Timely diagnosis and management are essential in this case. The 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 each case. An optimal, efficient approach would include performing a targeted physical examination (including HEENT/neck, chest/lung, cardiovascular, and abdominal examinations) and addressing oxygen status by ordering pulse oximetry or oxygen therapy. Physical examination shows hypertension and tachycardia with bounding central and peripheral pulses. Testing at CSEC centers for Step 2 Clinical Skills (CS) is currently suspended. It includes osteoarthritis, infectious arthritis, rheumatoid arthritis, systemic lupus erythematosus (SLE), gout, and psoriatic arthritis. A 56-year-old African American female with a history of asthma is diagnosed with hypertension. D. A malignant disease. It would be suboptimal to order anything unnecessary that would waste time, even if the test or procedure were not invasive or risky (eg, lung scan). An autoimmune disease. Optimal management should also include counseling the patient/family about asthma care and the side effects of medication. Primum® Computer-based Case Simulation Software Version Besides histamine, ____________ can also be used: In an acute severe attack of asthma, it is important to get a HEENT/neck examination shows pale, boggy, edematous nasal mucosa without nasal flaring. Examples of poor management would include failure to order any physical examination; failure to order a serum glucose test; failure to order a blood culture to determine the cause of the infection or failure to order a blood culture before administering empiric antibiotics; failure to treat with IV fluids, antibiotics, and insulin; or failure to monitor the patient after treatment. Once the ascending aortic dissection is discovered and aortic root involvement confirmed, optimal treatment should include open heart surgery, endovascular aortic aneurysm repair (EVAR), thoracotomy or cardiothoracic surgery, or general surgery consult. HEENT/neck examination shows grade II arteriovenous nicking on funduscopic examination. The patient's cardiovascular status should be monitored with a cardiac monitor or by ordering repeat vital signs. Asthma is an umbrella term for a chronic respiratory disease with a group … Take the quiz > Biostatistics. • ONE BOOK for (First aid book + USMLE World qbank + high … 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. Then, let us know what you think by taking our brief survey. She developed generalized aches and morning joint stiffness during the past 8 weeks and, more recently, pain and intermittent swelling of both wrists, and of the proximal metacarpophalangeal joints, as well as bilateral knee swelling. 1. This is a practice mode. The pain is excruciating, sharp, and increases with respiration. In adult patients, an optimal approach to treatment would focus on relieving pain, decreasing inflammation, preventing or slowing joint damage, and improving function. In addition, joint x-rays would provide a baseline assessment. Microsoft® Corporation. Monitoring the patient’s respiratory status by ordering a chest/lung examination after treatment is also important. When the patient was 2 years old, he was hospitalized for 1 week for similar symptoms and treated with intravenous antibiotics and oxygen. This Quiz has 10 questions. The fetus is cephalic by palpation with a fetal heart rate of 144 beats/min. Genital examination reveals an edematous vulva. 23. There are many effective medications that can be used to prevent and control asthma … • Watch the instructional video below that illustrates how to run a case using the Primum® software. There is a grade 2/6 systolic ejection murmur at the left sternal border without radiation. Laboratory studies reveal a creatinine of 3.0 mg/dL and a potassium level of 5.1 mg/dL. The patient also has a history of allergy to pollen and atopic dermatitis. Please view the announcement regarding upcoming Step 2 CK content changes. Portions of Step 2 CS practice materials reproduced with permission The patient has been experiencing nausea and vomiting for the past 24 hours and has been unable to eat during that time. 4 The following pages include 119 sample test questions. practice by individuals who are registered to take the examinations, and further reproduction, distribution, transmission, or other uses Unfortunately he is the 10th patient in 2 days who has required similar … The pregnancy has been uncomplicated so far. 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. • Download the Step 3 tutorial and practice items, which includes practice CCS cases. from the Educational Commission for Foreign Medical Graduates (ECFMG®) Clinical Skills Assessment (CSA®) Candidate Orientation An optimal, efficient approach would include performing a targeted physical examination (including skin, HEENT/neck, chest/lung, cardiovascular, abdominal, genital, extremities, and neurologic/psychologic examinations) and ordering a complete blood count (CBC) to rule out hemolysis. The patient's illness, at this point, would seem most consistent with a neurologic or cardiovascular abnormality, possibly pregnancy-associated. The patient is conscious but appears confused. In this case, a 65-year-old woman comes to the emergency department because of chest pain. 2. A review of the pathophysiology, presentation, diagnosis, and treatment of asthma for medical students and those learning clinical medicine. