ABFM KSA Asthma Version 2 (V2) (Latest Update 2025 /
2026) 100% Verified Comprehensive Questions & Correct
Answers with Rationales | Graded A+
A 26-year-old male with asthma is seen in the emergency department. He is short of
breath to a degree that makes it difficult to speak in sentences and he appears tired. On
examination you note diminished breath sounds with an occasional wheeze. His FEV1 is
15% of predicted and his pCO2 is 45 mm Hg. He is given albuterol (Proventil, Ventolin)
over the next hour but he has a poor response. He is not able to repeat the spirometry
and he now appears drowsy. Which one of the following would be consistent with
imminent respiratory failure?
A. A pCO2 of 45 mm Hg
B. Diminished breath sounds
C. An FEV1 of 15% of predicted
D. Difficulty speaking in sentences
E. The absence of wheezes
CORRECT ANSWER ✓ ✓: E. The absence of wheezes
RATIONALE: In a severe asthma exacerbation, wheezing is caused by air moving
through narrowed airways. As the patient tires and approaches respiratory failure, air
movement becomes so minimal that wheezing ceases, resulting in a "silent chest," which
is an ominous sign.
A 35-year-old male who was admitted to the intensive-care unit with a severe asthma
exacerbation has failed to improve with aggressive bronchodilator therapy and systemic
,corticosteroid therapy. For the past 10 minutes he has appeared more fatigued, but less
wheezing is heard and his pulsus paradoxus, which had been 30 mm Hg, is <10 mm Hg.
His pO2 is 75 mm Hg and his pCO2 is 48 mm Hg on 6 L/min of oxygen. Which one of
the following interventions would be the most appropriate next step in the
management of this patient?
A. Administer a second dose of systemic corticosteroids
B. Add an inhaled anticholinergic agent
C. Initiate noninvasive positive-pressure ventilation
D. Administer intravenous theophylline
E. Intubation and Mechanical Ventilation
CORRECT ANSWER ✓ ✓: E. Intubation and Mechanical Ventilation
RATIONALE: The patient is showing signs of impending respiratory arrest, including
fatigue, a silent chest (less wheezing due to minimal air movement), a falling pulsus
paradoxus (indicating worsening cardiac output), and hypercapnia (pCO2 >45 mm Hg)
despite therapy. Immediate intubation and mechanical ventilation are required.
A 28-year-old female presents with progressively worsening asthma after a recent viral
upper respiratory infection. When you enter the room, she appears in distress and is
only able to talk in words, not sentences. Her respiratory rate is 34/min and her heart
rate is 126 beats/min. Her oxygen saturation before oxygen was administered was 89%.
You begin treatment with a nebulized short-acting β-agonist (SABA) plus ipratropium
and give an initial dose of oral prednisone. After one hour her symptoms are not
responsive to initial treatment efforts. Which one of the following should you consider
as a possible adjunctive treatment?
A. Inhaled corticosteroids
B. Oral theophylline
C. Intravenous magnesium sulfate
D. A long-acting β-agonist
E. Omalizumab (Xolair)
,CORRECT ANSWER ✓ ✓: C. Intravenous magnesium sulfate
RATIONALE: IV magnesium sulfate is a recommended adjunctive treatment for severe,
life-threatening asthma exacerbations that are not responding to standard SABA,
ipratropium, and corticosteroid therapy. It works as a bronchodilator by relaxing smooth
muscle.
A 22-year-old female presents to your office with an acute asthma attack that
developed 2 days after the onset of a viral upper respiratory infection. Her asthma is
usually well controlled, with a personal best peak expiratory flow (PEF) of 380 L/min. On
initial evaluation by the nurse she has a pulse rate of 120 beats/min, a respiratory rate of
32/min, and an oxygen saturation of 92% on room air. On examination she is very
dyspneic with diffuse inspiratory and expiratory wheezing and she is using accessory
muscles to breathe. Her PEF is 150 L/min. Inhaled β-agonists and systemic
corticosteroids are administered and she is reevaluated 1 hour later. Which one of the
following would provide the most reassurance that she is responding to therapy?
A. A respiratory rate of 28/min
B. An oxygen saturation of 94%
C. A PEF of 310 L/min
D. The ability to speak in full sentences
E. The absence of wheezing
CORRECT ANSWER ✓ ✓: C. A PEF of 310 L/min
RATIONALE: Peak expiratory flow (PEF) is an objective measure of airflow obstruction. A
PEF of 310 L/min is over 80% of her personal best (380 L/min), which is a key indicator
of a good response to therapy and suggests a significantly improved airway function.
