USMLE Forum Archives - USMLE Step 2 CK - IM 12
IM 12
TheOne - 11-06-06 12:57
A 20-year-old woman is admitted to the medical services with a severe asthma attack. She is also nauseous and has vomited twice today. The patient has a long history of severe asthma with multiple hospitalizations and one intubation 2 years ago. Two days prior to admission, she was exposed to dust while moving a file cabinet in her basement. Since that time, she has had progressively worsening shortness of breath. she had tried home albuterol and ipratropium nebulizers, as well as his standard cromolyn therapy, but none of these interventions relieved
her symptoms. In the hospital, the patient's peak flow rates are decreased by nearly 40% from baseline. Which of the following agents should most likely be added to the patient's therapy to alleviate her current symptoms?
A. Beclomethasone
B. Disodium cromoglycate
C. Hydrocortisone
D. Prednisone
E. Theophylline
TheOne - 11-06-06 12:57
A 20-year-old woman is admitted to the medical services with a severe asthma attack. She is also nauseous and has vomited twice today. The patient has a long history of severe asthma with multiple hospitalizations and one intubation 2 years ago. Two days prior to admission, she was exposed to dust while moving a file cabinet in her basement. Since that time, she has had progressively worsening shortness of breath. she had tried home albuterol and ipratropium nebulizers, as well as his standard cromolyn therapy, but none of these interventions relieved
her symptoms. In the hospital, the patient's peak flow rates are decreased by nearly 40% from baseline. Which of the following agents should most likely be added to the patient's therapy to alleviate her current symptoms?
A. Beclomethasone
B. Disodium cromoglycate
C. Hydrocortisone
D. Prednisone
E. Theophylline
Page 1
#1
Re: IM 12 kingkong - 11-06-06 20:57 immediate therapy should be IV theophylline.not sure but a wild guess.since theophylline can act rapidly and relieve the patient symtoms immediately.
#2
Re: IM 12
TheOne - 11-09-06 13:02 Explanation: The correct answer is C. It would be most appropriate to add an IV steroidal agent, such as hydrocortisone, to augment the action of bronchodilators by reducing inflammation surrounding the airways.
Beclomethasone (choice A), a surface-acting steroid dispensed in aerosolized form, is used when the side effects of systemic steroids need to be avoided. Such agents, however, also have minimal utility in the acute treatment of bronchospasm.
Disodium cromoglycate (choice B) is a mast cell stabilizer that is used only for the prevention of bronchospasm due to asthma. Once bronchospasm is established, this type of agent has little utility.
An IV steroid is preferred over an oral steroid, such as prednisone (choice D), since this patient has a history of recent nausea and vomiting and, therefore, may have impaired absorption of oral medications. In addition, the time course of onset of an oral agent is too long to have any effect in an acute situation.
Theophylline (choice E), a methylxanthine phosphodiesterase inhibitor, is useful for the chronic control of asthma, but it has lesser utility in the acute treatment of bronchospasm.
Page 1