Asthma

Question 1

1. Which one of the following is a common symptom of chronic asthma?

A. Cyanosis
B. Wheezing
C. Hypoxemia
D. Edema
E. Nasal congestion

Answer 1

B

Question 2

2. Which one of the following comorbid conditions may worsen asthma control?

A. Obesity
B. Hypertension
C. Diabetes
D. Hyperlipidemia
E. Otitis media

Answer 2

A

Question 3

3. Which one of the following situations indicates controlled asthma?

A. Using one canister of albuterol each month
B. Exercising with SABA use before the activity
C. Waking at night only three times a week with a cough
D. Visiting the emergency department one time in the past year for asthma
E. Missing school once a month because of asthma symptoms

Answer 3

B

Question 4

4. An 11-year-old boy with asthma reports using albuterol once or twice in the past
   month. He is able to play soccer well by using albuterol before games. He denies
   waking at night, and his last spirometry reading FEV1/FVC was 88% (0.88). What
   additional asthma treatment is appropriate for this patient?

A. Montelukast
B. Salmeterol
C. Prednisone
D. Ciclesonide
E. No additional medication needed

Answer 4

E

Question 5

5. Which one of the following educational strategies may help an asthma patient with
   worsening asthma from cats, strong odors, gastroesophageal reflux disease (GERD),
   cold air, and upper respiratory infections?

A. Have pets groomed monthly
B. Use bleach to clean the bathroom once a week
C. Take medication for GERD as needed for symptoms
D. Wear a scarf to cover the nose and mouth during cold winter months
E. Obtain an influenza vaccine after the age of 65

Answer 5

D

Question 6

6. The optimal delivery method of albuterol for a typical 16-year-old asthma patient is:

A. Nebulization
B. Oral solution
C. MDI with a valved-holding chamber and mask
D. MDI
E. Oral tablet

Answer 6

D

Question 7

7. Which one of the following medications requires monitoring of growth in children?

A. Montelukast
B. Zileuton
C. Theophylline
D. Fluticasone
E. Omalizumab

Answer 7

D

Question 8

8. During pregnancy, which one of the following medications is preferred as the longterm control medication?

A. Budesonide
B. Theophylline
C. Montelukast
D. Omalizumab
E. Zafirlukast

Answer 8

A

Question 9

9. Dosing for omalizumab is based on which of the following criteria?

A. Age
B. Renal function
C. Baseline IgE levels
D. Liver function
E. Baseline severity of asthma

Answer 9

C

Question 10

10. A 25-year-old woman is taking levalbuterol and formoterol for her poorly controlled asthma. Which one of the following therapeutic recommendations is most appropriate for her?

A. Switch formoterol to tiotropium
B. Add fluticasone DPI to her regimen
C. Switch formoterol alone to budesonide/formoterol MDI
D. Add montelukast to her regimen
E. Discontinue levalbuterol and continue formoterol

Answer 10

C

Question 11

11. Proper use of inhaled corticosteroids includes:

A. Priming the inhaler before each use
B. Checking to see if the inhaler is empty by shaking the inhaler
C. Discontinuing inhaled corticosteroids while oral corticosteroids are being used
D. Waiting to use the medication until an acute asthma exacerbation occurs
E. Rinsing the mouth after each use

Answer 11

E

Question 12

12. Which one of the following medications may worsen asthma control?

A. Carvedilol
B. Furosemide
C. Losartan
D. Varenicline
E. Atorvastatin

Answer 12

A

Question 13

13. A 15-year-old boy with a diagnosis of moderate, persistent asthma returns to his
    physician’s office. He has had no exacerbations in the last 2 years, and he has no complaints about his current regimen of fluticasone 220 mcg, 1 puff twice daily, montelukast 10 mg daily, and albuterol as needed. After 3 months of well-controlled asthma, which one of the following therapeutic recommendations is recommended?

