ABFM KSA ASTHMA FINALS ANSWERS AND
QUESTIONS SET A+
✔✔A 47-year-old female with moderate severe asthma presents with a recent history of
more frequent exacerbations now accompanied by expectoration of brown mucus plugs,
intermittent fever, and increasing fatigue. She is afebrile today and her wheezing is
minimal. A chest radiograph shows opacities in the parenchyma of the upper lobes, with
evidence of atelectasis.
Which one of the following is true regarding the diagnosis of this condition? - ✔✔B.
Laboratory evaluation will show a total serum IgE concentration >1000 ng/mL (N 0-430)
✔✔Which one of the following is known to be an adverse effect associated with the use
of β-agonists? - ✔✔D. Tremor
✔✔You see a 24-year-old male with moderate persistent asthma treated with a high-
dose inhaled corticosteroid combined with a long-acting β-agonist. He reports that his
cough and wheezing have improved but he continues to require daily use of an albuterol
(Proventil, Ventolin) inhaler. He notes that he did not require the use of his albuterol
rescue inhaler even once during a recent 1-week vacation in Maui.Reviewing his
medication adherence and assessing for specific asthma triggers reveals no specific
modifiable exposure. His total serum IgE level is 130 IU/mL (N 6-97). Specific allergy
immunoassay testing does not reveal a confirmed allergen.
Which one of the following would be most appropriate at this time? - ✔✔C. Add
omalizumab (Xolair)
✔✔A 52-year-old male who works at a poultry processing plant sends a message
through your clinic's patient portal to inform you that he was exposed to COVID-19 at
work. New COVID-19 variants have been diagnosed in a few of his coworkers and he
has not been able to receive a COVID-19 vaccine yet. He has mild persistent asthma
and he asks if his asthma increases his risk of contracting COVID-19 and having a bad
outcome. He also asks you if he should discontinue his inhaled corticosteroid because
he has heard that prolonged corticosteroid use weakens the immune system.
, Which one of the following would be appropriate advice about asthma and COVID-19? -
✔✔B. Use of inhaled corticosteroids is safe for managing asthma symptoms in patients
exposed to COVID-19
✔✔A 52-year-old male with a history of asthma attributed to aspirin-exacerbated
respiratory disease (AERD) presents to the emergency department with a severe
exacerbation of dyspnea and wheezing that has not responded to use of his rescue
inhaler with a spacer at home. On examination he has a respiratory rate of 35/min and a
pulse rate of 130 beats/min, and he is using accessory muscles of inspiration to
breathe. He can only give short responses to your questions. His initial oxygen
saturation is 88%.
Which one of the following would be most appropriate to administer initially as you
quickly evaluate this patient? - ✔✔D. Oxygen via Nasal Cannula
✔✔A 15-year-old male with a history of asthma presents to your office with worsening
asthma symptoms. He reports wheezing episodes 5-6 days per week and nighttime
awakenings that have increased in frequency to 1-2 nights per week. He went to an
urgent care center 6 months ago for an upper respiratory infection with a severe cough,
which was his second asthma exacerbation this year. His FEV1 in your office is 70% of
predicted.
This patient's asthma should be categorized as - ✔✔D. moderate persistant
✔✔An 11-year-old male is brought to your office by his father. They have just moved
into your community and they are establishing care because the adolescent has
moderate persistent asthma treated with inhaled corticosteroids (ICSs) daily and
albuterol (Proventil, Ventolin) as needed. Under the care of his previous physician the
patient and family started using an asthma action plan and have found it very useful.
However, despite good adherence and following the asthma action plan, the father
reports that since their move they have had three emergency department visits in the
last 6 months for his son's asthma exacerbations.
A baseline FEV1 today is 80% of predicted. On examination the patient has mild
wheezing which clears with coughing, and you note boggy turbinates. You also notice
that he has dog hair on his pants.
In addition to exploring the role of allergens in his new environment, the preferred next
step in his - ✔✔C. Low-dose budesonide/formoterol (Symbicort) daily and as needed
✔✔A 22-year-old male with long-standing asthma develops an asthma exacerbation
following an upper respiratory infection. He is seen in the emergency department with
severe dyspnea and a fall in peak flow to 270 L/min, which is 45% of his personal best
peak flow of 600 L/min. He is hospitalized and aggressively treated with short-acting β-
agonists, plus oral prednisone, 40 mg daily. He responds incompletely to therapy, with
an increase in his peak flow to 340 L/min (57% of personal best).
According to National Asthma Education and Prevention Program guidelines, hospital
discharge can be considered in this patient once the peak flow rate rises above - ✔✔B.
