ABFM KSA ASTHMA COMPREHENSIVE ANSWERS
AND QUESTIONS SET A+
✔✔A 12-year-old male who has intermittent asthma is brought to your office by his
father. The patient's asthma was well controlled until the beginning of soccer season.
He is a forward and reports that he has experienced increasing shortness of breath and
coughing that begins during training runs and long practices. His wheezing peaks about
5-10 minutes after he stops. He notes that the use of his albuterol (Proventil, Ventolin)
inhaler does help attenuate his symptoms but does not completely relieve them, and his
exercise tolerance seems to be worsening.
Which one of the following has been shown to be most effective for use before exercise,
as the next step in treatment of his condition? - ✔✔C. Budesonide/formoterol
(Symbicort)
✔✔The 2020 focused updates to the asthma management guidelines recommend
which one of the following allergen avoidance measures as part of a multifaceted,
comprehensive approach for patients sensitive to house dust mite allergens? - ✔✔A.
Encasing pillows and mattresses in an allergen-impermeable cover
✔✔The use of long-acting β-agonists as monotherapy in asthma has been associated
with an increased risk for - ✔✔E. severe asthma exacerbations
✔✔A patient with moderate persistent asthma presents to your office urgently because
of dyspnea and wheezing that have worsened over the last 36 hours. She reports that
she developed mild upper respiratory symptoms several days ago that are now worse,
but she does not have any fever, sputum production, or chest pain. She says that her
efforts to manage the exacerbation at home have been unsuccessful. On examination
she appears anxious and prefers to remain upright on the examination table due to
dyspnea. She has a respiratory rate of 26/min and her oxygen saturation is 95% on
room air.
Which one of the following would be the best method for objective assessment of the
severity of this patient's asthma attack? - ✔✔B. Measurement of peak expiratory flow
, ✔✔A 4-year-old is brought to your office by his mother because of recurrent episodes of
wheezing over the past year, generally associated with viral upper respiratory tract
infections. He is otherwise healthy and meeting all of his growth and developmental
milestones. He is afebrile today and his respiratory rate is 48/min. On auscultation you
hear diffuse, high-pitched wheezing at the end of expiration.
The most likely cause of his recurrent wheezing is - ✔✔A. Asthma
✔✔A 14-year-old female presents for a routine health maintenance visit. She has a
history of episodic wheezing in the past treated with inhaled albuterol (Proventil,
Ventolin) as needed. She tells you that she uses her inhaler less than once a week and
rarely develops nighttime wheezing. Her FEV1 is 90% of predicted. However, she
reports that on four occasions during the past year she developed a persistent cough
and wheezing, which required urgent care visits and short courses of oral
corticosteroids.
Which one of the following would be the preferred treatment for her asthma? - ✔✔D.
Add a low-dose inhaled corticosteroid for daily use, along with an as-needed short-
acting β-agonist
✔✔A 29-year-old female at 32 weeks gestation presents with a 3-day history of
increasing wheezing and dyspnea. She has a history of asthma since childhood.
Which one of the following pCO2 levels is the threshold for respiratory failure in this
patient? - ✔✔B. 35 mm Hg
✔✔Extrinsic IgE-mediated allergy can serve as a trigger for asthma. Which one of the
following can reduce corticosteroid requirements in patients with asthma by reducing
free-circulating IgE? - ✔✔C. Omalizumab (Xolair)
✔✔You are treating a 21-year-old female for moderate persistent asthma, which has
been under good control. You had been considering step-down therapy, but she
presents for follow-up after a weekend emergency department visit for an anaphylactic
reaction she had while celebrating her birthday.
Which one of the following items served at her birthday celebration is most likely to
cause this reaction? - ✔✔E. Wine
✔✔The mother of a 12-year-old male calls your office and tells you that over the past
few days he has had a low-grade fever, runny nose, and cough with yellowish phlegm.
He has a history of mild persistent asthma with a personal best peak flow of 410 L/min,
managed with daily use of budesonide/formoterol (Symbicort) plus as-needed albuterol
(Proventil, Ventolin). The mother says that 2 nights ago he awoke in the middle of the
night because of a coughing fit. She reports that his initial peak flow measurement had
dropped to 283 L/min (69% of personal best). You advise her to continue the
ICS/formoterol and to increase the frequency of his albuterol use to every 6 hours
during this acute infection. She calls 2 days later and reports that his peak flow is only
300 L/min (73% of personal best) and it has remained below 330 L/min (80% of
personal best) over the past 48 hours.
