Respiratory q4
zkadhem - 05-19-09 11:09

Q.4. A 43-year-old woman has severe episodic asthma, requiring her to visit the emergency department and receive a course of oral steroids four to five times per year, and requires oral steroids approximately half the days of the year. She uses high-dose inhaled corticosteroids twice daily. She works in an electronic assembly plant soldering components to integrated circuits. She has gained approximately 30 pounds over the past five years, which she attributes to her oral steroids. She has chronic severe frontal headaches and takes Fiorinal (aspirin, butabarbital, and caffeine) approximately four times per week for treatment of these. She has had sinus drainage surgery with removal of obstructing nasal polyps but this has had only minimal effect on her headaches. She has no pets, no foreign travel, and has never smoked cigarettes. A chest radiograph is normal. Pulmonary function tests show the FEV1/FVC ratio is 0.68, and her FEV1 is 72% predicted. The most appropriate treatment for this patient would include:
A. A 24-hour esophageal pH probe test for GERD, prescription of a proton pump inhibitor, and a chest CT to evaluate for silicosis
B. Serum immunoglobulins with IgG subtypes, a sputum culture, a sweat chloride test, a igh-resolution chest CT, and prescription of antibiotics
C. Panel of auto-antibodies, creatinine clearance, sinus CT, nasal mucosal biopsy, and immunosuppressive therapy
D. Bronchoscopy to evaluate for central airway obstruction, nutrition consultation for weight-loss, and prescription of alendronate for treatment of osteoporosis
E. Daily monitoring of peak expiratory flow, prescription of nasal steroids, a leukotriene receptor antagonist, and discontinuation of the current analgesic medication