A. Discontinue albuterol
B. Lower the dose of fluticasone
C. Switch fluticasone to salmeterol
D. Lower the dose of montelukast
E. Switch albuterol to levalbuterol

Answer 13

B

Question 14

14. A 21-year-old woman with asthma calls the clinic very short of breath and wondering if she should initiate prednisone. She has been using her albuterol via nebulization every 2 hours with minimal relief of her wheezing and shortness of breath. Her peak flow is 180 L/min and her personal best is 400 L/min. What therapeutic recommendation is best in this situation?

A. Stop all medications and call 9-1-1
B. Start prednisone at home and continue albuterol nebulization until her peak flow
is greater than 70% of her personal best
C. Double the dose of her ICS/LABA inhaler
D. Discontinue albuterol and start ipratropium nebulization
E. Initiate prednisone at home, continue albuterol MDI, and proceed to the
emergency department

Answer 14

E

Question 15

15. Which one of the following statements is true about treatment of an asthma
    exacerbation in the hospital?

A. Corticosteroids are administered intravenously for the fastest onset of action
B. Oxygen therapy is initiated for all patients
C. Albuterol may be administered continuously via nebulization
D. Inhaled corticosteroids are discontinued while in the hospital
E. Corticosteroid dosing in the hospital is double that of outpatient use

Answer 15

C

Question 16

1. A 23-year-old patient with mild intermittent asthma comes into clinic for asthma follow-up. Which of the following would be concerning about the patient’s use of inhalers?

A. She uses budesonide/formoterol daily 15 minutes before exercising
B. She uses budesonide–formoterol as needed for shortness of breath
C. She uses a spacer with her MDI inhaler
D. She uses salmeterol twice daily as her maintenance inhaler

Answer 16

D

Question 17

2. A 68-year-old patient is having difficulty coordinating his breath with actuation of his MDI inhaler. Which of the following will maximize delivery of the medication while minimizing local adverse effects?

A. Using a spacer with a face mask
B. Switching to an inhalation solution for nebulization and using a face mask
C. Using a spacer with a mouthpiece
D. Rinsing and expectorating after use

Answer 17

C

Question 18

3. Which one of the following medications treats both asthma and allergic rhinitis?

A. Tiotropium
B. Montelukast
C. Albuterol
D. Salmeterol

Answer 18

B

Question 19

4. Which of the following is a common side effect of inhaled corticosteroids?

A. Dyspnea
B. Tremor
C. Oral candidiasis
D. Urinary retention

Answer 19

C

Question 20

5. A 10-year-old girl presents with an asthma exacerbation. She weighs 70 pounds and is able to swallow tablets well. Which of the following is the correct prednisone dose for this patient?

A. 10 mg orally daily
B. 10 mg orally twice daily
C. 70 mg orally once daily
D. 20 mg orally twice daily

Answer 20

D

Question 21

6. An 87-year-old man has a history of asthma, COPD, heart failure, and osteoarthritis in his hands and knees. His FEV 1 is 35% predicted (severe obstruction) and he has low inspiratory flow. The patient requires an inhaler to help manage his shortness of breath. He has a
   caregiver who can assist him with medication administration. In the past, the patient has demonstrated very poor technique with an albuterol MDI inhaler because he was unable to coordinate his breath with the actuation of the device. Which of the following inhaler devices
   would be best for this patient?

A. A metered-dose inhaler with spacer
B. A slow-mist inhaler
C. A breath-activated inhaler
D. A dry-powder inhaler

Answer 21

A

Question 22

7. A 4-year-old patient with asthma has parents who both smoke cigarettes. Which of the following parental actions is appropriate to help improve the child’s asthma?