AND QUESTIONS SET A+
✔✔A 12-year-old male who has intermittent asthma is brought to your office by his
father. The patient's asthma was well controlled until the beginning of soccer season.
He is a forward and reports that he has experienced increasing shortness of breath and
coughing that begins during training runs and long practices. His wheezing peaks about
5-10 minutes after he stops. He notes that the use of his albuterol (Proventil, Ventolin)
inhaler does help attenuate his symptoms but does not completely relieve them, and his
exercise tolerance seems to be worsening.
Which one of the following has been shown to be most effective for use before exercise,
as the next step in treatment of his condition? - ✔✔C. Budesonide/formoterol
(Symbicort)
✔✔The 2020 focused updates to the asthma management guidelines recommend
which one of the following allergen avoidance measures as part of a multifaceted,
comprehensive approach for patients sensitive to house dust mite allergens? - ✔✔A.
Encasing pillows and mattresses in an allergen-impermeable cover
✔✔The use of long-acting β-agonists as monotherapy in asthma has been associated
with an increased risk for - ✔✔E. severe asthma exacerbations
✔✔A patient with moderate persistent asthma presents to your office urgently because
of dyspnea and wheezing that have worsened over the last 36 hours. She reports that
she developed mild upper respiratory symptoms several days ago that are now worse,
but she does not have any fever, sputum production, or chest pain. She says that her
efforts to manage the exacerbation at home have been unsuccessful. On examination
she appears anxious and prefers to remain upright on the examination table due to
dyspnea. She has a respiratory rate of 26/min and her oxygen saturation is 95% on
room air.
Which one of the following would be the best method for objective assessment of the
severity of this patient's asthma attack? - ✔✔B. Measurement of peak expiratory flow
, ✔✔A 4-year-old is brought to your office by his mother because of recurrent episodes of
wheezing over the past year, generally associated with viral upper respiratory tract
infections. He is otherwise healthy and meeting all of his growth and developmental
milestones. He is afebrile today and his respiratory rate is 48/min. On auscultation you
hear diffuse, high-pitched wheezing at the end of expiration.
The most likely cause of his recurrent wheezing is - ✔✔A. Asthma
✔✔A 14-year-old female presents for a routine health maintenance visit. She has a
history of episodic wheezing in the past treated with inhaled albuterol (Proventil,
Ventolin) as needed. She tells you that she uses her inhaler less than once a week and
rarely develops nighttime wheezing. Her FEV1 is 90% of predicted. However, she
reports that on four occasions during the past year she developed a persistent cough
and wheezing, which required urgent care visits and short courses of oral
corticosteroids.
Which one of the following would be the preferred treatment for her asthma? - ✔✔D.
Add a low-dose inhaled corticosteroid for daily use, along with an as-needed short-
acting β-agonist
✔✔A 29-year-old female at 32 weeks gestation presents with a 3-day history of
increasing wheezing and dyspnea. She has a history of asthma since childhood.
Which one of the following pCO2 levels is the threshold for respiratory failure in this
patient? - ✔✔B. 35 mm Hg
✔✔Extrinsic IgE-mediated allergy can serve as a trigger for asthma. Which one of the
following can reduce corticosteroid requirements in patients with asthma by reducing
free-circulating IgE? - ✔✔C. Omalizumab (Xolair)
✔✔You are treating a 21-year-old female for moderate persistent asthma, which has
been under good control. You had been considering step-down therapy, but she
presents for follow-up after a weekend emergency department visit for an anaphylactic
reaction she had while celebrating her birthday.
Which one of the following items served at her birthday celebration is most likely to
cause this reaction? - ✔✔E. Wine
✔✔The mother of a 12-year-old male calls your office and tells you that over the past
few days he has had a low-grade fever, runny nose, and cough with yellowish phlegm.
He has a history of mild persistent asthma with a personal best peak flow of 410 L/min,
managed with daily use of budesonide/formoterol (Symbicort) plus as-needed albuterol
(Proventil, Ventolin). The mother says that 2 nights ago he awoke in the middle of the
night because of a coughing fit. She reports that his initial peak flow measurement had
dropped to 283 L/min (69% of personal best). You advise her to continue the
ICS/formoterol and to increase the frequency of his albuterol use to every 6 hours
during this acute infection. She calls 2 days later and reports that his peak flow is only
300 L/min (73% of personal best) and it has remained below 330 L/min (80% of
personal best) over the past 48 hours.
