A patient with asthma experiences nocturnal cough, wheezing, and chest tightness several times per week. Which of the following medications is most appropriate for long-term control of asthma symptoms and prevention of exacerbations?

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Question 1 of 5

A patient with asthma experiences nocturnal cough, wheezing, and chest tightness several times per week. Which of the following medications is most appropriate for long-term control of asthma symptoms and prevention of exacerbations?

Correct Answer: A

Rationale: Fluticasone/salmeterol (Advair) is a combination medication consisting of an inhaled corticosteroid (fluticasone) and a long-acting beta-agonist (salmeterol). This combination medication is recommended for long-term control of asthma symptoms and for the prevention of exacerbations. Fluticasone reduces airway inflammation, while salmeterol helps to relax the muscles of the airways, improving breathing. Using this combination medication regularly can help manage asthma symptoms and reduce the risk of asthma attacks. It is not appropriate to use short-acting beta-agonists like albuterol (salbutamol) on a long-term basis for asthma control. Ipratropium bromide (Atrovent) is an anticholinergic bronchodilator that is more commonly used for chronic obstructive pulmonary disease (COPD

Question 2 of 5

A patient with chronic obstructive pulmonary disease (COPD) is admitted to the hospital with acute exacerbation and respiratory failure requiring mechanical ventilation. Which of the following ventilator settings is most appropriate for minimizing the risk of ventilator-induced lung injury (VILI) in this patient?

Correct Answer: A

Rationale: Patients with COPD are at increased risk for developing ventilator-induced lung injury (VILI) due to their underlying lung pathology. Using a low tidal volume strategy (6-8 ml/kg predicted body weight) has been shown to reduce the risk of VILI in these patients. Additionally, applying high positive end-expiratory pressure (PEEP) helps to recruit collapsed alveoli, improve oxygenation, and decrease the risk of barotrauma by keeping the alveoli open throughout the respiratory cycle. Therefore, the most appropriate ventilator settings to minimize the risk of VILI in a COPD patient with acute exacerbation and respiratory failure requiring mechanical ventilation would be low tidal volume and high PEEP.

Question 3 of 5

A patient presents with bone pain, fatigue, and frequent infections. Laboratory tests reveal pancytopenia, hypocellular bone marrow, and absence of reticulocytes. Which of the following conditions is most likely to cause these findings?

Correct Answer: A

Rationale: Aplastic anemia is a condition characterized by a reduction in the number of all three blood cell types: red blood cells, white blood cells, and platelets. The patient's presentation of bone pain, fatigue, frequent infections, pancytopenia (decreased counts of all blood cell types), hypocellular bone marrow (reduced cellularity in the bone marrow), and absence of reticulocytes is indicative of aplastic anemia.

Question 4 of 5

A patient with a history of sickle cell disease presents with severe abdominal pain, fever, and jaundice. Laboratory tests reveal anemia, reticulocytosis, elevated indirect bilirubin, and presence of Howell-Jolly bodies on peripheral blood smear. Which of the following conditions is most likely to cause these findings?

Correct Answer: A

Rationale: Acute splenic sequestration crisis is a complication seen in patients with sickle cell disease characterized by the sudden pooling of sickled red blood cells in the spleen, leading to splenic enlargement, severe anemia, and hypovolemic shock. This pooling results in a rapid drop in hemoglobin levels, causing anemia. The spleen's sequestration of large numbers of red blood cells can cause a sudden rise in the number of immature red blood cells (reticulocytes) in the blood (reticulocytosis). The destruction of these trapped red blood cells in the spleen leads to hemolysis, evidenced by elevated indirect bilirubin levels and the presence of Howell-Jolly bodies (nuclear remnants of erythrocytes) on peripheral blood smear. Patients may present with severe abdominal pain, fever, jaundice, and signs of hemodynamic instability, which

Question 5 of 5

A patient presents with fatigue, pallor, and exertional dyspnea. Laboratory tests reveal severe anemia, low serum iron, low transferrin saturation, and elevated total iron-binding capacity (TIBC). Which of the following conditions is most likely to cause these findings?

Correct Answer: A

Rationale: The clinical presentation of fatigue, pallor, exertional dyspnea along with the laboratory findings of severe anemia, low serum iron, low transferrin saturation, and elevated TIBC are consistent with iron deficiency anemia. In iron deficiency anemia, there is inadequate iron available for erythropoiesis leading to microcytic hypochromic anemia. The low serum iron and transferrin saturation, along with the elevated TIBC, indicate decreased iron stores and increased iron-binding capacity as the body tries to compensate for the deficiency by increasing absorption and recycling of iron. Anemia of chronic disease typically presents with mild to moderate anemia, normal to low TIBC, and low transferrin saturation due to iron sequestration in macrophages. Sideroblastic anemia usually has elevated serum iron, high saturation, and normal to low TIBC. Thalassemia presents with microcytic hyp

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