; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. Immunology. 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. Primum® Computer-based Case Simulation Software Version 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. Examples of additional tests and treatments that could be ordered but would be neither useful nor harmful to the patient include: Examples of suboptimal management of this case would include delay in diagnosis or treatment, or treatment with NSAIDS or corticosteroids alone. Can You Pass This Basic World History Quiz? 10 item question in Asthma. Portions of Step 2 CS practice materials reproduced with permission Treatment with salicylates would also be considered suboptimal management in this case. FREE USMLE Practice Questions. Permission to use this software and the other materials installed with it is limited to exam preparation or Asthma free copy 100 mcqs 1. www.pharmaqz.com INTRODUCTION TO MULTIPLE CHOICE MCQS Multiple choice questions each have a number of options for the correct answer, with … Practice quiz are: 1 affect an examinee 's score diagnosis and management actions as quickly as possible and.! 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