MSN 621 FINAL EXAM I COMPETENCY REVIEW
2026 MOCK TEST COMPLETE KEY INSIGHTS
◉ What is a late bedside finding of asthma?
Answer: Low pulse ox reading.
◉ Describe bedside peak flow measures with asthma.
Answer: Peak flow measures also can be used to assess asthma and
should always be checked against a nomogram as well as the
individual patient's normal baseline function. The different
severities of acute asthma attacks have an associated peak flow
measurement, recorded as a certain percentage of expected peak
flow.
◉ Describe labs with asthma
Answer: Urea and electrolytes (kidney function) should be taken if
the patient has a high dose or repeat salbutamol, as one of the side
effects of salbutamol is to cause potassium to shift into the
intracellular space transiently, which can induce a transient,
iatrogenic hypokalaemia. Eosinophilia is common but is not specific
for asthma. Recent studies show that levels of sputum eosinophils
may guide therapy. In addition, some patients may have an elevation
of serum IgE.
,◉ Describe ABGs with asthma
Answer: Arterial blood gas may reveal hypoxemia and respiratory
acidosis. Studies indicate that periostin may be a marker for asthma,
but its clinical role remains unsettled.
◉ Describe the EKG with asthma.
Answer: An ECG will reveal sinus tachycardia, which may be due to
asthma, albuterol, or theophylline.
◉ Describe why/when a chest xray and CT should be done with
asthma
Answer: A chest x-ray is an important test, especially if patients have
a history of risk of the potential foreign body or possible infection. A
Chest CT scan is done in patients with recurrent symptoms who do
not respond to therapy.
◉ Describe how diagnosis of asthma is performed.
Answer: Spirometry is the diagnostic method of choice and will
show an obstructive pattern that is partially or completely resolved
by salbutamol. Spirometry should be done before treatment to
determine the severity of the disorder. A reduced ratio of FEV1 to
FVC is indicative of airway obstruction, which is reversible with
treatment. Reversibility testing is done by giving the patient inhaled
short-acting beta 2 agonists, and after that, the spirometry test is
repeated. If there is a 12% or 200ml improvement in FEV1 from the
previous value, then it shows reversibility and diagnostic for
,bronchial asthma. Peak expiratory flow measurement is common
today and allows one to document response to therapy. A limitation
of this test is that it is effort dependent.
◉ What are 2 alternatives to diagnose asthma but are not the gold
standard?
Answer: In some patients, a methacholine/histamine challenge may
be required to determine if airway hyper-reactivity is present. This
test should only be done by trained individuals.
Exercise spirometry may help identify patients with exercise-
induced bronchoconstriction.
◉ What are the conservative measures for asthma treatment?
Answer: § calming the patient to get them to relax, moving outside
or away from the likely source of allergen, and cooling the person.
Removing clothing and washing the face and mouth to remove
allergens is sometimes done, but it is not evidence-based.
§ This means avoiding tobacco, dust mites, animals, and pollen.
§ Weight reduction in obese asthmatics leads to improved control.
§ Monoclonal antibody therapy is indicated for patients with
moderate to severe asthma who have a positive skin test. The
treatment can lower IgE levels, which in turn decreases histamine
production. However, the cost of the injections is high.
§ Bronchial thermoplasty is a relatively new technique that delivers
thermal energy to the airway wall and reduces the narrowing of the
, airways. Several studies show that it can reduce emergency visits
and days missed from school.
◉ What are the medical treatments for asthma? (not the steps)
Answer: bronchodilators like beta-2 agonists and muscarinic
antagonists (salbutamol and ipratropium bromide respectively) and
anti-inflammatories such as inhaled steroids (usually beclometasone
but steroids via any route will be helpful).
◉ There are five steps in the management of chronic asthma;
treatment is started depending on the severity and then escalated or
de-escalated depending on the response to treatment:
Answer: · Step 1: The Preferred controller is as needed low dose
inhaled corticosteroid and formoterol.
· Step 2: The preferred controllers are daily low dose inhaled
corticosteroid plus as-needed short-acting beta 2 agonists.
· Step 3: The preferred controllers are low dose inhaled
corticosteroid and long-acting beta 2 agonists plus as-needed short-
acting beta 2 agonists.
· Step 4: The preferred controller is a medium-dose inhaled
corticosteroid and long-acting beta 2 agonist plus as-needed short-
acting beta 2 agonists.
· Step 5: High dose inhaled corticosteroid and long-acting beta 2
agonist plus long-acting muscarinic antagonist/anti-IgE.