A. Smoking outside the home and car
B. Using an air purifier
C. Quitting smoking together by getting counseling and using medication
D. Switching to electronic cigarettes or cigars

Answer 22

C

Question 23

8. Which of the following patients is exhibiting poor asthma control?

A. A 23-year-old patient who uses her albuterol MDI 3 to 4 days per week prior to
exercise class
B. A 38-year-old patient who refills his albuterol MDI twice per month
C. An 8-year-old patient who used his albuterol MDI twice this month after visiting his grandmother who smokes
D. A 62-year-old patient whose peak expiratory flow has consistently been 85% of her personal best this week

Answer 23

B

Question 24

9. Which patient should be considered for initiation of tiotropium therapy?

A. A 15-year-old who is on low-dose mometasone–formoterol as needed before playing volleyball daily.
B. A 5-year-old who is on medium-dose budesonide–formoterol and continues to
experience asthma symptoms every day
C. A 24-year-old who is on medium-dose budesonide–formoterol and had an asthma exacerbation in the past month.
D. A 20-year-old who is on fluticasone–umeclidinium–vilanterol and is experiencing frequent nighttime awakenings due to asthma symptoms

Answer 24

C

Question 25

10. According to current guidelines, which would be the preferred treatment for a 15-year-old patient who experiences asthma symptoms once or twice per month when playing in her grandmother’s basement? A. Albuterol 2 puffs every 4–6 hours as needed B. High-dose budesonide–formoterol 2 actuations as needed C. Medium-dose budesonide daily plus albuterol as needed D. Albuterol 2 puffs every 4–6 hour as needed plus low-dose fluticasone propionate

Answer 25

D

Question 26

11. A 51-year-old woman with severe persistent asthma has been taking fluticasone–vilanterol 200/5 mcg, 1 inhalation daily; montelukast 10 mg orally daily; tiotropium 1.25 mcg, 2 inhalations daily; and prednisone 10 mg orally daily for the past 30 days. She has had multiple exacerbations, especially when prednisone is tapered off. Which laboratory test may help determine if mepolizumab is a good treatment option to help this patient discontinue prednisone? A. CBC with differential B. IgE C. RAST D. Pulmonary function tests

Answer 26

A

Question 27

12. According to current guidelines, which would be the preferred reliever regimen for a 5-year-old patient with asthma symptoms occurring once a month or less? A. Albuterol 1 to 2 puffs every 4 to 6 hours as needed B. Low-dose budesonide–formoterol 1 puff as needed C. Low-dose budesonide daily plus albuterol as needed D. Montelukast 10 mg orally at bedtime

Answer 27

A

Question 28

13. Which of the following would be an appropriate instruction to include in an asthma action plan for an adult patient? A. If experiencing asthma symptoms, use albuterol and ciclesonide 2 puffs each, every 20 minutes up to 1 hour if needed. B. If having a difficult time speaking due to shortness of breath, call the nurse at the doctor’s office for prednisone C. If asthma symptoms persist despite more frequent use of albuterol and ciclesonide, add prednisone 60 mg/day for 30 days D. If asthma symptoms persist after initial use of albuterol and ciclesonide, continue albuterol and add guaifenesin

Answer 28

A

Question 29

14. A 71-year-old woman with asthma is confused about all of her medications. Which of the following issues needs to be addressed with the patient today? A. Mometasone–formoterol 100/5 mcg, 2 inhalations twice daily (120 actuations). The inhaler counter reads “10” and inhaler was last filled 4 months ago. B. Albuterol 90 mcg, 2 inhalations every 6 hours as needed for shortness of breath. The counter reads “170.” The inhaler was last filled 1 month ago. C. Tiotropium Respimat 1.25 mcg, 2 inhalations daily. Dose counter “0.” Last filled 30 days ago. D. Prednisone 20-mg tablets 40 mg orally for 3 days. Last filled one year ago. Four tablets remaining.

Answer 29

A

Question 30

15. Which of the following statements uses motivational interviewing to increase adherence to ICS? A. It is important to take this medication every day as directed to prevent asthma symptoms. B. Inflammation is the key factor making the airways tight. This medication will keep the inflammation away. C. How did the doctor tell you to take this medication? D. What is it that you dislike about this medication? What medications have helped your asthma in the past?

Answer 30

D