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A 17-year-old patient has had asthma since childhood. His asthma is well controlled on an albuterol inhaler (salbutamol) as required and fluticasone 100 mcg twice a day. Now, he presents to the clinic complaining of increased shortness of breath and excessive coughing at night. Wheezing is heard upon the physical examination. Which of the following is the mechanism of action behind the next course of action?
A 17-year-old patient has had asthma since childhood. His asthma is well controlled on an albuterol inhaler (salbutamol) as required and fluticasone 100 mcg twice a day. Now, he presents to the clinic complaining of increased shortness of breath and excessive coughing at night. Wheezing is heard upon the physical examination. Which of the following is the mechanism of action behind the next course of action?
Which of the following drugs causes vasodilation that can be blocked by atropine?
Which of the following drugs causes vasodilation that can be blocked by atropine?
Which statement about the effects of anesthetics is most accurate?
Which statement about the effects of anesthetics is most accurate?
What percentage of medical professionals abuse psychoactive substances and does this affect their professional activity?
What percentage of medical professionals abuse psychoactive substances and does this affect their professional activity?
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Which statement regarding the rapidity of nerve blockade by local anesthetics is true?
Which statement regarding the rapidity of nerve blockade by local anesthetics is true?
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Which agent is approved for treatment-resistant schizophrenia?
Which agent is approved for treatment-resistant schizophrenia?
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Which statement by the patient indicates that he needs further clarification regarding lithium intake?
Which statement by the patient indicates that he needs further clarification regarding lithium intake?
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A 54-year-old man presents with a history of depression, chronic obstructive pulmonary disease, peripheral arterial disease, benign prostatic hyperplasia, and erectile dysfunction. He has been maintained on sertraline for several years and has recently been started on tadalafil (for erectile dysfunction), roflumilast (for COPD) and cilostazol (for peripheral arterial disease). The patient's wife had to call 911 and have the patient taken to the emergency department because he was threatening suicide. What is the mechanism of action of the most likely medication causing this patient's mood change?
A 54-year-old man presents with a history of depression, chronic obstructive pulmonary disease, peripheral arterial disease, benign prostatic hyperplasia, and erectile dysfunction. He has been maintained on sertraline for several years and has recently been started on tadalafil (for erectile dysfunction), roflumilast (for COPD) and cilostazol (for peripheral arterial disease). The patient's wife had to call 911 and have the patient taken to the emergency department because he was threatening suicide. What is the mechanism of action of the most likely medication causing this patient's mood change?
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A 24 year-old patient presents on a bright sunny Spring morning with a constellation of signs & symptoms that include a stuffy runny nose, sneezing, red, itchy & watery eyes, and a cough related to postnasal drip. A diagnosis of allergic rhinitis is made. In addition to a decongestant or corticosteroid spray, what other medication could you recommend that would counteract the effects related to histamine release, but have the least impact on mental status?
A 24 year-old patient presents on a bright sunny Spring morning with a constellation of signs & symptoms that include a stuffy runny nose, sneezing, red, itchy & watery eyes, and a cough related to postnasal drip. A diagnosis of allergic rhinitis is made. In addition to a decongestant or corticosteroid spray, what other medication could you recommend that would counteract the effects related to histamine release, but have the least impact on mental status?
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Which of the following symptoms indicates an opioid overdose?
Which of the following symptoms indicates an opioid overdose?
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A 15-year-old female presents with a history of anxiety and depression. A friend brought her to the emergency department in the evening after her skin turned pale. She takes paroxetine, bupropion, lorazepam, and trazodone. She confessed to ingesting “many” phenazopyridine from her mother's medicine cabinet that morning. Her parents are divorced. She lives with her mother, who works at night, and she has no relationship with her father. She had an argument with her boyfriend yesterday. She admits to severe depression. Physical exam shows pale skin, dyspnea, tachycardia, fatigue, and splenomegaly. Her hemoglobin was 8.2 gm/dL, and the reticulocyte count was 5.9%. Of the erythrocytes, 8.2% contained Heinz bodies. “Bite” cells (degmacytes) are also present. Both direct and indirect Combs' tests are pending. What is the most likely preliminary diagnosis?
A 15-year-old female presents with a history of anxiety and depression. A friend brought her to the emergency department in the evening after her skin turned pale. She takes paroxetine, bupropion, lorazepam, and trazodone. She confessed to ingesting “many” phenazopyridine from her mother's medicine cabinet that morning. Her parents are divorced. She lives with her mother, who works at night, and she has no relationship with her father. She had an argument with her boyfriend yesterday. She admits to severe depression. Physical exam shows pale skin, dyspnea, tachycardia, fatigue, and splenomegaly. Her hemoglobin was 8.2 gm/dL, and the reticulocyte count was 5.9%. Of the erythrocytes, 8.2% contained Heinz bodies. “Bite” cells (degmacytes) are also present. Both direct and indirect Combs' tests are pending. What is the most likely preliminary diagnosis?
