A 17-year-old male presents for evaluation of shortness of breath. He has episodes where he will audibly wheeze and have chest tightness. His symptoms worsen if he tries to exercise, especially when it is cold. He has used an OTC inhaler with good relief of his symptoms, but he finds that his symptoms are worsening. He now has episodes of wheezing on a daily basis and will have nighttime wheezing and coughing, on average, five or six times a month. You suspect a diagnosis of asthma. Which of the following would confirm your suspicion of the diagnosis of asthma?
Answer(s): B
Asthma is a chronic lung disease characterized by inflammation of the airways, causing recurrent symptoms. The characteristic symptoms are wheezing, chest tightness, shortness of breath, or cough. Symptoms often worsen in the face of certain triggers, which include allergens, cold air, exercise, or other irritants. Physical examination may reveal hyperexpansion of the thorax, expiratory wheezing with a prolonged expiratory phase of respiration, and signs of allergies or atopic dermatitis. Asthma can be diagnosed by a history of episodic symptoms of airway obstruction (wheeze, dyspnea, cough, chest tightness), establishing the presence of airflow obstruction that is at least partially reversible and ruling out other causes of these symptoms/signs. Airflow obstruction can be shown by spirometry revealing an FEV1 of <80% predicted or an FEV1/forced vital capacity of <65% of the lower limit of normal. Reversibility can be shown by an FEV1 increase of 15% and at least 200 mL with the use of a short- acting beta agonist. Expiratory wheezing on examination is commonly seen in asthma but is a nonspecific finding. Many patients with asthma have elevated serum IgE levels; it is unusual to find asthma in individuals who have a low level of serum IgE. The sputum of asthmatics may contain eosinophils, Charcot-Leyden crystals, Curschmann spirals, or Creola bodies.However, eosinophils may also be present in the sputum of patients with other conditions such as Churg- Strauss syndrome or eosinophilic pneumonia. Peak-flow monitoring is useful for the short- and long-term monitoring of asthma patients and for exacerbation management (by aiding in the determination of exacerbation severity which directs therapeutic decision making). persistent based on the frequency of symptoms and the degree of airflow obstruction. Based on this patient's frequency of symptoms, he falls into the moderate persistent class. An often neglected diagnosis is exerciseinduced asthma which is characterized by attacks immediately following exertion and by the lack of any long- term sequelae or increase in airway reactivity.
A 17-year-old male presents for evaluation of shortness of breath. He has episodes where he will audibly wheeze and have chest tightness. His symptoms worsen if he tries to exercise, especially when it is cold. He has used an OTC inhaler with good relief of his symptoms, but he finds that his symptoms are worsening. He now has episodes of wheezing on a daily basis and will have nighttime wheezing and coughing, on average, five or six times a month. You suspect a diagnosis of asthma.Your diagnostic workup confirms the diagnosis of asthma. What clinical classification of asthma does this patient have?
Answer(s): D
Asthma is a chronic lung disease characterized by inflammation of the airways, causing recurrent symptoms. The characteristic symptoms are wheezing, chest tightness, shortness of breath, or cough. Symptoms often worsen in the face of certain triggers, which include allergens, cold air, exercise, or other irritants. Physical examination may reveal hyperexpansion of the thorax, expiratory wheezing with a prolonged expiratory phase of respiration, and signs of allergies or atopic dermatitis. Asthma can be diagnosed by a history of episodic symptoms of airway obstruction (wheeze, dyspnea, cough, chest tightness), establishing the presence of airflow obstruction that is at least partially reversible and ruling out other causes of these symptoms/signs. Airflow obstruction can be shown by spirometry revealing an FEV1 of <80% predicted or an FEV1/forced vital capacity of <65% of the lower limit of normal. Reversibility can be shown by an FEV1 increase of 15% and at least 200 mL with the use of a short- acting beta agonist. Expiratory wheezing on examination is commonly seen in asthma but is a nonspecific finding. Many patients with asthma have elevated serum IgE levels; it is unusual to find asthma in individuals who have a low level of serum IgE. The sputum of asthmatics may contain eosinophils, Charcot-Leyden crystals, Curschmann spirals, or Creola bodies.However, eosinophils may also be present in the sputum of patients with other conditions such as Churg- Strauss syndrome or eosinophilic pneumonia. Peak-flow monitoring is useful for the short- and long-term monitoring of asthma patients and for exacerbation management (by aiding in the determination of exacerbation severity which directs therapeutic decision making). persistent based on the frequency of symptoms and the degree of airflow obstruction. Based on this patient's frequency of symptoms, he falls into the moderate persistent class. An often neglected diagnosis is exerciseinduced asthma which is characterized by attacks immediately following exertion and by the lack of any long- term sequelae or increase in airway reactivity
A 17-year-old male presents for evaluation of shortness of breath. He has episodes where he will audibly wheeze and have chest tightness. His symptoms worsen if he tries to exercise, especially when it is cold. He has used an OTC inhaler with good relief of his symptoms, but he finds that his symptoms are worsening. He now has episodes of wheezing on a daily basis and will have nighttime wheezing and coughing, on average, five or six times a month. You suspect a diagnosis of asthma.Which of the following is the most appropriate pharmacologic regimen for this patient?
