CMN 568 - UNIT 3 ASTHMA PRACTICE EXAM QUESTIONS AND ANSWERS 2023

The strongest identifiable predisposing factor for the development of asthma is _________, but obesity is increasingly recognized as a risk factor. Atopy A syndrome characterized by a tendency to be "hyperallergic". (papa 243) Essentials of Asthma Diagnosis: - Episodic or chronic symptoms of airflow obstruction. - Reversibility of airflow obstruction, either spontaneously or following bronchodilator therapy. - Symptoms frequently worse at night or in the early morning. - Prolonged expiration and diffuse wheezes on physical exam. - Limitation of airflow on pulmonary function testing or positive bronchoprovocation challenge. ... Which of the following findings on physical exam increase the probability of asthma? a. nasal mucosal swelling b. increased nasal secretions c. nasal polyps d. all of the above d. all of the above All are often seen in pts with allergic asthma. (papa 246) True or False: Wheezing during forced expiration correlates well with the presence of air flow obstruction. False: Wheezing during normal breathing correlates well with the presence of air flow obstruction, not during forced expiration. (papa 246) What findings on an ABG may indicate impending respiratory failure of an asthmatic pt and need for mechanical ventilation? a. Decreased PaCO2 and respiratory acidosis. b. Increased PaCO2 and respiratory acidosis. c. Increased PaCO2 and respiratory alkalosis. d. Decreased PaCO2 and respiratory alkalosis. b. Increased PaCO2 and respiratory acidosis. (papa 246) During a PFT, a patient inhales methacholine causing a ≥ 20% decrease in his FEV1. Is this a positive or negative test, and what is the test called? a. negative methacholine test of bronchial provocation. b. positive bronchial provocation c. positive methacholine test of bronchial provocation. d. none of the above c. Positive methacholine test of bronchial provocation. A negative test has a negative predictive value of asthma of 95%. (papa 247) When instructing your patient on how to use the PEF meter to monitor asthma control, when do you tell him to use it for the most accurate measurements? a. After morning bronchodilator dose and before dinner. b. As soon as he wakes up after bronchodilator and right before he goes to bed. c. As soon as he wakes up before bronchodilator and early afternoon after bronchodilator. d. Directly after morning bronchodilator dose and then again directly after lunchtime bronchodilator dose. c. As soon as he wakes up before bronchodilator and early afternoon after bronchodilator. PEF is generally lowest on first awakening and highest several hours before the midpoint of the waking day. A 20% change in PEF values from morning to afternoon suggests inadequately controlled asthma. (papa 247) When considering the differential diagnosis of asthma, what lower airway disorder can mimic asthma in patients who have atypical symptoms or poor response to therapy? a. laryngotracheal masses b. bronchiolitis obliterans c. churg-strauss syndrome d. episodic laryngeal dyskinesis. b. bronchiolitis obliterans All answers are considered in the differential diagnosis, but are not lower airway disorders. Other lower airway disorders that can mimic asthma include COPD, bronchiectasis, allergic bronchopulmonary mycosis, CF, and eosinophilic pneumonia. (papa 248) NAEPP 3 recommends daily therapy with which drugs as the cornerstone or first line therapy for persistent asthma? a. SABAs b. ICSs c. LABAs d. None of the above b. ICSs Daily anti-inflammtory therapy with inhaled corticosteroids. (papa 250) True or False: The use of an inhalation chamber coupled with mouth washing after DPI use decreases local side effects and systemic absorption. False: The use of an inhalation chamber coupled with mouth washing after MDI use decreases local side effects, such as cough, dysphonia and oropharyngeal candidiasis and systemic absorption. (papa 250) Name at least 4 ICSs used for daily treatment of asthma. - Beclomethasone HFA - Budesonide DPI (Pulmicort) - Flunisolide - Fluticasone (Flovent) - Mometasone - Triamcinolone acetonide (papa 253) Name 3 systemic corticosteroids used for long term therapy in patients with refractory, poorly controlled asthma. - Methylprednisolone - Prednisolone - Prednisone (papa 251) True or False: The Mediator Inhibitors Cromolyn Sodium and Nedocromil can be effective when taken before an allergen exposure or exercise but do not relieve asthmatic symptoms once present. True: Both are long term control medications that prevent asthma symptoms and improve airway function in patients with mild persistent asthma or exercise induced symptoms. (papa 250) True or False: Monotherapy with LABAs has been associated with a small but statistically significant increased risk of severe or fatal asthma attacks. True (papa 250) Identifying complicating conditions in the initial evaluation of a newly diagnosed asthma pt or in patients whose asthma is difficult to treat is crucial to reduce symptoms. These conditions include all EXCEPT: a. Rhinosinusitis b. GERD c. Obesity d. DM e. OSA d. DM (papa 248) What are 2 Inhaled LABAs? a. Fluticasone & Budesonide b. Salmeterol & Formoterol c. Cromolyn & Nedocromil d. Tiotropium & Flunisolide b. Salmeterol & Formoterol (papa 250) Which of the following infections predisposes a patient to acute exacerbations of asthma and may underlie chronic, severe asthma? a. rhinovirus b. Mycoplasma pneumoniae c. Chlamydophila pneumoniae d. all of the above d. all of the above (papa 256) True or False: Doubling the dose of ICSs is not effective in the acute setting and is not recommended in the NAEPP 3 guidelines. True (papa 256) When classifying the severity of a patients asthma, it is important to assess what? a. risk b. control c. impairment d. a and c d. a and c Classification goes mostly by the frequency of symptoms and need for rescue meds. (papa 244) A 12 year old has asthma symptoms about once a week requiring the use of a SABA, and had night-time awakening twice a month with no interference in daily activity. Where would he be classified in severity of asthma? a. Intermittent b. Mild Persistent c. Moderate Persistent d. Severe Persistent a. Intermittent (papa 244) An asthma patient on theophylline (which is a methylxanthine, and second line agent) must have blood monitoring done. Theophylline levels must be maintained at: A) 1-5 mcg/ml B) 2-10 mcg/ml C) 5-10 mcg/ml D) 5-15 mcg/ml d. 5-15 mcg/ml at steady-state: At least 48 hours on same dosage. (papa 252) Preferred treatment for intermittent asthma? SABA PRN (papa249) A 15 year old with asthma symptoms 4 days a week requiring SABA use, with nighttime awakenings 3-4 times a month and minor limitation of normal activity, would be classified as having what severity of asthma? a. Intermittent b. Mild Persistent c. Moderate Persistent d. Severe Persistent b. Mild Persistent (papa 244) Preferred treatment for a 14 year old with asthma symptoms 3 days a week and dyspnea with activity. a. SABA PRN b. Low-dose ICS and SABA PRN c. Low-dose ICS and LABA d. Medium-dose ICS and SABA PRN b. Low-dose ICS and SABA PRN (papa 249) A 12 year old with daily asthma symptoms requiring rescue SABA inhaler use, awakening more than once a week with an FEV < 80% predicted would be classified as having what severity of asthma? a. Intermittent b. Mild Persistent c. Moderate Persistent d. Severe Persistent c. Moderate Persistent (papa 244) A 12 year old has daily asthma symptoms requiring rescue SABA inhaler use, awakening 3 nights a week, and an FEV < 80% predicted. What step of tx should you initiate, what is the recommended tx? - Pt has moderate persistent asthma. - Step 3 Low dose ICS + LABA OR Medium-dose ICS + LABA