ABFM Knowledge Self-Assessment (KSA)
Asthma Module Complete Study Guide:
Verified Exam Questions, Correct Answers,
and Detailed Clinical Rationales for Family
Medicine Board Review and Recertification
Preparation (Latest Updated Edition)
Question 1: Diagnosis of Asthma
A 24-year-old woman reports episodic wheezing, chest tightness, and cough that
worsen with exposure to dust and during the early morning hours. Her spirometry
shows an FEV₁ increase of 14% and 230 mL after bronchodilator administration.
Which finding most strongly supports the diagnosis of asthma?
A. Reduced total lung capacity
B. Persistent airflow obstruction without variability
C. Significant bronchodilator reversibility
D. Increased residual volume alone
E. Progressive decline in FEV₁ without improvement
Correct Answer: C. Significant bronchodilator reversibility
Rationale: Asthma is characterized by variable respiratory symptoms and variable
expiratory airflow limitation. A significant improvement in FEV₁ after bronchodilator
administration provides objective evidence that airflow obstruction is reversible. An
,increase of at least 12% and 200 mL has traditionally been used as supportive evidence of
variable airflow limitation. This patient's improvement exceeds both thresholds, making
asthma strongly supported when interpreted alongside her episodic symptoms and
trigger-related pattern.
Question 2: Exercise-Induced Bronchospasm
A patient with suspected exercise-induced bronchospasm undergoes baseline
pulmonary function testing revealing an FEV₁ of 3.1 L.
Which post-exercise measurements would support a diagnosis of exercise-induced
bronchospasm? (Mark all that are true.)
A. FEV₁ 2.8 L
B. FEV₁ 2.5 L
C. FEV₁ 2.2 L
D. PEF 540 L/min
E. PEF 525 L/min
Correct Answer: B, C
Rationale: An exercise challenge test is used to establish the diagnosis of exercise-induced
bronchospasm (EIB). A 15% decrease in PEF or FEV₁ after exercise is compatible with EIB. A
15% decrease from an FEV₁ of 3.1 L would be below 2.635 L, making 2.5 L and 2.2 L
significant.
Question 3: Acid-Base Abnormalities in Asthma
Exacerbation
Which one of the following is the most common acid/base abnormality in the
early stages of an asthma exacerbation?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Mixed respiratory alkalosis with metabolic acidosis
Correct Answer: B. Respiratory alkalosis
Rationale: Initial findings on arterial blood gas analysis in a patient with an asthma
exacerbation typically include hypoxemia and hypocapnia. Primary hypocapnia, with its
resulting cellular and renal compensation, produces a respiratory alkalosis. The finding of
respiratory acidosis, or a failure to reduce pCO₂, in a patient with an asthma exacerbation
would indicate respiratory muscle fatigue and impending respiratory failure.
Question 4: Asthma Pathophysiology
Mediators linked to the pathophysiology of asthma include which of the
following? (Mark all that are true.)
A. Histamine
B. Leukotrienes
C. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
D. Interleukin-4 and interleukin-5
E. Tumor necrosis factor alpha
Correct Answer: All of the above
Rationale: It is postulated that allergic inflammation in asthma arises from an imbalance
between T helper 1 (Th1) cells and T helper 2 (Th2) cells. Th2 cells release specific
cytokines, including interleukin-4, -5, -9, and -13, which promote eosinophil growth and
migration, as well as mast cell differentiation and IgE production. Inhaled antigens
activate mast cells and Th2 cells in the airway, causing the release of histamine and
, cysteinyl leukotrienes, leading to rapid contraction of airway smooth muscle. Mast cells
also produce various cytokines, including GM-CSF and tumor necrosis factor alpha.
Question 5: Asthma Severity Classification
A patient has asthma symptoms 3 days a week and wakes up 3 times a month due to
asthma.
How is this severity classified?
A. Mild Persistent
B. Moderate Persistent
C. Severe Persistent
D. Intermittent
Correct Answer: A. Mild Persistent
Rationale: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week (but not daily) and nighttime awakenings 3-4 times per month.
Question 6: Pharmacologic Management
A 19-year-old college student experiences asthma symptoms two to three times each
week and occasionally wakes at night because of coughing. She currently uses only a
short-acting bronchodilator when symptoms occur.
Which management principle is most appropriate?
