KSA Asthma questions with detailed correct answers.

KSA Asthma questions with detailed correct
answers.




A 26-year-old male with asthma is seen in the emergency department. He is short of breath to a
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degree that makes it difficult to speak in sentences and he appears tired. On examination you note
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diminished breath sounds with an occasional wheeze. His FEV1 is 15% of predicted and his pCO2 is 45
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mm Hg. He is given albuterol (Proventil, Ventolin) over the next hour but he has a poor response. He
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is not able to repeat the spirometry and he now appears drowsy. Which one of the following would
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be consistent with imminent respiratory failure? - ANS--E. The absence of wheezes
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Which one of the following is true regarding leukotriene modifiers for treatment of asthma in adults? -
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ANS--D. They are less effective than inhaled corticosteroids (ICSs)
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Chronic low- to medium-dose inhaled corticosteroid use in children is associated with - ANS--E. no
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long-term adverse effects
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An 18-year-old female presents to your office with a history of wheezing, coughing, and year-round
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symptoms of rhinitis. She reports that her symptoms occur several times a week but rarely more than
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once a day, except in the last year, when she has had to intermittently use albuterol (Proventil,
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Ventolin) every day for a week at a time. She wakes up with nighttime coughing weekly, with no fever
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or other symptoms, and tells you that the coughing is severe enough to make her cat jump off the
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bed. Albuterol helps her symptoms temporarily. She has been treated with oral corticosteroids on
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three occasions this past year, most recently 6 weeks ago. Her Asthma Control Test score is 17. Pre-
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and postbronchodilator spirometry results are shown below.
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Initial testing ss




FVC............2.0 L (80% of predicted) ss ss ss ss




FEV1............1.4 L (70% of predicted) ss ss ss ss




FEF 25-75............1.5 L/sec (89% of predicted)
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, 15 minutes post bronchodilator - ANS--A. Budesonide/formoterol (Symbicort), with an increase in
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dosage for exacerbations
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A 22-year-old female presents to your office with an acute asthma attack that developed 2 days after
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the onset of a viral upper respiratory infection. Her asthma is usually well controlled, with a personal
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best peak expiratory flow (PEF) of 380 L/min. On initial evaluation by the nurse she has a pulse rate of
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120 beats/min, a respiratory rate of 32/min, and an oxygen saturation of 92% on room air. On
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examination she is very dyspneic with diffuse inspiratory and expiratory wheezing and she is using
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accessory muscles to breathe. Her PEF is 150 L/min. Inhaled β-agonists and systemic corticosteroids
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are administered and she is reevaluated 1 hour later. Which one of the following would provide the
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most reassurance that she is responding to therapy? - ANS--C. A PEF of 310 L/min
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You are counseling a patient with moderate persistent asthma about the value of following a written
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asthma action plan. To encourage her to use an asthma action plan you share the results of studies
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that document their benefit in optimizing asthma control and reducing future risk.
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Which one of the following is an accurate statement regarding asthma action plans? - ANS--D. The lack
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of a written asthma action plan is a risk factor for death from asthma
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A 28-year-old female presents with progressively worsening asthma after a recent viral upper
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respiratory infection. When you enter the room, she appears in distress and is only able to talk in
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words, not sentences. Her respiratory rate is 34/min and her heart rate is 126 beats/min. Her oxygen
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saturation before oxygen was administered was 89%. You begin treatment with a nebulized short-
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acting β-agonist (SABA) plus ipratropium and give an initial dose of oral prednisone. After one hour her
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symptoms are not responsive to initial treatment efforts.
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Which one of the following should you consider as a possible adjunctive treatment? - ANS--C.
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Intravenous magnesium sulfate
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Which one of the following is true regarding regular use of inhaled corticosteroids (ICSs) in patients
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with persistent asthma? - ANS--A. Oral candidiasis is a potential side effect of ICS use
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You have recently opened a new practice in western North Carolina. In your first week of seeing
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patients, a 17-year-old male reports that his asthma is usually worse in the early spring.
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