A 13-year-old male with a history of moderate persistent asthma presents to the
emergency department with a 2-day history of worsening dyspnea despite frequent use
of an inhaled β-agonist. An examination reveals a restless patient with a respiratory rate
of 35/min, obvious suprasternal retractions, and loud inspiratory and expiratory
wheezes. His peak flow is 250 L/min (49% of personal best). His oxygen saturation is
89%. Which one of the following management options would be most effective for
, preventing hospitalization in this patient?
A. Continuous nebulized short-acting β-agonist
B. Intravenous corticosteroids
C. An inhaled anticholinergic agent in combination with a short-acting β-agonist
D. Subcutaneous epinephrine
E. Intravenous magnesium sulfate
CORRECT ANSWER ✓ ✓: C. An inhaled anticholinergic agent in combination with a
short-acting β-agonist
RATIONALE: The addition of an inhaled anticholinergic (like ipratropium) to a SABA has
been shown to produce additional bronchodilation and significantly reduce
hospitalization rates in patients with moderate to severe asthma exacerbations.
A 7-year-old is brought to the emergency department with a severe asthma
exacerbation that does not respond to a combination of oxygen and continuous short-
acting β-agonists plus ipratropium. Oral corticosteroids have been given. Which one of
the following medications has been shown to be effective as adjunctive therapy to
improve lung function and decrease hospitalizations?
A. Inhaled corticosteroids
B. Intravenous theophylline
C. Subcutaneous terbutaline
D. Montelukast (Singulair)
E. Intravenous magnesium sulfate
CORRECT ANSWER ✓ ✓: E. Intravenous magnesium sulfate
RATIONALE: In children with severe asthma exacerbations not responding to standard
therapy, IV magnesium sulfate is an effective and safe adjunctive treatment that can
improve lung function and reduce the need for hospitalization.
You are counseling a patient with moderate persistent asthma about the value of
following a written asthma action plan. To encourage her to use an asthma action plan
you share the results of studies that document their benefit in optimizing asthma
control and reducing future risk. Which one of the following is an accurate statement
2026) 100% Verified Comprehensive Questions & Correct
Answers with Rationales | Graded A+
A 26-year-old male with asthma is seen in the emergency department. He is short of
breath to a degree that makes it difficult to speak in sentences and he appears tired. On
examination you note diminished breath sounds with an occasional wheeze. His FEV1 is
15% of predicted and his pCO2 is 45 mm Hg. He is given albuterol (Proventil, Ventolin)
over the next hour but he has a poor response. He is not able to repeat the spirometry
and he now appears drowsy. Which one of the following would be consistent with
imminent respiratory failure?
A. A pCO2 of 45 mm Hg
B. Diminished breath sounds
C. An FEV1 of 15% of predicted
D. Difficulty speaking in sentences
E. The absence of wheezes
CORRECT ANSWER ✓ ✓: E. The absence of wheezes
RATIONALE: In a severe asthma exacerbation, wheezing is caused by air moving
through narrowed airways. As the patient tires and approaches respiratory failure, air
movement becomes so minimal that wheezing ceases, resulting in a "silent chest," which
is an ominous sign.
A 35-year-old male who was admitted to the intensive-care unit with a severe asthma
exacerbation has failed to improve with aggressive bronchodilator therapy and systemic
,corticosteroid therapy. For the past 10 minutes he has appeared more fatigued, but less
wheezing is heard and his pulsus paradoxus, which had been 30 mm Hg, is <10 mm Hg.
His pO2 is 75 mm Hg and his pCO2 is 48 mm Hg on 6 L/min of oxygen. Which one of
the following interventions would be the most appropriate next step in the
management of this patient?
A. Administer a second dose of systemic corticosteroids
B. Add an inhaled anticholinergic agent
C. Initiate noninvasive positive-pressure ventilation
D. Administer intravenous theophylline
E. Intubation and Mechanical Ventilation
CORRECT ANSWER ✓ ✓: E. Intubation and Mechanical Ventilation
RATIONALE: The patient is showing signs of impending respiratory arrest, including
fatigue, a silent chest (less wheezing due to minimal air movement), a falling pulsus
paradoxus (indicating worsening cardiac output), and hypercapnia (pCO2 >45 mm Hg)
despite therapy. Immediate intubation and mechanical ventilation are required.
