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Major depressive disorder — USMLE Step 2 CK MCQ

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HardPsychiatryMajor depressive disorderUSMLE Step 2 CK

A 42-year-old with asthma remains symptomatic on medium-dose inhaled corticosteroid-formoterol maintenance-and-reliever therapy. Adherence and technique are confirmed, spirometry shows reversible obstruction and exacerbations continue. Before selecting a biologic, what is the most appropriate next step?

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Correct answer: E — Obtain eosinophils, IgE and sensitization testing for phenotyping

Before selecting a biologic, severe asthma must be phenotyped with blood eosinophils, total IgE and allergen sensitization testing, with FeNO and other clinical features added as appropriate. Total IgE alone does not establish anti-IgE eligibility without sensitization and dosing-range criteria. Exacerbation history alone does not establish an eosinophilic phenotype for anti-IL5 therapy, and FeNO alone does not determine anti-IL4-receptor selection. Bronchial thermoplasty is not chosen before specialist phenotyping and appropriate biologic assessment.

Reference: GINA 2026 strategy report for asthma management and prevention: https://ginasthma.org/2026-gina-strategy-report/