sprint123
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A 45-year-old man is evaluated because of a persistent cough. He is a lifelong nonsmoker without a history of lung disease. He has had a cough productive of clear sputum for approximately 6 months. The cough is particularly troublesome at night and toward the end of the workweek. The patient works in an automobile repair shop spray-painting cars. He has worked in his present job for 2 years. He denies a history of allergies, and there is no family history of asthma or allergies. The chest examination shows a few expiratory wheezes. Spirometry shows moderate airflow obstruction and substantial improvement after inhalation of a bronchodilator.
Which of the following is the best management option for this patient?
( A ) Measure carbon monoxide diffusing capacity
( B ) Advise him to change jobs
( C ) Prescribe an inhaled bronchodilator
( D ) Measure IgE antibody to anhydrides
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| babydoc4usmle
Forum Guru
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personally i would say: get out of that job
but USMLE probably won't like my answer
what about D?
seems to me that he is reacting to paint at work that is why he feels worse by the end of the week, than he has couple of days off, feels better and next week starts all over again.
BUT i am still confused about this word MANAGEMENT?
does it mean TESTING to make definitive diagnosis or TREATMENT of assumed diagnosis? completly different answers
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| mytime
Go Marching in!
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Babydoc no wonder u got a 99...  I'd say the same Sprint!!
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| babydoc4usmle
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Thank you, Mytime
btw, love your smileys, too bad they don't work with FireFox;(
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| sprint123
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If the question asks what is the best management?-It could be either diagnosis or treatment.,depending on the case.
aNYONE WANT TO TRY?
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| babydoc4usmle
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so my answer was not correct?
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| Justice
Forum Fanatic
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Clearly, this is ( B ) Advise him to change jobs;
You have to counsel the Pt, which would be the requested management
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| silenced, M.D.
Forum Guru
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I would say Change Job, because even if he is tested for IgE, he wil continue to have symptoms as long as he is exposed to the source of the problem.
I just remembered a basic rule from Dr. Conrad Fischer: if there is something causing the problem, take it away.
Edited by silenced, M.D. on 04/06/07 - 08:45 PM
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"Sólo los débiles se enojan. El hombre fuerte, aun al caer, sonríe". ~ José Martí "...it ain't about how hard you hit. It's about how hard you can get hit and keep moving forward. How much you can take and keep moving forward. That's how winning is done". ~ Rocky Balboa
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| babydoc4usmle
Forum Guru
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i seeeeeeeeeeeeeeeeee
question: how to figure out from reading question what is being asked: testing or treatment? is there a sertain "sign" or something else that helps to identify what is ment under MANAGEMENT? or there is a rule that i just don't know of?
please, help me understand....fell very stupid right now;(
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| sprint123
Forum Guru
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You don't have to..babydoc..Since u are bang on target..Answer id Change the job...
It is a case of occupation induced asthma.If u havea good look at the other options ,though it might give a better diagnosis ,definitiley the best option for the patient is to change jobs..
I think ,from now onwards,I should look at a question in a patient's view I suppose.
Any suggestions?
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| neo335
Forum Elite
Topics: 39
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hi spirit.. so the answer wud b to change the job? i was thinking may b it shud b hecking out the IgE levels before we ask him to change his job.. can u please let me know the answer n explain why it wud not b D?
n whn they mean management, thewy mean it cud b anything.. basically what wud u do next.. it cud b any test to confirm a diagnosis or any treament that wud giv him relief..
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| dr19
Forum Senior
Topics: 12
Posts: 121
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B
It can be an inflammatory reasponse to foreign bodies,and not necessarily an allergic response.Do U agree?
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