> Jack is 62 years old; he works in sales for a multinational company and leads a busy and stressful life. Jack has had asthma since childhood. He has been prescribed Flixotide (fluticasone) metered dose inhaler (MDI) 125mcg/actuation 2 inhalations twice daily and salbutamol MDI 100mcg 2 puffs prn. > > > Jack has been extremely busy lately with some overseas trips and has missed the evening dose of his medications on some days. He was taken to the emergency department today by his partner with a chief complaint of shortness of breath. He claims that he has been struggling to breathe and tried his salbutamol inhaler three times at the prescribed dose before going into the emergency department. Jack claims he suffers from breathlessness and has episodes of wheezing at least 3-4 times a week during the day and uses his salbutamol inhaler when needed. > > The diagnosis has been acute exacerbation of asthma and was promptly managed in the emergency department with additional doses of salbutamol via spacer. > 1. *Which of the following might have worsened Jack’s asthma control?* **I. Advancing age** II. Male gender **III. Stress at work** **IV. Medication nonadherence** 1. I, III 2. **I, III, IV** 3. II, IV 4. III,IV *2. What recommendations would you make in terms of managing Jack’s asthma upon discharge from the emergency department?* I. Substitute Flixotide (fluticasone 125mcg/actuation) MDI with Seretide MDI (fluticasone 125 microgram /actuation + salmeterol 25 microgram /actuation) 2 puffs twice daily **II. Reinforce the importance of good adherence and spacer use** **III. Increase the dose of fluticasone MDI to 250 mcg/actuation, 2 inhalations twice daily** **IV. Address and/or remove trigger factors** 1. II,IV 2. I,II,IV 3. II,III,IV 4. I

An 18-year-old girl is brought in to the hospital by her parents because of an asthma attack. She normally takes inhaled fluticasone and albuterol; however, she is not currently responding to the albuterol. On examination, she appears anxious and is moderately short of breath. There are loud bilateral wheezes on examination, with a prolonged inspiratory and expiratory phase and use of accessory muscles of respiration. Her temperature is 37.6°C, blood pressure is 118/78 mmHg, heart rate is 106 beats per minute, respiratory rate is 26 breaths per minute, and oxygen saturation is 93% on room air. She is placed on supplemental oxygen and bronchodilators and an arterial blood gas is drawn. Arterial Blood GaspH 7.40PaO2 60 mmHgPaCO2 40 mmHg Which of the following is the most appropriate next step in management?  Ask StudybuddyGroup of answer choicesIntubationIncrease supplemental oxygen flow rateAzithromycinIV corticosteroids

Keenan uses several inhaled medications to manage asthma. What side effects might he experience?Diarrhea and gasRapid pulse and nervousnessWeakness and fatigueFrequent urination and urgency

Mr. Garner has a normal sleep schedule of 11 P.M. to 7 A.M. However, he frequently wakes up, gasping for breath. He has recently put on a lot of weight, and his snoring has worsened. Which condition is a medical diagnosis likely to reveal? A. asthma B. sleep apnea syndrome C. bronchitis D. emphysema E. hypoxia

A 48-year-old man presents to the hospital with swelling of the abdomen and legs. He first noticed shortness of breath with exertion several months ago, and has had a few episodes where he momentarily became lightheaded and lost consciousness. Now the symptoms have been progressing with increased dyspnea and edema. He reports that he has always lived a healthy lifestyle and has no past medical history. There is no family history of any cardiac or pulmonary disease, or any cancer. He was born in Brazil and moved to the United States at the age of 43. He does not smoke or drink alcohol. On cardiac examination, the apex is displaced laterally with an S3 on auscultation. Estimated central venous pressure is 15 mmHg, and there are faint crackles at the base of his lungs. He has hepatomegaly with shifting dullness and bilateral pitting edema of the lower extremities. An ECG is normal, with no visible Q waves. Which infectious etiology is most likely responsible for this patient's disease?

he DLCO is "decreased" in patients with Chronic BronchitisGroup of answer choicesTrueFalse