IM is having airway obstruction difficulties this week. 😀
No real stupid exam tricks on this missed question, but the miss rate is 42%. This is a good example of some of the exams long vignette forms. There are four key facts identified, and the test-taker has to integrate all of them, not lending too much weight to any one of them, recall the complex classification system, and apply it correctly.
The most widely referenced classification system in the US is from NAEPP, from 2007. The GINA guidelines are updated annually. Both systems weigh multiple criteria, which is what the test-taker is supposed to do here.
FEV1 is in normal range, but the history says daytime symptoms 3-4 times a week, so reliance on spirometry alone would be wrong.
Daytime frequency points towards persistent, the FEV1 toward mild. The nighttime awakenings are critical, but if considered in isolation, would point towards intermittent asthma. And intermittent (a) is the most frequently given incorrect answer. They’re looking at spirometry and nighttime awakenings.
With daytime frequency, some nighttime awakenings, and an FEV1 pointing towards mild, the correct answer is (b), mild persistent.
These are some of the toughest types of exam questions. You’ve got no tricks, no clues, just four measures and your knowledge of classification.
When in doubt, always identify all the key findings mentioned in a question. There is almost never a distractor in the question stem.
This question appears in Med-Challenger Internal Medicine Exam Review with CME
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