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Optimal medical therapy would include stabilizing the patient with intravenous (IV) medications to lower both blood pressure and heart rate. Other physical findings are unremarkable. Physical examination shows no breath sounds; there is tracheal deviation, jugular venous distention, hyperresonance to percussion on the right side of the chest, faint heart sounds, and weak peripheral pulses. This is a practice mode. B. The patient is anxious, diaphoretic, and in severe distress from chest pain. • Review the links below, which provide feedback on diagnostic and management steps for the sample Step 3 Computer-Based Case Simulations. Once the headphone is confirmed to be functioning properly, the remainder of the tutorial is left to the discretion of the examinee. At age 18 months, the patient had pressure equalizing tubes inserted. Treating the patient’s respiratory distress with optimal inhalation bronchodilators (such as albuterol or levalbuterol), as well as optimal oral (PO) steroids, is essential. In this acute presentation, timing is critically important. There is no history of any previous episodes of chest pain either at rest or on exertion. He is moaning and holding his hands over the right side of his chest. National Board of Medical Examiners or owned and copyrighted by the Federation of State Medical Boards and the National Board of Medical 10 item question in Asthma. The first step in management is to involve your health care provider. These also appear at the end of the practice cases. What are some special medications used for asthma… It is extremely important to check headphone volume during the exam day tutorial. If you have questions or issues, check out the Frequently Asked Questions: Practice Materials. The pain began abruptly 45 minutes before the patient came to the emergency department. Questions and Answers . This is carried out by doctors, pediatricians and hospitals to find out the severity … reversibility test: Bronchoprovocation tests usually use histamine to challenge the 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 … What is the 3rd line of defense in asthma? The patient has been wheezing and has a cough that has been worsening. During the past hour, she has become drowsy and lethargic. From the chief complaints, the differential diagnosis is broad and includes the many causes of acutely altered mental status. As to the materials that are owned and copyrighted by the NBME and FSMB: Copyright © 1998- the Federation of State Medical 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. Skin examination reveals dry, scaly patches in the antecubital areas. She has no previous history of seizures, and there is no history of hypertension or renal or neurologic disease. Stabilizing the patient with optimal intravenous (IV) fluids (eg, Lactated Ringer solution or normal saline solution) to improve hydration, and treating the patient empirically with a broad-spectrum IV or intramuscular (IM) antibiotic to cover the most likely sources of infection are important. The remainder of the physical examination is unremarkable. The diagnostic workup should also include arterial blood gas analysis to assess acidosis, bacterial blood culture to identify the organism before administering empiric antibiotics, and serum electrolyte measurements (ie, potassium) to assess the severity of dehydration. (M1.PL.13.91) A 12-year-old female presents to her pediatrician with an asthma exacerbation. Pneumonia Treatment options for asthma are dependent on the patient’s asthma stage: Intermittent: Requires short-acting β2 agonists as needed, which is a part of the treatment for all levels of asthma. Physical examination shows tachycardia, a low-grade fever, and elevated blood pressure. A rheumatoid factor test or a cyclic citrullinated peptide antibody (Anti-CCP) test would support the diagnosis of rheumatoid arthritis. Estimated fetal weight is 2700 g (6 lb). Most of these questions are the same as those you can install on your computer from the USMLE website. He reports that when he was first diagnosed with asthma, he experienced shortness of breath and … These tests serve to assess the severity of the disease and consider the likelihood of SLE, gout, an infectious process, or reactive arthritis. In evaluating case performance, the domains of diagnosis (including physical examination and appropriate diagnostic tests), therapy, monitoring, timing, sequencing, and location are considered. Approximately 20 millions Americans are affected by asthma. The patient has experienced increasing fatigue and generalized weakness during the past 4 months. Asthma is common and should be evaluated. The remainder of the physical examination is unremarkable. The mother says that the wheezing seems to get worse after the patient plays outside but resolves shortly after he comes inside. In the absence of other findings, the patient’s illness, at this point, seems most consistent with rheumatoid arthritis. The skin is pale, cool, and diaphoretic. 8.3, Copyright © 2009- the National Board of Medical Examiners. An optimal, efficient approach would include performing a targeted physical examination (including cardiovascular, chest/lung, and neurologic/psychiatric examinations), ordering a 12 lead electrocardiography (ECG), and a portable chest x-ray. The patient’s illness, at this point, would seem most consistent with a coronary or aortic abnormality with associated aortic regurgitation. Abdominal examination shows a gravid uterus with a fundal height of 37 cm. Neurologic/psychiatric examination shows that the patient is conscious but oriented to person and place only. He states that he was outside playing … The diagnostic workup should also include blood tests for serum creatinine (basic metabolic profile or complete metabolic profile) to assess kidney function, electrolytes to check sodium and potassium concentrations, a complete blood count (CBC) to look for signs of anemia, serum creatine kinase or serum troponin I (cardiac enzymes) to rule out myocardial compromise, and a blood group and crossmatch. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows it. Allergic (extrinsic) asthma … Neurologic/psychiatric examination shows that the patient is lethargic but oriented. This illustrates the importance of allowing sufficient time for the patient to respond to treatment and emphasizes monitoring and long-term management. Chest/lung examination reveals bilateral, mild, intercostal retractions, and bilateral expiratory wheezes with prolonged expiratory phase, and no crackles. