ABFM Asthma KSA V2: Practice
Questions, Answers, and Clinical
Rationales (Based on 2026
GINA/NAEPP Guidelines)
Domain 1: Pathogenesis & Diagnosis (Questions 1–25)
1. A 28-year-old with no significant past medical history presents with
intermittent wheezing and chest tightness. Which finding on
spirometry is most consistent with a diagnosis of asthma?
A) FEV₁/FVC ratio < 0.70 with a ≥12% and ≥200 mL improvement in
FEV₁ post-bronchodilator
B) FEV₁/FVC ratio > 0.80 with no bronchodilator response
C) A decreased DLCO
D) A normal FEV₁ with a decreased FVC
Answer: A
Rationale: The diagnosis of asthma requires objective evidence of variable
expiratory airflow limitation. Spirometry demonstrating an obstructive
pattern (FEV₁/FVC < 0.70) that is significantly reversible (≥12% and ≥200
mL improvement in FEV₁) after bronchodilator administration confirms the
diagnosis.
,2. A 45-year-old with a history of allergic rhinitis reports a chronic
cough, especially at night. Which of the following is the most specific
test to confirm a diagnosis of asthma?
A) Chest radiograph
B) Fractional exhaled nitric oxide (FeNO) measurement
C) Bronchodilator reversibility testing with spirometry
D) Methacholine challenge test
Answer: C
Rationale: While FeNO and methacholine challenges can support a
diagnosis, bronchodilator reversibility testing with spirometry is the most
specific and widely accepted objective test to confirm asthma. A chest
radiograph is useful to rule out other diagnoses but is not diagnostic for
asthma.
3. According to GINA guidelines, which of the following is a key
component of the initial diagnosis of asthma in a patient with
suggestive symptoms?
A) Empirical treatment with a long-acting beta-agonist (LABA)
B) Spirometry before initiating controller therapy
C) A trial of oral corticosteroids
D) Allergy skin testing
Answer: B
Rationale: GINA strongly recommends performing spirometry (or peak
expiratory flow) to confirm the diagnosis before starting inhaled
corticosteroids, as this provides a baseline for assessing bronchodilator
reversibility. Relying on symptoms alone can lead to over- or under-
diagnosis.
,4. A 6-year-old child is being evaluated for possible asthma. What is
the minimum improvement in FEV₁ required to confirm a positive
bronchodilator response?
A) 5% and 100 mL
B) 10% and 150 mL
C) 12% and 200 mL
D) 15% and 250 mL
Answer: C
Rationale: A positive bronchodilator response is defined as an
improvement in FEV₁ of ≥12% and an absolute increase of ≥200 mL from
the pre-bronchodilator measurement. This criterion is consistent across
major guidelines, including GINA and NAEPP.
5. A patient's spirometry shows an FEV₁ of 65% of predicted and an
FEV₁/FVC ratio of 0.65. After bronchodilator administration, the FEV₁
improves to 78% of predicted. How should this be interpreted?
A) Normal spirometry
B) Restrictive pattern
C) Obstructive pattern with significant reversibility, consistent with
asthma
D) Obstructive pattern without reversibility, suggesting COPD
Answer: C
Rationale: The low FEV₁/FVC ratio (0.65) confirms an obstructive defect.
The significant improvement in FEV₁ (from 65% to 78% predicted, which is a
20% relative increase and >200 mL) demonstrates reversibility, making
asthma the most likely diagnosis.
6. What is the primary pathophysiologic mechanism in asthma that
leads to the characteristic symptoms of wheezing and dyspnea?
, A) Alveolar destruction
B) Airway inflammation, bronchoconstriction, and mucus
hypersecretion
C) Pulmonary fibrosis
D) Pulmonary hypertension
Answer: B
Rationale: Asthma is a chronic inflammatory disorder of the airways. This
inflammation leads to airway hyperresponsiveness, bronchoconstriction
(smooth muscle contraction), and increased mucus production, which
together cause variable airflow obstruction and the classic symptoms of
wheezing, chest tightness, and dyspnea.
7. A 32-year-old with suspected asthma has normal baseline
spirometry. Which test is most appropriate to confirm the diagnosis?
A) DLCO measurement
B) Bronchial provocation test (e.g., methacholine challenge)
C) High-resolution CT of the chest
D) Arterial blood gas
Answer: B
Rationale: When baseline spirometry is normal, a bronchial provocation
test can be used to demonstrate airway hyperresponsiveness, a hallmark of
asthma. A positive test (e.g., a ≥20% drop in FEV₁ with methacholine)
supports the diagnosis.
8. A patient with known asthma is being evaluated for a chronic
cough. Which of the following is a common asthma mimic that should
be considered?
