I am going to answer the sample USMLE Step 2 CK Questions with Explanation. These questions are available at USMLE.org
A 9-year-old girl is brought to the clinic for a routine examination. She has a 4-year history of asthma. Her only medication is inhaled albuterol with a spacer as needed. She uses it only occasionally and has not used it at all during the past 4 weeks. Her father reports that his daughter has an episode of coughing that awakens her at night once weekly. He also says that his daughter has a sedentary lifestyle because “she coughs if she runs too much.” No one in the family smokes cigarettes, and there are no pets. Gas heaters are used in the home. The patient is at the 25th percentile for height and 90th percentile for weight and BMI. Respirations are 16/min. Lungs are clear to auscultation. There is no clubbing of the digits. The remainder of the examination shows no abnormalities.
Which of the following is the most appropriate next step in management?
(A) Add oral theophylline to the regimen
(B) Add fluticasone by metered-dose inhaler with a spacer to the regimen
(C) Add salmeterol by metered-dose inhaler with a spacer to the regimen
(D) Begin a 5-day course of oral prednisone
(E) No change in management is necessary
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Answer
This patient symptoms, nighttime coughing that awakens her once weekly and exercise-induced symptoms indicate that her asthma is persistent and not adequately controlled with her current regimen of as-needed albuterol alone. According to asthma management guidelines, the addition of a daily inhaled corticosteroid, such as fluticasone, is recommended to control persistent asthma.
Theophylline is not typically a first-line treatment for asthma and has a narrow therapeutic window with significant side effects. It is less commonly used in current asthma management.
Salmeterol is a long-acting beta-agonist (LABA). LABAs should not be used as monotherapy in asthma because they do not address inflammation and can increase the risk of asthma-related death if used without an inhaled corticosteroid. If LABAs are used, they should be combined with an inhaled corticosteroid.
Oral corticosteroids like prednisone are used for acute exacerbations of asthma but are not indicated for regular control of persistent asthma. They are generally reserved for severe exacerbations or when there is an acute deterioration in symptoms.
Maintaining the current management would be inappropriate. Her asthma is not well-controlled, and an adjustment in her treatment regimen is necessary to improve control and prevent symptoms.
The correct answer is (B) Add fluticasone by metered-dose inhaler with a spacer to the regimen
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