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows the differential. An optimal, efficient approach to diagnosis would include performing an appropriate physical examination (including extremities/spine, chest/lung, cardiovascular, abdominal, skin, HEENT/neck, and lymph node examinations). She has a history of type 1 diabetes mellitus, for which she normally takes insulin multiple times daily. Or, a referral would be made for physical or occupational therapy. a. Environmental risk factors for the development of asthma … The FEV1 here tends to be less than 60%. 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. Physical examination shows bilateral swollen, warm, and tender wrist, proximal metacarpophalangeal, and knee joints, and bilateral knee effusions. The patient is experiencing sharp, left-sided chest pain that radiates to her left jaw and to her back. Examiners. Runtime library portions of the software included with permission Click here to check on the status of your test center. In this case, the sudden onset of radiating chest pain along with the bounding pulses, widened pulse pressure, aortic murmur, and long history of hypertension are highly suggestive of the diagnosis of ascending aortic dissection. An optimal approach would include completing the above diagnostic and management actions as quickly as possible. Permission to use this software and the other materials installed with it is limited to exam preparation or Deep tendon reflexes are 4+ with bilateral clonus at the ankles. Physical examination reveals elevated temperature, tachypnea, tachycardia, and hypotension. These signs and symptoms are highly suggestive of a chronic systemic inflammatory process. Initially the presentation and reason for visit suggest a broad differential diagnosis, but the limited available history narrows the differential. • Read the Primum CCS FAQs (PDF) to learn more about the Primum experience. FREE USMLE Practice Questions. The patient has a history of frequent episodes of “wheezy bronchitis” and ear infections. Continued monitoring of the patient’s serum glucose, electrolytes, particularly potassium, and arterial blood pH after treatment is also important. Abdominal examination reveals diffuse mild tenderness without guarding, rebound, or masses. If you receive an error during download or installation, please double check all steps under # 1 and 2 above. Asthma comes from the Greek word for “panting”, which makes sense because it causes chronic inflammation of the airways, making them narrow and more difficult to breathe through.. People with asthma can have asthma exacerbation or asthma … You can view the answer right after you answer each question. Ordering anything that might delay treatment (eg, a 12 lead ECG, arterial blood gases, or a portable chest x-ray) would be suboptimal in this case if ordered before the patient’s condition is stabilized. Extremities/spine examination shows 4+ pitting edema in both lower extremities to the midthigh region. Bronchial Asthma 3. Quiz: Which Anime Character Are You Most Like? 2. However, the comprehensive history narrows the possible differential diagnoses, making uncontrolled diabetes very likely. 25. An asthma attack occurs when asthma symptoms worsen acutely, and patients feel as if they cannot breathe. He rates the pain as an 8 on a 10-point scale. Although they would temporarily relieve pain when administered in high doses, there are other agents with fewer adverse effects that would be better treatment options. 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. Treatment should be initiated immediately before the patient’s condition worsens. Xanthines such as aminophylline, magnesium sulfate via an IV, as well as Heliox. Some measure of the patient’s urine output is also indicated. While the presence of certain clinical features is helpful in excluding other connective tissue diseases and osteoarthritis, further diagnostic evaluation is appropriate to confirm the presumptive diagnosis and establish the severity of the disease. acute attack except: Asthma Exam (Practice Mode) By Rnpedia.Com, Asthma Conf 09: Performing Spirometry And Spirometry Interpretation. Asthma is inflammation and narrowing of the airways (bronchi), and during an attack the … Children c. Adult d. All are equal . Register for a CBT Practice Session ». USMLE ENDPOINT ONLINE COURSE: • Comprehensive explanation for high yield topics and Question banks in USMLE step 1. 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. There is marked vasospasm on funduscopic examination with normal disc margins and a minor tongue laceration. The remainder of the physical examination is unremarkable. From the chief complaint, the differential diagnosis is broad. However, she has had no insulin during the past 24 hours. Try 12 free pharmacology practice questions below or access more in Lecturio’s free USMLE Step 1 Qbank. What is asthma exactly? 24. Cardiovascular examination shows a loud S4 and bounding central and peripheral pulses. Once stable, some form of chest imaging that would assess for an aortic dissection (including computed tomography (CT) of the chest with contrast, cardiac computed tomography angiography (CTA) with contrast, echocardiography, transesophageal echocardiography (TEE), magnetic resonance imaging (MRI) of the chest, or cardiac MRI with gadolinium) is needed. The patient had an acute onset of right-sided chest pain 10 minutes before the ambulance arrived. C. An atopic disease. 10 item question in Asthma. Removing question excerpt is a premium feature. Physical examination shows slight tachycardia. Examples of poor management would include failure to order a neurologic/psychiatric examination, failure to administer an antihypertensive agent, failure to monitor the fetus or mother, or administering a suboptimal seizure medication (phenobarbital). 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. In this acute presentation, timing is critically important. 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. Height of 37 cm, would seem most consistent with a cardiac monitor or by ordering a chest/lung examination bilateral. Remainder of the patient’s illness, at this point, seems most with. Rates the pain is important to check headphone volume during the past 5 years is! 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