A. Begin an inhaled corticosteroid-containing treatment strategy
B. Continue bronchodilator-only treatment indefinitely
C. Start daily oral corticosteroids
D. Use antibiotics whenever wheezing occurs
E. Avoid all physical activity
Asthma Module Complete Study Guide:
Verified Exam Questions, Correct Answers,
and Detailed Clinical Rationales for Family
Medicine Board Review and Recertification
Preparation (Latest Updated Edition)
Question 1: Diagnosis of Asthma
A 24-year-old woman reports episodic wheezing, chest tightness, and cough that
worsen with exposure to dust and during the early morning hours. Her spirometry
shows an FEV₁ increase of 14% and 230 mL after bronchodilator administration.
Which finding most strongly supports the diagnosis of asthma?
A. Reduced total lung capacity
B. Persistent airflow obstruction without variability
C. Significant bronchodilator reversibility
D. Increased residual volume alone
E. Progressive decline in FEV₁ without improvement
Correct Answer: C. Significant bronchodilator reversibility
Rationale: Asthma is characterized by variable respiratory symptoms and variable
expiratory airflow limitation. A significant improvement in FEV₁ after bronchodilator
administration provides objective evidence that airflow obstruction is reversible. An
,increase of at least 12% and 200 mL has traditionally been used as supportive evidence of
variable airflow limitation. This patient's improvement exceeds both thresholds, making
asthma strongly supported when interpreted alongside her episodic symptoms and
trigger-related pattern.
Question 2: Exercise-Induced Bronchospasm
A patient with suspected exercise-induced bronchospasm undergoes baseline
pulmonary function testing revealing an FEV₁ of 3.1 L.
Which post-exercise measurements would support a diagnosis of exercise-induced
bronchospasm? (Mark all that are true.)
A. FEV₁ 2.8 L
B. FEV₁ 2.5 L
C. FEV₁ 2.2 L
D. PEF 540 L/min
E. PEF 525 L/min
Correct Answer: B, C
Rationale: An exercise challenge test is used to establish the diagnosis of exercise-induced
bronchospasm (EIB). A 15% decrease in PEF or FEV₁ after exercise is compatible with EIB. A
15% decrease from an FEV₁ of 3.1 L would be below 2.635 L, making 2.5 L and 2.2 L
significant.
Question 3: Acid-Base Abnormalities in Asthma
Exacerbation
Which one of the following is the most common acid/base abnormality in the
early stages of an asthma exacerbation?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Mixed respiratory alkalosis with metabolic acidosis
Correct Answer: B. Respiratory alkalosis
Rationale: Initial findings on arterial blood gas analysis in a patient with an asthma
exacerbation typically include hypoxemia and hypocapnia. Primary hypocapnia, with its
resulting cellular and renal compensation, produces a respiratory alkalosis. The finding of
respiratory acidosis, or a failure to reduce pCO₂, in a patient with an asthma exacerbation
would indicate respiratory muscle fatigue and impending respiratory failure.
Question 4: Asthma Pathophysiology
Mediators linked to the pathophysiology of asthma include which of the
following? (Mark all that are true.)
A. Histamine
B. Leukotrienes
C. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
D. Interleukin-4 and interleukin-5
E. Tumor necrosis factor alpha
Correct Answer: All of the above
Rationale: It is postulated that allergic inflammation in asthma arises from an imbalance
between T helper 1 (Th1) cells and T helper 2 (Th2) cells. Th2 cells release specific
cytokines, including interleukin-4, -5, -9, and -13, which promote eosinophil growth and
migration, as well as mast cell differentiation and IgE production. Inhaled antigens
activate mast cells and Th2 cells in the airway, causing the release of histamine and
, cysteinyl leukotrienes, leading to rapid contraction of airway smooth muscle. Mast cells
also produce various cytokines, including GM-CSF and tumor necrosis factor alpha.
Question 5: Asthma Severity Classification
A patient has asthma symptoms 3 days a week and wakes up 3 times a month due to
asthma.
How is this severity classified?
A. Mild Persistent
B. Moderate Persistent
C. Severe Persistent
D. Intermittent
Correct Answer: A. Mild Persistent
Rationale: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week (but not daily) and nighttime awakenings 3-4 times per month.
Question 6: Pharmacologic Management
A 19-year-old college student experiences asthma symptoms two to three times each
week and occasionally wakes at night because of coughing. She currently uses only a
short-acting bronchodilator when symptoms occur.
Which management principle is most appropriate?
A. Begin an inhaled corticosteroid-containing treatment strategy
B. Continue bronchodilator-only treatment indefinitely
C. Start daily oral corticosteroids
D. Use antibiotics whenever wheezing occurs
E. Avoid all physical activity
