A 19-year-old man returns to the office for follow-up management of asthma. His asthma was originall

Discussion in 'Step 3' started by samuel, Oct 13, 2014.

  1. samuel

    samuel New Member

    A 19-year-old man returns to the office for follow-up management of asthma. His asthma was originally diagnosed at age 7, and he had been doing well with occasional use of a short-acting ß2-agonist when required. He has no other past medical history, and his development has been otherwise normal. In the last several months, his symptoms have become more frequent and have worsened. At his last visit, he was placed on a long-acting ß2-agonist and advised to continue using the short-acting ß2-agonist when needed. He now reports symptoms occurring on a daily basis, and he has frequent nighttime symptoms. He went to the emergency department once for shortness of breath since his last visit. He has been coughing for the last 2 hours without relief from his medications. Peak expiratory flow rate shows a 30% improvement after two inhalations of a ß-agonist. Oxygen therapy is initiated.

    On physical examination, which of the following is an ominous sign indicating the greatest need for immediate transfer to the emergency department?

    A. Prolonged expiration
    B. Pulsus paradoxus
    C. Tachypnea
    D. Use of accessory muscles
    E. Widespread polyphonic, high-pitched wheezes

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