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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? - ANSWER-E. The absence of wheezes
Which one of the following is true regarding leukotriene modifiers
for treatment of asthma in adults? - ANSWER-D. They are less
effective than inhaled corticosteroids (ICSs)
Chronic low- to medium-dose inhaled corticosteroid use in children
is associated with - ANSWER-E. no long-term adverse effects
An 18-year-old female presents to your office with a history of
wheezing, coughing, and year-round symptoms of rhinitis. She
reports that her symptoms occur several times a week but rarely
more than once a day, except in the last year, when she has had to
intermittently use albuterol (Proventil, Ventolin) every day for a
week at a time. She wakes up with nighttime coughing weekly, with
no fever or other symptoms, and tells you that the coughing is severe
enough to make her cat jump off the bed. Albuterol helps her
symptoms temporarily. She has been treated with oral
,corticosteroids on three occasions this past year, most recently 6
weeks ago. Her Asthma Control Test score is 17. Pre- and
postbronchodilator spirometry results are shown below.
Initial testing
FVC............2.0 L (80% of predicted)
FEV1............1.4 L (70% of predicted)
FEF 25-75............1.5 L/sec (89% of predicted)
15 minutes post bronchodilator - ANSWER-A.
Budesonide/formoterol
(Symbicort), with an increase in dosage for exacerbations
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? - ANSWER-C. Intravenous magnesium
sulfate
Which one of the following is true regarding regular use of inhaled
corticosteroids (ICSs) in patients with persistent asthma? -
ANSWER-A. Oral candidiasis is a potential side effect of ICS use
, You have recently opened a new practice in western North Carolina.
In your first week of seeing patients, a 17-year-old male reports that
his asthma is usually worse in the early spring.
Which one of the following is most likely triggering his symptoms at
that time of year? - ANSWER-A. Tree Pollen
A 14-year-old female presents with a recent history of cough and
shortness of breath with exercise. Baseline pulmonary function
testing reveals an FEV1 of 3.1 L and a peak expiratory flow of 600
L/min. Exercise testing is scheduled.
If measured within 30 minutes of exercise, which one of the
following FEV1 values would support a diagnosis of mild exercise-
induced bronchospasm in this patient? - ANSWER-B. 2.8L
A 14-year-old female with a history of asthma presents to your office
for follow-up. Her mother reports that the patient has become
increasingly agitated during the day and has frequent nightmares,
which she never had before. When asking about any other changes
to her routine, family stressors, or medication changes you learn
that she was seen by an allergy specialist 2 months ago and was
given a new prescription to help with her asthma management. Her
mother cannot recall the name of this new medication and it is not in
your electronic medical record.
Which one of the following asthma medications is most likely to
have precipitated these symptoms? - ANSWER-D. Montelukast
(Singulair)