D028 EXAM QUESTIONS AND
VERIFIED CORRECT ANSWERS
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Plan - CORRECT ANSWER-Encourage Ms. Jones to continue to monitor symptoms and log her
episodes of asthma symptoms and wheezing with associated factors and bring log to next visit.
• Obtain office oxygen saturation. • Order PFTs to be completed after exacerbation to have
baseline available for future comparison. • Encourage to wash bedding and consider dust mite
covers to decrease allergic nighttime symptoms. • NMT in office x 1. • Educate to increase
intake of water and other fluids. • Educate Ms. Jones on when to seek emergent care including
episodes of chest pain or shortness of breath unrelieved by rest, worsening asthma symptoms
or wheezing, or the sense that rescue inhaler is not helping. • Revisit clinic in 2-4 weeks for
follow up and evaluation.
Assessment - CORRECT ANSWER-Asthma exacerbation
Objective - CORRECT ANSWER-General: Ms. Jones is a pleasant, obese 28-year-old African
American woman in no acute distress. She is alert and oriented and sitting upright on exam
table. She maintains eye contact throughout interview and examination. • Respiratory: Chest
expansion is symmetrical with respirations. Normal fremitus, symmetric bilaterally. Chest
resonant to percussion; no dullness. Bilateral expiratory wheezes in posterior lower lobes.
Bilateral muffled words with notable expiratory wheezes in posterior lower lobes. No crackles.
In office spirometry: FVC 1.78 FEV1/FVC ratio 87.02% SpO2: 97%.
Subjective - CORRECT ANSWER-HPI: Ms. Jones is a pleasant 28-year-old African American
woman who presented to the clinic with complaints of shortness of breath and wheezing
following a near asthma attack that she had two days ago. She reports that she was at her
cousin's house and was exposed to cats which triggered her asthma symptoms. At the time of
, the incident she notes that her wheezes were a 6/10 severity and her shortness of breath was a
7-8/10 severity and lasted five minutes. She did not experience any chest pain or allergic
symptoms. At that time she used her albuterol inhaler and her symptoms decreased although
they did not completely resolve. Since that incident she notes that she has had 10 episodes of
wheezing and has shortness of breath approximately every four hours. Her last episode of
shortness of breath was this morning before coming to clinic. She notes that her current
symptoms seem to be worsened by lying flat and movement and are accompanied by a non-
productive cough. She awakens with night-time shortness of breath twice per night. She
complains that her current symptoms are beginning to interfere with her daily activities and she
is concerned that her albuterol inhaler seems to be less effective than previous. Currently she
states that her breathing is normal. Diagnosed with asthma at age 2.5 years. She has no recent
use of spirometry, does not use a peak flow, does not record attacks, and does not have a home
nebulizer or vaporizer. She has been hospitalized five times for asthma, last at age 16. She has
never been intubated for her asthma. She does not have a current pulmonologist or allergist.
Social History: She is not aware of any environmental exposures or irritants at her job or home.
She changes her sheets weekly and denies dust/mildew at her home. She uses a hypoallergenic
pillow cover and her mattress is one yea
Established chief complaint - CORRECT ANSWER-Reports increased breathing problems and
shortness of breath(Found)Pro Tip: Foundational questions about general well-being are
important in assessing how a patient feels at the current moment. This creates a space for Tina
to contextualize her current feeling in relation to a chief complaint.Example Question:What
brings you in today?
Finding:
Reports decreased effectiveness of inhaler
Finding:
Asked about onset of symptoms - CORRECT ANSWER-Finding:
Reports symptoms began two days ago
Asked about frequency and duration of SOB episodes - CORRECT ANSWER-Reports
exacerbations lasting several minutes(Found)Pro Tip: Knowing the duration of an asthma or