Pre-Test 1. A 52-year-old Caucasian woman presents 5 days after an acute asthma exacerbation that led her to present to a local emergency department. She explains that her asthma was diagnosed 10 years earlier and had been well controlled with inhaled corticosteroid (ICS) therapy until about 3 years ago, when she began experiencing exacerbations roughly twice a year. She also reports experiencing intermittent, low-grade fevers over the past few months and a 3.2-kg weight gain in the past year without changing her dietary habits or level of physical activity. Noteworthy findings from the laboratory evaluations and imaging studies ordered by the emergency department physician include the followingPeripheral blood eosinophil count: 732/mcLAntineutrophil cytoplasmic antibodies (ANCA) status: negativeChest radiograph: ground-glass opacities in the lungs, with a bilateral symmetrical distribution< Which of the following statements best reflects the latest evidence on the epidemiology of eosinophilic granulomatosis with polyangiitis (EGPA)? a. The patient’s ANCA-negative status makes it very unlikely that she has EGPA. b. The patient’s sex places her at elevated risk for EGPA. c. The patient’s increasing exacerbations, weight gain, intermittent fever, and blood eosinophil count all are consistent with EGPA, whereas her adult-onset asthma is not typically associated with EGPA. d. The patient’s adult-onset asthma, intermittent fever, blood eosinophil count, and imaging findings all are consistent with EGPA, whereas her weight gain is not typically associated with EGPA. 2. After a thorough evaluation, you diagnose the patient with EGPA. Which of the following steps is recommended by expert consensus panels upon diagnosis of EGPA? a. Refer the patient to a genetic counselor. b. Evaluate the patient for potential renal, cardiac, gastrointestinal, and neurologic involvement. c. Repeat ANCA testing. d. Measure serum immunoglobulin levels quarterly as a means of monitoring disease activity. 3. The patient returns for a follow-up visit 12 months after your diagnosis of EGPA. She has been doing well on ICS, 10 mg per day, with no indication of disease progression at prior quarterly visits or at this visit. However, each time you have attempted to lower the dose of her ICS over the past year, she has reported worsening asthma symptoms. At this visit, you consider introducing another agent to her treatment regimen, and you weigh the evidence for the various therapeutic classes employed in managing EGPA. Which of the following statements regarding the role of anti-interleukin (IL)-5 biologic agents in the treatment of EGPA IS NOT CORRECT? a. Anti-IL-5 biologic agents target an IL implicated in the pathogenesis of EGPA. b. Although anti-IL-5 biologic agents are used in the treatment of EGPA, none have been approved by the US Food and Drug Administration (FDA) specifically for use in this disease state. c. One anti-IL-5 biologic agent has been approved by the FDA for use in EGPA, whereas another is in late stages of clinical development for this purpose. d. Clinical research has shown that an anti-IL-5 biologic therapy can facilitate steroid tapering while maintaining disease control in adults with relapsing or refractory EGPA. 4. An expert consensus panel has recommended employing shared decision making in managing patients with EGPA. Which of the following statements best describes shared decision making? a. Shared decision making seeks to involve various specialists in formulating treatment plans for patients with complex conditions and has been shown to improve outcomes. b. Shared decision making seeks to involve various specialists in formulating treatment plans for patients with complex conditions but has not yet been shown to have an impact on outcomes. c. Shared decision making seeks to involve patients in decisions regarding their care and has been shown to improve adherence to treatment regimens for chronic conditions. d. Shared decision making seeks to involve patients in decisions regarding their care but has not yet been shown to have an impact on adherence to treatment regimens for chronic conditions. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
