#march2020mccqe1
A 37-year-old man with asthma is evaluated for frequent episodes of wheezing and dyspnea unrelieved by short-acting β-agonist therapy. He uses his controller medications regularly, including an inhaled long-acting β-agonist and inhaled high-dose corticosteroids. He has symptoms daily and frequent nocturnal symptoms. On physical examination, the patient is in mild respiratory distress. The temperature is 37.0°C (98.6°F), blood pressure is 140/85 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. He has bilateral wheezing. Spirometry shows an FEV1 of 65% of predicted. After the supervised use of a bronchodilator in the office, there was relief of symptoms, and repeat spirometry 10 minutes after the administration of the bronchodilator showed that the FEV1 increased to 85% of predicted. Which of the following is the most appropriate next step in this patient's management?
(A) Add a leukotriene-modifying drug
(B) Have the patient demonstrate his inhaler technique
(C) Have the patient keep a symptom and treatment log
(D) Start oral prednisone therapy
A 37-year-old man with asthma is evaluated for frequent episodes of wheezing and dyspnea unrelieved by short-acting β-agonist therapy. He uses his controller medications regularly, including an inhaled long-acting β-agonist and inhaled high-dose corticosteroids. He has symptoms daily and frequent nocturnal symptoms. On physical examination, the patient is in mild respiratory distress. The temperature is 37.0°C (98.6°F), blood pressure is 140/85 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. He has bilateral wheezing. Spirometry shows an FEV1 of 65% of predicted. After the supervised use of a bronchodilator in the office, there was relief of symptoms, and repeat spirometry 10 minutes after the administration of the bronchodilator showed that the FEV1 increased to 85% of predicted. Which of the following is the most appropriate next step in this patient's management?
(A) Add a leukotriene-modifying drug
(B) Have the patient demonstrate his inhaler technique
(C) Have the patient keep a symptom and treatment log
(D) Start oral prednisone therapy
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