A) Gastroesophageal reflux disease (GERD)
B) Congestive heart failure
Questions, Answers, and Clinical
Rationales (Based on 2026
GINA/NAEPP Guidelines)
Domain 1: Pathogenesis & Diagnosis (Questions 1–25)
1. A 28-year-old with no significant past medical history presents with
intermittent wheezing and chest tightness. Which finding on
spirometry is most consistent with a diagnosis of asthma?
A) FEV₁/FVC ratio < 0.70 with a ≥12% and ≥200 mL improvement in
FEV₁ post-bronchodilator
B) FEV₁/FVC ratio > 0.80 with no bronchodilator response
C) A decreased DLCO
D) A normal FEV₁ with a decreased FVC
Answer: A
Rationale: The diagnosis of asthma requires objective evidence of variable
expiratory airflow limitation. Spirometry demonstrating an obstructive
pattern (FEV₁/FVC < 0.70) that is significantly reversible (≥12% and ≥200
mL improvement in FEV₁) after bronchodilator administration confirms the
diagnosis.
,2. A 45-year-old with a history of allergic rhinitis reports a chronic
cough, especially at night. Which of the following is the most specific
test to confirm a diagnosis of asthma?
A) Chest radiograph
B) Fractional exhaled nitric oxide (FeNO) measurement
C) Bronchodilator reversibility testing with spirometry
D) Methacholine challenge test
Answer: C
Rationale: While FeNO and methacholine challenges can support a
diagnosis, bronchodilator reversibility testing with spirometry is the most
specific and widely accepted objective test to confirm asthma. A chest
radiograph is useful to rule out other diagnoses but is not diagnostic for
asthma.
3. According to GINA guidelines, which of the following is a key
component of the initial diagnosis of asthma in a patient with
suggestive symptoms?
A) Empirical treatment with a long-acting beta-agonist (LABA)
B) Spirometry before initiating controller therapy
C) A trial of oral corticosteroids
D) Allergy skin testing
Answer: B
Rationale: GINA strongly recommends performing spirometry (or peak
expiratory flow) to confirm the diagnosis before starting inhaled
corticosteroids, as this provides a baseline for assessing bronchodilator
reversibility. Relying on symptoms alone can lead to over- or under-
diagnosis.
,4. A 6-year-old child is being evaluated for possible asthma. What is
the minimum improvement in FEV₁ required to confirm a positive
bronchodilator response?
A) 5% and 100 mL
B) 10% and 150 mL
C) 12% and 200 mL
D) 15% and 250 mL
Answer: C
Rationale: A positive bronchodilator response is defined as an
improvement in FEV₁ of ≥12% and an absolute increase of ≥200 mL from
the pre-bronchodilator measurement. This criterion is consistent across
major guidelines, including GINA and NAEPP.
5. A patient's spirometry shows an FEV₁ of 65% of predicted and an
FEV₁/FVC ratio of 0.65. After bronchodilator administration, the FEV₁
improves to 78% of predicted. How should this be interpreted?
A) Normal spirometry
B) Restrictive pattern
C) Obstructive pattern with significant reversibility, consistent with
asthma
D) Obstructive pattern without reversibility, suggesting COPD
Answer: C
Rationale: The low FEV₁/FVC ratio (0.65) confirms an obstructive defect.
The significant improvement in FEV₁ (from 65% to 78% predicted, which is a
20% relative increase and >200 mL) demonstrates reversibility, making
asthma the most likely diagnosis.
6. What is the primary pathophysiologic mechanism in asthma that
leads to the characteristic symptoms of wheezing and dyspnea?
, A) Alveolar destruction
B) Airway inflammation, bronchoconstriction, and mucus
hypersecretion
C) Pulmonary fibrosis
D) Pulmonary hypertension
Answer: B
Rationale: Asthma is a chronic inflammatory disorder of the airways. This
inflammation leads to airway hyperresponsiveness, bronchoconstriction
(smooth muscle contraction), and increased mucus production, which
together cause variable airflow obstruction and the classic symptoms of
wheezing, chest tightness, and dyspnea.
7. A 32-year-old with suspected asthma has normal baseline
spirometry. Which test is most appropriate to confirm the diagnosis?
A) DLCO measurement
B) Bronchial provocation test (e.g., methacholine challenge)
C) High-resolution CT of the chest
D) Arterial blood gas
Answer: B
Rationale: When baseline spirometry is normal, a bronchial provocation
test can be used to demonstrate airway hyperresponsiveness, a hallmark of
asthma. A positive test (e.g., a ≥20% drop in FEV₁ with methacholine)
supports the diagnosis.
8. A patient with known asthma is being evaluated for a chronic
cough. Which of the following is a common asthma mimic that should
be considered?
A) Gastroesophageal reflux disease (GERD)
B) Congestive heart failure