A74-year-old male with a history of hypertension, CAD, and a 50 pack-year history of smoking presents with complaints of pain and cramping sensation of the thigh and buttock areas for the past 2 months. On detailed history, patient reports that the pain is usually during ambulation and relieves with sitting down. The pain does not change with respect to sitting or supine position. He denies any recent trauma, weakness of the legs, or paresthesias. He takes his prescription medications regularly and denies using alcohol, drugs, or any herbs/ supplements. Which of the following should be performed as an initial test to help confirm your clinical impression?
Answer(s): A
Peripheral arterial disease (PAD) affects roughly 12% of the U.S. population with higher prevalence rates in persons over the age of 70. The classic symptoms of PAD are intermittent claudication which is usually described by patients as cramping pain in the calf, legs, thighs, or buttocks during any type of exercise that quickly relieves with rest. This scenario of worsening with activity and relief with rest is consistent with the disease process, as the pain results from ischemia. The ischemia is worse during periods of increased oxygen demand where the vascular insufficiency fails to meet the demand. Not all patients with PAD are symptomatic, thus an assessment of risk factors and a thorough physical examination are usually key to making the diagnosis in asymptomatic patients. The ABI is an easy, inexpensive, noninvasive test with a high correlation to angiography that can be done in the office. ABI is the usual initial test to screen for PAD.A value of greater than 1.0 is considered normal, whereas values less than 0.9 are consistent with varying grades of PAD:· 1.0 or greater: normal· 0.810.9: mild PAD· 0.510.8: moderate PAD· <0.5: severe PADThe sensitivity of the ABI can be increased if performed post exercise. The ABI, however, has its limitations in patients with noncompressible, calcified vessels such as the elderly or in patients with diabetes. An ABI of greater than 1.3 may suggest the above scenario and its utility would be suspect. In these cases, more detailed testing may be warranted. Other modalities to assess PAD include arterial Dopplers, magnetic resonance angiography, and conventional angiography. The initial therapy for patients with PAD should be a trial of a structured walking program along with smoking cessation. Walking programs have been shown to increase walking distance without symptoms. In addition, walking also improves endothelial function, collateral vessel formation and function, and control of blood pressure, lipids, and blood sugars.Pentoxyfylline has been traditionally recommended for PAD; however its efficacy is modest at best based on newer trial data. Antiplatelet agents may also be added for PAD as it will improve cardiovascular risk and perhaps modify the pathogenesis for PAD. Ultimately, risk factor modification is key for prevention and reduction of complications and comorbidities. Severe PAD or patients who require more specialized intervention may require vascular surgery consultation.
A74-year-old male with a history of hypertension, CAD, and a 50 pack-year history of smoking presents with complaints of pain and cramping sensation of the thigh and buttock areas for the past 2 months. On detailed history, patient reports that the pain is usually during ambulation and relieves with sitting down. The pain does not change with respect to sitting or supine position. He denies any recent trauma, weakness of the legs, or paresthesias. He takes his prescription medications regularly and denies using alcohol, drugs, or any herbs/ supplements. Which of the following should be performed as an initial test to help confirm your clinical impression?Which of the following measures should be implemented for the management of this patient's condition?
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