420 L/min
QUESTIONS SET A+
✔✔A 47-year-old female with moderate severe asthma presents with a recent history of
more frequent exacerbations now accompanied by expectoration of brown mucus plugs,
intermittent fever, and increasing fatigue. She is afebrile today and her wheezing is
minimal. A chest radiograph shows opacities in the parenchyma of the upper lobes, with
evidence of atelectasis.
Which one of the following is true regarding the diagnosis of this condition? - ✔✔B.
Laboratory evaluation will show a total serum IgE concentration >1000 ng/mL (N 0-430)
✔✔Which one of the following is known to be an adverse effect associated with the use
of β-agonists? - ✔✔D. Tremor
✔✔You see a 24-year-old male with moderate persistent asthma treated with a high-
dose inhaled corticosteroid combined with a long-acting β-agonist. He reports that his
cough and wheezing have improved but he continues to require daily use of an albuterol
(Proventil, Ventolin) inhaler. He notes that he did not require the use of his albuterol
rescue inhaler even once during a recent 1-week vacation in Maui.Reviewing his
medication adherence and assessing for specific asthma triggers reveals no specific
modifiable exposure. His total serum IgE level is 130 IU/mL (N 6-97). Specific allergy
immunoassay testing does not reveal a confirmed allergen.
Which one of the following would be most appropriate at this time? - ✔✔C. Add
omalizumab (Xolair)
✔✔A 52-year-old male who works at a poultry processing plant sends a message
through your clinic's patient portal to inform you that he was exposed to COVID-19 at
work. New COVID-19 variants have been diagnosed in a few of his coworkers and he
has not been able to receive a COVID-19 vaccine yet. He has mild persistent asthma
and he asks if his asthma increases his risk of contracting COVID-19 and having a bad
outcome. He also asks you if he should discontinue his inhaled corticosteroid because
he has heard that prolonged corticosteroid use weakens the immune system.
, Which one of the following would be appropriate advice about asthma and COVID-19? -
✔✔B. Use of inhaled corticosteroids is safe for managing asthma symptoms in patients
exposed to COVID-19
✔✔A 52-year-old male with a history of asthma attributed to aspirin-exacerbated
respiratory disease (AERD) presents to the emergency department with a severe
exacerbation of dyspnea and wheezing that has not responded to use of his rescue
inhaler with a spacer at home. On examination he has a respiratory rate of 35/min and a
pulse rate of 130 beats/min, and he is using accessory muscles of inspiration to
breathe. He can only give short responses to your questions. His initial oxygen
saturation is 88%.
Which one of the following would be most appropriate to administer initially as you
quickly evaluate this patient? - ✔✔D. Oxygen via Nasal Cannula
✔✔A 15-year-old male with a history of asthma presents to your office with worsening
asthma symptoms. He reports wheezing episodes 5-6 days per week and nighttime
awakenings that have increased in frequency to 1-2 nights per week. He went to an
urgent care center 6 months ago for an upper respiratory infection with a severe cough,
which was his second asthma exacerbation this year. His FEV1 in your office is 70% of
predicted.
This patient's asthma should be categorized as - ✔✔D. moderate persistant
✔✔An 11-year-old male is brought to your office by his father. They have just moved
into your community and they are establishing care because the adolescent has
moderate persistent asthma treated with inhaled corticosteroids (ICSs) daily and
albuterol (Proventil, Ventolin) as needed. Under the care of his previous physician the
patient and family started using an asthma action plan and have found it very useful.
However, despite good adherence and following the asthma action plan, the father
reports that since their move they have had three emergency department visits in the
last 6 months for his son's asthma exacerbations.
A baseline FEV1 today is 80% of predicted. On examination the patient has mild
wheezing which clears with coughing, and you note boggy turbinates. You also notice
that he has dog hair on his pants.
In addition to exploring the role of allergens in his new environment, the preferred next
step in his - ✔✔C. Low-dose budesonide/formoterol (Symbicort) daily and as needed
✔✔A 22-year-old male with long-standing asthma develops an asthma exacerbation
following an upper respiratory infection. He is seen in the emergency department with
severe dyspnea and a fall in peak flow to 270 L/min, which is 45% of his personal best
peak flow of 600 L/min. He is hospitalized and aggressively treated with short-acting β-
agonists, plus oral prednisone, 40 mg daily. He responds incompletely to therapy, with
an increase in his peak flow to 340 L/min (57% of personal best).
According to National Asthma Education and Prevention Program guidelines, hospital
discharge can be considered in this patient once the peak flow rate rises above - ✔✔B.
420 L/min