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JQ is a professional 40 year old golfer who has developed a progressively more painful stiffness in her arms and legs over the past year that interferes with her ability to compete in golf tournaments. During her most recent medical checkup, her lab results reveal an elevated erythrocyte sedimentation rate (ESR), elevated CRP level and a high RF level. Xray imaging revealed the presence of bilateral erosion of several joints in her arms and legs. After being referred to a rheumatologist, she is prescribed methotrexate. Which of the following best describes the mechanism of action of this drug?
JQ is a professional 40 year old golfer who has developed a progressively more painful stiffness in her arms and legs over the past year that interferes with her ability to compete in golf tournaments. During her most recent medical checkup, her lab results reveal an elevated erythrocyte sedimentation rate (ESR), elevated CRP level and a high RF level. Xray imaging revealed the presence of bilateral erosion of several joints in her arms and legs. After being referred to a rheumatologist, she is prescribed methotrexate. Which of the following best describes the mechanism of action of this drug?
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A patient is diagnosed with having both absence seizures and concomitant generalized tonic-clonic seizures. Which of the following would be most effective in treating both types of seizures, yet not have significant sedating side effects?
A patient is diagnosed with having both absence seizures and concomitant generalized tonic-clonic seizures. Which of the following would be most effective in treating both types of seizures, yet not have significant sedating side effects?
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A 35-year-old man presents to the clinic for follow-up. He has a history of partial epilepsy and has been taking oral carbamazepine and phenytoin. He reports poor control of his symptoms. His baseline investigations are normal. A novel antiepileptic agent of the sulfonamide group, which exerts action on T-type calcium channels, is added to his regimen. The patient presents to the emergency department a few weeks later with hyperventilation, fatigue, and anorexia. Physical examination is unremarkable. Which of the following lab parameters is most consistent with this patient's current presentation?
A 35-year-old man presents to the clinic for follow-up. He has a history of partial epilepsy and has been taking oral carbamazepine and phenytoin. He reports poor control of his symptoms. His baseline investigations are normal. A novel antiepileptic agent of the sulfonamide group, which exerts action on T-type calcium channels, is added to his regimen. The patient presents to the emergency department a few weeks later with hyperventilation, fatigue, and anorexia. Physical examination is unremarkable. Which of the following lab parameters is most consistent with this patient's current presentation?
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A 65-year-old woman with a history of cardiomyopathy is being evaluated for a beta-blocker. She would prefer to take this medication as few times a day as possible. Thus, a once-a-day medication would be ideal for her. Given that once-a-day medications generally have longer half-life values, their serum levels also have lower variance. Which of the following is the most appropriate medication for this patient?
A 65-year-old woman with a history of cardiomyopathy is being evaluated for a beta-blocker. She would prefer to take this medication as few times a day as possible. Thus, a once-a-day medication would be ideal for her. Given that once-a-day medications generally have longer half-life values, their serum levels also have lower variance. Which of the following is the most appropriate medication for this patient?
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A patient with myocardial infarction, heart failure and arrhythmia is prescribed lidocaine by continuous intravenous infusion. The target plasma concentration is 3 mg/l. The pharmacokinetic parameters of lidocaine for the general population are Vd=70 I, CI=25 l/h and t1/2=1.4 h. The infusion begins. The plasma concentration of lidocaine was measured 2.8 hours after its onset and was reported to be 2.4 mg/l. This indicates that the steady state plasma concentration will be
A patient with myocardial infarction, heart failure and arrhythmia is prescribed lidocaine by continuous intravenous infusion. The target plasma concentration is 3 mg/l. The pharmacokinetic parameters of lidocaine for the general population are Vd=70 I, CI=25 l/h and t1/2=1.4 h. The infusion begins. The plasma concentration of lidocaine was measured 2.8 hours after its onset and was reported to be 2.4 mg/l. This indicates that the steady state plasma concentration will be
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A 58-year-old man with a history of rosacea blepharoconjunctivitis and keratitis presents to the clinic for a second opinion for the treatment of his dry eye symptoms. He has constant foreign body sensation, tearing, redness, and a gritty feeling in both eyes. He mentions in his history that he was tested for ocular cicatricial pemphigoid in the past, but he never followed up. His slit lamp examination reveals 2+ inferior corneal punctate epithelial erosions and small punctate openings inferiorly. His diagnosis is presumed ocular cicatricial pemphigoid with keratoconjunctivitis sicca. Which of the following treatments for keratoconjunctivitis sicca is most associated with ocular cicatricial pemphigoid?
