MEDICINEnotes

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عارفين ليش مش A

A 46-year-old man with severe bronchial asthma continues to have recurrent exacerbations despite optimized high-dose ICS-LABA therapy. Adherence, inhaler technique, and comorbidities have been carefully addressed. His blood eosinophil count remains persistently elevated, and specialist assessment confirms severe eosinophilic asthma. He prefers a treatment administered under supervision in an infusion unit rather than self-injections at home.

What is the most appropriate next step? A. Start mepolizumab immediately because the eosinophil count confirms severe eosinophilic asthma B. Start dupilumab because nasal polyposis and elevated eosinophils predict a good response C. Increase the inhaled corticosteroid dose and reassess after 3 months D. Refer for specialist evaluation for a systemic eosinophilic disorder before attributing the findings solely to severe asthma E. Start omalizumab because recurrent exacerbations indicate severe allergic asthma

A 44-year-old man with adult-onset bronchial asthma remains poorly controlled despite high-dose ICS-LABA therapy. Adherence and inhaler technique have been repeatedly confirmed. During the last year, he has required four courses of systemic corticosteroids. He also has chronic rhinosinusitis with nasal polyps. His blood eosinophil count, previously around 600 cells/µL, is now 2,400 cells/µL. Over the past month, he has developed a painful purpuric rash over both legs and new numbness with weakness of his right foot.

عندكم ساعة

في خدعة في السؤال من يقول عليها

نبي حد يجاوب ويفسرلي اجابة السؤال

A 24-year-old man with known asthma presents with a severe exacerbation. On arrival, he is tachypneic and anxious. His initial ABG shows: pH 7.47 PaCO₂ 29 mmHg PaO₂ 72 mmHg One hour later, he appears quieter and his respiratory rate falls from 34 to 22/min. Repeat ABG shows: pH 7.35 PaCO₂ 44 mmHg PaO₂ 68 mmHg

A 20-year-old woman was diagnosed with asthma six months ago. At diagnosis, she had daily symptoms and frequent nocturnal awakening. She is now completely asymptomatic on low-intensity treatment.

A 28-year-old woman with known asthma has been using low-dose ICS-LABA for the last 3 months. She reports daytime symptoms on 4 days per week and occasional nocturnal awakening. She insists that she takes her medication regularly. Her prescriptions have been refilled on time.

A 28-year-old woman with asthma is prescribed low-dose ICS-LABA. She continues to experience symptoms four days per week. Her physician is considering increasing her inhaled corticosteroid dose. During review, she demonstrates that she does not shake her inhaler and actuates it after finishing inspiration.