Midterm Exam-Primary Care and Collaboration

A patient diagnosed with chronic obstructive pulmonary disease reports daily symptoms of dyspnea and cough. Which medication will the primary health care provider prescribe? a. Ipratropium bromide b. Pirbuterol acetate c. Salmeterol xinafoate d. Theophylline ANS: A - Ipratropium bromide is an anticholinergic medication and is used as first-line therapy in patients with daily symptoms. Pirbuterol acetate and salmeterol xinafoate are both beta2-adrenergics and are used to relieve bronchospasm; pirbuterol is a short-term medication used for symptomatic relief and salmeterol is a long-term medication useful for reducing nocturnal symptoms. Theophylline is a third-line agent. A 25-year-old patient has a tuberculosis (TB) skin test which reveals an area of induration of 12 mm. The patient is a recent immigrant from Mexico and lives in a homeless shelter. What is the recommended treatment for this patient? a. Administer the bacillus Calmette-Guérin (BCG) vaccine b. Begin isoniazid (INH) preventive therapy c. Order isoniazid (INH) and Rifampin d. Perform regular TB skin testing every few months ANS: B - Patients younger than 35 who have any risk factors for TB and with an area of induration > 10 mm should be considered for INH preventive therapy. This patient is an immigrant from Mexico and lives in a homeless shelter, so TB preventive therapy is acceptable. BCG vaccine is not helpful. INH and Rifampin are used if patients develop symptoms or if there is antibiotic resistance. A 35-year old patient develops acute viral bronchitis. Which is the focus for the management of symptoms in this patient? a. Trimethoprim-sulfamethoxazole therapy b. Antibiotic therapy c. Supportive care d. Antitussive therapy ANS: C - The mainstay of treatment in acute bronchitis is directed toward symptom reduction and supportive care. Data suggest that 85% of patients diagnosed with acute bronchitis will improve without specific treatment. Trimethoprim-sulfamethoxazole is prescribed for pertussis when macrolides are not an option. Antibiotic therapy is not effective in treating viral acute bronchitis.