Suboptimal treatment would include other antihypertensive agents. These type of questions may be found on NCLEX and definitely on nursing lecture exams. Take the quiz > Cardio. There are many effective medications that can be used to prevent and control asthma … The practice package includes proprietary information and materials that are licensed by the You can view the answer right after you answer each question. The patient had an acute onset of right-sided chest pain 10 minutes before the ambulance arrived. Primum® Computer-based Case Simulation Software Version During the past hour, she has become drowsy and lethargic. B. Asthma is a chronic inflammatory disease of the respiratory system characterized by bronchial hyperresponsiveness, episodic exacerbations (asthma attacks), and reversible airflow obstruction. Treatment should be initiated immediately before the patient’s condition worsens. acute attack except: Asthma Exam (Practice Mode) By Rnpedia.Com, Asthma Conf 09: Performing Spirometry And Spirometry Interpretation. 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. The computer-based case simulation database contains thousands of possible tests and treatments. This NCLEX review will discuss asthma. With the availability of effective treatment for rheumatoid arthritis and concerns about opioid addiction, narcotic analgesics should have a limited role in treatment. Cardiovascular examination shows a loud S4 and bounding central and peripheral pulses. Immunology. This is a practice mode. Environmental risk factors for the development of asthma … 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). 1. There is no history of any previous episodes of chest pain either at rest or on exertion. Pneumonia Asthma questionnaire is a compilation of questions which is used to diagnose people, especially small children with asthma. Skin examination reveals dry, scaly patches in the antecubital areas. 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 … Timely diagnosis and management are essential in this case. Children c. Adult d. All are equal . If you still experience issues after following the instructions above, please contact us. The patient's illness, at this point, would seem most consistent with a neurologic or cardiovascular abnormality, possibly pregnancy-associated. Please view the announcement regarding upcoming Step 2 CK content changes. 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. Physical examination shows slight tachycardia. The patient is conscious but appears confused. Editor-In-Chief: C. Michael Gibson, M.S., M.D. 2. In this case simulation, when NSAID or corticosteroid treatment is initiated, the patient regularly reports both joint and systemic improvements. The comprehensive history, however, narrows the differential. Testing at CSEC centers for Step 2 Clinical Skills (CS) is currently suspended. Asthma is basically: A. If you have questions or issues, check out the Frequently Asked Questions: ... are highly suggestive of the diagnosis of asthma. It includes osteoarthritis, infectious arthritis, rheumatoid arthritis, systemic lupus erythematosus (SLE), gout, and psoriatic arthritis. What is the 3rd line of defense in asthma? Pharmacology makes up 15–22% of the Step 1 exam. 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. The patient's cardiovascular status should be monitored with a cardiac monitor or by ordering repeat vital signs. 10 item question in Asthma. practice by individuals who are registered to take the examinations, and further reproduction, distribution, transmission, or other uses Please note that reviewing the sample questions … Allergic (extrinsic) asthma … Treatment with salicylates would also be considered suboptimal management in this case. The remainder of the physical examination is unremarkable. It is extremely important to check headphone volume during the exam day tutorial. 8.3, Copyright © 2009- the National Board of Medical Examiners. Diseases of the Respiratory System 2. National Board of Medical Examiners or owned and copyrighted by the Federation of State Medical Boards and the National Board of Medical Manual, Copyright © 2002 by the ECFMG. As soon as the absent breath sounds and exam findings consistent with tension pneumothorax are discovered, optimal treatment would include performing a needle thoracostomy for decompression followed by a chest tube insertion for lung reexpansion. Asthma is an umbrella term for a chronic respiratory disease with a group … In this case, a 65-year-old man is brought to the emergency department by ambulance because of acute chest pain and respiratory distress. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. If you do not find the answer you need, please fill out our contact form. A chest x-ray should be ordered to confirm appropriate tube placement and lung reexpansion. The parameter to detect reversibility in airflow obstruction on a are prohibited without permission from the copyright holders. HEENT/neck examination shows dry mucous membranes. 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. 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. Examples of poor management would include failure to order any physical examination or failure to treat rheumatoid arthritis. At age 18 months, the patient had pressure equalizing tubes inserted. She has no previous history of seizures, and there is no history of hypertension or renal or neurologic disease. Download Step 3 tutorial and practice items, including practice CCS cases. Treating the patient’s respiratory distress with optimal inhalation bronchodilators (such as albuterol or levalbuterol), as well as optimal oral (PO) steroids, is essential. Diseases of the Respiratory System 2. Studies demonstrated that patients presenting to EDs for … Delaying diagnosis or treatment and pursuing alternative diagnoses with tests such as a lung scan will waste valuable time and could be harmful or even fatal to the patient. This is carried out by doctors, pediatricians and hospitals to find out the severity … The pain is excruciating, sharp, and increases with respiration. and the National Board of Medical Examiners. Unfortunately he is the 10th patient in 2 days who has required similar … Abdominal examination shows a gravid uterus with a fundal height of 37 cm. Other physical findings are unremarkable. The patient’s roommate says that the patient experienced some chills yesterday. The patient has been experiencing nausea and vomiting for the past 24 hours and has been unable to eat during that time. This illustrates the importance of allowing sufficient time for the patient to respond to treatment and emphasizes monitoring and long-term management. 23. Taken together, the history and physical examination findings support the initial impression of complications of type 1 diabetes mellitus. The pain began abruptly 45 minutes before the patient came to the emergency department. (M1.PL.15.75) A 16-year-old boy with a history of severe, persistent asthma presents to the emergency department with severe shortness of breath and cough. The remainder of the physical examination is unremarkable. From the chief complaint, the differential diagnosis is broad; however, the comprehensive history narrows the differential. Take the quiz > Microbiology. 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. He rates the pain as an 8 on a 10-point scale. Microsoft® Corporation. Or, a referral would be made for physical or occupational therapy. Runtime library portions of the software included with permission The mother says that the wheezing seems to get worse after the patient plays outside but resolves shortly after he comes inside. The patient’s illness, at this point, would seem most consistent with a coronary or aortic abnormality with associated aortic regurgitation. 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). ; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. 25. Examples of invasive tests that would subject the patient to unnecessary discomfort or risk and add no useful information include: While many case scenarios run for a relatively short period of simulated time, a matter of hours or days, this scenario runs for a longer period of time, weeks. 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