KSA Asthma Exam: Questions & Answers: Guaranteed A+ Guide : Updated

A 22-year-old male with long-standing asthma develops an asthma exacerbation following an upper respiratory infection. He is seen in the emergency department with severe dyspnea and a fall in peak flow to 270 L/min, which is 45% of his personal best peak flow of 600 L/min. He is hospitalized and aggressively treated with short-acting β-agonists, plus oral prednisone, 40 mg daily. He responds incompletely to therapy, with an increase in his peak flow to 340 L/min (57% of personal best). According to National Asthma Education and Prevention Program guidelines, hospital discharge can be considered in this patient once the peak flow rate rises above (Ans- B. 420 L/min A 27-year-old male presents with a history of an intermittent but debilitating cough that appears to have no specific trigger, although it seems to be worse with exercise or when he is anxious. He also says that the cough has lasted for up to 4 months after an upper respiratory infection and does not respond to antitussives. You are considering a bronchoprovocation test. Which one of the following statements is true regarding bronchoprovocation testing? (Ans- D. Testing is not recommended in patients with a baseline FEV1 <60% of predictedA 15-year-old male sees you for routine follow-up of mild persistent asthma that has been well controlled in the past with daily use of an inhaled corticosteroid and as-needed use of a short-acting β-agonist. He reports that he has been having symptoms that required the use of his short-acting β-agonist 3-4 times a month, but with no nighttime awakening. His peak flow measured at home yesterday was 400 L/min (75% of personal best). Before stepping up his therapy with daily and as-needed use of a lowdose inhaled corticosteroid plus formoterol, which one of the following should you consider at this visit? (Ans- A. Reviewing inhaler technique to ensure correct use A 20-year-old male presents with a history of acute worsening of his chronic asthma, which previously met the criteria for mild persistent asthma. This exacerbation started a week ago and coincided with the height of ragweed pollen production in your community. The patient is a member of his college cross-country team and runs several miles each week. On examination he is tachypneic and short of breath, uses accessory muscles to breathe, and has some difficulty speaking. He initially has a good response to two administrations of a short-acting β- agonist, 20 minutes apart using a metered-dose inhaler with a spacer. His symptoms reoccur while he is still in the office, although they are milder. You determine that a course of oral corticosteroids would be beneficial. Which one of the following is true regarding the use of systemic corticosteroids in this patient?