Posted by starting from IP 76.169.65.71 on March 27, 2008 at 20:28:56:
Stupid usmle123 questions.
A 55-year-old man is seen in your office for the first time complaining of a persistent cough. The cough began 6 months ago and occurs four to five times a week, usually during the day but occasionally these episodes awaken him from sleep. He has no other symptoms. There is no smoking history. Past medical history is significant for hypertension, diagnosed 20 years ago, and osteoarthritis of both knees. Medications are hydrochlorothiazide, lisinopril, and ibuprofen. On examination, vital signs are temperature: 32°C (89.6°F); blood pressure (BP): 120/75 mm Hg; heart rate (HR): 80 beats/min; respiratory rate (RR): 14 breaths/min. Expiratory wheezing is present bilaterally. There are no other abnormal findings.
Item 2 of 3
As part of your assessment of the patient’s acute condition, you order pulmonary function tests. Spirometry measurements are recorded. Results are as follows:
Measured Predicted % Predicted
FVC 2.63 3.11 84
FEV1 1.37 2.28 60
FEV1/FVC 52 73
FEF25-75 0.59 2.56 23
PEF 4.90 5.78 85
FEV1 increased 15% after administration of a short-acting bronchodilator.
At this point, which of the following will likely be most useful in determining the optimum management of the patient’s acute condition?
Click on the circle next to your answer choice
A. Antihistamine and nasal prednisone trial
B. Computed tomography sinus series
C. Eosinophil count
D. Gallium lung scan
E. Methacholine bronchoprovocation test