doc_clotaire
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A 31-year-old woman presents to the emergency department with three
hours of shortness of breath. She had been walking her dog this
afternoon and had not been outside for more than a few minutes before
she began to feel chest tightness, wheezing, and a cough. She has not
had any relief from her bronchodilators or steroid inhalers that she
uses daily. She states that her daily activities have become affected
by frequent episodes of shortness of breath that recur a few times
during each week. These attacks can last days at a time, and she is
afraid that her current medications are no longer of assistance to
her. On physical examination, she has a temperature of 98.8 F, a pulse
of 98/min, a blood pressure of 136/90 mm Hg, and a respiratory rate of
23/min. There is some evidence of hyperemia and secretions in the
nasal passages bilaterally. She is using her accessory muscles to
breathe, and wheezing is audible. Pulmonary function testing reveals
an FEV1 of 68% of predicted, with a reduced FEV1/FVC ratio. This
increases by 14% after high-dose bronchodilators are administered. Her
peak expiratory flow was 158 L/min before bronchodilators were given.
Arterial blood gases on room air are: pH 7.36, pCO2 48 mm Hg, and pO2
60 mm Hg. Chest x-ray shows evidence of hyperinflated lungs. The
severity of this patient's clinical condition corresponds with which
of the following classifications of asthma?
(A) Moderate intermittent
(B) Severe intermittent
(C) Mild persistent
(D) Moderate persistent
(E) Severe persistent
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| muna
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D
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| cookie909
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| dr.wad
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| Justice
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(D)
I guess this is one of the Fischer's Qs...
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| sprint123
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| doc_clotaire
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Answer:
(D) Moderate persistent
Explanation:
This patient presents with an acute attack of asthma, likely
precipitated by allergens from the environment. Her symptoms are
suggestive of moderate persistent asthma, as she requires the daily
use of an inhaled short-acting β2-agonist, the exacerbations are
affecting her daily activities, and they recur at a frequency of more
than twice per week, lasting days at a time. Other parameters
consistent with moderate persistent asthma are the occurrence of
nocturnal symptoms more than once per week. Her FEV1 value of 68% is
consistent with the criteria for the FEV1 to fall between 60 and 80%
of predicted, a reduced ratio of FEV1/FVC to <75%, and the
reversibility of airflow obstruction with bronchodilators of greater
than 12%. A peak expiratory flow of less than 200 L/min indicates
severe airflow obstruction. During a mild asthma exacerbation,
arterial blood gases may be normal or reveal a respiratory alkalosis
with an increased A-a gradient. The combination of an increased PaCO2
and respiratory acidosis may indicate respiratory failure, and the
need for mechanical ventilation should be considered.
There are four classifications of asthma:
1. Mild intermittent -- symptoms less than 2�/week and FEV1 >80%
2. Mild persistent -- symptoms greater than 2�/week but less than
l�/day with FEV1 >80%
3. Moderate persistent -- daily symptoms greater than 2�/week with
FEV1 >60 and <80%
4. Severe persistent -- continual symptoms with limited physical
activity and FEV1 <60%
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| sachida
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A patient qualifying for two different stages should be classified in the more severe stage.
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