A 58-year-old man with a history of rosacea blepharoconjunctivitis and keratitis presents to the clinic for a second opinion for the treatment of his dry eye symptoms. He has constant foreign body sensation, tearing, redness, and a gritty feeling in both eyes. He mentions in his history that he was tested for ocular cicatricial pemphigoid in the past, but he never followed up. His slit lamp examination reveals 2+ inferior corneal punctate epithelial erosions and small punctate openings inferiorly. His diagnosis is presumed ocular cicatricial pemphigoid with keratoconjunctivitis sicca. Which of the following treatments for keratoconjunctivitis sicca is most associated with ocular cicatricial pemphigoid?
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13 A patient is diagnosed with having both absence seizures and concomitant generalized tonic-clonic seizures. Which of the following would be most effective in treating both types of seizures, yet not have significant sedating side effects?
13 A patient is diagnosed with having both absence seizures and concomitant generalized tonic-clonic seizures. Which of the following would be most effective in treating both types of seizures, yet not have significant sedating side effects?
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Ceftriaxone 2 g in 100 ml of physiological solution was prescribed, which should be infused over 30 mim. Available with a macro drop kit 15 drops/ml. Calculate the rate of venous infusion in drops per minute
Ceftriaxone 2 g in 100 ml of physiological solution was prescribed, which should be infused over 30 mim. Available with a macro drop kit 15 drops/ml. Calculate the rate of venous infusion in drops per minute
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A 34-year-old woman presents to the clinic with a chief complaint of redness of the skin with burning and itching sensation. The patient has a history of diabetes mellitus type 2, hypertension, obesity, and hypertriglyceridemia. The patient takes niacin 250 mg daily, losartan 25 mg daily, metformin 500 mg twice daily. Which of the following is the most appropriate recommendation for this patient?
A 34-year-old woman presents to the clinic with a chief complaint of redness of the skin with burning and itching sensation. The patient has a history of diabetes mellitus type 2, hypertension, obesity, and hypertriglyceridemia. The patient takes niacin 250 mg daily, losartan 25 mg daily, metformin 500 mg twice daily. Which of the following is the most appropriate recommendation for this patient?
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Study Notes
Test 4, Question 1
- A 17-year-old patient with asthma has well-controlled asthma on albuterol inhaler and fluticasone.
- The patient presents with increased shortness of breath and coughing at night.
- The mechanism of action for the next course of treatment is increasing cAMP resulting in relaxation of bronchiolar smooth muscle and increasing airflow.
Teaching Points
- Long-acting beta-2 agonists increase cAMP, relaxing bronchiolar smooth muscle and increasing bronchiole airflow.
- Adding a long-acting beta-2 agonist like salmeterol has been shown to decrease the use of rescue medication.
- Long-acting beta-2 agonists are usually prescribed for severe persistent asthma not properly controlled by the combination of a short-acting beta-agonist and a corticosteroid.
- This patient requires step-up treatment: low dose inhaled corticosteroid plus long-acting beta-agonist.
Additional Information
- Bethanechol causes vasodilation that can be blocked by atropine.
- 10-15% of medical professionals abuse psychoactive substances and this affects their work.
- The most accurate statement about anesthetics is that under halothane anesthesia bronchial smooth muscle contracts.
- Propofol has an antiemetic effect.
- Clozapine is the only agent approved for treatment-resistant schizophrenia.
- Roflumilast is a phosphodiesterase 4 enzyme inhibitor used to treat chronic obstructive pulmonary disease.
- The most appropriate recommendation for a patient experiencing niacin-induced flushing is to take aspirin 30 min before the niacin dose.
- Metoprolol succinate is an extended-release formulation of metoprolol with a longer serum half-life (better for once-daily dosing).
- Diazepam 3.75 mg IV push (can be repeated once after 5 minutes) is recommended safe, and appropriate for the patient in question with a maximum of 10 mg.
- A reduction in bicarbonate level to about 2 mEq/L is commonly observed with zonisamide use
- 50 drops per minute is the recommended rate for a 100 mL solution with 15 drops per mL.
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Description
Test your knowledge on asthma management, focusing on the use of long-acting beta-2 agonists and their mechanisms of action. This quiz covers treatment strategies for patients with uncontrolled asthma symptoms and discusses the benefits of adding these medications. Enhance your understanding of respiratory therapies and patient care in asthma management.
