Pulmonary Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Pulmonary Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations

A 54-year-old man with atopic history presents to the emergency department with chest tightness, wheezing, and nighttime cough after dust exposure. His exam reveals expiratory wheezes, he demonstrates partial relief with nebulized bronchodilator, and he is concerned about steroid use. Considering recent guideline changes, how should symptom management and discharge planning be approached for such a patient? What key elements differentiate optimal therapy in this context? VIDEO INFO Category: Pulmonary Pathology, Pathology, USMLE Step 1 Difficulty: Easy - Basic level - Suitable for medical students Question Type: Recent Changes Case Type: ED Case Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 54-year-old man comes to the emergency department with 2 days of chest tightness, wheeze, and nighttime cough that worsened after cleaning a dusty basement. He has atopic dermatitis and primary hyperparathyroidism. He lives alone and reports using an over-the-counter antihistamine as needed; he is not on any inhaled controller. He reports wheezing with NSAIDs, hives and a prior anaphylactic reaction to penicillin, and itching with a cephalosporin years ago. He has never smoked or vaped.... OPTIONS A. Discharge with low-dose budesonide-formoterol inhaler (e.g., 160/4.5 mcg) to use as the sole reliever, 1 inhalation by mouth as needed for symptoms, with inhaler teaching and spacer use at home. B. Discharge with albuterol metered-dose inhaler 90 mcg per puff, 2 puffs as needed for symptoms, without any inhaled corticosteroid, because short-acting beta agonist alone is adequate as a reliever. C. Start daily montelukast 10 mg by mouth at bedtime as the only therapy for quick symptom relief, using albuterol only if symptoms persist after tablets. D. Give a 5-day burst of oral prednisone 40 mg daily and stop all inhalers on discharge, to minimize overlapping therapies and adverse effects. CORRECT ANSWER A. Discharge with low-dose budesonide-formoterol inhaler (e.g., 160/4.5 mcg) to use as the sole reliever, 1 inhalation by mouth as needed for symptoms, with inhaler teaching and spacer use at home. EXPLANATION This patient has mild asthma with reversible airflow obstruction (FEV1 rose from 2.50 L to 2.90 L; 16% and 400 mL) and eosinophilic airway inflammation suggested by an elevated fractional exhaled nitric oxide (45 ppb). Recent international guidance prioritizes anti-inflammatory reliever therapy rather than short-acting beta-agonist alone. Per GINA 2024 and BTS/NICE/SIGN NG245 (2024), as-needed low-dose inhaled corticosteroid-formoterol as the sole reliever reduces severe exacerbations while providing rapid symptom relief. The SYGMA program showed that as-needed budesonide-formoterol reduced exacerbation risk compared with SABA-only strategies in mild asthma, aligning with his preference for an inhaler only when I feel tight. An ICS-formoterol reliever also addresses his concern about steroid side effects by delivering low total steroid exposure concentrated at symptom times. Albuterol alone is discouraged because SABA-only strategies increase exacerbation risk and do not treat airway inflammation. Montelukast is not a reliever and has slower onset with boxed warnings for neuropsychiatric effects; it does not replace an inhaled reliever.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------