A 28-year-old female presents with progressively worsening asthma after a recent viral
upper respiratory infection. When you enter the room, she appears in distress and is
only able to talk in words, not sentences. Her respiratory rate is 34/min and her heart
rate is 126 beats/min. Her oxygen saturation before oxygen was administered was 89%.
You begin treatment with a nebulized short-acting β-agonist (SABA) plus ipratropium
and give an initial dose of oral prednisone. After one hour her symptoms are not
responsive to initial treatment efforts. Which one of the following should you consider
as a possible adjunctive treatment?
A. Inhaled corticosteroids
B. Oral theophylline
C. Intravenous magnesium sulfate
D. A long-acting β-agonist
E. Omalizumab (Xolair)
,CORRECT ANSWER ✓ ✓: C. Intravenous magnesium sulfate
RATIONALE: IV magnesium sulfate is a recommended adjunctive treatment for severe,
life-threatening asthma exacerbations that are not responding to standard SABA,
ipratropium, and corticosteroid therapy. It works as a bronchodilator by relaxing smooth
muscle.
A 22-year-old female presents to your office with an acute asthma attack that
developed 2 days after the onset of a viral upper respiratory infection. Her asthma is
usually well controlled, with a personal best peak expiratory flow (PEF) of 380 L/min. On
initial evaluation by the nurse she has a pulse rate of 120 beats/min, a respiratory rate of
32/min, and an oxygen saturation of 92% on room air. On examination she is very
dyspneic with diffuse inspiratory and expiratory wheezing and she is using accessory
muscles to breathe. Her PEF is 150 L/min. Inhaled β-agonists and systemic
corticosteroids are administered and she is reevaluated 1 hour later. Which one of the
following would provide the most reassurance that she is responding to therapy?
A. A respiratory rate of 28/min
B. An oxygen saturation of 94%
C. A PEF of 310 L/min
D. The ability to speak in full sentences
E. The absence of wheezing
CORRECT ANSWER ✓ ✓: C. A PEF of 310 L/min
RATIONALE: Peak expiratory flow (PEF) is an objective measure of airflow obstruction. A
PEF of 310 L/min is over 80% of her personal best (380 L/min), which is a key indicator
of a good response to therapy and suggests a significantly improved airway function.
A 13-year-old male with a history of moderate persistent asthma presents to the
emergency department with a 2-day history of worsening dyspnea despite frequent use
of an inhaled β-agonist. An examination reveals a restless patient with a respiratory rate
of 35/min, obvious suprasternal retractions, and loud inspiratory and expiratory
wheezes. His peak flow is 250 L/min (49% of personal best). His oxygen saturation is
89%. Which one of the following management options would be most effective for
, preventing hospitalization in this patient?
A. Continuous nebulized short-acting β-agonist
B. Intravenous corticosteroids
C. An inhaled anticholinergic agent in combination with a short-acting β-agonist
D. Subcutaneous epinephrine
E. Intravenous magnesium sulfate
CORRECT ANSWER ✓ ✓: C. An inhaled anticholinergic agent in combination with a
short-acting β-agonist
RATIONALE: The addition of an inhaled anticholinergic (like ipratropium) to a SABA has
been shown to produce additional bronchodilation and significantly reduce
hospitalization rates in patients with moderate to severe asthma exacerbations.
A 7-year-old is brought to the emergency department with a severe asthma
exacerbation that does not respond to a combination of oxygen and continuous short-
acting β-agonists plus ipratropium. Oral corticosteroids have been given. Which one of
the following medications has been shown to be effective as adjunctive therapy to
improve lung function and decrease hospitalizations?
A. Inhaled corticosteroids
B. Intravenous theophylline
C. Subcutaneous terbutaline
D. Montelukast (Singulair)
E. Intravenous magnesium sulfate
CORRECT ANSWER ✓ ✓: E. Intravenous magnesium sulfate
RATIONALE: In children with severe asthma exacerbations not responding to standard
therapy, IV magnesium sulfate is an effective and safe adjunctive treatment that can
improve lung function and reduce the need for hospitalization.
You are counseling a patient with moderate persistent asthma about the value of
following a written asthma action plan. To encourage her to use an asthma action plan
you share the results of studies that document their benefit in optimizing asthma
control and reducing future risk. Which one of the following is an accurate statement