2026 MOCK TEST COMPLETE KEY INSIGHTS
◉ What is a late bedside finding of asthma?
Answer: Low pulse ox reading.
◉ Describe bedside peak flow measures with asthma.
Answer: Peak flow measures also can be used to assess asthma and
should always be checked against a nomogram as well as the
individual patient's normal baseline function. The different
severities of acute asthma attacks have an associated peak flow
measurement, recorded as a certain percentage of expected peak
flow.
◉ Describe labs with asthma
Answer: Urea and electrolytes (kidney function) should be taken if
the patient has a high dose or repeat salbutamol, as one of the side
effects of salbutamol is to cause potassium to shift into the
intracellular space transiently, which can induce a transient,
iatrogenic hypokalaemia. Eosinophilia is common but is not specific
for asthma. Recent studies show that levels of sputum eosinophils
may guide therapy. In addition, some patients may have an elevation
of serum IgE.
,◉ Describe ABGs with asthma
Answer: Arterial blood gas may reveal hypoxemia and respiratory
acidosis. Studies indicate that periostin may be a marker for asthma,
but its clinical role remains unsettled.
◉ Describe the EKG with asthma.
Answer: An ECG will reveal sinus tachycardia, which may be due to
asthma, albuterol, or theophylline.
◉ Describe why/when a chest xray and CT should be done with
asthma
Answer: A chest x-ray is an important test, especially if patients have
a history of risk of the potential foreign body or possible infection. A
Chest CT scan is done in patients with recurrent symptoms who do
not respond to therapy.
◉ Describe how diagnosis of asthma is performed.
Answer: Spirometry is the diagnostic method of choice and will
show an obstructive pattern that is partially or completely resolved
by salbutamol. Spirometry should be done before treatment to
determine the severity of the disorder. A reduced ratio of FEV1 to
FVC is indicative of airway obstruction, which is reversible with
treatment. Reversibility testing is done by giving the patient inhaled
short-acting beta 2 agonists, and after that, the spirometry test is
repeated. If there is a 12% or 200ml improvement in FEV1 from the
previous value, then it shows reversibility and diagnostic for
,bronchial asthma. Peak expiratory flow measurement is common
today and allows one to document response to therapy. A limitation
of this test is that it is effort dependent.
◉ What are 2 alternatives to diagnose asthma but are not the gold
standard?
Answer: In some patients, a methacholine/histamine challenge may
be required to determine if airway hyper-reactivity is present. This
test should only be done by trained individuals.
Exercise spirometry may help identify patients with exercise-
induced bronchoconstriction.
◉ What are the conservative measures for asthma treatment?
Answer: § calming the patient to get them to relax, moving outside
or away from the likely source of allergen, and cooling the person.
Removing clothing and washing the face and mouth to remove
allergens is sometimes done, but it is not evidence-based.
§ This means avoiding tobacco, dust mites, animals, and pollen.
§ Weight reduction in obese asthmatics leads to improved control.
§ Monoclonal antibody therapy is indicated for patients with
moderate to severe asthma who have a positive skin test. The
treatment can lower IgE levels, which in turn decreases histamine
production. However, the cost of the injections is high.
§ Bronchial thermoplasty is a relatively new technique that delivers
thermal energy to the airway wall and reduces the narrowing of the
, airways. Several studies show that it can reduce emergency visits
and days missed from school.
◉ What are the medical treatments for asthma? (not the steps)
Answer: bronchodilators like beta-2 agonists and muscarinic
antagonists (salbutamol and ipratropium bromide respectively) and
anti-inflammatories such as inhaled steroids (usually beclometasone
but steroids via any route will be helpful).
◉ There are five steps in the management of chronic asthma;
treatment is started depending on the severity and then escalated or
de-escalated depending on the response to treatment:
Answer: · Step 1: The Preferred controller is as needed low dose
inhaled corticosteroid and formoterol.
· Step 2: The preferred controllers are daily low dose inhaled
corticosteroid plus as-needed short-acting beta 2 agonists.
· Step 3: The preferred controllers are low dose inhaled
corticosteroid and long-acting beta 2 agonists plus as-needed short-
acting beta 2 agonists.
· Step 4: The preferred controller is a medium-dose inhaled
corticosteroid and long-acting beta 2 agonist plus as-needed short-
acting beta 2 agonists.
· Step 5: High dose inhaled corticosteroid and long-acting beta 2
agonist plus long-acting muscarinic antagonist/anti-IgE.
